hospital_name last_updated_on version hospital_location hospital_address license_number|MD "To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated." TidalHealth Nanticoke 12/10/2024 3.0.0 Nanticoke Memorial Hospital "81 Middleford Rd. Seaford, DE 19973" HSPTL-8|DE TRUE description code|1 code|1|type code|2 code|2|type code|3 code|3|type code|4 code|4|type modifiers setting drug_unit_of_measurement drug_type_of_measurement standard_charge|gross standard_charge|discounted_cash standard_charge|CBS_MARYLAND|BCBS_CAREFIRST|negotiated_dollar standard_charge|CBS_MARYLAND|BCBS_CAREFIRST|negotiated_percentage standard_charge|CBS_MARYLAND|BCBS_CAREFIRST|negotiated_algorithm estimated_amount|CBS_MARYLAND|BCBS_CAREFIRST standard_charge|CBS_MARYLAND|BCBS_CAREFIRST|methodology additional_payer_notes|CBS_MARYLAND|BCBS_CAREFIRST standard_charge|BLUECHOICE_HMO|CAREFIRST_BLUECHOICE_HMO|negotiated_dollar standard_charge|BLUECHOICE_HMO|CAREFIRST_BLUECHOICE_HMO|negotiated_percentage standard_charge|BLUECHOICE_HMO|CAREFIRST_BLUECHOICE_HMO|negotiated_algorithm estimated_amount|BLUECHOICE_HMO|CAREFIRST_BLUECHOICE_HMO standard_charge|BLUECHOICE_HMO|CAREFIRST_BLUECHOICE_HMO|methodology additional_payer_notes|BLUECHOICE_HMO|CAREFIRST_BLUECHOICE_HMO standard_charge|BCBS_OF_DELAWARE|HIGHMARK_DELAWARE_BCBS|negotiated_dollar standard_charge|BCBS_OF_DELAWARE|HIGHMARK_DELAWARE_BCBS|negotiated_percentage standard_charge|BCBS_OF_DELAWARE|HIGHMARK_DELAWARE_BCBS|negotiated_algorithm estimated_amount|BCBS_OF_DELAWARE|HIGHMARK_DELAWARE_BCBS standard_charge|BCBS_OF_DELAWARE|HIGHMARK_DELAWARE_BCBS|methodology additional_payer_notes|BCBS_OF_DELAWARE|HIGHMARK_DELAWARE_BCBS standard_charge|UNITED_HEALTHCARE|UHC_CHOICE_PLUS_POS|negotiated_dollar standard_charge|UNITED_HEALTHCARE|UHC_CHOICE_PLUS_POS|negotiated_percentage standard_charge|UNITED_HEALTHCARE|UHC_CHOICE_PLUS_POS|negotiated_algorithm estimated_amount|UNITED_HEALTHCARE|UHC_CHOICE_PLUS_POS standard_charge|UNITED_HEALTHCARE|UHC_CHOICE_PLUS_POS|methodology additional_payer_notes|UNITED_HEALTHCARE|UHC_CHOICE_PLUS_POS standard_charge|HUMANA_MEDICARE_ADVANTAGE|HUMANA_MEDICARE_ADVANTAGE_PPO_PLAN|negotiated_dollar standard_charge|HUMANA_MEDICARE_ADVANTAGE|HUMANA_MEDICARE_ADVANTAGE_PPO_PLAN|negotiated_percentage standard_charge|HUMANA_MEDICARE_ADVANTAGE|HUMANA_MEDICARE_ADVANTAGE_PPO_PLAN|negotiated_algorithm estimated_amount|HUMANA_MEDICARE_ADVANTAGE|HUMANA_MEDICARE_ADVANTAGE_PPO_PLAN standard_charge|HUMANA_MEDICARE_ADVANTAGE|HUMANA_MEDICARE_ADVANTAGE_PPO_PLAN|methodology additional_payer_notes|HUMANA_MEDICARE_ADVANTAGE|HUMANA_MEDICARE_ADVANTAGE_PPO_PLAN standard_charge|HUMANA_MEDICARE_ADVANTAGE|HUMANA_MEDICARE_ADVANTAGE|negotiated_dollar standard_charge|HUMANA_MEDICARE_ADVANTAGE|HUMANA_MEDICARE_ADVANTAGE|negotiated_percentage standard_charge|HUMANA_MEDICARE_ADVANTAGE|HUMANA_MEDICARE_ADVANTAGE|negotiated_algorithm estimated_amount|HUMANA_MEDICARE_ADVANTAGE|HUMANA_MEDICARE_ADVANTAGE standard_charge|HUMANA_MEDICARE_ADVANTAGE|HUMANA_MEDICARE_ADVANTAGE|methodology additional_payer_notes|HUMANA_MEDICARE_ADVANTAGE|HUMANA_MEDICARE_ADVANTAGE standard_charge|AMERIHEALTH_CARITAS_DELAWARE_MCO|AMERIHEALTH_CARITAS|negotiated_dollar standard_charge|AMERIHEALTH_CARITAS_DELAWARE_MCO|AMERIHEALTH_CARITAS|negotiated_percentage standard_charge|AMERIHEALTH_CARITAS_DELAWARE_MCO|AMERIHEALTH_CARITAS|negotiated_algorithm estimated_amount|AMERIHEALTH_CARITAS_DELAWARE_MCO|AMERIHEALTH_CARITAS standard_charge|AMERIHEALTH_CARITAS_DELAWARE_MCO|AMERIHEALTH_CARITAS|methodology additional_payer_notes|AMERIHEALTH_CARITAS_DELAWARE_MCO|AMERIHEALTH_CARITAS standard_charge|min standard_charge|max additional_generic_notes "Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures" 003 MS-DRG inpatient 141371 141371 152767 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 212362 other Inpatient DRG 152767 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 212362 other Inpatient DRG 141371 Service paid by case rate. 3506.66 other IP General Discharge 141371 152767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures" 004 MS-DRG inpatient 139294 139294 100721 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 141563 other Inpatient DRG 100721 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 141563 other Inpatient DRG 139294 Service paid by case rate. 3506.66 other IP General Discharge 100721 139294 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC" 011 MS-DRG inpatient 33802 33802 73356.2 Base payment rate plus any adjustments related to transfers and outliers. 73356.2 case rate 33802 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 27379.6 percent of total billed charges 38463 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 54110.9 other Inpatient DRG 38463 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 54110.9 other Inpatient DRG 33802 Service paid by case rate. 3506.66 other IP General Discharge 33802 73356.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC 020 MS-DRG inpatient 114306 114306 57460 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 80795.8 other Inpatient DRG 57460 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 80795.8 other Inpatient DRG 114306 Service paid by case rate. 3506.66 other IP General Discharge 57460 114306 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 021 MS-DRG inpatient 46285.2 46285.2 39401.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 55429.7 other Inpatient DRG 39401.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 55429.7 other Inpatient DRG 46285.2 Service paid by case rate. 3506.66 other IP General Discharge 39401.8 46285.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/McC 022 MS-DRG inpatient 31937.2 31937.2 17590.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 24791.6 other Inpatient DRG 17590.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 24791.6 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 31937.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator 023 MS-DRG inpatient 56498.5 56498.5 40666.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 57206.1 other Inpatient DRG 40666.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 57206.1 other Inpatient DRG 56498.5 Service paid by case rate. 3506.66 other IP General Discharge 40666.4 56498.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC 024 MS-DRG inpatient 41922.8 41922.8 27098.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 38147.5 other Inpatient DRG 27098.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 38147.5 other Inpatient DRG 41922.8 Service paid by case rate. 3506.66 other IP General Discharge 27098.6 41922.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Craniotomy And Endovascular Intracranial Procedures With McC 025 MS-DRG inpatient 52090.1 52090.1 31879 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 44862.5 other Inpatient DRG 31879 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 44862.5 other Inpatient DRG 52090.1 Service paid by case rate. 3506.66 other IP General Discharge 31879 52090.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Craniotomy And Endovascular Intracranial Procedures With Cc 026 MS-DRG inpatient 39042 39042 21802.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 30707.5 other Inpatient DRG 21802.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 30707.5 other Inpatient DRG 39042 Service paid by case rate. 3506.66 other IP General Discharge 21802.1 39042 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Craniotomy And Endovascular Intracranial Procedures Without Cc/McC 027 MS-DRG inpatient 34059.9 34059.9 17590.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 24791.6 other Inpatient DRG 17590.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 24791.6 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 34059.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Spinal Procedures With McC 028 MS-DRG inpatient 28081.1 28081.1 43335.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 57435.6 other Inpatient DRG 43335.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 57435.6 other Inpatient DRG 28081.1 Service paid by case rate. 3506.66 other IP General Discharge 28081.1 43335.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Spinal Procedures With Cc Or Spinal Neurostimulators 029 MS-DRG inpatient 25072.1 25072.1 23927.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 33692.5 other Inpatient DRG 23927.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 33692.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 25072.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Spinal Procedures Without Cc/McC 030 MS-DRG inpatient 76254.6 76254.6 15862.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22364.3 other Inpatient DRG 15862.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22364.3 other Inpatient DRG 76254.6 Service paid by case rate. 3506.66 other IP General Discharge 15862.5 76254.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Ventricular Shunt Procedures With McC 031 MS-DRG inpatient 73295.1 73295.1 29870.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 42041.8 other Inpatient DRG 29870.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 42041.8 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 73295.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Ventricular Shunt Procedures With Cc 032 MS-DRG inpatient 37939.6 37939.6 15223.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21466.1 other Inpatient DRG 15223.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21466.1 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 37939.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Ventricular Shunt Procedures Without Cc/McC 033 MS-DRG inpatient 41201.9 41201.9 11373 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16057.9 other Inpatient DRG 11373 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16057.9 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 41201.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Carotid Artery Stent Procedures With McC 034 MS-DRG inpatient 39954.7 39954.7 27719.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 39019.7 other Inpatient DRG 27719.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 39019.7 other Inpatient DRG 39954.7 Service paid by case rate. 3506.66 other IP General Discharge 27719.5 39954.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Carotid Artery Stent Procedures With Cc 035 MS-DRG inpatient 30829.3 30829.3 16214.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22859 other Inpatient DRG 16214.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22859 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 30829.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Carotid Artery Stent Procedures Without Cc/McC 036 MS-DRG inpatient 30756.2 30756.2 13066.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18437.1 other Inpatient DRG 13066.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18437.1 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 30756.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Extracranial Procedures With McC 037 MS-DRG inpatient 19661.7 19661.7 23671.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 33334.1 other Inpatient DRG 23671.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 33334.1 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 23671.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Extracranial Procedures With Cc 038 MS-DRG inpatient 19077.5 19077.5 11484.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16215.1 other Inpatient DRG 11484.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16215.1 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 19077.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Extracranial Procedures Without Cc/McC 039 MS-DRG inpatient 16007.7 16007.7 8113.76 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11479.7 other Inpatient DRG 8113.76 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11479.7 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 16007.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Peripheral, Cranial Nerve And Other Nervous System Procedures With McC" 040 MS-DRG inpatient 50438.9 50438.9 53802.9 Base payment rate plus any adjustments related to transfers and outliers. 24642.5 case rate 44564.3 case rate 44564.3 case rate 44564.3 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 36097.1 percent of total billed charges 26887.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 37851.1 other Inpatient DRG 26887.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 37851.1 other Inpatient DRG 50438.9 Service paid by case rate. 3506.66 other IP General Discharge 26887.6 53802.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator" 041 MS-DRG inpatient 51434.5 47112.2 33205.7 Base payment rate plus any adjustments related to transfers and outliers. 33205.7 case rate 45889.2 case rate 51434.5 Base payment rate plus any adjustments related to transfers and outliers. 32445.4 case rate 45889.2 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 37170.2 percent of total billed charges 16100.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22698.8 other Inpatient DRG 16100.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22698.8 other Inpatient DRG 47112.2 Service paid by case rate. 3506.66 other IP General Discharge 16100.6 51434.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC" 042 MS-DRG inpatient 52519.2 43501.4 26269.4 Base payment rate plus any adjustments related to transfers and outliers. 26269.4 case rate 43501.4 case rate 52519.2 Base payment rate plus any adjustments related to transfers and outliers. 20719.1 case rate 43501.4 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 35236.1 percent of total billed charges 12528.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17681.1 other Inpatient DRG 12528.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17681.1 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 52519.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Spinal Disorders And Injuries With Cc/McC 052 MS-DRG inpatient 22281.2 22281.2 14345.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20233.5 other Inpatient DRG 14345.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20233.5 other Inpatient DRG 22281.2 Service paid by case rate. 3506.66 other IP General Discharge 14345.6 22281.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Spinal Disorders And Injuries Without Cc/McC 053 MS-DRG inpatient 11545.4 11545.4 7292.89 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10531.8 other Inpatient DRG 7292.89 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10531.8 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 11545.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Nervous System Neoplasms With McC 054 MS-DRG inpatient 15840.2 15840.2 10686.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15093.6 other Inpatient DRG 10686.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15093.6 other Inpatient DRG 15840.2 Service paid by case rate. 3506.66 other IP General Discharge 10686.5 15840.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Nervous System Neoplasms Without McC 055 MS-DRG inpatient 14561.9 14561.9 7776.57 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11006.1 other Inpatient DRG 7776.57 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11006.1 other Inpatient DRG 14561.9 Service paid by case rate. 3506.66 other IP General Discharge 7776.57 14561.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Degenerative Nervous System Disorders With McC 056 MS-DRG inpatient 19203.6 19203.6 17850 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 25156.1 other Inpatient DRG 17850 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 25156.1 other Inpatient DRG 19203.6 Service paid by case rate. 3506.66 other IP General Discharge 17850 19203.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Degenerative Nervous System Disorders Without McC 057 MS-DRG inpatient 13493.5 13493.5 18483.9 Base payment rate plus any adjustments related to transfers and outliers. 7109.19 case rate 13493.5 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 10929.7 percent of total billed charges 9514.52 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11952.7 other Inpatient DRG 9514.52 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11952.7 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 18483.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Multiple Sclerosis And Cerebellar Ataxia With McC 058 MS-DRG inpatient 18054.5 18054.5 24502.7 Base payment rate plus any adjustments related to transfers and outliers. 9608.91 case rate 18054.5 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 14624.2 percent of total billed charges 13157.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18564.3 other Inpatient DRG 13157.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18564.3 other Inpatient DRG 18054.5 Service paid by case rate. 3506.66 other IP General Discharge 13157.2 24502.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Multiple Sclerosis And Cerebellar Ataxia With Cc 059 MS-DRG inpatient 14173.5 14173.5 8721.82 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12333.9 other Inpatient DRG 8721.82 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12333.9 other Inpatient DRG 14173.5 Service paid by case rate. 3506.66 other IP General Discharge 8721.82 14173.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC 060 MS-DRG inpatient 13849.3 13849.3 12871.3 Base payment rate plus any adjustments related to transfers and outliers. 12871.3 case rate 11944.1 case rate 11944.1 case rate 11944.1 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 9674.71 percent of total billed charges 6361.55 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9018.44 other Inpatient DRG 6361.55 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9018.44 other Inpatient DRG 13849.3 Service paid by case rate. 3506.66 other IP General Discharge 6361.55 13849.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC" 061 MS-DRG inpatient 47574.6 47574.6 41648.8 Base payment rate plus any adjustments related to transfers and outliers. 41648.8 case rate 47574.6 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 38535.4 percent of total billed charges 19270 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 27150.8 other Inpatient DRG 19270 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 27150.8 other Inpatient DRG 32052.8 Service paid by case rate. 3506.66 other IP General Discharge 19270 47574.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc" 062 MS-DRG inpatient 44241.9 44241.9 27228.1 Base payment rate plus any adjustments related to transfers and outliers. 27228.1 case rate 43032.1 case rate 43032.1 case rate 43032.1 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 34856 percent of total billed charges 12694.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17914.4 other Inpatient DRG 12694.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17914.4 other Inpatient DRG 44241.9 Service paid by case rate. 3506.66 other IP General Discharge 12694.6 44241.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC" 063 MS-DRG inpatient 40472.7 40472.7 22453.4 Base payment rate plus any adjustments related to transfers and outliers. 22453.4 case rate 40144.3 case rate 40144.3 case rate 40472.7 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 32782.8 percent of total billed charges 10013.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14148.3 other Inpatient DRG 10013.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14148.3 other Inpatient DRG 40472.7 Service paid by case rate. 3506.66 other IP General Discharge 10013.5 40472.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Intracranial Hemorrhage Or Cerebral Infarction With McC 064 MS-DRG inpatient 36125 27500.2 28006.3 Base payment rate plus any adjustments related to transfers and outliers. 28006.3 case rate 27500.2 case rate 36125 Base payment rate plus any adjustments related to transfers and outliers. 27316.7 case rate 27500.2 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 22275.1 percent of total billed charges 14179.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20000.2 other Inpatient DRG 14179.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20000.2 other Inpatient DRG 27440.4 Service paid by case rate. 3506.66 other IP General Discharge 14179.5 36125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 065 MS-DRG inpatient 16260.2 16260.2 14434.9 Base payment rate plus any adjustments related to transfers and outliers. 14434.9 case rate 16122.1 case rate 14642.7 Base payment rate plus any adjustments related to transfers and outliers. 14642.7 case rate 16122.1 93 "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 13058.9 percent of total billed charges 7249.77 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10266.1 other Inpatient DRG 7249.77 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10266.1 other Inpatient DRG 16260.2 Service paid by case rate. 3506.66 other IP General Discharge 7249.77 16260.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC 066 MS-DRG inpatient 12791.1 12791.1 9920.1 Base payment rate plus any adjustments related to transfers and outliers. 9920.1 case rate 12228.5 case rate 12228.5 case rate 12228.5 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 9905.06 percent of total billed charges 4906.61 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6974.7 other Inpatient DRG 4906.61 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6974.7 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 12791.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Nonspecific Cva And Precerebral Occlusion Without Infarction With McC 067 MS-DRG inpatient 13678.1 13678.1 9934.24 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14351.9 other Inpatient DRG 9934.24 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14351.9 other Inpatient DRG 13678.1 Service paid by case rate. 3506.66 other IP General Discharge 9934.24 13678.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC 068 MS-DRG inpatient 9987.1 9987.1 6284.56 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8910.29 other Inpatient DRG 6284.56 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8910.29 other Inpatient DRG 9987.1 Service paid by case rate. 3506.66 other IP General Discharge 6284.56 9987.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Transient Ischemia Without Thrombolytic 069 MS-DRG inpatient 15170.9 15170.9 11331.8 Base payment rate plus any adjustments related to transfers and outliers. 11331.8 case rate 13551 case rate 13551 Base payment rate plus any adjustments related to transfers and outliers. 11827.8 case rate 13551 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 10976.3 percent of total billed charges 5704.29 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8095.19 other Inpatient DRG 5704.29 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8095.19 other Inpatient DRG 15170.9 Service paid by case rate. 3506.66 other IP General Discharge 5704.29 15170.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Nonspecific Cerebrovascular Disorders With McC 070 MS-DRG inpatient 25492 25492 24487.1 Base payment rate plus any adjustments related to transfers and outliers. 24487.1 case rate 25492 Base payment rate plus any adjustments related to transfers and outliers. 22862.4 case rate 25492 93 "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement." 20648.5 percent of total billed charges 12394.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17492.8 other Inpatient DRG 12394.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17492.8 other Inpatient DRG 25492 Service paid by case rate. 3506.66 other IP General Discharge 12394.5 25492 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Nonspecific Cerebrovascular Disorders With Cc 071 MS-DRG inpatient 19986.2 19986.2 15181.9 Base payment rate plus any adjustments related to transfers and outliers. 15181.9 case rate 19986.2 93 "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement." 16188.9 percent of total billed charges 7512.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10634.6 other Inpatient DRG 7512.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10634.6 other Inpatient DRG 15784.8 Service paid by case rate. 3506.66 other IP General Discharge 7512.1 19986.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Nonspecific Cerebrovascular Disorders Without Cc/McC 072 MS-DRG inpatient 13528.7 13528.7 5489.81 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7967.97 other Inpatient DRG 5489.81 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7967.97 other Inpatient DRG 13528.7 Service paid by case rate. 3506.66 other IP General Discharge 5489.81 13528.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cranial And Peripheral Nerve Disorders With McC 073 MS-DRG inpatient 20304.9 20304.9 21293.1 Base payment rate plus any adjustments related to transfers and outliers. 21293.1 case rate 20304.9 Base payment rate plus any adjustments related to transfers and outliers. 14562 case rate 20304.9 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement." 16447 percent of total billed charges 10608 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15319.7 other Inpatient DRG 10608 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15319.7 other Inpatient DRG 17722.7 Service paid by case rate. 3506.66 other IP General Discharge 10608 21293.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cranial And Peripheral Nerve Disorders Without McC 074 MS-DRG inpatient 11529.1 11529.1 14537.2 Base payment rate plus any adjustments related to transfers and outliers. 14537.2 case rate 11529.1 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 9338.61 percent of total billed charges 7194.95 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10417.2 other Inpatient DRG 7194.95 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10417.2 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 14537.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Viral Meningitis With Cc/McC 075 MS-DRG inpatient 7763.75 7763.75 12278.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17329.6 other Inpatient DRG 12278.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17329.6 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 12278.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Viral Meningitis Without Cc/McC 076 MS-DRG inpatient 14571.6 14571.6 6536.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9263.77 other Inpatient DRG 6536.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9263.77 other Inpatient DRG 14571.6 Service paid by case rate. 3506.66 other IP General Discharge 6536.2 14571.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hypertensive Encephalopathy With McC 077 MS-DRG inpatient 43710.2 43710.2 22214.8 Base payment rate plus any adjustments related to transfers and outliers. 22214.8 case rate 43710.2 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 35405.2 percent of total billed charges 10593.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15298.6 other Inpatient DRG 10593.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15298.6 other Inpatient DRG 26103 Service paid by case rate. 3506.66 other IP General Discharge 10593.3 43710.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hypertensive Encephalopathy With Cc 078 MS-DRG inpatient 10558.4 10558.4 7129.74 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10323.5 other Inpatient DRG 7129.74 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10323.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 10558.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Nontraumatic Stupor And Coma With McC 080 MS-DRG inpatient 7446.12 7446.12 14170.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19987.2 other Inpatient DRG 14170.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19987.2 other Inpatient DRG 7446.12 Service paid by case rate. 3506.66 other IP General Discharge 7446.12 14170.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Nontraumatic Stupor And Coma Without McC 081 MS-DRG inpatient 16180 16180 6449.94 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9142.6 other Inpatient DRG 6449.94 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9142.6 other Inpatient DRG 16180 Service paid by case rate. 3506.66 other IP General Discharge 6449.94 16180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Traumatic Stupor And Coma >1 Hour With McC 082 MS-DRG inpatient 37143.7 37143.7 32171.8 Base payment rate plus any adjustments related to transfers and outliers. 32171.8 case rate 37143.7 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 30086.4 percent of total billed charges 15973.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22827.2 other Inpatient DRG 15973.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22827.2 other Inpatient DRG 15839.9 Service paid by case rate. 3506.66 other IP General Discharge 15839.9 37143.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Traumatic Stupor And Coma >1 Hour With Cc 083 MS-DRG inpatient 15351.4 15351.4 9910.87 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14004.1 other Inpatient DRG 9910.87 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14004.1 other Inpatient DRG 15351.4 Service paid by case rate. 3506.66 other IP General Discharge 9910.87 15351.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Traumatic Stupor And Coma >1 Hour Without Cc/McC 084 MS-DRG inpatient 8671.08 8671.08 6814.93 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9655.29 other Inpatient DRG 6814.93 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9655.29 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 8671.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Traumatic Stupor And Coma <1 Hour With McC 085 MS-DRG inpatient 15065 15065 16152.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22771.9 other Inpatient DRG 16152.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22771.9 other Inpatient DRG 15065 Service paid by case rate. 3506.66 other IP General Discharge 15065 16152.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Traumatic Stupor And Coma <1 Hour With Cc 086 MS-DRG inpatient 15146 15146 9349.85 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13216.1 other Inpatient DRG 9349.85 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13216.1 other Inpatient DRG 15146 Service paid by case rate. 3506.66 other IP General Discharge 9349.85 15146 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Traumatic Stupor And Coma <1 Hour Without Cc/McC 087 MS-DRG inpatient 8223.83 8223.83 6301.67 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8934.33 other Inpatient DRG 6301.67 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8934.33 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 8223.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Concussion With McC 088 MS-DRG inpatient 34419.2 34419.2 10055.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14207.4 other Inpatient DRG 10055.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14207.4 other Inpatient DRG 34419.2 Service paid by case rate. 3506.66 other IP General Discharge 10055.6 34419.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Concussion With Cc 089 MS-DRG inpatient 21584.7 21584.7 7642.56 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10817.9 other Inpatient DRG 7642.56 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10817.9 other Inpatient DRG 21584.7 Service paid by case rate. 3506.66 other IP General Discharge 7642.56 21584.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Disorders Of Nervous System With McC 091 MS-DRG inpatient 32929.6 32929.6 24532.5 Base payment rate plus any adjustments related to transfers and outliers. 24532.5 case rate 29574.7 case rate 29574.7 case rate 29574.7 93 "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 23955.5 percent of total billed charges 12994 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18334.9 other Inpatient DRG 12994 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18334.9 other Inpatient DRG 32929.6 Service paid by case rate. 3506.66 other IP General Discharge 12994 32929.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Disorders Of Nervous System With Cc 092 MS-DRG inpatient 13943 13943 14121 Base payment rate plus any adjustments related to transfers and outliers. 14121 case rate 13943 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 11293.8 percent of total billed charges 7547.75 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10684.7 other Inpatient DRG 7547.75 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10684.7 other Inpatient DRG 13943 Service paid by case rate. 3506.66 other IP General Discharge 7547.75 14121 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Disorders Of Nervous System Without Cc/McC 093 MS-DRG inpatient 4765.41 4765.41 10861.7 Base payment rate plus any adjustments related to transfers and outliers. 10861.7 case rate 14633.3 case rate 14633.3 case rate 14633.3 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 11853 percent of total billed charges 5626.59 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7986.05 other Inpatient DRG 5626.59 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7986.05 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 14633.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Bacterial And Tuberculous Infections Of Nervous System With McC 094 MS-DRG inpatient 43406.2 43406.2 26007.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 36615.5 other Inpatient DRG 26007.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 36615.5 other Inpatient DRG 43406.2 Service paid by case rate. 3506.66 other IP General Discharge 26007.9 43406.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Bacterial And Tuberculous Infections Of Nervous System With Cc 095 MS-DRG inpatient 14878 14878 36311.7 Base payment rate plus any adjustments related to transfers and outliers. 36311.7 case rate 14878 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 12051.2 percent of total billed charges 17087.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 24084.7 other Inpatient DRG 17087.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 24084.7 other Inpatient DRG 14878 Service paid by case rate. 3506.66 other IP General Discharge 14878 36311.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC 096 MS-DRG inpatient 14021.2 14021.2 17087.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 24084.7 other Inpatient DRG 17087.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 24084.7 other Inpatient DRG 14021.2 Service paid by case rate. 3506.66 other IP General Discharge 14021.2 17087.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC 097 MS-DRG inpatient 27819.1 27819.1 25554.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 35978.6 other Inpatient DRG 25554.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 35978.6 other Inpatient DRG 27819.1 Service paid by case rate. 3506.66 other IP General Discharge 25554.5 27819.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc 098 MS-DRG inpatient 22899.3 22899.3 15105.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21780.2 other Inpatient DRG 15105.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21780.2 other Inpatient DRG 22899.3 Service paid by case rate. 3506.66 other IP General Discharge 15105.7 22899.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC 099 MS-DRG inpatient 16934.7 16934.7 9931.55 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14033.2 other Inpatient DRG 9931.55 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14033.2 other Inpatient DRG 16934.7 Service paid by case rate. 3506.66 other IP General Discharge 9931.55 16934.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Seizures With McC 100 MS-DRG inpatient 17619.9 17619.9 27282 Base payment rate plus any adjustments related to transfers and outliers. 27282 case rate 17619.9 93 "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 14272.2 percent of total billed charges 14151.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19961.1 other Inpatient DRG 14151.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19961.1 other Inpatient DRG 17619.9 Service paid by case rate. 3506.66 other IP General Discharge 14151.7 27282 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Seizures Without McC 101 MS-DRG inpatient 14944.7 14934.9 12803.1 Base payment rate plus any adjustments related to transfers and outliers. 12803.1 case rate 14285.4 case rate 14944.7 Base payment rate plus any adjustments related to transfers and outliers. 13890.2 case rate 14285.4 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 11571.2 percent of total billed charges 6569.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9310.82 other Inpatient DRG 6569.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9310.82 other Inpatient DRG 14934.9 Service paid by case rate. 3506.66 other IP General Discharge 6569.7 14944.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Headaches With McC 102 MS-DRG inpatient 16397.9 16397.9 16330.9 Base payment rate plus any adjustments related to transfers and outliers. 16330.9 case rate 16397.9 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 13282.3 percent of total billed charges 8459.78 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12234 other Inpatient DRG 8459.78 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12234 other Inpatient DRG 13081.1 Service paid by case rate. 3506.66 other IP General Discharge 8459.78 16397.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Headaches Without McC 103 MS-DRG inpatient 15583.3 15583.3 11823.2 Base payment rate plus any adjustments related to transfers and outliers. 11823.2 case rate 11106.6 case rate 11106.6 case rate 11106.6 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 8996.36 percent of total billed charges 5906.28 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8566.18 other Inpatient DRG 5906.28 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8566.18 other Inpatient DRG 15583.3 Service paid by case rate. 3506.66 other IP General Discharge 5906.28 15583.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Extraocular Procedures Except Orbit 115 MS-DRG inpatient 18609.1 18609.1 10913.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15412 other Inpatient DRG 10913.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15412 other Inpatient DRG 18609.1 Service paid by case rate. 3506.66 other IP General Discharge 10913.2 18609.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Acute Major Eye Infections Without Cc/McC 122 MS-DRG inpatient 7812.58 7812.58 4835.32 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6874.55 other Inpatient DRG 4835.32 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6874.55 other Inpatient DRG 7812.58 Service paid by case rate. 3506.66 other IP General Discharge 4835.32 7812.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Neurological Eye Disorders 123 MS-DRG inpatient 10965.8 10965.8 11273.5 Base payment rate plus any adjustments related to transfers and outliers. 11273.5 case rate 10965.8 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 8882.31 percent of total billed charges 5725.68 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8125.24 other Inpatient DRG 5725.68 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8125.24 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 11273.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Disorders Of The Eye With McC Or Thrombolytic Agent 124 MS-DRG inpatient 11290.1 11290.1 9294.25 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13138 other Inpatient DRG 9294.25 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13138 other Inpatient DRG 11290.1 Service paid by case rate. 3506.66 other IP General Discharge 9294.25 11290.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Disorders Of The Eye Without McC 125 MS-DRG inpatient 9319.1 9319.1 14284.2 Base payment rate plus any adjustments related to transfers. 14284.2 case rate 7911.88 case rate 7911.88 case rate 7911.88 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 6408.63 percent of total billed charges 5886.07 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8350.54 other Inpatient DRG 5886.07 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8350.54 other Inpatient DRG 9319.1 Service paid by case rate. 3506.66 other IP General Discharge 5886.07 14284.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Sinus And Mastoid Procedures With Cc/McC 135 MS-DRG inpatient 35398.3 35398.3 16561.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22916.4 other Inpatient DRG 16561.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22916.4 other Inpatient DRG 35398.3 Service paid by case rate. 3506.66 other IP General Discharge 16561.9 35398.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Mouth Procedures With Cc/McC 137 MS-DRG inpatient 12788 12788 9969.33 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14086.3 other Inpatient DRG 9969.33 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14086.3 other Inpatient DRG 12788 Service paid by case rate. 3506.66 other IP General Discharge 9969.33 12788 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Head And Neck Procedures With Cc 141 MS-DRG inpatient 13425 13425 14525.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20946.3 other Inpatient DRG 14525.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20946.3 other Inpatient DRG 13425 Service paid by case rate. 3506.66 other IP General Discharge 13425 14525.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Other Ear, Nose, Mouth And Throat O.R. Procedures With McC" 143 MS-DRG inpatient 49360 49360 23316.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 33282.6 other Inpatient DRG 23316.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 33282.6 other Inpatient DRG 49360 Service paid by case rate. 3506.66 other IP General Discharge 23316.6 49360 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc" 144 MS-DRG inpatient 11642.7 11642.7 12133 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17510.1 other Inpatient DRG 12133 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17510.1 other Inpatient DRG 11642.7 Service paid by case rate. 3506.66 other IP General Discharge 11642.7 12133 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/McC" 145 MS-DRG inpatient 11452.3 11452.3 8561.44 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12272.9 other Inpatient DRG 8561.44 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12272.9 other Inpatient DRG 11452.3 Service paid by case rate. 3506.66 other IP General Discharge 8561.44 11452.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Ear, Nose, Mouth And Throat Malignancy With McC" 146 MS-DRG inpatient 23259.2 23259.2 16352.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23052.3 other Inpatient DRG 16352.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23052.3 other Inpatient DRG 23259.2 Service paid by case rate. 3506.66 other IP General Discharge 16352.3 23259.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Ear, Nose, Mouth And Throat Malignancy With Cc" 147 MS-DRG inpatient 6161.85 6161.85 8872.95 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12546.2 other Inpatient DRG 8872.95 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12546.2 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 8872.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Ear, Nose, Mouth And Throat Malignancy Without Cc/McC" 148 MS-DRG inpatient 5461.41 5461.41 5050.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7306.08 other Inpatient DRG 5050.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7306.08 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 5461.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Dysequilibrium 149 MS-DRG inpatient 6697.7 6697.7 10722.5 Base payment rate plus any adjustments related to transfers and outliers. 10722.5 case rate 6697.7 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 5425.13 percent of total billed charges 5221.28 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7582.25 other Inpatient DRG 5221.28 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7582.25 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 10722.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Epistaxis With McC 150 MS-DRG inpatient 8939.42 8939.42 9852.42 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13922 other Inpatient DRG 9852.42 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13922 other Inpatient DRG 8939.42 Service paid by case rate. 3506.66 other IP General Discharge 8939.42 9852.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Epistaxis Without McC 151 MS-DRG inpatient 8070.22 8070.22 5403.57 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7776.5 other Inpatient DRG 5403.57 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7776.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 8070.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Otitis Media And Uri With McC 152 MS-DRG inpatient 15312.3 15312.3 8330.77 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12048.7 other Inpatient DRG 8330.77 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12048.7 other Inpatient DRG 15312.3 Service paid by case rate. 3506.66 other IP General Discharge 8330.77 15312.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Otitis Media And Uri Without McC 153 MS-DRG inpatient 8661.66 8661.66 9806.48 Base payment rate plus any adjustments related to transfers and outliers. 9806.48 case rate 17218.2 case rate 17218.2 case rate 17218.2 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 13946.8 percent of total billed charges 5151.87 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7418.1 other Inpatient DRG 5151.87 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7418.1 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 17218.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Other Ear, Nose, Mouth And Throat Diagnoses With McC" 154 MS-DRG inpatient 48784 48784 11592.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16366.3 other Inpatient DRG 11592.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16366.3 other Inpatient DRG 48784 Service paid by case rate. 3506.66 other IP General Discharge 11592.5 48784 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Other Ear, Nose, Mouth And Throat Diagnoses With Cc" 155 MS-DRG inpatient 23920.6 23920.6 13055.9 Base payment rate plus any adjustments related to transfers and outliers. 13055.9 case rate 23920.6 93 "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 19375.7 percent of total billed charges 6655.25 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9430.99 other Inpatient DRG 6655.25 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9430.99 other Inpatient DRG 23920.6 Service paid by case rate. 3506.66 other IP General Discharge 6655.25 23920.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC" 156 MS-DRG inpatient 8206.42 8206.42 4595.88 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6683.92 other Inpatient DRG 4595.88 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6683.92 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 8206.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Dental And Oral Diseases With McC 157 MS-DRG inpatient 18081.8 18081.8 11672.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16478.5 other Inpatient DRG 11672.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16478.5 other Inpatient DRG 18081.8 Service paid by case rate. 3506.66 other IP General Discharge 11672.4 18081.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Dental And Oral Diseases With Cc 158 MS-DRG inpatient 4780.21 4780.21 6580.06 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8828.8 other Inpatient DRG 6580.06 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8828.8 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 6580.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Dental And Oral Diseases Without Cc/McC 159 MS-DRG inpatient 6671.29 6671.29 4702.01 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6687.31 other Inpatient DRG 4702.01 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6687.31 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 6671.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Chest Procedures With McC 163 MS-DRG inpatient 35858.3 35858.3 68790.2 Base payment rate plus any adjustments related to transfers and outliers. 68790.2 case rate 35858.3 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 29045.2 percent of total billed charges 32854.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 46233.4 other Inpatient DRG 32854.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 46233.4 other Inpatient DRG 35858.3 Service paid by case rate. 3506.66 other IP General Discharge 32854.9 68790.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Chest Procedures With Cc 164 MS-DRG inpatient 36525.8 31469.3 36679.5 Base payment rate plus any adjustments related to transfers and outliers. 11462.4 case rate 26606.3 Base payment rate plus any adjustments related to transfers and outliers. 10850.4 case rate 36525.8 Base payment rate plus any adjustments related to transfers and outliers. 35138.9 case rate 31469.3 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 25490.2 percent of total billed charges 17941.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22734.1 other Inpatient DRG 17941.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22734.1 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 36679.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Chest Procedures Without Cc/McC 165 MS-DRG inpatient 46322.8 28756.7 27365.8 Base payment rate plus any adjustments related to transfers and outliers. 27365.8 case rate 28756.7 case rate 46322.8 Base payment rate plus any adjustments related to transfers and outliers. 27185.7 case rate 28756.7 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 23293 percent of total billed charges 13287 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18746.5 other Inpatient DRG 13287 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18746.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 46322.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Respiratory System O.R. Procedures With McC 166 MS-DRG inpatient 33588.4 33588.4 52061.7 Base payment rate plus any adjustments related to transfers and outliers. 52061.7 case rate 31187.9 case rate 31187.9 case rate 31187.9 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 25262.2 percent of total billed charges 27452.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 38644.2 other Inpatient DRG 27452.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 38644.2 other Inpatient DRG 33588.4 Service paid by case rate. 3506.66 other IP General Discharge 27452.2 52061.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Respiratory System O.R. Procedures With Cc 167 MS-DRG inpatient 24923.5 24923.5 26999.4 Base payment rate plus any adjustments related to transfers and outliers. 8999.81 case rate 21180.5 case rate 21180.5 case rate 21180.5 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 17156.3 percent of total billed charges 13024.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18378 other Inpatient DRG 13024.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18378 other Inpatient DRG 24923.5 Service paid by case rate. 3506.66 other IP General Discharge 13024.6 26999.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Respiratory System O.R. Procedures Without Cc/McC 168 MS-DRG inpatient 33723.1 33723.1 20132.8 Base payment rate plus any adjustments related to transfers and outliers. 20132.8 case rate 19345.2 Base payment rate plus any adjustments related to transfers and outliers. 18916.6 case rate 33723.1 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 27315.7 percent of total billed charges 9650.68 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13638.6 other Inpatient DRG 9650.68 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13638.6 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 33723.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Pulmonary Embolism With McC Or Acute Cor Pulmonale 175 MS-DRG inpatient 92248.1 14925.8 19837.3 Base payment rate plus any adjustments related to transfers and outliers. 19837.3 case rate 10943.8 Base payment rate plus any adjustments related to transfers and outliers. 2006.35 case rate 92248.1 Base payment rate plus any adjustments related to transfers and outliers. 19579.3 case rate 14925.8 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 12089.9 percent of total billed charges 10044.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14192.4 other Inpatient DRG 10044.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14192.4 other Inpatient DRG 13355 Service paid by case rate. 3506.66 other IP General Discharge 10044.9 92248.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Pulmonary Embolism Without McC 176 MS-DRG inpatient 11621.5 11621.5 11611.6 Base payment rate plus any adjustments related to transfers and outliers. 11611.6 case rate 11085.5 Base payment rate plus any adjustments related to transfers and outliers. 11075.1 case rate 11621.5 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 9413.42 percent of total billed charges 5806.23 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8238.39 other Inpatient DRG 5806.23 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8238.39 other Inpatient DRG 11621.5 Service paid by case rate. 3506.66 other IP General Discharge 5806.23 11621.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Respiratory Infections And Inflammations With McC 177 MS-DRG inpatient 17051.2 17051.2 25278.1 Base payment rate plus any adjustments related to transfers and outliers. 25278.1 case rate 12997.5 Base payment rate plus any adjustments related to transfers and outliers. 12087.7 case rate 10365.4 Base payment rate plus any adjustments related to transfers and outliers. 9569.59 case rate 17051.2 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 13811.5 percent of total billed charges 11523.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16269.2 other Inpatient DRG 11523.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16269.2 other Inpatient DRG 17051.2 Service paid by case rate. 3506.66 other IP General Discharge 10365.4 25278.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Respiratory Infections And Inflammations With Cc 178 MS-DRG inpatient 13141.9 13141.9 15437.6 Base payment rate plus any adjustments related to transfers and outliers. 15437.6 case rate 12648.3 case rate 12648.3 case rate 12648.3 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 10245.1 percent of total billed charges 7072.27 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10016.8 other Inpatient DRG 7072.27 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10016.8 other Inpatient DRG 13141.9 Service paid by case rate. 3506.66 other IP General Discharge 7072.27 15437.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Respiratory Infections And Inflammations Without Cc/McC 179 MS-DRG inpatient 9046.82 9046.82 11154.3 Base payment rate plus any adjustments related to transfers and outliers. 11154.3 case rate 12805.4 case rate 12805.4 case rate 12805.4 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 10372.4 percent of total billed charges 5486.87 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7789.79 other Inpatient DRG 5486.87 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7789.79 other Inpatient DRG 9046.82 Service paid by case rate. 3506.66 other IP General Discharge 5486.87 12805.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Respiratory Neoplasms With McC 180 MS-DRG inpatient 33156.1 33156.1 24056.8 Base payment rate plus any adjustments related to transfers and outliers. 24056.8 case rate 33156.1 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 26856.4 percent of total billed charges 12187 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17587.7 other Inpatient DRG 12187 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17587.7 other Inpatient DRG 22852 Service paid by case rate. 3506.66 other IP General Discharge 12187 33156.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Respiratory Neoplasms With Cc 181 MS-DRG inpatient 14890.3 14890.3 16100.8 Base payment rate plus any adjustments related to transfers and outliers. 16100.8 case rate 14890.3 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 12061.2 percent of total billed charges 7914.16 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11199.4 other Inpatient DRG 7914.16 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11199.4 other Inpatient DRG 14890.3 Service paid by case rate. 3506.66 other IP General Discharge 7914.16 16100.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Respiratory Neoplasms Without Cc/McC 182 MS-DRG inpatient 58272.2 58272.2 5970.19 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8468.71 other Inpatient DRG 5970.19 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8468.71 other Inpatient DRG 58272.2 Service paid by case rate. 3506.66 other IP General Discharge 5970.19 58272.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Chest Trauma With McC 183 MS-DRG inpatient 14279.5 14279.5 21334.2 Base payment rate plus any adjustments related to transfers and outliers. 21334.2 case rate 11779.8 case rate 11779.8 case rate 11779.8 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 9541.65 percent of total billed charges 11314.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15975.8 other Inpatient DRG 11314.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15975.8 other Inpatient DRG 14279.5 Service paid by case rate. 3506.66 other IP General Discharge 11314.5 21334.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Chest Trauma With Cc 184 MS-DRG inpatient 10146.2 10146.2 7613.33 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10776.8 other Inpatient DRG 7613.33 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10776.8 other Inpatient DRG 10146.2 Service paid by case rate. 3506.66 other IP General Discharge 7613.33 10146.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Chest Trauma Without Cc/McC 185 MS-DRG inpatient 9162.89 9162.89 5543.19 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7868.89 other Inpatient DRG 5543.19 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7868.89 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 9162.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Pleural Effusion With McC 186 MS-DRG inpatient 19451.9 19451.9 11263.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15903.7 other Inpatient DRG 11263.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15903.7 other Inpatient DRG 19451.9 Service paid by case rate. 3506.66 other IP General Discharge 11263.2 19451.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Pleural Effusion With Cc 187 MS-DRG inpatient 19140.5 19140.5 14853.9 Base payment rate plus any adjustments related to transfers and outliers. 5713.03 case rate 19140.5 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 15503.8 percent of total billed charges 7156.39 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10134.9 other Inpatient DRG 7156.39 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10134.9 other Inpatient DRG 10593.1 Service paid by case rate. 3506.66 other IP General Discharge 7156.39 19140.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Pleural Effusion Without Cc/McC 188 MS-DRG inpatient 6364.63 6364.63 5233.09 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7433.3 other Inpatient DRG 5233.09 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7433.3 other Inpatient DRG 6364.63 Service paid by case rate. 3506.66 other IP General Discharge 5233.09 6364.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Pulmonary Edema And Respiratory Failure 189 MS-DRG inpatient 24138.9 19469.9 17141.8 Base payment rate plus any adjustments related to transfers and outliers. 17141.8 case rate 24138.9 Base payment rate plus any adjustments related to transfers and outliers. 22449.2 case rate 19308.1 Base payment rate plus any adjustments related to transfers and outliers. 15418.7 case rate 19469.9 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 15770.6 percent of total billed charges 8821.62 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12474.1 other Inpatient DRG 8821.62 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12474.1 other Inpatient DRG 19308.1 Service paid by case rate. 3506.66 other IP General Discharge 8821.62 24138.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Chronic Obstructive Pulmonary Disease With McC 190 MS-DRG inpatient 24976.9 17307.1 15416.3 Base payment rate plus any adjustments related to transfers and outliers. 15416.3 case rate 17307.1 case rate 24976.9 Base payment rate plus any adjustments related to transfers and outliers. 18290.5 case rate 17307.1 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 14018.8 percent of total billed charges 8007.54 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11330.5 other Inpatient DRG 8007.54 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11330.5 other Inpatient DRG 16863.8 Service paid by case rate. 3506.66 other IP General Discharge 8007.54 24976.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Chronic Obstructive Pulmonary Disease With Cc 191 MS-DRG inpatient 15111.5 15111.5 12273.4 Base payment rate plus any adjustments related to transfers and outliers. 12273.4 case rate 14673 case rate 14673 case rate 14673 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 11885.1 percent of total billed charges 6124.17 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8684.99 other Inpatient DRG 6124.17 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8684.99 other Inpatient DRG 15111.5 Service paid by case rate. 3506.66 other IP General Discharge 6124.17 15111.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Chronic Obstructive Pulmonary Disease Without Cc/McC 192 MS-DRG inpatient 9409.58 9409.58 4499.82 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6545.95 other Inpatient DRG 4499.82 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6545.95 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 9409.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Simple Pneumonia And Pleurisy With McC 193 MS-DRG inpatient 9845.63 18678 18444.1 Base payment rate plus any adjustments related to transfers and outliers. 18444.1 case rate 9845.63 Base payment rate plus any adjustments related to transfers and outliers. 10859.2 case rate 9549.83 Base payment rate plus any adjustments related to transfers and outliers. 7891.25 case rate 17498.5 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 14173.8 percent of total billed charges 9394.05 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13278.2 other Inpatient DRG 9394.05 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13278.2 other Inpatient DRG 18678 Service paid by case rate. 3506.66 other IP General Discharge 9394.05 18678 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Simple Pneumonia And Pleurisy With Cc 194 MS-DRG inpatient 13817.4 13817.4 11932.5 Base payment rate plus any adjustments related to transfers and outliers. 11932.5 case rate 13817.4 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 11192.1 percent of total billed charges 5845.44 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8293.47 other Inpatient DRG 5845.44 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8293.47 other Inpatient DRG 12380.9 Service paid by case rate. 3506.66 other IP General Discharge 5845.44 13817.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Simple Pneumonia And Pleurisy Without Cc/McC 195 MS-DRG inpatient 8959.72 8959.72 9114.84 Base payment rate plus any adjustments related to transfers and outliers. 9114.84 case rate 11348 case rate 11348 Base payment rate plus any adjustments related to transfers and outliers. 10141.4 case rate 11348 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 9191.9 percent of total billed charges 4439.68 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6318.8 other Inpatient DRG 4439.68 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6318.8 other Inpatient DRG 8959.72 Service paid by case rate. 3506.66 other IP General Discharge 4439.68 11348 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Interstitial Lung Disease With McC 196 MS-DRG inpatient 11494.6 11494.6 24678.8 Base payment rate plus any adjustments related to transfers and outliers. 24678.8 case rate 10382 case rate 10382 case rate 10382 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 8409.46 percent of total billed charges 13431.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16313.7 other Inpatient DRG 13431.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16313.7 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 24678.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Interstitial Lung Disease With Cc 197 MS-DRG inpatient 32335.6 32335.6 13969.1 Base payment rate plus any adjustments related to transfers and outliers. 13969.1 case rate 32335.6 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 26191.8 percent of total billed charges 7056.59 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9994.75 other Inpatient DRG 7056.59 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9994.75 other Inpatient DRG 20282.8 Service paid by case rate. 3506.66 other IP General Discharge 7056.59 32335.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Interstitial Lung Disease Without Cc/McC 198 MS-DRG inpatient 6327.35 6327.35 4992.86 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7095.86 other Inpatient DRG 4992.86 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7095.86 other Inpatient DRG 6327.35 Service paid by case rate. 3506.66 other IP General Discharge 4992.86 6327.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Pneumothorax With McC 199 MS-DRG inpatient 34800.7 24118.5 24975.6 Base payment rate plus any adjustments related to transfers and outliers. 24975.6 case rate 24118.5 case rate 34800.7 Base payment rate plus any adjustments related to transfers and outliers. 19549.4 case rate 24118.5 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 19536 percent of total billed charges 12583.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17758.2 other Inpatient DRG 12583.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17758.2 other Inpatient DRG 19548.3 Service paid by case rate. 3506.66 other IP General Discharge 12583.4 34800.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Pneumothorax With Cc 200 MS-DRG inpatient 14161.8 13255.6 15224.5 Base payment rate plus any adjustments related to transfers and outliers. 15224.5 case rate 13255.6 case rate 14161.8 Base payment rate plus any adjustments related to transfers and outliers. 14161.8 case rate 13255.6 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 10737 percent of total billed charges 7894.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11171.3 other Inpatient DRG 7894.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11171.3 other Inpatient DRG 13255.6 Service paid by case rate. 3506.66 other IP General Discharge 7894.2 15224.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Pneumothorax Without Cc/McC 201 MS-DRG inpatient 8710.38 8710.38 10337.6 Base payment rate plus any adjustments related to transfers and outliers. 10337.6 case rate 6531.18 case rate 6531.18 case rate 6531.18 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 5290.24 percent of total billed charges 4825.34 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6860.54 other Inpatient DRG 4825.34 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6860.54 other Inpatient DRG 8710.38 Service paid by case rate. 3506.66 other IP General Discharge 4825.34 10337.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Bronchitis And Asthma With Cc/McC 202 MS-DRG inpatient 11976.2 11976.2 13148.2 Base payment rate plus any adjustments related to transfers and outliers. 13148.2 case rate 11976.2 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 9700.75 percent of total billed charges 6891.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9762.44 other Inpatient DRG 6891.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9762.44 other Inpatient DRG 11976.2 Service paid by case rate. 3506.66 other IP General Discharge 6891.2 13148.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Bronchitis And Asthma Without Cc/McC 203 MS-DRG inpatient 7777.86 7777.86 4963.63 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7054.81 other Inpatient DRG 4963.63 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7054.81 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 7777.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Respiratory Signs And Symptoms 204 MS-DRG inpatient 12830.5 12830.5 11495.1 Base payment rate plus any adjustments related to transfers and outliers. 11495.1 case rate 11728.7 Base payment rate plus any adjustments related to transfers and outliers. 10877.4 case rate 11728.7 case rate 11728.7 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 9500.25 percent of total billed charges 5780.57 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8202.34 other Inpatient DRG 5780.57 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8202.34 other Inpatient DRG 12830.5 Service paid by case rate. 3506.66 other IP General Discharge 5780.57 12830.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Respiratory System Diagnoses With McC 205 MS-DRG inpatient 14073.9 14073.9 25293.8 Base payment rate plus any adjustments related to transfers and outliers. 25293.8 case rate 14073.9 case rate 14073.9 case rate 14073.9 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 11399.9 percent of total billed charges 13456.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18984.8 other Inpatient DRG 13456.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18984.8 other Inpatient DRG 14073.9 Service paid by case rate. 3506.66 other IP General Discharge 13456.6 25293.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Respiratory System Diagnoses Without McC 206 MS-DRG inpatient 9487.46 9487.46 12688.1 Base payment rate plus any adjustments related to transfers and outliers. 8750.39 case rate 6835.98 case rate 11379.9 Base payment rate plus any adjustments related to transfers and outliers. 10379 case rate 6835.98 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 5537.14 percent of total billed charges 6457.07 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9152.62 other Inpatient DRG 6457.07 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9152.62 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 12688.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Respiratory System Diagnosis With Ventilator Support >96 Hours 207 MS-DRG inpatient 72789.7 72789.7 93248.9 Base payment rate plus any adjustments related to transfers and outliers. 93248.9 case rate 123374 case rate 123374 case rate 123374 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 99932.8 percent of total billed charges 46105.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 57918.4 other Inpatient DRG 46105.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 57918.4 other Inpatient DRG 72789.7 Service paid by case rate. 3506.66 other IP General Discharge 46105.6 123374 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Respiratory System Diagnosis With Ventilator Support <=96 Hours 208 MS-DRG inpatient 27228 27228 36926.6 Base payment rate plus any adjustments related to transfers and outliers. 36926.6 case rate 23995.4 Base payment rate plus any adjustments related to transfers and outliers. 21512.5 case rate 27228 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 22054.7 percent of total billed charges 19133.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 26959.5 other Inpatient DRG 19133.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 26959.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 36926.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Concomitant Aortic And Mitral Valve Procedures 212 MS-DRG inpatient 92667.8 92667.8 77652.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 109160 other Inpatient DRG 77652.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 109160 other Inpatient DRG 92667.8 Service paid by case rate. 3506.66 other IP General Discharge 77652.4 92667.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Heart Assist System Implant 215 MS-DRG inpatient 85257.7 85257.7 75521.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 106167 other Inpatient DRG 75521.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 106167 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 85257.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC 216 MS-DRG inpatient 170737 170737 68793.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 96716.1 other Inpatient DRG 68793.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 96716.1 other Inpatient DRG 170737 Service paid by case rate. 3506.66 other IP General Discharge 68793.7 170737 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc 217 MS-DRG inpatient 72855.4 72855.4 46032.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 64743.2 other Inpatient DRG 46032.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 64743.2 other Inpatient DRG 72855.4 Service paid by case rate. 3506.66 other IP General Discharge 46032.1 72855.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC 219 MS-DRG inpatient 78363.1 78363.1 55153.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 75943.1 other Inpatient DRG 55153.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 75943.1 other Inpatient DRG 78363.1 Service paid by case rate. 3506.66 other IP General Discharge 55153.9 78363.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc 220 MS-DRG inpatient 85288.2 85288.2 37755.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 53116.6 other Inpatient DRG 37755.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 53116.6 other Inpatient DRG 85288.2 Service paid by case rate. 3506.66 other IP General Discharge 37755.1 85288.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC 221 MS-DRG inpatient 49656.2 49656.2 32736.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 46067.2 other Inpatient DRG 32736.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 46067.2 other Inpatient DRG 49656.2 Service paid by case rate. 3506.66 other IP General Discharge 32736.6 49656.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Cardiothoracic Procedures With McC 228 MS-DRG inpatient 47660.7 47660.7 35327.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 50826.7 other Inpatient DRG 35327.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 50826.7 other Inpatient DRG 47660.7 Service paid by case rate. 3506.66 other IP General Discharge 35327.6 47660.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Cardiothoracic Procedures Without McC 229 MS-DRG inpatient 44788 44788 22142.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 31185.2 other Inpatient DRG 22142.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 31185.2 other Inpatient DRG 44788 Service paid by case rate. 3506.66 other IP General Discharge 22142.1 44788 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Coronary Bypass With Ptca With McC 231 MS-DRG inpatient 147983 147983 60403.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 84930.3 other Inpatient DRG 60403.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 84930.3 other Inpatient DRG 147983 Service paid by case rate. 3506.66 other IP General Discharge 60403.4 147983 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Coronary Bypass With Ptca Without McC 232 MS-DRG inpatient 73736.1 73736.1 43543.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 61247.5 other Inpatient DRG 43543.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 61247.5 other Inpatient DRG 73736.1 Service paid by case rate. 3506.66 other IP General Discharge 43543.5 73736.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC 233 MS-DRG inpatient 77839.8 77839.8 106773 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 38340 other Inpatient DRG 106773 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 38340 other Inpatient DRG 77839.8 Service paid by case rate. 3506.66 other IP General Discharge 77839.8 106773 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC 234 MS-DRG inpatient 67576.2 67576.2 37923.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 53352.9 other Inpatient DRG 37923.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 53352.9 other Inpatient DRG 67576.2 Service paid by case rate. 3506.66 other IP General Discharge 37923.4 67576.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Coronary Bypass Without Cardiac Catheterization With McC 235 MS-DRG inpatient 58878.4 58878.4 41943.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 58828.4 other Inpatient DRG 41943.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 58828.4 other Inpatient DRG 58878.4 Service paid by case rate. 3506.66 other IP General Discharge 41943.2 58878.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Coronary Bypass Without Cardiac Catheterization Without McC 236 MS-DRG inpatient 49717.8 49717.8 29311.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 41255.7 other Inpatient DRG 29311.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 41255.7 other Inpatient DRG 49717.8 Service paid by case rate. 3506.66 other IP General Discharge 29311.3 49717.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC 239 MS-DRG inpatient 41678 41678 66040.7 Base payment rate plus any adjustments related to transfers and outliers. 66040.7 case rate 38507.3 case rate 38507.3 case rate 38507.3 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 31190.9 percent of total billed charges 35903.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 43877.2 other Inpatient DRG 35903.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 43877.2 other Inpatient DRG 41678 Service paid by case rate. 3506.66 other IP General Discharge 35903.1 66040.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc 240 MS-DRG inpatient 29490.2 29490.2 19696 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 28373.6 other Inpatient DRG 19696 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 28373.6 other Inpatient DRG 29490.2 Service paid by case rate. 3506.66 other IP General Discharge 19696 29490.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC 241 MS-DRG inpatient 21265.1 21265.1 10762.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15200.7 other Inpatient DRG 10762.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15200.7 other Inpatient DRG 21265.1 Service paid by case rate. 3506.66 other IP General Discharge 10762.7 21265.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Permanent Cardiac Pacemaker Implant With McC 242 MS-DRG inpatient 57216.7 57216.7 49330.7 Base payment rate plus any adjustments related to transfers and outliers. 49330.7 case rate 57216.7 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 46345.5 percent of total billed charges 24180.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 34048 other Inpatient DRG 24180.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 34048 other Inpatient DRG 57216.7 Service paid by case rate. 3506.66 other IP General Discharge 24180.2 57216.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Permanent Cardiac Pacemaker Implant With Cc 243 MS-DRG inpatient 54308.4 45889.1 33289.5 Base payment rate plus any adjustments related to transfers and outliers. 33289.5 case rate 54308.4 Base payment rate plus any adjustments related to transfers and outliers. case rate 45889.1 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 37170.1 percent of total billed charges 16058.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22639.7 other Inpatient DRG 16058.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22639.7 other Inpatient DRG 29674.3 Service paid by case rate. 3506.66 other IP General Discharge 16058.6 54308.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Permanent Cardiac Pacemaker Implant Without Cc/McC 244 MS-DRG inpatient 42533.8 42533.8 26999.4 Base payment rate plus any adjustments related to transfers and outliers. 26999.4 case rate 42533.8 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 34452.3 percent of total billed charges 12865 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18153.7 other Inpatient DRG 12865 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18153.7 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 42533.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Aicd Generator Procedures 245 MS-DRG inpatient 55674.7 55674.7 34833.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 49013.1 other Inpatient DRG 34833.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 49013.1 other Inpatient DRG 55674.7 Service paid by case rate. 3506.66 other IP General Discharge 34833.8 55674.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Percutaneous Cardiovascular Procedures Without Intraluminal Device With McC 250 MS-DRG inpatient 44869.8 44869.8 34364.6 Base payment rate plus any adjustments related to transfers and outliers. 34364.6 case rate 44869.8 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 36344.5 percent of total billed charges 16486.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23240.5 other Inpatient DRG 16486.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23240.5 other Inpatient DRG 17549 Service paid by case rate. 3506.66 other IP General Discharge 16486.3 44869.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Percutaneous Cardiovascular Procedures Without Intraluminal Device Without McC 251 MS-DRG inpatient 53710.3 53710.3 28423.4 Base payment rate plus any adjustments related to transfers. 21054.3 case rate 53710.3 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 43505.3 percent of total billed charges 11138.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15728.4 other Inpatient DRG 11138.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15728.4 other Inpatient DRG 17524.1 Service paid by case rate. 3506.66 other IP General Discharge 11138.4 53710.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Vascular Procedures With McC 252 MS-DRG inpatient 88717.9 88717.9 47481.6 Base payment rate plus any adjustments related to transfers and outliers. 47481.6 case rate 88717.9 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement." 71861.5 percent of total billed charges 24452.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 34430.5 other Inpatient DRG 24452.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 34430.5 other Inpatient DRG 33258.5 Service paid by case rate. 3506.66 other IP General Discharge 24452.5 88717.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Vascular Procedures With Cc 253 MS-DRG inpatient 72001.9 72001.9 37976.2 Base payment rate plus any adjustments related to transfers and outliers. 37976.2 case rate 72001.9 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 58321.6 percent of total billed charges 18198.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 25645.7 other Inpatient DRG 18198.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 25645.7 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 72001.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Vascular Procedures Without Cc/McC 254 MS-DRG inpatient 72736.5 72736.5 25968.4 Base payment rate plus any adjustments related to transfers and outliers. 25968.4 case rate 72736.5 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 58916.6 percent of total billed charges 12470 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17599 other Inpatient DRG 12470 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17599 other Inpatient DRG 28220.7 Service paid by case rate. 3506.66 other IP General Discharge 12470 72736.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Upper Limb And Toe Amputation For Circulatory System Disorders With McC 255 MS-DRG inpatient 30322.3 30322.3 36436.7 Base payment rate plus any adjustments related to transfers and outliers. 36436.7 case rate 30322.3 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 24561 percent of total billed charges 18650.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 26280.6 other Inpatient DRG 18650.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 26280.6 other Inpatient DRG 30322.3 Service paid by case rate. 3506.66 other IP General Discharge 18650.5 36436.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Upper Limb And Toe Amputation For Circulatory System Disorders With Cc 256 MS-DRG inpatient 30308.3 30308.3 12073 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17041.2 other Inpatient DRG 12073 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17041.2 other Inpatient DRG 30308.3 Service paid by case rate. 3506.66 other IP General Discharge 12073 30308.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cardiac Pacemaker Device Replacement With McC 258 MS-DRG inpatient 30303.2 30303.2 19998.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 28174.1 other Inpatient DRG 19998.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 28174.1 other Inpatient DRG 30303.2 Service paid by case rate. 3506.66 other IP General Discharge 19998.5 30303.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cardiac Pacemaker Device Replacement Without McC 259 MS-DRG inpatient 29346.6 29346.6 12529.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17682.1 other Inpatient DRG 12529.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17682.1 other Inpatient DRG 29346.6 Service paid by case rate. 3506.66 other IP General Discharge 12529.2 29346.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cardiac Pacemaker Revision Except Device Replacement With McC 260 MS-DRG inpatient 62416.3 62416.3 49687.1 Base payment rate plus any adjustments related to transfers and outliers. 49687.1 case rate 62416.3 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 50557.2 percent of total billed charges 24285.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 34196.2 other Inpatient DRG 24285.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 34196.2 other Inpatient DRG 57929.9 Service paid by case rate. 3506.66 other IP General Discharge 24285.7 62416.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cardiac Pacemaker Revision Except Device Replacement With Cc 261 MS-DRG inpatient 44176.6 44176.6 27137.2 Base payment rate plus any adjustments related to transfers and outliers. 27137.2 case rate 44176.6 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 35783.1 percent of total billed charges 13525.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19082 other Inpatient DRG 13525.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19082 other Inpatient DRG 26757.8 Service paid by case rate. 3506.66 other IP General Discharge 13525.8 44176.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC 262 MS-DRG inpatient 35743.1 35743.1 10819 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15279.8 other Inpatient DRG 10819 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15279.8 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 35743.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Vein Ligation And Stripping 263 MS-DRG inpatient 19406.5 19406.5 19808.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 28287 other Inpatient DRG 19808.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 28287 other Inpatient DRG 19406.5 Service paid by case rate. 3506.66 other IP General Discharge 19406.5 19808.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Circulatory System O.R. Procedures 264 MS-DRG inpatient 23019.4 23019.4 47004.4 Base payment rate plus any adjustments related to transfers and outliers. 47004.4 case rate 17370.6 case rate 17370.6 case rate 17370.6 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 14070.2 percent of total billed charges 24913.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 35078.4 other Inpatient DRG 24913.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 35078.4 other Inpatient DRG 23019.4 Service paid by case rate. 3506.66 other IP General Discharge 17370.6 47004.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Aicd Lead Procedures 265 MS-DRG inpatient 51972.6 51972.6 25427 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 35799.4 other Inpatient DRG 25427 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 35799.4 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 51972.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Endovascular Cardiac Valve Replacement And Supplement Procedures With McC 266 MS-DRG inpatient 77160.4 77160.4 42703.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 60066.9 other Inpatient DRG 42703.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 60066.9 other Inpatient DRG 77160.4 Service paid by case rate. 3506.66 other IP General Discharge 42703.1 77160.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC 267 MS-DRG inpatient 70362.4 70362.4 33535.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 47189.7 other Inpatient DRG 33535.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 47189.7 other Inpatient DRG 70362.4 Service paid by case rate. 3506.66 other IP General Discharge 33535.7 70362.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Aortic And Heart Assist Procedures Except Pulsation Balloon With McC 268 MS-DRG inpatient 52588.8 52588.8 47527.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 66844 other Inpatient DRG 47527.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 66844 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 52588.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC 269 MS-DRG inpatient 76001.4 76001.4 29657.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 41742.3 other Inpatient DRG 29657.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 41742.3 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 76001.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Major Cardiovascular Procedures With McC 270 MS-DRG inpatient 32537.3 32537.3 72609.1 Base payment rate plus any adjustments related to transfers and outliers. 72609.1 case rate 32537.3 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 26355.2 percent of total billed charges 36589.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 51479.4 other Inpatient DRG 36589.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 51479.4 other Inpatient DRG 30355.8 Service paid by case rate. 3506.66 other IP General Discharge 30355.8 72609.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Major Cardiovascular Procedures With Cc 271 MS-DRG inpatient 48387.7 48387.7 49476.9 Base payment rate plus any adjustments related to transfers and outliers. 49476.9 case rate 17172.3 case rate 17172.3 case rate 17172.3 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 13909.6 percent of total billed charges 24553.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 34572.7 other Inpatient DRG 24553.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 34572.7 other Inpatient DRG 48387.7 Service paid by case rate. 3506.66 other IP General Discharge 17172.3 49476.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Major Cardiovascular Procedures Without Cc/McC 272 MS-DRG inpatient 35524.9 35524.9 17835.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 25136.1 other Inpatient DRG 17835.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 25136.1 other Inpatient DRG 35524.9 Service paid by case rate. 3506.66 other IP General Discharge 17835.7 35524.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Percutaneous And Other Intracardiac Procedures With McC 273 MS-DRG inpatient 52375.3 52375.3 56992.6 Base payment rate plus any adjustments related to transfers and outliers. 56992.6 case rate 122538 case rate 122538 case rate 122538 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 99255.6 percent of total billed charges 27872.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 39235 other Inpatient DRG 27872.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 39235 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 122538 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Percutaneous And Other Intracardiac Procedures Without McC 274 MS-DRG inpatient 49208.5 49208.5 47711.6 Base payment rate plus any adjustments related to transfers and outliers. 47711.6 case rate 123657 Base payment rate plus any adjustments related to transfers and outliers. 115001 case rate 123657 case rate 123657 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 100162 percent of total billed charges 22246.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 31332.4 other Inpatient DRG 22246.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 31332.4 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 123657 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cardiac Defibrillator Implant With Cardiac Catheterization And McC 275 MS-DRG inpatient 54145.3 54145.3 50374.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 70842.4 other Inpatient DRG 50374.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 70842.4 other Inpatient DRG 54145.3 Service paid by case rate. 3506.66 other IP General Discharge 50374.2 54145.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cardiac Defibrillator Implant With McC Or Carotid Sinus Neurostimulator 276 MS-DRG inpatient 70940.3 70940.3 157047 case rate 157047 case rate 157047 case rate 157047 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 127208 percent of total billed charges 44154.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 62105.7 other Inpatient DRG 44154.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 62105.7 other Inpatient DRG 70940.3 Service paid by case rate. 3506.66 other IP General Discharge 44154.5 157047 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cardiac Defibrillator Implant Without McC 277 MS-DRG inpatient 64333.5 64333.5 138440 case rate 138440 case rate 138440 case rate 138440 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 112137 percent of total billed charges 33163.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 46666.9 other Inpatient DRG 33163.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 46666.9 other Inpatient DRG 64333.5 Service paid by case rate. 3506.66 other IP General Discharge 33163.6 138440 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without McC 279 MS-DRG inpatient 36142.8 36142.8 36142.8 28117.1 case rate 36142.8 case rate 36142.8 Base payment rate plus any adjustments related to transfers and outliers. 28117.1 case rate 36142.8 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement." 29275.7 percent of total billed charges 22841.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 32167.5 other Inpatient DRG 22841.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 32167.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 36142.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Acute Myocardial Infarction, Discharged Alive With McC" 280 MS-DRG inpatient 26006.6 26006.6 22814.1 Base payment rate plus any adjustments related to transfers and outliers. 22814.1 case rate 22753.8 case rate 20416.3 Base payment rate plus any adjustments related to transfers and outliers. 20411.4 case rate 22753.8 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 18430.6 percent of total billed charges 11701.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16519.5 other Inpatient DRG 11701.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16519.5 other Inpatient DRG 26006.6 Service paid by case rate. 3506.66 other IP General Discharge 11701.6 26006.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Acute Myocardial Infarction, Discharged Alive With Cc" 281 MS-DRG inpatient 17606.8 17606.8 13046 Base payment rate plus any adjustments related to transfers and outliers. 13046 case rate 17606.8 case rate 15606.7 Base payment rate plus any adjustments related to transfers and outliers. 15606.7 case rate 17606.8 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 14261.5 percent of total billed charges 6571.13 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9312.83 other Inpatient DRG 6571.13 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9312.83 other Inpatient DRG 16895.8 Service paid by case rate. 3506.66 other IP General Discharge 6571.13 17606.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Acute Myocardial Infarction, Discharged Alive Without Cc/McC" 282 MS-DRG inpatient 19379.9 17150.7 10178.6 Base payment rate plus any adjustments related to transfers and outliers. 10178.6 case rate 17150.7 case rate 19379.9 Base payment rate plus any adjustments related to transfers and outliers. 16856.9 case rate 17150.7 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 13892.1 percent of total billed charges 5168.94 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7343.2 other Inpatient DRG 5168.94 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7343.2 other Inpatient DRG 17150.7 Service paid by case rate. 3506.66 other IP General Discharge 5168.94 19379.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Acute Myocardial Infarction, Expired With McC" 283 MS-DRG inpatient 17479.5 17479.5 27248 Base payment rate plus any adjustments related to transfers and outliers. 27248 case rate 17479.5 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 14158.4 percent of total billed charges 13939.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19662.7 other Inpatient DRG 13939.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19662.7 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 27248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Acute Myocardial Infarction, Expired With Cc" 284 MS-DRG inpatient 8666.38 8666.38 5281.57 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7501.4 other Inpatient DRG 5281.57 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7501.4 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 8666.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Circulatory Disorders Except Ami, With Cardiac Catheterization With McC" 286 MS-DRG inpatient 28373.2 28373.2 30122.4 Base payment rate plus any adjustments related to transfers and outliers. 30122.4 case rate 26675.5 case rate 24389.6 Base payment rate plus any adjustments related to transfers and outliers. 21517.1 case rate 26675.5 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 21607.1 percent of total billed charges 15777.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22245.2 other Inpatient DRG 15777.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22245.2 other Inpatient DRG 28373.2 Service paid by case rate. 3506.66 other IP General Discharge 15777.7 30122.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC" 287 MS-DRG inpatient 23775.4 23775.4 15625 Base payment rate plus any adjustments related to transfers and outliers. 15625 case rate 22434.7 case rate 14749.9 Base payment rate plus any adjustments related to transfers and outliers. 14749.9 case rate 22434.7 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 18172.1 percent of total billed charges 7767.31 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10993.1 other Inpatient DRG 7767.31 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10993.1 other Inpatient DRG 23775.4 Service paid by case rate. 3506.66 other IP General Discharge 7767.31 23775.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Acute And Subacute Endocarditis With McC 288 MS-DRG inpatient 10235.8 10235.8 38295.7 Base payment rate plus any adjustments related to transfers and outliers. 38295.7 case rate 10235.8 93 "Additional drugs, labs, and other services can be included in reimbursement." 8290.93 percent of total billed charges 19470.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 27432.2 other Inpatient DRG 19470.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 27432.2 other Inpatient DRG 10235.8 Service paid by case rate. 3506.66 other IP General Discharge 10235.8 38295.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Acute And Subacute Endocarditis With Cc 289 MS-DRG inpatient 18781.3 18781.3 11238.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15869.6 other Inpatient DRG 11238.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15869.6 other Inpatient DRG 18781.3 Service paid by case rate. 3506.66 other IP General Discharge 11238.9 18781.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Acute And Subacute Endocarditis Without Cc/McC 290 MS-DRG inpatient 21218.1 21218.1 6978.89 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9885.6 other Inpatient DRG 6978.89 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9885.6 other Inpatient DRG 21218.1 Service paid by case rate. 3506.66 other IP General Discharge 6978.89 21218.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Heart Failure And Shock With McC 291 MS-DRG inpatient 15575.5 15575.5 18175.7 Base payment rate plus any adjustments related to transfers and outliers. 18175.7 case rate 15483.6 case rate 14597.7 Base payment rate plus any adjustments related to transfers and outliers. 12305.4 case rate 15483.6 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 12541.7 percent of total billed charges 9302.09 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13149 other Inpatient DRG 9302.09 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13149 other Inpatient DRG 15575.5 Service paid by case rate. 3506.66 other IP General Discharge 9302.09 18175.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Heart Failure And Shock With Cc 292 MS-DRG inpatient 5839.78 5839.78 12253.5 Base payment rate plus any adjustments related to transfers and outliers. 4299.47 case rate 5839.78 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 4730.21 percent of total billed charges 6005.14 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8016.89 other Inpatient DRG 6005.14 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8016.89 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 12253.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Heart Failure And Shock Without Cc/McC 293 MS-DRG inpatient 9645.03 9645.03 3913.59 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers. Additional labs, radiology services, and other services can be included in reimbursement." 6759.07 other Inpatient DRG 3913.59 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers. Additional labs, radiology services, and other services can be included in reimbursement." 6759.07 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 9645.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Deep Vein Thrombophlebitis With Cc/McC 294 MS-DRG inpatient 28642.3 28642.3 8753.19 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12377.9 other Inpatient DRG 8753.19 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12377.9 other Inpatient DRG 28642.3 Service paid by case rate. 3506.66 other IP General Discharge 8753.19 28642.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Cardiac Arrest, Unexplained With McC" 296 MS-DRG inpatient 48631.1 48631.1 23267.1 Base payment rate plus any adjustments related to transfers and outliers. 23267.1 case rate 48631.1 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 39391.1 percent of total billed charges 11678.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16487.5 other Inpatient DRG 11678.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16487.5 other Inpatient DRG 17211.9 Service paid by case rate. 3506.66 other IP General Discharge 11678.8 48631.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Cardiac Arrest, Unexplained With Cc" 297 MS-DRG inpatient 18661.4 18661.4 5021.38 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7135.91 other Inpatient DRG 5021.38 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7135.91 other Inpatient DRG 18661.4 Service paid by case rate. 3506.66 other IP General Discharge 5021.38 18661.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Peripheral Vascular Disorders With McC 299 MS-DRG inpatient 9633.06 9633.06 21842.7 Base payment rate plus any adjustments related to transfers and outliers. 21842.7 case rate 9633.06 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 7802.77 percent of total billed charges 11531.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16281.2 other Inpatient DRG 11531.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16281.2 other Inpatient DRG 13016.2 Service paid by case rate. 3506.66 other IP General Discharge 9633.06 21842.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Peripheral Vascular Disorders With Cc 300 MS-DRG inpatient 20546.7 19002.5 14643.7 Base payment rate plus any adjustments related to transfers and outliers. 14643.7 case rate 20546.7 Base payment rate plus any adjustments related to transfers and outliers. 14643.7 case rate 19002.5 case rate 19002.5 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 15392 percent of total billed charges 7631.15 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10801.8 other Inpatient DRG 7631.15 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10801.8 other Inpatient DRG 16336.9 Service paid by case rate. 3506.66 other IP General Discharge 7631.15 20546.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Peripheral Vascular Disorders Without Cc/McC 301 MS-DRG inpatient 4898.33 4898.33 5084.82 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7225.03 other Inpatient DRG 5084.82 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7225.03 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 5084.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Atherosclerosis With McC 302 MS-DRG inpatient 4978.97 4978.97 8291.97 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11730.1 other Inpatient DRG 8291.97 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11730.1 other Inpatient DRG 4978.97 Service paid by case rate. 3506.66 other IP General Discharge 4978.97 8291.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Atherosclerosis Without McC 303 MS-DRG inpatient 12190.2 12190.2 12190.2 74 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 9020.77 percent of total billed charges 12190.2 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 9874.08 percent of total billed charges 349.4 "Additional labs, radiology services, and other services can be included in reimbursement." 970 fee schedule 349.4 "Additional labs, radiology services, and other services can be included in reimbursement." 970 fee schedule 11953 51 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 5266.36 percent of total billed charges 349.4 12190.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hypertension With McC 304 MS-DRG inpatient 15263.8 15263.8 15602.3 Base payment rate plus any adjustments related to transfers and outliers. 15602.3 case rate 15184 case rate 15184 case rate 15184 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 12299 percent of total billed charges 8374.66 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11846.2 other Inpatient DRG 8374.66 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11846.2 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 15602.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hypertension Without McC 305 MS-DRG inpatient 7086.54 11563.8 10589 Base payment rate plus any adjustments related to transfers and outliers. 10589 case rate 10425.6 case rate 7086.54 Base payment rate plus any adjustments related to transfers and outliers. 6509 case rate 10425.6 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 8444.75 percent of total billed charges 5351.43 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7599.53 other Inpatient DRG 5351.43 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7599.53 other Inpatient DRG 11563.8 Service paid by case rate. 3506.66 other IP General Discharge 5351.43 11563.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cardiac Congenital And Valvular Disorders With McC 306 MS-DRG inpatient 15557.7 15557.7 10674.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15076.6 other Inpatient DRG 10674.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15076.6 other Inpatient DRG 15557.7 Service paid by case rate. 3506.66 other IP General Discharge 10674.3 15557.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cardiac Congenital And Valvular Disorders Without McC 307 MS-DRG inpatient 9986.62 9986.62 6603.21 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9357.89 other Inpatient DRG 6603.21 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9357.89 other Inpatient DRG 9986.62 Service paid by case rate. 3506.66 other IP General Discharge 6603.21 9986.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cardiac Arrhythmia And Conduction Disorders With McC 308 MS-DRG inpatient 18041.9 18041.9 16653.3 Base payment rate plus any adjustments related to transfers and outliers. 16653.3 case rate 16411.4 case rate 16411.4 case rate 16411.4 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 13293.3 percent of total billed charges 206.88 "Additional labs, radiology services, therapy services, and other services can be included in reimbursement." 1346.42 fee schedule 206.88 "Additional labs, radiology services, therapy services, and other services can be included in reimbursement." 1346.42 fee schedule 18041.9 Service paid by case rate. 3506.66 other IP General Discharge 206.88 18041.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cardiac Arrhythmia And Conduction Disorders With Cc 309 MS-DRG inpatient 11784.1 11784.1 10475.4 Base payment rate plus any adjustments related to transfers and outliers. 10475.4 case rate 11784.1 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 9545.13 percent of total billed charges 5270.16 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7485.38 other Inpatient DRG 5270.16 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7485.38 other Inpatient DRG 11358.8 Service paid by case rate. 3506.66 other IP General Discharge 5270.16 11784.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cardiac Arrhythmia And Conduction Disorders Without Cc/McC 310 MS-DRG inpatient 5491.76 11839.8 7828.14 Base payment rate plus any adjustments related to transfers and outliers. 7828.14 case rate 10854.2 case rate 5491.76 Base payment rate plus any adjustments related to transfers and outliers. 4914.18 case rate 10854.2 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 8791.94 percent of total billed charges 3988.44 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 5684.96 other Inpatient DRG 3988.44 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 5684.96 other Inpatient DRG 11839.8 Service paid by case rate. 3506.66 other IP General Discharge 3988.44 11839.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Angina Pectoris 311 MS-DRG inpatient 8906.06 8906.06 9488.36 Base payment rate plus any adjustments related to transfers and outliers. 9488.36 case rate 8906.06 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 7213.9 percent of total billed charges 4979.32 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7076.83 other Inpatient DRG 4979.32 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7076.83 other Inpatient DRG 11271.8 Service paid by case rate. 3506.66 other IP General Discharge 4979.32 11271.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Syncope And Collapse 312 MS-DRG inpatient 16037.7 16037.7 12110 Base payment rate plus any adjustments related to transfers and outliers. 12110 case rate 16037.7 case rate 11549.7 Base payment rate plus any adjustments related to transfers and outliers. 8563.82 case rate 16037.7 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 12990.5 percent of total billed charges 6054.22 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8778.67 other Inpatient DRG 6054.22 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8778.67 other Inpatient DRG 16037.7 Service paid by case rate. 3506.66 other IP General Discharge 6054.22 16037.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Chest Pain 313 MS-DRG inpatient 12902.3 12902.3 10273.7 Base payment rate plus any adjustments related to transfers and outliers. 10273.7 case rate 12902.3 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 10450.8 percent of total billed charges 5073.34 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7369.74 other Inpatient DRG 5073.34 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7369.74 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 12902.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Circulatory System Diagnoses With McC 314 MS-DRG inpatient 6190.95 19969.3 29577.1 Base payment rate plus any adjustments related to transfers and outliers. 29577.1 case rate 19716.3 case rate 19716.3 93 "Additional drugs, labs, therapy services, and other services can be included in reimbursement." 15970.2 percent of total billed charges 15350.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21645.4 other Inpatient DRG 15350.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21645.4 other Inpatient DRG 19969.3 Service paid by case rate. 3506.66 other IP General Discharge 6190.95 29577.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Circulatory System Diagnoses With Cc 315 MS-DRG inpatient 15307.7 15307.7 13754.6 Base payment rate plus any adjustments related to transfers and outliers. 13754.6 case rate 15307.7 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 12399.3 percent of total billed charges 6859.84 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9718.37 other Inpatient DRG 6859.84 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9718.37 other Inpatient DRG 13900.5 Service paid by case rate. 3506.66 other IP General Discharge 6859.84 15307.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Circulatory System Diagnoses Without Cc/McC 316 MS-DRG inpatient 10634.4 10634.4 4865.97 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6917.62 other Inpatient DRG 4865.97 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6917.62 other Inpatient DRG 10634.4 Service paid by case rate. 3506.66 other IP General Discharge 4865.97 10634.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Endovascular Cardiac Valve Procedures With McC 319 MS-DRG inpatient 32262.8 32262.8 31312.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 44066.5 other Inpatient DRG 31312.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 44066.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 32262.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Endovascular Cardiac Valve Procedures Without McC 320 MS-DRG inpatient 34216.7 34216.7 16499.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23259.5 other Inpatient DRG 16499.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23259.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 34216.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Percutaneous Cardiovascular Procedures With Intraluminal Device With McC Or 4+ Arteries/Intraluminal Devices 321 MS-DRG inpatient 69955.4 69955.4 153117 45953.7 case rate 69955.4 case rate 153117 Base payment rate plus any adjustments related to transfers and outliers. 45953.7 case rate 69955.4 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 56663.9 percent of total billed charges 20292.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 28587.7 other Inpatient DRG 20292.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 28587.7 other Inpatient DRG 68843.7 Service paid by case rate. 3506.66 other IP General Discharge 20292.9 153117 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Percutaneous Cardiovascular Procedures With Intraluminal Device Without McC 322 MS-DRG inpatient 56591.5 56591.5 41158.9 34692.9 case rate 50921.4 Base payment rate plus any adjustments related to transfers and outliers. 24823.8 case rate 41158.9 Base payment rate plus any adjustments related to transfers and outliers. 34692.9 case rate 54770.3 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 44363.9 percent of total billed charges 12896.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18197.8 other Inpatient DRG 12896.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18197.8 other Inpatient DRG 56591.5 Service paid by case rate. 3506.66 other IP General Discharge 12896.3 56591.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Coronary Intravascular Lithotripsy With Intraluminal Device With McC 323 MS-DRG inpatient 70015 70015 70015 case rate 70015 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 56712.2 percent of total billed charges 30362.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 42731.7 other Inpatient DRG 30362.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 42731.7 other Inpatient DRG 63185.5 Service paid by case rate. 3506.66 other IP General Discharge 30362.1 70015 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Coronary Intravascular Lithotripsy With Intraluminal Device Without McC 324 MS-DRG inpatient 113092 113092 113092 case rate 113092 93 "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement." 91604.5 percent of total billed charges 22775.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 32075.4 other Inpatient DRG 22775.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 32075.4 other Inpatient DRG 113092 Service paid by case rate. 3506.66 other IP General Discharge 22775.8 113092 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Stomach, Esophageal And Duodenal Procedures With McC" 326 MS-DRG inpatient 77472.6 77472.6 72697.2 Base payment rate plus any adjustments related to transfers and outliers. 72697.2 case rate 77472.6 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 62752.8 percent of total billed charges 36203.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 50937.7 other Inpatient DRG 36203.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 50937.7 other Inpatient DRG 64808 Service paid by case rate. 3506.66 other IP General Discharge 36203.9 77472.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Stomach, Esophageal And Duodenal Procedures With Cc" 327 MS-DRG inpatient 45453.8 45453.8 36375.6 Base payment rate plus any adjustments related to transfers and outliers. 36375.6 case rate 45453.8 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 36817.6 percent of total billed charges 17308.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 24396.1 other Inpatient DRG 17308.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 24396.1 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 45453.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Stomach, Esophageal And Duodenal Procedures Without Cc/McC" 328 MS-DRG inpatient 21379 21379 23542.7 Base payment rate plus any adjustments related to transfers and outliers. 14268.3 case rate 15927.8 case rate 15927.8 Base payment rate plus any adjustments related to transfers and outliers. 15924.2 case rate 15927.8 93 "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement." 12901.5 percent of total billed charges 11358.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16037.9 other Inpatient DRG 11358.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16037.9 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 23542.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Small And Large Bowel Procedures With McC 329 MS-DRG inpatient 63622.9 63622.9 65660.1 Base payment rate plus any adjustments related to transfers and outliers. 65660.1 case rate 63622.9 case rate 63622.9 Base payment rate plus any adjustments related to transfers and outliers. 55579.2 case rate 63622.9 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 51534.5 percent of total billed charges 32732.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 46061.1 other Inpatient DRG 32732.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 46061.1 other Inpatient DRG 60637.6 Service paid by case rate. 3506.66 other IP General Discharge 32732.3 65660.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Small And Large Bowel Procedures With Cc 330 MS-DRG inpatient 59483.2 59483.2 34871.6 Base payment rate plus any adjustments related to transfers and outliers. 34871.6 case rate 52897.4 case rate 52897.4 case rate 52897.4 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 42846.8 percent of total billed charges 16631.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23971.6 other Inpatient DRG 16631.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23971.6 other Inpatient DRG 59483.2 Service paid by case rate. 3506.66 other IP General Discharge 16631.4 59483.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Small And Large Bowel Procedures Without Cc/McC 331 MS-DRG inpatient 37927 37927 24268.4 Base payment rate plus any adjustments related to transfers and outliers. 9157.88 case rate 37927 case rate 24859.7 Base payment rate plus any adjustments related to transfers and outliers. 24472.7 case rate 37927 93 "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement." 30720.9 percent of total billed charges 11769.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16614.6 other Inpatient DRG 11769.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16614.6 other Inpatient DRG 37727.3 Service paid by case rate. 3506.66 other IP General Discharge 11769.3 37927 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Rectal Resection With McC 332 MS-DRG inpatient 34441.7 34441.7 24725.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 34814.1 other Inpatient DRG 24725.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 34814.1 other Inpatient DRG 34441.7 Service paid by case rate. 3506.66 other IP General Discharge 24725.5 34441.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Rectal Resection With Cc 333 MS-DRG inpatient 32638.5 32638.5 15149 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21362 other Inpatient DRG 15149 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21362 other Inpatient DRG 32638.5 Service paid by case rate. 3506.66 other IP General Discharge 15149 32638.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Rectal Resection Without Cc/McC 334 MS-DRG inpatient 30212.1 30212.1 11822 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16688.7 other Inpatient DRG 11822 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16688.7 other Inpatient DRG 30212.1 Service paid by case rate. 3506.66 other IP General Discharge 11822 30212.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Peritoneal Adhesiolysis With McC 335 MS-DRG inpatient 37914.7 37914.7 52317.3 Base payment rate plus any adjustments related to transfers and outliers. 52317.3 case rate 27084.7 case rate 27084.7 Base payment rate plus any adjustments related to transfers and outliers. 52317.3 case rate 27084.7 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 21938.6 percent of total billed charges 25833.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 34696.1 other Inpatient DRG 25833.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 34696.1 other Inpatient DRG 37914.7 Service paid by case rate. 3506.66 other IP General Discharge 25833.3 52317.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Peritoneal Adhesiolysis With Cc 336 MS-DRG inpatient 34665.1 34665.1 30207.7 Base payment rate plus any adjustments related to transfers and outliers. 30207.7 case rate 33999.9 case rate 18904.4 Base payment rate plus any adjustments related to transfers and outliers. 18412.4 case rate 33999.9 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 27540 percent of total billed charges 15058.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18090.7 other Inpatient DRG 15058.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18090.7 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 34665.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Peritoneal Adhesiolysis Without Cc/McC 337 MS-DRG inpatient 22837.2 22837.2 10491.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15152.5 other Inpatient DRG 10491.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15152.5 other Inpatient DRG 22837.2 Service paid by case rate. 3506.66 other IP General Discharge 10491.6 22837.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Minor Small And Large Bowel Procedures With McC 344 MS-DRG inpatient 36039.2 36039.2 19213.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 27680.8 other Inpatient DRG 19213.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 27680.8 other Inpatient DRG 36039.2 Service paid by case rate. 3506.66 other IP General Discharge 19213.6 36039.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Minor Small And Large Bowel Procedures With Cc 345 MS-DRG inpatient 27777.3 27777.3 10615.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14994.5 other Inpatient DRG 10615.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14994.5 other Inpatient DRG 27777.3 Service paid by case rate. 3506.66 other IP General Discharge 10615.9 27777.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Minor Small And Large Bowel Procedures Without Cc/McC 346 MS-DRG inpatient 14655.9 14655.9 8876.51 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12551.2 other Inpatient DRG 8876.51 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12551.2 other Inpatient DRG 14655.9 Service paid by case rate. 3506.66 other IP General Discharge 8876.51 14655.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Anal And Stomal Procedures With McC 347 MS-DRG inpatient 31837.2 31837.2 16870.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23780.2 other Inpatient DRG 16870.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23780.2 other Inpatient DRG 31837.2 Service paid by case rate. 3506.66 other IP General Discharge 16870.5 31837.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Anal And Stomal Procedures With Cc 348 MS-DRG inpatient 17399.3 17399.3 9124.44 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13188.7 other Inpatient DRG 9124.44 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13188.7 other Inpatient DRG 17399.3 Service paid by case rate. 3506.66 other IP General Discharge 9124.44 17399.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Anal And Stomal Procedures Without Cc/McC 349 MS-DRG inpatient 10138.8 10138.8 6279.57 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8903.28 other Inpatient DRG 6279.57 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8903.28 other Inpatient DRG 10138.8 Service paid by case rate. 3506.66 other IP General Discharge 6279.57 10138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Inguinal And Femoral Hernia Procedures With McC 350 MS-DRG inpatient 15209 15209 17249.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 24313 other Inpatient DRG 17249.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 24313 other Inpatient DRG 15209 Service paid by case rate. 3506.66 other IP General Discharge 15209 17249.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Inguinal And Femoral Hernia Procedures With Cc 351 MS-DRG inpatient 31337.5 31337.5 20879.8 Base payment rate plus any adjustments related to transfers and outliers. 20879.8 case rate 31337.5 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 25383.4 percent of total billed charges 10726.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15149.7 other Inpatient DRG 10726.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15149.7 other Inpatient DRG 26338.7 Service paid by case rate. 3506.66 other IP General Discharge 10726.4 31337.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Inguinal And Femoral Hernia Procedures Without Cc/McC 352 MS-DRG inpatient 39755.7 39755.7 15652 Base payment rate plus any adjustments related to transfers and outliers. 15652 case rate 39755.7 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 32202 percent of total billed charges 7859.27 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11122.3 other Inpatient DRG 7859.27 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11122.3 other Inpatient DRG 39755.7 Service paid by case rate. 3506.66 other IP General Discharge 7859.27 39755.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hernia Procedures Except Inguinal And Femoral With McC 353 MS-DRG inpatient 28222.4 28222.4 40728.5 Base payment rate plus any adjustments related to transfers and outliers. 40728.5 case rate 28222.4 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 22860.2 percent of total billed charges 20906.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 29449.8 other Inpatient DRG 20906.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 29449.8 other Inpatient DRG 28222.4 Service paid by case rate. 3506.66 other IP General Discharge 20906.7 40728.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hernia Procedures Except Inguinal And Femoral With Cc 354 MS-DRG inpatient 33776.2 33776.2 24881.9 Base payment rate plus any adjustments related to transfers and outliers. 24881.9 case rate 33776.2 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 27358.7 percent of total billed charges 12126.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17116.3 other Inpatient DRG 12126.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17116.3 other Inpatient DRG 33660.9 Service paid by case rate. 3506.66 other IP General Discharge 12126.4 33776.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hernia Procedures Except Inguinal And Femoral Without Cc/McC 355 MS-DRG inpatient 41548.1 41548.1 19489.4 Base payment rate plus any adjustments related to transfers and outliers. 19489.4 case rate 41548.1 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 33654 percent of total billed charges 9503.12 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13431.4 other Inpatient DRG 9503.12 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13431.4 other Inpatient DRG 16190.2 Service paid by case rate. 3506.66 other IP General Discharge 9503.12 41548.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Digestive System O.R. Procedures With McC 356 MS-DRG inpatient 26372.4 26372.4 30406.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 42793.8 other Inpatient DRG 30406.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 42793.8 other Inpatient DRG 26372.4 Service paid by case rate. 3506.66 other IP General Discharge 26372.4 30406.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Digestive System O.R. Procedures With Cc 357 MS-DRG inpatient 25924.7 25924.7 31900.5 Base payment rate plus any adjustments related to transfers and outliers. 31900.5 case rate 23663 Base payment rate plus any adjustments related to transfers and outliers. 23663 case rate 25924.7 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 20999 percent of total billed charges 16052.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22631.7 other Inpatient DRG 16052.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22631.7 other Inpatient DRG 24706.4 Service paid by case rate. 3506.66 other IP General Discharge 16052.9 31900.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Digestive System O.R. Procedures Without Cc/McC 358 MS-DRG inpatient 14242.1 14242.1 9659.23 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13650.7 other Inpatient DRG 9659.23 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13650.7 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 14242.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Esophageal Disorders With McC 368 MS-DRG inpatient 21721.1 21721.1 24913.2 Base payment rate plus any adjustments related to transfers and outliers. 24913.2 case rate 19077.5 case rate 19077.5 case rate 19077.5 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 15452.8 percent of total billed charges 11904 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16803.9 other Inpatient DRG 11904 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16803.9 other Inpatient DRG 21721.1 Service paid by case rate. 3506.66 other IP General Discharge 11904 24913.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Esophageal Disorders With Cc 369 MS-DRG inpatient 15970.3 15970.3 14515.9 Base payment rate plus any adjustments related to transfers and outliers. 14515.9 case rate 15970.3 Base payment rate plus any adjustments related to transfers and outliers. 15038.4 case rate 15970.3 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 12936 percent of total billed charges 7254.05 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10272.1 other Inpatient DRG 7254.05 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10272.1 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 15970.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Esophageal Disorders Without Cc/McC 370 MS-DRG inpatient 14382.3 14382.3 10633 Base payment rate plus any adjustments related to transfers and outliers. 10633 case rate 13708.6 case rate 13708.6 case rate 14382.3 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 11649.7 percent of total billed charges 4975.04 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7070.82 other Inpatient DRG 4975.04 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7070.82 other Inpatient DRG 14382.3 Service paid by case rate. 3506.66 other IP General Discharge 4975.04 14382.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Gastrointestinal Disorders And Peritoneal Infections With McC 371 MS-DRG inpatient 37613.2 37613.2 24026.9 Base payment rate plus any adjustments related to transfers and outliers. 24026.9 case rate 37613.2 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 30466.7 percent of total billed charges 12462.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17588.9 other Inpatient DRG 12462.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17588.9 other Inpatient DRG 20226.4 Service paid by case rate. 3506.66 other IP General Discharge 12462.9 37613.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Gastrointestinal Disorders And Peritoneal Infections With Cc 372 MS-DRG inpatient 17211.5 17211.5 14457.6 Base payment rate plus any adjustments related to transfers and outliers. 14457.6 case rate 14332.5 case rate 14332.5 case rate 14332.5 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 11609.3 percent of total billed charges 7337.45 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10389.3 other Inpatient DRG 7337.45 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10389.3 other Inpatient DRG 17211.5 Service paid by case rate. 3506.66 other IP General Discharge 7337.45 17211.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC 373 MS-DRG inpatient 8016.03 8016.03 10310.7 Base payment rate plus any adjustments related to transfers and outliers. 10310.7 case rate 15901.8 case rate 15901.8 Base payment rate plus any adjustments related to transfers and outliers. 13050.5 case rate 15901.8 93 "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement." 12880.5 percent of total billed charges 5023.56 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7298.25 other Inpatient DRG 5023.56 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7298.25 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 15901.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Digestive Malignancy With McC 374 MS-DRG inpatient 22418.6 22418.6 15052 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21225.8 other Inpatient DRG 15052 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21225.8 other Inpatient DRG 22418.6 Service paid by case rate. 3506.66 other IP General Discharge 15052 22418.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Digestive Malignancy With Cc 375 MS-DRG inpatient 34302.3 34302.3 8401.58 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12045.3 other Inpatient DRG 8401.58 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12045.3 other Inpatient DRG 34302.3 Service paid by case rate. 3506.66 other IP General Discharge 8401.58 34302.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Digestive Malignancy Without Cc/McC 376 MS-DRG inpatient 4980.87 4980.87 15966.1 Base payment rate plus any adjustments related to transfers. 3894.17 case rate 3362.35 case rate 3362.35 Base payment rate plus any adjustments related to transfers and outliers. 2304.37 case rate 3362.35 93 Additional drugs and other services can be included in reimbursement. 2723.51 percent of total billed charges 6293.83 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8923.3 other Inpatient DRG 6293.83 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8923.3 other Inpatient DRG 3506.66 3506.66 case rate 3362.35 15966.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Gastrointestinal Hemorrhage With McC 377 MS-DRG inpatient 29644.1 23481 25251.2 Base payment rate plus any adjustments related to transfers and outliers. 25251.2 case rate 23481 case rate 29644.1 Base payment rate plus any adjustments related to transfers and outliers. 29639.5 case rate 23481 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 19019.6 percent of total billed charges 12960.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18287.9 other Inpatient DRG 12960.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18287.9 other Inpatient DRG 23306 Service paid by case rate. 3506.66 other IP General Discharge 12960.5 29644.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Gastrointestinal Hemorrhage With Cc 378 MS-DRG inpatient 17840.9 17840.9 13989 Base payment rate plus any adjustments related to transfers and outliers. 13989 case rate 13655.4 Base payment rate plus any adjustments related to transfers and outliers. 13655.4 case rate 17840.9 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement." 14451.1 percent of total billed charges 7028.07 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9954.69 other Inpatient DRG 7028.07 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9954.69 other Inpatient DRG 17840.9 Service paid by case rate. 3506.66 other IP General Discharge 7028.07 17840.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Gastrointestinal Hemorrhage Without Cc/McC 379 MS-DRG inpatient 6763.17 6763.17 4439.52 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6386.36 other Inpatient DRG 4439.52 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6386.36 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 6763.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Complicated Peptic Ulcer With McC 380 MS-DRG inpatient 22352.8 22352.8 13717.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19351.3 other Inpatient DRG 13717.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19351.3 other Inpatient DRG 22352.8 Service paid by case rate. 3506.66 other IP General Discharge 13717.5 22352.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Complicated Peptic Ulcer With Cc 381 MS-DRG inpatient 18230.3 18230.3 14990.2 Base payment rate plus any adjustments related to transfers and outliers. 14990.2 case rate 18230.3 93 "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement." 14766.6 percent of total billed charges 7763.74 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10988.1 other Inpatient DRG 7763.74 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10988.1 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 18230.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Complicated Peptic Ulcer Without Cc/McC 382 MS-DRG inpatient 10015.6 10015.6 5308.22 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7707.13 other Inpatient DRG 5308.22 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7707.13 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 10015.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Uncomplicated Peptic Ulcer With McC 383 MS-DRG inpatient 26102.4 26102.4 9011.96 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12741.4 other Inpatient DRG 9011.96 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12741.4 other Inpatient DRG 26102.4 Service paid by case rate. 3506.66 other IP General Discharge 9011.96 26102.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Uncomplicated Peptic Ulcer Without McC 384 MS-DRG inpatient 15120.1 15120.1 6199.02 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8790.13 other Inpatient DRG 6199.02 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8790.13 other Inpatient DRG 15120.1 Service paid by case rate. 3506.66 other IP General Discharge 6199.02 15120.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Inflammatory Bowel Disease With McC 385 MS-DRG inpatient 10441.6 10441.6 11581.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16351.3 other Inpatient DRG 11581.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16351.3 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 11581.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Inflammatory Bowel Disease With Cc 386 MS-DRG inpatient 19995.2 16481.6 14057.1 Base payment rate plus any adjustments related to transfers and outliers. 14057.1 case rate 19995.2 Base payment rate plus any adjustments related to transfers and outliers. 18595.5 case rate 10233.6 Base payment rate plus any adjustments related to transfers and outliers. 8966.25 case rate 10233.6 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 8289.27 percent of total billed charges 6812.13 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9867.34 other Inpatient DRG 6812.13 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9867.34 other Inpatient DRG 16481.6 Service paid by case rate. 3506.66 other IP General Discharge 6812.13 19995.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Inflammatory Bowel Disease Without Cc/McC 387 MS-DRG inpatient 9253.37 9253.37 9822.1 Base payment rate plus any adjustments related to transfers and outliers. 9822.1 case rate 9253.37 Base payment rate plus any adjustments related to transfers and outliers. 8666.67 case rate 9253.37 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 7495.22 percent of total billed charges 4778.29 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6794.45 other Inpatient DRG 4778.29 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6794.45 other Inpatient DRG 9253.37 Service paid by case rate. 3506.66 other IP General Discharge 4778.29 9822.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Gastrointestinal Obstruction With McC 388 MS-DRG inpatient 15804.1 15804.1 26034 Base payment rate plus any adjustments related to transfers. 4974.65 case rate 15804.1 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 12801.3 percent of total billed charges 10479 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14416.1 other Inpatient DRG 10479 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14416.1 other Inpatient DRG 15804.1 Service paid by case rate. 3506.66 other IP General Discharge 10479 26034 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Gastrointestinal Obstruction With Cc 389 MS-DRG inpatient 6913.19 12184.2 11462.4 Base payment rate plus any adjustments related to transfers and outliers. 11462.4 case rate 11859.6 case rate 6913.19 Base payment rate plus any adjustments related to transfers and outliers. 6913.19 case rate 11859.6 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 9606.3 percent of total billed charges 5714.99 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8110.22 other Inpatient DRG 5714.99 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8110.22 other Inpatient DRG 12184.2 Service paid by case rate. 3506.66 other IP General Discharge 5714.99 12184.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Gastrointestinal Obstruction Without Cc/McC 390 MS-DRG inpatient 8924.66 8924.66 8031.23 Base payment rate plus any adjustments related to transfers and outliers. 8031.23 case rate 8015.47 Base payment rate plus any adjustments related to transfers and outliers. 7265.81 case rate 8924.66 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 7228.96 percent of total billed charges 3900.05 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 5560.8 other Inpatient DRG 3900.05 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 5560.8 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 8924.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC" 391 MS-DRG inpatient 18074.1 18074.1 18235.4 Base payment rate plus any adjustments related to transfers and outliers. 18235.4 case rate 18074.1 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 14640.1 percent of total billed charges 9159.52 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12948.7 other Inpatient DRG 9159.52 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12948.7 other Inpatient DRG 17482.6 Service paid by case rate. 3506.66 other IP General Discharge 9159.52 18235.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC" 392 MS-DRG inpatient 32950 11734.2 11185.5 Base payment rate plus any adjustments related to transfers and outliers. 11185.5 case rate 10172.5 Base payment rate plus any adjustments related to transfers and outliers. 10695.2 case rate 32950 Base payment rate plus any adjustments related to transfers and outliers. 9726.81 case rate 11684 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 9464.04 percent of total billed charges 5508.04 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7994.15 other Inpatient DRG 5508.04 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7994.15 other Inpatient DRG 11734.2 Service paid by case rate. 3506.66 other IP General Discharge 5508.04 32950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Digestive System Diagnoses With McC 393 MS-DRG inpatient 22677.5 19238.1 29009.1 Base payment rate plus any adjustments related to transfers. 11840.4 case rate 16890.6 case rate 22677.5 Base payment rate plus any adjustments related to transfers and outliers. 21237.3 case rate 16890.6 93 "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement." 13681.4 percent of total billed charges 11355.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16393.3 other Inpatient DRG 11355.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16393.3 other Inpatient DRG 19238.1 Service paid by case rate. 3506.66 other IP General Discharge 11355.4 29009.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Digestive System Diagnoses With Cc 394 MS-DRG inpatient 14900.5 14900.5 13392.5 Base payment rate plus any adjustments related to transfers and outliers. 13392.5 case rate 12205.3 Base payment rate plus any adjustments related to transfers and outliers. 11061 case rate 14900.5 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 12069.4 percent of total billed charges 6568.84 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9517.88 other Inpatient DRG 6568.84 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9517.88 other Inpatient DRG 12205.3 Service paid by case rate. 3506.66 other IP General Discharge 6568.84 14900.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Digestive System Diagnoses Without Cc/McC 395 MS-DRG inpatient 6889.61 6889.61 24268.4 Base payment rate plus any adjustments related to transfers and outliers. 24268.4 case rate 39208.4 case rate 39208.4 case rate 39208.4 93 "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement." 31758.8 percent of total billed charges 4536.63 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6455 other Inpatient DRG 4536.63 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6455 other Inpatient DRG 6889.61 Service paid by case rate. 3506.66 other IP General Discharge 4536.63 39208.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Appendix Procedures With McC 397 MS-DRG inpatient 65652.5 65652.5 17661.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 24891.7 other Inpatient DRG 17661.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 24891.7 other Inpatient DRG 65652.5 Service paid by case rate. 3506.66 other IP General Discharge 17661.8 65652.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Appendix Procedures With Cc 398 MS-DRG inpatient 21471.4 21471.4 14560.4 14557.5 case rate 18518.9 case rate 14560.4 Base payment rate plus any adjustments related to transfers and outliers. 14557.5 case rate 18518.9 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 15000.3 percent of total billed charges 10787.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15235.8 other Inpatient DRG 10787.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15235.8 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 21471.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Appendix Procedures Without Cc/McC 399 MS-DRG inpatient 24627.2 24627.2 24627.2 21775.6 case rate 24627.2 Base payment rate plus any adjustments related to transfers and outliers. 21775.6 case rate 24627.2 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 19948 percent of total billed charges 8013.24 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11338.5 other Inpatient DRG 8013.24 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11338.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 24627.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Pancreas, Liver And Shunt Procedures With McC" 405 MS-DRG inpatient 72835.6 72835.6 38696.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 54439.4 other Inpatient DRG 38696.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 54439.4 other Inpatient DRG 72835.6 Service paid by case rate. 3506.66 other IP General Discharge 38696.8 72835.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Pancreas, Liver And Shunt Procedures With Cc" 406 MS-DRG inpatient 19750.5 19750.5 20018.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 28202.2 other Inpatient DRG 20018.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 28202.2 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 20018.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Pancreas, Liver And Shunt Procedures Without Cc/McC" 407 MS-DRG inpatient 29214 29214 15223.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21467.1 other Inpatient DRG 15223.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21467.1 other Inpatient DRG 29214 Service paid by case rate. 3506.66 other IP General Discharge 15223.8 29214 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC 408 MS-DRG inpatient 73518.2 73518.2 24957.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 35140.5 other Inpatient DRG 24957.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 35140.5 other Inpatient DRG 73518.2 Service paid by case rate. 3506.66 other IP General Discharge 24957.9 73518.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc 409 MS-DRG inpatient 57815.5 57815.5 14943.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21073.6 other Inpatient DRG 14943.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21073.6 other Inpatient DRG 57815.5 Service paid by case rate. 3506.66 other IP General Discharge 14943.7 57815.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cholecystectomy With C.D.E. With McC 411 MS-DRG inpatient 24513.9 24513.9 21317 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 30702 other Inpatient DRG 21317 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 30702 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 24513.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cholecystectomy With C.D.E. Without Cc/McC 413 MS-DRG inpatient 14317.5 14317.5 11850.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16728.8 other Inpatient DRG 11850.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16728.8 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 14317.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cholecystectomy Except By Laparoscope Without C.D.E. With McC 414 MS-DRG inpatient 33839.1 33839.1 50199.8 Base payment rate plus any adjustments related to transfers and outliers. 50199.8 case rate 33839.1 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 27409.7 percent of total billed charges 24975.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 35165.5 other Inpatient DRG 24975.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 35165.5 other Inpatient DRG 33839.1 Service paid by case rate. 3506.66 other IP General Discharge 24975.7 50199.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cholecystectomy Except By Laparoscope Without C.D.E. With Cc 415 MS-DRG inpatient 28137.8 28137.8 28404 Base payment rate plus any adjustments related to transfers and outliers. 28404 case rate 26622 case rate 26622 case rate 26622 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 21563.8 percent of total billed charges 14100.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19889 other Inpatient DRG 14100.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19889 other Inpatient DRG 28137.8 Service paid by case rate. 3506.66 other IP General Discharge 14100.3 28404 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC 416 MS-DRG inpatient 26540.2 26540.2 19547.6 Base payment rate plus any adjustments related to transfers and outliers. 19547.6 case rate 26540.2 93 "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement." 21497.6 percent of total billed charges 9767.59 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13802.9 other Inpatient DRG 9767.59 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13802.9 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 26540.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Laparoscopic Cholecystectomy Without C.D.E. With McC 417 MS-DRG inpatient 37761.8 37761.8 33768.1 Base payment rate plus any adjustments related to transfers and outliers. 33768.1 case rate 37761.8 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 30587 percent of total billed charges 16941.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23879.4 other Inpatient DRG 16941.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23879.4 other Inpatient DRG 35283.4 Service paid by case rate. 3506.66 other IP General Discharge 16941.1 37761.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Laparoscopic Cholecystectomy Without C.D.E. With Cc 418 MS-DRG inpatient 31520.6 31520.6 23589.5 Base payment rate plus any adjustments related to transfers and outliers. 23589.5 case rate 29292.6 Base payment rate plus any adjustments related to transfers and outliers. 29276.8 case rate 31520.6 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement." 25531.7 percent of total billed charges 11822.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16689.7 other Inpatient DRG 11822.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16689.7 other Inpatient DRG 29614.5 Service paid by case rate. 3506.66 other IP General Discharge 11822.8 31520.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC 419 MS-DRG inpatient 35585.4 30986.6 18533.6 Base payment rate plus any adjustments related to transfers and outliers. 18533.6 case rate 30986.6 case rate 35585.4 Base payment rate plus any adjustments related to transfers and outliers. 19511.3 case rate 30986.6 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement." 25099.2 percent of total billed charges 9392.62 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13276.2 other Inpatient DRG 9392.62 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13276.2 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 35585.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hepatobiliary Diagnostic Procedures With McC 420 MS-DRG inpatient 46959.5 46959.5 46315.6 Base payment rate plus any adjustments related to transfers and outliers. 46315.6 case rate 46959.5 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 38037.2 percent of total billed charges 25158.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 35421.9 other Inpatient DRG 25158.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 35421.9 other Inpatient DRG 46959.5 Service paid by case rate. 3506.66 other IP General Discharge 25158.2 46959.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hepatobiliary Diagnostic Procedures With Cc 421 MS-DRG inpatient 19566.6 19566.6 11673.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16479.5 other Inpatient DRG 11673.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16479.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 19566.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hepatobiliary Diagnostic Procedures Without Cc/McC 422 MS-DRG inpatient 11908.3 11908.3 10474 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14795.2 other Inpatient DRG 10474 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14795.2 other Inpatient DRG 11908.3 Service paid by case rate. 3506.66 other IP General Discharge 10474 11908.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Hepatobiliary Or Pancreas O.R. Procedures With McC 423 MS-DRG inpatient 34626 34626 28992.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 40808.1 other Inpatient DRG 28992.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 40808.1 other Inpatient DRG 34626 Service paid by case rate. 3506.66 other IP General Discharge 28992.7 34626 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Hepatobiliary Or Pancreas O.R. Procedures With Cc 424 MS-DRG inpatient 23695.3 23695.3 16275.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22944.1 other Inpatient DRG 16275.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22944.1 other Inpatient DRG 23695.3 Service paid by case rate. 3506.66 other IP General Discharge 16275.3 23695.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/McC 428 MS-DRG inpatient 152210 152210 39244.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 55208.4 other Inpatient DRG 39244.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 55208.4 other Inpatient DRG 152210 Service paid by case rate. 3506.66 other IP General Discharge 39244.3 152210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cirrhosis And Alcoholic Hepatitis With McC 432 MS-DRG inpatient 33135.9 19282.3 26816.2 Base payment rate plus any adjustments related to transfers and outliers. 26816.2 case rate 19282.3 case rate 33135.9 Base payment rate plus any adjustments related to transfers and outliers. 14605.6 case rate 19282.3 93 "Additional drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement." 15618.7 percent of total billed charges 13965.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19699.8 other Inpatient DRG 13965.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19699.8 other Inpatient DRG 18795.8 Service paid by case rate. 3506.66 other IP General Discharge 13965.6 33135.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cirrhosis And Alcoholic Hepatitis With Cc 433 MS-DRG inpatient 41528.2 41528.2 14767.2 Base payment rate plus any adjustments related to transfers and outliers. 14767.2 case rate 41528.2 93 "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 33637.8 percent of total billed charges 7625.45 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10793.8 other Inpatient DRG 7625.45 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10793.8 other Inpatient DRG 17241.8 Service paid by case rate. 3506.66 other IP General Discharge 7625.45 41528.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cirrhosis And Alcoholic Hepatitis Without Cc/McC 434 MS-DRG inpatient 4752.02 4752.02 8914.6 Base payment rate plus any adjustments related to transfers and outliers. 8914.6 case rate 4055.89 case rate 4055.89 case rate 4752.02 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 3849.13 percent of total billed charges 4964.35 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7055.81 other Inpatient DRG 4964.35 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7055.81 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 8914.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Malignancy Of Hepatobiliary System Or Pancreas With McC 435 MS-DRG inpatient 23885.6 23885.6 24827.9 Base payment rate plus any adjustments related to transfers and outliers. 24827.9 case rate 19347.2 case rate 19347.2 case rate 19347.2 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 15671.2 percent of total billed charges 13006.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18352 other Inpatient DRG 13006.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18352 other Inpatient DRG 23885.6 Service paid by case rate. 3506.66 other IP General Discharge 13006.1 24827.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Malignancy Of Hepatobiliary System Or Pancreas With Cc 436 MS-DRG inpatient 13493.1 13493.1 8038.19 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11373.6 other Inpatient DRG 8038.19 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11373.6 other Inpatient DRG 13493.1 Service paid by case rate. 3506.66 other IP General Discharge 8038.19 13493.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Disorders Of Pancreas Except Malignancy With McC 438 MS-DRG inpatient 17345 17345 23538.4 Base payment rate plus any adjustments related to transfers and outliers. 23538.4 case rate 17073.8 case rate 17073.8 case rate 17073.8 93 "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement." 13829.7 percent of total billed charges 11860.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16742.8 other Inpatient DRG 11860.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16742.8 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 23538.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Disorders Of Pancreas Except Malignancy With Cc 439 MS-DRG inpatient 13071.9 13071.9 12352.9 Base payment rate plus any adjustments related to transfers and outliers. 12352.9 case rate 13071.9 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 10588.2 percent of total billed charges 6132.01 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8696 other Inpatient DRG 6132.01 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8696 other Inpatient DRG 12883.1 Service paid by case rate. 3506.66 other IP General Discharge 6132.01 13071.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Disorders Of Pancreas Except Malignancy Without Cc/McC 440 MS-DRG inpatient 8393.77 8393.77 8612.09 Base payment rate plus any adjustments related to transfers and outliers. 8612.09 case rate 6453.43 Base payment rate plus any adjustments related to transfers and outliers. 5923.45 case rate 8393.77 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 6798.96 percent of total billed charges 4384.79 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6241.71 other Inpatient DRG 4384.79 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6241.71 other Inpatient DRG 8393.77 Service paid by case rate. 3506.66 other IP General Discharge 4384.79 8612.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC" 441 MS-DRG inpatient 22677.8 22677.8 26910 Base payment rate plus any adjustments related to transfers and outliers. 26910 case rate 22677.8 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 18369 percent of total billed charges 13475.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19010.8 other Inpatient DRG 13475.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19010.8 other Inpatient DRG 14959.4 Service paid by case rate. 3506.66 other IP General Discharge 13475.2 26910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc" 442 MS-DRG inpatient 18072.2 18072.2 13435.1 Base payment rate plus any adjustments related to transfers and outliers. 13435.1 case rate 17366.3 case rate 17366.3 case rate 17366.3 93 "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement." 14066.7 percent of total billed charges 6887.64 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9757.42 other Inpatient DRG 6887.64 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9757.42 other Inpatient DRG 18072.2 Service paid by case rate. 3506.66 other IP General Discharge 6887.64 18072.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC" 443 MS-DRG inpatient 14604.5 14604.5 9258.28 Base payment rate plus any adjustments related to transfers and outliers. 9258.28 case rate 14604.5 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 11829.6 percent of total billed charges 5008.54 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7117.88 other Inpatient DRG 5008.54 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7117.88 other Inpatient DRG 11263.8 Service paid by case rate. 3506.66 other IP General Discharge 5008.54 14604.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Disorders Of The Biliary Tract With McC 444 MS-DRG inpatient 26198.5 25347.2 23642.1 Base payment rate plus any adjustments related to transfers and outliers. 23642.1 case rate 24183.1 case rate 26198.5 Base payment rate plus any adjustments related to transfers and outliers. 21165.1 case rate 24183.1 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement." 19588.3 percent of total billed charges 12008.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16950.1 other Inpatient DRG 12008.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16950.1 other Inpatient DRG 25347.2 Service paid by case rate. 3506.66 other IP General Discharge 12008.1 26198.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Disorders Of The Biliary Tract With Cc 445 MS-DRG inpatient 17121.9 17121.9 15616.5 Base payment rate plus any adjustments related to transfers and outliers. 15616.5 case rate 17121.9 93 "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 13868.7 percent of total billed charges 7730.24 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10941 other Inpatient DRG 7730.24 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10941 other Inpatient DRG 15618.8 Service paid by case rate. 3506.66 other IP General Discharge 7730.24 17121.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Disorders Of The Biliary Tract Without Cc/McC 446 MS-DRG inpatient 8380.06 8380.06 11527.8 Base payment rate plus any adjustments related to transfers and outliers. 11527.8 case rate 8380.06 93 "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement." 6787.85 percent of total billed charges 5682.91 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8065.16 other Inpatient DRG 5682.91 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8065.16 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 11527.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Single Level Spinal Fusion Except Cervical Without McC 451 MS-DRG inpatient 34536.5 34536.5 21997.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 30981.9 other Inpatient DRG 21997.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 30981.9 other Inpatient DRG 34536.5 Service paid by case rate. 3506.66 other IP General Discharge 21997.4 34536.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC" 456 MS-DRG inpatient 170253 170253 57100 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 81657.4 other Inpatient DRG 57100 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 81657.4 other Inpatient DRG 170253 Service paid by case rate. 3506.66 other IP General Discharge 57100 170253 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc" 457 MS-DRG inpatient 85874.4 85874.4 40910.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 57549.6 other Inpatient DRG 40910.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 57549.6 other Inpatient DRG 85874.4 Service paid by case rate. 3506.66 other IP General Discharge 40910.9 85874.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC" 458 MS-DRG inpatient 29959.5 29959.5 30779.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 43317.5 other Inpatient DRG 30779.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 43317.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 30779.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC 462 MS-DRG inpatient 31398.8 31398.8 20413.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 28756.9 other Inpatient DRG 20413.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 28756.9 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 31398.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC 463 MS-DRG inpatient 35193.2 35193.2 38499.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 51122 other Inpatient DRG 38499.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 51122 other Inpatient DRG 35193.2 Service paid by case rate. 3506.66 other IP General Discharge 35193.2 38499.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc 464 MS-DRG inpatient 18606.5 18606.5 42424.2 Base payment rate plus any adjustments related to transfers and outliers. 42424.2 case rate 18606.5 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 15071.3 percent of total billed charges 21019.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 27707.2 other Inpatient DRG 21019.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 27707.2 other Inpatient DRG 18606.5 Service paid by case rate. 3506.66 other IP General Discharge 18606.5 42424.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC 465 MS-DRG inpatient 18970.8 18970.8 28300.3 Base payment rate plus any adjustments related to transfers and outliers. 28300.3 case rate 18970.8 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 15366.3 percent of total billed charges 12374.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17464.8 other Inpatient DRG 12374.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17464.8 other Inpatient DRG 18970.8 Service paid by case rate. 3506.66 other IP General Discharge 12374.5 28300.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Revision Of Hip Or Knee Replacement With McC 466 MS-DRG inpatient 151032 151032 36315.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 52039.6 other Inpatient DRG 36315.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 52039.6 other Inpatient DRG 151032 Service paid by case rate. 3506.66 other IP General Discharge 36315.2 151032 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Revision Of Hip Or Knee Replacement With Cc 467 MS-DRG inpatient 59134.5 59134.5 51495 Base payment rate plus any adjustments related to transfers and outliers. 51495 case rate 39736.7 case rate 39736.7 case rate 39736.7 93 "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement." 32186.7 percent of total billed charges 24414.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 34377.5 other Inpatient DRG 24414.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 34377.5 other Inpatient DRG 59134.5 Service paid by case rate. 3506.66 other IP General Discharge 24414.7 59134.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Revision Of Hip Or Knee Replacement Without Cc/McC 468 MS-DRG inpatient 70531.2 50505.3 39613.6 Base payment rate plus any adjustments related to transfers and outliers. 39613.6 case rate 50505.3 case rate 70531.2 Base payment rate plus any adjustments related to transfers and outliers. 42117.6 case rate 50505.3 93 "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement." 40909.3 percent of total billed charges 18699.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 26349.7 other Inpatient DRG 18699.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 26349.7 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 70531.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement 469 MS-DRG inpatient 26919.1 26919.1 23299.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 32811.4 other Inpatient DRG 23299.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 32811.4 other Inpatient DRG 26919.1 Service paid by case rate. 3506.66 other IP General Discharge 23299.8 26919.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC 470 MS-DRG inpatient 30748.5 30748.5 27152.8 Base payment rate plus any adjustments related to transfers and outliers. 27152.8 case rate 26329.7 Base payment rate plus any adjustments related to transfers and outliers. 22558.7 case rate 30748.5 93 "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 24906.3 percent of total billed charges 13441 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18962.8 other Inpatient DRG 13441 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18962.8 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 30748.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cervical Spinal Fusion With McC 471 MS-DRG inpatient 30026.5 30026.5 34623.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 48717.7 other Inpatient DRG 34623.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 48717.7 other Inpatient DRG 30026.5 Service paid by case rate. 3506.66 other IP General Discharge 30026.5 34623.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cervical Spinal Fusion With Cc 472 MS-DRG inpatient 43594.6 43594.6 20651.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 29091.4 other Inpatient DRG 20651.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 29091.4 other Inpatient DRG 43594.6 Service paid by case rate. 3506.66 other IP General Discharge 20651.5 43594.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cervical Spinal Fusion Without Cc/McC 473 MS-DRG inpatient 39267 39267 16874.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23786.3 other Inpatient DRG 16874.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23786.3 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 39267 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Amputation For Musculoskeletal System And Connective Tissue Disorders With McC 474 MS-DRG inpatient 47632.9 47632.9 58184.2 Base payment rate plus any adjustments related to transfers and outliers. 58184.2 case rate 47632.9 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 38582.6 percent of total billed charges 31967.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 44986.7 other Inpatient DRG 31967.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 44986.7 other Inpatient DRG 45239.7 Service paid by case rate. 3506.66 other IP General Discharge 31967.4 58184.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc 475 MS-DRG inpatient 14383.6 14383.6 15377.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21056.2 other Inpatient DRG 15377.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21056.2 other Inpatient DRG 14383.6 Service paid by case rate. 3506.66 other IP General Discharge 14383.6 15377.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC 476 MS-DRG inpatient 13935.4 13935.4 8290.54 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11728.1 other Inpatient DRG 8290.54 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11728.1 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 13935.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Biopsies Of Musculoskeletal System And Connective Tissue With McC 477 MS-DRG inpatient 15610.8 15610.8 24513.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 32761.5 other Inpatient DRG 24513.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 32761.5 other Inpatient DRG 15610.8 Service paid by case rate. 3506.66 other IP General Discharge 15610.8 24513.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Biopsies Of Musculoskeletal System And Connective Tissue With Cc 478 MS-DRG inpatient 31691.2 31691.2 33359.1 Base payment rate plus any adjustments related to transfers and outliers. 33359.1 case rate 28701.5 Base payment rate plus any adjustments related to transfers and outliers. 27329.3 case rate 31691.2 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 25670 percent of total billed charges 16669.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23497.9 other Inpatient DRG 16669.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23497.9 other Inpatient DRG 31691.2 Service paid by case rate. 3506.66 other IP General Discharge 16669.5 33359.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC 479 MS-DRG inpatient 22477.3 22477.3 13069 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18854.6 other Inpatient DRG 13069 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18854.6 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 22477.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hip And Femur Procedures Except Major Joint With McC 480 MS-DRG inpatient 32703.4 32703.4 42123.1 Base payment rate plus any adjustments related to transfers and outliers. 42123.1 case rate 32703.4 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 26489.8 percent of total billed charges 20965.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 29366.5 other Inpatient DRG 20965.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 29366.5 other Inpatient DRG 32703.4 Service paid by case rate. 3506.66 other IP General Discharge 20965.2 42123.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hip And Femur Procedures Except Major Joint With Cc 481 MS-DRG inpatient 28890.8 28890.8 30000.3 Base payment rate plus any adjustments related to transfers and outliers. 30000.3 case rate 28890.8 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 23401.6 percent of total billed charges 14791.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20859.3 other Inpatient DRG 14791.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20859.3 other Inpatient DRG 28890.8 Service paid by case rate. 3506.66 other IP General Discharge 14791.1 30000.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hip And Femur Procedures Except Major Joint Without Cc/McC 482 MS-DRG inpatient 26306.9 26306.9 23377.9 Base payment rate plus any adjustments related to transfers and outliers. 23377.9 case rate 23540.7 case rate 23540.7 case rate 23540.7 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 19068 percent of total billed charges 11308.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15967.8 other Inpatient DRG 11308.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15967.8 other Inpatient DRG 26306.9 Service paid by case rate. 3506.66 other IP General Discharge 11308.8 26306.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Joint Or Limb Reattachment Procedures Of Upper Extremities 483 MS-DRG inpatient 42014.3 42014.3 18164.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 25597.7 other Inpatient DRG 18164.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 25597.7 other Inpatient DRG 42014.3 Service paid by case rate. 3506.66 other IP General Discharge 18164.3 42014.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Knee Procedures With Principal Diagnosis Of Infection With McC 485 MS-DRG inpatient 38179 38179 46170.7 Base payment rate plus any adjustments related to transfers and outliers. 46170.7 case rate 32281.3 case rate 32281.3 case rate 32281.3 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 26147.8 percent of total billed charges 22979.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 32361.8 other Inpatient DRG 22979.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 32361.8 other Inpatient DRG 38179 Service paid by case rate. 3506.66 other IP General Discharge 22979.7 46170.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Knee Procedures With Principal Diagnosis Of Infection With Cc 486 MS-DRG inpatient 41632 38043.6 29625.4 Base payment rate plus any adjustments related to transfers and outliers. 29625.4 case rate 29391 case rate 41632 Base payment rate plus any adjustments related to transfers and outliers. case rate 29391 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 23806.7 percent of total billed charges 15117.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21317.9 other Inpatient DRG 15117.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21317.9 other Inpatient DRG 38043.6 Service paid by case rate. 3506.66 other IP General Discharge 15117.6 41632 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC 487 MS-DRG inpatient 15718.6 15718.6 10831.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15641 other Inpatient DRG 10831.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15641 other Inpatient DRG 15718.6 Service paid by case rate. 3506.66 other IP General Discharge 10831.7 15718.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC 488 MS-DRG inpatient 28701 28701 32227.2 Base payment rate plus any adjustments related to transfers and outliers. 32227.2 case rate 24853.9 case rate 24853.9 case rate 24853.9 93 "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement." 20131.6 percent of total billed charges 14009.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19761.9 other Inpatient DRG 14009.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19761.9 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 32227.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC 489 MS-DRG inpatient 20615.4 20615.4 18881.6 Base payment rate plus any adjustments related to transfers and outliers. 18881.6 case rate 20615.4 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 16698.5 percent of total billed charges 8829.47 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12485.1 other Inpatient DRG 8829.47 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12485.1 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 20615.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC" 492 MS-DRG inpatient 37179.6 37179.6 24273.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 34511.3 other Inpatient DRG 24273.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 34511.3 other Inpatient DRG 37179.6 Service paid by case rate. 3506.66 other IP General Discharge 24273.7 37179.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc" 493 MS-DRG inpatient 39248.3 39248.3 33741.1 Base payment rate plus any adjustments related to transfers and outliers. 33741.1 case rate 39248.3 Base payment rate plus any adjustments related to transfers and outliers. 24286.9 case rate 39248.3 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 31791.1 percent of total billed charges 17115.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 24124.7 other Inpatient DRG 17115.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 24124.7 other Inpatient DRG 39248.3 Service paid by case rate. 3506.66 other IP General Discharge 17115.7 39248.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC" 494 MS-DRG inpatient 39382.4 39382.4 26824.7 Base payment rate plus any adjustments related to transfers and outliers. 26824.7 case rate 22866.7 case rate 22270.6 Base payment rate plus any adjustments related to transfers and outliers. 22265 case rate 22866.7 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 18522 percent of total billed charges 13441 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18962.8 other Inpatient DRG 13441 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18962.8 other Inpatient DRG 39382.4 Service paid by case rate. 3506.66 other IP General Discharge 13441 39382.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC 495 MS-DRG inpatient 80903.3 80903.3 52751.9 Base payment rate plus any adjustments related to transfers and outliers. 52751.9 case rate 80903.3 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 65531.7 percent of total billed charges 25094.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 35332.8 other Inpatient DRG 25094.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 35332.8 other Inpatient DRG 80903.3 Service paid by case rate. 3506.66 other IP General Discharge 25094.8 80903.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc 496 MS-DRG inpatient 19336.3 19336.3 29819.9 Base payment rate plus any adjustments related to transfers and outliers. 8399.98 case rate 19327.8 case rate 19327.8 case rate 19336.3 93 "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 15662.4 percent of total billed charges 14064 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18963.4 other Inpatient DRG 14064 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18963.4 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 29819.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC 497 MS-DRG inpatient 41135.6 41135.6 9573.69 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13530.5 other Inpatient DRG 9573.69 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13530.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 41135.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC 498 MS-DRG inpatient 15886.6 15886.6 17997.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 25363.4 other Inpatient DRG 17997.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 25363.4 other Inpatient DRG 15886.6 Service paid by case rate. 3506.66 other IP General Discharge 15886.6 17997.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Soft Tissue Procedures With McC 500 MS-DRG inpatient 51217.5 51217.5 45510.3 Base payment rate plus any adjustments related to transfers and outliers. 45510.3 case rate 51217.5 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 41486.2 percent of total billed charges 22586.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 31810 other Inpatient DRG 22586.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 31810 other Inpatient DRG 25609.7 Service paid by case rate. 3506.66 other IP General Discharge 22586.9 51217.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Soft Tissue Procedures With Cc 501 MS-DRG inpatient 23289.5 23289.5 24964.3 Base payment rate plus any adjustments related to transfers and outliers. 24964.3 case rate 23289.5 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 18864.5 percent of total billed charges 12723.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17955.4 other Inpatient DRG 12723.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17955.4 other Inpatient DRG 17755.4 Service paid by case rate. 3506.66 other IP General Discharge 12723.8 24964.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Soft Tissue Procedures Without Cc/McC 502 MS-DRG inpatient 17084.6 17084.6 19520.7 Base payment rate plus any adjustments related to transfers and outliers. 19520.7 case rate 12301.8 case rate 12301.8 case rate 12301.8 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 9964.41 percent of total billed charges 9959.35 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14072.2 other Inpatient DRG 9959.35 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14072.2 other Inpatient DRG 17084.6 Service paid by case rate. 3506.66 other IP General Discharge 9959.35 19520.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Foot Procedures With McC 503 MS-DRG inpatient 91941.1 91941.1 35977.9 Base payment rate plus any adjustments related to transfers and outliers. 35977.9 case rate 62544.4 case rate 62544.4 case rate 62544.4 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 50661 percent of total billed charges 18865.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 26583 other Inpatient DRG 18865.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 26583 other Inpatient DRG 91941.1 Service paid by case rate. 3506.66 other IP General Discharge 18865.8 91941.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Foot Procedures With Cc 504 MS-DRG inpatient 22338.8 22338.8 12514.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17662 other Inpatient DRG 12514.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17662 other Inpatient DRG 22338.8 Service paid by case rate. 3506.66 other IP General Discharge 12514.9 22338.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Foot Procedures Without Cc/McC 505 MS-DRG inpatient 15546.4 15546.4 12514.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17662 other Inpatient DRG 12514.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17662 other Inpatient DRG 15546.4 Service paid by case rate. 3506.66 other IP General Discharge 12514.9 15546.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Shoulder Or Elbow Joint Procedures With Cc/McC 507 MS-DRG inpatient 32719.5 32719.5 26341.9 Base payment rate plus any adjustments related to transfers and outliers. 26341.9 case rate 32719.5 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 26502.8 percent of total billed charges 13815.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19489.5 other Inpatient DRG 13815.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19489.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 32719.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Shoulder Or Elbow Joint Procedures Without Cc/McC 508 MS-DRG inpatient 27117 27117 20567.3 Base payment rate plus any adjustments related to transfers and outliers. 20567.3 case rate 24058.8 case rate 24058.8 case rate 27117 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 21964.8 percent of total billed charges 9200.15 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13005.8 other Inpatient DRG 9200.15 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13005.8 other Inpatient DRG 27117 Service paid by case rate. 3506.66 other IP General Discharge 9200.15 27117 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC" 510 MS-DRG inpatient 31108.3 31108.3 41016.8 Base payment rate plus any adjustments related to transfers and outliers. 41016.8 case rate 31108.3 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 25197.7 percent of total billed charges 20373.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 27243.5 other Inpatient DRG 20373.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 27243.5 other Inpatient DRG 31108.3 Service paid by case rate. 3506.66 other IP General Discharge 20373.5 41016.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc" 511 MS-DRG inpatient 22907.6 22907.6 28105.8 Base payment rate plus any adjustments related to transfers and outliers. 28105.8 case rate 22907.6 Base payment rate plus any adjustments related to transfers and outliers. 22903 case rate 22907.6 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 18555.2 percent of total billed charges 13982 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19722.8 other Inpatient DRG 13982 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19722.8 other Inpatient DRG 22310.2 Service paid by case rate. 3506.66 other IP General Discharge 13982 28105.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC" 512 MS-DRG inpatient 22850.6 22850.6 22815.5 Base payment rate plus any adjustments related to transfers and outliers. 22815.5 case rate 22618.3 case rate 22618.3 case rate 22618.3 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 18320.8 percent of total billed charges 11460.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16181.1 other Inpatient DRG 11460.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16181.1 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 22850.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC" 513 MS-DRG inpatient 59106.7 59106.7 10732.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15157.7 other Inpatient DRG 10732.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15157.7 other Inpatient DRG 59106.7 Service paid by case rate. 3506.66 other IP General Discharge 10732.1 59106.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC" 514 MS-DRG inpatient 12159.5 12159.5 14666.4 Base payment rate plus any adjustments related to transfers and outliers. 14666.4 case rate 12159.5 Base payment rate plus any adjustments related to transfers and outliers. 11295.1 case rate 12159.5 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 9849.23 percent of total billed charges 7268.31 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10292.2 other Inpatient DRG 7268.31 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10292.2 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 14666.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC 515 MS-DRG inpatient 32147.7 32147.7 22043 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 31046 other Inpatient DRG 22043 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 31046 other Inpatient DRG 32147.7 Service paid by case rate. 3506.66 other IP General Discharge 22043 32147.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc 516 MS-DRG inpatient 36415.5 36415.5 28884 Base payment rate plus any adjustments related to transfers and outliers. 28884 case rate 36415.5 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 29496.6 percent of total billed charges 14339.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20225.5 other Inpatient DRG 14339.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20225.5 other Inpatient DRG 30465.4 Service paid by case rate. 3506.66 other IP General Discharge 14339.9 36415.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC 517 MS-DRG inpatient 24133.4 24133.4 21443.6 Base payment rate plus any adjustments related to transfers and outliers. 21443.6 case rate 23212.7 case rate 23212.7 case rate 23212.7 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 18802.3 percent of total billed charges 10640.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15028.5 other Inpatient DRG 10640.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15028.5 other Inpatient DRG 24133.4 Service paid by case rate. 3506.66 other IP General Discharge 10640.1 24133.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator 518 MS-DRG inpatient 39961.4 39961.4 25547.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 35968.6 other Inpatient DRG 25547.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 35968.6 other Inpatient DRG 39961.4 Service paid by case rate. 3506.66 other IP General Discharge 25547.4 39961.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Back And Neck Procedures Except Spinal Fusion With Cc 519 MS-DRG inpatient 27265 27265 14055.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19826 other Inpatient DRG 14055.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19826 other Inpatient DRG 27265 Service paid by case rate. 3506.66 other IP General Discharge 14055.4 27265 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Back And Neck Procedures Except Spinal Fusion Without Cc/McC 520 MS-DRG inpatient 18404.1 18404.1 10216 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14432.7 other Inpatient DRG 10216 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14432.7 other Inpatient DRG 18404.1 Service paid by case rate. 3506.66 other IP General Discharge 10216 18404.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hip Replacement With Principal Diagnosis Of Hip Fracture With McC 521 MS-DRG inpatient 35457.5 35457.5 42878.7 Base payment rate plus any adjustments related to transfers and outliers. 42878.7 case rate 27166.3 case rate 27166.3 case rate 27166.3 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 22004.7 percent of total billed charges 20777 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 28600.6 other Inpatient DRG 20777 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 28600.6 other Inpatient DRG 35457.5 Service paid by case rate. 3506.66 other IP General Discharge 20777 42878.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC 522 MS-DRG inpatient 38153.3 38153.3 30859.5 Base payment rate plus any adjustments related to transfers and outliers. 30859.5 case rate 37639.6 case rate 37639.6 case rate 37639.6 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 30488.1 percent of total billed charges 15028.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21192.8 other Inpatient DRG 15028.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21192.8 other Inpatient DRG 38153.3 Service paid by case rate. 3506.66 other IP General Discharge 15028.5 38153.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Fractures Of Femur With McC 533 MS-DRG inpatient 20520.1 20520.1 220.53 "Additional labs, radiology services, therapy services, and other services can be included in reimbursement." 1019.94 fee schedule 220.53 "Additional labs, radiology services, therapy services, and other services can be included in reimbursement." 1019.94 fee schedule 20520.1 Service paid by case rate. 3506.66 other IP General Discharge 220.53 20520.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Fractures Of Femur Without McC 534 MS-DRG inpatient 5254.2 5254.2 5801.96 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7635.33 other Inpatient DRG 5801.96 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7635.33 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 5801.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Fractures Of Hip And Pelvis With McC 535 MS-DRG inpatient 8727.15 8727.15 18313.5 Base payment rate plus any adjustments related to transfers and outliers. 18313.5 case rate 8727.15 Base payment rate plus any adjustments related to transfers and outliers. 387858 case rate 8727.15 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 7068.98 percent of total billed charges 9480.31 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13399.3 other Inpatient DRG 9480.31 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13399.3 other Inpatient DRG 17289.3 Service paid by case rate. 3506.66 other IP General Discharge 8727.15 18313.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Fractures Of Hip And Pelvis Without McC 536 MS-DRG inpatient 18596.7 18596.7 11036.4 Base payment rate plus any adjustments related to transfers and outliers. 11036.4 case rate 18596.7 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 15063.3 percent of total billed charges 5780.57 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8202.34 other Inpatient DRG 5780.57 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8202.34 other Inpatient DRG 10663.4 Service paid by case rate. 3506.66 other IP General Discharge 5780.57 18596.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC" 537 MS-DRG inpatient 9899.77 9899.77 6002.96 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8676.14 other Inpatient DRG 6002.96 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8676.14 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 9899.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC" 538 MS-DRG inpatient 7521.09 7521.09 4786.85 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6806.47 other Inpatient DRG 4786.85 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6806.47 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 7521.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Osteomyelitis With McC 539 MS-DRG inpatient 34902.1 34902.1 28345.8 Base payment rate plus any adjustments related to transfers and outliers. 28345.8 case rate 34902.1 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 28270.7 percent of total billed charges 14419 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20336.6 other Inpatient DRG 14419 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20336.6 other Inpatient DRG 13967.8 Service paid by case rate. 3506.66 other IP General Discharge 13967.8 34902.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Osteomyelitis With Cc 540 MS-DRG inpatient 11667.1 11667.1 23252.4 Base payment rate plus any adjustments related to transfers. 9965.31 case rate 10935.8 case rate 10935.8 case rate 10935.8 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 8858 percent of total billed charges 9227.24 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13043.8 other Inpatient DRG 9227.24 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13043.8 other Inpatient DRG 11667.1 Service paid by case rate. 3506.66 other IP General Discharge 9227.24 23252.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Osteomyelitis Without Cc/McC 541 MS-DRG inpatient 7912.92 12873 11617.2 Base payment rate plus any adjustments related to transfers and outliers. 11617.2 case rate 12873 93 "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 10427.2 percent of total billed charges 6236.09 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8842.2 other Inpatient DRG 6236.09 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8842.2 other Inpatient DRG 12873 Service paid by case rate. 3506.66 other IP General Discharge 6236.09 12873 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC 542 MS-DRG inpatient 6488.59 6488.59 13294.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18756.5 other Inpatient DRG 13294.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18756.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 13294.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc 543 MS-DRG inpatient 18781 18781 19535.8 Base payment rate plus any adjustments related to transfers. 19535.8 case rate 18781 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 15212.6 percent of total billed charges 7647.17 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11066.8 other Inpatient DRG 7647.17 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11066.8 other Inpatient DRG 12022.8 Service paid by case rate. 3506.66 other IP General Discharge 7647.17 19535.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC 544 MS-DRG inpatient 16602.3 16602.3 5387.07 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7649.6 other Inpatient DRG 5387.07 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7649.6 other Inpatient DRG 16602.3 Service paid by case rate. 3506.66 other IP General Discharge 5387.07 16602.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Connective Tissue Disorders With McC 545 MS-DRG inpatient 21560 21560 17480.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 25191.2 other Inpatient DRG 17480.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 25191.2 other Inpatient DRG 21560 Service paid by case rate. 3506.66 other IP General Discharge 17480.5 21560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Connective Tissue Disorders With Cc 546 MS-DRG inpatient 21714.5 21714.5 17121.9 Base payment rate plus any adjustments related to transfers and outliers. 17121.9 case rate 21714.5 Base payment rate plus any adjustments related to transfers and outliers. 18879.5 case rate 21714.5 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 17588.7 percent of total billed charges 8252.76 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11675 other Inpatient DRG 8252.76 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11675 other Inpatient DRG 21714.5 Service paid by case rate. 3506.66 other IP General Discharge 8252.76 21714.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Connective Tissue Disorders Without Cc/McC 547 MS-DRG inpatient 7201.19 7201.19 5319.35 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7554.46 other Inpatient DRG 5319.35 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7554.46 other Inpatient DRG 7201.19 Service paid by case rate. 3506.66 other IP General Discharge 5319.35 7201.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Septic Arthritis With McC 548 MS-DRG inpatient 23015.5 23015.5 14360.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20254.5 other Inpatient DRG 14360.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20254.5 other Inpatient DRG 23015.5 Service paid by case rate. 3506.66 other IP General Discharge 14360.5 23015.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Septic Arthritis With Cc 549 MS-DRG inpatient 14885.7 14885.7 17208.6 Base payment rate plus any adjustments related to transfers and outliers. 17208.6 case rate 10862 case rate 10862 case rate 10862 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 8798.18 percent of total billed charges 8589.95 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12148.6 other Inpatient DRG 8589.95 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12148.6 other Inpatient DRG 14885.7 Service paid by case rate. 3506.66 other IP General Discharge 8589.95 17208.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Septic Arthritis Without Cc/McC 550 MS-DRG inpatient 54502.8 54502.8 5640.37 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8154.52 other Inpatient DRG 5640.37 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8154.52 other Inpatient DRG 54502.8 Service paid by case rate. 3506.66 other IP General Discharge 5640.37 54502.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Medical Back Problems With McC 551 MS-DRG inpatient 3462.95 3462.95 3462.95 74 "Additional drugs, labs, and therapy services can be included in reimbursement." 2562.6 percent of total billed charges 3462.95 93 "Additional drugs, labs, and therapy services can be included in reimbursement." 2804.98 percent of total billed charges 11932.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16684.7 other Inpatient DRG 11932.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16684.7 other Inpatient DRG 14669.7 Service paid by case rate. 3506.66 other IP General Discharge 3462.95 14669.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Medical Back Problems Without McC 552 MS-DRG inpatient 14304.5 14304.5 13641 Base payment rate plus any adjustments related to transfers and outliers. 13641 case rate 14304.5 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 11586.6 percent of total billed charges 6870.53 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9733.4 other Inpatient DRG 6870.53 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9733.4 other Inpatient DRG 11046.5 Service paid by case rate. 3506.66 other IP General Discharge 6870.53 14304.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Bone Diseases And Arthropathies With McC 553 MS-DRG inpatient 28661.6 28661.6 18830.4 Base payment rate plus any adjustments related to transfers and outliers. 18830.4 case rate 28661.6 93 "Additional drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement." 23215.9 percent of total billed charges 9475.71 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13574.7 other Inpatient DRG 9475.71 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13574.7 other Inpatient DRG 12757.7 Service paid by case rate. 3506.66 other IP General Discharge 9475.71 28661.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Bone Diseases And Arthropathies Without McC 554 MS-DRG inpatient 24771.2 24771.2 11648.5 Base payment rate plus any adjustments related to transfers and outliers. 11648.5 case rate 24771.2 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 20064.7 percent of total billed charges 5761.85 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8358.71 other Inpatient DRG 5761.85 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8358.71 other Inpatient DRG 15129.6 Service paid by case rate. 3506.66 other IP General Discharge 5761.85 24771.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC 555 MS-DRG inpatient 19841.9 19841.9 9808.74 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14171.6 other Inpatient DRG 9808.74 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14171.6 other Inpatient DRG 19841.9 Service paid by case rate. 3506.66 other IP General Discharge 9808.74 19841.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC 556 MS-DRG inpatient 11536.3 11536.3 5820.49 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8258.41 other Inpatient DRG 5820.49 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8258.41 other Inpatient DRG 11536.3 Service paid by case rate. 3506.66 other IP General Discharge 5820.49 11536.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Tendonitis, Myositis And Bursitis With McC" 557 MS-DRG inpatient 21343.5 21343.5 20335.8 Base payment rate plus any adjustments related to transfers and outliers. 20335.8 case rate 21343.5 93 "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement." 17288.3 percent of total billed charges 11047.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15600.3 other Inpatient DRG 11047.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15600.3 other Inpatient DRG 20635.7 Service paid by case rate. 3506.66 other IP General Discharge 11047.2 21343.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Tendonitis, Myositis And Bursitis Without McC" 558 MS-DRG inpatient 9565.98 9565.98 9565.98 74 "Additional drugs, labs, therapy services, and other services can be included in reimbursement." 7078.83 percent of total billed charges 22848.9 Base payment rate plus any adjustments related to transfers and outliers. 21249.5 case rate 9565.98 case rate 9565.98 93 "Additional drugs, labs, therapy services, and other services can be included in reimbursement." 7748.44 percent of total billed charges 6157.67 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8666.09 other Inpatient DRG 6157.67 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8666.09 other Inpatient DRG 12435 Service paid by case rate. 3506.66 other IP General Discharge 6157.67 22848.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Aftercare, Musculoskeletal System And Connective Tissue With McC" 559 MS-DRG inpatient 18644.3 18644.3 25350.6 Base payment rate plus any adjustments related to transfers and outliers. 25350.6 case rate 18644.3 93 "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 15101.9 percent of total billed charges 13231.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18668.4 other Inpatient DRG 13231.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18668.4 other Inpatient DRG 18644.3 Service paid by case rate. 3506.66 other IP General Discharge 13231.4 25350.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Aftercare, Musculoskeletal System And Connective Tissue With Cc" 560 MS-DRG inpatient 9721.09 9721.09 15559.7 Base payment rate plus any adjustments related to transfers and outliers. 6765.09 case rate 5856.88 case rate 5856.88 case rate 5856.88 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 4744.06 percent of total billed charges 8118.03 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11485.7 other Inpatient DRG 8118.03 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11485.7 other Inpatient DRG 9721.09 Service paid by case rate. 3506.66 other IP General Discharge 5856.88 15559.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC" 561 MS-DRG inpatient 11767.4 11767.4 11222.4 Base payment rate plus any adjustments related to transfers and outliers. 11222.4 case rate 11767.4 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 9531.57 percent of total billed charges 5828.33 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8269.43 other Inpatient DRG 5828.33 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8269.43 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 11767.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC" 562 MS-DRG inpatient 12531.9 12531.9 10662 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14284.1 other Inpatient DRG 10662 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14284.1 other Inpatient DRG 12531.9 Service paid by case rate. 3506.66 other IP General Discharge 10662 12531.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC" 563 MS-DRG inpatient 12176.1 12176.1 12230.8 Base payment rate plus any adjustments related to transfers and outliers. 12230.8 case rate 11574.6 case rate 11574.6 case rate 11574.6 93 "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 9375.43 percent of total billed charges 6279.28 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9101.95 other Inpatient DRG 6279.28 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9101.95 other Inpatient DRG 12176.1 Service paid by case rate. 3506.66 other IP General Discharge 6279.28 12230.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Musculoskeletal System And Connective Tissue Diagnoses With McC 564 MS-DRG inpatient 18919 18919 22060 Base payment rate plus any adjustments related to transfers and outliers. 22060 case rate 12881.8 case rate 12881.8 case rate 12881.8 93 "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement." 10434.2 percent of total billed charges 11186.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15795.5 other Inpatient DRG 11186.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15795.5 other Inpatient DRG 18919 Service paid by case rate. 3506.66 other IP General Discharge 11186.2 22060 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Musculoskeletal System And Connective Tissue Diagnoses With Cc 565 MS-DRG inpatient 15614.2 15614.2 14023 Base payment rate plus any adjustments related to transfers and outliers. 14023 case rate 15614.2 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 12647.5 percent of total billed charges 7268.31 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10292.2 other Inpatient DRG 7268.31 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10292.2 other Inpatient DRG 12360.7 Service paid by case rate. 3506.66 other IP General Discharge 7268.31 15614.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC 566 MS-DRG inpatient 8906.45 8906.45 5261.94 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7640.65 other Inpatient DRG 5261.94 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7640.65 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 8906.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Skin Debridement With McC 570 MS-DRG inpatient 33521.2 33521.2 41428.7 Base payment rate plus any adjustments related to transfers and outliers. 41428.7 case rate 105074 case rate 105074 case rate 105074 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 85109.8 percent of total billed charges 21459.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 30226.9 other Inpatient DRG 21459.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 30226.9 other Inpatient DRG 33521.2 Service paid by case rate. 3506.66 other IP General Discharge 21459.9 105074 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Skin Debridement With Cc 571 MS-DRG inpatient 29146.7 29146.7 23413.4 Base payment rate plus any adjustments related to transfers and outliers. 23413.4 case rate 22887.8 case rate 22887.8 case rate 22887.8 93 "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement." 18539.1 percent of total billed charges 11939 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16125.6 other Inpatient DRG 11939 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16125.6 other Inpatient DRG 29146.7 Service paid by case rate. 3506.66 other IP General Discharge 11939 29146.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Skin Debridement Without Cc/McC 572 MS-DRG inpatient 13484.4 13484.4 17093.5 Base payment rate plus any adjustments related to transfers and outliers. 7682.48 case rate 13479.3 case rate 13479.3 case rate 13484.4 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 10922.4 percent of total billed charges 8133.97 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11689.6 other Inpatient DRG 8133.97 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11689.6 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 17093.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Skin Graft For Skin Ulcer Or Cellulitis With Cc 574 MS-DRG inpatient 59078.2 59078.2 51192.5 Base payment rate plus any adjustments related to transfers and outliers. 51192.5 case rate 57097.5 case rate 57097.5 case rate 59078.2 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 47853.3 percent of total billed charges 24698.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 34776 other Inpatient DRG 24698.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 34776 other Inpatient DRG 59078.2 Service paid by case rate. 3506.66 other IP General Discharge 24698.4 59078.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Skin Graft Except For Skin Ulcer Or Cellulitis With Cc 577 MS-DRG inpatient 39569.5 39569.5 18980.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 26744.2 other Inpatient DRG 18980.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 26744.2 other Inpatient DRG 39569.5 Service paid by case rate. 3506.66 other IP General Discharge 18980.6 39569.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Other Skin, Subcutaneous Tissue And Breast Procedures With McC" 579 MS-DRG inpatient 18888 18888 23232.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 30015.9 other Inpatient DRG 23232.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 30015.9 other Inpatient DRG 18888 Service paid by case rate. 3506.66 other IP General Discharge 18888 23232.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Other Skin, Subcutaneous Tissue And Breast Procedures With Cc" 580 MS-DRG inpatient 21824.7 21824.7 24657.5 Base payment rate plus any adjustments related to transfers and outliers. 24657.5 case rate 18891 case rate 18891 Base payment rate plus any adjustments related to transfers and outliers. 18199.6 case rate 18891 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 15301.8 percent of total billed charges 12245.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17519.1 other Inpatient DRG 12245.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17519.1 other Inpatient DRG 21824.7 Service paid by case rate. 3506.66 other IP General Discharge 12245.9 24657.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC" 581 MS-DRG inpatient 9516.65 9516.65 10258.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14492.8 other Inpatient DRG 10258.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14492.8 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 10258.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Mastectomy For Malignancy Without Cc/McC 583 MS-DRG inpatient 20556.3 20556.3 11708.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16529.5 other Inpatient DRG 11708.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16529.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 20556.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC" 584 MS-DRG inpatient 9482.66 9482.66 30332.6 Base payment rate plus any adjustments related to transfers and outliers. 30332.6 case rate 19894.7 case rate 19894.7 case rate 20472.7 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement." 16582.9 percent of total billed charges 13732.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19807.3 other Inpatient DRG 13732.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19807.3 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 30332.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC" 585 MS-DRG inpatient 11518.5 11518.5 14150.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19959.1 other Inpatient DRG 14150.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19959.1 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 14150.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Skin Ulcers With McC 592 MS-DRG inpatient 17808.7 17808.7 14657.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20672.1 other Inpatient DRG 14657.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20672.1 other Inpatient DRG 17808.7 Service paid by case rate. 3506.66 other IP General Discharge 14657.8 17808.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Skin Ulcers With Cc 593 MS-DRG inpatient 7195.09 7195.09 16359.3 Base payment rate plus any adjustments related to transfers and outliers. 5112.28 case rate 7195.09 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 5828.02 percent of total billed charges 8482.91 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12267.2 other Inpatient DRG 8482.91 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12267.2 other Inpatient DRG 19249.9 Service paid by case rate. 3506.66 other IP General Discharge 7195.09 19249.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Skin Disorders With McC 595 MS-DRG inpatient 10658.5 10658.5 30412.2 Base payment rate plus any adjustments related to transfers and outliers. 14835.2 case rate 10658.5 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 8633.37 percent of total billed charges 15077 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21260.9 other Inpatient DRG 15077 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21260.9 other Inpatient DRG 10658.5 Service paid by case rate. 3506.66 other IP General Discharge 10658.5 30412.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Skin Disorders Without McC 596 MS-DRG inpatient 13084.2 13084.2 7706 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10907 other Inpatient DRG 7706 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10907 other Inpatient DRG 13084.2 Service paid by case rate. 3506.66 other IP General Discharge 7706 13084.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Malignant Breast Disorders With McC 597 MS-DRG inpatient 42313.8 42313.8 23916.2 Base payment rate plus any adjustments related to transfers and outliers. 23916.2 case rate 42313.8 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 34274.2 percent of total billed charges 12521.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17671 other Inpatient DRG 12521.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17671 other Inpatient DRG 42313.8 Service paid by case rate. 3506.66 other IP General Discharge 12521.4 42313.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Malignant Breast Disorders With Cc 598 MS-DRG inpatient 8379.64 8379.64 8405.09 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12155.5 other Inpatient DRG 8405.09 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12155.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 8405.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Non-Malignant Breast Disorders With Cc/McC 600 MS-DRG inpatient 25910.5 25910.5 14785.7 Base payment rate plus any adjustments related to transfers and outliers. 14785.7 case rate 25910.5 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 20987.6 percent of total billed charges 6823.48 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9667.3 other Inpatient DRG 6823.48 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9667.3 other Inpatient DRG 25910.5 Service paid by case rate. 3506.66 other IP General Discharge 6823.48 25910.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Non-Malignant Breast Disorders Without Cc/McC 601 MS-DRG inpatient 10376.7 10376.7 4441.63 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6406.81 other Inpatient DRG 4441.63 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6406.81 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 10376.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cellulitis With McC 602 MS-DRG inpatient 96970.5 14193.3 20467.9 Base payment rate plus any adjustments related to transfers and outliers. 20467.9 case rate 12619.6 case rate 96970.5 Base payment rate plus any adjustments related to transfers and outliers. 19576.9 case rate 12619.6 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 10221.8 percent of total billed charges 10474.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14343.2 other Inpatient DRG 10474.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14343.2 other Inpatient DRG 14193.3 Service paid by case rate. 3506.66 other IP General Discharge 10474.7 96970.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cellulitis Without McC 603 MS-DRG inpatient 13465 13465 12523.3 Base payment rate plus any adjustments related to transfers and outliers. 12523.3 case rate 11650.4 case rate 13465 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 10906.7 percent of total billed charges 6279.57 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8903.28 other Inpatient DRG 6279.57 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8903.28 other Inpatient DRG 13465 Service paid by case rate. 3506.66 other IP General Discharge 6279.57 13465 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Trauma To The Skin, Subcutaneous Tissue And Breast With McC" 604 MS-DRG inpatient 14815.6 14815.6 10590.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14959.4 other Inpatient DRG 10590.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14959.4 other Inpatient DRG 14815.6 Service paid by case rate. 3506.66 other IP General Discharge 10590.9 14815.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Trauma To The Skin, Subcutaneous Tissue And Breast Without McC" 605 MS-DRG inpatient 24816.7 24816.7 12929.5 Base payment rate plus any adjustments related to transfers and outliers. 12929.5 case rate 24816.7 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 20101.5 percent of total billed charges 6371.83 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9234.88 other Inpatient DRG 6371.83 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9234.88 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 24816.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Minor Skin Disorders With McC 606 MS-DRG inpatient 12258 12258 11477.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16205.1 other Inpatient DRG 11477.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16205.1 other Inpatient DRG 12258 Service paid by case rate. 3506.66 other IP General Discharge 11477.7 12258 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Minor Skin Disorders Without McC 607 MS-DRG inpatient 11195 11195 6264.55 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9080.8 other Inpatient DRG 6264.55 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9080.8 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 11195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Adrenal And Pituitary Procedures With Cc/McC 614 MS-DRG inpatient 20961.3 20961.3 16244.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22901.1 other Inpatient DRG 16244.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22901.1 other Inpatient DRG 20961.3 Service paid by case rate. 3506.66 other IP General Discharge 16244.6 20961.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Adrenal And Pituitary Procedures Without Cc/McC 615 MS-DRG inpatient 34891.3 34891.3 20959.3 Base payment rate plus any adjustments related to transfers and outliers. 20959.3 case rate 34891.3 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 28262 percent of total billed charges 10214.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14430.7 other Inpatient DRG 10214.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14430.7 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 34891.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC" 616 MS-DRG inpatient 68091.4 68091.4 53463.4 Base payment rate plus any adjustments related to transfers and outliers. 53463.4 case rate 68091.4 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 55154 percent of total billed charges 27551.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 38783.4 other Inpatient DRG 27551.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 38783.4 other Inpatient DRG 68063.8 Service paid by case rate. 3506.66 other IP General Discharge 27551.3 68091.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc" 617 MS-DRG inpatient 28855.6 28855.6 27608.7 Base payment rate plus any adjustments related to transfers and outliers. 27608.7 case rate 28855.6 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 23373 percent of total billed charges 13773.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18869.5 other Inpatient DRG 13773.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18869.5 other Inpatient DRG 27132.6 Service paid by case rate. 3506.66 other IP General Discharge 13773.9 28855.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. O.R. Procedures For Obesity With McC 619 MS-DRG inpatient 22762.8 22762.8 19435.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 27383.1 other Inpatient DRG 19435.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 27383.1 other Inpatient DRG 22762.8 Service paid by case rate. 3506.66 other IP General Discharge 19435.4 22762.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. O.R. Procedures For Obesity With Cc 620 MS-DRG inpatient 54642.2 54642.2 23938.9 Base payment rate plus any adjustments related to transfers and outliers. 23938.9 case rate 43085.5 Base payment rate plus any adjustments related to transfers and outliers. 23244.5 case rate 54642.2 93 "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement." 44260.2 percent of total billed charges 11383.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16072.9 other Inpatient DRG 11383.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16072.9 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 54642.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. O.R. Procedures For Obesity Without Cc/McC 621 MS-DRG inpatient 40503 40343.6 22084.1 Base payment rate plus any adjustments related to transfers and outliers. 22084.1 case rate 34102.7 Base payment rate plus any adjustments related to transfers and outliers. 22084.1 case rate 40503 Base payment rate plus any adjustments related to transfers and outliers. 846503 case rate 40343.6 93 "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement." 32678.3 percent of total billed charges 10419.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14719.1 other Inpatient DRG 10419.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14719.1 other Inpatient DRG 40343.6 Service paid by case rate. 3506.66 other IP General Discharge 10419.9 40503 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC" 622 MS-DRG inpatient 31369.1 31369.1 26689.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 36589.4 other Inpatient DRG 26689.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 36589.4 other Inpatient DRG 31369.1 Service paid by case rate. 3506.66 other IP General Discharge 26689.4 31369.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc" 623 MS-DRG inpatient 34176.8 34176.8 26765.1 Base payment rate plus any adjustments related to transfers and outliers. 26765.1 case rate 25567.6 Base payment rate plus any adjustments related to transfers and outliers. 20960.7 case rate 34176.8 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 27683.2 percent of total billed charges 13644.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19248.2 other Inpatient DRG 13644.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19248.2 other Inpatient DRG 34176.8 Service paid by case rate. 3506.66 other IP General Discharge 13644.1 34176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC" 624 MS-DRG inpatient 24033.1 24033.1 6683.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9617.23 other Inpatient DRG 6683.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9617.23 other Inpatient DRG 24033.1 Service paid by case rate. 3506.66 other IP General Discharge 6683.7 24033.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Thyroid, Parathyroid And Thyroglossal Procedures With McC" 625 MS-DRG inpatient 40738.2 40738.2 20436.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 28790 other Inpatient DRG 20436.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 28790 other Inpatient DRG 40738.2 Service paid by case rate. 3506.66 other IP General Discharge 20436.9 40738.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Thyroid, Parathyroid And Thyroglossal Procedures With Cc" 626 MS-DRG inpatient 57021.4 57021.4 10607.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15300.3 other Inpatient DRG 10607.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15300.3 other Inpatient DRG 57021.4 Service paid by case rate. 3506.66 other IP General Discharge 10607.5 57021.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC" 627 MS-DRG inpatient 38858.9 38858.9 9030.49 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12767.5 other Inpatient DRG 9030.49 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12767.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 38858.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC" 628 MS-DRG inpatient 35973.6 35973.6 51763.4 Base payment rate plus any adjustments related to transfers and outliers. 51763.4 case rate 35973.6 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 29138.6 percent of total billed charges 28131.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 39598.5 other Inpatient DRG 28131.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 39598.5 other Inpatient DRG 29252.2 Service paid by case rate. 3506.66 other IP General Discharge 28131.5 51763.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc" 629 MS-DRG inpatient 27488.2 27488.2 31866.5 Base payment rate plus any adjustments related to transfers and outliers. 31866.5 case rate 27488.2 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 22265.4 percent of total billed charges 16040 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22613.7 other Inpatient DRG 16040 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22613.7 other Inpatient DRG 27488.2 Service paid by case rate. 3506.66 other IP General Discharge 16040 31866.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Diabetes With McC 637 MS-DRG inpatient 8644.74 18024.1 19821.7 Base payment rate plus any adjustments related to transfers and outliers. 19821.7 case rate 18024.1 case rate 8644.74 Base payment rate plus any adjustments related to transfers and outliers. 8644.74 case rate 18024.1 93 "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement." 14599.5 percent of total billed charges 10381.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14665 other Inpatient DRG 10381.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14665 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 19821.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Diabetes With Cc 638 MS-DRG inpatient 9409.67 16450.6 12441 Base payment rate plus any adjustments related to transfers and outliers. 12441 case rate 16450.6 case rate 9409.67 Base payment rate plus any adjustments related to transfers and outliers. 9405.3 case rate 16450.6 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 13325 percent of total billed charges 6538.34 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9266.76 other Inpatient DRG 6538.34 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9266.76 other Inpatient DRG 11527 Service paid by case rate. 3506.66 other IP General Discharge 6538.34 16450.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Diabetes Without Cc/McC 639 MS-DRG inpatient 9476.7 7921.92 8532.56 Base payment rate plus any adjustments related to transfers and outliers. 8532.56 case rate 7921.92 case rate 9476.7 Base payment rate plus any adjustments related to transfers and outliers. 9476.7 case rate 7921.92 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 6416.75 percent of total billed charges 4466.77 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6356.87 other Inpatient DRG 4466.77 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6356.87 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 9476.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC" 640 MS-DRG inpatient 62896.7 15132.6 17969.8 Base payment rate plus any adjustments related to transfers and outliers. 17969.8 case rate 62896.7 Base payment rate plus any adjustments related to transfers and outliers. 50946.3 case rate 16810.6 Base payment rate plus any adjustments related to transfers and outliers. 15155.8 case rate 14691.9 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 11900.4 percent of total billed charges 9467.47 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13381.3 other Inpatient DRG 9467.47 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13381.3 other Inpatient DRG 15132.6 Service paid by case rate. 3506.66 other IP General Discharge 9467.47 62896.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC" 641 MS-DRG inpatient 9974.78 11151.9 10938.4 Base payment rate plus any adjustments related to transfers and outliers. 10938.4 case rate 11151.9 case rate 9974.78 Base payment rate plus any adjustments related to transfers and outliers. 9118.91 case rate 11151.9 93 "Additional drugs, labs, therapy services, and other services can be included in reimbursement." 9033 percent of total billed charges 5570.99 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7907.94 other Inpatient DRG 5570.99 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7907.94 other Inpatient DRG 11151.9 Service paid by case rate. 3506.66 other IP General Discharge 5570.99 11151.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Inborn And Other Disorders Of Metabolism 642 MS-DRG inpatient 13568.5 13568.5 19929.7 Base payment rate plus any adjustments related to transfers and outliers. 19929.7 case rate 13568.5 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 10990.5 percent of total billed charges 8847.29 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12510.1 other Inpatient DRG 8847.29 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12510.1 other Inpatient DRG 11136 Service paid by case rate. 3506.66 other IP General Discharge 8847.29 19929.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Endocrine Disorders With McC 643 MS-DRG inpatient 16067.9 16067.9 23343.8 Base payment rate plus any adjustments related to transfers and outliers. 23343.8 case rate 11916.6 case rate 11916.6 case rate 11916.6 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 9652.42 percent of total billed charges 11814.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16677.7 other Inpatient DRG 11814.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16677.7 other Inpatient DRG 16067.9 Service paid by case rate. 3506.66 other IP General Discharge 11814.2 23343.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Endocrine Disorders With Cc 644 MS-DRG inpatient 12461 12461 14473.3 Base payment rate plus any adjustments related to transfers and outliers. 14473.3 case rate 12461 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 10093.4 percent of total billed charges 7367.39 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10431.3 other Inpatient DRG 7367.39 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10431.3 other Inpatient DRG 12461 Service paid by case rate. 3506.66 other IP General Discharge 7367.39 14473.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Endocrine Disorders Without Cc/McC 645 MS-DRG inpatient 8822.51 8822.51 10546.4 Base payment rate plus any adjustments related to transfers and outliers. 10546.4 case rate 8822.51 Base payment rate plus any adjustments related to transfers and outliers. 8603.54 case rate 8822.51 93 "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement." 7146.24 percent of total billed charges 5334.86 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7745.4 other Inpatient DRG 5334.86 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7745.4 other Inpatient DRG 6679.53 Service paid by case rate. 3506.66 other IP General Discharge 5334.86 10546.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Bladder Procedures With McC 653 MS-DRG inpatient 45819.4 45819.4 39736.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 55899.3 other Inpatient DRG 39736.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 55899.3 other Inpatient DRG 45819.4 Service paid by case rate. 3506.66 other IP General Discharge 39736.2 45819.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Bladder Procedures With Cc 654 MS-DRG inpatient 14860.2 14860.2 20116.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 28339.4 other Inpatient DRG 20116.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 28339.4 other Inpatient DRG 14860.2 Service paid by case rate. 3506.66 other IP General Discharge 14860.2 20116.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Bladder Procedures Without Cc/McC 655 MS-DRG inpatient 26210.8 26210.8 14807.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20882.3 other Inpatient DRG 14807.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20882.3 other Inpatient DRG 26210.8 Service paid by case rate. 3506.66 other IP General Discharge 14807.5 26210.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Kidney And Ureter Procedures For Neoplasm With McC 656 MS-DRG inpatient 45704 45704 23222.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 32703.2 other Inpatient DRG 23222.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 32703.2 other Inpatient DRG 45704 Service paid by case rate. 3506.66 other IP General Discharge 23222.8 45704 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Kidney And Ureter Procedures For Neoplasm With Cc 657 MS-DRG inpatient 19385.5 19385.5 13031 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18387 other Inpatient DRG 13031 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18387 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 19385.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Kidney And Ureter Procedures For Neoplasm Without Cc/McC 658 MS-DRG inpatient 16922.4 16922.4 10720.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15141.7 other Inpatient DRG 10720.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15141.7 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 16922.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Kidney And Ureter Procedures For Non-Neoplasm With McC 659 MS-DRG inpatient 17118.3 17118.3 18421.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 25959.2 other Inpatient DRG 18421.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 25959.2 other Inpatient DRG 17118.3 Service paid by case rate. 3506.66 other IP General Discharge 17118.3 18421.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Kidney And Ureter Procedures For Non-Neoplasm With Cc 660 MS-DRG inpatient 13064.4 13064.4 20041.9 Base payment rate plus any adjustments related to transfers and outliers. 20041.9 case rate 13064.4 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 10582.2 percent of total billed charges 9551.59 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13499.4 other Inpatient DRG 9551.59 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13499.4 other Inpatient DRG 12224.4 Service paid by case rate. 3506.66 other IP General Discharge 9551.59 20041.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC 661 MS-DRG inpatient 15550.2 15550.2 15308.3 Base payment rate plus any adjustments related to transfers and outliers. 15308.3 case rate 15072.2 Base payment rate plus any adjustments related to transfers and outliers. 13546.4 case rate 15550.2 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement." 12595.6 percent of total billed charges 7318.21 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10362.2 other Inpatient DRG 7318.21 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10362.2 other Inpatient DRG 11072.6 Service paid by case rate. 3506.66 other IP General Discharge 7318.21 15550.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Minor Bladder Procedures With McC 662 MS-DRG inpatient 21447.5 21447.5 20535.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 29410.1 other Inpatient DRG 20535.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 29410.1 other Inpatient DRG 21447.5 Service paid by case rate. 3506.66 other IP General Discharge 20535.7 21447.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Minor Bladder Procedures With Cc 663 MS-DRG inpatient 9970.91 9970.91 10887.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15376 other Inpatient DRG 10887.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15376 other Inpatient DRG 9970.91 Service paid by case rate. 3506.66 other IP General Discharge 9970.91 10887.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Minor Bladder Procedures Without Cc/McC 664 MS-DRG inpatient 14896.5 14896.5 7697.45 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10895 other Inpatient DRG 7697.45 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10895 other Inpatient DRG 14896.5 Service paid by case rate. 3506.66 other IP General Discharge 7697.45 14896.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Prostatectomy With Cc 666 MS-DRG inpatient 11966.7 11966.7 11636.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16694.2 other Inpatient DRG 11636.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16694.2 other Inpatient DRG 11966.7 Service paid by case rate. 3506.66 other IP General Discharge 11636.7 11966.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Transurethral Procedures With McC 668 MS-DRG inpatient 62198.5 62198.5 19757.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 28215.1 other Inpatient DRG 19757.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 28215.1 other Inpatient DRG 62198.5 Service paid by case rate. 3506.66 other IP General Discharge 19757.7 62198.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Transurethral Procedures With Cc 669 MS-DRG inpatient 11623.7 11623.7 11031.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15578.2 other Inpatient DRG 11031.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15578.2 other Inpatient DRG 11623.7 Service paid by case rate. 3506.66 other IP General Discharge 11031.5 11623.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Transurethral Procedures Without Cc/McC 670 MS-DRG inpatient 12656.6 12656.6 6673.56 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9602.74 other Inpatient DRG 6673.56 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9602.74 other Inpatient DRG 12656.6 Service paid by case rate. 3506.66 other IP General Discharge 6673.56 12656.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Urethral Procedures Without Cc/McC 672 MS-DRG inpatient 8912.03 8912.03 7800.81 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11040.2 other Inpatient DRG 7800.81 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11040.2 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 8912.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Kidney And Urinary Tract Procedures With McC 673 MS-DRG inpatient 52965.2 52965.2 49621.8 Base payment rate plus any adjustments related to transfers and outliers. 49621.8 case rate 43870.7 case rate 43870.7 case rate 43870.7 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 35535.3 percent of total billed charges 29868.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 42038.8 other Inpatient DRG 29868.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 42038.8 other Inpatient DRG 52965.2 Service paid by case rate. 3506.66 other IP General Discharge 29868.8 52965.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Kidney And Urinary Tract Procedures With Cc 674 MS-DRG inpatient 92604.8 92604.8 33665.8 Base payment rate plus any adjustments related to transfers and outliers. 33665.8 case rate 92604.8 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 75009.9 percent of total billed charges 16454.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23196.5 other Inpatient DRG 16454.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23196.5 other Inpatient DRG 46691.7 Service paid by case rate. 3506.66 other IP General Discharge 16454.9 92604.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Kidney And Urinary Tract Procedures Without Cc/McC 675 MS-DRG inpatient 16462.8 16462.8 23950.3 Base payment rate plus any adjustments related to transfers and outliers. 23950.3 case rate 16462.8 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement." 13334.9 percent of total billed charges 11157.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15755.5 other Inpatient DRG 11157.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15755.5 other Inpatient DRG 16462.8 Service paid by case rate. 3506.66 other IP General Discharge 11157.7 23950.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Renal Failure With McC 682 MS-DRG inpatient 18944.6 18944.6 21112.7 Base payment rate plus any adjustments related to transfers and outliers. 21112.7 case rate 14780 Base payment rate plus any adjustments related to transfers and outliers. 10963.5 case rate 18944.6 93 "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 15345.1 percent of total billed charges 10707.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14799.9 other Inpatient DRG 10707.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14799.9 other Inpatient DRG 18944.6 Service paid by case rate. 3506.66 other IP General Discharge 10707.1 21112.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Renal Failure With Cc 683 MS-DRG inpatient 9805.23 14024.4 12709.4 Base payment rate plus any adjustments related to transfers and outliers. 12709.4 case rate 14024.4 case rate 9805.23 Base payment rate plus any adjustments related to transfers and outliers. 9246.94 case rate 14024.4 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 11359.7 percent of total billed charges 6336.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8983.39 other Inpatient DRG 6336.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8983.39 other Inpatient DRG 13555.8 Service paid by case rate. 3506.66 other IP General Discharge 6336.6 14024.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Renal Failure Without Cc/McC 684 MS-DRG inpatient 6909.16 6909.16 8589.37 Base payment rate plus any adjustments related to transfers and outliers. 8589.37 case rate 6909.16 93 "Additional drugs, imaging services, labs, and other services can be included in reimbursement." 5596.43 percent of total billed charges 4330.62 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6165.61 other Inpatient DRG 4330.62 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6165.61 other Inpatient DRG 6909.16 Service paid by case rate. 3506.66 other IP General Discharge 4330.62 8589.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Kidney And Urinary Tract Neoplasms With McC 686 MS-DRG inpatient 10504.4 10504.4 12896.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18445.5 other Inpatient DRG 12896.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18445.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 12896.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Kidney And Urinary Tract Neoplasms With Cc 687 MS-DRG inpatient 14215.7 14215.7 7503.55 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10622.6 other Inpatient DRG 7503.55 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10622.6 other Inpatient DRG 14215.7 Service paid by case rate. 3506.66 other IP General Discharge 7503.55 14215.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Kidney And Urinary Tract Neoplasms Without Cc/McC 688 MS-DRG inpatient 19203.4 19203.4 5162.52 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7334.18 other Inpatient DRG 5162.52 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7334.18 other Inpatient DRG 19203.4 Service paid by case rate. 3506.66 other IP General Discharge 5162.52 19203.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Kidney And Urinary Tract Infections With McC 689 MS-DRG inpatient 15438.4 14734.8 16291.1 Base payment rate plus any adjustments related to transfers and outliers. 16291.1 case rate 13318 case rate 15438.4 Base payment rate plus any adjustments related to transfers and outliers. 14751 case rate 13318 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 10787.6 percent of total billed charges 8343.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11802.2 other Inpatient DRG 8343.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11802.2 other Inpatient DRG 14734.8 Service paid by case rate. 3506.66 other IP General Discharge 8343.3 16291.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Kidney And Urinary Tract Infections Without McC 690 MS-DRG inpatient 17014.4 11169.7 11299.1 Base payment rate plus any adjustments related to transfers and outliers. 11299.1 case rate 11169.7 case rate 17014.4 Base payment rate plus any adjustments related to transfers and outliers. 9235.33 case rate 11169.7 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 9047.45 percent of total billed charges 5721.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8119.23 other Inpatient DRG 5721.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8119.23 other Inpatient DRG 11169.7 Service paid by case rate. 3506.66 other IP General Discharge 5721.4 17014.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Urinary Stones With McC 693 MS-DRG inpatient 5797.19 5797.19 9930.04 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14345.9 other Inpatient DRG 9930.04 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14345.9 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 9930.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Urinary Stones Without McC 694 MS-DRG inpatient 6414.66 6414.66 5570.28 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7906.94 other Inpatient DRG 5570.28 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7906.94 other Inpatient DRG 6414.66 Service paid by case rate. 3506.66 other IP General Discharge 5570.28 6414.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Kidney And Urinary Tract Signs And Symptoms With McC 695 MS-DRG inpatient 12495.6 12495.6 8385.46 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12127.3 other Inpatient DRG 8385.46 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12127.3 other Inpatient DRG 12495.6 Service paid by case rate. 3506.66 other IP General Discharge 8385.46 12495.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Kidney And Urinary Tract Signs And Symptoms Without McC 696 MS-DRG inpatient 29094.1 29094.1 22758.7 Base payment rate plus any adjustments related to transfers and outliers. 22758.7 case rate 29094.1 case rate 29094.1 case rate 29094.1 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 23566.3 percent of total billed charges 4930.84 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7008.74 other Inpatient DRG 4930.84 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7008.74 other Inpatient DRG 10108.4 Service paid by case rate. 3506.66 other IP General Discharge 4930.84 29094.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Urethral Stricture 697 MS-DRG inpatient 10943.7 10943.7 7141.42 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10113.9 other Inpatient DRG 7141.42 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10113.9 other Inpatient DRG 10943.7 Service paid by case rate. 3506.66 other IP General Discharge 7141.42 10943.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Kidney And Urinary Tract Diagnoses With McC 698 MS-DRG inpatient 27217.8 27217.8 22758.7 Base payment rate plus any adjustments related to transfers and outliers. 22758.7 case rate 23693.7 case rate 16022.7 Base payment rate plus any adjustments related to transfers and outliers. 16019.9 case rate 23693.7 93 "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 19191.9 percent of total billed charges 11982.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16914 other Inpatient DRG 11982.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16914 other Inpatient DRG 27217.8 Service paid by case rate. 3506.66 other IP General Discharge 11982.4 27217.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Kidney And Urinary Tract Diagnoses With Cc 699 MS-DRG inpatient 10003.3 10003.3 14373.8 Base payment rate plus any adjustments related to transfers and outliers. 14373.8 case rate 10003.3 Base payment rate plus any adjustments related to transfers and outliers. 9112.53 case rate 10003.3 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 8102.69 percent of total billed charges 7269.73 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10294.2 other Inpatient DRG 7269.73 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10294.2 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 14373.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Kidney And Urinary Tract Diagnoses Without Cc/McC 700 MS-DRG inpatient 7279.95 7279.95 4966.07 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6992.01 other Inpatient DRG 4966.07 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6992.01 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 7279.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Male Pelvic Procedures With Cc/McC 707 MS-DRG inpatient 15616.8 15616.8 13833 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19513.5 other Inpatient DRG 13833 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19513.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 15616.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Male Pelvic Procedures Without Cc/McC 708 MS-DRG inpatient 20527.8 20527.8 10567.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14926.4 other Inpatient DRG 10567.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14926.4 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 20527.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Penis Procedures With Cc/McC 709 MS-DRG inpatient 59747.4 59747.4 15220 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21944.4 other Inpatient DRG 15220 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21944.4 other Inpatient DRG 59747.4 Service paid by case rate. 3506.66 other IP General Discharge 15220 59747.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Penis Procedures Without Cc/McC 710 MS-DRG inpatient 6142.13 6142.13 10702.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15115.6 other Inpatient DRG 10702.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15115.6 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 10702.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Testes Procedures With Cc/McC 711 MS-DRG inpatient 31004.1 31004.1 29020.4 Base payment rate plus any adjustments related to transfers and outliers. 29020.4 case rate 27943.5 case rate 27943.5 case rate 31004.1 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 25113.3 percent of total billed charges 13619.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19214.1 other Inpatient DRG 13619.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19214.1 other Inpatient DRG 31004.1 Service paid by case rate. 3506.66 other IP General Discharge 13619.9 31004.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Testes Procedures Without Cc/McC 712 MS-DRG inpatient 9528.2 9528.2 7624.73 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10792.8 other Inpatient DRG 7624.73 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10792.8 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 9528.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Transurethral Prostatectomy With Cc/McC 713 MS-DRG inpatient 11631.9 11631.9 10307.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14560.9 other Inpatient DRG 10307.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14560.9 other Inpatient DRG 11631.9 Service paid by case rate. 3506.66 other IP General Discharge 10307.2 11631.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Transurethral Prostatectomy Without Cc/McC 714 MS-DRG inpatient 9903.79 9903.79 6698.02 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9491.08 other Inpatient DRG 6698.02 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9491.08 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 9903.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC 715 MS-DRG inpatient 16847.4 16847.4 16097.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22694.8 other Inpatient DRG 16097.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22694.8 other Inpatient DRG 16847.4 Service paid by case rate. 3506.66 other IP General Discharge 16097.8 16847.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC 717 MS-DRG inpatient 11331.9 11331.9 12716.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18348 other Inpatient DRG 12716.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18348 other Inpatient DRG 11331.9 Service paid by case rate. 3506.66 other IP General Discharge 11331.9 12716.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC 718 MS-DRG inpatient 19171.4 19171.4 8780.99 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12417 other Inpatient DRG 8780.99 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12417 other Inpatient DRG 19171.4 Service paid by case rate. 3506.66 other IP General Discharge 8780.99 19171.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Malignancy, Male Reproductive System With McC" 722 MS-DRG inpatient 32334.1 32334.1 12323.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17393.7 other Inpatient DRG 12323.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17393.7 other Inpatient DRG 32334.1 Service paid by case rate. 3506.66 other IP General Discharge 12323.9 32334.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Malignancy, Male Reproductive System With Cc" 723 MS-DRG inpatient 57511.4 57511.4 8004.69 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11326.5 other Inpatient DRG 8004.69 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11326.5 other Inpatient DRG 57511.4 Service paid by case rate. 3506.66 other IP General Discharge 8004.69 57511.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Benign Prostatic Hypertrophy With McC 725 MS-DRG inpatient 16362.1 16362.1 9004.12 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12730.4 other Inpatient DRG 9004.12 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12730.4 other Inpatient DRG 16362.1 Service paid by case rate. 3506.66 other IP General Discharge 9004.12 16362.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Benign Prostatic Hypertrophy Without McC 726 MS-DRG inpatient 13709.4 13709.4 5124.52 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7379.17 other Inpatient DRG 5124.52 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7379.17 other Inpatient DRG 13709.4 Service paid by case rate. 3506.66 other IP General Discharge 5124.52 13709.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Inflammation Of The Male Reproductive System With McC 727 MS-DRG inpatient 12512.3 12512.3 9709.95 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13941.1 other Inpatient DRG 9709.95 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 13941.1 other Inpatient DRG 12512.3 Service paid by case rate. 3506.66 other IP General Discharge 9709.95 12512.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Inflammation Of The Male Reproductive System Without McC 728 MS-DRG inpatient 5427.75 5427.75 5824.77 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8264.43 other Inpatient DRG 5824.77 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8264.43 other Inpatient DRG 5427.75 Service paid by case rate. 3506.66 other IP General Discharge 5427.75 5824.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Male Reproductive System Diagnoses With Cc/McC 729 MS-DRG inpatient 14472.8 14472.8 7038.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10192.6 other Inpatient DRG 7038.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10192.6 other Inpatient DRG 14472.8 Service paid by case rate. 3506.66 other IP General Discharge 7038.6 14472.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Male Reproductive System Diagnoses Without Cc/McC 730 MS-DRG inpatient 4344.02 4344.02 9313.67 Base payment rate plus any adjustments related to transfers and outliers. 6209.11 case rate 4344.02 93 "Additional drugs, imaging services, labs, and other services can be included in reimbursement." 3518.66 percent of total billed charges 4326.34 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6159.6 other Inpatient DRG 4326.34 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6159.6 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 9313.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC 738 MS-DRG inpatient 10382.7 10382.7 10812.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15270.8 other Inpatient DRG 10812.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15270.8 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 10812.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC 739 MS-DRG inpatient 35232 35232 28376.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 39942.9 other Inpatient DRG 28376.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 39942.9 other Inpatient DRG 35232 Service paid by case rate. 3506.66 other IP General Discharge 28376.8 35232 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc 740 MS-DRG inpatient 28752.2 28752.2 12961.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18288.9 other Inpatient DRG 12961.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18288.9 other Inpatient DRG 28752.2 Service paid by case rate. 3506.66 other IP General Discharge 12961.2 28752.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC 742 MS-DRG inpatient 38621.3 38621.3 25593.4 Base payment rate plus any adjustments related to transfers and outliers. 25593.4 case rate 37779.4 Base payment rate plus any adjustments related to transfers and outliers. 30476 case rate 38621.3 93 "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement." 31283.3 percent of total billed charges 13021.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18373 other Inpatient DRG 13021.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18373 other Inpatient DRG 20064.5 Service paid by case rate. 3506.66 other IP General Discharge 13021.1 38621.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC 743 MS-DRG inpatient 34821.7 34821.7 16624.9 Base payment rate plus any adjustments related to transfers and outliers. 16624.9 case rate 34821.7 Base payment rate plus any adjustments related to transfers and outliers. 15701.9 case rate 34821.7 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 28205.6 percent of total billed charges 8544.32 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12084.5 other Inpatient DRG 8544.32 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12084.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 34821.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC" 744 MS-DRG inpatient 26150.6 26150.6 13928.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19647.7 other Inpatient DRG 13928.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19647.7 other Inpatient DRG 26150.6 Service paid by case rate. 3506.66 other IP General Discharge 13928.5 26150.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC" 745 MS-DRG inpatient 7315.32 7315.32 7305.37 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10344.2 other Inpatient DRG 7305.37 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10344.2 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 7315.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Vagina, Cervix And Vulva Procedures With Cc/McC" 746 MS-DRG inpatient 14043.9 14043.9 22203.4 Base payment rate plus any adjustments related to transfers and outliers. 22203.4 case rate 14043.9 93 "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement." 11375.6 percent of total billed charges 11936.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16850 other Inpatient DRG 11936.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16850 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 22203.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Vagina, Cervix And Vulva Procedures Without Cc/McC" 747 MS-DRG inpatient 12847.5 12847.5 6026.32 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8701.68 other Inpatient DRG 6026.32 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8701.68 other Inpatient DRG 12847.5 Service paid by case rate. 3506.66 other IP General Discharge 6026.32 12847.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Female Reproductive System O.R. Procedures With Cc/McC 749 MS-DRG inpatient 15773.6 15773.6 18451.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 26001.2 other Inpatient DRG 18451.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 26001.2 other Inpatient DRG 15773.6 Service paid by case rate. 3506.66 other IP General Discharge 15773.6 18451.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Malignancy, Female Reproductive System With McC" 754 MS-DRG inpatient 24979.7 24979.7 24667.5 Base payment rate plus any adjustments related to transfers and outliers. 24667.5 case rate 24979.7 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 20233.5 percent of total billed charges 12897 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18114.9 other Inpatient DRG 12897 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18114.9 other Inpatient DRG 13971.9 Service paid by case rate. 3506.66 other IP General Discharge 12897 24979.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Malignancy, Female Reproductive System With Cc" 755 MS-DRG inpatient 9323.47 9323.47 15353.8 Base payment rate plus any adjustments related to transfers and outliers. 15353.8 case rate 9323.47 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 7552.01 percent of total billed charges 7913.44 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11198.4 other Inpatient DRG 7913.44 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11198.4 other Inpatient DRG 36940.1 Service paid by case rate. 3506.66 other IP General Discharge 7913.44 36940.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Infections, Female Reproductive System With McC" 757 MS-DRG inpatient 6392.46 6392.46 10088.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14253.5 other Inpatient DRG 10088.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14253.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 10088.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Infections, Female Reproductive System With Cc" 758 MS-DRG inpatient 8003.21 8003.21 6959.37 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10078.8 other Inpatient DRG 6959.37 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10078.8 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 8003.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Infections, Female Reproductive System Without Cc/McC" 759 MS-DRG inpatient 11910.8 11910.8 4561.58 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6490.04 other Inpatient DRG 4561.58 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6490.04 other Inpatient DRG 11910.8 Service paid by case rate. 3506.66 other IP General Discharge 4561.58 11910.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Menstrual And Other Female Reproductive System Disorders With Cc/McC 760 MS-DRG inpatient 32224.1 32224.1 13727.7 Base payment rate plus any adjustments related to transfers and outliers. 13727.7 case rate 32224.1 93 "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement." 26101.5 percent of total billed charges 6979 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10107 other Inpatient DRG 6979 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10107 other Inpatient DRG 22105.4 Service paid by case rate. 3506.66 other IP General Discharge 6979 32224.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Menstrual And Other Female Reproductive System Disorders Without Cc/McC 761 MS-DRG inpatient 17800.4 17800.4 8034.07 Base payment rate plus any adjustments related to transfers and outliers. 8034.07 case rate 17027.4 case rate 17027.4 Base payment rate plus any adjustments related to transfers and outliers. 8413.21 case rate 17800.4 93 "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement." 14418.3 percent of total billed charges 3823.02 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 5529.14 other Inpatient DRG 3823.02 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 5529.14 other Inpatient DRG 17800.4 Service paid by case rate. 3506.66 other IP General Discharge 3823.02 17800.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C 768 MS-DRG inpatient 13145.8 12308.3 16286.9 Base payment rate plus any adjustments related to transfers and outliers. 16286.9 case rate 12198.8 case rate 13145.8 Base payment rate plus any adjustments related to transfers and outliers. 8943.86 case rate 12198.8 93 "Additional drugs, labs, supplies, and other services can be included in reimbursement." 9881.03 percent of total billed charges 7815.07 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11060.2 other Inpatient DRG 7815.07 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11060.2 other Inpatient DRG 12308.3 Service paid by case rate. 3506.66 other IP General Discharge 7815.07 16286.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Postpartum And Post Abortion Diagnoses With O.R. Procedures 769 MS-DRG inpatient 34481.7 34481.7 23593.8 Base payment rate plus any adjustments related to transfers and outliers. 23593.8 case rate 34481.7 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement." 27930.2 percent of total billed charges 10824.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15630.9 other Inpatient DRG 10824.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15630.9 other Inpatient DRG 27173.6 Service paid by case rate. 3506.66 other IP General Discharge 10824.7 34481.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Abortion With D&C, Aspiration Curettage Or Hysterotomy" 770 MS-DRG inpatient 13533.7 13533.7 12296.1 Base payment rate plus any adjustments related to transfers and outliers. 12296.1 case rate 13533.7 93 "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement." 10962.3 percent of total billed charges 7669.65 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10855.9 other Inpatient DRG 7669.65 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10855.9 other Inpatient DRG 11869.5 Service paid by case rate. 3506.66 other IP General Discharge 7669.65 13533.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Postpartum And Post Abortion Diagnoses Without O.R. Procedures 776 MS-DRG inpatient 9938.94 9938.94 9900.21 Base payment rate plus any adjustments related to transfers and outliers. 9900.21 case rate 5547.28 case rate 5547.28 case rate 5547.28 93 "Additional drugs, imaging services, labs, and other services can be included in reimbursement." 4493.31 percent of total billed charges 5085.53 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7226.03 other Inpatient DRG 5085.53 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7226.03 other Inpatient DRG 9938.94 Service paid by case rate. 3506.66 other IP General Discharge 5085.53 9938.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Abortion Without D&C 779 MS-DRG inpatient 9280.54 9280.54 14466.2 Base payment rate plus any adjustments related to transfers and outliers. 14466.2 case rate 12199.2 Base payment rate plus any adjustments related to transfers and outliers. 9145.26 case rate 9280.54 93 "Additional drugs, imaging services, labs, and other services can be included in reimbursement." 7517.22 percent of total billed charges 6663.09 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9442 other Inpatient DRG 6663.09 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9442 other Inpatient DRG 9280.54 Service paid by case rate. 3506.66 other IP General Discharge 6663.09 14466.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cesarean Section With Sterilization With McC 783 MS-DRG inpatient 13815.8 13815.8 13130.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18527.2 other Inpatient DRG 13130.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18527.2 other Inpatient DRG 1048.16 1048.16 case rate 1048.16 13815.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cesarean Section With Sterilization With Cc 784 MS-DRG inpatient 16388.8 16388.8 14826.9 Base payment rate plus any adjustments related to transfers and outliers. 14826.9 case rate 13369.4 Base payment rate plus any adjustments related to transfers and outliers. 13211.9 case rate 16388.8 93 "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement." 13274.9 percent of total billed charges 7720.26 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10927 other Inpatient DRG 7720.26 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10927 other Inpatient DRG 16388.8 Service paid by case rate. 3506.66 other IP General Discharge 7720.26 16388.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cesarean Section With Sterilization Without Cc/McC 785 MS-DRG inpatient 15538.9 15538.9 12953.6 Base payment rate plus any adjustments related to transfers and outliers. 12953.6 case rate 15278.7 case rate 13348.4 Base payment rate plus any adjustments related to transfers and outliers. 10926.3 case rate 15278.7 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 12375.7 percent of total billed charges 6236.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8843.2 other Inpatient DRG 6236.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8843.2 other Inpatient DRG 15538.9 Service paid by case rate. 3506.66 other IP General Discharge 6236.8 15538.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cesarean Section Without Sterilization With McC 786 MS-DRG inpatient 15229.1 15229.1 22936.2 Base payment rate plus any adjustments related to transfers and outliers. 22936.2 case rate 15002.6 case rate 13117.9 Base payment rate plus any adjustments related to transfers and outliers. 763459 case rate 15002.6 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 12152.1 percent of total billed charges 11518.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16262.2 other Inpatient DRG 11518.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16262.2 other Inpatient DRG 15229.1 Service paid by case rate. 3506.66 other IP General Discharge 11518.4 22936.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cesarean Section Without Sterilization With Cc 787 MS-DRG inpatient 14510 14510 15129.4 Base payment rate plus any adjustments related to transfers and outliers. 15129.4 case rate 12951 Base payment rate plus any adjustments related to transfers and outliers. 8195.32 case rate 11589.9 Base payment rate plus any adjustments related to transfers and outliers. 8624.19 case rate 14510 93 "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement." 11753.1 percent of total billed charges 7569.13 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10714.7 other Inpatient DRG 7569.13 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10714.7 other Inpatient DRG 14507.9 51 "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement." 5065.62 percent of total billed charges 7569.13 15129.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cesarean Section Without Sterilization Without Cc/McC 788 MS-DRG inpatient 14505.8 14505.8 12389.8 Base payment rate plus any adjustments related to transfers and outliers. 12389.8 case rate 14084.4 case rate 12372.7 Base payment rate plus any adjustments related to transfers and outliers. 11372.3 case rate 14084.4 93 "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement." 11408.4 percent of total billed charges 6451.37 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9144.6 other Inpatient DRG 6451.37 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9144.6 other Inpatient DRG 14505.8 Service paid by case rate. 3506.66 other IP General Discharge 6451.37 14505.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Neonates, Died Or Transferred To Another Acute Care Facility" 789 MS-DRG inpatient 5625.18 3136.14 26161.9 Base payment rate plus any adjustments related to transfers. 26161.9 case rate 3136.14 case rate 5625.18 Base payment rate plus any adjustments related to transfers and outliers. 4724.79 case rate 3136.14 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 2540.28 percent of total billed charges 12850.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18133.7 other Inpatient DRG 12850.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18133.7 other Inpatient DRG 1048.16 1048.16 case rate 1048.16 26161.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Extreme Immaturity Or Respiratory Distress Syndrome, Neonate" 790 MS-DRG inpatient 17599.1 17599.1 42379.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 59612.3 other Inpatient DRG 42379.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 59612.3 other Inpatient DRG 1048.16 1048.16 case rate 1048.16 42379.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Prematurity With Major Problems 791 MS-DRG inpatient 9212.23 9212.23 58922.3 Base payment rate plus any adjustments related to transfers. 58922.3 case rate 9212.23 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 7461.91 percent of total billed charges 28942.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 40738 other Inpatient DRG 28942.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 40738 other Inpatient DRG 1048.16 1048.16 case rate 1048.16 58922.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Prematurity Without Major Problems 792 MS-DRG inpatient 7325.08 3518.26 35553.1 Base payment rate plus any adjustments related to transfers. 35553.1 case rate 3164 case rate 7325.08 Base payment rate plus any adjustments related to transfers and outliers. 4369.52 case rate 3164 93 "Additional drugs, labs, and therapy services can be included in reimbursement." 2562.84 percent of total billed charges 17463.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 24613.4 other Inpatient DRG 17463.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 24613.4 other Inpatient DRG 1048.16 1048.16 case rate 1048.16 35553.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Full Term Neonate With Major Problems 793 MS-DRG inpatient 9253.92 9253.92 60525.7 Base payment rate plus any adjustments related to transfers. 60525.7 case rate 10781.3 Base payment rate plus any adjustments related to transfers and outliers. 10026.6 case rate 6709.06 Base payment rate plus any adjustments related to transfers and outliers. 5314.14 case rate 9253.92 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 7495.67 percent of total billed charges 29730.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 41844.5 other Inpatient DRG 29730.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 41844.5 other Inpatient DRG 1048.16 1048.16 case rate 1048.16 60525.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Neonate With Other Significant Problems 794 MS-DRG inpatient 6611.54 2753.81 21423.3 Base payment rate plus any adjustments related to transfers. 21423.3 case rate 4305.81 Base payment rate plus any adjustments related to transfers and outliers. 4004.41 case rate 6611.54 Base payment rate plus any adjustments related to transfers and outliers. 3659.89 case rate 2619 93 "Additional drugs, labs, and therapy services can be included in reimbursement." 2121.39 percent of total billed charges 10523.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14864.3 other Inpatient DRG 10523.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14864.3 other Inpatient DRG 1048.16 1048.16 case rate 1048.16 21423.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Normal Newborn 795 MS-DRG inpatient 2268.3 2268.3 2900.19 Base payment rate plus any adjustments related to transfers. 2900.19 case rate 1842 Base payment rate plus any adjustments related to transfers and outliers. 1713.07 case rate 1796.81 Base payment rate plus any adjustments related to transfers and outliers. 1796.81 case rate 2268.3 93 "Additional drugs, labs, and therapy services can be included in reimbursement." 1837.32 percent of total billed charges 1424.29 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 2083.13 other Inpatient DRG 1424.29 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 2083.13 other Inpatient DRG 1048.16 1048.16 case rate 1048.16 2900.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Vaginal Delivery With Sterilization And/Or D&C With McC 796 MS-DRG inpatient 8221.28 8221.28 9100.35 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12865.6 other Inpatient DRG 9100.35 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12865.6 other Inpatient DRG 8221.28 Service paid by case rate. 3506.66 other IP General Discharge 8221.28 9100.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Vaginal Delivery With Sterilization And/Or D&C With Cc 797 MS-DRG inpatient 8433.11 8433.11 6901.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9777.46 other Inpatient DRG 6901.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9777.46 other Inpatient DRG 8433.11 Service paid by case rate. 3506.66 other IP General Discharge 6901.9 8433.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC 798 MS-DRG inpatient 16809.3 16809.3 13178 Base payment rate plus any adjustments related to transfers and outliers. 13178 case rate 16809.3 93 "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement." 13615.6 percent of total billed charges 6901.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9777.46 other Inpatient DRG 6901.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9777.46 other Inpatient DRG 1048.16 1048.16 case rate 1048.16 16809.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Splenic Procedures With McC 799 MS-DRG inpatient 22080.8 22080.8 33892.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 47691.3 other Inpatient DRG 33892.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 47691.3 other Inpatient DRG 22080.8 Service paid by case rate. 3506.66 other IP General Discharge 22080.8 33892.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Splenic Procedures With Cc 800 MS-DRG inpatient 38040 38040 20769.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 29257.6 other Inpatient DRG 20769.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 29257.6 other Inpatient DRG 38040 Service paid by case rate. 3506.66 other IP General Discharge 20769.8 38040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other O.R. Procedures Of The Blood And Blood Forming Organs With McC 802 MS-DRG inpatient 131181 131181 25553.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 36771.2 other Inpatient DRG 25553.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 36771.2 other Inpatient DRG 131181 Service paid by case rate. 3506.66 other IP General Discharge 25553.1 131181 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc 803 MS-DRG inpatient 18538.8 18538.8 13028.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18796.2 other Inpatient DRG 13028.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18796.2 other Inpatient DRG 18538.8 Service paid by case rate. 3506.66 other IP General Discharge 13028.3 18538.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC 804 MS-DRG inpatient 15008.5 15008.5 17920.1 Base payment rate plus any adjustments related to transfers and outliers. 17920.1 case rate 15008.5 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 12156.9 percent of total billed charges 7880.65 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11152.3 other Inpatient DRG 7880.65 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11152.3 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 17920.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Vaginal Delivery Without Sterilization Or D&C With McC 805 MS-DRG inpatient 12182.6 12035.8 14281.5 Base payment rate plus any adjustments related to transfers and outliers. 14281.5 case rate 12026.4 case rate 12182.6 Base payment rate plus any adjustments related to transfers and outliers. 12182.6 case rate 12026.4 93 "Additional drugs, labs, supplies, and other services can be included in reimbursement." 9741.34 percent of total billed charges 7113.62 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10074.9 other Inpatient DRG 7113.62 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10074.9 other Inpatient DRG 12035.8 Service paid by case rate. 3506.66 other IP General Discharge 7113.62 14281.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Vaginal Delivery Without Sterilization Or D&C With Cc 806 MS-DRG inpatient 19469.8 11777 9910.16 Base payment rate plus any adjustments related to transfers and outliers. 9910.16 case rate 19469.8 Base payment rate plus any adjustments related to transfers and outliers. 18106.9 case rate 14308.6 Base payment rate plus any adjustments related to transfers and outliers. 8677.87 case rate 11647.5 93 "Additional drugs, labs, and other services can be included in reimbursement." 9434.49 percent of total billed charges 5157.53 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7327.17 other Inpatient DRG 5157.53 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7327.17 other Inpatient DRG 11777 Service paid by case rate. 3506.66 other IP General Discharge 5157.53 19469.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Vaginal Delivery Without Sterilization Or D&C Without Cc/McC 807 MS-DRG inpatient 11450.2 10781.6 8967.14 Base payment rate plus any adjustments related to transfers and outliers. 8967.14 case rate 10637.8 Base payment rate plus any adjustments related to transfers and outliers. 8907.64 case rate 11450.2 Base payment rate plus any adjustments related to transfers and outliers. 9738.47 case rate 10731.7 93 "Additional drugs, labs, and other services can be included in reimbursement." 8692.69 percent of total billed charges 4542.33 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6463.01 other Inpatient DRG 4542.33 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6463.01 other Inpatient DRG 10781.6 Service paid by case rate. 3506.66 other IP General Discharge 4542.33 11450.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC 808 MS-DRG inpatient 23581.8 23581.8 30406.5 Base payment rate plus any adjustments related to transfers and outliers. 30406.5 case rate 21461.4 case rate 16795.3 Base payment rate plus any adjustments related to transfers and outliers. 15771.2 case rate 21461.4 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 17383.7 percent of total billed charges 16327.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23017.2 other Inpatient DRG 16327.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23017.2 other Inpatient DRG 23581.8 Service paid by case rate. 3506.66 other IP General Discharge 16327.3 30406.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc 809 MS-DRG inpatient 43522.4 39580.4 21572.3 Base payment rate plus any adjustments related to transfers. 21572.3 case rate 39580.4 case rate 43522.4 Base payment rate plus any adjustments related to transfers and outliers. 40129.3 case rate 39580.4 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 32060.1 percent of total billed charges 8828.75 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12484.1 other Inpatient DRG 8828.75 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12484.1 other Inpatient DRG 25888.6 Service paid by case rate. 3506.66 other IP General Discharge 8828.75 43522.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC 810 MS-DRG inpatient 27185.9 27185.9 6784.27 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9612.24 other Inpatient DRG 6784.27 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9612.24 other Inpatient DRG 27185.9 Service paid by case rate. 3506.66 other IP General Discharge 6784.27 27185.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Red Blood Cell Disorders With McC 811 MS-DRG inpatient 15951.8 15951.8 19745 Base payment rate plus any adjustments related to transfers and outliers. 19745 case rate 15072.4 case rate 15072.4 case rate 15072.4 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 12208.7 percent of total billed charges 10028.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14169.4 other Inpatient DRG 10028.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14169.4 other Inpatient DRG 15951.8 Service paid by case rate. 3506.66 other IP General Discharge 10028.5 19745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Red Blood Cell Disorders Without McC 812 MS-DRG inpatient 9032.23 17192.3 12753.4 Base payment rate plus any adjustments related to transfers and outliers. 12753.4 case rate 17192.3 case rate 9032.23 Base payment rate plus any adjustments related to transfers and outliers. 9032.23 case rate 17192.3 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 13925.8 percent of total billed charges 6315.03 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9153.31 other Inpatient DRG 6315.03 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9153.31 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 17192.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Coagulation Disorders 813 MS-DRG inpatient 17416.9 17416.9 22227.5 Base payment rate plus any adjustments related to transfers and outliers. 22227.5 case rate 17416.9 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 14107.7 percent of total billed charges 11034.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15582.3 other Inpatient DRG 11034.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15582.3 other Inpatient DRG 17416.9 Service paid by case rate. 3506.66 other IP General Discharge 11034.3 22227.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Reticuloendothelial And Immunity Disorders With McC 814 MS-DRG inpatient 43574.8 43574.8 14900.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21013.5 other Inpatient DRG 14900.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21013.5 other Inpatient DRG 43574.8 Service paid by case rate. 3506.66 other IP General Discharge 14900.9 43574.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Reticuloendothelial And Immunity Disorders With Cc 815 MS-DRG inpatient 16920.2 16920.2 14643.7 Base payment rate plus any adjustments related to transfers and outliers. 14643.7 case rate 16920.2 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 13705.4 percent of total billed charges 7243.36 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10257.1 other Inpatient DRG 7243.36 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10257.1 other Inpatient DRG 10497.2 Service paid by case rate. 3506.66 other IP General Discharge 7243.36 16920.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Reticuloendothelial And Immunity Disorders Without Cc/McC 816 MS-DRG inpatient 8444.99 8444.99 4700.59 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6685.3 other Inpatient DRG 4700.59 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6685.3 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 8444.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Antepartum Diagnoses With O.R. Procedures With McC 817 MS-DRG inpatient 24348.3 24348.3 44449.4 Base payment rate plus any adjustments related to transfers and outliers. 44449.4 case rate 24348.3 Base payment rate plus any adjustments related to transfers and outliers. 22001.3 case rate 24348.3 93 "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement." 19722.1 percent of total billed charges 18071.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 25467.5 other Inpatient DRG 18071.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 25467.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 44449.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Antepartum Diagnoses With O.R. Procedures With Cc 818 MS-DRG inpatient 23453.8 23453.8 22582.6 Base payment rate plus any adjustments related to transfers and outliers. 22582.6 case rate 23453.8 93 "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement." 18997.6 percent of total billed charges 9181.62 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12979.8 other Inpatient DRG 9181.62 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12979.8 other Inpatient DRG 15848.4 Service paid by case rate. 3506.66 other IP General Discharge 9181.62 23453.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC 819 MS-DRG inpatient 31743.6 31743.6 12618.5 Base payment rate plus any adjustments related to transfers and outliers. 12618.5 case rate 31200.5 case rate 31200.5 Base payment rate plus any adjustments related to transfers and outliers. 12618.5 case rate 31743.6 93 "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement." 25712.3 percent of total billed charges 5820.49 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8258.41 other Inpatient DRG 5820.49 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8258.41 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 31743.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Lymphoma And Leukemia With Major O.R. Procedures With McC 820 MS-DRG inpatient 66591.1 66591.1 75520.6 Base payment rate plus any adjustments related to transfers and outliers. 75520.6 case rate 66591.1 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 53938.8 percent of total billed charges 41501.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 58379.7 other Inpatient DRG 41501.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 58379.7 other Inpatient DRG 66591.1 Service paid by case rate. 3506.66 other IP General Discharge 41501.9 75520.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Lymphoma And Leukemia With Major O.R. Procedures With Cc 821 MS-DRG inpatient 29908.8 29908.8 30710.4 Base payment rate plus any adjustments related to transfers and outliers. 7976.73 case rate 27828.3 case rate 27828.3 case rate 29908.8 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 24226.2 percent of total billed charges 15912.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22434.4 other Inpatient DRG 15912.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22434.4 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 30710.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC 822 MS-DRG inpatient 35898.7 35898.7 17113.4 Base payment rate plus any adjustments related to transfers and outliers. 17113.4 case rate 33092.3 case rate 33092.3 case rate 35898.7 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 29077.9 percent of total billed charges 8152.25 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11533.8 other Inpatient DRG 8152.25 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11533.8 other Inpatient DRG 35898.7 Service paid by case rate. 3506.66 other IP General Discharge 8152.25 35898.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Lymphoma And Non-Acute Leukemia With Other Procedures With McC 823 MS-DRG inpatient 76216.4 76216.4 33356.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 46937.3 other Inpatient DRG 33356.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 46937.3 other Inpatient DRG 76216.4 Service paid by case rate. 3506.66 other IP General Discharge 33356.1 76216.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Lymphoma And Non-Acute Leukemia With Other Procedures With Cc 824 MS-DRG inpatient 32709.2 32709.2 15677.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22105 other Inpatient DRG 15677.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22105 other Inpatient DRG 32709.2 Service paid by case rate. 3506.66 other IP General Discharge 15677.9 32709.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC 825 MS-DRG inpatient 22342.2 22342.2 18698.3 Base payment rate plus any adjustments related to transfers and outliers. 18698.3 case rate 22342.2 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 18097.2 percent of total billed charges 8773.15 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12406 other Inpatient DRG 8773.15 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12406 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 22342.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC 826 MS-DRG inpatient 57169 57169 34040.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 47898.6 other Inpatient DRG 34040.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 47898.6 other Inpatient DRG 57169 Service paid by case rate. 3506.66 other IP General Discharge 34040.4 57169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc 827 MS-DRG inpatient 17258 17258 34577.6 Base payment rate plus any adjustments related to transfers and outliers. 8866.05 case rate 17258 Base payment rate plus any adjustments related to transfers and outliers. 16049.9 case rate 17258 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 13979 percent of total billed charges 16821.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23711.2 other Inpatient DRG 16821.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 23711.2 other Inpatient DRG 17006.3 Service paid by case rate. 3506.66 other IP General Discharge 16821.3 34577.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC 828 MS-DRG inpatient 21281.4 21281.4 24698.7 Base payment rate plus any adjustments related to transfers and outliers. 13350.7 case rate 21281.4 Base payment rate plus any adjustments related to transfers and outliers. 20648.8 case rate 21281.4 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 17237.9 percent of total billed charges 11425.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16132 other Inpatient DRG 11425.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16132 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 24698.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC 829 MS-DRG inpatient 25150.8 25150.8 21981.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 30959.9 other Inpatient DRG 21981.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 30959.9 other Inpatient DRG 25150.8 Service paid by case rate. 3506.66 other IP General Discharge 21981.7 25150.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC 830 MS-DRG inpatient 13524.9 13524.9 10424.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14726.1 other Inpatient DRG 10424.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14726.1 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 13524.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Antepartum Diagnoses Without O.R. Procedures With McC 831 MS-DRG inpatient 9224.94 9224.94 19260 Base payment rate plus any adjustments related to transfers. 4279.99 case rate 5999.75 Base payment rate plus any adjustments related to transfers and outliers. 5579.76 case rate 5999.75 case rate 5999.75 93 "Additional drugs, imaging services, labs, and other services can be included in reimbursement." 4859.79 percent of total billed charges 8204.29 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11606.9 other Inpatient DRG 8204.29 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11606.9 other Inpatient DRG 9224.94 Service paid by case rate. 3506.66 other IP General Discharge 5999.75 19260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Antepartum Diagnoses Without O.R. Procedures With Cc 832 MS-DRG inpatient 6559.71 6559.71 9948.5 Base payment rate plus any adjustments related to transfers and outliers. 9948.5 case rate 6559.71 93 "Additional drugs, imaging services, labs, and other services can be included in reimbursement." 5313.37 percent of total billed charges 5327.19 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7565.48 other Inpatient DRG 5327.19 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7565.48 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 9948.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC 833 MS-DRG inpatient 3144.61 3144.61 7157.81 Base payment rate plus any adjustments related to transfers and outliers. 7157.81 case rate 2096.94 case rate 2096.94 case rate 2096.94 93 "Additional drugs, labs, and other services can be included in reimbursement." 1698.51 percent of total billed charges 3705.44 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 5287.44 other Inpatient DRG 3705.44 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 5287.44 other Inpatient DRG 3506.66 3506.66 case rate 2096.94 7157.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Acute Leukemia With McC 834 MS-DRG inpatient 53531.1 53531.1 39399 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 55425.7 other Inpatient DRG 39399 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 55425.7 other Inpatient DRG 53531.1 Service paid by case rate. 3506.66 other IP General Discharge 39399 53531.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Acute Leukemia With Cc 835 MS-DRG inpatient 14186.8 14186.8 15225.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18714.8 other Inpatient DRG 15225.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18714.8 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 15225.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Lymphoma And Non-Acute Leukemia With McC 840 MS-DRG inpatient 53529.8 53529.8 21911.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 31556 other Inpatient DRG 21911.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 31556 other Inpatient DRG 53529.8 Service paid by case rate. 3506.66 other IP General Discharge 21911.6 53529.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Lymphoma And Non-Acute Leukemia With Cc 841 MS-DRG inpatient 11070.3 11070.3 11032.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14023.9 other Inpatient DRG 11032.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14023.9 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 11070.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Lymphoma And Non-Acute Leukemia Without Cc/McC 842 MS-DRG inpatient 9597.02 9597.02 7497.85 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10614.6 other Inpatient DRG 7497.85 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10614.6 other Inpatient DRG 9597.02 Service paid by case rate. 3506.66 other IP General Discharge 7497.85 9597.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC 843 MS-DRG inpatient 20668.4 20668.4 27515 Base payment rate plus any adjustments related to transfers and outliers. 27515 case rate 20668.4 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement." 16741.4 percent of total billed charges 13045.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18820.4 other Inpatient DRG 13045.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18820.4 other Inpatient DRG 14929.9 Service paid by case rate. 3506.66 other IP General Discharge 13045.1 27515 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc 844 MS-DRG inpatient 11329.7 11329.7 7708.22 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11080.8 other Inpatient DRG 7708.22 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11080.8 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 11329.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC 846 MS-DRG inpatient 14543.9 14543.9 18203.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 25652.8 other Inpatient DRG 18203.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 25652.8 other Inpatient DRG 14543.9 Service paid by case rate. 3506.66 other IP General Discharge 14543.9 18203.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc 847 MS-DRG inpatient 13149.1 13149.1 9057.58 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12805.5 other Inpatient DRG 9057.58 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12805.5 other Inpatient DRG 13149.1 Service paid by case rate. 3506.66 other IP General Discharge 9057.58 13149.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Infectious And Parasitic Diseases With O.R. Procedures With McC 853 MS-DRG inpatient 43567.3 43567.3 69604 Base payment rate plus any adjustments related to transfers and outliers. 69604 case rate 25918.6 Base payment rate plus any adjustments related to transfers and outliers. 68060.5 case rate 35611.8 Base payment rate plus any adjustments related to transfers and outliers. 35593.5 case rate 43567.3 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 35289.5 percent of total billed charges 35653.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 48193.6 other Inpatient DRG 35653.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 48193.6 other Inpatient DRG 42598.4 Service paid by case rate. 3506.66 other IP General Discharge 25918.6 69604 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Infectious And Parasitic Diseases With O.R. Procedures With Cc 854 MS-DRG inpatient 42805.5 29706.8 29193.6 Base payment rate plus any adjustments related to transfers and outliers. 29193.6 case rate 29120.8 case rate 42805.5 Base payment rate plus any adjustments related to transfers and outliers. 15701.9 case rate 29120.8 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 23587.9 percent of total billed charges 14244.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20091.3 other Inpatient DRG 14244.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20091.3 other Inpatient DRG 29706.8 Service paid by case rate. 3506.66 other IP General Discharge 14244.3 42805.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC 855 MS-DRG inpatient 12341.6 12341.6 11587.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16359.3 other Inpatient DRG 11587.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16359.3 other Inpatient DRG 12341.6 Service paid by case rate. 3506.66 other IP General Discharge 11587.5 12341.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC 856 MS-DRG inpatient 33501.3 33501.3 62669.2 Base payment rate plus any adjustments related to transfers and outliers. 62669.2 case rate 33501.3 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 27136 percent of total billed charges 32159.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 40387.5 other Inpatient DRG 32159.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 40387.5 other Inpatient DRG 23446 Service paid by case rate. 3506.66 other IP General Discharge 23446 62669.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc 857 MS-DRG inpatient 9954.14 9954.14 29952 Base payment rate plus any adjustments related to transfers and outliers. 29952 case rate 9954.14 93 "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement." 8062.84 percent of total billed charges 15532.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21900.7 other Inpatient DRG 15532.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21900.7 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 29952 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC 858 MS-DRG inpatient 10598.9 10598.9 20090.2 Base payment rate plus any adjustments related to transfers and outliers. 20090.2 case rate 10598.9 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 8585.06 percent of total billed charges 9184.47 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12706.9 other Inpatient DRG 9184.47 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12706.9 other Inpatient DRG 10598.9 Service paid by case rate. 3506.66 other IP General Discharge 9184.47 20090.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Postoperative And Post-Traumatic Infections With McC 862 MS-DRG inpatient 33428.6 26886.4 25976.9 Base payment rate plus any adjustments related to transfers and outliers. 25976.9 case rate 26886.4 case rate 33428.6 Base payment rate plus any adjustments related to transfers and outliers. 18136.2 case rate 26886.4 93 "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 21778 percent of total billed charges 12914.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17670.9 other Inpatient DRG 12914.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17670.9 other Inpatient DRG 26886.4 Service paid by case rate. 3506.66 other IP General Discharge 12914.7 33428.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Postoperative And Post-Traumatic Infections Without McC 863 MS-DRG inpatient 3115.35 3115.35 14285.8 Base payment rate plus any adjustments related to transfers and outliers. 14285.8 case rate 3115.35 93 Additional drugs and labs can be included in reimbursement. 2523.46 percent of total billed charges 7127.87 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10094.9 other Inpatient DRG 7127.87 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10094.9 other Inpatient DRG 12708.5 Service paid by case rate. 3506.66 other IP General Discharge 3115.35 14285.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Fever And Inflammatory Conditions 864 MS-DRG inpatient 6681.2 6681.2 6400.76 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9073.52 other Inpatient DRG 6400.76 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9073.52 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 6681.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Viral Illness With McC 865 MS-DRG inpatient 15791.2 15791.2 10521.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14861.3 other Inpatient DRG 10521.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14861.3 other Inpatient DRG 15791.2 Service paid by case rate. 3506.66 other IP General Discharge 10521.1 15791.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Viral Illness Without McC 866 MS-DRG inpatient 7959.76 7959.76 6306.66 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8941.33 other Inpatient DRG 6306.66 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8941.33 other Inpatient DRG 7959.76 Service paid by case rate. 3506.66 other IP General Discharge 6306.66 7959.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Infectious And Parasitic Diseases Diagnoses With McC 867 MS-DRG inpatient 29887.2 29887.2 30014.5 Base payment rate plus any adjustments related to transfers and outliers. 30014.5 case rate 29887.2 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 24208.7 percent of total billed charges 14669.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21153.8 other Inpatient DRG 14669.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21153.8 other Inpatient DRG 20619.3 Service paid by case rate. 3506.66 other IP General Discharge 14669.6 30014.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Infectious And Parasitic Diseases Diagnoses With Cc 868 MS-DRG inpatient 19718.7 19718.7 7485.01 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10596.5 other Inpatient DRG 7485.01 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10596.5 other Inpatient DRG 19718.7 Service paid by case rate. 3506.66 other IP General Discharge 7485.01 19718.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC 869 MS-DRG inpatient 19780.6 19780.6 5129.02 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7287.12 other Inpatient DRG 5129.02 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7287.12 other Inpatient DRG 19780.6 Service paid by case rate. 3506.66 other IP General Discharge 5129.02 19780.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Septicemia Or Severe Sepsis With Mv >96 Hours 870 MS-DRG inpatient 96056.7 96056.7 124750 Base payment rate plus any adjustments related to transfers. 47980.8 case rate 96056.7 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 77805.9 percent of total billed charges 49590 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 66144.3 other Inpatient DRG 49590 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 66144.3 other Inpatient DRG 101818 Service paid by case rate. 3506.66 other IP General Discharge 49590 124750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Septicemia Or Severe Sepsis Without Mv >96 Hours With McC 871 MS-DRG inpatient 22298.4 22298.4 27796.2 Base payment rate plus any adjustments related to transfers and outliers. 27796.2 case rate 17798.3 Base payment rate plus any adjustments related to transfers and outliers. 14416.7 case rate 16262.6 Base payment rate plus any adjustments related to transfers and outliers. 15536.1 case rate 22298.4 93 "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement." 18061.7 percent of total billed charges 13988.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18879.6 other Inpatient DRG 13988.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18879.6 other Inpatient DRG 22277.2 Service paid by case rate. 3506.66 other IP General Discharge 13988.4 27796.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC 872 MS-DRG inpatient 18463.4 15836.4 14599.7 Base payment rate plus any adjustments related to transfers and outliers. 14599.7 case rate 11855.7 Base payment rate plus any adjustments related to transfers and outliers. 11367.6 case rate 18463.4 Base payment rate plus any adjustments related to transfers and outliers. 9235.33 case rate 14622.3 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 11844.1 percent of total billed charges 7349.57 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10406.3 other Inpatient DRG 7349.57 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10406.3 other Inpatient DRG 15836.4 Service paid by case rate. 3506.66 other IP General Discharge 7349.57 18463.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. O.R. Procedures With Principal Diagnosis Of Mental Illness 876 MS-DRG inpatient 24795.6 24795.6 28011.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 39429.3 other Inpatient DRG 28011.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 39429.3 other Inpatient DRG 867 8670 per diem Estimated amount calculated based on 10 day length of stay. 867 28011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Acute Adjustment Reaction And Psychosocial Dysfunction 880 MS-DRG inpatient 9435.16 9435.16 12984.9 Base payment rate plus any adjustments related to transfers. 12984.9 case rate 10708.5 case rate 10708.5 case rate 10708.5 93 "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement." 8673.93 percent of total billed charges 6833.46 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9681.33 other Inpatient DRG 6833.46 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9681.33 other Inpatient DRG 9435.16 Service paid by case rate. 3506.66 other IP General Discharge 6833.46 12984.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Depressive Neuroses 881 MS-DRG inpatient 8196.91 8196.91 6355.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9211.72 other Inpatient DRG 6355.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9211.72 other Inpatient DRG 867 2601 per diem Estimated amount calculated based on 39 day length of stay. 867 8196.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Neuroses Except Depressive 882 MS-DRG inpatient 6351.35 6351.35 12516.4 Base payment rate plus any adjustments related to transfers. 12516.4 case rate 18153.5 case rate 18153.5 case rate 18683.5 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 15133.6 percent of total billed charges 6856.99 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9714.37 other Inpatient DRG 6856.99 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9714.37 other Inpatient DRG 867 1734 per diem Estimated amount calculated based on 3 day length of stay. 867 18683.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Disorders Of Personality And Impulse Control 883 MS-DRG inpatient 42390.1 42390.1 13233.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18671.4 other Inpatient DRG 13233.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18671.4 other Inpatient DRG 42390.1 Service paid by case rate. 3506.66 other IP General Discharge 13233.5 42390.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Organic Disturbances And Intellectual Disability 884 MS-DRG inpatient 16409.9 16409.9 11905.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16805.9 other Inpatient DRG 11905.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16805.9 other Inpatient DRG 16409.9 Service paid by case rate. 3506.66 other IP General Discharge 11905.5 16409.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Psychoses 885 MS-DRG inpatient 12731.8 12731.8 18563.2 Base payment rate plus any adjustments related to transfers. 18563.2 case rate 12731.8 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 10312.8 percent of total billed charges 10047.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14196.4 other Inpatient DRG 10047.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14196.4 other Inpatient DRG 867 3468 per diem Estimated amount calculated based on 5 day length of stay. 867 18563.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Behavioral And Developmental Disorders 886 MS-DRG inpatient 11582.9 11582.9 12805.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18070.6 other Inpatient DRG 12805.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18070.6 other Inpatient DRG 11582.9 Service paid by case rate. 3506.66 other IP General Discharge 11582.9 12805.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Mental Disorder Diagnoses 887 MS-DRG inpatient 2886.55 2886.55 8478.03 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11991.4 other Inpatient DRG 8478.03 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11991.4 other Inpatient DRG 3506.66 3506.66 case rate 2886.55 8478.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Alcohol, Drug Abuse Or Dependence, Left Ama" 894 MS-DRG inpatient 12172.4 12172.4 8120.7 Base payment rate plus any adjustments related to transfers and outliers. 8120.7 case rate 12172.4 Base payment rate plus any adjustments related to transfers and outliers. 11575.3 case rate 11877 case rate 11877 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 9620.36 percent of total billed charges 4448.95 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6331.83 other Inpatient DRG 4448.95 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6331.83 other Inpatient DRG 12172.4 Service paid by case rate. 3506.66 other IP General Discharge 4448.95 12172.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC" 896 MS-DRG inpatient 31935 21048.8 24933 Base payment rate plus any adjustments related to transfers and outliers. 24933 case rate 21048.8 case rate 31935 Base payment rate plus any adjustments related to transfers and outliers. 23302 case rate 21048.8 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 17049.6 percent of total billed charges 12466.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17989.5 other Inpatient DRG 12466.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17989.5 other Inpatient DRG 18411.9 Service paid by case rate. 3506.66 other IP General Discharge 12466.7 31935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC" 897 MS-DRG inpatient 5505.2 13651.5 12090.2 Base payment rate plus any adjustments related to transfers and outliers. 12090.2 case rate 10561.7 case rate 5505.2 Base payment rate plus any adjustments related to transfers and outliers. 4832.64 case rate 10561.7 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 8554.95 percent of total billed charges 6288.84 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8916.3 other Inpatient DRG 6288.84 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8916.3 other Inpatient DRG 13651.5 Service paid by case rate. 3506.66 other IP General Discharge 5505.2 13651.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Wound Debridements For Injuries With McC 901 MS-DRG inpatient 14383.2 14383.2 31581.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 44444 other Inpatient DRG 31581.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 44444 other Inpatient DRG 14383.2 Service paid by case rate. 3506.66 other IP General Discharge 14383.2 31581.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Wound Debridements For Injuries With Cc 902 MS-DRG inpatient 12976.5 12976.5 170.54 Additional labs and other services can be included in reimbursement. 619.98 fee schedule 170.54 Additional labs and other services can be included in reimbursement. 619.98 fee schedule 12976.5 51 "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement." 5409.88 percent of total billed charges 170.54 12976.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Wound Debridements For Injuries Without Cc/McC 903 MS-DRG inpatient 15043 15043 8689.75 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12288.8 other Inpatient DRG 8689.75 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12288.8 other Inpatient DRG 15043 Service paid by case rate. 3506.66 other IP General Discharge 8689.75 15043 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other O.R. Procedures For Injuries With McC 907 MS-DRG inpatient 47677.9 47677.9 54900.7 Base payment rate plus any adjustments related to transfers and outliers. 54900.7 case rate 47677.9 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 38619.1 percent of total billed charges 28396.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 39971 other Inpatient DRG 28396.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 39971 other Inpatient DRG 35258.7 Service paid by case rate. 3506.66 other IP General Discharge 28396.7 54900.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other O.R. Procedures For Injuries With Cc 908 MS-DRG inpatient 28999.8 28999.8 29206.4 Base payment rate plus any adjustments related to transfers and outliers. 29206.4 case rate 28999.8 Base payment rate plus any adjustments related to transfers and outliers. 25651.8 case rate 28999.8 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 23489.8 percent of total billed charges 14378.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20279.5 other Inpatient DRG 14378.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 20279.5 other Inpatient DRG 24946.2 Service paid by case rate. 3506.66 other IP General Discharge 14378.4 29206.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other O.R. Procedures For Injuries Without Cc/McC 909 MS-DRG inpatient 11839.9 11839.9 9040.47 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12781.5 other Inpatient DRG 9040.47 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12781.5 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 11839.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Traumatic Injury Without McC 914 MS-DRG inpatient 23119 23119 6364.11 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9144.2 other Inpatient DRG 6364.11 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9144.2 other Inpatient DRG 23119 Service paid by case rate. 3506.66 other IP General Discharge 6364.11 23119 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Allergic Reactions With McC 915 MS-DRG inpatient 24681.5 24681.5 12388.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17483.8 other Inpatient DRG 12388.1 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17483.8 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 24681.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Allergic Reactions Without McC 916 MS-DRG inpatient 9199.17 9199.17 9432.97 Base payment rate plus any adjustments related to transfers and outliers. 9432.97 case rate 9199.17 Base payment rate plus any adjustments related to transfers and outliers. 8504.52 case rate 9199.17 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 7451.31 percent of total billed charges 4733.38 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6731.37 other Inpatient DRG 4733.38 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 6731.37 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 9432.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Poisoning And Toxic Effects Of Drugs With McC 917 MS-DRG inpatient 5510.12 16955.5 21622.5 Base payment rate plus any adjustments related to transfers and outliers. 21622.5 case rate 16955.5 case rate 5510.12 Base payment rate plus any adjustments related to transfers and outliers. 5170.27 case rate 16955.5 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 13734 percent of total billed charges 11688 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16500.5 other Inpatient DRG 11688 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16500.5 other Inpatient DRG 16225.6 Service paid by case rate. 3506.66 other IP General Discharge 5510.12 21622.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Poisoning And Toxic Effects Of Drugs Without McC 918 MS-DRG inpatient 8937.31 8937.31 15419.8 Base payment rate plus any adjustments related to transfers. 12849.8 case rate 11352.5 Base payment rate plus any adjustments related to transfers and outliers. 8900.85 case rate 8937.31 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 7239.23 percent of total billed charges 6304.52 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8938.33 other Inpatient DRG 6304.52 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8938.33 other Inpatient DRG 8937.31 Service paid by case rate. 3506.66 other IP General Discharge 6304.52 15419.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Complications Of Treatment With McC 919 MS-DRG inpatient 9409.26 9409.26 25472.7 Base payment rate plus any adjustments related to transfers and outliers. 25472.7 case rate 11162.1 case rate 11162.1 case rate 11162.1 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 9041.34 percent of total billed charges 12998.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18340.9 other Inpatient DRG 12998.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 18340.9 other Inpatient DRG 9409.26 Service paid by case rate. 3506.66 other IP General Discharge 9409.26 25472.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Complications Of Treatment With Cc 920 MS-DRG inpatient 28129.7 28129.7 14511.6 Base payment rate plus any adjustments related to transfers and outliers. 14511.6 case rate 28129.7 Base payment rate plus any adjustments related to transfers and outliers. 16881.7 case rate 28129.7 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 22785.1 percent of total billed charges 7241.22 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10254.1 other Inpatient DRG 7241.22 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10254.1 other Inpatient DRG 14065.5 Service paid by case rate. 3506.66 other IP General Discharge 7241.22 28129.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Complications Of Treatment Without Cc/McC 921 MS-DRG inpatient 15831.4 15831.4 4892.45 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7109.92 other Inpatient DRG 4892.45 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 7109.92 other Inpatient DRG 15831.4 Service paid by case rate. 3506.66 other IP General Discharge 4892.45 15831.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Other Injury, Poisoning And Toxic Effect Diagnoses With McC" 922 MS-DRG inpatient 12475.5 12475.5 12041.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16997.1 other Inpatient DRG 12041.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16997.1 other Inpatient DRG 12475.5 Service paid by case rate. 3506.66 other IP General Discharge 12041.6 12475.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Other Injury, Poisoning And Toxic Effect Diagnoses Without McC" 923 MS-DRG inpatient 17413 17413 13395.3 Base payment rate plus any adjustments related to transfers and outliers. 13395.3 case rate 12923.4 case rate 12923.4 case rate 12923.4 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 10467.9 percent of total billed charges 7269.73 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10294.2 other Inpatient DRG 7269.73 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10294.2 other Inpatient DRG 17413 Service paid by case rate. 3506.66 other IP General Discharge 7269.73 17413 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Full Thickness Burn Without Skin Graft Or Inhalation Injury 934 MS-DRG inpatient 12385.2 12385.2 14671 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19190.8 other Inpatient DRG 14671 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19190.8 other Inpatient DRG 12385.2 Service paid by case rate. 3506.66 other IP General Discharge 12385.2 14671 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Non-Extensive Burns 935 MS-DRG inpatient 11848.1 11848.1 28746.3 Base payment rate plus any adjustments related to transfers and outliers. 28746.3 case rate 10691.1 case rate 10691.1 case rate 11848.1 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 9596.98 percent of total billed charges 15656.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22075 other Inpatient DRG 15656.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 22075 other Inpatient DRG 11848.1 Service paid by case rate. 3506.66 other IP General Discharge 10691.1 28746.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC 939 MS-DRG inpatient 17892 17892 22624.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 31863.1 other Inpatient DRG 22624.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 31863.1 other Inpatient DRG 17892 Service paid by case rate. 3506.66 other IP General Discharge 17892 22624.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc 940 MS-DRG inpatient 46825.2 46825.2 15050.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21223.8 other Inpatient DRG 15050.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 21223.8 other Inpatient DRG 46825.2 Service paid by case rate. 3506.66 other IP General Discharge 15050.6 46825.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC 941 MS-DRG inpatient 50125.1 50125.1 13930.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19650.7 other Inpatient DRG 13930.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 19650.7 other Inpatient DRG 50125.1 Service paid by case rate. 3506.66 other IP General Discharge 13930.7 50125.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Signs And Symptoms With McC 947 MS-DRG inpatient 8766.38 8766.38 17264 Base payment rate plus any adjustments related to transfers and outliers. 17264 case rate 11614.5 case rate 16740.6 Base payment rate plus any adjustments related to transfers and outliers. 15249.3 case rate 11614.5 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 9407.7 percent of total billed charges 9168.07 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12960.7 other Inpatient DRG 9168.07 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 12960.7 other Inpatient DRG 8766.38 Service paid by case rate. 3506.66 other IP General Discharge 8766.38 17264 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Signs And Symptoms Without McC 948 MS-DRG inpatient 15631.6 15631.6 15631.6 74 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 11567.3 percent of total billed charges 15631.6 93 "Additional drugs, labs, radiology services, and other services can be included in reimbursement." 12661.6 percent of total billed charges 5663.66 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8038.12 other Inpatient DRG 5663.66 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 8038.12 other Inpatient DRG 12248.5 Service paid by case rate. 3506.66 other IP General Discharge 5663.66 15631.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Aftercare With Cc/McC 949 MS-DRG inpatient 21395 21395 16928.8 Base payment rate plus any adjustments related to transfers and outliers. 16928.8 case rate 21395 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 17329.9 percent of total billed charges 7691.03 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10885.9 other Inpatient DRG 7691.03 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10885.9 other Inpatient DRG 15055.2 Service paid by case rate. 3506.66 other IP General Discharge 7691.03 21395 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Factors Influencing Health Status 951 MS-DRG inpatient 5944 5944 8083.78 Base payment rate plus any adjustments related to transfers and outliers. 7029.37 case rate 5944 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 4814.64 percent of total billed charges 4041.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 5759.06 other Inpatient DRG 4041.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 5759.06 other Inpatient DRG 3506.66 3506.66 case rate 3506.66 8083.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Craniotomy For Multiple Significant Trauma 955 MS-DRG inpatient 75465.6 75465.6 48673.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 68453.2 other Inpatient DRG 48673.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 68453.2 other Inpatient DRG 75465.6 Service paid by case rate. 3506.66 other IP General Discharge 48673.3 75465.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma" 956 MS-DRG inpatient 31937.3 31937.3 27246.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 38355.8 other Inpatient DRG 27246.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 38355.8 other Inpatient DRG 31937.3 Service paid by case rate. 3506.66 other IP General Discharge 27246.9 31937.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other O.R. Procedures For Multiple Significant Trauma With McC 957 MS-DRG inpatient 45545.4 45545.4 53205.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 74819.7 other Inpatient DRG 53205.6 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 74819.7 other Inpatient DRG 45545.4 Service paid by case rate. 3506.66 other IP General Discharge 45545.4 53205.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other O.R. Procedures For Multiple Significant Trauma With Cc 958 MS-DRG inpatient 64344 64344 29294.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 41232.7 other Inpatient DRG 29294.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 41232.7 other Inpatient DRG 64344 Service paid by case rate. 3506.66 other IP General Discharge 29294.9 64344 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other O.R. Procedures For Multiple Significant Trauma Without Cc/McC 959 MS-DRG inpatient 26945.6 26945.6 18845.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 26555 other Inpatient DRG 18845.8 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 26555 other Inpatient DRG 26945.6 Service paid by case rate. 3506.66 other IP General Discharge 18845.8 26945.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Multiple Significant Trauma With McC 963 MS-DRG inpatient 28724.3 28724.3 19365.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 27285 other Inpatient DRG 19365.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 27285 other Inpatient DRG 28724.3 Service paid by case rate. 3506.66 other IP General Discharge 19365.5 28724.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Multiple Significant Trauma With Cc 964 MS-DRG inpatient 32927.8 32927.8 20798.8 Base payment rate plus any adjustments related to transfers and outliers. 20798.8 case rate 32927.8 Base payment rate plus any adjustments related to transfers and outliers. 20328.9 case rate 32927.8 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 26671.5 percent of total billed charges 10694.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15104.6 other Inpatient DRG 10694.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 15104.6 other Inpatient DRG 19813.6 Service paid by case rate. 3506.66 other IP General Discharge 10694.3 32927.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Other Multiple Significant Trauma Without Cc/McC 965 MS-DRG inpatient 23880.1 23880.1 12922.4 Base payment rate plus any adjustments related to transfers and outliers. 12922.4 case rate 22063.6 case rate 22063.6 case rate 23880.1 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 19342.9 percent of total billed charges 6504.83 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9219.7 other Inpatient DRG 6504.83 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 9219.7 other Inpatient DRG 23880.1 Service paid by case rate. 3506.66 other IP General Discharge 6504.83 23880.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hiv With Extensive O.R. Procedures With McC 969 MS-DRG inpatient 142602 142602 45080.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 63406.4 other Inpatient DRG 45080.5 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 63406.4 other Inpatient DRG 142602 Service paid by case rate. 3506.66 other IP General Discharge 45080.5 142602 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hiv With Major Related Condition With McC 974 MS-DRG inpatient 26478.4 26478.4 40802.3 Base payment rate plus any adjustments related to transfers and outliers. 40802.3 case rate 24903.3 case rate 24903.3 Base payment rate plus any adjustments related to transfers and outliers. 20914.4 case rate 24903.3 93 "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 20171.7 percent of total billed charges 21286 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 29982.6 other Inpatient DRG 21286 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 29982.6 other Inpatient DRG 26478.4 Service paid by case rate. 3506.66 other IP General Discharge 21286 40802.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hiv With Major Related Condition With Cc 975 MS-DRG inpatient 12185.4 12185.4 19537.7 Base payment rate plus any adjustments related to transfers and outliers. 19537.7 case rate 11606 case rate 11606 case rate 11606 93 "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement." 9400.85 percent of total billed charges 10131.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14314.5 other Inpatient DRG 10131.9 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14314.5 other Inpatient DRG 12185.4 Service paid by case rate. 3506.66 other IP General Discharge 10131.9 19537.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hiv With Major Related Condition Without Cc/McC 976 MS-DRG inpatient 10536.5 10536.5 7149.26 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10124.9 other Inpatient DRG 7149.26 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 10124.9 other Inpatient DRG 10536.5 Service paid by case rate. 3506.66 other IP General Discharge 7149.26 10536.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hiv With Or Without Other Related Condition 977 MS-DRG inpatient 23952.9 23952.9 9928.63 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14219.7 other Inpatient DRG 9928.63 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 14219.7 other Inpatient DRG 23952.9 Service paid by case rate. 3506.66 other IP General Discharge 9928.63 23952.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC 981 MS-DRG inpatient 53600.7 53600.7 65050.8 Base payment rate plus any adjustments related to transfers and outliers. 20328.4 case rate 39521.6 case rate 17550.5 Base payment rate plus any adjustments related to transfers and outliers. 16680.6 case rate 39521.6 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 32012.5 percent of total billed charges 33891.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 44201.7 other Inpatient DRG 33891.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 44201.7 other Inpatient DRG 53600.7 Service paid by case rate. 3506.66 other IP General Discharge 17550.5 65050.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc 982 MS-DRG inpatient 34626.1 34626.1 35621.5 Base payment rate plus any adjustments related to transfers and outliers. 6195.04 case rate 34626.1 93 "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement." 28047.1 percent of total billed charges 17454.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 24600.3 other Inpatient DRG 17454.3 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 24600.3 other Inpatient DRG 33985.5 Service paid by case rate. 3506.66 other IP General Discharge 17454.3 35621.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC 983 MS-DRG inpatient 29125.3 29125.3 11891.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16785.9 other Inpatient DRG 11891.2 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 16785.9 other Inpatient DRG 29125.3 Service paid by case rate. 3506.66 other IP General Discharge 11891.2 29125.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC 987 MS-DRG inpatient 25519.4 25519.4 47127.9 Base payment rate plus any adjustments related to transfers and outliers. 16440 case rate 18925.7 case rate 18925.7 case rate 18925.7 93 "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 15329.8 percent of total billed charges 24971.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 35159.5 other Inpatient DRG 24971.4 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 35159.5 other Inpatient DRG 25519.4 Service paid by case rate. 3506.66 other IP General Discharge 18925.7 47127.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc 988 MS-DRG inpatient 29810.1 29810.1 24092.3 Base payment rate plus any adjustments related to transfers and outliers. 24092.3 case rate 29810.1 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement." 24146.2 percent of total billed charges 12232.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17265.5 other Inpatient DRG 12232.7 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 17265.5 other Inpatient DRG 23349.6 Service paid by case rate. 3506.66 other IP General Discharge 12232.7 29810.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC 989 MS-DRG inpatient 23420.5 23420.5 15656.3 Base payment rate plus any adjustments related to transfers and outliers. 15656.3 case rate 22316.2 case rate 22316.2 case rate 23420.5 93 "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement." 18970.6 percent of total billed charges 8236.37 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11652 other Inpatient DRG 8236.37 "Wage-adjusted base payment rate plus any adjustments related to capital costs, indirect medical education (IME), disproportionate share hospital (DSH) adjustors, new technology, hemophilia, sole community hospital (SCH) and Medicare Dependent Hospital (MDH) adjustors, transfers, and outliers." 11652 other Inpatient DRG 17346.1 Service paid by case rate. 3506.66 other IP General Discharge 8236.37 23420.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Daily Care MSU PX-120000001 CDM 120000001 LOCAL 0120 RC outpatient 875 875 875 875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Daily Care Pssu PX-120000003 CDM 120000003 LOCAL 0120 RC outpatient 875 875 875 875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Daily Care Ssu PX-120000004 CDM 120000004 LOCAL 0120 RC outpatient 875 875 875 875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Daily Care CDU PX-120000005 CDM 120000005 LOCAL 0120 RC outpatient 1175 1175 1175 1175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Daily Care OB PX-120000006 CDM 120000006 LOCAL 0120 RC outpatient 875 875 875 875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Daily Care Progressive Care Unit PX-160000001 CDM 160000001 LOCAL 0160 RC outpatient 1175 1175 1175 1175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Daily Care PCU HC PX-160000002 CDM 160000002 LOCAL 0160 RC outpatient 1175 1175 1175 1175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Daily Care Nursery PX-170000002 CDM 170000002 LOCAL 0170 RC outpatient 600 600 600 600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Newborn Level 1 Norm Ft/Preterm Neo PX-171924271 CDM 92586 CPT 0171 RC outpatient 625 625 625 625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Newborn Level 2 Low Birth Weight Neo PX-172924261 CDM 92586 CPT 0172 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 51 331.5 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Newborn Level 3 Sick Neo Icu PX-173924281 CDM 92586 CPT 0173 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Daily Care CICU PX-200000002 CDM 200000002 LOCAL 0200 RC outpatient 2400 2400 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Influenza Admin PX-250771000 CDM G0008 CPT 0771 RC outpatient 0.01 0.01 0.01 74 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pneumococcal Admin PX-250771001 CDM G0009 CPT 0771 RC outpatient 0.01 0.01 0.01 74 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Blood Specimen From Implanted Device PX-260365911 CDM 36591 CPT 0260 RC outpatient 304.28 304.28 304.28 74 225.17 percent of total billed charges 304.28 93 246.47 percent of total billed charges 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 62.3 189.57 percent of total billed charges 304.28 304.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Infusion Hydration 0-1 Hr PX-260963600 CDM 96360 CPT 0260 RC outpatient 510.55 510.55 458.26 458.26 fee schedule 510.55 93 413.55 percent of total billed charges 510.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.54 other OPPS APC 510.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.54 other OPPS APC 510.55 51 260.38 percent of total billed charges 458.26 510.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Infusion Hydration Each Add Hr PX-260963610 CDM 96361 CPT 0260 RC outpatient 113.15 113.15 122.11 122.11 fee schedule 113.15 93 91.65 percent of total billed charges 113.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 113.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 113.15 51 57.71 percent of total billed charges 113.15 122.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Infusion Therapy Non Chemo 0-1hr PX-260963650 CDM 96365 CPT 0260 RC outpatient 510.55 510.55 643.38 643.38 fee schedule 510.55 93 413.55 percent of total billed charges 510.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.54 other OPPS APC 510.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.54 other OPPS APC 510.55 62.3 318.07 percent of total billed charges 510.55 643.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Infusion Non Chemo Each Add Hr PX-260963660 CDM 96366 CPT 0260 RC outpatient 122 122 147.97 147.97 fee schedule 122 93 98.82 percent of total billed charges 122 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 122 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 122 62.3 76.01 percent of total billed charges 122 147.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Infus Non Chemo Sequential 0-1hr PX-260963670 CDM 96367 CPT 0260 RC outpatient 169 169 169 74 125.06 percent of total billed charges 169 93 136.89 percent of total billed charges 169 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 169 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 169 51 86.19 percent of total billed charges 169 169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Infusion Therpay Concurrent PX-260963680 CDM 96368 CPT 0260 RC outpatient 204 204 204 74 150.96 percent of total billed charges 204 93 165.24 percent of total billed charges 204 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 204 other OPPS APC 204 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 204 other OPPS APC 204 62.3 127.09 percent of total billed charges 204 204 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Inj. Non Chemo Intramuscular/Sub PX-260963720 CDM 96372 CPT 0260 RC outpatient 204 204 146.04 146.04 fee schedule 204 93 165.24 percent of total billed charges 204 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 204 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 204 51 104.04 percent of total billed charges 146.04 204 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Inj. Non Chemo IV Push Initial PX-260963740 CDM 96374 CPT 0260 RC outpatient 510.55 510.55 275.41 275.41 fee schedule 510.55 93 413.55 percent of total billed charges 510.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.54 other OPPS APC 510.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.54 other OPPS APC 510.55 62.3 318.07 percent of total billed charges 275.41 510.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Inj Non Chemo IV Push Sequential PX-260963750 CDM 96375 CPT 0260 RC outpatient 358 358 166.24 166.24 fee schedule 358 93 289.98 percent of total billed charges 358 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 358 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 358 51 182.58 percent of total billed charges 166.24 358 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Therapeutic,Prophylatic,Diag Inj Ea Add'l Push New Drug" PX-260963760 CDM 96376 CPT 0260 RC outpatient 125 125 125 74 92.5 percent of total billed charges 125 93 101.25 percent of total billed charges 125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 125 other OPPS APC 125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 125 other OPPS APC 125 62.3 77.88 percent of total billed charges 125 125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Xr Intrathecal Inj of Chemo PX-260964500 CDM 96450 CPT 0260 RC outpatient 806.7 806.7 543.98 543.98 fee schedule 806.7 93 653.43 percent of total billed charges 806.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 345.31 other OPPS APC 806.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 345.31 other OPPS APC 806.7 62.3 502.57 percent of total billed charges 543.98 806.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Irrigation Implanted Venous Acces PX-260965230 CDM 96523 CPT 0260 RC outpatient 145.7 145.7 115.95 115.95 fee schedule 145.7 93 118.02 percent of total billed charges 145.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.37 other OPPS APC 145.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.37 other OPPS APC 145.7 62.3 90.77 percent of total billed charges 115.95 145.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Kit Epistat PX-270000001 CDM 0270 RC outpatient 266 266 266 93 215.46 percent of total billed charges 266 266 other OPPS APC 266 266 other OPPS APC 266 27.63 73.5 percent of total billed charges 266 266 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Tray Pack 5/6 Fr PX-270000002 CDM 0270 RC outpatient 64.09 64.09 64.09 93 51.91 percent of total billed charges 64.09 64.09 other OPPS APC 64.09 64.09 other OPPS APC 64.09 27.63 17.71 percent of total billed charges 64.09 64.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Mask,Full Face Small W/Hg" PX-270000008 CDM 0270 RC outpatient 50.46 50.46 50.46 93 40.87 percent of total billed charges 50.46 50.46 other OPPS APC 50.46 50.46 other OPPS APC 50.46 27.63 13.94 percent of total billed charges 50.46 50.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Mask,Full Face Med W/Hg" PX-270000009 CDM 0270 RC outpatient 50 50 50 74 37 percent of total billed charges 50 93 40.5 percent of total billed charges 50 50 other OPPS APC 50 50 other OPPS APC 50 27.63 13.82 percent of total billed charges 50 50 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Kit Pleura-Seal Thoracentesis PX-270000011 CDM 0270 RC outpatient 118 118 118 93 95.58 percent of total billed charges 118 118 other OPPS APC 118 118 other OPPS APC 118 27.63 32.6 percent of total billed charges 118 118 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Belt, Security Roll- Universal" PX-270000012 CDM 0270 RC outpatient 60.22 60.22 60.22 93 48.78 percent of total billed charges 60.22 60.22 other OPPS APC 60.22 60.22 other OPPS APC 60.22 27.63 16.64 percent of total billed charges 60.22 60.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Trach Cuff 8dct PX-270000013 CDM 0270 RC outpatient 90.22 90.22 90.22 93 73.08 percent of total billed charges 90.22 90.22 other OPPS APC 90.22 90.22 other OPPS APC 90.22 27.63 24.93 percent of total billed charges 90.22 90.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Trach Cuff Fenstrated Lo Press PX-270000014 CDM 0270 RC outpatient 64.4 64.4 64.4 93 52.16 percent of total billed charges 64.4 64.4 other OPPS APC 64.4 64.4 other OPPS APC 64.4 27.63 17.79 percent of total billed charges 64.4 64.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Trach Cuff Low Pressure 4 PX-270000017 CDM 0270 RC outpatient 117.89 117.89 117.89 93 95.49 percent of total billed charges 117.89 117.89 other OPPS APC 117.89 117.89 other OPPS APC 117.89 27.63 32.57 percent of total billed charges 117.89 117.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Trach Cuff TB Lp6 PX-270000018 CDM 0270 RC outpatient 91.7 91.7 91.7 93 74.28 percent of total billed charges 91.7 91.7 other OPPS APC 91.7 91.7 other OPPS APC 91.7 27.63 25.34 percent of total billed charges 91.7 91.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Tube Cuffless Trach #8 PX-270000019 CDM 0270 RC outpatient 83.42 83.42 83.42 93 67.57 percent of total billed charges 83.42 83.42 other OPPS APC 83.42 83.42 other OPPS APC 83.42 27.63 23.05 percent of total billed charges 83.42 83.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Trach Cuffless Fenstrated 4 PX-270000020 CDM 0270 RC outpatient 96.44 96.44 96.44 93 78.12 percent of total billed charges 96.44 96.44 other OPPS APC 96.44 96.44 other OPPS APC 96.44 27.63 26.65 percent of total billed charges 96.44 96.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Needle Spinal Whitacre 22f X 3.5 PX-270000021 CDM 0272 RC outpatient 82.68 82.68 82.68 93 66.97 percent of total billed charges 82.68 82.68 other OPPS APC 82.68 82.68 other OPPS APC 82.68 27.63 22.84 percent of total billed charges 82.68 82.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Kit Monitor Single Line Vamp PX-270000022 CDM 0270 RC outpatient 92.78 92.78 92.78 93 75.15 percent of total billed charges 92.78 92.78 other OPPS APC 92.78 92.78 other OPPS APC 92.78 27.63 25.64 percent of total billed charges 92.78 92.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Aerobika Opep PX-270000023 CDM 0270 RC outpatient 90.02 90.02 90.02 93 72.92 percent of total billed charges 90.02 90.02 other OPPS APC 90.02 90.02 other OPPS APC 90.02 27.63 24.87 percent of total billed charges 90.02 90.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Trac Med. Dressing Kit PX-270000024 CDM 0270 RC outpatient 83.03 83.03 83.03 93 67.25 percent of total billed charges 83.03 83.03 other OPPS APC 83.03 83.03 other OPPS APC 83.03 27.63 22.94 percent of total billed charges 83.03 83.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Canister Info Vac PX-270000025 CDM 0270 RC outpatient 69.07 69.07 69.07 93 55.95 percent of total billed charges 69.07 69.07 other OPPS APC 69.07 69.07 other OPPS APC 69.07 27.63 19.08 percent of total billed charges 69.07 69.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Trach Cuffless Fenstrated 6cfn PX-270000026 CDM 0270 RC outpatient 132.46 132.46 132.46 93 107.29 percent of total billed charges 132.46 132.46 other OPPS APC 132.46 132.46 other OPPS APC 132.46 27.63 36.6 percent of total billed charges 132.46 132.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Trach Tube Foam Cuffed #7 PX-270000027 CDM 0270 RC outpatient 204.44 204.44 204.44 93 165.6 percent of total billed charges 204.44 204.44 other OPPS APC 204.44 204.44 other OPPS APC 204.44 27.63 56.49 percent of total billed charges 204.44 204.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Tube Cuffless Trach #6 PX-270000028 CDM 0270 RC outpatient 121.94 121.94 121.94 93 98.77 percent of total billed charges 121.94 121.94 other OPPS APC 121.94 121.94 other OPPS APC 121.94 27.63 33.69 percent of total billed charges 121.94 121.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Catheter-Swan Ganz 7.5fr Paceport PX-270000029 CDM 0270 RC outpatient 97.86 97.86 97.86 93 79.27 percent of total billed charges 97.86 97.86 other OPPS APC 97.86 97.86 other OPPS APC 97.86 27.63 27.04 percent of total billed charges 97.86 97.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Need Marrow Bone Sterile PX-270000030 CDM 0270 RC outpatient 65.98 65.98 65.98 93 53.44 percent of total billed charges 65.98 65.98 other OPPS APC 65.98 65.98 other OPPS APC 65.98 27.63 18.23 percent of total billed charges 65.98 65.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Skin Temp Probe, Disposable" PX-270000031 CDM 0270 RC outpatient 480 480 480 93 388.8 percent of total billed charges 480 480 other OPPS APC 480 480 other OPPS APC 480 27.63 132.62 percent of total billed charges 480 480 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Tips Bilicheck Disp Calibration PX-270000032 CDM 0270 RC outpatient 540.22 540.22 540.22 93 437.58 percent of total billed charges 540.22 540.22 other OPPS APC 540.22 540.22 other OPPS APC 540.22 27.63 149.26 percent of total billed charges 540.22 540.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Tray Epidural PX-270000033 CDM 0270 RC outpatient 68.57 68.57 68.57 93 55.54 percent of total billed charges 68.57 68.57 other OPPS APC 68.57 68.57 other OPPS APC 68.57 27.63 18.95 percent of total billed charges 68.57 68.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Trach Tube Foam Cuffed #8 PX-270000034 CDM 0270 RC outpatient 205.2 205.2 205.2 93 166.21 percent of total billed charges 205.2 205.2 other OPPS APC 205.2 205.2 other OPPS APC 205.2 27.63 56.7 percent of total billed charges 205.2 205.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Tube Trach Shiley Perc Sz6 Dual Cann PX-270000035 CDM 0270 RC outpatient 869.74 869.74 869.74 93 704.49 percent of total billed charges 869.74 869.74 other OPPS APC 869.74 869.74 other OPPS APC 869.74 27.63 240.31 percent of total billed charges 869.74 869.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Swan Tubing 10/Cs PX-270000036 CDM 0270 RC outpatient 293.56 293.56 293.56 93 237.78 percent of total billed charges 293.56 293.56 other OPPS APC 293.56 293.56 other OPPS APC 293.56 27.63 81.11 percent of total billed charges 293.56 293.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Mask, Full Face Xsmall W/Hg" PX-270000037 CDM 0270 RC outpatient 50.94 50.94 50.94 93 41.26 percent of total billed charges 50.94 50.94 other OPPS APC 50.94 50.94 other OPPS APC 50.94 27.63 14.07 percent of total billed charges 50.94 50.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Trach Cuffed Nonfen 4 PX-270000038 CDM 0270 RC outpatient 90.22 90.22 90.22 93 73.08 percent of total billed charges 90.22 90.22 other OPPS APC 90.22 90.22 other OPPS APC 90.22 27.63 24.93 percent of total billed charges 90.22 90.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Trach Cuffless Fenstrated 8cfn PX-270000039 CDM 0270 RC outpatient 97.81 97.81 97.81 93 79.23 percent of total billed charges 97.81 97.81 other OPPS APC 97.81 97.81 other OPPS APC 97.81 27.63 27.02 percent of total billed charges 97.81 97.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Tray Pack 8 PX-270000040 CDM 0270 RC outpatient 143.94 143.94 143.94 93 116.59 percent of total billed charges 143.94 143.94 other OPPS APC 143.94 143.94 other OPPS APC 143.94 27.63 39.77 percent of total billed charges 143.94 143.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Pulse Ox Probe Wrap PX-270000041 CDM 0270 RC outpatient 20 20 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Pluer E Vac Infant PX-270000042 CDM 0270 RC outpatient 356 356 356 93 288.36 percent of total billed charges 356 356 other OPPS APC 356 356 other OPPS APC 356 27.63 98.36 percent of total billed charges 356 356 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 270000042 PX-270000043 CDM 0270 RC outpatient 59 59 59 93 47.79 percent of total billed charges 59 59 other OPPS APC 59 59 other OPPS APC 59 27.63 16.3 percent of total billed charges 59 59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Algo Newborn Hearing Screening PX-270000044 CDM 0270 RC outpatient 54 54 54 93 43.74 percent of total billed charges 54 54 other OPPS APC 54 54 other OPPS APC 54 27.63 14.92 percent of total billed charges 54 54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Foley Catheter Tray PX-270009004 CDM 270009004 LOCAL 0270 RC outpatient 47.52 47.52 47.52 74 35.16 percent of total billed charges 47.52 93 38.49 percent of total billed charges 47.52 47.52 other OPPS APC 47.52 47.52 other OPPS APC 47.52 27.63 13.13 percent of total billed charges 47.52 47.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Apligaf-per 44 Sq Cm PX-270041010 CDM Q4101 CPT 0270 RC outpatient 86 86 34.73 34.73 fee schedule 86 93 69.66 percent of total billed charges 86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 86 other OPPS APC 86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 86 other OPPS APC 86 27.63 23.76 percent of total billed charges 34.73 86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Theraskin 2x3 PX-270041210 CDM Q4121 CPT 0270 RC outpatient 117.58 117.58 53.63 53.63 fee schedule 117.58 93 95.24 percent of total billed charges 117.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 117.58 other OPPS APC 117.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 117.58 other OPPS APC 117.58 27.63 32.49 percent of total billed charges 53.63 117.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Theraskin 1x1 PX-270041212 CDM Q4121 CPT 0636 RC outpatient 497 497 53.63 53.63 fee schedule 497 93 402.57 percent of total billed charges 497 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 497 other OPPS APC 497 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 497 other OPPS APC 497 24.86 123.55 percent of total billed charges 53.63 497 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Puraply Am 4x4 Sq Cm PX-270141348 CDM Q4196 CPT 0270 RC outpatient 317.47 317.47 116.75 116.75 fee schedule 317.47 93 257.15 percent of total billed charges 317.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 317.47 other OPPS APC 317.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 317.47 other OPPS APC 317.47 27.63 87.72 percent of total billed charges 116.75 317.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Headband Eeg Pediatric PX-270200001 CDM 0270 RC outpatient 1500 1500 1500 74 1110 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 1500 other OPPS APC 1500 1500 other OPPS APC 1500 27.63 414.45 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Headband Eeg Adult Medium/Large PX-270200002 CDM 0270 RC outpatient 1500 1500 1500 74 1110 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 1500 other OPPS APC 1500 1500 other OPPS APC 1500 27.63 414.45 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MC Crutch Push Button Adjustable Aluminum Youth 54 to 62in PX-270800030 CDM 0270 RC outpatient 56 56 56 74 41.44 percent of total billed charges 56 93 45.36 percent of total billed charges 56 56 other OPPS APC 56 56 other OPPS APC 56 27.63 15.47 percent of total billed charges 56 56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MC Crutch Adjustable Push Button Aluminum Adult Medium 62 to 70 PX-270800031 CDM 0270 RC outpatient 40 40 40 74 29.6 percent of total billed charges 40 93 32.4 percent of total billed charges 40 40 other OPPS APC 40 40 other OPPS APC 40 27.63 11.05 percent of total billed charges 40 40 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MC Crutch Push Button Adjustable Aluminum Adult Tall 70 to 78in PX-270800032 CDM 0270 RC outpatient 43 43 43 74 31.82 percent of total billed charges 43 93 34.83 percent of total billed charges 43 43 other OPPS APC 43 43 other OPPS APC 43 27.63 11.88 percent of total billed charges 43 43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MC Sensor Pulse Oximeter Finger Disposable Adult 18in PX-270800051 CDM 0270 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Dispense Male Condom to Male or Female PX-270A42671 CDM A4267 HCPCS 0270 RC outpatient 212 212 212 74 156.88 percent of total billed charges 212 93 171.72 percent of total billed charges 212 212 other OPPS APC 212 212 other OPPS APC 212 27.63 58.58 percent of total billed charges 212 212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Aerosol Mask PX-270A70151 CDM A7015 HCPCS 0270 RC outpatient 317 317 317 74 234.58 percent of total billed charges 317 93 256.77 percent of total billed charges 317 317 other OPPS APC 317 317 other OPPS APC 317 27.63 87.59 percent of total billed charges 317 317 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Nebulizer Tubing PX-270A70161 CDM A7016 HCPCS 0270 RC outpatient 438 438 438 74 324.12 percent of total billed charges 438 93 354.78 percent of total billed charges 438 438 other OPPS APC 438 438 other OPPS APC 438 27.63 121.02 percent of total billed charges 438 438 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Albuterol,Inhalation Solution, Up to 2.5 Mg" PX-270J76201 CDM J7620 HCPCS 0270 RC outpatient 438 438 0.15 0.15 fee schedule 438 93 354.78 percent of total billed charges 438 438 other OPPS APC 438 438 other OPPS APC 438 27.63 121.02 percent of total billed charges 0.15 438 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Contraceptive Pills for Birth Control PX-270S49931 CDM S4993 HCPCS 0270 RC outpatient 438 438 438 74 324.12 percent of total billed charges 438 93 354.78 percent of total billed charges 438 438 other OPPS APC 438 438 other OPPS APC 438 27.63 121.02 percent of total billed charges 438 438 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Catheter Phillips 10fr PX-272000004 CDM 0272 RC outpatient 216.42 216.42 216.42 93 175.3 percent of total billed charges 216.42 216.42 other OPPS APC 216.42 216.42 other OPPS APC 216.42 27.63 59.8 percent of total billed charges 216.42 216.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Catheter Phillips 16fr PX-272000005 CDM 0272 RC outpatient 148.08 148.08 148.08 93 119.94 percent of total billed charges 148.08 148.08 other OPPS APC 148.08 148.08 other OPPS APC 148.08 27.63 40.91 percent of total billed charges 148.08 148.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Catheter Phillips 22fr PX-272000006 CDM 0272 RC outpatient 131.66 131.66 131.66 93 106.64 percent of total billed charges 131.66 131.66 other OPPS APC 131.66 131.66 other OPPS APC 131.66 27.63 36.38 percent of total billed charges 131.66 131.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Catheter Phillips 8fr PX-272000007 CDM 0272 RC outpatient 109.61 109.61 109.61 93 88.78 percent of total billed charges 109.61 109.61 other OPPS APC 109.61 109.61 other OPPS APC 109.61 27.63 30.29 percent of total billed charges 109.61 109.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Kit High Flow Mac Sheath Introducer PX-272000009 CDM 0270 RC outpatient 1190.6 1190.6 1190.6 93 964.39 percent of total billed charges 1190.6 1190.6 other OPPS APC 1190.6 1190.6 other OPPS APC 1190.6 27.63 328.96 percent of total billed charges 1190.6 1190.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Needle Set Ez Io 15mm Pediatric PX-272000010 CDM 0272 RC outpatient 1150 1150 1150 93 931.5 percent of total billed charges 1150 1150 other OPPS APC 1150 1150 other OPPS APC 1150 27.63 317.75 percent of total billed charges 1150 1150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Bougie Endotracheal Tube Introducer PX-272000011 CDM 0272 RC outpatient 139.42 139.42 139.42 93 112.93 percent of total billed charges 139.42 139.42 other OPPS APC 139.42 139.42 other OPPS APC 139.42 27.63 38.52 percent of total billed charges 139.42 139.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Quikclot 4x4 Xray PX-272000012 CDM 0272 RC outpatient 371.6 371.6 371.6 93 301 percent of total billed charges 371.6 371.6 other OPPS APC 371.6 371.6 other OPPS APC 371.6 27.63 102.67 percent of total billed charges 371.6 371.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Quikclot Zfold Hemostatic 3x4 Xray PX-272000013 CDM 0272 RC outpatient 900.2 900.2 900.2 93 729.16 percent of total billed charges 900.2 900.2 other OPPS APC 900.2 900.2 other OPPS APC 900.2 27.63 248.73 percent of total billed charges 900.2 900.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Tray Foley Lf 16fr Temp Sensing PX-272000014 CDM 0272 RC outpatient 68.98 68.98 68.98 93 55.87 percent of total billed charges 68.98 68.98 other OPPS APC 68.98 68.98 other OPPS APC 68.98 27.63 19.06 percent of total billed charges 68.98 68.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Pneumothorax Set Wayne 10.2f PX-272000015 CDM 0272 RC outpatient 416 416 416 93 336.96 percent of total billed charges 416 416 other OPPS APC 416 416 other OPPS APC 416 27.63 114.94 percent of total billed charges 416 416 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Surgiflo (Floseal) PX-272000016 CDM 0272 RC outpatient 387.99 387.99 387.99 93 314.27 percent of total billed charges 387.99 387.99 other OPPS APC 387.99 387.99 other OPPS APC 387.99 27.63 107.2 percent of total billed charges 387.99 387.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hyperflex Trach Tube Sz-8 PX-272000017 CDM 0272 RC outpatient 380.32 380.32 380.32 93 308.06 percent of total billed charges 380.32 380.32 other OPPS APC 380.32 380.32 other OPPS APC 380.32 27.63 105.08 percent of total billed charges 380.32 380.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Combi Tube 41fr PX-272000018 CDM 0272 RC outpatient 355.52 355.52 355.52 93 287.97 percent of total billed charges 355.52 355.52 other OPPS APC 355.52 355.52 other OPPS APC 355.52 27.63 98.23 percent of total billed charges 355.52 355.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Tube Trach Shiley Perc Sz8 Dual Cann PX-272000019 CDM 0272 RC outpatient 869.74 869.74 869.74 93 704.49 percent of total billed charges 869.74 869.74 other OPPS APC 869.74 869.74 other OPPS APC 869.74 27.63 240.31 percent of total billed charges 869.74 869.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Combitube 37 F PX-272000020 CDM 0272 RC outpatient 319.88 319.88 319.88 93 259.1 percent of total billed charges 319.88 319.88 other OPPS APC 319.88 319.88 other OPPS APC 319.88 27.63 88.38 percent of total billed charges 319.88 319.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Positioner Arterial Line PX-272000021 CDM 0272 RC outpatient 223.4 223.4 223.4 93 180.95 percent of total billed charges 223.4 223.4 other OPPS APC 223.4 223.4 other OPPS APC 223.4 27.63 61.73 percent of total billed charges 223.4 223.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Catheter Umbilical 8 Fr Triple Lumen PX-272000022 CDM 0272 RC outpatient 82.5 82.5 82.5 93 66.83 percent of total billed charges 82.5 82.5 other OPPS APC 82.5 82.5 other OPPS APC 82.5 27.63 22.79 percent of total billed charges 82.5 82.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Catheter Umbilical 3.5 Fr Double Lumen PX-272000023 CDM 0272 RC outpatient 65.91 65.91 65.91 93 53.39 percent of total billed charges 65.91 65.91 other OPPS APC 65.91 65.91 other OPPS APC 65.91 27.63 18.21 percent of total billed charges 65.91 65.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Catheter Umbilical 5 Fr Double Lumen PX-272000024 CDM 0272 RC outpatient 62.71 62.71 62.71 93 50.8 percent of total billed charges 62.71 62.71 other OPPS APC 62.71 62.71 other OPPS APC 62.71 27.63 17.33 percent of total billed charges 62.71 62.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Iupc, Catheters-Intran Plus" PX-272000026 CDM 0272 RC outpatient 600 600 600 93 486 percent of total billed charges 600 600 other OPPS APC 600 600 other OPPS APC 600 27.63 165.78 percent of total billed charges 600 600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Umbilicup PX-272000027 CDM 0272 RC outpatient 459.86 459.86 459.86 93 372.49 percent of total billed charges 459.86 459.86 other OPPS APC 459.86 459.86 other OPPS APC 459.86 27.63 127.06 percent of total billed charges 459.86 459.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Patient Circuit Highflow PX-272000028 CDM 0272 RC outpatient 904 904 904 74 668.96 percent of total billed charges 904 93 732.24 percent of total billed charges 904 904 other OPPS APC 904 904 other OPPS APC 904 27.63 249.78 percent of total billed charges 904 904 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Needle Set Ez Io Blue 25mm Adult PX-272000029 CDM 0272 RC outpatient 1314 1314 1314 93 1064.34 percent of total billed charges 1314 1314 other OPPS APC 1314 1314 other OPPS APC 1314 27.63 363.06 percent of total billed charges 1314 1314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Needle Set Ez Io Yellow 15g PX-272000030 CDM 0272 RC outpatient 1366 1366 1366 93 1106.46 percent of total billed charges 1366 1366 other OPPS APC 1366 1366 other OPPS APC 1366 27.63 377.43 percent of total billed charges 1366 1366 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Post Partum Balloon 24 Fr PX-272000031 CDM 0272 RC outpatient 651 651 651 93 527.31 percent of total billed charges 651 651 other OPPS APC 651 651 other OPPS APC 651 27.63 179.87 percent of total billed charges 651 651 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Catheter Bartholin Gland Ch10 5cc PX-272C17292 CDM C1729 HCPCS 0272 RC outpatient 454 454 454 74 335.96 percent of total billed charges 454 93 367.74 percent of total billed charges 454 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 454 other OPPS APC 454 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 454 other OPPS APC 454 27.63 125.44 percent of total billed charges 454 454 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Chest Drain Valve,Heimlich" PX-272C17293 CDM C1729 HCPCS 0272 RC outpatient 471 471 471 74 348.54 percent of total billed charges 471 93 381.51 percent of total billed charges 471 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 471 other OPPS APC 471 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 471 other OPPS APC 471 27.63 130.14 percent of total billed charges 471 471 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 272c17294 PX-272C17294 CDM C1729 CPT 0272 RC outpatient 475 475 475 74 351.5 percent of total billed charges 475 93 384.75 percent of total billed charges 475 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 475 other OPPS APC 475 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 475 other OPPS APC 475 27.63 131.24 percent of total billed charges 475 475 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Thoracic Catheter 10 Fr PX-272C17295 CDM 0272 RC outpatient 488 488 488 93 395.28 percent of total billed charges 488 488 other OPPS APC 488 488 other OPPS APC 488 27.63 134.83 percent of total billed charges 488 488 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Catheter Quad Lumen PX-272C17512 CDM C1751 HCPCS 0272 RC outpatient 488 488 488 74 361.12 percent of total billed charges 488 93 395.28 percent of total billed charges 488 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488 other OPPS APC 488 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488 other OPPS APC 488 27.63 134.83 percent of total billed charges 488 488 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Spring Wire J .025"" X 35cm" PX-272C17692 CDM C1769 HCPCS 0272 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 494 other OPPS APC 494 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Spring Wire .018 X 25cm (a-Line) PX-272C17693 CDM C1769 HCPCS 0272 RC outpatient 707 707 707 74 523.18 percent of total billed charges 707 93 572.67 percent of total billed charges 707 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 707 other OPPS APC 707 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 707 other OPPS APC 707 27.63 195.34 percent of total billed charges 707 707 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Spring Wire .032"" X 60cm (C-Line)" PX-272C17694 CDM C1769 HCPCS 0272 RC outpatient 707 707 707 74 523.18 percent of total billed charges 707 93 572.67 percent of total billed charges 707 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 707 other OPPS APC 707 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 707 other OPPS APC 707 27.63 195.34 percent of total billed charges 707 707 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cvc Guild for Quad Lumen Cath PX-272C17695 CDM C1769 HCPCS 0272 RC outpatient 707 707 707 74 523.18 percent of total billed charges 707 93 572.67 percent of total billed charges 707 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 707 other OPPS APC 707 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 707 other OPPS APC 707 27.63 195.34 percent of total billed charges 707 707 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Collar Vista PX-274L01721 CDM L0172 HCPCS 0274 RC outpatient 732 732 732 57 417.24 percent of total billed charges 732 93 592.92 percent of total billed charges 732 732 other OPPS APC 732 732 other OPPS APC 732 51 373.32 percent of total billed charges 732 732 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Sling Sam Medium 32-50 PX-274L06211 CDM L0621 HCPCS 0274 RC outpatient 732 732 732 57 417.24 percent of total billed charges 732 93 592.92 percent of total billed charges 732 732 other OPPS APC 732 732 other OPPS APC 732 51 373.32 percent of total billed charges 732 732 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Sling Sam Large 36-60 PX-274L06212 CDM L0621 HCPCS 0274 RC outpatient 767 767 767 57 437.19 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 51 391.17 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Sling Sam Small 27-47 PX-274L06213 CDM L0621 HCPCS 0274 RC outpatient 1232 1232 1232 57 702.24 percent of total billed charges 1232 93 997.92 percent of total billed charges 1232 1232 other OPPS APC 1232 1232 other OPPS APC 1232 51 628.32 percent of total billed charges 1232 1232 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Left Ventricular Lead PX-275C19000 CDM C1900 HCPCS 0275 RC outpatient 4726 4726 4726 57 2693.82 percent of total billed charges 4726 93 3828.06 percent of total billed charges 4726 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4726 other OPPS APC 4726 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4726 other OPPS APC 4726 51 2410.26 percent of total billed charges 4726 4726 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pacemaker Other Than Single or Dual Lead PX-275C26210 CDM C2621 HCPCS 0275 RC outpatient 16095 16095 16095 57 9174.15 percent of total billed charges 16095 93 13037 percent of total billed charges 16095 16095 other OPPS APC 16095 16095 other OPPS APC 16095 51 8208.45 percent of total billed charges 16095 16095 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Aicd Dual Chamber PX-278C17210 CDM C1721 CPT 0278 RC outpatient 20850 20850 20850 57 11884.5 percent of total billed charges 20850 93 16888.5 percent of total billed charges 20850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20850 other OPPS APC 20850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20850 other OPPS APC 20850 51 10633.5 percent of total billed charges 20850 20850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Tray Central Line Triple 7fr X 20 Arrow PX-278C17511 CDM C1751 HCPCS 0278 RC outpatient 184.77 184.77 184.77 57 105.32 percent of total billed charges 184.77 93 149.66 percent of total billed charges 184.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 184.77 other OPPS APC 184.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 184.77 other OPPS APC 184.77 51 94.23 percent of total billed charges 184.77 184.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Tracy Central Quad 8.5fr X 16cm Arrow PX-278C17512 CDM C1751 HCPCS 0278 RC outpatient 224.72 224.72 224.72 57 128.09 percent of total billed charges 224.72 93 182.02 percent of total billed charges 224.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 224.72 other OPPS APC 224.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 224.72 other OPPS APC 224.72 51 114.61 percent of total billed charges 224.72 224.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 12x20 Cath Kit Lg Bore Mult-Lumen Nu0125 PX-278C17513 CDM C1751 HCPCS 0278 RC outpatient 163.5 163.5 163.5 57 93.2 percent of total billed charges 163.5 93 132.44 percent of total billed charges 163.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 163.5 other OPPS APC 163.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 163.5 other OPPS APC 163.5 51 83.39 percent of total billed charges 163.5 163.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC 12x16 Cath Kit Lg Bore Multilumen Nu0123 PX-278C17514 CDM C1751 HCPCS 0278 RC outpatient 25 25 25 57 14.25 percent of total billed charges 25 93 20.25 percent of total billed charges 25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 25 other OPPS APC 25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 25 other OPPS APC 25 51 12.75 percent of total billed charges 25 25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC 12x16 Cath Kit Lg Bore Multilumen (Sub) PX-278C17515 CDM C1751 HCPCS 0278 RC outpatient 27.5 27.5 27.5 57 15.68 percent of total billed charges 27.5 93 22.28 percent of total billed charges 27.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.5 other OPPS APC 27.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.5 other OPPS APC 27.5 51 14.03 percent of total billed charges 27.5 27.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Catheter Filiform 3fr PX-278C17582 CDM C1758 HCPCS 0278 RC outpatient 27.5 27.5 27.5 57 15.68 percent of total billed charges 27.5 93 22.28 percent of total billed charges 27.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.5 other OPPS APC 27.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.5 other OPPS APC 27.5 51 14.03 percent of total billed charges 27.5 27.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Catheter Filiform 4fr PX-278C17583 CDM C1758 HCPCS 0278 RC outpatient 27.5 27.5 27.5 57 15.68 percent of total billed charges 27.5 93 22.28 percent of total billed charges 27.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.5 other OPPS APC 27.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.5 other OPPS APC 27.5 51 14.03 percent of total billed charges 27.5 27.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Catheter Filiform 5r PX-278C17584 CDM C1758 HCPCS 0278 RC outpatient 38 38 38 57 21.66 percent of total billed charges 38 93 30.78 percent of total billed charges 38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38 other OPPS APC 38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38 other OPPS APC 38 51 19.38 percent of total billed charges 38 38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Shockwave Catheter Lithotripsy PX-278C17610 CDM C1761 CPT 0278 RC outpatient 11000 11000 11000 57 6270 percent of total billed charges 11000 93 8910 percent of total billed charges 11000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11000 other OPPS APC 11000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11000 other OPPS APC 11000 51 5610 percent of total billed charges 11000 11000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Lead Aicd Endo Single Coil PX-278C17770 CDM C1777 CPT 0278 RC outpatient 6750 6750 6750 57 3847.5 percent of total billed charges 6750 93 5467.5 percent of total billed charges 6750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6750 other OPPS APC 6750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6750 other OPPS APC 6750 51 3442.5 percent of total billed charges 6750 6750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Toric Lens PX-278V27871 CDM V2787 CPT 0278 RC outpatient 480 480 480 57 273.6 percent of total billed charges 480 93 388.8 percent of total billed charges 480 480 other OPPS APC 480 480 other OPPS APC 480 51 244.8 percent of total billed charges 480 480 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Nash Fibrotest, Serum and Plasma" PX-300000300 CDM 0003M CPT 0300 RC outpatient 1258.5 1258.5 1258.5 74 931.29 percent of total billed charges 1258.5 93 1019.39 percent of total billed charges 503.4 503.4 fee schedule 503.4 503.4 fee schedule 503.4 503.4 fee schedule 503.4 1258.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Psa Screen (Psas) PX-300001030 CDM G0103 CPT 0300 RC outpatient 61 61 49.34 49.34 fee schedule 61 93 49.41 percent of total billed charges 19.31 19.31 fee schedule 19.31 19.31 fee schedule 19.31 19.31 fee schedule 19.31 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Liver Ds Alys 3 Bmrk Srm Alg PX-3000014M0 CDM 0014M CPT 0300 RC outpatient 440.48 440.48 440.48 74 325.96 percent of total billed charges 440.48 93 356.79 percent of total billed charges 440.48 440.48 other OPPS APC 440.48 440.48 other OPPS APC 440.48 51 224.64 percent of total billed charges 440.48 440.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Thyroseq PX-3000026U0 CDM 0026U CPT 0300 RC outpatient 9000 9000 9000 74 6660 percent of total billed charges 9000 93 7290 percent of total billed charges 3600 3600 fee schedule 3600 3600 fee schedule 3600 3600 fee schedule 3600 9000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Real Time Quaking Induced for Prion (Rt-Quic) PX-3000035U0 CDM 0035U CPT outpatient 1352.47 1352.47 1352.47 74 1000.83 percent of total billed charges 1352.47 93 1095.5 percent of total billed charges 1352.47 1352.47 other OPPS APC 1352.47 1352.47 other OPPS APC 540.99 540.99 fee schedule 540.99 1352.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Infct Ds Bct/Vir Resp 22 Targets Ars/Cov2 PX-3000202U0 CDM 0202U CPT 0300 RC outpatient 1041.95 1041.95 983.6 983.6 fee schedule 1041.95 93 843.98 percent of total billed charges 416.78 416.78 fee schedule 416.78 416.78 fee schedule 416.78 416.78 fee schedule 416.78 1041.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Infectious Detection Sars-Cov2,Influenza a/B, Rsv" PX-300024100 CDM 0241U CPT 0300 RC outpatient 356.58 356.58 356.58 74 263.87 percent of total billed charges 356.58 93 288.83 percent of total billed charges 142.63 142.63 fee schedule 142.63 142.63 fee schedule 142.63 142.63 fee schedule 142.63 356.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Beta Amyloid Aî²40&Aî²42 Lc-Ms/Ms Ratio Plasma PX-3000346U0 CDM 0346U CPT 0300 RC outpatient 233.15 233.15 233.15 74 172.53 percent of total billed charges 233.15 93 188.85 percent of total billed charges 93.26 93.26 fee schedule 93.26 93.26 fee schedule 93.26 93.26 fee schedule 93.26 233.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Neuro Alys β-Amyl 1-42&1-40 PX-3000358U0 CDM 0358U CPT 0300 RC outpatient 651.25 651.25 651.25 74 481.93 percent of total billed charges 651.25 93 527.51 percent of total billed charges 260.5 260.5 fee schedule 260.5 260.5 fee schedule 260.5 260.5 fee schedule 260.5 651.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Venipuncture PX-300364150 CDM 36415 CPT 0300 RC outpatient 22.08 22.08 5.76 5.76 fee schedule 22.08 93 17.88 percent of total billed charges 8.83 8.83 fee schedule 8.83 8.83 fee schedule 8.83 8.83 fee schedule 5.76 22.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Venipuncture-Venous PX-300364151 CDM 36415 CPT 0300 RC outpatient 22.08 22.08 5.76 5.76 fee schedule 22.08 93 17.88 percent of total billed charges 8.83 8.83 fee schedule 8.83 8.83 fee schedule 8.83 8.83 fee schedule 5.76 22.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Venipuncture PX-300364152 CDM 36415 CPT 0300 RC outpatient 22.08 22.08 5.76 5.76 fee schedule 22.08 93 17.88 percent of total billed charges 8.83 8.83 fee schedule 8.83 8.83 fee schedule 8.83 8.83 fee schedule 5.76 22.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Natera Draw Charge PX-300364153 CDM 36415 CPT 0300 RC outpatient 25 25 5.76 5.76 fee schedule 25 93 20.25 percent of total billed charges 8.83 8.83 fee schedule 8.83 8.83 fee schedule 8.83 8.83 fee schedule 5.76 25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Nh Venipuncture PX-300364155 CDM 36415 CPT 0300 RC outpatient 22.08 22.08 5.76 5.76 fee schedule 22.08 93 17.88 percent of total billed charges 8.83 8.83 fee schedule 8.83 8.83 fee schedule 8.83 8.83 fee schedule 5.76 22.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chem8(Basic Metabolic) PX-300800480 CDM 80048 CPT 0301 RC outpatient 110 110 22.71 22.71 fee schedule 110 93 89.1 percent of total billed charges 8.46 8.46 fee schedule 8.46 8.46 fee schedule 8.46 8.46 fee schedule 8.46 110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Electrolytes (Lyte) PX-300800510 CDM 80051 CPT 0301 RC outpatient 86 86 18.82 18.82 fee schedule 86 93 69.66 percent of total billed charges 7.01 7.01 fee schedule 7.01 7.01 fee schedule 7.01 7.01 fee schedule 7.01 86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Comp Metabolic Panel (Cmp) PX-300800530 CDM 80053 CPT 0301 RC outpatient 135 135 28.36 28.36 fee schedule 135 93 109.35 percent of total billed charges 10.56 10.56 fee schedule 10.56 10.56 fee schedule 10.56 10.56 fee schedule 10.56 135 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Lipid Profile (Lipd) PX-300800610 CDM 80061 CPT 0301 RC outpatient 170 170 35.94 35.94 fee schedule 170 93 137.7 percent of total billed charges 13.39 13.39 fee schedule 13.39 13.39 fee schedule 13.39 13.39 fee schedule 13.39 170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Renal Profile (Renal) PX-300800690 CDM 80069 CPT 0301 RC outpatient 97 97 23.29 23.29 fee schedule 97 93 78.57 percent of total billed charges 8.68 8.68 fee schedule 8.68 8.68 fee schedule 8.68 8.68 fee schedule 8.68 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Viral Hepatitis Study PX-300800741 CDM 80074 CPT 0300 RC outpatient 187 187 127.76 127.76 fee schedule 187 93 151.47 percent of total billed charges 47.63 47.63 fee schedule 47.63 47.63 fee schedule 47.63 47.63 fee schedule 47.63 187 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hepatic Panel (Livr) PX-300800760 CDM 80076 CPT 0301 RC outpatient 110 110 21.93 21.93 fee schedule 110 93 89.1 percent of total billed charges 8.17 8.17 fee schedule 8.17 8.17 fee schedule 8.17 8.17 fee schedule 8.17 110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Amikacin PX-300801500 CDM 80150 CPT 0300 RC outpatient 60 60 40.44 40.44 fee schedule 60 93 48.6 percent of total billed charges 15.08 15.08 fee schedule 15.08 15.08 fee schedule 15.08 15.08 fee schedule 15.08 60 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Carbamazepine (Teg) PX-300801560 CDM 80156 CPT 0301 RC outpatient 183 183 39.05 39.05 fee schedule 183 93 148.23 percent of total billed charges 14.57 14.57 fee schedule 14.57 14.57 fee schedule 14.57 14.57 fee schedule 14.57 183 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cyclosporin (Cyclo) PX-300801580 CDM 80158 CPT 0301 RC outpatient 231 231 48.44 48.44 fee schedule 231 93 187.11 percent of total billed charges 18.05 18.05 fee schedule 18.05 18.05 fee schedule 18.05 18.05 fee schedule 18.05 231 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Clozapine PX-300801590 CDM 80159 CPT 0300 RC outpatient 50.37 50.37 48.44 48.44 fee schedule 50.37 93 40.8 percent of total billed charges 20.15 20.15 fee schedule 20.15 20.15 fee schedule 20.15 20.15 fee schedule 20.15 50.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Assay Carbamazephine 10,11 Epoxide" PX-300801610 CDM 80161 CPT 0300 RC outpatient 46.6 46.6 43.99 43.99 fee schedule 46.6 93 37.75 percent of total billed charges 46.6 46.6 other OPPS APC 46.6 46.6 other OPPS APC 18.64 18.64 fee schedule 18.64 46.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Digoxin, Serum (Dig)" PX-300801620 CDM 80162 CPT 0300 RC outpatient 170 170 35.62 35.62 fee schedule 170 93 137.7 percent of total billed charges 13.28 13.28 fee schedule 13.28 13.28 fee schedule 13.28 13.28 fee schedule 13.28 170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Depakene (Depk)(VA) PX-300801640 CDM 80164 CPT 0301 RC outpatient 170 170 36.35 36.35 fee schedule 170 93 137.7 percent of total billed charges 13.54 13.54 fee schedule 13.54 13.54 fee schedule 13.54 13.54 fee schedule 13.54 170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Drug Screen Quant Dipropylacetic Acid Free PX-300801650 CDM 80165 CPT 0300 RC outpatient 33.85 33.85 35.4 35.4 fee schedule 33.85 93 27.42 percent of total billed charges 13.54 13.54 fee schedule 13.54 13.54 fee schedule 13.54 13.54 fee schedule 13.54 35.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Gentamicin PX-300801700 CDM 80170 CPT 0301 RC outpatient 208 208 43.97 43.97 fee schedule 208 93 168.48 percent of total billed charges 16.38 16.38 fee schedule 16.38 16.38 fee schedule 16.38 16.38 fee schedule 16.38 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Lamotrigine (Lamo) PX-300801750 CDM 80175 CPT 0301 RC outpatient 45 45 34.73 34.73 fee schedule 45 93 36.45 percent of total billed charges 13.25 13.25 fee schedule 13.25 13.25 fee schedule 13.25 13.25 fee schedule 13.25 45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Levetiracetam (Leve) PX-300801770 CDM 80177 CPT 0301 RC outpatient 45 45 34.73 34.73 fee schedule 45 93 36.45 percent of total billed charges 13.25 13.25 fee schedule 13.25 13.25 fee schedule 13.25 13.25 fee schedule 13.25 45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Lithium,Serum (Li)" PX-300801780 CDM 80178 CPT 0301 RC outpatient 86 86 17.74 17.74 fee schedule 86 93 69.66 percent of total billed charges 6.61 6.61 fee schedule 6.61 6.61 fee schedule 6.61 6.61 fee schedule 6.61 86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Drug Screen Quantitative Mycophenolate PX-300801800 CDM 80180 CPT 0300 RC outpatient 62 62 47.29 47.29 fee schedule 62 93 50.22 percent of total billed charges 62 62 other OPPS APC 62 62 other OPPS APC 18.05 18.05 fee schedule 18.05 62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Oxcarbazepine PX-300801830 CDM 80183 CPT 0300 RC outpatient 33.12 33.12 34.73 34.73 fee schedule 33.12 93 26.83 percent of total billed charges 13.25 13.25 fee schedule 13.25 13.25 fee schedule 13.25 13.25 fee schedule 13.25 34.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Phenobarbital (Phen) PX-300801840 CDM 80184 CPT 0300 RC outpatient 146 146 30.74 30.74 fee schedule 146 93 118.26 percent of total billed charges 15.3 15.3 fee schedule 15.3 15.3 fee schedule 15.3 15.3 fee schedule 15.3 146 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Dilantin (Ptn) PX-300801850 CDM 80185 CPT 0300 RC outpatient 170 170 35.56 35.56 fee schedule 170 93 137.7 percent of total billed charges 13.25 13.25 fee schedule 13.25 13.25 fee schedule 13.25 13.25 fee schedule 13.25 170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Drug Assay Itraconazole PX-300801890 CDM 80189 CPT 0300 RC outpatient 67.77 67.77 63.98 63.98 fee schedule 67.77 93 54.89 percent of total billed charges 27.11 27.11 fee schedule 27.11 27.11 fee schedule 27.11 27.11 fee schedule 27.11 67.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Rapamycin (Rapa) PX-300801950 CDM 80195 CPT 0300 RC outpatient 34.32 34.32 37.34 37.34 fee schedule 34.32 93 27.8 percent of total billed charges 13.73 13.73 fee schedule 13.73 13.73 fee schedule 13.73 13.73 fee schedule 13.73 37.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Assay of Sirolimus PX-300801951 CDM 80195 CPT 0300 RC outpatient 34.32 34.32 37.34 37.34 fee schedule 34.32 93 27.8 percent of total billed charges 13.73 13.73 fee schedule 13.73 13.73 fee schedule 13.73 13.73 fee schedule 13.73 37.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fk506(Tacrolimus) PX-300801970 CDM 80197 CPT 0300 RC outpatient 208 208 36.81 36.81 fee schedule 208 93 168.48 percent of total billed charges 13.73 13.73 fee schedule 13.73 13.73 fee schedule 13.73 13.73 fee schedule 13.73 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Aminophylline (Theo)(Amfn) PX-300801980 CDM 80198 CPT 0300 RC outpatient 183 183 37.96 37.96 fee schedule 183 93 148.23 percent of total billed charges 183 183 other OPPS APC 183 183 other OPPS APC 14.14 14.14 fee schedule 14.14 183 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Drug Screen Quantitative Tiagabine PX-300801990 CDM 80199 CPT 0300 RC outpatient 67.77 67.77 47.29 47.29 fee schedule 67.77 93 54.89 percent of total billed charges 27.11 27.11 fee schedule 27.11 27.11 fee schedule 27.11 27.11 fee schedule 27.11 67.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Topiramate (Topi) PX-300802010 CDM 80201 CPT 0300 RC outpatient 29.8 29.8 31.99 31.99 fee schedule 29.8 93 24.14 percent of total billed charges 11.92 11.92 fee schedule 11.92 11.92 fee schedule 11.92 11.92 fee schedule 11.92 31.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vancomycin PX-300802020 CDM 80202 CPT 0301 RC outpatient 170 170 36.35 36.35 fee schedule 170 93 137.7 percent of total billed charges 13.54 13.54 fee schedule 13.54 13.54 fee schedule 13.54 13.54 fee schedule 13.54 170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Drug Screen Quant Zonisamide PX-300802030 CDM 80203 CPT 0300 RC outpatient 33.12 33.12 34.73 34.73 fee schedule 33.12 93 26.83 percent of total billed charges 13.25 13.25 fee schedule 13.25 13.25 fee schedule 13.25 13.25 fee schedule 13.25 34.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Drug Asy Hydroxychloroquine PX-300802200 CDM 80220 CPT 0300 RC outpatient 46.6 46.6 43.99 43.99 fee schedule 46.6 93 37.75 percent of total billed charges 18.64 18.64 fee schedule 18.64 18.64 fee schedule 18.64 18.64 fee schedule 18.64 46.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Lacosamide, S" PX-300802350 CDM 80235 CPT 0300 RC outpatient 100 100 63.98 63.98 fee schedule 100 93 81 percent of total billed charges 27.11 27.11 fee schedule 27.11 27.11 fee schedule 27.11 27.11 fee schedule 27.11 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Flecainide (Flec) PX-300802992 CDM 80181 CPT 0300 RC outpatient 46.6 46.6 43.99 43.99 fee schedule 46.6 93 37.75 percent of total billed charges 18.64 18.64 fee schedule 18.64 18.64 fee schedule 18.64 18.64 fee schedule 18.64 46.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Amiodarone Level PX-300802995 CDM 80151 CPT 0300 RC outpatient 46.6 46.6 43.99 43.99 fee schedule 46.6 93 37.75 percent of total billed charges 18.64 18.64 fee schedule 18.64 18.64 fee schedule 18.64 18.64 fee schedule 18.64 46.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Drug Screen, Abbrev. (Adrug)" PX-300803011 CDM 80307 CPT 0300 RC outpatient 158 158 47.96 47.96 fee schedule 158 93 127.98 percent of total billed charges 62.14 62.14 fee schedule 62.14 62.14 fee schedule 62.14 62.14 fee schedule 47.96 158 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Drug Screen Meconium PX-300803012 CDM 80307 CPT 0300 RC outpatient 158 158 47.96 47.96 fee schedule 158 93 127.98 percent of total billed charges 62.14 62.14 fee schedule 62.14 62.14 fee schedule 62.14 62.14 fee schedule 47.96 158 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Prenatal Drug Scrn. (Pnds) PX-300803015 CDM 80307 CPT 0300 RC outpatient 158 158 47.96 47.96 fee schedule 158 93 127.98 percent of total billed charges 62.14 62.14 fee schedule 62.14 62.14 fee schedule 62.14 62.14 fee schedule 47.96 158 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Salicylate Serum (Sali) PX-300803020 CDM 80179 CPT 0300 RC outpatient 97 97 43.99 43.99 fee schedule 97 93 78.57 percent of total billed charges 114.43 114.43 fee schedule 114.43 114.43 fee schedule 18.64 18.64 fee schedule 18.64 114.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Acetaminophen (Ace) PX-300803021 CDM 80143 CPT 0300 RC outpatient 256 256 43.99 43.99 fee schedule 256 93 207.36 percent of total billed charges 18.64 18.64 fee schedule 18.64 18.64 fee schedule 18.64 18.64 fee schedule 18.64 256 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Prenatal Drug Screen & Buprenorphine,Urine" PX-300803023 CDM 80307 CPT 0300 RC outpatient 155.35 155.35 47.96 47.96 fee schedule 155.35 93 125.83 percent of total billed charges 62.14 62.14 fee schedule 62.14 62.14 fee schedule 62.14 62.14 fee schedule 47.96 155.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Urine Drug Screen, Instrument Chem Analyzer" PX-300803043 CDM 80307 CPT 0300 RC outpatient 206.56 206.56 47.96 47.96 fee schedule 206.56 93 167.31 percent of total billed charges 62.14 62.14 fee schedule 62.14 62.14 fee schedule 62.14 62.14 fee schedule 47.96 206.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Drug Screeen Fentanyl PX-300803070 CDM 80307 CPT 0300 RC outpatient 155.35 155.35 47.96 47.96 fee schedule 155.35 93 125.83 percent of total billed charges 62.14 62.14 fee schedule 62.14 62.14 fee schedule 62.14 62.14 fee schedule 47.96 155.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Drug Monitor Panel1 Conf Urine PX-3008030771 CDM 80307 CPT 0300 RC outpatient 155.35 155.35 47.96 47.96 fee schedule 155.35 93 125.83 percent of total billed charges 62.14 62.14 fee schedule 62.14 62.14 fee schedule 62.14 62.14 fee schedule 47.96 155.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Blood Alcohol (Alco) PX-300803200 CDM 80320 CPT 0301 RC outpatient 286.08 286.08 56.99 56.99 fee schedule 286.08 93 231.72 percent of total billed charges 114.43 114.43 fee schedule 114.43 114.43 fee schedule 286.08 51 145.9 percent of total billed charges 56.99 286.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Drug Screening, Fentanyl" PX-300803540 CDM 80354 CPT 0300 RC outpatient 286.08 286.08 286.08 74 211.7 percent of total billed charges 286.08 93 231.72 percent of total billed charges 286.08 286.08 other OPPS APC 286.08 286.08 other OPPS APC 286.08 51 145.9 percent of total billed charges 286.08 286.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Opioids , Opiate Analogs 1 or 2" PX-300803620 CDM G0480 CPT 0300 RC outpatient 286.07 286.07 286.07 74 211.69 percent of total billed charges 286.07 93 231.72 percent of total billed charges 114.43 114.43 fee schedule 114.43 114.43 fee schedule 114.43 114.43 fee schedule 114.43 286.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Opioids Opiate Analogs 8-14 PX-300803622 CDM G0481 CPT 0300 RC outpatient 391.72 391.72 391.72 74 289.87 percent of total billed charges 391.72 93 317.29 percent of total billed charges 391.72 391.72 other OPPS APC 391.72 391.72 other OPPS APC 156.59 156.59 fee schedule 156.59 391.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Opioids Opiate Analogs 15-21 PX-300803623 CDM G0482 CPT 0300 RC outpatient 496.85 496.85 496.85 74 367.67 percent of total billed charges 496.85 93 402.45 percent of total billed charges 496.85 496.85 other OPPS APC 496.85 496.85 other OPPS APC 198.74 198.74 fee schedule 198.74 496.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Opioids Opiate Analogs 22+ PX-300803624 CDM G0483 CPT 0300 RC outpatient 617.3 617.3 617.3 74 456.8 percent of total billed charges 617.3 93 500.01 percent of total billed charges 617.3 617.3 other OPPS APC 617.3 617.3 other OPPS APC 246.92 246.92 fee schedule 246.92 617.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Urine Dipstick Test(Urdip) PX-300810000 CDM 81000 CPT 0300 RC outpatient 12 12 8.51 8.51 fee schedule 12 93 9.72 percent of total billed charges 4.02 4.02 fee schedule 4.02 4.02 fee schedule 4.02 4.02 fee schedule 4.02 12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Urine W/Microscopic (Uwm) PX-300810010 CDM 81001 CPT 0307 RC outpatient 37 37 8.51 8.51 fee schedule 37 93 29.97 percent of total billed charges 3.17 3.17 fee schedule 3.17 3.17 fee schedule 3.17 3.17 fee schedule 3.17 37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Refractometer Specific Gravity PX-300810020 CDM 81002 CPT 0300 RC outpatient 33 33 6.85 6.85 fee schedule 33 93 26.73 percent of total billed charges 33 33 other OPPS APC 33 33 other OPPS APC 3.48 3.48 fee schedule 3.48 33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Urinalysis Routine PX-300810030 CDM 81003 CPT 0307 RC outpatient 25 25 6.03 6.03 fee schedule 25 93 20.25 percent of total billed charges 2.25 2.25 fee schedule 2.25 2.25 fee schedule 2.25 2.25 fee schedule 2.25 25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ucg Spot Test (Ucg) PX-300810250 CDM 81025 CPT 0300 RC outpatient 97 97 16.97 16.97 fee schedule 97 93 78.57 percent of total billed charges 8.61 8.61 fee schedule 8.61 8.61 fee schedule 8.61 8.61 fee schedule 8.61 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Brca1/Brca2 Gene Analysis PX-300811620 CDM 81162 CPT 0300 RC outpatient 4562.2 4562.2 5866.63 5866.63 fee schedule 4562.2 93 3695.38 percent of total billed charges 1824.88 1824.88 fee schedule 1824.88 1824.88 fee schedule 1824.88 1824.88 fee schedule 1824.88 5866.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bcr Abl P210 Mrna Quant PX-300812060 CDM 81206 CPT 0300 RC outpatient 560 560 194.27 194.27 fee schedule 560 93 453.6 percent of total billed charges 163.96 163.96 fee schedule 163.96 163.96 fee schedule 163.96 163.96 fee schedule 163.96 560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Bcr/Abl, Rna,Qual, Diagnostic" PX-300812061 CDM 81206 CPT 0300 RC outpatient 560 560 194.27 194.27 fee schedule 560 93 453.6 percent of total billed charges 163.96 163.96 fee schedule 163.96 163.96 fee schedule 163.96 163.96 fee schedule 163.96 560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bcr Abl P190 Mrna Quant PX-300812070 CDM 81207 CPT 0300 RC outpatient 493 493 161.99 161.99 fee schedule 493 93 399.33 percent of total billed charges 144.84 144.84 fee schedule 144.84 144.84 fee schedule 144.84 144.84 fee schedule 144.84 493 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Bcr/Abl,Rna, Qual Minor Qual, Diagnostic" PX-300812071 CDM 81207 CPT 0300 RC outpatient 493 493 161.99 161.99 fee schedule 493 93 399.33 percent of total billed charges 144.84 144.84 fee schedule 144.84 144.84 fee schedule 144.84 144.84 fee schedule 144.84 493 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Bcr/Abl, Rna, Other, Qual, Diagnostic" PX-300812081 CDM 81208 CPT 0300 RC outpatient 536.55 536.55 245.68 245.68 fee schedule 536.55 93 434.61 percent of total billed charges 214.62 214.62 fee schedule 214.62 214.62 fee schedule 214.62 214.62 fee schedule 214.62 536.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Braf Analysis PX-300812103 CDM 81210 CPT 0300 RC outpatient 438.5 438.5 100.2 100.2 fee schedule 438.5 93 355.19 percent of total billed charges 175.4 175.4 fee schedule 175.4 175.4 fee schedule 175.4 175.4 fee schedule 100.2 438.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cebpa Gene Analysis Full Gene Sequence PX-300812180 CDM 81218 CPT 0300 RC outpatient 604.75 604.75 777.64 777.64 fee schedule 604.75 93 489.85 percent of total billed charges 241.9 241.9 fee schedule 241.9 241.9 fee schedule 241.9 241.9 fee schedule 241.9 777.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Calr Mutation Analysis, Myeloproliferative Neoplasm" PX-300812190 CDM 81219 CPT 0300 RC outpatient 304.07 304.07 391 391 fee schedule 304.07 93 246.3 percent of total billed charges 121.63 121.63 fee schedule 121.63 121.63 fee schedule 121.63 121.63 fee schedule 121.63 391 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Calr Mutation Anal, Myeloproliferative Neoplasm, Reflex" PX-300812191 CDM 81219 CPT 0300 RC outpatient 304.07 304.07 391 391 fee schedule 304.07 93 246.3 percent of total billed charges 121.63 121.63 fee schedule 121.63 121.63 fee schedule 121.63 121.63 fee schedule 121.63 391 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Myeloprolifetative Neoplasm, Calr W Reflex Mpl" PX-300812192 CDM 81219 CPT 0300 RC outpatient 304.07 304.07 391 391 fee schedule 304.07 93 246.3 percent of total billed charges 121.63 121.63 fee schedule 121.63 121.63 fee schedule 121.63 121.63 fee schedule 121.63 391 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cystic Fib.Carrier and Detection PX-300812200 CDM 81220 CPT 0300 RC outpatient 1391.5 1391.5 1973.67 1973.67 fee schedule 1391.5 93 1127.12 percent of total billed charges 556.6 556.6 fee schedule 556.6 556.6 fee schedule 556.6 556.6 fee schedule 556.6 1973.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Full Gene Sequence(Cystic Fibrosis) PX-300812230 CDM 81223 CPT 0300 RC outpatient 3158.29 3158.29 3412.7 3412.7 fee schedule 3158.29 93 2558.21 percent of total billed charges 3158.29 3158.29 other OPPS APC 3158.29 3158.29 other OPPS APC 499 499 fee schedule 499 3412.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cyp2c19 Gene Analysis Common Variants PX-300812250 CDM 81225 CPT 0300 RC outpatient 728.4 728.4 219.86 219.86 fee schedule 728.4 93 590 percent of total billed charges 291.36 291.36 fee schedule 291.36 291.36 fee schedule 291.36 291.36 fee schedule 219.86 728.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cytogenomic Chrom Microarray Congen PX-300812290 CDM 81229 CPT 0300 RC outpatient 2900 2900 964.44 964.44 fee schedule 2900 93 2349 percent of total billed charges 1160 1160 fee schedule 1160 1160 fee schedule 1160 1160 fee schedule 964.44 2900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Chromosomal Microarray,Autopsy, Prod Conception,Stillbirth" PX-300812291 CDM 81229 CPT 0300 RC outpatient 2900 2900 964.44 964.44 fee schedule 2900 93 2349 percent of total billed charges 1160 1160 fee schedule 1160 1160 fee schedule 1160 1160 fee schedule 964.44 2900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Prothrombin 20210 Mutation (Ptgm) PX-300812401 CDM 81240 CPT 0300 RC outpatient 164.23 164.23 111.69 111.69 fee schedule 164.23 93 133.03 percent of total billed charges 65.69 65.69 fee schedule 65.69 65.69 fee schedule 65.69 65.69 fee schedule 65.69 164.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Factor V Leiden (F5dna) PX-300812410 CDM 81241 CPT 0302 RC outpatient 196 196 78.18 78.18 fee schedule 196 93 158.76 percent of total billed charges 73.37 73.37 fee schedule 73.37 73.37 fee schedule 73.37 73.37 fee schedule 73.37 196 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Fmr1(Fragile 1 Mental Retardation) Gene Analysis,Eval Abnormal Alleles" PX-300812430 CDM 81243 CPT 0300 RC outpatient 142.6 142.6 515.99 515.99 fee schedule 142.6 93 115.51 percent of total billed charges 57.04 57.04 fee schedule 57.04 57.04 fee schedule 57.04 57.04 fee schedule 57.04 515.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Fmri Gene Analysis, Charac of Alleles" PX-300812440 CDM 81244 CPT 0300 RC outpatient 112.22 112.22 67.73 67.73 fee schedule 112.22 93 90.9 percent of total billed charges 44.89 44.89 fee schedule 44.89 44.89 fee schedule 44.89 44.89 fee schedule 44.89 112.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Flt3 Gene Analysis Internal Tandem Dup Variants PX-300812450 CDM 81245 CPT 0300 RC outpatient 413.77 413.77 210.95 210.95 fee schedule 413.77 93 335.15 percent of total billed charges 165.51 165.51 fee schedule 165.51 165.51 fee schedule 165.51 165.51 fee schedule 165.51 413.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Flt3 Gene Anlys Tyrosine Kinase Domain Variants PX-300812460 CDM 81246 CPT 0300 RC outpatient 207.5 207.5 159.44 159.44 fee schedule 207.5 93 168.08 percent of total billed charges 83 83 fee schedule 83 83 fee schedule 83 83 fee schedule 83 207.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hexa Gene Analysis Common Variants PX-300812550 CDM 81255 CPT 0300 RC outpatient 128.62 128.62 532.65 532.65 fee schedule 128.62 93 104.18 percent of total billed charges 51.45 51.45 fee schedule 51.45 51.45 fee schedule 51.45 51.45 fee schedule 51.45 532.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hemochromatosis Hfe Gene Analysis PX-300812560 CDM 81256 CPT 0300 RC outpatient 222.93 222.93 136.32 136.32 fee schedule 222.93 93 180.57 percent of total billed charges 65.36 65.36 fee schedule 65.36 65.36 fee schedule 65.36 65.36 fee schedule 65.36 222.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Hba1/Hba2, Gene Analysis, Common Deltions or Variant" PX-300812570 CDM 81257 CPT 0300 RC outpatient 802.06 802.06 477.64 477.64 fee schedule 802.06 93 649.67 percent of total billed charges 102.26 102.26 fee schedule 102.26 102.26 fee schedule 102.26 102.26 fee schedule 102.26 802.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Hba1,Hba2 Full Gene Sequence" PX-300812590 CDM 81259 CPT 0300 RC outpatient 1500 1500 1500 74 1110 percent of total billed charges 1500 93 1215 percent of total billed charges 600 600 fee schedule 600 600 fee schedule 600 600 fee schedule 600 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Igh@ Rearrange Abnormal Clonal Pop Amplified PX-300812610 CDM 81261 CPT 0300 RC outpatient 494.97 494.97 195.32 195.32 fee schedule 494.97 93 400.93 percent of total billed charges 197.99 197.99 fee schedule 197.99 197.99 fee schedule 197.99 197.99 fee schedule 195.32 494.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Igk@Gene Rearrange Detect Abnormal Clonal Pop PX-300812640 CDM 81264 CPT 0300 RC outpatient 431.82 431.82 720.44 720.44 fee schedule 431.82 93 349.77 percent of total billed charges 172.73 172.73 fee schedule 172.73 172.73 fee schedule 172.73 172.73 fee schedule 172.73 720.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Jak2 V617f Mutation PX-300812700 CDM 81270 CPT 0310 RC outpatient 627 627 109.69 109.69 fee schedule 627 93 507.87 percent of total billed charges 91.66 91.66 fee schedule 91.66 91.66 fee schedule 91.66 91.66 fee schedule 91.66 627 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Myeloproliferative Neoplasm,Jak2 V617f W Reflex" PX-300812702 CDM 81270 CPT 0300 RC outpatient 627 627 109.69 109.69 fee schedule 627 93 507.87 percent of total billed charges 91.66 91.66 fee schedule 91.66 91.66 fee schedule 91.66 91.66 fee schedule 91.66 627 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Jak2 Gene Trgt Sequence Alys PX-300812791 CDM 81279 CPT 0300 RC outpatient 463 463 463 74 342.62 percent of total billed charges 463 93 375.03 percent of total billed charges 185.2 185.2 fee schedule 185.2 185.2 fee schedule 185.2 185.2 fee schedule 185.2 463 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mlh1 Hypermethylation Analysis PX-300812880 CDM 81288 CPT 0300 RC outpatient 480.8 480.8 306.51 306.51 fee schedule 480.8 93 389.45 percent of total billed charges 480.8 480.8 other OPPS APC 480.8 480.8 other OPPS APC 192.32 192.32 fee schedule 192.32 480.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Msh6 Gene Known Variants PX-300812990 CDM 81299 CPT 0300 RC outpatient 770 770 136.32 136.32 fee schedule 770 93 623.7 percent of total billed charges 770 770 other OPPS APC 770 770 other OPPS APC 308 308 fee schedule 136.32 770 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Myd88 L265p Gene Mutation Analysis (Myd88) PX-300813050 CDM 81305 CPT 0300 RC outpatient 438.5 438.5 438.5 74 324.49 percent of total billed charges 438.5 93 355.19 percent of total billed charges 175.4 175.4 fee schedule 175.4 175.4 fee schedule 175.4 175.4 fee schedule 175.4 438.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Npm1 Nucleophosmin Gene Anal Exon 12 Variants PX-300813100 CDM 81310 CPT 0300 RC outpatient 616.3 616.3 87.57 87.57 fee schedule 616.3 93 499.2 percent of total billed charges 246.52 246.52 fee schedule 246.52 246.52 fee schedule 246.52 246.52 fee schedule 87.57 616.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pmp22 Gene Full Sequence PX-300813250 CDM 81325 CPT 0300 RC outpatient 1923.95 1923.95 1923.95 74 1423.72 percent of total billed charges 1923.95 93 1558.4 percent of total billed charges 1923.95 1923.95 other OPPS APC 1923.95 1923.95 other OPPS APC 769.58 769.58 fee schedule 769.58 1923.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sma Carrier by Del/Dup (Smncs) PX-300813290 CDM 81329 CPT 0300 RC outpatient 342.5 342.5 342.5 74 253.45 percent of total billed charges 342.5 93 277.43 percent of total billed charges 137 137 fee schedule 137 137 fee schedule 137 137 fee schedule 137 342.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Serpina 1 Gene PX-300813320 CDM 81332 CPT 0300 RC outpatient 109.12 109.12 136.32 136.32 fee schedule 109.12 93 88.39 percent of total billed charges 43.65 43.65 fee schedule 43.65 43.65 fee schedule 43.65 43.65 fee schedule 43.65 136.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Trb@ Rearrangement Anal Amplification Method PX-300813401 CDM 81340 CPT 0300 RC outpatient 522.3 522.3 715.55 715.55 fee schedule 522.3 93 423.06 percent of total billed charges 208.92 208.92 fee schedule 208.92 208.92 fee schedule 208.92 208.92 fee schedule 208.92 715.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Trg Gene Rearrangement Analysis PX-300813420 CDM 81342 CPT 0300 RC outpatient 1511.25 1511.25 192.4 192.4 fee schedule 1511.25 93 1224.11 percent of total billed charges 201.5 201.5 fee schedule 201.5 201.5 fee schedule 201.5 201.5 fee schedule 192.4 1511.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Hla Class I Typing, Low Resolution, One Antigen Equiv" PX-300813740 CDM 81374 CPT 0300 RC outpatient 185.83 185.83 317.91 317.91 fee schedule 185.83 93 150.52 percent of total billed charges 74.33 74.33 fee schedule 74.33 74.33 fee schedule 74.33 74.33 fee schedule 74.33 317.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hla I Typing Complete Hr PX-300813790 CDM 81379 CPT 0300 RC outpatient 838.45 838.45 444.31 444.31 fee schedule 838.45 93 679.14 percent of total billed charges 335.38 335.38 fee schedule 335.38 335.38 fee schedule 335.38 335.38 fee schedule 335.38 838.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Admark Apoe Genotype Anal & Interp PX-300814014 CDM 81401 CPT 0300 RC outpatient 342.5 342.5 259.42 259.42 fee schedule 342.5 93 277.43 percent of total billed charges 137 137 fee schedule 137 137 fee schedule 137 137 fee schedule 137 342.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Mpl Exon 10 Mutation Detection, Blood" PX-300814031 CDM 81339 CPT 0300 RC outpatient 463 463 463 74 342.62 percent of total billed charges 463 93 375.03 percent of total billed charges 185.2 185.2 fee schedule 185.2 185.2 fee schedule 185.2 185.2 fee schedule 185.2 463 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Mpl Exon 10 Mutation Detection, Reflex" PX-300814032 CDM 81339 CPT 0300 RC outpatient 463 463 463 74 342.62 percent of total billed charges 463 93 375.03 percent of total billed charges 185.2 185.2 fee schedule 185.2 185.2 fee schedule 185.2 185.2 fee schedule 185.2 463 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Molecular Pathology Procedure, Level 9" PX-300814080 CDM 81408 CPT 0300 RC outpatient 5000 5000 5852.19 5852.19 fee schedule 5000 93 4050 percent of total billed charges 2000 2000 fee schedule 2000 2000 fee schedule 2000 2000 fee schedule 2000 5852.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fetal Chrmoml Aneuploidy PX-300814200 CDM 81420 CPT 0300 RC outpatient 1897.62 1897.62 1897.62 74 1404.24 percent of total billed charges 1897.62 93 1537.07 percent of total billed charges 759.05 759.05 fee schedule 759.05 759.05 fee schedule 759.05 759.05 fee schedule 759.05 1897.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hereditary Colon Ca Dsrdrs Dup/Del Analys 5 Gen PX-300814360 CDM 81436 CPT 0300 RC outpatient 1462.25 1462.25 1529.76 1529.76 fee schedule 1462.25 93 1184.42 percent of total billed charges 584.9 584.9 fee schedule 584.9 584.9 fee schedule 584.9 584.9 fee schedule 584.9 1529.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Genetic Testing for Severe Inherited Conditions PX-300814430 CDM 81443 CPT 0300 RC outpatient 6121.4 6121.4 6121.4 74 4529.84 percent of total billed charges 6121.4 93 4958.33 percent of total billed charges 2448.56 2448.56 fee schedule 2448.56 2448.56 fee schedule 2448.56 2448.56 fee schedule 2448.56 6121.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Onco (Ovarian) Biochemical Assay Two Proteins PX-300815000 CDM 81500 CPT 0300 RC outpatient 651.25 651.25 651.25 74 481.93 percent of total billed charges 651.25 93 527.51 percent of total billed charges 260.5 260.5 fee schedule 260.5 260.5 fee schedule 260.5 260.5 fee schedule 260.5 651.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Afp Maternal 4 Marker PX-300815110 CDM 81511 CPT 0300 RC outpatient 383.75 383.75 383.75 74 283.98 percent of total billed charges 383.75 93 310.84 percent of total billed charges 153.5 153.5 fee schedule 153.5 153.5 fee schedule 153.5 153.5 fee schedule 153.5 383.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Infectious Disease, Bacterial Vaginosis, Quant Real Time Amp" PX-300815130 CDM 81513 CPT 0300 RC outpatient 356.57 356.57 356.57 74 263.86 percent of total billed charges 356.57 93 288.82 percent of total billed charges 142.63 142.63 fee schedule 142.63 142.63 fee schedule 142.63 142.63 fee schedule 142.63 356.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Liver Ds Alys 3 Biomrk Srm Alg PX-300815170 CDM 81517 CPT 0310 RC outpatient 1258.5 1258.5 1258.5 74 931.29 percent of total billed charges 1258.5 93 1019.39 percent of total billed charges 176.19 176.19 fee schedule 176.19 176.19 fee schedule 176.19 176.19 fee schedule 176.19 1258.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Fibro Test Acti Test, S (Fibro)" PX-300815960 CDM 81596 CPT 0300 RC outpatient 217 217 217 74 160.58 percent of total billed charges 217 93 175.77 percent of total billed charges 72.19 72.19 fee schedule 72.19 72.19 fee schedule 72.19 72.19 fee schedule 72.19 217 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Ketone Bodies Serum, Qualitative" PX-300820090 CDM 82009 CPT 0301 RC outpatient 19 19 7.8 7.8 fee schedule 19 93 15.39 percent of total billed charges 4.52 4.52 fee schedule 4.52 4.52 fee schedule 4.52 4.52 fee schedule 4.52 19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Beta Hydroxybutyrate (Bhob) PX-300820100 CDM 82010 CPT 0300 RC outpatient 29 29 21.93 21.93 fee schedule 29 93 23.49 percent of total billed charges 8.17 8.17 fee schedule 8.17 8.17 fee schedule 8.17 8.17 fee schedule 8.17 29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Acylcarnitines Quant PX-300820170 CDM 82017 CPT 0300 RC outpatient 42.17 42.17 45.25 45.25 fee schedule 42.17 93 34.16 percent of total billed charges 16.87 16.87 fee schedule 16.87 16.87 fee schedule 16.87 16.87 fee schedule 16.87 45.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Acth (Acth) PX-300820240 CDM 82024 CPT 0301 RC outpatient 500 500 103.62 103.62 fee schedule 500 93 405 percent of total billed charges 38.62 38.62 fee schedule 38.62 38.62 fee schedule 38.62 38.62 fee schedule 38.62 500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Albumin;Serum, Plasma or Whole Blood" PX-300820400 CDM 82040 CPT 0301 RC outpatient 61 61 13.29 13.29 fee schedule 61 93 49.41 percent of total billed charges 4.95 4.95 fee schedule 4.95 4.95 fee schedule 4.95 4.95 fee schedule 4.95 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Albumin, Urine/Other Source Quantitative Ea." PX-300820420 CDM 82042 CPT 0301 RC outpatient 73 73 4.72 4.72 fee schedule 73 93 59.13 percent of total billed charges 7.78 7.78 fee schedule 7.78 7.78 fee schedule 7.78 7.78 fee schedule 4.72 73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Urine,Microalbumin" PX-300820430 CDM 82043 CPT 0301 RC outpatient 73 73 15.53 15.53 fee schedule 73 93 59.13 percent of total billed charges 5.78 5.78 fee schedule 5.78 5.78 fee schedule 5.78 5.78 fee schedule 5.78 73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Aldolase (Alse) PX-300820850 CDM 82085 CPT 0301 RC outpatient 122 122 26.04 26.04 fee schedule 122 93 98.82 percent of total billed charges 9.71 9.71 fee schedule 9.71 9.71 fee schedule 9.71 9.71 fee schedule 9.71 122 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Aldosterone PX-300820880 CDM 82088 CPT 0301 RC outpatient 298 298 109.32 109.32 fee schedule 298 93 241.38 percent of total billed charges 40.75 40.75 fee schedule 40.75 40.75 fee schedule 40.75 40.75 fee schedule 40.75 298 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Alpha-1-Antitrypsin (Ala) PX-300821030 CDM 82103 CPT 0301 RC outpatient 33.6 33.6 36.04 36.04 fee schedule 33.6 93 27.22 percent of total billed charges 13.44 13.44 fee schedule 13.44 13.44 fee schedule 13.44 13.44 fee schedule 13.44 36.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Chg Alpha-1-Antitrypsin, Pheno" PX-300821040 CDM 82104 CPT 0301 RC outpatient 52 52 38.78 38.78 fee schedule 52 93 42.12 percent of total billed charges 14.46 14.46 fee schedule 14.46 14.46 fee schedule 14.46 14.46 fee schedule 14.46 52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Alpha-Fetoprotein (Afp) Serum PX-300821050 CDM 82105 CPT 0301 RC outpatient 238 238 45 45 fee schedule 238 93 192.78 percent of total billed charges 16.77 16.77 fee schedule 16.77 16.77 fee schedule 16.77 16.77 fee schedule 16.77 238 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ammonia PX-300821400 CDM 82140 CPT 0301 RC outpatient 183 183 39.09 39.09 fee schedule 183 93 148.23 percent of total billed charges 14.57 14.57 fee schedule 14.57 14.57 fee schedule 14.57 14.57 fee schedule 14.57 183 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Amylase PX-300821500 CDM 82150 CPT 0301 RC outpatient 86 86 17.4 17.4 fee schedule 86 93 69.66 percent of total billed charges 6.48 6.48 fee schedule 6.48 6.48 fee schedule 6.48 6.48 fee schedule 6.48 86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Androstenedione (Andrs) PX-300821570 CDM 82157 CPT 0300 RC outpatient 81 81 78.53 78.53 fee schedule 81 93 65.61 percent of total billed charges 29.28 29.28 fee schedule 29.28 29.28 fee schedule 29.28 29.28 fee schedule 29.28 81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Assay of Androsterone PX-300821600 CDM 82160 CPT 0300 RC outpatient 64 64 67.08 67.08 fee schedule 64 93 51.84 percent of total billed charges 25.55 25.55 fee schedule 25.55 25.55 fee schedule 25.55 25.55 fee schedule 25.55 67.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Angiotensin I Convert Enzyme PX-300821640 CDM 82164 CPT 0301 RC outpatient 195 195 39.15 39.15 fee schedule 195 93 157.95 percent of total billed charges 14.6 14.6 fee schedule 14.6 14.6 fee schedule 14.6 14.6 fee schedule 14.6 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Assay Anti-Mullerian Horm PX-300821660 CDM 82166 CPT 0301 RC outpatient 96.55 96.55 91.14 91.14 fee schedule 96.55 93 78.21 percent of total billed charges 38.62 38.62 fee schedule 38.62 38.62 fee schedule 38.62 38.62 fee schedule 38.62 96.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chg Assay of Alpolipoprotein PX-300821720 CDM 82172 CPT 0300 RC outpatient 52.73 52.73 41.57 41.57 fee schedule 52.73 93 42.71 percent of total billed charges 21.09 21.09 fee schedule 21.09 21.09 fee schedule 21.09 21.09 fee schedule 21.09 52.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Arsenic (Arsu) PX-300821750 CDM 82175 CPT 0300 RC outpatient 47.53 47.53 50.9 50.9 fee schedule 47.53 93 38.5 percent of total billed charges 18.97 18.97 fee schedule 18.97 18.97 fee schedule 18.97 18.97 fee schedule 18.97 50.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Beta 2 Microglobulin (B2m) PX-300822320 CDM 82232 CPT 0300 RC outpatient 158 158 43.41 43.41 fee schedule 158 93 127.98 percent of total billed charges 16.18 16.18 fee schedule 16.18 16.18 fee schedule 16.18 16.18 fee schedule 16.18 158 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bilirubin Total PX-300822470 CDM 82247 CPT 0301 RC outpatient 61 61 13.48 13.48 fee schedule 61 93 49.41 percent of total billed charges 5.02 5.02 fee schedule 5.02 5.02 fee schedule 5.02 5.02 fee schedule 5.02 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Direct Bilirubin(Dbil) PX-300822480 CDM 82248 CPT 0301 RC outpatient 61 61 13.48 13.48 fee schedule 61 93 49.41 percent of total billed charges 5.02 5.02 fee schedule 5.02 5.02 fee schedule 5.02 5.02 fee schedule 5.02 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Occult Bld Feces (Ocb) PX-300822700 CDM 82270 CPT 0300 RC outpatient 26 26 8.72 8.72 fee schedule 26 93 21.06 percent of total billed charges 4.38 4.38 fee schedule 4.38 4.38 fee schedule 4.38 4.38 fee schedule 4.38 26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Occult Blood X2 PX-300822702 CDM 82270 CPT 0300 RC outpatient 26 26 8.72 8.72 fee schedule 26 93 21.06 percent of total billed charges 4.38 4.38 fee schedule 4.38 4.38 fee schedule 4.38 4.38 fee schedule 4.38 26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Occult Blood X3 PX-300822703 CDM 82270 CPT 0300 RC outpatient 26 26 8.72 8.72 fee schedule 26 93 21.06 percent of total billed charges 4.38 4.38 fee schedule 4.38 4.38 fee schedule 4.38 4.38 fee schedule 4.38 26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Blood, Occult, Qual, Feces, Single Specimen" PX-300822720 CDM 82272 CPT 0301 RC outpatient 37 37 8.85 8.85 fee schedule 37 93 29.97 percent of total billed charges 4.23 4.23 fee schedule 4.23 4.23 fee schedule 4.23 4.23 fee schedule 4.23 37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fecal Occult Blood Immuno PX-300822740 CDM 82274 CPT 0300 RC outpatient 57 57 42.66 42.66 fee schedule 57 93 46.17 percent of total billed charges 15.92 15.92 fee schedule 15.92 15.92 fee schedule 15.92 15.92 fee schedule 15.92 57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vitamin D -25 Hydroxy PX-300823060 CDM 82306 CPT 0300 RC outpatient 353 353 79.41 79.41 fee schedule 353 93 285.93 percent of total billed charges 29.6 29.6 fee schedule 29.6 29.6 fee schedule 29.6 29.6 fee schedule 29.6 353 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Calcium Total PX-300823100 CDM 82310 CPT 0301 RC outpatient 61 61 13.82 13.82 fee schedule 61 93 49.41 percent of total billed charges 5.16 5.16 fee schedule 5.16 5.16 fee schedule 5.16 5.16 fee schedule 5.16 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Calcium Ionized PX-300823300 CDM 82330 CPT 0300 RC outpatient 86 86 36.65 36.65 fee schedule 86 93 69.66 percent of total billed charges 13.68 13.68 fee schedule 13.68 13.68 fee schedule 13.68 13.68 fee schedule 13.68 86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Calcium Random Urine PX-300823400 CDM 82340 CPT 0301 RC outpatient 73 73 16.19 16.19 fee schedule 73 93 59.13 percent of total billed charges 6.03 6.03 fee schedule 6.03 6.03 fee schedule 6.03 6.03 fee schedule 6.03 73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Stone Analysis (Stone) PX-300823650 CDM 82365 CPT 0301 RC outpatient 158 158 34.58 34.58 fee schedule 158 93 127.98 percent of total billed charges 12.9 12.9 fee schedule 12.9 12.9 fee schedule 12.9 12.9 fee schedule 12.9 158 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Co2 (Co2) PX-300823740 CDM 82374 CPT 0300 RC outpatient 71 71 13.11 13.11 fee schedule 71 93 57.51 percent of total billed charges 4.88 4.88 fee schedule 4.88 4.88 fee schedule 4.88 4.88 fee schedule 4.88 71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Rt Co-Ox Analysis PX-300823750 CDM 82375 CPT 0300 RC outpatient 195 195 33.06 33.06 fee schedule 195 93 157.95 percent of total billed charges 12.32 12.32 fee schedule 12.32 12.32 fee schedule 12.32 12.32 fee schedule 12.32 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cea (Ceam) PX-300823780 CDM 82378 CPT 0300 RC outpatient 243 243 50.9 50.9 fee schedule 243 93 196.83 percent of total billed charges 18.96 18.96 fee schedule 18.96 18.96 fee schedule 18.96 18.96 fee schedule 18.96 243 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Carnitine(Total and Free) Quant., Each Spec" PX-300823790 CDM 82379 CPT 0300 RC outpatient 42.17 42.17 45.25 45.25 fee schedule 42.17 93 34.16 percent of total billed charges 16.87 16.87 fee schedule 16.87 16.87 fee schedule 16.87 16.87 fee schedule 16.87 45.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Catecholamines Fract. PX-300823840 CDM 82384 CPT 0300 RC outpatient 63.12 63.12 67.74 67.74 fee schedule 63.12 93 51.13 percent of total billed charges 25.25 25.25 fee schedule 25.25 25.25 fee schedule 25.25 25.25 fee schedule 25.25 67.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ceruloplasmin (Cermn) PX-300823900 CDM 82390 CPT 0301 RC outpatient 135 135 28.82 28.82 fee schedule 135 93 109.35 percent of total billed charges 10.74 10.74 fee schedule 10.74 10.74 fee schedule 10.74 10.74 fee schedule 10.74 135 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chloride Urine PX-300824360 CDM 82436 CPT 0301 RC outpatient 61 61 13.48 13.48 fee schedule 61 93 49.41 percent of total billed charges 5.75 5.75 fee schedule 5.75 5.75 fee schedule 5.75 5.75 fee schedule 5.75 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cholesterol (Chol) PX-300824650 CDM 82465 CPT 0301 RC outpatient 61 61 11.67 11.67 fee schedule 61 93 49.41 percent of total billed charges 4.35 4.35 fee schedule 4.35 4.35 fee schedule 4.35 4.35 fee schedule 4.35 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Urine,Citrate 24hr (Citu)" PX-300825070 CDM 82507 CPT 0300 RC outpatient 69.5 69.5 74.59 74.59 fee schedule 69.5 93 56.3 percent of total billed charges 27.8 27.8 fee schedule 27.8 27.8 fee schedule 27.8 27.8 fee schedule 27.8 74.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Collagen Cross Links, Any Method" PX-300825230 CDM 82523 CPT 0300 RC outpatient 46.7 46.7 29.13 29.13 fee schedule 46.7 93 37.83 percent of total billed charges 18.68 18.68 fee schedule 18.68 18.68 fee schedule 18.68 18.68 fee schedule 18.68 46.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Copper PX-300825250 CDM 82525 CPT 0301 RC outpatient 97 97 27.96 27.96 fee schedule 97 93 78.57 percent of total billed charges 12.41 12.41 fee schedule 12.41 12.41 fee schedule 12.41 12.41 fee schedule 12.41 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cortisol Free PX-300825300 CDM 82530 CPT 0301 RC outpatient 219 219 44.83 44.83 fee schedule 219 93 177.39 percent of total billed charges 16.71 16.71 fee schedule 16.71 16.71 fee schedule 16.71 16.71 fee schedule 16.71 219 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cortisol Total PX-300825330 CDM 82533 CPT 0301 RC outpatient 208 208 43.74 43.74 fee schedule 208 93 168.48 percent of total billed charges 16.3 16.3 fee schedule 16.3 16.3 fee schedule 16.3 16.3 fee schedule 16.3 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Column Chromatography, Each Specimin" PX-300825420 CDM 82542 CPT 0300 RC outpatient 62 62 48.44 48.44 fee schedule 62 93 50.22 percent of total billed charges 24.09 24.09 fee schedule 24.09 24.09 fee schedule 24.09 24.09 fee schedule 24.09 62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cpk (Cpk) PX-300825500 CDM 82550 CPT 0301 RC outpatient 91 91 17.47 17.47 fee schedule 91 93 73.71 percent of total billed charges 6.51 6.51 fee schedule 6.51 6.51 fee schedule 6.51 6.51 fee schedule 6.51 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cpk-Mb (CKMB) PX-300825530 CDM 82553 CPT 0301 RC outpatient 97 97 20.66 20.66 fee schedule 97 93 78.57 percent of total billed charges 97 97 other OPPS APC 97 97 other OPPS APC 11.55 11.55 fee schedule 11.55 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Creatinine Blood PX-300825650 CDM 82565 CPT 0301 RC outpatient 61 61 13.75 13.75 fee schedule 61 93 49.41 percent of total billed charges 5.12 5.12 fee schedule 5.12 5.12 fee schedule 5.12 5.12 fee schedule 5.12 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Creatinine Other Source PX-300825700 CDM 82570 CPT 0301 RC outpatient 22 22 13.88 13.88 fee schedule 22 93 17.82 percent of total billed charges 5.18 5.18 fee schedule 5.18 5.18 fee schedule 5.18 5.18 fee schedule 5.18 22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Creat Clear 24 Hr (Crcl) PX-300825750 CDM 82575 CPT 0301 RC outpatient 122 122 25.34 25.34 fee schedule 122 93 98.82 percent of total billed charges 9.46 9.46 fee schedule 9.46 9.46 fee schedule 9.46 9.46 fee schedule 9.46 122 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cryoglobulin (Cry) PX-300825950 CDM 82595 CPT 0300 RC outpatient 86 86 17.36 17.36 fee schedule 86 93 69.66 percent of total billed charges 6.47 6.47 fee schedule 6.47 6.47 fee schedule 6.47 6.47 fee schedule 6.47 86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC B-12 (B12) PX-300826071 CDM 82607 CPT 0301 RC outpatient 195 195 40.44 40.44 fee schedule 195 93 157.95 percent of total billed charges 15.08 15.08 fee schedule 15.08 15.08 fee schedule 15.08 15.08 fee schedule 15.08 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cystatin C PX-300826100 CDM 82610 CPT 0300 RC outpatient 46.3 46.3 36.96 36.96 fee schedule 46.3 93 37.5 percent of total billed charges 18.52 18.52 fee schedule 18.52 18.52 fee schedule 18.52 18.52 fee schedule 18.52 46.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Dhea,Unconjugated (Dhea)" PX-300826260 CDM 82626 CPT 0300 RC outpatient 63.18 63.18 67.8 67.8 fee schedule 63.18 93 51.18 percent of total billed charges 25.27 25.27 fee schedule 25.27 25.27 fee schedule 25.27 25.27 fee schedule 25.27 67.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Dhea, Sulfate (Dheas)" PX-300826270 CDM 82627 CPT 0301 RC outpatient 78 78 59.65 59.65 fee schedule 78 93 63.18 percent of total billed charges 22.23 22.23 fee schedule 22.23 22.23 fee schedule 22.23 22.23 fee schedule 22.23 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vitamin D - Dihydroxy (Vitdd) PX-300826520 CDM 82652 CPT 0301 RC outpatient 366 366 103.26 103.26 fee schedule 366 93 296.46 percent of total billed charges 38.5 38.5 fee schedule 38.5 38.5 fee schedule 38.5 38.5 fee schedule 38.5 366 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Erthropoietin (Erytp) PX-300826680 CDM 82668 CPT 0301 RC outpatient 208 208 46.68 46.68 fee schedule 208 93 168.48 percent of total billed charges 18.79 18.79 fee schedule 18.79 18.79 fee schedule 18.79 18.79 fee schedule 18.79 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Estradiol PX-300826700 CDM 82670 CPT 0300 RC outpatient 366 366 74.96 74.96 fee schedule 366 93 296.46 percent of total billed charges 27.94 27.94 fee schedule 27.94 27.94 fee schedule 27.94 27.94 fee schedule 27.94 366 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Estrone PX-300826790 CDM 82679 CPT 0300 RC outpatient 62.38 62.38 66.97 66.97 fee schedule 62.38 93 50.53 percent of total billed charges 24.95 24.95 fee schedule 24.95 24.95 fee schedule 24.95 24.95 fee schedule 24.95 66.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Assay of Direct Measurement Free Estradiol PX-300826810 CDM 82681 CPT 0300 RC outpatient 69.85 69.85 65.94 65.94 fee schedule 69.85 93 56.58 percent of total billed charges 27.94 27.94 fee schedule 27.94 27.94 fee schedule 27.94 27.94 fee schedule 27.94 69.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Long Chain Fatty Acids PX-300827260 CDM 82726 CPT 0300 RC outpatient 49.37 49.37 48.44 48.44 fee schedule 49.37 93 39.99 percent of total billed charges 19.75 19.75 fee schedule 19.75 19.75 fee schedule 19.75 19.75 fee schedule 19.75 49.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ferritin (Fer) PX-300827280 CDM 82728 CPT 0301 RC outpatient 170 170 36.54 36.54 fee schedule 170 93 137.7 percent of total billed charges 13.63 13.63 fee schedule 13.63 13.63 fee schedule 13.63 13.63 fee schedule 13.63 170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fetal Fibronectin (Ffn) PX-300827310 CDM 82731 CPT 0301 RC outpatient 231 231 172.78 172.78 fee schedule 231 93 187.11 percent of total billed charges 64.41 64.41 fee schedule 64.41 64.41 fee schedule 64.41 64.41 fee schedule 64.41 231 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Folic Acid (Fol) PX-300827460 CDM 82746 CPT 0300 RC outpatient 195 195 39.44 39.44 fee schedule 195 93 157.95 percent of total billed charges 14.7 14.7 fee schedule 14.7 14.7 fee schedule 14.7 14.7 fee schedule 14.7 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Assay of Folic Acid, RBC" PX-300827470 CDM 82747 CPT 0300 RC outpatient 60 60 46.21 46.21 fee schedule 60 93 48.6 percent of total billed charges 60 60 other OPPS APC 60 60 other OPPS APC 17.65 17.65 fee schedule 17.65 60 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Immunoglobulin Iga,Igd,Igc,Igm Each" PX-300827840 CDM 82784 CPT 0301 RC outpatient 51.14 51.14 24.94 24.94 fee schedule 51.14 93 41.42 percent of total billed charges 9.3 9.3 fee schedule 9.3 9.3 fee schedule 9.3 9.3 fee schedule 9.3 51.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ige (Ige) PX-300827850 CDM 82785 CPT 0301 RC outpatient 97 97 44.18 44.18 fee schedule 97 93 78.57 percent of total billed charges 16.46 16.46 fee schedule 16.46 16.46 fee schedule 16.46 16.46 fee schedule 16.46 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Igg Subglass (Iggs) PX-300827870 CDM 82787 CPT 0301 RC outpatient 28 28 21.5 21.5 fee schedule 28 93 22.68 percent of total billed charges 8.02 8.02 fee schedule 8.02 8.02 fee schedule 8.02 8.02 fee schedule 8.02 28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Rt Venous Bg-Analysis-Only (Abga) PX-300828000 CDM 82800 CPT 0300 RC outpatient 37 37 22.71 22.71 fee schedule 37 93 29.97 percent of total billed charges 11 11 fee schedule 11 11 fee schedule 11 11 fee schedule 11 37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Rt Blood Gas Analysis PX-300828030 CDM 82803 CPT 0300 RC outpatient 231 231 51.92 51.92 fee schedule 231 93 187.11 percent of total billed charges 26.07 26.07 fee schedule 26.07 26.07 fee schedule 26.07 26.07 fee schedule 26.07 231 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Gastrin (Gasn) PX-300829410 CDM 82941 CPT 0300 RC outpatient 44.07 44.07 47.31 47.31 fee schedule 44.07 93 35.7 percent of total billed charges 17.63 17.63 fee schedule 17.63 17.63 fee schedule 17.63 17.63 fee schedule 17.63 47.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Glucose Fluid PX-300829450 CDM 82945 CPT 0301 RC outpatient 48 48 10.52 10.52 fee schedule 48 93 38.88 percent of total billed charges 3.93 3.93 fee schedule 3.93 3.93 fee schedule 3.93 3.93 fee schedule 3.93 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Glucose Quantitative Blood PX-300829470 CDM 82947 CPT 0301 RC outpatient 23 23 10.52 10.52 fee schedule 23 93 18.63 percent of total billed charges 3.93 3.93 fee schedule 3.93 3.93 fee schedule 3.93 3.93 fee schedule 3.93 23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Glucose, Post Gluc. Dose(Includes Gluc)" PX-300829500 CDM 82950 CPT 0300 RC outpatient 61 61 12.75 12.75 fee schedule 61 93 49.41 percent of total billed charges 4.75 4.75 fee schedule 4.75 4.75 fee schedule 4.75 4.75 fee schedule 4.75 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Gluc. Challenge Screen (Gluc) PX-300829501 CDM 82950 CPT 0300 RC outpatient 61 61 12.75 12.75 fee schedule 61 93 49.41 percent of total billed charges 4.75 4.75 fee schedule 4.75 4.75 fee schedule 4.75 4.75 fee schedule 4.75 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Post Glucose Test PX-300829505 CDM 82952 CPT 0301 RC outpatient 37 37 7.72 7.72 fee schedule 37 93 29.97 percent of total billed charges 3.92 3.92 fee schedule 3.92 3.92 fee schedule 3.92 3.92 fee schedule 3.92 37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Glucose Tolerance Test 3 Specimens PX-300829511 CDM 82951 CPT 0300 RC outpatient 170 170 34.54 34.54 fee schedule 170 93 137.7 percent of total billed charges 12.87 12.87 fee schedule 12.87 12.87 fee schedule 12.87 12.87 fee schedule 12.87 170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC G6pd Quantitative (G6pdq) PX-300829550 CDM 82955 CPT 0300 RC outpatient 40.79 40.79 23.46 23.46 fee schedule 40.79 93 33.04 percent of total billed charges 9.7 9.7 fee schedule 9.7 9.7 fee schedule 9.7 9.7 fee schedule 9.7 40.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ggtp (Gt) PX-300829770 CDM 82977 CPT 0301 RC outpatient 86 86 19.32 19.32 fee schedule 86 93 69.66 percent of total billed charges 7.2 7.2 fee schedule 7.2 7.2 fee schedule 7.2 7.2 fee schedule 7.2 86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Fructosamine, Serum" PX-300829850 CDM 82985 CPT 0301 RC outpatient 53 53 40.44 40.44 fee schedule 53 93 42.93 percent of total billed charges 16.76 16.76 fee schedule 16.76 16.76 fee schedule 16.76 16.76 fee schedule 16.76 53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fsh (Fsh) PX-300830010 CDM 83001 CPT 0301 RC outpatient 243 243 49.86 49.86 fee schedule 243 93 196.83 percent of total billed charges 18.58 18.58 fee schedule 18.58 18.58 fee schedule 18.58 18.58 fee schedule 18.58 243 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Lh (Lh) PX-300830021 CDM 83002 CPT 0301 RC outpatient 243 243 49.69 49.69 fee schedule 243 93 196.83 percent of total billed charges 18.52 18.52 fee schedule 18.52 18.52 fee schedule 18.52 18.52 fee schedule 18.52 243 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Haptoglobin, Bld. (Hap)" PX-300830100 CDM 83010 CPT 0300 RC outpatient 158 158 33.75 33.75 fee schedule 158 93 127.98 percent of total billed charges 12.58 12.58 fee schedule 12.58 12.58 fee schedule 12.58 12.58 fee schedule 12.58 158 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC H. Pylori Urea Breath Test (Ubt) PX-300830130 CDM 83013 CPT 0301 RC outpatient 229 229 180.69 180.69 fee schedule 229 93 185.49 percent of total billed charges 67.36 67.36 fee schedule 67.36 67.36 fee schedule 67.36 67.36 fee schedule 67.36 229 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Heavy Metal Quantitative Each PX-300830180 CDM 83018 CPT 0300 RC outpatient 75 75 58.91 58.91 fee schedule 75 93 60.75 percent of total billed charges 21.96 21.96 fee schedule 21.96 21.96 fee schedule 21.96 21.96 fee schedule 21.96 75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hgb Investigation (Hin)(Helec) PX-300830200 CDM 83020 CPT 0300 RC outpatient 170 170 34.54 34.54 fee schedule 170 93 137.7 percent of total billed charges 12.87 12.87 fee schedule 12.87 12.87 fee schedule 12.87 12.87 fee schedule 12.87 170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hemoglobin F Fetal Qualitative PX-300830330 CDM 83033 CPT 0300 RC outpatient 20 20 15.48 15.48 fee schedule 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 8 8 fee schedule 8 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hemoglobin A1c (A1c) PX-300830360 CDM 83036 CPT 0301 RC outpatient 122 122 26.04 26.04 fee schedule 122 93 98.82 percent of total billed charges 9.71 9.71 fee schedule 9.71 9.71 fee schedule 9.71 9.71 fee schedule 9.71 122 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Plasma Hgb (Phgb) PX-300830510 CDM 83051 CPT 0300 RC outpatient 18.27 18.27 19.6 19.6 fee schedule 18.27 93 14.8 percent of total billed charges 7.31 7.31 fee schedule 7.31 7.31 fee schedule 7.31 7.31 fee schedule 7.31 19.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Assay of Histamine PX-300830880 CDM 83088 CPT 0300 RC outpatient 73.83 73.83 79.22 79.22 fee schedule 73.83 93 59.8 percent of total billed charges 29.53 29.53 fee schedule 29.53 29.53 fee schedule 29.53 29.53 fee schedule 29.53 79.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Homocysteine, Tl Plasma (Hcp)" PX-300830900 CDM 83090 CPT 0301 RC outpatient 329 329 45.25 45.25 fee schedule 329 93 266.49 percent of total billed charges 17.92 17.92 fee schedule 17.92 17.92 fee schedule 17.92 17.92 fee schedule 17.92 329 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC 5-Hiaa (Hiaa) PX-300834970 CDM 83497 CPT 0301 RC outpatient 170 170 34.58 34.58 fee schedule 170 93 137.7 percent of total billed charges 12.9 12.9 fee schedule 12.9 12.9 fee schedule 12.9 12.9 fee schedule 12.9 170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC 17 Hydroxy Progesterone (17hpg) PX-300834980 CDM 83498 CPT 0301 RC outpatient 195 195 72.86 72.86 fee schedule 195 93 157.95 percent of total billed charges 27.17 27.17 fee schedule 27.17 27.17 fee schedule 27.17 27.17 fee schedule 27.17 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Immunoassay,Non Infectious Disease;Multi, Step" PX-300835160 CDM 83516 CPT 0301 RC outpatient 40 40 29.55 29.55 fee schedule 40 93 32.4 percent of total billed charges 11.53 11.53 fee schedule 11.53 11.53 fee schedule 11.53 11.53 fee schedule 11.53 40 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Immunoassay Analyte Quantitative by Radioimmunoassay PX-300835190 CDM 83519 CPT 0300 RC outpatient 94 94 36.25 36.25 fee schedule 94 93 76.14 percent of total billed charges 18.4 18.4 fee schedule 18.4 18.4 fee schedule 18.4 18.4 fee schedule 18.4 94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Acetycholine Receptor Ab (Aceab) PX-300835192 CDM 83519 CPT 0300 RC outpatient 94 94 36.25 36.25 fee schedule 94 93 76.14 percent of total billed charges 18.4 18.4 fee schedule 18.4 18.4 fee schedule 18.4 18.4 fee schedule 18.4 94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Methotrexate, Serum" PX-300835200 CDM 80204 CPT 0300 RC outpatient 96.42 96.42 91.03 91.03 fee schedule 96.42 93 78.1 percent of total billed charges 96.42 96.42 other OPPS APC 96.42 96.42 other OPPS APC 38.57 38.57 fee schedule 38.57 96.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tryptase (Trypt) PX-300835204 CDM 83520 CPT 0300 RC outpatient 78.67 78.67 34.73 34.73 fee schedule 78.67 93 63.72 percent of total billed charges 17.27 17.27 fee schedule 17.27 17.27 fee schedule 17.27 17.27 fee schedule 17.27 78.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Glom.Basement Ab (Agbm) PX-300835207 CDM 83520 CPT 0300 RC outpatient 243 243 34.73 34.73 fee schedule 243 93 196.83 percent of total billed charges 17.27 17.27 fee schedule 17.27 17.27 fee schedule 17.27 17.27 fee schedule 17.27 243 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Immunoassay for Analyte, Quantitative Not Specified" PX-300835210 CDM 83520 CPT 0300 RC outpatient 243 243 34.73 34.73 fee schedule 243 93 196.83 percent of total billed charges 17.27 17.27 fee schedule 17.27 17.27 fee schedule 17.27 17.27 fee schedule 17.27 243 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Thyrotropin Receptor Antibody,Serum" PX-300835216 CDM 83520 CPT 0300 RC outpatient 243 243 34.73 34.73 fee schedule 243 93 196.83 percent of total billed charges 17.27 17.27 fee schedule 17.27 17.27 fee schedule 17.27 17.27 fee schedule 17.27 243 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Pancreatic Elastase, Feces" PX-300835220 CDM 83520 CPT 0300 RC outpatient 243 243 34.73 34.73 fee schedule 243 93 196.83 percent of total billed charges 17.27 17.27 fee schedule 17.27 17.27 fee schedule 17.27 17.27 fee schedule 17.27 243 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Phospho Tau 217 PX-300835223 CDM 83520 CPT 0300 RC outpatient 43.17 43.17 34.73 34.73 fee schedule 43.17 93 34.97 percent of total billed charges 17.27 17.27 fee schedule 17.27 17.27 fee schedule 17.27 17.27 fee schedule 17.27 43.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Insulin (Inln) PX-300835250 CDM 83525 CPT 0301 RC outpatient 146 146 30.68 30.68 fee schedule 146 93 118.26 percent of total billed charges 11.43 11.43 fee schedule 11.43 11.43 fee schedule 11.43 11.43 fee schedule 11.43 146 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Iron,Serum (Fee)" PX-300835400 CDM 83540 CPT 0301 RC outpatient 86 86 17.38 17.38 fee schedule 86 93 69.66 percent of total billed charges 6.47 6.47 fee schedule 6.47 6.47 fee schedule 6.47 6.47 fee schedule 6.47 86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Lactic Acid (Lact) PX-300836050 CDM 83605 CPT 0301 RC outpatient 135 135 28.65 28.65 fee schedule 135 93 109.35 percent of total billed charges 11.57 11.57 fee schedule 11.57 11.57 fee schedule 11.57 11.57 fee schedule 11.57 135 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ldh PX-300836150 CDM 83615 CPT 0301 RC outpatient 73 73 16.2 16.2 fee schedule 73 93 59.13 percent of total billed charges 6.04 6.04 fee schedule 6.04 6.04 fee schedule 6.04 6.04 fee schedule 6.04 73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fecal Lactoferrin PX-300836300 CDM 83630 CPT 0300 RC outpatient 75.33 75.33 29.55 29.55 fee schedule 75.33 93 61.02 percent of total billed charges 19.7 19.7 fee schedule 19.7 19.7 fee schedule 19.7 19.7 fee schedule 19.7 75.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Lead PX-300836550 CDM 83655 CPT 0301 RC outpatient 36.19 36.19 32.47 32.47 fee schedule 36.19 93 29.31 percent of total billed charges 12.11 12.11 fee schedule 12.11 12.11 fee schedule 12.11 12.11 fee schedule 12.11 36.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Lipase, Serum (Lpse)" PX-300836900 CDM 83690 CPT 0301 RC outpatient 86 86 18.47 18.47 fee schedule 86 93 69.66 percent of total billed charges 6.89 6.89 fee schedule 6.89 6.89 fee schedule 6.89 6.89 fee schedule 6.89 86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Lipoprotein a (Lpa) PX-300836950 CDM 83695 CPT 0300 RC outpatient 35.8 35.8 35.21 35.21 fee schedule 35.8 93 29 percent of total billed charges 14.32 14.32 fee schedule 14.32 14.32 fee schedule 14.32 14.32 fee schedule 14.32 35.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Assay Lipoprotein Pla2 PX-300836980 CDM 83698 CPT 0300 RC outpatient 115.77 115.77 92.31 92.31 fee schedule 115.77 93 93.77 percent of total billed charges 46.31 46.31 fee schedule 46.31 46.31 fee schedule 46.31 46.31 fee schedule 46.31 115.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Chg Lipoprotein, Blood,by Nmr Spect" PX-300837040 CDM 83704 CPT 0300 RC outpatient 85.47 85.47 85.8 85.8 fee schedule 85.47 93 69.23 percent of total billed charges 34.19 34.19 fee schedule 34.19 34.19 fee schedule 34.19 34.19 fee schedule 34.19 85.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hdl Cholesterol (Hdl) PX-300837181 CDM 83718 CPT 0300 RC outpatient 110 110 21.96 21.96 fee schedule 110 93 89.1 percent of total billed charges 8.19 8.19 fee schedule 8.19 8.19 fee schedule 8.19 8.19 fee schedule 8.19 110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Direct Low Density Lipoprotein PX-300837210 CDM 83721 CPT 0300 RC outpatient 110 110 25.59 25.59 fee schedule 110 93 89.1 percent of total billed charges 10.5 10.5 fee schedule 10.5 10.5 fee schedule 10.5 10.5 fee schedule 10.5 110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Magnesium PX-300837350 CDM 83735 CPT 0301 RC outpatient 86 86 17.97 17.97 fee schedule 86 93 69.66 percent of total billed charges 6.7 6.7 fee schedule 6.7 6.7 fee schedule 6.7 6.7 fee schedule 6.7 86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Assay of Manganese PX-300837850 CDM 83785 CPT 0300 RC outpatient 69.87 69.87 56.66 56.66 fee schedule 69.87 93 56.59 percent of total billed charges 26.65 26.65 fee schedule 26.65 26.65 fee schedule 26.65 26.65 fee schedule 26.65 69.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mass Spectrometry & Tandem Mass Spectr Non Drug Analytes Not Spec. PX-300837890 CDM 83789 CPT 0300 RC outpatient 65 65 48.44 48.44 fee schedule 65 93 52.65 percent of total billed charges 24.11 24.11 fee schedule 24.11 24.11 fee schedule 24.11 24.11 fee schedule 24.11 65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mercury (Hgu) PX-300838250 CDM 83825 CPT 0300 RC outpatient 40.7 40.7 43.62 43.62 fee schedule 40.7 93 32.97 percent of total billed charges 16.26 16.26 fee schedule 16.26 16.26 fee schedule 16.26 16.26 fee schedule 16.26 43.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Metanephrines PX-300838350 CDM 83835 CPT 0301 RC outpatient 62 62 45.45 45.45 fee schedule 62 93 50.22 percent of total billed charges 16.94 16.94 fee schedule 16.94 16.94 fee schedule 16.94 16.94 fee schedule 16.94 62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Myoglobin PX-300838740 CDM 83874 CPT 0301 RC outpatient 170 170 34.64 34.64 fee schedule 170 93 137.7 percent of total billed charges 12.92 12.92 fee schedule 12.92 12.92 fee schedule 12.92 12.92 fee schedule 12.92 170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC B Type Naturiuretic Peptide PX-300838800 CDM 83880 CPT 0301 RC outpatient 98.15 98.15 91.07 91.07 fee schedule 98.15 93 79.5 percent of total billed charges 39.26 39.26 fee schedule 39.26 39.26 fee schedule 39.26 39.26 fee schedule 39.26 98.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Nephelometry, Ea Analyte Not Elsewhere Specified" PX-300838830 CDM 83883 CPT 0300 RC outpatient 50 50 36.48 36.48 fee schedule 50 93 40.5 percent of total billed charges 13.6 13.6 fee schedule 13.6 13.6 fee schedule 13.6 13.6 fee schedule 13.6 50 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Oligoclonal Immune(Oligoclonal Bands) PX-300839160 CDM 83916 CPT 0300 RC outpatient 78 78 53.93 53.93 fee schedule 78 93 63.18 percent of total billed charges 27.39 27.39 fee schedule 27.39 27.39 fee schedule 27.39 27.39 fee schedule 27.39 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Organic Acids Total Quant PX-300839180 CDM 83918 CPT 0300 RC outpatient 59 59 44.16 44.16 fee schedule 59 93 47.79 percent of total billed charges 23.6 23.6 fee schedule 23.6 23.6 fee schedule 23.6 23.6 fee schedule 23.6 59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Methylalonic Acid, Serum(Mmas)" PX-300839210 CDM 83921 CPT 0301 RC outpatient 71 71 44.16 44.16 fee schedule 71 93 57.51 percent of total billed charges 21.21 21.21 fee schedule 21.21 21.21 fee schedule 21.21 21.21 fee schedule 21.21 71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Serum Osmolality (Osm) PX-300839300 CDM 83930 CPT 0300 RC outpatient 86 86 17.22 17.22 fee schedule 86 93 69.66 percent of total billed charges 6.61 6.61 fee schedule 6.61 6.61 fee schedule 6.61 6.61 fee schedule 6.61 86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Osmolality,Urine (Uosm)" PX-300839350 CDM 83935 CPT 0300 RC outpatient 86 86 18.28 18.28 fee schedule 86 93 69.66 percent of total billed charges 6.82 6.82 fee schedule 6.82 6.82 fee schedule 6.82 6.82 fee schedule 6.82 86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Ca Oxalate, Urine (Oxu)" PX-300839450 CDM 83945 CPT 0300 RC outpatient 36.12 36.12 34.54 34.54 fee schedule 36.12 93 29.26 percent of total billed charges 14.45 14.45 fee schedule 14.45 14.45 fee schedule 14.45 14.45 fee schedule 14.45 36.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Parathormone PX-300839700 CDM 83970 CPT 0300 RC outpatient 103.2 103.2 110.73 110.73 fee schedule 103.2 93 83.59 percent of total billed charges 41.28 41.28 fee schedule 41.28 41.28 fee schedule 41.28 41.28 fee schedule 41.28 110.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Ph, Body Fluid, Except Blood" PX-300839860 CDM 83986 CPT 0301 RC outpatient 24 24 7.97 7.97 fee schedule 24 93 19.44 percent of total billed charges 3.58 3.58 fee schedule 3.58 3.58 fee schedule 3.58 3.58 fee schedule 3.58 24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Calprotectin, Fecal" PX-300839930 CDM 83993 CPT 0301 RC outpatient 70 70 53.38 53.38 fee schedule 70 93 56.7 percent of total billed charges 19.63 19.63 fee schedule 19.63 19.63 fee schedule 19.63 19.63 fee schedule 19.63 70 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Alk Phosphatase (Alkp) PX-300840750 CDM 84075 CPT 0301 RC outpatient 61 61 13.88 13.88 fee schedule 61 93 49.41 percent of total billed charges 5.18 5.18 fee schedule 5.18 5.18 fee schedule 5.18 5.18 fee schedule 5.18 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Alkaline Phos. Isoenzymes (Apiso) PX-300840800 CDM 84080 CPT 0300 RC outpatient 52 52 39.67 39.67 fee schedule 52 93 42.12 percent of total billed charges 14.78 14.78 fee schedule 14.78 14.78 fee schedule 14.78 14.78 fee schedule 14.78 52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Phosphorus Inorganic (Phosphate) PX-300841000 CDM 84100 CPT 0301 RC outpatient 61 61 12.73 12.73 fee schedule 61 93 49.41 percent of total billed charges 4.74 4.74 fee schedule 4.74 4.74 fee schedule 4.74 4.74 fee schedule 4.74 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Phosphorus, Urine 24hr." PX-300841050 CDM 84105 CPT 0300 RC outpatient 14.45 14.45 13.88 13.88 fee schedule 14.45 93 11.7 percent of total billed charges 5.78 5.78 fee schedule 5.78 5.78 fee schedule 5.78 5.78 fee schedule 5.78 14.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Porphyrins, Urine, Quantification, Fractionation" PX-300841200 CDM 84120 CPT 0300 RC outpatient 36.77 36.77 39.46 39.46 fee schedule 36.77 93 29.78 percent of total billed charges 14.71 14.71 fee schedule 14.71 14.71 fee schedule 14.71 14.71 fee schedule 14.71 39.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Potassium (K) PX-300841320 CDM 84132 CPT 0301 RC outpatient 61 61 12.33 12.33 fee schedule 61 93 49.41 percent of total billed charges 4.76 4.76 fee schedule 4.76 4.76 fee schedule 4.76 4.76 fee schedule 4.76 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Potassium Urine PX-300841330 CDM 84133 CPT 0301 RC outpatient 61 61 11.54 11.54 fee schedule 61 93 49.41 percent of total billed charges 4.73 4.73 fee schedule 4.73 4.73 fee schedule 4.73 4.73 fee schedule 4.73 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pre-Albumin PX-300841340 CDM 84134 CPT 0300 RC outpatient 195 195 39.13 39.13 fee schedule 195 93 157.95 percent of total billed charges 14.59 14.59 fee schedule 14.59 14.59 fee schedule 14.59 14.59 fee schedule 14.59 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Progesterone (Prog) PX-300841440 CDM 84144 CPT 0300 RC outpatient 269 269 55.97 55.97 fee schedule 269 93 217.89 percent of total billed charges 20.86 20.86 fee schedule 20.86 20.86 fee schedule 20.86 20.86 fee schedule 20.86 269 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Procalcitonin (Pct) PX-300841450 CDM 84145 CPT 0300 RC outpatient 68 68 72.83 72.83 fee schedule 68 93 55.08 percent of total billed charges 27.22 27.22 fee schedule 27.22 27.22 fee schedule 27.22 27.22 fee schedule 27.22 72.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Prolactin (Prol) PX-300841460 CDM 84146 CPT 0300 RC outpatient 256 256 51.99 51.99 fee schedule 256 93 207.36 percent of total billed charges 19.38 19.38 fee schedule 19.38 19.38 fee schedule 19.38 19.38 fee schedule 19.38 256 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Prolactin, Diluted" PX-300841461 CDM 84146 CPT 0300 RC outpatient 256 256 51.99 51.99 fee schedule 256 93 207.36 percent of total billed charges 19.38 19.38 fee schedule 19.38 19.38 fee schedule 19.38 19.38 fee schedule 19.38 256 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Psa Total PX-300841530 CDM 84153 CPT 0301 RC outpatient 78 78 49.34 49.34 fee schedule 78 93 63.18 percent of total billed charges 18.39 18.39 fee schedule 18.39 18.39 fee schedule 18.39 18.39 fee schedule 18.39 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Free Psa PX-300841540 CDM 84154 CPT 0301 RC outpatient 78 78 49.34 49.34 fee schedule 78 93 63.18 percent of total billed charges 18.39 18.39 fee schedule 18.39 18.39 fee schedule 18.39 18.39 fee schedule 18.39 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Protein (Tp) PX-300841551 CDM 84155 CPT 0301 RC outpatient 15 15 9.83 9.83 fee schedule 15 93 12.15 percent of total billed charges 3.67 3.67 fee schedule 3.67 3.67 fee schedule 3.67 3.67 fee schedule 3.67 15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Protein Total Urine PX-300841560 CDM 84156 CPT 0301 RC outpatient 46 46 9.83 9.83 fee schedule 46 93 37.26 percent of total billed charges 3.67 3.67 fee schedule 3.67 3.67 fee schedule 3.67 3.67 fee schedule 3.67 46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fluid T. Protein (Fpro) PX-300841570 CDM 84157 CPT 0301 RC outpatient 48 48 9.83 9.83 fee schedule 48 93 38.88 percent of total billed charges 4 4 fee schedule 4 4 fee schedule 4 4 fee schedule 4 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fluid T. Protein (Fpro) PX-300841571 CDM 84157 CPT 0300 RC outpatient 48 48 9.83 9.83 fee schedule 48 93 38.88 percent of total billed charges 4 4 fee schedule 4 4 fee schedule 4 4 fee schedule 4 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Protein E'phores (Pe) PX-300841650 CDM 84165 CPT 0300 RC outpatient 46 46 28.82 28.82 fee schedule 46 93 37.26 percent of total billed charges 10.74 10.74 fee schedule 10.74 10.74 fee schedule 10.74 10.74 fee schedule 10.74 46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Protein Electrophoretic, Othe Fluids" PX-300841660 CDM 84166 CPT 0301 RC outpatient 75 75 47.85 47.85 fee schedule 75 93 60.75 percent of total billed charges 17.83 17.83 fee schedule 17.83 17.83 fee schedule 17.83 17.83 fee schedule 17.83 75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Protein Westrn Blot I&R Blood/Other Fluid PX-300841810 CDM 84181 CPT 0300 RC outpatient 42.57 42.57 45.7 45.7 fee schedule 42.57 93 34.48 percent of total billed charges 17.03 17.03 fee schedule 17.03 17.03 fee schedule 17.03 17.03 fee schedule 17.03 45.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Western Blot W/Interp and Report;Blood/Other Fluid PX-300841820 CDM 84182 CPT 0300 RC outpatient 73.02 73.02 48.29 48.29 fee schedule 73.02 93 59.15 percent of total billed charges 29.21 29.21 fee schedule 29.21 29.21 fee schedule 29.21 29.21 fee schedule 29.21 73.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pyridoxal Phosphate (Vitamin B6) PX-300842070 CDM 84207 CPT 0301 RC outpatient 399 399 75.36 75.36 fee schedule 399 93 323.19 percent of total billed charges 28.1 28.1 fee schedule 28.1 28.1 fee schedule 28.1 28.1 fee schedule 28.1 399 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Soluble Transferrin Receptor PX-300842380 CDM 84238 CPT 0300 RC outpatient 91.42 91.42 98.09 98.09 fee schedule 91.42 93 74.05 percent of total billed charges 36.57 36.57 fee schedule 36.57 36.57 fee schedule 36.57 36.57 fee schedule 36.57 98.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Renin (Ren) PX-300842440 CDM 84244 CPT 0301 RC outpatient 280 280 59 59 fee schedule 280 93 226.8 percent of total billed charges 21.99 21.99 fee schedule 21.99 21.99 fee schedule 21.99 21.99 fee schedule 21.99 280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Selenium PX-300842550 CDM 84255 CPT 0300 RC outpatient 63.83 63.83 68.49 68.49 fee schedule 63.83 93 51.7 percent of total billed charges 25.53 25.53 fee schedule 25.53 25.53 fee schedule 25.53 25.53 fee schedule 25.53 68.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Serotonin,Blood (Srtnb)" PX-300842600 CDM 84260 CPT 0300 RC outpatient 77.45 77.45 83.1 83.1 fee schedule 77.45 93 62.73 percent of total billed charges 30.98 30.98 fee schedule 30.98 30.98 fee schedule 30.98 30.98 fee schedule 30.98 83.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sex Hormone Binding Globulin (Shbg) PX-300842700 CDM 84270 CPT 0301 RC outpatient 137 137 52.92 52.92 fee schedule 137 93 110.97 percent of total billed charges 21.73 21.73 fee schedule 21.73 21.73 fee schedule 21.73 21.73 fee schedule 21.73 137 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sodium (Na) PX-300842950 CDM 84295 CPT 0301 RC outpatient 61 61 12.9 12.9 fee schedule 61 93 49.41 percent of total billed charges 4.81 4.81 fee schedule 4.81 4.81 fee schedule 4.81 4.81 fee schedule 4.81 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sodium Urine PX-300843000 CDM 84300 CPT 0301 RC outpatient 61 61 12.48 12.48 fee schedule 61 93 49.41 percent of total billed charges 5.06 5.06 fee schedule 5.06 5.06 fee schedule 5.06 5.06 fee schedule 5.06 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Somatomedin C (Somc) PX-300843050 CDM 84305 CPT 0300 RC outpatient 70 70 46.66 46.66 fee schedule 70 93 56.7 percent of total billed charges 21.26 21.26 fee schedule 21.26 21.26 fee schedule 21.26 21.26 fee schedule 21.26 70 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Spectophototometry, Analyte" PX-300843110 CDM 84311 CPT 0300 RC outpatient 25 25 18.76 18.76 fee schedule 25 93 20.25 percent of total billed charges 8.1 8.1 fee schedule 8.1 8.1 fee schedule 8.1 8.1 fee schedule 8.1 25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Testoserone, Free" PX-300844020 CDM 84402 CPT 0300 RC outpatient 329 329 68.29 68.29 fee schedule 329 93 266.49 percent of total billed charges 25.47 25.47 fee schedule 25.47 25.47 fee schedule 25.47 25.47 fee schedule 25.47 329 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Testosterone (Tes) PX-300844030 CDM 84403 CPT 0300 RC outpatient 329 329 69.27 69.27 fee schedule 329 93 266.49 percent of total billed charges 25.81 25.81 fee schedule 25.81 25.81 fee schedule 25.81 25.81 fee schedule 25.81 329 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vitamin B-1 (Vitb1) PX-300844250 CDM 84425 CPT 0301 RC outpatient 225 225 56.97 56.97 fee schedule 225 93 182.25 percent of total billed charges 21.23 21.23 fee schedule 21.23 21.23 fee schedule 21.23 21.23 fee schedule 21.23 225 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Thyroglobulin (Tg) PX-300844320 CDM 84432 CPT 0301 RC outpatient 68 68 43.08 43.08 fee schedule 68 93 55.08 percent of total billed charges 16.06 16.06 fee schedule 16.06 16.06 fee schedule 16.06 16.06 fee schedule 16.06 68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Asy Thiopurin S-Mthyltrnsfrs PX-300844330 CDM 84433 CPT 0300 RC outpatient 55.42 55.42 52.32 52.32 fee schedule 55.42 93 44.89 percent of total billed charges 22.17 22.17 fee schedule 22.17 22.17 fee schedule 22.17 22.17 fee schedule 22.17 55.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Newborn Screen One(Nbscr1) PX-300844370 CDM 84437 CPT 0300 RC outpatient 16.18 16.18 17.36 17.36 fee schedule 16.18 93 13.11 percent of total billed charges 6.47 6.47 fee schedule 6.47 6.47 fee schedule 6.47 6.47 fee schedule 6.47 17.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Thyroxine Free PX-300844390 CDM 84439 CPT 0301 RC outpatient 110 110 24.19 24.19 fee schedule 110 93 89.1 percent of total billed charges 9.02 9.02 fee schedule 9.02 9.02 fee schedule 9.02 9.02 fee schedule 9.02 110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tsh PX-300844430 CDM 84443 CPT 0300 RC outpatient 208 208 45.06 45.06 fee schedule 208 93 168.48 percent of total billed charges 16.8 16.8 fee schedule 16.8 16.8 fee schedule 16.8 16.8 fee schedule 16.8 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Thyroid Stimulating Ig (Tsig) PX-300844450 CDM 84445 CPT 0301 RC outpatient 722 722 136.42 136.42 fee schedule 722 93 584.82 percent of total billed charges 50.86 50.86 fee schedule 50.86 50.86 fee schedule 50.86 50.86 fee schedule 50.86 722 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vitamin E (Vite) PX-300844460 CDM 84446 CPT 0301 RC outpatient 50 50 38.04 38.04 fee schedule 50 93 40.5 percent of total billed charges 14.18 14.18 fee schedule 14.18 14.18 fee schedule 14.18 14.18 fee schedule 14.18 50 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ast (Sgot) PX-300844500 CDM 84450 CPT 0301 RC outpatient 73 73 13.86 13.86 fee schedule 73 93 59.13 percent of total billed charges 5.18 5.18 fee schedule 5.18 5.18 fee schedule 5.18 5.18 fee schedule 5.18 73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Alt (Sgpt) PX-300844600 CDM 84460 CPT 0301 RC outpatient 73 73 14.21 14.21 fee schedule 73 93 59.13 percent of total billed charges 5.3 5.3 fee schedule 5.3 5.3 fee schedule 5.3 5.3 fee schedule 5.3 73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Transferrin (Tranf) PX-300844660 CDM 84466 CPT 0301 RC outpatient 170 170 28.67 28.67 fee schedule 170 93 137.7 percent of total billed charges 12.76 12.76 fee schedule 12.76 12.76 fee schedule 12.76 12.76 fee schedule 12.76 170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Triglycerides PX-300844780 CDM 84478 CPT 0301 RC outpatient 21 21 15.44 15.44 fee schedule 21 93 17.01 percent of total billed charges 5.74 5.74 fee schedule 5.74 5.74 fee schedule 5.74 5.74 fee schedule 5.74 21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC T3 by Ria (T3r) PX-300844800 CDM 84480 CPT 0300 RC outpatient 135 135 38.04 38.04 fee schedule 135 93 109.35 percent of total billed charges 14.18 14.18 fee schedule 14.18 14.18 fee schedule 14.18 14.18 fee schedule 14.18 135 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Free T3 (Ft3) PX-300844810 CDM 84481 CPT 0300 RC outpatient 219 219 45.45 45.45 fee schedule 219 93 177.39 percent of total billed charges 16.94 16.94 fee schedule 16.94 16.94 fee schedule 16.94 16.94 fee schedule 16.94 219 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Triodothyronine T3, Reverse" PX-300844820 CDM 84482 CPT 0300 RC outpatient 39.4 39.4 42.28 42.28 fee schedule 39.4 93 31.91 percent of total billed charges 15.76 15.76 fee schedule 15.76 15.76 fee schedule 15.76 15.76 fee schedule 15.76 42.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Troponin-I(Tni) PX-300844840 CDM 84484 CPT 0301 RC outpatient 110 110 23.37 23.37 fee schedule 110 93 89.1 percent of total billed charges 12.47 12.47 fee schedule 12.47 12.47 fee schedule 12.47 12.47 fee schedule 12.47 110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bun (Bun) PX-300845200 CDM 84520 CPT 0301 RC outpatient 48 48 10.58 10.58 fee schedule 48 93 38.88 percent of total billed charges 3.95 3.95 fee schedule 3.95 3.95 fee schedule 3.95 3.95 fee schedule 3.95 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Urea Nitrogen Random PX-300845400 CDM 84540 CPT 0301 RC outpatient 70 70 12.75 12.75 fee schedule 70 93 56.7 percent of total billed charges 5.56 5.56 fee schedule 5.56 5.56 fee schedule 5.56 5.56 fee schedule 5.56 70 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Uric Acid (Uric) PX-300845500 CDM 84550 CPT 0301 RC outpatient 61 61 12.12 12.12 fee schedule 61 93 49.41 percent of total billed charges 4.52 4.52 fee schedule 4.52 4.52 fee schedule 4.52 4.52 fee schedule 4.52 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Uric Acid Other Source PX-300845600 CDM 84560 CPT 0300 RC outpatient 12.7 12.7 9.27 9.27 fee schedule 12.7 93 10.29 percent of total billed charges 5.08 5.08 fee schedule 5.08 5.08 fee schedule 5.08 5.08 fee schedule 5.08 12.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vas Ints Polypeptide (Vip) PX-300845860 CDM 84586 CPT 0300 RC outpatient 88.32 88.32 94.79 94.79 fee schedule 88.32 93 71.54 percent of total billed charges 35.33 35.33 fee schedule 35.33 35.33 fee schedule 35.33 35.33 fee schedule 35.33 94.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vitamin a (Vita) PX-300845900 CDM 84590 CPT 0301 RC outpatient 40 40 31.1 31.1 fee schedule 40 93 32.4 percent of total billed charges 11.61 11.61 fee schedule 11.61 11.61 fee schedule 11.61 11.61 fee schedule 11.61 40 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Zinc PX-300846300 CDM 84630 CPT 0301 RC outpatient 97 97 27.96 27.96 fee schedule 97 93 78.57 percent of total billed charges 11.39 11.39 fee schedule 11.39 11.39 fee schedule 11.39 11.39 fee schedule 11.39 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C-Peptide (Cpep) PX-300846810 CDM 84681 CPT 0301 RC outpatient 269 269 55.81 55.81 fee schedule 269 93 217.89 percent of total billed charges 20.81 20.81 fee schedule 20.81 20.81 fee schedule 20.81 20.81 fee schedule 20.81 269 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Gonadotropin, Chorionic(Hcg);Quantitative" PX-300847020 CDM 84702 CPT 0301 RC outpatient 183 183 38.92 38.92 fee schedule 183 93 148.23 percent of total billed charges 15.05 15.05 fee schedule 15.05 15.05 fee schedule 15.05 15.05 fee schedule 15.05 183 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Blood Count Automated Differential Wbc Count PX-300850040 CDM 85004 CPT 0300 RC outpatient 48.52 48.52 17.36 17.36 fee schedule 48.52 93 39.3 percent of total billed charges 6.47 6.47 fee schedule 6.47 6.47 fee schedule 6.47 6.47 fee schedule 6.47 48.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Manual Differential PX-300850070 CDM 85007 CPT 0300 RC outpatient 12 12 9.24 9.24 fee schedule 12 93 9.72 percent of total billed charges 3.8 3.8 fee schedule 3.8 3.8 fee schedule 3.8 3.8 fee schedule 3.8 12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hematocrit (Hct) PX-300850140 CDM 85014 CPT 0305 RC outpatient 25 25 6.36 6.36 fee schedule 25 93 20.25 percent of total billed charges 2.37 2.37 fee schedule 2.37 2.37 fee schedule 2.37 2.37 fee schedule 2.37 25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hemoglobin (Hgb) PX-300850180 CDM 85018 CPT 0305 RC outpatient 25 25 6.36 6.36 fee schedule 25 93 20.25 percent of total billed charges 2.37 2.37 fee schedule 2.37 2.37 fee schedule 2.37 2.37 fee schedule 2.37 25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cbc W/Diff (Cbcd) PX-300850250 CDM 85025 CPT 0305 RC outpatient 97 97 20.85 20.85 fee schedule 97 93 78.57 percent of total billed charges 7.77 7.77 fee schedule 7.77 7.77 fee schedule 7.77 7.77 fee schedule 7.77 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cbc (Cbc) PX-300850270 CDM 85027 CPT 0305 RC outpatient 73 73 17.36 17.36 fee schedule 73 93 59.13 percent of total billed charges 6.47 6.47 fee schedule 6.47 6.47 fee schedule 6.47 6.47 fee schedule 6.47 73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Reticulocyte CT (Ret) PX-300850450 CDM 85045 CPT 0305 RC outpatient 48 48 10.73 10.73 fee schedule 48 93 38.88 percent of total billed charges 3.99 3.99 fee schedule 3.99 3.99 fee schedule 3.99 3.99 fee schedule 3.99 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Blood Count Leukocyte Wbc Automated PX-300850480 CDM 85048 CPT 0300 RC outpatient 19.05 19.05 6.82 6.82 fee schedule 19.05 93 15.43 percent of total billed charges 19.05 19.05 other OPPS APC 19.05 19.05 other OPPS APC 2.54 2.54 fee schedule 2.54 19.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Platelet Count PX-300850490 CDM 85049 CPT 0305 RC outpatient 48 48 12 12 fee schedule 48 93 38.88 percent of total billed charges 4.48 4.48 fee schedule 4.48 4.48 fee schedule 4.48 4.48 fee schedule 4.48 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Factor VIII Antigen (F8ag) PX-300852400 CDM 85240 CPT 0305 RC outpatient 284 284 48.04 48.04 fee schedule 284 93 230.04 percent of total billed charges 17.9 17.9 fee schedule 17.9 17.9 fee schedule 17.9 17.9 fee schedule 17.9 284 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ristocetin Cofactor PX-300852450 CDM 85245 CPT 0300 RC outpatient 57.35 57.35 61.56 61.56 fee schedule 57.35 93 46.45 percent of total billed charges 22.94 22.94 fee schedule 22.94 22.94 fee schedule 22.94 22.94 fee schedule 22.94 61.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vonwillebrand Factor Ag PX-300852460 CDM 85246 CPT 0300 RC outpatient 57.35 57.35 61.56 61.56 fee schedule 57.35 93 46.45 percent of total billed charges 22.94 22.94 fee schedule 22.94 22.94 fee schedule 22.94 22.94 fee schedule 22.94 61.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Von Willebrand Factor PX-300852470 CDM 85247 CPT 0300 RC outpatient 57.35 57.35 61.56 61.56 fee schedule 57.35 93 46.45 percent of total billed charges 22.94 22.94 fee schedule 22.94 22.94 fee schedule 22.94 22.94 fee schedule 22.94 61.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Chg Antithrombin II Test, Activ" PX-300853000 CDM 85300 CPT 0305 RC outpatient 122 122 25.96 25.96 fee schedule 122 93 98.82 percent of total billed charges 11.85 11.85 fee schedule 11.85 11.85 fee schedule 11.85 11.85 fee schedule 11.85 122 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Protein C (Protc) PX-300853020 CDM 85302 CPT 0300 RC outpatient 43 43 32.26 32.26 fee schedule 43 93 34.83 percent of total billed charges 12.01 12.01 fee schedule 12.01 12.01 fee schedule 12.01 12.01 fee schedule 12.01 43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Chg Clot Inhib Protein C, Activ" PX-300853030 CDM 85303 CPT 0305 RC outpatient 231 231 37.09 37.09 fee schedule 231 93 187.11 percent of total billed charges 13.84 13.84 fee schedule 13.84 13.84 fee schedule 13.84 13.84 fee schedule 13.84 231 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Protein S Ag, Tl" PX-300853050 CDM 85305 CPT 0300 RC outpatient 42 42 31.1 31.1 fee schedule 42 93 34.02 percent of total billed charges 11.61 11.61 fee schedule 11.61 11.61 fee schedule 11.61 11.61 fee schedule 11.61 42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Protein S Free PX-300853060 CDM 85306 CPT 0305 RC outpatient 231 231 41.11 41.11 fee schedule 231 93 187.11 percent of total billed charges 15.32 15.32 fee schedule 15.32 15.32 fee schedule 15.32 15.32 fee schedule 15.32 231 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC D Dimer Quantitative PX-300853790 CDM 85379 CPT 0305 RC outpatient 146 146 21.72 21.72 fee schedule 146 93 118.26 percent of total billed charges 10.18 10.18 fee schedule 10.18 10.18 fee schedule 10.18 10.18 fee schedule 10.18 146 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fibrinogen Activity PX-300853840 CDM 85384 CPT 0305 RC outpatient 97 97 22.79 22.79 fee schedule 97 93 78.57 percent of total billed charges 9.72 9.72 fee schedule 9.72 9.72 fee schedule 9.72 9.72 fee schedule 9.72 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Factor VIII Profile (F8bat) PX-300853970 CDM 85397 CPT 0300 RC outpatient 77.15 77.15 62.4 62.4 fee schedule 77.15 93 62.49 percent of total billed charges 30.86 30.86 fee schedule 30.86 30.86 fee schedule 30.86 30.86 fee schedule 30.86 77.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fetaldex Screen (Fedxs) PX-300854600 CDM 85460 CPT 0305 RC outpatient 96 96 20.76 20.76 fee schedule 96 93 77.76 percent of total billed charges 7.73 7.73 fee schedule 7.73 7.73 fee schedule 7.73 7.73 fee schedule 7.73 96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Hemoglobin, Fetal, Rosette" PX-300854610 CDM 85461 CPT 0300 RC outpatient 62 62 17.78 17.78 fee schedule 62 93 50.22 percent of total billed charges 62 62 other OPPS APC 62 62 other OPPS APC 9.36 9.36 fee schedule 9.36 62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Heparin Assay PX-300855200 CDM 85520 CPT 0305 RC outpatient 45 45 35.12 35.12 fee schedule 45 93 36.45 percent of total billed charges 13.09 13.09 fee schedule 13.09 13.09 fee schedule 13.09 13.09 fee schedule 13.09 45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Muramidase PX-300855490 CDM 85549 CPT 0300 RC outpatient 46.95 46.95 38.94 38.94 fee schedule 46.95 93 38.03 percent of total billed charges 18.75 18.75 fee schedule 18.75 18.75 fee schedule 18.75 18.75 fee schedule 18.75 46.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Platelet Neutralization PX-300855970 CDM 85597 CPT 0305 RC outpatient 76 76 48.23 48.23 fee schedule 76 93 61.56 percent of total billed charges 17.98 17.98 fee schedule 17.98 17.98 fee schedule 17.98 17.98 fee schedule 17.98 76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Phospholipid, Hexagonal" PX-300855980 CDM 85598 CPT 0300 RC outpatient 70 70 48.88 48.88 fee schedule 70 93 56.7 percent of total billed charges 17.98 17.98 fee schedule 17.98 17.98 fee schedule 17.98 17.98 fee schedule 17.98 70 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Prothrombin Time (Prot)(Pros) PX-300856100 CDM 85610 CPT 0305 RC outpatient 48 48 10.54 10.54 fee schedule 48 93 38.88 percent of total billed charges 4.29 4.29 fee schedule 4.29 4.29 fee schedule 4.29 4.29 fee schedule 4.29 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Russell Viper Venom Time Diluted PX-300856130 CDM 85613 CPT 0305 RC outpatient 42 42 25.67 25.67 fee schedule 42 93 34.02 percent of total billed charges 9.58 9.58 fee schedule 9.58 9.58 fee schedule 9.58 9.58 fee schedule 9.58 42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sickle Cell Prep (Sikl) PX-300856600 CDM 85660 CPT 0300 RC outpatient 48 48 14.59 14.59 fee schedule 48 93 38.88 percent of total billed charges 5.51 5.51 fee schedule 5.51 5.51 fee schedule 5.51 5.51 fee schedule 5.51 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Thrombin Time, Plasma" PX-300856700 CDM 85670 CPT 0300 RC outpatient 40 40 13.75 13.75 fee schedule 40 93 32.4 percent of total billed charges 5.77 5.77 fee schedule 5.77 5.77 fee schedule 5.77 5.77 fee schedule 5.77 40 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ptt Screening PX-300857300 CDM 85730 CPT 0305 RC outpatient 73 73 16.09 16.09 fee schedule 73 93 59.13 percent of total billed charges 6.01 6.01 fee schedule 6.01 6.01 fee schedule 6.01 6.01 fee schedule 6.01 73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Viscosity, Serum (Vsc)" PX-300858100 CDM 85810 CPT 0300 RC outpatient 29.17 29.17 31.33 31.33 fee schedule 29.17 93 23.63 percent of total billed charges 11.67 11.67 fee schedule 11.67 11.67 fee schedule 11.67 11.67 fee schedule 11.67 31.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Allergan Spec Igg Quant, Each X8" PX-300860010 CDM 86001 CPT 0302 RC outpatient 22 22 14.02 14.02 fee schedule 22 93 17.82 percent of total billed charges 7.82 7.82 fee schedule 7.82 7.82 fee schedule 7.82 7.82 fee schedule 7.82 22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Rast (Rst1) PX-300860030 CDM 86003 CPT 0302 RC outpatient 75 75 14.02 14.02 fee schedule 75 93 60.75 percent of total billed charges 5.22 5.22 fee schedule 5.22 5.22 fee schedule 5.22 5.22 fee schedule 5.22 75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Allergen Specific Ige;Quant or Semiquant, Recombinant or Purifed Component, Each" PX-300860080 CDM 86008 CPT 0300 RC outpatient 44.83 44.83 44.83 74 33.17 percent of total billed charges 44.83 93 36.31 percent of total billed charges 17.93 17.93 fee schedule 17.93 17.93 fee schedule 17.93 17.93 fee schedule 17.93 44.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Platelet Antibodies PX-300860220 CDM 86022 CPT 0302 RC outpatient 170 170 27.96 27.96 fee schedule 170 93 137.7 percent of total billed charges 18.37 18.37 fee schedule 18.37 18.37 fee schedule 18.37 18.37 fee schedule 18.37 170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Immunoglobulin Assay PX-300860230 CDM 86023 CPT 0300 RC outpatient 31.15 31.15 33.41 33.41 fee schedule 31.15 93 25.23 percent of total billed charges 31.15 31.15 other OPPS APC 31.15 31.15 other OPPS APC 12.46 12.46 fee schedule 12.46 33.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Anti Nuclear Antibody PX-300860380 CDM 86038 CPT 0300 RC outpatient 41 41 32.43 32.43 fee schedule 41 93 33.21 percent of total billed charges 12.09 12.09 fee schedule 12.09 12.09 fee schedule 12.09 12.09 fee schedule 12.09 41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Acetylcholine Receptor Blocking Antibody PX-300860420 CDM 86042 CPT 0300 RC outpatient 46 46 43.42 43.42 fee schedule 46 93 37.26 percent of total billed charges 18.4 18.4 fee schedule 18.4 18.4 fee schedule 18.4 18.4 fee schedule 18.4 46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Aquaporin-4 Antb Cba Each PX-300860520 CDM 86052 CPT 0300 RC outpatient 30.12 30.12 28.44 28.44 fee schedule 30.12 93 24.4 percent of total billed charges 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 30.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Asto Titer (Asto) PX-300860600 CDM 86060 CPT 0300 RC outpatient 97 97 19.58 19.58 fee schedule 97 93 78.57 percent of total billed charges 7.3 7.3 fee schedule 7.3 7.3 fee schedule 7.3 7.3 fee schedule 7.3 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC C-Reactive Protein, Inflammatory" PX-300861400 CDM 86140 CPT 0302 RC outpatient 73 73 13.88 13.88 fee schedule 73 93 59.13 percent of total billed charges 5.18 5.18 fee schedule 5.18 5.18 fee schedule 5.18 5.18 fee schedule 5.18 73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Hscrp, Cardiac" PX-300861410 CDM 86141 CPT 0302 RC outpatient 51 51 34.73 34.73 fee schedule 51 93 41.31 percent of total billed charges 12.95 12.95 fee schedule 12.95 12.95 fee schedule 12.95 12.95 fee schedule 12.95 51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Beta 2 Glycoprotein 1 Antibody Each PX-300861460 CDM 86146 CPT 0306 RC outpatient 93 93 68.24 68.24 fee schedule 93 93 75.33 percent of total billed charges 25.45 25.45 fee schedule 25.45 25.45 fee schedule 25.45 25.45 fee schedule 25.45 93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Cardiolipin Antibody, Ea Ig Class" PX-300861470 CDM 86147 CPT 0302 RC outpatient 100 100 68.24 68.24 fee schedule 100 93 81 percent of total billed charges 25.45 25.45 fee schedule 25.45 25.45 fee schedule 25.45 25.45 fee schedule 25.45 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Complement;Antigen Each Component PX-300861600 CDM 86160 CPT 0302 RC outpatient 158 158 32.22 32.22 fee schedule 158 93 127.98 percent of total billed charges 12 12 fee schedule 12 12 fee schedule 12 12 fee schedule 12 158 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Complement C4 (C4) PX-300861601 CDM 86160 CPT 0300 RC outpatient 158 158 32.22 32.22 fee schedule 158 93 127.98 percent of total billed charges 12 12 fee schedule 12 12 fee schedule 12 12 fee schedule 12 158 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Complement C3 (C3) PX-300861602 CDM 86160 CPT 0300 RC outpatient 158 158 32.22 32.22 fee schedule 158 93 127.98 percent of total billed charges 12 12 fee schedule 12 12 fee schedule 12 12 fee schedule 12 158 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Complement-Tl (Tcmp) PX-300861620 CDM 86162 CPT 0300 RC outpatient 66 66 54.51 54.51 fee schedule 66 93 53.46 percent of total billed charges 20.32 20.32 fee schedule 20.32 20.32 fee schedule 20.32 20.32 fee schedule 20.32 66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cyclic Citrullinated Peptide PX-300862000 CDM 86200 CPT 0302 RC outpatient 47 47 35.21 35.21 fee schedule 47 93 38.07 percent of total billed charges 12.95 12.95 fee schedule 12.95 12.95 fee schedule 12.95 12.95 fee schedule 12.95 47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Anti-Dna Antibody (Adna) PX-300862250 CDM 86225 CPT 0300 RC outpatient 183 183 36.86 36.86 fee schedule 183 93 148.23 percent of total billed charges 13.74 13.74 fee schedule 13.74 13.74 fee schedule 13.74 13.74 fee schedule 13.74 183 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ab to Extractable Nuclear Ag(Ena) PX-300862350 CDM 86235 CPT 0300 RC outpatient 76 76 48.12 48.12 fee schedule 76 93 61.56 percent of total billed charges 17.93 17.93 fee schedule 17.93 17.93 fee schedule 17.93 17.93 fee schedule 17.93 76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Autoantibodies to Ss-a/Ro PX-300862351 CDM 86235 CPT 0300 RC outpatient 76 76 48.12 48.12 fee schedule 76 93 61.56 percent of total billed charges 17.93 17.93 fee schedule 17.93 17.93 fee schedule 17.93 17.93 fee schedule 17.93 76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Autoantibodies to Ss-B/La PX-300862352 CDM 86235 CPT 0300 RC outpatient 76 76 48.12 48.12 fee schedule 76 93 61.56 percent of total billed charges 17.93 17.93 fee schedule 17.93 17.93 fee schedule 17.93 17.93 fee schedule 17.93 76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Autoantibodies to Scl 70 PX-300862353 CDM 86235 CPT 0300 RC outpatient 76 76 48.12 48.12 fee schedule 76 93 61.56 percent of total billed charges 17.93 17.93 fee schedule 17.93 17.93 fee schedule 17.93 17.93 fee schedule 17.93 76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Autoantibodies to Sm PX-300862354 CDM 86235 CPT 0300 RC outpatient 76 76 48.12 48.12 fee schedule 76 93 61.56 percent of total billed charges 17.93 17.93 fee schedule 17.93 17.93 fee schedule 17.93 17.93 fee schedule 17.93 76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Autoantibodies to U1rnp PX-300862355 CDM 86235 CPT 0300 RC outpatient 76 76 48.12 48.12 fee schedule 76 93 61.56 percent of total billed charges 17.93 17.93 fee schedule 17.93 17.93 fee schedule 17.93 17.93 fee schedule 17.93 76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Autoantibodies to Jo 1 PX-300862356 CDM 86235 CPT 0300 RC outpatient 76 76 48.12 48.12 fee schedule 76 93 61.56 percent of total billed charges 17.93 17.93 fee schedule 17.93 17.93 fee schedule 17.93 17.93 fee schedule 17.93 76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Centromere Antibody (Cma) PX-300862357 CDM 86235 CPT 0300 RC outpatient 64.54 64.54 48.12 48.12 fee schedule 64.54 93 52.28 percent of total billed charges 17.93 17.93 fee schedule 17.93 17.93 fee schedule 17.93 17.93 fee schedule 17.93 64.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Histone Antibody (Hista) PX-300862358 CDM 86235 CPT 0300 RC outpatient 76 76 48.12 48.12 fee schedule 76 93 61.56 percent of total billed charges 17.93 17.93 fee schedule 17.93 17.93 fee schedule 17.93 17.93 fee schedule 17.93 76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Fluorescent Noninfectious Agent Antibody, Screen Ea" PX-300862550 CDM 86255 CPT 0302 RC outpatient 68.55 68.55 32.33 32.33 fee schedule 68.55 93 55.53 percent of total billed charges 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 68.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Anti-Smooth Muscle Ab (Asmus) PX-300862551 CDM 86255 CPT 0300 RC outpatient 68.55 68.55 32.33 32.33 fee schedule 68.55 93 55.53 percent of total billed charges 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 68.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fluorescent Noninfectious Agent Antibody;Titer Ea PX-300862560 CDM 86256 CPT 0302 RC outpatient 31 31 23.46 23.46 fee schedule 31 93 25.11 percent of total billed charges 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Immunoassay Tumor Antigen PX-300863000 CDM 86300 CPT 0302 RC outpatient 84 84 55.81 55.81 fee schedule 84 93 68.04 percent of total billed charges 20.81 20.81 fee schedule 20.81 20.81 fee schedule 20.81 20.81 fee schedule 20.81 84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ca 199 (Ca199) PX-300863010 CDM 86301 CPT 0300 RC outpatient 298 298 55.81 55.81 fee schedule 298 93 241.38 percent of total billed charges 20.81 20.81 fee schedule 20.81 20.81 fee schedule 20.81 20.81 fee schedule 20.81 298 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ca 125 Ag (C125) PX-300863040 CDM 86304 CPT 0300 RC outpatient 269 269 55.81 55.81 fee schedule 269 93 217.89 percent of total billed charges 20.81 20.81 fee schedule 20.81 20.81 fee schedule 20.81 20.81 fee schedule 20.81 269 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mono Test (Mono) PX-300863080 CDM 86308 CPT 0302 RC outpatient 61 61 13.88 13.88 fee schedule 61 93 49.41 percent of total billed charges 5.18 5.18 fee schedule 5.18 5.18 fee schedule 5.18 5.18 fee schedule 5.18 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chromogranin A PX-300863160 CDM 86316 CPT 0300 RC outpatient 75 75 55.81 55.81 fee schedule 75 93 60.75 percent of total billed charges 20.81 20.81 fee schedule 20.81 20.81 fee schedule 20.81 20.81 fee schedule 20.81 75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Immunoassay Infectious Agent Antibody Quantitative PX-300863170 CDM 86317 CPT 0300 RC outpatient 54 54 40.22 40.22 fee schedule 54 93 43.74 percent of total billed charges 14.99 14.99 fee schedule 14.99 14.99 fee schedule 14.99 14.99 fee schedule 14.99 54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Immunodiffusion Nes PX-300863290 CDM 86329 CPT 0300 RC outpatient 35.12 35.12 28.67 28.67 fee schedule 35.12 93 28.45 percent of total billed charges 35.12 35.12 other OPPS APC 35.12 35.12 other OPPS APC 14.05 14.05 fee schedule 14.05 35.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Immunodiffusion Ouchterology X5 PX-300863310 CDM 86331 CPT 0302 RC outpatient 43 43 32.16 32.16 fee schedule 43 93 34.83 percent of total billed charges 11.98 11.98 fee schedule 11.98 11.98 fee schedule 11.98 11.98 fee schedule 11.98 43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Immunofixation, Blood" PX-300863340 CDM 86334 CPT 0300 RC outpatient 149 149 59.92 59.92 fee schedule 149 93 120.69 percent of total billed charges 22.34 22.34 fee schedule 22.34 22.34 fee schedule 22.34 22.34 fee schedule 22.34 149 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Immunofixation Electrophoresis, Other Fluid" PX-300863350 CDM 86335 CPT 0302 RC outpatient 125 125 78.72 78.72 fee schedule 125 93 101.25 percent of total billed charges 29.35 29.35 fee schedule 29.35 29.35 fee schedule 29.35 29.35 fee schedule 29.35 125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Insulin Antibodies (Inab) PX-300863370 CDM 86337 CPT 0300 RC outpatient 250 250 46.68 46.68 fee schedule 250 93 202.5 percent of total billed charges 21.41 21.41 fee schedule 21.41 21.41 fee schedule 21.41 21.41 fee schedule 21.41 250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Intrinsic Factor Antibodies PX-300863400 CDM 86340 CPT 0300 RC outpatient 52 52 40.44 40.44 fee schedule 52 93 42.12 percent of total billed charges 15.08 15.08 fee schedule 15.08 15.08 fee schedule 15.08 15.08 fee schedule 15.08 52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Islet Cell Antibody PX-300863410 CDM 86341 CPT 0302 RC outpatient 153 153 53.09 53.09 fee schedule 153 93 123.93 percent of total billed charges 23.57 23.57 fee schedule 23.57 23.57 fee schedule 23.57 23.57 fee schedule 23.57 153 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC B Cells, Total Count" PX-300863550 CDM 86355 CPT 0300 RC outpatient 94.32 94.32 102.59 102.59 fee schedule 94.32 93 76.4 percent of total billed charges 37.73 37.73 fee schedule 37.73 37.73 fee schedule 37.73 37.73 fee schedule 37.73 102.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mononuclear Cell Antigen PX-300863560 CDM 86356 CPT 0300 RC outpatient 66.95 66.95 72.81 72.81 fee schedule 66.95 93 54.23 percent of total billed charges 26.78 26.78 fee schedule 26.78 26.78 fee schedule 26.78 26.78 fee schedule 26.78 72.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Natural Killer Cells, Total Count" PX-300863570 CDM 86357 CPT 0300 RC outpatient 94.32 94.32 102.59 102.59 fee schedule 94.32 93 76.4 percent of total billed charges 37.73 37.73 fee schedule 37.73 37.73 fee schedule 37.73 37.73 fee schedule 37.73 102.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC T Cells, Total Count" PX-300863590 CDM 86359 CPT 0300 RC outpatient 94.32 94.32 101.18 101.18 fee schedule 94.32 93 76.4 percent of total billed charges 37.73 37.73 fee schedule 37.73 37.73 fee schedule 37.73 37.73 fee schedule 37.73 101.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC T Cells, Absolute Cd4 &Cd8, Include Ratio" PX-300863600 CDM 86360 CPT 0300 RC outpatient 117.45 117.45 126.05 126.05 fee schedule 117.45 93 95.13 percent of total billed charges 46.98 46.98 fee schedule 46.98 46.98 fee schedule 46.98 46.98 fee schedule 46.98 126.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mog-Igg1 Antb Cba Each PX-300863620 CDM 86362 CPT 0300 RC outpatient 30.12 30.12 28.44 28.44 fee schedule 30.12 93 24.4 percent of total billed charges 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 30.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Microsomal Antibodies(Thyroid/Kidney/Liver) Ea. PX-300863760 CDM 86376 CPT 0302 RC outpatient 195 195 39.03 39.03 fee schedule 195 93 157.95 percent of total billed charges 14.55 14.55 fee schedule 14.55 14.55 fee schedule 14.55 14.55 fee schedule 14.55 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ra Test (Ra) PX-300864300 CDM 86430 CPT 0300 RC outpatient 73 73 15.23 15.23 fee schedule 73 93 59.13 percent of total billed charges 6.14 6.14 fee schedule 6.14 6.14 fee schedule 6.14 6.14 fee schedule 6.14 73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Rheumatoid Factor; Quantitative PX-300864310 CDM 86431 CPT 0302 RC outpatient 73 73 15.23 15.23 fee schedule 73 93 59.13 percent of total billed charges 5.67 5.67 fee schedule 5.67 5.67 fee schedule 5.67 5.67 fee schedule 5.67 73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC M Tuberculosis by Quantiferon PX-300864800 CDM 86480 CPT 0302 RC outpatient 154.95 154.95 168.56 168.56 fee schedule 154.95 93 125.51 percent of total billed charges 61.98 61.98 fee schedule 61.98 61.98 fee schedule 61.98 61.98 fee schedule 61.98 168.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Syphilis Test, Non Treponemal Antibody, Qualit(Vdrl,Rpr,Art)" PX-300865920 CDM 86592 CPT 0302 RC outpatient 60 60 11.44 11.44 fee schedule 60 93 48.6 percent of total billed charges 4.27 4.27 fee schedule 4.27 4.27 fee schedule 4.27 4.27 fee schedule 4.27 60 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Adenovirus Antibody PX-300866030 CDM 86603 CPT 0300 RC outpatient 32.17 32.17 34.52 34.52 fee schedule 32.17 93 26.06 percent of total billed charges 12.87 12.87 fee schedule 12.87 12.87 fee schedule 12.87 12.87 fee schedule 12.87 34.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Aspergillus, Antibody" PX-300866060 CDM 86606 CPT 0302 RC outpatient 54 54 40.38 40.38 fee schedule 54 93 43.74 percent of total billed charges 15.05 15.05 fee schedule 15.05 15.05 fee schedule 15.05 15.05 fee schedule 15.05 54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Bacterium, Antibody" PX-300866090 CDM 86609 CPT 0300 RC outpatient 46 46 34.56 34.56 fee schedule 46 93 37.26 percent of total billed charges 12.88 12.88 fee schedule 12.88 12.88 fee schedule 12.88 12.88 fee schedule 12.88 46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bartonella Ab Panel PX-300866110 CDM 86611 CPT 0300 RC outpatient 25.45 25.45 27.3 27.3 fee schedule 25.45 93 20.61 percent of total billed charges 10.18 10.18 fee schedule 10.18 10.18 fee schedule 10.18 10.18 fee schedule 10.18 27.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Blastomyces Antibody PX-300866120 CDM 86612 CPT 0300 RC outpatient 32.25 32.25 34.62 34.62 fee schedule 32.25 93 26.12 percent of total billed charges 12.9 12.9 fee schedule 12.9 12.9 fee schedule 12.9 12.9 fee schedule 12.9 34.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Lyme Disease, Conf. (Lymwb)" PX-300866170 CDM 86617 CPT 0300 RC outpatient 62 62 41.55 41.55 fee schedule 62 93 50.22 percent of total billed charges 15.49 15.49 fee schedule 15.49 15.49 fee schedule 15.49 15.49 fee schedule 15.49 62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Borrelia Burgdorferi(Lyme Disease) PX-300866180 CDM 86618 CPT 0300 RC outpatient 219 219 45.7 45.7 fee schedule 219 93 177.39 percent of total billed charges 17.03 17.03 fee schedule 17.03 17.03 fee schedule 17.03 17.03 fee schedule 17.03 219 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Brucella Agglutination PX-300866220 CDM 86622 CPT 0300 RC outpatient 34 34 21.95 21.95 fee schedule 34 93 27.54 percent of total billed charges 8.93 8.93 fee schedule 8.93 8.93 fee schedule 8.93 8.93 fee schedule 8.93 34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Candida Antibody PX-300866280 CDM 86628 CPT 0300 RC outpatient 90.07 90.07 28.67 28.67 fee schedule 90.07 93 72.96 percent of total billed charges 90.07 90.07 other OPPS APC 90.07 90.07 other OPPS APC 12.01 12.01 fee schedule 12.01 90.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC  Chlamydia Igm Antibody PX-300866320 CDM 86632 CPT 0300 RC outpatient 95.1 95.1 28.67 28.67 fee schedule 95.1 93 77.03 percent of total billed charges 12.68 12.68 fee schedule 12.68 12.68 fee schedule 12.68 12.68 fee schedule 12.68 95.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Antibody Coxiella Burnetii Q Fever PX-300866380 CDM 86638 CPT 0300 RC outpatient 30.3 30.3 32.52 32.52 fee schedule 30.3 93 24.54 percent of total billed charges 12.12 12.12 fee schedule 12.12 12.12 fee schedule 12.12 12.12 fee schedule 12.12 32.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Antibody Cryptococcus PX-300866410 CDM 86641 CPT 0300 RC outpatient 36.02 36.02 38.67 38.67 fee schedule 36.02 93 29.18 percent of total billed charges 36.02 36.02 other OPPS APC 36.02 36.02 other OPPS APC 14.41 14.41 fee schedule 14.41 38.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cytomegalovirus(Cmv) PX-300866440 CDM 86644 CPT 0302 RC outpatient 61 61 38.61 38.61 fee schedule 61 93 49.41 percent of total billed charges 14.39 14.39 fee schedule 14.39 14.39 fee schedule 14.39 14.39 fee schedule 14.39 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Torch Test (Tort) PX-300866441 CDM 86644 CPT 0300 RC outpatient 61 61 38.61 38.61 fee schedule 61 93 49.41 percent of total billed charges 14.39 14.39 fee schedule 14.39 14.39 fee schedule 14.39 14.39 fee schedule 14.39 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Antibody Cytomegalovirus (Cmv) PX-300866450 CDM 86645 CPT 0302 RC outpatient 219 219 45.2 45.2 fee schedule 219 93 177.39 percent of total billed charges 16.85 16.85 fee schedule 16.85 16.85 fee schedule 16.85 16.85 fee schedule 16.85 219 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Diphtheria Antibody PX-300866480 CDM 86648 CPT 0300 RC outpatient 38.02 38.02 40.8 40.8 fee schedule 38.02 93 30.8 percent of total billed charges 15.21 15.21 fee schedule 15.21 15.21 fee schedule 15.21 15.21 fee schedule 15.21 40.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Encephalitis Californ Antbdy PX-300866510 CDM 86651 CPT 0300 RC outpatient 32.97 32.97 35.39 35.39 fee schedule 32.97 93 26.71 percent of total billed charges 32.97 32.97 other OPPS APC 32.97 32.97 other OPPS APC 13.19 13.19 fee schedule 13.19 35.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Arbovirus PX-300866520 CDM 86652 CPT 0300 RC outpatient 115 115 35.39 35.39 fee schedule 115 93 93.15 percent of total billed charges 115 115 other OPPS APC 115 115 other OPPS APC 13.19 13.19 fee schedule 13.19 115 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Encephaltis St Louis Antbody PX-300866530 CDM 86653 CPT 0300 RC outpatient 32.97 32.97 35.39 35.39 fee schedule 32.97 93 26.71 percent of total billed charges 32.97 32.97 other OPPS APC 32.97 32.97 other OPPS APC 13.19 13.19 fee schedule 13.19 35.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Encephalitis, Western Equine" PX-300866540 CDM 86654 CPT 0300 RC outpatient 32.97 32.97 35.39 35.39 fee schedule 32.97 93 26.71 percent of total billed charges 13.19 13.19 fee schedule 13.19 13.19 fee schedule 13.19 13.19 fee schedule 13.19 35.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Eb Virus Serology (Ebvs) PX-300866630 CDM 86663 CPT 0302 RC outpatient 219 219 35.19 35.19 fee schedule 219 93 177.39 percent of total billed charges 13.12 13.12 fee schedule 13.12 13.12 fee schedule 13.12 13.12 fee schedule 13.12 219 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Antibody Ehrlichia PX-300866660 CDM 86666 CPT 0302 RC outpatient 36 36 27.3 27.3 fee schedule 36 93 29.16 percent of total billed charges 10.18 10.18 fee schedule 10.18 10.18 fee schedule 10.18 10.18 fee schedule 10.18 36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Francisella Turlarensis Ab PX-300866680 CDM 86668 CPT 0300 RC outpatient 106.2 106.2 27.9 27.9 fee schedule 106.2 93 86.02 percent of total billed charges 14.16 14.16 fee schedule 14.16 14.16 fee schedule 14.16 14.16 fee schedule 14.16 106.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Helminth, Antibody" PX-300866820 CDM 86682 CPT 0300 RC outpatient 62 62 34.89 34.89 fee schedule 62 93 50.22 percent of total billed charges 13.01 13.01 fee schedule 13.01 13.01 fee schedule 13.01 13.01 fee schedule 13.01 62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Htlv or Hiv Antibody, Confirmatory Test(Eg. Western Blot)" PX-300866890 CDM 86689 CPT 0300 RC outpatient 53 53 51.94 51.94 fee schedule 53 93 42.93 percent of total billed charges 19.35 19.35 fee schedule 19.35 19.35 fee schedule 19.35 19.35 fee schedule 19.35 53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC State Hiv Conf Test (Shiv) PX-300866891 CDM 86689 CPT 0300 RC outpatient 53 53 51.94 51.94 fee schedule 53 93 42.93 percent of total billed charges 19.35 19.35 fee schedule 19.35 19.35 fee schedule 19.35 19.35 fee schedule 19.35 53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Antibody Hep Delta Agent PX-300866920 CDM 86692 CPT 0300 RC outpatient 42.9 42.9 46.04 46.04 fee schedule 42.9 93 34.75 percent of total billed charges 17.16 17.16 fee schedule 17.16 17.16 fee schedule 17.16 17.16 fee schedule 17.16 46.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Herpes Simplex, Nonspec Type, Antibody" PX-300866940 CDM 86694 CPT 0300 RC outpatient 73 73 38.61 38.61 fee schedule 73 93 59.13 percent of total billed charges 14.39 14.39 fee schedule 14.39 14.39 fee schedule 14.39 14.39 fee schedule 14.39 73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Herpes Serology (Hese) PX-300866941 CDM 86694 CPT 0300 RC outpatient 73 73 38.61 38.61 fee schedule 73 93 59.13 percent of total billed charges 14.39 14.39 fee schedule 14.39 14.39 fee schedule 14.39 14.39 fee schedule 14.39 73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Herpes Simplex, Type 1, Antibody" PX-300866950 CDM 86695 CPT 0302 RC outpatient 122 122 35.39 35.39 fee schedule 122 93 98.82 percent of total billed charges 13.19 13.19 fee schedule 13.19 13.19 fee schedule 13.19 13.19 fee schedule 13.19 122 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Herpes Simplex, Type 2, Antibody" PX-300866960 CDM 86696 CPT 0302 RC outpatient 100 100 51.94 51.94 fee schedule 100 93 81 percent of total billed charges 19.35 19.35 fee schedule 19.35 19.35 fee schedule 19.35 19.35 fee schedule 19.35 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Histoplasma PX-300866980 CDM 86698 CPT 0300 RC outpatient 34.47 34.47 28.67 28.67 fee schedule 34.47 93 27.92 percent of total billed charges 13.79 13.79 fee schedule 13.79 13.79 fee schedule 13.79 13.79 fee schedule 13.79 34.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Anti-HB Core (Core) PX-300867040 CDM 86704 CPT 0302 RC outpatient 158 158 32.33 32.33 fee schedule 158 93 127.98 percent of total billed charges 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 158 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Anti-Core Igm (Corem) PX-300867050 CDM 86705 CPT 0302 RC outpatient 158 158 31.56 31.56 fee schedule 158 93 127.98 percent of total billed charges 11.77 11.77 fee schedule 11.77 11.77 fee schedule 11.77 11.77 fee schedule 11.77 158 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Anti-Hbsag (Hab) PX-300867060 CDM 86706 CPT 0300 RC outpatient 135 135 28.82 28.82 fee schedule 135 93 109.35 percent of total billed charges 10.74 10.74 fee schedule 10.74 10.74 fee schedule 10.74 10.74 fee schedule 10.74 135 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Anti-Hbe (Eab) PX-300867070 CDM 86707 CPT 0302 RC outpatient 97 97 31.03 31.03 fee schedule 97 93 78.57 percent of total billed charges 11.57 11.57 fee schedule 11.57 11.57 fee schedule 11.57 11.57 fee schedule 11.57 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hepatitis a Antibody (Haab) PX-300867080 CDM 86708 CPT 0302 RC outpatient 52 52 33.24 33.24 fee schedule 52 93 42.12 percent of total billed charges 12.39 12.39 fee schedule 12.39 12.39 fee schedule 12.39 12.39 fee schedule 12.39 52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Anti-Hav, Igm (Hav)" PX-300867090 CDM 86709 CPT 0300 RC outpatient 146 146 30.2 30.2 fee schedule 146 93 118.26 percent of total billed charges 11.26 11.26 fee schedule 11.26 11.26 fee schedule 11.26 11.26 fee schedule 11.26 146 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Antibody Influenza Virus PX-300867100 CDM 86710 CPT 0300 RC outpatient 33.87 33.87 36.36 36.36 fee schedule 33.87 93 27.43 percent of total billed charges 13.55 13.55 fee schedule 13.55 13.55 fee schedule 13.55 13.55 fee schedule 13.55 36.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Antibody John Cunningham Virus PX-300867110 CDM 86711 CPT 0300 RC outpatient 66 66 38 38 fee schedule 66 93 53.46 percent of total billed charges 16.89 16.89 fee schedule 16.89 16.89 fee schedule 16.89 16.89 fee schedule 16.89 66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mumps Titer (Muse) PX-300867350 CDM 86735 CPT 0300 RC outpatient 170 170 35 35 fee schedule 170 93 137.7 percent of total billed charges 13.05 13.05 fee schedule 13.05 13.05 fee schedule 13.05 13.05 fee schedule 13.05 170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mycoplasma Serology (Myse) PX-300867380 CDM 86738 CPT 0302 RC outpatient 56 56 35.54 35.54 fee schedule 56 93 45.36 percent of total billed charges 13.24 13.24 fee schedule 13.24 13.24 fee schedule 13.24 13.24 fee schedule 13.24 56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Parvovirus PX-300867470 CDM 86747 CPT 0302 RC outpatient 65 65 40.32 40.32 fee schedule 65 93 52.65 percent of total billed charges 15.03 15.03 fee schedule 15.03 15.03 fee schedule 15.03 15.03 fee schedule 15.03 65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Antibody Protozoa, Not Elsewhere Specified" PX-300867530 CDM 86753 CPT 0300 RC outpatient 30.97 30.97 33.25 33.25 fee schedule 30.97 93 25.09 percent of total billed charges 12.39 12.39 fee schedule 12.39 12.39 fee schedule 12.39 12.39 fee schedule 12.39 33.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Rickettsia PX-300867570 CDM 86757 CPT 0302 RC outpatient 76 76 51.94 51.94 fee schedule 76 93 61.56 percent of total billed charges 19.35 19.35 fee schedule 19.35 19.35 fee schedule 19.35 19.35 fee schedule 19.35 76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Rocky Mtn Spotted Fever (Rmsf) PX-300867590 CDM 86759 CPT 0300 RC outpatient 69 69 35.39 35.39 fee schedule 69 93 55.89 percent of total billed charges 18.23 18.23 fee schedule 18.23 18.23 fee schedule 18.23 18.23 fee schedule 18.23 69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Rubella Test (Rube) PX-300867620 CDM 86762 CPT 0300 RC outpatient 170 170 38.61 38.61 fee schedule 170 93 137.7 percent of total billed charges 14.39 14.39 fee schedule 14.39 14.39 fee schedule 14.39 14.39 fee schedule 14.39 170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Rubeola Screen (Rbola) PX-300867650 CDM 86765 CPT 0300 RC outpatient 135 135 26.27 26.27 fee schedule 135 93 109.35 percent of total billed charges 12.88 12.88 fee schedule 12.88 12.88 fee schedule 12.88 12.88 fee schedule 12.88 135 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Immunoassay Infectious Agent Antibody(Ies), Qualit/Semiquant, Multi-Step Covid-19" PX-300867691 CDM 86769 CPT 0300 RC outpatient 119 119 99.43 99.43 fee schedule 119 93 96.39 percent of total billed charges 42.13 42.13 fee schedule 42.13 42.13 fee schedule 42.13 42.13 fee schedule 42.13 119 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tetanus Antibody PX-300867740 CDM 86774 CPT 0300 RC outpatient 37 37 39.71 39.71 fee schedule 37 93 29.97 percent of total billed charges 14.8 14.8 fee schedule 14.8 14.8 fee schedule 14.8 14.8 fee schedule 14.8 39.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Toxoplasma Serology (Tose) PX-300867770 CDM 86777 CPT 0302 RC outpatient 135 135 38.61 38.61 fee schedule 135 93 109.35 percent of total billed charges 14.39 14.39 fee schedule 14.39 14.39 fee schedule 14.39 14.39 fee schedule 14.39 135 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Chg Toxoplasma, Igm" PX-300867780 CDM 86778 CPT 0300 RC outpatient 36.02 36.02 38.63 38.63 fee schedule 36.02 93 29.18 percent of total billed charges 14.41 14.41 fee schedule 14.41 14.41 fee schedule 14.41 14.41 fee schedule 14.41 38.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fta (Fta) PX-300867800 CDM 86780 CPT 0300 RC outpatient 33.1 33.1 36 36 fee schedule 33.1 93 26.81 percent of total billed charges 13.24 13.24 fee schedule 13.24 13.24 fee schedule 13.24 13.24 fee schedule 13.24 36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Varicella-Zoster PX-300867870 CDM 86787 CPT 0300 RC outpatient 44 44 34.56 34.56 fee schedule 44 93 35.64 percent of total billed charges 12.88 12.88 fee schedule 12.88 12.88 fee schedule 12.88 12.88 fee schedule 12.88 44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Antibody West Nile Virus Igm PX-300867880 CDM 86788 CPT 0300 RC outpatient 42.12 42.12 45.81 45.81 fee schedule 42.12 93 34.12 percent of total billed charges 16.85 16.85 fee schedule 16.85 16.85 fee schedule 16.85 16.85 fee schedule 16.85 45.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Antibody West Nile Virus Igg PX-300867890 CDM 86789 CPT 0300 RC outpatient 35.97 35.97 39.15 39.15 fee schedule 35.97 93 29.14 percent of total billed charges 14.39 14.39 fee schedule 14.39 14.39 fee schedule 14.39 14.39 fee schedule 14.39 39.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Anti-Thyroglobulin Ab (Athyr) PX-300868000 CDM 86800 CPT 0302 RC outpatient 208 208 42.66 42.66 fee schedule 208 93 168.48 percent of total billed charges 15.91 15.91 fee schedule 15.91 15.91 fee schedule 15.91 15.91 fee schedule 15.91 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ant-Hepatitits C (Ahcv) PX-300868030 CDM 86803 CPT 0300 RC outpatient 183 183 38.28 38.28 fee schedule 183 93 148.23 percent of total billed charges 14.27 14.27 fee schedule 14.27 14.27 fee schedule 14.27 14.27 fee schedule 14.27 183 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hla B27 (Hla) PX-300868120 CDM 86812 CPT 0302 RC outpatient 329 329 69.24 69.24 fee schedule 329 93 266.49 percent of total billed charges 25.81 25.81 fee schedule 25.81 25.81 fee schedule 25.81 25.81 fee schedule 25.81 329 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Antibody Screen (Abst) PX-300868500 CDM 86850 CPT 0300 RC outpatient 129.08 129.08 35.47 35.47 fee schedule 129.08 93 104.55 percent of total billed charges 129.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 129.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 9.77 9.77 fee schedule 9.77 129.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Antibody Elution, RBC, Ea Elution" PX-300868600 CDM 86860 CPT 0300 RC outpatient 406.85 406.85 50.01 50.01 fee schedule 406.85 93 329.55 percent of total billed charges 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 51 207.49 percent of total billed charges 50.01 406.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Antibody Identification PX-300868700 CDM 86870 CPT 0300 RC outpatient 856.2 856.2 66.91 66.91 fee schedule 856.2 93 693.52 percent of total billed charges 856.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 366.5 other OPPS APC 856.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 366.5 other OPPS APC 856.2 51 436.66 percent of total billed charges 66.91 856.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Direct Coombs PX-300868800 CDM 86880 CPT 0300 RC outpatient 145.7 145.7 14.4 14.4 fee schedule 145.7 93 118.02 percent of total billed charges 145.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.37 other OPPS APC 145.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.37 other OPPS APC 5.39 5.39 fee schedule 5.39 145.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Antibody Titer (Abti) PX-300868860 CDM 86886 CPT 0302 RC outpatient 406.85 406.85 13.88 13.88 fee schedule 406.85 93 329.55 percent of total billed charges 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 5.18 5.18 fee schedule 5.18 406.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Patient Blood Type (Bty) PX-300869000 CDM 86900 CPT 0300 RC outpatient 304.28 304.28 8.01 8.01 fee schedule 304.28 93 246.47 percent of total billed charges 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 2.99 2.99 fee schedule 2.99 304.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Blood Typing, Abo" PX-300869001 CDM 86900 CPT 0300 RC outpatient 304.28 304.28 8.01 8.01 fee schedule 304.28 93 246.47 percent of total billed charges 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 2.99 2.99 fee schedule 2.99 304.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Blood Typing Rh (D) PX-300869010 CDM 86901 CPT 0300 RC outpatient 95.53 95.53 8.12 8.12 fee schedule 95.53 93 77.38 percent of total billed charges 95.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40.89 other OPPS APC 95.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40.89 other OPPS APC 2.99 2.99 fee schedule 2.99 95.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Antigen Typing PX-300869020 CDM 86902 CPT 0300 RC outpatient 856.2 856.2 25.32 25.32 fee schedule 856.2 93 693.52 percent of total billed charges 856.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 366.5 other OPPS APC 856.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 366.5 other OPPS APC 6.35 6.35 fee schedule 6.35 856.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ahg Phase Crossmatch Antiglobulin PX-300869220 CDM 86922 CPT 0300 RC outpatient 406.85 406.85 51.73 51.73 fee schedule 406.85 93 329.55 percent of total billed charges 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 51 207.49 percent of total billed charges 51.73 406.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Crossmatch (Xm) PX-300869230 CDM 86923 CPT 0300 RC outpatient 406.85 406.85 30.02 30.02 fee schedule 406.85 93 329.55 percent of total billed charges 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 51 207.49 percent of total billed charges 30.02 406.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Special Test Bb PX-300869990 CDM 86999 CPT 0300 RC outpatient 70.93 70.93 46.85 46.85 fee schedule 70.93 93 57.45 percent of total billed charges 70.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.36 other OPPS APC 70.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.36 other OPPS APC 70.93 51 36.17 percent of total billed charges 46.85 70.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Culture Blood (Blc) PX-300870400 CDM 87040 CPT 0306 RC outpatient 122 122 27.69 27.69 fee schedule 122 93 98.82 percent of total billed charges 10.32 10.32 fee schedule 10.32 10.32 fee schedule 10.32 10.32 fee schedule 10.32 122 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sm Cult Respir (Resc) PX-300870700 CDM 87070 CPT 0300 RC outpatient 97 97 23.1 23.1 fee schedule 97 93 78.57 percent of total billed charges 8.62 8.62 fee schedule 8.62 8.62 fee schedule 8.62 8.62 fee schedule 8.62 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sm Cult Genital (Gesc) PX-300870701 CDM 87070 CPT 0300 RC outpatient 97 97 23.1 23.1 fee schedule 97 93 78.57 percent of total billed charges 8.62 8.62 fee schedule 8.62 8.62 fee schedule 8.62 8.62 fee schedule 8.62 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sm Cult CSF (Sfsc) PX-300870702 CDM 87070 CPT 0300 RC outpatient 97 97 23.1 23.1 fee schedule 97 93 78.57 percent of total billed charges 8.62 8.62 fee schedule 8.62 8.62 fee schedule 8.62 8.62 fee schedule 8.62 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cult Throat (Thrc) PX-300870703 CDM 87070 CPT 0300 RC outpatient 97 97 23.1 23.1 fee schedule 97 93 78.57 percent of total billed charges 8.62 8.62 fee schedule 8.62 8.62 fee schedule 8.62 8.62 fee schedule 8.62 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sm Cult Misc (Misc) PX-300870705 CDM 87070 CPT 0300 RC outpatient 97 97 23.1 23.1 fee schedule 97 93 78.57 percent of total billed charges 8.62 8.62 fee schedule 8.62 8.62 fee schedule 8.62 8.62 fee schedule 8.62 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Culture,Bacterial,Anaerobic Isolate, Add, ID Ea Isolate" PX-300870760 CDM 87076 CPT 0300 RC outpatient 42 42 21.68 21.68 fee schedule 42 93 34.02 percent of total billed charges 8.08 8.08 fee schedule 8.08 8.08 fee schedule 8.08 8.08 fee schedule 8.08 42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Culture,Bacterial,Aerobic Isolate. Add ID Ea Isolate" PX-300870770 CDM 87077 CPT 0300 RC outpatient 135 135 21.68 21.68 fee schedule 135 93 109.35 percent of total billed charges 8.08 8.08 fee schedule 8.08 8.08 fee schedule 8.08 8.08 fee schedule 8.08 135 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bacterial Identification X 1 PX-300870771 CDM 87077 CPT 0306 RC outpatient 135 135 21.68 21.68 fee schedule 135 93 109.35 percent of total billed charges 8.08 8.08 fee schedule 8.08 8.08 fee schedule 8.08 8.08 fee schedule 8.08 135 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mrsa Screen Culture(Mrsac) PX-300870816 CDM 87081 CPT 0300 RC outpatient 97 97 17.78 17.78 fee schedule 97 93 78.57 percent of total billed charges 6.63 6.63 fee schedule 6.63 6.63 fee schedule 6.63 6.63 fee schedule 6.63 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Staph. Aureus Screen Ortho PX-300870817 CDM 87081 CPT 0300 RC outpatient 97 97 17.78 17.78 fee schedule 97 93 78.57 percent of total billed charges 6.63 6.63 fee schedule 6.63 6.63 fee schedule 6.63 6.63 fee schedule 6.63 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cult Urine (Urnc) PX-300870860 CDM 87086 CPT 0300 RC outpatient 97 97 21.66 21.66 fee schedule 97 93 78.57 percent of total billed charges 8.07 8.07 fee schedule 8.07 8.07 fee schedule 8.07 8.07 fee schedule 8.07 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Presumptive Identification X 1 PX-300870880 CDM 87088 CPT 0300 RC outpatient 44 44 21.72 21.72 fee schedule 44 93 35.64 percent of total billed charges 8.09 8.09 fee schedule 8.09 8.09 fee schedule 8.09 8.09 fee schedule 8.09 44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fungus Sm and Cult (Fusc) PX-300871020 CDM 87102 CPT 0300 RC outpatient 97 97 22.54 22.54 fee schedule 97 93 78.57 percent of total billed charges 8.41 8.41 fee schedule 8.41 8.41 fee schedule 8.41 8.41 fee schedule 8.41 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Yeast Identification X 1 PX-300871060 CDM 87106 CPT 0300 RC outpatient 38 38 27.69 27.69 fee schedule 38 93 30.78 percent of total billed charges 10.32 10.32 fee schedule 10.32 10.32 fee schedule 10.32 10.32 fee schedule 10.32 38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Culture,Fungi, Definitive ID, Ea Organism,Mold" PX-300871070 CDM 87107 CPT 0300 RC outpatient 38 38 27.69 27.69 fee schedule 38 93 30.78 percent of total billed charges 10.32 10.32 fee schedule 10.32 10.32 fee schedule 10.32 10.32 fee schedule 10.32 38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Culture,Tubercle,Afb, Any Source W/Isol&Presumphc Smear and Culture Acid Fast (Afsc" PX-300871160 CDM 87116 CPT 0300 RC outpatient 38 38 16.47 16.47 fee schedule 38 93 30.78 percent of total billed charges 10.8 10.8 fee schedule 10.8 10.8 fee schedule 10.8 10.8 fee schedule 10.8 38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pbp2a Test PX-300871472 CDM 87147 CPT 0306 RC outpatient 37 37 13.88 13.88 fee schedule 37 93 29.97 percent of total billed charges 5.18 5.18 fee schedule 5.18 5.18 fee schedule 5.18 5.18 fee schedule 5.18 37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Blood Culture Gram Positive PX-300871490 CDM 87149 CPT 0300 RC outpatient 74.28 74.28 53.8 53.8 fee schedule 74.28 93 60.17 percent of total billed charges 20.05 20.05 fee schedule 20.05 20.05 fee schedule 20.05 20.05 fee schedule 20.05 74.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Blood Culture Gram Negative PX-300871491 CDM 87149 CPT 0300 RC outpatient 74.28 74.28 53.8 53.8 fee schedule 74.28 93 60.17 percent of total billed charges 20.05 20.05 fee schedule 20.05 20.05 fee schedule 20.05 20.05 fee schedule 20.05 74.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Blood Culture Gram Negative 6 PX-300871492 CDM 87149 CPT 0300 RC outpatient 74.28 74.28 53.8 53.8 fee schedule 74.28 93 60.17 percent of total billed charges 20.05 20.05 fee schedule 20.05 20.05 fee schedule 20.05 20.05 fee schedule 20.05 74.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Blood Culture Gram Negative 7 PX-300871493 CDM 87149 CPT 0300 RC outpatient 74.28 74.28 53.8 53.8 fee schedule 74.28 93 60.17 percent of total billed charges 20.05 20.05 fee schedule 20.05 20.05 fee schedule 20.05 20.05 fee schedule 20.05 74.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Blood Culture Gram Positive 11 PX-300871494 CDM 87149 CPT 0300 RC outpatient 74.28 74.28 53.8 53.8 fee schedule 74.28 93 60.17 percent of total billed charges 20.05 20.05 fee schedule 20.05 20.05 fee schedule 20.05 20.05 fee schedule 20.05 74.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Blood Culture Gram Positive 2 PX-300871495 CDM 87149 CPT 0300 RC outpatient 74.28 74.28 53.8 53.8 fee schedule 74.28 93 60.17 percent of total billed charges 20.05 20.05 fee schedule 20.05 20.05 fee schedule 20.05 20.05 fee schedule 20.05 74.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Blood Culture Gram Positive 1 PX-300871496 CDM 87149 CPT 0300 RC outpatient 74.28 74.28 53.8 53.8 fee schedule 74.28 93 60.17 percent of total billed charges 20.05 20.05 fee schedule 20.05 20.05 fee schedule 20.05 20.05 fee schedule 20.05 74.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Culture Typing, ID Nucleic Acid(Dna or Rna)Probe" PX-300871500 CDM 87150 CPT 0300 RC outpatient 120 120 95.44 95.44 fee schedule 120 93 97.2 percent of total billed charges 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Culture Refer for ID, Fungus&Culture ID (Funid(Dsf)" PX-300871530 CDM 87153 CPT 0300 RC outpatient 288.4 288.4 313.71 313.71 fee schedule 288.4 93 233.6 percent of total billed charges 115.36 115.36 fee schedule 115.36 115.36 fee schedule 115.36 115.36 fee schedule 115.36 313.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Organism Referred for ID, Anaerobic Bacteria(Isan,Isae)" PX-300871532 CDM 87153 CPT 0300 RC outpatient 288.4 288.4 313.71 313.71 fee schedule 288.4 93 233.6 percent of total billed charges 115.36 115.36 fee schedule 115.36 115.36 fee schedule 115.36 115.36 fee schedule 115.36 313.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tissue Grinding PX-300871760 CDM 87176 CPT 0300 RC outpatient 30 30 15.78 15.78 fee schedule 30 93 24.3 percent of total billed charges 5.88 5.88 fee schedule 5.88 5.88 fee schedule 5.88 5.88 fee schedule 5.88 30 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ova and Parasites (Onp) PX-300871770 CDM 87177 CPT 0300 RC outpatient 44.28 44.28 16.47 16.47 fee schedule 44.28 93 35.87 percent of total billed charges 8.9 8.9 fee schedule 8.9 8.9 fee schedule 8.9 8.9 fee schedule 8.9 44.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sensitivity Testing PX-300871860 CDM 87186 CPT 0300 RC outpatient 62 62 23.19 23.19 fee schedule 62 93 50.22 percent of total billed charges 8.65 8.65 fee schedule 8.65 8.65 fee schedule 8.65 8.65 fee schedule 8.65 62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Gram Stain (Gram) PX-300872054 CDM 87205 CPT 0306 RC outpatient 48 48 11.44 11.44 fee schedule 48 93 38.88 percent of total billed charges 4.27 4.27 fee schedule 4.27 4.27 fee schedule 4.27 4.27 fee schedule 4.27 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Malaria Smear (Mal) PX-300872070 CDM 87207 CPT 0300 RC outpatient 42 42 16.07 16.07 fee schedule 42 93 34.02 percent of total billed charges 5.99 5.99 fee schedule 5.99 5.99 fee schedule 5.99 5.99 fee schedule 5.99 42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Smear, Wet Mount, Simple Stain" PX-300872100 CDM 87210 CPT 0300 RC outpatient 48 48 11.44 11.44 fee schedule 48 93 38.88 percent of total billed charges 5.82 5.82 fee schedule 5.82 5.82 fee schedule 5.82 5.82 fee schedule 5.82 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Koh Prep PX-300872200 CDM 87220 CPT 0300 RC outpatient 37 37 9.27 9.27 fee schedule 37 93 29.97 percent of total billed charges 37 37 other OPPS APC 37 37 other OPPS APC 4.27 4.27 fee schedule 4.27 37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Giardia PX-300872690 CDM 87269 CPT 0300 RC outpatient 57 57 29.55 29.55 fee schedule 57 93 46.17 percent of total billed charges 13.61 13.61 fee schedule 13.61 13.61 fee schedule 13.61 13.61 fee schedule 13.61 57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Chylmd Trach Ag, Dfa" PX-300872700 CDM 87270 CPT 0300 RC outpatient 39 39 29.55 29.55 fee schedule 39 93 31.59 percent of total billed charges 39 39 other OPPS APC 39 39 other OPPS APC 11.98 11.98 fee schedule 11.98 39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ag Detection Polyval If PX-300873000 CDM 87300 CPT 0300 RC outpatient 29.95 29.95 29.55 29.55 fee schedule 29.95 93 24.26 percent of total billed charges 11.98 11.98 fee schedule 11.98 11.98 fee schedule 11.98 11.98 fee schedule 11.98 29.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Aspergilus, Antigen, Bronchoalevolar Lavage" PX-300873050 CDM 87305 CPT 0302 RC outpatient 40 40 29.93 29.93 fee schedule 40 93 32.4 percent of total billed charges 11.98 11.98 fee schedule 11.98 11.98 fee schedule 11.98 11.98 fee schedule 11.98 40 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cl Difficile Latex Test (Cdt) PX-300873240 CDM 87324 CPT 0300 RC outpatient 47 47 29.55 29.55 fee schedule 47 93 38.07 percent of total billed charges 11.98 11.98 fee schedule 11.98 11.98 fee schedule 11.98 11.98 fee schedule 11.98 47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Entamoeb Hist Group Ag Ia PX-300873370 CDM 87337 CPT 0300 RC outpatient 29.95 29.95 29.55 29.55 fee schedule 29.95 93 24.26 percent of total billed charges 11.98 11.98 fee schedule 11.98 11.98 fee schedule 11.98 11.98 fee schedule 11.98 29.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC H.Pylori Antigen, Stool" PX-300873380 CDM 87338 CPT 0306 RC outpatient 38 38 29.55 29.55 fee schedule 38 93 30.78 percent of total billed charges 14.38 14.38 fee schedule 14.38 14.38 fee schedule 14.38 14.38 fee schedule 14.38 38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hepatitis B Surface Antigen PX-300873400 CDM 87340 CPT 0300 RC outpatient 135 135 27.71 27.71 fee schedule 135 93 109.35 percent of total billed charges 10.33 10.33 fee schedule 10.33 10.33 fee schedule 10.33 10.33 fee schedule 10.33 135 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hep B. Surface Ag Neutralization PX-300873410 CDM 87341 CPT 0300 RC outpatient 56 56 27.71 27.71 fee schedule 56 93 45.36 percent of total billed charges 10.33 10.33 fee schedule 10.33 10.33 fee schedule 10.33 10.33 fee schedule 10.33 56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hepatitis Be Antigen (Eag) PX-300873500 CDM 87350 CPT 0306 RC outpatient 97 97 30.91 30.91 fee schedule 97 93 78.57 percent of total billed charges 11.53 11.53 fee schedule 11.53 11.53 fee schedule 11.53 11.53 fee schedule 11.53 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Histoplasma Capsul Ag Ia PX-300873850 CDM 87385 CPT 0300 RC outpatient 33.12 33.12 29.55 29.55 fee schedule 33.12 93 26.83 percent of total billed charges 33.12 33.12 other OPPS APC 33.12 33.12 other OPPS APC 13.25 13.25 fee schedule 13.25 33.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Hiv-Q Antigen(S) W Hiv-1/Hiv-2 Antibodies,Simple" PX-300873890 CDM 87389 CPT 0300 RC outpatient 80 80 65.51 65.51 fee schedule 80 93 64.8 percent of total billed charges 24.08 24.08 fee schedule 24.08 24.08 fee schedule 24.08 24.08 fee schedule 24.08 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Legionella Urinary Antigen PX-300874490 CDM 87449 CPT 0306 RC outpatient 71.45 71.45 29.55 29.55 fee schedule 71.45 93 57.87 percent of total billed charges 11.98 11.98 fee schedule 11.98 11.98 fee schedule 11.98 11.98 fee schedule 11.98 71.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Fungitell, Bal" PX-300874491 CDM 87449 CPT 0300 RC outpatient 71.45 71.45 29.55 29.55 fee schedule 71.45 93 57.87 percent of total billed charges 11.98 11.98 fee schedule 11.98 11.98 fee schedule 11.98 11.98 fee schedule 11.98 71.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bartonella Dna Amp Probe PX-300874710 CDM 87471 CPT 0300 RC outpatient 87.72 87.72 94.16 94.16 fee schedule 87.72 93 71.05 percent of total billed charges 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 94.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Borrelia Burgdorferi, Amplified Probe Technique" PX-300874760 CDM 87476 CPT 0300 RC outpatient 157.03 157.03 94.16 94.16 fee schedule 157.03 93 127.19 percent of total billed charges 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 157.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Borrelia Miyamotoi Dna Real Time Pcr Misc PX-300874780 CDM 87478 CPT 0300 RC outpatient 87.72 87.72 82.81 82.81 fee schedule 87.72 93 71.05 percent of total billed charges 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 87.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Candida Species Amplified Probe PX-300874810 CDM 87481 CPT 0300 RC outpatient 120 120 94.16 94.16 fee schedule 120 93 97.2 percent of total billed charges 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Infectious Agent Detection by Nucleic Acid (Dna or Rna) PX-300874830 CDM 87483 CPT 0300 RC outpatient 1041.95 1041.95 1041.95 74 771.04 percent of total billed charges 1041.95 93 843.98 percent of total billed charges 416.78 416.78 fee schedule 416.78 416.78 fee schedule 416.78 416.78 fee schedule 416.78 1041.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Chlamydia Pneumoniae, Dna, Amp Probe" PX-300874860 CDM 87486 CPT 0300 RC outpatient 87.73 87.73 94.16 94.16 fee schedule 87.73 93 71.06 percent of total billed charges 87.73 87.73 other OPPS APC 87.73 87.73 other OPPS APC 35.09 35.09 fee schedule 35.09 94.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Chlamydia Trachomatis, Amplified Probe" PX-300874910 CDM 87491 CPT 0306 RC outpatient 123 123 94.16 94.16 fee schedule 123 93 99.63 percent of total billed charges 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 123 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cmv by Rapid Pcr (Cmvpcr) PX-300874960 CDM 87496 CPT 0300 RC outpatient 151.95 151.95 94.16 94.16 fee schedule 151.95 93 123.08 percent of total billed charges 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 151.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Cmv, Quant, Pcr, Plasma" PX-300874970 CDM 87497 CPT 0306 RC outpatient 107.1 107.1 76.13 76.13 fee schedule 107.1 93 86.75 percent of total billed charges 42.84 42.84 fee schedule 42.84 42.84 fee schedule 42.84 42.84 fee schedule 42.84 107.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Enterovirus by Pcr (Pcrent) PX-300874980 CDM 87498 CPT 0300 RC outpatient 463 463 95.44 95.44 fee schedule 463 93 375.03 percent of total billed charges 463 463 other OPPS APC 463 463 other OPPS APC 35.09 35.09 fee schedule 35.09 463 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Enteric Bacterial Panel, Stool" PX-300875060 CDM 87506 CPT 0300 RC outpatient 657.48 657.48 557.66 557.66 fee schedule 657.48 93 532.56 percent of total billed charges 262.99 262.99 fee schedule 262.99 262.99 fee schedule 262.99 262.99 fee schedule 262.99 657.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Hepatitis B Viral Dna,Qnt(Qhbv)" PX-300875170 CDM 87517 CPT 0300 RC outpatient 107.1 107.1 76.13 76.13 fee schedule 107.1 93 86.75 percent of total billed charges 42.84 42.84 fee schedule 42.84 42.84 fee schedule 42.84 42.84 fee schedule 42.84 107.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Hepatitis C, Reverse Transcription & Quantification" PX-300875220 CDM 87522 CPT 0306 RC outpatient 121 121 76.13 76.13 fee schedule 121 93 98.01 percent of total billed charges 42.84 42.84 fee schedule 42.84 42.84 fee schedule 42.84 42.84 fee schedule 42.84 121 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Herpes by Pcr (Hsvpcr) PX-300875290 CDM 87529 CPT 0306 RC outpatient 123 123 94.16 94.16 fee schedule 123 93 99.63 percent of total billed charges 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 123 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hhv-6 Dna Quant PX-300875330 CDM 87533 CPT 0300 RC outpatient 104.4 104.4 76.13 76.13 fee schedule 104.4 93 84.56 percent of total billed charges 41.76 41.76 fee schedule 41.76 41.76 fee schedule 41.76 41.76 fee schedule 41.76 104.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hiv Rna by Pcr (Pcrhiv) PX-300875360 CDM 87536 CPT 0306 RC outpatient 310 310 228.27 228.27 fee schedule 310 93 251.1 percent of total billed charges 85.1 85.1 fee schedule 85.1 85.1 fee schedule 85.1 85.1 fee schedule 85.1 310 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mycoplasma Genitalium Amplified Probe PX-300875630 CDM 87563 CPT 0300 RC outpatient 253 253 82.81 82.81 fee schedule 253 93 204.93 percent of total billed charges 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 253 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Mycoplasma Pneumoniae, Amp Probe" PX-300875810 CDM 87581 CPT 0300 RC outpatient 88 88 94.16 94.16 fee schedule 88 93 71.28 percent of total billed charges 88 88 other OPPS APC 88 88 other OPPS APC 35.09 35.09 fee schedule 35.09 94.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC N. Gono, Amplified Probe" PX-300875910 CDM 87591 CPT 0300 RC outpatient 123 123 94.16 94.16 fee schedule 123 93 99.63 percent of total billed charges 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 123 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Orthopoxvirus Amp Prb Each Monkeypox PX-300875930 CDM 87593 CPT 0300 RC outpatient 77 77 77 74 56.98 percent of total billed charges 77 93 62.37 percent of total billed charges 77 Service paid by fee schedule. 77 other Lab Fee Schedule 77 Service paid by fee schedule. 77 other Lab Fee Schedule 77 Service paid by fee schedule. 77 other Lab Fee Schedule 77 77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Human Papillomavirus(Hpv) PX-300876240 CDM 87624 CPT 0300 RC outpatient 150 150 94.16 94.16 fee schedule 150 93 121.5 percent of total billed charges 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hpv Genotypes 16&18 PX-300876250 CDM 87625 CPT 0300 RC outpatient 101.38 101.38 94.16 94.16 fee schedule 101.38 93 82.12 percent of total billed charges 40.55 40.55 fee schedule 40.55 40.55 fee schedule 40.55 40.55 fee schedule 40.55 101.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Respiratory Virus, Influenza Type a&Bm 3-5 Targets" PX-300876310 CDM 87631 CPT 0300 RC outpatient 356.58 356.58 338.57 338.57 fee schedule 356.58 93 288.83 percent of total billed charges 142.63 142.63 fee schedule 142.63 142.63 fee schedule 142.63 142.63 fee schedule 142.63 356.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Resp Virus,Multiplex, Reverse Trans/Amp, 12-25 Targets" PX-300876330 CDM 87633 CPT 0300 RC outpatient 1041.95 1041.95 1099.99 1099.99 fee schedule 1041.95 93 843.98 percent of total billed charges 416.78 416.78 fee schedule 416.78 416.78 fee schedule 416.78 416.78 fee schedule 416.78 1099.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Infectious Agent Detection by Nucleic Acid, Respiratory Syndrome" PX-300876350 CDM U0002 CPT 0300 RC outpatient 128.28 128.28 121.14 121.14 fee schedule 128.28 93 103.91 percent of total billed charges 51.31 51.31 fee schedule 51.31 51.31 fee schedule 51.31 51.31 fee schedule 51.31 128.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Infectious Agent Detection by Nucleic Acid, High Throughput Tech" PX-300876351 CDM U0003 CPT 0300 RC outpatient 75 75 236 236 fee schedule 75 93 60.75 percent of total billed charges 75 75 other OPPS APC 75 75 other OPPS APC 75 51 38.25 percent of total billed charges 75 236 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Infec Agent Detection Amplified Probe PX-300876352 CDM U0005 CPT 0300 RC outpatient 25 25 59 59 fee schedule 25 93 20.25 percent of total billed charges 25 25 other OPPS APC 25 25 other OPPS APC 25 51 12.75 percent of total billed charges 25 59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Surgey Mrsa Screen (Sxmr) PX-300876410 CDM 87641 CPT 0306 RC outpatient 87.72 87.72 95.44 95.44 fee schedule 87.72 93 71.05 percent of total billed charges 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 95.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Trichomonas Vaginalis PX-300876610 CDM 87661 CPT 0300 RC outpatient 238 238 91.91 91.91 fee schedule 238 93 192.78 percent of total billed charges 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 238 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Zika Virus Dna/Rna Amp Probe PX-300876620 CDM 87662 CPT 0300 RC outpatient 128.27 128.27 149.51 149.51 fee schedule 128.27 93 103.9 percent of total billed charges 51.31 51.31 fee schedule 51.31 51.31 fee schedule 51.31 51.31 fee schedule 51.31 149.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Infectious Agent Amplified Probe, Ea Organism" PX-300877980 CDM 87798 CPT 0306 RC outpatient 120 120 94.16 94.16 fee schedule 120 93 97.2 percent of total billed charges 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Infectious Agent Quantification, Ea Organism" PX-300877990 CDM 87799 CPT 0300 RC outpatient 153 153 114.91 114.91 fee schedule 153 93 123.93 percent of total billed charges 42.84 42.84 fee schedule 42.84 42.84 fee schedule 42.84 42.84 fee schedule 42.84 153 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Infectious Agent, Multiple Orgs, Amplified Probe" PX-300878010 CDM 87801 CPT 0302 RC outpatient 251 251 188.29 188.29 fee schedule 251 93 203.31 percent of total billed charges 70.2 70.2 fee schedule 70.2 70.2 fee schedule 70.2 70.2 fee schedule 70.2 251 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Streptococcus, Group A" PX-300878800 CDM 87880 CPT 0300 RC outpatient 73 73 29.55 29.55 fee schedule 73 93 59.13 percent of total billed charges 16.53 16.53 fee schedule 16.53 16.53 fee schedule 16.53 16.53 fee schedule 16.53 73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Infectious Agent Immunoassay Not Specified PX-300878990 CDM 87899 CPT 0300 RC outpatient 40.18 40.18 29.55 29.55 fee schedule 40.18 93 32.55 percent of total billed charges 16.07 16.07 fee schedule 16.07 16.07 fee schedule 16.07 16.07 fee schedule 16.07 40.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Hiv-1 Genotypic PR Rt-Resistance,P" PX-300879010 CDM 87901 CPT 0300 RC outpatient 643.63 643.63 690.6 690.6 fee schedule 643.63 93 521.34 percent of total billed charges 257.45 257.45 fee schedule 257.45 257.45 fee schedule 257.45 257.45 fee schedule 257.45 690.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Genotype by Nucleic Acid,Hepatitis C" PX-300879020 CDM 87902 CPT 0300 RC outpatient 1015 1015 690.6 690.6 fee schedule 1015 93 822.15 percent of total billed charges 257.45 257.45 fee schedule 257.45 257.45 fee schedule 257.45 257.45 fee schedule 257.45 1015 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cytp Insitu Hybrid Urne Spec 3-5 Probes Cptr Ea PX-300881210 CDM 88121 CPT 0300 RC outpatient 406.85 406.85 1113.87 1113.87 fee schedule 406.85 93 329.55 percent of total billed charges 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 51 207.49 percent of total billed charges 406.85 1113.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Flow Cyto, Cell Sfc, Cytoplasm or Nuc Mark" PX-300881840 CDM 88184 CPT 0300 RC outpatient 856.2 856.2 51.07 51.07 fee schedule 856.2 93 693.52 percent of total billed charges 856.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 366.5 other OPPS APC 856.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 366.5 other OPPS APC 856.2 51 436.66 percent of total billed charges 51.07 856.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Flow Cytometry Each Add'l Marker PX-300881850 CDM 88185 CPT 0300 RC outpatient 28 28 36.3 36.3 fee schedule 28 93 22.68 percent of total billed charges 28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28 other OPPS APC 28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28 other OPPS APC 28 51 14.28 percent of total billed charges 28 36.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Flow Cytometry Each Add'l Marker PX-300881855 CDM 88185 CPT 0300 RC outpatient 28 28 36.3 36.3 fee schedule 28 93 22.68 percent of total billed charges 28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28 other OPPS APC 28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28 other OPPS APC 28 51 14.28 percent of total billed charges 28 36.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Flow Cyto Interp 2 to 8 Markers PX-300881870 CDM 88187 CPT 0300 RC outpatient 23 23 21.52 21.52 fee schedule 23 93 18.63 percent of total billed charges 34.48 34.48 fee schedule 34.48 34.48 fee schedule 23 51 11.73 percent of total billed charges 21.52 34.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Flow Cyto Interp 9 to 15 Markers PX-300881880 CDM 88188 CPT 0300 RC outpatient 111.5 111.5 68.2 68.2 fee schedule 111.5 93 90.32 percent of total billed charges 59.38 59.38 fee schedule 59.38 59.38 fee schedule 111.5 51 56.87 percent of total billed charges 59.38 111.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Flow Cyto Interp 16 or Great Mark PX-300881890 CDM 88189 CPT 0300 RC outpatient 225 225 66.76 66.76 fee schedule 225 93 182.25 percent of total billed charges 80.42 80.42 fee schedule 80.42 80.42 fee schedule 225 51 114.75 percent of total billed charges 66.76 225 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Chg Tissue Culture, Placenta" PX-300882350 CDM 88235 CPT 0300 RC outpatient 375.75 375.75 395.02 395.02 fee schedule 375.75 93 304.36 percent of total billed charges 375.75 375.75 other OPPS APC 375.75 375.75 other OPPS APC 150.3 150.3 fee schedule 150.3 395.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Tissue Culture Neoplastic Disorders;Bone Marrow, Blood Cells" PX-300882370 CDM 88237 CPT 0300 RC outpatient 359.38 359.38 338.82 338.82 fee schedule 359.38 93 291.1 percent of total billed charges 143.75 143.75 fee schedule 143.75 143.75 fee schedule 143.75 143.75 fee schedule 143.75 359.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chromosome Analysis 20-25 Cells PX-300882640 CDM 88264 CPT 0300 RC outpatient 361.53 361.53 334.35 334.35 fee schedule 361.53 93 292.84 percent of total billed charges 144.61 144.61 fee schedule 144.61 144.61 fee schedule 144.61 144.61 fee schedule 144.61 361.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Metaphases, 20-25 (Bill Only" PX-300882641 CDM 88264 CPT 0300 RC outpatient 361.53 361.53 334.35 334.35 fee schedule 361.53 93 292.84 percent of total billed charges 144.61 144.61 fee schedule 144.61 144.61 fee schedule 144.61 144.61 fee schedule 144.61 361.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Molecular Cytogenetics;Dna Probe Each PX-300882710 CDM 88271 CPT 0300 RC outpatient 188 188 57.47 57.47 fee schedule 188 93 152.28 percent of total billed charges 21.42 21.42 fee schedule 21.42 21.42 fee schedule 21.42 21.42 fee schedule 21.42 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Molecular Cytogenetics Chrmoml Ish 10-30 Cll PX-300882730 CDM 88273 CPT 0300 RC outpatient 87.02 87.02 86.19 86.19 fee schedule 87.02 93 70.49 percent of total billed charges 87.02 87.02 other OPPS APC 87.02 87.02 other OPPS APC 34.81 34.81 fee schedule 34.81 87.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Interphases, 25-99 (Bill Only)" PX-300882740 CDM 88274 CPT 0300 RC outpatient 156.25 156.25 93.37 93.37 fee schedule 156.25 93 126.56 percent of total billed charges 42.38 42.38 fee schedule 42.38 42.38 fee schedule 42.38 42.38 fee schedule 42.38 156.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Interphases, <25 (Bill Only)" PX-300882741 CDM 88274 CPT 0300 RC outpatient 156.25 156.25 93.37 93.37 fee schedule 156.25 93 126.56 percent of total billed charges 42.38 42.38 fee schedule 42.38 42.38 fee schedule 42.38 42.38 fee schedule 42.38 156.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Interphases, >=100 (Bill Only)" PX-300882750 CDM 88275 CPT 0300 RC outpatient 127.98 127.98 107.73 107.73 fee schedule 127.98 93 103.66 percent of total billed charges 51.19 51.19 fee schedule 51.19 51.19 fee schedule 51.19 51.19 fee schedule 51.19 127.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Metaphases Add'l Cells (Bill Only PX-300882850 CDM 88285 CPT 0300 RC outpatient 85.5 85.5 50.96 50.96 fee schedule 85.5 93 69.26 percent of total billed charges 85.5 85.5 other OPPS APC 85.5 85.5 other OPPS APC 26.91 26.91 fee schedule 26.91 85.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cytogenetic Study PX-300882990 CDM 88299 CPT 0300 RC outpatient 129.08 129.08 49.09 49.09 fee schedule 129.08 93 104.55 percent of total billed charges 129.08 129.08 other OPPS APC 129.08 129.08 other OPPS APC 129.08 51 65.83 percent of total billed charges 49.09 129.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Consult, W/Slide Prep(Csppc)" PX-300883230 CDM 88323 CPT 0300 RC outpatient 129.08 129.08 73.63 73.63 fee schedule 129.08 93 104.55 percent of total billed charges 129.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 129.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 129.08 51 65.83 percent of total billed charges 73.63 129.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Immuno Sendout Addl PX-300883410 CDM 88341 CPT 0300 RC outpatient 279 279 279 74 206.46 percent of total billed charges 279 93 225.99 percent of total billed charges 279 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 279 other OPPS APC 279 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 279 other OPPS APC 279 51 142.29 percent of total billed charges 279 279 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Immuno Sendout PX-300883420 CDM 88342 CPT 0300 RC outpatient 406.85 406.85 79.6 79.6 fee schedule 406.85 93 329.55 percent of total billed charges 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 51 207.49 percent of total billed charges 79.6 406.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Morphometric Anal,in Situ Hybrid,Manu,per Spec,Each Multi Probe Stain" PX-300883770 CDM 88377 CPT 0300 RC outpatient 406.85 406.85 747.93 747.93 fee schedule 406.85 93 329.55 percent of total billed charges 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 51 207.49 percent of total billed charges 406.85 747.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Morphometric in Situ Multiplex Prob Stai PX-300883771 CDM 88377 CPT 0300 RC outpatient 406.85 406.85 747.93 747.93 fee schedule 406.85 93 329.55 percent of total billed charges 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 51 207.49 percent of total billed charges 406.85 747.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Microdissection Laser PX-300883800 CDM 88380 CPT 0300 RC outpatient 553.46 553.46 553.46 74 409.56 percent of total billed charges 553.46 93 448.3 percent of total billed charges 553.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 553.46 other OPPS APC 553.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 553.46 other OPPS APC 553.46 51 282.26 percent of total billed charges 553.46 553.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Microdissection, Manual" PX-300883810 CDM 88381 CPT 0301 RC outpatient 176.56 176.56 176.56 74 130.65 percent of total billed charges 176.56 93 143.01 percent of total billed charges 176.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176.56 other OPPS APC 176.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176.56 other OPPS APC 176.56 51 90.05 percent of total billed charges 176.56 176.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Mlh1 Hypermehtylation,Braf Mutation Analys, Tumor" PX-300883811 CDM 88381 CPT 0300 RC outpatient 176.56 176.56 176.56 74 130.65 percent of total billed charges 176.56 93 143.01 percent of total billed charges 176.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176.56 other OPPS APC 176.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176.56 other OPPS APC 176.56 51 90.05 percent of total billed charges 176.56 176.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fluid Cell Count (Fcc) PX-300890500 CDM 89050 CPT 0300 RC outpatient 48 48 12.69 12.69 fee schedule 48 93 38.88 percent of total billed charges 4.72 4.72 fee schedule 4.72 4.72 fee schedule 4.72 4.72 fee schedule 4.72 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fluid Cell Count W/Differential (Fdif) PX-300890510 CDM 89051 CPT 0300 RC outpatient 61 61 14.78 14.78 fee schedule 61 93 49.41 percent of total billed charges 5.6 5.6 fee schedule 5.6 5.6 fee schedule 5.6 5.6 fee schedule 5.6 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Stool for Polys (Stsm) PX-300890550 CDM 89055 CPT 0300 RC outpatient 18 18 11.44 11.44 fee schedule 18 93 14.58 percent of total billed charges 4.27 4.27 fee schedule 4.27 4.27 fee schedule 4.27 4.27 fee schedule 4.27 18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fluid Crystals (Fldc) PX-300890600 CDM 89060 CPT 0300 RC outpatient 86 86 19.18 19.18 fee schedule 86 93 69.66 percent of total billed charges 7.33 7.33 fee schedule 7.33 7.33 fee schedule 7.33 7.33 fee schedule 7.33 86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Eosinophil Smear (Eosm) PX-300891900 CDM 89190 CPT 0300 RC outpatient 17 17 12.75 12.75 fee schedule 17 93 13.77 percent of total billed charges 5.79 5.79 fee schedule 5.79 5.79 fee schedule 5.79 5.79 fee schedule 5.79 17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sputum Collected PX-300892200 CDM 89220 CPT 0300 RC outpatient 406.85 406.85 70.23 70.23 fee schedule 406.85 93 329.55 percent of total billed charges 406.85 406.85 other OPPS APC 406.85 406.85 other OPPS APC 406.85 51 207.49 percent of total billed charges 70.23 406.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sperm Post Vas (Spck) PX-300893210 CDM 89321 CPT 0300 RC outpatient 43 43 32.33 32.33 fee schedule 43 93 34.83 percent of total billed charges 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Quantitative Assay Drug PX-301802991 CDM 80299 CPT 0301 RC outpatient 111 111 36.73 36.73 fee schedule 111 93 89.91 percent of total billed charges 18.64 18.64 fee schedule 18.64 18.64 fee schedule 18.64 18.64 fee schedule 18.64 111 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tn Screening Heroine Metabolite PX-301803560 CDM 80356 CPT 0301 RC outpatient 286.08 286.08 286.08 74 211.7 percent of total billed charges 286.08 93 231.72 percent of total billed charges 286.08 286.08 other OPPS APC 286.08 286.08 other OPPS APC 286.08 51 145.9 percent of total billed charges 286.08 286.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hla Class II Typing Low Res 1 Locus PX-301813760 CDM 81376 CPT 0301 RC outpatient 340 340 193.23 193.23 fee schedule 340 93 275.4 percent of total billed charges 122.22 122.22 fee schedule 122.22 122.22 fee schedule 122.22 122.22 fee schedule 122.22 340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hla Class II Typing High Res 1 Locus PX-301813820 CDM 81382 CPT 0301 RC outpatient 344 344 180.75 180.75 fee schedule 344 93 278.64 percent of total billed charges 123.68 123.68 fee schedule 123.68 123.68 fee schedule 123.68 123.68 fee schedule 123.68 344 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Gastric Occult Blood PX-301822711 CDM 82271 CPT 0301 RC outpatient 37 37 8.85 8.85 fee schedule 37 93 29.97 percent of total billed charges 37 37 other OPPS APC 37 37 other OPPS APC 5.32 5.32 fee schedule 5.32 37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Carboxyhemoglobin - Pft Outpt PX-301823752 CDM 82375 CPT 0301 RC outpatient 195 195 33.06 33.06 fee schedule 195 93 157.95 percent of total billed charges 12.32 12.32 fee schedule 12.32 12.32 fee schedule 12.32 12.32 fee schedule 12.32 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chromium PX-301824951 CDM 82495 CPT 0301 RC outpatient 61 61 18.76 18.76 fee schedule 61 93 49.41 percent of total billed charges 20.28 20.28 fee schedule 20.28 20.28 fee schedule 20.28 20.28 fee schedule 18.76 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cpk Isoenzymes PX-301825521 CDM 82552 CPT 0301 RC outpatient 170 170 35.92 35.92 fee schedule 170 93 137.7 percent of total billed charges 13.39 13.39 fee schedule 13.39 13.39 fee schedule 13.39 13.39 fee schedule 13.39 170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Estriol PX-301826771 CDM 82677 CPT 0301 RC outpatient 60.45 60.45 64.88 64.88 fee schedule 60.45 93 48.96 percent of total billed charges 24.18 24.18 fee schedule 24.18 24.18 fee schedule 24.18 24.18 fee schedule 24.18 64.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Fat,Feces;Qual" PX-301827051 CDM 82705 CPT 0301 RC outpatient 18 18 13.65 13.65 fee schedule 18 93 14.58 percent of total billed charges 5.1 5.1 fee schedule 5.1 5.1 fee schedule 5.1 5.1 fee schedule 5.1 18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Gases Blood O2 Sat Only PX-301828102 CDM 82810 CPT 0301 RC outpatient 30 30 23.42 23.42 fee schedule 30 93 24.3 percent of total billed charges 30 30 other OPPS APC 30 30 other OPPS APC 9.77 9.77 fee schedule 9.77 30 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Glucose Blood, Glucose Montior Dev" PX-301829471 CDM 82947 CPT 0301 RC outpatient 23 23 10.52 10.52 fee schedule 23 93 18.63 percent of total billed charges 3.93 3.93 fee schedule 3.93 3.93 fee schedule 3.93 3.93 fee schedule 3.93 23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Immunoassay Analyte;Qt by Ria PX-301835194 CDM 83519 CPT 0301 RC outpatient 94 94 36.25 36.25 fee schedule 94 93 76.14 percent of total billed charges 18.4 18.4 fee schedule 18.4 18.4 fee schedule 18.4 18.4 fee schedule 18.4 94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Immunoassay Quant Nos Nanab PX-301835201 CDM 83520 CPT 0301 RC outpatient 243 243 34.73 34.73 fee schedule 243 93 196.83 percent of total billed charges 17.27 17.27 fee schedule 17.27 17.27 fee schedule 17.27 17.27 fee schedule 17.27 243 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Nephelometry, Ea Analyte (Flcp)" PX-301835210 CDM 83521 CPT 0301 RC outpatient 43.18 43.18 40.76 40.76 fee schedule 43.18 93 34.98 percent of total billed charges 17.27 17.27 fee schedule 17.27 17.27 fee schedule 17.27 17.27 fee schedule 17.27 43.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Nephelometry, Ea Analyte (Msp3)" PX-301835211 CDM 83521 CPT 0301 RC outpatient 43.18 43.18 40.76 40.76 fee schedule 43.18 93 34.98 percent of total billed charges 17.27 17.27 fee schedule 17.27 17.27 fee schedule 17.27 17.27 fee schedule 17.27 43.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Iron Binding Capacity, % Sat" PX-301835501 CDM 83550 CPT 0301 RC outpatient 110 110 23.44 23.44 fee schedule 110 93 89.1 percent of total billed charges 8.74 8.74 fee schedule 8.74 8.74 fee schedule 8.74 8.74 fee schedule 8.74 110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CSF Myelin Bas Pro PX-301838731 CDM 83873 CPT 0301 RC outpatient 43 43 46.16 46.16 fee schedule 43 93 34.83 percent of total billed charges 17.2 17.2 fee schedule 17.2 17.2 fee schedule 17.2 17.2 fee schedule 17.2 46.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Nucleotidase 5' PX-301839151 CDM 83915 CPT 0301 RC outpatient 27.87 27.87 29.91 29.91 fee schedule 27.87 93 22.57 percent of total billed charges 11.15 11.15 fee schedule 11.15 11.15 fee schedule 11.15 11.15 fee schedule 11.15 29.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hmd Screening PX-301840301 CDM 84030 CPT 0301 RC outpatient 150 150 14.76 14.76 fee schedule 150 93 121.5 percent of total billed charges 150 150 other OPPS APC 150 150 other OPPS APC 5.5 5.5 fee schedule 5.5 150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Tn Placental Alpha Microglobulin-1, Cervical Vaginal Secretion Qual" PX-301841120 CDM 84112 CPT 0301 RC outpatient 245 245 175.16 175.16 fee schedule 245 93 198.45 percent of total billed charges 98.11 98.11 fee schedule 98.11 98.11 fee schedule 98.11 98.11 fee schedule 98.11 245 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Proinsulin PX-301842061 CDM 84206 CPT 0301 RC outpatient 66.72 66.72 26.98 26.98 fee schedule 66.72 93 54.04 percent of total billed charges 26.69 26.69 fee schedule 26.69 26.69 fee schedule 26.69 26.69 fee schedule 26.69 66.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC T4 (Thyroxine) PX-301844361 CDM 84436 CPT 0301 RC outpatient 86 86 18.45 18.45 fee schedule 86 93 69.66 percent of total billed charges 6.87 6.87 fee schedule 6.87 6.87 fee schedule 6.87 6.87 fee schedule 6.87 86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC T3 Uptake PX-301844791 CDM 84479 CPT 0301 RC outpatient 86 86 17.36 17.36 fee schedule 86 93 69.66 percent of total billed charges 6.47 6.47 fee schedule 6.47 6.47 fee schedule 6.47 6.47 fee schedule 6.47 86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vitamin K Q 36585 PX-301845971 CDM 84597 CPT 0301 RC outpatient 34.3 34.3 36.77 36.77 fee schedule 34.3 93 27.78 percent of total billed charges 13.72 13.72 fee schedule 13.72 13.72 fee schedule 13.72 13.72 fee schedule 13.72 36.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Hcg, Qualitative" PX-301847031 CDM 84703 CPT 0301 RC outpatient 18.8 18.8 20.14 20.14 fee schedule 18.8 93 15.23 percent of total billed charges 7.52 7.52 fee schedule 7.52 7.52 fee schedule 7.52 7.52 fee schedule 7.52 20.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Microdissection Manual Tc B045 PX-301883812 CDM 88381 CPT 0301 RC outpatient 176.56 176.56 176.56 74 130.65 percent of total billed charges 176.56 93 143.01 percent of total billed charges 176.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176.56 other OPPS APC 176.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176.56 other OPPS APC 176.56 51 90.05 percent of total billed charges 176.56 176.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bilicheck Transcutaneous - Each Time PX-301887201 CDM 88720 CPT 0301 RC outpatient 18 18 13.48 13.48 fee schedule 18 93 14.58 percent of total billed charges 5.02 5.02 fee schedule 5.02 5.02 fee schedule 5.02 5.02 fee schedule 5.02 18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Clarsure Oligo-Snp Array PX-302812291 CDM 81229 CPT 0302 RC outpatient 2900 2900 964.44 964.44 fee schedule 2900 93 2349 percent of total billed charges 1160 1160 fee schedule 1160 1160 fee schedule 1160 1160 fee schedule 964.44 2900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Apoliprotein E Genotyping PX-302814012 CDM 81401 CPT 0302 RC outpatient 342.5 342.5 259.42 259.42 fee schedule 342.5 93 277.43 percent of total billed charges 137 137 fee schedule 137 137 fee schedule 137 137 fee schedule 137 342.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Pancreatic Elastase, Feces" PX-302826530 CDM 82653 CPT 0300 RC outpatient 57.43 57.43 54.21 54.21 fee schedule 57.43 93 46.52 percent of total billed charges 22.97 22.97 fee schedule 22.97 22.97 fee schedule 22.97 22.97 fee schedule 22.97 57.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Immunoassay Not Inf Ab/Ag, Quant by Ria" PX-302835191 CDM 83519 CPT 0302 RC outpatient 94 94 36.25 36.25 fee schedule 94 93 76.14 percent of total billed charges 18.4 18.4 fee schedule 18.4 18.4 fee schedule 18.4 18.4 fee schedule 18.4 94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Interleukin-6 (Il-6), Serum" PX-302835290 CDM 83529 CPT 0302 RC outpatient 43.18 43.18 40.76 40.76 fee schedule 43.18 93 34.98 percent of total billed charges 17.27 17.27 fee schedule 17.27 17.27 fee schedule 17.27 17.27 fee schedule 17.27 43.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Smooth Muscle Fluorescent Ab, Screen Ea (Sma)" PX-302860150 CDM 86015 LOCAL 0302 RC outpatient 30.13 30.13 27.21 27.21 fee schedule 30.13 93 24.41 percent of total billed charges 30.13 30.13 other OPPS APC 30.13 30.13 other OPPS APC 12.05 12.05 fee schedule 12.05 30.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Wbc Antibody Identification PX-302860211 CDM 86021 CPT 0302 RC outpatient 56 56 27.96 27.96 fee schedule 56 93 45.36 percent of total billed charges 15.05 15.05 fee schedule 15.05 15.05 fee schedule 15.05 15.05 fee schedule 15.05 56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Anticytoplasmic Neut Fluorescent Ab, Screen Ea (Anca)" PX-302860360 CDM 86036 CPT 0302 RC outpatient 30.12 30.12 28.44 28.44 fee schedule 30.12 93 24.4 percent of total billed charges 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 30.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Inflammatory Bowel Disease Panel Fluorescent Ab, Screen Ea (Ibdpt)" PX-302860361 CDM 86036 CPT 0302 RC outpatient 30.13 30.13 28.44 28.44 fee schedule 30.13 93 24.41 percent of total billed charges 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 30.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ana Titer and Pattern PX-302860391 CDM 86039 CPT 0302 RC outpatient 27.9 27.9 29.95 29.95 fee schedule 27.9 93 22.6 percent of total billed charges 11.16 11.16 fee schedule 11.16 11.16 fee schedule 11.16 11.16 fee schedule 11.16 29.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Acetylcholn Rcptr Bndng Antb PX-302860410 CDM 86041 CPT 0302 RC outpatient 46 46 43.42 43.42 fee schedule 46 93 37.26 percent of total billed charges 18.4 18.4 fee schedule 18.4 18.4 fee schedule 18.4 18.4 fee schedule 18.4 46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Acetylcholn Rcptr Modlg Antb PX-302860430 CDM 86043 CPT 0302 RC outpatient 30.12 30.12 28.44 28.44 fee schedule 30.12 93 24.4 percent of total billed charges 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 30.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Nmo/Aqp4 Facs Fluorescent Noninfectious Ab, Screen Ea (Nmofs/Nmofc)" PX-302860530 CDM 86053 CPT 0302 RC outpatient 94.33 94.33 28.44 28.44 fee schedule 94.33 93 76.41 percent of total billed charges 37.73 37.73 fee schedule 37.73 37.73 fee schedule 37.73 37.73 fee schedule 28.44 94.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Immunoassay for Analyte Not Inf Ab or Ag PX-302861481 CDM 86148 CPT 0302 RC outpatient 40.18 40.18 26.63 26.63 fee schedule 40.18 93 32.55 percent of total billed charges 16.07 16.07 fee schedule 16.07 16.07 fee schedule 16.07 16.07 fee schedule 16.07 40.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC C1 Inhibitor, Functional" PX-302861611 CDM 86161 CPT 0302 RC outpatient 30 30 32.22 32.22 fee schedule 30 93 24.3 percent of total billed charges 12 12 fee schedule 12 12 fee schedule 12 12 fee schedule 12 32.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Endomysial Fluorescent Ab, Screen Ea (Ema)" PX-302862310 CDM 86231 CPT 0302 RC outpatient 30.23 30.23 28.53 28.53 fee schedule 30.23 93 24.49 percent of total billed charges 12.09 12.09 fee schedule 12.09 12.09 fee schedule 12.09 12.09 fee schedule 12.09 30.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Gliadin (Deaminated) Antibody PX-302862580 CDM 86258 CPT 0302 RC outpatient 30.12 30.12 27.21 27.21 fee schedule 30.12 93 24.4 percent of total billed charges 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 30.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Inhibin A PX-302863361 CDM 86336 CPT 0302 RC outpatient 38.97 38.97 41.8 41.8 fee schedule 38.97 93 31.57 percent of total billed charges 15.59 15.59 fee schedule 15.59 15.59 fee schedule 15.59 15.59 fee schedule 15.59 41.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC T Cells;Absolute Cd4 PX-302863611 CDM 86361 CPT 0302 RC outpatient 94 94 71.83 71.83 fee schedule 94 93 76.14 percent of total billed charges 26.78 26.78 fee schedule 26.78 26.78 fee schedule 26.78 26.78 fee schedule 26.78 94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Fluorescent Noninfectious Agent Ab, Screen Ea (Facs)" PX-302863630 CDM 86363 CPT 0302 RC outpatient 94.33 94.33 28.44 28.44 fee schedule 94.33 93 76.41 percent of total billed charges 37.73 37.73 fee schedule 37.73 37.73 fee schedule 37.73 37.73 fee schedule 28.44 94.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tissue Transglutaminase (Ttg) Ab PX-302863640 CDM 86364 CPT 0302 RC outpatient 28.83 28.83 27.21 27.21 fee schedule 28.83 93 23.35 percent of total billed charges 11.53 11.53 fee schedule 11.53 11.53 fee schedule 11.53 11.53 fee schedule 11.53 28.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Muscle-Specific Kinase Antb PX-302863660 CDM 86366 CPT 0302 RC outpatient 46 46 43.42 43.42 fee schedule 46 93 37.26 percent of total billed charges 18.4 18.4 fee schedule 18.4 18.4 fee schedule 18.4 18.4 fee schedule 18.4 46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Mitochondrial Ab, Immunoassay;Multi, Step (AMA)" PX-302863810 CDM 86381 CPT 0302 RC outpatient 63.63 63.63 60.06 60.06 fee schedule 63.63 93 51.54 percent of total billed charges 25.45 25.45 fee schedule 25.45 25.45 fee schedule 25.45 25.45 fee schedule 25.45 63.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ppd Skin Test PX-302865800 CDM 86580 CPT 0302 RC outpatient 70.93 70.93 12.56 12.56 fee schedule 70.93 93 57.45 percent of total billed charges 70.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.36 other OPPS APC 70.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.36 other OPPS APC 70.93 51 36.17 percent of total billed charges 12.56 70.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Rpr Titer PX-302865931 CDM 86593 CPT 0302 RC outpatient 57 57 11.83 11.83 fee schedule 57 93 46.17 percent of total billed charges 4.4 4.4 fee schedule 4.4 4.4 fee schedule 4.4 4.4 fee schedule 4.4 57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC P/Q Type Calcium Channel Ab Quant by Radioimmunoassay PX-302865960 CDM 86596 CPT 0302 RC outpatient 30.12 30.12 43.42 43.42 fee schedule 30.12 93 24.4 percent of total billed charges 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 12.05 fee schedule 12.05 43.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Coccidiodes PX-302866351 CDM 86635 CPT 0302 RC outpatient 37.6 37.6 28.67 28.67 fee schedule 37.6 93 30.46 percent of total billed charges 11.47 11.47 fee schedule 11.47 11.47 fee schedule 11.47 11.47 fee schedule 11.47 37.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Epstein Barr Nuclear Antigen PX-302866641 CDM 86664 CPT 0302 RC outpatient 157 157 41.05 41.05 fee schedule 157 93 127.17 percent of total billed charges 15.29 15.29 fee schedule 15.29 15.29 fee schedule 15.29 15.29 fee schedule 15.29 157 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Epstein-Barr Virus Vca Igg Ab PX-302866651 CDM 86665 CPT 0302 RC outpatient 86 86 48.67 48.67 fee schedule 86 93 69.66 percent of total billed charges 18.14 18.14 fee schedule 18.14 18.14 fee schedule 18.14 18.14 fee schedule 18.14 86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hiv -1 PX-302867011 CDM 86701 CPT 0302 RC outpatient 110 110 23.83 23.83 fee schedule 110 93 89.1 percent of total billed charges 8.89 8.89 fee schedule 8.89 8.89 fee schedule 8.89 8.89 fee schedule 8.89 110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Antibody Hiv 2 PX-302867021 CDM 86702 CPT 0302 RC outpatient 36 36 28.34 28.34 fee schedule 36 93 29.16 percent of total billed charges 13.52 13.52 fee schedule 13.52 13.52 fee schedule 13.52 13.52 fee schedule 13.52 36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hiv 1 & 2 Single Assay PX-302867031 CDM 86703 CPT 0302 RC outpatient 59 59 36.81 36.81 fee schedule 59 93 47.79 percent of total billed charges 59 59 other OPPS APC 59 59 other OPPS APC 13.71 13.71 fee schedule 13.71 59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Antibody Trichinella PX-302867840 CDM 86784 CPT 0302 RC outpatient 31.4 31.4 33.7 33.7 fee schedule 31.4 93 25.43 percent of total billed charges 12.56 12.56 fee schedule 12.56 12.56 fee schedule 12.56 12.56 fee schedule 12.56 33.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Red Blood Cell Automated PX-305850411 CDM 85041 CPT 0305 RC outpatient 13 13 7.72 7.72 fee schedule 13 93 10.53 percent of total billed charges 3.02 3.02 fee schedule 3.02 3.02 fee schedule 3.02 3.02 fee schedule 3.02 13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Activated Clotting Time PX-305853471 CDM 85347 CPT 0305 RC outpatient 57 57 11.42 11.42 fee schedule 57 93 46.17 percent of total billed charges 4.28 4.28 fee schedule 4.28 4.28 fee schedule 4.28 4.28 fee schedule 4.28 57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fibrin Split Product PX-305853621 CDM 85362 CPT 0305 RC outpatient 17.23 17.23 18.47 18.47 fee schedule 17.23 93 13.96 percent of total billed charges 6.89 6.89 fee schedule 6.89 6.89 fee schedule 6.89 6.89 fee schedule 6.89 18.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Sed Rate Erythrocyte, Automated" PX-305856521 CDM 85652 CPT 0305 RC outpatient 37 37 7.24 7.24 fee schedule 37 93 29.97 percent of total billed charges 2.7 2.7 fee schedule 2.7 2.7 fee schedule 2.7 2.7 fee schedule 2.7 37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Fungus, Blood" PX-306871031 CDM 87103 CPT 0306 RC outpatient 51.15 51.15 24.19 24.19 fee schedule 51.15 93 41.43 percent of total billed charges 51.15 51.15 other OPPS APC 51.15 51.15 other OPPS APC 20.46 20.46 fee schedule 20.46 51.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vaginal Smear Ferning PX-306872051 CDM 87205 CPT 0306 RC outpatient 48 48 11.44 11.44 fee schedule 48 93 38.88 percent of total billed charges 4.27 4.27 fee schedule 4.27 4.27 fee schedule 4.27 4.27 fee schedule 4.27 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Herpes Culture W/O Typing PX-306872551 CDM 87255 CPT 0306 RC outpatient 84.65 84.65 90.84 90.84 fee schedule 84.65 93 68.57 percent of total billed charges 33.86 33.86 fee schedule 33.86 33.86 fee schedule 33.86 33.86 fee schedule 33.86 90.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Iaad Ia Cryptosporidium PX-306873280 CDM 87328 CPT 0306 RC outpatient 34.55 34.55 29.55 29.55 fee schedule 34.55 93 27.99 percent of total billed charges 13.82 13.82 fee schedule 13.82 13.82 fee schedule 13.82 13.82 fee schedule 13.82 34.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Giardia Antigen, Brushing" PX-306873291 CDM 87329 CPT 0306 RC outpatient 29.95 29.95 29.55 29.55 fee schedule 29.95 93 24.26 percent of total billed charges 11.98 11.98 fee schedule 11.98 11.98 fee schedule 11.98 11.98 fee schedule 11.98 29.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Candida, Dna, Dir Probe" PX-306874800 CDM 87480 CPT 0306 RC outpatient 72 72 53.8 53.8 fee schedule 72 93 58.32 percent of total billed charges 20.05 20.05 fee schedule 20.05 20.05 fee schedule 20.05 20.05 fee schedule 20.05 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Clostridium Difficile, Toxin Gene" PX-306874931 CDM 87493 CPT 0306 RC outpatient 126 126 95.44 95.44 fee schedule 126 93 102.06 percent of total billed charges 37.27 37.27 fee schedule 37.27 37.27 fee schedule 37.27 37.27 fee schedule 37.27 126 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Infectious Agent Dna/Rna Influenza 1st 2 Types PX-306875020 CDM 87502 CPT 0306 RC outpatient 292 292 231.4 231.4 fee schedule 292 93 236.52 percent of total billed charges 95.8 95.8 fee schedule 95.8 95.8 fee schedule 95.8 95.8 fee schedule 95.8 292 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Gardner Vag, Dna, Dir Probe" PX-306875100 CDM 87510 CPT 0306 RC outpatient 72 72 53.8 53.8 fee schedule 72 93 58.32 percent of total billed charges 20.05 20.05 fee schedule 20.05 20.05 fee schedule 20.05 20.05 fee schedule 20.05 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Gardner Vag Dna Quant PX-306875121 CDM 87512 CPT 0306 RC outpatient 104.4 104.4 76.13 76.13 fee schedule 104.4 93 84.56 percent of total billed charges 41.76 41.76 fee schedule 41.76 41.76 fee schedule 41.76 41.76 fee schedule 41.76 104.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Mycobacterium Tuberculosis, Pcr" PX-306875561 CDM 87556 CPT 0306 RC outpatient 104.2 104.2 94.16 94.16 fee schedule 104.2 93 84.4 percent of total billed charges 41.68 41.68 fee schedule 41.68 41.68 fee schedule 41.68 41.68 fee schedule 41.68 104.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Iadna Dna/Rna Rsv Amplified Probe Technique PX-306876340 CDM 87634 CPT 0306 RC outpatient 175.5 175.5 204.52 204.52 fee schedule 175.5 93 142.16 percent of total billed charges 175.5 175.5 other OPPS APC 175.5 175.5 other OPPS APC 70.2 70.2 fee schedule 70.2 204.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mssa by Pcr PX-306876401 CDM 87640 CPT 0306 RC outpatient 87.72 87.72 95.44 95.44 fee schedule 87.72 93 71.05 percent of total billed charges 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 95.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Strep a by Pcr PX-306876511 CDM 87651 CPT 0306 RC outpatient 87.72 87.72 94.16 94.16 fee schedule 87.72 93 71.05 percent of total billed charges 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 35.09 fee schedule 35.09 94.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Trichomonas Vagin, Dir Probe" PX-306876600 CDM 87660 CPT 0306 RC outpatient 72 72 53.8 53.8 fee schedule 72 93 58.32 percent of total billed charges 20.05 20.05 fee schedule 20.05 20.05 fee schedule 20.05 20.05 fee schedule 20.05 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Inf Agent by Nucleic Acid, Quantificatio" PX-306877992 CDM 87799 CPT 0306 RC outpatient 153 153 114.91 114.91 fee schedule 153 93 123.93 percent of total billed charges 42.84 42.84 fee schedule 42.84 42.84 fee schedule 42.84 42.84 fee schedule 42.84 153 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Molecular Testing Bbd PX-309814031 CDM 81403 CPT 0309 RC outpatient 463 463 406.86 406.86 fee schedule 463 93 375.03 percent of total billed charges 185.2 185.2 fee schedule 185.2 185.2 fee schedule 185.2 185.2 fee schedule 185.2 463 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Braf Mutation Anal (Oth Solid Tum PX-310812101 CDM 81210 CPT 0310 RC outpatient 447 447 100.2 100.2 fee schedule 447 93 362.07 percent of total billed charges 175.4 175.4 fee schedule 175.4 175.4 fee schedule 175.4 175.4 fee schedule 100.2 447 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tpmg Thiopurine S-Methyltrans Gene Analysis Tpnuv PX-310813350 CDM 81335 CPT 0310 RC outpatient 437.02 437.02 437.02 74 323.39 percent of total billed charges 437.02 93 353.99 percent of total billed charges 174.81 174.81 fee schedule 174.81 174.81 fee schedule 174.81 174.81 fee schedule 174.81 437.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ugt1a1 Gene Polymorphism PX-310813500 CDM 81350 CPT 0310 RC outpatient 585 585 181.18 181.18 fee schedule 585 93 473.85 percent of total billed charges 234 234 fee schedule 234 234 fee schedule 234 234 fee schedule 181.18 585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Molecular Pathology Procedure, Level 4" PX-310814030 CDM 81403 CPT 0310 RC outpatient 463 463 406.86 406.86 fee schedule 463 93 375.03 percent of total billed charges 185.2 185.2 fee schedule 185.2 185.2 fee schedule 185.2 185.2 fee schedule 185.2 463 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Target Genomic Sequ Analysis Panel, Solid Organ Neopl 5-50 Genes" PX-310814451 CDM 81445 CPT 0310 RC outpatient 1495 1495 1147.99 1147.99 fee schedule 1495 93 1210.95 percent of total billed charges 597.91 597.91 fee schedule 597.91 597.91 fee schedule 597.91 597.91 fee schedule 597.91 1495 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Solid Tumor Panel PX-310814453 CDM 81445 CPT 0310 RC outpatient 1495 1495 1147.99 1147.99 fee schedule 1495 93 1210.95 percent of total billed charges 597.91 597.91 fee schedule 597.91 597.91 fee schedule 597.91 597.91 fee schedule 597.91 1495 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Target Genomic Sequence Analysis PX-310814501 CDM 81450 CPT 0310 RC outpatient 1898.82 1898.82 1244.93 1244.93 fee schedule 1898.82 93 1538.04 percent of total billed charges 759.53 759.53 fee schedule 759.53 759.53 fee schedule 759.53 759.53 fee schedule 759.53 1898.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Cytology Washing, Smears" PX-310881040 CDM 88104 CPT 0310 RC outpatient 122 122 44.08 44.08 fee schedule 122 93 98.82 percent of total billed charges 122 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40.89 other OPPS APC 122 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40.89 other OPPS APC 122 51 62.22 percent of total billed charges 44.08 122 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Cytology, Cytospins" PX-310881080 CDM 88108 CPT 0310 RC outpatient 155 155 49.23 49.23 fee schedule 155 93 125.55 percent of total billed charges 155 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40.89 other OPPS APC 155 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40.89 other OPPS APC 155 51 79.05 percent of total billed charges 49.23 155 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fine Needle Aspiration PX-310881720 CDM 88172 CPT 0310 RC outpatient 406.85 406.85 57.49 57.49 fee schedule 406.85 93 329.55 percent of total billed charges 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 51 207.49 percent of total billed charges 57.49 406.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Fna, Interpretation]" PX-310881730 CDM 88173 CPT 0310 RC outpatient 231 231 79.53 79.53 fee schedule 231 93 187.11 percent of total billed charges 231 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 231 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 231 51 117.81 percent of total billed charges 79.53 231 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Fna, Ea Addl Immediate Interp Same Site" PX-310881770 CDM 88177 CPT 0310 RC outpatient 36 36 36 74 26.64 percent of total billed charges 36 93 29.16 percent of total billed charges 36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36 other OPPS APC 36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36 other OPPS APC 36 51 18.36 percent of total billed charges 36 36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Dna Ploidy PX-310881820 CDM 88182 CPT 0310 RC outpatient 298 298 76.35 76.35 fee schedule 298 93 241.38 percent of total billed charges 298 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 298 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 298 51 151.98 percent of total billed charges 76.35 298 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Flow Cytometry, Cell Cycle or Dna Analysis" PX-310881821 CDM 88182 CPT 0310 RC outpatient 298 298 76.35 76.35 fee schedule 298 93 241.38 percent of total billed charges 298 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 298 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 298 51 151.98 percent of total billed charges 76.35 298 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Surg Path, Level I" PX-310883040 CDM 88300 CPT 0310 RC outpatient 243 243 28.11 28.11 fee schedule 243 93 196.83 percent of total billed charges 243 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.36 other OPPS APC 243 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.36 other OPPS APC 243 51 123.93 percent of total billed charges 28.11 243 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Surg Path, Level II" PX-310883050 CDM 88302 CPT 0310 RC outpatient 426 426 49.56 49.56 fee schedule 426 93 345.06 percent of total billed charges 426 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.36 other OPPS APC 426 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.36 other OPPS APC 426 51 217.26 percent of total billed charges 49.56 426 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Surg Path, Level III" PX-310883051 CDM 88304 CPT 0310 RC outpatient 426 426 65.99 65.99 fee schedule 426 93 345.06 percent of total billed charges 426 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 426 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 426 51 217.26 percent of total billed charges 65.99 426 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Surg Path, Level IV" PX-310883052 CDM 88305 CPT 0310 RC outpatient 426 426 89.94 89.94 fee schedule 426 93 345.06 percent of total billed charges 426 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 426 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 426 51 217.26 percent of total billed charges 89.94 426 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Surg Path Prostate PX-310883053 CDM 88305 CPT 0310 RC outpatient 426 426 89.94 89.94 fee schedule 426 93 345.06 percent of total billed charges 426 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 426 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 426 51 217.26 percent of total billed charges 89.94 426 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Renal Path Level IV Wet Ts PX-310883054 CDM 88305 CPT 0310 RC outpatient 341 341 89.94 89.94 fee schedule 341 93 276.21 percent of total billed charges 341 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 341 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 341 51 173.91 percent of total billed charges 89.94 341 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Surg Path, Level V" PX-310883070 CDM 88307 CPT 0310 RC outpatient 856.2 856.2 135.51 135.51 fee schedule 856.2 93 693.52 percent of total billed charges 856.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 366.5 other OPPS APC 856.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 366.5 other OPPS APC 856.2 51 436.66 percent of total billed charges 135.51 856.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Surg Path, Level VI" PX-310883071 CDM 88309 CPT 0310 RC outpatient 2048.23 2048.23 177.61 177.61 fee schedule 2048.23 93 1659.07 percent of total billed charges 2048.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 876.76 other OPPS APC 2048.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 876.76 other OPPS APC 2048.23 51 1044.6 percent of total billed charges 177.61 2048.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Decal PX-310883110 CDM 88311 CPT 0310 RC outpatient 86 86 25.54 25.54 fee schedule 86 93 69.66 percent of total billed charges 86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 86 other OPPS APC 86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 86 other OPPS APC 86 51 43.86 percent of total billed charges 25.54 86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Special Stain I PX-310883120 CDM 88312 CPT 0310 RC outpatient 129.08 129.08 43.26 43.26 fee schedule 129.08 93 104.55 percent of total billed charges 129.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 129.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 129.08 51 65.83 percent of total billed charges 43.26 129.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Special Stain II PX-310883130 CDM 88313 CPT 0310 RC outpatient 145.7 145.7 43.26 43.26 fee schedule 145.7 93 118.02 percent of total billed charges 145.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.37 other OPPS APC 145.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.37 other OPPS APC 145.7 51 74.31 percent of total billed charges 43.26 145.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Frozen Section PX-310883310 CDM 88331 CPT 0310 RC outpatient 500 500 70.09 70.09 fee schedule 500 93 405 percent of total billed charges 500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 500 51 255 percent of total billed charges 70.09 500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Add'l Frozen Section PX-310883320 CDM 88332 CPT 0310 RC outpatient 87 87 30.47 30.47 fee schedule 87 93 70.47 percent of total billed charges 87 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 87 other OPPS APC 87 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 87 other OPPS APC 87 51 44.37 percent of total billed charges 30.47 87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Touch Prep PX-310883330 CDM 88333 CPT 0310 RC outpatient 2048.23 2048.23 45.83 45.83 fee schedule 2048.23 93 1659.07 percent of total billed charges 2048.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 876.76 other OPPS APC 2048.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 876.76 other OPPS APC 2048.23 51 1044.6 percent of total billed charges 45.83 2048.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Additional Touch Prep PX-310883340 CDM 88334 CPT 0310 RC outpatient 41 41 42.5 42.5 fee schedule 41 93 33.21 percent of total billed charges 41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41 other OPPS APC 41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41 other OPPS APC 41 51 20.91 percent of total billed charges 41 42.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Immunoperoxidase Stain Addl PX-310883410 CDM 88341 CPT 0310 RC outpatient 279 279 279 74 206.46 percent of total billed charges 279 93 225.99 percent of total billed charges 279 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 279 other OPPS APC 279 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 279 other OPPS APC 279 51 142.29 percent of total billed charges 279 279 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Immunoperoxidase Stain PX-310883420 CDM 88342 CPT 0310 RC outpatient 406.85 406.85 79.6 79.6 fee schedule 406.85 93 329.55 percent of total billed charges 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 51 207.49 percent of total billed charges 79.6 406.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Immunohistochemistry, Each Antibody" PX-310883422 CDM 88342 CPT 0310 RC outpatient 406.85 406.85 79.6 79.6 fee schedule 406.85 93 329.55 percent of total billed charges 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 51 207.49 percent of total billed charges 79.6 406.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Immunofluorescence PX-310883460 CDM 88346 CPT 0310 RC outpatient 500 500 70.02 70.02 fee schedule 500 93 405 percent of total billed charges 500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 500 51 255 percent of total billed charges 70.02 500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Igg2 Immunofluo Stain Renal PX-310883461 CDM 88346 CPT 0310 RC outpatient 743.62 743.62 70.02 70.02 fee schedule 743.62 93 602.33 percent of total billed charges 743.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 743.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 743.62 51 379.25 percent of total billed charges 70.02 743.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Renal Biopsy Electron Microscopy PX-310883480 CDM 88348 CPT 0310 RC outpatient 2048.23 2048.23 397.49 397.49 fee schedule 2048.23 93 1659.07 percent of total billed charges 2048.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 876.76 other OPPS APC 2048.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 876.76 other OPPS APC 2048.23 51 1044.6 percent of total billed charges 397.49 2048.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Tumor Ihc Quant or Semi Quant, Ea Antibody" PX-310883600 CDM 88360 CPT 0312 RC outpatient 406.85 406.85 93.6 93.6 fee schedule 406.85 93 329.55 percent of total billed charges 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 51 207.49 percent of total billed charges 93.6 406.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ihc Antibody via Image Analysis PX-310883610 CDM 88361 CPT 0310 RC outpatient 856.2 856.2 100.87 100.87 fee schedule 856.2 93 693.52 percent of total billed charges 856.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 366.5 other OPPS APC 856.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 366.5 other OPPS APC 856.2 51 436.66 percent of total billed charges 100.87 856.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC in Situ Hybird (Fish) Ea Add Sing Probe PX-310883641 CDM 88364 CPT 0310 RC outpatient 194.4 194.4 194.4 74 143.86 percent of total billed charges 194.4 93 157.46 percent of total billed charges 194.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 194.4 other OPPS APC 194.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 194.4 other OPPS APC 194.4 51 99.14 percent of total billed charges 194.4 194.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tissue in-Situ Hybridization PX-310883650 CDM 88365 CPT 0312 RC outpatient 406.85 406.85 113.92 113.92 fee schedule 406.85 93 329.55 percent of total billed charges 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 51 207.49 percent of total billed charges 113.92 406.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Her-2 Fish by Clarient PX-310883740 CDM 88374 CPT 0310 RC outpatient 406.85 406.85 651.15 651.15 fee schedule 406.85 93 329.55 percent of total billed charges 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 51 207.49 percent of total billed charges 406.85 651.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC M/Phmtrc Alsy Ish Quant/Semiq Cptr Ea Multiprb PX-310883741 CDM 88374 CPT 0310 RC outpatient 406.85 406.85 651.15 651.15 fee schedule 406.85 93 329.55 percent of total billed charges 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 51 207.49 percent of total billed charges 406.85 651.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Morphometric in Situ Multiplex Prob Stai PX-310883771 CDM 88377 CPT 0310 RC outpatient 406.85 406.85 747.93 747.93 fee schedule 406.85 93 329.55 percent of total billed charges 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 51 207.49 percent of total billed charges 406.85 747.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Microdissection Manual-Glob PX-310883814 CDM 88381 CPT 0310 RC outpatient 176.56 176.56 176.56 74 130.65 percent of total billed charges 176.56 93 143.01 percent of total billed charges 176.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176.56 other OPPS APC 176.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176.56 other OPPS APC 176.56 51 90.05 percent of total billed charges 176.56 176.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Microdissection Manual-Inter PX-310883815 CDM 88381 CPT 0310 RC outpatient 176.56 176.56 176.56 74 130.65 percent of total billed charges 176.56 93 143.01 percent of total billed charges 176.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176.56 other OPPS APC 176.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176.56 other OPPS APC 176.56 51 90.05 percent of total billed charges 176.56 176.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cytology Select Enhancement PX-311881120 CDM 88112 CPT 0311 RC outpatient 129.08 129.08 64.85 64.85 fee schedule 129.08 93 104.55 percent of total billed charges 129.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 129.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.25 other OPPS APC 129.08 51 65.83 percent of total billed charges 64.85 129.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cytology Thin Prep Manual PX-311881420 CDM 88142 CPT 0311 RC outpatient 97 97 54.36 54.36 fee schedule 97 93 78.57 percent of total billed charges 20.26 20.26 fee schedule 20.26 20.26 fee schedule 20.26 20.26 fee schedule 20.26 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cytology Auto Thin Prep Screen PX-311881750 CDM 88175 CPT 0311 RC outpatient 95 95 71.06 71.06 fee schedule 95 93 76.95 percent of total billed charges 26.61 26.61 fee schedule 26.61 26.61 fee schedule 26.61 26.61 fee schedule 26.61 95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Pap Smear Collection PX-311Q00911 CDM Q0091 HCPCS 0311 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 51 39.78 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Culture, Typing;Immunofluorscent Eac" PX-312871401 CDM 87140 CPT 0306 RC outpatient 13.92 13.92 14.96 14.96 fee schedule 13.92 93 11.28 percent of total billed charges 13.92 13.92 other OPPS APC 13.92 13.92 other OPPS APC 5.57 5.57 fee schedule 5.57 14.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Tumor Immunohistochem, Ea Ab, Manual" PX-312883602 CDM 88360 CPT 0312 RC outpatient 406.85 406.85 93.6 93.6 fee schedule 406.85 93 329.55 percent of total billed charges 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.15 other OPPS APC 406.85 51 207.49 percent of total billed charges 93.6 406.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Si Joint Inject W Anesth PX-320270960 CDM 27096 CPT 0320 RC outpatient 2556 2556 11.41 2556 fee schedule 2556 93 2070.36 percent of total billed charges 2556 2556 other OPPS APC 2556 2556 other OPPS APC 2556 32.21 823.29 percent of total billed charges 11.41 2556 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Inject Contrast Knee Arthorgr PX-320273700 CDM 27369 CPT 0320 RC outpatient 61 61 61 74 45.14 percent of total billed charges 61 93 49.41 percent of total billed charges 61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 61 other OPPS APC 61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 61 other OPPS APC 61 51 31.11 percent of total billed charges 61 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hip W Pelvis 4 or More Views PX-320350302 CDM 73503 CPT 0320 RC outpatient 316 316 85.63 85.63 fee schedule 316 93 255.96 percent of total billed charges 316 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 316 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 45.79 45.79 fee schedule 45.79 316 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Xr Fl Ng Tube Placement PX-320437520 CDM 43752 CPT 0320 RC outpatient 949.07 949.07 949.07 74 702.31 percent of total billed charges 949.07 93 768.75 percent of total billed charges 949.07 949.07 other OPPS APC 949.07 949.07 other OPPS APC 949.07 51 484.03 percent of total billed charges 949.07 949.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC T-Tube Cholangiogram PX-320475310 CDM 47531 CPT 0320 RC outpatient 8240.85 8240.85 11.41 11.41 fee schedule 8240.85 93 6675.09 percent of total billed charges 8240.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3527.55 other OPPS APC 8240.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3527.55 other OPPS APC 8240.85 51 4202.83 percent of total billed charges 11.41 8240.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Xr T Tube Cholangiog New Access PX-320475320 CDM 47532 CPT 0320 RC outpatient 8240.85 8240.85 11.41 8240.85 fee schedule 8240.85 93 6675.09 percent of total billed charges 8240.85 8240.85 other OPPS APC 8240.85 8240.85 other OPPS APC 8240.85 32.21 2654.38 percent of total billed charges 11.41 8240.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Xr Fl Cecum Tube Placement PX-320494420 CDM 49442 CPT 0320 RC outpatient 2810.9 2810.9 2810.9 74 2080.07 percent of total billed charges 2810.9 93 2276.83 percent of total billed charges 2810.9 2810.9 other OPPS APC 2810.9 2810.9 other OPPS APC 2810.9 51 1433.56 percent of total billed charges 2810.9 2810.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Replacement of GI Tube Under Fluoro PX-320494501 CDM 49450 CPT 0320 RC outpatient 2159.23 2159.23 2159.23 74 1597.83 percent of total billed charges 2159.23 93 1748.98 percent of total billed charges 2159.23 2159.23 other OPPS APC 2159.23 2159.23 other OPPS APC 2159.23 51 1101.21 percent of total billed charges 2159.23 2159.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Lumbar Injection Pain Mgt PX-320623231 CDM 62323 CPT 0320 RC outpatient 1647.25 1647.25 1647.25 74 1218.97 percent of total billed charges 1647.25 93 1334.27 percent of total billed charges 1647.25 1647.25 other OPPS APC 1647.25 1647.25 other OPPS APC 1647.25 51 840.1 percent of total billed charges 1647.25 1647.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Orbit-Foreign Body PX-320700300 CDM 70030 CPT 0320 RC outpatient 216.45 216.45 62.26 62.26 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 23.7 23.7 fee schedule 23.7 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mandible - Limited < 4 Views PX-320701001 CDM 70100 CPT 0320 RC outpatient 216.45 216.45 72.65 72.65 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 29.54 29.54 fee schedule 29.54 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mandible PX-320701100 CDM 70110 CPT 0320 RC outpatient 261.88 261.88 91.42 91.42 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 31.17 31.17 fee schedule 31.17 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Facial Bones PX-320701400 CDM 70140 CPT 0320 RC outpatient 219 219 84.52 84.52 fee schedule 219 93 177.39 percent of total billed charges 219 219 other OPPS APC 219 219 other OPPS APC 22.07 22.07 fee schedule 22.07 219 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Facial Bones PX-320701500 CDM 70150 CPT 0320 RC outpatient 280 280 108.28 108.28 fee schedule 280 93 226.8 percent of total billed charges 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 34.09 34.09 fee schedule 34.09 280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Nose-Nasal Bones PX-320701600 CDM 70160 CPT 0320 RC outpatient 216.45 216.45 71.81 71.81 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 28.9 28.9 fee schedule 28.9 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Orbit-Fracture PX-320702000 CDM 70200 CPT 0320 RC outpatient 261.88 261.88 110.92 110.92 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 33.77 33.77 fee schedule 33.77 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sinuses PX-320702100 CDM 70210 CPT 0320 RC outpatient 276 276 82.85 82.85 fee schedule 276 93 223.56 percent of total billed charges 276 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 276 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 23.37 23.37 fee schedule 23.37 276 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sinuses PX-320702200 CDM 70220 CPT 0320 RC outpatient 317 317 107.47 107.47 fee schedule 317 93 256.77 percent of total billed charges 317 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 317 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 26.62 26.62 fee schedule 26.62 317 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sella Turcica PX-320702400 CDM 70240 CPT 0320 RC outpatient 216.45 216.45 63.91 63.91 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 216.45 other OPPS APC 216.45 216.45 other OPPS APC 23.37 23.37 fee schedule 23.37 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Skull < 4 Views PX-320702500 CDM 70250 CPT 0320 RC outpatient 261.88 261.88 90.58 90.58 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 26.62 26.62 fee schedule 26.62 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Skull - Complete Min 4 Views PX-320702600 CDM 70260 CPT 0320 RC outpatient 317 317 129.79 129.79 fee schedule 317 93 256.77 percent of total billed charges 317 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 317 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 30.52 30.52 fee schedule 30.52 317 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tm Joints - Unilateral PX-320703280 CDM 70328 CPT 0320 RC outpatient 216.45 216.45 69.79 69.79 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 25.32 25.32 fee schedule 25.32 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tm Joints - Bilateral PX-320703300 CDM 70330 CPT 0320 RC outpatient 216.45 216.45 112.36 112.36 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 216.45 other OPPS APC 216.45 216.45 other OPPS APC 40.59 40.59 fee schedule 40.59 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Soft Tissues of Neck PX-320703600 CDM 70360 CPT 0320 RC outpatient 216.45 216.45 62.26 62.26 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 22.07 22.07 fee schedule 22.07 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chest Single Ap View PX-320710100 CDM 71045 CPT 0320 RC outpatient 216.45 216.45 198.63 198.63 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 16.88 16.88 fee schedule 16.88 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chest 2 Views PX-320710200 CDM 71046 CPT 0320 RC outpatient 216.45 216.45 198.63 198.63 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 22.72 22.72 fee schedule 22.72 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Im Chest Apical Lordtic PX-320710210 CDM 71021 CPT 0320 RC outpatient 256 256 256 74 189.44 percent of total billed charges 256 93 207.36 percent of total billed charges 256 256 other OPPS APC 256 256 other OPPS APC 256 51 130.56 percent of total billed charges 256 256 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chest & Obliques PX-320710220 CDM 71022 CPT 0324 RC outpatient 256 256 256 74 189.44 percent of total billed charges 256 93 207.36 percent of total billed charges 256 256 other OPPS APC 256 256 other OPPS APC 256 51 130.56 percent of total billed charges 256 256 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chest-Decubitus PX-320710350 CDM 71048 CPT 0320 RC outpatient 280 280 198.63 198.63 fee schedule 280 93 226.8 percent of total billed charges 280 280 other OPPS APC 280 280 other OPPS APC 30.52 30.52 fee schedule 30.52 280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ribs PX-320711000 CDM 71100 CPT 0320 RC outpatient 216.45 216.45 83.18 83.18 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 25.65 25.65 fee schedule 25.65 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ribs With Chest PX-320711010 CDM 71101 CPT 0320 RC outpatient 293 293 98.82 98.82 fee schedule 293 93 237.33 percent of total billed charges 293 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 293 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 28.9 28.9 fee schedule 28.9 293 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ribs Bilateral With Chest PX-320711110 CDM 71111 CPT 0320 RC outpatient 378 378 126.45 126.45 fee schedule 378 93 306.18 percent of total billed charges 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 36.37 36.37 fee schedule 36.37 378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sternum PX-320711200 CDM 71120 CPT 0320 RC outpatient 243 243 89.18 89.18 fee schedule 243 93 196.83 percent of total billed charges 243 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 243 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 23.7 23.7 fee schedule 23.7 243 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sterno-Clavicular Jt PX-320711300 CDM 71130 CPT 0320 RC outpatient 216.45 216.45 96.58 96.58 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 30.19 30.19 fee schedule 30.19 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Spine 1 View PX-320720200 CDM 72020 CPT 0320 RC outpatient 216.45 216.45 59.63 59.63 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 16.23 16.23 fee schedule 16.23 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Xr C Spine 3 Views or Less PX-320720400 CDM 72040 CPT 0320 RC outpatient 216.45 216.45 86.05 86.05 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 28.25 28.25 fee schedule 28.25 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Xr C Spine 4 or 5 Views PX-320720500 CDM 72050 CPT 0320 RC outpatient 329 329 125.61 125.61 fee schedule 329 93 266.49 percent of total billed charges 329 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 329 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 39.94 39.94 fee schedule 39.94 329 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Xr C-Spine 6 or More Views PX-320720520 CDM 72052 CPT 0320 RC outpatient 451 451 155.37 155.37 fee schedule 451 93 365.31 percent of total billed charges 451 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 451 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 47.09 47.09 fee schedule 47.09 451 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Thoracic Spine 2 Views PX-320720700 CDM 72070 CPT 0320 RC outpatient 261.88 261.88 90.83 90.83 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 22.72 22.72 fee schedule 22.72 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Thoracic Spine 3 Views PX-320720720 CDM 72072 CPT 0320 RC outpatient 323 323 99.23 99.23 fee schedule 323 93 261.63 percent of total billed charges 323 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 323 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 28.25 28.25 fee schedule 28.25 323 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Thoracic Spine 4 Views PX-320720741 CDM 72074 CPT 0320 RC outpatient 261.88 261.88 117.19 117.19 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 32.14 32.14 fee schedule 32.14 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Spine-Thoracolumbar PX-320720800 CDM 72080 CPT 0320 RC outpatient 243 243 92.75 92.75 fee schedule 243 93 196.83 percent of total billed charges 243 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 243 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 24.02 24.02 fee schedule 24.02 243 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Scoliosis Series PX-320720810 CDM 72081 CPT 0320 RC outpatient 216.45 216.45 99.65 99.65 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 29.54 29.54 fee schedule 29.54 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Xr Thor & Lum Spine Port 1 View PX-320720811 CDM 72081 CPT 0320 RC outpatient 216.45 216.45 99.65 99.65 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 29.54 29.54 fee schedule 29.54 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Xr Scoliosis Series 2-3 View PX-320720820 CDM 72082 CPT 0320 RC outpatient 261.88 261.88 155.2 155.2 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 53.91 53.91 fee schedule 53.91 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Xr Port Thor/Lumb Spine 2-3 View PX-320720821 CDM 72082 CPT 0320 RC outpatient 261.88 261.88 155.2 155.2 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 53.91 53.91 fee schedule 53.91 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Xr Scoliosis Series 4-5 View PX-320720830 CDM 72083 CPT 0320 RC outpatient 300 300 99.65 99.65 fee schedule 300 93 243 percent of total billed charges 300 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 300 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 60.73 60.73 fee schedule 60.73 300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Xr Scoliosis Series Min 6 View PX-320720840 CDM 72084 CPT 0320 RC outpatient 357 357 99.65 99.65 fee schedule 357 93 289.17 percent of total billed charges 357 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 357 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 76.95 76.95 fee schedule 76.95 357 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Lumbar Spine 2 Views PX-320721000 CDM 72100 CPT 0320 RC outpatient 269 269 92.75 92.75 fee schedule 269 93 217.89 percent of total billed charges 269 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 269 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 28.57 28.57 fee schedule 28.57 269 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Lumbar Spine Min 4 Views PX-320721100 CDM 72110 CPT 0320 RC outpatient 366 366 127.53 127.53 fee schedule 366 93 296.46 percent of total billed charges 366 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 366 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 38.64 38.64 fee schedule 38.64 366 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Lumbar Spine 6 View W Bend PX-320721140 CDM 72114 CPT 0320 RC outpatient 395 395 161.12 161.12 fee schedule 395 93 319.95 percent of total billed charges 395 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 395 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 45.79 45.79 fee schedule 45.79 395 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Lumb Spine Bending Views 2 or 3 PX-320721200 CDM 72120 CPT 0320 RC outpatient 269 269 115.26 115.26 fee schedule 269 93 217.89 percent of total billed charges 269 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 269 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 29.22 29.22 fee schedule 29.22 269 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pelvis PX-320721700 CDM 72170 CPT 0320 RC outpatient 261.88 261.88 71.81 71.81 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 19.15 19.15 fee schedule 19.15 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pelvis : Comp > 3 Views PX-320721901 CDM 72190 CPT 0320 RC outpatient 261.88 261.88 91.92 91.92 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 29.54 29.54 fee schedule 29.54 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sacro-Iliac Joints PX-320722020 CDM 72202 CPT 0320 RC outpatient 261.88 261.88 84.52 84.52 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 27.92 27.92 fee schedule 27.92 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sacrum and/or Coccyx PX-320722200 CDM 72220 CPT 0320 RC outpatient 231 231 78.06 78.06 fee schedule 231 93 187.11 percent of total billed charges 231 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 231 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 23.7 23.7 fee schedule 23.7 231 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cervical Myelogram PX-320722400 CDM 62302 CPT 0361 RC outpatient 1907.2 1907.2 1392.16 1392.16 fee schedule 1907.2 93 1544.83 percent of total billed charges 1907.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 816.39 other OPPS APC 1907.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 816.39 other OPPS APC 1907.2 32.21 614.31 percent of total billed charges 1392.16 1907.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Thoracic Myelogram PX-320722550 CDM 72255 CPT 0320 RC outpatient 1907.2 1907.2 534.81 534.81 fee schedule 1907.2 93 1544.83 percent of total billed charges 1907.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 816.39 other OPPS APC 1907.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 816.39 other OPPS APC 63.33 63.33 fee schedule 63.33 1907.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Lumbar Myelogram PX-320722650 CDM 62304 CPT 0361 RC outpatient 1907.2 1907.2 1392.16 1392.16 fee schedule 1907.2 93 1544.83 percent of total billed charges 1907.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 816.39 other OPPS APC 1907.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 816.39 other OPPS APC 1907.2 32.21 614.31 percent of total billed charges 1392.16 1907.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Myelogram, Complete" PX-320722700 CDM 72270 CPT 0320 RC outpatient 1907.2 1907.2 762.95 762.95 fee schedule 1907.2 93 1544.83 percent of total billed charges 1907.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 816.39 other OPPS APC 1907.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 816.39 other OPPS APC 86.06 86.06 fee schedule 86.06 1907.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Clavicle PX-320730000 CDM 73000 CPT 0320 RC outpatient 216.45 216.45 70.04 70.04 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 24.02 24.02 fee schedule 24.02 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Scapula PX-320730100 CDM 73010 CPT 0320 RC outpatient 261.88 261.88 71.81 71.81 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 14.93 14.93 fee schedule 14.93 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Shoulder 1 View PX-320730202 CDM 73020 CPT 0320 RC outpatient 216.45 216.45 64.41 64.41 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 216.45 other OPPS APC 216.45 216.45 other OPPS APC 13.95 13.95 fee schedule 13.95 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Shoulder PX-320730300 CDM 73030 CPT 0320 RC outpatient 231 231 78.9 78.9 fee schedule 231 93 187.11 percent of total billed charges 231 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 231 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 25.32 25.32 fee schedule 25.32 231 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Shoulder Arthrogram PX-320730400 CDM 73040 CPT 0322 RC outpatient 916.05 916.05 273.29 273.29 fee schedule 916.05 93 742 percent of total billed charges 916.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 916.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 102.63 102.63 fee schedule 102.63 916.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Acromio-Clav Joints PX-320730500 CDM 73050 CPT 0320 RC outpatient 256 256 91.08 91.08 fee schedule 256 93 207.36 percent of total billed charges 256 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 256 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 19.48 19.48 fee schedule 19.48 256 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Humerus PX-320730600 CDM 73060 CPT 0320 RC outpatient 216.45 216.45 78.06 78.06 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 23.7 23.7 fee schedule 23.7 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Elbow PX-320730700 CDM 73070 CPT 0320 RC outpatient 216.45 216.45 69.2 69.2 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 20.77 20.77 fee schedule 20.77 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Elbow 3 Views PX-320730800 CDM 73080 CPT 0320 RC outpatient 231 231 78.06 78.06 fee schedule 231 93 187.11 percent of total billed charges 231 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 231 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 24.02 24.02 fee schedule 24.02 231 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Elbow Arthrogram PX-320730850 CDM 73085 CPT 0320 RC outpatient 916.05 916.05 274.98 274.98 fee schedule 916.05 93 742 percent of total billed charges 916.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 916.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 72.75 72.75 fee schedule 72.75 916.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Forearm PX-320730900 CDM 73090 CPT 0320 RC outpatient 216.45 216.45 70.04 70.04 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 21.1 21.1 fee schedule 21.1 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Wrist PX-320731000 CDM 73100 CPT 0320 RC outpatient 216.45 216.45 67.15 67.15 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 25.32 25.32 fee schedule 25.32 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Wrist 2 Views PX-320731002 CDM 73100 CPT 0320 RC outpatient 216.45 216.45 67.15 67.15 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 25.32 25.32 fee schedule 25.32 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Wrist 3 View PX-320731100 CDM 73110 CPT 0320 RC outpatient 219 219 72.77 72.77 fee schedule 219 93 177.39 percent of total billed charges 219 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 219 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 32.14 32.14 fee schedule 32.14 219 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Wrist Arthorgram PX-320731150 CDM 73115 CPT 0320 RC outpatient 916.05 916.05 222.79 222.79 fee schedule 916.05 93 742 percent of total billed charges 916.05 916.05 other OPPS APC 916.05 916.05 other OPPS APC 105.55 105.55 fee schedule 105.55 916.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hand PX-320731200 CDM 73120 CPT 0320 RC outpatient 261.88 261.88 67.15 67.15 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 23.05 23.05 fee schedule 23.05 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Xr Hand, 3 Views" PX-320731300 CDM 73130 CPT 0320 RC outpatient 219 219 72.77 72.77 fee schedule 219 93 177.39 percent of total billed charges 219 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 219 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 28.25 28.25 fee schedule 28.25 219 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Finger PX-320731400 CDM 73140 CPT 0320 RC outpatient 216.45 216.45 57.02 57.02 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 30.84 30.84 fee schedule 30.84 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Hip for Progress, 1 View" PX-320735010 CDM 73501 CPT 0320 RC outpatient 243 243 85.63 85.63 fee schedule 243 93 196.83 percent of total billed charges 243 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 243 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 23.37 23.37 fee schedule 23.37 243 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Hip for Fx, 2 or 3 Views" PX-320735020 CDM 73502 CPT 0320 RC outpatient 231 231 85.63 85.63 fee schedule 231 93 187.11 percent of total billed charges 231 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 231 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 36.04 36.04 fee schedule 36.04 231 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hips Bilaeral W Pelvis 2 Views PX-320735211 CDM 73521 CPT 0320 RC outpatient 269 269 97.98 97.98 fee schedule 269 93 217.89 percent of total billed charges 269 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 269 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 29.87 29.87 fee schedule 29.87 269 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hips Bilateral W Pelvis 3 4 Views PX-320735221 CDM 73522 CPT 0320 RC outpatient 354 354 97.98 97.98 fee schedule 354 93 286.74 percent of total billed charges 354 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 354 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 38.96 38.96 fee schedule 38.96 354 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pelvis/Hips PX-320735230 CDM 73523 CPT 0320 RC outpatient 439 439 97.98 97.98 fee schedule 439 93 355.59 percent of total billed charges 439 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 439 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 45.79 45.79 fee schedule 45.79 439 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Xr Hip Arthrogram PX-320735250 CDM 73525 CPT 0320 RC outpatient 916.05 916.05 274.02 274.02 fee schedule 916.05 93 742 percent of total billed charges 916.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 916.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 98.41 98.41 fee schedule 98.41 916.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Xr Femur (1)View PX-320735510 CDM 73551 CPT 0320 RC outpatient 216.45 216.45 78.06 78.06 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 216.45 other OPPS APC 216.45 216.45 other OPPS APC 20.77 20.77 fee schedule 20.77 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Femur PX-320735520 CDM 73552 CPT 0320 RC outpatient 250 250 78.06 78.06 fee schedule 250 93 202.5 percent of total billed charges 250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 26.3 26.3 fee schedule 26.3 250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Knee PX-320735600 CDM 73560 CPT 0320 RC outpatient 216.45 216.45 71.81 71.81 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 25.65 25.65 fee schedule 25.65 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Knees 3 Views PX-320735621 CDM 73562 CPT 0320 RC outpatient 269 269 78.9 78.9 fee schedule 269 93 217.89 percent of total billed charges 269 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 269 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 31.17 31.17 fee schedule 31.17 269 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Knee Complete PX-320735640 CDM 73564 CPT 0320 RC outpatient 280 280 87.97 87.97 fee schedule 280 93 226.8 percent of total billed charges 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 35.39 35.39 fee schedule 35.39 280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Knees Weight Bear Both PX-320735650 CDM 73565 CPT 0320 RC outpatient 216.45 216.45 68.95 68.95 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 31.17 31.17 fee schedule 31.17 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Arthrogram Knee PX-320735800 CDM 73580 CPT 0320 RC outpatient 916.05 916.05 324.28 324.28 fee schedule 916.05 93 742 percent of total billed charges 916.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 916.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 78.27 78.27 fee schedule 78.27 916.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Leg PX-320735900 CDM 73590 CPT 0320 RC outpatient 216.45 216.45 71.81 71.81 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 23.37 23.37 fee schedule 23.37 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Lower Extremity Infant 2 Views PX-320735921 CDM 73592 CPT 0320 RC outpatient 216.45 216.45 67.15 67.15 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 216.45 other OPPS APC 216.45 216.45 other OPPS APC 23.37 23.37 fee schedule 23.37 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ankle PX-320736000 CDM 73600 CPT 0320 RC outpatient 216.45 216.45 67.15 67.15 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 24.02 24.02 fee schedule 24.02 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Xr Ankle, 3 Views" PX-320736100 CDM 73610 CPT 0320 RC outpatient 219 219 72.77 72.77 fee schedule 219 93 177.39 percent of total billed charges 219 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 219 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 27.6 27.6 fee schedule 27.6 219 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Arthrogram Ankle PX-320736150 CDM 73615 CPT 0320 RC outpatient 916.05 916.05 274.02 274.02 fee schedule 916.05 93 742 percent of total billed charges 916.05 916.05 other OPPS APC 916.05 916.05 other OPPS APC 98.41 98.41 fee schedule 98.41 916.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Foot PX-320736200 CDM 73620 CPT 0320 RC outpatient 216.45 216.45 67.15 67.15 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 20.77 20.77 fee schedule 20.77 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Xr Foot 3 Views PX-320736300 CDM 73630 CPT 0320 RC outpatient 219 219 72.77 72.77 fee schedule 219 93 177.39 percent of total billed charges 219 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 219 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 25.65 25.65 fee schedule 25.65 219 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Heel PX-320736500 CDM 73650 CPT 0320 RC outpatient 216.45 216.45 65.25 65.25 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 20.45 20.45 fee schedule 20.45 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Toe PX-320736600 CDM 73660 CPT 0320 RC outpatient 216.45 216.45 57.02 57.02 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 22.4 22.4 fee schedule 22.4 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Xr Cysto/Litho Abdomen PX-320740000 CDM 74018 CPT 0320 RC outpatient 216.45 216.45 94.03 94.03 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 21.1 21.1 fee schedule 21.1 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Abdomen 2 Views PX-320740200 CDM 74019 CPT 0320 RC outpatient 268 268 94.03 94.03 fee schedule 268 93 217.08 percent of total billed charges 268 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 268 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 25.32 25.32 fee schedule 25.32 268 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Acute Abd Multiviews W 1 View Cxr PX-320740220 CDM 74022 CPT 0320 RC outpatient 261.88 261.88 110.39 110.39 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 34.09 34.09 fee schedule 34.09 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Esophagus Single Contrast Inc. Scout Chest/Delayed Images PX-320742200 CDM 74220 CPT 0320 RC outpatient 439 439 172.3 172.3 fee schedule 439 93 355.59 percent of total billed charges 439 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 439 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 67.55 67.55 fee schedule 67.55 439 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Esophagus Double Contrast PX-320742210 CDM 74221 CPT 0320 RC outpatient 437.65 437.65 380.84 380.84 fee schedule 437.65 93 354.5 percent of total billed charges 437.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 437.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 75.02 75.02 fee schedule 75.02 437.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Modified Barium Swallow W Scout/Delayed Images PX-320742300 CDM 74230 CPT 0320 RC outpatient 439 439 192.24 192.24 fee schedule 439 93 355.59 percent of total billed charges 439 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 439 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 97.11 97.11 fee schedule 97.11 439 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Gastrografin GI W Scout W/WO Delayed Images PX-320742400 CDM 74240 CPT 0320 RC outpatient 446 446 227.1 227.1 fee schedule 446 93 361.26 percent of total billed charges 446 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 446 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 82.82 82.82 fee schedule 82.82 446 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ugi Double Contrast PX-320742460 CDM 74246 CPT 0320 RC outpatient 446 446 245.78 245.78 fee schedule 446 93 361.26 percent of total billed charges 446 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 446 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 94.51 94.51 fee schedule 94.51 446 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Upper GI Series PX-320742470 CDM 74246 CPT 0320 RC outpatient 446 446 245.78 245.78 fee schedule 446 93 361.26 percent of total billed charges 446 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 446 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 94.51 94.51 fee schedule 94.51 446 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ugi/Small Bowel PX-320742490 CDM 74248 CPT 0320 RC outpatient 695 695 363.41 363.41 fee schedule 695 93 562.95 percent of total billed charges 695 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 695 other OPPS APC 695 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 695 other OPPS APC 48.38 48.38 fee schedule 48.38 695 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Small Bowel Series W Scout/Single Contrast PX-320742500 CDM 74250 CPT 0320 RC outpatient 524 524 185.34 185.34 fee schedule 524 93 424.44 percent of total billed charges 524 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 524 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 81.84 81.84 fee schedule 81.84 524 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Barium Enema Single Contrast W Scout/Delayed Images PX-320742700 CDM 74270 CPT 0320 RC outpatient 695 695 252.26 252.26 fee schedule 695 93 562.95 percent of total billed charges 695 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 695 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 102.3 102.3 fee schedule 102.3 695 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Barium Enema W/Air Doubele Contrast W Scout/Delayed Images PX-320742800 CDM 74280 CPT 0320 RC outpatient 817 817 338.71 338.71 fee schedule 817 93 661.77 percent of total billed charges 817 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 817 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 156.54 156.54 fee schedule 156.54 817 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Oper Cholangiogrm PX-320743000 CDM 74300 CPT 0320 RC outpatient 341 341 113.45 113.45 fee schedule 341 93 276.21 percent of total billed charges 341 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 341 other OPPS APC 341 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 341 other OPPS APC 341 51 173.91 percent of total billed charges 113.45 341 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Oper Cholagiogram Additional Images PX-320743010 CDM 74301 CPT 0320 RC outpatient 302 302 302 74 223.48 percent of total billed charges 302 93 244.62 percent of total billed charges 302 302 other OPPS APC 302 302 other OPPS APC 302 51 154.02 percent of total billed charges 302 302 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ercp PX-320743301 CDM 74330 CPT 0320 RC outpatient 426 426 419.32 419.32 fee schedule 426 93 345.06 percent of total billed charges 426 426 other OPPS APC 426 426 other OPPS APC 426 51 217.26 percent of total billed charges 419.32 426 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IV Pyleograms PX-320744000 CDM 74400 CPT 0320 RC outpatient 536 536 226.31 226.31 fee schedule 536 93 434.16 percent of total billed charges 536 536 other OPPS APC 536 536 other OPPS APC 109.11 109.11 fee schedule 109.11 536 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Retro Pyleogram PX-320744200 CDM 74420 CPT 0320 RC outpatient 916.05 916.05 303.8 303.8 fee schedule 916.05 93 742 percent of total billed charges 916.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 916.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 52.61 52.61 fee schedule 52.61 916.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cystogram PX-320744300 CDM 74430 CPT 0320 RC outpatient 916.05 916.05 142.5 142.5 fee schedule 916.05 93 742 percent of total billed charges 916.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 916.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 25.65 25.65 fee schedule 25.65 916.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Urethrocystogram Retro PX-320744501 CDM 74450 CPT 0320 RC outpatient 583.68 583.68 184.97 184.97 fee schedule 583.68 93 472.78 percent of total billed charges 583.68 583.68 other OPPS APC 583.68 583.68 other OPPS APC 583.68 51 297.68 percent of total billed charges 184.97 583.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Urethrogram PX-320744550 CDM 74455 CPT 0320 RC outpatient 583.68 583.68 197.92 197.92 fee schedule 583.68 93 472.78 percent of total billed charges 583.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 583.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 86.39 86.39 fee schedule 86.39 583.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Xr Hysterosalpingogram PX-320747400 CDM 74740 CPT 0320 RC outpatient 612 612 175.96 175.96 fee schedule 612 93 495.72 percent of total billed charges 612 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 612 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 73.72 73.72 fee schedule 73.72 612 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Shunt Series PX-320758090 CDM 75809 CPT 0320 RC outpatient 301 301 133.17 133.17 fee schedule 301 93 243.81 percent of total billed charges 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 57.8 57.8 fee schedule 57.8 301 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Venogram PX-320758200 CDM 75820 CPT 0320 RC outpatient 3814.83 3814.83 178.4 178.4 fee schedule 3814.83 93 3090.01 percent of total billed charges 3814.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1632.96 other OPPS APC 3814.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1632.96 other OPPS APC 57.8 57.8 fee schedule 57.8 3814.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Venogram Extremity Uni PX-320758201 CDM 75820 CPT 0320 RC outpatient 3814.83 3814.83 178.4 178.4 fee schedule 3814.83 93 3090.01 percent of total billed charges 3814.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1632.96 other OPPS APC 3814.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1632.96 other OPPS APC 57.8 57.8 fee schedule 57.8 3814.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Venogram Extremity Bilat PX-320758221 CDM 75822 CPT 0320 RC outpatient 3814.83 3814.83 272.7 272.7 fee schedule 3814.83 93 3090.01 percent of total billed charges 3814.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1632.96 other OPPS APC 3814.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1632.96 other OPPS APC 63.98 63.98 fee schedule 63.98 3814.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ivc PX-320758251 CDM 75825 CPT 0320 RC outpatient 7592.53 7592.53 1388.51 1388.51 fee schedule 7592.53 93 6149.95 percent of total billed charges 7592.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250.03 other OPPS APC 7592.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250.03 other OPPS APC 60.08 60.08 fee schedule 60.08 7592.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Venogram Renal Bil PX-320758331 CDM 75833 CPT 0320 RC outpatient 7592.53 7592.53 1430.54 1430.54 fee schedule 7592.53 93 6149.95 percent of total billed charges 7592.53 7592.53 other OPPS APC 7592.53 7592.53 other OPPS APC 77.28 77.28 fee schedule 77.28 7592.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Abscess Drain PX-320759891 CDM 75989 CPT 0320 RC outpatient 500 500 453.72 453.72 fee schedule 500 93 405 percent of total billed charges 500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 500 other OPPS APC 500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 500 other OPPS APC 55.53 55.53 fee schedule 55.53 500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fluoro Only -Up to 1 Hr PX-320760000 CDM 76000 CPT 0320 RC outpatient 583.68 583.68 150.12 150.12 fee schedule 583.68 93 472.78 percent of total billed charges 583.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 583.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 27.27 27.27 fee schedule 27.27 583.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Foreign Body Localization PX-320760100 CDM 76010 CPT 0320 RC outpatient 216.45 216.45 72.65 72.65 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 20.45 20.45 fee schedule 20.45 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC X-Ray Exam Surgical Specimen PX-320760980 CDM 76098 CPT 0320 RC outpatient 1314.08 1314.08 60.46 60.46 fee schedule 1314.08 93 1064.4 percent of total billed charges 1314.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 562.5 other OPPS APC 1314.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 562.5 other OPPS APC 26.95 26.95 fee schedule 26.95 1314.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Fluoroscopic Guidance Cvad PX-320770011 CDM 77001 CPT 0320 RC outpatient 122 122 257.97 257.97 fee schedule 122 93 98.82 percent of total billed charges 122 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 122 other OPPS APC 122 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 122 other OPPS APC 78.92 78.92 fee schedule 78.92 257.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fluro Guide Needle Placement PX-320770020 CDM 77002 CPT 0320 RC outpatient 237 237 171.74 171.74 fee schedule 237 93 191.97 percent of total billed charges 237 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 237 other OPPS APC 237 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 237 other OPPS APC 87.36 87.36 fee schedule 87.36 237 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Foot Arthrogram PX-320770021 CDM 77002 CPT 0320 RC outpatient 237 237 171.74 171.74 fee schedule 237 93 191.97 percent of total billed charges 237 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 237 other OPPS APC 237 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 237 other OPPS APC 87.36 87.36 fee schedule 87.36 237 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Toe Arthrogram PX-320770022 CDM 77002 CPT 0320 RC outpatient 237 237 171.74 171.74 fee schedule 237 93 191.97 percent of total billed charges 237 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 237 other OPPS APC 237 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 237 other OPPS APC 87.36 87.36 fee schedule 87.36 237 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bone Age Survey PX-320770720 CDM 77072 CPT 0320 RC outpatient 261.88 261.88 98.77 98.77 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 16.55 16.55 fee schedule 16.55 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Scanogram PX-320770730 CDM 77073 CPT 0320 RC outpatient 261.88 261.88 127.13 127.13 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 31.49 31.49 fee schedule 31.49 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Long Bone Survey PX-320770740 CDM 77074 CPT 0320 RC outpatient 361 361 169.31 169.31 fee schedule 361 93 292.41 percent of total billed charges 361 361 other OPPS APC 361 361 other OPPS APC 43.51 43.51 fee schedule 43.51 361 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Metastatic Bone Survey PX-320770750 CDM 77075 CPT 0320 RC outpatient 574 574 233.87 233.87 fee schedule 574 93 464.94 percent of total billed charges 574 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 574 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 71.76 71.76 fee schedule 71.76 574 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bone Survey Complete PX-320770755 CDM 77075 CPT 0320 RC outpatient 574 574 233.87 233.87 fee schedule 574 93 464.94 percent of total billed charges 574 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 574 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 71.76 71.76 fee schedule 71.76 574 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Infant Osseous Survey PX-320770760 CDM 77076 CPT 0320 RC outpatient 261.88 261.88 283.74 283.74 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 261.88 other OPPS APC 261.88 261.88 other OPPS APC 72.41 72.41 fee schedule 72.41 283.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Dexa Bone Density Axial PX-320770801 CDM 77080 CPT 0320 RC outpatient 261.88 261.88 153.53 153.53 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 28.9 28.9 fee schedule 28.9 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Dexa Scan Axial W Vert Fracture Assessme PX-320770851 CDM 77085 CPT 0320 RC outpatient 261.88 261.88 210.44 210.44 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 38.3 38.3 fee schedule 38.3 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Renal Lt/Rt Uni (W or W/O Flush) PX-323362511 CDM 36251 CPT 0323 RC outpatient 7592.53 7592.53 7592.53 74 5618.47 percent of total billed charges 7592.53 93 6149.95 percent of total billed charges 7592.53 7592.53 other OPPS APC 7592.53 7592.53 other OPPS APC 7592.53 51 3872.19 percent of total billed charges 7592.53 7592.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Renal Bil (W or W/O Flush) PX-323362521 CDM 36252 CPT 0323 RC outpatient 7592.53 7592.53 7592.53 74 5618.47 percent of total billed charges 7592.53 93 6149.95 percent of total billed charges 7592.53 7592.53 other OPPS APC 7592.53 7592.53 other OPPS APC 7592.53 51 3872.19 percent of total billed charges 7592.53 7592.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Abdominal Aortogram PX-323756251 CDM 75625 CPT 0323 RC outpatient 7592.53 7592.53 1388.72 1388.72 fee schedule 7592.53 93 6149.95 percent of total billed charges 7592.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250.03 other OPPS APC 7592.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250.03 other OPPS APC 58.45 58.45 fee schedule 58.45 7592.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Abd Aortogram With Runoff PX-323756301 CDM 75630 CPT 0323 RC outpatient 7592.53 7592.53 1522.04 1522.04 fee schedule 7592.53 93 6149.95 percent of total billed charges 7592.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250.03 other OPPS APC 7592.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250.03 other OPPS APC 62.99 62.99 fee schedule 62.99 7592.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vas Proc Angiography Ext Rs&I PX-323757101 CDM 75710 CPT 0323 RC outpatient 7592.53 7592.53 1390.41 1390.41 fee schedule 7592.53 93 6149.95 percent of total billed charges 7592.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250.03 other OPPS APC 7592.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250.03 other OPPS APC 67.21 67.21 fee schedule 67.21 7592.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Angio Extremity Bil PX-323757161 CDM 75716 CPT 0323 RC outpatient 7592.53 7592.53 1408.37 1408.37 fee schedule 7592.53 93 6149.95 percent of total billed charges 7592.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250.03 other OPPS APC 7592.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250.03 other OPPS APC 70.13 70.13 fee schedule 70.13 7592.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chest - W/Apical Lordotic 3 Views PX-324710471 CDM 71047 CPT 0324 RC outpatient 256 256 198.63 198.63 fee schedule 256 93 207.36 percent of total billed charges 256 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 256 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 28.57 28.57 fee schedule 28.57 256 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Chemo,Subq/Intra Non Hor Anti Neo" PX-331964010 CDM 96401 CPT 0331 RC outpatient 213.15 213.15 92.35 92.35 fee schedule 213.15 93 172.65 percent of total billed charges 213.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 213.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 69.9 69.9 fee schedule 69.9 213.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chemo Subq/Intra Hor Anti Neo PX-331964020 CDM 96402 CPT 0331 RC outpatient 213.15 213.15 92.35 92.35 fee schedule 213.15 93 172.65 percent of total billed charges 213.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 213.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 34.51 34.51 fee schedule 34.51 213.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chemo Admin IV Push-Singl/Initial PX-331964090 CDM 96409 CPT 0331 RC outpatient 847.04 847.04 345.13 345.13 fee schedule 847.04 93 686.1 percent of total billed charges 847.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 345.31 other OPPS APC 847.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 345.31 other OPPS APC 97.5 97.5 fee schedule 97.5 847.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chemo Admin IV Push-Each Add Drug PX-331964110 CDM 96411 CPT 0331 RC outpatient 282.45 282.45 176.27 176.27 fee schedule 282.45 93 228.78 percent of total billed charges 282.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 282.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 53.02 53.02 fee schedule 53.02 282.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Simulation Simple Initial PX-333772801 CDM 77280 CPT 0333 RC outpatient 330 330 427.36 427.36 fee schedule 330 93 267.3 percent of total billed charges 330 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 138.35 other OPPS APC 330 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 138.35 other OPPS APC 226.06 226.06 fee schedule 226.06 427.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Simulation, Intermediate" PX-333772850 CDM 77285 CPT 0333 RC outpatient 880.13 880.13 678.39 678.39 fee schedule 880.13 93 712.91 percent of total billed charges 880.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 376.74 other OPPS APC 880.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 376.74 other OPPS APC 374.82 374.82 fee schedule 374.82 880.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Simulation, Complex" PX-333772900 CDM 77290 CPT 0333 RC outpatient 880.13 880.13 831.88 831.88 fee schedule 880.13 93 712.91 percent of total billed charges 880.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 376.74 other OPPS APC 880.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 376.74 other OPPS APC 356.61 356.61 fee schedule 356.61 880.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Respiratory Motion Mgmt PX-333772930 CDM 77293 CPT 0333 RC outpatient 425 425 425 74 314.5 percent of total billed charges 425 93 344.25 percent of total billed charges 425 425 other OPPS APC 425 425 other OPPS APC 296.2 296.2 fee schedule 296.2 425 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC 3d Treatment Planning PX-333772950 CDM 77295 CPT 0333 RC outpatient 3300.53 3300.53 3317.08 3317.08 fee schedule 3300.53 93 2673.43 percent of total billed charges 3300.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1412.81 other OPPS APC 3300.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1412.81 other OPPS APC 250.66 250.66 fee schedule 250.66 3317.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Basic Dosimetry Calc PX-333773000 CDM 77300 CPT 0333 RC outpatient 426 426 206.2 206.2 fee schedule 426 93 345.06 percent of total billed charges 426 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 138.35 other OPPS APC 426 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 138.35 other OPPS APC 32.79 32.79 fee schedule 32.79 426 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Imrt Plan PX-333773010 CDM 77301 CPT 0333 RC outpatient 3300.53 3300.53 3719.05 3719.05 fee schedule 3300.53 93 2673.43 percent of total billed charges 3300.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1412.81 other OPPS APC 3300.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1412.81 other OPPS APC 1392.02 1392.02 fee schedule 1392.02 3719.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Computer Isodose-Complex PX-333773070 CDM 77307 CPT 0333 RC outpatient 880.13 880.13 448.1 448.1 fee schedule 880.13 93 712.91 percent of total billed charges 880.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 376.74 other OPPS APC 880.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 376.74 other OPPS APC 132.8 132.8 fee schedule 132.8 880.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Brachy Therapy Dos-Simple PX-333773160 CDM 77316 CPT 0333 RC outpatient 880.13 880.13 344.98 344.98 fee schedule 880.13 93 712.91 percent of total billed charges 880.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 376.74 other OPPS APC 880.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 376.74 other OPPS APC 168.84 168.84 fee schedule 168.84 880.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Special Therapy Port Plan PX-333773211 CDM 77321 CPT 0333 RC outpatient 880.13 880.13 513.26 513.26 fee schedule 880.13 93 712.91 percent of total billed charges 880.13 880.13 other OPPS APC 880.13 880.13 other OPPS APC 43.51 43.51 fee schedule 43.51 880.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Special Dosimetry (Eg,Tld)" PX-333773311 CDM 77331 CPT 0333 RC outpatient 353 353 151.32 151.32 fee schedule 353 93 285.93 percent of total billed charges 353 353 other OPPS APC 353 353 other OPPS APC 18.83 18.83 fee schedule 18.83 353 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Treatment Devices-Simple PX-333773320 CDM 77332 CPT 0333 RC outpatient 566 566 196.67 196.67 fee schedule 566 93 458.46 percent of total billed charges 566 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 138.35 other OPPS APC 566 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 138.35 other OPPS APC 15.25 15.25 fee schedule 15.25 566 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tx Device Intermediate (Mod 59) PX-333773331 CDM 77333 CPT 0333 RC outpatient 500 500 287.46 287.46 fee schedule 500 93 405 percent of total billed charges 500 500 other OPPS APC 500 500 other OPPS APC 95.48 95.48 fee schedule 95.48 500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Treatment Devices-Complex PX-333773340 CDM 77334 CPT 0333 RC outpatient 880.13 880.13 469.12 469.12 fee schedule 880.13 93 712.91 percent of total billed charges 880.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 376.74 other OPPS APC 880.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 376.74 other OPPS APC 63.98 63.98 fee schedule 63.98 880.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Physics, Consult., Cont." PX-333773360 CDM 77336 CPT 0333 RC outpatient 353 353 296.86 296.86 fee schedule 353 93 285.93 percent of total billed charges 353 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 138.35 other OPPS APC 353 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 138.35 other OPPS APC 86.61 86.61 fee schedule 86.61 353 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Design Mlc Device for Imrt PX-333773380 CDM 77338 CPT 0333 RC outpatient 880.13 880.13 773.89 773.89 fee schedule 880.13 93 712.91 percent of total billed charges 880.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 376.74 other OPPS APC 880.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 376.74 other OPPS APC 238.62 238.62 fee schedule 238.62 880.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Physics Consultation PX-333773700 CDM 77370 CPT 0333 RC outpatient 744 744 347.13 347.13 fee schedule 744 93 602.64 percent of total billed charges 744 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 138.35 other OPPS APC 744 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 138.35 other OPPS APC 140.76 140.76 fee schedule 140.76 744 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Treatment Delivery Srs Linear PX-333773720 CDM 77372 CPT 0333 RC outpatient 19432 19432 2057.52 2057.52 fee schedule 19432 93 15739.9 percent of total billed charges 19432 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7940.05 other OPPS APC 19432 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7940.05 other OPPS APC 928.39 928.39 fee schedule 928.39 19432 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sbrt Treatment Delivery per Frac PX-333773730 CDM 77373 CPT 0333 RC outpatient 4334 4334 3809.3 3809.3 fee schedule 4334 93 3510.54 percent of total billed charges 4334 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1819.37 other OPPS APC 4334 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1819.37 other OPPS APC 969.24 969.24 fee schedule 969.24 4334 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Imrt Treatments Simple PX-333773850 CDM 77385 CPT 0333 RC outpatient 1402.18 1402.18 1729.87 1729.87 fee schedule 1402.18 93 1135.77 percent of total billed charges 1402.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 600.21 other OPPS APC 1402.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 600.21 other OPPS APC 1402.18 51 715.11 percent of total billed charges 1402.18 1729.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Imrt Treatments Complex PX-333773860 CDM 77386 CPT 0333 RC outpatient 1402.18 1402.18 1729.87 1729.87 fee schedule 1402.18 93 1135.77 percent of total billed charges 1402.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 600.21 other OPPS APC 1402.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 600.21 other OPPS APC 1402.18 51 715.11 percent of total billed charges 1402.18 1729.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Stereoscopic Guide Vol Rad Ther PX-333773870 CDM 77387 CPT 0333 RC outpatient 311 311 281.59 281.59 fee schedule 311 93 251.91 percent of total billed charges 311 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 311 other OPPS APC 311 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 311 other OPPS APC 311 51 158.61 percent of total billed charges 281.59 311 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Scan for Therapy Guide PX-333773871 CDM 77387 CPT 0333 RC outpatient 311 311 281.59 281.59 fee schedule 311 93 251.91 percent of total billed charges 311 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 311 other OPPS APC 311 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 311 other OPPS APC 311 51 158.61 percent of total billed charges 281.59 311 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Trmt Delivery =>1mev, Complex" PX-333774120 CDM 77412 CPT 0333 RC outpatient 640.15 640.15 232.47 232.47 fee schedule 640.15 93 518.52 percent of total billed charges 640.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 274.02 other OPPS APC 640.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 274.02 other OPPS APC 640.15 51 326.48 percent of total billed charges 232.47 640.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Port Films PX-333774170 CDM 77417 CPT 0333 RC outpatient 231 231 59.38 59.38 fee schedule 231 93 187.11 percent of total billed charges 231 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 231 other OPPS APC 231 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 231 other OPPS APC 14.6 14.6 fee schedule 14.6 231 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Special Treatment Procedure PX-333774700 CDM 77470 CPT 0333 RC outpatient 1402.18 1402.18 1355.93 1355.93 fee schedule 1402.18 93 1135.77 percent of total billed charges 1402.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 600.21 other OPPS APC 1402.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 600.21 other OPPS APC 35.05 35.05 fee schedule 35.05 1402.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sbrt W/Positron Emission Del PX-333C97950 CDM C9795 CPT 0333 RC outpatient 9376.25 9376.25 9376.25 74 6938.43 percent of total billed charges 9376.25 93 7594.76 percent of total billed charges 9376.25 9376.25 other OPPS APC 9376.25 9376.25 other OPPS APC 9376.25 51 4781.89 percent of total billed charges 9376.25 9376.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Rad Therapy Anal Cancer Rad Onc Model,90 Day Episode, Tc" PX-333M10730 CDM M1073 CPT 0333 RC outpatient 17517.6 17517.6 17517.6 74 12963 percent of total billed charges 17517.6 93 14189.2 percent of total billed charges 17517.6 17517.6 other OPPS APC 17517.6 17517.6 other OPPS APC 17517.6 51 8933.96 percent of total billed charges 17517.6 17517.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Rad Therapy Bladder Cancer Rad Onc Model,90 Day Episode, Tc" PX-333M10750 CDM M1075 CPT 0333 RC outpatient 14069.1 14069.1 14069.1 74 10411.1 percent of total billed charges 14069.1 93 11395.9 percent of total billed charges 14069.1 14069.1 other OPPS APC 14069.1 14069.1 other OPPS APC 14069.1 51 7175.22 percent of total billed charges 14069.1 14069.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Rad Therapy Bone Metastases Rad Onc Model,90 Day Episode, Tc" PX-333M10770 CDM M1077 CPT 0333 RC outpatient 6209.37 6209.37 6209.37 74 4594.93 percent of total billed charges 6209.37 93 5029.59 percent of total billed charges 6209.37 6209.37 other OPPS APC 6209.37 6209.37 other OPPS APC 6209.37 51 3166.78 percent of total billed charges 6209.37 6209.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Rad Therapy Brain Metastases Rad Onc Model,90 Day Episode, Tc" PX-333M10790 CDM M1079 CPT 0333 RC outpatient 10128 10128 10128 74 7494.69 percent of total billed charges 10128 93 8203.65 percent of total billed charges 10128 10128 other OPPS APC 10128 10128 other OPPS APC 10128 51 5165.26 percent of total billed charges 10128 10128 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Rad Therapy Breast Cancer Rad Onc Model,90 Day Episode, Tc" PX-333M10810 CDM M1081 CPT 0333 RC outpatient 10317 10317 10317 74 7634.57 percent of total billed charges 10317 93 8356.75 percent of total billed charges 10317 10317 other OPPS APC 10317 10317 other OPPS APC 10317 51 5261.66 percent of total billed charges 10317 10317 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Rad Therapy Cervical Cancer Rad Onc Model, 90 Day Episode Tc" PX-333M10830 CDM M1083 CPT 0333 RC outpatient 14094.8 14094.8 14094.8 74 10430.1 percent of total billed charges 14094.8 93 11416.8 percent of total billed charges 14094.8 14094.8 other OPPS APC 14094.8 14094.8 other OPPS APC 14094.8 51 7188.32 percent of total billed charges 14094.8 14094.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Rad Therapy Cns Tumors Rad Onc Model, 90 Day Episode Tc" PX-333M10850 CDM M1085 CPT 0333 RC outpatient 15434.9 15434.9 15434.9 74 11421.8 percent of total billed charges 15434.9 93 12502.2 percent of total billed charges 15434.9 15434.9 other OPPS APC 15434.9 15434.9 other OPPS APC 15434.9 51 7871.78 percent of total billed charges 15434.9 15434.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Rad Therapy Colorectal Cancer Rad Onc Model,90 Day Episode Tc" PX-333M10870 CDM M1087 CPT 0333 RC outpatient 12646.7 12646.7 12646.7 74 9358.57 percent of total billed charges 12646.7 93 10243.8 percent of total billed charges 12646.7 12646.7 other OPPS APC 12646.7 12646.7 other OPPS APC 12646.7 51 6449.83 percent of total billed charges 12646.7 12646.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Rad Therapy Head&Neck Cancer Rad Onc Model, 90 Day Episode Tc" PX-333M10890 CDM M1089 CPT 0333 RC outpatient 18223.5 18223.5 18223.5 74 13485.4 percent of total billed charges 18223.5 93 14761 percent of total billed charges 18223.5 18223.5 other OPPS APC 18223.5 18223.5 other OPPS APC 18223.5 51 9293.97 percent of total billed charges 18223.5 18223.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Rad Therapy Lung Cancer Rad Onc Model, 90 Day Episode Tc" PX-333M10950 CDM M1095 CPT 0333 RC outpatient 12477.9 12477.9 12477.9 74 9233.66 percent of total billed charges 12477.9 93 10107.1 percent of total billed charges 12477.9 12477.9 other OPPS APC 12477.9 12477.9 other OPPS APC 12477.9 51 6363.74 percent of total billed charges 12477.9 12477.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Rad Therapy Lymphoma Rad Onc Model, 90 Day Episode Tc" PX-333M10970 CDM M1097 CPT 0333 RC outpatient 8239.84 8239.84 8239.84 74 6097.48 percent of total billed charges 8239.84 93 6674.27 percent of total billed charges 8239.84 8239.84 other OPPS APC 8239.84 8239.84 other OPPS APC 8239.84 51 4202.32 percent of total billed charges 8239.84 8239.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Rad Therapy Pancreatic Cancer Rad Onc Model, 90 Day Episode Tc" PX-333M10990 CDM M1099 CPT 0333 RC outpatient 14129.2 14129.2 14129.2 74 10455.6 percent of total billed charges 14129.2 93 11444.6 percent of total billed charges 14129.2 14129.2 other OPPS APC 14129.2 14129.2 other OPPS APC 14129.2 51 7205.87 percent of total billed charges 14129.2 14129.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Rad Therapy Prostate Cancer Rad Onc Model, 90 Day Episode Tc" PX-333M11010 CDM M1101 CPT 0333 RC outpatient 12101.2 12101.2 12101.2 74 8954.9 percent of total billed charges 12101.2 93 9801.99 percent of total billed charges 12101.2 12101.2 other OPPS APC 12101.2 12101.2 other OPPS APC 12101.2 51 6171.62 percent of total billed charges 12101.2 12101.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Rad Therapy Upper GI Cancer Rad Onc Model, 90 Day Episode Tc" PX-333M11030 CDM M1103 CPT 0333 RC outpatient 15233.2 15233.2 15233.2 74 11272.5 percent of total billed charges 15233.2 93 12338.9 percent of total billed charges 15233.2 15233.2 other OPPS APC 15233.2 15233.2 other OPPS APC 15233.2 51 7768.91 percent of total billed charges 15233.2 15233.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Rad Therapy Uterine Cancer Rad Onc Model, 90 Day Episode Tc" PX-333M11050 CDM M1105 CPT 0333 RC outpatient 14777.1 14777.1 14777.1 74 10935 percent of total billed charges 14777.1 93 11969.4 percent of total billed charges 14777.1 14777.1 other OPPS APC 14777.1 14777.1 other OPPS APC 14777.1 51 7536.31 percent of total billed charges 14777.1 14777.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chemo Admin by Infusion 0-1 Hr PX-335964130 CDM 96413 CPT 0335 RC outpatient 847.04 847.04 516.13 516.13 fee schedule 847.04 93 686.1 percent of total billed charges 847.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 345.31 other OPPS APC 847.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 345.31 other OPPS APC 126.09 126.09 fee schedule 126.09 847.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chemo Admin by Infus Ea Add 1hr PX-335964150 CDM 96415 CPT 0335 RC outpatient 183.75 183.75 92.35 92.35 fee schedule 183.75 93 148.84 percent of total billed charges 183.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 183.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 27.04 27.04 fee schedule 27.04 183.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chemo Admin by Infuse Prol W Pump PX-335964160 CDM 96416 CPT 0335 RC outpatient 873.13 873.13 873.13 74 646.12 percent of total billed charges 873.13 93 707.24 percent of total billed charges 873.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 345.31 other OPPS APC 873.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 345.31 other OPPS APC 124.1 124.1 fee schedule 124.1 873.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chemo Intrav Drip > 8 Hrs W Pump PX-335964161 CDM 96416 CPT 0335 RC outpatient 873.13 873.13 873.13 74 646.12 percent of total billed charges 873.13 93 707.24 percent of total billed charges 873.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 345.31 other OPPS APC 873.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 345.31 other OPPS APC 124.1 124.1 fee schedule 124.1 873.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chemo Admin by Infuse Ea Addl Seq PX-335964170 CDM 96417 CPT 0335 RC outpatient 578.55 578.55 159.82 159.82 fee schedule 578.55 93 468.63 percent of total billed charges 578.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 578.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 62.1 62.1 fee schedule 62.1 578.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chemotx Admn Ia Nfs >8 Hr Prtble Impltbl Pmp PX-335964250 CDM 96425 CPT 0335 RC outpatient 831.55 831.55 543.98 543.98 fee schedule 831.55 93 673.56 percent of total billed charges 831.55 831.55 other OPPS APC 831.55 831.55 other OPPS APC 163.98 163.98 fee schedule 163.98 831.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC 65030 - Chemotherapy,Intrathecal" PX-335964501 CDM 96450 CPT 0335 RC outpatient 806.7 806.7 806.7 74 596.96 percent of total billed charges 806.7 93 653.43 percent of total billed charges 806.7 806.7 other OPPS APC 806.7 806.7 other OPPS APC 806.7 Service paid by fee schedule. 806.7 other 331 &335 806.7 806.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Refilling & Maintenance Portable Pump PX-335965210 CDM 96521 CPT 0335 RC outpatient 516.42 516.42 345.13 345.13 fee schedule 516.42 93 418.3 percent of total billed charges 516.42 516.42 other OPPS APC 516.42 516.42 other OPPS APC 120.85 120.85 fee schedule 120.85 516.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Refill&Maintenance Pump Drug Dlvr Systemic PX-335965220 CDM 96522 CPT 0335 RC outpatient 516.42 516.42 345.13 345.13 fee schedule 516.42 93 418.3 percent of total billed charges 516.42 516.42 other OPPS APC 516.42 516.42 other OPPS APC 114.68 114.68 fee schedule 114.68 516.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Concurrent Chemo Infusion PX-335965490 CDM 96549 CPT 0335 RC outpatient 113.15 113.15 113.15 74 83.73 percent of total billed charges 113.15 93 91.65 percent of total billed charges 113.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 113.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 113.15 Service paid by fee schedule. 113.15 other 331 &335 113.15 113.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chemo Extend IV Infus W/Pump PX-335G04980 CDM G0498 CPT 0335 RC outpatient 831.55 831.55 831.55 74 615.35 percent of total billed charges 831.55 93 673.56 percent of total billed charges 831.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 345.31 other OPPS APC 831.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 345.31 other OPPS APC 831.55 Service paid by fee schedule. 831.55 other 331 &335 831.55 831.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Inj Radioactive Tracer for ID of Sentinel Node PX-340387920 CDM 38792 CPT 0340 RC outpatient 982.43 982.43 982.43 74 727 percent of total billed charges 982.43 93 795.77 percent of total billed charges 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 982.43 51 501.04 percent of total billed charges 982.43 982.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Thyroid Uptake Sing/Mul Qm PX-340780120 CDM 78012 CPT 0340 RC outpatient 982.43 982.43 535.1 535.1 fee schedule 982.43 93 795.77 percent of total billed charges 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 70.44 70.44 fee schedule 70.44 982.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Thyroid Scan PX-340780130 CDM 78013 CPT 0340 RC outpatient 982.42 982.42 535.1 535.1 fee schedule 982.42 93 795.76 percent of total billed charges 982.42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 982.42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 150.34 150.34 fee schedule 150.34 982.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Thyroid Imag Sing/Mul Qm PX-340780140 CDM 78014 CPT 0340 RC outpatient 982.43 982.43 535.1 535.1 fee schedule 982.43 93 795.77 percent of total billed charges 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 189.96 189.96 fee schedule 189.96 982.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Thyroid Ca Mets-Whole Body PX-340780180 CDM 78018 CPT 0340 RC outpatient 1426 1426 642.95 642.95 fee schedule 1426 93 1155.06 percent of total billed charges 1426 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.11 other OPPS APC 1426 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.11 other OPPS APC 239.65 239.65 fee schedule 239.65 1426 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Parathyroid Planar Inc Subtr PX-340780700 CDM 78070 CPT 0340 RC outpatient 982.43 982.43 514.47 514.47 fee schedule 982.43 93 795.77 percent of total billed charges 982.43 982.43 other OPPS APC 982.43 982.43 other OPPS APC 226.33 226.33 fee schedule 226.33 982.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Parathyroid Scan W Spect PX-340780710 CDM 78071 CPT 0340 RC outpatient 982.43 982.43 673.06 673.06 fee schedule 982.43 93 795.77 percent of total billed charges 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 258.49 258.49 fee schedule 258.49 982.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Parathyroid Scan W Spect & CT PX-340780720 CDM 78072 CPT 0340 RC outpatient 1287.48 1287.48 673.06 673.06 fee schedule 1287.48 93 1042.86 percent of total billed charges 1287.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.11 other OPPS APC 1287.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.11 other OPPS APC 316.94 316.94 fee schedule 316.94 1287.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Lymphatics and Lymph Node Imaging PX-340781950 CDM 78195 CPT 0340 RC outpatient 1287.48 1287.48 548.9 548.9 fee schedule 1287.48 93 1042.86 percent of total billed charges 1287.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.11 other OPPS APC 1287.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.11 other OPPS APC 262.05 262.05 fee schedule 262.05 1287.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hepabilry Sys Imag Inc Gallbladder PX-340782260 CDM 78226 CPT 0340 RC outpatient 982.43 982.43 463.65 463.65 fee schedule 982.43 93 795.77 percent of total billed charges 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 255.56 255.56 fee schedule 255.56 982.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hepabilry Sys Imag W Pharma PX-340782270 CDM 78227 CPT 0340 RC outpatient 1287.48 1287.48 463.65 463.65 fee schedule 1287.48 93 1042.86 percent of total billed charges 1287.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.11 other OPPS APC 1287.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.11 other OPPS APC 347.46 347.46 fee schedule 347.46 1287.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC NM GI Gastric Empty Image Study PX-340782640 CDM 78264 CPT 0340 RC outpatient 982.43 982.43 503.19 503.19 fee schedule 982.43 93 795.77 percent of total billed charges 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 258.8 258.8 fee schedule 258.8 982.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Acute GI Blood Loss PX-340782780 CDM 78278 CPT 0340 RC outpatient 982.43 982.43 601.06 601.06 fee schedule 982.43 93 795.77 percent of total billed charges 982.43 982.43 other OPPS APC 982.43 982.43 other OPPS APC 265.95 265.95 fee schedule 265.95 982.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bowel Scan-Meckels PX-340782900 CDM 78290 CPT 0340 RC outpatient 982.43 982.43 384.27 384.27 fee schedule 982.43 93 795.77 percent of total billed charges 982.43 982.43 other OPPS APC 982.43 982.43 other OPPS APC 262.37 262.37 fee schedule 262.37 982.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bone Scan-Limited PX-340783000 CDM 78300 CPT 0341 RC outpatient 982.43 982.43 321.36 321.36 fee schedule 982.43 93 795.77 percent of total billed charges 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 173.41 173.41 fee schedule 173.41 982.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bone Scan-Whole Body PX-340783060 CDM 78306 CPT 0340 RC outpatient 982.43 982.43 526.83 526.83 fee schedule 982.43 93 795.77 percent of total billed charges 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 224.07 224.07 fee schedule 224.07 982.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC 3 Phase Bone Scan PX-340783150 CDM 78315 CPT 0340 RC outpatient 2145 2145 595.9 595.9 fee schedule 2145 93 1737.45 percent of total billed charges 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 262.7 262.7 fee schedule 262.7 2145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bone Spect PX-340783200 CDM 78803 CPT 0340 RC outpatient 3382.33 3382.33 782.98 782.98 fee schedule 3382.33 93 2739.69 percent of total billed charges 3382.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1447.82 other OPPS APC 3382.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1447.82 other OPPS APC 290.32 290.32 fee schedule 290.32 3382.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Myocardial Perf-Spect/Single PX-340784510 CDM 78451 CPT 0341 RC outpatient 3382.33 3382.33 833.45 833.45 fee schedule 3382.33 93 2739.69 percent of total billed charges 3382.33 3382.33 other OPPS APC 3382.33 3382.33 other OPPS APC 243.55 243.55 fee schedule 243.55 3382.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Myocardial Perf-Spect/Multi PX-340784520 CDM 78452 CPT 0340 RC outpatient 3382.33 3382.33 1349.01 1349.01 fee schedule 3382.33 93 2739.69 percent of total billed charges 3382.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1447.82 other OPPS APC 3382.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1447.82 other OPPS APC 349.4 349.4 fee schedule 349.4 3382.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Muga-Single Study PX-340784720 CDM 78472 CPT 0340 RC outpatient 1443 1443 666.1 666.1 fee schedule 1443 93 1168.83 percent of total billed charges 1443 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 1443 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 161.06 161.06 fee schedule 161.06 1443 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pulm Perfusion Particulate PX-340785800 CDM 78580 CPT 0340 RC outpatient 982.43 982.43 428.99 428.99 fee schedule 982.43 93 795.77 percent of total billed charges 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 177.95 177.95 fee schedule 177.95 982.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC NM Pulmonary Vent Perfusion Imag PX-340785820 CDM 78582 CPT 0340 RC outpatient 1287.48 1287.48 690.33 690.33 fee schedule 1287.48 93 1042.86 percent of total billed charges 1287.48 1287.48 other OPPS APC 1287.48 1287.48 other OPPS APC 247.77 247.77 fee schedule 247.77 1287.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC NM Pulmon Perfusion Vent Quan Dif PX-340785980 CDM 78598 CPT 0340 RC outpatient 1287.48 1287.48 852.97 852.97 fee schedule 1287.48 93 1042.86 percent of total billed charges 1287.48 1287.48 other OPPS APC 1287.48 1287.48 other OPPS APC 231.2 231.2 fee schedule 231.2 1287.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Brain Scan <4 Views W Vasc Flow PX-340786010 CDM 78601 CPT 0340 RC outpatient 982.43 982.43 398.63 398.63 fee schedule 982.43 93 795.77 percent of total billed charges 982.43 982.43 other OPPS APC 982.43 982.43 other OPPS APC 172.42 172.42 fee schedule 172.42 982.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC NM Kidney Scan-Vas Flow/Funct W/O PX-340787070 CDM 78707 CPT 0340 RC outpatient 1287.48 1287.48 557.88 557.88 fee schedule 1287.48 93 1042.86 percent of total billed charges 1287.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.11 other OPPS APC 1287.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.11 other OPPS APC 167.23 167.23 fee schedule 167.23 1287.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Kidney Imag-Vasc Flow/Fun W 1phar PX-340787080 CDM 78708 CPT 0340 RC outpatient 1287.48 1287.48 588 588 fee schedule 1287.48 93 1042.86 percent of total billed charges 1287.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.11 other OPPS APC 1287.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.11 other OPPS APC 116.87 116.87 fee schedule 116.87 1287.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tumor Imaging Single Area/Single Day PX-340788000 CDM 78800 CPT 0340 RC outpatient 982.43 982.43 417.33 417.33 fee schedule 982.43 93 795.77 percent of total billed charges 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 196.79 196.79 fee schedule 196.79 982.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tumor Imaging-Spect Single Area Single Day PX-340788030 CDM 78803 CPT 0340 RC outpatient 3382.33 3382.33 782.98 782.98 fee schedule 3382.33 93 2739.69 percent of total billed charges 3382.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1447.82 other OPPS APC 3382.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1447.82 other OPPS APC 290.32 290.32 fee schedule 290.32 3382.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Inflammation Imaging-Wb PX-340788060 CDM 78306 CPT 0340 RC outpatient 1426 1426 526.83 526.83 fee schedule 1426 93 1155.06 percent of total billed charges 1426 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 1426 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 224.07 224.07 fee schedule 224.07 1426 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Inflammation Imaging-Spect PX-340788070 CDM 78803 CPT 0340 RC outpatient 3382.33 3382.33 782.98 782.98 fee schedule 3382.33 93 2739.69 percent of total billed charges 3382.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1447.82 other OPPS APC 3382.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1447.82 other OPPS APC 290.32 290.32 fee schedule 290.32 3382.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC NM Tumor Imaging-Spect CT Single Area Single Day PX-340788300 CDM 78830 CPT 0340 RC outpatient 3382.32 3382.32 783.19 783.19 fee schedule 3382.32 93 2739.68 percent of total billed charges 3382.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1447.82 other OPPS APC 3382.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1447.82 other OPPS APC 359.49 359.49 fee schedule 359.49 3382.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pyrophosphate PX-343000002 CDM A9538 CPT 0343 RC outpatient 110 110 110 74 81.4 percent of total billed charges 110 93 89.1 percent of total billed charges 110 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110 other OPPS APC 110 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110 other OPPS APC 110 24.86 27.35 percent of total billed charges 110 110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tc99m Membrofenin PX-343095370 CDM A9537 CPT 0343 RC outpatient 135.25 135.25 135.25 74 100.09 percent of total billed charges 135.25 93 109.55 percent of total billed charges 135.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 135.25 other OPPS APC 135.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 135.25 other OPPS APC 135.25 24.86 33.62 percent of total billed charges 135.25 135.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Z NM Tc99m Tag Rrc per Dose 30mci PX-343095600 CDM A9560 CPT 0343 RC outpatient 275.44 275.44 275.44 74 203.83 percent of total billed charges 275.44 93 223.11 percent of total billed charges 275.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 275.44 other OPPS APC 275.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 275.44 other OPPS APC 275.44 24.86 68.47 percent of total billed charges 275.44 275.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tc99 Tilmanocept Diag 0.5mci PX-343A95200 CDM A9520 HCPCS 0343 RC outpatient 896 896 896 74 663.04 percent of total billed charges 896 93 725.76 percent of total billed charges 896 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 896 other OPPS APC 896 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 896 other OPPS APC 896 24.86 222.75 percent of total billed charges 896 896 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tc99m Oxidronate Up to 30 Mci PX-343A95610 CDM A9561 HCPCS 0343 RC outpatient 111 111 111 74 82.14 percent of total billed charges 111 93 89.91 percent of total billed charges 111 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 111 other OPPS APC 111 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 111 other OPPS APC 111 24.86 27.59 percent of total billed charges 111 111 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Percut Drain Abscess W or W/Ocath PX-350759891 CDM 75989 CPT 0350 RC outpatient 500 500 453.72 453.72 fee schedule 500 93 405 percent of total billed charges 500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 500 other OPPS APC 500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 500 other OPPS APC 55.53 55.53 fee schedule 55.53 500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Head W/O Contrast PX-351704500 CDM 70450 CPT 0351 RC outpatient 1024 1024 570.3 570.3 fee schedule 1024 93 829.44 percent of total billed charges 1024 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 1024 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 67.22 67.22 fee schedule 67.22 1024 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T-Head Scan W Contrast PX-351704600 CDM 70460 CPT 0351 RC outpatient 1246 1246 696.51 696.51 fee schedule 1246 93 1009.26 percent of total billed charges 1246 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 1246 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 96.46 96.46 fee schedule 96.46 1246 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T-Head Scan W/WO Contrast PX-351704700 CDM 70470 CPT 0351 RC outpatient 1755 1755 853.7 853.7 fee schedule 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 115.28 115.28 fee schedule 115.28 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC CT Orbit, Sella Post Fossa W/O Contrast" PX-351704800 CDM 70480 CPT 0351 RC outpatient 1476 1476 620.88 620.88 fee schedule 1476 93 1195.56 percent of total billed charges 1476 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 1476 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 100.02 100.02 fee schedule 100.02 1476 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC CT Orbit, Sella Post Fossa W Contrast" PX-351704810 CDM 70481 CPT 0351 RC outpatient 762 762 725.67 725.67 fee schedule 762 93 617.22 percent of total billed charges 762 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 762 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 128.93 128.93 fee schedule 128.93 762 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC CT Orbit, Sella Post Fossa W W/O" PX-351704820 CDM 70482 CPT 0351 RC outpatient 907 907 874.39 874.39 fee schedule 907 93 734.67 percent of total billed charges 907 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 907 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 152.96 152.96 fee schedule 152.96 907 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T-Maxillofacial WO Contrast PX-351704860 CDM 70486 CPT 0351 RC outpatient 1218 1218 603.74 603.74 fee schedule 1218 93 986.58 percent of total billed charges 1218 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 1218 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 88.99 88.99 fee schedule 88.99 1218 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T-Maxillofacial W Contrast PX-351704870 CDM 70487 CPT 0351 RC outpatient 762 762 717.12 717.12 fee schedule 762 93 617.22 percent of total billed charges 762 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 762 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 100.67 100.67 fee schedule 100.67 762 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T-Maxillofacial W/WO Contras PX-351704880 CDM 70488 CPT 0351 RC outpatient 907 907 870 870 fee schedule 907 93 734.67 percent of total billed charges 907 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 907 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 126.33 126.33 fee schedule 126.33 907 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T-Neck Scan W/O Contrast PX-351704900 CDM 70490 CPT 0351 RC outpatient 939 939 620.88 620.88 fee schedule 939 93 760.59 percent of total billed charges 939 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 939 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 91.26 91.26 fee schedule 91.26 939 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T-Neck Scan W Contrast PX-351704910 CDM 70491 CPT 0351 RC outpatient 1085 1085 725.67 725.67 fee schedule 1085 93 878.85 percent of total billed charges 1085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 1085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 121.13 121.13 fee schedule 121.13 1085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T-Neck Scan W/WO Contrast PX-351704920 CDM 70492 CPT 0351 RC outpatient 1231 1231 873.45 873.45 fee schedule 1231 93 997.11 percent of total billed charges 1231 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 1231 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 147.44 147.44 fee schedule 147.44 1231 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Lung Cancer Screening PX-352002970 CDM 71271 CPT 0352 RC outpatient 261.88 261.88 169.08 169.08 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 88 88 fee schedule 88 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Perfusion Cerebral W Contrast PX-352004200 CDM 0042T CPT 0352 RC outpatient 1161 1161 1161 74 859.14 percent of total billed charges 1161 93 940.41 percent of total billed charges 1161 1161 other OPPS APC 1161 1161 other OPPS APC 1161 51 592.11 percent of total billed charges 1161 1161 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC CT Guide Drain Cath Abd Wall,Neck" PX-352100300 CDM 10030 CPT 0352 RC outpatient 1675.9 1675.9 1675.9 74 1240.17 percent of total billed charges 1675.9 93 1357.48 percent of total billed charges 1675.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 717.38 other OPPS APC 1675.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 717.38 other OPPS APC 1675.9 51 854.71 percent of total billed charges 1675.9 1675.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Lung Needle Biopsy PX-352324080 CDM 32408 CPT 0361 RC outpatient 3861.88 3861.88 2292.66 2292.66 fee schedule 3861.88 93 3128.12 percent of total billed charges 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 32.21 1243.91 percent of total billed charges 2292.66 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Guide Cath Drain Visceral PX-352494050 CDM 49405 CPT 0352 RC outpatient 3861.88 3861.88 3861.88 74 2857.79 percent of total billed charges 3861.88 93 3128.12 percent of total billed charges 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 51 1969.56 percent of total billed charges 3861.88 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Guide Cath Periton Retroper PX-352494060 CDM 49406 CPT 0352 RC outpatient 3861.88 3861.88 3861.88 74 2857.79 percent of total billed charges 3861.88 93 3128.12 percent of total billed charges 3861.88 3861.88 other OPPS APC 3861.88 3861.88 other OPPS APC 3861.88 51 1969.56 percent of total billed charges 3861.88 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Tmj (Also for Sella) PX-352704800 CDM 70480 CPT 0352 RC outpatient 1476 1476 620.88 620.88 fee schedule 1476 93 1195.56 percent of total billed charges 1476 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 1476 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 100.02 100.02 fee schedule 100.02 1476 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cta Head PX-352704960 CDM 70496 CPT 0352 RC outpatient 781 781 1262.57 1262.57 fee schedule 781 93 632.61 percent of total billed charges 781 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 781 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 196.15 196.15 fee schedule 196.15 1262.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cta Neck PX-352704980 CDM 70498 CPT 0352 RC outpatient 781 781 1262.57 1262.57 fee schedule 781 93 632.61 percent of total billed charges 781 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 781 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 195.83 195.83 fee schedule 195.83 1262.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Diagnostic Thorax W/O Contrast PX-352712500 CDM 71250 CPT 0352 RC outpatient 1584 1584 724.62 724.62 fee schedule 1584 93 1283.04 percent of total billed charges 1584 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 1584 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 83.47 83.47 fee schedule 83.47 1584 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T Diagnostic -Thorax Scan W Contrast PX-352712600 CDM 71260 CPT 0352 RC outpatient 1621 1621 850.25 850.25 fee schedule 1621 93 1313.01 percent of total billed charges 1621 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 1621 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 113.66 113.66 fee schedule 113.66 1621 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T Diagnostic-Thorax W/WO Contrast PX-352712700 CDM 71270 CPT 0352 RC outpatient 1670 1670 1042.64 1042.64 fee schedule 1670 93 1352.7 percent of total billed charges 1670 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 1670 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 139.32 139.32 fee schedule 139.32 1670 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cta Chest PX-352712750 CDM 71275 CPT 0352 RC outpatient 781 781 1276.26 1276.26 fee schedule 781 93 632.61 percent of total billed charges 781 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 781 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 198.42 198.42 fee schedule 198.42 1276.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T-C Spine W/O Contrast PX-352721250 CDM 72125 CPT 0352 RC outpatient 1218 1218 724.62 724.62 fee schedule 1218 93 986.58 percent of total billed charges 1218 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 1218 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 84.44 84.44 fee schedule 84.44 1218 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T-C Spine W Contrast PX-352721260 CDM 72126 CPT 0352 RC outpatient 1085 1085 846.91 846.91 fee schedule 1085 93 878.85 percent of total billed charges 1085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 1085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 113.01 113.01 fee schedule 113.01 1085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T-C Spine W/WO Contrast PX-352721270 CDM 72127 CPT 0352 RC outpatient 1218 1218 1030.62 1030.62 fee schedule 1218 93 986.58 percent of total billed charges 1218 1218 other OPPS APC 1218 1218 other OPPS APC 139.65 139.65 fee schedule 139.65 1218 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T-T Spine W/O Contrast PX-352721280 CDM 72128 CPT 0352 RC outpatient 1110 1110 724.62 724.62 fee schedule 1110 93 899.1 percent of total billed charges 1110 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 1110 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 84.11 84.11 fee schedule 84.11 1110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T-T Spine W Contrast PX-352721290 CDM 72129 CPT 0352 RC outpatient 1250 1250 847.64 847.64 fee schedule 1250 93 1012.5 percent of total billed charges 1250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 1250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 113.98 113.98 fee schedule 113.98 1250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T-T Spine W/WO Contrast PX-352721300 CDM 72130 CPT 0352 RC outpatient 1085.4 1085.4 1030.62 1030.62 fee schedule 1085.4 93 879.17 percent of total billed charges 1085.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 1085.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 140.62 140.62 fee schedule 140.62 1085.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T-L Spine W/O Contrast PX-352721310 CDM 72131 CPT 0352 RC outpatient 1670 1670 724.62 724.62 fee schedule 1670 93 1352.7 percent of total billed charges 1670 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 1670 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 83.47 83.47 fee schedule 83.47 1670 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T-L Spine W Contrast PX-352721320 CDM 72132 CPT 0352 RC outpatient 1722 1722 846.91 846.91 fee schedule 1722 93 1394.82 percent of total billed charges 1722 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 1722 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 113.33 113.33 fee schedule 113.33 1722 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T-L Spine W/WO Contrast PX-352721330 CDM 72133 CPT 0352 RC outpatient 1900 1900 1030.62 1030.62 fee schedule 1900 93 1539 percent of total billed charges 1900 1900 other OPPS APC 1900 1900 other OPPS APC 139.97 139.97 fee schedule 139.97 1900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cta Pelvis PX-352721910 CDM 72191 CPT 0352 RC outpatient 781 781 1393.3 1393.3 fee schedule 781 93 632.61 percent of total billed charges 781 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 781 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 222.79 222.79 fee schedule 222.79 1393.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Pelvis W/O Contrast PX-352721920 CDM 72192 CPT 0352 RC outpatient 1268 1268 716.89 716.89 fee schedule 1268 93 1027.08 percent of total billed charges 1268 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 1268 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 83.14 83.14 fee schedule 83.14 1268 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T-Pelvis Scan W Contrast PX-352721930 CDM 72193 CPT 0352 RC outpatient 1487 1487 817.27 817.27 fee schedule 1487 93 1204.47 percent of total billed charges 1487 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 1487 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 176.03 176.03 fee schedule 176.03 1487 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T-Pelvis Scan W/WO Contrast PX-352721940 CDM 72194 CPT 0352 RC outpatient 1511 1511 987.17 987.17 fee schedule 1511 93 1223.91 percent of total billed charges 1511 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 1511 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 197.46 197.46 fee schedule 197.46 1511 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Upper Extrem WO Contrast PX-352732000 CDM 73200 CPT 0352 RC outpatient 634 634 621.59 621.59 fee schedule 634 93 513.54 percent of total billed charges 634 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 634 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 115.62 115.62 fee schedule 115.62 634 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Upper Extrem W Contrast PX-352732010 CDM 73201 CPT 0352 RC outpatient 916.05 916.05 724.62 724.62 fee schedule 916.05 93 742 percent of total billed charges 916.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 916.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 147.77 147.77 fee schedule 147.77 916.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Upper Extrem Wwo Contrast PX-352732020 CDM 73202 CPT 0350 RC outpatient 821 821 882.59 882.59 fee schedule 821 93 665.01 percent of total billed charges 821 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 821 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 193.57 193.57 fee schedule 193.57 882.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cta Upper Extremity PX-352732060 CDM 73206 CPT 0352 RC outpatient 781 781 1289.97 1289.97 fee schedule 781 93 632.61 percent of total billed charges 781 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 781 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 215.32 215.32 fee schedule 215.32 1289.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Lower Extrem WO Contrast PX-352737000 CDM 73700 CPT 0352 RC outpatient 1110 1110 621.59 621.59 fee schedule 1110 93 899.1 percent of total billed charges 1110 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 1110 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 83.79 83.79 fee schedule 83.79 1110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Lower Extrem W Contrast PX-352737010 CDM 73701 CPT 0352 RC outpatient 1293 1293 724.62 724.62 fee schedule 1293 93 1047.33 percent of total billed charges 1293 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 1293 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 113.66 113.66 fee schedule 113.66 1293 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Lower Extr Wwo Contrast PX-352737020 CDM 73702 CPT 0352 RC outpatient 907 907 881.85 881.85 fee schedule 907 93 734.67 percent of total billed charges 907 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 907 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 139.97 139.97 fee schedule 139.97 907 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cta Lower Extremity PX-352737060 CDM 73706 CPT 0352 RC outpatient 781 781 1301.05 1301.05 fee schedule 781 93 632.61 percent of total billed charges 781 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 781 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 237.06 237.06 fee schedule 237.06 1301.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Abdomen W/O Contrast PX-352741500 CDM 74150 CPT 0352 RC outpatient 1328 1328 703.41 703.41 fee schedule 1328 93 1075.68 percent of total billed charges 1328 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 1328 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 82.17 82.17 fee schedule 82.17 1328 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T-Abdomen W Contrast PX-352741600 CDM 74160 CPT 0352 RC outpatient 1304 1304 830.96 830.96 fee schedule 1304 93 1056.24 percent of total billed charges 1304 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 1304 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 175.05 175.05 fee schedule 175.05 1304 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T-Abdomen W/WO Contrast PX-352741700 CDM 74170 CPT 0352 RC outpatient 2023 2023 1008.59 1008.59 fee schedule 2023 93 1638.63 percent of total billed charges 2023 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 2023 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 198.44 198.44 fee schedule 198.44 2023 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cta Abd/Pel W Contrast PX-352741740 CDM 74174 CPT 0352 RC outpatient 2000 2000 2796 2796 fee schedule 2000 93 1620 percent of total billed charges 2000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 2000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 280.59 280.59 fee schedule 280.59 2796 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cta Abdomen PX-352741750 CDM 74175 CPT 0352 RC outpatient 781 781 1402.7 1402.7 fee schedule 781 93 632.61 percent of total billed charges 781 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 781 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 223.11 223.11 fee schedule 223.11 1402.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Abd and Pelvis W/O Contrast PX-352741760 CDM 74176 CPT 0352 RC outpatient 1962 1962 1744.82 1744.82 fee schedule 1962 93 1589.22 percent of total billed charges 1962 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 1962 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 103.59 103.59 fee schedule 103.59 1962 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Abd and Pelvis W Contrast PX-352741770 CDM 74177 CPT 0352 RC outpatient 2048 2048 2384.15 2384.15 fee schedule 2048 93 1658.88 percent of total billed charges 2048 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 2048 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 220.53 220.53 fee schedule 220.53 2384.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Abd and Pelvis 1+ Section/Reg PX-352741780 CDM 74178 CPT 0352 RC outpatient 2779 2779 2668.89 2668.89 fee schedule 2779 93 2250.99 percent of total billed charges 2779 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 2779 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 249.1 249.1 fee schedule 249.1 2779 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC C/T Abd/Pelvis Urogram W&W/O PX-352741781 CDM 74178 CPT 0352 RC outpatient 2779 2779 2668.89 2668.89 fee schedule 2779 93 2250.99 percent of total billed charges 2779 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 2779 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 249.1 249.1 fee schedule 249.1 2779 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Heart Wout Contrst Coro Calc PX-352755710 CDM 75571 CPT 0352 RC outpatient 216.45 216.45 119.51 119.51 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 216.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 73.38 73.38 fee schedule 73.38 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cta Aorta W Runoff W Contrst Post PX-352756350 CDM 75635 CPT 0350 RC outpatient 781 781 1833.95 1833.95 fee schedule 781 93 632.61 percent of total billed charges 781 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 781 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 187.34 other OPPS APC 302.66 302.66 fee schedule 302.66 1833.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Guided Needle Biopsy PX-352770120 CDM 77012 CPT 0352 RC outpatient 914 914 488.93 488.93 fee schedule 914 93 740.34 percent of total billed charges 914 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 914 other OPPS APC 914 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 914 other OPPS APC 68.85 68.85 fee schedule 68.85 914 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cyst Aspiration - CT Guide PX-352770121 CDM 77012 CPT 0350 RC outpatient 914 914 488.93 488.93 fee schedule 914 93 740.34 percent of total billed charges 914 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 914 other OPPS APC 914 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 914 other OPPS APC 68.85 68.85 fee schedule 68.85 914 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT-Therapy Plan PX-352770140 CDM 77014 CPT 0352 RC outpatient 300 300 457.23 457.23 fee schedule 300 93 243 percent of total billed charges 300 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 300 other OPPS APC 300 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 300 other OPPS APC 73.4 73.4 fee schedule 73.4 457.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Bone Length, Scanogram" PX-352770731 CDM 77073 CPT 0352 RC outpatient 261.88 261.88 127.13 127.13 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 31.49 31.49 fee schedule 31.49 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Bone Density Axial 1 or > Site PX-352770780 CDM 77078 CPT 0352 RC outpatient 216.45 216.45 152.4 152.4 fee schedule 216.45 93 175.32 percent of total billed charges 216.45 216.45 other OPPS APC 216.45 216.45 other OPPS APC 89.31 89.31 fee schedule 89.31 216.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Operating Room (Minutes) PX-360000003 CDM 360000003 LOCAL 0360 RC outpatient 1000 1000 1000 Service paid by fee schedule. 1000 fee schedule Ambulatory 1000 93 810 percent of total billed charges 1000 1000 other OPPS APC 1000 1000 other OPPS APC 1000 32.21 322.1 percent of total billed charges 1000 1000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Operating Room (Minutes) PX-360000005 CDM 360000005 LOCAL 0360 RC outpatient 2000 2000 2000 Service paid by fee schedule. 2000 fee schedule Ambulatory 2000 93 1620 percent of total billed charges 2000 2000 other OPPS APC 2000 2000 other OPPS APC 2000 32.21 644.2 percent of total billed charges 2000 2000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cptr-Asst Dir Ms Px PX-360209851 CDM 20985 CPT 0360 RC outpatient 0.01 0.01 11.41 11.41 fee schedule 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Service paid by percent of billed. 0.01 other OP OR/ASC 0.01 11.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC NM Inj Radioact Trac Sent Node PX-360387920 CDM 38792 CPT 0360 RC outpatient 982.43 982.43 461.65 461.65 fee schedule 982.43 93 795.77 percent of total billed charges 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 982.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420.53 other OPPS APC 982.43 32.21 316.44 percent of total billed charges 461.65 982.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Stent Arterial Placement Initial PX-361000001 CDM 361000001 LOCAL 0361 RC outpatient 11528 11528 11528 Service paid by fee schedule. 11528 fee schedule Ambulatory 11528 93 9337.68 percent of total billed charges 11528 11528 other OPPS APC 11528 11528 other OPPS APC 11528 32.21 3713.17 percent of total billed charges 11528 11528 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Stent Arterial Placement Additional PX-361000002 CDM 361000002 LOCAL 0361 RC outpatient 5575 5575 5575 Service paid by fee schedule. 5575 fee schedule Ambulatory 5575 93 4515.75 percent of total billed charges 5575 5575 other OPPS APC 5575 5575 other OPPS APC 5575 32.21 1795.71 percent of total billed charges 5575 5575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Embolization Venous PX-361000003 CDM 361000003 LOCAL 0361 RC outpatient 11178 11178 11178 Service paid by fee schedule. 11178 fee schedule Ambulatory 11178 93 9054.18 percent of total billed charges 11178 11178 other OPPS APC 11178 11178 other OPPS APC 11178 32.21 3600.43 percent of total billed charges 11178 11178 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Embolization Arterial PX-361000004 CDM 361000004 LOCAL 0361 RC outpatient 11178 11178 11178 Service paid by fee schedule. 11178 fee schedule Ambulatory 11178 93 9054.18 percent of total billed charges 11178 11178 other OPPS APC 11178 11178 other OPPS APC 11178 32.21 3600.43 percent of total billed charges 11178 11178 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cpu First 30 Minutes PX-361000006 CDM 361000006 LOCAL 0361 RC outpatient 314 314 314 Service paid by fee schedule. 314 fee schedule Ambulatory 314 93 254.34 percent of total billed charges 314 314 other OPPS APC 314 314 other OPPS APC 314 32.21 101.14 percent of total billed charges 314 314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cpu Procedure Each Addl 15 Minutes PX-361000007 CDM 361000007 LOCAL 0361 RC outpatient 105 105 105 Service paid by fee schedule. 105 fee schedule Ambulatory 105 93 85.05 percent of total billed charges 105 105 other OPPS APC 105 105 other OPPS APC 105 32.21 33.82 percent of total billed charges 105 105 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC US Fine Needle Aspiration First Lesion PX-361100051 CDM 10005 CPT 0361 RC outpatient 1675.9 1675.9 1392.16 1392.16 fee schedule 1675.9 93 1357.48 percent of total billed charges 1675.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 717.38 other OPPS APC 1675.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 717.38 other OPPS APC 1675.9 32.21 539.81 percent of total billed charges 1392.16 1675.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC US Fine Needle Aspiration Add Lesion PX-361100061 CDM 10006 CPT 0361 RC outpatient 581 581 11.41 11.41 fee schedule 581 93 470.61 percent of total billed charges 581 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 581 other OPPS APC 581 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 581 other OPPS APC 581 32.21 187.14 percent of total billed charges 11.41 581 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Fine Needle Aspiratiion First Lesion PX-361100091 CDM 10009 CPT 0361 RC outpatient 1675.9 1675.9 1392.16 1392.16 fee schedule 1675.9 93 1357.48 percent of total billed charges 1675.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 717.38 other OPPS APC 1675.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 717.38 other OPPS APC 1675.9 32.21 539.81 percent of total billed charges 1392.16 1675.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Insertion Drug Delivery Implant PX-361119810 CDM 11981 CPT 0361 RC outpatient 304.28 304.28 461.65 304.28 fee schedule 304.28 93 246.47 percent of total billed charges 304.28 304.28 other OPPS APC 304.28 304.28 other OPPS APC 304.28 32.21 98.01 percent of total billed charges 304.28 461.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Remove Drug Implant Device PX-361119820 CDM 11982 CPT 0361 RC outpatient 949.08 949.08 461.65 949.08 fee schedule 949.08 93 768.75 percent of total billed charges 949.08 949.08 other OPPS APC 949.08 949.08 other OPPS APC 949.08 32.21 305.7 percent of total billed charges 461.65 949.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Remove W Reinsertion Drug Implant PX-361119830 CDM 11983 CPT 0361 RC outpatient 949.08 949.08 461.65 949.08 fee schedule 949.08 93 768.75 percent of total billed charges 949.08 949.08 other OPPS APC 949.08 949.08 other OPPS APC 949.08 32.21 305.7 percent of total billed charges 461.65 949.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Skin Tissue Procedure PX-361179992 CDM 17999 CPT 0361 RC outpatient 476.88 476.88 2292.66 476.88 fee schedule 476.88 93 386.27 percent of total billed charges 476.88 476.88 other OPPS APC 476.88 476.88 other OPPS APC 476.88 32.21 153.6 percent of total billed charges 476.88 2292.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Puncture Aspir Cyst Breast PX-361190001 CDM 19000 CPT 0361 RC outpatient 1675.9 1675.9 1392.16 1675.9 fee schedule 1675.9 93 1357.48 percent of total billed charges 1675.9 1675.9 other OPPS APC 1675.9 1675.9 other OPPS APC 1675.9 32.21 539.81 percent of total billed charges 1392.16 1675.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Breast Cyst Asp Each Add'l PX-361190011 CDM 19001 CPT 0361 RC outpatient 316 316 11.41 316 fee schedule 316 93 255.96 percent of total billed charges 316 316 other OPPS APC 316 316 other OPPS APC 316 32.21 101.78 percent of total billed charges 11.41 316 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sl Breast Biopsy Localization Each Addit PX-361190821 CDM 19082 CPT 0361 RC outpatient 1629 1629 11.41 11.41 fee schedule 1629 93 1319.49 percent of total billed charges 1629 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1629 other OPPS APC 1629 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1629 other OPPS APC 1629 32.21 524.7 percent of total billed charges 11.41 1629 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC US Percut Ndl Core W Imag 1st Les PX-361190830 CDM 19083 CPT 0361 RC outpatient 4147 4147 1392.16 1392.16 fee schedule 4147 93 3359.07 percent of total billed charges 4147 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 4147 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 4147 32.21 1335.75 percent of total billed charges 1392.16 4147 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sl Breast Localization Initial PX-361192831 CDM 19283 CPT 0361 RC outpatient 1675.9 1675.9 1392.16 1392.16 fee schedule 1675.9 93 1357.48 percent of total billed charges 1675.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 717.38 other OPPS APC 1675.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 717.38 other OPPS APC 1675.9 32.21 539.81 percent of total billed charges 1392.16 1675.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sl Breast Localization Each Additional PX-361192841 CDM 19284 CPT 0361 RC outpatient 1129 1129 11.41 11.41 fee schedule 1129 93 914.49 percent of total billed charges 1129 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1129 other OPPS APC 1129 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1129 other OPPS APC 1129 32.21 363.65 percent of total billed charges 11.41 1129 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Muscle Biopsy PX-361202000 CDM 20200 CPT 0361 RC outpatient 3861.88 3861.88 2292.66 3861.88 fee schedule 3861.88 93 3128.12 percent of total billed charges 3861.88 3861.88 other OPPS APC 3861.88 3861.88 other OPPS APC 3861.88 32.21 1243.91 percent of total billed charges 2292.66 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Biopsy Muscle Percutaneous Needle PX-361202061 CDM 20206 CPT 0361 RC outpatient 3861.88 3861.88 1392.16 1392.16 fee schedule 3861.88 93 3128.12 percent of total billed charges 3861.88 3861.88 other OPPS APC 3861.88 3861.88 other OPPS APC 3861.88 32.21 1243.91 percent of total billed charges 1392.16 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bone Biopsy Trocar/Needle PX-361202200 CDM 20220 CPT 0361 RC outpatient 3861.88 3861.88 1392.16 1392.16 fee schedule 3861.88 93 3128.12 percent of total billed charges 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 32.21 1243.91 percent of total billed charges 1392.16 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Deep Bone Bx - Femur, Vert. Body" PX-361202252 CDM 20225 CPT 0361 RC outpatient 3861.88 3861.88 2292.66 2292.66 fee schedule 3861.88 93 3128.12 percent of total billed charges 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 32.21 1243.91 percent of total billed charges 2292.66 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fistula or Sinus Tract Study PX-361205011 CDM 20501 CPT 0361 RC outpatient 61 61 11.41 61 fee schedule 61 93 49.41 percent of total billed charges 61 61 other OPPS APC 61 61 other OPPS APC 61 32.21 19.65 percent of total billed charges 11.41 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Aspirate/Inj Ganglion Cyst PX-361206120 CDM 20612 CPT 0361 RC outpatient 705.5 705.5 461.65 461.65 fee schedule 705.5 93 571.46 percent of total billed charges 705.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301.99 other OPPS APC 705.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301.99 other OPPS APC 705.5 32.21 227.24 percent of total billed charges 461.65 705.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Biopsy, Soft Tissue Neck or Thorax" PX-361215500 CDM 21550 CPT 0361 RC outpatient 3861.88 3861.88 2292.66 2292.66 fee schedule 3861.88 93 3128.12 percent of total billed charges 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 32.21 1243.91 percent of total billed charges 2292.66 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hip Arthrogram PX-361270930 CDM 27093 CPT 0361 RC outpatient 440 440 11.41 440 fee schedule 440 93 356.4 percent of total billed charges 440 440 other OPPS APC 440 440 other OPPS APC 440 32.21 141.72 percent of total billed charges 11.41 440 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Endotracheal Intubation or Assist PX-361315000 CDM 31500 CPT 0361 RC outpatient 581.83 581.83 581.83 74 430.55 percent of total billed charges 581.83 93 471.28 percent of total billed charges 581.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.05 other OPPS APC 581.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.05 other OPPS APC 581.83 31.25 181.82 percent of total billed charges 581.83 581.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Insertion of Long Term Pleural Cath PX-361325501 CDM 32550 CPT 0361 RC outpatient 8240.85 8240.85 3445.29 3445.29 fee schedule 8240.85 93 6675.09 percent of total billed charges 8240.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3527.55 other OPPS APC 8240.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3527.55 other OPPS APC 8240.85 32.21 2654.38 percent of total billed charges 3445.29 8240.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Chest Tube Insertion Thoracostomy PX-361325511 CDM 32551 CPT 0361 RC outpatient 3814.83 3814.83 1392.16 3814.83 fee schedule 3814.83 93 3090.01 percent of total billed charges 3814.83 3814.83 other OPPS APC 3814.83 3814.83 other OPPS APC 3814.83 32.21 1228.76 percent of total billed charges 1392.16 3814.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Removal Indwelling Tunneled Catheter PX-361325520 CDM 32552 CPT 0361 RC outpatient 1496.38 1496.38 1392.16 1392.16 fee schedule 1496.38 93 1212.07 percent of total billed charges 1496.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 640.53 other OPPS APC 1496.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 640.53 other OPPS APC 1496.38 32.21 481.98 percent of total billed charges 1392.16 1496.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC US Thoracentesis Puncture for Aspira PX-361325551 CDM 32555 CPT 0361 RC outpatient 1496.38 1496.38 1392.16 1392.16 fee schedule 1496.38 93 1212.07 percent of total billed charges 1496.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 640.53 other OPPS APC 1496.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 640.53 other OPPS APC 1496.38 32.21 481.98 percent of total billed charges 1392.16 1496.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC CT/Thoracentesis, W/Tube" PX-361325572 CDM 32557 CPT 0361 RC outpatient 3814.83 3814.83 1392.16 3814.83 fee schedule 3814.83 93 3090.01 percent of total billed charges 3814.83 3814.83 other OPPS APC 3814.83 3814.83 other OPPS APC 3814.83 32.21 1228.76 percent of total billed charges 1392.16 3814.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Lyse Chest Fibrin Init Day PX-361325610 CDM 32561 CPT 0361 RC outpatient 4489.12 4489.12 461.65 4489.12 fee schedule 4489.12 93 3636.19 percent of total billed charges 4489.12 4489.12 other OPPS APC 4489.12 4489.12 other OPPS APC 4489.12 32.21 1445.95 percent of total billed charges 461.65 4489.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Thorascopy Diagnostic PX-361326010 CDM 32601 CPT 0361 RC outpatient 13744 13744 6386.89 13744 fee schedule 13744 93 11132.6 percent of total billed charges 13744 13744 other OPPS APC 13744 13744 other OPPS APC 13744 32.21 4426.94 percent of total billed charges 6386.89 13744 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Thorascopy W/Bx Med Space PX-361326060 CDM 32606 CPT 0361 RC outpatient 13744 13744 6386.89 13744 fee schedule 13744 93 11132.6 percent of total billed charges 13744 13744 other OPPS APC 13744 13744 other OPPS APC 13744 32.21 4426.94 percent of total billed charges 6386.89 13744 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Thorascopy W/Bx Infiltrate PX-361326070 CDM 32607 CPT 0361 RC outpatient 24519.4 24519.4 8788.2 24519.4 fee schedule 24519.4 93 19860.7 percent of total billed charges 24519.4 24519.4 other OPPS APC 24519.4 24519.4 other OPPS APC 24519.4 32.21 7897.7 percent of total billed charges 8788.2 24519.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Thorascopy W/Bx Nodule PX-361326080 CDM 32608 CPT 0361 RC outpatient 24519.4 24519.4 8788.2 24519.4 fee schedule 24519.4 93 19860.7 percent of total billed charges 24519.4 24519.4 other OPPS APC 24519.4 24519.4 other OPPS APC 24519.4 32.21 7897.7 percent of total billed charges 8788.2 24519.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Thorascopy W/Bx Pleura PX-361326090 CDM 32609 CPT 0361 RC outpatient 13744 13744 6386.89 13744 fee schedule 13744 93 11132.6 percent of total billed charges 13744 13744 other OPPS APC 13744 13744 other OPPS APC 13744 32.21 4426.94 percent of total billed charges 6386.89 13744 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Insertion of Bivent Lead PX-361332250 CDM 33225 CPT 0361 RC outpatient 7075 7075 11.41 11.41 fee schedule 7075 93 5730.75 percent of total billed charges 7075 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7075 other OPPS APC 7075 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7075 other OPPS APC 7075 32.21 2278.86 percent of total billed charges 11.41 7075 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Removal of Pacemaker System PX-361332340 CDM 33234 CPT 0361 RC outpatient 9354.05 9354.05 3445.29 3445.29 fee schedule 9354.05 93 7576.78 percent of total billed charges 9354.05 9354.05 other OPPS APC 9354.05 9354.05 other OPPS APC 9354.05 32.21 3012.94 percent of total billed charges 3445.29 9354.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Acid Insertion Single or Dual PX-361332490 CDM 33249 CPT 0361 RC outpatient 78364.9 78364.9 11789.8 11789.8 fee schedule 78364.9 93 63475.6 percent of total billed charges 78364.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 33544.6 other OPPS APC 78364.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 33544.6 other OPPS APC 78364.9 32.21 25241.3 percent of total billed charges 11789.8 78364.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Aicd Battery Change Single Lead PX-361332620 CDM 33262 CPT 0361 RC outpatient 56146.6 56146.6 7587.55 56146.6 fee schedule 56146.6 93 45478.8 percent of total billed charges 56146.6 56146.6 other OPPS APC 56146.6 56146.6 other OPPS APC 56146.6 32.21 18084.8 percent of total billed charges 7587.55 56146.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Aicd Battery Change Dual Lead PX-361332630 CDM 33263 CPT 0361 RC outpatient 56146.6 56146.6 7587.55 7587.55 fee schedule 56146.6 93 45478.8 percent of total billed charges 56146.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24033.9 other OPPS APC 56146.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24033.9 other OPPS APC 56146.6 32.21 18084.8 percent of total billed charges 7587.55 56146.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Aicd Battery Change Multi Lead PX-361332640 CDM 33264 CPT 0361 RC outpatient 78364.9 78364.9 7587.55 7587.55 fee schedule 78364.9 93 63475.6 percent of total billed charges 78364.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 33544.6 other OPPS APC 78364.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 33544.6 other OPPS APC 78364.9 32.21 25241.3 percent of total billed charges 7587.55 78364.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Venography, Needle Inject" PX-361360051 CDM 36005 CPT 0361 RC outpatient 473 473 11.41 11.41 fee schedule 473 93 383.13 percent of total billed charges 473 473 other OPPS APC 473 473 other OPPS APC 473 32.21 152.35 percent of total billed charges 11.41 473 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Superior or Inferior Vena Cava Cath PX-361360101 CDM 36010 CPT 0361 RC outpatient 918 918 11.41 918 fee schedule 918 93 743.58 percent of total billed charges 918 918 other OPPS APC 918 918 other OPPS APC 918 32.21 295.69 percent of total billed charges 11.41 918 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Venous Vascular 2nd Order/>Slctv Branc PX-361360121 CDM 36012 CPT 0361 RC outpatient 963 963 11.41 963 fee schedule 963 93 780.03 percent of total billed charges 963 963 other OPPS APC 963 963 other OPPS APC 963 32.21 310.18 percent of total billed charges 11.41 963 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Retrograde, Brachial" PX-361361201 CDM 36120 CPT 0361 RC outpatient 737 737 737 Service paid by fee schedule. 737 fee schedule Ambulatory 737 93 596.97 percent of total billed charges 737 737 other OPPS APC 737 737 other OPPS APC 737 32.21 237.39 percent of total billed charges 737 737 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Common Femoral, Ipsilateral" PX-361361401 CDM 36140 CPT 0361 RC outpatient 897 897 11.41 897 fee schedule 897 93 726.57 percent of total billed charges 897 897 other OPPS APC 897 897 other OPPS APC 897 32.21 288.92 percent of total billed charges 11.41 897 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Aorta, Catheter Non-Selective" PX-361362001 CDM 36200 CPT 0361 RC outpatient 1314 1314 11.41 11.41 fee schedule 1314 93 1064.34 percent of total billed charges 1314 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1314 other OPPS APC 1314 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1314 other OPPS APC 1314 32.21 423.24 percent of total billed charges 11.41 1314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ins Cath Abdominal Art 1st PX-361362452 CDM 36245 CPT 0361 RC outpatient 1582 1582 11.41 11.41 fee schedule 1582 93 1281.42 percent of total billed charges 1582 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1582 other OPPS APC 1582 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1582 other OPPS APC 1582 32.21 509.56 percent of total billed charges 11.41 1582 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ins Cath Abd/L-Ext Art 2nd PX-361362461 CDM 36246 CPT 0361 RC outpatient 1623 1623 11.41 1623 fee schedule 1623 93 1314.63 percent of total billed charges 1623 1623 other OPPS APC 1623 1623 other OPPS APC 1623 32.21 522.77 percent of total billed charges 11.41 1623 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vascular Abdominal 3rd Order PX-361362471 CDM 36247 CPT 0361 RC outpatient 1763 1763 11.41 11.41 fee schedule 1763 93 1428.03 percent of total billed charges 1763 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1763 other OPPS APC 1763 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1763 other OPPS APC 1763 32.21 567.86 percent of total billed charges 11.41 1763 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Inj Sclero Spider Veins PX-361364681 CDM 36468 CPT 0361 RC outpatient 949.8 949.8 461.65 949.8 fee schedule 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 949.8 32.21 305.93 percent of total billed charges 461.65 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Inject of Sclerosing Agent: Single Vein PX-361364701 CDM 36470 CPT 0361 RC outpatient 949.8 949.8 461.65 461.65 fee schedule 949.8 93 769.34 percent of total billed charges 949.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 406.57 other OPPS APC 949.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 406.57 other OPPS APC 949.8 32.21 305.93 percent of total billed charges 461.65 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Inj Sclero Soln Vein Multi Leg PX-361364711 CDM 36471 CPT 0361 RC outpatient 949.8 949.8 461.65 949.8 fee schedule 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 949.8 32.21 305.93 percent of total billed charges 461.65 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Central Venous Acces Non-Tunneled PX-361365560 CDM 36556 CPT 0361 RC outpatient 7592.53 7592.53 2292.66 7592.53 fee schedule 7592.53 93 6149.95 percent of total billed charges 7592.53 7592.53 other OPPS APC 7592.53 7592.53 other OPPS APC 7592.53 32.21 2445.55 percent of total billed charges 2292.66 7592.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Cvad Insertion Non-Tunneled PX-361365561 CDM 36556 CPT 0361 RC outpatient 7592.53 7592.53 2292.66 7592.53 fee schedule 7592.53 93 6149.95 percent of total billed charges 7592.53 7592.53 other OPPS APC 7592.53 7592.53 other OPPS APC 7592.53 32.21 2445.55 percent of total billed charges 2292.66 7592.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Cvad Insertion Tunneled PX-361365581 CDM 36558 CPT 0361 RC outpatient 7592.53 7592.53 2844.96 2844.96 fee schedule 7592.53 93 6149.95 percent of total billed charges 7592.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250.03 other OPPS APC 7592.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250.03 other OPPS APC 7592.53 32.21 2445.55 percent of total billed charges 2844.96 7592.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Cvad Insertion Port PX-361365611 CDM 36561 CPT 0361 RC outpatient 7592.53 7592.53 3445.29 3445.29 fee schedule 7592.53 93 6149.95 percent of total billed charges 7592.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250.03 other OPPS APC 7592.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250.03 other OPPS APC 7592.53 32.21 2445.55 percent of total billed charges 3445.29 7592.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Xr Picc Lne Insertion PX-361365731 CDM 36573 CPT 0361 RC outpatient 3814.83 3814.83 1392.16 1392.16 fee schedule 3814.83 93 3090.01 percent of total billed charges 3814.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1632.96 other OPPS APC 3814.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1632.96 other OPPS APC 3814.83 32.21 1228.76 percent of total billed charges 1392.16 3814.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Repair Tunneled Cv Cath PX-361365760 CDM 36576 CPT 0361 RC outpatient 11444.5 11444.5 2292.66 2292.66 fee schedule 11444.5 93 9270.02 percent of total billed charges 11444.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1632.96 other OPPS APC 11444.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1632.96 other OPPS APC 11444.5 32.21 3686.26 percent of total billed charges 2292.66 11444.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Cvad Replace Tunnel Comp Non Port PX-361365811 CDM 36581 CPT 0361 RC outpatient 7592.53 7592.53 2292.66 2292.66 fee schedule 7592.53 93 6149.95 percent of total billed charges 7592.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250.03 other OPPS APC 7592.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250.03 other OPPS APC 7592.53 32.21 2445.55 percent of total billed charges 2292.66 7592.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Cvad Replace Tunneled Port Comp PX-361365821 CDM 36582 CPT 0361 RC outpatient 7592.53 7592.53 3445.29 7592.53 fee schedule 7592.53 93 6149.95 percent of total billed charges 7592.53 7592.53 other OPPS APC 7592.53 7592.53 other OPPS APC 7592.53 32.21 2445.55 percent of total billed charges 3445.29 7592.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Cvad Replacement Picc PX-361365841 CDM 36584 CPT 0361 RC outpatient 3814.83 3814.83 1392.16 3814.83 fee schedule 3814.83 93 3090.01 percent of total billed charges 3814.83 3814.83 other OPPS APC 3814.83 3814.83 other OPPS APC 3814.83 32.21 1228.76 percent of total billed charges 1392.16 3814.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cpu First 30 Minutes PX-361365890 CDM 36589 CPT 0361 RC outpatient 1496.38 1496.38 1392.16 1392.16 fee schedule 1496.38 93 1212.07 percent of total billed charges 1496.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 640.53 other OPPS APC 1496.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 640.53 other OPPS APC 1496.38 32.21 481.98 percent of total billed charges 1392.16 1496.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Removal Tunneled Central Venous Cathw/O Subcu Port/Pump PX-361365891 CDM 36589 CPT 0361 RC outpatient 1496.38 1496.38 1392.16 1392.16 fee schedule 1496.38 93 1212.07 percent of total billed charges 1496.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 640.53 other OPPS APC 1496.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 640.53 other OPPS APC 1496.38 32.21 481.98 percent of total billed charges 1392.16 1496.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Removal of Tunneled Cv Cath W/ Pump PX-361365901 CDM 36590 CPT 0361 RC outpatient 3814.83 3814.83 1392.16 1392.16 fee schedule 3814.83 93 3090.01 percent of total billed charges 3814.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1632.96 other OPPS APC 3814.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1632.96 other OPPS APC 3814.83 32.21 1228.76 percent of total billed charges 1392.16 3814.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Central Line Reposition W Fluoro PX-361365970 CDM 36597 CPT 0361 RC outpatient 3814.83 3814.83 1392.16 3814.83 fee schedule 3814.83 93 3090.01 percent of total billed charges 3814.83 3814.83 other OPPS APC 3814.83 3814.83 other OPPS APC 3814.83 32.21 1228.76 percent of total billed charges 1392.16 3814.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Contrast Inj/Eval Exist Cvad Inc Flu PX-361365981 CDM 36598 CPT 0361 RC outpatient 510.55 510.55 461.65 461.65 fee schedule 510.55 93 413.55 percent of total billed charges 510.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.54 other OPPS APC 510.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.54 other OPPS APC 510.55 32.21 164.45 percent of total billed charges 461.65 510.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Dial Fistulagram PX-361369011 CDM 36901 CPT 0361 RC outpatient 3814.83 3814.83 1392.16 3814.83 fee schedule 3814.83 93 3090.01 percent of total billed charges 3814.83 3814.83 other OPPS APC 3814.83 3814.83 other OPPS APC 3814.83 32.21 1228.76 percent of total billed charges 1392.16 3814.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Dial Fistulagram Thrombectomy PX-361369041 CDM 36904 CPT 0361 RC outpatient 13614.6 13614.6 6386.89 13614.6 fee schedule 13614.6 93 11027.8 percent of total billed charges 13614.6 13614.6 other OPPS APC 13614.6 13614.6 other OPPS APC 13614.6 32.21 4385.26 percent of total billed charges 6386.89 13614.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Dial Fistulagram Thrombec Pta Periph PX-361369051 CDM 36905 CPT 0361 RC outpatient 26204.5 26204.5 14791.5 26204.5 fee schedule 26204.5 93 21225.7 percent of total billed charges 26204.5 26204.5 other OPPS APC 26204.5 26204.5 other OPPS APC 26204.5 32.21 8440.48 percent of total billed charges 14791.5 26204.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Dial Fistulagram Pta Central Segment PX-361369071 CDM 36907 CPT 0361 RC outpatient 6106 6106 11.41 6106 fee schedule 6106 93 4945.86 percent of total billed charges 6106 6106 other OPPS APC 6106 6106 other OPPS APC 6106 32.21 1966.74 percent of total billed charges 11.41 6106 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Thrombectomy Arterial Initial PX-361371841 CDM 37184 CPT 0361 RC outpatient 41768.3 41768.3 4285.74 41768.3 fee schedule 41768.3 93 33832.3 percent of total billed charges 41768.3 41768.3 other OPPS APC 41768.3 41768.3 other OPPS APC 41768.3 32.21 13453.6 percent of total billed charges 4285.74 41768.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Thrombectomy Arterial Secondary PX-361371861 CDM 37186 CPT 0361 RC outpatient 4705 4705 11.41 4705 fee schedule 4705 93 3811.05 percent of total billed charges 4705 4705 other OPPS APC 4705 4705 other OPPS APC 4705 32.21 1515.48 percent of total billed charges 11.41 4705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Thrombectomy Venous PX-361371871 CDM 37187 CPT 0361 RC outpatient 26204.5 26204.5 6386.89 26204.5 fee schedule 26204.5 93 21225.7 percent of total billed charges 26204.5 26204.5 other OPPS APC 26204.5 26204.5 other OPPS APC 26204.5 32.21 8440.48 percent of total billed charges 6386.89 26204.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Thrombectomy Venous Subsequent Day PX-361371881 CDM 37188 CPT 0361 RC outpatient 7592.53 7592.53 2292.66 7592.53 fee schedule 7592.53 93 6149.95 percent of total billed charges 7592.53 7592.53 other OPPS APC 7592.53 7592.53 other OPPS APC 7592.53 32.21 2445.55 percent of total billed charges 2292.66 7592.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Ivc Filter Insertion PX-361371911 CDM 37191 CPT 0361 RC outpatient 13089.8 13089.8 2844.96 13089.8 fee schedule 13089.8 93 10602.7 percent of total billed charges 13089.8 13089.8 other OPPS APC 13089.8 13089.8 other OPPS APC 13089.8 32.21 4216.22 percent of total billed charges 2844.96 13089.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Thrombolysis Venous Initial Trt Day PX-361372121 CDM 37212 CPT 0361 RC outpatient 7592.53 7592.53 3445.29 7592.53 fee schedule 7592.53 93 6149.95 percent of total billed charges 7592.53 7592.53 other OPPS APC 7592.53 7592.53 other OPPS APC 7592.53 32.21 2445.55 percent of total billed charges 3445.29 7592.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Thrombolysis Subsequent Day PX-361372131 CDM 37213 CPT 0361 RC outpatient 7592.53 7592.53 2292.66 7592.53 fee schedule 7592.53 93 6149.95 percent of total billed charges 7592.53 7592.53 other OPPS APC 7592.53 7592.53 other OPPS APC 7592.53 32.21 2445.55 percent of total billed charges 2292.66 7592.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Thrombolysis Cath Rmvl Subsequent Day PX-361372141 CDM 37214 CPT 0361 RC outpatient 7592.53 7592.53 2292.66 7592.53 fee schedule 7592.53 93 6149.95 percent of total billed charges 7592.53 7592.53 other OPPS APC 7592.53 7592.53 other OPPS APC 7592.53 32.21 2445.55 percent of total billed charges 2292.66 7592.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC IR Iliac Arter, Initial, Pta" PX-361372201 CDM 37220 CPT 0361 RC outpatient 13614.6 13614.6 7587.55 13614.6 fee schedule 13614.6 93 11027.8 percent of total billed charges 13614.6 13614.6 other OPPS APC 13614.6 13614.6 other OPPS APC 13614.6 32.21 4385.26 percent of total billed charges 7587.55 13614.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC IR Iliac Artery, Initial, Pta, Stent" PX-361372211 CDM 37221 CPT 0361 RC outpatient 26204.5 26204.5 7587.55 26204.5 fee schedule 26204.5 93 21225.7 percent of total billed charges 26204.5 26204.5 other OPPS APC 26204.5 26204.5 other OPPS APC 26204.5 32.21 8440.48 percent of total billed charges 7587.55 26204.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC IR Iliac Artery, Add'l, Pta" PX-361372221 CDM 37222 CPT 0361 RC outpatient 6106 6106 7587.55 7587.55 fee schedule 6106 93 4945.86 percent of total billed charges 6106 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6106 other OPPS APC 6106 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6106 other OPPS APC 6106 32.21 1966.74 percent of total billed charges 6106 7587.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC IR Fem/Pop Art, Init'l, Pta" PX-361372241 CDM 37224 CPT 0361 RC outpatient 13614.6 13614.6 3445.29 3445.29 fee schedule 13614.6 93 11027.8 percent of total billed charges 13614.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5827.81 other OPPS APC 13614.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5827.81 other OPPS APC 13614.6 32.21 4385.26 percent of total billed charges 3445.29 13614.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC IR Fem/Pop Art, Initial, Pta Ather" PX-361372251 CDM 37225 CPT 0361 RC outpatient 41768.3 41768.3 4285.74 41768.3 fee schedule 41768.3 93 33832.3 percent of total billed charges 41768.3 41768.3 other OPPS APC 41768.3 41768.3 other OPPS APC 41768.3 32.21 13453.6 percent of total billed charges 4285.74 41768.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC IR Fem/Pop Art, Initial, Pta Stent" PX-361372261 CDM 37226 CPT 0361 RC outpatient 26204.5 26204.5 6386.89 26204.5 fee schedule 26204.5 93 21225.7 percent of total billed charges 26204.5 26204.5 other OPPS APC 26204.5 26204.5 other OPPS APC 26204.5 32.21 8440.48 percent of total billed charges 6386.89 26204.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC IR Fem/Pop Art, Init'l, Pta Stent Arther" PX-361372271 CDM 37227 CPT 0361 RC outpatient 41768.3 41768.3 8788.2 8788.2 fee schedule 41768.3 93 33832.3 percent of total billed charges 41768.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17879.2 other OPPS APC 41768.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17879.2 other OPPS APC 41768.3 32.21 13453.6 percent of total billed charges 8788.2 41768.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC IR Tib/per , Initial, Pta" PX-361372281 CDM 37228 CPT 0361 RC outpatient 26204.5 26204.5 11789.8 26204.5 fee schedule 26204.5 93 21225.7 percent of total billed charges 26204.5 26204.5 other OPPS APC 26204.5 26204.5 other OPPS APC 26204.5 32.21 8440.48 percent of total billed charges 11789.8 26204.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC IR Tib/per, Initial, Pta, Ather" PX-361372291 CDM 37229 CPT 0361 RC outpatient 41768.3 41768.3 8788.2 41768.3 fee schedule 41768.3 93 33832.3 percent of total billed charges 41768.3 41768.3 other OPPS APC 41768.3 41768.3 other OPPS APC 41768.3 32.21 13453.6 percent of total billed charges 8788.2 41768.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tib/per Revasc W/Stent PX-361372301 CDM 37230 CPT 0361 RC outpatient 41768.3 41768.3 8788.2 8788.2 fee schedule 41768.3 93 33832.3 percent of total billed charges 41768.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17879.2 other OPPS APC 41768.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17879.2 other OPPS APC 41768.3 32.21 13453.6 percent of total billed charges 8788.2 41768.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC IR Tib/per, Add'l Pta" PX-361372321 CDM 37232 CPT 0361 RC outpatient 6106 6106 11.41 6106 fee schedule 6106 93 4945.86 percent of total billed charges 6106 6106 other OPPS APC 6106 6106 other OPPS APC 6106 32.21 1966.74 percent of total billed charges 11.41 6106 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC IR Tib/per, Add'l, Pta Stent" PX-361372331 CDM 37233 CPT 0361 RC outpatient 13139 13139 11.41 11.41 fee schedule 13139 93 10642.6 percent of total billed charges 13139 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13139 other OPPS APC 13139 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13139 other OPPS APC 13139 32.21 4232.07 percent of total billed charges 11.41 13139 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Stent Venous Placement Initial PX-361372381 CDM 37238 CPT 0361 RC outpatient 26204.5 26204.5 6386.89 6386.89 fee schedule 26204.5 93 21225.7 percent of total billed charges 26204.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11217 other OPPS APC 26204.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11217 other OPPS APC 26204.5 32.21 8440.48 percent of total billed charges 6386.89 26204.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Transcth Intvsc Stnt Opn Prc Vei PX-361372391 CDM 37239 CPT 0361 RC outpatient 5575 5575 11.41 5575 fee schedule 5575 93 4515.75 percent of total billed charges 5575 5575 other OPPS APC 5575 5575 other OPPS APC 5575 32.21 1795.71 percent of total billed charges 11.41 5575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IR Pta Venous Initial PX-361372481 CDM 37248 CPT 0361 RC outpatient 13614.6 13614.6 6386.89 13614.6 fee schedule 13614.6 93 11027.8 percent of total billed charges 13614.6 13614.6 other OPPS APC 13614.6 13614.6 other OPPS APC 13614.6 32.21 4385.26 percent of total billed charges 6386.89 13614.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Irpta Venous Additional PX-361372491 CDM 37249 CPT 0361 RC outpatient 12576 12576 11.41 12576 fee schedule 12576 93 10186.6 percent of total billed charges 12576 12576 other OPPS APC 12576 12576 other OPPS APC 12576 32.21 4050.73 percent of total billed charges 11.41 12576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ivus Non Coronary Initial Vessel PX-361372521 CDM 37252 CPT 0361 RC outpatient 2044 2044 11.41 11.41 fee schedule 2044 93 1655.64 percent of total billed charges 2044 2044 other OPPS APC 2044 2044 other OPPS APC 2044 32.21 658.37 percent of total billed charges 11.41 2044 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ivus Non Coronary Additional Vessel PX-361372531 CDM 37253 CPT 0361 RC outpatient 1812 1812 11.41 11.41 fee schedule 1812 93 1467.72 percent of total billed charges 1812 1812 other OPPS APC 1812 1812 other OPPS APC 1812 32.21 583.65 percent of total billed charges 11.41 1812 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Diagnostic Bone Marrow Aspirations PX-361382200 CDM 38220 CPT 0361 RC outpatient 3861.88 3861.88 2292.66 3861.88 fee schedule 3861.88 93 3128.12 percent of total billed charges 3861.88 3861.88 other OPPS APC 3861.88 3861.88 other OPPS APC 3861.88 32.21 1243.91 percent of total billed charges 2292.66 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Bone Marrorw Biopsy and Aspiration PX-361382220 CDM 38222 CPT 0361 RC outpatient 6768.38 6768.38 2292.66 2292.66 fee schedule 6768.38 93 5482.39 percent of total billed charges 6768.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2897.24 other OPPS APC 6768.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2897.24 other OPPS APC 6768.38 32.21 2180.1 percent of total billed charges 2292.66 6768.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Biopsy Lymph Node Super(Axil Ing Cer PX-361385051 CDM 38505 CPT 0361 RC outpatient 3861.88 3861.88 1392.16 1392.16 fee schedule 3861.88 93 3128.12 percent of total billed charges 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 32.21 1243.91 percent of total billed charges 1392.16 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC US Bx Salivary Gland PX-361424001 CDM 42400 CPT 0361 RC outpatient 1675.9 1675.9 1392.16 1392.16 fee schedule 1675.9 93 1357.48 percent of total billed charges 1675.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 717.38 other OPPS APC 1675.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 717.38 other OPPS APC 1675.9 32.21 539.81 percent of total billed charges 1392.16 1675.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Biopsy Oropharynx PX-361428001 CDM 42800 CPT 0361 RC outpatient 3632.63 3632.63 2292.66 3632.63 fee schedule 3632.63 93 2942.43 percent of total billed charges 3632.63 3632.63 other OPPS APC 3632.63 3632.63 other OPPS APC 3632.63 32.21 1170.07 percent of total billed charges 2292.66 3632.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC CT/Appendiceal Abscess, Percut" PX-361449012 CDM 44901 CPT 0361 RC outpatient 1743 1743 1743 Service paid by fee schedule. 1743 fee schedule Ambulatory 1743 93 1411.83 percent of total billed charges 1743 1743 other OPPS APC 1743 1743 other OPPS APC 1743 32.21 561.42 percent of total billed charges 1743 1743 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC US Liver Bx Percut Needle PX-361470001 CDM 47000 CPT 0361 RC outpatient 3861.88 3861.88 1392.16 1392.16 fee schedule 3861.88 93 3128.12 percent of total billed charges 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 32.21 1243.91 percent of total billed charges 1392.16 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Abscess Drain Liver - CT Percut PX-361470113 CDM 47011 CPT 0361 RC outpatient 1743 1743 1743 Service paid by fee schedule. 1743 fee schedule Ambulatory 1743 93 1411.83 percent of total billed charges 1743 1743 other OPPS APC 1743 1743 other OPPS APC 1743 32.21 561.42 percent of total billed charges 1743 1743 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Incision of Gallbladder PX-361474900 CDM 47490 CPT 0361 RC outpatient 8240.85 8240.85 2292.66 8240.85 fee schedule 8240.85 93 6675.09 percent of total billed charges 8240.85 8240.85 other OPPS APC 8240.85 8240.85 other OPPS APC 8240.85 32.21 2654.38 percent of total billed charges 2292.66 8240.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Biliary Drain Catheter US Guidance PX-361475332 CDM 47533 CPT 0361 RC outpatient 8240.85 8240.85 11.41 8240.85 fee schedule 8240.85 93 6675.09 percent of total billed charges 8240.85 8240.85 other OPPS APC 8240.85 8240.85 other OPPS APC 8240.85 32.21 2654.38 percent of total billed charges 11.41 8240.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Needle Biopsy of Pancreas PX-361481020 CDM 48102 CPT 0361 RC outpatient 3861.88 3861.88 1392.16 3861.88 fee schedule 3861.88 93 3128.12 percent of total billed charges 3861.88 3861.88 other OPPS APC 3861.88 3861.88 other OPPS APC 3861.88 32.21 1243.91 percent of total billed charges 1392.16 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC US Paracentesis Initial PX-361490831 CDM 49083 CPT 0361 RC outpatient 2159.23 2159.23 1392.16 1392.16 fee schedule 2159.23 93 1748.98 percent of total billed charges 2159.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 924.27 other OPPS APC 2159.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 924.27 other OPPS APC 2159.23 32.21 695.49 percent of total billed charges 1392.16 2159.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC MC Arthrocent,Apsirat &/or Inject, Major Joint/Bursa" PX-361490839 CDM 20610 CPT 0361 RC outpatient 705.5 705.5 461.65 461.65 fee schedule 705.5 93 571.46 percent of total billed charges 705.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301.99 other OPPS APC 705.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301.99 other OPPS APC 705.5 32.21 227.24 percent of total billed charges 461.65 705.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Biopsy Abdominal Mass PX-361491800 CDM 49180 CPT 0361 RC outpatient 3861.88 3861.88 1392.16 1392.16 fee schedule 3861.88 93 3128.12 percent of total billed charges 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 32.21 1243.91 percent of total billed charges 1392.16 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Abscess Drain Perirenal W Con Sed PX-361494053 CDM 49405 CPT 0361 RC outpatient 3861.88 3861.88 2292.66 2292.66 fee schedule 3861.88 93 3128.12 percent of total billed charges 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 32.21 1243.91 percent of total billed charges 2292.66 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Xr Rep Gastro Jejungo Under Fluo PX-361494400 CDM 49440 CPT 0361 RC outpatient 4532.48 4532.48 2292.66 2292.66 fee schedule 4532.48 93 3671.31 percent of total billed charges 4532.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1940.15 other OPPS APC 4532.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1940.15 other OPPS APC 4532.48 32.21 1459.91 percent of total billed charges 2292.66 4532.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Xr Rep Duod/Jejuno Tube W Fluoro PX-361494510 CDM 49451 CPT 0361 RC outpatient 2159.23 2159.23 1392.16 1392.16 fee schedule 2159.23 93 1748.98 percent of total billed charges 2159.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 924.27 other OPPS APC 2159.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 924.27 other OPPS APC 2159.23 32.21 695.49 percent of total billed charges 1392.16 2159.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC CT Biopsy Renal Percut PX-361502001 CDM 50200 CPT 0361 RC outpatient 3861.88 3861.88 2292.66 2292.66 fee schedule 3861.88 93 3128.12 percent of total billed charges 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 32.21 1243.91 percent of total billed charges 2292.66 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC US Renal Bx Percut Trocar/Needle PX-361502002 CDM 50200 CPT 0361 RC outpatient 3861.88 3861.88 2292.66 2292.66 fee schedule 3861.88 93 3128.12 percent of total billed charges 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 32.21 1243.91 percent of total billed charges 2292.66 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Remove Renal Tube W/Fluoro PX-361503890 CDM 50389 CPT 0361 RC outpatient 4881.45 4881.45 4881.45 4881.45 fee schedule 4881.45 4881.45 percent of total billed charges 4881.45 4881.45 other OPPS APC 4881.45 4881.45 other OPPS APC 4881.45 4881.45 percent of total billed charges 4881.45 4881.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Drainage of Kidney Lesion PX-361503900 CDM 50390 CPT 0361 RC outpatient 1675.9 1675.9 1392.16 1675.9 fee schedule 1675.9 93 1357.48 percent of total billed charges 1675.9 1675.9 other OPPS APC 1675.9 1675.9 other OPPS APC 1675.9 32.21 539.81 percent of total billed charges 1392.16 1675.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Nephrostomy Drain Insertion PX-361504321 CDM 50432 CPT 0361 RC outpatient 4851.65 4851.65 11.41 4851.65 fee schedule 4851.65 93 3929.84 percent of total billed charges 4851.65 4851.65 other OPPS APC 4851.65 4851.65 other OPPS APC 4851.65 32.21 1562.72 percent of total billed charges 11.41 4851.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Nephhrostomy Drain Replacement PX-361504351 CDM 50435 CPT 0361 RC outpatient 4851.65 4851.65 11.41 11.41 fee schedule 4851.65 93 3929.84 percent of total billed charges 4851.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2076.78 other OPPS APC 4851.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2076.78 other OPPS APC 4851.65 32.21 1562.72 percent of total billed charges 11.41 4851.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Dilation Existnephhrostomy New Access PX-361504371 CDM 50437 CPT 0361 RC outpatient 8303.95 8303.95 3445.29 8303.95 fee schedule 8303.95 93 6726.2 percent of total billed charges 8303.95 8303.95 other OPPS APC 8303.95 8303.95 other OPPS APC 8303.95 32.21 2674.7 percent of total billed charges 3445.29 8303.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Rad/Cysto/Vcug Injection PX-361516001 CDM 51600 CPT 0361 RC outpatient 61 61 11.41 61 fee schedule 61 93 49.41 percent of total billed charges 61 61 other OPPS APC 61 61 other OPPS APC 61 32.21 19.65 percent of total billed charges 11.41 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Urethrocystogram-Retro Inj Proc PX-361516101 CDM 51610 CPT 0361 RC outpatient 61 61 11.41 61 fee schedule 61 93 49.41 percent of total billed charges 61 61 other OPPS APC 61 61 other OPPS APC 61 32.21 19.65 percent of total billed charges 11.41 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Drainage of Ovarian Cyst(S) PX-361588050 CDM 58805 CPT 0361 RC outpatient 7446.92 7446.92 1392.16 7446.92 fee schedule 7446.92 93 6032.01 percent of total billed charges 7446.92 7446.92 other OPPS APC 7446.92 7446.92 other OPPS APC 7446.92 32.21 2398.65 percent of total billed charges 1392.16 7446.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Biopsy of Thyroid PX-361601001 CDM 60100 CPT 0361 RC outpatient 1675.9 1675.9 1392.16 1392.16 fee schedule 1675.9 93 1357.48 percent of total billed charges 1675.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 717.38 other OPPS APC 1675.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 717.38 other OPPS APC 1675.9 32.21 539.81 percent of total billed charges 1392.16 1675.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Lumbar Puncture PX-361622700 CDM 62328 CPT 0361 RC outpatient 1647.25 1647.25 1392.16 1392.16 fee schedule 1647.25 93 1334.27 percent of total billed charges 1647.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705.12 other OPPS APC 1647.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705.12 other OPPS APC 1647.25 32.21 530.58 percent of total billed charges 1392.16 1647.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MC Cerumen Removal PX-361692098 CDM 69209 CPT 0361 RC outpatient 145.7 145.7 145.7 Service paid by fee schedule. 145.7 fee schedule Ambulatory 145.7 93 118.02 percent of total billed charges 145.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.37 other OPPS APC 145.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.37 other OPPS APC 145.7 32.21 46.93 percent of total billed charges 145.7 145.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Application on-Body Injector Timed Subcutaneous Inj PX-361963770 CDM 96377 CPT 0361 RC outpatient 113.15 113.15 113.15 Service paid by fee schedule. 113.15 fee schedule Ambulatory 113.15 93 91.65 percent of total billed charges 113.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 113.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 113.15 32.21 36.45 percent of total billed charges 113.15 113.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ivl With Angioplasty PX-361C97641 CDM C9764 CPT 0361 RC outpatient 26538.3 26538.3 26538.3 Service paid by fee schedule. 26538.3 fee schedule Ambulatory 26538.3 93 21496 percent of total billed charges 26538.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11217 other OPPS APC 26538.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11217 other OPPS APC 26538.3 32.21 8547.98 percent of total billed charges 26538.3 26538.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ivl+Stent With Angioplasty PX-361C97651 CDM C9765 CPT 0361 RC outpatient 42944 42944 7587.55 7587.55 fee schedule 42944 93 34784.6 percent of total billed charges 42944 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17879.2 other OPPS APC 42944 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17879.2 other OPPS APC 42944 32.21 13832.3 percent of total billed charges 7587.55 42944 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ivl+Atherectomy With Angioplasty PX-361C97661 CDM C9766 CPT 0361 RC outpatient 42944 42944 42944 Service paid by fee schedule. 42944 fee schedule Ambulatory 42944 93 34784.6 percent of total billed charges 42944 42944 other OPPS APC 42944 42944 other OPPS APC 42944 32.21 13832.3 percent of total billed charges 42944 42944 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ivl+Stent+Atherectomy With Angioplasty PX-361C97671 CDM C9767 CPT 0361 RC outpatient 42944 42944 14791.5 42944 fee schedule 42944 93 34784.6 percent of total billed charges 42944 42944 other OPPS APC 42944 42944 other OPPS APC 42944 32.21 13832.3 percent of total billed charges 14791.5 42944 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ivl With Angioplasty PX-361C97721 CDM C9772 CPT 0361 RC outpatient 26538.3 26538.3 26538.3 Service paid by fee schedule. 26538.3 fee schedule Ambulatory 26538.3 93 21496 percent of total billed charges 26538.3 26538.3 other OPPS APC 26538.3 26538.3 other OPPS APC 26538.3 32.21 8547.98 percent of total billed charges 26538.3 26538.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ivl+Stent With Angioplasty PX-361C97731 CDM C9773 CPT 0361 RC outpatient 42944 42944 42944 Service paid by fee schedule. 42944 fee schedule Ambulatory 42944 93 34784.6 percent of total billed charges 42944 42944 other OPPS APC 42944 42944 other OPPS APC 42944 32.21 13832.3 percent of total billed charges 42944 42944 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ivl+Atherectomy With Angioplasty PX-361C97741 CDM C9774 CPT 0361 RC outpatient 42944 42944 42944 Service paid by fee schedule. 42944 fee schedule Ambulatory 42944 93 34784.6 percent of total billed charges 42944 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17879.2 other OPPS APC 42944 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17879.2 other OPPS APC 42944 32.21 13832.3 percent of total billed charges 42944 42944 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ivl+Stent+Atherectomy With Angioplasty PX-361C97751 CDM C9775 CPT 0361 RC outpatient 42944 42944 42944 Service paid by fee schedule. 42944 fee schedule Ambulatory 42944 93 34784.6 percent of total billed charges 42944 42944 other OPPS APC 42944 42944 other OPPS APC 42944 32.21 13832.3 percent of total billed charges 42944 42944 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Anesthesiology PX-370000000 CDM 370000000 LOCAL 0370 RC outpatient 341 341 341 74 252.34 percent of total billed charges 341 93 276.21 percent of total billed charges 341 341 other OPPS APC 341 341 other OPPS APC 341 28.78 98.14 percent of total billed charges 341 341 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Anesthesia Lo/Reg 0-30 Mins PX-370000001 CDM 370000001 LOCAL 0370 RC outpatient 275 275 275 74 203.5 percent of total billed charges 275 93 222.75 percent of total billed charges 275 275 other OPPS APC 275 275 other OPPS APC 275 28.78 79.15 percent of total billed charges 275 275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Anesthesia Lo/Reg Add'l 15 Minutes PX-370000002 CDM 370000002 LOCAL 0370 RC outpatient 75 75 75 74 55.5 percent of total billed charges 75 93 60.75 percent of total billed charges 75 75 other OPPS APC 75 75 other OPPS APC 75 28.78 21.59 percent of total billed charges 75 75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Anesth Supplies 0-30 Mins PX-370000003 CDM 0370 RC outpatient 300 300 300 74 222 percent of total billed charges 300 93 243 percent of total billed charges 300 300 other OPPS APC 300 300 other OPPS APC 300 28.78 86.34 percent of total billed charges 300 300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Anesthesia Gen 0-30 Mins. PX-370000004 CDM 370000004 LOCAL 0370 RC outpatient 450 450 450 74 333 percent of total billed charges 450 93 364.5 percent of total billed charges 450 450 other OPPS APC 450 450 other OPPS APC 450 28.78 129.51 percent of total billed charges 450 450 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Anesthesia Gen Add'l 15 Mins PX-370000005 CDM 370000005 LOCAL 0370 RC outpatient 150 150 150 74 111 percent of total billed charges 150 93 121.5 percent of total billed charges 150 150 other OPPS APC 150 150 other OPPS APC 150 28.78 43.17 percent of total billed charges 150 150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Anesth. Supplies Add'l 15 Mins PX-370000006 CDM 0370 RC outpatient 100 100 100 74 74 percent of total billed charges 100 93 81 percent of total billed charges 100 100 other OPPS APC 100 100 other OPPS APC 100 28.78 28.78 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Moderate Sedation < 5yrs First 15 Min PX-370991511 CDM 99151 CPT 0370 RC outpatient 125 125 125 74 92.5 percent of total billed charges 125 93 101.25 percent of total billed charges 125 125 other OPPS APC 125 125 other OPPS APC 125 28.78 35.98 percent of total billed charges 125 125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Moderate Sedation Same Phys >5 Initial 15 Min PX-370991521 CDM 99152 CPT 0370 RC outpatient 125 125 125 74 92.5 percent of total billed charges 125 93 101.25 percent of total billed charges 125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 125 other OPPS APC 125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 125 other OPPS APC 125 28.78 35.98 percent of total billed charges 125 125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Moderate Sedation Same Phy Each Addl 15 Min PX-370991531 CDM 99153 CPT 0370 RC outpatient 60 60 60 74 44.4 percent of total billed charges 60 93 48.6 percent of total billed charges 60 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 60 other OPPS APC 60 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 60 other OPPS APC 60 28.78 17.27 percent of total billed charges 60 60 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Leukopoor Rbc's PX-390090160 CDM P9016 CPT 0390 RC outpatient 452.05 452.05 452.05 74 334.52 percent of total billed charges 452.05 93 366.16 percent of total billed charges 452.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180.82 other OPPS APC 452.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180.82 other OPPS APC 452.05 49.98 225.93 percent of total billed charges 452.05 452.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Rhogam (Uf) PX-390903840 CDM 90384 CPT 0390 RC outpatient 163 163 163 74 120.62 percent of total billed charges 163 93 132.03 percent of total billed charges 163 163 other OPPS APC 163 163 other OPPS APC 163 49.98 81.47 percent of total billed charges 163 163 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Psooralen Treated Platelets PX-390907300 CDM P9073 CPT 0390 RC outpatient 1378.2 1378.2 1378.2 74 1019.87 percent of total billed charges 1378.2 93 1116.34 percent of total billed charges 1378.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.28 other OPPS APC 1378.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.28 other OPPS APC 1378.2 49.98 688.82 percent of total billed charges 1378.2 1378.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Washed Red Blood Cells Unit PX-390P90220 CDM P9022 CPT 0390 RC outpatient 992.8 992.8 992.8 74 734.67 percent of total billed charges 992.8 93 804.17 percent of total billed charges 992.8 992.8 other OPPS APC 992.8 992.8 other OPPS APC 992.8 49.98 496.2 percent of total billed charges 992.8 992.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Platelet Pheresis Leukoreduced Irradiated PX-390P90370 CDM P9037 CPT 0390 RC outpatient 1681.2 1681.2 1681.2 74 1244.09 percent of total billed charges 1681.2 93 1361.77 percent of total billed charges 1681.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 672.48 other OPPS APC 1681.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 672.48 other OPPS APC 1681.2 49.98 840.26 percent of total billed charges 1681.2 1681.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC RBC Leukoreduced Irradiated PX-390P90400 CDM P9040 CPT 0390 RC outpatient 631.2 631.2 631.2 74 467.09 percent of total billed charges 631.2 93 511.27 percent of total billed charges 631.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252.48 other OPPS APC 631.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252.48 other OPPS APC 631.2 49.98 315.47 percent of total billed charges 631.2 631.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Blood, L/R, Froz/Degly/Wash" PX-390P90540 CDM P9054 CPT 0390 RC outpatient 809.73 809.73 809.73 74 599.2 percent of total billed charges 809.73 93 655.88 percent of total billed charges 809.73 809.73 other OPPS APC 809.73 809.73 other OPPS APC 809.73 49.98 404.7 percent of total billed charges 809.73 809.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ffp Between 8-24 Hrs of Collect PX-390P90591 CDM P9059 CPT 0390 RC outpatient 181.43 181.43 181.43 74 134.26 percent of total billed charges 181.43 93 146.96 percent of total billed charges 181.43 181.43 other OPPS APC 181.43 181.43 other OPPS APC 181.43 49.98 90.68 percent of total billed charges 181.43 181.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Plasma Processing Fee PX-391000000 CDM P9017 CPT 0390 RC outpatient 199.9 199.9 199.9 74 147.93 percent of total billed charges 199.9 93 161.92 percent of total billed charges 199.9 199.9 other OPPS APC 199.9 199.9 other OPPS APC 199.9 49.98 99.91 percent of total billed charges 199.9 199.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cryoprecipitate Processing Fee PX-391000001 CDM P9012 CPT 0390 RC outpatient 552.07 552.07 552.07 74 408.53 percent of total billed charges 552.07 93 447.18 percent of total billed charges 552.07 552.07 other OPPS APC 552.07 552.07 other OPPS APC 552.07 49.98 275.92 percent of total billed charges 552.07 552.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Red Blood Cell Process Fee PX-391000002 CDM P9016 HCPCS 0390 RC outpatient 452.05 452.05 452.05 74 334.52 percent of total billed charges 452.05 93 366.16 percent of total billed charges 452.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180.82 other OPPS APC 452.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180.82 other OPPS APC 452.05 49.98 225.93 percent of total billed charges 452.05 452.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Transfus,Blood/Blood Comp 0-90min" PX-391364300 CDM 36430 CPT 0391 RC outpatient 1034.03 1034.03 1034.03 74 765.18 percent of total billed charges 1034.03 93 837.56 percent of total billed charges 1034.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 442.62 other OPPS APC 1034.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 442.62 other OPPS APC 1034.03 51 527.36 percent of total billed charges 1034.03 1034.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Transf,Blood/Blood Comp 91-150min" PX-391364301 CDM 36430 CPT 0391 RC outpatient 1034.03 1034.03 1034.03 74 765.18 percent of total billed charges 1034.03 93 837.56 percent of total billed charges 1034.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 442.62 other OPPS APC 1034.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 442.62 other OPPS APC 1034.03 51 527.36 percent of total billed charges 1034.03 1034.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Transf,Blood/Blood Comp 151-210mi" PX-391364302 CDM 36430 CPT 0391 RC outpatient 1034.03 1034.03 1034.03 74 765.18 percent of total billed charges 1034.03 93 837.56 percent of total billed charges 1034.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 442.62 other OPPS APC 1034.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 442.62 other OPPS APC 1034.03 51 527.36 percent of total billed charges 1034.03 1034.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Transf,Blood/Blood Comp 211-270mi" PX-391364303 CDM 36430 CPT 0391 RC outpatient 1034.03 1034.03 1034.03 74 765.18 percent of total billed charges 1034.03 93 837.56 percent of total billed charges 1034.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 442.62 other OPPS APC 1034.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 442.62 other OPPS APC 1034.03 51 527.36 percent of total billed charges 1034.03 1034.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Transf,Blood/Blood Comp 271-330mi" PX-391364304 CDM 36430 CPT 0391 RC outpatient 1034.03 1034.03 1034.03 74 765.18 percent of total billed charges 1034.03 93 837.56 percent of total billed charges 1034.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 442.62 other OPPS APC 1034.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 442.62 other OPPS APC 1034.03 51 527.36 percent of total billed charges 1034.03 1034.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Transf,Blood/Blood Comp 331-390mi" PX-391364305 CDM 36430 CPT 0391 RC outpatient 1034.03 1034.03 1034.03 74 765.18 percent of total billed charges 1034.03 93 837.56 percent of total billed charges 1034.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 442.62 other OPPS APC 1034.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 442.62 other OPPS APC 1034.03 51 527.36 percent of total billed charges 1034.03 1034.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Transf,Blood/Blood Comp 391-450mi" PX-391364306 CDM 36430 CPT 0391 RC outpatient 1034.03 1034.03 1034.03 74 765.18 percent of total billed charges 1034.03 93 837.56 percent of total billed charges 1034.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 442.62 other OPPS APC 1034.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 442.62 other OPPS APC 1034.03 51 527.36 percent of total billed charges 1034.03 1034.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Transf,Blood/Blood Comp 451-510mi" PX-391364307 CDM 36430 CPT 0391 RC outpatient 1034.03 1034.03 1034.03 74 765.18 percent of total billed charges 1034.03 93 837.56 percent of total billed charges 1034.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 442.62 other OPPS APC 1034.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 442.62 other OPPS APC 1034.03 51 527.36 percent of total billed charges 1034.03 1034.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pheresis (Platelets) PX-399090350 CDM P9035 CPT 0390 RC outpatient 1180.83 1180.83 1180.83 74 873.81 percent of total billed charges 1180.83 93 956.47 percent of total billed charges 1180.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.33 other OPPS APC 1180.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.33 other OPPS APC 1180.83 49.98 590.18 percent of total billed charges 1180.83 1180.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bd Mammo Diag Digital 2d Bilat PX-401002050 CDM 77066 CPT 0401 RC outpatient 188 188 260.85 260.85 fee schedule 188 93 152.28 percent of total billed charges 109.11 109.11 fee schedule 109.11 109.11 fee schedule 109.11 109.11 fee schedule 109.11 260.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bd Mammo Diag Digital 2drt PX-401002065 CDM 77065 CPT 0401 RC outpatient 176 176 205.47 205.47 fee schedule 176 93 142.56 percent of total billed charges 85.09 85.09 fee schedule 85.09 85.09 fee schedule 85.09 85.09 fee schedule 85.09 205.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bd Mammo Diag Digital 2d Lt PX-401002067 CDM 77065 CPT 0401 RC outpatient 176 176 205.47 205.47 fee schedule 176 93 142.56 percent of total billed charges 85.09 85.09 fee schedule 85.09 85.09 fee schedule 85.09 85.09 fee schedule 85.09 205.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bd Mammo Diag Gigital Tomo PX-401002790 CDM G0279 CPT 0401 RC outpatient 144.75 144.75 144.75 74 107.12 percent of total billed charges 144.75 93 117.25 percent of total billed charges 18.84 18.84 fee schedule 18.84 18.84 fee schedule 144.75 51 73.82 percent of total billed charges 18.84 144.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Stereotactic Breast Biopsy PX-401190810 CDM 19081 CPT 0401 RC outpatient 4147 4147 2292.66 2292.66 fee schedule 4147 93 3359.07 percent of total billed charges 4147 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 4147 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 4147 32.21 1335.75 percent of total billed charges 2292.66 4147 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bd US Breast Biopsy 1st Lesion PX-401190830 CDM 19083 CPT 0402 RC outpatient 4147 4147 1392.16 1392.16 fee schedule 4147 93 3359.07 percent of total billed charges 4147 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 4147 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 4147 32.21 1335.75 percent of total billed charges 1392.16 4147 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC US Breast Needle Biopsy Ea Add PX-401190840 CDM 19084 CPT 0402 RC outpatient 1338 1338 11.41 1338 fee schedule 1338 93 1083.78 percent of total billed charges 1338 1338 other OPPS APC 1338 1338 other OPPS APC 1338 32.21 430.97 percent of total billed charges 11.41 1338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Breast Surgical Specimen (2) PX-401760980 CDM 76098 CPT 0401 RC outpatient 1314.08 1314.08 60.46 60.46 fee schedule 1314.08 93 1064.4 percent of total billed charges 1314.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 562.5 other OPPS APC 1314.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 562.5 other OPPS APC 26.95 26.95 fee schedule 26.95 1314.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bd Mammo Diag Digital Tomo Unilateral PX-401770610 CDM 77061 CPT 0401 RC outpatient 123.03 123.03 49.01 49.01 fee schedule 123.03 93 99.65 percent of total billed charges 123.03 123.03 other OPPS APC 123.03 123.03 other OPPS APC 123.03 51 62.75 percent of total billed charges 49.01 123.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC US Thora PX-402325550 CDM 32555 CPT 0361 RC outpatient 1496.38 1496.38 1392.16 1392.16 fee schedule 1496.38 93 1212.07 percent of total billed charges 1496.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 640.53 other OPPS APC 1496.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 640.53 other OPPS APC 1496.38 32.21 481.98 percent of total billed charges 1392.16 1496.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC US Guide Abd Paracentesis PX-402490830 CDM 49083 CPT 0402 RC outpatient 2159.23 2159.23 2159.23 74 1597.83 percent of total billed charges 2159.23 93 1748.98 percent of total billed charges 2159.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 924.27 other OPPS APC 2159.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 924.27 other OPPS APC 2159.23 51 1101.21 percent of total billed charges 2159.23 2159.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC US Guid Pleural Drain Tube PX-402494050 CDM 49405 CPT 0402 RC outpatient 3861.88 3861.88 2292.66 2292.66 fee schedule 3861.88 93 3128.12 percent of total billed charges 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 32.21 1243.91 percent of total billed charges 2292.66 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC US Guid Perit,Retro Drain Tube" PX-402494060 CDM 49406 CPT 0361 RC outpatient 3861.88 3861.88 2292.66 3861.88 fee schedule 3861.88 93 3128.12 percent of total billed charges 3861.88 3861.88 other OPPS APC 3861.88 3861.88 other OPPS APC 3861.88 32.21 1243.91 percent of total billed charges 2292.66 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC US Guid Cth per Periton Retro PX-402494070 CDM 49407 CPT 0402 RC outpatient 3861.88 3861.88 3861.88 74 2857.79 percent of total billed charges 3861.88 93 3128.12 percent of total billed charges 3861.88 3861.88 other OPPS APC 3861.88 3861.88 other OPPS APC 3861.88 51 1969.56 percent of total billed charges 3861.88 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Abscess Drainage W/Catheter-US Guide PX-402759891 CDM 75989 CPT 0402 RC outpatient 500 500 453.72 453.72 fee schedule 500 93 405 percent of total billed charges 500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 500 other OPPS APC 500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 500 other OPPS APC 55.53 55.53 fee schedule 55.53 500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Neonate Cranial Sono PX-402765060 CDM 76506 CPT 0402 RC outpatient 466 466 220.7 220.7 fee schedule 466 93 377.46 percent of total billed charges 466 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 466 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 80.22 80.22 fee schedule 80.22 466 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Thyroid Sonography PX-402765360 CDM 76536 CPT 0402 RC outpatient 658 658 207.68 207.68 fee schedule 658 93 532.98 percent of total billed charges 658 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 658 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 81.84 81.84 fee schedule 81.84 658 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chest PX-402766040 CDM 76604 CPT 0402 RC outpatient 305 305 194.87 194.87 fee schedule 305 93 247.05 percent of total billed charges 305 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 305 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 29.54 29.54 fee schedule 29.54 305 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bd Breast Ultrasound Uni Rt PX-402766415 CDM 76641 CPT 0402 RC outpatient 261.88 261.88 168.41 168.41 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 66.57 66.57 fee schedule 66.57 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bd Breast Ultrasound Uni Lt PX-402766416 CDM 76641 CPT 0402 RC outpatient 261.88 261.88 168.41 168.41 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 66.57 66.57 fee schedule 66.57 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bd US Breast Uni Limited Focus PX-402766420 CDM 76642 CPT 0402 RC outpatient 230 230 168.41 168.41 fee schedule 230 93 186.3 percent of total billed charges 230 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 230 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 51.63 51.63 fee schedule 51.63 230 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bd Breast Ultrasound Limited Rt PX-402766425 CDM 76642 CPT 0402 RC outpatient 230 230 168.41 168.41 fee schedule 230 93 186.3 percent of total billed charges 230 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 230 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 51.63 51.63 fee schedule 51.63 230 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bd Breast Ultrasound Limited Lt PX-402766426 CDM 76642 CPT 0402 RC outpatient 230 230 168.41 168.41 fee schedule 230 93 186.3 percent of total billed charges 230 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 230 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 51.63 51.63 fee schedule 51.63 230 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Abdomen Complete PX-402767000 CDM 76700 CPT 0402 RC outpatient 792 792 292.62 292.62 fee schedule 792 93 641.52 percent of total billed charges 792 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 792 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 76.63 76.63 fee schedule 76.63 792 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Abdomen Limited B PX-402767050 CDM 76705 CPT 0402 RC outpatient 463 463 211.13 211.13 fee schedule 463 93 375.03 percent of total billed charges 463 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 463 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 58.13 58.13 fee schedule 58.13 463 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Liver Sonogram PX-402767052 CDM 76705 CPT 0402 RC outpatient 463 463 211.13 211.13 fee schedule 463 93 375.03 percent of total billed charges 463 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 463 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 58.13 58.13 fee schedule 58.13 463 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Spleen Sonogram PX-402767054 CDM 76705 CPT 0402 RC outpatient 463 463 211.13 211.13 fee schedule 463 93 375.03 percent of total billed charges 463 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 463 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 58.13 58.13 fee schedule 58.13 463 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Right Upper Quadrant PX-402767055 CDM 76705 CPT 0402 RC outpatient 463 463 211.13 211.13 fee schedule 463 93 375.03 percent of total billed charges 463 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 463 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 58.13 58.13 fee schedule 58.13 463 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pyloric Stenosis PX-402767057 CDM 76705 CPT 0402 RC outpatient 463 463 211.13 211.13 fee schedule 463 93 375.03 percent of total billed charges 463 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 463 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 58.13 58.13 fee schedule 58.13 463 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Retroperitoneal Complete PX-402767700 CDM 76770 CPT 0402 RC outpatient 537 537 283.22 283.22 fee schedule 537 93 434.97 percent of total billed charges 537 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 537 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 71.77 71.77 fee schedule 71.77 537 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC US Retroperitoneal Ltd PX-402767750 CDM 76775 CPT 0402 RC outpatient 463 463 210.3 210.3 fee schedule 463 93 375.03 percent of total billed charges 463 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 463 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 31.82 31.82 fee schedule 31.82 463 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Renal Sonogram PX-402767751 CDM 76775 CPT 0402 RC outpatient 463 463 210.3 210.3 fee schedule 463 93 375.03 percent of total billed charges 463 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 463 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 31.82 31.82 fee schedule 31.82 463 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sonogram of Transplant Kidney PX-402767760 CDM 76776 CPT 0402 RC outpatient 463 463 199.3 199.3 fee schedule 463 93 375.03 percent of total billed charges 463 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 463 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 109.11 109.11 fee schedule 109.11 463 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Spinal Canal PX-402768000 CDM 76800 CPT 0402 RC outpatient 333 333 271.83 271.83 fee schedule 333 93 269.73 percent of total billed charges 333 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 333 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 108.8 108.8 fee schedule 108.8 333 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC OB 1st Trimester PX-402768010 CDM 76801 CPT 0402 RC outpatient 865 865 327.46 327.46 fee schedule 865 93 700.65 percent of total billed charges 865 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 865 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 69.17 69.17 fee schedule 69.17 865 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pregnancy Comp 2+ Fetus Under 14 Wks PX-402768021 CDM 76802 CPT 0402 RC outpatient 179 179 208.92 208.92 fee schedule 179 93 144.99 percent of total billed charges 179 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 179 other OPPS APC 179 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 179 other OPPS APC 20.46 20.46 fee schedule 20.46 208.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC OB 2nd & 3rd Trimester PX-402768050 CDM 76805 CPT 0402 RC outpatient 865 865 327.46 327.46 fee schedule 865 93 700.65 percent of total billed charges 865 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 865 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 86.7 86.7 fee schedule 86.7 865 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pregnancy Exam Multiple Gestation PX-402768100 CDM 76810 CPT 0402 RC outpatient 277 277 233.49 233.49 fee schedule 277 93 224.37 percent of total billed charges 277 277 other OPPS APC 277 277 other OPPS APC 40.26 40.26 fee schedule 40.26 277 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC OB Complete Detailed PX-402768110 CDM 76811 CPT 0402 RC outpatient 583.68 583.68 601.69 601.69 fee schedule 583.68 93 472.78 percent of total billed charges 583.68 583.68 other OPPS APC 583.68 583.68 other OPPS APC 86.04 86.04 fee schedule 86.04 601.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC US OB Limited PX-402768150 CDM 76815 CPT 0402 RC outpatient 378 378 219.95 219.95 fee schedule 378 93 306.18 percent of total billed charges 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 49.36 49.36 fee schedule 49.36 378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pregnancy Repeat (Dates and/or Wght) PX-402768161 CDM 76816 CPT 0402 RC outpatient 463 463 214.79 214.79 fee schedule 463 93 375.03 percent of total billed charges 463 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 463 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 68.2 68.2 fee schedule 68.2 463 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC US, Pregnant Uterus, Transvaginal" PX-402768170 CDM 76817 CPT 0402 RC outpatient 277 277 239.22 239.22 fee schedule 277 93 224.37 percent of total billed charges 277 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 277 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 55.86 55.86 fee schedule 55.86 277 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Biophys Profile W/ Non Stress PX-402768190 CDM 76819 CPT 0402 RC outpatient 475 475 254.35 254.35 fee schedule 475 93 384.75 percent of total billed charges 475 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 475 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 48.37 48.37 fee schedule 48.37 475 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Transvaginal Sonogram PX-402768300 CDM 76830 CPT 0402 RC outpatient 512 512 234.31 234.31 fee schedule 512 93 414.72 percent of total billed charges 512 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 512 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 84.75 84.75 fee schedule 84.75 512 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pelvic Sonogram PX-402768560 CDM 76856 CPT 0402 RC outpatient 488 488 234.31 234.31 fee schedule 488 93 395.28 percent of total billed charges 488 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 488 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 71.45 71.45 fee schedule 71.45 488 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Iud Localization PX-402768562 CDM 76856 CPT 0402 RC outpatient 488 488 234.31 234.31 fee schedule 488 93 395.28 percent of total billed charges 488 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 488 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 71.45 71.45 fee schedule 71.45 488 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sono Pelvis Limited PX-402768570 CDM 76857 CPT 0402 RC outpatient 261.88 261.88 212.53 212.53 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 25.65 25.65 fee schedule 25.65 261.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Scrotum Sonogram PX-402768700 CDM 76870 CPT 0402 RC outpatient 536 536 228.23 228.23 fee schedule 536 93 434.16 percent of total billed charges 536 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 536 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 68.52 68.52 fee schedule 68.52 536 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Extremity PX-402768810 CDM 76881 CPT 0402 RC outpatient 800 800 211.13 211.13 fee schedule 800 93 648 percent of total billed charges 800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 10.71 10.71 fee schedule 10.71 800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC US Axillary PX-402768820 CDM 76882 CPT 0402 RC outpatient 500 500 211.13 211.13 fee schedule 500 93 405 percent of total billed charges 500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 30.19 30.19 fee schedule 30.19 500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC US Hips Bilateral PX-402768850 CDM 76885 CPT 0402 RC outpatient 378 378 239.41 239.41 fee schedule 378 93 306.18 percent of total billed charges 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.65 other OPPS APC 98.39 98.39 fee schedule 98.39 378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ultrasound Guide Needle Place PX-402769420 CDM 76942 CPT 0402 RC outpatient 273 273 355.11 355.11 fee schedule 273 93 221.13 percent of total billed charges 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 27.6 27.6 fee schedule 27.6 355.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vl Psa Injection U/S Guide PX-402769421 CDM 76942 CPT 0402 RC outpatient 273 273 355.11 355.11 fee schedule 273 93 221.13 percent of total billed charges 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 27.6 27.6 fee schedule 27.6 355.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Liver Bx - US Guide PX-402769422 CDM 76942 CPT 0402 RC outpatient 273 273 355.11 355.11 fee schedule 273 93 221.13 percent of total billed charges 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 27.6 27.6 fee schedule 27.6 355.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Renal Bx - US Guide PX-402769423 CDM 76942 CPT 0402 RC outpatient 273 273 355.11 355.11 fee schedule 273 93 221.13 percent of total billed charges 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 27.6 27.6 fee schedule 27.6 355.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC US Biopsy Soft Tissue/Muscle Guide PX-402769424 CDM 76942 CPT 0402 RC outpatient 273 273 355.11 355.11 fee schedule 273 93 221.13 percent of total billed charges 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 27.6 27.6 fee schedule 27.6 355.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Cyst, Any Location Skin - US" PX-402769428 CDM 76942 CPT 0402 RC outpatient 273 273 355.11 355.11 fee schedule 273 93 221.13 percent of total billed charges 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 27.6 27.6 fee schedule 27.6 355.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC US Guidance,Intraoperative" PX-402769980 CDM 76998 CPT 0402 RC outpatient 329 329 329 74 243.46 percent of total billed charges 329 93 266.49 percent of total billed charges 329 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 329 other OPPS APC 329 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 329 other OPPS APC 329 51 167.79 percent of total billed charges 329 329 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bd Mammo Screen Digital 2d PX-403002050 CDM 77067 CPT 0403 RC outpatient 175 175 197.07 197.07 fee schedule 175 93 141.75 percent of total billed charges 89.96 89.96 fee schedule 89.96 89.96 fee schedule 89.96 89.96 fee schedule 89.96 197.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bd Tomosynthesis Bilateral PX-403770630 CDM 77063 CPT 0403 RC outpatient 68.95 68.95 41.67 41.67 fee schedule 68.95 93 55.85 percent of total billed charges 23.39 23.39 fee schedule 23.39 23.39 fee schedule 23.39 23.39 fee schedule 23.39 68.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pet CT Standard Body Scan PX-404788151 CDM 78815 CPT 0404 RC outpatient 3726.5 3726.5 2197.53 2197.53 fee schedule 3726.5 93 3018.47 percent of total billed charges 3726.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1595.15 other OPPS APC 3726.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1595.15 other OPPS APC 3726.5 51 1900.52 percent of total billed charges 2197.53 3726.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pet CT Whole Body Scan PX-404788161 CDM 78816 CPT 0404 RC outpatient 3726.5 3726.5 2270.2 2270.2 fee schedule 3726.5 93 3018.47 percent of total billed charges 3726.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1595.15 other OPPS APC 3726.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1595.15 other OPPS APC 3726.5 51 1900.52 percent of total billed charges 2270.2 3726.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pulmonary Rehab-Other PX-410002390 CDM G0239 CPT 0410 RC outpatient 95.53 95.53 142.6 142.6 fee schedule 95.53 93 77.38 percent of total billed charges 95.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40.89 other OPPS APC 95.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40.89 other OPPS APC 95.53 31.25 29.85 percent of total billed charges 95.53 142.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Suctioning PX-410317200 CDM 31720 CPT 0410 RC outpatient 508.05 508.05 508.05 74 375.96 percent of total billed charges 508.05 93 411.52 percent of total billed charges 508.05 508.05 other OPPS APC 508.05 508.05 other OPPS APC 508.05 31.25 158.77 percent of total billed charges 508.05 508.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mech Vent Adult PX-410940020 CDM 94002 CPT 0410 RC outpatient 1492.7 1492.7 221.53 221.53 fee schedule 1492.7 93 1209.09 percent of total billed charges 1492.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 638.96 other OPPS APC 1492.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 638.96 other OPPS APC 1492.7 31.25 466.47 percent of total billed charges 221.53 1492.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mech Vent Subsequent Adult PX-410940030 CDM 94003 CPT 0410 RC outpatient 1492.7 1492.7 368.82 368.82 fee schedule 1492.7 93 1209.09 percent of total billed charges 1492.7 1492.7 other OPPS APC 1492.7 1492.7 other OPPS APC 1492.7 31.25 466.47 percent of total billed charges 368.82 1492.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mdi Initial PX-410946404 CDM 94640 CPT 0410 RC outpatient 508.05 508.05 34.08 34.08 fee schedule 508.05 93 411.52 percent of total billed charges 508.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 217.47 other OPPS APC 508.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 217.47 other OPPS APC 508.05 31.25 158.77 percent of total billed charges 34.08 508.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cont Neb W/Bronchodilator First Hr PX-410946407 CDM 94644 CPT 0410 RC outpatient 304.28 304.28 97.14 97.14 fee schedule 304.28 93 246.47 percent of total billed charges 304.28 304.28 other OPPS APC 304.28 304.28 other OPPS APC 304.28 31.25 95.09 percent of total billed charges 97.14 304.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cont Neb W/Bronchodilat Addl Hr PX-410946408 CDM 94645 CPT 0410 RC outpatient 194 194 126.83 126.83 fee schedule 194 93 157.14 percent of total billed charges 194 194 other OPPS APC 194 194 other OPPS APC 194 31.25 60.63 percent of total billed charges 126.83 194 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hand Held Nebulizer/Ippb/Mdi-IP PX-410946409 CDM 94640 CPT 0410 RC outpatient 508.05 508.05 34.08 34.08 fee schedule 508.05 93 411.52 percent of total billed charges 508.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 217.47 other OPPS APC 508.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 217.47 other OPPS APC 508.05 31.25 158.77 percent of total billed charges 34.08 508.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hand Held Nebulizer/Ibb/Mdi-OP PX-410946410 CDM 94640 CPT 0410 RC outpatient 508.05 508.05 34.08 34.08 fee schedule 508.05 93 411.52 percent of total billed charges 508.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 217.47 other OPPS APC 508.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 217.47 other OPPS APC 508.05 31.25 158.77 percent of total billed charges 34.08 508.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Aerosol Treatment PX-410946411 CDM 94640 CPT 0410 RC outpatient 508.05 508.05 34.08 34.08 fee schedule 508.05 93 411.52 percent of total billed charges 508.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 217.47 other OPPS APC 508.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 217.47 other OPPS APC 508.05 31.25 158.77 percent of total billed charges 34.08 508.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cpap PX-410946600 CDM 94660 CPT 0410 RC outpatient 508.05 508.05 144.83 144.83 fee schedule 508.05 93 411.52 percent of total billed charges 508.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 217.47 other OPPS APC 508.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 217.47 other OPPS APC 508.05 31.25 158.77 percent of total billed charges 144.83 508.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bipap/Cpap PX-410946601 CDM 94660 CPT 0410 RC outpatient 508.05 508.05 144.83 144.83 fee schedule 508.05 93 411.52 percent of total billed charges 508.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 217.47 other OPPS APC 508.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 217.47 other OPPS APC 508.05 31.25 158.77 percent of total billed charges 144.83 508.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Acapella Initial Rx PX-410946672 CDM 94667 CPT 0410 RC outpatient 304.28 304.28 58.29 58.29 fee schedule 304.28 93 246.47 percent of total billed charges 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 31.25 95.09 percent of total billed charges 58.29 304.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cpt&Postual Drain Subseq Rx 4 POS PX-410946681 CDM 94668 CPT 0410 RC outpatient 304.28 304.28 56.99 56.99 fee schedule 304.28 93 246.47 percent of total billed charges 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 31.25 95.09 percent of total billed charges 56.99 304.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Acapella Sub Rx PX-410946682 CDM 94668 CPT 0410 RC outpatient 304.28 304.28 56.99 56.99 fee schedule 304.28 93 246.47 percent of total billed charges 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 31.25 95.09 percent of total billed charges 56.99 304.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pulse Oximetry Continuous PX-410947620 CDM 94762 CPT 0410 RC outpatient 372.08 372.08 59.07 59.07 fee schedule 372.08 93 301.38 percent of total billed charges 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 31.25 116.28 percent of total billed charges 59.07 372.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Comprehensive Patient Assessments PX-410947991 CDM 94799 CPT 0410 RC outpatient 372.08 372.08 97.09 97.09 fee schedule 372.08 93 301.38 percent of total billed charges 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 31.25 116.28 percent of total billed charges 97.09 372.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Endotracheal Tube Care Non Vented PX-410947992 CDM 94799 CPT 0410 RC outpatient 372.08 372.08 97.09 97.09 fee schedule 372.08 93 301.38 percent of total billed charges 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 31.25 116.28 percent of total billed charges 97.09 372.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tracheostomy Tube Care PX-410947993 CDM 94799 CPT 0410 RC outpatient 372.08 372.08 97.09 97.09 fee schedule 372.08 93 301.38 percent of total billed charges 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 31.25 116.28 percent of total billed charges 97.09 372.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Spontaneous Mechanics Non Vented PX-410947994 CDM 94799 CPT 0410 RC outpatient 372.08 372.08 97.09 97.09 fee schedule 372.08 93 301.38 percent of total billed charges 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 31.25 116.28 percent of total billed charges 97.09 372.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Continous Aerosol Rx Initial Day PX-410947995 CDM 94799 CPT 0410 RC outpatient 372.08 372.08 97.09 97.09 fee schedule 372.08 93 301.38 percent of total billed charges 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 31.25 116.28 percent of total billed charges 97.09 372.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Continous Aerosol Rx Subseq Day PX-410947996 CDM 94799 CPT 0410 RC outpatient 372.08 372.08 97.09 97.09 fee schedule 372.08 93 301.38 percent of total billed charges 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 31.25 116.28 percent of total billed charges 97.09 372.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Oxygen Therapy Initial Day PX-410947997 CDM 94799 CPT 0410 RC outpatient 372.08 372.08 97.09 97.09 fee schedule 372.08 93 301.38 percent of total billed charges 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 31.25 116.28 percent of total billed charges 97.09 372.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Oxygen Therapy Subseq Day PX-410947998 CDM 94799 CPT 0410 RC outpatient 372.08 372.08 97.09 97.09 fee schedule 372.08 93 301.38 percent of total billed charges 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 31.25 116.28 percent of total billed charges 97.09 372.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pulm Treatment for Resp Fx Ea 15 Min PX-410G02381 CDM G0238 CPT 0410 RC outpatient 70.93 70.93 131.44 131.44 fee schedule 70.93 93 57.45 percent of total billed charges 70.93 70.93 other OPPS APC 70.93 70.93 other OPPS APC 70.93 31.25 22.17 percent of total billed charges 70.93 131.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hbo per 30 Mins PX-413991831 CDM 99183 CPT 0413 RC outpatient 330 330 330 74 244.2 percent of total billed charges 330 93 267.3 percent of total billed charges 102.8 102.8 fee schedule 102.8 102.8 fee schedule 330 51 168.3 percent of total billed charges 102.8 330 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pt App Mlt-Lay Com L Leg/Ft 8-22 PX-420295810 CDM 29581 CPT 0420 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 100 375.33 percent of total billed charges 375.33 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pt App Mlt-Lay Comp L Leg/Ft23-37 PX-420295811 CDM 29581 CPT 0420 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 100 375.33 percent of total billed charges 375.33 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pt App Multlayer Comp Bil PX-4202958115 CDM 29581 CPT 0420 RC outpatient 728 728 728 74 538.72 percent of total billed charges 728 93 589.68 percent of total billed charges 728 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 728 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 728 100 728 percent of total billed charges 728 728 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pt App Mlt-Lay Comp L Leg/Ft38-52 PX-420295812 CDM 29581 CPT 0420 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 100 375.33 percent of total billed charges 375.33 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pt App Mlt-Lay Comp L Feg/Ft53-67 PX-420295813 CDM 29581 CPT 0420 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 100 375.33 percent of total billed charges 375.33 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pt App Mlt-Lay Comp L Leg/Ft 68-82 PX-420295814 CDM 29581 CPT 0420 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 100 375.33 percent of total billed charges 375.33 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tn Biofeedback PX-420909010 CDM 90901 CPT 0420 RC outpatient 132 132 132 74 97.68 percent of total billed charges 132 93 106.92 percent of total billed charges 18.71 18.71 fee schedule 18.71 18.71 fee schedule 132 100 132 percent of total billed charges 18.71 132 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Range of Motion Measurement,Exc Hand" PX-420958511 CDM 95851 CPT 0420 RC outpatient 52.98 52.98 20.32 20.32 fee schedule 52.98 93 42.91 percent of total billed charges 52.98 52.98 other OPPS APC 52.98 52.98 other OPPS APC 52.98 100 52.98 percent of total billed charges 20.32 52.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Canalith Repositioning Proc PX-420959920 CDM 95992 CPT 0420 RC outpatient 110 110 110 74 81.4 percent of total billed charges 110 93 89.1 percent of total billed charges 34.81 34.81 fee schedule 34.81 34.81 fee schedule 110 100 110 percent of total billed charges 34.81 110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Re Evaluation 8-22 Min PX-420970020 CDM 97164 CPT 0420 RC outpatient 170.95 170.95 81.84 81.84 fee schedule 170.95 93 138.47 percent of total billed charges 170.95 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 69.51 fee schedule 170.95 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 69.51 fee schedule 170.95 100 170.95 percent of total billed charges 81.84 170.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Re Evaluation 23-37 Min PX-420970021 CDM 97164 CPT 0420 RC outpatient 170.95 170.95 81.84 81.84 fee schedule 170.95 93 138.47 percent of total billed charges 170.95 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 69.51 fee schedule 170.95 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 69.51 fee schedule 170.95 100 170.95 percent of total billed charges 81.84 170.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Re Evaluation 38-52 Min PX-420970022 CDM 97164 CPT 0420 RC outpatient 170.95 170.95 81.84 81.84 fee schedule 170.95 93 138.47 percent of total billed charges 170.95 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 69.51 fee schedule 170.95 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 69.51 fee schedule 170.95 100 170.95 percent of total billed charges 81.84 170.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Re Evaluation 53-67 Min PX-420970023 CDM 97164 CPT 0420 RC outpatient 170.95 170.95 81.84 81.84 fee schedule 170.95 93 138.47 percent of total billed charges 170.95 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 69.51 fee schedule 170.95 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 69.51 fee schedule 170.95 100 170.95 percent of total billed charges 81.84 170.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hot/Cold Pack PX-420970101 CDM 97010 CPT 0420 RC outpatient 13 13 13 74 9.62 percent of total billed charges 13 93 10.53 percent of total billed charges 13 13 other OPPS APC 13 13 other OPPS APC 13 100 13 percent of total billed charges 13 13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pt Mechanical Tract 8-22 PX-420970120 CDM 97012 CPT 0420 RC outpatient 81 81 49.6 49.6 fee schedule 81 93 65.61 percent of total billed charges 81 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14 fee schedule 81 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14 fee schedule 81 100 81 percent of total billed charges 49.6 81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Traction (Mechanical) PX-420970121 CDM 97012 CPT 0420 RC outpatient 81 81 49.6 49.6 fee schedule 81 93 65.61 percent of total billed charges 81 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14 fee schedule 81 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14 fee schedule 81 100 81 percent of total billed charges 49.6 81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pt Mechanical Tract 38-52 PX-420970122 CDM 97012 CPT 0420 RC outpatient 81 81 49.6 49.6 fee schedule 81 93 65.61 percent of total billed charges 81 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14 fee schedule 81 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14 fee schedule 81 100 81 percent of total billed charges 49.6 81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pt Mechancial Tract 53-67 PX-420970123 CDM 97012 CPT 0420 RC outpatient 81 81 49.6 49.6 fee schedule 81 93 65.61 percent of total billed charges 81 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14 fee schedule 81 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14 fee schedule 81 100 81 percent of total billed charges 49.6 81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pt Mechanical Tract 68-82 PX-420970124 CDM 97012 CPT 0420 RC outpatient 81 81 49.6 49.6 fee schedule 81 93 65.61 percent of total billed charges 81 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14 fee schedule 81 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14 fee schedule 81 100 81 percent of total billed charges 49.6 81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Electrical Stimulatn Unatt Non Wound PX-420970141 CDM 97014 CPT 0420 RC outpatient 48 48 45.88 45.88 fee schedule 48 93 38.88 percent of total billed charges 48 48 other OPPS APC 48 48 other OPPS APC 48 100 48 percent of total billed charges 45.88 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Extrem Pump 8-22 Min PX-420970160 CDM 97016 CPT 0420 RC outpatient 72 72 53.32 53.32 fee schedule 72 93 58.32 percent of total billed charges 72 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 11.64 fee schedule 72 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 11.64 fee schedule 72 100 72 percent of total billed charges 53.32 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Extrem Pump 23-37 PX-420970161 CDM 97016 CPT 0420 RC outpatient 72 72 53.32 53.32 fee schedule 72 93 58.32 percent of total billed charges 72 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 11.64 fee schedule 72 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 11.64 fee schedule 72 100 72 percent of total billed charges 53.32 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Extrem Pump 38-52 PX-420970162 CDM 97016 CPT 0420 RC outpatient 72 72 53.32 53.32 fee schedule 72 93 58.32 percent of total billed charges 72 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 11.64 fee schedule 72 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 11.64 fee schedule 72 100 72 percent of total billed charges 53.32 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Extrem Pump 53-67 PX-420970163 CDM 97016 CPT 0420 RC outpatient 72 72 53.32 53.32 fee schedule 72 93 58.32 percent of total billed charges 72 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 11.64 fee schedule 72 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 11.64 fee schedule 72 100 72 percent of total billed charges 53.32 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Extrem Pump 68-82 Min PX-420970164 CDM 97016 CPT 0420 RC outpatient 72 72 53.32 53.32 fee schedule 72 93 58.32 percent of total billed charges 72 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 11.64 fee schedule 72 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 11.64 fee schedule 72 100 72 percent of total billed charges 53.32 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vasopneumatic Device PX-420970165 CDM 97016 CPT 0420 RC outpatient 72 72 53.32 53.32 fee schedule 72 93 58.32 percent of total billed charges 72 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 11.64 fee schedule 72 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 11.64 fee schedule 72 100 72 percent of total billed charges 53.32 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pt E-Stim Not WC Manual 8-22 PX-420970320 CDM 97032 CPT 0420 RC outpatient 48 48 44.64 44.64 fee schedule 48 93 38.88 percent of total billed charges 48 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14.33 fee schedule 48 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14.33 fee schedule 48 100 48 percent of total billed charges 44.64 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Iontophoresis 15 Mins PX-420970331 CDM 420970331 LOCAL 0420 RC outpatient 110 110 110 74 81.4 percent of total billed charges 110 93 89.1 percent of total billed charges 110 110 other OPPS APC 110 110 other OPPS APC 110 100 110 percent of total billed charges 110 110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Contrast Baths 15 Mins PX-420970341 CDM 420970341 LOCAL 0420 RC outpatient 27 27 27 74 19.98 percent of total billed charges 27 93 21.87 percent of total billed charges 27 27 other OPPS APC 27 27 other OPPS APC 27 100 27 percent of total billed charges 27 27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ultrasound PX-420970350 CDM 97035 CPT 0420 RC outpatient 48 48 42.16 42.16 fee schedule 48 93 38.88 percent of total billed charges 48 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 13.97 fee schedule 48 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 13.97 fee schedule 48 100 48 percent of total billed charges 42.16 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Therapeutic Exercises Th PX-420971100 CDM 97110 CPT 0420 RC outpatient 72.05 72.05 59.52 59.52 fee schedule 72.05 93 58.36 percent of total billed charges 72.05 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 29.3 fee schedule 72.05 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 29.3 fee schedule 72.05 100 72.05 percent of total billed charges 59.52 72.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Neuromuscular Reeducation PX-420971120 CDM 97112 CPT 0420 RC outpatient 86 86 57.04 57.04 fee schedule 86 93 69.66 percent of total billed charges 86 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 33.62 fee schedule 86 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 33.62 fee schedule 86 100 86 percent of total billed charges 57.04 86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ambulation Train PX-420971160 CDM 97116 CPT 0420 RC outpatient 72.05 72.05 54.56 54.56 fee schedule 72.05 93 58.36 percent of total billed charges 72.05 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 29.3 fee schedule 72.05 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 29.3 fee schedule 72.05 100 72.05 percent of total billed charges 54.56 72.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Massage 15 Min PX-420971240 CDM 97124 CPT 0420 RC outpatient 74.35 74.35 49.6 49.6 fee schedule 74.35 93 60.22 percent of total billed charges 74.35 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 30.23 fee schedule 74.35 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 30.23 fee schedule 74.35 100 74.35 percent of total billed charges 49.6 74.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Manual Therapy PX-420971400 CDM 97140 CPT 0420 RC outpatient 66.35 66.35 54.56 54.56 fee schedule 66.35 93 53.74 percent of total billed charges 66.35 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 26.98 fee schedule 66.35 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 26.98 fee schedule 66.35 100 66.35 percent of total billed charges 54.56 66.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pt Group Therapy 8-22 Min 2 Pts PX-420971500 CDM 97150 CPT 0420 RC outpatient 79.62 79.62 47.12 47.12 fee schedule 79.62 93 64.49 percent of total billed charges 79.62 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 17.98 fee schedule 79.62 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 17.98 fee schedule 79.62 100 79.62 percent of total billed charges 47.12 79.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Therapeutic Ex. Group PX-420971501 CDM 97150 CPT 0420 RC outpatient 79.62 79.62 47.12 47.12 fee schedule 79.62 93 64.49 percent of total billed charges 79.62 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 17.98 fee schedule 79.62 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 17.98 fee schedule 79.62 100 79.62 percent of total billed charges 47.12 79.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Evaluation Low Complexity 8-22 Min PX-420971610 CDM 97161 CPT 0420 RC outpatient 246.43 246.43 148.8 148.8 fee schedule 246.43 93 199.61 percent of total billed charges 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 100 246.43 percent of total billed charges 148.8 246.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Evaluation Low Complexity 23-37 Min PX-420971611 CDM 97161 CPT 0420 RC outpatient 246.43 246.43 148.8 148.8 fee schedule 246.43 93 199.61 percent of total billed charges 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 100 246.43 percent of total billed charges 148.8 246.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Evaluation Low Complexity 38-52 Min PX-420971612 CDM 97161 CPT 0420 RC outpatient 246.43 246.43 148.8 148.8 fee schedule 246.43 93 199.61 percent of total billed charges 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 100 246.43 percent of total billed charges 148.8 246.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Evaluation Mod Complexity 8-22 Min PX-420971620 CDM 97162 CPT 0420 RC outpatient 246.43 246.43 148.8 148.8 fee schedule 246.43 93 199.61 percent of total billed charges 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 100 246.43 percent of total billed charges 148.8 246.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Evaluation Mod Complexity 23-37min PX-420971621 CDM 97162 CPT 0420 RC outpatient 246.43 246.43 148.8 148.8 fee schedule 246.43 93 199.61 percent of total billed charges 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 100 246.43 percent of total billed charges 148.8 246.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Evaluation Mod Complexity 38-52 Min PX-420971622 CDM 97162 CPT 0420 RC outpatient 246.43 246.43 148.8 148.8 fee schedule 246.43 93 199.61 percent of total billed charges 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 100 246.43 percent of total billed charges 148.8 246.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Evaluation Mod Complexity 53-67 Min PX-420971623 CDM 97162 CPT 0420 RC outpatient 246.43 246.43 148.8 148.8 fee schedule 246.43 93 199.61 percent of total billed charges 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 100 246.43 percent of total billed charges 148.8 246.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Evaluation Mod Complexity 68-82 Min PX-420971624 CDM 97162 CPT 0420 RC outpatient 246.43 246.43 148.8 148.8 fee schedule 246.43 93 199.61 percent of total billed charges 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 100 246.43 percent of total billed charges 148.8 246.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Evaluation High Complexity 8-22 Min PX-420971630 CDM 97163 CPT 0420 RC outpatient 246.43 246.43 148.8 148.8 fee schedule 246.43 93 199.61 percent of total billed charges 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 100 246.43 percent of total billed charges 148.8 246.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Evaluation High Complexity 23-37 Min PX-420971631 CDM 97163 CPT 0420 RC outpatient 246.43 246.43 148.8 148.8 fee schedule 246.43 93 199.61 percent of total billed charges 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 100 246.43 percent of total billed charges 148.8 246.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Evaluation High Complexity 38-52 Min PX-420971632 CDM 97163 CPT 0420 RC outpatient 246.43 246.43 148.8 148.8 fee schedule 246.43 93 199.61 percent of total billed charges 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 100 246.43 percent of total billed charges 148.8 246.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Evaluation High Complexity 53-67 Min PX-420971633 CDM 97163 CPT 0420 RC outpatient 246.43 246.43 148.8 148.8 fee schedule 246.43 93 199.61 percent of total billed charges 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 100 246.43 percent of total billed charges 148.8 246.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Functional Activity Th PX-420975300 CDM 97530 CPT 0420 RC outpatient 89.9 89.9 64.48 64.48 fee schedule 89.9 93 72.82 percent of total billed charges 89.9 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 36.56 fee schedule 89.9 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 36.56 fee schedule 89.9 100 89.9 percent of total billed charges 64.48 89.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Orthotics Fitting/Training 15 Mins PX-420977601 CDM 420977601 LOCAL 0420 RC outpatient 52 52 52 74 38.48 percent of total billed charges 52 93 42.12 percent of total billed charges 52 52 other OPPS APC 52 52 other OPPS APC 52 100 52 percent of total billed charges 52 52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Prosthetics Fitting/Training 15 Mins PX-420977611 CDM 420977611 LOCAL 0420 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 100 91 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pt Evaluatoin Moderate Complexity PX-424971621 CDM 97162 CPT 0424 RC outpatient 246.43 246.43 148.8 148.8 fee schedule 246.43 93 199.61 percent of total billed charges 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 100.21 fee schedule 246.43 100 246.43 percent of total billed charges 148.8 246.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot App M/L Comp L Leg/Ft 8-22 PX-430295810 CDM 29581 CPT 0430 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 100 375.33 percent of total billed charges 375.33 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot App M/L Comp L Leg/Ft 23-37 PX-430295811 CDM 29581 CPT 0430 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 100 375.33 percent of total billed charges 375.33 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot App Multlayer Comp Bil PX-4302958115 CDM 29581 CPT 0430 RC outpatient 728 728 728 74 538.72 percent of total billed charges 728 93 589.68 percent of total billed charges 728 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 728 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 728 100 728 percent of total billed charges 728 728 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot App M/L Comp L Leg/Ft 38-52 PX-430295812 CDM 29581 CPT 0430 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 100 375.33 percent of total billed charges 375.33 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot App M/L Comp L Leg/Ft 53-67 PX-430295813 CDM 29581 CPT 0430 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 100 375.33 percent of total billed charges 375.33 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot App M/L L Leg/Ft 68-82 PX-430295814 CDM 29581 CPT 0430 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 100 375.33 percent of total billed charges 375.33 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot App M/L Comp Up Arm/Fing 8-22 PX-430295840 CDM 29584 CPT 0430 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 100 375.33 percent of total billed charges 375.33 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC OP App M/L Comp Up Arm/Fing 23-37 PX-430295841 CDM 29584 CPT 0430 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 100 375.33 percent of total billed charges 375.33 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot App M/L Comp Up Arm/Fing 38-52 PX-430295842 CDM 29584 CPT 0430 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 100 375.33 percent of total billed charges 375.33 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot App M/L Comp Up Arm/Fing 53-67 PX-430295843 CDM 29584 CPT 0430 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 100 375.33 percent of total billed charges 375.33 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot App M/L Comp Up Arm/Fing 68-82 PX-430295844 CDM 29584 CPT 0430 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 100 375.33 percent of total billed charges 375.33 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Range of Motion Measurements, Hand" PX-430958521 CDM 95852 CPT 0430 RC outpatient 43.98 43.98 14.82 14.82 fee schedule 43.98 93 35.62 percent of total billed charges 5.24 5.24 fee schedule 5.24 5.24 fee schedule 43.98 100 43.98 percent of total billed charges 5.24 43.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hot/Cold Packs PX-430970101 CDM 97010 CPT 0430 RC outpatient 13 13 13 74 9.62 percent of total billed charges 13 93 10.53 percent of total billed charges 13 13 other OPPS APC 13 13 other OPPS APC 13 100 13 percent of total billed charges 13 13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot Mechanical Tract 8-22 PX-430970120 CDM 97012 CPT 0430 RC outpatient 81 81 49.6 49.6 fee schedule 81 93 65.61 percent of total billed charges 81 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14 fee schedule 81 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14 fee schedule 81 100 81 percent of total billed charges 49.6 81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot Mechanical Tract 23-37 PX-430970121 CDM 97012 CPT 0430 RC outpatient 81 81 49.6 49.6 fee schedule 81 93 65.61 percent of total billed charges 81 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14 fee schedule 81 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14 fee schedule 81 100 81 percent of total billed charges 49.6 81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot Mechanical Tract 38-52 PX-430970122 CDM 97012 CPT 0430 RC outpatient 81 81 49.6 49.6 fee schedule 81 93 65.61 percent of total billed charges 81 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14 fee schedule 81 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14 fee schedule 81 100 81 percent of total billed charges 49.6 81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot Mechanical Tract 53-67 PX-430970123 CDM 97012 CPT 0430 RC outpatient 81 81 49.6 49.6 fee schedule 81 93 65.61 percent of total billed charges 81 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14 fee schedule 81 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14 fee schedule 81 100 81 percent of total billed charges 49.6 81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Electrical Stimulatn Unatt Non Wound PX-430970141 CDM 97014 CPT 0430 RC outpatient 48 48 45.88 45.88 fee schedule 48 93 38.88 percent of total billed charges 48 48 other OPPS APC 48 48 other OPPS APC 48 100 48 percent of total billed charges 45.88 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vasopneumatic Device PX-430970161 CDM 97016 CPT 0430 RC outpatient 72 72 53.32 53.32 fee schedule 72 93 58.32 percent of total billed charges 72 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 11.64 fee schedule 72 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 11.64 fee schedule 72 100 72 percent of total billed charges 53.32 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Paraffin Bath PX-430970181 CDM 97018 CPT 0430 RC outpatient 40 40 47.12 47.12 fee schedule 40 93 32.4 percent of total billed charges 40 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 5.63 fee schedule 40 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 5.63 fee schedule 40 100 40 percent of total billed charges 40 47.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Manual Electrical Stimulation 15 Min PX-430970321 CDM 97032 CPT 0430 RC outpatient 48 48 44.64 44.64 fee schedule 48 93 38.88 percent of total billed charges 48 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14.33 fee schedule 48 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 14.33 fee schedule 48 100 48 percent of total billed charges 44.64 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Iontophoresis 15 Mins PX-430970331 CDM 97033 CPT 0430 RC outpatient 110 110 50.84 50.84 fee schedule 110 93 89.1 percent of total billed charges 110 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 19.29 fee schedule 110 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 19.29 fee schedule 110 100 110 percent of total billed charges 50.84 110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ultrasound (15 Mins.) PX-430970351 CDM 97035 CPT 0430 RC outpatient 48 48 42.16 42.16 fee schedule 48 93 38.88 percent of total billed charges 48 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 13.97 fee schedule 48 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 13.97 fee schedule 48 100 48 percent of total billed charges 42.16 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot Therapeutic Exercise 15 Min Th PX-430971100 CDM 97110 CPT 0430 RC outpatient 72.05 72.05 59.52 59.52 fee schedule 72.05 93 58.36 percent of total billed charges 72.05 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 29.3 fee schedule 72.05 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 29.3 fee schedule 72.05 100 72.05 percent of total billed charges 59.52 72.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot Neuromuscular Reed 15 Min PX-430971120 CDM 97112 CPT 0430 RC outpatient 86 86 57.04 57.04 fee schedule 86 93 69.66 percent of total billed charges 86 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 33.62 fee schedule 86 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 33.62 fee schedule 86 100 86 percent of total billed charges 57.04 86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Massage PX-430971241 CDM 97124 CPT 0430 RC outpatient 74.35 74.35 49.6 49.6 fee schedule 74.35 93 60.22 percent of total billed charges 74.35 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 30.23 fee schedule 74.35 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 30.23 fee schedule 74.35 100 74.35 percent of total billed charges 49.6 74.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Manual Therapy Techniques PX-430971401 CDM 97140 CPT 0430 RC outpatient 66.35 66.35 54.56 54.56 fee schedule 66.35 93 53.74 percent of total billed charges 66.35 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 26.98 fee schedule 66.35 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 26.98 fee schedule 66.35 100 66.35 percent of total billed charges 54.56 66.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Therapeutic Ex. Group PX-430971501 CDM 97150 CPT 0430 RC outpatient 79.62 79.62 47.12 47.12 fee schedule 79.62 93 64.49 percent of total billed charges 79.62 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 17.98 fee schedule 79.62 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 17.98 fee schedule 79.62 100 79.62 percent of total billed charges 47.12 79.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot Evaluation Low Complexity 8-22 PX-430971650 CDM 97165 CPT 0430 RC outpatient 248.88 248.88 148.8 148.8 fee schedule 248.88 93 201.59 percent of total billed charges 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 100 248.88 percent of total billed charges 148.8 248.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot Evaluation Low Complexity 23-37 PX-430971651 CDM 97165 CPT 0430 RC outpatient 248.88 248.88 148.8 148.8 fee schedule 248.88 93 201.59 percent of total billed charges 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 100 248.88 percent of total billed charges 148.8 248.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot Evaluation Low Complexity 38-52 PX-430971652 CDM 97165 CPT 0430 RC outpatient 248.88 248.88 148.8 148.8 fee schedule 248.88 93 201.59 percent of total billed charges 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 100 248.88 percent of total billed charges 148.8 248.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot Evaluation Mod Complexity 8-22 PX-430971660 CDM 97166 CPT 0430 RC outpatient 248.88 248.88 148.8 148.8 fee schedule 248.88 93 201.59 percent of total billed charges 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 100 248.88 percent of total billed charges 148.8 248.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot Evaluation Mod Complexity 23-37 PX-430971661 CDM 97166 CPT 0430 RC outpatient 248.88 248.88 148.8 148.8 fee schedule 248.88 93 201.59 percent of total billed charges 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 100 248.88 percent of total billed charges 148.8 248.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot Evaluation Mod Complexity 38-52 PX-430971662 CDM 97166 CPT 0430 RC outpatient 248.88 248.88 148.8 148.8 fee schedule 248.88 93 201.59 percent of total billed charges 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 100 248.88 percent of total billed charges 148.8 248.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot Evaluation Mod Complexity 53-67 PX-430971663 CDM 97166 CPT 0430 RC outpatient 248.88 248.88 148.8 148.8 fee schedule 248.88 93 201.59 percent of total billed charges 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 100 248.88 percent of total billed charges 148.8 248.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot Evaluation High Complexity 8-22 PX-430971670 CDM 97167 CPT 0430 RC outpatient 248.88 248.88 148.8 148.8 fee schedule 248.88 93 201.59 percent of total billed charges 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 100 248.88 percent of total billed charges 148.8 248.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot Evaluation High Complexity 23-37 PX-430971671 CDM 97167 CPT 0430 RC outpatient 248.88 248.88 148.8 148.8 fee schedule 248.88 93 201.59 percent of total billed charges 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 100 248.88 percent of total billed charges 148.8 248.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot Evaluation High Complexity 38-52 PX-430971672 CDM 97167 CPT 0430 RC outpatient 248.88 248.88 148.8 148.8 fee schedule 248.88 93 201.59 percent of total billed charges 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 100 248.88 percent of total billed charges 148.8 248.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot Evaluation High Complexity 53-67 PX-430971673 CDM 97167 CPT 0430 RC outpatient 248.88 248.88 148.8 148.8 fee schedule 248.88 93 201.59 percent of total billed charges 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 101.2 fee schedule 248.88 100 248.88 percent of total billed charges 148.8 248.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot Functional Activity 15 Min Th PX-430975300 CDM 97530 CPT 0430 RC outpatient 89.9 89.9 64.48 64.48 fee schedule 89.9 93 72.82 percent of total billed charges 89.9 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 36.56 fee schedule 89.9 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 36.56 fee schedule 89.9 100 89.9 percent of total billed charges 64.48 89.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Adl Training (15 Mins) PX-430975351 CDM 97535 CPT 0430 RC outpatient 80.18 80.18 59.52 59.52 fee schedule 80.18 93 64.95 percent of total billed charges 80.18 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 32.6 fee schedule 80.18 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 32.6 fee schedule 80.18 100 80.18 percent of total billed charges 59.52 80.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot WC Select Debride <= 20 Cm PX-430975970 CDM 97597 CPT 0430 RC outpatient 476.88 476.88 136.47 136.47 fee schedule 476.88 93 386.27 percent of total billed charges 34.45 34.45 fee schedule 34.45 34.45 fee schedule 476.88 100 476.88 percent of total billed charges 34.45 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot WC Select Debride > 20 Cm PX-430975980 CDM 97598 CPT 0430 RC outpatient 271 271 172.91 172.91 fee schedule 271 93 219.51 percent of total billed charges 23.91 23.91 fee schedule 23.91 23.91 fee schedule 271 100 271 percent of total billed charges 23.91 271 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Prosthetics Fitting/Training 15 Mins PX-430977611 CDM 97761 CPT 0430 RC outpatient 102.18 102.18 81.84 81.84 fee schedule 102.18 93 82.77 percent of total billed charges 102.18 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 41.55 fee schedule 102.18 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 41.55 fee schedule 102.18 100 102.18 percent of total billed charges 81.84 102.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ot Daily Living Skills 15 Min PX-430985350 CDM 97535 CPT 0430 RC outpatient 105 105 59.52 59.52 fee schedule 105 93 85.05 percent of total billed charges 105 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 32.6 fee schedule 105 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 32.6 fee schedule 105 100 105 percent of total billed charges 59.52 105 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Basic Treatment/8-22 Min Ind PX-440925070 CDM 92507 CPT 0440 RC outpatient 187.68 187.68 104.16 104.16 fee schedule 187.68 93 152.02 percent of total billed charges 187.68 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 76.31 fee schedule 187.68 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 76.31 fee schedule 187.68 100 187.68 percent of total billed charges 104.16 187.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Basic Treatment/23-37 Min Ind PX-440925071 CDM 92507 CPT 0440 RC outpatient 187.68 187.68 104.16 104.16 fee schedule 187.68 93 152.02 percent of total billed charges 187.68 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 76.31 fee schedule 187.68 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 76.31 fee schedule 187.68 100 187.68 percent of total billed charges 104.16 187.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Basic Treatment/38-52 Min Ind PX-440925072 CDM 92507 CPT 0440 RC outpatient 187.68 187.68 104.16 104.16 fee schedule 187.68 93 152.02 percent of total billed charges 187.68 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 76.31 fee schedule 187.68 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 76.31 fee schedule 187.68 100 187.68 percent of total billed charges 104.16 187.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Basic Treatment/53-67 Min Ind PX-440925073 CDM 92507 CPT 0440 RC outpatient 187.68 187.68 104.16 104.16 fee schedule 187.68 93 152.02 percent of total billed charges 187.68 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 76.31 fee schedule 187.68 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 76.31 fee schedule 187.68 100 187.68 percent of total billed charges 104.16 187.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Eval Sound/Lang Compre 8-22 PX-440925230 CDM 92523 CPT 0444 RC outpatient 560.45 560.45 176.08 176.08 fee schedule 560.45 93 453.96 percent of total billed charges 560.45 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 227.89 fee schedule 560.45 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 227.89 fee schedule 560.45 100 560.45 percent of total billed charges 176.08 560.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Eval Sound/Lang Compre 23-37 PX-440925231 CDM 92523 CPT 0440 RC outpatient 560.45 560.45 176.08 176.08 fee schedule 560.45 93 453.96 percent of total billed charges 560.45 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 227.89 fee schedule 560.45 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 227.89 fee schedule 560.45 100 560.45 percent of total billed charges 176.08 560.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Eval Sound/Lang Compre 38-52 PX-440925232 CDM 92523 CPT 0440 RC outpatient 560.45 560.45 176.08 176.08 fee schedule 560.45 93 453.96 percent of total billed charges 560.45 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 227.89 fee schedule 560.45 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 227.89 fee schedule 560.45 100 560.45 percent of total billed charges 176.08 560.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Eval Sound/Lang Compre 53-67 PX-440925233 CDM 92523 CPT 0440 RC outpatient 560.45 560.45 176.08 176.08 fee schedule 560.45 93 453.96 percent of total billed charges 560.45 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 227.89 fee schedule 560.45 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 227.89 fee schedule 560.45 100 560.45 percent of total billed charges 176.08 560.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Eval Sound/Lang Compre 68-82 PX-440925234 CDM 92523 CPT 0440 RC outpatient 560.45 560.45 176.08 176.08 fee schedule 560.45 93 453.96 percent of total billed charges 560.45 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 227.89 fee schedule 560.45 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 227.89 fee schedule 560.45 100 560.45 percent of total billed charges 176.08 560.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Eval Behav Qual Voice 8-22 PX-440925240 CDM 92524 CPT 0440 RC outpatient 269.6 269.6 176.08 176.08 fee schedule 269.6 93 218.38 percent of total billed charges 269.6 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 109.63 fee schedule 269.6 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 109.63 fee schedule 269.6 100 269.6 percent of total billed charges 176.08 269.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Eval Behav Qual Voice 23-37 PX-440925241 CDM 92524 CPT 0440 RC outpatient 269.6 269.6 176.08 176.08 fee schedule 269.6 93 218.38 percent of total billed charges 269.6 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 109.63 fee schedule 269.6 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 109.63 fee schedule 269.6 100 269.6 percent of total billed charges 176.08 269.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Eval Behav Qual Voice 38-52 PX-440925242 CDM 92524 CPT 0440 RC outpatient 269.6 269.6 176.08 176.08 fee schedule 269.6 93 218.38 percent of total billed charges 269.6 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 109.63 fee schedule 269.6 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 109.63 fee schedule 269.6 100 269.6 percent of total billed charges 176.08 269.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Eval Behav Qual Voice 53-67 PX-440925243 CDM 92524 CPT 0440 RC outpatient 269.6 269.6 176.08 176.08 fee schedule 269.6 93 218.38 percent of total billed charges 269.6 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 109.63 fee schedule 269.6 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 109.63 fee schedule 269.6 100 269.6 percent of total billed charges 176.08 269.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Eval Behav Qual Voice 68-82 PX-440925244 CDM 92524 CPT 0440 RC outpatient 269.6 269.6 176.08 176.08 fee schedule 269.6 93 218.38 percent of total billed charges 269.6 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 109.63 fee schedule 269.6 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 109.63 fee schedule 269.6 100 269.6 percent of total billed charges 176.08 269.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Eval Behav Qual Voice 83-97 PX-440925245 CDM 92524 CPT 0440 RC outpatient 269.6 269.6 176.08 176.08 fee schedule 269.6 93 218.38 percent of total billed charges 269.6 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 109.63 fee schedule 269.6 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 109.63 fee schedule 269.6 100 269.6 percent of total billed charges 176.08 269.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Treat Swallow/Oral Feed 8-22mn PX-440925260 CDM 92526 CPT 0440 RC outpatient 208.03 208.03 230.45 230.45 fee schedule 208.03 93 168.5 percent of total billed charges 208.03 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 84.59 fee schedule 208.03 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 84.59 fee schedule 208.03 100 208.03 percent of total billed charges 208.03 230.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Treat Swallow/Oral Feed/23-37 PX-440925261 CDM 92526 CPT 0440 RC outpatient 208.03 208.03 230.45 230.45 fee schedule 208.03 93 168.5 percent of total billed charges 208.03 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 84.59 fee schedule 208.03 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 84.59 fee schedule 208.03 100 208.03 percent of total billed charges 208.03 230.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Treat Swallow/Oral Feed/38-52 PX-440925262 CDM 92526 CPT 0440 RC outpatient 208.03 208.03 230.45 230.45 fee schedule 208.03 93 168.5 percent of total billed charges 208.03 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 84.59 fee schedule 208.03 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 84.59 fee schedule 208.03 100 208.03 percent of total billed charges 208.03 230.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Treat Swallow/Oral Feed/53-67 PX-440925263 CDM 92526 CPT 0440 RC outpatient 208.03 208.03 230.45 230.45 fee schedule 208.03 93 168.5 percent of total billed charges 208.03 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 84.59 fee schedule 208.03 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 84.59 fee schedule 208.03 100 208.03 percent of total billed charges 208.03 230.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Eval Use/Fit Voice Prost 23-37 PX-440925971 CDM 92597 CPT 0440 RC outpatient 209 209 181.04 181.04 fee schedule 209 93 169.29 percent of total billed charges 209 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 72.31 fee schedule 209 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 72.31 fee schedule 209 100 209 percent of total billed charges 181.04 209 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Eval Use/Fit Voice Pros 38-52 PX-440925972 CDM 92597 CPT 0440 RC outpatient 209 209 181.04 181.04 fee schedule 209 93 169.29 percent of total billed charges 209 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 72.31 fee schedule 209 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 72.31 fee schedule 209 100 209 percent of total billed charges 181.04 209 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Eval Use/Fit Voice Pros 53-67 PX-440925973 CDM 92597 CPT 0440 RC outpatient 209 209 181.04 181.04 fee schedule 209 93 169.29 percent of total billed charges 209 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 72.31 fee schedule 209 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 72.31 fee schedule 209 100 209 percent of total billed charges 181.04 209 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Eval Oral/Pharyn Swallow 8-22 PX-440926100 CDM 92610 CPT 0440 RC outpatient 317 317 377.2 377.2 fee schedule 317 93 256.77 percent of total billed charges 68.88 68.88 fee schedule 68.88 68.88 fee schedule 317 100 317 percent of total billed charges 68.88 377.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Eval Oral/Pharyn Swallow 23-37 PX-440926101 CDM 92610 CPT 0440 RC outpatient 317 317 377.2 377.2 fee schedule 317 93 256.77 percent of total billed charges 68.88 68.88 fee schedule 68.88 68.88 fee schedule 317 100 317 percent of total billed charges 68.88 377.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Eval Oral/Pharyn Swallow 38-52 PX-440926102 CDM 92610 CPT 0440 RC outpatient 317 317 377.2 377.2 fee schedule 317 93 256.77 percent of total billed charges 68.88 68.88 fee schedule 68.88 68.88 fee schedule 317 100 317 percent of total billed charges 68.88 377.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Eval Oral/Pharyn Swallow 53-67 PX-440926103 CDM 92610 CPT 0440 RC outpatient 317 317 377.2 377.2 fee schedule 317 93 256.77 percent of total billed charges 68.88 68.88 fee schedule 68.88 68.88 fee schedule 317 100 317 percent of total billed charges 68.88 377.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Motion Fluoro Eval Swallow8-22 PX-440926110 CDM 92611 CPT 0440 RC outpatient 225.75 225.75 377.2 377.2 fee schedule 225.75 93 182.86 percent of total billed charges 90.3 90.3 fee schedule 90.3 90.3 fee schedule 225.75 100 225.75 percent of total billed charges 90.3 377.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Motion Fluoro Eval Swall 23-37 PX-440926111 CDM 92611 CPT 0440 RC outpatient 225.75 225.75 377.2 377.2 fee schedule 225.75 93 182.86 percent of total billed charges 90.3 90.3 fee schedule 90.3 90.3 fee schedule 225.75 100 225.75 percent of total billed charges 90.3 377.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Motion Fluoro Eval Swall 38-52 PX-440926112 CDM 92611 CPT 0440 RC outpatient 225.75 225.75 377.2 377.2 fee schedule 225.75 93 182.86 percent of total billed charges 90.3 90.3 fee schedule 90.3 90.3 fee schedule 225.75 100 225.75 percent of total billed charges 90.3 377.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Motion Fluoro Eval Swall 53-67 PX-440926113 CDM 92611 CPT 0440 RC outpatient 225.75 225.75 377.2 377.2 fee schedule 225.75 93 182.86 percent of total billed charges 90.3 90.3 fee schedule 90.3 90.3 fee schedule 225.75 100 225.75 percent of total billed charges 90.3 377.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Motion Fluoro Swal 68-82 PX-440926114 CDM 92611 CPT 0440 RC outpatient 225.75 225.75 377.2 377.2 fee schedule 225.75 93 182.86 percent of total billed charges 90.3 90.3 fee schedule 90.3 90.3 fee schedule 225.75 100 225.75 percent of total billed charges 90.3 377.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Motion Fluoro Eval Swal 83-97 PX-440926115 CDM 92611 CPT 0440 RC outpatient 225.75 225.75 377.2 377.2 fee schedule 225.75 93 182.86 percent of total billed charges 90.3 90.3 fee schedule 90.3 90.3 fee schedule 225.75 100 225.75 percent of total billed charges 90.3 377.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Motion Fluoro Eval Swal 98-112 PX-440926116 CDM 92611 CPT 0440 RC outpatient 225.75 225.75 377.2 377.2 fee schedule 225.75 93 182.86 percent of total billed charges 90.3 90.3 fee schedule 90.3 90.3 fee schedule 225.75 100 225.75 percent of total billed charges 90.3 377.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Motion Fluoro Eval Swal113-127 PX-440926117 CDM 92611 CPT 0440 RC outpatient 225.75 225.75 377.2 377.2 fee schedule 225.75 93 182.86 percent of total billed charges 90.3 90.3 fee schedule 90.3 90.3 fee schedule 225.75 100 225.75 percent of total billed charges 90.3 377.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Assess Aphasia W/Rpt per Hr PX-440961050 CDM 96105 CPT 0440 RC outpatient 293 293 293 74 216.82 percent of total billed charges 293 93 237.33 percent of total billed charges 94.42 94.42 fee schedule 94.42 94.42 fee schedule 293 100 293 percent of total billed charges 94.42 293 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Standard Cognitive Performance Testing PX-440961250 CDM 96125 CPT 0440 RC outpatient 296 296 296 74 219.04 percent of total billed charges 296 93 239.76 percent of total billed charges 296 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 102.25 fee schedule 296 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 102.25 fee schedule 296 100 296 percent of total billed charges 296 296 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Develop Cognitive Skills Ea Add'l 15 Min PX-440971301 CDM 97130 CPT 0440 RC outpatient 70.75 70.75 70.75 74 52.36 percent of total billed charges 70.75 93 57.31 percent of total billed charges 20.72 20.72 fee schedule 20.72 20.72 fee schedule 70.75 100 70.75 percent of total billed charges 20.72 70.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC St Develop Cognitive Skills/15 Mn PX-440975320 CDM 97129 CPT 0440 RC outpatient 83 83 88.04 88.04 fee schedule 83 93 67.23 percent of total billed charges 21.7 21.7 fee schedule 21.7 21.7 fee schedule 83 100 83 percent of total billed charges 21.7 88.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Development of Cognitive Skills PX-441G05151 CDM G0515 CPT 0441 RC outpatient 30 30 30 74 22.2 percent of total billed charges 30 93 24.3 percent of total billed charges 30 30 other OPPS APC 30 30 other OPPS APC 30 100 30 percent of total billed charges 30 30 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Evaluation of Speech Fluency PX-444925211 CDM 92521 CPT 0444 RC outpatient 326.93 326.93 176.08 176.08 fee schedule 326.93 93 264.81 percent of total billed charges 326.93 326.93 other OPPS APC 326.93 326.93 other OPPS APC 326.93 100 326.93 percent of total billed charges 176.08 326.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Evaluation of Speech Sound Production PX-444925221 CDM 92522 CPT 0444 RC outpatient 273.65 273.65 176.08 176.08 fee schedule 273.65 93 221.66 percent of total billed charges 273.65 273.65 other OPPS APC 273.65 273.65 other OPPS APC 273.65 100 273.65 percent of total billed charges 176.08 273.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Eval Speech Sound Prod W/Lang Comp&Expr PX-444925231 CDM 92523 CPT 0444 RC outpatient 560.45 560.45 176.08 176.08 fee schedule 560.45 93 453.96 percent of total billed charges 560.45 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 227.89 fee schedule 560.45 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 227.89 fee schedule 560.45 100 560.45 percent of total billed charges 176.08 560.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Eval Speech Reduced Services Mod 52 PX-444925232 CDM 92523 CPT 0444 RC outpatient 560.45 560.45 176.08 176.08 fee schedule 560.45 93 453.96 percent of total billed charges 560.45 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 227.89 fee schedule 560.45 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 227.89 fee schedule 560.45 100 560.45 percent of total billed charges 176.08 560.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Behavior&Qualitative Analysys Voice&Reso PX-444925241 CDM 92524 CPT 0440 RC outpatient 269.6 269.6 176.08 176.08 fee schedule 269.6 93 218.38 percent of total billed charges 269.6 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 109.63 fee schedule 269.6 "The highest priced service per service date from the OP Rehab fee schedules is priced at the full fee schedule rate, while all others for that service date are priced at the reduced fee schedule rate." 109.63 fee schedule 269.6 100 269.6 percent of total billed charges 176.08 269.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Eval of Swallowing & Oral Function PX-444926101 CDM 92610 CPT 0444 RC outpatient 351 351 377.2 377.2 fee schedule 351 93 284.31 percent of total billed charges 68.88 68.88 fee schedule 68.88 68.88 fee schedule 351 100 351 percent of total billed charges 68.88 377.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Modify Barium Swallow Study PX-444926111 CDM 92611 CPT 0444 RC outpatient 225.75 225.75 377.2 377.2 fee schedule 225.75 93 182.86 percent of total billed charges 90.3 90.3 fee schedule 90.3 90.3 fee schedule 225.75 100 225.75 percent of total billed charges 90.3 377.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Drainage of Skin Abscess PX-450100601 CDM 10060 CPT 0450 RC outpatient 476.88 476.88 476.88 74 352.89 percent of total billed charges 476.88 93 386.27 percent of total billed charges 476.88 476.88 other OPPS APC 476.88 476.88 other OPPS APC 199.69 199.69 case rate 199.69 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Skin Abcess Drain Comp or Multiple PX-450100611 CDM 10061 CPT 0450 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 199.69 199.69 case rate 199.69 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Drainage of Pilonidal Cyst Simple PX-450100801 CDM 10080 CPT 0450 RC outpatient 1675.9 1675.9 1675.9 74 1240.17 percent of total billed charges 1675.9 93 1357.48 percent of total billed charges 1675.9 1675.9 other OPPS APC 1675.9 1675.9 other OPPS APC 199.69 199.69 case rate 199.69 1675.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Remove Foreign Body Subcutan Simple PX-450101201 CDM 10120 CPT 0450 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 199.69 199.69 case rate 199.69 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Drainage of Hematoma/Fluid PX-450101401 CDM 10140 CPT 0450 RC outpatient 3861.88 3861.88 3861.88 74 2857.79 percent of total billed charges 3861.88 93 3128.12 percent of total billed charges 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 199.69 199.69 case rate 199.69 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Puncture Drainage of Lesion PX-450101601 CDM 10160 CPT 0450 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 199.69 199.69 case rate 199.69 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Removal of Nail Plate Simple PX-450117301 CDM 11730 CPT 0450 RC outpatient 476.88 476.88 476.88 74 352.89 percent of total billed charges 476.88 93 386.27 percent of total billed charges 476.88 476.88 other OPPS APC 476.88 476.88 other OPPS APC 199.69 199.69 case rate 199.69 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Avulsion of Nail Plate Addl (Ea) PX-450117321 CDM 11732 CPT 0450 RC outpatient 150 150 150 74 111 percent of total billed charges 150 93 121.5 percent of total billed charges 150 150 other OPPS APC 150 150 other OPPS APC 199.69 199.69 case rate 150 199.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Drain Blood From Under Nail PX-450117401 CDM 11740 CPT 0450 RC outpatient 304.28 304.28 304.28 74 225.17 percent of total billed charges 304.28 93 246.47 percent of total billed charges 304.28 304.28 other OPPS APC 304.28 304.28 other OPPS APC 199.69 199.69 case rate 199.69 304.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Removal of Nail Bed PX-450117501 CDM 11750 CPT 0450 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 199.69 199.69 case rate 199.69 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Repair of Nail Bed PX-450117601 CDM 11760 CPT 0450 RC outpatient 1496 1496 1496 74 1107.04 percent of total billed charges 1496 93 1211.76 percent of total billed charges 1496 1496 other OPPS APC 1496 1496 other OPPS APC 199.69 199.69 case rate 199.69 1496 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Excision of Nail Fold, Toe" PX-450117651 CDM 11765 CPT 0450 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 199.69 199.69 case rate 199.69 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Repair Superf.Wound 2.5cm or Less PX-450120011 CDM 12001 CPT 0450 RC outpatient 476.88 476.88 476.88 74 352.89 percent of total billed charges 476.88 93 386.27 percent of total billed charges 476.88 476.88 other OPPS APC 476.88 476.88 other OPPS APC 199.69 199.69 case rate 199.69 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Repair Superf.Wound 2.6 - 7.5 Cm PX-450120021 CDM 12002 CPT 0450 RC outpatient 476.88 476.88 476.88 74 352.89 percent of total billed charges 476.88 93 386.27 percent of total billed charges 476.88 476.88 other OPPS APC 476.88 476.88 other OPPS APC 199.69 199.69 case rate 199.69 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Repair Superf.Wound 7.6 - 12.5 Cm PX-450120041 CDM 12004 CPT 0450 RC outpatient 476.88 476.88 476.88 74 352.89 percent of total billed charges 476.88 93 386.27 percent of total billed charges 476.88 476.88 other OPPS APC 476.88 476.88 other OPPS APC 199.69 199.69 case rate 199.69 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Repair Superf. Wound 12.6 - 20.0 Cm PX-450120051 CDM 12005 CPT 0450 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 199.69 199.69 case rate 199.69 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Repair Simple Scalp/Neck/Ax/Genit/Trunk 20.1-30.0 Cm PX-450120061 CDM 12006 CPT 0450 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 199.69 199.69 case rate 199.69 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Repair Superf.Wound Over 30.0 Cm PX-450120071 CDM 12007 CPT 0450 RC outpatient 476.88 476.88 476.88 74 352.89 percent of total billed charges 476.88 93 386.27 percent of total billed charges 476.88 476.88 other OPPS APC 476.88 476.88 other OPPS APC 199.69 199.69 case rate 199.69 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Repair Superf Wound 2.5 Cm or Less PX-450120111 CDM 12011 CPT 0450 RC outpatient 476.88 476.88 476.88 74 352.89 percent of total billed charges 476.88 93 386.27 percent of total billed charges 476.88 476.88 other OPPS APC 476.88 476.88 other OPPS APC 199.69 199.69 case rate 199.69 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Repair Superf Wound 2.6 - 5.0 Cm PX-450120131 CDM 12013 CPT 0450 RC outpatient 476.88 476.88 476.88 74 352.89 percent of total billed charges 476.88 93 386.27 percent of total billed charges 476.88 476.88 other OPPS APC 476.88 476.88 other OPPS APC 199.69 199.69 case rate 199.69 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Repair Superf Wound 5.1 - 7.5 Cm PX-450120141 CDM 12014 CPT 0450 RC outpatient 476.88 476.88 476.88 74 352.89 percent of total billed charges 476.88 93 386.27 percent of total billed charges 476.88 476.88 other OPPS APC 476.88 476.88 other OPPS APC 199.69 199.69 case rate 199.69 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Repair Superf Wound 7.6 - 12.5 Cm PX-450120151 CDM 12015 CPT 0450 RC outpatient 476.88 476.88 476.88 74 352.89 percent of total billed charges 476.88 93 386.27 percent of total billed charges 476.88 476.88 other OPPS APC 476.88 476.88 other OPPS APC 199.69 199.69 case rate 199.69 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Repair Simple Face/Ear/Eyelids/Nose/Lips/Mouth 12.6-20.0 Cm PX-450120161 CDM 12016 CPT 0450 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 199.69 199.69 case rate 199.69 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Repair Simple Face/Ears/Eyelids/Nose/Lips/Mouth 20.1-30.0 Cm PX-450120171 CDM 12017 CPT 0450 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 199.69 199.69 case rate 199.69 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Closure of Split Wound PX-450120201 CDM 12020 CPT 0450 RC outpatient 1496 1496 1496 74 1107.04 percent of total billed charges 1496 93 1211.76 percent of total billed charges 1496 1496 other OPPS APC 1496 1496 other OPPS APC 199.69 199.69 case rate 199.69 1496 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Repair Simple Face/Ears/Eyelids/Nose/Lips/Mouth 2.5 Cm or Less PX-450120311 CDM 12031 CPT 0450 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 199.69 199.69 case rate 199.69 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Layer Closure of Wound 2.6 - 7.5 Cm PX-450120321 CDM 12032 CPT 0450 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 199.69 199.69 case rate 199.69 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Layer Closure of Wound 7.6 - 12.5cm PX-450120341 CDM 12034 CPT 0450 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 199.69 199.69 case rate 199.69 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Repair Intermediate Scalp/Ax/Trunk/Extrem 12.6-20.0 Cm PX-450120351 CDM 12035 CPT 0450 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 199.69 199.69 case rate 199.69 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Repair Intermediate Neck/Hands/Feet/Xtrnl Gent 2.5 Cm/< PX-450120411 CDM 12041 CPT 0450 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 199.69 199.69 case rate 199.69 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Layer Closure of Wound 2.6 - 7.5 Cm PX-450120421 CDM 12042 CPT 0450 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 199.69 199.69 case rate 199.69 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Layer Closure of Wound 7.6 - 12.5cm PX-450120441 CDM 12044 CPT 0450 RC outpatient 1496 1496 1496 74 1107.04 percent of total billed charges 1496 93 1211.76 percent of total billed charges 1496 1496 other OPPS APC 1496 1496 other OPPS APC 199.69 199.69 case rate 199.69 1496 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Layer Closure of Wound 2.5cm or Less PX-450120511 CDM 12051 CPT 0450 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 199.69 199.69 case rate 199.69 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Layer Closure of Wound 2.6 - 5.0 Cm PX-450120521 CDM 12052 CPT 0450 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 199.69 199.69 case rate 199.69 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Layer Closure of Wound 5.1 - 7.5 Cm PX-450120531 CDM 12053 CPT 0450 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 199.69 199.69 case rate 199.69 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Layer Closure of Wound 7.6 - 12.5cm PX-450120541 CDM 12054 CPT 0450 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 199.69 199.69 case rate 199.69 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Repair, Complex Trunk 2.6 - 7.5 Cm" PX-450131011 CDM 13101 CPT 0450 RC outpatient 1496 1496 1496 74 1107.04 percent of total billed charges 1496 93 1211.76 percent of total billed charges 1496 1496 other OPPS APC 1496 1496 other OPPS APC 199.69 199.69 case rate 199.69 1496 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Repair Eyelids,Nose,Ears 2.6-7.5 Cm" PX-450131521 CDM 13152 CPT 0450 RC outpatient 1496 1496 1496 74 1107.04 percent of total billed charges 1496 93 1211.76 percent of total billed charges 1496 1496 other OPPS APC 1496 1496 other OPPS APC 199.69 199.69 case rate 199.69 1496 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tx Burn Debrid Dress Par Thick <5% PX-450160201 CDM 16020 CPT 0450 RC outpatient 476.88 476.88 476.88 74 352.89 percent of total billed charges 476.88 93 386.27 percent of total billed charges 476.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 204.13 other OPPS APC 476.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 204.13 other OPPS APC 199.69 199.69 case rate 199.69 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Skin Tissue Procedure PX-450179991 CDM 17999 CPT 0450 RC outpatient 476.88 476.88 476.88 74 352.89 percent of total billed charges 476.88 93 386.27 percent of total billed charges 476.88 476.88 other OPPS APC 476.88 476.88 other OPPS APC 199.69 199.69 case rate 199.69 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Explore Penetrating Wound,Extreme" PX-450201031 CDM 20103 CPT 0450 RC outpatient 3861.88 3861.88 3861.88 74 2857.79 percent of total billed charges 3861.88 93 3128.12 percent of total billed charges 3861.88 3861.88 other OPPS APC 3861.88 3861.88 other OPPS APC 199.69 199.69 case rate 199.69 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Foreign Body Remvl Tendon Muscle Sim PX-450205201 CDM 20520 CPT 0450 RC outpatient 3861.88 3861.88 3861.88 74 2857.79 percent of total billed charges 3861.88 93 3128.12 percent of total billed charges 3861.88 3861.88 other OPPS APC 3861.88 3861.88 other OPPS APC 199.69 199.69 case rate 199.69 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Drain/Inject, Intermed Joint/Bursa" PX-450206051 CDM 20605 CPT 0450 RC outpatient 705.5 705.5 705.5 74 522.07 percent of total billed charges 705.5 93 571.46 percent of total billed charges 705.5 705.5 other OPPS APC 705.5 705.5 other OPPS APC 199.69 199.69 case rate 199.69 705.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Drain/Inject, Major Joint/Bursa" PX-450206101 CDM 20610 CPT 0450 RC outpatient 705.5 705.5 705.5 74 522.07 percent of total billed charges 705.5 93 571.46 percent of total billed charges 705.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301.99 other OPPS APC 705.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301.99 other OPPS APC 199.69 199.69 case rate 199.69 705.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Removal of Support Implant PX-450206701 CDM 20670 CPT 0450 RC outpatient 3861.88 3861.88 3861.88 74 2857.79 percent of total billed charges 3861.88 93 3128.12 percent of total billed charges 3861.88 3861.88 other OPPS APC 3861.88 3861.88 other OPPS APC 199.69 199.69 case rate 199.69 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ac Joint Dislocation W/Manipulation PX-450235451 CDM 23545 CPT 0450 RC outpatient 561.73 561.73 561.73 74 415.68 percent of total billed charges 561.73 93 455 percent of total billed charges 561.73 561.73 other OPPS APC 561.73 561.73 other OPPS APC 199.69 199.69 case rate 199.69 561.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Treat Shoulder Dislocation W/Manipul PX-450236501 CDM 23650 CPT 0450 RC outpatient 561.73 561.73 561.73 74 415.68 percent of total billed charges 561.73 93 455 percent of total billed charges 561.73 561.73 other OPPS APC 561.73 561.73 other OPPS APC 199.69 199.69 case rate 199.69 561.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Closed Trmt Shldr Disloc W/Man &Anes PX-450236551 CDM 23655 CPT 0450 RC outpatient 3828.33 3828.33 3828.33 74 2832.96 percent of total billed charges 3828.33 93 3100.95 percent of total billed charges 3828.33 3828.33 other OPPS APC 3828.33 3828.33 other OPPS APC 199.69 199.69 case rate 199.69 3828.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Treat Disloc/Fx Shoulder W/Surg W/Mn PX-450236751 CDM 23675 CPT 0450 RC outpatient 3828.33 3828.33 3828.33 74 2832.96 percent of total billed charges 3828.33 93 3100.95 percent of total billed charges 3828.33 3828.33 other OPPS APC 3828.33 3828.33 other OPPS APC 199.69 199.69 case rate 199.69 3828.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Close Treat Humerus Fx W/O Manipulat PX-450245001 CDM 24500 CPT 0450 RC outpatient 561.73 561.73 561.73 74 415.68 percent of total billed charges 561.73 93 455 percent of total billed charges 561.73 561.73 other OPPS APC 561.73 561.73 other OPPS APC 199.69 199.69 case rate 199.69 561.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Elbow Dislocation Closed Tx W Sedate PX-450246051 CDM 24605 CPT 0450 RC outpatient 3828.33 3828.33 3828.33 74 2832.96 percent of total billed charges 3828.33 93 3100.95 percent of total billed charges 3828.33 3828.33 other OPPS APC 3828.33 3828.33 other OPPS APC 199.69 199.69 case rate 199.69 3828.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Treat Close Nursemaid Elbow W/Manip PX-450246401 CDM 24640 CPT 0450 RC outpatient 561.73 561.73 561.73 74 415.68 percent of total billed charges 561.73 93 455 percent of total billed charges 561.73 561.73 other OPPS APC 561.73 561.73 other OPPS APC 199.69 199.69 case rate 199.69 561.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Treat Fx of Ulna W/Manipulation PX-450255351 CDM 25535 CPT 0450 RC outpatient 561.73 561.73 561.73 74 415.68 percent of total billed charges 561.73 93 455 percent of total billed charges 561.73 561.73 other OPPS APC 561.73 561.73 other OPPS APC 199.69 199.69 case rate 199.69 561.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Treat Fx Radius & Ulna W/Manipulatio PX-450255651 CDM 25565 CPT 0450 RC outpatient 3828.33 3828.33 3828.33 74 2832.96 percent of total billed charges 3828.33 93 3100.95 percent of total billed charges 3828.33 3828.33 other OPPS APC 3828.33 3828.33 other OPPS APC 199.69 199.69 case rate 199.69 3828.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Treat Fx Radius W&W/O Ulna W/Manipul PX-450256051 CDM 25605 CPT 0450 RC outpatient 3828.33 3828.33 3828.33 74 2832.96 percent of total billed charges 3828.33 93 3100.95 percent of total billed charges 3828.33 3828.33 other OPPS APC 3828.33 3828.33 other OPPS APC 199.69 199.69 case rate 199.69 3828.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Drainage of Finger Abscess,Simple" PX-450260101 CDM 26010 CPT 0450 RC outpatient 476.88 476.88 476.88 74 352.89 percent of total billed charges 476.88 93 386.27 percent of total billed charges 476.88 476.88 other OPPS APC 476.88 476.88 other OPPS APC 199.69 199.69 case rate 199.69 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Drainage of Finger Abscess, Complicated" PX-450260111 CDM 26011 CPT 0450 RC outpatient 3861.88 3861.88 3861.88 74 2857.79 percent of total billed charges 3861.88 93 3128.12 percent of total billed charges 3861.88 3861.88 other OPPS APC 3861.88 3861.88 other OPPS APC 199.69 199.69 case rate 199.69 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Treat Knuckle Dislocation PX-450267001 CDM 26700 CPT 0450 RC outpatient 561.73 561.73 561.73 74 415.68 percent of total billed charges 561.73 93 455 percent of total billed charges 561.73 561.73 other OPPS APC 561.73 561.73 other OPPS APC 199.69 199.69 case rate 199.69 561.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Treat Finger Fx, Ea W/Manipulation" PX-450267251 CDM 26725 CPT 0450 RC outpatient 561.73 561.73 561.73 74 415.68 percent of total billed charges 561.73 93 455 percent of total billed charges 561.73 561.73 other OPPS APC 561.73 561.73 other OPPS APC 199.69 199.69 case rate 199.69 561.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Finger IP Joint Dislocation WO Anes PX-450267701 CDM 26770 CPT 0450 RC outpatient 561.73 561.73 561.73 74 415.68 percent of total billed charges 561.73 93 455 percent of total billed charges 561.73 561.73 other OPPS APC 561.73 561.73 other OPPS APC 199.69 199.69 case rate 199.69 561.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Clsd Reductn Ipjt Disloc W/Manp/Anes PX-450267751 CDM 26775 CPT 0450 RC outpatient 2533 2533 2533 74 1874.42 percent of total billed charges 2533 93 2051.73 percent of total billed charges 2533 2533 other OPPS APC 2533 2533 other OPPS APC 199.69 199.69 case rate 199.69 2533 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Amputation,Finger or Thumb, Pri/Sec" PX-450269511 CDM 26951 CPT 0450 RC outpatient 7710.08 7710.08 7710.08 74 5705.46 percent of total billed charges 7710.08 93 6245.16 percent of total billed charges 7710.08 7710.08 other OPPS APC 7710.08 7710.08 other OPPS APC 199.69 199.69 case rate 199.69 7710.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Treat Hip Dislocation W/O Anes. PX-450272501 CDM 27250 CPT 0450 RC outpatient 561.73 561.73 561.73 74 415.68 percent of total billed charges 561.73 93 455 percent of total billed charges 561.73 561.73 other OPPS APC 561.73 561.73 other OPPS APC 199.69 199.69 case rate 199.69 561.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Clsed Red Disloc Post Hip Arthr WO A PX-450272651 CDM 27265 CPT 0450 RC outpatient 561.73 561.73 561.73 74 415.68 percent of total billed charges 561.73 93 455 percent of total billed charges 561.73 561.73 other OPPS APC 561.73 561.73 other OPPS APC 199.69 199.69 case rate 199.69 561.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Clsed Red Dislocat Post Hip Arthrop PX-450272661 CDM 27266 CPT 0450 RC outpatient 3828.33 3828.33 3828.33 74 2832.96 percent of total billed charges 3828.33 93 3100.95 percent of total billed charges 3828.33 3828.33 other OPPS APC 3828.33 3828.33 other OPPS APC 199.69 199.69 case rate 199.69 3828.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Treat Kneecap Dislocation PX-450275601 CDM 27560 CPT 0450 RC outpatient 561.73 561.73 561.73 74 415.68 percent of total billed charges 561.73 93 455 percent of total billed charges 561.73 561.73 other OPPS APC 561.73 561.73 other OPPS APC 199.69 199.69 case rate 199.69 561.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Treat Tibia Fx, W/Manipulation" PX-450277521 CDM 27752 CPT 0450 RC outpatient 3828.33 3828.33 3828.33 74 2832.96 percent of total billed charges 3828.33 93 3100.95 percent of total billed charges 3828.33 3828.33 other OPPS APC 3828.33 3828.33 other OPPS APC 199.69 199.69 case rate 199.69 3828.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Treat of Distal Fibula Fx W/Manipula PX-450277881 CDM 27788 CPT 0450 RC outpatient 561.73 561.73 561.73 74 415.68 percent of total billed charges 561.73 93 455 percent of total billed charges 561.73 561.73 other OPPS APC 561.73 561.73 other OPPS APC 199.69 199.69 case rate 199.69 561.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Closed Tx Bimalleolar Ankle Fracture W/Man PX-450278100 CDM 27810 CPT 0450 RC outpatient 3828.33 3828.33 3828.33 74 2832.96 percent of total billed charges 3828.33 93 3100.95 percent of total billed charges 3828.33 3828.33 other OPPS APC 3828.33 3828.33 other OPPS APC 199.69 199.69 case rate 199.69 3828.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Trt Ankle Dislocation W/O Anesthesia PX-450278401 CDM 27840 CPT 0450 RC outpatient 561.73 561.73 561.73 74 415.68 percent of total billed charges 561.73 93 455 percent of total billed charges 561.73 561.73 other OPPS APC 561.73 561.73 other OPPS APC 199.69 199.69 case rate 199.69 561.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ankle Dislocate Closed Tx W Anes PX-450278421 CDM 27842 CPT 0450 RC outpatient 3828.33 3828.33 3828.33 74 2832.96 percent of total billed charges 3828.33 93 3100.95 percent of total billed charges 3828.33 3828.33 other OPPS APC 3828.33 3828.33 other OPPS APC 199.69 199.69 case rate 199.69 3828.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Removal of Foot Foreign Body Subcut PX-450281901 CDM 28190 CPT 0450 RC outpatient 1675.9 1675.9 1675.9 74 1240.17 percent of total billed charges 1675.9 93 1357.48 percent of total billed charges 1675.9 1675.9 other OPPS APC 1675.9 1675.9 other OPPS APC 199.69 199.69 case rate 199.69 1675.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Closed Trt of Big Toe Fx W/ Manipula PX-450284951 CDM 28495 CPT 0450 RC outpatient 561.73 561.73 561.73 74 415.68 percent of total billed charges 561.73 93 455 percent of total billed charges 561.73 561.73 other OPPS APC 561.73 561.73 other OPPS APC 199.69 199.69 case rate 199.69 561.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Closed Trtmt Toe Disloc W/O Anesthes PX-450286301 CDM 28630 CPT 0450 RC outpatient 561.73 561.73 561.73 74 415.68 percent of total billed charges 561.73 93 455 percent of total billed charges 561.73 561.73 other OPPS APC 561.73 561.73 other OPPS APC 199.69 199.69 case rate 199.69 561.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Closed Trtmt of Disloc Toe W/O Anes PX-450286601 CDM 28660 CPT 0450 RC outpatient 561.73 561.73 561.73 74 415.68 percent of total billed charges 561.73 93 455 percent of total billed charges 561.73 561.73 other OPPS APC 561.73 561.73 other OPPS APC 199.69 199.69 case rate 199.69 561.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Application of Long Arm Cast PX-450290651 CDM 29065 CPT 0450 RC outpatient 639.7 639.7 639.7 74 473.38 percent of total billed charges 639.7 93 518.16 percent of total billed charges 639.7 639.7 other OPPS APC 639.7 639.7 other OPPS APC 199.69 199.69 case rate 199.69 639.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Apply Long Arm Splint PX-450291051 CDM 29105 CPT 0450 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 375.33 other OPPS APC 375.33 375.33 other OPPS APC 199.69 199.69 case rate 199.69 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Apply Forearm Splint PX-450291251 CDM 29125 CPT 0450 RC outpatient 344 344 344 74 254.56 percent of total billed charges 344 93 278.64 percent of total billed charges 344 344 other OPPS APC 344 344 other OPPS APC 199.69 199.69 case rate 199.69 344 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Apply Forearm Splint, Dynamic" PX-450291261 CDM 29126 CPT 0450 RC outpatient 344 344 344 74 254.56 percent of total billed charges 344 93 278.64 percent of total billed charges 344 344 other OPPS APC 344 344 other OPPS APC 199.69 199.69 case rate 199.69 344 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Application Finger Splint, Static" PX-450291301 CDM 29130 CPT 0450 RC outpatient 344 344 344 74 254.56 percent of total billed charges 344 93 278.64 percent of total billed charges 344 344 other OPPS APC 344 344 other OPPS APC 199.69 199.69 case rate 199.69 344 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Strapping of Shoulder PX-450292401 CDM 29240 CPT 0450 RC outpatient 344 344 344 74 254.56 percent of total billed charges 344 93 278.64 percent of total billed charges 344 344 other OPPS APC 344 344 other OPPS APC 199.69 199.69 case rate 199.69 344 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Apply Short Leg Cast PX-450294051 CDM 29405 CPT 0450 RC outpatient 639.7 639.7 639.7 74 473.38 percent of total billed charges 639.7 93 518.16 percent of total billed charges 639.7 639.7 other OPPS APC 639.7 639.7 other OPPS APC 199.69 199.69 case rate 199.69 639.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Application Long Leg Splint PX-450295051 CDM 29505 CPT 0450 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 375.33 other OPPS APC 375.33 375.33 other OPPS APC 199.69 199.69 case rate 199.69 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Application Lower Leg Splint PX-450295151 CDM 29515 CPT 0450 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 375.33 other OPPS APC 375.33 375.33 other OPPS APC 199.69 199.69 case rate 199.69 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Strapping of Knee PX-450295301 CDM 29530 CPT 0450 RC outpatient 304.28 304.28 304.28 74 225.17 percent of total billed charges 304.28 93 246.47 percent of total billed charges 304.28 304.28 other OPPS APC 304.28 304.28 other OPPS APC 199.69 199.69 case rate 199.69 304.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Strapping of Ankle PX-450295401 CDM 29540 CPT 0450 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 375.33 other OPPS APC 375.33 375.33 other OPPS APC 199.69 199.69 case rate 199.69 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Removal/Bivalve Cast Gaunt Boot Body PX-450297001 CDM 29700 CPT 0450 RC outpatient 639.7 639.7 639.7 74 473.38 percent of total billed charges 639.7 93 518.16 percent of total billed charges 639.7 639.7 other OPPS APC 639.7 639.7 other OPPS APC 199.69 199.69 case rate 199.69 639.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Remove Nasal Foreign Body PX-450303001 CDM 30300 CPT 0450 RC outpatient 328 328 328 74 242.72 percent of total billed charges 328 93 265.68 percent of total billed charges 328 328 other OPPS APC 328 328 other OPPS APC 199.69 199.69 case rate 199.69 328 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Control of Nosebleed, Simple" PX-450309011 CDM 30901 CPT 0450 RC outpatient 438 438 438 74 324.12 percent of total billed charges 438 93 354.78 percent of total billed charges 438 438 other OPPS APC 438 438 other OPPS APC 199.69 199.69 case rate 199.69 438 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Control of Nosebleed, Posterior" PX-450309051 CDM 30905 CPT 0450 RC outpatient 438 438 438 74 324.12 percent of total billed charges 438 93 354.78 percent of total billed charges 438 438 other OPPS APC 438 438 other OPPS APC 199.69 199.69 case rate 199.69 438 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Insert Emergency Airway PX-450315001 CDM 31500 CPT 0450 RC outpatient 581.83 581.83 581.83 74 430.55 percent of total billed charges 581.83 93 471.28 percent of total billed charges 581.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.05 other OPPS APC 581.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.05 other OPPS APC 199.69 199.69 case rate 199.69 581.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chest Tube Insertion W Thoracostomy PX-450325511 CDM 32551 CPT 0450 RC outpatient 3814.83 3814.83 3814.83 74 2822.97 percent of total billed charges 3814.83 93 3090.01 percent of total billed charges 3814.83 3814.83 other OPPS APC 3814.83 3814.83 other OPPS APC 199.69 199.69 case rate 199.69 3814.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Place Needle in Vein PX-450360001 CDM 36000 CPT 0450 RC outpatient 146 146 146 74 108.04 percent of total billed charges 146 93 118.26 percent of total billed charges 146 146 other OPPS APC 146 146 other OPPS APC 199.69 199.69 case rate 146 199.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Central Line Insert Non Tunnel 5yr&> PX-450365561 CDM 36556 CPT 0450 RC outpatient 7592.53 7592.53 7592.53 74 5618.47 percent of total billed charges 7592.53 93 6149.95 percent of total billed charges 7592.53 7592.53 other OPPS APC 7592.53 7592.53 other OPPS APC 199.69 199.69 case rate 199.69 7592.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Repair of Lacertion 2.5cm Mouth/Tong PX-450412501 CDM 41250 CPT 0450 RC outpatient 949.08 949.08 949.08 74 702.32 percent of total billed charges 949.08 93 768.75 percent of total billed charges 949.08 949.08 other OPPS APC 949.08 949.08 other OPPS APC 199.69 199.69 case rate 199.69 949.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Drainage of Gum Lesion PX-450418001 CDM 41800 CPT 0450 RC outpatient 369 369 369 74 273.06 percent of total billed charges 369 93 298.89 percent of total billed charges 369 369 other OPPS APC 369 369 other OPPS APC 199.69 199.69 case rate 199.69 369 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Incision and Drainage Abscess Perito PX-450427001 CDM 42700 CPT 0450 RC outpatient 581.83 581.83 581.83 74 430.55 percent of total billed charges 581.83 93 471.28 percent of total billed charges 581.83 581.83 other OPPS APC 581.83 581.83 other OPPS APC 199.69 199.69 case rate 199.69 581.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Replacement Gastrotomy Tube Percutaneous PX-450437621 CDM 43762 CPT 0450 RC outpatient 588.7 588.7 588.7 74 435.64 percent of total billed charges 588.7 93 476.85 percent of total billed charges 588.7 588.7 other OPPS APC 588.7 588.7 other OPPS APC 199.69 199.69 case rate 199.69 588.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Incision of Anal Abscess PX-450460501 CDM 46050 CPT 0450 RC outpatient 2177.03 2177.03 2177.03 74 1611 percent of total billed charges 2177.03 93 1763.39 percent of total billed charges 2177.03 2177.03 other OPPS APC 2177.03 2177.03 other OPPS APC 199.69 199.69 case rate 199.69 2177.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Incise External Hemorrhoid PX-450460831 CDM 46083 CPT 0450 RC outpatient 623 623 623 74 461.02 percent of total billed charges 623 93 504.63 percent of total billed charges 623 623 other OPPS APC 623 623 other OPPS APC 199.69 199.69 case rate 199.69 623 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Fluoro Exam of G Colon Tube PX-450494650 CDM 49465 CPT 0450 RC outpatient 583.8 583.8 583.8 74 432.01 percent of total billed charges 583.8 93 472.88 percent of total billed charges 583.8 583.8 other OPPS APC 583.8 583.8 other OPPS APC 199.69 199.69 case rate 199.69 583.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Insert Non-Indwelling Bladder Cath PX-450517011 CDM 51701 CPT 0450 RC outpatient 304.28 304.28 304.28 74 225.17 percent of total billed charges 304.28 93 246.47 percent of total billed charges 304.28 304.28 other OPPS APC 304.28 304.28 other OPPS APC 199.69 199.69 case rate 199.69 304.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Insert Urinary Catheter PX-450517021 CDM 51702 CPT 0450 RC outpatient 304.28 304.28 304.28 74 225.17 percent of total billed charges 304.28 93 246.47 percent of total billed charges 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 232.88 232.88 case rate 232.88 304.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Change of Bladder Tube PX-450517051 CDM 51705 CPT 0450 RC outpatient 588.7 588.7 588.7 74 435.64 percent of total billed charges 588.7 93 476.85 percent of total billed charges 588.7 588.7 other OPPS APC 588.7 588.7 other OPPS APC 199.69 199.69 case rate 199.69 588.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC I&D Scrotum PX-450547001 CDM 54700 CPT 0450 RC outpatient 4851.65 4851.65 4851.65 74 3590.22 percent of total billed charges 4851.65 93 3929.84 percent of total billed charges 4851.65 4851.65 other OPPS APC 4851.65 4851.65 other OPPS APC 199.69 199.69 case rate 199.69 4851.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC I & D of Vulva/Perineum PX-450564051 CDM 56405 CPT 0450 RC outpatient 764.15 764.15 764.15 74 565.47 percent of total billed charges 764.15 93 618.96 percent of total billed charges 764.15 764.15 other OPPS APC 764.15 764.15 other OPPS APC 199.69 199.69 case rate 199.69 764.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Drainage Bartholin Gland Abscess PX-450564201 CDM 56420 CPT 0450 RC outpatient 474.65 474.65 474.65 74 351.24 percent of total billed charges 474.65 93 384.47 percent of total billed charges 474.65 474.65 other OPPS APC 474.65 474.65 other OPPS APC 199.69 199.69 case rate 199.69 474.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Spinal Tap, Diagnostic" PX-450622701 CDM 62270 CPT 0450 RC outpatient 1647.25 1647.25 1647.25 74 1218.97 percent of total billed charges 1647.25 93 1334.27 percent of total billed charges 1647.25 1647.25 other OPPS APC 1647.25 1647.25 other OPPS APC 199.69 199.69 case rate 199.69 1647.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Inject, Epidural,of Blood Clot Patch" PX-450622731 CDM 62273 CPT 0450 RC outpatient 1647.25 1647.25 1647.25 74 1218.97 percent of total billed charges 1647.25 93 1334.27 percent of total billed charges 1647.25 1647.25 other OPPS APC 1647.25 1647.25 other OPPS APC 199.69 199.69 case rate 199.69 1647.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Remove Foreign Body From Eye PX-450652051 CDM 65205 CPT 0450 RC outpatient 516 516 516 74 381.84 percent of total billed charges 516 93 417.96 percent of total billed charges 516 516 other OPPS APC 516 516 other OPPS APC 199.69 199.69 case rate 199.69 516 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Remove Foreign Body From Eye,Embed" PX-450652101 CDM 65210 CPT 0450 RC outpatient 949.08 949.08 949.08 74 702.32 percent of total billed charges 949.08 93 768.75 percent of total billed charges 949.08 949.08 other OPPS APC 949.08 949.08 other OPPS APC 199.69 199.69 case rate 199.69 949.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Remove F.Body From Eye,Corneal-W/O S" PX-450652201 CDM 65220 CPT 0450 RC outpatient 949.08 949.08 949.08 74 702.32 percent of total billed charges 949.08 93 768.75 percent of total billed charges 949.08 949.08 other OPPS APC 949.08 949.08 other OPPS APC 199.69 199.69 case rate 199.69 949.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Remove F.Body Eye, Corneal W/Slit La" PX-450652221 CDM 65222 CPT 0450 RC outpatient 516 516 516 74 381.84 percent of total billed charges 516 93 417.96 percent of total billed charges 516 516 other OPPS APC 516 516 other OPPS APC 199.69 199.69 case rate 199.69 516 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Canthotomy PX-450677151 CDM 67715 CPT 0450 RC outpatient 5566.2 5566.2 5566.2 74 4118.99 percent of total billed charges 5566.2 93 4508.62 percent of total billed charges 5566.2 5566.2 other OPPS APC 5566.2 5566.2 other OPPS APC 199.69 199.69 case rate 199.69 5566.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Removal Embedded FB Eyelid PX-450679381 CDM 67938 CPT 0450 RC outpatient 693.9 693.9 693.9 74 513.49 percent of total billed charges 693.9 93 562.06 percent of total billed charges 693.9 693.9 other OPPS APC 693.9 693.9 other OPPS APC 199.69 199.69 case rate 199.69 693.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Removal FB Ex Aud Canal PX-450692001 CDM 69200 CPT 0450 RC outpatient 304.28 304.28 304.28 74 225.17 percent of total billed charges 304.28 93 246.47 percent of total billed charges 304.28 304.28 other OPPS APC 304.28 304.28 other OPPS APC 199.69 199.69 case rate 199.69 304.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Remove Impacted Ear Wax PX-450692101 CDM 69210 CPT 0450 RC outpatient 145.7 145.7 145.7 74 107.82 percent of total billed charges 145.7 93 118.02 percent of total billed charges 145.7 145.7 other OPPS APC 145.7 145.7 other OPPS APC 199.69 199.69 case rate 145.7 199.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Heart/Lung Resuscitation Cpr PX-450929501 CDM 92950 CPT 0450 RC outpatient 874 874 395.42 395.42 fee schedule 874 93 707.94 percent of total billed charges 874 874 other OPPS APC 874 874 other OPPS APC 199.69 199.69 case rate 199.69 874 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Temporary External Pacing PX-450929531 CDM 92953 CPT 0450 RC outpatient 1550.25 1550.25 1550.25 74 1147.19 percent of total billed charges 1550.25 93 1255.7 percent of total billed charges 1550.25 1550.25 other OPPS APC 1550.25 1550.25 other OPPS APC 199.69 199.69 case rate 199.69 1550.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Cardioversion Electric, Ext" PX-450929601 CDM 92960 CPT 0450 RC outpatient 1550.25 1550.25 899.47 899.47 fee schedule 1550.25 93 1255.7 percent of total billed charges 1550.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 663.59 other OPPS APC 1550.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 663.59 other OPPS APC 199.69 199.69 case rate 199.69 1550.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hydration Infusion to 1 Hr PX-450963601 CDM 96360 CPT 0450 RC outpatient 510.55 510.55 458.26 458.26 fee schedule 510.55 93 413.55 percent of total billed charges 510.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.54 other OPPS APC 510.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.54 other OPPS APC 199.69 199.69 case rate 199.69 510.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hydration Infusion Ea Addl Hr PX-450963611 CDM 96361 CPT 0450 RC outpatient 113.15 113.15 122.11 122.11 fee schedule 113.15 93 91.65 percent of total billed charges 113.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 113.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 232.88 232.88 case rate 113.15 232.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IV Infusion for Therapy Prophyl Dx PX-450963651 CDM 96365 CPT 0450 RC outpatient 510.55 510.55 643.38 643.38 fee schedule 510.55 93 413.55 percent of total billed charges 510.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.54 other OPPS APC 510.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.54 other OPPS APC 199.69 199.69 case rate 199.69 643.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IV Infus Initial Up to 1 Hour W 59 Mod PX-450963652 CDM 96365 CPT 0450 RC outpatient 510.55 510.55 643.38 643.38 fee schedule 510.55 93 413.55 percent of total billed charges 510.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.54 other OPPS APC 510.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.54 other OPPS APC 199.69 199.69 case rate 199.69 643.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IV Infuse Ther Prophyl Dx Ea Add Hr PX-450963661 CDM 96366 CPT 0450 RC outpatient 113.15 113.15 147.97 147.97 fee schedule 113.15 93 91.65 percent of total billed charges 113.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 113.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 199.69 199.69 case rate 113.15 199.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IV Infus Ea Add Hour W 59 Mod PX-450963662 CDM 96366 CPT 0450 RC outpatient 113.15 113.15 147.97 147.97 fee schedule 113.15 93 91.65 percent of total billed charges 113.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 113.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 199.69 199.69 case rate 113.15 199.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IV Infus Ea New Med 16-90 Min W Mod59 PX-450963671 CDM 96367 CPT 0450 RC outpatient 167.8 167.8 167.8 74 124.17 percent of total billed charges 167.8 93 135.92 percent of total billed charges 167.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 167.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 199.69 199.69 case rate 167.8 199.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IV Infuse Addl Seq Infusion 1st Hr PX-450963672 CDM 96367 CPT 0450 RC outpatient 167.8 167.8 167.8 74 124.17 percent of total billed charges 167.8 93 135.92 percent of total billed charges 167.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 167.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 199.69 199.69 case rate 167.8 199.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Inject Sc Imtherp Prophyl Dx PX-450963721 CDM 96372 CPT 0450 RC outpatient 167.8 167.8 146.04 146.04 fee schedule 167.8 93 135.92 percent of total billed charges 167.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 167.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 199.69 199.69 case rate 146.04 199.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Inject IV Therp Prophyl Dx Sgl Initi PX-450963741 CDM 96374 CPT 0450 RC outpatient 510.55 510.55 275.41 275.41 fee schedule 510.55 93 413.55 percent of total billed charges 510.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.54 other OPPS APC 510.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.54 other OPPS APC 199.69 199.69 case rate 199.69 510.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Inject Ivther Prophyl Dx Ea Add Drug PX-450963751 CDM 96375 CPT 0450 RC outpatient 169 169 166.24 166.24 fee schedule 169 93 136.89 percent of total billed charges 169 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 169 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.43 other OPPS APC 199.69 199.69 case rate 166.24 199.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IV Push Ea Seq Same Drug After 30 Mins PX-450963761 CDM 96376 CPT 0450 RC outpatient 125 125 125 74 92.5 percent of total billed charges 125 93 101.25 percent of total billed charges 125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 125 other OPPS APC 125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 125 other OPPS APC 199.69 199.69 case rate 125 199.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC ER Level I PX-450992811 CDM 99281 CPT 0450 RC outpatient 211.48 211.48 204 204 case rate 211.48 93 171.3 percent of total billed charges 211.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 90.52 other OPPS APC 211.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 90.52 other OPPS APC 199.69 199.69 case rate 199.69 211.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC ER Level II PX-450992821 CDM 99282 CPT 0450 RC outpatient 389.58 389.58 353 353 case rate 389.58 93 315.56 percent of total billed charges 389.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 166.76 other OPPS APC 389.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 166.76 other OPPS APC 199.69 199.69 case rate 199.69 389.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC ER Level III PX-450992831 CDM 99283 CPT 0450 RC outpatient 679.63 679.63 755 755 case rate 679.63 93 550.5 percent of total billed charges 679.63 679.63 other OPPS APC 679.63 679.63 other OPPS APC 199.69 199.69 case rate 199.69 755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC ER Level IV PX-450992841 CDM 99284 CPT 0450 RC outpatient 1055 1055 1839 1839 case rate 1055 93 854.55 percent of total billed charges 1055 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 451.6 other OPPS APC 1055 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 451.6 other OPPS APC 232.88 232.88 case rate 232.88 1839 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC ER Level V PX-450992851 CDM 99285 CPT 0450 RC outpatient 1529.98 1529.98 2751 2751 case rate 1529.98 93 1239.28 percent of total billed charges 1529.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 654.91 other OPPS APC 1529.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 654.91 other OPPS APC 199.69 199.69 case rate 199.69 2751 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Critical Care 30-74 Mins PX-450992911 CDM 99291 CPT 0450 RC outpatient 2113.7 2113.7 1839 1839 case rate 2113.7 93 1712.1 percent of total billed charges 2113.7 2113.7 other OPPS APC 2113.7 2113.7 other OPPS APC 199.69 199.69 case rate 199.69 2113.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Critical Care, Addl 30 Min" PX-450992921 CDM 99292 CPT 0450 RC outpatient 311 311 2751 2751 case rate 311 93 251.91 percent of total billed charges 311 311 other OPPS APC 311 311 other OPPS APC 199.69 199.69 case rate 199.69 2751 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC ER-Screening PX-451992811 CDM 99281 CPT 0450 RC outpatient 211.48 64 64 case rate 211.48 93 171.3 percent of total billed charges 211.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 90.52 other OPPS APC 211.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 90.52 other OPPS APC 199.69 199.69 case rate 64 211.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC ER-Screening PX-451992811 CDM 99281 CPT 0451 RC outpatient 211.48 211.48 64 64 case rate 211.48 93 171.3 percent of total billed charges 211.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 90.52 other OPPS APC 211.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 90.52 other OPPS APC 199.69 199.69 case rate 64 211.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC ER-Intermediate Visit PX-452992820 CDM 99282 CPT 0450 RC outpatient 389.58 353 353 case rate 389.58 93 315.56 percent of total billed charges 389.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 166.76 other OPPS APC 389.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 166.76 other OPPS APC 199.69 199.69 case rate 199.69 389.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC ER-Intermediate Visit PX-452992820 CDM 99282 CPT 0452 RC outpatient 389.58 389.58 353 353 case rate 389.58 93 315.56 percent of total billed charges 389.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 166.76 other OPPS APC 389.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 166.76 other OPPS APC 199.69 199.69 case rate 199.69 389.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC ER-Extended Visit PX-452992830 CDM 99283 CPT 0450 RC outpatient 679.63 755 755 case rate 679.63 93 550.5 percent of total billed charges 679.63 679.63 other OPPS APC 679.63 679.63 other OPPS APC 199.69 199.69 case rate 199.69 755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC ER-Extended Visit PX-452992830 CDM 99283 CPT 0452 RC outpatient 679.63 679.63 755 755 case rate 679.63 93 550.5 percent of total billed charges 679.63 679.63 other OPPS APC 679.63 679.63 other OPPS APC 199.69 199.69 case rate 199.69 755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC ER-Intensive Visit PX-452992840 CDM 99284 CPT 0450 RC outpatient 1055 1839 1839 case rate 1055 93 854.55 percent of total billed charges 1055 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 451.6 other OPPS APC 1055 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 451.6 other OPPS APC 232.88 232.88 case rate 232.88 1839 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC ER-Intensive Visit PX-452992840 CDM 99284 CPT 0452 RC outpatient 1055 1055 1839 1839 case rate 1055 93 854.55 percent of total billed charges 1055 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 451.6 other OPPS APC 1055 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 451.6 other OPPS APC 232.88 232.88 case rate 232.88 1839 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC ER-Comprehensive Visit PX-452992850 CDM 99285 CPT 0450 RC outpatient 1529.98 2751 2751 case rate 1529.98 93 1239.28 percent of total billed charges 1529.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 654.91 other OPPS APC 1529.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 654.91 other OPPS APC 199.69 199.69 case rate 199.69 2751 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC ER-Comprehensive Visit PX-452992850 CDM 99285 CPT 0452 RC outpatient 1529.98 1529.98 2751 2751 case rate 1529.98 93 1239.28 percent of total billed charges 1529.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 654.91 other OPPS APC 1529.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 654.91 other OPPS APC 199.69 199.69 case rate 199.69 2751 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Rt Blood Gas Puncture PX-460366000 CDM 36600 CPT 0460 RC outpatient 304.28 304.28 304.28 74 225.17 percent of total billed charges 304.28 93 246.47 percent of total billed charges 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 51 155.18 percent of total billed charges 304.28 304.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Screening Spirometry PX-460940101 CDM 94010 CPT 0460 RC outpatient 372.08 372.08 90.81 90.81 fee schedule 372.08 93 301.38 percent of total billed charges 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 51 189.76 percent of total billed charges 90.81 372.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Incentive Spirometry Initial PX-460940102 CDM 94010 CPT 0460 RC outpatient 372.08 372.08 90.81 90.81 fee schedule 372.08 93 301.38 percent of total billed charges 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 51 189.76 percent of total billed charges 90.81 372.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Incentive Spirometry Subsequent PX-460940103 CDM 94010 CPT 0460 RC outpatient 372.08 372.08 90.81 90.81 fee schedule 372.08 93 301.38 percent of total billed charges 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 51 189.76 percent of total billed charges 90.81 372.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Simple Spirometry PX-460940104 CDM 94010 CPT 0460 RC outpatient 372.08 372.08 90.81 90.81 fee schedule 372.08 93 301.38 percent of total billed charges 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 51 189.76 percent of total billed charges 90.81 372.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Screening Spiro. C Bd PX-460940600 CDM 94060 CPT 0460 RC outpatient 747.65 747.65 150.5 150.5 fee schedule 747.65 93 605.6 percent of total billed charges 747.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 320.04 other OPPS APC 747.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 320.04 other OPPS APC 747.65 51 381.3 percent of total billed charges 150.5 747.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Eval Bronchospasm W/ Methacholine PX-460940701 CDM 94070 CPT 0460 RC outpatient 747.65 747.65 155.64 155.64 fee schedule 747.65 93 605.6 percent of total billed charges 747.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 320.04 other OPPS APC 747.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 320.04 other OPPS APC 747.65 51 381.3 percent of total billed charges 155.64 747.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vital Capacity PX-460941500 CDM 94150 CPT 0460 RC outpatient 372.07 372.07 62.94 62.94 fee schedule 372.07 93 301.38 percent of total billed charges 372.07 372.07 other OPPS APC 372.07 372.07 other OPPS APC 372.07 51 189.76 percent of total billed charges 62.94 372.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Maximum Volume Vent PX-460942000 CDM 94200 CPT 0460 RC outpatient 145.7 145.7 60.35 60.35 fee schedule 145.7 93 118.02 percent of total billed charges 145.7 145.7 other OPPS APC 145.7 145.7 other OPPS APC 145.7 51 74.31 percent of total billed charges 60.35 145.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pulmonary Stress Testing Simple PX-460946201 CDM 94618 CPT 0460 RC outpatient 304.28 304.28 339.84 339.84 fee schedule 304.28 93 246.47 percent of total billed charges 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 51 155.18 percent of total billed charges 304.28 339.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pulmonary Stress Testing PX-460946204 CDM 94618 CPT 0460 RC outpatient 304.28 304.28 339.84 339.84 fee schedule 304.28 93 246.47 percent of total billed charges 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 51 155.18 percent of total billed charges 304.28 339.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pulmonary Stress Test PX-460946211 CDM 94621 CPT 0460 RC outpatient 747.65 747.65 198.43 198.43 fee schedule 747.65 93 605.6 percent of total billed charges 747.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 320.04 other OPPS APC 747.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 320.04 other OPPS APC 747.65 51 381.3 percent of total billed charges 198.43 747.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Demonstration of Nebulazation PX-460946640 CDM 94664 CPT 0460 RC outpatient 508.05 508.05 41.87 41.87 fee schedule 508.05 93 411.52 percent of total billed charges 508.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 217.47 other OPPS APC 508.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 217.47 other OPPS APC 508.05 51 259.11 percent of total billed charges 41.87 508.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Gas Dilution or Washout PX-460947271 CDM 94727 CPT 0460 RC outpatient 372.08 372.08 110.64 110.64 fee schedule 372.08 93 301.38 percent of total billed charges 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 51 189.76 percent of total billed charges 110.64 372.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Diffusion/Volume PX-460947290 CDM 94729 CPT 0460 RC outpatient 183 183 349.56 349.56 fee schedule 183 93 148.23 percent of total billed charges 183 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 183 other OPPS APC 183 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 183 other OPPS APC 183 51 93.33 percent of total billed charges 183 349.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pf Pulse Ox PX-460947600 CDM 94760 CPT 0460 RC outpatient 40 40 5.97 5.97 fee schedule 40 93 32.4 percent of total billed charges 40 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40 other OPPS APC 40 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40 other OPPS APC 40 51 20.4 percent of total billed charges 5.97 40 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pulse Oximetry PX-460947601 CDM 94760 CPT 0460 RC outpatient 40 40 5.97 5.97 fee schedule 40 93 32.4 percent of total billed charges 40 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40 other OPPS APC 40 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40 other OPPS APC 40 51 20.4 percent of total billed charges 5.97 40 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pulse Oximetry Multiple Readings PX-460947612 CDM 94761 CPT 0460 RC outpatient 117 117 12.53 12.53 fee schedule 117 93 94.77 percent of total billed charges 117 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 117 other OPPS APC 117 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 117 other OPPS APC 117 51 59.67 percent of total billed charges 12.53 117 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Aep Scr Auditory Potential W/Stimuli Auto Alysl PX-471926500 CDM 92650 CPT 0471 RC outpatient 275.18 275.18 211.48 211.48 fee schedule 275.18 93 222.9 percent of total billed charges 275.18 275.18 other OPPS APC 275.18 275.18 other OPPS APC 275.18 51 140.34 percent of total billed charges 211.48 275.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ek Cardioversion PX-480929600 CDM 92960 CPT 0480 RC outpatient 1550.25 1550.25 899.47 899.47 fee schedule 1550.25 93 1255.7 percent of total billed charges 1550.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 663.59 other OPPS APC 1550.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 663.59 other OPPS APC 1550.25 51 790.63 percent of total billed charges 899.47 1550.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ec Echo 2d-M Doppler/Color PX-480933060 CDM 93306 CPT 0480 RC outpatient 1314.08 1314.08 744.46 744.46 fee schedule 1314.08 93 1064.4 percent of total billed charges 1314.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 562.5 other OPPS APC 1314.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 562.5 other OPPS APC 1314.08 51 670.18 percent of total billed charges 744.46 1314.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Echo 2d Limited/Follow-Up PX-480933080 CDM 93308 CPT 0480 RC outpatient 583.68 583.68 293.35 293.35 fee schedule 583.68 93 472.78 percent of total billed charges 583.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 583.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 583.68 51 297.68 percent of total billed charges 293.35 583.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tee Probe Placement Only PX-480933130 CDM 93313 CPT 0480 RC outpatient 1314.08 1314.08 116.8 116.8 fee schedule 1314.08 93 1064.4 percent of total billed charges 1314.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 562.5 other OPPS APC 1314.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 562.5 other OPPS APC 1314.08 51 670.18 percent of total billed charges 116.8 1314.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cardiac Doppler Follow-Up PX-480933210 CDM 93321 CPT 0480 RC outpatient 304 304 147.92 147.92 fee schedule 304 93 246.24 percent of total billed charges 304 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 304 other OPPS APC 304 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 304 other OPPS APC 304 51 155.04 percent of total billed charges 147.92 304 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Doppler Color Flow PX-480933250 CDM 93325 CPT 0480 RC outpatient 280 280 341.35 341.35 fee schedule 280 93 226.8 percent of total billed charges 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 51 142.8 percent of total billed charges 280 341.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ek Tilt Table 45 Min or Less PX-480936600 CDM 93660 CPT 0480 RC outpatient 1276.7 1276.7 262.24 262.24 fee schedule 1276.7 93 1034.13 percent of total billed charges 1276.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 546.5 other OPPS APC 1276.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 546.5 other OPPS APC 1276.7 51 651.12 percent of total billed charges 262.24 1276.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ek Tilt Table >45 Min PX-480936601 CDM 93660 CPT 0480 RC outpatient 1276.7 1276.7 262.24 262.24 fee schedule 1276.7 93 1034.13 percent of total billed charges 1276.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 546.5 other OPPS APC 1276.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 546.5 other OPPS APC 1276.7 51 651.12 percent of total billed charges 262.24 1276.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Pacemaker Insert Ventricular Lead PX-481332071 CDM 33207 CPT 0481 RC outpatient 25435.4 25435.4 25435.4 74 18822.2 percent of total billed charges 25435.4 93 20602.7 percent of total billed charges 25435.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10887.8 other OPPS APC 25435.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10887.8 other OPPS APC 25435.4 51 12972 percent of total billed charges 25435.4 25435.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Pacemaker Insertion Dual Lead PX-481332081 CDM 33208 CPT 0481 RC outpatient 25435.4 25435.4 25435.4 74 18822.2 percent of total billed charges 25435.4 93 20602.7 percent of total billed charges 25435.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10887.8 other OPPS APC 25435.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10887.8 other OPPS APC 25435.4 51 12972 percent of total billed charges 25435.4 25435.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Temporary Pacemaker Insertion PX-481332101 CDM 33210 CPT 0481 RC outpatient 20236.5 20236.5 20236.5 74 14975 percent of total billed charges 20236.5 93 16391.6 percent of total billed charges 20236.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8662.37 other OPPS APC 20236.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8662.37 other OPPS APC 20236.5 51 10320.6 percent of total billed charges 20236.5 20236.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pacemaker Leads Repostion Single Ch PX-481332151 CDM 33215 CPT 0481 RC outpatient 7592.53 7592.53 7592.53 74 5618.47 percent of total billed charges 7592.53 93 6149.95 percent of total billed charges 7592.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250.03 other OPPS APC 7592.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250.03 other OPPS APC 7592.53 51 3872.19 percent of total billed charges 7592.53 7592.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Pacemaker Pocket Revision PX-481332221 CDM 33222 CPT 0481 RC outpatient 4343.83 4343.83 4343.83 74 3214.43 percent of total billed charges 4343.83 93 3518.5 percent of total billed charges 4343.83 4343.83 other OPPS APC 4343.83 4343.83 other OPPS APC 4343.83 51 2215.35 percent of total billed charges 4343.83 4343.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Pacemaker Battery Change Single PX-481332271 CDM 33227 CPT 0481 RC outpatient 20236.5 20236.5 20236.5 74 14975 percent of total billed charges 20236.5 93 16391.6 percent of total billed charges 20236.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8662.37 other OPPS APC 20236.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8662.37 other OPPS APC 20236.5 51 10320.6 percent of total billed charges 20236.5 20236.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Pacemaker Battery Change Dual PX-481332281 CDM 33228 CPT 0481 RC outpatient 25435.4 25435.4 25435.4 74 18822.2 percent of total billed charges 25435.4 93 20602.7 percent of total billed charges 25435.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10887.8 other OPPS APC 25435.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10887.8 other OPPS APC 25435.4 51 12972 percent of total billed charges 25435.4 25435.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Loop Recorder Insertion PX-481332851 CDM 33285 CPT 0481 RC outpatient 20236.5 20236.5 20236.5 74 14975 percent of total billed charges 20236.5 93 16391.6 percent of total billed charges 20236.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8662.37 other OPPS APC 20236.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8662.37 other OPPS APC 20236.5 51 10320.6 percent of total billed charges 20236.5 20236.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Loop Recorder Removal PX-481332861 CDM 33286 CPT 0481 RC outpatient 2000 2000 2000 74 1480 percent of total billed charges 2000 93 1620 percent of total billed charges 2000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 717.38 other OPPS APC 2000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 717.38 other OPPS APC 2000 51 1020 percent of total billed charges 2000 2000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Perc Ins of Balloon Pump PX-481339671 CDM 33967 CPT 0481 RC outpatient 2684 2684 2684 74 1986.16 percent of total billed charges 2684 93 2174.04 percent of total billed charges 2684 2684 other OPPS APC 2684 2684 other OPPS APC 2684 51 1368.84 percent of total billed charges 2684 2684 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Coronary Angioplasty Major Branch PX-481929201 CDM 92920 CPT 0481 RC outpatient 13614.6 13614.6 1377.89 1377.89 fee schedule 13614.6 93 11027.8 percent of total billed charges 13614.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5827.81 other OPPS APC 13614.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5827.81 other OPPS APC 13614.6 51 6943.45 percent of total billed charges 1377.89 13614.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Coronary Angioplasty Addl Branch PX-481929211 CDM 92921 CPT 0481 RC outpatient 6150 6150 97.33 97.33 fee schedule 6150 93 4981.5 percent of total billed charges 6150 6150 other OPPS APC 6150 6150 other OPPS APC 6150 51 3136.5 percent of total billed charges 97.33 6150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Coronary Stent Major Branch PX-481929281 CDM 92928 CPT 0481 RC outpatient 26204.5 26204.5 1573.91 1573.91 fee schedule 26204.5 93 21225.7 percent of total billed charges 26204.5 26204.5 other OPPS APC 26204.5 26204.5 other OPPS APC 26204.5 51 13364.3 percent of total billed charges 1573.91 26204.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Coronary Thombectomy PX-481929731 CDM 92973 CPT 0481 RC outpatient 6763 6763 6763 74 5004.62 percent of total billed charges 6763 93 5478.03 percent of total billed charges 6763 6763 other OPPS APC 6763 6763 other OPPS APC 6763 51 3449.13 percent of total billed charges 6763 6763 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Ivus Initial Vessel PX-481929781 CDM 92978 CPT 0481 RC outpatient 300 300 763.11 763.11 fee schedule 300 93 243 percent of total billed charges 300 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 300 other OPPS APC 300 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 300 other OPPS APC 300 51 153 percent of total billed charges 300 763.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Ivus Additional Vessel PX-481929791 CDM 92979 CPT 0481 RC outpatient 150 150 458.76 458.76 fee schedule 150 93 121.5 percent of total billed charges 150 150 other OPPS APC 150 150 other OPPS APC 150 51 76.5 percent of total billed charges 150 458.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ep Echo Transesophageal (Tee) PX-481933550 CDM 93355 CPT 0481 RC outpatient 1904 1904 1904 74 1408.96 percent of total billed charges 1904 93 1542.24 percent of total billed charges 1904 1904 other OPPS APC 1904 1904 other OPPS APC 1904 51 971.04 percent of total billed charges 1904 1904 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Right Heart Cath PX-481934511 CDM 93451 CPT 0481 RC outpatient 7761.83 7761.83 2337.84 2337.84 fee schedule 7761.83 93 6287.08 percent of total billed charges 7761.83 7761.83 other OPPS APC 7761.83 7761.83 other OPPS APC 7761.83 51 3958.53 percent of total billed charges 2337.84 7761.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Lh W/Lv PX-481934521 CDM 93452 CPT 0481 RC outpatient 7761.83 7761.83 6353.97 6353.97 fee schedule 7761.83 93 6287.08 percent of total billed charges 7761.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3322.5 other OPPS APC 7761.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3322.5 other OPPS APC 7761.83 51 3958.53 percent of total billed charges 6353.97 7761.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Coronary Only PX-481934541 CDM 93454 CPT 0481 RC outpatient 7761.83 7761.83 2046.8 2046.8 fee schedule 7761.83 93 6287.08 percent of total billed charges 7761.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3322.5 other OPPS APC 7761.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3322.5 other OPPS APC 7761.83 51 3958.53 percent of total billed charges 2046.8 7761.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Coronary W/Bypass PX-481934551 CDM 93455 CPT 0481 RC outpatient 7813 7813 6551.9 6551.9 fee schedule 7813 93 6328.53 percent of total billed charges 7813 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3322.5 other OPPS APC 7813 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3322.5 other OPPS APC 7813 51 3984.63 percent of total billed charges 6551.9 7813 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Coronary W/Rh PX-481934561 CDM 93456 CPT 0481 RC outpatient 7761.83 7761.83 7921.06 7921.06 fee schedule 7761.83 93 6287.08 percent of total billed charges 7761.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3322.5 other OPPS APC 7761.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3322.5 other OPPS APC 7761.83 51 3958.53 percent of total billed charges 7761.83 7921.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Coronary W/Bypas W/Rh PX-481934571 CDM 93457 CPT 0481 RC outpatient 7813 7813 8245.23 8245.23 fee schedule 7813 93 6328.53 percent of total billed charges 7813 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3322.5 other OPPS APC 7813 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3322.5 other OPPS APC 7813 51 3984.63 percent of total billed charges 7813 8245.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Coronary W/Lh W/Lv PX-481934581 CDM 93458 CPT 0481 RC outpatient 7793 7793 12986.1 12986.1 fee schedule 7793 93 6312.33 percent of total billed charges 7793 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3322.5 other OPPS APC 7793 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3322.5 other OPPS APC 7793 51 3974.43 percent of total billed charges 7793 12986.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Cornary W/Lh W/Lv W/Bypass PX-481934591 CDM 93459 CPT 0481 RC outpatient 7927 7927 6831 6831 fee schedule 7927 93 6420.87 percent of total billed charges 7927 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3322.5 other OPPS APC 7927 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3322.5 other OPPS APC 7927 51 4042.77 percent of total billed charges 6831 7927 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Cornary W/L&R W/Lv PX-481934601 CDM 93460 CPT 0481 RC outpatient 7793 7793 7652.39 7652.39 fee schedule 7793 93 6312.33 percent of total billed charges 7793 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3322.5 other OPPS APC 7793 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3322.5 other OPPS APC 7793 51 3974.43 percent of total billed charges 7652.39 7793 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Cornary W/L&R W/Lv W/Bypass PX-481934611 CDM 93461 CPT 0481 RC outpatient 7927 7927 7855.21 7855.21 fee schedule 7927 93 6420.87 percent of total billed charges 7927 7927 other OPPS APC 7927 7927 other OPPS APC 7927 51 4042.77 percent of total billed charges 7855.21 7927 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Aortic Angiography PX-481935671 CDM 93567 CPT 0481 RC outpatient 34 34 35.09 35.09 fee schedule 34 93 27.54 percent of total billed charges 34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34 other OPPS APC 34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34 other OPPS APC 34 51 17.34 percent of total billed charges 34 35.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Intravascular Dopler Initial Vessel PX-481935711 CDM 93571 CPT 0481 RC outpatient 300 300 759.85 759.85 fee schedule 300 93 243 percent of total billed charges 300 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 300 other OPPS APC 300 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 300 other OPPS APC 300 51 153 percent of total billed charges 300 759.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Intravascular Dopler Addl Vessel PX-481935721 CDM 93572 CPT 0481 RC outpatient 150 150 451.44 451.44 fee schedule 150 93 121.5 percent of total billed charges 150 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 150 other OPPS APC 150 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 150 other OPPS APC 150 51 76.5 percent of total billed charges 150 451.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ep Intra-Ventric&/Atrial Mapg Tachycard W/Cath MA PX-481936090 CDM 93609 CPT 0481 RC outpatient 2750 2750 1015.79 1015.79 fee schedule 2750 93 2227.5 percent of total billed charges 2750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2750 other OPPS APC 2750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2750 other OPPS APC 2750 51 1402.5 percent of total billed charges 1015.79 2750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ep Study W/O Arrythmia Induction PX-481936190 CDM 93619 CPT 0481 RC outpatient 17789 17789 1920.12 1920.12 fee schedule 17789 93 14409.1 percent of total billed charges 17789 17789 other OPPS APC 17789 17789 other OPPS APC 17789 51 9072.42 percent of total billed charges 1920.12 17789 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ep W/Attempted Arrythmia Induction PX-481936200 CDM 93620 CPT 0481 RC outpatient 17789 17789 1026.77 1026.77 fee schedule 17789 93 14409.1 percent of total billed charges 17789 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7614.71 other OPPS APC 17789 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7614.71 other OPPS APC 17789 51 9072.42 percent of total billed charges 1026.77 17789 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Stimulation Pacing Heart PX-481936230 CDM 93623 CPT 0481 RC outpatient 3506 3506 3506 74 2594.44 percent of total billed charges 3506 93 2839.86 percent of total billed charges 3506 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3506 other OPPS APC 3506 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3506 other OPPS APC 3506 51 1788.06 percent of total billed charges 3506 3506 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ep Dft/Nips Post Implant PX-481936240 CDM 93624 CPT 0481 RC outpatient 17789 17789 924.06 924.06 fee schedule 17789 93 14409.1 percent of total billed charges 17789 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7614.71 other OPPS APC 17789 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7614.71 other OPPS APC 17789 51 9072.42 percent of total billed charges 924.06 17789 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ep Icd/Dft at Time of Implant PX-481936410 CDM 93641 CPT 0481 RC outpatient 2427.75 2427.75 1631 1631 fee schedule 2427.75 93 1966.48 percent of total billed charges 2427.75 2427.75 other OPPS APC 2427.75 2427.75 other OPPS APC 2427.75 51 1238.15 percent of total billed charges 1631 2427.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ep Ablate Heart Dysrhythm Focus PX-481936500 CDM 93650 CPT 0481 RC outpatient 17789 17789 1523.26 1523.26 fee schedule 17789 93 14409.1 percent of total billed charges 17789 17789 other OPPS APC 17789 17789 other OPPS APC 17789 51 9072.42 percent of total billed charges 1523.26 17789 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ep Compre Ep Eval Abltj 3d Mapg Tx Svt PX-481936530 CDM 93653 CPT 0481 RC outpatient 58703.2 58703.2 22985.2 22985.2 fee schedule 58703.2 93 47549.6 percent of total billed charges 58703.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24216.4 other OPPS APC 58703.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24216.4 other OPPS APC 58703.2 51 29938.6 percent of total billed charges 22985.2 58703.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ep Compre Ep Eval Abltj 3d Mapg Tx Vt PX-481936540 CDM 93654 CPT 0481 RC outpatient 58703.2 58703.2 22985.2 22985.2 fee schedule 58703.2 93 47549.6 percent of total billed charges 58703.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24216.4 other OPPS APC 58703.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24216.4 other OPPS APC 58703.2 51 29938.6 percent of total billed charges 22985.2 58703.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ep Icar Catheter Ablation Arrhythmia Add On PX-481936550 CDM 93655 CPT 0481 RC outpatient 6450.99 6450.99 22985.2 22985.2 fee schedule 6450.99 93 5225.3 percent of total billed charges 6450.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6450.99 other OPPS APC 6450.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6450.99 other OPPS APC 6450.99 51 3290 percent of total billed charges 6450.99 22985.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ep Compre Ep Eval Abltj Atr Fib Pulm Vein Isolation PX-481936560 CDM 93656 CPT 0481 RC outpatient 58703.2 58703.2 22985.2 22985.2 fee schedule 58703.2 93 47549.6 percent of total billed charges 58703.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24216.4 other OPPS APC 58703.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24216.4 other OPPS APC 58703.2 51 29938.6 percent of total billed charges 22985.2 58703.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ep Ablate L/R Atrial Fibril W/Isolated Pulm Vein PX-481936570 CDM 93657 CPT 0481 RC outpatient 6632 6632 22985.2 22985.2 fee schedule 6632 93 5371.92 percent of total billed charges 6632 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6632 other OPPS APC 6632 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6632 other OPPS APC 6632 51 3382.32 percent of total billed charges 6632 22985.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ep Intracard Echocard W/Ther/Dx Ivntj Incl Img S&I PX-481936620 CDM 93662 CPT 0481 RC outpatient 3300 3300 390.08 390.08 fee schedule 3300 93 2673 percent of total billed charges 3300 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3300 other OPPS APC 3300 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3300 other OPPS APC 3300 51 1683 percent of total billed charges 390.08 3300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Coronary Stent Major Branch - Des PX-481C96001 CDM C9600 CPT 0481 RC outpatient 26204.5 26204.5 1573.91 1573.91 fee schedule 26204.5 93 21225.7 percent of total billed charges 26204.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11217 other OPPS APC 26204.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11217 other OPPS APC 26204.5 51 13364.3 percent of total billed charges 1573.91 26204.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Coronary Stent Addl Branch - Des PX-481C96011 CDM C9601 CPT 0481 RC outpatient 9658 9658 63.72 63.72 fee schedule 9658 93 7822.98 percent of total billed charges 9658 9658 other OPPS APC 9658 9658 other OPPS APC 9658 51 4925.58 percent of total billed charges 63.72 9658 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Coronary Ather/ Stent Major Brnch-Des PX-481C96021 CDM C9602 CPT 0481 RC outpatient 41768.3 41768.3 1812.98 1812.98 fee schedule 41768.3 93 33832.3 percent of total billed charges 41768.3 41768.3 other OPPS APC 41768.3 41768.3 other OPPS APC 41768.3 51 21301.8 percent of total billed charges 1812.98 41768.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Coronary Ather & Stent Addl Brnch-Des PX-481C96031 CDM C9603 CPT 0481 RC outpatient 9658 9658 19.47 19.47 fee schedule 9658 93 7822.98 percent of total billed charges 9658 9658 other OPPS APC 9658 9658 other OPPS APC 9658 51 4925.58 percent of total billed charges 19.47 9658 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Coronary Bypass Graft Major Brnch-Des PX-481C96041 CDM C9604 CPT 0481 RC outpatient 26204.5 26204.5 1573.91 1573.91 fee schedule 26204.5 93 21225.7 percent of total billed charges 26204.5 26204.5 other OPPS APC 26204.5 26204.5 other OPPS APC 26204.5 51 13364.3 percent of total billed charges 1573.91 26204.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Coronary Bypass Graft Addl Branch-Des PX-481C96051 CDM C9605 CPT 0481 RC outpatient 9658 9658 62.82 62.82 fee schedule 9658 93 7822.98 percent of total billed charges 9658 9658 other OPPS APC 9658 9658 other OPPS APC 9658 51 4925.58 percent of total billed charges 62.82 9658 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Coronary Pci in Ami (Stemi) - Des PX-481C96061 CDM C9606 CPT 0481 RC outpatient 15035 15035 1814.93 1814.93 fee schedule 15035 93 12178.4 percent of total billed charges 15035 15035 other OPPS APC 15035 15035 other OPPS APC 15035 51 7667.85 percent of total billed charges 1814.93 15035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Coronary Pci in Cto Major - Des PX-481C96071 CDM C9607 CPT 0481 RC outpatient 41768.3 41768.3 1814.93 1814.93 fee schedule 41768.3 93 33832.3 percent of total billed charges 41768.3 41768.3 other OPPS APC 41768.3 41768.3 other OPPS APC 41768.3 51 21301.8 percent of total billed charges 1814.93 41768.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cc Coronary Pci in Cto Addl Branch - Des PX-481C96081 CDM C9608 CPT 0481 RC outpatient 9658 9658 21.24 21.24 fee schedule 9658 93 7822.98 percent of total billed charges 9658 9658 other OPPS APC 9658 9658 other OPPS APC 9658 51 4925.58 percent of total billed charges 21.24 9658 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vascular Closure Device Insertion PX-481G02691 CDM G0269 HCPCS 0481 RC outpatient 355 355 355 74 262.7 percent of total billed charges 355 93 287.55 percent of total billed charges 355 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 355 other OPPS APC 355 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 355 other OPPS APC 355 51 181.05 percent of total billed charges 355 355 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Exer Tolerance Test PX-482930170 CDM 93017 CPT 0482 RC outpatient 817 817 190.62 190.62 fee schedule 817 93 661.77 percent of total billed charges 817 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 320.04 other OPPS APC 817 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 320.04 other OPPS APC 817 51 416.67 percent of total billed charges 190.62 817 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Transesophageal Echo PX-483933120 CDM 93312 CPT 0483 RC outpatient 1314.08 1314.08 730.8 730.8 fee schedule 1314.08 93 1064.4 percent of total billed charges 1314.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 562.5 other OPPS APC 1314.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 562.5 other OPPS APC 1314.08 51 670.18 percent of total billed charges 730.8 1314.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Stress/Pharmacological Echo PX-483933500 CDM 93350 CPT 0483 RC outpatient 1314.08 1314.08 405.5 405.5 fee schedule 1314.08 93 1064.4 percent of total billed charges 1314.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 562.5 other OPPS APC 1314.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 562.5 other OPPS APC 1314.08 51 670.18 percent of total billed charges 405.5 1314.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Stress Echo W/Ecg Monitoring PX-483933511 CDM 93351 CPT 0483 RC outpatient 1314.08 1314.08 700.9 700.9 fee schedule 1314.08 93 1064.4 percent of total billed charges 1314.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 562.5 other OPPS APC 1314.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 562.5 other OPPS APC 1314.08 51 670.18 percent of total billed charges 700.9 1314.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. I & D Abscess PX-510100601 CDM 10060 CPT 0510 RC outpatient 476.88 476.88 102 102 case rate 476.88 93 386.27 percent of total billed charges 476.88 476.88 other OPPS APC 476.88 476.88 other OPPS APC 173.05 173.05 case rate 102 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Epistaxis Control:Simple PX-510309011 CDM 30901 CPT 0510 RC outpatient 438 438 102 102 case rate 438 93 354.78 percent of total billed charges 438 438 other OPPS APC 438 438 other OPPS APC 173.05 173.05 case rate 102 438 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Epistaxis Control:Complex PX-510309031 CDM 30903 CPT 0510 RC outpatient 405 405 102 102 case rate 405 93 328.05 percent of total billed charges 405 405 other OPPS APC 405 405 other OPPS APC 173.05 173.05 case rate 102 405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Laryngoscopy, Flexible Fiberoptic; Diagn" PX-510315751 CDM 31575 CPT 0510 RC outpatient 471.83 471.83 102 102 case rate 471.83 93 382.18 percent of total billed charges 471.83 471.83 other OPPS APC 471.83 471.83 other OPPS APC 173.05 173.05 case rate 102 471.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Coll of Blood Venous Access Dev PX-510365910 CDM 36591 CPT 0510 RC outpatient 304.28 304.28 102 102 case rate 304.28 93 246.47 percent of total billed charges 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 173.05 173.05 case rate 102 304.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Declot Thrombo Agent Dev/Catheter PX-510365930 CDM 36593 CPT 0510 RC outpatient 806.7 806.7 102 102 case rate 806.7 93 653.43 percent of total billed charges 806.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 345.31 other OPPS APC 806.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 345.31 other OPPS APC 173.05 173.05 case rate 102 806.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Removal of Foreign Body (Eye) PX-510652051 CDM 65205 CPT 0510 RC outpatient 516 516 102 102 case rate 516 93 417.96 percent of total billed charges 516 516 other OPPS APC 516 516 other OPPS APC 173.05 173.05 case rate 102 516 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Remove Impacted Cerument (Single Side) PX-510692101 CDM 69210 CPT 0510 RC outpatient 145.7 145.7 102 102 case rate 145.7 93 118.02 percent of total billed charges 145.7 145.7 other OPPS APC 145.7 145.7 other OPPS APC 173.05 173.05 case rate 102 173.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Immun Admin W/ Counseling PX-510904601 CDM 90460 CPT 0510 RC outpatient 31 31 31 74 22.94 percent of total billed charges 31 93 25.11 percent of total billed charges 22.52 22.52 fee schedule 22.52 22.52 fee schedule OPPS APC 31 31 case rate 22.52 31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Ea Addt'l Vaccine W/ Counseling PX-510904611 CDM 90461 CPT 0510 RC outpatient 24 24 24 74 17.76 percent of total billed charges 24 93 19.44 percent of total billed charges 8.53 8.53 fee schedule 8.53 8.53 fee schedule OPPS APC 24 24 case rate 8.53 24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MC Immunization Ea Add PX-510904729 CDM 90472 CPT 0510 RC outpatient 70 70 102 102 case rate 70 93 56.7 percent of total billed charges 70 70 other OPPS APC 70 70 other OPPS APC 173.05 173.05 case rate 70 173.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MMR PX-510907071 CDM 90707 CPT 0510 RC outpatient 91 91 102 102 case rate 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 173.05 173.05 case rate 91 173.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Individ Psych W. Eval & Mgnt 30 Mins (16-37) Mins PX-510908331 CDM 90833 CPT 0510 RC outpatient 129 129 395.54 395.54 fee schedule 129 93 104.49 percent of total billed charges 129 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 129 other OPPS APC 129 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 129 other OPPS APC 129 129 case rate 129 395.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Individ Pscyh W/ Eval & Mgnt 45 Mins (38-52) Mins PX-510908361 CDM 90836 CPT 0510 RC outpatient 164 164 395.54 395.54 fee schedule 164 93 132.84 percent of total billed charges 164 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 164 other OPPS APC 164 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 164 other OPPS APC 164 164 case rate 164 395.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Individ Psych W/ Eval & Mgnt 60 Mins (53+) Mins PX-510908381 CDM 90838 CPT 0510 RC outpatient 216 216 102 102 case rate 216 93 174.96 percent of total billed charges 216 216 other OPPS APC 216 216 other OPPS APC 173.05 173.05 case rate 102 216 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Fluorescein Stain PX-510922301 CDM 92230 CPT 0510 RC outpatient 1276.7 1276.7 102 102 case rate 1276.7 93 1034.13 percent of total billed charges 1276.7 1276.7 other OPPS APC 1276.7 1276.7 other OPPS APC 173.05 173.05 case rate 102 1276.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Audiometry PX-510925511 CDM 92551 CPT 0510 RC outpatient 20 20 102 102 case rate 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 173.05 173.05 case rate 20 173.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Nebulizer Treatment PX-510946401 CDM 94640 CPT 0510 RC outpatient 508.05 508.05 102 102 case rate 508.05 93 411.52 percent of total billed charges 508.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 217.47 other OPPS APC 508.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 217.47 other OPPS APC 173.05 173.05 case rate 102 508.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. One Allergy Injection PX-510951151 CDM 95115 CPT 0510 RC outpatient 113.15 113.15 102 102 case rate 113.15 93 91.65 percent of total billed charges 113.15 113.15 other OPPS APC 113.15 113.15 other OPPS APC 173.05 173.05 case rate 102 173.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Multi Allergy Injection PX-510951171 CDM 95117 CPT 0510 RC outpatient 113.15 113.15 102 102 case rate 113.15 93 91.65 percent of total billed charges 113.15 113.15 other OPPS APC 113.15 113.15 other OPPS APC 173.05 173.05 case rate 102 173.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Brief Emotional/Behavioral Assessment PX-510961271 CDM 96127 CPT 0510 RC outpatient 95.53 95.53 95.53 74 70.69 percent of total billed charges 95.53 93 77.38 percent of total billed charges 95.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40.89 other OPPS APC 95.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40.89 other OPPS APC 95.53 95.53 fee schedule 95.53 95.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Admin Health Risk Assessment PX-510961601 CDM 96160 CPT 0510 RC outpatient 68.35 68.35 68.35 74 50.58 percent of total billed charges 68.35 93 55.36 percent of total billed charges 68.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.26 other OPPS APC 68.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.26 other OPPS APC 68.35 68.35 fee schedule 68.35 68.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Injection - Sub Q or Im PX-510963720 CDM 96372 CPT 0510 RC outpatient 167.8 167.8 102 102 case rate 167.8 93 135.92 percent of total billed charges 167.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 167.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 173.05 173.05 case rate 102 173.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MC Med Nutr Ther Ind Initial PX-510978029 CDM 97802 CPT 0942 RC outpatient 89.23 89.23 102 102 case rate 89.23 93 72.28 percent of total billed charges 89.23 89.23 other OPPS APC 89.23 89.23 other OPPS APC 173.05 173.05 case rate 89.23 173.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC MC Med Nut Ther, Ind Re Asses" PX-510978039 CDM 97803 CPT 0942 RC outpatient 77.73 77.73 102 102 case rate 77.73 93 62.96 percent of total billed charges 77.73 77.73 other OPPS APC 77.73 77.73 other OPPS APC 173.05 173.05 case rate 77.73 173.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC MC Med Nut Ther, Group Re" PX-510978049 CDM 97804 CPT 0942 RC outpatient 40.93 40.93 102 102 case rate 40.93 93 33.15 percent of total billed charges 40.93 40.93 other OPPS APC 40.93 40.93 other OPPS APC 173.05 173.05 case rate 40.93 173.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Speciment Handling PX-510990001 CDM 99000 CPT 0510 RC outpatient 15 15 15 74 11.1 percent of total billed charges 15 93 12.15 percent of total billed charges 15 15 other OPPS APC 15 15 other OPPS APC 15 15 fee schedule 15 15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Visual Function Screening PX-510991721 CDM 99172 CPT 0510 RC outpatient 6 6 102 102 case rate 6 93 4.86 percent of total billed charges 6 6 other OPPS APC 6 6 other OPPS APC 173.05 173.05 case rate 6 173.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Snellen Screen PX-510991731 CDM 99173 CPT 0510 RC outpatient 35 35 7.1 7.1 fee schedule 35 93 28.35 percent of total billed charges 35 35 other OPPS APC 35 35 other OPPS APC 35 35 fee schedule 7.1 35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC OP Visit, New 0-10 Min" PX-510992010 CDM 99202 CPT 0510 RC outpatient 314.88 314.88 102 102 case rate 314.88 93 255.05 percent of total billed charges 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 173.05 173.05 case rate 102 314.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC OP Visit New 11-25 Min PX-510992020 CDM 99202 CPT 0510 RC outpatient 314.88 314.88 102 102 case rate 314.88 93 255.05 percent of total billed charges 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 173.05 173.05 case rate 102 314.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC New Pt Visit Level 2 PX-510992022 CDM 99202 HCPCS 0510 RC outpatient 314.88 314.88 102 102 case rate 314.88 93 255.05 percent of total billed charges 46.21 46.21 fee schedule 46.21 46.21 fee schedule OPPS APC 173.05 173.05 case rate 46.21 314.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC OP Visit New 26-45 Min PX-510992030 CDM 99203 CPT 0510 RC outpatient 314.88 314.88 102 102 case rate 314.88 93 255.05 percent of total billed charges 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 173.05 173.05 case rate 102 314.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC New Pt Visit Level 3 PX-510992032 CDM 99203 HCPCS 0510 RC outpatient 314.88 314.88 102 102 case rate 314.88 93 255.05 percent of total billed charges 79.92 79.92 fee schedule 79.92 79.92 fee schedule OPPS APC 173.05 173.05 case rate 79.92 314.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC OP Visit New 46-90 Min PX-510992040 CDM 99204 CPT 0510 RC outpatient 314.88 314.88 102 102 case rate 314.88 93 255.05 percent of total billed charges 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 173.05 173.05 case rate 102 314.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC New Pt Visit Level 4 PX-510992041 CDM 99204 HCPCS 0510 RC outpatient 314.88 314.88 102 102 case rate 314.88 93 255.05 percent of total billed charges 130.06 130.06 fee schedule 130.06 130.06 fee schedule OPPS APC 173.05 173.05 case rate 102 314.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC OP Visit New 90 Min or > PX-510992050 CDM 99205 CPT 0510 RC outpatient 314.88 314.88 102 102 case rate 314.88 93 255.05 percent of total billed charges 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 173.05 173.05 case rate 102 314.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC New Pt Visit Level 5 PX-510992051 CDM 99205 HCPCS 0510 RC outpatient 314.88 314.88 102 102 case rate 314.88 93 255.05 percent of total billed charges 176.89 176.89 fee schedule 176.89 176.89 fee schedule OPPS APC 173.05 173.05 case rate 102 314.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC OP Visit Est 0-10 Min PX-510992110 CDM 99211 CPT 0510 RC outpatient 314.88 314.88 102 102 case rate 314.88 93 255.05 percent of total billed charges 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 173.05 173.05 case rate 102 314.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ocp Visit 0-10 Min PX-510992113 CDM 99211 CPT 0510 RC outpatient 25 25 102 102 case rate 25 93 20.25 percent of total billed charges 25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 173.05 173.05 case rate 25 173.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC OP Visit Est 11-25 Min PX-510992120 CDM 99212 CPT 0510 RC outpatient 314.88 314.88 102 102 case rate 314.88 93 255.05 percent of total billed charges 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 173.05 173.05 case rate 102 314.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC OP Visit Est 26-45 Min PX-510992130 CDM 99213 CPT 0510 RC outpatient 314.88 314.88 102 102 case rate 314.88 93 255.05 percent of total billed charges 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 173.05 173.05 case rate 102 314.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC OP Visit Est 46-90 Min PX-510992140 CDM 99214 CPT 0510 RC outpatient 314.88 314.88 102 102 case rate 314.88 93 255.05 percent of total billed charges 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 173.05 173.05 case rate 102 314.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC OP Visit Est 90 Min or > PX-510992150 CDM 99215 CPT 0510 RC outpatient 314.88 314.88 102 102 case rate 314.88 93 255.05 percent of total billed charges 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 173.05 173.05 case rate 102 314.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MC Prolonged First Hour PX-510993549 CDM 99354 CPT 0510 RC outpatient 218 218 102 102 case rate 218 93 176.58 percent of total billed charges 218 218 other OPPS APC 218 218 other OPPS APC 173.05 173.05 case rate 102 218 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. New Pat: Age 12-17 Years PX-510993841 CDM 99384 CPT 0510 RC outpatient 201 201 201 74 148.74 percent of total billed charges 201 93 162.81 percent of total billed charges 201 201 other OPPS APC 201 201 other OPPS APC 201 201 case rate 201 201 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. New Pat: Age 18+ Years PX-510993851 CDM 99385 CPT 0510 RC outpatient 201 201 102 102 case rate 201 93 162.81 percent of total billed charges 201 201 other OPPS APC 201 201 other OPPS APC 173.05 173.05 case rate 102 201 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Est. Pat: 5-11 Years PX-510993931 CDM 99393 CPT 0510 RC outpatient 201 201 201 74 148.74 percent of total billed charges 201 93 162.81 percent of total billed charges 201 201 other OPPS APC 201 201 other OPPS APC 201 201 case rate 201 201 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Est. Pat: 12-17 Years PX-510993941 CDM 99394 CPT 0510 RC outpatient 175 175 175 74 129.5 percent of total billed charges 175 93 141.75 percent of total billed charges 175 175 other OPPS APC 175 175 other OPPS APC 175 175 case rate 175 175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Est. Pat: Age 18+Years PX-510993951 CDM 99395 CPT 0510 RC outpatient 201 201 201 74 148.74 percent of total billed charges 201 93 162.81 percent of total billed charges 201 201 other OPPS APC 201 201 other OPPS APC 201 201 case rate 201 201 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC 15 Min. Indiv PX-510994011 CDM 99401 CPT 0510 RC outpatient 84 84 84 74 62.16 percent of total billed charges 84 93 68.04 percent of total billed charges 84 84 other OPPS APC 84 84 other OPPS APC 173.05 173.05 case rate 84 173.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC 30 Min. Indiv PX-510994021 CDM 99402 CPT 0510 RC outpatient 144 144 144 74 106.56 percent of total billed charges 144 93 116.64 percent of total billed charges 144 144 other OPPS APC 144 144 other OPPS APC 144 144 case rate 144 144 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC 45 Min. Indiv PX-510994031 CDM 99403 CPT 0510 RC outpatient 201 201 201 74 148.74 percent of total billed charges 201 93 162.81 percent of total billed charges 201 201 other OPPS APC 201 201 other OPPS APC 201 201 case rate 201 201 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC 60 Min. Indiv PX-510994041 CDM 99404 CPT 0510 RC outpatient 185 185 102 102 case rate 185 93 149.85 percent of total billed charges 185 185 other OPPS APC 185 185 other OPPS APC 173.05 173.05 case rate 102 185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Subst Abuse Screen, 15-30mins" PX-510994081 CDM 99408 CPT 0510 RC outpatient 66 66 66 74 48.84 percent of total billed charges 66 93 53.46 percent of total billed charges 66 66 other OPPS APC 66 66 other OPPS APC 66 66 case rate 66 66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Subst Abuse Screen, > 30mins" PX-510994091 CDM 99409 CPT 0510 RC outpatient 123 123 102 102 case rate 123 93 99.63 percent of total billed charges 123 123 other OPPS APC 123 123 other OPPS APC 173.05 173.05 case rate 102 173.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC 30 Min. Group PX-510994111 CDM 99411 CPT 0510 RC outpatient 25 25 102 102 case rate 25 93 20.25 percent of total billed charges 25 25 other OPPS APC 25 25 other OPPS APC 173.05 173.05 case rate 25 173.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC 60 Min. Group PX-510994121 CDM 99412 CPT 0510 RC outpatient 50 50 102 102 case rate 50 93 40.5 percent of total billed charges 50 50 other OPPS APC 50 50 other OPPS APC 173.05 173.05 case rate 50 173.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Preventive Med Service PX-510994291 CDM 99429 CPT 0510 RC outpatient 215 215 102 102 case rate 215 93 174.15 percent of total billed charges 215 215 other OPPS APC 215 215 other OPPS APC 173.05 173.05 case rate 102 215 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Unlisted E/M Service PX-510994990 CDM 99499 CPT 0510 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 176 other OPPS APC 176 176 other OPPS APC 176 176 case rate 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Bh Counseling, per 15 Mins" PX-510H00041 CDM H0004 HCPCS 0510 RC outpatient 21 21 21 74 15.54 percent of total billed charges 21 93 17.01 percent of total billed charges 21 21 other OPPS APC 21 21 other OPPS APC 21 21 case rate 21 21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Crisis Intervention Srvc, per 15 Mins" PX-510H20111 CDM H2011 HCPCS 0510 RC outpatient 21 21 102 102 case rate 21 93 17.01 percent of total billed charges 21 21 other OPPS APC 21 21 other OPPS APC 173.05 173.05 case rate 21 173.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Clinic Service PX-510T10150 CDM T1015 HCPCS 0510 RC outpatient 206 206 206 74 152.44 percent of total billed charges 206 93 166.86 percent of total billed charges 206 206 other OPPS APC 206 206 other OPPS APC 206 206 case rate 206 206 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC MRI Orbit, Face, or Neck W/O" PX-610705400 CDM 70540 CPT 0610 RC outpatient 2145 2145 1258.89 1258.89 fee schedule 2145 93 1737.45 percent of total billed charges 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 165.31 165.31 fee schedule 165.31 2145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC MRI Orbit, Face, or Neck W" PX-610705420 CDM 70542 CPT 0610 RC outpatient 2307 2307 1510.86 1510.86 fee schedule 2307 93 1868.67 percent of total billed charges 2307 2307 other OPPS APC 2307 2307 other OPPS APC 195.18 195.18 fee schedule 195.18 2307 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC MRI Orbit, Face, or Neck W WO" PX-610705430 CDM 70543 CPT 0610 RC outpatient 2925 2925 2696.04 2696.04 fee schedule 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 241.63 241.63 fee schedule 241.63 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI-Chest PX-610715500 CDM 71550 CPT 0610 RC outpatient 2001 2001 1276.26 1276.26 fee schedule 2001 93 1620.81 percent of total billed charges 2001 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 2001 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 272.16 272.16 fee schedule 272.16 2001 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI-Chest W Contrast PX-610715510 CDM 71551 CPT 0610 RC outpatient 2307 2307 1528.23 1528.23 fee schedule 2307 93 1868.67 percent of total billed charges 2307 2307 other OPPS APC 2307 2307 other OPPS APC 295.55 295.55 fee schedule 295.55 2307 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI-Chest W/WO Contrast PX-610715520 CDM 71552 CPT 0610 RC outpatient 2731 2731 2696.33 2696.33 fee schedule 2731 93 2212.11 percent of total billed charges 2731 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 2731 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 369.59 369.59 fee schedule 369.59 2731 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI-Pelvis PX-610721950 CDM 72195 CPT 0610 RC outpatient 2145 2145 1276.99 1276.99 fee schedule 2145 93 1737.45 percent of total billed charges 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 162.71 162.71 fee schedule 162.71 2145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI-Pelvis W Contrast PX-610721960 CDM 72196 CPT 0610 RC outpatient 2001 2001 1528.23 1528.23 fee schedule 2001 93 1620.81 percent of total billed charges 2001 2001 other OPPS APC 2001 2001 other OPPS APC 190.3 190.3 fee schedule 190.3 2001 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI-Pelvis W/WO Contrast PX-610721970 CDM 72197 CPT 0610 RC outpatient 2925 2925 2713.93 2713.93 fee schedule 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 237.4 237.4 fee schedule 237.4 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI Upper Extrem WO Contrast PX-610732180 CDM 73218 CPT 0610 RC outpatient 2145 2145 1258.89 1258.89 fee schedule 2145 93 1737.45 percent of total billed charges 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 242.28 242.28 fee schedule 242.28 2145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI Upper Extrem W Contrast PX-610732190 CDM 73219 CPT 0610 RC outpatient 2307 2307 1511.82 1511.82 fee schedule 2307 93 1868.67 percent of total billed charges 2307 2307 other OPPS APC 2307 2307 other OPPS APC 258.19 258.19 fee schedule 258.19 2307 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI Upper Extrem W WO Contrast PX-610732200 CDM 73220 CPT 0610 RC outpatient 2001 2001 2696.04 2696.04 fee schedule 2001 93 1620.81 percent of total billed charges 2001 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 2001 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 312.76 312.76 fee schedule 312.76 2696.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI Upper Extrem Joint WO Cont PX-610732210 CDM 73221 CPT 0610 RC outpatient 2145 2145 1258.89 1258.89 fee schedule 2145 93 1737.45 percent of total billed charges 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 141.27 141.27 fee schedule 141.27 2145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI Upper Extrem Joint W Cont PX-610732220 CDM 73222 CPT 0610 RC outpatient 2307 2307 1510.86 1510.86 fee schedule 2307 93 1868.67 percent of total billed charges 2307 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 816.39 other OPPS APC 2307 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 816.39 other OPPS APC 239.68 239.68 fee schedule 239.68 2307 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI Upper Extrem Joint Wwo Cont PX-610732230 CDM 73223 CPT 0610 RC outpatient 2731 2731 2696.04 2696.04 fee schedule 2731 93 2212.11 percent of total billed charges 2731 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 2731 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 289.7 289.7 fee schedule 289.7 2731 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI Lower Extrem Joint Wwo Cont PX-610732730 CDM 73723 CPT 0610 RC outpatient 2731 2731 2696.04 2696.04 fee schedule 2731 93 2212.11 percent of total billed charges 2731 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 2731 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 288.4 288.4 fee schedule 288.4 2731 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI Lower Extrem WO Contrast PX-610737180 CDM 73718 CPT 0610 RC outpatient 2145 2145 1258.89 1258.89 fee schedule 2145 93 1737.45 percent of total billed charges 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 162.38 162.38 fee schedule 162.38 2145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI Lower Extrem W Contrast PX-610737190 CDM 73719 CPT 0610 RC outpatient 2307 2307 1510.86 1510.86 fee schedule 2307 93 1868.67 percent of total billed charges 2307 2307 other OPPS APC 2307 2307 other OPPS APC 189.98 189.98 fee schedule 189.98 2307 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI Lower Extrem Wwo Contrast PX-610737200 CDM 73720 CPT 0610 RC outpatient 2145 2145 2695.1 2695.1 fee schedule 2145 93 1737.45 percent of total billed charges 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 240 240 fee schedule 240 2695.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI Lower Extrem Joint WO Cont PX-610737210 CDM 73721 CPT 0610 RC outpatient 2145 2145 1258.89 1258.89 fee schedule 2145 93 1737.45 percent of total billed charges 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 140.94 140.94 fee schedule 140.94 2145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI Lower Extrem Joint W Cont PX-610737220 CDM 73722 CPT 0610 RC outpatient 2307 2307 1510.86 1510.86 fee schedule 2307 93 1868.67 percent of total billed charges 2307 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 816.39 other OPPS APC 2307 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 816.39 other OPPS APC 240.33 240.33 fee schedule 240.33 2307 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI Lower Extrem Joint Wwo Cont PX-610737230 CDM 73723 CPT 0610 RC outpatient 2731 2731 2696.04 2696.04 fee schedule 2731 93 2212.11 percent of total billed charges 2731 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 2731 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 288.4 288.4 fee schedule 288.4 2731 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI Abdomen WO Contrast PX-610741810 CDM 74181 CPT 0610 RC outpatient 2145 2145 1276.26 1276.26 fee schedule 2145 93 1737.45 percent of total billed charges 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 129.58 129.58 fee schedule 129.58 2145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI Abdomen W Contrast PX-610741820 CDM 74182 CPT 0610 RC outpatient 2307 2307 1528.23 1528.23 fee schedule 2307 93 1868.67 percent of total billed charges 2307 2307 other OPPS APC 2307 2307 other OPPS APC 224.41 224.41 fee schedule 224.41 2307 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI Abdomen W WO Contrast PX-610741830 CDM 74183 CPT 0610 RC outpatient 2925 2925 2713.93 2713.93 fee schedule 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 238.7 238.7 fee schedule 238.7 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bd MRI Breast Bilateral W/WO Contrast PX-610770490 CDM 77049 CPT 0610 RC outpatient 2731 2731 2264.18 2264.18 fee schedule 2731 93 2212.11 percent of total billed charges 2731 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 2731 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 238.38 238.38 fee schedule 238.38 2731 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bd MRI Breast Bilateral No Contrast PX-610770590 CDM 77047 CPT 0610 RC outpatient 2145 2145 2264.18 2264.18 fee schedule 2145 93 1737.45 percent of total billed charges 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 146.47 146.47 fee schedule 146.47 2264.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI Brain WO Contrast PX-611705510 CDM 70551 CPT 0611 RC outpatient 2145 2145 1289.89 1289.89 fee schedule 2145 93 1737.45 percent of total billed charges 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 128.93 128.93 fee schedule 128.93 2145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MRI Brain W Contrast PX-611705520 CDM 70552 CPT 0611 RC outpatient 2463 2463 1547.5 1547.5 fee schedule 2463 93 1995.03 percent of total billed charges 2463 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 2463 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 189.65 189.65 fee schedule 189.65 2463 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI-C-Spine PX-612721410 CDM 72141 CPT 0612 RC outpatient 2145 2145 1303.68 1303.68 fee schedule 2145 93 1737.45 percent of total billed charges 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 123.4 123.4 fee schedule 123.4 2145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI-C Spine W Contrast PX-612721420 CDM 72142 CPT 0612 RC outpatient 2307 2307 1564.66 1564.66 fee schedule 2307 93 1868.67 percent of total billed charges 2307 2307 other OPPS APC 2307 2307 other OPPS APC 194.2 194.2 fee schedule 194.2 2307 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI-T-Spine PX-612721460 CDM 72146 CPT 0612 RC outpatient 2145 2145 1425.99 1425.99 fee schedule 2145 93 1737.45 percent of total billed charges 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 123.08 123.08 fee schedule 123.08 2145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI-T-Spine W Contrast PX-612721470 CDM 72147 CPT 0612 RC outpatient 2307 2307 1563.7 1563.7 fee schedule 2307 93 1868.67 percent of total billed charges 2307 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 2307 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 192.25 192.25 fee schedule 192.25 2307 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI-L-Spine PX-612721480 CDM 72148 CPT 0612 RC outpatient 2145 2145 1412.19 1412.19 fee schedule 2145 93 1737.45 percent of total billed charges 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 2145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 123.73 123.73 fee schedule 123.73 2145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI-L-Spine W Contrast PX-612721490 CDM 72149 CPT 0612 RC outpatient 2307 2307 1548.46 1548.46 fee schedule 2307 93 1868.67 percent of total billed charges 2307 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 2307 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 189.65 189.65 fee schedule 189.65 2307 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI-C Spine W/WO Contrast PX-612721560 CDM 72156 CPT 0612 RC outpatient 2925 2925 2780.29 2780.29 fee schedule 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 215.96 215.96 fee schedule 215.96 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI-T Spine W/WO Contrast PX-612721570 CDM 72157 CPT 0612 RC outpatient 2925 2925 2778.59 2778.59 fee schedule 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 216.61 216.61 fee schedule 216.61 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MRI-L-Spine W/WO Contrast PX-612721580 CDM 72158 CPT 0612 RC outpatient 2925 2925 2755.39 2755.39 fee schedule 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 215.32 215.32 fee schedule 215.32 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mra Head WO Contrast PX-615705440 CDM 70544 CPT 0615 RC outpatient 1426 1426 1256.55 1256.55 fee schedule 1426 93 1155.06 percent of total billed charges 1426 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 1426 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 161.39 161.39 fee schedule 161.39 1426 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mra-Neck PX-615705470 CDM 70547 CPT 0615 RC outpatient 1334 1334 1255.59 1255.59 fee schedule 1334 93 1080.54 percent of total billed charges 1334 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 1334 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 161.72 161.72 fee schedule 161.72 1334 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mra Neck W & W/O Contrast PX-615705491 CDM 70549 CPT 0615 RC outpatient 1719 1719 2399.34 2399.34 fee schedule 1719 93 1392.39 percent of total billed charges 1719 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 1719 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 264.35 264.35 fee schedule 264.35 2399.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mra Lower Extremity PX-616737250 CDM 73725 CPT 0616 RC outpatient 2078.63 2078.63 1329.39 1329.39 fee schedule 2078.63 93 1683.69 percent of total billed charges 254.6 254.6 fee schedule 254.6 254.6 fee schedule OPPS APC 254.6 254.6 fee schedule 254.6 2078.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mra-Chest PX-618715550 CDM 71555 CPT 0618 RC outpatient 2078.63 2078.63 1328.55 1328.55 fee schedule 2078.63 93 1683.69 percent of total billed charges 2078.63 2078.63 other OPPS APC 2078.63 2078.63 other OPPS APC 252.98 252.98 fee schedule 252.98 2078.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mra-Pelvis PX-618721980 CDM 72198 CPT 0618 RC outpatient 2078.63 2078.63 1326.77 1326.77 fee schedule 2078.63 93 1683.69 percent of total billed charges 257.53 257.53 fee schedule 257.53 257.53 fee schedule OPPS APC 257.53 257.53 fee schedule 257.53 2078.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mra Upper Extremity PX-618732250 CDM 73225 CPT 0618 RC outpatient 2078.63 2078.63 1578.41 1578.41 fee schedule 2078.63 93 1683.69 percent of total billed charges 2078.63 2078.63 other OPPS APC 2078.63 2078.63 other OPPS APC 264.02 264.02 fee schedule 264.02 2078.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mra Abdomen W WO Contrast PX-618741850 CDM 74185 CPT 0618 RC outpatient 2078.63 2078.63 1326.77 1326.77 fee schedule 2078.63 93 1683.69 percent of total billed charges 256.23 256.23 fee schedule 256.23 256.23 fee schedule OPPS APC 256.23 256.23 fee schedule 256.23 2078.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Hep a Peds/Adol 2 Dose Schedule PX-636906331 CDM 90633 CPT 0636 RC outpatient 112 112 112 74 82.88 percent of total billed charges 112 93 90.72 percent of total billed charges 112 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112 other OPPS APC 112 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112 other OPPS APC 112 112 fee schedule 112 112 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Influenza > 3 Years PX-636906581 CDM 90658 CPT 0636 RC outpatient 28.42 28.42 28.42 74 21.03 percent of total billed charges 28.42 93 23.02 percent of total billed charges 28.42 28.42 other OPPS APC 28.42 28.42 other OPPS APC 28.42 28.42 fee schedule 28.42 28.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IPB PX-636907131 CDM 90713 CPT 0636 RC outpatient 80 80 80 74 59.2 percent of total billed charges 80 93 64.8 percent of total billed charges 80 80 other OPPS APC 80 80 other OPPS APC 80 24.86 19.89 percent of total billed charges 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TD PX-636907141 CDM 90714 CPT 0636 RC outpatient 86 86 35.44 35.44 fee schedule 86 93 69.66 percent of total billed charges 86 86 other OPPS APC 86 86 other OPPS APC 86 24.86 21.38 percent of total billed charges 35.44 86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Tdap > 7 Years PX-636907151 CDM 90715 CPT 0636 RC outpatient 120 120 44.23 44.23 fee schedule 120 93 97.2 percent of total billed charges 120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 120 other OPPS APC 120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 120 other OPPS APC 120 120 percent of total billed charges 44.23 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Dtap Hepb-Ipv PX-636907231 CDM 90723 CPT 0636 RC outpatient 142 142 142 74 105.08 percent of total billed charges 142 93 115.02 percent of total billed charges 142 142 other OPPS APC 142 142 other OPPS APC 142 24.86 35.3 percent of total billed charges 142 142 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Menactra (Meningococcal) PX-636907341 CDM 90734 CPT 0636 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 260 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "Hep B, 3 Doses Ped/Adol" PX-636907441 CDM 90744 CPT 0636 RC outpatient 81 81 34.12 34.12 fee schedule 81 93 65.61 percent of total billed charges 81 81 other OPPS APC 81 81 other OPPS APC 81 24.86 20.14 percent of total billed charges 34.12 81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tn Theraskin 1x2= 13 Cm per Sq Cm PX-636Q41210 CDM Q4121 CPT 0636 RC outpatient 260 260 53.63 53.63 fee schedule 260 93 210.6 percent of total billed charges 260 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 260 other OPPS APC 260 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 260 other OPPS APC 260 24.86 64.64 percent of total billed charges 53.63 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tn Theraskin .50x.50= 3 Cm per Sq Cm PX-636Q41213 CDM Q4121 CPT 0636 RC outpatient 895 895 53.63 53.63 fee schedule 895 93 724.95 percent of total billed charges 895 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 895 other OPPS APC 895 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 895 other OPPS APC 895 24.86 222.5 percent of total billed charges 53.63 895 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tn Theraskin 2x2= 26 Cm per Sq Cm PX-636Q41214 CDM Q4121 CPT 0636 RC outpatient 147 147 53.63 53.63 fee schedule 147 93 119.07 percent of total billed charges 147 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 147 other OPPS APC 147 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 147 other OPPS APC 147 24.86 36.54 percent of total billed charges 53.63 147 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tn Theraskin 3x6= 116 Cm per Sq Cm PX-636Q41215 CDM Q4121 CPT 0636 RC outpatient 93 93 53.63 53.63 fee schedule 93 93 75.33 percent of total billed charges 93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 93 other OPPS APC 93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 93 other OPPS APC 93 24.86 23.12 percent of total billed charges 53.63 93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Puraply Am 1.6 Cm Disc; per Sq Cm PX-636Q41960 CDM Q4196 CPT 0636 RC outpatient 317.47 317.47 116.75 116.75 fee schedule 317.47 93 257.15 percent of total billed charges 317.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 317.47 other OPPS APC 317.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 317.47 other OPPS APC 317.47 24.86 78.92 percent of total billed charges 116.75 317.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Trauma Criteria Verified PX-683G03901 CDM G0390 CPT 0683 RC outpatient 3261.18 3261.18 3261.18 74 2413.27 percent of total billed charges 3261.18 93 2641.56 percent of total billed charges 3261.18 3261.18 other OPPS APC 3261.18 3261.18 other OPPS APC 3261.18 51 1663.2 percent of total billed charges 3261.18 3261.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pacu Recovery 1st 15 Mins PX-710000001 CDM 710000001 LOCAL 0710 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 200 other OPPS APC 200 200 other OPPS APC 200 92.68 185.36 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pacu Recovery Ea 15 Mins After 1st PX-710000002 CDM 710000002 LOCAL 0710 RC outpatient 75 75 75 74 55.5 percent of total billed charges 75 93 60.75 percent of total billed charges 75 75 other OPPS APC 75 75 other OPPS APC 75 92.68 69.51 percent of total billed charges 75 75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC OP Recovery Up to 1st 30 Minutes PX-710000003 CDM 710000003 LOCAL 0710 RC outpatient 169 169 169 74 125.06 percent of total billed charges 169 93 136.89 percent of total billed charges 169 169 other OPPS APC 169 169 other OPPS APC 169 92.68 156.63 percent of total billed charges 169 169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC OP Recovery Ea 15 Min Aft Init 30min PX-710000004 CDM 710000004 LOCAL 0710 RC outpatient 17 17 17 74 12.58 percent of total billed charges 17 93 13.77 percent of total billed charges 17 17 other OPPS APC 17 17 other OPPS APC 17 92.68 15.76 percent of total billed charges 17 17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Circumcision PX-720000029 CDM 720000029 LOCAL 0723 RC outpatient 1900 1900 1900 74 1406 percent of total billed charges 1900 93 1539 percent of total billed charges 1900 1900 other OPPS APC 1900 1900 other OPPS APC 1900 51 969 percent of total billed charges 1900 1900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC External Cephalic Version PX-722594121 CDM 59412 CPT 0722 RC outpatient 7446.93 7446.93 7446.93 74 5510.73 percent of total billed charges 7446.93 93 6032.01 percent of total billed charges 7446.93 7446.93 other OPPS APC 7446.93 7446.93 other OPPS APC 212.36 212.36 case rate 212.36 7446.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Delivery of Placenta (as Sep Proced) PX-722594141 CDM 59414 CPT 0722 RC outpatient 7446.93 7446.93 7446.93 74 5510.73 percent of total billed charges 7446.93 93 6032.01 percent of total billed charges 7446.93 7446.93 other OPPS APC 7446.93 7446.93 other OPPS APC 212.36 212.36 case rate 212.36 7446.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Circumcision Using Clamp W Reg Block PX-723541501 CDM 54150 CPT 0723 RC outpatient 4851.65 4851.65 4851.65 74 3590.22 percent of total billed charges 4851.65 93 3929.84 percent of total billed charges 4851.65 4851.65 other OPPS APC 4851.65 4851.65 other OPPS APC 4851.65 51 2474.34 percent of total billed charges 4851.65 4851.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Electrocardiogram PX-730930050 CDM 93005 CPT 0730 RC outpatient 219 219 50.27 50.27 fee schedule 219 93 177.39 percent of total billed charges 219 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.37 other OPPS APC 219 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.37 other OPPS APC 219 51 111.69 percent of total billed charges 50.27 219 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ext Ecg Connection >48hr Up to 7 Days PX-730932410 CDM 93242 CPT 0731 RC outpatient 142.12 142.12 79.86 79.86 fee schedule 142.12 93 115.12 percent of total billed charges 142.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40.89 other OPPS APC 142.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40.89 other OPPS APC 142.12 51 72.48 percent of total billed charges 79.86 142.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Ext Ecg Connection >7 Up to 15 Days PX-730932450 CDM 93246 CPT 0731 RC outpatient 142.12 142.12 131.36 131.36 fee schedule 142.12 93 115.12 percent of total billed charges 142.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40.89 other OPPS APC 142.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40.89 other OPPS APC 142.12 51 72.48 percent of total billed charges 131.36 142.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Holter Monitor Hook-Up PX-731932250 CDM 93225 CPT 0731 RC outpatient 304.28 304.28 140.59 140.59 fee schedule 304.28 93 246.47 percent of total billed charges 304.28 304.28 other OPPS APC 304.28 304.28 other OPPS APC 304.28 51 155.18 percent of total billed charges 140.59 304.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Holter 24 Hour PX-731932260 CDM 93226 CPT 0731 RC outpatient 213 213 247.12 247.12 fee schedule 213 93 172.53 percent of total billed charges 213 213 other OPPS APC 213 213 other OPPS APC 213 51 108.63 percent of total billed charges 213 247.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Eeg W/O Video 2-12 Hours Unmonitored PX-740957050 CDM 95705 CPT 0740 RC outpatient 747.65 747.65 2002.74 2002.74 fee schedule 747.65 93 605.6 percent of total billed charges 747.65 747.65 other OPPS APC 747.65 747.65 other OPPS APC 747.65 51 381.3 percent of total billed charges 747.65 2002.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Eeg W/O Video 12-26 Hours Unmonitored PX-740957080 CDM 95708 CPT 0740 RC outpatient 1276.7 1276.7 2002.74 2002.74 fee schedule 1276.7 93 1034.13 percent of total billed charges 1276.7 1276.7 other OPPS APC 1276.7 1276.7 other OPPS APC 1276.7 51 651.12 percent of total billed charges 1276.7 2002.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Polysom Age <6 W/Param 4or> PX-740957820 CDM 95782 CPT 0740 RC outpatient 2490.45 2490.45 1902.47 1902.47 fee schedule 2490.45 93 2017.26 percent of total billed charges 2490.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1066.05 other OPPS APC 2490.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1066.05 other OPPS APC 2490.45 51 1270.13 percent of total billed charges 1902.47 2490.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sleep Study Unattended Watch Pat PX-740958000 CDM 95800 CPT 0740 RC outpatient 372.08 372.08 372.08 74 275.34 percent of total billed charges 372.08 93 301.38 percent of total billed charges 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 51 189.76 percent of total billed charges 372.08 372.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mult Sleep Latency Test PX-740958050 CDM 95805 CPT 0740 RC outpatient 2169 2169 2076.78 2076.78 fee schedule 2169 93 1756.89 percent of total billed charges 2169 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 546.5 other OPPS APC 2169 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 546.5 other OPPS APC 2169 51 1106.19 percent of total billed charges 2076.78 2169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Polysom Age 6>W/Param 4>&6hrs PX-740958100 CDM 95810 CPT 0740 RC outpatient 2490.45 2490.45 2268.76 2268.76 fee schedule 2490.45 93 2017.26 percent of total billed charges 2490.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1066.05 other OPPS APC 2490.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1066.05 other OPPS APC 2490.45 51 1270.13 percent of total billed charges 2268.76 2490.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Polysom Age 6> Split/Cpap PX-740958110 CDM 95811 CPT 0740 RC outpatient 2490.45 2490.45 2479.42 2479.42 fee schedule 2490.45 93 2017.26 percent of total billed charges 2490.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1066.05 other OPPS APC 2490.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1066.05 other OPPS APC 2490.45 51 1270.13 percent of total billed charges 2479.42 2490.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Eeg - Awake & Drowsy PX-740958161 CDM 95816 CPT 0740 RC outpatient 747.65 747.65 515.4 515.4 fee schedule 747.65 93 605.6 percent of total billed charges 747.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 320.04 other OPPS APC 747.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 320.04 other OPPS APC 747.65 51 381.3 percent of total billed charges 515.4 747.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Eeg PX-740958190 CDM 95819 CPT 0740 RC outpatient 747.65 747.65 436.53 436.53 fee schedule 747.65 93 605.6 percent of total billed charges 747.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 320.04 other OPPS APC 747.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 320.04 other OPPS APC 747.65 51 381.3 percent of total billed charges 436.53 747.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Eeg 24 Hour Recording for Seizure PX-740959501 CDM 95950 CPT 0740 RC outpatient 2004 2004 2004 74 1482.96 percent of total billed charges 2004 93 1623.24 percent of total billed charges 2004 2004 other OPPS APC 2004 2004 other OPPS APC 2004 51 1022.04 percent of total billed charges 2004 2004 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Endoscopy Procedure First 30 Mins PX-750000002 CDM 750000002 LOCAL 0750 RC outpatient 1200 1200 1200 Service paid by fee schedule. 1200 fee schedule Ambulatory 1200 93 972 percent of total billed charges 1200 1200 other OPPS APC 1200 1200 other OPPS APC 1200 51 612 percent of total billed charges 1200 1200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Endoscopy Procedure Ea Addl 15 Mins PX-750000003 CDM 750000003 LOCAL 0750 RC outpatient 500 500 500 Service paid by fee schedule. 500 fee schedule Ambulatory 500 93 405 percent of total billed charges 500 500 other OPPS APC 500 500 other OPPS APC 500 51 255 percent of total billed charges 500 500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Egd Transoral Control Bleeding Any Method PX-750432350 CDM 43235 CPT 0750 RC outpatient 2159.23 2159.23 1392.16 2159.23 fee schedule 2159.23 93 1748.98 percent of total billed charges 2159.23 2159.23 other OPPS APC 2159.23 2159.23 other OPPS APC 2159.23 51 1101.21 percent of total billed charges 1392.16 2159.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Esophageal Manometry Study W/I&R PX-750910101 CDM 91010 CPT 0750 RC outpatient 1276.7 1276.7 1276.7 Service paid by fee schedule. 1276.7 fee schedule Ambulatory 1276.7 93 1034.13 percent of total billed charges 1276.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 546.5 other OPPS APC 1276.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 546.5 other OPPS APC 1276.7 51 651.12 percent of total billed charges 1276.7 1276.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Esoph G-Esop Refulx E/Electrod Plcmt PX-750910351 CDM 91035 CPT 0750 RC outpatient 1276.7 1276.7 1276.7 Service paid by fee schedule. 1276.7 fee schedule Ambulatory 1276.7 93 1034.13 percent of total billed charges 1276.7 1276.7 other OPPS APC 1276.7 1276.7 other OPPS APC 1276.7 51 651.12 percent of total billed charges 1276.7 1276.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Impedence (Less Than 1 Hour) PX-750910371 CDM 91037 CPT 0750 RC outpatient 747.65 747.65 747.65 Service paid by fee schedule. 747.65 fee schedule Ambulatory 747.65 93 605.6 percent of total billed charges 747.65 747.65 other OPPS APC 747.65 747.65 other OPPS APC 747.65 51 381.3 percent of total billed charges 747.65 747.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pill Cam Procedure PX-750911101 CDM 91110 CPT 0750 RC outpatient 2159.23 2159.23 2159.23 Service paid by fee schedule. 2159.23 fee schedule Ambulatory 2159.23 93 1748.98 percent of total billed charges 2159.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 924.27 other OPPS APC 2159.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 924.27 other OPPS APC 2159.23 51 1101.21 percent of total billed charges 2159.23 2159.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Anorectal Manometry PX-750911221 CDM 91122 CPT 0750 RC outpatient 747.65 747.65 747.65 Service paid by fee schedule. 747.65 fee schedule Ambulatory 747.65 93 605.6 percent of total billed charges 747.65 747.65 other OPPS APC 747.65 747.65 other OPPS APC 747.65 51 381.3 percent of total billed charges 747.65 747.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC I&D Abscess-Single PX-761100600 CDM 10060 CPT 0761 RC outpatient 476.88 476.88 476.88 74 352.89 percent of total billed charges 476.88 93 386.27 percent of total billed charges 476.88 476.88 other OPPS APC 476.88 476.88 other OPPS APC 476.88 51 243.21 percent of total billed charges 476.88 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC I&D Abscess-Multiple PX-761100610 CDM 10061 CPT 0761 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 949.8 51 484.4 percent of total billed charges 949.8 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hematoma Fluid Seroma Drainage PX-761101402 CDM 10140 CPT 0761 RC outpatient 3861.88 3861.88 3861.88 74 2857.79 percent of total billed charges 3861.88 93 3128.12 percent of total billed charges 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 51 1969.56 percent of total billed charges 3861.88 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Puncture Aspiration of Abscess PX-761101600 CDM 10160 CPT 0761 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 949.8 51 484.4 percent of total billed charges 949.8 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC I&D Post-OP Wound PX-761101800 CDM 10180 CPT 0761 RC outpatient 6768.38 6768.38 6768.38 74 5008.6 percent of total billed charges 6768.38 93 5482.39 percent of total billed charges 6768.38 6768.38 other OPPS APC 6768.38 6768.38 other OPPS APC 6768.38 51 3451.87 percent of total billed charges 6768.38 6768.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Debride Sub Q W/Mod PX-761110420 CDM 11042 CPT 0761 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 406.57 other OPPS APC 949.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 406.57 other OPPS APC 949.8 51 484.4 percent of total billed charges 949.8 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Debride Muscle W/Mod PX-761110430 CDM 11043 CPT 0761 RC outpatient 1496 1496 1496 74 1107.04 percent of total billed charges 1496 93 1211.76 percent of total billed charges 1496 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 640.37 other OPPS APC 1496 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 640.37 other OPPS APC 1496 51 762.96 percent of total billed charges 1496 1496 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Debride Bone W/Mod PX-761110440 CDM 11044 CPT 0761 RC outpatient 3861.88 3861.88 3861.88 74 2857.79 percent of total billed charges 3861.88 93 3128.12 percent of total billed charges 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1653.1 other OPPS APC 3861.88 51 1969.56 percent of total billed charges 3861.88 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Debride Sub Q Ea Add 20 Sq Cm PX-761110450 CDM 11045 CPT 0761 RC outpatient 556 556 556 74 411.44 percent of total billed charges 556 93 450.36 percent of total billed charges 556 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 556 other OPPS APC 556 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 556 other OPPS APC 556 51 283.56 percent of total billed charges 556 556 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Debride Muscle Each Add. 20sq PX-761110460 CDM 11046 CPT 0761 RC outpatient 665 665 665 74 492.1 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 51 339.15 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Debride Bone Ea Add 20 Sq Cm PX-761110470 CDM 11047 CPT 0761 RC outpatient 1286 1286 1286 74 951.64 percent of total billed charges 1286 93 1041.66 percent of total billed charges 1286 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1286 other OPPS APC 1286 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1286 other OPPS APC 1286 51 655.86 percent of total billed charges 1286 1286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Paring Benign Lesion - One PX-761110550 CDM 11055 CPT 0761 RC outpatient 476.88 476.88 476.88 74 352.89 percent of total billed charges 476.88 93 386.27 percent of total billed charges 476.88 476.88 other OPPS APC 476.88 476.88 other OPPS APC 476.88 51 243.21 percent of total billed charges 476.88 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Paring Benign Lesion - 2-4 PX-761110560 CDM 11056 CPT 0761 RC outpatient 476.88 476.88 476.88 74 352.89 percent of total billed charges 476.88 93 386.27 percent of total billed charges 476.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 204.13 other OPPS APC 476.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 204.13 other OPPS APC 476.88 51 243.21 percent of total billed charges 476.88 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tangential Biopsy of Skin PX-761111020 CDM 11102 CPT 0761 RC outpatient 476.88 476.88 476.88 74 352.89 percent of total billed charges 476.88 93 386.27 percent of total billed charges 476.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 204.13 other OPPS APC 476.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 204.13 other OPPS APC 476.88 51 243.21 percent of total billed charges 476.88 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Tangential Biopsy of Skin Each Add'l PX-761111030 CDM 11103 CPT 0761 RC outpatient 94 94 94 74 69.56 percent of total billed charges 94 93 76.14 percent of total billed charges 94 94 other OPPS APC 94 94 other OPPS APC 94 51 47.94 percent of total billed charges 94 94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Punch Biopsy of Skin PX-761111040 CDM 11104 CPT 0761 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 406.57 other OPPS APC 949.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 406.57 other OPPS APC 949.8 51 484.4 percent of total billed charges 949.8 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Punch Biopsy of Skin Each Add'l PX-761111050 CDM 11105 CPT 0761 RC outpatient 118 118 118 74 87.32 percent of total billed charges 118 93 95.58 percent of total billed charges 118 118 other OPPS APC 118 118 other OPPS APC 118 51 60.18 percent of total billed charges 118 118 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Insicional Biospy of Skin PX-761111060 CDM 11106 CPT 0761 RC outpatient 1496 1496 1496 74 1107.04 percent of total billed charges 1496 93 1211.76 percent of total billed charges 1496 1496 other OPPS APC 1496 1496 other OPPS APC 1496 51 762.96 percent of total billed charges 1496 1496 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Insicional Biospy of Skin Each Add'l PX-761111070 CDM 11107 CPT 0761 RC outpatient 151 151 151 74 111.74 percent of total billed charges 151 93 122.31 percent of total billed charges 151 151 other OPPS APC 151 151 other OPPS APC 151 51 77.01 percent of total billed charges 151 151 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Excisional Biopsy Malignant Lesion .5cm or Less PX-761116000 CDM 11600 CPT 0761 RC outpatient 1675.9 1675.9 1675.9 74 1240.17 percent of total billed charges 1675.9 93 1357.48 percent of total billed charges 1675.9 1675.9 other OPPS APC 1675.9 1675.9 other OPPS APC 1675.9 51 854.71 percent of total billed charges 1675.9 1675.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Excisional Biopsy Malignant Lesion .6-1.0 Cm PX-761116010 CDM 11601 CPT 0761 RC outpatient 1675.9 1675.9 1675.9 74 1240.17 percent of total billed charges 1675.9 93 1357.48 percent of total billed charges 1675.9 1675.9 other OPPS APC 1675.9 1675.9 other OPPS APC 1675.9 51 854.71 percent of total billed charges 1675.9 1675.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Excisional Biopsy Malignant Lesion 1.1-2.0 Cm PX-761116020 CDM 11602 CPT 0761 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 949.8 51 484.4 percent of total billed charges 949.8 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Trim Nondystrophic Nails, Any No." PX-761117190 CDM 11719 CPT 0761 RC outpatient 145.7 145.7 145.7 74 107.82 percent of total billed charges 145.7 93 118.02 percent of total billed charges 145.7 145.7 other OPPS APC 145.7 145.7 other OPPS APC 145.7 51 74.31 percent of total billed charges 145.7 145.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Debride Nail 1-5 PX-761117200 CDM 11720 CPT 0761 RC outpatient 145.7 145.7 145.7 74 107.82 percent of total billed charges 145.7 93 118.02 percent of total billed charges 145.7 145.7 other OPPS APC 145.7 145.7 other OPPS APC 145.7 51 74.31 percent of total billed charges 145.7 145.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Debride Nail >5 PX-761117210 CDM 11721 CPT 0761 RC outpatient 145.7 145.7 145.7 74 107.82 percent of total billed charges 145.7 93 118.02 percent of total billed charges 145.7 145.7 other OPPS APC 145.7 145.7 other OPPS APC 145.7 51 74.31 percent of total billed charges 145.7 145.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Avulsion of Nail Plate Single PX-761117300 CDM 11730 CPT 0761 RC outpatient 476.88 476.88 476.88 74 352.89 percent of total billed charges 476.88 93 386.27 percent of total billed charges 476.88 476.88 other OPPS APC 476.88 476.88 other OPPS APC 476.88 51 243.21 percent of total billed charges 476.88 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Avulsion of Nail Plate, Ea Addl" PX-761117320 CDM 11732 CPT 0761 RC outpatient 150 150 150 74 111 percent of total billed charges 150 93 121.5 percent of total billed charges 150 150 other OPPS APC 150 150 other OPPS APC 150 51 76.5 percent of total billed charges 150 150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Excision Nail Partial or Complete PX-761117500 CDM 11750 CPT 0761 RC outpatient 949.8 949.8 949.8 74 702.85 percent of total billed charges 949.8 93 769.34 percent of total billed charges 949.8 949.8 other OPPS APC 949.8 949.8 other OPPS APC 949.8 51 484.4 percent of total billed charges 949.8 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Closure Surgical Wound, Extesive/Complicated" PX-761131600 CDM 13160 CPT 0761 RC outpatient 4343.83 4343.83 4343.83 74 3214.43 percent of total billed charges 4343.83 93 3518.5 percent of total billed charges 4343.83 4343.83 other OPPS APC 4343.83 4343.83 other OPPS APC 4343.83 51 2215.35 percent of total billed charges 4343.83 4343.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Gft Skin Sub T/a/L >100cm 1st 25 PX-761152710 CDM 15271 CPT 0761 RC outpatient 4343.83 4343.83 4343.83 74 3214.43 percent of total billed charges 4343.83 93 3518.5 percent of total billed charges 4343.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1859.4 other OPPS APC 4343.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1859.4 other OPPS APC 4343.83 51 2215.35 percent of total billed charges 4343.83 4343.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Gft Skin Sub T/a/L <100cm Add 25 PX-761152720 CDM 15272 CPT 0761 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 429 other OPPS APC 429 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 429 other OPPS APC 429 51 218.79 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Gft Skin Sub T/a/L >100cm 1st 100 PX-761152730 CDM 15273 CPT 0761 RC outpatient 8545.65 8545.65 8545.65 74 6323.78 percent of total billed charges 8545.65 93 6921.98 percent of total billed charges 8545.65 8545.65 other OPPS APC 8545.65 8545.65 other OPPS APC 8545.65 51 4358.28 percent of total billed charges 8545.65 8545.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Gft Skin Sub T/a/L >100cm Ea Addl PX-761152740 CDM 15274 CPT 0761 RC outpatient 808 808 808 74 597.92 percent of total billed charges 808 93 654.48 percent of total billed charges 808 808 other OPPS APC 808 808 other OPPS APC 808 51 412.08 percent of total billed charges 808 808 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Gft Skin Sub F/S/E <100cm 1st 25 PX-761152750 CDM 15275 CPT 0761 RC outpatient 4343.83 4343.83 4343.83 74 3214.43 percent of total billed charges 4343.83 93 3518.5 percent of total billed charges 4343.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1859.4 other OPPS APC 4343.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1859.4 other OPPS APC 4343.83 51 2215.35 percent of total billed charges 4343.83 4343.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Gft Skin Sub F/S <100cm Ea Add 25 PX-761152760 CDM 15276 CPT 0761 RC outpatient 540 540 540 74 399.6 percent of total billed charges 540 93 437.4 percent of total billed charges 540 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 540 other OPPS APC 540 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 540 other OPPS APC 540 51 275.4 percent of total billed charges 540 540 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Gft Skin Sub F/S/E >100cm 1st 100 PX-761152770 CDM 15277 CPT 0761 RC outpatient 4343.83 4343.83 4343.83 74 3214.43 percent of total billed charges 4343.83 93 3518.5 percent of total billed charges 4343.83 4343.83 other OPPS APC 4343.83 4343.83 other OPPS APC 4343.83 51 2215.35 percent of total billed charges 4343.83 4343.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Gft Skin Sub F/S>100cm Ea Add 100 PX-761152780 CDM 15278 CPT 0761 RC outpatient 550 550 550 74 407 percent of total billed charges 550 93 445.5 percent of total billed charges 550 550 other OPPS APC 550 550 other OPPS APC 550 51 280.5 percent of total billed charges 550 550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Chemical Cauterization PX-761172500 CDM 17250 CPT 0761 RC outpatient 476.88 476.88 476.88 74 352.89 percent of total billed charges 476.88 93 386.27 percent of total billed charges 476.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 204.13 other OPPS APC 476.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 204.13 other OPPS APC 476.88 51 243.21 percent of total billed charges 476.88 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Bone Biospy-Superficial Ribs, Ilium, Sternum,Spinous" PX-761202400 CDM 20240 CPT 0761 RC outpatient 6768.38 6768.38 6768.38 74 5008.6 percent of total billed charges 6768.38 93 5482.39 percent of total billed charges 6768.38 6768.38 other OPPS APC 6768.38 6768.38 other OPPS APC 6768.38 51 3451.87 percent of total billed charges 6768.38 6768.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Apply Tl Contact Leg Cast PX-761294450 CDM 29445 CPT 0761 RC outpatient 639.7 639.7 639.7 74 473.38 percent of total billed charges 639.7 93 518.16 percent of total billed charges 639.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273.83 other OPPS APC 639.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273.83 other OPPS APC 639.7 51 326.25 percent of total billed charges 639.7 639.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Apply Unna Boot PX-761295800 CDM 29580 CPT 0761 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 51 191.42 percent of total billed charges 375.33 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Strapping Unna Boot Lt PX-761295801 CDM 29580 CPT 0761 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 51 191.42 percent of total billed charges 375.33 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Strapping Unna Boot Rt PX-761295803 CDM 29580 CPT 0761 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 51 191.42 percent of total billed charges 375.33 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Strapping Unna Boot Bilateral PX-761295804 CDM 29580 CPT 0761 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 51 191.42 percent of total billed charges 375.33 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Apply Profore Bilateral PX-761295810 CDM 29581 CPT 0761 RC outpatient 375.33 375.33 375.33 74 277.74 percent of total billed charges 375.33 93 304.02 percent of total billed charges 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.66 other OPPS APC 375.33 51 191.42 percent of total billed charges 375.33 375.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vl Venous Ablation Laser First Vein PX-761364781 CDM 36478 CPT 0761 RC outpatient 7592.53 7592.53 7592.53 74 5618.47 percent of total billed charges 7592.53 93 6149.95 percent of total billed charges 7592.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250.03 other OPPS APC 7592.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250.03 other OPPS APC 7592.53 51 3872.19 percent of total billed charges 7592.53 7592.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Bone Marrow/Aspiration PX-761382210 CDM 38221 CPT 0761 RC outpatient 3861.88 3861.88 3861.88 74 2857.79 percent of total billed charges 3861.88 93 3128.12 percent of total billed charges 3861.88 3861.88 other OPPS APC 3861.88 3861.88 other OPPS APC 3861.88 51 1969.56 percent of total billed charges 3861.88 3861.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Insertion Straight Bladder Cath PX-761517011 CDM 51701 CPT 0761 RC outpatient 304.28 304.28 304.28 74 225.17 percent of total billed charges 304.28 93 246.47 percent of total billed charges 304.28 304.28 other OPPS APC 304.28 304.28 other OPPS APC 304.28 51 155.18 percent of total billed charges 304.28 304.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Medical Induced Delivery Nv/Stillbrn PX-761598551 CDM 59855 CPT 0761 RC outpatient 3600 3600 3600 74 2664 percent of total billed charges 3600 93 2916 percent of total billed charges 3600 3600 other OPPS APC 3600 3600 other OPPS APC 3600 51 1836 percent of total billed charges 3600 3600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IV Infusion Med 16-90 Mins Initial PX-761963652 CDM 96365 CPT 0761 RC outpatient 510.55 510.55 643.38 643.38 fee schedule 510.55 93 413.55 percent of total billed charges 510.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.54 other OPPS APC 510.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.54 other OPPS APC 510.55 51 260.38 percent of total billed charges 510.55 643.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IV Push Each Add of Same Drug PX-761963761 CDM 96376 CPT 0761 RC outpatient 125 125 125 74 92.5 percent of total billed charges 125 93 101.25 percent of total billed charges 125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 125 other OPPS APC 125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 125 other OPPS APC 125 51 63.75 percent of total billed charges 125 125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC IV Push Ea Seq Same Drug After 30 Mins PX-761963762 CDM 96376 CPT 0761 RC outpatient 125 125 125 74 92.5 percent of total billed charges 125 93 101.25 percent of total billed charges 125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 125 other OPPS APC 125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 125 other OPPS APC 125 51 63.75 percent of total billed charges 125 125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Port Flush PX-761965231 CDM 96523 CPT 0761 RC outpatient 145.7 145.7 115.95 115.95 fee schedule 145.7 93 118.02 percent of total billed charges 145.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.37 other OPPS APC 145.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.37 other OPPS APC 145.7 51 74.31 percent of total billed charges 115.95 145.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Debride Open Wound W/Mod PX-761975970 CDM 97597 CPT 0761 RC outpatient 476.88 476.88 136.47 136.47 fee schedule 476.88 93 386.27 percent of total billed charges 476.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 204.13 other OPPS APC 476.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 204.13 other OPPS APC 476.88 51 243.21 percent of total billed charges 136.47 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Debride Open Each Add. 20sq PX-761975980 CDM 97598 CPT 0761 RC outpatient 155 155 172.91 172.91 fee schedule 155 93 125.55 percent of total billed charges 155 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 155 other OPPS APC 155 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 155 other OPPS APC 155 51 79.05 percent of total billed charges 155 172.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC WC Negative Pressure <=50 Cm PX-761976052 CDM 97605 CPT 0761 RC outpatient 476.88 476.88 89.92 89.92 fee schedule 476.88 93 386.27 percent of total billed charges 476.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 204.13 other OPPS APC 476.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 204.13 other OPPS APC 476.88 51 243.21 percent of total billed charges 89.92 476.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Neg Pressure Wound Treatment >50cm PX-761976062 CDM 97606 CPT 0761 RC outpatient 949.8 949.8 87.89 87.89 fee schedule 949.8 93 769.34 percent of total billed charges 949.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 406.57 other OPPS APC 949.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 406.57 other OPPS APC 949.8 51 484.4 percent of total billed charges 87.89 949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC OB Exam Room - Level I PX-761992111 CDM 99211 CPT 0761 RC outpatient 314.88 314.88 314.88 74 233.01 percent of total billed charges 314.88 93 255.05 percent of total billed charges 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 314.88 51 160.59 percent of total billed charges 314.88 314.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC OB Exam Room - Level II PX-761992121 CDM 99212 CPT 0761 RC outpatient 314.88 314.88 314.88 74 233.01 percent of total billed charges 314.88 93 255.05 percent of total billed charges 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 314.88 51 160.59 percent of total billed charges 314.88 314.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC OB Exam Room - Level III PX-761992131 CDM 99213 CPT 0761 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 325 51 165.75 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC OB Exam Room - Level IV PX-761992141 CDM 99214 CPT 0761 RC outpatient 367 367 367 74 271.58 percent of total billed charges 367 93 297.27 percent of total billed charges 367 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 367 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 367 51 187.17 percent of total billed charges 367 367 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC OB Exam Room - Level V PX-761992151 CDM 99215 CPT 0761 RC outpatient 411 411 411 74 304.14 percent of total billed charges 411 93 332.91 percent of total billed charges 411 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 411 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 411 51 209.61 percent of total billed charges 411 411 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Observation Carve Out PX-762003780 CDM G0378 CPT 0762 RC outpatient 49 49 647 647 case rate 49 93 39.69 percent of total billed charges 49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 49 other OPPS APC 49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 49 other OPPS APC 1224 1224 case rate 49 1224 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Observation Service PX-762003781 CDM G0378 CPT 0762 RC outpatient 49 49 647 647 case rate 49 93 39.69 percent of total billed charges 49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 49 other OPPS APC 49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 49 other OPPS APC 1224 1224 case rate 49 1224 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Immunization Administration PX-771904711 CDM 90471 CPT 0771 RC outpatient 167.8 167.8 79.01 79.01 fee schedule 167.8 93 135.92 percent of total billed charges 167.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 167.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.83 other OPPS APC 167.8 51 85.58 percent of total billed charges 79.01 167.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Inj Tixagevimab/Cilagavimab PX-771M02200 CDM M0220 CPT 0771 RC outpatient 376.25 376.25 376.25 74 278.43 percent of total billed charges 376.25 93 304.76 percent of total billed charges 376.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 161.06 other OPPS APC 376.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 161.06 other OPPS APC 376.25 51 191.89 percent of total billed charges 376.25 376.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Casirivimab and Imdevimab Includes Infusion or Injection and Post Admin Monitoring PX-771M02430 CDM M0243 HCPCS 0771 RC outpatient 1126.25 1126.25 1126.25 74 833.43 percent of total billed charges 1126.25 93 912.26 percent of total billed charges 1126.25 1126.25 other OPPS APC 1126.25 1126.25 other OPPS APC 1126.25 51 574.39 percent of total billed charges 1126.25 1126.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Hemodialysis PX-801000001 CDM 801000001 LOCAL 0801 RC outpatient 470 470 470 74 347.8 percent of total billed charges 470 93 380.7 percent of total billed charges 470 470 other OPPS APC 470 470 other OPPS APC 470 51 239.7 percent of total billed charges 470 470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Peritoneal Dialysis or Crrt PX-802000001 CDM 802000001 LOCAL 0802 RC outpatient 470 470 470 74 347.8 percent of total billed charges 470 93 380.7 percent of total billed charges 470 470 other OPPS APC 470 470 other OPPS APC 470 51 239.7 percent of total billed charges 470 470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Unsched Dialysis Esrd PX-820002570 CDM G0257 CPT 0820 RC outpatient 1664.53 1664.53 1664.53 74 1231.75 percent of total billed charges 1664.53 93 1348.27 percent of total billed charges 1664.53 1664.53 other OPPS APC 1664.53 1664.53 other OPPS APC 1664.53 51 848.91 percent of total billed charges 1664.53 1664.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MC Bh Psych Assessment PX-900907919 CDM 90791 CPT 0900 RC outpatient 379.78 379.78 379.78 74 281.04 percent of total billed charges 379.78 93 307.62 percent of total billed charges 379.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 162.56 other OPPS APC 379.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 162.56 other OPPS APC 379.78 51 193.69 percent of total billed charges 379.78 379.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MC Bh Therapy 30 Min Ind PX-900908329 CDM 90832 CPT 0914 RC outpatient 379.78 379.78 395.54 395.54 fee schedule 379.78 93 307.62 percent of total billed charges 67.51 67.51 fee schedule 67.51 67.51 fee schedule OPPS APC 379.78 379.78 percent of total billed charges 67.51 395.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MC Bh Therapy 45 Min Ind PX-900908349 CDM 90834 CPT 0914 RC outpatient 379.78 379.78 379.78 74 281.04 percent of total billed charges 379.78 93 307.62 percent of total billed charges 379.78 379.78 other OPPS APC 379.78 379.78 other OPPS APC 379.78 51 193.69 percent of total billed charges 379.78 379.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MC Bh Therapy 60 Min Ind PX-900908379 CDM 90837 CPT 0914 RC outpatient 379.78 379.78 379.78 74 281.04 percent of total billed charges 379.78 93 307.62 percent of total billed charges 379.78 379.78 other OPPS APC 379.78 379.78 other OPPS APC 379.78 51 193.69 percent of total billed charges 379.78 379.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MC Bh Psychotherapy Crisis 60 Min PX-900908399 CDM 90839 CPT 0914 RC outpatient 379.78 379.78 379.78 74 281.04 percent of total billed charges 379.78 93 307.62 percent of total billed charges 379.78 379.78 other OPPS APC 379.78 379.78 other OPPS APC 379.78 51 193.69 percent of total billed charges 379.78 379.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MC Bh Psychotherapy Crisis Add 30 Min PX-900908409 CDM 90840 CPT 0914 RC outpatient 117 117 117 74 86.58 percent of total billed charges 117 93 94.77 percent of total billed charges 117 117 other OPPS APC 117 117 other OPPS APC 117 51 59.67 percent of total billed charges 117 117 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Interactive Complexity PX-900908751 CDM 90875 CPT 0900 RC outpatient 97 97 97 74 71.78 percent of total billed charges 97 93 78.57 percent of total billed charges 97 97 other OPPS APC 97 97 other OPPS APC 97 51 49.47 percent of total billed charges 97 97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MC Bh Group Therapy PX-915908539 CDM 90853 CPT 0915 RC outpatient 212.33 212.33 212.33 74 157.12 percent of total billed charges 212.33 93 171.99 percent of total billed charges 212.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 90.89 other OPPS APC 212.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 90.89 other OPPS APC 212.33 51 108.29 percent of total billed charges 212.33 212.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MC Bh Family Psychotherapy W/O Patient PX-916908469 CDM 90846 CPT 0916 RC outpatient 379.78 379.78 379.78 74 281.04 percent of total billed charges 379.78 93 307.62 percent of total billed charges 379.78 379.78 other OPPS APC 379.78 379.78 other OPPS APC 379.78 51 193.69 percent of total billed charges 379.78 379.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC MC Bh Family Psychotherapy W/ Patient PX-916908479 CDM 90847 CPT 0916 RC outpatient 379.78 379.78 379.78 74 281.04 percent of total billed charges 379.78 93 307.62 percent of total billed charges 379.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 162.56 other OPPS APC 379.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 162.56 other OPPS APC 379.78 51 193.69 percent of total billed charges 379.78 379.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Sleep Study Unattended PX-920958061 CDM 95806 CPT 0920 RC outpatient 1800 1800 547 547 fee schedule 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 1800 51 918 percent of total billed charges 547 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Sleep Study Attended PX-920958070 CDM 95807 CPT 0920 RC outpatient 1276.7 1276.7 1477.43 1477.43 fee schedule 1276.7 93 1034.13 percent of total billed charges 1276.7 1276.7 other OPPS APC 1276.7 1276.7 other OPPS APC 1276.7 51 651.12 percent of total billed charges 1276.7 1477.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Polysomnography,4 Parameters W/Cpap" PX-920958111 CDM 95811 CPT 0920 RC outpatient 2490.45 2490.45 2479.42 2479.42 fee schedule 2490.45 93 2017.26 percent of total billed charges 2490.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1066.05 other OPPS APC 2490.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1066.05 other OPPS APC 2490.45 51 1270.13 percent of total billed charges 2479.42 2490.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Elect Analysis Impant Neurostimul Complx PX-920959771 CDM 95977 CPT 0920 RC outpatient 293 293 293 74 216.82 percent of total billed charges 293 93 237.33 percent of total billed charges 293 293 other OPPS APC 293 293 other OPPS APC 293 51 149.43 percent of total billed charges 293 293 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vl Vein Mapping PX-921003650 CDM 93985 CPT 0921 RC outpatient 587.5 587.5 549.97 549.97 fee schedule 587.5 93 475.88 percent of total billed charges 587.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 587.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 587.5 51 299.63 percent of total billed charges 549.97 587.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vl Aaa Screen Initial PX-921003890 CDM 76706 CPT 0402 RC outpatient 261.88 261.88 264.43 264.43 fee schedule 261.88 93 212.12 percent of total billed charges 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 261.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 78.92 78.92 fee schedule 78.92 264.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pseudoa Thrombin Injection Vas Ctr PX-921360021 CDM 36002 CPT 0921 RC outpatient 1496.38 1496.38 1496.38 74 1107.32 percent of total billed charges 1496.38 93 1212.07 percent of total billed charges 1496.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 640.53 other OPPS APC 1496.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 640.53 other OPPS APC 1496.38 51 763.15 percent of total billed charges 1496.38 1496.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC US Guide for Vascular Access PX-921769371 CDM 76937 CPT 0402 RC outpatient 305 305 80.38 80.38 fee schedule 305 93 247.05 percent of total billed charges 305 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 305 other OPPS APC 305 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 305 other OPPS APC 24.02 24.02 fee schedule 24.02 305 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vl Carotid Duplex Bilateral PX-921938800 CDM 93880 CPT 0921 RC outpatient 707 707 688.22 688.22 fee schedule 707 93 572.67 percent of total billed charges 707 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 707 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 707 51 360.57 percent of total billed charges 688.22 707 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vl Carotid Duplex Unilateral PX-921938820 CDM 93882 CPT 0921 RC outpatient 438 438 437.21 437.21 fee schedule 438 93 354.78 percent of total billed charges 438 438 other OPPS APC 438 438 other OPPS APC 438 51 223.38 percent of total billed charges 437.21 438 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vl Uea Single Level Unilateral PX-921939220 CDM 93922 CPT 0921 RC outpatient 304.28 304.28 325.42 325.42 fee schedule 304.28 93 246.47 percent of total billed charges 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 51 155.18 percent of total billed charges 304.28 325.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vl Uea Multiple Level Unilat PX-921939230 CDM 93923 CPT 0921 RC outpatient 372.08 372.08 499.16 499.16 fee schedule 372.08 93 301.38 percent of total billed charges 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 159.27 other OPPS APC 372.08 51 189.76 percent of total billed charges 372.08 499.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vl Duplex Lea Bilateral PX-921939250 CDM 93925 CPT 0921 RC outpatient 707 707 819.23 819.23 fee schedule 707 93 572.67 percent of total billed charges 707 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 707 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 707 51 360.57 percent of total billed charges 707 819.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vl Duplex Lea Unilateral PX-921939260 CDM 93926 CPT 0921 RC outpatient 438 438 496.52 496.52 fee schedule 438 93 354.78 percent of total billed charges 438 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 438 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 438 51 223.38 percent of total billed charges 438 496.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vl Duplex Uea Bilateral PX-921939300 CDM 93930 CPT 0921 RC outpatient 707 707 655.14 655.14 fee schedule 707 93 572.67 percent of total billed charges 707 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 707 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 707 51 360.57 percent of total billed charges 655.14 707 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vl Duplex Uea Unilateral PX-921939310 CDM 93931 CPT 0921 RC outpatient 438 438 427.42 427.42 fee schedule 438 93 354.78 percent of total billed charges 438 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 438 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 438 51 223.38 percent of total billed charges 427.42 438 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vl Duplex Venous Map Bilat PX-921939700 CDM 93970 CPT 0921 RC outpatient 767 767 668.28 668.28 fee schedule 767 93 621.27 percent of total billed charges 767 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 767 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 767 51 391.17 percent of total billed charges 668.28 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vl Duplex Venous Map Unilat PX-921939710 CDM 93971 CPT 0921 RC outpatient 475 475 454.94 454.94 fee schedule 475 93 384.75 percent of total billed charges 475 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 475 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 475 51 242.25 percent of total billed charges 454.94 475 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vl Renal Artery Duplex Complete PX-921939750 CDM 93975 CPT 0921 RC outpatient 583.68 583.68 1039.6 1039.6 fee schedule 583.68 93 472.78 percent of total billed charges 583.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 583.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 583.68 51 297.68 percent of total billed charges 583.68 1039.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vl Renal Artery Duplex Limited PX-921939760 CDM 93976 CPT 0921 RC outpatient 488 488 611.15 611.15 fee schedule 488 93 395.28 percent of total billed charges 488 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 488 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 488 51 248.88 percent of total billed charges 488 611.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Duplex Limited, Abd, Pel, Retroperi V C" PX-921939761 CDM 93976 CPT 0921 RC outpatient 488 488 611.15 611.15 fee schedule 488 93 395.28 percent of total billed charges 488 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 488 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 488 51 248.88 percent of total billed charges 488 611.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vl Aortic Duplex Scan Complete PX-921939780 CDM 93978 CPT 0921 RC outpatient 732 732 583.86 583.86 fee schedule 732 93 592.92 percent of total billed charges 732 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 732 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249.85 other OPPS APC 732 51 373.32 percent of total billed charges 583.86 732 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vl Aortic Duplex Scan Limited PX-921939790 CDM 93979 CPT 0921 RC outpatient 454 454 410.45 410.45 fee schedule 454 93 367.74 percent of total billed charges 454 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 454 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 454 51 231.54 percent of total billed charges 410.45 454 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Vl Duplex Art/Ven Pre-OP Vessel Mapping, Unilateral" PX-921939860 CDM 93986 CPT 0921 RC outpatient 267.2 267.2 264.51 264.51 fee schedule 267.2 93 216.43 percent of total billed charges 267.2 267.2 other OPPS APC 267.2 267.2 other OPPS APC 267.2 51 136.27 percent of total billed charges 264.51 267.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Vl Duplex Hd Art Av Graft PX-921939900 CDM 93990 CPT 0921 RC outpatient 471 471 476.08 476.08 fee schedule 471 93 381.51 percent of total billed charges 471 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 471 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.1 other OPPS APC 471 51 240.21 percent of total billed charges 471 476.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Body Plethysmography PX-921947260 CDM 94726 CPT 0921 RC outpatient 747.65 747.65 110.64 110.64 fee schedule 747.65 93 605.6 percent of total billed charges 747.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 320.04 other OPPS APC 747.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 320.04 other OPPS APC 747.65 51 381.3 percent of total billed charges 110.64 747.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Phlebotomy-Therapeutic PX-940991591 CDM 99195 CPT 0940 RC outpatient 304.28 304.28 201.85 201.85 fee schedule 304.28 93 246.47 percent of total billed charges 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 51 155.18 percent of total billed charges 201.85 304.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Phlebotomy (Phle) PX-940991950 CDM 99195 CPT 0940 RC outpatient 304.28 304.28 201.85 201.85 fee schedule 304.28 93 246.47 percent of total billed charges 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130.25 other OPPS APC 304.28 51 155.18 percent of total billed charges 201.85 304.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Diabetes OP Self Mgmt Indiv. PX-942001080 CDM G0108 CPT 0942 RC outpatient 133.48 133.48 133.48 74 98.78 percent of total billed charges 133.48 93 108.12 percent of total billed charges 53.39 53.39 fee schedule 53.39 53.39 fee schedule 133.48 51 68.07 percent of total billed charges 53.39 133.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC D Iabetes OP Self Mgmt Group PX-942001090 CDM G0109 CPT 0942 RC outpatient 48 48 48 74 35.52 percent of total billed charges 48 93 38.88 percent of total billed charges 15.39 15.39 fee schedule 15.39 15.39 fee schedule 48 51 24.48 percent of total billed charges 15.39 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Glucose Monitor Continous Pt Equip PX-942952490 CDM 95249 CPT 0942 RC outpatient 145.7 145.7 145.7 74 107.82 percent of total billed charges 145.7 93 118.02 percent of total billed charges 145.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.37 other OPPS APC 145.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.37 other OPPS APC 145.7 51 74.31 percent of total billed charges 145.7 145.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mnt Initial Assess Ind 15 Min PX-942978020 CDM 97802 CPT 0942 RC outpatient 89.23 89.23 89.23 74 66.03 percent of total billed charges 89.23 93 72.28 percent of total billed charges 31.14 31.14 fee schedule 31.14 31.14 fee schedule 89.23 51 45.51 percent of total billed charges 31.14 89.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mnt Initial Assessment per 15 Mins PX-942978021 CDM 97802 CPT 0942 RC outpatient 89.23 89.23 89.23 74 66.03 percent of total billed charges 89.23 93 72.28 percent of total billed charges 31.14 31.14 fee schedule 31.14 31.14 fee schedule 89.23 51 45.51 percent of total billed charges 31.14 89.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mnt Interv & Reass Ind 15 Min PX-942978030 CDM 97803 CPT 0942 RC outpatient 77.73 77.73 77.73 74 57.52 percent of total billed charges 77.73 93 62.96 percent of total billed charges 26.55 26.55 fee schedule 26.55 26.55 fee schedule 77.73 51 39.64 percent of total billed charges 26.55 77.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mnt Fu 1:1 W Pt Each 15 Mins PX-942978031 CDM 97803 CPT 0942 RC outpatient 77.73 77.73 77.73 74 57.52 percent of total billed charges 77.73 93 62.96 percent of total billed charges 26.55 26.55 fee schedule 26.55 26.55 fee schedule 77.73 51 39.64 percent of total billed charges 26.55 77.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Mnt Group per 30 Minutes PX-942978041 CDM 97804 CPT 0942 RC outpatient 40.93 40.93 40.93 74 30.29 percent of total billed charges 40.93 93 33.15 percent of total billed charges 40.93 40.93 other OPPS APC 40.93 40.93 other OPPS APC 40.93 51 20.87 percent of total billed charges 40.93 40.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Diabetes OP Self Mgmt Ind. Rn PX-942990780 CDM 98960 CPT 0942 RC outpatient 72 72 72 74 53.28 percent of total billed charges 72 93 58.32 percent of total billed charges 53.39 53.39 fee schedule 53.39 53.39 fee schedule 72 51 36.72 percent of total billed charges 53.39 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Diabetes OP Self Mgmt Group 2-4 PX-942990781 CDM 98961 CPT 0942 RC outpatient 141 141 141 74 104.34 percent of total billed charges 141 93 114.21 percent of total billed charges 53.39 53.39 fee schedule 53.39 53.39 fee schedule 141 51 71.91 percent of total billed charges 53.39 141 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Diabetes OP Self Mgmt Group 5-8 PX-942990782 CDM 98962 CPT 0942 RC outpatient 40 40 40 74 29.6 percent of total billed charges 40 93 32.4 percent of total billed charges 15.39 15.39 fee schedule 15.39 15.39 fee schedule 40 51 20.4 percent of total billed charges 15.39 40 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Individual 30 Min Dsmt PX-942992111 CDM 99211 CPT 0942 RC outpatient 314.88 314.88 314.88 74 233.01 percent of total billed charges 314.88 93 255.05 percent of total billed charges 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 314.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.78 other OPPS APC 314.88 51 160.59 percent of total billed charges 314.88 314.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Smoking Cessation-Intermediate PX-942994060 CDM 99406 CPT 0942 RC outpatient 68.35 68.35 68.35 74 50.58 percent of total billed charges 68.35 93 55.36 percent of total billed charges 68.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.26 other OPPS APC 68.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.26 other OPPS APC 68.35 51 34.86 percent of total billed charges 68.35 68.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Smoking Cessation - Intensive PX-942994070 CDM 99407 CPT 0942 RC outpatient 68.35 68.35 68.35 74 50.58 percent of total billed charges 68.35 93 55.36 percent of total billed charges 68.35 68.35 other OPPS APC 68.35 68.35 other OPPS APC 68.35 51 34.86 percent of total billed charges 68.35 68.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Mnt 1:1 15 Min 2nd Ref/Year, Medicare" PX-942G02701 CDM G0270 CPT 0942 RC outpatient 77.73 77.73 77.73 74 57.52 percent of total billed charges 77.73 93 62.96 percent of total billed charges 26.55 26.55 fee schedule 26.55 26.55 fee schedule 77.73 51 39.64 percent of total billed charges 26.55 77.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HC Mnt Group 30 Min, 2nd Ref, Same Year" PX-942G02711 CDM G0271 CPT 0942 RC outpatient 40.93 40.93 40.93 74 30.29 percent of total billed charges 40.93 93 33.15 percent of total billed charges 40.93 40.93 other OPPS APC 40.93 40.93 other OPPS APC 40.93 51 20.87 percent of total billed charges 40.93 40.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Cardiac Rehab Therapy PX-943937981 CDM 93798 CPT 0943 RC outpatient 314.75 314.75 314.75 74 232.92 percent of total billed charges 314.75 93 254.95 percent of total billed charges 314.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.73 other OPPS APC 314.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.73 other OPPS APC 314.75 51 160.52 percent of total billed charges 314.75 314.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pulmonary Rehab-Copd PX-948004240 CDM G0424 CPT 0948 RC outpatient 100 100 100 74 74 percent of total billed charges 100 93 81 percent of total billed charges 100 100 other OPPS APC 100 100 other OPPS APC 100 51 51 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pulmonary Rehab W/O Continuous Oximetry Monitor PX-948946250 CDM 94625 CPT 0948 RC outpatient 145.7 145.7 134.17 134.17 fee schedule 145.7 93 118.02 percent of total billed charges 145.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.37 other OPPS APC 145.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.37 other OPPS APC 145.7 51 74.31 percent of total billed charges 134.17 145.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HC Pulmonary Rehab W/ Continuous Oximetry Monitor PX-948946260 CDM 94626 CPT 0948 RC outpatient 145.7 145.7 134.17 134.17 fee schedule 145.7 93 118.02 percent of total billed charges 145.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.37 other OPPS APC 145.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.37 other OPPS APC 145.7 51 74.31 percent of total billed charges 134.17 145.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Office Visit Level 3 Est 99213 PX-988992131 CDM 99213 CPT 0988 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 64.25 64.25 fee schedule 64.25 64.25 fee schedule 325 51 165.75 percent of total billed charges 64.25 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Office Visit Level 4 Est 99214 PX-988992141 CDM 99214 CPT 0988 RC outpatient 367 367 367 74 271.58 percent of total billed charges 367 93 297.27 percent of total billed charges 94.75 94.75 fee schedule 94.75 94.75 fee schedule 367 51 187.17 percent of total billed charges 94.75 367 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Office Visit Level 5 Est 99215 PX-988992151 CDM 99215 CPT 0988 RC outpatient 411 411 411 74 304.14 percent of total billed charges 411 93 332.91 percent of total billed charges 140.6 140.6 fee schedule 140.6 140.6 fee schedule 411 51 209.61 percent of total billed charges 140.6 411 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Initial Hospital Care/Day PX-988992211 CDM 99221 CPT 0988 RC outpatient 220 220 220 74 162.8 percent of total billed charges 220 93 178.2 percent of total billed charges 220 220 other OPPS APC 220 220 other OPPS APC 220 51 112.2 percent of total billed charges 220 220 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Initial Hospital Care/Day 50 Minutes 99222 PX-988992221 CDM 99222 CPT 0988 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 51 152.49 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Initial Hospital Care/Day 70 Minutes 99223 PX-988992231 CDM 99223 CPT 0988 RC outpatient 440 440 440 74 325.6 percent of total billed charges 440 93 356.4 percent of total billed charges 440 440 other OPPS APC 440 440 other OPPS APC 440 51 224.4 percent of total billed charges 440 440 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Subsequent Hospital Care 99231 PX-988992311 CDM 99231 CPT 0988 RC outpatient 88 88 88 74 65.12 percent of total billed charges 88 93 71.28 percent of total billed charges 88 88 other OPPS APC 88 88 other OPPS APC 88 51 44.88 percent of total billed charges 88 88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Subsequent Hospital Care 99232 PX-988992321 CDM 99232 CPT 0988 RC outpatient 160 160 160 74 118.4 percent of total billed charges 160 93 129.6 percent of total billed charges 160 160 other OPPS APC 160 160 other OPPS APC 160 51 81.6 percent of total billed charges 160 160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Subsequent Hospital Care 99233 PX-988992331 CDM 99233 CPT 0988 RC outpatient 229 229 229 74 169.46 percent of total billed charges 229 93 185.49 percent of total billed charges 229 229 other OPPS APC 229 229 other OPPS APC 229 51 116.79 percent of total billed charges 229 229 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Advncd Care Plan 30 Min 99497 PX-988994971 CDM 99497 CPT 0988 RC outpatient 424 424 424 74 313.76 percent of total billed charges 424 93 343.44 percent of total billed charges 424 424 other OPPS APC 424 424 other OPPS APC 424 51 216.24 percent of total billed charges 424 424 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MRI Brain W WO Contrast PX-IMG271B CDM 70553 CPT 0611 RC outpatient 2925 2925 2755.39 2755.39 fee schedule 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.12 other OPPS APC 214.67 214.67 fee schedule 214.67 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAMINOPHEN 160 MG/5 ML ORAL LIQUID RX-100 CDM A9270 HCPCS 0250 RC 00904-7014-16 NDC outpatient 473 ML 12.35 12.35 74 9.14 percent of total billed charges 12.35 93 10 percent of total billed charges 12.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.35 other OPPS APC 12.35 12.35 other OPPS APC 12.35 24.86 3.07 percent of total billed charges 12.35 12.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAMINOPHEN 160 MG/5 ML ORAL LIQUID RX-100 CDM A9270 HCPCS 0637 RC 00904-7014-16 NDC outpatient 473 ML 12.35 12.35 12.35 74 9.14 percent of total billed charges 12.35 93 10 percent of total billed charges 12.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.35 other OPPS APC 12.35 12.35 other OPPS APC 12.35 24.86 3.07 percent of total billed charges 12.35 12.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION RX-10010 CDM A9270 HCPCS 0250 RC 68382-0444-05 NDC outpatient 50 ML 441.88 441.88 74 326.99 percent of total billed charges 441.88 93 357.92 percent of total billed charges 441.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 441.88 other OPPS APC 441.88 441.88 other OPPS APC 441.88 24.86 109.85 percent of total billed charges 441.88 441.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION RX-10010 CDM A9270 HCPCS 0637 RC 68382-0444-05 NDC outpatient 50 ML 441.88 441.88 441.88 74 326.99 percent of total billed charges 441.88 93 357.92 percent of total billed charges 441.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 441.88 other OPPS APC 441.88 441.88 other OPPS APC 441.88 24.86 109.85 percent of total billed charges 441.88 441.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FAMOTIDINE 20 MG TABLET RX-10011 CDM A9270 HCPCS 0250 RC 00904-7193-61 NDC outpatient 1 UN 0.23 0.23 74 0.17 percent of total billed charges 0.23 93 0.19 percent of total billed charges 0.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.23 other OPPS APC 0.23 0.23 other OPPS APC 0.23 24.86 0.06 percent of total billed charges 0.23 0.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FAMOTIDINE 20 MG TABLET RX-10011 CDM A9270 HCPCS 0637 RC 00904-7193-61 NDC outpatient 1 UN 0.23 0.23 0.23 74 0.17 percent of total billed charges 0.23 93 0.19 percent of total billed charges 0.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.23 other OPPS APC 0.23 0.23 other OPPS APC 0.23 24.86 0.06 percent of total billed charges 0.23 0.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OFATUMUMAB 100 MG/5 ML INTRAVENOUS SOLUTION RX-100265 CDM J9302 HCPCS 0636 RC 00078-0669-13 NDC outpatient 5 ML 1342.35 1342.35 1342.35 74 993.34 percent of total billed charges 1342.35 93 1087.3 percent of total billed charges 1342.35 1342.35 other OPPS APC 1342.35 1342.35 other OPPS APC 1342.35 24.86 333.71 percent of total billed charges 1342.35 1342.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROMIDEPSIN 10 MG/2 ML INTRAVENOUS POWDER FOR SOLUTION RX-100344 CDM J9319 HCPCS 0250 RC 59572-0984-01 NDC outpatient 2 ML 9595.95 9595.95 9595.95 74 7101 percent of total billed charges 9595.95 93 7772.72 percent of total billed charges 9595.95 9595.95 other OPPS APC 9595.95 9595.95 other OPPS APC 9595.95 24.86 2385.55 percent of total billed charges 9595.95 9595.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILGRASTIM 300 MCG/ML INJECTION SOLUTION RX-10036 CDM J1442 HCPCS 0636 RC 55513-0530-01 NDC outpatient 1 ML 944.5 944.5 337.59 337.59 fee schedule 944.5 93 765.05 percent of total billed charges 944.5 944.5 other OPPS APC 944.5 944.5 other OPPS APC 944.5 24.86 234.8 percent of total billed charges 337.59 944.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FINASTERIDE 5 MG TABLET RX-10037 CDM A9270 HCPCS 0250 RC 00904-6830-06 NDC outpatient 1 UN 2.03 2.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.03 other OPPS APC 2.03 2.03 other OPPS APC 2.03 24.86 0.5 percent of total billed charges 2.03 2.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FINASTERIDE 5 MG TABLET RX-10037 CDM A9270 HCPCS 0637 RC 00904-6830-06 NDC outpatient 1 UN 2.03 2.03 2.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.03 other OPPS APC 2.03 2.03 other OPPS APC 2.03 24.86 0.5 percent of total billed charges 2.03 2.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FINASTERIDE 5 MG TABLET RX-10037 CDM A9270 HCPCS 0250 RC 50268-0314-15 NDC outpatient 1 UN 7.82 7.82 74 5.79 percent of total billed charges 7.82 93 6.33 percent of total billed charges 7.82 7.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FINASTERIDE 5 MG TABLET RX-10037 CDM A9270 HCPCS 0637 RC 50268-0314-15 NDC outpatient 1 UN 7.82 7.82 7.82 74 5.79 percent of total billed charges 7.82 93 6.33 percent of total billed charges 7.82 7.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLECAINIDE 50 MG TABLET RX-10043 CDM A9270 HCPCS 0250 RC 00054-0010-20 NDC outpatient 1 UN 5.05 5.05 74 3.74 percent of total billed charges 5.05 93 4.09 percent of total billed charges 5.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.05 other OPPS APC 5.05 5.05 other OPPS APC 5.05 24.86 1.26 percent of total billed charges 5.05 5.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLECAINIDE 50 MG TABLET RX-10043 CDM A9270 HCPCS 0637 RC 00054-0010-20 NDC outpatient 1 UN 5.05 5.05 5.05 74 3.74 percent of total billed charges 5.05 93 4.09 percent of total billed charges 5.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.05 other OPPS APC 5.05 5.05 other OPPS APC 5.05 24.86 1.26 percent of total billed charges 5.05 5.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUCONAZOLE 100 MG TABLET RX-10044 CDM A9270 HCPCS 0250 RC 50268-0337-15 NDC outpatient 1 UN 23.83 23.83 74 17.63 percent of total billed charges 23.83 93 19.3 percent of total billed charges 23.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 23.83 other OPPS APC 23.83 23.83 other OPPS APC 23.83 24.86 5.92 percent of total billed charges 23.83 23.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUCONAZOLE 100 MG TABLET RX-10044 CDM A9270 HCPCS 0637 RC 50268-0337-15 NDC outpatient 1 UN 23.83 23.83 23.83 74 17.63 percent of total billed charges 23.83 93 19.3 percent of total billed charges 23.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 23.83 other OPPS APC 23.83 23.83 other OPPS APC 23.83 24.86 5.92 percent of total billed charges 23.83 23.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUCONAZOLE 200 MG TABLET RX-10045 CDM A9270 HCPCS 0250 RC 50268-0339-15 NDC outpatient 1 UN 40.79 40.79 74 30.18 percent of total billed charges 40.79 93 33.04 percent of total billed charges 40.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40.79 other OPPS APC 40.79 40.79 other OPPS APC 40.79 24.86 10.14 percent of total billed charges 40.79 40.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUCONAZOLE 200 MG TABLET RX-10045 CDM A9270 HCPCS 0637 RC 50268-0339-15 NDC outpatient 1 UN 40.79 40.79 40.79 74 30.18 percent of total billed charges 40.79 93 33.04 percent of total billed charges 40.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40.79 other OPPS APC 40.79 40.79 other OPPS APC 40.79 24.86 10.14 percent of total billed charges 40.79 40.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUCONAZOLE 50 MG TABLET RX-10046 CDM A9270 HCPCS 0250 RC 57237-0003-30 NDC outpatient 1 UN 14.01 14.01 74 10.37 percent of total billed charges 14.01 93 11.35 percent of total billed charges 14.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.01 other OPPS APC 14.01 14.01 other OPPS APC 14.01 24.86 3.48 percent of total billed charges 14.01 14.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUCONAZOLE 50 MG TABLET RX-10046 CDM A9270 HCPCS 0637 RC 57237-0003-30 NDC outpatient 1 UN 14.01 14.01 14.01 74 10.37 percent of total billed charges 14.01 93 11.35 percent of total billed charges 14.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.01 other OPPS APC 14.01 14.01 other OPPS APC 14.01 24.86 3.48 percent of total billed charges 14.01 14.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK RX-10049 CDM J1450 HCPCS 0636 RC 00409-4688-22 NDC outpatient 100 ML 22.39 22.39 3.06 3.06 fee schedule 22.39 93 18.14 percent of total billed charges 22.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.39 other OPPS APC 22.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.39 other OPPS APC 22.39 24.86 5.57 percent of total billed charges 3.06 22.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK RX-10049 CDM J1450 HCPCS 0636 RC 00409-4688-22 NDC outpatient 200 ME 22.39 22.39 3.06 3.06 fee schedule 22.39 93 18.14 percent of total billed charges 22.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.39 other OPPS APC 22.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.39 other OPPS APC 22.39 24.86 5.57 percent of total billed charges 3.06 22.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK RX-10050 CDM J1450 HCPCS 0636 RC 25021-0184-87 NDC outpatient 200 ML 42 42 6.12 6.12 fee schedule 42 93 34.02 percent of total billed charges 42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42 other OPPS APC 42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42 other OPPS APC 42 24.86 10.44 percent of total billed charges 6.12 42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK RX-10050 CDM J1450 HCPCS 0636 RC 25021-0184-87 NDC outpatient 400 ME 42 42 6.12 6.12 fee schedule 42 93 34.02 percent of total billed charges 42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42 other OPPS APC 42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42 other OPPS APC 42 24.86 10.44 percent of total billed charges 6.12 42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUCYTOSINE 500 MG CAPSULE RX-10052 CDM A9270 HCPCS 0250 RC 43386-0770-01 NDC outpatient 1 UN 397.02 397.02 74 293.79 percent of total billed charges 397.02 93 321.59 percent of total billed charges 397.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 397.02 other OPPS APC 397.02 397.02 other OPPS APC 397.02 24.86 98.7 percent of total billed charges 397.02 397.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUCYTOSINE 500 MG CAPSULE RX-10052 CDM A9270 HCPCS 0637 RC 43386-0770-01 NDC outpatient 1 UN 397.02 397.02 397.02 74 293.79 percent of total billed charges 397.02 93 321.59 percent of total billed charges 397.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 397.02 other OPPS APC 397.02 397.02 other OPPS APC 397.02 24.86 98.7 percent of total billed charges 397.02 397.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUDROCORTISONE 0.1 MG TABLET RX-10054 CDM A9270 HCPCS 0250 RC 50268-0330-15 NDC outpatient 1 UN 4 4 74 2.96 percent of total billed charges 4 93 3.24 percent of total billed charges 4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4 other OPPS APC 4 4 other OPPS APC 4 24.86 0.99 percent of total billed charges 4 4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUDROCORTISONE 0.1 MG TABLET RX-10054 CDM A9270 HCPCS 0637 RC 50268-0330-15 NDC outpatient 1 UN 4 4 4 74 2.96 percent of total billed charges 4 93 3.24 percent of total billed charges 4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4 other OPPS APC 4 4 other OPPS APC 4 24.86 0.99 percent of total billed charges 4 4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION RX-10059 CDM 250000000 HCPCS 0250 RC 17478-0253-10 NDC outpatient 5 ML 216 216 216 74 159.84 percent of total billed charges 216 93 174.96 percent of total billed charges 216 216 other OPPS APC 216 216 other OPPS APC 216 24.86 53.7 percent of total billed charges 216 216 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DICLOFENAC EPOLAMINE 1.3 % TRANSDERMAL 12 HOUR PATCH RX-100614 CDM A9270 HCPCS 0250 RC 82347-0405-04 NDC outpatient 1 UN 31.89 31.89 74 23.6 percent of total billed charges 31.89 93 25.83 percent of total billed charges 31.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 31.89 other OPPS APC 31.89 31.89 other OPPS APC 31.89 24.86 7.93 percent of total billed charges 31.89 31.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DICLOFENAC EPOLAMINE 1.3 % TRANSDERMAL 12 HOUR PATCH RX-100614 CDM A9270 HCPCS 0637 RC 82347-0405-04 NDC outpatient 1 UN 31.89 31.89 31.89 74 23.6 percent of total billed charges 31.89 93 25.83 percent of total billed charges 31.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 31.89 other OPPS APC 31.89 31.89 other OPPS APC 31.89 24.86 7.93 percent of total billed charges 31.89 31.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUOXETINE 20 MG CAPSULE RX-10070 CDM A9270 HCPCS 0250 RC 00904-7346-61 NDC outpatient 1 UN 0.29 0.29 74 0.21 percent of total billed charges 0.29 93 0.23 percent of total billed charges 0.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.29 other OPPS APC 0.29 0.29 other OPPS APC 0.29 24.86 0.07 percent of total billed charges 0.29 0.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUOXETINE 20 MG CAPSULE RX-10070 CDM A9270 HCPCS 0637 RC 00904-7346-61 NDC outpatient 1 UN 0.29 0.29 0.29 74 0.21 percent of total billed charges 0.29 93 0.23 percent of total billed charges 0.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.29 other OPPS APC 0.29 0.29 other OPPS APC 0.29 24.86 0.07 percent of total billed charges 0.29 0.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION RX-100740 CDM J1742 HCPCS 0636 RC 23155-0326-31 NDC outpatient 10 ML 932.2 932.2 932.2 74 689.83 percent of total billed charges 932.2 93 755.08 percent of total billed charges 932.2 932.2 other OPPS APC 932.2 932.2 other OPPS APC 932.2 24.86 231.74 percent of total billed charges 932.2 932.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLURBIPROFEN 0.03 % EYE DROPS RX-10080 CDM A9270 HCPCS 0250 RC 69292-0722-25 NDC outpatient 2.5 ML 108 108 74 79.92 percent of total billed charges 108 93 87.48 percent of total billed charges 108 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 108 other OPPS APC 108 108 other OPPS APC 108 24.86 26.85 percent of total billed charges 108 108 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLURBIPROFEN 0.03 % EYE DROPS RX-10080 CDM A9270 HCPCS 0637 RC 69292-0722-25 NDC outpatient 2.5 ML 108 108 108 74 79.92 percent of total billed charges 108 93 87.48 percent of total billed charges 108 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 108 other OPPS APC 108 108 other OPPS APC 108 24.86 26.85 percent of total billed charges 108 108 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUVOXAMINE 50 MG TABLET RX-10085 CDM A9270 HCPCS 0250 RC 00832-1671-11 NDC outpatient 1 UN 6.44 6.44 74 4.77 percent of total billed charges 6.44 93 5.22 percent of total billed charges 6.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.44 other OPPS APC 6.44 6.44 other OPPS APC 6.44 24.86 1.6 percent of total billed charges 6.44 6.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUVOXAMINE 50 MG TABLET RX-10085 CDM A9270 HCPCS 0637 RC 00832-1671-11 NDC outpatient 1 UN 6.44 6.44 6.44 74 4.77 percent of total billed charges 6.44 93 5.22 percent of total billed charges 6.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.44 other OPPS APC 6.44 6.44 other OPPS APC 6.44 24.86 1.6 percent of total billed charges 6.44 6.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAMINOPHEN 325 MG TABLET RX-101 CDM A9150 HCPCS 0250 RC 00904-6773-61 NDC outpatient 1 UN 0.17 0.17 74 0.13 percent of total billed charges 0.17 93 0.14 percent of total billed charges 0.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.17 other OPPS APC 0.17 0.17 other OPPS APC 0.17 24.86 0.04 percent of total billed charges 0.17 0.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAMINOPHEN 325 MG TABLET RX-101 CDM A9150 HCPCS 0637 RC 00904-6773-61 NDC outpatient 1 UN 0.17 0.17 0.17 74 0.13 percent of total billed charges 0.17 93 0.14 percent of total billed charges 0.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.17 other OPPS APC 0.17 0.17 other OPPS APC 0.17 24.86 0.04 percent of total billed charges 0.17 0.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION RX-10100 CDM A9579 HCPCS 0636 RC 00270-1111-04 NDC outpatient 5 ML 45 45 8.83 8.83 fee schedule 45 93 36.45 percent of total billed charges 45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 45 other OPPS APC 45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 45 other OPPS APC 45 24.86 11.19 percent of total billed charges 8.83 45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MENINGOC VAC A,C,Y,W-135 DIP(PF) 10 MCG-5 MCG/0.5 ML IM KIT (2 VIALS)" RX-101034 CDM 250000000 HCPCS 0250 RC 58160-0955-09 NDC outpatient 0.5 ML 471.68 471.68 471.68 74 349.04 percent of total billed charges 471.68 93 382.06 percent of total billed charges 471.68 471.68 other OPPS APC 471.68 471.68 other OPPS APC 471.68 24.86 117.26 percent of total billed charges 471.68 471.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK RX-10106 CDM J1580 HCPCS 0636 RC 00338-0503-48 NDC outpatient 100 ML 11.97 11.97 3.41 3.41 fee schedule 11.97 93 9.7 percent of total billed charges 11.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.97 other OPPS APC 11.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.97 other OPPS APC 11.97 24.86 2.98 percent of total billed charges 3.41 11.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK RX-10106 CDM J1580 HCPCS 0636 RC 00338-0503-48 NDC outpatient 80 ME 11.97 11.97 3.41 3.41 fee schedule 11.97 93 9.7 percent of total billed charges 11.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.97 other OPPS APC 11.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.97 other OPPS APC 11.97 24.86 2.98 percent of total billed charges 3.41 11.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENTAMICIN 100 MG/50 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK RX-10112 CDM J1580 HCPCS 0636 RC 00338-0511-41 NDC outpatient 100 ME 12.45 12.45 6.82 6.82 fee schedule 12.45 93 10.08 percent of total billed charges 12.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.45 other OPPS APC 12.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.45 other OPPS APC 12.45 24.86 3.1 percent of total billed charges 6.82 12.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENTAMICIN 100 MG/50 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK RX-10112 CDM J1580 HCPCS 0636 RC 00338-0511-41 NDC outpatient 50 ML 12.45 12.45 6.82 6.82 fee schedule 12.45 93 10.08 percent of total billed charges 12.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.45 other OPPS APC 12.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.45 other OPPS APC 12.45 24.86 3.1 percent of total billed charges 6.82 12.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENTAMICIN 100 MG/50 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|DISCARDED DRUG NOT ADMINISTERED RX-10112 CDM J1580 HCPCS 0636 RC 00338-0511-41 NDC JW outpatient 100 ME 12.45 12.45 3.41 3.41 fee schedule 3.41 12.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIPIZIDE 10 MG TABLET RX-10116 CDM A9270 HCPCS 0250 RC 50268-0362-15 NDC outpatient 1 UN 1.9 1.9 74 1.41 percent of total billed charges 1.9 93 1.54 percent of total billed charges 1.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.9 other OPPS APC 1.9 1.9 other OPPS APC 1.9 24.86 0.47 percent of total billed charges 1.9 1.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIPIZIDE 10 MG TABLET RX-10116 CDM A9270 HCPCS 0637 RC 50268-0362-15 NDC outpatient 1 UN 1.9 1.9 1.9 74 1.41 percent of total billed charges 1.9 93 1.54 percent of total billed charges 1.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.9 other OPPS APC 1.9 1.9 other OPPS APC 1.9 24.86 0.47 percent of total billed charges 1.9 1.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIPIZIDE 5 MG TABLET RX-10117 CDM A9270 HCPCS 0250 RC 50268-0361-11 NDC outpatient 1 UN 1.11 1.11 74 0.82 percent of total billed charges 1.11 93 0.9 percent of total billed charges 1.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.11 other OPPS APC 1.11 1.11 other OPPS APC 1.11 24.86 0.28 percent of total billed charges 1.11 1.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIPIZIDE 5 MG TABLET RX-10117 CDM A9270 HCPCS 0637 RC 50268-0361-11 NDC outpatient 1 UN 1.11 1.11 1.11 74 0.82 percent of total billed charges 1.11 93 0.9 percent of total billed charges 1.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.11 other OPPS APC 1.11 1.11 other OPPS APC 1.11 24.86 0.28 percent of total billed charges 1.11 1.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLYCOPYRROLATE 1 MG TABLET RX-10130 CDM A9270 HCPCS 0250 RC 00904-6709-61 NDC outpatient 1 UN 3.25 3.25 74 2.41 percent of total billed charges 3.25 93 2.63 percent of total billed charges 3.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.25 other OPPS APC 3.25 3.25 other OPPS APC 3.25 24.86 0.81 percent of total billed charges 3.25 3.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLYCOPYRROLATE 1 MG TABLET RX-10130 CDM A9270 HCPCS 0637 RC 00904-6709-61 NDC outpatient 1 UN 3.25 3.25 3.25 74 2.41 percent of total billed charges 3.25 93 2.63 percent of total billed charges 3.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.25 other OPPS APC 3.25 3.25 other OPPS APC 3.25 24.86 0.81 percent of total billed charges 3.25 3.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT RX-10137 CDM J9202 HCPCS 0636 RC 70720-0950-36 NDC outpatient 3.6 ME 2978.45 2978.45 700.38 700.38 fee schedule 2978.45 93 2412.54 percent of total billed charges 2978.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 674.77 other OPPS APC 2978.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 674.77 other OPPS APC 2978.45 24.86 740.44 percent of total billed charges 700.38 2978.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION" RX-10176 CDM J1644 HCPCS 0636 RC 00781-3538-25 NDC outpatient 1 ML 5.63 5.63 5.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.63 other OPPS APC 5.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.63 other OPPS APC 5.63 24.86 1.4 percent of total billed charges 5.63 5.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION" RX-10176 CDM J1644 HCPCS 0636 RC 71288-0402-02 NDC outpatient 1 ML 5.4 5.4 0.3 0.3 fee schedule 5.4 93 4.37 percent of total billed charges 0.3 5.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION" RX-10181 CDM J1644 HCPCS 0636 RC 25021-0402-01 NDC outpatient 1 ML 4.5 4.5 4.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.5 other OPPS APC 4.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.5 other OPPS APC 4.5 24.86 1.12 percent of total billed charges 4.5 4.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION" RX-10181 CDM J1644 HCPCS 0636 RC 72603-0412-25 NDC outpatient 1 ML 4.73 4.73 1.51 1.51 fee schedule 4.73 93 3.83 percent of total billed charges 1.51 4.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEPATITIS B IMMUNE GLOBULIN GREATR THAN 312 UNIT/ML INTRAMUSCULAR SOLN RX-10183 CDM 90371 HCPCS 0636 RC 69800-4202-01 NDC outpatient 1 ML 515.68 515.68 156.09 156.09 fee schedule 515.68 93 417.7 percent of total billed charges 515.68 515.68 other OPPS APC 515.68 515.68 other OPPS APC 515.68 24.86 128.2 percent of total billed charges 156.09 515.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCORTISONE 5 MG TABLET RX-10209 CDM A9270 HCPCS 0250 RC 59651-0413-50 NDC outpatient 1 UN 0.85 0.85 74 0.63 percent of total billed charges 0.85 93 0.69 percent of total billed charges 0.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.85 other OPPS APC 0.85 0.85 other OPPS APC 0.85 24.86 0.21 percent of total billed charges 0.85 0.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCORTISONE 5 MG TABLET RX-10209 CDM A9270 HCPCS 0637 RC 59651-0413-50 NDC outpatient 1 UN 0.85 0.85 0.85 74 0.63 percent of total billed charges 0.85 93 0.69 percent of total billed charges 0.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.85 other OPPS APC 0.85 0.85 other OPPS APC 0.85 24.86 0.21 percent of total billed charges 0.85 0.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCORTISONE 100 MG/60 ML ENEMA RX-10210 CDM A9270 HCPCS 0250 RC 62559-0138-07 NDC outpatient 1 UN 64.29 64.29 74 47.57 percent of total billed charges 64.29 93 52.07 percent of total billed charges 64.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 64.29 other OPPS APC 64.29 64.29 other OPPS APC 64.29 24.86 15.98 percent of total billed charges 64.29 64.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCORTISONE 100 MG/60 ML ENEMA RX-10210 CDM A9270 HCPCS 0637 RC 62559-0138-07 NDC outpatient 1 UN 64.29 64.29 64.29 74 47.57 percent of total billed charges 64.29 93 52.07 percent of total billed charges 64.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 64.29 other OPPS APC 64.29 64.29 other OPPS APC 64.29 24.86 15.98 percent of total billed charges 64.29 64.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROXYCHLOROQUINE 200 MG TABLET RX-10235 CDM A9270 HCPCS 0250 RC 00904-7046-61 NDC outpatient 1 UN 4.17 4.17 74 3.09 percent of total billed charges 4.17 93 3.38 percent of total billed charges 4.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.17 other OPPS APC 4.17 4.17 other OPPS APC 4.17 24.86 1.04 percent of total billed charges 4.17 4.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROXYCHLOROQUINE 200 MG TABLET RX-10235 CDM A9270 HCPCS 0637 RC 00904-7046-61 NDC outpatient 1 UN 4.17 4.17 4.17 74 3.09 percent of total billed charges 4.17 93 3.38 percent of total billed charges 4.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.17 other OPPS APC 4.17 4.17 other OPPS APC 4.17 24.86 1.04 percent of total billed charges 4.17 4.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROXYUREA 500 MG CAPSULE RX-10236 CDM A9270 HCPCS 0250 RC 00904-6939-61 NDC outpatient 1 UN 2.9 2.9 74 2.15 percent of total billed charges 2.9 93 2.35 percent of total billed charges 2.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.9 other OPPS APC 2.9 2.9 other OPPS APC 2.9 24.86 0.72 percent of total billed charges 2.9 2.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROXYUREA 500 MG CAPSULE RX-10236 CDM A9270 HCPCS 0637 RC 00904-6939-61 NDC outpatient 1 UN 2.9 2.9 2.9 74 2.15 percent of total billed charges 2.9 93 2.35 percent of total billed charges 2.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.9 other OPPS APC 2.9 2.9 other OPPS APC 2.9 24.86 0.72 percent of total billed charges 2.9 2.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBUPROFEN 100 MG/5 ML ORAL SUSPENSION RX-10246 CDM A9270 HCPCS 0250 RC 00121-0914-00 NDC outpatient 5 ML 2.18 2.18 74 1.61 percent of total billed charges 2.18 93 1.77 percent of total billed charges 2.18 2.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBUPROFEN 100 MG/5 ML ORAL SUSPENSION RX-10246 CDM A9270 HCPCS 0637 RC 00121-0914-00 NDC outpatient 5 ML 2.18 2.18 2.18 74 1.61 percent of total billed charges 2.18 93 1.77 percent of total billed charges 2.18 2.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBUPROFEN 100 MG/5 ML ORAL SUSPENSION RX-10246 CDM A9270 HCPCS 0250 RC 68094-0494-61 NDC outpatient 5 ML 2.36 2.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.36 other OPPS APC 2.36 2.36 other OPPS APC 2.36 24.86 0.59 percent of total billed charges 2.36 2.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBUPROFEN 100 MG/5 ML ORAL SUSPENSION RX-10246 CDM A9270 HCPCS 0637 RC 68094-0494-61 NDC outpatient 5 ML 2.36 2.36 2.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.36 other OPPS APC 2.36 2.36 other OPPS APC 2.36 24.86 0.59 percent of total billed charges 2.36 2.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION RX-10248 CDM J9208 HCPCS 0636 RC 63323-0142-10 NDC outpatient 20 ML 174.15 174.15 28.98 28.98 fee schedule 174.15 93 141.06 percent of total billed charges 174.15 174.15 other OPPS APC 174.15 174.15 other OPPS APC 174.15 24.86 43.29 percent of total billed charges 28.98 174.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION RX-10266 CDM 250000000 HCPCS 0250 RC 70100-0424-02 NDC outpatient 10 ML 636.72 636.72 636.72 74 471.17 percent of total billed charges 636.72 93 515.74 percent of total billed charges 636.72 636.72 other OPPS APC 636.72 636.72 other OPPS APC 636.72 24.86 158.29 percent of total billed charges 636.72 636.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION RX-10266 CDM 250000000 HCPCS 0250 RC 70100-0424-02 NDC outpatient 25 ME 636.72 636.72 636.72 74 471.17 percent of total billed charges 636.72 93 515.74 percent of total billed charges 636.72 636.72 other OPPS APC 636.72 636.72 other OPPS APC 636.72 24.86 158.29 percent of total billed charges 636.72 636.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION RX-10284 CDM A9270 HCPCS 0250 RC 00002-8315-01 NDC outpatient 10 ML 133.83 133.83 74 99.03 percent of total billed charges 133.83 93 108.4 percent of total billed charges 133.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 133.83 other OPPS APC 133.83 133.83 other OPPS APC 133.83 24.86 33.27 percent of total billed charges 133.83 133.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION RX-10284 CDM A9270 HCPCS 0637 RC 00002-8315-01 NDC outpatient 10 ML 133.83 133.83 133.83 74 99.03 percent of total billed charges 133.83 93 108.4 percent of total billed charges 133.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 133.83 other OPPS APC 133.83 133.83 other OPPS APC 133.83 24.86 33.27 percent of total billed charges 133.83 133.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP RX-10286 CDM A9270 HCPCS 0250 RC 00002-8715-01 NDC outpatient 10 ML 133.83 133.83 74 99.03 percent of total billed charges 133.83 93 108.4 percent of total billed charges 133.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 133.83 other OPPS APC 133.83 133.83 other OPPS APC 133.83 24.86 33.27 percent of total billed charges 133.83 133.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP RX-10286 CDM A9270 HCPCS 0637 RC 00002-8715-01 NDC outpatient 10 ML 133.83 133.83 133.83 74 99.03 percent of total billed charges 133.83 93 108.4 percent of total billed charges 133.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 133.83 other OPPS APC 133.83 133.83 other OPPS APC 133.83 24.86 33.27 percent of total billed charges 133.83 133.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP RX-10286 CDM A9270 HCPCS 0250 RC 00002-8715-17 NDC outpatient 3 ML 133.83 133.83 74 99.03 percent of total billed charges 133.83 93 108.4 percent of total billed charges 133.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 133.83 other OPPS APC 133.83 133.83 other OPPS APC 133.83 24.86 33.27 percent of total billed charges 133.83 133.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP RX-10286 CDM A9270 HCPCS 0637 RC 00002-8715-17 NDC outpatient 3 ML 133.83 133.83 133.83 74 99.03 percent of total billed charges 133.83 93 108.4 percent of total billed charges 133.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 133.83 other OPPS APC 133.83 133.83 other OPPS APC 133.83 24.86 33.27 percent of total billed charges 133.83 133.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION RX-10289 CDM J1815 HCPCS 0250 RC 00002-8215-01 NDC outpatient 10 ML 133.83 133.83 74 99.03 percent of total billed charges 133.83 93 108.4 percent of total billed charges 133.83 133.83 other OPPS APC 133.83 133.83 other OPPS APC 133.83 24.86 33.27 percent of total billed charges 133.83 133.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION RX-10289 CDM J1815 HCPCS 0637 RC 00002-8215-01 NDC outpatient 10 ML 133.83 133.83 133.83 74 99.03 percent of total billed charges 133.83 93 108.4 percent of total billed charges 133.83 133.83 other OPPS APC 133.83 133.83 other OPPS APC 133.83 24.86 33.27 percent of total billed charges 133.83 133.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY RX-103 CDM A9270 HCPCS 0250 RC 45802-0732-30 NDC outpatient 1 UN 1.46 1.46 74 1.08 percent of total billed charges 1.46 93 1.18 percent of total billed charges 1.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.46 other OPPS APC 1.46 1.46 other OPPS APC 1.46 24.86 0.36 percent of total billed charges 1.46 1.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY RX-103 CDM A9270 HCPCS 0637 RC 45802-0732-30 NDC outpatient 1 UN 1.46 1.46 1.46 74 1.08 percent of total billed charges 1.46 93 1.18 percent of total billed charges 1.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.46 other OPPS APC 1.46 1.46 other OPPS APC 1.46 24.86 0.36 percent of total billed charges 1.46 1.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM RX-1031 CDM A9270 HCPCS 0250 RC 00713-0326-15 NDC outpatient 15 GR 55.93 55.93 74 41.39 percent of total billed charges 55.93 93 45.3 percent of total billed charges 55.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.93 other OPPS APC 55.93 55.93 other OPPS APC 55.93 24.86 13.9 percent of total billed charges 55.93 55.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BETAMETHASONE VALERATE 0.1 % TOPICAL CREAM RX-1031 CDM A9270 HCPCS 0637 RC 00713-0326-15 NDC outpatient 15 GR 55.93 55.93 55.93 74 41.39 percent of total billed charges 55.93 93 45.3 percent of total billed charges 55.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.93 other OPPS APC 55.93 55.93 other OPPS APC 55.93 24.86 13.9 percent of total billed charges 55.93 55.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BETAMETHASONE VALERATE 0.1 % LOTION RX-1032 CDM A9270 HCPCS 0250 RC 00168-0041-60 NDC outpatient 60 ML 180 180 74 133.2 percent of total billed charges 180 93 145.8 percent of total billed charges 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 180 other OPPS APC 180 24.86 44.75 percent of total billed charges 180 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BETAMETHASONE VALERATE 0.1 % LOTION RX-1032 CDM A9270 HCPCS 0637 RC 00168-0041-60 NDC outpatient 60 ML 180 180 180 74 133.2 percent of total billed charges 180 93 145.8 percent of total billed charges 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 180 other OPPS APC 180 24.86 44.75 percent of total billed charges 180 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION RX-10323 CDM Q9967 HCPCS 0636 RC 00407-1414-91 NDC outpatient 100 ML 100 100 14.52 14.52 fee schedule 100 93 81 percent of total billed charges 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 24.86 24.86 percent of total billed charges 14.52 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IOPAMIDOL 200 MG IODINE/ML (41 %) INTRATHECAL SOLUTION RX-10325 CDM Q9966 HCPCS 0636 RC 00270-1411-11 NDC outpatient 10 ML 30 30 4.24 4.24 fee schedule 30 93 24.3 percent of total billed charges 30 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30 other OPPS APC 30 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30 other OPPS APC 30 24.86 7.46 percent of total billed charges 4.24 30 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IOPAMIDOL 300 MG IODINE/ML (61 %) INTRATHECAL SOLUTION RX-10327 CDM Q9967 HCPCS 0636 RC 00270-1412-15 NDC outpatient 15 ML 15 15 2.18 2.18 fee schedule 15 93 12.15 percent of total billed charges 15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15 other OPPS APC 15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15 other OPPS APC 15 24.86 3.73 percent of total billed charges 2.18 15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IOPAMIDOL 370 MG IODINE/ML (76 %) INTRAVENOUS SOLUTION RX-10328 CDM Q9967 HCPCS 0636 RC 00270-1316-30 NDC outpatient 50 ML 50 50 7.26 7.26 fee schedule 50 93 40.5 percent of total billed charges 50 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 50 other OPPS APC 50 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 50 other OPPS APC 50 24.86 12.43 percent of total billed charges 7.26 50 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT RX-1033 CDM A9270 HCPCS 0250 RC 00168-0033-15 NDC outpatient 15 GR 50.85 50.85 74 37.63 percent of total billed charges 50.85 93 41.19 percent of total billed charges 50.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 50.85 other OPPS APC 50.85 50.85 other OPPS APC 50.85 24.86 12.64 percent of total billed charges 50.85 50.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BETAMETHASONE VALERATE 0.1 % TOPICAL OINTMENT RX-1033 CDM A9270 HCPCS 0637 RC 00168-0033-15 NDC outpatient 15 GR 50.85 50.85 50.85 74 37.63 percent of total billed charges 50.85 93 41.19 percent of total billed charges 50.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 50.85 other OPPS APC 50.85 50.85 other OPPS APC 50.85 24.86 12.64 percent of total billed charges 50.85 50.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IOTHALAMATE MEGLUMINE 60 % INJECTION SOLUTION RX-10333 CDM Q9961 HCPCS 0636 RC 00019-0953-05 NDC outpatient 50 ML 50 50 6.05 6.05 fee schedule 50 93 40.5 percent of total billed charges 50 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 50 other OPPS APC 50 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 50 other OPPS APC 50 24.86 12.43 percent of total billed charges 6.05 50 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ITRACONAZOLE 100 MG CAPSULE RX-10364 CDM A9270 HCPCS 0250 RC 60687-0299-25 NDC outpatient 1 UN 10 10 74 7.4 percent of total billed charges 10 93 8.1 percent of total billed charges 10 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10 other OPPS APC 10 10 other OPPS APC 10 24.86 2.49 percent of total billed charges 10 10 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ITRACONAZOLE 100 MG CAPSULE RX-10364 CDM A9270 HCPCS 0637 RC 60687-0299-25 NDC outpatient 1 UN 10 10 10 74 7.4 percent of total billed charges 10 93 8.1 percent of total billed charges 10 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10 other OPPS APC 10 10 other OPPS APC 10 24.86 2.49 percent of total billed charges 10 10 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KETOCONAZOLE 2 % TOPICAL CREAM RX-10368 CDM A9270 HCPCS 0250 RC 51672-1298-01 NDC outpatient 15 GR 328.33 328.33 74 242.96 percent of total billed charges 328.33 93 265.95 percent of total billed charges 328.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 328.33 other OPPS APC 328.33 328.33 other OPPS APC 328.33 24.86 81.62 percent of total billed charges 328.33 328.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KETOCONAZOLE 2 % TOPICAL CREAM RX-10368 CDM A9270 HCPCS 0637 RC 51672-1298-01 NDC outpatient 15 GR 328.33 328.33 328.33 74 242.96 percent of total billed charges 328.33 93 265.95 percent of total billed charges 328.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 328.33 other OPPS APC 328.33 328.33 other OPPS APC 328.33 24.86 81.62 percent of total billed charges 328.33 328.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KETOROLAC 10 MG TABLET RX-10371 CDM A9270 HCPCS 0250 RC 69452-0275-20 NDC outpatient 1 UN 5.4 5.4 74 4 percent of total billed charges 5.4 93 4.37 percent of total billed charges 5.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.4 other OPPS APC 5.4 5.4 other OPPS APC 5.4 24.86 1.34 percent of total billed charges 5.4 5.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KETOROLAC 10 MG TABLET RX-10371 CDM A9270 HCPCS 0637 RC 69452-0275-20 NDC outpatient 1 UN 5.4 5.4 5.4 74 4 percent of total billed charges 5.4 93 4.37 percent of total billed charges 5.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.4 other OPPS APC 5.4 5.4 other OPPS APC 5.4 24.86 1.34 percent of total billed charges 5.4 5.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LABETALOL 5 MG/ML INTRAVENOUS SOLUTION RX-10372 CDM J1920 HCPCS 0636 RC 36000-0320-01 NDC outpatient 4 ML 12.66 12.66 1.11 1.11 fee schedule 12.66 93 10.25 percent of total billed charges 12.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.07 other OPPS APC 12.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.07 other OPPS APC 12.66 24.86 3.15 percent of total billed charges 1.11 12.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LABETALOL 5 MG/ML INTRAVENOUS SOLUTION RX-10372 CDM J1920 HCPCS 0636 RC 36000-0324-01 NDC outpatient 40 ML 14.38 14.38 11.13 11.13 fee schedule 14.38 93 11.65 percent of total billed charges 14.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.68 other OPPS APC 14.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.68 other OPPS APC 14.38 24.86 3.57 percent of total billed charges 11.13 14.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LABETALOL 5 MG/ML INTRAVENOUS SOLUTION RX-10372 CDM J1920 HCPCS 0636 RC 72603-0146-01 NDC outpatient 20 ML 19.03 19.03 5.57 5.57 fee schedule 19.03 93 15.41 percent of total billed charges 19.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.34 other OPPS APC 19.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.34 other OPPS APC 19.03 24.86 4.73 percent of total billed charges 5.57 19.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LABETALOL 100 MG TABLET RX-10373 CDM A9270 HCPCS 0250 RC 60687-0439-11 NDC outpatient 1 UN 1.36 1.36 74 1.01 percent of total billed charges 1.36 93 1.1 percent of total billed charges 1.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.36 other OPPS APC 1.36 1.36 other OPPS APC 1.36 24.86 0.34 percent of total billed charges 1.36 1.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LABETALOL 100 MG TABLET RX-10373 CDM A9270 HCPCS 0637 RC 60687-0439-11 NDC outpatient 1 UN 1.36 1.36 1.36 74 1.01 percent of total billed charges 1.36 93 1.1 percent of total billed charges 1.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.36 other OPPS APC 1.36 1.36 other OPPS APC 1.36 24.86 0.34 percent of total billed charges 1.36 1.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMMONIUM LACTATE 12 % LOTION RX-10380 CDM A9270 HCPCS 0250 RC 00904-5984-26 NDC outpatient 226 GR 95.3 95.3 74 70.52 percent of total billed charges 95.3 93 77.19 percent of total billed charges 95.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 95.3 other OPPS APC 95.3 95.3 other OPPS APC 95.3 24.86 23.69 percent of total billed charges 95.3 95.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMMONIUM LACTATE 12 % LOTION RX-10380 CDM A9270 HCPCS 0637 RC 00904-5984-26 NDC outpatient 226 GR 95.3 95.3 95.3 74 70.52 percent of total billed charges 95.3 93 77.19 percent of total billed charges 95.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 95.3 other OPPS APC 95.3 95.3 other OPPS APC 95.3 24.86 23.69 percent of total billed charges 95.3 95.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAMSULOSIN 0.4 MG CAPSULE RX-103890 CDM A9270 HCPCS 0250 RC 50268-0740-11 NDC outpatient 1 UN 1.19 1.19 74 0.88 percent of total billed charges 1.19 93 0.96 percent of total billed charges 1.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.19 other OPPS APC 1.19 1.19 other OPPS APC 1.19 24.86 0.3 percent of total billed charges 1.19 1.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAMSULOSIN 0.4 MG CAPSULE RX-103890 CDM A9270 HCPCS 0637 RC 50268-0740-11 NDC outpatient 1 UN 1.19 1.19 1.19 74 0.88 percent of total billed charges 1.19 93 0.96 percent of total billed charges 1.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.19 other OPPS APC 1.19 1.19 other OPPS APC 1.19 24.86 0.3 percent of total billed charges 1.19 1.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY RX-104 CDM A9270 HCPCS 0250 RC 51672-2116-02 NDC outpatient 1 UN 2.01 2.01 74 1.49 percent of total billed charges 2.01 93 1.63 percent of total billed charges 2.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.01 other OPPS APC 2.01 2.01 other OPPS APC 2.01 24.86 0.5 percent of total billed charges 2.01 2.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY RX-104 CDM A9270 HCPCS 0637 RC 51672-2116-02 NDC outpatient 1 UN 2.01 2.01 2.01 74 1.49 percent of total billed charges 2.01 93 1.63 percent of total billed charges 2.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.01 other OPPS APC 2.01 2.01 other OPPS APC 2.01 24.86 0.5 percent of total billed charges 2.01 2.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOTHYROXINE 88 MCG TABLET RX-10403 CDM A9270 HCPCS 0250 RC 42292-0038-20 NDC outpatient 1 UN 1.52 1.52 74 1.12 percent of total billed charges 1.52 93 1.23 percent of total billed charges 1.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.52 other OPPS APC 1.52 1.52 other OPPS APC 1.52 24.86 0.38 percent of total billed charges 1.52 1.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOTHYROXINE 88 MCG TABLET RX-10403 CDM A9270 HCPCS 0637 RC 42292-0038-20 NDC outpatient 1 UN 1.52 1.52 1.52 74 1.12 percent of total billed charges 1.52 93 1.23 percent of total billed charges 1.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.52 other OPPS APC 1.52 1.52 other OPPS APC 1.52 24.86 0.38 percent of total billed charges 1.52 1.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOTHYROXINE 112 MCG TABLET RX-10404 CDM A9270 HCPCS 0250 RC 42292-0039-20 NDC outpatient 1 UN 1.77 1.77 74 1.31 percent of total billed charges 1.77 93 1.43 percent of total billed charges 1.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.77 other OPPS APC 1.77 1.77 other OPPS APC 1.77 24.86 0.44 percent of total billed charges 1.77 1.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOTHYROXINE 112 MCG TABLET RX-10404 CDM A9270 HCPCS 0637 RC 42292-0039-20 NDC outpatient 1 UN 1.77 1.77 1.77 74 1.31 percent of total billed charges 1.77 93 1.43 percent of total billed charges 1.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.77 other OPPS APC 1.77 1.77 other OPPS APC 1.77 24.86 0.44 percent of total billed charges 1.77 1.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOTHYROXINE 137 MCG TABLET RX-10405 CDM A9270 HCPCS 0250 RC 42292-0041-20 NDC outpatient 1 UN 1.82 1.82 74 1.35 percent of total billed charges 1.82 93 1.47 percent of total billed charges 1.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.82 other OPPS APC 1.82 1.82 other OPPS APC 1.82 24.86 0.45 percent of total billed charges 1.82 1.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOTHYROXINE 137 MCG TABLET RX-10405 CDM A9270 HCPCS 0637 RC 42292-0041-20 NDC outpatient 1 UN 1.82 1.82 1.82 74 1.35 percent of total billed charges 1.82 93 1.47 percent of total billed charges 1.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.82 other OPPS APC 1.82 1.82 other OPPS APC 1.82 24.86 0.45 percent of total billed charges 1.82 1.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOTHYROXINE 175 MCG TABLET RX-10406 CDM A9270 HCPCS 0250 RC 42292-0040-20 NDC outpatient 1 UN 2.2 2.2 74 1.63 percent of total billed charges 2.2 93 1.78 percent of total billed charges 2.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.2 other OPPS APC 2.2 2.2 other OPPS APC 2.2 24.86 0.55 percent of total billed charges 2.2 2.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOTHYROXINE 175 MCG TABLET RX-10406 CDM A9270 HCPCS 0637 RC 42292-0040-20 NDC outpatient 1 UN 2.2 2.2 2.2 74 1.63 percent of total billed charges 2.2 93 1.78 percent of total billed charges 2.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.2 other OPPS APC 2.2 2.2 other OPPS APC 2.2 24.86 0.55 percent of total billed charges 2.2 2.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION RX-104207 CDM J2003 HCPCS 0636 RC 00143-9595-25 NDC outpatient 5 ML 7.38 7.38 7.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.38 other OPPS APC 7.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.38 other OPPS APC 7.38 24.86 1.83 percent of total billed charges 7.38 7.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION RX-104207 CDM J2001 HCPCS 0636 RC 63739-0170-24 NDC outpatient 5 ML 6.13 6.13 0.18 0.18 fee schedule 6.13 93 4.97 percent of total billed charges 0.18 6.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION RX-104208 CDM 250000000 HCPCS 0250 RC 00143-9594-25 NDC outpatient 5 ML 6.63 6.63 6.63 74 4.91 percent of total billed charges 6.63 93 5.37 percent of total billed charges 6.63 6.63 other OPPS APC 6.63 6.63 other OPPS APC 6.63 24.86 1.65 percent of total billed charges 6.63 6.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION" RX-10427 CDM 250000000 HCPCS 0250 RC 63323-0482-27 NDC outpatient 20 ML 14.73 14.73 14.73 74 10.9 percent of total billed charges 14.73 93 11.93 percent of total billed charges 14.73 14.73 other OPPS APC 14.73 14.73 other OPPS APC 14.73 24.86 3.66 percent of total billed charges 14.73 14.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION" RX-10428 CDM 250000000 HCPCS 0250 RC 63323-0487-17 NDC outpatient 10 ML 29.04 29.04 29.04 74 21.49 percent of total billed charges 29.04 93 23.52 percent of total billed charges 29.04 29.04 other OPPS APC 29.04 29.04 other OPPS APC 29.04 24.86 7.22 percent of total billed charges 29.04 29.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200,000 INJECTION SOLUTION" RX-10429 CDM 250000000 HCPCS 0250 RC 00409-1209-01 NDC outpatient 5 ML 16.28 16.28 16.28 74 12.05 percent of total billed charges 16.28 93 13.19 percent of total billed charges 16.28 16.28 other OPPS APC 16.28 16.28 other OPPS APC 16.28 24.86 4.05 percent of total billed charges 16.28 16.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BETHANECHOL CHLORIDE 10 MG TABLET RX-1043 CDM A9270 HCPCS 0250 RC 00832-0511-89 NDC outpatient 1 UN 5.01 5.01 74 3.71 percent of total billed charges 5.01 93 4.06 percent of total billed charges 5.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.01 other OPPS APC 5.01 5.01 other OPPS APC 5.01 24.86 1.25 percent of total billed charges 5.01 5.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BETHANECHOL CHLORIDE 10 MG TABLET RX-1043 CDM A9270 HCPCS 0637 RC 00832-0511-89 NDC outpatient 1 UN 5.01 5.01 5.01 74 3.71 percent of total billed charges 5.01 93 4.06 percent of total billed charges 5.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.01 other OPPS APC 5.01 5.01 other OPPS APC 5.01 24.86 1.25 percent of total billed charges 5.01 5.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION" RX-10430 CDM 250000000 HCPCS 0250 RC 63323-0483-27 NDC outpatient 20 ML 14.94 14.94 14.94 74 11.06 percent of total billed charges 14.94 93 12.1 percent of total billed charges 14.94 14.94 other OPPS APC 14.94 14.94 other OPPS APC 14.94 24.86 3.71 percent of total billed charges 14.94 14.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION" RX-10431 CDM 250000000 HCPCS 0250 RC 00409-3183-01 NDC outpatient 20 ML 15.14 15.14 15.14 74 11.2 percent of total billed charges 15.14 93 12.26 percent of total billed charges 15.14 15.14 other OPPS APC 15.14 15.14 other OPPS APC 15.14 24.86 3.76 percent of total billed charges 15.14 15.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM RX-10434 CDM 250000000 HCPCS 0250 RC 62332-0582-04 NDC outpatient 5 GR 22.95 22.95 22.95 74 16.98 percent of total billed charges 22.95 93 18.59 percent of total billed charges 22.95 22.95 other OPPS APC 22.95 22.95 other OPPS APC 22.95 24.86 5.71 percent of total billed charges 22.95 22.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BETHANECHOL CHLORIDE 25 MG TABLET RX-1044 CDM A9270 HCPCS 0250 RC 00832-0512-89 NDC outpatient 1 UN 6.68 6.68 74 4.94 percent of total billed charges 6.68 93 5.41 percent of total billed charges 6.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.68 other OPPS APC 6.68 6.68 other OPPS APC 6.68 24.86 1.66 percent of total billed charges 6.68 6.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BETHANECHOL CHLORIDE 25 MG TABLET RX-1044 CDM A9270 HCPCS 0637 RC 00832-0512-89 NDC outpatient 1 UN 6.68 6.68 6.68 74 4.94 percent of total billed charges 6.68 93 5.41 percent of total billed charges 6.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.68 other OPPS APC 6.68 6.68 other OPPS APC 6.68 24.86 1.66 percent of total billed charges 6.68 6.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LISINOPRIL 10 MG TABLET RX-10449 CDM A9270 HCPCS 0250 RC 00904-6798-61 NDC outpatient 1 UN 0.16 0.16 74 0.12 percent of total billed charges 0.16 93 0.13 percent of total billed charges 0.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.16 other OPPS APC 0.16 0.16 other OPPS APC 0.16 24.86 0.04 percent of total billed charges 0.16 0.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LISINOPRIL 10 MG TABLET RX-10449 CDM A9270 HCPCS 0637 RC 00904-6798-61 NDC outpatient 1 UN 0.16 0.16 0.16 74 0.12 percent of total billed charges 0.16 93 0.13 percent of total billed charges 0.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.16 other OPPS APC 0.16 0.16 other OPPS APC 0.16 24.86 0.04 percent of total billed charges 0.16 0.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LISINOPRIL 40 MG TABLET RX-10450 CDM A9270 HCPCS 0250 RC 00904-7200-61 NDC outpatient 1 UN 0.42 0.42 74 0.31 percent of total billed charges 0.42 93 0.34 percent of total billed charges 0.42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.42 other OPPS APC 0.42 0.42 other OPPS APC 0.42 24.86 0.1 percent of total billed charges 0.42 0.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LISINOPRIL 40 MG TABLET RX-10450 CDM A9270 HCPCS 0637 RC 00904-7200-61 NDC outpatient 1 UN 0.42 0.42 0.42 74 0.31 percent of total billed charges 0.42 93 0.34 percent of total billed charges 0.42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.42 other OPPS APC 0.42 0.42 other OPPS APC 0.42 24.86 0.1 percent of total billed charges 0.42 0.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LISINOPRIL 5 MG TABLET RX-10451 CDM A9270 HCPCS 0250 RC 00904-6797-61 NDC outpatient 1 UN 0.2 0.2 74 0.15 percent of total billed charges 0.2 93 0.16 percent of total billed charges 0.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.2 other OPPS APC 0.2 0.2 other OPPS APC 0.2 24.86 0.05 percent of total billed charges 0.2 0.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LISINOPRIL 5 MG TABLET RX-10451 CDM A9270 HCPCS 0637 RC 00904-6797-61 NDC outpatient 1 UN 0.2 0.2 0.2 74 0.15 percent of total billed charges 0.2 93 0.16 percent of total billed charges 0.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.2 other OPPS APC 0.2 0.2 other OPPS APC 0.2 24.86 0.05 percent of total billed charges 0.2 0.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE" RX-10454 CDM A9270 HCPCS 0250 RC 68084-0640-01 NDC outpatient 1 UN 1.2 1.2 74 0.89 percent of total billed charges 1.2 93 0.97 percent of total billed charges 1.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.2 other OPPS APC 1.2 1.2 other OPPS APC 1.2 24.86 0.3 percent of total billed charges 1.2 1.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE" RX-10454 CDM A9270 HCPCS 0637 RC 68084-0640-01 NDC outpatient 1 UN 1.2 1.2 1.2 74 0.89 percent of total billed charges 1.2 93 0.97 percent of total billed charges 1.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.2 other OPPS APC 1.2 1.2 other OPPS APC 1.2 24.86 0.3 percent of total billed charges 1.2 1.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE" RX-10455 CDM A9270 HCPCS 0250 RC 68084-0655-11 NDC outpatient 1 UN 1.89 1.89 74 1.4 percent of total billed charges 1.89 93 1.53 percent of total billed charges 1.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.89 other OPPS APC 1.89 1.89 other OPPS APC 1.89 24.86 0.47 percent of total billed charges 1.89 1.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE" RX-10455 CDM A9270 HCPCS 0637 RC 68084-0655-11 NDC outpatient 1 UN 1.89 1.89 1.89 74 1.4 percent of total billed charges 1.89 93 1.53 percent of total billed charges 1.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.89 other OPPS APC 1.89 1.89 other OPPS APC 1.89 24.86 0.47 percent of total billed charges 1.89 1.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIFAXIMIN 550 MG TABLET RX-104604 CDM A9270 HCPCS 0250 RC 65649-0303-03 NDC outpatient 1 UN 163.37 163.37 74 120.89 percent of total billed charges 163.37 93 132.33 percent of total billed charges 163.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 163.37 other OPPS APC 163.37 163.37 other OPPS APC 163.37 24.86 40.61 percent of total billed charges 163.37 163.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIFAXIMIN 550 MG TABLET RX-104604 CDM A9270 HCPCS 0637 RC 65649-0303-03 NDC outpatient 1 UN 163.37 163.37 163.37 74 120.89 percent of total billed charges 163.37 93 132.33 percent of total billed charges 163.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 163.37 other OPPS APC 163.37 163.37 other OPPS APC 163.37 24.86 40.61 percent of total billed charges 163.37 163.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LORAZEPAM 2 MG/ML INJECTION SOLUTION RX-10467 CDM J2060 HCPCS 0636 RC 00641-6044-25 NDC outpatient 1 ML 3.89 3.89 0.97 0.97 fee schedule 3.89 93 3.15 percent of total billed charges 3.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.89 other OPPS APC 3.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.89 other OPPS APC 3.89 24.86 0.97 percent of total billed charges 0.97 3.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LORAZEPAM 4 MG/ML INJECTION SOLUTION RX-10468 CDM J2060 HCPCS 0636 RC 00641-6045-01 NDC outpatient 1 ML 8.48 8.48 1.94 1.94 fee schedule 8.48 93 6.87 percent of total billed charges 8.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.48 other OPPS APC 8.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.48 other OPPS APC 8.48 24.86 2.11 percent of total billed charges 1.94 8.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIPULEUCEL-T IN LACTATED RINGERS 50 MILLION CELL/250 ML IV SUSPENSION RX-104852 CDM Q2043 HCPCS 0636 RC 30237-8900-06 NDC outpatient 250 ML 147787 147787 60571.3 60571.3 fee schedule 147787 93 119707 percent of total billed charges 147787 147787 other OPPS APC 147787 147787 other OPPS APC 147787 24.86 36739.8 percent of total billed charges 60571.3 147787 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET RX-10491 CDM A9270 HCPCS 0250 RC 64980-0339-01 NDC outpatient 1 UN 0.37 0.37 74 0.27 percent of total billed charges 0.37 93 0.3 percent of total billed charges 0.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.37 other OPPS APC 0.37 0.37 other OPPS APC 0.37 24.86 0.09 percent of total billed charges 0.37 0.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET RX-10491 CDM A9270 HCPCS 0637 RC 64980-0339-01 NDC outpatient 1 UN 0.37 0.37 0.37 74 0.27 percent of total billed charges 0.37 93 0.3 percent of total billed charges 0.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.37 other OPPS APC 0.37 0.37 other OPPS APC 0.37 24.86 0.09 percent of total billed charges 0.37 0.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LACTULOSE 20 GRAM/30 ML ORAL SOLUTION RX-104962 CDM A9270 HCPCS 0250 RC 00121-1154-00 NDC outpatient 30 ML 4.54 4.54 74 3.36 percent of total billed charges 4.54 93 3.68 percent of total billed charges 4.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.54 other OPPS APC 4.54 4.54 other OPPS APC 4.54 24.86 1.13 percent of total billed charges 4.54 4.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LACTULOSE 20 GRAM/30 ML ORAL SOLUTION RX-104962 CDM A9270 HCPCS 0637 RC 00121-1154-00 NDC outpatient 30 ML 4.54 4.54 4.54 74 3.36 percent of total billed charges 4.54 93 3.68 percent of total billed charges 4.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.54 other OPPS APC 4.54 4.54 other OPPS APC 4.54 24.86 1.13 percent of total billed charges 4.54 4.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY RX-105 CDM A9270 HCPCS 0250 RC 45802-0730-30 NDC outpatient 1 UN 1.67 1.67 74 1.24 percent of total billed charges 1.67 93 1.35 percent of total billed charges 1.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.67 other OPPS APC 1.67 1.67 other OPPS APC 1.67 24.86 0.42 percent of total billed charges 1.67 1.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY RX-105 CDM A9270 HCPCS 0637 RC 45802-0730-30 NDC outpatient 1 UN 1.67 1.67 1.67 74 1.24 percent of total billed charges 1.67 93 1.35 percent of total billed charges 1.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.67 other OPPS APC 1.67 1.67 other OPPS APC 1.67 24.86 0.42 percent of total billed charges 1.67 1.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT" RX-10512 CDM 90707 HCPCS 0636 RC 00006-4681-00 NDC outpatient 0.5 ML 276.36 276.36 276.36 74 204.51 percent of total billed charges 276.36 93 223.85 percent of total billed charges 276.36 276.36 other OPPS APC 276.36 276.36 other OPPS APC 276.36 24.86 68.7 percent of total billed charges 276.36 276.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MERCAPTOPURINE 50 MG TABLET RX-10531 CDM A9270 HCPCS 0250 RC 00378-3547-52 NDC outpatient 1 UN 10.23 10.23 74 7.57 percent of total billed charges 10.23 93 8.29 percent of total billed charges 10.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.23 other OPPS APC 10.23 10.23 other OPPS APC 10.23 24.86 2.54 percent of total billed charges 10.23 10.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MERCAPTOPURINE 50 MG TABLET RX-10531 CDM A9270 HCPCS 0637 RC 00378-3547-52 NDC outpatient 1 UN 10.23 10.23 10.23 74 7.57 percent of total billed charges 10.23 93 8.29 percent of total billed charges 10.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.23 other OPPS APC 10.23 10.23 other OPPS APC 10.23 24.86 2.54 percent of total billed charges 10.23 10.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MESALAMINE ER 250 MG CAPSULE,EXTENDED RELEASE" RX-10533 CDM A9270 HCPCS 0250 RC 54092-0189-81 NDC outpatient 1 UN 9.11 9.11 74 6.74 percent of total billed charges 9.11 93 7.38 percent of total billed charges 9.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.11 other OPPS APC 9.11 9.11 other OPPS APC 9.11 24.86 2.26 percent of total billed charges 9.11 9.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MESALAMINE ER 250 MG CAPSULE,EXTENDED RELEASE" RX-10533 CDM A9270 HCPCS 0637 RC 54092-0189-81 NDC outpatient 1 UN 9.11 9.11 9.11 74 6.74 percent of total billed charges 9.11 93 7.38 percent of total billed charges 9.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.11 other OPPS APC 9.11 9.11 other OPPS APC 9.11 24.86 2.26 percent of total billed charges 9.11 9.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESALAMINE 4 GRAM/60 ML ENEMA RX-10535 CDM A9270 HCPCS 0250 RC 21922-0045-47 NDC outpatient 60 ML 61.05 61.05 74 45.18 percent of total billed charges 61.05 93 49.45 percent of total billed charges 61.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 61.05 other OPPS APC 61.05 61.05 other OPPS APC 61.05 24.86 15.18 percent of total billed charges 61.05 61.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESALAMINE 4 GRAM/60 ML ENEMA RX-10535 CDM A9270 HCPCS 0637 RC 21922-0045-47 NDC outpatient 60 ML 61.05 61.05 61.05 74 45.18 percent of total billed charges 61.05 93 49.45 percent of total billed charges 61.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 61.05 other OPPS APC 61.05 61.05 other OPPS APC 61.05 24.86 15.18 percent of total billed charges 61.05 61.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESNA 100 MG/ML INTRAVENOUS SOLUTION RX-10537 CDM J9209 HCPCS 0636 RC 00338-1305-01 NDC outpatient 10 ML 75 75 9.5 9.5 fee schedule 75 93 60.75 percent of total billed charges 75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 75 other OPPS APC 75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 75 other OPPS APC 75 24.86 18.65 percent of total billed charges 9.5 75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METFORMIN 500 MG TABLET RX-10544 CDM A9270 HCPCS 0250 RC 00904-7162-61 NDC outpatient 1 UN 0.2 0.2 74 0.15 percent of total billed charges 0.2 93 0.16 percent of total billed charges 0.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.2 other OPPS APC 0.2 0.2 other OPPS APC 0.2 24.86 0.05 percent of total billed charges 0.2 0.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METFORMIN 500 MG TABLET RX-10544 CDM A9270 HCPCS 0637 RC 00904-7162-61 NDC outpatient 1 UN 0.2 0.2 0.2 74 0.15 percent of total billed charges 0.2 93 0.16 percent of total billed charges 0.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.2 other OPPS APC 0.2 0.2 other OPPS APC 0.2 24.86 0.05 percent of total billed charges 0.2 0.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE" RX-105460 CDM J1642 HCPCS 0636 RC 64253-0222-33 NDC outpatient 3 ML 8.23 8.23 0.25 0.25 fee schedule 8.23 93 6.67 percent of total billed charges 8.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.23 other OPPS APC 8.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.23 other OPPS APC 8.23 24.86 2.05 percent of total billed charges 0.25 8.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE RX-105502 CDM J0897 HCPCS 0636 RC 55513-0710-01 NDC outpatient 1 ML 5358.35 5358.35 1656.73 1656.73 fee schedule 5358.35 93 4340.26 percent of total billed charges 1656.73 5358.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE RX-105502 CDM J0897 HCPCS 0636 RC 55513-0710-21 NDC outpatient 1 ML 5358.35 5358.35 5358.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1617.6 other OPPS APC 5358.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1617.6 other OPPS APC 5358.35 24.86 1332.09 percent of total billed charges 5358.35 5358.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHIMAZOLE 5 MG TABLET RX-10553 CDM A9270 HCPCS 0250 RC 60687-0669-01 NDC outpatient 1 UN 1.79 1.79 74 1.32 percent of total billed charges 1.79 93 1.45 percent of total billed charges 1.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.79 other OPPS APC 1.79 1.79 other OPPS APC 1.79 24.86 0.44 percent of total billed charges 1.79 1.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHIMAZOLE 5 MG TABLET RX-10553 CDM A9270 HCPCS 0637 RC 60687-0669-01 NDC outpatient 1 UN 1.79 1.79 1.79 74 1.32 percent of total billed charges 1.79 93 1.45 percent of total billed charges 1.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.79 other OPPS APC 1.79 1.79 other OPPS APC 1.79 24.86 0.44 percent of total billed charges 1.79 1.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION" RX-105633 CDM 250000000 HCPCS 0250 RC 00409-1746-10 NDC outpatient 10 ML 13.91 13.91 13.91 74 10.29 percent of total billed charges 13.91 93 11.27 percent of total billed charges 13.91 13.91 other OPPS APC 13.91 13.91 other OPPS APC 13.91 24.86 3.46 percent of total billed charges 13.91 13.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION" RX-105634 CDM 250000000 HCPCS 0250 RC 63323-0462-17 NDC outpatient 10 ML 20.64 20.64 20.64 74 15.27 percent of total billed charges 20.64 93 16.72 percent of total billed charges 20.64 20.64 other OPPS APC 20.64 20.64 other OPPS APC 20.64 24.86 5.13 percent of total billed charges 20.64 20.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION RX-105640 CDM J0665 HCPCS 0636 RC 00409-1162-02 NDC outpatient 30 ML 6.71 6.71 7.26 7.26 fee schedule 6.71 93 5.44 percent of total billed charges 6.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.3 other OPPS APC 6.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.3 other OPPS APC 6.71 24.86 1.67 percent of total billed charges 6.71 7.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS SOLUTION RX-105644 CDM J9043 HCPCS 0636 RC 00024-5824-11 NDC outpatient 1.5 ML 42439.6 42439.6 14111.3 14111.3 fee schedule 42439.6 93 34376.1 percent of total billed charges 42439.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12987.3 other OPPS APC 42439.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12987.3 other OPPS APC 42439.6 24.86 10550.5 percent of total billed charges 14111.3 42439.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION RX-10571 CDM J2210 HCPCS 0636 RC 00517-0740-20 NDC outpatient 1 ML 91.11 91.11 23.85 23.85 fee schedule 91.11 93 73.8 percent of total billed charges 91.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 91.11 other OPPS APC 91.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 91.11 other OPPS APC 91.11 24.86 22.65 percent of total billed charges 23.85 91.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHYLERGONOVINE 0.2 MG TABLET RX-10572 CDM A9270 HCPCS 0250 RC 69238-1605-02 NDC outpatient 1 UN 168.08 168.08 74 124.38 percent of total billed charges 168.08 93 136.14 percent of total billed charges 168.08 168.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHYLERGONOVINE 0.2 MG TABLET RX-10572 CDM A9270 HCPCS 0637 RC 69238-1605-02 NDC outpatient 1 UN 168.08 168.08 168.08 74 124.38 percent of total billed charges 168.08 93 136.14 percent of total billed charges 168.08 168.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHYLERGONOVINE 0.2 MG TABLET RX-10572 CDM A9270 HCPCS 0250 RC 69238-1605-08 NDC outpatient 1 UN 167.98 167.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 167.98 other OPPS APC 167.98 167.98 other OPPS APC 167.98 24.86 41.76 percent of total billed charges 167.98 167.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHYLERGONOVINE 0.2 MG TABLET RX-10572 CDM A9270 HCPCS 0637 RC 69238-1605-08 NDC outpatient 1 UN 167.98 167.98 167.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 167.98 other OPPS APC 167.98 167.98 other OPPS APC 167.98 24.86 41.76 percent of total billed charges 167.98 167.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION" RX-10577 CDM J2919 HCPCS 0636 RC 43598-0130-74 NDC outpatient 1000 ME 97.5 97.5 97.5 74 72.15 percent of total billed charges 97.5 93 78.98 percent of total billed charges 97.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.5 other OPPS APC 97.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.5 other OPPS APC 97.5 24.86 24.24 percent of total billed charges 97.5 97.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION" RX-10577 CDM J2919 HCPCS 0636 RC 43598-0130-74 NDC outpatient 16 ML 97.5 97.5 97.5 74 72.15 percent of total billed charges 97.5 93 78.98 percent of total billed charges 97.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.5 other OPPS APC 97.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.5 other OPPS APC 97.5 24.86 24.24 percent of total billed charges 97.5 97.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION RX-10578 CDM J2919 HCPCS 0636 RC 43598-0129-01 NDC outpatient 2 ML 22.8 22.8 22.8 74 16.87 percent of total billed charges 22.8 93 18.47 percent of total billed charges 22.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.8 other OPPS APC 22.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.8 other OPPS APC 22.8 24.86 5.67 percent of total billed charges 22.8 22.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHYLPREDNISOLONE SODIUM SUCCINATE 2 GRAM INTRAVENOUS SOLUTION RX-10579 CDM J2919 HCPCS 0636 RC 00009-0850-01 NDC outpatient 2000 ME 326.58 326.58 326.58 74 241.67 percent of total billed charges 326.58 93 264.53 percent of total billed charges 326.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 326.58 other OPPS APC 326.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 326.58 other OPPS APC 326.58 24.86 81.19 percent of total billed charges 326.58 326.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG SOLUTION FOR INJECTION RX-10580 CDM J2919 HCPCS 0636 RC 00143-9753-25 NDC outpatient 1 ML 12.24 12.24 12.24 74 9.06 percent of total billed charges 12.24 93 9.91 percent of total billed charges 12.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.24 other OPPS APC 12.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.24 other OPPS APC 12.24 24.86 3.04 percent of total billed charges 12.24 12.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION RX-10581 CDM J2919 HCPCS 0636 RC 43598-0128-11 NDC outpatient 500 ME 66 66 66 74 48.84 percent of total billed charges 66 93 53.46 percent of total billed charges 66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 66 other OPPS APC 66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 66 other OPPS APC 66 24.86 16.41 percent of total billed charges 66 66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION RX-10581 CDM J2919 HCPCS 0636 RC 43598-0128-11 NDC outpatient 8 ML 66 66 66 74 48.84 percent of total billed charges 66 93 53.46 percent of total billed charges 66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 66 other OPPS APC 66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 66 other OPPS APC 66 24.86 16.41 percent of total billed charges 66 66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METOLAZONE 2.5 MG TABLET RX-10587 CDM A9270 HCPCS 0250 RC 81005-0124-01 NDC outpatient 1 UN 0.47 0.47 74 0.35 percent of total billed charges 0.47 93 0.38 percent of total billed charges 0.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.47 other OPPS APC 0.47 0.47 other OPPS APC 0.47 24.86 0.12 percent of total billed charges 0.47 0.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METOLAZONE 2.5 MG TABLET RX-10587 CDM A9270 HCPCS 0637 RC 81005-0124-01 NDC outpatient 1 UN 0.47 0.47 0.47 74 0.35 percent of total billed charges 0.47 93 0.38 percent of total billed charges 0.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.47 other OPPS APC 0.47 0.47 other OPPS APC 0.47 24.86 0.12 percent of total billed charges 0.47 0.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE RX-105899 CDM J1650 HCPCS 0636 RC 71839-0109-10 NDC outpatient 0.3 ML 20.94 20.94 2.32 2.32 fee schedule 20.94 93 16.96 percent of total billed charges 20.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20.94 other OPPS APC 20.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20.94 other OPPS APC 20.94 24.86 5.21 percent of total billed charges 2.32 20.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE RX-105900 CDM J1650 HCPCS 0636 RC 71839-0110-10 NDC outpatient 0.4 ML 27.91 27.91 3.1 3.1 fee schedule 27.91 93 22.61 percent of total billed charges 27.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.91 other OPPS APC 27.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.91 other OPPS APC 27.91 24.86 6.94 percent of total billed charges 3.1 27.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE RX-105901 CDM J1650 HCPCS 0636 RC 71839-0111-10 NDC outpatient 0.6 ML 41.94 41.94 4.65 4.65 fee schedule 41.94 93 33.97 percent of total billed charges 41.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.94 other OPPS APC 41.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.94 other OPPS APC 41.94 24.86 10.43 percent of total billed charges 4.65 41.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE RX-105902 CDM J1650 HCPCS 0636 RC 71839-0112-10 NDC outpatient 0.8 ML 55.89 55.89 6.2 6.2 fee schedule 55.89 93 45.27 percent of total billed charges 55.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.89 other OPPS APC 55.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.89 other OPPS APC 55.89 24.86 13.89 percent of total billed charges 6.2 55.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE RX-105903 CDM J1650 HCPCS 0636 RC 71839-0113-10 NDC outpatient 1 ML 69.86 69.86 7.74 7.74 fee schedule 69.86 93 56.59 percent of total billed charges 69.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 69.86 other OPPS APC 69.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 69.86 other OPPS APC 69.86 24.86 17.37 percent of total billed charges 7.74 69.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE RX-105904 CDM J1650 HCPCS 0636 RC 71839-0115-10 NDC outpatient 0.8 ML 83.85 83.85 9.29 9.29 fee schedule 83.85 93 67.92 percent of total billed charges 83.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 83.85 other OPPS APC 83.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 83.85 other OPPS APC 83.85 24.86 20.85 percent of total billed charges 9.29 83.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL RX-10592 CDM A9270 HCPCS 0250 RC 45802-0139-70 NDC outpatient 70 GR 382.08 382.08 74 282.74 percent of total billed charges 382.08 93 309.48 percent of total billed charges 382.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 382.08 other OPPS APC 382.08 382.08 other OPPS APC 382.08 24.86 94.99 percent of total billed charges 382.08 382.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL RX-10592 CDM A9270 HCPCS 0637 RC 45802-0139-70 NDC outpatient 70 GR 382.08 382.08 382.08 74 282.74 percent of total billed charges 382.08 93 309.48 percent of total billed charges 382.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 382.08 other OPPS APC 382.08 382.08 other OPPS APC 382.08 24.86 94.99 percent of total billed charges 382.08 382.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICONAZOLE NITRATE 100 MG VAGINAL SUPPOSITORY RX-10603 CDM A9270 HCPCS 0250 RC 61269-0736-07 NDC outpatient 7 UN 24.48 24.48 74 18.12 percent of total billed charges 24.48 93 19.83 percent of total billed charges 24.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.48 other OPPS APC 24.48 24.48 other OPPS APC 24.48 24.86 6.09 percent of total billed charges 24.48 24.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICONAZOLE NITRATE 100 MG VAGINAL SUPPOSITORY RX-10603 CDM A9270 HCPCS 0637 RC 61269-0736-07 NDC outpatient 7 UN 24.48 24.48 24.48 74 18.12 percent of total billed charges 24.48 93 19.83 percent of total billed charges 24.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.48 other OPPS APC 24.48 24.48 other OPPS APC 24.48 24.86 6.09 percent of total billed charges 24.48 24.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SODIUM,POTASSIUM,MAG SULFATES 17.5 GRAM-3.13 GRAM-1.6 GRAM ORAL SOLN" RX-106061 CDM 250000000 HCPCS 0250 RC 10572-0012-01 NDC outpatient 354 ML 261.7 261.7 261.7 74 193.66 percent of total billed charges 261.7 93 211.98 percent of total billed charges 261.7 261.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SODIUM,POTASSIUM,MAG SULFATES 17.5 GRAM-3.13 GRAM-1.6 GRAM ORAL SOLN" RX-106061 CDM 250000000 HCPCS 0250 RC 43386-0700-83 NDC outpatient 354 ML 294.4 294.4 294.4 294.4 other OPPS APC 294.4 294.4 other OPPS APC 294.4 24.86 73.19 percent of total billed charges 294.4 294.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ULIPRISTAL 30 MG TABLET RX-106079 CDM A9270 HCPCS 0250 RC 73302-0456-01 NDC outpatient 1 UN 116.25 116.25 74 86.03 percent of total billed charges 116.25 93 94.16 percent of total billed charges 116.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 116.25 other OPPS APC 116.25 116.25 other OPPS APC 116.25 24.86 28.9 percent of total billed charges 116.25 116.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ULIPRISTAL 30 MG TABLET RX-106079 CDM A9270 HCPCS 0637 RC 73302-0456-01 NDC outpatient 1 UN 116.25 116.25 116.25 74 86.03 percent of total billed charges 116.25 93 94.16 percent of total billed charges 116.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 116.25 other OPPS APC 116.25 116.25 other OPPS APC 116.25 24.86 28.9 percent of total billed charges 116.25 116.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIDAZOLAM 5 MG/ML INJECTION SOLUTION RX-10608 CDM J2250 HCPCS 0636 RC 00641-6061-25 NDC outpatient 1 ML 3.6 3.6 0.79 0.79 fee schedule 3.6 93 2.92 percent of total billed charges 3.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.6 other OPPS APC 3.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.6 other OPPS APC 3.6 24.86 0.89 percent of total billed charges 0.79 3.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIDAZOLAM 5 MG/ML INJECTION SOLUTION RX-10608 CDM J2250 HCPCS 0636 RC 70860-0601-42 NDC outpatient 10 ML 18 18 7.87 7.87 fee schedule 18 93 14.58 percent of total billed charges 18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18 other OPPS APC 18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18 other OPPS APC 18 24.86 4.47 percent of total billed charges 7.87 18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIDODRINE 2.5 MG TABLET RX-10609 CDM A9270 HCPCS 0250 RC 00904-6817-61 NDC outpatient 1 UN 2.58 2.58 74 1.91 percent of total billed charges 2.58 93 2.09 percent of total billed charges 2.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.58 other OPPS APC 2.58 2.58 other OPPS APC 2.58 24.86 0.64 percent of total billed charges 2.58 2.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIDODRINE 2.5 MG TABLET RX-10609 CDM A9270 HCPCS 0637 RC 00904-6817-61 NDC outpatient 1 UN 2.58 2.58 2.58 74 1.91 percent of total billed charges 2.58 93 2.09 percent of total billed charges 2.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.58 other OPPS APC 2.58 2.58 other OPPS APC 2.58 24.86 0.64 percent of total billed charges 2.58 2.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIDODRINE 5 MG TABLET RX-10610 CDM A9270 HCPCS 0250 RC 00904-6818-06 NDC outpatient 1 UN 1.8 1.8 74 1.33 percent of total billed charges 1.8 93 1.46 percent of total billed charges 1.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.8 other OPPS APC 1.8 1.8 other OPPS APC 1.8 24.86 0.45 percent of total billed charges 1.8 1.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIDODRINE 5 MG TABLET RX-10610 CDM A9270 HCPCS 0637 RC 00904-6818-06 NDC outpatient 1 UN 1.8 1.8 1.8 74 1.33 percent of total billed charges 1.8 93 1.46 percent of total billed charges 1.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.8 other OPPS APC 1.8 1.8 other OPPS APC 1.8 24.86 0.45 percent of total billed charges 1.8 1.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT" RX-106249 CDM A9270 HCPCS 0250 RC 61314-0631-36 NDC outpatient 3.5 GR 110 110 74 81.4 percent of total billed charges 110 93 89.1 percent of total billed charges 110 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110 other OPPS APC 110 110 other OPPS APC 110 24.86 27.35 percent of total billed charges 110 110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT" RX-106249 CDM A9270 HCPCS 0637 RC 61314-0631-36 NDC outpatient 3.5 GR 110 110 110 74 81.4 percent of total billed charges 110 93 89.1 percent of total billed charges 110 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110 other OPPS APC 110 110 other OPPS APC 110 24.86 27.35 percent of total billed charges 110 110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIAZEPAM 5 MG/ML INJECTION SYRINGE RX-106278 CDM J3360 HCPCS 0636 RC 00641-6244-10 NDC outpatient 2 ML 73.83 73.83 11.98 11.98 fee schedule 73.83 93 59.8 percent of total billed charges 73.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 73.83 other OPPS APC 73.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 73.83 other OPPS APC 73.83 24.86 18.35 percent of total billed charges 11.98 73.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MISOPROSTOL 100 MCG TABLET RX-10628 CDM A9270 HCPCS 0250 RC 60687-0735-01 NDC outpatient 1 UN 6.2 6.2 74 4.59 percent of total billed charges 6.2 93 5.02 percent of total billed charges 6.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.2 other OPPS APC 6.2 6.2 other OPPS APC 6.2 24.86 1.54 percent of total billed charges 6.2 6.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MISOPROSTOL 100 MCG TABLET RX-10628 CDM A9270 HCPCS 0637 RC 60687-0735-01 NDC outpatient 1 UN 6.2 6.2 6.2 74 4.59 percent of total billed charges 6.2 93 5.02 percent of total billed charges 6.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.2 other OPPS APC 6.2 6.2 other OPPS APC 6.2 24.86 1.54 percent of total billed charges 6.2 6.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MISOPROSTOL 200 MCG TABLET RX-10629 CDM A9270 HCPCS 0250 RC 60687-0746-01 NDC outpatient 1 UN 6.82 6.82 74 5.05 percent of total billed charges 6.82 93 5.52 percent of total billed charges 6.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.82 other OPPS APC 6.82 6.82 other OPPS APC 6.82 24.86 1.7 percent of total billed charges 6.82 6.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MISOPROSTOL 200 MCG TABLET RX-10629 CDM A9270 HCPCS 0637 RC 60687-0746-01 NDC outpatient 1 UN 6.82 6.82 6.82 74 5.05 percent of total billed charges 6.82 93 5.52 percent of total billed charges 6.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.82 other OPPS APC 6.82 6.82 other OPPS APC 6.82 24.86 1.7 percent of total billed charges 6.82 6.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MITOMYCIN 20 MG INTRAVENOUS SOLUTION RX-10630 CDM J9280 HCPCS 0636 RC 72819-0153-02 NDC outpatient 40 ML 1895.95 1895.95 360.82 360.82 fee schedule 1895.95 93 1535.72 percent of total billed charges 1895.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 170.02 other OPPS APC 1895.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 170.02 other OPPS APC 1895.95 24.86 471.33 percent of total billed charges 360.82 1895.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MITOMYCIN 5 MG INTRAVENOUS SOLUTION RX-10632 CDM J9280 HCPCS 0636 RC 16729-0115-05 NDC outpatient 10 ML 681.15 681.15 90.21 90.21 fee schedule 681.15 93 551.73 percent of total billed charges 681.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42.51 other OPPS APC 681.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42.51 other OPPS APC 681.15 24.86 169.33 percent of total billed charges 90.21 681.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION RX-106348 CDM J2405 HCPCS 0636 RC 00409-4755-03 NDC outpatient 2 ML 3.86 3.86 0.48 0.48 fee schedule 3.86 93 3.13 percent of total billed charges 0.48 3.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION RX-106348 CDM J2405 HCPCS 0636 RC 60505-6130-05 NDC outpatient 2 ML 1.8 1.8 1.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.8 other OPPS APC 1.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.8 other OPPS APC 1.8 24.86 0.45 percent of total billed charges 1.8 1.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION RX-106349 CDM J2405 HCPCS 0636 RC 00641-6079-01 NDC outpatient 20 ML 23.55 23.55 4.84 4.84 fee schedule 23.55 93 19.08 percent of total billed charges 23.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 23.55 other OPPS APC 23.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 23.55 other OPPS APC 23.55 24.86 5.85 percent of total billed charges 4.84 23.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION RX-106363 CDM 250000000 HCPCS 0250 RC 00409-4278-01 NDC outpatient 50 ML 12.97 12.97 12.97 74 9.6 percent of total billed charges 12.97 93 10.51 percent of total billed charges 12.97 12.97 other OPPS APC 12.97 12.97 other OPPS APC 12.97 24.86 3.22 percent of total billed charges 12.97 12.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOCETAXEL 20 MG/ML (1 ML) INTRAVENOUS SOLUTION RX-106443 CDM J9171 HCPCS 0636 RC 16729-0267-63 NDC outpatient 1 ML 912.88 912.88 21.3 21.3 fee schedule 912.88 93 739.43 percent of total billed charges 912.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 912.88 other OPPS APC 912.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 912.88 other OPPS APC 912.88 24.86 226.94 percent of total billed charges 21.3 912.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DABIGATRAN ETEXILATE 75 MG CAPSULE RX-106490 CDM A9270 HCPCS 0250 RC 00597-0355-56 NDC outpatient 1 UN 9.92 9.92 74 7.34 percent of total billed charges 9.92 93 8.04 percent of total billed charges 9.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.92 other OPPS APC 9.92 9.92 other OPPS APC 9.92 24.86 2.47 percent of total billed charges 9.92 9.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DABIGATRAN ETEXILATE 75 MG CAPSULE RX-106490 CDM A9270 HCPCS 0637 RC 00597-0355-56 NDC outpatient 1 UN 9.92 9.92 9.92 74 7.34 percent of total billed charges 9.92 93 8.04 percent of total billed charges 9.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.92 other OPPS APC 9.92 9.92 other OPPS APC 9.92 24.86 2.47 percent of total billed charges 9.92 9.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DABIGATRAN ETEXILATE 150 MG CAPSULE RX-106491 CDM A9270 HCPCS 0250 RC 00597-0360-82 NDC outpatient 1 UN 9.92 9.92 74 7.34 percent of total billed charges 9.92 93 8.04 percent of total billed charges 9.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.92 other OPPS APC 9.92 9.92 other OPPS APC 9.92 24.86 2.47 percent of total billed charges 9.92 9.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DABIGATRAN ETEXILATE 150 MG CAPSULE RX-106491 CDM A9270 HCPCS 0637 RC 00597-0360-82 NDC outpatient 1 UN 9.92 9.92 9.92 74 7.34 percent of total billed charges 9.92 93 8.04 percent of total billed charges 9.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.92 other OPPS APC 9.92 9.92 other OPPS APC 9.92 24.86 2.47 percent of total billed charges 9.92 9.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET RX-10663 CDM A9270 HCPCS 0250 RC 00904-0539-61 NDC outpatient 1 UN 0.12 0.12 74 0.09 percent of total billed charges 0.12 93 0.1 percent of total billed charges 0.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.12 other OPPS APC 0.12 0.12 other OPPS APC 0.12 24.86 0.03 percent of total billed charges 0.12 0.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET RX-10663 CDM A9270 HCPCS 0637 RC 00904-0539-61 NDC outpatient 1 UN 0.12 0.12 0.12 74 0.09 percent of total billed charges 0.12 93 0.1 percent of total billed charges 0.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.12 other OPPS APC 0.12 0.12 other OPPS APC 0.12 24.86 0.03 percent of total billed charges 0.12 0.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MUPIROCIN 2 % TOPICAL OINTMENT RX-10674 CDM A9270 HCPCS 0250 RC 50268-0568-15 NDC outpatient 1 GR 12.82 12.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.82 other OPPS APC 12.82 12.82 other OPPS APC 12.82 24.86 3.19 percent of total billed charges 12.82 12.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MUPIROCIN 2 % TOPICAL OINTMENT RX-10674 CDM A9270 HCPCS 0637 RC 50268-0568-15 NDC outpatient 1 GR 12.82 12.82 12.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.82 other OPPS APC 12.82 12.82 other OPPS APC 12.82 24.86 3.19 percent of total billed charges 12.82 12.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MUPIROCIN 2 % TOPICAL OINTMENT RX-10674 CDM A9270 HCPCS 0250 RC 81033-0020-99 NDC outpatient 1 GR 7.5 7.5 74 5.55 percent of total billed charges 7.5 93 6.08 percent of total billed charges 7.5 7.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MUPIROCIN 2 % TOPICAL OINTMENT RX-10674 CDM A9270 HCPCS 0637 RC 81033-0020-99 NDC outpatient 1 GR 7.5 7.5 7.5 74 5.55 percent of total billed charges 7.5 93 6.08 percent of total billed charges 7.5 7.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NABUMETONE 500 MG TABLET RX-10676 CDM A9270 HCPCS 0250 RC 50228-0465-01 NDC outpatient 1 UN 3.1 3.1 74 2.29 percent of total billed charges 3.1 93 2.51 percent of total billed charges 3.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.1 other OPPS APC 3.1 3.1 other OPPS APC 3.1 24.86 0.77 percent of total billed charges 3.1 3.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NABUMETONE 500 MG TABLET RX-10676 CDM A9270 HCPCS 0637 RC 50228-0465-01 NDC outpatient 1 UN 3.1 3.1 3.1 74 2.29 percent of total billed charges 3.1 93 2.51 percent of total billed charges 3.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.1 other OPPS APC 3.1 3.1 other OPPS APC 3.1 24.86 0.77 percent of total billed charges 3.1 3.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION RX-106773 CDM J9179 HCPCS 0636 RC 62856-0389-01 NDC outpatient 2 ML 4230 4230 1470.03 1470.03 fee schedule 4230 93 3426.3 percent of total billed charges 4230 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1357.85 other OPPS APC 4230 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1357.85 other OPPS APC 4230 24.86 1051.58 percent of total billed charges 1470.03 4230 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION RX-106783 CDM J1453 HCPCS 0636 RC 83634-0776-10 NDC outpatient 5 ML 120 120 23.6 23.6 fee schedule 120 93 97.2 percent of total billed charges 120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 120 other OPPS APC 120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 120 other OPPS APC 120 24.86 29.83 percent of total billed charges 23.6 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION RX-106804 CDM J0897 HCPCS 0636 RC 55513-0730-01 NDC outpatient 1.7 ML 9856.4 9856.4 3313.46 3313.46 fee schedule 9856.4 93 7983.68 percent of total billed charges 9856.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3235.2 other OPPS APC 9856.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3235.2 other OPPS APC 9856.4 24.86 2450.3 percent of total billed charges 3313.46 9856.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS" RX-10708 CDM A9270 HCPCS 0250 RC 61314-0630-06 NDC outpatient 5 ML 110 110 74 81.4 percent of total billed charges 110 93 89.1 percent of total billed charges 110 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110 other OPPS APC 110 110 other OPPS APC 110 24.86 27.35 percent of total billed charges 110 110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS" RX-10708 CDM A9270 HCPCS 0637 RC 61314-0630-06 NDC outpatient 5 ML 110 110 110 74 81.4 percent of total billed charges 110 93 89.1 percent of total billed charges 110 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110 other OPPS APC 110 110 other OPPS APC 110 24.86 27.35 percent of total billed charges 110 110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NICARDIPINE 20 MG CAPSULE RX-10712 CDM A9270 HCPCS 0250 RC 42806-0501-09 NDC outpatient 1 UN 38.74 38.74 74 28.67 percent of total billed charges 38.74 93 31.38 percent of total billed charges 38.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.74 other OPPS APC 38.74 38.74 other OPPS APC 38.74 24.86 9.63 percent of total billed charges 38.74 38.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NICARDIPINE 20 MG CAPSULE RX-10712 CDM A9270 HCPCS 0637 RC 42806-0501-09 NDC outpatient 1 UN 38.74 38.74 38.74 74 28.67 percent of total billed charges 38.74 93 31.38 percent of total billed charges 38.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.74 other OPPS APC 38.74 38.74 other OPPS APC 38.74 24.86 9.63 percent of total billed charges 38.74 38.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NICOTINE (POLACRILEX) 2 MG GUM RX-10717 CDM A9270 HCPCS 0250 RC 00536-3029-34 NDC outpatient 1 UN 1.5 1.5 74 1.11 percent of total billed charges 1.5 93 1.22 percent of total billed charges 1.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.5 other OPPS APC 1.5 1.5 other OPPS APC 1.5 24.86 0.37 percent of total billed charges 1.5 1.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NICOTINE (POLACRILEX) 2 MG GUM RX-10717 CDM A9270 HCPCS 0637 RC 00536-3029-34 NDC outpatient 1 UN 1.5 1.5 1.5 74 1.11 percent of total billed charges 1.5 93 1.22 percent of total billed charges 1.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.5 other OPPS APC 1.5 1.5 other OPPS APC 1.5 24.86 0.37 percent of total billed charges 1.5 1.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NIMODIPINE 30 MG CAPSULE RX-10722 CDM A9270 HCPCS 0250 RC 23155-0512-11 NDC outpatient 1 UN 46.03 46.03 74 34.06 percent of total billed charges 46.03 93 37.28 percent of total billed charges 46.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 46.03 other OPPS APC 46.03 46.03 other OPPS APC 46.03 24.86 11.44 percent of total billed charges 46.03 46.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NIMODIPINE 30 MG CAPSULE RX-10722 CDM A9270 HCPCS 0637 RC 23155-0512-11 NDC outpatient 1 UN 46.03 46.03 46.03 74 34.06 percent of total billed charges 46.03 93 37.28 percent of total billed charges 46.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 46.03 other OPPS APC 46.03 46.03 other OPPS APC 46.03 24.86 11.44 percent of total billed charges 46.03 46.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE RX-10724 CDM A9270 HCPCS 0250 RC 50268-0625-15 NDC outpatient 1 UN 10.72 10.72 74 7.93 percent of total billed charges 10.72 93 8.68 percent of total billed charges 10.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.72 other OPPS APC 10.72 10.72 other OPPS APC 10.72 24.86 2.66 percent of total billed charges 10.72 10.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE RX-10724 CDM A9270 HCPCS 0637 RC 50268-0625-15 NDC outpatient 1 UN 10.72 10.72 10.72 74 7.93 percent of total billed charges 10.72 93 8.68 percent of total billed charges 10.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.72 other OPPS APC 10.72 10.72 other OPPS APC 10.72 24.86 2.66 percent of total billed charges 10.72 10.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NORGESTREL 0.3 MG-ETHINYL ESTRADIOL 30 MCG TABLET RX-10752 CDM A9270 HCPCS 0250 RC 00555-9049-79 NDC outpatient 1 UN 2.73 2.73 74 2.02 percent of total billed charges 2.73 93 2.21 percent of total billed charges 2.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.73 other OPPS APC 2.73 2.73 other OPPS APC 2.73 24.86 0.68 percent of total billed charges 2.73 2.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NORGESTREL 0.3 MG-ETHINYL ESTRADIOL 30 MCG TABLET RX-10752 CDM A9270 HCPCS 0637 RC 00555-9049-79 NDC outpatient 1 UN 2.73 2.73 2.73 74 2.02 percent of total billed charges 2.73 93 2.21 percent of total billed charges 2.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.73 other OPPS APC 2.73 2.73 other OPPS APC 2.73 24.86 0.68 percent of total billed charges 2.73 2.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTAROLINE FOSAMIL 400 MG INTRAVENOUS SOLUTION RX-107670 CDM J0712 HCPCS 0636 RC 00456-0400-10 NDC outpatient 20 ML 735.6 735.6 177.63 177.63 fee schedule 735.6 93 595.84 percent of total billed charges 735.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 157.4 other OPPS APC 735.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 157.4 other OPPS APC 735.6 24.86 182.87 percent of total billed charges 177.63 735.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTAROLINE FOSAMIL 400 MG INTRAVENOUS SOLUTION RX-107670 CDM J0712 HCPCS 0636 RC 00456-0400-10 NDC outpatient 400 ME 735.6 735.6 177.63 177.63 fee schedule 735.6 93 595.84 percent of total billed charges 735.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 157.4 other OPPS APC 735.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 157.4 other OPPS APC 735.6 24.86 182.87 percent of total billed charges 177.63 735.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION RX-107671 CDM J0712 HCPCS 0636 RC 00456-0600-10 NDC outpatient 20 ML 735.6 735.6 266.44 266.44 fee schedule 735.6 93 595.84 percent of total billed charges 735.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.1 other OPPS APC 735.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.1 other OPPS APC 735.6 24.86 182.87 percent of total billed charges 266.44 735.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION RX-107671 CDM J0712 HCPCS 0636 RC 00456-0600-10 NDC outpatient 600 ME 735.6 735.6 266.44 266.44 fee schedule 735.6 93 595.84 percent of total billed charges 735.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.1 other OPPS APC 735.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.1 other OPPS APC 735.6 24.86 182.87 percent of total billed charges 266.44 735.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BISACODYL 5 MG TABLET,DELAYED RELEASE" RX-1079 CDM A9270 HCPCS 0250 RC 00904-6407-61 NDC outpatient 1 UN 0.19 0.19 74 0.14 percent of total billed charges 0.19 93 0.15 percent of total billed charges 0.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.19 other OPPS APC 0.19 0.19 other OPPS APC 0.19 24.86 0.05 percent of total billed charges 0.19 0.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BISACODYL 5 MG TABLET,DELAYED RELEASE" RX-1079 CDM A9270 HCPCS 0637 RC 00904-6407-61 NDC outpatient 1 UN 0.19 0.19 0.19 74 0.14 percent of total billed charges 0.19 93 0.15 percent of total billed charges 0.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.19 other OPPS APC 0.19 0.19 other OPPS APC 0.19 24.86 0.05 percent of total billed charges 0.19 0.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION" RX-108021 CDM J0136 HCPCS 0636 RC 00264-4100-90 NDC outpatient 1000 ME 24.3 24.3 6.05 6.05 fee schedule 24.3 93 19.68 percent of total billed charges 6.05 24.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION" RX-108021 CDM J0134 HCPCS 0636 RC 63323-0434-00 NDC outpatient 100 ML 28.8 28.8 28.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.1 other OPPS APC 28.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.1 other OPPS APC 28.8 24.86 7.16 percent of total billed charges 28.8 28.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE RX-108027 CDM J1652 HCPCS 0636 RC 55150-0231-10 NDC outpatient 0.4 ML 217.88 217.88 12.22 12.22 fee schedule 217.88 93 176.48 percent of total billed charges 217.88 217.88 other OPPS APC 217.88 217.88 other OPPS APC 217.88 24.86 54.16 percent of total billed charges 12.22 217.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE RX-108029 CDM J1652 HCPCS 0636 RC 67457-0585-08 NDC outpatient 0.8 ML 321.53 321.53 24.44 24.44 fee schedule 321.53 93 260.44 percent of total billed charges 321.53 321.53 other OPPS APC 321.53 321.53 other OPPS APC 321.53 24.86 79.93 percent of total billed charges 24.44 321.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DARBEPOETIN ALFA 25 MCG/0.42 ML IN POLYSORBATE INJECTION SYRINGE RX-108041 CDM J0881 HCPCS 0636 RC 55513-0057-04 NDC outpatient 0.42 ML 580.51 580.51 83.79 83.79 fee schedule 580.51 93 470.21 percent of total billed charges 580.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 75.9 other OPPS APC 580.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 75.9 other OPPS APC 580.51 24.86 144.31 percent of total billed charges 83.79 580.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DARBEPOETIN ALFA 40 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE RX-108042 CDM J0881 HCPCS 0636 RC 55513-0021-04 NDC outpatient 0.4 ML 928.8 928.8 134.07 134.07 fee schedule 928.8 93 752.33 percent of total billed charges 928.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 121.44 other OPPS APC 928.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 121.44 other OPPS APC 928.8 24.86 230.9 percent of total billed charges 134.07 928.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DARBEPOETIN ALFA 60 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE RX-108043 CDM J0881 HCPCS 0636 RC 55513-0023-01 NDC outpatient 0.3 ML 1393.2 1393.2 201.1 201.1 fee schedule 1393.2 93 1128.49 percent of total billed charges 1393.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.16 other OPPS APC 1393.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.16 other OPPS APC 1393.2 24.86 346.35 percent of total billed charges 201.1 1393.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE RX-108044 CDM J0881 HCPCS 0636 RC 55513-0025-01 NDC outpatient 0.5 ML 2322 2322 335.17 335.17 fee schedule 2322 93 1880.82 percent of total billed charges 2322 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 303.6 other OPPS APC 2322 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 303.6 other OPPS APC 2322 24.86 577.25 percent of total billed charges 335.17 2322 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DARBEPOETIN ALFA 150 MCG/0.3 ML IN POLYSORBATE INJECTION SYRINGE RX-108046 CDM J0881 HCPCS 0636 RC 55513-0027-04 NDC outpatient 0.3 ML 3483 3483 502.76 502.76 fee schedule 3483 93 2821.23 percent of total billed charges 3483 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455.4 other OPPS APC 3483 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455.4 other OPPS APC 3483 24.86 865.87 percent of total billed charges 502.76 3483 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DARBEPOETIN ALFA 200 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE RX-108047 CDM J0881 HCPCS 0636 RC 55513-0028-01 NDC outpatient 0.4 ML 4644 4644 670.34 670.34 fee schedule 4644 93 3761.64 percent of total billed charges 4644 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 607.2 other OPPS APC 4644 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 607.2 other OPPS APC 4644 24.86 1154.5 percent of total billed charges 670.34 4644 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DARBEPOETIN ALFA 300 MCG/0.6 ML IN POLYSORBATE INJECTION SYRINGE RX-108048 CDM J0881 HCPCS 0636 RC 55513-0111-01 NDC outpatient 0.6 ML 6966 6966 1005.51 1005.51 fee schedule 6966 93 5642.46 percent of total billed charges 6966 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 910.8 other OPPS APC 6966 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 910.8 other OPPS APC 6966 24.86 1731.75 percent of total billed charges 1005.51 6966 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE" RX-108049 CDM J0561 HCPCS 0636 RC 60793-0701-10 NDC outpatient 2 ML 914.97 914.97 276.32 276.32 fee schedule 914.97 93 741.13 percent of total billed charges 914.97 914.97 other OPPS APC 914.97 914.97 other OPPS APC 914.97 24.86 227.46 percent of total billed charges 276.32 914.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PENICILLIN G BENZATHINE 2,400,000 UNIT/4 ML INTRAMUSCULAR SYRINGE" RX-108050 CDM J0561 HCPCS 0636 RC 60793-0702-10 NDC outpatient 4 ML 1874.92 1874.92 552.63 552.63 fee schedule 1874.92 93 1518.69 percent of total billed charges 1874.92 1874.92 other OPPS APC 1874.92 1874.92 other OPPS APC 1874.92 24.86 466.11 percent of total billed charges 552.63 1874.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION RX-108055 CDM J9303 HCPCS 0636 RC 55513-0954-01 NDC outpatient 5 ML 5176.15 5176.15 1708.88 1708.88 fee schedule 5176.15 93 4192.68 percent of total billed charges 5176.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1593.26 other OPPS APC 5176.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1593.26 other OPPS APC 5176.15 24.86 1286.79 percent of total billed charges 1708.88 5176.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION RX-108057 CDM J9303 HCPCS 0636 RC 55513-0956-01 NDC outpatient 20 ML 20704.5 20704.5 6835.53 6835.53 fee schedule 20704.5 93 16770.7 percent of total billed charges 20704.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6373.04 other OPPS APC 20704.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6373.04 other OPPS APC 20704.5 24.86 5147.15 percent of total billed charges 6835.53 20704.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOCILIZUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION RX-108063 CDM J3262 HCPCS 0636 RC 50242-0137-01 NDC outpatient 20 ML 7967.45 7967.45 2700.72 2700.72 fee schedule 7967.45 93 6453.63 percent of total billed charges 7967.45 7967.45 other OPPS APC 7967.45 7967.45 other OPPS APC 7967.45 24.86 1980.71 percent of total billed charges 2700.72 7967.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION RX-108065 CDM J9035 HCPCS 0636 RC 50242-0060-01 NDC outpatient 4 ML 2390.83 2390.83 839.86 839.86 fee schedule 2390.83 93 1936.57 percent of total billed charges 2390.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 727.04 other OPPS APC 2390.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 727.04 other OPPS APC 2390.83 24.86 594.36 percent of total billed charges 839.86 2390.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION RX-108065 CDM J9035 HCPCS 0636 RC 50242-0061-01 NDC outpatient 16 ML 9563.28 9563.28 3359.44 3359.44 fee schedule 9563.28 93 7746.26 percent of total billed charges 9563.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2908.16 other OPPS APC 9563.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2908.16 other OPPS APC 9563.28 24.86 2377.43 percent of total billed charges 3359.44 9563.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION RX-108072 CDM J9055 HCPCS 0636 RC 66733-0958-23 NDC outpatient 100 ML 4824.5 4824.5 1645.6 1645.6 fee schedule 4824.5 93 3907.85 percent of total billed charges 4824.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1509.58 other OPPS APC 4824.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1509.58 other OPPS APC 4824.5 24.86 1199.37 percent of total billed charges 1645.6 4824.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILGRASTIM 480 MCG/0.8 ML INJECTION SYRINGE RX-108076 CDM J1442 HCPCS 0636 RC 55513-0209-91 NDC outpatient 0.8 ML 1594.3 1594.3 540.14 540.14 fee schedule 1594.3 93 1291.38 percent of total billed charges 1594.3 1594.3 other OPPS APC 1594.3 1594.3 other OPPS APC 1594.3 24.86 396.34 percent of total billed charges 540.14 1594.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE RX-108096 CDM J9395 HCPCS 0636 RC 00143-9022-02 NDC outpatient 5 ML 225 225 108.05 108.05 fee schedule 225 93 182.25 percent of total billed charges 225 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 75.06 other OPPS APC 225 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 75.06 other OPPS APC 225 24.86 55.94 percent of total billed charges 108.05 225 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXYCHLOROSENE SODIUM TOPICAL POWDER FOR SOLUTION RX-10811 CDM 250000000 HCPCS 0250 RC 00327-0001-10 NDC outpatient 2 GR 17.5 17.5 17.5 74 12.95 percent of total billed charges 17.5 93 14.18 percent of total billed charges 17.5 17.5 other OPPS APC 17.5 17.5 other OPPS APC 17.5 24.86 4.35 percent of total billed charges 17.5 17.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOFLOXACIN 250 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK RX-108118 CDM J1956 HCPCS 0636 RC 36000-0046-24 NDC outpatient 250 ME 12 12 1.05 1.05 fee schedule 12 93 9.72 percent of total billed charges 12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12 other OPPS APC 12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12 other OPPS APC 12 24.86 2.98 percent of total billed charges 1.05 12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOFLOXACIN 250 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK RX-108118 CDM J1956 HCPCS 0636 RC 36000-0046-24 NDC outpatient 50 ML 12 12 1.05 1.05 fee schedule 12 93 9.72 percent of total billed charges 12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12 other OPPS APC 12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12 other OPPS APC 12 24.86 2.98 percent of total billed charges 1.05 12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK RX-108119 CDM J1956 HCPCS 0636 RC 00143-9721-24 NDC outpatient 100 ML 18.36 18.36 2.11 2.11 fee schedule 18.36 93 14.87 percent of total billed charges 18.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.36 other OPPS APC 18.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.36 other OPPS APC 18.36 24.86 4.56 percent of total billed charges 2.11 18.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK RX-108119 CDM J1956 HCPCS 0636 RC 00143-9721-24 NDC outpatient 500 ME 18.36 18.36 2.11 2.11 fee schedule 18.36 93 14.87 percent of total billed charges 18.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.36 other OPPS APC 18.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.36 other OPPS APC 18.36 24.86 4.56 percent of total billed charges 2.11 18.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK RX-108120 CDM J1956 HCPCS 0636 RC 00409-4444-24 NDC outpatient 150 ML 10.78 10.78 3.16 3.16 fee schedule 10.78 93 8.73 percent of total billed charges 10.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.78 other OPPS APC 10.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.78 other OPPS APC 10.78 24.86 2.68 percent of total billed charges 3.16 10.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK RX-108120 CDM J1956 HCPCS 0636 RC 00409-4444-24 NDC outpatient 750 ME 10.78 10.78 3.16 3.16 fee schedule 10.78 93 8.73 percent of total billed charges 10.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.78 other OPPS APC 10.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.78 other OPPS APC 10.78 24.86 2.68 percent of total billed charges 3.16 10.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO-OSM) IV PIGGYBACK RX-108121 CDM J2543 HCPCS 0636 RC 00338-9638-12 NDC outpatient 100 ML 30.75 30.75 6.2 6.2 fee schedule 30.75 93 24.91 percent of total billed charges 30.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.75 other OPPS APC 30.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.75 other OPPS APC 30.75 24.86 7.64 percent of total billed charges 6.2 30.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIPERACILLIN-TAZOBACTAM 4.5 GRAM/100 ML DEXTROSE(ISO-OSM) IV PIGGYBACK RX-108121 CDM J2543 HCPCS 0636 RC 00338-9638-12 NDC outpatient 4.5 GR 30.75 30.75 6.2 6.2 fee schedule 30.75 93 24.91 percent of total billed charges 30.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.75 other OPPS APC 30.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.75 other OPPS APC 30.75 24.86 7.64 percent of total billed charges 6.2 30.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION RX-108122 CDM J9171 HCPCS 0636 RC 16729-0267-64 NDC outpatient 4 ML 3651.5 3651.5 85.18 85.18 fee schedule 3651.5 93 2957.72 percent of total billed charges 3651.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3651.5 other OPPS APC 3651.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3651.5 other OPPS APC 3651.5 24.86 907.76 percent of total billed charges 85.18 3651.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXYCODONE 5 MG/5 ML ORAL SOLUTION RX-10813 CDM A9270 HCPCS 0250 RC 00904-6828-94 NDC outpatient 5 ML 13.16 13.16 74 9.74 percent of total billed charges 13.16 93 10.66 percent of total billed charges 13.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.16 other OPPS APC 13.16 13.16 other OPPS APC 13.16 24.86 3.27 percent of total billed charges 13.16 13.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXYCODONE 5 MG/5 ML ORAL SOLUTION RX-10813 CDM A9270 HCPCS 0637 RC 00904-6828-94 NDC outpatient 5 ML 13.16 13.16 13.16 74 9.74 percent of total billed charges 13.16 93 10.66 percent of total billed charges 13.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.16 other OPPS APC 13.16 13.16 other OPPS APC 13.16 24.86 3.27 percent of total billed charges 13.16 13.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CIPROFLOXACIN 200 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK RX-108130 CDM J0744 HCPCS 0636 RC 00409-2300-24 NDC outpatient 100 ML 8.79 8.79 2.23 2.23 fee schedule 8.79 93 7.12 percent of total billed charges 8.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.79 other OPPS APC 8.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.79 other OPPS APC 8.79 24.86 2.19 percent of total billed charges 2.23 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CIPROFLOXACIN 200 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK RX-108130 CDM J0744 HCPCS 0636 RC 00409-2300-24 NDC outpatient 200 ME 8.79 8.79 2.23 2.23 fee schedule 8.79 93 7.12 percent of total billed charges 8.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.79 other OPPS APC 8.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.79 other OPPS APC 8.79 24.86 2.19 percent of total billed charges 2.23 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMIKACIN 500 MG/2 ML INJECTION SOLUTION RX-108131 CDM J0278 HCPCS 0636 RC 23155-0290-31 NDC outpatient 2 ML 22.5 22.5 5.32 5.32 fee schedule 22.5 93 18.23 percent of total billed charges 22.5 22.5 other OPPS APC 22.5 22.5 other OPPS APC 22.5 24.86 5.59 percent of total billed charges 5.32 22.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK RX-108132 CDM J0744 HCPCS 0636 RC 00409-3300-24 NDC outpatient 200 ML 10.85 10.85 4.45 4.45 fee schedule 10.85 93 8.79 percent of total billed charges 10.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.85 other OPPS APC 10.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.85 other OPPS APC 10.85 24.86 2.7 percent of total billed charges 4.45 10.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK RX-108132 CDM J0744 HCPCS 0636 RC 00409-3300-24 NDC outpatient 400 ME 10.85 10.85 4.45 4.45 fee schedule 10.85 93 8.79 percent of total billed charges 10.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.85 other OPPS APC 10.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.85 other OPPS APC 10.85 24.86 2.7 percent of total billed charges 4.45 10.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXYCODONE 5 MG TABLET RX-10814 CDM A9270 HCPCS 0250 RC 00904-6966-61 NDC outpatient 1 UN 0.99 0.99 74 0.73 percent of total billed charges 0.99 93 0.8 percent of total billed charges 0.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.99 other OPPS APC 0.99 0.99 other OPPS APC 0.99 24.86 0.25 percent of total billed charges 0.99 0.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXYCODONE 5 MG TABLET RX-10814 CDM A9270 HCPCS 0637 RC 00904-6966-61 NDC outpatient 1 UN 0.99 0.99 0.99 74 0.73 percent of total billed charges 0.99 93 0.8 percent of total billed charges 0.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.99 other OPPS APC 0.99 0.99 other OPPS APC 0.99 24.86 0.25 percent of total billed charges 0.99 0.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION RX-10839 CDM A9270 HCPCS 0250 RC 52268-0100-01 NDC outpatient 1 UN 74.73 74.73 74 55.3 percent of total billed charges 74.73 93 60.53 percent of total billed charges 74.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 74.73 other OPPS APC 74.73 74.73 other OPPS APC 74.73 24.86 18.58 percent of total billed charges 74.73 74.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION RX-10839 CDM A9270 HCPCS 0637 RC 52268-0100-01 NDC outpatient 1 UN 74.73 74.73 74.73 74 55.3 percent of total billed charges 74.73 93 60.53 percent of total billed charges 74.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 74.73 other OPPS APC 74.73 74.73 other OPPS APC 74.73 24.86 18.58 percent of total billed charges 74.73 74.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAROXETINE 20 MG TABLET RX-10855 CDM A9270 HCPCS 0250 RC 00904-5677-61 NDC outpatient 1 UN 7.35 7.35 74 5.44 percent of total billed charges 7.35 93 5.95 percent of total billed charges 7.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.35 other OPPS APC 7.35 7.35 other OPPS APC 7.35 24.86 1.83 percent of total billed charges 7.35 7.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAROXETINE 20 MG TABLET RX-10855 CDM A9270 HCPCS 0637 RC 00904-5677-61 NDC outpatient 1 UN 7.35 7.35 7.35 74 5.44 percent of total billed charges 7.35 93 5.95 percent of total billed charges 7.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.35 other OPPS APC 7.35 7.35 other OPPS APC 7.35 24.86 1.83 percent of total billed charges 7.35 7.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 750 MG/150 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK RX-108740 CDM J3370 HCPCS 0636 RC 00338-3580-48 NDC outpatient 150 ML 192.75 192.75 5.49 5.49 fee schedule 192.75 93 156.13 percent of total billed charges 192.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.75 other OPPS APC 192.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.75 other OPPS APC 192.75 24.86 47.92 percent of total billed charges 5.49 192.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 750 MG/150 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK RX-108740 CDM J3370 HCPCS 0636 RC 00338-3580-48 NDC outpatient 750 ME 192.75 192.75 5.49 5.49 fee schedule 192.75 93 156.13 percent of total billed charges 192.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.75 other OPPS APC 192.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.75 other OPPS APC 192.75 24.86 47.92 percent of total billed charges 5.49 192.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BELIMUMAB 120 MG INTRAVENOUS SOLUTION RX-108842 CDM J0490 HCPCS 0636 RC 49401-0101-01 NDC outpatient 1.5 ML 1866.9 1866.9 697.54 697.54 fee schedule 1866.9 93 1512.19 percent of total billed charges 1866.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 649.79 other OPPS APC 1866.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 649.79 other OPPS APC 1866.9 24.86 464.11 percent of total billed charges 697.54 1866.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BELIMUMAB 400 MG INTRAVENOUS SOLUTION RX-108843 CDM J0490 HCPCS 0636 RC 49401-0102-01 NDC outpatient 5 ML 6222.65 6222.65 2325.14 2325.14 fee schedule 6222.65 93 5040.35 percent of total billed charges 6222.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2165.96 other OPPS APC 6222.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2165.96 other OPPS APC 6222.65 24.86 1546.95 percent of total billed charges 2325.14 6222.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOCETAXEL 80 MG/8 ML (10 MG/ML) INTRAVENOUS SOLUTION RX-108907 CDM J9171 HCPCS 0636 RC 43066-0006-01 NDC outpatient 8 ML 492 492 85.18 85.18 fee schedule 492 93 398.52 percent of total billed charges 492 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 492 other OPPS APC 492 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 492 other OPPS APC 492 24.86 122.31 percent of total billed charges 85.18 492 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOCETAXEL 20 MG/2 ML (10 MG/ML) INTRAVENOUS SOLUTION RX-108910 CDM J9171 HCPCS 0636 RC 62332-0678-02 NDC outpatient 2 ML 971.53 971.53 21.3 21.3 fee schedule 971.53 93 786.94 percent of total billed charges 971.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 971.53 other OPPS APC 971.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 971.53 other OPPS APC 971.53 24.86 241.52 percent of total billed charges 21.3 971.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IPILIMUMAB 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION RX-108955 CDM J9228 HCPCS 0636 RC 00003-2327-11 NDC outpatient 10 ML 26109.4 26109.4 9585.02 9585.02 fee schedule 26109.4 93 21148.6 percent of total billed charges 26109.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8844.2 other OPPS APC 26109.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8844.2 other OPPS APC 26109.4 24.86 6490.8 percent of total billed charges 9585.02 26109.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PENICILLIN G BENZATHINE 600,000 UNIT/ML INTRAMUSCULAR SYRINGE" RX-10897 CDM J0561 HCPCS 0636 RC 60793-0700-10 NDC outpatient 1 ML 528.29 528.29 138.16 138.16 fee schedule 528.29 93 427.91 percent of total billed charges 528.29 528.29 other OPPS APC 528.29 528.29 other OPPS APC 528.29 24.86 131.33 percent of total billed charges 138.16 528.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION RX-1090 CDM A9270 HCPCS 0250 RC 00536-1286-36 NDC outpatient 237 ML 8.91 8.91 74 6.59 percent of total billed charges 8.91 93 7.22 percent of total billed charges 8.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.91 other OPPS APC 8.91 8.91 other OPPS APC 8.91 24.86 2.22 percent of total billed charges 8.91 8.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION RX-1090 CDM A9270 HCPCS 0637 RC 00536-1286-36 NDC outpatient 237 ML 8.91 8.91 8.91 74 6.59 percent of total billed charges 8.91 93 7.22 percent of total billed charges 8.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.91 other OPPS APC 8.91 8.91 other OPPS APC 8.91 24.86 2.22 percent of total billed charges 8.91 8.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENICILLIN G POT 3 MILLION UNIT/50 ML-DEXTROSE INTRAVENOUS PIGGYBACK RX-10900 CDM J2540 HCPCS 0636 RC 00338-1025-41 NDC outpatient 50 ML 35.63 35.63 6.11 6.11 fee schedule 35.63 93 28.86 percent of total billed charges 35.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35.63 other OPPS APC 35.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35.63 other OPPS APC 35.63 24.86 8.86 percent of total billed charges 6.11 35.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) INTRAVENOUS SOLUTION RX-109034 CDM 250000000 HCPCS 0250 RC 00641-6164-10 NDC outpatient 3 ML 30 30 30 74 22.2 percent of total billed charges 30 93 24.3 percent of total billed charges 30 30 other OPPS APC 30 30 other OPPS APC 30 24.86 7.46 percent of total billed charges 30 30 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENTOSTATIN 10 MG INTRAVENOUS SOLUTION RX-10910 CDM J9268 HCPCS 0636 RC 00409-0801-01 NDC outpatient 5 ML 8853.85 8853.85 2725.61 2725.61 fee schedule 8853.85 93 7171.62 percent of total billed charges 8853.85 8853.85 other OPPS APC 8853.85 8853.85 other OPPS APC 8853.85 24.86 2201.07 percent of total billed charges 2725.61 8853.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERMETHRIN 5 % TOPICAL CREAM RX-10917 CDM A9270 HCPCS 0250 RC 21922-0021-07 NDC outpatient 60 GR 295.01 295.01 74 218.31 percent of total billed charges 295.01 93 238.96 percent of total billed charges 295.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 295.01 other OPPS APC 295.01 295.01 other OPPS APC 295.01 24.86 73.34 percent of total billed charges 295.01 295.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERMETHRIN 5 % TOPICAL CREAM RX-10917 CDM A9270 HCPCS 0637 RC 21922-0021-07 NDC outpatient 60 GR 295.01 295.01 295.01 74 218.31 percent of total billed charges 295.01 93 238.96 percent of total billed charges 295.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 295.01 other OPPS APC 295.01 295.01 other OPPS APC 295.01 24.86 73.34 percent of total billed charges 295.01 295.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERMETHRIN 1 % TOPICAL LIQUID RX-10918 CDM A9270 HCPCS 0250 RC 63736-0120-02 NDC outpatient 59 ML 24.19 24.19 74 17.9 percent of total billed charges 24.19 93 19.59 percent of total billed charges 24.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.19 other OPPS APC 24.19 24.19 other OPPS APC 24.19 24.86 6.01 percent of total billed charges 24.19 24.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERMETHRIN 1 % TOPICAL LIQUID RX-10918 CDM A9270 HCPCS 0637 RC 63736-0120-02 NDC outpatient 59 ML 24.19 24.19 24.19 74 17.9 percent of total billed charges 24.19 93 19.59 percent of total billed charges 24.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.19 other OPPS APC 24.19 24.19 other OPPS APC 24.19 24.86 6.01 percent of total billed charges 24.19 24.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROFLUMILAST 500 MCG TABLET RX-109401 CDM A9270 HCPCS 0250 RC 59651-0275-90 NDC outpatient 1 UN 37.66 37.66 74 27.87 percent of total billed charges 37.66 93 30.5 percent of total billed charges 37.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 37.66 other OPPS APC 37.66 37.66 other OPPS APC 37.66 24.86 9.36 percent of total billed charges 37.66 37.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROFLUMILAST 500 MCG TABLET RX-109401 CDM A9270 HCPCS 0637 RC 59651-0275-90 NDC outpatient 1 UN 37.66 37.66 37.66 74 27.87 percent of total billed charges 37.66 93 30.5 percent of total billed charges 37.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 37.66 other OPPS APC 37.66 37.66 other OPPS APC 37.66 24.86 9.36 percent of total billed charges 37.66 37.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENTOLAMINE 5 MG INJECTION SOLUTION RX-10947 CDM J2760 HCPCS 0636 RC 00143-9564-10 NDC outpatient 1 ML 1469.89 1469.89 523.02 523.02 fee schedule 1469.89 93 1190.61 percent of total billed charges 1469.89 1469.89 other OPPS APC 1469.89 1469.89 other OPPS APC 1469.89 24.86 365.41 percent of total billed charges 523.02 1469.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENTOLAMINE 5 MG INJECTION SOLUTION RX-10947 CDM J2760 HCPCS 0636 RC 00143-9564-10 NDC outpatient 5 ME 1469.89 1469.89 523.02 523.02 fee schedule 1469.89 93 1190.61 percent of total billed charges 1469.89 1469.89 other OPPS APC 1469.89 1469.89 other OPPS APC 1469.89 24.86 365.41 percent of total billed charges 523.02 1469.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT FOR PREPARATION OF TC 99M-PENTETIC ACID 20 MG IV SOLUTION RX-109481 CDM A9539 HCPCS 0343 RC 65174-0288-30 NDC outpatient 1.01818 UN 82 82 82 74 60.68 percent of total billed charges 82 93 66.42 percent of total billed charges 82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 82 other OPPS APC 82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 82 other OPPS APC 82 24.86 20.39 percent of total billed charges 82 82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENYTOIN 50 MG CHEWABLE TABLET RX-11018 CDM A9270 HCPCS 0250 RC 66993-0372-02 NDC outpatient 1 UN 1.32 1.32 74 0.98 percent of total billed charges 1.32 93 1.07 percent of total billed charges 1.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.32 other OPPS APC 1.32 1.32 other OPPS APC 1.32 24.86 0.33 percent of total billed charges 1.32 1.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENYTOIN 50 MG CHEWABLE TABLET RX-11018 CDM A9270 HCPCS 0637 RC 66993-0372-02 NDC outpatient 1 UN 1.32 1.32 1.32 74 0.98 percent of total billed charges 1.32 93 1.07 percent of total billed charges 1.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.32 other OPPS APC 1.32 1.32 other OPPS APC 1.32 24.86 0.33 percent of total billed charges 1.32 1.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE RX-11019 CDM A9270 HCPCS 0250 RC 00071-3740-66 NDC outpatient 1 UN 4.36 4.36 74 3.23 percent of total billed charges 4.36 93 3.53 percent of total billed charges 4.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.36 other OPPS APC 4.36 4.36 other OPPS APC 4.36 24.86 1.08 percent of total billed charges 4.36 4.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE RX-11019 CDM A9270 HCPCS 0637 RC 00071-3740-66 NDC outpatient 1 UN 4.36 4.36 4.36 74 3.23 percent of total billed charges 4.36 93 3.53 percent of total billed charges 4.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.36 other OPPS APC 4.36 4.36 other OPPS APC 4.36 24.86 1.08 percent of total billed charges 4.36 4.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION RX-11023 CDM J3430 HCPCS 0636 RC 43598-0405-16 NDC outpatient 1 ML 128.3 128.3 32.79 32.79 fee schedule 128.3 93 103.92 percent of total billed charges 128.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 128.3 other OPPS APC 128.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 128.3 other OPPS APC 128.3 24.86 31.9 percent of total billed charges 32.79 128.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHYTONADIONE (VITAMIN K1) 5 MG TABLET RX-11024 CDM A9270 HCPCS 0250 RC 76282-0740-30 NDC outpatient 1 UN 21.48 21.48 74 15.9 percent of total billed charges 21.48 93 17.4 percent of total billed charges 21.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 21.48 other OPPS APC 21.48 21.48 other OPPS APC 21.48 24.86 5.34 percent of total billed charges 21.48 21.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHYTONADIONE (VITAMIN K1) 5 MG TABLET RX-11024 CDM A9270 HCPCS 0637 RC 76282-0740-30 NDC outpatient 1 UN 21.48 21.48 21.48 74 15.9 percent of total billed charges 21.48 93 17.4 percent of total billed charges 21.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 21.48 other OPPS APC 21.48 21.48 other OPPS APC 21.48 24.86 5.34 percent of total billed charges 21.48 21.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIVAROXABAN 10 MG TABLET RX-110250 CDM A9270 HCPCS 0250 RC 50458-0580-10 NDC outpatient 1 UN 56.96 56.96 74 42.15 percent of total billed charges 56.96 93 46.14 percent of total billed charges 56.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56.96 other OPPS APC 56.96 56.96 other OPPS APC 56.96 24.86 14.16 percent of total billed charges 56.96 56.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIVAROXABAN 10 MG TABLET RX-110250 CDM A9270 HCPCS 0637 RC 50458-0580-10 NDC outpatient 1 UN 56.96 56.96 56.96 74 42.15 percent of total billed charges 56.96 93 46.14 percent of total billed charges 56.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56.96 other OPPS APC 56.96 56.96 other OPPS APC 56.96 24.86 14.16 percent of total billed charges 56.96 56.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "AMIODARONE 150 MG/100 ML (1.5 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV" RX-110257 CDM J0283 HCPCS 0636 RC 43066-0150-10 NDC outpatient 100 ML 104.07 104.07 104.07 74 77.01 percent of total billed charges 104.07 93 84.3 percent of total billed charges 104.07 104.07 other OPPS APC 104.07 104.07 other OPPS APC 104.07 24.86 25.87 percent of total billed charges 104.07 104.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "AMIODARONE 150 MG/100 ML (1.5 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV" RX-110257 CDM J0283 HCPCS 0636 RC 43066-0150-10 NDC outpatient 150 ME 104.07 104.07 104.07 74 77.01 percent of total billed charges 104.07 93 84.3 percent of total billed charges 104.07 104.07 other OPPS APC 104.07 104.07 other OPPS APC 104.07 24.86 25.87 percent of total billed charges 104.07 104.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "AMIODARONE 360 MG/200 ML (1.8 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV" RX-110258 CDM J0283 HCPCS 0636 RC 43066-0360-20 NDC outpatient 200 ML 138.42 138.42 138.42 74 102.43 percent of total billed charges 138.42 93 112.12 percent of total billed charges 138.42 138.42 other OPPS APC 138.42 138.42 other OPPS APC 138.42 24.86 34.41 percent of total billed charges 138.42 138.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIDAXOMICIN 200 MG TABLET RX-110360 CDM A9270 HCPCS 0250 RC 52015-0080-01 NDC outpatient 1 UN 747.12 747.12 74 552.87 percent of total billed charges 747.12 93 605.17 percent of total billed charges 747.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 747.12 other OPPS APC 747.12 747.12 other OPPS APC 747.12 24.86 185.73 percent of total billed charges 747.12 747.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIDAXOMICIN 200 MG TABLET RX-110360 CDM A9270 HCPCS 0637 RC 52015-0080-01 NDC outpatient 1 UN 747.12 747.12 747.12 74 552.87 percent of total billed charges 747.12 93 605.17 percent of total billed charges 747.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 747.12 other OPPS APC 747.12 747.12 other OPPS APC 747.12 24.86 185.73 percent of total billed charges 747.12 747.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TICAGRELOR 90 MG TABLET RX-110427 CDM 250000000 HCPCS 0250 RC 00186-0777-39 NDC outpatient 1 UN 22.56 22.56 22.56 74 16.69 percent of total billed charges 22.56 93 18.27 percent of total billed charges 22.56 22.56 other OPPS APC 22.56 22.56 other OPPS APC 22.56 24.86 5.61 percent of total billed charges 22.56 22.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTAS AND SOD CITRATE-CITRIC ACID 550 MG-500 MG-334 MG/5 ML ORAL SOLN RX-11057 CDM A9270 HCPCS 0250 RC 00121-0677-16 NDC outpatient 473 ML 149 149 74 110.26 percent of total billed charges 149 93 120.69 percent of total billed charges 149 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 149 other OPPS APC 149 149 other OPPS APC 149 24.86 37.04 percent of total billed charges 149 149 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTAS AND SOD CITRATE-CITRIC ACID 550 MG-500 MG-334 MG/5 ML ORAL SOLN RX-11057 CDM A9270 HCPCS 0637 RC 00121-0677-16 NDC outpatient 473 ML 149 149 149 74 110.26 percent of total billed charges 149 93 120.69 percent of total billed charges 149 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 149 other OPPS APC 149 149 other OPPS APC 149 24.86 37.04 percent of total billed charges 149 149 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK RX-11074 CDM J3480 HCPCS 0636 RC 00338-0709-48 NDC outpatient 100 ML 11.84 11.84 0.61 0.61 fee schedule 11.84 93 9.59 percent of total billed charges 11.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.84 other OPPS APC 11.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.84 other OPPS APC 11.84 24.86 2.94 percent of total billed charges 0.61 11.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK RX-11076 CDM J3480 HCPCS 0636 RC 00338-0705-48 NDC outpatient 100 ML 12.25 12.25 1.21 1.21 fee schedule 12.25 93 9.92 percent of total billed charges 12.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.25 other OPPS APC 12.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.25 other OPPS APC 12.25 24.86 3.05 percent of total billed charges 1.21 12.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS RX-11081 CDM J3480 HCPCS 0636 RC 00338-0691-04 NDC outpatient 1000 ML 31.9 31.9 1.21 1.21 fee schedule 31.9 93 25.84 percent of total billed charges 31.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 31.9 other OPPS APC 31.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 31.9 other OPPS APC 31.9 24.86 7.93 percent of total billed charges 1.21 31.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM CHLORIDE 40 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS RX-11082 CDM J3480 HCPCS 0636 RC 00338-0695-04 NDC outpatient 1000 ML 32.99 32.99 2.42 2.42 fee schedule 32.99 93 26.72 percent of total billed charges 32.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 32.99 other OPPS APC 32.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 32.99 other OPPS APC 32.99 24.86 8.2 percent of total billed charges 2.42 32.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE" RX-11083 CDM A9270 HCPCS 0250 RC 68084-0850-32 NDC outpatient 1 UN 7.24 7.24 74 5.36 percent of total billed charges 7.24 93 5.86 percent of total billed charges 7.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.24 other OPPS APC 7.24 7.24 other OPPS APC 7.24 24.86 1.8 percent of total billed charges 7.24 7.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE" RX-11083 CDM A9270 HCPCS 0637 RC 68084-0850-32 NDC outpatient 1 UN 7.24 7.24 7.24 74 5.36 percent of total billed charges 7.24 93 5.86 percent of total billed charges 7.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.24 other OPPS APC 7.24 7.24 other OPPS APC 7.24 24.86 1.8 percent of total billed charges 7.24 7.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSELTAMIVIR 6 MG/ML ORAL SUSPENSION RX-110998 CDM A9270 HCPCS 0250 RC 00527-5137-62 NDC outpatient 60 ML 432.88 432.88 74 320.33 percent of total billed charges 432.88 93 350.63 percent of total billed charges 432.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.88 other OPPS APC 432.88 432.88 other OPPS APC 432.88 24.86 107.61 percent of total billed charges 432.88 432.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSELTAMIVIR 6 MG/ML ORAL SUSPENSION RX-110998 CDM A9270 HCPCS 0637 RC 00527-5137-62 NDC outpatient 60 ML 432.88 432.88 432.88 74 320.33 percent of total billed charges 432.88 93 350.63 percent of total billed charges 432.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.88 other OPPS APC 432.88 432.88 other OPPS APC 432.88 24.86 107.61 percent of total billed charges 432.88 432.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRAVASTATIN 10 MG TABLET RX-11110 CDM A9270 HCPCS 0250 RC 00904-5891-61 NDC outpatient 1 UN 7.24 7.24 74 5.36 percent of total billed charges 7.24 93 5.86 percent of total billed charges 7.24 7.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRAVASTATIN 10 MG TABLET RX-11110 CDM A9270 HCPCS 0637 RC 00904-5891-61 NDC outpatient 1 UN 7.24 7.24 7.24 74 5.36 percent of total billed charges 7.24 93 5.86 percent of total billed charges 7.24 7.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRAVASTATIN 10 MG TABLET RX-11110 CDM A9270 HCPCS 0250 RC 50268-0665-15 NDC outpatient 1 UN 7.24 7.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.24 other OPPS APC 7.24 7.24 other OPPS APC 7.24 24.86 1.8 percent of total billed charges 7.24 7.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRAVASTATIN 10 MG TABLET RX-11110 CDM A9270 HCPCS 0637 RC 50268-0665-15 NDC outpatient 1 UN 7.24 7.24 7.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.24 other OPPS APC 7.24 7.24 other OPPS APC 7.24 24.86 1.8 percent of total billed charges 7.24 7.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRAVASTATIN 20 MG TABLET RX-11111 CDM A9270 HCPCS 0250 RC 00904-5892-61 NDC outpatient 1 UN 6.24 6.24 74 4.62 percent of total billed charges 6.24 93 5.05 percent of total billed charges 6.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.24 other OPPS APC 6.24 6.24 other OPPS APC 6.24 24.86 1.55 percent of total billed charges 6.24 6.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRAVASTATIN 20 MG TABLET RX-11111 CDM A9270 HCPCS 0637 RC 00904-5892-61 NDC outpatient 1 UN 6.24 6.24 6.24 74 4.62 percent of total billed charges 6.24 93 5.05 percent of total billed charges 6.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.24 other OPPS APC 6.24 6.24 other OPPS APC 6.24 24.86 1.55 percent of total billed charges 6.24 6.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRAVASTATIN 40 MG TABLET RX-11112 CDM A9270 HCPCS 0250 RC 50268-0667-15 NDC outpatient 1 UN 10.74 10.74 74 7.95 percent of total billed charges 10.74 93 8.7 percent of total billed charges 10.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.74 other OPPS APC 10.74 10.74 other OPPS APC 10.74 24.86 2.67 percent of total billed charges 10.74 10.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRAVASTATIN 40 MG TABLET RX-11112 CDM A9270 HCPCS 0637 RC 50268-0667-15 NDC outpatient 1 UN 10.74 10.74 10.74 74 7.95 percent of total billed charges 10.74 93 8.7 percent of total billed charges 10.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.74 other OPPS APC 10.74 10.74 other OPPS APC 10.74 24.86 2.67 percent of total billed charges 10.74 10.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZINC OXIDE-COD LIVER OIL 40 % TOPICAL PASTE RX-111153 CDM A9270 HCPCS 0250 RC 74300-0000-70 NDC outpatient 57 GR 8.11 8.11 74 6 percent of total billed charges 8.11 93 6.57 percent of total billed charges 8.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.11 other OPPS APC 8.11 8.11 other OPPS APC 8.11 24.86 2.02 percent of total billed charges 8.11 8.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZINC OXIDE-COD LIVER OIL 40 % TOPICAL PASTE RX-111153 CDM A9270 HCPCS 0637 RC 74300-0000-70 NDC outpatient 57 GR 8.11 8.11 8.11 74 6 percent of total billed charges 8.11 93 6.57 percent of total billed charges 8.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.11 other OPPS APC 8.11 8.11 other OPPS APC 8.11 24.86 2.02 percent of total billed charges 8.11 8.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENZOCAINE 15 MG-MENTHOL 2.6 MG LOZENGES RX-111183 CDM A9270 HCPCS 0250 RC 63824-0732-16 NDC outpatient 1 UN 0.77 0.77 74 0.57 percent of total billed charges 0.77 93 0.62 percent of total billed charges 0.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.77 other OPPS APC 0.77 0.77 other OPPS APC 0.77 24.86 0.19 percent of total billed charges 0.77 0.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENZOCAINE 15 MG-MENTHOL 2.6 MG LOZENGES RX-111183 CDM A9270 HCPCS 0637 RC 63824-0732-16 NDC outpatient 1 UN 0.77 0.77 0.77 74 0.57 percent of total billed charges 0.77 93 0.62 percent of total billed charges 0.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.77 other OPPS APC 0.77 0.77 other OPPS APC 0.77 24.86 0.19 percent of total billed charges 0.77 0.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET RX-111196 CDM A9270 HCPCS 0250 RC 20555-0019-00 NDC outpatient 1 UN 0.1 0.1 74 0.07 percent of total billed charges 0.1 93 0.08 percent of total billed charges 0.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.1 other OPPS APC 0.1 0.1 other OPPS APC 0.1 24.86 0.02 percent of total billed charges 0.1 0.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET RX-111196 CDM A9270 HCPCS 0637 RC 20555-0019-00 NDC outpatient 1 UN 0.1 0.1 0.1 74 0.07 percent of total billed charges 0.1 93 0.08 percent of total billed charges 0.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.1 other OPPS APC 0.1 0.1 other OPPS APC 0.1 24.86 0.02 percent of total billed charges 0.1 0.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRIMIDONE 50 MG TABLET RX-11129 CDM A9270 HCPCS 0250 RC 50268-0686-15 NDC outpatient 1 UN 2.39 2.39 74 1.77 percent of total billed charges 2.39 93 1.94 percent of total billed charges 2.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.39 other OPPS APC 2.39 2.39 other OPPS APC 2.39 24.86 0.59 percent of total billed charges 2.39 2.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRIMIDONE 50 MG TABLET RX-11129 CDM A9270 HCPCS 0637 RC 50268-0686-15 NDC outpatient 1 UN 2.39 2.39 2.39 74 1.77 percent of total billed charges 2.39 93 1.94 percent of total billed charges 2.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.39 other OPPS APC 2.39 2.39 other OPPS APC 2.39 24.86 0.59 percent of total billed charges 2.39 2.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION RX-111348 CDM J9042 HCPCS 0636 RC 51144-0050-01 NDC outpatient 10 ML 35226 35226 12668.7 12668.7 fee schedule 35226 93 28533.1 percent of total billed charges 35226 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11992.8 other OPPS APC 35226 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11992.8 other OPPS APC 35226 24.86 8757.18 percent of total billed charges 12668.7 35226 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICATIBANT 30 MG/3 ML SUBCUTANEOUS SYRINGE RX-111395 CDM J1744 HCPCS 0636 RC 60505-6214-01 NDC outpatient 3 ML 31770.4 31770.4 31770.4 74 23510.1 percent of total billed charges 31770.4 93 25734 percent of total billed charges 31770.4 31770.4 other OPPS APC 31770.4 31770.4 other OPPS APC 31770.4 24.86 7898.11 percent of total billed charges 31770.4 31770.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY RX-11143 CDM A9270 HCPCS 0250 RC 45802-0758-30 NDC outpatient 1 UN 44.27 44.27 74 32.76 percent of total billed charges 44.27 93 35.86 percent of total billed charges 44.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.27 other OPPS APC 44.27 44.27 other OPPS APC 44.27 24.86 11.01 percent of total billed charges 44.27 44.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY RX-11143 CDM A9270 HCPCS 0637 RC 45802-0758-30 NDC outpatient 1 UN 44.27 44.27 44.27 74 32.76 percent of total billed charges 44.27 93 35.86 percent of total billed charges 44.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.27 other OPPS APC 44.27 44.27 other OPPS APC 44.27 24.86 11.01 percent of total billed charges 44.27 44.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZOLEDRONIC ACID 4 MG/100 ML-MANNITOL-0.9 % NACL INTRAVENOUS PIGGYBACK RX-111464 CDM J3489 HCPCS 0636 RC 25021-0826-82 NDC outpatient 100 ML 540 540 41.48 41.48 fee schedule 540 93 437.4 percent of total billed charges 540 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 540 other OPPS APC 540 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 540 other OPPS APC 540 24.86 134.24 percent of total billed charges 41.48 540 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROPOFOL 10 MG/ML INTRAVENOUS EMULSION RX-11150 CDM J2704 HCPCS 0636 RC 16714-0690-10 NDC outpatient 100 ML 64.79 64.79 10.89 10.89 fee schedule 64.79 93 52.48 percent of total billed charges 64.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 64.79 other OPPS APC 64.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 64.79 other OPPS APC 64.79 24.86 16.11 percent of total billed charges 10.89 64.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PYRIDOSTIGMINE BROMIDE 60 MG TABLET RX-11239 CDM A9270 HCPCS 0250 RC 00904-6622-61 NDC outpatient 1 UN 4.04 4.04 74 2.99 percent of total billed charges 4.04 93 3.27 percent of total billed charges 4.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.04 other OPPS APC 4.04 4.04 other OPPS APC 4.04 24.86 1 percent of total billed charges 4.04 4.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PYRIDOSTIGMINE BROMIDE 60 MG TABLET RX-11239 CDM A9270 HCPCS 0637 RC 00904-6622-61 NDC outpatient 1 UN 4.04 4.04 4.04 74 2.99 percent of total billed charges 4.04 93 3.27 percent of total billed charges 4.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.04 other OPPS APC 4.04 4.04 other OPPS APC 4.04 24.86 1 percent of total billed charges 4.04 4.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR SOLUTION RX-11256 CDM 90377 HCPCS 0636 RC 76125-0150-11 NDC outpatient 10 ML 10209.7 10209.7 2672.16 2672.16 fee schedule 10209.7 93 8269.88 percent of total billed charges 10209.7 10209.7 other OPPS APC 10209.7 10209.7 other OPPS APC 10209.7 24.86 2538.14 percent of total billed charges 2672.16 10209.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RAMIPRIL 1.25 MG CAPSULE RX-11258 CDM A9270 HCPCS 0250 RC 68382-0144-06 NDC outpatient 1 UN 3.83 3.83 74 2.83 percent of total billed charges 3.83 93 3.1 percent of total billed charges 3.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.83 other OPPS APC 3.83 3.83 other OPPS APC 3.83 24.86 0.95 percent of total billed charges 3.83 3.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RAMIPRIL 1.25 MG CAPSULE RX-11258 CDM A9270 HCPCS 0637 RC 68382-0144-06 NDC outpatient 1 UN 3.83 3.83 3.83 74 2.83 percent of total billed charges 3.83 93 3.1 percent of total billed charges 3.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.83 other OPPS APC 3.83 3.83 other OPPS APC 3.83 24.86 0.95 percent of total billed charges 3.83 3.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RAMIPRIL 2.5 MG CAPSULE RX-11260 CDM A9270 HCPCS 0250 RC 65862-0475-01 NDC outpatient 1 UN 4.52 4.52 74 3.34 percent of total billed charges 4.52 93 3.66 percent of total billed charges 4.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.52 other OPPS APC 4.52 4.52 other OPPS APC 4.52 24.86 1.12 percent of total billed charges 4.52 4.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RAMIPRIL 2.5 MG CAPSULE RX-11260 CDM A9270 HCPCS 0637 RC 65862-0475-01 NDC outpatient 1 UN 4.52 4.52 4.52 74 3.34 percent of total billed charges 4.52 93 3.66 percent of total billed charges 4.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.52 other OPPS APC 4.52 4.52 other OPPS APC 4.52 24.86 1.12 percent of total billed charges 4.52 4.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RAMIPRIL 5 MG CAPSULE RX-11261 CDM A9270 HCPCS 0250 RC 68382-0146-01 NDC outpatient 1 UN 4.74 4.74 74 3.51 percent of total billed charges 4.74 93 3.84 percent of total billed charges 4.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.74 other OPPS APC 4.74 4.74 other OPPS APC 4.74 24.86 1.18 percent of total billed charges 4.74 4.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RAMIPRIL 5 MG CAPSULE RX-11261 CDM A9270 HCPCS 0637 RC 68382-0146-01 NDC outpatient 1 UN 4.74 4.74 4.74 74 3.51 percent of total billed charges 4.74 93 3.84 percent of total billed charges 4.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.74 other OPPS APC 4.74 4.74 other OPPS APC 4.74 24.86 1.18 percent of total billed charges 4.74 4.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUPIVACAINE LIPOSOME(PF) 1.3 %(13.3 MG/ML) SUSPENSION FOR INFILTRATION RX-112781 CDM C9290 HCPCS 0250 RC 65250-0133-09 NDC outpatient 10 ML 682.9 682.9 682.9 74 505.35 percent of total billed charges 682.9 93 553.15 percent of total billed charges 682.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.9 other OPPS APC 682.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.9 other OPPS APC 682.9 24.86 169.77 percent of total billed charges 682.9 682.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GEMCITABINE 200 MG/5.26 ML (38 MG/ML) INTRAVENOUS SOLUTION RX-112786 CDM J9201 HCPCS 0636 RC 00409-0183-01 NDC outpatient 5.26 ML 28 28 4.24 4.24 fee schedule 28 93 22.68 percent of total billed charges 28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28 other OPPS APC 28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28 other OPPS APC 28 24.86 6.96 percent of total billed charges 4.24 28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION RX-112787 CDM J9201 HCPCS 0636 RC 00409-0181-01 NDC outpatient 26.3 ML 135.9 135.9 21.18 21.18 fee schedule 135.9 93 110.08 percent of total billed charges 135.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 135.9 other OPPS APC 135.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 135.9 other OPPS APC 135.9 24.86 33.78 percent of total billed charges 21.18 135.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIVAROXABAN 15 MG TABLET RX-112834 CDM A9270 HCPCS 0250 RC 50458-0578-10 NDC outpatient 1 UN 56.96 56.96 74 42.15 percent of total billed charges 56.96 93 46.14 percent of total billed charges 56.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56.96 other OPPS APC 56.96 56.96 other OPPS APC 56.96 24.86 14.16 percent of total billed charges 56.96 56.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIVAROXABAN 15 MG TABLET RX-112834 CDM A9270 HCPCS 0637 RC 50458-0578-10 NDC outpatient 1 UN 56.96 56.96 56.96 74 42.15 percent of total billed charges 56.96 93 46.14 percent of total billed charges 56.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56.96 other OPPS APC 56.96 56.96 other OPPS APC 56.96 24.86 14.16 percent of total billed charges 56.96 56.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIVAROXABAN 20 MG TABLET RX-112835 CDM A9270 HCPCS 0250 RC 50458-0579-10 NDC outpatient 1 UN 56.96 56.96 74 42.15 percent of total billed charges 56.96 93 46.14 percent of total billed charges 56.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56.96 other OPPS APC 56.96 56.96 other OPPS APC 56.96 24.86 14.16 percent of total billed charges 56.96 56.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIVAROXABAN 20 MG TABLET RX-112835 CDM A9270 HCPCS 0637 RC 50458-0579-10 NDC outpatient 1 UN 56.96 56.96 56.96 74 42.15 percent of total billed charges 56.96 93 46.14 percent of total billed charges 56.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56.96 other OPPS APC 56.96 56.96 other OPPS APC 56.96 24.86 14.16 percent of total billed charges 56.96 56.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIFABUTIN 150 MG CAPSULE RX-11290 CDM A9270 HCPCS 0250 RC 10135-0738-01 NDC outpatient 1 UN 29.02 29.02 74 21.47 percent of total billed charges 29.02 93 23.51 percent of total billed charges 29.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.02 other OPPS APC 29.02 29.02 other OPPS APC 29.02 24.86 7.21 percent of total billed charges 29.02 29.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIFABUTIN 150 MG CAPSULE RX-11290 CDM A9270 HCPCS 0637 RC 10135-0738-01 NDC outpatient 1 UN 29.02 29.02 29.02 74 21.47 percent of total billed charges 29.02 93 23.51 percent of total billed charges 29.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.02 other OPPS APC 29.02 29.02 other OPPS APC 29.02 24.86 7.21 percent of total billed charges 29.02 29.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIFAMPIN 600 MG INTRAVENOUS SOLUTION RX-11291 CDM 250000000 HCPCS 0250 RC 63323-0351-20 NDC outpatient 10 ML 459 459 459 74 339.66 percent of total billed charges 459 93 371.79 percent of total billed charges 459 459 other OPPS APC 459 459 other OPPS APC 459 24.86 114.11 percent of total billed charges 459 459 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIFAMPIN 600 MG INTRAVENOUS SOLUTION RX-11291 CDM 250000000 HCPCS 0250 RC 63323-0351-20 NDC outpatient 600 ME 459 459 459 74 339.66 percent of total billed charges 459 93 371.79 percent of total billed charges 459 459 other OPPS APC 459 459 other OPPS APC 459 24.86 114.11 percent of total billed charges 459 459 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIFAMPIN 150 MG CAPSULE RX-11292 CDM A9270 HCPCS 0250 RC 68180-0658-06 NDC outpatient 1 UN 8.11 8.11 74 6 percent of total billed charges 8.11 93 6.57 percent of total billed charges 8.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.11 other OPPS APC 8.11 8.11 other OPPS APC 8.11 24.86 2.02 percent of total billed charges 8.11 8.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIFAMPIN 150 MG CAPSULE RX-11292 CDM A9270 HCPCS 0637 RC 68180-0658-06 NDC outpatient 1 UN 8.11 8.11 8.11 74 6 percent of total billed charges 8.11 93 6.57 percent of total billed charges 8.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.11 other OPPS APC 8.11 8.11 other OPPS APC 8.11 24.86 2.02 percent of total billed charges 8.11 8.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAZOLAMIDE 250 MG TABLET RX-113 CDM A9270 HCPCS 0250 RC 00904-6663-61 NDC outpatient 1 UN 10.84 10.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.84 other OPPS APC 10.84 10.84 other OPPS APC 10.84 24.86 2.69 percent of total billed charges 10.84 10.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAZOLAMIDE 250 MG TABLET RX-113 CDM A9270 HCPCS 0637 RC 00904-6663-61 NDC outpatient 1 UN 10.84 10.84 10.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.84 other OPPS APC 10.84 10.84 other OPPS APC 10.84 24.86 2.69 percent of total billed charges 10.84 10.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAZOLAMIDE 250 MG TABLET RX-113 CDM A9270 HCPCS 0250 RC 50268-0054-11 NDC outpatient 1 UN 10.47 10.47 74 7.75 percent of total billed charges 10.47 93 8.48 percent of total billed charges 10.47 10.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAZOLAMIDE 250 MG TABLET RX-113 CDM A9270 HCPCS 0637 RC 50268-0054-11 NDC outpatient 1 UN 10.47 10.47 10.47 74 7.75 percent of total billed charges 10.47 93 8.48 percent of total billed charges 10.47 10.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOTHYROXINE 100 MCG INTRAVENOUS POWDER FOR SOLUTION RX-113060 CDM 250000000 HCPCS 0250 RC 25021-0468-10 NDC outpatient 0.1 ME 283.5 283.5 283.5 74 209.79 percent of total billed charges 283.5 93 229.64 percent of total billed charges 283.5 283.5 other OPPS APC 283.5 283.5 other OPPS APC 283.5 24.86 70.48 percent of total billed charges 283.5 283.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOTHYROXINE 100 MCG INTRAVENOUS POWDER FOR SOLUTION RX-113060 CDM 250000000 HCPCS 0250 RC 25021-0468-10 NDC outpatient 5 ML 283.5 283.5 283.5 74 209.79 percent of total billed charges 283.5 93 229.64 percent of total billed charges 283.5 283.5 other OPPS APC 283.5 283.5 other OPPS APC 283.5 24.86 70.48 percent of total billed charges 283.5 283.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP" RX-113088 CDM 90716 HCPCS 0636 RC 00006-4827-00 NDC outpatient 0.5 ML 548.63 548.63 548.63 74 405.99 percent of total billed charges 548.63 93 444.39 percent of total billed charges 548.63 548.63 other OPPS APC 548.63 548.63 other OPPS APC 548.63 24.86 136.39 percent of total billed charges 548.63 548.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENTETATE INDIUM DISODIUM IN-111 1.5 MCI/1.5 ML INTRATHECAL SOLUTION RX-113146 CDM A9548 HCPCS 0343 RC 17156-0251-08 NDC outpatient 1 ML 5778 5778 5778 74 4275.72 percent of total billed charges 5778 93 4680.18 percent of total billed charges 5778 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5778 other OPPS APC 5778 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5778 other OPPS APC 5778 24.86 1436.41 percent of total billed charges 5778 5778 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO-OSM) IV PIGGYBACK RX-113475 CDM J1953 HCPCS 0636 RC 44567-0501-01 NDC outpatient 100 ML 24.54 24.54 4.24 4.24 fee schedule 24.54 93 19.88 percent of total billed charges 24.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.54 other OPPS APC 24.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.54 other OPPS APC 24.54 24.86 6.1 percent of total billed charges 4.24 24.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE (ISO-OSM) IV PIGGYBACK RX-113475 CDM J1953 HCPCS 0636 RC 44567-0501-01 NDC outpatient 500 ME 24.54 24.54 4.24 4.24 fee schedule 24.54 93 19.88 percent of total billed charges 24.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.54 other OPPS APC 24.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.54 other OPPS APC 24.54 24.86 6.1 percent of total billed charges 4.24 24.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LEVETIRACETAM 1,000 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK" RX-113476 CDM J1953 HCPCS 0636 RC 44567-0502-10 NDC outpatient 100 ML 33.33 33.33 8.47 8.47 fee schedule 33.33 93 27 percent of total billed charges 33.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 33.33 other OPPS APC 33.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 33.33 other OPPS APC 33.33 24.86 8.29 percent of total billed charges 8.47 33.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LEVETIRACETAM 1,000 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK" RX-113476 CDM J1953 HCPCS 0636 RC 44567-0502-10 NDC outpatient 1000 ME 33.33 33.33 8.47 8.47 fee schedule 33.33 93 27 percent of total billed charges 33.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 33.33 other OPPS APC 33.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 33.33 other OPPS APC 33.33 24.86 8.29 percent of total billed charges 8.47 33.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SENNOSIDES 8.6 MG TABLET RX-11349 CDM A9270 HCPCS 0250 RC 00904-7252-61 NDC outpatient 1 UN 0.13 0.13 74 0.1 percent of total billed charges 0.13 93 0.11 percent of total billed charges 0.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.13 other OPPS APC 0.13 0.13 other OPPS APC 0.13 24.86 0.03 percent of total billed charges 0.13 0.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SENNOSIDES 8.6 MG TABLET RX-11349 CDM A9270 HCPCS 0637 RC 00904-7252-61 NDC outpatient 1 UN 0.13 0.13 0.13 74 0.1 percent of total billed charges 0.13 93 0.11 percent of total billed charges 0.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.13 other OPPS APC 0.13 0.13 other OPPS APC 0.13 24.86 0.03 percent of total billed charges 0.13 0.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SERTRALINE 100 MG TABLET RX-11350 CDM A9270 HCPCS 0250 RC 00904-6926-61 NDC outpatient 1 UN 1.37 1.37 74 1.01 percent of total billed charges 1.37 93 1.11 percent of total billed charges 1.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.37 other OPPS APC 1.37 1.37 other OPPS APC 1.37 24.86 0.34 percent of total billed charges 1.37 1.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SERTRALINE 100 MG TABLET RX-11350 CDM A9270 HCPCS 0637 RC 00904-6926-61 NDC outpatient 1 UN 1.37 1.37 1.37 74 1.01 percent of total billed charges 1.37 93 1.11 percent of total billed charges 1.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.37 other OPPS APC 1.37 1.37 other OPPS APC 1.37 24.86 0.34 percent of total billed charges 1.37 1.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SERTRALINE 50 MG TABLET RX-11351 CDM A9270 HCPCS 0250 RC 50268-0769-15 NDC outpatient 1 UN 1.14 1.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.14 other OPPS APC 1.14 1.14 other OPPS APC 1.14 24.86 0.28 percent of total billed charges 1.14 1.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SERTRALINE 50 MG TABLET RX-11351 CDM A9270 HCPCS 0637 RC 50268-0769-15 NDC outpatient 1 UN 1.14 1.14 1.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.14 other OPPS APC 1.14 1.14 other OPPS APC 1.14 24.86 0.28 percent of total billed charges 1.14 1.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SERTRALINE 50 MG TABLET RX-11351 CDM A9270 HCPCS 0250 RC 60687-0242-01 NDC outpatient 1 UN 1.01 1.01 74 0.75 percent of total billed charges 1.01 93 0.82 percent of total billed charges 1.01 1.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SERTRALINE 50 MG TABLET RX-11351 CDM A9270 HCPCS 0637 RC 60687-0242-01 NDC outpatient 1 UN 1.01 1.01 1.01 74 0.75 percent of total billed charges 1.01 93 0.82 percent of total billed charges 1.01 1.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LURASIDONE 20 MG TABLET RX-113587 CDM A9270 HCPCS 0250 RC 67877-0638-30 NDC outpatient 1 UN 127.58 127.58 74 94.41 percent of total billed charges 127.58 93 103.34 percent of total billed charges 127.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 127.58 other OPPS APC 127.58 127.58 other OPPS APC 127.58 24.86 31.72 percent of total billed charges 127.58 127.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LURASIDONE 20 MG TABLET RX-113587 CDM A9270 HCPCS 0637 RC 67877-0638-30 NDC outpatient 1 UN 127.58 127.58 127.58 74 94.41 percent of total billed charges 127.58 93 103.34 percent of total billed charges 127.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 127.58 other OPPS APC 127.58 127.58 other OPPS APC 127.58 24.86 31.72 percent of total billed charges 127.58 127.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK RX-113850 CDM J0690 HCPCS 0636 RC 00264-3105-11 NDC outpatient 2 GR 44.28 44.28 3.97 3.97 fee schedule 44.28 93 35.87 percent of total billed charges 44.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.28 other OPPS APC 44.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.28 other OPPS APC 44.28 24.86 11.01 percent of total billed charges 3.97 44.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK RX-113850 CDM J0690 HCPCS 0636 RC 00264-3105-11 NDC outpatient 50 ML 44.28 44.28 3.97 3.97 fee schedule 44.28 93 35.87 percent of total billed charges 44.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.28 other OPPS APC 44.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.28 other OPPS APC 44.28 24.86 11.01 percent of total billed charges 3.97 44.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA RX-11395 CDM A9270 HCPCS 0250 RC 00536-7415-51 NDC outpatient 1 UN 2.58 2.58 74 1.91 percent of total billed charges 2.58 93 2.09 percent of total billed charges 2.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.58 other OPPS APC 2.58 2.58 other OPPS APC 2.58 24.86 0.64 percent of total billed charges 2.58 2.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA RX-11395 CDM A9270 HCPCS 0637 RC 00536-7415-51 NDC outpatient 1 UN 2.58 2.58 2.58 74 1.91 percent of total billed charges 2.58 93 2.09 percent of total billed charges 2.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.58 other OPPS APC 2.58 2.58 other OPPS APC 2.58 24.86 0.64 percent of total billed charges 2.58 2.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION RX-114 CDM J1120 HCPCS 0636 RC 39822-0190-01 NDC outpatient 5 ML 98.45 98.45 33.9 33.9 fee schedule 98.45 93 79.74 percent of total billed charges 98.45 98.45 other OPPS APC 98.45 98.45 other OPPS APC 98.45 24.86 24.47 percent of total billed charges 33.9 98.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION RX-114 CDM J1120 HCPCS 0636 RC 39822-0190-01 NDC outpatient 500 ME 98.45 98.45 33.9 33.9 fee schedule 98.45 93 79.74 percent of total billed charges 98.45 98.45 other OPPS APC 98.45 98.45 other OPPS APC 98.45 24.86 24.47 percent of total billed charges 33.9 98.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION RX-11403 CDM 250000000 HCPCS 0250 RC 00264-2201-00 NDC outpatient 1000 ML 12 12 12 74 8.88 percent of total billed charges 12 93 9.72 percent of total billed charges 12 12 other OPPS APC 12 12 other OPPS APC 12 24.86 2.98 percent of total billed charges 12 12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOTALOL 80 MG TABLET RX-11421 CDM A9270 HCPCS 0250 RC 76385-0125-01 NDC outpatient 1 UN 10.57 10.57 74 7.82 percent of total billed charges 10.57 93 8.56 percent of total billed charges 10.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.57 other OPPS APC 10.57 10.57 other OPPS APC 10.57 24.86 2.63 percent of total billed charges 10.57 10.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOTALOL 80 MG TABLET RX-11421 CDM A9270 HCPCS 0637 RC 76385-0125-01 NDC outpatient 1 UN 10.57 10.57 10.57 74 7.82 percent of total billed charges 10.57 93 8.56 percent of total billed charges 10.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.57 other OPPS APC 10.57 10.57 other OPPS APC 10.57 24.86 2.63 percent of total billed charges 10.57 10.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPIRONOLACTONE 50 MG TABLET RX-11426 CDM A9270 HCPCS 0250 RC 63739-0545-10 NDC outpatient 1 UN 2.18 2.18 74 1.61 percent of total billed charges 2.18 93 1.77 percent of total billed charges 2.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.18 other OPPS APC 2.18 2.18 other OPPS APC 2.18 24.86 0.54 percent of total billed charges 2.18 2.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPIRONOLACTONE 50 MG TABLET RX-11426 CDM A9270 HCPCS 0637 RC 63739-0545-10 NDC outpatient 1 UN 2.18 2.18 2.18 74 1.61 percent of total billed charges 2.18 93 1.77 percent of total billed charges 2.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.18 other OPPS APC 2.18 2.18 other OPPS APC 2.18 24.86 0.54 percent of total billed charges 2.18 2.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUCRALFATE 100 MG/ML ORAL SUSPENSION RX-11441 CDM A9270 HCPCS 0250 RC 50268-0745-14 NDC outpatient 10 ML 9.31 9.31 74 6.89 percent of total billed charges 9.31 93 7.54 percent of total billed charges 9.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.31 other OPPS APC 9.31 9.31 other OPPS APC 9.31 24.86 2.31 percent of total billed charges 9.31 9.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUCRALFATE 100 MG/ML ORAL SUSPENSION RX-11441 CDM A9270 HCPCS 0637 RC 50268-0745-14 NDC outpatient 10 ML 9.31 9.31 9.31 74 6.89 percent of total billed charges 9.31 93 7.54 percent of total billed charges 9.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.31 other OPPS APC 9.31 9.31 other OPPS APC 9.31 24.86 2.31 percent of total billed charges 9.31 9.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUCRALFATE 1 GRAM TABLET RX-11442 CDM A9270 HCPCS 0250 RC 60687-0695-01 NDC outpatient 1 UN 1.16 1.16 74 0.86 percent of total billed charges 1.16 93 0.94 percent of total billed charges 1.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.16 other OPPS APC 1.16 1.16 other OPPS APC 1.16 24.86 0.29 percent of total billed charges 1.16 1.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUCRALFATE 1 GRAM TABLET RX-11442 CDM A9270 HCPCS 0637 RC 60687-0695-01 NDC outpatient 1 UN 1.16 1.16 1.16 74 0.86 percent of total billed charges 1.16 93 0.94 percent of total billed charges 1.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.16 other OPPS APC 1.16 1.16 other OPPS APC 1.16 24.86 0.29 percent of total billed charges 1.16 1.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MAGNESIUM 64 MG (MAGNESIUM CHLORIDE) TABLET,DELAYED RELEASE" RX-114555 CDM A9270 HCPCS 0250 RC 10006-0700-13 NDC outpatient 1 UN 0.25 0.25 74 0.19 percent of total billed charges 0.25 93 0.2 percent of total billed charges 0.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.25 other OPPS APC 0.25 0.25 other OPPS APC 0.25 24.86 0.06 percent of total billed charges 0.25 0.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MAGNESIUM 64 MG (MAGNESIUM CHLORIDE) TABLET,DELAYED RELEASE" RX-114555 CDM A9270 HCPCS 0637 RC 10006-0700-13 NDC outpatient 1 UN 0.25 0.25 0.25 74 0.19 percent of total billed charges 0.25 93 0.2 percent of total billed charges 0.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.25 other OPPS APC 0.25 0.25 other OPPS APC 0.25 24.86 0.06 percent of total billed charges 0.25 0.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION RX-11507 CDM J3105 HCPCS 0636 RC 00143-9746-10 NDC outpatient 1 ML 12 12 2.61 2.61 fee schedule 12 93 9.72 percent of total billed charges 12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12 other OPPS APC 12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12 other OPPS APC 12 24.86 2.98 percent of total billed charges 2.61 12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TERBUTALINE 2.5 MG TABLET RX-11508 CDM A9270 HCPCS 0250 RC 62559-0721-01 NDC outpatient 1 UN 13.61 13.61 74 10.07 percent of total billed charges 13.61 93 11.02 percent of total billed charges 13.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.61 other OPPS APC 13.61 13.61 other OPPS APC 13.61 24.86 3.38 percent of total billed charges 13.61 13.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TERBUTALINE 2.5 MG TABLET RX-11508 CDM A9270 HCPCS 0637 RC 62559-0721-01 NDC outpatient 1 UN 13.61 13.61 13.61 74 10.07 percent of total billed charges 13.61 93 11.02 percent of total billed charges 13.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.61 other OPPS APC 13.61 13.61 other OPPS APC 13.61 24.86 3.38 percent of total billed charges 13.61 13.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TETRACAINE HCL (PF) 1 % (10 MG/ML) INJECTION SOLUTION RX-11517 CDM 250000000 HCPCS 0250 RC 54288-0127-10 NDC outpatient 2 ML 227.58 227.58 227.58 74 168.41 percent of total billed charges 227.58 93 184.34 percent of total billed charges 227.58 227.58 other OPPS APC 227.58 227.58 other OPPS APC 227.58 24.86 56.58 percent of total billed charges 227.58 227.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TETRACAINE HCL (PF) 1 % (10 MG/ML) INJECTION SOLUTION RX-11517 CDM 250000000 HCPCS 0250 RC 54288-0127-10 NDC outpatient 20 ME 227.58 227.58 227.58 74 168.41 percent of total billed charges 227.58 93 184.34 percent of total billed charges 227.58 227.58 other OPPS APC 227.58 227.58 other OPPS APC 227.58 24.86 56.58 percent of total billed charges 227.58 227.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIMOLOL MALEATE 0.25 % EYE DROPS RX-11561 CDM A9270 HCPCS 0250 RC 61314-0226-05 NDC outpatient 5 ML 37.5 37.5 74 27.75 percent of total billed charges 37.5 93 30.38 percent of total billed charges 37.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 37.5 other OPPS APC 37.5 37.5 other OPPS APC 37.5 24.86 9.32 percent of total billed charges 37.5 37.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIMOLOL MALEATE 0.25 % EYE DROPS RX-11561 CDM A9270 HCPCS 0637 RC 61314-0226-05 NDC outpatient 5 ML 37.5 37.5 37.5 74 27.75 percent of total billed charges 37.5 93 30.38 percent of total billed charges 37.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 37.5 other OPPS APC 37.5 37.5 other OPPS APC 37.5 24.86 9.32 percent of total billed charges 37.5 37.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION RX-11565 CDM J3260 HCPCS 0636 RC 70700-0173-86 NDC outpatient 1200 ME 546.88 546.88 45.38 45.38 fee schedule 546.88 93 442.97 percent of total billed charges 546.88 546.88 other OPPS APC 546.88 546.88 other OPPS APC 546.88 24.86 135.95 percent of total billed charges 45.38 546.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION RX-11565 CDM J3260 HCPCS 0636 RC 70700-0173-86 NDC outpatient 30 ML 546.88 546.88 45.38 45.38 fee schedule 546.88 93 442.97 percent of total billed charges 546.88 546.88 other OPPS APC 546.88 546.88 other OPPS APC 546.88 24.86 135.95 percent of total billed charges 45.38 546.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION" RX-11573 CDM 250000000 HCPCS 0250 RC 81284-0611-10 NDC outpatient 10 ML 16.5 16.5 16.5 74 12.21 percent of total billed charges 16.5 93 13.37 percent of total billed charges 16.5 16.5 other OPPS APC 16.5 16.5 other OPPS APC 16.5 24.86 4.1 percent of total billed charges 16.5 16.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIAMCINOLONE ACETONIDE 10 MG/ML SUSPENSION FOR INJECTION RX-11584 CDM J3301 HCPCS 0636 RC 00003-0494-20 NDC outpatient 5 ML 36.28 36.28 5.75 5.75 fee schedule 36.28 93 29.39 percent of total billed charges 36.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36.28 other OPPS APC 36.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36.28 other OPPS APC 36.28 24.86 9.02 percent of total billed charges 5.75 36.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIFLURIDINE 1 % EYE DROPS RX-11595 CDM A9270 HCPCS 0250 RC 61314-0044-75 NDC outpatient 7.5 ML 612.53 612.53 74 453.27 percent of total billed charges 612.53 93 496.15 percent of total billed charges 612.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.53 other OPPS APC 612.53 612.53 other OPPS APC 612.53 24.86 152.27 percent of total billed charges 612.53 612.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIFLURIDINE 1 % EYE DROPS RX-11595 CDM A9270 HCPCS 0637 RC 61314-0044-75 NDC outpatient 7.5 ML 612.53 612.53 612.53 74 453.27 percent of total billed charges 612.53 93 496.15 percent of total billed charges 612.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.53 other OPPS APC 612.53 612.53 other OPPS APC 612.53 24.86 152.27 percent of total billed charges 612.53 612.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS" RX-11596 CDM A9270 HCPCS 0250 RC 61314-0628-10 NDC outpatient 10 ML 43.55 43.55 74 32.23 percent of total billed charges 43.55 93 35.28 percent of total billed charges 43.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 43.55 other OPPS APC 43.55 43.55 other OPPS APC 43.55 24.86 10.83 percent of total billed charges 43.55 43.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS" RX-11596 CDM A9270 HCPCS 0637 RC 61314-0628-10 NDC outpatient 10 ML 43.55 43.55 43.55 74 32.23 percent of total billed charges 43.55 93 35.28 percent of total billed charges 43.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 43.55 other OPPS APC 43.55 43.55 other OPPS APC 43.55 24.86 10.83 percent of total billed charges 43.55 43.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. URSODIOL 300 MG CAPSULE RX-11624 CDM A9270 HCPCS 0250 RC 60687-0100-01 NDC outpatient 1 UN 19.11 19.11 74 14.14 percent of total billed charges 19.11 93 15.48 percent of total billed charges 19.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.11 other OPPS APC 19.11 19.11 other OPPS APC 19.11 24.86 4.75 percent of total billed charges 19.11 19.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. URSODIOL 300 MG CAPSULE RX-11624 CDM A9270 HCPCS 0637 RC 60687-0100-01 NDC outpatient 1 UN 19.11 19.11 19.11 74 14.14 percent of total billed charges 19.11 93 15.48 percent of total billed charges 19.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.11 other OPPS APC 19.11 19.11 other OPPS APC 19.11 24.86 4.75 percent of total billed charges 19.11 19.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION RX-11627 CDM J3370 HCPCS 0636 RC 70436-0023-82 NDC outpatient 100 ML 180 180 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 24.86 44.75 percent of total billed charges 180 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION RX-11627 CDM J3370 HCPCS 0636 RC 70594-0048-01 NDC outpatient 10 GR 180 180 54.93 54.93 fee schedule 180 93 145.8 percent of total billed charges 54.93 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 125 MG CAPSULE RX-11628 CDM A9270 HCPCS 0250 RC 62559-0390-20 NDC outpatient 1 UN 78.27 78.27 74 57.92 percent of total billed charges 78.27 93 63.4 percent of total billed charges 78.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 78.27 other OPPS APC 78.27 78.27 other OPPS APC 78.27 24.86 19.46 percent of total billed charges 78.27 78.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 125 MG CAPSULE RX-11628 CDM A9270 HCPCS 0637 RC 62559-0390-20 NDC outpatient 1 UN 78.27 78.27 78.27 74 57.92 percent of total billed charges 78.27 93 63.4 percent of total billed charges 78.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 78.27 other OPPS APC 78.27 78.27 other OPPS APC 78.27 24.86 19.46 percent of total billed charges 78.27 78.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 250 MG CAPSULE RX-11629 CDM A9270 HCPCS 0250 RC 62559-0391-20 NDC outpatient 1 UN 144.29 144.29 74 106.77 percent of total billed charges 144.29 93 116.87 percent of total billed charges 144.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 144.29 other OPPS APC 144.29 144.29 other OPPS APC 144.29 24.86 35.87 percent of total billed charges 144.29 144.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 250 MG CAPSULE RX-11629 CDM A9270 HCPCS 0637 RC 62559-0391-20 NDC outpatient 1 UN 144.29 144.29 144.29 74 106.77 percent of total billed charges 144.29 93 116.87 percent of total billed charges 144.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 144.29 other OPPS APC 144.29 144.29 other OPPS APC 144.29 24.86 35.87 percent of total billed charges 144.29 144.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 50 MG/ML ORAL SOLUTION RX-11630 CDM A9270 HCPCS 0250 RC 65628-0208-10 NDC outpatient 300 ML 780.4 780.4 74 577.5 percent of total billed charges 780.4 93 632.12 percent of total billed charges 780.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 780.4 other OPPS APC 780.4 780.4 other OPPS APC 780.4 24.86 194.01 percent of total billed charges 780.4 780.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 50 MG/ML ORAL SOLUTION RX-11630 CDM A9270 HCPCS 0637 RC 65628-0208-10 NDC outpatient 300 ML 780.4 780.4 780.4 74 577.5 percent of total billed charges 780.4 93 632.12 percent of total billed charges 780.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 780.4 other OPPS APC 780.4 780.4 other OPPS APC 780.4 24.86 194.01 percent of total billed charges 780.4 780.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION RX-11634 CDM 250000000 HCPCS 0250 RC 47335-0931-44 NDC outpatient 10 ME 25.5 25.5 25.5 74 18.87 percent of total billed charges 25.5 93 20.66 percent of total billed charges 25.5 25.5 other OPPS APC 25.5 25.5 other OPPS APC 25.5 24.86 6.34 percent of total billed charges 25.5 25.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION RX-11634 CDM 250000000 HCPCS 0250 RC 47335-0931-44 NDC outpatient 10 ML 25.5 25.5 25.5 74 18.87 percent of total billed charges 25.5 93 20.66 percent of total billed charges 25.5 25.5 other OPPS APC 25.5 25.5 other OPPS APC 25.5 24.86 6.34 percent of total billed charges 25.5 25.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIMOLOL MALEATE (PF) 0.5 % EYE DROPS IN A DROPPERETTE RX-116381 CDM A9270 HCPCS 0250 RC 50742-0288-60 NDC outpatient 1 UN 22.76 22.76 74 16.84 percent of total billed charges 22.76 93 18.44 percent of total billed charges 22.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.76 other OPPS APC 22.76 22.76 other OPPS APC 22.76 24.86 5.66 percent of total billed charges 22.76 22.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIMOLOL MALEATE (PF) 0.5 % EYE DROPS IN A DROPPERETTE RX-116381 CDM A9270 HCPCS 0637 RC 50742-0288-60 NDC outpatient 1 UN 22.76 22.76 22.76 74 16.84 percent of total billed charges 22.76 93 18.44 percent of total billed charges 22.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.76 other OPPS APC 22.76 22.76 other OPPS APC 22.76 24.86 5.66 percent of total billed charges 22.76 22.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERTUZUMAB 420 MG/14 ML (30 MG/ML) INTRAVENOUS SOLUTION RX-116596 CDM J9306 HCPCS 0636 RC 50242-0145-01 NDC outpatient 14 ML 19580.4 19580.4 7368.9 7368.9 fee schedule 19580.4 93 15860.1 percent of total billed charges 19580.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6769.56 other OPPS APC 19580.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6769.56 other OPPS APC 19580.4 24.86 4867.68 percent of total billed charges 7368.9 19580.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WARFARIN 1 MG TABLET RX-11664 CDM A9270 HCPCS 0250 RC 00832-1211-01 NDC outpatient 1 UN 1.54 1.54 74 1.14 percent of total billed charges 1.54 93 1.25 percent of total billed charges 1.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.54 other OPPS APC 1.54 1.54 other OPPS APC 1.54 24.86 0.38 percent of total billed charges 1.54 1.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WARFARIN 1 MG TABLET RX-11664 CDM A9270 HCPCS 0637 RC 00832-1211-01 NDC outpatient 1 UN 1.54 1.54 1.54 74 1.14 percent of total billed charges 1.54 93 1.25 percent of total billed charges 1.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.54 other OPPS APC 1.54 1.54 other OPPS APC 1.54 24.86 0.38 percent of total billed charges 1.54 1.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "WATER FOR INJECTION, STERILE INJECTION SOLUTION" RX-11671 CDM A4216 HCPCS 0636 RC 00409-4887-24 NDC outpatient 50 ML 8.02 8.02 8.02 74 5.93 percent of total billed charges 8.02 93 6.5 percent of total billed charges 8.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.02 other OPPS APC 8.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.02 other OPPS APC 8.02 24.86 1.99 percent of total billed charges 8.02 8.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "WATER FOR INJECTION, STERILE INJECTION SOLUTION" RX-11671 CDM A4216 HCPCS 0636 RC 00409-4887-25 NDC outpatient 100 ML 14.89 14.89 14.89 74 11.02 percent of total billed charges 14.89 93 12.06 percent of total billed charges 14.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.89 other OPPS APC 14.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.89 other OPPS APC 14.89 24.86 3.7 percent of total billed charges 14.89 14.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "WATER FOR INJECTION, STERILE INJECTION SOLUTION" RX-11671 CDM A4216 HCPCS 0636 RC 63323-0185-07 NDC outpatient 10 ML 13.17 13.17 13.17 74 9.75 percent of total billed charges 13.17 93 10.67 percent of total billed charges 13.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.17 other OPPS APC 13.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.17 other OPPS APC 13.17 24.86 3.27 percent of total billed charges 13.17 13.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMORPHONE 1 MG/ML INJECTION SYRINGE RX-116806 CDM J1171 HCPCS 0636 RC 00409-1283-31 NDC outpatient 1 ML 7.8 7.8 7.8 74 5.77 percent of total billed charges 7.8 93 6.32 percent of total billed charges 7.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.8 other OPPS APC 7.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.8 other OPPS APC 7.8 24.86 1.94 percent of total billed charges 7.8 7.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMORPHONE 2 MG/ML INJECTION SYRINGE RX-116807 CDM J1171 HCPCS 0636 RC 00409-1312-30 NDC outpatient 1 ML 10.1 10.1 10.1 74 7.47 percent of total billed charges 10.1 93 8.18 percent of total billed charges 10.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.1 other OPPS APC 10.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.1 other OPPS APC 10.1 24.86 2.51 percent of total billed charges 10.1 10.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMORPHONE (PF) 4 MG/ML INJECTION SOLUTION RX-116808 CDM J1170 HCPCS 0636 RC 63323-0854-03 NDC outpatient 1 ML 13.44 13.44 4.96 4.96 fee schedule 13.44 93 10.89 percent of total billed charges 13.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.44 other OPPS APC 13.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.44 other OPPS APC 13.44 24.86 3.34 percent of total billed charges 4.96 13.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMORPHONE (PF) 4 MG/ML INJECTION SOLUTION RX-116808 CDM J1171 HCPCS 0636 RC 63323-0854-03 NDC outpatient 1 ML 13.44 13.44 4.96 4.96 fee schedule 13.44 93 10.89 percent of total billed charges 13.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.44 other OPPS APC 13.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.44 other OPPS APC 13.44 24.86 3.34 percent of total billed charges 4.96 13.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZIDOVUDINE 10 MG/ML INTRAVENOUS SOLUTION RX-11691 CDM J3485 HCPCS 0636 RC 49702-0213-01 NDC outpatient 20 ML 87.57 87.57 34.61 34.61 fee schedule 87.57 93 70.93 percent of total billed charges 87.57 87.57 other OPPS APC 87.57 87.57 other OPPS APC 87.57 24.86 21.77 percent of total billed charges 34.61 87.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZIDOVUDINE 100 MG CAPSULE RX-11692 CDM A9270 HCPCS 0250 RC 65862-0107-01 NDC outpatient 1 UN 5.05 5.05 74 3.74 percent of total billed charges 5.05 93 4.09 percent of total billed charges 5.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.05 other OPPS APC 5.05 5.05 other OPPS APC 5.05 24.86 1.26 percent of total billed charges 5.05 5.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZIDOVUDINE 100 MG CAPSULE RX-11692 CDM A9270 HCPCS 0637 RC 65862-0107-01 NDC outpatient 1 UN 5.05 5.05 5.05 74 3.74 percent of total billed charges 5.05 93 4.09 percent of total billed charges 5.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.05 other OPPS APC 5.05 5.05 other OPPS APC 5.05 24.86 1.26 percent of total billed charges 5.05 5.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZIDOVUDINE 10 MG/ML ORAL SYRUP RX-11693 CDM A9270 HCPCS 0250 RC 65862-0048-24 NDC outpatient 240 ML 141.05 141.05 74 104.38 percent of total billed charges 141.05 93 114.25 percent of total billed charges 141.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 141.05 other OPPS APC 141.05 141.05 other OPPS APC 141.05 24.86 35.07 percent of total billed charges 141.05 141.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZIDOVUDINE 10 MG/ML ORAL SYRUP RX-11693 CDM A9270 HCPCS 0637 RC 65862-0048-24 NDC outpatient 240 ML 141.05 141.05 141.05 74 104.38 percent of total billed charges 141.05 93 114.25 percent of total billed charges 141.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 141.05 other OPPS APC 141.05 141.05 other OPPS APC 141.05 24.86 35.07 percent of total billed charges 141.05 141.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZOLPIDEM 5 MG TABLET RX-11701 CDM A9270 HCPCS 0250 RC 00093-0073-01 NDC outpatient 1 UN 11.57 11.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.57 other OPPS APC 11.57 11.57 other OPPS APC 11.57 24.86 2.88 percent of total billed charges 11.57 11.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZOLPIDEM 5 MG TABLET RX-11701 CDM A9270 HCPCS 0637 RC 00093-0073-01 NDC outpatient 1 UN 11.57 11.57 11.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.57 other OPPS APC 11.57 11.57 other OPPS APC 11.57 24.86 2.88 percent of total billed charges 11.57 11.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION RX-117032 CDM J9260 HCPCS 0636 RC 00143-9519-10 NDC outpatient 2 ML 10.08 10.08 3.1 3.1 fee schedule 10.08 93 8.16 percent of total billed charges 10.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.08 other OPPS APC 10.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.08 other OPPS APC 10.08 24.86 2.51 percent of total billed charges 3.1 10.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARFILZOMIB 60 MG INTRAVENOUS SOLUTION RX-117047 CDM J9047 HCPCS 0636 RC 76075-0101-01 NDC outpatient 30 ML 9825.55 9825.55 3221.99 3221.99 fee schedule 9825.55 93 7958.7 percent of total billed charges 9825.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2974.62 other OPPS APC 9825.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2974.62 other OPPS APC 9825.55 24.86 2442.63 percent of total billed charges 3221.99 9825.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SYRINGE RX-117592 CDM J3430 HCPCS 0636 RC 76329-1240-01 NDC outpatient 0.5 ML 74.19 74.19 3.28 3.28 fee schedule 74.19 93 60.09 percent of total billed charges 74.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 74.19 other OPPS APC 74.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 74.19 other OPPS APC 74.19 24.86 18.44 percent of total billed charges 3.28 74.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MORPHINE ER 30 MG TABLET,EXTENDED RELEASE" RX-119007 CDM A9270 HCPCS 0250 RC 00406-8330-01 NDC outpatient 1 UN 7.93 7.93 74 5.87 percent of total billed charges 7.93 93 6.42 percent of total billed charges 7.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.93 other OPPS APC 7.93 7.93 other OPPS APC 7.93 24.86 1.97 percent of total billed charges 7.93 7.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MORPHINE ER 30 MG TABLET,EXTENDED RELEASE" RX-119007 CDM A9270 HCPCS 0637 RC 00406-8330-01 NDC outpatient 1 UN 7.93 7.93 7.93 74 5.87 percent of total billed charges 7.93 93 6.42 percent of total billed charges 7.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.93 other OPPS APC 7.93 7.93 other OPPS APC 7.93 24.86 1.97 percent of total billed charges 7.93 7.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APIXABAN 2.5 MG TABLET RX-119040 CDM A9270 HCPCS 0250 RC 00003-0893-31 NDC outpatient 1 UN 29.73 29.73 74 22 percent of total billed charges 29.73 93 24.08 percent of total billed charges 29.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.73 other OPPS APC 29.73 29.73 other OPPS APC 29.73 24.86 7.39 percent of total billed charges 29.73 29.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APIXABAN 2.5 MG TABLET RX-119040 CDM A9270 HCPCS 0637 RC 00003-0893-31 NDC outpatient 1 UN 29.73 29.73 29.73 74 22 percent of total billed charges 29.73 93 24.08 percent of total billed charges 29.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.73 other OPPS APC 29.73 29.73 other OPPS APC 29.73 24.86 7.39 percent of total billed charges 29.73 29.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION RX-119135 CDM J1596 HCPCS 0636 RC 66794-0203-42 NDC outpatient 2 ML 12 12 12 74 8.88 percent of total billed charges 12 93 9.72 percent of total billed charges 12 12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION RX-119135 CDM J1596 HCPCS 0636 RC 70860-0781-01 NDC outpatient 1 ML 2.1 2.1 2.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.1 other OPPS APC 2.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.1 other OPPS APC 2.1 24.86 0.52 percent of total billed charges 2.1 2.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION RX-119149 CDM 250000000 HCPCS 0250 RC 71288-0712-06 NDC outpatient 5 ML 21 21 21 74 15.54 percent of total billed charges 21 93 17.01 percent of total billed charges 21 21 other OPPS APC 21 21 other OPPS APC 21 24.86 5.22 percent of total billed charges 21 21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MORPHINE ER 15 MG TABLET,EXTENDED RELEASE" RX-119246 CDM A9270 HCPCS 0250 RC 00406-8315-62 NDC outpatient 1 UN 4.69 4.69 74 3.47 percent of total billed charges 4.69 93 3.8 percent of total billed charges 4.69 4.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MORPHINE ER 15 MG TABLET,EXTENDED RELEASE" RX-119246 CDM A9270 HCPCS 0637 RC 00406-8315-62 NDC outpatient 1 UN 4.69 4.69 4.69 74 3.47 percent of total billed charges 4.69 93 3.8 percent of total billed charges 4.69 4.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MORPHINE ER 15 MG TABLET,EXTENDED RELEASE" RX-119246 CDM A9270 HCPCS 0250 RC 00904-6557-61 NDC outpatient 1 UN 3.44 3.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.44 other OPPS APC 3.44 3.44 other OPPS APC 3.44 24.86 0.86 percent of total billed charges 3.44 3.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MORPHINE ER 15 MG TABLET,EXTENDED RELEASE" RX-119246 CDM A9270 HCPCS 0637 RC 00904-6557-61 NDC outpatient 1 UN 3.44 3.44 3.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.44 other OPPS APC 3.44 3.44 other OPPS APC 3.44 24.86 0.86 percent of total billed charges 3.44 3.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MORPHINE ER 100 MG TABLET,EXTENDED RELEASE" RX-119248 CDM A9270 HCPCS 0250 RC 00406-8390-62 NDC outpatient 1 UN 19.1 19.1 74 14.13 percent of total billed charges 19.1 93 15.47 percent of total billed charges 19.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.1 other OPPS APC 19.1 19.1 other OPPS APC 19.1 24.86 4.75 percent of total billed charges 19.1 19.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MORPHINE ER 100 MG TABLET,EXTENDED RELEASE" RX-119248 CDM A9270 HCPCS 0637 RC 00406-8390-62 NDC outpatient 1 UN 19.1 19.1 19.1 74 14.13 percent of total billed charges 19.1 93 15.47 percent of total billed charges 19.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.1 other OPPS APC 19.1 19.1 other OPPS APC 19.1 24.86 4.75 percent of total billed charges 19.1 19.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN RX-11931 CDM 90648 HCPCS 0636 RC 49281-0547-58 NDC outpatient 0.5 ML 38.39 38.39 38.39 74 28.41 percent of total billed charges 38.39 93 31.1 percent of total billed charges 38.39 38.39 other OPPS APC 38.39 38.39 other OPPS APC 38.39 24.86 9.54 percent of total billed charges 38.39 38.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APIXABAN 5 MG TABLET RX-119614 CDM A9270 HCPCS 0250 RC 00003-0894-31 NDC outpatient 1 UN 29.73 29.73 74 22 percent of total billed charges 29.73 93 24.08 percent of total billed charges 29.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.73 other OPPS APC 29.73 29.73 other OPPS APC 29.73 24.86 7.39 percent of total billed charges 29.73 29.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APIXABAN 5 MG TABLET RX-119614 CDM A9270 HCPCS 0637 RC 00003-0894-31 NDC outpatient 1 UN 29.73 29.73 29.73 74 22 percent of total billed charges 29.73 93 24.08 percent of total billed charges 29.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.73 other OPPS APC 29.73 29.73 other OPPS APC 29.73 24.86 7.39 percent of total billed charges 29.73 29.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVONORGESTREL 14 MCG/24 HR (UP TO 3 YRS) 13.5 MG INTRAUTERINE DEVICE RX-119672 CDM J7301 HCPCS 0636 RC 50419-0422-01 NDC outpatient 1 UN 1155.86 1155.86 1155.86 74 855.34 percent of total billed charges 1155.86 93 936.25 percent of total billed charges 1155.86 1155.86 other OPPS APC 1155.86 1155.86 other OPPS APC 1155.86 24.86 287.35 percent of total billed charges 1155.86 1155.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION RX-119843 CDM Q9966 HCPCS 0636 RC 00407-1412-33 NDC outpatient 100 ML 300 300 42.35 42.35 fee schedule 300 93 243 percent of total billed charges 300 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 300 other OPPS APC 300 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 300 other OPPS APC 300 24.86 74.58 percent of total billed charges 42.35 300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION RX-120068 CDM 250000000 HCPCS 0250 RC 23155-0661-42 NDC outpatient 5 ML 420 420 420 74 310.8 percent of total billed charges 420 93 340.2 percent of total billed charges 420 420 other OPPS APC 420 420 other OPPS APC 420 24.86 104.41 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION RX-120086 CDM J9354 HCPCS 0636 RC 50242-0088-01 NDC outpatient 5 ML 11792 11792 4375.36 4375.36 fee schedule 11792 93 9551.52 percent of total billed charges 11792 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4044.5 other OPPS APC 11792 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4044.5 other OPPS APC 11792 24.86 2931.49 percent of total billed charges 4375.36 11792 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADO-TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS SOLUTION RX-120087 CDM J9354 HCPCS 0636 RC 50242-0087-01 NDC outpatient 8 ML 18867.2 18867.2 7000.58 7000.58 fee schedule 18867.2 93 15282.4 percent of total billed charges 18867.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6471.2 other OPPS APC 18867.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6471.2 other OPPS APC 18867.2 24.86 4690.38 percent of total billed charges 7000.58 18867.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION RX-120105 CDM 250000000 HCPCS 0250 RC 48433-0230-15 NDC outpatient 14 ML 96.75 96.75 96.75 74 71.6 percent of total billed charges 96.75 93 78.37 percent of total billed charges 96.75 96.75 other OPPS APC 96.75 96.75 other OPPS APC 96.75 24.86 24.05 percent of total billed charges 96.75 96.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMINO ACID 10 % INTRAVENOUS SOLUTION RX-120107 CDM 250000000 HCPCS 0250 RC 00264-1933-10 NDC outpatient 500 ML 117.9 117.9 117.9 74 87.25 percent of total billed charges 117.9 93 95.5 percent of total billed charges 117.9 117.9 other OPPS APC 117.9 117.9 other OPPS APC 117.9 24.86 29.31 percent of total billed charges 117.9 117.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL LIQUID RX-120230 CDM A9270 HCPCS 0250 RC 60569-0062-04 NDC outpatient 118 ML 10.03 10.03 74 7.42 percent of total billed charges 10.03 93 8.12 percent of total billed charges 10.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.03 other OPPS APC 10.03 10.03 other OPPS APC 10.03 24.86 2.49 percent of total billed charges 10.03 10.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL LIQUID RX-120230 CDM A9270 HCPCS 0637 RC 60569-0062-04 NDC outpatient 118 ML 10.03 10.03 10.03 74 7.42 percent of total billed charges 10.03 93 8.12 percent of total billed charges 10.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.03 other OPPS APC 10.03 10.03 other OPPS APC 10.03 24.86 2.49 percent of total billed charges 10.03 10.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MECLIZINE 12.5 MG TABLET RX-12024 CDM A9270 HCPCS 0250 RC 50268-0522-15 NDC outpatient 1 UN 1.75 1.75 74 1.3 percent of total billed charges 1.75 93 1.42 percent of total billed charges 1.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.75 other OPPS APC 1.75 1.75 other OPPS APC 1.75 24.86 0.44 percent of total billed charges 1.75 1.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MECLIZINE 12.5 MG TABLET RX-12024 CDM A9270 HCPCS 0637 RC 50268-0522-15 NDC outpatient 1 UN 1.75 1.75 1.75 74 1.3 percent of total billed charges 1.75 93 1.42 percent of total billed charges 1.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.75 other OPPS APC 1.75 1.75 other OPPS APC 1.75 24.86 0.44 percent of total billed charges 1.75 1.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET RX-120245 CDM A9270 HCPCS 0250 RC 64850-0502-01 NDC outpatient 1 UN 4.29 4.29 74 3.17 percent of total billed charges 4.29 93 3.47 percent of total billed charges 4.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.29 other OPPS APC 4.29 4.29 other OPPS APC 4.29 24.86 1.07 percent of total billed charges 4.29 4.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET RX-120245 CDM A9270 HCPCS 0637 RC 64850-0502-01 NDC outpatient 1 UN 4.29 4.29 4.29 74 3.17 percent of total billed charges 4.29 93 3.47 percent of total billed charges 4.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.29 other OPPS APC 4.29 4.29 other OPPS APC 4.29 24.86 1.07 percent of total billed charges 4.29 4.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SENNOSIDES 8.8 MG/5 ML ORAL SYRUP RX-120359 CDM A9270 HCPCS 0250 RC 48433-0219-40 NDC outpatient 5 ML 5.95 5.95 74 4.4 percent of total billed charges 5.95 93 4.82 percent of total billed charges 5.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.95 other OPPS APC 5.95 5.95 other OPPS APC 5.95 24.86 1.48 percent of total billed charges 5.95 5.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SENNOSIDES 8.8 MG/5 ML ORAL SYRUP RX-120359 CDM A9270 HCPCS 0637 RC 48433-0219-40 NDC outpatient 5 ML 5.95 5.95 5.95 74 4.4 percent of total billed charges 5.95 93 4.82 percent of total billed charges 5.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.95 other OPPS APC 5.95 5.95 other OPPS APC 5.95 24.86 1.48 percent of total billed charges 5.95 5.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION RX-120393 CDM J1160 HCPCS 0636 RC 00781-3059-95 NDC outpatient 2 ML 18.69 18.69 12.34 12.34 fee schedule 18.69 93 15.14 percent of total billed charges 18.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.69 other OPPS APC 18.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.69 other OPPS APC 18.69 24.86 4.65 percent of total billed charges 12.34 18.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXAMETHASONE 1 MG/ML DROPS (CONCENTRATE) RX-120398 CDM A9270 HCPCS 0250 RC 00054-3176-44 NDC outpatient 30 ML 80.43 80.43 74 59.52 percent of total billed charges 80.43 93 65.15 percent of total billed charges 80.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 80.43 other OPPS APC 80.43 80.43 other OPPS APC 80.43 24.86 19.99 percent of total billed charges 80.43 80.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXAMETHASONE 1 MG/ML DROPS (CONCENTRATE) RX-120398 CDM A9270 HCPCS 0637 RC 00054-3176-44 NDC outpatient 30 ML 80.43 80.43 80.43 74 59.52 percent of total billed charges 80.43 93 65.15 percent of total billed charges 80.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 80.43 other OPPS APC 80.43 80.43 other OPPS APC 80.43 24.86 19.99 percent of total billed charges 80.43 80.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENZOCAINE 20 % ORAL MUCOSAL LIQUID RX-120407 CDM A9270 HCPCS 0250 RC 50024-0432-01 NDC outpatient 12 ML 10.98 10.98 74 8.13 percent of total billed charges 10.98 93 8.89 percent of total billed charges 10.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.98 other OPPS APC 10.98 10.98 other OPPS APC 10.98 24.86 2.73 percent of total billed charges 10.98 10.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENZOCAINE 20 % ORAL MUCOSAL LIQUID RX-120407 CDM A9270 HCPCS 0637 RC 50024-0432-01 NDC outpatient 12 ML 10.98 10.98 10.98 74 8.13 percent of total billed charges 10.98 93 8.89 percent of total billed charges 10.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.98 other OPPS APC 10.98 10.98 other OPPS APC 10.98 24.86 2.73 percent of total billed charges 10.98 10.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMORPHONE (PF) 1 MG/ML INJECTION SOLUTION RX-120414 CDM J1171 HCPCS 0636 RC 63323-0852-25 NDC outpatient 1 ML 12.96 12.96 12.96 74 9.59 percent of total billed charges 12.96 93 10.5 percent of total billed charges 12.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.96 other OPPS APC 12.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.96 other OPPS APC 12.96 24.86 3.22 percent of total billed charges 12.96 12.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION RX-120425 CDM 250000000 HCPCS 0250 RC 70095-0050-03 NDC outpatient 50 ML 65.37 65.37 65.37 74 48.37 percent of total billed charges 65.37 93 52.95 percent of total billed charges 65.37 65.37 other OPPS APC 65.37 65.37 other OPPS APC 65.37 24.86 16.25 percent of total billed charges 65.37 65.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM BICARBONATE 4.2 % INTRAVENOUS SOLUTION RX-120447 CDM 250000000 HCPCS 0250 RC 00409-5555-02 NDC outpatient 5 ML 23.24 23.24 23.24 74 17.2 percent of total billed charges 23.24 93 18.82 percent of total billed charges 23.24 23.24 other OPPS APC 23.24 23.24 other OPPS APC 23.24 24.86 5.78 percent of total billed charges 23.24 23.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION RX-120465 CDM A9270 HCPCS 0250 RC 65162-0468-19 NDC outpatient 100 ML 155.08 155.08 74 114.76 percent of total billed charges 155.08 93 125.61 percent of total billed charges 155.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 155.08 other OPPS APC 155.08 155.08 other OPPS APC 155.08 24.86 38.55 percent of total billed charges 155.08 155.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION RX-120465 CDM A9270 HCPCS 0637 RC 65162-0468-19 NDC outpatient 100 ML 155.08 155.08 155.08 74 114.76 percent of total billed charges 155.08 93 125.61 percent of total billed charges 155.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 155.08 other OPPS APC 155.08 155.08 other OPPS APC 155.08 24.86 38.55 percent of total billed charges 155.08 155.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE 50 MG/ML INTRAVENOUS SOLUTION RX-120506 CDM J2270 HCPCS 0636 RC 00409-1896-20 NDC outpatient 20 ML 56.53 56.53 525.14 525.14 fee schedule 56.53 93 45.79 percent of total billed charges 56.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56.53 other OPPS APC 56.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56.53 other OPPS APC 56.53 24.86 14.05 percent of total billed charges 56.53 525.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLUCAGON 1 MG SOLUTION FOR INJECTION RX-120613 CDM J1610 HCPCS 0636 RC 00002-8031-01 NDC outpatient 1 ML 842.4 842.4 222.8 222.8 fee schedule 842.4 93 682.34 percent of total billed charges 842.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.3 other OPPS APC 842.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.3 other OPPS APC 842.4 24.86 209.42 percent of total billed charges 222.8 842.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLUCAGON 1 MG SOLUTION FOR INJECTION RX-120613 CDM J1610 HCPCS 0636 RC 00002-8031-01 NDC outpatient 1 UN 842.4 842.4 222.8 222.8 fee schedule 842.4 93 682.34 percent of total billed charges 842.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.3 other OPPS APC 842.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.3 other OPPS APC 842.4 24.86 209.42 percent of total billed charges 222.8 842.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE HCL 2 % MUCOSAL SOLUTION RX-120624 CDM A9270 HCPCS 0250 RC 00121-4950-15 NDC outpatient 15 ML 16.82 16.82 74 12.45 percent of total billed charges 16.82 93 13.62 percent of total billed charges 16.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.82 other OPPS APC 16.82 16.82 other OPPS APC 16.82 24.86 4.18 percent of total billed charges 16.82 16.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE HCL 2 % MUCOSAL SOLUTION RX-120624 CDM A9270 HCPCS 0637 RC 00121-4950-15 NDC outpatient 15 ML 16.82 16.82 16.82 74 12.45 percent of total billed charges 16.82 93 13.62 percent of total billed charges 16.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.82 other OPPS APC 16.82 16.82 other OPPS APC 16.82 24.86 4.18 percent of total billed charges 16.82 16.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION RX-120683 CDM J0697 HCPCS 0636 RC 25021-0119-20 NDC outpatient 1.5 GR 16.28 16.28 5.11 5.11 fee schedule 16.28 93 13.19 percent of total billed charges 16.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.28 other OPPS APC 16.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.28 other OPPS APC 16.28 24.86 4.05 percent of total billed charges 5.11 16.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION RX-120683 CDM J0697 HCPCS 0636 RC 25021-0119-20 NDC outpatient 15 ML 16.28 16.28 5.11 5.11 fee schedule 16.28 93 13.19 percent of total billed charges 16.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.28 other OPPS APC 16.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.28 other OPPS APC 16.28 24.86 4.05 percent of total billed charges 5.11 16.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION RX-120692 CDM A9270 HCPCS 0250 RC 70954-0240-10 NDC outpatient 450 ML 221.48 221.48 74 163.9 percent of total billed charges 221.48 93 179.4 percent of total billed charges 221.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 221.48 other OPPS APC 221.48 221.48 other OPPS APC 221.48 24.86 55.06 percent of total billed charges 221.48 221.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION RX-120692 CDM A9270 HCPCS 0637 RC 70954-0240-10 NDC outpatient 450 ML 221.48 221.48 221.48 74 163.9 percent of total billed charges 221.48 93 179.4 percent of total billed charges 221.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 221.48 other OPPS APC 221.48 221.48 other OPPS APC 221.48 24.86 55.06 percent of total billed charges 221.48 221.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROAMPHETAMINE-AMPHETAMINE 5 MG TABLET RX-120747 CDM A9270 HCPCS 0250 RC 11534-0190-01 NDC outpatient 1 UN 4.29 4.29 74 3.17 percent of total billed charges 4.29 93 3.47 percent of total billed charges 4.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.29 other OPPS APC 4.29 4.29 other OPPS APC 4.29 24.86 1.07 percent of total billed charges 4.29 4.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROAMPHETAMINE-AMPHETAMINE 5 MG TABLET RX-120747 CDM A9270 HCPCS 0637 RC 11534-0190-01 NDC outpatient 1 UN 4.29 4.29 4.29 74 3.17 percent of total billed charges 4.29 93 3.47 percent of total billed charges 4.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.29 other OPPS APC 4.29 4.29 other OPPS APC 4.29 24.86 1.07 percent of total billed charges 4.29 4.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR" RX-12098 CDM A9270 HCPCS 0250 RC 00480-3310-01 NDC outpatient 1 UN 10.74 10.74 74 7.95 percent of total billed charges 10.74 93 8.7 percent of total billed charges 10.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.74 other OPPS APC 10.74 10.74 other OPPS APC 10.74 24.86 2.67 percent of total billed charges 10.74 10.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR" RX-12098 CDM A9270 HCPCS 0637 RC 00480-3310-01 NDC outpatient 1 UN 10.74 10.74 10.74 74 7.95 percent of total billed charges 10.74 93 8.7 percent of total billed charges 10.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.74 other OPPS APC 10.74 10.74 other OPPS APC 10.74 24.86 2.67 percent of total billed charges 10.74 10.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MEMANTINE 21 MG CAPSULE SPRINKLE,EXTENDED RELEASE 24HR" RX-121475 CDM A9270 HCPCS 0250 RC 68382-0548-06 NDC outpatient 1 UN 38.2 38.2 74 28.27 percent of total billed charges 38.2 93 30.94 percent of total billed charges 38.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.2 other OPPS APC 38.2 38.2 other OPPS APC 38.2 24.86 9.5 percent of total billed charges 38.2 38.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MEMANTINE 21 MG CAPSULE SPRINKLE,EXTENDED RELEASE 24HR" RX-121475 CDM A9270 HCPCS 0637 RC 68382-0548-06 NDC outpatient 1 UN 38.2 38.2 38.2 74 28.27 percent of total billed charges 38.2 93 30.94 percent of total billed charges 38.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.2 other OPPS APC 38.2 38.2 other OPPS APC 38.2 24.86 9.5 percent of total billed charges 38.2 38.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MEMANTINE 28 MG CAPSULE SPRINKLE,EXTENDED RELEASE 24HR" RX-121476 CDM A9270 HCPCS 0250 RC 59651-0407-30 NDC outpatient 1 UN 38.2 38.2 74 28.27 percent of total billed charges 38.2 93 30.94 percent of total billed charges 38.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.2 other OPPS APC 38.2 38.2 other OPPS APC 38.2 24.86 9.5 percent of total billed charges 38.2 38.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MEMANTINE 28 MG CAPSULE SPRINKLE,EXTENDED RELEASE 24HR" RX-121476 CDM A9270 HCPCS 0637 RC 59651-0407-30 NDC outpatient 1 UN 38.2 38.2 38.2 74 28.27 percent of total billed charges 38.2 93 30.94 percent of total billed charges 38.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.2 other OPPS APC 38.2 38.2 other OPPS APC 38.2 24.86 9.5 percent of total billed charges 38.2 38.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPINEPHRINE 1 MG/ML INJECTION SOLUTION RX-121505 CDM J0171 HCPCS 0636 RC 76329-9060-00 NDC outpatient 30 ML 675 675 250.47 250.47 fee schedule 675 93 546.75 percent of total billed charges 675 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 675 other OPPS APC 675 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 675 other OPPS APC 675 24.86 167.81 percent of total billed charges 250.47 675 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV RX-121732 CDM 250000000 HCPCS 0250 RC 00338-9557-12 NDC outpatient 100 ML 84.24 84.24 84.24 84.24 other OPPS APC 84.24 84.24 other OPPS APC 84.24 24.86 20.94 percent of total billed charges 84.24 84.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV RX-121732 CDM 250000000 HCPCS 0250 RC 70121-1712-03 NDC outpatient 0.4 ME 80 80 80 74 59.2 percent of total billed charges 80 93 64.8 percent of total billed charges 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE RX-122008 CDM 250000000 HCPCS 0250 RC 00409-7517-16 NDC outpatient 50 ML 48.91 48.91 48.91 74 36.19 percent of total billed charges 48.91 93 39.62 percent of total billed charges 48.91 48.91 other OPPS APC 48.91 48.91 other OPPS APC 48.91 24.86 12.16 percent of total billed charges 48.91 48.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENLAFAXINE 50 MG TABLET RX-12204 CDM A9270 HCPCS 0250 RC 23155-0248-01 NDC outpatient 1 UN 5.16 5.16 74 3.82 percent of total billed charges 5.16 93 4.18 percent of total billed charges 5.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.16 other OPPS APC 5.16 5.16 other OPPS APC 5.16 24.86 1.28 percent of total billed charges 5.16 5.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENLAFAXINE 50 MG TABLET RX-12204 CDM A9270 HCPCS 0637 RC 23155-0248-01 NDC outpatient 1 UN 5.16 5.16 5.16 74 3.82 percent of total billed charges 5.16 93 4.18 percent of total billed charges 5.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.16 other OPPS APC 5.16 5.16 other OPPS APC 5.16 24.86 1.28 percent of total billed charges 5.16 5.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENLAFAXINE 75 MG TABLET RX-12206 CDM A9270 HCPCS 0250 RC 68001-0160-00 NDC outpatient 1 UN 0.9 0.9 74 0.67 percent of total billed charges 0.9 93 0.73 percent of total billed charges 0.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.9 other OPPS APC 0.9 0.9 other OPPS APC 0.9 24.86 0.22 percent of total billed charges 0.9 0.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENLAFAXINE 75 MG TABLET RX-12206 CDM A9270 HCPCS 0637 RC 68001-0160-00 NDC outpatient 1 UN 0.9 0.9 0.9 74 0.67 percent of total billed charges 0.9 93 0.73 percent of total billed charges 0.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.9 other OPPS APC 0.9 0.9 other OPPS APC 0.9 24.86 0.22 percent of total billed charges 0.9 0.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENLAFAXINE 37.5 MG TABLET RX-12207 CDM A9270 HCPCS 0250 RC 68084-0844-01 NDC outpatient 1 UN 5.01 5.01 74 3.71 percent of total billed charges 5.01 93 4.06 percent of total billed charges 5.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.01 other OPPS APC 5.01 5.01 other OPPS APC 5.01 24.86 1.25 percent of total billed charges 5.01 5.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENLAFAXINE 37.5 MG TABLET RX-12207 CDM A9270 HCPCS 0637 RC 68084-0844-01 NDC outpatient 1 UN 5.01 5.01 5.01 74 3.71 percent of total billed charges 5.01 93 4.06 percent of total billed charges 5.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.01 other OPPS APC 5.01 5.01 other OPPS APC 5.01 24.86 1.25 percent of total billed charges 5.01 5.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LORAZEPAM 2 MG/ML INJECTION SYRINGE RX-122071 CDM J2060 HCPCS 0636 RC 00409-1985-03 NDC outpatient 1 ML 10.77 10.77 0.97 0.97 fee schedule 10.77 93 8.72 percent of total billed charges 10.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.77 other OPPS APC 10.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.77 other OPPS APC 10.77 24.86 2.68 percent of total billed charges 0.97 10.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METOCLOPRAMIDE 5 MG/ML INJECTION SYRINGE RX-122075 CDM J2765 HCPCS 0636 RC 76045-0101-20 NDC outpatient 2 ML 7.98 7.98 1.42 1.42 fee schedule 7.98 93 6.46 percent of total billed charges 7.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.98 other OPPS APC 7.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.98 other OPPS APC 7.98 24.86 1.98 percent of total billed charges 1.42 7.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DORNASE ALFA 1 MG/ML SOLUTION FOR INHALATION RX-12211 CDM J7639 HCPCS 0636 RC 50242-0100-40 NDC outpatient 2.5 ML 389.64 389.64 178.89 178.89 fee schedule 389.64 93 315.61 percent of total billed charges 389.64 389.64 other OPPS APC 389.64 389.64 other OPPS APC 389.64 24.86 96.86 percent of total billed charges 178.89 389.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION" RX-122149 CDM J1459 HCPCS 0636 RC 44206-0436-05 NDC outpatient 50 ML 2639.1 2639.1 547.89 547.89 fee schedule 2639.1 93 2137.67 percent of total billed charges 2639.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 485.79 other OPPS APC 2639.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 485.79 other OPPS APC 2639.1 24.86 656.08 percent of total billed charges 547.89 2639.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION" RX-122149 CDM J1459 HCPCS 0636 RC 44206-0437-10 NDC outpatient 100 ML 5278.2 5278.2 1095.78 1095.78 fee schedule 5278.2 93 4275.34 percent of total billed charges 5278.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 971.58 other OPPS APC 5278.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 971.58 other OPPS APC 5278.2 24.86 1312.16 percent of total billed charges 1095.78 5278.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION" RX-122149 CDM J1459 HCPCS 0636 RC 44206-0438-20 NDC outpatient 200 ML 10556.4 10556.4 2191.55 2191.55 fee schedule 10556.4 93 8550.68 percent of total billed charges 10556.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1943.16 other OPPS APC 10556.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1943.16 other OPPS APC 10556.4 24.86 2624.32 percent of total billed charges 2191.55 10556.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "IMMUNE GLOB,GAMM(IGG) 10 %-PRO-IGA 0 TO 50 MCG/ML INTRAVENOUS SOLUTION" RX-122149 CDM J1459 HCPCS 0636 RC 44206-0439-40 NDC outpatient 400 ML 21112.8 21112.8 4383.1 4383.1 fee schedule 21112.8 93 17101.4 percent of total billed charges 21112.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3886.32 other OPPS APC 21112.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3886.32 other OPPS APC 21112.8 24.86 5248.64 percent of total billed charges 4383.1 21112.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COPPER 380 SQUARE MM INTRAUTERINE DEVICE RX-122184 CDM J7300 HCPCS 0250 RC 59365-5128-01 NDC outpatient 1 UN 840.28 840.28 840.28 74 621.81 percent of total billed charges 840.28 93 680.63 percent of total billed charges 840.28 840.28 other OPPS APC 840.28 840.28 other OPPS APC 840.28 24.86 208.89 percent of total billed charges 840.28 840.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION RX-122185 CDM J0665 HCPCS 0636 RC 00409-1165-01 NDC outpatient 10 ML 7.37 7.37 3.63 3.63 fee schedule 7.37 93 5.97 percent of total billed charges 7.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.65 other OPPS APC 7.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.65 other OPPS APC 7.37 24.86 1.83 percent of total billed charges 3.63 7.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MILRINONE 40 MG/200 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK RX-122187 CDM J2260 HCPCS 0636 RC 00409-1983-10 NDC outpatient 200 ML 96.17 96.17 17.13 17.13 fee schedule 96.17 93 77.9 percent of total billed charges 96.17 96.17 other OPPS APC 96.17 96.17 other OPPS APC 96.17 24.86 23.91 percent of total billed charges 17.13 96.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MILRINONE 40 MG/200 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK RX-122187 CDM J2260 HCPCS 0636 RC 00409-1983-10 NDC outpatient 40 ME 96.17 96.17 17.13 17.13 fee schedule 96.17 93 77.9 percent of total billed charges 96.17 96.17 other OPPS APC 96.17 96.17 other OPPS APC 96.17 24.86 23.91 percent of total billed charges 17.13 96.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION RX-1222 CDM J0665 HCPCS 0636 RC 70594-0114-02 NDC outpatient 10 ML 19.68 19.68 1.21 1.21 fee schedule 19.68 93 15.94 percent of total billed charges 19.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.55 other OPPS APC 19.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.55 other OPPS APC 19.68 24.86 4.89 percent of total billed charges 1.21 19.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION RX-122267 CDM J2710 HCPCS 0636 RC 70069-0806-10 NDC outpatient 10 ML 23.44 23.44 23.44 74 17.35 percent of total billed charges 23.44 93 18.99 percent of total billed charges 23.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 23.44 other OPPS APC 23.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 23.44 other OPPS APC 23.44 24.86 5.83 percent of total billed charges 23.44 23.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUPIVACAINE HCL 0.5 % (5 MG/ML) INJECTION SOLUTION RX-1223 CDM J0665 HCPCS 0636 RC 00143-9329-10 NDC outpatient 50 ML 33 33 12.1 12.1 fee schedule 33 93 26.73 percent of total billed charges 33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.5 other OPPS APC 33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.5 other OPPS APC 33 24.86 8.2 percent of total billed charges 12.1 33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR" RX-122363 CDM A9270 HCPCS 0250 RC 59011-0410-20 NDC outpatient 1 UN 16.43 16.43 74 12.16 percent of total billed charges 16.43 93 13.31 percent of total billed charges 16.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.43 other OPPS APC 16.43 16.43 other OPPS APC 16.43 24.86 4.08 percent of total billed charges 16.43 16.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR" RX-122363 CDM A9270 HCPCS 0637 RC 59011-0410-20 NDC outpatient 1 UN 16.43 16.43 16.43 74 12.16 percent of total billed charges 16.43 93 13.31 percent of total billed charges 16.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.43 other OPPS APC 16.43 16.43 other OPPS APC 16.43 24.86 4.08 percent of total billed charges 16.43 16.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "OXYCODONE ER 15 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR" RX-122365 CDM A9270 HCPCS 0250 RC 59011-0415-20 NDC outpatient 1 UN 24.16 24.16 74 17.88 percent of total billed charges 24.16 93 19.57 percent of total billed charges 24.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.16 other OPPS APC 24.16 24.16 other OPPS APC 24.16 24.86 6.01 percent of total billed charges 24.16 24.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "OXYCODONE ER 15 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR" RX-122365 CDM A9270 HCPCS 0637 RC 59011-0415-20 NDC outpatient 1 UN 24.16 24.16 24.16 74 17.88 percent of total billed charges 24.16 93 19.57 percent of total billed charges 24.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.16 other OPPS APC 24.16 24.16 other OPPS APC 24.16 24.86 6.01 percent of total billed charges 24.16 24.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR" RX-122366 CDM A9270 HCPCS 0250 RC 59011-0420-20 NDC outpatient 1 UN 30.6 30.6 74 22.64 percent of total billed charges 30.6 93 24.79 percent of total billed charges 30.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.6 other OPPS APC 30.6 30.6 other OPPS APC 30.6 24.86 7.61 percent of total billed charges 30.6 30.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR" RX-122366 CDM A9270 HCPCS 0637 RC 59011-0420-20 NDC outpatient 1 UN 30.6 30.6 30.6 74 22.64 percent of total billed charges 30.6 93 24.79 percent of total billed charges 30.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.6 other OPPS APC 30.6 30.6 other OPPS APC 30.6 24.86 7.61 percent of total billed charges 30.6 30.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR" RX-122368 CDM A9270 HCPCS 0250 RC 59011-0440-20 NDC outpatient 1 UN 52.39 52.39 74 38.77 percent of total billed charges 52.39 93 42.44 percent of total billed charges 52.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52.39 other OPPS APC 52.39 52.39 other OPPS APC 52.39 24.86 13.02 percent of total billed charges 52.39 52.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR" RX-122368 CDM A9270 HCPCS 0637 RC 59011-0440-20 NDC outpatient 1 UN 52.39 52.39 52.39 74 38.77 percent of total billed charges 52.39 93 42.44 percent of total billed charges 52.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52.39 other OPPS APC 52.39 52.39 other OPPS APC 52.39 24.86 13.02 percent of total billed charges 52.39 52.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR" RX-122370 CDM A9270 HCPCS 0250 RC 59011-0480-20 NDC outpatient 1 UN 91.45 91.45 74 67.67 percent of total billed charges 91.45 93 74.07 percent of total billed charges 91.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 91.45 other OPPS APC 91.45 91.45 other OPPS APC 91.45 24.86 22.73 percent of total billed charges 91.45 91.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR" RX-122370 CDM A9270 HCPCS 0637 RC 59011-0480-20 NDC outpatient 1 UN 91.45 91.45 91.45 74 67.67 percent of total billed charges 91.45 93 74.07 percent of total billed charges 91.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 91.45 other OPPS APC 91.45 91.45 other OPPS APC 91.45 24.86 22.73 percent of total billed charges 91.45 91.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BUPIVACAINE-EPINEPHRINE (PF) 0.75 %-1:200,000 INJECTION SOLUTION" RX-122524 CDM 250000000 HCPCS 0250 RC 63323-0460-01 NDC outpatient 30 ML 38.52 38.52 38.52 74 28.5 percent of total billed charges 38.52 93 31.2 percent of total billed charges 38.52 38.52 other OPPS APC 38.52 38.52 other OPPS APC 38.52 24.86 9.58 percent of total billed charges 38.52 38.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GOLIMUMAB 12.5 MG/ML INTRAVENOUS SOLUTION RX-122614 CDM J1602 HCPCS 0636 RC 57894-0350-01 NDC outpatient 4 ML 5997.58 5997.58 758.07 758.07 fee schedule 5997.58 93 4858.04 percent of total billed charges 5997.58 5997.58 other OPPS APC 5997.58 5997.58 other OPPS APC 5997.58 24.86 1491 percent of total billed charges 758.07 5997.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BACITRACIN 500 UNIT/GRAM TOPICAL PACKET RX-122637 CDM A9270 HCPCS 0250 RC 45802-0060-70 NDC outpatient 1 UN 0.58 0.58 74 0.43 percent of total billed charges 0.58 93 0.47 percent of total billed charges 0.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.58 other OPPS APC 0.58 0.58 other OPPS APC 0.58 24.86 0.14 percent of total billed charges 0.58 0.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BACITRACIN 500 UNIT/GRAM TOPICAL PACKET RX-122637 CDM A9270 HCPCS 0637 RC 45802-0060-70 NDC outpatient 1 UN 0.58 0.58 0.58 74 0.43 percent of total billed charges 0.58 93 0.47 percent of total billed charges 0.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.58 other OPPS APC 0.58 0.58 other OPPS APC 0.58 24.86 0.14 percent of total billed charges 0.58 0.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION RX-122648 CDM J1439 HCPCS 0636 RC 00517-0650-01 NDC outpatient 15 ML 4467.83 4467.83 961.95 961.95 fee schedule 4467.83 93 3618.94 percent of total billed charges 4467.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825.75 other OPPS APC 4467.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825.75 other OPPS APC 4467.83 24.86 1110.7 percent of total billed charges 961.95 4467.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASCORBIC ACID (VITAMIN C) 500 MG/5 ML ORAL SYRUP RX-122683 CDM A9270 HCPCS 0250 RC 57896-0842-16 NDC outpatient 473 ML 35.98 35.98 74 26.63 percent of total billed charges 35.98 93 29.14 percent of total billed charges 35.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35.98 other OPPS APC 35.98 35.98 other OPPS APC 35.98 24.86 8.94 percent of total billed charges 35.98 35.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASCORBIC ACID (VITAMIN C) 500 MG/5 ML ORAL SYRUP RX-122683 CDM A9270 HCPCS 0637 RC 57896-0842-16 NDC outpatient 473 ML 35.98 35.98 35.98 74 26.63 percent of total billed charges 35.98 93 29.14 percent of total billed charges 35.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35.98 other OPPS APC 35.98 35.98 other OPPS APC 35.98 24.86 8.94 percent of total billed charges 35.98 35.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET RX-122735 CDM A9270 HCPCS 0250 RC 67877-0422-60 NDC outpatient 1 UN 8.38 8.38 74 6.2 percent of total billed charges 8.38 93 6.79 percent of total billed charges 8.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.38 other OPPS APC 8.38 8.38 other OPPS APC 8.38 24.86 2.08 percent of total billed charges 8.38 8.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET RX-122735 CDM A9270 HCPCS 0637 RC 67877-0422-60 NDC outpatient 1 UN 8.38 8.38 8.38 74 6.2 percent of total billed charges 8.38 93 6.79 percent of total billed charges 8.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.38 other OPPS APC 8.38 8.38 other OPPS APC 8.38 24.86 2.08 percent of total billed charges 8.38 8.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMINOPHYLLINE 500 MG/20 ML INTRAVENOUS SOLUTION RX-122752 CDM J0280 HCPCS 0636 RC 00409-5922-01 NDC outpatient 20 ML 31.91 31.91 10.29 10.29 fee schedule 31.91 93 25.85 percent of total billed charges 31.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 31.91 other OPPS APC 31.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 31.91 other OPPS APC 31.91 24.86 7.93 percent of total billed charges 10.29 31.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOLUTEGRAVIR 50 MG TABLET RX-122784 CDM A9270 HCPCS 0250 RC 49702-0228-13 NDC outpatient 1 UN 225.75 225.75 74 167.06 percent of total billed charges 225.75 93 182.86 percent of total billed charges 225.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 225.75 other OPPS APC 225.75 225.75 other OPPS APC 225.75 24.86 56.12 percent of total billed charges 225.75 225.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOLUTEGRAVIR 50 MG TABLET RX-122784 CDM A9270 HCPCS 0637 RC 49702-0228-13 NDC outpatient 1 UN 225.75 225.75 225.75 74 167.06 percent of total billed charges 225.75 93 182.86 percent of total billed charges 225.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 225.75 other OPPS APC 225.75 225.75 other OPPS APC 225.75 24.86 56.12 percent of total billed charges 225.75 225.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION RX-123049 CDM 250000000 HCPCS 0250 RC 71288-0505-03 NDC outpatient 2 ML 16.2 16.2 16.2 74 11.99 percent of total billed charges 16.2 93 13.12 percent of total billed charges 16.2 16.2 other OPPS APC 16.2 16.2 other OPPS APC 16.2 24.86 4.03 percent of total billed charges 16.2 16.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION RX-123070 CDM J9041 HCPCS 0636 RC 83090-0008-01 NDC outpatient 3.5 ML 900 900 121.12 121.12 fee schedule 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.02 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.02 other OPPS APC 900 24.86 223.74 percent of total billed charges 121.12 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALANCED SALT SOLUTION COMBINATION NO.2 INTRAOCULAR IRRIGATION RX-123439 CDM A9270 HCPCS 0250 RC 00065-1795-04 NDC outpatient 500 ML 106.17 106.17 74 78.57 percent of total billed charges 106.17 93 86 percent of total billed charges 106.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.17 other OPPS APC 106.17 106.17 other OPPS APC 106.17 24.86 26.39 percent of total billed charges 106.17 106.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALANCED SALT SOLUTION COMBINATION NO.2 INTRAOCULAR IRRIGATION RX-123439 CDM A9270 HCPCS 0637 RC 00065-1795-04 NDC outpatient 500 ML 106.17 106.17 106.17 74 78.57 percent of total billed charges 106.17 93 86 percent of total billed charges 106.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.17 other OPPS APC 106.17 106.17 other OPPS APC 106.17 24.86 26.39 percent of total billed charges 106.17 106.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSPENSION RX-123560 CDM A9270 HCPCS 0250 RC 00574-0520-74 NDC outpatient 120 ML 41.76 41.76 74 30.9 percent of total billed charges 41.76 93 33.83 percent of total billed charges 41.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.76 other OPPS APC 41.76 41.76 other OPPS APC 41.76 24.86 10.38 percent of total billed charges 41.76 41.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSPENSION RX-123560 CDM A9270 HCPCS 0637 RC 00574-0520-74 NDC outpatient 120 ML 41.76 41.76 41.76 74 30.9 percent of total billed charges 41.76 93 33.83 percent of total billed charges 41.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.76 other OPPS APC 41.76 41.76 other OPPS APC 41.76 24.86 10.38 percent of total billed charges 41.76 41.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACTIVATED CHARCOAL 25 GRAM/120 ML ORAL SUSPENSION RX-123563 CDM A9270 HCPCS 0250 RC 00574-0521-74 NDC outpatient 120 ML 41.76 41.76 74 30.9 percent of total billed charges 41.76 93 33.83 percent of total billed charges 41.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.76 other OPPS APC 41.76 41.76 other OPPS APC 41.76 24.86 10.38 percent of total billed charges 41.76 41.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACTIVATED CHARCOAL 25 GRAM/120 ML ORAL SUSPENSION RX-123563 CDM A9270 HCPCS 0637 RC 00574-0521-74 NDC outpatient 120 ML 41.76 41.76 41.76 74 30.9 percent of total billed charges 41.76 93 33.83 percent of total billed charges 41.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.76 other OPPS APC 41.76 41.76 other OPPS APC 41.76 24.86 10.38 percent of total billed charges 41.76 41.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION RX-12370 CDM J2404 HCPCS 0636 RC 00143-9689-10 NDC outpatient 10 ML 76.56 76.56 76.56 74 56.65 percent of total billed charges 76.56 93 62.01 percent of total billed charges 76.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 76.56 other OPPS APC 76.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 76.56 other OPPS APC 76.56 24.86 19.03 percent of total billed charges 76.56 76.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS RX-123744 CDM J2590 HCPCS 0636 RC 70004-0085-44 NDC outpatient 500 ML 30.5 30.5 30.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.5 other OPPS APC 30.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.5 other OPPS APC 30.5 24.86 7.58 percent of total billed charges 30.5 30.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS RX-123744 CDM J2590 HCPCS 0636 RC 90000-0003-25 NDC outpatient 500 ML 18.63 18.63 18.63 74 13.79 percent of total billed charges 18.63 93 15.09 percent of total billed charges 18.63 18.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SENNA LEAF EXTRACT 176 MG/5 ML ORAL SYRUP RX-123778 CDM A9270 HCPCS 0250 RC 00121-4722-15 NDC outpatient 15 ML 12.07 12.07 74 8.93 percent of total billed charges 12.07 93 9.78 percent of total billed charges 12.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.07 other OPPS APC 12.07 12.07 other OPPS APC 12.07 24.86 3 percent of total billed charges 12.07 12.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SENNA LEAF EXTRACT 176 MG/5 ML ORAL SYRUP RX-123778 CDM A9270 HCPCS 0637 RC 00121-4722-15 NDC outpatient 15 ML 12.07 12.07 12.07 74 8.93 percent of total billed charges 12.07 93 9.78 percent of total billed charges 12.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.07 other OPPS APC 12.07 12.07 other OPPS APC 12.07 24.86 3 percent of total billed charges 12.07 12.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM CHLORIDE-ALOE VERA NASAL GEL RX-123800 CDM A9270 HCPCS 0250 RC 00225-0525-47 NDC outpatient 14.1 GR 8.36 8.36 74 6.19 percent of total billed charges 8.36 93 6.77 percent of total billed charges 8.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.36 other OPPS APC 8.36 8.36 other OPPS APC 8.36 24.86 2.08 percent of total billed charges 8.36 8.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM CHLORIDE-ALOE VERA NASAL GEL RX-123800 CDM A9270 HCPCS 0637 RC 00225-0525-47 NDC outpatient 14.1 GR 8.36 8.36 8.36 74 6.19 percent of total billed charges 8.36 93 6.77 percent of total billed charges 8.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.36 other OPPS APC 8.36 8.36 other OPPS APC 8.36 24.86 2.08 percent of total billed charges 8.36 8.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLYCERIN-WITCH HAZEL 12.5 %-50 % TOPICAL PADS RX-124081 CDM A9270 HCPCS 0250 RC 50289-3250-01 NDC outpatient 40 UN 8.18 8.18 74 6.05 percent of total billed charges 8.18 93 6.63 percent of total billed charges 8.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.18 other OPPS APC 8.18 8.18 other OPPS APC 8.18 24.86 2.03 percent of total billed charges 8.18 8.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLYCERIN-WITCH HAZEL 12.5 %-50 % TOPICAL PADS RX-124081 CDM A9270 HCPCS 0637 RC 50289-3250-01 NDC outpatient 40 UN 8.18 8.18 8.18 74 6.05 percent of total billed charges 8.18 93 6.63 percent of total billed charges 8.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.18 other OPPS APC 8.18 8.18 other OPPS APC 8.18 24.86 2.03 percent of total billed charges 8.18 8.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEPERIDINE (PF) 25 MG/ML INJECTION SYRINGE RX-124106 CDM J2175 HCPCS 0636 RC 00409-1176-30 NDC outpatient 1 ML 18.12 18.12 8.35 8.35 fee schedule 18.12 93 14.68 percent of total billed charges 18.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.12 other OPPS APC 18.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.12 other OPPS APC 18.12 24.86 4.5 percent of total billed charges 8.35 18.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEPERIDINE (PF) 50 MG/ML INJECTION SYRINGE RX-124107 CDM J2175 HCPCS 0636 RC 00409-1178-30 NDC outpatient 1 ML 22.67 22.67 8.35 8.35 fee schedule 22.67 93 18.36 percent of total billed charges 22.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.67 other OPPS APC 22.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.67 other OPPS APC 22.67 24.86 5.64 percent of total billed charges 8.35 22.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCIUM 250 MG (AS CARBONATE)-VITAMIN D3 3.125 MCG (125 UNIT) TABLET RX-124113 CDM A9270 HCPCS 0250 RC 00904-1882-60 NDC outpatient 1 UN 0.05 0.05 74 0.04 percent of total billed charges 0.05 93 0.04 percent of total billed charges 0.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.05 other OPPS APC 0.05 0.05 other OPPS APC 0.05 24.86 0.01 percent of total billed charges 0.05 0.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCIUM 250 MG (AS CARBONATE)-VITAMIN D3 3.125 MCG (125 UNIT) TABLET RX-124113 CDM A9270 HCPCS 0637 RC 00904-1882-60 NDC outpatient 1 UN 0.05 0.05 0.05 74 0.04 percent of total billed charges 0.05 93 0.04 percent of total billed charges 0.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.05 other OPPS APC 0.05 0.05 other OPPS APC 0.05 24.86 0.01 percent of total billed charges 0.05 0.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK RX-124116 CDM J7050 HCPCS 0636 RC 00338-9159-30 NDC outpatient 100 ML 21.61 21.61 0.73 0.73 fee schedule 21.61 93 17.5 percent of total billed charges 21.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 21.61 other OPPS APC 21.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 21.61 other OPPS APC 21.61 24.86 5.37 percent of total billed charges 0.73 21.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS PIGGYBACK RX-124117 CDM J7060 HCPCS 0636 RC 00338-9147-30 NDC outpatient 100 ML 21.61 21.61 2.07 2.07 fee schedule 21.61 93 17.5 percent of total billed charges 21.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 21.61 other OPPS APC 21.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 21.61 other OPPS APC 21.61 24.86 5.37 percent of total billed charges 2.07 21.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE" RX-124258 CDM J1642 HCPCS 0636 RC 64253-0333-35 NDC outpatient 5 ML 9.28 9.28 4.24 4.24 fee schedule 9.28 93 7.52 percent of total billed charges 9.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.28 other OPPS APC 9.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.28 other OPPS APC 9.28 24.86 2.31 percent of total billed charges 4.24 9.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET" RX-124308 CDM A9270 HCPCS 0250 RC 00904-7239-61 NDC outpatient 1 UN 0.68 0.68 74 0.5 percent of total billed charges 0.68 93 0.55 percent of total billed charges 0.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.68 other OPPS APC 0.68 0.68 other OPPS APC 0.68 24.86 0.17 percent of total billed charges 0.68 0.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET" RX-124308 CDM A9270 HCPCS 0637 RC 00904-7239-61 NDC outpatient 1 UN 0.68 0.68 0.68 74 0.5 percent of total billed charges 0.68 93 0.55 percent of total billed charges 0.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.68 other OPPS APC 0.68 0.68 other OPPS APC 0.68 24.86 0.17 percent of total billed charges 0.68 0.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEPATITIS B IMMUNE GLOBULIN-MALTOSE >312 UNIT/ML (5 ML) INJECTION SOLN RX-124338 CDM 636000000 HCPCS 0636 RC 70257-0051-51 NDC outpatient 5 ML 2669.83 2669.83 2669.83 74 1975.67 percent of total billed charges 2669.83 93 2162.56 percent of total billed charges 2669.83 2669.83 other OPPS APC 2669.83 2669.83 other OPPS APC 2669.83 24.86 663.72 percent of total billed charges 2669.83 2669.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOBRAMYCIN 0.3 % EYE DROPS RX-124422 CDM A9270 HCPCS 0250 RC 70069-0131-01 NDC outpatient 5 ML 15.63 15.63 74 11.57 percent of total billed charges 15.63 93 12.66 percent of total billed charges 15.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.63 other OPPS APC 15.63 15.63 other OPPS APC 15.63 24.86 3.89 percent of total billed charges 15.63 15.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOBRAMYCIN 0.3 % EYE DROPS RX-124422 CDM A9270 HCPCS 0637 RC 70069-0131-01 NDC outpatient 5 ML 15.63 15.63 15.63 74 11.57 percent of total billed charges 15.63 93 12.66 percent of total billed charges 15.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.63 other OPPS APC 15.63 15.63 other OPPS APC 15.63 24.86 3.89 percent of total billed charges 15.63 15.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VIT A 300 MCG-C 200 MG-E 27 MG-LUTEIN 2 MG AND MINERALS TABLET RX-124571 CDM A9270 HCPCS 0250 RC 00536-5090-08 NDC outpatient 1 UN 0.19 0.19 74 0.14 percent of total billed charges 0.19 93 0.15 percent of total billed charges 0.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.19 other OPPS APC 0.19 0.19 other OPPS APC 0.19 24.86 0.05 percent of total billed charges 0.19 0.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VIT A 300 MCG-C 200 MG-E 27 MG-LUTEIN 2 MG AND MINERALS TABLET RX-124571 CDM A9270 HCPCS 0637 RC 00536-5090-08 NDC outpatient 1 UN 0.19 0.19 0.19 74 0.14 percent of total billed charges 0.19 93 0.15 percent of total billed charges 0.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.19 other OPPS APC 0.19 0.19 other OPPS APC 0.19 24.86 0.05 percent of total billed charges 0.19 0.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION RX-124656 CDM J9181 HCPCS 0636 RC 63323-0104-06 NDC outpatient 5 ML 37.33 37.33 7.99 7.99 fee schedule 37.33 93 30.24 percent of total billed charges 37.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 37.33 other OPPS APC 37.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 37.33 other OPPS APC 37.33 24.86 9.28 percent of total billed charges 7.99 37.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TBO-FILGRASTIM 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE RX-124716 CDM J1447 HCPCS 0636 RC 63459-0910-36 NDC outpatient 0.5 ML 898.8 898.8 145.2 145.2 fee schedule 898.8 93 728.03 percent of total billed charges 898.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 116.4 other OPPS APC 898.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 116.4 other OPPS APC 898.8 24.86 223.44 percent of total billed charges 145.2 898.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TBO-FILGRASTIM 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE RX-124717 CDM J1447 HCPCS 0636 RC 63459-0912-36 NDC outpatient 0.8 ML 1431.3 1431.3 232.32 232.32 fee schedule 1431.3 93 1159.35 percent of total billed charges 1431.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 186.24 other OPPS APC 1431.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 186.24 other OPPS APC 1431.3 24.86 355.82 percent of total billed charges 232.32 1431.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT" RX-124722 CDM A9270 HCPCS 0250 RC 45802-0143-70 NDC outpatient 1 UN 0.7 0.7 74 0.52 percent of total billed charges 0.7 93 0.57 percent of total billed charges 0.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.7 other OPPS APC 0.7 0.7 other OPPS APC 0.7 24.86 0.17 percent of total billed charges 0.7 0.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT" RX-124722 CDM A9270 HCPCS 0637 RC 45802-0143-70 NDC outpatient 1 UN 0.7 0.7 0.7 74 0.52 percent of total billed charges 0.7 93 0.57 percent of total billed charges 0.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.7 other OPPS APC 0.7 0.7 other OPPS APC 0.7 24.86 0.17 percent of total billed charges 0.7 0.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT RX-124764 CDM A9270 HCPCS 0250 RC 00573-2871-93 NDC outpatient 28 GR 30.33 30.33 74 22.44 percent of total billed charges 30.33 93 24.57 percent of total billed charges 30.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.33 other OPPS APC 30.33 30.33 other OPPS APC 30.33 24.86 7.54 percent of total billed charges 30.33 30.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT RX-124764 CDM A9270 HCPCS 0637 RC 00573-2871-93 NDC outpatient 28 GR 30.33 30.33 30.33 74 22.44 percent of total billed charges 30.33 93 24.57 percent of total billed charges 30.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.33 other OPPS APC 30.33 30.33 other OPPS APC 30.33 24.86 7.54 percent of total billed charges 30.33 30.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION" RX-124767 CDM J9301 HCPCS 0636 RC 50242-0070-01 NDC outpatient 40 ML 24725.5 24725.5 8052.55 8052.55 fee schedule 24725.5 93 20027.7 percent of total billed charges 24725.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7458.8 other OPPS APC 24725.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7458.8 other OPPS APC 24725.5 24.86 6146.77 percent of total billed charges 8052.55 24725.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERITONEAL DIALYSIS 28 AND ICODEXTRIN 7.5 % CA 3.5 MEQ/L-MAG 0.5 MEQ/L RX-124804 CDM 250000000 HCPCS 0250 RC 00941-0679-06 NDC outpatient 2000 ML 40 40 40 74 29.6 percent of total billed charges 40 93 32.4 percent of total billed charges 40 40 other OPPS APC 40 40 other OPPS APC 40 24.86 9.94 percent of total billed charges 40 40 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION RX-124833 CDM J0171 HCPCS 0636 RC 54288-0103-10 NDC outpatient 1 ML 43.75 43.75 8.35 8.35 fee schedule 43.75 93 35.44 percent of total billed charges 43.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 43.75 other OPPS APC 43.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 43.75 other OPPS APC 43.75 24.86 10.88 percent of total billed charges 8.35 43.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "POSACONAZOLE 100 MG TABLET,DELAYED RELEASE" RX-124917 CDM A9270 HCPCS 0250 RC 60687-0523-21 NDC outpatient 1 UN 141.5 141.5 74 104.71 percent of total billed charges 141.5 93 114.62 percent of total billed charges 141.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 141.5 other OPPS APC 141.5 141.5 other OPPS APC 141.5 24.86 35.18 percent of total billed charges 141.5 141.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "POSACONAZOLE 100 MG TABLET,DELAYED RELEASE" RX-124917 CDM A9270 HCPCS 0637 RC 60687-0523-21 NDC outpatient 1 UN 141.5 141.5 141.5 74 104.71 percent of total billed charges 141.5 93 114.62 percent of total billed charges 141.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 141.5 other OPPS APC 141.5 141.5 other OPPS APC 141.5 24.86 35.18 percent of total billed charges 141.5 141.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION RX-124962 CDM J3490 HCPCS 0636 RC 00641-6022-25 NDC outpatient 2 ML 2.86 2.86 2.86 74 2.12 percent of total billed charges 2.86 93 2.32 percent of total billed charges 2.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.86 other OPPS APC 2.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.86 other OPPS APC 2.86 24.86 0.71 percent of total billed charges 2.86 2.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "EPINEPHRINE (JR) 0.15 MG/0.3 ML INJECTION,AUTO-INJECTOR" RX-124985 CDM J0171 HCPCS 0636 RC 49502-0101-02 NDC outpatient 0.3 ML 468.75 468.75 1.67 1.67 fee schedule 468.75 93 379.69 percent of total billed charges 468.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 468.75 other OPPS APC 468.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 468.75 other OPPS APC 468.75 24.86 116.53 percent of total billed charges 1.67 468.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "EPINEPHRINE (JR) 0.15 MG/0.3 ML INJECTION,AUTO-INJECTOR|DISCARDED DRUG NOT ADMINISTERED" RX-124985 CDM J0171 HCPCS 0636 RC 49502-0101-02 NDC JW outpatient 0.3 ML 468.75 468.75 0.83 0.83 fee schedule 0.83 468.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR" RX-124987 CDM J0171 HCPCS 0636 RC 00115-1694-49 NDC outpatient 0.3 ML 617.52 617.52 2.5 2.5 fee schedule 617.52 93 500.19 percent of total billed charges 617.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 617.52 other OPPS APC 617.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 617.52 other OPPS APC 617.52 24.86 153.52 percent of total billed charges 2.5 617.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE RX-125001 CDM J0171 HCPCS 0636 RC 76329-3318-01 NDC outpatient 10 ML 37.5 37.5 8.35 8.35 fee schedule 37.5 93 30.38 percent of total billed charges 37.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 37.5 other OPPS APC 37.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 37.5 other OPPS APC 37.5 24.86 9.32 percent of total billed charges 8.35 37.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA RX-125159 CDM A9270 HCPCS 0250 RC 00132-0202-20 NDC outpatient 1 UN 3.75 3.75 74 2.78 percent of total billed charges 3.75 93 3.04 percent of total billed charges 3.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.75 other OPPS APC 3.75 3.75 other OPPS APC 3.75 24.86 0.93 percent of total billed charges 3.75 3.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA RX-125159 CDM A9270 HCPCS 0637 RC 00132-0202-20 NDC outpatient 1 UN 3.75 3.75 3.75 74 2.78 percent of total billed charges 3.75 93 3.04 percent of total billed charges 3.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.75 other OPPS APC 3.75 3.75 other OPPS APC 3.75 24.86 0.93 percent of total billed charges 3.75 3.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE RX-125166 CDM 90746 HCPCS 0250 RC 58160-0821-52 NDC outpatient 1 ML 208.1 208.1 208.1 74 153.99 percent of total billed charges 208.1 93 168.56 percent of total billed charges 208.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 208.1 other OPPS APC 208.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 208.1 other OPPS APC 208.1 24.86 51.73 percent of total billed charges 208.1 208.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE RX-125248 CDM 90744 HCPCS 0636 RC 58160-0820-52 NDC outpatient 0.5 ML 84.89 84.89 34.12 34.12 fee schedule 84.89 93 68.76 percent of total billed charges 84.89 84.89 other OPPS APC 84.89 84.89 other OPPS APC 84.89 24.86 21.1 percent of total billed charges 34.12 84.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE" RX-125331 CDM 90632 HCPCS 0636 RC 58160-0826-52 NDC outpatient 1 ML 248.23 248.23 82.03 82.03 fee schedule 248.23 93 201.07 percent of total billed charges 248.23 248.23 other OPPS APC 248.23 248.23 other OPPS APC 248.23 24.86 61.71 percent of total billed charges 82.03 248.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERFLUTREN LIPID MICROSPHERES 1.1 MG/ML INTRAVENOUS SUSPENSION RX-125504 CDM Q9957 HCPCS 0636 RC 11994-0011-01 NDC outpatient 2 ML 735.9 735.9 97.53 97.53 fee schedule 735.9 93 596.08 percent of total billed charges 735.9 735.9 other OPPS APC 735.9 735.9 other OPPS APC 735.9 24.86 182.94 percent of total billed charges 97.53 735.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION RX-125686 CDM J9308 HCPCS 0636 RC 00002-7669-01 NDC outpatient 10 ML 4370.38 4370.38 1572.27 1572.27 fee schedule 4370.38 93 3540.01 percent of total billed charges 4370.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1421.42 other OPPS APC 4370.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1421.42 other OPPS APC 4370.38 24.86 1086.48 percent of total billed charges 1572.27 4370.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION RX-125686 CDM J9308 HCPCS 0636 RC 00002-7678-01 NDC outpatient 50 ML 21851.8 21851.8 7861.37 7861.37 fee schedule 21851.8 93 17700 percent of total billed charges 21851.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7107.1 other OPPS APC 21851.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7107.1 other OPPS APC 21851.8 24.86 5432.37 percent of total billed charges 7861.37 21851.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIPERACILLIN-TAZOBACTAM 40.5 GRAM INTRAVENOUS SOLUTION RX-12587 CDM J2543 HCPCS 0636 RC 61990-0150-01 NDC outpatient 180 ML 227.83 227.83 55.76 55.76 fee schedule 227.83 93 184.54 percent of total billed charges 227.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 227.83 other OPPS APC 227.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 227.83 other OPPS APC 227.83 24.86 56.64 percent of total billed charges 55.76 227.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIPERACILLIN-TAZOBACTAM 40.5 GRAM INTRAVENOUS SOLUTION RX-12587 CDM J2543 HCPCS 0636 RC 61990-0150-01 NDC outpatient 40.5 GR 227.83 227.83 55.76 55.76 fee schedule 227.83 93 184.54 percent of total billed charges 227.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 227.83 other OPPS APC 227.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 227.83 other OPPS APC 227.83 24.86 56.64 percent of total billed charges 55.76 227.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIDAZOLAM (PF) 2 MG/2 ML (1 MG/ML) INJECTION SYRINGE RX-126055 CDM J2250 HCPCS 0636 RC 76045-0001-20 NDC outpatient 2 ML 9.42 9.42 0.31 0.31 fee schedule 9.42 93 7.63 percent of total billed charges 9.42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.42 other OPPS APC 9.42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.42 other OPPS APC 9.42 24.86 2.34 percent of total billed charges 0.31 9.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ARTICAINE 4 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION CARTRIDGE" RX-126093 CDM 250000000 HCPCS 0250 RC 00362-9048-02 NDC outpatient 1.7 ML 2.51 2.51 2.51 74 1.86 percent of total billed charges 2.51 93 2.03 percent of total billed charges 2.51 2.51 other OPPS APC 2.51 2.51 other OPPS APC 2.51 24.86 0.62 percent of total billed charges 2.51 2.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. USTEKINUMAB 45 MG/0.5 ML SUBCUTANEOUS SYRINGE RX-126167 CDM J3357 HCPCS 0250 RC 57894-0060-03 NDC outpatient 0.5 ML 41764.3 41764.3 74 30905.6 percent of total billed charges 41764.3 93 33829.1 percent of total billed charges 41764.3 41764.3 other OPPS APC 41764.3 41764.3 other OPPS APC 41764.3 24.86 10382.6 percent of total billed charges 41764.3 41764.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. USTEKINUMAB 45 MG/0.5 ML SUBCUTANEOUS SYRINGE RX-126167 CDM J3357 HCPCS 0637 RC 57894-0060-03 NDC outpatient 0.5 ML 41764.3 41764.3 41764.3 74 30905.6 percent of total billed charges 41764.3 93 33829.1 percent of total billed charges 41764.3 41764.3 other OPPS APC 41764.3 41764.3 other OPPS APC 41764.3 24.86 10382.6 percent of total billed charges 41764.3 41764.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE" RX-126194 CDM A9270 HCPCS 0250 RC 51079-0978-20 NDC outpatient 1 UN 2.33 2.33 74 1.72 percent of total billed charges 2.33 93 1.89 percent of total billed charges 2.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.33 other OPPS APC 2.33 2.33 other OPPS APC 2.33 24.86 0.58 percent of total billed charges 2.33 2.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE" RX-126194 CDM A9270 HCPCS 0637 RC 51079-0978-20 NDC outpatient 1 UN 2.33 2.33 2.33 74 1.72 percent of total billed charges 2.33 93 1.89 percent of total billed charges 2.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.33 other OPPS APC 2.33 2.33 other OPPS APC 2.33 24.86 0.58 percent of total billed charges 2.33 2.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN RX-1262 CDM 250000000 HCPCS 0250 RC 00517-2502-10 NDC outpatient 2 ML 102.15 102.15 102.15 74 75.59 percent of total billed charges 102.15 93 82.74 percent of total billed charges 102.15 102.15 other OPPS APC 102.15 102.15 other OPPS APC 102.15 24.86 25.39 percent of total billed charges 102.15 102.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION RX-126219 CDM J3380 HCPCS 0636 RC 64764-0300-20 NDC outpatient 5 ML 25999.8 25999.8 7764.57 7764.57 fee schedule 25999.8 93 21059.8 percent of total billed charges 25999.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6678 other OPPS APC 25999.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6678 other OPPS APC 25999.8 24.86 6463.54 percent of total billed charges 7764.57 25999.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENYLEPHRINE 0.25 %-COCOA BUTTER 88.44 % RECTAL SUPPOSITORY RX-126347 CDM A9270 HCPCS 0250 RC 00536-1186-12 NDC outpatient 1 UN 0.6 0.6 74 0.44 percent of total billed charges 0.6 93 0.49 percent of total billed charges 0.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.6 other OPPS APC 0.6 0.6 other OPPS APC 0.6 24.86 0.15 percent of total billed charges 0.6 0.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENYLEPHRINE 0.25 %-COCOA BUTTER 88.44 % RECTAL SUPPOSITORY RX-126347 CDM A9270 HCPCS 0637 RC 00536-1186-12 NDC outpatient 1 UN 0.6 0.6 0.6 74 0.44 percent of total billed charges 0.6 93 0.49 percent of total billed charges 0.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.6 other OPPS APC 0.6 0.6 other OPPS APC 0.6 24.86 0.15 percent of total billed charges 0.6 0.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CYCLOPHOSPHAMIDE 25 MG CAPSULE RX-126404 CDM J8530 HCPCS 0636 RC 62332-0618-31 NDC outpatient 1 UN 22.46 22.46 1.09 1.09 fee schedule 22.46 93 18.19 percent of total billed charges 22.46 22.46 other OPPS APC 22.46 22.46 other OPPS APC 22.46 24.86 5.58 percent of total billed charges 1.09 22.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK RX-126466 CDM J3475 HCPCS 0636 RC 00264-4204-52 NDC outpatient 50 ML 13.26 13.26 13.26 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.26 other OPPS APC 13.26 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.26 other OPPS APC 13.26 24.86 3.3 percent of total billed charges 13.26 13.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK RX-126466 CDM J3475 HCPCS 0636 RC 70121-1719-01 NDC outpatient 50 ML 37.5 37.5 4.26 4.26 fee schedule 37.5 93 30.38 percent of total billed charges 4.26 37.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BELINOSTAT 500 MG INTRAVENOUS SOLUTION RX-126470 CDM J9032 HCPCS 0636 RC 72893-0002-01 NDC outpatient 10 ML 7205.5 7205.5 2718.27 2718.27 fee schedule 7205.5 93 5836.46 percent of total billed charges 7205.5 7205.5 other OPPS APC 7205.5 7205.5 other OPPS APC 7205.5 24.86 1791.29 percent of total billed charges 2718.27 7205.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION RX-126576 CDM J3475 HCPCS 0636 RC 63323-0106-15 NDC outpatient 20 GR 18.48 18.48 42.59 42.59 fee schedule 18.48 93 14.97 percent of total billed charges 18.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.48 other OPPS APC 18.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.48 other OPPS APC 18.48 24.86 4.59 percent of total billed charges 18.48 42.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION RX-126576 CDM J3475 HCPCS 0636 RC 63323-0106-15 NDC outpatient 500 ML 18.48 18.48 42.59 42.59 fee schedule 18.48 93 14.97 percent of total billed charges 18.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.48 other OPPS APC 18.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.48 other OPPS APC 18.48 24.86 4.59 percent of total billed charges 18.48 42.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DANTROLENE 250 MG INTRAVENOUS SUSPENSION RX-126579 CDM 250000000 HCPCS 0250 RC 42367-0540-32 NDC outpatient 250 ME 9380.25 9380.25 9380.25 74 6941.39 percent of total billed charges 9380.25 93 7598 percent of total billed charges 9380.25 9380.25 other OPPS APC 9380.25 9380.25 other OPPS APC 9380.25 24.86 2331.93 percent of total billed charges 9380.25 9380.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EMPAGLIFLOZIN 10 MG TABLET RX-126630 CDM A9270 HCPCS 0250 RC 00597-0152-37 NDC outpatient 1 UN 61.11 61.11 74 45.22 percent of total billed charges 61.11 93 49.5 percent of total billed charges 61.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 61.11 other OPPS APC 61.11 61.11 other OPPS APC 61.11 24.86 15.19 percent of total billed charges 61.11 61.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EMPAGLIFLOZIN 10 MG TABLET RX-126630 CDM A9270 HCPCS 0637 RC 00597-0152-37 NDC outpatient 1 UN 61.11 61.11 61.11 74 45.22 percent of total billed charges 61.11 93 49.5 percent of total billed charges 61.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 61.11 other OPPS APC 61.11 61.11 other OPPS APC 61.11 24.86 15.19 percent of total billed charges 61.11 61.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EMPAGLIFLOZIN 25 MG TABLET RX-126632 CDM A9270 HCPCS 0250 RC 00597-0153-37 NDC outpatient 1 UN 61.11 61.11 74 45.22 percent of total billed charges 61.11 93 49.5 percent of total billed charges 61.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 61.11 other OPPS APC 61.11 61.11 other OPPS APC 61.11 24.86 15.19 percent of total billed charges 61.11 61.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EMPAGLIFLOZIN 25 MG TABLET RX-126632 CDM A9270 HCPCS 0637 RC 00597-0153-37 NDC outpatient 1 UN 61.11 61.11 61.11 74 45.22 percent of total billed charges 61.11 93 49.5 percent of total billed charges 61.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 61.11 other OPPS APC 61.11 61.11 other OPPS APC 61.11 24.86 15.19 percent of total billed charges 61.11 61.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PARENTERAL AMINO ACID 10 % COMBINATION NO.6 INTRAVENOUS SOLUTION RX-126660 CDM 250000000 HCPCS 0250 RC 00338-0644-03 NDC outpatient 500 ML 60.32 60.32 60.32 74 44.64 percent of total billed charges 60.32 93 48.86 percent of total billed charges 60.32 60.32 other OPPS APC 60.32 60.32 other OPPS APC 60.32 24.86 15 percent of total billed charges 60.32 60.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SYRINGE RX-126728 CDM 90714 HCPCS 0636 RC 49281-0215-15 NDC outpatient 0.5 ML 110.56 110.56 35.44 35.44 fee schedule 110.56 93 89.55 percent of total billed charges 110.56 110.56 other OPPS APC 110.56 110.56 other OPPS APC 110.56 24.86 27.49 percent of total billed charges 35.44 110.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SUSP RX-126731 CDM 90714 HCPCS 0636 RC 49281-0215-10 NDC outpatient 0.5 ML 110.56 110.56 35.44 35.44 fee schedule 110.56 93 89.55 percent of total billed charges 110.56 110.56 other OPPS APC 110.56 110.56 other OPPS APC 110.56 24.86 27.49 percent of total billed charges 35.44 110.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE RX-126885 CDM J1670 HCPCS 0636 RC 13533-0634-02 NDC outpatient 1 ML 1947.5 1947.5 617.55 617.55 fee schedule 1947.5 93 1577.48 percent of total billed charges 1947.5 1947.5 other OPPS APC 1947.5 1947.5 other OPPS APC 1947.5 24.86 484.15 percent of total billed charges 617.55 1947.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHYL SALICYLATE-MENTHOL 29 %-7.6 % TOPICAL OINTMENT RX-126889 CDM A9270 HCPCS 0250 RC 41167-0008-79 NDC outpatient 99.2 GR 23.05 23.05 74 17.06 percent of total billed charges 23.05 93 18.67 percent of total billed charges 23.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 23.05 other OPPS APC 23.05 23.05 other OPPS APC 23.05 24.86 5.73 percent of total billed charges 23.05 23.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHYL SALICYLATE-MENTHOL 29 %-7.6 % TOPICAL OINTMENT RX-126889 CDM A9270 HCPCS 0637 RC 41167-0008-79 NDC outpatient 99.2 GR 23.05 23.05 23.05 74 17.06 percent of total billed charges 23.05 93 18.67 percent of total billed charges 23.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 23.05 other OPPS APC 23.05 23.05 other OPPS APC 23.05 24.86 5.73 percent of total billed charges 23.05 23.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE (PF) 30 MG/30 ML (1 MG/ML) PCA INTRAVENOUS SOLUTION RX-127015 CDM J2270 HCPCS 0636 RC 76329-1912-01 NDC outpatient 30 ML 42 42 15.75 15.75 fee schedule 42 93 34.02 percent of total billed charges 42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42 other OPPS APC 42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42 other OPPS APC 42 24.86 10.44 percent of total billed charges 15.75 42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WHITE PETROLATUM-MINERAL OIL 94 %-3 % EYE OINTMENT RX-127124 CDM A9270 HCPCS 0250 RC 00065-0518-01 NDC outpatient 3.5 GR 21.46 21.46 74 15.88 percent of total billed charges 21.46 93 17.38 percent of total billed charges 21.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 21.46 other OPPS APC 21.46 21.46 other OPPS APC 21.46 24.86 5.33 percent of total billed charges 21.46 21.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WHITE PETROLATUM-MINERAL OIL 94 %-3 % EYE OINTMENT RX-127124 CDM A9270 HCPCS 0637 RC 00065-0518-01 NDC outpatient 3.5 GR 21.46 21.46 21.46 74 15.88 percent of total billed charges 21.46 93 17.38 percent of total billed charges 21.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 21.46 other OPPS APC 21.46 21.46 other OPPS APC 21.46 24.86 5.33 percent of total billed charges 21.46 21.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY RX-127188 CDM A9270 HCPCS 0250 RC 48582-0001-55 NDC outpatient 45 ML 20.25 20.25 74 14.99 percent of total billed charges 20.25 93 16.4 percent of total billed charges 20.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20.25 other OPPS APC 20.25 20.25 other OPPS APC 20.25 24.86 5.03 percent of total billed charges 20.25 20.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY RX-127188 CDM A9270 HCPCS 0637 RC 48582-0001-55 NDC outpatient 45 ML 20.25 20.25 20.25 74 14.99 percent of total billed charges 20.25 93 16.4 percent of total billed charges 20.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20.25 other OPPS APC 20.25 20.25 other OPPS APC 20.25 24.86 5.03 percent of total billed charges 20.25 20.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR RX-127193 CDM A9270 HCPCS 0250 RC 25021-0673-77 NDC outpatient 11 ML 19.05 19.05 74 14.1 percent of total billed charges 19.05 93 15.43 percent of total billed charges 19.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.05 other OPPS APC 19.05 19.05 other OPPS APC 19.05 24.86 4.74 percent of total billed charges 19.05 19.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR RX-127193 CDM A9270 HCPCS 0637 RC 25021-0673-77 NDC outpatient 11 ML 19.05 19.05 19.05 74 14.1 percent of total billed charges 19.05 93 15.43 percent of total billed charges 19.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.05 other OPPS APC 19.05 19.05 other OPPS APC 19.05 24.86 4.74 percent of total billed charges 19.05 19.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION RX-127195 CDM J9370 HCPCS 0636 RC 61703-0309-16 NDC outpatient 2 ML 46.2 46.2 17.09 17.09 fee schedule 46.2 93 37.42 percent of total billed charges 46.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 46.2 other OPPS APC 46.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 46.2 other OPPS APC 46.2 24.86 11.49 percent of total billed charges 17.09 46.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM RX-127197 CDM A9270 HCPCS 0250 RC 72140-0000-21 NDC outpatient 454 GR 55.61 55.61 74 41.15 percent of total billed charges 55.61 93 45.04 percent of total billed charges 55.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.61 other OPPS APC 55.61 55.61 other OPPS APC 55.61 24.86 13.82 percent of total billed charges 55.61 55.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LANOLIN ALCOHOLS-MINERAL OIL-W.PETROLATUM-CERESIN TOPICAL CREAM RX-127197 CDM A9270 HCPCS 0637 RC 72140-0000-21 NDC outpatient 454 GR 55.61 55.61 55.61 74 41.15 percent of total billed charges 55.61 93 45.04 percent of total billed charges 55.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.61 other OPPS APC 55.61 55.61 other OPPS APC 55.61 24.86 13.82 percent of total billed charges 55.61 55.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLEVIDIPINE 50 MG/100 ML INTRAVENOUS EMULSION RX-127211 CDM 250000000 HCPCS 0250 RC 10122-0611-01 NDC outpatient 100 ML 513.38 513.38 513.38 74 379.9 percent of total billed charges 513.38 93 415.84 percent of total billed charges 513.38 513.38 other OPPS APC 513.38 513.38 other OPPS APC 513.38 24.86 127.63 percent of total billed charges 513.38 513.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TERBINAFINE HCL 250 MG TABLET RX-12724 CDM A9270 HCPCS 0250 RC 69097-0859-02 NDC outpatient 1 UN 32.56 32.56 74 24.09 percent of total billed charges 32.56 93 26.37 percent of total billed charges 32.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 32.56 other OPPS APC 32.56 32.56 other OPPS APC 32.56 24.86 8.09 percent of total billed charges 32.56 32.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TERBINAFINE HCL 250 MG TABLET RX-12724 CDM A9270 HCPCS 0637 RC 69097-0859-02 NDC outpatient 1 UN 32.56 32.56 32.56 74 24.09 percent of total billed charges 32.56 93 26.37 percent of total billed charges 32.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 32.56 other OPPS APC 32.56 32.56 other OPPS APC 32.56 24.86 8.09 percent of total billed charges 32.56 32.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOXORUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION RX-127247 CDM J9000 HCPCS 0636 RC 63323-0883-30 NDC outpatient 25 ML 100 100 14.28 14.28 fee schedule 100 93 81 percent of total billed charges 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 24.86 24.86 percent of total billed charges 14.28 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOXORUBICIN 10 MG/5 ML INTRAVENOUS SOLUTION RX-127248 CDM J9000 HCPCS 0636 RC 45963-0733-55 NDC outpatient 5 ML 30 30 2.86 2.86 fee schedule 30 93 24.3 percent of total billed charges 30 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30 other OPPS APC 30 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30 other OPPS APC 30 24.86 7.46 percent of total billed charges 2.86 30 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION MIST FOR INHALATION RX-127331 CDM 250000000 HCPCS 0250 RC 00597-0100-51 NDC outpatient 4 GR 225 225 225 74 166.5 percent of total billed charges 225 93 182.25 percent of total billed charges 225 225 other OPPS APC 225 225 other OPPS APC 225 24.86 55.94 percent of total billed charges 225 225 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FAMOTIDINE (PF) 20 MG/50 ML IN 0.9 % NACL (ISO) INTRAVENOUS PIGGYBACK RX-12735 CDM J3490 HCPCS 0636 RC 00338-5197-41 NDC outpatient 20 ME 16.79 16.79 16.79 74 12.42 percent of total billed charges 16.79 93 13.6 percent of total billed charges 16.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.79 other OPPS APC 16.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.79 other OPPS APC 16.79 24.86 4.17 percent of total billed charges 16.79 16.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FAMOTIDINE (PF) 20 MG/50 ML IN 0.9 % NACL (ISO) INTRAVENOUS PIGGYBACK RX-12735 CDM J3490 HCPCS 0636 RC 00338-5197-41 NDC outpatient 50 ML 16.79 16.79 16.79 74 12.42 percent of total billed charges 16.79 93 13.6 percent of total billed charges 16.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.79 other OPPS APC 16.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.79 other OPPS APC 16.79 24.86 4.17 percent of total billed charges 16.79 16.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOPAMINE 400 MG/10 ML (40 MG/ML) INTRAVENOUS SOLUTION RX-127389 CDM J1265 HCPCS 0636 RC 00409-9104-20 NDC outpatient 10 ML 9.68 9.68 7.99 7.99 fee schedule 9.68 93 7.84 percent of total billed charges 9.68 9.68 other OPPS APC 9.68 9.68 other OPPS APC 9.68 24.86 2.41 percent of total billed charges 7.99 9.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NALOXEGOL 12.5 MG TABLET RX-127395 CDM A9270 HCPCS 0250 RC 82625-8801-01 NDC outpatient 1 UN 41.57 41.57 74 30.76 percent of total billed charges 41.57 93 33.67 percent of total billed charges 41.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.57 other OPPS APC 41.57 41.57 other OPPS APC 41.57 24.86 10.33 percent of total billed charges 41.57 41.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NALOXEGOL 12.5 MG TABLET RX-127395 CDM A9270 HCPCS 0637 RC 82625-8801-01 NDC outpatient 1 UN 41.57 41.57 41.57 74 30.76 percent of total billed charges 41.57 93 33.67 percent of total billed charges 41.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.57 other OPPS APC 41.57 41.57 other OPPS APC 41.57 24.86 10.33 percent of total billed charges 41.57 41.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIROFIBAN 12.5 MG/250 ML (50 MCG/ML)-0.9 % SODIUM CHLORIDE INTRAVENOUS RX-127467 CDM J3246 HCPCS 0636 RC 14789-0102-02 NDC outpatient 12.5 ME 480 480 480 74 355.2 percent of total billed charges 480 93 388.8 percent of total billed charges 480 480 other OPPS APC 480 480 other OPPS APC 480 24.86 119.33 percent of total billed charges 480 480 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIROFIBAN 12.5 MG/250 ML (50 MCG/ML)-0.9 % SODIUM CHLORIDE INTRAVENOUS RX-127467 CDM J3246 HCPCS 0636 RC 14789-0102-02 NDC outpatient 250 ML 480 480 480 74 355.2 percent of total billed charges 480 93 388.8 percent of total billed charges 480 480 other OPPS APC 480 480 other OPPS APC 480 24.86 119.33 percent of total billed charges 480 480 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MULTIVITAMIN-FERROUS FUMARATE-FOLIC ACID 18 MG-400 MCG TABLET RX-127478 CDM A9270 HCPCS 0250 RC 00904-2641-72 NDC outpatient 1 UN 0.09 0.09 74 0.07 percent of total billed charges 0.09 93 0.07 percent of total billed charges 0.09 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.09 other OPPS APC 0.09 0.09 other OPPS APC 0.09 24.86 0.02 percent of total billed charges 0.09 0.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MULTIVITAMIN-FERROUS FUMARATE-FOLIC ACID 18 MG-400 MCG TABLET RX-127478 CDM A9270 HCPCS 0637 RC 00904-2641-72 NDC outpatient 1 UN 0.09 0.09 0.09 74 0.07 percent of total billed charges 0.09 93 0.07 percent of total billed charges 0.09 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.09 other OPPS APC 0.09 0.09 other OPPS APC 0.09 24.86 0.02 percent of total billed charges 0.09 0.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION RX-127568 CDM A9270 HCPCS 0250 RC 00121-4799-40 NDC outpatient 5 ML 23.37 23.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 23.37 other OPPS APC 23.37 23.37 other OPPS APC 23.37 24.86 5.81 percent of total billed charges 23.37 23.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION RX-127568 CDM A9270 HCPCS 0637 RC 00121-4799-40 NDC outpatient 5 ML 23.37 23.37 23.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 23.37 other OPPS APC 23.37 23.37 other OPPS APC 23.37 24.86 5.81 percent of total billed charges 23.37 23.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION RX-127568 CDM A9270 HCPCS 0250 RC 50268-0470-13 NDC outpatient 5 ML 17.19 17.19 74 12.72 percent of total billed charges 17.19 93 13.92 percent of total billed charges 17.19 17.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION RX-127568 CDM A9270 HCPCS 0637 RC 50268-0470-13 NDC outpatient 5 ML 17.19 17.19 17.19 74 12.72 percent of total billed charges 17.19 93 13.92 percent of total billed charges 17.19 17.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE" RX-127603 CDM 90621 HCPCS 0636 RC 00005-0100-01 NDC outpatient 0.5 ML 570.41 570.41 570.41 74 422.1 percent of total billed charges 570.41 93 462.03 percent of total billed charges 570.41 570.41 other OPPS APC 570.41 570.41 other OPPS APC 570.41 24.86 141.8 percent of total billed charges 570.41 570.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION RX-127636 CDM J2598 HCPCS 0636 RC 43598-0914-25 NDC outpatient 1 ML 69 69 66.55 66.55 fee schedule 69 93 55.89 percent of total billed charges 69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 32.38 other OPPS APC 69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 32.38 other OPPS APC 69 24.86 17.15 percent of total billed charges 66.55 69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION RX-127665 CDM 250000000 HCPCS 0250 RC 00409-7295-11 NDC outpatient 15 ML 44.37 44.37 44.37 44.37 other OPPS APC 44.37 44.37 other OPPS APC 44.37 24.86 11.03 percent of total billed charges 44.37 44.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION RX-127665 CDM 250000000 HCPCS 0250 RC 63323-0086-05 NDC outpatient 5 ML 44.43 44.43 44.43 74 32.88 percent of total billed charges 44.43 93 35.99 percent of total billed charges 44.43 44.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHOCARBAMOL 100 MG/ML INJECTION SOLUTION RX-127749 CDM J2800 HCPCS 0636 RC 71288-0716-10 NDC outpatient 10 ML 27 27 7.59 7.59 fee schedule 27 93 21.87 percent of total billed charges 27 27 other OPPS APC 27 27 other OPPS APC 27 24.86 6.71 percent of total billed charges 7.59 27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE" RX-127772 CDM J2791 HCPCS 0636 RC 44206-0300-01 NDC outpatient 2 ML 481.15 481.15 83.85 83.85 fee schedule 481.15 93 389.73 percent of total billed charges 481.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 481.15 other OPPS APC 481.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 481.15 other OPPS APC 481.15 24.86 119.61 percent of total billed charges 83.85 481.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTOLOZANE-TAZOBACTAM 1.5 GRAM INTRAVENOUS SOLUTION RX-127841 CDM J0695 HCPCS 0636 RC 67919-0030-01 NDC outpatient 1.5 GR 475.95 475.95 172.06 172.06 fee schedule 475.95 93 385.52 percent of total billed charges 475.95 475.95 other OPPS APC 475.95 475.95 other OPPS APC 475.95 24.86 118.32 percent of total billed charges 172.06 475.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTOLOZANE-TAZOBACTAM 1.5 GRAM INTRAVENOUS SOLUTION RX-127841 CDM J0695 HCPCS 0636 RC 67919-0030-01 NDC outpatient 10 ML 475.95 475.95 172.06 172.06 fee schedule 475.95 93 385.52 percent of total billed charges 475.95 475.95 other OPPS APC 475.95 475.95 other OPPS APC 475.95 24.86 118.32 percent of total billed charges 172.06 475.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION RX-127843 CDM J9299 HCPCS 0636 RC 00003-3772-11 NDC outpatient 4 ML 3817.33 3817.33 1390.53 1390.53 fee schedule 3817.33 93 3092.04 percent of total billed charges 3817.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1270 other OPPS APC 3817.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1270 other OPPS APC 3817.33 24.86 948.99 percent of total billed charges 1390.53 3817.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION RX-127844 CDM J9299 HCPCS 0636 RC 00003-3774-12 NDC outpatient 10 ML 9543.28 9543.28 3476.33 3476.33 fee schedule 9543.28 93 7730.06 percent of total billed charges 9543.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3175 other OPPS APC 9543.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3175 other OPPS APC 9543.28 24.86 2372.46 percent of total billed charges 3476.33 9543.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LISDEXAMFETAMINE 10 MG CAPSULE RX-127928 CDM A9270 HCPCS 0250 RC 42858-0161-01 NDC outpatient 1 UN 27.7 27.7 74 20.5 percent of total billed charges 27.7 93 22.44 percent of total billed charges 27.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.7 other OPPS APC 27.7 27.7 other OPPS APC 27.7 24.86 6.89 percent of total billed charges 27.7 27.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LISDEXAMFETAMINE 10 MG CAPSULE RX-127928 CDM A9270 HCPCS 0637 RC 42858-0161-01 NDC outpatient 1 UN 27.7 27.7 27.7 74 20.5 percent of total billed charges 27.7 93 22.44 percent of total billed charges 27.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.7 other OPPS APC 27.7 27.7 other OPPS APC 27.7 24.86 6.89 percent of total billed charges 27.7 27.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION RX-127964 CDM J9271 HCPCS 0636 RC 00006-3026-02 NDC outpatient 4 ML 17006 17006 6256.91 6256.91 fee schedule 17006 93 13774.9 percent of total billed charges 17006 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5821.6 other OPPS APC 17006 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5821.6 other OPPS APC 17006 24.86 4227.7 percent of total billed charges 6256.91 17006 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PILOCARPINE 5 MG TABLET RX-12803 CDM A9270 HCPCS 0250 RC 00228-2801-11 NDC outpatient 1 UN 3.81 3.81 74 2.82 percent of total billed charges 3.81 93 3.09 percent of total billed charges 3.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.81 other OPPS APC 3.81 3.81 other OPPS APC 3.81 24.86 0.95 percent of total billed charges 3.81 3.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PILOCARPINE 5 MG TABLET RX-12803 CDM A9270 HCPCS 0637 RC 00228-2801-11 NDC outpatient 1 UN 3.81 3.81 3.81 74 2.82 percent of total billed charges 3.81 93 3.09 percent of total billed charges 3.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.81 other OPPS APC 3.81 3.81 other OPPS APC 3.81 24.86 0.95 percent of total billed charges 3.81 3.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH RX-128147 CDM A9270 HCPCS 0250 RC 50742-0505-24 NDC outpatient 1 UN 57.44 57.44 74 42.51 percent of total billed charges 57.44 93 46.53 percent of total billed charges 57.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 57.44 other OPPS APC 57.44 57.44 other OPPS APC 57.44 24.86 14.28 percent of total billed charges 57.44 57.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH RX-128147 CDM A9270 HCPCS 0637 RC 50742-0505-24 NDC outpatient 1 UN 57.44 57.44 57.44 74 42.51 percent of total billed charges 57.44 93 46.53 percent of total billed charges 57.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 57.44 other OPPS APC 57.44 57.44 other OPPS APC 57.44 24.86 14.28 percent of total billed charges 57.44 57.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION RX-128163 CDM J0714 HCPCS 0636 RC 00456-2700-01 NDC outpatient 12 ML 1186.76 1186.76 422.24 422.24 fee schedule 1186.76 93 961.28 percent of total billed charges 1186.76 1186.76 other OPPS APC 1186.76 1186.76 other OPPS APC 1186.76 24.86 295.03 percent of total billed charges 422.24 1186.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION RX-128163 CDM J0714 HCPCS 0636 RC 00456-2700-01 NDC outpatient 2.5 GR 1186.76 1186.76 422.24 422.24 fee schedule 1186.76 93 961.28 percent of total billed charges 1186.76 1186.76 other OPPS APC 1186.76 1186.76 other OPPS APC 1186.76 24.86 295.03 percent of total billed charges 422.24 1186.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION RX-128328 CDM 250000000 HCPCS 0250 RC 00781-3755-95 NDC outpatient 4 ML 56.9 56.9 56.9 74 42.11 percent of total billed charges 56.9 93 46.09 percent of total billed charges 56.9 56.9 other OPPS APC 56.9 56.9 other OPPS APC 56.9 24.86 14.15 percent of total billed charges 56.9 56.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION RX-128452 CDM A9270 HCPCS 0250 RC 68094-0231-61 NDC outpatient 1 UN 2.7 2.7 74 2 percent of total billed charges 2.7 93 2.19 percent of total billed charges 2.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.7 other OPPS APC 2.7 2.7 other OPPS APC 2.7 24.86 0.67 percent of total billed charges 2.7 2.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION RX-128452 CDM A9270 HCPCS 0637 RC 68094-0231-61 NDC outpatient 1 UN 2.7 2.7 2.7 74 2 percent of total billed charges 2.7 93 2.19 percent of total billed charges 2.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.7 other OPPS APC 2.7 2.7 other OPPS APC 2.7 24.86 0.67 percent of total billed charges 2.7 2.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION RX-128467 CDM A9270 HCPCS 0250 RC 00121-1971-00 NDC outpatient 20.3 ML 6.11 6.11 74 4.52 percent of total billed charges 6.11 93 4.95 percent of total billed charges 6.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.11 other OPPS APC 6.11 6.11 other OPPS APC 6.11 24.86 1.52 percent of total billed charges 6.11 6.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION RX-128467 CDM A9270 HCPCS 0637 RC 00121-1971-00 NDC outpatient 20.3 ML 6.11 6.11 6.11 74 4.52 percent of total billed charges 6.11 93 4.95 percent of total billed charges 6.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.11 other OPPS APC 6.11 6.11 other OPPS APC 6.11 24.86 1.52 percent of total billed charges 6.11 6.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE 4 %-MENTHOL 1 % TOPICAL PATCH RX-128493 CDM A9270 HCPCS 0250 RC 10882-0529-30 NDC outpatient 1 UN 11.97 11.97 74 8.86 percent of total billed charges 11.97 93 9.7 percent of total billed charges 11.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.97 other OPPS APC 11.97 11.97 other OPPS APC 11.97 24.86 2.98 percent of total billed charges 11.97 11.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE 4 %-MENTHOL 1 % TOPICAL PATCH RX-128493 CDM A9270 HCPCS 0637 RC 10882-0529-30 NDC outpatient 1 UN 11.97 11.97 11.97 74 8.86 percent of total billed charges 11.97 93 9.7 percent of total billed charges 11.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.97 other OPPS APC 11.97 11.97 other OPPS APC 11.97 24.86 2.98 percent of total billed charges 11.97 11.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION RX-128612 CDM J2919 HCPCS 0636 RC 00009-0039-28 NDC outpatient 1 ML 19.41 19.41 19.41 74 14.36 percent of total billed charges 19.41 93 15.72 percent of total billed charges 19.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.41 other OPPS APC 19.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.41 other OPPS APC 19.41 24.86 4.83 percent of total billed charges 19.41 19.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION RX-128613 CDM J2919 HCPCS 0636 RC 00009-0047-22 NDC outpatient 2 ML 31.26 31.26 31.26 74 23.13 percent of total billed charges 31.26 93 25.32 percent of total billed charges 31.26 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 31.26 other OPPS APC 31.26 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 31.26 other OPPS APC 31.26 24.86 7.77 percent of total billed charges 31.26 31.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID RX-128727 CDM A9270 HCPCS 0250 RC 00573-0513-30 NDC outpatient 236 ML 17.7 17.7 74 13.1 percent of total billed charges 17.7 93 14.34 percent of total billed charges 17.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.7 other OPPS APC 17.7 17.7 other OPPS APC 17.7 24.86 4.4 percent of total billed charges 17.7 17.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID RX-128727 CDM A9270 HCPCS 0637 RC 00573-0513-30 NDC outpatient 236 ML 17.7 17.7 17.7 74 13.1 percent of total billed charges 17.7 93 14.34 percent of total billed charges 17.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.7 other OPPS APC 17.7 17.7 other OPPS APC 17.7 24.86 4.4 percent of total billed charges 17.7 17.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT FOR PREPARATION OF TC-99M-MEDRONATE SODIUM 20 MG IV SOLUTION RX-128729 CDM A9503 HCPCS 0343 RC 45567-0040-01 NDC outpatient 1 UN 61 61 61 74 45.14 percent of total billed charges 61 93 49.41 percent of total billed charges 61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 61 other OPPS APC 61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 61 other OPPS APC 61 24.86 15.16 percent of total billed charges 61 61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT FOR THE PREPARATION OF TC-99M-MEBROFENIN 45 MG IV SOLUTION RX-128734 CDM A9537 HCPCS 0343 RC 45567-0455-01 NDC outpatient 1.0303 UN 100 100 100 74 74 percent of total billed charges 100 93 81 percent of total billed charges 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 24.86 24.86 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PREPARATION OF TC-99M-SODIUM PYROPHOSPHATE 12 MG IV SOLUTION RX-128740 CDM A9538 HCPCS 0343 RC 45567-0060-01 NDC outpatient 1.01818 UN 340 340 340 74 251.6 percent of total billed charges 340 93 275.4 percent of total billed charges 340 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 340 other OPPS APC 340 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 340 other OPPS APC 340 24.86 84.52 percent of total billed charges 340 340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION RX-128761 CDM J1720 HCPCS 0636 RC 00009-0011-03 NDC outpatient 2 ML 64.25 64.25 19.99 19.99 fee schedule 64.25 93 52.04 percent of total billed charges 64.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 64.25 other OPPS APC 64.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 64.25 other OPPS APC 64.25 24.86 15.97 percent of total billed charges 19.99 64.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) IN 0.9 % NACL IV RX-128838 CDM 250000000 HCPCS 0250 RC 81298-9655-03 NDC outpatient 250 ML 114 114 114 74 84.36 percent of total billed charges 114 93 92.34 percent of total billed charges 114 114 other OPPS APC 114 114 other OPPS APC 114 24.86 28.34 percent of total billed charges 114 114 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENYLEPHRINE 40 MG/250 ML (160 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV RX-128845 CDM J2371 HCPCS 0250 RC 70004-0825-40 NDC outpatient 250 ML 111.58 111.58 111.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 111.58 other OPPS APC 111.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 111.58 other OPPS APC 111.58 24.86 27.74 percent of total billed charges 111.58 111.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENYLEPHRINE 40 MG/250 ML (160 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV RX-128845 CDM J2371 HCPCS 0250 RC 90000-0002-05 NDC outpatient 250 ML 39.9 39.9 39.9 74 29.53 percent of total billed charges 39.9 93 32.32 percent of total billed charges 39.9 39.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) IN DEXTROSE 5 % IV RX-128857 CDM 250000000 HCPCS 0250 RC 00338-0108-20 NDC outpatient 250 ML 100.06 100.06 100.06 74 74.04 percent of total billed charges 100.06 93 81.05 percent of total billed charges 100.06 100.06 other OPPS APC 100.06 100.06 other OPPS APC 100.06 24.86 24.87 percent of total billed charges 100.06 100.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET RX-128903 CDM A9270 HCPCS 0250 RC 50268-0851-15 NDC outpatient 1 UN 0.79 0.79 74 0.58 percent of total billed charges 0.79 93 0.64 percent of total billed charges 0.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.79 other OPPS APC 0.79 0.79 other OPPS APC 0.79 24.86 0.2 percent of total billed charges 0.79 0.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET RX-128903 CDM A9270 HCPCS 0637 RC 50268-0851-15 NDC outpatient 1 UN 0.79 0.79 0.79 74 0.58 percent of total billed charges 0.79 93 0.64 percent of total billed charges 0.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.79 other OPPS APC 0.79 0.79 other OPPS APC 0.79 24.86 0.2 percent of total billed charges 0.79 0.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP RX-129033 CDM A9270 HCPCS 0250 RC 60687-0576-86 NDC outpatient 5 ML 18.5 18.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.5 other OPPS APC 18.5 18.5 other OPPS APC 18.5 24.86 4.6 percent of total billed charges 18.5 18.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP RX-129033 CDM A9270 HCPCS 0637 RC 60687-0576-86 NDC outpatient 5 ML 18.5 18.5 18.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.5 other OPPS APC 18.5 18.5 other OPPS APC 18.5 24.86 4.6 percent of total billed charges 18.5 18.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP RX-129033 CDM A9270 HCPCS 0250 RC 68094-0764-62 NDC outpatient 5 ML 18.34 18.34 74 13.57 percent of total billed charges 18.34 93 14.86 percent of total billed charges 18.34 18.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP RX-129033 CDM A9270 HCPCS 0637 RC 68094-0764-62 NDC outpatient 5 ML 18.34 18.34 18.34 74 13.57 percent of total billed charges 18.34 93 14.86 percent of total billed charges 18.34 18.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT FOR PREPARATION OF TC 99M-SODIUM THIOSULFATE 2 MG SOLUTION RX-129043 CDM A9541 HCPCS 0343 RC 45567-0030-01 NDC outpatient 1 UN 120 120 120 74 88.8 percent of total billed charges 120 93 97.2 percent of total billed charges 120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 120 other OPPS APC 120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 120 other OPPS APC 120 24.86 29.83 percent of total billed charges 120 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PREPARATION OF TC 99M-SESTAMIBI COMBO NO.1 IV SOLUTION RX-129046 CDM A9500 HCPCS 0343 RC 45567-0555-02 NDC outpatient 1.0101 UN 852 852 852 74 630.48 percent of total billed charges 852 93 690.12 percent of total billed charges 852 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 852 other OPPS APC 852 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 852 other OPPS APC 852 24.86 211.81 percent of total billed charges 852 852 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TETRACAINE HCL (PF) 0.5 % EYE DROPS RX-129115 CDM A9270 HCPCS 0250 RC 00065-0741-14 NDC outpatient 4 ML 39.66 39.66 74 29.35 percent of total billed charges 39.66 93 32.12 percent of total billed charges 39.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.66 other OPPS APC 39.66 39.66 other OPPS APC 39.66 24.86 9.86 percent of total billed charges 39.66 39.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TETRACAINE HCL (PF) 0.5 % EYE DROPS RX-129115 CDM A9270 HCPCS 0637 RC 00065-0741-14 NDC outpatient 4 ML 39.66 39.66 39.66 74 29.35 percent of total billed charges 39.66 93 32.12 percent of total billed charges 39.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.66 other OPPS APC 39.66 39.66 other OPPS APC 39.66 24.86 9.86 percent of total billed charges 39.66 39.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM PHOSPHATE 15 MMOL/250 ML IN 0.9 % SODIUM CHLORIDE IV SOLN RX-129131 CDM 250000000 HCPCS 0250 RC 70004-0841-40 NDC outpatient 250 ML 84.5 84.5 84.5 84.5 other OPPS APC 84.5 84.5 other OPPS APC 84.5 24.86 21.01 percent of total billed charges 84.5 84.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE" RX-12933 CDM J7507 HCPCS 0636 RC 00904-7097-61 NDC outpatient 1 UN 4.11 4.11 0.33 0.33 fee schedule 4.11 93 3.33 percent of total billed charges 4.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.11 other OPPS APC 4.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.11 other OPPS APC 4.11 24.86 1.02 percent of total billed charges 0.33 4.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEUPROLIDE 7.5 MG INTRAMUSCULAR SYRINGE KIT RX-129337 CDM J9217 HCPCS 0636 RC 00074-3642-03 NDC outpatient 8 ME 6541.13 6541.13 378.66 378.66 fee schedule 6541.13 93 5298.32 percent of total billed charges 6541.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 353.02 other OPPS APC 6541.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 353.02 other OPPS APC 6541.13 24.86 1626.12 percent of total billed charges 378.66 6541.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEUPROLIDE 7.5 MG INTRAMUSCULAR SYRINGE KIT|DISCARDED DRUG NOT ADMINISTERED RX-129337 CDM J9217 HCPCS 0636 RC 00074-3642-03 NDC JW outpatient 8 ME 6541.13 6541.13 189.33 189.33 fee schedule 6541.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176.51 other OPPS APC 6541.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176.51 other OPPS APC 189.33 6541.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE" RX-12934 CDM J7507 HCPCS 0636 RC 64380-0722-06 NDC outpatient 1 UN 55.75 55.75 1.63 1.63 fee schedule 55.75 93 45.16 percent of total billed charges 55.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.75 other OPPS APC 55.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.75 other OPPS APC 55.75 24.86 13.86 percent of total billed charges 1.63 55.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION RX-129471 CDM J1325 HCPCS 0636 RC 66215-0402-01 NDC outpatient 5 ML 141 141 54.78 54.78 fee schedule 141 93 114.21 percent of total billed charges 141 141 other OPPS APC 141 141 other OPPS APC 141 24.86 35.05 percent of total billed charges 54.78 141 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT FOR PREPARATION OF TC 99M-ALBUMIN 2.5 MG INTRAVENOUS SOLUTION RX-129512 CDM A9540 HCPCS 0343 RC 65174-0270-30 NDC outpatient 1 UN 47 47 47 74 34.78 percent of total billed charges 47 93 38.07 percent of total billed charges 47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 47 other OPPS APC 47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 47 other OPPS APC 47 24.86 11.68 percent of total billed charges 47 47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HEPARIN (PORCINE) 5,000 UNIT/500 ML(10 UNIT/ML) IN 0.9 % NACL IV SOLN" RX-129514 CDM J1644 HCPCS 0250 RC 90000-0003-28 NDC outpatient 500 ML 6.65 6.65 6.65 74 4.92 percent of total billed charges 6.65 93 5.39 percent of total billed charges 6.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.65 other OPPS APC 6.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.65 other OPPS APC 6.65 24.86 1.65 percent of total billed charges 6.65 6.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE RX-129705 CDM 250000000 HCPCS 0250 RC 00409-2339-24 NDC outpatient 4 ML 27.25 27.25 27.25 74 20.17 percent of total billed charges 27.25 93 22.07 percent of total billed charges 27.25 27.25 other OPPS APC 27.25 27.25 other OPPS APC 27.25 24.86 6.77 percent of total billed charges 27.25 27.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION RX-129740 CDM A9270 HCPCS 0250 RC 00121-4675-00 NDC outpatient 5 ML 3.75 3.75 74 2.78 percent of total billed charges 3.75 93 3.04 percent of total billed charges 3.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.75 other OPPS APC 3.75 3.75 other OPPS APC 3.75 24.86 0.93 percent of total billed charges 3.75 3.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION RX-129740 CDM A9270 HCPCS 0637 RC 00121-4675-00 NDC outpatient 5 ML 3.75 3.75 3.75 74 2.78 percent of total billed charges 3.75 93 3.04 percent of total billed charges 3.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.75 other OPPS APC 3.75 3.75 other OPPS APC 3.75 24.86 0.93 percent of total billed charges 3.75 3.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION" RX-129852 CDM 250000000 HCPCS 0250 RC 54643-5649-01 NDC outpatient 10 ML 33.08 33.08 33.08 74 24.48 percent of total billed charges 33.08 93 26.79 percent of total billed charges 33.08 33.08 other OPPS APC 33.08 33.08 other OPPS APC 33.08 24.86 8.22 percent of total billed charges 33.08 33.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CALCIUM 500 MG/5 ML (AS CALCIUM CARB 1,250 MG/5 ML) ORAL SUSPENSION" RX-1299 CDM A9270 HCPCS 0250 RC 00121-4766-05 NDC outpatient 5 ML 7.69 7.69 74 5.69 percent of total billed charges 7.69 93 6.23 percent of total billed charges 7.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.69 other OPPS APC 7.69 7.69 other OPPS APC 7.69 24.86 1.91 percent of total billed charges 7.69 7.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CALCIUM 500 MG/5 ML (AS CALCIUM CARB 1,250 MG/5 ML) ORAL SUSPENSION" RX-1299 CDM A9270 HCPCS 0637 RC 00121-4766-05 NDC outpatient 5 ML 7.69 7.69 7.69 74 5.69 percent of total billed charges 7.69 93 6.23 percent of total billed charges 7.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.69 other OPPS APC 7.69 7.69 other OPPS APC 7.69 24.86 1.91 percent of total billed charges 7.69 7.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CALCIUM 500 MG (AS CALCIUM CARBONATE 1,250 MG) TABLET" RX-1300 CDM A9270 HCPCS 0250 RC 00904-1883-61 NDC outpatient 1 UN 0.28 0.28 74 0.21 percent of total billed charges 0.28 93 0.23 percent of total billed charges 0.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.28 other OPPS APC 0.28 0.28 other OPPS APC 0.28 24.86 0.07 percent of total billed charges 0.28 0.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CALCIUM 500 MG (AS CALCIUM CARBONATE 1,250 MG) TABLET" RX-1300 CDM A9270 HCPCS 0637 RC 00904-1883-61 NDC outpatient 1 UN 0.28 0.28 0.28 74 0.21 percent of total billed charges 0.28 93 0.23 percent of total billed charges 0.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.28 other OPPS APC 0.28 0.28 other OPPS APC 0.28 24.86 0.07 percent of total billed charges 0.28 0.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM BICARBONATE 10 MEQ/10 ML (8.4 %) INTRAVENOUS SYRINGE RX-130121 CDM 250000000 HCPCS 0250 RC 00409-4900-14 NDC outpatient 10 ML 77.92 77.92 77.92 74 57.66 percent of total billed charges 77.92 93 63.12 percent of total billed charges 77.92 77.92 other OPPS APC 77.92 77.92 other OPPS APC 77.92 24.86 19.37 percent of total billed charges 77.92 77.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CALCIUM 600 MG (AS CALCIUM CARBONATE 1,500 MG) TABLET" RX-1302 CDM A9270 HCPCS 0250 RC 20555-0005-00 NDC outpatient 1 UN 0.07 0.07 74 0.05 percent of total billed charges 0.07 93 0.06 percent of total billed charges 0.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.07 other OPPS APC 0.07 0.07 other OPPS APC 0.07 24.86 0.02 percent of total billed charges 0.07 0.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CALCIUM 600 MG (AS CALCIUM CARBONATE 1,500 MG) TABLET" RX-1302 CDM A9270 HCPCS 0637 RC 20555-0005-00 NDC outpatient 1 UN 0.07 0.07 0.07 74 0.05 percent of total billed charges 0.07 93 0.06 percent of total billed charges 0.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.07 other OPPS APC 0.07 0.07 other OPPS APC 0.07 24.86 0.02 percent of total billed charges 0.07 0.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPINEPHRINE HCL 4 MG/250 ML (16 MCG/ML) IN 0.9 % SODIUM CHLOR IV SOLN RX-130262 CDM J0171 HCPCS 0636 RC 90000-0002-04 NDC outpatient 250 ML 59.8 59.8 33.4 33.4 fee schedule 59.8 93 48.44 percent of total billed charges 59.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.8 other OPPS APC 59.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.8 other OPPS APC 59.8 24.86 14.87 percent of total billed charges 33.4 59.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE" RX-130353 CDM J2353 HCPCS 0636 RC 00078-0818-81 NDC outpatient 20 ME 13848.9 13848.9 4751.43 4751.43 fee schedule 13848.9 93 11217.6 percent of total billed charges 13848.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4297.68 other OPPS APC 13848.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4297.68 other OPPS APC 13848.9 24.86 3442.84 percent of total billed charges 4751.43 13848.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE" RX-130355 CDM J2353 HCPCS 0636 RC 00078-0825-81 NDC outpatient 30 ME 20737.7 20737.7 7127.14 7127.14 fee schedule 20737.7 93 16797.5 percent of total billed charges 20737.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6446.52 other OPPS APC 20737.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6446.52 other OPPS APC 20737.7 24.86 5155.39 percent of total billed charges 7127.14 20737.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GABAPENTIN 250 MG/5 ML (5 ML) ORAL SOLUTION RX-130378 CDM A9270 HCPCS 0250 RC 42192-0608-45 NDC outpatient 5 ML 18.03 18.03 74 13.34 percent of total billed charges 18.03 93 14.6 percent of total billed charges 18.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.03 other OPPS APC 18.03 18.03 other OPPS APC 18.03 24.86 4.48 percent of total billed charges 18.03 18.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GABAPENTIN 250 MG/5 ML (5 ML) ORAL SOLUTION RX-130378 CDM A9270 HCPCS 0637 RC 42192-0608-45 NDC outpatient 5 ML 18.03 18.03 18.03 74 13.34 percent of total billed charges 18.03 93 14.6 percent of total billed charges 18.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.03 other OPPS APC 18.03 18.03 other OPPS APC 18.03 24.86 4.48 percent of total billed charges 18.03 18.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION RX-130504 CDM J2250 HCPCS 0636 RC 00409-2308-01 NDC outpatient 1 ML 3.49 3.49 0.79 0.79 fee schedule 3.49 93 2.83 percent of total billed charges 3.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.49 other OPPS APC 3.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.49 other OPPS APC 3.49 24.86 0.87 percent of total billed charges 0.79 3.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION RX-130505 CDM J2250 HCPCS 0636 RC 00409-2305-17 NDC outpatient 2 ML 3.22 3.22 0.31 0.31 fee schedule 3.22 93 2.61 percent of total billed charges 3.22 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.22 other OPPS APC 3.22 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.22 other OPPS APC 3.22 24.86 0.8 percent of total billed charges 0.31 3.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMINO ACIDS-PROTEIN HYDROLYSATE 15 GRAM-100 KCAL/30 ML ORAL LIQUID PKT RX-130515 CDM A9270 HCPCS 0250 RC 26974-0410-42 NDC outpatient 1 UN 3.75 3.75 74 2.78 percent of total billed charges 3.75 93 3.04 percent of total billed charges 3.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.75 other OPPS APC 3.75 3.75 other OPPS APC 3.75 24.86 0.93 percent of total billed charges 3.75 3.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMINO ACIDS-PROTEIN HYDROLYSATE 15 GRAM-100 KCAL/30 ML ORAL LIQUID PKT RX-130515 CDM A9270 HCPCS 0637 RC 26974-0410-42 NDC outpatient 1 UN 3.75 3.75 3.75 74 2.78 percent of total billed charges 3.75 93 3.04 percent of total billed charges 3.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.75 other OPPS APC 3.75 3.75 other OPPS APC 3.75 24.86 0.93 percent of total billed charges 3.75 3.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE RX-1306 CDM 250000000 HCPCS 0250 RC 76329-3304-01 NDC outpatient 10 ML 31.5 31.5 31.5 74 23.31 percent of total billed charges 31.5 93 25.52 percent of total billed charges 31.5 31.5 other OPPS APC 31.5 31.5 other OPPS APC 31.5 24.86 7.83 percent of total billed charges 31.5 31.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LIDOCAINE 4 %-EPINEPHRINE BITA 1:1,000-TETRACAINE 0.5 % TOP.SOLN" RX-130671 CDM A9270 HCPCS 0250 RC 90000-0002-93 NDC outpatient 3 ML 2.63 2.63 74 1.95 percent of total billed charges 2.63 93 2.13 percent of total billed charges 2.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.63 other OPPS APC 2.63 2.63 other OPPS APC 2.63 24.86 0.65 percent of total billed charges 2.63 2.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LIDOCAINE 4 %-EPINEPHRINE BITA 1:1,000-TETRACAINE 0.5 % TOP.SOLN" RX-130671 CDM A9270 HCPCS 0637 RC 90000-0002-93 NDC outpatient 3 ML 2.63 2.63 2.63 74 1.95 percent of total billed charges 2.63 93 2.13 percent of total billed charges 2.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.63 other OPPS APC 2.63 2.63 other OPPS APC 2.63 24.86 0.65 percent of total billed charges 2.63 2.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LISINOPRIL 2.5 MG TABLET RX-13089 CDM A9270 HCPCS 0250 RC 60687-0656-11 NDC outpatient 1 UN 1.71 1.71 74 1.27 percent of total billed charges 1.71 93 1.39 percent of total billed charges 1.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.71 other OPPS APC 1.71 1.71 other OPPS APC 1.71 24.86 0.43 percent of total billed charges 1.71 1.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LISINOPRIL 2.5 MG TABLET RX-13089 CDM A9270 HCPCS 0637 RC 60687-0656-11 NDC outpatient 1 UN 1.71 1.71 1.71 74 1.27 percent of total billed charges 1.71 93 1.39 percent of total billed charges 1.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.71 other OPPS APC 1.71 1.71 other OPPS APC 1.71 24.86 0.43 percent of total billed charges 1.71 1.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUDEOXYGLUCOSE F-18 20 MCI TO 300 MCI/ML INTRAVENOUS SOLUTION RX-131197 CDM A9552 HCPCS 0343 RC 65857-0100-30 NDC outpatient 1 UN 563 563 563 74 416.62 percent of total billed charges 563 93 456.03 percent of total billed charges 563 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 563 other OPPS APC 563 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 563 other OPPS APC 563 24.86 139.96 percent of total billed charges 563 563 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION RX-1312 CDM J0612 HCPCS 0250 RC 80830-1672-02 NDC outpatient 10 ML 30 30 30 74 22.2 percent of total billed charges 30 93 24.3 percent of total billed charges 30 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30 other OPPS APC 30 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30 other OPPS APC 30 24.86 7.46 percent of total billed charges 30 30 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALACYCLOVIR 500 MG TABLET RX-13133 CDM A9270 HCPCS 0250 RC 63739-0077-10 NDC outpatient 1 UN 4.09 4.09 74 3.03 percent of total billed charges 4.09 93 3.31 percent of total billed charges 4.09 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.09 other OPPS APC 4.09 4.09 other OPPS APC 4.09 24.86 1.02 percent of total billed charges 4.09 4.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALACYCLOVIR 500 MG TABLET RX-13133 CDM A9270 HCPCS 0637 RC 63739-0077-10 NDC outpatient 1 UN 4.09 4.09 4.09 74 3.03 percent of total billed charges 4.09 93 3.31 percent of total billed charges 4.09 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.09 other OPPS APC 4.09 4.09 other OPPS APC 4.09 24.86 1.02 percent of total billed charges 4.09 4.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE 2 MG/ML INTRAVENOUS SYRINGE RX-131378 CDM J2270 HCPCS 0636 RC 00409-1890-03 NDC outpatient 1 ML 6.39 6.39 5.25 5.25 fee schedule 6.39 93 5.18 percent of total billed charges 6.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.39 other OPPS APC 6.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.39 other OPPS APC 6.39 24.86 1.59 percent of total billed charges 5.25 6.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE 4 MG/ML INTRAVENOUS SYRINGE RX-131379 CDM J2270 HCPCS 0636 RC 00409-1891-01 NDC outpatient 1 ML 5.84 5.84 5.25 5.25 fee schedule 5.84 93 4.73 percent of total billed charges 5.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.84 other OPPS APC 5.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.84 other OPPS APC 5.84 24.86 1.45 percent of total billed charges 5.25 5.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HUM PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION RX-131485 CDM J7168 HCPCS 0636 RC 63833-0386-02 NDC outpatient 1 UN 3925 3925 3925 74 2904.5 percent of total billed charges 3925 93 3179.25 percent of total billed charges 3925 3925 other OPPS APC 3925 3925 other OPPS APC 3925 24.86 975.76 percent of total billed charges 3925 3925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HUM PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION RX-131485 CDM J7168 HCPCS 0636 RC 63833-0386-02 NDC outpatient 20 ML 3925 3925 3925 74 2904.5 percent of total billed charges 3925 93 3179.25 percent of total billed charges 3925 3925 other OPPS APC 3925 3925 other OPPS APC 3925 24.86 975.76 percent of total billed charges 3925 3925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1,240 UNIT) IV SOLUTION" RX-131557 CDM J7168 HCPCS 0636 RC 63833-0387-02 NDC outpatient 1 UN 7850 7850 7850 74 5809 percent of total billed charges 7850 93 6358.5 percent of total billed charges 7850 7850 other OPPS APC 7850 7850 other OPPS APC 7850 24.86 1951.51 percent of total billed charges 7850 7850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1,240 UNIT) IV SOLUTION" RX-131557 CDM J7168 HCPCS 0636 RC 63833-0387-02 NDC outpatient 40 ML 7850 7850 7850 74 5809 percent of total billed charges 7850 93 6358.5 percent of total billed charges 7850 7850 other OPPS APC 7850 7850 other OPPS APC 7850 24.86 1951.51 percent of total billed charges 7850 7850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE" RX-13184 CDM A9270 HCPCS 0250 RC 75834-0320-01 NDC outpatient 1 UN 2.69 2.69 74 1.99 percent of total billed charges 2.69 93 2.18 percent of total billed charges 2.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.69 other OPPS APC 2.69 2.69 other OPPS APC 2.69 24.86 0.67 percent of total billed charges 2.69 2.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE" RX-13184 CDM A9270 HCPCS 0637 RC 75834-0320-01 NDC outpatient 1 UN 2.69 2.69 2.69 74 1.99 percent of total billed charges 2.69 93 2.18 percent of total billed charges 2.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.69 other OPPS APC 2.69 2.69 other OPPS APC 2.69 24.86 0.67 percent of total billed charges 2.69 2.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEGFILGRASTIM 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUTANEOUS INJECTOR RX-131981 CDM J2506 HCPCS 0636 RC 55513-0192-01 NDC outpatient 0.6 ML 19254 19254 1174.09 1174.09 fee schedule 19254 93 15595.7 percent of total billed charges 19254 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 373.73 other OPPS APC 19254 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 373.73 other OPPS APC 19254 24.86 4786.54 percent of total billed charges 1174.09 19254 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION RX-132215 CDM J1611 HCPCS 0636 RC 63323-0593-03 NDC outpatient 1 ML 758.05 758.05 115.76 115.76 fee schedule 758.05 93 614.02 percent of total billed charges 758.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 108.93 other OPPS APC 758.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 108.93 other OPPS APC 758.05 24.86 188.45 percent of total billed charges 115.76 758.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION RX-132215 CDM J1611 HCPCS 0636 RC 63323-0593-03 NDC outpatient 1 UN 758.05 758.05 115.76 115.76 fee schedule 758.05 93 614.02 percent of total billed charges 758.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 108.93 other OPPS APC 758.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 108.93 other OPPS APC 758.05 24.86 188.45 percent of total billed charges 115.76 758.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAPSAICIN 0.025 % TOPICAL CREAM RX-1350 CDM A9270 HCPCS 0250 RC 00536-2525-25 NDC outpatient 60 GR 24.88 24.88 74 18.41 percent of total billed charges 24.88 93 20.15 percent of total billed charges 24.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.88 other OPPS APC 24.88 24.88 other OPPS APC 24.88 24.86 6.19 percent of total billed charges 24.88 24.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAPSAICIN 0.025 % TOPICAL CREAM RX-1350 CDM A9270 HCPCS 0637 RC 00536-2525-25 NDC outpatient 60 GR 24.88 24.88 24.88 74 18.41 percent of total billed charges 24.88 93 20.15 percent of total billed charges 24.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.88 other OPPS APC 24.88 24.88 other OPPS APC 24.88 24.86 6.19 percent of total billed charges 24.88 24.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT RX-13545 CDM A9572 HCPCS 0343 RC 00019-9050-40 NDC outpatient 1.0606 UN 7600 7600 7600 74 5624 percent of total billed charges 7600 93 6156 percent of total billed charges 7600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7600 other OPPS APC 7600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7600 other OPPS APC 7600 24.86 1889.36 percent of total billed charges 7600 7600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBAMAZEPINE 100 MG CHEWABLE TABLET RX-1355 CDM A9270 HCPCS 0250 RC 00904-3854-61 NDC outpatient 1 UN 1.6 1.6 74 1.18 percent of total billed charges 1.6 93 1.3 percent of total billed charges 1.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.6 other OPPS APC 1.6 1.6 other OPPS APC 1.6 24.86 0.4 percent of total billed charges 1.6 1.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBAMAZEPINE 100 MG CHEWABLE TABLET RX-1355 CDM A9270 HCPCS 0637 RC 00904-3854-61 NDC outpatient 1 UN 1.6 1.6 1.6 74 1.18 percent of total billed charges 1.6 93 1.3 percent of total billed charges 1.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.6 other OPPS APC 1.6 1.6 other OPPS APC 1.6 24.86 0.4 percent of total billed charges 1.6 1.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBAMAZEPINE 200 MG TABLET RX-1357 CDM A9270 HCPCS 0250 RC 68084-0444-01 NDC outpatient 1 UN 1.7 1.7 74 1.26 percent of total billed charges 1.7 93 1.38 percent of total billed charges 1.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.7 other OPPS APC 1.7 1.7 other OPPS APC 1.7 24.86 0.42 percent of total billed charges 1.7 1.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBAMAZEPINE 200 MG TABLET RX-1357 CDM A9270 HCPCS 0637 RC 68084-0444-01 NDC outpatient 1 UN 1.7 1.7 1.7 74 1.26 percent of total billed charges 1.7 93 1.38 percent of total billed charges 1.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.7 other OPPS APC 1.7 1.7 other OPPS APC 1.7 24.86 0.42 percent of total billed charges 1.7 1.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUCONAZOLE 150 MG TABLET RX-13577 CDM A9270 HCPCS 0250 RC 57237-0005-11 NDC outpatient 1 UN 34.84 34.84 74 25.78 percent of total billed charges 34.84 93 28.22 percent of total billed charges 34.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.84 other OPPS APC 34.84 34.84 other OPPS APC 34.84 24.86 8.66 percent of total billed charges 34.84 34.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUCONAZOLE 150 MG TABLET RX-13577 CDM A9270 HCPCS 0637 RC 57237-0005-11 NDC outpatient 1 UN 34.84 34.84 34.84 74 25.78 percent of total billed charges 34.84 93 28.22 percent of total billed charges 34.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.84 other OPPS APC 34.84 34.84 other OPPS APC 34.84 24.86 8.66 percent of total billed charges 34.84 34.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBAMIDE PEROXIDE 10 % ORAL RINSE RX-1358 CDM A9270 HCPCS 0250 RC 42037-0104-76 NDC outpatient 60 ML 19.2 19.2 74 14.21 percent of total billed charges 19.2 93 15.55 percent of total billed charges 19.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.2 other OPPS APC 19.2 19.2 other OPPS APC 19.2 24.86 4.77 percent of total billed charges 19.2 19.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBAMIDE PEROXIDE 10 % ORAL RINSE RX-1358 CDM A9270 HCPCS 0637 RC 42037-0104-76 NDC outpatient 60 ML 19.2 19.2 19.2 74 14.21 percent of total billed charges 19.2 93 15.55 percent of total billed charges 19.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.2 other OPPS APC 19.2 19.2 other OPPS APC 19.2 24.86 4.77 percent of total billed charges 19.2 19.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBAMIDE PEROXIDE 6.5 % EAR DROPS RX-1359 CDM A9270 HCPCS 0250 RC 00904-6627-35 NDC outpatient 15 ML 5.68 5.68 74 4.2 percent of total billed charges 5.68 93 4.6 percent of total billed charges 5.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.68 other OPPS APC 5.68 5.68 other OPPS APC 5.68 24.86 1.41 percent of total billed charges 5.68 5.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBAMIDE PEROXIDE 6.5 % EAR DROPS RX-1359 CDM A9270 HCPCS 0637 RC 00904-6627-35 NDC outpatient 15 ML 5.68 5.68 5.68 74 4.2 percent of total billed charges 5.68 93 4.6 percent of total billed charges 5.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.68 other OPPS APC 5.68 5.68 other OPPS APC 5.68 24.86 1.41 percent of total billed charges 5.68 5.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICONAZOLE NITRATE 2 % TOPICAL OINTMENT RX-13651 CDM A9270 HCPCS 0250 RC 53329-0774-14 NDC outpatient 56 GR 11.43 11.43 74 8.46 percent of total billed charges 11.43 93 9.26 percent of total billed charges 11.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.43 other OPPS APC 11.43 11.43 other OPPS APC 11.43 24.86 2.84 percent of total billed charges 11.43 11.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICONAZOLE NITRATE 2 % TOPICAL OINTMENT RX-13651 CDM A9270 HCPCS 0637 RC 53329-0774-14 NDC outpatient 56 GR 11.43 11.43 11.43 74 8.46 percent of total billed charges 11.43 93 9.26 percent of total billed charges 11.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.43 other OPPS APC 11.43 11.43 other OPPS APC 11.43 24.86 2.84 percent of total billed charges 11.43 11.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEUPROLIDE 3.75 MG INTRAMUSCULAR SYRINGE KIT RX-13691 CDM J1950 HCPCS 0636 RC 00074-3641-03 NDC outpatient 3.75 ME 5146.03 5146.03 1761.94 1761.94 fee schedule 5146.03 93 4168.28 percent of total billed charges 5146.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1617.65 other OPPS APC 5146.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1617.65 other OPPS APC 5146.03 24.86 1279.3 percent of total billed charges 1761.94 5146.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARISOPRODOL 350 MG TABLET RX-1395 CDM A9270 HCPCS 0250 RC 69584-0111-10 NDC outpatient 1 UN 1.5 1.5 74 1.11 percent of total billed charges 1.5 93 1.22 percent of total billed charges 1.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.5 other OPPS APC 1.5 1.5 other OPPS APC 1.5 24.86 0.37 percent of total billed charges 1.5 1.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARISOPRODOL 350 MG TABLET RX-1395 CDM A9270 HCPCS 0637 RC 69584-0111-10 NDC outpatient 1 UN 1.5 1.5 1.5 74 1.11 percent of total billed charges 1.5 93 1.22 percent of total billed charges 1.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.5 other OPPS APC 1.5 1.5 other OPPS APC 1.5 24.86 0.37 percent of total billed charges 1.5 1.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAMOTRIGINE 25 MG TABLET RX-13981 CDM A9270 HCPCS 0250 RC 00904-7007-61 NDC outpatient 1 UN 0.51 0.51 74 0.38 percent of total billed charges 0.51 93 0.41 percent of total billed charges 0.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.51 other OPPS APC 0.51 0.51 other OPPS APC 0.51 24.86 0.13 percent of total billed charges 0.51 0.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAMOTRIGINE 25 MG TABLET RX-13981 CDM A9270 HCPCS 0637 RC 00904-7007-61 NDC outpatient 1 UN 0.51 0.51 0.51 74 0.38 percent of total billed charges 0.51 93 0.41 percent of total billed charges 0.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.51 other OPPS APC 0.51 0.51 other OPPS APC 0.51 24.86 0.13 percent of total billed charges 0.51 0.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAMOTRIGINE 100 MG TABLET RX-13982 CDM A9270 HCPCS 0250 RC 68084-0319-11 NDC outpatient 1 UN 0.58 0.58 74 0.43 percent of total billed charges 0.58 93 0.47 percent of total billed charges 0.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.58 other OPPS APC 0.58 0.58 other OPPS APC 0.58 24.86 0.14 percent of total billed charges 0.58 0.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAMOTRIGINE 100 MG TABLET RX-13982 CDM A9270 HCPCS 0637 RC 68084-0319-11 NDC outpatient 1 UN 0.58 0.58 0.58 74 0.43 percent of total billed charges 0.58 93 0.47 percent of total billed charges 0.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.58 other OPPS APC 0.58 0.58 other OPPS APC 0.58 24.86 0.14 percent of total billed charges 0.58 0.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALANCED SALT SOLUTION COMBINATION NO.1 INTRAOCULAR IRRIGATION RX-14123 CDM A9270 HCPCS 0250 RC 00065-0800-50 NDC outpatient 500 ML 231.75 231.75 74 171.5 percent of total billed charges 231.75 93 187.72 percent of total billed charges 231.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 231.75 other OPPS APC 231.75 231.75 other OPPS APC 231.75 24.86 57.61 percent of total billed charges 231.75 231.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALANCED SALT SOLUTION COMBINATION NO.1 INTRAOCULAR IRRIGATION RX-14123 CDM A9270 HCPCS 0637 RC 00065-0800-50 NDC outpatient 500 ML 231.75 231.75 231.75 74 171.5 percent of total billed charges 231.75 93 187.72 percent of total billed charges 231.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 231.75 other OPPS APC 231.75 231.75 other OPPS APC 231.75 24.86 57.61 percent of total billed charges 231.75 231.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KETOCONAZOLE 2 % SHAMPOO RX-14132 CDM A9270 HCPCS 0250 RC 63646-0010-04 NDC outpatient 120 ML 58.95 58.95 74 43.62 percent of total billed charges 58.95 93 47.75 percent of total billed charges 58.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 58.95 other OPPS APC 58.95 58.95 other OPPS APC 58.95 24.86 14.65 percent of total billed charges 58.95 58.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KETOCONAZOLE 2 % SHAMPOO RX-14132 CDM A9270 HCPCS 0637 RC 63646-0010-04 NDC outpatient 120 ML 58.95 58.95 58.95 74 43.62 percent of total billed charges 58.95 93 47.75 percent of total billed charges 58.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 58.95 other OPPS APC 58.95 58.95 other OPPS APC 58.95 24.86 14.65 percent of total billed charges 58.95 58.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION RX-14203 CDM J9390 HCPCS 0636 RC 25021-0204-01 NDC outpatient 1 ML 75 75 9.44 9.44 fee schedule 75 93 60.75 percent of total billed charges 75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 75 other OPPS APC 75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 75 other OPPS APC 75 24.86 18.65 percent of total billed charges 9.44 75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUCONAZOLE 40 MG/ML ORAL SUSPENSION RX-14233 CDM A9270 HCPCS 0250 RC 16714-0696-01 NDC outpatient 35 ML 323.73 323.73 74 239.56 percent of total billed charges 323.73 93 262.22 percent of total billed charges 323.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 323.73 other OPPS APC 323.73 323.73 other OPPS APC 323.73 24.86 80.48 percent of total billed charges 323.73 323.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUCONAZOLE 40 MG/ML ORAL SUSPENSION RX-14233 CDM A9270 HCPCS 0637 RC 16714-0696-01 NDC outpatient 35 ML 323.73 323.73 323.73 74 239.56 percent of total billed charges 323.73 93 262.22 percent of total billed charges 323.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 323.73 other OPPS APC 323.73 323.73 other OPPS APC 323.73 24.86 80.48 percent of total billed charges 323.73 323.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION RX-1445 CDM J0690 HCPCS 0636 RC 00781-3451-70 NDC outpatient 10 ML 18.75 18.75 1.98 1.98 fee schedule 18.75 93 15.19 percent of total billed charges 18.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.75 other OPPS APC 18.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.75 other OPPS APC 18.75 24.86 4.66 percent of total billed charges 1.98 18.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION RX-1445 CDM J0690 HCPCS 0636 RC 00781-3451-70 NDC outpatient 1000 ME 18.75 18.75 1.98 1.98 fee schedule 18.75 93 15.19 percent of total billed charges 18.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.75 other OPPS APC 18.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.75 other OPPS APC 18.75 24.86 4.66 percent of total billed charges 1.98 18.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION RX-1446 CDM J0690 HCPCS 0636 RC 00781-3452-46 NDC outpatient 10000 ME 150 150 19.84 19.84 fee schedule 150 93 121.5 percent of total billed charges 150 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 150 other OPPS APC 150 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 150 other OPPS APC 150 24.86 37.29 percent of total billed charges 19.84 150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION RX-1446 CDM J0690 HCPCS 0636 RC 00781-3452-46 NDC outpatient 50 ML 150 150 19.84 19.84 fee schedule 150 93 121.5 percent of total billed charges 150 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 150 other OPPS APC 150 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 150 other OPPS APC 150 24.86 37.29 percent of total billed charges 19.84 150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DORZOLAMIDE 2 % EYE DROPS RX-14471 CDM A9270 HCPCS 0250 RC 24208-0485-10 NDC outpatient 10 ML 114.73 114.73 74 84.9 percent of total billed charges 114.73 93 92.93 percent of total billed charges 114.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 114.73 other OPPS APC 114.73 114.73 other OPPS APC 114.73 24.86 28.52 percent of total billed charges 114.73 114.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DORZOLAMIDE 2 % EYE DROPS RX-14471 CDM A9270 HCPCS 0637 RC 24208-0485-10 NDC outpatient 10 ML 114.73 114.73 114.73 74 84.9 percent of total billed charges 114.73 93 92.93 percent of total billed charges 114.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 114.73 other OPPS APC 114.73 114.73 other OPPS APC 114.73 24.86 28.52 percent of total billed charges 114.73 114.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFAZOLIN 500 MG SOLUTION FOR INJECTION RX-1448 CDM J0690 HCPCS 0636 RC 44567-0706-25 NDC outpatient 5 ML 4.8 4.8 0.99 0.99 fee schedule 4.8 93 3.89 percent of total billed charges 4.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.8 other OPPS APC 4.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.8 other OPPS APC 4.8 24.86 1.19 percent of total billed charges 0.99 4.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFAZOLIN 500 MG SOLUTION FOR INJECTION RX-1448 CDM J0690 HCPCS 0636 RC 44567-0706-25 NDC outpatient 500 ME 4.8 4.8 0.99 0.99 fee schedule 4.8 93 3.89 percent of total billed charges 4.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.8 other OPPS APC 4.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.8 other OPPS APC 4.8 24.86 1.19 percent of total billed charges 0.99 4.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TERAZOSIN 1 MG CAPSULE RX-14550 CDM A9270 HCPCS 0250 RC 50268-0764-15 NDC outpatient 1 UN 4.02 4.02 74 2.97 percent of total billed charges 4.02 93 3.26 percent of total billed charges 4.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.02 other OPPS APC 4.02 4.02 other OPPS APC 4.02 24.86 1 percent of total billed charges 4.02 4.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TERAZOSIN 1 MG CAPSULE RX-14550 CDM A9270 HCPCS 0637 RC 50268-0764-15 NDC outpatient 1 UN 4.02 4.02 4.02 74 2.97 percent of total billed charges 4.02 93 3.26 percent of total billed charges 4.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.02 other OPPS APC 4.02 4.02 other OPPS APC 4.02 24.86 1 percent of total billed charges 4.02 4.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TERAZOSIN 5 MG CAPSULE RX-14553 CDM A9270 HCPCS 0250 RC 50268-0766-15 NDC outpatient 1 UN 4.02 4.02 74 2.97 percent of total billed charges 4.02 93 3.26 percent of total billed charges 4.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.02 other OPPS APC 4.02 4.02 other OPPS APC 4.02 24.86 1 percent of total billed charges 4.02 4.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TERAZOSIN 5 MG CAPSULE RX-14553 CDM A9270 HCPCS 0637 RC 50268-0766-15 NDC outpatient 1 UN 4.02 4.02 4.02 74 2.97 percent of total billed charges 4.02 93 3.26 percent of total billed charges 4.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.02 other OPPS APC 4.02 4.02 other OPPS APC 4.02 24.86 1 percent of total billed charges 4.02 4.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE" RX-14626 CDM A9270 HCPCS 0250 RC 75834-0158-01 NDC outpatient 1 UN 3.6 3.6 74 2.66 percent of total billed charges 3.6 93 2.92 percent of total billed charges 3.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.6 other OPPS APC 3.6 3.6 other OPPS APC 3.6 24.86 0.89 percent of total billed charges 3.6 3.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE" RX-14626 CDM A9270 HCPCS 0637 RC 75834-0158-01 NDC outpatient 1 UN 3.6 3.6 3.6 74 2.66 percent of total billed charges 3.6 93 2.92 percent of total billed charges 3.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.6 other OPPS APC 3.6 3.6 other OPPS APC 3.6 24.86 0.89 percent of total billed charges 3.6 3.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAMADOL 50 MG TABLET RX-14632 CDM A9270 HCPCS 0250 RC 60687-0795-01 NDC outpatient 1 UN 0.44 0.44 74 0.33 percent of total billed charges 0.44 93 0.36 percent of total billed charges 0.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.44 other OPPS APC 0.44 0.44 other OPPS APC 0.44 24.86 0.11 percent of total billed charges 0.44 0.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAMADOL 50 MG TABLET RX-14632 CDM A9270 HCPCS 0637 RC 60687-0795-01 NDC outpatient 1 UN 0.44 0.44 0.44 74 0.33 percent of total billed charges 0.44 93 0.36 percent of total billed charges 0.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.44 other OPPS APC 0.44 0.44 other OPPS APC 0.44 24.86 0.11 percent of total billed charges 0.44 0.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION RX-1465 CDM J0697 HCPCS 0636 RC 00143-9979-22 NDC outpatient 7.5 ML 8.77 8.77 2.55 2.55 fee schedule 8.77 93 7.1 percent of total billed charges 8.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.77 other OPPS APC 8.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.77 other OPPS APC 8.77 24.86 2.18 percent of total billed charges 2.55 8.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION RX-1465 CDM J0697 HCPCS 0636 RC 00143-9979-22 NDC outpatient 750 ME 8.77 8.77 2.55 2.55 fee schedule 8.77 93 7.1 percent of total billed charges 8.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.77 other OPPS APC 8.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.77 other OPPS APC 8.77 24.86 2.18 percent of total billed charges 2.55 8.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETIC ACID (BULK) 5 % LIQUID RX-14702 CDM 250000000 HCPCS 0250 RC 51552-0055-06 NDC outpatient 500 ML 175.45 175.45 175.45 74 129.83 percent of total billed charges 175.45 93 142.11 percent of total billed charges 175.45 175.45 other OPPS APC 175.45 175.45 other OPPS APC 175.45 24.86 43.62 percent of total billed charges 175.45 175.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METFORMIN 850 MG TABLET RX-14719 CDM A9270 HCPCS 0250 RC 00904-7163-61 NDC outpatient 1 UN 0.63 0.63 74 0.47 percent of total billed charges 0.63 93 0.51 percent of total billed charges 0.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.63 other OPPS APC 0.63 0.63 other OPPS APC 0.63 24.86 0.16 percent of total billed charges 0.63 0.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METFORMIN 850 MG TABLET RX-14719 CDM A9270 HCPCS 0637 RC 00904-7163-61 NDC outpatient 1 UN 0.63 0.63 0.63 74 0.47 percent of total billed charges 0.63 93 0.51 percent of total billed charges 0.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.63 other OPPS APC 0.63 0.63 other OPPS APC 0.63 24.86 0.16 percent of total billed charges 0.63 0.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIZANIDINE 4 MG TABLET RX-14793 CDM A9270 HCPCS 0250 RC 50268-0760-15 NDC outpatient 1 UN 3.79 3.79 74 2.8 percent of total billed charges 3.79 93 3.07 percent of total billed charges 3.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.79 other OPPS APC 3.79 3.79 other OPPS APC 3.79 24.86 0.94 percent of total billed charges 3.79 3.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIZANIDINE 4 MG TABLET RX-14793 CDM A9270 HCPCS 0637 RC 50268-0760-15 NDC outpatient 1 UN 3.79 3.79 3.79 74 2.8 percent of total billed charges 3.79 93 3.07 percent of total billed charges 3.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.79 other OPPS APC 3.79 3.79 other OPPS APC 3.79 24.86 0.94 percent of total billed charges 3.79 3.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOSARTAN 25 MG TABLET RX-14823 CDM A9270 HCPCS 0250 RC 50268-0504-15 NDC outpatient 1 UN 1.5 1.5 74 1.11 percent of total billed charges 1.5 93 1.22 percent of total billed charges 1.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.5 other OPPS APC 1.5 1.5 other OPPS APC 1.5 24.86 0.37 percent of total billed charges 1.5 1.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOSARTAN 25 MG TABLET RX-14823 CDM A9270 HCPCS 0637 RC 50268-0504-15 NDC outpatient 1 UN 1.5 1.5 1.5 74 1.11 percent of total billed charges 1.5 93 1.22 percent of total billed charges 1.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.5 other OPPS APC 1.5 1.5 other OPPS APC 1.5 24.86 0.37 percent of total billed charges 1.5 1.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOSARTAN 50 MG TABLET RX-14824 CDM A9270 HCPCS 0250 RC 50268-0505-11 NDC outpatient 1 UN 1.58 1.58 74 1.17 percent of total billed charges 1.58 93 1.28 percent of total billed charges 1.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.58 other OPPS APC 1.58 1.58 other OPPS APC 1.58 24.86 0.39 percent of total billed charges 1.58 1.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOSARTAN 50 MG TABLET RX-14824 CDM A9270 HCPCS 0637 RC 50268-0505-11 NDC outpatient 1 UN 1.58 1.58 1.58 74 1.17 percent of total billed charges 1.58 93 1.28 percent of total billed charges 1.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.58 other OPPS APC 1.58 1.58 other OPPS APC 1.58 24.86 0.39 percent of total billed charges 1.58 1.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET RX-14825 CDM A9270 HCPCS 0250 RC 70700-0268-94 NDC outpatient 1 UN 251 251 74 185.74 percent of total billed charges 251 93 203.31 percent of total billed charges 251 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 251 other OPPS APC 251 251 other OPPS APC 251 24.86 62.4 percent of total billed charges 251 251 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET RX-14825 CDM A9270 HCPCS 0637 RC 70700-0268-94 NDC outpatient 1 UN 251 251 251 74 185.74 percent of total billed charges 251 93 203.31 percent of total billed charges 251 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 251 other OPPS APC 251 251 other OPPS APC 251 24.86 62.4 percent of total billed charges 251 251 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DOPAMINE 400 MG/250 ML (1,600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN" RX-14845 CDM J1265 HCPCS 0636 RC 00409-7809-22 NDC outpatient 250 ML 41.41 41.41 7.99 7.99 fee schedule 41.41 93 33.54 percent of total billed charges 41.41 41.41 other OPPS APC 41.41 41.41 other OPPS APC 41.41 24.86 10.29 percent of total billed charges 7.99 41.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DOPAMINE 400 MG/250 ML (1,600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN" RX-14845 CDM J1265 HCPCS 0636 RC 00409-7809-22 NDC outpatient 400 ME 41.41 41.41 7.99 7.99 fee schedule 41.41 93 33.54 percent of total billed charges 41.41 41.41 other OPPS APC 41.41 41.41 other OPPS APC 41.41 24.86 10.29 percent of total billed charges 7.99 41.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DOPAMINE 800 MG/250 ML (3,200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN" RX-14846 CDM J1265 HCPCS 0636 RC 00409-7810-22 NDC outpatient 250 ML 61.78 61.78 15.97 15.97 fee schedule 61.78 93 50.04 percent of total billed charges 61.78 61.78 other OPPS APC 61.78 61.78 other OPPS APC 61.78 24.86 15.36 percent of total billed charges 15.97 61.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION RX-14868 CDM J2002 HCPCS 0636 RC 00338-0409-03 NDC outpatient 2000 ME 20.4 20.4 20.4 74 15.1 percent of total billed charges 20.4 93 16.52 percent of total billed charges 20.4 20.4 other OPPS APC 20.4 20.4 other OPPS APC 20.4 24.86 5.07 percent of total billed charges 20.4 20.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION RX-14868 CDM J2002 HCPCS 0636 RC 00338-0409-03 NDC outpatient 500 ML 20.4 20.4 20.4 74 15.1 percent of total billed charges 20.4 93 16.52 percent of total billed charges 20.4 20.4 other OPPS APC 20.4 20.4 other OPPS APC 20.4 24.86 5.07 percent of total billed charges 20.4 20.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION RX-14953 CDM A9270 HCPCS 0250 RC 68462-0421-69 NDC outpatient 5 ML 103.25 103.25 74 76.41 percent of total billed charges 103.25 93 83.63 percent of total billed charges 103.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 103.25 other OPPS APC 103.25 103.25 other OPPS APC 103.25 24.86 25.67 percent of total billed charges 103.25 103.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION RX-14953 CDM A9270 HCPCS 0637 RC 68462-0421-69 NDC outpatient 5 ML 103.25 103.25 103.25 74 76.41 percent of total billed charges 103.25 93 83.63 percent of total billed charges 103.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 103.25 other OPPS APC 103.25 103.25 other OPPS APC 103.25 24.86 25.67 percent of total billed charges 103.25 103.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MYCOPHENOLATE MOFETIL 250 MG CAPSULE RX-15113 CDM J7517 HCPCS 0636 RC 51079-0721-20 NDC outpatient 1 UN 9.91 9.91 0.24 0.24 fee schedule 9.91 93 8.03 percent of total billed charges 9.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.91 other OPPS APC 9.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.91 other OPPS APC 9.91 24.86 2.46 percent of total billed charges 0.24 9.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXRAZOXANE HCL 500 MG INTRAVENOUS SOLUTION RX-15157 CDM J1190 HCPCS 0636 RC 72266-0101-01 NDC outpatient 50 ML 1375.53 1375.53 260.03 260.03 fee schedule 1375.53 93 1114.18 percent of total billed charges 1375.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.99 other OPPS APC 1375.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.99 other OPPS APC 1375.53 24.86 341.96 percent of total billed charges 260.03 1375.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUMATRIPTAN 25 MG TABLET RX-15327 CDM A9270 HCPCS 0250 RC 69452-0344-72 NDC outpatient 1 UN 59.3 59.3 74 43.88 percent of total billed charges 59.3 93 48.03 percent of total billed charges 59.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.3 other OPPS APC 59.3 59.3 other OPPS APC 59.3 24.86 14.74 percent of total billed charges 59.3 59.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUMATRIPTAN 25 MG TABLET RX-15327 CDM A9270 HCPCS 0637 RC 69452-0344-72 NDC outpatient 1 UN 59.3 59.3 59.3 74 43.88 percent of total billed charges 59.3 93 48.03 percent of total billed charges 59.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.3 other OPPS APC 59.3 59.3 other OPPS APC 59.3 24.86 14.74 percent of total billed charges 59.3 59.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION RX-15330 CDM J0153 HCPCS 0636 RC 23155-0258-32 NDC outpatient 30 ML 499.23 499.23 55.54 55.54 fee schedule 499.23 93 404.38 percent of total billed charges 499.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 499.23 other OPPS APC 499.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 499.23 other OPPS APC 499.23 24.86 124.11 percent of total billed charges 55.54 499.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE" RX-15340 CDM A9270 HCPCS 0250 RC 60687-0606-01 NDC outpatient 1 UN 1.59 1.59 74 1.18 percent of total billed charges 1.59 93 1.29 percent of total billed charges 1.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.59 other OPPS APC 1.59 1.59 other OPPS APC 1.59 24.86 0.4 percent of total billed charges 1.59 1.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE" RX-15340 CDM A9270 HCPCS 0637 RC 60687-0606-01 NDC outpatient 1 UN 1.59 1.59 1.59 74 1.18 percent of total billed charges 1.59 93 1.29 percent of total billed charges 1.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.59 other OPPS APC 1.59 1.59 other OPPS APC 1.59 24.86 0.4 percent of total billed charges 1.59 1.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEUCOVORIN CALCIUM 10 MG/ML INJECTION SOLUTION RX-15370 CDM J0640 HCPCS 0636 RC 63323-0631-10 NDC outpatient 10 ML 72.28 72.28 10.72 10.72 fee schedule 72.28 93 58.55 percent of total billed charges 72.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 72.28 other OPPS APC 72.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 72.28 other OPPS APC 72.28 24.86 17.97 percent of total billed charges 10.72 72.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION RX-15426 CDM J0640 HCPCS 0636 RC 70436-0118-80 NDC outpatient 20 ML 72 72 21.44 21.44 fee schedule 72 93 58.32 percent of total billed charges 72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 72 other OPPS APC 72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 72 other OPPS APC 72 24.86 17.9 percent of total billed charges 21.44 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHERRY FLAVOR (BULK) ORAL LIQUID RX-1562 CDM A9270 HCPCS 0250 RC 31722-0938-47 NDC outpatient 473 ML 50.83 50.83 74 37.61 percent of total billed charges 50.83 93 41.17 percent of total billed charges 50.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 50.83 other OPPS APC 50.83 50.83 other OPPS APC 50.83 24.86 12.64 percent of total billed charges 50.83 50.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHERRY FLAVOR (BULK) ORAL LIQUID RX-1562 CDM A9270 HCPCS 0637 RC 31722-0938-47 NDC outpatient 473 ML 50.83 50.83 50.83 74 37.61 percent of total billed charges 50.83 93 41.17 percent of total billed charges 50.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 50.83 other OPPS APC 50.83 50.83 other OPPS APC 50.83 24.86 12.64 percent of total billed charges 50.83 50.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION RX-15706 CDM A9270 HCPCS 0250 RC 00121-1190-30 NDC outpatient 30 ML 13.85 13.85 74 10.25 percent of total billed charges 13.85 93 11.22 percent of total billed charges 13.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.85 other OPPS APC 13.85 13.85 other OPPS APC 13.85 24.86 3.44 percent of total billed charges 13.85 13.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION RX-15706 CDM A9270 HCPCS 0637 RC 00121-1190-30 NDC outpatient 30 ML 13.85 13.85 13.85 74 10.25 percent of total billed charges 13.85 93 11.22 percent of total billed charges 13.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.85 other OPPS APC 13.85 13.85 other OPPS APC 13.85 24.86 3.44 percent of total billed charges 13.85 13.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLUCOSAMINE SULFATE 500 MG CAPSULE RX-15717 CDM A9270 HCPCS 0250 RC 43292-0558-57 NDC outpatient 1 UN 0.18 0.18 74 0.13 percent of total billed charges 0.18 93 0.15 percent of total billed charges 0.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.18 other OPPS APC 0.18 0.18 other OPPS APC 0.18 24.86 0.04 percent of total billed charges 0.18 0.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLUCOSAMINE SULFATE 500 MG CAPSULE RX-15717 CDM A9270 HCPCS 0637 RC 43292-0558-57 NDC outpatient 1 UN 0.18 0.18 0.18 74 0.13 percent of total billed charges 0.18 93 0.15 percent of total billed charges 0.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.18 other OPPS APC 0.18 0.18 other OPPS APC 0.18 24.86 0.04 percent of total billed charges 0.18 0.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY RX-15738 CDM A9270 HCPCS 0250 RC 60505-0823-06 NDC outpatient 3.7 ML 296.35 296.35 74 219.3 percent of total billed charges 296.35 93 240.04 percent of total billed charges 296.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 296.35 other OPPS APC 296.35 296.35 other OPPS APC 296.35 24.86 73.67 percent of total billed charges 296.35 296.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY RX-15738 CDM A9270 HCPCS 0637 RC 60505-0823-06 NDC outpatient 3.7 ML 296.35 296.35 296.35 74 219.3 percent of total billed charges 296.35 93 240.04 percent of total billed charges 296.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 296.35 other OPPS APC 296.35 296.35 other OPPS APC 296.35 24.86 73.67 percent of total billed charges 296.35 296.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BICALUTAMIDE 50 MG TABLET RX-15746 CDM A9270 HCPCS 0250 RC 16729-0023-10 NDC outpatient 1 UN 45.89 45.89 74 33.96 percent of total billed charges 45.89 93 37.17 percent of total billed charges 45.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 45.89 other OPPS APC 45.89 45.89 other OPPS APC 45.89 24.86 11.41 percent of total billed charges 45.89 45.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BICALUTAMIDE 50 MG TABLET RX-15746 CDM A9270 HCPCS 0637 RC 16729-0023-10 NDC outpatient 1 UN 45.89 45.89 45.89 74 33.96 percent of total billed charges 45.89 93 37.17 percent of total billed charges 45.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 45.89 other OPPS APC 45.89 45.89 other OPPS APC 45.89 24.86 11.41 percent of total billed charges 45.89 45.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARVEDILOL 6.25 MG TABLET RX-15747 CDM A9270 HCPCS 0250 RC 68084-0854-01 NDC outpatient 1 UN 4.88 4.88 74 3.61 percent of total billed charges 4.88 93 3.95 percent of total billed charges 4.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.88 other OPPS APC 4.88 4.88 other OPPS APC 4.88 24.86 1.21 percent of total billed charges 4.88 4.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARVEDILOL 6.25 MG TABLET RX-15747 CDM A9270 HCPCS 0637 RC 68084-0854-01 NDC outpatient 1 UN 4.88 4.88 4.88 74 3.61 percent of total billed charges 4.88 93 3.95 percent of total billed charges 4.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.88 other OPPS APC 4.88 4.88 other OPPS APC 4.88 24.86 1.21 percent of total billed charges 4.88 4.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARVEDILOL 25 MG TABLET RX-15748 CDM A9270 HCPCS 0250 RC 00904-7308-61 NDC outpatient 1 UN 2.72 2.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.72 other OPPS APC 2.72 2.72 other OPPS APC 2.72 24.86 0.68 percent of total billed charges 2.72 2.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARVEDILOL 25 MG TABLET RX-15748 CDM A9270 HCPCS 0637 RC 00904-7308-61 NDC outpatient 1 UN 2.72 2.72 2.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.72 other OPPS APC 2.72 2.72 other OPPS APC 2.72 24.86 0.68 percent of total billed charges 2.72 2.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARVEDILOL 25 MG TABLET RX-15748 CDM A9270 HCPCS 0250 RC 72888-0037-01 NDC outpatient 1 UN 5.35 5.35 74 3.96 percent of total billed charges 5.35 93 4.33 percent of total billed charges 5.35 5.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARVEDILOL 25 MG TABLET RX-15748 CDM A9270 HCPCS 0637 RC 72888-0037-01 NDC outpatient 1 UN 5.35 5.35 5.35 74 3.96 percent of total billed charges 5.35 93 4.33 percent of total billed charges 5.35 5.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARVEDILOL 12.5 MG TABLET RX-15749 CDM A9270 HCPCS 0250 RC 00781-5223-01 NDC outpatient 1 UN 5.35 5.35 74 3.96 percent of total billed charges 5.35 93 4.33 percent of total billed charges 5.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.35 other OPPS APC 5.35 5.35 other OPPS APC 5.35 24.86 1.33 percent of total billed charges 5.35 5.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARVEDILOL 12.5 MG TABLET RX-15749 CDM A9270 HCPCS 0637 RC 00781-5223-01 NDC outpatient 1 UN 5.35 5.35 5.35 74 3.96 percent of total billed charges 5.35 93 4.33 percent of total billed charges 5.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.35 other OPPS APC 5.35 5.35 other OPPS APC 5.35 24.86 1.33 percent of total billed charges 5.35 5.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION RX-15796 CDM A9270 HCPCS 0250 RC 70710-1457-01 NDC outpatient 15 ML 87.2 87.2 74 64.53 percent of total billed charges 87.2 93 70.63 percent of total billed charges 87.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 87.2 other OPPS APC 87.2 87.2 other OPPS APC 87.2 24.86 21.68 percent of total billed charges 87.2 87.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION RX-15796 CDM A9270 HCPCS 0637 RC 70710-1457-01 NDC outpatient 15 ML 87.2 87.2 87.2 74 64.53 percent of total billed charges 87.2 93 70.63 percent of total billed charges 87.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 87.2 other OPPS APC 87.2 87.2 other OPPS APC 87.2 24.86 21.68 percent of total billed charges 87.2 87.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION RX-15797 CDM A9270 HCPCS 0250 RC 70710-1460-02 NDC outpatient 30 ML 87.21 87.21 74 64.54 percent of total billed charges 87.21 93 70.64 percent of total billed charges 87.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 87.21 other OPPS APC 87.21 87.21 other OPPS APC 87.21 24.86 21.68 percent of total billed charges 87.21 87.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION RX-15797 CDM A9270 HCPCS 0637 RC 70710-1460-02 NDC outpatient 30 ML 87.21 87.21 87.21 74 64.54 percent of total billed charges 87.21 93 70.64 percent of total billed charges 87.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 87.21 other OPPS APC 87.21 87.21 other OPPS APC 87.21 24.86 21.68 percent of total billed charges 87.21 87.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE (PF) 1 MG/ML INJECTION SOLUTION RX-15852 CDM J2274 HCPCS 0636 RC 00409-3815-12 NDC outpatient 10 ML 27.25 27.25 17.92 17.92 fee schedule 27.25 93 22.07 percent of total billed charges 27.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.25 other OPPS APC 27.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.25 other OPPS APC 27.25 24.86 6.77 percent of total billed charges 17.92 27.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS RX-15859 CDM J2305 HCPCS 0636 RC 00338-1049-02 NDC outpatient 250 ML 67.62 67.62 14.76 14.76 fee schedule 67.62 93 54.77 percent of total billed charges 67.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.08 other OPPS APC 67.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.08 other OPPS APC 67.62 24.86 16.81 percent of total billed charges 14.76 67.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAMIVUDINE 150 MG TABLET RX-15880 CDM A9270 HCPCS 0250 RC 00904-6583-04 NDC outpatient 1 UN 23.1 23.1 74 17.09 percent of total billed charges 23.1 93 18.71 percent of total billed charges 23.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 23.1 other OPPS APC 23.1 23.1 other OPPS APC 23.1 24.86 5.74 percent of total billed charges 23.1 23.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAMIVUDINE 150 MG TABLET RX-15880 CDM A9270 HCPCS 0637 RC 00904-6583-04 NDC outpatient 1 UN 23.1 23.1 23.1 74 17.09 percent of total billed charges 23.1 93 18.71 percent of total billed charges 23.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 23.1 other OPPS APC 23.1 23.1 other OPPS APC 23.1 24.86 5.74 percent of total billed charges 23.1 23.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAMIVUDINE 10 MG/ML ORAL SOLUTION RX-15881 CDM A9270 HCPCS 0250 RC 57237-0274-24 NDC outpatient 240 ML 299.25 299.25 74 221.45 percent of total billed charges 299.25 93 242.39 percent of total billed charges 299.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 299.25 other OPPS APC 299.25 299.25 other OPPS APC 299.25 24.86 74.39 percent of total billed charges 299.25 299.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAMIVUDINE 10 MG/ML ORAL SOLUTION RX-15881 CDM A9270 HCPCS 0637 RC 57237-0274-24 NDC outpatient 240 ML 299.25 299.25 299.25 74 221.45 percent of total billed charges 299.25 93 242.39 percent of total billed charges 299.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 299.25 other OPPS APC 299.25 299.25 other OPPS APC 299.25 24.86 74.39 percent of total billed charges 299.25 299.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACARBOSE 50 MG TABLET RX-15895 CDM A9270 HCPCS 0250 RC 72789-0132-60 NDC outpatient 1 UN 1.09 1.09 74 0.81 percent of total billed charges 1.09 93 0.88 percent of total billed charges 1.09 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.09 other OPPS APC 1.09 1.09 other OPPS APC 1.09 24.86 0.27 percent of total billed charges 1.09 1.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACARBOSE 50 MG TABLET RX-15895 CDM A9270 HCPCS 0637 RC 72789-0132-60 NDC outpatient 1 UN 1.09 1.09 1.09 74 0.81 percent of total billed charges 1.09 93 0.88 percent of total billed charges 1.09 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.09 other OPPS APC 1.09 1.09 other OPPS APC 1.09 24.86 0.27 percent of total billed charges 1.09 1.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACARBOSE 100 MG TABLET RX-15896 CDM A9270 HCPCS 0250 RC 00054-0142-25 NDC outpatient 1 UN 2.94 2.94 74 2.18 percent of total billed charges 2.94 93 2.38 percent of total billed charges 2.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.94 other OPPS APC 2.94 2.94 other OPPS APC 2.94 24.86 0.73 percent of total billed charges 2.94 2.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACARBOSE 100 MG TABLET RX-15896 CDM A9270 HCPCS 0637 RC 00054-0142-25 NDC outpatient 1 UN 2.94 2.94 2.94 74 2.18 percent of total billed charges 2.94 93 2.38 percent of total billed charges 2.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.94 other OPPS APC 2.94 2.94 other OPPS APC 2.94 24.86 0.73 percent of total billed charges 2.94 2.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM HYPOCHLORITE 0.25 % SOLUTION RX-15950 CDM A9270 HCPCS 0250 RC 39328-0063-25 NDC outpatient 473 ML 34.88 34.88 74 25.81 percent of total billed charges 34.88 93 28.25 percent of total billed charges 34.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.88 other OPPS APC 34.88 34.88 other OPPS APC 34.88 24.86 8.67 percent of total billed charges 34.88 34.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM HYPOCHLORITE 0.25 % SOLUTION RX-15950 CDM A9270 HCPCS 0637 RC 39328-0063-25 NDC outpatient 473 ML 34.88 34.88 34.88 74 25.81 percent of total billed charges 34.88 93 28.25 percent of total billed charges 34.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.88 other OPPS APC 34.88 34.88 other OPPS APC 34.88 24.86 8.67 percent of total billed charges 34.88 34.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS RX-15981 CDM J1250 HCPCS 0636 RC 00338-1073-02 NDC outpatient 250 ML 67.35 67.35 10.08 10.08 fee schedule 67.35 93 54.55 percent of total billed charges 67.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 67.35 other OPPS APC 67.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 67.35 other OPPS APC 67.35 24.86 16.74 percent of total billed charges 10.08 67.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE RX-16005 CDM A9270 HCPCS 0250 RC 00555-0808-02 NDC outpatient 1 UN 93.38 93.38 74 69.1 percent of total billed charges 93.38 93 75.64 percent of total billed charges 93.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 93.38 other OPPS APC 93.38 93.38 other OPPS APC 93.38 24.86 23.21 percent of total billed charges 93.38 93.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE RX-16005 CDM A9270 HCPCS 0637 RC 00555-0808-02 NDC outpatient 1 UN 93.38 93.38 93.38 74 69.1 percent of total billed charges 93.38 93 75.64 percent of total billed charges 93.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 93.38 other OPPS APC 93.38 93.38 other OPPS APC 93.38 24.86 23.21 percent of total billed charges 93.38 93.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM CHLORIDE 20 MEQ/L-LACTATED RINGERS-5 % DEXTROSE INTRAVENOUS RX-16014 CDM 250000000 HCPCS 0250 RC 00338-0811-04 NDC outpatient 1000 ML 33.68 33.68 33.68 74 24.92 percent of total billed charges 33.68 93 27.28 percent of total billed charges 33.68 33.68 other OPPS APC 33.68 33.68 other OPPS APC 33.68 24.86 8.37 percent of total billed charges 33.68 33.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DESMOPRESSIN 0.1 MG TABLET RX-16052 CDM A9270 HCPCS 0250 RC 60505-0257-01 NDC outpatient 1 UN 7.56 7.56 74 5.59 percent of total billed charges 7.56 93 6.12 percent of total billed charges 7.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.56 other OPPS APC 7.56 7.56 other OPPS APC 7.56 24.86 1.88 percent of total billed charges 7.56 7.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DESMOPRESSIN 0.1 MG TABLET RX-16052 CDM A9270 HCPCS 0637 RC 60505-0257-01 NDC outpatient 1 UN 7.56 7.56 7.56 74 5.59 percent of total billed charges 7.56 93 6.12 percent of total billed charges 7.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.56 other OPPS APC 7.56 7.56 other OPPS APC 7.56 24.86 1.88 percent of total billed charges 7.56 7.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK RX-16162 CDM J3475 HCPCS 0636 RC 00264-4400-54 NDC outpatient 1 GR 9.06 9.06 2.13 2.13 fee schedule 9.06 93 7.34 percent of total billed charges 9.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.06 other OPPS APC 9.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.06 other OPPS APC 9.06 24.86 2.25 percent of total billed charges 2.13 9.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK RX-16162 CDM J3475 HCPCS 0636 RC 00264-4400-54 NDC outpatient 100 ML 9.06 9.06 2.13 2.13 fee schedule 9.06 93 7.34 percent of total billed charges 9.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.06 other OPPS APC 9.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.06 other OPPS APC 9.06 24.86 2.25 percent of total billed charges 2.13 9.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION RX-16169 CDM 250000000 HCPCS 0250 RC 70069-0151-10 NDC outpatient 20 ML 811.5 811.5 811.5 74 600.51 percent of total billed charges 811.5 93 657.32 percent of total billed charges 811.5 811.5 other OPPS APC 811.5 811.5 other OPPS APC 811.5 24.86 201.74 percent of total billed charges 811.5 811.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANASTROZOLE 1 MG TABLET RX-16205 CDM A9270 HCPCS 0250 RC 50268-0075-11 NDC outpatient 1 UN 5.18 5.18 74 3.83 percent of total billed charges 5.18 93 4.2 percent of total billed charges 5.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.18 other OPPS APC 5.18 5.18 other OPPS APC 5.18 24.86 1.29 percent of total billed charges 5.18 5.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANASTROZOLE 1 MG TABLET RX-16205 CDM A9270 HCPCS 0637 RC 50268-0075-11 NDC outpatient 1 UN 5.18 5.18 5.18 74 3.83 percent of total billed charges 5.18 93 4.2 percent of total billed charges 5.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.18 other OPPS APC 5.18 5.18 other OPPS APC 5.18 24.86 1.29 percent of total billed charges 5.18 5.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANGRELOR 50 MG INTRAVENOUS SOLUTION RX-162144 CDM C9460 HCPCS 0636 RC 10122-0620-01 NDC outpatient 5 ML 2863.3 2863.3 2863.3 74 2118.84 percent of total billed charges 2863.3 93 2319.27 percent of total billed charges 2863.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 941.2 other OPPS APC 2863.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 941.2 other OPPS APC 2863.3 24.86 711.82 percent of total billed charges 2863.3 2863.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANGRELOR 50 MG INTRAVENOUS SOLUTION RX-162144 CDM C9460 HCPCS 0636 RC 10122-0620-01 NDC outpatient 50 ME 2863.3 2863.3 2863.3 74 2118.84 percent of total billed charges 2863.3 93 2319.27 percent of total billed charges 2863.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 941.2 other OPPS APC 2863.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 941.2 other OPPS APC 2863.3 24.86 711.82 percent of total billed charges 2863.3 2863.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCITRIOL 1 MCG/ML ORAL SOLUTION RX-16218 CDM A9270 HCPCS 0250 RC 64980-0447-15 NDC outpatient 15 ML 1190 1190 74 880.6 percent of total billed charges 1190 93 963.9 percent of total billed charges 1190 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1190 other OPPS APC 1190 1190 other OPPS APC 1190 24.86 295.83 percent of total billed charges 1190 1190 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCITRIOL 1 MCG/ML ORAL SOLUTION RX-16218 CDM A9270 HCPCS 0637 RC 64980-0447-15 NDC outpatient 15 ML 1190 1190 1190 74 880.6 percent of total billed charges 1190 93 963.9 percent of total billed charges 1190 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1190 other OPPS APC 1190 1190 other OPPS APC 1190 24.86 295.83 percent of total billed charges 1190 1190 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET RX-162214 CDM A9270 HCPCS 0250 RC 00078-0659-20 NDC outpatient 1 UN 34.41 34.41 74 25.46 percent of total billed charges 34.41 93 27.87 percent of total billed charges 34.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.41 other OPPS APC 34.41 34.41 other OPPS APC 34.41 24.86 8.55 percent of total billed charges 34.41 34.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET RX-162214 CDM A9270 HCPCS 0637 RC 00078-0659-20 NDC outpatient 1 UN 34.41 34.41 34.41 74 25.46 percent of total billed charges 34.41 93 27.87 percent of total billed charges 34.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.41 other OPPS APC 34.41 34.41 other OPPS APC 34.41 24.86 8.55 percent of total billed charges 34.41 34.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET RX-162215 CDM A9270 HCPCS 0250 RC 00078-0777-20 NDC outpatient 1 UN 34.41 34.41 74 25.46 percent of total billed charges 34.41 93 27.87 percent of total billed charges 34.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.41 other OPPS APC 34.41 34.41 other OPPS APC 34.41 24.86 8.55 percent of total billed charges 34.41 34.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET RX-162215 CDM A9270 HCPCS 0637 RC 00078-0777-20 NDC outpatient 1 UN 34.41 34.41 34.41 74 25.46 percent of total billed charges 34.41 93 27.87 percent of total billed charges 34.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.41 other OPPS APC 34.41 34.41 other OPPS APC 34.41 24.86 8.55 percent of total billed charges 34.41 34.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET RX-162216 CDM A9270 HCPCS 0250 RC 00078-0696-20 NDC outpatient 1 UN 34.41 34.41 74 25.46 percent of total billed charges 34.41 93 27.87 percent of total billed charges 34.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.41 other OPPS APC 34.41 34.41 other OPPS APC 34.41 24.86 8.55 percent of total billed charges 34.41 34.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET RX-162216 CDM A9270 HCPCS 0637 RC 00078-0696-20 NDC outpatient 1 UN 34.41 34.41 34.41 74 25.46 percent of total billed charges 34.41 93 27.87 percent of total billed charges 34.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.41 other OPPS APC 34.41 34.41 other OPPS APC 34.41 24.86 8.55 percent of total billed charges 34.41 34.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHLORDIAZEPOXIDE 25 MG CAPSULE RX-1623 CDM A9270 HCPCS 0250 RC 00555-0159-02 NDC outpatient 1 UN 1.08 1.08 74 0.8 percent of total billed charges 1.08 93 0.87 percent of total billed charges 1.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.08 other OPPS APC 1.08 1.08 other OPPS APC 1.08 24.86 0.27 percent of total billed charges 1.08 1.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHLORDIAZEPOXIDE 25 MG CAPSULE RX-1623 CDM A9270 HCPCS 0637 RC 00555-0159-02 NDC outpatient 1 UN 1.08 1.08 1.08 74 0.8 percent of total billed charges 1.08 93 0.87 percent of total billed charges 1.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.08 other OPPS APC 1.08 1.08 other OPPS APC 1.08 24.86 0.27 percent of total billed charges 1.08 1.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHLORDIAZEPOXIDE 5 MG CAPSULE RX-1624 CDM A9270 HCPCS 0250 RC 00555-0158-02 NDC outpatient 1 UN 0.89 0.89 74 0.66 percent of total billed charges 0.89 93 0.72 percent of total billed charges 0.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.89 other OPPS APC 0.89 0.89 other OPPS APC 0.89 24.86 0.22 percent of total billed charges 0.89 0.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHLORDIAZEPOXIDE 5 MG CAPSULE RX-1624 CDM A9270 HCPCS 0637 RC 00555-0158-02 NDC outpatient 1 UN 0.89 0.89 0.89 74 0.66 percent of total billed charges 0.89 93 0.72 percent of total billed charges 0.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.89 other OPPS APC 0.89 0.89 other OPPS APC 0.89 24.86 0.22 percent of total billed charges 0.89 0.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRABECTEDIN 1 MG INTRAVENOUS SOLUTION RX-162437 CDM J9352 HCPCS 0636 RC 59676-0610-01 NDC outpatient 20 ML 10344 10344 10344 74 7654.52 percent of total billed charges 10344 93 8378.6 percent of total billed charges 10344 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3628.24 other OPPS APC 10344 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3628.24 other OPPS APC 10344 24.86 2571.51 percent of total billed charges 10344 10344 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE RX-162447 CDM Q5101 HCPCS 0636 RC 61314-0326-01 NDC outpatient 0.8 ML 1316.95 1316.95 98.74 98.74 fee schedule 1316.95 93 1066.73 percent of total billed charges 1316.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 173.76 other OPPS APC 1316.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 173.76 other OPPS APC 1316.95 24.86 327.39 percent of total billed charges 98.74 1316.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE RX-162448 CDM Q5101 HCPCS 0636 RC 61314-0318-05 NDC outpatient 0.5 ML 823.09 823.09 61.71 61.71 fee schedule 823.09 93 666.7 percent of total billed charges 823.09 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 108.6 other OPPS APC 823.09 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 108.6 other OPPS APC 823.09 24.86 204.62 percent of total billed charges 61.71 823.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GOSERELIN 10.8 MG SUBCUTANEOUS IMPLANT RX-16254 CDM J9202 HCPCS 0636 RC 70720-0951-30 NDC outpatient 10.8 ME 8350.9 8350.9 2101.15 2101.15 fee schedule 8350.9 93 6764.23 percent of total billed charges 8350.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2024.32 other OPPS APC 8350.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2024.32 other OPPS APC 8350.9 24.86 2076.03 percent of total billed charges 2101.15 8350.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TICAGRELOR 60 MG TABLET RX-162565 CDM 250000000 HCPCS 0250 RC 00186-0776-60 NDC outpatient 1 UN 22.57 22.57 22.57 74 16.7 percent of total billed charges 22.57 93 18.28 percent of total billed charges 22.57 22.57 other OPPS APC 22.57 22.57 other OPPS APC 22.57 24.86 5.61 percent of total billed charges 22.57 22.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION RX-162824 CDM J3490 HCPCS 0636 RC 00597-0197-05 NDC outpatient 50 ML 7359.24 7359.24 7359.24 74 5445.84 percent of total billed charges 7359.24 93 5960.98 percent of total billed charges 7359.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7359.24 other OPPS APC 7359.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7359.24 other OPPS APC 7359.24 24.86 1829.51 percent of total billed charges 7359.24 7359.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK RX-162936 CDM J0690 HCPCS 0636 RC 90000-0003-57 NDC outpatient 100 ML 13.1 13.1 3.97 3.97 fee schedule 13.1 93 10.61 percent of total billed charges 13.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.1 other OPPS APC 13.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.1 other OPPS APC 13.1 24.86 3.26 percent of total billed charges 3.97 13.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK RX-162936 CDM J0690 HCPCS 0636 RC 90000-0003-57 NDC outpatient 2 GR 13.1 13.1 3.97 3.97 fee schedule 13.1 93 10.61 percent of total billed charges 13.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.1 other OPPS APC 13.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.1 other OPPS APC 13.1 24.86 3.26 percent of total billed charges 3.97 13.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPOUNDING VEHICLE SUSPENSION SUGAR-FREE NO.20 ORAL RX-162944 CDM A9270 HCPCS 0250 RC 00574-0303-16 NDC outpatient 473 ML 55.33 55.33 74 40.94 percent of total billed charges 55.33 93 44.82 percent of total billed charges 55.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.33 other OPPS APC 55.33 55.33 other OPPS APC 55.33 24.86 13.76 percent of total billed charges 55.33 55.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPOUNDING VEHICLE SUSPENSION SUGAR-FREE NO.20 ORAL RX-162944 CDM A9270 HCPCS 0637 RC 00574-0303-16 NDC outpatient 473 ML 55.33 55.33 55.33 74 40.94 percent of total billed charges 55.33 93 44.82 percent of total billed charges 55.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.33 other OPPS APC 55.33 55.33 other OPPS APC 55.33 24.86 13.76 percent of total billed charges 55.33 55.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM RX-16299 CDM A9270 HCPCS 0250 RC 00904-5354-31 NDC outpatient 28 GR 10.88 10.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.88 other OPPS APC 10.88 10.88 other OPPS APC 10.88 24.86 2.7 percent of total billed charges 10.88 10.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM RX-16299 CDM A9270 HCPCS 0637 RC 00904-5354-31 NDC outpatient 28 GR 10.88 10.88 10.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.88 other OPPS APC 10.88 10.88 other OPPS APC 10.88 24.86 2.7 percent of total billed charges 10.88 10.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM RX-16299 CDM A9270 HCPCS 0250 RC 45802-0358-03 NDC outpatient 28 GR 9.98 9.98 74 7.39 percent of total billed charges 9.98 93 8.08 percent of total billed charges 9.98 9.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM RX-16299 CDM A9270 HCPCS 0637 RC 45802-0358-03 NDC outpatient 28 GR 9.98 9.98 9.98 74 7.39 percent of total billed charges 9.98 93 8.08 percent of total billed charges 9.98 9.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE 4 MG/ML INTRAVENOUS SOLUTION RX-163028 CDM J2270 HCPCS 0636 RC 00641-6125-25 NDC outpatient 1 ML 7.5 7.5 5.25 5.25 fee schedule 7.5 93 6.08 percent of total billed charges 7.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.5 other OPPS APC 7.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.5 other OPPS APC 7.5 24.86 1.86 percent of total billed charges 5.25 7.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MULTIVITAMIN-MINERALS-IRON FUMARATE 7.5 MG-FOLIC ACID 400 MCG TABLET RX-163038 CDM A9270 HCPCS 0250 RC 79854-0400-50 NDC outpatient 1 UN 0.15 0.15 74 0.11 percent of total billed charges 0.15 93 0.12 percent of total billed charges 0.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.15 other OPPS APC 0.15 0.15 other OPPS APC 0.15 24.86 0.04 percent of total billed charges 0.15 0.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MULTIVITAMIN-MINERALS-IRON FUMARATE 7.5 MG-FOLIC ACID 400 MCG TABLET RX-163038 CDM A9270 HCPCS 0637 RC 79854-0400-50 NDC outpatient 1 UN 0.15 0.15 0.15 74 0.11 percent of total billed charges 0.15 93 0.12 percent of total billed charges 0.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.15 other OPPS APC 0.15 0.15 other OPPS APC 0.15 24.86 0.04 percent of total billed charges 0.15 0.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIDAZOLAM (PF) 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION RX-163121 CDM J2251 HCPCS 0636 RC 00143-9380-10 NDC outpatient 100 ML 89.97 89.97 32.67 32.67 fee schedule 89.97 93 72.88 percent of total billed charges 32.67 89.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIDAZOLAM (PF) 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION RX-163121 CDM J2251 HCPCS 0636 RC 44567-0611-10 NDC outpatient 100 ML 89.97 89.97 89.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 89.97 other OPPS APC 89.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 89.97 other OPPS APC 89.97 24.86 22.37 percent of total billed charges 89.97 89.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS RX-163155 CDM J9205 HCPCS 0636 RC 15054-0043-01 NDC outpatient 10 ML 8505 8505 3041.67 3041.67 fee schedule 8505 93 6889.05 percent of total billed charges 8505 8505 other OPPS APC 8505 8505 other OPPS APC 8505 24.86 2114.34 percent of total billed charges 3041.67 8505 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION RX-163299 CDM J9145 HCPCS 0636 RC 57894-0502-05 NDC outpatient 5 ML 2007 2007 705.31 705.31 fee schedule 2007 93 1625.67 percent of total billed charges 2007 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 651.17 other OPPS APC 2007 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 651.17 other OPPS APC 2007 24.86 498.94 percent of total billed charges 705.31 2007 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION RX-163299 CDM J9145 HCPCS 0636 RC 57894-0502-20 NDC outpatient 20 ML 8027.98 8027.98 2821.24 2821.24 fee schedule 8027.98 93 6502.66 percent of total billed charges 8027.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2604.68 other OPPS APC 8027.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2604.68 other OPPS APC 8027.98 24.86 1995.76 percent of total billed charges 2821.24 8027.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHLOROPROCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION RX-1634 CDM J2401 HCPCS 0636 RC 63323-0477-27 NDC outpatient 20 ML 63.93 63.93 19.36 19.36 fee schedule 63.93 93 51.78 percent of total billed charges 63.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.2 other OPPS APC 63.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.2 other OPPS APC 63.93 24.86 15.89 percent of total billed charges 19.36 63.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIMEPIRIDE 1 MG TABLET RX-16355 CDM A9270 HCPCS 0250 RC 50268-0358-15 NDC outpatient 1 UN 2.52 2.52 74 1.86 percent of total billed charges 2.52 93 2.04 percent of total billed charges 2.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.52 other OPPS APC 2.52 2.52 other OPPS APC 2.52 24.86 0.63 percent of total billed charges 2.52 2.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIMEPIRIDE 1 MG TABLET RX-16355 CDM A9270 HCPCS 0637 RC 50268-0358-15 NDC outpatient 1 UN 2.52 2.52 2.52 74 1.86 percent of total billed charges 2.52 93 2.04 percent of total billed charges 2.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.52 other OPPS APC 2.52 2.52 other OPPS APC 2.52 24.86 0.63 percent of total billed charges 2.52 2.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFEPIME 1 GRAM SOLUTION FOR INJECTION RX-16369 CDM J0692 HCPCS 0636 RC 44567-0240-10 NDC outpatient 1 GR 17.1 17.1 2.81 2.81 fee schedule 17.1 93 13.85 percent of total billed charges 17.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.1 other OPPS APC 17.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.1 other OPPS APC 17.1 24.86 4.25 percent of total billed charges 2.81 17.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFEPIME 1 GRAM SOLUTION FOR INJECTION RX-16369 CDM J0692 HCPCS 0636 RC 44567-0240-10 NDC outpatient 10 ML 17.1 17.1 2.81 2.81 fee schedule 17.1 93 13.85 percent of total billed charges 17.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.1 other OPPS APC 17.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.1 other OPPS APC 17.1 24.86 4.25 percent of total billed charges 2.81 17.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFEPIME 2 GRAM SOLUTION FOR INJECTION RX-16371 CDM J0692 HCPCS 0636 RC 00409-9735-10 NDC outpatient 10 ML 30.15 30.15 5.61 5.61 fee schedule 30.15 93 24.42 percent of total billed charges 30.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.15 other OPPS APC 30.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.15 other OPPS APC 30.15 24.86 7.5 percent of total billed charges 5.61 30.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFEPIME 2 GRAM SOLUTION FOR INJECTION RX-16371 CDM J0692 HCPCS 0636 RC 00409-9735-10 NDC outpatient 2 GR 30.15 30.15 5.61 5.61 fee schedule 30.15 93 24.42 percent of total billed charges 30.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.15 other OPPS APC 30.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.15 other OPPS APC 30.15 24.86 7.5 percent of total billed charges 5.61 30.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION RX-1649 CDM J3230 HCPCS 0636 RC 55150-0319-25 NDC outpatient 2 ML 99.3 99.3 41.04 41.04 fee schedule 99.3 93 80.43 percent of total billed charges 99.3 99.3 other OPPS APC 99.3 99.3 other OPPS APC 99.3 24.86 24.69 percent of total billed charges 41.04 99.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHLORPROMAZINE 25 MG TABLET RX-1656 CDM Q0161 HCPCS 0250 RC 00904-7130-61 NDC outpatient 1 UN 15.63 15.63 74 11.57 percent of total billed charges 15.63 93 12.66 percent of total billed charges 15.63 15.63 other OPPS APC 15.63 15.63 other OPPS APC 15.63 24.86 3.89 percent of total billed charges 15.63 15.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHLORPROMAZINE 25 MG TABLET RX-1656 CDM Q0161 HCPCS 0637 RC 00904-7130-61 NDC outpatient 1 UN 15.63 15.63 15.63 74 11.57 percent of total billed charges 15.63 93 12.66 percent of total billed charges 15.63 15.63 other OPPS APC 15.63 15.63 other OPPS APC 15.63 24.86 3.89 percent of total billed charges 15.63 15.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHLORTHALIDONE 25 MG TABLET RX-1661 CDM A9270 HCPCS 0250 RC 50268-0167-11 NDC outpatient 1 UN 5.74 5.74 74 4.25 percent of total billed charges 5.74 93 4.65 percent of total billed charges 5.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.74 other OPPS APC 5.74 5.74 other OPPS APC 5.74 24.86 1.43 percent of total billed charges 5.74 5.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHLORTHALIDONE 25 MG TABLET RX-1661 CDM A9270 HCPCS 0637 RC 50268-0167-11 NDC outpatient 1 UN 5.74 5.74 5.74 74 4.25 percent of total billed charges 5.74 93 4.65 percent of total billed charges 5.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.74 other OPPS APC 5.74 5.74 other OPPS APC 5.74 24.86 1.43 percent of total billed charges 5.74 5.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "THROMBIN (HUM PLAS)-FIBRINOGEN-CA 800-1,200 UNIT/ML(2 ML X 2) TOP SOLN" RX-166125 CDM 250000000 HCPCS 0250 RC 63713-0390-22 NDC outpatient 4 ML 840.85 840.85 840.85 74 622.23 percent of total billed charges 840.85 93 681.09 percent of total billed charges 840.85 840.85 other OPPS APC 840.85 840.85 other OPPS APC 840.85 24.86 209.04 percent of total billed charges 840.85 840.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION RX-166150 CDM 250000000 HCPCS 0250 RC 00006-5423-02 NDC outpatient 2 ML 388.98 388.98 388.98 74 287.85 percent of total billed charges 388.98 93 315.07 percent of total billed charges 388.98 388.98 other OPPS APC 388.98 388.98 other OPPS APC 388.98 24.86 96.7 percent of total billed charges 388.98 388.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION RX-166150 CDM 250000000 HCPCS 0250 RC 00006-5425-05 NDC outpatient 5 ML 712.5 712.5 712.5 74 527.25 percent of total billed charges 712.5 93 577.13 percent of total billed charges 712.5 712.5 other OPPS APC 712.5 712.5 other OPPS APC 712.5 24.86 177.13 percent of total billed charges 712.5 712.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRENATAL VITS NO.130-FERROUS FUM 27 MG IRON-FOLIC ACID 800 MCG TABLET RX-166177 CDM A9270 HCPCS 0250 RC 77333-0715-10 NDC outpatient 1 UN 0.52 0.52 74 0.38 percent of total billed charges 0.52 93 0.42 percent of total billed charges 0.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.52 other OPPS APC 0.52 0.52 other OPPS APC 0.52 24.86 0.13 percent of total billed charges 0.52 0.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRENATAL VITS NO.130-FERROUS FUM 27 MG IRON-FOLIC ACID 800 MCG TABLET RX-166177 CDM A9270 HCPCS 0637 RC 77333-0715-10 NDC outpatient 1 UN 0.52 0.52 0.52 74 0.38 percent of total billed charges 0.52 93 0.42 percent of total billed charges 0.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.52 other OPPS APC 0.52 0.52 other OPPS APC 0.52 24.86 0.13 percent of total billed charges 0.52 0.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELOTUZUMAB 300 MG INTRAVENOUS SOLUTION RX-166210 CDM J9176 HCPCS 0636 RC 00003-2291-11 NDC outpatient 12 ML 6693.13 6693.13 2461.14 2461.14 fee schedule 6693.13 93 5421.44 percent of total billed charges 6693.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2273.4 other OPPS APC 6693.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2273.4 other OPPS APC 6693.13 24.86 1663.91 percent of total billed charges 2461.14 6693.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELOTUZUMAB 400 MG INTRAVENOUS SOLUTION RX-166211 CDM J9176 HCPCS 0636 RC 00003-4522-11 NDC outpatient 16 ML 8924.08 8924.08 3281.52 3281.52 fee schedule 8924.08 93 7228.5 percent of total billed charges 8924.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3031.2 other OPPS APC 8924.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3031.2 other OPPS APC 8924.08 24.86 2218.53 percent of total billed charges 3281.52 8924.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENDAMUSTINE 25 MG/ML INTRAVENOUS SOLUTION RX-166249 CDM J9059 HCPCS 0636 RC 10019-0079-01 NDC outpatient 4 ML 7020 7020 2734.6 2734.6 fee schedule 7020 93 5686.2 percent of total billed charges 7020 7020 other OPPS APC 7020 7020 other OPPS APC 7020 24.86 1745.17 percent of total billed charges 2734.6 7020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAROXETINE 10 MG TABLET RX-16632 CDM A9270 HCPCS 0250 RC 50268-0640-15 NDC outpatient 1 UN 1.92 1.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.92 other OPPS APC 1.92 1.92 other OPPS APC 1.92 24.86 0.48 percent of total billed charges 1.92 1.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAROXETINE 10 MG TABLET RX-16632 CDM A9270 HCPCS 0637 RC 50268-0640-15 NDC outpatient 1 UN 1.92 1.92 1.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.92 other OPPS APC 1.92 1.92 other OPPS APC 1.92 24.86 0.48 percent of total billed charges 1.92 1.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAROXETINE 10 MG TABLET RX-16632 CDM A9270 HCPCS 0250 RC 63739-0888-10 NDC outpatient 1 UN 1.82 1.82 74 1.35 percent of total billed charges 1.82 93 1.47 percent of total billed charges 1.82 1.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAROXETINE 10 MG TABLET RX-16632 CDM A9270 HCPCS 0637 RC 63739-0888-10 NDC outpatient 1 UN 1.82 1.82 1.82 74 1.35 percent of total billed charges 1.82 93 1.47 percent of total billed charges 1.82 1.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN RX-166444 CDM J1815 HCPCS 0250 RC 00002-8824-01 NDC outpatient 3 ML 861.3 861.3 74 637.36 percent of total billed charges 861.3 93 697.65 percent of total billed charges 861.3 861.3 other OPPS APC 861.3 861.3 other OPPS APC 861.3 24.86 214.12 percent of total billed charges 861.3 861.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN RX-166444 CDM J1815 HCPCS 0637 RC 00002-8824-01 NDC outpatient 3 ML 861.3 861.3 861.3 74 637.36 percent of total billed charges 861.3 93 697.65 percent of total billed charges 861.3 861.3 other OPPS APC 861.3 861.3 other OPPS APC 861.3 24.86 214.12 percent of total billed charges 861.3 861.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION RX-167136 CDM 250000000 HCPCS 0250 RC 00781-3269-95 NDC outpatient 1 ML 147.79 147.79 147.79 74 109.36 percent of total billed charges 147.79 93 119.71 percent of total billed charges 147.79 147.79 other OPPS APC 147.79 147.79 other OPPS APC 147.79 24.86 36.74 percent of total billed charges 147.79 147.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION" RX-167147 CDM J9022 HCPCS 0636 RC 50242-0917-01 NDC outpatient 20 ML 32772.3 32772.3 11325.6 11325.6 fee schedule 32772.3 93 26545.5 percent of total billed charges 32772.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10349 other OPPS APC 32772.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10349 other OPPS APC 32772.3 24.86 8147.19 percent of total billed charges 11325.6 32772.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARFILZOMIB 30 MG INTRAVENOUS SOLUTION RX-168718 CDM J9047 HCPCS 0636 RC 76075-0102-01 NDC outpatient 15 ML 4912.78 4912.78 1610.99 1610.99 fee schedule 4912.78 93 3979.35 percent of total billed charges 4912.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1487.31 other OPPS APC 4912.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1487.31 other OPPS APC 4912.78 24.86 1221.32 percent of total billed charges 1610.99 4912.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM POLYSTYRENE SULFONATE 15 GRAM-SORBITOL 20 GRAM/60 ML ORAL SUSP RX-169319 CDM A9270 HCPCS 0250 RC 46287-0006-01 NDC outpatient 473 ML 656.25 656.25 74 485.63 percent of total billed charges 656.25 93 531.56 percent of total billed charges 656.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 656.25 other OPPS APC 656.25 656.25 other OPPS APC 656.25 24.86 163.14 percent of total billed charges 656.25 656.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM POLYSTYRENE SULFONATE 15 GRAM-SORBITOL 20 GRAM/60 ML ORAL SUSP RX-169319 CDM A9270 HCPCS 0637 RC 46287-0006-01 NDC outpatient 473 ML 656.25 656.25 656.25 74 485.63 percent of total billed charges 656.25 93 531.56 percent of total billed charges 656.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 656.25 other OPPS APC 656.25 656.25 other OPPS APC 656.25 24.86 163.14 percent of total billed charges 656.25 656.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM POLYSTYRENE SULFONATE 15 GRAM-SORBITOL 20 GRAM/60 ML ORAL SUSP RX-169319 CDM A9270 HCPCS 0250 RC 46287-0006-60 NDC outpatient 60 ML 77.51 77.51 74 57.36 percent of total billed charges 77.51 93 62.78 percent of total billed charges 77.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 77.51 other OPPS APC 77.51 77.51 other OPPS APC 77.51 24.86 19.27 percent of total billed charges 77.51 77.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM POLYSTYRENE SULFONATE 15 GRAM-SORBITOL 20 GRAM/60 ML ORAL SUSP RX-169319 CDM A9270 HCPCS 0637 RC 46287-0006-60 NDC outpatient 60 ML 77.51 77.51 77.51 74 57.36 percent of total billed charges 77.51 93 62.78 percent of total billed charges 77.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 77.51 other OPPS APC 77.51 77.51 other OPPS APC 77.51 24.86 19.27 percent of total billed charges 77.51 77.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION RX-17012 CDM J9040 HCPCS 0636 RC 00143-9241-01 NDC outpatient 10 ML 318.3 318.3 56 56 fee schedule 318.3 93 257.82 percent of total billed charges 318.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 318.3 other OPPS APC 318.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 318.3 other OPPS APC 318.3 24.86 79.13 percent of total billed charges 56 318.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET RX-17023 CDM A9270 HCPCS 0250 RC 42192-0339-01 NDC outpatient 1 UN 2.13 2.13 74 1.58 percent of total billed charges 2.13 93 1.73 percent of total billed charges 2.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.13 other OPPS APC 2.13 2.13 other OPPS APC 2.13 24.86 0.53 percent of total billed charges 2.13 2.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET RX-17023 CDM A9270 HCPCS 0637 RC 42192-0339-01 NDC outpatient 1 UN 2.13 2.13 2.13 74 1.58 percent of total billed charges 2.13 93 1.73 percent of total billed charges 2.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.13 other OPPS APC 2.13 2.13 other OPPS APC 2.13 24.86 0.53 percent of total billed charges 2.13 2.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION RX-17122 CDM 636000000 HCPCS 0636 RC 71288-0114-50 NDC outpatient 26.3 ML 137.8 137.8 137.8 137.8 other OPPS APC 137.8 137.8 other OPPS APC 137.8 24.86 34.26 percent of total billed charges 137.8 137.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION RX-173535 CDM 250000000 HCPCS 0250 RC 70710-1838-05 NDC outpatient 10 ML 703.17 703.17 703.17 74 520.35 percent of total billed charges 703.17 93 569.57 percent of total billed charges 703.17 703.17 other OPPS APC 703.17 703.17 other OPPS APC 703.17 24.86 174.81 percent of total billed charges 703.17 703.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. USTEKINUMAB 130 MG/26 ML INTRAVENOUS SOLUTION RX-173660 CDM J3358 HCPCS 0636 RC 57894-0054-27 NDC outpatient 26 ML 6073.53 6073.53 1868.72 1868.72 fee schedule 6073.53 93 4919.56 percent of total billed charges 6073.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1685.71 other OPPS APC 6073.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1685.71 other OPPS APC 6073.53 24.86 1509.88 percent of total billed charges 1868.72 6073.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLINDAMYCIN HCL 150 MG CAPSULE RX-1740 CDM A9270 HCPCS 0250 RC 00904-5959-61 NDC outpatient 1 UN 1.83 1.83 74 1.35 percent of total billed charges 1.83 93 1.48 percent of total billed charges 1.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.83 other OPPS APC 1.83 1.83 other OPPS APC 1.83 24.86 0.45 percent of total billed charges 1.83 1.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLINDAMYCIN HCL 150 MG CAPSULE RX-1740 CDM A9270 HCPCS 0637 RC 00904-5959-61 NDC outpatient 1 UN 1.83 1.83 1.83 74 1.35 percent of total billed charges 1.83 93 1.48 percent of total billed charges 1.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.83 other OPPS APC 1.83 1.83 other OPPS APC 1.83 24.86 0.45 percent of total billed charges 1.83 1.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION RX-17405 CDM A9270 HCPCS 0250 RC 00002-7510-01 NDC outpatient 10 ML 199.2 199.2 74 147.41 percent of total billed charges 199.2 93 161.35 percent of total billed charges 199.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 199.2 other OPPS APC 199.2 199.2 other OPPS APC 199.2 24.86 49.52 percent of total billed charges 199.2 199.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION RX-17405 CDM A9270 HCPCS 0637 RC 00002-7510-01 NDC outpatient 10 ML 199.2 199.2 199.2 74 147.41 percent of total billed charges 199.2 93 161.35 percent of total billed charges 199.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 199.2 other OPPS APC 199.2 199.2 other OPPS APC 199.2 24.86 49.52 percent of total billed charges 199.2 199.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIRTAZAPINE 15 MG TABLET RX-17466 CDM A9270 HCPCS 0250 RC 63739-0098-10 NDC outpatient 1 UN 0.4 0.4 74 0.3 percent of total billed charges 0.4 93 0.32 percent of total billed charges 0.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.4 other OPPS APC 0.4 0.4 other OPPS APC 0.4 24.86 0.1 percent of total billed charges 0.4 0.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIRTAZAPINE 15 MG TABLET RX-17466 CDM A9270 HCPCS 0637 RC 63739-0098-10 NDC outpatient 1 UN 0.4 0.4 0.4 74 0.3 percent of total billed charges 0.4 93 0.32 percent of total billed charges 0.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.4 other OPPS APC 0.4 0.4 other OPPS APC 0.4 24.86 0.1 percent of total billed charges 0.4 0.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMORPHONE (PF) 0.5 MG/0.5 ML INJECTION SYRINGE RX-174764 CDM J1170 HCPCS 0636 RC 76045-0009-96 NDC outpatient 0.5 ML 12.45 12.45 4.96 4.96 fee schedule 12.45 93 10.08 percent of total billed charges 12.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.45 other OPPS APC 12.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.45 other OPPS APC 12.45 24.86 3.1 percent of total billed charges 4.96 12.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMORPHONE (PF) 0.5 MG/0.5 ML INJECTION SYRINGE RX-174764 CDM J1171 HCPCS 0636 RC 76045-0009-96 NDC outpatient 0.5 ML 12.45 12.45 4.96 4.96 fee schedule 12.45 93 10.08 percent of total billed charges 12.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.45 other OPPS APC 12.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.45 other OPPS APC 12.45 24.86 3.1 percent of total billed charges 4.96 12.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AVELUMAB 20 MG/ML INTRAVENOUS SOLUTION RX-175173 CDM J9023 HCPCS 0636 RC 44087-3535-01 NDC outpatient 10 ML 5808.13 5808.13 2067.65 2067.65 fee schedule 5808.13 93 4704.59 percent of total billed charges 5808.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1903.52 other OPPS APC 5808.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1903.52 other OPPS APC 5808.13 24.86 1443.9 percent of total billed charges 2067.65 5808.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION RX-175187 CDM J2350 HCPCS 0636 RC 50242-0150-01 NDC outpatient 10 ML 59143.2 59143.2 21032.2 21032.2 fee schedule 59143.2 93 47905.9 percent of total billed charges 59143.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17939.4 other OPPS APC 59143.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17939.4 other OPPS APC 59143.2 24.86 14703 percent of total billed charges 21032.2 59143.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONIDINE HCL 0.1 MG TABLET RX-1755 CDM A9270 HCPCS 0250 RC 60687-0113-01 NDC outpatient 1 UN 0.92 0.92 74 0.68 percent of total billed charges 0.92 93 0.75 percent of total billed charges 0.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.92 other OPPS APC 0.92 0.92 other OPPS APC 0.92 24.86 0.23 percent of total billed charges 0.92 0.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONIDINE HCL 0.1 MG TABLET RX-1755 CDM A9270 HCPCS 0637 RC 60687-0113-01 NDC outpatient 1 UN 0.92 0.92 0.92 74 0.68 percent of total billed charges 0.92 93 0.75 percent of total billed charges 0.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.92 other OPPS APC 0.92 0.92 other OPPS APC 0.92 24.86 0.23 percent of total billed charges 0.92 0.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONIDINE HCL 0.2 MG TABLET RX-1756 CDM A9270 HCPCS 0250 RC 60687-0124-01 NDC outpatient 1 UN 0.92 0.92 74 0.68 percent of total billed charges 0.92 93 0.75 percent of total billed charges 0.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.92 other OPPS APC 0.92 0.92 other OPPS APC 0.92 24.86 0.23 percent of total billed charges 0.92 0.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONIDINE HCL 0.2 MG TABLET RX-1756 CDM A9270 HCPCS 0637 RC 60687-0124-01 NDC outpatient 1 UN 0.92 0.92 0.92 74 0.68 percent of total billed charges 0.92 93 0.75 percent of total billed charges 0.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.92 other OPPS APC 0.92 0.92 other OPPS APC 0.92 24.86 0.23 percent of total billed charges 0.92 0.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION RX-175608 CDM J9355 HCPCS 0636 RC 50242-0132-01 NDC outpatient 7.15 ML 4675.25 4675.25 1388.29 1388.29 fee schedule 4675.25 93 3786.95 percent of total billed charges 4675.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1169.1 other OPPS APC 4675.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1169.1 other OPPS APC 4675.25 24.86 1162.27 percent of total billed charges 1388.29 4675.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONIDINE HCL 0.3 MG TABLET RX-1757 CDM A9270 HCPCS 0250 RC 00228-2129-10 NDC outpatient 1 UN 1.31 1.31 74 0.97 percent of total billed charges 1.31 93 1.06 percent of total billed charges 1.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.31 other OPPS APC 1.31 1.31 other OPPS APC 1.31 24.86 0.33 percent of total billed charges 1.31 1.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONIDINE HCL 0.3 MG TABLET RX-1757 CDM A9270 HCPCS 0637 RC 00228-2129-10 NDC outpatient 1 UN 1.31 1.31 1.31 74 0.97 percent of total billed charges 1.31 93 1.06 percent of total billed charges 1.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.31 other OPPS APC 1.31 1.31 other OPPS APC 1.31 24.86 0.33 percent of total billed charges 1.31 1.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLINDAMYCIN 600 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK RX-175734 CDM J0737 HCPCS 0636 RC 00338-9549-24 NDC outpatient 50 ML 32.04 32.04 32.04 74 23.71 percent of total billed charges 32.04 93 25.95 percent of total billed charges 32.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.63 other OPPS APC 32.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.63 other OPPS APC 32.04 24.86 7.97 percent of total billed charges 32.04 32.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK RX-175735 CDM J0737 HCPCS 0250 RC 00338-9553-24 NDC outpatient 50 ML 39.15 39.15 39.15 74 28.97 percent of total billed charges 39.15 93 31.71 percent of total billed charges 39.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.15 other OPPS APC 39.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.15 other OPPS APC 39.15 24.86 9.73 percent of total billed charges 39.15 39.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION RX-175756 CDM J9173 HCPCS 0636 RC 00310-4500-12 NDC outpatient 2.4 ML 2972.1 2972.1 1092.63 1092.63 fee schedule 2972.1 93 2407.4 percent of total billed charges 2972.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 981.78 other OPPS APC 2972.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 981.78 other OPPS APC 2972.1 24.86 738.86 percent of total billed charges 1092.63 2972.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION RX-175756 CDM J9173 HCPCS 0636 RC 00310-4611-50 NDC outpatient 10 ML 12383.7 12383.7 4552.63 4552.63 fee schedule 12383.7 93 10030.8 percent of total billed charges 12383.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4090.75 other OPPS APC 12383.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4090.75 other OPPS APC 12383.7 24.86 3078.59 percent of total billed charges 4552.63 12383.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION RX-17595 CDM Q9967 HCPCS 0636 RC 00407-2223-19 NDC outpatient 150 ML 150 150 21.78 21.78 fee schedule 150 93 121.5 percent of total billed charges 150 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 150 other OPPS APC 150 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 150 other OPPS APC 150 24.86 37.29 percent of total billed charges 21.78 150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMIN 350 MG INTRAVENOUS POWDER FOR SOLUTION RX-176422 CDM J1640 HCPCS 0636 RC 55292-0702-55 NDC outpatient 350 ME 32083.5 32083.5 12417 12417 fee schedule 32083.5 93 25987.7 percent of total billed charges 32083.5 32083.5 other OPPS APC 32083.5 32083.5 other OPPS APC 32083.5 24.86 7975.97 percent of total billed charges 12417 32083.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMIN 350 MG INTRAVENOUS POWDER FOR SOLUTION RX-176422 CDM J1640 HCPCS 0636 RC 55292-0702-55 NDC outpatient 50 ML 32083.5 32083.5 12417 12417 fee schedule 32083.5 93 25987.7 percent of total billed charges 32083.5 32083.5 other OPPS APC 32083.5 32083.5 other OPPS APC 32083.5 24.86 7975.97 percent of total billed charges 12417 32083.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION RX-176525 CDM Q5104 HCPCS 0636 RC 78206-0162-01 NDC outpatient 10 ML 2260.18 2260.18 405.71 405.71 fee schedule 2260.18 93 1830.75 percent of total billed charges 2260.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 271.82 other OPPS APC 2260.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 271.82 other OPPS APC 2260.18 24.86 561.88 percent of total billed charges 405.71 2260.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOTRIMAZOLE 1 % TOPICAL CREAM RX-1767 CDM A9270 HCPCS 0250 RC 51672-2002-02 NDC outpatient 30 GR 27.5 27.5 74 20.35 percent of total billed charges 27.5 93 22.28 percent of total billed charges 27.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.5 other OPPS APC 27.5 27.5 other OPPS APC 27.5 24.86 6.84 percent of total billed charges 27.5 27.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOTRIMAZOLE 1 % TOPICAL CREAM RX-1767 CDM A9270 HCPCS 0637 RC 51672-2002-02 NDC outpatient 30 GR 27.5 27.5 27.5 74 20.35 percent of total billed charges 27.5 93 22.28 percent of total billed charges 27.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.5 other OPPS APC 27.5 27.5 other OPPS APC 27.5 24.86 6.84 percent of total billed charges 27.5 27.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOTRIMAZOLE 1 % VAGINAL CREAM RX-1769 CDM A9270 HCPCS 0250 RC 51672-2003-06 NDC outpatient 45 GR 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20 other OPPS APC 20 20 other OPPS APC 20 24.86 4.97 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOTRIMAZOLE 1 % VAGINAL CREAM RX-1769 CDM A9270 HCPCS 0637 RC 51672-2003-06 NDC outpatient 45 GR 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20 other OPPS APC 20 20 other OPPS APC 20 24.86 4.97 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APREPITANT 130 MG/18 ML (7.2 MG/ML) INTRAVENOUS EMULSION RX-177960 CDM J0185 HCPCS 0636 RC 47426-0201-01 NDC outpatient 18 ML 1310.8 1310.8 256.4 256.4 fee schedule 1310.8 93 1061.75 percent of total billed charges 1310.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 229.45 other OPPS APC 1310.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 229.45 other OPPS APC 1310.8 24.86 325.86 percent of total billed charges 256.4 1310.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENRALIZUMAB 30 MG/ML SUBCUTANEOUS SYRINGE RX-177968 CDM J0517 HCPCS 0636 RC 00310-1730-30 NDC outpatient 1 ML 17030.3 17030.3 5853.38 5853.38 fee schedule 17030.3 93 13794.5 percent of total billed charges 17030.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5018.91 other OPPS APC 17030.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5018.91 other OPPS APC 17030.3 24.86 4233.72 percent of total billed charges 5853.38 17030.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER RX-17837 CDM A9270 HCPCS 0250 RC 00173-0682-24 NDC outpatient 8.13313 GR 69.29 69.29 74 51.27 percent of total billed charges 69.29 93 56.12 percent of total billed charges 69.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 69.29 other OPPS APC 69.29 69.29 other OPPS APC 69.29 24.86 17.23 percent of total billed charges 69.29 69.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER RX-17837 CDM A9270 HCPCS 0637 RC 00173-0682-24 NDC outpatient 8.13313 GR 69.29 69.29 69.29 74 51.27 percent of total billed charges 69.29 93 56.12 percent of total billed charges 69.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 69.29 other OPPS APC 69.29 69.29 other OPPS APC 69.29 24.86 17.23 percent of total billed charges 69.29 69.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION RX-178527 CDM J9299 HCPCS 0636 RC 00003-3734-13 NDC outpatient 24 ML 22903.9 22903.9 8343.19 8343.19 fee schedule 22903.9 93 18552.2 percent of total billed charges 22903.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7620 other OPPS APC 22903.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7620 other OPPS APC 22903.9 24.86 5693.92 percent of total billed charges 8343.19 22903.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ALPHA-1-PROTEINASE INHIBITOR (HUMAN) 1,000 MG (+/-)/20 ML IV SOLUTION" RX-178534 CDM J0256 HCPCS 0636 RC 13533-0705-01 NDC outpatient 20 ML 1550 1550 556.6 556.6 fee schedule 1550 93 1255.5 percent of total billed charges 1550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 493.5 other OPPS APC 1550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 493.5 other OPPS APC 1550 24.86 385.33 percent of total billed charges 556.6 1550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET RX-178803 CDM A9270 HCPCS 0250 RC 61958-2501-01 NDC outpatient 1 UN 398.13 398.13 74 294.62 percent of total billed charges 398.13 93 322.49 percent of total billed charges 398.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 398.13 other OPPS APC 398.13 398.13 other OPPS APC 398.13 24.86 98.98 percent of total billed charges 398.13 398.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET RX-178803 CDM A9270 HCPCS 0637 RC 61958-2501-01 NDC outpatient 1 UN 398.13 398.13 398.13 74 294.62 percent of total billed charges 398.13 93 322.49 percent of total billed charges 398.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 398.13 other OPPS APC 398.13 398.13 other OPPS APC 398.13 24.86 98.98 percent of total billed charges 398.13 398.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRIMONIDINE 0.2 % EYE DROPS RX-17881 CDM A9270 HCPCS 0250 RC 70069-0231-01 NDC outpatient 5 ML 31.25 31.25 74 23.13 percent of total billed charges 31.25 93 25.31 percent of total billed charges 31.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 31.25 other OPPS APC 31.25 31.25 other OPPS APC 31.25 24.86 7.77 percent of total billed charges 31.25 31.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRIMONIDINE 0.2 % EYE DROPS RX-17881 CDM A9270 HCPCS 0637 RC 70069-0231-01 NDC outpatient 5 ML 31.25 31.25 31.25 74 23.13 percent of total billed charges 31.25 93 25.31 percent of total billed charges 31.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 31.25 other OPPS APC 31.25 31.25 other OPPS APC 31.25 24.86 7.77 percent of total billed charges 31.25 31.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TENECTEPLASE 50 MG INTRAVENOUS SOLUTION RX-178964 CDM J3101 HCPCS 0636 RC 50242-0120-47 NDC outpatient 10 ML 23482.8 23482.8 8715.03 8715.03 fee schedule 23482.8 93 19021.1 percent of total billed charges 23482.8 23482.8 other OPPS APC 23482.8 23482.8 other OPPS APC 23482.8 24.86 5837.82 percent of total billed charges 8715.03 23482.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TENECTEPLASE 50 MG INTRAVENOUS SOLUTION RX-178964 CDM J3101 HCPCS 0636 RC 50242-0120-47 NDC outpatient 50 ME 23482.8 23482.8 8715.03 8715.03 fee schedule 23482.8 93 19021.1 percent of total billed charges 23482.8 23482.8 other OPPS APC 23482.8 23482.8 other OPPS APC 23482.8 24.86 5837.82 percent of total billed charges 8715.03 23482.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASCORBIC ACID (VITAMIN C) 500 MG/ML INTRAVENOUS SOLUTION RX-178975 CDM 250000000 HCPCS 0250 RC 67157-0101-50 NDC outpatient 50 ML 811.8 811.8 811.8 74 600.73 percent of total billed charges 811.8 93 657.56 percent of total billed charges 811.8 811.8 other OPPS APC 811.8 811.8 other OPPS APC 811.8 24.86 201.81 percent of total billed charges 811.8 811.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THROMBIN(HUMAN)-FIBRINOGEN-APROTININ SYN-CALCIUM 10 ML TOPICAL SYRINGE RX-179024 CDM 250000000 HCPCS 0250 RC 00338-9568-01 NDC outpatient 10 ML 2083.98 2083.98 2083.98 74 1542.15 percent of total billed charges 2083.98 93 1688.02 percent of total billed charges 2083.98 2083.98 other OPPS APC 2083.98 2083.98 other OPPS APC 2083.98 24.86 518.08 percent of total billed charges 2083.98 2083.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STERILE TALC 4 GRAM INTRAPLEURAL SUSPENSION RX-179049 CDM 250000000 HCPCS 0250 RC 62327-0444-44 NDC outpatient 4 GR 350 350 350 74 259 percent of total billed charges 350 93 283.5 percent of total billed charges 350 350 other OPPS APC 350 350 other OPPS APC 350 24.86 87.01 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE 4 MG/ML INJECTION SOLUTION RX-179385 CDM J2272 HCPCS 0636 RC 63323-0454-00 NDC outpatient 1 ML 8.61 8.61 7.91 7.91 fee schedule 8.61 93 6.97 percent of total billed charges 8.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.61 other OPPS APC 8.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.61 other OPPS APC 8.61 24.86 2.14 percent of total billed charges 7.91 8.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COCAINE 4 % NASAL SOLUTION RX-179391 CDM A9270 HCPCS 0250 RC 70839-0362-04 NDC outpatient 4 ML 882 882 74 652.68 percent of total billed charges 882 93 714.42 percent of total billed charges 882 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 882 other OPPS APC 882 882 other OPPS APC 882 24.86 219.27 percent of total billed charges 882 882 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COCAINE 4 % NASAL SOLUTION RX-179391 CDM A9270 HCPCS 0637 RC 70839-0362-04 NDC outpatient 4 ML 882 882 882 74 652.68 percent of total billed charges 882 93 714.42 percent of total billed charges 882 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 882 other OPPS APC 882 882 other OPPS APC 882 24.86 219.27 percent of total billed charges 882 882 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IRON DEXTRAN 50 MG/ML INJECTION SOLUTION RX-179392 CDM J1750 HCPCS 0636 RC 00023-6082-10 NDC outpatient 2 ML 106.53 106.53 39.2 39.2 fee schedule 106.53 93 86.29 percent of total billed charges 106.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35.34 other OPPS APC 106.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35.34 other OPPS APC 106.53 24.86 26.48 percent of total billed charges 39.2 106.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STERILE WATER FOR INJECTION SYRINGE RX-179536 CDM A4216 HCPCS 0636 RC 64253-0020-30 NDC outpatient 10 ML 4 4 4 74 2.96 percent of total billed charges 4 93 3.24 percent of total billed charges 4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4 other OPPS APC 4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4 other OPPS APC 4 24.86 0.99 percent of total billed charges 4 4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION RX-179661 CDM J0878 HCPCS 0636 RC 43598-0476-11 NDC outpatient 350 ME 120 120 29.65 29.65 fee schedule 120 93 97.2 percent of total billed charges 120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 120 other OPPS APC 120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 120 other OPPS APC 120 24.86 29.83 percent of total billed charges 29.65 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION RX-179661 CDM J0878 HCPCS 0636 RC 43598-0476-11 NDC outpatient 7 ML 120 120 29.65 29.65 fee schedule 120 93 97.2 percent of total billed charges 120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 120 other OPPS APC 120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 120 other OPPS APC 120 24.86 29.83 percent of total billed charges 29.65 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARICITINIB 2 MG TABLET RX-179662 CDM A9270 HCPCS 0250 RC 00002-4182-30 NDC outpatient 1 UN 274 274 74 202.76 percent of total billed charges 274 93 221.94 percent of total billed charges 274 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 274 other OPPS APC 274 274 other OPPS APC 274 24.86 68.12 percent of total billed charges 274 274 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARICITINIB 2 MG TABLET RX-179662 CDM A9270 HCPCS 0637 RC 00002-4182-30 NDC outpatient 1 UN 274 274 274 74 202.76 percent of total billed charges 274 93 221.94 percent of total billed charges 274 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 274 other OPPS APC 274 274 other OPPS APC 274 24.86 68.12 percent of total billed charges 274 274 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION" RX-179692 CDM Q5106 HCPCS 0635 RC 00069-1305-10 NDC outpatient 1 ML 66.18 66.18 17.11 17.11 fee schedule 66.18 93 53.61 percent of total billed charges 66.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.24 other OPPS APC 66.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.24 other OPPS APC 66.18 51 33.75 percent of total billed charges 17.11 66.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "EPOETIN ALFA-EPBX 3,000 UNIT/ML INJECTION SOLUTION" RX-179693 CDM Q5106 HCPCS 0635 RC 00069-1306-10 NDC outpatient 1 ML 99.27 99.27 25.66 25.66 fee schedule 99.27 93 80.41 percent of total billed charges 99.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.85 other OPPS APC 99.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.85 other OPPS APC 99.27 51 50.63 percent of total billed charges 25.66 99.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION" RX-179694 CDM Q5106 HCPCS 0635 RC 00069-1307-10 NDC outpatient 1 ML 132.36 132.36 34.22 34.22 fee schedule 132.36 93 107.21 percent of total billed charges 132.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.47 other OPPS APC 132.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.47 other OPPS APC 132.36 51 67.5 percent of total billed charges 34.22 132.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION" RX-179695 CDM Q5106 HCPCS 0635 RC 00069-1308-10 NDC outpatient 1 ML 330.9 330.9 85.55 85.55 fee schedule 330.9 93 268.03 percent of total billed charges 330.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 76.18 other OPPS APC 330.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 76.18 other OPPS APC 330.9 51 168.76 percent of total billed charges 85.55 330.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION" RX-179696 CDM Q5106 HCPCS 0635 RC 00069-1309-04 NDC outpatient 1 ML 1323.6 1323.6 342.19 342.19 fee schedule 1323.6 93 1072.12 percent of total billed charges 1323.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 304.72 other OPPS APC 1323.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 304.72 other OPPS APC 1323.6 51 675.04 percent of total billed charges 342.19 1323.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBCUTANEOUS SYRINGE RX-179765 CDM Q5108 HCPCS 0636 RC 83257-0005-41 NDC outpatient 0.6 ML 6262.5 6262.5 1522.42 1522.42 fee schedule 6262.5 93 5072.63 percent of total billed charges 6262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1626.41 other OPPS APC 6262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1626.41 other OPPS APC 6262.5 24.86 1556.86 percent of total billed charges 1522.42 6262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CODEINE SULFATE 15 MG TABLET RX-1801 CDM A9270 HCPCS 0250 RC 00054-0243-24 NDC outpatient 1 UN 2.16 2.16 74 1.6 percent of total billed charges 2.16 93 1.75 percent of total billed charges 2.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.16 other OPPS APC 2.16 2.16 other OPPS APC 2.16 24.86 0.54 percent of total billed charges 2.16 2.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CODEINE SULFATE 15 MG TABLET RX-1801 CDM A9270 HCPCS 0637 RC 00054-0243-24 NDC outpatient 1 UN 2.16 2.16 2.16 74 1.6 percent of total billed charges 2.16 93 1.75 percent of total billed charges 2.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.16 other OPPS APC 2.16 2.16 other OPPS APC 2.16 24.86 0.54 percent of total billed charges 2.16 2.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARFILZOMIB 10 MG INTRAVENOUS SOLUTION RX-180200 CDM J9047 HCPCS 0636 RC 76075-0103-01 NDC outpatient 5 ML 1637.58 1637.58 537 537 fee schedule 1637.58 93 1326.44 percent of total billed charges 1637.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 495.77 other OPPS APC 1637.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 495.77 other OPPS APC 1637.58 24.86 407.1 percent of total billed charges 537 1637.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PARENTERAL AMINO ACID 15 % COMBINATION NO.5 INTRAVENOUS SOLUTION RX-180214 CDM 250000000 HCPCS 0250 RC 00338-0502-06 NDC outpatient 2000 ML 97.17 97.17 97.17 74 71.91 percent of total billed charges 97.17 93 78.71 percent of total billed charges 97.17 97.17 other OPPS APC 97.17 97.17 other OPPS APC 97.17 24.86 24.16 percent of total billed charges 97.17 97.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET RX-180215 CDM A9270 HCPCS 0250 RC 00310-1105-01 NDC outpatient 1 UN 82.05 82.05 74 60.72 percent of total billed charges 82.05 93 66.46 percent of total billed charges 82.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 82.05 other OPPS APC 82.05 82.05 other OPPS APC 82.05 24.86 20.4 percent of total billed charges 82.05 82.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET RX-180215 CDM A9270 HCPCS 0637 RC 00310-1105-01 NDC outpatient 1 UN 82.05 82.05 82.05 74 60.72 percent of total billed charges 82.05 93 66.46 percent of total billed charges 82.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 82.05 other OPPS APC 82.05 82.05 other OPPS APC 82.05 24.86 20.4 percent of total billed charges 82.05 82.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET RX-180216 CDM A9270 HCPCS 0250 RC 00310-1110-30 NDC outpatient 1 UN 82.05 82.05 74 60.72 percent of total billed charges 82.05 93 66.46 percent of total billed charges 82.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 82.05 other OPPS APC 82.05 82.05 other OPPS APC 82.05 24.86 20.4 percent of total billed charges 82.05 82.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET RX-180216 CDM A9270 HCPCS 0637 RC 00310-1110-30 NDC outpatient 1 UN 82.05 82.05 82.05 74 60.72 percent of total billed charges 82.05 93 66.46 percent of total billed charges 82.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 82.05 other OPPS APC 82.05 82.05 other OPPS APC 82.05 24.86 20.4 percent of total billed charges 82.05 82.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOGAMULIZUMAB-KPKC 4 MG/ML INTRAVENOUS SOLUTION RX-180278 CDM J9204 HCPCS 0636 RC 42747-0761-01 NDC outpatient 5 ML 13790.1 13790.1 5175.65 5175.65 fee schedule 13790.1 93 11170 percent of total billed charges 13790.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4776.96 other OPPS APC 13790.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4776.96 other OPPS APC 13790.1 24.86 3428.21 percent of total billed charges 5175.65 13790.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILGRASTIM-AAFI 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE RX-180281 CDM Q5110 HCPCS 0636 RC 00069-0291-10 NDC outpatient 0.5 ML 657 657 112.53 112.53 fee schedule 657 93 532.17 percent of total billed charges 657 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 81 other OPPS APC 657 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 81 other OPPS APC 657 24.86 163.33 percent of total billed charges 112.53 657 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILGRASTIM-AAFI 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE RX-180282 CDM Q5110 HCPCS 0636 RC 00069-0292-10 NDC outpatient 0.8 ML 1051.2 1051.2 180.05 180.05 fee schedule 1051.2 93 851.47 percent of total billed charges 1051.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 129.6 other OPPS APC 1051.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 129.6 other OPPS APC 1051.2 24.86 261.33 percent of total billed charges 180.05 1051.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT FOR PREPARATION OF TC-99M-BICISATE 0.9 MG INTRAVENOUS SOLUTION RX-180754 CDM A9557 HCPCS 0343 RC 11994-0006-02 NDC outpatient 1.01818 UN 2914.32 2914.32 2914.32 74 2156.6 percent of total billed charges 2914.32 93 2360.6 percent of total billed charges 2914.32 2914.32 other OPPS APC 2914.32 2914.32 other OPPS APC 2914.32 24.86 724.5 percent of total billed charges 2914.32 2914.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIVAROXABAN 2.5 MG TABLET RX-180762 CDM A9270 HCPCS 0250 RC 50458-0577-01 NDC outpatient 1 UN 28.48 28.48 74 21.08 percent of total billed charges 28.48 93 23.07 percent of total billed charges 28.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28.48 other OPPS APC 28.48 28.48 other OPPS APC 28.48 24.86 7.08 percent of total billed charges 28.48 28.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIVAROXABAN 2.5 MG TABLET RX-180762 CDM A9270 HCPCS 0637 RC 50458-0577-01 NDC outpatient 1 UN 28.48 28.48 28.48 74 21.08 percent of total billed charges 28.48 93 23.07 percent of total billed charges 28.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28.48 other OPPS APC 28.48 28.48 other OPPS APC 28.48 24.86 7.08 percent of total billed charges 28.48 28.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANTIVENIN CROTALIDAE (EQUINE) SOLUTION FOR INJECTION RX-180779 CDM J0841 HCPCS 0636 RC 66621-0790-01 NDC outpatient 1 UN 3960 3960 1163.72 1163.72 fee schedule 3960 93 3207.6 percent of total billed charges 3960 3960 other OPPS APC 3960 3960 other OPPS APC 3960 24.86 984.46 percent of total billed charges 1163.72 3960 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANTIVENIN CROTALIDAE (EQUINE) SOLUTION FOR INJECTION RX-180779 CDM J0841 HCPCS 0636 RC 66621-0790-01 NDC outpatient 10 ML 3960 3960 1163.72 1163.72 fee schedule 3960 93 3207.6 percent of total billed charges 3960 3960 other OPPS APC 3960 3960 other OPPS APC 3960 24.86 984.46 percent of total billed charges 1163.72 3960 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMIPLIMAB-RWLC 50 MG/ML INTRAVENOUS SOLUTION RX-180799 CDM J9119 HCPCS 0636 RC 61755-0008-01 NDC outpatient 7 ML 30893.5 30893.5 10756.9 10756.9 fee schedule 30893.5 93 25023.7 percent of total billed charges 30893.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9884 other OPPS APC 30893.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9884 other OPPS APC 30893.5 24.86 7680.11 percent of total billed charges 10756.9 30893.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT FOR THE PREP OF TC-99M-TILMANOCEPT 250 MCG SOLUTION FOR INJECTION RX-180883 CDM A9520 HCPCS 0343 RC 65857-0425-05 NDC outpatient 1 UN 157.1 157.1 157.1 74 116.25 percent of total billed charges 157.1 93 127.25 percent of total billed charges 157.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 157.1 other OPPS APC 157.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 157.1 other OPPS APC 157.1 24.86 39.06 percent of total billed charges 157.1 157.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE RX-181103 CDM J2357 HCPCS 0636 RC 50242-0214-01 NDC outpatient 0.5 ML 2077.45 2077.45 674.27 674.27 fee schedule 2077.45 93 1682.73 percent of total billed charges 2077.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 574.4 other OPPS APC 2077.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 574.4 other OPPS APC 2077.45 24.86 516.45 percent of total billed charges 674.27 2077.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE RX-181105 CDM J2357 HCPCS 0636 RC 50242-0215-01 NDC outpatient 1 ML 4154.88 4154.88 1348.55 1348.55 fee schedule 4154.88 93 3365.45 percent of total billed charges 4154.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1148.79 other OPPS APC 4154.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1148.79 other OPPS APC 4154.88 24.86 1032.9 percent of total billed charges 1348.55 4154.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 1.5 GRAM INTRAVENOUS SOLUTION RX-181362 CDM J3371 HCPCS 0636 RC 67457-0824-99 NDC outpatient 1500 ME 72.36 72.36 21.56 21.56 fee schedule 72.36 93 58.61 percent of total billed charges 72.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.02 other OPPS APC 72.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.02 other OPPS APC 72.36 24.86 17.99 percent of total billed charges 21.56 72.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 1.5 GRAM INTRAVENOUS SOLUTION RX-181362 CDM J3371 HCPCS 0636 RC 67457-0824-99 NDC outpatient 30 ML 72.36 72.36 21.56 21.56 fee schedule 72.36 93 58.61 percent of total billed charges 72.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.02 other OPPS APC 72.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.02 other OPPS APC 72.36 24.86 17.99 percent of total billed charges 21.56 72.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEGFILGRASTIM-CBQV 6 MG/0.6 ML SUBCUTANEOUS SYRINGE RX-181379 CDM Q5111 HCPCS 0636 RC 70114-0101-01 NDC outpatient 0.6 ML 12525 12525 1709.29 1709.29 fee schedule 12525 93 10145.3 percent of total billed charges 12525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1720.52 other OPPS APC 12525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1720.52 other OPPS APC 12525 24.86 3113.72 percent of total billed charges 1709.29 12525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION RX-181624 CDM J3370 HCPCS 0636 RC 00143-9152-01 NDC outpatient 1250 ME 60.3 60.3 8.24 8.24 fee schedule 60.3 93 48.84 percent of total billed charges 60.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 60.3 other OPPS APC 60.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 60.3 other OPPS APC 60.3 24.86 14.99 percent of total billed charges 8.24 60.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|DISCARDED DRUG NOT ADMINISTERED RX-181624 CDM J3370 HCPCS 0636 RC 00143-9152-01 NDC JW outpatient 1250 ME 60.3 60.3 5.49 5.49 fee schedule 5.49 60.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE, ISO-OSM IV SOLUTION" RX-181634 CDM J0612 HCPCS 0250 RC 80830-2362-09 NDC outpatient 1 GR 59.25 59.25 59.25 74 43.85 percent of total billed charges 59.25 93 47.99 percent of total billed charges 59.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.25 other OPPS APC 59.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.25 other OPPS APC 59.25 24.86 14.73 percent of total billed charges 59.25 59.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE, ISO-OSM IV SOLUTION" RX-181634 CDM J0612 HCPCS 0250 RC 80830-2362-09 NDC outpatient 50 ML 59.25 59.25 59.25 74 43.85 percent of total billed charges 59.25 93 47.99 percent of total billed charges 59.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.25 other OPPS APC 59.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.25 other OPPS APC 59.25 24.86 14.73 percent of total billed charges 59.25 59.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY) RX-181659 CDM A9270 HCPCS 0250 RC 68094-0045-58 NDC outpatient 0.5 ML 8.88 8.88 74 6.57 percent of total billed charges 8.88 93 7.19 percent of total billed charges 8.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.88 other OPPS APC 8.88 8.88 other OPPS APC 8.88 24.86 2.21 percent of total billed charges 8.88 8.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY) RX-181659 CDM A9270 HCPCS 0637 RC 68094-0045-58 NDC outpatient 0.5 ML 8.88 8.88 8.88 74 6.57 percent of total billed charges 8.88 93 7.19 percent of total billed charges 8.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.88 other OPPS APC 8.88 8.88 other OPPS APC 8.88 24.86 2.21 percent of total billed charges 8.88 8.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION RX-18192 CDM J2795 HCPCS 0636 RC 70069-0062-10 NDC outpatient 20 ML 27.04 27.04 3.39 3.39 fee schedule 27.04 93 21.9 percent of total billed charges 27.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.04 other OPPS APC 27.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.04 other OPPS APC 27.04 24.86 6.72 percent of total billed charges 3.39 27.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION RX-18195 CDM J2795 HCPCS 0636 RC 70069-0064-01 NDC outpatient 30 ML 26.58 26.58 12.71 12.71 fee schedule 26.58 93 21.53 percent of total billed charges 26.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 26.58 other OPPS APC 26.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 26.58 other OPPS APC 26.58 24.86 6.61 percent of total billed charges 12.71 26.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 1.5 GRAM/300 ML IN DILUENT COMBINATION IV PIGGYBACK RX-182033 CDM J3372 HCPCS 0636 RC 70594-0043-01 NDC outpatient 2 GR 92 92 30.06 30.06 fee schedule 92 93 74.52 percent of total billed charges 69 69 other OPPS APC 69 69 other OPPS APC 69 24.86 17.15 percent of total billed charges 30.06 92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 1.5 GRAM/300 ML IN DILUENT COMBINATION IV PIGGYBACK RX-182033 CDM J3372 HCPCS 0636 RC 70594-0043-01 NDC outpatient 300 ML 69 69 30.06 30.06 fee schedule 92 93 74.52 percent of total billed charges 69 69 other OPPS APC 69 69 other OPPS APC 69 24.86 17.15 percent of total billed charges 30.06 92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATEZOLIZUMAB 840 MG/14 ML (60 MG/ML) INTRAVENOUS SOLUTION RX-182087 CDM J9022 HCPCS 0636 RC 50242-0918-01 NDC outpatient 14 ML 22940.6 22940.6 7927.92 7927.92 fee schedule 22940.6 93 18581.9 percent of total billed charges 22940.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7244.33 other OPPS APC 22940.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7244.33 other OPPS APC 22940.6 24.86 5703.03 percent of total billed charges 7927.92 22940.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLCHICINE 0.6 MG TABLET RX-1821 CDM A9270 HCPCS 0250 RC 67877-0589-01 NDC outpatient 1 UN 16.84 16.84 74 12.46 percent of total billed charges 16.84 93 13.64 percent of total billed charges 16.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.84 other OPPS APC 16.84 16.84 other OPPS APC 16.84 24.86 4.19 percent of total billed charges 16.84 16.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLCHICINE 0.6 MG TABLET RX-1821 CDM A9270 HCPCS 0637 RC 67877-0589-01 NDC outpatient 1 UN 16.84 16.84 16.84 74 12.46 percent of total billed charges 16.84 93 13.64 percent of total billed charges 16.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.84 other OPPS APC 16.84 16.84 other OPPS APC 16.84 24.86 4.19 percent of total billed charges 16.84 16.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POLATUZUMAB VEDOTIN-PIIQ 140 MG INTRAVENOUS SOLUTION RX-182753 CDM J9309 HCPCS 0636 RC 50242-0105-01 NDC outpatient 7 ML 54208 54208 19377.7 19377.7 fee schedule 54208 93 43908.5 percent of total billed charges 54208 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18169.3 other OPPS APC 54208 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18169.3 other OPPS APC 54208 24.86 13476.1 percent of total billed charges 19377.7 54208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BISOPROLOL FUMARATE 10 MG TABLET RX-18287 CDM A9270 HCPCS 0250 RC 29300-0127-01 NDC outpatient 1 UN 3.51 3.51 74 2.6 percent of total billed charges 3.51 93 2.84 percent of total billed charges 3.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.51 other OPPS APC 3.51 3.51 other OPPS APC 3.51 24.86 0.87 percent of total billed charges 3.51 3.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BISOPROLOL FUMARATE 10 MG TABLET RX-18287 CDM A9270 HCPCS 0637 RC 29300-0127-01 NDC outpatient 1 UN 3.51 3.51 3.51 74 2.6 percent of total billed charges 3.51 93 2.84 percent of total billed charges 3.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.51 other OPPS APC 3.51 3.51 other OPPS APC 3.51 24.86 0.87 percent of total billed charges 3.51 3.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BISOPROLOL FUMARATE 5 MG TABLET RX-18288 CDM A9270 HCPCS 0250 RC 52817-0270-10 NDC outpatient 1 UN 5.64 5.64 74 4.17 percent of total billed charges 5.64 93 4.57 percent of total billed charges 5.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.64 other OPPS APC 5.64 5.64 other OPPS APC 5.64 24.86 1.4 percent of total billed charges 5.64 5.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BISOPROLOL FUMARATE 5 MG TABLET RX-18288 CDM A9270 HCPCS 0637 RC 52817-0270-10 NDC outpatient 1 UN 5.64 5.64 5.64 74 4.17 percent of total billed charges 5.64 93 4.57 percent of total billed charges 5.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.64 other OPPS APC 5.64 5.64 other OPPS APC 5.64 24.86 1.4 percent of total billed charges 5.64 5.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BISOPROLOL 10 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET RX-18289 CDM A9270 HCPCS 0250 RC 10135-0742-30 NDC outpatient 1 UN 1.16 1.16 74 0.86 percent of total billed charges 1.16 93 0.94 percent of total billed charges 1.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.16 other OPPS APC 1.16 1.16 other OPPS APC 1.16 24.86 0.29 percent of total billed charges 1.16 1.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BISOPROLOL 10 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET RX-18289 CDM A9270 HCPCS 0637 RC 10135-0742-30 NDC outpatient 1 UN 1.16 1.16 1.16 74 0.86 percent of total billed charges 1.16 93 0.94 percent of total billed charges 1.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.16 other OPPS APC 1.16 1.16 other OPPS APC 1.16 24.86 0.29 percent of total billed charges 1.16 1.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BISOPROLOL 5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET RX-18290 CDM A9270 HCPCS 0250 RC 42799-0921-30 NDC outpatient 1 UN 18.43 18.43 74 13.64 percent of total billed charges 18.43 93 14.93 percent of total billed charges 18.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.43 other OPPS APC 18.43 18.43 other OPPS APC 18.43 24.86 4.58 percent of total billed charges 18.43 18.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BISOPROLOL 5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET RX-18290 CDM A9270 HCPCS 0637 RC 42799-0921-30 NDC outpatient 1 UN 18.43 18.43 18.43 74 13.64 percent of total billed charges 18.43 93 14.93 percent of total billed charges 18.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.43 other OPPS APC 18.43 18.43 other OPPS APC 18.43 24.86 4.58 percent of total billed charges 18.43 18.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BISOPROLOL 2.5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET RX-18291 CDM A9270 HCPCS 0250 RC 68462-0878-30 NDC outpatient 1 UN 18.43 18.43 74 13.64 percent of total billed charges 18.43 93 14.93 percent of total billed charges 18.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.43 other OPPS APC 18.43 18.43 other OPPS APC 18.43 24.86 4.58 percent of total billed charges 18.43 18.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BISOPROLOL 2.5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET RX-18291 CDM A9270 HCPCS 0637 RC 68462-0878-30 NDC outpatient 1 UN 18.43 18.43 18.43 74 13.64 percent of total billed charges 18.43 93 14.93 percent of total billed charges 18.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.43 other OPPS APC 18.43 18.43 other OPPS APC 18.43 24.86 4.58 percent of total billed charges 18.43 18.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TORSEMIDE 20 MG TABLET RX-18293 CDM A9270 HCPCS 0250 RC 50268-0756-11 NDC outpatient 1 UN 2.08 2.08 74 1.54 percent of total billed charges 2.08 93 1.68 percent of total billed charges 2.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.08 other OPPS APC 2.08 2.08 other OPPS APC 2.08 24.86 0.52 percent of total billed charges 2.08 2.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TORSEMIDE 20 MG TABLET RX-18293 CDM A9270 HCPCS 0637 RC 50268-0756-11 NDC outpatient 1 UN 2.08 2.08 2.08 74 1.54 percent of total billed charges 2.08 93 1.68 percent of total billed charges 2.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.08 other OPPS APC 2.08 2.08 other OPPS APC 2.08 24.86 0.52 percent of total billed charges 2.08 2.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION RX-182932 CDM Q5107 HCPCS 0636 RC 55513-0206-01 NDC outpatient 4 ML 2093.2 2093.2 324.16 324.16 fee schedule 2093.2 93 1695.49 percent of total billed charges 2093.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 265.85 other OPPS APC 2093.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 265.85 other OPPS APC 2093.2 24.86 520.37 percent of total billed charges 324.16 2093.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION RX-182932 CDM Q5107 HCPCS 0636 RC 55513-0207-01 NDC outpatient 16 ML 8372.68 8372.68 1296.64 1296.64 fee schedule 8372.68 93 6781.87 percent of total billed charges 8372.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1063.4 other OPPS APC 8372.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1063.4 other OPPS APC 8372.68 24.86 2081.45 percent of total billed charges 1296.64 8372.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CALCIUM GLUCONATE 2 GRAM/100 ML IN SODIUM CHLORIDE,ISO-OSM IV SOLUTION" RX-182936 CDM J0612 HCPCS 0250 RC 65219-0164-50 NDC outpatient 100 ML 118.5 118.5 118.5 74 87.69 percent of total billed charges 118.5 93 95.99 percent of total billed charges 118.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 118.5 other OPPS APC 118.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 118.5 other OPPS APC 118.5 24.86 29.46 percent of total billed charges 118.5 118.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CALCIUM GLUCONATE 2 GRAM/100 ML IN SODIUM CHLORIDE,ISO-OSM IV SOLUTION" RX-182936 CDM J0612 HCPCS 0250 RC 65219-0164-50 NDC outpatient 2 GR 118.5 118.5 118.5 74 87.69 percent of total billed charges 118.5 93 95.99 percent of total billed charges 118.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 118.5 other OPPS APC 118.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 118.5 other OPPS APC 118.5 24.86 29.46 percent of total billed charges 118.5 118.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 2 GRAM/400 ML IN DILUENT COMBINATION IV PIGGYBACK RX-182941 CDM J3372 HCPCS 0636 RC 70594-0044-01 NDC outpatient 2 GR 84 84 30.06 30.06 fee schedule 84 93 68.04 percent of total billed charges 84 84 other OPPS APC 84 84 other OPPS APC 84 24.86 20.88 percent of total billed charges 30.06 84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 2 GRAM/400 ML IN DILUENT COMBINATION IV PIGGYBACK RX-182941 CDM J3372 HCPCS 0636 RC 70594-0044-01 NDC outpatient 400 ML 84 84 30.06 30.06 fee schedule 84 93 68.04 percent of total billed charges 84 84 other OPPS APC 84 84 other OPPS APC 84 24.86 20.88 percent of total billed charges 30.06 84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRASTUZUMAB-ANNS 420 MG INTRAVENOUS SOLUTION RX-182967 CDM Q5117 HCPCS 0636 RC 55513-0132-01 NDC outpatient 20 ML 11424.5 11424.5 1148.53 1148.53 fee schedule 11424.5 93 9253.89 percent of total billed charges 11424.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1021.94 other OPPS APC 11424.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1021.94 other OPPS APC 11424.5 24.86 2840.14 percent of total billed charges 1148.53 11424.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MODIFIED LANOLIN 100 % TOPICAL CREAM RX-182982 CDM A9270 HCPCS 0250 RC 44677-0102-02 NDC outpatient 7 GR 6 6 74 4.44 percent of total billed charges 6 93 4.86 percent of total billed charges 6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6 other OPPS APC 6 6 other OPPS APC 6 24.86 1.49 percent of total billed charges 6 6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MODIFIED LANOLIN 100 % TOPICAL CREAM RX-182982 CDM A9270 HCPCS 0637 RC 44677-0102-02 NDC outpatient 7 GR 6 6 6 74 4.44 percent of total billed charges 6 93 4.86 percent of total billed charges 6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6 other OPPS APC 6 6 other OPPS APC 6 24.86 1.49 percent of total billed charges 6 6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION RX-18302 CDM J2543 HCPCS 0636 RC 55150-0121-50 NDC outpatient 20 ML 68.88 68.88 68.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 68.88 other OPPS APC 68.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 68.88 other OPPS APC 68.88 24.86 17.12 percent of total billed charges 68.88 68.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION RX-18302 CDM J2543 HCPCS 0636 RC 81284-0153-10 NDC outpatient 4.5 GR 18 18 6.2 6.2 fee schedule 18 93 14.58 percent of total billed charges 6.2 18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION RX-18303 CDM J2543 HCPCS 0636 RC 55150-0120-30 NDC outpatient 15 ML 16.5 16.5 4.65 4.65 fee schedule 16.5 93 13.37 percent of total billed charges 16.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.5 other OPPS APC 16.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.5 other OPPS APC 16.5 24.86 4.1 percent of total billed charges 4.65 16.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION RX-18303 CDM J2543 HCPCS 0636 RC 55150-0120-30 NDC outpatient 3.375 GR 16.5 16.5 4.65 4.65 fee schedule 16.5 93 13.37 percent of total billed charges 16.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.5 other OPPS APC 16.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.5 other OPPS APC 16.5 24.86 4.1 percent of total billed charges 4.65 16.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION RX-18304 CDM J2543 HCPCS 0636 RC 55150-0119-30 NDC outpatient 10 ML 36.25 36.25 3.1 3.1 fee schedule 36.25 93 29.36 percent of total billed charges 36.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36.25 other OPPS APC 36.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36.25 other OPPS APC 36.25 24.86 9.01 percent of total billed charges 3.1 36.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION RX-18304 CDM J2543 HCPCS 0636 RC 55150-0119-30 NDC outpatient 2.25 GR 36.25 36.25 3.1 3.1 fee schedule 36.25 93 29.36 percent of total billed charges 36.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36.25 other OPPS APC 36.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36.25 other OPPS APC 36.25 24.86 9.01 percent of total billed charges 3.1 36.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GABAPENTIN 400 MG CAPSULE RX-18307 CDM A9270 HCPCS 0250 RC 63739-0904-10 NDC outpatient 1 UN 0.56 0.56 74 0.41 percent of total billed charges 0.56 93 0.45 percent of total billed charges 0.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.56 other OPPS APC 0.56 0.56 other OPPS APC 0.56 24.86 0.14 percent of total billed charges 0.56 0.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GABAPENTIN 400 MG CAPSULE RX-18307 CDM A9270 HCPCS 0637 RC 63739-0904-10 NDC outpatient 1 UN 0.56 0.56 0.56 74 0.41 percent of total billed charges 0.56 93 0.45 percent of total billed charges 0.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.56 other OPPS APC 0.56 0.56 other OPPS APC 0.56 24.86 0.14 percent of total billed charges 0.56 0.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GABAPENTIN 300 MG CAPSULE RX-18308 CDM A9270 HCPCS 0250 RC 63739-0903-10 NDC outpatient 1 UN 0.49 0.49 74 0.36 percent of total billed charges 0.49 93 0.4 percent of total billed charges 0.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.49 other OPPS APC 0.49 0.49 other OPPS APC 0.49 24.86 0.12 percent of total billed charges 0.49 0.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GABAPENTIN 300 MG CAPSULE RX-18308 CDM A9270 HCPCS 0637 RC 63739-0903-10 NDC outpatient 1 UN 0.49 0.49 0.49 74 0.36 percent of total billed charges 0.49 93 0.4 percent of total billed charges 0.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.49 other OPPS APC 0.49 0.49 other OPPS APC 0.49 24.86 0.12 percent of total billed charges 0.49 0.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GABAPENTIN 100 MG CAPSULE RX-18309 CDM A9270 HCPCS 0250 RC 63739-0902-10 NDC outpatient 1 UN 0.27 0.27 74 0.2 percent of total billed charges 0.27 93 0.22 percent of total billed charges 0.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.27 other OPPS APC 0.27 0.27 other OPPS APC 0.27 24.86 0.07 percent of total billed charges 0.27 0.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GABAPENTIN 100 MG CAPSULE RX-18309 CDM A9270 HCPCS 0637 RC 63739-0902-10 NDC outpatient 1 UN 0.27 0.27 0.27 74 0.2 percent of total billed charges 0.27 93 0.22 percent of total billed charges 0.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.27 other OPPS APC 0.27 0.27 other OPPS APC 0.27 24.86 0.07 percent of total billed charges 0.27 0.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RISPERIDONE 1 MG TABLET RX-18313 CDM A9270 HCPCS 0250 RC 00904-7362-61 NDC outpatient 1 UN 1.07 1.07 74 0.79 percent of total billed charges 1.07 93 0.87 percent of total billed charges 1.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.07 other OPPS APC 1.07 1.07 other OPPS APC 1.07 24.86 0.27 percent of total billed charges 1.07 1.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RISPERIDONE 1 MG TABLET RX-18313 CDM A9270 HCPCS 0637 RC 00904-7362-61 NDC outpatient 1 UN 1.07 1.07 1.07 74 0.79 percent of total billed charges 1.07 93 0.87 percent of total billed charges 1.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.07 other OPPS APC 1.07 1.07 other OPPS APC 1.07 24.86 0.27 percent of total billed charges 1.07 1.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV" RX-18315 CDM J1250 HCPCS 0636 RC 00338-1075-02 NDC outpatient 250 ML 119.84 119.84 20.16 20.16 fee schedule 119.84 93 97.07 percent of total billed charges 119.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 119.84 other OPPS APC 119.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 119.84 other OPPS APC 119.84 24.86 29.79 percent of total billed charges 20.16 119.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK" RX-183302 CDM 250000000 HCPCS 0250 RC 80830-2329-02 NDC outpatient 100 ML 61.44 61.44 61.44 74 45.47 percent of total billed charges 61.44 93 49.77 percent of total billed charges 61.44 61.44 other OPPS APC 61.44 61.44 other OPPS APC 61.44 24.86 15.27 percent of total billed charges 61.44 61.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS RX-183364 CDM 250000000 HCPCS 0250 RC 00338-9540-02 NDC outpatient 250 ML 141.36 141.36 141.36 74 104.61 percent of total billed charges 141.36 93 114.5 percent of total billed charges 141.36 141.36 other OPPS APC 141.36 141.36 other OPPS APC 141.36 24.86 35.14 percent of total billed charges 141.36 141.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIGOXIN 500 MCG/2 ML (250 MCG/ML) (0.5 MG/2 ML) INJECTION SOLUTION RX-183805 CDM J1160 HCPCS 0636 RC 70515-0261-10 NDC outpatient 2 ML 429.68 429.68 12.34 12.34 fee schedule 429.68 93 348.04 percent of total billed charges 429.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 429.68 other OPPS APC 429.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 429.68 other OPPS APC 429.68 24.86 106.82 percent of total billed charges 12.34 429.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRASTUZUMAB-DKST 420 MG INTRAVENOUS SOLUTION RX-183813 CDM Q5114 HCPCS 0636 RC 83257-0004-12 NDC outpatient 20 ML 7875.15 7875.15 1937.26 1937.26 fee schedule 7875.15 93 6378.87 percent of total billed charges 7875.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2274.64 other OPPS APC 7875.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2274.64 other OPPS APC 7875.15 24.86 1957.76 percent of total billed charges 1937.26 7875.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION RX-183818 CDM Q5115 HCPCS 0636 RC 63459-0103-10 NDC outpatient 10 ML 2536.65 2536.65 454.23 454.23 fee schedule 2536.65 93 2054.69 percent of total billed charges 2536.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 335.94 other OPPS APC 2536.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 335.94 other OPPS APC 2536.65 24.86 630.61 percent of total billed charges 454.23 2536.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION RX-183818 CDM Q5115 HCPCS 0636 RC 63459-0104-50 NDC outpatient 50 ML 12683.3 12683.3 2271.17 2271.17 fee schedule 12683.3 93 10273.4 percent of total billed charges 12683.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1679.7 other OPPS APC 12683.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1679.7 other OPPS APC 12683.3 24.86 3153.06 percent of total billed charges 2271.17 12683.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEVACIZUMAB-BVZR 25 MG/ML INTRAVENOUS SOLUTION RX-183827 CDM Q5118 HCPCS 0636 RC 00069-0315-01 NDC outpatient 4 ML 1840.2 1840.2 321.86 321.86 fee schedule 1840.2 93 1490.56 percent of total billed charges 1840.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 235.86 other OPPS APC 1840.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 235.86 other OPPS APC 1840.2 24.86 457.47 percent of total billed charges 321.86 1840.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION RX-183837 CDM Q5119 HCPCS 0636 RC 00069-0238-01 NDC outpatient 10 ML 2150.4 2150.4 314 314 fee schedule 2150.4 93 1741.82 percent of total billed charges 2150.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 224.37 other OPPS APC 2150.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 224.37 other OPPS APC 2150.4 24.86 534.59 percent of total billed charges 314 2150.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMIPENEM-CILASTATIN-RELEBACTAM 1.25 GRAM INTRAVENOUS SOLUTION RX-183839 CDM J0742 HCPCS 0636 RC 00006-3856-01 NDC outpatient 10 ML 920.79 920.79 568.7 568.7 fee schedule 1473.27 93 1193.35 percent of total billed charges 920.79 920.79 other OPPS APC 920.79 920.79 other OPPS APC 920.79 24.86 228.91 percent of total billed charges 568.7 1473.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMIPENEM-CILASTATIN-RELEBACTAM 1.25 GRAM INTRAVENOUS SOLUTION RX-183839 CDM J0742 HCPCS 0636 RC 00006-3856-01 NDC outpatient 2 GR 1473.27 1473.27 568.7 568.7 fee schedule 1473.27 93 1193.35 percent of total billed charges 920.79 920.79 other OPPS APC 920.79 920.79 other OPPS APC 920.79 24.86 228.91 percent of total billed charges 568.7 1473.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRASTUZUMAB-DKST 150 MG INTRAVENOUS SOLUTION RX-183847 CDM Q5114 HCPCS 0636 RC 83257-0001-11 NDC outpatient 7.15 ML 2821.53 2821.53 691.88 691.88 fee schedule 2821.53 93 2285.44 percent of total billed charges 2821.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 812.37 other OPPS APC 2821.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 812.37 other OPPS APC 2821.53 24.86 701.43 percent of total billed charges 691.88 2821.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE" RX-18385 CDM A9270 HCPCS 0250 RC 68084-0697-01 NDC outpatient 1 UN 4.16 4.16 74 3.08 percent of total billed charges 4.16 93 3.37 percent of total billed charges 4.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.16 other OPPS APC 4.16 4.16 other OPPS APC 4.16 24.86 1.03 percent of total billed charges 4.16 4.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE" RX-18385 CDM A9270 HCPCS 0637 RC 68084-0697-01 NDC outpatient 1 UN 4.16 4.16 4.16 74 3.08 percent of total billed charges 4.16 93 3.37 percent of total billed charges 4.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.16 other OPPS APC 4.16 4.16 other OPPS APC 4.16 24.86 1.03 percent of total billed charges 4.16 4.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE" RX-18386 CDM A9270 HCPCS 0250 RC 68084-0708-25 NDC outpatient 1 UN 1.84 1.84 74 1.36 percent of total billed charges 1.84 93 1.49 percent of total billed charges 1.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.84 other OPPS APC 1.84 1.84 other OPPS APC 1.84 24.86 0.46 percent of total billed charges 1.84 1.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE" RX-18386 CDM A9270 HCPCS 0637 RC 68084-0708-25 NDC outpatient 1 UN 1.84 1.84 1.84 74 1.36 percent of total billed charges 1.84 93 1.49 percent of total billed charges 1.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.84 other OPPS APC 1.84 1.84 other OPPS APC 1.84 24.86 0.46 percent of total billed charges 1.84 1.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REMIFENTANIL 2 MG INTRAVENOUS SOLUTION RX-18400 CDM 250000000 HCPCS 0250 RC 00143-9392-10 NDC outpatient 2 ME 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 367.5 other OPPS APC 367.5 367.5 other OPPS APC 367.5 24.86 91.36 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REMIFENTANIL 2 MG INTRAVENOUS SOLUTION RX-18400 CDM 250000000 HCPCS 0250 RC 00143-9392-10 NDC outpatient 2 ML 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 367.5 other OPPS APC 367.5 367.5 other OPPS APC 367.5 24.86 91.36 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRASTUZUMAB-ANNS 150 MG INTRAVENOUS SOLUTION RX-184010 CDM Q5117 HCPCS 0636 RC 55513-0141-01 NDC outpatient 7.15 ML 4080.2 4080.2 410.19 410.19 fee schedule 4080.2 93 3304.96 percent of total billed charges 4080.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 364.98 other OPPS APC 4080.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 364.98 other OPPS APC 4080.2 24.86 1014.34 percent of total billed charges 410.19 4080.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARICITINIB 1 MG TABLET RX-184014 CDM A9270 HCPCS 0250 RC 00002-4732-30 NDC outpatient 1 UN 274 274 74 202.76 percent of total billed charges 274 93 221.94 percent of total billed charges 274 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 274 other OPPS APC 274 274 other OPPS APC 274 24.86 68.12 percent of total billed charges 274 274 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARICITINIB 1 MG TABLET RX-184014 CDM A9270 HCPCS 0637 RC 00002-4732-30 NDC outpatient 1 UN 274 274 274 74 202.76 percent of total billed charges 274 93 221.94 percent of total billed charges 274 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 274 other OPPS APC 274 274 other OPPS APC 274 24.86 68.12 percent of total billed charges 274 274 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEGFILGRASTIM-BMEZ 6 MG/0.6 ML SUBCUTANEOUS SYRINGE RX-184055 CDM Q5120 HCPCS 0636 RC 61314-0866-01 NDC outpatient 0.6 ML 11776.6 11776.6 411.64 411.64 fee schedule 11776.6 93 9539.05 percent of total billed charges 11776.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4161.06 other OPPS APC 11776.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4161.06 other OPPS APC 11776.6 24.86 2927.66 percent of total billed charges 411.64 11776.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION RX-184067 CDM J0896 HCPCS 0636 RC 59572-0711-01 NDC outpatient 25 ME 11860.3 11860.3 4472.16 4472.16 fee schedule 11860.3 93 9606.8 percent of total billed charges 11860.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4061.5 other OPPS APC 11860.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4061.5 other OPPS APC 11860.3 24.86 2948.46 percent of total billed charges 4472.16 11860.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LUSPATERCEPT-AAMT 75 MG SUBCUTANEOUS SOLUTION RX-184068 CDM J0896 HCPCS 0636 RC 59572-0775-01 NDC outpatient 1.5 ML 35580.7 35580.7 13416.5 13416.5 fee schedule 35580.7 93 28820.3 percent of total billed charges 35580.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12184.5 other OPPS APC 35580.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12184.5 other OPPS APC 35580.7 24.86 8845.35 percent of total billed charges 13416.5 35580.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MINERAL OIL, LIGHT STERILE" RX-184088 CDM A9270 HCPCS 0250 RC 63323-0254-10 NDC outpatient 10 ML 59.94 59.94 74 44.36 percent of total billed charges 59.94 93 48.55 percent of total billed charges 59.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.94 other OPPS APC 59.94 59.94 other OPPS APC 59.94 24.86 14.9 percent of total billed charges 59.94 59.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MINERAL OIL, LIGHT STERILE" RX-184088 CDM A9270 HCPCS 0637 RC 63323-0254-10 NDC outpatient 10 ML 59.94 59.94 59.94 74 44.36 percent of total billed charges 59.94 93 48.55 percent of total billed charges 59.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.94 other OPPS APC 59.94 59.94 other OPPS APC 59.94 24.86 14.9 percent of total billed charges 59.94 59.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION RX-184095 CDM J0791 HCPCS 0636 RC 00078-0883-61 NDC outpatient 10 ML 7358.83 7358.83 2890.45 2890.45 fee schedule 7358.83 93 5960.65 percent of total billed charges 7358.83 7358.83 other OPPS APC 7358.83 7358.83 other OPPS APC 7358.83 24.86 1829.41 percent of total billed charges 2890.45 7358.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION RX-184112 CDM J2796 HCPCS 0636 RC 55513-0223-01 NDC outpatient 0.25 ML 3932.95 3932.95 1416.64 1416.64 fee schedule 3932.95 93 3185.69 percent of total billed charges 3932.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1313.68 other OPPS APC 3932.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1313.68 other OPPS APC 3932.95 24.86 977.73 percent of total billed charges 1416.64 3932.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION|DISCARDED DRUG NOT ADMINISTERED RX-184112 CDM J2796 HCPCS 0636 RC 55513-0223-01 NDC JW outpatient 0.25 ML 3932.95 3932.95 1307.67 1307.67 fee schedule 3932.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1212.62 other OPPS APC 3932.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1212.62 other OPPS APC 1307.67 3932.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GIVOSIRAN 189 MG/ML SUBCUTANEOUS SOLUTION RX-184131 CDM J0223 HCPCS 0636 RC 71336-1001-01 NDC outpatient 189 ME 127848 127848 48537.2 48537.2 fee schedule 127848 93 103557 percent of total billed charges 127848 127848 other OPPS APC 127848 127848 other OPPS APC 127848 24.86 31783 percent of total billed charges 48537.2 127848 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENFORTUMAB VEDOTIN-EJFV 20 MG INTRAVENOUS SOLUTION RX-184207 CDM J9177 HCPCS 0636 RC 51144-0020-01 NDC outpatient 2 ML 8427 8427 3087.92 3087.92 fee schedule 8427 93 6825.87 percent of total billed charges 8427 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2939.28 other OPPS APC 8427 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2939.28 other OPPS APC 8427 24.86 2094.95 percent of total billed charges 3087.92 8427 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENFORTUMAB VEDOTIN-EJFV 30 MG INTRAVENOUS SOLUTION RX-184208 CDM J9177 HCPCS 0636 RC 51144-0030-01 NDC outpatient 3 ML 12640.5 12640.5 4631.88 4631.88 fee schedule 12640.5 93 10238.8 percent of total billed charges 12640.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4408.92 other OPPS APC 12640.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4408.92 other OPPS APC 12640.5 24.86 3142.43 percent of total billed charges 4631.88 12640.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FAM-TRASTUZUMAB DERUXTECAN-NXKI 100 MG INTRAVENOUS SOLUTION RX-184213 CDM J9358 HCPCS 0636 RC 65597-0406-01 NDC outpatient 5 ML 8425.1 8425.1 2994.75 2994.75 fee schedule 8425.1 93 6824.33 percent of total billed charges 8425.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2781.1 other OPPS APC 8425.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2781.1 other OPPS APC 8425.1 24.86 2094.48 percent of total billed charges 2994.75 8425.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRASTUZUMAB-QYYP 420 MG INTRAVENOUS SOLUTION RX-184974 CDM Q5116 HCPCS 0636 RC 00069-0305-01 NDC outpatient 20 ML 10173.3 10173.3 1109.91 1109.91 fee schedule 10173.3 93 8240.33 percent of total billed charges 10173.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 805.14 other OPPS APC 10173.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 805.14 other OPPS APC 10173.3 24.86 2529.07 percent of total billed charges 1109.91 10173.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION RX-184992 CDM J0699 HCPCS 0636 RC 59630-0266-10 NDC outpatient 1 GR 658.98 658.98 246.84 246.84 fee schedule 658.98 93 533.77 percent of total billed charges 658.98 658.98 other OPPS APC 658.98 658.98 other OPPS APC 658.98 24.86 163.82 percent of total billed charges 246.84 658.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SACITUZUMAB GOVITECAN-HZIY 180 MG INTRAVENOUS SOLUTION RX-185328 CDM J9317 HCPCS 0636 RC 55135-0132-01 NDC outpatient 18 ML 7391.88 7391.88 2738.18 2738.18 fee schedule 7391.88 93 5987.42 percent of total billed charges 7391.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2496.1 other OPPS APC 7391.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2496.1 other OPPS APC 7391.88 24.86 1837.62 percent of total billed charges 2738.18 7391.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN" RX-185355 CDM J9144 HCPCS 0636 RC 57894-0503-01 NDC outpatient 15 ML 29079.2 29079.2 10092.9 10092.9 fee schedule 29079.2 93 23554.2 percent of total billed charges 29079.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9253.98 other OPPS APC 29079.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9253.98 other OPPS APC 29079.2 24.86 7229.09 percent of total billed charges 10092.9 29079.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. C.I. ACID BLUE 90 0.025 % INTRAOCULAR SYRINGE RX-186163 CDM A9270 HCPCS 0250 RC 68803-0722-25 NDC outpatient 0.5 ML 350 350 74 259 percent of total billed charges 350 93 283.5 percent of total billed charges 350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 350 other OPPS APC 350 350 other OPPS APC 350 24.86 87.01 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. C.I. ACID BLUE 90 0.025 % INTRAOCULAR SYRINGE RX-186163 CDM A9270 HCPCS 0637 RC 68803-0722-25 NDC outpatient 0.5 ML 350 350 350 74 259 percent of total billed charges 350 93 283.5 percent of total billed charges 350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 350 other OPPS APC 350 350 other OPPS APC 350 24.86 87.01 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION RX-186173 CDM J0248 HCPCS 0250 RC 61958-2901-02 NDC outpatient 1 UN 1798.45 1798.45 1798.45 74 1330.85 percent of total billed charges 1798.45 93 1456.74 percent of total billed charges 1798.45 1798.45 other OPPS APC 1798.45 1798.45 other OPPS APC 1798.45 24.86 447.09 percent of total billed charges 1798.45 1798.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION RX-186173 CDM J0248 HCPCS 0250 RC 61958-2901-02 NDC outpatient 20 ML 1798.45 1798.45 1798.45 74 1330.85 percent of total billed charges 1798.45 93 1456.74 percent of total billed charges 1798.45 1798.45 other OPPS APC 1798.45 1798.45 other OPPS APC 1798.45 24.86 447.09 percent of total billed charges 1798.45 1798.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LATANOPROST 0.005 % EYE DROPS RX-18621 CDM A9270 HCPCS 0250 RC 59762-0333-02 NDC outpatient 2.5 ML 238.18 238.18 74 176.25 percent of total billed charges 238.18 93 192.93 percent of total billed charges 238.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.18 other OPPS APC 238.18 238.18 other OPPS APC 238.18 24.86 59.21 percent of total billed charges 238.18 238.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LATANOPROST 0.005 % EYE DROPS RX-18621 CDM A9270 HCPCS 0637 RC 59762-0333-02 NDC outpatient 2.5 ML 238.18 238.18 238.18 74 176.25 percent of total billed charges 238.18 93 192.93 percent of total billed charges 238.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.18 other OPPS APC 238.18 238.18 other OPPS APC 238.18 24.86 59.21 percent of total billed charges 238.18 238.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LURBINECTEDIN 4 MG INTRAVENOUS SOLUTION RX-186313 CDM J9223 HCPCS 0636 RC 68727-0712-01 NDC outpatient 8 ML 24090 24090 9003.37 9003.37 fee schedule 24090 93 19512.9 percent of total billed charges 24090 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8144.16 other OPPS APC 24090 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8144.16 other OPPS APC 24090 24.86 5988.77 percent of total billed charges 9003.37 24090 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PERTUZUMAB 1,200 MG-TRASTUZUMAB 600 MG-HYALURON-ZZXF/15 ML SUBCUT SOLN" RX-186382 CDM J9316 HCPCS 0636 RC 50242-0245-01 NDC outpatient 15 ML 39951.8 39951.8 14015.4 14015.4 fee schedule 39951.8 93 32360.9 percent of total billed charges 39951.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11623.7 other OPPS APC 39951.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11623.7 other OPPS APC 39951.8 24.86 9932.01 percent of total billed charges 14015.4 39951.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERTUZUMAB 600 MG-TRASTUZUMAB 600 MG-HYALURONID-ZZXF/10 ML SUBCUT SOLN RX-186383 CDM J9316 HCPCS 0636 RC 50242-0260-01 NDC outpatient 10 ML 26633.5 26633.5 9343.62 9343.62 fee schedule 26633.5 93 21573.1 percent of total billed charges 26633.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7749.12 other OPPS APC 26633.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7749.12 other OPPS APC 26633.5 24.86 6621.08 percent of total billed charges 9343.62 26633.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MIDAZOLAM (PF) 1 MG/ML IN SODIUM CHLORIDE,ISO-OSM INTRAVENOUS SOLUTION" RX-186428 CDM j2250 HCPCS 0636 RC 69374-0314-10 NDC outpatient 100 ME 55 55 55 74 40.7 percent of total billed charges 55 93 44.55 percent of total billed charges 55 55 other OPPS APC 55 55 other OPPS APC 55 24.86 13.67 percent of total billed charges 55 55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MIDAZOLAM (PF) 1 MG/ML IN SODIUM CHLORIDE,ISO-OSM INTRAVENOUS SOLUTION" RX-186428 CDM j2250 HCPCS 0636 RC 69374-0314-10 NDC outpatient 100 ML 55 55 55 74 40.7 percent of total billed charges 55 93 44.55 percent of total billed charges 55 55 other OPPS APC 55 55 other OPPS APC 55 24.86 13.67 percent of total billed charges 55 55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION RX-186511 CDM J9073 HCPCS 0636 RC 50742-0520-05 NDC outpatient 5 ML 2197.5 2197.5 2197.5 74 1626.15 percent of total billed charges 2197.5 93 1779.98 percent of total billed charges 2197.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 185 other OPPS APC 2197.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 185 other OPPS APC 2197.5 24.86 546.3 percent of total billed charges 2197.5 2197.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAFASITAMAB-CXIX 200 MG INTRAVENOUS SOLUTION RX-186521 CDM J9349 HCPCS 0636 RC 73535-0208-01 NDC outpatient 5 ML 4044.6 4044.6 1518.55 1518.55 fee schedule 4044.6 93 3276.13 percent of total billed charges 4044.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1370.9 other OPPS APC 4044.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1370.9 other OPPS APC 4044.6 24.86 1005.49 percent of total billed charges 1518.55 4044.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BELANTAMAB MAFODOTIN-BLMF 100 MG INTRAVENOUS SOLUTION RX-186527 CDM J9037 HCPCS 0636 RC 00173-0896-01 NDC outpatient 2 ML 25203.5 25203.5 25203.5 74 18650.6 percent of total billed charges 25203.5 93 20414.8 percent of total billed charges 25203.5 25203.5 other OPPS APC 25203.5 25203.5 other OPPS APC 25203.5 24.86 6265.59 percent of total billed charges 25203.5 25203.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THROMBIN(HUM-PLAS)-FIBRIN-CALC 500 UNIT-80 MG/ML (4ML) TOPICAL SYRINGE RX-186585 CDM 250000000 HCPCS 0250 RC 61953-0012-01 NDC outpatient 4 ML 566.45 566.45 566.45 74 419.17 percent of total billed charges 566.45 93 458.82 percent of total billed charges 566.45 566.45 other OPPS APC 566.45 566.45 other OPPS APC 566.45 24.86 140.82 percent of total billed charges 566.45 566.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FERRIC DERISOMALTOSE 100 MG IRON/ML INTRAVENOUS SOLUTION RX-187165 CDM J1437 HCPCS 0636 RC 73594-9310-01 NDC outpatient 10 ML 9740.3 9740.3 2353.45 2353.45 fee schedule 9740.3 93 7889.64 percent of total billed charges 9740.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2105.2 other OPPS APC 9740.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2105.2 other OPPS APC 9740.3 24.86 2421.44 percent of total billed charges 2353.45 9740.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION RX-187184 CDM 250000000 HCPCS 0250 RC 00517-9305-25 NDC outpatient 1 ML 77.46 77.46 77.46 74 57.32 percent of total billed charges 77.46 93 62.74 percent of total billed charges 77.46 77.46 other OPPS APC 77.46 77.46 other OPPS APC 77.46 24.86 19.26 percent of total billed charges 77.46 77.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ISOPROTERENOL 200 MCG/50 ML(4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV SOLN RX-187320 CDM 250000000 HCPCS 0250 RC 70004-0695-31 NDC outpatient 0.2 ME 433.13 433.13 433.13 74 320.52 percent of total billed charges 433.13 93 350.84 percent of total billed charges 433.13 433.13 other OPPS APC 433.13 433.13 other OPPS APC 433.13 24.86 107.68 percent of total billed charges 433.13 433.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ISOPROTERENOL 200 MCG/50 ML(4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV SOLN RX-187320 CDM 250000000 HCPCS 0250 RC 70004-0695-31 NDC outpatient 50 ML 433.13 433.13 433.13 74 320.52 percent of total billed charges 433.13 93 350.84 percent of total billed charges 433.13 433.13 other OPPS APC 433.13 433.13 other OPPS APC 433.13 24.86 107.68 percent of total billed charges 433.13 433.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMINO ACIDS 8 %-DEXTROSE 14 %-ELECTROLYTES INTRAVENOUS SOLUTION RX-187355 CDM 250000000 HCPCS 0250 RC 00338-0202-01 NDC outpatient 1000 ML 188.83 188.83 188.83 74 139.73 percent of total billed charges 188.83 93 152.95 percent of total billed charges 188.83 188.83 other OPPS APC 188.83 188.83 other OPPS APC 188.83 24.86 46.94 percent of total billed charges 188.83 188.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMINO ACID 8 % IN DEXTROSE 14 % WATER INTRAVENOUS SOLUTION RX-187358 CDM 250000000 HCPCS 0250 RC 00338-0180-01 NDC outpatient 1000 ML 187.08 187.08 187.08 74 138.44 percent of total billed charges 187.08 93 151.53 percent of total billed charges 187.08 187.08 other OPPS APC 187.08 187.08 other OPPS APC 187.08 24.86 46.51 percent of total billed charges 187.08 187.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DONEPEZIL 5 MG TABLET RX-18786 CDM A9270 HCPCS 0250 RC 60687-0292-01 NDC outpatient 1 UN 1.95 1.95 74 1.44 percent of total billed charges 1.95 93 1.58 percent of total billed charges 1.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.95 other OPPS APC 1.95 1.95 other OPPS APC 1.95 24.86 0.48 percent of total billed charges 1.95 1.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DONEPEZIL 5 MG TABLET RX-18786 CDM A9270 HCPCS 0637 RC 60687-0292-01 NDC outpatient 1 UN 1.95 1.95 1.95 74 1.44 percent of total billed charges 1.95 93 1.58 percent of total billed charges 1.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.95 other OPPS APC 1.95 1.95 other OPPS APC 1.95 24.86 0.48 percent of total billed charges 1.95 1.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION RX-188306 CDM J0461 HCPCS 0636 RC 16729-0525-08 NDC outpatient 1 ML 36 36 3.87 3.87 fee schedule 36 93 29.16 percent of total billed charges 36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36 other OPPS APC 36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36 other OPPS APC 36 24.86 8.95 percent of total billed charges 3.87 36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATROPINE 1 MG/ML INTRAVENOUS SOLUTION RX-188307 CDM J0461 HCPCS 0636 RC 16729-0526-08 NDC outpatient 1 ML 56.52 56.52 9.68 9.68 fee schedule 56.52 93 45.78 percent of total billed charges 56.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56.52 other OPPS APC 56.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56.52 other OPPS APC 56.52 24.86 14.05 percent of total billed charges 9.68 56.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THROMBIN(HUM-PLAS)-FIBRIN-CAL 500 UNIT-80 MG/ML (10ML) TOPICAL SYRINGE RX-188316 CDM 250000000 HCPCS 0250 RC 61953-0014-01 NDC outpatient 10 ML 1283.63 1283.63 1283.63 74 949.89 percent of total billed charges 1283.63 93 1039.74 percent of total billed charges 1283.63 1283.63 other OPPS APC 1283.63 1283.63 other OPPS APC 1283.63 24.86 319.11 percent of total billed charges 1283.63 1283.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "EPOETIN ALFA-EPBX 20,000 UNIT/ML INJECTION SOLUTION" RX-188412 CDM Q5106 HCPCS 0635 RC 00069-1311-10 NDC outpatient 1 ML 661.8 661.8 171.09 171.09 fee schedule 661.8 93 536.06 percent of total billed charges 661.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.36 other OPPS APC 661.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.36 other OPPS APC 661.8 51 337.52 percent of total billed charges 171.09 661.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION RX-18877 CDM Q0162 HCPCS 0250 RC 50268-0647-14 NDC outpatient 5 ML 38.27 38.27 74 28.32 percent of total billed charges 38.27 93 31 percent of total billed charges 38.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.27 other OPPS APC 38.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.27 other OPPS APC 38.27 24.86 9.51 percent of total billed charges 38.27 38.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION RX-18877 CDM Q0162 HCPCS 0637 RC 50268-0647-14 NDC outpatient 5 ML 38.27 38.27 38.27 74 28.32 percent of total billed charges 38.27 93 31 percent of total billed charges 38.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.27 other OPPS APC 38.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.27 other OPPS APC 38.27 24.86 9.51 percent of total billed charges 38.27 38.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION RX-18908 CDM 250000000 HCPCS 0250 RC 70069-0261-01 NDC outpatient 2 ML 62.5 62.5 62.5 74 46.25 percent of total billed charges 62.5 93 50.63 percent of total billed charges 62.5 62.5 other OPPS APC 62.5 62.5 other OPPS APC 62.5 24.86 15.54 percent of total billed charges 62.5 62.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOFLOXACIN 500 MG TABLET RX-18919 CDM A9270 HCPCS 0250 RC 00904-6352-61 NDC outpatient 1 UN 42.06 42.06 74 31.12 percent of total billed charges 42.06 93 34.07 percent of total billed charges 42.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42.06 other OPPS APC 42.06 42.06 other OPPS APC 42.06 24.86 10.46 percent of total billed charges 42.06 42.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOFLOXACIN 500 MG TABLET RX-18919 CDM A9270 HCPCS 0637 RC 00904-6352-61 NDC outpatient 1 UN 42.06 42.06 42.06 74 31.12 percent of total billed charges 42.06 93 34.07 percent of total billed charges 42.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42.06 other OPPS APC 42.06 42.06 other OPPS APC 42.06 24.86 10.46 percent of total billed charges 42.06 42.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOPIRAMATE 25 MG TABLET RX-18920 CDM A9270 HCPCS 0250 RC 68084-0342-01 NDC outpatient 1 UN 5.25 5.25 74 3.89 percent of total billed charges 5.25 93 4.25 percent of total billed charges 5.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.25 other OPPS APC 5.25 5.25 other OPPS APC 5.25 24.86 1.31 percent of total billed charges 5.25 5.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOPIRAMATE 25 MG TABLET RX-18920 CDM A9270 HCPCS 0637 RC 68084-0342-01 NDC outpatient 1 UN 5.25 5.25 5.25 74 3.89 percent of total billed charges 5.25 93 4.25 percent of total billed charges 5.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.25 other OPPS APC 5.25 5.25 other OPPS APC 5.25 24.86 1.31 percent of total billed charges 5.25 5.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOPIRAMATE 100 MG TABLET RX-18922 CDM A9270 HCPCS 0250 RC 68084-0344-01 NDC outpatient 1 UN 15.5 15.5 74 11.47 percent of total billed charges 15.5 93 12.56 percent of total billed charges 15.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.5 other OPPS APC 15.5 15.5 other OPPS APC 15.5 24.86 3.85 percent of total billed charges 15.5 15.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOPIRAMATE 100 MG TABLET RX-18922 CDM A9270 HCPCS 0637 RC 68084-0344-01 NDC outpatient 1 UN 15.5 15.5 15.5 74 11.47 percent of total billed charges 15.5 93 12.56 percent of total billed charges 15.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.5 other OPPS APC 15.5 15.5 other OPPS APC 15.5 24.86 3.85 percent of total billed charges 15.5 15.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRASTUZUMAB-QYYP 150 MG INTRAVENOUS SOLUTION RX-189426 CDM Q5116 HCPCS 0636 RC 00069-0308-01 NDC outpatient 7.15 ML 3633.3 3633.3 396.4 396.4 fee schedule 3633.3 93 2942.97 percent of total billed charges 3633.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 287.55 other OPPS APC 3633.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 287.55 other OPPS APC 3633.3 24.86 903.24 percent of total billed charges 396.4 3633.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONCASTUXIMAB TESIRINE-LPYL 10 MG INTRAVENOUS SOLUTION RX-189782 CDM J9359 HCPCS 0636 RC 79952-0110-01 NDC outpatient 2 ML 81069.8 81069.8 30049.4 30049.4 fee schedule 81069.8 93 65666.5 percent of total billed charges 81069.8 81069.8 other OPPS APC 81069.8 81069.8 other OPPS APC 81069.8 24.86 20154 percent of total billed charges 30049.4 81069.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONCASTUXIMAB TESIRINE-LPYL 10 MG INTRAVENOUS SOLUTION|DISCARDED DRUG NOT ADMINISTERED RX-189782 CDM J9359 HCPCS 0636 RC 79952-0110-01 NDC JW outpatient 2 ML 81069.8 81069.8 29825.2 29825.2 fee schedule 29825.2 81069.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOSTARLIMAB-GXLY 50 MG/ML INTRAVENOUS SOLUTION RX-189790 CDM J9272 HCPCS 0636 RC 00173-0898-03 NDC outpatient 10 ML 34689.3 34689.3 12951.8 12951.8 fee schedule 34689.3 93 28098.4 percent of total billed charges 34689.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11820.1 other OPPS APC 34689.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11820.1 other OPPS APC 34689.3 24.86 8623.77 percent of total billed charges 12951.8 34689.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMIVANTAMAB-VMJW 50 MG/ML INTRAVENOUS SOLUTION RX-189911 CDM J9061 HCPCS 0636 RC 57894-0501-01 NDC outpatient 7 ML 10448 10448 3921.61 3921.61 fee schedule 10448 93 8462.86 percent of total billed charges 10448 10448 other OPPS APC 10448 10448 other OPPS APC 10448 24.86 2597.37 percent of total billed charges 3921.61 10448 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE RX-190859 CDM 90677 HCPCS 0636 RC 00005-2000-10 NDC outpatient 0.5 ML 784.43 784.43 329.51 329.51 fee schedule 784.43 93 635.39 percent of total billed charges 784.43 784.43 other OPPS APC 784.43 784.43 other OPPS APC 784.43 24.86 195.01 percent of total billed charges 329.51 784.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHOTREXATE (PF) 125 MG/5 ML SYRINGE KIT RX-191303 CDM J9260 HCPCS 0636 RC 05446-1505-05 NDC outpatient 5 ML 650 650 9.29 9.29 fee schedule 650 93 526.5 percent of total billed charges 650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 650 other OPPS APC 650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 650 other OPPS APC 650 24.86 161.59 percent of total billed charges 9.29 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHOTREXATE (PF) 125 MG/5 ML SYRINGE KIT|DISCARDED DRUG NOT ADMINISTERED RX-191303 CDM J9260 HCPCS 0636 RC 05446-1505-05 NDC JW outpatient 5 ML 650 650 6.2 6.2 fee schedule 6.2 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NIVOLUMAB 120 MG/12 ML INTRAVENOUS SOLUTION RX-191359 CDM J9299 HCPCS 0636 RC 00003-3756-14 NDC outpatient 12 ML 11451.9 11451.9 4171.6 4171.6 fee schedule 11451.9 93 9276.06 percent of total billed charges 11451.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3810 other OPPS APC 11451.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3810 other OPPS APC 11451.9 24.86 2846.95 percent of total billed charges 4171.6 11451.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATORVASTATIN 10 MG TABLET RX-19176 CDM A9270 HCPCS 0250 RC 00904-6290-61 NDC outpatient 1 UN 1.25 1.25 74 0.93 percent of total billed charges 1.25 93 1.01 percent of total billed charges 1.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.25 other OPPS APC 1.25 1.25 other OPPS APC 1.25 24.86 0.31 percent of total billed charges 1.25 1.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATORVASTATIN 10 MG TABLET RX-19176 CDM A9270 HCPCS 0637 RC 00904-6290-61 NDC outpatient 1 UN 1.25 1.25 1.25 74 0.93 percent of total billed charges 1.25 93 1.01 percent of total billed charges 1.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.25 other OPPS APC 1.25 1.25 other OPPS APC 1.25 24.86 0.31 percent of total billed charges 1.25 1.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATORVASTATIN 40 MG TABLET RX-19177 CDM A9270 HCPCS 0250 RC 50268-0095-15 NDC outpatient 1 UN 1.32 1.32 74 0.98 percent of total billed charges 1.32 93 1.07 percent of total billed charges 1.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.32 other OPPS APC 1.32 1.32 other OPPS APC 1.32 24.86 0.33 percent of total billed charges 1.32 1.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATORVASTATIN 40 MG TABLET RX-19177 CDM A9270 HCPCS 0637 RC 50268-0095-15 NDC outpatient 1 UN 1.32 1.32 1.32 74 0.98 percent of total billed charges 1.32 93 1.07 percent of total billed charges 1.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.32 other OPPS APC 1.32 1.32 other OPPS APC 1.32 24.86 0.33 percent of total billed charges 1.32 1.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATORVASTATIN 20 MG TABLET RX-19178 CDM A9270 HCPCS 0250 RC 50268-0094-15 NDC outpatient 1 UN 1.31 1.31 74 0.97 percent of total billed charges 1.31 93 1.06 percent of total billed charges 1.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.31 other OPPS APC 1.31 1.31 other OPPS APC 1.31 24.86 0.33 percent of total billed charges 1.31 1.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATORVASTATIN 20 MG TABLET RX-19178 CDM A9270 HCPCS 0637 RC 50268-0094-15 NDC outpatient 1 UN 1.31 1.31 1.31 74 0.97 percent of total billed charges 1.31 93 1.06 percent of total billed charges 1.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.31 other OPPS APC 1.31 1.31 other OPPS APC 1.31 24.86 0.33 percent of total billed charges 1.31 1.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK" RX-191988 CDM A9270 HCPCS 0250 RC 00069-5321-30 NDC outpatient 1 UN 4357.65 4357.65 74 3224.66 percent of total billed charges 4357.65 93 3529.7 percent of total billed charges 4357.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4357.65 other OPPS APC 4357.65 4357.65 other OPPS APC 4357.65 24.86 1083.31 percent of total billed charges 4357.65 4357.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLET,DOSE PACK" RX-191988 CDM A9270 HCPCS 0637 RC 00069-5321-30 NDC outpatient 1 UN 4357.65 4357.65 4357.65 74 3224.66 percent of total billed charges 4357.65 93 3529.7 percent of total billed charges 4357.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4357.65 other OPPS APC 4357.65 4357.65 other OPPS APC 4357.65 24.86 1083.31 percent of total billed charges 4357.65 4357.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFAZOLIN 2 GRAM SOLUTION FOR INJECTION RX-192218 CDM J0690 HCPCS 0636 RC 60505-6231-05 NDC outpatient 14.7 ML 18.28 18.28 3.97 3.97 fee schedule 18.28 93 14.81 percent of total billed charges 18.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.28 other OPPS APC 18.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.28 other OPPS APC 18.28 24.86 4.54 percent of total billed charges 3.97 18.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFAZOLIN 2 GRAM SOLUTION FOR INJECTION RX-192218 CDM J0690 HCPCS 0636 RC 60505-6231-05 NDC outpatient 2000 ME 18.28 18.28 3.97 3.97 fee schedule 18.28 93 14.81 percent of total billed charges 18.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.28 other OPPS APC 18.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.28 other OPPS APC 18.28 24.86 4.54 percent of total billed charges 3.97 18.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VASOPRESSIN 0.4 UNIT/ML INTRAVENOUS SOLUTION RX-192380 CDM J2598 HCPCS 0250 RC 42023-0219-10 NDC outpatient 100 ML 1274.27 1274.27 1274.27 74 942.96 percent of total billed charges 1274.27 93 1032.16 percent of total billed charges 1274.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1274.27 other OPPS APC 1274.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1274.27 other OPPS APC 1274.27 24.86 316.78 percent of total billed charges 1274.27 1274.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION RX-192534 CDM J9298 HCPCS 0636 RC 00003-7125-11 NDC outpatient 20 ML 44469.3 44469.3 16769.6 16769.6 fee schedule 44469.3 93 36020.2 percent of total billed charges 44469.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15236.9 other OPPS APC 44469.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15236.9 other OPPS APC 44469.3 24.86 11055.1 percent of total billed charges 16769.6 44469.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CLONIDINE (PF) 1,000 MCG/10 ML (100 MCG/ML) EPIDURAL SOLUTION" RX-19333 CDM J0735 HCPCS 0636 RC 00143-9724-01 NDC outpatient 10 ML 126 126 24.02 24.02 fee schedule 126 93 102.06 percent of total billed charges 126 126 other OPPS APC 126 126 other OPPS APC 126 24.86 31.32 percent of total billed charges 24.02 126 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEVACIZUMAB-MALY 25 MG/ML INTRAVENOUS SOLUTION RX-193458 CDM Q5126 HCPCS 0636 RC 70121-1754-07 NDC outpatient 4 ML 2155.8 2155.8 827.76 827.76 fee schedule 2155.8 93 1746.2 percent of total billed charges 2155.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 568.56 other OPPS APC 2155.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 568.56 other OPPS APC 2155.8 24.86 535.93 percent of total billed charges 827.76 2155.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEVACIZUMAB-MALY 25 MG/ML INTRAVENOUS SOLUTION RX-193458 CDM Q5126 HCPCS 0636 RC 70121-1755-01 NDC outpatient 16 ML 8623.2 8623.2 3311.04 3311.04 fee schedule 8623.2 93 6984.79 percent of total billed charges 8623.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2274.24 other OPPS APC 8623.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2274.24 other OPPS APC 8623.2 24.86 2143.73 percent of total billed charges 3311.04 8623.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEMETREXED DISODIUM 25 MG/ML INTRAVENOUS SOLUTION RX-193520 CDM J9294 HCPCS 0636 RC 00409-1045-01 NDC outpatient 4 ML 330 330 114.1 114.1 fee schedule 330 93 267.3 percent of total billed charges 330 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.18 other OPPS APC 330 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.18 other OPPS APC 330 24.86 82.04 percent of total billed charges 114.1 330 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEMETREXED 100 MG INTRAVENOUS POWDER FOR SOLUTION RX-193544 CDM J9323 HCPCS 0636 RC 00409-1060-01 NDC outpatient 4 ML 330 330 330 74 244.2 percent of total billed charges 330 93 267.3 percent of total billed charges 330 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 105.54 other OPPS APC 330 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 105.54 other OPPS APC 330 24.86 82.04 percent of total billed charges 330 330 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WARFARIN 3 MG TABLET RX-19433 CDM A9270 HCPCS 0250 RC 00832-1214-01 NDC outpatient 1 UN 1.66 1.66 74 1.23 percent of total billed charges 1.66 93 1.34 percent of total billed charges 1.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.66 other OPPS APC 1.66 1.66 other OPPS APC 1.66 24.86 0.41 percent of total billed charges 1.66 1.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WARFARIN 3 MG TABLET RX-19433 CDM A9270 HCPCS 0637 RC 00832-1214-01 NDC outpatient 1 UN 1.66 1.66 1.66 74 1.23 percent of total billed charges 1.66 93 1.34 percent of total billed charges 1.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.66 other OPPS APC 1.66 1.66 other OPPS APC 1.66 24.86 0.41 percent of total billed charges 1.66 1.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INTRAVENOUS SOLUTION RX-194674 CDM 250000000 HCPCS 0250 RC 81284-0315-05 NDC outpatient 5 ML 1200 1200 1200 74 888 percent of total billed charges 1200 93 972 percent of total billed charges 1200 1200 other OPPS APC 1200 1200 other OPPS APC 1200 24.86 298.32 percent of total billed charges 1200 1200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET RX-19483 CDM A9270 HCPCS 0250 RC 00904-5460-52 NDC outpatient 1 UN 0.09 0.09 74 0.07 percent of total billed charges 0.09 93 0.07 percent of total billed charges 0.09 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.09 other OPPS APC 0.09 0.09 other OPPS APC 0.09 24.86 0.02 percent of total billed charges 0.09 0.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET RX-19483 CDM A9270 HCPCS 0637 RC 00904-5460-52 NDC outpatient 1 UN 0.09 0.09 0.09 74 0.07 percent of total billed charges 0.09 93 0.07 percent of total billed charges 0.09 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.09 other OPPS APC 0.09 0.09 other OPPS APC 0.09 24.86 0.02 percent of total billed charges 0.09 0.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREMELIMUMAB-ACTL 20 MG/ML INTRAVENOUS SOLUTION RX-194930 CDM J9347 HCPCS 0636 RC 00310-4535-30 NDC outpatient 15 ML 119340 119340 46765.3 46765.3 fee schedule 119340 93 96665.4 percent of total billed charges 119340 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40634.4 other OPPS APC 119340 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40634.4 other OPPS APC 119340 24.86 29667.9 percent of total billed charges 46765.3 119340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION RX-194935 CDM J9380 HCPCS 0636 RC 57894-0450-01 NDC outpatient 1.7 ML 29145.9 29145.9 10804.2 10804.2 fee schedule 29145.9 93 23608.2 percent of total billed charges 29145.9 29145.9 other OPPS APC 29145.9 29145.9 other OPPS APC 29145.9 24.86 7245.68 percent of total billed charges 10804.2 29145.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TECLISTAMAB-CQYV 10 MG/ML SUBCUTANEOUS SOLUTION RX-194936 CDM J9380 HCPCS 0636 RC 57894-0449-01 NDC outpatient 3 ML 5714.88 5714.88 2118.47 2118.47 fee schedule 5714.88 93 4629.05 percent of total billed charges 5714.88 5714.88 other OPPS APC 5714.88 5714.88 other OPPS APC 5714.88 24.86 1420.72 percent of total billed charges 2118.47 5714.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MENINGOCOCCAL VAC A,C,Y,W-135 DIP(PF) 10 MCG-5 MCG/0.5 ML IM SOLUTION" RX-194940 CDM 250000000 HCPCS 0250 RC 58160-0827-30 NDC outpatient 0.5 ML 471.68 471.68 471.68 74 349.04 percent of total billed charges 471.68 93 382.06 percent of total billed charges 471.68 471.68 other OPPS APC 471.68 471.68 other OPPS APC 471.68 24.86 117.26 percent of total billed charges 471.68 471.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIRVETUXIMAB SORAVTANSINE-GYNX 5 MG/ML INTRAVENOUS SOLUTION RX-194988 CDM J9063 HCPCS 0636 RC 72903-0853-01 NDC outpatient 20 ML 19461.5 19461.5 7511.68 7511.68 fee schedule 19461.5 93 15763.8 percent of total billed charges 19461.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6675.8 other OPPS APC 19461.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6675.8 other OPPS APC 19461.5 24.86 4838.12 percent of total billed charges 7511.68 19461.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOSUNETUZUMAB-AXGB 1 MG/ML INTRAVENOUS SOLUTION RX-195188 CDM J9350 HCPCS 0636 RC 50242-0142-01 NDC outpatient 30 ML 55081.3 55081.3 55081.3 74 40760.2 percent of total billed charges 55081.3 93 44615.9 percent of total billed charges 55081.3 55081.3 other OPPS APC 55081.3 55081.3 other OPPS APC 55081.3 24.86 13693.2 percent of total billed charges 55081.3 55081.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFAZOLIN 2 GRAM INTRAVENOUS SOLUTION RX-196037 CDM J0687 HCPCS 0636 RC 44567-0840-25 NDC outpatient 14.7 ML 14.64 14.64 14.64 74 10.83 percent of total billed charges 14.64 93 11.86 percent of total billed charges 14.64 14.64 other OPPS APC 14.64 14.64 other OPPS APC 14.64 24.86 3.64 percent of total billed charges 14.64 14.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFAZOLIN 2 GRAM INTRAVENOUS SOLUTION RX-196037 CDM J0687 HCPCS 0636 RC 44567-0840-25 NDC outpatient 2000 ME 14.64 14.64 14.64 74 10.83 percent of total billed charges 14.64 93 11.86 percent of total billed charges 14.64 14.64 other OPPS APC 14.64 14.64 other OPPS APC 14.64 24.86 3.64 percent of total billed charges 14.64 14.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFAZOLIN 3 GRAM INTRAVENOUS SOLUTION RX-196038 CDM J0688 HCPCS 0636 RC 00143-9140-25 NDC outpatient 15.3 ML 26.33 26.33 26.33 74 19.48 percent of total billed charges 26.33 93 21.33 percent of total billed charges 26.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 26.33 other OPPS APC 26.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 26.33 other OPPS APC 26.33 24.86 6.55 percent of total billed charges 26.33 26.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFAZOLIN 3 GRAM INTRAVENOUS SOLUTION RX-196038 CDM J0688 HCPCS 0636 RC 00143-9140-25 NDC outpatient 3000 ME 26.33 26.33 26.33 74 19.48 percent of total billed charges 26.33 93 21.33 percent of total billed charges 26.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 26.33 other OPPS APC 26.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 26.33 other OPPS APC 26.33 24.86 6.55 percent of total billed charges 26.33 26.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENYLEPHRINE 10 % EYE DROPS RX-19636 CDM A9270 HCPCS 0250 RC 70756-0614-30 NDC outpatient 5 ML 125 125 74 92.5 percent of total billed charges 125 93 101.25 percent of total billed charges 125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 125 other OPPS APC 125 125 other OPPS APC 125 24.86 31.08 percent of total billed charges 125 125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENYLEPHRINE 10 % EYE DROPS RX-19636 CDM A9270 HCPCS 0637 RC 70756-0614-30 NDC outpatient 5 ML 125 125 125 74 92.5 percent of total billed charges 125 93 101.25 percent of total billed charges 125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 125 other OPPS APC 125 125 other OPPS APC 125 24.86 31.08 percent of total billed charges 125 125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPINEPHRINE 4 MG/250 ML (16 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV SOLN RX-196733 CDM 636000000 HCPCS 0636 RC 42023-0315-10 NDC outpatient 250 ML 135 135 135 74 99.9 percent of total billed charges 135 93 109.35 percent of total billed charges 135 135 other OPPS APC 135 135 other OPPS APC 135 24.86 33.56 percent of total billed charges 135 135 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY RX-19696 CDM A9270 HCPCS 0250 RC 00283-0679-02 NDC outpatient 57 GR 78.51 78.51 74 58.1 percent of total billed charges 78.51 93 63.59 percent of total billed charges 78.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 78.51 other OPPS APC 78.51 78.51 other OPPS APC 78.51 24.86 19.52 percent of total billed charges 78.51 78.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY RX-19696 CDM A9270 HCPCS 0637 RC 00283-0679-02 NDC outpatient 57 GR 78.51 78.51 78.51 74 58.1 percent of total billed charges 78.51 93 63.59 percent of total billed charges 78.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 78.51 other OPPS APC 78.51 78.51 other OPPS APC 78.51 24.86 19.52 percent of total billed charges 78.51 78.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBACHOL 0.01 % INTRAOCULAR SOLUTION RX-19704 CDM 250000000 HCPCS 0250 RC 00065-0023-15 NDC outpatient 1.5 ML 134.04 134.04 134.04 74 99.19 percent of total billed charges 134.04 93 108.57 percent of total billed charges 134.04 134.04 other OPPS APC 134.04 134.04 other OPPS APC 134.04 24.86 33.32 percent of total billed charges 134.04 134.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KETOROLAC 0.5 % EYE DROPS RX-19733 CDM A9270 HCPCS 0250 RC 61314-0126-05 NDC outpatient 5 ML 263.75 263.75 74 195.18 percent of total billed charges 263.75 93 213.64 percent of total billed charges 263.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 263.75 other OPPS APC 263.75 263.75 other OPPS APC 263.75 24.86 65.57 percent of total billed charges 263.75 263.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KETOROLAC 0.5 % EYE DROPS RX-19733 CDM A9270 HCPCS 0637 RC 61314-0126-05 NDC outpatient 5 ML 263.75 263.75 263.75 74 195.18 percent of total billed charges 263.75 93 213.64 percent of total billed charges 263.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 263.75 other OPPS APC 263.75 263.75 other OPPS APC 263.75 24.86 65.57 percent of total billed charges 263.75 263.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION RX-19736 CDM J1050 HCPCS 0636 RC 55150-0329-01 NDC outpatient 1 ML 109.93 109.93 109.93 74 81.35 percent of total billed charges 109.93 93 89.04 percent of total billed charges 109.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 109.93 other OPPS APC 109.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 109.93 other OPPS APC 109.93 24.86 27.33 percent of total billed charges 109.93 109.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOFITAMAB-GXBM 1 MG/ML INTRAVENOUS SOLUTION RX-197361 CDM J9286 HCPCS 0636 RC 50242-0127-01 NDC outpatient 10 ML 31576.7 31576.7 31576.7 74 23366.7 percent of total billed charges 31576.7 93 25577.1 percent of total billed charges 31576.7 31576.7 other OPPS APC 31576.7 31576.7 other OPPS APC 31576.7 24.86 7849.96 percent of total billed charges 31576.7 31576.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METRONIDAZOLE 0.75 % TOPICAL GEL RX-19741 CDM A9270 HCPCS 0250 RC 51672-4116-06 NDC outpatient 45 GR 798.45 798.45 74 590.85 percent of total billed charges 798.45 93 646.74 percent of total billed charges 798.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 798.45 other OPPS APC 798.45 798.45 other OPPS APC 798.45 24.86 198.49 percent of total billed charges 798.45 798.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METRONIDAZOLE 0.75 % TOPICAL GEL RX-19741 CDM A9270 HCPCS 0637 RC 51672-4116-06 NDC outpatient 45 GR 798.45 798.45 798.45 74 590.85 percent of total billed charges 798.45 93 646.74 percent of total billed charges 798.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 798.45 other OPPS APC 798.45 798.45 other OPPS APC 798.45 24.86 198.49 percent of total billed charges 798.45 798.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OFLOXACIN 0.3 % EYE DROPS RX-19746 CDM A9270 HCPCS 0250 RC 72485-0613-10 NDC outpatient 5 ML 45.23 45.23 74 33.47 percent of total billed charges 45.23 93 36.64 percent of total billed charges 45.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 45.23 other OPPS APC 45.23 45.23 other OPPS APC 45.23 24.86 11.24 percent of total billed charges 45.23 45.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OFLOXACIN 0.3 % EYE DROPS RX-19746 CDM A9270 HCPCS 0637 RC 72485-0613-10 NDC outpatient 5 ML 45.23 45.23 45.23 74 33.47 percent of total billed charges 45.23 93 36.64 percent of total billed charges 45.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 45.23 other OPPS APC 45.23 45.23 other OPPS APC 45.23 24.86 11.24 percent of total billed charges 45.23 45.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SERTRALINE 25 MG TABLET RX-19882 CDM A9270 HCPCS 0250 RC 60687-0231-01 NDC outpatient 1 UN 1.01 1.01 74 0.75 percent of total billed charges 1.01 93 0.82 percent of total billed charges 1.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.01 other OPPS APC 1.01 1.01 other OPPS APC 1.01 24.86 0.25 percent of total billed charges 1.01 1.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SERTRALINE 25 MG TABLET RX-19882 CDM A9270 HCPCS 0637 RC 60687-0231-01 NDC outpatient 1 UN 1.01 1.01 1.01 74 0.75 percent of total billed charges 1.01 93 0.82 percent of total billed charges 1.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.01 other OPPS APC 1.01 1.01 other OPPS APC 1.01 24.86 0.25 percent of total billed charges 1.01 1.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEGFILGRASTIM-CBQV 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUT INJECTOR RX-199600 CDM Q5111 HCPCS 0636 RC 70114-0130-01 NDC outpatient 0.6 ML 12525 12525 1709.29 1709.29 fee schedule 12525 93 10145.3 percent of total billed charges 12525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1720.52 other OPPS APC 12525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1720.52 other OPPS APC 12525 24.86 3113.72 percent of total billed charges 1709.29 12525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TARLATAMAB-DLLE 10 MG INTRAVENOUS SOLUTION RX-200547 CDM 636000000 HCPCS 0636 RC 55513-0077-01 NDC outpatient 1 UN 45000 45000 45000 74 33300 percent of total billed charges 45000 93 36450 percent of total billed charges 45000 45000 other OPPS APC 45000 45000 other OPPS APC 45000 24.86 11187 percent of total billed charges 45000 45000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TARLATAMAB-DLLE 1 MG INTRAVENOUS SOLUTION RX-200548 CDM 636000000 HCPCS 0636 RC 55513-0059-01 NDC outpatient 1 UN 4500 4500 4500 74 3330 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 4500 other OPPS APC 4500 4500 other OPPS APC 4500 24.86 1118.7 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION" RX-2007 CDM J3420 HCPCS 0636 RC 70512-0840-25 NDC outpatient 1 ML 11.13 11.13 1.5 1.5 fee schedule 11.13 93 9.02 percent of total billed charges 11.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.13 other OPPS APC 11.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.13 other OPPS APC 11.13 24.86 2.77 percent of total billed charges 1.5 11.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET RX-2008 CDM A9270 HCPCS 0250 RC 50268-0852-15 NDC outpatient 1 UN 0.77 0.77 74 0.57 percent of total billed charges 0.77 93 0.62 percent of total billed charges 0.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.77 other OPPS APC 0.77 0.77 other OPPS APC 0.77 24.86 0.19 percent of total billed charges 0.77 0.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET RX-2008 CDM A9270 HCPCS 0637 RC 50268-0852-15 NDC outpatient 1 UN 0.77 0.77 0.77 74 0.57 percent of total billed charges 0.77 93 0.62 percent of total billed charges 0.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.77 other OPPS APC 0.77 0.77 other OPPS APC 0.77 24.86 0.19 percent of total billed charges 0.77 0.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET" RX-2009 CDM A9270 HCPCS 0250 RC 50268-0855-15 NDC outpatient 1 UN 0.89 0.89 74 0.66 percent of total billed charges 0.89 93 0.72 percent of total billed charges 0.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.89 other OPPS APC 0.89 0.89 other OPPS APC 0.89 24.86 0.22 percent of total billed charges 0.89 0.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET" RX-2009 CDM A9270 HCPCS 0637 RC 50268-0855-15 NDC outpatient 1 UN 0.89 0.89 0.89 74 0.66 percent of total billed charges 0.89 93 0.72 percent of total billed charges 0.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.89 other OPPS APC 0.89 0.89 other OPPS APC 0.89 24.86 0.22 percent of total billed charges 0.89 0.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLU VACCINE TS 2024-25(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE RX-201007 CDM 90656 HCPCS 0636 RC 49281-0424-50 NDC outpatient 0.5 ML 61.67 61.67 61.67 74 45.64 percent of total billed charges 61.67 93 49.95 percent of total billed charges 61.67 61.67 other OPPS APC 61.67 61.67 other OPPS APC 61.67 24.86 15.33 percent of total billed charges 61.67 61.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJECTION SOLUTION RX-20156 CDM J9100 HCPCS 0636 RC 63323-0120-20 NDC outpatient 20 ML 62.7 62.7 21.05 21.05 fee schedule 62.7 93 50.79 percent of total billed charges 62.7 62.7 other OPPS APC 62.7 62.7 other OPPS APC 62.7 24.86 15.59 percent of total billed charges 21.05 62.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CYCLOBENZAPRINE 10 MG TABLET RX-2017 CDM A9270 HCPCS 0250 RC 60687-0558-01 NDC outpatient 1 UN 0.54 0.54 74 0.4 percent of total billed charges 0.54 93 0.44 percent of total billed charges 0.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.54 other OPPS APC 0.54 0.54 other OPPS APC 0.54 24.86 0.13 percent of total billed charges 0.54 0.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CYCLOBENZAPRINE 10 MG TABLET RX-2017 CDM A9270 HCPCS 0637 RC 60687-0558-01 NDC outpatient 1 UN 0.54 0.54 0.54 74 0.4 percent of total billed charges 0.54 93 0.44 percent of total billed charges 0.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.54 other OPPS APC 0.54 0.54 other OPPS APC 0.54 24.86 0.13 percent of total billed charges 0.54 0.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CYCLOPENTOLATE 1 % EYE DROPS RX-2025 CDM A9270 HCPCS 0250 RC 61314-0396-01 NDC outpatient 2 ML 42 42 74 31.08 percent of total billed charges 42 93 34.02 percent of total billed charges 42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42 other OPPS APC 42 42 other OPPS APC 42 24.86 10.44 percent of total billed charges 42 42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CYCLOPENTOLATE 1 % EYE DROPS RX-2025 CDM A9270 HCPCS 0637 RC 61314-0396-01 NDC outpatient 2 ML 42 42 42 74 31.08 percent of total billed charges 42 93 34.02 percent of total billed charges 42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42 other OPPS APC 42 42 other OPPS APC 42 24.86 10.44 percent of total billed charges 42 42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CYPROHEPTADINE 4 MG TABLET RX-2033 CDM A9270 HCPCS 0250 RC 50268-0189-15 NDC outpatient 1 UN 2.68 2.68 74 1.98 percent of total billed charges 2.68 93 2.17 percent of total billed charges 2.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.68 other OPPS APC 2.68 2.68 other OPPS APC 2.68 24.86 0.67 percent of total billed charges 2.68 2.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CYPROHEPTADINE 4 MG TABLET RX-2033 CDM A9270 HCPCS 0637 RC 50268-0189-15 NDC outpatient 1 UN 2.68 2.68 2.68 74 1.98 percent of total billed charges 2.68 93 2.17 percent of total billed charges 2.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.68 other OPPS APC 2.68 2.68 other OPPS APC 2.68 24.86 0.67 percent of total billed charges 2.68 2.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION RX-20472 CDM 250000000 HCPCS 0250 RC 72485-0509-10 NDC outpatient 20 ML 19.67 19.67 19.67 74 14.56 percent of total billed charges 19.67 93 15.93 percent of total billed charges 19.67 19.67 other OPPS APC 19.67 19.67 other OPPS APC 19.67 24.86 4.89 percent of total billed charges 19.67 19.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MELOXICAM 7.5 MG TABLET RX-20566 CDM A9270 HCPCS 0250 RC 50268-0525-15 NDC outpatient 1 UN 7.75 7.75 74 5.74 percent of total billed charges 7.75 93 6.28 percent of total billed charges 7.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.75 other OPPS APC 7.75 7.75 other OPPS APC 7.75 24.86 1.93 percent of total billed charges 7.75 7.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MELOXICAM 7.5 MG TABLET RX-20566 CDM A9270 HCPCS 0637 RC 50268-0525-15 NDC outpatient 1 UN 7.75 7.75 7.75 74 5.74 percent of total billed charges 7.75 93 6.28 percent of total billed charges 7.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.75 other OPPS APC 7.75 7.75 other OPPS APC 7.75 24.86 1.93 percent of total billed charges 7.75 7.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMIFOSTINE CRYSTALLINE 500 MG INTRAVENOUS SOLUTION RX-20803 CDM J0207 HCPCS 0636 RC 76310-0017-50 NDC outpatient 10 ML 3214.22 3214.22 3214.22 74 2378.52 percent of total billed charges 3214.22 93 2603.52 percent of total billed charges 3214.22 3214.22 other OPPS APC 3214.22 3214.22 other OPPS APC 3214.22 24.86 799.06 percent of total billed charges 3214.22 3214.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION RX-20887 CDM 250000000 HCPCS 0250 RC 70860-0784-05 NDC outpatient 5 ML 15 15 15 74 11.1 percent of total billed charges 15 93 12.15 percent of total billed charges 15 15 other OPPS APC 15 15 other OPPS APC 15 24.86 3.73 percent of total billed charges 15 15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DACARBAZINE 200 MG INTRAVENOUS SOLUTION RX-2091 CDM J9130 HCPCS 0636 RC 63323-0128-20 NDC outpatient 20 ML 36 36 9.24 9.24 fee schedule 36 93 29.16 percent of total billed charges 36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36 other OPPS APC 36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36 other OPPS APC 36 24.86 8.95 percent of total billed charges 9.24 36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZITHROMYCIN 250 MG TABLET RX-20943 CDM A9270 HCPCS 0250 RC 50268-0074-11 NDC outpatient 1 UN 3.71 3.71 74 2.75 percent of total billed charges 3.71 93 3.01 percent of total billed charges 3.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.71 other OPPS APC 3.71 3.71 other OPPS APC 3.71 24.86 0.92 percent of total billed charges 3.71 3.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZITHROMYCIN 250 MG TABLET RX-20943 CDM A9270 HCPCS 0637 RC 50268-0074-11 NDC outpatient 1 UN 3.71 3.71 3.71 74 2.75 percent of total billed charges 3.71 93 3.01 percent of total billed charges 3.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.71 other OPPS APC 3.71 3.71 other OPPS APC 3.71 24.86 0.92 percent of total billed charges 3.71 3.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOCARNITINE 200 MG/ML INTRAVENOUS SOLUTION RX-20954 CDM J1955 HCPCS 0636 RC 00143-9852-10 NDC outpatient 5 ML 107.01 107.01 40.43 40.43 fee schedule 107.01 93 86.68 percent of total billed charges 107.01 107.01 other OPPS APC 107.01 107.01 other OPPS APC 107.01 24.86 26.6 percent of total billed charges 40.43 107.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEUPROLIDE 11.25 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT RX-21044 CDM J1950 HCPCS 0636 RC 00074-3663-03 NDC outpatient 11.25 ME 15438.2 15438.2 5285.82 5285.82 fee schedule 15438.2 93 12504.9 percent of total billed charges 15438.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4852.94 other OPPS APC 15438.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4852.94 other OPPS APC 15438.2 24.86 3837.94 percent of total billed charges 5285.82 15438.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OLANZAPINE 2.5 MG TABLET RX-21057 CDM A9270 HCPCS 0250 RC 60505-3110-00 NDC outpatient 1 UN 28 28 74 20.72 percent of total billed charges 28 93 22.68 percent of total billed charges 28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28 other OPPS APC 28 28 other OPPS APC 28 24.86 6.96 percent of total billed charges 28 28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OLANZAPINE 2.5 MG TABLET RX-21057 CDM A9270 HCPCS 0637 RC 60505-3110-00 NDC outpatient 1 UN 28 28 28 74 20.72 percent of total billed charges 28 93 22.68 percent of total billed charges 28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28 other OPPS APC 28 28 other OPPS APC 28 24.86 6.96 percent of total billed charges 28 28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXCARBAZEPINE 300 MG TABLET RX-21061 CDM A9270 HCPCS 0250 RC 50268-0680-15 NDC outpatient 1 UN 2.54 2.54 74 1.88 percent of total billed charges 2.54 93 2.06 percent of total billed charges 2.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.54 other OPPS APC 2.54 2.54 other OPPS APC 2.54 24.86 0.63 percent of total billed charges 2.54 2.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXCARBAZEPINE 300 MG TABLET RX-21061 CDM A9270 HCPCS 0637 RC 50268-0680-15 NDC outpatient 1 UN 2.54 2.54 2.54 74 1.88 percent of total billed charges 2.54 93 2.06 percent of total billed charges 2.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.54 other OPPS APC 2.54 2.54 other OPPS APC 2.54 24.86 0.63 percent of total billed charges 2.54 2.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CITALOPRAM 20 MG TABLET RX-21062 CDM A9270 HCPCS 0250 RC 00904-6085-61 NDC outpatient 1 UN 6.74 6.74 74 4.99 percent of total billed charges 6.74 93 5.46 percent of total billed charges 6.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.74 other OPPS APC 6.74 6.74 other OPPS APC 6.74 24.86 1.68 percent of total billed charges 6.74 6.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CITALOPRAM 20 MG TABLET RX-21062 CDM A9270 HCPCS 0637 RC 00904-6085-61 NDC outpatient 1 UN 6.74 6.74 6.74 74 4.99 percent of total billed charges 6.74 93 5.46 percent of total billed charges 6.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.74 other OPPS APC 6.74 6.74 other OPPS APC 6.74 24.86 1.68 percent of total billed charges 6.74 6.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION RX-21063 CDM J0456 HCPCS 0636 RC 70095-0025-02 NDC outpatient 5 ML 18 18 3.17 3.17 fee schedule 18 93 14.58 percent of total billed charges 18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18 other OPPS APC 18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18 other OPPS APC 18 24.86 4.47 percent of total billed charges 3.17 18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION RX-21063 CDM J0456 HCPCS 0636 RC 70095-0025-02 NDC outpatient 500 ME 18 18 3.17 3.17 fee schedule 18 93 14.58 percent of total billed charges 18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18 other OPPS APC 18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18 other OPPS APC 18 24.86 4.47 percent of total billed charges 3.17 18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM HYPOCHLORITE 0.5 % SOLUTION RX-2110 CDM A9270 HCPCS 0250 RC 00436-0946-16 NDC outpatient 473 ML 34.65 34.65 74 25.64 percent of total billed charges 34.65 93 28.07 percent of total billed charges 34.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.65 other OPPS APC 34.65 34.65 other OPPS APC 34.65 24.86 8.61 percent of total billed charges 34.65 34.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM HYPOCHLORITE 0.5 % SOLUTION RX-2110 CDM A9270 HCPCS 0637 RC 00436-0946-16 NDC outpatient 473 ML 34.65 34.65 34.65 74 25.64 percent of total billed charges 34.65 93 28.07 percent of total billed charges 34.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.65 other OPPS APC 34.65 34.65 other OPPS APC 34.65 24.86 8.61 percent of total billed charges 34.65 34.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED) RX-21135 CDM A9270 HCPCS 0250 RC 60505-0815-00 NDC outpatient 5 ML 615.63 615.63 74 455.57 percent of total billed charges 615.63 93 498.66 percent of total billed charges 615.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 615.63 other OPPS APC 615.63 615.63 other OPPS APC 615.63 24.86 153.05 percent of total billed charges 615.63 615.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED) RX-21135 CDM A9270 HCPCS 0637 RC 60505-0815-00 NDC outpatient 5 ML 615.63 615.63 615.63 74 455.57 percent of total billed charges 615.63 93 498.66 percent of total billed charges 615.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 615.63 other OPPS APC 615.63 615.63 other OPPS APC 615.63 24.86 153.05 percent of total billed charges 615.63 615.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRAMIPEXOLE 1 MG TABLET RX-21288 CDM A9270 HCPCS 0250 RC 60687-0592-21 NDC outpatient 1 UN 3.32 3.32 74 2.46 percent of total billed charges 3.32 93 2.69 percent of total billed charges 3.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.32 other OPPS APC 3.32 3.32 other OPPS APC 3.32 24.86 0.83 percent of total billed charges 3.32 3.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRAMIPEXOLE 1 MG TABLET RX-21288 CDM A9270 HCPCS 0637 RC 60687-0592-21 NDC outpatient 1 UN 3.32 3.32 3.32 74 2.46 percent of total billed charges 3.32 93 2.69 percent of total billed charges 3.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.32 other OPPS APC 3.32 3.32 other OPPS APC 3.32 24.86 0.83 percent of total billed charges 3.32 3.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRAMIPEXOLE 0.25 MG TABLET RX-21290 CDM A9270 HCPCS 0250 RC 00904-6704-61 NDC outpatient 1 UN 0.78 0.78 74 0.58 percent of total billed charges 0.78 93 0.63 percent of total billed charges 0.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.78 other OPPS APC 0.78 0.78 other OPPS APC 0.78 24.86 0.19 percent of total billed charges 0.78 0.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRAMIPEXOLE 0.25 MG TABLET RX-21290 CDM A9270 HCPCS 0637 RC 00904-6704-61 NDC outpatient 1 UN 0.78 0.78 0.78 74 0.58 percent of total billed charges 0.78 93 0.63 percent of total billed charges 0.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.78 other OPPS APC 0.78 0.78 other OPPS APC 0.78 24.86 0.19 percent of total billed charges 0.78 0.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE" RX-21300 CDM A9270 HCPCS 0250 RC 60505-0033-06 NDC outpatient 1 UN 2.86 2.86 74 2.12 percent of total billed charges 2.86 93 2.32 percent of total billed charges 2.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.86 other OPPS APC 2.86 2.86 other OPPS APC 2.86 24.86 0.71 percent of total billed charges 2.86 2.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE" RX-21300 CDM A9270 HCPCS 0637 RC 60505-0033-06 NDC outpatient 1 UN 2.86 2.86 2.86 74 2.12 percent of total billed charges 2.86 93 2.32 percent of total billed charges 2.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.86 other OPPS APC 2.86 2.86 other OPPS APC 2.86 24.86 0.71 percent of total billed charges 2.86 2.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DAPSONE 100 MG TABLET RX-2131 CDM A9270 HCPCS 0250 RC 70954-0136-10 NDC outpatient 1 UN 7.56 7.56 74 5.59 percent of total billed charges 7.56 93 6.12 percent of total billed charges 7.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.56 other OPPS APC 7.56 7.56 other OPPS APC 7.56 24.86 1.88 percent of total billed charges 7.56 7.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DAPSONE 100 MG TABLET RX-2131 CDM A9270 HCPCS 0637 RC 70954-0136-10 NDC outpatient 1 UN 7.56 7.56 7.56 74 5.59 percent of total billed charges 7.56 93 6.12 percent of total billed charges 7.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.56 other OPPS APC 7.56 7.56 other OPPS APC 7.56 24.86 1.88 percent of total billed charges 7.56 7.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DAPSONE 25 MG TABLET RX-2132 CDM A9270 HCPCS 0250 RC 70954-0135-10 NDC outpatient 1 UN 6.17 6.17 74 4.57 percent of total billed charges 6.17 93 5 percent of total billed charges 6.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.17 other OPPS APC 6.17 6.17 other OPPS APC 6.17 24.86 1.53 percent of total billed charges 6.17 6.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DAPSONE 25 MG TABLET RX-2132 CDM A9270 HCPCS 0637 RC 70954-0135-10 NDC outpatient 1 UN 6.17 6.17 6.17 74 4.57 percent of total billed charges 6.17 93 5 percent of total billed charges 6.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.17 other OPPS APC 6.17 6.17 other OPPS APC 6.17 24.86 1.53 percent of total billed charges 6.17 6.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WARFARIN 4 MG TABLET RX-21372 CDM A9270 HCPCS 0250 RC 00832-1215-01 NDC outpatient 1 UN 1.66 1.66 74 1.23 percent of total billed charges 1.66 93 1.34 percent of total billed charges 1.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.66 other OPPS APC 1.66 1.66 other OPPS APC 1.66 24.86 0.41 percent of total billed charges 1.66 1.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WARFARIN 4 MG TABLET RX-21372 CDM A9270 HCPCS 0637 RC 00832-1215-01 NDC outpatient 1 UN 1.66 1.66 1.66 74 1.23 percent of total billed charges 1.66 93 1.34 percent of total billed charges 1.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.66 other OPPS APC 1.66 1.66 other OPPS APC 1.66 24.86 0.41 percent of total billed charges 1.66 1.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LETROZOLE 2.5 MG TABLET RX-21509 CDM A9270 HCPCS 0250 RC 50268-0476-11 NDC outpatient 1 UN 45.13 45.13 74 33.4 percent of total billed charges 45.13 93 36.56 percent of total billed charges 45.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 45.13 other OPPS APC 45.13 45.13 other OPPS APC 45.13 24.86 11.22 percent of total billed charges 45.13 45.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LETROZOLE 2.5 MG TABLET RX-21509 CDM A9270 HCPCS 0637 RC 50268-0476-11 NDC outpatient 1 UN 45.13 45.13 45.13 74 33.4 percent of total billed charges 45.13 93 36.56 percent of total billed charges 45.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 45.13 other OPPS APC 45.13 45.13 other OPPS APC 45.13 24.86 11.22 percent of total billed charges 45.13 45.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROPINIROLE 0.25 MG TABLET RX-21688 CDM A9270 HCPCS 0250 RC 00904-6373-61 NDC outpatient 1 UN 1.48 1.48 74 1.1 percent of total billed charges 1.48 93 1.2 percent of total billed charges 1.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.48 other OPPS APC 1.48 1.48 other OPPS APC 1.48 24.86 0.37 percent of total billed charges 1.48 1.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROPINIROLE 0.25 MG TABLET RX-21688 CDM A9270 HCPCS 0637 RC 00904-6373-61 NDC outpatient 1 UN 1.48 1.48 1.48 74 1.1 percent of total billed charges 1.48 93 1.2 percent of total billed charges 1.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.48 other OPPS APC 1.48 1.48 other OPPS APC 1.48 24.86 0.37 percent of total billed charges 1.48 1.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROPINIROLE 1 MG TABLET RX-21689 CDM A9270 HCPCS 0250 RC 50268-0743-15 NDC outpatient 1 UN 1.7 1.7 74 1.26 percent of total billed charges 1.7 93 1.38 percent of total billed charges 1.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.7 other OPPS APC 1.7 1.7 other OPPS APC 1.7 24.86 0.42 percent of total billed charges 1.7 1.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROPINIROLE 1 MG TABLET RX-21689 CDM A9270 HCPCS 0637 RC 50268-0743-15 NDC outpatient 1 UN 1.7 1.7 1.7 74 1.26 percent of total billed charges 1.7 93 1.38 percent of total billed charges 1.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.7 other OPPS APC 1.7 1.7 other OPPS APC 1.7 24.86 0.42 percent of total billed charges 1.7 1.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUETIAPINE 25 MG TABLET RX-21823 CDM A9270 HCPCS 0250 RC 50268-0630-15 NDC outpatient 1 UN 9.29 9.29 74 6.87 percent of total billed charges 9.29 93 7.52 percent of total billed charges 9.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.29 other OPPS APC 9.29 9.29 other OPPS APC 9.29 24.86 2.31 percent of total billed charges 9.29 9.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUETIAPINE 25 MG TABLET RX-21823 CDM A9270 HCPCS 0637 RC 50268-0630-15 NDC outpatient 1 UN 9.29 9.29 9.29 74 6.87 percent of total billed charges 9.29 93 7.52 percent of total billed charges 9.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.29 other OPPS APC 9.29 9.29 other OPPS APC 9.29 24.86 2.31 percent of total billed charges 9.29 9.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUETIAPINE 100 MG TABLET RX-21824 CDM A9270 HCPCS 0250 RC 50268-0632-15 NDC outpatient 1 UN 16.15 16.15 74 11.95 percent of total billed charges 16.15 93 13.08 percent of total billed charges 16.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.15 other OPPS APC 16.15 16.15 other OPPS APC 16.15 24.86 4.01 percent of total billed charges 16.15 16.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUETIAPINE 100 MG TABLET RX-21824 CDM A9270 HCPCS 0637 RC 50268-0632-15 NDC outpatient 1 UN 16.15 16.15 16.15 74 11.95 percent of total billed charges 16.15 93 13.08 percent of total billed charges 16.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.15 other OPPS APC 16.15 16.15 other OPPS APC 16.15 24.86 4.01 percent of total billed charges 16.15 16.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION RX-21900 CDM J0289 HCPCS 0636 RC 62756-0233-01 NDC outpatient 50 ME 764.23 764.23 159.05 159.05 fee schedule 764.23 93 619.03 percent of total billed charges 764.23 764.23 other OPPS APC 764.23 764.23 other OPPS APC 764.23 24.86 189.99 percent of total billed charges 159.05 764.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP" RX-22120 CDM 90675 HCPCS 0636 RC 50632-0010-01 NDC outpatient 1 ML 1241.73 1241.73 376.69 376.69 fee schedule 1241.73 93 1005.8 percent of total billed charges 1241.73 1241.73 other OPPS APC 1241.73 1241.73 other OPPS APC 1241.73 24.86 308.69 percent of total billed charges 376.69 1241.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOPIDOGREL 75 MG TABLET RX-22142 CDM A9270 HCPCS 0250 RC 00904-6294-61 NDC outpatient 1 UN 10.91 10.91 74 8.07 percent of total billed charges 10.91 93 8.84 percent of total billed charges 10.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.91 other OPPS APC 10.91 10.91 other OPPS APC 10.91 24.86 2.71 percent of total billed charges 10.91 10.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOPIDOGREL 75 MG TABLET RX-22142 CDM A9270 HCPCS 0637 RC 00904-6294-61 NDC outpatient 1 UN 10.91 10.91 10.91 74 8.07 percent of total billed charges 10.91 93 8.84 percent of total billed charges 10.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.91 other OPPS APC 10.91 10.91 other OPPS APC 10.91 24.86 2.71 percent of total billed charges 10.91 10.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RALOXIFENE 60 MG TABLET RX-22143 CDM A9270 HCPCS 0250 RC 50268-0694-15 NDC outpatient 1 UN 17.82 17.82 74 13.19 percent of total billed charges 17.82 93 14.43 percent of total billed charges 17.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.82 other OPPS APC 17.82 17.82 other OPPS APC 17.82 24.86 4.43 percent of total billed charges 17.82 17.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RALOXIFENE 60 MG TABLET RX-22143 CDM A9270 HCPCS 0637 RC 50268-0694-15 NDC outpatient 1 UN 17.82 17.82 17.82 74 13.19 percent of total billed charges 17.82 93 14.43 percent of total billed charges 17.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.82 other OPPS APC 17.82 17.82 other OPPS APC 17.82 24.86 4.43 percent of total billed charges 17.82 17.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS" RX-22149 CDM J9312 HCPCS 0636 RC 50242-0051-21 NDC outpatient 10 ML 2818.55 2818.55 925.05 925.05 fee schedule 2818.55 93 2283.03 percent of total billed charges 2818.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 773.14 other OPPS APC 2818.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 773.14 other OPPS APC 2818.55 24.86 700.69 percent of total billed charges 925.05 2818.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS" RX-22149 CDM J9312 HCPCS 0636 RC 50242-0053-06 NDC outpatient 50 ML 14092.8 14092.8 4625.23 4625.23 fee schedule 14092.8 93 11415.2 percent of total billed charges 14092.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3865.7 other OPPS APC 14092.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3865.7 other OPPS APC 14092.8 24.86 3503.47 percent of total billed charges 4625.23 14092.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILTIAZEM 100 MG INTRAVENOUS SOLUTION RX-22156 CDM 250000000 HCPCS 0250 RC 00409-4350-03 NDC outpatient 100 ME 34.24 34.24 34.24 74 25.34 percent of total billed charges 34.24 93 27.73 percent of total billed charges 34.24 34.24 other OPPS APC 34.24 34.24 other OPPS APC 34.24 24.86 8.51 percent of total billed charges 34.24 34.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION RX-22185 CDM 250000000 HCPCS 0250 RC 70710-1478-01 NDC outpatient 1.5 ML 4500 4500 4500 74 3330 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 4500 other OPPS APC 4500 4500 other OPPS APC 4500 24.86 1118.7 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MUPIROCIN CALCIUM 2 % TOPICAL CREAM RX-22251 CDM A9270 HCPCS 0250 RC 51672-1370-01 NDC outpatient 15 GR 612.9 612.9 74 453.55 percent of total billed charges 612.9 93 496.45 percent of total billed charges 612.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.9 other OPPS APC 612.9 612.9 other OPPS APC 612.9 24.86 152.37 percent of total billed charges 612.9 612.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MUPIROCIN CALCIUM 2 % TOPICAL CREAM RX-22251 CDM A9270 HCPCS 0637 RC 51672-1370-01 NDC outpatient 15 GR 612.9 612.9 612.9 74 453.55 percent of total billed charges 612.9 93 496.45 percent of total billed charges 612.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.9 other OPPS APC 612.9 612.9 other OPPS APC 612.9 24.86 152.37 percent of total billed charges 612.9 612.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFDINIR 300 MG CAPSULE RX-22289 CDM A9270 HCPCS 0250 RC 68180-0711-60 NDC outpatient 1 UN 12.79 12.79 74 9.46 percent of total billed charges 12.79 93 10.36 percent of total billed charges 12.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.79 other OPPS APC 12.79 12.79 other OPPS APC 12.79 24.86 3.18 percent of total billed charges 12.79 12.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFDINIR 300 MG CAPSULE RX-22289 CDM A9270 HCPCS 0637 RC 68180-0711-60 NDC outpatient 1 UN 12.79 12.79 12.79 74 9.46 percent of total billed charges 12.79 93 10.36 percent of total billed charges 12.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.79 other OPPS APC 12.79 12.79 other OPPS APC 12.79 24.86 3.18 percent of total billed charges 12.79 12.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFDINIR 125 MG/5 ML ORAL SUSPENSION RX-22290 CDM A9270 HCPCS 0250 RC 65862-0218-60 NDC outpatient 60 ML 127.38 127.38 74 94.26 percent of total billed charges 127.38 93 103.18 percent of total billed charges 127.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 127.38 other OPPS APC 127.38 127.38 other OPPS APC 127.38 24.86 31.67 percent of total billed charges 127.38 127.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFDINIR 125 MG/5 ML ORAL SUSPENSION RX-22290 CDM A9270 HCPCS 0637 RC 65862-0218-60 NDC outpatient 60 ML 127.38 127.38 127.38 74 94.26 percent of total billed charges 127.38 93 103.18 percent of total billed charges 127.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 127.38 other OPPS APC 127.38 127.38 other OPPS APC 127.38 24.86 31.67 percent of total billed charges 127.38 127.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KETOROLAC 15 MG/ML INJECTION SOLUTION RX-22472 CDM J1885 HCPCS 0636 RC 72266-0234-25 NDC outpatient 1 ML 3.03 3.03 0.63 0.63 fee schedule 3.03 93 2.45 percent of total billed charges 3.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.03 other OPPS APC 3.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.03 other OPPS APC 3.03 24.86 0.75 percent of total billed charges 0.63 3.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION RX-22473 CDM J1885 HCPCS 0636 RC 25021-0701-01 NDC outpatient 1 ML 14.97 14.97 1.26 1.26 fee schedule 14.97 93 12.13 percent of total billed charges 1.26 14.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION RX-22473 CDM J1885 HCPCS 0636 RC 72266-0118-25 NDC outpatient 1 ML 5.25 5.25 5.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.25 other OPPS APC 5.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.25 other OPPS APC 5.25 24.86 1.31 percent of total billed charges 5.25 5.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MONTELUKAST 10 MG TABLET RX-22509 CDM A9270 HCPCS 0250 RC 00904-6808-61 NDC outpatient 1 UN 1 1 74 0.74 percent of total billed charges 1 93 0.81 percent of total billed charges 1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1 other OPPS APC 1 1 other OPPS APC 1 24.86 0.25 percent of total billed charges 1 1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MONTELUKAST 10 MG TABLET RX-22509 CDM A9270 HCPCS 0637 RC 00904-6808-61 NDC outpatient 1 UN 1 1 1 74 0.74 percent of total billed charges 1 93 0.81 percent of total billed charges 1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1 other OPPS APC 1 1 other OPPS APC 1 24.86 0.25 percent of total billed charges 1 1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION RX-22560 CDM A9270 HCPCS 0250 RC 65862-0496-47 NDC outpatient 473 ML 538.5 538.5 74 398.49 percent of total billed charges 538.5 93 436.19 percent of total billed charges 538.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 538.5 other OPPS APC 538.5 538.5 other OPPS APC 538.5 24.86 133.87 percent of total billed charges 538.5 538.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION RX-22560 CDM A9270 HCPCS 0637 RC 65862-0496-47 NDC outpatient 473 ML 538.5 538.5 538.5 74 398.49 percent of total billed charges 538.5 93 436.19 percent of total billed charges 538.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 538.5 other OPPS APC 538.5 538.5 other OPPS APC 538.5 24.86 133.87 percent of total billed charges 538.5 538.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REPAGLINIDE 1 MG TABLET RX-22586 CDM A9270 HCPCS 0250 RC 65862-0671-01 NDC outpatient 1 UN 9.15 9.15 74 6.77 percent of total billed charges 9.15 93 7.41 percent of total billed charges 9.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.15 other OPPS APC 9.15 9.15 other OPPS APC 9.15 24.86 2.27 percent of total billed charges 9.15 9.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REPAGLINIDE 1 MG TABLET RX-22586 CDM A9270 HCPCS 0637 RC 65862-0671-01 NDC outpatient 1 UN 9.15 9.15 9.15 74 6.77 percent of total billed charges 9.15 93 7.41 percent of total billed charges 9.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.15 other OPPS APC 9.15 9.15 other OPPS APC 9.15 24.86 2.27 percent of total billed charges 9.15 9.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOLTERODINE 1 MG TABLET RX-22782 CDM A9270 HCPCS 0250 RC 31722-0805-60 NDC outpatient 1 UN 8.28 8.28 74 6.13 percent of total billed charges 8.28 93 6.71 percent of total billed charges 8.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.28 other OPPS APC 8.28 8.28 other OPPS APC 8.28 24.86 2.06 percent of total billed charges 8.28 8.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOLTERODINE 1 MG TABLET RX-22782 CDM A9270 HCPCS 0637 RC 31722-0805-60 NDC outpatient 1 UN 8.28 8.28 8.28 74 6.13 percent of total billed charges 8.28 93 6.71 percent of total billed charges 8.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.28 other OPPS APC 8.28 8.28 other OPPS APC 8.28 24.86 2.06 percent of total billed charges 8.28 8.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DESIPRAMINE 25 MG TABLET RX-2286 CDM A9270 HCPCS 0250 RC 50742-0113-01 NDC outpatient 1 UN 5.02 5.02 74 3.71 percent of total billed charges 5.02 93 4.07 percent of total billed charges 5.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.02 other OPPS APC 5.02 5.02 other OPPS APC 5.02 24.86 1.25 percent of total billed charges 5.02 5.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DESIPRAMINE 25 MG TABLET RX-2286 CDM A9270 HCPCS 0637 RC 50742-0113-01 NDC outpatient 1 UN 5.02 5.02 5.02 74 3.71 percent of total billed charges 5.02 93 4.07 percent of total billed charges 5.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.02 other OPPS APC 5.02 5.02 other OPPS APC 5.02 24.86 1.25 percent of total billed charges 5.02 5.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PARICALCITOL 5 MCG/ML SOLUTION FOR HEMODIALYSIS PORT INJECTION RX-22960 CDM J2501 HCPCS 0636 RC 16729-0311-08 NDC outpatient 1 ML 31.5 31.5 2.84 2.84 fee schedule 31.5 93 25.52 percent of total billed charges 31.5 31.5 other OPPS APC 31.5 31.5 other OPPS APC 31.5 24.86 7.83 percent of total billed charges 2.84 31.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS RX-22982 CDM A9270 HCPCS 0250 RC 70069-0051-01 NDC outpatient 10 ML 62.5 62.5 74 46.25 percent of total billed charges 62.5 93 50.63 percent of total billed charges 62.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.5 other OPPS APC 62.5 62.5 other OPPS APC 62.5 24.86 15.54 percent of total billed charges 62.5 62.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS RX-22982 CDM A9270 HCPCS 0637 RC 70069-0051-01 NDC outpatient 10 ML 62.5 62.5 62.5 74 46.25 percent of total billed charges 62.5 93 50.63 percent of total billed charges 62.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.5 other OPPS APC 62.5 62.5 other OPPS APC 62.5 24.86 15.54 percent of total billed charges 62.5 62.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET RX-22992 CDM A9270 HCPCS 0250 RC 42571-0160-30 NDC outpatient 1 UN 14.8 14.8 74 10.95 percent of total billed charges 14.8 93 11.99 percent of total billed charges 14.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.8 other OPPS APC 14.8 14.8 other OPPS APC 14.8 24.86 3.68 percent of total billed charges 14.8 14.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET RX-22992 CDM A9270 HCPCS 0637 RC 42571-0160-30 NDC outpatient 1 UN 14.8 14.8 14.8 74 10.95 percent of total billed charges 14.8 93 11.99 percent of total billed charges 14.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.8 other OPPS APC 14.8 14.8 other OPPS APC 14.8 24.86 3.68 percent of total billed charges 14.8 14.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASILIXIMAB 20 MG INTRAVENOUS SOLUTION RX-23082 CDM J0480 HCPCS 0636 RC 00078-0331-84 NDC outpatient 20 ME 13409.3 13409.3 5010.17 5010.17 fee schedule 13409.3 93 10861.5 percent of total billed charges 13409.3 13409.3 other OPPS APC 13409.3 13409.3 other OPPS APC 13409.3 24.86 3333.55 percent of total billed charges 5010.17 13409.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASILIXIMAB 20 MG INTRAVENOUS SOLUTION RX-23082 CDM J0480 HCPCS 0636 RC 00078-0331-84 NDC outpatient 5 ML 13409.3 13409.3 5010.17 5010.17 fee schedule 13409.3 93 10861.5 percent of total billed charges 13409.3 13409.3 other OPPS APC 13409.3 13409.3 other OPPS APC 13409.3 24.86 3333.55 percent of total billed charges 5010.17 13409.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION RX-23123 CDM J1327 HCPCS 0636 RC 70436-0027-80 NDC outpatient 100 ML 1171.9 1171.9 1171.9 74 867.21 percent of total billed charges 1171.9 93 949.24 percent of total billed charges 1171.9 1171.9 other OPPS APC 1171.9 1171.9 other OPPS APC 1171.9 24.86 291.33 percent of total billed charges 1171.9 1171.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION RX-23124 CDM J1327 HCPCS 0636 RC 70860-0303-10 NDC outpatient 10 ML 112.65 112.65 112.65 74 83.36 percent of total billed charges 112.65 93 91.25 percent of total billed charges 112.65 112.65 other OPPS APC 112.65 112.65 other OPPS APC 112.65 24.86 28 percent of total billed charges 112.65 112.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION RX-23128 CDM J0133 HCPCS 0636 RC 55150-0154-10 NDC outpatient 10 ML 40 40 4.84 4.84 fee schedule 40 93 32.4 percent of total billed charges 40 40 other OPPS APC 40 40 other OPPS APC 40 24.86 9.94 percent of total billed charges 4.84 40 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE" RX-23150 CDM A9270 HCPCS 0250 RC 00591-2882-01 NDC outpatient 1 UN 4.58 4.58 74 3.39 percent of total billed charges 4.58 93 3.71 percent of total billed charges 4.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.58 other OPPS APC 4.58 4.58 other OPPS APC 4.58 24.86 1.14 percent of total billed charges 4.58 4.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE" RX-23150 CDM A9270 HCPCS 0637 RC 00591-2882-01 NDC outpatient 1 UN 4.58 4.58 4.58 74 3.39 percent of total billed charges 4.58 93 3.71 percent of total billed charges 4.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.58 other OPPS APC 4.58 4.58 other OPPS APC 4.58 24.86 1.14 percent of total billed charges 4.58 4.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXAMETHASONE 0.5 MG/5 ML ORAL SOLUTION RX-2320 CDM A9270 HCPCS 0250 RC 00054-3177-63 NDC outpatient 500 ML 59.78 59.78 74 44.24 percent of total billed charges 59.78 93 48.42 percent of total billed charges 59.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.78 other OPPS APC 59.78 59.78 other OPPS APC 59.78 24.86 14.86 percent of total billed charges 59.78 59.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXAMETHASONE 0.5 MG/5 ML ORAL SOLUTION RX-2320 CDM A9270 HCPCS 0637 RC 00054-3177-63 NDC outpatient 500 ML 59.78 59.78 59.78 74 44.24 percent of total billed charges 59.78 93 48.42 percent of total billed charges 59.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.78 other OPPS APC 59.78 59.78 other OPPS APC 59.78 24.86 14.86 percent of total billed charges 59.78 59.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXAMETHASONE 0.5 MG TABLET RX-2322 CDM J8540 HCPCS 0636 RC 00054-4179-25 NDC outpatient 1 UN 0.35 0.35 0.24 0.24 fee schedule 0.35 93 0.28 percent of total billed charges 0.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.35 other OPPS APC 0.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.35 other OPPS APC 0.35 24.86 0.09 percent of total billed charges 0.24 0.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANDESARTAN 32 MG TABLET RX-23232 CDM A9270 HCPCS 0250 RC 00378-3232-93 NDC outpatient 1 UN 10.42 10.42 74 7.71 percent of total billed charges 10.42 93 8.44 percent of total billed charges 10.42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.42 other OPPS APC 10.42 10.42 other OPPS APC 10.42 24.86 2.59 percent of total billed charges 10.42 10.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANDESARTAN 32 MG TABLET RX-23232 CDM A9270 HCPCS 0637 RC 00378-3232-93 NDC outpatient 1 UN 10.42 10.42 10.42 74 7.71 percent of total billed charges 10.42 93 8.44 percent of total billed charges 10.42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.42 other OPPS APC 10.42 10.42 other OPPS APC 10.42 24.86 2.59 percent of total billed charges 10.42 10.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CIPROFLOXACIN 0.3 % EYE OINTMENT RX-23234 CDM A9270 HCPCS 0250 RC 00078-0841-01 NDC outpatient 3.5 GR 815.56 815.56 74 603.51 percent of total billed charges 815.56 93 660.6 percent of total billed charges 815.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 815.56 other OPPS APC 815.56 815.56 other OPPS APC 815.56 24.86 202.75 percent of total billed charges 815.56 815.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CIPROFLOXACIN 0.3 % EYE OINTMENT RX-23234 CDM A9270 HCPCS 0637 RC 00078-0841-01 NDC outpatient 3.5 GR 815.56 815.56 815.56 74 603.51 percent of total billed charges 815.56 93 660.6 percent of total billed charges 815.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 815.56 other OPPS APC 815.56 815.56 other OPPS APC 815.56 24.86 202.75 percent of total billed charges 815.56 815.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXAMETHASONE 1 MG TABLET RX-2324 CDM A9270 HCPCS 0250 RC 00054-8174-25 NDC outpatient 1 UN 0.93 0.93 74 0.69 percent of total billed charges 0.93 93 0.75 percent of total billed charges 0.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.93 other OPPS APC 0.93 0.93 other OPPS APC 0.93 24.86 0.23 percent of total billed charges 0.93 0.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXAMETHASONE 1 MG TABLET RX-2324 CDM A9270 HCPCS 0637 RC 00054-8174-25 NDC outpatient 1 UN 0.93 0.93 0.93 74 0.69 percent of total billed charges 0.93 93 0.75 percent of total billed charges 0.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.93 other OPPS APC 0.93 0.93 other OPPS APC 0.93 24.86 0.23 percent of total billed charges 0.93 0.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXAMETHASONE 2 MG TABLET RX-2326 CDM A9270 HCPCS 0250 RC 00054-8176-25 NDC outpatient 1 UN 1.86 1.86 74 1.38 percent of total billed charges 1.86 93 1.51 percent of total billed charges 1.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.86 other OPPS APC 1.86 1.86 other OPPS APC 1.86 24.86 0.46 percent of total billed charges 1.86 1.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXAMETHASONE 2 MG TABLET RX-2326 CDM A9270 HCPCS 0637 RC 00054-8176-25 NDC outpatient 1 UN 1.86 1.86 1.86 74 1.38 percent of total billed charges 1.86 93 1.51 percent of total billed charges 1.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.86 other OPPS APC 1.86 1.86 other OPPS APC 1.86 24.86 0.46 percent of total billed charges 1.86 1.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXAMETHASONE 4 MG TABLET RX-2327 CDM J8540 HCPCS 0636 RC 00904-7266-61 NDC outpatient 1 UN 3.14 3.14 1.94 1.94 fee schedule 3.14 93 2.54 percent of total billed charges 3.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.14 other OPPS APC 3.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.14 other OPPS APC 3.14 24.86 0.78 percent of total billed charges 1.94 3.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION RX-2331 CDM J1100 HCPCS 0636 RC 00641-0367-25 NDC outpatient 1 ML 4.29 4.29 1.45 1.45 fee schedule 4.29 93 3.47 percent of total billed charges 4.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.29 other OPPS APC 4.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.29 other OPPS APC 4.29 24.86 1.07 percent of total billed charges 1.45 4.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION RX-2332 CDM J1100 HCPCS 0636 RC 00641-6145-25 NDC outpatient 1 ML 2.91 2.91 0.58 0.58 fee schedule 2.91 93 2.36 percent of total billed charges 2.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.91 other OPPS APC 2.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.91 other OPPS APC 2.91 24.86 0.72 percent of total billed charges 0.58 2.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXAMETHASONE SODIUM PHOSPHATE 0.1 % EYE DROPS RX-2335 CDM A9270 HCPCS 0250 RC 24208-0720-02 NDC outpatient 5 ML 161.7 161.7 74 119.66 percent of total billed charges 161.7 93 130.98 percent of total billed charges 161.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 161.7 other OPPS APC 161.7 161.7 other OPPS APC 161.7 24.86 40.2 percent of total billed charges 161.7 161.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXAMETHASONE SODIUM PHOSPHATE 0.1 % EYE DROPS RX-2335 CDM A9270 HCPCS 0637 RC 24208-0720-02 NDC outpatient 5 ML 161.7 161.7 161.7 74 119.66 percent of total billed charges 161.7 93 130.98 percent of total billed charges 161.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 161.7 other OPPS APC 161.7 161.7 other OPPS APC 161.7 24.86 40.2 percent of total billed charges 161.7 161.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 875 MG TABLET RX-23458 CDM A9270 HCPCS 0250 RC 57237-0029-20 NDC outpatient 1 UN 2.29 2.29 74 1.69 percent of total billed charges 2.29 93 1.85 percent of total billed charges 2.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.29 other OPPS APC 2.29 2.29 other OPPS APC 2.29 24.86 0.57 percent of total billed charges 2.29 2.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 875 MG TABLET RX-23458 CDM A9270 HCPCS 0637 RC 57237-0029-20 NDC outpatient 1 UN 2.29 2.29 2.29 74 1.69 percent of total billed charges 2.29 93 1.85 percent of total billed charges 2.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.29 other OPPS APC 2.29 2.29 other OPPS APC 2.29 24.86 0.57 percent of total billed charges 2.29 2.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION RX-2357 CDM 250000000 HCPCS 0250 RC 00338-0023-02 NDC outpatient 250 ML 19.05 19.05 19.05 74 14.1 percent of total billed charges 19.05 93 15.43 percent of total billed charges 19.05 19.05 other OPPS APC 19.05 19.05 other OPPS APC 19.05 24.86 4.74 percent of total billed charges 19.05 19.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION RX-2357 CDM 250000000 HCPCS 0250 RC 00338-0023-03 NDC outpatient 500 ML 17.63 17.63 17.63 74 13.05 percent of total billed charges 17.63 93 14.28 percent of total billed charges 17.63 17.63 other OPPS APC 17.63 17.63 other OPPS APC 17.63 24.86 4.38 percent of total billed charges 17.63 17.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION RX-2357 CDM 250000000 HCPCS 0250 RC 00338-0023-04 NDC outpatient 1000 ML 22.66 22.66 22.66 74 16.77 percent of total billed charges 22.66 93 18.35 percent of total billed charges 22.66 22.66 other OPPS APC 22.66 22.66 other OPPS APC 22.66 24.86 5.63 percent of total billed charges 22.66 22.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 25 % IN WATER (D25W) INTRAVENOUS SYRINGE RX-2361 CDM 250000000 HCPCS 0250 RC 00409-1775-40 NDC outpatient 10 ML 51.04 51.04 51.04 74 37.77 percent of total billed charges 51.04 93 41.34 percent of total billed charges 51.04 51.04 other OPPS APC 51.04 51.04 other OPPS APC 51.04 24.86 12.69 percent of total billed charges 51.04 51.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEUCOVORIN CALCIUM 500 MG SOLUTION FOR INJECTION RX-23617 CDM J0640 HCPCS 0636 RC 71288-0164-50 NDC outpatient 10 ML 258.58 258.58 53.6 53.6 fee schedule 258.58 93 209.45 percent of total billed charges 258.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 258.58 other OPPS APC 258.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 258.58 other OPPS APC 258.58 24.86 64.28 percent of total billed charges 53.6 258.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEUCOVORIN CALCIUM 500 MG SOLUTION FOR INJECTION RX-23617 CDM J0640 HCPCS 0636 RC 71288-0164-50 NDC outpatient 500 ME 258.58 258.58 53.6 53.6 fee schedule 258.58 93 209.45 percent of total billed charges 258.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 258.58 other OPPS APC 258.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 258.58 other OPPS APC 258.58 24.86 64.28 percent of total billed charges 53.6 258.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION RX-2364 CDM J7070 HCPCS 0636 RC 00338-0017-04 NDC outpatient 1000 ML 16.6 16.6 4.14 4.14 fee schedule 16.6 93 13.45 percent of total billed charges 16.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.6 other OPPS APC 16.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.6 other OPPS APC 16.6 24.86 4.13 percent of total billed charges 4.14 16.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION RX-2365 CDM 250000000 HCPCS 0250 RC 00409-6648-02 NDC outpatient 50 ML 12.93 12.93 12.93 74 9.57 percent of total billed charges 12.93 93 10.47 percent of total billed charges 12.93 12.93 other OPPS APC 12.93 12.93 other OPPS APC 12.93 24.86 3.21 percent of total billed charges 12.93 12.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION RX-2367 CDM 250000000 HCPCS 0250 RC 00264-7387-50 NDC outpatient 2000 ML 42.91 42.91 42.91 74 31.75 percent of total billed charges 42.91 93 34.76 percent of total billed charges 42.91 42.91 other OPPS APC 42.91 42.91 other OPPS APC 42.91 24.86 10.67 percent of total billed charges 42.91 42.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION RX-2367 CDM 250000000 HCPCS 0250 RC 00990-7918-19 NDC outpatient 500 ML 37.59 37.59 37.59 74 27.82 percent of total billed charges 37.59 93 30.45 percent of total billed charges 37.59 37.59 other OPPS APC 37.59 37.59 other OPPS APC 37.59 24.86 9.34 percent of total billed charges 37.59 37.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INFLIXIMAB 100 MG INTRAVENOUS SOLUTION RX-23796 CDM J1745 HCPCS 0636 RC 57894-0160-01 NDC outpatient 10 ML 1425 1425 375.58 375.58 fee schedule 1425 93 1154.25 percent of total billed charges 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 322.23 other OPPS APC 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 322.23 other OPPS APC 1425 24.86 354.26 percent of total billed charges 375.58 1425 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEFLUNOMIDE 10 MG TABLET RX-23872 CDM A9270 HCPCS 0250 RC 70748-0129-06 NDC outpatient 1 UN 41.06 41.06 74 30.38 percent of total billed charges 41.06 93 33.26 percent of total billed charges 41.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.06 other OPPS APC 41.06 41.06 other OPPS APC 41.06 24.86 10.21 percent of total billed charges 41.06 41.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEFLUNOMIDE 10 MG TABLET RX-23872 CDM A9270 HCPCS 0637 RC 70748-0129-06 NDC outpatient 1 UN 41.06 41.06 41.06 74 30.38 percent of total billed charges 41.06 93 33.26 percent of total billed charges 41.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.06 other OPPS APC 41.06 41.06 other OPPS APC 41.06 24.86 10.21 percent of total billed charges 41.06 41.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIAZEPAM 5 MG/ML INJECTION SOLUTION RX-2401 CDM J3360 HCPCS 0636 RC 00409-3213-12 NDC outpatient 10 ML 150.32 150.32 59.9 59.9 fee schedule 150.32 93 121.76 percent of total billed charges 150.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 150.32 other OPPS APC 150.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 150.32 other OPPS APC 150.32 24.86 37.37 percent of total billed charges 59.9 150.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIAZEPAM 10 MG TABLET RX-2403 CDM A9270 HCPCS 0250 RC 00172-3927-60 NDC outpatient 1 UN 0.83 0.83 74 0.61 percent of total billed charges 0.83 93 0.67 percent of total billed charges 0.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.83 other OPPS APC 0.83 0.83 other OPPS APC 0.83 24.86 0.21 percent of total billed charges 0.83 0.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIAZEPAM 10 MG TABLET RX-2403 CDM A9270 HCPCS 0637 RC 00172-3927-60 NDC outpatient 1 UN 0.83 0.83 0.83 74 0.61 percent of total billed charges 0.83 93 0.67 percent of total billed charges 0.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.83 other OPPS APC 0.83 0.83 other OPPS APC 0.83 24.86 0.21 percent of total billed charges 0.83 0.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIAZEPAM 2 MG TABLET RX-2404 CDM A9270 HCPCS 0250 RC 51079-0284-20 NDC outpatient 1 UN 0.61 0.61 74 0.45 percent of total billed charges 0.61 93 0.49 percent of total billed charges 0.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.61 other OPPS APC 0.61 0.61 other OPPS APC 0.61 24.86 0.15 percent of total billed charges 0.61 0.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIAZEPAM 2 MG TABLET RX-2404 CDM A9270 HCPCS 0637 RC 51079-0284-20 NDC outpatient 1 UN 0.61 0.61 0.61 74 0.45 percent of total billed charges 0.61 93 0.49 percent of total billed charges 0.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.61 other OPPS APC 0.61 0.61 other OPPS APC 0.61 24.86 0.15 percent of total billed charges 0.61 0.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIAZEPAM 5 MG TABLET RX-2405 CDM A9270 HCPCS 0250 RC 51079-0285-20 NDC outpatient 1 UN 0.81 0.81 74 0.6 percent of total billed charges 0.81 93 0.66 percent of total billed charges 0.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.81 other OPPS APC 0.81 0.81 other OPPS APC 0.81 24.86 0.2 percent of total billed charges 0.81 0.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIAZEPAM 5 MG TABLET RX-2405 CDM A9270 HCPCS 0637 RC 51079-0285-20 NDC outpatient 1 UN 0.81 0.81 0.81 74 0.6 percent of total billed charges 0.81 93 0.66 percent of total billed charges 0.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.81 other OPPS APC 0.81 0.81 other OPPS APC 0.81 24.86 0.2 percent of total billed charges 0.81 0.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION RX-24119 CDM A9270 HCPCS 0250 RC 65862-0057-24 NDC outpatient 240 ML 473.21 473.21 74 350.18 percent of total billed charges 473.21 93 383.3 percent of total billed charges 473.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 473.21 other OPPS APC 473.21 473.21 other OPPS APC 473.21 24.86 117.64 percent of total billed charges 473.21 473.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION RX-24119 CDM A9270 HCPCS 0637 RC 65862-0057-24 NDC outpatient 240 ML 473.21 473.21 473.21 74 350.18 percent of total billed charges 473.21 93 383.3 percent of total billed charges 473.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 473.21 other OPPS APC 473.21 473.21 other OPPS APC 473.21 24.86 117.64 percent of total billed charges 473.21 473.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIBUCAINE 1 % TOPICAL OINTMENT RX-2412 CDM A9270 HCPCS 0250 RC 71399-2829-01 NDC outpatient 28 GR 9.78 9.78 74 7.24 percent of total billed charges 9.78 93 7.92 percent of total billed charges 9.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.78 other OPPS APC 9.78 9.78 other OPPS APC 9.78 24.86 2.43 percent of total billed charges 9.78 9.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIBUCAINE 1 % TOPICAL OINTMENT RX-2412 CDM A9270 HCPCS 0637 RC 71399-2829-01 NDC outpatient 28 GR 9.78 9.78 9.78 74 7.24 percent of total billed charges 9.78 93 7.92 percent of total billed charges 9.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.78 other OPPS APC 9.78 9.78 other OPPS APC 9.78 24.86 2.43 percent of total billed charges 9.78 9.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DICYCLOMINE 10 MG CAPSULE RX-2418 CDM A9270 HCPCS 0250 RC 60687-0369-01 NDC outpatient 1 UN 1.65 1.65 74 1.22 percent of total billed charges 1.65 93 1.34 percent of total billed charges 1.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.65 other OPPS APC 1.65 1.65 other OPPS APC 1.65 24.86 0.41 percent of total billed charges 1.65 1.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DICYCLOMINE 10 MG CAPSULE RX-2418 CDM A9270 HCPCS 0637 RC 60687-0369-01 NDC outpatient 1 UN 1.65 1.65 1.65 74 1.22 percent of total billed charges 1.65 93 1.34 percent of total billed charges 1.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.65 other OPPS APC 1.65 1.65 other OPPS APC 1.65 24.86 0.41 percent of total billed charges 1.65 1.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ANTIVENIN LATRODECTUS MACTANS 6,000 UNIT SOLUTION FOR INJECTION" RX-24188 CDM 636000000 HCPCS 0636 RC 00006-5424-02 NDC outpatient 1 UN 83.13 83.13 83.13 74 61.52 percent of total billed charges 83.13 93 67.34 percent of total billed charges 83.13 83.13 other OPPS APC 83.13 83.13 other OPPS APC 83.13 24.86 20.67 percent of total billed charges 83.13 83.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DICYCLOMINE 20 MG TABLET RX-2420 CDM A9270 HCPCS 0250 RC 60687-0380-01 NDC outpatient 1 UN 1.37 1.37 74 1.01 percent of total billed charges 1.37 93 1.11 percent of total billed charges 1.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.37 other OPPS APC 1.37 1.37 other OPPS APC 1.37 24.86 0.34 percent of total billed charges 1.37 1.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DICYCLOMINE 20 MG TABLET RX-2420 CDM A9270 HCPCS 0637 RC 60687-0380-01 NDC outpatient 1 UN 1.37 1.37 1.37 74 1.01 percent of total billed charges 1.37 93 1.11 percent of total billed charges 1.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.37 other OPPS APC 1.37 1.37 other OPPS APC 1.37 24.86 0.34 percent of total billed charges 1.37 1.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET RX-24216 CDM A9270 HCPCS 0250 RC 63739-0432-02 NDC outpatient 1 UN 0.17 0.17 74 0.13 percent of total billed charges 0.17 93 0.14 percent of total billed charges 0.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.17 other OPPS APC 0.17 0.17 other OPPS APC 0.17 24.86 0.04 percent of total billed charges 0.17 0.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET RX-24216 CDM A9270 HCPCS 0637 RC 63739-0432-02 NDC outpatient 1 UN 0.17 0.17 0.17 74 0.13 percent of total billed charges 0.17 93 0.14 percent of total billed charges 0.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.17 other OPPS APC 0.17 0.17 other OPPS APC 0.17 24.86 0.04 percent of total billed charges 0.17 0.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR" RX-24268 CDM A9270 HCPCS 0250 RC 00904-6450-61 NDC outpatient 1 UN 5.07 5.07 74 3.75 percent of total billed charges 5.07 93 4.11 percent of total billed charges 5.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.07 other OPPS APC 5.07 5.07 other OPPS APC 5.07 24.86 1.26 percent of total billed charges 5.07 5.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR" RX-24268 CDM A9270 HCPCS 0637 RC 00904-6450-61 NDC outpatient 1 UN 5.07 5.07 5.07 74 3.75 percent of total billed charges 5.07 93 4.11 percent of total billed charges 5.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.07 other OPPS APC 5.07 5.07 other OPPS APC 5.07 24.86 1.26 percent of total billed charges 5.07 5.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALUMINUM HYDROX-MAGNESIUM CARB 95 MG-358 MG/15 ML ORAL SUSPENSION RX-24314 CDM A9270 HCPCS 0250 RC 00904-7727-14 NDC outpatient 355 ML 13.18 13.18 74 9.75 percent of total billed charges 13.18 93 10.68 percent of total billed charges 13.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.18 other OPPS APC 13.18 13.18 other OPPS APC 13.18 24.86 3.28 percent of total billed charges 13.18 13.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALUMINUM HYDROX-MAGNESIUM CARB 95 MG-358 MG/15 ML ORAL SUSPENSION RX-24314 CDM A9270 HCPCS 0637 RC 00904-7727-14 NDC outpatient 355 ML 13.18 13.18 13.18 74 9.75 percent of total billed charges 13.18 93 10.68 percent of total billed charges 13.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.18 other OPPS APC 13.18 13.18 other OPPS APC 13.18 24.86 3.28 percent of total billed charges 13.18 13.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) IN DEXTROSE 5 % IV" RX-24329 CDM J1644 HCPCS 0636 RC 63323-0523-74 NDC outpatient 250 ML 28.19 28.19 7.56 7.56 fee schedule 28.19 93 22.83 percent of total billed charges 28.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28.19 other OPPS APC 28.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28.19 other OPPS APC 28.19 24.86 7.01 percent of total billed charges 7.56 28.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIGOXIN 125 MCG (0.125 MG) TABLET RX-2444 CDM A9270 HCPCS 0250 RC 60687-0540-01 NDC outpatient 1 UN 3.48 3.48 74 2.58 percent of total billed charges 3.48 93 2.82 percent of total billed charges 3.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.48 other OPPS APC 3.48 3.48 other OPPS APC 3.48 24.86 0.87 percent of total billed charges 3.48 3.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIGOXIN 125 MCG (0.125 MG) TABLET RX-2444 CDM A9270 HCPCS 0637 RC 60687-0540-01 NDC outpatient 1 UN 3.48 3.48 3.48 74 2.58 percent of total billed charges 3.48 93 2.82 percent of total billed charges 3.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.48 other OPPS APC 3.48 3.48 other OPPS APC 3.48 24.86 0.87 percent of total billed charges 3.48 3.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR" RX-24470 CDM A9270 HCPCS 0250 RC 50268-0627-11 NDC outpatient 1 UN 7.69 7.69 74 5.69 percent of total billed charges 7.69 93 6.23 percent of total billed charges 7.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.69 other OPPS APC 7.69 7.69 other OPPS APC 7.69 24.86 1.91 percent of total billed charges 7.69 7.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR" RX-24470 CDM A9270 HCPCS 0637 RC 50268-0627-11 NDC outpatient 1 UN 7.69 7.69 7.69 74 5.69 percent of total billed charges 7.69 93 6.23 percent of total billed charges 7.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.69 other OPPS APC 7.69 7.69 other OPPS APC 7.69 24.86 1.91 percent of total billed charges 7.69 7.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CILOSTAZOL 50 MG TABLET RX-24473 CDM A9270 HCPCS 0250 RC 50268-0176-15 NDC outpatient 1 UN 5.59 5.59 74 4.14 percent of total billed charges 5.59 93 4.53 percent of total billed charges 5.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.59 other OPPS APC 5.59 5.59 other OPPS APC 5.59 24.86 1.39 percent of total billed charges 5.59 5.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CILOSTAZOL 50 MG TABLET RX-24473 CDM A9270 HCPCS 0637 RC 50268-0176-15 NDC outpatient 1 UN 5.59 5.59 5.59 74 4.14 percent of total billed charges 5.59 93 4.53 percent of total billed charges 5.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.59 other OPPS APC 5.59 5.59 other OPPS APC 5.59 24.86 1.39 percent of total billed charges 5.59 5.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CILOSTAZOL 100 MG TABLET RX-24474 CDM A9270 HCPCS 0250 RC 50268-0177-15 NDC outpatient 1 UN 5.63 5.63 74 4.17 percent of total billed charges 5.63 93 4.56 percent of total billed charges 5.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.63 other OPPS APC 5.63 5.63 other OPPS APC 5.63 24.86 1.4 percent of total billed charges 5.63 5.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CILOSTAZOL 100 MG TABLET RX-24474 CDM A9270 HCPCS 0637 RC 50268-0177-15 NDC outpatient 1 UN 5.63 5.63 5.63 74 4.17 percent of total billed charges 5.63 93 4.56 percent of total billed charges 5.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.63 other OPPS APC 5.63 5.63 other OPPS APC 5.63 24.86 1.4 percent of total billed charges 5.63 5.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CELECOXIB 100 MG CAPSULE RX-24500 CDM A9270 HCPCS 0250 RC 50268-0168-15 NDC outpatient 1 UN 10.92 10.92 74 8.08 percent of total billed charges 10.92 93 8.85 percent of total billed charges 10.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.92 other OPPS APC 10.92 10.92 other OPPS APC 10.92 24.86 2.71 percent of total billed charges 10.92 10.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CELECOXIB 100 MG CAPSULE RX-24500 CDM A9270 HCPCS 0637 RC 50268-0168-15 NDC outpatient 1 UN 10.92 10.92 10.92 74 8.08 percent of total billed charges 10.92 93 8.85 percent of total billed charges 10.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.92 other OPPS APC 10.92 10.92 other OPPS APC 10.92 24.86 2.71 percent of total billed charges 10.92 10.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CELECOXIB 200 MG CAPSULE RX-24501 CDM A9270 HCPCS 0250 RC 00904-6503-61 NDC outpatient 1 UN 18.95 18.95 74 14.02 percent of total billed charges 18.95 93 15.35 percent of total billed charges 18.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.95 other OPPS APC 18.95 18.95 other OPPS APC 18.95 24.86 4.71 percent of total billed charges 18.95 18.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CELECOXIB 200 MG CAPSULE RX-24501 CDM A9270 HCPCS 0637 RC 00904-6503-61 NDC outpatient 1 UN 18.95 18.95 18.95 74 14.02 percent of total billed charges 18.95 93 15.35 percent of total billed charges 18.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.95 other OPPS APC 18.95 18.95 other OPPS APC 18.95 24.86 4.71 percent of total billed charges 18.95 18.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR" RX-24521 CDM A9270 HCPCS 0250 RC 00904-6449-61 NDC outpatient 1 UN 4.15 4.15 74 3.07 percent of total billed charges 4.15 93 3.36 percent of total billed charges 4.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.15 other OPPS APC 4.15 4.15 other OPPS APC 4.15 24.86 1.03 percent of total billed charges 4.15 4.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR" RX-24521 CDM A9270 HCPCS 0637 RC 00904-6449-61 NDC outpatient 1 UN 4.15 4.15 4.15 74 3.07 percent of total billed charges 4.15 93 3.36 percent of total billed charges 4.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.15 other OPPS APC 4.15 4.15 other OPPS APC 4.15 24.86 1.03 percent of total billed charges 4.15 4.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET RX-24559 CDM A9270 HCPCS 0250 RC 77333-0948-10 NDC outpatient 1 UN 0.57 0.57 74 0.42 percent of total billed charges 0.57 93 0.46 percent of total billed charges 0.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.57 other OPPS APC 0.57 0.57 other OPPS APC 0.57 24.86 0.14 percent of total billed charges 0.57 0.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET RX-24559 CDM A9270 HCPCS 0637 RC 77333-0948-10 NDC outpatient 1 UN 0.57 0.57 0.57 74 0.42 percent of total billed charges 0.57 93 0.46 percent of total billed charges 0.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.57 other OPPS APC 0.57 0.57 other OPPS APC 0.57 24.86 0.14 percent of total billed charges 0.57 0.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIMOLOL MALEATE 0.25 % EYE GEL FORMING SOLUTION RX-24575 CDM A9270 HCPCS 0250 RC 61314-0224-05 NDC outpatient 5 ML 344.75 344.75 74 255.12 percent of total billed charges 344.75 93 279.25 percent of total billed charges 344.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 344.75 other OPPS APC 344.75 344.75 other OPPS APC 344.75 24.86 85.7 percent of total billed charges 344.75 344.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIMOLOL MALEATE 0.25 % EYE GEL FORMING SOLUTION RX-24575 CDM A9270 HCPCS 0637 RC 61314-0224-05 NDC outpatient 5 ML 344.75 344.75 344.75 74 255.12 percent of total billed charges 344.75 93 279.25 percent of total billed charges 344.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 344.75 other OPPS APC 344.75 344.75 other OPPS APC 344.75 24.86 85.7 percent of total billed charges 344.75 344.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIMOLOL MALEATE 0.5 % EYE GEL FORMING SOLUTION RX-24576 CDM A9270 HCPCS 0250 RC 61314-0225-05 NDC outpatient 5 ML 543.18 543.18 74 401.95 percent of total billed charges 543.18 93 439.98 percent of total billed charges 543.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 543.18 other OPPS APC 543.18 543.18 other OPPS APC 543.18 24.86 135.03 percent of total billed charges 543.18 543.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIMOLOL MALEATE 0.5 % EYE GEL FORMING SOLUTION RX-24576 CDM A9270 HCPCS 0637 RC 61314-0225-05 NDC outpatient 5 ML 543.18 543.18 543.18 74 401.95 percent of total billed charges 543.18 93 439.98 percent of total billed charges 543.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 543.18 other OPPS APC 543.18 543.18 other OPPS APC 543.18 24.86 135.03 percent of total billed charges 543.18 543.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MODAFINIL 200 MG TABLET RX-24703 CDM A9270 HCPCS 0250 RC 68084-0721-21 NDC outpatient 1 UN 88.47 88.47 74 65.47 percent of total billed charges 88.47 93 71.66 percent of total billed charges 88.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 88.47 other OPPS APC 88.47 88.47 other OPPS APC 88.47 24.86 21.99 percent of total billed charges 88.47 88.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MODAFINIL 200 MG TABLET RX-24703 CDM A9270 HCPCS 0637 RC 68084-0721-21 NDC outpatient 1 UN 88.47 88.47 88.47 74 65.47 percent of total billed charges 88.47 93 71.66 percent of total billed charges 88.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 88.47 other OPPS APC 88.47 88.47 other OPPS APC 88.47 24.86 21.99 percent of total billed charges 88.47 88.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILTIAZEM 30 MG TABLET RX-2475 CDM A9270 HCPCS 0250 RC 60687-0717-01 NDC outpatient 1 UN 1.32 1.32 74 0.98 percent of total billed charges 1.32 93 1.07 percent of total billed charges 1.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.32 other OPPS APC 1.32 1.32 other OPPS APC 1.32 24.86 0.33 percent of total billed charges 1.32 1.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILTIAZEM 30 MG TABLET RX-2475 CDM A9270 HCPCS 0637 RC 60687-0717-01 NDC outpatient 1 UN 1.32 1.32 1.32 74 0.98 percent of total billed charges 1.32 93 1.07 percent of total billed charges 1.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.32 other OPPS APC 1.32 1.32 other OPPS APC 1.32 24.86 0.33 percent of total billed charges 1.32 1.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILTIAZEM 60 MG TABLET RX-2476 CDM A9270 HCPCS 0250 RC 50228-0482-01 NDC outpatient 1 UN 3.92 3.92 74 2.9 percent of total billed charges 3.92 93 3.18 percent of total billed charges 3.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.92 other OPPS APC 3.92 3.92 other OPPS APC 3.92 24.86 0.97 percent of total billed charges 3.92 3.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILTIAZEM 60 MG TABLET RX-2476 CDM A9270 HCPCS 0637 RC 50228-0482-01 NDC outpatient 1 UN 3.92 3.92 3.92 74 2.9 percent of total billed charges 3.92 93 3.18 percent of total billed charges 3.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.92 other OPPS APC 3.92 3.92 other OPPS APC 3.92 24.86 0.97 percent of total billed charges 3.92 3.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILTIAZEM 90 MG TABLET RX-2477 CDM A9270 HCPCS 0250 RC 50228-0483-01 NDC outpatient 1 UN 5.36 5.36 74 3.97 percent of total billed charges 5.36 93 4.34 percent of total billed charges 5.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.36 other OPPS APC 5.36 5.36 other OPPS APC 5.36 24.86 1.33 percent of total billed charges 5.36 5.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILTIAZEM 90 MG TABLET RX-2477 CDM A9270 HCPCS 0637 RC 50228-0483-01 NDC outpatient 1 UN 5.36 5.36 5.36 74 3.97 percent of total billed charges 5.36 93 4.34 percent of total billed charges 5.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.36 other OPPS APC 5.36 5.36 other OPPS APC 5.36 24.86 1.33 percent of total billed charges 5.36 5.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROMETHORPHAN-GUAIFENESIN 30 MG-600 MG TABLET EXTENDED RELEASE12 HR RX-24844 CDM A9270 HCPCS 0250 RC 70677-1050-01 NDC outpatient 1 UN 0.88 0.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.88 other OPPS APC 0.88 0.88 other OPPS APC 0.88 24.86 0.22 percent of total billed charges 0.88 0.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROMETHORPHAN-GUAIFENESIN 30 MG-600 MG TABLET EXTENDED RELEASE12 HR RX-24844 CDM A9270 HCPCS 0637 RC 70677-1050-01 NDC outpatient 1 UN 0.88 0.88 0.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.88 other OPPS APC 0.88 0.88 other OPPS APC 0.88 24.86 0.22 percent of total billed charges 0.88 0.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MICONAZOLE NITRATE 1,200 MG-2 % VAGINAL KIT" RX-24853 CDM A9270 HCPCS 0250 RC 63736-0441-80 NDC outpatient 1 UN 46.38 46.38 74 34.32 percent of total billed charges 46.38 93 37.57 percent of total billed charges 46.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 46.38 other OPPS APC 46.38 46.38 other OPPS APC 46.38 24.86 11.53 percent of total billed charges 46.38 46.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MICONAZOLE NITRATE 1,200 MG-2 % VAGINAL KIT" RX-24853 CDM A9270 HCPCS 0637 RC 63736-0441-80 NDC outpatient 1 UN 46.38 46.38 46.38 74 34.32 percent of total billed charges 46.38 93 37.57 percent of total billed charges 46.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 46.38 other OPPS APC 46.38 46.38 other OPPS APC 46.38 24.86 11.53 percent of total billed charges 46.38 46.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE" RX-24914 CDM J7507 HCPCS 0636 RC 00469-0607-73 NDC outpatient 1 UN 10.78 10.78 0.33 0.33 fee schedule 10.78 93 8.73 percent of total billed charges 10.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.78 other OPPS APC 10.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.78 other OPPS APC 10.78 24.86 2.68 percent of total billed charges 0.33 10.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER RX-24984 CDM A9270 HCPCS 0250 RC 70677-1068-02 NDC outpatient 510 GR 24.98 24.98 74 18.49 percent of total billed charges 24.98 93 20.23 percent of total billed charges 24.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.98 other OPPS APC 24.98 24.98 other OPPS APC 24.98 24.86 6.21 percent of total billed charges 24.98 24.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER RX-24984 CDM A9270 HCPCS 0637 RC 70677-1068-02 NDC outpatient 510 GR 24.98 24.98 24.98 74 18.49 percent of total billed charges 24.98 93 20.23 percent of total billed charges 24.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.98 other OPPS APC 24.98 24.98 other OPPS APC 24.98 24.86 6.21 percent of total billed charges 24.98 24.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION RX-25005 CDM J7517 HCPCS 0636 RC 66689-0307-08 NDC outpatient 160 ML 3623.75 3623.75 30.98 30.98 fee schedule 3623.75 93 2935.24 percent of total billed charges 3623.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3623.75 other OPPS APC 3623.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3623.75 other OPPS APC 3623.75 24.86 900.86 percent of total billed charges 30.98 3623.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION RX-2508 CDM J1200 HCPCS 0636 RC 00641-0376-25 NDC outpatient 1 ML 3.52 3.52 1.21 1.21 fee schedule 3.52 93 2.85 percent of total billed charges 3.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.52 other OPPS APC 3.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.52 other OPPS APC 3.52 24.86 0.88 percent of total billed charges 1.21 3.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIPHENHYDRAMINE 25 MG CAPSULE RX-2509 CDM Q0163 HCPCS 0250 RC 00904-7237-61 NDC outpatient 1 UN 0.13 0.13 74 0.1 percent of total billed charges 0.13 93 0.11 percent of total billed charges 0.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.13 other OPPS APC 0.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.13 other OPPS APC 0.13 24.86 0.03 percent of total billed charges 0.13 0.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIPHENHYDRAMINE 25 MG CAPSULE RX-2509 CDM Q0163 HCPCS 0637 RC 00904-7237-61 NDC outpatient 1 UN 0.13 0.13 0.13 74 0.1 percent of total billed charges 0.13 93 0.11 percent of total billed charges 0.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.13 other OPPS APC 0.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.13 other OPPS APC 0.13 24.86 0.03 percent of total billed charges 0.13 0.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIPHENHYDRAMINE 50 MG CAPSULE RX-2510 CDM Q0163 HCPCS 0250 RC 00904-2056-61 NDC outpatient 1 UN 0.14 0.14 74 0.1 percent of total billed charges 0.14 93 0.11 percent of total billed charges 0.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.14 other OPPS APC 0.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.14 other OPPS APC 0.14 24.86 0.03 percent of total billed charges 0.14 0.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIPHENHYDRAMINE 50 MG CAPSULE RX-2510 CDM Q0163 HCPCS 0637 RC 00904-2056-61 NDC outpatient 1 UN 0.14 0.14 0.14 74 0.1 percent of total billed charges 0.14 93 0.11 percent of total billed charges 0.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.14 other OPPS APC 0.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.14 other OPPS APC 0.14 24.86 0.03 percent of total billed charges 0.14 0.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR RX-2511 CDM Q0163 HCPCS 0250 RC 00121-0978-10 NDC outpatient 10 ML 11.28 11.28 74 8.35 percent of total billed charges 11.28 93 9.14 percent of total billed charges 11.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.28 other OPPS APC 11.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.28 other OPPS APC 11.28 24.86 2.8 percent of total billed charges 11.28 11.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR RX-2511 CDM Q0163 HCPCS 0637 RC 00121-0978-10 NDC outpatient 10 ML 11.28 11.28 11.28 74 8.35 percent of total billed charges 11.28 93 9.14 percent of total billed charges 11.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.28 other OPPS APC 11.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.28 other OPPS APC 11.28 24.86 2.8 percent of total billed charges 11.28 11.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CIPROFLOXACIN 500 MG TABLET RX-25119 CDM A9270 HCPCS 0250 RC 00904-7243-61 NDC outpatient 1 UN 0.93 0.93 74 0.69 percent of total billed charges 0.93 93 0.75 percent of total billed charges 0.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.93 other OPPS APC 0.93 0.93 other OPPS APC 0.93 24.86 0.23 percent of total billed charges 0.93 0.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CIPROFLOXACIN 500 MG TABLET RX-25119 CDM A9270 HCPCS 0637 RC 00904-7243-61 NDC outpatient 1 UN 0.93 0.93 0.93 74 0.69 percent of total billed charges 0.93 93 0.75 percent of total billed charges 0.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.93 other OPPS APC 0.93 0.93 other OPPS APC 0.93 24.86 0.23 percent of total billed charges 0.93 0.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET RX-2516 CDM A9270 HCPCS 0250 RC 71205-0909-00 NDC outpatient 1 UN 0.55 0.55 74 0.41 percent of total billed charges 0.55 93 0.45 percent of total billed charges 0.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.55 other OPPS APC 0.55 0.55 other OPPS APC 0.55 24.86 0.14 percent of total billed charges 0.55 0.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET RX-2516 CDM A9270 HCPCS 0637 RC 71205-0909-00 NDC outpatient 1 UN 0.55 0.55 0.55 74 0.41 percent of total billed charges 0.55 93 0.45 percent of total billed charges 0.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.55 other OPPS APC 0.55 0.55 other OPPS APC 0.55 24.86 0.14 percent of total billed charges 0.55 0.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HETASTARCH 6 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION RX-25174 CDM 250000000 HCPCS 0250 RC 00409-7248-03 NDC outpatient 500 ML 68.57 68.57 68.57 74 50.74 percent of total billed charges 68.57 93 55.54 percent of total billed charges 68.57 68.57 other OPPS APC 68.57 68.57 other OPPS APC 68.57 24.86 17.05 percent of total billed charges 68.57 68.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRUP RX-252 CDM A9270 HCPCS 0250 RC 70752-0102-12 NDC outpatient 473 ML 151.58 151.58 74 112.17 percent of total billed charges 151.58 93 122.78 percent of total billed charges 151.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 151.58 other OPPS APC 151.58 151.58 other OPPS APC 151.58 24.86 37.68 percent of total billed charges 151.58 151.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRUP RX-252 CDM A9270 HCPCS 0637 RC 70752-0102-12 NDC outpatient 473 ML 151.58 151.58 151.58 74 112.17 percent of total billed charges 151.58 93 122.78 percent of total billed charges 151.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 151.58 other OPPS APC 151.58 151.58 other OPPS APC 151.58 24.86 37.68 percent of total billed charges 151.58 151.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE" RX-25238 CDM A9270 HCPCS 0250 RC 00591-2880-01 NDC outpatient 1 UN 4.37 4.37 74 3.23 percent of total billed charges 4.37 93 3.54 percent of total billed charges 4.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.37 other OPPS APC 4.37 4.37 other OPPS APC 4.37 24.86 1.09 percent of total billed charges 4.37 4.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE" RX-25238 CDM A9270 HCPCS 0637 RC 00591-2880-01 NDC outpatient 1 UN 4.37 4.37 4.37 74 3.23 percent of total billed charges 4.37 93 3.54 percent of total billed charges 4.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.37 other OPPS APC 4.37 4.37 other OPPS APC 4.37 24.86 1.09 percent of total billed charges 4.37 4.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION RX-25246 CDM A9270 HCPCS 0250 RC 65862-0071-01 NDC outpatient 100 ML 24.53 24.53 74 18.15 percent of total billed charges 24.53 93 19.87 percent of total billed charges 24.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.53 other OPPS APC 24.53 24.53 other OPPS APC 24.53 24.86 6.1 percent of total billed charges 24.53 24.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION RX-25246 CDM A9270 HCPCS 0637 RC 65862-0071-01 NDC outpatient 100 ML 24.53 24.53 24.53 74 18.15 percent of total billed charges 24.53 93 19.87 percent of total billed charges 24.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.53 other OPPS APC 24.53 24.53 other OPPS APC 24.53 24.86 6.1 percent of total billed charges 24.53 24.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIPYRIDAMOLE 25 MG TABLET RX-2528 CDM A9270 HCPCS 0250 RC 00115-1070-01 NDC outpatient 1 UN 3.56 3.56 74 2.63 percent of total billed charges 3.56 93 2.88 percent of total billed charges 3.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.56 other OPPS APC 3.56 3.56 other OPPS APC 3.56 24.86 0.89 percent of total billed charges 3.56 3.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIPYRIDAMOLE 25 MG TABLET RX-2528 CDM A9270 HCPCS 0637 RC 00115-1070-01 NDC outpatient 1 UN 3.56 3.56 3.56 74 2.63 percent of total billed charges 3.56 93 2.88 percent of total billed charges 3.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.56 other OPPS APC 3.56 3.56 other OPPS APC 3.56 24.86 0.89 percent of total billed charges 3.56 3.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFAZOLIN 1 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK RX-25365 CDM J0689 HCPCS 0636 RC 00338-3503-41 NDC outpatient 1 GR 14 14 2.78 2.78 fee schedule 14 93 11.34 percent of total billed charges 14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.52 other OPPS APC 14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.52 other OPPS APC 14 24.86 3.48 percent of total billed charges 2.78 14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFAZOLIN 1 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK RX-25365 CDM J0689 HCPCS 0636 RC 00338-3503-41 NDC outpatient 50 ML 14 14 2.78 2.78 fee schedule 14 93 11.34 percent of total billed charges 14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.52 other OPPS APC 14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.52 other OPPS APC 14 24.86 3.48 percent of total billed charges 2.78 14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALBUTEROL SULFATE 4 MG TABLET RX-254 CDM A9270 HCPCS 0250 RC 00378-0572-01 NDC outpatient 1 UN 14.69 14.69 74 10.87 percent of total billed charges 14.69 93 11.9 percent of total billed charges 14.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.69 other OPPS APC 14.69 14.69 other OPPS APC 14.69 24.86 3.65 percent of total billed charges 14.69 14.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALBUTEROL SULFATE 4 MG TABLET RX-254 CDM A9270 HCPCS 0637 RC 00378-0572-01 NDC outpatient 1 UN 14.69 14.69 14.69 74 10.87 percent of total billed charges 14.69 93 11.9 percent of total billed charges 14.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.69 other OPPS APC 14.69 14.69 other OPPS APC 14.69 24.86 3.65 percent of total billed charges 14.69 14.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET RX-25424 CDM A9270 HCPCS 0250 RC 00904-6931-81 NDC outpatient 1 UN 3.87 3.87 74 2.86 percent of total billed charges 3.87 93 3.13 percent of total billed charges 3.87 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.87 other OPPS APC 3.87 3.87 other OPPS APC 3.87 24.86 0.96 percent of total billed charges 3.87 3.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET RX-25424 CDM A9270 HCPCS 0637 RC 00904-6931-81 NDC outpatient 1 UN 3.87 3.87 3.87 74 2.86 percent of total billed charges 3.87 93 3.13 percent of total billed charges 3.87 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.87 other OPPS APC 3.87 3.87 other OPPS APC 3.87 24.86 0.96 percent of total billed charges 3.87 3.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DIVALPROEX 250 MG TABLET,DELAYED RELEASE" RX-2552 CDM A9270 HCPCS 0250 RC 00904-6860-61 NDC outpatient 1 UN 0.6 0.6 74 0.44 percent of total billed charges 0.6 93 0.49 percent of total billed charges 0.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.6 other OPPS APC 0.6 0.6 other OPPS APC 0.6 24.86 0.15 percent of total billed charges 0.6 0.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DIVALPROEX 250 MG TABLET,DELAYED RELEASE" RX-2552 CDM A9270 HCPCS 0637 RC 00904-6860-61 NDC outpatient 1 UN 0.6 0.6 0.6 74 0.44 percent of total billed charges 0.6 93 0.49 percent of total billed charges 0.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.6 other OPPS APC 0.6 0.6 other OPPS APC 0.6 24.86 0.15 percent of total billed charges 0.6 0.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RISPERIDONE 0.5 MG TABLET RX-25520 CDM A9270 HCPCS 0250 RC 00904-7361-61 NDC outpatient 1 UN 0.82 0.82 74 0.61 percent of total billed charges 0.82 93 0.66 percent of total billed charges 0.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.82 other OPPS APC 0.82 0.82 other OPPS APC 0.82 24.86 0.2 percent of total billed charges 0.82 0.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RISPERIDONE 0.5 MG TABLET RX-25520 CDM A9270 HCPCS 0637 RC 00904-7361-61 NDC outpatient 1 UN 0.82 0.82 0.82 74 0.61 percent of total billed charges 0.82 93 0.66 percent of total billed charges 0.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.82 other OPPS APC 0.82 0.82 other OPPS APC 0.82 24.86 0.2 percent of total billed charges 0.82 0.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIOGLITAZONE 15 MG TABLET RX-25528 CDM A9270 HCPCS 0250 RC 33342-0054-07 NDC outpatient 1 UN 17.52 17.52 74 12.96 percent of total billed charges 17.52 93 14.19 percent of total billed charges 17.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.52 other OPPS APC 17.52 17.52 other OPPS APC 17.52 24.86 4.36 percent of total billed charges 17.52 17.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIOGLITAZONE 15 MG TABLET RX-25528 CDM A9270 HCPCS 0637 RC 33342-0054-07 NDC outpatient 1 UN 17.52 17.52 17.52 74 12.96 percent of total billed charges 17.52 93 14.19 percent of total billed charges 17.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.52 other OPPS APC 17.52 17.52 other OPPS APC 17.52 24.86 4.36 percent of total billed charges 17.52 17.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIOGLITAZONE 30 MG TABLET RX-25529 CDM A9270 HCPCS 0250 RC 33342-0055-07 NDC outpatient 1 UN 26.77 26.77 74 19.81 percent of total billed charges 26.77 93 21.68 percent of total billed charges 26.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 26.77 other OPPS APC 26.77 26.77 other OPPS APC 26.77 24.86 6.66 percent of total billed charges 26.77 26.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIOGLITAZONE 30 MG TABLET RX-25529 CDM A9270 HCPCS 0637 RC 33342-0055-07 NDC outpatient 1 UN 26.77 26.77 26.77 74 19.81 percent of total billed charges 26.77 93 21.68 percent of total billed charges 26.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 26.77 other OPPS APC 26.77 26.77 other OPPS APC 26.77 24.86 6.66 percent of total billed charges 26.77 26.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DIVALPROEX 500 MG TABLET,DELAYED RELEASE" RX-2553 CDM A9270 HCPCS 0250 RC 00904-6861-90 NDC outpatient 1 UN 0.98 0.98 74 0.73 percent of total billed charges 0.98 93 0.79 percent of total billed charges 0.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.98 other OPPS APC 0.98 0.98 other OPPS APC 0.98 24.86 0.24 percent of total billed charges 0.98 0.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DIVALPROEX 500 MG TABLET,DELAYED RELEASE" RX-2553 CDM A9270 HCPCS 0637 RC 00904-6861-90 NDC outpatient 1 UN 0.98 0.98 0.98 74 0.73 percent of total billed charges 0.98 93 0.79 percent of total billed charges 0.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.98 other OPPS APC 0.98 0.98 other OPPS APC 0.98 24.86 0.24 percent of total billed charges 0.98 0.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOCUSATE SODIUM 100 MG CAPSULE RX-2566 CDM A9270 HCPCS 0250 RC 00904-7183-61 NDC outpatient 1 UN 0.15 0.15 74 0.11 percent of total billed charges 0.15 93 0.12 percent of total billed charges 0.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.15 other OPPS APC 0.15 0.15 other OPPS APC 0.15 24.86 0.04 percent of total billed charges 0.15 0.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOCUSATE SODIUM 100 MG CAPSULE RX-2566 CDM A9270 HCPCS 0637 RC 00904-7183-61 NDC outpatient 1 UN 0.15 0.15 0.15 74 0.11 percent of total billed charges 0.15 93 0.12 percent of total billed charges 0.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.15 other OPPS APC 0.15 0.15 other OPPS APC 0.15 24.86 0.04 percent of total billed charges 0.15 0.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOXEPIN 10 MG CAPSULE RX-2608 CDM A9270 HCPCS 0250 RC 51079-0436-01 NDC outpatient 1 UN 1.6 1.6 74 1.18 percent of total billed charges 1.6 93 1.3 percent of total billed charges 1.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.6 other OPPS APC 1.6 1.6 other OPPS APC 1.6 24.86 0.4 percent of total billed charges 1.6 1.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOXEPIN 10 MG CAPSULE RX-2608 CDM A9270 HCPCS 0637 RC 51079-0436-01 NDC outpatient 1 UN 1.6 1.6 1.6 74 1.18 percent of total billed charges 1.6 93 1.3 percent of total billed charges 1.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.6 other OPPS APC 1.6 1.6 other OPPS APC 1.6 24.86 0.4 percent of total billed charges 1.6 1.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOXEPIN 25 MG CAPSULE RX-2611 CDM A9270 HCPCS 0250 RC 51079-0437-20 NDC outpatient 1 UN 2.11 2.11 74 1.56 percent of total billed charges 2.11 93 1.71 percent of total billed charges 2.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.11 other OPPS APC 2.11 2.11 other OPPS APC 2.11 24.86 0.52 percent of total billed charges 2.11 2.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOXEPIN 25 MG CAPSULE RX-2611 CDM A9270 HCPCS 0637 RC 51079-0437-20 NDC outpatient 1 UN 2.11 2.11 2.11 74 1.56 percent of total billed charges 2.11 93 1.71 percent of total billed charges 2.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.11 other OPPS APC 2.11 2.11 other OPPS APC 2.11 24.86 0.52 percent of total billed charges 2.11 2.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION RX-2622 CDM 250000000 HCPCS 0250 RC 00143-9381-10 NDC outpatient 100 ME 63.18 63.18 63.18 74 46.75 percent of total billed charges 63.18 93 51.18 percent of total billed charges 63.18 63.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION RX-2622 CDM 250000000 HCPCS 0250 RC 72266-0237-05 NDC outpatient 10 ML 44.02 44.02 44.02 44.02 other OPPS APC 44.02 44.02 other OPPS APC 44.02 24.86 10.94 percent of total billed charges 44.02 44.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE" RX-26225 CDM A9270 HCPCS 0250 RC 50268-0639-15 NDC outpatient 1 UN 10.07 10.07 74 7.45 percent of total billed charges 10.07 93 8.16 percent of total billed charges 10.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.07 other OPPS APC 10.07 10.07 other OPPS APC 10.07 24.86 2.5 percent of total billed charges 10.07 10.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE" RX-26225 CDM A9270 HCPCS 0637 RC 50268-0639-15 NDC outpatient 1 UN 10.07 10.07 10.07 74 7.45 percent of total billed charges 10.07 93 8.16 percent of total billed charges 10.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.07 other OPPS APC 10.07 10.07 other OPPS APC 10.07 24.86 2.5 percent of total billed charges 10.07 10.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION RX-26226 CDM 250000000 HCPCS 0250 RC 55150-0202-10 NDC outpatient 10 ML 21.25 21.25 21.25 21.25 other OPPS APC 21.25 21.25 other OPPS APC 21.25 24.86 5.28 percent of total billed charges 21.25 21.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION RX-26226 CDM 250000000 HCPCS 0250 RC 67850-0150-25 NDC outpatient 40 ME 12.5 12.5 12.5 74 9.25 percent of total billed charges 12.5 93 10.13 percent of total billed charges 12.5 12.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE" RX-26371 CDM A9270 HCPCS 0250 RC 68084-0282-11 NDC outpatient 1 UN 3.96 3.96 74 2.93 percent of total billed charges 3.96 93 3.21 percent of total billed charges 3.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.96 other OPPS APC 3.96 3.96 other OPPS APC 3.96 24.86 0.98 percent of total billed charges 3.96 3.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE" RX-26371 CDM A9270 HCPCS 0637 RC 68084-0282-11 NDC outpatient 1 UN 3.96 3.96 3.96 74 2.93 percent of total billed charges 3.96 93 3.21 percent of total billed charges 3.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.96 other OPPS APC 3.96 3.96 other OPPS APC 3.96 24.86 0.98 percent of total billed charges 3.96 3.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DROPERIDOL 2.5 MG/ML INJECTION SOLUTION RX-2654 CDM J1790 HCPCS 0636 RC 00517-9702-25 NDC outpatient 2 ML 29.04 29.04 29.04 74 21.49 percent of total billed charges 29.04 93 23.52 percent of total billed charges 29.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.04 other OPPS APC 29.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.04 other OPPS APC 29.04 24.86 7.22 percent of total billed charges 29.04 29.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSELTAMIVIR 75 MG CAPSULE RX-26546 CDM A9270 HCPCS 0250 RC 72205-0044-11 NDC outpatient 1 UN 38.65 38.65 74 28.6 percent of total billed charges 38.65 93 31.31 percent of total billed charges 38.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.65 other OPPS APC 38.65 38.65 other OPPS APC 38.65 24.86 9.61 percent of total billed charges 38.65 38.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSELTAMIVIR 75 MG CAPSULE RX-26546 CDM A9270 HCPCS 0637 RC 72205-0044-11 NDC outpatient 1 UN 38.65 38.65 38.65 74 28.6 percent of total billed charges 38.65 93 31.31 percent of total billed charges 38.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.65 other OPPS APC 38.65 38.65 other OPPS APC 38.65 24.86 9.61 percent of total billed charges 38.65 38.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENTACAPONE 200 MG TABLET RX-26547 CDM A9270 HCPCS 0250 RC 60687-0188-11 NDC outpatient 1 UN 12.36 12.36 74 9.15 percent of total billed charges 12.36 93 10.01 percent of total billed charges 12.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.36 other OPPS APC 12.36 12.36 other OPPS APC 12.36 24.86 3.07 percent of total billed charges 12.36 12.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENTACAPONE 200 MG TABLET RX-26547 CDM A9270 HCPCS 0637 RC 60687-0188-11 NDC outpatient 1 UN 12.36 12.36 12.36 74 9.15 percent of total billed charges 12.36 93 10.01 percent of total billed charges 12.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.36 other OPPS APC 12.36 12.36 other OPPS APC 12.36 24.86 3.07 percent of total billed charges 12.36 12.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVETIRACETAM 250 MG TABLET RX-26816 CDM A9270 HCPCS 0250 RC 00904-7123-61 NDC outpatient 1 UN 0.56 0.56 74 0.41 percent of total billed charges 0.56 93 0.45 percent of total billed charges 0.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.56 other OPPS APC 0.56 0.56 other OPPS APC 0.56 24.86 0.14 percent of total billed charges 0.56 0.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVETIRACETAM 250 MG TABLET RX-26816 CDM A9270 HCPCS 0637 RC 00904-7123-61 NDC outpatient 1 UN 0.56 0.56 0.56 74 0.41 percent of total billed charges 0.56 93 0.45 percent of total billed charges 0.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.56 other OPPS APC 0.56 0.56 other OPPS APC 0.56 24.86 0.14 percent of total billed charges 0.56 0.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVETIRACETAM 500 MG TABLET RX-26817 CDM A9270 HCPCS 0250 RC 00904-7124-61 NDC outpatient 1 UN 0.63 0.63 74 0.47 percent of total billed charges 0.63 93 0.51 percent of total billed charges 0.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.63 other OPPS APC 0.63 0.63 other OPPS APC 0.63 24.86 0.16 percent of total billed charges 0.63 0.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVETIRACETAM 500 MG TABLET RX-26817 CDM A9270 HCPCS 0637 RC 00904-7124-61 NDC outpatient 1 UN 0.63 0.63 0.63 74 0.47 percent of total billed charges 0.63 93 0.51 percent of total billed charges 0.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.63 other OPPS APC 0.63 0.63 other OPPS APC 0.63 24.86 0.16 percent of total billed charges 0.63 0.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVETIRACETAM 750 MG TABLET RX-26818 CDM A9270 HCPCS 0250 RC 68084-0882-01 NDC outpatient 1 UN 2.1 2.1 74 1.55 percent of total billed charges 2.1 93 1.7 percent of total billed charges 2.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.1 other OPPS APC 2.1 2.1 other OPPS APC 2.1 24.86 0.52 percent of total billed charges 2.1 2.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVETIRACETAM 750 MG TABLET RX-26818 CDM A9270 HCPCS 0637 RC 68084-0882-01 NDC outpatient 1 UN 2.1 2.1 2.1 74 1.55 percent of total billed charges 2.1 93 1.7 percent of total billed charges 2.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.1 other OPPS APC 2.1 2.1 other OPPS APC 2.1 24.86 0.52 percent of total billed charges 2.1 2.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOFETILIDE 125 MCG CAPSULE RX-26965 CDM A9270 HCPCS 0250 RC 72205-0039-60 NDC outpatient 1 UN 24.36 24.36 74 18.03 percent of total billed charges 24.36 93 19.73 percent of total billed charges 24.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.36 other OPPS APC 24.36 24.36 other OPPS APC 24.36 24.86 6.06 percent of total billed charges 24.36 24.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOFETILIDE 125 MCG CAPSULE RX-26965 CDM A9270 HCPCS 0637 RC 72205-0039-60 NDC outpatient 1 UN 24.36 24.36 24.36 74 18.03 percent of total billed charges 24.36 93 19.73 percent of total billed charges 24.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.36 other OPPS APC 24.36 24.36 other OPPS APC 24.36 24.86 6.06 percent of total billed charges 24.36 24.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION RX-27032 CDM J7674 HCPCS 0636 RC 64281-0100-06 NDC outpatient 100 ME 249 249 98.01 98.01 fee schedule 249 93 201.69 percent of total billed charges 249 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249 other OPPS APC 249 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 249 other OPPS APC 249 24.86 61.9 percent of total billed charges 98.01 249 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION" RX-27038 CDM A9270 HCPCS 0250 RC 11980-0174-05 NDC outpatient 5 ML 481.2 481.2 74 356.09 percent of total billed charges 481.2 93 389.77 percent of total billed charges 481.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 481.2 other OPPS APC 481.2 481.2 other OPPS APC 481.2 24.86 119.63 percent of total billed charges 481.2 481.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PREDNISOLONE ACETATE 0.12 % EYE DROPS,SUSPENSION" RX-27038 CDM A9270 HCPCS 0637 RC 11980-0174-05 NDC outpatient 5 ML 481.2 481.2 481.2 74 356.09 percent of total billed charges 481.2 93 389.77 percent of total billed charges 481.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 481.2 other OPPS APC 481.2 481.2 other OPPS APC 481.2 24.86 119.63 percent of total billed charges 481.2 481.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PORACTANT ALFA 120 MG/1.5 ML INTRATRACHEAL SUSPENSION RX-27047 CDM 250000000 HCPCS 0250 RC 10122-0510-01 NDC outpatient 1.5 ML 1712.96 1712.96 1712.96 74 1267.59 percent of total billed charges 1712.96 93 1387.5 percent of total billed charges 1712.96 1712.96 other OPPS APC 1712.96 1712.96 other OPPS APC 1712.96 24.86 425.84 percent of total billed charges 1712.96 1712.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXCARBAZEPINE 150 MG TABLET RX-27049 CDM A9270 HCPCS 0250 RC 00904-7262-61 NDC outpatient 1 UN 1.71 1.71 74 1.27 percent of total billed charges 1.71 93 1.39 percent of total billed charges 1.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.71 other OPPS APC 1.71 1.71 other OPPS APC 1.71 24.86 0.43 percent of total billed charges 1.71 1.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXCARBAZEPINE 150 MG TABLET RX-27049 CDM A9270 HCPCS 0637 RC 00904-7262-61 NDC outpatient 1 UN 1.71 1.71 1.71 74 1.27 percent of total billed charges 1.71 93 1.39 percent of total billed charges 1.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.71 other OPPS APC 1.71 1.71 other OPPS APC 1.71 24.86 0.43 percent of total billed charges 1.71 1.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL RX-27096 CDM A9270 HCPCS 0250 RC 45802-0210-01 NDC outpatient 4.9 GR 561.18 561.18 74 415.27 percent of total billed charges 561.18 93 454.56 percent of total billed charges 561.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 561.18 other OPPS APC 561.18 561.18 other OPPS APC 561.18 24.86 139.51 percent of total billed charges 561.18 561.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL RX-27096 CDM A9270 HCPCS 0637 RC 45802-0210-01 NDC outpatient 4.9 GR 561.18 561.18 561.18 74 415.27 percent of total billed charges 561.18 93 454.56 percent of total billed charges 561.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 561.18 other OPPS APC 561.18 561.18 other OPPS APC 561.18 24.86 139.51 percent of total billed charges 561.18 561.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CLONIDINE (PF) 5,000 MCG/10 ML EPIDURAL SOLUTION" RX-27113 CDM J0735 HCPCS 0636 RC 39822-2010-01 NDC outpatient 10 ML 306.25 306.25 120.09 120.09 fee schedule 306.25 93 248.06 percent of total billed charges 306.25 306.25 other OPPS APC 306.25 306.25 other OPPS APC 306.25 24.86 76.13 percent of total billed charges 120.09 306.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR" RX-27181 CDM A9270 HCPCS 0250 RC 59651-0018-90 NDC outpatient 1 UN 10.6 10.6 74 7.84 percent of total billed charges 10.6 93 8.59 percent of total billed charges 10.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.6 other OPPS APC 10.6 10.6 other OPPS APC 10.6 24.86 2.64 percent of total billed charges 10.6 10.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR" RX-27181 CDM A9270 HCPCS 0637 RC 59651-0018-90 NDC outpatient 1 UN 10.6 10.6 10.6 74 7.84 percent of total billed charges 10.6 93 8.59 percent of total billed charges 10.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.6 other OPPS APC 10.6 10.6 other OPPS APC 10.6 24.86 2.64 percent of total billed charges 10.6 10.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MONTELUKAST 4 MG CHEWABLE TABLET RX-27234 CDM A9270 HCPCS 0250 RC 50268-0573-11 NDC outpatient 1 UN 9.15 9.15 74 6.77 percent of total billed charges 9.15 93 7.41 percent of total billed charges 9.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.15 other OPPS APC 9.15 9.15 other OPPS APC 9.15 24.86 2.27 percent of total billed charges 9.15 9.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MONTELUKAST 4 MG CHEWABLE TABLET RX-27234 CDM A9270 HCPCS 0637 RC 50268-0573-11 NDC outpatient 1 UN 9.15 9.15 9.15 74 6.77 percent of total billed charges 9.15 93 7.41 percent of total billed charges 9.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.15 other OPPS APC 9.15 9.15 other OPPS APC 9.15 24.86 2.27 percent of total billed charges 9.15 9.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMPICILLIN 1 GRAM INTRAVENOUS SOLUTION RX-27280 CDM J0290 HCPCS 0636 RC 00781-3412-92 NDC outpatient 1 GR 44.79 44.79 1.79 1.79 fee schedule 44.79 93 36.28 percent of total billed charges 44.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.79 other OPPS APC 44.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.79 other OPPS APC 44.79 24.86 11.13 percent of total billed charges 1.79 44.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMPICILLIN 1 GRAM INTRAVENOUS SOLUTION RX-27280 CDM J0290 HCPCS 0636 RC 00781-3412-92 NDC outpatient 8 ML 44.79 44.79 1.79 1.79 fee schedule 44.79 93 36.28 percent of total billed charges 44.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.79 other OPPS APC 44.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.79 other OPPS APC 44.79 24.86 11.13 percent of total billed charges 1.79 44.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE 10 MG/ML INTRAVENOUS SOLUTION RX-27390 CDM J2270 HCPCS 0636 RC 00641-6127-25 NDC outpatient 1 ML 7.65 7.65 5.25 5.25 fee schedule 7.65 93 6.2 percent of total billed charges 7.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.65 other OPPS APC 7.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.65 other OPPS APC 7.65 24.86 1.9 percent of total billed charges 5.25 7.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION" RX-27431 CDM Q2050 HCPCS 0636 RC 70710-1530-01 NDC outpatient 10 ML 2034.9 2034.9 200.86 200.86 fee schedule 2034.9 93 1648.27 percent of total billed charges 2034.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 266.16 other OPPS APC 2034.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 266.16 other OPPS APC 2034.9 24.86 505.88 percent of total billed charges 200.86 2034.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 40 % ORAL GEL RX-27466 CDM A9270 HCPCS 0250 RC 00574-0069-15 NDC outpatient 3 UN 19.75 19.75 74 14.62 percent of total billed charges 19.75 93 16 percent of total billed charges 19.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.75 other OPPS APC 19.75 19.75 other OPPS APC 19.75 24.86 4.91 percent of total billed charges 19.75 19.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 40 % ORAL GEL RX-27466 CDM A9270 HCPCS 0637 RC 00574-0069-15 NDC outpatient 3 UN 19.75 19.75 19.75 74 14.62 percent of total billed charges 19.75 93 16 percent of total billed charges 19.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.75 other OPPS APC 19.75 19.75 other OPPS APC 19.75 24.86 4.91 percent of total billed charges 19.75 19.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DINOPROSTONE ER 10 MG VAGINAL INSERT,CONTROLLED RELEASE" RX-27467 CDM 250000000 HCPCS 0250 RC 55566-2800-01 NDC outpatient 1 UN 1571.95 1571.95 1571.95 74 1163.24 percent of total billed charges 1571.95 93 1273.28 percent of total billed charges 1571.95 1571.95 other OPPS APC 1571.95 1571.95 other OPPS APC 1571.95 24.86 390.79 percent of total billed charges 1571.95 1571.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH RX-27505 CDM A9270 HCPCS 0250 RC 00378-0871-16 NDC outpatient 1 UN 82.81 82.81 74 61.28 percent of total billed charges 82.81 93 67.08 percent of total billed charges 82.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 82.81 other OPPS APC 82.81 82.81 other OPPS APC 82.81 24.86 20.59 percent of total billed charges 82.81 82.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH RX-27505 CDM A9270 HCPCS 0637 RC 00378-0871-16 NDC outpatient 1 UN 82.81 82.81 82.81 74 61.28 percent of total billed charges 82.81 93 67.08 percent of total billed charges 82.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 82.81 other OPPS APC 82.81 82.81 other OPPS APC 82.81 24.86 20.59 percent of total billed charges 82.81 82.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH RX-27506 CDM A9270 HCPCS 0250 RC 52817-0611-04 NDC outpatient 1 UN 329.51 329.51 74 243.84 percent of total billed charges 329.51 93 266.9 percent of total billed charges 329.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 329.51 other OPPS APC 329.51 329.51 other OPPS APC 329.51 24.86 81.92 percent of total billed charges 329.51 329.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH RX-27506 CDM A9270 HCPCS 0637 RC 52817-0611-04 NDC outpatient 1 UN 329.51 329.51 329.51 74 243.84 percent of total billed charges 329.51 93 266.9 percent of total billed charges 329.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 329.51 other OPPS APC 329.51 329.51 other OPPS APC 329.51 24.86 81.92 percent of total billed charges 329.51 329.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH RX-27507 CDM A9270 HCPCS 0250 RC 52817-0612-04 NDC outpatient 1 UN 457.1 457.1 74 338.25 percent of total billed charges 457.1 93 370.25 percent of total billed charges 457.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 457.1 other OPPS APC 457.1 457.1 other OPPS APC 457.1 24.86 113.64 percent of total billed charges 457.1 457.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH RX-27507 CDM A9270 HCPCS 0637 RC 52817-0612-04 NDC outpatient 1 UN 457.1 457.1 457.1 74 338.25 percent of total billed charges 457.1 93 370.25 percent of total billed charges 457.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 457.1 other OPPS APC 457.1 457.1 other OPPS APC 457.1 24.86 113.64 percent of total billed charges 457.1 457.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE" RX-27631 CDM A9270 HCPCS 0250 RC 63739-0995-10 NDC outpatient 1 UN 2.25 2.25 74 1.67 percent of total billed charges 2.25 93 1.82 percent of total billed charges 2.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.25 other OPPS APC 2.25 2.25 other OPPS APC 2.25 24.86 0.56 percent of total billed charges 2.25 2.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE" RX-27631 CDM A9270 HCPCS 0637 RC 63739-0995-10 NDC outpatient 1 UN 2.25 2.25 2.25 74 1.67 percent of total billed charges 2.25 93 1.82 percent of total billed charges 2.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.25 other OPPS APC 2.25 2.25 other OPPS APC 2.25 24.86 0.56 percent of total billed charges 2.25 2.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR" RX-27632 CDM A9270 HCPCS 0250 RC 66993-0408-32 NDC outpatient 1 UN 4.92 4.92 74 3.64 percent of total billed charges 4.92 93 3.99 percent of total billed charges 4.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.92 other OPPS APC 4.92 4.92 other OPPS APC 4.92 24.86 1.22 percent of total billed charges 4.92 4.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CARBAMAZEPINE ER 200 MG CAPSULE,EXTENDED RELEASE MPHASE12HR" RX-27632 CDM A9270 HCPCS 0637 RC 66993-0408-32 NDC outpatient 1 UN 4.92 4.92 4.92 74 3.64 percent of total billed charges 4.92 93 3.99 percent of total billed charges 4.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.92 other OPPS APC 4.92 4.92 other OPPS APC 4.92 24.86 1.22 percent of total billed charges 4.92 4.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CARBAMAZEPINE ER 300 MG CAPSULE,EXTENDED RELEASE MPHASE12HR" RX-27633 CDM A9270 HCPCS 0250 RC 66993-0409-32 NDC outpatient 1 UN 4.92 4.92 74 3.64 percent of total billed charges 4.92 93 3.99 percent of total billed charges 4.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.92 other OPPS APC 4.92 4.92 other OPPS APC 4.92 24.86 1.22 percent of total billed charges 4.92 4.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CARBAMAZEPINE ER 300 MG CAPSULE,EXTENDED RELEASE MPHASE12HR" RX-27633 CDM A9270 HCPCS 0637 RC 66993-0409-32 NDC outpatient 1 UN 4.92 4.92 4.92 74 3.64 percent of total billed charges 4.92 93 3.99 percent of total billed charges 4.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.92 other OPPS APC 4.92 4.92 other OPPS APC 4.92 24.86 1.22 percent of total billed charges 4.92 4.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR" RX-27634 CDM A9270 HCPCS 0250 RC 51672-4123-01 NDC outpatient 1 UN 2.87 2.87 74 2.12 percent of total billed charges 2.87 93 2.32 percent of total billed charges 2.87 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.87 other OPPS APC 2.87 2.87 other OPPS APC 2.87 24.86 0.71 percent of total billed charges 2.87 2.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR" RX-27634 CDM A9270 HCPCS 0637 RC 51672-4123-01 NDC outpatient 1 UN 2.87 2.87 2.87 74 2.12 percent of total billed charges 2.87 93 2.32 percent of total billed charges 2.87 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.87 other OPPS APC 2.87 2.87 other OPPS APC 2.87 24.86 0.71 percent of total billed charges 2.87 2.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOPIRAMATE 15 MG SPRINKLE CAPSULE RX-27641 CDM A9270 HCPCS 0250 RC 68382-0004-14 NDC outpatient 1 UN 6.05 6.05 74 4.48 percent of total billed charges 6.05 93 4.9 percent of total billed charges 6.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.05 other OPPS APC 6.05 6.05 other OPPS APC 6.05 24.86 1.5 percent of total billed charges 6.05 6.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOPIRAMATE 15 MG SPRINKLE CAPSULE RX-27641 CDM A9270 HCPCS 0637 RC 68382-0004-14 NDC outpatient 1 UN 6.05 6.05 6.05 74 4.48 percent of total billed charges 6.05 93 4.9 percent of total billed charges 6.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.05 other OPPS APC 6.05 6.05 other OPPS APC 6.05 24.86 1.5 percent of total billed charges 6.05 6.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE" RX-27644 CDM A9270 HCPCS 0250 RC 43598-0339-60 NDC outpatient 1 UN 20.89 20.89 74 15.46 percent of total billed charges 20.89 93 16.92 percent of total billed charges 20.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20.89 other OPPS APC 20.89 20.89 other OPPS APC 20.89 24.86 5.19 percent of total billed charges 20.89 20.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE" RX-27644 CDM A9270 HCPCS 0637 RC 43598-0339-60 NDC outpatient 1 UN 20.89 20.89 20.89 74 15.46 percent of total billed charges 20.89 93 16.92 percent of total billed charges 20.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20.89 other OPPS APC 20.89 20.89 other OPPS APC 20.89 24.86 5.19 percent of total billed charges 20.89 20.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 24 HR" RX-27659 CDM A9270 HCPCS 0250 RC 50268-0598-15 NDC outpatient 1 UN 5.64 5.64 74 4.17 percent of total billed charges 5.64 93 4.57 percent of total billed charges 5.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.64 other OPPS APC 5.64 5.64 other OPPS APC 5.64 24.86 1.4 percent of total billed charges 5.64 5.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 24 HR" RX-27659 CDM A9270 HCPCS 0637 RC 50268-0598-15 NDC outpatient 1 UN 5.64 5.64 5.64 74 4.17 percent of total billed charges 5.64 93 4.57 percent of total billed charges 5.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.64 other OPPS APC 5.64 5.64 other OPPS APC 5.64 24.86 1.4 percent of total billed charges 5.64 5.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUORESCEIN 1 MG EYE STRIPS RX-27663 CDM A9270 HCPCS 0250 RC 17238-0900-11 NDC outpatient 1 UN 0.66 0.66 74 0.49 percent of total billed charges 0.66 93 0.53 percent of total billed charges 0.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.66 other OPPS APC 0.66 0.66 other OPPS APC 0.66 24.86 0.16 percent of total billed charges 0.66 0.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUORESCEIN 1 MG EYE STRIPS RX-27663 CDM A9270 HCPCS 0637 RC 17238-0900-11 NDC outpatient 1 UN 0.66 0.66 0.66 74 0.49 percent of total billed charges 0.66 93 0.53 percent of total billed charges 0.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.66 other OPPS APC 0.66 0.66 other OPPS APC 0.66 24.86 0.16 percent of total billed charges 0.66 0.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONDANSETRON 4 MG DISINTEGRATING TABLET RX-27697 CDM Q0162 HCPCS 0250 RC 57237-0077-10 NDC outpatient 1 UN 55.71 55.71 74 41.23 percent of total billed charges 55.71 93 45.13 percent of total billed charges 55.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.71 other OPPS APC 55.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.71 other OPPS APC 55.71 24.86 13.85 percent of total billed charges 55.71 55.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONDANSETRON 4 MG DISINTEGRATING TABLET RX-27697 CDM Q0162 HCPCS 0637 RC 57237-0077-10 NDC outpatient 1 UN 55.71 55.71 55.71 74 41.23 percent of total billed charges 55.71 93 45.13 percent of total billed charges 55.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.71 other OPPS APC 55.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.71 other OPPS APC 55.71 24.86 13.85 percent of total billed charges 55.71 55.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONDANSETRON 8 MG DISINTEGRATING TABLET RX-27698 CDM A9270 HCPCS 0250 RC 57237-0078-10 NDC outpatient 1 UN 92.83 92.83 74 68.69 percent of total billed charges 92.83 93 75.19 percent of total billed charges 92.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.83 other OPPS APC 92.83 92.83 other OPPS APC 92.83 24.86 23.08 percent of total billed charges 92.83 92.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONDANSETRON 8 MG DISINTEGRATING TABLET RX-27698 CDM A9270 HCPCS 0637 RC 57237-0078-10 NDC outpatient 1 UN 92.83 92.83 92.83 74 68.69 percent of total billed charges 92.83 93 75.19 percent of total billed charges 92.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.83 other OPPS APC 92.83 92.83 other OPPS APC 92.83 24.86 23.08 percent of total billed charges 92.83 92.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IOPAMIDOL 300 MG IODINE/ML (61 %) INTRAVENOUS SOLUTION RX-27737 CDM Q9967 HCPCS 0636 RC 00270-1315-30 NDC outpatient 50 ML 50 50 7.26 7.26 fee schedule 50 93 40.5 percent of total billed charges 50 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 50 other OPPS APC 50 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 50 other OPPS APC 50 24.86 12.43 percent of total billed charges 7.26 50 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZONISAMIDE 100 MG CAPSULE RX-27780 CDM A9270 HCPCS 0250 RC 50268-0816-15 NDC outpatient 1 UN 4.3 4.3 74 3.18 percent of total billed charges 4.3 93 3.48 percent of total billed charges 4.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.3 other OPPS APC 4.3 4.3 other OPPS APC 4.3 24.86 1.07 percent of total billed charges 4.3 4.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZONISAMIDE 100 MG CAPSULE RX-27780 CDM A9270 HCPCS 0637 RC 50268-0816-15 NDC outpatient 1 UN 4.3 4.3 4.3 74 3.18 percent of total billed charges 4.3 93 3.48 percent of total billed charges 4.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.3 other OPPS APC 4.3 4.3 other OPPS APC 4.3 24.86 1.07 percent of total billed charges 4.3 4.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERITON.DIALYSIS SOLN 6-1.5 % DEXTROS LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L RX-27796 CDM 250000000 HCPCS 0250 RC 00941-0424-52 NDC outpatient 2000 ML 84.15 84.15 84.15 74 62.27 percent of total billed charges 84.15 93 68.16 percent of total billed charges 84.15 84.15 other OPPS APC 84.15 84.15 other OPPS APC 84.15 24.86 20.92 percent of total billed charges 84.15 84.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERITONEAL DIALYSIS SOLN 7-2.5 % DEXT.LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L RX-27800 CDM 250000000 HCPCS 0250 RC 00941-0430-52 NDC outpatient 2000 ML 93.9 93.9 93.9 74 69.49 percent of total billed charges 93.9 93 76.06 percent of total billed charges 93.9 93.9 other OPPS APC 93.9 93.9 other OPPS APC 93.9 24.86 23.34 percent of total billed charges 93.9 93.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERITON. DIALYSIS SOLN 8-4.25 % DEXTROSE CALC 2.5 MEQ/L-MAG 0.5 MEQ/L RX-27804 CDM 250000000 HCPCS 0250 RC 00941-0459-08 NDC outpatient 2000 ML 30.33 30.33 30.33 74 22.44 percent of total billed charges 30.33 93 24.57 percent of total billed charges 30.33 30.33 other OPPS APC 30.33 30.33 other OPPS APC 30.33 24.86 7.54 percent of total billed charges 30.33 30.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR" RX-27857 CDM A9270 HCPCS 0250 RC 68084-0698-01 NDC outpatient 1 UN 9.36 9.36 74 6.93 percent of total billed charges 9.36 93 7.58 percent of total billed charges 9.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.36 other OPPS APC 9.36 9.36 other OPPS APC 9.36 24.86 2.33 percent of total billed charges 9.36 9.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR" RX-27857 CDM A9270 HCPCS 0637 RC 68084-0698-01 NDC outpatient 1 UN 9.36 9.36 9.36 74 6.93 percent of total billed charges 9.36 93 7.58 percent of total billed charges 9.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.36 other OPPS APC 9.36 9.36 other OPPS APC 9.36 24.86 2.33 percent of total billed charges 9.36 9.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR" RX-27858 CDM A9270 HCPCS 0250 RC 68084-0709-01 NDC outpatient 1 UN 10.5 10.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.5 other OPPS APC 10.5 10.5 other OPPS APC 10.5 24.86 2.61 percent of total billed charges 10.5 10.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR" RX-27858 CDM A9270 HCPCS 0637 RC 68084-0709-01 NDC outpatient 1 UN 10.5 10.5 10.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.5 other OPPS APC 10.5 10.5 other OPPS APC 10.5 24.86 2.61 percent of total billed charges 10.5 10.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH RX-27860 CDM A9270 HCPCS 0250 RC 43598-0446-71 NDC outpatient 1 UN 5.36 5.36 74 3.97 percent of total billed charges 5.36 93 4.34 percent of total billed charges 5.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.36 other OPPS APC 5.36 5.36 other OPPS APC 5.36 24.86 1.33 percent of total billed charges 5.36 5.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH RX-27860 CDM A9270 HCPCS 0637 RC 43598-0446-71 NDC outpatient 1 UN 5.36 5.36 5.36 74 3.97 percent of total billed charges 5.36 93 4.34 percent of total billed charges 5.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.36 other OPPS APC 5.36 5.36 other OPPS APC 5.36 24.86 1.33 percent of total billed charges 5.36 5.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH RX-27862 CDM A9270 HCPCS 0250 RC 43598-0447-74 NDC outpatient 1 UN 5.34 5.34 74 3.95 percent of total billed charges 5.34 93 4.33 percent of total billed charges 5.34 5.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH RX-27862 CDM A9270 HCPCS 0637 RC 43598-0447-74 NDC outpatient 1 UN 5.34 5.34 5.34 74 3.95 percent of total billed charges 5.34 93 4.33 percent of total billed charges 5.34 5.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH RX-27862 CDM A9270 HCPCS 0250 RC 60505-0706-20 NDC outpatient 1 UN 5.72 5.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.72 other OPPS APC 5.72 5.72 other OPPS APC 5.72 24.86 1.42 percent of total billed charges 5.72 5.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH RX-27862 CDM A9270 HCPCS 0637 RC 60505-0706-20 NDC outpatient 1 UN 5.72 5.72 5.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.72 other OPPS APC 5.72 5.72 other OPPS APC 5.72 24.86 1.42 percent of total billed charges 5.72 5.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH RX-27863 CDM A9270 HCPCS 0250 RC 48985-0001-53 NDC outpatient 1 UN 2.86 2.86 74 2.12 percent of total billed charges 2.86 93 2.32 percent of total billed charges 2.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.86 other OPPS APC 2.86 2.86 other OPPS APC 2.86 24.86 0.71 percent of total billed charges 2.86 2.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH RX-27863 CDM A9270 HCPCS 0637 RC 48985-0001-53 NDC outpatient 1 UN 2.86 2.86 2.86 74 2.12 percent of total billed charges 2.86 93 2.32 percent of total billed charges 2.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.86 other OPPS APC 2.86 2.86 other OPPS APC 2.86 24.86 0.71 percent of total billed charges 2.86 2.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LANOLIN-MINERAL OIL LOTION RX-2787 CDM A9270 HCPCS 0250 RC 72140-0110-20 NDC outpatient 500 ML 44.9 44.9 74 33.23 percent of total billed charges 44.9 93 36.37 percent of total billed charges 44.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.9 other OPPS APC 44.9 44.9 other OPPS APC 44.9 24.86 11.16 percent of total billed charges 44.9 44.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LANOLIN-MINERAL OIL LOTION RX-2787 CDM A9270 HCPCS 0637 RC 72140-0110-20 NDC outpatient 500 ML 44.9 44.9 44.9 74 33.23 percent of total billed charges 44.9 93 36.37 percent of total billed charges 44.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.9 other OPPS APC 44.9 44.9 other OPPS APC 44.9 24.86 11.16 percent of total billed charges 44.9 44.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FENTANYL 25 MCG/HR TRANSDERMAL PATCH RX-27905 CDM A9270 HCPCS 0250 RC 00406-9125-76 NDC outpatient 1 UN 36.05 36.05 74 26.68 percent of total billed charges 36.05 93 29.2 percent of total billed charges 36.05 36.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FENTANYL 25 MCG/HR TRANSDERMAL PATCH RX-27905 CDM A9270 HCPCS 0637 RC 00406-9125-76 NDC outpatient 1 UN 36.05 36.05 36.05 74 26.68 percent of total billed charges 36.05 93 29.2 percent of total billed charges 36.05 36.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FENTANYL 25 MCG/HR TRANSDERMAL PATCH RX-27905 CDM A9270 HCPCS 0250 RC 47781-0424-47 NDC outpatient 1 UN 53.17 53.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 53.17 other OPPS APC 53.17 53.17 other OPPS APC 53.17 24.86 13.22 percent of total billed charges 53.17 53.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FENTANYL 25 MCG/HR TRANSDERMAL PATCH RX-27905 CDM A9270 HCPCS 0637 RC 47781-0424-47 NDC outpatient 1 UN 53.17 53.17 53.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 53.17 other OPPS APC 53.17 53.17 other OPPS APC 53.17 24.86 13.22 percent of total billed charges 53.17 53.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FENTANYL 50 MCG/HR TRANSDERMAL PATCH RX-27906 CDM A9270 HCPCS 0250 RC 00378-9122-98 NDC outpatient 1 UN 65.9 65.9 74 48.77 percent of total billed charges 65.9 93 53.38 percent of total billed charges 65.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 65.9 other OPPS APC 65.9 65.9 other OPPS APC 65.9 24.86 16.38 percent of total billed charges 65.9 65.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FENTANYL 50 MCG/HR TRANSDERMAL PATCH RX-27906 CDM A9270 HCPCS 0637 RC 00378-9122-98 NDC outpatient 1 UN 65.9 65.9 65.9 74 48.77 percent of total billed charges 65.9 93 53.38 percent of total billed charges 65.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 65.9 other OPPS APC 65.9 65.9 other OPPS APC 65.9 24.86 16.38 percent of total billed charges 65.9 65.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FENTANYL 75 MCG/HR TRANSDERMAL PATCH RX-27907 CDM A9270 HCPCS 0250 RC 47781-0427-47 NDC outpatient 1 UN 148.27 148.27 74 109.72 percent of total billed charges 148.27 93 120.1 percent of total billed charges 148.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 148.27 other OPPS APC 148.27 148.27 other OPPS APC 148.27 24.86 36.86 percent of total billed charges 148.27 148.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FENTANYL 75 MCG/HR TRANSDERMAL PATCH RX-27907 CDM A9270 HCPCS 0637 RC 47781-0427-47 NDC outpatient 1 UN 148.27 148.27 148.27 74 109.72 percent of total billed charges 148.27 93 120.1 percent of total billed charges 148.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 148.27 other OPPS APC 148.27 148.27 other OPPS APC 148.27 24.86 36.86 percent of total billed charges 148.27 148.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FENTANYL 100 MCG/HR TRANSDERMAL PATCH RX-27908 CDM A9270 HCPCS 0250 RC 00378-9124-98 NDC outpatient 1 UN 133.4 133.4 74 98.72 percent of total billed charges 133.4 93 108.05 percent of total billed charges 133.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 133.4 other OPPS APC 133.4 133.4 other OPPS APC 133.4 24.86 33.16 percent of total billed charges 133.4 133.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FENTANYL 100 MCG/HR TRANSDERMAL PATCH RX-27908 CDM A9270 HCPCS 0637 RC 00378-9124-98 NDC outpatient 1 UN 133.4 133.4 133.4 74 98.72 percent of total billed charges 133.4 93 108.05 percent of total billed charges 133.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 133.4 other OPPS APC 133.4 133.4 other OPPS APC 133.4 24.86 33.16 percent of total billed charges 133.4 133.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMINO ACID 4.25 % IN 10 % DEXTROSE INTRAVENOUS SOLUTION RX-27928 CDM 250000000 HCPCS 0250 RC 00338-1091-04 NDC outpatient 2000 ML 226.33 226.33 226.33 74 167.48 percent of total billed charges 226.33 93 183.33 percent of total billed charges 226.33 226.33 other OPPS APC 226.33 226.33 other OPPS APC 226.33 24.86 56.27 percent of total billed charges 226.33 226.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMINO ACID 4.25 % IN 10 % DEXTROSE INTRAVENOUS SOLUTION RX-27928 CDM 250000000 HCPCS 0250 RC 00338-1134-03 NDC outpatient 1000 ML 116.91 116.91 116.91 74 86.51 percent of total billed charges 116.91 93 94.7 percent of total billed charges 116.91 116.91 other OPPS APC 116.91 116.91 other OPPS APC 116.91 24.86 29.06 percent of total billed charges 116.91 116.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LACTOBACILLUS RHAMNOSUS GG 10 BILLION CELL CAPSULE RX-27974 CDM A9270 HCPCS 0250 RC 49100-0400-07 NDC outpatient 1 UN 5.15 5.15 74 3.81 percent of total billed charges 5.15 93 4.17 percent of total billed charges 5.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.15 other OPPS APC 5.15 5.15 other OPPS APC 5.15 24.86 1.28 percent of total billed charges 5.15 5.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LACTOBACILLUS RHAMNOSUS GG 10 BILLION CELL CAPSULE RX-27974 CDM A9270 HCPCS 0637 RC 49100-0400-07 NDC outpatient 1 UN 5.15 5.15 5.15 74 3.81 percent of total billed charges 5.15 93 4.17 percent of total billed charges 5.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.15 other OPPS APC 5.15 5.15 other OPPS APC 5.15 24.86 1.28 percent of total billed charges 5.15 5.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS RX-27980 CDM A9270 HCPCS 0250 RC 00065-0408-72 NDC outpatient 15 ML 83.88 83.88 74 62.07 percent of total billed charges 83.88 93 67.94 percent of total billed charges 83.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 83.88 other OPPS APC 83.88 83.88 other OPPS APC 83.88 24.86 20.85 percent of total billed charges 83.88 83.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS RX-27980 CDM A9270 HCPCS 0637 RC 00065-0408-72 NDC outpatient 15 ML 83.88 83.88 83.88 74 62.07 percent of total billed charges 83.88 93 67.94 percent of total billed charges 83.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 83.88 other OPPS APC 83.88 83.88 other OPPS APC 83.88 24.86 20.85 percent of total billed charges 83.88 83.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SERTRALINE 20 MG/ML ORAL CONCENTRATE RX-28011 CDM A9270 HCPCS 0250 RC 16714-0601-02 NDC outpatient 60 ML 167.73 167.73 74 124.12 percent of total billed charges 167.73 93 135.86 percent of total billed charges 167.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 167.73 other OPPS APC 167.73 167.73 other OPPS APC 167.73 24.86 41.7 percent of total billed charges 167.73 167.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SERTRALINE 20 MG/ML ORAL CONCENTRATE RX-28011 CDM A9270 HCPCS 0637 RC 16714-0601-02 NDC outpatient 60 ML 167.73 167.73 167.73 74 124.12 percent of total billed charges 167.73 93 135.86 percent of total billed charges 167.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 167.73 other OPPS APC 167.73 167.73 other OPPS APC 167.73 24.86 41.7 percent of total billed charges 167.73 167.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE" RX-28018 CDM 250000000 HCPCS 0250 RC 63713-0019-72 NDC outpatient 1 UN 16.85 16.85 16.85 74 12.47 percent of total billed charges 16.85 93 13.65 percent of total billed charges 16.85 16.85 other OPPS APC 16.85 16.85 other OPPS APC 16.85 24.86 4.19 percent of total billed charges 16.85 16.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE" RX-28025 CDM 250000000 HCPCS 0250 RC 63713-0019-74 NDC outpatient 1 UN 82.26 82.26 82.26 74 60.87 percent of total billed charges 82.26 93 66.63 percent of total billed charges 82.26 82.26 other OPPS APC 82.26 82.26 other OPPS APC 82.26 24.86 20.45 percent of total billed charges 82.26 82.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENZOCAINE 20 %-MENTHOL 0.5 % TOPICAL AEROSOL RX-28048 CDM A9270 HCPCS 0250 RC 16864-0680-03 NDC outpatient 85 GR 16.55 16.55 74 12.25 percent of total billed charges 16.55 93 13.41 percent of total billed charges 16.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.55 other OPPS APC 16.55 16.55 other OPPS APC 16.55 24.86 4.11 percent of total billed charges 16.55 16.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENZOCAINE 20 %-MENTHOL 0.5 % TOPICAL AEROSOL RX-28048 CDM A9270 HCPCS 0637 RC 16864-0680-03 NDC outpatient 85 GR 16.55 16.55 16.55 74 12.25 percent of total billed charges 16.55 93 13.41 percent of total billed charges 16.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.55 other OPPS APC 16.55 16.55 other OPPS APC 16.55 24.86 4.11 percent of total billed charges 16.55 16.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALAMINE 8 %-ZINC OXIDE 8 % LOTION RX-28055 CDM A9270 HCPCS 0250 RC 00904-2533-21 NDC outpatient 177 ML 5.88 5.88 74 4.35 percent of total billed charges 5.88 93 4.76 percent of total billed charges 5.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.88 other OPPS APC 5.88 5.88 other OPPS APC 5.88 24.86 1.46 percent of total billed charges 5.88 5.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALAMINE 8 %-ZINC OXIDE 8 % LOTION RX-28055 CDM A9270 HCPCS 0637 RC 00904-2533-21 NDC outpatient 177 ML 5.88 5.88 5.88 74 4.35 percent of total billed charges 5.88 93 4.76 percent of total billed charges 5.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.88 other OPPS APC 5.88 5.88 other OPPS APC 5.88 24.86 1.46 percent of total billed charges 5.88 5.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OLANZAPINE 5 MG DISINTEGRATING TABLET RX-28159 CDM A9270 HCPCS 0250 RC 55111-0262-81 NDC outpatient 1 UN 5.19 5.19 74 3.84 percent of total billed charges 5.19 93 4.2 percent of total billed charges 5.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.19 other OPPS APC 5.19 5.19 other OPPS APC 5.19 24.86 1.29 percent of total billed charges 5.19 5.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OLANZAPINE 5 MG DISINTEGRATING TABLET RX-28159 CDM A9270 HCPCS 0637 RC 55111-0262-81 NDC outpatient 1 UN 5.19 5.19 5.19 74 3.84 percent of total billed charges 5.19 93 4.2 percent of total billed charges 5.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.19 other OPPS APC 5.19 5.19 other OPPS APC 5.19 24.86 1.29 percent of total billed charges 5.19 5.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINEZOLID 600 MG TABLET RX-28224 CDM A9270 HCPCS 0250 RC 67877-0419-84 NDC outpatient 1 UN 459.16 459.16 74 339.78 percent of total billed charges 459.16 93 371.92 percent of total billed charges 459.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 459.16 other OPPS APC 459.16 459.16 other OPPS APC 459.16 24.86 114.15 percent of total billed charges 459.16 459.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINEZOLID 600 MG TABLET RX-28224 CDM A9270 HCPCS 0637 RC 67877-0419-84 NDC outpatient 1 UN 459.16 459.16 459.16 74 339.78 percent of total billed charges 459.16 93 371.92 percent of total billed charges 459.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 459.16 other OPPS APC 459.16 459.16 other OPPS APC 459.16 24.86 114.15 percent of total billed charges 459.16 459.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINEZOLID 100 MG/5 ML ORAL SUSPENSION RX-28225 CDM A9270 HCPCS 0250 RC 00009-5136-04 NDC outpatient 150 ML 736.46 736.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 736.46 other OPPS APC 736.46 736.46 other OPPS APC 736.46 24.86 183.08 percent of total billed charges 736.46 736.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINEZOLID 100 MG/5 ML ORAL SUSPENSION RX-28225 CDM A9270 HCPCS 0637 RC 00009-5136-04 NDC outpatient 150 ML 736.46 736.46 736.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 736.46 other OPPS APC 736.46 736.46 other OPPS APC 736.46 24.86 183.08 percent of total billed charges 736.46 736.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINEZOLID 100 MG/5 ML ORAL SUSPENSION RX-28225 CDM A9270 HCPCS 0250 RC 31722-0865-25 NDC outpatient 150 ML 1840.93 1840.93 74 1362.29 percent of total billed charges 1840.93 93 1491.15 percent of total billed charges 1840.93 1840.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINEZOLID 100 MG/5 ML ORAL SUSPENSION RX-28225 CDM A9270 HCPCS 0637 RC 31722-0865-25 NDC outpatient 150 ML 1840.93 1840.93 1840.93 74 1362.29 percent of total billed charges 1840.93 93 1491.15 percent of total billed charges 1840.93 1840.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK RX-28226 CDM J2020 HCPCS 0636 RC 57664-0683-31 NDC outpatient 300 ML 195.33 195.33 11.87 11.87 fee schedule 195.33 93 158.22 percent of total billed charges 195.33 195.33 other OPPS APC 195.33 195.33 other OPPS APC 195.33 24.86 48.56 percent of total billed charges 11.87 195.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK RX-28226 CDM J2020 HCPCS 0636 RC 57664-0683-31 NDC outpatient 600 ME 195.33 195.33 11.87 11.87 fee schedule 195.33 93 158.22 percent of total billed charges 195.33 195.33 other OPPS APC 195.33 195.33 other OPPS APC 195.33 24.86 48.56 percent of total billed charges 11.87 195.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENTAMIDINE 300 MG SOLUTION FOR INHALATION RX-28235 CDM A9270 HCPCS 0250 RC 13925-0522-01 NDC outpatient 300 ME 451.25 451.25 74 333.93 percent of total billed charges 451.25 93 365.51 percent of total billed charges 451.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 451.25 other OPPS APC 451.25 451.25 other OPPS APC 451.25 24.86 112.18 percent of total billed charges 451.25 451.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENTAMIDINE 300 MG SOLUTION FOR INHALATION RX-28235 CDM A9270 HCPCS 0637 RC 13925-0522-01 NDC outpatient 300 ME 451.25 451.25 451.25 74 333.93 percent of total billed charges 451.25 93 365.51 percent of total billed charges 451.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 451.25 other OPPS APC 451.25 451.25 other OPPS APC 451.25 24.86 112.18 percent of total billed charges 451.25 451.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION RX-28282 CDM A9270 HCPCS 0250 RC 00088-2220-33 NDC outpatient 10 ML 192.78 192.78 74 142.66 percent of total billed charges 192.78 93 156.15 percent of total billed charges 192.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.78 other OPPS APC 192.78 192.78 other OPPS APC 192.78 24.86 47.93 percent of total billed charges 192.78 192.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION RX-28282 CDM A9270 HCPCS 0637 RC 00088-2220-33 NDC outpatient 10 ML 192.78 192.78 192.78 74 142.66 percent of total billed charges 192.78 93 156.15 percent of total billed charges 192.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.78 other OPPS APC 192.78 192.78 other OPPS APC 192.78 24.86 47.93 percent of total billed charges 192.78 192.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET RX-28384 CDM A9270 HCPCS 0250 RC 00406-0125-62 NDC outpatient 1 UN 3.03 3.03 74 2.24 percent of total billed charges 3.03 93 2.45 percent of total billed charges 3.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.03 other OPPS APC 3.03 3.03 other OPPS APC 3.03 24.86 0.75 percent of total billed charges 3.03 3.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET RX-28384 CDM A9270 HCPCS 0637 RC 00406-0125-62 NDC outpatient 1 UN 3.03 3.03 3.03 74 2.24 percent of total billed charges 3.03 93 2.45 percent of total billed charges 3.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.03 other OPPS APC 3.03 3.03 other OPPS APC 3.03 24.86 0.75 percent of total billed charges 3.03 3.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION" RX-28400 CDM A4217 HCPCS 0636 RC 00338-0013-04 NDC outpatient 1000 ML 28.94 28.94 28.94 74 21.42 percent of total billed charges 28.94 93 23.44 percent of total billed charges 28.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28.94 other OPPS APC 28.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28.94 other OPPS APC 28.94 24.86 7.19 percent of total billed charges 28.94 28.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION RX-2850 CDM J0171 HCPCS 0636 RC 42023-0159-01 NDC outpatient 1 ML 44.88 44.88 8.35 8.35 fee schedule 44.88 93 36.35 percent of total billed charges 8.35 44.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION RX-2850 CDM J0171 HCPCS 0636 RC 54288-0119-25 NDC outpatient 1 ML 40.4 40.4 40.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40.4 other OPPS APC 40.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40.4 other OPPS APC 40.4 24.86 10.04 percent of total billed charges 40.4 40.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE" RX-2863 CDM A9270 HCPCS 0250 RC 50268-0297-15 NDC outpatient 1 UN 4.8 4.8 74 3.55 percent of total billed charges 4.8 93 3.89 percent of total billed charges 4.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.8 other OPPS APC 4.8 4.8 other OPPS APC 4.8 24.86 1.19 percent of total billed charges 4.8 4.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE" RX-2863 CDM A9270 HCPCS 0637 RC 50268-0297-15 NDC outpatient 1 UN 4.8 4.8 4.8 74 3.55 percent of total billed charges 4.8 93 3.89 percent of total billed charges 4.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.8 other OPPS APC 4.8 4.8 other OPPS APC 4.8 24.86 1.19 percent of total billed charges 4.8 4.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR" RX-28643 CDM A9270 HCPCS 0250 RC 50268-0597-11 NDC outpatient 1 UN 3.28 3.28 74 2.43 percent of total billed charges 3.28 93 2.66 percent of total billed charges 3.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.28 other OPPS APC 3.28 3.28 other OPPS APC 3.28 24.86 0.82 percent of total billed charges 3.28 3.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR" RX-28643 CDM A9270 HCPCS 0637 RC 50268-0597-11 NDC outpatient 1 UN 3.28 3.28 3.28 74 2.43 percent of total billed charges 3.28 93 2.66 percent of total billed charges 3.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.28 other OPPS APC 3.28 3.28 other OPPS APC 3.28 24.86 0.82 percent of total billed charges 3.28 3.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP" RX-28810 CDM A9270 HCPCS 0250 RC 24208-0635-62 NDC outpatient 10 ML 251.7 251.7 74 186.26 percent of total billed charges 251.7 93 203.88 percent of total billed charges 251.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 251.7 other OPPS APC 251.7 251.7 other OPPS APC 251.7 24.86 62.57 percent of total billed charges 251.7 251.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP" RX-28810 CDM A9270 HCPCS 0637 RC 24208-0635-62 NDC outpatient 10 ML 251.7 251.7 251.7 74 186.26 percent of total billed charges 251.7 93 203.88 percent of total billed charges 251.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 251.7 other OPPS APC 251.7 251.7 other OPPS APC 251.7 24.86 62.57 percent of total billed charges 251.7 251.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR RX-28824 CDM A9270 HCPCS 0250 RC 63629-8847-01 NDC outpatient 30 GR 218.33 218.33 74 161.56 percent of total billed charges 218.33 93 176.85 percent of total billed charges 218.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.33 other OPPS APC 218.33 218.33 other OPPS APC 218.33 24.86 54.28 percent of total billed charges 218.33 218.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR RX-28824 CDM A9270 HCPCS 0637 RC 63629-8847-01 NDC outpatient 30 GR 218.33 218.33 218.33 74 161.56 percent of total billed charges 218.33 93 176.85 percent of total billed charges 218.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.33 other OPPS APC 218.33 218.33 other OPPS APC 218.33 24.86 54.28 percent of total billed charges 218.33 218.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CYCLOSPORINE MODIFIED 25 MG CAPSULE RX-28842 CDM J7515 HCPCS 0636 RC 51862-0458-47 NDC outpatient 1 UN 3.44 3.44 0.86 0.86 fee schedule 3.44 93 2.79 percent of total billed charges 3.44 3.44 other OPPS APC 3.44 3.44 other OPPS APC 3.44 24.86 0.86 percent of total billed charges 0.86 3.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CYCLOSPORINE MODIFIED 100 MG CAPSULE RX-28843 CDM J7502 HCPCS 0636 RC 23155-0839-11 NDC outpatient 1 UN 13.74 13.74 2.01 2.01 fee schedule 13.74 93 11.13 percent of total billed charges 13.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.74 other OPPS APC 13.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.74 other OPPS APC 13.74 24.86 3.42 percent of total billed charges 2.01 13.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCORTISONE 1 %-PRAMOXINE 1 % RECTAL FOAM RX-28849 CDM A9270 HCPCS 0250 RC 00037-6822-10 NDC outpatient 10 GR 555.35 555.35 74 410.96 percent of total billed charges 555.35 93 449.83 percent of total billed charges 555.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 555.35 other OPPS APC 555.35 555.35 other OPPS APC 555.35 24.86 138.06 percent of total billed charges 555.35 555.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCORTISONE 1 %-PRAMOXINE 1 % RECTAL FOAM RX-28849 CDM A9270 HCPCS 0637 RC 00037-6822-10 NDC outpatient 10 GR 555.35 555.35 555.35 74 410.96 percent of total billed charges 555.35 93 449.83 percent of total billed charges 555.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 555.35 other OPPS APC 555.35 555.35 other OPPS APC 555.35 24.86 138.06 percent of total billed charges 555.35 555.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT RX-2888 CDM A9270 HCPCS 0250 RC 24208-0910-19 NDC outpatient 1 GR 31.04 31.04 74 22.97 percent of total billed charges 31.04 93 25.14 percent of total billed charges 31.04 31.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT RX-2888 CDM A9270 HCPCS 0637 RC 24208-0910-19 NDC outpatient 1 GR 31.04 31.04 31.04 74 22.97 percent of total billed charges 31.04 93 25.14 percent of total billed charges 31.04 31.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT RX-2888 CDM A9270 HCPCS 0250 RC 72485-0670-31 NDC outpatient 1 GR 50.09 50.09 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 50.09 other OPPS APC 50.09 50.09 other OPPS APC 50.09 24.86 12.45 percent of total billed charges 50.09 50.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT RX-2888 CDM A9270 HCPCS 0637 RC 72485-0670-31 NDC outpatient 1 GR 50.09 50.09 50.09 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 50.09 other OPPS APC 50.09 50.09 other OPPS APC 50.09 24.86 12.45 percent of total billed charges 50.09 50.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHONDROITIN-SOD HYALURON 3 %-4 %(0.5 ML)1 %(0.55 ML)INTRAOCULAR SYRING RX-28917 CDM 250000000 HCPCS 0250 RC 08065-1831-50 NDC outpatient 1.5 ML 1590.05 1590.05 1590.05 74 1176.64 percent of total billed charges 1590.05 93 1287.94 percent of total billed charges 1590.05 1590.05 other OPPS APC 1590.05 1590.05 other OPPS APC 1590.05 24.86 395.29 percent of total billed charges 1590.05 1590.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHONDROITIN-SOD HYALURON 3 %-4 %(0.5 ML)1 %(0.55 ML)INTRAOCULAR SYRING|DISCARDED DRUG NOT ADMINISTERED RX-28917 CDM 250000000 HCPCS 0250 RC 08065-1831-50 NDC JW outpatient 1.5 ML 795.03 795.03 795.03 74 588.32 percent of total billed charges 795.03 93 643.97 percent of total billed charges 795.03 795.03 other OPPS APC 795.03 795.03 other OPPS APC 795.03 24.86 197.64 percent of total billed charges 795.03 795.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION RX-28947 CDM J0883 HCPCS 0636 RC 00143-9674-01 NDC outpatient 2.5 ML 1500 1500 1500 74 1110 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 1500 other OPPS APC 1500 1500 other OPPS APC 1500 24.86 372.9 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIROLIMUS 1 MG TABLET RX-28958 CDM J7520 HCPCS 0636 RC 50268-0718-11 NDC outpatient 1 UN 87.72 87.72 3.55 3.55 fee schedule 87.72 93 71.05 percent of total billed charges 87.72 87.72 other OPPS APC 87.72 87.72 other OPPS APC 87.72 24.86 21.81 percent of total billed charges 3.55 87.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOFLOXACIN 750 MG TABLET RX-28964 CDM A9270 HCPCS 0250 RC 00904-6353-61 NDC outpatient 1 UN 61.54 61.54 74 45.54 percent of total billed charges 61.54 93 49.85 percent of total billed charges 61.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 61.54 other OPPS APC 61.54 61.54 other OPPS APC 61.54 24.86 15.3 percent of total billed charges 61.54 61.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOFLOXACIN 750 MG TABLET RX-28964 CDM A9270 HCPCS 0637 RC 00904-6353-61 NDC outpatient 1 UN 61.54 61.54 61.54 74 45.54 percent of total billed charges 61.54 93 49.85 percent of total billed charges 61.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 61.54 other OPPS APC 61.54 61.54 other OPPS APC 61.54 24.86 15.3 percent of total billed charges 61.54 61.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION RX-2899 CDM A9270 HCPCS 0250 RC 75834-0295-01 NDC outpatient 100 ML 1013.53 1013.53 74 750.01 percent of total billed charges 1013.53 93 820.96 percent of total billed charges 1013.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1013.53 other OPPS APC 1013.53 1013.53 other OPPS APC 1013.53 24.86 251.96 percent of total billed charges 1013.53 1013.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION RX-2899 CDM A9270 HCPCS 0637 RC 75834-0295-01 NDC outpatient 100 ML 1013.53 1013.53 1013.53 74 750.01 percent of total billed charges 1013.53 93 820.96 percent of total billed charges 1013.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1013.53 other OPPS APC 1013.53 1013.53 other OPPS APC 1013.53 24.86 251.96 percent of total billed charges 1013.53 1013.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR" RX-28995 CDM A9270 HCPCS 0250 RC 50268-0550-15 NDC outpatient 1 UN 1.56 1.56 74 1.15 percent of total billed charges 1.56 93 1.26 percent of total billed charges 1.56 1.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR" RX-28995 CDM A9270 HCPCS 0637 RC 50268-0550-15 NDC outpatient 1 UN 1.56 1.56 1.56 74 1.15 percent of total billed charges 1.56 93 1.26 percent of total billed charges 1.56 1.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR" RX-28995 CDM A9270 HCPCS 0250 RC 70010-0491-01 NDC outpatient 1 UN 2.14 2.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.14 other OPPS APC 2.14 2.14 other OPPS APC 2.14 24.86 0.53 percent of total billed charges 2.14 2.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR" RX-28995 CDM A9270 HCPCS 0637 RC 70010-0491-01 NDC outpatient 1 UN 2.14 2.14 2.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.14 other OPPS APC 2.14 2.14 other OPPS APC 2.14 24.86 0.53 percent of total billed charges 2.14 2.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ERYTHROMYCIN LACTOBIONATE 500 MG INTRAVENOUS SOLUTION RX-2903 CDM J1364 HCPCS 0636 RC 00409-6482-01 NDC outpatient 10 ML 272.66 272.66 99.68 99.68 fee schedule 272.66 93 220.85 percent of total billed charges 272.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 65.38 other OPPS APC 272.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 65.38 other OPPS APC 272.66 24.86 67.78 percent of total billed charges 99.68 272.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ERYTHROMYCIN LACTOBIONATE 500 MG INTRAVENOUS SOLUTION RX-2903 CDM J1364 HCPCS 0636 RC 00409-6482-01 NDC outpatient 500 ME 272.66 272.66 99.68 99.68 fee schedule 272.66 93 220.85 percent of total billed charges 272.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 65.38 other OPPS APC 272.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 65.38 other OPPS APC 272.66 24.86 67.78 percent of total billed charges 99.68 272.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION RX-29132 CDM J1756 HCPCS 0636 RC 00517-2340-10 NDC outpatient 5 ML 183.66 183.66 22.99 22.99 fee schedule 183.66 93 148.76 percent of total billed charges 183.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 183.66 other OPPS APC 183.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 183.66 other OPPS APC 183.66 24.86 45.66 percent of total billed charges 22.99 183.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GABAPENTIN 250 MG/5 ML ORAL SOLUTION RX-29169 CDM A9270 HCPCS 0250 RC 65162-0698-90 NDC outpatient 473 ML 372.28 372.28 74 275.49 percent of total billed charges 372.28 93 301.55 percent of total billed charges 372.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 372.28 other OPPS APC 372.28 372.28 other OPPS APC 372.28 24.86 92.55 percent of total billed charges 372.28 372.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GABAPENTIN 250 MG/5 ML ORAL SOLUTION RX-29169 CDM A9270 HCPCS 0637 RC 65162-0698-90 NDC outpatient 473 ML 372.28 372.28 372.28 74 275.49 percent of total billed charges 372.28 93 301.55 percent of total billed charges 372.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 372.28 other OPPS APC 372.28 372.28 other OPPS APC 372.28 24.86 92.55 percent of total billed charges 372.28 372.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR" RX-29270 CDM A9270 HCPCS 0250 RC 60687-0195-01 NDC outpatient 1 UN 2.42 2.42 74 1.79 percent of total billed charges 2.42 93 1.96 percent of total billed charges 2.42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.42 other OPPS APC 2.42 2.42 other OPPS APC 2.42 24.86 0.6 percent of total billed charges 2.42 2.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR" RX-29270 CDM A9270 HCPCS 0637 RC 60687-0195-01 NDC outpatient 1 UN 2.42 2.42 2.42 74 1.79 percent of total billed charges 2.42 93 1.96 percent of total billed charges 2.42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.42 other OPPS APC 2.42 2.42 other OPPS APC 2.42 24.86 0.6 percent of total billed charges 2.42 2.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR" RX-29272 CDM A9270 HCPCS 0250 RC 60687-0206-01 NDC outpatient 1 UN 2.42 2.42 74 1.79 percent of total billed charges 2.42 93 1.96 percent of total billed charges 2.42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.42 other OPPS APC 2.42 2.42 other OPPS APC 2.42 24.86 0.6 percent of total billed charges 2.42 2.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR" RX-29272 CDM A9270 HCPCS 0637 RC 60687-0206-01 NDC outpatient 1 UN 2.42 2.42 2.42 74 1.79 percent of total billed charges 2.42 93 1.96 percent of total billed charges 2.42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.42 other OPPS APC 2.42 2.42 other OPPS APC 2.42 24.86 0.6 percent of total billed charges 2.42 2.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR" RX-29274 CDM A9270 HCPCS 0250 RC 00904-7219-61 NDC outpatient 1 UN 1.45 1.45 74 1.07 percent of total billed charges 1.45 93 1.17 percent of total billed charges 1.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.45 other OPPS APC 1.45 1.45 other OPPS APC 1.45 24.86 0.36 percent of total billed charges 1.45 1.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR" RX-29274 CDM A9270 HCPCS 0637 RC 00904-7219-61 NDC outpatient 1 UN 1.45 1.45 1.45 74 1.07 percent of total billed charges 1.45 93 1.17 percent of total billed charges 1.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.45 other OPPS APC 1.45 1.45 other OPPS APC 1.45 24.86 0.36 percent of total billed charges 1.45 1.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR" RX-29276 CDM A9270 HCPCS 0250 RC 60687-0228-11 NDC outpatient 1 UN 6.7 6.7 74 4.96 percent of total billed charges 6.7 93 5.43 percent of total billed charges 6.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.7 other OPPS APC 6.7 6.7 other OPPS APC 6.7 24.86 1.67 percent of total billed charges 6.7 6.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR" RX-29276 CDM A9270 HCPCS 0637 RC 60687-0228-11 NDC outpatient 1 UN 6.7 6.7 6.7 74 4.96 percent of total billed charges 6.7 93 5.43 percent of total billed charges 6.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.7 other OPPS APC 6.7 6.7 other OPPS APC 6.7 24.86 1.67 percent of total billed charges 6.7 6.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVONORGESTREL 21 MCG/24 HR (UP TO 8 YEARS) 52 MG INTRAUTERINE DEVICE RX-29280 CDM J7298 HCPCS 0636 RC 50419-0423-01 NDC outpatient 1 UN 1388.15 1388.15 1388.15 74 1027.23 percent of total billed charges 1388.15 93 1124.4 percent of total billed charges 1388.15 1388.15 other OPPS APC 1388.15 1388.15 other OPPS APC 1388.15 24.86 345.09 percent of total billed charges 1388.15 1388.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOCOSANOL 10 % TOPICAL CREAM RX-29287 CDM A9270 HCPCS 0250 RC 00766-0801-55 NDC outpatient 2 GR 46.38 46.38 74 34.32 percent of total billed charges 46.38 93 37.57 percent of total billed charges 46.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 46.38 other OPPS APC 46.38 46.38 other OPPS APC 46.38 24.86 11.53 percent of total billed charges 46.38 46.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOCOSANOL 10 % TOPICAL CREAM RX-29287 CDM A9270 HCPCS 0637 RC 00766-0801-55 NDC outpatient 2 GR 46.38 46.38 46.38 74 34.32 percent of total billed charges 46.38 93 37.57 percent of total billed charges 46.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 46.38 other OPPS APC 46.38 46.38 other OPPS APC 46.38 24.86 11.53 percent of total billed charges 46.38 46.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLUTION RX-29302 CDM J7510 HCPCS 0636 RC 42799-0815-01 NDC outpatient 237 ML 185 185 39.8 39.8 fee schedule 185 93 149.85 percent of total billed charges 185 185 other OPPS APC 185 185 other OPPS APC 185 24.86 45.99 percent of total billed charges 39.8 185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION RX-29335 CDM J1800 HCPCS 0636 RC 63323-0604-01 NDC outpatient 1 ML 34.44 34.44 34.44 74 25.49 percent of total billed charges 34.44 93 27.9 percent of total billed charges 34.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.44 other OPPS APC 34.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.44 other OPPS APC 34.44 24.86 8.56 percent of total billed charges 34.44 34.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION RX-29396 CDM J0583 HCPCS 0636 RC 83634-0400-10 NDC outpatient 250 ME 270 270 66.55 66.55 fee schedule 270 93 218.7 percent of total billed charges 270 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 270 other OPPS APC 270 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 270 other OPPS APC 270 24.86 67.12 percent of total billed charges 66.55 270 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION RX-29396 CDM J0583 HCPCS 0636 RC 83634-0400-10 NDC outpatient 5 ML 270 270 66.55 66.55 fee schedule 270 93 218.7 percent of total billed charges 270 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 270 other OPPS APC 270 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 270 other OPPS APC 270 24.86 67.12 percent of total billed charges 66.55 270 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM RX-29424 CDM A9270 HCPCS 0250 RC 00472-0379-15 NDC outpatient 15 GR 96.88 96.88 74 71.69 percent of total billed charges 96.88 93 78.47 percent of total billed charges 96.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 96.88 other OPPS APC 96.88 96.88 other OPPS APC 96.88 24.86 24.08 percent of total billed charges 96.88 96.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM RX-29424 CDM A9270 HCPCS 0637 RC 00472-0379-15 NDC outpatient 15 GR 96.88 96.88 96.88 74 71.69 percent of total billed charges 96.88 93 78.47 percent of total billed charges 96.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 96.88 other OPPS APC 96.88 96.88 other OPPS APC 96.88 24.86 24.08 percent of total billed charges 96.88 96.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TOLTERODINE ER 2 MG CAPSULE,EXTENDED RELEASE 24 HR" RX-29434 CDM A9270 HCPCS 0250 RC 43975-0322-03 NDC outpatient 1 UN 20.09 20.09 74 14.87 percent of total billed charges 20.09 93 16.27 percent of total billed charges 20.09 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20.09 other OPPS APC 20.09 20.09 other OPPS APC 20.09 24.86 4.99 percent of total billed charges 20.09 20.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TOLTERODINE ER 2 MG CAPSULE,EXTENDED RELEASE 24 HR" RX-29434 CDM A9270 HCPCS 0637 RC 43975-0322-03 NDC outpatient 1 UN 20.09 20.09 20.09 74 14.87 percent of total billed charges 20.09 93 16.27 percent of total billed charges 20.09 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20.09 other OPPS APC 20.09 20.09 other OPPS APC 20.09 24.86 4.99 percent of total billed charges 20.09 20.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % LOTION RX-29436 CDM A9270 HCPCS 0250 RC 51672-1308-03 NDC outpatient 30 ML 418.9 418.9 74 309.99 percent of total billed charges 418.9 93 339.31 percent of total billed charges 418.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 418.9 other OPPS APC 418.9 418.9 other OPPS APC 418.9 24.86 104.14 percent of total billed charges 418.9 418.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % LOTION RX-29436 CDM A9270 HCPCS 0637 RC 51672-1308-03 NDC outpatient 30 ML 418.9 418.9 418.9 74 309.99 percent of total billed charges 418.9 93 339.31 percent of total billed charges 418.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 418.9 other OPPS APC 418.9 418.9 other OPPS APC 418.9 24.86 104.14 percent of total billed charges 418.9 418.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE (PF) 0.5 MG/ML INJECTION SOLUTION RX-29464 CDM J2274 HCPCS 0636 RC 00641-6020-10 NDC outpatient 10 ML 86.88 86.88 17.92 17.92 fee schedule 86.88 93 70.37 percent of total billed charges 86.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 86.88 other OPPS APC 86.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 86.88 other OPPS APC 86.88 24.86 21.6 percent of total billed charges 17.92 86.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ETHYL CHLORIDE 100 % TOPICAL SPRAY RX-2951 CDM A9270 HCPCS 0250 RC 00386-0001-02 NDC outpatient 1 UN 80.01 80.01 74 59.21 percent of total billed charges 80.01 93 64.81 percent of total billed charges 80.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 80.01 other OPPS APC 80.01 80.01 other OPPS APC 80.01 24.86 19.89 percent of total billed charges 80.01 80.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ETHYL CHLORIDE 100 % TOPICAL SPRAY RX-2951 CDM A9270 HCPCS 0637 RC 00386-0001-02 NDC outpatient 1 UN 80.01 80.01 80.01 74 59.21 percent of total billed charges 80.01 93 64.81 percent of total billed charges 80.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 80.01 other OPPS APC 80.01 80.01 other OPPS APC 80.01 24.86 19.89 percent of total billed charges 80.01 80.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIRTAZAPINE 15 MG DISINTEGRATING TABLET RX-29531 CDM A9270 HCPCS 0250 RC 65862-0021-06 NDC outpatient 1 UN 5.89 5.89 74 4.36 percent of total billed charges 5.89 93 4.77 percent of total billed charges 5.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.89 other OPPS APC 5.89 5.89 other OPPS APC 5.89 24.86 1.46 percent of total billed charges 5.89 5.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIRTAZAPINE 15 MG DISINTEGRATING TABLET RX-29531 CDM A9270 HCPCS 0637 RC 65862-0021-06 NDC outpatient 1 UN 5.89 5.89 5.89 74 4.36 percent of total billed charges 5.89 93 4.77 percent of total billed charges 5.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.89 other OPPS APC 5.89 5.89 other OPPS APC 5.89 24.86 1.46 percent of total billed charges 5.89 5.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL RX-29676 CDM 250000000 HCPCS 0250 RC 00904-3865-75 NDC outpatient 44 ML 2.83 2.83 2.83 74 2.09 percent of total billed charges 2.83 93 2.29 percent of total billed charges 2.83 2.83 other OPPS APC 2.83 2.83 other OPPS APC 2.83 24.86 0.7 percent of total billed charges 2.83 2.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZIPRASIDONE 20 MG CAPSULE RX-29778 CDM A9270 HCPCS 0250 RC 00904-6269-45 NDC outpatient 1 UN 8.28 8.28 74 6.13 percent of total billed charges 8.28 93 6.71 percent of total billed charges 8.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.28 other OPPS APC 8.28 8.28 other OPPS APC 8.28 24.86 2.06 percent of total billed charges 8.28 8.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZIPRASIDONE 20 MG CAPSULE RX-29778 CDM A9270 HCPCS 0637 RC 00904-6269-45 NDC outpatient 1 UN 8.28 8.28 8.28 74 6.13 percent of total billed charges 8.28 93 6.71 percent of total billed charges 8.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.28 other OPPS APC 8.28 8.28 other OPPS APC 8.28 24.86 2.06 percent of total billed charges 8.28 8.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV" RX-29805 CDM J1805 HCPCS 0636 RC 25021-0308-84 NDC outpatient 250 ML 495 495 72.6 72.6 fee schedule 495 93 400.95 percent of total billed charges 495 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.5 other OPPS APC 495 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.5 other OPPS APC 495 24.86 123.06 percent of total billed charges 72.6 495 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV" RX-29805 CDM J1805 HCPCS 0636 RC 25021-0308-84 NDC outpatient 2500 ME 495 495 72.6 72.6 fee schedule 495 93 400.95 percent of total billed charges 495 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.5 other OPPS APC 495 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.5 other OPPS APC 495 24.86 123.06 percent of total billed charges 72.6 495 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GALANTAMINE 4 MG TABLET RX-29806 CDM A9270 HCPCS 0250 RC 68084-0729-21 NDC outpatient 1 UN 10.5 10.5 74 7.77 percent of total billed charges 10.5 93 8.51 percent of total billed charges 10.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.5 other OPPS APC 10.5 10.5 other OPPS APC 10.5 24.86 2.61 percent of total billed charges 10.5 10.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GALANTAMINE 4 MG TABLET RX-29806 CDM A9270 HCPCS 0637 RC 68084-0729-21 NDC outpatient 1 UN 10.5 10.5 10.5 74 7.77 percent of total billed charges 10.5 93 8.51 percent of total billed charges 10.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.5 other OPPS APC 10.5 10.5 other OPPS APC 10.5 24.86 2.61 percent of total billed charges 10.5 10.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR" RX-29858 CDM A9270 HCPCS 0250 RC 50268-0540-15 NDC outpatient 1 UN 2.76 2.76 74 2.04 percent of total billed charges 2.76 93 2.24 percent of total billed charges 2.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.76 other OPPS APC 2.76 2.76 other OPPS APC 2.76 24.86 0.69 percent of total billed charges 2.76 2.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR" RX-29858 CDM A9270 HCPCS 0637 RC 50268-0540-15 NDC outpatient 1 UN 2.76 2.76 2.76 74 2.04 percent of total billed charges 2.76 93 2.24 percent of total billed charges 2.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.76 other OPPS APC 2.76 2.76 other OPPS APC 2.76 24.86 0.69 percent of total billed charges 2.76 2.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR" RX-30070 CDM A9270 HCPCS 0250 RC 50268-0541-15 NDC outpatient 1 UN 2.76 2.76 74 2.04 percent of total billed charges 2.76 93 2.24 percent of total billed charges 2.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.76 other OPPS APC 2.76 2.76 other OPPS APC 2.76 24.86 0.69 percent of total billed charges 2.76 2.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR" RX-30070 CDM A9270 HCPCS 0637 RC 50268-0541-15 NDC outpatient 1 UN 2.76 2.76 2.76 74 2.04 percent of total billed charges 2.76 93 2.24 percent of total billed charges 2.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.76 other OPPS APC 2.76 2.76 other OPPS APC 2.76 24.86 0.69 percent of total billed charges 2.76 2.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR" RX-30071 CDM A9270 HCPCS 0250 RC 60687-0413-65 NDC outpatient 1 UN 2.49 2.49 74 1.84 percent of total billed charges 2.49 93 2.02 percent of total billed charges 2.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.49 other OPPS APC 2.49 2.49 other OPPS APC 2.49 24.86 0.62 percent of total billed charges 2.49 2.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR" RX-30071 CDM A9270 HCPCS 0637 RC 60687-0413-65 NDC outpatient 1 UN 2.49 2.49 2.49 74 1.84 percent of total billed charges 2.49 93 2.02 percent of total billed charges 2.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.49 other OPPS APC 2.49 2.49 other OPPS APC 2.49 24.86 0.62 percent of total billed charges 2.49 2.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALGANCICLOVIR 450 MG TABLET RX-30148 CDM A9270 HCPCS 0250 RC 50268-0787-12 NDC outpatient 1 UN 373.57 373.57 74 276.44 percent of total billed charges 373.57 93 302.59 percent of total billed charges 373.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 373.57 other OPPS APC 373.57 373.57 other OPPS APC 373.57 24.86 92.87 percent of total billed charges 373.57 373.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALGANCICLOVIR 450 MG TABLET RX-30148 CDM A9270 HCPCS 0637 RC 50268-0787-12 NDC outpatient 1 UN 373.57 373.57 373.57 74 276.44 percent of total billed charges 373.57 93 302.59 percent of total billed charges 373.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 373.57 other OPPS APC 373.57 373.57 other OPPS APC 373.57 24.86 92.87 percent of total billed charges 373.57 373.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CITALOPRAM 10 MG TABLET RX-30264 CDM A9270 HCPCS 0250 RC 00904-6084-61 NDC outpatient 1 UN 6.07 6.07 74 4.49 percent of total billed charges 6.07 93 4.92 percent of total billed charges 6.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.07 other OPPS APC 6.07 6.07 other OPPS APC 6.07 24.86 1.51 percent of total billed charges 6.07 6.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CITALOPRAM 10 MG TABLET RX-30264 CDM A9270 HCPCS 0637 RC 00904-6084-61 NDC outpatient 1 UN 6.07 6.07 6.07 74 4.49 percent of total billed charges 6.07 93 4.92 percent of total billed charges 6.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.07 other OPPS APC 6.07 6.07 other OPPS APC 6.07 24.86 1.51 percent of total billed charges 6.07 6.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION RX-3037 CDM J3010 HCPCS 0636 RC 00409-9094-22 NDC outpatient 2 ML 4.62 4.62 0.96 0.96 fee schedule 4.62 93 3.74 percent of total billed charges 4.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.62 other OPPS APC 4.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.62 other OPPS APC 4.62 24.86 1.15 percent of total billed charges 0.96 4.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUAR GUM ORAL PACKET RX-30538 CDM A9270 HCPCS 0250 RC 43900-0976-47 NDC outpatient 1 UN 91.05 91.05 74 67.38 percent of total billed charges 91.05 93 73.75 percent of total billed charges 91.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 91.05 other OPPS APC 91.05 91.05 other OPPS APC 91.05 24.86 22.64 percent of total billed charges 91.05 91.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUAR GUM ORAL PACKET RX-30538 CDM A9270 HCPCS 0637 RC 43900-0976-47 NDC outpatient 1 UN 91.05 91.05 91.05 74 67.38 percent of total billed charges 91.05 93 73.75 percent of total billed charges 91.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 91.05 other OPPS APC 91.05 91.05 other OPPS APC 91.05 24.86 22.64 percent of total billed charges 91.05 91.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE 2 MG/ML INJECTION SOLUTION RX-30594 CDM J2272 HCPCS 0636 RC 63323-0452-01 NDC outpatient 1 ML 8.61 8.61 7.91 7.91 fee schedule 8.61 93 6.97 percent of total billed charges 8.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.61 other OPPS APC 8.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.61 other OPPS APC 8.61 24.86 2.14 percent of total billed charges 7.91 8.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID RX-3071 CDM A9270 HCPCS 0250 RC 00904-7277-70 NDC outpatient 5 ML 6.54 6.54 74 4.84 percent of total billed charges 6.54 93 5.3 percent of total billed charges 6.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.54 other OPPS APC 6.54 6.54 other OPPS APC 6.54 24.86 1.63 percent of total billed charges 6.54 6.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID RX-3071 CDM A9270 HCPCS 0637 RC 00904-7277-70 NDC outpatient 5 ML 6.54 6.54 6.54 74 4.84 percent of total billed charges 6.54 93 5.3 percent of total billed charges 6.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.54 other OPPS APC 6.54 6.54 other OPPS APC 6.54 24.86 1.63 percent of total billed charges 6.54 6.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FERROUS SULFATE 325 MG (65 MG IRON) TABLET RX-3074 CDM A9270 HCPCS 0250 RC 00904-7591-61 NDC outpatient 1 UN 0.09 0.09 74 0.07 percent of total billed charges 0.09 93 0.07 percent of total billed charges 0.09 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.09 other OPPS APC 0.09 0.09 other OPPS APC 0.09 24.86 0.02 percent of total billed charges 0.09 0.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FERROUS SULFATE 325 MG (65 MG IRON) TABLET RX-3074 CDM A9270 HCPCS 0637 RC 00904-7591-61 NDC outpatient 1 UN 0.09 0.09 0.09 74 0.07 percent of total billed charges 0.09 93 0.07 percent of total billed charges 0.09 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.09 other OPPS APC 0.09 0.09 other OPPS APC 0.09 24.86 0.02 percent of total billed charges 0.09 0.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FENTANYL (PF) 10 MCG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS RX-30807 CDM 250000000 HCPCS 0250 RC 90000-0002-29 NDC outpatient 100 ML 1.48 1.48 1.48 74 1.1 percent of total billed charges 1.48 93 1.2 percent of total billed charges 1.48 1.48 other OPPS APC 1.48 1.48 other OPPS APC 1.48 24.86 0.37 percent of total billed charges 1.48 1.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS RX-30851 CDM J2270 HCPCS 0636 RC 90000-0002-41 NDC outpatient 100 ML 41.97 41.97 52.51 52.51 fee schedule 41.97 93 34 percent of total billed charges 41.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.97 other OPPS APC 41.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.97 other OPPS APC 41.97 24.86 10.43 percent of total billed charges 41.97 52.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE RX-30961 CDM A9270 HCPCS 0250 RC 00904-7119-06 NDC outpatient 1 UN 3.04 3.04 74 2.25 percent of total billed charges 3.04 93 2.46 percent of total billed charges 3.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.04 other OPPS APC 3.04 3.04 other OPPS APC 3.04 24.86 0.76 percent of total billed charges 3.04 3.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE RX-30961 CDM A9270 HCPCS 0637 RC 00904-7119-06 NDC outpatient 1 UN 3.04 3.04 3.04 74 2.25 percent of total billed charges 3.04 93 2.46 percent of total billed charges 3.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.04 other OPPS APC 3.04 3.04 other OPPS APC 3.04 24.86 0.76 percent of total billed charges 3.04 3.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOPURINOL 100 MG TABLET RX-310 CDM A9270 HCPCS 0250 RC 00904-7041-61 NDC outpatient 1 UN 1 1 74 0.74 percent of total billed charges 1 93 0.81 percent of total billed charges 1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1 other OPPS APC 1 1 other OPPS APC 1 24.86 0.25 percent of total billed charges 1 1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOPURINOL 100 MG TABLET RX-310 CDM A9270 HCPCS 0637 RC 00904-7041-61 NDC outpatient 1 UN 1 1 1 74 0.74 percent of total billed charges 1 93 0.81 percent of total billed charges 1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1 other OPPS APC 1 1 other OPPS APC 1 24.86 0.25 percent of total billed charges 1 1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS" RX-31025 CDM J9267 HCPCS 0636 RC 00703-3213-01 NDC outpatient 5 ML 30 30 4.36 4.36 fee schedule 30 93 24.3 percent of total billed charges 30 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30 other OPPS APC 30 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30 other OPPS APC 30 24.86 7.46 percent of total billed charges 4.36 30 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS" RX-31025 CDM J9267 HCPCS 0636 RC 00703-3217-01 NDC outpatient 25 ML 198 198 21.78 21.78 fee schedule 198 93 160.38 percent of total billed charges 198 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 198 other OPPS APC 198 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 198 other OPPS APC 198 24.86 49.22 percent of total billed charges 21.78 198 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS" RX-31025 CDM J9267 HCPCS 0636 RC 61703-0342-22 NDC outpatient 17 ML 86.1 86.1 14.81 14.81 fee schedule 86.1 93 69.74 percent of total billed charges 86.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 86.1 other OPPS APC 86.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 86.1 other OPPS APC 86.1 24.86 21.4 percent of total billed charges 14.81 86.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS" RX-31025 CDM J9267 HCPCS 0636 RC 61703-0342-50 NDC outpatient 50 ML 213.9 213.9 43.56 43.56 fee schedule 213.9 93 173.26 percent of total billed charges 213.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 213.9 other OPPS APC 213.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 213.9 other OPPS APC 213.9 24.86 53.18 percent of total billed charges 43.56 213.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOPURINOL 300 MG TABLET RX-311 CDM A9270 HCPCS 0250 RC 00904-6572-61 NDC outpatient 1 UN 2.03 2.03 74 1.5 percent of total billed charges 2.03 93 1.64 percent of total billed charges 2.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.03 other OPPS APC 2.03 2.03 other OPPS APC 2.03 24.86 0.5 percent of total billed charges 2.03 2.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOPURINOL 300 MG TABLET RX-311 CDM A9270 HCPCS 0637 RC 00904-6572-61 NDC outpatient 1 UN 2.03 2.03 2.03 74 1.5 percent of total billed charges 2.03 93 1.64 percent of total billed charges 2.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.03 other OPPS APC 2.03 2.03 other OPPS APC 2.03 24.86 0.5 percent of total billed charges 2.03 2.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALSARTAN 160 MG TABLET RX-31210 CDM A9270 HCPCS 0250 RC 60687-0634-01 NDC outpatient 1 UN 3.62 3.62 74 2.68 percent of total billed charges 3.62 93 2.93 percent of total billed charges 3.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.62 other OPPS APC 3.62 3.62 other OPPS APC 3.62 24.86 0.9 percent of total billed charges 3.62 3.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALSARTAN 160 MG TABLET RX-31210 CDM A9270 HCPCS 0637 RC 60687-0634-01 NDC outpatient 1 UN 3.62 3.62 3.62 74 2.68 percent of total billed charges 3.62 93 2.93 percent of total billed charges 3.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.62 other OPPS APC 3.62 3.62 other OPPS APC 3.62 24.86 0.9 percent of total billed charges 3.62 3.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAMADOL 37.5 MG-ACETAMINOPHEN 325 MG TABLET RX-31288 CDM A9270 HCPCS 0250 RC 53746-0617-01 NDC outpatient 1 UN 2.57 2.57 74 1.9 percent of total billed charges 2.57 93 2.08 percent of total billed charges 2.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.57 other OPPS APC 2.57 2.57 other OPPS APC 2.57 24.86 0.64 percent of total billed charges 2.57 2.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAMADOL 37.5 MG-ACETAMINOPHEN 325 MG TABLET RX-31288 CDM A9270 HCPCS 0637 RC 53746-0617-01 NDC outpatient 1 UN 2.57 2.57 2.57 74 1.9 percent of total billed charges 2.57 93 2.08 percent of total billed charges 2.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.57 other OPPS APC 2.57 2.57 other OPPS APC 2.57 24.86 0.64 percent of total billed charges 2.57 2.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALTEPLASE 2 MG INTRA-CATHETER SOLUTION RX-31310 CDM J2997 HCPCS 0636 RC 50242-0041-64 NDC outpatient 2 ME 529.05 529.05 203.52 203.52 fee schedule 529.05 93 428.53 percent of total billed charges 529.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.94 other OPPS APC 529.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.94 other OPPS APC 529.05 24.86 131.52 percent of total billed charges 203.52 529.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION RX-31432 CDM J1162 HCPCS 0636 RC 50633-0120-11 NDC outpatient 1 UN 14349 14349 5243.61 5243.61 fee schedule 14349 93 11622.7 percent of total billed charges 14349 14349 other OPPS APC 14349 14349 other OPPS APC 14349 24.86 3567.16 percent of total billed charges 5243.61 14349 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALBUTEROL SULFATE 1.25 MG/3 ML SOLUTION FOR NEBULIZATION RX-31578 CDM J7613 HCPCS 0636 RC 00487-9904-01 NDC outpatient 3 ML 3.99 3.99 0.07 0.07 fee schedule 3.99 93 3.23 percent of total billed charges 3.99 3.99 other OPPS APC 3.99 3.99 other OPPS APC 3.99 24.86 0.99 percent of total billed charges 0.07 3.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DEXTROAMPHETAMINE-AMPHETAMINE ER 10 MG 24HR CAPSULE,EXTEND RELEASE" RX-31587 CDM A9270 HCPCS 0250 RC 64850-0511-01 NDC outpatient 1 UN 15.33 15.33 74 11.34 percent of total billed charges 15.33 93 12.42 percent of total billed charges 15.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.33 other OPPS APC 15.33 15.33 other OPPS APC 15.33 24.86 3.81 percent of total billed charges 15.33 15.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DEXTROAMPHETAMINE-AMPHETAMINE ER 10 MG 24HR CAPSULE,EXTEND RELEASE" RX-31587 CDM A9270 HCPCS 0637 RC 64850-0511-01 NDC outpatient 1 UN 15.33 15.33 15.33 74 11.34 percent of total billed charges 15.33 93 12.42 percent of total billed charges 15.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.33 other OPPS APC 15.33 15.33 other OPPS APC 15.33 24.86 3.81 percent of total billed charges 15.33 15.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE RX-31921 CDM J1650 HCPCS 0636 RC 71839-0116-10 NDC outpatient 1 ML 104.82 104.82 11.62 11.62 fee schedule 104.82 93 84.9 percent of total billed charges 104.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 104.82 other OPPS APC 104.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 104.82 other OPPS APC 104.82 24.86 26.06 percent of total billed charges 11.62 104.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ERTAPENEM 1 GRAM SOLUTION FOR INJECTION RX-31922 CDM J1335 HCPCS 0636 RC 55150-0282-20 NDC outpatient 1 GR 180 180 30.42 30.42 fee schedule 180 93 145.8 percent of total billed charges 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 24.86 44.75 percent of total billed charges 30.42 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ERTAPENEM 1 GRAM SOLUTION FOR INJECTION RX-31922 CDM J1335 HCPCS 0636 RC 55150-0282-20 NDC outpatient 10 ML 180 180 30.42 30.42 fee schedule 180 93 145.8 percent of total billed charges 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 24.86 44.75 percent of total billed charges 30.42 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE RX-32215 CDM J1652 HCPCS 0636 RC 00781-3443-95 NDC outpatient 0.5 ML 73.44 73.44 6.11 6.11 fee schedule 73.44 93 59.49 percent of total billed charges 73.44 73.44 other OPPS APC 73.44 73.44 other OPPS APC 73.44 24.86 18.26 percent of total billed charges 6.11 73.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE RX-32267 CDM J2506 HCPCS 0636 RC 55513-0190-01 NDC outpatient 0.6 ML 19254 19254 1174.09 1174.09 fee schedule 19254 93 15595.7 percent of total billed charges 19254 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 373.73 other OPPS APC 19254 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 373.73 other OPPS APC 19254 24.86 4786.54 percent of total billed charges 1174.09 19254 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOLIC ACID 5 MG/ML INJECTION SOLUTION RX-3232 CDM 250000000 HCPCS 0250 RC 39822-1100-01 NDC outpatient 10 ML 109.38 109.38 109.38 74 80.94 percent of total billed charges 109.38 93 88.6 percent of total billed charges 109.38 109.38 other OPPS APC 109.38 109.38 other OPPS APC 109.38 24.86 27.19 percent of total billed charges 109.38 109.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOLIC ACID 1 MG TABLET RX-3233 CDM A9270 HCPCS 0250 RC 00904-7224-61 NDC outpatient 1 UN 0.51 0.51 74 0.38 percent of total billed charges 0.51 93 0.41 percent of total billed charges 0.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.51 other OPPS APC 0.51 0.51 other OPPS APC 0.51 24.86 0.13 percent of total billed charges 0.51 0.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOLIC ACID 1 MG TABLET RX-3233 CDM A9270 HCPCS 0637 RC 00904-7224-61 NDC outpatient 1 UN 0.51 0.51 0.51 74 0.38 percent of total billed charges 0.51 93 0.41 percent of total billed charges 0.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.51 other OPPS APC 0.51 0.51 other OPPS APC 0.51 24.86 0.13 percent of total billed charges 0.51 0.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOLIC ACID 400 MCG TABLET RX-3234 CDM A9270 HCPCS 0250 RC 50268-0346-15 NDC outpatient 1 UN 0.69 0.69 74 0.51 percent of total billed charges 0.69 93 0.56 percent of total billed charges 0.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.69 other OPPS APC 0.69 0.69 other OPPS APC 0.69 24.86 0.17 percent of total billed charges 0.69 0.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOLIC ACID 400 MCG TABLET RX-3234 CDM A9270 HCPCS 0637 RC 50268-0346-15 NDC outpatient 1 UN 0.69 0.69 0.69 74 0.51 percent of total billed charges 0.69 93 0.56 percent of total billed charges 0.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.69 other OPPS APC 0.69 0.69 other OPPS APC 0.69 24.86 0.17 percent of total billed charges 0.69 0.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALPRAZOLAM 0.25 MG TABLET RX-324 CDM A9270 HCPCS 0250 RC 60687-0377-01 NDC outpatient 1 UN 0.92 0.92 74 0.68 percent of total billed charges 0.92 93 0.75 percent of total billed charges 0.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.92 other OPPS APC 0.92 0.92 other OPPS APC 0.92 24.86 0.23 percent of total billed charges 0.92 0.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALPRAZOLAM 0.25 MG TABLET RX-324 CDM A9270 HCPCS 0637 RC 60687-0377-01 NDC outpatient 1 UN 0.92 0.92 0.92 74 0.68 percent of total billed charges 0.92 93 0.75 percent of total billed charges 0.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.92 other OPPS APC 0.92 0.92 other OPPS APC 0.92 24.86 0.23 percent of total billed charges 0.92 0.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALPRAZOLAM 0.5 MG TABLET RX-325 CDM A9270 HCPCS 0250 RC 60687-0388-01 NDC outpatient 1 UN 1.11 1.11 74 0.82 percent of total billed charges 1.11 93 0.9 percent of total billed charges 1.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.11 other OPPS APC 1.11 1.11 other OPPS APC 1.11 24.86 0.28 percent of total billed charges 1.11 1.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALPRAZOLAM 0.5 MG TABLET RX-325 CDM A9270 HCPCS 0637 RC 60687-0388-01 NDC outpatient 1 UN 1.11 1.11 1.11 74 0.82 percent of total billed charges 1.11 93 0.9 percent of total billed charges 1.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.11 other OPPS APC 1.11 1.11 other OPPS APC 1.11 24.86 0.28 percent of total billed charges 1.11 1.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION RX-32589 CDM J2430 HCPCS 0636 RC 61703-0324-18 NDC outpatient 10 ML 42.05 42.05 11.77 11.77 fee schedule 42.05 93 34.06 percent of total billed charges 42.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42.05 other OPPS APC 42.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42.05 other OPPS APC 42.05 24.86 10.45 percent of total billed charges 11.77 42.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALPRAZOLAM 1 MG TABLET RX-326 CDM A9270 HCPCS 0250 RC 00781-1079-01 NDC outpatient 1 UN 2.89 2.89 74 2.14 percent of total billed charges 2.89 93 2.34 percent of total billed charges 2.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.89 other OPPS APC 2.89 2.89 other OPPS APC 2.89 24.86 0.72 percent of total billed charges 2.89 2.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALPRAZOLAM 1 MG TABLET RX-326 CDM A9270 HCPCS 0637 RC 00781-1079-01 NDC outpatient 1 UN 2.89 2.89 2.89 74 2.14 percent of total billed charges 2.89 93 2.34 percent of total billed charges 2.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.89 other OPPS APC 2.89 2.89 other OPPS APC 2.89 24.86 0.72 percent of total billed charges 2.89 2.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PAROXETINE ER 12.5 MG TABLET,EXTENDED RELEASE 24 HR" RX-32631 CDM A9270 HCPCS 0250 RC 42858-0703-03 NDC outpatient 1 UN 2 2 74 1.48 percent of total billed charges 2 93 1.62 percent of total billed charges 2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2 other OPPS APC 2 2 other OPPS APC 2 24.86 0.5 percent of total billed charges 2 2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PAROXETINE ER 12.5 MG TABLET,EXTENDED RELEASE 24 HR" RX-32631 CDM A9270 HCPCS 0637 RC 42858-0703-03 NDC outpatient 1 UN 2 2 2 74 1.48 percent of total billed charges 2 93 1.62 percent of total billed charges 2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2 other OPPS APC 2 2 other OPPS APC 2 24.86 0.5 percent of total billed charges 2 2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION RX-32700 CDM J0585 HCPCS 0636 RC 00023-1145-01 NDC outpatient 1 UN 1938 1938 724.79 724.79 fee schedule 1938 93 1569.78 percent of total billed charges 1938 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 640.6 other OPPS APC 1938 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 640.6 other OPPS APC 1938 24.86 481.79 percent of total billed charges 724.79 1938 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEUPROLIDE 7.5 MG (1 MONTH) SUBCUTANEOUS SYRINGE RX-32893 CDM J9217 HCPCS 0636 RC 62935-0756-80 NDC outpatient 7.5 ME 1355.08 1355.08 189.33 189.33 fee schedule 1355.08 93 1097.61 percent of total billed charges 1355.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176.51 other OPPS APC 1355.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176.51 other OPPS APC 1355.08 24.86 336.87 percent of total billed charges 189.33 1355.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUROSEMIDE 10 MG/ML INJECTION SOLUTION RX-3291 CDM J1940 HCPCS 0636 RC 72603-0133-25 NDC outpatient 2 ML 8.2 8.2 0.57 0.57 fee schedule 8.2 93 6.64 percent of total billed charges 8.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.2 other OPPS APC 8.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.2 other OPPS APC 8.2 24.86 2.04 percent of total billed charges 0.57 8.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUROSEMIDE 40 MG/5 ML (8 MG/ML) ORAL SOLUTION RX-3293 CDM 636000000 HCPCS 0636 RC 68094-0867-59 NDC outpatient 5 ML 6.16 6.16 6.16 74 4.56 percent of total billed charges 6.16 93 4.99 percent of total billed charges 6.16 6.16 other OPPS APC 6.16 6.16 other OPPS APC 6.16 24.86 1.53 percent of total billed charges 6.16 6.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUROSEMIDE 20 MG TABLET RX-3294 CDM A9270 HCPCS 0250 RC 00054-8297-25 NDC outpatient 1 UN 1.29 1.29 74 0.95 percent of total billed charges 1.29 93 1.04 percent of total billed charges 1.29 1.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUROSEMIDE 20 MG TABLET RX-3294 CDM A9270 HCPCS 0637 RC 00054-8297-25 NDC outpatient 1 UN 1.29 1.29 1.29 74 0.95 percent of total billed charges 1.29 93 1.04 percent of total billed charges 1.29 1.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUROSEMIDE 20 MG TABLET RX-3294 CDM A9270 HCPCS 0250 RC 00904-7177-61 NDC outpatient 1 UN 0.23 0.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.23 other OPPS APC 0.23 0.23 other OPPS APC 0.23 24.86 0.06 percent of total billed charges 0.23 0.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUROSEMIDE 20 MG TABLET RX-3294 CDM A9270 HCPCS 0637 RC 00904-7177-61 NDC outpatient 1 UN 0.23 0.23 0.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.23 other OPPS APC 0.23 0.23 other OPPS APC 0.23 24.86 0.06 percent of total billed charges 0.23 0.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUROSEMIDE 40 MG TABLET RX-3295 CDM A9270 HCPCS 0250 RC 00904-7178-61 NDC outpatient 1 UN 0.24 0.24 74 0.18 percent of total billed charges 0.24 93 0.19 percent of total billed charges 0.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.24 other OPPS APC 0.24 0.24 other OPPS APC 0.24 24.86 0.06 percent of total billed charges 0.24 0.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUROSEMIDE 40 MG TABLET RX-3295 CDM A9270 HCPCS 0637 RC 00904-7178-61 NDC outpatient 1 UN 0.24 0.24 0.24 74 0.18 percent of total billed charges 0.24 93 0.19 percent of total billed charges 0.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.24 other OPPS APC 0.24 0.24 other OPPS APC 0.24 24.86 0.06 percent of total billed charges 0.24 0.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VORICONAZOLE 200 MG TABLET RX-33009 CDM A9270 HCPCS 0250 RC 00049-3180-30 NDC outpatient 1 UN 11.18 11.18 74 8.27 percent of total billed charges 11.18 93 9.06 percent of total billed charges 11.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.18 other OPPS APC 11.18 11.18 other OPPS APC 11.18 24.86 2.78 percent of total billed charges 11.18 11.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VORICONAZOLE 200 MG TABLET RX-33009 CDM A9270 HCPCS 0637 RC 00049-3180-30 NDC outpatient 1 UN 11.18 11.18 11.18 74 8.27 percent of total billed charges 11.18 93 9.06 percent of total billed charges 11.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.18 other OPPS APC 11.18 11.18 other OPPS APC 11.18 24.86 2.78 percent of total billed charges 11.18 11.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VORICONAZOLE 200 MG INTRAVENOUS SOLUTION RX-33010 CDM J3465 HCPCS 0636 RC 00781-3416-94 NDC outpatient 20 ML 381.45 381.45 27.83 27.83 fee schedule 381.45 93 308.97 percent of total billed charges 381.45 381.45 other OPPS APC 381.45 381.45 other OPPS APC 381.45 24.86 94.83 percent of total billed charges 27.83 381.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VORICONAZOLE 200 MG INTRAVENOUS SOLUTION RX-33010 CDM J3465 HCPCS 0636 RC 00781-3416-94 NDC outpatient 200 ME 381.45 381.45 27.83 27.83 fee schedule 381.45 93 308.97 percent of total billed charges 381.45 381.45 other OPPS APC 381.45 381.45 other OPPS APC 381.45 24.86 94.83 percent of total billed charges 27.83 381.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION RX-33175 CDM J3486 HCPCS 0636 RC 72266-0160-01 NDC outpatient 20 ME 98.37 98.37 21.93 21.93 fee schedule 98.37 93 79.68 percent of total billed charges 98.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 98.37 other OPPS APC 98.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 98.37 other OPPS APC 98.37 24.86 24.45 percent of total billed charges 21.93 98.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET RX-33227 CDM A9270 HCPCS 0250 RC 69452-0336-11 NDC outpatient 1 UN 9.47 9.47 74 7.01 percent of total billed charges 9.47 93 7.67 percent of total billed charges 9.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.47 other OPPS APC 9.47 9.47 other OPPS APC 9.47 24.86 2.35 percent of total billed charges 9.47 9.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET RX-33227 CDM A9270 HCPCS 0637 RC 69452-0336-11 NDC outpatient 1 UN 9.47 9.47 9.47 74 7.01 percent of total billed charges 9.47 93 7.67 percent of total billed charges 9.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.47 other OPPS APC 9.47 9.47 other OPPS APC 9.47 24.86 2.35 percent of total billed charges 9.47 9.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET RX-33228 CDM A9270 HCPCS 0250 RC 65862-0503-20 NDC outpatient 1 UN 12.68 12.68 74 9.38 percent of total billed charges 12.68 93 10.27 percent of total billed charges 12.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.68 other OPPS APC 12.68 12.68 other OPPS APC 12.68 24.86 3.15 percent of total billed charges 12.68 12.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET RX-33228 CDM A9270 HCPCS 0637 RC 65862-0503-20 NDC outpatient 1 UN 12.68 12.68 12.68 74 9.38 percent of total billed charges 12.68 93 10.27 percent of total billed charges 12.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.68 other OPPS APC 12.68 12.68 other OPPS APC 12.68 24.86 3.15 percent of total billed charges 12.68 12.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 200 MG-POTASSIUM CLAVULANATE 28.5 MG/5 ML ORAL SUSPENSION RX-33229 CDM A9270 HCPCS 0250 RC 00143-9981-01 NDC outpatient 100 ML 97.13 97.13 74 71.88 percent of total billed charges 97.13 93 78.68 percent of total billed charges 97.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.13 other OPPS APC 97.13 97.13 other OPPS APC 97.13 24.86 24.15 percent of total billed charges 97.13 97.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 200 MG-POTASSIUM CLAVULANATE 28.5 MG/5 ML ORAL SUSPENSION RX-33229 CDM A9270 HCPCS 0637 RC 00143-9981-01 NDC outpatient 100 ML 97.13 97.13 97.13 74 71.88 percent of total billed charges 97.13 93 78.68 percent of total billed charges 97.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.13 other OPPS APC 97.13 97.13 other OPPS APC 97.13 24.86 24.15 percent of total billed charges 97.13 97.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION RX-33230 CDM A9270 HCPCS 0250 RC 00143-9982-01 NDC outpatient 100 ML 185.13 185.13 74 137 percent of total billed charges 185.13 93 149.96 percent of total billed charges 185.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 185.13 other OPPS APC 185.13 185.13 other OPPS APC 185.13 24.86 46.02 percent of total billed charges 185.13 185.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION RX-33230 CDM A9270 HCPCS 0637 RC 00143-9982-01 NDC outpatient 100 ML 185.13 185.13 185.13 74 137 percent of total billed charges 185.13 93 149.96 percent of total billed charges 185.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 185.13 other OPPS APC 185.13 185.13 other OPPS APC 185.13 24.86 46.02 percent of total billed charges 185.13 185.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ESCITALOPRAM 10 MG TABLET RX-33512 CDM A9270 HCPCS 0250 RC 68084-0617-11 NDC outpatient 1 UN 10.8 10.8 74 7.99 percent of total billed charges 10.8 93 8.75 percent of total billed charges 10.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.8 other OPPS APC 10.8 10.8 other OPPS APC 10.8 24.86 2.68 percent of total billed charges 10.8 10.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ESCITALOPRAM 10 MG TABLET RX-33512 CDM A9270 HCPCS 0637 RC 68084-0617-11 NDC outpatient 1 UN 10.8 10.8 10.8 74 7.99 percent of total billed charges 10.8 93 8.75 percent of total billed charges 10.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.8 other OPPS APC 10.8 10.8 other OPPS APC 10.8 24.86 2.68 percent of total billed charges 10.8 10.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ESCITALOPRAM 20 MG TABLET RX-33513 CDM A9270 HCPCS 0250 RC 00904-6427-61 NDC outpatient 1 UN 11.43 11.43 74 8.46 percent of total billed charges 11.43 93 9.26 percent of total billed charges 11.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.43 other OPPS APC 11.43 11.43 other OPPS APC 11.43 24.86 2.84 percent of total billed charges 11.43 11.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ESCITALOPRAM 20 MG TABLET RX-33513 CDM A9270 HCPCS 0637 RC 00904-6427-61 NDC outpatient 1 UN 11.43 11.43 11.43 74 8.46 percent of total billed charges 11.43 93 9.26 percent of total billed charges 11.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.43 other OPPS APC 11.43 11.43 other OPPS APC 11.43 24.86 2.84 percent of total billed charges 11.43 11.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALSARTAN 40 MG TABLET RX-33541 CDM A9270 HCPCS 0250 RC 60687-0612-21 NDC outpatient 1 UN 2.5 2.5 74 1.85 percent of total billed charges 2.5 93 2.03 percent of total billed charges 2.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.5 other OPPS APC 2.5 2.5 other OPPS APC 2.5 24.86 0.62 percent of total billed charges 2.5 2.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALSARTAN 40 MG TABLET RX-33541 CDM A9270 HCPCS 0637 RC 60687-0612-21 NDC outpatient 1 UN 2.5 2.5 2.5 74 1.85 percent of total billed charges 2.5 93 2.03 percent of total billed charges 2.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.5 other OPPS APC 2.5 2.5 other OPPS APC 2.5 24.86 0.62 percent of total billed charges 2.5 2.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RASBURICASE 1.5 MG INTRAVENOUS SOLUTION RX-33591 CDM J2783 HCPCS 0636 RC 00024-5150-10 NDC outpatient 1 ML 3223.55 3223.55 1223.82 1223.82 fee schedule 3223.55 93 2611.08 percent of total billed charges 3223.55 3223.55 other OPPS APC 3223.55 3223.55 other OPPS APC 3223.55 24.86 801.37 percent of total billed charges 1223.82 3223.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CELECOXIB 400 MG CAPSULE RX-33653 CDM A9270 HCPCS 0250 RC 72241-0025-03 NDC outpatient 1 UN 28.44 28.44 74 21.05 percent of total billed charges 28.44 93 23.04 percent of total billed charges 28.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28.44 other OPPS APC 28.44 28.44 other OPPS APC 28.44 24.86 7.07 percent of total billed charges 28.44 28.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CELECOXIB 400 MG CAPSULE RX-33653 CDM A9270 HCPCS 0637 RC 72241-0025-03 NDC outpatient 1 UN 28.44 28.44 28.44 74 21.05 percent of total billed charges 28.44 93 23.04 percent of total billed charges 28.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28.44 other OPPS APC 28.44 28.44 other OPPS APC 28.44 24.86 7.07 percent of total billed charges 28.44 28.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEUPROLIDE 22.5 MG (3 MONTH) SUBCUTANEOUS SYRINGE RX-33669 CDM J9217 HCPCS 0636 RC 62935-0227-10 NDC outpatient 22.5 ME 4065.2 4065.2 567.99 567.99 fee schedule 4065.2 93 3292.81 percent of total billed charges 4065.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 529.53 other OPPS APC 4065.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 529.53 other OPPS APC 4065.2 24.86 1010.61 percent of total billed charges 567.99 4065.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GEMFIBROZIL 600 MG TABLET RX-3378 CDM A9270 HCPCS 0250 RC 60687-0224-01 NDC outpatient 1 UN 5.79 5.79 74 4.28 percent of total billed charges 5.79 93 4.69 percent of total billed charges 5.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.79 other OPPS APC 5.79 5.79 other OPPS APC 5.79 24.86 1.44 percent of total billed charges 5.79 5.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GEMFIBROZIL 600 MG TABLET RX-3378 CDM A9270 HCPCS 0637 RC 60687-0224-01 NDC outpatient 1 UN 5.79 5.79 5.79 74 4.28 percent of total billed charges 5.79 93 4.69 percent of total billed charges 5.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.79 other OPPS APC 5.79 5.79 other OPPS APC 5.79 24.86 1.44 percent of total billed charges 5.79 5.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METAXALONE 800 MG TABLET RX-33963 CDM A9270 HCPCS 0250 RC 50268-0530-15 NDC outpatient 1 UN 24.48 24.48 74 18.12 percent of total billed charges 24.48 93 19.83 percent of total billed charges 24.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.48 other OPPS APC 24.48 24.48 other OPPS APC 24.48 24.86 6.09 percent of total billed charges 24.48 24.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METAXALONE 800 MG TABLET RX-33963 CDM A9270 HCPCS 0637 RC 50268-0530-15 NDC outpatient 1 UN 24.48 24.48 24.48 74 18.12 percent of total billed charges 24.48 93 19.83 percent of total billed charges 24.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.48 other OPPS APC 24.48 24.48 other OPPS APC 24.48 24.86 6.09 percent of total billed charges 24.48 24.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DUTASTERIDE 0.5 MG CAPSULE RX-34089 CDM A9270 HCPCS 0250 RC 42806-0549-09 NDC outpatient 1 UN 15.13 15.13 74 11.2 percent of total billed charges 15.13 93 12.26 percent of total billed charges 15.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.13 other OPPS APC 15.13 15.13 other OPPS APC 15.13 24.86 3.76 percent of total billed charges 15.13 15.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DUTASTERIDE 0.5 MG CAPSULE RX-34089 CDM A9270 HCPCS 0637 RC 42806-0549-09 NDC outpatient 1 UN 15.13 15.13 15.13 74 11.2 percent of total billed charges 15.13 93 12.26 percent of total billed charges 15.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.13 other OPPS APC 15.13 15.13 other OPPS APC 15.13 24.86 3.76 percent of total billed charges 15.13 15.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EZETIMIBE 10 MG TABLET RX-34153 CDM A9270 HCPCS 0250 RC 10135-0787-90 NDC outpatient 1 UN 0.31 0.31 74 0.23 percent of total billed charges 0.31 93 0.25 percent of total billed charges 0.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.31 other OPPS APC 0.31 0.31 other OPPS APC 0.31 24.86 0.08 percent of total billed charges 0.31 0.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EZETIMIBE 10 MG TABLET RX-34153 CDM A9270 HCPCS 0637 RC 10135-0787-90 NDC outpatient 1 UN 0.31 0.31 0.31 74 0.23 percent of total billed charges 0.31 93 0.25 percent of total billed charges 0.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.31 other OPPS APC 0.31 0.31 other OPPS APC 0.31 24.86 0.08 percent of total billed charges 0.31 0.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENTAMICIN 0.1 % TOPICAL CREAM RX-3423 CDM A9270 HCPCS 0250 RC 45802-0056-35 NDC outpatient 15 GR 123.45 123.45 74 91.35 percent of total billed charges 123.45 93 99.99 percent of total billed charges 123.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 123.45 other OPPS APC 123.45 123.45 other OPPS APC 123.45 24.86 30.69 percent of total billed charges 123.45 123.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENTAMICIN 0.1 % TOPICAL CREAM RX-3423 CDM A9270 HCPCS 0637 RC 45802-0056-35 NDC outpatient 15 GR 123.45 123.45 123.45 74 91.35 percent of total billed charges 123.45 93 99.99 percent of total billed charges 123.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 123.45 other OPPS APC 123.45 123.45 other OPPS APC 123.45 24.86 30.69 percent of total billed charges 123.45 123.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION SOLUTION RX-3425 CDM J1580 HCPCS 0636 RC 63323-0173-01 NDC outpatient 2 ML 18.51 18.51 3.41 3.41 fee schedule 18.51 93 14.99 percent of total billed charges 18.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.51 other OPPS APC 18.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.51 other OPPS APC 18.51 24.86 4.6 percent of total billed charges 3.41 18.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENTAMICIN 40 MG/ML INJECTION SOLUTION RX-3426 CDM J1580 HCPCS 0636 RC 63323-0010-02 NDC outpatient 2 ML 13.92 13.92 3.41 3.41 fee schedule 13.92 93 11.28 percent of total billed charges 13.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.92 other OPPS APC 13.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.92 other OPPS APC 13.92 24.86 3.46 percent of total billed charges 3.41 13.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENTAMICIN 40 MG/ML INJECTION SOLUTION RX-3426 CDM J1580 HCPCS 0636 RC 63323-0010-20 NDC outpatient 20 ML 99.93 99.93 34.12 34.12 fee schedule 99.93 93 80.94 percent of total billed charges 99.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 99.93 other OPPS APC 99.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 99.93 other OPPS APC 99.93 24.86 24.84 percent of total billed charges 34.12 99.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENTAMICIN 0.3 % EYE DROPS RX-3428 CDM A9270 HCPCS 0250 RC 24208-0580-60 NDC outpatient 5 ML 107.13 107.13 74 79.28 percent of total billed charges 107.13 93 86.78 percent of total billed charges 107.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 107.13 other OPPS APC 107.13 107.13 other OPPS APC 107.13 24.86 26.63 percent of total billed charges 107.13 107.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENTAMICIN 0.3 % EYE DROPS RX-3428 CDM A9270 HCPCS 0637 RC 24208-0580-60 NDC outpatient 5 ML 107.13 107.13 107.13 74 79.28 percent of total billed charges 107.13 93 86.78 percent of total billed charges 107.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 107.13 other OPPS APC 107.13 107.13 other OPPS APC 107.13 24.86 26.63 percent of total billed charges 107.13 107.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARIPIPRAZOLE 10 MG TABLET RX-34369 CDM A9270 HCPCS 0250 RC 50268-0089-15 NDC outpatient 1 UN 74.82 74.82 74 55.37 percent of total billed charges 74.82 93 60.6 percent of total billed charges 74.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 74.82 other OPPS APC 74.82 74.82 other OPPS APC 74.82 24.86 18.6 percent of total billed charges 74.82 74.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARIPIPRAZOLE 10 MG TABLET RX-34369 CDM A9270 HCPCS 0637 RC 50268-0089-15 NDC outpatient 1 UN 74.82 74.82 74.82 74 55.37 percent of total billed charges 74.82 93 60.6 percent of total billed charges 74.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 74.82 other OPPS APC 74.82 74.82 other OPPS APC 74.82 24.86 18.6 percent of total billed charges 74.82 74.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR" RX-34418 CDM A9270 HCPCS 0250 RC 50268-0259-15 NDC outpatient 1 UN 1.56 1.56 74 1.15 percent of total billed charges 1.56 93 1.26 percent of total billed charges 1.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.56 other OPPS APC 1.56 1.56 other OPPS APC 1.56 24.86 0.39 percent of total billed charges 1.56 1.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR" RX-34418 CDM A9270 HCPCS 0637 RC 50268-0259-15 NDC outpatient 1 UN 1.56 1.56 1.56 74 1.15 percent of total billed charges 1.56 93 1.26 percent of total billed charges 1.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.56 other OPPS APC 1.56 1.56 other OPPS APC 1.56 24.86 0.39 percent of total billed charges 1.56 1.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATOMOXETINE 10 MG CAPSULE RX-34444 CDM A9270 HCPCS 0250 RC 68462-0265-30 NDC outpatient 1 UN 35.59 35.59 74 26.34 percent of total billed charges 35.59 93 28.83 percent of total billed charges 35.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35.59 other OPPS APC 35.59 35.59 other OPPS APC 35.59 24.86 8.85 percent of total billed charges 35.59 35.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATOMOXETINE 10 MG CAPSULE RX-34444 CDM A9270 HCPCS 0637 RC 68462-0265-30 NDC outpatient 1 UN 35.59 35.59 35.59 74 26.34 percent of total billed charges 35.59 93 28.83 percent of total billed charges 35.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35.59 other OPPS APC 35.59 35.59 other OPPS APC 35.59 24.86 8.85 percent of total billed charges 35.59 35.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATOMOXETINE 18 MG CAPSULE RX-34445 CDM A9270 HCPCS 0250 RC 68462-0266-30 NDC outpatient 1 UN 35.59 35.59 74 26.34 percent of total billed charges 35.59 93 28.83 percent of total billed charges 35.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35.59 other OPPS APC 35.59 35.59 other OPPS APC 35.59 24.86 8.85 percent of total billed charges 35.59 35.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATOMOXETINE 18 MG CAPSULE RX-34445 CDM A9270 HCPCS 0637 RC 68462-0266-30 NDC outpatient 1 UN 35.59 35.59 35.59 74 26.34 percent of total billed charges 35.59 93 28.83 percent of total billed charges 35.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35.59 other OPPS APC 35.59 35.59 other OPPS APC 35.59 24.86 8.85 percent of total billed charges 35.59 35.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATOMOXETINE 25 MG CAPSULE RX-34446 CDM A9270 HCPCS 0250 RC 50268-0057-11 NDC outpatient 1 UN 10.54 10.54 74 7.8 percent of total billed charges 10.54 93 8.54 percent of total billed charges 10.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.54 other OPPS APC 10.54 10.54 other OPPS APC 10.54 24.86 2.62 percent of total billed charges 10.54 10.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATOMOXETINE 25 MG CAPSULE RX-34446 CDM A9270 HCPCS 0637 RC 50268-0057-11 NDC outpatient 1 UN 10.54 10.54 10.54 74 7.8 percent of total billed charges 10.54 93 8.54 percent of total billed charges 10.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.54 other OPPS APC 10.54 10.54 other OPPS APC 10.54 24.86 2.62 percent of total billed charges 10.54 10.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET RX-34505 CDM A9270 HCPCS 0250 RC 00406-0123-62 NDC outpatient 1 UN 1.99 1.99 74 1.47 percent of total billed charges 1.99 93 1.61 percent of total billed charges 1.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.99 other OPPS APC 1.99 1.99 other OPPS APC 1.99 24.86 0.49 percent of total billed charges 1.99 1.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET RX-34505 CDM A9270 HCPCS 0637 RC 00406-0123-62 NDC outpatient 1 UN 1.99 1.99 1.99 74 1.47 percent of total billed charges 1.99 93 1.61 percent of total billed charges 1.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.99 other OPPS APC 1.99 1.99 other OPPS APC 1.99 24.86 0.49 percent of total billed charges 1.99 1.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK RX-34524 CDM J2543 HCPCS 0636 RC 00338-9636-24 NDC outpatient 3.375 GR 24.63 24.63 4.65 4.65 fee schedule 24.63 93 19.95 percent of total billed charges 24.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.63 other OPPS APC 24.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.63 other OPPS APC 24.63 24.86 6.12 percent of total billed charges 4.65 24.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK RX-34524 CDM J2543 HCPCS 0636 RC 00338-9636-24 NDC outpatient 50 ML 24.63 24.63 4.65 4.65 fee schedule 24.63 93 19.95 percent of total billed charges 24.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.63 other OPPS APC 24.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.63 other OPPS APC 24.63 24.86 6.12 percent of total billed charges 4.65 24.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET" RX-34594 CDM A9270 HCPCS 0250 RC 16714-0185-02 NDC outpatient 1 UN 39.44 39.44 74 29.19 percent of total billed charges 39.44 93 31.95 percent of total billed charges 39.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.44 other OPPS APC 39.44 39.44 other OPPS APC 39.44 24.86 9.8 percent of total billed charges 39.44 39.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET" RX-34594 CDM A9270 HCPCS 0637 RC 16714-0185-02 NDC outpatient 1 UN 39.44 39.44 39.44 74 29.19 percent of total billed charges 39.44 93 31.95 percent of total billed charges 39.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.44 other OPPS APC 39.44 39.44 other OPPS APC 39.44 24.86 9.8 percent of total billed charges 39.44 39.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET" RX-34595 CDM A9270 HCPCS 0250 RC 65862-0896-78 NDC outpatient 1 UN 39.44 39.44 74 29.19 percent of total billed charges 39.44 93 31.95 percent of total billed charges 39.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.44 other OPPS APC 39.44 39.44 other OPPS APC 39.44 24.86 9.8 percent of total billed charges 39.44 39.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET" RX-34595 CDM A9270 HCPCS 0637 RC 65862-0896-78 NDC outpatient 1 UN 39.44 39.44 39.44 74 29.19 percent of total billed charges 39.44 93 31.95 percent of total billed charges 39.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.44 other OPPS APC 39.44 39.44 other OPPS APC 39.44 24.86 9.8 percent of total billed charges 39.44 39.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET RX-34711 CDM A9270 HCPCS 0250 RC 60687-0481-21 NDC outpatient 1 UN 6.13 6.13 74 4.54 percent of total billed charges 6.13 93 4.97 percent of total billed charges 6.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.13 other OPPS APC 6.13 6.13 other OPPS APC 6.13 24.86 1.52 percent of total billed charges 6.13 6.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET RX-34711 CDM A9270 HCPCS 0637 RC 60687-0481-21 NDC outpatient 1 UN 6.13 6.13 6.13 74 4.54 percent of total billed charges 6.13 93 4.97 percent of total billed charges 6.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.13 other OPPS APC 6.13 6.13 other OPPS APC 6.13 24.86 1.52 percent of total billed charges 6.13 6.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUPRENORPHINE HCL 8 MG SUBLINGUAL TABLET RX-34712 CDM A9270 HCPCS 0250 RC 60687-0492-21 NDC outpatient 1 UN 10.5 10.5 74 7.77 percent of total billed charges 10.5 93 8.51 percent of total billed charges 10.5 10.5 other OPPS APC 10.5 10.5 other OPPS APC 10.5 24.86 2.61 percent of total billed charges 10.5 10.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUPRENORPHINE HCL 8 MG SUBLINGUAL TABLET RX-34712 CDM A9270 HCPCS 0637 RC 60687-0492-21 NDC outpatient 1 UN 10.5 10.5 10.5 74 7.77 percent of total billed charges 10.5 93 8.51 percent of total billed charges 10.5 10.5 other OPPS APC 10.5 10.5 other OPPS APC 10.5 24.86 2.61 percent of total billed charges 10.5 10.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET RX-34713 CDM A9270 HCPCS 0250 RC 50268-0144-15 NDC outpatient 1 UN 11.88 11.88 74 8.79 percent of total billed charges 11.88 93 9.62 percent of total billed charges 11.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.88 other OPPS APC 11.88 11.88 other OPPS APC 11.88 24.86 2.95 percent of total billed charges 11.88 11.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET RX-34713 CDM A9270 HCPCS 0637 RC 50268-0144-15 NDC outpatient 1 UN 11.88 11.88 11.88 74 8.79 percent of total billed charges 11.88 93 9.62 percent of total billed charges 11.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.88 other OPPS APC 11.88 11.88 other OPPS APC 11.88 24.86 2.95 percent of total billed charges 11.88 11.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET RX-34714 CDM A9270 HCPCS 0250 RC 50268-0145-15 NDC outpatient 1 UN 21.14 21.14 74 15.64 percent of total billed charges 21.14 93 17.12 percent of total billed charges 21.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 21.14 other OPPS APC 21.14 21.14 other OPPS APC 21.14 24.86 5.26 percent of total billed charges 21.14 21.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET RX-34714 CDM A9270 HCPCS 0637 RC 50268-0145-15 NDC outpatient 1 UN 21.14 21.14 21.14 74 15.64 percent of total billed charges 21.14 93 17.12 percent of total billed charges 21.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 21.14 other OPPS APC 21.14 21.14 other OPPS APC 21.14 24.86 5.26 percent of total billed charges 21.14 21.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION" RX-34814 CDM A9270 HCPCS 0250 RC 24208-0631-10 NDC outpatient 10 ML 251.7 251.7 74 186.26 percent of total billed charges 251.7 93 203.88 percent of total billed charges 251.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 251.7 other OPPS APC 251.7 251.7 other OPPS APC 251.7 24.86 62.57 percent of total billed charges 251.7 251.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION" RX-34814 CDM A9270 HCPCS 0637 RC 24208-0631-10 NDC outpatient 10 ML 251.7 251.7 251.7 74 186.26 percent of total billed charges 251.7 93 203.88 percent of total billed charges 251.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 251.7 other OPPS APC 251.7 251.7 other OPPS APC 251.7 24.86 62.57 percent of total billed charges 251.7 251.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROSUVASTATIN 10 MG TABLET RX-35134 CDM A9270 HCPCS 0250 RC 50268-0709-11 NDC outpatient 1 UN 3.44 3.44 74 2.55 percent of total billed charges 3.44 93 2.79 percent of total billed charges 3.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.44 other OPPS APC 3.44 3.44 other OPPS APC 3.44 24.86 0.86 percent of total billed charges 3.44 3.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROSUVASTATIN 10 MG TABLET RX-35134 CDM A9270 HCPCS 0637 RC 50268-0709-11 NDC outpatient 1 UN 3.44 3.44 3.44 74 2.55 percent of total billed charges 3.44 93 2.79 percent of total billed charges 3.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.44 other OPPS APC 3.44 3.44 other OPPS APC 3.44 24.86 0.86 percent of total billed charges 3.44 3.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROSUVASTATIN 20 MG TABLET RX-35135 CDM A9270 HCPCS 0250 RC 50268-0710-11 NDC outpatient 1 UN 3.7 3.7 74 2.74 percent of total billed charges 3.7 93 3 percent of total billed charges 3.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.7 other OPPS APC 3.7 3.7 other OPPS APC 3.7 24.86 0.92 percent of total billed charges 3.7 3.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROSUVASTATIN 20 MG TABLET RX-35135 CDM A9270 HCPCS 0637 RC 50268-0710-11 NDC outpatient 1 UN 3.7 3.7 3.7 74 2.74 percent of total billed charges 3.7 93 3 percent of total billed charges 3.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.7 other OPPS APC 3.7 3.7 other OPPS APC 3.7 24.86 0.92 percent of total billed charges 3.7 3.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEUPROLIDE 30 MG (4 MONTH) SUBCUTANEOUS SYRINGE RX-35236 CDM J9217 HCPCS 0636 RC 62935-0306-40 NDC outpatient 30 ME 5420.28 5420.28 757.31 757.31 fee schedule 5420.28 93 4390.43 percent of total billed charges 5420.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 706.04 other OPPS APC 5420.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 706.04 other OPPS APC 5420.28 24.86 1347.48 percent of total billed charges 757.31 5420.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALUMINUM HYDROXIDE GEL 320 MG/5 ML ORAL SUSPENSION RX-353 CDM A9270 HCPCS 0250 RC 00536-0091-85 NDC outpatient 473 ML 19.55 19.55 74 14.47 percent of total billed charges 19.55 93 15.84 percent of total billed charges 19.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.55 other OPPS APC 19.55 19.55 other OPPS APC 19.55 24.86 4.86 percent of total billed charges 19.55 19.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALUMINUM HYDROXIDE GEL 320 MG/5 ML ORAL SUSPENSION RX-353 CDM A9270 HCPCS 0637 RC 00536-0091-85 NDC outpatient 473 ML 19.55 19.55 19.55 74 14.47 percent of total billed charges 19.55 93 15.84 percent of total billed charges 19.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.55 other OPPS APC 19.55 19.55 other OPPS APC 19.55 24.86 4.86 percent of total billed charges 19.55 19.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUAIFENESIN 100 MG/5 ML ORAL LIQUID RX-3542 CDM A9270 HCPCS 0250 RC 00121-1488-00 NDC outpatient 10 ML 4.82 4.82 74 3.57 percent of total billed charges 4.82 93 3.9 percent of total billed charges 4.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.82 other OPPS APC 4.82 4.82 other OPPS APC 4.82 24.86 1.2 percent of total billed charges 4.82 4.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUAIFENESIN 100 MG/5 ML ORAL LIQUID RX-3542 CDM A9270 HCPCS 0637 RC 00121-1488-00 NDC outpatient 10 ML 4.82 4.82 4.82 74 3.57 percent of total billed charges 4.82 93 3.9 percent of total billed charges 4.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.82 other OPPS APC 4.82 4.82 other OPPS APC 4.82 24.86 1.2 percent of total billed charges 4.82 4.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APREPITANT 125 MG CAPSULE RX-35489 CDM J8501 HCPCS 0250 RC 68462-0585-40 NDC outpatient 1 UN 795.97 795.97 74 589.02 percent of total billed charges 795.97 93 644.74 percent of total billed charges 795.97 795.97 other OPPS APC 795.97 795.97 other OPPS APC 795.97 24.86 197.88 percent of total billed charges 795.97 795.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APREPITANT 125 MG CAPSULE RX-35489 CDM J8501 HCPCS 0637 RC 68462-0585-40 NDC outpatient 1 UN 795.97 795.97 795.97 74 589.02 percent of total billed charges 795.97 93 644.74 percent of total billed charges 795.97 795.97 other OPPS APC 795.97 795.97 other OPPS APC 795.97 24.86 197.88 percent of total billed charges 795.97 795.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXYBUTYNIN 3.9 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH RX-35495 CDM A9270 HCPCS 0250 RC 00023-6153-01 NDC outpatient 1 UN 254.95 254.95 74 188.66 percent of total billed charges 254.95 93 206.51 percent of total billed charges 254.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 254.95 other OPPS APC 254.95 254.95 other OPPS APC 254.95 24.86 63.38 percent of total billed charges 254.95 254.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXYBUTYNIN 3.9 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH RX-35495 CDM A9270 HCPCS 0637 RC 00023-6153-01 NDC outpatient 1 UN 254.95 254.95 254.95 74 188.66 percent of total billed charges 254.95 93 206.51 percent of total billed charges 254.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 254.95 other OPPS APC 254.95 254.95 other OPPS APC 254.95 24.86 63.38 percent of total billed charges 254.95 254.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONAZEPAM 0.25 MG DISINTEGRATING TABLET RX-35626 CDM A9270 HCPCS 0250 RC 00093-9291-67 NDC outpatient 1 UN 3.25 3.25 74 2.41 percent of total billed charges 3.25 93 2.63 percent of total billed charges 3.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.25 other OPPS APC 3.25 3.25 other OPPS APC 3.25 24.86 0.81 percent of total billed charges 3.25 3.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONAZEPAM 0.25 MG DISINTEGRATING TABLET RX-35626 CDM A9270 HCPCS 0637 RC 00093-9291-67 NDC outpatient 1 UN 3.25 3.25 3.25 74 2.41 percent of total billed charges 3.25 93 2.63 percent of total billed charges 3.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.25 other OPPS APC 3.25 3.25 other OPPS APC 3.25 24.86 0.81 percent of total billed charges 3.25 3.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION RX-35640 CDM J3489 HCPCS 0636 RC 72603-0198-01 NDC outpatient 5 ML 257.15 257.15 41.48 41.48 fee schedule 257.15 93 208.29 percent of total billed charges 257.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 257.15 other OPPS APC 257.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 257.15 other OPPS APC 257.15 24.86 63.93 percent of total billed charges 41.48 257.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AGALSIDASE BETA 35 MG INTRAVENOUS SOLUTION RX-35775 CDM J0180 HCPCS 0636 RC 58468-0040-01 NDC outpatient 35 ME 22364.2 22364.2 8605.1 8605.1 fee schedule 22364.2 93 18115 percent of total billed charges 22364.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7823.27 other OPPS APC 22364.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7823.27 other OPPS APC 22364.2 24.86 5559.74 percent of total billed charges 8605.1 22364.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AGALSIDASE BETA 35 MG INTRAVENOUS SOLUTION RX-35775 CDM J0180 HCPCS 0636 RC 58468-0040-01 NDC outpatient 5 ML 22364.2 22364.2 8605.1 8605.1 fee schedule 22364.2 93 18115 percent of total billed charges 22364.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7823.27 other OPPS APC 22364.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7823.27 other OPPS APC 22364.2 24.86 5559.74 percent of total billed charges 8605.1 22364.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LARONIDASE 2.9 MG/5 ML INTRAVENOUS SOLUTION RX-35779 CDM J1931 HCPCS 0636 RC 58468-0070-01 NDC outpatient 5 ML 3211.68 3211.68 1226.4 1226.4 fee schedule 3211.68 93 2601.46 percent of total billed charges 3211.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1122.24 other OPPS APC 3211.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1122.24 other OPPS APC 3211.68 24.86 798.42 percent of total billed charges 1226.4 3211.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HALOPERIDOL 0.5 MG TABLET RX-3578 CDM A9270 HCPCS 0250 RC 00904-7389-61 NDC outpatient 1 UN 1.17 1.17 74 0.87 percent of total billed charges 1.17 93 0.95 percent of total billed charges 1.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.17 other OPPS APC 1.17 1.17 other OPPS APC 1.17 24.86 0.29 percent of total billed charges 1.17 1.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HALOPERIDOL 0.5 MG TABLET RX-3578 CDM A9270 HCPCS 0637 RC 00904-7389-61 NDC outpatient 1 UN 1.17 1.17 1.17 74 0.87 percent of total billed charges 1.17 93 0.95 percent of total billed charges 1.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.17 other OPPS APC 1.17 1.17 other OPPS APC 1.17 24.86 0.29 percent of total billed charges 1.17 1.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HALOPERIDOL 1 MG TABLET RX-3579 CDM A9270 HCPCS 0250 RC 00832-1520-89 NDC outpatient 1 UN 1.23 1.23 74 0.91 percent of total billed charges 1.23 93 1 percent of total billed charges 1.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.23 other OPPS APC 1.23 1.23 other OPPS APC 1.23 24.86 0.31 percent of total billed charges 1.23 1.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HALOPERIDOL 1 MG TABLET RX-3579 CDM A9270 HCPCS 0637 RC 00832-1520-89 NDC outpatient 1 UN 1.23 1.23 1.23 74 0.91 percent of total billed charges 1.23 93 1 percent of total billed charges 1.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.23 other OPPS APC 1.23 1.23 other OPPS APC 1.23 24.86 0.31 percent of total billed charges 1.23 1.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HALOPERIDOL 5 MG TABLET RX-3583 CDM A9270 HCPCS 0250 RC 00904-6782-61 NDC outpatient 1 UN 2.28 2.28 74 1.69 percent of total billed charges 2.28 93 1.85 percent of total billed charges 2.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.28 other OPPS APC 2.28 2.28 other OPPS APC 2.28 24.86 0.57 percent of total billed charges 2.28 2.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HALOPERIDOL 5 MG TABLET RX-3583 CDM A9270 HCPCS 0637 RC 00904-6782-61 NDC outpatient 1 UN 2.28 2.28 2.28 74 1.69 percent of total billed charges 2.28 93 1.85 percent of total billed charges 2.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.28 other OPPS APC 2.28 2.28 other OPPS APC 2.28 24.86 0.57 percent of total billed charges 2.28 2.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION RX-3584 CDM J1630 HCPCS 0636 RC 67457-0426-00 NDC outpatient 1 ML 3.6 3.6 1.57 1.57 fee schedule 3.6 93 2.92 percent of total billed charges 3.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.6 other OPPS APC 3.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.6 other OPPS APC 3.6 24.86 0.89 percent of total billed charges 1.57 3.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE RX-3585 CDM A9270 HCPCS 0250 RC 00121-0581-04 NDC outpatient 120 ML 135.5 135.5 74 100.27 percent of total billed charges 135.5 93 109.76 percent of total billed charges 135.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 135.5 other OPPS APC 135.5 135.5 other OPPS APC 135.5 24.86 33.69 percent of total billed charges 135.5 135.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE RX-3585 CDM A9270 HCPCS 0637 RC 00121-0581-04 NDC outpatient 120 ML 135.5 135.5 135.5 74 100.27 percent of total billed charges 135.5 93 109.76 percent of total billed charges 135.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 135.5 other OPPS APC 135.5 135.5 other OPPS APC 135.5 24.86 33.69 percent of total billed charges 135.5 135.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)" RX-35942 CDM A9270 HCPCS 0250 RC 00904-7292-61 NDC outpatient 1 UN 1.11 1.11 74 0.82 percent of total billed charges 1.11 93 0.9 percent of total billed charges 1.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.11 other OPPS APC 1.11 1.11 other OPPS APC 1.11 24.86 0.28 percent of total billed charges 1.11 1.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)" RX-35942 CDM A9270 HCPCS 0637 RC 00904-7292-61 NDC outpatient 1 UN 1.11 1.11 1.11 74 0.82 percent of total billed charges 1.11 93 0.9 percent of total billed charges 1.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.11 other OPPS APC 1.11 1.11 other OPPS APC 1.11 24.86 0.28 percent of total billed charges 1.11 1.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)" RX-35943 CDM A9270 HCPCS 0250 RC 00904-7293-61 NDC outpatient 1 UN 1.23 1.23 74 0.91 percent of total billed charges 1.23 93 1 percent of total billed charges 1.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.23 other OPPS APC 1.23 1.23 other OPPS APC 1.23 24.86 0.31 percent of total billed charges 1.23 1.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)" RX-35943 CDM A9270 HCPCS 0637 RC 00904-7293-61 NDC outpatient 1 UN 1.23 1.23 1.23 74 0.91 percent of total billed charges 1.23 93 1 percent of total billed charges 1.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.23 other OPPS APC 1.23 1.23 other OPPS APC 1.23 24.86 0.31 percent of total billed charges 1.23 1.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM CHLORIDE 20 MEQ/L IN 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLN RX-36046 CDM J3480 HCPCS 0636 RC 00338-0704-34 NDC outpatient 1000 ML 21.69 21.69 1.21 1.21 fee schedule 21.69 93 17.57 percent of total billed charges 21.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 21.69 other OPPS APC 21.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 21.69 other OPPS APC 21.69 24.86 5.39 percent of total billed charges 1.21 21.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMANTADINE HCL 100 MG CAPSULE RX-364 CDM A9270 HCPCS 0250 RC 50268-0069-15 NDC outpatient 1 UN 8.71 8.71 74 6.45 percent of total billed charges 8.71 93 7.06 percent of total billed charges 8.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.71 other OPPS APC 8.71 8.71 other OPPS APC 8.71 24.86 2.17 percent of total billed charges 8.71 8.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMANTADINE HCL 100 MG CAPSULE RX-364 CDM A9270 HCPCS 0637 RC 50268-0069-15 NDC outpatient 1 UN 8.71 8.71 8.71 74 6.45 percent of total billed charges 8.71 93 7.06 percent of total billed charges 8.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.71 other OPPS APC 8.71 8.71 other OPPS APC 8.71 24.86 2.17 percent of total billed charges 8.71 8.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION" RX-36576 CDM A9270 HCPCS 0250 RC 43598-0326-75 NDC outpatient 7.5 ML 672.55 672.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 672.55 other OPPS APC 672.55 672.55 other OPPS APC 672.55 24.86 167.2 percent of total billed charges 672.55 672.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION" RX-36576 CDM A9270 HCPCS 0637 RC 43598-0326-75 NDC outpatient 7.5 ML 672.55 672.55 672.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 672.55 other OPPS APC 672.55 672.55 other OPPS APC 672.55 24.86 167.2 percent of total billed charges 672.55 672.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION" RX-36576 CDM A9270 HCPCS 0250 RC 72485-0625-13 NDC outpatient 7.5 ML 384.58 384.58 74 284.59 percent of total billed charges 384.58 93 311.51 percent of total billed charges 384.58 384.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION" RX-36576 CDM A9270 HCPCS 0637 RC 72485-0625-13 NDC outpatient 7.5 ML 384.58 384.58 384.58 74 284.59 percent of total billed charges 384.58 93 311.51 percent of total billed charges 384.58 384.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVETIRACETAM 100 MG/ML ORAL SOLUTION RX-36590 CDM A9270 HCPCS 0250 RC 31722-0574-47 NDC outpatient 473 ML 769.35 769.35 74 569.32 percent of total billed charges 769.35 93 623.17 percent of total billed charges 769.35 769.35 other OPPS APC 769.35 769.35 other OPPS APC 769.35 24.86 191.26 percent of total billed charges 769.35 769.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVETIRACETAM 100 MG/ML ORAL SOLUTION RX-36590 CDM A9270 HCPCS 0637 RC 31722-0574-47 NDC outpatient 473 ML 769.35 769.35 769.35 74 569.32 percent of total billed charges 769.35 93 623.17 percent of total billed charges 769.35 769.35 other OPPS APC 769.35 769.35 other OPPS APC 769.35 24.86 191.26 percent of total billed charges 769.35 769.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION RX-36591 CDM J2469 HCPCS 0636 RC 16714-0834-01 NDC outpatient 5 ML 933.6 933.6 933.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 933.6 other OPPS APC 933.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 933.6 other OPPS APC 933.6 24.86 232.09 percent of total billed charges 933.6 933.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION RX-36591 CDM J2469 HCPCS 0636 RC 36000-0326-02 NDC outpatient 5 ML 18 18 11.37 11.37 fee schedule 18 93 14.58 percent of total billed charges 11.37 18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROSUVASTATIN 5 MG TABLET RX-36612 CDM A9270 HCPCS 0250 RC 65862-0293-90 NDC outpatient 1 UN 22.37 22.37 74 16.55 percent of total billed charges 22.37 93 18.12 percent of total billed charges 22.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.37 other OPPS APC 22.37 22.37 other OPPS APC 22.37 24.86 5.56 percent of total billed charges 22.37 22.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROSUVASTATIN 5 MG TABLET RX-36612 CDM A9270 HCPCS 0637 RC 65862-0293-90 NDC outpatient 1 UN 22.37 22.37 22.37 74 16.55 percent of total billed charges 22.37 93 18.12 percent of total billed charges 22.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.37 other OPPS APC 22.37 22.37 other OPPS APC 22.37 24.86 5.56 percent of total billed charges 22.37 22.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE" RX-36775 CDM A9270 HCPCS 0250 RC 00904-7084-61 NDC outpatient 1 UN 5.57 5.57 74 4.12 percent of total billed charges 5.57 93 4.51 percent of total billed charges 5.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.57 other OPPS APC 5.57 5.57 other OPPS APC 5.57 24.86 1.38 percent of total billed charges 5.57 5.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE" RX-36775 CDM A9270 HCPCS 0637 RC 00904-7084-61 NDC outpatient 1 UN 5.57 5.57 5.57 74 4.12 percent of total billed charges 5.57 93 4.51 percent of total billed charges 5.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.57 other OPPS APC 5.57 5.57 other OPPS APC 5.57 24.86 1.38 percent of total billed charges 5.57 5.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMIODARONE 100 MG TABLET RX-36959 CDM A9270 HCPCS 0250 RC 50268-0097-15 NDC outpatient 1 UN 18.58 18.58 74 13.75 percent of total billed charges 18.58 93 15.05 percent of total billed charges 18.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.58 other OPPS APC 18.58 18.58 other OPPS APC 18.58 24.86 4.62 percent of total billed charges 18.58 18.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMIODARONE 100 MG TABLET RX-36959 CDM A9270 HCPCS 0637 RC 50268-0097-15 NDC outpatient 1 UN 18.58 18.58 18.58 74 13.75 percent of total billed charges 18.58 93 15.05 percent of total billed charges 18.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.58 other OPPS APC 18.58 18.58 other OPPS APC 18.58 24.86 4.62 percent of total billed charges 18.58 18.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID RX-36962 CDM A9270 HCPCS 0250 RC 00121-1870-00 NDC outpatient 10 ML 5.55 5.55 74 4.11 percent of total billed charges 5.55 93 4.5 percent of total billed charges 5.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.55 other OPPS APC 5.55 5.55 other OPPS APC 5.55 24.86 1.38 percent of total billed charges 5.55 5.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID RX-36962 CDM A9270 HCPCS 0637 RC 00121-1870-00 NDC outpatient 10 ML 5.55 5.55 5.55 74 4.11 percent of total billed charges 5.55 93 4.5 percent of total billed charges 5.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.55 other OPPS APC 5.55 5.55 other OPPS APC 5.55 24.86 1.38 percent of total billed charges 5.55 5.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDRALAZINE 20 MG/ML INJECTION SOLUTION RX-3697 CDM J0360 HCPCS 0636 RC 63323-0614-01 NDC outpatient 1 ML 42.96 42.96 6.52 6.52 fee schedule 42.96 93 34.8 percent of total billed charges 42.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42.96 other OPPS APC 42.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42.96 other OPPS APC 42.96 24.86 10.68 percent of total billed charges 6.52 42.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENOL 1.4 % MUCOSAL AEROSOL SPRAY RX-36976 CDM A9270 HCPCS 0250 RC 00904-6305-21 NDC outpatient 177 ML 7.23 7.23 74 5.35 percent of total billed charges 7.23 93 5.86 percent of total billed charges 7.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.23 other OPPS APC 7.23 7.23 other OPPS APC 7.23 24.86 1.8 percent of total billed charges 7.23 7.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENOL 1.4 % MUCOSAL AEROSOL SPRAY RX-36976 CDM A9270 HCPCS 0637 RC 00904-6305-21 NDC outpatient 177 ML 7.23 7.23 7.23 74 5.35 percent of total billed charges 7.23 93 5.86 percent of total billed charges 7.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.23 other OPPS APC 7.23 7.23 other OPPS APC 7.23 24.86 1.8 percent of total billed charges 7.23 7.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDRALAZINE 10 MG TABLET RX-3698 CDM A9270 HCPCS 0250 RC 23155-0832-01 NDC outpatient 1 UN 1.03 1.03 74 0.76 percent of total billed charges 1.03 93 0.83 percent of total billed charges 1.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.03 other OPPS APC 1.03 1.03 other OPPS APC 1.03 24.86 0.26 percent of total billed charges 1.03 1.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDRALAZINE 10 MG TABLET RX-3698 CDM A9270 HCPCS 0637 RC 23155-0832-01 NDC outpatient 1 UN 1.03 1.03 1.03 74 0.76 percent of total billed charges 1.03 93 0.83 percent of total billed charges 1.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.03 other OPPS APC 1.03 1.03 other OPPS APC 1.03 24.86 0.26 percent of total billed charges 1.03 1.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPLERENONE 25 MG TABLET RX-36983 CDM A9270 HCPCS 0250 RC 31722-0049-30 NDC outpatient 1 UN 10.85 10.85 74 8.03 percent of total billed charges 10.85 93 8.79 percent of total billed charges 10.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.85 other OPPS APC 10.85 10.85 other OPPS APC 10.85 24.86 2.7 percent of total billed charges 10.85 10.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPLERENONE 25 MG TABLET RX-36983 CDM A9270 HCPCS 0637 RC 31722-0049-30 NDC outpatient 1 UN 10.85 10.85 10.85 74 8.03 percent of total billed charges 10.85 93 8.79 percent of total billed charges 10.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.85 other OPPS APC 10.85 10.85 other OPPS APC 10.85 24.86 2.7 percent of total billed charges 10.85 10.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZONISAMIDE 50 MG CAPSULE RX-36988 CDM A9270 HCPCS 0250 RC 76282-0227-01 NDC outpatient 1 UN 0.49 0.49 74 0.36 percent of total billed charges 0.49 93 0.4 percent of total billed charges 0.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.49 other OPPS APC 0.49 0.49 other OPPS APC 0.49 24.86 0.12 percent of total billed charges 0.49 0.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZONISAMIDE 50 MG CAPSULE RX-36988 CDM A9270 HCPCS 0637 RC 76282-0227-01 NDC outpatient 1 UN 0.49 0.49 0.49 74 0.36 percent of total billed charges 0.49 93 0.4 percent of total billed charges 0.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.49 other OPPS APC 0.49 0.49 other OPPS APC 0.49 24.86 0.12 percent of total billed charges 0.49 0.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION RX-36989 CDM J0878 HCPCS 0636 RC 72603-0152-01 NDC outpatient 500 ME 1239.03 1239.03 42.35 42.35 fee schedule 1239.03 93 1003.61 percent of total billed charges 42.35 1239.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION RX-36989 CDM J0878 HCPCS 0636 RC 83090-0011-01 NDC outpatient 10 ML 90 90 90 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 90 other OPPS APC 90 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 90 other OPPS APC 90 24.86 22.37 percent of total billed charges 90 90 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDRALAZINE 25 MG TABLET RX-3700 CDM A9270 HCPCS 0250 RC 63739-0327-10 NDC outpatient 1 UN 0.36 0.36 74 0.27 percent of total billed charges 0.36 93 0.29 percent of total billed charges 0.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.36 other OPPS APC 0.36 0.36 other OPPS APC 0.36 24.86 0.09 percent of total billed charges 0.36 0.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDRALAZINE 25 MG TABLET RX-3700 CDM A9270 HCPCS 0637 RC 63739-0327-10 NDC outpatient 1 UN 0.36 0.36 0.36 74 0.27 percent of total billed charges 0.36 93 0.29 percent of total billed charges 0.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.36 other OPPS APC 0.36 0.36 other OPPS APC 0.36 24.86 0.09 percent of total billed charges 0.36 0.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDRALAZINE 50 MG TABLET RX-3701 CDM A9270 HCPCS 0250 RC 63739-0328-10 NDC outpatient 1 UN 0.41 0.41 74 0.3 percent of total billed charges 0.41 93 0.33 percent of total billed charges 0.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.41 other OPPS APC 0.41 0.41 other OPPS APC 0.41 24.86 0.1 percent of total billed charges 0.41 0.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDRALAZINE 50 MG TABLET RX-3701 CDM A9270 HCPCS 0637 RC 63739-0328-10 NDC outpatient 1 UN 0.41 0.41 0.41 74 0.3 percent of total billed charges 0.41 93 0.33 percent of total billed charges 0.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.41 other OPPS APC 0.41 0.41 other OPPS APC 0.41 24.86 0.1 percent of total billed charges 0.41 0.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEMANTINE 5 MG TABLET RX-37170 CDM A9270 HCPCS 0250 RC 00904-6505-61 NDC outpatient 1 UN 2.39 2.39 74 1.77 percent of total billed charges 2.39 93 1.94 percent of total billed charges 2.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.39 other OPPS APC 2.39 2.39 other OPPS APC 2.39 24.86 0.59 percent of total billed charges 2.39 2.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEMANTINE 5 MG TABLET RX-37170 CDM A9270 HCPCS 0637 RC 00904-6505-61 NDC outpatient 1 UN 2.39 2.39 2.39 74 1.77 percent of total billed charges 2.39 93 1.94 percent of total billed charges 2.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.39 other OPPS APC 2.39 2.39 other OPPS APC 2.39 24.86 0.59 percent of total billed charges 2.39 2.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCHLOROTHIAZIDE 25 MG TABLET RX-3720 CDM A9270 HCPCS 0250 RC 60687-0593-01 NDC outpatient 1 UN 0.63 0.63 74 0.47 percent of total billed charges 0.63 93 0.51 percent of total billed charges 0.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.63 other OPPS APC 0.63 0.63 other OPPS APC 0.63 24.86 0.16 percent of total billed charges 0.63 0.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCHLOROTHIAZIDE 25 MG TABLET RX-3720 CDM A9270 HCPCS 0637 RC 60687-0593-01 NDC outpatient 1 UN 0.63 0.63 0.63 74 0.47 percent of total billed charges 0.63 93 0.51 percent of total billed charges 0.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.63 other OPPS APC 0.63 0.63 other OPPS APC 0.63 24.86 0.16 percent of total billed charges 0.63 0.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCORTISONE 1 % TOPICAL CREAM RX-3726 CDM A9270 HCPCS 0250 RC 45802-0438-03 NDC outpatient 28 GR 9.98 9.98 74 7.39 percent of total billed charges 9.98 93 8.08 percent of total billed charges 9.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.98 other OPPS APC 9.98 9.98 other OPPS APC 9.98 24.86 2.48 percent of total billed charges 9.98 9.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCORTISONE 1 % TOPICAL CREAM RX-3726 CDM A9270 HCPCS 0637 RC 45802-0438-03 NDC outpatient 28 GR 9.98 9.98 9.98 74 7.39 percent of total billed charges 9.98 93 8.08 percent of total billed charges 9.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.98 other OPPS APC 9.98 9.98 other OPPS APC 9.98 24.86 2.48 percent of total billed charges 9.98 9.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCORTISONE 1 % TOPICAL OINTMENT RX-3731 CDM A9270 HCPCS 0250 RC 45802-0276-03 NDC outpatient 28 GR 9.98 9.98 74 7.39 percent of total billed charges 9.98 93 8.08 percent of total billed charges 9.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.98 other OPPS APC 9.98 9.98 other OPPS APC 9.98 24.86 2.48 percent of total billed charges 9.98 9.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCORTISONE 1 % TOPICAL OINTMENT RX-3731 CDM A9270 HCPCS 0637 RC 45802-0276-03 NDC outpatient 28 GR 9.98 9.98 9.98 74 7.39 percent of total billed charges 9.98 93 8.08 percent of total billed charges 9.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.98 other OPPS APC 9.98 9.98 other OPPS APC 9.98 24.86 2.48 percent of total billed charges 9.98 9.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCORTISONE 10 MG TABLET RX-3733 CDM A9270 HCPCS 0250 RC 60687-0582-11 NDC outpatient 1 UN 5.01 5.01 74 3.71 percent of total billed charges 5.01 93 4.06 percent of total billed charges 5.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.01 other OPPS APC 5.01 5.01 other OPPS APC 5.01 24.86 1.25 percent of total billed charges 5.01 5.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCORTISONE 10 MG TABLET RX-3733 CDM A9270 HCPCS 0637 RC 60687-0582-11 NDC outpatient 1 UN 5.01 5.01 5.01 74 3.71 percent of total billed charges 5.01 93 4.06 percent of total billed charges 5.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.01 other OPPS APC 5.01 5.01 other OPPS APC 5.01 24.86 1.25 percent of total billed charges 5.01 5.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCORTISONE 20 MG TABLET RX-3734 CDM A9270 HCPCS 0250 RC 59651-0415-01 NDC outpatient 1 UN 2.72 2.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.72 other OPPS APC 2.72 2.72 other OPPS APC 2.72 24.86 0.68 percent of total billed charges 2.72 2.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCORTISONE 20 MG TABLET RX-3734 CDM A9270 HCPCS 0637 RC 59651-0415-01 NDC outpatient 1 UN 2.72 2.72 2.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.72 other OPPS APC 2.72 2.72 other OPPS APC 2.72 24.86 0.68 percent of total billed charges 2.72 2.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCORTISONE 20 MG TABLET RX-3734 CDM A9270 HCPCS 0250 RC 59762-0075-01 NDC outpatient 1 UN 2.72 2.72 74 2.01 percent of total billed charges 2.72 93 2.2 percent of total billed charges 2.72 2.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCORTISONE 20 MG TABLET RX-3734 CDM A9270 HCPCS 0637 RC 59762-0075-01 NDC outpatient 1 UN 2.72 2.72 2.72 74 2.01 percent of total billed charges 2.72 93 2.2 percent of total billed charges 2.72 2.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY RX-3738 CDM A9270 HCPCS 0250 RC 00713-0503-12 NDC outpatient 1 UN 56.62 56.62 74 41.9 percent of total billed charges 56.62 93 45.86 percent of total billed charges 56.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56.62 other OPPS APC 56.62 56.62 other OPPS APC 56.62 24.86 14.08 percent of total billed charges 56.62 56.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY RX-3738 CDM A9270 HCPCS 0637 RC 00713-0503-12 NDC outpatient 1 UN 56.62 56.62 56.62 74 41.9 percent of total billed charges 56.62 93 45.86 percent of total billed charges 56.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56.62 other OPPS APC 56.62 56.62 other OPPS APC 56.62 24.86 14.08 percent of total billed charges 56.62 56.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TETANUS-DIPHTHERIA TOXOIDS-TD 2 LF UNIT-2 LF UNIT/0.5 ML IM SUSPENSION RX-37504 CDM 90714 HCPCS 0636 RC 13533-0131-01 NDC outpatient 0.5 ML 83.96 83.96 35.44 35.44 fee schedule 83.96 93 68.01 percent of total billed charges 83.96 83.96 other OPPS APC 83.96 83.96 other OPPS APC 83.96 24.86 20.87 percent of total billed charges 35.44 83.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMORPHONE (PF) 1 MG/ML INJECTION SYRINGE RX-3757 CDM J1171 HCPCS 0636 RC 76045-0009-11 NDC outpatient 1 ML 12.45 12.45 12.45 74 9.21 percent of total billed charges 12.45 93 10.08 percent of total billed charges 12.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.45 other OPPS APC 12.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.45 other OPPS APC 12.45 24.86 3.1 percent of total billed charges 12.45 12.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMORPHONE 2 MG TABLET RX-3760 CDM A9270 HCPCS 0250 RC 00406-3243-01 NDC outpatient 1 UN 1.21 1.21 74 0.9 percent of total billed charges 1.21 93 0.98 percent of total billed charges 1.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.21 other OPPS APC 1.21 1.21 other OPPS APC 1.21 24.86 0.3 percent of total billed charges 1.21 1.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMORPHONE 2 MG TABLET RX-3760 CDM A9270 HCPCS 0637 RC 00406-3243-01 NDC outpatient 1 UN 1.21 1.21 1.21 74 0.9 percent of total billed charges 1.21 93 0.98 percent of total billed charges 1.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.21 other OPPS APC 1.21 1.21 other OPPS APC 1.21 24.86 0.3 percent of total billed charges 1.21 1.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMORPHONE 4 MG TABLET RX-3761 CDM A9270 HCPCS 0250 RC 00054-0264-25 NDC outpatient 1 UN 1.54 1.54 74 1.14 percent of total billed charges 1.54 93 1.25 percent of total billed charges 1.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.54 other OPPS APC 1.54 1.54 other OPPS APC 1.54 24.86 0.38 percent of total billed charges 1.54 1.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMORPHONE 4 MG TABLET RX-3761 CDM A9270 HCPCS 0637 RC 00054-0264-25 NDC outpatient 1 UN 1.54 1.54 1.54 74 1.14 percent of total billed charges 1.54 93 1.25 percent of total billed charges 1.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.54 other OPPS APC 1.54 1.54 other OPPS APC 1.54 24.86 0.38 percent of total billed charges 1.54 1.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METOPROLOL TARTRATE 25 MG TABLET RX-37637 CDM A9270 HCPCS 0250 RC 51079-0255-20 NDC outpatient 1 UN 0.61 0.61 74 0.45 percent of total billed charges 0.61 93 0.49 percent of total billed charges 0.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.61 other OPPS APC 0.61 0.61 other OPPS APC 0.61 24.86 0.15 percent of total billed charges 0.61 0.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METOPROLOL TARTRATE 25 MG TABLET RX-37637 CDM A9270 HCPCS 0637 RC 51079-0255-20 NDC outpatient 1 UN 0.61 0.61 0.61 74 0.45 percent of total billed charges 0.61 93 0.49 percent of total billed charges 0.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.61 other OPPS APC 0.61 0.61 other OPPS APC 0.61 24.86 0.15 percent of total billed charges 0.61 0.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PROPAFENONE ER 225 MG CAPSULE,EXTENDED RELEASE 12 HR" RX-37643 CDM A9270 HCPCS 0250 RC 64380-0184-01 NDC outpatient 1 UN 19.74 19.74 74 14.61 percent of total billed charges 19.74 93 15.99 percent of total billed charges 19.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.74 other OPPS APC 19.74 19.74 other OPPS APC 19.74 24.86 4.91 percent of total billed charges 19.74 19.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PROPAFENONE ER 225 MG CAPSULE,EXTENDED RELEASE 12 HR" RX-37643 CDM A9270 HCPCS 0637 RC 64380-0184-01 NDC outpatient 1 UN 19.74 19.74 19.74 74 14.61 percent of total billed charges 19.74 93 15.99 percent of total billed charges 19.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.74 other OPPS APC 19.74 19.74 other OPPS APC 19.74 24.86 4.91 percent of total billed charges 19.74 19.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PROPAFENONE ER 325 MG CAPSULE,EXTENDED RELEASE 12 HR" RX-37644 CDM A9270 HCPCS 0250 RC 69680-0131-60 NDC outpatient 1 UN 2.95 2.95 74 2.18 percent of total billed charges 2.95 93 2.39 percent of total billed charges 2.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.95 other OPPS APC 2.95 2.95 other OPPS APC 2.95 24.86 0.73 percent of total billed charges 2.95 2.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PROPAFENONE ER 325 MG CAPSULE,EXTENDED RELEASE 12 HR" RX-37644 CDM A9270 HCPCS 0637 RC 69680-0131-60 NDC outpatient 1 UN 2.95 2.95 2.95 74 2.18 percent of total billed charges 2.95 93 2.39 percent of total billed charges 2.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.95 other OPPS APC 2.95 2.95 other OPPS APC 2.95 24.86 0.73 percent of total billed charges 2.95 2.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR" RX-37648 CDM A9270 HCPCS 0250 RC 59651-0780-30 NDC outpatient 1 UN 1.02 1.02 74 0.75 percent of total billed charges 1.02 93 0.83 percent of total billed charges 1.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.02 other OPPS APC 1.02 1.02 other OPPS APC 1.02 24.86 0.25 percent of total billed charges 1.02 1.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR" RX-37648 CDM A9270 HCPCS 0637 RC 59651-0780-30 NDC outpatient 1 UN 1.02 1.02 1.02 74 0.75 percent of total billed charges 1.02 93 0.83 percent of total billed charges 1.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.02 other OPPS APC 1.02 1.02 other OPPS APC 1.02 24.86 0.25 percent of total billed charges 1.02 1.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR" RX-37649 CDM A9270 HCPCS 0250 RC 68084-0111-01 NDC outpatient 1 UN 1.8 1.8 74 1.33 percent of total billed charges 1.8 93 1.46 percent of total billed charges 1.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.8 other OPPS APC 1.8 1.8 other OPPS APC 1.8 24.86 0.45 percent of total billed charges 1.8 1.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR" RX-37649 CDM A9270 HCPCS 0637 RC 68084-0111-01 NDC outpatient 1 UN 1.8 1.8 1.8 74 1.33 percent of total billed charges 1.8 93 1.46 percent of total billed charges 1.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.8 other OPPS APC 1.8 1.8 other OPPS APC 1.8 24.86 0.45 percent of total billed charges 1.8 1.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR" RX-37651 CDM A9270 HCPCS 0250 RC 00904-6718-39 NDC outpatient 1 UN 2.68 2.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.68 other OPPS APC 2.68 2.68 other OPPS APC 2.68 24.86 0.67 percent of total billed charges 2.68 2.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR" RX-37651 CDM A9270 HCPCS 0637 RC 00904-6718-39 NDC outpatient 1 UN 2.68 2.68 2.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.68 other OPPS APC 2.68 2.68 other OPPS APC 2.68 24.86 0.67 percent of total billed charges 2.68 2.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR" RX-37651 CDM A9270 HCPCS 0250 RC 68084-0572-01 NDC outpatient 1 UN 2.51 2.51 74 1.86 percent of total billed charges 2.51 93 2.03 percent of total billed charges 2.51 2.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR" RX-37651 CDM A9270 HCPCS 0637 RC 68084-0572-01 NDC outpatient 1 UN 2.51 2.51 2.51 74 1.86 percent of total billed charges 2.51 93 2.03 percent of total billed charges 2.51 2.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROXYZINE HCL 50 MG/ML INTRAMUSCULAR SOLUTION RX-3770 CDM J3410 HCPCS 0636 RC 00517-5601-25 NDC outpatient 1 ML 92.61 92.61 31.1 31.1 fee schedule 92.61 93 75.01 percent of total billed charges 92.61 92.61 other OPPS APC 92.61 92.61 other OPPS APC 92.61 24.86 23.02 percent of total billed charges 31.1 92.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROXYZINE HCL 10 MG/5 ML ORAL SOLUTION RX-3771 CDM A9270 HCPCS 0250 RC 62135-0750-47 NDC outpatient 473 ML 1500.01 1500.01 74 1110.01 percent of total billed charges 1500.01 93 1215.01 percent of total billed charges 1500.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500.01 other OPPS APC 1500.01 1500.01 other OPPS APC 1500.01 24.86 372.9 percent of total billed charges 1500.01 1500.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROXYZINE HCL 10 MG/5 ML ORAL SOLUTION RX-3771 CDM A9270 HCPCS 0637 RC 62135-0750-47 NDC outpatient 473 ML 1500.01 1500.01 1500.01 74 1110.01 percent of total billed charges 1500.01 93 1215.01 percent of total billed charges 1500.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500.01 other OPPS APC 1500.01 1500.01 other OPPS APC 1500.01 24.86 372.9 percent of total billed charges 1500.01 1500.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROXYZINE HCL 10 MG TABLET RX-3772 CDM A9270 HCPCS 0250 RC 63739-0483-10 NDC outpatient 1 UN 0.72 0.72 74 0.53 percent of total billed charges 0.72 93 0.58 percent of total billed charges 0.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.72 other OPPS APC 0.72 0.72 other OPPS APC 0.72 24.86 0.18 percent of total billed charges 0.72 0.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROXYZINE HCL 10 MG TABLET RX-3772 CDM A9270 HCPCS 0637 RC 63739-0483-10 NDC outpatient 1 UN 0.72 0.72 0.72 74 0.53 percent of total billed charges 0.72 93 0.58 percent of total billed charges 0.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.72 other OPPS APC 0.72 0.72 other OPPS APC 0.72 24.86 0.18 percent of total billed charges 0.72 0.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROXYZINE HCL 25 MG TABLET RX-3774 CDM A9270 HCPCS 0250 RC 63739-0486-10 NDC outpatient 1 UN 0.82 0.82 74 0.61 percent of total billed charges 0.82 93 0.66 percent of total billed charges 0.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.82 other OPPS APC 0.82 0.82 other OPPS APC 0.82 24.86 0.2 percent of total billed charges 0.82 0.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROXYZINE HCL 25 MG TABLET RX-3774 CDM A9270 HCPCS 0637 RC 63739-0486-10 NDC outpatient 1 UN 0.82 0.82 0.82 74 0.61 percent of total billed charges 0.82 93 0.66 percent of total billed charges 0.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.82 other OPPS APC 0.82 0.82 other OPPS APC 0.82 24.86 0.2 percent of total billed charges 0.82 0.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEMETREXED DISODIUM 500 MG INTRAVENOUS POWDER FOR SOLUTION RX-37894 CDM J9305 HCPCS 0636 RC 43598-0387-11 NDC outpatient 20 ML 2379 2379 2379 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 209.2 other OPPS APC 2379 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 209.2 other OPPS APC 2379 24.86 591.42 percent of total billed charges 2379 2379 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION RX-37989 CDM J9055 HCPCS 0636 RC 66733-0948-23 NDC outpatient 50 ML 2412.28 2412.28 822.8 822.8 fee schedule 2412.28 93 1953.95 percent of total billed charges 2412.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 754.79 other OPPS APC 2412.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 754.79 other OPPS APC 2412.28 24.86 599.69 percent of total billed charges 822.8 2412.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MYCOPHENOLATE SODIUM 360 MG TABLET,DELAYED RELEASE" RX-38063 CDM J7518 HCPCS 0636 RC 16729-0189-29 NDC outpatient 1 UN 22.85 22.85 1.52 1.52 fee schedule 22.85 93 18.51 percent of total billed charges 22.85 22.85 other OPPS APC 22.85 22.85 other OPPS APC 22.85 24.86 5.68 percent of total billed charges 1.52 22.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CINACALCET 30 MG TABLET RX-38100 CDM A9270 HCPCS 0250 RC 65862-0831-30 NDC outpatient 1 UN 76.64 76.64 74 56.71 percent of total billed charges 76.64 93 62.08 percent of total billed charges 76.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 76.64 other OPPS APC 76.64 76.64 other OPPS APC 76.64 24.86 19.05 percent of total billed charges 76.64 76.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CINACALCET 30 MG TABLET RX-38100 CDM A9270 HCPCS 0637 RC 65862-0831-30 NDC outpatient 1 UN 76.64 76.64 76.64 74 56.71 percent of total billed charges 76.64 93 62.08 percent of total billed charges 76.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 76.64 other OPPS APC 76.64 76.64 other OPPS APC 76.64 24.86 19.05 percent of total billed charges 76.64 76.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CINACALCET 60 MG TABLET RX-38101 CDM A9270 HCPCS 0250 RC 69097-0411-02 NDC outpatient 1 UN 153.28 153.28 74 113.43 percent of total billed charges 153.28 93 124.16 percent of total billed charges 153.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 153.28 other OPPS APC 153.28 153.28 other OPPS APC 153.28 24.86 38.11 percent of total billed charges 153.28 153.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CINACALCET 60 MG TABLET RX-38101 CDM A9270 HCPCS 0637 RC 69097-0411-02 NDC outpatient 1 UN 153.28 153.28 153.28 74 113.43 percent of total billed charges 153.28 93 124.16 percent of total billed charges 153.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 153.28 other OPPS APC 153.28 153.28 other OPPS APC 153.28 24.86 38.11 percent of total billed charges 153.28 153.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE" RX-38224 CDM A9270 HCPCS 0250 RC 00527-4116-37 NDC outpatient 1 UN 5.15 5.15 74 3.81 percent of total billed charges 5.15 93 4.17 percent of total billed charges 5.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.15 other OPPS APC 5.15 5.15 other OPPS APC 5.15 24.86 1.28 percent of total billed charges 5.15 5.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE" RX-38224 CDM A9270 HCPCS 0637 RC 00527-4116-37 NDC outpatient 1 UN 5.15 5.15 5.15 74 3.81 percent of total billed charges 5.15 93 4.17 percent of total billed charges 5.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.15 other OPPS APC 5.15 5.15 other OPPS APC 5.15 24.86 1.28 percent of total billed charges 5.15 5.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE" RX-38225 CDM A9270 HCPCS 0250 RC 00228-2779-11 NDC outpatient 1 UN 6.03 6.03 74 4.46 percent of total billed charges 6.03 93 4.88 percent of total billed charges 6.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.03 other OPPS APC 6.03 6.03 other OPPS APC 6.03 24.86 1.5 percent of total billed charges 6.03 6.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE" RX-38225 CDM A9270 HCPCS 0637 RC 00228-2779-11 NDC outpatient 1 UN 6.03 6.03 6.03 74 4.46 percent of total billed charges 6.03 93 4.88 percent of total billed charges 6.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.03 other OPPS APC 6.03 6.03 other OPPS APC 6.03 24.86 1.5 percent of total billed charges 6.03 6.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LACTULOSE 10 GRAM/15 ML ORAL SOLUTION RX-38245 CDM A9270 HCPCS 0250 RC 00527-5125-70 NDC outpatient 473 ML 91.25 91.25 74 67.53 percent of total billed charges 91.25 93 73.91 percent of total billed charges 91.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 91.25 other OPPS APC 91.25 91.25 other OPPS APC 91.25 24.86 22.68 percent of total billed charges 91.25 91.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LACTULOSE 10 GRAM/15 ML ORAL SOLUTION RX-38245 CDM A9270 HCPCS 0637 RC 00527-5125-70 NDC outpatient 473 ML 91.25 91.25 91.25 74 67.53 percent of total billed charges 91.25 93 73.91 percent of total billed charges 91.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 91.25 other OPPS APC 91.25 91.25 other OPPS APC 91.25 24.86 22.68 percent of total billed charges 91.25 91.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION RX-38263 CDM J2359 HCPCS 0636 RC 55150-0308-01 NDC outpatient 10 ME 106.33 106.33 106.33 74 78.68 percent of total billed charges 106.33 93 86.13 percent of total billed charges 106.33 106.33 other OPPS APC 106.33 106.33 other OPPS APC 106.33 24.86 26.43 percent of total billed charges 106.33 106.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION RX-38271 CDM J9075 HCPCS 0636 RC 16714-0859-01 NDC outpatient 25 ML 1034.88 1034.88 1034.88 74 765.81 percent of total billed charges 1034.88 93 838.25 percent of total billed charges 1034.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 101 other OPPS APC 1034.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 101 other OPPS APC 1034.88 24.86 257.27 percent of total billed charges 1034.88 1034.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP RX-38285 CDM A9270 HCPCS 0250 RC 63739-0159-77 NDC outpatient 30 ML 5.67 5.67 74 4.2 percent of total billed charges 5.67 93 4.59 percent of total billed charges 5.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.67 other OPPS APC 5.67 5.67 other OPPS APC 5.67 24.86 1.41 percent of total billed charges 5.67 5.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP RX-38285 CDM A9270 HCPCS 0637 RC 63739-0159-77 NDC outpatient 30 ML 5.67 5.67 5.67 74 4.2 percent of total billed charges 5.67 93 4.59 percent of total billed charges 5.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.67 other OPPS APC 5.67 5.67 other OPPS APC 5.67 24.86 1.41 percent of total billed charges 5.67 5.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION RX-38303 CDM J0132 HCPCS 0636 RC 70594-0111-02 NDC outpatient 30 ML 180 180 53 53 fee schedule 180 93 145.8 percent of total billed charges 180 180 other OPPS APC 180 180 other OPPS APC 180 24.86 44.75 percent of total billed charges 53 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBUPROFEN 200 MG TABLET RX-3841 CDM A9270 HCPCS 0250 RC 00904-7914-61 NDC outpatient 1 UN 0.2 0.2 74 0.15 percent of total billed charges 0.2 93 0.16 percent of total billed charges 0.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.2 other OPPS APC 0.2 0.2 other OPPS APC 0.2 24.86 0.05 percent of total billed charges 0.2 0.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBUPROFEN 200 MG TABLET RX-3841 CDM A9270 HCPCS 0637 RC 00904-7914-61 NDC outpatient 1 UN 0.2 0.2 0.2 74 0.15 percent of total billed charges 0.2 93 0.16 percent of total billed charges 0.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.2 other OPPS APC 0.2 0.2 other OPPS APC 0.2 24.86 0.05 percent of total billed charges 0.2 0.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBUPROFEN 600 MG TABLET RX-3844 CDM A9270 HCPCS 0250 RC 00904-5854-61 NDC outpatient 1 UN 0.77 0.77 74 0.57 percent of total billed charges 0.77 93 0.62 percent of total billed charges 0.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.77 other OPPS APC 0.77 0.77 other OPPS APC 0.77 24.86 0.19 percent of total billed charges 0.77 0.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBUPROFEN 600 MG TABLET RX-3844 CDM A9270 HCPCS 0637 RC 00904-5854-61 NDC outpatient 1 UN 0.77 0.77 0.77 74 0.57 percent of total billed charges 0.77 93 0.62 percent of total billed charges 0.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.77 other OPPS APC 0.77 0.77 other OPPS APC 0.77 24.86 0.19 percent of total billed charges 0.77 0.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBUPROFEN 800 MG TABLET RX-3845 CDM A9270 HCPCS 0250 RC 00904-5855-61 NDC outpatient 1 UN 1 1 74 0.74 percent of total billed charges 1 93 0.81 percent of total billed charges 1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1 other OPPS APC 1 1 other OPPS APC 1 24.86 0.25 percent of total billed charges 1 1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBUPROFEN 800 MG TABLET RX-3845 CDM A9270 HCPCS 0637 RC 00904-5855-61 NDC outpatient 1 UN 1 1 1 74 0.74 percent of total billed charges 1 93 0.81 percent of total billed charges 1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1 other OPPS APC 1 1 other OPPS APC 1 24.86 0.25 percent of total billed charges 1 1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION RX-38488 CDM A9270 HCPCS 0250 RC 70954-0600-10 NDC outpatient 120 ML 295 295 74 218.3 percent of total billed charges 295 93 238.95 percent of total billed charges 295 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 295 other OPPS APC 295 295 other OPPS APC 295 24.86 73.34 percent of total billed charges 295 295 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION RX-38488 CDM A9270 HCPCS 0637 RC 70954-0600-10 NDC outpatient 120 ML 295 295 295 74 218.3 percent of total billed charges 295 93 238.95 percent of total billed charges 295 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 295 other OPPS APC 295 295 other OPPS APC 295 24.86 73.34 percent of total billed charges 295 295 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AGALSIDASE BETA 5 MG INTRAVENOUS SOLUTION RX-38494 CDM J0180 HCPCS 0636 RC 58468-0041-01 NDC outpatient 1 ML 3194.35 3194.35 1229.3 1229.3 fee schedule 3194.35 93 2587.42 percent of total billed charges 3194.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1117.61 other OPPS APC 3194.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1117.61 other OPPS APC 3194.35 24.86 794.12 percent of total billed charges 1229.3 3194.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AGALSIDASE BETA 5 MG INTRAVENOUS SOLUTION RX-38494 CDM J0180 HCPCS 0636 RC 58468-0041-01 NDC outpatient 5 ME 3194.35 3194.35 1229.3 1229.3 fee schedule 3194.35 93 2587.42 percent of total billed charges 3194.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1117.61 other OPPS APC 3194.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1117.61 other OPPS APC 3194.35 24.86 794.12 percent of total billed charges 1229.3 3194.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMIPRAMINE 10 MG TABLET RX-3860 CDM A9270 HCPCS 0250 RC 69584-0425-10 NDC outpatient 1 UN 1.08 1.08 74 0.8 percent of total billed charges 1.08 93 0.87 percent of total billed charges 1.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.08 other OPPS APC 1.08 1.08 other OPPS APC 1.08 24.86 0.27 percent of total billed charges 1.08 1.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMIPRAMINE 10 MG TABLET RX-3860 CDM A9270 HCPCS 0637 RC 69584-0425-10 NDC outpatient 1 UN 1.08 1.08 1.08 74 0.8 percent of total billed charges 1.08 93 0.87 percent of total billed charges 1.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.08 other OPPS APC 1.08 1.08 other OPPS APC 1.08 24.86 0.27 percent of total billed charges 1.08 1.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMIPRAMINE 25 MG TABLET RX-3861 CDM A9270 HCPCS 0250 RC 69584-0426-10 NDC outpatient 1 UN 1.8 1.8 74 1.33 percent of total billed charges 1.8 93 1.46 percent of total billed charges 1.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.8 other OPPS APC 1.8 1.8 other OPPS APC 1.8 24.86 0.45 percent of total billed charges 1.8 1.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMIPRAMINE 25 MG TABLET RX-3861 CDM A9270 HCPCS 0637 RC 69584-0426-10 NDC outpatient 1 UN 1.8 1.8 1.8 74 1.33 percent of total billed charges 1.8 93 1.46 percent of total billed charges 1.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.8 other OPPS APC 1.8 1.8 other OPPS APC 1.8 24.86 0.45 percent of total billed charges 1.8 1.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT" RX-38701 CDM A9270 HCPCS 0250 RC 24208-0780-55 NDC outpatient 3.5 GR 142.38 142.38 74 105.36 percent of total billed charges 142.38 93 115.33 percent of total billed charges 142.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 142.38 other OPPS APC 142.38 142.38 other OPPS APC 142.38 24.86 35.4 percent of total billed charges 142.38 142.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT" RX-38701 CDM A9270 HCPCS 0637 RC 24208-0780-55 NDC outpatient 3.5 GR 142.38 142.38 142.38 74 105.36 percent of total billed charges 142.38 93 115.33 percent of total billed charges 142.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 142.38 other OPPS APC 142.38 142.38 other OPPS APC 142.38 24.86 35.4 percent of total billed charges 142.38 142.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION RX-38703 CDM J0153 HCPCS 0636 RC 25021-0318-02 NDC outpatient 2 ML 18 18 3.7 3.7 fee schedule 18 93 14.58 percent of total billed charges 3.7 18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION RX-38703 CDM J0153 HCPCS 0636 RC 67457-0855-02 NDC outpatient 2 ML 18.75 18.75 18.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.75 other OPPS APC 18.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.75 other OPPS APC 18.75 24.86 4.66 percent of total billed charges 18.75 18.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INDAPAMIDE 2.5 MG TABLET RX-3879 CDM A9270 HCPCS 0250 RC 16571-0876-01 NDC outpatient 1 UN 3.88 3.88 74 2.87 percent of total billed charges 3.88 93 3.14 percent of total billed charges 3.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.88 other OPPS APC 3.88 3.88 other OPPS APC 3.88 24.86 0.96 percent of total billed charges 3.88 3.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INDAPAMIDE 2.5 MG TABLET RX-3879 CDM A9270 HCPCS 0637 RC 16571-0876-01 NDC outpatient 1 UN 3.88 3.88 3.88 74 2.87 percent of total billed charges 3.88 93 3.14 percent of total billed charges 3.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.88 other OPPS APC 3.88 3.88 other OPPS APC 3.88 24.86 0.96 percent of total billed charges 3.88 3.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SELENIUM SULFIDE 1 % SHAMPOO RX-38961 CDM A9270 HCPCS 0250 RC 00536-1995-53 NDC outpatient 207 ML 11.43 11.43 74 8.46 percent of total billed charges 11.43 93 9.26 percent of total billed charges 11.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.43 other OPPS APC 11.43 11.43 other OPPS APC 11.43 24.86 2.84 percent of total billed charges 11.43 11.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SELENIUM SULFIDE 1 % SHAMPOO RX-38961 CDM A9270 HCPCS 0637 RC 00536-1995-53 NDC outpatient 207 ML 11.43 11.43 11.43 74 8.46 percent of total billed charges 11.43 93 9.26 percent of total billed charges 11.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.43 other OPPS APC 11.43 11.43 other OPPS APC 11.43 24.86 2.84 percent of total billed charges 11.43 11.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INDOMETHACIN 25 MG CAPSULE RX-3897 CDM A9270 HCPCS 0250 RC 50268-0430-11 NDC outpatient 1 UN 1.08 1.08 74 0.8 percent of total billed charges 1.08 93 0.87 percent of total billed charges 1.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.08 other OPPS APC 1.08 1.08 other OPPS APC 1.08 24.86 0.27 percent of total billed charges 1.08 1.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INDOMETHACIN 25 MG CAPSULE RX-3897 CDM A9270 HCPCS 0637 RC 50268-0430-11 NDC outpatient 1 UN 1.08 1.08 1.08 74 0.8 percent of total billed charges 1.08 93 0.87 percent of total billed charges 1.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.08 other OPPS APC 1.08 1.08 other OPPS APC 1.08 24.86 0.27 percent of total billed charges 1.08 1.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VITAMIN B COMPLEX AND VITAMIN C NO.20-FOLIC ACID 1 MG CAPSULE RX-38978 CDM A9270 HCPCS 0250 RC 63044-0622-01 NDC outpatient 1 UN 1.65 1.65 74 1.22 percent of total billed charges 1.65 93 1.34 percent of total billed charges 1.65 1.65 other OPPS APC 1.65 1.65 other OPPS APC 1.65 24.86 0.41 percent of total billed charges 1.65 1.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VITAMIN B COMPLEX AND VITAMIN C NO.20-FOLIC ACID 1 MG CAPSULE RX-38978 CDM A9270 HCPCS 0637 RC 63044-0622-01 NDC outpatient 1 UN 1.65 1.65 1.65 74 1.22 percent of total billed charges 1.65 93 1.34 percent of total billed charges 1.65 1.65 other OPPS APC 1.65 1.65 other OPPS APC 1.65 24.86 0.41 percent of total billed charges 1.65 1.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER" RX-39136 CDM A9270 HCPCS 0250 RC 68308-0152-15 NDC outpatient 1 UN 54.88 54.88 74 40.61 percent of total billed charges 54.88 93 44.45 percent of total billed charges 54.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 54.88 other OPPS APC 54.88 54.88 other OPPS APC 54.88 24.86 13.64 percent of total billed charges 54.88 54.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER" RX-39136 CDM A9270 HCPCS 0637 RC 68308-0152-15 NDC outpatient 1 UN 54.88 54.88 54.88 74 40.61 percent of total billed charges 54.88 93 44.45 percent of total billed charges 54.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 54.88 other OPPS APC 54.88 54.88 other OPPS APC 54.88 24.86 13.64 percent of total billed charges 54.88 54.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET RX-39255 CDM A9270 HCPCS 0250 RC 00904-7172-07 NDC outpatient 1 UN 5.84 5.84 74 4.32 percent of total billed charges 5.84 93 4.73 percent of total billed charges 5.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.84 other OPPS APC 5.84 5.84 other OPPS APC 5.84 24.86 1.45 percent of total billed charges 5.84 5.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET RX-39255 CDM A9270 HCPCS 0637 RC 00904-7172-07 NDC outpatient 1 UN 5.84 5.84 5.84 74 4.32 percent of total billed charges 5.84 93 4.73 percent of total billed charges 5.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.84 other OPPS APC 5.84 5.84 other OPPS APC 5.84 24.86 1.45 percent of total billed charges 5.84 5.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION RX-39265 CDM J9045 HCPCS 0636 RC 16729-0295-12 NDC outpatient 60 ML 215.1 215.1 215.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 215.1 other OPPS APC 215.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 215.1 other OPPS APC 215.1 24.86 53.47 percent of total billed charges 215.1 215.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION RX-39265 CDM J9045 HCPCS 0636 RC 54288-0167-01 NDC outpatient 60 ML 301.38 301.38 32.96 32.96 fee schedule 301.38 93 244.12 percent of total billed charges 32.96 301.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DULOXETINE 20 MG CAPSULE,DELAYED RELEASE" RX-39275 CDM A9270 HCPCS 0250 RC 00904-7043-04 NDC outpatient 1 UN 4.37 4.37 74 3.23 percent of total billed charges 4.37 93 3.54 percent of total billed charges 4.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.37 other OPPS APC 4.37 4.37 other OPPS APC 4.37 24.86 1.09 percent of total billed charges 4.37 4.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DULOXETINE 20 MG CAPSULE,DELAYED RELEASE" RX-39275 CDM A9270 HCPCS 0637 RC 00904-7043-04 NDC outpatient 1 UN 4.37 4.37 4.37 74 3.23 percent of total billed charges 4.37 93 3.54 percent of total billed charges 4.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.37 other OPPS APC 4.37 4.37 other OPPS APC 4.37 24.86 1.09 percent of total billed charges 4.37 4.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DULOXETINE 30 MG CAPSULE,DELAYED RELEASE" RX-39276 CDM A9270 HCPCS 0250 RC 57237-0018-30 NDC outpatient 1 UN 19.63 19.63 74 14.53 percent of total billed charges 19.63 93 15.9 percent of total billed charges 19.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.63 other OPPS APC 19.63 19.63 other OPPS APC 19.63 24.86 4.88 percent of total billed charges 19.63 19.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DULOXETINE 30 MG CAPSULE,DELAYED RELEASE" RX-39276 CDM A9270 HCPCS 0637 RC 57237-0018-30 NDC outpatient 1 UN 19.63 19.63 19.63 74 14.53 percent of total billed charges 19.63 93 15.9 percent of total billed charges 19.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.63 other OPPS APC 19.63 19.63 other OPPS APC 19.63 24.86 4.88 percent of total billed charges 19.63 19.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DULOXETINE 60 MG CAPSULE,DELAYED RELEASE" RX-39277 CDM A9270 HCPCS 0250 RC 68180-0296-09 NDC outpatient 1 UN 19.63 19.63 74 14.53 percent of total billed charges 19.63 93 15.9 percent of total billed charges 19.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.63 other OPPS APC 19.63 19.63 other OPPS APC 19.63 24.86 4.88 percent of total billed charges 19.63 19.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DULOXETINE 60 MG CAPSULE,DELAYED RELEASE" RX-39277 CDM A9270 HCPCS 0637 RC 68180-0296-09 NDC outpatient 1 UN 19.63 19.63 19.63 74 14.53 percent of total billed charges 19.63 93 15.9 percent of total billed charges 19.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.63 other OPPS APC 19.63 19.63 other OPPS APC 19.63 24.86 4.88 percent of total billed charges 19.63 19.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFDINIR 250 MG/5 ML ORAL SUSPENSION RX-39522 CDM A9270 HCPCS 0250 RC 67877-0548-98 NDC outpatient 60 ML 248.21 248.21 74 183.68 percent of total billed charges 248.21 93 201.05 percent of total billed charges 248.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 248.21 other OPPS APC 248.21 248.21 other OPPS APC 248.21 24.86 61.71 percent of total billed charges 248.21 248.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFDINIR 250 MG/5 ML ORAL SUSPENSION RX-39522 CDM A9270 HCPCS 0637 RC 67877-0548-98 NDC outpatient 60 ML 248.21 248.21 248.21 74 183.68 percent of total billed charges 248.21 93 201.05 percent of total billed charges 248.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 248.21 other OPPS APC 248.21 248.21 other OPPS APC 248.21 24.86 61.71 percent of total billed charges 248.21 248.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION RX-39744 CDM 250000000 HCPCS 0250 RC 00143-9784-10 NDC outpatient 5 ML 20.32 20.32 20.32 74 15.04 percent of total billed charges 20.32 93 16.46 percent of total billed charges 20.32 20.32 other OPPS APC 20.32 20.32 other OPPS APC 20.32 24.86 5.05 percent of total billed charges 20.32 20.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOBRAMYCIN 40 MG/ML INJECTION SOLUTION RX-39918 CDM J3260 HCPCS 0636 RC 67457-0473-22 NDC outpatient 2 ML 5.94 5.94 3.03 3.03 fee schedule 5.94 93 4.81 percent of total billed charges 5.94 5.94 other OPPS APC 5.94 5.94 other OPPS APC 5.94 24.86 1.48 percent of total billed charges 3.03 5.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOFLOXACIN 250 MG/10 ML ORAL SOLUTION RX-39970 CDM A9270 HCPCS 0250 RC 70954-0852-10 NDC outpatient 100 ML 802.53 802.53 74 593.87 percent of total billed charges 802.53 93 650.05 percent of total billed charges 802.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 802.53 other OPPS APC 802.53 802.53 other OPPS APC 802.53 24.86 199.51 percent of total billed charges 802.53 802.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOFLOXACIN 250 MG/10 ML ORAL SOLUTION RX-39970 CDM A9270 HCPCS 0637 RC 70954-0852-10 NDC outpatient 100 ML 802.53 802.53 802.53 74 593.87 percent of total billed charges 802.53 93 650.05 percent of total billed charges 802.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 802.53 other OPPS APC 802.53 802.53 other OPPS APC 802.53 24.86 199.51 percent of total billed charges 802.53 802.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET RX-40009 CDM A9270 HCPCS 0250 RC 51079-0599-20 NDC outpatient 1 UN 4.78 4.78 74 3.54 percent of total billed charges 4.78 93 3.87 percent of total billed charges 4.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.78 other OPPS APC 4.78 4.78 other OPPS APC 4.78 24.86 1.19 percent of total billed charges 4.78 4.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET RX-40009 CDM A9270 HCPCS 0637 RC 51079-0599-20 NDC outpatient 1 UN 4.78 4.78 4.78 74 3.54 percent of total billed charges 4.78 93 3.87 percent of total billed charges 4.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.78 other OPPS APC 4.78 4.78 other OPPS APC 4.78 24.86 1.19 percent of total billed charges 4.78 4.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET RX-40010 CDM A9270 HCPCS 0250 RC 60687-0629-21 NDC outpatient 1 UN 7 7 74 5.18 percent of total billed charges 7 93 5.67 percent of total billed charges 7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7 other OPPS APC 7 7 other OPPS APC 7 24.86 1.74 percent of total billed charges 7 7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET RX-40010 CDM A9270 HCPCS 0637 RC 60687-0629-21 NDC outpatient 1 UN 7 7 7 74 5.18 percent of total billed charges 7 93 5.67 percent of total billed charges 7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7 other OPPS APC 7 7 other OPPS APC 7 24.86 1.74 percent of total billed charges 7 7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM CHLORIDE 0.9 % IV BOLUS RX-400291 CDM J7030 HCPCS 0636 RC 00338-0049-04 NDC outpatient 1000 ML 14.77 14.77 2.9 2.9 fee schedule 14.77 93 11.96 percent of total billed charges 14.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.77 other OPPS APC 14.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.77 other OPPS APC 14.77 24.86 3.67 percent of total billed charges 2.9 14.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM CHLORIDE 0.45 % IV BOLUS RX-400292 CDM 250000000 HCPCS 0250 RC 00338-0043-04 NDC outpatient 1000 ML 18.78 18.78 18.78 74 13.9 percent of total billed charges 18.78 93 15.21 percent of total billed charges 18.78 18.78 other OPPS APC 18.78 18.78 other OPPS APC 18.78 24.86 4.67 percent of total billed charges 18.78 18.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 5 % IV BOLUS RX-400293 CDM J7060 HCPCS 0636 RC 00338-0017-02 NDC outpatient 250 ML 12.93 12.93 2.07 2.07 fee schedule 12.93 93 10.47 percent of total billed charges 12.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.93 other OPPS APC 12.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.93 other OPPS APC 12.93 24.86 3.21 percent of total billed charges 2.07 12.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 5 % IV BOLUS RX-400293 CDM J7060 HCPCS 0636 RC 00338-0017-03 NDC outpatient 500 ML 12.31 12.31 2.07 2.07 fee schedule 12.31 93 9.97 percent of total billed charges 12.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.31 other OPPS APC 12.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.31 other OPPS APC 12.31 24.86 3.06 percent of total billed charges 2.07 12.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 5 % IV BOLUS RX-400293 CDM J7070 HCPCS 0636 RC 00338-0017-04 NDC outpatient 1000 ML 16.6 16.6 4.14 4.14 fee schedule 16.6 93 13.45 percent of total billed charges 16.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.6 other OPPS APC 16.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.6 other OPPS APC 16.6 24.86 4.13 percent of total billed charges 4.14 16.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 5 % IV BOLUS RX-400293 CDM J7060 HCPCS 0636 RC 00338-0017-10 NDC outpatient 25 ML 8 8 2.07 2.07 fee schedule 8 93 6.48 percent of total billed charges 8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8 other OPPS APC 8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8 other OPPS APC 8 24.86 1.99 percent of total billed charges 2.07 8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 5 % IV BOLUS RX-400293 CDM J7060 HCPCS 0636 RC 00338-0017-31 NDC outpatient 50 ML 7.07 7.07 2.07 2.07 fee schedule 7.07 93 5.73 percent of total billed charges 7.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.07 other OPPS APC 7.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.07 other OPPS APC 7.07 24.86 1.76 percent of total billed charges 2.07 7.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 5 % IV BOLUS RX-400293 CDM J7060 HCPCS 0636 RC 00338-0017-38 NDC outpatient 100 ML 7.07 7.07 2.07 2.07 fee schedule 7.07 93 5.73 percent of total billed charges 7.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.07 other OPPS APC 7.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.07 other OPPS APC 7.07 24.86 1.76 percent of total billed charges 2.07 7.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 5 % AND 0.9 % NACL IV BOLUS RX-400294 CDM J7042 HCPCS 0636 RC 00264-7610-10 NDC outpatient 500 ML 12 12 1.34 1.34 fee schedule 12 93 9.72 percent of total billed charges 12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12 other OPPS APC 12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12 other OPPS APC 12 24.86 2.98 percent of total billed charges 1.34 12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 5 % AND 0.45 % NACL IV BOLUS RX-400295 CDM S5010 HCPCS 0250 RC 00338-0085-04 NDC outpatient 1000 ML 18.65 18.65 18.65 74 13.8 percent of total billed charges 18.65 93 15.11 percent of total billed charges 18.65 18.65 other OPPS APC 18.65 18.65 other OPPS APC 18.65 24.86 4.64 percent of total billed charges 18.65 18.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LACTATED RINGERS IV BOLUS RX-400296 CDM J7120 HCPCS 0636 RC 00338-0117-04 NDC outpatient 1000 ML 15.48 15.48 2.72 2.72 fee schedule 15.48 93 12.54 percent of total billed charges 15.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.48 other OPPS APC 15.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.48 other OPPS APC 15.48 24.86 3.85 percent of total billed charges 2.72 15.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 5 % IN LACTATED RINGERS IV BOLUS RX-400297 CDM J7121 HCPCS 0636 RC 00338-0125-04 NDC outpatient 1000 ML 17.87 17.87 17.87 74 13.22 percent of total billed charges 17.87 93 14.47 percent of total billed charges 17.87 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.87 other OPPS APC 17.87 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.87 other OPPS APC 17.87 24.86 4.44 percent of total billed charges 17.87 17.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 10 % IV BOLUS RX-400302 CDM 250000000 HCPCS 0250 RC 00338-0023-02 NDC outpatient 250 ML 19.05 19.05 19.05 74 14.1 percent of total billed charges 19.05 93 15.43 percent of total billed charges 19.05 19.05 other OPPS APC 19.05 19.05 other OPPS APC 19.05 24.86 4.74 percent of total billed charges 19.05 19.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM BICARBONATE 1 MEQ/ML INFUSION RX-400328 CDM 250000000 HCPCS 0250 RC 51754-5001-05 NDC outpatient 250 ML 131.25 131.25 131.25 74 97.13 percent of total billed charges 131.25 93 106.31 percent of total billed charges 131.25 131.25 other OPPS APC 131.25 131.25 other OPPS APC 131.25 24.86 32.63 percent of total billed charges 131.25 131.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENOBARBITAL IV SYRINGE 65 MG/ML (NEO/PED) RX-400610 CDM 250000000 HCPCS 0250 RC 00641-0476-21 NDC outpatient 1 ML 79.07 79.07 79.07 74 58.51 percent of total billed charges 79.07 93 64.05 percent of total billed charges 79.07 79.07 other OPPS APC 79.07 79.07 other OPPS APC 79.07 24.86 19.66 percent of total billed charges 79.07 79.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MISOPROSTOL 25 MCG PO PARTIAL TABLET RX-400620 CDM A9270 HCPCS 0250 RC 90000-0002-17 NDC outpatient 1 UN 0.73 0.73 74 0.54 percent of total billed charges 0.73 93 0.59 percent of total billed charges 0.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.73 other OPPS APC 0.73 0.73 other OPPS APC 0.73 24.86 0.18 percent of total billed charges 0.73 0.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MISOPROSTOL 25 MCG PO PARTIAL TABLET RX-400620 CDM A9270 HCPCS 0637 RC 90000-0002-17 NDC outpatient 1 UN 0.73 0.73 0.73 74 0.54 percent of total billed charges 0.73 93 0.59 percent of total billed charges 0.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.73 other OPPS APC 0.73 0.73 other OPPS APC 0.73 24.86 0.18 percent of total billed charges 0.73 0.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION RX-40120 CDM J2323 HCPCS 0636 RC 64406-0008-01 NDC outpatient 15 ML 24628 24628 8515.98 8515.98 fee schedule 24628 93 19948.7 percent of total billed charges 24628 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7246.2 other OPPS APC 24628 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7246.2 other OPPS APC 24628 24.86 6122.53 percent of total billed charges 8515.98 24628 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ISONIAZID 100 MG TABLET RX-4026 CDM A9270 HCPCS 0250 RC 00555-0066-02 NDC outpatient 1 UN 0.37 0.37 74 0.27 percent of total billed charges 0.37 93 0.3 percent of total billed charges 0.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.37 other OPPS APC 0.37 0.37 other OPPS APC 0.37 24.86 0.09 percent of total billed charges 0.37 0.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ISONIAZID 100 MG TABLET RX-4026 CDM A9270 HCPCS 0637 RC 00555-0066-02 NDC outpatient 1 UN 0.37 0.37 0.37 74 0.27 percent of total billed charges 0.37 93 0.3 percent of total billed charges 0.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.37 other OPPS APC 0.37 0.37 other OPPS APC 0.37 24.86 0.09 percent of total billed charges 0.37 0.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ISONIAZID 300 MG TABLET RX-4027 CDM A9270 HCPCS 0250 RC 00555-0071-01 NDC outpatient 1 UN 1.27 1.27 74 0.94 percent of total billed charges 1.27 93 1.03 percent of total billed charges 1.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.27 other OPPS APC 1.27 1.27 other OPPS APC 1.27 24.86 0.32 percent of total billed charges 1.27 1.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ISONIAZID 300 MG TABLET RX-4027 CDM A9270 HCPCS 0637 RC 00555-0071-01 NDC outpatient 1 UN 1.27 1.27 1.27 74 0.94 percent of total billed charges 1.27 93 1.03 percent of total billed charges 1.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.27 other OPPS APC 1.27 1.27 other OPPS APC 1.27 24.86 0.32 percent of total billed charges 1.27 1.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION RX-403 CDM 250000000 HCPCS 0250 RC 00409-4346-73 NDC outpatient 20 ML 21.84 21.84 21.84 74 16.16 percent of total billed charges 21.84 93 17.69 percent of total billed charges 21.84 21.84 other OPPS APC 21.84 21.84 other OPPS APC 21.84 24.86 5.43 percent of total billed charges 21.84 21.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION RX-40475 CDM J9264 HCPCS 0636 RC 00480-3290-01 NDC outpatient 20 ML 4800 4800 1375.77 1375.77 fee schedule 4800 93 3888 percent of total billed charges 4800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1334.4 other OPPS APC 4800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1334.4 other OPPS APC 4800 24.86 1193.28 percent of total billed charges 1375.77 4800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ISOSORBIDE DINITRATE 10 MG TABLET RX-4064 CDM A9270 HCPCS 0250 RC 00904-6619-61 NDC outpatient 1 UN 1.83 1.83 74 1.35 percent of total billed charges 1.83 93 1.48 percent of total billed charges 1.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.83 other OPPS APC 1.83 1.83 other OPPS APC 1.83 24.86 0.45 percent of total billed charges 1.83 1.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ISOSORBIDE DINITRATE 10 MG TABLET RX-4064 CDM A9270 HCPCS 0637 RC 00904-6619-61 NDC outpatient 1 UN 1.83 1.83 1.83 74 1.35 percent of total billed charges 1.83 93 1.48 percent of total billed charges 1.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.83 other OPPS APC 1.83 1.83 other OPPS APC 1.83 24.86 0.45 percent of total billed charges 1.83 1.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ISOSORBIDE DINITRATE 5 MG TABLET RX-4068 CDM A9270 HCPCS 0250 RC 50268-0447-15 NDC outpatient 1 UN 2.66 2.66 74 1.97 percent of total billed charges 2.66 93 2.15 percent of total billed charges 2.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.66 other OPPS APC 2.66 2.66 other OPPS APC 2.66 24.86 0.66 percent of total billed charges 2.66 2.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ISOSORBIDE DINITRATE 5 MG TABLET RX-4068 CDM A9270 HCPCS 0637 RC 50268-0447-15 NDC outpatient 1 UN 2.66 2.66 2.66 74 1.97 percent of total billed charges 2.66 93 2.15 percent of total billed charges 2.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.66 other OPPS APC 2.66 2.66 other OPPS APC 2.66 24.86 0.66 percent of total billed charges 2.66 2.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE PROPIONATE 44 MCG/ACTUATION HFA AEROSOL INHALER RX-40697 CDM A9270 HCPCS 0250 RC 66993-0078-96 NDC outpatient 10.6 GR 582.95 582.95 74 431.38 percent of total billed charges 582.95 93 472.19 percent of total billed charges 582.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 582.95 other OPPS APC 582.95 582.95 other OPPS APC 582.95 24.86 144.92 percent of total billed charges 582.95 582.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE PROPIONATE 44 MCG/ACTUATION HFA AEROSOL INHALER RX-40697 CDM A9270 HCPCS 0637 RC 66993-0078-96 NDC outpatient 10.6 GR 582.95 582.95 582.95 74 431.38 percent of total billed charges 582.95 93 472.19 percent of total billed charges 582.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 582.95 other OPPS APC 582.95 582.95 other OPPS APC 582.95 24.86 144.92 percent of total billed charges 582.95 582.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER RX-40698 CDM A9270 HCPCS 0250 RC 66993-0079-96 NDC outpatient 12 GR 780.43 780.43 74 577.52 percent of total billed charges 780.43 93 632.15 percent of total billed charges 780.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 780.43 other OPPS APC 780.43 780.43 other OPPS APC 780.43 24.86 194.01 percent of total billed charges 780.43 780.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER RX-40698 CDM A9270 HCPCS 0637 RC 66993-0079-96 NDC outpatient 12 GR 780.43 780.43 780.43 74 577.52 percent of total billed charges 780.43 93 632.15 percent of total billed charges 780.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 780.43 other OPPS APC 780.43 780.43 other OPPS APC 780.43 24.86 194.01 percent of total billed charges 780.43 780.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER RX-40699 CDM A9270 HCPCS 0250 RC 66993-0080-96 NDC outpatient 12 GR 1212.2 1212.2 74 897.03 percent of total billed charges 1212.2 93 981.88 percent of total billed charges 1212.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1212.2 other OPPS APC 1212.2 1212.2 other OPPS APC 1212.2 24.86 301.35 percent of total billed charges 1212.2 1212.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER RX-40699 CDM A9270 HCPCS 0637 RC 66993-0080-96 NDC outpatient 12 GR 1212.2 1212.2 1212.2 74 897.03 percent of total billed charges 1212.2 93 981.88 percent of total billed charges 1212.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1212.2 other OPPS APC 1212.2 1212.2 other OPPS APC 1212.2 24.86 301.35 percent of total billed charges 1212.2 1212.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION RX-407 CDM J0280 HCPCS 0636 RC 00409-5921-01 NDC outpatient 10 ML 49.58 49.58 5.14 5.14 fee schedule 49.58 93 40.16 percent of total billed charges 49.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 49.58 other OPPS APC 49.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 49.58 other OPPS APC 49.58 24.86 12.33 percent of total billed charges 5.14 49.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (REMICADE) RX-4080000000 CDM J1745 HCPCS 0636 RC 57894-0030-01 NDC outpatient 10 ML 3503.45 3503.45 375.58 375.58 fee schedule 3503.45 93 2837.79 percent of total billed charges 3503.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 322.23 other OPPS APC 3503.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 322.23 other OPPS APC 3503.45 24.86 870.96 percent of total billed charges 375.58 3503.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION (PROCRIT)" RX-4080000002 CDM J0885 HCPCS 0635 RC 59676-0320-04 NDC outpatient 1 ML 1603.5 1603.5 157.06 157.06 fee schedule 1603.5 93 1298.84 percent of total billed charges 1603.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 150.56 other OPPS APC 1603.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 150.56 other OPPS APC 1603.5 51 817.79 percent of total billed charges 157.06 1603.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "EPOETIN ALFA 3,000 UNIT/ML INJECTION SOLUTION (PROCRIT)" RX-4080000003 CDM J0885 HCPCS 0635 RC 59676-0303-01 NDC outpatient 1 ML 240.55 240.55 23.56 23.56 fee schedule 240.55 93 194.85 percent of total billed charges 240.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.58 other OPPS APC 240.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.58 other OPPS APC 240.55 51 122.68 percent of total billed charges 23.56 240.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "EPOETIN ALFA 4,000 UNIT/ML INJECTION SOLUTION (PROCRIT)" RX-4080000004 CDM J0885 HCPCS 0635 RC 59676-0304-01 NDC outpatient 1 ML 320.7 320.7 31.41 31.41 fee schedule 320.7 93 259.77 percent of total billed charges 320.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.11 other OPPS APC 320.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.11 other OPPS APC 320.7 51 163.56 percent of total billed charges 31.41 320.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION (PROCRIT)" RX-4080000005 CDM J0885 HCPCS 0635 RC 59676-0340-01 NDC outpatient 1 ML 3207 3207 314.12 314.12 fee schedule 3207 93 2597.67 percent of total billed charges 3207 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301.12 other OPPS APC 3207 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301.12 other OPPS APC 3207 51 1635.57 percent of total billed charges 314.12 3207 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION (PROCRIT)" RX-4080000011 CDM J0885 HCPCS 0636 RC 59676-0310-01 NDC outpatient 1 ML 801.75 801.75 78.53 78.53 fee schedule 801.75 93 649.42 percent of total billed charges 801.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 75.28 other OPPS APC 801.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 75.28 other OPPS APC 801.75 24.86 199.32 percent of total billed charges 78.53 801.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "EPOETIN ALFA 2,000 UNIT/ML INJECTION SOLUTION (PROCRIT)" RX-4080000012 CDM J0885 HCPCS 0636 RC 59676-0302-00 NDC outpatient 1 ML 160.38 160.38 15.71 15.71 fee schedule 160.38 93 129.91 percent of total billed charges 160.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.06 other OPPS APC 160.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.06 other OPPS APC 160.38 24.86 39.87 percent of total billed charges 15.71 160.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENDAMUSTINE 25 MG/ML INTRAVENOUS SOLUTION (BENDEKA) RX-4080000015 CDM J9034 HCPCS 0636 RC 63459-0348-04 NDC outpatient 4 ML 7421.4 7421.4 1883.97 1883.97 fee schedule 7421.4 93 6011.33 percent of total billed charges 7421.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1294.6 other OPPS APC 7421.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1294.6 other OPPS APC 7421.4 24.86 1844.96 percent of total billed charges 1883.97 7421.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMUNE GLOBU G 5 GRAM/50 ML(10 %)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN (GAMUNEX-C) RX-4080000018 CDM J1561 HCPCS 0636 RC 13533-0800-20 NDC outpatient 5 GR 1951.8 1951.8 578.02 578.02 fee schedule 1951.8 93 1580.96 percent of total billed charges 1951.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.05 other OPPS APC 1951.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.05 other OPPS APC 1951.8 24.86 485.22 percent of total billed charges 578.02 1951.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMUNE GLOBU G 5 GRAM/50 ML(10 %)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN (GAMUNEX-C) RX-4080000018 CDM J1561 HCPCS 0636 RC 13533-0800-20 NDC outpatient 50 ML 1951.8 1951.8 578.02 578.02 fee schedule 1951.8 93 1580.96 percent of total billed charges 1951.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.05 other OPPS APC 1951.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.05 other OPPS APC 1951.8 24.86 485.22 percent of total billed charges 578.02 1951.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMUNE GLOB G 10 GRAM/100 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN (GAMUNEX-C) RX-4080000023 CDM J1561 HCPCS 0636 RC 13533-0800-71 NDC outpatient 10 GR 4107.6 4107.6 1156.03 1156.03 fee schedule 4107.6 93 3327.16 percent of total billed charges 4107.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 976.1 other OPPS APC 4107.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 976.1 other OPPS APC 4107.6 24.86 1021.15 percent of total billed charges 1156.03 4107.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMUNE GLOB G 10 GRAM/100 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN (GAMUNEX-C) RX-4080000023 CDM J1561 HCPCS 0636 RC 13533-0800-71 NDC outpatient 100 ML 4107.6 4107.6 1156.03 1156.03 fee schedule 4107.6 93 3327.16 percent of total billed charges 4107.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 976.1 other OPPS APC 4107.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 976.1 other OPPS APC 4107.6 24.86 1021.15 percent of total billed charges 1156.03 4107.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN (GAMUNEX-C) RX-4080000025 CDM J1561 HCPCS 0636 RC 13533-0800-24 NDC outpatient 20 GR 7807.2 7807.2 2312.07 2312.07 fee schedule 7807.2 93 6323.83 percent of total billed charges 7807.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1952.2 other OPPS APC 7807.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1952.2 other OPPS APC 7807.2 24.86 1940.87 percent of total billed charges 2312.07 7807.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN (GAMUNEX-C) RX-4080000025 CDM J1561 HCPCS 0636 RC 13533-0800-24 NDC outpatient 200 ML 7807.2 7807.2 2312.07 2312.07 fee schedule 7807.2 93 6323.83 percent of total billed charges 7807.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1952.2 other OPPS APC 7807.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1952.2 other OPPS APC 7807.2 24.86 1940.87 percent of total billed charges 2312.07 7807.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN (GAMUNEX-C) RX-4080000026 CDM J1561 HCPCS 0636 RC 13533-0800-40 NDC outpatient 40 GR 16430.4 16430.4 4624.14 4624.14 fee schedule 16430.4 93 13308.6 percent of total billed charges 16430.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3904.4 other OPPS APC 16430.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3904.4 other OPPS APC 16430.4 24.86 4084.6 percent of total billed charges 4624.14 16430.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN (GAMUNEX-C) RX-4080000026 CDM J1561 HCPCS 0636 RC 13533-0800-40 NDC outpatient 400 ML 16430.4 16430.4 4624.14 4624.14 fee schedule 16430.4 93 13308.6 percent of total billed charges 16430.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3904.4 other OPPS APC 16430.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3904.4 other OPPS APC 16430.4 24.86 4084.6 percent of total billed charges 4624.14 16430.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEUPROLIDE ACETATE 45 MG (6 MONTH) SUBCUTANEOUS SYRINGE RX-40801 CDM J9217 HCPCS 0636 RC 62935-0461-50 NDC outpatient 45 ME 8130.4 8130.4 1135.97 1135.97 fee schedule 8130.4 93 6585.62 percent of total billed charges 8130.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1059.06 other OPPS APC 8130.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1059.06 other OPPS APC 8130.4 24.86 2021.22 percent of total billed charges 1135.97 8130.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FAMOTIDINE 8 MG/ML ORAL SYRINGE RX-408100101 CDM A9270 HCPCS 0250 RC 70954-0316-10 NDC outpatient 50 ML 442.38 442.38 74 327.36 percent of total billed charges 442.38 93 358.33 percent of total billed charges 442.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 442.38 other OPPS APC 442.38 442.38 other OPPS APC 442.38 24.86 109.98 percent of total billed charges 442.38 442.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FAMOTIDINE 8 MG/ML ORAL SYRINGE RX-408100101 CDM A9270 HCPCS 0637 RC 70954-0316-10 NDC outpatient 50 ML 442.38 442.38 442.38 74 327.36 percent of total billed charges 442.38 93 358.33 percent of total billed charges 442.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 442.38 other OPPS APC 442.38 442.38 other OPPS APC 442.38 24.86 109.98 percent of total billed charges 442.38 442.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FAT EMULSION 20 % INFUSION RX-408100141 CDM 250000000 HCPCS 0250 RC 00264-4460-10 NDC outpatient 500 ML 96.84 96.84 96.84 74 71.66 percent of total billed charges 96.84 93 78.44 percent of total billed charges 96.84 96.84 other OPPS APC 96.84 96.84 other OPPS APC 96.84 24.86 24.07 percent of total billed charges 96.84 96.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENTAMICIN IV SYRINGE 2 MG/ML (STRAIGHT DRAW) RX-408101121 CDM J1580 HCPCS 0636 RC 00338-0511-41 NDC outpatient 100 ME 12.45 12.45 6.82 6.82 fee schedule 12.45 93 10.08 percent of total billed charges 12.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.45 other OPPS APC 12.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.45 other OPPS APC 12.45 24.86 3.1 percent of total billed charges 6.82 12.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENTAMICIN IV SYRINGE 2 MG/ML (STRAIGHT DRAW) RX-408101121 CDM J1580 HCPCS 0636 RC 00338-0511-41 NDC outpatient 50 ML 12.45 12.45 6.82 6.82 fee schedule 12.45 93 10.08 percent of total billed charges 12.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.45 other OPPS APC 12.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.45 other OPPS APC 12.45 24.86 3.1 percent of total billed charges 6.82 12.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENTAMICIN IV SYRINGE 2 MG/ML (STRAIGHT DRAW)|DISCARDED DRUG NOT ADMINISTERED RX-408101121 CDM J1580 HCPCS 0636 RC 00338-0511-41 NDC JW outpatient 100 ME 12.45 12.45 3.41 3.41 fee schedule 3.41 12.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN - PTT CALCULATOR RX-408101761 CDM J1644 HCPCS 0636 RC 63739-0920-25 NDC outpatient 1 ML 7.53 7.53 0.3 0.3 fee schedule 7.53 93 6.1 percent of total billed charges 7.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.53 other OPPS APC 7.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.53 other OPPS APC 7.53 24.86 1.87 percent of total billed charges 0.3 7.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION WRAPPER RX-408104208 CDM J2001 HCPCS 0250 RC 55150-0165-05 NDC outpatient 5 ML 9 9 9 74 6.66 percent of total billed charges 9 93 7.29 percent of total billed charges 9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9 other OPPS APC 9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9 other OPPS APC 9 24.86 2.24 percent of total billed charges 9 9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION WRAPPER RX-408104208 CDM J2003 HCPCS 0250 RC 55150-0165-05 NDC outpatient 5 ML 9 9 9 74 6.66 percent of total billed charges 9 93 7.29 percent of total billed charges 9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9 other OPPS APC 9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9 other OPPS APC 9 24.86 2.24 percent of total billed charges 9 9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION WRAPPER" RX-408104311 CDM 250000000 HCPCS 0250 RC 63323-0489-02 NDC outpatient 20 ML 61.83 61.83 61.83 74 45.75 percent of total billed charges 61.83 93 50.08 percent of total billed charges 61.83 61.83 other OPPS APC 61.83 61.83 other OPPS APC 61.83 24.86 15.37 percent of total billed charges 61.83 61.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LORAZEPAM 2 MG/ML INJECTION WRAPPER RX-4081046701 CDM J2060 HCPCS 0636 RC 00641-6001-25 NDC outpatient 1 ML 5.71 5.71 0.97 0.97 fee schedule 5.71 93 4.63 percent of total billed charges 5.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.71 other OPPS APC 5.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.71 other OPPS APC 5.71 24.86 1.42 percent of total billed charges 0.97 5.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIDAZOLAM 5 MG/ML INTRANASAL SOLUTION RX-408106081 CDM J2250 HCPCS 0636 RC 00641-6061-01 NDC outpatient 1 ML 3.6 3.6 0.79 0.79 fee schedule 3.6 93 2.92 percent of total billed charges 3.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.6 other OPPS APC 3.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.6 other OPPS APC 3.6 24.86 0.89 percent of total billed charges 0.79 3.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION WRAPPER RX-4081063491 CDM J2405 HCPCS 0636 RC 36000-0012-25 NDC outpatient 2 ML 2.7 2.7 0.48 0.48 fee schedule 2.7 93 2.19 percent of total billed charges 2.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.7 other OPPS APC 2.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.7 other OPPS APC 2.7 24.86 0.67 percent of total billed charges 0.48 2.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOCETAXEL 20 MG/ML INTRAVENOUS SOLUTION WRAPPER RX-40810644301 CDM J9171 HCPCS 0636 RC 47335-0895-40 NDC outpatient 4 ML 3651.5 3651.5 85.18 85.18 fee schedule 3651.5 93 2957.72 percent of total billed charges 3651.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3651.5 other OPPS APC 3651.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3651.5 other OPPS APC 3651.5 24.86 907.76 percent of total billed charges 85.18 3651.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUCONAZOLE IVPB CUSTOM RX-4081070 CDM J1450 HCPCS 0636 RC 00338-6046-48 NDC outpatient 100 ML 55.99 55.99 3.06 3.06 fee schedule 55.99 93 45.35 percent of total billed charges 55.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.99 other OPPS APC 55.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.99 other OPPS APC 55.99 24.86 13.92 percent of total billed charges 3.06 55.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENICILLIN G BENZATHINE CUSTOM SYRINGE RX-4081080491 CDM J0561 HCPCS 0636 RC 60793-0701-10 NDC outpatient 2 ML 914.97 914.97 276.32 276.32 fee schedule 914.97 93 741.13 percent of total billed charges 914.97 914.97 other OPPS APC 914.97 914.97 other OPPS APC 914.97 24.86 227.46 percent of total billed charges 276.32 914.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG 3350-ELECTROLYTES 236-22.74-6.74-5.86 G SOLN 1 L RX-408108391 CDM A9270 HCPCS 0250 RC 90000-0002-01 NDC outpatient 1000 ML 6.17 6.17 74 4.57 percent of total billed charges 6.17 93 5 percent of total billed charges 6.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.17 other OPPS APC 6.17 6.17 other OPPS APC 6.17 24.86 1.53 percent of total billed charges 6.17 6.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG 3350-ELECTROLYTES 236-22.74-6.74-5.86 G SOLN 1 L RX-408108391 CDM A9270 HCPCS 0637 RC 90000-0002-01 NDC outpatient 1000 ML 6.17 6.17 6.17 74 4.57 percent of total billed charges 6.17 93 5 percent of total billed charges 6.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.17 other OPPS APC 6.17 6.17 other OPPS APC 6.17 24.86 1.53 percent of total billed charges 6.17 6.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG 3350-ELECTROLYTES 236-22.74-6.74-5.86 G SOLN 2 L RX-408108392 CDM A9270 HCPCS 0250 RC 90000-0002-02 NDC outpatient 2000 ML 12.33 12.33 74 9.12 percent of total billed charges 12.33 93 9.99 percent of total billed charges 12.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.33 other OPPS APC 12.33 12.33 other OPPS APC 12.33 24.86 3.07 percent of total billed charges 12.33 12.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG 3350-ELECTROLYTES 236-22.74-6.74-5.86 G SOLN 2 L RX-408108392 CDM A9270 HCPCS 0637 RC 90000-0002-02 NDC outpatient 2000 ML 12.33 12.33 12.33 74 9.12 percent of total billed charges 12.33 93 9.99 percent of total billed charges 12.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.33 other OPPS APC 12.33 12.33 other OPPS APC 12.33 24.86 3.07 percent of total billed charges 12.33 12.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG 3350-ELECTROLYTES 236-22.74-6.74-5.86 G SOLN 3 L RX-408108393 CDM A9270 HCPCS 0250 RC 90000-0002-12 NDC outpatient 3000 ML 18.49 18.49 74 13.68 percent of total billed charges 18.49 93 14.98 percent of total billed charges 18.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.49 other OPPS APC 18.49 18.49 other OPPS APC 18.49 24.86 4.6 percent of total billed charges 18.49 18.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG 3350-ELECTROLYTES 236-22.74-6.74-5.86 G SOLN 3 L RX-408108393 CDM A9270 HCPCS 0637 RC 90000-0002-12 NDC outpatient 3000 ML 18.49 18.49 18.49 74 13.68 percent of total billed charges 18.49 93 14.98 percent of total billed charges 18.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.49 other OPPS APC 18.49 18.49 other OPPS APC 18.49 24.86 4.6 percent of total billed charges 18.49 18.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG 3350-ELECTROLYTES 236-22.74-6.74-5.86 G SOLN 500 ML RX-408108394 CDM A9270 HCPCS 0250 RC outpatient 500 ML 30.7 30.7 74 22.72 percent of total billed charges 30.7 93 24.87 percent of total billed charges 30.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.7 other OPPS APC 30.7 30.7 other OPPS APC 30.7 24.86 7.63 percent of total billed charges 30.7 30.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG 3350-ELECTROLYTES 236-22.74-6.74-5.86 G SOLN 500 ML RX-408108394 CDM A9270 HCPCS 0637 RC outpatient 500 ML 30.7 30.7 30.7 74 22.72 percent of total billed charges 30.7 93 24.87 percent of total billed charges 30.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.7 other OPPS APC 30.7 30.7 other OPPS APC 30.7 24.86 7.63 percent of total billed charges 30.7 30.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IPILIMUMAB 5 MG/ML INTRAVENOUS SOLUTION WRAPPER RX-40810895501 CDM J9228 HCPCS 0636 RC 00003-2327-11 NDC outpatient 10 ML 26109.4 26109.4 9585.02 9585.02 fee schedule 26109.4 93 21148.6 percent of total billed charges 26109.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8844.2 other OPPS APC 26109.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8844.2 other OPPS APC 26109.4 24.86 6490.8 percent of total billed charges 9585.02 26109.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAFFEINE CITRATED IV SYRINGE (NEO/PED) RX-40810903401 CDM 250000000 HCPCS 0250 RC 63323-0407-03 NDC outpatient 3 ML 93.4 93.4 93.4 74 69.12 percent of total billed charges 93.4 93 75.65 percent of total billed charges 93.4 93.4 other OPPS APC 93.4 93.4 other OPPS APC 93.4 24.86 23.22 percent of total billed charges 93.4 93.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROPOFOL 10 MG/ML BOLUS RX-408111501 CDM J2704 HCPCS 0636 RC 00409-6010-25 NDC outpatient 20 ML 12.97 12.97 2.18 2.18 fee schedule 12.97 93 10.51 percent of total billed charges 12.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.97 other OPPS APC 12.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.97 other OPPS APC 12.97 24.86 3.22 percent of total billed charges 2.18 12.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML INTRAMUSCULAR SOLUTION 2 ML RX-40811256 CDM 90377 HCPCS 0636 RC 76125-0150-02 NDC outpatient 2 ML 2236.85 2236.85 534.43 534.43 fee schedule 2236.85 93 1811.85 percent of total billed charges 2236.85 2236.85 other OPPS APC 2236.85 2236.85 other OPPS APC 2236.85 24.86 556.08 percent of total billed charges 534.43 2236.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMORPHONE 1 MG/ML INJECTION SYRINGE (PACU) RX-4081168061 CDM J1170 HCPCS 0636 RC 00409-1283-03 NDC outpatient 1 ML 7.8 7.8 4.96 4.96 fee schedule 7.8 93 6.32 percent of total billed charges 7.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.8 other OPPS APC 7.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.8 other OPPS APC 7.8 24.86 1.94 percent of total billed charges 4.96 7.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMORPHONE 1 MG/ML INJECTION SYRINGE (PACU) RX-4081168061 CDM J1171 HCPCS 0636 RC 00409-1283-03 NDC outpatient 1 ML 7.8 7.8 4.96 4.96 fee schedule 7.8 93 6.32 percent of total billed charges 7.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.8 other OPPS APC 7.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.8 other OPPS APC 7.8 24.86 1.94 percent of total billed charges 4.96 7.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMORPHONE 2 MG/ML INJECTION SYRINGE (PACU) RX-4081168071 CDM J1170 HCPCS 0636 RC 00409-1312-03 NDC outpatient 1 ML 10.1 10.1 4.96 4.96 fee schedule 10.1 93 8.18 percent of total billed charges 10.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.1 other OPPS APC 10.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.1 other OPPS APC 10.1 24.86 2.51 percent of total billed charges 4.96 10.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMORPHONE 2 MG/ML INJECTION SYRINGE (PACU) RX-4081168071 CDM J1171 HCPCS 0636 RC 00409-1312-03 NDC outpatient 1 ML 10.1 10.1 4.96 4.96 fee schedule 10.1 93 8.18 percent of total billed charges 10.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.1 other OPPS APC 10.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.1 other OPPS APC 10.1 24.86 2.51 percent of total billed charges 4.96 10.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADENOSINE IN 0.9% SODIUM CHLORIDE SIMPLE (CATH LAB) RX-40811801 CDM J0153 HCPCS 0636 RC 90000-0001-96 NDC outpatient 500 ML 3.06 3.06 3.09 3.09 fee schedule 3.06 93 2.48 percent of total billed charges 3.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.06 other OPPS APC 3.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.06 other OPPS APC 3.06 24.86 0.76 percent of total billed charges 3.06 3.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE 2 MG/ML INTRAVENOUS SYRINGE (PACU) RX-4081191461 CDM J2270 HCPCS 0636 RC 00409-1890-01 NDC outpatient 1 ML 6.39 6.39 5.25 5.25 fee schedule 6.39 93 5.18 percent of total billed charges 6.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.39 other OPPS APC 6.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.39 other OPPS APC 6.39 24.86 1.59 percent of total billed charges 5.25 6.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTAZIDIME 22.5 MG/ML SOLUTION FOR INJECTION (FOR CNR) RX-408119511 CDM 636000000 HCPCS 0636 RC 90000-0003-94 NDC outpatient 44.4 ML 33 33 33 74 24.42 percent of total billed charges 33 93 26.73 percent of total billed charges 33 33 other OPPS APC 33 33 other OPPS APC 33 24.86 8.2 percent of total billed charges 33 33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLINDAMYCIN 75 MG/5 ML ORAL SYRINGE RX-4081204651 CDM A9270 HCPCS 0250 RC 16714-0483-01 NDC outpatient 100 ML 155.2 155.2 74 114.85 percent of total billed charges 155.2 93 125.71 percent of total billed charges 155.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 155.2 other OPPS APC 155.2 155.2 other OPPS APC 155.2 24.86 38.58 percent of total billed charges 155.2 155.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLINDAMYCIN 75 MG/5 ML ORAL SYRINGE RX-4081204651 CDM A9270 HCPCS 0637 RC 16714-0483-01 NDC outpatient 100 ML 155.2 155.2 155.2 74 114.85 percent of total billed charges 155.2 93 125.71 percent of total billed charges 155.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 155.2 other OPPS APC 155.2 155.2 other OPPS APC 155.2 24.86 38.58 percent of total billed charges 155.2 155.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION (NO RECON) RX-4081206831 CDM J0697 HCPCS 0636 RC 00143-9977-22 NDC outpatient 1.5 GR 17.54 17.54 5.11 5.11 fee schedule 17.54 93 14.21 percent of total billed charges 17.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.54 other OPPS APC 17.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.54 other OPPS APC 17.54 24.86 4.36 percent of total billed charges 5.11 17.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MILRINONE IV SYRINGE (NEO/PED) RX-4081210 CDM 250000000 HCPCS 0250 RC 00000-0000-18 NDC outpatient 50 ML 51.34 51.34 51.34 74 37.99 percent of total billed charges 51.34 93 41.59 percent of total billed charges 51.34 51.34 other OPPS APC 51.34 51.34 other OPPS APC 51.34 24.86 12.76 percent of total billed charges 51.34 51.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN ORAL SYRINGE 25 MG/ML RX-4081216 CDM A9270 HCPCS 0250 RC 00000-0000-15 NDC outpatient 800 ML 830 830 74 614.2 percent of total billed charges 830 93 672.3 percent of total billed charges 830 830 other OPPS APC 830 830 other OPPS APC 830 24.86 206.34 percent of total billed charges 830 830 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN ORAL SYRINGE 25 MG/ML RX-4081216 CDM A9270 HCPCS 0637 RC 00000-0000-15 NDC outpatient 800 ML 830 830 830 74 614.2 percent of total billed charges 830 93 672.3 percent of total billed charges 830 830 other OPPS APC 830 830 other OPPS APC 830 24.86 206.34 percent of total billed charges 830 830 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXMEDETOMIDINE 4 MCG/ML IN NACL PREMIX WRAPPER RX-40812173101 CDM 250000000 HCPCS 0250 RC 42023-0187-10 NDC outpatient 100 ML 240 240 240 74 177.6 percent of total billed charges 240 93 194.4 percent of total billed charges 240 240 other OPPS APC 240 240 other OPPS APC 240 24.86 59.66 percent of total billed charges 240 240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION (NO DILUTION) RX-4081230701 CDM J9041 HCPCS 0636 RC 00143-9098-01 NDC outpatient 3.5 ME 105 105 121.12 121.12 fee schedule 105 93 85.05 percent of total billed charges 105 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.02 other OPPS APC 105 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.02 other OPPS APC 105 24.86 26.1 percent of total billed charges 105 121.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALANCED SALT SOLUTION NO.2 IRRIGATION (15 ML) RX-4081234391 CDM A9270 HCPCS 0250 RC 00065-0795-15 NDC outpatient 15 ML 36.48 36.48 74 27 percent of total billed charges 36.48 93 29.55 percent of total billed charges 36.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36.48 other OPPS APC 36.48 36.48 other OPPS APC 36.48 24.86 9.07 percent of total billed charges 36.48 36.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALANCED SALT SOLUTION NO.2 IRRIGATION (15 ML) RX-4081234391 CDM A9270 HCPCS 0637 RC 00065-0795-15 NDC outpatient 15 ML 36.48 36.48 36.48 74 27 percent of total billed charges 36.48 93 29.55 percent of total billed charges 36.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36.48 other OPPS APC 36.48 36.48 other OPPS APC 36.48 24.86 9.07 percent of total billed charges 36.48 36.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMORPHONE (PF) 100 MCG/0.3 ML EPIDURAL BOLUS RX-4081253111 CDM J1170 HCPCS 0636 RC 90000-0003-21 NDC outpatient 0.3 ML 1.08 1.08 4.96 4.96 fee schedule 1.08 93 0.87 percent of total billed charges 1.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.08 other OPPS APC 1.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.08 other OPPS APC 1.08 24.86 0.27 percent of total billed charges 1.08 4.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMORPHONE (PF) 100 MCG/0.3 ML EPIDURAL BOLUS RX-4081253111 CDM J1171 HCPCS 0636 RC 90000-0003-21 NDC outpatient 0.3 ML 1.08 1.08 4.96 4.96 fee schedule 1.08 93 0.87 percent of total billed charges 1.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.08 other OPPS APC 1.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.08 other OPPS APC 1.08 24.86 0.27 percent of total billed charges 1.08 4.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TECHNETIUM TC 99M FILTERED SULFUR COLLOID RX-4081263 CDM A9541 HCPCS 0343 RC 99990-4084-64 NDC outpatient 4 UN 1120 1120 1120 74 828.8 percent of total billed charges 1120 93 907.2 percent of total billed charges 1120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1120 other OPPS APC 1120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1120 other OPPS APC 1120 24.86 278.43 percent of total billed charges 1120 1120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TC-99M-EXEMETAZIME TAGGED WBC RX-4081264 CDM A9569 HCPCS 0343 RC outpatient 1.01818 UN 5778 5778 5778 74 4275.72 percent of total billed charges 5778 93 4680.18 percent of total billed charges 5778 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5778 other OPPS APC 5778 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5778 other OPPS APC 5778 24.86 1436.41 percent of total billed charges 5778 5778 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAGNESIUM SULFATE CUSTOM IVPB FROM 2G/50ML RX-4081264661 CDM J3475 HCPCS 0636 RC 63323-0106-02 NDC outpatient 2 GR 38.49 38.49 4.26 4.26 fee schedule 38.49 93 31.18 percent of total billed charges 38.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.49 other OPPS APC 38.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.49 other OPPS APC 38.49 24.86 9.57 percent of total billed charges 4.26 38.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAGNESIUM SULFATE CUSTOM IVPB FROM 2G/50ML RX-4081264661 CDM J3475 HCPCS 0636 RC 63323-0106-02 NDC outpatient 50 ML 38.49 38.49 4.26 4.26 fee schedule 38.49 93 31.18 percent of total billed charges 38.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.49 other OPPS APC 38.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.49 other OPPS APC 38.49 24.86 9.57 percent of total billed charges 4.26 38.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR (FOR SHORTAGE) RX-4081271931 CDM A9270 HCPCS 0250 RC 76329-3015-05 NDC outpatient 20 ML 30.51 30.51 74 22.58 percent of total billed charges 30.51 93 24.71 percent of total billed charges 30.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.51 other OPPS APC 30.51 30.51 other OPPS APC 30.51 24.86 7.58 percent of total billed charges 30.51 30.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR (FOR SHORTAGE) RX-4081271931 CDM A9270 HCPCS 0637 RC 76329-3015-05 NDC outpatient 20 ML 30.51 30.51 30.51 74 22.58 percent of total billed charges 30.51 93 24.71 percent of total billed charges 30.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.51 other OPPS APC 30.51 30.51 other OPPS APC 30.51 24.86 7.58 percent of total billed charges 30.51 30.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOXORUBICIN 2 MG/ML INTRAVENOUS SOLUTION WRAPPER RX-40812724801 CDM J9000 HCPCS 0636 RC 00069-3032-20 NDC outpatient 25 ML 73.7 73.7 14.28 14.28 fee schedule 73.7 93 59.7 percent of total billed charges 73.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 73.7 other OPPS APC 73.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 73.7 other OPPS APC 73.7 24.86 18.32 percent of total billed charges 14.28 73.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIOTROPIUM BROMIDE 2.5 MCG INHALER (PATIENT SPECIFIC) RX-4081273311 CDM 250000000 HCPCS 0250 RC 00597-0100-51 NDC outpatient 4 GR 225 225 225 74 166.5 percent of total billed charges 225 93 182.25 percent of total billed charges 225 225 other OPPS APC 225 225 other OPPS APC 225 24.86 55.94 percent of total billed charges 225 225 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION (NO RECON) RX-4081281631 CDM J0714 HCPCS 0636 RC 00456-2700-10 NDC outpatient 2.5 GR 1186.76 1186.76 422.24 422.24 fee schedule 1186.76 93 961.28 percent of total billed charges 1186.76 1186.76 other OPPS APC 1186.76 1186.76 other OPPS APC 1186.76 24.86 295.03 percent of total billed charges 422.24 1186.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE ORAL SOLUTION 0.5 MG/ML RX-4081298 CDM A9270 HCPCS 0250 RC 00000-0000-32 NDC outpatient 1 ML 0.53 0.53 74 0.39 percent of total billed charges 0.53 93 0.43 percent of total billed charges 0.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.53 other OPPS APC 0.53 0.53 other OPPS APC 0.53 24.86 0.13 percent of total billed charges 0.53 0.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE ORAL SOLUTION 0.5 MG/ML RX-4081298 CDM A9270 HCPCS 0637 RC 00000-0000-32 NDC outpatient 1 ML 0.53 0.53 0.53 74 0.39 percent of total billed charges 0.53 93 0.43 percent of total billed charges 0.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.53 other OPPS APC 0.53 0.53 other OPPS APC 0.53 24.86 0.13 percent of total billed charges 0.53 0.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLUTION RX-4081305041 CDM J2250 HCPCS 0636 RC 00409-2308-21 NDC outpatient 1 ML 3.49 3.49 0.79 0.79 fee schedule 3.49 93 2.83 percent of total billed charges 3.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.49 other OPPS APC 3.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.49 other OPPS APC 3.49 24.86 0.87 percent of total billed charges 0.79 3.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION (PACU) RX-4081305051 CDM J2250 HCPCS 0636 RC 00409-2305-16 NDC outpatient 2 ML 3.22 3.22 0.31 0.31 fee schedule 3.22 93 2.61 percent of total billed charges 3.22 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.22 other OPPS APC 3.22 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.22 other OPPS APC 3.22 24.86 0.8 percent of total billed charges 0.31 3.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE (PACU) RX-4081309611 CDM J1171 HCPCS 0636 RC 76045-0009-06 NDC outpatient 0.5 ML 12.45 12.45 12.45 74 9.21 percent of total billed charges 12.45 93 10.08 percent of total billed charges 12.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.45 other OPPS APC 12.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.45 other OPPS APC 12.45 24.86 3.1 percent of total billed charges 12.45 12.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCIUM GLUCONATE 100 MG/ML IV SYRINGE (NEO/PED) RX-408131201 CDM J0612 HCPCS 0250 RC 63323-0360-01 NDC outpatient 10 ML 30.06 30.06 30.06 74 22.24 percent of total billed charges 30.06 93 24.35 percent of total billed charges 30.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.06 other OPPS APC 30.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30.06 other OPPS APC 30.06 24.86 7.47 percent of total billed charges 30.06 30.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONIDINE 5 MCG/ML ORAL SYRINGE RX-4081317 CDM A9270 HCPCS 0250 RC 90000-0001-38 NDC outpatient 1 ML 0.15 0.15 74 0.11 percent of total billed charges 0.15 93 0.12 percent of total billed charges 0.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.15 other OPPS APC 0.15 0.15 other OPPS APC 0.15 24.86 0.04 percent of total billed charges 0.15 0.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONIDINE 5 MCG/ML ORAL SYRINGE RX-4081317 CDM A9270 HCPCS 0637 RC 90000-0001-38 NDC outpatient 1 ML 0.15 0.15 0.15 74 0.11 percent of total billed charges 0.15 93 0.12 percent of total billed charges 0.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.15 other OPPS APC 0.15 0.15 other OPPS APC 0.15 24.86 0.04 percent of total billed charges 0.15 0.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXAMETHASONE 0.5 MG/5 ML ORAL SYRINGE RX-4081319 CDM A9270 HCPCS 0250 RC 00054-3177-63 NDC outpatient 500 ML 59.78 59.78 74 44.24 percent of total billed charges 59.78 93 48.42 percent of total billed charges 59.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.78 other OPPS APC 59.78 59.78 other OPPS APC 59.78 24.86 14.86 percent of total billed charges 59.78 59.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXAMETHASONE 0.5 MG/5 ML ORAL SYRINGE RX-4081319 CDM A9270 HCPCS 0637 RC 00054-3177-63 NDC outpatient 500 ML 59.78 59.78 59.78 74 44.24 percent of total billed charges 59.78 93 48.42 percent of total billed charges 59.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.78 other OPPS APC 59.78 59.78 other OPPS APC 59.78 24.86 14.86 percent of total billed charges 59.78 59.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXAMETHASONE 1 MG/ML ORAL SYRINGE RX-4081321 CDM A9270 HCPCS 0250 RC 00054-3176-44 NDC outpatient 30 ML 80.43 80.43 74 59.52 percent of total billed charges 80.43 93 65.15 percent of total billed charges 80.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 80.43 other OPPS APC 80.43 80.43 other OPPS APC 80.43 24.86 19.99 percent of total billed charges 80.43 80.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXAMETHASONE 1 MG/ML ORAL SYRINGE RX-4081321 CDM A9270 HCPCS 0637 RC 00054-3176-44 NDC outpatient 30 ML 80.43 80.43 80.43 74 59.52 percent of total billed charges 80.43 93 65.15 percent of total billed charges 80.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 80.43 other OPPS APC 80.43 80.43 other OPPS APC 80.43 24.86 19.99 percent of total billed charges 80.43 80.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUROSEMIDE 10 MG/ML ORAL SYRINGE (FROM VIAL) NEO RX-4081324 CDM A9270 HCPCS 0250 RC 71288-0203-03 NDC outpatient 2 ML 3 3 74 2.22 percent of total billed charges 3 93 2.43 percent of total billed charges 3 3 other OPPS APC 3 3 other OPPS APC 3 24.86 0.75 percent of total billed charges 3 3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUROSEMIDE 10 MG/ML ORAL SYRINGE (FROM VIAL) NEO RX-4081324 CDM A9270 HCPCS 0637 RC 71288-0203-03 NDC outpatient 2 ML 3 3 3 74 2.22 percent of total billed charges 3 93 2.43 percent of total billed charges 3 3 other OPPS APC 3 3 other OPPS APC 3 24.86 0.75 percent of total billed charges 3 3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUROSEMIDE 10 MG/ML ORAL SYRINGE (FROM VIAL) NEO|DISCARDED DRUG NOT ADMINISTERED RX-4081324 CDM A9270 HCPCS 0250 RC 71288-0203-03 NDC JW outpatient 2 ML 3 3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3 other OPPS APC 3 3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSELTAMIVIR 6 MG/ML ORAL SYRINGE RX-4081327 CDM A9270 HCPCS 0250 RC 00527-5137-62 NDC outpatient 60 ML 432.88 432.88 74 320.33 percent of total billed charges 432.88 93 350.63 percent of total billed charges 432.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.88 other OPPS APC 432.88 432.88 other OPPS APC 432.88 24.86 107.61 percent of total billed charges 432.88 432.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSELTAMIVIR 6 MG/ML ORAL SYRINGE RX-4081327 CDM A9270 HCPCS 0637 RC 00527-5137-62 NDC outpatient 60 ML 432.88 432.88 432.88 74 320.33 percent of total billed charges 432.88 93 350.63 percent of total billed charges 432.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.88 other OPPS APC 432.88 432.88 other OPPS APC 432.88 24.86 107.61 percent of total billed charges 432.88 432.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONDANSETRON ODT 4 MG TO GO RX-4081344 CDM A9270 HCPCS 0250 RC 00000-0000-66 NDC outpatient 4 UN 0.98 0.98 74 0.73 percent of total billed charges 0.98 93 0.79 percent of total billed charges 0.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.98 other OPPS APC 0.98 0.98 other OPPS APC 0.98 24.86 0.24 percent of total billed charges 0.98 0.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONDANSETRON ODT 4 MG TO GO RX-4081344 CDM A9270 HCPCS 0637 RC 00000-0000-66 NDC outpatient 4 UN 0.98 0.98 0.98 74 0.73 percent of total billed charges 0.98 93 0.79 percent of total billed charges 0.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.98 other OPPS APC 0.98 0.98 other OPPS APC 0.98 24.86 0.24 percent of total billed charges 0.98 0.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALBUTEROL INHALER 90 MCG TO GO RX-4081346 CDM A9270 HCPCS 0250 RC 00000-0000-68 NDC outpatient 1 UN 68.15 68.15 74 50.43 percent of total billed charges 68.15 93 55.2 percent of total billed charges 68.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 68.15 other OPPS APC 68.15 68.15 other OPPS APC 68.15 24.86 16.94 percent of total billed charges 68.15 68.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALBUTEROL INHALER 90 MCG TO GO RX-4081346 CDM A9270 HCPCS 0637 RC 00000-0000-68 NDC outpatient 1 UN 68.15 68.15 68.15 74 50.43 percent of total billed charges 68.15 93 55.2 percent of total billed charges 68.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 68.15 other OPPS APC 68.15 68.15 other OPPS APC 68.15 24.86 16.94 percent of total billed charges 68.15 68.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ERYTHROMYCIN 0.5% OPHTH OINT TO GO RX-4081347 CDM A9270 HCPCS 0250 RC 90000-0002-51 NDC outpatient 1 UN 18.13 18.13 74 13.42 percent of total billed charges 18.13 93 14.69 percent of total billed charges 18.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.13 other OPPS APC 18.13 18.13 other OPPS APC 18.13 24.86 4.51 percent of total billed charges 18.13 18.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ERYTHROMYCIN 0.5% OPHTH OINT TO GO RX-4081347 CDM A9270 HCPCS 0637 RC 90000-0002-51 NDC outpatient 1 UN 18.13 18.13 18.13 74 13.42 percent of total billed charges 18.13 93 14.69 percent of total billed charges 18.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.13 other OPPS APC 18.13 18.13 other OPPS APC 18.13 24.86 4.51 percent of total billed charges 18.13 18.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZITHROMYCIN 100 MG/5 ML TO GO RX-4081349 CDM A9270 HCPCS 0250 RC 00000-0000-71 NDC outpatient 15 ML 87.2 87.2 74 64.53 percent of total billed charges 87.2 93 70.63 percent of total billed charges 87.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 87.2 other OPPS APC 87.2 87.2 other OPPS APC 87.2 24.86 21.68 percent of total billed charges 87.2 87.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZITHROMYCIN 100 MG/5 ML TO GO RX-4081349 CDM A9270 HCPCS 0637 RC 00000-0000-71 NDC outpatient 15 ML 87.2 87.2 87.2 74 64.53 percent of total billed charges 87.2 93 70.63 percent of total billed charges 87.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 87.2 other OPPS APC 87.2 87.2 other OPPS APC 87.2 24.86 21.68 percent of total billed charges 87.2 87.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SULFACETAMIDE 10% OPHTH DROPS TO GO RX-4081350 CDM A9270 HCPCS 0250 RC 00000-0000-72 NDC outpatient 1 UN 139.13 139.13 74 102.96 percent of total billed charges 139.13 93 112.7 percent of total billed charges 139.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 139.13 other OPPS APC 139.13 139.13 other OPPS APC 139.13 24.86 34.59 percent of total billed charges 139.13 139.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SULFACETAMIDE 10% OPHTH DROPS TO GO RX-4081350 CDM A9270 HCPCS 0637 RC 00000-0000-72 NDC outpatient 1 UN 139.13 139.13 139.13 74 102.96 percent of total billed charges 139.13 93 112.7 percent of total billed charges 139.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 139.13 other OPPS APC 139.13 139.13 other OPPS APC 139.13 24.86 34.59 percent of total billed charges 139.13 139.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 400 MG/5 ML TO GO RX-4081351 CDM A9270 HCPCS 0250 RC 00000-0000-73 NDC outpatient 1 UN 24.53 24.53 74 18.15 percent of total billed charges 24.53 93 19.87 percent of total billed charges 24.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.53 other OPPS APC 24.53 24.53 other OPPS APC 24.53 24.86 6.1 percent of total billed charges 24.53 24.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 400 MG/5 ML TO GO RX-4081351 CDM A9270 HCPCS 0637 RC 00000-0000-73 NDC outpatient 1 UN 24.53 24.53 24.53 74 18.15 percent of total billed charges 24.53 93 19.87 percent of total billed charges 24.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.53 other OPPS APC 24.53 24.53 other OPPS APC 24.53 24.86 6.1 percent of total billed charges 24.53 24.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POST EXPOSURE PROPHYLAXIS KIT RX-4081419 CDM A9270 HCPCS 0250 RC 90000-0001-10 NDC outpatient 1 UN 0.01 0.01 74 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 0.01 other OPPS APC 0.01 Service paid by percent of billed. 0.01 other OP Drugs 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POST EXPOSURE PROPHYLAXIS KIT RX-4081419 CDM A9270 HCPCS 0637 RC 90000-0001-10 NDC outpatient 1 UN 0.01 0.01 0.01 74 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 0.01 other OPPS APC 0.01 Service paid by percent of billed. 0.01 other OP Drugs 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE CONCENTRATE 20 MG/1 ML ORAL SYRINGE RX-4081420 CDM A9270 HCPCS 0250 RC 90000-0001-76 NDC outpatient 1 ML 2.1 2.1 74 1.55 percent of total billed charges 2.1 93 1.7 percent of total billed charges 2.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.1 other OPPS APC 2.1 2.1 other OPPS APC 2.1 24.86 0.52 percent of total billed charges 2.1 2.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE CONCENTRATE 20 MG/1 ML ORAL SYRINGE RX-4081420 CDM A9270 HCPCS 0637 RC 90000-0001-76 NDC outpatient 1 ML 2.1 2.1 2.1 74 1.55 percent of total billed charges 2.1 93 1.7 percent of total billed charges 2.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.1 other OPPS APC 2.1 2.1 other OPPS APC 2.1 24.86 0.52 percent of total billed charges 2.1 2.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION WRAPPER RX-4081420301 CDM J9390 HCPCS 0636 RC 45963-0607-55 NDC outpatient 1 ML 54 54 9.44 9.44 fee schedule 54 93 43.74 percent of total billed charges 54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 54 other OPPS APC 54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 54 other OPPS APC 54 24.86 13.42 percent of total billed charges 9.44 54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FAT EMULSION 20% BOLUS FOR OVERDOSE RX-4081425 CDM 250000000 HCPCS 0250 RC 90000-0001-18 NDC outpatient 1 ML 0.06 0.06 0.06 74 0.04 percent of total billed charges 0.06 93 0.05 percent of total billed charges 0.06 0.06 other OPPS APC 0.06 0.06 other OPPS APC 0.06 24.86 0.01 percent of total billed charges 0.06 0.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION (NO RECON) RX-40814451 CDM J0690 HCPCS 0636 RC 44567-0707-25 NDC outpatient 1000 ME 4.95 4.95 1.98 1.98 fee schedule 4.95 93 4.01 percent of total billed charges 4.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.95 other OPPS APC 4.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.95 other OPPS APC 4.95 24.86 1.23 percent of total billed charges 1.98 4.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXAMETHASONE IV SYRINGE 4 MG/ML (PEDIATRIC) RX-4081448 CDM J1100 HCPCS 0636 RC 63323-0165-01 NDC outpatient 1 ML 8.64 8.64 0.58 0.58 fee schedule 8.64 93 7 percent of total billed charges 8.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.64 other OPPS APC 8.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.64 other OPPS APC 8.64 24.86 2.15 percent of total billed charges 0.58 8.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAGNESIUM SULFATE IV SYRINGE 40 MG/ML (NEO/PED) RX-4081450 CDM 250000000 HCPCS 0250 RC 63323-0106-02 NDC outpatient 50 ML 38.49 38.49 38.49 74 28.48 percent of total billed charges 38.49 93 31.18 percent of total billed charges 38.49 38.49 other OPPS APC 38.49 38.49 other OPPS APC 38.49 24.86 9.57 percent of total billed charges 38.49 38.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION (NO RECON) RX-40814652 CDM J0697 HCPCS 0636 RC 25021-0118-10 NDC outpatient 750 ME 9.18 9.18 2.55 2.55 fee schedule 9.18 93 7.44 percent of total billed charges 9.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.18 other OPPS APC 9.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.18 other OPPS APC 9.18 24.86 2.28 percent of total billed charges 2.55 9.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACYCLOVIR 40 MG/ML ORAL SYRINGE RX-4081572 CDM A9270 HCPCS 0250 RC 70954-0188-10 NDC outpatient 473 ML 1113 1113 74 823.62 percent of total billed charges 1113 93 901.53 percent of total billed charges 1113 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1113 other OPPS APC 1113 1113 other OPPS APC 1113 24.86 276.69 percent of total billed charges 1113 1113 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACYCLOVIR 40 MG/ML ORAL SYRINGE RX-4081572 CDM A9270 HCPCS 0637 RC 70954-0188-10 NDC outpatient 473 ML 1113 1113 1113 74 823.62 percent of total billed charges 1113 93 901.53 percent of total billed charges 1113 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1113 other OPPS APC 1113 1113 other OPPS APC 1113 24.86 276.69 percent of total billed charges 1113 1113 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBAMAZEPINE 20 MG/ML ORAL SYRINGE RX-4081577 CDM A9270 HCPCS 0250 RC 00078-0508-83 NDC outpatient 450 ML 581.9 581.9 74 430.61 percent of total billed charges 581.9 93 471.34 percent of total billed charges 581.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 581.9 other OPPS APC 581.9 581.9 other OPPS APC 581.9 24.86 144.66 percent of total billed charges 581.9 581.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBAMAZEPINE 20 MG/ML ORAL SYRINGE RX-4081577 CDM A9270 HCPCS 0637 RC 00078-0508-83 NDC outpatient 450 ML 581.9 581.9 581.9 74 430.61 percent of total billed charges 581.9 93 471.34 percent of total billed charges 581.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 581.9 other OPPS APC 581.9 581.9 other OPPS APC 581.9 24.86 144.66 percent of total billed charges 581.9 581.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZITHROMYCIN 100 MG/5 ML ORAL SYRINGE RX-408157961 CDM A9270 HCPCS 0250 RC 70710-1457-01 NDC outpatient 15 ML 87.2 87.2 74 64.53 percent of total billed charges 87.2 93 70.63 percent of total billed charges 87.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 87.2 other OPPS APC 87.2 87.2 other OPPS APC 87.2 24.86 21.68 percent of total billed charges 87.2 87.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZITHROMYCIN 100 MG/5 ML ORAL SYRINGE RX-408157961 CDM A9270 HCPCS 0637 RC 70710-1457-01 NDC outpatient 15 ML 87.2 87.2 87.2 74 64.53 percent of total billed charges 87.2 93 70.63 percent of total billed charges 87.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 87.2 other OPPS APC 87.2 87.2 other OPPS APC 87.2 24.86 21.68 percent of total billed charges 87.2 87.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZITHROMYCIN 200 MG/5 ML ORAL SYRINGE RX-408157971 CDM A9270 HCPCS 0250 RC 00093-2026-31 NDC outpatient 30 ML 87.21 87.21 74 64.54 percent of total billed charges 87.21 93 70.64 percent of total billed charges 87.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 87.21 other OPPS APC 87.21 87.21 other OPPS APC 87.21 24.86 21.68 percent of total billed charges 87.21 87.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZITHROMYCIN 200 MG/5 ML ORAL SYRINGE RX-408157971 CDM A9270 HCPCS 0637 RC 00093-2026-31 NDC outpatient 30 ML 87.21 87.21 87.21 74 64.54 percent of total billed charges 87.21 93 70.64 percent of total billed charges 87.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 87.21 other OPPS APC 87.21 87.21 other OPPS APC 87.21 24.86 21.68 percent of total billed charges 87.21 87.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFEPIME 1 GRAM SOLUTION FOR INJECTION (NO RECON) RX-408163691 CDM J0692 HCPCS 0636 RC 00409-9566-10 NDC outpatient 1 GR 18.27 18.27 2.81 2.81 fee schedule 18.27 93 14.8 percent of total billed charges 18.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.27 other OPPS APC 18.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.27 other OPPS APC 18.27 24.86 4.54 percent of total billed charges 2.81 18.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFEPIME 2 GRAM SOLUTION FOR INJECTION (NO RECON) RX-408163711 CDM J0692 HCPCS 0636 RC 70594-0090-02 NDC outpatient 2 GR 29.4 29.4 5.61 5.61 fee schedule 29.4 93 23.81 percent of total billed charges 29.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.4 other OPPS APC 29.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.4 other OPPS APC 29.4 24.86 7.31 percent of total billed charges 5.61 29.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION SHARED VIAL RX-408174051 CDM J1815 HCPCS 0250 RC 00002-7510-01 NDC outpatient 10 ML 199.2 199.2 74 147.41 percent of total billed charges 199.2 93 161.35 percent of total billed charges 199.2 199.2 other OPPS APC 199.2 199.2 other OPPS APC 199.2 24.86 49.52 percent of total billed charges 199.2 199.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION SHARED VIAL RX-408174051 CDM J1815 HCPCS 0637 RC 00002-7510-01 NDC outpatient 10 ML 199.2 199.2 199.2 74 147.41 percent of total billed charges 199.2 93 161.35 percent of total billed charges 199.2 199.2 other OPPS APC 199.2 199.2 other OPPS APC 199.2 24.86 49.52 percent of total billed charges 199.2 199.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN LISPRO (U-100) 100 UNIT/ML SLIDING SCALE VIAL RX-408174052 CDM J1815 HCPCS 0250 RC 00002-7510-01 NDC outpatient 10 ML 199.2 199.2 74 147.41 percent of total billed charges 199.2 93 161.35 percent of total billed charges 199.2 199.2 other OPPS APC 199.2 199.2 other OPPS APC 199.2 24.86 49.52 percent of total billed charges 199.2 199.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN LISPRO (U-100) 100 UNIT/ML SLIDING SCALE VIAL RX-408174052 CDM J1815 HCPCS 0637 RC 00002-7510-01 NDC outpatient 10 ML 199.2 199.2 199.2 74 147.41 percent of total billed charges 199.2 93 161.35 percent of total billed charges 199.2 199.2 other OPPS APC 199.2 199.2 other OPPS APC 199.2 24.86 49.52 percent of total billed charges 199.2 199.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN LISPRO (U-100) 100 UNIT/ML PATIENT SPECIFIC VIAL RX-408174053 CDM J1815 HCPCS 0250 RC 00002-7510-01 NDC outpatient 10 ML 199.2 199.2 74 147.41 percent of total billed charges 199.2 93 161.35 percent of total billed charges 199.2 199.2 other OPPS APC 199.2 199.2 other OPPS APC 199.2 24.86 49.52 percent of total billed charges 199.2 199.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN LISPRO (U-100) 100 UNIT/ML PATIENT SPECIFIC VIAL RX-408174053 CDM J1815 HCPCS 0637 RC 00002-7510-01 NDC outpatient 10 ML 199.2 199.2 199.2 74 147.41 percent of total billed charges 199.2 93 161.35 percent of total billed charges 199.2 199.2 other OPPS APC 199.2 199.2 other OPPS APC 199.2 24.86 49.52 percent of total billed charges 199.2 199.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARGININE 7G-GLUTAM 7G-CAHMB 1.5G-COLLA-MV-MIN ORAL PWD PKT ORANGE RX-4081778561 CDM A9270 HCPCS 0250 RC 59781-0666-93 NDC outpatient 1 UN 7.09 7.09 74 5.25 percent of total billed charges 7.09 93 5.74 percent of total billed charges 7.09 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.09 other OPPS APC 7.09 7.09 other OPPS APC 7.09 24.86 1.76 percent of total billed charges 7.09 7.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARGININE 7G-GLUTAM 7G-CAHMB 1.5G-COLLA-MV-MIN ORAL PWD PKT ORANGE RX-4081778561 CDM A9270 HCPCS 0637 RC 59781-0666-93 NDC outpatient 1 UN 7.09 7.09 7.09 74 5.25 percent of total billed charges 7.09 93 5.74 percent of total billed charges 7.09 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.09 other OPPS APC 7.09 7.09 other OPPS APC 7.09 24.86 1.76 percent of total billed charges 7.09 7.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARGININE 7G-GLUTAM 7G-CAHMB 1.5G-COLLA-MV-MIN ORAL PWD PKT FRUIT RX-4081778562 CDM A9270 HCPCS 0250 RC 59781-0666-94 NDC outpatient 1 UN 7.09 7.09 74 5.25 percent of total billed charges 7.09 93 5.74 percent of total billed charges 7.09 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.09 other OPPS APC 7.09 7.09 other OPPS APC 7.09 24.86 1.76 percent of total billed charges 7.09 7.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARGININE 7G-GLUTAM 7G-CAHMB 1.5G-COLLA-MV-MIN ORAL PWD PKT FRUIT RX-4081778562 CDM A9270 HCPCS 0637 RC 59781-0666-94 NDC outpatient 1 UN 7.09 7.09 7.09 74 5.25 percent of total billed charges 7.09 93 5.74 percent of total billed charges 7.09 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.09 other OPPS APC 7.09 7.09 other OPPS APC 7.09 24.86 1.76 percent of total billed charges 7.09 7.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL (PATIENT SPECIFIC) RX-408178372 CDM A9270 HCPCS 0250 RC 00173-0682-24 NDC outpatient 8 GR 68.15 68.15 74 50.43 percent of total billed charges 68.15 93 55.2 percent of total billed charges 68.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 68.15 other OPPS APC 68.15 68.15 other OPPS APC 68.15 24.86 16.94 percent of total billed charges 68.15 68.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL (PATIENT SPECIFIC) RX-408178372 CDM A9270 HCPCS 0637 RC 00173-0682-24 NDC outpatient 8 GR 68.15 68.15 68.15 74 50.43 percent of total billed charges 68.15 93 55.2 percent of total billed charges 68.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 68.15 other OPPS APC 68.15 68.15 other OPPS APC 68.15 24.86 16.94 percent of total billed charges 68.15 68.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TENECTEPLASE 50 MG INTRAVENOUS KIT FOR ACUTE ISCHEMIC STROKE RX-408178964 CDM J3101 HCPCS 0636 RC 90000-0009-11 NDC outpatient 50 ME 23482.8 23482.8 8715.03 8715.03 fee schedule 23482.8 93 19021.1 percent of total billed charges 23482.8 23482.8 other OPPS APC 23482.8 23482.8 other OPPS APC 23482.8 24.86 5837.82 percent of total billed charges 8715.03 23482.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIMETHYL SULFOXIDE (DMSO) 99.99% TOPICAL SOLUTION TO GO RX-40818072 CDM A9270 HCPCS 0250 RC 00000-0007-23 NDC outpatient 1 UN 186 186 74 137.64 percent of total billed charges 186 93 150.66 percent of total billed charges 186 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 186 other OPPS APC 186 186 other OPPS APC 186 24.86 46.24 percent of total billed charges 186 186 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIMETHYL SULFOXIDE (DMSO) 99.99% TOPICAL SOLUTION TO GO RX-40818072 CDM A9270 HCPCS 0637 RC 00000-0007-23 NDC outpatient 1 UN 186 186 186 74 137.64 percent of total billed charges 186 93 150.66 percent of total billed charges 186 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 186 other OPPS APC 186 186 other OPPS APC 186 24.86 46.24 percent of total billed charges 186 186 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROPIVACAINE (PF) 2 MG/ML (0.2 %) EPIDURAL RX-408181921 CDM J2795 HCPCS 0636 RC 25021-0671-82 NDC outpatient 100 ML 115.89 115.89 16.94 16.94 fee schedule 115.89 93 93.87 percent of total billed charges 115.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 115.89 other OPPS APC 115.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 115.89 other OPPS APC 115.89 24.86 28.81 percent of total billed charges 16.94 115.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION (NO RECON) RX-408183031 CDM J2543 HCPCS 0636 RC 64679-0056-01 NDC outpatient 3.375 GR 54.39 54.39 4.65 4.65 fee schedule 54.39 93 44.06 percent of total billed charges 54.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 54.39 other OPPS APC 54.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 54.39 other OPPS APC 54.39 24.86 13.52 percent of total billed charges 4.65 54.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FAT EMULSION 20%-OLIVE OIL SOYBEAN OIL (CLINOLIPID) INFUSION RX-4081833641 CDM 250000000 HCPCS 0250 RC 00338-9540-01 NDC outpatient 100 ML 103.57 103.57 103.57 74 76.64 percent of total billed charges 103.57 93 83.89 percent of total billed charges 103.57 103.57 other OPPS APC 103.57 103.57 other OPPS APC 103.57 24.86 25.75 percent of total billed charges 103.57 103.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FAT EMULSION-OLIVE OIL SOYBEAN OIL (CLINOLIPID) BOLUS FOR OVERDOSE RX-4081833643 CDM 250000000 HCPCS 0250 RC 00338-9540-01 NDC outpatient 100 ML 103.57 103.57 103.57 74 76.64 percent of total billed charges 103.57 93 83.89 percent of total billed charges 103.57 103.57 other OPPS APC 103.57 103.57 other OPPS APC 103.57 24.86 25.75 percent of total billed charges 103.57 103.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL IV SOLUTION (TN) RX-408183534 CDM A9270 HCPCS 0250 RC 00338-0126-12 NDC outpatient 100 ML 105 105 74 77.7 percent of total billed charges 105 93 85.05 percent of total billed charges 105 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 105 other OPPS APC 105 105 other OPPS APC 105 24.86 26.1 percent of total billed charges 105 105 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL IV SOLUTION (TN) RX-408183534 CDM A9270 HCPCS 0637 RC 00338-0126-12 NDC outpatient 100 ML 105 105 105 74 77.7 percent of total billed charges 105 93 85.05 percent of total billed charges 105 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 105 other OPPS APC 105 105 other OPPS APC 105 24.86 26.1 percent of total billed charges 105 105 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MINERAL OIL - SODIUM LAURETH SULFATE LOTION RX-4081853 CDM A9270 HCPCS 0250 RC 10742-0052-10 NDC outpatient 1 UN 7.01 7.01 74 5.19 percent of total billed charges 7.01 93 5.68 percent of total billed charges 7.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.01 other OPPS APC 7.01 7.01 other OPPS APC 7.01 24.86 1.74 percent of total billed charges 7.01 7.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MINERAL OIL - SODIUM LAURETH SULFATE LOTION RX-4081853 CDM A9270 HCPCS 0637 RC 10742-0052-10 NDC outpatient 1 UN 7.01 7.01 7.01 74 5.19 percent of total billed charges 7.01 93 5.68 percent of total billed charges 7.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.01 other OPPS APC 7.01 7.01 other OPPS APC 7.01 24.86 1.74 percent of total billed charges 7.01 7.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIPHENHYDR-LIDO-AL HYDROX-MAG HYDROX-SIMETH ORAL SUSPENSION RX-4081854 CDM A9270 HCPCS 0250 RC 65628-0050-04 NDC outpatient 119 ML 270 270 74 199.8 percent of total billed charges 270 93 218.7 percent of total billed charges 270 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 270 other OPPS APC 270 270 other OPPS APC 270 24.86 67.12 percent of total billed charges 270 270 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIPHENHYDR-LIDO-AL HYDROX-MAG HYDROX-SIMETH ORAL SUSPENSION RX-4081854 CDM A9270 HCPCS 0637 RC 65628-0050-04 NDC outpatient 119 ML 270 270 270 74 199.8 percent of total billed charges 270 93 218.7 percent of total billed charges 270 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 270 other OPPS APC 270 270 other OPPS APC 270 24.86 67.12 percent of total billed charges 270 270 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION (NO RECON) RX-408210631 CDM J0456 HCPCS 0636 RC 70860-0100-41 NDC outpatient 500 ME 15 15 3.17 3.17 fee schedule 15 93 12.15 percent of total billed charges 15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15 other OPPS APC 15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15 other OPPS APC 15 24.86 3.73 percent of total billed charges 3.17 15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFDINIR 125 MG/5 ML ORAL SYRINGE RX-408222901 CDM A9270 HCPCS 0250 RC 67877-0547-98 NDC outpatient 60 ML 127.25 127.25 74 94.17 percent of total billed charges 127.25 93 103.07 percent of total billed charges 127.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 127.25 other OPPS APC 127.25 127.25 other OPPS APC 127.25 24.86 31.63 percent of total billed charges 127.25 127.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFDINIR 125 MG/5 ML ORAL SYRINGE RX-408222901 CDM A9270 HCPCS 0637 RC 67877-0547-98 NDC outpatient 60 ML 127.25 127.25 127.25 74 94.17 percent of total billed charges 127.25 93 103.07 percent of total billed charges 127.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 127.25 other OPPS APC 127.25 127.25 other OPPS APC 127.25 24.86 31.63 percent of total billed charges 127.25 127.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXAMETHASONE 4 MG/ML VIAL FOR ORAL USE RX-4082332 CDM J1100 HCPCS 0636 RC 63323-0165-01 NDC outpatient 1 ML 8.64 8.64 0.58 0.58 fee schedule 8.64 93 7 percent of total billed charges 8.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.64 other OPPS APC 8.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.64 other OPPS APC 8.64 24.86 2.15 percent of total billed charges 0.58 8.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION WRAPPER RX-40823321 CDM J1100 HCPCS 0636 RC 63323-0165-01 NDC outpatient 1 ML 8.64 8.64 0.58 0.58 fee schedule 8.64 93 7 percent of total billed charges 8.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.64 other OPPS APC 8.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.64 other OPPS APC 8.64 24.86 2.15 percent of total billed charges 0.58 8.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 5 % IN WATER NON-DEHP RX-40823641 CDM J7070 HCPCS 0636 RC 00338-0017-04 NDC outpatient 1000 ML 16.6 16.6 4.14 4.14 fee schedule 16.6 93 13.45 percent of total billed charges 16.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.6 other OPPS APC 16.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.6 other OPPS APC 16.6 24.86 4.13 percent of total billed charges 4.14 16.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 400 MG/5 ML ORAL SYRINGE RX-408252461 CDM A9270 HCPCS 0250 RC 00143-9887-01 NDC outpatient 100 ML 24.53 24.53 74 18.15 percent of total billed charges 24.53 93 19.87 percent of total billed charges 24.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.53 other OPPS APC 24.53 24.53 other OPPS APC 24.53 24.86 6.1 percent of total billed charges 24.53 24.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 400 MG/5 ML ORAL SYRINGE RX-408252461 CDM A9270 HCPCS 0637 RC 00143-9887-01 NDC outpatient 100 ML 24.53 24.53 24.53 74 18.15 percent of total billed charges 24.53 93 19.87 percent of total billed charges 24.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.53 other OPPS APC 24.53 24.53 other OPPS APC 24.53 24.86 6.1 percent of total billed charges 24.53 24.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PORACTANT ALFA 120 MG/1.5 ML INTRATRACHEAL SUSPENSION WRAPPER RX-4082704701 CDM 250000000 HCPCS 0250 RC 10122-0510-01 NDC outpatient 1.5 ML 1712.96 1712.96 1712.96 74 1267.59 percent of total billed charges 1712.96 93 1387.5 percent of total billed charges 1712.96 1712.96 other OPPS APC 1712.96 1712.96 other OPPS APC 1712.96 24.86 425.84 percent of total billed charges 1712.96 1712.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM CHLORIDE 0.9 % NON-DEHP SOLUTION RX-408278381 CDM J7030 HCPCS 0636 RC 00338-0049-04 NDC outpatient 1000 ML 14.77 14.77 2.9 2.9 fee schedule 14.77 93 11.96 percent of total billed charges 14.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.77 other OPPS APC 14.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.77 other OPPS APC 14.77 24.86 3.67 percent of total billed charges 2.9 14.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION SHARED VIAL RX-408282821 CDM A9270 HCPCS 0250 RC 00088-2220-33 NDC outpatient 10 ML 192.78 192.78 74 142.66 percent of total billed charges 192.78 93 156.15 percent of total billed charges 192.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.78 other OPPS APC 192.78 192.78 other OPPS APC 192.78 24.86 47.93 percent of total billed charges 192.78 192.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION SHARED VIAL RX-408282821 CDM A9270 HCPCS 0637 RC 00088-2220-33 NDC outpatient 10 ML 192.78 192.78 192.78 74 142.66 percent of total billed charges 192.78 93 156.15 percent of total billed charges 192.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.78 other OPPS APC 192.78 192.78 other OPPS APC 192.78 24.86 47.93 percent of total billed charges 192.78 192.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL SYRINGE RX-40828991 CDM A9270 HCPCS 0250 RC 69238-1503-01 NDC outpatient 100 ML 1013.53 1013.53 74 750.01 percent of total billed charges 1013.53 93 820.96 percent of total billed charges 1013.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1013.53 other OPPS APC 1013.53 1013.53 other OPPS APC 1013.53 24.86 251.96 percent of total billed charges 1013.53 1013.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL SYRINGE RX-40828991 CDM A9270 HCPCS 0637 RC 69238-1503-01 NDC outpatient 100 ML 1013.53 1013.53 1013.53 74 750.01 percent of total billed charges 1013.53 93 820.96 percent of total billed charges 1013.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1013.53 other OPPS APC 1013.53 1013.53 other OPPS APC 1013.53 24.86 251.96 percent of total billed charges 1013.53 1013.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ERYTHROMYCIN LACTOBIONATE 500 MG INTRAVENOUS SOLUTION (NO RECON) RX-40829031 CDM J1364 HCPCS 0636 RC 00409-6482-01 NDC outpatient 500 ME 272.66 272.66 99.68 99.68 fee schedule 272.66 93 220.85 percent of total billed charges 272.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 65.38 other OPPS APC 272.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 65.38 other OPPS APC 272.66 24.86 67.78 percent of total billed charges 99.68 272.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IRON SUCROSE 20 MG IRON/ML INTRAVENOUS SOLUTION RX-4082913201 CDM J1756 HCPCS 0636 RC 00517-2340-10 NDC outpatient 5 ML 183.66 183.66 22.99 22.99 fee schedule 183.66 93 148.76 percent of total billed charges 183.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 183.66 other OPPS APC 183.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 183.66 other OPPS APC 183.66 24.86 45.66 percent of total billed charges 22.99 183.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML ORAL SOLUTION WRAPPER RX-4082930201 CDM J7510 HCPCS 0636 RC 00121-0759-08 NDC outpatient 237 ML 185 185 39.8 39.8 fee schedule 185 93 149.85 percent of total billed charges 185 185 other OPPS APC 185 185 other OPPS APC 185 24.86 45.99 percent of total billed charges 39.8 185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION (PACU) RX-40830371 CDM J3010 HCPCS 0636 RC 00409-9094-12 NDC outpatient 2 ML 4.62 4.62 0.96 0.96 fee schedule 4.62 93 3.74 percent of total billed charges 4.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.62 other OPPS APC 4.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.62 other OPPS APC 4.62 24.86 1.15 percent of total billed charges 0.96 4.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALTEPLASE 1 MG INTRA-CATHETER SYRINGE RX-408313101 CDM J2997 HCPCS 0636 RC 90000-0002-91 NDC outpatient 1 ME 180.65 180.65 101.76 101.76 fee schedule 180.65 93 146.33 percent of total billed charges 180.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 91.47 other OPPS APC 180.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 91.47 other OPPS APC 180.65 24.86 44.91 percent of total billed charges 101.76 180.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 200 MG-POTASSIUM CLAVULANATE 28.5 MG/5 ML ORAL SYRINGE RX-408332291 CDM A9270 HCPCS 0250 RC 00781-6102-46 NDC outpatient 100 ML 90.43 90.43 74 66.92 percent of total billed charges 90.43 93 73.25 percent of total billed charges 90.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 90.43 other OPPS APC 90.43 90.43 other OPPS APC 90.43 24.86 22.48 percent of total billed charges 90.43 90.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 200 MG-POTASSIUM CLAVULANATE 28.5 MG/5 ML ORAL SYRINGE RX-408332291 CDM A9270 HCPCS 0637 RC 00781-6102-46 NDC outpatient 100 ML 90.43 90.43 90.43 74 66.92 percent of total billed charges 90.43 93 73.25 percent of total billed charges 90.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 90.43 other OPPS APC 90.43 90.43 other OPPS APC 90.43 24.86 22.48 percent of total billed charges 90.43 90.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SYRINGE RX-408332301 CDM A9270 HCPCS 0250 RC 00781-6104-46 NDC outpatient 100 ML 172.33 172.33 74 127.52 percent of total billed charges 172.33 93 139.59 percent of total billed charges 172.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 172.33 other OPPS APC 172.33 172.33 other OPPS APC 172.33 24.86 42.84 percent of total billed charges 172.33 172.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SYRINGE RX-408332301 CDM A9270 HCPCS 0637 RC 00781-6104-46 NDC outpatient 100 ML 172.33 172.33 172.33 74 127.52 percent of total billed charges 172.33 93 139.59 percent of total billed charges 172.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 172.33 other OPPS APC 172.33 172.33 other OPPS APC 172.33 24.86 42.84 percent of total billed charges 172.33 172.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENTAMICIN SULFATE PF <1 MONTH 10 MG/ML IM INJECTION RX-40834251 CDM J1580 HCPCS 0636 RC 63323-0173-02 NDC outpatient 2 ML 18.51 18.51 3.41 3.41 fee schedule 18.51 93 14.99 percent of total billed charges 18.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.51 other OPPS APC 18.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.51 other OPPS APC 18.51 24.86 4.6 percent of total billed charges 3.41 18.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENTAMICIN SULFATE PF <20 KG 10 MG/ML IM INJECTION RX-40834252 CDM J1580 HCPCS 0636 RC 63323-0173-02 NDC outpatient 2 ML 18.51 18.51 3.41 3.41 fee schedule 18.51 93 14.99 percent of total billed charges 18.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.51 other OPPS APC 18.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.51 other OPPS APC 18.51 24.86 4.6 percent of total billed charges 3.41 18.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVETIRACETAM 100 MG/ML ORAL SOLUTION WRAPPER RX-408365901 CDM A9270 HCPCS 0250 RC 00121-4799-05 NDC outpatient 5 ML 23.37 23.37 74 17.29 percent of total billed charges 23.37 93 18.93 percent of total billed charges 23.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 23.37 other OPPS APC 23.37 23.37 other OPPS APC 23.37 24.86 5.81 percent of total billed charges 23.37 23.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVETIRACETAM 100 MG/ML ORAL SOLUTION WRAPPER RX-408365901 CDM A9270 HCPCS 0637 RC 00121-4799-05 NDC outpatient 5 ML 23.37 23.37 23.37 74 17.29 percent of total billed charges 23.37 93 18.93 percent of total billed charges 23.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 23.37 other OPPS APC 23.37 23.37 other OPPS APC 23.37 24.86 5.81 percent of total billed charges 23.37 23.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMORPHONE 4 MG/ML INJECTION SYRINGE (PACU) RX-40837591 CDM J1171 HCPCS 0636 RC 63323-0854-10 NDC outpatient 1 ML 13.44 13.44 13.44 74 9.95 percent of total billed charges 13.44 93 10.89 percent of total billed charges 13.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.44 other OPPS APC 13.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.44 other OPPS APC 13.44 24.86 3.34 percent of total billed charges 13.44 13.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAPPER RX-4083824501 CDM A9270 HCPCS 0250 RC 00121-1154-30 NDC outpatient 30 ML 4.54 4.54 74 3.36 percent of total billed charges 4.54 93 3.68 percent of total billed charges 4.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.54 other OPPS APC 4.54 4.54 other OPPS APC 4.54 24.86 1.13 percent of total billed charges 4.54 4.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAPPER RX-4083824501 CDM A9270 HCPCS 0637 RC 00121-1154-30 NDC outpatient 30 ML 4.54 4.54 4.54 74 3.36 percent of total billed charges 4.54 93 3.68 percent of total billed charges 4.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.54 other OPPS APC 4.54 4.54 other OPPS APC 4.54 24.86 1.13 percent of total billed charges 4.54 4.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFDINIR 250 MG/5 ML ORAL SYRINGE RX-408395221 CDM A9270 HCPCS 0250 RC 68180-0723-04 NDC outpatient 60 ML 248.7 248.7 74 184.04 percent of total billed charges 248.7 93 201.45 percent of total billed charges 248.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 248.7 other OPPS APC 248.7 248.7 other OPPS APC 248.7 24.86 61.83 percent of total billed charges 248.7 248.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFDINIR 250 MG/5 ML ORAL SYRINGE RX-408395221 CDM A9270 HCPCS 0637 RC 68180-0723-04 NDC outpatient 60 ML 248.7 248.7 248.7 74 184.04 percent of total billed charges 248.7 93 201.45 percent of total billed charges 248.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 248.7 other OPPS APC 248.7 248.7 other OPPS APC 248.7 24.86 61.83 percent of total billed charges 248.7 248.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM IODIDE-123 3.7 MBQ (200 MICROCI) DIAGNOSTIC 10 CAPS RX-4084001 CDM A9509 HCPCS 0343 RC 00019-N602-20 NDC outpatient 1.13636 UN 9600 9600 9600 74 7104 percent of total billed charges 9600 93 7776 percent of total billed charges 9600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9600 other OPPS APC 9600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9600 other OPPS APC 9600 24.86 2386.56 percent of total billed charges 9600 9600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METRONIDAZOLE IV SYRINGE (NEO/PED) RX-40840043 CDM J1836 HCPCS 0250 RC 00338-1055-48 NDC outpatient 100 ML 6.88 6.88 6.88 74 5.09 percent of total billed charges 6.88 93 5.57 percent of total billed charges 6.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.88 other OPPS APC 6.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.88 other OPPS APC 6.88 24.86 1.71 percent of total billed charges 6.88 6.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GALLIUM CITRATE GA 67 RX-40840060 CDM A9556 HCPCS 0343 RC 00019-9180-06 NDC outpatient 1.81818 UN 90 90 90 74 66.6 percent of total billed charges 90 93 72.9 percent of total billed charges 90 90 other OPPS APC 90 90 other OPPS APC 90 24.86 22.37 percent of total billed charges 90 90 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TECHNETIUM TC 99M-LABELED RED BLOOD CELLS RX-40840062 CDM A9560 HCPCS 0343 RC 00019-9068-20 NDC outpatient 1 UN 51 51 51 74 37.74 percent of total billed charges 51 93 41.31 percent of total billed charges 51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 51 other OPPS APC 51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 51 other OPPS APC 51 24.86 12.68 percent of total billed charges 51 51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM PERTECHNETATE TC 99M INJECTION PER MCI RX-40840066 CDM A9512 HCPCS 0343 RC 11994-0900-5U NDC outpatient 1 UN 9 9 9 74 6.66 percent of total billed charges 9 93 7.29 percent of total billed charges 9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9 other OPPS APC 9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9 other OPPS APC 9 24.86 2.24 percent of total billed charges 9 9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TECHNETIUM TC 99M PYROPHOSPHATE LABELED RBCS RX-40840067 CDM A9560 HCPCS 0343 RC outpatient 1 UN 51 51 51 74 37.74 percent of total billed charges 51 93 41.31 percent of total billed charges 51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 51 other OPPS APC 51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 51 other OPPS APC 51 24.86 12.68 percent of total billed charges 51 51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TECHNETIUM TC 99M MERTIATIDE RX-40840068 CDM A9562 HCPCS 0343 RC 00019-9096-20 NDC outpatient 1.0303 UN 1218 1218 1218 74 901.32 percent of total billed charges 1218 93 986.58 percent of total billed charges 1218 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1218 other OPPS APC 1218 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1218 other OPPS APC 1218 24.86 302.79 percent of total billed charges 1218 1218 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE 110 MCG/ACTUATION HFA (PATIENT SPECIFIC) RX-408406981 CDM A9270 HCPCS 0250 RC 66993-0079-96 NDC outpatient 12 GR 780.43 780.43 74 577.52 percent of total billed charges 780.43 93 632.15 percent of total billed charges 780.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 780.43 other OPPS APC 780.43 780.43 other OPPS APC 780.43 24.86 194.01 percent of total billed charges 780.43 780.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE 110 MCG/ACTUATION HFA (PATIENT SPECIFIC) RX-408406981 CDM A9270 HCPCS 0637 RC 66993-0079-96 NDC outpatient 12 GR 780.43 780.43 780.43 74 577.52 percent of total billed charges 780.43 93 632.15 percent of total billed charges 780.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 780.43 other OPPS APC 780.43 780.43 other OPPS APC 780.43 24.86 194.01 percent of total billed charges 780.43 780.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE 220 MCG/ACTUATION HFA (PATIENT SPECIFIC) RX-408406991 CDM A9270 HCPCS 0250 RC 66993-0080-96 NDC outpatient 12 GR 1212.2 1212.2 74 897.03 percent of total billed charges 1212.2 93 981.88 percent of total billed charges 1212.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1212.2 other OPPS APC 1212.2 1212.2 other OPPS APC 1212.2 24.86 301.35 percent of total billed charges 1212.2 1212.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE 220 MCG/ACTUATION HFA (PATIENT SPECIFIC) RX-408406991 CDM A9270 HCPCS 0637 RC 66993-0080-96 NDC outpatient 12 GR 1212.2 1212.2 1212.2 74 897.03 percent of total billed charges 1212.2 93 981.88 percent of total billed charges 1212.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1212.2 other OPPS APC 1212.2 1212.2 other OPPS APC 1212.2 24.86 301.35 percent of total billed charges 1212.2 1212.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IPRATROPIUM BROMIDE 17 MCG/ACT HFA INHALER (PATIENT SPECIFIC) RX-408411421 CDM A9270 HCPCS 0250 RC 00597-0087-17 NDC outpatient 12.9 GR 1416.18 1416.18 74 1047.97 percent of total billed charges 1416.18 93 1147.11 percent of total billed charges 1416.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1416.18 other OPPS APC 1416.18 1416.18 other OPPS APC 1416.18 24.86 352.06 percent of total billed charges 1416.18 1416.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IPRATROPIUM BROMIDE 17 MCG/ACT HFA INHALER (PATIENT SPECIFIC) RX-408411421 CDM A9270 HCPCS 0637 RC 00597-0087-17 NDC outpatient 12.9 GR 1416.18 1416.18 1416.18 74 1047.97 percent of total billed charges 1416.18 93 1147.11 percent of total billed charges 1416.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1416.18 other OPPS APC 1416.18 1416.18 other OPPS APC 1416.18 24.86 352.06 percent of total billed charges 1416.18 1416.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DICYCLOMINE 10 MG/5 ML ORAL SYRINGE RX-408421191 CDM A9270 HCPCS 0250 RC 00603-1161-58 NDC outpatient 473 ML 355.23 355.23 74 262.87 percent of total billed charges 355.23 93 287.74 percent of total billed charges 355.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 355.23 other OPPS APC 355.23 355.23 other OPPS APC 355.23 24.86 88.31 percent of total billed charges 355.23 355.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DICYCLOMINE 10 MG/5 ML ORAL SYRINGE RX-408421191 CDM A9270 HCPCS 0637 RC 00603-1161-58 NDC outpatient 473 ML 355.23 355.23 355.23 74 262.87 percent of total billed charges 355.23 93 287.74 percent of total billed charges 355.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 355.23 other OPPS APC 355.23 355.23 other OPPS APC 355.23 24.86 88.31 percent of total billed charges 355.23 355.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVALBUTEROL HFA MCG/ACTUATION AEROSOL INHALER (PATIENT SPECIFIC) RX-408434721 CDM 636000000 HCPCS 0636 RC 00591-2927-54 NDC outpatient 15 GR 184.25 184.25 184.25 74 136.35 percent of total billed charges 184.25 93 149.24 percent of total billed charges 184.25 184.25 other OPPS APC 184.25 184.25 other OPPS APC 184.25 24.86 45.8 percent of total billed charges 184.25 184.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 125 MG/5 ML ORAL SYRINGE RX-4084531 CDM A9270 HCPCS 0250 RC 00781-6039-46 NDC outpatient 100 ML 8.9 8.9 74 6.59 percent of total billed charges 8.9 93 7.21 percent of total billed charges 8.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.9 other OPPS APC 8.9 8.9 other OPPS APC 8.9 24.86 2.21 percent of total billed charges 8.9 8.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 125 MG/5 ML ORAL SYRINGE RX-4084531 CDM A9270 HCPCS 0637 RC 00781-6039-46 NDC outpatient 100 ML 8.9 8.9 8.9 74 6.59 percent of total billed charges 8.9 93 7.21 percent of total billed charges 8.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.9 other OPPS APC 8.9 8.9 other OPPS APC 8.9 24.86 2.21 percent of total billed charges 8.9 8.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 250 MG/5 ML ORAL SYRINGE RX-4084541 CDM A9270 HCPCS 0250 RC 00143-9889-01 NDC outpatient 100 ML 15.23 15.23 74 11.27 percent of total billed charges 15.23 93 12.34 percent of total billed charges 15.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.23 other OPPS APC 15.23 15.23 other OPPS APC 15.23 24.86 3.79 percent of total billed charges 15.23 15.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 250 MG/5 ML ORAL SYRINGE RX-4084541 CDM A9270 HCPCS 0637 RC 00143-9889-01 NDC outpatient 100 ML 15.23 15.23 15.23 74 11.27 percent of total billed charges 15.23 93 12.34 percent of total billed charges 15.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.23 other OPPS APC 15.23 15.23 other OPPS APC 15.23 24.86 3.79 percent of total billed charges 15.23 15.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMPICILLIN 1 GRAM SOLUTION FOR INJECTION (NO RECON) RX-4084691 CDM J0290 HCPCS 0636 RC 70594-0086-02 NDC outpatient 1 GR 10.5 10.5 1.79 1.79 fee schedule 10.5 93 8.51 percent of total billed charges 10.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.5 other OPPS APC 10.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.5 other OPPS APC 10.5 24.86 2.61 percent of total billed charges 1.79 10.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METRONIDAZOLE CUSTOM IVPB RX-40850181 CDM J1836 HCPCS 0250 RC 25021-0131-82 NDC outpatient 100 ML 6.88 6.88 6.88 74 5.09 percent of total billed charges 6.88 93 5.57 percent of total billed charges 6.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.88 other OPPS APC 6.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.88 other OPPS APC 6.88 24.86 1.71 percent of total billed charges 6.88 6.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METRONIDAZOLE CUSTOM IVPB RX-40850181 CDM J1836 HCPCS 0250 RC 25021-0131-82 NDC outpatient 500 ME 6.88 6.88 6.88 74 5.09 percent of total billed charges 6.88 93 5.57 percent of total billed charges 6.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.88 other OPPS APC 6.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.88 other OPPS APC 6.88 24.86 1.71 percent of total billed charges 6.88 6.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAFCILLIN 1 GRAM SOLUTION FOR INJECTION (NO RECON) RX-40853331 CDM 250000000 HCPCS 0250 RC 44567-0221-10 NDC outpatient 1000 ME 33 33 33 74 24.42 percent of total billed charges 33 93 26.73 percent of total billed charges 33 33 other OPPS APC 33 33 other OPPS APC 33 24.86 8.2 percent of total billed charges 33 33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NITROGLYCERIN 50 MCG/ML INJECTION RX-40855991 CDM 250000000 HCPCS 0250 RC 90000-0003-15 NDC outpatient 25 ML 1.02 1.02 1.02 74 0.75 percent of total billed charges 1.02 93 0.83 percent of total billed charges 1.02 1.02 other OPPS APC 1.02 1.02 other OPPS APC 1.02 24.86 0.25 percent of total billed charges 1.02 1.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENICILLIN G POTASSIUM 5 MIL UNIT SOLN FOR INJ (PED RECON) RX-40860861 CDM J2540 HCPCS 0636 RC 44567-0311-10 NDC outpatient 1 UN 13.08 13.08 11 11 fee schedule 13.08 93 10.59 percent of total billed charges 13.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.08 other OPPS APC 13.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.08 other OPPS APC 13.08 24.86 3.25 percent of total billed charges 11 13.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENICILLIN G POTASSIUM 5 MIL UNIT SOLN FOR INJ (PED RECON)|DISCARDED DRUG NOT ADMINISTERED RX-40860861 CDM J2540 HCPCS 0636 RC 44567-0311-10 NDC JW outpatient 1 UN 13.08 13.08 9.78 9.78 fee schedule 9.78 13.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENICILLIN V POTASSIUM 125 MG/5 ML ORAL SYRINGE RX-40860901 CDM A9270 HCPCS 0250 RC 00093-4125-73 NDC outpatient 100 ML 24.88 24.88 74 18.41 percent of total billed charges 24.88 93 20.15 percent of total billed charges 24.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.88 other OPPS APC 24.88 24.88 other OPPS APC 24.88 24.86 6.19 percent of total billed charges 24.88 24.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENICILLIN V POTASSIUM 125 MG/5 ML ORAL SYRINGE RX-40860901 CDM A9270 HCPCS 0637 RC 00093-4125-73 NDC outpatient 100 ML 24.88 24.88 24.88 74 18.41 percent of total billed charges 24.88 93 20.15 percent of total billed charges 24.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.88 other OPPS APC 24.88 24.88 other OPPS APC 24.88 24.86 6.19 percent of total billed charges 24.88 24.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM CHLORIDE 3 % INTRAVENOUS INJECTION SOLUTION BOLUS RX-4087321 CDM 250000000 HCPCS 0250 RC 00338-0054-03 NDC outpatient 500 ML 19.05 19.05 19.05 74 14.1 percent of total billed charges 19.05 93 15.43 percent of total billed charges 19.05 19.05 other OPPS APC 19.05 19.05 other OPPS APC 19.05 24.86 4.74 percent of total billed charges 19.05 19.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM CHLORIDE 3 % INTRAVENOUS SOLUTION INFUSIION CUSTOM RX-40873211 CDM 250000000 HCPCS 0250 RC 00338-0054-03 NDC outpatient 500 ML 19.05 19.05 19.05 74 14.1 percent of total billed charges 19.05 93 15.43 percent of total billed charges 19.05 19.05 other OPPS APC 19.05 19.05 other OPPS APC 19.05 24.86 4.74 percent of total billed charges 19.05 19.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM CHLORIDE 3 % INTRAVENOUS BOLUS CUSTOM RX-408732111 CDM 250000000 HCPCS 0250 RC 00338-0054-03 NDC outpatient 500 ML 19.05 19.05 19.05 74 14.1 percent of total billed charges 19.05 93 15.43 percent of total billed charges 19.05 19.05 other OPPS APC 19.05 19.05 other OPPS APC 19.05 24.86 4.74 percent of total billed charges 19.05 19.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE 45 MCG-SALMETEROL 21 MCG/ACT HFA INH (PATIENT SPECIFIC) RX-408771731 CDM A9270 HCPCS 0250 RC 66993-0086-96 NDC outpatient 12 GR 930.7 930.7 74 688.72 percent of total billed charges 930.7 93 753.87 percent of total billed charges 930.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930.7 other OPPS APC 930.7 930.7 other OPPS APC 930.7 24.86 231.37 percent of total billed charges 930.7 930.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE 45 MCG-SALMETEROL 21 MCG/ACT HFA INH (PATIENT SPECIFIC) RX-408771731 CDM A9270 HCPCS 0637 RC 66993-0086-96 NDC outpatient 12 GR 930.7 930.7 930.7 74 688.72 percent of total billed charges 930.7 93 753.87 percent of total billed charges 930.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930.7 other OPPS APC 930.7 930.7 other OPPS APC 930.7 24.86 231.37 percent of total billed charges 930.7 930.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE 115 MCG-SALMETEROL 21 MCG/ACT HFA INH (PATIENT SPECIFIC) RX-408771741 CDM A9270 HCPCS 0250 RC 66993-0087-96 NDC outpatient 24 GR 2312.81 2312.81 74 1711.48 percent of total billed charges 2312.81 93 1873.38 percent of total billed charges 2312.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2312.81 other OPPS APC 2312.81 2312.81 other OPPS APC 2312.81 24.86 574.96 percent of total billed charges 2312.81 2312.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE 115 MCG-SALMETEROL 21 MCG/ACT HFA INH (PATIENT SPECIFIC) RX-408771741 CDM A9270 HCPCS 0637 RC 66993-0087-96 NDC outpatient 24 GR 2312.81 2312.81 2312.81 74 1711.48 percent of total billed charges 2312.81 93 1873.38 percent of total billed charges 2312.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2312.81 other OPPS APC 2312.81 2312.81 other OPPS APC 2312.81 24.86 574.96 percent of total billed charges 2312.81 2312.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE 230 MCG-SALMETEROL 21 MCG/ACT HFA INH (PATIENT SPECIFIC) RX-408771751 CDM A9270 HCPCS 0250 RC 66993-0088-96 NDC outpatient 12 GR 1520.88 1520.88 74 1125.45 percent of total billed charges 1520.88 93 1231.91 percent of total billed charges 1520.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1520.88 other OPPS APC 1520.88 1520.88 other OPPS APC 1520.88 24.86 378.09 percent of total billed charges 1520.88 1520.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE 230 MCG-SALMETEROL 21 MCG/ACT HFA INH (PATIENT SPECIFIC) RX-408771751 CDM A9270 HCPCS 0637 RC 66993-0088-96 NDC outpatient 12 GR 1520.88 1520.88 1520.88 74 1125.45 percent of total billed charges 1520.88 93 1231.91 percent of total billed charges 1520.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1520.88 other OPPS APC 1520.88 1520.88 other OPPS APC 1520.88 24.86 378.09 percent of total billed charges 1520.88 1520.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "VANCOMYCIN 1,000 MG INTRAVENOUS SOLUTION (NO RECON)" RX-40884421 CDM J3370 HCPCS 0636 RC 70436-0021-82 NDC outpatient 1000 ME 9 9 5.49 5.49 fee schedule 9 93 7.29 percent of total billed charges 9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9 other OPPS APC 9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9 other OPPS APC 9 24.86 2.24 percent of total billed charges 5.49 9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION (DIALYSIS)" RX-40889811 CDM P9047 HCPCS 0636 RC 68516-5216-01 NDC outpatient 50 ML 138.03 138.03 60.58 60.58 fee schedule 138.03 93 111.8 percent of total billed charges 138.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 53.08 other OPPS APC 138.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 53.08 other OPPS APC 138.03 24.86 34.31 percent of total billed charges 60.58 138.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IRINOTECAN 20 MG/ML INTRAVENOUS SOLUTION WRAPPER RX-4089105501 CDM J9206 HCPCS 0636 RC 45963-0614-51 NDC outpatient 2 ML 67.5 67.5 6.85 6.85 fee schedule 67.5 93 54.68 percent of total billed charges 67.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 67.5 other OPPS APC 67.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 67.5 other OPPS APC 67.5 24.86 16.78 percent of total billed charges 6.85 67.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN IV SYRINGE 5 MG/ML (1 G PMX STRAIGHT DRAW) RX-408928951 CDM J3370 HCPCS 0636 RC 90000-0004-01 NDC outpatient 1 ML 0.36 0.36 2.75 2.75 fee schedule 0.36 93 0.29 percent of total billed charges 0.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.36 other OPPS APC 0.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.36 other OPPS APC 0.36 24.86 0.09 percent of total billed charges 0.36 2.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN IV SYRINGE 5 MG/ML (1 G PMX STRAIGHT DRAW) RX-408928951 CDM J3370 HCPCS 0636 RC 90000-0004-01 NDC outpatient 5 ME 0.36 0.36 2.75 2.75 fee schedule 0.36 93 0.29 percent of total billed charges 0.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.36 other OPPS APC 0.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.36 other OPPS APC 0.36 24.86 0.09 percent of total billed charges 0.36 2.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 5 MG/ML IVPB (1 G PMX STRAIGHT DRAW) RX-408928952 CDM J3370 HCPCS 0636 RC 90000-0004-02 NDC outpatient 1 ML 0.36 0.36 2.75 2.75 fee schedule 0.36 93 0.29 percent of total billed charges 0.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.36 other OPPS APC 0.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.36 other OPPS APC 0.36 24.86 0.09 percent of total billed charges 0.36 2.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 5 MG/ML IVPB (1 G PMX STRAIGHT DRAW) RX-408928952 CDM J3370 HCPCS 0636 RC 90000-0004-02 NDC outpatient 5 ME 0.36 0.36 2.75 2.75 fee schedule 0.36 93 0.29 percent of total billed charges 0.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.36 other OPPS APC 0.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.36 other OPPS APC 0.36 24.86 0.09 percent of total billed charges 0.36 2.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLEVIDIPINE 0.5 MG/ML INTRAVENOUS EMULSION WRAPPER RX-4089393601 CDM 250000000 HCPCS 0250 RC 10122-0610-10 NDC outpatient 50 ML 256.7 256.7 256.7 74 189.96 percent of total billed charges 256.7 93 207.93 percent of total billed charges 256.7 256.7 other OPPS APC 256.7 256.7 other OPPS APC 256.7 24.86 63.82 percent of total billed charges 256.7 256.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION (NO RECON) RX-40894611 CDM J0694 HCPCS 0636 RC 44567-0245-25 NDC outpatient 1 GR 29.85 29.85 29.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.85 other OPPS APC 29.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.85 other OPPS APC 29.85 24.86 7.42 percent of total billed charges 29.85 29.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION (NO RECON) RX-4089463 CDM J0694 HCPCS 0636 RC 00143-9877-01 NDC outpatient 2 GR 59.4 59.4 59.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.4 other OPPS APC 59.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.4 other OPPS APC 59.4 24.86 14.77 percent of total billed charges 59.4 59.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION (NO RECON) RX-40894741 CDM J0713 HCPCS 0636 RC 44567-0235-25 NDC outpatient 1 GR 13.5 13.5 4.19 4.19 fee schedule 13.5 93 10.94 percent of total billed charges 13.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.5 other OPPS APC 13.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.5 other OPPS APC 13.5 24.86 3.36 percent of total billed charges 4.19 13.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION (NO RECON) RX-40894761 CDM J0713 HCPCS 0636 RC 00409-5084-11 NDC outpatient 2 GR 28.66 28.66 8.37 8.37 fee schedule 28.66 93 23.21 percent of total billed charges 28.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28.66 other OPPS APC 28.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28.66 other OPPS APC 28.66 24.86 7.12 percent of total billed charges 8.37 28.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION (NO RECON) RX-40894871 CDM J0696 HCPCS 0636 RC 00781-3208-95 NDC outpatient 1 GR 115 115 2.61 2.61 fee schedule 115 93 93.15 percent of total billed charges 115 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 115 other OPPS APC 115 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 115 other OPPS APC 115 24.86 28.59 percent of total billed charges 2.61 115 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION (NO RECON) RX-40894881 CDM J0696 HCPCS 0636 RC 60505-6149-04 NDC outpatient 2 GR 228.27 228.27 5.23 5.23 fee schedule 228.27 93 184.9 percent of total billed charges 228.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 228.27 other OPPS APC 228.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 228.27 other OPPS APC 228.27 24.86 56.75 percent of total billed charges 5.23 228.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTRIAXONE 250 MG SOLUTION FOR INJECTION (NO RECON) RX-40894891 CDM J0696 HCPCS 0636 RC 00409-7337-01 NDC outpatient 250 ME 2.29 2.29 0.65 0.65 fee schedule 2.29 93 1.85 percent of total billed charges 2.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.29 other OPPS APC 2.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.29 other OPPS APC 2.29 24.86 0.57 percent of total billed charges 0.65 2.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTRIAXONE 500 MG SOLUTION FOR INJECTION (NO RECON) RX-40894901 CDM J0696 HCPCS 0636 RC 00409-7338-01 NDC outpatient 500 ME 2.9 2.9 1.31 1.31 fee schedule 2.9 93 2.35 percent of total billed charges 2.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.9 other OPPS APC 2.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.9 other OPPS APC 2.9 24.86 0.72 percent of total billed charges 1.31 2.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTRIAXONE 2000 MG/20 ML IV SYRINGE (TN) RX-40894914 CDM J0696 HCPCS 0636 RC 90000-0002-35 NDC outpatient 20 ML 22.3 22.3 5.23 5.23 fee schedule 22.3 93 18.06 percent of total billed charges 22.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.3 other OPPS APC 22.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.3 other OPPS APC 22.3 24.86 5.54 percent of total billed charges 5.23 22.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTRIAXONE 1000 MG/10 ML IV SYRINGE (TN) RX-40894915 CDM J0696 HCPCS 0636 RC 90000-0002-34 NDC outpatient 10 ML 11.15 11.15 2.61 2.61 fee schedule 11.15 93 9.03 percent of total billed charges 11.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.15 other OPPS APC 11.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.15 other OPPS APC 11.15 24.86 2.77 percent of total billed charges 2.61 11.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTRIAXONE IV SYRINGE 40 MG/ML (STRAIGHT DRAW) RX-40894931 CDM J0696 HCPCS 0636 RC 00264-3155-11 NDC outpatient 50 ML 78.72 78.72 5.23 5.23 fee schedule 78.72 93 63.76 percent of total billed charges 78.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 78.72 other OPPS APC 78.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 78.72 other OPPS APC 78.72 24.86 19.57 percent of total billed charges 5.23 78.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTRIAXONE IVPB 40 MG/ML (STRAIGHT DRAW) RX-40894932 CDM J0696 HCPCS 0636 RC 00264-3155-11 NDC outpatient 50 ML 78.72 78.72 5.23 5.23 fee schedule 78.72 93 63.76 percent of total billed charges 78.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 78.72 other OPPS APC 78.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 78.72 other OPPS APC 78.72 24.86 19.57 percent of total billed charges 5.23 78.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEPHALEXIN 250 MG/5 ML ORAL SYRINGE RX-40895021 CDM A9270 HCPCS 0250 RC 67877-0545-88 NDC outpatient 100 ML 57.13 57.13 74 42.28 percent of total billed charges 57.13 93 46.28 percent of total billed charges 57.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 57.13 other OPPS APC 57.13 57.13 other OPPS APC 57.13 24.86 14.2 percent of total billed charges 57.13 57.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEPHALEXIN 250 MG/5 ML ORAL SYRINGE RX-40895021 CDM A9270 HCPCS 0637 RC 67877-0545-88 NDC outpatient 100 ML 57.13 57.13 57.13 74 42.28 percent of total billed charges 57.13 93 46.28 percent of total billed charges 57.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 57.13 other OPPS APC 57.13 57.13 other OPPS APC 57.13 24.86 14.2 percent of total billed charges 57.13 57.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMIPENEM-CILASTATIN 250 MG INTRAVENOUS SOLUTION (NO RECON) RX-40896021 CDM J0743 HCPCS 0636 RC 63323-0349-25 NDC outpatient 250 ME 44.97 44.97 8.16 8.16 fee schedule 44.97 93 36.43 percent of total billed charges 44.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.97 other OPPS APC 44.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.97 other OPPS APC 44.97 24.86 11.18 percent of total billed charges 8.16 44.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION (NO RECON) RX-40896031 CDM J0743 HCPCS 0636 RC 63323-0322-25 NDC outpatient 500 ME 89.94 89.94 16.31 16.31 fee schedule 89.94 93 72.85 percent of total billed charges 89.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 89.94 other OPPS APC 89.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 89.94 other OPPS APC 89.94 24.86 22.36 percent of total billed charges 16.31 89.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLINDAMYCIN IV SYRINGE 6 MG/ML (NEO/PED) RX-408962501 CDM 250000000 HCPCS 0250 RC 00781-3288-91 NDC outpatient 50 ML 24.6 24.6 24.6 74 18.2 percent of total billed charges 24.6 93 19.93 percent of total billed charges 24.6 24.6 other OPPS APC 24.6 24.6 other OPPS APC 24.6 24.86 6.12 percent of total billed charges 24.6 24.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABAZITAXEL 60 MG/6 ML FIRST DILUTION IV SOLN RX-410132 CDM J9043 HCPCS 0636 RC 00024-5824-11 NDC outpatient 1.5 ML 42439.6 42439.6 14111.3 14111.3 fee schedule 42439.6 93 34376.1 percent of total billed charges 42439.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12987.3 other OPPS APC 42439.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12987.3 other OPPS APC 42439.6 24.86 10550.5 percent of total billed charges 14111.3 42439.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENZOCAINE 6 MG-MENTHOL 10 MG LOZENGES RX-41085 CDM A9270 HCPCS 0250 RC 78112-0011-06 NDC outpatient 1 UN 0.34 0.34 74 0.25 percent of total billed charges 0.34 93 0.28 percent of total billed charges 0.34 0.34 other OPPS APC 0.34 0.34 other OPPS APC 0.34 24.86 0.08 percent of total billed charges 0.34 0.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENZOCAINE 6 MG-MENTHOL 10 MG LOZENGES RX-41085 CDM A9270 HCPCS 0637 RC 78112-0011-06 NDC outpatient 1 UN 0.34 0.34 0.34 74 0.25 percent of total billed charges 0.34 93 0.28 percent of total billed charges 0.34 0.34 other OPPS APC 0.34 0.34 other OPPS APC 0.34 24.86 0.08 percent of total billed charges 0.34 0.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION RX-41137 CDM A9577 HCPCS 0636 RC 00270-5164-13 NDC outpatient 10 ML 90 90 20.69 20.69 fee schedule 90 93 72.9 percent of total billed charges 90 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 90 other OPPS APC 90 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 90 other OPPS APC 90 24.86 22.37 percent of total billed charges 20.69 90 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER RX-41142 CDM A9270 HCPCS 0250 RC 00597-0087-17 NDC outpatient 12.9 GR 1416.18 1416.18 74 1047.97 percent of total billed charges 1416.18 93 1147.11 percent of total billed charges 1416.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1416.18 other OPPS APC 1416.18 1416.18 other OPPS APC 1416.18 24.86 352.06 percent of total billed charges 1416.18 1416.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER RX-41142 CDM A9270 HCPCS 0637 RC 00597-0087-17 NDC outpatient 12.9 GR 1416.18 1416.18 1416.18 74 1047.97 percent of total billed charges 1416.18 93 1147.11 percent of total billed charges 1416.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1416.18 other OPPS APC 1416.18 1416.18 other OPPS APC 1416.18 24.86 352.06 percent of total billed charges 1416.18 1416.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICAFUNGIN 50 MG INTRAVENOUS SOLUTION RX-41144 CDM J2247 HCPCS 0636 RC 42023-0229-10 NDC outpatient 5 ML 224.4 224.4 16.34 16.34 fee schedule 224.4 93 181.76 percent of total billed charges 224.4 224.4 other OPPS APC 224.4 224.4 other OPPS APC 224.4 24.86 55.79 percent of total billed charges 16.34 224.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICAFUNGIN 50 MG INTRAVENOUS SOLUTION RX-41144 CDM J2247 HCPCS 0636 RC 42023-0229-10 NDC outpatient 50 ME 224.4 224.4 16.34 16.34 fee schedule 224.4 93 181.76 percent of total billed charges 224.4 224.4 other OPPS APC 224.4 224.4 other OPPS APC 224.4 24.86 55.79 percent of total billed charges 16.34 224.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DIPHTH,PERTUSSIS(ACEL),TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5ML IM SYRINGE" RX-41293 CDM 90715 HCPCS 0636 RC 58160-0842-52 NDC outpatient 0.5 ML 141.05 141.05 44.23 44.23 fee schedule 141.05 93 114.25 percent of total billed charges 141.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 141.05 other OPPS APC 141.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 141.05 other OPPS APC 141.05 141.05 other OP Drugs 44.23 141.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM CHLORIDE 0.9 % INJECTION SOLUTION RX-41463 CDM 250000000 HCPCS 0250 RC 63323-0186-10 NDC outpatient 10 ML 3.06 3.06 3.06 74 2.26 percent of total billed charges 3.06 93 2.48 percent of total billed charges 3.06 3.06 other OPPS APC 3.06 3.06 other OPPS APC 3.06 24.86 0.76 percent of total billed charges 3.06 3.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIGECYCLINE 50 MG INTRAVENOUS SOLUTION RX-41652 CDM J3243 HCPCS 0636 RC 70121-1647-07 NDC outpatient 5 ML 247.5 247.5 42.35 42.35 fee schedule 247.5 93 200.48 percent of total billed charges 247.5 247.5 other OPPS APC 247.5 247.5 other OPPS APC 247.5 24.86 61.53 percent of total billed charges 42.35 247.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIGECYCLINE 50 MG INTRAVENOUS SOLUTION RX-41652 CDM J3243 HCPCS 0636 RC 70121-1647-07 NDC outpatient 50 ME 247.5 247.5 42.35 42.35 fee schedule 247.5 93 200.48 percent of total billed charges 247.5 247.5 other OPPS APC 247.5 247.5 other OPPS APC 247.5 24.86 61.53 percent of total billed charges 42.35 247.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION RX-41673 CDM J9390 HCPCS 0636 RC 45963-0607-56 NDC outpatient 5 ML 270 270 47.19 47.19 fee schedule 270 93 218.7 percent of total billed charges 270 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 270 other OPPS APC 270 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 270 other OPPS APC 270 24.86 67.12 percent of total billed charges 47.19 270 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION RX-41793 CDM 250000000 HCPCS 0250 RC 24201-0201-05 NDC outpatient 2 ML 231 231 231 74 170.94 percent of total billed charges 231 93 187.11 percent of total billed charges 231 231 other OPPS APC 231 231 other OPPS APC 231 24.86 57.43 percent of total billed charges 231 231 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE 5 % TOPICAL OINTMENT RX-41831 CDM A9270 HCPCS 0250 RC 70752-0113-03 NDC outpatient 35.44 GR 791.7 791.7 74 585.86 percent of total billed charges 791.7 93 641.28 percent of total billed charges 791.7 791.7 other OPPS APC 791.7 791.7 other OPPS APC 791.7 24.86 196.82 percent of total billed charges 791.7 791.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE 5 % TOPICAL OINTMENT RX-41831 CDM A9270 HCPCS 0637 RC 70752-0113-03 NDC outpatient 35.44 GR 791.7 791.7 791.7 74 585.86 percent of total billed charges 791.7 93 641.28 percent of total billed charges 791.7 791.7 other OPPS APC 791.7 791.7 other OPPS APC 791.7 24.86 196.82 percent of total billed charges 791.7 791.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET RX-41832 CDM A9270 HCPCS 0250 RC 50268-0717-15 NDC outpatient 1 UN 41.2 41.2 74 30.49 percent of total billed charges 41.2 93 33.37 percent of total billed charges 41.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.2 other OPPS APC 41.2 41.2 other OPPS APC 41.2 24.86 10.24 percent of total billed charges 41.2 41.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET RX-41832 CDM A9270 HCPCS 0637 RC 50268-0717-15 NDC outpatient 1 UN 41.2 41.2 41.2 74 30.49 percent of total billed charges 41.2 93 33.37 percent of total billed charges 41.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.2 other OPPS APC 41.2 41.2 other OPPS APC 41.2 24.86 10.24 percent of total billed charges 41.2 41.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DICYCLOMINE 10 MG/5 ML ORAL SOLUTION RX-42119 CDM A9270 HCPCS 0250 RC 00054-0622-63 NDC outpatient 473 ML 355.23 355.23 74 262.87 percent of total billed charges 355.23 93 287.74 percent of total billed charges 355.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 355.23 other OPPS APC 355.23 355.23 other OPPS APC 355.23 24.86 88.31 percent of total billed charges 355.23 355.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DICYCLOMINE 10 MG/5 ML ORAL SOLUTION RX-42119 CDM A9270 HCPCS 0637 RC 00054-0622-63 NDC outpatient 473 ML 355.23 355.23 355.23 74 262.87 percent of total billed charges 355.23 93 287.74 percent of total billed charges 355.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 355.23 other OPPS APC 355.23 355.23 other OPPS APC 355.23 24.86 88.31 percent of total billed charges 355.23 355.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PREGABALIN 25 MG CAPSULE RX-42162 CDM A9270 HCPCS 0250 RC 60687-0473-01 NDC outpatient 1 UN 4.05 4.05 74 3 percent of total billed charges 4.05 93 3.28 percent of total billed charges 4.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.05 other OPPS APC 4.05 4.05 other OPPS APC 4.05 24.86 1.01 percent of total billed charges 4.05 4.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PREGABALIN 25 MG CAPSULE RX-42162 CDM A9270 HCPCS 0637 RC 60687-0473-01 NDC outpatient 1 UN 4.05 4.05 4.05 74 3 percent of total billed charges 4.05 93 3.28 percent of total billed charges 4.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.05 other OPPS APC 4.05 4.05 other OPPS APC 4.05 24.86 1.01 percent of total billed charges 4.05 4.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PREGABALIN 50 MG CAPSULE RX-42163 CDM A9270 HCPCS 0250 RC 00904-6992-61 NDC outpatient 1 UN 2.27 2.27 74 1.68 percent of total billed charges 2.27 93 1.84 percent of total billed charges 2.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.27 other OPPS APC 2.27 2.27 other OPPS APC 2.27 24.86 0.56 percent of total billed charges 2.27 2.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PREGABALIN 50 MG CAPSULE RX-42163 CDM A9270 HCPCS 0637 RC 00904-6992-61 NDC outpatient 1 UN 2.27 2.27 2.27 74 1.68 percent of total billed charges 2.27 93 1.84 percent of total billed charges 2.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.27 other OPPS APC 2.27 2.27 other OPPS APC 2.27 24.86 0.56 percent of total billed charges 2.27 2.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PREGABALIN 75 MG CAPSULE RX-42164 CDM A9270 HCPCS 0250 RC 60687-0495-01 NDC outpatient 1 UN 4.05 4.05 74 3 percent of total billed charges 4.05 93 3.28 percent of total billed charges 4.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.05 other OPPS APC 4.05 4.05 other OPPS APC 4.05 24.86 1.01 percent of total billed charges 4.05 4.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PREGABALIN 75 MG CAPSULE RX-42164 CDM A9270 HCPCS 0637 RC 60687-0495-01 NDC outpatient 1 UN 4.05 4.05 4.05 74 3 percent of total billed charges 4.05 93 3.28 percent of total billed charges 4.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.05 other OPPS APC 4.05 4.05 other OPPS APC 4.05 24.86 1.01 percent of total billed charges 4.05 4.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PREGABALIN 100 MG CAPSULE RX-42165 CDM A9270 HCPCS 0250 RC 00904-7001-61 NDC outpatient 1 UN 2.53 2.53 74 1.87 percent of total billed charges 2.53 93 2.05 percent of total billed charges 2.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.53 other OPPS APC 2.53 2.53 other OPPS APC 2.53 24.86 0.63 percent of total billed charges 2.53 2.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PREGABALIN 100 MG CAPSULE RX-42165 CDM A9270 HCPCS 0637 RC 00904-7001-61 NDC outpatient 1 UN 2.53 2.53 2.53 74 1.87 percent of total billed charges 2.53 93 2.05 percent of total billed charges 2.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.53 other OPPS APC 2.53 2.53 other OPPS APC 2.53 24.86 0.63 percent of total billed charges 2.53 2.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID RX-42219 CDM A9270 HCPCS 0250 RC 00904-6836-20 NDC outpatient 120 ML 10.95 10.95 74 8.1 percent of total billed charges 10.95 93 8.87 percent of total billed charges 10.95 10.95 other OPPS APC 10.95 10.95 other OPPS APC 10.95 24.86 2.72 percent of total billed charges 10.95 10.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOPERAMIDE 1 MG/7.5 ML ORAL LIQUID RX-42219 CDM A9270 HCPCS 0637 RC 00904-6836-20 NDC outpatient 120 ML 10.95 10.95 10.95 74 8.1 percent of total billed charges 10.95 93 8.87 percent of total billed charges 10.95 10.95 other OPPS APC 10.95 10.95 other OPPS APC 10.95 24.86 2.72 percent of total billed charges 10.95 10.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KETAMINE 10 MG/ML INJECTION SOLUTION RX-4236 CDM 250000000 HCPCS 0250 RC 65219-0184-20 NDC outpatient 20 ML 59.34 59.34 59.34 74 43.91 percent of total billed charges 59.34 93 48.07 percent of total billed charges 59.34 59.34 other OPPS APC 59.34 59.34 other OPPS APC 59.34 24.86 14.75 percent of total billed charges 59.34 59.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KETAMINE 100 MG/ML INJECTION SOLUTION RX-4237 CDM 250000000 HCPCS 0250 RC 00409-2051-05 NDC outpatient 5 ML 24.94 24.94 24.94 74 18.46 percent of total billed charges 24.94 93 20.2 percent of total billed charges 24.94 24.94 other OPPS APC 24.94 24.94 other OPPS APC 24.94 24.86 6.2 percent of total billed charges 24.94 24.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LACTATED RINGERS INTRAVENOUS SOLUTION RX-4318 CDM J7120 HCPCS 0636 RC 00338-0117-04 NDC outpatient 1000 ML 15.48 15.48 2.72 2.72 fee schedule 15.48 93 12.54 percent of total billed charges 15.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.48 other OPPS APC 15.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.48 other OPPS APC 15.48 24.86 3.85 percent of total billed charges 2.72 15.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMITRIPTYLINE 10 MG TABLET RX-432 CDM A9270 HCPCS 0250 RC 50268-0037-15 NDC outpatient 1 UN 1.25 1.25 74 0.93 percent of total billed charges 1.25 93 1.01 percent of total billed charges 1.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.25 other OPPS APC 1.25 1.25 other OPPS APC 1.25 24.86 0.31 percent of total billed charges 1.25 1.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMITRIPTYLINE 10 MG TABLET RX-432 CDM A9270 HCPCS 0637 RC 50268-0037-15 NDC outpatient 1 UN 1.25 1.25 1.25 74 0.93 percent of total billed charges 1.25 93 1.01 percent of total billed charges 1.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.25 other OPPS APC 1.25 1.25 other OPPS APC 1.25 24.86 0.31 percent of total billed charges 1.25 1.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVALBUTEROL HFA 45 MCG/ACTUATION AEROSOL INHALER RX-43472 CDM 636000000 HCPCS 0636 RC 00591-2927-54 NDC outpatient 15 GR 184.25 184.25 184.25 74 136.35 percent of total billed charges 184.25 93 149.24 percent of total billed charges 184.25 184.25 other OPPS APC 184.25 184.25 other OPPS APC 184.25 24.86 45.8 percent of total billed charges 184.25 184.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMITRIPTYLINE 25 MG TABLET RX-435 CDM A9270 HCPCS 0250 RC 50268-0038-15 NDC outpatient 1 UN 1.25 1.25 74 0.93 percent of total billed charges 1.25 93 1.01 percent of total billed charges 1.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.25 other OPPS APC 1.25 1.25 other OPPS APC 1.25 24.86 0.31 percent of total billed charges 1.25 1.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMITRIPTYLINE 25 MG TABLET RX-435 CDM A9270 HCPCS 0637 RC 50268-0038-15 NDC outpatient 1 UN 1.25 1.25 1.25 74 0.93 percent of total billed charges 1.25 93 1.01 percent of total billed charges 1.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.25 other OPPS APC 1.25 1.25 other OPPS APC 1.25 24.86 0.31 percent of total billed charges 1.25 1.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION RX-4392 CDM J0640 HCPCS 0636 RC 00143-9554-01 NDC outpatient 10 ML 48 48 10.72 10.72 fee schedule 48 93 38.88 percent of total billed charges 48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48 other OPPS APC 48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48 other OPPS APC 48 24.86 11.93 percent of total billed charges 10.72 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEUCOVORIN CALCIUM 350 MG SOLUTION FOR INJECTION RX-4393 CDM J0640 HCPCS 0636 RC 67457-0530-35 NDC outpatient 17.5 ML 78 78 37.52 37.52 fee schedule 78 93 63.18 percent of total billed charges 78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 78 other OPPS APC 78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 78 other OPPS APC 78 24.86 19.39 percent of total billed charges 37.52 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEUCOVORIN CALCIUM 50 MG SOLUTION FOR INJECTION RX-4394 CDM J0640 HCPCS 0636 RC 00143-9555-01 NDC outpatient 50 ME 30 30 5.36 5.36 fee schedule 30 93 24.3 percent of total billed charges 30 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30 other OPPS APC 30 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30 other OPPS APC 30 24.86 7.46 percent of total billed charges 5.36 30 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOTHYROXINE 25 MCG TABLET RX-4420 CDM A9270 HCPCS 0250 RC 00904-6949-61 NDC outpatient 1 UN 1.37 1.37 74 1.01 percent of total billed charges 1.37 93 1.11 percent of total billed charges 1.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.37 other OPPS APC 1.37 1.37 other OPPS APC 1.37 24.86 0.34 percent of total billed charges 1.37 1.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOTHYROXINE 25 MCG TABLET RX-4420 CDM A9270 HCPCS 0637 RC 00904-6949-61 NDC outpatient 1 UN 1.37 1.37 1.37 74 1.01 percent of total billed charges 1.37 93 1.11 percent of total billed charges 1.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.37 other OPPS APC 1.37 1.37 other OPPS APC 1.37 24.86 0.34 percent of total billed charges 1.37 1.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOTHYROXINE 50 MCG TABLET RX-4421 CDM A9270 HCPCS 0250 RC 00904-6950-61 NDC outpatient 1 UN 1.41 1.41 74 1.04 percent of total billed charges 1.41 93 1.14 percent of total billed charges 1.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.41 other OPPS APC 1.41 1.41 other OPPS APC 1.41 24.86 0.35 percent of total billed charges 1.41 1.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOTHYROXINE 50 MCG TABLET RX-4421 CDM A9270 HCPCS 0637 RC 00904-6950-61 NDC outpatient 1 UN 1.41 1.41 1.41 74 1.04 percent of total billed charges 1.41 93 1.14 percent of total billed charges 1.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.41 other OPPS APC 1.41 1.41 other OPPS APC 1.41 24.86 0.35 percent of total billed charges 1.41 1.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOTHYROXINE 75 MCG TABLET RX-4422 CDM A9270 HCPCS 0250 RC 00904-6951-61 NDC outpatient 1 UN 1.72 1.72 74 1.27 percent of total billed charges 1.72 93 1.39 percent of total billed charges 1.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.72 other OPPS APC 1.72 1.72 other OPPS APC 1.72 24.86 0.43 percent of total billed charges 1.72 1.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOTHYROXINE 75 MCG TABLET RX-4422 CDM A9270 HCPCS 0637 RC 00904-6951-61 NDC outpatient 1 UN 1.72 1.72 1.72 74 1.27 percent of total billed charges 1.72 93 1.39 percent of total billed charges 1.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.72 other OPPS APC 1.72 1.72 other OPPS APC 1.72 24.86 0.43 percent of total billed charges 1.72 1.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOTHYROXINE 100 MCG TABLET RX-4423 CDM A9270 HCPCS 0250 RC 00904-6953-61 NDC outpatient 1 UN 1.76 1.76 74 1.3 percent of total billed charges 1.76 93 1.43 percent of total billed charges 1.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.76 other OPPS APC 1.76 1.76 other OPPS APC 1.76 24.86 0.44 percent of total billed charges 1.76 1.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOTHYROXINE 100 MCG TABLET RX-4423 CDM A9270 HCPCS 0637 RC 00904-6953-61 NDC outpatient 1 UN 1.76 1.76 1.76 74 1.3 percent of total billed charges 1.76 93 1.43 percent of total billed charges 1.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.76 other OPPS APC 1.76 1.76 other OPPS APC 1.76 24.86 0.44 percent of total billed charges 1.76 1.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOTHYROXINE 125 MCG TABLET RX-4424 CDM A9270 HCPCS 0250 RC 00904-6955-61 NDC outpatient 1 UN 2.07 2.07 74 1.53 percent of total billed charges 2.07 93 1.68 percent of total billed charges 2.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.07 other OPPS APC 2.07 2.07 other OPPS APC 2.07 24.86 0.51 percent of total billed charges 2.07 2.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVOTHYROXINE 125 MCG TABLET RX-4424 CDM A9270 HCPCS 0637 RC 00904-6955-61 NDC outpatient 1 UN 2.07 2.07 2.07 74 1.53 percent of total billed charges 2.07 93 1.68 percent of total billed charges 2.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.07 other OPPS APC 2.07 2.07 other OPPS APC 2.07 24.86 0.51 percent of total billed charges 2.07 2.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION RX-4450 CDM A9270 HCPCS 0250 RC 00121-0972-51 NDC outpatient 50 ML 161.6 161.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 161.6 other OPPS APC 161.6 161.6 other OPPS APC 161.6 24.86 40.17 percent of total billed charges 161.6 161.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION RX-4450 CDM A9270 HCPCS 0637 RC 00121-0972-51 NDC outpatient 50 ML 161.6 161.6 161.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 161.6 other OPPS APC 161.6 161.6 other OPPS APC 161.6 24.86 40.17 percent of total billed charges 161.6 161.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION RX-4450 CDM A9270 HCPCS 0250 RC 64679-0465-51 NDC outpatient 50 ML 120 120 74 88.8 percent of total billed charges 120 93 97.2 percent of total billed charges 120 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION RX-4450 CDM A9270 HCPCS 0637 RC 64679-0465-51 NDC outpatient 50 ML 120 120 120 74 88.8 percent of total billed charges 120 93 97.2 percent of total billed charges 120 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION RX-4452 CDM 250000000 HCPCS 0250 RC 63323-0201-02 NDC outpatient 2 ML 7.8 7.8 7.8 74 5.77 percent of total billed charges 7.8 93 6.32 percent of total billed charges 7.8 7.8 other OPPS APC 7.8 7.8 other OPPS APC 7.8 24.86 1.94 percent of total billed charges 7.8 7.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION RX-4454 CDM 250000000 HCPCS 0250 RC 00143-9575-01 NDC outpatient 50 ML 11.04 11.04 11.04 74 8.17 percent of total billed charges 11.04 93 8.94 percent of total billed charges 11.04 11.04 other OPPS APC 11.04 11.04 other OPPS APC 11.04 24.86 2.74 percent of total billed charges 11.04 11.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE (PF) 50 MG/5 ML (1 %) INTRAVENOUS SYRINGE RX-4457 CDM 250000000 HCPCS 0250 RC 00409-4904-34 NDC outpatient 5 ML 53.98 53.98 53.98 74 39.95 percent of total billed charges 53.98 93 43.72 percent of total billed charges 53.98 53.98 other OPPS APC 53.98 53.98 other OPPS APC 53.98 24.86 13.42 percent of total billed charges 53.98 53.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE RX-4459 CDM 250000000 HCPCS 0250 RC 00409-1323-05 NDC outpatient 5 ML 18.03 18.03 18.03 74 13.34 percent of total billed charges 18.03 93 14.6 percent of total billed charges 18.03 18.03 other OPPS APC 18.03 18.03 other OPPS APC 18.03 24.86 4.48 percent of total billed charges 18.03 18.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXAPINE 100 MG TABLET RX-446 CDM A9270 HCPCS 0250 RC 00591-5715-01 NDC outpatient 1 UN 5.4 5.4 74 4 percent of total billed charges 5.4 93 4.37 percent of total billed charges 5.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.4 other OPPS APC 5.4 5.4 other OPPS APC 5.4 24.86 1.34 percent of total billed charges 5.4 5.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXAPINE 100 MG TABLET RX-446 CDM A9270 HCPCS 0637 RC 00591-5715-01 NDC outpatient 1 UN 5.4 5.4 5.4 74 4 percent of total billed charges 5.4 93 4.37 percent of total billed charges 5.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.4 other OPPS APC 5.4 5.4 other OPPS APC 5.4 24.86 1.34 percent of total billed charges 5.4 5.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 250 MG CAPSULE RX-450 CDM A9270 HCPCS 0250 RC 65862-0016-01 NDC outpatient 1 UN 0.63 0.63 74 0.47 percent of total billed charges 0.63 93 0.51 percent of total billed charges 0.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.63 other OPPS APC 0.63 0.63 other OPPS APC 0.63 24.86 0.16 percent of total billed charges 0.63 0.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 250 MG CAPSULE RX-450 CDM A9270 HCPCS 0637 RC 65862-0016-01 NDC outpatient 1 UN 0.63 0.63 0.63 74 0.47 percent of total billed charges 0.63 93 0.51 percent of total billed charges 0.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.63 other OPPS APC 0.63 0.63 other OPPS APC 0.63 24.86 0.16 percent of total billed charges 0.63 0.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 500 MG CAPSULE RX-451 CDM A9270 HCPCS 0250 RC 16714-0299-03 NDC outpatient 1 UN 1.1 1.1 74 0.81 percent of total billed charges 1.1 93 0.89 percent of total billed charges 1.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.1 other OPPS APC 1.1 1.1 other OPPS APC 1.1 24.86 0.27 percent of total billed charges 1.1 1.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 500 MG CAPSULE RX-451 CDM A9270 HCPCS 0637 RC 16714-0299-03 NDC outpatient 1 UN 1.1 1.1 1.1 74 0.81 percent of total billed charges 1.1 93 0.89 percent of total billed charges 1.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.1 other OPPS APC 1.1 1.1 other OPPS APC 1.1 24.86 0.27 percent of total billed charges 1.1 1.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LITHIUM CARBONATE 150 MG CAPSULE RX-4528 CDM A9270 HCPCS 0250 RC 00054-8526-25 NDC outpatient 1 UN 0.47 0.47 74 0.35 percent of total billed charges 0.47 93 0.38 percent of total billed charges 0.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.47 other OPPS APC 0.47 0.47 other OPPS APC 0.47 24.86 0.12 percent of total billed charges 0.47 0.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LITHIUM CARBONATE 150 MG CAPSULE RX-4528 CDM A9270 HCPCS 0637 RC 00054-8526-25 NDC outpatient 1 UN 0.47 0.47 0.47 74 0.35 percent of total billed charges 0.47 93 0.38 percent of total billed charges 0.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.47 other OPPS APC 0.47 0.47 other OPPS APC 0.47 24.86 0.12 percent of total billed charges 0.47 0.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 125 MG/5 ML ORAL SUSPENSION RX-453 CDM A9270 HCPCS 0250 RC 00781-6039-46 NDC outpatient 100 ML 8.9 8.9 74 6.59 percent of total billed charges 8.9 93 7.21 percent of total billed charges 8.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.9 other OPPS APC 8.9 8.9 other OPPS APC 8.9 24.86 2.21 percent of total billed charges 8.9 8.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 125 MG/5 ML ORAL SUSPENSION RX-453 CDM A9270 HCPCS 0637 RC 00781-6039-46 NDC outpatient 100 ML 8.9 8.9 8.9 74 6.59 percent of total billed charges 8.9 93 7.21 percent of total billed charges 8.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.9 other OPPS APC 8.9 8.9 other OPPS APC 8.9 24.86 2.21 percent of total billed charges 8.9 8.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION RX-454 CDM A9270 HCPCS 0250 RC 65862-0707-01 NDC outpatient 100 ML 15.33 15.33 74 11.34 percent of total billed charges 15.33 93 12.42 percent of total billed charges 15.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.33 other OPPS APC 15.33 15.33 other OPPS APC 15.33 24.86 3.81 percent of total billed charges 15.33 15.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION RX-454 CDM A9270 HCPCS 0637 RC 65862-0707-01 NDC outpatient 100 ML 15.33 15.33 15.33 74 11.34 percent of total billed charges 15.33 93 12.42 percent of total billed charges 15.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.33 other OPPS APC 15.33 15.33 other OPPS APC 15.33 24.86 3.81 percent of total billed charges 15.33 15.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOPERAMIDE 2 MG CAPSULE RX-4560 CDM A9270 HCPCS 0250 RC 50268-0482-15 NDC outpatient 1 UN 2.48 2.48 74 1.84 percent of total billed charges 2.48 93 2.01 percent of total billed charges 2.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.48 other OPPS APC 2.48 2.48 other OPPS APC 2.48 24.86 0.62 percent of total billed charges 2.48 2.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOPERAMIDE 2 MG CAPSULE RX-4560 CDM A9270 HCPCS 0637 RC 50268-0482-15 NDC outpatient 1 UN 2.48 2.48 2.48 74 1.84 percent of total billed charges 2.48 93 2.01 percent of total billed charges 2.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.48 other OPPS APC 2.48 2.48 other OPPS APC 2.48 24.86 0.62 percent of total billed charges 2.48 2.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LORAZEPAM 0.5 MG TABLET RX-4572 CDM A9270 HCPCS 0250 RC 00904-6007-61 NDC outpatient 1 UN 0.24 0.24 74 0.18 percent of total billed charges 0.24 93 0.19 percent of total billed charges 0.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.24 other OPPS APC 0.24 0.24 other OPPS APC 0.24 24.86 0.06 percent of total billed charges 0.24 0.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LORAZEPAM 0.5 MG TABLET RX-4572 CDM A9270 HCPCS 0637 RC 00904-6007-61 NDC outpatient 1 UN 0.24 0.24 0.24 74 0.18 percent of total billed charges 0.24 93 0.19 percent of total billed charges 0.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.24 other OPPS APC 0.24 0.24 other OPPS APC 0.24 24.86 0.06 percent of total billed charges 0.24 0.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LORAZEPAM 1 MG TABLET RX-4573 CDM A9270 HCPCS 0250 RC 00093-3426-01 NDC outpatient 1 UN 2.2 2.2 74 1.63 percent of total billed charges 2.2 93 1.78 percent of total billed charges 2.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.2 other OPPS APC 2.2 2.2 other OPPS APC 2.2 24.86 0.55 percent of total billed charges 2.2 2.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LORAZEPAM 1 MG TABLET RX-4573 CDM A9270 HCPCS 0637 RC 00093-3426-01 NDC outpatient 1 UN 2.2 2.2 2.2 74 1.63 percent of total billed charges 2.2 93 1.78 percent of total billed charges 2.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.2 other OPPS APC 2.2 2.2 other OPPS APC 2.2 24.86 0.55 percent of total billed charges 2.2 2.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION RX-464 CDM J0285 HCPCS 0636 RC 39822-1055-05 NDC outpatient 1 UN 150 150 47.57 47.57 fee schedule 150 93 121.5 percent of total billed charges 150 150 other OPPS APC 150 150 other OPPS APC 150 24.86 37.29 percent of total billed charges 47.57 150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION RX-464 CDM J0285 HCPCS 0636 RC 39822-1055-05 NDC outpatient 50 ME 150 150 47.57 47.57 fee schedule 150 93 121.5 percent of total billed charges 150 150 other OPPS APC 150 150 other OPPS APC 150 24.86 37.29 percent of total billed charges 47.57 150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMPICILLIN 1 GRAM SOLUTION FOR INJECTION RX-469 CDM J0290 HCPCS 0636 RC 44567-0102-10 NDC outpatient 1 GR 18 18 1.79 1.79 fee schedule 18 93 14.58 percent of total billed charges 18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18 other OPPS APC 18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18 other OPPS APC 18 24.86 4.47 percent of total billed charges 1.79 18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMPICILLIN 1 GRAM SOLUTION FOR INJECTION RX-469 CDM J0290 HCPCS 0636 RC 44567-0102-10 NDC outpatient 8 ML 18 18 1.79 1.79 fee schedule 18 93 14.58 percent of total billed charges 18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18 other OPPS APC 18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18 other OPPS APC 18 24.86 4.47 percent of total billed charges 1.79 18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAGNESIUM CITRATE ORAL SOLUTION RX-4712 CDM A9270 HCPCS 0250 RC 70677-1111-01 NDC outpatient 296 ML 4.76 4.76 74 3.52 percent of total billed charges 4.76 93 3.86 percent of total billed charges 4.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.76 other OPPS APC 4.76 4.76 other OPPS APC 4.76 24.86 1.18 percent of total billed charges 4.76 4.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAGNESIUM CITRATE ORAL SOLUTION RX-4712 CDM A9270 HCPCS 0637 RC 70677-1111-01 NDC outpatient 296 ML 4.76 4.76 4.76 74 3.52 percent of total billed charges 4.76 93 3.86 percent of total billed charges 4.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.76 other OPPS APC 4.76 4.76 other OPPS APC 4.76 24.86 1.18 percent of total billed charges 4.76 4.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAGNESIUM SULFATE 4 GRAM/100 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK RX-4719 CDM J3475 HCPCS 0636 RC 70121-1720-01 NDC outpatient 100 ML 18.75 18.75 8.52 8.52 fee schedule 18.75 93 15.19 percent of total billed charges 18.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.75 other OPPS APC 18.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.75 other OPPS APC 18.75 24.86 4.66 percent of total billed charges 8.52 18.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAGNESIUM SULFATE 4 GRAM/100 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK RX-4719 CDM J3475 HCPCS 0636 RC 70121-1720-01 NDC outpatient 4 GR 18.75 18.75 8.52 8.52 fee schedule 18.75 93 15.19 percent of total billed charges 18.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.75 other OPPS APC 18.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.75 other OPPS APC 18.75 24.86 4.66 percent of total billed charges 8.52 18.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMPICILLIN 2 GRAM SOLUTION FOR INJECTION RX-472 CDM J0290 HCPCS 0636 RC 72485-0422-10 NDC outpatient 16 ML 21.33 21.33 3.58 3.58 fee schedule 21.33 93 17.28 percent of total billed charges 21.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 21.33 other OPPS APC 21.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 21.33 other OPPS APC 21.33 24.86 5.3 percent of total billed charges 3.58 21.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMPICILLIN 2 GRAM SOLUTION FOR INJECTION RX-472 CDM J0290 HCPCS 0636 RC 72485-0422-10 NDC outpatient 2 GR 21.33 21.33 3.58 3.58 fee schedule 21.33 93 17.28 percent of total billed charges 21.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 21.33 other OPPS APC 21.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 21.33 other OPPS APC 21.33 24.86 5.3 percent of total billed charges 3.58 21.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION RX-4720 CDM J3475 HCPCS 0636 RC 63323-0064-11 NDC outpatient 10 ML 7.41 7.41 10.65 10.65 fee schedule 7.41 93 6 percent of total billed charges 7.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.41 other OPPS APC 7.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.41 other OPPS APC 7.41 24.86 1.84 percent of total billed charges 7.41 10.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMPICILLIN 250 MG SOLUTION FOR INJECTION RX-473 CDM J0290 HCPCS 0636 RC 00781-3402-95 NDC outpatient 250 ME 10.47 10.47 0.9 0.9 fee schedule 10.47 93 8.48 percent of total billed charges 10.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.47 other OPPS APC 10.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.47 other OPPS APC 10.47 24.86 2.6 percent of total billed charges 0.9 10.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMPICILLIN 250 MG SOLUTION FOR INJECTION RX-473 CDM J0290 HCPCS 0636 RC 00781-3402-95 NDC outpatient 5 ML 10.47 10.47 0.9 0.9 fee schedule 10.47 93 8.48 percent of total billed charges 10.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.47 other OPPS APC 10.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.47 other OPPS APC 10.47 24.86 2.6 percent of total billed charges 0.9 10.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMPICILLIN 500 MG SOLUTION FOR INJECTION RX-474 CDM J0290 HCPCS 0636 RC 65219-0016-10 NDC outpatient 5 ML 7.38 7.38 0.9 0.9 fee schedule 7.38 93 5.98 percent of total billed charges 7.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.38 other OPPS APC 7.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.38 other OPPS APC 7.38 24.86 1.83 percent of total billed charges 0.9 7.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMPICILLIN 500 MG SOLUTION FOR INJECTION RX-474 CDM J0290 HCPCS 0636 RC 65219-0016-10 NDC outpatient 500 ME 7.38 7.38 0.9 0.9 fee schedule 7.38 93 5.98 percent of total billed charges 7.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.38 other OPPS APC 7.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.38 other OPPS APC 7.38 24.86 1.83 percent of total billed charges 0.9 7.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MANNITOL 20 % INTRAVENOUS SOLUTION RX-4749 CDM 250000000 HCPCS 0250 RC 00990-7715-13 NDC outpatient 100 GR 57.15 57.15 57.15 74 42.29 percent of total billed charges 57.15 93 46.29 percent of total billed charges 57.15 57.15 other OPPS APC 57.15 57.15 other OPPS APC 57.15 24.86 14.21 percent of total billed charges 57.15 57.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MANNITOL 20 % INTRAVENOUS SOLUTION RX-4749 CDM 250000000 HCPCS 0250 RC 00990-7715-13 NDC outpatient 500 ML 57.15 57.15 57.15 74 42.29 percent of total billed charges 57.15 93 46.29 percent of total billed charges 57.15 57.15 other OPPS APC 57.15 57.15 other OPPS APC 57.15 24.86 14.21 percent of total billed charges 57.15 57.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MANNITOL 25 % INTRAVENOUS SOLUTION RX-4750 CDM J2150 HCPCS 0636 RC 63323-0024-25 NDC outpatient 50 ML 18.18 18.18 5.63 5.63 fee schedule 18.18 93 14.73 percent of total billed charges 18.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.18 other OPPS APC 18.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18.18 other OPPS APC 18.18 24.86 4.52 percent of total billed charges 5.63 18.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEDROXYPROGESTERONE 2.5 MG TABLET RX-4855 CDM A9270 HCPCS 0250 RC 00555-0872-02 NDC outpatient 1 UN 0.79 0.79 74 0.58 percent of total billed charges 0.79 93 0.64 percent of total billed charges 0.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.79 other OPPS APC 0.79 0.79 other OPPS APC 0.79 24.86 0.2 percent of total billed charges 0.79 0.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEDROXYPROGESTERONE 2.5 MG TABLET RX-4855 CDM A9270 HCPCS 0637 RC 00555-0872-02 NDC outpatient 1 UN 0.79 0.79 0.79 74 0.58 percent of total billed charges 0.79 93 0.64 percent of total billed charges 0.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.79 other OPPS APC 0.79 0.79 other OPPS APC 0.79 24.86 0.2 percent of total billed charges 0.79 0.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEGESTROL 20 MG TABLET RX-4870 CDM A9270 HCPCS 0250 RC 64380-0158-01 NDC outpatient 1 UN 1.73 1.73 74 1.28 percent of total billed charges 1.73 93 1.4 percent of total billed charges 1.73 1.73 other OPPS APC 1.73 1.73 other OPPS APC 1.73 24.86 0.43 percent of total billed charges 1.73 1.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEGESTROL 20 MG TABLET RX-4870 CDM A9270 HCPCS 0637 RC 64380-0158-01 NDC outpatient 1 UN 1.73 1.73 1.73 74 1.28 percent of total billed charges 1.73 93 1.4 percent of total billed charges 1.73 1.73 other OPPS APC 1.73 1.73 other OPPS APC 1.73 24.86 0.43 percent of total billed charges 1.73 1.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEGESTROL 40 MG TABLET RX-4871 CDM A9270 HCPCS 0250 RC 00904-7236-61 NDC outpatient 1 UN 0.7 0.7 74 0.52 percent of total billed charges 0.7 93 0.57 percent of total billed charges 0.7 0.7 other OPPS APC 0.7 0.7 other OPPS APC 0.7 24.86 0.17 percent of total billed charges 0.7 0.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEGESTROL 40 MG TABLET RX-4871 CDM A9270 HCPCS 0637 RC 00904-7236-61 NDC outpatient 1 UN 0.7 0.7 0.7 74 0.52 percent of total billed charges 0.7 93 0.57 percent of total billed charges 0.7 0.7 other OPPS APC 0.7 0.7 other OPPS APC 0.7 24.86 0.17 percent of total billed charges 0.7 0.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION RX-4903 CDM J2175 HCPCS 0636 RC 00641-6052-01 NDC outpatient 1 ML 7.61 7.61 8.35 8.35 fee schedule 7.61 93 6.16 percent of total billed charges 7.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.61 other OPPS APC 7.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.61 other OPPS APC 7.61 24.86 1.89 percent of total billed charges 7.61 8.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEPERIDINE (PF) 50 MG/ML INJECTION SOLUTION RX-4904 CDM J2175 HCPCS 0636 RC 00641-6053-25 NDC outpatient 1 ML 7.93 7.93 8.35 8.35 fee schedule 7.93 93 6.42 percent of total billed charges 7.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.93 other OPPS APC 7.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.93 other OPPS APC 7.93 24.86 1.97 percent of total billed charges 7.93 8.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHADONE 10 MG/5 ML ORAL SOLUTION RX-4951 CDM A9270 HCPCS 0250 RC 00054-3556-63 NDC outpatient 500 ML 172.68 172.68 74 127.78 percent of total billed charges 172.68 93 139.87 percent of total billed charges 172.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 172.68 other OPPS APC 172.68 172.68 other OPPS APC 172.68 24.86 42.93 percent of total billed charges 172.68 172.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHADONE 10 MG/5 ML ORAL SOLUTION RX-4951 CDM A9270 HCPCS 0637 RC 00054-3556-63 NDC outpatient 500 ML 172.68 172.68 172.68 74 127.78 percent of total billed charges 172.68 93 139.87 percent of total billed charges 172.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 172.68 other OPPS APC 172.68 172.68 other OPPS APC 172.68 24.86 42.93 percent of total billed charges 172.68 172.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHADONE 10 MG TABLET RX-4953 CDM A9270 HCPCS 0250 RC 00054-0710-20 NDC outpatient 1 UN 1.1 1.1 74 0.81 percent of total billed charges 1.1 93 0.89 percent of total billed charges 1.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.1 other OPPS APC 1.1 1.1 other OPPS APC 1.1 24.86 0.27 percent of total billed charges 1.1 1.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHADONE 10 MG TABLET RX-4953 CDM A9270 HCPCS 0637 RC 00054-0710-20 NDC outpatient 1 UN 1.1 1.1 1.1 74 0.81 percent of total billed charges 1.1 93 0.89 percent of total billed charges 1.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.1 other OPPS APC 1.1 1.1 other OPPS APC 1.1 24.86 0.27 percent of total billed charges 1.1 1.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHADONE 5 MG TABLET RX-4954 CDM A9270 HCPCS 0250 RC 00054-0709-20 NDC outpatient 1 UN 0.97 0.97 74 0.72 percent of total billed charges 0.97 93 0.79 percent of total billed charges 0.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.97 other OPPS APC 0.97 0.97 other OPPS APC 0.97 24.86 0.24 percent of total billed charges 0.97 0.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHADONE 5 MG TABLET RX-4954 CDM A9270 HCPCS 0637 RC 00054-0709-20 NDC outpatient 1 UN 0.97 0.97 0.97 74 0.72 percent of total billed charges 0.97 93 0.79 percent of total billed charges 0.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.97 other OPPS APC 0.97 0.97 other OPPS APC 0.97 24.86 0.24 percent of total billed charges 0.97 0.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHAZOLAMIDE 50 MG TABLET RX-4962 CDM A9270 HCPCS 0250 RC 68094-0808-50 NDC outpatient 1 UN 8.98 8.98 74 6.65 percent of total billed charges 8.98 93 7.27 percent of total billed charges 8.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.98 other OPPS APC 8.98 8.98 other OPPS APC 8.98 24.86 2.23 percent of total billed charges 8.98 8.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHAZOLAMIDE 50 MG TABLET RX-4962 CDM A9270 HCPCS 0637 RC 68094-0808-50 NDC outpatient 1 UN 8.98 8.98 8.98 74 6.65 percent of total billed charges 8.98 93 7.27 percent of total billed charges 8.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.98 other OPPS APC 8.98 8.98 other OPPS APC 8.98 24.86 2.23 percent of total billed charges 8.98 8.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHOCARBAMOL 500 MG TABLET RX-4971 CDM A9270 HCPCS 0250 RC 63739-0991-10 NDC outpatient 1 UN 0.71 0.71 74 0.53 percent of total billed charges 0.71 93 0.58 percent of total billed charges 0.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.71 other OPPS APC 0.71 0.71 other OPPS APC 0.71 24.86 0.18 percent of total billed charges 0.71 0.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHOCARBAMOL 500 MG TABLET RX-4971 CDM A9270 HCPCS 0637 RC 63739-0991-10 NDC outpatient 1 UN 0.71 0.71 0.71 74 0.53 percent of total billed charges 0.71 93 0.58 percent of total billed charges 0.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.71 other OPPS APC 0.71 0.71 other OPPS APC 0.71 24.86 0.18 percent of total billed charges 0.71 0.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHOTREXATE SODIUM 2.5 MG TABLET RX-4973 CDM J8610 HCPCS 0636 RC 16729-0486-01 NDC outpatient 1 UN 10.03 10.03 0.27 0.27 fee schedule 10.03 93 8.12 percent of total billed charges 10.03 10.03 other OPPS APC 10.03 10.03 other OPPS APC 10.03 24.86 2.49 percent of total billed charges 0.27 10.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHOTREXATE SODIUM 25 MG/ML INJECTION SOLUTION RX-4974 CDM J9250 HCPCS 0636 RC 61703-0350-38 NDC outpatient 2 ML 21.81 21.81 3.15 3.15 fee schedule 21.81 93 17.67 percent of total billed charges 21.81 21.81 other OPPS APC 21.81 21.81 other OPPS APC 21.81 24.86 5.42 percent of total billed charges 3.15 21.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHYLPHENIDATE 5 MG TABLET RX-4988 CDM A9270 HCPCS 0250 RC 68084-0805-21 NDC outpatient 1 UN 6.16 6.16 74 4.56 percent of total billed charges 6.16 93 4.99 percent of total billed charges 6.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.16 other OPPS APC 6.16 6.16 other OPPS APC 6.16 24.86 1.53 percent of total billed charges 6.16 6.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHYLPHENIDATE 5 MG TABLET RX-4988 CDM A9270 HCPCS 0637 RC 68084-0805-21 NDC outpatient 1 UN 6.16 6.16 6.16 74 4.56 percent of total billed charges 6.16 93 4.99 percent of total billed charges 6.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.16 other OPPS APC 6.16 6.16 other OPPS APC 6.16 24.86 1.53 percent of total billed charges 6.16 6.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHYLPREDNISOLONE 4 MG TABLET RX-4993 CDM J7509 HCPCS 0636 RC 42806-0400-01 NDC outpatient 1 UN 4.13 4.13 0.3 0.3 fee schedule 4.13 93 3.35 percent of total billed charges 4.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.13 other OPPS APC 4.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.13 other OPPS APC 4.13 24.86 1.03 percent of total billed charges 0.3 4.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION RX-4995 CDM J1010 HCPCS 0636 RC 00009-3073-03 NDC outpatient 1 ML 34.11 34.11 34.11 74 25.24 percent of total billed charges 34.11 93 27.63 percent of total billed charges 34.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.11 other OPPS APC 34.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.11 other OPPS APC 34.11 24.86 8.48 percent of total billed charges 34.11 34.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION RX-4996 CDM J1010 HCPCS 0636 RC 00009-3475-03 NDC outpatient 1 ML 59.18 59.18 59.18 74 43.79 percent of total billed charges 59.18 93 47.94 percent of total billed charges 59.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.18 other OPPS APC 59.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.18 other OPPS APC 59.18 24.86 14.71 percent of total billed charges 59.18 59.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION RX-5002 CDM J2765 HCPCS 0636 RC 00409-3414-11 NDC outpatient 2 ML 2.02 2.02 2.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.02 other OPPS APC 2.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.02 other OPPS APC 2.02 24.86 0.5 percent of total billed charges 2.02 2.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METOCLOPRAMIDE 10 MG TABLET RX-5005 CDM A9270 HCPCS 0250 RC 60687-0631-01 NDC outpatient 1 UN 1.8 1.8 74 1.33 percent of total billed charges 1.8 93 1.46 percent of total billed charges 1.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.8 other OPPS APC 1.8 1.8 other OPPS APC 1.8 24.86 0.45 percent of total billed charges 1.8 1.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METOCLOPRAMIDE 10 MG TABLET RX-5005 CDM A9270 HCPCS 0637 RC 60687-0631-01 NDC outpatient 1 UN 1.8 1.8 1.8 74 1.33 percent of total billed charges 1.8 93 1.46 percent of total billed charges 1.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.8 other OPPS APC 1.8 1.8 other OPPS APC 1.8 24.86 0.45 percent of total billed charges 1.8 1.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION RX-5007 CDM 250000000 HCPCS 0250 RC 00143-9660-10 NDC outpatient 5 ML 8.09 8.09 8.09 74 5.99 percent of total billed charges 8.09 93 6.55 percent of total billed charges 8.09 8.09 other OPPS APC 8.09 8.09 other OPPS APC 8.09 24.86 2.01 percent of total billed charges 8.09 8.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METOPROLOL TARTRATE 50 MG TABLET RX-5009 CDM A9270 HCPCS 0250 RC 51079-0801-20 NDC outpatient 1 UN 1.43 1.43 74 1.06 percent of total billed charges 1.43 93 1.16 percent of total billed charges 1.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.43 other OPPS APC 1.43 1.43 other OPPS APC 1.43 24.86 0.36 percent of total billed charges 1.43 1.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METOPROLOL TARTRATE 50 MG TABLET RX-5009 CDM A9270 HCPCS 0637 RC 51079-0801-20 NDC outpatient 1 UN 1.43 1.43 1.43 74 1.06 percent of total billed charges 1.43 93 1.16 percent of total billed charges 1.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.43 other OPPS APC 1.43 1.43 other OPPS APC 1.43 24.86 0.36 percent of total billed charges 1.43 1.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METRONIDAZOLE 250 MG TABLET RX-5015 CDM A9270 HCPCS 0250 RC 00904-7156-61 NDC outpatient 1 UN 1.21 1.21 74 0.9 percent of total billed charges 1.21 93 0.98 percent of total billed charges 1.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.21 other OPPS APC 1.21 1.21 other OPPS APC 1.21 24.86 0.3 percent of total billed charges 1.21 1.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METRONIDAZOLE 250 MG TABLET RX-5015 CDM A9270 HCPCS 0637 RC 00904-7156-61 NDC outpatient 1 UN 1.21 1.21 1.21 74 0.9 percent of total billed charges 1.21 93 0.98 percent of total billed charges 1.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.21 other OPPS APC 1.21 1.21 other OPPS APC 1.21 24.86 0.3 percent of total billed charges 1.21 1.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METRONIDAZOLE 500 MG TABLET RX-5016 CDM A9270 HCPCS 0250 RC 00904-7126-61 NDC outpatient 1 UN 2.11 2.11 74 1.56 percent of total billed charges 2.11 93 1.71 percent of total billed charges 2.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.11 other OPPS APC 2.11 2.11 other OPPS APC 2.11 24.86 0.52 percent of total billed charges 2.11 2.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METRONIDAZOLE 500 MG TABLET RX-5016 CDM A9270 HCPCS 0637 RC 00904-7126-61 NDC outpatient 1 UN 2.11 2.11 2.11 74 1.56 percent of total billed charges 2.11 93 1.71 percent of total billed charges 2.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.11 other OPPS APC 2.11 2.11 other OPPS APC 2.11 24.86 0.52 percent of total billed charges 2.11 2.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK RX-5018 CDM J1836 HCPCS 0636 RC 00409-0152-01 NDC outpatient 100 ML 6.34 6.34 6.34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.3 other OPPS APC 6.34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.3 other OPPS APC 6.34 24.86 1.58 percent of total billed charges 6.34 6.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK RX-5018 CDM J1836 HCPCS 0636 RC 47335-0993-01 NDC outpatient 500 ME 8.06 8.06 1.21 1.21 fee schedule 8.06 93 6.53 percent of total billed charges 1.21 8.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICONAZOLE NITRATE 2 % VAGINAL CREAM RX-5040 CDM A9270 HCPCS 0250 RC 51672-2035-06 NDC outpatient 45 GR 28.63 28.63 74 21.19 percent of total billed charges 28.63 93 23.19 percent of total billed charges 28.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28.63 other OPPS APC 28.63 28.63 other OPPS APC 28.63 24.86 7.12 percent of total billed charges 28.63 28.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICONAZOLE NITRATE 2 % VAGINAL CREAM RX-5040 CDM A9270 HCPCS 0637 RC 51672-2035-06 NDC outpatient 45 GR 28.63 28.63 28.63 74 21.19 percent of total billed charges 28.63 93 23.19 percent of total billed charges 28.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28.63 other OPPS APC 28.63 28.63 other OPPS APC 28.63 24.86 7.12 percent of total billed charges 28.63 28.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MINERAL OIL ENEMA RX-5087 CDM A9270 HCPCS 0250 RC 00132-0301-40 NDC outpatient 1 UN 5.21 5.21 74 3.86 percent of total billed charges 5.21 93 4.22 percent of total billed charges 5.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.21 other OPPS APC 5.21 5.21 other OPPS APC 5.21 24.86 1.3 percent of total billed charges 5.21 5.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MINERAL OIL ENEMA RX-5087 CDM A9270 HCPCS 0637 RC 00132-0301-40 NDC outpatient 1 UN 5.21 5.21 5.21 74 3.86 percent of total billed charges 5.21 93 4.22 percent of total billed charges 5.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.21 other OPPS APC 5.21 5.21 other OPPS APC 5.21 24.86 1.3 percent of total billed charges 5.21 5.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MINOCYCLINE 100 MG CAPSULE RX-5110 CDM A9270 HCPCS 0250 RC 00904-6888-06 NDC outpatient 1 UN 3.45 3.45 74 2.55 percent of total billed charges 3.45 93 2.79 percent of total billed charges 3.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.45 other OPPS APC 3.45 3.45 other OPPS APC 3.45 24.86 0.86 percent of total billed charges 3.45 3.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MINOCYCLINE 100 MG CAPSULE RX-5110 CDM A9270 HCPCS 0637 RC 00904-6888-06 NDC outpatient 1 UN 3.45 3.45 3.45 74 2.55 percent of total billed charges 3.45 93 2.79 percent of total billed charges 3.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.45 other OPPS APC 3.45 3.45 other OPPS APC 3.45 24.86 0.86 percent of total billed charges 3.45 3.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MINOXIDIL 10 MG TABLET RX-5114 CDM A9270 HCPCS 0250 RC 49884-0257-01 NDC outpatient 1 UN 4.22 4.22 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.22 other OPPS APC 4.22 4.22 other OPPS APC 4.22 24.86 1.05 percent of total billed charges 4.22 4.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MINOXIDIL 10 MG TABLET RX-5114 CDM A9270 HCPCS 0637 RC 49884-0257-01 NDC outpatient 1 UN 4.22 4.22 4.22 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.22 other OPPS APC 4.22 4.22 other OPPS APC 4.22 24.86 1.05 percent of total billed charges 4.22 4.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MINOXIDIL 10 MG TABLET RX-5114 CDM A9270 HCPCS 0250 RC 68084-0205-01 NDC outpatient 1 UN 5.3 5.3 74 3.92 percent of total billed charges 5.3 93 4.29 percent of total billed charges 5.3 5.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MINOXIDIL 10 MG TABLET RX-5114 CDM A9270 HCPCS 0637 RC 68084-0205-01 NDC outpatient 1 UN 5.3 5.3 5.3 74 3.92 percent of total billed charges 5.3 93 4.29 percent of total billed charges 5.3 5.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MINOXIDIL 2.5 MG TABLET RX-5115 CDM A9270 HCPCS 0250 RC 68084-0204-01 NDC outpatient 1 UN 4.24 4.24 74 3.14 percent of total billed charges 4.24 93 3.43 percent of total billed charges 4.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.24 other OPPS APC 4.24 4.24 other OPPS APC 4.24 24.86 1.05 percent of total billed charges 4.24 4.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MINOXIDIL 2.5 MG TABLET RX-5115 CDM A9270 HCPCS 0637 RC 68084-0204-01 NDC outpatient 1 UN 4.24 4.24 4.24 74 3.14 percent of total billed charges 4.24 93 3.43 percent of total billed charges 4.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.24 other OPPS APC 4.24 4.24 other OPPS APC 4.24 24.86 1.05 percent of total billed charges 4.24 4.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE 10 MG/ML INJECTION SOLUTION RX-5168 CDM J2272 HCPCS 0636 RC 63323-0451-01 NDC outpatient 1 ML 9.15 9.15 7.91 7.91 fee schedule 9.15 93 7.41 percent of total billed charges 9.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.15 other OPPS APC 9.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.15 other OPPS APC 9.15 24.86 2.27 percent of total billed charges 7.91 9.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE 2 MG/ML INJECTION SYRINGE RX-5170 CDM J2272 HCPCS 0636 RC 76045-0004-11 NDC outpatient 1 ML 8.61 8.61 7.91 7.91 fee schedule 8.61 93 6.97 percent of total billed charges 8.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.61 other OPPS APC 8.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.61 other OPPS APC 8.61 24.86 2.14 percent of total billed charges 7.91 8.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE 15 MG IMMEDIATE RELEASE TABLET RX-5178 CDM A9270 HCPCS 0250 RC 00054-0235-24 NDC outpatient 1 UN 2.28 2.28 74 1.69 percent of total billed charges 2.28 93 1.85 percent of total billed charges 2.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.28 other OPPS APC 2.28 2.28 other OPPS APC 2.28 24.86 0.57 percent of total billed charges 2.28 2.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE 15 MG IMMEDIATE RELEASE TABLET RX-5178 CDM A9270 HCPCS 0637 RC 00054-0235-24 NDC outpatient 1 UN 2.28 2.28 2.28 74 1.69 percent of total billed charges 2.28 93 1.85 percent of total billed charges 2.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.28 other OPPS APC 2.28 2.28 other OPPS APC 2.28 24.86 0.57 percent of total billed charges 2.28 2.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE 30 MG IMMEDIATE RELEASE TABLET RX-5179 CDM A9270 HCPCS 0250 RC 00054-0236-24 NDC outpatient 1 UN 3.86 3.86 74 2.86 percent of total billed charges 3.86 93 3.13 percent of total billed charges 3.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.86 other OPPS APC 3.86 3.86 other OPPS APC 3.86 24.86 0.96 percent of total billed charges 3.86 3.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORPHINE 30 MG IMMEDIATE RELEASE TABLET RX-5179 CDM A9270 HCPCS 0637 RC 00054-0236-24 NDC outpatient 1 UN 3.86 3.86 3.86 74 2.86 percent of total billed charges 3.86 93 3.13 percent of total billed charges 3.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.86 other OPPS APC 3.86 3.86 other OPPS APC 3.86 24.86 0.96 percent of total billed charges 3.86 3.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NADOLOL 20 MG TABLET RX-5330 CDM A9270 HCPCS 0250 RC 00904-7070-07 NDC outpatient 1 UN 9.17 9.17 74 6.79 percent of total billed charges 9.17 93 7.43 percent of total billed charges 9.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.17 other OPPS APC 9.17 9.17 other OPPS APC 9.17 24.86 2.28 percent of total billed charges 9.17 9.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NADOLOL 20 MG TABLET RX-5330 CDM A9270 HCPCS 0637 RC 00904-7070-07 NDC outpatient 1 UN 9.17 9.17 9.17 74 6.79 percent of total billed charges 9.17 93 7.43 percent of total billed charges 9.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.17 other OPPS APC 9.17 9.17 other OPPS APC 9.17 24.86 2.28 percent of total billed charges 9.17 9.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAFCILLIN 1 GRAM SOLUTION FOR INJECTION RX-5333 CDM 250000000 HCPCS 0250 RC 55150-0122-15 NDC outpatient 1000 ME 36.25 36.25 36.25 74 26.83 percent of total billed charges 36.25 93 29.36 percent of total billed charges 36.25 36.25 other OPPS APC 36.25 36.25 other OPPS APC 36.25 24.86 9.01 percent of total billed charges 36.25 36.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAFCILLIN 1 GRAM SOLUTION FOR INJECTION RX-5333 CDM 250000000 HCPCS 0250 RC 55150-0122-15 NDC outpatient 4 ML 36.25 36.25 36.25 74 26.83 percent of total billed charges 36.25 93 29.36 percent of total billed charges 36.25 36.25 other OPPS APC 36.25 36.25 other OPPS APC 36.25 24.86 9.01 percent of total billed charges 36.25 36.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAFCILLIN 2 GRAM SOLUTION FOR INJECTION RX-5335 CDM S0032 HCPCS 0250 RC 72485-0406-10 NDC outpatient 2000 ME 30.85 30.85 30.85 74 22.83 percent of total billed charges 30.85 93 24.99 percent of total billed charges 30.85 30.85 other OPPS APC 30.85 30.85 other OPPS APC 30.85 24.86 7.67 percent of total billed charges 30.85 30.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAFCILLIN 2 GRAM SOLUTION FOR INJECTION RX-5335 CDM S0032 HCPCS 0250 RC 72485-0406-10 NDC outpatient 8 ML 30.85 30.85 30.85 74 22.83 percent of total billed charges 30.85 93 24.99 percent of total billed charges 30.85 30.85 other OPPS APC 30.85 30.85 other OPPS APC 30.85 24.86 7.67 percent of total billed charges 30.85 30.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NALBUPHINE 10 MG/ML INJECTION SOLUTION RX-5339 CDM J2300 HCPCS 0636 RC 00409-1463-01 NDC outpatient 1 ML 13.38 13.38 3.1 3.1 fee schedule 13.38 93 10.84 percent of total billed charges 3.1 13.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NALBUPHINE 20 MG/ML INJECTION SOLUTION RX-5340 CDM J2300 HCPCS 0636 RC 90000-0003-91 NDC outpatient 0.5 ML 7.95 7.95 3.1 3.1 fee schedule 7.95 93 6.44 percent of total billed charges 7.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.95 other OPPS APC 7.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.95 other OPPS APC 7.95 24.86 1.98 percent of total billed charges 3.1 7.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NALOXONE 0.4 MG/ML INJECTION SOLUTION RX-5373 CDM J2310 HCPCS 0636 RC 36000-0308-10 NDC outpatient 1 ME 37.5 37.5 10.79 10.79 fee schedule 37.5 93 30.38 percent of total billed charges 15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15 other OPPS APC 15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15 other OPPS APC 15 24.86 3.73 percent of total billed charges 10.79 37.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NALOXONE 0.4 MG/ML INJECTION SOLUTION RX-5373 CDM J2310 HCPCS 0636 RC 36000-0308-10 NDC outpatient 1 ML 15 15 10.79 10.79 fee schedule 37.5 93 30.38 percent of total billed charges 15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15 other OPPS APC 15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15 other OPPS APC 15 24.86 3.73 percent of total billed charges 10.79 37.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NALOXONE 1 MG/ML INJECTION SYRINGE RX-5374 CDM J2310 HCPCS 0636 RC 76329-1469-01 NDC outpatient 2 ML 99 99 21.59 21.59 fee schedule 99 93 80.19 percent of total billed charges 99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 99 other OPPS APC 99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 99 other OPPS APC 99 24.86 24.61 percent of total billed charges 21.59 99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAPHAZOLINE 0.025 %-PHENIRAMINE 0.3 % EYE DROPS RX-5384 CDM A9270 HCPCS 0250 RC 00065-0085-15 NDC outpatient 15 ML 23.53 23.53 74 17.41 percent of total billed charges 23.53 93 19.06 percent of total billed charges 23.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 23.53 other OPPS APC 23.53 23.53 other OPPS APC 23.53 24.86 5.85 percent of total billed charges 23.53 23.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAPHAZOLINE 0.025 %-PHENIRAMINE 0.3 % EYE DROPS RX-5384 CDM A9270 HCPCS 0637 RC 00065-0085-15 NDC outpatient 15 ML 23.53 23.53 23.53 74 17.41 percent of total billed charges 23.53 93 19.06 percent of total billed charges 23.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 23.53 other OPPS APC 23.53 23.53 other OPPS APC 23.53 24.86 5.85 percent of total billed charges 23.53 23.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAPROXEN 375 MG TABLET RX-5392 CDM A9270 HCPCS 0250 RC 50268-0595-15 NDC outpatient 1 UN 2.47 2.47 74 1.83 percent of total billed charges 2.47 93 2 percent of total billed charges 2.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.47 other OPPS APC 2.47 2.47 other OPPS APC 2.47 24.86 0.61 percent of total billed charges 2.47 2.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAPROXEN 375 MG TABLET RX-5392 CDM A9270 HCPCS 0637 RC 50268-0595-15 NDC outpatient 1 UN 2.47 2.47 2.47 74 1.83 percent of total billed charges 2.47 93 2 percent of total billed charges 2.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.47 other OPPS APC 2.47 2.47 other OPPS APC 2.47 24.86 0.61 percent of total billed charges 2.47 2.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAPROXEN 500 MG TABLET RX-5393 CDM A9270 HCPCS 0250 RC 63739-0403-10 NDC outpatient 1 UN 0.64 0.64 74 0.47 percent of total billed charges 0.64 93 0.52 percent of total billed charges 0.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.64 other OPPS APC 0.64 0.64 other OPPS APC 0.64 24.86 0.16 percent of total billed charges 0.64 0.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAPROXEN 500 MG TABLET RX-5393 CDM A9270 HCPCS 0637 RC 63739-0403-10 NDC outpatient 1 UN 0.64 0.64 0.64 74 0.47 percent of total billed charges 0.64 93 0.52 percent of total billed charges 0.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.64 other OPPS APC 0.64 0.64 other OPPS APC 0.64 24.86 0.16 percent of total billed charges 0.64 0.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEOMYCIN 500 MG TABLET RX-5472 CDM A9270 HCPCS 0250 RC 00093-1177-01 NDC outpatient 1 UN 3.72 3.72 74 2.75 percent of total billed charges 3.72 93 3.01 percent of total billed charges 3.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.72 other OPPS APC 3.72 3.72 other OPPS APC 3.72 24.86 0.92 percent of total billed charges 3.72 3.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEOMYCIN 500 MG TABLET RX-5472 CDM A9270 HCPCS 0637 RC 00093-1177-01 NDC outpatient 1 UN 3.72 3.72 3.72 74 2.75 percent of total billed charges 3.72 93 3.01 percent of total billed charges 3.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.72 other OPPS APC 3.72 3.72 other OPPS APC 3.72 24.86 0.92 percent of total billed charges 3.72 3.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS" RX-5474 CDM A9270 HCPCS 0250 RC 24208-0790-62 NDC outpatient 10 ML 153.15 153.15 74 113.33 percent of total billed charges 153.15 93 124.05 percent of total billed charges 153.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 153.15 other OPPS APC 153.15 153.15 other OPPS APC 153.15 24.86 38.07 percent of total billed charges 153.15 153.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS" RX-5474 CDM A9270 HCPCS 0637 RC 24208-0790-62 NDC outpatient 10 ML 153.15 153.15 153.15 74 113.33 percent of total billed charges 153.15 93 124.05 percent of total billed charges 153.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 153.15 other OPPS APC 153.15 153.15 other OPPS APC 153.15 24.86 38.07 percent of total billed charges 153.15 153.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NIFEDIPINE 10 MG CAPSULE RX-5558 CDM A9270 HCPCS 0250 RC 00904-7229-61 NDC outpatient 1 UN 3.23 3.23 74 2.39 percent of total billed charges 3.23 93 2.62 percent of total billed charges 3.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.23 other OPPS APC 3.23 3.23 other OPPS APC 3.23 24.86 0.8 percent of total billed charges 3.23 3.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NIFEDIPINE 10 MG CAPSULE RX-5558 CDM A9270 HCPCS 0637 RC 00904-7229-61 NDC outpatient 1 UN 3.23 3.23 3.23 74 2.39 percent of total billed charges 3.23 93 2.62 percent of total billed charges 3.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.23 other OPPS APC 3.23 3.23 other OPPS APC 3.23 24.86 0.8 percent of total billed charges 3.23 3.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE RX-5595 CDM A9270 HCPCS 0250 RC 50268-0623-15 NDC outpatient 1 UN 11.05 11.05 74 8.18 percent of total billed charges 11.05 93 8.95 percent of total billed charges 11.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.05 other OPPS APC 11.05 11.05 other OPPS APC 11.05 24.86 2.75 percent of total billed charges 11.05 11.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE RX-5595 CDM A9270 HCPCS 0637 RC 50268-0623-15 NDC outpatient 1 UN 11.05 11.05 11.05 74 8.18 percent of total billed charges 11.05 93 8.95 percent of total billed charges 11.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.05 other OPPS APC 11.05 11.05 other OPPS APC 11.05 24.86 2.75 percent of total billed charges 11.05 11.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION RX-5599 CDM J2305 HCPCS 0636 RC 00517-4810-25 NDC outpatient 10 ML 46.65 46.65 14.76 14.76 fee schedule 46.65 93 37.79 percent of total billed charges 46.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.08 other OPPS APC 46.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.08 other OPPS APC 46.65 24.86 11.6 percent of total billed charges 14.76 46.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET RX-5604 CDM A9270 HCPCS 0250 RC 59762-3304-03 NDC outpatient 1 UN 2.57 2.57 74 1.9 percent of total billed charges 2.57 93 2.08 percent of total billed charges 2.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.57 other OPPS APC 2.57 2.57 other OPPS APC 2.57 24.86 0.64 percent of total billed charges 2.57 2.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET RX-5604 CDM A9270 HCPCS 0637 RC 59762-3304-03 NDC outpatient 1 UN 2.57 2.57 2.57 74 1.9 percent of total billed charges 2.57 93 2.08 percent of total billed charges 2.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.57 other OPPS APC 2.57 2.57 other OPPS APC 2.57 24.86 0.64 percent of total billed charges 2.57 2.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NITROGLYCERIN 2 % TRANSDERMAL OINTMENT RX-5606 CDM A9270 HCPCS 0250 RC 00281-0326-08 NDC outpatient 1 GR 7.57 7.57 74 5.6 percent of total billed charges 7.57 93 6.13 percent of total billed charges 7.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.57 other OPPS APC 7.57 7.57 other OPPS APC 7.57 24.86 1.88 percent of total billed charges 7.57 7.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NITROGLYCERIN 2 % TRANSDERMAL OINTMENT RX-5606 CDM A9270 HCPCS 0637 RC 00281-0326-08 NDC outpatient 1 GR 7.57 7.57 7.57 74 5.6 percent of total billed charges 7.57 93 6.13 percent of total billed charges 7.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.57 other OPPS APC 7.57 7.57 other OPPS APC 7.57 24.86 1.88 percent of total billed charges 7.57 7.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NORTRIPTYLINE 25 MG CAPSULE RX-5675 CDM A9270 HCPCS 0250 RC 50268-0604-15 NDC outpatient 1 UN 1.48 1.48 74 1.1 percent of total billed charges 1.48 93 1.2 percent of total billed charges 1.48 1.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NORTRIPTYLINE 25 MG CAPSULE RX-5675 CDM A9270 HCPCS 0637 RC 50268-0604-15 NDC outpatient 1 UN 1.48 1.48 1.48 74 1.1 percent of total billed charges 1.48 93 1.2 percent of total billed charges 1.48 1.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NORTRIPTYLINE 25 MG CAPSULE RX-5675 CDM A9270 HCPCS 0250 RC 75907-0070-01 NDC outpatient 1 UN 3.67 3.67 3.67 other OPPS APC 3.67 3.67 other OPPS APC 3.67 24.86 0.91 percent of total billed charges 3.67 3.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NORTRIPTYLINE 25 MG CAPSULE RX-5675 CDM A9270 HCPCS 0637 RC 75907-0070-01 NDC outpatient 1 UN 3.67 3.67 3.67 3.67 other OPPS APC 3.67 3.67 other OPPS APC 3.67 24.86 0.91 percent of total billed charges 3.67 3.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NORTRIPTYLINE 50 MG CAPSULE RX-5676 CDM A9270 HCPCS 0250 RC 00093-0812-01 NDC outpatient 1 UN 6.92 6.92 74 5.12 percent of total billed charges 6.92 93 5.61 percent of total billed charges 6.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.92 other OPPS APC 6.92 6.92 other OPPS APC 6.92 24.86 1.72 percent of total billed charges 6.92 6.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NORTRIPTYLINE 50 MG CAPSULE RX-5676 CDM A9270 HCPCS 0637 RC 00093-0812-01 NDC outpatient 1 UN 6.92 6.92 6.92 74 5.12 percent of total billed charges 6.92 93 5.61 percent of total billed charges 6.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.92 other OPPS APC 6.92 6.92 other OPPS APC 6.92 24.86 1.72 percent of total billed charges 6.92 6.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM" RX-5749 CDM A9270 HCPCS 0250 RC 45802-0059-35 NDC outpatient 15 GR 43.76 43.76 74 32.38 percent of total billed charges 43.76 93 35.45 percent of total billed charges 43.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 43.76 other OPPS APC 43.76 43.76 other OPPS APC 43.76 24.86 10.88 percent of total billed charges 43.76 43.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM" RX-5749 CDM A9270 HCPCS 0637 RC 45802-0059-35 NDC outpatient 15 GR 43.76 43.76 43.76 74 32.38 percent of total billed charges 43.76 93 35.45 percent of total billed charges 43.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 43.76 other OPPS APC 43.76 43.76 other OPPS APC 43.76 24.86 10.88 percent of total billed charges 43.76 43.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT" RX-5750 CDM A9270 HCPCS 0250 RC 33342-0481-15 NDC outpatient 15 GR 43.76 43.76 74 32.38 percent of total billed charges 43.76 93 35.45 percent of total billed charges 43.76 43.76 other OPPS APC 43.76 43.76 other OPPS APC 43.76 24.86 10.88 percent of total billed charges 43.76 43.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT" RX-5750 CDM A9270 HCPCS 0637 RC 33342-0481-15 NDC outpatient 15 GR 43.76 43.76 43.76 74 32.38 percent of total billed charges 43.76 93 35.45 percent of total billed charges 43.76 43.76 other OPPS APC 43.76 43.76 other OPPS APC 43.76 24.86 10.88 percent of total billed charges 43.76 43.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION" RX-5751 CDM A9270 HCPCS 0250 RC 00904-7276-41 NDC outpatient 5 ML 2.54 2.54 74 1.88 percent of total billed charges 2.54 93 2.06 percent of total billed charges 2.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.54 other OPPS APC 2.54 2.54 other OPPS APC 2.54 24.86 0.63 percent of total billed charges 2.54 2.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION" RX-5751 CDM A9270 HCPCS 0637 RC 00904-7276-41 NDC outpatient 5 ML 2.54 2.54 2.54 74 1.88 percent of total billed charges 2.54 93 2.06 percent of total billed charges 2.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.54 other OPPS APC 2.54 2.54 other OPPS APC 2.54 24.86 0.63 percent of total billed charges 2.54 2.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM" RX-5754 CDM A9270 HCPCS 0250 RC 45802-0880-14 NDC outpatient 15 GR 62.85 62.85 74 46.51 percent of total billed charges 62.85 93 50.91 percent of total billed charges 62.85 62.85 other OPPS APC 62.85 62.85 other OPPS APC 62.85 24.86 15.62 percent of total billed charges 62.85 62.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM" RX-5754 CDM A9270 HCPCS 0637 RC 45802-0880-14 NDC outpatient 15 GR 62.85 62.85 62.85 74 46.51 percent of total billed charges 62.85 93 50.91 percent of total billed charges 62.85 62.85 other OPPS APC 62.85 62.85 other OPPS APC 62.85 24.86 15.62 percent of total billed charges 62.85 62.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NYSTATIN-TRIAMCINOLONE 100,000 UNIT/GRAM-0.1 % TOPICAL OINTMENT" RX-5755 CDM A9270 HCPCS 0250 RC 21922-0031-04 NDC outpatient 15 GR 279.86 279.86 74 207.1 percent of total billed charges 279.86 93 226.69 percent of total billed charges 279.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 279.86 other OPPS APC 279.86 279.86 other OPPS APC 279.86 24.86 69.57 percent of total billed charges 279.86 279.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NYSTATIN-TRIAMCINOLONE 100,000 UNIT/GRAM-0.1 % TOPICAL OINTMENT" RX-5755 CDM A9270 HCPCS 0637 RC 21922-0031-04 NDC outpatient 15 GR 279.86 279.86 279.86 74 207.1 percent of total billed charges 279.86 93 226.69 percent of total billed charges 279.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 279.86 other OPPS APC 279.86 279.86 other OPPS APC 279.86 24.86 69.57 percent of total billed charges 279.86 279.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXYBUTYNIN CHLORIDE 5 MG TABLET RX-5938 CDM A9270 HCPCS 0250 RC 60687-0670-01 NDC outpatient 1 UN 1.26 1.26 74 0.93 percent of total billed charges 1.26 93 1.02 percent of total billed charges 1.26 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.26 other OPPS APC 1.26 1.26 other OPPS APC 1.26 24.86 0.31 percent of total billed charges 1.26 1.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXYBUTYNIN CHLORIDE 5 MG TABLET RX-5938 CDM A9270 HCPCS 0637 RC 60687-0670-01 NDC outpatient 1 UN 1.26 1.26 1.26 74 0.93 percent of total billed charges 1.26 93 1.02 percent of total billed charges 1.26 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.26 other OPPS APC 1.26 1.26 other OPPS APC 1.26 24.86 0.31 percent of total billed charges 1.26 1.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET RX-5940 CDM A9270 HCPCS 0250 RC 00406-0512-23 NDC outpatient 1 UN 3.43 3.43 74 2.54 percent of total billed charges 3.43 93 2.78 percent of total billed charges 3.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.43 other OPPS APC 3.43 3.43 other OPPS APC 3.43 24.86 0.85 percent of total billed charges 3.43 3.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET RX-5940 CDM A9270 HCPCS 0637 RC 00406-0512-23 NDC outpatient 1 UN 3.43 3.43 3.43 74 2.54 percent of total billed charges 3.43 93 2.78 percent of total billed charges 3.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.43 other OPPS APC 3.43 3.43 other OPPS APC 3.43 24.86 0.85 percent of total billed charges 3.43 3.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXYMETAZOLINE 0.05 % NASAL SPRAY RX-5943 CDM A9270 HCPCS 0250 RC 70677-1037-01 NDC outpatient 30 ML 4.26 4.26 74 3.15 percent of total billed charges 4.26 93 3.45 percent of total billed charges 4.26 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.26 other OPPS APC 4.26 4.26 other OPPS APC 4.26 24.86 1.06 percent of total billed charges 4.26 4.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXYMETAZOLINE 0.05 % NASAL SPRAY RX-5943 CDM A9270 HCPCS 0637 RC 70677-1037-01 NDC outpatient 30 ML 4.26 4.26 4.26 74 3.15 percent of total billed charges 4.26 93 3.45 percent of total billed charges 4.26 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.26 other OPPS APC 4.26 4.26 other OPPS APC 4.26 24.86 1.06 percent of total billed charges 4.26 4.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXYTOCIN 10 UNIT/ML INJECTION SOLUTION RX-5944 CDM J2590 HCPCS 0636 RC 42023-0116-25 NDC outpatient 1 ML 10.8 10.8 10.8 74 7.99 percent of total billed charges 10.8 93 8.75 percent of total billed charges 10.8 10.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXYTOCIN 10 UNIT/ML INJECTION SOLUTION RX-5944 CDM J2590 HCPCS 0636 RC 63323-0012-11 NDC outpatient 1 ML 10.35 10.35 10.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.35 other OPPS APC 10.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.35 other OPPS APC 10.35 24.86 2.57 percent of total billed charges 10.35 10.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION RX-6085 CDM J2540 HCPCS 0636 RC 70860-0127-51 NDC outpatient 1 UN 165 165 41.55 41.55 fee schedule 165 93 133.65 percent of total billed charges 165 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165 other OPPS APC 165 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165 other OPPS APC 165 24.86 41.02 percent of total billed charges 41.55 165 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION RX-6085 CDM J2540 HCPCS 0636 RC 70860-0127-51 NDC outpatient 40 ML 165 165 41.55 41.55 fee schedule 165 93 133.65 percent of total billed charges 165 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165 other OPPS APC 165 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165 other OPPS APC 165 24.86 41.02 percent of total billed charges 41.55 165 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION RX-6086 CDM J2540 HCPCS 0636 RC 44567-0311-10 NDC outpatient 1 UN 13.08 13.08 11 11 fee schedule 13.08 93 10.59 percent of total billed charges 13.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.08 other OPPS APC 13.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.08 other OPPS APC 13.08 24.86 3.25 percent of total billed charges 11 13.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION RX-6086 CDM J2540 HCPCS 0636 RC 44567-0311-10 NDC outpatient 10 ML 13.08 13.08 11 11 fee schedule 13.08 93 10.59 percent of total billed charges 13.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.08 other OPPS APC 13.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.08 other OPPS APC 13.08 24.86 3.25 percent of total billed charges 11 13.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|DISCARDED DRUG NOT ADMINISTERED RX-6086 CDM J2540 HCPCS 0636 RC 44567-0311-10 NDC JW outpatient 1 UN 13.08 13.08 9.78 9.78 fee schedule 9.78 13.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENICILLIN G SODIUM 5 MILLION UNIT SOLUTION FOR INJECTION RX-6087 CDM 250000000 HCPCS 0250 RC 00781-6153-94 NDC outpatient 1 UN 144 144 144 74 106.56 percent of total billed charges 144 93 116.64 percent of total billed charges 144 144 other OPPS APC 144 144 other OPPS APC 144 24.86 35.8 percent of total billed charges 144 144 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENICILLIN G SODIUM 5 MILLION UNIT SOLUTION FOR INJECTION RX-6087 CDM 250000000 HCPCS 0250 RC 00781-6153-94 NDC outpatient 10 ML 144 144 144 74 106.56 percent of total billed charges 144 93 116.64 percent of total billed charges 144 144 other OPPS APC 144 144 other OPPS APC 144 24.86 35.8 percent of total billed charges 144 144 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENICILLIN V POTASSIUM 125 MG/5 ML ORAL SOLUTION RX-6090 CDM A9270 HCPCS 0250 RC 00093-4125-73 NDC outpatient 100 ML 24.88 24.88 74 18.41 percent of total billed charges 24.88 93 20.15 percent of total billed charges 24.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.88 other OPPS APC 24.88 24.88 other OPPS APC 24.88 24.86 6.19 percent of total billed charges 24.88 24.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENICILLIN V POTASSIUM 125 MG/5 ML ORAL SOLUTION RX-6090 CDM A9270 HCPCS 0637 RC 00093-4125-73 NDC outpatient 100 ML 24.88 24.88 24.88 74 18.41 percent of total billed charges 24.88 93 20.15 percent of total billed charges 24.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.88 other OPPS APC 24.88 24.88 other OPPS APC 24.88 24.86 6.19 percent of total billed charges 24.88 24.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENICILLIN V POTASSIUM 250 MG TABLET RX-6092 CDM A9270 HCPCS 0250 RC 57237-0040-01 NDC outpatient 1 UN 2.13 2.13 74 1.58 percent of total billed charges 2.13 93 1.73 percent of total billed charges 2.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.13 other OPPS APC 2.13 2.13 other OPPS APC 2.13 24.86 0.53 percent of total billed charges 2.13 2.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENICILLIN V POTASSIUM 250 MG TABLET RX-6092 CDM A9270 HCPCS 0637 RC 57237-0040-01 NDC outpatient 1 UN 2.13 2.13 2.13 74 1.58 percent of total billed charges 2.13 93 1.73 percent of total billed charges 2.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.13 other OPPS APC 2.13 2.13 other OPPS APC 2.13 24.86 0.53 percent of total billed charges 2.13 2.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENICILLIN V POTASSIUM 500 MG TABLET RX-6093 CDM A9270 HCPCS 0250 RC 00093-1174-01 NDC outpatient 1 UN 5.06 5.06 74 3.74 percent of total billed charges 5.06 93 4.1 percent of total billed charges 5.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.06 other OPPS APC 5.06 5.06 other OPPS APC 5.06 24.86 1.26 percent of total billed charges 5.06 5.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PENICILLIN V POTASSIUM 500 MG TABLET RX-6093 CDM A9270 HCPCS 0637 RC 00093-1174-01 NDC outpatient 1 UN 5.06 5.06 5.06 74 3.74 percent of total billed charges 5.06 93 4.1 percent of total billed charges 5.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.06 other OPPS APC 5.06 5.06 other OPPS APC 5.06 24.86 1.26 percent of total billed charges 5.06 5.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENAZOPYRIDINE 100 MG TABLET RX-6193 CDM A9270 HCPCS 0250 RC 65162-0681-10 NDC outpatient 1 UN 6.75 6.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.75 other OPPS APC 6.75 6.75 other OPPS APC 6.75 24.86 1.68 percent of total billed charges 6.75 6.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENAZOPYRIDINE 100 MG TABLET RX-6193 CDM A9270 HCPCS 0637 RC 65162-0681-10 NDC outpatient 1 UN 6.75 6.75 6.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.75 other OPPS APC 6.75 6.75 other OPPS APC 6.75 24.86 1.68 percent of total billed charges 6.75 6.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENAZOPYRIDINE 100 MG TABLET RX-6193 CDM A9270 HCPCS 0250 RC 75826-0114-10 NDC outpatient 1 UN 0.81 0.81 74 0.6 percent of total billed charges 0.81 93 0.66 percent of total billed charges 0.81 0.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENAZOPYRIDINE 100 MG TABLET RX-6193 CDM A9270 HCPCS 0637 RC 75826-0114-10 NDC outpatient 1 UN 0.81 0.81 0.81 74 0.6 percent of total billed charges 0.81 93 0.66 percent of total billed charges 0.81 0.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR RX-6212 CDM A9270 HCPCS 0250 RC 00121-0942-16 NDC outpatient 473 ML 229.71 229.71 74 169.99 percent of total billed charges 229.71 93 186.07 percent of total billed charges 229.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 229.71 other OPPS APC 229.71 229.71 other OPPS APC 229.71 24.86 57.11 percent of total billed charges 229.71 229.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR RX-6212 CDM A9270 HCPCS 0637 RC 00121-0942-16 NDC outpatient 473 ML 229.71 229.71 229.71 74 169.99 percent of total billed charges 229.71 93 186.07 percent of total billed charges 229.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 229.71 other OPPS APC 229.71 229.71 other OPPS APC 229.71 24.86 57.11 percent of total billed charges 229.71 229.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENOBARBITAL 100 MG TABLET RX-6213 CDM A9270 HCPCS 0250 RC 16571-0669-01 NDC outpatient 1 UN 1.86 1.86 74 1.38 percent of total billed charges 1.86 93 1.51 percent of total billed charges 1.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.86 other OPPS APC 1.86 1.86 other OPPS APC 1.86 24.86 0.46 percent of total billed charges 1.86 1.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENOBARBITAL 100 MG TABLET RX-6213 CDM A9270 HCPCS 0637 RC 16571-0669-01 NDC outpatient 1 UN 1.86 1.86 1.86 74 1.38 percent of total billed charges 1.86 93 1.51 percent of total billed charges 1.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.86 other OPPS APC 1.86 1.86 other OPPS APC 1.86 24.86 0.46 percent of total billed charges 1.86 1.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENOBARBITAL 32.4 MG TABLET RX-6217 CDM A9270 HCPCS 0250 RC 00904-6575-61 NDC outpatient 1 UN 1.14 1.14 74 0.84 percent of total billed charges 1.14 93 0.92 percent of total billed charges 1.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.14 other OPPS APC 1.14 1.14 other OPPS APC 1.14 24.86 0.28 percent of total billed charges 1.14 1.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENOBARBITAL 32.4 MG TABLET RX-6217 CDM A9270 HCPCS 0637 RC 00904-6575-61 NDC outpatient 1 UN 1.14 1.14 1.14 74 0.84 percent of total billed charges 1.14 93 0.92 percent of total billed charges 1.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.14 other OPPS APC 1.14 1.14 other OPPS APC 1.14 24.86 0.28 percent of total billed charges 1.14 1.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION RX-6221 CDM J2560 HCPCS 0636 RC 54288-0137-01 NDC outpatient 1 ML 165 165 89.9 89.9 fee schedule 165 93 133.65 percent of total billed charges 165 165 other OPPS APC 165 165 other OPPS APC 165 24.86 41.02 percent of total billed charges 89.9 165 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION|DISCARDED DRUG NOT ADMINISTERED RX-6221 CDM J2560 HCPCS 0636 RC 54288-0137-01 NDC JW outpatient 1 ML 165 165 44.95 44.95 fee schedule 44.95 165 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENOBARBITAL SODIUM 65 MG/ML INJECTION SOLUTION RX-6224 CDM J2560 HCPCS 0636 RC 00641-0476-25 NDC outpatient 1 ML 79.07 79.07 44.95 44.95 fee schedule 79.07 93 64.05 percent of total billed charges 79.07 79.07 other OPPS APC 79.07 79.07 other OPPS APC 79.07 24.86 19.66 percent of total billed charges 44.95 79.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION RX-6242 CDM J2371 HCPCS 0636 RC 23155-0620-41 NDC outpatient 1 ML 6 6 6 74 4.44 percent of total billed charges 6 93 4.86 percent of total billed charges 6 6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION RX-6242 CDM J2371 HCPCS 0636 RC 72485-0504-25 NDC outpatient 1 ML 5.7 5.7 5.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.7 other OPPS APC 5.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.7 other OPPS APC 5.7 24.86 1.42 percent of total billed charges 5.7 5.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENYLEPHRINE 0.25 % NASAL SPRAY RX-6243 CDM 250000000 HCPCS 0250 RC 00225-0800-47 NDC outpatient 15 ML 10.4 10.4 10.4 74 7.7 percent of total billed charges 10.4 93 8.42 percent of total billed charges 10.4 10.4 other OPPS APC 10.4 10.4 other OPPS APC 10.4 24.86 2.59 percent of total billed charges 10.4 10.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENYLEPHRINE 0.5 % NASAL SPRAY RX-6244 CDM 250000000 HCPCS 0250 RC 00225-0805-47 NDC outpatient 15 ML 10.4 10.4 10.4 74 7.7 percent of total billed charges 10.4 93 8.42 percent of total billed charges 10.4 10.4 other OPPS APC 10.4 10.4 other OPPS APC 10.4 24.86 2.59 percent of total billed charges 10.4 10.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION RX-6256 CDM J1165 HCPCS 0636 RC 00641-0493-25 NDC outpatient 2 ML 4.17 4.17 1.43 1.43 fee schedule 4.17 93 3.38 percent of total billed charges 4.17 4.17 other OPPS APC 4.17 4.17 other OPPS APC 4.17 24.86 1.04 percent of total billed charges 1.43 4.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE RX-6257 CDM A9270 HCPCS 0250 RC 00071-0369-40 NDC outpatient 1 UN 5.57 5.57 74 4.12 percent of total billed charges 5.57 93 4.51 percent of total billed charges 5.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.57 other OPPS APC 5.57 5.57 other OPPS APC 5.57 24.86 1.38 percent of total billed charges 5.57 5.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE RX-6257 CDM A9270 HCPCS 0637 RC 00071-0369-40 NDC outpatient 1 UN 5.57 5.57 5.57 74 4.12 percent of total billed charges 5.57 93 4.51 percent of total billed charges 5.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.57 other OPPS APC 5.57 5.57 other OPPS APC 5.57 24.86 1.38 percent of total billed charges 5.57 5.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PILOCARPINE 1 % EYE DROPS RX-6279 CDM A9270 HCPCS 0250 RC 70069-0181-01 NDC outpatient 15 ML 231.83 231.83 74 171.55 percent of total billed charges 231.83 93 187.78 percent of total billed charges 231.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 231.83 other OPPS APC 231.83 231.83 other OPPS APC 231.83 24.86 57.63 percent of total billed charges 231.83 231.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PILOCARPINE 1 % EYE DROPS RX-6279 CDM A9270 HCPCS 0637 RC 70069-0181-01 NDC outpatient 15 ML 231.83 231.83 231.83 74 171.55 percent of total billed charges 231.83 93 187.78 percent of total billed charges 231.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 231.83 other OPPS APC 231.83 231.83 other OPPS APC 231.83 24.86 57.63 percent of total billed charges 231.83 231.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIROXICAM 20 MG CAPSULE RX-6311 CDM A9270 HCPCS 0250 RC 00093-0757-01 NDC outpatient 1 UN 11.22 11.22 74 8.3 percent of total billed charges 11.22 93 9.09 percent of total billed charges 11.22 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.22 other OPPS APC 11.22 11.22 other OPPS APC 11.22 24.86 2.79 percent of total billed charges 11.22 11.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIROXICAM 20 MG CAPSULE RX-6311 CDM A9270 HCPCS 0637 RC 00093-0757-01 NDC outpatient 1 UN 11.22 11.22 11.22 74 8.3 percent of total billed charges 11.22 93 9.09 percent of total billed charges 11.22 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.22 other OPPS APC 11.22 11.22 other OPPS APC 11.22 24.86 2.79 percent of total billed charges 11.22 11.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION" RX-6393 CDM 250000000 HCPCS 0250 RC 72266-0249-10 NDC outpatient 1 UN 28.68 28.68 28.68 74 21.22 percent of total billed charges 28.68 93 23.23 percent of total billed charges 28.68 28.68 other OPPS APC 28.68 28.68 other OPPS APC 28.68 24.86 7.13 percent of total billed charges 28.68 28.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION RX-6420 CDM 250000000 HCPCS 0250 RC 51754-2001-04 NDC outpatient 20 ML 16.2 16.2 16.2 74 11.99 percent of total billed charges 16.2 93 13.12 percent of total billed charges 16.2 16.2 other OPPS APC 16.2 16.2 other OPPS APC 16.2 24.86 4.03 percent of total billed charges 16.2 16.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION RX-6429 CDM J3480 HCPCS 0636 RC 63323-0965-20 NDC outpatient 20 ML 6.9 6.9 2.42 2.42 fee schedule 6.9 93 5.59 percent of total billed charges 6.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.9 other OPPS APC 6.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.9 other OPPS APC 6.9 24.86 1.72 percent of total billed charges 2.42 6.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID RX-6432 CDM A9270 HCPCS 0250 RC 81033-0220-15 NDC outpatient 15 ML 10.5 10.5 74 7.77 percent of total billed charges 10.5 93 8.51 percent of total billed charges 10.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.5 other OPPS APC 10.5 10.5 other OPPS APC 10.5 24.86 2.61 percent of total billed charges 10.5 10.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID RX-6432 CDM A9270 HCPCS 0637 RC 81033-0220-15 NDC outpatient 15 ML 10.5 10.5 10.5 74 7.77 percent of total billed charges 10.5 93 8.51 percent of total billed charges 10.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.5 other OPPS APC 10.5 10.5 other OPPS APC 10.5 24.86 2.61 percent of total billed charges 10.5 10.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION RX-6445 CDM A9270 HCPCS 0250 RC 75834-0280-30 NDC outpatient 30 ML 1004.08 1004.08 74 743.02 percent of total billed charges 1004.08 93 813.3 percent of total billed charges 1004.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1004.08 other OPPS APC 1004.08 1004.08 other OPPS APC 1004.08 24.86 249.61 percent of total billed charges 1004.08 1004.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION RX-6445 CDM A9270 HCPCS 0637 RC 75834-0280-30 NDC outpatient 30 ML 1004.08 1004.08 1004.08 74 743.02 percent of total billed charges 1004.08 93 813.3 percent of total billed charges 1004.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1004.08 other OPPS APC 1004.08 1004.08 other OPPS APC 1004.08 24.86 249.61 percent of total billed charges 1004.08 1004.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POVIDONE-IODINE 10 % TOPICAL OINTMENT RX-6455 CDM A9270 HCPCS 0250 RC 00536-1271-80 NDC outpatient 29 GR 9.01 9.01 74 6.67 percent of total billed charges 9.01 93 7.3 percent of total billed charges 9.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.01 other OPPS APC 9.01 9.01 other OPPS APC 9.01 24.86 2.24 percent of total billed charges 9.01 9.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POVIDONE-IODINE 10 % TOPICAL OINTMENT RX-6455 CDM A9270 HCPCS 0637 RC 00536-1271-80 NDC outpatient 29 GR 9.01 9.01 9.01 74 6.67 percent of total billed charges 9.01 93 7.3 percent of total billed charges 9.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.01 other OPPS APC 9.01 9.01 other OPPS APC 9.01 24.86 2.24 percent of total billed charges 9.01 9.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION RX-6462 CDM 250000000 HCPCS 0250 RC 60977-0141-27 NDC outpatient 1 GR 260.1 260.1 260.1 74 192.47 percent of total billed charges 260.1 93 210.68 percent of total billed charges 260.1 260.1 other OPPS APC 260.1 260.1 other OPPS APC 260.1 24.86 64.66 percent of total billed charges 260.1 260.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION RX-6462 CDM 250000000 HCPCS 0250 RC 60977-0141-27 NDC outpatient 20 ML 260.1 260.1 260.1 74 192.47 percent of total billed charges 260.1 93 210.68 percent of total billed charges 260.1 260.1 other OPPS APC 260.1 260.1 other OPPS APC 260.1 24.86 64.66 percent of total billed charges 260.1 260.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRAZOSIN 1 MG CAPSULE RX-6468 CDM A9270 HCPCS 0250 RC 00904-7020-61 NDC outpatient 1 UN 4.05 4.05 74 3 percent of total billed charges 4.05 93 3.28 percent of total billed charges 4.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.05 other OPPS APC 4.05 4.05 other OPPS APC 4.05 24.86 1.01 percent of total billed charges 4.05 4.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRAZOSIN 1 MG CAPSULE RX-6468 CDM A9270 HCPCS 0637 RC 00904-7020-61 NDC outpatient 1 UN 4.05 4.05 4.05 74 3 percent of total billed charges 4.05 93 3.28 percent of total billed charges 4.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.05 other OPPS APC 4.05 4.05 other OPPS APC 4.05 24.86 1.01 percent of total billed charges 4.05 4.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION" RX-6487 CDM A9270 HCPCS 0250 RC 61314-0637-05 NDC outpatient 5 ML 138.3 138.3 74 102.34 percent of total billed charges 138.3 93 112.02 percent of total billed charges 138.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 138.3 other OPPS APC 138.3 138.3 other OPPS APC 138.3 24.86 34.38 percent of total billed charges 138.3 138.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION" RX-6487 CDM A9270 HCPCS 0637 RC 61314-0637-05 NDC outpatient 5 ML 138.3 138.3 138.3 74 102.34 percent of total billed charges 138.3 93 112.02 percent of total billed charges 138.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 138.3 other OPPS APC 138.3 138.3 other OPPS APC 138.3 24.86 34.38 percent of total billed charges 138.3 138.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PREDNISONE 5 MG/5 ML ORAL SOLUTION RX-6492 CDM J7512 HCPCS 0636 RC 00054-3722-50 NDC outpatient 120 ML 240 240 1.45 1.45 fee schedule 240 93 194.4 percent of total billed charges 240 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 240 other OPPS APC 240 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 240 other OPPS APC 240 24.86 59.66 percent of total billed charges 1.45 240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PREDNISONE 1 MG TABLET RX-6493 CDM J7512 HCPCS 0636 RC 64380-0782-06 NDC outpatient 1 UN 0.64 0.64 0.01 0.01 fee schedule 0.64 93 0.52 percent of total billed charges 0.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.64 other OPPS APC 0.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.64 other OPPS APC 0.64 24.86 0.16 percent of total billed charges 0.01 0.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PREDNISONE 10 MG TABLET RX-6494 CDM J7512 HCPCS 0636 RC 00904-6923-61 NDC outpatient 1 UN 0.47 0.47 0.12 0.12 fee schedule 0.47 93 0.38 percent of total billed charges 0.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.47 other OPPS APC 0.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.47 other OPPS APC 0.47 24.86 0.12 percent of total billed charges 0.12 0.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PREDNISONE 20 MG TABLET RX-6496 CDM J7512 HCPCS 0636 RC 60687-0145-01 NDC outpatient 1 UN 0.6 0.6 0.24 0.24 fee schedule 0.6 93 0.49 percent of total billed charges 0.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.6 other OPPS APC 0.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.6 other OPPS APC 0.6 24.86 0.15 percent of total billed charges 0.24 0.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PREDNISONE 5 MG TABLET RX-6497 CDM J7512 HCPCS 0636 RC 60687-0122-01 NDC outpatient 1 UN 0.51 0.51 0.06 0.06 fee schedule 0.51 93 0.41 percent of total billed charges 0.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.51 other OPPS APC 0.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.51 other OPPS APC 0.51 24.86 0.13 percent of total billed charges 0.06 0.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRIMAQUINE 26.3 MG (15 MG BASE) TABLET RX-6541 CDM A9270 HCPCS 0250 RC 76385-0102-01 NDC outpatient 1 UN 4.5 4.5 74 3.33 percent of total billed charges 4.5 93 3.65 percent of total billed charges 4.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.5 other OPPS APC 4.5 4.5 other OPPS APC 4.5 24.86 1.12 percent of total billed charges 4.5 4.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRIMAQUINE 26.3 MG (15 MG BASE) TABLET RX-6541 CDM A9270 HCPCS 0637 RC 76385-0102-01 NDC outpatient 1 UN 4.5 4.5 4.5 74 3.33 percent of total billed charges 4.5 93 3.65 percent of total billed charges 4.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.5 other OPPS APC 4.5 4.5 other OPPS APC 4.5 24.86 1.12 percent of total billed charges 4.5 4.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRIMIDONE 250 MG TABLET RX-6544 CDM A9270 HCPCS 0250 RC 68084-0203-01 NDC outpatient 1 UN 2.63 2.63 74 1.95 percent of total billed charges 2.63 93 2.13 percent of total billed charges 2.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.63 other OPPS APC 2.63 2.63 other OPPS APC 2.63 24.86 0.65 percent of total billed charges 2.63 2.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRIMIDONE 250 MG TABLET RX-6544 CDM A9270 HCPCS 0637 RC 68084-0203-01 NDC outpatient 1 UN 2.63 2.63 2.63 74 1.95 percent of total billed charges 2.63 93 2.13 percent of total billed charges 2.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.63 other OPPS APC 2.63 2.63 other OPPS APC 2.63 24.86 0.65 percent of total billed charges 2.63 2.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBENECID 500 MG TABLET RX-6561 CDM A9270 HCPCS 0250 RC 10135-0541-01 NDC outpatient 1 UN 4.5 4.5 74 3.33 percent of total billed charges 4.5 93 3.65 percent of total billed charges 4.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.5 other OPPS APC 4.5 4.5 other OPPS APC 4.5 24.86 1.12 percent of total billed charges 4.5 4.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBENECID 500 MG TABLET RX-6561 CDM A9270 HCPCS 0637 RC 10135-0541-01 NDC outpatient 1 UN 4.5 4.5 4.5 74 3.33 percent of total billed charges 4.5 93 3.65 percent of total billed charges 4.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.5 other OPPS APC 4.5 4.5 other OPPS APC 4.5 24.86 1.12 percent of total billed charges 4.5 4.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION RX-6580 CDM J0780 HCPCS 0636 RC 25021-0790-02 NDC outpatient 2 ML 15.9 15.9 3.44 3.44 fee schedule 15.9 93 12.88 percent of total billed charges 15.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.9 other OPPS APC 15.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.9 other OPPS APC 15.9 24.86 3.95 percent of total billed charges 3.44 15.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROCHLORPERAZINE MALEATE 5 MG TABLET RX-6583 CDM Q0164 HCPCS 0250 RC 50268-0684-15 NDC outpatient 1 UN 4.03 4.03 74 2.98 percent of total billed charges 4.03 93 3.26 percent of total billed charges 4.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.03 other OPPS APC 4.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.03 other OPPS APC 4.03 24.86 1 percent of total billed charges 4.03 4.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROCHLORPERAZINE MALEATE 5 MG TABLET RX-6583 CDM Q0164 HCPCS 0637 RC 50268-0684-15 NDC outpatient 1 UN 4.03 4.03 4.03 74 2.98 percent of total billed charges 4.03 93 3.26 percent of total billed charges 4.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.03 other OPPS APC 4.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.03 other OPPS APC 4.03 24.86 1 percent of total billed charges 4.03 4.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMETHAZINE 25 MG/ML INJECTION SOLUTION RX-6618 CDM J2550 HCPCS 0636 RC 00641-0928-25 NDC outpatient 1 ML 5.55 5.55 5.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.55 other OPPS APC 5.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.55 other OPPS APC 5.55 24.86 1.38 percent of total billed charges 5.55 5.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP RX-6620 CDM Q0169 HCPCS 0250 RC 27808-0051-02 NDC outpatient 473 ML 120 120 74 88.8 percent of total billed charges 120 93 97.2 percent of total billed charges 120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 120 other OPPS APC 120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 120 other OPPS APC 120 24.86 29.83 percent of total billed charges 120 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP RX-6620 CDM Q0169 HCPCS 0637 RC 27808-0051-02 NDC outpatient 473 ML 120 120 120 74 88.8 percent of total billed charges 120 93 97.2 percent of total billed charges 120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 120 other OPPS APC 120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 120 other OPPS APC 120 24.86 29.83 percent of total billed charges 120 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMETHAZINE 25 MG TABLET RX-6622 CDM Q0169 HCPCS 0250 RC 00904-7304-61 NDC outpatient 1 UN 0.47 0.47 74 0.35 percent of total billed charges 0.47 93 0.38 percent of total billed charges 0.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.47 other OPPS APC 0.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.47 other OPPS APC 0.47 24.86 0.12 percent of total billed charges 0.47 0.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMETHAZINE 25 MG TABLET RX-6622 CDM Q0169 HCPCS 0637 RC 00904-7304-61 NDC outpatient 1 UN 0.47 0.47 0.47 74 0.35 percent of total billed charges 0.47 93 0.38 percent of total billed charges 0.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.47 other OPPS APC 0.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.47 other OPPS APC 0.47 24.86 0.12 percent of total billed charges 0.47 0.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMETHAZINE 50 MG RECTAL SUPPOSITORY RX-6624 CDM A9270 HCPCS 0250 RC 00713-0132-12 NDC outpatient 1 UN 89.42 89.42 74 66.17 percent of total billed charges 89.42 93 72.43 percent of total billed charges 89.42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 89.42 other OPPS APC 89.42 89.42 other OPPS APC 89.42 24.86 22.23 percent of total billed charges 89.42 89.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMETHAZINE 50 MG RECTAL SUPPOSITORY RX-6624 CDM A9270 HCPCS 0637 RC 00713-0132-12 NDC outpatient 1 UN 89.42 89.42 89.42 74 66.17 percent of total billed charges 89.42 93 72.43 percent of total billed charges 89.42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 89.42 other OPPS APC 89.42 89.42 other OPPS APC 89.42 24.86 22.23 percent of total billed charges 89.42 89.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASCORBIC ACID (VITAMIN C) 500 MG TABLET RX-664 CDM A9270 HCPCS 0250 RC 00904-0523-61 NDC outpatient 1 UN 0.17 0.17 74 0.13 percent of total billed charges 0.17 93 0.14 percent of total billed charges 0.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.17 other OPPS APC 0.17 0.17 other OPPS APC 0.17 24.86 0.04 percent of total billed charges 0.17 0.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASCORBIC ACID (VITAMIN C) 500 MG TABLET RX-664 CDM A9270 HCPCS 0637 RC 00904-0523-61 NDC outpatient 1 UN 0.17 0.17 0.17 74 0.13 percent of total billed charges 0.17 93 0.14 percent of total billed charges 0.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.17 other OPPS APC 0.17 0.17 other OPPS APC 0.17 24.86 0.04 percent of total billed charges 0.17 0.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROPARACAINE 0.5 % EYE DROPS RX-6644 CDM A9270 HCPCS 0250 RC 24208-0730-06 NDC outpatient 15 ML 105.28 105.28 74 77.91 percent of total billed charges 105.28 93 85.28 percent of total billed charges 105.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 105.28 other OPPS APC 105.28 105.28 other OPPS APC 105.28 24.86 26.17 percent of total billed charges 105.28 105.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROPARACAINE 0.5 % EYE DROPS RX-6644 CDM A9270 HCPCS 0637 RC 24208-0730-06 NDC outpatient 15 ML 105.28 105.28 105.28 74 77.91 percent of total billed charges 105.28 93 85.28 percent of total billed charges 105.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 105.28 other OPPS APC 105.28 105.28 other OPPS APC 105.28 24.86 26.17 percent of total billed charges 105.28 105.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROPRANOLOL 20 MG/5 ML (4 MG/ML) ORAL SOLUTION RX-6654 CDM A9270 HCPCS 0250 RC 00054-3727-63 NDC outpatient 500 ML 164.7 164.7 74 121.88 percent of total billed charges 164.7 93 133.41 percent of total billed charges 164.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 164.7 other OPPS APC 164.7 164.7 other OPPS APC 164.7 24.86 40.94 percent of total billed charges 164.7 164.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROPRANOLOL 20 MG/5 ML (4 MG/ML) ORAL SOLUTION RX-6654 CDM A9270 HCPCS 0637 RC 00054-3727-63 NDC outpatient 500 ML 164.7 164.7 164.7 74 121.88 percent of total billed charges 164.7 93 133.41 percent of total billed charges 164.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 164.7 other OPPS APC 164.7 164.7 other OPPS APC 164.7 24.86 40.94 percent of total billed charges 164.7 164.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROPRANOLOL 10 MG TABLET RX-6656 CDM A9270 HCPCS 0250 RC 50268-0662-15 NDC outpatient 1 UN 0.88 0.88 74 0.65 percent of total billed charges 0.88 93 0.71 percent of total billed charges 0.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.88 other OPPS APC 0.88 0.88 other OPPS APC 0.88 24.86 0.22 percent of total billed charges 0.88 0.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROPRANOLOL 10 MG TABLET RX-6656 CDM A9270 HCPCS 0637 RC 50268-0662-15 NDC outpatient 1 UN 0.88 0.88 0.88 74 0.65 percent of total billed charges 0.88 93 0.71 percent of total billed charges 0.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.88 other OPPS APC 0.88 0.88 other OPPS APC 0.88 24.86 0.22 percent of total billed charges 0.88 0.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROPRANOLOL 20 MG TABLET RX-6657 CDM A9270 HCPCS 0250 RC 60687-0598-01 NDC outpatient 1 UN 1.39 1.39 74 1.03 percent of total billed charges 1.39 93 1.13 percent of total billed charges 1.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.39 other OPPS APC 1.39 1.39 other OPPS APC 1.39 24.86 0.35 percent of total billed charges 1.39 1.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROPRANOLOL 20 MG TABLET RX-6657 CDM A9270 HCPCS 0637 RC 60687-0598-01 NDC outpatient 1 UN 1.39 1.39 1.39 74 1.03 percent of total billed charges 1.39 93 1.13 percent of total billed charges 1.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.39 other OPPS APC 1.39 1.39 other OPPS APC 1.39 24.86 0.35 percent of total billed charges 1.39 1.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION RX-6677 CDM J2720 HCPCS 0636 RC 63323-0229-05 NDC outpatient 5 ML 46.44 46.44 5.38 5.38 fee schedule 46.44 93 37.62 percent of total billed charges 46.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 46.44 other OPPS APC 46.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 46.44 other OPPS APC 46.44 24.86 11.54 percent of total billed charges 5.38 46.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION RX-6677 CDM J2720 HCPCS 0636 RC 63323-0229-30 NDC outpatient 25 ML 158.73 158.73 26.92 26.92 fee schedule 158.73 93 128.57 percent of total billed charges 158.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 158.73 other OPPS APC 158.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 158.73 other OPPS APC 158.73 24.86 39.46 percent of total billed charges 26.92 158.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSEUDOEPHEDRINE 30 MG TABLET RX-6714 CDM A9270 HCPCS 0250 RC 00904-5053-59 NDC outpatient 1 UN 0.08 0.08 74 0.06 percent of total billed charges 0.08 93 0.06 percent of total billed charges 0.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.08 other OPPS APC 0.08 0.08 other OPPS APC 0.08 24.86 0.02 percent of total billed charges 0.08 0.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSEUDOEPHEDRINE 30 MG TABLET RX-6714 CDM A9270 HCPCS 0637 RC 00904-5053-59 NDC outpatient 1 UN 0.08 0.08 0.08 74 0.06 percent of total billed charges 0.08 93 0.06 percent of total billed charges 0.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.08 other OPPS APC 0.08 0.08 other OPPS APC 0.08 24.86 0.02 percent of total billed charges 0.08 0.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PYRAZINAMIDE 500 MG TABLET RX-6738 CDM A9270 HCPCS 0250 RC 10135-0735-60 NDC outpatient 1 UN 22.93 22.93 74 16.97 percent of total billed charges 22.93 93 18.57 percent of total billed charges 22.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.93 other OPPS APC 22.93 22.93 other OPPS APC 22.93 24.86 5.7 percent of total billed charges 22.93 22.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PYRAZINAMIDE 500 MG TABLET RX-6738 CDM A9270 HCPCS 0637 RC 10135-0735-60 NDC outpatient 1 UN 22.93 22.93 22.93 74 16.97 percent of total billed charges 22.93 93 18.57 percent of total billed charges 22.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.93 other OPPS APC 22.93 22.93 other OPPS APC 22.93 24.86 5.7 percent of total billed charges 22.93 22.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION RX-6744 CDM J3415 HCPCS 0636 RC 63323-0180-01 NDC outpatient 1 ML 65.19 65.19 18.15 18.15 fee schedule 65.19 93 52.8 percent of total billed charges 65.19 65.19 other OPPS APC 65.19 65.19 other OPPS APC 65.19 24.86 16.21 percent of total billed charges 18.15 65.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PYRIDOXINE (VITAMIN B6) 50 MG TABLET RX-6748 CDM A9270 HCPCS 0250 RC 77333-0940-10 NDC outpatient 1 UN 0.43 0.43 74 0.32 percent of total billed charges 0.43 93 0.35 percent of total billed charges 0.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.43 other OPPS APC 0.43 0.43 other OPPS APC 0.43 24.86 0.11 percent of total billed charges 0.43 0.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PYRIDOXINE (VITAMIN B6) 50 MG TABLET RX-6748 CDM A9270 HCPCS 0637 RC 77333-0940-10 NDC outpatient 1 UN 0.43 0.43 0.43 74 0.32 percent of total billed charges 0.43 93 0.35 percent of total billed charges 0.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.43 other OPPS APC 0.43 0.43 other OPPS APC 0.43 24.86 0.11 percent of total billed charges 0.43 0.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASPIRIN 81 MG CHEWABLE TABLET RX-679 CDM A9270 HCPCS 0250 RC 63739-0434-02 NDC outpatient 1 UN 0.2 0.2 74 0.15 percent of total billed charges 0.2 93 0.16 percent of total billed charges 0.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.2 other OPPS APC 0.2 0.2 other OPPS APC 0.2 24.86 0.05 percent of total billed charges 0.2 0.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASPIRIN 81 MG CHEWABLE TABLET RX-679 CDM A9270 HCPCS 0637 RC 63739-0434-02 NDC outpatient 1 UN 0.2 0.2 0.2 74 0.15 percent of total billed charges 0.2 93 0.16 percent of total billed charges 0.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.2 other OPPS APC 0.2 0.2 other OPPS APC 0.2 24.86 0.05 percent of total billed charges 0.2 0.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASPIRIN 325 MG TABLET RX-681 CDM A9270 HCPCS 0250 RC 66553-0001-01 NDC outpatient 1 UN 0.15 0.15 74 0.11 percent of total billed charges 0.15 93 0.12 percent of total billed charges 0.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.15 other OPPS APC 0.15 0.15 other OPPS APC 0.15 24.86 0.04 percent of total billed charges 0.15 0.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASPIRIN 325 MG TABLET RX-681 CDM A9270 HCPCS 0637 RC 66553-0001-01 NDC outpatient 1 UN 0.15 0.15 0.15 74 0.11 percent of total billed charges 0.15 93 0.12 percent of total billed charges 0.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.15 other OPPS APC 0.15 0.15 other OPPS APC 0.15 24.86 0.04 percent of total billed charges 0.15 0.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ASPIRIN 325 MG TABLET,DELAYED RELEASE" RX-685 CDM A9270 HCPCS 0250 RC 69618-0015-01 NDC outpatient 1 UN 0.05 0.05 74 0.04 percent of total billed charges 0.05 93 0.04 percent of total billed charges 0.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.05 other OPPS APC 0.05 0.05 other OPPS APC 0.05 24.86 0.01 percent of total billed charges 0.05 0.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ASPIRIN 325 MG TABLET,DELAYED RELEASE" RX-685 CDM A9270 HCPCS 0637 RC 69618-0015-01 NDC outpatient 1 UN 0.05 0.05 0.05 74 0.04 percent of total billed charges 0.05 93 0.04 percent of total billed charges 0.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.05 other OPPS APC 0.05 0.05 other OPPS APC 0.05 24.86 0.01 percent of total billed charges 0.05 0.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASPIRIN 300 MG RECTAL SUPPOSITORY RX-693 CDM A9270 HCPCS 0250 RC 00574-7034-12 NDC outpatient 1 UN 3.65 3.65 74 2.7 percent of total billed charges 3.65 93 2.96 percent of total billed charges 3.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.65 other OPPS APC 3.65 3.65 other OPPS APC 3.65 24.86 0.91 percent of total billed charges 3.65 3.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASPIRIN 300 MG RECTAL SUPPOSITORY RX-693 CDM A9270 HCPCS 0637 RC 00574-7034-12 NDC outpatient 1 UN 3.65 3.65 3.65 74 2.7 percent of total billed charges 3.65 93 2.96 percent of total billed charges 3.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.65 other OPPS APC 3.65 3.65 other OPPS APC 3.65 24.86 0.91 percent of total billed charges 3.65 3.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRIMONIDINE 0.1 % EYE DROPS RX-70262 CDM A9270 HCPCS 0250 RC 82182-0321-05 NDC outpatient 5 ML 554.15 554.15 74 410.07 percent of total billed charges 554.15 93 448.86 percent of total billed charges 554.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 554.15 other OPPS APC 554.15 554.15 other OPPS APC 554.15 24.86 137.76 percent of total billed charges 554.15 554.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRIMONIDINE 0.1 % EYE DROPS RX-70262 CDM A9270 HCPCS 0637 RC 82182-0321-05 NDC outpatient 5 ML 554.15 554.15 554.15 74 410.07 percent of total billed charges 554.15 93 448.86 percent of total billed charges 554.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 554.15 other OPPS APC 554.15 554.15 other OPPS APC 554.15 24.86 137.76 percent of total billed charges 554.15 554.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET" RX-70284 CDM A9270 HCPCS 0250 RC 60258-0006-01 NDC outpatient 1 UN 1.64 1.64 74 1.21 percent of total billed charges 1.64 93 1.33 percent of total billed charges 1.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.64 other OPPS APC 1.64 1.64 other OPPS APC 1.64 24.86 0.41 percent of total billed charges 1.64 1.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET" RX-70284 CDM A9270 HCPCS 0637 RC 60258-0006-01 NDC outpatient 1 UN 1.64 1.64 1.64 74 1.21 percent of total billed charges 1.64 93 1.33 percent of total billed charges 1.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.64 other OPPS APC 1.64 1.64 other OPPS APC 1.64 24.86 0.41 percent of total billed charges 1.64 1.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION RX-70287 CDM J0129 HCPCS 0636 RC 00003-2187-13 NDC outpatient 10 ML 4387.45 4387.45 1234.81 1234.81 fee schedule 4387.45 93 3553.83 percent of total billed charges 4387.45 4387.45 other OPPS APC 4387.45 4387.45 other OPPS APC 4387.45 24.86 1090.72 percent of total billed charges 1234.81 4387.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION RX-70287 CDM J0129 HCPCS 0636 RC 00003-2187-13 NDC outpatient 250 ME 4387.45 4387.45 1234.81 1234.81 fee schedule 4387.45 93 3553.83 percent of total billed charges 4387.45 4387.45 other OPPS APC 4387.45 4387.45 other OPPS APC 4387.45 24.86 1090.72 percent of total billed charges 1234.81 4387.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARIPIPRAZOLE 2 MG TABLET RX-70306 CDM A9270 HCPCS 0250 RC 50268-0087-12 NDC outpatient 1 UN 76.47 76.47 74 56.59 percent of total billed charges 76.47 93 61.94 percent of total billed charges 76.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 76.47 other OPPS APC 76.47 76.47 other OPPS APC 76.47 24.86 19.01 percent of total billed charges 76.47 76.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARIPIPRAZOLE 2 MG TABLET RX-70306 CDM A9270 HCPCS 0637 RC 50268-0087-12 NDC outpatient 1 UN 76.47 76.47 76.47 74 56.59 percent of total billed charges 76.47 93 61.94 percent of total billed charges 76.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 76.47 other OPPS APC 76.47 76.47 other OPPS APC 76.47 24.86 19.01 percent of total billed charges 76.47 76.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR" RX-70434 CDM A9270 HCPCS 0250 RC 60687-0549-11 NDC outpatient 1 UN 4.2 4.2 74 3.11 percent of total billed charges 4.2 93 3.4 percent of total billed charges 4.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.2 other OPPS APC 4.2 4.2 other OPPS APC 4.2 24.86 1.04 percent of total billed charges 4.2 4.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR" RX-70434 CDM A9270 HCPCS 0637 RC 60687-0549-11 NDC outpatient 1 UN 4.2 4.2 4.2 74 3.11 percent of total billed charges 4.2 93 3.4 percent of total billed charges 4.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.2 other OPPS APC 4.2 4.2 other OPPS APC 4.2 24.86 1.04 percent of total billed charges 4.2 4.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCODONE 5 MG-ACETAMINOPHEN 300 MG TABLET RX-70449 CDM A9270 HCPCS 0250 RC 42858-0040-01 NDC outpatient 1 UN 0.78 0.78 74 0.58 percent of total billed charges 0.78 93 0.63 percent of total billed charges 0.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.78 other OPPS APC 0.78 0.78 other OPPS APC 0.78 24.86 0.19 percent of total billed charges 0.78 0.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCODONE 5 MG-ACETAMINOPHEN 300 MG TABLET RX-70449 CDM A9270 HCPCS 0637 RC 42858-0040-01 NDC outpatient 1 UN 0.78 0.78 0.78 74 0.58 percent of total billed charges 0.78 93 0.63 percent of total billed charges 0.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.78 other OPPS APC 0.78 0.78 other OPPS APC 0.78 24.86 0.19 percent of total billed charges 0.78 0.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION" RX-70536 CDM A9270 HCPCS 0250 RC 00536-1183-99 NDC outpatient 1 UN 29.7 29.7 74 21.98 percent of total billed charges 29.7 93 24.06 percent of total billed charges 29.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.7 other OPPS APC 29.7 29.7 other OPPS APC 29.7 24.86 7.38 percent of total billed charges 29.7 29.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION" RX-70536 CDM A9270 HCPCS 0637 RC 00536-1183-99 NDC outpatient 1 UN 29.7 29.7 29.7 74 21.98 percent of total billed charges 29.7 93 24.06 percent of total billed charges 29.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.7 other OPPS APC 29.7 29.7 other OPPS APC 29.7 24.86 7.38 percent of total billed charges 29.7 29.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION" RX-70678 CDM 250000000 HCPCS 0250 RC 39822-1220-01 NDC outpatient 20 ML 425 425 425 74 314.5 percent of total billed charges 425 93 344.25 percent of total billed charges 425 425 other OPPS APC 425 425 other OPPS APC 425 24.86 105.66 percent of total billed charges 425 425 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATENOLOL 25 MG TABLET RX-717 CDM A9270 HCPCS 0250 RC 00904-7187-61 NDC outpatient 1 UN 0.59 0.59 74 0.44 percent of total billed charges 0.59 93 0.48 percent of total billed charges 0.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.59 other OPPS APC 0.59 0.59 other OPPS APC 0.59 24.86 0.15 percent of total billed charges 0.59 0.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATENOLOL 25 MG TABLET RX-717 CDM A9270 HCPCS 0637 RC 00904-7187-61 NDC outpatient 1 UN 0.59 0.59 0.59 74 0.44 percent of total billed charges 0.59 93 0.48 percent of total billed charges 0.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.59 other OPPS APC 0.59 0.59 other OPPS APC 0.59 24.86 0.15 percent of total billed charges 0.59 0.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATENOLOL 50 MG TABLET RX-718 CDM A9270 HCPCS 0250 RC 51079-0684-20 NDC outpatient 1 UN 2.23 2.23 74 1.65 percent of total billed charges 2.23 93 1.81 percent of total billed charges 2.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.23 other OPPS APC 2.23 2.23 other OPPS APC 2.23 24.86 0.55 percent of total billed charges 2.23 2.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATENOLOL 50 MG TABLET RX-718 CDM A9270 HCPCS 0637 RC 51079-0684-20 NDC outpatient 1 UN 2.23 2.23 2.23 74 1.65 percent of total billed charges 2.23 93 1.81 percent of total billed charges 2.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.23 other OPPS APC 2.23 2.23 other OPPS APC 2.23 24.86 0.55 percent of total billed charges 2.23 2.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SILVER SULFADIAZINE 1 % TOPICAL CREAM RX-7224 CDM A9270 HCPCS 0250 RC 63629-8773-01 NDC outpatient 400 GR 104.05 104.05 74 77 percent of total billed charges 104.05 93 84.28 percent of total billed charges 104.05 104.05 other OPPS APC 104.05 104.05 other OPPS APC 104.05 24.86 25.87 percent of total billed charges 104.05 104.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SILVER SULFADIAZINE 1 % TOPICAL CREAM RX-7224 CDM A9270 HCPCS 0637 RC 63629-8773-01 NDC outpatient 400 GR 104.05 104.05 104.05 74 77 percent of total billed charges 104.05 93 84.28 percent of total billed charges 104.05 104.05 other OPPS APC 104.05 104.05 other OPPS APC 104.05 24.86 25.87 percent of total billed charges 104.05 104.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIMETHICONE 80 MG CHEWABLE TABLET RX-7227 CDM A9270 HCPCS 0250 RC 77333-0812-25 NDC outpatient 1 UN 0.59 0.59 74 0.44 percent of total billed charges 0.59 93 0.48 percent of total billed charges 0.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.59 other OPPS APC 0.59 0.59 other OPPS APC 0.59 24.86 0.15 percent of total billed charges 0.59 0.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIMETHICONE 80 MG CHEWABLE TABLET RX-7227 CDM A9270 HCPCS 0637 RC 77333-0812-25 NDC outpatient 1 UN 0.59 0.59 0.59 74 0.44 percent of total billed charges 0.59 93 0.48 percent of total billed charges 0.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.59 other OPPS APC 0.59 0.59 other OPPS APC 0.59 24.86 0.15 percent of total billed charges 0.59 0.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION" RX-7228 CDM A9270 HCPCS 0250 RC 70677-1078-01 NDC outpatient 30 ML 8.76 8.76 74 6.48 percent of total billed charges 8.76 93 7.1 percent of total billed charges 8.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.76 other OPPS APC 8.76 8.76 other OPPS APC 8.76 24.86 2.18 percent of total billed charges 8.76 8.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION" RX-7228 CDM A9270 HCPCS 0637 RC 70677-1078-01 NDC outpatient 30 ML 8.76 8.76 8.76 74 6.48 percent of total billed charges 8.76 93 7.1 percent of total billed charges 8.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.76 other OPPS APC 8.76 8.76 other OPPS APC 8.76 24.86 2.18 percent of total billed charges 8.76 8.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIMPLE SYRUP RX-7242 CDM A9270 HCPCS 0250 RC 00395-2661-16 NDC outpatient 473 ML 42.23 42.23 74 31.25 percent of total billed charges 42.23 93 34.21 percent of total billed charges 42.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42.23 other OPPS APC 42.23 42.23 other OPPS APC 42.23 24.86 10.5 percent of total billed charges 42.23 42.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIMPLE SYRUP RX-7242 CDM A9270 HCPCS 0637 RC 00395-2661-16 NDC outpatient 473 ML 42.23 42.23 42.23 74 31.25 percent of total billed charges 42.23 93 34.21 percent of total billed charges 42.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42.23 other OPPS APC 42.23 42.23 other OPPS APC 42.23 24.86 10.5 percent of total billed charges 42.23 42.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATROPINE 0.1 MG/ML INJECTION SYRINGE RX-730 CDM J0461 HCPCS 0636 RC 64253-0400-91 NDC outpatient 10 ML 30 30 9.68 9.68 fee schedule 30 93 24.3 percent of total billed charges 30 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30 other OPPS APC 30 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30 other OPPS APC 30 24.86 7.46 percent of total billed charges 9.68 30 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION RX-7301 CDM 250000000 HCPCS 0250 RC 00409-7299-73 NDC outpatient 20 ML 9.6 9.6 9.6 9.6 other OPPS APC 9.6 9.6 other OPPS APC 9.6 24.86 2.39 percent of total billed charges 9.6 9.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION RX-7301 CDM 250000000 HCPCS 0250 RC 69784-0230-10 NDC outpatient 50 ML 54.5 54.5 54.5 74 40.33 percent of total billed charges 54.5 93 44.15 percent of total billed charges 54.5 54.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) INTRAVENOUS SYRINGE RX-7306 CDM 250000000 HCPCS 0250 RC 00409-5534-14 NDC outpatient 10 ML 60.33 60.33 60.33 74 44.64 percent of total billed charges 60.33 93 48.87 percent of total billed charges 60.33 60.33 other OPPS APC 60.33 60.33 other OPPS APC 60.33 24.86 15 percent of total billed charges 60.33 60.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS SYRINGE RX-7309 CDM 250000000 HCPCS 0250 RC 76329-3352-01 NDC outpatient 50 ML 53.76 53.76 53.76 74 39.78 percent of total billed charges 53.76 93 43.55 percent of total billed charges 53.76 53.76 other OPPS APC 53.76 53.76 other OPPS APC 53.76 24.86 13.36 percent of total billed charges 53.76 53.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATROPINE 0.4 MG/ML INJECTION SOLUTION RX-731 CDM J0461 HCPCS 0636 RC 16729-0512-43 NDC outpatient 20 ML 210 210 77.44 77.44 fee schedule 210 93 170.1 percent of total billed charges 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 24.86 52.21 percent of total billed charges 77.44 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM BICARBONATE 650 MG TABLET RX-7312 CDM A9270 HCPCS 0250 RC 66553-0008-01 NDC outpatient 1 UN 0.18 0.18 74 0.13 percent of total billed charges 0.18 93 0.15 percent of total billed charges 0.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.18 other OPPS APC 0.18 0.18 other OPPS APC 0.18 24.86 0.04 percent of total billed charges 0.18 0.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM BICARBONATE 650 MG TABLET RX-7312 CDM A9270 HCPCS 0637 RC 66553-0008-01 NDC outpatient 1 UN 0.18 0.18 0.18 74 0.13 percent of total billed charges 0.18 93 0.15 percent of total billed charges 0.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.18 other OPPS APC 0.18 0.18 other OPPS APC 0.18 24.86 0.04 percent of total billed charges 0.18 0.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION RX-7318 CDM 250000000 HCPCS 0250 RC 00264-7802-00 NDC outpatient 1000 ML 11.7 11.7 11.7 74 8.66 percent of total billed charges 11.7 93 9.48 percent of total billed charges 11.7 11.7 other OPPS APC 11.7 11.7 other OPPS APC 11.7 24.86 2.91 percent of total billed charges 11.7 11.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION RX-7321 CDM 250000000 HCPCS 0250 RC 63323-0530-75 NDC outpatient 500 ML 12 12 12 74 8.88 percent of total billed charges 12 93 9.72 percent of total billed charges 12 12 other OPPS APC 12 12 other OPPS APC 12 24.86 2.98 percent of total billed charges 12 12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION RX-7322 CDM 250000000 HCPCS 0250 RC 00409-1141-02 NDC outpatient 100 ML 39.53 39.53 39.53 74 29.25 percent of total billed charges 39.53 93 32.02 percent of total billed charges 39.53 39.53 other OPPS APC 39.53 39.53 other OPPS APC 39.53 24.86 9.83 percent of total billed charges 39.53 39.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM CHLORIDE 1 GRAM TABLET RX-7328 CDM A9270 HCPCS 0250 RC 00223-1760-01 NDC outpatient 1 UN 0.2 0.2 74 0.15 percent of total billed charges 0.2 93 0.16 percent of total billed charges 0.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.2 other OPPS APC 0.2 0.2 other OPPS APC 0.2 24.86 0.05 percent of total billed charges 0.2 0.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM CHLORIDE 1 GRAM TABLET RX-7328 CDM A9270 HCPCS 0637 RC 00223-1760-01 NDC outpatient 1 UN 0.2 0.2 0.2 74 0.15 percent of total billed charges 0.2 93 0.16 percent of total billed charges 0.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.2 other OPPS APC 0.2 0.2 other OPPS APC 0.2 24.86 0.05 percent of total billed charges 0.2 0.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATROPINE 1 MG/ML INJECTION SOLUTION RX-734 CDM J0461 HCPCS 0636 RC 00517-1001-25 NDC outpatient 1 ML 50.88 50.88 9.68 9.68 fee schedule 50.88 93 41.21 percent of total billed charges 50.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 50.88 other OPPS APC 50.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 50.88 other OPPS APC 50.88 24.86 12.65 percent of total billed charges 9.68 50.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION RX-7351 CDM 250000000 HCPCS 0250 RC 63323-0881-16 NDC outpatient 15 ML 123.63 123.63 123.63 74 91.49 percent of total billed charges 123.63 93 100.14 percent of total billed charges 123.63 123.63 other OPPS APC 123.63 123.63 other OPPS APC 123.63 24.86 30.73 percent of total billed charges 123.63 123.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SULFACETAMIDE SODIUM 10 % EYE DROPS RX-7359 CDM A9270 HCPCS 0250 RC 24208-0670-04 NDC outpatient 15 ML 152.51 152.51 74 112.86 percent of total billed charges 152.51 93 123.53 percent of total billed charges 152.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.51 other OPPS APC 152.51 152.51 other OPPS APC 152.51 24.86 37.91 percent of total billed charges 152.51 152.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SULFACETAMIDE SODIUM 10 % EYE DROPS RX-7359 CDM A9270 HCPCS 0637 RC 24208-0670-04 NDC outpatient 15 ML 152.51 152.51 152.51 74 112.86 percent of total billed charges 152.51 93 123.53 percent of total billed charges 152.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.51 other OPPS APC 152.51 152.51 other OPPS APC 152.51 24.86 37.91 percent of total billed charges 152.51 152.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATROPINE 1 % EYE DROPS RX-736 CDM A9270 HCPCS 0250 RC 60505-6226-01 NDC outpatient 5 ML 138.65 138.65 74 102.6 percent of total billed charges 138.65 93 112.31 percent of total billed charges 138.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 138.65 other OPPS APC 138.65 138.65 other OPPS APC 138.65 24.86 34.47 percent of total billed charges 138.65 138.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATROPINE 1 % EYE DROPS RX-736 CDM A9270 HCPCS 0637 RC 60505-6226-01 NDC outpatient 5 ML 138.65 138.65 138.65 74 102.6 percent of total billed charges 138.65 93 112.31 percent of total billed charges 138.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 138.65 other OPPS APC 138.65 138.65 other OPPS APC 138.65 24.86 34.47 percent of total billed charges 138.65 138.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION RX-7364 CDM 250000000 HCPCS 0250 RC 60267-0705-50 NDC outpatient 50 ML 267.5 267.5 267.5 74 197.95 percent of total billed charges 267.5 93 216.68 percent of total billed charges 267.5 267.5 other OPPS APC 267.5 267.5 other OPPS APC 267.5 24.86 66.5 percent of total billed charges 267.5 267.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SORBITOL 70 % SOLUTION RX-7413 CDM A9270 HCPCS 0250 RC 46287-0500-01 NDC outpatient 473 ML 38.15 38.15 74 28.23 percent of total billed charges 38.15 93 30.9 percent of total billed charges 38.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.15 other OPPS APC 38.15 38.15 other OPPS APC 38.15 24.86 9.48 percent of total billed charges 38.15 38.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SORBITOL 70 % SOLUTION RX-7413 CDM A9270 HCPCS 0637 RC 46287-0500-01 NDC outpatient 473 ML 38.15 38.15 38.15 74 28.23 percent of total billed charges 38.15 93 30.9 percent of total billed charges 38.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.15 other OPPS APC 38.15 38.15 other OPPS APC 38.15 24.86 9.48 percent of total billed charges 38.15 38.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPIRONOLACTONE 25 MG TABLET RX-7437 CDM A9270 HCPCS 0250 RC 00904-6927-61 NDC outpatient 1 UN 0.47 0.47 74 0.35 percent of total billed charges 0.47 93 0.38 percent of total billed charges 0.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.47 other OPPS APC 0.47 0.47 other OPPS APC 0.47 24.86 0.12 percent of total billed charges 0.47 0.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPIRONOLACTONE 25 MG TABLET RX-7437 CDM A9270 HCPCS 0637 RC 00904-6927-61 NDC outpatient 1 UN 0.47 0.47 0.47 74 0.35 percent of total billed charges 0.47 93 0.38 percent of total billed charges 0.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.47 other OPPS APC 0.47 0.47 other OPPS APC 0.47 24.86 0.12 percent of total billed charges 0.47 0.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "WATER FOR IRRIGATION, STERILE SOLUTION" RX-7485 CDM A4217 HCPCS 0636 RC 00264-2101-00 NDC outpatient 1000 ML 5 5 5 74 3.7 percent of total billed charges 5 93 4.05 percent of total billed charges 5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5 other OPPS APC 5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5 other OPPS APC 5 24.86 1.24 percent of total billed charges 5 5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "WATER FOR IRRIGATION, STERILE SOLUTION" RX-7485 CDM A4217 HCPCS 0636 RC 00264-2101-10 NDC outpatient 500 ML 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.75 other OPPS APC 9.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.75 other OPPS APC 9.75 24.86 2.42 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION RX-7536 CDM J0330 HCPCS 0636 RC 00143-9338-25 NDC outpatient 10 ML 34.5 34.5 34.5 74 25.53 percent of total billed charges 34.5 93 27.95 percent of total billed charges 34.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.5 other OPPS APC 34.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.5 other OPPS APC 34.5 24.86 8.58 percent of total billed charges 34.5 34.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SULFADIAZINE 500 MG TABLET RX-7554 CDM A9270 HCPCS 0250 RC 42806-0757-60 NDC outpatient 1 UN 50.1 50.1 74 37.07 percent of total billed charges 50.1 93 40.58 percent of total billed charges 50.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 50.1 other OPPS APC 50.1 50.1 other OPPS APC 50.1 24.86 12.45 percent of total billed charges 50.1 50.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SULFADIAZINE 500 MG TABLET RX-7554 CDM A9270 HCPCS 0637 RC 42806-0757-60 NDC outpatient 1 UN 50.1 50.1 50.1 74 37.07 percent of total billed charges 50.1 93 40.58 percent of total billed charges 50.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 50.1 other OPPS APC 50.1 50.1 other OPPS APC 50.1 24.86 12.45 percent of total billed charges 50.1 50.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET RX-7555 CDM A9270 HCPCS 0250 RC 00904-2725-61 NDC outpatient 1 UN 0.94 0.94 74 0.7 percent of total billed charges 0.94 93 0.76 percent of total billed charges 0.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.94 other OPPS APC 0.94 0.94 other OPPS APC 0.94 24.86 0.23 percent of total billed charges 0.94 0.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET RX-7555 CDM A9270 HCPCS 0637 RC 00904-2725-61 NDC outpatient 1 UN 0.94 0.94 0.94 74 0.7 percent of total billed charges 0.94 93 0.76 percent of total billed charges 0.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.94 other OPPS APC 0.94 0.94 other OPPS APC 0.94 24.86 0.23 percent of total billed charges 0.94 0.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION RX-7556 CDM 250000000 HCPCS 0250 RC 70069-0362-01 NDC outpatient 10 ML 38.02 38.02 38.02 74 28.13 percent of total billed charges 38.02 93 30.8 percent of total billed charges 38.02 38.02 other OPPS APC 38.02 38.02 other OPPS APC 38.02 24.86 9.45 percent of total billed charges 38.02 38.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET RX-7557 CDM A9270 HCPCS 0250 RC 50268-0728-11 NDC outpatient 1 UN 1.66 1.66 74 1.23 percent of total billed charges 1.66 93 1.34 percent of total billed charges 1.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.66 other OPPS APC 1.66 1.66 other OPPS APC 1.66 24.86 0.41 percent of total billed charges 1.66 1.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET RX-7557 CDM A9270 HCPCS 0637 RC 50268-0728-11 NDC outpatient 1 UN 1.66 1.66 1.66 74 1.23 percent of total billed charges 1.66 93 1.34 percent of total billed charges 1.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.66 other OPPS APC 1.66 1.66 other OPPS APC 1.66 24.86 0.41 percent of total billed charges 1.66 1.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SULFASALAZINE 500 MG TABLET RX-7562 CDM A9270 HCPCS 0250 RC 00093-3234-01 NDC outpatient 1 UN 0.64 0.64 74 0.47 percent of total billed charges 0.64 93 0.52 percent of total billed charges 0.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.64 other OPPS APC 0.64 0.64 other OPPS APC 0.64 24.86 0.16 percent of total billed charges 0.64 0.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SULFASALAZINE 500 MG TABLET RX-7562 CDM A9270 HCPCS 0637 RC 00093-3234-01 NDC outpatient 1 UN 0.64 0.64 0.64 74 0.47 percent of total billed charges 0.64 93 0.52 percent of total billed charges 0.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.64 other OPPS APC 0.64 0.64 other OPPS APC 0.64 24.86 0.16 percent of total billed charges 0.64 0.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SULFASALAZINE 500 MG TABLET,DELAYED RELEASE" RX-7563 CDM A9270 HCPCS 0250 RC 59762-0104-05 NDC outpatient 1 UN 0.86 0.86 74 0.64 percent of total billed charges 0.86 93 0.7 percent of total billed charges 0.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.86 other OPPS APC 0.86 0.86 other OPPS APC 0.86 24.86 0.21 percent of total billed charges 0.86 0.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SULFASALAZINE 500 MG TABLET,DELAYED RELEASE" RX-7563 CDM A9270 HCPCS 0637 RC 59762-0104-05 NDC outpatient 1 UN 0.86 0.86 0.86 74 0.64 percent of total billed charges 0.86 93 0.7 percent of total billed charges 0.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.86 other OPPS APC 0.86 0.86 other OPPS APC 0.86 24.86 0.21 percent of total billed charges 0.86 0.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DARBEPOETIN ALFA 500 MCG/ML IN POLYSORBATE INJECTION SYRINGE RX-76334 CDM J0881 HCPCS 0636 RC 55513-0032-01 NDC outpatient 1 ML 11610 11610 1675.85 1675.85 fee schedule 11610 93 9404.1 percent of total billed charges 11610 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1518 other OPPS APC 11610 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1518 other OPPS APC 11610 24.86 2886.25 percent of total billed charges 1675.85 11610 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETYLCYSTEINE 600 MG CAPSULE RX-76335 CDM A9270 HCPCS 0250 RC 79854-0040-97 NDC outpatient 1 UN 0.15 0.15 74 0.11 percent of total billed charges 0.15 93 0.12 percent of total billed charges 0.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.15 other OPPS APC 0.15 0.15 other OPPS APC 0.15 24.86 0.04 percent of total billed charges 0.15 0.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETYLCYSTEINE 600 MG CAPSULE RX-76335 CDM A9270 HCPCS 0637 RC 79854-0040-97 NDC outpatient 1 UN 0.15 0.15 0.15 74 0.11 percent of total billed charges 0.15 93 0.12 percent of total billed charges 0.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.15 other OPPS APC 0.15 0.15 other OPPS APC 0.15 24.86 0.04 percent of total billed charges 0.15 0.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION" RX-76338 CDM J3473 HCPCS 0636 RC 18657-0117-04 NDC outpatient 1 ML 167.4 167.4 61.71 61.71 fee schedule 167.4 93 135.59 percent of total billed charges 167.4 167.4 other OPPS APC 167.4 167.4 other OPPS APC 167.4 24.86 41.62 percent of total billed charges 61.71 167.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DECITABINE 50 MG INTRAVENOUS SOLUTION RX-76364 CDM J0894 HCPCS 0636 RC 00143-9385-01 NDC outpatient 10 ML 300 300 114.35 114.35 fee schedule 300 93 243 percent of total billed charges 300 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 300 other OPPS APC 300 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 300 other OPPS APC 300 24.86 74.58 percent of total billed charges 114.35 300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) INTRAOCULAR KIT RX-76641 CDM 250000000 HCPCS 0250 RC 24208-0539-20 NDC outpatient 2 ML 385.93 385.93 385.93 74 285.59 percent of total billed charges 385.93 93 312.6 percent of total billed charges 385.93 385.93 other OPPS APC 385.93 385.93 other OPPS APC 385.93 24.86 95.94 percent of total billed charges 385.93 385.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZATHIOPRINE 100 MG SOLUTION FOR INJECTION RX-767 CDM J7501 HCPCS 0636 RC 00143-9566-01 NDC outpatient 10 ML 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 750 other OPPS APC 750 750 other OPPS APC 750 24.86 186.45 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM HYPOCHLORITE 0.125 % SOLUTION RX-76720 CDM A9270 HCPCS 0250 RC 00436-0672-16 NDC outpatient 473 ML 34.65 34.65 74 25.64 percent of total billed charges 34.65 93 28.07 percent of total billed charges 34.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.65 other OPPS APC 34.65 34.65 other OPPS APC 34.65 24.86 8.61 percent of total billed charges 34.65 34.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM HYPOCHLORITE 0.125 % SOLUTION RX-76720 CDM A9270 HCPCS 0637 RC 00436-0672-16 NDC outpatient 473 ML 34.65 34.65 34.65 74 25.64 percent of total billed charges 34.65 93 28.07 percent of total billed charges 34.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.65 other OPPS APC 34.65 34.65 other OPPS APC 34.65 24.86 8.61 percent of total billed charges 34.65 34.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION RX-76824 CDM A9270 HCPCS 0250 RC 00121-0945-00 NDC outpatient 10 ML 12.54 12.54 74 9.28 percent of total billed charges 12.54 93 10.16 percent of total billed charges 12.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.54 other OPPS APC 12.54 12.54 other OPPS APC 12.54 24.86 3.12 percent of total billed charges 12.54 12.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION RX-76824 CDM A9270 HCPCS 0637 RC 00121-0945-00 NDC outpatient 10 ML 12.54 12.54 12.54 74 9.28 percent of total billed charges 12.54 93 10.16 percent of total billed charges 12.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.54 other OPPS APC 12.54 12.54 other OPPS APC 12.54 24.86 3.12 percent of total billed charges 12.54 12.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APREPITANT 40 MG CAPSULE RX-76843 CDM J8501 HCPCS 0250 RC 00781-2321-51 NDC outpatient 1 UN 274.84 274.84 74 203.38 percent of total billed charges 274.84 93 222.62 percent of total billed charges 274.84 274.84 other OPPS APC 274.84 274.84 other OPPS APC 274.84 24.86 68.33 percent of total billed charges 274.84 274.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APREPITANT 40 MG CAPSULE RX-76843 CDM J8501 HCPCS 0637 RC 00781-2321-51 NDC outpatient 1 UN 274.84 274.84 274.84 74 203.38 percent of total billed charges 274.84 93 222.62 percent of total billed charges 274.84 274.84 other OPPS APC 274.84 274.84 other OPPS APC 274.84 24.86 68.33 percent of total billed charges 274.84 274.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RASBURICASE 7.5 MG INTRAVENOUS SOLUTION RX-76868 CDM J2783 HCPCS 0636 RC 00024-5151-75 NDC outpatient 5 ML 16117.7 16117.7 6119.09 6119.09 fee schedule 16117.7 93 13055.3 percent of total billed charges 16117.7 16117.7 other OPPS APC 16117.7 16117.7 other OPPS APC 16117.7 24.86 4006.86 percent of total billed charges 6119.09 16117.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RASBURICASE 7.5 MG INTRAVENOUS SOLUTION RX-76868 CDM J2783 HCPCS 0636 RC 00024-5151-75 NDC outpatient 7.5 ME 16117.7 16117.7 6119.09 6119.09 fee schedule 16117.7 93 13055.3 percent of total billed charges 16117.7 16117.7 other OPPS APC 16117.7 16117.7 other OPPS APC 16117.7 24.86 4006.86 percent of total billed charges 6119.09 16117.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET" RX-76950 CDM A9270 HCPCS 0250 RC 48433-0104-01 NDC outpatient 1 UN 0.53 0.53 74 0.39 percent of total billed charges 0.53 93 0.43 percent of total billed charges 0.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.53 other OPPS APC 0.53 0.53 other OPPS APC 0.53 24.86 0.13 percent of total billed charges 0.53 0.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET" RX-76950 CDM A9270 HCPCS 0637 RC 48433-0104-01 NDC outpatient 1 UN 0.53 0.53 0.53 74 0.39 percent of total billed charges 0.53 93 0.43 percent of total billed charges 0.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.53 other OPPS APC 0.53 0.53 other OPPS APC 0.53 24.86 0.13 percent of total billed charges 0.53 0.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DARBEPOETIN ALFA 40 MCG/ML IN POLYSORBATE INJECTION RX-76963 CDM J0881 HCPCS 0636 RC 55513-0003-01 NDC outpatient 1 ML 928.8 928.8 134.07 134.07 fee schedule 928.8 93 752.33 percent of total billed charges 928.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 121.44 other OPPS APC 928.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 121.44 other OPPS APC 928.8 24.86 230.9 percent of total billed charges 134.07 928.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLYCERIN (CHILD) RECTAL SUPPOSITORY RX-76974 CDM 250000000 HCPCS 0250 RC 58980-0409-12 NDC outpatient 1 UN 2.11 2.11 2.11 74 1.56 percent of total billed charges 2.11 93 1.71 percent of total billed charges 2.11 2.11 other OPPS APC 2.11 2.11 other OPPS APC 2.11 24.86 0.52 percent of total billed charges 2.11 2.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCIUM 600 MG (AS CARBONATE)-VITAMIN D3 10 MCG (400 UNIT) TABLET RX-76978 CDM A9270 HCPCS 0250 RC 20555-0017-00 NDC outpatient 1 UN 0.45 0.45 74 0.33 percent of total billed charges 0.45 93 0.36 percent of total billed charges 0.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.45 other OPPS APC 0.45 0.45 other OPPS APC 0.45 24.86 0.11 percent of total billed charges 0.45 0.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCIUM 600 MG (AS CARBONATE)-VITAMIN D3 10 MCG (400 UNIT) TABLET RX-76978 CDM A9270 HCPCS 0637 RC 20555-0017-00 NDC outpatient 1 UN 0.45 0.45 0.45 74 0.33 percent of total billed charges 0.45 93 0.36 percent of total billed charges 0.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.45 other OPPS APC 0.45 0.45 other OPPS APC 0.45 24.86 0.11 percent of total billed charges 0.45 0.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCHLOROTHIAZIDE 12.5 MG TABLET RX-76988 CDM A9270 HCPCS 0250 RC 16729-0182-01 NDC outpatient 1 UN 1.07 1.07 74 0.79 percent of total billed charges 1.07 93 0.87 percent of total billed charges 1.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.07 other OPPS APC 1.07 1.07 other OPPS APC 1.07 24.86 0.27 percent of total billed charges 1.07 1.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROCHLOROTHIAZIDE 12.5 MG TABLET RX-76988 CDM A9270 HCPCS 0637 RC 16729-0182-01 NDC outpatient 1 UN 1.07 1.07 1.07 74 0.79 percent of total billed charges 1.07 93 0.87 percent of total billed charges 1.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.07 other OPPS APC 1.07 1.07 other OPPS APC 1.07 24.86 0.27 percent of total billed charges 1.07 1.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ETONOGESTREL 68 MG SUBDERMAL IMPLANT RX-77012 CDM J7307 HCPCS 0636 RC 78206-0145-01 NDC outpatient 1 UN 981.56 981.56 981.56 74 726.35 percent of total billed charges 981.56 93 795.06 percent of total billed charges 981.56 981.56 other OPPS APC 981.56 981.56 other OPPS APC 981.56 24.86 244.02 percent of total billed charges 981.56 981.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAMOXIFEN 10 MG TABLET RX-7711 CDM A9270 HCPCS 0250 RC 59651-0299-60 NDC outpatient 1 UN 4.74 4.74 74 3.51 percent of total billed charges 4.74 93 3.84 percent of total billed charges 4.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.74 other OPPS APC 4.74 4.74 other OPPS APC 4.74 24.86 1.18 percent of total billed charges 4.74 4.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAMOXIFEN 10 MG TABLET RX-7711 CDM A9270 HCPCS 0637 RC 59651-0299-60 NDC outpatient 1 UN 4.74 4.74 4.74 74 3.51 percent of total billed charges 4.74 93 3.84 percent of total billed charges 4.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.74 other OPPS APC 4.74 4.74 other OPPS APC 4.74 24.86 1.18 percent of total billed charges 4.74 4.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE PROPIONATE 45 MCG-SALMETEROL 21 MCG/ACTUATION HFA INHALER RX-77173 CDM A9270 HCPCS 0250 RC 66993-0086-96 NDC outpatient 12 GR 930.7 930.7 74 688.72 percent of total billed charges 930.7 93 753.87 percent of total billed charges 930.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930.7 other OPPS APC 930.7 930.7 other OPPS APC 930.7 24.86 231.37 percent of total billed charges 930.7 930.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE PROPIONATE 45 MCG-SALMETEROL 21 MCG/ACTUATION HFA INHALER RX-77173 CDM A9270 HCPCS 0637 RC 66993-0086-96 NDC outpatient 12 GR 930.7 930.7 930.7 74 688.72 percent of total billed charges 930.7 93 753.87 percent of total billed charges 930.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930.7 other OPPS APC 930.7 930.7 other OPPS APC 930.7 24.86 231.37 percent of total billed charges 930.7 930.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE PROPIONATE 115 MCG-SALMETEROL 21 MCG/ACTUATION HFA INHALER RX-77174 CDM A9270 HCPCS 0250 RC 66993-0087-96 NDC outpatient 12 GR 1156.4 1156.4 74 855.74 percent of total billed charges 1156.4 93 936.68 percent of total billed charges 1156.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1156.4 other OPPS APC 1156.4 1156.4 other OPPS APC 1156.4 24.86 287.48 percent of total billed charges 1156.4 1156.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE PROPIONATE 115 MCG-SALMETEROL 21 MCG/ACTUATION HFA INHALER RX-77174 CDM A9270 HCPCS 0637 RC 66993-0087-96 NDC outpatient 12 GR 1156.4 1156.4 1156.4 74 855.74 percent of total billed charges 1156.4 93 936.68 percent of total billed charges 1156.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1156.4 other OPPS APC 1156.4 1156.4 other OPPS APC 1156.4 24.86 287.48 percent of total billed charges 1156.4 1156.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE PROPIONATE 230 MCG-SALMETEROL 21 MCG/ACTUATION HFA INHALER RX-77175 CDM A9270 HCPCS 0250 RC 66993-0088-96 NDC outpatient 12 GR 1520.88 1520.88 74 1125.45 percent of total billed charges 1520.88 93 1231.91 percent of total billed charges 1520.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1520.88 other OPPS APC 1520.88 1520.88 other OPPS APC 1520.88 24.86 378.09 percent of total billed charges 1520.88 1520.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTICASONE PROPIONATE 230 MCG-SALMETEROL 21 MCG/ACTUATION HFA INHALER RX-77175 CDM A9270 HCPCS 0637 RC 66993-0088-96 NDC outpatient 12 GR 1520.88 1520.88 1520.88 74 1125.45 percent of total billed charges 1520.88 93 1231.91 percent of total billed charges 1520.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1520.88 other OPPS APC 1520.88 1520.88 other OPPS APC 1520.88 24.86 378.09 percent of total billed charges 1520.88 1520.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION RX-77195 CDM J1953 HCPCS 0636 RC 00409-1886-02 NDC outpatient 5 ML 11.67 11.67 4.24 4.24 fee schedule 11.67 93 9.45 percent of total billed charges 11.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.67 other OPPS APC 11.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.67 other OPPS APC 11.67 24.86 2.9 percent of total billed charges 4.24 11.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) ORAL SOLUTION RX-77411 CDM A9270 HCPCS 0250 RC 25021-0602-03 NDC outpatient 3 ML 60 60 74 44.4 percent of total billed charges 60 93 48.6 percent of total billed charges 60 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 60 other OPPS APC 60 60 other OPPS APC 60 24.86 14.92 percent of total billed charges 60 60 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) ORAL SOLUTION RX-77411 CDM A9270 HCPCS 0637 RC 25021-0602-03 NDC outpatient 3 ML 60 60 60 74 44.4 percent of total billed charges 60 93 48.6 percent of total billed charges 60 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 60 other OPPS APC 60 60 other OPPS APC 60 24.86 14.92 percent of total billed charges 60 60 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TEMAZEPAM 15 MG CAPSULE RX-7753 CDM A9270 HCPCS 0250 RC 00228-2076-10 NDC outpatient 1 UN 1.84 1.84 74 1.36 percent of total billed charges 1.84 93 1.49 percent of total billed charges 1.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.84 other OPPS APC 1.84 1.84 other OPPS APC 1.84 24.86 0.46 percent of total billed charges 1.84 1.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TEMAZEPAM 15 MG CAPSULE RX-7753 CDM A9270 HCPCS 0637 RC 00228-2076-10 NDC outpatient 1 UN 1.84 1.84 1.84 74 1.36 percent of total billed charges 1.84 93 1.49 percent of total billed charges 1.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.84 other OPPS APC 1.84 1.84 other OPPS APC 1.84 24.86 0.46 percent of total billed charges 1.84 1.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TEMAZEPAM 30 MG CAPSULE RX-7754 CDM A9270 HCPCS 0250 RC 00228-2077-10 NDC outpatient 1 UN 2.22 2.22 74 1.64 percent of total billed charges 2.22 93 1.8 percent of total billed charges 2.22 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.22 other OPPS APC 2.22 2.22 other OPPS APC 2.22 24.86 0.55 percent of total billed charges 2.22 2.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TEMAZEPAM 30 MG CAPSULE RX-7754 CDM A9270 HCPCS 0637 RC 00228-2077-10 NDC outpatient 1 UN 2.22 2.22 2.22 74 1.64 percent of total billed charges 2.22 93 1.8 percent of total billed charges 2.22 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.22 other OPPS APC 2.22 2.22 other OPPS APC 2.22 24.86 0.55 percent of total billed charges 2.22 2.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SITAGLIPTIN PHOSPHATE 25 MG TABLET RX-77615 CDM A9270 HCPCS 0250 RC 00006-0221-01 NDC outpatient 1 UN 57.3 57.3 74 42.4 percent of total billed charges 57.3 93 46.41 percent of total billed charges 57.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 57.3 other OPPS APC 57.3 57.3 other OPPS APC 57.3 24.86 14.24 percent of total billed charges 57.3 57.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SITAGLIPTIN PHOSPHATE 25 MG TABLET RX-77615 CDM A9270 HCPCS 0637 RC 00006-0221-01 NDC outpatient 1 UN 57.3 57.3 57.3 74 42.4 percent of total billed charges 57.3 93 46.41 percent of total billed charges 57.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 57.3 other OPPS APC 57.3 57.3 other OPPS APC 57.3 24.86 14.24 percent of total billed charges 57.3 57.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SITAGLIPTIN PHOSPHATE 50 MG TABLET RX-77616 CDM A9270 HCPCS 0250 RC 00006-0112-01 NDC outpatient 1 UN 57.3 57.3 74 42.4 percent of total billed charges 57.3 93 46.41 percent of total billed charges 57.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 57.3 other OPPS APC 57.3 57.3 other OPPS APC 57.3 24.86 14.24 percent of total billed charges 57.3 57.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SITAGLIPTIN PHOSPHATE 50 MG TABLET RX-77616 CDM A9270 HCPCS 0637 RC 00006-0112-01 NDC outpatient 1 UN 57.3 57.3 57.3 74 42.4 percent of total billed charges 57.3 93 46.41 percent of total billed charges 57.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 57.3 other OPPS APC 57.3 57.3 other OPPS APC 57.3 24.86 14.24 percent of total billed charges 57.3 57.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SITAGLIPTIN PHOSPHATE 100 MG TABLET RX-77617 CDM A9270 HCPCS 0250 RC 00006-0277-28 NDC outpatient 1 UN 57.3 57.3 74 42.4 percent of total billed charges 57.3 93 46.41 percent of total billed charges 57.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 57.3 other OPPS APC 57.3 57.3 other OPPS APC 57.3 24.86 14.24 percent of total billed charges 57.3 57.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SITAGLIPTIN PHOSPHATE 100 MG TABLET RX-77617 CDM A9270 HCPCS 0637 RC 00006-0277-28 NDC outpatient 1 UN 57.3 57.3 57.3 74 42.4 percent of total billed charges 57.3 93 46.41 percent of total billed charges 57.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 57.3 other OPPS APC 57.3 57.3 other OPPS APC 57.3 24.86 14.24 percent of total billed charges 57.3 57.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICAFUNGIN 100 MG INTRAVENOUS SOLUTION RX-77685 CDM J2247 HCPCS 0636 RC 42023-0230-10 NDC outpatient 100 ME 448.8 448.8 32.67 32.67 fee schedule 448.8 93 363.53 percent of total billed charges 448.8 448.8 other OPPS APC 448.8 448.8 other OPPS APC 448.8 24.86 111.57 percent of total billed charges 32.67 448.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICAFUNGIN 100 MG INTRAVENOUS SOLUTION RX-77685 CDM J2247 HCPCS 0636 RC 42023-0230-10 NDC outpatient 5 ML 448.8 448.8 32.67 32.67 fee schedule 448.8 93 363.53 percent of total billed charges 448.8 448.8 other OPPS APC 448.8 448.8 other OPPS APC 448.8 24.86 111.57 percent of total billed charges 32.67 448.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION RX-77725 CDM A9270 HCPCS 0250 RC 00121-1576-10 NDC outpatient 10 ML 12.16 12.16 74 9 percent of total billed charges 12.16 93 9.85 percent of total billed charges 12.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.16 other OPPS APC 12.16 12.16 other OPPS APC 12.16 24.86 3.02 percent of total billed charges 12.16 12.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION RX-77725 CDM A9270 HCPCS 0637 RC 00121-1576-10 NDC outpatient 10 ML 12.16 12.16 12.16 74 9 percent of total billed charges 12.16 93 9.85 percent of total billed charges 12.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.16 other OPPS APC 12.16 12.16 other OPPS APC 12.16 24.86 3.02 percent of total billed charges 12.16 12.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TETRACAINE 0.5 % EYE DROPS RX-7795 CDM A9270 HCPCS 0250 RC 68682-0920-05 NDC outpatient 5 ML 90 90 74 66.6 percent of total billed charges 90 93 72.9 percent of total billed charges 90 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 90 other OPPS APC 90 90 other OPPS APC 90 24.86 22.37 percent of total billed charges 90 90 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TETRACAINE 0.5 % EYE DROPS RX-7795 CDM A9270 HCPCS 0637 RC 68682-0920-05 NDC outpatient 5 ML 90 90 90 74 66.6 percent of total billed charges 90 93 72.9 percent of total billed charges 90 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 90 other OPPS APC 90 90 other OPPS APC 90 24.86 22.37 percent of total billed charges 90 90 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID RX-78003 CDM A9270 HCPCS 0250 RC 00121-1550-10 NDC outpatient 10 ML 12.75 12.75 74 9.44 percent of total billed charges 12.75 93 10.33 percent of total billed charges 12.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.75 other OPPS APC 12.75 12.75 other OPPS APC 12.75 24.86 3.17 percent of total billed charges 12.75 12.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID RX-78003 CDM A9270 HCPCS 0637 RC 00121-1550-10 NDC outpatient 10 ML 12.75 12.75 12.75 74 9.44 percent of total billed charges 12.75 93 10.33 percent of total billed charges 12.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.75 other OPPS APC 12.75 12.75 other OPPS APC 12.75 24.86 3.17 percent of total billed charges 12.75 12.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THEOPHYLLINE 80 MG/15 ML ORAL ELIXIR RX-7820 CDM A9270 HCPCS 0250 RC 00121-0820-16 NDC outpatient 473 ML 279.38 279.38 74 206.74 percent of total billed charges 279.38 93 226.3 percent of total billed charges 279.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 279.38 other OPPS APC 279.38 279.38 other OPPS APC 279.38 24.86 69.45 percent of total billed charges 279.38 279.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THEOPHYLLINE 80 MG/15 ML ORAL ELIXIR RX-7820 CDM A9270 HCPCS 0637 RC 00121-0820-16 NDC outpatient 473 ML 279.38 279.38 279.38 74 206.74 percent of total billed charges 279.38 93 226.3 percent of total billed charges 279.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 279.38 other OPPS APC 279.38 279.38 other OPPS APC 279.38 24.86 69.45 percent of total billed charges 279.38 279.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THEOPHYLLINE 80 MG/15 ML ORAL ELIXIR RX-7820 CDM A9270 HCPCS 0250 RC 00121-4820-15 NDC outpatient 15 ML 31.31 31.31 74 23.17 percent of total billed charges 31.31 93 25.36 percent of total billed charges 31.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 31.31 other OPPS APC 31.31 31.31 other OPPS APC 31.31 24.86 7.78 percent of total billed charges 31.31 31.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THEOPHYLLINE 80 MG/15 ML ORAL ELIXIR RX-7820 CDM A9270 HCPCS 0637 RC 00121-4820-15 NDC outpatient 15 ML 31.31 31.31 31.31 74 23.17 percent of total billed charges 31.31 93 25.36 percent of total billed charges 31.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 31.31 other OPPS APC 31.31 31.31 other OPPS APC 31.31 24.86 7.78 percent of total billed charges 31.31 31.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZACITIDINE 100 MG SOLUTION FOR INJECTION RX-78420 CDM J9025 HCPCS 0636 RC 72485-0201-01 NDC outpatient 10 ML 1544.05 1544.05 45.98 45.98 fee schedule 1544.05 93 1250.68 percent of total billed charges 1544.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1544.05 other OPPS APC 1544.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1544.05 other OPPS APC 1544.05 24.86 383.85 percent of total billed charges 45.98 1544.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION RX-7876 CDM J3411 HCPCS 0636 RC 43598-0050-25 NDC outpatient 2 ML 19.2 19.2 5.71 5.71 fee schedule 19.2 93 15.55 percent of total billed charges 19.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.2 other OPPS APC 19.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.2 other OPPS APC 19.2 24.86 4.77 percent of total billed charges 5.71 19.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THIOTHIXENE 2 MG CAPSULE RX-7904 CDM A9270 HCPCS 0250 RC 00378-2002-01 NDC outpatient 1 UN 3.93 3.93 74 2.91 percent of total billed charges 3.93 93 3.18 percent of total billed charges 3.93 3.93 other OPPS APC 3.93 3.93 other OPPS APC 3.93 24.86 0.98 percent of total billed charges 3.93 3.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THIOTHIXENE 2 MG CAPSULE RX-7904 CDM A9270 HCPCS 0637 RC 00378-2002-01 NDC outpatient 1 UN 3.93 3.93 3.93 74 2.91 percent of total billed charges 3.93 93 3.18 percent of total billed charges 3.93 3.93 other OPPS APC 3.93 3.93 other OPPS APC 3.93 24.86 0.98 percent of total billed charges 3.93 3.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THIOTHIXENE 5 MG CAPSULE RX-7906 CDM A9270 HCPCS 0250 RC 00378-3005-01 NDC outpatient 1 UN 5.96 5.96 74 4.41 percent of total billed charges 5.96 93 4.83 percent of total billed charges 5.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.96 other OPPS APC 5.96 5.96 other OPPS APC 5.96 24.86 1.48 percent of total billed charges 5.96 5.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THIOTHIXENE 5 MG CAPSULE RX-7906 CDM A9270 HCPCS 0637 RC 00378-3005-01 NDC outpatient 1 UN 5.96 5.96 5.96 74 4.41 percent of total billed charges 5.96 93 4.83 percent of total billed charges 5.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.96 other OPPS APC 5.96 5.96 other OPPS APC 5.96 24.86 1.48 percent of total billed charges 5.96 5.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOLNAFTATE 1 % TOPICAL CREAM RX-8020 CDM A9270 HCPCS 0250 RC 51672-2020-01 NDC outpatient 15 GR 12.75 12.75 74 9.44 percent of total billed charges 12.75 93 10.33 percent of total billed charges 12.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.75 other OPPS APC 12.75 12.75 other OPPS APC 12.75 24.86 3.17 percent of total billed charges 12.75 12.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOLNAFTATE 1 % TOPICAL CREAM RX-8020 CDM A9270 HCPCS 0637 RC 51672-2020-01 NDC outpatient 15 GR 12.75 12.75 12.75 74 9.44 percent of total billed charges 12.75 93 10.33 percent of total billed charges 12.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.75 other OPPS APC 12.75 12.75 other OPPS APC 12.75 24.86 3.17 percent of total billed charges 12.75 12.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOLNAFTATE 1 % TOPICAL POWDER RX-8021 CDM 250000000 HCPCS 0250 RC 00536-1329-26 NDC outpatient 45 GR 6.43 6.43 6.43 74 4.76 percent of total billed charges 6.43 93 5.21 percent of total billed charges 6.43 6.43 other OPPS APC 6.43 6.43 other OPPS APC 6.43 24.86 1.6 percent of total billed charges 6.43 6.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAZODONE 50 MG TABLET RX-8085 CDM A9270 HCPCS 0250 RC 00904-6868-61 NDC outpatient 1 UN 0.38 0.38 74 0.28 percent of total billed charges 0.38 93 0.31 percent of total billed charges 0.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.38 other OPPS APC 0.38 0.38 other OPPS APC 0.38 24.86 0.09 percent of total billed charges 0.38 0.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAZODONE 50 MG TABLET RX-8085 CDM A9270 HCPCS 0637 RC 00904-6868-61 NDC outpatient 1 UN 0.38 0.38 0.38 74 0.28 percent of total billed charges 0.38 93 0.31 percent of total billed charges 0.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.38 other OPPS APC 0.38 0.38 other OPPS APC 0.38 24.86 0.09 percent of total billed charges 0.38 0.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM RX-8113 CDM A9270 HCPCS 0250 RC 00168-0004-15 NDC outpatient 15 GR 9 9 74 6.66 percent of total billed charges 9 93 7.29 percent of total billed charges 9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9 other OPPS APC 9 9 other OPPS APC 9 24.86 2.24 percent of total billed charges 9 9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM RX-8113 CDM A9270 HCPCS 0637 RC 00168-0004-15 NDC outpatient 15 GR 9 9 9 74 6.66 percent of total billed charges 9 93 7.29 percent of total billed charges 9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9 other OPPS APC 9 9 other OPPS APC 9 24.86 2.24 percent of total billed charges 9 9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIAMCINOLONE ACETONIDE 0.1 % LOTION RX-8116 CDM A9270 HCPCS 0250 RC 00713-0676-53 NDC outpatient 60 ML 225 225 74 166.5 percent of total billed charges 225 93 182.25 percent of total billed charges 225 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 225 other OPPS APC 225 225 other OPPS APC 225 24.86 55.94 percent of total billed charges 225 225 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIAMCINOLONE ACETONIDE 0.1 % LOTION RX-8116 CDM A9270 HCPCS 0637 RC 00713-0676-53 NDC outpatient 60 ML 225 225 225 74 166.5 percent of total billed charges 225 93 182.25 percent of total billed charges 225 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 225 other OPPS APC 225 225 other OPPS APC 225 24.86 55.94 percent of total billed charges 225 225 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT RX-8118 CDM A9270 HCPCS 0250 RC 00168-0006-15 NDC outpatient 15 GR 13.95 13.95 74 10.32 percent of total billed charges 13.95 93 11.3 percent of total billed charges 13.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.95 other OPPS APC 13.95 13.95 other OPPS APC 13.95 24.86 3.47 percent of total billed charges 13.95 13.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT RX-8118 CDM A9270 HCPCS 0637 RC 00168-0006-15 NDC outpatient 15 GR 13.95 13.95 13.95 74 10.32 percent of total billed charges 13.95 93 11.3 percent of total billed charges 13.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13.95 other OPPS APC 13.95 13.95 other OPPS APC 13.95 24.86 3.47 percent of total billed charges 13.95 13.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION RX-8120 CDM J3301 HCPCS 0636 RC 16714-0130-25 NDC outpatient 1 ML 25.5 25.5 25.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 25.5 other OPPS APC 25.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 25.5 other OPPS APC 25.5 24.86 6.34 percent of total billed charges 25.5 25.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION RX-8120 CDM J3301 HCPCS 0636 RC 67457-0621-99 NDC outpatient 1 ML 26.67 26.67 4.6 4.6 fee schedule 26.67 93 21.6 percent of total billed charges 4.6 26.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE RX-8121 CDM A9270 HCPCS 0250 RC 00713-0655-40 NDC outpatient 5 GR 207.58 207.58 74 153.61 percent of total billed charges 207.58 93 168.14 percent of total billed charges 207.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 207.58 other OPPS APC 207.58 207.58 other OPPS APC 207.58 24.86 51.6 percent of total billed charges 207.58 207.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE RX-8121 CDM A9270 HCPCS 0637 RC 00713-0655-40 NDC outpatient 5 GR 207.58 207.58 207.58 74 153.61 percent of total billed charges 207.58 93 168.14 percent of total billed charges 207.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 207.58 other OPPS APC 207.58 207.58 other OPPS APC 207.58 24.86 51.6 percent of total billed charges 207.58 207.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET RX-8132 CDM A9270 HCPCS 0250 RC 68084-0750-25 NDC outpatient 1 UN 2.47 2.47 74 1.83 percent of total billed charges 2.47 93 2 percent of total billed charges 2.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.47 other OPPS APC 2.47 2.47 other OPPS APC 2.47 24.86 0.61 percent of total billed charges 2.47 2.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET RX-8132 CDM A9270 HCPCS 0637 RC 68084-0750-25 NDC outpatient 1 UN 2.47 2.47 2.47 74 1.83 percent of total billed charges 2.47 93 2 percent of total billed charges 2.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.47 other OPPS APC 2.47 2.47 other OPPS APC 2.47 24.86 0.61 percent of total billed charges 2.47 2.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIAMTERENE 75 MG-HYDROCHLOROTHIAZIDE 50 MG TABLET RX-8134 CDM A9270 HCPCS 0250 RC 68382-0857-01 NDC outpatient 1 UN 2.79 2.79 74 2.06 percent of total billed charges 2.79 93 2.26 percent of total billed charges 2.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.79 other OPPS APC 2.79 2.79 other OPPS APC 2.79 24.86 0.69 percent of total billed charges 2.79 2.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIAMTERENE 75 MG-HYDROCHLOROTHIAZIDE 50 MG TABLET RX-8134 CDM A9270 HCPCS 0637 RC 68382-0857-01 NDC outpatient 1 UN 2.79 2.79 2.79 74 2.06 percent of total billed charges 2.79 93 2.26 percent of total billed charges 2.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.79 other OPPS APC 2.79 2.79 other OPPS APC 2.79 24.86 0.69 percent of total billed charges 2.79 2.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR" RX-81426 CDM A9270 HCPCS 0250 RC 00904-7182-61 NDC outpatient 1 UN 6.18 6.18 74 4.57 percent of total billed charges 6.18 93 5.01 percent of total billed charges 6.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.18 other OPPS APC 6.18 6.18 other OPPS APC 6.18 24.86 1.54 percent of total billed charges 6.18 6.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR" RX-81426 CDM A9270 HCPCS 0637 RC 00904-7182-61 NDC outpatient 1 UN 6.18 6.18 6.18 74 4.57 percent of total billed charges 6.18 93 5.01 percent of total billed charges 6.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.18 other OPPS APC 6.18 6.18 other OPPS APC 6.18 24.86 1.54 percent of total billed charges 6.18 6.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBACK RX-81434 CDM J3489 HCPCS 0636 RC 72266-0152-01 NDC outpatient 100 ML 333 333 51.85 51.85 fee schedule 333 93 269.73 percent of total billed charges 333 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 333 other OPPS APC 333 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 333 other OPPS APC 333 24.86 82.78 percent of total billed charges 51.85 333 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LISDEXAMFETAMINE 30 MG CAPSULE RX-81474 CDM A9270 HCPCS 0250 RC 47781-0564-01 NDC outpatient 1 UN 27.7 27.7 74 20.5 percent of total billed charges 27.7 93 22.44 percent of total billed charges 27.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.7 other OPPS APC 27.7 27.7 other OPPS APC 27.7 24.86 6.89 percent of total billed charges 27.7 27.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LISDEXAMFETAMINE 30 MG CAPSULE RX-81474 CDM A9270 HCPCS 0637 RC 47781-0564-01 NDC outpatient 1 UN 27.7 27.7 27.7 74 20.5 percent of total billed charges 27.7 93 22.44 percent of total billed charges 27.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.7 other OPPS APC 27.7 27.7 other OPPS APC 27.7 24.86 6.89 percent of total billed charges 27.7 27.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LISDEXAMFETAMINE 50 MG CAPSULE RX-81475 CDM A9270 HCPCS 0250 RC 42858-0165-01 NDC outpatient 1 UN 27.7 27.7 74 20.5 percent of total billed charges 27.7 93 22.44 percent of total billed charges 27.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.7 other OPPS APC 27.7 27.7 other OPPS APC 27.7 24.86 6.89 percent of total billed charges 27.7 27.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LISDEXAMFETAMINE 50 MG CAPSULE RX-81475 CDM A9270 HCPCS 0637 RC 42858-0165-01 NDC outpatient 1 UN 27.7 27.7 27.7 74 20.5 percent of total billed charges 27.7 93 22.44 percent of total billed charges 27.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.7 other OPPS APC 27.7 27.7 other OPPS APC 27.7 24.86 6.89 percent of total billed charges 27.7 27.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ECULIZUMAB 300 MG/30 ML INTRAVENOUS SOLUTION RX-81696 CDM J1300 HCPCS 0636 RC 25682-0001-01 NDC outpatient 30 ML 19569 19569 7732.26 7732.26 fee schedule 19569 93 15850.9 percent of total billed charges 19569 19569 other OPPS APC 19569 19569 other OPPS APC 19569 24.86 4864.85 percent of total billed charges 7732.26 19569 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLYCERIN 99.5 % TOPICAL SOLUTION RX-82033 CDM A9270 HCPCS 0250 RC 00395-1031-16 NDC outpatient 473 ML 66.23 66.23 74 49.01 percent of total billed charges 66.23 93 53.65 percent of total billed charges 66.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 66.23 other OPPS APC 66.23 66.23 other OPPS APC 66.23 24.86 16.46 percent of total billed charges 66.23 66.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLYCERIN 99.5 % TOPICAL SOLUTION RX-82033 CDM A9270 HCPCS 0637 RC 00395-1031-16 NDC outpatient 473 ML 66.23 66.23 66.23 74 49.01 percent of total billed charges 66.23 93 53.65 percent of total billed charges 66.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 66.23 other OPPS APC 66.23 66.23 other OPPS APC 66.23 24.86 16.46 percent of total billed charges 66.23 66.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION RX-82085 CDM J1805 HCPCS 0636 RC 55150-0194-10 NDC outpatient 10 ML 22 22 2.9 2.9 fee schedule 22 93 17.82 percent of total billed charges 22 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.94 other OPPS APC 22 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.94 other OPPS APC 22 24.86 5.47 percent of total billed charges 2.9 22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR" RX-82089 CDM A9270 HCPCS 0250 RC 50228-0382-60 NDC outpatient 1 UN 43.82 43.82 74 32.43 percent of total billed charges 43.82 93 35.49 percent of total billed charges 43.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 43.82 other OPPS APC 43.82 43.82 other OPPS APC 43.82 24.86 10.89 percent of total billed charges 43.82 43.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR" RX-82089 CDM A9270 HCPCS 0637 RC 50228-0382-60 NDC outpatient 1 UN 43.82 43.82 43.82 74 32.43 percent of total billed charges 43.82 93 35.49 percent of total billed charges 43.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 43.82 other OPPS APC 43.82 43.82 other OPPS APC 43.82 24.86 10.89 percent of total billed charges 43.82 43.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUOROURACIL 500 MG/10 ML INTRAVENOUS SOLUTION RX-82200 CDM J9190 HCPCS 0636 RC 63323-0117-10 NDC outpatient 10 ML 10.26 10.26 2.09 2.09 fee schedule 10.26 93 8.31 percent of total billed charges 10.26 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.26 other OPPS APC 10.26 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.26 other OPPS APC 10.26 24.86 2.55 percent of total billed charges 2.09 10.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUOROURACIL 1 GRAM/20 ML INTRAVENOUS SOLUTION RX-82204 CDM J9190 HCPCS 0636 RC 63323-0117-20 NDC outpatient 20 ML 20.52 20.52 4.19 4.19 fee schedule 20.52 93 16.62 percent of total billed charges 20.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20.52 other OPPS APC 20.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20.52 other OPPS APC 20.52 24.86 5.1 percent of total billed charges 4.19 20.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLINDAMYCIN 150 MG/ML INJECTION SOLUTION RX-82301 CDM J0736 HCPCS 0636 RC 00009-0775-26 NDC outpatient 4 ML 8.83 8.83 3.68 3.68 fee schedule 8.83 93 7.15 percent of total billed charges 8.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.93 other OPPS APC 8.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.93 other OPPS APC 8.83 24.86 2.2 percent of total billed charges 3.68 8.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROPICAMIDE 1 % EYE DROPS RX-8250 CDM A9270 HCPCS 0250 RC 70069-0121-01 NDC outpatient 15 ML 89.08 89.08 74 65.92 percent of total billed charges 89.08 93 72.15 percent of total billed charges 89.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 89.08 other OPPS APC 89.08 89.08 other OPPS APC 89.08 24.86 22.15 percent of total billed charges 89.08 89.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROPICAMIDE 1 % EYE DROPS RX-8250 CDM A9270 HCPCS 0637 RC 70069-0121-01 NDC outpatient 15 ML 89.08 89.08 89.08 74 65.92 percent of total billed charges 89.08 93 72.15 percent of total billed charges 89.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 89.08 other OPPS APC 89.08 89.08 other OPPS APC 89.08 24.86 22.15 percent of total billed charges 89.08 89.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH RX-82504 CDM A9270 HCPCS 0250 RC 00378-9070-93 NDC outpatient 1 UN 42.25 42.25 74 31.27 percent of total billed charges 42.25 93 34.22 percent of total billed charges 42.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42.25 other OPPS APC 42.25 42.25 other OPPS APC 42.25 24.86 10.5 percent of total billed charges 42.25 42.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH RX-82504 CDM A9270 HCPCS 0637 RC 00378-9070-93 NDC outpatient 1 UN 42.25 42.25 42.25 74 31.27 percent of total billed charges 42.25 93 34.22 percent of total billed charges 42.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42.25 other OPPS APC 42.25 42.25 other OPPS APC 42.25 24.86 10.5 percent of total billed charges 42.25 42.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH RX-82505 CDM A9270 HCPCS 0250 RC 00378-9071-93 NDC outpatient 1 UN 42.25 42.25 74 31.27 percent of total billed charges 42.25 93 34.22 percent of total billed charges 42.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42.25 other OPPS APC 42.25 42.25 other OPPS APC 42.25 24.86 10.5 percent of total billed charges 42.25 42.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH RX-82505 CDM A9270 HCPCS 0637 RC 00378-9071-93 NDC outpatient 1 UN 42.25 42.25 42.25 74 31.27 percent of total billed charges 42.25 93 34.22 percent of total billed charges 42.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42.25 other OPPS APC 42.25 42.25 other OPPS APC 42.25 24.86 10.5 percent of total billed charges 42.25 42.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION RX-8259 CDM 250000000 HCPCS 0250 RC 49281-0752-21 NDC outpatient 1 ML 303.4 303.4 303.4 74 224.52 percent of total billed charges 303.4 93 245.75 percent of total billed charges 303.4 303.4 other OPPS APC 303.4 303.4 other OPPS APC 303.4 24.86 75.43 percent of total billed charges 303.4 303.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION RX-8259 CDM 250000000 HCPCS 0250 RC 49281-0752-22 NDC outpatient 5 ML 1182.13 1182.13 1182.13 74 874.78 percent of total billed charges 1182.13 93 957.53 percent of total billed charges 1182.13 1182.13 other OPPS APC 1182.13 1182.13 other OPPS APC 1182.13 24.86 293.88 percent of total billed charges 1182.13 1182.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HEPARIN, PORCINE (PF) 1 UNIT/ML INTRAVENOUS SYRINGE" RX-82592 CDM J1642 HCPCS 0636 RC 64253-0444-25 NDC outpatient 5 ML 9.48 9.48 0.08 0.08 fee schedule 9.48 93 7.68 percent of total billed charges 9.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.48 other OPPS APC 9.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.48 other OPPS APC 9.48 24.86 2.36 percent of total billed charges 0.08 9.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION RX-8428 CDM A9270 HCPCS 0250 RC 00121-0675-85 NDC outpatient 473 ML 181.25 181.25 74 134.13 percent of total billed charges 181.25 93 146.81 percent of total billed charges 181.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 181.25 other OPPS APC 181.25 181.25 other OPPS APC 181.25 24.86 45.06 percent of total billed charges 181.25 181.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION RX-8428 CDM A9270 HCPCS 0637 RC 00121-0675-85 NDC outpatient 473 ML 181.25 181.25 181.25 74 134.13 percent of total billed charges 181.25 93 146.81 percent of total billed charges 181.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 181.25 other OPPS APC 181.25 181.25 other OPPS APC 181.25 24.86 45.06 percent of total billed charges 181.25 181.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALPROIC ACID 250 MG CAPSULE RX-8429 CDM A9270 HCPCS 0250 RC 63739-0086-10 NDC outpatient 1 UN 1.29 1.29 74 0.95 percent of total billed charges 1.29 93 1.04 percent of total billed charges 1.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.29 other OPPS APC 1.29 1.29 other OPPS APC 1.29 24.86 0.32 percent of total billed charges 1.29 1.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALPROIC ACID 250 MG CAPSULE RX-8429 CDM A9270 HCPCS 0637 RC 63739-0086-10 NDC outpatient 1 UN 1.29 1.29 1.29 74 0.95 percent of total billed charges 1.29 93 1.04 percent of total billed charges 1.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.29 other OPPS APC 1.29 1.29 other OPPS APC 1.29 24.86 0.32 percent of total billed charges 1.29 1.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION" RX-8442 CDM J3370 HCPCS 0636 RC 16714-0309-10 NDC outpatient 1000 ME 48.12 48.12 5.49 5.49 fee schedule 48.12 93 38.98 percent of total billed charges 48.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.12 other OPPS APC 48.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.12 other OPPS APC 48.12 24.86 11.96 percent of total billed charges 5.49 48.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION" RX-8442 CDM J3370 HCPCS 0636 RC 16714-0309-10 NDC outpatient 20 ML 48.12 48.12 5.49 5.49 fee schedule 48.12 93 38.98 percent of total billed charges 48.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.12 other OPPS APC 48.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.12 other OPPS APC 48.12 24.86 11.96 percent of total billed charges 5.49 48.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 500 MG INTRAVENOUS SOLUTION RX-8443 CDM J3370 HCPCS 0636 RC 70436-0020-82 NDC outpatient 10 ML 9 9 9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9 other OPPS APC 9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9 other OPPS APC 9 24.86 2.24 percent of total billed charges 9 9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 500 MG INTRAVENOUS SOLUTION RX-8443 CDM J3370 HCPCS 0636 RC 71288-0022-11 NDC outpatient 500 ME 9 9 2.75 2.75 fee schedule 9 93 7.29 percent of total billed charges 2.75 9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION RX-8444 CDM J3370 HCPCS 0636 RC 63323-0295-61 NDC outpatient 100 ML 238.5 238.5 27.47 27.47 fee schedule 238.5 93 193.19 percent of total billed charges 238.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.5 other OPPS APC 238.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.5 other OPPS APC 238.5 24.86 59.29 percent of total billed charges 27.47 238.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION RX-8444 CDM J3370 HCPCS 0636 RC 63323-0295-61 NDC outpatient 5 GR 238.5 238.5 27.47 27.47 fee schedule 238.5 93 193.19 percent of total billed charges 238.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.5 other OPPS APC 238.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.5 other OPPS APC 238.5 24.86 59.29 percent of total billed charges 27.47 238.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEOMYCIN-BACITRACIN-POLY-HC 3.5 MG-400-10,000 UNIT/G-1 % EYE OINTMENT" RX-849 CDM A9270 HCPCS 0250 RC 24208-0785-55 NDC outpatient 3.5 GR 162.63 162.63 74 120.35 percent of total billed charges 162.63 93 131.73 percent of total billed charges 162.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 162.63 other OPPS APC 162.63 162.63 other OPPS APC 162.63 24.86 40.43 percent of total billed charges 162.63 162.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEOMYCIN-BACITRACIN-POLY-HC 3.5 MG-400-10,000 UNIT/G-1 % EYE OINTMENT" RX-849 CDM A9270 HCPCS 0637 RC 24208-0785-55 NDC outpatient 3.5 GR 162.63 162.63 162.63 74 120.35 percent of total billed charges 162.63 93 131.73 percent of total billed charges 162.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 162.63 other OPPS APC 162.63 162.63 other OPPS APC 162.63 24.86 40.43 percent of total billed charges 162.63 162.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT RX-850 CDM A9270 HCPCS 0250 RC 00713-0280-31 NDC outpatient 28.4 GR 8.68 8.68 74 6.42 percent of total billed charges 8.68 93 7.03 percent of total billed charges 8.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.68 other OPPS APC 8.68 8.68 other OPPS APC 8.68 24.86 2.16 percent of total billed charges 8.68 8.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT RX-850 CDM A9270 HCPCS 0637 RC 00713-0280-31 NDC outpatient 28.4 GR 8.68 8.68 8.68 74 6.42 percent of total billed charges 8.68 93 7.03 percent of total billed charges 8.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.68 other OPPS APC 8.68 8.68 other OPPS APC 8.68 24.86 2.16 percent of total billed charges 8.68 8.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BACITRACIN 500 UNIT/GRAM EYE OINTMENT RX-852 CDM A9270 HCPCS 0250 RC 00574-4022-35 NDC outpatient 3.5 GR 324.23 324.23 74 239.93 percent of total billed charges 324.23 93 262.63 percent of total billed charges 324.23 324.23 other OPPS APC 324.23 324.23 other OPPS APC 324.23 24.86 80.6 percent of total billed charges 324.23 324.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BACITRACIN 500 UNIT/GRAM EYE OINTMENT RX-852 CDM A9270 HCPCS 0637 RC 00574-4022-35 NDC outpatient 3.5 GR 324.23 324.23 324.23 74 239.93 percent of total billed charges 324.23 93 262.63 percent of total billed charges 324.23 324.23 other OPPS APC 324.23 324.23 other OPPS APC 324.23 24.86 80.6 percent of total billed charges 324.23 324.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION RX-8527 CDM 250000000 HCPCS 0250 RC 70069-0271-25 NDC outpatient 2 ML 31.25 31.25 31.25 74 23.13 percent of total billed charges 31.25 93 25.31 percent of total billed charges 31.25 31.25 other OPPS APC 31.25 31.25 other OPPS APC 31.25 24.86 7.77 percent of total billed charges 31.25 31.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERAPAMIL 120 MG TABLET RX-8528 CDM A9270 HCPCS 0250 RC 00591-0345-01 NDC outpatient 1 UN 1.72 1.72 74 1.27 percent of total billed charges 1.72 93 1.39 percent of total billed charges 1.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.72 other OPPS APC 1.72 1.72 other OPPS APC 1.72 24.86 0.43 percent of total billed charges 1.72 1.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERAPAMIL 120 MG TABLET RX-8528 CDM A9270 HCPCS 0637 RC 00591-0345-01 NDC outpatient 1 UN 1.72 1.72 1.72 74 1.27 percent of total billed charges 1.72 93 1.39 percent of total billed charges 1.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.72 other OPPS APC 1.72 1.72 other OPPS APC 1.72 24.86 0.43 percent of total billed charges 1.72 1.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERAPAMIL 80 MG TABLET RX-8530 CDM A9270 HCPCS 0250 RC 00591-0343-01 NDC outpatient 1 UN 1.34 1.34 74 0.99 percent of total billed charges 1.34 93 1.09 percent of total billed charges 1.34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.34 other OPPS APC 1.34 1.34 other OPPS APC 1.34 24.86 0.33 percent of total billed charges 1.34 1.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERAPAMIL 80 MG TABLET RX-8530 CDM A9270 HCPCS 0637 RC 00591-0343-01 NDC outpatient 1 UN 1.34 1.34 1.34 74 0.99 percent of total billed charges 1.34 93 1.09 percent of total billed charges 1.34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.34 other OPPS APC 1.34 1.34 other OPPS APC 1.34 24.86 0.33 percent of total billed charges 1.34 1.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT" RX-854 CDM A9270 HCPCS 0250 RC 45802-0143-03 NDC outpatient 28 GR 15.38 15.38 74 11.38 percent of total billed charges 15.38 93 12.46 percent of total billed charges 15.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.38 other OPPS APC 15.38 15.38 other OPPS APC 15.38 24.86 3.82 percent of total billed charges 15.38 15.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT" RX-854 CDM A9270 HCPCS 0637 RC 45802-0143-03 NDC outpatient 28 GR 15.38 15.38 15.38 74 11.38 percent of total billed charges 15.38 93 12.46 percent of total billed charges 15.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15.38 other OPPS APC 15.38 15.38 other OPPS APC 15.38 24.86 3.82 percent of total billed charges 15.38 15.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BACITRACIN-POLYMYXIN B 500 UNIT-10,000 UNIT/GRAM EYE OINTMENT" RX-856 CDM A9270 HCPCS 0250 RC 24208-0555-55 NDC outpatient 3.5 GR 71.63 71.63 74 53.01 percent of total billed charges 71.63 93 58.02 percent of total billed charges 71.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.63 other OPPS APC 71.63 71.63 other OPPS APC 71.63 24.86 17.81 percent of total billed charges 71.63 71.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BACITRACIN-POLYMYXIN B 500 UNIT-10,000 UNIT/GRAM EYE OINTMENT" RX-856 CDM A9270 HCPCS 0637 RC 24208-0555-55 NDC outpatient 3.5 GR 71.63 71.63 71.63 74 53.01 percent of total billed charges 71.63 93 58.02 percent of total billed charges 71.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 71.63 other OPPS APC 71.63 71.63 other OPPS APC 71.63 24.86 17.81 percent of total billed charges 71.63 71.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION RX-8594 CDM J9360 HCPCS 0636 RC 63323-0278-10 NDC outpatient 10 ML 161.28 161.28 45.13 45.13 fee schedule 161.28 93 130.64 percent of total billed charges 161.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 161.28 other OPPS APC 161.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 161.28 other OPPS APC 161.28 24.86 40.09 percent of total billed charges 45.13 161.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BACLOFEN 10 MG TABLET RX-860 CDM A9270 HCPCS 0250 RC 50268-0106-15 NDC outpatient 1 UN 1.56 1.56 74 1.15 percent of total billed charges 1.56 93 1.26 percent of total billed charges 1.56 1.56 other OPPS APC 1.56 1.56 other OPPS APC 1.56 24.86 0.39 percent of total billed charges 1.56 1.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BACLOFEN 10 MG TABLET RX-860 CDM A9270 HCPCS 0637 RC 50268-0106-15 NDC outpatient 1 UN 1.56 1.56 1.56 74 1.15 percent of total billed charges 1.56 93 1.26 percent of total billed charges 1.56 1.56 other OPPS APC 1.56 1.56 other OPPS APC 1.56 24.86 0.39 percent of total billed charges 1.56 1.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE" RX-8639 CDM A9270 HCPCS 0250 RC 00904-2085-60 NDC outpatient 1 UN 0.13 0.13 74 0.1 percent of total billed charges 0.13 93 0.11 percent of total billed charges 0.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.13 other OPPS APC 0.13 0.13 other OPPS APC 0.13 24.86 0.03 percent of total billed charges 0.13 0.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE" RX-8639 CDM A9270 HCPCS 0637 RC 00904-2085-60 NDC outpatient 1 UN 0.13 0.13 0.13 74 0.1 percent of total billed charges 0.13 93 0.11 percent of total billed charges 0.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.13 other OPPS APC 0.13 0.13 other OPPS APC 0.13 24.86 0.03 percent of total billed charges 0.13 0.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "VITAMIN A 2,400 MCG CAPSULE" RX-8641 CDM A9270 HCPCS 0250 RC 54629-0110-01 NDC outpatient 1 UN 0.1 0.1 74 0.07 percent of total billed charges 0.1 93 0.08 percent of total billed charges 0.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.1 other OPPS APC 0.1 0.1 other OPPS APC 0.1 24.86 0.02 percent of total billed charges 0.1 0.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "VITAMIN A 2,400 MCG CAPSULE" RX-8641 CDM A9270 HCPCS 0637 RC 54629-0110-01 NDC outpatient 1 UN 0.1 0.1 0.1 74 0.07 percent of total billed charges 0.1 93 0.08 percent of total billed charges 0.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.1 other OPPS APC 0.1 0.1 other OPPS APC 0.1 24.86 0.02 percent of total billed charges 0.1 0.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT RX-8723 CDM A9270 HCPCS 0250 RC 41100-0811-63 NDC outpatient 43 GR 10.3 10.3 74 7.62 percent of total billed charges 10.3 93 8.34 percent of total billed charges 10.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.3 other OPPS APC 10.3 10.3 other OPPS APC 10.3 24.86 2.56 percent of total billed charges 10.3 10.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT RX-8723 CDM A9270 HCPCS 0637 RC 41100-0811-63 NDC outpatient 43 GR 10.3 10.3 10.3 74 7.62 percent of total billed charges 10.3 93 8.34 percent of total billed charges 10.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.3 other OPPS APC 10.3 10.3 other OPPS APC 10.3 24.86 2.56 percent of total billed charges 10.3 10.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WARFARIN 10 MG TABLET RX-8748 CDM A9270 HCPCS 0250 RC 00832-1219-01 NDC outpatient 1 UN 2.38 2.38 74 1.76 percent of total billed charges 2.38 93 1.93 percent of total billed charges 2.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.38 other OPPS APC 2.38 2.38 other OPPS APC 2.38 24.86 0.59 percent of total billed charges 2.38 2.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WARFARIN 10 MG TABLET RX-8748 CDM A9270 HCPCS 0637 RC 00832-1219-01 NDC outpatient 1 UN 2.38 2.38 2.38 74 1.76 percent of total billed charges 2.38 93 1.93 percent of total billed charges 2.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.38 other OPPS APC 2.38 2.38 other OPPS APC 2.38 24.86 0.59 percent of total billed charges 2.38 2.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WARFARIN 2 MG TABLET RX-8749 CDM A9270 HCPCS 0250 RC 62584-0984-01 NDC outpatient 1 UN 1.54 1.54 74 1.14 percent of total billed charges 1.54 93 1.25 percent of total billed charges 1.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.54 other OPPS APC 1.54 1.54 other OPPS APC 1.54 24.86 0.38 percent of total billed charges 1.54 1.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WARFARIN 2 MG TABLET RX-8749 CDM A9270 HCPCS 0637 RC 62584-0984-01 NDC outpatient 1 UN 1.54 1.54 1.54 74 1.14 percent of total billed charges 1.54 93 1.25 percent of total billed charges 1.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.54 other OPPS APC 1.54 1.54 other OPPS APC 1.54 24.86 0.38 percent of total billed charges 1.54 1.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WARFARIN 2.5 MG TABLET RX-8750 CDM A9270 HCPCS 0250 RC 68084-0027-11 NDC outpatient 1 UN 1.59 1.59 74 1.18 percent of total billed charges 1.59 93 1.29 percent of total billed charges 1.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.59 other OPPS APC 1.59 1.59 other OPPS APC 1.59 24.86 0.4 percent of total billed charges 1.59 1.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WARFARIN 2.5 MG TABLET RX-8750 CDM A9270 HCPCS 0637 RC 68084-0027-11 NDC outpatient 1 UN 1.59 1.59 1.59 74 1.18 percent of total billed charges 1.59 93 1.29 percent of total billed charges 1.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.59 other OPPS APC 1.59 1.59 other OPPS APC 1.59 24.86 0.4 percent of total billed charges 1.59 1.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WARFARIN 5 MG TABLET RX-8751 CDM A9270 HCPCS 0250 RC 62584-0994-01 NDC outpatient 1 UN 1.61 1.61 74 1.19 percent of total billed charges 1.61 93 1.3 percent of total billed charges 1.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.61 other OPPS APC 1.61 1.61 other OPPS APC 1.61 24.86 0.4 percent of total billed charges 1.61 1.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WARFARIN 5 MG TABLET RX-8751 CDM A9270 HCPCS 0637 RC 62584-0994-01 NDC outpatient 1 UN 1.61 1.61 1.61 74 1.19 percent of total billed charges 1.61 93 1.3 percent of total billed charges 1.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.61 other OPPS APC 1.61 1.61 other OPPS APC 1.61 24.86 0.4 percent of total billed charges 1.61 1.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WARFARIN 7.5 MG TABLET RX-8752 CDM A9270 HCPCS 0250 RC 00832-1218-01 NDC outpatient 1 UN 2.31 2.31 74 1.71 percent of total billed charges 2.31 93 1.87 percent of total billed charges 2.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.31 other OPPS APC 2.31 2.31 other OPPS APC 2.31 24.86 0.57 percent of total billed charges 2.31 2.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WARFARIN 7.5 MG TABLET RX-8752 CDM A9270 HCPCS 0637 RC 00832-1218-01 NDC outpatient 1 UN 2.31 2.31 2.31 74 1.71 percent of total billed charges 2.31 93 1.87 percent of total billed charges 2.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.31 other OPPS APC 2.31 2.31 other OPPS APC 2.31 24.86 0.57 percent of total billed charges 2.31 2.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIAZEPAM 5 MG-7.5 MG-10 MG RECTAL KIT RX-87867 CDM A9270 HCPCS 0250 RC 68682-0652-20 NDC outpatient 1 UN 910.15 910.15 74 673.51 percent of total billed charges 910.15 93 737.22 percent of total billed charges 910.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 910.15 other OPPS APC 910.15 910.15 other OPPS APC 910.15 24.86 226.26 percent of total billed charges 910.15 910.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIAZEPAM 5 MG-7.5 MG-10 MG RECTAL KIT RX-87867 CDM A9270 HCPCS 0637 RC 68682-0652-20 NDC outpatient 1 UN 910.15 910.15 910.15 74 673.51 percent of total billed charges 910.15 93 737.22 percent of total billed charges 910.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 910.15 other OPPS APC 910.15 910.15 other OPPS APC 910.15 24.86 226.26 percent of total billed charges 910.15 910.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET RX-87911 CDM A9270 HCPCS 0250 RC 51801-0014-30 NDC outpatient 1 UN 1.43 1.43 74 1.06 percent of total billed charges 1.43 93 1.16 percent of total billed charges 1.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.43 other OPPS APC 1.43 1.43 other OPPS APC 1.43 24.86 0.36 percent of total billed charges 1.43 1.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET RX-87911 CDM A9270 HCPCS 0637 RC 51801-0014-30 NDC outpatient 1 UN 1.43 1.43 1.43 74 1.06 percent of total billed charges 1.43 93 1.16 percent of total billed charges 1.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.43 other OPPS APC 1.43 1.43 other OPPS APC 1.43 24.86 0.36 percent of total billed charges 1.43 1.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM BICARBONATE-CITRIC ACID 20 MEQ EFFERVESCENT TABLET RX-87912 CDM A9270 HCPCS 0250 RC 51801-0012-30 NDC outpatient 1 UN 1.65 1.65 74 1.22 percent of total billed charges 1.65 93 1.34 percent of total billed charges 1.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.65 other OPPS APC 1.65 1.65 other OPPS APC 1.65 24.86 0.41 percent of total billed charges 1.65 1.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM BICARBONATE-CITRIC ACID 20 MEQ EFFERVESCENT TABLET RX-87912 CDM A9270 HCPCS 0637 RC 51801-0012-30 NDC outpatient 1 UN 1.65 1.65 1.65 74 1.22 percent of total billed charges 1.65 93 1.34 percent of total billed charges 1.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.65 other OPPS APC 1.65 1.65 other OPPS APC 1.65 24.86 0.41 percent of total billed charges 1.65 1.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION RX-88010 CDM Q2009 HCPCS 0636 RC 68462-0622-64 NDC outpatient 10 ML 142.5 142.5 142.5 74 105.45 percent of total billed charges 142.5 93 115.43 percent of total billed charges 142.5 142.5 other OPPS APC 142.5 142.5 other OPPS APC 142.5 24.86 35.43 percent of total billed charges 142.5 142.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION RX-88011 CDM Q2009 HCPCS 0636 RC 00641-6136-25 NDC outpatient 2 ML 44.4 44.4 44.4 74 32.86 percent of total billed charges 44.4 93 35.96 percent of total billed charges 44.4 44.4 other OPPS APC 44.4 44.4 other OPPS APC 44.4 24.86 11.04 percent of total billed charges 44.4 44.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION RX-88376 CDM J9060 HCPCS 0636 RC 00143-9504-01 NDC outpatient 50 ML 46.03 46.03 18.09 18.09 fee schedule 46.03 93 37.28 percent of total billed charges 46.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 46.03 other OPPS APC 46.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 46.03 other OPPS APC 46.03 24.86 11.44 percent of total billed charges 18.09 46.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAMINOPHEN 650 MG/20.3 ML ORAL SUSPENSION RX-88505 CDM A9270 HCPCS 0250 RC 68094-0030-59 NDC outpatient 20.3 ML 5.41 5.41 74 4 percent of total billed charges 5.41 93 4.38 percent of total billed charges 5.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.41 other OPPS APC 5.41 5.41 other OPPS APC 5.41 24.86 1.34 percent of total billed charges 5.41 5.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETAMINOPHEN 650 MG/20.3 ML ORAL SUSPENSION RX-88505 CDM A9270 HCPCS 0637 RC 68094-0030-59 NDC outpatient 20.3 ML 5.41 5.41 5.41 74 4 percent of total billed charges 5.41 93 4.38 percent of total billed charges 5.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.41 other OPPS APC 5.41 5.41 other OPPS APC 5.41 24.86 1.34 percent of total billed charges 5.41 5.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RALTEGRAVIR 400 MG TABLET RX-88608 CDM A9270 HCPCS 0250 RC 00006-0227-61 NDC outpatient 1 UN 99.84 99.84 74 73.88 percent of total billed charges 99.84 93 80.87 percent of total billed charges 99.84 99.84 other OPPS APC 99.84 99.84 other OPPS APC 99.84 24.86 24.82 percent of total billed charges 99.84 99.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RALTEGRAVIR 400 MG TABLET RX-88608 CDM A9270 HCPCS 0637 RC 00006-0227-61 NDC outpatient 1 UN 99.84 99.84 99.84 74 73.88 percent of total billed charges 99.84 93 80.87 percent of total billed charges 99.84 99.84 other OPPS APC 99.84 99.84 other OPPS APC 99.84 24.86 24.82 percent of total billed charges 99.84 99.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IXABEPILONE 15 MG INTRAVENOUS SOLUTION RX-88652 CDM J9207 HCPCS 0636 RC 70020-1910-01 NDC outpatient 7.5 ML 5925.18 5925.18 2098.32 2098.32 fee schedule 5925.18 93 4799.4 percent of total billed charges 5925.18 5925.18 other OPPS APC 5925.18 5925.18 other OPPS APC 5925.18 24.86 1473 percent of total billed charges 2098.32 5925.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IXABEPILONE 45 MG INTRAVENOUS SOLUTION RX-88653 CDM J9207 HCPCS 0636 RC 70020-1911-01 NDC outpatient 22.5 ML 17775.5 17775.5 6294.96 6294.96 fee schedule 17775.5 93 14398.2 percent of total billed charges 17775.5 17775.5 other OPPS APC 17775.5 17775.5 other OPPS APC 17775.5 24.86 4419 percent of total billed charges 6294.96 17775.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSELTAMIVIR 30 MG CAPSULE RX-88704 CDM A9270 HCPCS 0250 RC 00527-4591-13 NDC outpatient 1 UN 35.46 35.46 74 26.24 percent of total billed charges 35.46 93 28.72 percent of total billed charges 35.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35.46 other OPPS APC 35.46 35.46 other OPPS APC 35.46 24.86 8.82 percent of total billed charges 35.46 35.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSELTAMIVIR 30 MG CAPSULE RX-88704 CDM A9270 HCPCS 0637 RC 00527-4591-13 NDC outpatient 1 UN 35.46 35.46 35.46 74 26.24 percent of total billed charges 35.46 93 28.72 percent of total billed charges 35.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35.46 other OPPS APC 35.46 35.46 other OPPS APC 35.46 24.86 8.82 percent of total billed charges 35.46 35.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSELTAMIVIR 45 MG CAPSULE RX-88705 CDM A9270 HCPCS 0250 RC 00527-4592-13 NDC outpatient 1 UN 35.46 35.46 74 26.24 percent of total billed charges 35.46 93 28.72 percent of total billed charges 35.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35.46 other OPPS APC 35.46 35.46 other OPPS APC 35.46 24.86 8.82 percent of total billed charges 35.46 35.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSELTAMIVIR 45 MG CAPSULE RX-88705 CDM A9270 HCPCS 0637 RC 00527-4592-13 NDC outpatient 1 UN 35.46 35.46 35.46 74 26.24 percent of total billed charges 35.46 93 28.72 percent of total billed charges 35.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35.46 other OPPS APC 35.46 35.46 other OPPS APC 35.46 24.86 8.82 percent of total billed charges 35.46 35.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZINC OXIDE 20 % TOPICAL OINTMENT RX-8874 CDM A9270 HCPCS 0250 RC 00536-1316-25 NDC outpatient 60 GR 9.03 9.03 74 6.68 percent of total billed charges 9.03 93 7.31 percent of total billed charges 9.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.03 other OPPS APC 9.03 9.03 other OPPS APC 9.03 24.86 2.24 percent of total billed charges 9.03 9.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZINC OXIDE 20 % TOPICAL OINTMENT RX-8874 CDM A9270 HCPCS 0637 RC 00536-1316-25 NDC outpatient 60 GR 9.03 9.03 9.03 74 6.68 percent of total billed charges 9.03 93 7.31 percent of total billed charges 9.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9.03 other OPPS APC 9.03 9.03 other OPPS APC 9.03 24.86 2.24 percent of total billed charges 9.03 9.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE RX-8880 CDM A9270 HCPCS 0250 RC 77333-0983-10 NDC outpatient 1 UN 0.59 0.59 74 0.44 percent of total billed charges 0.59 93 0.48 percent of total billed charges 0.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.59 other OPPS APC 0.59 0.59 other OPPS APC 0.59 24.86 0.15 percent of total billed charges 0.59 0.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE RX-8880 CDM A9270 HCPCS 0637 RC 77333-0983-10 NDC outpatient 1 UN 0.59 0.59 0.59 74 0.44 percent of total billed charges 0.59 93 0.48 percent of total billed charges 0.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.59 other OPPS APC 0.59 0.59 other OPPS APC 0.59 24.86 0.15 percent of total billed charges 0.59 0.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEVELAMER CARBONATE 800 MG TABLET RX-89201 CDM A9270 HCPCS 0250 RC 50268-0720-15 NDC outpatient 1 UN 22.25 22.25 74 16.47 percent of total billed charges 22.25 93 18.02 percent of total billed charges 22.25 22.25 other OPPS APC 22.25 22.25 other OPPS APC 22.25 24.86 5.53 percent of total billed charges 22.25 22.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEVELAMER CARBONATE 800 MG TABLET RX-89201 CDM A9270 HCPCS 0637 RC 50268-0720-15 NDC outpatient 1 UN 22.25 22.25 22.25 74 16.47 percent of total billed charges 22.25 93 18.02 percent of total billed charges 22.25 22.25 other OPPS APC 22.25 22.25 other OPPS APC 22.25 24.86 5.53 percent of total billed charges 22.25 22.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEBIVOLOL 5 MG TABLET RX-89284 CDM A9270 HCPCS 0250 RC 59651-0138-90 NDC outpatient 1 UN 11.85 11.85 74 8.77 percent of total billed charges 11.85 93 9.6 percent of total billed charges 11.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.85 other OPPS APC 11.85 11.85 other OPPS APC 11.85 24.86 2.95 percent of total billed charges 11.85 11.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEBIVOLOL 5 MG TABLET RX-89284 CDM A9270 HCPCS 0637 RC 59651-0138-90 NDC outpatient 1 UN 11.85 11.85 11.85 74 8.77 percent of total billed charges 11.85 93 9.6 percent of total billed charges 11.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.85 other OPPS APC 11.85 11.85 other OPPS APC 11.85 24.86 2.95 percent of total billed charges 11.85 11.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOPIDOGREL 300 MG TABLET RX-89346 CDM A9270 HCPCS 0250 RC 00904-6467-07 NDC outpatient 1 UN 48.17 48.17 74 35.65 percent of total billed charges 48.17 93 39.02 percent of total billed charges 48.17 48.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOPIDOGREL 300 MG TABLET RX-89346 CDM A9270 HCPCS 0637 RC 00904-6467-07 NDC outpatient 1 UN 48.17 48.17 48.17 74 35.65 percent of total billed charges 48.17 93 39.02 percent of total billed charges 48.17 48.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOPIDOGREL 300 MG TABLET RX-89346 CDM A9270 HCPCS 0250 RC 50268-0184-12 NDC outpatient 1 UN 48.17 48.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.17 other OPPS APC 48.17 48.17 other OPPS APC 48.17 24.86 11.98 percent of total billed charges 48.17 48.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOPIDOGREL 300 MG TABLET RX-89346 CDM A9270 HCPCS 0637 RC 50268-0184-12 NDC outpatient 1 UN 48.17 48.17 48.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.17 other OPPS APC 48.17 48.17 other OPPS APC 48.17 24.86 11.98 percent of total billed charges 48.17 48.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION RX-89350 CDM J9305 HCPCS 0636 RC 43598-0386-62 NDC outpatient 4 ML 477 477 90.51 90.51 fee schedule 477 93 386.37 percent of total billed charges 477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.84 other OPPS APC 477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.84 other OPPS APC 477 24.86 118.58 percent of total billed charges 90.51 477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION" RX-89570 CDM 250000000 HCPCS 0250 RC 00338-0322-01 NDC outpatient 5 ML 258 258 258 74 190.92 percent of total billed charges 258 93 208.98 percent of total billed charges 258 258 other OPPS APC 258 258 other OPPS APC 258 24.86 64.14 percent of total billed charges 258 258 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET RX-8958 CDM A9270 HCPCS 0250 RC 10702-0253-01 NDC outpatient 1 UN 4.22 4.22 74 3.12 percent of total billed charges 4.22 93 3.42 percent of total billed charges 4.22 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.22 other OPPS APC 4.22 4.22 other OPPS APC 4.22 24.86 1.05 percent of total billed charges 4.22 4.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET RX-8958 CDM A9270 HCPCS 0637 RC 10702-0253-01 NDC outpatient 1 UN 4.22 4.22 4.22 74 3.12 percent of total billed charges 4.22 93 3.42 percent of total billed charges 4.22 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.22 other OPPS APC 4.22 4.22 other OPPS APC 4.22 24.86 1.05 percent of total billed charges 4.22 4.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETIC ACID 0.25 % IRRIGATION SOLUTION RX-8963 CDM 250000000 HCPCS 0250 RC 00338-0656-04 NDC outpatient 1000 ML 24.18 24.18 24.18 74 17.89 percent of total billed charges 24.18 93 19.59 percent of total billed charges 24.18 24.18 other OPPS APC 24.18 24.18 other OPPS APC 24.18 24.86 6.01 percent of total billed charges 24.18 24.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACYCLOVIR 200 MG CAPSULE RX-8969 CDM A9270 HCPCS 0250 RC 00904-5789-61 NDC outpatient 1 UN 3.83 3.83 74 2.83 percent of total billed charges 3.83 93 3.1 percent of total billed charges 3.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.83 other OPPS APC 3.83 3.83 other OPPS APC 3.83 24.86 0.95 percent of total billed charges 3.83 3.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACYCLOVIR 200 MG CAPSULE RX-8969 CDM A9270 HCPCS 0637 RC 00904-5789-61 NDC outpatient 1 UN 3.83 3.83 3.83 74 2.83 percent of total billed charges 3.83 93 3.1 percent of total billed charges 3.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.83 other OPPS APC 3.83 3.83 other OPPS APC 3.83 24.86 0.95 percent of total billed charges 3.83 3.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION RX-8970 CDM A9270 HCPCS 0250 RC 72205-0170-72 NDC outpatient 473 ML 1113 1113 74 823.62 percent of total billed charges 1113 93 901.53 percent of total billed charges 1113 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1113 other OPPS APC 1113 1113 other OPPS APC 1113 24.86 276.69 percent of total billed charges 1113 1113 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION RX-8970 CDM A9270 HCPCS 0637 RC 72205-0170-72 NDC outpatient 473 ML 1113 1113 1113 74 823.62 percent of total billed charges 1113 93 901.53 percent of total billed charges 1113 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1113 other OPPS APC 1113 1113 other OPPS APC 1113 24.86 276.69 percent of total billed charges 1113 1113 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACYCLOVIR 800 MG TABLET RX-8972 CDM A9270 HCPCS 0250 RC 50268-0062-11 NDC outpatient 1 UN 10.55 10.55 74 7.81 percent of total billed charges 10.55 93 8.55 percent of total billed charges 10.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.55 other OPPS APC 10.55 10.55 other OPPS APC 10.55 24.86 2.62 percent of total billed charges 10.55 10.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACYCLOVIR 800 MG TABLET RX-8972 CDM A9270 HCPCS 0637 RC 50268-0062-11 NDC outpatient 1 UN 10.55 10.55 10.55 74 7.81 percent of total billed charges 10.55 93 8.55 percent of total billed charges 10.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.55 other OPPS APC 10.55 10.55 other OPPS APC 10.55 24.86 2.62 percent of total billed charges 10.55 10.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALBENDAZOLE 200 MG TABLET RX-8979 CDM A9270 HCPCS 0250 RC 72205-0051-08 NDC outpatient 1 UN 572.27 572.27 74 423.48 percent of total billed charges 572.27 93 463.54 percent of total billed charges 572.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 572.27 other OPPS APC 572.27 572.27 other OPPS APC 572.27 24.86 142.27 percent of total billed charges 572.27 572.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALBENDAZOLE 200 MG TABLET RX-8979 CDM A9270 HCPCS 0637 RC 72205-0051-08 NDC outpatient 1 UN 572.27 572.27 572.27 74 423.48 percent of total billed charges 572.27 93 463.54 percent of total billed charges 572.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 572.27 other OPPS APC 572.27 572.27 other OPPS APC 572.27 24.86 142.27 percent of total billed charges 572.27 572.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION" RX-8981 CDM P9047 HCPCS 0636 RC 68982-0643-01 NDC outpatient 50 ML 172.2 172.2 60.58 60.58 fee schedule 172.2 93 139.48 percent of total billed charges 172.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 53.08 other OPPS APC 172.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 53.08 other OPPS APC 172.2 24.86 42.81 percent of total billed charges 60.58 172.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALPROSTADIL 500 MCG/ML INJECTION SOLUTION RX-9001 CDM J0270 HCPCS 0636 RC 00009-3169-06 NDC outpatient 1 ML 460.8 460.8 460.8 74 340.99 percent of total billed charges 460.8 93 373.25 percent of total billed charges 460.8 460.8 other OPPS APC 460.8 460.8 other OPPS APC 460.8 24.86 114.55 percent of total billed charges 460.8 460.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALTEPLASE 100 MG INTRAVENOUS SOLUTION RX-9002 CDM J2997 HCPCS 0636 RC 50242-0085-27 NDC outpatient 100 ME 26401.1 26401.1 10176.1 10176.1 fee schedule 26401.1 93 21384.9 percent of total billed charges 26401.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9147 other OPPS APC 26401.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9147 other OPPS APC 26401.1 24.86 6563.31 percent of total billed charges 10176.1 26401.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALTEPLASE 100 MG INTRAVENOUS SOLUTION RX-9002 CDM J2997 HCPCS 0636 RC 50242-0085-27 NDC outpatient 100 ML 26401.1 26401.1 10176.1 10176.1 fee schedule 26401.1 93 21384.9 percent of total billed charges 26401.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9147 other OPPS APC 26401.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9147 other OPPS APC 26401.1 24.86 6563.31 percent of total billed charges 10176.1 26401.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALTEPLASE 50 MG INTRAVENOUS SOLUTION RX-9003 CDM J2997 HCPCS 0636 RC 50242-0044-13 NDC outpatient 50 ME 13200.5 13200.5 5088.05 5088.05 fee schedule 13200.5 93 10692.5 percent of total billed charges 13200.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4573.5 other OPPS APC 13200.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4573.5 other OPPS APC 13200.5 24.86 3281.66 percent of total billed charges 5088.05 13200.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALTEPLASE 50 MG INTRAVENOUS SOLUTION RX-9003 CDM J2997 HCPCS 0636 RC 50242-0044-13 NDC outpatient 50 ML 13200.5 13200.5 5088.05 5088.05 fee schedule 13200.5 93 10692.5 percent of total billed charges 13200.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4573.5 other OPPS APC 13200.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4573.5 other OPPS APC 13200.5 24.86 3281.66 percent of total billed charges 5088.05 13200.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CALCIUM ACETATE 952 MG-ALUMINUM SULFATE 1,347 MG TOPICAL POWDER PACKET" RX-9020 CDM A9270 HCPCS 0250 RC 57074-0001-77 NDC outpatient 1 UN 0.13 0.13 74 0.1 percent of total billed charges 0.13 93 0.11 percent of total billed charges 0.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.13 other OPPS APC 0.13 0.13 other OPPS APC 0.13 24.86 0.03 percent of total billed charges 0.13 0.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CALCIUM ACETATE 952 MG-ALUMINUM SULFATE 1,347 MG TOPICAL POWDER PACKET" RX-9020 CDM A9270 HCPCS 0637 RC 57074-0001-77 NDC outpatient 1 UN 0.13 0.13 0.13 74 0.1 percent of total billed charges 0.13 93 0.11 percent of total billed charges 0.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.13 other OPPS APC 0.13 0.13 other OPPS APC 0.13 24.86 0.03 percent of total billed charges 0.13 0.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALUMINUM CHLORIDE 20 % TOPICAL SOLUTION RX-9028 CDM A9270 HCPCS 0250 RC 00096-0707-37 NDC outpatient 37.5 ML 23.43 23.43 74 17.34 percent of total billed charges 23.43 93 18.98 percent of total billed charges 23.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 23.43 other OPPS APC 23.43 23.43 other OPPS APC 23.43 24.86 5.82 percent of total billed charges 23.43 23.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALUMINUM CHLORIDE 20 % TOPICAL SOLUTION RX-9028 CDM A9270 HCPCS 0637 RC 00096-0707-37 NDC outpatient 37.5 ML 23.43 23.43 23.43 74 17.34 percent of total billed charges 23.43 93 18.98 percent of total billed charges 23.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 23.43 other OPPS APC 23.43 23.43 other OPPS APC 23.43 24.86 5.82 percent of total billed charges 23.43 23.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMINOCAPROIC ACID 500 MG TABLET RX-9063 CDM A9270 HCPCS 0250 RC 62559-0225-30 NDC outpatient 1 UN 56.01 56.01 74 41.45 percent of total billed charges 56.01 93 45.37 percent of total billed charges 56.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56.01 other OPPS APC 56.01 56.01 other OPPS APC 56.01 24.86 13.92 percent of total billed charges 56.01 56.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMINOCAPROIC ACID 500 MG TABLET RX-9063 CDM A9270 HCPCS 0637 RC 62559-0225-30 NDC outpatient 1 UN 56.01 56.01 56.01 74 41.45 percent of total billed charges 56.01 93 45.37 percent of total billed charges 56.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56.01 other OPPS APC 56.01 56.01 other OPPS APC 56.01 24.86 13.92 percent of total billed charges 56.01 56.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMIODARONE 200 MG TABLET RX-9066 CDM A9270 HCPCS 0250 RC 63739-0051-10 NDC outpatient 1 UN 0.64 0.64 74 0.47 percent of total billed charges 0.64 93 0.52 percent of total billed charges 0.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.64 other OPPS APC 0.64 0.64 other OPPS APC 0.64 24.86 0.16 percent of total billed charges 0.64 0.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMIODARONE 200 MG TABLET RX-9066 CDM A9270 HCPCS 0637 RC 63739-0051-10 NDC outpatient 1 UN 0.64 0.64 0.64 74 0.47 percent of total billed charges 0.64 93 0.52 percent of total billed charges 0.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.64 other OPPS APC 0.64 0.64 other OPPS APC 0.64 24.86 0.16 percent of total billed charges 0.64 0.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMLODIPINE 10 MG TABLET RX-9069 CDM A9270 HCPCS 0250 RC 00904-6371-61 NDC outpatient 1 UN 5.64 5.64 74 4.17 percent of total billed charges 5.64 93 4.57 percent of total billed charges 5.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.64 other OPPS APC 5.64 5.64 other OPPS APC 5.64 24.86 1.4 percent of total billed charges 5.64 5.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMLODIPINE 10 MG TABLET RX-9069 CDM A9270 HCPCS 0637 RC 00904-6371-61 NDC outpatient 1 UN 5.64 5.64 5.64 74 4.17 percent of total billed charges 5.64 93 4.57 percent of total billed charges 5.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5.64 other OPPS APC 5.64 5.64 other OPPS APC 5.64 24.86 1.4 percent of total billed charges 5.64 5.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMLODIPINE 2.5 MG TABLET RX-9070 CDM A9270 HCPCS 0250 RC 00904-6369-61 NDC outpatient 1 UN 3.99 3.99 74 2.95 percent of total billed charges 3.99 93 3.23 percent of total billed charges 3.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.99 other OPPS APC 3.99 3.99 other OPPS APC 3.99 24.86 0.99 percent of total billed charges 3.99 3.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMLODIPINE 2.5 MG TABLET RX-9070 CDM A9270 HCPCS 0637 RC 00904-6369-61 NDC outpatient 1 UN 3.99 3.99 3.99 74 2.95 percent of total billed charges 3.99 93 3.23 percent of total billed charges 3.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.99 other OPPS APC 3.99 3.99 other OPPS APC 3.99 24.86 0.99 percent of total billed charges 3.99 3.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMLODIPINE 5 MG TABLET RX-9071 CDM A9270 HCPCS 0250 RC 00904-6370-61 NDC outpatient 1 UN 4.11 4.11 74 3.04 percent of total billed charges 4.11 93 3.33 percent of total billed charges 4.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.11 other OPPS APC 4.11 4.11 other OPPS APC 4.11 24.86 1.02 percent of total billed charges 4.11 4.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMLODIPINE 5 MG TABLET RX-9071 CDM A9270 HCPCS 0637 RC 00904-6370-61 NDC outpatient 1 UN 4.11 4.11 4.11 74 3.04 percent of total billed charges 4.11 93 3.33 percent of total billed charges 4.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.11 other OPPS APC 4.11 4.11 other OPPS APC 4.11 24.86 1.02 percent of total billed charges 4.11 4.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION RX-9083 CDM J0295 HCPCS 0636 RC 55150-0116-20 NDC outpatient 1.5 GR 19.34 19.34 2.15 2.15 fee schedule 19.34 93 15.67 percent of total billed charges 19.34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.34 other OPPS APC 19.34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.34 other OPPS APC 19.34 24.86 4.81 percent of total billed charges 2.15 19.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION RX-9083 CDM J0295 HCPCS 0636 RC 55150-0116-20 NDC outpatient 4 ML 19.34 19.34 2.15 2.15 fee schedule 19.34 93 15.67 percent of total billed charges 19.34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.34 other OPPS APC 19.34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.34 other OPPS APC 19.34 24.86 4.81 percent of total billed charges 2.15 19.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION RX-9084 CDM J0295 HCPCS 0636 RC 55150-0117-20 NDC outpatient 3 GR 36.5 36.5 4.31 4.31 fee schedule 36.5 93 29.57 percent of total billed charges 36.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36.5 other OPPS APC 36.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36.5 other OPPS APC 36.5 24.86 9.07 percent of total billed charges 4.31 36.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION RX-9084 CDM J0295 HCPCS 0636 RC 55150-0117-20 NDC outpatient 8 ML 36.5 36.5 4.31 4.31 fee schedule 36.5 93 29.57 percent of total billed charges 36.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36.5 other OPPS APC 36.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36.5 other OPPS APC 36.5 24.86 9.07 percent of total billed charges 4.31 36.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION" RX-91047 CDM 90371 HCPCS 0636 RC 69800-4203-01 NDC outpatient 5 ML 2258.2 2258.2 780.45 780.45 fee schedule 2258.2 93 1829.14 percent of total billed charges 2258.2 2258.2 other OPPS APC 2258.2 2258.2 other OPPS APC 2258.2 24.86 561.39 percent of total billed charges 780.45 2258.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION RX-91054 CDM J9206 HCPCS 0636 RC 16714-0131-01 NDC outpatient 5 ML 152.3 152.3 17.12 17.12 fee schedule 152.3 93 123.36 percent of total billed charges 152.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.3 other OPPS APC 152.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.3 other OPPS APC 152.3 24.86 37.86 percent of total billed charges 17.12 152.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IRINOTECAN 40 MG/2 ML INTRAVENOUS SOLUTION RX-91055 CDM J9206 HCPCS 0636 RC 16714-0027-01 NDC outpatient 2 ML 97.9 97.9 6.85 6.85 fee schedule 97.9 93 79.3 percent of total billed charges 97.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.9 other OPPS APC 97.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.9 other OPPS APC 97.9 24.86 24.34 percent of total billed charges 6.85 97.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION RX-91279 CDM J2354 HCPCS 0636 RC 00641-6175-10 NDC outpatient 1 ML 19.5 19.5 6 6 fee schedule 19.5 93 15.8 percent of total billed charges 19.5 19.5 other OPPS APC 19.5 19.5 other OPPS APC 19.5 24.86 4.85 percent of total billed charges 6 19.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION RX-91281 CDM J2354 HCPCS 0636 RC 68462-0897-10 NDC outpatient 1 ML 109.38 109.38 30.01 30.01 fee schedule 109.38 93 88.6 percent of total billed charges 109.38 109.38 other OPPS APC 109.38 109.38 other OPPS APC 109.38 24.86 27.19 percent of total billed charges 30.01 109.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION RX-91349 CDM J1885 HCPCS 0636 RC 72266-0119-25 NDC outpatient 2 ML 6 6 2.52 2.52 fee schedule 6 93 4.86 percent of total billed charges 6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6 other OPPS APC 6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6 other OPPS APC 6 24.86 1.49 percent of total billed charges 2.52 6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE RX-91408 CDM J2785 HCPCS 0636 RC 36000-0364-01 NDC outpatient 5 ML 75 75 284.35 284.35 fee schedule 75 93 60.75 percent of total billed charges 75 284.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE RX-91408 CDM J2785 HCPCS 0636 RC 67457-0994-05 NDC outpatient 5 ML 90 90 90 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 90 other OPPS APC 90 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 90 other OPPS APC 90 24.86 22.37 percent of total billed charges 90 90 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ASPIRIN 81 MG TABLET,DELAYED RELEASE" RX-9151 CDM A9270 HCPCS 0250 RC 63739-0212-02 NDC outpatient 1 UN 0.14 0.14 74 0.1 percent of total billed charges 0.14 93 0.11 percent of total billed charges 0.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.14 other OPPS APC 0.14 0.14 other OPPS APC 0.14 24.86 0.03 percent of total billed charges 0.14 0.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ASPIRIN 81 MG TABLET,DELAYED RELEASE" RX-9151 CDM A9270 HCPCS 0637 RC 63739-0212-02 NDC outpatient 1 UN 0.14 0.14 0.14 74 0.1 percent of total billed charges 0.14 93 0.11 percent of total billed charges 0.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.14 other OPPS APC 0.14 0.14 other OPPS APC 0.14 24.86 0.03 percent of total billed charges 0.14 0.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET RX-9158 CDM A9270 HCPCS 0250 RC 00067-2039-24 NDC outpatient 1 UN 0.55 0.55 74 0.41 percent of total billed charges 0.55 93 0.45 percent of total billed charges 0.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.55 other OPPS APC 0.55 0.55 other OPPS APC 0.55 24.86 0.14 percent of total billed charges 0.55 0.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET RX-9158 CDM A9270 HCPCS 0637 RC 00067-2039-24 NDC outpatient 1 UN 0.55 0.55 0.55 74 0.41 percent of total billed charges 0.55 93 0.45 percent of total billed charges 0.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.55 other OPPS APC 0.55 0.55 other OPPS APC 0.55 24.86 0.14 percent of total billed charges 0.55 0.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLUTION RX-91651 CDM 250000000 HCPCS 0250 RC 65649-0551-02 NDC outpatient 0.6 ML 480.93 480.93 480.93 74 355.89 percent of total billed charges 480.93 93 389.55 percent of total billed charges 480.93 480.93 other OPPS APC 480.93 480.93 other OPPS APC 480.93 24.86 119.56 percent of total billed charges 480.93 480.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZATHIOPRINE 50 MG TABLET RX-9183 CDM J7500 HCPCS 0636 RC 68084-0229-01 NDC outpatient 1 UN 2.12 2.12 15.65 15.65 fee schedule 2.12 93 1.72 percent of total billed charges 2.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.12 other OPPS APC 2.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.12 other OPPS APC 2.12 24.86 0.53 percent of total billed charges 2.12 15.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZTREONAM 1 GRAM SOLUTION FOR INJECTION RX-9185 CDM J0457 HCPCS 0636 RC 00409-0829-01 NDC outpatient 1 GR 99 99 99 74 73.26 percent of total billed charges 99 93 80.19 percent of total billed charges 99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.74 other OPPS APC 99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.74 other OPPS APC 99 24.86 24.61 percent of total billed charges 99 99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZTREONAM 1 GRAM SOLUTION FOR INJECTION RX-9185 CDM J0457 HCPCS 0636 RC 00409-0829-01 NDC outpatient 10 ML 99 99 99 74 73.26 percent of total billed charges 99 93 80.19 percent of total billed charges 99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.74 other OPPS APC 99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.74 other OPPS APC 99 24.86 24.61 percent of total billed charges 99 99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZTREONAM 2 GRAM SOLUTION FOR INJECTION RX-9186 CDM J0457 HCPCS 0636 RC 00409-0830-11 NDC outpatient 10 ML 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.48 other OPPS APC 195 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.48 other OPPS APC 195 24.86 48.48 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AZTREONAM 2 GRAM SOLUTION FOR INJECTION RX-9186 CDM J0457 HCPCS 0636 RC 00409-0830-11 NDC outpatient 2 GR 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.48 other OPPS APC 195 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.48 other OPPS APC 195 24.86 48.48 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALVIMOPAN 12 MG CAPSULE RX-91870 CDM A9270 HCPCS 0250 RC 00254-3012-55 NDC outpatient 1 UN 471.33 471.33 74 348.78 percent of total billed charges 471.33 93 381.78 percent of total billed charges 471.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 471.33 other OPPS APC 471.33 471.33 other OPPS APC 471.33 24.86 117.17 percent of total billed charges 471.33 471.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALVIMOPAN 12 MG CAPSULE RX-91870 CDM A9270 HCPCS 0637 RC 00254-3012-55 NDC outpatient 1 UN 471.33 471.33 471.33 74 348.78 percent of total billed charges 471.33 93 381.78 percent of total billed charges 471.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 471.33 other OPPS APC 471.33 471.33 other OPPS APC 471.33 24.86 117.17 percent of total billed charges 471.33 471.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENZTROPINE 1 MG/ML INJECTION SOLUTION RX-9259 CDM J0515 HCPCS 0636 RC 68382-0860-02 NDC outpatient 2 ML 146.88 146.88 37 37 fee schedule 146.88 93 118.97 percent of total billed charges 146.88 146.88 other OPPS APC 146.88 146.88 other OPPS APC 146.88 24.86 36.51 percent of total billed charges 37 146.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION RX-9266 CDM J0702 HCPCS 0636 RC 78206-0118-01 NDC outpatient 5 ML 124.75 124.75 79.38 79.38 fee schedule 124.75 93 101.05 percent of total billed charges 124.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 124.75 other OPPS APC 124.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 124.75 other OPPS APC 124.75 24.86 31.01 percent of total billed charges 79.38 124.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZINC OXIDE 13 % TOPICAL CREAM RX-92811 CDM A9270 HCPCS 0250 RC 74300-0003-01 NDC outpatient 113 GR 10.46 10.46 74 7.74 percent of total billed charges 10.46 93 8.47 percent of total billed charges 10.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.46 other OPPS APC 10.46 10.46 other OPPS APC 10.46 24.86 2.6 percent of total billed charges 10.46 10.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZINC OXIDE 13 % TOPICAL CREAM RX-92811 CDM A9270 HCPCS 0637 RC 74300-0003-01 NDC outpatient 113 GR 10.46 10.46 10.46 74 7.74 percent of total billed charges 10.46 93 8.47 percent of total billed charges 10.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.46 other OPPS APC 10.46 10.46 other OPPS APC 10.46 24.86 2.6 percent of total billed charges 10.46 10.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) INTRAVENOUS SOLUTION" RX-92854 CDM J7189 HCPCS 0636 RC 00169-7202-01 NDC outpatient 2 ML 13450 13450 5517.6 5517.6 fee schedule 13450 93 10894.5 percent of total billed charges 13450 13450 other OPPS APC 13450 13450 other OPPS APC 13450 24.86 3343.67 percent of total billed charges 5517.6 13450 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION" RX-92855 CDM J7189 HCPCS 0636 RC 00169-7205-01 NDC outpatient 5 ML 33625 33625 13794 13794 fee schedule 33625 93 27236.3 percent of total billed charges 33625 33625 other OPPS APC 33625 33625 other OPPS APC 33625 24.86 8359.18 percent of total billed charges 13794 33625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION RX-9289 CDM J9040 HCPCS 0636 RC 00143-9240-01 NDC outpatient 5 ML 171.6 171.6 28 28 fee schedule 171.6 93 139 percent of total billed charges 171.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 171.6 other OPPS APC 171.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 171.6 other OPPS APC 171.6 24.86 42.66 percent of total billed charges 28 171.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK RX-92895 CDM J3370 HCPCS 0636 RC 00338-3552-48 NDC outpatient 1 GR 72 72 5.49 5.49 fee schedule 72 93 58.32 percent of total billed charges 72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 72 other OPPS APC 72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 72 other OPPS APC 72 24.86 17.9 percent of total billed charges 5.49 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK RX-92895 CDM J3370 HCPCS 0636 RC 00338-3552-48 NDC outpatient 200 ML 72 72 5.49 5.49 fee schedule 72 93 58.32 percent of total billed charges 72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 72 other OPPS APC 72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 72 other OPPS APC 72 24.86 17.9 percent of total billed charges 5.49 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BROMOCRIPTINE 2.5 MG TABLET RX-9297 CDM A9270 HCPCS 0250 RC 00574-0106-03 NDC outpatient 1 UN 10.35 10.35 74 7.66 percent of total billed charges 10.35 93 8.38 percent of total billed charges 10.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.35 other OPPS APC 10.35 10.35 other OPPS APC 10.35 24.86 2.57 percent of total billed charges 10.35 10.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BROMOCRIPTINE 2.5 MG TABLET RX-9297 CDM A9270 HCPCS 0637 RC 00574-0106-03 NDC outpatient 1 UN 10.35 10.35 10.35 74 7.66 percent of total billed charges 10.35 93 8.38 percent of total billed charges 10.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10.35 other OPPS APC 10.35 10.35 other OPPS APC 10.35 24.86 2.57 percent of total billed charges 10.35 10.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUMETANIDE 0.25 MG/ML INJECTION SOLUTION RX-9308 CDM J1939 HCPCS 0636 RC 68462-0469-54 NDC outpatient 4 ML 6.83 6.83 6.83 74 5.05 percent of total billed charges 6.83 93 5.53 percent of total billed charges 6.83 6.83 other OPPS APC 6.83 6.83 other OPPS APC 6.83 24.86 1.7 percent of total billed charges 6.83 6.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION RX-93084 CDM 250000000 HCPCS 0250 RC 00143-9875-01 NDC outpatient 3 ML 6 6 6 74 4.44 percent of total billed charges 6 93 4.86 percent of total billed charges 6 6 other OPPS APC 6 6 other OPPS APC 6 24.86 1.49 percent of total billed charges 6 6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUMETANIDE 1 MG TABLET RX-9310 CDM A9270 HCPCS 0250 RC 50268-0131-15 NDC outpatient 1 UN 3.75 3.75 74 2.78 percent of total billed charges 3.75 93 3.04 percent of total billed charges 3.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.75 other OPPS APC 3.75 3.75 other OPPS APC 3.75 24.86 0.93 percent of total billed charges 3.75 3.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUMETANIDE 1 MG TABLET RX-9310 CDM A9270 HCPCS 0637 RC 50268-0131-15 NDC outpatient 1 UN 3.75 3.75 3.75 74 2.78 percent of total billed charges 3.75 93 3.04 percent of total billed charges 3.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.75 other OPPS APC 3.75 3.75 other OPPS APC 3.75 24.86 0.93 percent of total billed charges 3.75 3.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION RX-9316 CDM J0665 HCPCS 0250 RC 00409-1761-10 NDC outpatient 2 ML 16.46 16.46 16.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.46 other OPPS APC 16.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.46 other OPPS APC 16.46 24.86 4.09 percent of total billed charges 16.46 16.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION RX-9316 CDM J0665 HCPCS 0250 RC 00409-1761-18 NDC outpatient 2 ML 5.05 5.05 5.05 74 3.74 percent of total billed charges 5.05 93 4.09 percent of total billed charges 5.05 5.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUPROPION HCL 100 MG TABLET RX-9321 CDM A9270 HCPCS 0250 RC 60687-0351-01 NDC outpatient 1 UN 4.47 4.47 74 3.31 percent of total billed charges 4.47 93 3.62 percent of total billed charges 4.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.47 other OPPS APC 4.47 4.47 other OPPS APC 4.47 24.86 1.11 percent of total billed charges 4.47 4.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUPROPION HCL 100 MG TABLET RX-9321 CDM A9270 HCPCS 0637 RC 60687-0351-01 NDC outpatient 1 UN 4.47 4.47 4.47 74 3.31 percent of total billed charges 4.47 93 3.62 percent of total billed charges 4.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.47 other OPPS APC 4.47 4.47 other OPPS APC 4.47 24.86 1.11 percent of total billed charges 4.47 4.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUPROPION HCL 75 MG TABLET RX-9322 CDM A9270 HCPCS 0250 RC 50268-0142-15 NDC outpatient 1 UN 3.98 3.98 74 2.95 percent of total billed charges 3.98 93 3.22 percent of total billed charges 3.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.98 other OPPS APC 3.98 3.98 other OPPS APC 3.98 24.86 0.99 percent of total billed charges 3.98 3.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUPROPION HCL 75 MG TABLET RX-9322 CDM A9270 HCPCS 0637 RC 50268-0142-15 NDC outpatient 1 UN 3.98 3.98 3.98 74 2.95 percent of total billed charges 3.98 93 3.22 percent of total billed charges 3.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.98 other OPPS APC 3.98 3.98 other OPPS APC 3.98 24.86 0.99 percent of total billed charges 3.98 3.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUSPIRONE 10 MG TABLET RX-9323 CDM A9270 HCPCS 0250 RC 51079-0986-01 NDC outpatient 1 UN 3.37 3.37 74 2.49 percent of total billed charges 3.37 93 2.73 percent of total billed charges 3.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.37 other OPPS APC 3.37 3.37 other OPPS APC 3.37 24.86 0.84 percent of total billed charges 3.37 3.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUSPIRONE 10 MG TABLET RX-9323 CDM A9270 HCPCS 0637 RC 51079-0986-01 NDC outpatient 1 UN 3.37 3.37 3.37 74 2.49 percent of total billed charges 3.37 93 2.73 percent of total billed charges 3.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.37 other OPPS APC 3.37 3.37 other OPPS APC 3.37 24.86 0.84 percent of total billed charges 3.37 3.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUSPIRONE 5 MG TABLET RX-9324 CDM A9270 HCPCS 0250 RC 51079-0985-20 NDC outpatient 1 UN 1.93 1.93 74 1.43 percent of total billed charges 1.93 93 1.56 percent of total billed charges 1.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.93 other OPPS APC 1.93 1.93 other OPPS APC 1.93 24.86 0.48 percent of total billed charges 1.93 1.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUSPIRONE 5 MG TABLET RX-9324 CDM A9270 HCPCS 0637 RC 51079-0985-20 NDC outpatient 1 UN 1.93 1.93 1.93 74 1.43 percent of total billed charges 1.93 93 1.56 percent of total billed charges 1.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.93 other OPPS APC 1.93 1.93 other OPPS APC 1.93 24.86 0.48 percent of total billed charges 1.93 1.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOPICAL SPRAY RX-9328 CDM A9270 HCPCS 0250 RC 10223-0201-03 NDC outpatient 20 GR 357 357 74 264.18 percent of total billed charges 357 93 289.17 percent of total billed charges 357 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 357 other OPPS APC 357 357 other OPPS APC 357 24.86 88.75 percent of total billed charges 357 357 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOPICAL SPRAY RX-9328 CDM A9270 HCPCS 0637 RC 10223-0201-03 NDC outpatient 20 GR 357 357 357 74 264.18 percent of total billed charges 357 93 289.17 percent of total billed charges 357 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 357 other OPPS APC 357 357 other OPPS APC 357 24.86 88.75 percent of total billed charges 357 357 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION RX-9347 CDM J0630 HCPCS 0636 RC 43598-0051-11 NDC outpatient 2 ML 7984.05 7984.05 1559.8 1559.8 fee schedule 7984.05 93 6467.08 percent of total billed charges 7984.05 7984.05 other OPPS APC 7984.05 7984.05 other OPPS APC 7984.05 24.86 1984.83 percent of total billed charges 1559.8 7984.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCITRIOL 0.25 MCG CAPSULE RX-9350 CDM A9270 HCPCS 0250 RC 60687-0345-01 NDC outpatient 1 UN 2.22 2.22 74 1.64 percent of total billed charges 2.22 93 1.8 percent of total billed charges 2.22 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.22 other OPPS APC 2.22 2.22 other OPPS APC 2.22 24.86 0.55 percent of total billed charges 2.22 2.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCITRIOL 0.25 MCG CAPSULE RX-9350 CDM A9270 HCPCS 0637 RC 60687-0345-01 NDC outpatient 1 UN 2.22 2.22 2.22 74 1.64 percent of total billed charges 2.22 93 1.8 percent of total billed charges 2.22 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.22 other OPPS APC 2.22 2.22 other OPPS APC 2.22 24.86 0.55 percent of total billed charges 2.22 2.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION RX-93566 CDM J2796 HCPCS 0636 RC 55513-0221-01 NDC outpatient 0.5 ML 7865.75 7865.75 2724.32 2724.32 fee schedule 7865.75 93 6371.26 percent of total billed charges 7865.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2526.3 other OPPS APC 7865.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2526.3 other OPPS APC 7865.75 24.86 1955.43 percent of total billed charges 2724.32 7865.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MITOXANTRONE 2 MG/ML CONCENTRATE,INTRAVENOUS" RX-93747 CDM J9293 HCPCS 0636 RC 63323-0132-10 NDC outpatient 10 ML 1222.98 1222.98 132.71 132.71 fee schedule 1222.98 93 990.61 percent of total billed charges 1222.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.6 other OPPS APC 1222.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 218.6 other OPPS APC 1222.98 24.86 304.03 percent of total billed charges 132.71 1222.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET RX-9385 CDM A9270 HCPCS 0250 RC 66553-0004-01 NDC outpatient 1 UN 0.17 0.17 74 0.13 percent of total billed charges 0.17 93 0.14 percent of total billed charges 0.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.17 other OPPS APC 0.17 0.17 other OPPS APC 0.17 24.86 0.04 percent of total billed charges 0.17 0.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET RX-9385 CDM A9270 HCPCS 0637 RC 66553-0004-01 NDC outpatient 1 UN 0.17 0.17 0.17 74 0.13 percent of total billed charges 0.17 93 0.14 percent of total billed charges 0.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.17 other OPPS APC 0.17 0.17 other OPPS APC 0.17 24.86 0.04 percent of total billed charges 0.17 0.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLEVIDIPINE 25 MG/50 ML INTRAVENOUS EMULSION RX-93936 CDM 250000000 HCPCS 0250 RC 10122-0610-10 NDC outpatient 50 ML 256.7 256.7 256.7 74 189.96 percent of total billed charges 256.7 93 207.93 percent of total billed charges 256.7 256.7 other OPPS APC 256.7 256.7 other OPPS APC 256.7 24.86 63.82 percent of total billed charges 256.7 256.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAPTOPRIL 25 MG TABLET RX-9402 CDM A9270 HCPCS 0250 RC 60687-0315-21 NDC outpatient 1 UN 4.62 4.62 74 3.42 percent of total billed charges 4.62 93 3.74 percent of total billed charges 4.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.62 other OPPS APC 4.62 4.62 other OPPS APC 4.62 24.86 1.15 percent of total billed charges 4.62 4.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAPTOPRIL 25 MG TABLET RX-9402 CDM A9270 HCPCS 0637 RC 60687-0315-21 NDC outpatient 1 UN 4.62 4.62 4.62 74 3.42 percent of total billed charges 4.62 93 3.74 percent of total billed charges 4.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.62 other OPPS APC 4.62 4.62 other OPPS APC 4.62 24.86 1.15 percent of total billed charges 4.62 4.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAPTOPRIL 50 MG TABLET RX-9403 CDM A9270 HCPCS 0250 RC 00378-3017-01 NDC outpatient 1 UN 4.01 4.01 74 2.97 percent of total billed charges 4.01 93 3.25 percent of total billed charges 4.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.01 other OPPS APC 4.01 4.01 other OPPS APC 4.01 24.86 1 percent of total billed charges 4.01 4.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAPTOPRIL 50 MG TABLET RX-9403 CDM A9270 HCPCS 0637 RC 00378-3017-01 NDC outpatient 1 UN 4.01 4.01 4.01 74 2.97 percent of total billed charges 4.01 93 3.25 percent of total billed charges 4.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.01 other OPPS APC 4.01 4.01 other OPPS APC 4.01 24.86 1 percent of total billed charges 4.01 4.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET RX-9406 CDM A9270 HCPCS 0250 RC 72888-0106-01 NDC outpatient 1 UN 1.78 1.78 74 1.32 percent of total billed charges 1.78 93 1.44 percent of total billed charges 1.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.78 other OPPS APC 1.78 1.78 other OPPS APC 1.78 24.86 0.44 percent of total billed charges 1.78 1.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET RX-9406 CDM A9270 HCPCS 0637 RC 72888-0106-01 NDC outpatient 1 UN 1.78 1.78 1.78 74 1.32 percent of total billed charges 1.78 93 1.44 percent of total billed charges 1.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.78 other OPPS APC 1.78 1.78 other OPPS APC 1.78 24.86 0.44 percent of total billed charges 1.78 1.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET RX-9407 CDM A9270 HCPCS 0250 RC 00904-7501-61 NDC outpatient 1 UN 0.75 0.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.75 other OPPS APC 0.75 0.75 other OPPS APC 0.75 24.86 0.19 percent of total billed charges 0.75 0.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET RX-9407 CDM A9270 HCPCS 0637 RC 00904-7501-61 NDC outpatient 1 UN 0.75 0.75 0.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.75 other OPPS APC 0.75 0.75 other OPPS APC 0.75 24.86 0.19 percent of total billed charges 0.75 0.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET RX-9407 CDM A9270 HCPCS 0250 RC 60687-0661-01 NDC outpatient 1 UN 2.05 2.05 74 1.52 percent of total billed charges 2.05 93 1.66 percent of total billed charges 2.05 2.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET RX-9407 CDM A9270 HCPCS 0637 RC 60687-0661-01 NDC outpatient 1 UN 2.05 2.05 2.05 74 1.52 percent of total billed charges 2.05 93 1.66 percent of total billed charges 2.05 2.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION RX-9413 CDM 250000000 HCPCS 0250 RC 00009-0856-05 NDC outpatient 1 ML 420 420 420 74 310.8 percent of total billed charges 420 93 340.2 percent of total billed charges 420 420 other OPPS APC 420 420 other OPPS APC 420 24.86 104.41 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN RX-94576 CDM 250000000 HCPCS 0250 RC 00143-9633-10 NDC outpatient 200 ML 487.92 487.92 487.92 74 361.06 percent of total billed charges 487.92 93 395.22 percent of total billed charges 487.92 487.92 other OPPS APC 487.92 487.92 other OPPS APC 487.92 24.86 121.3 percent of total billed charges 487.92 487.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN RX-94576 CDM 250000000 HCPCS 0250 RC 00143-9633-10 NDC outpatient 40 ME 487.92 487.92 487.92 74 361.06 percent of total billed charges 487.92 93 395.22 percent of total billed charges 487.92 487.92 other OPPS APC 487.92 487.92 other OPPS APC 487.92 24.86 121.3 percent of total billed charges 487.92 487.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION RX-9461 CDM J0694 HCPCS 0636 RC 44567-0245-25 NDC outpatient 1 GR 29.85 29.85 5.71 5.71 fee schedule 29.85 93 24.18 percent of total billed charges 29.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.85 other OPPS APC 29.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.85 other OPPS APC 29.85 24.86 7.42 percent of total billed charges 5.71 29.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION RX-9461 CDM J0694 HCPCS 0636 RC 44567-0245-25 NDC outpatient 10 ML 29.85 29.85 5.71 5.71 fee schedule 29.85 93 24.18 percent of total billed charges 29.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.85 other OPPS APC 29.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.85 other OPPS APC 29.85 24.86 7.42 percent of total billed charges 5.71 29.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION RX-9463 CDM J0694 HCPCS 0636 RC 00143-9877-25 NDC outpatient 2 GR 59.4 59.4 11.42 11.42 fee schedule 59.4 93 48.11 percent of total billed charges 59.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.4 other OPPS APC 59.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.4 other OPPS APC 59.4 24.86 14.77 percent of total billed charges 11.42 59.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION RX-9463 CDM J0694 HCPCS 0636 RC 00143-9877-25 NDC outpatient 20 ML 59.4 59.4 11.42 11.42 fee schedule 59.4 93 48.11 percent of total billed charges 59.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.4 other OPPS APC 59.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.4 other OPPS APC 59.4 24.86 14.77 percent of total billed charges 11.42 59.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION RX-9474 CDM J0713 HCPCS 0636 RC 00409-5082-16 NDC outpatient 1 GR 12.79 12.79 4.19 4.19 fee schedule 12.79 93 10.36 percent of total billed charges 12.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.79 other OPPS APC 12.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.79 other OPPS APC 12.79 24.86 3.18 percent of total billed charges 4.19 12.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION RX-9474 CDM J0713 HCPCS 0636 RC 00409-5082-16 NDC outpatient 10 ML 12.79 12.79 4.19 4.19 fee schedule 12.79 93 10.36 percent of total billed charges 12.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.79 other OPPS APC 12.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12.79 other OPPS APC 12.79 24.86 3.18 percent of total billed charges 4.19 12.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION RX-9476 CDM J0713 HCPCS 0636 RC 44567-0236-10 NDC outpatient 10 ML 30 30 8.37 8.37 fee schedule 30 93 24.3 percent of total billed charges 30 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30 other OPPS APC 30 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30 other OPPS APC 30 24.86 7.46 percent of total billed charges 8.37 30 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION RX-9476 CDM J0713 HCPCS 0636 RC 44567-0236-10 NDC outpatient 2 GR 30 30 8.37 8.37 fee schedule 30 93 24.3 percent of total billed charges 30 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30 other OPPS APC 30 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 30 other OPPS APC 30 24.86 7.46 percent of total billed charges 8.37 30 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION RX-9487 CDM J0696 HCPCS 0636 RC 00143-9857-25 NDC outpatient 1 GR 6 6 2.61 2.61 fee schedule 6 93 4.86 percent of total billed charges 6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6 other OPPS APC 6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6 other OPPS APC 6 24.86 1.49 percent of total billed charges 2.61 6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION RX-9487 CDM J0696 HCPCS 0636 RC 00143-9857-25 NDC outpatient 10 ML 6 6 2.61 2.61 fee schedule 6 93 4.86 percent of total billed charges 6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6 other OPPS APC 6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6 other OPPS APC 6 24.86 1.49 percent of total billed charges 2.61 6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION RX-9488 CDM J0696 HCPCS 0636 RC 00781-3209-90 NDC outpatient 2 GR 228.53 228.53 5.23 5.23 fee schedule 228.53 93 185.11 percent of total billed charges 228.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 228.53 other OPPS APC 228.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 228.53 other OPPS APC 228.53 24.86 56.81 percent of total billed charges 5.23 228.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION RX-9488 CDM J0696 HCPCS 0636 RC 00781-3209-90 NDC outpatient 20 ML 228.53 228.53 5.23 5.23 fee schedule 228.53 93 185.11 percent of total billed charges 228.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 228.53 other OPPS APC 228.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 228.53 other OPPS APC 228.53 24.86 56.81 percent of total billed charges 5.23 228.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTRIAXONE 250 MG SOLUTION FOR INJECTION RX-9489 CDM J0696 HCPCS 0636 RC 00409-7337-01 NDC outpatient 2.5 ML 2.29 2.29 0.65 0.65 fee schedule 2.29 93 1.85 percent of total billed charges 2.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.29 other OPPS APC 2.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.29 other OPPS APC 2.29 24.86 0.57 percent of total billed charges 0.65 2.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTRIAXONE 250 MG SOLUTION FOR INJECTION RX-9489 CDM J0696 HCPCS 0636 RC 00409-7337-01 NDC outpatient 250 ME 2.29 2.29 0.65 0.65 fee schedule 2.29 93 1.85 percent of total billed charges 2.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.29 other OPPS APC 2.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.29 other OPPS APC 2.29 24.86 0.57 percent of total billed charges 0.65 2.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTRIAXONE 500 MG SOLUTION FOR INJECTION RX-9490 CDM J0696 HCPCS 0636 RC 44567-0700-25 NDC outpatient 500 ME 6.6 6.6 1.31 1.31 fee schedule 6.6 93 5.35 percent of total billed charges 6.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.6 other OPPS APC 6.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.6 other OPPS APC 6.6 24.86 1.64 percent of total billed charges 1.31 6.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTRIAXONE 10 GRAM SOLUTION FOR INJECTION RX-9491 CDM J0696 HCPCS 0636 RC 00143-9678-01 NDC outpatient 10 GR 60 60 26.14 26.14 fee schedule 60 93 48.6 percent of total billed charges 60 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 60 other OPPS APC 60 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 60 other OPPS APC 60 24.86 14.92 percent of total billed charges 26.14 60 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTRIAXONE 10 GRAM SOLUTION FOR INJECTION RX-9491 CDM J0696 HCPCS 0636 RC 00143-9678-01 NDC outpatient 100 ML 60 60 26.14 26.14 fee schedule 60 93 48.6 percent of total billed charges 60 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 60 other OPPS APC 60 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 60 other OPPS APC 60 24.86 14.92 percent of total billed charges 26.14 60 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTRIAXONE 1 GRAM/50 ML IN DEXTROSE (ISO-OSMOT) INTRAVENOUS PIGGYBACK RX-9492 CDM J0696 HCPCS 0636 RC 00264-3153-11 NDC outpatient 1 GR 59.04 59.04 2.61 2.61 fee schedule 59.04 93 47.82 percent of total billed charges 59.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.04 other OPPS APC 59.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.04 other OPPS APC 59.04 24.86 14.68 percent of total billed charges 2.61 59.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTRIAXONE 1 GRAM/50 ML IN DEXTROSE (ISO-OSMOT) INTRAVENOUS PIGGYBACK RX-9492 CDM J0696 HCPCS 0636 RC 00264-3153-11 NDC outpatient 50 ML 59.04 59.04 2.61 2.61 fee schedule 59.04 93 47.82 percent of total billed charges 59.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.04 other OPPS APC 59.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.04 other OPPS APC 59.04 24.86 14.68 percent of total billed charges 2.61 59.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTRIAXONE 2 GRAM/50 ML IN DEXTROSE (ISO-OSM) INTRAVENOUS PIGGYBACK RX-9493 CDM J0696 HCPCS 0636 RC 00264-3155-11 NDC outpatient 2 GR 78.72 78.72 5.23 5.23 fee schedule 78.72 93 63.76 percent of total billed charges 78.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 78.72 other OPPS APC 78.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 78.72 other OPPS APC 78.72 24.86 19.57 percent of total billed charges 5.23 78.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFTRIAXONE 2 GRAM/50 ML IN DEXTROSE (ISO-OSM) INTRAVENOUS PIGGYBACK RX-9493 CDM J0696 HCPCS 0636 RC 00264-3155-11 NDC outpatient 50 ML 78.72 78.72 5.23 5.23 fee schedule 78.72 93 63.76 percent of total billed charges 78.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 78.72 other OPPS APC 78.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 78.72 other OPPS APC 78.72 24.86 19.57 percent of total billed charges 5.23 78.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFUROXIME AXETIL 250 MG TABLET RX-9495 CDM A9270 HCPCS 0250 RC 67877-0215-20 NDC outpatient 1 UN 14.16 14.16 74 10.48 percent of total billed charges 14.16 93 11.47 percent of total billed charges 14.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.16 other OPPS APC 14.16 14.16 other OPPS APC 14.16 24.86 3.52 percent of total billed charges 14.16 14.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEFUROXIME AXETIL 250 MG TABLET RX-9495 CDM A9270 HCPCS 0637 RC 67877-0215-20 NDC outpatient 1 UN 14.16 14.16 14.16 74 10.48 percent of total billed charges 14.16 93 11.47 percent of total billed charges 14.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.16 other OPPS APC 14.16 14.16 other OPPS APC 14.16 24.86 3.52 percent of total billed charges 14.16 14.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEPHALEXIN 250 MG CAPSULE RX-9499 CDM A9270 HCPCS 0250 RC 50268-0151-15 NDC outpatient 1 UN 1.7 1.7 74 1.26 percent of total billed charges 1.7 93 1.38 percent of total billed charges 1.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.7 other OPPS APC 1.7 1.7 other OPPS APC 1.7 24.86 0.42 percent of total billed charges 1.7 1.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEPHALEXIN 250 MG CAPSULE RX-9499 CDM A9270 HCPCS 0637 RC 50268-0151-15 NDC outpatient 1 UN 1.7 1.7 1.7 74 1.26 percent of total billed charges 1.7 93 1.38 percent of total billed charges 1.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.7 other OPPS APC 1.7 1.7 other OPPS APC 1.7 24.86 0.42 percent of total billed charges 1.7 1.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEPHALEXIN 500 MG CAPSULE RX-9500 CDM A9270 HCPCS 0250 RC 00904-7337-35 NDC outpatient 1 UN 0.93 0.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.93 other OPPS APC 0.93 0.93 other OPPS APC 0.93 24.86 0.23 percent of total billed charges 0.93 0.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEPHALEXIN 500 MG CAPSULE RX-9500 CDM A9270 HCPCS 0637 RC 00904-7337-35 NDC outpatient 1 UN 0.93 0.93 0.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.93 other OPPS APC 0.93 0.93 other OPPS APC 0.93 24.86 0.23 percent of total billed charges 0.93 0.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEPHALEXIN 500 MG CAPSULE RX-9500 CDM A9270 HCPCS 0250 RC 50268-0152-11 NDC outpatient 1 UN 3.06 3.06 74 2.26 percent of total billed charges 3.06 93 2.48 percent of total billed charges 3.06 3.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEPHALEXIN 500 MG CAPSULE RX-9500 CDM A9270 HCPCS 0637 RC 50268-0152-11 NDC outpatient 1 UN 3.06 3.06 3.06 74 2.26 percent of total billed charges 3.06 93 2.48 percent of total billed charges 3.06 3.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION RX-9502 CDM A9270 HCPCS 0250 RC 67877-0545-88 NDC outpatient 100 ML 57.13 57.13 74 42.28 percent of total billed charges 57.13 93 46.28 percent of total billed charges 57.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 57.13 other OPPS APC 57.13 57.13 other OPPS APC 57.13 24.86 14.2 percent of total billed charges 57.13 57.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION RX-9502 CDM A9270 HCPCS 0637 RC 67877-0545-88 NDC outpatient 100 ML 57.13 57.13 57.13 74 42.28 percent of total billed charges 57.13 93 46.28 percent of total billed charges 57.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 57.13 other OPPS APC 57.13 57.13 other OPPS APC 57.13 24.86 14.2 percent of total billed charges 57.13 57.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CETIRIZINE 10 MG TABLET RX-9506 CDM A9270 HCPCS 0250 RC 51079-0597-20 NDC outpatient 1 UN 6.24 6.24 74 4.62 percent of total billed charges 6.24 93 5.05 percent of total billed charges 6.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.24 other OPPS APC 6.24 6.24 other OPPS APC 6.24 24.86 1.55 percent of total billed charges 6.24 6.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CETIRIZINE 10 MG TABLET RX-9506 CDM A9270 HCPCS 0637 RC 51079-0597-20 NDC outpatient 1 UN 6.24 6.24 6.24 74 4.62 percent of total billed charges 6.24 93 5.05 percent of total billed charges 6.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.24 other OPPS APC 6.24 6.24 other OPPS APC 6.24 24.86 1.55 percent of total billed charges 6.24 6.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH RX-9516 CDM A9270 HCPCS 0250 RC 81033-0512-50 NDC outpatient 15 ML 3.3 3.3 74 2.44 percent of total billed charges 3.3 93 2.67 percent of total billed charges 3.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.3 other OPPS APC 3.3 3.3 other OPPS APC 3.3 24.86 0.82 percent of total billed charges 3.3 3.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH RX-9516 CDM A9270 HCPCS 0637 RC 81033-0512-50 NDC outpatient 15 ML 3.3 3.3 3.3 74 2.44 percent of total billed charges 3.3 93 2.67 percent of total billed charges 3.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.3 other OPPS APC 3.3 3.3 other OPPS APC 3.3 24.86 0.82 percent of total billed charges 3.3 3.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION RX-9526 CDM J1205 HCPCS 0636 RC 25021-0305-20 NDC outpatient 20 ML 180 180 70.28 70.28 fee schedule 180 93 145.8 percent of total billed charges 180 180 other OPPS APC 180 180 other OPPS APC 180 24.86 44.75 percent of total billed charges 70.28 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION RX-9526 CDM J1205 HCPCS 0636 RC 25021-0305-20 NDC outpatient 500 ME 180 180 70.28 70.28 fee schedule 180 93 145.8 percent of total billed charges 180 180 other OPPS APC 180 180 other OPPS APC 180 24.86 44.75 percent of total billed charges 70.28 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR" RX-95676 CDM A9270 HCPCS 0250 RC 50228-0380-60 NDC outpatient 1 UN 22.18 22.18 74 16.41 percent of total billed charges 22.18 93 17.97 percent of total billed charges 22.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.18 other OPPS APC 22.18 22.18 other OPPS APC 22.18 24.86 5.51 percent of total billed charges 22.18 22.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR" RX-95676 CDM A9270 HCPCS 0637 RC 50228-0380-60 NDC outpatient 1 UN 22.18 22.18 22.18 74 16.41 percent of total billed charges 22.18 93 17.97 percent of total billed charges 22.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.18 other OPPS APC 22.18 22.18 other OPPS APC 22.18 24.86 5.51 percent of total billed charges 22.18 22.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION RX-95811 CDM 250000000 HCPCS 0250 RC 66794-0228-41 NDC outpatient 5 ML 14.4 14.4 14.4 74 10.66 percent of total billed charges 14.4 93 11.66 percent of total billed charges 14.4 14.4 other OPPS APC 14.4 14.4 other OPPS APC 14.4 24.86 3.58 percent of total billed charges 14.4 14.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET RX-9588 CDM A9270 HCPCS 0250 RC 42806-0266-95 NDC outpatient 1 UN 8.38 8.38 74 6.2 percent of total billed charges 8.38 93 6.79 percent of total billed charges 8.38 8.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET RX-9588 CDM A9270 HCPCS 0637 RC 42806-0266-95 NDC outpatient 1 UN 8.38 8.38 8.38 74 6.2 percent of total billed charges 8.38 93 6.79 percent of total billed charges 8.38 8.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET RX-9588 CDM A9270 HCPCS 0250 RC 67877-0298-60 NDC outpatient 1 UN 8.43 8.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.43 other OPPS APC 8.43 8.43 other OPPS APC 8.43 24.86 2.1 percent of total billed charges 8.43 8.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET RX-9588 CDM A9270 HCPCS 0637 RC 67877-0298-60 NDC outpatient 1 UN 8.43 8.43 8.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.43 other OPPS APC 8.43 8.43 other OPPS APC 8.43 24.86 2.1 percent of total billed charges 8.43 8.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMIPENEM-CILASTATIN 250 MG INTRAVENOUS SOLUTION RX-9602 CDM J0743 HCPCS 0636 RC 63323-0349-25 NDC outpatient 10 ML 44.97 44.97 8.16 8.16 fee schedule 44.97 93 36.43 percent of total billed charges 44.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.97 other OPPS APC 44.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.97 other OPPS APC 44.97 24.86 11.18 percent of total billed charges 8.16 44.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMIPENEM-CILASTATIN 250 MG INTRAVENOUS SOLUTION RX-9602 CDM J0743 HCPCS 0636 RC 63323-0349-25 NDC outpatient 250 ME 44.97 44.97 8.16 8.16 fee schedule 44.97 93 36.43 percent of total billed charges 44.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.97 other OPPS APC 44.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.97 other OPPS APC 44.97 24.86 11.18 percent of total billed charges 8.16 44.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION RX-9603 CDM J0743 HCPCS 0636 RC 44567-0705-10 NDC outpatient 20 ML 82.05 82.05 16.31 16.31 fee schedule 82.05 93 66.46 percent of total billed charges 82.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 82.05 other OPPS APC 82.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 82.05 other OPPS APC 82.05 24.86 20.4 percent of total billed charges 16.31 82.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION RX-9603 CDM J0743 HCPCS 0636 RC 44567-0705-10 NDC outpatient 500 ME 82.05 82.05 16.31 16.31 fee schedule 82.05 93 66.46 percent of total billed charges 82.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 82.05 other OPPS APC 82.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 82.05 other OPPS APC 82.05 24.86 20.4 percent of total billed charges 16.31 82.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CIMETIDINE 300 MG TABLET RX-9605 CDM A9270 HCPCS 0250 RC 00378-0317-01 NDC outpatient 1 UN 4.02 4.02 74 2.97 percent of total billed charges 4.02 93 3.26 percent of total billed charges 4.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.02 other OPPS APC 4.02 4.02 other OPPS APC 4.02 24.86 1 percent of total billed charges 4.02 4.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CIMETIDINE 300 MG TABLET RX-9605 CDM A9270 HCPCS 0637 RC 00378-0317-01 NDC outpatient 1 UN 4.02 4.02 4.02 74 2.97 percent of total billed charges 4.02 93 3.26 percent of total billed charges 4.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.02 other OPPS APC 4.02 4.02 other OPPS APC 4.02 24.86 1 percent of total billed charges 4.02 4.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CIPROFLOXACIN 0.3 % EYE DROPS RX-9610 CDM A9270 HCPCS 0250 RC 61314-0656-05 NDC outpatient 5 ML 118.28 118.28 74 87.53 percent of total billed charges 118.28 93 95.81 percent of total billed charges 118.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 118.28 other OPPS APC 118.28 118.28 other OPPS APC 118.28 24.86 29.4 percent of total billed charges 118.28 118.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CIPROFLOXACIN 0.3 % EYE DROPS RX-9610 CDM A9270 HCPCS 0637 RC 61314-0656-05 NDC outpatient 5 ML 118.28 118.28 118.28 74 87.53 percent of total billed charges 118.28 93 95.81 percent of total billed charges 118.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 118.28 other OPPS APC 118.28 118.28 other OPPS APC 118.28 24.86 29.4 percent of total billed charges 118.28 118.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLARITHROMYCIN 250 MG TABLET RX-9616 CDM A9270 HCPCS 0250 RC 50268-0178-15 NDC outpatient 1 UN 14.6 14.6 74 10.8 percent of total billed charges 14.6 93 11.83 percent of total billed charges 14.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.6 other OPPS APC 14.6 14.6 other OPPS APC 14.6 24.86 3.63 percent of total billed charges 14.6 14.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLARITHROMYCIN 250 MG TABLET RX-9616 CDM A9270 HCPCS 0637 RC 50268-0178-15 NDC outpatient 1 UN 14.6 14.6 14.6 74 10.8 percent of total billed charges 14.6 93 11.83 percent of total billed charges 14.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.6 other OPPS APC 14.6 14.6 other OPPS APC 14.6 24.86 3.63 percent of total billed charges 14.6 14.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLINDAMYCIN 1 % TOPICAL GEL RX-9623 CDM A9270 HCPCS 0250 RC 73473-0300-30 NDC outpatient 30 GR 207.3 207.3 74 153.4 percent of total billed charges 207.3 93 167.91 percent of total billed charges 207.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 207.3 other OPPS APC 207.3 207.3 other OPPS APC 207.3 24.86 51.53 percent of total billed charges 207.3 207.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLINDAMYCIN 1 % TOPICAL GEL RX-9623 CDM A9270 HCPCS 0637 RC 73473-0300-30 NDC outpatient 30 GR 207.3 207.3 207.3 74 153.4 percent of total billed charges 207.3 93 167.91 percent of total billed charges 207.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 207.3 other OPPS APC 207.3 207.3 other OPPS APC 207.3 24.86 51.53 percent of total billed charges 207.3 207.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLINDAMYCIN 2 % VAGINAL CREAM RX-9624 CDM A9270 HCPCS 0250 RC 59762-5009-01 NDC outpatient 40 GR 271.5 271.5 74 200.91 percent of total billed charges 271.5 93 219.92 percent of total billed charges 271.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 271.5 other OPPS APC 271.5 271.5 other OPPS APC 271.5 24.86 67.49 percent of total billed charges 271.5 271.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLINDAMYCIN 2 % VAGINAL CREAM RX-9624 CDM A9270 HCPCS 0637 RC 59762-5009-01 NDC outpatient 40 GR 271.5 271.5 271.5 74 200.91 percent of total billed charges 271.5 93 219.92 percent of total billed charges 271.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 271.5 other OPPS APC 271.5 271.5 other OPPS APC 271.5 24.86 67.49 percent of total billed charges 271.5 271.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLINDAMYCIN 300 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK RX-9625 CDM J0736 HCPCS 0636 RC 00338-3410-24 NDC outpatient 50 ML 21.24 21.24 1.84 1.84 fee schedule 21.24 93 17.2 percent of total billed charges 21.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.47 other OPPS APC 21.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.47 other OPPS APC 21.24 24.86 5.28 percent of total billed charges 1.84 21.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK RX-9626 CDM J0736 HCPCS 0636 RC 00781-3289-09 NDC outpatient 50 ML 37.1 37.1 3.68 3.68 fee schedule 37.1 93 30.05 percent of total billed charges 37.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.93 other OPPS APC 37.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.93 other OPPS APC 37.1 24.86 9.22 percent of total billed charges 3.68 37.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK RX-9627 CDM J0736 HCPCS 0636 RC 00781-3290-09 NDC outpatient 50 ML 45.31 45.31 5.52 5.52 fee schedule 45.31 93 36.7 percent of total billed charges 45.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.4 other OPPS APC 45.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.4 other OPPS APC 45.31 24.86 11.26 percent of total billed charges 5.52 45.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONAZEPAM 0.5 MG TABLET RX-9637 CDM A9270 HCPCS 0250 RC 00904-7227-61 NDC outpatient 1 UN 1.57 1.57 74 1.16 percent of total billed charges 1.57 93 1.27 percent of total billed charges 1.57 1.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONAZEPAM 0.5 MG TABLET RX-9637 CDM A9270 HCPCS 0637 RC 00904-7227-61 NDC outpatient 1 UN 1.57 1.57 1.57 74 1.16 percent of total billed charges 1.57 93 1.27 percent of total billed charges 1.57 1.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONAZEPAM 0.5 MG TABLET RX-9637 CDM A9270 HCPCS 0250 RC 16729-0136-00 NDC outpatient 1 UN 1.88 1.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.88 other OPPS APC 1.88 1.88 other OPPS APC 1.88 24.86 0.47 percent of total billed charges 1.88 1.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONAZEPAM 0.5 MG TABLET RX-9637 CDM A9270 HCPCS 0637 RC 16729-0136-00 NDC outpatient 1 UN 1.88 1.88 1.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.88 other OPPS APC 1.88 1.88 other OPPS APC 1.88 24.86 0.47 percent of total billed charges 1.88 1.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONAZEPAM 1 MG TABLET RX-9638 CDM A9270 HCPCS 0250 RC 50268-0174-15 NDC outpatient 1 UN 1.77 1.77 74 1.31 percent of total billed charges 1.77 93 1.43 percent of total billed charges 1.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.77 other OPPS APC 1.77 1.77 other OPPS APC 1.77 24.86 0.44 percent of total billed charges 1.77 1.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLONAZEPAM 1 MG TABLET RX-9638 CDM A9270 HCPCS 0637 RC 50268-0174-15 NDC outpatient 1 UN 1.77 1.77 1.77 74 1.31 percent of total billed charges 1.77 93 1.43 percent of total billed charges 1.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.77 other OPPS APC 1.77 1.77 other OPPS APC 1.77 24.86 0.44 percent of total billed charges 1.77 1.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOTRIMAZOLE 10 MG TROCHE RX-9644 CDM A9270 HCPCS 0250 RC 00054-8146-22 NDC outpatient 1 UN 8.59 8.59 74 6.36 percent of total billed charges 8.59 93 6.96 percent of total billed charges 8.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.59 other OPPS APC 8.59 8.59 other OPPS APC 8.59 24.86 2.14 percent of total billed charges 8.59 8.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOTRIMAZOLE 10 MG TROCHE RX-9644 CDM A9270 HCPCS 0637 RC 00054-8146-22 NDC outpatient 1 UN 8.59 8.59 8.59 74 6.36 percent of total billed charges 8.59 93 6.96 percent of total billed charges 8.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.59 other OPPS APC 8.59 8.59 other OPPS APC 8.59 24.86 2.14 percent of total billed charges 8.59 8.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOZAPINE 100 MG TABLET RX-9647 CDM A9270 HCPCS 0250 RC 51079-0922-20 NDC outpatient 1 UN 8.57 8.57 74 6.34 percent of total billed charges 8.57 93 6.94 percent of total billed charges 8.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.57 other OPPS APC 8.57 8.57 other OPPS APC 8.57 24.86 2.13 percent of total billed charges 8.57 8.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOZAPINE 100 MG TABLET RX-9647 CDM A9270 HCPCS 0637 RC 51079-0922-20 NDC outpatient 1 UN 8.57 8.57 8.57 74 6.34 percent of total billed charges 8.57 93 6.94 percent of total billed charges 8.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.57 other OPPS APC 8.57 8.57 other OPPS APC 8.57 24.86 2.13 percent of total billed charges 8.57 8.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOZAPINE 25 MG TABLET RX-9648 CDM A9270 HCPCS 0250 RC 51079-0921-20 NDC outpatient 1 UN 3.31 3.31 74 2.45 percent of total billed charges 3.31 93 2.68 percent of total billed charges 3.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.31 other OPPS APC 3.31 3.31 other OPPS APC 3.31 24.86 0.82 percent of total billed charges 3.31 3.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOZAPINE 25 MG TABLET RX-9648 CDM A9270 HCPCS 0637 RC 51079-0921-20 NDC outpatient 1 UN 3.31 3.31 3.31 74 2.45 percent of total billed charges 3.31 93 2.68 percent of total billed charges 3.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.31 other OPPS APC 3.31 3.31 other OPPS APC 3.31 24.86 0.82 percent of total billed charges 3.31 3.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLISTIN (COLISTIMETHATE SODIUM) 150 MG SOLUTION FOR INJECTION RX-9681 CDM J0770 HCPCS 0636 RC 42023-0107-01 NDC outpatient 150 ME 84 84 14.02 14.02 fee schedule 84 93 68.04 percent of total billed charges 84 84 other OPPS APC 84 84 other OPPS APC 84 24.86 20.88 percent of total billed charges 14.02 84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLISTIN (COLISTIMETHATE SODIUM) 150 MG SOLUTION FOR INJECTION RX-9681 CDM J0770 HCPCS 0636 RC 42023-0107-01 NDC outpatient 2 ML 84 84 14.02 14.02 fee schedule 84 93 68.04 percent of total billed charges 84 84 other OPPS APC 84 84 other OPPS APC 84 24.86 20.88 percent of total billed charges 14.02 84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT RX-9682 CDM A9270 HCPCS 0250 RC 50484-0010-30 NDC outpatient 30 GR 907.05 907.05 74 671.22 percent of total billed charges 907.05 93 734.71 percent of total billed charges 907.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 907.05 other OPPS APC 907.05 907.05 other OPPS APC 907.05 24.86 225.49 percent of total billed charges 907.05 907.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT RX-9682 CDM A9270 HCPCS 0637 RC 50484-0010-30 NDC outpatient 30 GR 907.05 907.05 907.05 74 671.22 percent of total billed charges 907.05 93 734.71 percent of total billed charges 907.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 907.05 other OPPS APC 907.05 907.05 other OPPS APC 907.05 24.86 225.49 percent of total billed charges 907.05 907.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION RX-9686 CDM J0834 HCPCS 0636 RC 00548-5900-00 NDC outpatient 0.25 ME 319.74 319.74 31.82 31.82 fee schedule 319.74 93 258.99 percent of total billed charges 319.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 319.74 other OPPS APC 319.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 319.74 other OPPS APC 319.74 24.86 79.49 percent of total billed charges 31.82 319.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION RX-9686 CDM J0834 HCPCS 0636 RC 00548-5900-00 NDC outpatient 2 ML 319.74 319.74 31.82 31.82 fee schedule 319.74 93 258.99 percent of total billed charges 319.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 319.74 other OPPS APC 319.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 319.74 other OPPS APC 319.74 24.86 79.49 percent of total billed charges 31.82 319.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTEMETHER-LUMEFANTRINE 20 MG-120 MG TABLET RX-96948 CDM A9270 HCPCS 0250 RC 00078-0568-45 NDC outpatient 1 UN 16.85 16.85 74 12.47 percent of total billed charges 16.85 93 13.65 percent of total billed charges 16.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.85 other OPPS APC 16.85 16.85 other OPPS APC 16.85 24.86 4.19 percent of total billed charges 16.85 16.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTEMETHER-LUMEFANTRINE 20 MG-120 MG TABLET RX-96948 CDM A9270 HCPCS 0637 RC 00078-0568-45 NDC outpatient 1 UN 16.85 16.85 16.85 74 12.47 percent of total billed charges 16.85 93 13.65 percent of total billed charges 16.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16.85 other OPPS APC 16.85 16.85 other OPPS APC 16.85 24.86 4.19 percent of total billed charges 16.85 16.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LACOSAMIDE 50 MG TABLET RX-96968 CDM A9270 HCPCS 0250 RC 00904-7244-68 NDC outpatient 1 UN 3.7 3.7 74 2.74 percent of total billed charges 3.7 93 3 percent of total billed charges 3.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.7 other OPPS APC 3.7 3.7 other OPPS APC 3.7 24.86 0.92 percent of total billed charges 3.7 3.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LACOSAMIDE 50 MG TABLET RX-96968 CDM A9270 HCPCS 0637 RC 00904-7244-68 NDC outpatient 1 UN 3.7 3.7 3.7 74 2.74 percent of total billed charges 3.7 93 3 percent of total billed charges 3.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.7 other OPPS APC 3.7 3.7 other OPPS APC 3.7 24.86 0.92 percent of total billed charges 3.7 3.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LACOSAMIDE 100 MG TABLET RX-96969 CDM A9270 HCPCS 0250 RC 00904-7245-68 NDC outpatient 1 UN 6.16 6.16 74 4.56 percent of total billed charges 6.16 93 4.99 percent of total billed charges 6.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.16 other OPPS APC 6.16 6.16 other OPPS APC 6.16 24.86 1.53 percent of total billed charges 6.16 6.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LACOSAMIDE 100 MG TABLET RX-96969 CDM A9270 HCPCS 0637 RC 00904-7245-68 NDC outpatient 1 UN 6.16 6.16 6.16 74 4.56 percent of total billed charges 6.16 93 4.99 percent of total billed charges 6.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.16 other OPPS APC 6.16 6.16 other OPPS APC 6.16 24.86 1.53 percent of total billed charges 6.16 6.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION RX-96972 CDM C9254 HCPCS 0636 RC 72205-0220-07 NDC outpatient 20 ML 120 120 120 74 88.8 percent of total billed charges 120 93 97.2 percent of total billed charges 120 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION RX-96972 CDM C9254 HCPCS 0636 RC 83090-0012-10 NDC outpatient 20 ML 120 120 120 120 other OPPS APC 120 120 other OPPS APC 120 24.86 29.83 percent of total billed charges 120 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEGARELIX 80 MG SUBCUTANEOUS SOLUTION RX-96986 CDM J9155 HCPCS 0636 RC 55566-8303-01 NDC outpatient 4 ML 1465.35 1465.35 383.33 383.33 fee schedule 1465.35 93 1186.93 percent of total billed charges 1465.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 334.08 other OPPS APC 1465.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 334.08 other OPPS APC 1465.35 24.86 364.29 percent of total billed charges 383.33 1465.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEGARELIX 120 MG SUBCUTANEOUS SOLUTION RX-96987 CDM J9155 HCPCS 0636 RC 55566-8403-01 NDC outpatient 3 ML 2286.28 2286.28 2286.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 501.12 other OPPS APC 2286.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 501.12 other OPPS APC 2286.28 24.86 568.37 percent of total billed charges 2286.28 2286.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CETIRIZINE 5 MG/5 ML ORAL SOLUTION RX-97141 CDM A9270 HCPCS 0250 RC 68094-0004-62 NDC outpatient 5 ML 7.18 7.18 74 5.31 percent of total billed charges 7.18 93 5.82 percent of total billed charges 7.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.18 other OPPS APC 7.18 7.18 other OPPS APC 7.18 24.86 1.78 percent of total billed charges 7.18 7.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CETIRIZINE 5 MG/5 ML ORAL SOLUTION RX-97141 CDM A9270 HCPCS 0637 RC 68094-0004-62 NDC outpatient 5 ML 7.18 7.18 7.18 74 5.31 percent of total billed charges 7.18 93 5.82 percent of total billed charges 7.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7.18 other OPPS APC 7.18 7.18 other OPPS APC 7.18 24.86 1.78 percent of total billed charges 7.18 7.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DANTROLENE 25 MG CAPSULE RX-9718 CDM A9270 HCPCS 0250 RC 00904-7211-04 NDC outpatient 1 UN 4.75 4.75 74 3.52 percent of total billed charges 4.75 93 3.85 percent of total billed charges 4.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.75 other OPPS APC 4.75 4.75 other OPPS APC 4.75 24.86 1.18 percent of total billed charges 4.75 4.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DANTROLENE 25 MG CAPSULE RX-9718 CDM A9270 HCPCS 0637 RC 00904-7211-04 NDC outpatient 1 UN 4.75 4.75 4.75 74 3.52 percent of total billed charges 4.75 93 3.85 percent of total billed charges 4.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.75 other OPPS APC 4.75 4.75 other OPPS APC 4.75 24.86 1.18 percent of total billed charges 4.75 4.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFEROXAMINE 500 MG SOLUTION FOR INJECTION RX-9723 CDM J0895 HCPCS 0636 RC 63323-0597-10 NDC outpatient 5 ML 38.85 38.85 9.81 9.81 fee schedule 38.85 93 31.47 percent of total billed charges 38.85 38.85 other OPPS APC 38.85 38.85 other OPPS APC 38.85 24.86 9.66 percent of total billed charges 9.81 38.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION RX-97252 CDM 250000000 HCPCS 0250 RC 00641-6013-10 NDC outpatient 5 ML 10.26 10.26 10.26 74 7.59 percent of total billed charges 10.26 93 8.31 percent of total billed charges 10.26 10.26 other OPPS APC 10.26 10.26 other OPPS APC 10.26 24.86 2.55 percent of total billed charges 10.26 10.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TEMOZOLOMIDE 100 MG INTRAVENOUS SOLUTION RX-97260 CDM J9328 HCPCS 0636 RC 00085-1381-01 NDC outpatient 40 ML 3009.33 3009.33 1188.22 1188.22 fee schedule 3009.33 93 2437.56 percent of total billed charges 3009.33 3009.33 other OPPS APC 3009.33 3009.33 other OPPS APC 3009.33 24.86 748.12 percent of total billed charges 1188.22 3009.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOD BICARB-CITRIC AC-SIMETH 2.21 GRAM-1.53 GRAM/4 GRAM GRANULES EFFERV RX-97293 CDM A9270 HCPCS 0250 RC 10361-0793-01 NDC outpatient 1 UN 8.37 8.37 74 6.19 percent of total billed charges 8.37 93 6.78 percent of total billed charges 8.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.37 other OPPS APC 8.37 8.37 other OPPS APC 8.37 24.86 2.08 percent of total billed charges 8.37 8.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOD BICARB-CITRIC AC-SIMETH 2.21 GRAM-1.53 GRAM/4 GRAM GRANULES EFFERV RX-97293 CDM A9270 HCPCS 0637 RC 10361-0793-01 NDC outpatient 1 UN 8.37 8.37 8.37 74 6.19 percent of total billed charges 8.37 93 6.78 percent of total billed charges 8.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8.37 other OPPS APC 8.37 8.37 other OPPS APC 8.37 24.86 2.08 percent of total billed charges 8.37 8.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION RX-97342 CDM 250000000 HCPCS 0250 RC 00143-9638-05 NDC outpatient 6 ME 36 36 36 74 26.64 percent of total billed charges 36 93 29.16 percent of total billed charges 36 36 other OPPS APC 36 36 other OPPS APC 36 24.86 8.95 percent of total billed charges 36 36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCIUM 200 MG (AS CITRATE)-VITAMIN D3 6.25 MCG (250 UNIT) TABLET RX-97353 CDM A9270 HCPCS 0250 RC 00536-3223-01 NDC outpatient 1 UN 0.14 0.14 74 0.1 percent of total billed charges 0.14 93 0.11 percent of total billed charges 0.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.14 other OPPS APC 0.14 0.14 other OPPS APC 0.14 24.86 0.03 percent of total billed charges 0.14 0.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCIUM 200 MG (AS CITRATE)-VITAMIN D3 6.25 MCG (250 UNIT) TABLET RX-97353 CDM A9270 HCPCS 0637 RC 00536-3223-01 NDC outpatient 1 UN 0.14 0.14 0.14 74 0.1 percent of total billed charges 0.14 93 0.11 percent of total billed charges 0.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.14 other OPPS APC 0.14 0.14 other OPPS APC 0.14 24.86 0.03 percent of total billed charges 0.14 0.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VANCOMYCIN 750 MG INTRAVENOUS SOLUTION RX-97371 CDM J3370 HCPCS 0636 RC 71288-0024-21 NDC outpatient 750 ME 27 27 5.49 5.49 fee schedule 27 93 21.87 percent of total billed charges 27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27 other OPPS APC 27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27 other OPPS APC 27 24.86 6.71 percent of total billed charges 5.49 27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION RX-9748 CDM J2597 HCPCS 0636 RC 65219-0293-01 NDC outpatient 1 ML 45 45 33.2 33.2 fee schedule 45 93 36.45 percent of total billed charges 45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 21.68 other OPPS APC 45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 21.68 other OPPS APC 45 24.86 11.19 percent of total billed charges 33.2 45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP RX-9774 CDM A9270 HCPCS 0250 RC 00121-1276-00 NDC outpatient 10 ML 6.92 6.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.92 other OPPS APC 6.92 6.92 other OPPS APC 6.92 24.86 1.72 percent of total billed charges 6.92 6.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP RX-9774 CDM A9270 HCPCS 0637 RC 00121-1276-00 NDC outpatient 10 ML 6.92 6.92 6.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.92 other OPPS APC 6.92 6.92 other OPPS APC 6.92 24.86 1.72 percent of total billed charges 6.92 6.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP RX-9774 CDM A9270 HCPCS 0250 RC 63739-0506-10 NDC outpatient 10 ML 6.92 6.92 74 5.12 percent of total billed charges 6.92 93 5.61 percent of total billed charges 6.92 6.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP RX-9774 CDM A9270 HCPCS 0637 RC 63739-0506-10 NDC outpatient 10 ML 6.92 6.92 6.92 74 5.12 percent of total billed charges 6.92 93 5.61 percent of total billed charges 6.92 6.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 5 % AND LACTATED RINGERS INTRAVENOUS SOLUTION RX-9788 CDM J7121 HCPCS 0636 RC 00338-0125-04 NDC outpatient 1000 ML 17.87 17.87 17.87 74 13.22 percent of total billed charges 17.87 93 14.47 percent of total billed charges 17.87 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.87 other OPPS APC 17.87 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.87 other OPPS APC 17.87 24.86 4.44 percent of total billed charges 17.87 17.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOLVAPTAN 30 MG TABLET RX-97894 CDM A9270 HCPCS 0250 RC 60505-4318-00 NDC outpatient 1 UN 1464.75 1464.75 74 1083.92 percent of total billed charges 1464.75 93 1186.45 percent of total billed charges 1464.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1464.75 other OPPS APC 1464.75 1464.75 other OPPS APC 1464.75 24.86 364.14 percent of total billed charges 1464.75 1464.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOLVAPTAN 30 MG TABLET RX-97894 CDM A9270 HCPCS 0637 RC 60505-4318-00 NDC outpatient 1 UN 1464.75 1464.75 1464.75 74 1083.92 percent of total billed charges 1464.75 93 1186.45 percent of total billed charges 1464.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1464.75 other OPPS APC 1464.75 1464.75 other OPPS APC 1464.75 24.86 364.14 percent of total billed charges 1464.75 1464.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS RX-9795 CDM 250000000 HCPCS 0250 RC 00338-0803-04 NDC outpatient 1000 ML 31.9 31.9 31.9 74 23.61 percent of total billed charges 31.9 93 25.84 percent of total billed charges 31.9 31.9 other OPPS APC 31.9 31.9 other OPPS APC 31.9 24.86 7.93 percent of total billed charges 31.9 31.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) CAPSULE" RX-97953 CDM A9270 HCPCS 0250 RC 77333-0308-10 NDC outpatient 1 UN 0.61 0.61 74 0.45 percent of total billed charges 0.61 93 0.49 percent of total billed charges 0.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.61 other OPPS APC 0.61 0.61 other OPPS APC 0.61 24.86 0.15 percent of total billed charges 0.61 0.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) CAPSULE" RX-97953 CDM A9270 HCPCS 0637 RC 77333-0308-10 NDC outpatient 1 UN 0.61 0.61 0.61 74 0.45 percent of total billed charges 0.61 93 0.49 percent of total billed charges 0.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.61 other OPPS APC 0.61 0.61 other OPPS APC 0.61 24.86 0.15 percent of total billed charges 0.61 0.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV RX-9799 CDM 250000000 HCPCS 0250 RC 00338-0669-04 NDC outpatient 1000 ML 29.12 29.12 29.12 74 21.55 percent of total billed charges 29.12 93 23.59 percent of total billed charges 29.12 29.12 other OPPS APC 29.12 29.12 other OPPS APC 29.12 24.86 7.24 percent of total billed charges 29.12 29.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV RX-9801 CDM 250000000 HCPCS 0250 RC 00338-0671-04 NDC outpatient 1000 ML 17.72 17.72 17.72 74 13.11 percent of total billed charges 17.72 93 14.35 percent of total billed charges 17.72 17.72 other OPPS APC 17.72 17.72 other OPPS APC 17.72 24.86 4.41 percent of total billed charges 17.72 17.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL" RX-98034 CDM A9270 HCPCS 0250 RC 00032-0046-70 NDC outpatient 1 UN 6.24 6.24 74 4.62 percent of total billed charges 6.24 93 5.05 percent of total billed charges 6.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.24 other OPPS APC 6.24 6.24 other OPPS APC 6.24 24.86 1.55 percent of total billed charges 6.24 6.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LIPASE-PROTEASE-AMYLASE 6,000-19,000-30,000 UNIT CAPSULE,DELAYED REL" RX-98034 CDM A9270 HCPCS 0637 RC 00032-0046-70 NDC outpatient 1 UN 6.24 6.24 6.24 74 4.62 percent of total billed charges 6.24 93 5.05 percent of total billed charges 6.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6.24 other OPPS APC 6.24 6.24 other OPPS APC 6.24 24.86 1.55 percent of total billed charges 6.24 6.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL" RX-98036 CDM A9270 HCPCS 0250 RC 00032-2636-01 NDC outpatient 1 UN 24.7 24.7 74 18.28 percent of total billed charges 24.7 93 20.01 percent of total billed charges 24.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.7 other OPPS APC 24.7 24.7 other OPPS APC 24.7 24.86 6.14 percent of total billed charges 24.7 24.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LIPASE-PROTEASE-AMYLASE 24,000-76,000-120,000 UNIT CAPSULE,DELAYED REL" RX-98036 CDM A9270 HCPCS 0637 RC 00032-2636-01 NDC outpatient 1 UN 24.7 24.7 24.7 74 18.28 percent of total billed charges 24.7 93 20.01 percent of total billed charges 24.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24.7 other OPPS APC 24.7 24.7 other OPPS APC 24.7 24.86 6.14 percent of total billed charges 24.7 24.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTASSIUM CHLORIDE 40 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV RX-9807 CDM 250000000 HCPCS 0250 RC 00338-0675-04 NDC outpatient 1000 ML 29.32 29.32 29.32 74 21.7 percent of total billed charges 29.32 93 23.75 percent of total billed charges 29.32 29.32 other OPPS APC 29.32 29.32 other OPPS APC 29.32 24.86 7.29 percent of total billed charges 29.32 29.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 10 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION RX-9808 CDM 250000000 HCPCS 0250 RC 00264-7623-20 NDC outpatient 250 ML 11.22 11.22 11.22 74 8.3 percent of total billed charges 11.22 93 9.09 percent of total billed charges 11.22 11.22 other OPPS APC 11.22 11.22 other OPPS APC 11.22 24.86 2.79 percent of total billed charges 11.22 11.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION RX-9812 CDM 250000000 HCPCS 0250 RC 00338-0077-04 NDC outpatient 1000 ML 18.64 18.64 18.64 74 13.79 percent of total billed charges 18.64 93 15.1 percent of total billed charges 18.64 18.64 other OPPS APC 18.64 18.64 other OPPS APC 18.64 24.86 4.63 percent of total billed charges 18.64 18.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION RX-9814 CDM S5010 HCPCS 0250 RC 00338-0085-04 NDC outpatient 1000 ML 18.65 18.65 18.65 74 13.8 percent of total billed charges 18.65 93 15.11 percent of total billed charges 18.65 18.65 other OPPS APC 18.65 18.65 other OPPS APC 18.65 24.86 4.64 percent of total billed charges 18.65 18.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION RX-9815 CDM J7042 HCPCS 0636 RC 00338-0089-03 NDC outpatient 500 ML 14.18 14.18 1.34 1.34 fee schedule 14.18 93 11.49 percent of total billed charges 14.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.18 other OPPS APC 14.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14.18 other OPPS APC 14.18 24.86 3.53 percent of total billed charges 1.34 14.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION RX-9815 CDM J7042 HCPCS 0636 RC 00338-0089-04 NDC outpatient 1000 ML 17.73 17.73 2.69 2.69 fee schedule 17.73 93 14.36 percent of total billed charges 17.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.73 other OPPS APC 17.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17.73 other OPPS APC 17.73 24.86 4.41 percent of total billed charges 2.69 17.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION RX-98249 CDM J9190 HCPCS 0636 RC 25021-0215-99 NDC outpatient 100 ML 165 165 20.93 20.93 fee schedule 165 93 133.65 percent of total billed charges 165 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165 other OPPS APC 165 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165 other OPPS APC 165 24.86 41.02 percent of total billed charges 20.93 165 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION RX-9828 CDM Q9963 HCPCS 0636 RC 00270-0445-35 NDC outpatient 30 ML 30 30 7.26 7.26 fee schedule 30 93 24.3 percent of total billed charges 30 30 other OPPS APC 30 30 other OPPS APC 30 24.86 7.46 percent of total billed charges 7.26 30 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FERUMOXYTOL 510 MG/17 ML (30 MG/ML) INTRAVENOUS SOLUTION RX-98312 CDM Q0138 HCPCS 0636 RC 59338-0775-01 NDC outpatient 17 ML 3580.85 3580.85 290.04 290.04 fee schedule 3580.85 93 2900.49 percent of total billed charges 3580.85 3580.85 other OPPS APC 3580.85 3580.85 other OPPS APC 3580.85 24.86 890.2 percent of total billed charges 290.04 3580.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRONEDARONE 400 MG TABLET RX-98329 CDM A9270 HCPCS 0250 RC 00024-4142-60 NDC outpatient 1 UN 39.91 39.91 74 29.53 percent of total billed charges 39.91 93 32.33 percent of total billed charges 39.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.91 other OPPS APC 39.91 39.91 other OPPS APC 39.91 24.86 9.92 percent of total billed charges 39.91 39.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRONEDARONE 400 MG TABLET RX-98329 CDM A9270 HCPCS 0637 RC 00024-4142-60 NDC outpatient 1 UN 39.91 39.91 39.91 74 29.53 percent of total billed charges 39.91 93 32.33 percent of total billed charges 39.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.91 other OPPS APC 39.91 39.91 other OPPS APC 39.91 24.86 9.92 percent of total billed charges 39.91 39.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRASUGREL 10 MG TABLET RX-98373 CDM A9270 HCPCS 0250 RC 65862-0830-30 NDC outpatient 1 UN 41.27 41.27 74 30.54 percent of total billed charges 41.27 93 33.43 percent of total billed charges 41.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.27 other OPPS APC 41.27 41.27 other OPPS APC 41.27 24.86 10.26 percent of total billed charges 41.27 41.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRASUGREL 10 MG TABLET RX-98373 CDM A9270 HCPCS 0637 RC 65862-0830-30 NDC outpatient 1 UN 41.27 41.27 41.27 74 30.54 percent of total billed charges 41.27 93 33.43 percent of total billed charges 41.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.27 other OPPS APC 41.27 41.27 other OPPS APC 41.27 24.86 10.26 percent of total billed charges 41.27 41.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CASTOR OIL 100 % ORAL RX-98399 CDM A9270 HCPCS 0250 RC 00395-0515-92 NDC outpatient 59 ML 11.5 11.5 74 8.51 percent of total billed charges 11.5 93 9.32 percent of total billed charges 11.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.5 other OPPS APC 11.5 11.5 other OPPS APC 11.5 24.86 2.86 percent of total billed charges 11.5 11.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CASTOR OIL 100 % ORAL RX-98399 CDM A9270 HCPCS 0637 RC 00395-0515-92 NDC outpatient 59 ML 11.5 11.5 11.5 74 8.51 percent of total billed charges 11.5 93 9.32 percent of total billed charges 11.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11.5 other OPPS APC 11.5 11.5 other OPPS APC 11.5 24.86 2.86 percent of total billed charges 11.5 11.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INDIUM IN-111 OXYQUINOLINE 1 MCI/ML (37 MBQ/ML)(1 ML) INTRAVENOUS SOLN RX-98452 CDM A9570 HCPCS 0343 RC 17156-0021-01 NDC outpatient 1 UN 2625 2625 2625 74 1942.5 percent of total billed charges 2625 93 2126.25 percent of total billed charges 2625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2625 other OPPS APC 2625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2625 other OPPS APC 2625 24.86 652.58 percent of total billed charges 2625 2625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODIUM IODIDE-123 3.7 MBQ (100 MICROCI) CAPSULE RX-98462 CDM A9516 HCPCS 0343 RC 00019-9602-20 NDC outpatient 1 UN 70.29 70.29 70.29 74 52.01 percent of total billed charges 70.29 93 56.93 percent of total billed charges 70.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 70.29 other OPPS APC 70.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 70.29 other OPPS APC 70.29 24.86 17.47 percent of total billed charges 70.29 70.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THALLOUS CHLORIDE TL-201 37 MBQ/ML (1 MCI/ML) INTRAVENOUS SOLUTION RX-98468 CDM A9505 HCPCS 0343 RC 17156-0299-18 NDC outpatient 1.0909 UN 194 194 194 74 143.56 percent of total billed charges 194 93 157.14 percent of total billed charges 194 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 194 other OPPS APC 194 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 194 other OPPS APC 194 24.86 48.23 percent of total billed charges 194 194 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION RX-9859 CDM J1110 HCPCS 0636 RC 81284-0411-05 NDC outpatient 1 ML 234 234 57.74 57.74 fee schedule 234 93 189.54 percent of total billed charges 234 234 other OPPS APC 234 234 other OPPS APC 234 24.86 58.17 percent of total billed charges 57.74 234 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENZONATATE 100 MG CAPSULE RX-988 CDM A9270 HCPCS 0250 RC 00904-7153-61 NDC outpatient 1 UN 1.49 1.49 74 1.1 percent of total billed charges 1.49 93 1.21 percent of total billed charges 1.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.49 other OPPS APC 1.49 1.49 other OPPS APC 1.49 24.86 0.37 percent of total billed charges 1.49 1.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENZONATATE 100 MG CAPSULE RX-988 CDM A9270 HCPCS 0637 RC 00904-7153-61 NDC outpatient 1 UN 1.49 1.49 1.49 74 1.1 percent of total billed charges 1.49 93 1.21 percent of total billed charges 1.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.49 other OPPS APC 1.49 1.49 other OPPS APC 1.49 24.86 0.37 percent of total billed charges 1.49 1.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIPYRIDAMOLE 5 MG/ML INTRAVENOUS SOLUTION RX-9891 CDM J1245 HCPCS 0636 RC 00641-2569-44 NDC outpatient 10 ML 59.4 59.4 21.54 21.54 fee schedule 59.4 93 48.11 percent of total billed charges 59.4 59.4 other OPPS APC 59.4 59.4 other OPPS APC 59.4 24.86 14.77 percent of total billed charges 21.54 59.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION RX-9892 CDM J1250 HCPCS 0636 RC 70436-0203-82 NDC outpatient 20 ML 19.44 19.44 10.08 10.08 fee schedule 19.44 93 15.75 percent of total billed charges 19.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.44 other OPPS APC 19.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19.44 other OPPS APC 19.44 24.86 4.83 percent of total billed charges 10.08 19.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOXAZOSIN 2 MG TABLET RX-9895 CDM A9270 HCPCS 0250 RC 50268-0223-15 NDC outpatient 1 UN 2.55 2.55 74 1.89 percent of total billed charges 2.55 93 2.07 percent of total billed charges 2.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.55 other OPPS APC 2.55 2.55 other OPPS APC 2.55 24.86 0.63 percent of total billed charges 2.55 2.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOXAZOSIN 2 MG TABLET RX-9895 CDM A9270 HCPCS 0637 RC 50268-0223-15 NDC outpatient 1 UN 2.55 2.55 2.55 74 1.89 percent of total billed charges 2.55 93 2.07 percent of total billed charges 2.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2.55 other OPPS APC 2.55 2.55 other OPPS APC 2.55 24.86 0.63 percent of total billed charges 2.55 2.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOXAZOSIN 8 MG TABLET RX-9897 CDM A9270 HCPCS 0250 RC 68382-0786-01 NDC outpatient 1 UN 3.72 3.72 74 2.75 percent of total billed charges 3.72 93 3.01 percent of total billed charges 3.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.72 other OPPS APC 3.72 3.72 other OPPS APC 3.72 24.86 0.92 percent of total billed charges 3.72 3.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOXAZOSIN 8 MG TABLET RX-9897 CDM A9270 HCPCS 0637 RC 68382-0786-01 NDC outpatient 1 UN 3.72 3.72 3.72 74 2.75 percent of total billed charges 3.72 93 3.01 percent of total billed charges 3.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.72 other OPPS APC 3.72 3.72 other OPPS APC 3.72 24.86 0.92 percent of total billed charges 3.72 3.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE RX-9900 CDM A9270 HCPCS 0250 RC 50268-0281-15 NDC outpatient 1 UN 3.11 3.11 74 2.3 percent of total billed charges 3.11 93 2.52 percent of total billed charges 3.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.11 other OPPS APC 3.11 3.11 other OPPS APC 3.11 24.86 0.77 percent of total billed charges 3.11 3.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE RX-9900 CDM A9270 HCPCS 0637 RC 50268-0281-15 NDC outpatient 1 UN 3.11 3.11 3.11 74 2.3 percent of total billed charges 3.11 93 2.52 percent of total billed charges 3.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.11 other OPPS APC 3.11 3.11 other OPPS APC 3.11 24.86 0.77 percent of total billed charges 3.11 3.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOXYCYCLINE MONOHYDRATE 25 MG/5 ML ORAL SUSPENSION RX-9902 CDM A9270 HCPCS 0250 RC 68180-0657-01 NDC outpatient 60 ML 56.93 56.93 74 42.13 percent of total billed charges 56.93 93 46.11 percent of total billed charges 56.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56.93 other OPPS APC 56.93 56.93 other OPPS APC 56.93 24.86 14.15 percent of total billed charges 56.93 56.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOXYCYCLINE MONOHYDRATE 25 MG/5 ML ORAL SUSPENSION RX-9902 CDM A9270 HCPCS 0637 RC 68180-0657-01 NDC outpatient 60 ML 56.93 56.93 56.93 74 42.13 percent of total billed charges 56.93 93 46.11 percent of total billed charges 56.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56.93 other OPPS APC 56.93 56.93 other OPPS APC 56.93 24.86 14.15 percent of total billed charges 56.93 56.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRONABINOL 2.5 MG CAPSULE RX-9904 CDM Q0167 HCPCS 0250 RC 60687-0375-21 NDC outpatient 1 UN 21.23 21.23 74 15.71 percent of total billed charges 21.23 93 17.2 percent of total billed charges 21.23 21.23 other OPPS APC 21.23 21.23 other OPPS APC 21.23 24.86 5.28 percent of total billed charges 21.23 21.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRONABINOL 2.5 MG CAPSULE RX-9904 CDM Q0167 HCPCS 0637 RC 60687-0375-21 NDC outpatient 1 UN 21.23 21.23 21.23 74 15.71 percent of total billed charges 21.23 93 17.2 percent of total billed charges 21.23 21.23 other OPPS APC 21.23 21.23 other OPPS APC 21.23 24.86 5.28 percent of total billed charges 21.23 21.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WHITE PETROLATUM 41 % TOPICAL OINTMENT RX-9922 CDM A9270 HCPCS 0250 RC 72140-0031-47 NDC outpatient 396 GR 56.36 56.36 74 41.71 percent of total billed charges 56.36 93 45.65 percent of total billed charges 56.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56.36 other OPPS APC 56.36 56.36 other OPPS APC 56.36 24.86 14.01 percent of total billed charges 56.36 56.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WHITE PETROLATUM 41 % TOPICAL OINTMENT RX-9922 CDM A9270 HCPCS 0637 RC 72140-0031-47 NDC outpatient 396 GR 56.36 56.36 56.36 74 41.71 percent of total billed charges 56.36 93 45.65 percent of total billed charges 56.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56.36 other OPPS APC 56.36 56.36 other OPPS APC 56.36 24.86 14.01 percent of total billed charges 56.36 56.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENALAPRIL MALEATE 2.5 MG TABLET RX-9925 CDM A9270 HCPCS 0250 RC 51672-4037-01 NDC outpatient 1 UN 3.65 3.65 74 2.7 percent of total billed charges 3.65 93 2.96 percent of total billed charges 3.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.65 other OPPS APC 3.65 3.65 other OPPS APC 3.65 24.86 0.91 percent of total billed charges 3.65 3.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENALAPRIL MALEATE 2.5 MG TABLET RX-9925 CDM A9270 HCPCS 0637 RC 51672-4037-01 NDC outpatient 1 UN 3.65 3.65 3.65 74 2.7 percent of total billed charges 3.65 93 2.96 percent of total billed charges 3.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.65 other OPPS APC 3.65 3.65 other OPPS APC 3.65 24.86 0.91 percent of total billed charges 3.65 3.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENALAPRIL MALEATE 5 MG TABLET RX-9927 CDM A9270 HCPCS 0250 RC 43547-0546-10 NDC outpatient 1 UN 4.63 4.63 74 3.43 percent of total billed charges 4.63 93 3.75 percent of total billed charges 4.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.63 other OPPS APC 4.63 4.63 other OPPS APC 4.63 24.86 1.15 percent of total billed charges 4.63 4.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENALAPRIL MALEATE 5 MG TABLET RX-9927 CDM A9270 HCPCS 0637 RC 43547-0546-10 NDC outpatient 1 UN 4.63 4.63 4.63 74 3.43 percent of total billed charges 4.63 93 3.75 percent of total billed charges 4.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.63 other OPPS APC 4.63 4.63 other OPPS APC 4.63 24.86 1.15 percent of total billed charges 4.63 4.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION RX-9929 CDM 250000000 HCPCS 0250 RC 43598-0078-58 NDC outpatient 1 ML 15.93 15.93 15.93 74 11.79 percent of total billed charges 15.93 93 12.9 percent of total billed charges 15.93 15.93 other OPPS APC 15.93 15.93 other OPPS APC 15.93 24.86 3.96 percent of total billed charges 15.93 15.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS" RX-9943 CDM A9270 HCPCS 0250 RC 75834-0010-60 NDC outpatient 60 ML 88.4 88.4 74 65.42 percent of total billed charges 88.4 93 71.6 percent of total billed charges 88.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 88.4 other OPPS APC 88.4 88.4 other OPPS APC 88.4 24.86 21.98 percent of total billed charges 88.4 88.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS" RX-9943 CDM A9270 HCPCS 0637 RC 75834-0010-60 NDC outpatient 60 ML 88.4 88.4 88.4 74 65.42 percent of total billed charges 88.4 93 71.6 percent of total billed charges 88.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 88.4 other OPPS APC 88.4 88.4 other OPPS APC 88.4 24.86 21.98 percent of total billed charges 88.4 88.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVONORGESTREL 1.5 MG TABLET RX-99445 CDM A9270 HCPCS 0250 RC 00536-1142-63 NDC outpatient 1 UN 22.63 22.63 74 16.75 percent of total billed charges 22.63 93 18.33 percent of total billed charges 22.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.63 other OPPS APC 22.63 22.63 other OPPS APC 22.63 24.86 5.63 percent of total billed charges 22.63 22.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEVONORGESTREL 1.5 MG TABLET RX-99445 CDM A9270 HCPCS 0637 RC 00536-1142-63 NDC outpatient 1 UN 22.63 22.63 22.63 74 16.75 percent of total billed charges 22.63 93 18.33 percent of total billed charges 22.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.63 other OPPS APC 22.63 22.63 other OPPS APC 22.63 24.86 5.63 percent of total billed charges 22.63 22.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION RX-99610 CDM J9263 HCPCS 0636 RC 60505-6132-06 NDC outpatient 10 ML 150 150 7.26 7.26 fee schedule 150 93 121.5 percent of total billed charges 7.26 150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION RX-99610 CDM J9263 HCPCS 0636 RC 72603-0301-01 NDC outpatient 10 ML 370.93 370.93 370.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 370.93 other OPPS APC 370.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 370.93 other OPPS APC 370.93 24.86 92.21 percent of total billed charges 370.93 370.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION RX-99612 CDM J9263 HCPCS 0636 RC 72603-0101-01 NDC outpatient 20 ML 683.93 683.93 14.52 14.52 fee schedule 683.93 93 553.98 percent of total billed charges 683.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 683.93 other OPPS APC 683.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 683.93 other OPPS APC 683.93 24.86 170.02 percent of total billed charges 14.52 683.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ESTRADIOL 1 MG TABLET RX-9967 CDM A9270 HCPCS 0250 RC 42806-0088-01 NDC outpatient 1 UN 1.7 1.7 74 1.26 percent of total billed charges 1.7 93 1.38 percent of total billed charges 1.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.7 other OPPS APC 1.7 1.7 other OPPS APC 1.7 24.86 0.42 percent of total billed charges 1.7 1.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ESTRADIOL 1 MG TABLET RX-9967 CDM A9270 HCPCS 0637 RC 42806-0088-01 NDC outpatient 1 UN 1.7 1.7 1.7 74 1.26 percent of total billed charges 1.7 93 1.38 percent of total billed charges 1.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.7 other OPPS APC 1.7 1.7 other OPPS APC 1.7 24.86 0.42 percent of total billed charges 1.7 1.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET RX-99694 CDM A9270 HCPCS 0250 RC 00115-1365-29 NDC outpatient 1 UN 48.14 48.14 74 35.62 percent of total billed charges 48.14 93 38.99 percent of total billed charges 48.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.14 other OPPS APC 48.14 48.14 other OPPS APC 48.14 24.86 11.97 percent of total billed charges 48.14 48.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET RX-99694 CDM A9270 HCPCS 0637 RC 00115-1365-29 NDC outpatient 1 UN 48.14 48.14 48.14 74 35.62 percent of total billed charges 48.14 93 38.99 percent of total billed charges 48.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.14 other OPPS APC 48.14 48.14 other OPPS APC 48.14 24.86 11.97 percent of total billed charges 48.14 48.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION RX-9972 CDM J1410 HCPCS 0636 RC 00046-0749-05 NDC outpatient 25 ME 1104.15 1104.15 424.52 424.52 fee schedule 1104.15 93 894.36 percent of total billed charges 1104.15 1104.15 other OPPS APC 1104.15 1104.15 other OPPS APC 1104.15 24.86 274.49 percent of total billed charges 424.52 1104.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION RX-9972 CDM J1410 HCPCS 0636 RC 00046-0749-05 NDC outpatient 5 ML 1104.15 1104.15 424.52 424.52 fee schedule 1104.15 93 894.36 percent of total billed charges 1104.15 1104.15 other OPPS APC 1104.15 1104.15 other OPPS APC 1104.15 24.86 274.49 percent of total billed charges 424.52 1104.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONJUGATED ESTROGENS 0.3 MG TABLET RX-9973 CDM A9270 HCPCS 0250 RC 00046-1100-81 NDC outpatient 1 UN 20.72 20.72 74 15.33 percent of total billed charges 20.72 93 16.78 percent of total billed charges 20.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20.72 other OPPS APC 20.72 20.72 other OPPS APC 20.72 24.86 5.15 percent of total billed charges 20.72 20.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONJUGATED ESTROGENS 0.3 MG TABLET RX-9973 CDM A9270 HCPCS 0637 RC 00046-1100-81 NDC outpatient 1 UN 20.72 20.72 20.72 74 15.33 percent of total billed charges 20.72 93 16.78 percent of total billed charges 20.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20.72 other OPPS APC 20.72 20.72 other OPPS APC 20.72 24.86 5.15 percent of total billed charges 20.72 20.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONJUGATED ESTROGENS 0.625 MG TABLET RX-9974 CDM A9270 HCPCS 0250 RC 00046-1102-81 NDC outpatient 1 UN 20.72 20.72 74 15.33 percent of total billed charges 20.72 93 16.78 percent of total billed charges 20.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20.72 other OPPS APC 20.72 20.72 other OPPS APC 20.72 24.86 5.15 percent of total billed charges 20.72 20.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONJUGATED ESTROGENS 0.625 MG TABLET RX-9974 CDM A9270 HCPCS 0637 RC 00046-1102-81 NDC outpatient 1 UN 20.72 20.72 20.72 74 15.33 percent of total billed charges 20.72 93 16.78 percent of total billed charges 20.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20.72 other OPPS APC 20.72 20.72 other OPPS APC 20.72 24.86 5.15 percent of total billed charges 20.72 20.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM RX-9977 CDM A9270 HCPCS 0250 RC 00046-0872-21 NDC outpatient 30 GR 1350.15 1350.15 74 999.11 percent of total billed charges 1350.15 93 1093.62 percent of total billed charges 1350.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350.15 other OPPS APC 1350.15 1350.15 other OPPS APC 1350.15 24.86 335.65 percent of total billed charges 1350.15 1350.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM RX-9977 CDM A9270 HCPCS 0637 RC 00046-0872-21 NDC outpatient 30 GR 1350.15 1350.15 1350.15 74 999.11 percent of total billed charges 1350.15 93 1093.62 percent of total billed charges 1350.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350.15 other OPPS APC 1350.15 1350.15 other OPPS APC 1350.15 24.86 335.65 percent of total billed charges 1350.15 1350.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ETHACRYNATE SODIUM 50 MG INTRAVENOUS SOLUTION RX-9979 CDM A9270 HCPCS 0250 RC 42023-0157-01 NDC outpatient 50 ME 11400 11400 74 8436 percent of total billed charges 11400 93 9234 percent of total billed charges 11400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11400 other OPPS APC 11400 11400 other OPPS APC 11400 24.86 2834.04 percent of total billed charges 11400 11400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ETHACRYNATE SODIUM 50 MG INTRAVENOUS SOLUTION RX-9979 CDM A9270 HCPCS 0250 RC 42023-0157-01 NDC outpatient 50 ML 11400 11400 74 8436 percent of total billed charges 11400 93 9234 percent of total billed charges 11400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11400 other OPPS APC 11400 11400 other OPPS APC 11400 24.86 2834.04 percent of total billed charges 11400 11400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ETHACRYNATE SODIUM 50 MG INTRAVENOUS SOLUTION RX-9979 CDM A9270 HCPCS 0637 RC 42023-0157-01 NDC outpatient 50 ME 11400 11400 11400 74 8436 percent of total billed charges 11400 93 9234 percent of total billed charges 11400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11400 other OPPS APC 11400 11400 other OPPS APC 11400 24.86 2834.04 percent of total billed charges 11400 11400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ETHACRYNATE SODIUM 50 MG INTRAVENOUS SOLUTION RX-9979 CDM A9270 HCPCS 0637 RC 42023-0157-01 NDC outpatient 50 ML 11400 11400 11400 74 8436 percent of total billed charges 11400 93 9234 percent of total billed charges 11400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11400 other OPPS APC 11400 11400 other OPPS APC 11400 24.86 2834.04 percent of total billed charges 11400 11400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ETHACRYNIC ACID 25 MG TABLET RX-9980 CDM A9270 HCPCS 0250 RC 68180-0159-01 NDC outpatient 1 UN 59.88 59.88 74 44.31 percent of total billed charges 59.88 93 48.5 percent of total billed charges 59.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.88 other OPPS APC 59.88 59.88 other OPPS APC 59.88 24.86 14.89 percent of total billed charges 59.88 59.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ETHACRYNIC ACID 25 MG TABLET RX-9980 CDM A9270 HCPCS 0637 RC 68180-0159-01 NDC outpatient 1 UN 59.88 59.88 59.88 74 44.31 percent of total billed charges 59.88 93 48.5 percent of total billed charges 59.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 59.88 other OPPS APC 59.88 59.88 other OPPS APC 59.88 24.86 14.89 percent of total billed charges 59.88 59.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ETHAMBUTOL 400 MG TABLET RX-9983 CDM A9270 HCPCS 0250 RC 68084-0280-01 NDC outpatient 1 UN 4.07 4.07 74 3.01 percent of total billed charges 4.07 93 3.3 percent of total billed charges 4.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.07 other OPPS APC 4.07 4.07 other OPPS APC 4.07 24.86 1.01 percent of total billed charges 4.07 4.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ETHAMBUTOL 400 MG TABLET RX-9983 CDM A9270 HCPCS 0637 RC 68084-0280-01 NDC outpatient 1 UN 4.07 4.07 4.07 74 3.01 percent of total billed charges 4.07 93 3.3 percent of total billed charges 4.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4.07 other OPPS APC 4.07 4.07 other OPPS APC 4.07 24.86 1.01 percent of total billed charges 4.07 4.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENZTROPINE 1 MG TABLET RX-999 CDM A9270 HCPCS 0250 RC 00904-7289-61 NDC outpatient 1 UN 1.42 1.42 74 1.05 percent of total billed charges 1.42 93 1.15 percent of total billed charges 1.42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.42 other OPPS APC 1.42 1.42 other OPPS APC 1.42 24.86 0.35 percent of total billed charges 1.42 1.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENZTROPINE 1 MG TABLET RX-999 CDM A9270 HCPCS 0637 RC 00904-7289-61 NDC outpatient 1 UN 1.42 1.42 1.42 74 1.05 percent of total billed charges 1.42 93 1.15 percent of total billed charges 1.42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.42 other OPPS APC 1.42 1.42 other OPPS APC 1.42 24.86 0.35 percent of total billed charges 1.42 1.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX 2.7MM LP LOCKING 12MM SUP-#AR-8827L-12 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX 2.7MM LP LOCKING 14MM SUP-#AR-8827L-14 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX 2.7MM LP LOCKING 16MM SUP-#AR-8827L-16 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX 2.7MM LP LOCKING 18MM SUP-#AR-8827L-18 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX 2.7MM LP LOCKING 20MM SUP-#AR-8827L-20 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX 2.7MM LP LOCKING 22MM SUP-#AR-8827L-22 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX 2.7MM LP LOCKING 24MM SUP-#AR-8827L-24 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX 2.7MM LP LOCKING 26MM #AR-8827L-26 SUP-#AR-8827L-26 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1.7 X 7MM CROSSPIN ST SUP-0 CDM C1713 HCPCS 0278 RC outpatient 244.02 244.02 244.02 57 139.09 percent of total billed charges 244.02 93 197.66 percent of total billed charges 244.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 244.02 other OPPS APC 244.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 244.02 other OPPS APC 244.02 51 124.45 percent of total billed charges 244.02 244.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION STEINMANN STAINLESS STEEL L229 MM OD2.4 MM 1 END DIAMOND POINT STYLE 6 THREAD NONSTERILE SUP-00-0262-006-04 CDM 0270 RC outpatient 49.81 49.81 49.81 74 36.86 percent of total billed charges 49.81 93 40.35 percent of total billed charges 49.81 49.81 other OPPS APC 49.81 49.81 other OPPS APC 49.81 27.63 13.76 percent of total billed charges 49.81 49.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE BONE STAINLESS STEEL L19 MM X W8.7 IN OD2 MM BARB NONSTERILE SUP-00-2229-002-00 CDM 0270 RC outpatient 131.12 131.12 131.12 74 97.03 percent of total billed charges 131.12 93 106.21 percent of total billed charges 131.12 131.12 other OPPS APC 131.12 131.12 other OPPS APC 131.12 27.63 36.23 percent of total billed charges 131.12 131.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE BONE STAINLESS STEEL L22 MM X W8.7 MM OD2 MM BARB NONSTERILE SUP-00-2229-003-00 CDM 0270 RC outpatient 131.12 131.12 131.12 74 97.03 percent of total billed charges 131.12 93 106.21 percent of total billed charges 131.12 131.12 other OPPS APC 131.12 131.12 other OPPS APC 131.12 27.63 36.23 percent of total billed charges 131.12 131.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE BONE STAINLESS STEEL L25.4 MM X W8.7 MM OD2 MM BARB NONSTERILE SUP-00-2229-004-00 CDM 0270 RC outpatient 102.86 102.86 102.86 74 76.12 percent of total billed charges 102.86 93 83.32 percent of total billed charges 102.86 102.86 other OPPS APC 102.86 102.86 other OPPS APC 102.86 27.63 28.42 percent of total billed charges 102.86 102.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE ORTHOPEDIC CABLE-READY STAINLESS STEEL L914 MM OD1.8 MM CERCLAGE STERILE SUP-00-2232-001-28 CDM 0270 RC outpatient 1176.19 1176.19 1176.19 74 870.38 percent of total billed charges 1176.19 93 952.71 percent of total billed charges 1176.19 1176.19 other OPPS APC 1176.19 1176.19 other OPPS APC 1176.19 27.63 324.98 percent of total billed charges 1176.19 1176.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CABLE CABLE-READY LONG L121 MM X W23 MM 4 INTEGRAL GREATER TROCHANTER REATTACHMENT SUP-00-2232-002-05 CDM 0270 RC outpatient 6690.74 6690.74 6690.74 74 4951.15 percent of total billed charges 6690.74 93 5419.5 percent of total billed charges 6690.74 6690.74 other OPPS APC 6690.74 6690.74 other OPPS APC 6690.74 27.63 1848.65 percent of total billed charges 6690.74 6690.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASSEMBLY CABLE PIN ZIMMER CABLE-READY COCR L91 CM L14.5 MM X H4 MM OD1.8 MM CERCLAGE STERILE NCB SUP-00-2232-002-28 CDM 0270 RC outpatient 656.19 656.19 656.19 74 485.58 percent of total billed charges 656.19 93 531.51 percent of total billed charges 656.19 656.19 other OPPS APC 656.19 656.19 other OPPS APC 656.19 27.63 181.31 percent of total billed charges 656.19 656.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE ORTHOPEDIC CABLE-READY COCR L635 CM OD1.8 MM TROCHANTER CERCLAGE CRIMP SUP-00-2232-004-18 CDM 0270 RC outpatient 1021.93 1021.93 1021.93 74 756.23 percent of total billed charges 1021.93 93 827.76 percent of total billed charges 1021.93 1021.93 other OPPS APC 1021.93 1021.93 other OPPS APC 1021.93 27.63 282.36 percent of total billed charges 1021.93 1021.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE ORTHOPEDIC CABLE-READY COCR LONG L635 MM OD1.8 MM INTEGRAL CRIMP GRIP STERILE GREATER TROCHANTER REATTACHMENT SUP-00-2232-005-18 CDM 0270 RC outpatient 732.71 732.71 732.71 74 542.21 percent of total billed charges 732.71 93 593.5 percent of total billed charges 732.71 732.71 other OPPS APC 732.71 732.71 other OPPS APC 732.71 27.63 202.45 percent of total billed charges 732.71 732.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CABLE CABLE-READY SHORT L53 MM X W23 MM 2 INTEGRAL LATEX FREE GREATER TROCHANTER REATTACHMENT SUP-00-2232-02-04 CDM 0270 RC outpatient 4021.99 4021.99 4021.99 74 2976.27 percent of total billed charges 4021.99 93 3257.81 percent of total billed charges 4021.99 4021.99 other OPPS APC 4021.99 4021.99 other OPPS APC 4021.99 27.63 1111.28 percent of total billed charges 4021.99 4021.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM ODSEC2.7 MM ELBOW PERIARTICULAR CORTICAL SELF TAP NONSTERILE SUP-00-2348-010-35 CDM 0270 RC outpatient 100.28 100.28 100.28 74 74.21 percent of total billed charges 100.28 93 81.23 percent of total billed charges 100.28 100.28 other OPPS APC 100.28 100.28 other OPPS APC 100.28 27.63 27.71 percent of total billed charges 100.28 100.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L12 MM OD3.5 MM ODSEC2.7 MM ELBOW CORTICAL PERIARTICULAR SELF TAP NONSTERILE SUP-00-2348-012-35 CDM 0270 RC outpatient 97.34 97.34 97.34 74 72.03 percent of total billed charges 97.34 93 78.85 percent of total billed charges 97.34 97.34 other OPPS APC 97.34 97.34 other OPPS APC 97.34 27.63 26.9 percent of total billed charges 97.34 97.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC2.7 MM ELBOW CORTICAL PERIARTICULAR SELF TAP NONSTERILE SUP-00-2348-014-35 CDM 0270 RC outpatient 97.34 97.34 97.34 74 72.03 percent of total billed charges 97.34 93 78.85 percent of total billed charges 97.34 97.34 other OPPS APC 97.34 97.34 other OPPS APC 97.34 27.63 26.9 percent of total billed charges 97.34 97.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L16 MM OD3.5 MM ODSEC2.7 MM ELBOW CORTICAL PERIARTICULAR SELF TAP NONSTERILE SUP-00-2348-016-35 CDM 0270 RC outpatient 100.28 100.28 100.28 74 74.21 percent of total billed charges 100.28 93 81.23 percent of total billed charges 100.28 100.28 other OPPS APC 100.28 100.28 other OPPS APC 100.28 27.63 27.71 percent of total billed charges 100.28 100.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC2.7 MM ELBOW CORTICAL PERIARTICULAR SELF TAP NONSTERILE SUP-00-2348-018-35 CDM 0270 RC outpatient 89.13 89.13 89.13 74 65.96 percent of total billed charges 89.13 93 72.2 percent of total billed charges 89.13 89.13 other OPPS APC 89.13 89.13 other OPPS APC 89.13 27.63 24.63 percent of total billed charges 89.13 89.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC2.7 MM ELBOW CORTICAL PERIARTICULAR SELF TAP NONSTERILE SUP-00-2348-020-35 CDM 0270 RC outpatient 97.34 97.34 97.34 74 72.03 percent of total billed charges 97.34 93 78.85 percent of total billed charges 97.34 97.34 other OPPS APC 97.34 97.34 other OPPS APC 97.34 27.63 26.9 percent of total billed charges 97.34 97.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L22 MM OD3.5 MM ODSEC2.7 MM ELBOW CORTICAL PERIARTICULAR SELF TAP NONSTERILE SUP-00-2348-022-35 CDM 0270 RC outpatient 97.34 97.34 97.34 74 72.03 percent of total billed charges 97.34 93 78.85 percent of total billed charges 97.34 97.34 other OPPS APC 97.34 97.34 other OPPS APC 97.34 27.63 26.9 percent of total billed charges 97.34 97.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L106 MM FIBULAR RIGHT DISTAL LATERAL 6 HOLE LOCK NONSTERILE 2.7-3.5 MM SCREW SUP-00-2357-017-06 CDM 0270 RC outpatient 1872 1872 1872 74 1385.28 percent of total billed charges 1872 93 1516.32 percent of total billed charges 1872 1872 other OPPS APC 1872 1872 other OPPS APC 1872 27.63 517.23 percent of total billed charges 1872 1872 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L80 MM FIBULAR LEFT DISTAL LATERAL 4 HOLE LOCK LOW PROFILE COMPRESSION NONSTERILE 2.7-3.5 MM SCREW SUP-00-2357-018-04 CDM 0270 RC outpatient 1802.84 1802.84 1802.84 74 1334.1 percent of total billed charges 1802.84 93 1460.3 percent of total billed charges 1802.84 1802.84 other OPPS APC 1802.84 1802.84 other OPPS APC 1802.84 27.63 498.12 percent of total billed charges 1802.84 1802.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L106 MM FIBULA LEFT DISTAL LATERAL 6 HOLE LOCK NONSTERILE 2.7-3.5 MM SCREW SUP-00-2357-018-06 CDM 0270 RC outpatient 1872 1872 1872 74 1385.28 percent of total billed charges 1872 93 1516.32 percent of total billed charges 1872 1872 other OPPS APC 1872 1872 other OPPS APC 1872 27.63 517.23 percent of total billed charges 1872 1872 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL STANDARD OD2 MM LATEX FREE SUP-00-2360-175-20 CDM 0270 RC outpatient 578.45 578.45 578.45 74 428.05 percent of total billed charges 578.45 93 468.54 percent of total billed charges 578.45 578.45 other OPPS APC 578.45 578.45 other OPPS APC 578.45 27.63 159.83 percent of total billed charges 578.45 578.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL STANDARD OD2.7 MM LATEX FREE SUP-00-2360-205-27 CDM 0270 RC outpatient 346.32 346.32 346.32 74 256.28 percent of total billed charges 346.32 93 280.52 percent of total billed charges 346.32 346.32 other OPPS APC 346.32 346.32 other OPPS APC 346.32 27.63 95.69 percent of total billed charges 346.32 346.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE BONE ZIMALOY L25 MM X W16.2 MM EPIPHYSIS NONSTERILE SUP-00-4060-002-00 CDM 0270 RC outpatient 259.38 259.38 259.38 74 191.94 percent of total billed charges 259.38 93 210.1 percent of total billed charges 259.38 259.38 other OPPS APC 259.38 259.38 other OPPS APC 259.38 27.63 71.67 percent of total billed charges 259.38 259.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER HUMERAL TRABECULAR METAL 12 MM SHOULDER REVERSE SUP-00-4349-039-12 CDM 270010024 LOCAL 0270 RC outpatient 1674.4 1674.4 1674.4 74 1239.06 percent of total billed charges 1674.4 93 1356.26 percent of total billed charges 1674.4 1674.4 other OPPS APC 1674.4 1674.4 other OPPS APC 1674.4 27.63 462.64 percent of total billed charges 1674.4 1674.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER SHOULDER TRABECULAR METAL POLYETHYLENE 7 D STANDARD H+6 MM OD40 MM HUMERUS REVERSE STERILE SUP-00-4349-040-06 CDM 270010024 LOCAL 0270 RC outpatient 3471.03 3471.03 3471.03 74 2568.56 percent of total billed charges 3471.03 93 2811.53 percent of total billed charges 3471.03 3471.03 other OPPS APC 3471.03 3471.03 other OPPS APC 3471.03 27.63 959.05 percent of total billed charges 3471.03 3471.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER SHOULDER TRABECULAR METAL POLYETHYLENE 12 D 65 D H+6 MM OD36 MM HUMERUS REVERSE RETENTIVE STERILE SUP-00-4349-065-06 CDM 270010024 LOCAL 0270 RC outpatient 2639 2639 2639 74 1952.86 percent of total billed charges 2639 93 2137.59 percent of total billed charges 2639 2639 other OPPS APC 2639 2639 other OPPS APC 2639 27.63 729.16 percent of total billed charges 2639 2639 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT TALAR TRABECULAR METAL 2 LEFT TOTAL ANKLE SUP-00-4500-012-00 CDM 0270 RC outpatient 14872 14872 14872 74 11005.3 percent of total billed charges 14872 93 12046.3 percent of total billed charges 14872 14872 other OPPS APC 14872 14872 other OPPS APC 14872 27.63 4109.13 percent of total billed charges 14872 14872 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT TALAR TRABECULAR METAL 3 LEFT TOTAL ANKLE SUP-00-4500-013-00 CDM 0270 RC outpatient 14872 14872 14872 74 11005.3 percent of total billed charges 14872 93 12046.3 percent of total billed charges 14872 14872 other OPPS APC 14872 14872 other OPPS APC 14872 27.63 4109.13 percent of total billed charges 14872 14872 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT TALAR TRABECULAR METAL 5 LEFT TOTAL ANKLE SUP-00-4500-015-00 CDM 0270 RC outpatient 14872 14872 14872 74 11005.3 percent of total billed charges 14872 93 12046.3 percent of total billed charges 14872 14872 other OPPS APC 14872 14872 other OPPS APC 14872 27.63 4109.13 percent of total billed charges 14872 14872 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANKLE TM TOTAL RIGHT TALUS SIZE 2 SUP-00-4500-022-00 CDM 0270 RC outpatient 14872 14872 14872 74 11005.3 percent of total billed charges 14872 93 12046.3 percent of total billed charges 14872 14872 other OPPS APC 14872 14872 other OPPS APC 14872 27.63 4109.13 percent of total billed charges 14872 14872 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT TALAR TRABECULAR METAL 3 RIGHT TOTAL ANKLE SUP-00-4500-023-00 CDM 0270 RC outpatient 14872 14872 14872 74 11005.3 percent of total billed charges 14872 93 12046.3 percent of total billed charges 14872 14872 other OPPS APC 14872 14872 other OPPS APC 14872 27.63 4109.13 percent of total billed charges 14872 14872 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT TALAR TRABECULAR METAL 4 RIGHT TOTAL ANKLE SUP-00-4500-024-00 CDM 0270 RC outpatient 14872 14872 14872 74 11005.3 percent of total billed charges 14872 93 12046.3 percent of total billed charges 14872 14872 other OPPS APC 14872 14872 other OPPS APC 14872 27.63 4109.13 percent of total billed charges 14872 14872 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TALUS ZIMMER TM TOTAL ANKLE RIGHT SIZE 5 SUP-00-4500-025-00 CDM 0270 RC outpatient 14872 14872 14872 74 11005.3 percent of total billed charges 14872 93 12046.3 percent of total billed charges 14872 14872 other OPPS APC 14872 14872 other OPPS APC 14872 27.63 4109.13 percent of total billed charges 14872 14872 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT TIBIAL TRABECULAR METAL 2 TOTAL ANKLE SUP-00-4500-042-00 CDM 0270 RC outpatient 11440 11440 11440 74 8465.6 percent of total billed charges 11440 93 9266.4 percent of total billed charges 11440 11440 other OPPS APC 11440 11440 other OPPS APC 11440 27.63 3160.87 percent of total billed charges 11440 11440 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT TIBIAL TRABECULAR METAL 3 TOTAL ANKLE SUP-00-4500-043-00 CDM 0270 RC outpatient 11440 11440 11440 74 8465.6 percent of total billed charges 11440 93 9266.4 percent of total billed charges 11440 11440 other OPPS APC 11440 11440 other OPPS APC 11440 27.63 3160.87 percent of total billed charges 11440 11440 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT TIBIAL TRABECULAR METAL 4 TOTAL ANKLE SUP-00-4500-044-00 CDM 0270 RC outpatient 11440 11440 11440 74 8465.6 percent of total billed charges 11440 93 9266.4 percent of total billed charges 11440 11440 other OPPS APC 11440 11440 other OPPS APC 11440 27.63 3160.87 percent of total billed charges 11440 11440 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT TIBIAL TRABECULAR METAL 5 TOTAL ANKLE SUP-00-4500-045-00 CDM 0270 RC outpatient 11440 11440 11440 74 8465.6 percent of total billed charges 11440 93 9266.4 percent of total billed charges 11440 11440 other OPPS APC 11440 11440 other OPPS APC 11440 27.63 3160.87 percent of total billed charges 11440 11440 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL PROLONG ANKLE SUP-00-4500-052-00 CDM 270010025 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL PROLONG +0 3 ANKLE SUP-00-4500-053-00 CDM 270010025 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL PROLONG +0 4 ANKLE SUP-00-4500-054-00 CDM 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL PROLONG +2 4 ANKLE SUP-00-4500-054-02 CDM 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL PROLONG +0 5 ANKLE SUP-00-4500-055-00 CDM 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION TRABECULAR METAL CALCANEUS ANKLE SUP-00-4501-040-00 CDM 0270 RC outpatient 702 702 702 74 519.48 percent of total billed charges 702 93 568.62 percent of total billed charges 702 702 other OPPS APC 702 702 other OPPS APC 702 27.63 193.96 percent of total billed charges 702 702 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER TRABECULAR METAL OD1.6 MM ANKLE SUP-00-4501-040-01 CDM 0270 RC outpatient 210.6 210.6 210.6 74 155.84 percent of total billed charges 210.6 93 170.59 percent of total billed charges 210.6 210.6 other OPPS APC 210.6 210.6 other OPPS APC 210.6 27.63 58.19 percent of total billed charges 210.6 210.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN EXTERNAL FIXATION L4 MM ANKLE SUP-00-4501-040-04 CDM 0270 RC outpatient 403 403 403 74 298.22 percent of total billed charges 403 93 326.43 percent of total billed charges 403 403 other OPPS APC 403 403 other OPPS APC 403 27.63 111.35 percent of total billed charges 403 403 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN EXTERNAL FIXATION L5 MM ANKLE SUP-00-4501-040-05 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE ORTHOPEDIC PROTECTIVE SUP-00-4501-065-01 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SURGICAL ANKLE SUP-00-4501-076-00 CDM 0270 RC outpatient 819 819 819 74 606.06 percent of total billed charges 819 93 663.39 percent of total billed charges 819 819 other OPPS APC 819 819 other OPPS APC 819 27.63 226.29 percent of total billed charges 819 819 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL STAINLESS STEEL L110 MM OD2.5 MM QUICK CONNECT NONSTERILE SUP-00-4806-110-25 CDM 0270 RC outpatient 202.46 202.46 202.46 74 149.82 percent of total billed charges 202.46 93 163.99 percent of total billed charges 202.46 202.46 other OPPS APC 202.46 202.46 other OPPS APC 202.46 27.63 55.94 percent of total billed charges 202.46 202.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L10 MM OD2.7 MM ELBOW PERIARTICULAR LOCK NONSTERILE SMALL FRAGMENT UNIVERSAL SYSTEM SUP-00-4828-010-02 CDM 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L12 MM OD2.7 MM ELBOW PERIARTICULAR LOCK NONSTERILE SMALL FRAGMENT UNIVERSAL LOCK SYSTEM SUP-00-4828-012-02 CDM 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L14 MM OD2.7 MM ELBOW PERIARTICULAR LOCK NONSTERILE SMALL FRAGMENT UNIVERSAL LOCK SYSTEM SUP-00-4828-014-02 CDM 0270 RC outpatient 298.87 298.87 298.87 74 221.16 percent of total billed charges 298.87 93 242.08 percent of total billed charges 298.87 298.87 other OPPS APC 298.87 298.87 other OPPS APC 298.87 27.63 82.58 percent of total billed charges 298.87 298.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L16 MM OD2.7 MM ELBOW PERIARTICULAR LOCK NONSTERILE SMALL FRAGMENT UNIVERSAL LOCK SYSTEM SUP-00-4828-016-02 CDM 0270 RC outpatient 298.87 298.87 298.87 74 221.16 percent of total billed charges 298.87 93 242.08 percent of total billed charges 298.87 298.87 other OPPS APC 298.87 298.87 other OPPS APC 298.87 27.63 82.58 percent of total billed charges 298.87 298.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L18 MM OD2.7 MM ELBOW PERIARTICULAR LOCK NONSTERILE SMALL FRAGMENT UNIVERSAL LOCK SYSTEM SUP-00-4828-018-02 CDM 0270 RC outpatient 298.87 298.87 298.87 74 221.16 percent of total billed charges 298.87 93 242.08 percent of total billed charges 298.87 298.87 other OPPS APC 298.87 298.87 other OPPS APC 298.87 27.63 82.58 percent of total billed charges 298.87 298.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT ACETABULAR TRABECULAR METAL 15 D HIP SHIM REVISION SYSTEM SUP-00-4894-001-15 CDM 0270 RC outpatient 2382.9 2382.9 2382.9 74 1763.35 percent of total billed charges 2382.9 93 1930.15 percent of total billed charges 2382.9 2382.9 other OPPS APC 2382.9 2382.9 other OPPS APC 2382.9 27.63 658.4 percent of total billed charges 2382.9 2382.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT ACETABULAR TRABECULAR METAL STRAIGHT OD58 MM HIP BUTTRESS REVISION SYSTEM SUP-00-4894-001-58 CDM 270010024 LOCAL 0270 RC outpatient 7267 7267 7267 74 5377.58 percent of total billed charges 7267 93 5886.27 percent of total billed charges 7267 7267 other OPPS APC 7267 7267 other OPPS APC 7267 27.63 2007.87 percent of total billed charges 7267 7267 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER BIPOLAR LEGACY POLY OD42/43 MM ID22 MM HIP STERILE SUP-00-5001-042-22 CDM 270010024 LOCAL 0270 RC outpatient 741 741 741 74 548.34 percent of total billed charges 741 93 600.21 percent of total billed charges 741 741 other OPPS APC 741 741 other OPPS APC 741 27.63 204.74 percent of total billed charges 741 741 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL BIPOLAR MULTIPOLAR METAL OD43 MM HIP SUP-00-5001-043-00 CDM 270010024 LOCAL 0270 RC outpatient 1528.8 1528.8 1528.8 74 1131.31 percent of total billed charges 1528.8 93 1238.33 percent of total billed charges 1528.8 1528.8 other OPPS APC 1528.8 1528.8 other OPPS APC 1528.8 27.63 422.41 percent of total billed charges 1528.8 1528.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOWL BONE CEMENT QUICK-VAC VACUUM MIX LATEX FREE DISPOSABLE SUP-00-5049-001-00 CDM 0270 RC outpatient 167.4 167.4 167.4 74 123.88 percent of total billed charges 167.4 93 135.59 percent of total billed charges 167.4 167.4 other OPPS APC 167.4 167.4 other OPPS APC 167.4 27.63 46.25 percent of total billed charges 167.4 167.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOWL CEMENT MIXING ORTHOPAEDIC STERILE WITH SPATULA DISPOSABLE SUP-00-5049-001-15 CDM 270009196 LOCAL 0270 RC outpatient 153.24 153.24 153.24 74 113.4 percent of total billed charges 153.24 93 124.12 percent of total billed charges 153.24 153.24 other OPPS APC 153.24 153.24 other OPPS APC 153.24 27.63 42.34 percent of total billed charges 153.24 153.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN BONE HOLDING HEX HEAD SUP-00-5061-063-00 CDM 0270 RC outpatient 192.4 192.4 192.4 74 142.38 percent of total billed charges 192.4 93 155.84 percent of total billed charges 192.4 192.4 other OPPS APC 192.4 192.4 other OPPS APC 192.4 27.63 53.16 percent of total billed charges 192.4 192.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NOZZLE BONE CEMENT MILLER L12 MM OD.25 IN INJECTOR FLEXIBLE STERILE DISPOSABLE SUP-00-5069-054-00 CDM 0270 RC outpatient 54.08 54.08 54.08 74 40.02 percent of total billed charges 54.08 93 43.8 percent of total billed charges 54.08 54.08 other OPPS APC 54.08 54.08 other OPPS APC 54.08 27.63 14.94 percent of total billed charges 54.08 54.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP PULSED LAVAGE L22.86 CM OD.89 CM FEMUR RADIAL SPRAY HIGH CAPACITY STERILE INTRAMEDULLARY NAIL PULSAVAC PLUS PULSAVAC PLUS AC SUP-00-5150-182-00 CDM 0270 RC outpatient 18.72 18.72 18.72 74 13.85 percent of total billed charges 18.72 93 15.16 percent of total billed charges 18.72 18.72 other OPPS APC 18.72 18.72 other OPPS APC 18.72 27.63 5.17 percent of total billed charges 18.72 18.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONE COUPLED 7D SZ2 5MM 31X31 LCCK SUP-00-5446-052-21 CDM 270010024 LOCAL 0270 RC outpatient 12767 12767 12767 74 9447.61 percent of total billed charges 12767 93 10341.3 percent of total billed charges 12767 12767 other OPPS APC 12767 12767 other OPPS APC 12767 27.63 3527.53 percent of total billed charges 12767 12767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONE ZIMMER TM COUPLED LCCK 7D SIZE 5 5MM SUP-00-5446-055-31 CDM 270010024 LOCAL 0270 RC outpatient 14414.4 14414.4 14414.4 74 10666.7 percent of total billed charges 14414.4 93 11675.7 percent of total billed charges 14414.4 14414.4 other OPPS APC 14414.4 14414.4 other OPPS APC 14414.4 27.63 3982.7 percent of total billed charges 14414.4 14414.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIALCCK SIZE 3 5MM SUP-00-5447-053-31 CDM 270010025 LOCAL 0270 RC outpatient 13751.4 13751.4 13751.4 74 10176 percent of total billed charges 13751.4 93 11138.6 percent of total billed charges 13751.4 13751.4 other OPPS APC 13751.4 13751.4 other OPPS APC 13751.4 27.63 3799.51 percent of total billed charges 13751.4 13751.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT NEXGEN LCCK SIZE 3 5MM SUP-00-5447-053-36 CDM 270010025 LOCAL 0270 RC outpatient 13751.4 13751.4 13751.4 74 10176 percent of total billed charges 13751.4 93 11138.6 percent of total billed charges 13751.4 13751.4 other OPPS APC 13751.4 13751.4 other OPPS APC 13751.4 27.63 3799.51 percent of total billed charges 13751.4 13751.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT LCCK 0D SIZE 4 5MM SUP-00-5447-054-31 CDM 270010025 LOCAL 0270 RC outpatient 12766 12766 12766 74 9446.84 percent of total billed charges 12766 93 10340.5 percent of total billed charges 12766 12766 other OPPS APC 12766 12766 other OPPS APC 12766 27.63 3527.25 percent of total billed charges 12766 12766 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK SIZE 4 5MM SUP-00-5447-054-36 CDM 270010025 LOCAL 0270 RC outpatient 12766 12766 12766 74 9446.84 percent of total billed charges 12766 93 10340.5 percent of total billed charges 12766 12766 other OPPS APC 12766 12766 other OPPS APC 12766 27.63 3527.25 percent of total billed charges 12766 12766 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT LCCK SIZE 6 5 MM SUP-00-5447-056-46 CDM 270010025 LOCAL 0270 RC outpatient 12766 12766 12766 74 9446.84 percent of total billed charges 12766 93 10340.5 percent of total billed charges 12766 12766 other OPPS APC 12766 12766 other OPPS APC 12766 27.63 3527.25 percent of total billed charges 12766 12766 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL AUGMENT TRABECULAR METAL 100 SIZE 6 SUP-00-5448-006-27 CDM 270010025 LOCAL 0270 RC outpatient 5106.4 5106.4 5106.4 74 3778.74 percent of total billed charges 5106.4 93 4136.18 percent of total billed charges 5106.4 5106.4 other OPPS APC 5106.4 5106.4 other OPPS APC 5106.4 27.63 1410.9 percent of total billed charges 5106.4 5106.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTERIOR NEXGEN TRAB METAL AUG BLK SIZE C 5MM SUP-00-5490-033-01 CDM 270010025 LOCAL 0270 RC outpatient 4732 4732 4732 74 3501.68 percent of total billed charges 4732 93 3832.92 percent of total billed charges 4732 4732 other OPPS APC 4732 4732 other OPPS APC 4732 27.63 1307.45 percent of total billed charges 4732 4732 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL NEXGEN TRAB METAL AUG BLK SIZE C 5MM SUP-00-5490-033-10 CDM 270010025 LOCAL 0270 RC outpatient 4732 4732 4732 74 3501.68 percent of total billed charges 4732 93 3832.92 percent of total billed charges 4732 4732 other OPPS APC 4732 4732 other OPPS APC 4732 27.63 1307.45 percent of total billed charges 4732 4732 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN TRABECULAR METAL D H5 MM FEMORAL POSTERIOR SUP-00-5490-034-01 CDM 270010025 LOCAL 0270 RC outpatient 5106.4 5106.4 5106.4 74 3778.74 percent of total billed charges 5106.4 93 4136.18 percent of total billed charges 5106.4 5106.4 other OPPS APC 5106.4 5106.4 other OPPS APC 5106.4 27.63 1410.9 percent of total billed charges 5106.4 5106.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT FEMORAL NEXGEN TRABECULAR METAL E H5 MM KNEE SUP-00-5490-035-01 CDM 270010025 LOCAL 0270 RC outpatient 4732 4732 4732 74 3501.68 percent of total billed charges 4732 93 3832.92 percent of total billed charges 4732 4732 other OPPS APC 4732 4732 other OPPS APC 4732 27.63 1307.45 percent of total billed charges 4732 4732 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT FEMORAL NEXGEN TRABECULAR METAL E H10 MM POSTERIOR KNEE SUP-00-5490-035-02 CDM 270010025 LOCAL 0270 RC outpatient 4732 4732 4732 74 3501.68 percent of total billed charges 4732 93 3832.92 percent of total billed charges 4732 4732 other OPPS APC 4732 4732 other OPPS APC 4732 27.63 1307.45 percent of total billed charges 4732 4732 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN TRABECULAR METAL E H5 MM FEMORAL DISTAL SUP-00-5490-035-10 CDM 0270 RC outpatient 4732 4732 4732 74 3501.68 percent of total billed charges 4732 93 3832.92 percent of total billed charges 4732 4732 other OPPS APC 4732 4732 other OPPS APC 4732 27.63 1307.45 percent of total billed charges 4732 4732 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT NEXGEN POSTERIOR SIZE F 5MM SUP-00-5490-036-01 CDM 270010025 LOCAL 0270 RC outpatient 5106.4 5106.4 5106.4 74 3778.74 percent of total billed charges 5106.4 93 4136.18 percent of total billed charges 5106.4 5106.4 other OPPS APC 5106.4 5106.4 other OPPS APC 5106.4 27.63 1410.9 percent of total billed charges 5106.4 5106.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT NEXGEN DISTAL SIZE F 5MM SUP-00-5490-036-10 CDM 270010025 LOCAL 0270 RC outpatient 5106.4 5106.4 5106.4 74 3778.74 percent of total billed charges 5106.4 93 4136.18 percent of total billed charges 5106.4 5106.4 other OPPS APC 5106.4 5106.4 other OPPS APC 5106.4 27.63 1410.9 percent of total billed charges 5106.4 5106.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT NEXGEN DISTAL SIZE 10MM SUP-00-5490-036-20 CDM 270010025 LOCAL 0270 RC outpatient 5106.4 5106.4 5106.4 74 3778.74 percent of total billed charges 5106.4 93 4136.18 percent of total billed charges 5106.4 5106.4 other OPPS APC 5106.4 5106.4 other OPPS APC 5106.4 27.63 1410.9 percent of total billed charges 5106.4 5106.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW HEADED KNEE INSTRUMENTATION UNICOMPARTMENTAL SET STAINLESS STEEL STERILE 48MM SUP-00-5791-041-00 CDM 270010025 LOCAL 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASEPLATE TIBIAL HIGH FLEX TIVANIUM PRECOAT 5 KNEE LEFT MEDIAL RIGHT LATERAL UNICOMPARTMENTAL MODULAR STERILE SUP-00-5842-005-01 CDM 270010025 LOCAL 0270 RC outpatient 4626.83 4626.83 4626.83 74 3423.85 percent of total billed charges 4626.83 93 3747.73 percent of total billed charges 4626.83 4626.83 other OPPS APC 4626.83 4626.83 other OPPS APC 4626.83 27.63 1278.39 percent of total billed charges 4626.83 4626.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASEPLATE TIBIAL HIGH FLEX 6 TIVANIUM PRECOAT STERILE KNEE LEFT MEDIAL RIGHT LATERAL SUP-00-5842-006-01 CDM 270010025 LOCAL 0270 RC outpatient 4626.83 4626.83 4626.83 74 3423.85 percent of total billed charges 4626.83 93 3747.73 percent of total billed charges 4626.83 4626.83 other OPPS APC 4626.83 4626.83 other OPPS APC 4626.83 27.63 1278.39 percent of total billed charges 4626.83 4626.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR HIGH FLEX 6 H8 MM KNEE UNICOMPARTMENTAL SUP-00-5842-026-08 CDM 270010025 LOCAL 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP INSERTER HIGH FLEX STAINLESS STEEL KNEE ARTICULAR SURFACE UNICOMPARTMENTAL NONSTERILE DISPOSABLE SUP-00-5843-052-01 CDM 270010025 LOCAL 0270 RC outpatient 218.4 218.4 218.4 74 161.62 percent of total billed charges 218.4 93 176.9 percent of total billed charges 218.4 218.4 other OPPS APC 218.4 218.4 other OPPS APC 218.4 27.63 60.34 percent of total billed charges 218.4 218.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT NEXGEN ROTATING HINGE STEM TIBIAL PLATE SIZE 4 SUP-00-5880-004-00 CDM 270010025 LOCAL 0270 RC outpatient 10904.4 10904.4 10904.4 74 8069.26 percent of total billed charges 10904.4 93 8832.56 percent of total billed charges 10904.4 10904.4 other OPPS APC 10904.4 10904.4 other OPPS APC 10904.4 27.63 3012.89 percent of total billed charges 10904.4 10904.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE TIBIAL NEXGEN ZIMALOY PMMA UHMWPE 5 KNEE ROTATE HINGE STEM STERILE SUP-00-5880-005-00 CDM 270010025 LOCAL 0270 RC outpatient 10883.6 10883.6 10883.6 74 8053.86 percent of total billed charges 10883.6 93 8815.72 percent of total billed charges 10883.6 10883.6 other OPPS APC 10883.6 10883.6 other OPPS APC 10883.6 27.63 3007.14 percent of total billed charges 10883.6 10883.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT NEXGEN ROTATING HINGE FEMUR SIZE E RIGHT SUP-00-5880-015-02 CDM 270010025 LOCAL 0270 RC outpatient 21983 21983 21983 74 16267.4 percent of total billed charges 21983 93 17806.2 percent of total billed charges 21983 21983 other OPPS APC 21983 21983 other OPPS APC 21983 27.63 6073.9 percent of total billed charges 21983 21983 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL NEXGEN ZIMALOY F L76 MM X W66 MM KNEE RIGHT ROTATE HINGE STERILE SUP-00-5880-016-02 CDM 270010025 LOCAL 0270 RC outpatient 21931 21931 21931 74 16228.9 percent of total billed charges 21931 93 17764.1 percent of total billed charges 21931 21931 other OPPS APC 21931 21931 other OPPS APC 21931 27.63 6059.54 percent of total billed charges 21931 21931 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT NEXGEN ROTATING HINGE ARTICULAR SURGACE SIZE E 23MM SUP-00-5880-050-23 CDM 270010025 LOCAL 0270 RC outpatient 4828.2 4828.2 4828.2 74 3572.87 percent of total billed charges 4828.2 93 3910.84 percent of total billed charges 4828.2 4828.2 other OPPS APC 4828.2 4828.2 other OPPS APC 4828.2 27.63 1334.03 percent of total billed charges 4828.2 4828.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR NEXGEN ZIMALOY UHMWPE 5-6 F L77 MM X W44 MM X H14 MM KNEE ROTATE HINGE MACHINE MOLD STERILE SUP-00-5880-060-14 CDM 270010025 LOCAL 0270 RC outpatient 4804.8 4804.8 4804.8 74 3555.55 percent of total billed charges 4804.8 93 3891.89 percent of total billed charges 4804.8 4804.8 other OPPS APC 4804.8 4804.8 other OPPS APC 4804.8 27.63 1327.57 percent of total billed charges 4804.8 4804.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLUG STEM NEXGEN TIVANIUM TAPER KNEE FLEX STERILE SUP-00-5960-099-00 CDM 270010025 LOCAL 0270 RC outpatient 2059.2 2059.2 2059.2 74 1523.81 percent of total billed charges 2059.2 93 1667.95 percent of total billed charges 2059.2 2059.2 other OPPS APC 2059.2 2059.2 other OPPS APC 2059.2 27.63 568.96 percent of total billed charges 2059.2 2059.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LPS FIXED PROLONG ART SUR EF 3-4 20MM SUP-00-5962-032-20 CDM 270010025 LOCAL 0270 RC outpatient 3416.4 3416.4 3416.4 74 2528.14 percent of total billed charges 3416.4 93 2767.28 percent of total billed charges 3416.4 3416.4 other OPPS APC 3416.4 3416.4 other OPPS APC 3416.4 27.63 943.95 percent of total billed charges 3416.4 3416.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR NEXGEN LPS-FLEX PROLONG 3-4 E-F H23 MM KNEE FIX BEARING STERILE SUP-00-5962-032-23 CDM 270010025 LOCAL 0270 RC outpatient 3634.8 3634.8 3634.8 74 2689.75 percent of total billed charges 3634.8 93 2944.19 percent of total billed charges 3634.8 3634.8 other OPPS APC 3634.8 3634.8 other OPPS APC 3634.8 27.63 1004.3 percent of total billed charges 3634.8 3634.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR NEXGEN LPS-FLEX PROLONG 5-6 E-F H20 MM KNEE FIX BEARING STERILE SUP-00-5962-040-20 CDM 270010025 LOCAL 0270 RC outpatient 3634.8 3634.8 3634.8 74 2689.75 percent of total billed charges 3634.8 93 2944.19 percent of total billed charges 3634.8 3634.8 other OPPS APC 3634.8 3634.8 other OPPS APC 3634.8 27.63 1004.3 percent of total billed charges 3634.8 3634.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR LPS-FLEX NEXGEN PROLONG 5-6 G-H H14 MM KNEE FIX BEARING STERILE SUP-00-5962-042-14 CDM 270010025 LOCAL 0270 RC outpatient 3416.4 3416.4 3416.4 74 2528.14 percent of total billed charges 3416.4 93 2767.28 percent of total billed charges 3416.4 3416.4 other OPPS APC 3416.4 3416.4 other OPPS APC 3416.4 27.63 943.95 percent of total billed charges 3416.4 3416.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR LPS-FLEX NEXGEN PROLONG 7-10 G-H H20 MM KNEE FIXED BEARING STERILE SUP-00-5962-050-20 CDM 270010025 LOCAL 0270 RC outpatient 3634.8 3634.8 3634.8 74 2689.75 percent of total billed charges 3634.8 93 2944.19 percent of total billed charges 3634.8 3634.8 other OPPS APC 3634.8 3634.8 other OPPS APC 3634.8 27.63 1004.3 percent of total billed charges 3634.8 3634.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT NEXGEN CR ALL POLY TIB SIZE5 GRN SUP-00-5966-005-17 CDM 270010025 LOCAL 0270 RC outpatient 3198 3198 3198 74 2366.52 percent of total billed charges 3198 93 2590.38 percent of total billed charges 3198 3198 other OPPS APC 3198 3198 other OPPS APC 3198 27.63 883.61 percent of total billed charges 3198 3198 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SPRING FIXATION SHORT SUP-00-5967-033-01 CDM 270010025 LOCAL 0270 RC outpatient 1066 1066 1066 74 788.84 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 27.63 294.54 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDES LPS CT PSI CUTTING SUP-00-5970-000-17 CDM 270010025 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT PATELLAR NEXGEN PROLONG OD38 MM KNEE LATEX FREE SUP-00-5972-066-38 CDM 270010025 LOCAL 0270 RC outpatient 2464.8 2464.8 2464.8 74 1823.95 percent of total billed charges 2464.8 93 1996.49 percent of total billed charges 2464.8 2464.8 other OPPS APC 2464.8 2464.8 other OPPS APC 2464.8 27.63 681.02 percent of total billed charges 2464.8 2464.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR NEXGEN UHMWPE 3-4 C-H L66 MM X W42 MM X H17 MM KNEE ANTERIOR CONSTRAIN CRUCIATE RETAINING MACHINE MOLD STERILE SUP-00-5976-030-17 CDM 270010025 LOCAL 0270 RC outpatient 2714.4 2714.4 2714.4 74 2008.66 percent of total billed charges 2714.4 93 2198.66 percent of total billed charges 2714.4 2714.4 other OPPS APC 2714.4 2714.4 other OPPS APC 2714.4 27.63 749.99 percent of total billed charges 2714.4 2714.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA REAMER BLADE WITH PILOT HOLE SIZE 38 SUP-00-5979-095-38 CDM 270010025 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE REAMER PATELLA WITH PILOT HOLE SIZE 41 SUP-00-5979-095-41 CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE TIBIAL NEXGEN TIVANIUM PMMA UHMWPE PRECOAT MICRO L62 MM X W41 MM X H2 MM KNEE CEMENT MODULAR STEM STERILE SUP-00-5980-027-02 CDM 270010025 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE TIBIAL NEXGEN TIVANIUM UHMWPE 3 L66 MM X W42 MM X H3 MM KNEE CEMENTED MODULAR STEM PRECOAT STERILE SUP-00-5980-037-01 CDM 270010025 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE TIBIAL NEXGEN TIVANIUM UHMWPE 4 L66 MM X W46 MM X H4 MM KNEE CEMENTED MODULAR STEM PRECOAT STERILE SUP-00-5980-037-02 CDM 270010025 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE TIBIAL NEXGEN TIVANIUM UHMWPE 5 L74 MM X W46 MM X H5 MM KNEE CEMENTED MODULAR STEM PRECOAT STERILE SUP-00-5980-047-01 CDM 270010025 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE TIBIAL NEXGEN TIVANIUM UHMWPE 6 L74 MM X W50 MM X H6 MM KNEE CEMENTED MODULAR STEM PRECOAT STERILE SUP-00-5980-047-02 CDM 270010025 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW AUGMENTATION NEXGEN KNEE STEM EXTENSION REPLACEMENT STERILE SUP-00-5980-090-00 CDM 270010025 LOCAL 0270 RC outpatient 234 234 234 74 173.16 percent of total billed charges 234 93 189.54 percent of total billed charges 234 234 other OPPS APC 234 234 other OPPS APC 234 27.63 64.65 percent of total billed charges 234 234 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN TIVANIUM PMMA 2 HALF H5 MM KNEE TIBIAL STERILE SUP-00-5988-002-26 CDM 270010025 LOCAL 0270 RC outpatient 2215.2 2215.2 2215.2 74 1639.25 percent of total billed charges 2215.2 93 1794.31 percent of total billed charges 2215.2 2215.2 other OPPS APC 2215.2 2215.2 other OPPS APC 2215.2 27.63 612.06 percent of total billed charges 2215.2 2215.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE TIBIA AP WEDGED SIZE 3 SUP-00-5988-003-00 CDM 270010025 LOCAL 0270 RC outpatient 6409 6409 6409 74 4742.66 percent of total billed charges 6409 93 5191.29 percent of total billed charges 6409 6409 other OPPS APC 6409 6409 other OPPS APC 6409 27.63 1770.81 percent of total billed charges 6409 6409 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN TIVANIUM PMMA PRECOAT 3 FULL H10 MM KNEE TIBIA STERILE SUP-00-5988-003-10 CDM 270010025 LOCAL 0270 RC outpatient 3198 3198 3198 74 2366.52 percent of total billed charges 3198 93 2590.38 percent of total billed charges 3198 3198 other OPPS APC 3198 3198 other OPPS APC 3198 27.63 883.61 percent of total billed charges 3198 3198 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN TIVANIUM PMMA 3 HALF H5 MM KNEE TIBIAL PRECOAT STERILE SUP-00-5988-003-26 CDM 270010025 LOCAL 0270 RC outpatient 2449.2 2449.2 2449.2 74 1812.41 percent of total billed charges 2449.2 93 1983.85 percent of total billed charges 2449.2 2449.2 other OPPS APC 2449.2 2449.2 other OPPS APC 2449.2 27.63 676.71 percent of total billed charges 2449.2 2449.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN TIVANIUM PMMA 3 HALF H10 MM KNEE TIBIAL PRECOAT STERILE SUP-00-5988-003-27 CDM 270010025 LOCAL 0270 RC outpatient 2449.2 2449.2 2449.2 74 1812.41 percent of total billed charges 2449.2 93 1983.85 percent of total billed charges 2449.2 2449.2 other OPPS APC 2449.2 2449.2 other OPPS APC 2449.2 27.63 676.71 percent of total billed charges 2449.2 2449.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE TIBIAL NEXGEN TIVANIUM PMMA PRECOAT 4 WEDGE L66 MM X W46 MM KNEE CEMENT MODULAR STEM STERILE YELLOW YELLOW STRIPE SUP-00-5988-004-00 CDM 270010025 LOCAL 0270 RC outpatient 5475.6 5475.6 5475.6 74 4051.94 percent of total billed charges 5475.6 93 4435.24 percent of total billed charges 5475.6 5475.6 other OPPS APC 5475.6 5475.6 other OPPS APC 5475.6 27.63 1512.91 percent of total billed charges 5475.6 5475.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN TIVANIUM PMMA 4 HALF H10 MM KNEE TIBIAL PRECOAT STERILE SUP-00-5988-004-27 CDM 270010025 LOCAL 0270 RC outpatient 2449.2 2449.2 2449.2 74 1812.41 percent of total billed charges 2449.2 93 1983.85 percent of total billed charges 2449.2 2449.2 other OPPS APC 2449.2 2449.2 other OPPS APC 2449.2 27.63 676.71 percent of total billed charges 2449.2 2449.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN TIVANIUM PMMA 5 FULL H10 MM KNEE TIBIAL STERILE SUP-00-5988-005-10 CDM 270010025 LOCAL 0270 RC outpatient 3198 3198 3198 74 2366.52 percent of total billed charges 3198 93 2590.38 percent of total billed charges 3198 3198 other OPPS APC 3198 3198 other OPPS APC 3198 27.63 883.61 percent of total billed charges 3198 3198 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE TIBIAL NEXGEN TIVANIUM PMMA 22 D 5 THIRD H10 MM KNEE STERILE SUP-00-5988-005-22 CDM 270010025 LOCAL 0270 RC outpatient 2215.2 2215.2 2215.2 74 1639.25 percent of total billed charges 2215.2 93 1794.31 percent of total billed charges 2215.2 2215.2 other OPPS APC 2215.2 2215.2 other OPPS APC 2215.2 27.63 612.06 percent of total billed charges 2215.2 2215.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN TIVANIUM PMMA 5 HALF H5 MM KNEE TIBIAL PRECOAT STERILE SUP-00-5988-005-26 CDM 270010025 LOCAL 0270 RC outpatient 2215.2 2215.2 2215.2 74 1639.25 percent of total billed charges 2215.2 93 1794.31 percent of total billed charges 2215.2 2215.2 other OPPS APC 2215.2 2215.2 other OPPS APC 2215.2 27.63 612.06 percent of total billed charges 2215.2 2215.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN TIVANIUM PMMA 5 HALF H10 MM KNEE TIBIAL PRECOAT STERILE SUP-00-5988-005-27 CDM 270010025 LOCAL 0270 RC outpatient 2449.2 2449.2 2449.2 74 1812.41 percent of total billed charges 2449.2 93 1983.85 percent of total billed charges 2449.2 2449.2 other OPPS APC 2449.2 2449.2 other OPPS APC 2449.2 27.63 676.71 percent of total billed charges 2449.2 2449.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE TIBIAL WEDGED SIZE 6 SUP-00-5988-006-00 CDM 270010025 LOCAL 0270 RC outpatient 5475.6 5475.6 5475.6 74 4051.94 percent of total billed charges 5475.6 93 4435.24 percent of total billed charges 5475.6 5475.6 other OPPS APC 5475.6 5475.6 other OPPS APC 5475.6 27.63 1512.91 percent of total billed charges 5475.6 5475.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN TIVANIUM PMMA 8-9 HALF H5 MM KNEE TIBIAL PRECOAT STERILE SUP-00-5988-008-26 CDM 270010025 LOCAL 0270 RC outpatient 2449.2 2449.2 2449.2 74 1812.41 percent of total billed charges 2449.2 93 1983.85 percent of total billed charges 2449.2 2449.2 other OPPS APC 2449.2 2449.2 other OPPS APC 2449.2 27.63 676.71 percent of total billed charges 2449.2 2449.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN STRAIGHT L100 MM L145 MM OD10 MM KNEE TIBIA ROTATE HINGE STERILE SUP-00-5988-010-10 CDM 270010025 LOCAL 0270 RC outpatient 2776.8 2776.8 2776.8 74 2054.83 percent of total billed charges 2776.8 93 2249.21 percent of total billed charges 2776.8 2776.8 other OPPS APC 2776.8 2776.8 other OPPS APC 2776.8 27.63 767.23 percent of total billed charges 2776.8 2776.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM NEXGEN STRAIGHT 11MM X 100MM SUP-00-5988-010-11 CDM 270010025 LOCAL 0270 RC outpatient 2776.8 2776.8 2776.8 74 2054.83 percent of total billed charges 2776.8 93 2249.21 percent of total billed charges 2776.8 2776.8 other OPPS APC 2776.8 2776.8 other OPPS APC 2776.8 27.63 767.23 percent of total billed charges 2776.8 2776.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN STRAIGHT L100 MM L145 MM OD12 MM KNEE TIBIA ROTATE HINGE STERILE SUP-00-5988-010-12 CDM 270010025 LOCAL 0270 RC outpatient 2776.8 2776.8 2776.8 74 2054.83 percent of total billed charges 2776.8 93 2249.21 percent of total billed charges 2776.8 2776.8 other OPPS APC 2776.8 2776.8 other OPPS APC 2776.8 27.63 767.23 percent of total billed charges 2776.8 2776.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN STRAIGHT L100 MM L145 MM OD13 MM KNEE TIBIA ROTATE HINGE STERILE SUP-00-5988-010-13 CDM 270010025 LOCAL 0270 RC outpatient 2776.8 2776.8 2776.8 74 2054.83 percent of total billed charges 2776.8 93 2249.21 percent of total billed charges 2776.8 2776.8 other OPPS APC 2776.8 2776.8 other OPPS APC 2776.8 27.63 767.23 percent of total billed charges 2776.8 2776.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN STRAIGHT L100 MM L145 MM OD14 MM KNEE TIBIA ROTATE HINGE STERILE SUP-00-5988-010-14 CDM 270010025 LOCAL 0270 RC outpatient 2776.8 2776.8 2776.8 74 2054.83 percent of total billed charges 2776.8 93 2249.21 percent of total billed charges 2776.8 2776.8 other OPPS APC 2776.8 2776.8 other OPPS APC 2776.8 27.63 767.23 percent of total billed charges 2776.8 2776.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN STRAIGHT L100 MM L145 MM OD15 MM KNEE TIBIA ROTATE HINGE STERILE SUP-00-5988-010-15 CDM 270010025 LOCAL 0270 RC outpatient 2776.8 2776.8 2776.8 74 2054.83 percent of total billed charges 2776.8 93 2249.21 percent of total billed charges 2776.8 2776.8 other OPPS APC 2776.8 2776.8 other OPPS APC 2776.8 27.63 767.23 percent of total billed charges 2776.8 2776.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN STRAIGHT L100 MM L145 MM OD16 MM KNEE TIBIA ROTATE HINGE STERILE SUP-00-5988-010-16 CDM 270010025 LOCAL 0270 RC outpatient 2776.8 2776.8 2776.8 74 2054.83 percent of total billed charges 2776.8 93 2249.21 percent of total billed charges 2776.8 2776.8 other OPPS APC 2776.8 2776.8 other OPPS APC 2776.8 27.63 767.23 percent of total billed charges 2776.8 2776.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN STRAIGHT L100 MM L145 MM OD17 MM KNEE TIBIA ROTATE HINGE STERILE SUP-00-5988-010-17 CDM 270010025 LOCAL 0270 RC outpatient 2776.8 2776.8 2776.8 74 2054.83 percent of total billed charges 2776.8 93 2249.21 percent of total billed charges 2776.8 2776.8 other OPPS APC 2776.8 2776.8 other OPPS APC 2776.8 27.63 767.23 percent of total billed charges 2776.8 2776.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN STRAIGHT L100 MM L145 MM OD18 MM KNEE TIBIA ROTATE HINGE STERILE SUP-00-5988-010-18 CDM 270010025 LOCAL 0270 RC outpatient 2776.8 2776.8 2776.8 74 2054.83 percent of total billed charges 2776.8 93 2249.21 percent of total billed charges 2776.8 2776.8 other OPPS APC 2776.8 2776.8 other OPPS APC 2776.8 27.63 767.23 percent of total billed charges 2776.8 2776.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN STRAIGHT L100 MM L145 MM OD22 MM KNEE TIBIA ROTATING HINGE STERILE SUP-00-5988-010-22 CDM 270010025 LOCAL 0270 RC outpatient 2776.8 2776.8 2776.8 74 2054.83 percent of total billed charges 2776.8 93 2249.21 percent of total billed charges 2776.8 2776.8 other OPPS APC 2776.8 2776.8 other OPPS APC 2776.8 27.63 767.23 percent of total billed charges 2776.8 2776.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN STRAIGHT L155 MM L200 MM OD13 MM KNEE TIBIA ROTATE HINGE STERILE SUP-00-5988-011-13 CDM 270010025 LOCAL 0270 RC outpatient 2776.8 2776.8 2776.8 74 2054.83 percent of total billed charges 2776.8 93 2249.21 percent of total billed charges 2776.8 2776.8 other OPPS APC 2776.8 2776.8 other OPPS APC 2776.8 27.63 767.23 percent of total billed charges 2776.8 2776.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN STRAIGHT L155 MM L200 MM OD14 MM KNEE TIBIA ROTATE HINGE STERILE SUP-00-5988-011-14 CDM 270010025 LOCAL 0270 RC outpatient 2776.8 2776.8 2776.8 74 2054.83 percent of total billed charges 2776.8 93 2249.21 percent of total billed charges 2776.8 2776.8 other OPPS APC 2776.8 2776.8 other OPPS APC 2776.8 27.63 767.23 percent of total billed charges 2776.8 2776.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN STRAIGHT L155 MM L200 MM OD18 MM KNEE TIBIA ROTATE HINGE STERILE SUP-00-5988-011-18 CDM 270010025 LOCAL 0270 RC outpatient 2776.8 2776.8 2776.8 74 2054.83 percent of total billed charges 2776.8 93 2249.21 percent of total billed charges 2776.8 2776.8 other OPPS APC 2776.8 2776.8 other OPPS APC 2776.8 27.63 767.23 percent of total billed charges 2776.8 2776.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN STRAIGHT L30 MM L75 MM OD15 MM KNEE TIBIA ROTATE HINGE STERILE SUP-00-5988-012-15 CDM 270010025 LOCAL 0270 RC outpatient 3247.4 3247.4 3247.4 74 2403.08 percent of total billed charges 3247.4 93 2630.39 percent of total billed charges 3247.4 3247.4 other OPPS APC 3247.4 3247.4 other OPPS APC 3247.4 27.63 897.26 percent of total billed charges 3247.4 3247.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN TIVANIUM FLUTE L130 MM L175 MM OD12 MM KNEE FEMUR SHARP REPLACEMENT SCREW STERILE SUP-00-5988-016-12 CDM 270010025 LOCAL 0270 RC outpatient 3109.6 3109.6 3109.6 74 2301.1 percent of total billed charges 3109.6 93 2518.78 percent of total billed charges 3109.6 3109.6 other OPPS APC 3109.6 3109.6 other OPPS APC 3109.6 27.63 859.18 percent of total billed charges 3109.6 3109.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN TIVANIUM FLUTE L130 MM L175 MM OD13 MM KNEE FEMUR SHARP REPLACEMENT SCREW STERILE SUP-00-5988-016-13 CDM 270010025 LOCAL 0270 RC outpatient 2652 2652 2652 74 1962.48 percent of total billed charges 2652 93 2148.12 percent of total billed charges 2652 2652 other OPPS APC 2652 2652 other OPPS APC 2652 27.63 732.75 percent of total billed charges 2652 2652 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN TIVANIUM FLUTE L130 MM L175 MM OD14 MM KNEE FEMUR SHARP REPLACEMENT SCREW STERILE SUP-00-5988-016-14 CDM 270010025 LOCAL 0270 RC outpatient 2652 2652 2652 74 1962.48 percent of total billed charges 2652 93 2148.12 percent of total billed charges 2652 2652 other OPPS APC 2652 2652 other OPPS APC 2652 27.63 732.75 percent of total billed charges 2652 2652 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION NEXGEN TIVANIUM L130 MM L175 MM OD15 MM KNEE FEMUR SHARP FLUTED REPLACEMENT SCREW STERILE SUP-00-5988-016-15 CDM 270010025 LOCAL 0270 RC outpatient 2652 2652 2652 74 1962.48 percent of total billed charges 2652 93 2148.12 percent of total billed charges 2652 2652 other OPPS APC 2652 2652 other OPPS APC 2652 27.63 732.75 percent of total billed charges 2652 2652 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM NEXGEN FLUTED 16MM DIA X 175MM SUP-00-5988-016-16 CDM 270010025 LOCAL 0270 RC outpatient 2652 2652 2652 74 1962.48 percent of total billed charges 2652 93 2148.12 percent of total billed charges 2652 2652 other OPPS APC 2652 2652 other OPPS APC 2652 27.63 732.75 percent of total billed charges 2652 2652 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN FLUTE L130 MM L175 MM OD17 MM FEMUR KNEE SUP-00-5988-016-17 CDM 270010025 LOCAL 0270 RC outpatient 2652 2652 2652 74 1962.48 percent of total billed charges 2652 93 2148.12 percent of total billed charges 2652 2652 other OPPS APC 2652 2652 other OPPS APC 2652 27.63 732.75 percent of total billed charges 2652 2652 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM NEX GEN FLUTED 19`MM X 175MM SUP-00-5988-016-19 CDM 270010025 LOCAL 0270 RC outpatient 3109.6 3109.6 3109.6 74 2301.1 percent of total billed charges 3109.6 93 2518.78 percent of total billed charges 3109.6 3109.6 other OPPS APC 3109.6 3109.6 other OPPS APC 3109.6 27.63 859.18 percent of total billed charges 3109.6 3109.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM NEX GEN FLUTED 20MM X 175MM SUP-00-5988-016-20 CDM 270010025 LOCAL 0270 RC outpatient 3109.6 3109.6 3109.6 74 2301.1 percent of total billed charges 3109.6 93 2518.78 percent of total billed charges 3109.6 3109.6 other OPPS APC 3109.6 3109.6 other OPPS APC 3109.6 27.63 859.18 percent of total billed charges 3109.6 3109.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM NEX GEN FLUTED 22MM X 175MM SUP-00-5988-016-22 CDM 270010025 LOCAL 0270 RC outpatient 3109.6 3109.6 3109.6 74 2301.1 percent of total billed charges 3109.6 93 2518.78 percent of total billed charges 3109.6 3109.6 other OPPS APC 3109.6 3109.6 other OPPS APC 3109.6 27.63 859.18 percent of total billed charges 3109.6 3109.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN TIVANIUM OFFSET L100 MM L145 MM OD12 MM KNEE FEMUR STERILE SUP-00-5988-020-12 CDM 270010025 LOCAL 0270 RC outpatient 3260.4 3260.4 3260.4 74 2412.7 percent of total billed charges 3260.4 93 2640.92 percent of total billed charges 3260.4 3260.4 other OPPS APC 3260.4 3260.4 other OPPS APC 3260.4 27.63 900.85 percent of total billed charges 3260.4 3260.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN TIVANIUM OFFSET L100 MM L145 MM OD13 MM KNEE FEMUR STERILE SUP-00-5988-020-13 CDM 270010025 LOCAL 0270 RC outpatient 3619.2 3619.2 3619.2 74 2678.21 percent of total billed charges 3619.2 93 2931.55 percent of total billed charges 3619.2 3619.2 other OPPS APC 3619.2 3619.2 other OPPS APC 3619.2 27.63 999.98 percent of total billed charges 3619.2 3619.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN TIVANIUM OFFSET L100 MM L145 MM OD14 MM KNEE FEMUR STERILE SUP-00-5988-020-14 CDM 270010025 LOCAL 0270 RC outpatient 3619.2 3619.2 3619.2 74 2678.21 percent of total billed charges 3619.2 93 2931.55 percent of total billed charges 3619.2 3619.2 other OPPS APC 3619.2 3619.2 other OPPS APC 3619.2 27.63 999.98 percent of total billed charges 3619.2 3619.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN TIVANIUM OFFSET L100 MM L145 MM OD15 MM KNEE FEMUR STERILE SUP-00-5988-020-15 CDM 270010025 LOCAL 0270 RC outpatient 3619.2 3619.2 3619.2 74 2678.21 percent of total billed charges 3619.2 93 2931.55 percent of total billed charges 3619.2 3619.2 other OPPS APC 3619.2 3619.2 other OPPS APC 3619.2 27.63 999.98 percent of total billed charges 3619.2 3619.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN TIVANIUM OFFSET L100 MM L145 MM OD18 MM KNEE FEMUR STERILE SUP-00-5988-020-18 CDM 270010025 LOCAL 0270 RC outpatient 3619.2 3619.2 3619.2 74 2678.21 percent of total billed charges 3619.2 93 2931.55 percent of total billed charges 3619.2 3619.2 other OPPS APC 3619.2 3619.2 other OPPS APC 3619.2 27.63 999.98 percent of total billed charges 3619.2 3619.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN TIVANIUM OFFSET L200 MM L155 MM OD15 MM KNEE FEMUR STERILE SUP-00-5988-021-15 CDM 270010025 LOCAL 0270 RC outpatient 3619.2 3619.2 3619.2 74 2678.21 percent of total billed charges 3619.2 93 2931.55 percent of total billed charges 3619.2 3619.2 other OPPS APC 3619.2 3619.2 other OPPS APC 3619.2 27.63 999.98 percent of total billed charges 3619.2 3619.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN TIVANIUM OFFSET L155 MM L200 MM OD17 MM KNEE FEMUR STERILE SUP-00-5988-021-17 CDM 270010025 LOCAL 0270 RC outpatient 3619.2 3619.2 3619.2 74 2678.21 percent of total billed charges 3619.2 93 2931.55 percent of total billed charges 3619.2 3619.2 other OPPS APC 3619.2 3619.2 other OPPS APC 3619.2 27.63 999.98 percent of total billed charges 3619.2 3619.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN PRECOAT D H5 MM POSTERIOR SUP-00-5990-034-01 CDM 270010025 LOCAL 0270 RC outpatient 2449.2 2449.2 2449.2 74 1812.41 percent of total billed charges 2449.2 93 1983.85 percent of total billed charges 2449.2 2449.2 other OPPS APC 2449.2 2449.2 other OPPS APC 2449.2 27.63 676.71 percent of total billed charges 2449.2 2449.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN PRECOAT D H5 MM DISTAL SUP-00-5990-034-10 CDM 270010025 LOCAL 0270 RC outpatient 2449.2 2449.2 2449.2 74 1812.41 percent of total billed charges 2449.2 93 1983.85 percent of total billed charges 2449.2 2449.2 other OPPS APC 2449.2 2449.2 other OPPS APC 2449.2 27.63 676.71 percent of total billed charges 2449.2 2449.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN PRECOAT E H5 MM POSTERIOR SUP-00-5990-035-01 CDM 270010025 LOCAL 0270 RC outpatient 2449.2 2449.2 2449.2 74 1812.41 percent of total billed charges 2449.2 93 1983.85 percent of total billed charges 2449.2 2449.2 other OPPS APC 2449.2 2449.2 other OPPS APC 2449.2 27.63 676.71 percent of total billed charges 2449.2 2449.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN PRECOAT E H10 MM KNEE POSTERIOR ROTATE HINGE STERILE SUP-00-5990-035-02 CDM 270010025 LOCAL 0270 RC outpatient 2449.2 2449.2 2449.2 74 1812.41 percent of total billed charges 2449.2 93 1983.85 percent of total billed charges 2449.2 2449.2 other OPPS APC 2449.2 2449.2 other OPPS APC 2449.2 27.63 676.71 percent of total billed charges 2449.2 2449.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN PRECOAT E H5 MM DISTAL SUP-00-5990-035-10 CDM 270010025 LOCAL 0270 RC outpatient 2449.2 2449.2 2449.2 74 1812.41 percent of total billed charges 2449.2 93 1983.85 percent of total billed charges 2449.2 2449.2 other OPPS APC 2449.2 2449.2 other OPPS APC 2449.2 27.63 676.71 percent of total billed charges 2449.2 2449.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN PRECOAT E H10 MM DISTAL SUP-00-5990-035-20 CDM 270010025 LOCAL 0270 RC outpatient 2449.2 2449.2 2449.2 74 1812.41 percent of total billed charges 2449.2 93 1983.85 percent of total billed charges 2449.2 2449.2 other OPPS APC 2449.2 2449.2 other OPPS APC 2449.2 27.63 676.71 percent of total billed charges 2449.2 2449.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN PRECOAT F H5 MM POSTERIOR SUP-00-5990-036-01 CDM 270010025 LOCAL 0270 RC outpatient 2449.2 2449.2 2449.2 74 1812.41 percent of total billed charges 2449.2 93 1983.85 percent of total billed charges 2449.2 2449.2 other OPPS APC 2449.2 2449.2 other OPPS APC 2449.2 27.63 676.71 percent of total billed charges 2449.2 2449.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN PRECOAT F H10 MM POSTERIOR SUP-00-5990-036-02 CDM 270010025 LOCAL 0270 RC outpatient 2449.2 2449.2 2449.2 74 1812.41 percent of total billed charges 2449.2 93 1983.85 percent of total billed charges 2449.2 2449.2 other OPPS APC 2449.2 2449.2 other OPPS APC 2449.2 27.63 676.71 percent of total billed charges 2449.2 2449.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN PRECOAT F H5 MM DISTAL SUP-00-5990-036-10 CDM 270010025 LOCAL 0270 RC outpatient 2449.2 2449.2 2449.2 74 1812.41 percent of total billed charges 2449.2 93 1983.85 percent of total billed charges 2449.2 2449.2 other OPPS APC 2449.2 2449.2 other OPPS APC 2449.2 27.63 676.71 percent of total billed charges 2449.2 2449.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN PRECOAT F H10 MM DISTAL SUP-00-5990-036-20 CDM 270010025 LOCAL 0270 RC outpatient 2449.2 2449.2 2449.2 74 1812.41 percent of total billed charges 2449.2 93 1983.85 percent of total billed charges 2449.2 2449.2 other OPPS APC 2449.2 2449.2 other OPPS APC 2449.2 27.63 676.71 percent of total billed charges 2449.2 2449.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN F H10 MM DISTAL SUP-00-5990-036-21 CDM 270010025 LOCAL 0270 RC outpatient 2449.2 2449.2 2449.2 74 1812.41 percent of total billed charges 2449.2 93 1983.85 percent of total billed charges 2449.2 2449.2 other OPPS APC 2449.2 2449.2 other OPPS APC 2449.2 27.63 676.71 percent of total billed charges 2449.2 2449.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION NEXGEN PRECOAT G H5 MM DISTAL SUP-00-5990-037-10 CDM 270010025 LOCAL 0270 RC outpatient 2449.2 2449.2 2449.2 74 1812.41 percent of total billed charges 2449.2 93 1983.85 percent of total billed charges 2449.2 2449.2 other OPPS APC 2449.2 2449.2 other OPPS APC 2449.2 27.63 676.71 percent of total billed charges 2449.2 2449.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL LCCK OPTION NEXGEN ZIMALOY D L64 MM X W57.5 MM KNEE RIGHT SET SCREW CEMENTED REVISION STERILE SUP-00-5994-014-92 CDM 270010025 LOCAL 0270 RC outpatient 15022.8 15022.8 15022.8 74 11116.9 percent of total billed charges 15022.8 93 12168.5 percent of total billed charges 15022.8 15022.8 other OPPS APC 15022.8 15022.8 other OPPS APC 15022.8 27.63 4150.8 percent of total billed charges 15022.8 15022.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL LCCK OPTION NEXGEN ZIMALOY E L68 MM X W61.5 MM KNEE LEFT SET SCREW CEMENTED REVISION STERILE SUP-00-5994-015-91 CDM 270010025 LOCAL 0270 RC outpatient 17570.8 17570.8 17570.8 74 13002.4 percent of total billed charges 17570.8 93 14232.4 percent of total billed charges 17570.8 17570.8 other OPPS APC 17570.8 17570.8 other OPPS APC 17570.8 27.63 4854.81 percent of total billed charges 17570.8 17570.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL LCCK OPTION NEXGEN ZIMALOY E L68 MM X W61.5 MM KNEE RIGHT SET SCREW CEMENTED REVISION STERILE SUP-00-5994-015-92 CDM 270010025 LOCAL 0270 RC outpatient 15022.8 15022.8 15022.8 74 11116.9 percent of total billed charges 15022.8 93 12168.5 percent of total billed charges 15022.8 15022.8 other OPPS APC 15022.8 15022.8 other OPPS APC 15022.8 27.63 4150.8 percent of total billed charges 15022.8 15022.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL LCCK OPTION NEXGEN ZIMALOY F L72 MM X W65.5 MM KNEE LEFT SET SCREW CEMENTED REVISION STERILE SUP-00-5994-016-91 CDM 270010025 LOCAL 0270 RC outpatient 15022.8 15022.8 15022.8 74 11116.9 percent of total billed charges 15022.8 93 12168.5 percent of total billed charges 15022.8 15022.8 other OPPS APC 15022.8 15022.8 other OPPS APC 15022.8 27.63 4150.8 percent of total billed charges 15022.8 15022.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL NEXGEN LCCK OPTION ZIMALOY F L72 MM X W65.5 MM KNEE RIGHT SET SCREW CEMENTED REVISION STERILE SUP-00-5994-016-92 CDM 270010025 LOCAL 0270 RC outpatient 15022.8 15022.8 15022.8 74 11116.9 percent of total billed charges 15022.8 93 12168.5 percent of total billed charges 15022.8 15022.8 other OPPS APC 15022.8 15022.8 other OPPS APC 15022.8 27.63 4150.8 percent of total billed charges 15022.8 15022.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL LCCK OPTION NEXGEN ZIMALOY G L76.5 MM X W70.5 MM KNEE LEFT SET SCREW CEMENTED REVISION STERILE SUP-00-5994-017-91 CDM 270010025 LOCAL 0270 RC outpatient 15022.8 15022.8 15022.8 74 11116.9 percent of total billed charges 15022.8 93 12168.5 percent of total billed charges 15022.8 15022.8 other OPPS APC 15022.8 15022.8 other OPPS APC 15022.8 27.63 4150.8 percent of total billed charges 15022.8 15022.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTICULAR SURFACE LCCK PURPLE C/D SIZE 14MM SUP-00-5994-022-14 CDM 270010025 LOCAL 0270 RC outpatient 4992 4992 4992 74 3694.08 percent of total billed charges 4992 93 4043.52 percent of total billed charges 4992 4992 other OPPS APC 4992 4992 other OPPS APC 4992 27.63 1379.29 percent of total billed charges 4992 4992 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTICULAR SURFACE LCCK PURPLE C/D SIZE 17MM SUP-00-5994-022-17 CDM 270010025 LOCAL 0270 RC outpatient 4992 4992 4992 74 3694.08 percent of total billed charges 4992 93 4043.52 percent of total billed charges 4992 4992 other OPPS APC 4992 4992 other OPPS APC 4992 27.63 1379.29 percent of total billed charges 4992 4992 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR LCCK NEXGEN TIVANIUM UHMWPE 1-2 C-D MICRO L58 MM X W40 MM X H33 MM KNEE REVISION MACHINE MOLD STERILE SUP-00-5994-030-10 CDM 270010025 LOCAL 0270 RC outpatient 4992 4992 4992 74 3694.08 percent of total billed charges 4992 93 4043.52 percent of total billed charges 4992 4992 other OPPS APC 4992 4992 other OPPS APC 4992 27.63 1379.29 percent of total billed charges 4992 4992 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR NEXGEN LCCK TIVANIUM UHMWPE 3-4 C-D L66 MM X W42 MM X H17 MM KNEE REVISION MACHINE MOLD STERILE SUP-00-5994-030-17 CDM 270010025 LOCAL 0270 RC outpatient 4992 4992 4992 74 3694.08 percent of total billed charges 4992 93 4043.52 percent of total billed charges 4992 4992 other OPPS APC 4992 4992 other OPPS APC 4992 27.63 1379.29 percent of total billed charges 4992 4992 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR LCCK NEXGEN TIVANIUM UHMWPE 3-4 E-F L66 MM X W42 MM X H14 MM KNEE REVISION MACHINE MOLD STERILE SUP-00-5994-032-14 CDM 270010025 LOCAL 0270 RC outpatient 4992 4992 4992 74 3694.08 percent of total billed charges 4992 93 4043.52 percent of total billed charges 4992 4992 other OPPS APC 4992 4992 other OPPS APC 4992 27.63 1379.29 percent of total billed charges 4992 4992 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR LCCK NEXGEN TIVANIUM UHMWPE 3-4 E-F L66 MM X W42 MM X H17 MM KNEE REVISION MACHINE MOLD STERILE SUP-00-5994-032-17 CDM 270010025 LOCAL 0270 RC outpatient 4992 4992 4992 74 3694.08 percent of total billed charges 4992 93 4043.52 percent of total billed charges 4992 4992 other OPPS APC 4992 4992 other OPPS APC 4992 27.63 1379.29 percent of total billed charges 4992 4992 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR NEXGEN LCCK TIVANIUM UHMWPE 3-4 E-F L66 MM X W42 MM X H20 MM KNEE REVISION MACHINE MOLD STERILE SUP-00-5994-032-20 CDM 270010025 LOCAL 0270 RC outpatient 4992 4992 4992 74 3694.08 percent of total billed charges 4992 93 4043.52 percent of total billed charges 4992 4992 other OPPS APC 4992 4992 other OPPS APC 4992 27.63 1379.29 percent of total billed charges 4992 4992 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR LCCK NEXGEN TIVANIUM UHMWPE 3-4 E-F L66 MM X W42 MM X H28 MM KNEE REVISION MACHINE MOLD STERILE SUP-00-5994-032-28 CDM 270010025 LOCAL 0270 RC outpatient 4992 4992 4992 74 3694.08 percent of total billed charges 4992 93 4043.52 percent of total billed charges 4992 4992 other OPPS APC 4992 4992 other OPPS APC 4992 27.63 1379.29 percent of total billed charges 4992 4992 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR SURFACE NEXGEN LCCK EF 56 GREEN 10MM SUP-00-5994-040-10 CDM 270010025 LOCAL 0270 RC outpatient 6112.6 6112.6 6112.6 74 4523.32 percent of total billed charges 6112.6 93 4951.21 percent of total billed charges 6112.6 6112.6 other OPPS APC 6112.6 6112.6 other OPPS APC 6112.6 27.63 1688.91 percent of total billed charges 6112.6 6112.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR NEXGEN LCCK TIVANIUM UHMWPE 5-6 E-F L74 MM X W46 MM X H12 MM KNEE REVISION MACHINE MOLD STERILE SUP-00-5994-040-12 CDM 270010025 LOCAL 0270 RC outpatient 4992 4992 4992 74 3694.08 percent of total billed charges 4992 93 4043.52 percent of total billed charges 4992 4992 other OPPS APC 4992 4992 other OPPS APC 4992 27.63 1379.29 percent of total billed charges 4992 4992 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR NEXGEN LCCK TIVANIUM UHMWPE 5-6 E-F L74 MM X W46 MM X H14 MM KNEE REVISION MACHINE MOLD STERILE SUP-00-5994-040-14 CDM 270010025 LOCAL 0270 RC outpatient 4992 4992 4992 74 3694.08 percent of total billed charges 4992 93 4043.52 percent of total billed charges 4992 4992 other OPPS APC 4992 4992 other OPPS APC 4992 27.63 1379.29 percent of total billed charges 4992 4992 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR NEXGEN LCCK TIVANIUM UHMWPE 5-6 E-F L74 MM X W46 MM X H17 MM KNEE REVISION MACHINE MOLD STERILE SUP-00-5994-040-17 CDM 270010025 LOCAL 0270 RC outpatient 4992 4992 4992 74 3694.08 percent of total billed charges 4992 93 4043.52 percent of total billed charges 4992 4992 other OPPS APC 4992 4992 other OPPS APC 4992 27.63 1379.29 percent of total billed charges 4992 4992 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR NEXGEN LCCK TIVANIUM UHMWPE 5-6 E-F L74 MM X W46 MM X H20 MM KNEE REVISION MACHINE MOLD STERILE SUP-00-5994-040-20 CDM 270010025 LOCAL 0270 RC outpatient 4992 4992 4992 74 3694.08 percent of total billed charges 4992 93 4043.52 percent of total billed charges 4992 4992 other OPPS APC 4992 4992 other OPPS APC 4992 27.63 1379.29 percent of total billed charges 4992 4992 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR NEXGEN LCCK TIVANIUM UHMWPE 5-6 E-F L74 MM X W46 MM X H23 MM KNEE REVISION MACHINE MOLD STERILE SUP-00-5994-040-23 CDM 270010025 LOCAL 0270 RC outpatient 4992 4992 4992 74 3694.08 percent of total billed charges 4992 93 4043.52 percent of total billed charges 4992 4992 other OPPS APC 4992 4992 other OPPS APC 4992 27.63 1379.29 percent of total billed charges 4992 4992 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR LCCK NEXGEN TIVANIUM UHMWPE 5-6 G L74 MM X W46 MM X H14 MM KNEE REVISION MACHINE MOLD STERILE SUP-00-5994-042-14 CDM 270010025 LOCAL 0270 RC outpatient 4336.8 4336.8 4336.8 74 3209.23 percent of total billed charges 4336.8 93 3512.81 percent of total billed charges 4336.8 4336.8 other OPPS APC 4336.8 4336.8 other OPPS APC 4336.8 27.63 1198.26 percent of total billed charges 4336.8 4336.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR NEXGEN LCCK TIVANIUM UHMWPE 7-10 G-H L82 MM X W50 MM X H17 MM KNEE REVISION MACHINE MOLD STERILE SUP-00-5994-050-17 CDM 270010025 LOCAL 0270 RC outpatient 4992 4992 4992 74 3694.08 percent of total billed charges 4992 93 4043.52 percent of total billed charges 4992 4992 other OPPS APC 4992 4992 other OPPS APC 4992 27.63 1379.29 percent of total billed charges 4992 4992 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR LCCK NEXGEN TIVANIUM UHMWPE 7-10 G-H L82 MM X W50 MM X H20 MM KNEE REVISION MACHINE MOLD STERILE SUP-00-5994-050-20 CDM 270010025 LOCAL 0270 RC outpatient 4992 4992 4992 74 3694.08 percent of total billed charges 4992 93 4043.52 percent of total billed charges 4992 4992 other OPPS APC 4992 4992 other OPPS APC 4992 27.63 1379.29 percent of total billed charges 4992 4992 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR LCCK NEXGEN TIVANIUM UHMWPE 7-10 G-H L82 MM X W50 MM X H20 MM KNEE REVISION MACHINE MOLD STERILE SUP-00-5994-052-20 CDM 270010025 LOCAL 0270 RC outpatient 4992 4992 4992 74 3694.08 percent of total billed charges 4992 93 4043.52 percent of total billed charges 4992 4992 other OPPS APC 4992 4992 other OPPS APC 4992 27.63 1379.29 percent of total billed charges 4992 4992 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIA ALL POLY SIZE 6 GREEN 17MM SUP-00-5996-006-17 CDM 270010025 LOCAL 0270 RC outpatient 2964 2964 2964 74 2193.36 percent of total billed charges 2964 93 2400.84 percent of total billed charges 2964 2964 other OPPS APC 2964 2964 other OPPS APC 2964 27.63 818.95 percent of total billed charges 2964 2964 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN BONE STEINMANN HEADLESS THREADED GOLD NEXGEN 75MM SUP-00-5997-084-00 CDM 270010025 LOCAL 0270 RC outpatient 314.6 314.6 314.6 74 232.8 percent of total billed charges 314.6 93 254.83 percent of total billed charges 314.6 314.6 other OPPS APC 314.6 314.6 other OPPS APC 314.6 27.63 86.92 percent of total billed charges 314.6 314.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRILOGY TIVANIUM L30 MM OD4.5 MM HIP ACETABULAR SELF TAP STERILE SUP-00-6250-045-30 CDM 270010024 LOCAL 0270 RC outpatient 304.2 304.2 304.2 74 225.11 percent of total billed charges 304.2 93 246.4 percent of total billed charges 304.2 304.2 other OPPS APC 304.2 304.2 other OPPS APC 304.2 27.63 84.05 percent of total billed charges 304.2 304.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRILOGY TRABECULAR METAL L20 MM OD6.5 MM HIP STERILE SUP-00-6250-065-20 CDM 270010024 LOCAL 0270 RC outpatient 304.2 304.2 304.2 74 225.11 percent of total billed charges 304.2 93 246.4 percent of total billed charges 304.2 304.2 other OPPS APC 304.2 304.2 other OPPS APC 304.2 27.63 84.05 percent of total billed charges 304.2 304.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRILOGY TRABECULAR METAL L25 MM OD6.5 MM HIP STERILE SUP-00-6250-065-25 CDM 270010024 LOCAL 0270 RC outpatient 304.2 304.2 304.2 74 225.11 percent of total billed charges 304.2 93 246.4 percent of total billed charges 304.2 304.2 other OPPS APC 304.2 304.2 other OPPS APC 304.2 27.63 84.05 percent of total billed charges 304.2 304.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRILOGY TRABECULAR METAL L30 MM OD6.5 MM HIP ACETABULAR SUP-00-6250-065-30 CDM 270010024 LOCAL 0270 RC outpatient 304.2 304.2 304.2 74 225.11 percent of total billed charges 304.2 93 246.4 percent of total billed charges 304.2 304.2 other OPPS APC 304.2 304.2 other OPPS APC 304.2 27.63 84.05 percent of total billed charges 304.2 304.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L35 MM OD6.5 MM HIP SELF TAP SUP-00-6250-065-35 CDM 270010024 LOCAL 0270 RC outpatient 280.8 280.8 280.8 74 207.79 percent of total billed charges 280.8 93 227.45 percent of total billed charges 280.8 280.8 other OPPS APC 280.8 280.8 other OPPS APC 280.8 27.63 77.59 percent of total billed charges 280.8 280.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L40 MM OD6.5 MM HIP SELF TAP SUP-00-6250-065-40 CDM 270010024 LOCAL 0270 RC outpatient 304.2 304.2 304.2 74 225.11 percent of total billed charges 304.2 93 246.4 percent of total billed charges 304.2 304.2 other OPPS APC 304.2 304.2 other OPPS APC 304.2 27.63 84.05 percent of total billed charges 304.2 304.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER MODULAR LONGEVITY NEUTRAL 56MM SUP-00-6305-056-36 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR TRILOGY LONGEVITY H8.3 MM OD50/52/54 MM ID28 MM HIP CONSTRAIN SUP-00-6334-050-28 CDM 270010024 LOCAL 0270 RC outpatient 8190 8190 8190 74 6060.6 percent of total billed charges 8190 93 6633.9 percent of total billed charges 8190 8190 other OPPS APC 8190 8190 other OPPS APC 8190 27.63 2262.9 percent of total billed charges 8190 8190 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR TRILOGY LONGEVITY RING H8.4 MM OD60 MM ID36 MM HIP CONSTRAIN SUP-00-6334-060-36 CDM 270010024 LOCAL 0270 RC outpatient 8190 8190 8190 74 6060.6 percent of total billed charges 8190 93 6633.9 percent of total billed charges 8190 8190 other OPPS APC 8190 8190 other OPPS APC 8190 27.63 2262.9 percent of total billed charges 8190 8190 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR TRILOGY LONGEVITY H9.4 MM OD62 MM ID36 MM HIP CONSTRAIN SUP-00-6334-062-36 CDM 270010024 LOCAL 0270 RC outpatient 8190 8190 8190 74 6060.6 percent of total billed charges 8190 93 6633.9 percent of total billed charges 8190 8190 other OPPS APC 8190 8190 other OPPS APC 8190 27.63 2262.9 percent of total billed charges 8190 8190 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER LONGEVITY 7MM OFFSET 50/52/54 SUP-00-6341-050-32 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE OSTEOTOME EXPLANT 48 MM HEMISPHERE HIP TRUNCATE ACETABULAR CUP REMOVAL SYSTEM SUP-00-7053-048-10 CDM 270010024 LOCAL 0270 RC outpatient 1638 1638 1638 74 1212.12 percent of total billed charges 1638 93 1326.78 percent of total billed charges 1638 1638 other OPPS APC 1638 1638 other OPPS APC 1638 27.63 452.58 percent of total billed charges 1638 1638 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE OSTEOTOME EXPLANT 48 MM HEMISPHERE HIP FULL ACETABULAR CUP REMOVAL SYSTEM SUP-00-7053-048-20 CDM 270010024 LOCAL 0270 RC outpatient 1638 1638 1638 74 1212.12 percent of total billed charges 1638 93 1326.78 percent of total billed charges 1638 1638 other OPPS APC 1638 1638 other OPPS APC 1638 27.63 452.58 percent of total billed charges 1638 1638 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE OSTEOTOME EXPLANT 64 MM HEMISPHERE HIP TRUNCATE ACETABULAR CUP REMOVAL SYSTEM SUP-00-7053-064-10 CDM 270010025 LOCAL 0270 RC outpatient 1638 1638 1638 74 1212.12 percent of total billed charges 1638 93 1326.78 percent of total billed charges 1638 1638 other OPPS APC 1638 1638 other OPPS APC 1638 27.63 452.58 percent of total billed charges 1638 1638 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE OSTEOTOME EXPLANT 64 MM HEMISPHERE HIP FULL ACETABULAR CUP REMOVAL SYSTEM SUP-00-7053-064-20 CDM 270010025 LOCAL 0270 RC outpatient 1638 1638 1638 74 1212.12 percent of total billed charges 1638 93 1326.78 percent of total billed charges 1638 1638 other OPPS APC 1638 1638 other OPPS APC 1638 27.63 452.58 percent of total billed charges 1638 1638 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL VERSYS LEGACY ZIMALOY -2 MM 12/14 OD22 MM HIP STERILE SUP-00-8018-022-20 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL VERSYS LEGACY ZIMALOY -3.5 MM 12/14 TAPER OD28 MM HIP STERILE SUP-00-8018-028-01 CDM 270010024 LOCAL 0270 RC outpatient 1809.6 1809.6 1809.6 74 1339.1 percent of total billed charges 1809.6 93 1465.78 percent of total billed charges 1809.6 1809.6 other OPPS APC 1809.6 1809.6 other OPPS APC 1809.6 27.63 499.99 percent of total billed charges 1809.6 1809.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL VERSYS LEGACY ZIMALOY 0 MM 12/14 TAPER OD28 MM HIP STERILE SUP-00-8018-028-02 CDM 270010024 LOCAL 0270 RC outpatient 1809.6 1809.6 1809.6 74 1339.1 percent of total billed charges 1809.6 93 1465.78 percent of total billed charges 1809.6 1809.6 other OPPS APC 1809.6 1809.6 other OPPS APC 1809.6 27.63 499.99 percent of total billed charges 1809.6 1809.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL VERSYS LEGACY ZIMALOY +3.5 MM 12/14 TAPER OD28 MM HIP STERILE SUP-00-8018-028-03 CDM 270010024 LOCAL 0270 RC outpatient 1809.6 1809.6 1809.6 74 1339.1 percent of total billed charges 1809.6 93 1465.78 percent of total billed charges 1809.6 1809.6 other OPPS APC 1809.6 1809.6 other OPPS APC 1809.6 27.63 499.99 percent of total billed charges 1809.6 1809.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL VERSYS LEGACY ZIMALOY -3.5 MM 12/14 TAPER OD32 MM HIP STERILE SUP-00-8018-032-01 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL VERSYS LEGACY ZIMALOY -3.5 MM 12/14 TAPER OD36 MM HIP STERILE SUP-00-8018-036-01 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL VERSYS LEGACY ZIMALOY 0 MM 12/14 OD36 MM HIP STERILE SUP-00-8018-036-02 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR LONGEVITY JJ NEUTRAL OD54 MM ID36 MM HIP CONTINUUM SUP-00-8751-011-36 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR LONGEVITY KK ELEVATED OD56 MM ID32 MM HIP CONTINUUM SUP-00-8752-012-32 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR CONTINUUM TRABECULAR METAL TIVANIUM KK HEMISPHERICAL TAPER OD56 MM HIP MULTIHOLE SNAP FIT INTEGRATE LOCK MECHANISM SUP-00-8757-056-02 CDM 270010024 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR LONGEVITY 45 D II OD52 MM ID28 MM HIP CONSTRAINED SUP-00-8758-010-28 CDM 270010024 LOCAL 0270 RC outpatient 8190 8190 8190 74 6060.6 percent of total billed charges 8190 93 6633.9 percent of total billed charges 8190 8190 other OPPS APC 8190 8190 other OPPS APC 8190 27.63 2262.9 percent of total billed charges 8190 8190 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL TRILOGY IT CONTINUUM BIOLOX DELTA -3.5 MM 12/14 SMALL OD28 MM HIP ACETABULUM STERILE SUP-00-8775-028-01 CDM 270010024 LOCAL 0270 RC outpatient 3931.2 3931.2 3931.2 74 2909.09 percent of total billed charges 3931.2 93 3184.27 percent of total billed charges 3931.2 3931.2 other OPPS APC 3931.2 3931.2 other OPPS APC 3931.2 27.63 1086.19 percent of total billed charges 3931.2 3931.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL TRILOGY IT CONTINUUM BIOLOX DELTA +0 MM 12/14 MEDIUM OD28 MM HIP ACETABULUM STERILE SUP-00-8775-028-02 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL TRILOGY IT BIOLOX DELTA +0 MM 12/14 MEDIUM OD36 MM HIP ACETABULAR STERILE SUP-00-8775-036-02 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL OPTION BIOLOX DELTA +7 MM 12/14 XL OD28 MM HIP STERILE SUP-00-8777-028-04 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BACTISURE WOUND LAVAGE SUP-00-8887-001-00 CDM 0270 RC outpatient 1365 1365 1365 74 1010.1 percent of total billed charges 1365 93 1105.65 percent of total billed charges 1365 1365 other OPPS APC 1365 1365 other OPPS APC 1365 27.63 377.15 percent of total billed charges 1365 1365 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION WOUND CLEANSING BACTISURE SUP-00-8887-002-00 CDM 0270 RC outpatient 1495 1495 1495 74 1106.3 percent of total billed charges 1495 93 1210.95 percent of total billed charges 1495 1495 other OPPS APC 1495 1495 other OPPS APC 1495 27.63 413.07 percent of total billed charges 1495 1495 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LEGACY RINGLOC ZIMALOY COCR 6 D +7 MM MEDIUM OD28 MM HIP STERILE SUP-00-90260-029-00 CDM 270010024 LOCAL 0270 RC outpatient 1809.6 1809.6 1809.6 74 1339.1 percent of total billed charges 1809.6 93 1465.78 percent of total billed charges 1809.6 1809.6 other OPPS APC 1809.6 1809.6 other OPPS APC 1809.6 27.63 499.99 percent of total billed charges 1809.6 1809.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP TRACTION PLASTIC L3 1/8 IN L2 IN WIDE SERRATE GRIP EDGE AUTOCLAVABLE LATEX FREE DISPOSABLE SUP-00005700200 CDM 0270 RC outpatient 71.07 71.07 71.07 74 52.59 percent of total billed charges 71.07 93 57.57 percent of total billed charges 71.07 71.07 other OPPS APC 71.07 71.07 other OPPS APC 71.07 27.63 19.64 percent of total billed charges 71.07 71.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRUSH CYTOLOGY L115 CM OD3 MM ODSEC1.7 MM STERILE LATEX FREE DISPOSABLE BRONCHOSCOPE SUP-000107 CDM 0270 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 27.63 6.47 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRUSH CYTOLOGY CONMED L230 CM OD3 MM ODSEC2.1 MM GASTROINTESTINE SHEATH BRISTLE POSITIVE STOP THUMB RING STERILE LATEX FREE DISPOSABLE COLONOSCOPE SUP-000110 CDM 0270 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 27.63 6.47 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL L229 MM OD.9 MM 1 END DIAMOND POINT STYLE 6 NONSTERILE SUP-00018600169 CDM 0270 RC outpatient 123.42 123.42 123.42 74 91.33 percent of total billed charges 123.42 93 99.97 percent of total billed charges 123.42 123.42 other OPPS APC 123.42 123.42 other OPPS APC 123.42 27.63 34.1 percent of total billed charges 123.42 123.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL L229 MM OD1.1 MM 1 END DIAMOND POINT STYLE 6 NONSTERILE SUP-00018600269 CDM 0270 RC outpatient 76.05 76.05 76.05 74 56.28 percent of total billed charges 76.05 93 61.6 percent of total billed charges 76.05 76.05 other OPPS APC 76.05 76.05 other OPPS APC 76.05 27.63 21.01 percent of total billed charges 76.05 76.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL L229 MM OD1.6 MM 1 END DIAMOND POINT STYLE 6 NONSTERILE SUP-00018600369 CDM 0270 RC outpatient 12.68 12.68 12.68 74 9.38 percent of total billed charges 12.68 93 10.27 percent of total billed charges 12.68 12.68 other OPPS APC 12.68 12.68 other OPPS APC 12.68 27.63 3.5 percent of total billed charges 12.68 12.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION STEINMANN STAINLESS STEEL L22.9 MM OD2 MM 1 END DIAMOND POINT STYLE 6 NONSTERILE SUP-00018700169 CDM 0270 RC outpatient 14.6 14.6 14.6 74 10.8 percent of total billed charges 14.6 93 11.83 percent of total billed charges 14.6 14.6 other OPPS APC 14.6 14.6 other OPPS APC 14.6 27.63 4.03 percent of total billed charges 14.6 14.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION STEINMANN STAINLESS STEEL L22.9 MM OD2.8 MM 1 END DIAMOND POINT STYLE 6 NONSTERILE SUP-00018700369 CDM 0270 RC outpatient 23.78 23.78 23.78 74 17.6 percent of total billed charges 23.78 93 19.26 percent of total billed charges 23.78 23.78 other OPPS APC 23.78 23.78 other OPPS APC 23.78 27.63 6.57 percent of total billed charges 23.78 23.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION STEINMANN STAINLESS STEEL DIAMOND L22.9 CM OD3.2 MM 1 END POINT STYLE 6 NONSTERILE LATEX FREE SUP-00018700469 CDM 0270 RC outpatient 143.99 143.99 143.99 74 106.55 percent of total billed charges 143.99 93 116.63 percent of total billed charges 143.99 143.99 other OPPS APC 143.99 143.99 other OPPS APC 143.99 27.63 39.78 percent of total billed charges 143.99 143.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION STEINMANN STAINLESS STEEL L229 MM OD3.6 MM 1 END DIAMOND POINT STYLE 6 NONSTERILE SUP-00018700569 CDM 0270 RC outpatient 28.93 28.93 28.93 74 21.41 percent of total billed charges 28.93 93 23.43 percent of total billed charges 28.93 28.93 other OPPS APC 28.93 28.93 other OPPS APC 28.93 27.63 7.99 percent of total billed charges 28.93 28.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION STEINMANN STAINLESS STEEL L229 MM OD4 MM 1 END DIAMOND POINT STYLE 6 NONSTERILE SUP-00018700669 CDM 0270 RC outpatient 4.82 4.82 4.82 74 3.57 percent of total billed charges 4.82 93 3.9 percent of total billed charges 4.82 4.82 other OPPS APC 4.82 4.82 other OPPS APC 4.82 27.63 1.33 percent of total billed charges 4.82 4.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION STEINMANN STAINLESS STEEL L22.9 MM OD4.8 MM 1 END DIAMOND POINT STYLE 6 NONSTERILE SUP-00018700769 CDM 0270 RC outpatient 2.98 2.98 2.98 74 2.21 percent of total billed charges 2.98 93 2.41 percent of total billed charges 2.98 2.98 other OPPS APC 2.98 2.98 other OPPS APC 2.98 27.63 0.82 percent of total billed charges 2.98 2.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUBSTITUTE BONE GRAFT PROGENIX DEMINERALIZED BONE MATRIX BOVINE COLLAGEN .5 ML PUTTY SUP-000505 CDM 270010031 LOCAL 0270 RC outpatient 317.2 317.2 317.2 74 234.73 percent of total billed charges 317.2 93 256.93 percent of total billed charges 317.2 317.2 other OPPS APC 317.2 317.2 other OPPS APC 317.2 27.63 87.64 percent of total billed charges 317.2 317.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BINDER ABDOMINAL 30-45X12IN 4 ELASTIC PANEL COMFORT CONTACT CLOSURE MED SUP-00058404100 CDM 270009158 LOCAL 0270 RC outpatient 18.59 18.59 18.59 74 13.76 percent of total billed charges 18.59 93 15.06 percent of total billed charges 18.59 18.59 other OPPS APC 18.59 18.59 other OPPS APC 18.59 27.63 5.14 percent of total billed charges 18.59 18.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BINDER ABDOMINAL 46-62X12IN 4 ELASTIC PANEL CONTACT CLOSURE COMFORT LG LATEX SUP-00058404200 CDM 270009158 LOCAL 0270 RC outpatient 18.59 18.59 18.59 74 13.76 percent of total billed charges 18.59 93 15.06 percent of total billed charges 18.59 18.59 other OPPS APC 18.59 18.59 other OPPS APC 18.59 27.63 5.14 percent of total billed charges 18.59 18.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE RECTAL PLASTIC L20 IN OD24 FR FLEXIBLE CONNECTOR LUBRICANT NONSTERILE LATEX FREE DISPOSABLE SUP-0006510 CDM 270009047 LOCAL 0270 RC outpatient 5.96 5.96 5.96 74 4.41 percent of total billed charges 5.96 93 4.83 percent of total billed charges 5.96 5.96 other OPPS APC 5.96 5.96 other OPPS APC 5.96 27.63 1.65 percent of total billed charges 5.96 5.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CR2 BATTERIES-STERILE SUP-000656-01 CDM 0270 RC outpatient 65 65 65 74 48.1 percent of total billed charges 65 93 52.65 percent of total billed charges 65 65 other OPPS APC 65 65 other OPPS APC 65 27.63 17.96 percent of total billed charges 65 65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE GASTROSTOMY BARD 20FR 20CC SILICONE 3 FUNNEL BALLOON ADJUSTABLE EXTERNAL BOLSTER RADIOPAQUE SUP-000720 CDM 270009103 LOCAL 0270 RC outpatient 82.8 82.8 82.8 74 61.27 percent of total billed charges 82.8 93 67.07 percent of total billed charges 82.8 82.8 other OPPS APC 82.8 82.8 other OPPS APC 82.8 27.63 22.88 percent of total billed charges 82.8 82.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIGATOR ENDOSCOPIC FALOPE-RING FALLOPIAN TUBE BAND APPLICATOR GUIDE O RING STERILE REUSABLE SUP-000875-901 CDM outpatient 202.8 202.8 202.8 202.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GEL-FLOW NT .55G PWDR 1X6 SYR KIT SUP-0009104006 CDM 0270 RC outpatient 143 143 143 74 105.82 percent of total billed charges 143 93 115.83 percent of total billed charges 143 143 other OPPS APC 143 143 other OPPS APC 143 27.63 39.51 percent of total billed charges 143 143 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH SURGICAL MONOFILAMENT STRAP VENTRALEX SEPRA POLYPROPYLENE EPTFE SM CIRCLE 1.7IN SUP-0010301 CDM 0270 RC outpatient 1250.6 1250.6 1250.6 74 925.44 percent of total billed charges 1250.6 93 1012.99 percent of total billed charges 1250.6 1250.6 other OPPS APC 1250.6 1250.6 other OPPS APC 1250.6 27.63 345.54 percent of total billed charges 1250.6 1250.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH SURGICAL VENTRALEX SEPRA SORBAFLEX MED CIRCLE 2.5IN POLYPROPYLENE EPTFE STERILE MONOFILAMENT SELF EXPAND STRAP SUP-0010302 CDM 0270 RC outpatient 1329.9 1329.9 1329.9 74 984.13 percent of total billed charges 1329.9 93 1077.22 percent of total billed charges 1329.9 1329.9 other OPPS APC 1329.9 1329.9 other OPPS APC 1329.9 27.63 367.45 percent of total billed charges 1329.9 1329.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE SUTURE STAINLESS STEEL L60.96 CM OD.97 MM BEAD END SUP-00119103800 CDM 0270 RC outpatient 21.71 21.71 21.71 74 16.07 percent of total billed charges 21.71 93 17.59 percent of total billed charges 21.71 21.71 other OPPS APC 21.71 21.71 other OPPS APC 21.71 27.63 6 percent of total billed charges 21.71 21.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE SUTURE STAINLESS STEEL L24 IN OD16 GA ODSEC1.2 MM BEAD END LATEX FREE SUP-00119104800 CDM 0270 RC outpatient 35.35 35.35 35.35 74 26.16 percent of total billed charges 35.35 93 28.63 percent of total billed charges 35.35 35.35 other OPPS APC 35.35 35.35 other OPPS APC 35.35 27.63 9.77 percent of total billed charges 35.35 35.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEAL ENDOSCOPIC INSTRUMENT RUBBER SUP-00131 CDM 0270 RC outpatient 1.95 1.95 1.95 74 1.44 percent of total billed charges 1.95 93 1.58 percent of total billed charges 1.95 1.95 other OPPS APC 1.95 1.95 other OPPS APC 1.95 27.63 0.54 percent of total billed charges 1.95 1.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING OXYGEN AIRLIFE VINYL ADULT L7 FT TIP CRUSH RESISTANT LUMEN U CONNECT IT CONNECTOR LATEX FREE DISPOSABLE SUP-001350 CDM 0270 RC outpatient 0.76 0.76 0.76 74 0.56 percent of total billed charges 0.76 93 0.62 percent of total billed charges 0.76 0.76 other OPPS APC 0.76 0.76 other OPPS APC 0.76 27.63 0.21 percent of total billed charges 0.76 0.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK TEST 3M COMPLY BLACK DARK BROWN YELLOW DISPOSABLE LF BOWIE DICK PLUS EARLY WARNING SHEET STEAM STERILIZER SUP-00135LF CDM 0270 RC outpatient 6.63 6.63 6.63 74 4.91 percent of total billed charges 6.63 93 5.37 percent of total billed charges 6.63 6.63 other OPPS APC 6.63 6.63 other OPPS APC 6.63 27.63 1.83 percent of total billed charges 6.63 6.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMOBILIZER ORTHOPEDIC CONTOUR 22IN 29IN KNEE ELASTIC PATELLA STRAP PERFORATE SUP-00188550022 CDM 0481 RC outpatient 36.4 36.4 36.4 74 26.94 percent of total billed charges 36.4 93 29.48 percent of total billed charges 36.4 36.4 other OPPS APC 36.4 36.4 other OPPS APC 36.4 51 18.56 percent of total billed charges 36.4 36.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMOBILIZER ORTHOPEDIC FOAM L12 IN W 3 IN OD 29 IN KNEE ELASTIC STRAP PERFORATED SUP-00188850012 CDM 270009016 LOCAL 0270 RC outpatient 36.4 36.4 36.4 74 26.94 percent of total billed charges 36.4 93 29.48 percent of total billed charges 36.4 36.4 other OPPS APC 36.4 36.4 other OPPS APC 36.4 27.63 10.06 percent of total billed charges 36.4 36.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMBOLIZER ORTHOPEDIC FOAM L16 IN W 3 IN OD 29 IN KNEE ELASTIC STRAP PERFORATED SUP-00188850016 CDM 270009016 LOCAL 0270 RC outpatient 36.4 36.4 36.4 74 26.94 percent of total billed charges 36.4 93 29.48 percent of total billed charges 36.4 36.4 other OPPS APC 36.4 36.4 other OPPS APC 36.4 27.63 10.06 percent of total billed charges 36.4 36.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMOBILIZER ORTHOPEDIC ALUMINUM FOAM NYLON CONTOUR L22 IN OD29 IN KNEE ELASTIC PATELLA STRAP PERFORATE BREATHABLE SUP-00188850022 CDM 270009016 LOCAL 0270 RC outpatient 18.25 18.25 18.25 74 13.51 percent of total billed charges 18.25 93 14.78 percent of total billed charges 18.25 18.25 other OPPS APC 18.25 18.25 other OPPS APC 18.25 27.63 5.04 percent of total billed charges 18.25 18.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DERMACARRIERS SUP-00219501200 CDM 0270 RC outpatient 54.47 54.47 54.47 74 40.31 percent of total billed charges 54.47 93 44.12 percent of total billed charges 54.47 54.47 other OPPS APC 54.47 54.47 other OPPS APC 54.47 27.63 15.05 percent of total billed charges 54.47 54.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CABLE CABLE-READY STAINLESS STEEL L559 MM OD1.8 MM CERCLAGE STERILE LATEX FREE SUP-00223200118 CDM 0270 RC outpatient 970.45 970.45 970.45 74 718.13 percent of total billed charges 970.45 93 786.06 percent of total billed charges 970.45 970.45 other OPPS APC 970.45 970.45 other OPPS APC 970.45 27.63 268.14 percent of total billed charges 970.45 970.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID OSTEOFIL DEMINERALIZED BONE MATRIX 1 ML ALLOGRAFT PASTE FROZEN SUP-002401FZ CDM 270010012 LOCAL 0270 RC outpatient 491.4 491.4 491.4 74 363.64 percent of total billed charges 491.4 93 398.03 percent of total billed charges 491.4 491.4 other OPPS APC 491.4 491.4 other OPPS APC 491.4 27.63 135.77 percent of total billed charges 491.4 491.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER HEAT MOISTURE FOAM PAPER STRAIGHT 150-1500ML 40 GM EXCHANGER HEAT MOISTURE SUP-002874 CDM outpatient 5.76 5.76 5.76 5.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSTRUMENT ENDOSCOPIC SIGMOID 30CM 6FT 18FR DISPOSABLE STERILE PREATTACH TUBE ON OFF CONTROL SIGMOIDOSCOPY COLONOSCOPY SUP-0033050 CDM 0270 RC outpatient 11.41 11.41 11.41 74 8.44 percent of total billed charges 11.41 93 9.24 percent of total billed charges 11.41 11.41 other OPPS APC 11.41 11.41 other OPPS APC 11.41 27.63 3.15 percent of total billed charges 11.41 11.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE ADHESIVE COVERLET 3X2IN FABRIC STERILE LF PATCH XL WOUND PAD ABSORBENT ELASTIC SUP-00340000 CDM 270009017 LOCAL 0270 RC outpatient 3.84 3.84 3.84 74 2.84 percent of total billed charges 3.84 93 3.11 percent of total billed charges 3.84 3.84 other OPPS APC 3.84 3.84 other OPPS APC 3.84 27.63 1.06 percent of total billed charges 3.84 3.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING SUCTION POOLE GENTLE SUMP STERILE LATEX FREE DISPOSABLE SUP-0035040 CDM 0270 RC outpatient 3.74 3.74 3.74 74 2.77 percent of total billed charges 3.74 93 3.03 percent of total billed charges 3.74 3.74 other OPPS APC 3.74 3.74 other OPPS APC 3.74 27.63 1.03 percent of total billed charges 3.74 3.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CIRCUIT BREATHING AIRLIFE UNIVERSAL 72IN 96IN DISPOSABLE LF SMOOTH BORE TUBE RESPIRATORY FILTER SUP-003770 CDM 0270 RC outpatient 22.6 22.6 22.6 74 16.72 percent of total billed charges 22.6 93 18.31 percent of total billed charges 22.6 22.6 other OPPS APC 22.6 22.6 other OPPS APC 22.6 27.63 6.24 percent of total billed charges 22.6 22.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANISTER SUCTION BERKELEY SAFETOUCH BOTTLE SEAL CAP DISPOSABLE SUP-003987-901 CDM 0270 RC outpatient 24 24 24 74 17.76 percent of total billed charges 24 93 19.44 percent of total billed charges 24 24 other OPPS APC 24 24 other OPPS APC 24 27.63 6.63 percent of total billed charges 24 24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANISTER SUCTION BERKELEY SAFETOUCH GAUZE SEAL CAP O RING STERILE SUP-003997-901 CDM 0270 RC outpatient 6.24 6.24 6.24 74 4.62 percent of total billed charges 6.24 93 5.05 percent of total billed charges 6.24 6.24 other OPPS APC 6.24 6.24 other OPPS APC 6.24 27.63 1.72 percent of total billed charges 6.24 6.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER SHOULDER 36MM 7D +6MM OFFSET STANDARD HUMERUS TRABECULAR METAL POLYETHYLENE SUP-00434903606 CDM 270010030 LOCAL 0270 RC outpatient 3471.03 3471.03 3471.03 74 2568.56 percent of total billed charges 3471.03 93 2811.53 percent of total billed charges 3471.03 3471.03 other OPPS APC 3471.03 3471.03 other OPPS APC 3471.03 27.63 959.05 percent of total billed charges 3471.03 3471.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER HUMERAL TRABECULAR METAL 9 MM SHOULDER REVERSE SUP-00434903909 CDM 270010024 LOCAL 0270 RC outpatient 1674.4 1674.4 1674.4 74 1239.06 percent of total billed charges 1674.4 93 1356.26 percent of total billed charges 1674.4 1674.4 other OPPS APC 1674.4 1674.4 other OPPS APC 1674.4 27.63 462.64 percent of total billed charges 1674.4 1674.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT WRIST RADIAL HEAD COMPONENT MODULAR EVOLVE 22MM SUP-00434906606 CDM 0270 RC outpatient 5566.6 5566.6 5566.6 74 4119.28 percent of total billed charges 5566.6 93 4508.95 percent of total billed charges 5566.6 5566.6 other OPPS APC 5566.6 5566.6 other OPPS APC 5566.6 27.63 1538.05 percent of total billed charges 5566.6 5566.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER SHOULDER TRABECULAR METAL POLYETHYLENE 12 D 65 D H6+ MM OD40 MM HUMERUS REVERSE RETENTIVE STERILE SUP-00434906606 CDM 270010024 LOCAL 0270 RC outpatient 3471.03 3471.03 3471.03 74 2568.56 percent of total billed charges 3471.03 93 2811.53 percent of total billed charges 3471.03 3471.03 other OPPS APC 3471.03 3471.03 other OPPS APC 3471.03 27.63 959.05 percent of total billed charges 3471.03 3471.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DRAINAGE PVC ROUND L12 IN OD3/32 IN 400 CC 3 SPRING EVACUATOR TROCAR Y CONNECTOR TUBE HOLE PATTERN STERILE LATEX FREE DISPOSABLE SUP-0043600 CDM 270009033 LOCAL 0270 RC outpatient 18.83 18.83 18.83 74 13.93 percent of total billed charges 18.83 93 15.25 percent of total billed charges 18.83 18.83 other OPPS APC 18.83 18.83 other OPPS APC 18.83 27.63 5.2 percent of total billed charges 18.83 18.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DRAINAGE PVC ROUND L12 IN OD1/4 IN 400 ML 3 SPRING EVACUATOR TROCAR Y CONNECTOR TUBE HOLE PATTERN STERILE LATEX FREE DISPOSABLE SUP-0043620 CDM 270009033 LOCAL 0270 RC outpatient 18.83 18.83 18.83 74 13.93 percent of total billed charges 18.83 93 15.25 percent of total billed charges 18.83 18.83 other OPPS APC 18.83 18.83 other OPPS APC 18.83 27.63 5.2 percent of total billed charges 18.83 18.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER BONE POSTERIOR LUMBAR INTERBODY 7MM SUP-004807 CDM 270010012 LOCAL 0270 RC outpatient 5898.96 5898.96 5898.96 74 4365.23 percent of total billed charges 5898.96 93 4778.16 percent of total billed charges 5898.96 5898.96 other OPPS APC 5898.96 5898.96 other OPPS APC 5898.96 27.63 1629.88 percent of total billed charges 5898.96 5898.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER BONE POSTERIOR LUMBAR INTERBODY 8MM SUP-004808 CDM 270010012 LOCAL 0270 RC outpatient 6938.96 6938.96 6938.96 74 5134.83 percent of total billed charges 6938.96 93 5620.56 percent of total billed charges 6938.96 6938.96 other OPPS APC 6938.96 6938.96 other OPPS APC 6938.96 27.63 1917.23 percent of total billed charges 6938.96 6938.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER BONE POSTERIOR LUMBAR INTERBODY 9MM SUP-004809 CDM 270010012 LOCAL 0270 RC outpatient 6938.96 6938.96 6938.96 74 5134.83 percent of total billed charges 6938.96 93 5620.56 percent of total billed charges 6938.96 6938.96 other OPPS APC 6938.96 6938.96 other OPPS APC 6938.96 27.63 1917.23 percent of total billed charges 6938.96 6938.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER BONE POSTERIOR LUMBAR INTERBODY 10MM SUP-004810 CDM 270010020 LOCAL 0270 RC outpatient 6938.96 6938.96 6938.96 74 5134.83 percent of total billed charges 6938.96 93 5620.56 percent of total billed charges 6938.96 6938.96 other OPPS APC 6938.96 6938.96 other OPPS APC 6938.96 27.63 1917.23 percent of total billed charges 6938.96 6938.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER BONE POSTERIOR LUMBAR INTERBODY 11MM SUP-004811 CDM 270010012 LOCAL 0270 RC outpatient 6938.96 6938.96 6938.96 74 5134.83 percent of total billed charges 6938.96 93 5620.56 percent of total billed charges 6938.96 6938.96 other OPPS APC 6938.96 6938.96 other OPPS APC 6938.96 27.63 1917.23 percent of total billed charges 6938.96 6938.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER BONE POSTERIOR LUMBAR INTERBODY 12MM SUP-004812 CDM 270010020 LOCAL 0270 RC outpatient 6938.96 6938.96 6938.96 74 5134.83 percent of total billed charges 6938.96 93 5620.56 percent of total billed charges 6938.96 6938.96 other OPPS APC 6938.96 6938.96 other OPPS APC 6938.96 27.63 1917.23 percent of total billed charges 6938.96 6938.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER BONE POSTERIOR LUMBAR INTERBODY 13MM SUP-004813 CDM 270010012 LOCAL 0270 RC outpatient 6938.96 6938.96 6938.96 74 5134.83 percent of total billed charges 6938.96 93 5620.56 percent of total billed charges 6938.96 6938.96 other OPPS APC 6938.96 6938.96 other OPPS APC 6938.96 27.63 1917.23 percent of total billed charges 6938.96 6938.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER BONE POSTERIOR LUMBAR INTERBODY 15MM SUP-004815 CDM 270010012 LOCAL 0270 RC outpatient 6938.96 6938.96 6938.96 74 5134.83 percent of total billed charges 6938.96 93 5620.56 percent of total billed charges 6938.96 6938.96 other OPPS APC 6938.96 6938.96 other OPPS APC 6938.96 27.63 1917.23 percent of total billed charges 6938.96 6938.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT CONTOUR WEDGE 22X8X17-14.6MM CORTICAL SPINE FROZEN SLOT PYRAMIDAL TEETH PLIF SUP-004817 CDM 270010012 LOCAL 0270 RC outpatient 6546.54 6546.54 6546.54 74 4844.44 percent of total billed charges 6546.54 93 5302.7 percent of total billed charges 6546.54 6546.54 other OPPS APC 6546.54 6546.54 other OPPS APC 6546.54 27.63 1808.81 percent of total billed charges 6546.54 6546.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUBSTITUTE BONE GRAFT PROGENIX DEMINERALIZED BONE MATRIX BOVINE COLLAGEN 1 ML PUTTY SUP-005001 CDM 270010031 LOCAL 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUBSTITUTE BONE GRAFT PROGENIX DEMINERALIZED BONE MATRIX BOVINE COLLAGEN 5 ML PUTTY SUP-005005 CDM 270010031 LOCAL 0270 RC outpatient 1911 1911 1911 74 1414.14 percent of total billed charges 1911 93 1547.91 percent of total billed charges 1911 1911 other OPPS APC 1911 1911 other OPPS APC 1911 27.63 528.01 percent of total billed charges 1911 1911 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW MICRO 100 MICROPOWER THK.4MM 5.5MM SS STERILE COARSE TOOTH SAGITTAL SUP-00502313200 CDM 0270 RC outpatient 67.52 67.52 67.52 74 49.96 percent of total billed charges 67.52 93 54.69 percent of total billed charges 67.52 67.52 other OPPS APC 67.52 67.52 other OPPS APC 67.52 27.63 18.66 percent of total billed charges 67.52 67.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROSAGITTAL BLADE SUP-00502313500 CDM 0270 RC outpatient 33.9 33.9 33.9 74 25.09 percent of total billed charges 33.9 93 27.46 percent of total billed charges 33.9 33.9 other OPPS APC 33.9 33.9 other OPPS APC 33.9 27.63 9.37 percent of total billed charges 33.9 33.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW HALL MICROPOWER MICRO100 L41 MM X W9.5 MM X H.4 MM SAGITTAL FINE TOOTH SUP-00502314400 CDM 0270 RC outpatient 62.06 62.06 62.06 74 45.92 percent of total billed charges 62.06 93 50.27 percent of total billed charges 62.06 62.06 other OPPS APC 62.06 62.06 other OPPS APC 62.06 27.63 17.15 percent of total billed charges 62.06 62.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE OSCILLATOR SUP-00502316000 CDM 0270 RC outpatient 46.8 46.8 46.8 74 34.63 percent of total billed charges 46.8 93 37.91 percent of total billed charges 46.8 46.8 other OPPS APC 46.8 46.8 other OPPS APC 46.8 27.63 12.93 percent of total billed charges 46.8 46.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW MICRO 100 MICROPOWER L25.5 MM X W9.5 MM X H.4 MM SAGITTAL FINE TOOTH STERILE SUP-00502318300 CDM 0270 RC outpatient 34.63 34.63 34.63 74 25.63 percent of total billed charges 34.63 93 28.05 percent of total billed charges 34.63 34.63 other OPPS APC 34.63 34.63 other OPPS APC 34.63 27.63 9.57 percent of total billed charges 34.63 34.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAGITTAL STRAIGHT 5.5 X 18 X 0.6MM SUP-00502323500 CDM 0270 RC outpatient 41.6 41.6 41.6 74 30.78 percent of total billed charges 41.6 93 33.7 percent of total billed charges 41.6 41.6 other OPPS APC 41.6 41.6 other OPPS APC 41.6 27.63 11.49 percent of total billed charges 41.6 41.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOWL BONE CEMENT QUICK-VAC VACUUM MIX LATEX FREE DISPOSABLE SUP-00504900115 CDM 0270 RC outpatient 184.91 184.91 184.91 74 136.83 percent of total billed charges 184.91 93 149.78 percent of total billed charges 184.91 184.91 other OPPS APC 184.91 184.91 other OPPS APC 184.91 27.63 51.09 percent of total billed charges 184.91 184.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM BONE CEMENT COMPACT VACUUM MIXING STERILE SUP-00504903501 CDM 0270 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 27.63 57.47 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PREP QUIK USE FEMORAL BONE CEMENT SUP-00504905510 CDM 0270 RC outpatient 384.93 384.93 384.93 74 284.85 percent of total billed charges 384.93 93 311.79 percent of total billed charges 384.93 384.93 other OPPS APC 384.93 384.93 other OPPS APC 384.93 27.63 106.36 percent of total billed charges 384.93 384.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW HALL L44.6 MM X W40 MM X H.4 MM STERNOTOMY REPEAT STERILE SUP-00505927800 CDM 0270 RC outpatient 25.04 25.04 25.04 74 18.53 percent of total billed charges 25.04 93 20.28 percent of total billed charges 25.04 25.04 other OPPS APC 25.04 25.04 other OPPS APC 25.04 27.63 6.92 percent of total billed charges 25.04 25.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE REPLACEMENT 19.5 X 1.27 X 86MM SUP-00507210100 CDM 0270 RC outpatient 49.56 49.56 49.56 74 36.67 percent of total billed charges 49.56 93 40.14 percent of total billed charges 49.56 49.56 other OPPS APC 49.56 49.56 other OPPS APC 49.56 27.63 13.69 percent of total billed charges 49.56 49.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SURGICAL CARBIDE MEDIUM MICRO L19 MM OD2 MM TAPERED 6 FLUTED STERILE SUP-00509121400 CDM 0270 RC outpatient 22.7 22.7 22.7 74 16.8 percent of total billed charges 22.7 93 18.39 percent of total billed charges 22.7 22.7 other OPPS APC 22.7 22.7 other OPPS APC 22.7 27.63 6.27 percent of total billed charges 22.7 22.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR ORTHOPEDIC CARBIDE ROUND MEDIUM 5MM SUP-00509123000 CDM 0270 RC outpatient 48.75 48.75 48.75 74 36.08 percent of total billed charges 48.75 93 39.49 percent of total billed charges 48.75 48.75 other OPPS APC 48.75 48.75 other OPPS APC 48.75 27.63 13.47 percent of total billed charges 48.75 48.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SURGICAL CARBIDE MEDIUM OVAL L48 MM OD5.5 MM 10 FLUTED STERILE SUP-00509123800 CDM 0270 RC outpatient 85.83 85.83 85.83 74 63.51 percent of total billed charges 85.83 93 69.52 percent of total billed charges 85.83 85.83 other OPPS APC 85.83 85.83 other OPPS APC 85.83 27.63 23.71 percent of total billed charges 85.83 85.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SURGICAL MICROPOWER MICRO100 HALL CARBIDE 8 MM LONG L8 MM OD4 MM SMALL BONE OVAL FLUTED STERILE SUP-00509223600 CDM 0270 RC outpatient 58.5 58.5 58.5 74 43.29 percent of total billed charges 58.5 93 47.39 percent of total billed charges 58.5 58.5 other OPPS APC 58.5 58.5 other OPPS APC 58.5 27.63 16.16 percent of total billed charges 58.5 58.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SURGICAL CARBIDE MICRO OD6.5 MM ROUND 10 FLUTED STERILE SUP-00509323200 CDM 0270 RC outpatient 103.14 103.14 103.14 74 76.32 percent of total billed charges 103.14 93 83.54 percent of total billed charges 103.14 103.14 other OPPS APC 103.14 103.14 other OPPS APC 103.14 27.63 28.5 percent of total billed charges 103.14 103.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR FOR NEURO SUP-00509326200 CDM 0270 RC outpatient 70.38 70.38 70.38 74 52.08 percent of total billed charges 70.38 93 57.01 percent of total billed charges 70.38 70.38 other OPPS APC 70.38 70.38 other OPPS APC 70.38 27.63 19.45 percent of total billed charges 70.38 70.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP PULSED LAVAGE L12.7 CM MULTIORIFICE FAN SPRAY SPLASH SHIELD HIGH CAPACITY STERILE INTRAMEDULLARY NAIL SUP-00515017500 CDM 0270 RC outpatient 9.83 9.83 9.83 74 7.27 percent of total billed charges 9.83 93 7.96 percent of total billed charges 9.83 9.83 other OPPS APC 9.83 9.83 other OPPS APC 9.83 27.63 2.72 percent of total billed charges 9.83 9.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PULSED LAVAGE PULSAVAC PLUS FAN SPRAY TIP RETAIN MECHANISM ROCKER SWITCH TEXTURE PISTOL GRIP HANDLE SUP-00515047500 CDM 0270 RC outpatient 78.78 78.78 78.78 74 58.3 percent of total billed charges 78.78 93 63.81 percent of total billed charges 78.78 78.78 other OPPS APC 78.78 78.78 other OPPS APC 78.78 27.63 21.77 percent of total billed charges 78.78 78.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR I/B II UHMWPE THK18.5 MM W59 MM X H21 MM KNEE POSTERIOR STABILIZED MACHINE MOLD STERILE SUP-00522003206 CDM 270010025 LOCAL 0270 RC outpatient 6893.35 6893.35 6893.35 74 5101.08 percent of total billed charges 6893.35 93 5583.61 percent of total billed charges 6893.35 6893.35 other OPPS APC 6893.35 6893.35 other OPPS APC 6893.35 27.63 1904.63 percent of total billed charges 6893.35 6893.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT FEMORAL I/B II TIVANIUM KNEE FEMUR TIBIA LOCK CLIP STERILE SUP-00522006600 CDM 270010025 LOCAL 0270 RC outpatient 725.14 725.14 725.14 74 536.6 percent of total billed charges 725.14 93 587.36 percent of total billed charges 725.14 725.14 other OPPS APC 725.14 725.14 other OPPS APC 725.14 27.63 200.36 percent of total billed charges 725.14 725.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ZIMMER LCCK SIZE 4 5MM 41X34 CPL SUP-00544705441 CDM 270010025 LOCAL 0270 RC outpatient 13751.4 13751.4 13751.4 74 10176 percent of total billed charges 13751.4 93 11138.6 percent of total billed charges 13751.4 13751.4 other OPPS APC 13751.4 13751.4 other OPPS APC 13751.4 27.63 3799.51 percent of total billed charges 13751.4 13751.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE TIBIAL LCCK TRABECULAR METAL 0 D 5 CONE OD46 MM ODSEC34 MM ANTERIOR POSTERIOR COUPLED SUP-00544705546 CDM 270010025 LOCAL 0270 RC outpatient 13751.4 13751.4 13751.4 74 10176 percent of total billed charges 13751.4 93 11138.6 percent of total billed charges 13751.4 13751.4 other OPPS APC 13751.4 13751.4 other OPPS APC 13751.4 27.63 3799.51 percent of total billed charges 13751.4 13751.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT FEMORAL TRABECULAR METAL LARGE CONE H35 MM METAPHYSIS LEFT SUP-00545002235 CDM 270010025 LOCAL 0270 RC outpatient 11193 11193 11193 74 8282.82 percent of total billed charges 11193 93 9066.33 percent of total billed charges 11193 11193 other OPPS APC 11193 11193 other OPPS APC 11193 27.63 3092.63 percent of total billed charges 11193 11193 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE DENOVO CARTILAGE 110 MG ALLOGRAFT NATURAL SUP-00560600010 CDM 0270 RC outpatient 12142 12142 12142 74 8985.08 percent of total billed charges 12142 93 9835.02 percent of total billed charges 12142 12142 other OPPS APC 12142 12142 other OPPS APC 12142 27.63 3354.83 percent of total billed charges 12142 12142 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE DENOVO CARTILAGE 2.5 SQ CM ALLOGRAFT NATURAL SUP-00560600011 CDM 0270 RC outpatient 11440 11440 11440 74 8465.6 percent of total billed charges 11440 93 9266.4 percent of total billed charges 11440 11440 other OPPS APC 11440 11440 other OPPS APC 11440 27.63 3160.87 percent of total billed charges 11440 11440 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE TIBIAL NEXGEN ZIMALOY PMMA UHMWPE 6 KNEE ROTATE HINGE STEM STERILE SUP-00588000600 CDM 270010025 LOCAL 0270 RC outpatient 8143.2 8143.2 8143.2 74 6025.97 percent of total billed charges 8143.2 93 6595.99 percent of total billed charges 8143.2 8143.2 other OPPS APC 8143.2 8143.2 other OPPS APC 8143.2 27.63 2249.97 percent of total billed charges 8143.2 8143.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL NEXGEN ZIMALOY F L76 MM X W66 MM KNEE LEFT ROTATE HINGE STERILE SUP-00588001601 CDM 270010025 LOCAL 0270 RC outpatient 16395.6 16395.6 16395.6 74 12132.7 percent of total billed charges 16395.6 93 13280.4 percent of total billed charges 16395.6 16395.6 other OPPS APC 16395.6 16395.6 other OPPS APC 16395.6 27.63 4530.1 percent of total billed charges 16395.6 16395.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR NEXGEN ZIMALOY UHMWPE 5-6 F L77 MM X W44 MM X H17 MM KNEE ROTATING HINGE MACHINE MOLD STERILE SUP-00588006017 CDM 270010025 LOCAL 0270 RC outpatient 3588 3588 3588 74 2655.12 percent of total billed charges 3588 93 2906.28 percent of total billed charges 3588 3588 other OPPS APC 3588 3588 other OPPS APC 3588 27.63 991.36 percent of total billed charges 3588 3588 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE PIN ORTHOPEDIC LPS SUP-00597000014 CDM 270010025 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE REAMER NEXGEN STAINLESS STEEL OD41 MM KNEE PATELLA PILOT HOLE NONSTERILE SUP-00597909541 CDM 270010025 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA REAMER BLADE WITH PILOT HOLE SIZE 51 SUP-00597909551 CDM 270010025 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN TIVANIUM FLUTE L75 MM L120 MM OD15 MM KNEE TIBIA SHARP REPLACEMENT SCREW STERILE SUP-00598801515 CDM 270010025 LOCAL 0270 RC outpatient 2386.8 2386.8 2386.8 74 1766.23 percent of total billed charges 2386.8 93 1933.31 percent of total billed charges 2386.8 2386.8 other OPPS APC 2386.8 2386.8 other OPPS APC 2386.8 27.63 659.47 percent of total billed charges 2386.8 2386.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM NEXGEN TIVANIUM FLUTE L130 MM L175 MM OD24 MM KNEE FEMUR SHARP REPLACEMENT SCREW STERILE SUP-00598801624 CDM 270010025 LOCAL 0270 RC outpatient 3109.6 3109.6 3109.6 74 2301.1 percent of total billed charges 3109.6 93 2518.78 percent of total billed charges 3109.6 3109.6 other OPPS APC 3109.6 3109.6 other OPPS APC 3109.6 27.63 859.18 percent of total billed charges 3109.6 3109.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR LCCK NEXGEN TIVANIUM UHMWPE 3-4 E-F L66 MM X W42 MM X H10 MM KNEE REVISION MACHINE MOLD STERILE SUP-00599403210 CDM 270010025 LOCAL 0270 RC outpatient 4336.8 4336.8 4336.8 74 3209.23 percent of total billed charges 4336.8 93 3512.81 percent of total billed charges 4336.8 4336.8 other OPPS APC 4336.8 4336.8 other OPPS APC 4336.8 27.63 1198.26 percent of total billed charges 4336.8 4336.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR LCCK NEXGEN TIVANIUM UHMWPE 3-4 E-F L66 MM X W42 MM X H23 MM KNEE REVISION MACHINE MOLD STERILE SUP-00599403223 CDM 270010025 LOCAL 0270 RC outpatient 4336.8 4336.8 4336.8 74 3209.23 percent of total billed charges 4336.8 93 3512.81 percent of total billed charges 4336.8 4336.8 other OPPS APC 4336.8 4336.8 other OPPS APC 4336.8 27.63 1198.26 percent of total billed charges 4336.8 4336.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTICULAR LCCK NEXGEN TIVANIUM UHMWPE 5-6 E-F L74 MM X W46 MM X H10 MM KNEE REVISION MACHINE MOLD STERILE SUP-00599404010 CDM 270010025 LOCAL 0270 RC outpatient 4336.8 4336.8 4336.8 74 3209.23 percent of total billed charges 4336.8 93 3512.81 percent of total billed charges 4336.8 4336.8 other OPPS APC 4336.8 4336.8 other OPPS APC 4336.8 27.63 1198.26 percent of total billed charges 4336.8 4336.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL LPS NEXGEN UHMWPE 3 A-B L66 MM X W42 MM X H14 MM KNEE CEMENT STERILE SUP-00599602314 CDM 270010025 LOCAL 0270 RC outpatient 2964 2964 2964 74 2193.36 percent of total billed charges 2964 93 2400.84 percent of total billed charges 2964 2964 other OPPS APC 2964 2964 other OPPS APC 2964 27.63 818.95 percent of total billed charges 2964 2964 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PACING BARD 1CM PROXIMAL 110CM 5FR NATURAL RUBBER DISPOSABLE STERILE LATEX ELECTRODE BIPOLAR DISTAL TIP BALLOON SUP-006173P CDM 0270 RC outpatient 511.07 511.07 511.07 74 378.19 percent of total billed charges 511.07 93 413.97 percent of total billed charges 511.07 511.07 other OPPS APC 511.07 511.07 other OPPS APC 511.07 27.63 141.21 percent of total billed charges 511.07 511.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ACETABULAR TRILOGY TRABECULAR METAL TIVANIUM OD62 MM HIP MODULAR CUP LOCK REPLACEMENT STERILE SUP-00620106200 CDM 270010025 LOCAL 0270 RC outpatient 104 104 104 74 76.96 percent of total billed charges 104 93 84.24 percent of total billed charges 104 104 other OPPS APC 104 104 other OPPS APC 104 27.63 28.74 percent of total billed charges 104 104 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Temp PACING NO Balloon BARD 1CM PROXIMAL L115 CM OD5 FR BIPOLAR DISTAL TIP SEMI FLOATING CATHETER LATEX FREE SUP-006225P CDM 0270 RC outpatient 317.12 317.12 317.12 74 234.67 percent of total billed charges 317.12 93 256.87 percent of total billed charges 317.12 317.12 other OPPS APC 317.12 317.12 other OPPS APC 317.12 27.63 87.62 percent of total billed charges 317.12 317.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR TRILOGY LONGEVITY 10 D ELEVATED RIM H10.8 MM OD62 MM ID36 MM HIP PRIMARY MODULAR CUP STERILE SUP-00631006236 CDM 270010025 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BETADINE 5% STERILE OPTHALMIC PREP SOLUTION SUP-0065041130 CDM 0270 RC outpatient 26.65 26.65 26.65 74 19.72 percent of total billed charges 26.65 93 21.59 percent of total billed charges 26.65 26.65 other OPPS APC 26.65 26.65 other OPPS APC 26.65 27.63 7.36 percent of total billed charges 26.65 26.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION BSS 15ML SUP-0065079515 CDM 0270 RC outpatient 10.06 10.06 10.06 74 7.44 percent of total billed charges 10.06 93 8.15 percent of total billed charges 10.06 10.06 other OPPS APC 10.06 10.06 other OPPS APC 10.06 27.63 2.78 percent of total billed charges 10.06 10.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IRRIGATION BSS GLUCOSE SODIUM BICARBONATE GLUTATHIONE 500 ML INTRAOCULAR GLASS BOTTLE STERILE SUP-0065079550 CDM 0270 RC outpatient 16.74 16.74 16.74 74 12.39 percent of total billed charges 16.74 93 13.56 percent of total billed charges 16.74 16.74 other OPPS APC 16.74 16.74 other OPPS APC 16.74 27.63 4.63 percent of total billed charges 16.74 16.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CAPSULE DELIVERY ADVANCE L180 CM OD2.5 MM STERILE GASTROENTEROLOGY SUP-00711144 CDM 0270 RC outpatient 528.67 528.67 528.67 74 391.22 percent of total billed charges 528.67 93 428.22 percent of total billed charges 528.67 528.67 other OPPS APC 528.67 528.67 other OPPS APC 528.67 27.63 146.07 percent of total billed charges 528.67 528.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMARTCAP AQUASHIELD SUP-00711540 CDM outpatient 11.11 11.11 11.11 11.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRUSH ERCP ENDOSCOPIC INFINITY NITINOL L200 CM OD3 MM DRIVE WIRE STIFFER SOFTER BRISTLE STERILE LATEX FREE DISPOSABLE LONG SHORT GUIDEWIRE SUP-00711652 CDM 0270 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE DILATOR VASCULAR PARSONNET 1.0MM X 45CM SUP-007603 CDM 270009131 LOCAL 0270 RC outpatient 83.69 83.69 83.69 74 61.93 percent of total billed charges 83.69 93 67.79 percent of total billed charges 83.69 83.69 other OPPS APC 83.69 83.69 other OPPS APC 83.69 27.63 23.12 percent of total billed charges 83.69 83.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE VASCULAR BARD PARSONNET 45CM 1.5MM SS POLYURETHANE DISPOSABLE STERILE SHAFT SUP-007604 CDM 270009131 LOCAL 0270 RC outpatient 83.69 83.69 83.69 74 61.93 percent of total billed charges 83.69 93 67.79 percent of total billed charges 83.69 83.69 other OPPS APC 83.69 83.69 other OPPS APC 83.69 27.63 23.12 percent of total billed charges 83.69 83.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHUNT CAROTID BARD JAVID TAPER L27.5 CM OD10-17 FR TYPE 1852 KINK RESISTANT POLISH TIP BYPASS SUP-007714 CDM 0270 RC outpatient 33.02 33.02 33.02 74 24.43 percent of total billed charges 33.02 93 26.75 percent of total billed charges 33.02 33.02 other OPPS APC 33.02 33.02 other OPPS APC 33.02 27.63 9.12 percent of total billed charges 33.02 33.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FELT CARDIOVASCULAR THK1.65MM 4X4IN PTFE STERILE SUP-007836 CDM 0270 RC outpatient 562.38 562.38 562.38 74 416.16 percent of total billed charges 562.38 93 455.53 percent of total billed charges 562.38 562.38 other OPPS APC 562.38 562.38 other OPPS APC 562.38 27.63 155.39 percent of total billed charges 562.38 562.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL VERSYS ADVOCATE ZIMALOY 45 MM STANDARD OFFSET L145 MM OD16 MM HIP PRIMARY CEMENT SATIN FINISH STERILE SUP-00785001600 CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING 52CM 2.4MM ENDOCARDIAL ATRIAL VENTRICULAR BIPOLAR STRAIGHT EXTENDABLE SUP-00802526397738 CDM 0275 RC outpatient 1666.6 1666.6 1666.6 57 949.96 percent of total billed charges 1666.6 93 1349.95 percent of total billed charges 1666.6 1666.6 other OPPS APC 1666.6 1666.6 other OPPS APC 1666.6 51 849.97 percent of total billed charges 1666.6 1666.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPELLA CP WITH SMARTASSIST SUP-00813502011876 CDM 0481 RC outpatient 43800 43800 43800 74 32412 percent of total billed charges 43800 93 35478 percent of total billed charges 43800 43800 other OPPS APC 43800 43800 other OPPS APC 43800 51 22338 percent of total billed charges 43800 43800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEDTRONIC .035 STRAIGHT TIP GUIDEWIRE 175CM SUP-008629 CDM 0481 RC outpatient 15.6 15.6 15.6 74 11.54 percent of total billed charges 15.6 93 12.64 percent of total billed charges 15.6 15.6 other OPPS APC 15.6 15.6 other OPPS APC 15.6 51 7.96 percent of total billed charges 15.6 15.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR LONGEVITY 45 D 7 MM OFFSET LL OD58 MM ID36 MM HIP SUP-00875401336 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SWAB PREP PHENOL .175 - .2ML 30 AMPULE SNAP IT OPEN APPLICATOR LATEX FREE SUP-00884-6297-30 CDM 0270 RC outpatient 20.19 20.19 20.19 74 14.94 percent of total billed charges 20.19 93 16.35 percent of total billed charges 20.19 20.19 other OPPS APC 20.19 20.19 other OPPS APC 20.19 27.63 5.58 percent of total billed charges 20.19 20.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ESOPHAGEAL MINNESOTA 18FR NATURAL RUBBER DISPOSABLE NS LATEX 4 LUMEN 2 BALLOON SUP-0092220 CDM 0270 RC outpatient 1234.48 1234.48 1234.48 74 913.52 percent of total billed charges 1234.48 93 999.93 percent of total billed charges 1234.48 1234.48 other OPPS APC 1234.48 1234.48 other OPPS APC 1234.48 27.63 341.09 percent of total billed charges 1234.48 1234.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ESOPHAGEAL LINTON NATURAL RUBBER ADULT LARGE OD20 FR 700-800 CC 3 LUMEN BALLOON NONSTERILE LATEX DISPOSABLE SUP-0092740 CDM outpatient 1488.5 1488.5 1488.5 1488.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE DRAIN SILICONE T L30CM OD 10FR SOFT PLIABLE SUP-0099800 CDM 270009031 LOCAL 0270 RC outpatient 663 663 663 74 490.62 percent of total billed charges 663 93 537.03 percent of total billed charges 663 663 other OPPS APC 663 663 other OPPS APC 663 27.63 183.19 percent of total billed charges 663 663 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE DRAIN SILICONE T L30CM OD 12FR SOFT PLIABLE SUP-0099810 CDM 0270 RC outpatient 696.8 696.8 696.8 74 515.63 percent of total billed charges 696.8 93 564.41 percent of total billed charges 696.8 696.8 other OPPS APC 696.8 696.8 other OPPS APC 696.8 27.63 192.53 percent of total billed charges 696.8 696.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE DRAIN SILICONE T L30CM OD 14 FR SOFT PLIABLE SUP-0099820 CDM 0270 RC outpatient 663 663 663 74 490.62 percent of total billed charges 663 93 537.03 percent of total billed charges 663 663 other OPPS APC 663 663 other OPPS APC 663 27.63 183.19 percent of total billed charges 663 663 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE DRAIN SILICONE T L 30 CM OD 16 FR SOFT PLIABLE SUP-0099830 CDM 0270 RC outpatient 663 663 663 74 490.62 percent of total billed charges 663 93 537.03 percent of total billed charges 663 663 other OPPS APC 663 663 other OPPS APC 663 27.63 183.19 percent of total billed charges 663 663 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAD DUO THERM 25 X 64 SUP-01-00001 CDM 0272 RC outpatient 40 40 40 74 29.6 percent of total billed charges 40 93 32.4 percent of total billed charges 40 40 other OPPS APC 40 40 other OPPS APC 40 27.63 11.05 percent of total billed charges 40 40 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAD DUO THERM 22 X 16 SUP-01-00004 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GEL AQUASONIC SUP-01-00006 CDM 0272 RC outpatient 1.33 1.33 1.33 74 0.98 percent of total billed charges 1.33 93 1.08 percent of total billed charges 1.33 1.33 other OPPS APC 1.33 1.33 other OPPS APC 1.33 27.63 0.37 percent of total billed charges 1.33 1.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAIR HUGGER BLANKETS FULL BODY SUP-01-00008 CDM 0271 RC outpatient 20.2 20.2 20.2 74 14.95 percent of total billed charges 20.2 93 16.36 percent of total billed charges 20.2 20.2 other OPPS APC 20.2 20.2 other OPPS APC 20.2 27.63 5.58 percent of total billed charges 20.2 20.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISPOSABLE LEG PLATE W/PAD SUP-01-00020 CDM 0271 RC outpatient 1.11 1.11 1.11 74 0.82 percent of total billed charges 1.11 93 0.9 percent of total billed charges 1.11 1.11 other OPPS APC 1.11 1.11 other OPPS APC 1.11 27.63 0.31 percent of total billed charges 1.11 1.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FECAL COLLECTOR MEDIUM SUP-01-00023 CDM 0271 RC outpatient 3.51 3.51 3.51 74 2.6 percent of total billed charges 3.51 93 2.84 percent of total billed charges 3.51 3.51 other OPPS APC 3.51 3.51 other OPPS APC 3.51 27.63 0.97 percent of total billed charges 3.51 3.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FECAL COLLECTOR STANDARD SUP-01-00024 CDM 0271 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICE PACK SUP-01-00028 CDM 0271 RC outpatient 0.78 0.78 0.78 74 0.58 percent of total billed charges 0.78 93 0.63 percent of total billed charges 0.78 0.78 other OPPS APC 0.78 0.78 other OPPS APC 0.78 27.63 0.22 percent of total billed charges 0.78 0.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTUBATING STYLET 14 FR SUP-01-00029 CDM 0272 RC outpatient 2.16 2.16 2.16 74 1.6 percent of total billed charges 2.16 93 1.75 percent of total billed charges 2.16 2.16 other OPPS APC 2.16 2.16 other OPPS APC 2.16 27.63 0.6 percent of total billed charges 2.16 2.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTUBATING STYLET 6 FR SUP-01-00030 CDM 0272 RC outpatient 2.35 2.35 2.35 74 1.74 percent of total billed charges 2.35 93 1.9 percent of total billed charges 2.35 2.35 other OPPS APC 2.35 2.35 other OPPS APC 2.35 27.63 0.65 percent of total billed charges 2.35 2.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCALPEL DISP SZ 10 SAFETY SUP-01-00036 CDM 0272 RC outpatient 1.84 1.84 1.84 74 1.36 percent of total billed charges 1.84 93 1.49 percent of total billed charges 1.84 1.84 other OPPS APC 1.84 1.84 other OPPS APC 1.84 27.63 0.51 percent of total billed charges 1.84 1.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCALPEL DISP SZ 11 SAFETY SUP-01-00037 CDM 0272 RC outpatient 2.15 2.15 2.15 74 1.59 percent of total billed charges 2.15 93 1.74 percent of total billed charges 2.15 2.15 other OPPS APC 2.15 2.15 other OPPS APC 2.15 27.63 0.59 percent of total billed charges 2.15 2.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCALPEL DISP SZ 15 SAFETY SUP-01-00038 CDM 0272 RC outpatient 2.46 2.46 2.46 74 1.82 percent of total billed charges 2.46 93 1.99 percent of total billed charges 2.46 2.46 other OPPS APC 2.46 2.46 other OPPS APC 2.46 27.63 0.68 percent of total billed charges 2.46 2.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCALPEL DISP SZ 20 SAFETY SUP-01-00039 CDM 0272 RC outpatient 2.9 2.9 2.9 74 2.15 percent of total billed charges 2.9 93 2.35 percent of total billed charges 2.9 2.9 other OPPS APC 2.9 2.9 other OPPS APC 2.9 27.63 0.8 percent of total billed charges 2.9 2.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCISSORS S&B STERILE SUP-01-00041 CDM 0272 RC outpatient 1.27 1.27 1.27 74 0.94 percent of total billed charges 1.27 93 1.03 percent of total billed charges 1.27 1.27 other OPPS APC 1.27 1.27 other OPPS APC 1.27 27.63 0.35 percent of total billed charges 1.27 1.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCROTAL SUPPORT LARGE SUP-01-00043 CDM 0271 RC outpatient 38.72 38.72 38.72 74 28.65 percent of total billed charges 38.72 93 31.36 percent of total billed charges 38.72 38.72 other OPPS APC 38.72 38.72 other OPPS APC 38.72 27.63 10.7 percent of total billed charges 38.72 38.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCROTAL SUPPORT MEDIUM SUP-01-00044 CDM 0271 RC outpatient 34 34 34 74 25.16 percent of total billed charges 34 93 27.54 percent of total billed charges 34 34 other OPPS APC 34 34 other OPPS APC 34 27.63 9.39 percent of total billed charges 34 34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING KNEE-HI LARGE/LONG SUP-01-00046 CDM 0271 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING KNEE-HI LARGE/REGULAR SUP-01-00047 CDM 0271 RC outpatient 20.62 20.62 20.62 74 15.26 percent of total billed charges 20.62 93 16.7 percent of total billed charges 20.62 20.62 other OPPS APC 20.62 20.62 other OPPS APC 20.62 27.63 5.7 percent of total billed charges 20.62 20.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING KNEE-HI MEDIUM/LONG SUP-01-00048 CDM 0271 RC outpatient 2.03 2.03 2.03 74 1.5 percent of total billed charges 2.03 93 1.64 percent of total billed charges 2.03 2.03 other OPPS APC 2.03 2.03 other OPPS APC 2.03 27.63 0.56 percent of total billed charges 2.03 2.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING KNEE-HI MEDIUM/REGULA SUP-01-00049 CDM 0271 RC outpatient 21.13 21.13 21.13 74 15.64 percent of total billed charges 21.13 93 17.12 percent of total billed charges 21.13 21.13 other OPPS APC 21.13 21.13 other OPPS APC 21.13 27.63 5.84 percent of total billed charges 21.13 21.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING KNEE-HI SMALL/REGULAR SUP-01-00050 CDM 0271 RC outpatient 20.34 20.34 20.34 74 15.05 percent of total billed charges 20.34 93 16.48 percent of total billed charges 20.34 20.34 other OPPS APC 20.34 20.34 other OPPS APC 20.34 27.63 5.62 percent of total billed charges 20.34 20.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING THIGH-HI LARGE/LONG SUP-01-00051 CDM 0271 RC outpatient 32.32 32.32 32.32 74 23.92 percent of total billed charges 32.32 93 26.18 percent of total billed charges 32.32 32.32 other OPPS APC 32.32 32.32 other OPPS APC 32.32 27.63 8.93 percent of total billed charges 32.32 32.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING THIGH-HI LARGE/REGULA SUP-01-00052 CDM 0271 RC outpatient 32.45 32.45 32.45 74 24.01 percent of total billed charges 32.45 93 26.28 percent of total billed charges 32.45 32.45 other OPPS APC 32.45 32.45 other OPPS APC 32.45 27.63 8.97 percent of total billed charges 32.45 32.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING THIGH-HI LARGE/SHORT SUP-01-00053 CDM 0271 RC outpatient 32.6 32.6 32.6 74 24.12 percent of total billed charges 32.6 93 26.41 percent of total billed charges 32.6 32.6 other OPPS APC 32.6 32.6 other OPPS APC 32.6 27.63 9.01 percent of total billed charges 32.6 32.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING THIGH-HI MEDIUM/LONG SUP-01-00054 CDM 0271 RC outpatient 30.73 30.73 30.73 74 22.74 percent of total billed charges 30.73 93 24.89 percent of total billed charges 30.73 30.73 other OPPS APC 30.73 30.73 other OPPS APC 30.73 27.63 8.49 percent of total billed charges 30.73 30.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING THIGH-HI MEDIUM/REGUL SUP-01-00055 CDM 0271 RC outpatient 30.9 30.9 30.9 74 22.87 percent of total billed charges 30.9 93 25.03 percent of total billed charges 30.9 30.9 other OPPS APC 30.9 30.9 other OPPS APC 30.9 27.63 8.54 percent of total billed charges 30.9 30.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING THIGH-HI MEDIUM/SHORT SUP-01-00056 CDM 0271 RC outpatient 35.3 35.3 35.3 74 26.12 percent of total billed charges 35.3 93 28.59 percent of total billed charges 35.3 35.3 other OPPS APC 35.3 35.3 other OPPS APC 35.3 27.63 9.75 percent of total billed charges 35.3 35.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING THIGH-HI SMALL/LONG SUP-01-00057 CDM 0271 RC outpatient 3.99 3.99 3.99 74 2.95 percent of total billed charges 3.99 93 3.23 percent of total billed charges 3.99 3.99 other OPPS APC 3.99 3.99 other OPPS APC 3.99 27.63 1.1 percent of total billed charges 3.99 3.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING THIGH-HI SMALL/REGULA SUP-01-00058 CDM 0271 RC outpatient 25.26 25.26 25.26 74 18.69 percent of total billed charges 25.26 93 20.46 percent of total billed charges 25.26 25.26 other OPPS APC 25.26 25.26 other OPPS APC 25.26 27.63 6.98 percent of total billed charges 25.26 25.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING THIGH-HI SMALL/SHORT SUP-01-00059 CDM 0271 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THERMOMETER ORAL DIGITAL SUP-01-00064 CDM 0271 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCD SLEEVE KNEE LENGTH MEDIUM SUP-01-00068 CDM 0271 RC outpatient 58 58 58 74 42.92 percent of total billed charges 58 93 46.98 percent of total billed charges 58 58 other OPPS APC 58 58 other OPPS APC 58 27.63 16.03 percent of total billed charges 58 58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCD SLEEVE KNEE LENGTH LARGE 9 SUP-01-00069 CDM 0271 RC outpatient 83.75 83.75 83.75 74 61.98 percent of total billed charges 83.75 93 67.84 percent of total billed charges 83.75 83.75 other OPPS APC 83.75 83.75 other OPPS APC 83.75 27.63 23.14 percent of total billed charges 83.75 83.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TUBE FEEDING 5FR X 16""" SUP-01-00072 CDM 0272 RC outpatient 0.99 0.99 0.99 74 0.73 percent of total billed charges 0.99 93 0.8 percent of total billed charges 0.99 0.99 other OPPS APC 0.99 0.99 other OPPS APC 0.99 27.63 0.27 percent of total billed charges 0.99 0.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TUBE FEEDING ADULT/PED 8FR X 42""" SUP-01-00073 CDM 0272 RC outpatient 0.68 0.68 0.68 74 0.5 percent of total billed charges 0.68 93 0.55 percent of total billed charges 0.68 0.68 other OPPS APC 0.68 0.68 other OPPS APC 0.68 27.63 0.19 percent of total billed charges 0.68 0.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE LARYNGECTOMY SIZE 10 SUP-01-00077 CDM 0272 RC outpatient 197.47 197.47 197.47 74 146.13 percent of total billed charges 197.47 93 159.95 percent of total billed charges 197.47 197.47 other OPPS APC 197.47 197.47 other OPPS APC 197.47 27.63 54.56 percent of total billed charges 197.47 197.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE LARYNGECTOMY SIZE 6 SUP-01-00078 CDM 0272 RC outpatient 157.76 157.76 157.76 74 116.74 percent of total billed charges 157.76 93 127.79 percent of total billed charges 157.76 157.76 other OPPS APC 157.76 157.76 other OPPS APC 157.76 27.63 43.59 percent of total billed charges 157.76 157.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE LARYNGECTOMY SIZE 8 SUP-01-00079 CDM 0272 RC outpatient 159.49 159.49 159.49 74 118.02 percent of total billed charges 159.49 93 129.19 percent of total billed charges 159.49 159.49 other OPPS APC 159.49 159.49 other OPPS APC 159.49 27.63 44.07 percent of total billed charges 159.49 159.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE TONGUE JUNIOR SUP-01-00114 CDM 0271 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KELLY CURVED STERILE SUP-01-00126 CDM 0272 RC outpatient 1.51 1.51 1.51 74 1.12 percent of total billed charges 1.51 93 1.22 percent of total billed charges 1.51 1.51 other OPPS APC 1.51 1.51 other OPPS APC 1.51 27.63 0.42 percent of total billed charges 1.51 1.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHLORAPREP 3ML APPLICATOR CLEAR SUP-01-00144 CDM 0272 RC outpatient 84.88 84.88 84.88 74 62.81 percent of total billed charges 84.88 93 68.75 percent of total billed charges 84.88 84.88 other OPPS APC 84.88 84.88 other OPPS APC 84.88 27.63 23.45 percent of total billed charges 84.88 84.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PVI SCRUB 4 OZ SUP-01-00145 CDM 0272 RC outpatient 0.94 0.94 0.94 74 0.7 percent of total billed charges 0.94 93 0.76 percent of total billed charges 0.94 0.94 other OPPS APC 0.94 0.94 other OPPS APC 0.94 27.63 0.26 percent of total billed charges 0.94 0.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PVI SWAB SUP-01-00146 CDM 0272 RC outpatient 0.11 0.11 0.11 74 0.08 percent of total billed charges 0.11 93 0.09 percent of total billed charges 0.11 0.11 other OPPS APC 0.11 0.11 other OPPS APC 0.11 27.63 0.03 percent of total billed charges 0.11 0.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOAP CASTILE TOWELETTE SUP-01-00147 CDM 0272 RC outpatient 2.44 2.44 2.44 74 1.81 percent of total billed charges 2.44 93 1.98 percent of total billed charges 2.44 2.44 other OPPS APC 2.44 2.44 other OPPS APC 2.44 27.63 0.67 percent of total billed charges 2.44 2.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STETHOSCOPE DISPOSABLE SUP-01-00150 CDM 0271 RC outpatient 2.75 2.75 2.75 74 2.04 percent of total billed charges 2.75 93 2.23 percent of total billed charges 2.75 2.75 other OPPS APC 2.75 2.75 other OPPS APC 2.75 27.63 0.76 percent of total billed charges 2.75 2.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE SALEM SUMP 12FR ANTI REFLUX SUP-01-00193 CDM 0272 RC outpatient 1.54 1.54 1.54 74 1.14 percent of total billed charges 1.54 93 1.25 percent of total billed charges 1.54 1.54 other OPPS APC 1.54 1.54 other OPPS APC 1.54 27.63 0.43 percent of total billed charges 1.54 1.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE SALEM SUMP 14FR ANTI REFLUX SUP-01-00194 CDM 0272 RC outpatient 1.54 1.54 1.54 74 1.14 percent of total billed charges 1.54 93 1.25 percent of total billed charges 1.54 1.54 other OPPS APC 1.54 1.54 other OPPS APC 1.54 27.63 0.43 percent of total billed charges 1.54 1.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE SALEM SUMP 16FR ANTI REFLUX SUP-01-00195 CDM 0272 RC outpatient 1.54 1.54 1.54 74 1.14 percent of total billed charges 1.54 93 1.25 percent of total billed charges 1.54 1.54 other OPPS APC 1.54 1.54 other OPPS APC 1.54 27.63 0.43 percent of total billed charges 1.54 1.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE SALEM SUMP 18FR ANTI REFLUX SUP-01-00196 CDM 0272 RC outpatient 1.54 1.54 1.54 74 1.14 percent of total billed charges 1.54 93 1.25 percent of total billed charges 1.54 1.54 other OPPS APC 1.54 1.54 other OPPS APC 1.54 27.63 0.43 percent of total billed charges 1.54 1.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE ANTI-REFLUX SUP-01-00197 CDM 0272 RC outpatient 21.73 21.73 21.73 74 16.08 percent of total billed charges 21.73 93 17.6 percent of total billed charges 21.73 21.73 other OPPS APC 21.73 21.73 other OPPS APC 21.73 27.63 6 percent of total billed charges 21.73 21.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE LOPEZ ADULT NASOGASTRIC SUP-01-00198 CDM 0272 RC outpatient 2.97 2.97 2.97 74 2.2 percent of total billed charges 2.97 93 2.41 percent of total billed charges 2.97 2.97 other OPPS APC 2.97 2.97 other OPPS APC 2.97 27.63 0.82 percent of total billed charges 2.97 2.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NASAL TUBE FASTENER W/SKIN PREP SUP-01-00199 CDM 0272 RC outpatient 1.13 1.13 1.13 74 0.84 percent of total billed charges 1.13 93 0.92 percent of total billed charges 1.13 1.13 other OPPS APC 1.13 1.13 other OPPS APC 1.13 27.63 0.31 percent of total billed charges 1.13 1.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRANSDUCER HOLDER SUP-01-00212 CDM 0272 RC outpatient 23.94 23.94 23.94 74 17.72 percent of total billed charges 23.94 93 19.39 percent of total billed charges 23.94 23.94 other OPPS APC 23.94 23.94 other OPPS APC 23.94 27.63 6.61 percent of total billed charges 23.94 23.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TUBE FEEDING 8FR X 16""" SUP-01-00214 CDM 0272 RC outpatient 1.03 1.03 1.03 74 0.76 percent of total billed charges 1.03 93 0.83 percent of total billed charges 1.03 1.03 other OPPS APC 1.03 1.03 other OPPS APC 1.03 27.63 0.28 percent of total billed charges 1.03 1.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DERMABOND SUP-01-00223 CDM 0272 RC outpatient 76.01 76.01 76.01 74 56.25 percent of total billed charges 76.01 93 61.57 percent of total billed charges 76.01 76.01 other OPPS APC 76.01 76.01 other OPPS APC 76.01 27.63 21 percent of total billed charges 76.01 76.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING THIGH SHORT XL SUP-01-00234 CDM 0271 RC outpatient 74.64 74.64 74.64 74 55.23 percent of total billed charges 74.64 93 60.46 percent of total billed charges 74.64 74.64 other OPPS APC 74.64 74.64 other OPPS APC 74.64 27.63 20.62 percent of total billed charges 74.64 74.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING THIGH REG XL SUP-01-00235 CDM 0271 RC outpatient 40.94 40.94 40.94 74 30.3 percent of total billed charges 40.94 93 33.16 percent of total billed charges 40.94 40.94 other OPPS APC 40.94 40.94 other OPPS APC 40.94 27.63 11.31 percent of total billed charges 40.94 40.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING THIGH LONG XL SUP-01-00236 CDM 0271 RC outpatient 51.47 51.47 51.47 74 38.09 percent of total billed charges 51.47 93 41.69 percent of total billed charges 51.47 51.47 other OPPS APC 51.47 51.47 other OPPS APC 51.47 27.63 14.22 percent of total billed charges 51.47 51.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPASS FOR COMPARTMENT PRESSURE SUP-01-00237 CDM 0272 RC outpatient 359.84 359.84 359.84 74 266.28 percent of total billed charges 359.84 93 291.47 percent of total billed charges 359.84 359.84 other OPPS APC 359.84 359.84 other OPPS APC 359.84 27.63 99.42 percent of total billed charges 359.84 359.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCD FOOT CUFF REG SUP-01-00240 CDM 0271 RC outpatient 101.25 101.25 101.25 74 74.93 percent of total billed charges 101.25 93 82.01 percent of total billed charges 101.25 101.25 other OPPS APC 101.25 101.25 other OPPS APC 101.25 27.63 27.98 percent of total billed charges 101.25 101.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCD FOOT CUFF LG SUP-01-00241 CDM 0271 RC outpatient 101.25 101.25 101.25 74 74.93 percent of total billed charges 101.25 93 82.01 percent of total billed charges 101.25 101.25 other OPPS APC 101.25 101.25 other OPPS APC 101.25 27.63 27.98 percent of total billed charges 101.25 101.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCD SLEEVE KNEE LENGTH XLG SUP-01-00242 CDM 0271 RC outpatient 109.3 109.3 109.3 74 80.88 percent of total billed charges 109.3 93 88.53 percent of total billed charges 109.3 109.3 other OPPS APC 109.3 109.3 other OPPS APC 109.3 27.63 30.2 percent of total billed charges 109.3 109.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GEL ULTRASOUND AQUASONIC 100 STERILE LF 20GM COMPLETE AQUEOUS TRANSMISSION FOIL POUCH SUP-01-01 CDM 0270 RC outpatient 3.38 3.38 3.38 74 2.5 percent of total billed charges 3.38 93 2.74 percent of total billed charges 3.38 3.38 other OPPS APC 3.38 3.38 other OPPS APC 3.38 27.63 0.93 percent of total billed charges 3.38 3.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT HOLDING FORCEP-3D ORB PLT SUP-01-01820 CDM 0270 RC outpatient 5228.6 5228.6 5228.6 74 3869.16 percent of total billed charges 5228.6 93 4235.17 percent of total billed charges 5228.6 5228.6 other OPPS APC 5228.6 5228.6 other OPPS APC 5228.6 27.63 1444.66 percent of total billed charges 5228.6 5228.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GLOBE RETRACTOR, ADJUSTABLE" SUP-01-02395 CDM 0270 RC outpatient 1833 1833 1833 74 1356.42 percent of total billed charges 1833 93 1484.73 percent of total billed charges 1833 1833 other OPPS APC 1833 1833 other OPPS APC 1833 27.63 506.46 percent of total billed charges 1833 1833 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPHERE EMBOLIZATION EMBOZENE POLYZENE-F HYDROGEL 500 UM 2 ML SYRINGE STERILE DISPOSABLE RED SUP-01-0301-05002-11 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPHERE EMBOLIZATION EMBOZENE POLYZENE-F HYDROGEL 700 UM 2 ML SYRINGE STERILE DISPOSABLE GREEN SUP-01-0301-07002-11 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPHERE EMBOLIZATION EMBOZENE POLYZENE F HYDROGEL 900 UM 2 ML SYRINGE STERILE DISPOSABLE PURPLE SUP-01-0301-09002-11 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIGATURE WIRE/BLUNT 160MM SUP-01-03490 CDM 0270 RC outpatient 39 39 39 74 28.86 percent of total billed charges 39 93 31.59 percent of total billed charges 39 39 other OPPS APC 39 39 other OPPS APC 39 27.63 10.78 percent of total billed charges 39 39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GEL ULTRASOUND AQUASONIC 100 .25 L PH 6.5-6.95 TRANSMISSION AQUEOUS DISPENSER CLEAR BLUE SLIGHT SUP-01-08 CDM 0270 RC outpatient 6.42 6.42 6.42 74 4.75 percent of total billed charges 6.42 93 5.2 percent of total billed charges 6.42 6.42 other OPPS APC 6.42 6.42 other OPPS APC 6.42 27.63 1.77 percent of total billed charges 6.42 6.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEP/SELF-RETAINING PLATE SUP-01-08115 CDM 0270 RC outpatient 1339 1339 1339 74 990.86 percent of total billed charges 1339 93 1084.59 percent of total billed charges 1339 1339 other OPPS APC 1339 1339 other OPPS APC 1339 27.63 369.97 percent of total billed charges 1339 1339 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER/WIRE /TES/12CM SUP-01-15315 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SELF DRILLING 1.5MM X 4MM SUP-01-6104 CDM 0270 RC outpatient 152.1 152.1 152.1 74 112.55 percent of total billed charges 152.1 93 123.2 percent of total billed charges 152.1 152.1 other OPPS APC 152.1 152.1 other OPPS APC 152.1 27.63 42.03 percent of total billed charges 152.1 152.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LORENZ TITANIUM STRAIGHT MIDFACE 6 HOLE 1.5 MM SCREW SUP-01-7050 CDM 0270 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 27.63 57.47 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 6 HOLE DOUBLE WIDE SUP-01-7110 CDM 0270 RC outpatient 582.4 582.4 582.4 74 430.98 percent of total billed charges 582.4 93 471.74 percent of total billed charges 582.4 582.4 other OPPS APC 582.4 582.4 other OPPS APC 582.4 27.63 160.92 percent of total billed charges 582.4 582.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 6 HOLE DOUBLE WIDE LONG SUP-01-7112 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 6 HOLE DOUBLE WIDE XLONG SUP-01-7114 CDM 0270 RC outpatient 569.4 569.4 569.4 74 421.36 percent of total billed charges 569.4 93 461.21 percent of total billed charges 569.4 569.4 other OPPS APC 569.4 569.4 other OPPS APC 569.4 27.63 157.33 percent of total billed charges 569.4 569.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SQUARE 4 HOLE 12MM SUP-01-7131 CDM 0270 RC outpatient 569.4 569.4 569.4 74 421.36 percent of total billed charges 569.4 93 461.21 percent of total billed charges 569.4 569.4 other OPPS APC 569.4 569.4 other OPPS APC 569.4 27.63 157.33 percent of total billed charges 569.4 569.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TRAUMAONE MATRIX TITANIUM RECTANGLE MIDFACE 2 X 3 HOLE STERILE SILVER 1.5 MM SCREW SUP-01-7136 CDM 0270 RC outpatient 725.4 725.4 725.4 74 536.8 percent of total billed charges 725.4 93 587.57 percent of total billed charges 725.4 725.4 other OPPS APC 725.4 725.4 other OPPS APC 725.4 27.63 200.43 percent of total billed charges 725.4 725.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE RECTANGLE 2X4 HOLE SUP-01-7137 CDM 0270 RC outpatient 725.4 725.4 725.4 74 536.8 percent of total billed charges 725.4 93 587.57 percent of total billed charges 725.4 725.4 other OPPS APC 725.4 725.4 other OPPS APC 725.4 27.63 200.43 percent of total billed charges 725.4 725.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL TWIST 1.1 X 50MM 3.5MM W/STOP SUP-01-7141 CDM 0270 RC outpatient 340.6 340.6 340.6 74 252.04 percent of total billed charges 340.6 93 275.89 percent of total billed charges 340.6 340.6 other OPPS APC 340.6 340.6 other OPPS APC 340.6 27.63 94.11 percent of total billed charges 340.6 340.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH CRANIAL LORENZ L85 MM X W53 MM X H.6 MM NEURO PANEL 1.5 MM SCREW SUP-01-7182 CDM 0270 RC outpatient 3153.8 3153.8 3153.8 74 2333.81 percent of total billed charges 3153.8 93 2554.58 percent of total billed charges 3153.8 3153.8 other OPPS APC 3153.8 3153.8 other OPPS APC 3153.8 27.63 871.39 percent of total billed charges 3153.8 3153.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH CRANIAL LORENZ L85 MM X W53 MM X H.3 MM NEURO PANEL 1.5 MM SCREW SUP-01-7185 CDM 0270 RC outpatient 3153.8 3153.8 3153.8 74 2333.81 percent of total billed charges 3153.8 93 2554.58 percent of total billed charges 3153.8 3153.8 other OPPS APC 3153.8 3153.8 other OPPS APC 3153.8 27.63 871.39 percent of total billed charges 3153.8 3153.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SHUNT 18.5MM SUP-01-7305 CDM 0270 RC outpatient 566.8 566.8 566.8 74 419.43 percent of total billed charges 566.8 93 459.11 percent of total billed charges 566.8 566.8 other OPPS APC 566.8 566.8 other OPPS APC 566.8 27.63 156.61 percent of total billed charges 566.8 566.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BURR HOLE 13MM SUP-01-7306 CDM 0270 RC outpatient 566.8 566.8 566.8 74 419.43 percent of total billed charges 566.8 93 459.11 percent of total billed charges 566.8 566.8 other OPPS APC 566.8 566.8 other OPPS APC 566.8 27.63 156.61 percent of total billed charges 566.8 566.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BURR HOLE 18.5MM SUP-01-7308 CDM 0270 RC outpatient 566.8 566.8 566.8 74 419.43 percent of total billed charges 566.8 93 459.11 percent of total billed charges 566.8 566.8 other OPPS APC 566.8 566.8 other OPPS APC 566.8 27.63 156.61 percent of total billed charges 566.8 566.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LORENZ TITANIUM H.5 MM OD22 MM CRANIOMAXILLOFACIAL BURR HOLE 1.5 MM HIGH TORQUE SELF DRILL SCREW SUP-01-7309 CDM 0270 RC outpatient 566.8 566.8 566.8 74 419.43 percent of total billed charges 566.8 93 459.11 percent of total billed charges 566.8 566.8 other OPPS APC 566.8 566.8 other OPPS APC 566.8 27.63 156.61 percent of total billed charges 566.8 566.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BURR HOLE 25MM SUP-01-7310 CDM 0270 RC outpatient 566.8 566.8 566.8 74 419.43 percent of total billed charges 566.8 93 459.11 percent of total billed charges 566.8 566.8 other OPPS APC 566.8 566.8 other OPPS APC 566.8 27.63 156.61 percent of total billed charges 566.8 566.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE CRANIAL 2 HOLE STRAIGHT SUP-01-7345 CDM 0270 RC outpatient 127.4 127.4 127.4 74 94.28 percent of total billed charges 127.4 93 103.19 percent of total billed charges 127.4 127.4 other OPPS APC 127.4 127.4 other OPPS APC 127.4 27.63 35.2 percent of total billed charges 127.4 127.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE STRAIGHT 2 HOLE 16MM SUP-01-7347 CDM 0270 RC outpatient 127.4 127.4 127.4 74 94.28 percent of total billed charges 127.4 93 103.19 percent of total billed charges 127.4 127.4 other OPPS APC 127.4 127.4 other OPPS APC 127.4 27.63 35.2 percent of total billed charges 127.4 127.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL WAGNER SL REVISION PROTASUL-100 POROUS 135 D 12/14 L190 MM OD15 MM HIP DISTAL FILL STERILE SUP-01.00101.915 CDM 270010024 LOCAL 0270 RC outpatient 13197.6 13197.6 13197.6 74 9766.22 percent of total billed charges 13197.6 93 10690.1 percent of total billed charges 13197.6 13197.6 other OPPS APC 13197.6 13197.6 other OPPS APC 13197.6 27.63 3646.5 percent of total billed charges 13197.6 13197.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL WAGNER SL REVISION 135KN ANGLE 15MM X 225MM SUP-01.00102.215 CDM 270010024 LOCAL 0270 RC outpatient 14554.8 14554.8 14554.8 74 10770.5 percent of total billed charges 14554.8 93 11789.4 percent of total billed charges 14554.8 14554.8 other OPPS APC 14554.8 14554.8 other OPPS APC 14554.8 27.63 4021.49 percent of total billed charges 14554.8 14554.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM WAGNER REVISION 135NK ANGLE 16MMX225 SUP-01.00102.216 CDM 0270 RC outpatient 15145 15145 15145 74 11207.3 percent of total billed charges 15145 93 12267.5 percent of total billed charges 15145 15145 other OPPS APC 15145 15145 other OPPS APC 15145 27.63 4184.56 percent of total billed charges 15145 15145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL WAGNER SL REVISION PROTASUL-100 POROUS 135 D 12/14 L225 MM OD17 MM HIP DISTAL FILL STERILE SUP-01.00102.217 CDM 270010024 LOCAL 0270 RC outpatient 13197.6 13197.6 13197.6 74 9766.22 percent of total billed charges 13197.6 93 10690.1 percent of total billed charges 13197.6 13197.6 other OPPS APC 13197.6 13197.6 other OPPS APC 13197.6 27.63 3646.5 percent of total billed charges 13197.6 13197.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT WAGNER SL REVISION STEM 135NECK 19MM SUP-01.00102.219 CDM 270010024 LOCAL 0270 RC outpatient 15145 15145 15145 74 11207.3 percent of total billed charges 15145 93 12267.5 percent of total billed charges 15145 15145 other OPPS APC 15145 15145 other OPPS APC 15145 27.63 4184.56 percent of total billed charges 15145 15145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL WAGNER SL REVISION PROTASUL-100 POROUS 135 D 12/14 L265 MM OD16 MM HIP DISTAL FILL STERILE SUP-01.00102.616 CDM 270010025 LOCAL 0270 RC outpatient 14547 14547 14547 74 10764.8 percent of total billed charges 14547 93 11783.1 percent of total billed charges 14547 14547 other OPPS APC 14547 14547 other OPPS APC 14547 27.63 4019.34 percent of total billed charges 14547 14547 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL WAGNER SL REVISION PROTASUL-100 POROUS 135 D 12/14 L265 MM OD18 MM HIP DISTAL FILL STERILE SUP-01.00102.618 CDM 270010024 LOCAL 0270 RC outpatient 14554.8 14554.8 14554.8 74 10770.5 percent of total billed charges 14554.8 93 11789.4 percent of total billed charges 14554.8 14554.8 other OPPS APC 14554.8 14554.8 other OPPS APC 14554.8 27.63 4021.49 percent of total billed charges 14554.8 14554.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL WAGNER SL REVISION PROTASUL-100 POROUS 135 D 12/14 L265 MM OD19 MM HIP DISTAL FILL STERILE SUP-01.00102.619 CDM 270010024 LOCAL 0270 RC outpatient 14554.8 14554.8 14554.8 74 10770.5 percent of total billed charges 14554.8 93 11789.4 percent of total billed charges 14554.8 14554.8 other OPPS APC 14554.8 14554.8 other OPPS APC 14554.8 27.63 4021.49 percent of total billed charges 14554.8 14554.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL WAGNER SL REVISION PROTASUL-100 POROUS 135 D 12/14 L265 MM OD22 MM HIP DISTAL FILL STERILE SUP-01.00102.622 CDM 270010024 LOCAL 0270 RC outpatient 14554.8 14554.8 14554.8 74 10770.5 percent of total billed charges 14554.8 93 11789.4 percent of total billed charges 14554.8 14554.8 other OPPS APC 14554.8 14554.8 other OPPS APC 14554.8 27.63 4021.49 percent of total billed charges 14554.8 14554.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL WAGNER SL REVISION PROTASUL-100 POROUS 135 D 12/14 L305 MM OD18 MM HIP DISTAL FILL STERILE SUP-01.00103.018 CDM 270010024 LOCAL 0270 RC outpatient 14554.8 14554.8 14554.8 74 10770.5 percent of total billed charges 14554.8 93 11789.4 percent of total billed charges 14554.8 14554.8 other OPPS APC 14554.8 14554.8 other OPPS APC 14554.8 27.63 4021.49 percent of total billed charges 14554.8 14554.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL BENCOX DELTA -4 MM SHORT OD36 MM HIP SUP-01.01.287 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL BENCOX DELTA 0 MM MEDIUM OD36 MM HIP SUP-01.01.288 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL BENCOX DELTA +4 MM LONG OD36 MM HIP SUP-01.01.289 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL BENCOX DELTA OD36 MM HIP STERILE SUP-01.01.295 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL QUADRA STAINLESS STEEL 0 STANDARD HIP CEMENT SUP-01.12.040 CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT QUADRA C STANDARD #1 FEMORAL STEM SUP-01.12.041 CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL QUADRA STAINLESS STEEL 2 STANDARD HIP CEMENT SUP-01.12.042 CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL QUADRA STAINLESS STEEL 3 STANDARD HIP CEMENT SUP-01.12.043 CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL QUADRA STAINLESS STEEL 4 STANDARD HIP CEMENT SUP-01.12.044 CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUADRA-P STD STEM #3 SUP-01.12.123 CDM 270010024 LOCAL 0270 RC outpatient 4940 4940 4940 74 3655.6 percent of total billed charges 4940 93 4001.4 percent of total billed charges 4940 4940 other OPPS APC 4940 4940 other OPPS APC 4940 27.63 1364.92 percent of total billed charges 4940 4940 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUADRA-P STD STEM #6 SUP-01.12.126 CDM 270010024 LOCAL 0270 RC outpatient 4940 4940 4940 74 3655.6 percent of total billed charges 4940 93 4001.4 percent of total billed charges 4940 4940 other OPPS APC 4940 4940 other OPPS APC 4940 27.63 1364.92 percent of total billed charges 4940 4940 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUADRA-P LAT STEM #1 SUP-01.12.141 CDM 270010024 LOCAL 0270 RC outpatient 4940 4940 4940 74 3655.6 percent of total billed charges 4940 93 4001.4 percent of total billed charges 4940 4940 other OPPS APC 4940 4940 other OPPS APC 4940 27.63 1364.92 percent of total billed charges 4940 4940 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUADRA-P CEMENTED STANDARD OFFSET SIZE 5 SUP-01.12.215 CDM 270010024 LOCAL 0270 RC outpatient 4940 4940 4940 74 3655.6 percent of total billed charges 4940 93 4001.4 percent of total billed charges 4940 4940 other OPPS APC 4940 4940 other OPPS APC 4940 27.63 1364.92 percent of total billed charges 4940 4940 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL QUADRA TITANIUM NIOBIUM HA 2 STANDARD HIP SHORT NECK SUP-01.12.22SN CDM 270010025 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUADRA-P CEMENTED LATERALIZED OFFSET SIZE 2 SUP-01.12.232 CDM 270010024 LOCAL 0270 RC outpatient 4940 4940 4940 74 3655.6 percent of total billed charges 4940 93 4001.4 percent of total billed charges 4940 4940 other OPPS APC 4940 4940 other OPPS APC 4940 27.63 1364.92 percent of total billed charges 4940 4940 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL COCR MEDIUM OD28 MM HIP SUP-01.25.012 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COCR FEMORAL HEAD 22MM SIZE M 0 SUP-01.25.123 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERSAFIT DOUBLE MOBILITY HIGHCROSS LINER 046/22 SUP-01.26.2246MHC CDM 270010024 LOCAL 0270 RC outpatient 1300 1300 1300 74 962 percent of total billed charges 1300 93 1053 percent of total billed charges 1300 1300 other OPPS APC 1300 1300 other OPPS APC 1300 27.63 359.19 percent of total billed charges 1300 1300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL MECTACER BIOLOX DELTA MEDIUM OD28 MM HIP SUP-01.29.202 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL QUADRA-R BIOLOX DELTA -4 MM SMALL OD32 MM SUP-01.29.204 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL QUADRA-R BIOLOX DELTA 0 MM MEDIUM OD32 MM SUP-01.29.205 CDM 270010025 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL QUADRA-R BIOLOX DELTA +4 MM LARGE OD32 MM SUP-01.29.206 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL AMIS MECTACER BIOLOX DELTA 12/1 SMALL OD36 MM STERILE SUP-01.29.208 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL AMIS MECTACER BIOLOX DELTA 12/1 MEDIUM OD36 MM STERILE SUP-01.29.209 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL AMIS MECTACER BIOLOX DELTA 12/1 LARGE OD36 MM STERIL SUP-01.29.210 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL AMIS MECTACER BIOLOX DELTA 12/1 XL OD36 MM STERILE SUP-01.29.211 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL MECTACER BIOLOX DELTA 12/14 SMALL OD40 MM HIP NONSTERILE SUP-01.29.212 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL AMIS MECTACER BIOLOX DELTA 12/1 MEDIUM OD40 MM STERILE SUP-01.29.213 CDM 270010024 LOCAL 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BIOLOX DELTA FEMORAL HEAD L 40MM SUP-01.29.214 CDM 270010024 LOCAL 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL QUADRA-R MECTACER BIOLOX OPTION BALL OD36 MM HIP CERAMIC STERILE SUP-01.29.232H CDM 270010024 LOCAL 0270 RC outpatient 5085.6 5085.6 5085.6 74 3763.34 percent of total billed charges 5085.6 93 4119.34 percent of total billed charges 5085.6 5085.6 other OPPS APC 5085.6 5085.6 other OPPS APC 5085.6 27.63 1405.15 percent of total billed charges 5085.6 5085.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL MECTACER BIOLOX OPTION BALL OD40 MM HIP NONSTERILE SUP-01.29.233H CDM 270010024 LOCAL 0270 RC outpatient 4659.2 4659.2 4659.2 74 3447.81 percent of total billed charges 4659.2 93 3773.95 percent of total billed charges 4659.2 4659.2 other OPPS APC 4659.2 4659.2 other OPPS APC 4659.2 27.63 1287.34 percent of total billed charges 4659.2 4659.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL QUADRA-R MECTACER BIOLOX OPTION LARGE HIP SLEEVE SUP-01.29.242A CDM 270010024 LOCAL 0270 RC outpatient 509.6 509.6 509.6 74 377.1 percent of total billed charges 509.6 93 412.78 percent of total billed charges 509.6 509.6 other OPPS APC 509.6 509.6 other OPPS APC 509.6 27.63 140.8 percent of total billed charges 509.6 509.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLUG DOME HOLE MPACT ACETABULAR SCREW SHELL SUP-01.31.55TP CDM 270010024 LOCAL 0270 RC outpatient 143 143 143 74 105.82 percent of total billed charges 143 93 115.83 percent of total billed charges 143 143 other OPPS APC 143 143 other OPPS APC 143 27.63 39.51 percent of total billed charges 143 143 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT C HEMISPHERICAL OD48 MM HIP CEMENTLESS NO HOLE SUP-01.32.148SH CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT D OD50 MM HIP CEMENTLESS 2 HOLE SUP-01.32.150DH CDM 270010025 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT D OD50 MM HIP MULTIHOLE NONSTERILE SUP-01.32.150MH CDM 270010024 LOCAL 0270 RC outpatient 8529.3 8529.3 8529.3 74 6311.68 percent of total billed charges 8529.3 93 6908.73 percent of total billed charges 8529.3 8529.3 other OPPS APC 8529.3 8529.3 other OPPS APC 8529.3 27.63 2356.65 percent of total billed charges 8529.3 8529.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT D HEMISPHERICAL OD50 MM HIP MODULAR CUP SUP-01.32.150SH CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT E OD52 MM HIP 2 HOLE SUP-01.32.152DH CDM 270010025 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT E HEMISPHERICAL OD52 MM HIP MODULAR CUP SUP-01.32.152SH CDM 270010025 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT E HEMISPHERICAL OD54 MM HIP CEMENTLESS 2 HOLE MODULAR SUP-01.32.154DH CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT E HEMISPHERICAL OD54 MM HIP CEMENTLESS NO HOLE SUP-01.32.154SH CDM 270010025 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT F HEMISPHERICAL OD56 MM HIP CEMENTLESS 2 HOLE MODULAR SUP-01.32.156DH CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT F OD56 MM HIP MULTIHOLE NONSTERILE SUP-01.32.156MH CDM 270010024 LOCAL 0270 RC outpatient 1872 1872 1872 74 1385.28 percent of total billed charges 1872 93 1516.32 percent of total billed charges 1872 1872 other OPPS APC 1872 1872 other OPPS APC 1872 27.63 517.23 percent of total billed charges 1872 1872 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT F HEMISPHERICAL OD56 MM HIP MODULAR CUP SUP-01.32.156SH CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT F OD58 MM HIP 2 HOLE SUP-01.32.158DH CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT F OD58 MM HIP MULTIHOLE SUP-01.32.158MH CDM 270010024 LOCAL 0270 RC outpatient 8529.3 8529.3 8529.3 74 6311.68 percent of total billed charges 8529.3 93 6908.73 percent of total billed charges 8529.3 8529.3 other OPPS APC 8529.3 8529.3 other OPPS APC 8529.3 27.63 2356.65 percent of total billed charges 8529.3 8529.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT F HEMISPHERICAL OD58 MM HIP MODULAR CUP SUP-01.32.158SH CDM 270010025 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT G OD60 MM HIP 2 HOLE SUP-01.32.160DH CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT G OD60 MM HIP MULTIHOLE SUP-01.32.160MH CDM 270010024 LOCAL 0270 RC outpatient 8529.3 8529.3 8529.3 74 6311.68 percent of total billed charges 8529.3 93 6908.73 percent of total billed charges 8529.3 8529.3 other OPPS APC 8529.3 8529.3 other OPPS APC 8529.3 27.63 2356.65 percent of total billed charges 8529.3 8529.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT G HEMISPHERICAL OD60 MM HIP MODULAR CUP SUP-01.32.160SH CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT G OD62 MM HIP 2 HOLE STERILE SUP-01.32.162DH CDM 270010024 LOCAL 0270 RC outpatient 1820 1820 1820 74 1346.8 percent of total billed charges 1820 93 1474.2 percent of total billed charges 1820 1820 other OPPS APC 1820 1820 other OPPS APC 1820 27.63 502.87 percent of total billed charges 1820 1820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT G HEMISPHERICAL OD62 MM HIP MODULAR CUP SUP-01.32.162SH CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT G OD64 MM HIP MULTIHOLE SUP-01.32.164MH CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT J OD68 MM HIP MULTIHOLE SUP-01.32.168MH CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR VERSAFITCUP CC TRIO HIGHCROSS C OD28 MM HIP FLAT HEAD SUP-01.32.2839HCT CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MPACT HIGHCROSS 4 MM C OFFSET OD32 MM HIP HEAD SUP-01.32.3239HC4 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MPACT HIGHCROSS 4 MM D OFFSET OD32 MM HIP HEAD SUP-01.32.3241HC4 CDM 270010025 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MPACT HIGHCROSS D OD32 MM HIP HOOD HEAD SUP-01.32.3241HCAT CDM 270010025 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MPACT UHMWPE HIGHCROSS D OD32 MM HIP FLAT HEAD NONSTERILE SUP-01.32.3241HCT CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT LINEAR OFFSET 4MM 32/E SUP-01.32.3244HCA CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MPACT UHMWPE HIGHCROSS E OD32 MM HEAD SUP-01.32.3244HCT CDM 270010025 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR 10A HS 32MM SUP-01.32.3244HCT10A CDM 270010025 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MPACT HIGHCROSS 4 MM D OFFSET OD36 MM HIP SUP-01.32.3641HC4 CDM 270010024 LOCAL 0270 RC outpatient 1404 1404 1404 74 1038.96 percent of total billed charges 1404 93 1137.24 percent of total billed charges 1404 1404 other OPPS APC 1404 1404 other OPPS APC 1404 27.63 387.93 percent of total billed charges 1404 1404 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MPACT HIGHCROSS 10 D 4.5 MM E OFFSET OD36 MM HIP FACE CHANGE HEAD SUP-01.32.3644HC10A CDM 270010025 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MPACT UHMWPE HIGHCROSS E OD36 MM HIP HOOD HEAD SUP-01.32.3644HCAT CDM 270010025 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MPACT UHMWPE HIGHCROSS E OD36 MM HIP FLAT HEAD NONSTERILE SUP-01.32.3644HCT CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MPACT HIGHCROSS 10 D 4.5 MM F OFFSET OD36 MM HIP FACE CHANGE HEAD SUP-01.32.3648HC10A CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MPACT HIGHCROSS 4 MM F OFFSET OD36 MM HIP HEAD SUP-01.32.3648HC4 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MPACT UHMWPE HIGHCROSS F OD48 MM HIP FLAT HEAD NONSTERILE SUP-01.32.3648HCT CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MPACT HIGHCROSS 4 MM G OFFSET OD36 MM HIP HEAD SUP-01.32.3652HC4 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MPACT UHMWPE HIGHCROSS G OD52 MM HIP FLAT HEAD NONSTERILE SUP-01.32.3652HCT CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MPACT HIGHCROSS J OD36 MM HIP FLAT HEAD SUP-01.32.3656HCT CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOUBLE MOBILITY CONVERTER E SUP-01.32.3844MC CDM 270010024 LOCAL 0270 RC outpatient 4006.08 4006.08 4006.08 74 2964.5 percent of total billed charges 4006.08 93 3244.92 percent of total billed charges 4006.08 4006.08 other OPPS APC 4006.08 4006.08 other OPPS APC 4006.08 27.63 1106.88 percent of total billed charges 4006.08 4006.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MPACT HIGHCROSS F OD40 MM HIP FLAT HEAD NONSTERILE SUP-01.32.4048HCT CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MPACT HIGHCROSS 10 D 5 MM G OFFSET OD40 MM HIP FACE CHANGE SUP-01.32.4052HC10A CDM 270010024 LOCAL 0270 RC outpatient 1404 1404 1404 74 1038.96 percent of total billed charges 1404 93 1137.24 percent of total billed charges 1404 1404 other OPPS APC 1404 1404 other OPPS APC 1404 27.63 387.93 percent of total billed charges 1404 1404 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MPACT HIGHCROSS 4 MM G OFFSET OD40 MM HIP HEAD SUP-01.32.4052HC4 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ACETABULAR LINER HC 40G SUP-01.32.4052HCT CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MPACT HIGHCROSS J OD40 MM HIP FLAT HEAD SUP-01.32.4056HCT CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MPACT L15 MM OD6.5 MM CANCELLOUS HIP FLAT HEAD NONSTERILE SUP-01.32.6515 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MPACT L20 MM OD6.5 MM CANCELLOUS HIP FLAT HEAD SUP-01.32.6520 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MPACT L25 MM OD6.5 MM CANCELLOUS HIP FLAT HEAD NONSTERILE SUP-01.32.6525 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MPACT L30 MM OD6.5 MM HIP CANCELLOUS FLAT HEAD NONSTERILE SUP-01.32.6530 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MPACT L35 MM OD6.5 MM CANCELLOUS HIP FLAT HEAD SUP-01.32.6535 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MPACT L40 MM OD6.5 MM HIP CANCELLOUS FLAT HEAD NONSTERILE SUP-01.32.6540 CDM 270010025 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP ACETABULAR MPACT 3D TWO HOLE 54MM SUP-01.36.054DH CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP ACETABULAR MPACCT 3D TWO HOLE 50MM SUP-01.38.050DH CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT 3D OD52 MM HIP 2 HOLE SUP-01.38.052DH CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MPACT TWO HOLE 56MM SUP-01.38.056DH CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MPACT 3D TWO HOLE CUP 60 MM SUP-01.38.060DH CDM 270010024 LOCAL 0270 RC outpatient 1820 1820 1820 74 1346.8 percent of total billed charges 1820 93 1474.2 percent of total billed charges 1820 1820 other OPPS APC 1820 1820 other OPPS APC 1820 27.63 502.87 percent of total billed charges 1820 1820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 2 STANDARD 2 TAPER FLAT HIP SUP-01.39.002 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 3 STANDARD 2 TAPER FLAT HIP SUP-01.39.003 CDM 270010025 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 4 STANDARD 2 TAPER FLAT HIP SUP-01.39.004 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 5 STANDARD 2 TAPER FLAT HIP SUP-01.39.005 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 6 STANDARD 2 TAPER FLAT HIP SUP-01.39.006 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 7 STANDARD 2 TAPER FLAT HIP SUP-01.39.007 CDM 270010025 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 9 STANDARD 2 TAPER FLAT HIP SUP-01.39.009 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 10 STANDARD 2 TAPER FLAT HIP SUP-01.39.010 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 11 STANDARD 2 TAPER FLAT HIP SUP-01.39.011 CDM 270010025 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 2 2 TAPER FLAT HIP LATERALIZE SUP-01.39.202 CDM 270010024 LOCAL 0270 RC outpatient 4940 4940 4940 74 3655.6 percent of total billed charges 4940 93 4001.4 percent of total billed charges 4940 4940 other OPPS APC 4940 4940 other OPPS APC 4940 27.63 1364.92 percent of total billed charges 4940 4940 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 3 2 TAPER FLAT HIP LATERALIZE SUP-01.39.203 CDM 270010025 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 5 2 TAPER FLAT HIP LATERALIZE SUP-01.39.205 CDM 270010025 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 6 2 TAPER FLAT HIP LATERALIZE SUP-01.39.206 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 7 2 TAPER FLAT HIP LATERALIZE SUP-01.39.207 CDM 270010025 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 8 2 TAPER FLAT HIP LATERALIZE SUP-01.39.208 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 9 2 TAPER FLAT HIP LATERALIZE SUP-01.39.209 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 10 2 TAPER FLAT HIP LATERALIZE SUP-01.39.210 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 11 2 TAPER FLAT HIP LATERALIZE SUP-01.39.211 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC STANDARD #4 SUP-01.39.3241HCT CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 4 2 TAPER FLAT HIP LATERALIZE PLUS SUP-01.39.404 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 6 2 TAPER FLAT HIP LATERALIZE PLUS SUP-01.39.406 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 8 2 TAPER FLAT HIP LATERALIZE PLUS SUP-01.39.408 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 9 2 TAPER FLAT HIP LATERALIZE PLUS SUP-01.39.409 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL MASTERLOC MECTAGRIP 10 2 TAPER FLAT HIP LATERALIZE PLUS SUP-01.39.410 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTERLINE CAPNOGRAPHY SAMPLING SUP-010-700U CDM 0270 RC outpatient 22.88 22.88 22.88 74 16.93 percent of total billed charges 22.88 93 18.53 percent of total billed charges 22.88 22.88 other OPPS APC 22.88 22.88 other OPPS APC 22.88 27.63 6.32 percent of total billed charges 22.88 22.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL WAGNER SL REVISION PROTASUL-100 POROUS 135 D 12/14 L265 MM OD14 MM HIP DISTAL FILL STERILE SUP-0100102614 CDM 270010024 LOCAL 0270 RC outpatient 13197.6 13197.6 13197.6 74 9766.22 percent of total billed charges 13197.6 93 10690.1 percent of total billed charges 13197.6 13197.6 other OPPS APC 13197.6 13197.6 other OPPS APC 13197.6 27.63 3646.5 percent of total billed charges 13197.6 13197.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN INCISION CATTELL 11IN 12IN 10FR NATURAL RUBBER DISPOSABLE STERILE LATEX T TUBE SUP-0100150 CDM 270009031 LOCAL 0270 RC outpatient 9.91 9.91 9.91 74 7.33 percent of total billed charges 9.91 93 8.03 percent of total billed charges 9.91 9.91 other OPPS APC 9.91 9.91 other OPPS APC 9.91 27.63 2.74 percent of total billed charges 9.91 9.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX LUBRICATH 14FR 5CC RED NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY 1 DRAINAGE SUP-0102L14 CDM 0270 RC outpatient 26.78 26.78 26.78 74 19.82 percent of total billed charges 26.78 93 21.69 percent of total billed charges 26.78 26.78 other OPPS APC 26.78 26.78 other OPPS APC 26.78 27.63 7.4 percent of total billed charges 26.78 26.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX LUBRICATH 16FR 5CC RED RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY 1 DRAINAGE EYE MED SUP-0102L16 CDM 0270 RC outpatient 26.78 26.78 26.78 74 19.82 percent of total billed charges 26.78 93 21.69 percent of total billed charges 26.78 26.78 other OPPS APC 26.78 26.78 other OPPS APC 26.78 27.63 7.4 percent of total billed charges 26.78 26.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX LUBRICATH 18FR 5CC RED NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY 1 DRAINAGE SUP-0102L18 CDM 0270 RC outpatient 26.52 26.52 26.52 74 19.62 percent of total billed charges 26.52 93 21.48 percent of total billed charges 26.52 26.52 other OPPS APC 26.52 26.52 other OPPS APC 26.52 27.63 7.33 percent of total billed charges 26.52 26.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2.0MM HOLDING FORCEPS ANGLED 18CM SUP-0108110 CDM 0270 RC outpatient 246.48 246.48 246.48 74 182.4 percent of total billed charges 246.48 93 199.65 percent of total billed charges 246.48 246.48 other OPPS APC 246.48 246.48 other OPPS APC 246.48 27.63 68.1 percent of total billed charges 246.48 246.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL BARD POLYPROPYLENE L4IN X W1 IN GROIN MONOFILAMENT VENTRAL INGUINAL HERNIA REPAIR SUP-0112640 CDM 0270 RC outpatient 75.66 75.66 75.66 74 55.99 percent of total billed charges 75.66 93 61.28 percent of total billed charges 75.66 75.66 other OPPS APC 75.66 75.66 other OPPS APC 75.66 27.63 20.9 percent of total billed charges 75.66 75.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL BARD POLYPROPYLENE L14IN X W10 IN GROIN MONOFILAMENT VENTRAL INGUINAL HERNIA REPAIR SUP-0112660 CDM 0270 RC outpatient 481 481 481 74 355.94 percent of total billed charges 481 93 389.61 percent of total billed charges 481 481 other OPPS APC 481 481 other OPPS APC 481 27.63 132.9 percent of total billed charges 481 481 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL BARD POLYPROPYLENE L6IN X W3 IN GROIN MONOFILAMENT VENTRAL INGUINAL HERNIA REPAIR SUP-0112680 CDM 0270 RC outpatient 98.54 98.54 98.54 74 72.92 percent of total billed charges 98.54 93 79.82 percent of total billed charges 98.54 98.54 other OPPS APC 98.54 98.54 other OPPS APC 98.54 27.63 27.23 percent of total billed charges 98.54 98.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL MARLEX 6X3IN GROIN PATCH FLAT SHEET KNIT STERILE POLYPROPYLENE HERNIA SUP-0112680 CDM 270009092 LOCAL 0270 RC outpatient 114.9 114.9 114.9 74 85.03 percent of total billed charges 114.9 93 93.07 percent of total billed charges 114.9 114.9 other OPPS APC 114.9 114.9 other OPPS APC 114.9 27.63 31.75 percent of total billed charges 114.9 114.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL BARD POLYPROPYLENE L6IN X W6 IN GROIN MONOFILAMENT VENTRAL INGUINAL HERNIA REPAIR SUP-0112720 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLUG SURGICAL PERFIX MED TAPER 1.3IN 1.55IN POLYPROPYLENE STERILE GROIN MONOFILAMENT NONABSORBABLE HERNIA REPAIR SUP-0112760 CDM 0270 RC outpatient 361.66 361.66 361.66 74 267.63 percent of total billed charges 361.66 93 292.94 percent of total billed charges 361.66 361.66 other OPPS APC 361.66 361.66 other OPPS APC 361.66 27.63 99.93 percent of total billed charges 361.66 361.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLUG SURGICAL PERFIX LG TAPER 1.6IN 1.9IN POLYPROPYLENE STERILE GROIN MONOFILAMENT NONABSORBABLE HERNIA REPAIR SUP-0112770 CDM 0270 RC outpatient 368.68 368.68 368.68 74 272.82 percent of total billed charges 368.68 93 298.63 percent of total billed charges 368.68 368.68 other OPPS APC 368.68 368.68 other OPPS APC 368.68 27.63 101.87 percent of total billed charges 368.68 368.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH BARD PERFIX BARD POLYPROPYLENE SMALL L1 IN X W 1.35 IN PLUG MONOFILAMENT STERILE PREPERITONEAL REPAIR SUP-0112950 CDM 0270 RC outpatient 349.44 349.44 349.44 74 258.59 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 349.44 other OPPS APC 349.44 349.44 other OPPS APC 349.44 27.63 96.55 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH BARD PERFIX BARD POLYPROPYLENE MEDIUM L1.55 IN X W 1.3 IN PLUG MONOFILAMENT STERILE PREPERITONEAL REPAIR SUP-0112960 CDM 0270 RC outpatient 356.46 356.46 356.46 74 263.78 percent of total billed charges 356.46 93 288.73 percent of total billed charges 356.46 356.46 other OPPS APC 356.46 356.46 other OPPS APC 356.46 27.63 98.49 percent of total billed charges 356.46 356.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH BARD PERFIX BARD POLYPROPYLENE LARGE L1.6 IN X W 1.9 IN PLUG MONOFILAMENT STERILE PREPERITONEAL REPAIR SUP-0112970 CDM 0270 RC outpatient 361.66 361.66 361.66 74 267.63 percent of total billed charges 361.66 93 292.94 percent of total billed charges 361.66 361.66 other OPPS APC 361.66 361.66 other OPPS APC 361.66 27.63 99.93 percent of total billed charges 361.66 361.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH BARD PERFIX BARD POLYPROPYLENE EXTRA LARGE L1.6 IN X W 2 IN PLUG MONOFILAMENT STERILE PREPERITONEAL REPAIR 3D KNITTED TRIMMABLE SUP-0112980 CDM 0270 RC outpatient 433.16 433.16 433.16 74 320.54 percent of total billed charges 433.16 93 350.86 percent of total billed charges 433.16 433.16 other OPPS APC 433.16 433.16 other OPPS APC 433.16 27.63 119.68 percent of total billed charges 433.16 433.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP HEMOLOK LARGE SUP-011340 CDM 0270 RC outpatient 641.55 641.55 641.55 74 474.75 percent of total billed charges 641.55 93 519.66 percent of total billed charges 641.55 641.55 other OPPS APC 641.55 641.55 other OPPS APC 641.55 27.63 177.26 percent of total billed charges 641.55 641.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL BARD 3DMAX MED 3D CURVE CONTOUR 5X3IN POLYPROPYLENE STERILE GROIN LEFT SEAL EDGE LAPAROSCOPIC INGUINAL SUP-0115310 CDM 0270 RC outpatient 407.68 407.68 407.68 74 301.68 percent of total billed charges 407.68 93 330.22 percent of total billed charges 407.68 407.68 other OPPS APC 407.68 407.68 other OPPS APC 407.68 27.63 112.64 percent of total billed charges 407.68 407.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL BARD 3DMAX LG 3D CURVE CONTOUR 6X4IN POLYPROPYLENE STERILE GROIN LEFT SEAL EDGE LAPAROSCOPIC INGUINAL SUP-0115311 CDM 0270 RC outpatient 445.9 445.9 445.9 74 329.97 percent of total billed charges 445.9 93 361.18 percent of total billed charges 445.9 445.9 other OPPS APC 445.9 445.9 other OPPS APC 445.9 27.63 123.2 percent of total billed charges 445.9 445.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL 3DMAX POLYPROPYLENE XL 3D CURVE L7 IN X W5 IN GROIN LEFT CONTOUR SEAL EDGE STERILE LAPAROSCOPIC INGUINAL HERNIA REPAIR SUP-0115312 CDM 0270 RC outpatient 535.08 535.08 535.08 74 395.96 percent of total billed charges 535.08 93 433.41 percent of total billed charges 535.08 535.08 other OPPS APC 535.08 535.08 other OPPS APC 535.08 27.63 147.84 percent of total billed charges 535.08 535.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL BARD 3DMAX MED 3D CURVE CONTOUR 5X3IN POLYPROPYLENE STERILE GROIN RIGHT SEAL EDGE LAPAROSCOPIC INGUINAL SUP-0115320 CDM 0270 RC outpatient 407.68 407.68 407.68 74 301.68 percent of total billed charges 407.68 93 330.22 percent of total billed charges 407.68 407.68 other OPPS APC 407.68 407.68 other OPPS APC 407.68 27.63 112.64 percent of total billed charges 407.68 407.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL BARD 3DMAX LG 3D CURVE CONTOUR 6X4IN POLYPROPYLENE STERILE GROIN RIGHT SEAL EDGE LAPAROSCOPIC INGUINAL SUP-0115321 CDM 0270 RC outpatient 445.9 445.9 445.9 74 329.97 percent of total billed charges 445.9 93 361.18 percent of total billed charges 445.9 445.9 other OPPS APC 445.9 445.9 other OPPS APC 445.9 27.63 123.2 percent of total billed charges 445.9 445.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL 3DMAX POLYPROPYLENE XL 3D CURVE L7 IN X W5 IN GROIN RIGHT CONTOUR SEAL EDGE STERILE LAPAROSCOPIC INGUINAL HERNIA REPAIR SUP-0115322 CDM 0270 RC outpatient 535.08 535.08 535.08 74 395.96 percent of total billed charges 535.08 93 433.41 percent of total billed charges 535.08 535.08 other OPPS APC 535.08 535.08 other OPPS APC 535.08 27.63 147.84 percent of total billed charges 535.08 535.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE LAPAROSCOPIC PRECISIONPASS ID20 MM MESH SUP-0118101 CDM 0270 RC outpatient 309.4 309.4 309.4 74 228.96 percent of total billed charges 309.4 93 250.61 percent of total billed charges 309.4 309.4 other OPPS APC 309.4 309.4 other OPPS APC 309.4 27.63 85.49 percent of total billed charges 309.4 309.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX LUBRICATH STANDARD 20FR 5CC NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 3 WAY FOLEY 2 SUP-0119L20 CDM 270009008 LOCAL 0270 RC outpatient 11.33 11.33 11.33 74 8.38 percent of total billed charges 11.33 93 9.18 percent of total billed charges 11.33 11.33 other OPPS APC 11.33 11.33 other OPPS APC 11.33 27.63 3.13 percent of total billed charges 11.33 11.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIC-KEY LOW PROFILE GASTROSTOMY FEEDING 12FR 2.5CM STOMA SUP-0120-12-2.5 CDM 0270 RC outpatient 239.3 239.3 239.3 74 177.08 percent of total billed charges 239.3 93 193.83 percent of total billed charges 239.3 239.3 other OPPS APC 239.3 239.3 other OPPS APC 239.3 27.63 66.12 percent of total billed charges 239.3 239.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIC-KEY LOW PROFILE GASTROSTOMY FEEDING 12FR 3.0CM STOMA SUP-0120-12-3.0 CDM 0270 RC outpatient 234.65 234.65 234.65 74 173.64 percent of total billed charges 234.65 93 190.07 percent of total billed charges 234.65 234.65 other OPPS APC 234.65 234.65 other OPPS APC 234.65 27.63 64.83 percent of total billed charges 234.65 234.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIC-KEY LOW PROFILE GASTROSTOMY FEEDING 12FR 4.0CM STOMA SUP-0120-12-4.0 CDM 0270 RC outpatient 239.3 239.3 239.3 74 177.08 percent of total billed charges 239.3 93 193.83 percent of total billed charges 239.3 239.3 other OPPS APC 239.3 239.3 other OPPS APC 239.3 27.63 66.12 percent of total billed charges 239.3 239.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET EXTENSION MIC-KEY SECUR-LOK 12IN NS LF CONTINUOUS FEED LOW PROFILE DEHP FREE GASTROSTOMY JEJUNAL TRANSGASTRIC SUP-0121-12 CDM 0270 RC outpatient 20.48 20.48 20.48 74 15.16 percent of total billed charges 20.48 93 16.59 percent of total billed charges 20.48 20.48 other OPPS APC 20.48 20.48 other OPPS APC 20.48 27.63 5.66 percent of total billed charges 20.48 20.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD ICD RELIANCE SUP-0127-8 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIXATION POST 25MM SUP-013140 CDM 0270 RC outpatient 362.73 362.73 362.73 74 268.42 percent of total billed charges 362.73 93 293.81 percent of total billed charges 362.73 362.73 other OPPS APC 362.73 362.73 other OPPS APC 362.73 27.63 100.22 percent of total billed charges 362.73 362.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIXATION POST 30MM SUP-013141 CDM 0270 RC outpatient 335.4 335.4 335.4 74 248.2 percent of total billed charges 335.4 93 271.67 percent of total billed charges 335.4 335.4 other OPPS APC 335.4 335.4 other OPPS APC 335.4 27.63 92.67 percent of total billed charges 335.4 335.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIXATION POST 35MM SUP-013142 CDM 0270 RC outpatient 352.17 352.17 352.17 74 260.61 percent of total billed charges 352.17 93 285.26 percent of total billed charges 352.17 352.17 other OPPS APC 352.17 352.17 other OPPS APC 352.17 27.63 97.3 percent of total billed charges 352.17 352.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIXATION POST 40MM SUP-013143 CDM 0270 RC outpatient 352.17 352.17 352.17 74 260.61 percent of total billed charges 352.17 93 285.26 percent of total billed charges 352.17 352.17 other OPPS APC 352.17 352.17 other OPPS APC 352.17 27.63 97.3 percent of total billed charges 352.17 352.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POST FIXATION 45MM 4.5MM TITANIUM SUTURE ACL/PCL SYSTEM STERILE SUP-013144 CDM 0270 RC outpatient 335.4 335.4 335.4 74 248.2 percent of total billed charges 335.4 93 271.67 percent of total billed charges 335.4 335.4 other OPPS APC 335.4 335.4 other OPPS APC 335.4 27.63 92.67 percent of total billed charges 335.4 335.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIXATION POST 50MM SUP-013145 CDM 0270 RC outpatient 335.4 335.4 335.4 74 248.2 percent of total billed charges 335.4 93 271.67 percent of total billed charges 335.4 335.4 other OPPS APC 335.4 335.4 other OPPS APC 335.4 27.63 92.67 percent of total billed charges 335.4 335.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIXATION POST 55MM SUP-013146 CDM 0270 RC outpatient 352.17 352.17 352.17 74 260.61 percent of total billed charges 352.17 93 285.26 percent of total billed charges 352.17 352.17 other OPPS APC 352.17 352.17 other OPPS APC 352.17 27.63 97.3 percent of total billed charges 352.17 352.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUTTON FIXATION ENDOBUTTON TITANIUM L12 MM OD4 MM FEMUR SOFT TISSUE ARTHROSCOPIC STERILE DISPOSABLE SUP-013186 CDM 0270 RC outpatient 500.53 500.53 500.53 74 370.39 percent of total billed charges 500.53 93 405.43 percent of total billed charges 500.53 500.53 other OPPS APC 500.53 500.53 other OPPS APC 500.53 27.63 138.3 percent of total billed charges 500.53 500.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER OPAL 10MM X 28MM X 10MM SUP-013210 CDM 270010020 LOCAL 0270 RC outpatient 12672.1 12672.1 12672.1 74 9377.38 percent of total billed charges 12672.1 93 10264.4 percent of total billed charges 12672.1 12672.1 other OPPS APC 12672.1 12672.1 other OPPS APC 12672.1 27.63 3501.31 percent of total billed charges 12672.1 12672.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER OPAL 10MM X 28MM X 11MM SUP-013211 CDM 270010020 LOCAL 0270 RC outpatient 12672.1 12672.1 12672.1 74 9377.38 percent of total billed charges 12672.1 93 10264.4 percent of total billed charges 12672.1 12672.1 other OPPS APC 12672.1 12672.1 other OPPS APC 12672.1 27.63 3501.31 percent of total billed charges 12672.1 12672.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER OPAL 10MM X 28MM X 9MM SUP-01329 CDM 270010020 LOCAL 0270 RC outpatient 12672.1 12672.1 12672.1 74 9377.38 percent of total billed charges 12672.1 93 10264.4 percent of total billed charges 12672.1 12672.1 other OPPS APC 12672.1 12672.1 other OPPS APC 12672.1 27.63 3501.31 percent of total billed charges 12672.1 12672.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL COMPOSIX POLYPROPYLENE EPTFE ELLIPSE L13.2 IN X W10.2 IN PATCH LOW PROFILE LIGHTWEIGHT BIOCOMPATIBLE HERNIA SUP-0134113 CDM 0270 RC outpatient 4214.6 4214.6 4214.6 74 3118.8 percent of total billed charges 4214.6 93 3413.83 percent of total billed charges 4214.6 4214.6 other OPPS APC 4214.6 4214.6 other OPPS APC 4214.6 27.63 1164.49 percent of total billed charges 4214.6 4214.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL COMPOSIX POLYPROPYLENE EPTFE CIRCLE OD4.5 IN PATCH LOW PROFILE LIGHTWEIGHT BIOCOMPATIBLE HERNIA SUP-0134450 CDM 0270 RC outpatient 1820 1820 1820 74 1346.8 percent of total billed charges 1820 93 1474.2 percent of total billed charges 1820 1820 other OPPS APC 1820 1820 other OPPS APC 1820 27.63 502.87 percent of total billed charges 1820 1820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL COMPOSIX L/P POLYPROPYLENE EPTFE ELLIPSE L6.2 IN X W4.2 IN PATCH LOW PROFILE LIGHTWEIGHT BIOCOMPATIBLE HERNIA SUP-0134460 CDM 0270 RC outpatient 1157 1157 1157 74 856.18 percent of total billed charges 1157 93 937.17 percent of total billed charges 1157 1157 other OPPS APC 1157 1157 other OPPS APC 1157 27.63 319.68 percent of total billed charges 1157 1157 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL COMPOSIX L/P POLYPROPYLENE EPTFE OVAL L10.2 IN X W6.2 IN VENTRAL HERNIA PATCH SOFT LIGHTWEIGHT INTRODUCER TOOL OVAL STERILE LATEX FREE SUP-0134610 CDM 0270 RC outpatient 2483 2483 2483 74 1837.42 percent of total billed charges 2483 93 2011.23 percent of total billed charges 2483 2483 other OPPS APC 2483 2483 other OPPS APC 2483 27.63 686.05 percent of total billed charges 2483 2483 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL COMPOSIX POLYPROPYLENE EPTFE ELLIPTICAL L8.2 IN X W6.2 IN PATCH LOW PROFILE LIGHTWEIGHT SOFT HERNIA REPAIR SUP-0134680 CDM 0270 RC outpatient 1991.6 1991.6 1991.6 74 1473.78 percent of total billed charges 1991.6 93 1613.2 percent of total billed charges 1991.6 1991.6 other OPPS APC 1991.6 1991.6 other OPPS APC 1991.6 27.63 550.28 percent of total billed charges 1991.6 1991.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL COMPOSIX POLYPROPYLENE EPTFE ELLIPSE L9.2 IN X W7.2 IN VENTRAL 2 LAYER LARGE BORE LIGHTWEIGHT LOW PROFILE STERILE LATEX FREE HERNIA SUP-0134790 CDM 0270 RC outpatient 3229.2 3229.2 3229.2 74 2389.61 percent of total billed charges 3229.2 93 2615.65 percent of total billed charges 3229.2 3229.2 other OPPS APC 3229.2 3229.2 other OPPS APC 3229.2 27.63 892.23 percent of total billed charges 3229.2 3229.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL COMPOSIX POLYPROPYLENE EPTFE ELLIPSE L10.2 IN X W8.2 IN VENTRAL 2 LAYER LARGE BORE LIGHTWEIGHT LOW PROFILE STERILE LATEX FREE HERNIA SUP-0134810 CDM 0270 RC outpatient 4149.6 4149.6 4149.6 74 3070.7 percent of total billed charges 4149.6 93 3361.18 percent of total billed charges 4149.6 4149.6 other OPPS APC 4149.6 4149.6 other OPPS APC 4149.6 27.63 1146.53 percent of total billed charges 4149.6 4149.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRIEVER SUTURE ISOTAC STRAIGHT ROTATOR CUFF ISOMETRY STERILE LATEX FREE DISPOSABLE SUP-013593 CDM 0270 RC outpatient 121.58 121.58 121.58 74 89.97 percent of total billed charges 121.58 93 98.48 percent of total billed charges 121.58 121.58 other OPPS APC 121.58 121.58 other OPPS APC 121.58 27.63 33.59 percent of total billed charges 121.58 121.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL 55X.2MM LACTOMER TITANIUM VASCULAR LINEAR CUTTER RADIOTRANSPARENT SUP-013601 CDM 0270 RC outpatient 1945.57 1945.57 1945.57 74 1439.72 percent of total billed charges 1945.57 93 1575.91 percent of total billed charges 1945.57 1945.57 other OPPS APC 1945.57 1945.57 other OPPS APC 1945.57 27.63 537.56 percent of total billed charges 1945.57 1945.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIXATION BUTTON 17MM ACUFEX SUP-013636 CDM 0270 RC outpatient 182.35 182.35 182.35 74 134.94 percent of total billed charges 182.35 93 147.7 percent of total billed charges 182.35 182.35 other OPPS APC 182.35 182.35 other OPPS APC 182.35 27.63 50.38 percent of total billed charges 182.35 182.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD ICD RELIANCE SUP-0137-8 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRAP DISTRACTION GUHL FOOT ANKLE NONINVASIVE STERILE LATEX FREE DISPOSABLE SUP-014407 CDM outpatient 143.52 143.52 143.52 143.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ANGIOGRAPHY ACIST CVI ANGIOTOUCH 65IN DISPOSABLE 3 WAY HIGH PRESSURE STOPCOCK PREMIUM HIGH PRESSURE CONTRAST TUBE SUP-014667 CDM 0481 RC outpatient 1820 1820 1820 74 1346.8 percent of total billed charges 1820 93 1474.2 percent of total billed charges 1820 1820 other OPPS APC 1820 1820 other OPPS APC 1820 51 928.2 percent of total billed charges 1820 1820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD ICD RELIANCE SUP-0147-9 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT CORTICAL CONTOUR WEDGE L22 MM X W8 MM X H7-4.6 MM SPINE FREEZE DRIED SLOT PYRAMIDAL TEETH PLIF SUP-014807 CDM 270010020 LOCAL 0270 RC outpatient 6546.54 6546.54 6546.54 74 4844.44 percent of total billed charges 6546.54 93 5302.7 percent of total billed charges 6546.54 6546.54 other OPPS APC 6546.54 6546.54 other OPPS APC 6546.54 27.63 1808.81 percent of total billed charges 6546.54 6546.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT CORTICAL CONTOUR WEDGE L22 MM X W8 MM X H9-6.6 MM SPINE FREEZE DRIED SLOT PYRAMIDAL TEETH PLIF SUP-014809 CDM 270010020 LOCAL 0270 RC outpatient 6938.96 6938.96 6938.96 74 5134.83 percent of total billed charges 6938.96 93 5620.56 percent of total billed charges 6938.96 6938.96 other OPPS APC 6938.96 6938.96 other OPPS APC 6938.96 27.63 1917.23 percent of total billed charges 6938.96 6938.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT CORTICAL CONTOUR WEDGE L22 MM X W8 MM X H11-8.6 MM SPINE FREEZE DRIED PYRAMIDAL TEETH PLIF SUP-014811 CDM 270010020 LOCAL 0270 RC outpatient 6938.96 6938.96 6938.96 74 5134.83 percent of total billed charges 6938.96 93 5620.56 percent of total billed charges 6938.96 6938.96 other OPPS APC 6938.96 6938.96 other OPPS APC 6938.96 27.63 1917.23 percent of total billed charges 6938.96 6938.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT CORTICAL CONTOUR WEDGE L22 MM X W8 MM X H13-10.6 MM SPINE FREEZE DRIED SLOT PYRAMIDAL TEETH PLIF SUP-014813 CDM 270010020 LOCAL 0270 RC outpatient 6938.96 6938.96 6938.96 74 5134.83 percent of total billed charges 6938.96 93 5620.56 percent of total billed charges 6938.96 6938.96 other OPPS APC 6938.96 6938.96 other OPPS APC 6938.96 27.63 1917.23 percent of total billed charges 6938.96 6938.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT CORTICAL CONTOUR WEDGE L22 MM X W8 MM X H15-12.6 MM SPINE FREEZE DRIED SLOT PYRAMIDAL TEETH PLIF SUP-014815 CDM 270010020 LOCAL 0270 RC outpatient 6546.54 6546.54 6546.54 74 4844.44 percent of total billed charges 6546.54 93 5302.7 percent of total billed charges 6546.54 6546.54 other OPPS APC 6546.54 6546.54 other OPPS APC 6546.54 27.63 1808.81 percent of total billed charges 6546.54 6546.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ARTHROSCOPIC CANNU-FLEX L12 IN OD1.5 MM ACL PCL BLUNT TIP STERILE DISPOSABLE SUP-014859 CDM 0270 RC outpatient 115.28 115.28 115.28 74 85.31 percent of total billed charges 115.28 93 93.38 percent of total billed charges 115.28 115.28 other OPPS APC 115.28 115.28 other OPPS APC 115.28 27.63 31.85 percent of total billed charges 115.28 115.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE SURGICAL 24IN ENDOBUTTON ACL PCL PASSING NEEDLE ARTHROSCOPIC ACCESSORY STERILE SUP-014868 CDM 0270 RC outpatient 254.37 254.37 254.37 74 188.23 percent of total billed charges 254.37 93 206.04 percent of total billed charges 254.37 254.37 other OPPS APC 254.37 254.37 other OPPS APC 254.37 27.63 70.28 percent of total billed charges 254.37 254.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT FIXATION ENDOBUTTON TM PAC DYO CRUCIATE ACCESS SUP-014893 CDM 0270 RC outpatient 1366.59 1366.59 1366.59 74 1011.28 percent of total billed charges 1366.59 93 1106.94 percent of total billed charges 1366.59 1366.59 other OPPS APC 1366.59 1366.59 other OPPS APC 1366.59 27.63 377.59 percent of total billed charges 1366.59 1366.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT 9/11MM 26X7MM CORTICAL SPINE FREEZE DRIED DISTAL END BEVEL PYRAMIDAL TEETH TPLIF SUP-014907 CDM 270010012 LOCAL 0270 RC outpatient 11105.1 11105.1 11105.1 74 8217.77 percent of total billed charges 11105.1 93 8995.12 percent of total billed charges 11105.1 11105.1 other OPPS APC 11105.1 11105.1 other OPPS APC 11105.1 27.63 3068.34 percent of total billed charges 11105.1 11105.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT 9/11MM 26X9MM CORTICAL SPINE FREEZE DRIED DISTAL END BEVEL PYRAMIDAL TEETH TPLIF SUP-014909 CDM 270010012 LOCAL 0270 RC outpatient 11512.2 11512.2 11512.2 74 8519.01 percent of total billed charges 11512.2 93 9324.87 percent of total billed charges 11512.2 11512.2 other OPPS APC 11512.2 11512.2 other OPPS APC 11512.2 27.63 3180.82 percent of total billed charges 11512.2 11512.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT 9/11MM 26X11MM CORTICAL SPINE FREEZE DRIED DISTAL END BEVEL PYRAMIDAL TEETH TPLIF SUP-014911 CDM 270010012 LOCAL 0270 RC outpatient 11105.1 11105.1 11105.1 74 8217.77 percent of total billed charges 11105.1 93 8995.12 percent of total billed charges 11105.1 11105.1 other OPPS APC 11105.1 11105.1 other OPPS APC 11105.1 27.63 3068.34 percent of total billed charges 11105.1 11105.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT 9/11MM 26X13MM CORTICAL SPINE FREEZE DRIED DISTAL END BEVEL PYRAMIDAL TEETH TPLIF SUP-014913 CDM 270010012 LOCAL 0270 RC outpatient 11229 11229 11229 74 8309.47 percent of total billed charges 11229 93 9095.5 percent of total billed charges 11229 11229 other OPPS APC 11229 11229 other OPPS APC 11229 27.63 3102.58 percent of total billed charges 11229 11229 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT 9/11MM 26X15MM CORTICAL SPINE FREEZE DRIED DISTAL END BEVEL PYRAMIDAL TEETH TPLIF SUP-014915 CDM 270010012 LOCAL 0270 RC outpatient 11229 11229 11229 74 8309.47 percent of total billed charges 11229 93 9095.5 percent of total billed charges 11229 11229 other OPPS APC 11229 11229 other OPPS APC 11229 27.63 3102.58 percent of total billed charges 11229 11229 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ULTRASOUND VISIONS PV 5FR 150CM TAPERED TIP RX PERIPHERAL GLYDX PLATINUM HYDROPHILIC F/DIGITAL IVUS IMAGING NON-RADIOLUCENT 0.014IN GW SUP-014R CDM 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS BIOPSY RADIAL JAW 3 PEDIATRIC L160 CM OD1.8 MM GASTROINTESTINE NEEDLE STERILE DISPOSABLE YELLOW SUP-0157-9 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX LUBRICATH 26FR 5CC NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON SUP-0165L26 CDM 270009003 LOCAL 0270 RC outpatient 4.9 4.9 4.9 74 3.63 percent of total billed charges 4.9 93 3.97 percent of total billed charges 4.9 4.9 other OPPS APC 4.9 4.9 other OPPS APC 4.9 27.63 1.35 percent of total billed charges 4.9 4.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX LUBRICATH 28FR 5CC NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON SUP-0165L28 CDM 270009003 LOCAL 0270 RC outpatient 4.9 4.9 4.9 74 3.63 percent of total billed charges 4.9 93 3.97 percent of total billed charges 4.9 4.9 other OPPS APC 4.9 4.9 other OPPS APC 4.9 27.63 1.35 percent of total billed charges 4.9 4.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX LUBRICATH 10FR 3CC NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON SUP-0165PL10 CDM 270009003 LOCAL 0270 RC outpatient 4.9 4.9 4.9 74 3.63 percent of total billed charges 4.9 93 3.97 percent of total billed charges 4.9 4.9 other OPPS APC 4.9 4.9 other OPPS APC 4.9 27.63 1.35 percent of total billed charges 4.9 4.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX IC 12FR 5CC BACTI-GUARD NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON SUP-0165SI12 CDM 270009003 LOCAL 0270 RC outpatient 4.9 4.9 4.9 74 3.63 percent of total billed charges 4.9 93 3.97 percent of total billed charges 4.9 4.9 other OPPS APC 4.9 4.9 other OPPS APC 4.9 27.63 1.35 percent of total billed charges 4.9 4.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX IC 14FR 5CC BACTI-GUARD NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON SUP-0165SI14 CDM 270009003 LOCAL 0270 RC outpatient 4.9 4.9 4.9 74 3.63 percent of total billed charges 4.9 93 3.97 percent of total billed charges 4.9 4.9 other OPPS APC 4.9 4.9 other OPPS APC 4.9 27.63 1.35 percent of total billed charges 4.9 4.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX IC 16FR 5CC BACTI-GUARD NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON SUP-0165SI16 CDM 270009003 LOCAL 0270 RC outpatient 4.9 4.9 4.9 74 3.63 percent of total billed charges 4.9 93 3.97 percent of total billed charges 4.9 4.9 other OPPS APC 4.9 4.9 other OPPS APC 4.9 27.63 1.35 percent of total billed charges 4.9 4.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX IC BACTI-GUARD NATURAL RUBBER HYDROGEL OD18 FR 5 CC 2 WAY FOLEY BALLOON ATRAUMATIC INSERTION STERILE LATEX DISPOSABLE SUP-0165SI18 CDM 270009003 LOCAL 0270 RC outpatient 4.9 4.9 4.9 74 3.63 percent of total billed charges 4.9 93 3.97 percent of total billed charges 4.9 4.9 other OPPS APC 4.9 4.9 other OPPS APC 4.9 27.63 1.35 percent of total billed charges 4.9 4.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX IC 20FR 5CC BACTI-GUARD NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON SUP-0165SI20 CDM 270009003 LOCAL 0270 RC outpatient 4.9 4.9 4.9 74 3.63 percent of total billed charges 4.9 93 3.97 percent of total billed charges 4.9 4.9 other OPPS APC 4.9 4.9 other OPPS APC 4.9 27.63 1.35 percent of total billed charges 4.9 4.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX IC 22FR 5CC BACTI-GUARD NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON SUP-0165SI22 CDM 270009003 LOCAL 0270 RC outpatient 4.9 4.9 4.9 74 3.63 percent of total billed charges 4.9 93 3.97 percent of total billed charges 4.9 4.9 other OPPS APC 4.9 4.9 other OPPS APC 4.9 27.63 1.35 percent of total billed charges 4.9 4.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX IC 24FR 5CC BACTI-GUARD NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON SUP-0165SI24 CDM 270009003 LOCAL 0270 RC outpatient 4.9 4.9 4.9 74 3.63 percent of total billed charges 4.9 93 3.97 percent of total billed charges 4.9 4.9 other OPPS APC 4.9 4.9 other OPPS APC 4.9 27.63 1.35 percent of total billed charges 4.9 4.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX IC 26FR 5CC BACTI-GUARD NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON SUP-0165SI26 CDM outpatient 18.9 18.9 18.9 18.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCATHETER PRESSURE NAVVUS II L150 CM STERILE LATEX FREE DISPOSABLE SUP-016675 CDM 0481 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 51 994.5 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX IC 16FR 30CC BACTI-GUARD NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON SUP-0166SI16 CDM 270009003 LOCAL 0270 RC outpatient 4.9 4.9 4.9 74 3.63 percent of total billed charges 4.9 93 3.97 percent of total billed charges 4.9 4.9 other OPPS APC 4.9 4.9 other OPPS APC 4.9 27.63 1.35 percent of total billed charges 4.9 4.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX IC 18FR 30CC BACTI-GUARD NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON SUP-0166SI18 CDM 270009003 LOCAL 0270 RC outpatient 4.9 4.9 4.9 74 3.63 percent of total billed charges 4.9 93 3.97 percent of total billed charges 4.9 4.9 other OPPS APC 4.9 4.9 other OPPS APC 4.9 27.63 1.35 percent of total billed charges 4.9 4.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX IC 20FR 30CC BACTI-GUARD NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON SUP-0166SI20 CDM 270009003 LOCAL 0270 RC outpatient 4.9 4.9 4.9 74 3.63 percent of total billed charges 4.9 93 3.97 percent of total billed charges 4.9 4.9 other OPPS APC 4.9 4.9 other OPPS APC 4.9 27.63 1.35 percent of total billed charges 4.9 4.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX IC 22FR 30CC BACTI-GUARD NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON SUP-0166SI22 CDM 270009003 LOCAL 0270 RC outpatient 4.9 4.9 4.9 74 3.63 percent of total billed charges 4.9 93 3.97 percent of total billed charges 4.9 4.9 other OPPS APC 4.9 4.9 other OPPS APC 4.9 27.63 1.35 percent of total billed charges 4.9 4.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX IC 24FR 30CC BACTI-GUARD NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON SUP-0166SI24 CDM 270009003 LOCAL 0270 RC outpatient 4.9 4.9 4.9 74 3.63 percent of total billed charges 4.9 93 3.97 percent of total billed charges 4.9 4.9 other OPPS APC 4.9 4.9 other OPPS APC 4.9 27.63 1.35 percent of total billed charges 4.9 4.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX IC 26FR 30CC BACTI-GUARD NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON SUP-0166SI26 CDM 270009003 LOCAL 0270 RC outpatient 4.9 4.9 4.9 74 3.63 percent of total billed charges 4.9 93 3.97 percent of total billed charges 4.9 4.9 other OPPS APC 4.9 4.9 other OPPS APC 4.9 27.63 1.35 percent of total billed charges 4.9 4.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX IC BACTI-GUARD NATURAL RUBBER HYDROGEL OD28 FR 30 CC 2 WAY FOLEY BALLOON ATRAUMATIC INSERTION STERILE LATEX DISPOSABLE SUP-0166SI28 CDM 270009003 LOCAL 0270 RC outpatient 4.9 4.9 4.9 74 3.63 percent of total billed charges 4.9 93 3.97 percent of total billed charges 4.9 4.9 other OPPS APC 4.9 4.9 other OPPS APC 4.9 27.63 1.35 percent of total billed charges 4.9 4.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX IC 30FR 30CC BACTI-GUARD NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY BALLOON SUP-0166SI30 CDM 270009003 LOCAL 0270 RC outpatient 4.9 4.9 4.9 74 3.63 percent of total billed charges 4.9 93 3.97 percent of total billed charges 4.9 4.9 other OPPS APC 4.9 4.9 other OPPS APC 4.9 27.63 1.35 percent of total billed charges 4.9 4.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX LUBRICATH STANDARD 16FR 30CC NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 3 WAY FOLEY 2 SUP-0167L16 CDM 270009008 LOCAL 0270 RC outpatient 11.33 11.33 11.33 74 8.38 percent of total billed charges 11.33 93 9.18 percent of total billed charges 11.33 11.33 other OPPS APC 11.33 11.33 other OPPS APC 11.33 27.63 3.13 percent of total billed charges 11.33 11.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARD NATURAL RUBBER HYDROGEL SILICONE ELASTOMER STANDARD OD20 FR 30 CC 3 WAY 2 STAGGER DRAINAGE EYE FOLEY MEDIUM ROUND TIP STERILE LATEX DISPOSABLE SUP-0167L20 CDM 0270 RC outpatient 22.06 22.06 22.06 74 16.32 percent of total billed charges 22.06 93 17.87 percent of total billed charges 22.06 22.06 other OPPS APC 22.06 22.06 other OPPS APC 22.06 27.63 6.1 percent of total billed charges 22.06 22.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX LUBRICATH STANDARD 22FR 30CC NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 3 WAY FOLEY 2 SUP-0167L22 CDM 0270 RC outpatient 24.4 24.4 24.4 74 18.06 percent of total billed charges 24.4 93 19.76 percent of total billed charges 24.4 24.4 other OPPS APC 24.4 24.4 other OPPS APC 24.4 27.63 6.74 percent of total billed charges 24.4 24.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX LUBRICATH STANDARD 24FR 30CC NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 3 WAY FOLEY 2 SUP-0167L24 CDM 0270 RC outpatient 22.06 22.06 22.06 74 16.32 percent of total billed charges 22.06 93 17.87 percent of total billed charges 22.06 22.06 other OPPS APC 22.06 22.06 other OPPS APC 22.06 27.63 6.1 percent of total billed charges 22.06 22.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL STANDARD L 40 CM OD20 FR5 CC FOLEY 2 WAY DRAINAGE EYE MEDIUM OLIVE COUDE TIP STERILE LATEX DISPOSABLE CARSON MODEL SUP-0168L20 CDM 0270 RC outpatient 21.24 21.24 21.24 74 15.72 percent of total billed charges 21.24 93 17.2 percent of total billed charges 21.24 21.24 other OPPS APC 21.24 21.24 other OPPS APC 21.24 27.63 5.87 percent of total billed charges 21.24 21.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD ICD RELIANCE GORE SUP-0170-1 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT CORTICAL PARALLEL OVAL PYRAMIDAL TEETH L12 MM X W14 MM X H5 MM SPINE FREEZE DRIED MONOLITHIC LARGE CENTRAL LUMEN ACF SUP-017105 CDM 270010031 LOCAL 0270 RC outpatient 2701.97 2701.97 2701.97 74 1999.46 percent of total billed charges 2701.97 93 2188.6 percent of total billed charges 2701.97 2701.97 other OPPS APC 2701.97 2701.97 other OPPS APC 2701.97 27.63 746.55 percent of total billed charges 2701.97 2701.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT OVAL PARALLEL 12X14X6MM CORTICAL SPINE FREEZE DRIED MONOLITHIC LG CENTRAL LUMEN PYRAMIDAL TEETH ACF SUP-017106 CDM 270010012 LOCAL 0270 RC outpatient 2698.7 2698.7 2698.7 74 1997.04 percent of total billed charges 2698.7 93 2185.95 percent of total billed charges 2698.7 2698.7 other OPPS APC 2698.7 2698.7 other OPPS APC 2698.7 27.63 745.65 percent of total billed charges 2698.7 2698.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT OVAL PARALLEL 12X14X7MM CORTICAL SPINE FREEZE DRIED MONOLITHIC LG CENTRAL LUMEN PYRAMIDAL TEETH ACF SUP-017107 CDM 270010012 LOCAL 0270 RC outpatient 2701.97 2701.97 2701.97 74 1999.46 percent of total billed charges 2701.97 93 2188.6 percent of total billed charges 2701.97 2701.97 other OPPS APC 2701.97 2701.97 other OPPS APC 2701.97 27.63 746.55 percent of total billed charges 2701.97 2701.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT OVAL PARALLEL 12X14X8MM CORTICAL SPINE FREEZE DRIED MONOLITHIC LG CENTRAL LUMEN PYRAMIDAL TEETH ACF SUP-017108 CDM 270010012 LOCAL 0270 RC outpatient 2698.7 2698.7 2698.7 74 1997.04 percent of total billed charges 2698.7 93 2185.95 percent of total billed charges 2698.7 2698.7 other OPPS APC 2698.7 2698.7 other OPPS APC 2698.7 27.63 745.65 percent of total billed charges 2698.7 2698.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT OVAL PARALLEL 12X14X9MM CORTICAL SPINE FREEZE DRIED MONOLITHIC LG CENTRAL LUMEN PYRAMIDAL TEETH ACF SUP-017109 CDM 270010012 LOCAL 0270 RC outpatient 2698.7 2698.7 2698.7 74 1997.04 percent of total billed charges 2698.7 93 2185.95 percent of total billed charges 2698.7 2698.7 other OPPS APC 2698.7 2698.7 other OPPS APC 2698.7 27.63 745.65 percent of total billed charges 2698.7 2698.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT OVAL PARALLEL 12X14X10MM CORTICAL SPINE FREEZE DRIED MONOLITHIC LG CENTRAL LUMEN PYRAMIDAL TEETH ACF SUP-017110 CDM 270010012 LOCAL 0270 RC outpatient 2698.7 2698.7 2698.7 74 1997.04 percent of total billed charges 2698.7 93 2185.95 percent of total billed charges 2698.7 2698.7 other OPPS APC 2698.7 2698.7 other OPPS APC 2698.7 27.63 745.65 percent of total billed charges 2698.7 2698.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT CORTICAL 5 D LORDOTIC OVAL L12 MM X W14 MM X H5 MM SPINE FREEZE DRIED MONOLITHIC LARGE CENTRAL LUMEN PYRAMIDAL TEETH ACF SUP-017205 CDM 270010012 LOCAL 0270 RC outpatient 2698.7 2698.7 2698.7 74 1997.04 percent of total billed charges 2698.7 93 2185.95 percent of total billed charges 2698.7 2698.7 other OPPS APC 2698.7 2698.7 other OPPS APC 2698.7 27.63 745.65 percent of total billed charges 2698.7 2698.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT CORTICAL 5 D LORDOTIC OVAL L12 MM X W14 MM X H6 MM SPINE FREEZE DRIED MONOLITHIC LARGE CENTRAL LUMEN PYRAMIDAL TEETH ACF SUP-017206 CDM 270010012 LOCAL 0270 RC outpatient 2698.7 2698.7 2698.7 74 1997.04 percent of total billed charges 2698.7 93 2185.95 percent of total billed charges 2698.7 2698.7 other OPPS APC 2698.7 2698.7 other OPPS APC 2698.7 27.63 745.65 percent of total billed charges 2698.7 2698.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT CORTICAL 5 D LORDOTIC OVAL L12 MM X W14 MM X H7 MM SPINE FREEZE DRIED MONOLITHIC LARGE CENTRAL LUMEN PYRAMIDAL TEETH ACF SUP-017207 CDM 270010012 LOCAL 0270 RC outpatient 2698.7 2698.7 2698.7 74 1997.04 percent of total billed charges 2698.7 93 2185.95 percent of total billed charges 2698.7 2698.7 other OPPS APC 2698.7 2698.7 other OPPS APC 2698.7 27.63 745.65 percent of total billed charges 2698.7 2698.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT CORTICAL 5 D LORDOTIC OVAL L12 MM X W14 MM X H8 MM SPINE FREEZE DRIED MONOLITHIC LARGE CENTRAL LUMEN PYRAMIDAL TEETH ACF SUP-017208 CDM 270010012 LOCAL 0270 RC outpatient 2698.7 2698.7 2698.7 74 1997.04 percent of total billed charges 2698.7 93 2185.95 percent of total billed charges 2698.7 2698.7 other OPPS APC 2698.7 2698.7 other OPPS APC 2698.7 27.63 745.65 percent of total billed charges 2698.7 2698.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT CORTICAL 5 D LORDOTIC OVAL L12 MM X W14 MM X H9 MM SPINE CERVICAL ANTERIOR FREEZE DRIED MONOLITHIC LARGE CENTRAL LUMEN PYRAMIDAL TEETH ACF SUP-017209 CDM 270010012 LOCAL 0270 RC outpatient 2698.7 2698.7 2698.7 74 1997.04 percent of total billed charges 2698.7 93 2185.95 percent of total billed charges 2698.7 2698.7 other OPPS APC 2698.7 2698.7 other OPPS APC 2698.7 27.63 745.65 percent of total billed charges 2698.7 2698.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT CORTICAL 5 D LORDOTIC OVAL L12 MM X W14 MM X H10 MM SPINE FREEZE DRIED MONOLITHIC LARGE CENTRAL LUMEN PYRAMIDAL TEETH ACF SUP-017210 CDM 270010012 LOCAL 0270 RC outpatient 2701.4 2701.4 2701.4 74 1999.04 percent of total billed charges 2701.4 93 2188.13 percent of total billed charges 2701.4 2701.4 other OPPS APC 2701.4 2701.4 other OPPS APC 2701.4 27.63 746.4 percent of total billed charges 2701.4 2701.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT CORTICAL 5 D LORDOTIC OVAL L12 MM X W14 MM X H11 MM SPINE FREEZE DRIED MONOLITHIC LARGE CENTRAL LUMEN PYRAMIDAL TEETH ACF SUP-017211 CDM 270010012 LOCAL 0270 RC outpatient 2698.7 2698.7 2698.7 74 1997.04 percent of total billed charges 2698.7 93 2185.95 percent of total billed charges 2698.7 2698.7 other OPPS APC 2698.7 2698.7 other OPPS APC 2698.7 27.63 745.65 percent of total billed charges 2698.7 2698.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD ICD RELIANCE GORE SUP-0174-7 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL 30X3.5MM TITANIUM REGULAR THICK TISSUE LINEAR CUTTER SQUEEZE HANDLE SUP-017615 CDM 0270 RC outpatient 1363.65 1363.65 1363.65 74 1009.1 percent of total billed charges 1363.65 93 1104.56 percent of total billed charges 1363.65 1363.65 other OPPS APC 1363.65 1363.65 other OPPS APC 1363.65 27.63 376.78 percent of total billed charges 1363.65 1363.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY SENTINOL NITINOL L79 MM L135 CM OD10 MM SELF EXPAND ACCEPTS 6 FR SHEATH SUP-0180-1 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD ICD RELIANCE GORE SUP-0184-7 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON VALVULOPLASTY TRUE DILATION 18MM X 110CM 11 FRENCH SUP-0184511 CDM 0481 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 51 1989 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE MYO'LEAD ATRIAL DISP PT CABLE WHITE SUP-019-530 CDM 0270 RC outpatient 53.3 53.3 53.3 74 39.44 percent of total billed charges 53.3 93 43.17 percent of total billed charges 53.3 53.3 other OPPS APC 53.3 53.3 other OPPS APC 53.3 27.63 14.73 percent of total billed charges 53.3 53.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE MYO/LEAD VENTRICULAR DISP PT CABLE BLUE SUP-019-535 CDM 0270 RC outpatient 53.3 53.3 53.3 74 39.44 percent of total billed charges 53.3 93 43.17 percent of total billed charges 53.3 53.3 other OPPS APC 53.3 53.3 other OPPS APC 53.3 27.63 14.73 percent of total billed charges 53.3 53.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FABRIC VASCULAR 3X.2IN HEMASHIELD THK.76MM KNIT SUP-019525 CDM 0270 RC outpatient 1509.3 1509.3 1509.3 74 1116.88 percent of total billed charges 1509.3 93 1222.53 percent of total billed charges 1509.3 1509.3 other OPPS APC 1509.3 1509.3 other OPPS APC 1509.3 27.63 417.02 percent of total billed charges 1509.3 1509.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FABRIC CARDIOVASCULAR 6X2IN HEMASHIELD THK.76MM 2 VELOUR KNIT SUP-019527 CDM 0270 RC outpatient 1509.3 1509.3 1509.3 74 1116.88 percent of total billed charges 1509.3 93 1222.53 percent of total billed charges 1509.3 1509.3 other OPPS APC 1509.3 1509.3 other OPPS APC 1509.3 27.63 417.02 percent of total billed charges 1509.3 1509.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX LUBRICATH 16FR 5CC RED NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY 2 OPPOSING SUP-0196L16 CDM 0270 RC outpatient 31.3 31.3 31.3 74 23.16 percent of total billed charges 31.3 93 25.35 percent of total billed charges 31.3 31.3 other OPPS APC 31.3 31.3 other OPPS APC 31.3 27.63 8.65 percent of total billed charges 31.3 31.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX LUBRICATH 18FR 5CC RED NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY 2 OPPOSING SUP-0196L18 CDM 0270 RC outpatient 31.3 31.3 31.3 74 23.16 percent of total billed charges 31.3 93 25.35 percent of total billed charges 31.3 31.3 other OPPS APC 31.3 31.3 other OPPS APC 31.3 27.63 8.65 percent of total billed charges 31.3 31.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX LUBRICATH 20FR 5CC RED NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY 2 OPPOSING SUP-0196L20 CDM 0270 RC outpatient 31.3 31.3 31.3 74 23.16 percent of total billed charges 31.3 93 25.35 percent of total billed charges 31.3 31.3 other OPPS APC 31.3 31.3 other OPPS APC 31.3 27.63 8.65 percent of total billed charges 31.3 31.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARDEX LUBRICATH 22FR 5CC RED NATURAL RUBBER HYDROGEL DISPOSABLE STERILE LATEX 2 WAY FOLEY 2 OPPOSING SUP-0196L22 CDM 0270 RC outpatient 30.99 30.99 30.99 74 22.93 percent of total billed charges 30.99 93 25.1 percent of total billed charges 30.99 30.99 other OPPS APC 30.99 30.99 other OPPS APC 30.99 27.63 8.56 percent of total billed charges 30.99 30.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER COUDE FOLEY 12 FR 5CC SUP-02-00008 CDM C1729 HCPCS 0272 RC outpatient 41.21 41.21 41.21 74 30.5 percent of total billed charges 41.21 93 33.38 percent of total billed charges 41.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.21 other OPPS APC 41.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.21 other OPPS APC 41.21 27.63 11.39 percent of total billed charges 41.21 41.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER COUDE FOLEY 14 FR 5 C SUP-02-00009 CDM C1729 HCPCS 0272 RC outpatient 41.21 41.21 41.21 74 30.5 percent of total billed charges 41.21 93 33.38 percent of total billed charges 41.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.21 other OPPS APC 41.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.21 other OPPS APC 41.21 27.63 11.39 percent of total billed charges 41.21 41.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER COUDE FOLEY 16 FR SUP-02-00010 CDM C1729 HCPCS 0272 RC outpatient 41.21 41.21 41.21 74 30.5 percent of total billed charges 41.21 93 33.38 percent of total billed charges 41.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.21 other OPPS APC 41.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.21 other OPPS APC 41.21 27.63 11.39 percent of total billed charges 41.21 41.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FILIFORM 18 6 FR SUP-02-00014 CDM 0272 RC outpatient 233.61 233.61 233.61 74 172.87 percent of total billed charges 233.61 93 189.22 percent of total billed charges 233.61 233.61 other OPPS APC 233.61 233.61 other OPPS APC 233.61 27.63 64.55 percent of total billed charges 233.61 233.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FILIFORM 3 FR SUP-02-00015 CDM 0272 RC outpatient 249.6 249.6 249.6 74 184.7 percent of total billed charges 249.6 93 202.18 percent of total billed charges 249.6 249.6 other OPPS APC 249.6 249.6 other OPPS APC 249.6 27.63 68.96 percent of total billed charges 249.6 249.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FILIFORM 4 FR SUP-02-00016 CDM 0272 RC outpatient 256.26 256.26 256.26 74 189.63 percent of total billed charges 256.26 93 207.57 percent of total billed charges 256.26 256.26 other OPPS APC 256.26 256.26 other OPPS APC 256.26 27.63 70.8 percent of total billed charges 256.26 256.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FILIFORM 5 FR SUP-02-00017 CDM 0272 RC outpatient 255.18 255.18 255.18 74 188.83 percent of total billed charges 255.18 93 206.7 percent of total billed charges 255.18 255.18 other OPPS APC 255.18 255.18 other OPPS APC 255.18 27.63 70.51 percent of total billed charges 255.18 255.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FILIFORM 6FR SUP-02-00018 CDM 0272 RC outpatient 217.29 217.29 217.29 74 160.79 percent of total billed charges 217.29 93 176 percent of total billed charges 217.29 217.29 other OPPS APC 217.29 217.29 other OPPS APC 217.29 27.63 60.04 percent of total billed charges 217.29 217.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LF 12FR 2WAY 5CC SUP-02-00019 CDM C1729 HCPCS 0272 RC outpatient 3.21 3.21 3.21 74 2.38 percent of total billed charges 3.21 93 2.6 percent of total billed charges 3.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.21 other OPPS APC 3.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.21 other OPPS APC 3.21 27.63 0.89 percent of total billed charges 3.21 3.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LF 16 FR 2WAY 5CC SUP-02-00021 CDM C1729 HCPCS 0272 RC outpatient 3.21 3.21 3.21 74 2.38 percent of total billed charges 3.21 93 2.6 percent of total billed charges 3.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.21 other OPPS APC 3.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.21 other OPPS APC 3.21 27.63 0.89 percent of total billed charges 3.21 3.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LF 18 FR 2WAY 5CC SUP-02-00022 CDM C1729 HCPCS 0272 RC outpatient 3.21 3.21 3.21 74 2.38 percent of total billed charges 3.21 93 2.6 percent of total billed charges 3.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.21 other OPPS APC 3.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.21 other OPPS APC 3.21 27.63 0.89 percent of total billed charges 3.21 3.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LF 22FR 3WAY 30CC SUP-02-00030 CDM C1729 HCPCS 0272 RC outpatient 41.48 41.48 41.48 74 30.7 percent of total billed charges 41.48 93 33.6 percent of total billed charges 41.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.48 other OPPS APC 41.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 41.48 other OPPS APC 41.48 27.63 11.46 percent of total billed charges 41.48 41.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LATEX 22FR 3WAY 30CC SUP-02-00031 CDM C1729 HCPCS 0272 RC outpatient 35.64 35.64 35.64 74 26.37 percent of total billed charges 35.64 93 28.87 percent of total billed charges 35.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35.64 other OPPS APC 35.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35.64 other OPPS APC 35.64 27.63 9.85 percent of total billed charges 35.64 35.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LATEX 24FR 3WAY 30CC SUP-02-00034 CDM C1729 HCPCS 0272 RC outpatient 34.99 34.99 34.99 74 25.89 percent of total billed charges 34.99 93 28.34 percent of total billed charges 34.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.99 other OPPS APC 34.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.99 other OPPS APC 34.99 27.63 9.67 percent of total billed charges 34.99 34.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LF 24FR 3WAY 5CC SUP-02-00035 CDM C1729 HCPCS 0272 RC outpatient 44.55 44.55 44.55 74 32.97 percent of total billed charges 44.55 93 36.09 percent of total billed charges 44.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.55 other OPPS APC 44.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.55 other OPPS APC 44.55 27.63 12.31 percent of total billed charges 44.55 44.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY 6FR 1/5 BAG SUP-02-00037 CDM C1729 HCPCS 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20 other OPPS APC 20 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY PED LF 8FR 2WAY 3CC SUP-02-00038 CDM C1729 HCPCS 0272 RC outpatient 3.63 3.63 3.63 74 2.69 percent of total billed charges 3.63 93 2.94 percent of total billed charges 3.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.63 other OPPS APC 3.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.63 other OPPS APC 3.63 27.63 1 percent of total billed charges 3.63 3.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMATURIA CATHETER COUVELAIRE SUP-02-00039 CDM C1729 HCPCS 0272 RC outpatient 74.65 74.65 74.65 74 55.24 percent of total billed charges 74.65 93 60.47 percent of total billed charges 74.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 74.65 other OPPS APC 74.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 74.65 other OPPS APC 74.65 27.63 20.63 percent of total billed charges 74.65 74.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER MALE EXTERNAL LARGE SUP-02-00041 CDM 0272 RC outpatient 0.72 0.72 0.72 74 0.53 percent of total billed charges 0.72 93 0.58 percent of total billed charges 0.72 0.72 other OPPS APC 0.72 0.72 other OPPS APC 0.72 27.63 0.2 percent of total billed charges 0.72 0.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER MALE EXTERNAL MEDIUM SUP-02-00042 CDM 0272 RC outpatient 0.73 0.73 0.73 74 0.54 percent of total billed charges 0.73 93 0.59 percent of total billed charges 0.73 0.73 other OPPS APC 0.73 0.73 other OPPS APC 0.73 27.63 0.2 percent of total billed charges 0.73 0.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER MALECOT 24 FR SUP-02-00049 CDM C1729 HCPCS 0272 RC outpatient 94.8 94.8 94.8 74 70.15 percent of total billed charges 94.8 93 76.79 percent of total billed charges 94.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 94.8 other OPPS APC 94.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 94.8 other OPPS APC 94.8 27.63 26.19 percent of total billed charges 94.8 94.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER MALECOT 26 FR SUP-02-00050 CDM C1729 HCPCS 0272 RC outpatient 112.43 112.43 112.43 74 83.2 percent of total billed charges 112.43 93 91.07 percent of total billed charges 112.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.43 other OPPS APC 112.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.43 other OPPS APC 112.43 27.63 31.06 percent of total billed charges 112.43 112.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER MALECOT 28 FR SUP-02-00051 CDM C1729 HCPCS 0272 RC outpatient 35.37 35.37 35.37 74 26.17 percent of total billed charges 35.37 93 28.65 percent of total billed charges 35.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35.37 other OPPS APC 35.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35.37 other OPPS APC 35.37 27.63 9.77 percent of total billed charges 35.37 35.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PHILLIPS 10 FR SUP-02-00059 CDM 0272 RC outpatient 376.39 376.39 376.39 74 278.53 percent of total billed charges 376.39 93 304.88 percent of total billed charges 376.39 376.39 other OPPS APC 376.39 376.39 other OPPS APC 376.39 27.63 104 percent of total billed charges 376.39 376.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PHILLIPS 12 FR SUP-02-00060 CDM 0272 RC outpatient 376.39 376.39 376.39 74 278.53 percent of total billed charges 376.39 93 304.88 percent of total billed charges 376.39 376.39 other OPPS APC 376.39 376.39 other OPPS APC 376.39 27.63 104 percent of total billed charges 376.39 376.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PHILLIPS 14 FR SUP-02-00061 CDM 0272 RC outpatient 380.96 380.96 380.96 74 281.91 percent of total billed charges 380.96 93 308.58 percent of total billed charges 380.96 380.96 other OPPS APC 380.96 380.96 other OPPS APC 380.96 27.63 105.26 percent of total billed charges 380.96 380.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PHILLIPS 16 FR SUP-02-00062 CDM 0272 RC outpatient 302.56 302.56 302.56 74 223.89 percent of total billed charges 302.56 93 245.07 percent of total billed charges 302.56 302.56 other OPPS APC 302.56 302.56 other OPPS APC 302.56 27.63 83.6 percent of total billed charges 302.56 302.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PHILLIPS 18 FR SUP-02-00063 CDM 0272 RC outpatient 398.67 398.67 398.67 74 295.02 percent of total billed charges 398.67 93 322.92 percent of total billed charges 398.67 398.67 other OPPS APC 398.67 398.67 other OPPS APC 398.67 27.63 110.15 percent of total billed charges 398.67 398.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PHILLIPS 20 FR SUP-02-00064 CDM 0272 RC outpatient 302.02 302.02 302.02 74 223.49 percent of total billed charges 302.02 93 244.64 percent of total billed charges 302.02 302.02 other OPPS APC 302.02 302.02 other OPPS APC 302.02 27.63 83.45 percent of total billed charges 302.02 302.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PHILLIPS 22 FR SUP-02-00065 CDM 0272 RC outpatient 230.41 230.41 230.41 74 170.5 percent of total billed charges 230.41 93 186.63 percent of total billed charges 230.41 230.41 other OPPS APC 230.41 230.41 other OPPS APC 230.41 27.63 63.66 percent of total billed charges 230.41 230.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PHILLIPS 24 FR SUP-02-00066 CDM 0272 RC outpatient 268.69 268.69 268.69 74 198.83 percent of total billed charges 268.69 93 217.64 percent of total billed charges 268.69 268.69 other OPPS APC 268.69 268.69 other OPPS APC 268.69 27.63 74.24 percent of total billed charges 268.69 268.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PHILLIPS 8 FR SUP-02-00067 CDM 0272 RC outpatient 191.82 191.82 191.82 74 141.95 percent of total billed charges 191.82 93 155.37 percent of total billed charges 191.82 191.82 other OPPS APC 191.82 191.82 other OPPS APC 191.82 27.63 53 percent of total billed charges 191.82 191.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SUCTION 10 FR SUP-02-00068 CDM 0272 RC outpatient 0.37 0.37 0.37 74 0.27 percent of total billed charges 0.37 93 0.3 percent of total billed charges 0.37 0.37 other OPPS APC 0.37 0.37 other OPPS APC 0.37 27.63 0.1 percent of total billed charges 0.37 0.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SUCTION 14 FR SUP-02-00069 CDM 0272 RC outpatient 0.5 0.5 0.5 74 0.37 percent of total billed charges 0.5 93 0.41 percent of total billed charges 0.5 0.5 other OPPS APC 0.5 0.5 other OPPS APC 0.5 27.63 0.14 percent of total billed charges 0.5 0.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SUCTION 18 FR SUP-02-00070 CDM 0272 RC outpatient 0.45 0.45 0.45 74 0.33 percent of total billed charges 0.45 93 0.36 percent of total billed charges 0.45 0.45 other OPPS APC 0.45 0.45 other OPPS APC 0.45 27.63 0.12 percent of total billed charges 0.45 0.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THORACIC 32 FR SUP-02-00074 CDM C1729 HCPCS 0272 RC outpatient 25 25 25 74 18.5 percent of total billed charges 25 93 20.25 percent of total billed charges 25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 25 other OPPS APC 25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 25 other OPPS APC 25 27.63 6.91 percent of total billed charges 25 25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THORACIC 36FR SUP-02-00075 CDM C1729 HCPCS 0272 RC outpatient 25.64 25.64 25.64 74 18.97 percent of total billed charges 25.64 93 20.77 percent of total billed charges 25.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 25.64 other OPPS APC 25.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 25.64 other OPPS APC 25.64 27.63 7.08 percent of total billed charges 25.64 25.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THORACIC 16FR W/4 EYES SUP-02-00078 CDM C1729 HCPCS 0272 RC outpatient 26.94 26.94 26.94 74 19.94 percent of total billed charges 26.94 93 21.82 percent of total billed charges 26.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 26.94 other OPPS APC 26.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 26.94 other OPPS APC 26.94 27.63 7.44 percent of total billed charges 26.94 26.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THORACIC W/EYE 28 FR SUP-02-00080 CDM C1729 HCPCS 0272 RC outpatient 25.12 25.12 25.12 74 18.59 percent of total billed charges 25.12 93 20.35 percent of total billed charges 25.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 25.12 other OPPS APC 25.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 25.12 other OPPS APC 25.12 27.63 6.94 percent of total billed charges 25.12 25.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER UMBILICAL 3.5 FR SINGLE LUMEN SUP-02-00083 CDM 0272 RC outpatient 53.05 53.05 53.05 74 39.26 percent of total billed charges 53.05 93 42.97 percent of total billed charges 53.05 53.05 other OPPS APC 53.05 53.05 other OPPS APC 53.05 27.63 14.66 percent of total billed charges 53.05 53.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER UMBILICAL 5 FR SINGLE LUMEN SUP-02-00084 CDM 0272 RC outpatient 46.71 46.71 46.71 74 34.57 percent of total billed charges 46.71 93 37.84 percent of total billed charges 46.71 46.71 other OPPS APC 46.71 46.71 other OPPS APC 46.71 27.63 12.91 percent of total billed charges 46.71 46.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER UMBILICAL 8 FR TRIPLE LUMEN SUP-02-00085 CDM 0272 RC outpatient 165 165 165 74 122.1 percent of total billed charges 165 93 133.65 percent of total billed charges 165 165 other OPPS APC 165 165 other OPPS APC 165 27.63 45.59 percent of total billed charges 165 165 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LATEX 26FR 3-WAY 30CC SUP-02-00100 CDM C1729 HCPCS 0272 RC outpatient 34.53 34.53 34.53 74 25.55 percent of total billed charges 34.53 93 27.97 percent of total billed charges 34.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.53 other OPPS APC 34.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.53 other OPPS APC 34.53 27.63 9.54 percent of total billed charges 34.53 34.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER MALE EXTERNAL SMALL SUP-02-00101 CDM 0272 RC outpatient 0.73 0.73 0.73 74 0.54 percent of total billed charges 0.73 93 0.59 percent of total billed charges 0.73 0.73 other OPPS APC 0.73 0.73 other OPPS APC 0.73 27.63 0.2 percent of total billed charges 0.73 0.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PLUG PROTECTOR SUP-02-00103 CDM 0272 RC outpatient 0.23 0.23 0.23 74 0.17 percent of total billed charges 0.23 93 0.19 percent of total billed charges 0.23 0.23 other OPPS APC 0.23 0.23 other OPPS APC 0.23 27.63 0.06 percent of total billed charges 0.23 0.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LATEX 16FR 2WAY 5CC SUP-02-00105 CDM C1729 HCPCS 0272 RC outpatient 3.27 3.27 3.27 74 2.42 percent of total billed charges 3.27 93 2.65 percent of total billed charges 3.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.27 other OPPS APC 3.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.27 other OPPS APC 3.27 27.63 0.9 percent of total billed charges 3.27 3.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LATEX 18FR 2WAY 5CC SUP-02-00106 CDM C1729 HCPCS 0272 RC outpatient 3.35 3.35 3.35 74 2.48 percent of total billed charges 3.35 93 2.71 percent of total billed charges 3.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.35 other OPPS APC 3.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.35 other OPPS APC 3.35 27.63 0.93 percent of total billed charges 3.35 3.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER LATEX 8FR ALL PURPOSE SUP-02-00107 CDM C1729 HCPCS 0272 RC outpatient 0.77 0.77 0.77 74 0.57 percent of total billed charges 0.77 93 0.62 percent of total billed charges 0.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.77 other OPPS APC 0.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.77 other OPPS APC 0.77 27.63 0.21 percent of total billed charges 0.77 0.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER LATEX 12FR ALL PURPOSE SUP-02-00109 CDM C1729 HCPCS 0272 RC outpatient 0.77 0.77 0.77 74 0.57 percent of total billed charges 0.77 93 0.62 percent of total billed charges 0.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.77 other OPPS APC 0.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.77 other OPPS APC 0.77 27.63 0.21 percent of total billed charges 0.77 0.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER LATEX 14FR ALL PURPOSE SUP-02-00110 CDM C1729 HCPCS 0272 RC outpatient 0.77 0.77 0.77 74 0.57 percent of total billed charges 0.77 93 0.62 percent of total billed charges 0.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.77 other OPPS APC 0.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.77 other OPPS APC 0.77 27.63 0.21 percent of total billed charges 0.77 0.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER LATEX 16FR ALL PURPOSE SUP-02-00111 CDM C1729 HCPCS 0272 RC outpatient 0.77 0.77 0.77 74 0.57 percent of total billed charges 0.77 93 0.62 percent of total billed charges 0.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.77 other OPPS APC 0.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.77 other OPPS APC 0.77 27.63 0.21 percent of total billed charges 0.77 0.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER LATEX 18FR ALL PURPOSE SUP-02-00112 CDM C1729 HCPCS 0272 RC outpatient 0.77 0.77 0.77 74 0.57 percent of total billed charges 0.77 93 0.62 percent of total billed charges 0.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.77 other OPPS APC 0.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.77 other OPPS APC 0.77 27.63 0.21 percent of total billed charges 0.77 0.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER LATEX 20FR ALL PURPOSE SUP-02-00113 CDM C1729 HCPCS 0272 RC outpatient 0.73 0.73 0.73 74 0.54 percent of total billed charges 0.73 93 0.59 percent of total billed charges 0.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.73 other OPPS APC 0.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.73 other OPPS APC 0.73 27.63 0.2 percent of total billed charges 0.73 0.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LF 14FR 2WAY 5CC SUP-02-00114 CDM C1729 HCPCS 0272 RC outpatient 3.63 3.63 3.63 74 2.69 percent of total billed charges 3.63 93 2.94 percent of total billed charges 3.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.63 other OPPS APC 3.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.63 other OPPS APC 3.63 27.63 1 percent of total billed charges 3.63 3.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LF 20FR 2WAY 5CC SUP-02-00115 CDM C1729 HCPCS 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20 other OPPS APC 20 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LF 22FR 2WAY 5CC SUP-02-00116 CDM C1729 HCPCS 0272 RC outpatient 3.63 3.63 3.63 74 2.69 percent of total billed charges 3.63 93 2.94 percent of total billed charges 3.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.63 other OPPS APC 3.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.63 other OPPS APC 3.63 27.63 1 percent of total billed charges 3.63 3.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LF 22FR 2WAY 30CC SUP-02-00120 CDM C1729 HCPCS 0272 RC outpatient 29.22 29.22 29.22 74 21.62 percent of total billed charges 29.22 93 23.67 percent of total billed charges 29.22 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.22 other OPPS APC 29.22 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.22 other OPPS APC 29.22 27.63 8.07 percent of total billed charges 29.22 29.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LF 24FR 2WAY 30CC SUP-02-00121 CDM C1729 HCPCS 0272 RC outpatient 29.15 29.15 29.15 74 21.57 percent of total billed charges 29.15 93 23.61 percent of total billed charges 29.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.15 other OPPS APC 29.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.15 other OPPS APC 29.15 27.63 8.05 percent of total billed charges 29.15 29.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LATEX 20FR 2WAY 5CC SUP-02-00122 CDM C1729 HCPCS 0272 RC outpatient 3.27 3.27 3.27 74 2.42 percent of total billed charges 3.27 93 2.65 percent of total billed charges 3.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.27 other OPPS APC 3.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.27 other OPPS APC 3.27 27.63 0.9 percent of total billed charges 3.27 3.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LATEX 22FR 2WAY 5CC SUP-02-00123 CDM C1729 HCPCS 0272 RC outpatient 3.27 3.27 3.27 74 2.42 percent of total billed charges 3.27 93 2.65 percent of total billed charges 3.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.27 other OPPS APC 3.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.27 other OPPS APC 3.27 27.63 0.9 percent of total billed charges 3.27 3.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LATE 24FR 2WAY 5CC SUP-02-00124 CDM C1729 HCPCS 0272 RC outpatient 3.67 3.67 3.67 74 2.72 percent of total billed charges 3.67 93 2.97 percent of total billed charges 3.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.67 other OPPS APC 3.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.67 other OPPS APC 3.67 27.63 1.01 percent of total billed charges 3.67 3.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LATEX 22FR 2WAY 30CC SUP-02-00126 CDM C1729 HCPCS 0272 RC outpatient 3.81 3.81 3.81 74 2.82 percent of total billed charges 3.81 93 3.09 percent of total billed charges 3.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.81 other OPPS APC 3.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.81 other OPPS APC 3.81 27.63 1.05 percent of total billed charges 3.81 3.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LATEX 24FR 2WAY 30CC SUP-02-00127 CDM C1729 HCPCS 0272 RC outpatient 3.86 3.86 3.86 74 2.86 percent of total billed charges 3.86 93 3.13 percent of total billed charges 3.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.86 other OPPS APC 3.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.86 other OPPS APC 3.86 27.63 1.07 percent of total billed charges 3.86 3.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY 2WAY COUDE 18FR 30CC SUP-02-00128 CDM C1729 HCPCS 0272 RC outpatient 37.54 37.54 37.54 74 27.78 percent of total billed charges 37.54 93 30.41 percent of total billed charges 37.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 37.54 other OPPS APC 37.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 37.54 other OPPS APC 37.54 27.63 10.37 percent of total billed charges 37.54 37.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY 2WAY COUDE 18FR 5CC SUP-02-00129 CDM C1729 HCPCS 0272 RC outpatient 38.73 38.73 38.73 74 28.66 percent of total billed charges 38.73 93 31.37 percent of total billed charges 38.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.73 other OPPS APC 38.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.73 other OPPS APC 38.73 27.63 10.7 percent of total billed charges 38.73 38.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY 2WAY COUDE 20FR 5CC SUP-02-00130 CDM C1729 HCPCS 0272 RC outpatient 37.21 37.21 37.21 74 27.54 percent of total billed charges 37.21 93 30.14 percent of total billed charges 37.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 37.21 other OPPS APC 37.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 37.21 other OPPS APC 37.21 27.63 10.28 percent of total billed charges 37.21 37.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY 2WAY COUDE 22FR 5CC SUP-02-00131 CDM C1729 HCPCS 0272 RC outpatient 31.16 31.16 31.16 74 23.06 percent of total billed charges 31.16 93 25.24 percent of total billed charges 31.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 31.16 other OPPS APC 31.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 31.16 other OPPS APC 31.16 27.63 8.61 percent of total billed charges 31.16 31.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY 2WAY COUDE 24FR 5CC SUP-02-00132 CDM C1729 HCPCS 0272 RC outpatient 33.77 33.77 33.77 74 24.99 percent of total billed charges 33.77 93 27.35 percent of total billed charges 33.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 33.77 other OPPS APC 33.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 33.77 other OPPS APC 33.77 27.63 9.33 percent of total billed charges 33.77 33.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LATEX 18FR 3WAY 30CC SUP-02-00133 CDM C1729 HCPCS 0272 RC outpatient 34.83 34.83 34.83 74 25.77 percent of total billed charges 34.83 93 28.21 percent of total billed charges 34.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.83 other OPPS APC 34.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.83 other OPPS APC 34.83 27.63 9.62 percent of total billed charges 34.83 34.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER 6 EYE 20FR SUP-02-00135 CDM C1729 HCPCS 0272 RC outpatient 42.41 42.41 42.41 74 31.38 percent of total billed charges 42.41 93 34.35 percent of total billed charges 42.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42.41 other OPPS APC 42.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 42.41 other OPPS APC 42.41 27.63 11.72 percent of total billed charges 42.41 42.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER 6 EYE 24FR SUP-02-00137 CDM C1729 HCPCS 0272 RC outpatient 43.04 43.04 43.04 74 31.85 percent of total billed charges 43.04 93 34.86 percent of total billed charges 43.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 43.04 other OPPS APC 43.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 43.04 other OPPS APC 43.04 27.63 11.89 percent of total billed charges 43.04 43.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LATEX 26FR 2 WAY 5CC SUP-02-00138 CDM C1729 HCPCS 0272 RC outpatient 3.12 3.12 3.12 74 2.31 percent of total billed charges 3.12 93 2.53 percent of total billed charges 3.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.12 other OPPS APC 3.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.12 other OPPS APC 3.12 27.63 0.86 percent of total billed charges 3.12 3.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LATEX 28FR 2WAY 30CC SUP-02-00139 CDM C1729 HCPCS 0272 RC outpatient 3.62 3.62 3.62 74 2.68 percent of total billed charges 3.62 93 2.93 percent of total billed charges 3.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.62 other OPPS APC 3.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.62 other OPPS APC 3.62 27.63 1 percent of total billed charges 3.62 3.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER UMBILICAL 3.5 FR DOUBLE LUMEN SUP-02-00140 CDM 0272 RC outpatient 133.93 133.93 133.93 74 99.11 percent of total billed charges 133.93 93 108.48 percent of total billed charges 133.93 133.93 other OPPS APC 133.93 133.93 other OPPS APC 133.93 27.63 37 percent of total billed charges 133.93 133.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER UMBILICAL 5 FR DOUBLE LUMEN SUP-02-00141 CDM 0272 RC outpatient 125.42 125.42 125.42 74 92.81 percent of total billed charges 125.42 93 101.59 percent of total billed charges 125.42 125.42 other OPPS APC 125.42 125.42 other OPPS APC 125.42 27.63 34.65 percent of total billed charges 125.42 125.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LATEX 12FR 2WAY 5CC SUP-02-00142 CDM C1729 HCPCS 0272 RC outpatient 3.62 3.62 3.62 74 2.68 percent of total billed charges 3.62 93 2.93 percent of total billed charges 3.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.62 other OPPS APC 3.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.62 other OPPS APC 3.62 27.63 1 percent of total billed charges 3.62 3.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LATEX 26FR 2WAY 30CC SUP-02-00143 CDM C1729 HCPCS 0272 RC outpatient 3.88 3.88 3.88 74 2.87 percent of total billed charges 3.88 93 3.14 percent of total billed charges 3.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.88 other OPPS APC 3.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.88 other OPPS APC 3.88 27.63 1.07 percent of total billed charges 3.88 3.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LATEX 18FR 3WAY 5CC SUP-02-00144 CDM C1729 HCPCS 0272 RC outpatient 52.13 52.13 52.13 74 38.58 percent of total billed charges 52.13 93 42.23 percent of total billed charges 52.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52.13 other OPPS APC 52.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52.13 other OPPS APC 52.13 27.63 14.4 percent of total billed charges 52.13 52.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LATEX 20FR 3WAY 5CC SUP-02-00145 CDM C1729 HCPCS 0272 RC outpatient 52.13 52.13 52.13 74 38.58 percent of total billed charges 52.13 93 42.23 percent of total billed charges 52.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52.13 other OPPS APC 52.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52.13 other OPPS APC 52.13 27.63 14.4 percent of total billed charges 52.13 52.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LATEX 22FR 3WAY 5CC SUP-02-00146 CDM C1729 HCPCS 0272 RC outpatient 52.13 52.13 52.13 74 38.58 percent of total billed charges 52.13 93 42.23 percent of total billed charges 52.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52.13 other OPPS APC 52.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52.13 other OPPS APC 52.13 27.63 14.4 percent of total billed charges 52.13 52.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY LATEX 16FR 3WAY 5CC SUP-02-00147 CDM C1729 HCPCS 0272 RC outpatient 52.13 52.13 52.13 74 38.58 percent of total billed charges 52.13 93 42.23 percent of total billed charges 52.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52.13 other OPPS APC 52.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52.13 other OPPS APC 52.13 27.63 14.4 percent of total billed charges 52.13 52.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL LOGIC HI-FLEX 2.5 H15 MM KNEE POSTERIOR STABILIZE MODULAR NET COMPRESSION MOLD SUP-02-012-35-2515 CDM 270010025 LOCAL 0270 RC outpatient 3688.1 3688.1 3688.1 74 2729.19 percent of total billed charges 3688.1 93 2987.36 percent of total billed charges 3688.1 3688.1 other OPPS APC 3688.1 3688.1 other OPPS APC 3688.1 27.63 1019.02 percent of total billed charges 3688.1 3688.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER TIBIAL OPTETRAK LOGIC 4 H8 MM KNEE PROXIMAL SUP-02-012-42-4008 CDM 270010025 LOCAL 0270 RC outpatient 2457 2457 2457 74 1818.18 percent of total billed charges 2457 93 1990.17 percent of total billed charges 2457 2457 other OPPS APC 2457 2457 other OPPS APC 2457 27.63 678.87 percent of total billed charges 2457 2457 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL OPTETRAK LOGIC 2.5 H13 MM KNEE POSTERIOR STABILIZE CONSTRAIN MODULAR NET COMPRESSION MOLD SUP-02-012-44-2513 CDM 270010025 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL OPTETRAK LOGIC 3.5 H13 MM KNEE POSTERIOR STABILIZE CONSTRAIN MODULAR NET COMPRESSION MOLD SUP-02-012-44-3513 CDM 270010025 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT EXACTECH LOGIC PSC TIBIAL POSTERIOR STAB SIZE 4 11MM SUP-02-012-44-4011 CDM 270010025 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT TIBIAL TRAY OPTETRAK LOGIC 4F/3T KNEE FIT CEMENTED SUP-02-012-45-4030 CDM 270010025 LOCAL 0270 RC outpatient 10946 10946 10946 74 8100.04 percent of total billed charges 10946 93 8866.26 percent of total billed charges 10946 10946 other OPPS APC 10946 10946 other OPPS APC 10946 27.63 3024.38 percent of total billed charges 10946 10946 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T4 L8 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM SUP-02-130-208 CDM 270010022 LOCAL 0270 RC outpatient 333.84 333.84 333.84 74 247.04 percent of total billed charges 333.84 93 270.41 percent of total billed charges 333.84 333.84 other OPPS APC 333.84 333.84 other OPPS APC 333.84 27.63 92.24 percent of total billed charges 333.84 333.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILLBIT ZIMMER NCB SUP-02.00024.002 CDM 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CURVE L242 MM X W17.5 MM X H5.2 MM CONDYLAR LEFT PERIARTICULAR 10 HOLE LOW PROFILE PRECONTOUR LIMIT CONTACT NONSTERILE 4.5/5 MM SCREW SUP-02.001.300 CDM 270010022 LOCAL 0270 RC outpatient 4228.51 4228.51 4228.51 74 3129.1 percent of total billed charges 4228.51 93 3425.09 percent of total billed charges 4228.51 4228.51 other OPPS APC 4228.51 4228.51 other OPPS APC 4228.51 27.63 1168.34 percent of total billed charges 4228.51 4228.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI CURVE 278X17.5X5.2MM SS NS CONDYLAR LEFT PERIARTICULAR 12 HOLE LOW PROFILE PRECONTOUR LIMIT CONTACT SUP-02.001.302 CDM 270010022 LOCAL 0270 RC outpatient 4320.03 4320.03 4320.03 74 3196.82 percent of total billed charges 4320.03 93 3499.22 percent of total billed charges 4320.03 4320.03 other OPPS APC 4320.03 4320.03 other OPPS APC 4320.03 27.63 1193.62 percent of total billed charges 4320.03 4320.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI CURVE 314X17.5X5.2MM SS NS CONDYLAR LEFT PERIARTICULAR 14 HOLE LOW PROFILE PRECONTOUR LIMIT CONTACT SUP-02.001.304 CDM 270010022 LOCAL 0270 RC outpatient 4408.69 4408.69 4408.69 74 3262.43 percent of total billed charges 4408.69 93 3571.04 percent of total billed charges 4408.69 4408.69 other OPPS APC 4408.69 4408.69 other OPPS APC 4408.69 27.63 1218.12 percent of total billed charges 4408.69 4408.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI CURVE 350X17.5X5.2MM SS NS CONDYLAR LEFT PERIARTICULAR 16 HOLE LOW PROFILE PRECONTOUR LIMIT CONTACT SUP-02.001.306 CDM 270010022 LOCAL 0270 RC outpatient 4493.06 4493.06 4493.06 74 3324.86 percent of total billed charges 4493.06 93 3639.38 percent of total billed charges 4493.06 4493.06 other OPPS APC 4493.06 4493.06 other OPPS APC 4493.06 27.63 1241.43 percent of total billed charges 4493.06 4493.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL CURVE L422 MM X W17.5 MM X H5.2 MM CONDYLAR LEFT PERIARTICULAR 20 HOLE LOW PROFILE PRECONTOUR LIMIT CONTACT STERILE 4.5/5 MM SCREW SUP-02.001.310S CDM 270010022 LOCAL 0270 RC outpatient 4939.22 4939.22 4939.22 74 3655.02 percent of total billed charges 4939.22 93 4000.77 percent of total billed charges 4939.22 4939.22 other OPPS APC 4939.22 4939.22 other OPPS APC 4939.22 27.63 1364.71 percent of total billed charges 4939.22 4939.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL CURVE L458 MM X W17.5 MM X H5.2 MM CONDYLAR LEFT PERIARTICULAR 22 HOLE LOW PROFILE PRECONTOUR LIMIT CONTACT STERILE 4.5/5 MM SCREW SUP-02.001.312S CDM 270010022 LOCAL 0270 RC outpatient 4424.86 4424.86 4424.86 74 3274.4 percent of total billed charges 4424.86 93 3584.14 percent of total billed charges 4424.86 4424.86 other OPPS APC 4424.86 4424.86 other OPPS APC 4424.86 27.63 1222.59 percent of total billed charges 4424.86 4424.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI CURVE 242X17.5X5.2MM SS NS CONDYLAR RIGHT PERIARTICULAR 10 HOLE LOW PROFILE PRECONTOUR LIMIT SUP-02.001.320 CDM 270010022 LOCAL 0270 RC outpatient 3728.79 3728.79 3728.79 74 2759.3 percent of total billed charges 3728.79 93 3020.32 percent of total billed charges 3728.79 3728.79 other OPPS APC 3728.79 3728.79 other OPPS APC 3728.79 27.63 1030.26 percent of total billed charges 3728.79 3728.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI CURVE 278X17.5X5.2MM SS NS CONDYLAR RIGHT PERIARTICULAR 12 HOLE LOW PROFILE PRECONTOUR LIMIT SUP-02.001.322 CDM 270010022 LOCAL 0270 RC outpatient 4320.03 4320.03 4320.03 74 3196.82 percent of total billed charges 4320.03 93 3499.22 percent of total billed charges 4320.03 4320.03 other OPPS APC 4320.03 4320.03 other OPPS APC 4320.03 27.63 1193.62 percent of total billed charges 4320.03 4320.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI CURVE 314X17.5X5.2MM SS NS CONDYLAR RIGHT PERIARTICULAR 14 HOLE LOW PROFILE PRECONTOUR LIMIT SUP-02.001.324 CDM 270010022 LOCAL 0270 RC outpatient 4408.69 4408.69 4408.69 74 3262.43 percent of total billed charges 4408.69 93 3571.04 percent of total billed charges 4408.69 4408.69 other OPPS APC 4408.69 4408.69 other OPPS APC 4408.69 27.63 1218.12 percent of total billed charges 4408.69 4408.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI CURVE 350X17.5X5.2MM SS NS CONDYLAR RIGHT PERIARTICULAR 16 HOLE LOW PROFILE PRECONTOUR LIMIT SUP-02.001.326 CDM 270010022 LOCAL 0270 RC outpatient 4493.06 4493.06 4493.06 74 3324.86 percent of total billed charges 4493.06 93 3639.38 percent of total billed charges 4493.06 4493.06 other OPPS APC 4493.06 4493.06 other OPPS APC 4493.06 27.63 1241.43 percent of total billed charges 4493.06 4493.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL CURVE L422 MM X W17.5 MM X H5.2 MM CONDYLAR RIGHT PERIARTICULAR 20 HOLE LOW PROFILE PRECONTOUR LIMIT CONTACT STERILE 4.5/5 MM SCREW SUP-02.001.330S CDM 270010022 LOCAL 0270 RC outpatient 4939.22 4939.22 4939.22 74 3655.02 percent of total billed charges 4939.22 93 4000.77 percent of total billed charges 4939.22 4939.22 other OPPS APC 4939.22 4939.22 other OPPS APC 4939.22 27.63 1364.71 percent of total billed charges 4939.22 4939.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL CURVE L458 MM X W17.5 MM X H5.2 MM CONDYLAR RIGHT PERIARTICULAR 22 HOLE LOW PROFILE PRECONTOUR LIMIT CONTACT STERILE 4.5/5 MM SCREW SUP-02.001.332S CDM 270010022 LOCAL 0270 RC outpatient 5017.87 5017.87 5017.87 74 3713.22 percent of total billed charges 5017.87 93 4064.47 percent of total billed charges 5017.87 5017.87 other OPPS APC 5017.87 5017.87 other OPPS APC 5017.87 27.63 1386.44 percent of total billed charges 5017.87 5017.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NCB TI6AL4V 3.5 MM L28 MM OD5 MM ODSEC6.2 MM FEMUR CORTICAL 2 LEAD THREAD SELF TAP HEXAGONAL DRIVE SHALLOW PROFILE LARGE FRAGMENT SYSTEM PERIPROSTHETIC SUP-02.03150.028 CDM 0270 RC outpatient 439.92 439.92 439.92 74 325.54 percent of total billed charges 439.92 93 356.34 percent of total billed charges 439.92 439.92 other OPPS APC 439.92 439.92 other OPPS APC 439.92 27.63 121.55 percent of total billed charges 439.92 439.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NCB TI6AL4V 3.5 MM L30 MM OD5 MM ODSEC6.2 MM FEMUR CORTICAL 2 LEAD THREAD SELF TAP HEXAGONAL DRIVE SHALLOW PROFILE LARGE FRAGMENT SYSTEM PERIPROSTHETIC SUP-02.03150.030 CDM 0270 RC outpatient 439.92 439.92 439.92 74 325.54 percent of total billed charges 439.92 93 356.34 percent of total billed charges 439.92 439.92 other OPPS APC 439.92 439.92 other OPPS APC 439.92 27.63 121.55 percent of total billed charges 439.92 439.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NCB TI6AL4V 3.5 MM L32 MM OD5 MM ODSEC6.2 MM FEMUR CORTICAL 2 LEAD THREAD SELF TAP HEXAGONAL DRIVE SHALLOW PROFILE LARGE FRAGMENT SYSTEM PERIPROSTHETIC SUP-02.03150.032 CDM 0270 RC outpatient 439.92 439.92 439.92 74 325.54 percent of total billed charges 439.92 93 356.34 percent of total billed charges 439.92 439.92 other OPPS APC 439.92 439.92 other OPPS APC 439.92 27.63 121.55 percent of total billed charges 439.92 439.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NCB TI6AL4V 3.5 MM L34 MM OD5 MM ODSEC6.2 MM FEMUR CORTICAL 2 LEAD THREAD SELF TAP HEXAGONAL DRIVE SHALLOW PROFILE LARGE FRAGMENT SYSTEM PERIPROSTHETIC SUP-02.03150.034 CDM 0270 RC outpatient 439.92 439.92 439.92 74 325.54 percent of total billed charges 439.92 93 356.34 percent of total billed charges 439.92 439.92 other OPPS APC 439.92 439.92 other OPPS APC 439.92 27.63 121.55 percent of total billed charges 439.92 439.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NCB TI6AL4V 3.5 MM L38 MM OD5 MM ODSEC6.2 MM FEMUR CORTICAL 2 LEAD THREAD SELF TAP HEXAGONAL DRIVE SHALLOW PROFILE LARGE FRAGMENT SYSTEM PERIPROSTHETIC SUP-02.03150.038 CDM 0270 RC outpatient 439.92 439.92 439.92 74 325.54 percent of total billed charges 439.92 93 356.34 percent of total billed charges 439.92 439.92 other OPPS APC 439.92 439.92 other OPPS APC 439.92 27.63 121.55 percent of total billed charges 439.92 439.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NCB PROTASUL-64 L40 MM OD5 MM ODSEC4.4 MM FEMUR SELF TAP HEXAGONAL DRIVE NONSTERILE LARGE FRAGMENT SYSTEM SUP-02.03150.040 CDM 0270 RC outpatient 439.92 439.92 439.92 74 325.54 percent of total billed charges 439.92 93 356.34 percent of total billed charges 439.92 439.92 other OPPS APC 439.92 439.92 other OPPS APC 439.92 27.63 121.55 percent of total billed charges 439.92 439.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NCB TI6AL4V L44 MM OD5 MM ODSEC3.5 MM SELF TAP HEXAGON HEAD NONSTERILE LARGE FRAGMENT SYSTEM SUP-02.03150.044 CDM 0270 RC outpatient 439.92 439.92 439.92 74 325.54 percent of total billed charges 439.92 93 356.34 percent of total billed charges 439.92 439.92 other OPPS APC 439.92 439.92 other OPPS APC 439.92 27.63 121.55 percent of total billed charges 439.92 439.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NCB PROTASUL-64 L55 MM OD5 MM ODSEC3.5 MM FEMUR SELF TAP HEXAGON HEAD NONSTERILE LARGE FRAGMENT SYSTEM SUP-02.03150.055 CDM 0270 RC outpatient 444.7 444.7 444.7 74 329.08 percent of total billed charges 444.7 93 360.21 percent of total billed charges 444.7 444.7 other OPPS APC 444.7 444.7 other OPPS APC 444.7 27.63 122.87 percent of total billed charges 444.7 444.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NCB PROTASUL-64 L60 MM OD5 MM ODSEC3.5 MM FEMUR SELF TAP HEXAGON HEAD NONSTERILE LARGE FRAGMENT SYSTEM SUP-02.03150.060 CDM 0270 RC outpatient 439.92 439.92 439.92 74 325.54 percent of total billed charges 439.92 93 356.34 percent of total billed charges 439.92 439.92 other OPPS APC 439.92 439.92 other OPPS APC 439.92 27.63 121.55 percent of total billed charges 439.92 439.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NCB TI-6AL-4V L65 MM OD5 MM ODSEC3.5 MM FEMUR DISTAL SELF TAP HEXAGONAL DRIVE SUP-02.03150.065 CDM 0270 RC outpatient 444.7 444.7 444.7 74 329.08 percent of total billed charges 444.7 93 360.21 percent of total billed charges 444.7 444.7 other OPPS APC 444.7 444.7 other OPPS APC 444.7 27.63 122.87 percent of total billed charges 444.7 444.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NCB TI6AL4V L70 MM OD5 MM ODSEC3.5 MM SELF TAP HEXAGON HEAD NONSTERILE LARGE FRAGMENT SYSTEM SUP-02.03150.070 CDM 0270 RC outpatient 444.7 444.7 444.7 74 329.08 percent of total billed charges 444.7 93 360.21 percent of total billed charges 444.7 444.7 other OPPS APC 444.7 444.7 other OPPS APC 444.7 27.63 122.87 percent of total billed charges 444.7 444.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NCB PROTASUL-64 L75 MM OD5 MM ODSEC3.5 MM FEMUR SELF TAP HEXAGON HEAD NONSTERILE LARGE FRAGMENT SYSTEM SUP-02.03150.075 CDM 0270 RC outpatient 439.92 439.92 439.92 74 325.54 percent of total billed charges 439.92 93 356.34 percent of total billed charges 439.92 439.92 other OPPS APC 439.92 439.92 other OPPS APC 439.92 27.63 121.55 percent of total billed charges 439.92 439.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NCB PROTASUL-64 L80 MM OD5 MM ODSEC3.5 MM FEMUR SELF TAP HEXAGON HEAD NONSTERILE LARGE FRAGMENT SYSTEM SUP-02.03150.080 CDM 0270 RC outpatient 444.7 444.7 444.7 74 329.08 percent of total billed charges 444.7 93 360.21 percent of total billed charges 444.7 444.7 other OPPS APC 444.7 444.7 other OPPS APC 444.7 27.63 122.87 percent of total billed charges 444.7 444.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NCB PROTASUL-64 L85 MM OD5 MM ODSEC3.5 MM FEMUR SELF TAP HEXAGON HEAD NONSTERILE LARGE FRAGMENT SYSTEM SUP-02.03150.085 CDM 0270 RC outpatient 439.92 439.92 439.92 74 325.54 percent of total billed charges 439.92 93 356.34 percent of total billed charges 439.92 439.92 other OPPS APC 439.92 439.92 other OPPS APC 439.92 27.63 121.55 percent of total billed charges 439.92 439.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP END NCB 8MM 3.5MM TI6AL4V LOCK SUP-02.03150.300 CDM 0270 RC outpatient 402.48 402.48 402.48 74 297.84 percent of total billed charges 402.48 93 326.01 percent of total billed charges 402.48 402.48 other OPPS APC 402.48 402.48 other OPPS APC 402.48 27.63 111.21 percent of total billed charges 402.48 402.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NCB TI6AL4V L12 MM OD5 MM ODSEC6.2 MM 2 LEAD THREAD SHALLOW PROFILE UNICORTICAL LARGE FRAGMENT SYSTEM PERIPROSTHETIC SUP-02.03151.012 CDM 0270 RC outpatient 402.48 402.48 402.48 74 297.84 percent of total billed charges 402.48 93 326.01 percent of total billed charges 402.48 402.48 other OPPS APC 402.48 402.48 other OPPS APC 402.48 27.63 111.21 percent of total billed charges 402.48 402.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NCB TI6AL4V L14 MM OD5 MM ODSEC6.2 MM 2 LEAD THREAD SHALLOW PROFILE UNICORTICAL LARGE FRAGMENT SYSTEM PERIPROSTHETIC SUP-02.03151.014 CDM 0270 RC outpatient 402.48 402.48 402.48 74 297.84 percent of total billed charges 402.48 93 326.01 percent of total billed charges 402.48 402.48 other OPPS APC 402.48 402.48 other OPPS APC 402.48 27.63 111.21 percent of total billed charges 402.48 402.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NCB PROTASUL-64 L20 MM OD5 MM FEMUR UNICORTICAL LARGE FRAGMENT SYSTEM SUP-02.03151.020 CDM 0270 RC outpatient 402.48 402.48 402.48 74 297.84 percent of total billed charges 402.48 93 326.01 percent of total billed charges 402.48 402.48 other OPPS APC 402.48 402.48 other OPPS APC 402.48 27.63 111.21 percent of total billed charges 402.48 402.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE ZIMMER NCB PP PROXIMAL FEMORAL SUP-02.03263.018 CDM 0270 RC outpatient 4118.4 4118.4 4118.4 74 3047.62 percent of total billed charges 4118.4 93 3335.9 percent of total billed charges 4118.4 4118.4 other OPPS APC 4118.4 4118.4 other OPPS APC 4118.4 27.63 1137.91 percent of total billed charges 4118.4 4118.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE NCB TI6AL4V L355 MM FEMUR LEFT DISTAL 18 HOLE SCALLOP MIS INTERFACE NONSTERILE PERIPROSTHETIC SUP-02.03264.118 CDM 0270 RC outpatient 4392.21 4392.21 4392.21 74 3250.24 percent of total billed charges 4392.21 93 3557.69 percent of total billed charges 4392.21 4392.21 other OPPS APC 4392.21 4392.21 other OPPS APC 4392.21 27.63 1213.57 percent of total billed charges 4392.21 4392.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE FEMORAL GMK 3 H8 MM KNEE REVISION SUP-02.05.03DW CDM 270010025 LOCAL 0270 RC outpatient 3191.5 3191.5 3191.5 74 2361.71 percent of total billed charges 3191.5 93 2585.12 percent of total billed charges 3191.5 3191.5 other OPPS APC 3191.5 3191.5 other OPPS APC 3191.5 27.63 881.81 percent of total billed charges 3191.5 3191.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE FEMORAL GMK 3 H5 MM KNEE POSTERIOR REVISION SUP-02.05.03PW CDM 270010025 LOCAL 0270 RC outpatient 3191.5 3191.5 3191.5 74 2361.71 percent of total billed charges 3191.5 93 2585.12 percent of total billed charges 3191.5 3191.5 other OPPS APC 3191.5 3191.5 other OPPS APC 3191.5 27.63 881.81 percent of total billed charges 3191.5 3191.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE FEMORAL GMK 4 H5 MM KNEE POSTERIOR REVISION HINGE SUP-02.05.04PW CDM 270010025 LOCAL 0270 RC outpatient 2922.4 2922.4 2922.4 74 2162.58 percent of total billed charges 2922.4 93 2367.14 percent of total billed charges 2922.4 2922.4 other OPPS APC 2922.4 2922.4 other OPPS APC 2922.4 27.63 807.46 percent of total billed charges 2922.4 2922.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE FEMORAL GMK 5 H5 MM KNEE POSTERIOR REVISION SUP-02.05.05PW CDM 270010025 LOCAL 0270 RC outpatient 3191.5 3191.5 3191.5 74 2361.71 percent of total billed charges 3191.5 93 2585.12 percent of total billed charges 3191.5 3191.5 other OPPS APC 3191.5 3191.5 other OPPS APC 3191.5 27.63 881.81 percent of total billed charges 3191.5 3191.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER FEMORAL GMK 3 MM OFFSET KNEE REVISION CONNECTOR SUP-02.07.0003 CDM 270010025 LOCAL 0270 RC outpatient 5907.2 5907.2 5907.2 74 4371.33 percent of total billed charges 5907.2 93 4784.83 percent of total billed charges 5907.2 5907.2 other OPPS APC 5907.2 5907.2 other OPPS APC 5907.2 27.63 1632.16 percent of total billed charges 5907.2 5907.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER FEMORAL GMK 5 MM OFFSET KNEE REVISION CONNECTOR SUP-02.07.0005 CDM 270010024 LOCAL 0270 RC outpatient 6449.3 6449.3 6449.3 74 4772.48 percent of total billed charges 6449.3 93 5223.93 percent of total billed charges 6449.3 6449.3 other OPPS APC 6449.3 6449.3 other OPPS APC 6449.3 27.63 1781.94 percent of total billed charges 6449.3 6449.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT PATELLAR GMK 2 RESURFACING SUP-02.07.0034RP CDM 270010025 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL GMK 1 H17 MM SEMICONSTRAINED FIXED NONSTERILE SUP-02.07.0117SCF CDM 270010025 LOCAL 0270 RC outpatient 5681 5681 5681 74 4203.94 percent of total billed charges 5681 93 4601.61 percent of total billed charges 5681 5681 other OPPS APC 5681 5681 other OPPS APC 5681 27.63 1569.66 percent of total billed charges 5681 5681 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL GMK 2 H14 MM KNEE FIXED REVISION SEMICONSTRAINED NONSTERILE SUP-02.07.0214SCF CDM 270010025 LOCAL 0270 RC outpatient 5681 5681 5681 74 4203.94 percent of total billed charges 5681 93 4601.61 percent of total billed charges 5681 5681 other OPPS APC 5681 5681 other OPPS APC 5681 27.63 1569.66 percent of total billed charges 5681 5681 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL GMK 3 H14 MM KNEE FIXED REVISION SEMICONSTRAINED NONSTERILE SUP-02.07.0314SCF CDM 270010025 LOCAL 0270 RC outpatient 5681 5681 5681 74 4203.94 percent of total billed charges 5681 93 4601.61 percent of total billed charges 5681 5681 other OPPS APC 5681 5681 other OPPS APC 5681 27.63 1569.66 percent of total billed charges 5681 5681 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL GMK 3 H20 MM KNEE FIXED REVISION SEMICONSTRAINED NONSTERILE SUP-02.07.0320SCF CDM 270010025 LOCAL 0270 RC outpatient 5681 5681 5681 74 4203.94 percent of total billed charges 5681 93 4601.61 percent of total billed charges 5681 5681 other OPPS APC 5681 5681 other OPPS APC 5681 27.63 1569.66 percent of total billed charges 5681 5681 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL GMK 4 H14 MM KNEE FIXED REVISION SEMICONSTRAINED NONSTERILE SUP-02.07.0414SCF CDM 270010025 LOCAL 0270 RC outpatient 5681 5681 5681 74 4203.94 percent of total billed charges 5681 93 4601.61 percent of total billed charges 5681 5681 other OPPS APC 5681 5681 other OPPS APC 5681 27.63 1569.66 percent of total billed charges 5681 5681 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL GMK 4 H23 MM KNEE FIXED REVISION SEMICONSTRAINED NONSTERILE SUP-02.07.0423SCF CDM 270010025 LOCAL 0270 RC outpatient 5681 5681 5681 74 4203.94 percent of total billed charges 5681 93 4601.61 percent of total billed charges 5681 5681 other OPPS APC 5681 5681 other OPPS APC 5681 27.63 1569.66 percent of total billed charges 5681 5681 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL GMK REVISION 5 H14 MM KNEE FIXED REVISION SEMICONSTRAINED NONSTERILE SUP-02.07.0514SCF CDM 270010024 LOCAL 0270 RC outpatient 5681 5681 5681 74 4203.94 percent of total billed charges 5681 93 4601.61 percent of total billed charges 5681 5681 other OPPS APC 5681 5681 other OPPS APC 5681 27.63 1569.66 percent of total billed charges 5681 5681 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL GMK 5 H20 MM KNEE FIXED REVISION SEMICONSTRAINED NONSTERILE SUP-02.07.0520SCF CDM 270010025 LOCAL 0270 RC outpatient 5681 5681 5681 74 4203.94 percent of total billed charges 5681 93 4601.61 percent of total billed charges 5681 5681 other OPPS APC 5681 5681 other OPPS APC 5681 27.63 1569.66 percent of total billed charges 5681 5681 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL GMK COCR 1 LEFT REVISION CEMENTED FIXED BEARING NONSTERILE SUP-02.07.0681L CDM 270010025 LOCAL 0270 RC outpatient 8102.9 8102.9 8102.9 74 5996.15 percent of total billed charges 8102.9 93 6563.35 percent of total billed charges 8102.9 8102.9 other OPPS APC 8102.9 8102.9 other OPPS APC 8102.9 27.63 2238.83 percent of total billed charges 8102.9 8102.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL REVISION RIGHT S2 SUP-02.07.0682FR CDM 270010025 LOCAL 0270 RC outpatient 8102.9 8102.9 8102.9 74 5996.15 percent of total billed charges 8102.9 93 6563.35 percent of total billed charges 8102.9 8102.9 other OPPS APC 8102.9 8102.9 other OPPS APC 8102.9 27.63 2238.83 percent of total billed charges 8102.9 8102.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT TIBIAL TRAY GMK COCR 3 LEFT REVISION CEMENTED FIXED BEARING NONSTERILE SUP-02.07.0683L CDM 270010025 LOCAL 0270 RC outpatient 8102.9 8102.9 8102.9 74 5996.15 percent of total billed charges 8102.9 93 6563.35 percent of total billed charges 8102.9 8102.9 other OPPS APC 8102.9 8102.9 other OPPS APC 8102.9 27.63 2238.83 percent of total billed charges 8102.9 8102.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT TIBIAL TRAY GMK COCR 3 RIGHT REVISION CEMENTED FIXED BEARING NONSTERILE SUP-02.07.0683R CDM 270010025 LOCAL 0270 RC outpatient 8102.9 8102.9 8102.9 74 5996.15 percent of total billed charges 8102.9 93 6563.35 percent of total billed charges 8102.9 8102.9 other OPPS APC 8102.9 8102.9 other OPPS APC 8102.9 27.63 2238.83 percent of total billed charges 8102.9 8102.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL GMK COCR 4 LEFT REVISION CEMENTED FIXED BEARING NONSTERILE SUP-02.07.0684L CDM 270010025 LOCAL 0270 RC outpatient 8102.9 8102.9 8102.9 74 5996.15 percent of total billed charges 8102.9 93 6563.35 percent of total billed charges 8102.9 8102.9 other OPPS APC 8102.9 8102.9 other OPPS APC 8102.9 27.63 2238.83 percent of total billed charges 8102.9 8102.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL GMK COCR 4 RIGHT REVISION CEMENTED FIXED BEARING NONSTERILE SUP-02.07.0684R CDM 270010025 LOCAL 0270 RC outpatient 8102.9 8102.9 8102.9 74 5996.15 percent of total billed charges 8102.9 93 6563.35 percent of total billed charges 8102.9 8102.9 other OPPS APC 8102.9 8102.9 other OPPS APC 8102.9 27.63 2238.83 percent of total billed charges 8102.9 8102.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL GMK COCR 5 LEFT REVISION CEMENTED FIXED BEARING NONSTERILE SUP-02.07.0685L CDM 270010024 LOCAL 0270 RC outpatient 8102.9 8102.9 8102.9 74 5996.15 percent of total billed charges 8102.9 93 6563.35 percent of total billed charges 8102.9 8102.9 other OPPS APC 8102.9 8102.9 other OPPS APC 8102.9 27.63 2238.83 percent of total billed charges 8102.9 8102.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT TIBIAL TRAY GMK COCR 5 RIGHT REVISION CEMENTED FIXED BEARING NONSTERILE SUP-02.07.0685R CDM 270010025 LOCAL 0270 RC outpatient 8102.9 8102.9 8102.9 74 5996.15 percent of total billed charges 8102.9 93 6563.35 percent of total billed charges 8102.9 8102.9 other OPPS APC 8102.9 8102.9 other OPPS APC 8102.9 27.63 2238.83 percent of total billed charges 8102.9 8102.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE FEMORAL GMK 2 H4 MM KNEE HINGE SUP-02.07.204FDW CDM 270010025 LOCAL 0270 RC outpatient 3191.5 3191.5 3191.5 74 2361.71 percent of total billed charges 3191.5 93 2585.12 percent of total billed charges 3191.5 3191.5 other OPPS APC 3191.5 3191.5 other OPPS APC 3191.5 27.63 881.81 percent of total billed charges 3191.5 3191.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL GMK COCR 2 KNEE RIGHT CEMENTED POSTERIOR STABILIZE REVISION SUP-02.07.2402L CDM 270010025 LOCAL 0270 RC outpatient 16450.2 16450.2 16450.2 74 12173.2 percent of total billed charges 16450.2 93 13324.7 percent of total billed charges 16450.2 16450.2 other OPPS APC 16450.2 16450.2 other OPPS APC 16450.2 27.63 4545.19 percent of total billed charges 16450.2 16450.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL GMK COCR 2 KNEE RIGHT CEMENTED POSTERIOR STABILIZE REVISION SUP-02.07.2402R CDM 270010025 LOCAL 0270 RC outpatient 16450.2 16450.2 16450.2 74 12173.2 percent of total billed charges 16450.2 93 13324.7 percent of total billed charges 16450.2 16450.2 other OPPS APC 16450.2 16450.2 other OPPS APC 16450.2 27.63 4545.19 percent of total billed charges 16450.2 16450.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL GMK COCR 3 KNEE RIGHT CEMENTED POSTERIOR STABILIZE REVISION SUP-02.07.2403R CDM 270010025 LOCAL 0270 RC outpatient 16450.2 16450.2 16450.2 74 12173.2 percent of total billed charges 16450.2 93 13324.7 percent of total billed charges 16450.2 16450.2 other OPPS APC 16450.2 16450.2 other OPPS APC 16450.2 27.63 4545.19 percent of total billed charges 16450.2 16450.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL GMK COCR 4 KNEE LEFT CEMENTED POSTERIOR STABILIZE REVISION SUP-02.07.2404L CDM 270010025 LOCAL 0270 RC outpatient 16450.2 16450.2 16450.2 74 12173.2 percent of total billed charges 16450.2 93 13324.7 percent of total billed charges 16450.2 16450.2 other OPPS APC 16450.2 16450.2 other OPPS APC 16450.2 27.63 4545.19 percent of total billed charges 16450.2 16450.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL GMK COCR 5 KNEE LEFT CEMENTED POSTERIOR STABILIZE REVISION SUP-02.07.2405L CDM 270010024 LOCAL 0270 RC outpatient 16450.2 16450.2 16450.2 74 12173.2 percent of total billed charges 16450.2 93 13324.7 percent of total billed charges 16450.2 16450.2 other OPPS APC 16450.2 16450.2 other OPPS APC 16450.2 27.63 4545.19 percent of total billed charges 16450.2 16450.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL GMK COCR 5 KNEE LEFT CEMENTED POSTERIOR STABILIZE REVISION SUP-02.07.2405R CDM 270010025 LOCAL 0270 RC outpatient 16450.2 16450.2 16450.2 74 12173.2 percent of total billed charges 16450.2 93 13324.7 percent of total billed charges 16450.2 16450.2 other OPPS APC 16450.2 16450.2 other OPPS APC 16450.2 27.63 4545.19 percent of total billed charges 16450.2 16450.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE FEMORAL GMK 3 H4 MM KNEE REVISION SUP-02.07.304FDW CDM 270010025 LOCAL 0270 RC outpatient 3191.5 3191.5 3191.5 74 2361.71 percent of total billed charges 3191.5 93 2585.12 percent of total billed charges 3191.5 3191.5 other OPPS APC 3191.5 3191.5 other OPPS APC 3191.5 27.63 881.81 percent of total billed charges 3191.5 3191.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE FEMORAL GMK 3 H10 MM KNEE POSTERIOR REVISION SUP-02.07.310FPW CDM 270010025 LOCAL 0270 RC outpatient 3191.5 3191.5 3191.5 74 2361.71 percent of total billed charges 3191.5 93 2585.12 percent of total billed charges 3191.5 3191.5 other OPPS APC 3191.5 3191.5 other OPPS APC 3191.5 27.63 881.81 percent of total billed charges 3191.5 3191.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE AUGMENTATION GMK 3/12 MM FEMUR DISTAL STERILE REVISION HINGE TOTAL KNEE SYSTEM SUP-02.07.312FDA CDM 270010025 LOCAL 0270 RC outpatient 3191.5 3191.5 3191.5 74 2361.71 percent of total billed charges 3191.5 93 2585.12 percent of total billed charges 3191.5 3191.5 other OPPS APC 3191.5 3191.5 other OPPS APC 3191.5 27.63 881.81 percent of total billed charges 3191.5 3191.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE FEMORAL GMK 4 H4 MM KNEE DISTAL REVISION HINGE SUP-02.07.404FDW CDM 270010025 LOCAL 0270 RC outpatient 2922.4 2922.4 2922.4 74 2162.58 percent of total billed charges 2922.4 93 2367.14 percent of total billed charges 2922.4 2922.4 other OPPS APC 2922.4 2922.4 other OPPS APC 2922.4 27.63 807.46 percent of total billed charges 2922.4 2922.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE FEMORAL GMK 5 H4 MM KNEE REVISION SUP-02.07.504FDW CDM 270010025 LOCAL 0270 RC outpatient 3191.5 3191.5 3191.5 74 2361.71 percent of total billed charges 3191.5 93 2585.12 percent of total billed charges 3191.5 3191.5 other OPPS APC 3191.5 3191.5 other OPPS APC 3191.5 27.63 881.81 percent of total billed charges 3191.5 3191.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION L30 MM OD11 MM KNEE SUP-02.07.F11030 CDM 270010025 LOCAL 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION L65 MM OD11 MM SUP-02.07.F11066 CDM 270010025 LOCAL 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION GMK L105 MM OD10 MM FLUTED REVISION SUP-02.07.FCL10105 CDM 270010024 LOCAL 0270 RC outpatient 4726.8 4726.8 4726.8 74 3497.83 percent of total billed charges 4726.8 93 3828.71 percent of total billed charges 4726.8 4726.8 other OPPS APC 4726.8 4726.8 other OPPS APC 4726.8 27.63 1306.01 percent of total billed charges 4726.8 4726.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION GMK L105 MM OD11 MM FLUTED REVISION SUP-02.07.FCL11105 CDM 270010025 LOCAL 0270 RC outpatient 4342 4342 4342 74 3213.08 percent of total billed charges 4342 93 3517.02 percent of total billed charges 4342 4342 other OPPS APC 4342 4342 other OPPS APC 4342 27.63 1199.69 percent of total billed charges 4342 4342 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION GMK FLUTE L65 MM OD12 MM KNEE CEMENTLESS SUP-02.07.FCL12065 CDM 270010025 LOCAL 0270 RC outpatient 4726.8 4726.8 4726.8 74 3497.83 percent of total billed charges 4726.8 93 3828.71 percent of total billed charges 4726.8 4726.8 other OPPS APC 4726.8 4726.8 other OPPS APC 4726.8 27.63 1306.01 percent of total billed charges 4726.8 4726.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION GMK L150 MM OD13 MM FLUTED REVISION SUP-02.07.FCL13150 CDM 270010025 LOCAL 0270 RC outpatient 4726.8 4726.8 4726.8 74 3497.83 percent of total billed charges 4726.8 93 3828.71 percent of total billed charges 4726.8 4726.8 other OPPS APC 4726.8 4726.8 other OPPS APC 4726.8 27.63 1306.01 percent of total billed charges 4726.8 4726.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION GMK FLUTE L105 MM OD14 MM KNEE CEMENTLESS SUP-02.07.FCL14105 CDM 270010025 LOCAL 0270 RC outpatient 4342 4342 4342 74 3213.08 percent of total billed charges 4342 93 3517.02 percent of total billed charges 4342 4342 other OPPS APC 4342 4342 other OPPS APC 4342 27.63 1199.69 percent of total billed charges 4342 4342 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION GMK L105 MM OD15 MM FLUTED REVISION SUP-02.07.FCL15105 CDM 270010025 LOCAL 0270 RC outpatient 4726.8 4726.8 4726.8 74 3497.83 percent of total billed charges 4726.8 93 3828.71 percent of total billed charges 4726.8 4726.8 other OPPS APC 4726.8 4726.8 other OPPS APC 4726.8 27.63 1306.01 percent of total billed charges 4726.8 4726.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION GMK L65 MM OD16 MM FLUTED REVISION SUP-02.07.FCL16065 CDM 270010025 LOCAL 0270 RC outpatient 4726.8 4726.8 4726.8 74 3497.83 percent of total billed charges 4726.8 93 3828.71 percent of total billed charges 4726.8 4726.8 other OPPS APC 4726.8 4726.8 other OPPS APC 4726.8 27.63 1306.01 percent of total billed charges 4726.8 4726.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION GMK L105 MM OD16 MM FLUTED REVISION SUP-02.07.FCL16105 CDM 270010025 LOCAL 0270 RC outpatient 4726.8 4726.8 4726.8 74 3497.83 percent of total billed charges 4726.8 93 3828.71 percent of total billed charges 4726.8 4726.8 other OPPS APC 4726.8 4726.8 other OPPS APC 4726.8 27.63 1306.01 percent of total billed charges 4726.8 4726.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION GMK FLUTE L150 MM OD16 MM KNEE CEMENTLESS SUP-02.07.FCL16150 CDM 270010025 LOCAL 0270 RC outpatient 4342 4342 4342 74 3213.08 percent of total billed charges 4342 93 3517.02 percent of total billed charges 4342 4342 other OPPS APC 4342 4342 other OPPS APC 4342 27.63 1199.69 percent of total billed charges 4342 4342 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION GMK L105 MM OD18 MM FLUTED REVISION SUP-02.07.FCL18105 CDM 270010025 LOCAL 0270 RC outpatient 4726.8 4726.8 4726.8 74 3497.83 percent of total billed charges 4726.8 93 3828.71 percent of total billed charges 4726.8 4726.8 other OPPS APC 4726.8 4726.8 other OPPS APC 4726.8 27.63 1306.01 percent of total billed charges 4726.8 4726.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION GMK L150 MM OD18 MM FLUTED REVISION SUP-02.07.FCL18150 CDM 270010025 LOCAL 0270 RC outpatient 4726.8 4726.8 4726.8 74 3497.83 percent of total billed charges 4726.8 93 3828.71 percent of total billed charges 4726.8 4726.8 other OPPS APC 4726.8 4726.8 other OPPS APC 4726.8 27.63 1306.01 percent of total billed charges 4726.8 4726.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION GMK L105 MM OD20 MM FLUTED REVISION SUP-02.07.FCL20105 CDM 270010025 LOCAL 0270 RC outpatient 4726.8 4726.8 4726.8 74 3497.83 percent of total billed charges 4726.8 93 3828.71 percent of total billed charges 4726.8 4726.8 other OPPS APC 4726.8 4726.8 other OPPS APC 4726.8 27.63 1306.01 percent of total billed charges 4726.8 4726.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION GMK FLUTE L150 MM OD20 MM KNEE CEMENTLESS SUP-02.07.FCL20150 CDM 270010025 LOCAL 0270 RC outpatient 4726.8 4726.8 4726.8 74 3497.83 percent of total billed charges 4726.8 93 3828.71 percent of total billed charges 4726.8 4726.8 other OPPS APC 4726.8 4726.8 other OPPS APC 4726.8 27.63 1306.01 percent of total billed charges 4726.8 4726.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT FEMORAL 3DMETAL XL CONE KNEE DIAPHYSIS STERILE LATEX FREE SUP-02.07.FCXL30 CDM 270010025 LOCAL 0270 RC outpatient 9412 9412 9412 74 6964.88 percent of total billed charges 9412 93 7623.72 percent of total billed charges 9412 9412 other OPPS APC 9412 9412 other OPPS APC 9412 27.63 2600.54 percent of total billed charges 9412 9412 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION GMK L65 MM OD11 MM KNEE CEMENT SUP-02.07.FSC11065` CDM 270010025 LOCAL 0270 RC outpatient 4108 4108 4108 74 3039.92 percent of total billed charges 4108 93 3327.48 percent of total billed charges 4108 4108 other OPPS APC 4108 4108 other OPPS APC 4108 27.63 1135.04 percent of total billed charges 4108 4108 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT TIBIAL SCREWED S2 5MM SUP-02.07.TA205 CDM 270010025 LOCAL 0270 RC outpatient 3714.1 3714.1 3714.1 74 2748.43 percent of total billed charges 3714.1 93 3008.42 percent of total billed charges 3714.1 3714.1 other OPPS APC 3714.1 3714.1 other OPPS APC 3714.1 27.63 1026.21 percent of total billed charges 3714.1 3714.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL GMK HINGE 4 H12 MM FIX BEARING STERILE SUP-02.09.0412H CDM 270010025 LOCAL 0270 RC outpatient 6162 6162 6162 74 4559.88 percent of total billed charges 6162 93 4991.22 percent of total billed charges 6162 6162 other OPPS APC 6162 6162 other OPPS APC 6162 27.63 1702.56 percent of total billed charges 6162 6162 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL GMK HINGE 4 H14 MM FIX BEARING STERILE SUP-02.09.0414H CDM 270010025 LOCAL 0270 RC outpatient 6162 6162 6162 74 4559.88 percent of total billed charges 6162 93 4991.22 percent of total billed charges 6162 6162 other OPPS APC 6162 6162 other OPPS APC 6162 27.63 1702.56 percent of total billed charges 6162 6162 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL GMK HINGE 4 H17 MM FIX BEARING STERILE SUP-02.09.0417H CDM 270010025 LOCAL 0270 RC outpatient 6718.4 6718.4 6718.4 74 4971.62 percent of total billed charges 6718.4 93 5441.9 percent of total billed charges 6718.4 6718.4 other OPPS APC 6718.4 6718.4 other OPPS APC 6718.4 27.63 1856.29 percent of total billed charges 6718.4 6718.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL GMK HINGE 4 H20 MM FIX BEARING STERILE SUP-02.09.0420H CDM 270010025 LOCAL 0270 RC outpatient 6162 6162 6162 74 4559.88 percent of total billed charges 6162 93 4991.22 percent of total billed charges 6162 6162 other OPPS APC 6162 6162 other OPPS APC 6162 27.63 1702.56 percent of total billed charges 6162 6162 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL GMK HINGE 5 H17 MM FIX BEARING STERILE SUP-02.09.0517H CDM 270010025 LOCAL 0270 RC outpatient 6718.4 6718.4 6718.4 74 4971.62 percent of total billed charges 6718.4 93 5441.9 percent of total billed charges 6718.4 6718.4 other OPPS APC 6718.4 6718.4 other OPPS APC 6718.4 27.63 1856.29 percent of total billed charges 6718.4 6718.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL GMK COCR 3 KNEE LEFT CEMENT HINGE NONSTERILE SUP-02.09.2603L CDM 270010025 LOCAL 0270 RC outpatient 20966.4 20966.4 20966.4 74 15515.1 percent of total billed charges 20966.4 93 16982.8 percent of total billed charges 20966.4 20966.4 other OPPS APC 20966.4 20966.4 other OPPS APC 20966.4 27.63 5793.02 percent of total billed charges 20966.4 20966.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL GMK COCR 4 KNEE LEFT CEMENT HINGE NONSTERILE SUP-02.09.2604L CDM 270010025 LOCAL 0270 RC outpatient 19203.6 19203.6 19203.6 74 14210.7 percent of total billed charges 19203.6 93 15554.9 percent of total billed charges 19203.6 19203.6 other OPPS APC 19203.6 19203.6 other OPPS APC 19203.6 27.63 5305.95 percent of total billed charges 19203.6 19203.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL GMK COCR 4 KNEE RIGHT CEMENT HINGE NONSTERILE SUP-02.09.2604R CDM 270010025 LOCAL 0270 RC outpatient 19203.6 19203.6 19203.6 74 14210.7 percent of total billed charges 19203.6 93 15554.9 percent of total billed charges 19203.6 19203.6 other OPPS APC 19203.6 19203.6 other OPPS APC 19203.6 27.63 5305.95 percent of total billed charges 19203.6 19203.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL GMK COCR 5 KNEE LEFT CEMENT HINGE NONSTERILE SUP-02.09.2605L CDM 270010025 LOCAL 0270 RC outpatient 20966.4 20966.4 20966.4 74 15515.1 percent of total billed charges 20966.4 93 16982.8 percent of total billed charges 20966.4 20966.4 other OPPS APC 20966.4 20966.4 other OPPS APC 20966.4 27.63 5793.02 percent of total billed charges 20966.4 20966.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL GMK COCR 5 KNEE RIGHT CEMENT HINGE NONSTERILE SUP-02.09.2605R CDM 270010025 LOCAL 0270 RC outpatient 19203.6 19203.6 19203.6 74 14210.7 percent of total billed charges 19203.6 93 15554.9 percent of total billed charges 19203.6 19203.6 other OPPS APC 19203.6 19203.6 other OPPS APC 19203.6 27.63 5305.95 percent of total billed charges 19203.6 19203.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL GMK HINGE 3 KNEE LEFT FIX NONSTERILE SUP-02.09.4003L CDM 270010025 LOCAL 0270 RC outpatient 10972 10972 10972 74 8119.28 percent of total billed charges 10972 93 8887.32 percent of total billed charges 10972 10972 other OPPS APC 10972 10972 other OPPS APC 10972 27.63 3031.56 percent of total billed charges 10972 10972 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL GMK HINGE 4 KNEE LEFT FIX NONSTERILE SUP-02.09.4004L CDM 270010025 LOCAL 0270 RC outpatient 10051.6 10051.6 10051.6 74 7438.18 percent of total billed charges 10051.6 93 8141.8 percent of total billed charges 10051.6 10051.6 other OPPS APC 10051.6 10051.6 other OPPS APC 10051.6 27.63 2777.26 percent of total billed charges 10051.6 10051.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL GMK HINGE 4 KNEE RIGHT FIX NONSTERILE SUP-02.09.4004R CDM 270010025 LOCAL 0270 RC outpatient 10051.6 10051.6 10051.6 74 7438.18 percent of total billed charges 10051.6 93 8141.8 percent of total billed charges 10051.6 10051.6 other OPPS APC 10051.6 10051.6 other OPPS APC 10051.6 27.63 2777.26 percent of total billed charges 10051.6 10051.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL GMK HINGE 5 KNEE LEFT FIX NONSTERILE SUP-02.09.4005L CDM 270010025 LOCAL 0270 RC outpatient 10972 10972 10972 74 8119.28 percent of total billed charges 10972 93 8887.32 percent of total billed charges 10972 10972 other OPPS APC 10972 10972 other OPPS APC 10972 27.63 3031.56 percent of total billed charges 10972 10972 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION GMK THK5 MM 2 TIBIA SCREWED SUP-02.09.TA205 CDM 270010025 LOCAL 0270 RC outpatient 3714.1 3714.1 3714.1 74 2748.43 percent of total billed charges 3714.1 93 3008.42 percent of total billed charges 3714.1 3714.1 other OPPS APC 3714.1 3714.1 other OPPS APC 3714.1 27.63 1026.21 percent of total billed charges 3714.1 3714.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION GMK THK5 MM 3 TIBIA SCREWED SUP-02.09.TA305 CDM 270010025 LOCAL 0270 RC outpatient 3714.1 3714.1 3714.1 74 2748.43 percent of total billed charges 3714.1 93 3008.42 percent of total billed charges 3714.1 3714.1 other OPPS APC 3714.1 3714.1 other OPPS APC 3714.1 27.63 1026.21 percent of total billed charges 3714.1 3714.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION GMK THK10 MM 3 TIBIA SCREWED SUP-02.09.TA310 CDM 270010025 LOCAL 0270 RC outpatient 3714.1 3714.1 3714.1 74 2748.43 percent of total billed charges 3714.1 93 3008.42 percent of total billed charges 3714.1 3714.1 other OPPS APC 3714.1 3714.1 other OPPS APC 3714.1 27.63 1026.21 percent of total billed charges 3714.1 3714.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT TIBIAL GMK THK15 MM 3 RIGHT MEDIAL LEFT LATERAL SCREW STERILE LATEX FREE REVISION HINGE TOTAL KNEE SYSTEM SUP-02.09.TA315RMLL CDM 270010025 LOCAL 0270 RC outpatient 3714.1 3714.1 3714.1 74 2748.43 percent of total billed charges 3714.1 93 3008.42 percent of total billed charges 3714.1 3714.1 other OPPS APC 3714.1 3714.1 other OPPS APC 3714.1 27.63 1026.21 percent of total billed charges 3714.1 3714.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION GMK 4 H5 MM TIBIA SCREW STERILE LATEX FREE REVISION HINGE TOTAL KNEE SYSTEM SUP-02.09.TA405 CDM 270010025 LOCAL 0270 RC outpatient 3406 3406 3406 74 2520.44 percent of total billed charges 3406 93 2758.86 percent of total billed charges 3406 3406 other OPPS APC 3406 3406 other OPPS APC 3406 27.63 941.08 percent of total billed charges 3406 3406 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION GMK THK10 MM 4 TIBIA SCREWED SUP-02.09.TA410 CDM 270010025 LOCAL 0270 RC outpatient 3406 3406 3406 74 2520.44 percent of total billed charges 3406 93 2758.86 percent of total billed charges 3406 3406 other OPPS APC 3406 3406 other OPPS APC 3406 27.63 941.08 percent of total billed charges 3406 3406 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT TIBIAL GMK THK15 MM 4 RIGHT MEDIAL LEFT LATERAL SCREW STERILE LATEX FREE REVISION HINGE TOTAL KNEE SYSTEM SUP-02.09.TA415RMLL CDM 270010025 LOCAL 0270 RC outpatient 3714.1 3714.1 3714.1 74 2748.43 percent of total billed charges 3714.1 93 3008.42 percent of total billed charges 3714.1 3714.1 other OPPS APC 3714.1 3714.1 other OPPS APC 3714.1 27.63 1026.21 percent of total billed charges 3714.1 3714.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION GMK 5 H5 MM TIBIA SCREW STERILE LATEX FREE REVISION HINGE TOTAL KNEE SYSTEM SUP-02.09.TA505 CDM 270010025 LOCAL 0270 RC outpatient 3714.1 3714.1 3714.1 74 2748.43 percent of total billed charges 3714.1 93 3008.42 percent of total billed charges 3714.1 3714.1 other OPPS APC 3714.1 3714.1 other OPPS APC 3714.1 27.63 1026.21 percent of total billed charges 3714.1 3714.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL LOW PROFILE L57 MM X W10 MM X H3.4 MM PUBIC SYMPHYSIS PELVIS 4 HOLE COAXIAL COMBI NONSTERILE 3.5 MM SCREW SUP-02.100.004 CDM 270010022 LOCAL 0270 RC outpatient 1926.81 1926.81 1926.81 74 1425.84 percent of total billed charges 1926.81 93 1560.72 percent of total billed charges 1926.81 1926.81 other OPPS APC 1926.81 1926.81 other OPPS APC 1926.81 27.63 532.38 percent of total billed charges 1926.81 1926.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 78X10X3.4MM SS NS PUBIC SYMPHYSIS 6 HOLE LOW PROFILE COAXIAL PRECONTOUR 3.5MM SCREW SUP-02.100.006 CDM 270010022 LOCAL 0270 RC outpatient 2396.68 2396.68 2396.68 74 1773.54 percent of total billed charges 2396.68 93 1941.31 percent of total billed charges 2396.68 2396.68 other OPPS APC 2396.68 2396.68 other OPPS APC 2396.68 27.63 662.2 percent of total billed charges 2396.68 2396.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L57 MM PUBIC SYMPHYSIS 4 HOLE LOW PROFILE NONSTERILE 3.5 MM SCREWS SUP-02.100.014 CDM 270010022 LOCAL 0270 RC outpatient 2117.23 2117.23 2117.23 74 1566.75 percent of total billed charges 2117.23 93 1714.96 percent of total billed charges 2117.23 2117.23 other OPPS APC 2117.23 2117.23 other OPPS APC 2117.23 27.63 584.99 percent of total billed charges 2117.23 2117.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L52 MM X W10.1 MM X H3.7 MM PELVIC 4 HOLE LOCK LOW PROFILE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SUP-02.100.104 CDM 270010022 LOCAL 0270 RC outpatient 1786.07 1786.07 1786.07 74 1321.69 percent of total billed charges 1786.07 93 1446.72 percent of total billed charges 1786.07 1786.07 other OPPS APC 1786.07 1786.07 other OPPS APC 1786.07 27.63 493.49 percent of total billed charges 1786.07 1786.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL PELVIC 1 HOLE SPRING NONSTERILE 3.5 MM SCREW SUP-02.100.301 CDM 270010022 LOCAL 0270 RC outpatient 2044.25 2044.25 2044.25 74 1512.75 percent of total billed charges 2044.25 93 1655.84 percent of total billed charges 2044.25 2044.25 other OPPS APC 2044.25 2044.25 other OPPS APC 2044.25 27.63 564.83 percent of total billed charges 2044.25 2044.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL PELVIC 2 HOLE SPRING NONSTERILE 3.5 MM SCREW SUP-02.100.302 CDM 270010022 LOCAL 0270 RC outpatient 2207.79 2207.79 2207.79 74 1633.76 percent of total billed charges 2207.79 93 1788.31 percent of total billed charges 2207.79 2207.79 other OPPS APC 2207.79 2207.79 other OPPS APC 2207.79 27.63 610.01 percent of total billed charges 2207.79 2207.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL PELVIC 3 HOLE SPRING NONSTERILE 3.5 MM SCREW SUP-02.100.303 CDM 270010022 LOCAL 0270 RC outpatient 925.57 925.57 925.57 74 684.92 percent of total billed charges 925.57 93 749.71 percent of total billed charges 925.57 925.57 other OPPS APC 925.57 925.57 other OPPS APC 925.57 27.63 255.73 percent of total billed charges 925.57 925.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL STANDARD PELVIS QUADRILATERAL SURFACE STERILE 3.5 MM SCREW SUP-02.100.325S CDM 270010022 LOCAL 0270 RC outpatient 1349.27 1349.27 1349.27 74 998.46 percent of total billed charges 1349.27 93 1092.91 percent of total billed charges 1349.27 1349.27 other OPPS APC 1349.27 1349.27 other OPPS APC 1349.27 27.63 372.8 percent of total billed charges 1349.27 1349.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL LONG PELVIS QUADRILATERAL SURFACE STERILE 3.5 MM SCREW SUP-02.100.326S CDM 270010022 LOCAL 0270 RC outpatient 1837.68 1837.68 1837.68 74 1359.88 percent of total billed charges 1837.68 93 1488.52 percent of total billed charges 1837.68 1837.68 other OPPS APC 1837.68 1837.68 other OPPS APC 1837.68 27.63 507.75 percent of total billed charges 1837.68 1837.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL SHORT LOW PROFILE PELVIS QUADRILATERAL SURFACE STERILE 3.5 MM SCREW SUP-02.100.327S CDM 270010022 LOCAL 0270 RC outpatient 1519.44 1519.44 1519.44 74 1124.39 percent of total billed charges 1519.44 93 1230.75 percent of total billed charges 1519.44 1519.44 other OPPS APC 1519.44 1519.44 other OPPS APC 1519.44 27.63 419.82 percent of total billed charges 1519.44 1519.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 3.5MM LCP EXTRA ARTICULAR DISTAL HUMERUS 6 HOLE RIGHT SUP-02.104.006 CDM 270010022 LOCAL 0270 RC outpatient 3407.04 3407.04 3407.04 74 2521.21 percent of total billed charges 3407.04 93 2759.7 percent of total billed charges 3407.04 3407.04 other OPPS APC 3407.04 3407.04 other OPPS APC 3407.04 27.63 941.37 percent of total billed charges 3407.04 3407.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 194MM SS NS HUMERUS RIGHT EXTRAARTICULAR DISTAL 8 HOLE PRECONTOUR LIMIT CONTACT TAPER HEAD 3.5MM SUP-02.104.008 CDM 270010022 LOCAL 0270 RC outpatient 3616.6 3616.6 3616.6 74 2676.28 percent of total billed charges 3616.6 93 2929.45 percent of total billed charges 3616.6 3616.6 other OPPS APC 3616.6 3616.6 other OPPS APC 3616.6 27.63 999.27 percent of total billed charges 3616.6 3616.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 230MM SS NS HUMERUS RIGHT EXTRAARTICULAR DISTAL 10 HOLE PRECONTOUR LIMIT CONTACT TAPER HEAD 3.5MM SUP-02.104.010 CDM 270010022 LOCAL 0270 RC outpatient 3827.51 3827.51 3827.51 74 2832.36 percent of total billed charges 3827.51 93 3100.28 percent of total billed charges 3827.51 3827.51 other OPPS APC 3827.51 3827.51 other OPPS APC 3827.51 27.63 1057.54 percent of total billed charges 3827.51 3827.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PLATE 3.5,, LCP EXTRA-ARTICULAR DISTAL HUMBERUS LEFT 6 HOLE" SUP-02.104.026 CDM 270010022 LOCAL 0270 RC outpatient 3407.04 3407.04 3407.04 74 2521.21 percent of total billed charges 3407.04 93 2759.7 percent of total billed charges 3407.04 3407.04 other OPPS APC 3407.04 3407.04 other OPPS APC 3407.04 27.63 941.37 percent of total billed charges 3407.04 3407.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 194MM SS NS HUMERUS LEFT EXTRAARTICULAR DISTAL 8 HOLE PRECONTOUR LIMIT CONTACT TAPER HEAD 3.5MM SUP-02.104.028 CDM 270010022 LOCAL 0270 RC outpatient 3616.6 3616.6 3616.6 74 2676.28 percent of total billed charges 3616.6 93 2929.45 percent of total billed charges 3616.6 3616.6 other OPPS APC 3616.6 3616.6 other OPPS APC 3616.6 27.63 999.27 percent of total billed charges 3616.6 3616.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 230MM SS NS HUMERUS LEFT EXTRAARTICULAR DISTAL 10 HOLE PRECONTOUR LIMIT CONTACT TAPER HEAD 3.5MM SUP-02.104.030 CDM 270010022 LOCAL 0270 RC outpatient 3827.51 3827.51 3827.51 74 2832.36 percent of total billed charges 3827.51 93 3100.28 percent of total billed charges 3827.51 3827.51 other OPPS APC 3827.51 3827.51 other OPPS APC 3827.51 27.63 1057.54 percent of total billed charges 3827.51 3827.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L73 MM OLECRANON RIGHT PROXIMAL 2 HOLE VARIABLE ANGLE TAPER TIP ROUND PROFILE NONSTERILE 2.7/3.5 MM SCREW SUP-02.107.002 CDM 270010022 LOCAL 0270 RC outpatient 2160.11 2160.11 2160.11 74 1598.48 percent of total billed charges 2160.11 93 1749.69 percent of total billed charges 2160.11 2160.11 other OPPS APC 2160.11 2160.11 other OPPS APC 2160.11 27.63 596.84 percent of total billed charges 2160.11 2160.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L73 MM OLECRANON LEFT PROXIMAL 2 HOLE VARIABLE ANGLE TAPER TIP ROUND PROFILE NONSTERILE 2.7/3.5 MM SCREW SUP-02.107.102 CDM 270010022 LOCAL 0270 RC outpatient 2160.11 2160.11 2160.11 74 1598.48 percent of total billed charges 2160.11 93 1749.69 percent of total billed charges 2160.11 2160.11 other OPPS APC 2160.11 2160.11 other OPPS APC 2160.11 27.63 596.84 percent of total billed charges 2160.11 2160.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L116 MM OLECRANON RIGHT 4 HOLE ROUND PROFILE VARIABLE ANGLE TAPER TIP NONSTERILE 2.7/3.5 MM SCREW SUP-02.107.204 CDM 270010022 LOCAL 0270 RC outpatient 2428.69 2428.69 2428.69 74 1797.23 percent of total billed charges 2428.69 93 1967.24 percent of total billed charges 2428.69 2428.69 other OPPS APC 2428.69 2428.69 other OPPS APC 2428.69 27.63 671.05 percent of total billed charges 2428.69 2428.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L90 MM OLECRANON LEFT 2 HOLE VARIABLE ANGLE TAPER TIP ROUND PROFILE NONSTERILE 2.7/3.5 MM SCREW SUP-02.107.302 CDM 270010022 LOCAL 0270 RC outpatient 2428.69 2428.69 2428.69 74 1797.23 percent of total billed charges 2428.69 93 1967.24 percent of total billed charges 2428.69 2428.69 other OPPS APC 2428.69 2428.69 other OPPS APC 2428.69 27.63 671.05 percent of total billed charges 2428.69 2428.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L116 MM OLECRANON LEFT 4 HOLE VARIABLE ANGLE TAPER TIP ROUND PROFILE NONSTERILE 2.7/3.5 MM SCREW SUP-02.107.304 CDM 270010020 LOCAL 0270 RC outpatient 2428.69 2428.69 2428.69 74 1797.23 percent of total billed charges 2428.69 93 1967.24 percent of total billed charges 2428.69 2428.69 other OPPS APC 2428.69 2428.69 other OPPS APC 2428.69 27.63 671.05 percent of total billed charges 2428.69 2428.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL RADIUS RIGHT DISTAL VOLAR 5 HOLE SHAFT NONSTERILE SUP-02.110.005 CDM 270010022 LOCAL 0270 RC outpatient 4015.44 4015.44 4015.44 74 2971.43 percent of total billed charges 4015.44 93 3252.51 percent of total billed charges 4015.44 4015.44 other OPPS APC 4015.44 4015.44 other OPPS APC 4015.44 27.63 1109.47 percent of total billed charges 4015.44 4015.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL RADIUS RIGHT DISTAL VOLAR 11 HOLE SHAFT NONSTERILE SUP-02.110.011 CDM 270010022 LOCAL 0270 RC outpatient 4467.32 4467.32 4467.32 74 3305.82 percent of total billed charges 4467.32 93 3618.53 percent of total billed charges 4467.32 4467.32 other OPPS APC 4467.32 4467.32 other OPPS APC 4467.32 27.63 1234.32 percent of total billed charges 4467.32 4467.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL RADIUS LEFT DISTAL VOLAR 5 HOLE SHAFT NONSTERILE SUP-02.110.105 CDM 0270 RC outpatient 3540.89 3540.89 3540.89 74 2620.26 percent of total billed charges 3540.89 93 2868.12 percent of total billed charges 3540.89 3540.89 other OPPS APC 3540.89 3540.89 other OPPS APC 3540.89 27.63 978.35 percent of total billed charges 3540.89 3540.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL RADIUS LEFT DISTAL VOLAR 7 HOLE SHAFT NONSTERILE SUP-02.110.107 CDM 270010022 LOCAL 0270 RC outpatient 3989.8 3989.8 3989.8 74 2952.45 percent of total billed charges 3989.8 93 3231.74 percent of total billed charges 3989.8 3989.8 other OPPS APC 3989.8 3989.8 other OPPS APC 3989.8 27.63 1102.38 percent of total billed charges 3989.8 3989.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL RADIUS LEFT DISTAL VOLAR 9 HOLE SHAFT NONSTERILE SUP-02.110.109 CDM 270010022 LOCAL 0270 RC outpatient 4211.35 4211.35 4211.35 74 3116.4 percent of total billed charges 4211.35 93 3411.19 percent of total billed charges 4211.35 4211.35 other OPPS APC 4211.35 4211.35 other OPPS APC 4211.35 27.63 1163.6 percent of total billed charges 4211.35 4211.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL RADIUS LEFT DISTAL VOLAR 11 HOLE SHAFT NONSTERILE SUP-02.110.111 CDM 270010022 LOCAL 0270 RC outpatient 4467.32 4467.32 4467.32 74 3305.82 percent of total billed charges 4467.32 93 3618.53 percent of total billed charges 4467.32 4467.32 other OPPS APC 4467.32 4467.32 other OPPS APC 4467.32 27.63 1234.32 percent of total billed charges 4467.32 4467.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL RADIUS LEFT DISTAL VOLAR 4 HOLE HEAD 3 HOLE SHAFT VARIABLE ANGLE NONSTERILE 2.4 MM SCREW SUP-02.110.207 CDM 270010022 LOCAL 0270 RC outpatient 2792.4 2792.4 2792.4 74 2066.38 percent of total billed charges 2792.4 93 2261.84 percent of total billed charges 2792.4 2792.4 other OPPS APC 2792.4 2792.4 other OPPS APC 2792.4 27.63 771.54 percent of total billed charges 2792.4 2792.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL CONTOUR L50.5 MM RADIUS RIGHT DISTAL VOLAR 9 HOLE HEAD 3 HOLE SHAFT COLUMN ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-02.110.330 CDM 270010022 LOCAL 0270 RC outpatient 1998.7 1998.7 1998.7 74 1479.04 percent of total billed charges 1998.7 93 1618.95 percent of total billed charges 1998.7 1998.7 other OPPS APC 1998.7 1998.7 other OPPS APC 1998.7 27.63 552.24 percent of total billed charges 1998.7 1998.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL CONTOUR L50.5 MM RADIUS LEFT DISTAL VOLAR 9 HOLE HEAD 3 HOLE SHAFT COLUMN ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-02.110.331 CDM 270010022 LOCAL 0270 RC outpatient 2266.55 2266.55 2266.55 74 1677.25 percent of total billed charges 2266.55 93 1835.91 percent of total billed charges 2266.55 2266.55 other OPPS APC 2266.55 2266.55 other OPPS APC 2266.55 27.63 626.25 percent of total billed charges 2266.55 2266.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL CONTOUR L59.5 MM RADIUS RIGHT DISTAL VOLAR 9 HOLE HEAD 4 HOLE SHAFT COLUMN ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-02.110.340 CDM 270010022 LOCAL 0270 RC outpatient 2336.62 2336.62 2336.62 74 1729.1 percent of total billed charges 2336.62 93 1892.66 percent of total billed charges 2336.62 2336.62 other OPPS APC 2336.62 2336.62 other OPPS APC 2336.62 27.63 645.61 percent of total billed charges 2336.62 2336.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL CONTOUR L59.5 MM RADIUS LEFT DISTAL VOLAR 9 HOLE HEAD 4 HOLE SHAFT COLUMN ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-02.110.341 CDM 270010022 LOCAL 0270 RC outpatient 2336.62 2336.62 2336.62 74 1729.1 percent of total billed charges 2336.62 93 1892.66 percent of total billed charges 2336.62 2336.62 other OPPS APC 2336.62 2336.62 other OPPS APC 2336.62 27.63 645.61 percent of total billed charges 2336.62 2336.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL CONTOUR L68.5 MM RADIUS RIGHT DISTAL VOLAR 9 HOLE HEAD 5 HOLE SHAFT COLUMN ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-02.110.350 CDM 270010022 LOCAL 0270 RC outpatient 2121 2121 2121 74 1569.54 percent of total billed charges 2121 93 1718.01 percent of total billed charges 2121 2121 other OPPS APC 2121 2121 other OPPS APC 2121 27.63 586.03 percent of total billed charges 2121 2121 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL CONTOUR L68.5 MM RADIUS LEFT DISTAL VOLAR 9 HOLE HEAD 5 HOLE SHAFT COLUMN ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-02.110.351 CDM 270010022 LOCAL 0270 RC outpatient 2405.26 2405.26 2405.26 74 1779.89 percent of total billed charges 2405.26 93 1948.26 percent of total billed charges 2405.26 2405.26 other OPPS APC 2405.26 2405.26 other OPPS APC 2405.26 27.63 664.57 percent of total billed charges 2405.26 2405.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL CONTOUR L50.5 MM RADIUS RIGHT DISTAL VOLAR 8 HOLE HEAD 3 HOLE SHAFT COLUMN ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-02.110.430 CDM 270010022 LOCAL 0270 RC outpatient 1998.7 1998.7 1998.7 74 1479.04 percent of total billed charges 1998.7 93 1618.95 percent of total billed charges 1998.7 1998.7 other OPPS APC 1998.7 1998.7 other OPPS APC 1998.7 27.63 552.24 percent of total billed charges 1998.7 1998.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL CONTOUR L50.5 MM RADIUS LEFT DISTAL VOLAR 8 HOLE HEAD 3 HOLE SHAFT COLUMN ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-02.110.431 CDM 270010022 LOCAL 0270 RC outpatient 1998.7 1998.7 1998.7 74 1479.04 percent of total billed charges 1998.7 93 1618.95 percent of total billed charges 1998.7 1998.7 other OPPS APC 1998.7 1998.7 other OPPS APC 1998.7 27.63 552.24 percent of total billed charges 1998.7 1998.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL CONTOUR L59.5 MM RADIUS RIGHT DISTAL VOLAR 8 HOLE HEAD 4 HOLE SHAFT COLUMN ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-02.110.440 CDM 270010022 LOCAL 0270 RC outpatient 2060.47 2060.47 2060.47 74 1524.75 percent of total billed charges 2060.47 93 1668.98 percent of total billed charges 2060.47 2060.47 other OPPS APC 2060.47 2060.47 other OPPS APC 2060.47 27.63 569.31 percent of total billed charges 2060.47 2060.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL CONTOUR L59.5 MM RADIUS LEFT DISTAL VOLAR 8 HOLE HEAD 4 HOLE SHAFT COLUMN ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-02.110.441 CDM 270010022 LOCAL 0270 RC outpatient 2336.62 2336.62 2336.62 74 1729.1 percent of total billed charges 2336.62 93 1892.66 percent of total billed charges 2336.62 2336.62 other OPPS APC 2336.62 2336.62 other OPPS APC 2336.62 27.63 645.61 percent of total billed charges 2336.62 2336.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL CONTOUR L68.5 MM RADIUS RIGHT DISTAL VOLAR 8 HOLE HEAD 5 HOLE SHAFT COLUMN ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-02.110.450 CDM 270010022 LOCAL 0270 RC outpatient 2405.26 2405.26 2405.26 74 1779.89 percent of total billed charges 2405.26 93 1948.26 percent of total billed charges 2405.26 2405.26 other OPPS APC 2405.26 2405.26 other OPPS APC 2405.26 27.63 664.57 percent of total billed charges 2405.26 2405.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL CONTOUR L68.5 MM RADIUS LEFT DISTAL VOLAR 8 HOLE HEAD 5 HOLE SHAFT COLUMN ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-02.110.451 CDM 270010022 LOCAL 0270 RC outpatient 2405.26 2405.26 2405.26 74 1779.89 percent of total billed charges 2405.26 93 1948.26 percent of total billed charges 2405.26 2405.26 other OPPS APC 2405.26 2405.26 other OPPS APC 2405.26 27.63 664.57 percent of total billed charges 2405.26 2405.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL RADIUS PLATE 6HOLE HEAD 2 HOLE SHAFT RIGHT SUP-02.111.620 CDM 0270 RC outpatient 2494.44 2494.44 2494.44 74 1845.89 percent of total billed charges 2494.44 93 2020.5 percent of total billed charges 2494.44 2494.44 other OPPS APC 2494.44 2494.44 other OPPS APC 2494.44 27.63 689.21 percent of total billed charges 2494.44 2494.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL RADIUS PLATE 6HOLE HEAD 2 HOLE SHAFT LEFT SUP-02.111.621 CDM 0270 RC outpatient 2494.44 2494.44 2494.44 74 1845.89 percent of total billed charges 2494.44 93 2020.5 percent of total billed charges 2494.44 2494.44 other OPPS APC 2494.44 2494.44 other OPPS APC 2494.44 27.63 689.21 percent of total billed charges 2494.44 2494.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL RADIUS PLATE 6HOLE HEAD 3 HOLE SHAFT RIGHT SUP-02.111.630 CDM 0270 RC outpatient 2594.28 2594.28 2594.28 74 1919.77 percent of total billed charges 2594.28 93 2101.37 percent of total billed charges 2594.28 2594.28 other OPPS APC 2594.28 2594.28 other OPPS APC 2594.28 27.63 716.8 percent of total billed charges 2594.28 2594.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL RADIUS PLATE 6HOLE HEAD 3 HOLE SHAFT LEFT SUP-02.111.631 CDM 0270 RC outpatient 1513.33 1513.33 1513.33 74 1119.86 percent of total billed charges 1513.33 93 1225.8 percent of total billed charges 1513.33 1513.33 other OPPS APC 1513.33 1513.33 other OPPS APC 1513.33 27.63 418.13 percent of total billed charges 1513.33 1513.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL RADIUS PLATE 6HOLE HEAD 5 HOLE SHAFT RIGHT SUP-02.111.640 CDM 0270 RC outpatient 2691 2691 2691 74 1991.34 percent of total billed charges 2691 93 2179.71 percent of total billed charges 2691 2691 other OPPS APC 2691 2691 other OPPS APC 2691 27.63 743.52 percent of total billed charges 2691 2691 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL RADIUS PLATE 6HOLE HEAD 5 HOLE SHAFT LEFT SUP-02.111.641 CDM 0270 RC outpatient 2691 2691 2691 74 1991.34 percent of total billed charges 2691 93 2179.71 percent of total billed charges 2691 2691 other OPPS APC 2691 2691 other OPPS APC 2691 27.63 743.52 percent of total billed charges 2691 2691 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL RADIUS PLATE 6HOLE HEAD4 HOLE SHAFT RIGHT SUP-02.111.650 CDM 0270 RC outpatient 2792.4 2792.4 2792.4 74 2066.38 percent of total billed charges 2792.4 93 2261.84 percent of total billed charges 2792.4 2792.4 other OPPS APC 2792.4 2792.4 other OPPS APC 2792.4 27.63 771.54 percent of total billed charges 2792.4 2792.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL RADIUS PLATE 6HOLE HEAD4 HOLE SHAFT LEFT SUP-02.111.651 CDM 0270 RC outpatient 2792.4 2792.4 2792.4 74 2066.38 percent of total billed charges 2792.4 93 2261.84 percent of total billed charges 2792.4 2792.4 other OPPS APC 2792.4 2792.4 other OPPS APC 2792.4 27.63 771.54 percent of total billed charges 2792.4 2792.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL RADIUS PLATE 7HOLE HEAD 2 HOLE SHAFT RIGHT SUP-02.111.720 CDM 0270 RC outpatient 2494.44 2494.44 2494.44 74 1845.89 percent of total billed charges 2494.44 93 2020.5 percent of total billed charges 2494.44 2494.44 other OPPS APC 2494.44 2494.44 other OPPS APC 2494.44 27.63 689.21 percent of total billed charges 2494.44 2494.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL RADIUS PLATE 7HOLE HEAD 2 HOLE SHAFT LEFT SUP-02.111.721 CDM 0270 RC outpatient 2494.44 2494.44 2494.44 74 1845.89 percent of total billed charges 2494.44 93 2020.5 percent of total billed charges 2494.44 2494.44 other OPPS APC 2494.44 2494.44 other OPPS APC 2494.44 27.63 689.21 percent of total billed charges 2494.44 2494.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL RADIUS PLATE 7HOLE HEAD 3 HOLE SHAFT RIGHT SUP-02.111.730 CDM 0270 RC outpatient 2594.28 2594.28 2594.28 74 1919.77 percent of total billed charges 2594.28 93 2101.37 percent of total billed charges 2594.28 2594.28 other OPPS APC 2594.28 2594.28 other OPPS APC 2594.28 27.63 716.8 percent of total billed charges 2594.28 2594.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL RADIUS PLATE 7HOLE HEAD 3 HOLE SHAFT LEFT SUP-02.111.731 CDM 0270 RC outpatient 1513.33 1513.33 1513.33 74 1119.86 percent of total billed charges 1513.33 93 1225.8 percent of total billed charges 1513.33 1513.33 other OPPS APC 1513.33 1513.33 other OPPS APC 1513.33 27.63 418.13 percent of total billed charges 1513.33 1513.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL RADIUS PLATE 7HOLE HEAD 5 HOLE SHAFT RIGHT SUP-02.111.740 CDM 0270 RC outpatient 2691 2691 2691 74 1991.34 percent of total billed charges 2691 93 2179.71 percent of total billed charges 2691 2691 other OPPS APC 2691 2691 other OPPS APC 2691 27.63 743.52 percent of total billed charges 2691 2691 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL RADIUS PLATE 7HOLE HEAD 5 HOLE SHAFT LEFT SUP-02.111.741 CDM 0270 RC outpatient 1569.75 1569.75 1569.75 74 1161.62 percent of total billed charges 1569.75 93 1271.5 percent of total billed charges 1569.75 1569.75 other OPPS APC 1569.75 1569.75 other OPPS APC 1569.75 27.63 433.72 percent of total billed charges 1569.75 1569.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL RADIUS PLATE 7 HOLE HEAD 4 HOLE SHAFT RIGHT SUP-02.111.750 CDM 0270 RC outpatient 2792.4 2792.4 2792.4 74 2066.38 percent of total billed charges 2792.4 93 2261.84 percent of total billed charges 2792.4 2792.4 other OPPS APC 2792.4 2792.4 other OPPS APC 2792.4 27.63 771.54 percent of total billed charges 2792.4 2792.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL RADIUS PLATE 7HOLE HEAD4 HOLE SHAFT LEFT SUP-02.111.751 CDM 0270 RC outpatient 2792.4 2792.4 2792.4 74 2066.38 percent of total billed charges 2792.4 93 2261.84 percent of total billed charges 2792.4 2792.4 other OPPS APC 2792.4 2792.4 other OPPS APC 2792.4 27.63 771.54 percent of total billed charges 2792.4 2792.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L69 MM CLAVICLE LEFT ANTERIOR SUPERIOR 3 HOLE LATERAL EXTENSION PRECONTOUR LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.112.007 CDM 270010022 LOCAL 0270 RC outpatient 2175.24 2175.24 2175.24 74 1609.68 percent of total billed charges 2175.24 93 1761.94 percent of total billed charges 2175.24 2175.24 other OPPS APC 2175.24 2175.24 other OPPS APC 2175.24 27.63 601.02 percent of total billed charges 2175.24 2175.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L108 MM CLAVICLE RIGHT ANTERIOR SUPERIOR 6 HOLE LATERAL EXTENSION PRECONTOUR LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.112.008 CDM 270010022 LOCAL 0270 RC outpatient 2578.29 2578.29 2578.29 74 1907.93 percent of total billed charges 2578.29 93 2088.41 percent of total billed charges 2578.29 2578.29 other OPPS APC 2578.29 2578.29 other OPPS APC 2578.29 27.63 712.38 percent of total billed charges 2578.29 2578.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L108 MM CLAVICLE LEFT ANTERIOR SUPERIOR 6 HOLE LATERAL EXTENSION PRECONTOUR LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.112.009 CDM 270010022 LOCAL 0270 RC outpatient 2578.29 2578.29 2578.29 74 1907.93 percent of total billed charges 2578.29 93 2088.41 percent of total billed charges 2578.29 2578.29 other OPPS APC 2578.29 2578.29 other OPPS APC 2578.29 27.63 712.38 percent of total billed charges 2578.29 2578.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L123 MM CLAVICLE RIGHT ANTERIOR SUPERIOR 7 HOLE LATERAL EXTENSION PRECONTOUR LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.112.018 CDM 270010022 LOCAL 0270 RC outpatient 2644.07 2644.07 2644.07 74 1956.61 percent of total billed charges 2644.07 93 2141.7 percent of total billed charges 2644.07 2644.07 other OPPS APC 2644.07 2644.07 other OPPS APC 2644.07 27.63 730.56 percent of total billed charges 2644.07 2644.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L123 MM CLAVICLE LEFT ANTERIOR SUPERIOR 7 HOLE LATERAL EXTENSION PRECONTOUR LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.112.019 CDM 270010022 LOCAL 0270 RC outpatient 2644.07 2644.07 2644.07 74 1956.61 percent of total billed charges 2644.07 93 2141.7 percent of total billed charges 2644.07 2644.07 other OPPS APC 2644.07 2644.07 other OPPS APC 2644.07 27.63 730.56 percent of total billed charges 2644.07 2644.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L135 MM CLAVICLE RIGHT ANTERIOR SUPERIOR 8 HOLE LATERAL EXTENSION PRECONTOUR LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.112.020 CDM 270010022 LOCAL 0270 RC outpatient 2714.14 2714.14 2714.14 74 2008.46 percent of total billed charges 2714.14 93 2198.45 percent of total billed charges 2714.14 2714.14 other OPPS APC 2714.14 2714.14 other OPPS APC 2714.14 27.63 749.92 percent of total billed charges 2714.14 2714.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L135 MM CLAVICLE LEFT ANTERIOR SUPERIOR 8 HOLE LATERAL EXTENSION PRECONTOUR LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.112.021 CDM 270010022 LOCAL 0270 RC outpatient 2714.14 2714.14 2714.14 74 2008.46 percent of total billed charges 2714.14 93 2198.45 percent of total billed charges 2714.14 2714.14 other OPPS APC 2714.14 2714.14 other OPPS APC 2714.14 27.63 749.92 percent of total billed charges 2714.14 2714.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L94 MM CLAVICLE RIGHT ANTERIOR SUPERIOR 6 HOLE PRECONTOUR LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-02.112.026 CDM 270010022 LOCAL 0270 RC outpatient 2578.29 2578.29 2578.29 74 1907.93 percent of total billed charges 2578.29 93 2088.41 percent of total billed charges 2578.29 2578.29 other OPPS APC 2578.29 2578.29 other OPPS APC 2578.29 27.63 712.38 percent of total billed charges 2578.29 2578.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L94 MM CLAVICLE LEFT ANTERIOR SUPERIOR 6 HOLE PRECONTOUR LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-02.112.027 CDM 270010022 LOCAL 0270 RC outpatient 2578.29 2578.29 2578.29 74 1907.93 percent of total billed charges 2578.29 93 2088.41 percent of total billed charges 2578.29 2578.29 other OPPS APC 2578.29 2578.29 other OPPS APC 2578.29 27.63 712.38 percent of total billed charges 2578.29 2578.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L110 MM CLAVICLE RIGHT ANTERIOR SUPERIOR 7 HOLE PRECONTOUR LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-02.112.028 CDM 270010022 LOCAL 0270 RC outpatient 2331.6 2331.6 2331.6 74 1725.38 percent of total billed charges 2331.6 93 1888.6 percent of total billed charges 2331.6 2331.6 other OPPS APC 2331.6 2331.6 other OPPS APC 2331.6 27.63 644.22 percent of total billed charges 2331.6 2331.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L110 MM CLAVICLE LEFT ANTERIOR SUPERIOR 7 HOLE PRECONTOUR LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-02.112.029 CDM 270010022 LOCAL 0270 RC outpatient 2644.07 2644.07 2644.07 74 1956.61 percent of total billed charges 2644.07 93 2141.7 percent of total billed charges 2644.07 2644.07 other OPPS APC 2644.07 2644.07 other OPPS APC 2644.07 27.63 730.56 percent of total billed charges 2644.07 2644.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L120 MM CLAVICLE RIGHT ANTERIOR SUPERIOR 8 HOLE PRECONTOUR LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-02.112.030 CDM 270010022 LOCAL 0270 RC outpatient 2714.14 2714.14 2714.14 74 2008.46 percent of total billed charges 2714.14 93 2198.45 percent of total billed charges 2714.14 2714.14 other OPPS APC 2714.14 2714.14 other OPPS APC 2714.14 27.63 749.92 percent of total billed charges 2714.14 2714.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L120 MM CLAVICLE LEFT ANTERIOR SUPERIOR 8 HOLE PRECONTOUR LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-02.112.031 CDM 270010022 LOCAL 0270 RC outpatient 2714.14 2714.14 2714.14 74 2008.46 percent of total billed charges 2714.14 93 2198.45 percent of total billed charges 2714.14 2714.14 other OPPS APC 2714.14 2714.14 other OPPS APC 2714.14 27.63 749.92 percent of total billed charges 2714.14 2714.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L77 MM FIBULA RIGHT DISTAL POSTEROLATERAL 3 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.106 CDM 270010022 LOCAL 0270 RC outpatient 1032.85 1032.85 1032.85 74 764.31 percent of total billed charges 1032.85 93 836.61 percent of total billed charges 1032.85 1032.85 other OPPS APC 1032.85 1032.85 other OPPS APC 1032.85 27.63 285.38 percent of total billed charges 1032.85 1032.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L77 MM FIBULA LEFT DISTAL POSTEROLATERAL 3 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.107 CDM 270010022 LOCAL 0270 RC outpatient 1032.85 1032.85 1032.85 74 764.31 percent of total billed charges 1032.85 93 836.61 percent of total billed charges 1032.85 1032.85 other OPPS APC 1032.85 1032.85 other OPPS APC 1032.85 27.63 285.38 percent of total billed charges 1032.85 1032.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L90 MM FIBULA RIGHT DISTAL POSTEROLATERAL 4 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.108 CDM 270010022 LOCAL 0270 RC outpatient 1049.23 1049.23 1049.23 74 776.43 percent of total billed charges 1049.23 93 849.88 percent of total billed charges 1049.23 1049.23 other OPPS APC 1049.23 1049.23 other OPPS APC 1049.23 27.63 289.9 percent of total billed charges 1049.23 1049.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L90 MM FIBULA LEFT DISTAL POSTEROLATERAL 4 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.109 CDM 270010022 LOCAL 0270 RC outpatient 1049.23 1049.23 1049.23 74 776.43 percent of total billed charges 1049.23 93 849.88 percent of total billed charges 1049.23 1049.23 other OPPS APC 1049.23 1049.23 other OPPS APC 1049.23 27.63 289.9 percent of total billed charges 1049.23 1049.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L103 MM FIBULA RIGHT DISTAL POSTEROLATERAL 5 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.110 CDM 270010022 LOCAL 0270 RC outpatient 1064.7 1064.7 1064.7 74 787.88 percent of total billed charges 1064.7 93 862.41 percent of total billed charges 1064.7 1064.7 other OPPS APC 1064.7 1064.7 other OPPS APC 1064.7 27.63 294.18 percent of total billed charges 1064.7 1064.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L103 MM FIBULA LEFT DISTAL POSTEROLATERAL 5 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.111 CDM 270010022 LOCAL 0270 RC outpatient 1064.7 1064.7 1064.7 74 787.88 percent of total billed charges 1064.7 93 862.41 percent of total billed charges 1064.7 1064.7 other OPPS APC 1064.7 1064.7 other OPPS APC 1064.7 27.63 294.18 percent of total billed charges 1064.7 1064.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L116 MM FIBULA RIGHT DISTAL POSTEROLATERAL 6 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.112 CDM 270010022 LOCAL 0270 RC outpatient 1080.17 1080.17 1080.17 74 799.33 percent of total billed charges 1080.17 93 874.94 percent of total billed charges 1080.17 1080.17 other OPPS APC 1080.17 1080.17 other OPPS APC 1080.17 27.63 298.45 percent of total billed charges 1080.17 1080.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L116 MM FIBULA LEFT DISTAL POSTEROLATERAL 6 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.113 CDM 270010022 LOCAL 0270 RC outpatient 1080.17 1080.17 1080.17 74 799.33 percent of total billed charges 1080.17 93 874.94 percent of total billed charges 1080.17 1080.17 other OPPS APC 1080.17 1080.17 other OPPS APC 1080.17 27.63 298.45 percent of total billed charges 1080.17 1080.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L129 MM FIBULA RIGHT DISTAL POSTEROLATERAL 7 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.114 CDM 270010022 LOCAL 0270 RC outpatient 1095.64 1095.64 1095.64 74 810.77 percent of total billed charges 1095.64 93 887.47 percent of total billed charges 1095.64 1095.64 other OPPS APC 1095.64 1095.64 other OPPS APC 1095.64 27.63 302.73 percent of total billed charges 1095.64 1095.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L129 MM FIBULA LEFT DISTAL POSTEROLATERAL 7 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.115 CDM 270010022 LOCAL 0270 RC outpatient 1095.64 1095.64 1095.64 74 810.77 percent of total billed charges 1095.64 93 887.47 percent of total billed charges 1095.64 1095.64 other OPPS APC 1095.64 1095.64 other OPPS APC 1095.64 27.63 302.73 percent of total billed charges 1095.64 1095.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L181 MM FIBULA RIGHT DISTAL POSTEROLATERAL 11 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.122 CDM 270010022 LOCAL 0270 RC outpatient 1128.4 1128.4 1128.4 74 835.02 percent of total billed charges 1128.4 93 914 percent of total billed charges 1128.4 1128.4 other OPPS APC 1128.4 1128.4 other OPPS APC 1128.4 27.63 311.78 percent of total billed charges 1128.4 1128.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L181 MM FIBULA LEFT DISTAL POSTEROLATERAL 11 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.123 CDM 270010022 LOCAL 0270 RC outpatient 1773.2 1773.2 1773.2 74 1312.17 percent of total billed charges 1773.2 93 1436.29 percent of total billed charges 1773.2 1773.2 other OPPS APC 1773.2 1773.2 other OPPS APC 1773.2 27.63 489.94 percent of total billed charges 1773.2 1773.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L73 MM FIBULA LEFT DISTAL LATERAL 3 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.137 CDM 270010022 LOCAL 0270 RC outpatient 997.36 997.36 997.36 74 738.05 percent of total billed charges 997.36 93 807.86 percent of total billed charges 997.36 997.36 other OPPS APC 997.36 997.36 other OPPS APC 997.36 27.63 275.57 percent of total billed charges 997.36 997.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L86 MM FIBULA RIGHT DISTAL LATERAL 4 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.138 CDM 270010022 LOCAL 0270 RC outpatient 1015.56 1015.56 1015.56 74 751.51 percent of total billed charges 1015.56 93 822.6 percent of total billed charges 1015.56 1015.56 other OPPS APC 1015.56 1015.56 other OPPS APC 1015.56 27.63 280.6 percent of total billed charges 1015.56 1015.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L86 MM FIBULA LEFT DISTAL LATERAL 4 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.139 CDM 270010022 LOCAL 0270 RC outpatient 1595.88 1595.88 1595.88 74 1180.95 percent of total billed charges 1595.88 93 1292.66 percent of total billed charges 1595.88 1595.88 other OPPS APC 1595.88 1595.88 other OPPS APC 1595.88 27.63 440.94 percent of total billed charges 1595.88 1595.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L99 MM FIBULA RIGHT DISTAL LATERAL 5 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.140 CDM 270010022 LOCAL 0270 RC outpatient 1028.3 1028.3 1028.3 74 760.94 percent of total billed charges 1028.3 93 832.92 percent of total billed charges 1028.3 1028.3 other OPPS APC 1028.3 1028.3 other OPPS APC 1028.3 27.63 284.12 percent of total billed charges 1028.3 1028.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L99 MM FIBULA LEFT DISTAL LATERAL 5 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.141 CDM 270010022 LOCAL 0270 RC outpatient 1028.3 1028.3 1028.3 74 760.94 percent of total billed charges 1028.3 93 832.92 percent of total billed charges 1028.3 1028.3 other OPPS APC 1028.3 1028.3 other OPPS APC 1028.3 27.63 284.12 percent of total billed charges 1028.3 1028.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L112 MM FIBULA RIGHT DISTAL LATERAL 6 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.142 CDM 270010022 LOCAL 0270 RC outpatient 1641.64 1641.64 1641.64 74 1214.81 percent of total billed charges 1641.64 93 1329.73 percent of total billed charges 1641.64 1641.64 other OPPS APC 1641.64 1641.64 other OPPS APC 1641.64 27.63 453.59 percent of total billed charges 1641.64 1641.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L112 MM FIBULA LEFT DISTAL LATERAL 6 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.143 CDM 270010022 LOCAL 0270 RC outpatient 1641.64 1641.64 1641.64 74 1214.81 percent of total billed charges 1641.64 93 1329.73 percent of total billed charges 1641.64 1641.64 other OPPS APC 1641.64 1641.64 other OPPS APC 1641.64 27.63 453.59 percent of total billed charges 1641.64 1641.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L125 MM FIBULA RIGHT DISTAL LATERAL 7 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.144 CDM 270010022 LOCAL 0270 RC outpatient 1663.09 1663.09 1663.09 74 1230.69 percent of total billed charges 1663.09 93 1347.1 percent of total billed charges 1663.09 1663.09 other OPPS APC 1663.09 1663.09 other OPPS APC 1663.09 27.63 459.51 percent of total billed charges 1663.09 1663.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L125 MM FIBULA LEFT DISTAL LATERAL 7 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.145 CDM 270010022 LOCAL 0270 RC outpatient 1058.33 1058.33 1058.33 74 783.16 percent of total billed charges 1058.33 93 857.25 percent of total billed charges 1058.33 1058.33 other OPPS APC 1058.33 1058.33 other OPPS APC 1058.33 27.63 292.42 percent of total billed charges 1058.33 1058.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L151 MM FIBULA RIGHT DISTAL LATERAL 9 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.148 CDM 270010022 LOCAL 0270 RC outpatient 1746.03 1746.03 1746.03 74 1292.06 percent of total billed charges 1746.03 93 1414.28 percent of total billed charges 1746.03 1746.03 other OPPS APC 1746.03 1746.03 other OPPS APC 1746.03 27.63 482.43 percent of total billed charges 1746.03 1746.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L151 MM FIBULA LEFT DISTAL LATERAL 9 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.149 CDM 270010022 LOCAL 0270 RC outpatient 1746.03 1746.03 1746.03 74 1292.06 percent of total billed charges 1746.03 93 1414.28 percent of total billed charges 1746.03 1746.03 other OPPS APC 1746.03 1746.03 other OPPS APC 1746.03 27.63 482.43 percent of total billed charges 1746.03 1746.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L177 MM FIBULA RIGHT DISTAL LATERAL 11 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.152 CDM 270010022 LOCAL 0270 RC outpatient 1773.2 1773.2 1773.2 74 1312.17 percent of total billed charges 1773.2 93 1436.29 percent of total billed charges 1773.2 1773.2 other OPPS APC 1773.2 1773.2 other OPPS APC 1773.2 27.63 489.94 percent of total billed charges 1773.2 1773.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L177 MM FIBULA LEFT DISTAL LATERAL 11 HOLE NONSTERILE 2.7/3.5 MM SCREW SUP-02.112.153 CDM 270010022 LOCAL 0270 RC outpatient 1773.2 1773.2 1773.2 74 1312.17 percent of total billed charges 1773.2 93 1436.29 percent of total billed charges 1773.2 1773.2 other OPPS APC 1773.2 1773.2 other OPPS APC 1773.2 27.63 489.94 percent of total billed charges 1773.2 1773.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL T L64 MM TIBIA DISTAL 3 HOLE 4 LOCK NONSTERILE 3.5 MM SCREW SUP-02.112.203 CDM 270010022 LOCAL 0270 RC outpatient 1711.19 1711.19 1711.19 74 1266.28 percent of total billed charges 1711.19 93 1386.06 percent of total billed charges 1711.19 1711.19 other OPPS APC 1711.19 1711.19 other OPPS APC 1711.19 27.63 472.8 percent of total billed charges 1711.19 1711.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL T L90 MM TIBIA DISTAL 5 HOLE 4 LOCK NONSTERILE 3.5 MM SCREW SUP-02.112.205 CDM 270010022 LOCAL 0270 RC outpatient 1776.76 1776.76 1776.76 74 1314.8 percent of total billed charges 1776.76 93 1439.18 percent of total billed charges 1776.76 1776.76 other OPPS APC 1776.76 1776.76 other OPPS APC 1776.76 27.63 490.92 percent of total billed charges 1776.76 1776.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL T L132 MM TIBIA DISTAL POSTERIOR 8 HOLE 4 LOCK NONSTERILE 3.5 MM SCREW SUP-02.112.208 CDM 270010022 LOCAL 0270 RC outpatient 3876.73 3876.73 3876.73 74 2868.78 percent of total billed charges 3876.73 93 3140.15 percent of total billed charges 3876.73 3876.73 other OPPS APC 3876.73 3876.73 other OPPS APC 3876.73 27.63 1071.14 percent of total billed charges 3876.73 3876.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL T L184 MM TIBIA DISTAL POSTERIOR 12 HOLE 4 LOCK NONSTERILE 3.5 MM SCREW SUP-02.112.212 CDM 270010022 LOCAL 0270 RC outpatient 4135.56 4135.56 4135.56 74 3060.31 percent of total billed charges 4135.56 93 3349.8 percent of total billed charges 4135.56 4135.56 other OPPS APC 4135.56 4135.56 other OPPS APC 4135.56 27.63 1142.66 percent of total billed charges 4135.56 4135.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL T L236 MM TIBIA DISTAL POSTERIOR 16 HOLE 4 LOCK NONSTERILE 3.5 MM SCREW SUP-02.112.216 CDM 270010022 LOCAL 0270 RC outpatient 4287.14 4287.14 4287.14 74 3172.48 percent of total billed charges 4287.14 93 3472.58 percent of total billed charges 4287.14 4287.14 other OPPS APC 4287.14 4287.14 other OPPS APC 4287.14 27.63 1184.54 percent of total billed charges 4287.14 4287.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L109 MM X W13.5 MM X H3.7 MM TIBIA RIGHT DISTAL MEDIAL 4 HOLE WITHOUT TAB ROUND EDGE LOW PROFILE HEAD NONSTERILE 3.5 MM SCREW SUP-02.112.510 CDM 270010022 LOCAL 0270 RC outpatient 3570.71 3570.71 3570.71 74 2642.33 percent of total billed charges 3570.71 93 2892.28 percent of total billed charges 3570.71 3570.71 other OPPS APC 3570.71 3570.71 other OPPS APC 3570.71 27.63 986.59 percent of total billed charges 3570.71 3570.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L109 MM TIBIA RIGHT DISTAL MEDIAL 4 HOLE LOW BEND LOW PROFILE ROUND EDGE STERILE 3.5 MM SCREW SUP-02.112.510S CDM 270010022 LOCAL 0270 RC outpatient 3928.21 3928.21 3928.21 74 2906.88 percent of total billed charges 3928.21 93 3181.85 percent of total billed charges 3928.21 3928.21 other OPPS APC 3928.21 3928.21 other OPPS APC 3928.21 27.63 1085.36 percent of total billed charges 3928.21 3928.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L109 MM X W13.5 MM X H3.7 MM TIBIA LEFT DISTAL MEDIAL 4 HOLE WITHOUT TAB ROUND EDGE LOW PROFILE HEAD NONSTERILE 3.5 MM SCREW SUP-02.112.511 CDM 270010022 LOCAL 0270 RC outpatient 3148.73 3148.73 3148.73 74 2330.06 percent of total billed charges 3148.73 93 2550.47 percent of total billed charges 3148.73 3148.73 other OPPS APC 3148.73 3148.73 other OPPS APC 3148.73 27.63 869.99 percent of total billed charges 3148.73 3148.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L109 MM TIBIA LEFT DISTAL MEDIAL 4 HOLE LOW BEND LOW PROFILE ROUND EDGE STERILE 3.5 MM SCREW SUP-02.112.511S CDM 270010022 LOCAL 0270 RC outpatient 3928.21 3928.21 3928.21 74 2906.88 percent of total billed charges 3928.21 93 3181.85 percent of total billed charges 3928.21 3928.21 other OPPS APC 3928.21 3928.21 other OPPS APC 3928.21 27.63 1085.36 percent of total billed charges 3928.21 3928.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L135 MM X W13.5 MM X H3.7 MM TIBIA RIGHT DISTAL MEDIAL 6 HOLE WITHOUT TAB ROUND EDGE LOW PROFILE HEAD NONSTERILE 3.5 MM SCREW SUP-02.112.514 CDM 270010022 LOCAL 0270 RC outpatient 3610.75 3610.75 3610.75 74 2671.96 percent of total billed charges 3610.75 93 2924.71 percent of total billed charges 3610.75 3610.75 other OPPS APC 3610.75 3610.75 other OPPS APC 3610.75 27.63 997.65 percent of total billed charges 3610.75 3610.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L135 MM TIBIA RIGHT DISTAL MEDIAL 6 HOLE LOW BEND LOW PROFILE ROUND EDGE STERILE 3.5 MM SCREW SUP-02.112.514S CDM 270010022 LOCAL 0270 RC outpatient 3972.54 3972.54 3972.54 74 2939.68 percent of total billed charges 3972.54 93 3217.76 percent of total billed charges 3972.54 3972.54 other OPPS APC 3972.54 3972.54 other OPPS APC 3972.54 27.63 1097.61 percent of total billed charges 3972.54 3972.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L135 MM X W13.5 MM X H3.7 MM TIBIA LEFT DISTAL MEDIAL 6 HOLE WITHOUT TAB ROUND EDGE LOW PROFILE HEAD NONSTERILE 3.5 MM SCREW SUP-02.112.515 CDM 270010022 LOCAL 0270 RC outpatient 3610.75 3610.75 3610.75 74 2671.96 percent of total billed charges 3610.75 93 2924.71 percent of total billed charges 3610.75 3610.75 other OPPS APC 3610.75 3610.75 other OPPS APC 3610.75 27.63 997.65 percent of total billed charges 3610.75 3610.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L135 MM TIBIA LEFT DISTAL MEDIAL 6 HOLE LOW BEND LOW PROFILE ROUND EDGE STERILE 3.5 MM SCREW SUP-02.112.515S CDM 270010022 LOCAL 0270 RC outpatient 3972.54 3972.54 3972.54 74 2939.68 percent of total billed charges 3972.54 93 3217.76 percent of total billed charges 3972.54 3972.54 other OPPS APC 3972.54 3972.54 other OPPS APC 3972.54 27.63 1097.61 percent of total billed charges 3972.54 3972.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L161 MM X W13.5 MM X H3.7 MM TIBIA RIGHT DISTAL MEDIAL 8 HOLE WITHOUT TAB ROUND EDGE LOW PROFILE HEAD NONSTERILE 3.5 MM SCREW SUP-02.112.518 CDM 270010022 LOCAL 0270 RC outpatient 3215.55 3215.55 3215.55 74 2379.51 percent of total billed charges 3215.55 93 2604.6 percent of total billed charges 3215.55 3215.55 other OPPS APC 3215.55 3215.55 other OPPS APC 3215.55 27.63 888.46 percent of total billed charges 3215.55 3215.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L161 MM TIBIA RIGHT DISTAL MEDIAL 8 HOLE LOW BEND LOW PROFILE ROUND EDGE STERILE 3.5 MM SCREW SUP-02.112.518S CDM 270010022 LOCAL 0270 RC outpatient 4009.72 4009.72 4009.72 74 2967.19 percent of total billed charges 4009.72 93 3247.87 percent of total billed charges 4009.72 4009.72 other OPPS APC 4009.72 4009.72 other OPPS APC 4009.72 27.63 1107.89 percent of total billed charges 4009.72 4009.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L161 MM X W13.5 MM X H3.7 MM TIBIA LEFT DISTAL MEDIAL 8 HOLE WITHOUT TAB ROUND EDGE LOW PROFILE HEAD NONSTERILE 3.5 MM SCREW SUP-02.112.519 CDM 270010022 LOCAL 0270 RC outpatient 3646.5 3646.5 3646.5 74 2698.41 percent of total billed charges 3646.5 93 2953.67 percent of total billed charges 3646.5 3646.5 other OPPS APC 3646.5 3646.5 other OPPS APC 3646.5 27.63 1007.53 percent of total billed charges 3646.5 3646.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L161 MM TIBIA LEFT DISTAL MEDIAL 8 HOLE LOW BEND LOW PROFILE ROUND EDGE STERILE 3.5 MM SCREW SUP-02.112.519S CDM 270010022 LOCAL 0270 RC outpatient 4009.72 4009.72 4009.72 74 2967.19 percent of total billed charges 4009.72 93 3247.87 percent of total billed charges 4009.72 4009.72 other OPPS APC 4009.72 4009.72 other OPPS APC 4009.72 27.63 1107.89 percent of total billed charges 4009.72 4009.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L187 MM X W13.5 MM X H3.7 MM TIBIA RIGHT DISTAL MEDIAL 10 HOLE WITHOUT TAB ROUND EDGE LOW PROFILE HEAD NONSTERILE 3.5 MM SCREW SUP-02.112.522 CDM 270010022 LOCAL 0270 RC outpatient 3686.54 3686.54 3686.54 74 2728.04 percent of total billed charges 3686.54 93 2986.1 percent of total billed charges 3686.54 3686.54 other OPPS APC 3686.54 3686.54 other OPPS APC 3686.54 27.63 1018.59 percent of total billed charges 3686.54 3686.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L187 MM TIBIA RIGHT DISTAL MEDIAL 10 HOLE LOW BEND LOW PROFILE ROUND EDGE STERILE 3.5 MM SCREW SUP-02.112.522S CDM 270010022 LOCAL 0270 RC outpatient 4052.62 4052.62 4052.62 74 2998.94 percent of total billed charges 4052.62 93 3282.62 percent of total billed charges 4052.62 4052.62 other OPPS APC 4052.62 4052.62 other OPPS APC 4052.62 27.63 1119.74 percent of total billed charges 4052.62 4052.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L187 MM X W13.5 MM X H3.7 MM TIBIA LEFT DISTAL MEDIAL 10 HOLE WITHOUT TAB ROUND EDGE LOW PROFILE HEAD NONSTERILE 3.5 MM SCREW SUP-02.112.523 CDM 270010022 LOCAL 0270 RC outpatient 3686.54 3686.54 3686.54 74 2728.04 percent of total billed charges 3686.54 93 2986.1 percent of total billed charges 3686.54 3686.54 other OPPS APC 3686.54 3686.54 other OPPS APC 3686.54 27.63 1018.59 percent of total billed charges 3686.54 3686.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L187 MM TIBIA LEFT DISTAL MEDIAL 10 HOLE LOW BEND LOW PROFILE ROUND EDGE STERILE 3.5 MM SCREW SUP-02.112.523S CDM 270010022 LOCAL 0270 RC outpatient 4052.62 4052.62 4052.62 74 2998.94 percent of total billed charges 4052.62 93 3282.62 percent of total billed charges 4052.62 4052.62 other OPPS APC 4052.62 4052.62 other OPPS APC 4052.62 27.63 1119.74 percent of total billed charges 4052.62 4052.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L213 MM X W13.5 MM X H3.7 MM TIBIA RIGHT DISTAL MEDIAL 12 HOLE WITHOUT TAB ROUND EDGE LOW PROFILE HEAD NONSTERILE 3.5 MM SCREW SUP-02.112.526 CDM 270010022 LOCAL 0270 RC outpatient 3283.64 3283.64 3283.64 74 2429.89 percent of total billed charges 3283.64 93 2659.75 percent of total billed charges 3283.64 3283.64 other OPPS APC 3283.64 3283.64 other OPPS APC 3283.64 27.63 907.27 percent of total billed charges 3283.64 3283.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L213 MM TIBIA RIGHT DISTAL MEDIAL 12 HOLE LOW BEND LOW PROFILE ROUND EDGE STERILE 3.5 MM SCREW SUP-02.112.526S CDM 270010022 LOCAL 0270 RC outpatient 4096.95 4096.95 4096.95 74 3031.74 percent of total billed charges 4096.95 93 3318.53 percent of total billed charges 4096.95 4096.95 other OPPS APC 4096.95 4096.95 other OPPS APC 4096.95 27.63 1131.99 percent of total billed charges 4096.95 4096.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L213 MM X W13.5 MM X H3.7 MM TIBIA LEFT DISTAL MEDIAL 12 HOLE WITHOUT TAB ROUND EDGE LOW PROFILE HEAD NONSTERILE 3.5 MM SCREW SUP-02.112.527 CDM 270010022 LOCAL 0270 RC outpatient 3283.64 3283.64 3283.64 74 2429.89 percent of total billed charges 3283.64 93 2659.75 percent of total billed charges 3283.64 3283.64 other OPPS APC 3283.64 3283.64 other OPPS APC 3283.64 27.63 907.27 percent of total billed charges 3283.64 3283.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L213 MM TIBIA LEFT DISTAL MEDIAL 12 HOLE LOW BEND LOW PROFILE ROUND EDGE STERILE 3.5 MM SCREW SUP-02.112.527S CDM 270010022 LOCAL 0270 RC outpatient 3612.78 3612.78 3612.78 74 2673.46 percent of total billed charges 3612.78 93 2926.35 percent of total billed charges 3612.78 3612.78 other OPPS APC 3612.78 3612.78 other OPPS APC 3612.78 27.63 998.21 percent of total billed charges 3612.78 3612.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L239 MM X W13.5 MM X H3.7 MM TIBIA RIGHT DISTAL MEDIAL 14 HOLE WITHOUT TAB ROUND EDGE LOW PROFILE HEAD NONSTERILE 3.5 MM SCREW SUP-02.112.530 CDM 270010022 LOCAL 0270 RC outpatient 3326.52 3326.52 3326.52 74 2461.62 percent of total billed charges 3326.52 93 2694.48 percent of total billed charges 3326.52 3326.52 other OPPS APC 3326.52 3326.52 other OPPS APC 3326.52 27.63 919.12 percent of total billed charges 3326.52 3326.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L239 MM TIBIA LEFT DISTAL MEDIAL 14 HOLE LOW BEND LOW PROFILE ROUND EDGE NONSTERILE 3.5 MM SCREW SUP-02.112.531 CDM 270010022 LOCAL 0270 RC outpatient 3326.52 3326.52 3326.52 74 2461.62 percent of total billed charges 3326.52 93 2694.48 percent of total billed charges 3326.52 3326.52 other OPPS APC 3326.52 3326.52 other OPPS APC 3326.52 27.63 919.12 percent of total billed charges 3326.52 3326.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L239 MM TIBIA LEFT DISTAL MEDIAL 14 HOLE LOW BEND LOW PROFILE ROUND EDGE STERILE 3.5 MM SCREW SUP-02.112.531S CDM 270010022 LOCAL 0270 RC outpatient 4149.86 4149.86 4149.86 74 3070.9 percent of total billed charges 4149.86 93 3361.39 percent of total billed charges 4149.86 4149.86 other OPPS APC 4149.86 4149.86 other OPPS APC 4149.86 27.63 1146.61 percent of total billed charges 4149.86 4149.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L62 MM FIBULA RADIUS TIBIA ULNA 3 HOLE SHARP HOOK LOW PROFILE PRECONTOUR NONSTERILE 3.5 MM SCREW SUP-02.113.103 CDM 270010022 LOCAL 0270 RC outpatient 1097.46 1097.46 1097.46 74 812.12 percent of total billed charges 1097.46 93 888.94 percent of total billed charges 1097.46 1097.46 other OPPS APC 1097.46 1097.46 other OPPS APC 1097.46 27.63 303.23 percent of total billed charges 1097.46 1097.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VOLAR PLATE LEFT SUP-02.115.750 CDM 0270 RC outpatient 2489.76 2489.76 2489.76 74 1842.42 percent of total billed charges 2489.76 93 2016.71 percent of total billed charges 2489.76 2489.76 other OPPS APC 2489.76 2489.76 other OPPS APC 2489.76 27.63 687.92 percent of total billed charges 2489.76 2489.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VOLAR PLATE RIGHT SUP-02.115.751 CDM 0270 RC outpatient 2012.56 2012.56 2012.56 74 1489.29 percent of total billed charges 2012.56 93 1630.17 percent of total billed charges 2012.56 2012.56 other OPPS APC 2012.56 2012.56 other OPPS APC 2012.56 27.63 556.07 percent of total billed charges 2012.56 2012.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VOLAR PLATE RIGHT SUP-02.115.850 CDM 0270 RC outpatient 2489.76 2489.76 2489.76 74 1842.42 percent of total billed charges 2489.76 93 2016.71 percent of total billed charges 2489.76 2489.76 other OPPS APC 2489.76 2489.76 other OPPS APC 2489.76 27.63 687.92 percent of total billed charges 2489.76 2489.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VOLAR PLATE LEFT SUP-02.115.851 CDM 0270 RC outpatient 2489.76 2489.76 2489.76 74 1842.42 percent of total billed charges 2489.76 93 2016.71 percent of total billed charges 2489.76 2489.76 other OPPS APC 2489.76 2489.76 other OPPS APC 2489.76 27.63 687.92 percent of total billed charges 2489.76 2489.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL MEDIUM L82 MM HUMERUS RIGHT DISTAL LATERAL 2 HOLE VARIABLE ANGLE TAPER TIP ROUND PROFILE NONSTERILE 2.7/3.5 MM SCREW SUP-02.117-802 CDM 270010022 LOCAL 0270 RC outpatient 3251.25 3251.25 3251.25 74 2405.93 percent of total billed charges 3251.25 93 2633.51 percent of total billed charges 3251.25 3251.25 other OPPS APC 3251.25 3251.25 other OPPS APC 3251.25 27.63 898.32 percent of total billed charges 3251.25 3251.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2.7/3.5MM VA LCP POSTLAT DISTAL HUMERAL 9 HOLE SUP-02.117.209 CDM 270010022 LOCAL 0270 RC outpatient 3480.36 3480.36 3480.36 74 2575.47 percent of total billed charges 3480.36 93 2819.09 percent of total billed charges 3480.36 3480.36 other OPPS APC 3480.36 3480.36 other OPPS APC 3480.36 27.63 961.62 percent of total billed charges 3480.36 3480.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L179 MM HUMERUS RIGHT DISTAL POSTEROLATERAL 11 HOLE VARIABLE ANGLE TAPER TIP ROUND PROFILE STERILE 2.7/3.5 MM SCREW SUP-02.117.211S CDM 270010022 LOCAL 0270 RC outpatient 3634.8 3634.8 3634.8 74 2689.75 percent of total billed charges 3634.8 93 2944.19 percent of total billed charges 3634.8 3634.8 other OPPS APC 3634.8 3634.8 other OPPS APC 3634.8 27.63 1004.3 percent of total billed charges 3634.8 3634.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L205 MM HUMERUS RIGHT DISTAL POSTEROLATERAL 13 HOLE VARIABLE ANGLE TAPER TIP ROUND PROFILE STERILE 2.7/3.5 MM SCREW SUP-02.117.213S CDM 270010022 LOCAL 0270 RC outpatient 3634.8 3634.8 3634.8 74 2689.75 percent of total billed charges 3634.8 93 2944.19 percent of total billed charges 3634.8 3634.8 other OPPS APC 3634.8 3634.8 other OPPS APC 3634.8 27.63 1004.3 percent of total billed charges 3634.8 3634.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL MEDIUM L88 MM HUMERUS LEFT DISTAL POSTEROLATERAL 4 HOLE VARIABLE ANGLE TAPER TIP ROUND PROFILE NONSTERILE 2.7/3.5 MM SCREW SUP-02.117.304 CDM 270010022 LOCAL 0270 RC outpatient 2813.3 2813.3 2813.3 74 2081.84 percent of total billed charges 2813.3 93 2278.77 percent of total billed charges 2813.3 2813.3 other OPPS APC 2813.3 2813.3 other OPPS APC 2813.3 27.63 777.31 percent of total billed charges 2813.3 2813.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2.7/3.5MM VA LCP POSTLAT DISTAL HUMERAL 7 HOLE SUP-02.117.307 CDM 270010022 LOCAL 0270 RC outpatient 2813.3 2813.3 2813.3 74 2081.84 percent of total billed charges 2813.3 93 2278.77 percent of total billed charges 2813.3 2813.3 other OPPS APC 2813.3 2813.3 other OPPS APC 2813.3 27.63 777.31 percent of total billed charges 2813.3 2813.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL XLONG L153 MM HUMERUS LEFT DISTAL POSTEROLATERAL 9 HOLE VARIABLE ANGLE TAPER TIP ROUND PROFILE NONSTERILE 2.7/3.5 MM SCREW SUP-02.117.309 CDM 270010022 LOCAL 0270 RC outpatient 2813.3 2813.3 2813.3 74 2081.84 percent of total billed charges 2813.3 93 2278.77 percent of total billed charges 2813.3 2813.3 other OPPS APC 2813.3 2813.3 other OPPS APC 2813.3 27.63 777.31 percent of total billed charges 2813.3 2813.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L179 MM HUMERUS LEFT DISTAL POSTEROLATERAL 11 HOLE VARIABLE ANGLE TAPER TIP ROUND PROFILE STERILE 2.7/3.5 MM SCREW SUP-02.117.311S CDM 270010022 LOCAL 0270 RC outpatient 2938.13 2938.13 2938.13 74 2174.22 percent of total billed charges 2938.13 93 2379.89 percent of total billed charges 2938.13 2938.13 other OPPS APC 2938.13 2938.13 other OPPS APC 2938.13 27.63 811.81 percent of total billed charges 2938.13 2938.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L205 MM HUMERUS LEFT DISTAL POSTEROLATERAL 13 HOLE VARIABLE ANGLE TAPER TIP ROUND PROFILE STERILE 2.7/3.5 MM SCREW SUP-02.117.313S CDM 270010022 LOCAL 0270 RC outpatient 2938.13 2938.13 2938.13 74 2174.22 percent of total billed charges 2938.13 93 2379.89 percent of total billed charges 2938.13 2938.13 other OPPS APC 2938.13 2938.13 other OPPS APC 2938.13 27.63 811.81 percent of total billed charges 2938.13 2938.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL SHORT L72 MM HUMERUS RIGHT DISTAL MEDIAL 1 HOLE VARIABLE ANGLE TAPER TIP EXTEND NONSTERILE 2.7/3.5 MM SCREW SUP-02.117.601 CDM 270010022 LOCAL 0270 RC outpatient 2902.82 2902.82 2902.82 74 2148.09 percent of total billed charges 2902.82 93 2351.28 percent of total billed charges 2902.82 2902.82 other OPPS APC 2902.82 2902.82 other OPPS APC 2902.82 27.63 802.05 percent of total billed charges 2902.82 2902.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL MEDIUM L85 MM HUMERUS RIGHT DISTAL MEDIAL 2 HOLE VARIABLE ANGLE TAPER TIP EXTEND NONSTERILE 2.7/3.5 MM SCREW SUP-02.117.602 CDM 270010022 LOCAL 0270 RC outpatient 3591.12 3591.12 3591.12 74 2657.43 percent of total billed charges 3591.12 93 2908.81 percent of total billed charges 3591.12 3591.12 other OPPS APC 3591.12 3591.12 other OPPS APC 3591.12 27.63 992.23 percent of total billed charges 3591.12 3591.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL MEDIUM L85 MM HUMERUS LEFT DISTAL MEDIAL 2 HOLE VARIABLE ANGLE TAPER TIP EXTEND NONSTERILE 2.7/3.5 MM SCREW SUP-02.117.702 CDM 270010022 LOCAL 0270 RC outpatient 2902.82 2902.82 2902.82 74 2148.09 percent of total billed charges 2902.82 93 2351.28 percent of total billed charges 2902.82 2902.82 other OPPS APC 2902.82 2902.82 other OPPS APC 2902.82 27.63 802.05 percent of total billed charges 2902.82 2902.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL LONG L111 MM HUMERUS LEFT DISTAL MEDIAL 4 HOLE VARIABLE ANGLE TAPER TIP EXTEND NONSTERILE 2.7/3.5 MM SCREW SUP-02.117.704 CDM 270010022 LOCAL 0270 RC outpatient 3591.12 3591.12 3591.12 74 2657.43 percent of total billed charges 3591.12 93 2908.81 percent of total billed charges 3591.12 3591.12 other OPPS APC 3591.12 3591.12 other OPPS APC 3591.12 27.63 992.23 percent of total billed charges 3591.12 3591.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE DISTAL HUMERAL 2.7MM 2 HOLE SUP-02.117.802 CDM 270010022 LOCAL 0270 RC outpatient 3480.36 3480.36 3480.36 74 2575.47 percent of total billed charges 3480.36 93 2819.09 percent of total billed charges 3480.36 3480.36 other OPPS APC 3480.36 3480.36 other OPPS APC 3480.36 27.63 961.62 percent of total billed charges 3480.36 3480.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL LONG L121 MM HUMERUS RIGHT DISTAL LATERAL 5 HOLE VARIABLE ANGLE TAPER TIP ROUND PROFILE NONSTERILE 2.7/3.5 MM SCREW SUP-02.117.805 CDM 270010022 LOCAL 0270 RC outpatient 3480.36 3480.36 3480.36 74 2575.47 percent of total billed charges 3480.36 93 2819.09 percent of total billed charges 3480.36 3480.36 other OPPS APC 3480.36 3480.36 other OPPS APC 3480.36 27.63 961.62 percent of total billed charges 3480.36 3480.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T8 L14 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE HEAD NONSTERILE SUP-02.118.514 CDM 270010022 LOCAL 0270 RC outpatient 104.68 104.68 104.68 74 77.46 percent of total billed charges 104.68 93 84.79 percent of total billed charges 104.68 104.68 other OPPS APC 104.68 104.68 other OPPS APC 104.68 27.63 28.92 percent of total billed charges 104.68 104.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T8 L16 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE HEAD NONSTERILE SUP-02.118.516 CDM 270010022 LOCAL 0270 RC outpatient 129.48 129.48 129.48 74 95.82 percent of total billed charges 129.48 93 104.88 percent of total billed charges 129.48 129.48 other OPPS APC 129.48 129.48 other OPPS APC 129.48 27.63 35.78 percent of total billed charges 129.48 129.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L18 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE NONSTERILE SUP-02.118.518 CDM 270010022 LOCAL 0270 RC outpatient 104.68 104.68 104.68 74 77.46 percent of total billed charges 104.68 93 84.79 percent of total billed charges 104.68 104.68 other OPPS APC 104.68 104.68 other OPPS APC 104.68 27.63 28.92 percent of total billed charges 104.68 104.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L20 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE NONSTERILE SUP-02.118.520 CDM 270010022 LOCAL 0270 RC outpatient 129.48 129.48 129.48 74 95.82 percent of total billed charges 129.48 93 104.88 percent of total billed charges 129.48 129.48 other OPPS APC 129.48 129.48 other OPPS APC 129.48 27.63 35.78 percent of total billed charges 129.48 129.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T8 L22 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE HEAD NONSTERILE SUP-02.118.522 CDM 270010022 LOCAL 0270 RC outpatient 104.68 104.68 104.68 74 77.46 percent of total billed charges 104.68 93 84.79 percent of total billed charges 104.68 104.68 other OPPS APC 104.68 104.68 other OPPS APC 104.68 27.63 28.92 percent of total billed charges 104.68 104.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 24MM 2.7MM SS NS METAPHYSEAL SELF TAP LOW PROFILE STARDRIVE SUP-02.118.524 CDM 270010022 LOCAL 0270 RC outpatient 104.68 104.68 104.68 74 77.46 percent of total billed charges 104.68 93 84.79 percent of total billed charges 104.68 104.68 other OPPS APC 104.68 104.68 other OPPS APC 104.68 27.63 28.92 percent of total billed charges 104.68 104.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L26 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE NONSTERILE SUP-02.118.526 CDM 270010022 LOCAL 0270 RC outpatient 104.68 104.68 104.68 74 77.46 percent of total billed charges 104.68 93 84.79 percent of total billed charges 104.68 104.68 other OPPS APC 104.68 104.68 other OPPS APC 104.68 27.63 28.92 percent of total billed charges 104.68 104.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L28 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE NONSTERILE SUP-02.118.528 CDM 270010022 LOCAL 0270 RC outpatient 104.68 104.68 104.68 74 77.46 percent of total billed charges 104.68 93 84.79 percent of total billed charges 104.68 104.68 other OPPS APC 104.68 104.68 other OPPS APC 104.68 27.63 28.92 percent of total billed charges 104.68 104.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L30 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE NONSTERILE SUP-02.118.530 CDM 270010022 LOCAL 0270 RC outpatient 129.48 129.48 129.48 74 95.82 percent of total billed charges 129.48 93 104.88 percent of total billed charges 129.48 129.48 other OPPS APC 129.48 129.48 other OPPS APC 129.48 27.63 35.78 percent of total billed charges 129.48 129.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T8 L32 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE HEAD NONSTERILE SUP-02.118.532 CDM 270010022 LOCAL 0270 RC outpatient 104.68 104.68 104.68 74 77.46 percent of total billed charges 104.68 93 84.79 percent of total billed charges 104.68 104.68 other OPPS APC 104.68 104.68 other OPPS APC 104.68 27.63 28.92 percent of total billed charges 104.68 104.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7MM X 34MM SUP-02.118.534 CDM 270010022 LOCAL 0270 RC outpatient 104.68 104.68 104.68 74 77.46 percent of total billed charges 104.68 93 84.79 percent of total billed charges 104.68 104.68 other OPPS APC 104.68 104.68 other OPPS APC 104.68 27.63 28.92 percent of total billed charges 104.68 104.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T8 L36 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE HEAD NONSTERILE SUP-02.118.536 CDM 270010022 LOCAL 0270 RC outpatient 104.68 104.68 104.68 74 77.46 percent of total billed charges 104.68 93 84.79 percent of total billed charges 104.68 104.68 other OPPS APC 104.68 104.68 other OPPS APC 104.68 27.63 28.92 percent of total billed charges 104.68 104.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T8 L38 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE HEAD NONSTERILE SUP-02.118.538 CDM 270010022 LOCAL 0270 RC outpatient 104.68 104.68 104.68 74 77.46 percent of total billed charges 104.68 93 84.79 percent of total billed charges 104.68 104.68 other OPPS APC 104.68 104.68 other OPPS APC 104.68 27.63 28.92 percent of total billed charges 104.68 104.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L40 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE NONSTERILE SUP-02.118.540 CDM 270010022 LOCAL 0270 RC outpatient 104.68 104.68 104.68 74 77.46 percent of total billed charges 104.68 93 84.79 percent of total billed charges 104.68 104.68 other OPPS APC 104.68 104.68 other OPPS APC 104.68 27.63 28.92 percent of total billed charges 104.68 104.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L42 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE NONSTERILE SUP-02.118.542 CDM 270010022 LOCAL 0270 RC outpatient 104.68 104.68 104.68 74 77.46 percent of total billed charges 104.68 93 84.79 percent of total billed charges 104.68 104.68 other OPPS APC 104.68 104.68 other OPPS APC 104.68 27.63 28.92 percent of total billed charges 104.68 104.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L44 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE NONSTERILE SUP-02.118.544 CDM 270010022 LOCAL 0270 RC outpatient 104.68 104.68 104.68 74 77.46 percent of total billed charges 104.68 93 84.79 percent of total billed charges 104.68 104.68 other OPPS APC 104.68 104.68 other OPPS APC 104.68 27.63 28.92 percent of total billed charges 104.68 104.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T8 L46 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE HEAD NONSTERILE SUP-02.118.546 CDM 270010022 LOCAL 0270 RC outpatient 104.68 104.68 104.68 74 77.46 percent of total billed charges 104.68 93 84.79 percent of total billed charges 104.68 104.68 other OPPS APC 104.68 104.68 other OPPS APC 104.68 27.63 28.92 percent of total billed charges 104.68 104.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T8 L48 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE HEAD NONSTERILE SUP-02.118.548 CDM 270010022 LOCAL 0270 RC outpatient 129.48 129.48 129.48 74 95.82 percent of total billed charges 129.48 93 104.88 percent of total billed charges 129.48 129.48 other OPPS APC 129.48 129.48 other OPPS APC 129.48 27.63 35.78 percent of total billed charges 129.48 129.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L50 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE NONSTERILE SUP-02.118.550 CDM 270010022 LOCAL 0270 RC outpatient 129.48 129.48 129.48 74 95.82 percent of total billed charges 129.48 93 104.88 percent of total billed charges 129.48 129.48 other OPPS APC 129.48 129.48 other OPPS APC 129.48 27.63 35.78 percent of total billed charges 129.48 129.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T8 L52 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE HEAD NONSTERILE SUP-02.118.552 CDM 270010022 LOCAL 0270 RC outpatient 130.42 130.42 130.42 74 96.51 percent of total billed charges 130.42 93 105.64 percent of total billed charges 130.42 130.42 other OPPS APC 130.42 130.42 other OPPS APC 130.42 27.63 36.04 percent of total billed charges 130.42 130.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L54 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE NONSTERILE SUP-02.118.554 CDM 270010022 LOCAL 0270 RC outpatient 104.68 104.68 104.68 74 77.46 percent of total billed charges 104.68 93 84.79 percent of total billed charges 104.68 104.68 other OPPS APC 104.68 104.68 other OPPS APC 104.68 27.63 28.92 percent of total billed charges 104.68 104.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L56 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE NONSTERILE SUP-02.118.556 CDM 270010022 LOCAL 0270 RC outpatient 104.68 104.68 104.68 74 77.46 percent of total billed charges 104.68 93 84.79 percent of total billed charges 104.68 104.68 other OPPS APC 104.68 104.68 other OPPS APC 104.68 27.63 28.92 percent of total billed charges 104.68 104.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP T8 58MM 2.7MM SS NS ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE SUP-02.118.558 CDM 270010022 LOCAL 0270 RC outpatient 129.48 129.48 129.48 74 95.82 percent of total billed charges 129.48 93 104.88 percent of total billed charges 129.48 129.48 other OPPS APC 129.48 129.48 other OPPS APC 129.48 27.63 35.78 percent of total billed charges 129.48 129.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L60 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE NONSTERILE SUP-02.118.560 CDM 270010022 LOCAL 0270 RC outpatient 104.68 104.68 104.68 74 77.46 percent of total billed charges 104.68 93 84.79 percent of total billed charges 104.68 104.68 other OPPS APC 104.68 104.68 other OPPS APC 104.68 27.63 28.92 percent of total billed charges 104.68 104.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L62 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP STARDRIVE LOW PROFILE NONSTERILE SUP-02.118.562 CDM 270010022 LOCAL 0270 RC outpatient 129.48 129.48 129.48 74 95.82 percent of total billed charges 129.48 93 104.88 percent of total billed charges 129.48 129.48 other OPPS APC 129.48 129.48 other OPPS APC 129.48 27.63 35.78 percent of total billed charges 129.48 129.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T8 L66 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP LOW PROFILE HEAD STARDRIVE NONSTERILE SUP-02.118.566 CDM 270010022 LOCAL 0270 RC outpatient 129.48 129.48 129.48 74 95.82 percent of total billed charges 129.48 93 104.88 percent of total billed charges 129.48 129.48 other OPPS APC 129.48 129.48 other OPPS APC 129.48 27.63 35.78 percent of total billed charges 129.48 129.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T8 L68 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP LOW PROFILE HEAD STARDRIVE NONSTERILE SUP-02.118.568 CDM 270010022 LOCAL 0270 RC outpatient 104.68 104.68 104.68 74 77.46 percent of total billed charges 104.68 93 84.79 percent of total billed charges 104.68 104.68 other OPPS APC 104.68 104.68 other OPPS APC 104.68 27.63 28.92 percent of total billed charges 104.68 104.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T8 L70 MM OD2.7 MM ELBOW METAPHYSEAL SELF TAP LOW PROFILE HEAD STARDRIVE NONSTERILE SUP-02.118.570 CDM 270010022 LOCAL 0270 RC outpatient 104.68 104.68 104.68 74 77.46 percent of total billed charges 104.68 93 84.79 percent of total billed charges 104.68 104.68 other OPPS APC 104.68 104.68 other OPPS APC 104.68 27.63 28.92 percent of total billed charges 104.68 104.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL GMK 2 H12 MM RIGHT FIXED SPHERE FLEX SUP-02.12.0212FR CDM 270010025 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL GMK 3 H17 MM RIGHT FIXED SPHERE FLEX SUP-02.12.0317FR CDM 270010025 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL GMK T3I4 KNEE RIGHT CEMENT FIX SUP-02.12.T3I4R CDM 270010025 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L79 MM TIBIA PROXIMAL POSTEROMEDIAL 2 HOLE LOW PROFILE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.120.702 CDM 270010022 LOCAL 0270 RC outpatient 2619.11 2619.11 2619.11 74 1938.14 percent of total billed charges 2619.11 93 2121.48 percent of total billed charges 2619.11 2619.11 other OPPS APC 2619.11 2619.11 other OPPS APC 2619.11 27.63 723.66 percent of total billed charges 2619.11 2619.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L105 MM TIBIA PROXIMAL POSTEROMEDIAL 4 HOLE LOW PROFILE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.120.704 CDM 270010022 LOCAL 0270 RC outpatient 2646.85 2646.85 2646.85 74 1958.67 percent of total billed charges 2646.85 93 2143.95 percent of total billed charges 2646.85 2646.85 other OPPS APC 2646.85 2646.85 other OPPS APC 2646.85 27.63 731.32 percent of total billed charges 2646.85 2646.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L131 MM TIBIA PROXIMAL POSTEROMEDIAL 6 HOLE LOW PROFILE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.120.706 CDM 270010022 LOCAL 0270 RC outpatient 3030.17 3030.17 3030.17 74 2242.33 percent of total billed charges 3030.17 93 2454.44 percent of total billed charges 3030.17 3030.17 other OPPS APC 3030.17 3030.17 other OPPS APC 3030.17 27.63 837.24 percent of total billed charges 3030.17 3030.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L91 MM HUMERUS RIGHT PERIARTICULAR PROXIMAL 2 HOLE LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-02.123.020 CDM 270010022 LOCAL 0270 RC outpatient 4262.86 4262.86 4262.86 74 3154.52 percent of total billed charges 4262.86 93 3452.92 percent of total billed charges 4262.86 4262.86 other OPPS APC 4262.86 4262.86 other OPPS APC 4262.86 27.63 1177.83 percent of total billed charges 4262.86 4262.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L91 MM HUMERUS LEFT PERIARTICULAR PROXIMAL 2 HOLE LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-02.123.021 CDM 270010022 LOCAL 0270 RC outpatient 4262.86 4262.86 4262.86 74 3154.52 percent of total billed charges 4262.86 93 3452.92 percent of total billed charges 4262.86 4262.86 other OPPS APC 4262.86 4262.86 other OPPS APC 4262.86 27.63 1177.83 percent of total billed charges 4262.86 4262.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L127 MM HUMERUS RIGHT PERIARTICULAR PROXIMAL 4 HOLE LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-02.123.022 CDM 270010022 LOCAL 0270 RC outpatient 4643.21 4643.21 4643.21 74 3435.98 percent of total billed charges 4643.21 93 3761 percent of total billed charges 4643.21 4643.21 other OPPS APC 4643.21 4643.21 other OPPS APC 4643.21 27.63 1282.92 percent of total billed charges 4643.21 4643.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L127 MM HUMERUS LEFT PERIARTICULAR PROXIMAL 4 HOLE LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-02.123.023 CDM 270010022 LOCAL 0270 RC outpatient 4643.21 4643.21 4643.21 74 3435.98 percent of total billed charges 4643.21 93 3761 percent of total billed charges 4643.21 4643.21 other OPPS APC 4643.21 4643.21 other OPPS APC 4643.21 27.63 1282.92 percent of total billed charges 4643.21 4643.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE HUMERUS 3 HOLE RIGHT SUP-02.123.040 CDM 270010022 LOCAL 0270 RC outpatient 4325.05 4325.05 4325.05 74 3200.54 percent of total billed charges 4325.05 93 3503.29 percent of total billed charges 4325.05 4325.05 other OPPS APC 4325.05 4325.05 other OPPS APC 4325.05 27.63 1195.01 percent of total billed charges 4325.05 4325.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE HUMERUS 3 HOLE LEFT SUP-02.123.041 CDM 270010022 LOCAL 0270 RC outpatient 4325.05 4325.05 4325.05 74 3200.54 percent of total billed charges 4325.05 93 3503.29 percent of total billed charges 4325.05 4325.05 other OPPS APC 4325.05 4325.05 other OPPS APC 4325.05 27.63 1195.01 percent of total billed charges 4325.05 4325.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L76 MM TIBIA RIGHT PROXIMAL 4 HOLE LOW BEND LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.124.200 CDM 270010022 LOCAL 0270 RC outpatient 3229.43 3229.43 3229.43 74 2389.78 percent of total billed charges 3229.43 93 2615.84 percent of total billed charges 3229.43 3229.43 other OPPS APC 3229.43 3229.43 other OPPS APC 3229.43 27.63 892.29 percent of total billed charges 3229.43 3229.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L76 MM TIBIA LEFT PROXIMAL 4 HOLE LOW BEND LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.124.201 CDM 270010022 LOCAL 0270 RC outpatient 3229.43 3229.43 3229.43 74 2389.78 percent of total billed charges 3229.43 93 2615.84 percent of total billed charges 3229.43 3229.43 other OPPS APC 3229.43 3229.43 other OPPS APC 3229.43 27.63 892.29 percent of total billed charges 3229.43 3229.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L102 MM TIBIA RIGHT PROXIMAL 6 HOLE LOW BEND LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.124.204 CDM 270010022 LOCAL 0270 RC outpatient 3268.51 3268.51 3268.51 74 2418.7 percent of total billed charges 3268.51 93 2647.49 percent of total billed charges 3268.51 3268.51 other OPPS APC 3268.51 3268.51 other OPPS APC 3268.51 27.63 903.09 percent of total billed charges 3268.51 3268.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L102 MM TIBIA LEFT PROXIMAL 6 HOLE LOW BEND LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.124.205 CDM 270010022 LOCAL 0270 RC outpatient 3268.51 3268.51 3268.51 74 2418.7 percent of total billed charges 3268.51 93 2647.49 percent of total billed charges 3268.51 3268.51 other OPPS APC 3268.51 3268.51 other OPPS APC 3268.51 27.63 903.09 percent of total billed charges 3268.51 3268.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L128 MM TIBIA RIGHT PROXIMAL 8 HOLE LOW BEND LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.124.208 CDM 270010022 LOCAL 0270 RC outpatient 3303.82 3303.82 3303.82 74 2444.83 percent of total billed charges 3303.82 93 2676.09 percent of total billed charges 3303.82 3303.82 other OPPS APC 3303.82 3303.82 other OPPS APC 3303.82 27.63 912.85 percent of total billed charges 3303.82 3303.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L128 MM TIBIA LEFT PROXIMAL 8 HOLE LOW BEND LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.124.209 CDM 270010022 LOCAL 0270 RC outpatient 3303.82 3303.82 3303.82 74 2444.83 percent of total billed charges 3303.82 93 2676.09 percent of total billed charges 3303.82 3303.82 other OPPS APC 3303.82 3303.82 other OPPS APC 3303.82 27.63 912.85 percent of total billed charges 3303.82 3303.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L154 MM TIBIA RIGHT PROXIMAL 10 HOLE LOW BEND LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.124.212 CDM 270010022 LOCAL 0270 RC outpatient 3788.07 3788.07 3788.07 74 2803.17 percent of total billed charges 3788.07 93 3068.34 percent of total billed charges 3788.07 3788.07 other OPPS APC 3788.07 3788.07 other OPPS APC 3788.07 27.63 1046.64 percent of total billed charges 3788.07 3788.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L154 MM TIBIA LEFT PROXIMAL 10 HOLE LOW BEND LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.124.213 CDM 270010022 LOCAL 0270 RC outpatient 3788.07 3788.07 3788.07 74 2803.17 percent of total billed charges 3788.07 93 3068.34 percent of total billed charges 3788.07 3788.07 other OPPS APC 3788.07 3788.07 other OPPS APC 3788.07 27.63 1046.64 percent of total billed charges 3788.07 3788.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L180 MM TIBIA RIGHT PROXIMAL 12 HOLE LOW BEND LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.124.216 CDM 270010022 LOCAL 0270 RC outpatient 3500.54 3500.54 3500.54 74 2590.4 percent of total billed charges 3500.54 93 2835.44 percent of total billed charges 3500.54 3500.54 other OPPS APC 3500.54 3500.54 other OPPS APC 3500.54 27.63 967.2 percent of total billed charges 3500.54 3500.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L180 MM TIBIA LEFT PROXIMAL 12 HOLE LOW BEND LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.124.217 CDM 270010022 LOCAL 0270 RC outpatient 3500.54 3500.54 3500.54 74 2590.4 percent of total billed charges 3500.54 93 2835.44 percent of total billed charges 3500.54 3500.54 other OPPS APC 3500.54 3500.54 other OPPS APC 3500.54 27.63 967.2 percent of total billed charges 3500.54 3500.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L206 MM TIBIA RIGHT PROXIMAL 14 HOLE LOW BEND LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.124.220 CDM 270010022 LOCAL 0270 RC outpatient 4012.58 4012.58 4012.58 74 2969.31 percent of total billed charges 4012.58 93 3250.19 percent of total billed charges 4012.58 4012.58 other OPPS APC 4012.58 4012.58 other OPPS APC 4012.58 27.63 1108.68 percent of total billed charges 4012.58 4012.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L206 MM TIBIA LEFT PROXIMAL 14 HOLE LOW BEND LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.124.221 CDM 270010022 LOCAL 0270 RC outpatient 3538.37 3538.37 3538.37 74 2618.39 percent of total billed charges 3538.37 93 2866.08 percent of total billed charges 3538.37 3538.37 other OPPS APC 3538.37 3538.37 other OPPS APC 3538.37 27.63 977.65 percent of total billed charges 3538.37 3538.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L232 MM TIBIA RIGHT PROXIMAL 16 HOLE LOW BEND LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.124.224 CDM 270010022 LOCAL 0270 RC outpatient 4149.86 4149.86 4149.86 74 3070.9 percent of total billed charges 4149.86 93 3361.39 percent of total billed charges 4149.86 4149.86 other OPPS APC 4149.86 4149.86 other OPPS APC 4149.86 27.63 1146.61 percent of total billed charges 4149.86 4149.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L232 MM TIBIA LEFT PROXIMAL 16 HOLE LOW BEND LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-02.124.225 CDM 270010022 LOCAL 0270 RC outpatient 4149.86 4149.86 4149.86 74 3070.9 percent of total billed charges 4149.86 93 3361.39 percent of total billed charges 4149.86 4149.86 other OPPS APC 4149.86 4149.86 other OPPS APC 4149.86 27.63 1146.61 percent of total billed charges 4149.86 4149.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CURVE L336 MM CONDYLAR RIGHT PERIARTICULAR 16 HOLE 4 COLUMN THREAD VARIABLE ANGLE NONSTERILE 4.5 MM SCREW SUP-02.124.416 CDM 270010022 LOCAL 0270 RC outpatient 5126.78 5126.78 5126.78 74 3793.82 percent of total billed charges 5126.78 93 4152.69 percent of total billed charges 5126.78 5126.78 other OPPS APC 5126.78 5126.78 other OPPS APC 5126.78 27.63 1416.53 percent of total billed charges 5126.78 5126.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CURVE L336 MM CONDYLAR LEFT PERIARTICULAR 16 HOLE 4 COLUMN THREAD VARIABLE ANGLE NONSTERILE 4.5 MM SCREW SUP-02.124.417 CDM 270010022 LOCAL 0270 RC outpatient 5126.78 5126.78 5126.78 74 3793.82 percent of total billed charges 5126.78 93 4152.69 percent of total billed charges 5126.78 5126.78 other OPPS APC 5126.78 5126.78 other OPPS APC 5126.78 27.63 1416.53 percent of total billed charges 5126.78 5126.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CURVE L370 MM CONDYLAR RIGHT PERIARTICULAR 18 HOLE 4 COLUMN THREAD VARIABLE ANGLE NONSTERILE 4.5 MM SCREW SUP-02.124.418 CDM 270010022 LOCAL 0270 RC outpatient 5459.38 5459.38 5459.38 74 4039.94 percent of total billed charges 5459.38 93 4422.1 percent of total billed charges 5459.38 5459.38 other OPPS APC 5459.38 5459.38 other OPPS APC 5459.38 27.63 1508.43 percent of total billed charges 5459.38 5459.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CURVE L370 MM CONDYLAR LEFT PERIARTICULAR 18 HOLE 4 COLUMN THREAD VARIABLE ANGLE NONSTERILE 4.5 MM SCREW SUP-02.124.419 CDM 270010022 LOCAL 0270 RC outpatient 5459.38 5459.38 5459.38 74 4039.94 percent of total billed charges 5459.38 93 4422.1 percent of total billed charges 5459.38 5459.38 other OPPS APC 5459.38 5459.38 other OPPS APC 5459.38 27.63 1508.43 percent of total billed charges 5459.38 5459.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CURVE L405 MM CONDYLAR RIGHT PERIARTICULAR 20 HOLE 4 COLUMN THREAD VARIABLE ANGLE STERILE 4.5 MM SCREW SUP-02.124.420S CDM 270010022 LOCAL 0270 RC outpatient 6715.38 6715.38 6715.38 74 4969.38 percent of total billed charges 6715.38 93 5439.46 percent of total billed charges 6715.38 6715.38 other OPPS APC 6715.38 6715.38 other OPPS APC 6715.38 27.63 1855.46 percent of total billed charges 6715.38 6715.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CURVE L405 MM CONDYLAR LEFT PERIARTICULAR 20 HOLE 4 COLUMN THREAD VARIABLE ANGLE STERILE 4.5 MM SCREW SUP-02.124.421S CDM 270010022 LOCAL 0270 RC outpatient 6715.38 6715.38 6715.38 74 4969.38 percent of total billed charges 6715.38 93 5439.46 percent of total billed charges 6715.38 6715.38 other OPPS APC 6715.38 6715.38 other OPPS APC 6715.38 27.63 1855.46 percent of total billed charges 6715.38 6715.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CURVE L439 MM CONDYLAR RIGHT PERIARTICULAR 22 HOLE 4 COLUMN THREAD VARIABLE ANGLE STERILE 4.5 MM SCREW SUP-02.124.422S CDM 270010022 LOCAL 0270 RC outpatient 8317.92 8317.92 8317.92 74 6155.26 percent of total billed charges 8317.92 93 6737.52 percent of total billed charges 8317.92 8317.92 other OPPS APC 8317.92 8317.92 other OPPS APC 8317.92 27.63 2298.24 percent of total billed charges 8317.92 8317.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CURVE L439 MM CONDYLAR LEFT PERIARTICULAR 22 HOLE 4 COLUMN THREAD VARIABLE ANGLE STERILE 4.5 MM SCREW SUP-02.124.423S CDM 270010022 LOCAL 0270 RC outpatient 8317.92 8317.92 8317.92 74 6155.26 percent of total billed charges 8317.92 93 6737.52 percent of total billed charges 8317.92 8317.92 other OPPS APC 8317.92 8317.92 other OPPS APC 8317.92 27.63 2298.24 percent of total billed charges 8317.92 8317.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T15 L36 MM OD3.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-02.127.136 CDM 0270 RC outpatient 370.45 370.45 370.45 74 274.13 percent of total billed charges 370.45 93 300.06 percent of total billed charges 370.45 370.45 other OPPS APC 370.45 370.45 other OPPS APC 370.45 27.63 102.36 percent of total billed charges 370.45 370.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T15 L44 MM OD3.5 MM TIBIA PROXIMAL SELF TAP VARIABLE ANGLE LOCK STARDRIVE SUP-02.127.144 CDM 0270 RC outpatient 370.45 370.45 370.45 74 274.13 percent of total billed charges 370.45 93 300.06 percent of total billed charges 370.45 370.45 other OPPS APC 370.45 370.45 other OPPS APC 370.45 27.63 102.36 percent of total billed charges 370.45 370.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T15 L48 MM OD3.5 MM SELF TAP VARIABLE ANGLE LOCK STARDRIVE NONSTERILE SUP-02.127.148 CDM 0270 RC outpatient 370.45 370.45 370.45 74 274.13 percent of total billed charges 370.45 93 300.06 percent of total billed charges 370.45 370.45 other OPPS APC 370.45 370.45 other OPPS APC 370.45 27.63 102.36 percent of total billed charges 370.45 370.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T15 L50 MM OD3.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-02.127.150 CDM 0270 RC outpatient 370.45 370.45 370.45 74 274.13 percent of total billed charges 370.45 93 300.06 percent of total billed charges 370.45 370.45 other OPPS APC 370.45 370.45 other OPPS APC 370.45 27.63 102.36 percent of total billed charges 370.45 370.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T15 L58 MM OD3.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-02.127.158 CDM 0270 RC outpatient 811.2 811.2 811.2 74 600.29 percent of total billed charges 811.2 93 657.07 percent of total billed charges 811.2 811.2 other OPPS APC 811.2 811.2 other OPPS APC 811.2 27.63 224.13 percent of total billed charges 811.2 811.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T15 L60 MM OD3.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-02.127.160 CDM 0270 RC outpatient 811.2 811.2 811.2 74 600.29 percent of total billed charges 811.2 93 657.07 percent of total billed charges 811.2 811.2 other OPPS APC 811.2 811.2 other OPPS APC 811.2 27.63 224.13 percent of total billed charges 811.2 811.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T15 L65 MM OD3.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-02.127.165 CDM 0270 RC outpatient 811.2 811.2 811.2 74 600.29 percent of total billed charges 811.2 93 657.07 percent of total billed charges 811.2 811.2 other OPPS APC 811.2 811.2 other OPPS APC 811.2 27.63 224.13 percent of total billed charges 811.2 811.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T15 L70 MM OD3.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-02.127.170 CDM 0270 RC outpatient 811.2 811.2 811.2 74 600.29 percent of total billed charges 811.2 93 657.07 percent of total billed charges 811.2 811.2 other OPPS APC 811.2 811.2 other OPPS APC 811.2 27.63 224.13 percent of total billed charges 811.2 811.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T15 L75 MM OD3.5 MM TIBIA PROXIMAL SELF TAP VARIABLE ANGLE LOCK STARDRIVE SUP-02.127.175 CDM 0270 RC outpatient 811.2 811.2 811.2 74 600.29 percent of total billed charges 811.2 93 657.07 percent of total billed charges 811.2 811.2 other OPPS APC 811.2 811.2 other OPPS APC 811.2 27.63 224.13 percent of total billed charges 811.2 811.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T15 L80 MM OD3.5 MM TIBIA PROXIMAL SELF TAP VARIABLE ANGLE LOCK STARDRIVE SUP-02.127.180 CDM 0270 RC outpatient 811.2 811.2 811.2 74 600.29 percent of total billed charges 811.2 93 657.07 percent of total billed charges 811.2 811.2 other OPPS APC 811.2 811.2 other OPPS APC 811.2 27.63 224.13 percent of total billed charges 811.2 811.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T15 L85 MM OD3.5 MM TIBIA PROXIMAL SELF TAP VARIABLE ANGLE LOCK STARDRIVE SUP-02.127.185 CDM 0270 RC outpatient 811.2 811.2 811.2 74 600.29 percent of total billed charges 811.2 93 657.07 percent of total billed charges 811.2 811.2 other OPPS APC 811.2 811.2 other OPPS APC 811.2 27.63 224.13 percent of total billed charges 811.2 811.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T15 L90 MM OD3.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE SUP-02.127.190 CDM 0270 RC outpatient 370.45 370.45 370.45 74 274.13 percent of total billed charges 370.45 93 300.06 percent of total billed charges 370.45 370.45 other OPPS APC 370.45 370.45 other OPPS APC 370.45 27.63 102.36 percent of total billed charges 370.45 370.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T4 L6 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM SUP-02.130.206 CDM outpatient 333.84 333.84 333.84 333.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T4 L7 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM SUP-02.130.207 CDM 270010022 LOCAL 0270 RC outpatient 333.84 333.84 333.84 74 247.04 percent of total billed charges 333.84 93 270.41 percent of total billed charges 333.84 333.84 other OPPS APC 333.84 333.84 other OPPS APC 333.84 27.63 92.24 percent of total billed charges 333.84 333.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM SUP-02.130.211 CDM 270010022 LOCAL 0270 RC outpatient 333.84 333.84 333.84 74 247.04 percent of total billed charges 333.84 93 270.41 percent of total billed charges 333.84 333.84 other OPPS APC 333.84 333.84 other OPPS APC 333.84 27.63 92.24 percent of total billed charges 333.84 333.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T4 L14 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM SUP-02.130.214 CDM 270010022 LOCAL 0270 RC outpatient 333.84 333.84 333.84 74 247.04 percent of total billed charges 333.84 93 270.41 percent of total billed charges 333.84 333.84 other OPPS APC 333.84 333.84 other OPPS APC 333.84 27.63 92.24 percent of total billed charges 333.84 333.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T4 L20 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM SUP-02.130.220 CDM 270010022 LOCAL 0270 RC outpatient 333.84 333.84 333.84 74 247.04 percent of total billed charges 333.84 93 270.41 percent of total billed charges 333.84 333.84 other OPPS APC 333.84 333.84 other OPPS APC 333.84 27.63 92.24 percent of total billed charges 333.84 333.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL STRAIGHT H1 MM HAND 12 HOLE LOCK VARIABLE ANGLE NONSTERILE 1.5 MM SCREW SUP-02.130.251 CDM 270010022 LOCAL 0270 RC outpatient 1344.72 1344.72 1344.72 74 995.09 percent of total billed charges 1344.72 93 1089.22 percent of total billed charges 1344.72 1344.72 other OPPS APC 1344.72 1344.72 other OPPS APC 1344.72 27.63 371.55 percent of total billed charges 1344.72 1344.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T6 L11 MM OD2 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM SUP-02.130.311 CDM 270010022 LOCAL 0270 RC outpatient 347.88 347.88 347.88 74 257.43 percent of total billed charges 347.88 93 281.78 percent of total billed charges 347.88 347.88 other OPPS APC 347.88 347.88 other OPPS APC 347.88 27.63 96.12 percent of total billed charges 347.88 347.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T6 L13 MM OD2 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM SUP-02.130.313 CDM 270010022 LOCAL 0270 RC outpatient 347.88 347.88 347.88 74 257.43 percent of total billed charges 347.88 93 281.78 percent of total billed charges 347.88 347.88 other OPPS APC 347.88 347.88 other OPPS APC 347.88 27.63 96.12 percent of total billed charges 347.88 347.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T6 L15 MM OD2 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM SUP-02.130.315 CDM 270010022 LOCAL 0270 RC outpatient 347.88 347.88 347.88 74 257.43 percent of total billed charges 347.88 93 281.78 percent of total billed charges 347.88 347.88 other OPPS APC 347.88 347.88 other OPPS APC 347.88 27.63 96.12 percent of total billed charges 347.88 347.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL H1.3 MM HAND CONDYLAR 2 HOLE HEAD 6 HOLE SHAFT LOCK VARIABLE ANGLE NONSTERILE 2 MM SCREW SUP-02.130.355 CDM 270010022 LOCAL 0270 RC outpatient 1655.16 1655.16 1655.16 74 1224.82 percent of total billed charges 1655.16 93 1340.68 percent of total billed charges 1655.16 1655.16 other OPPS APC 1655.16 1655.16 other OPPS APC 1655.16 27.63 457.32 percent of total billed charges 1655.16 1655.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL SMALL PATELLA ANTERIOR LOCK VARIABLE ANGLE CORE STERILE 2.7 MM SCREW SUP-02.137.000S CDM 27000000 LOCAL 0270 RC outpatient 5910.84 5910.84 5910.84 74 4374.02 percent of total billed charges 5910.84 93 4787.78 percent of total billed charges 5910.84 5910.84 other OPPS APC 5910.84 5910.84 other OPPS APC 5910.84 27.63 1633.17 percent of total billed charges 5910.84 5910.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE SMALL PATELLA ANTERIOR 3 HOLE VARIABLE ANGLE LOCK STERILE 2.7 MM SCREW SUP-02.137.001S CDM 27000000 LOCAL 0270 RC outpatient 9967.1 9967.1 9967.1 74 7375.65 percent of total billed charges 9967.1 93 8073.35 percent of total billed charges 9967.1 9967.1 other OPPS APC 9967.1 9967.1 other OPPS APC 9967.1 27.63 2753.91 percent of total billed charges 9967.1 9967.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL SMALL PATELLA ANTERIOR 6 HOLE VARIALBE ANGLE LOCK WINDOW STERILE 2.7 MM SCREW SUP-02.137.002S CDM 27000000 LOCAL 0270 RC outpatient 6502.08 6502.08 6502.08 74 4811.54 percent of total billed charges 6502.08 93 5266.68 percent of total billed charges 6502.08 6502.08 other OPPS APC 6502.08 6502.08 other OPPS APC 6502.08 27.63 1796.52 percent of total billed charges 6502.08 6502.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL PATELLA ANTERIOR 3 HOLE LOCK VARIABLE ANGLE CORE STERILE 2.7 MM SCREW SUP-02.137.003S CDM 27000000 LOCAL 0270 RC outpatient 5910.84 5910.84 5910.84 74 4374.02 percent of total billed charges 5910.84 93 4787.78 percent of total billed charges 5910.84 5910.84 other OPPS APC 5910.84 5910.84 other OPPS APC 5910.84 27.63 1633.17 percent of total billed charges 5910.84 5910.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL PATELLA ANTERIOR 3 HOLE LOCK VARIABLE ANGLE STERILE 2.7 MM SCREW SUP-02.137.004S CDM 27000000 LOCAL 0270 RC outpatient 5910.84 5910.84 5910.84 74 4374.02 percent of total billed charges 5910.84 93 4787.78 percent of total billed charges 5910.84 5910.84 other OPPS APC 5910.84 5910.84 other OPPS APC 5910.84 27.63 1633.17 percent of total billed charges 5910.84 5910.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL PATELLA ANTERIOR 6 HOLE VARIABLE ANGLE LOCK STERILE 2.7 MM SCREW SUP-02.137.005S CDM 27000000 LOCAL 0270 RC outpatient 6502.08 6502.08 6502.08 74 4811.54 percent of total billed charges 6502.08 93 5266.68 percent of total billed charges 6502.08 6502.08 other OPPS APC 6502.08 6502.08 other OPPS APC 6502.08 27.63 1796.52 percent of total billed charges 6502.08 6502.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL SMALL PATELLA LATERAL LOCK VARIABLE ANGLE RIM STERILE 2.4/2.7 MM SCREW SUP-02.137.006S CDM 27000000 LOCAL 0270 RC outpatient 10966 10966 10966 74 8114.85 percent of total billed charges 10966 93 8882.48 percent of total billed charges 10966 10966 other OPPS APC 10966 10966 other OPPS APC 10966 27.63 3029.91 percent of total billed charges 10966 10966 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL PATELLA LATERAL LOCK VARIABLE ANGLE RIM STERILE 2.4/2.7 MM SCREW SUP-02.137.007S CDM 27000000 LOCAL 0270 RC outpatient 6502.08 6502.08 6502.08 74 4811.54 percent of total billed charges 6502.08 93 5266.68 percent of total billed charges 6502.08 6502.08 other OPPS APC 6502.08 6502.08 other OPPS APC 6502.08 27.63 1796.52 percent of total billed charges 6502.08 6502.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM STARDRIVE CORTEX SELF TAPPING 42MM SUP-02.200.042 CDM 270010025 LOCAL 0270 RC outpatient 65.78 65.78 65.78 74 48.68 percent of total billed charges 65.78 93 53.28 percent of total billed charges 65.78 65.78 other OPPS APC 65.78 65.78 other OPPS APC 65.78 27.63 18.18 percent of total billed charges 65.78 65.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM STARDRIVE CORTEX SELF TAPPING 44MM SUP-02.200.044 CDM 270010025 LOCAL 0270 RC outpatient 65.78 65.78 65.78 74 48.68 percent of total billed charges 65.78 93 53.28 percent of total billed charges 65.78 65.78 other OPPS APC 65.78 65.78 other OPPS APC 65.78 27.63 18.18 percent of total billed charges 65.78 65.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM STARDRIVE CORTEX SELF TAPPING 46MM SUP-02.200.046 CDM 270010025 LOCAL 0270 RC outpatient 65.78 65.78 65.78 74 48.68 percent of total billed charges 65.78 93 53.28 percent of total billed charges 65.78 65.78 other OPPS APC 65.78 65.78 other OPPS APC 65.78 27.63 18.18 percent of total billed charges 65.78 65.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM STARDRIVE CORTEX SELF TAPPING 48MM SUP-02.200.048 CDM 270010025 LOCAL 0270 RC outpatient 58.01 58.01 58.01 74 42.93 percent of total billed charges 58.01 93 46.99 percent of total billed charges 58.01 58.01 other OPPS APC 58.01 58.01 other OPPS APC 58.01 27.63 16.03 percent of total billed charges 58.01 58.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM STARDRIVE CORTEX SELF TAPPING 65MM SUP-02.200.065 CDM 270010025 LOCAL 0270 RC outpatient 58.01 58.01 58.01 74 42.93 percent of total billed charges 58.01 93 46.99 percent of total billed charges 58.01 58.01 other OPPS APC 58.01 58.01 other OPPS APC 58.01 27.63 16.03 percent of total billed charges 58.01 58.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM STARDRIVE CORTEX SELF TAPPING 70MM SUP-02.200.070 CDM 270010025 LOCAL 0270 RC outpatient 58.01 58.01 58.01 74 42.93 percent of total billed charges 58.01 93 46.99 percent of total billed charges 58.01 58.01 other OPPS APC 58.01 58.01 other OPPS APC 58.01 27.63 16.03 percent of total billed charges 58.01 58.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM STARDRIVE CORTEX SELF TAPPING 75MM SUP-02.200.075 CDM 270010025 LOCAL 0270 RC outpatient 58.01 58.01 58.01 74 42.93 percent of total billed charges 58.01 93 46.99 percent of total billed charges 58.01 58.01 other OPPS APC 58.01 58.01 other OPPS APC 58.01 27.63 16.03 percent of total billed charges 58.01 58.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM STARDRIVE CORTEX SELF TAPPING 80MM SUP-02.200.080 CDM 270010025 LOCAL 0270 RC outpatient 58.01 58.01 58.01 74 42.93 percent of total billed charges 58.01 93 46.99 percent of total billed charges 58.01 58.01 other OPPS APC 58.01 58.01 other OPPS APC 58.01 27.63 16.03 percent of total billed charges 58.01 58.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM STARDRIVE CORTEX SELF TAPPING 85 MM SUP-02.200.085 CDM 270010025 LOCAL 0270 RC outpatient 58.01 58.01 58.01 74 42.93 percent of total billed charges 58.01 93 46.99 percent of total billed charges 58.01 58.01 other OPPS APC 58.01 58.01 other OPPS APC 58.01 27.63 16.03 percent of total billed charges 58.01 58.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM STARDRIVE CORTEX SELF TAPPING 90MM SUP-02.200.090 CDM 270010025 LOCAL 0270 RC outpatient 65.78 65.78 65.78 74 48.68 percent of total billed charges 65.78 93 53.28 percent of total billed charges 65.78 65.78 other OPPS APC 65.78 65.78 other OPPS APC 65.78 27.63 18.18 percent of total billed charges 65.78 65.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM STARDRIVE CORTEX SELF TAPPING 95MM SUP-02.200.095 CDM 270010025 LOCAL 0270 RC outpatient 65.78 65.78 65.78 74 48.68 percent of total billed charges 65.78 93 53.28 percent of total billed charges 65.78 65.78 other OPPS APC 65.78 65.78 other OPPS APC 65.78 27.63 18.18 percent of total billed charges 65.78 65.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM STARDRIVE CORTEX SELF TAPPING 100MM SUP-02.200.100 CDM 270010025 LOCAL 0270 RC outpatient 82.94 82.94 82.94 74 61.38 percent of total billed charges 82.94 93 67.18 percent of total billed charges 82.94 82.94 other OPPS APC 82.94 82.94 other OPPS APC 82.94 27.63 22.92 percent of total billed charges 82.94 82.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM STARDRIVE CORTEX SELF TAPPING 105MM SUP-02.200.105 CDM 270010025 LOCAL 0270 RC outpatient 73.14 73.14 73.14 74 54.12 percent of total billed charges 73.14 93 59.24 percent of total billed charges 73.14 73.14 other OPPS APC 73.14 73.14 other OPPS APC 73.14 27.63 20.21 percent of total billed charges 73.14 73.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM STARDRIVE CORTEX SELF TAPPING 110MM SUP-02.200.110 CDM 270010025 LOCAL 0270 RC outpatient 73.14 73.14 73.14 74 54.12 percent of total billed charges 73.14 93 59.24 percent of total billed charges 73.14 73.14 other OPPS APC 73.14 73.14 other OPPS APC 73.14 27.63 20.21 percent of total billed charges 73.14 73.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM STARDRIVE CORTEX SELF TAPPING 115MM SUP-02.200.115 CDM 270010025 LOCAL 0270 RC outpatient 73.14 73.14 73.14 74 54.12 percent of total billed charges 73.14 93 59.24 percent of total billed charges 73.14 73.14 other OPPS APC 73.14 73.14 other OPPS APC 73.14 27.63 20.21 percent of total billed charges 73.14 73.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM STARDRIVE CORTEX SELF TAPPING 120MM SUP-02.200.120 CDM 270010025 LOCAL 0270 RC outpatient 73.14 73.14 73.14 74 54.12 percent of total billed charges 73.14 93 59.24 percent of total billed charges 73.14 73.14 other OPPS APC 73.14 73.14 other OPPS APC 73.14 27.63 20.21 percent of total billed charges 73.14 73.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM STARDRIVE CORTEX SELF TAPPING 125MM SUP-02.200.125 CDM 270010025 LOCAL 0270 RC outpatient 73.14 73.14 73.14 74 54.12 percent of total billed charges 73.14 93 59.24 percent of total billed charges 73.14 73.14 other OPPS APC 73.14 73.14 other OPPS APC 73.14 27.63 20.21 percent of total billed charges 73.14 73.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM STARDRIVE CORTEX SELF TAPPING 130MM SUP-02.200.130 CDM 270010025 LOCAL 0270 RC outpatient 233.3 233.3 233.3 74 172.64 percent of total billed charges 233.3 93 188.97 percent of total billed charges 233.3 233.3 other OPPS APC 233.3 233.3 other OPPS APC 233.3 27.63 64.46 percent of total billed charges 233.3 233.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM STARDRIVE CORTEX SELF TAPPING 135MM SUP-02.200.135 CDM 270010025 LOCAL 0270 RC outpatient 233.3 233.3 233.3 74 172.64 percent of total billed charges 233.3 93 188.97 percent of total billed charges 233.3 233.3 other OPPS APC 233.3 233.3 other OPPS APC 233.3 27.63 64.46 percent of total billed charges 233.3 233.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5MM STARDRIVE CORTEX SELF TAPPING 140MM SUP-02.200.140 CDM 270010025 LOCAL 0270 RC outpatient 233.3 233.3 233.3 74 172.64 percent of total billed charges 233.3 93 188.97 percent of total billed charges 233.3 233.3 other OPPS APC 233.3 233.3 other OPPS APC 233.3 27.63 64.46 percent of total billed charges 233.3 233.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM STARDRIVE CORTEX SELF TAPPING 145MM SUP-02.200.145 CDM 270010025 LOCAL 0270 RC outpatient 264.55 264.55 264.55 74 195.77 percent of total billed charges 264.55 93 214.29 percent of total billed charges 264.55 264.55 other OPPS APC 264.55 264.55 other OPPS APC 264.55 27.63 73.1 percent of total billed charges 264.55 264.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM STARDRIVE CORTEX SELF TAPPING 150MM SUP-02.200.150 CDM 270010025 LOCAL 0270 RC outpatient 233.3 233.3 233.3 74 172.64 percent of total billed charges 233.3 93 188.97 percent of total billed charges 233.3 233.3 other OPPS APC 233.3 233.3 other OPPS APC 233.3 27.63 64.46 percent of total billed charges 233.3 233.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 25MM 5MM 4.4MM SS NS CANNULATED SELF DRILL LOCK FIXED ANGLE SUP-02.205.025 CDM 270010022 LOCAL 0270 RC outpatient 507.65 507.65 507.65 74 375.66 percent of total billed charges 507.65 93 411.2 percent of total billed charges 507.65 507.65 other OPPS APC 507.65 507.65 other OPPS APC 507.65 27.63 140.26 percent of total billed charges 507.65 507.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 30MM 5MM 4.4MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.205.030 CDM 270010022 LOCAL 0270 RC outpatient 447.67 447.67 447.67 74 331.28 percent of total billed charges 447.67 93 362.61 percent of total billed charges 447.67 447.67 other OPPS APC 447.67 447.67 other OPPS APC 447.67 27.63 123.69 percent of total billed charges 447.67 447.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L35 MM OD5 MM ODSEC4.4 MM FEMORAL CONDYLAR PERIARTICULAR DISTAL FIX ANGLE CANNULATED SELF DRILL LOCK NONSTERILE SUP-02.205.035 CDM 270010022 LOCAL 0270 RC outpatient 507.65 507.65 507.65 74 375.66 percent of total billed charges 507.65 93 411.2 percent of total billed charges 507.65 507.65 other OPPS APC 507.65 507.65 other OPPS APC 507.65 27.63 140.26 percent of total billed charges 507.65 507.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L40 MM OD5 MM ODSEC4.4 MM PERIARTICULAR FEMORAL CONDYLAR DISTAL FIX ANGLE CANNULATED SELF DRILL LOCK NONSTERILE SUP-02.205.040 CDM 270010022 LOCAL 0270 RC outpatient 507.65 507.65 507.65 74 375.66 percent of total billed charges 507.65 93 411.2 percent of total billed charges 507.65 507.65 other OPPS APC 507.65 507.65 other OPPS APC 507.65 27.63 140.26 percent of total billed charges 507.65 507.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 45MM 5MM 4.4MM SS NS CANNULATED SELF DRILL LOCK FIXED ANGLE SUP-02.205.045 CDM 270010022 LOCAL 0270 RC outpatient 507.65 507.65 507.65 74 375.66 percent of total billed charges 507.65 93 411.2 percent of total billed charges 507.65 507.65 other OPPS APC 507.65 507.65 other OPPS APC 507.65 27.63 140.26 percent of total billed charges 507.65 507.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L50 MM OD5 MM ODSEC4.4 MM PERIARTICULAR FEMORAL CONDYLAR DISTAL FIX ANGLE CANNULATED SELF DRILL LOCK NONSTERILE SUP-02.205.050 CDM 270010022 LOCAL 0270 RC outpatient 507.65 507.65 507.65 74 375.66 percent of total billed charges 507.65 93 411.2 percent of total billed charges 507.65 507.65 other OPPS APC 507.65 507.65 other OPPS APC 507.65 27.63 140.26 percent of total billed charges 507.65 507.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L55 MM OD5 MM ODSEC4.4 MM PERIARTICULAR FEMORAL CONDYLAR DISTAL FIX ANGLE CANNULATED SELF DRILL LOCK NONSTERILE SUP-02.205.055 CDM 270010022 LOCAL 0270 RC outpatient 507.65 507.65 507.65 74 375.66 percent of total billed charges 507.65 93 411.2 percent of total billed charges 507.65 507.65 other OPPS APC 507.65 507.65 other OPPS APC 507.65 27.63 140.26 percent of total billed charges 507.65 507.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L60 MM OD5 MM ODSEC4.4 MM PERIARTICULAR FEMORAL CONDYLAR DISTAL FIX ANGLE CANNULATED SELF DRILL LOCK NONSTERILE SUP-02.205.060 CDM 270010022 LOCAL 0270 RC outpatient 447.67 447.67 447.67 74 331.28 percent of total billed charges 447.67 93 362.61 percent of total billed charges 447.67 447.67 other OPPS APC 447.67 447.67 other OPPS APC 447.67 27.63 123.69 percent of total billed charges 447.67 447.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L65 MM OD5 MM ODSEC4.4 MM PERIARTICULAR FEMORAL CONDYLAR DISTAL FIX ANGLE CANNULATED SELF DRILL LOCK NONSTERILE SUP-02.205.065 CDM 270010022 LOCAL 0270 RC outpatient 507.65 507.65 507.65 74 375.66 percent of total billed charges 507.65 93 411.2 percent of total billed charges 507.65 507.65 other OPPS APC 507.65 507.65 other OPPS APC 507.65 27.63 140.26 percent of total billed charges 507.65 507.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L70 MM OD5 MM ODSEC4.4 MM PERIARTICULAR FEMORAL CONDYLAR DISTAL FIX ANGLE CANNULATED SELF DRILL LOCK NONSTERILE SUP-02.205.070 CDM 270010022 LOCAL 0270 RC outpatient 447.67 447.67 447.67 74 331.28 percent of total billed charges 447.67 93 362.61 percent of total billed charges 447.67 447.67 other OPPS APC 447.67 447.67 other OPPS APC 447.67 27.63 123.69 percent of total billed charges 447.67 447.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L75 MM OD5 MM ODSEC4.4 MM PERIARTICULAR FEMORAL CONDYLAR DISTAL FIX ANGLE CANNULATED SELF DRILL LOCK NONSTERILE SUP-02.205.075 CDM 270010022 LOCAL 0270 RC outpatient 447.67 447.67 447.67 74 331.28 percent of total billed charges 447.67 93 362.61 percent of total billed charges 447.67 447.67 other OPPS APC 447.67 447.67 other OPPS APC 447.67 27.63 123.69 percent of total billed charges 447.67 447.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 80MM 5MM 4.4MM SS NS CANNULATED SELF DRILL LOCK FIXED ANGLE SUP-02.205.080 CDM 270010022 LOCAL 0270 RC outpatient 507.65 507.65 507.65 74 375.66 percent of total billed charges 507.65 93 411.2 percent of total billed charges 507.65 507.65 other OPPS APC 507.65 507.65 other OPPS APC 507.65 27.63 140.26 percent of total billed charges 507.65 507.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 4 MM FULL THREAD L85 MM OD5 MM ODSEC4.4 MM PROXIMAL MEDIAL TIBIA CANNULATED LOCKING SELF DRILLING SELF TAPPING TIP THREADED CONICAL HEAD NONSTERILE SUP-02.205.085 CDM 270010022 LOCAL 0270 RC outpatient 447.67 447.67 447.67 74 331.28 percent of total billed charges 447.67 93 362.61 percent of total billed charges 447.67 447.67 other OPPS APC 447.67 447.67 other OPPS APC 447.67 27.63 123.69 percent of total billed charges 447.67 447.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 90MM 5MM 4.4MM SS NS CANNULATED SELF DRILL LOCK FIXED ANGLE SUP-02.205.090 CDM 270010022 LOCAL 0270 RC outpatient 507.65 507.65 507.65 74 375.66 percent of total billed charges 507.65 93 411.2 percent of total billed charges 507.65 507.65 other OPPS APC 507.65 507.65 other OPPS APC 507.65 27.63 140.26 percent of total billed charges 507.65 507.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 95MM 5MM 4.4MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.205.095 CDM 270010022 LOCAL 0270 RC outpatient 507.65 507.65 507.65 74 375.66 percent of total billed charges 507.65 93 411.2 percent of total billed charges 507.65 507.65 other OPPS APC 507.65 507.65 other OPPS APC 507.65 27.63 140.26 percent of total billed charges 507.65 507.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 100MM 5MM 4.4MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.205.100 CDM 270010022 LOCAL 0270 RC outpatient 523.38 523.38 523.38 74 387.3 percent of total billed charges 523.38 93 423.94 percent of total billed charges 523.38 523.38 other OPPS APC 523.38 523.38 other OPPS APC 523.38 27.63 144.61 percent of total billed charges 523.38 523.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 105MM 5MM 4.4MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.205.105 CDM 270010022 LOCAL 0270 RC outpatient 523.38 523.38 523.38 74 387.3 percent of total billed charges 523.38 93 423.94 percent of total billed charges 523.38 523.38 other OPPS APC 523.38 523.38 other OPPS APC 523.38 27.63 144.61 percent of total billed charges 523.38 523.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 110MM 5MM 4.4MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.205.110 CDM 270010022 LOCAL 0270 RC outpatient 523.38 523.38 523.38 74 387.3 percent of total billed charges 523.38 93 423.94 percent of total billed charges 523.38 523.38 other OPPS APC 523.38 523.38 other OPPS APC 523.38 27.63 144.61 percent of total billed charges 523.38 523.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L115 MM OD5 MM PERIARTICULAR FEMUR CONDYLE SELF TAP TIP SELF DRILL CANNULATED LOCK NONSTERILE SUP-02.205.115 CDM 270010022 LOCAL 0270 RC outpatient 523.38 523.38 523.38 74 387.3 percent of total billed charges 523.38 93 423.94 percent of total billed charges 523.38 523.38 other OPPS APC 523.38 523.38 other OPPS APC 523.38 27.63 144.61 percent of total billed charges 523.38 523.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 120MM 5MM 4.4MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.205.120 CDM 270010022 LOCAL 0270 RC outpatient 523.38 523.38 523.38 74 387.3 percent of total billed charges 523.38 93 423.94 percent of total billed charges 523.38 523.38 other OPPS APC 523.38 523.38 other OPPS APC 523.38 27.63 144.61 percent of total billed charges 523.38 523.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 125MM 5MM 4.4MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.205.125 CDM 270010022 LOCAL 0270 RC outpatient 523.38 523.38 523.38 74 387.3 percent of total billed charges 523.38 93 423.94 percent of total billed charges 523.38 523.38 other OPPS APC 523.38 523.38 other OPPS APC 523.38 27.63 144.61 percent of total billed charges 523.38 523.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 130MM 5MM 4.4MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.205.130 CDM 270010022 LOCAL 0270 RC outpatient 523.38 523.38 523.38 74 387.3 percent of total billed charges 523.38 93 423.94 percent of total billed charges 523.38 523.38 other OPPS APC 523.38 523.38 other OPPS APC 523.38 27.63 144.61 percent of total billed charges 523.38 523.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 135MM 5MM 4.4MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.205.135 CDM 270010022 LOCAL 0270 RC outpatient 523.38 523.38 523.38 74 387.3 percent of total billed charges 523.38 93 423.94 percent of total billed charges 523.38 523.38 other OPPS APC 523.38 523.38 other OPPS APC 523.38 27.63 144.61 percent of total billed charges 523.38 523.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 140MM 5MM 4.4MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.205.140 CDM 270010022 LOCAL 0270 RC outpatient 523.38 523.38 523.38 74 387.3 percent of total billed charges 523.38 93 423.94 percent of total billed charges 523.38 523.38 other OPPS APC 523.38 523.38 other OPPS APC 523.38 27.63 144.61 percent of total billed charges 523.38 523.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 145MM 5MM 4.4MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.205.145 CDM 270010022 LOCAL 0270 RC outpatient 523.38 523.38 523.38 74 387.3 percent of total billed charges 523.38 93 423.94 percent of total billed charges 523.38 523.38 other OPPS APC 523.38 523.38 other OPPS APC 523.38 27.63 144.61 percent of total billed charges 523.38 523.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM PARTIAL THREAD 40MM 5MM 4.4MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR SUP-02.205.240 CDM 270010022 LOCAL 0270 RC outpatient 449.02 449.02 449.02 74 332.27 percent of total billed charges 449.02 93 363.71 percent of total billed charges 449.02 449.02 other OPPS APC 449.02 449.02 other OPPS APC 449.02 27.63 124.06 percent of total billed charges 449.02 449.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM PARTIAL THREAD 45MM 5MM 4.4MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR SUP-02.205.245 CDM 270010022 LOCAL 0270 RC outpatient 449.02 449.02 449.02 74 332.27 percent of total billed charges 449.02 93 363.71 percent of total billed charges 449.02 449.02 other OPPS APC 449.02 449.02 other OPPS APC 449.02 27.63 124.06 percent of total billed charges 449.02 449.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM PARTIAL THREAD 50MM 5MM 4.4MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR SUP-02.205.250 CDM 270010022 LOCAL 0270 RC outpatient 449.02 449.02 449.02 74 332.27 percent of total billed charges 449.02 93 363.71 percent of total billed charges 449.02 449.02 other OPPS APC 449.02 449.02 other OPPS APC 449.02 27.63 124.06 percent of total billed charges 449.02 449.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM PARTIAL THREAD 55MM 5MM 4.4MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR SUP-02.205.255 CDM 270010022 LOCAL 0270 RC outpatient 395.95 395.95 395.95 74 293 percent of total billed charges 395.95 93 320.72 percent of total billed charges 395.95 395.95 other OPPS APC 395.95 395.95 other OPPS APC 395.95 27.63 109.4 percent of total billed charges 395.95 395.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM PARTIAL THREAD 60MM 5MM 4.4MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR SUP-02.205.260 CDM 270010022 LOCAL 0270 RC outpatient 395.95 395.95 395.95 74 293 percent of total billed charges 395.95 93 320.72 percent of total billed charges 395.95 395.95 other OPPS APC 395.95 395.95 other OPPS APC 395.95 27.63 109.4 percent of total billed charges 395.95 395.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L65 MM OD5 MM ODSEC4.4 MM PERIARTICULAR FEMORAL CONDYLAR DISTAL FIX ANGLE CANNULATED SELF DRILL CONICAL HEAD NONSTERILE SUP-02.205.265 CDM 270010022 LOCAL 0270 RC outpatient 395.95 395.95 395.95 74 293 percent of total billed charges 395.95 93 320.72 percent of total billed charges 395.95 395.95 other OPPS APC 395.95 395.95 other OPPS APC 395.95 27.63 109.4 percent of total billed charges 395.95 395.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM PARTIAL THREAD 70MM 5MM 4.4MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR SUP-02.205.270 CDM 270010022 LOCAL 0270 RC outpatient 395.95 395.95 395.95 74 293 percent of total billed charges 395.95 93 320.72 percent of total billed charges 395.95 395.95 other OPPS APC 395.95 395.95 other OPPS APC 395.95 27.63 109.4 percent of total billed charges 395.95 395.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 4 MM PARTIAL THREAD CONE HEXAGON L75 MM OD5 MM ODSEC4.4 MM TIBIA MEDIAL PROXIMAL SELF DRILL SELF TAP CANNULATED SOCKET SMOOTH HEAD NONSTERILE SUP-02.205.275 CDM 270010022 LOCAL 0270 RC outpatient 449.02 449.02 449.02 74 332.27 percent of total billed charges 449.02 93 363.71 percent of total billed charges 449.02 449.02 other OPPS APC 449.02 449.02 other OPPS APC 449.02 27.63 124.06 percent of total billed charges 449.02 449.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 4 MM PARTIAL THREAD CONE HEXAGON L80 MM OD5 MM ODSEC4.4 MM TIBIA MEDIAL PROXIMAL SELF DRILL SELF TAP CANNULATED SOCKET SMOOTH HEAD NONSTERILE SUP-02.205.280 CDM 270010022 LOCAL 0270 RC outpatient 449.02 449.02 449.02 74 332.27 percent of total billed charges 449.02 93 363.71 percent of total billed charges 449.02 449.02 other OPPS APC 449.02 449.02 other OPPS APC 449.02 27.63 124.06 percent of total billed charges 449.02 449.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L85 MM OD5 MM ODSEC4.4 MM PERIARTICULAR FEMORAL CONDYLAR DISTAL FIX ANGLE CANNULATED SELF DRILL CONICAL HEAD NONSTERILE SUP-02.205.285 CDM 270010022 LOCAL 0270 RC outpatient 449.02 449.02 449.02 74 332.27 percent of total billed charges 449.02 93 363.71 percent of total billed charges 449.02 449.02 other OPPS APC 449.02 449.02 other OPPS APC 449.02 27.63 124.06 percent of total billed charges 449.02 449.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM PARTIAL THREAD 90MM 5MM 4.4MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR SUP-02.205.290 CDM 270010022 LOCAL 0270 RC outpatient 449.02 449.02 449.02 74 332.27 percent of total billed charges 449.02 93 363.71 percent of total billed charges 449.02 449.02 other OPPS APC 449.02 449.02 other OPPS APC 449.02 27.63 124.06 percent of total billed charges 449.02 449.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM PARTIAL THREAD 95MM 5MM 4.4MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR SUP-02.205.295 CDM 270010022 LOCAL 0270 RC outpatient 449.02 449.02 449.02 74 332.27 percent of total billed charges 449.02 93 363.71 percent of total billed charges 449.02 449.02 other OPPS APC 449.02 449.02 other OPPS APC 449.02 27.63 124.06 percent of total billed charges 449.02 449.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 20MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.020 CDM 270010022 LOCAL 0270 RC outpatient 755.04 755.04 755.04 74 558.73 percent of total billed charges 755.04 93 611.58 percent of total billed charges 755.04 755.04 other OPPS APC 755.04 755.04 other OPPS APC 755.04 27.63 208.62 percent of total billed charges 755.04 755.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 25MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.025 CDM 270010022 LOCAL 0270 RC outpatient 755.04 755.04 755.04 74 558.73 percent of total billed charges 755.04 93 611.58 percent of total billed charges 755.04 755.04 other OPPS APC 755.04 755.04 other OPPS APC 755.04 27.63 208.62 percent of total billed charges 755.04 755.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 30MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.030 CDM 270010022 LOCAL 0270 RC outpatient 755.04 755.04 755.04 74 558.73 percent of total billed charges 755.04 93 611.58 percent of total billed charges 755.04 755.04 other OPPS APC 755.04 755.04 other OPPS APC 755.04 27.63 208.62 percent of total billed charges 755.04 755.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 35MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.035 CDM 270010022 LOCAL 0270 RC outpatient 755.04 755.04 755.04 74 558.73 percent of total billed charges 755.04 93 611.58 percent of total billed charges 755.04 755.04 other OPPS APC 755.04 755.04 other OPPS APC 755.04 27.63 208.62 percent of total billed charges 755.04 755.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 40MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.040 CDM 270010022 LOCAL 0270 RC outpatient 755.04 755.04 755.04 74 558.73 percent of total billed charges 755.04 93 611.58 percent of total billed charges 755.04 755.04 other OPPS APC 755.04 755.04 other OPPS APC 755.04 27.63 208.62 percent of total billed charges 755.04 755.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 45MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.045 CDM 270010022 LOCAL 0270 RC outpatient 755.04 755.04 755.04 74 558.73 percent of total billed charges 755.04 93 611.58 percent of total billed charges 755.04 755.04 other OPPS APC 755.04 755.04 other OPPS APC 755.04 27.63 208.62 percent of total billed charges 755.04 755.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 50MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.050 CDM 270010022 LOCAL 0270 RC outpatient 755.04 755.04 755.04 74 558.73 percent of total billed charges 755.04 93 611.58 percent of total billed charges 755.04 755.04 other OPPS APC 755.04 755.04 other OPPS APC 755.04 27.63 208.62 percent of total billed charges 755.04 755.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 55MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.055 CDM 270010022 LOCAL 0270 RC outpatient 755.04 755.04 755.04 74 558.73 percent of total billed charges 755.04 93 611.58 percent of total billed charges 755.04 755.04 other OPPS APC 755.04 755.04 other OPPS APC 755.04 27.63 208.62 percent of total billed charges 755.04 755.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 60MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.060 CDM 270010022 LOCAL 0270 RC outpatient 755.04 755.04 755.04 74 558.73 percent of total billed charges 755.04 93 611.58 percent of total billed charges 755.04 755.04 other OPPS APC 755.04 755.04 other OPPS APC 755.04 27.63 208.62 percent of total billed charges 755.04 755.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 65MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.065 CDM 270010022 LOCAL 0270 RC outpatient 755.04 755.04 755.04 74 558.73 percent of total billed charges 755.04 93 611.58 percent of total billed charges 755.04 755.04 other OPPS APC 755.04 755.04 other OPPS APC 755.04 27.63 208.62 percent of total billed charges 755.04 755.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 70MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.070 CDM 270010022 LOCAL 0270 RC outpatient 755.04 755.04 755.04 74 558.73 percent of total billed charges 755.04 93 611.58 percent of total billed charges 755.04 755.04 other OPPS APC 755.04 755.04 other OPPS APC 755.04 27.63 208.62 percent of total billed charges 755.04 755.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 75MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.075 CDM 270010022 LOCAL 0270 RC outpatient 755.04 755.04 755.04 74 558.73 percent of total billed charges 755.04 93 611.58 percent of total billed charges 755.04 755.04 other OPPS APC 755.04 755.04 other OPPS APC 755.04 27.63 208.62 percent of total billed charges 755.04 755.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 4 MM FULL THREAD L80 MM OD7.3 MM ODSEC5 MM PERIARTICULAR FEMUR CONDYLAR DISTAL SELF DRILL CANNULATED LOCK CONICAL HEAD NONSTERILE SUP-02.207.080 CDM 270010022 LOCAL 0270 RC outpatient 665.81 665.81 665.81 74 492.7 percent of total billed charges 665.81 93 539.31 percent of total billed charges 665.81 665.81 other OPPS APC 665.81 665.81 other OPPS APC 665.81 27.63 183.96 percent of total billed charges 665.81 665.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 85MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.085 CDM 270010022 LOCAL 0270 RC outpatient 755.04 755.04 755.04 74 558.73 percent of total billed charges 755.04 93 611.58 percent of total billed charges 755.04 755.04 other OPPS APC 755.04 755.04 other OPPS APC 755.04 27.63 208.62 percent of total billed charges 755.04 755.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 90MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.090 CDM 270010022 LOCAL 0270 RC outpatient 755.04 755.04 755.04 74 558.73 percent of total billed charges 755.04 93 611.58 percent of total billed charges 755.04 755.04 other OPPS APC 755.04 755.04 other OPPS APC 755.04 27.63 208.62 percent of total billed charges 755.04 755.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 95MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.095 CDM 270010022 LOCAL 0270 RC outpatient 755.04 755.04 755.04 74 558.73 percent of total billed charges 755.04 93 611.58 percent of total billed charges 755.04 755.04 other OPPS APC 755.04 755.04 other OPPS APC 755.04 27.63 208.62 percent of total billed charges 755.04 755.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 100MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.100 CDM 270010022 LOCAL 0270 RC outpatient 769.34 769.34 769.34 74 569.31 percent of total billed charges 769.34 93 623.17 percent of total billed charges 769.34 769.34 other OPPS APC 769.34 769.34 other OPPS APC 769.34 27.63 212.57 percent of total billed charges 769.34 769.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 105MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.105 CDM 270010022 LOCAL 0270 RC outpatient 769.34 769.34 769.34 74 569.31 percent of total billed charges 769.34 93 623.17 percent of total billed charges 769.34 769.34 other OPPS APC 769.34 769.34 other OPPS APC 769.34 27.63 212.57 percent of total billed charges 769.34 769.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 110MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.110 CDM 270010022 LOCAL 0270 RC outpatient 769.34 769.34 769.34 74 569.31 percent of total billed charges 769.34 93 623.17 percent of total billed charges 769.34 769.34 other OPPS APC 769.34 769.34 other OPPS APC 769.34 27.63 212.57 percent of total billed charges 769.34 769.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 115MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.115 CDM 270010022 LOCAL 0270 RC outpatient 769.34 769.34 769.34 74 569.31 percent of total billed charges 769.34 93 623.17 percent of total billed charges 769.34 769.34 other OPPS APC 769.34 769.34 other OPPS APC 769.34 27.63 212.57 percent of total billed charges 769.34 769.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 120MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.120 CDM 270010022 LOCAL 0270 RC outpatient 769.34 769.34 769.34 74 569.31 percent of total billed charges 769.34 93 623.17 percent of total billed charges 769.34 769.34 other OPPS APC 769.34 769.34 other OPPS APC 769.34 27.63 212.57 percent of total billed charges 769.34 769.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 7.3MM 5MM 125MM LCP SS 4MM FULL THREAD PERIARTICULAR CONDYLE FEMUR TIBIA SUP-02.207.125 CDM 270010022 LOCAL 0270 RC outpatient 769.34 769.34 769.34 74 569.31 percent of total billed charges 769.34 93 623.17 percent of total billed charges 769.34 769.34 other OPPS APC 769.34 769.34 other OPPS APC 769.34 27.63 212.57 percent of total billed charges 769.34 769.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 7.3MM 5MM 130MM LCP SS 4MM FULL THREAD PERIARTICULAR CONDYLE FEMUR TIBIA SUP-02.207.130 CDM 270010022 LOCAL 0270 RC outpatient 769.34 769.34 769.34 74 569.31 percent of total billed charges 769.34 93 623.17 percent of total billed charges 769.34 769.34 other OPPS APC 769.34 769.34 other OPPS APC 769.34 27.63 212.57 percent of total billed charges 769.34 769.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 135MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.135 CDM 270010022 LOCAL 0270 RC outpatient 769.34 769.34 769.34 74 569.31 percent of total billed charges 769.34 93 623.17 percent of total billed charges 769.34 769.34 other OPPS APC 769.34 769.34 other OPPS APC 769.34 27.63 212.57 percent of total billed charges 769.34 769.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 140MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.140 CDM 270010022 LOCAL 0270 RC outpatient 769.34 769.34 769.34 74 569.31 percent of total billed charges 769.34 93 623.17 percent of total billed charges 769.34 769.34 other OPPS APC 769.34 769.34 other OPPS APC 769.34 27.63 212.57 percent of total billed charges 769.34 769.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 145MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL LOCK PERIARTICULAR PLATE SYSTEM SUP-02.207.145 CDM 270010022 LOCAL 0270 RC outpatient 769.34 769.34 769.34 74 569.31 percent of total billed charges 769.34 93 623.17 percent of total billed charges 769.34 769.34 other OPPS APC 769.34 769.34 other OPPS APC 769.34 27.63 212.57 percent of total billed charges 769.34 769.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 50MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR PLATE SUP-02.207.250 CDM 270010022 LOCAL 0270 RC outpatient 673.53 673.53 673.53 74 498.41 percent of total billed charges 673.53 93 545.56 percent of total billed charges 673.53 673.53 other OPPS APC 673.53 673.53 other OPPS APC 673.53 27.63 186.1 percent of total billed charges 673.53 673.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 55MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR PLATE SUP-02.207.255 CDM 270010022 LOCAL 0270 RC outpatient 673.53 673.53 673.53 74 498.41 percent of total billed charges 673.53 93 545.56 percent of total billed charges 673.53 673.53 other OPPS APC 673.53 673.53 other OPPS APC 673.53 27.63 186.1 percent of total billed charges 673.53 673.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 60MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR PLATE SUP-02.207.260 CDM 270010022 LOCAL 0270 RC outpatient 673.53 673.53 673.53 74 498.41 percent of total billed charges 673.53 93 545.56 percent of total billed charges 673.53 673.53 other OPPS APC 673.53 673.53 other OPPS APC 673.53 27.63 186.1 percent of total billed charges 673.53 673.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 65MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR PLATE SUP-02.207.265 CDM 270010022 LOCAL 0270 RC outpatient 673.53 673.53 673.53 74 498.41 percent of total billed charges 673.53 93 545.56 percent of total billed charges 673.53 673.53 other OPPS APC 673.53 673.53 other OPPS APC 673.53 27.63 186.1 percent of total billed charges 673.53 673.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 70MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR PLATE SUP-02.207.270 CDM 270010022 LOCAL 0270 RC outpatient 593.94 593.94 593.94 74 439.52 percent of total billed charges 593.94 93 481.09 percent of total billed charges 593.94 593.94 other OPPS APC 593.94 593.94 other OPPS APC 593.94 27.63 164.11 percent of total billed charges 593.94 593.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 75MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR PLATE SUP-02.207.275 CDM 270010022 LOCAL 0270 RC outpatient 673.53 673.53 673.53 74 498.41 percent of total billed charges 673.53 93 545.56 percent of total billed charges 673.53 673.53 other OPPS APC 673.53 673.53 other OPPS APC 673.53 27.63 186.1 percent of total billed charges 673.53 673.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 80MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR PLATE SUP-02.207.280 CDM 270010022 LOCAL 0270 RC outpatient 673.53 673.53 673.53 74 498.41 percent of total billed charges 673.53 93 545.56 percent of total billed charges 673.53 673.53 other OPPS APC 673.53 673.53 other OPPS APC 673.53 27.63 186.1 percent of total billed charges 673.53 673.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 85MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR PLATE SUP-02.207.285 CDM 270010022 LOCAL 0270 RC outpatient 593.94 593.94 593.94 74 439.52 percent of total billed charges 593.94 93 481.09 percent of total billed charges 593.94 593.94 other OPPS APC 593.94 593.94 other OPPS APC 593.94 27.63 164.11 percent of total billed charges 593.94 593.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM FULL THREAD 90MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR PLATE SUP-02.207.290 CDM 270010022 LOCAL 0270 RC outpatient 673.53 673.53 673.53 74 498.41 percent of total billed charges 673.53 93 545.56 percent of total billed charges 673.53 673.53 other OPPS APC 673.53 673.53 other OPPS APC 673.53 27.63 186.1 percent of total billed charges 673.53 673.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 4 MM FULL THREAD L95 MM OD7.3 MM ODSEC5 MM CANNULATED SMOOTH CONICAL HEAD SELF DRILL SELF TAP NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-02.207.295 CDM 270010022 LOCAL 0270 RC outpatient 673.53 673.53 673.53 74 498.41 percent of total billed charges 673.53 93 545.56 percent of total billed charges 673.53 673.53 other OPPS APC 673.53 673.53 other OPPS APC 673.53 27.63 186.1 percent of total billed charges 673.53 673.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 50MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR PLATE SUP-02.207.450 CDM 270010022 LOCAL 0270 RC outpatient 673.53 673.53 673.53 74 498.41 percent of total billed charges 673.53 93 545.56 percent of total billed charges 673.53 673.53 other OPPS APC 673.53 673.53 other OPPS APC 673.53 27.63 186.1 percent of total billed charges 673.53 673.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 55MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR PLATE SUP-02.207.455 CDM 270010022 LOCAL 0270 RC outpatient 673.53 673.53 673.53 74 498.41 percent of total billed charges 673.53 93 545.56 percent of total billed charges 673.53 673.53 other OPPS APC 673.53 673.53 other OPPS APC 673.53 27.63 186.1 percent of total billed charges 673.53 673.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 60MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR PLATE SUP-02.207.460 CDM 270010022 LOCAL 0270 RC outpatient 673.53 673.53 673.53 74 498.41 percent of total billed charges 673.53 93 545.56 percent of total billed charges 673.53 673.53 other OPPS APC 673.53 673.53 other OPPS APC 673.53 27.63 186.1 percent of total billed charges 673.53 673.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 95 D PARTIAL THREAD CONE L65 MM OD7.3 MM ODSEC5 MM PERIARTICULAR CONDYLE FEMUR TIBIA SELF DRILL SELF TAP CANNULATED SMOOTH HEAD NONSTERILE SUP-02.207.465 CDM 270010022 LOCAL 0270 RC outpatient 673.53 673.53 673.53 74 498.41 percent of total billed charges 673.53 93 545.56 percent of total billed charges 673.53 673.53 other OPPS APC 673.53 673.53 other OPPS APC 673.53 27.63 186.1 percent of total billed charges 673.53 673.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 70MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR PLATE SUP-02.207.470 CDM 270010022 LOCAL 0270 RC outpatient 673.53 673.53 673.53 74 498.41 percent of total billed charges 673.53 93 545.56 percent of total billed charges 673.53 673.53 other OPPS APC 673.53 673.53 other OPPS APC 673.53 27.63 186.1 percent of total billed charges 673.53 673.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 95 D PARTIAL THREAD CONE L75 MM OD7.3 MM ODSEC5 MM PERIARTICULAR CONDYLE FEMUR TIBIA SELF DRILL SELF TAP CANNULATED SMOOTH HEAD NONSTERILE SUP-02.207.475 CDM 270010022 LOCAL 0270 RC outpatient 673.53 673.53 673.53 74 498.41 percent of total billed charges 673.53 93 545.56 percent of total billed charges 673.53 673.53 other OPPS APC 673.53 673.53 other OPPS APC 673.53 27.63 186.1 percent of total billed charges 673.53 673.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 95 D PARTIAL THREAD CONE L80 MM OD7.3 MM ODSEC5 MM PERIARTICULAR CONDYLE FEMUR TIBIA SELF DRILL SELF TAP CANNULATED SMOOTH HEAD NONSTERILE SUP-02.207.480 CDM 270010022 LOCAL 0270 RC outpatient 673.53 673.53 673.53 74 498.41 percent of total billed charges 673.53 93 545.56 percent of total billed charges 673.53 673.53 other OPPS APC 673.53 673.53 other OPPS APC 673.53 27.63 186.1 percent of total billed charges 673.53 673.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 85MM 7.3MM 5MM SS NS CANNULATED SELF TAP SELF DRILL SMOOTH CONICAL HEAD PERIARTICULAR PLATE SUP-02.207.485 CDM 270010022 LOCAL 0270 RC outpatient 673.53 673.53 673.53 74 498.41 percent of total billed charges 673.53 93 545.56 percent of total billed charges 673.53 673.53 other OPPS APC 673.53 673.53 other OPPS APC 673.53 27.63 186.1 percent of total billed charges 673.53 673.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 95 D PARTIAL THREAD CONE L90 MM OD7.3 MM ODSEC5 MM PERIARTICULAR CONDYLE FEMUR TIBIA SELF DRILL SELF TAP CANNULATED SMOOTH HEAD NONSTERILE SUP-02.207.490 CDM 270010022 LOCAL 0270 RC outpatient 673.53 673.53 673.53 74 498.41 percent of total billed charges 673.53 93 545.56 percent of total billed charges 673.53 673.53 other OPPS APC 673.53 673.53 other OPPS APC 673.53 27.63 186.1 percent of total billed charges 673.53 673.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 95 D PARTIAL THREAD CONE L95 MM OD7.3 MM ODSEC5 MM PERIARTICULAR CONDYLE FEMUR TIBIA SELF DRILL SELF TAP CANNULATED SMOOTH HEAD NONSTERILE SUP-02.207.495 CDM 270010022 LOCAL 0270 RC outpatient 673.53 673.53 673.53 74 498.41 percent of total billed charges 673.53 93 545.56 percent of total billed charges 673.53 673.53 other OPPS APC 673.53 673.53 other OPPS APC 673.53 27.63 186.1 percent of total billed charges 673.53 673.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD L100 MM OD7.3 MM PERIARTICULAR CANNULATED SMOOTH CONICAL HEAD SELF DRILLING SELF TAPPING TIP NONSTERILE SUP-02.207.500 CDM 270010022 LOCAL 0270 RC outpatient 716.43 716.43 716.43 74 530.16 percent of total billed charges 716.43 93 580.31 percent of total billed charges 716.43 716.43 other OPPS APC 716.43 716.43 other OPPS APC 716.43 27.63 197.95 percent of total billed charges 716.43 716.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD L105 MM OD7.3 MM PERIARTICULAR CANNULATED SMOOTH CONICAL HEAD SELF DRILLING SELF TAPPING TIP NONSTERILE SUP-02.207.505 CDM 270010022 LOCAL 0270 RC outpatient 716.43 716.43 716.43 74 530.16 percent of total billed charges 716.43 93 580.31 percent of total billed charges 716.43 716.43 other OPPS APC 716.43 716.43 other OPPS APC 716.43 27.63 197.95 percent of total billed charges 716.43 716.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD L110 MM OD7.3 MM PERIARTICULAR CANNULATED SMOOTH CONICAL HEAD SELF DRILLING SELF TAPPING TIP NONSTERILE SUP-02.207.510 CDM 270010022 LOCAL 0270 RC outpatient 716.43 716.43 716.43 74 530.16 percent of total billed charges 716.43 93 580.31 percent of total billed charges 716.43 716.43 other OPPS APC 716.43 716.43 other OPPS APC 716.43 27.63 197.95 percent of total billed charges 716.43 716.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD L115 MM OD7.3 MM PERIARTICULAR CANNULATED SMOOTH CONICAL HEAD SELF DRILLING SELF TAPPING TIP NONSTERILE SUP-02.207.515 CDM 270010022 LOCAL 0270 RC outpatient 716.43 716.43 716.43 74 530.16 percent of total billed charges 716.43 93 580.31 percent of total billed charges 716.43 716.43 other OPPS APC 716.43 716.43 other OPPS APC 716.43 27.63 197.95 percent of total billed charges 716.43 716.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD L120 MM OD7.3 MM PERIARTICULAR CANNULATED SMOOTH CONICAL HEAD SELF DRILLING SELF TAPPING TIP NONSTERILE SUP-02.207.520 CDM 270010022 LOCAL 0270 RC outpatient 716.43 716.43 716.43 74 530.16 percent of total billed charges 716.43 93 580.31 percent of total billed charges 716.43 716.43 other OPPS APC 716.43 716.43 other OPPS APC 716.43 27.63 197.95 percent of total billed charges 716.43 716.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 14MM 2.4MM SS NS LOCK VARIABLE ANGLE STARDRIVE SUP-02.210.114 CDM 270010022 LOCAL 0270 RC outpatient 385.32 385.32 385.32 74 285.14 percent of total billed charges 385.32 93 312.11 percent of total billed charges 385.32 385.32 other OPPS APC 385.32 385.32 other OPPS APC 385.32 27.63 106.46 percent of total billed charges 385.32 385.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 18MM 2.4MM SS NS LOCK VARIABLE ANGLE STARDRIVE SUP-02.210.118 CDM 270010022 LOCAL 0270 RC outpatient 224.77 224.77 224.77 74 166.33 percent of total billed charges 224.77 93 182.06 percent of total billed charges 224.77 224.77 other OPPS APC 224.77 224.77 other OPPS APC 224.77 27.63 62.1 percent of total billed charges 224.77 224.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 10MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.010 CDM 270010022 LOCAL 0270 RC outpatient 325.34 325.34 325.34 74 240.75 percent of total billed charges 325.34 93 263.53 percent of total billed charges 325.34 325.34 other OPPS APC 325.34 325.34 other OPPS APC 325.34 27.63 89.89 percent of total billed charges 325.34 325.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 12MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.012 CDM 270010022 LOCAL 0270 RC outpatient 325.34 325.34 325.34 74 240.75 percent of total billed charges 325.34 93 263.53 percent of total billed charges 325.34 325.34 other OPPS APC 325.34 325.34 other OPPS APC 325.34 27.63 89.89 percent of total billed charges 325.34 325.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 14MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.014 CDM 270010022 LOCAL 0270 RC outpatient 732.16 732.16 732.16 74 541.8 percent of total billed charges 732.16 93 593.05 percent of total billed charges 732.16 732.16 other OPPS APC 732.16 732.16 other OPPS APC 732.16 27.63 202.3 percent of total billed charges 732.16 732.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 16MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.016 CDM 0270 RC outpatient 732.16 732.16 732.16 74 541.8 percent of total billed charges 732.16 93 593.05 percent of total billed charges 732.16 732.16 other OPPS APC 732.16 732.16 other OPPS APC 732.16 27.63 202.3 percent of total billed charges 732.16 732.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 18MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.018 CDM 270010022 LOCAL 0270 RC outpatient 732.16 732.16 732.16 74 541.8 percent of total billed charges 732.16 93 593.05 percent of total billed charges 732.16 732.16 other OPPS APC 732.16 732.16 other OPPS APC 732.16 27.63 202.3 percent of total billed charges 732.16 732.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 20MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.020 CDM 270010022 LOCAL 0270 RC outpatient 732.16 732.16 732.16 74 541.8 percent of total billed charges 732.16 93 593.05 percent of total billed charges 732.16 732.16 other OPPS APC 732.16 732.16 other OPPS APC 732.16 27.63 202.3 percent of total billed charges 732.16 732.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 22MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.022 CDM 270010022 LOCAL 0270 RC outpatient 732.16 732.16 732.16 74 541.8 percent of total billed charges 732.16 93 593.05 percent of total billed charges 732.16 732.16 other OPPS APC 732.16 732.16 other OPPS APC 732.16 27.63 202.3 percent of total billed charges 732.16 732.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 24MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.024 CDM 270010022 LOCAL 0270 RC outpatient 325.34 325.34 325.34 74 240.75 percent of total billed charges 325.34 93 263.53 percent of total billed charges 325.34 325.34 other OPPS APC 325.34 325.34 other OPPS APC 325.34 27.63 89.89 percent of total billed charges 325.34 325.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 26MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.026 CDM 270010022 LOCAL 0270 RC outpatient 732.16 732.16 732.16 74 541.8 percent of total billed charges 732.16 93 593.05 percent of total billed charges 732.16 732.16 other OPPS APC 732.16 732.16 other OPPS APC 732.16 27.63 202.3 percent of total billed charges 732.16 732.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L28 MM OD2.7 MM ELBOW VARIABLE ANGLE LOCK SELF TAP TIP STARDRIVE NONSTERILE SUP-02.211.028 CDM 270010022 LOCAL 0270 RC outpatient 325.34 325.34 325.34 74 240.75 percent of total billed charges 325.34 93 263.53 percent of total billed charges 325.34 325.34 other OPPS APC 325.34 325.34 other OPPS APC 325.34 27.63 89.89 percent of total billed charges 325.34 325.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 30MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.030 CDM 270010022 LOCAL 0270 RC outpatient 325.34 325.34 325.34 74 240.75 percent of total billed charges 325.34 93 263.53 percent of total billed charges 325.34 325.34 other OPPS APC 325.34 325.34 other OPPS APC 325.34 27.63 89.89 percent of total billed charges 325.34 325.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L32 MM OD2.7 MM CLAVICLE ANTERIOR VARIABLE ANGLE LOCK SELF TAP STARDRIVE NONSTERILE MODULAR PLATE SYSTEM SUP-02.211.032 CDM 270010022 LOCAL 0270 RC outpatient 325.34 325.34 325.34 74 240.75 percent of total billed charges 325.34 93 263.53 percent of total billed charges 325.34 325.34 other OPPS APC 325.34 325.34 other OPPS APC 325.34 27.63 89.89 percent of total billed charges 325.34 325.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 34MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.034 CDM 270010022 LOCAL 0270 RC outpatient 402.48 402.48 402.48 74 297.84 percent of total billed charges 402.48 93 326.01 percent of total billed charges 402.48 402.48 other OPPS APC 402.48 402.48 other OPPS APC 402.48 27.63 111.21 percent of total billed charges 402.48 402.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 36MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.036 CDM 270010022 LOCAL 0270 RC outpatient 402.48 402.48 402.48 74 297.84 percent of total billed charges 402.48 93 326.01 percent of total billed charges 402.48 402.48 other OPPS APC 402.48 402.48 other OPPS APC 402.48 27.63 111.21 percent of total billed charges 402.48 402.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 38MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.038 CDM 270010022 LOCAL 0270 RC outpatient 402.48 402.48 402.48 74 297.84 percent of total billed charges 402.48 93 326.01 percent of total billed charges 402.48 402.48 other OPPS APC 402.48 402.48 other OPPS APC 402.48 27.63 111.21 percent of total billed charges 402.48 402.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 40MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.040 CDM 270010022 LOCAL 0270 RC outpatient 402.48 402.48 402.48 74 297.84 percent of total billed charges 402.48 93 326.01 percent of total billed charges 402.48 402.48 other OPPS APC 402.48 402.48 other OPPS APC 402.48 27.63 111.21 percent of total billed charges 402.48 402.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 42MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.042 CDM 270010022 LOCAL 0270 RC outpatient 732.16 732.16 732.16 74 541.8 percent of total billed charges 732.16 93 593.05 percent of total billed charges 732.16 732.16 other OPPS APC 732.16 732.16 other OPPS APC 732.16 27.63 202.3 percent of total billed charges 732.16 732.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 44MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.044 CDM 270010022 LOCAL 0270 RC outpatient 325.34 325.34 325.34 74 240.75 percent of total billed charges 325.34 93 263.53 percent of total billed charges 325.34 325.34 other OPPS APC 325.34 325.34 other OPPS APC 325.34 27.63 89.89 percent of total billed charges 325.34 325.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 46MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.046 CDM 270010022 LOCAL 0270 RC outpatient 325.34 325.34 325.34 74 240.75 percent of total billed charges 325.34 93 263.53 percent of total billed charges 325.34 325.34 other OPPS APC 325.34 325.34 other OPPS APC 325.34 27.63 89.89 percent of total billed charges 325.34 325.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 48MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.048 CDM 270010022 LOCAL 0270 RC outpatient 732.16 732.16 732.16 74 541.8 percent of total billed charges 732.16 93 593.05 percent of total billed charges 732.16 732.16 other OPPS APC 732.16 732.16 other OPPS APC 732.16 27.63 202.3 percent of total billed charges 732.16 732.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 50MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.050 CDM 270010022 LOCAL 0270 RC outpatient 325.34 325.34 325.34 74 240.75 percent of total billed charges 325.34 93 263.53 percent of total billed charges 325.34 325.34 other OPPS APC 325.34 325.34 other OPPS APC 325.34 27.63 89.89 percent of total billed charges 325.34 325.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 52MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.052 CDM 270010022 LOCAL 0270 RC outpatient 325.34 325.34 325.34 74 240.75 percent of total billed charges 325.34 93 263.53 percent of total billed charges 325.34 325.34 other OPPS APC 325.34 325.34 other OPPS APC 325.34 27.63 89.89 percent of total billed charges 325.34 325.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 54MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.054 CDM 270010022 LOCAL 0270 RC outpatient 325.34 325.34 325.34 74 240.75 percent of total billed charges 325.34 93 263.53 percent of total billed charges 325.34 325.34 other OPPS APC 325.34 325.34 other OPPS APC 325.34 27.63 89.89 percent of total billed charges 325.34 325.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 56MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.056 CDM 270010022 LOCAL 0270 RC outpatient 402.48 402.48 402.48 74 297.84 percent of total billed charges 402.48 93 326.01 percent of total billed charges 402.48 402.48 other OPPS APC 402.48 402.48 other OPPS APC 402.48 27.63 111.21 percent of total billed charges 402.48 402.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 58MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.058 CDM 270010022 LOCAL 0270 RC outpatient 402.48 402.48 402.48 74 297.84 percent of total billed charges 402.48 93 326.01 percent of total billed charges 402.48 402.48 other OPPS APC 402.48 402.48 other OPPS APC 402.48 27.63 111.21 percent of total billed charges 402.48 402.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 60MM 2.7MM SS NS SELF TAP LOCK VARIABLE ANGLE STARDRIVE SUP-02.211.060 CDM 270010022 LOCAL 0270 RC outpatient 325.34 325.34 325.34 74 240.75 percent of total billed charges 325.34 93 263.53 percent of total billed charges 325.34 325.34 other OPPS APC 325.34 325.34 other OPPS APC 325.34 27.63 89.89 percent of total billed charges 325.34 325.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL XS X L24 MM FOREFOOT MIDFOOT VARIABLE ANGLE LOCK LOW PROFILE COMPRESSION WIRE WHOLE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.201 CDM 270010022 LOCAL 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL SMALL X L27 MM FOREFOOT MIDFOOT VARIABLE ANGLE LOCK LOW PROFILE COMPRESSION WIRE WHOLE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.202 CDM 270010022 LOCAL 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL MEDIUM X L32 MM FOREFOOT MIDFOOT VARIABLE ANGLE LOCK LOW PROFILE COMPRESSION WIRE WHOLE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.203 CDM 270010022 LOCAL 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL LARGE X L36 MM FOREFOOT MIDFOOT VARIABLE ANGLE LOCK LOW PROFILE COMPRESSION WIRE WHOLE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.204 CDM 270010022 LOCAL 0270 RC outpatient 5478.72 5478.72 5478.72 74 4054.25 percent of total billed charges 5478.72 93 4437.76 percent of total billed charges 5478.72 5478.72 other OPPS APC 5478.72 5478.72 other OPPS APC 5478.72 27.63 1513.77 percent of total billed charges 5478.72 5478.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2.4/2.7MM VA LOCKING OPENING WEDGE SUP-02.211.210 CDM 270010022 LOCAL 0270 RC outpatient 2856.36 2856.36 2856.36 74 2113.71 percent of total billed charges 2856.36 93 2313.65 percent of total billed charges 2856.36 2856.36 other OPPS APC 2856.36 2856.36 other OPPS APC 2856.36 27.63 789.21 percent of total billed charges 2856.36 2856.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2.4/2.7MM VA LOCKING OPEINING WEDGE 3MM SUP-02.211.211 CDM 270010022 LOCAL 0270 RC outpatient 2778.36 2778.36 2778.36 74 2055.99 percent of total billed charges 2778.36 93 2250.47 percent of total billed charges 2778.36 2778.36 other OPPS APC 2778.36 2778.36 other OPPS APC 2778.36 27.63 767.66 percent of total billed charges 2778.36 2778.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2.4/2.7MM VA LOCKING OPEINING WEDGE 4MM SUP-02.211.212 CDM 270010022 LOCAL 0270 RC outpatient 2778.36 2778.36 2778.36 74 2055.99 percent of total billed charges 2778.36 93 2250.47 percent of total billed charges 2778.36 2778.36 other OPPS APC 2778.36 2778.36 other OPPS APC 2778.36 27.63 767.66 percent of total billed charges 2778.36 2778.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2.4/2.7MM VA LOCKING OPEINING WEDGE 5MM SUP-02.211.213 CDM 270010022 LOCAL 0270 RC outpatient 2778.36 2778.36 2778.36 74 2055.99 percent of total billed charges 2778.36 93 2250.47 percent of total billed charges 2778.36 2778.36 other OPPS APC 2778.36 2778.36 other OPPS APC 2778.36 27.63 767.66 percent of total billed charges 2778.36 2778.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2.4/2.7MM VA LOCKING OPEINING WEDGE 6MM SUP-02.211.214 CDM 270010022 LOCAL 0270 RC outpatient 2856.36 2856.36 2856.36 74 2113.71 percent of total billed charges 2856.36 93 2313.65 percent of total billed charges 2856.36 2856.36 other OPPS APC 2856.36 2856.36 other OPPS APC 2856.36 27.63 789.21 percent of total billed charges 2856.36 2856.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2.4/2.7MM VA LOCKING NAVICULAR SUP-02.211.220 CDM 270010022 LOCAL 0270 RC outpatient 2740.17 2740.17 2740.17 74 2027.73 percent of total billed charges 2740.17 93 2219.54 percent of total billed charges 2740.17 2740.17 other OPPS APC 2740.17 2740.17 other OPPS APC 2740.17 27.63 757.11 percent of total billed charges 2740.17 2740.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2.4/2.7MM VA LOCKING CUBOID LEFT SUP-02.211.221 CDM 270010022 LOCAL 0270 RC outpatient 3389.88 3389.88 3389.88 74 2508.51 percent of total billed charges 3389.88 93 2745.8 percent of total billed charges 3389.88 3389.88 other OPPS APC 3389.88 3389.88 other OPPS APC 3389.88 27.63 936.62 percent of total billed charges 3389.88 3389.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2.4/2.7MM VA LOCKING CUBOID RIGHT SUP-02.211.222 CDM 270010022 LOCAL 0270 RC outpatient 3389.88 3389.88 3389.88 74 2508.51 percent of total billed charges 3389.88 93 2745.8 percent of total billed charges 3389.88 3389.88 other OPPS APC 3389.88 3389.88 other OPPS APC 3389.88 27.63 936.62 percent of total billed charges 3389.88 3389.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL FOREFOOT MIDFOOT 5 X 12 HOLE VARIABLE ANGLE LOCK MESH NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.224 CDM 270010022 LOCAL 0270 RC outpatient 3857.41 3857.41 3857.41 74 2854.48 percent of total billed charges 3857.41 93 3124.5 percent of total billed charges 3857.41 3857.41 other OPPS APC 3857.41 3857.41 other OPPS APC 3857.41 27.63 1065.8 percent of total billed charges 3857.41 3857.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL 0 D SMALL L42 MM FIRST METATARSOPHALANGEAL RIGHT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.230 CDM 270010022 LOCAL 0270 RC outpatient 2409.78 2409.78 2409.78 74 1783.24 percent of total billed charges 2409.78 93 1951.92 percent of total billed charges 2409.78 2409.78 other OPPS APC 2409.78 2409.78 other OPPS APC 2409.78 27.63 665.82 percent of total billed charges 2409.78 2409.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL 0 D SMALL L42 MM FIRST METATARSOPHALANGEAL LEFT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.231 CDM 270010022 LOCAL 0270 RC outpatient 2981.16 2981.16 2981.16 74 2206.06 percent of total billed charges 2981.16 93 2414.74 percent of total billed charges 2981.16 2981.16 other OPPS APC 2981.16 2981.16 other OPPS APC 2981.16 27.63 823.69 percent of total billed charges 2981.16 2981.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL 5 D SMALL L42 MM FIRST METATARSOPHALANGEAL RIGHT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.232 CDM 270010022 LOCAL 0270 RC outpatient 2981.16 2981.16 2981.16 74 2206.06 percent of total billed charges 2981.16 93 2414.74 percent of total billed charges 2981.16 2981.16 other OPPS APC 2981.16 2981.16 other OPPS APC 2981.16 27.63 823.69 percent of total billed charges 2981.16 2981.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL 5 D SMALL L42 MM FIRST METATARSOPHALANGEAL LEFT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.233 CDM 270010022 LOCAL 0270 RC outpatient 2981.16 2981.16 2981.16 74 2206.06 percent of total billed charges 2981.16 93 2414.74 percent of total billed charges 2981.16 2981.16 other OPPS APC 2981.16 2981.16 other OPPS APC 2981.16 27.63 823.69 percent of total billed charges 2981.16 2981.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL 10 D SMALL L42 MM FIRST METATARSOPHALANGEAL RIGHT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.234 CDM 270010022 LOCAL 0270 RC outpatient 2981.16 2981.16 2981.16 74 2206.06 percent of total billed charges 2981.16 93 2414.74 percent of total billed charges 2981.16 2981.16 other OPPS APC 2981.16 2981.16 other OPPS APC 2981.16 27.63 823.69 percent of total billed charges 2981.16 2981.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL 10 D SMALL L42 MM FIRST METATARSOPHALANGEAL LEFT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.235 CDM 270010022 LOCAL 0270 RC outpatient 2981.16 2981.16 2981.16 74 2206.06 percent of total billed charges 2981.16 93 2414.74 percent of total billed charges 2981.16 2981.16 other OPPS APC 2981.16 2981.16 other OPPS APC 2981.16 27.63 823.69 percent of total billed charges 2981.16 2981.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL 0 D MEDIUM L52 MM FIRST METATARSOPHALANGEAL RIGHT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.236 CDM 270010022 LOCAL 0270 RC outpatient 2981.16 2981.16 2981.16 74 2206.06 percent of total billed charges 2981.16 93 2414.74 percent of total billed charges 2981.16 2981.16 other OPPS APC 2981.16 2981.16 other OPPS APC 2981.16 27.63 823.69 percent of total billed charges 2981.16 2981.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL 0 D MEDIUM L52 MM FIRST METATARSOPHALANGEAL LEFT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.237 CDM 270010022 LOCAL 0270 RC outpatient 2981.16 2981.16 2981.16 74 2206.06 percent of total billed charges 2981.16 93 2414.74 percent of total billed charges 2981.16 2981.16 other OPPS APC 2981.16 2981.16 other OPPS APC 2981.16 27.63 823.69 percent of total billed charges 2981.16 2981.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL 5 D MEDIUM L52 MM FIRST METATARSOPHALANGEAL RIGHT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.238 CDM 270010022 LOCAL 0270 RC outpatient 2981.16 2981.16 2981.16 74 2206.06 percent of total billed charges 2981.16 93 2414.74 percent of total billed charges 2981.16 2981.16 other OPPS APC 2981.16 2981.16 other OPPS APC 2981.16 27.63 823.69 percent of total billed charges 2981.16 2981.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL 5 D MEDIUM L52 MM FIRST METATARSOPHALANGEAL LEFT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.239 CDM 270010022 LOCAL 0270 RC outpatient 2981.16 2981.16 2981.16 74 2206.06 percent of total billed charges 2981.16 93 2414.74 percent of total billed charges 2981.16 2981.16 other OPPS APC 2981.16 2981.16 other OPPS APC 2981.16 27.63 823.69 percent of total billed charges 2981.16 2981.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL 10 D MEDIUM L52 MM FIRST METATARSOPHALANGEAL RIGHT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.240 CDM 270010022 LOCAL 0270 RC outpatient 2981.16 2981.16 2981.16 74 2206.06 percent of total billed charges 2981.16 93 2414.74 percent of total billed charges 2981.16 2981.16 other OPPS APC 2981.16 2981.16 other OPPS APC 2981.16 27.63 823.69 percent of total billed charges 2981.16 2981.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL 10 D MEDIUM L52 MM FIRST METATARSOPHALANGEAL LEFT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.241 CDM 270010022 LOCAL 0270 RC outpatient 2981.16 2981.16 2981.16 74 2206.06 percent of total billed charges 2981.16 93 2414.74 percent of total billed charges 2981.16 2981.16 other OPPS APC 2981.16 2981.16 other OPPS APC 2981.16 27.63 823.69 percent of total billed charges 2981.16 2981.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL 5 D LARGE L57 MM FIRST METATARSOPHALANGEAL RIGHT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.242 CDM 270010022 LOCAL 0270 RC outpatient 2740.17 2740.17 2740.17 74 2027.73 percent of total billed charges 2740.17 93 2219.54 percent of total billed charges 2740.17 2740.17 other OPPS APC 2740.17 2740.17 other OPPS APC 2740.17 27.63 757.11 percent of total billed charges 2740.17 2740.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL 5 D LARGE L57 MM FIRST METATARSOPHALANGEAL LEFT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.243 CDM 270010022 LOCAL 0270 RC outpatient 3389.88 3389.88 3389.88 74 2508.51 percent of total billed charges 3389.88 93 2745.8 percent of total billed charges 3389.88 3389.88 other OPPS APC 3389.88 3389.88 other OPPS APC 3389.88 27.63 936.62 percent of total billed charges 3389.88 3389.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL 0 D L53 MM FIRST METATARSOPHALANGEAL RIGHT VARIABLE ANGLE FUSION LOW PROFILE REVISION NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.244 CDM 270010022 LOCAL 0270 RC outpatient 3761.16 3761.16 3761.16 74 2783.26 percent of total billed charges 3761.16 93 3046.54 percent of total billed charges 3761.16 3761.16 other OPPS APC 3761.16 3761.16 other OPPS APC 3761.16 27.63 1039.21 percent of total billed charges 3761.16 3761.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL 0 D L53 MM FIRST METATARSOPHALANGEAL LEFT VARIABLE ANGLE FUSION LOW PROFILE REVISION NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.245 CDM 270010022 LOCAL 0270 RC outpatient 3040.28 3040.28 3040.28 74 2249.81 percent of total billed charges 3040.28 93 2462.63 percent of total billed charges 3040.28 3040.28 other OPPS APC 3040.28 3040.28 other OPPS APC 3040.28 27.63 840.03 percent of total billed charges 3040.28 3040.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE FIRST TMT FUSION STANDARD SUP-02.211.246 CDM 270010022 LOCAL 0270 RC outpatient 5576.48 5576.48 5576.48 74 4126.6 percent of total billed charges 5576.48 93 4516.95 percent of total billed charges 5576.48 5576.48 other OPPS APC 5576.48 5576.48 other OPPS APC 5576.48 27.63 1540.78 percent of total billed charges 5576.48 5576.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL LONG L48 MM FIRST TARSOMETATARSAL VARIABLE ANGLE FUSION PRECONTOUR LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.247 CDM 270010022 LOCAL 0270 RC outpatient 2409.78 2409.78 2409.78 74 1783.24 percent of total billed charges 2409.78 93 1951.92 percent of total billed charges 2409.78 2409.78 other OPPS APC 2409.78 2409.78 other OPPS APC 2409.78 27.63 665.82 percent of total billed charges 2409.78 2409.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL SHORT CLOVERLEAF L38 MM FOREFOOT MIDFOOT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.250 CDM 270010022 LOCAL 0270 RC outpatient 4825.6 4825.6 4825.6 74 3570.94 percent of total billed charges 4825.6 93 3908.74 percent of total billed charges 4825.6 4825.6 other OPPS APC 4825.6 4825.6 other OPPS APC 4825.6 27.63 1333.31 percent of total billed charges 4825.6 4825.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL STANDARD CLOVERLEAF L45 MM FOREFOOT MIDFOOT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.251 CDM 270010022 LOCAL 0270 RC outpatient 4948.32 4948.32 4948.32 74 3661.76 percent of total billed charges 4948.32 93 4008.14 percent of total billed charges 4948.32 4948.32 other OPPS APC 4948.32 4948.32 other OPPS APC 4948.32 27.63 1367.22 percent of total billed charges 4948.32 4948.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL LONG CLOVERLEAF L64 MM FOREFOOT MIDFOOT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.252 CDM 270010022 LOCAL 0270 RC outpatient 5066.88 5066.88 5066.88 74 3749.49 percent of total billed charges 5066.88 93 4104.17 percent of total billed charges 5066.88 5066.88 other OPPS APC 5066.88 5066.88 other OPPS APC 5066.88 27.63 1399.98 percent of total billed charges 5066.88 5066.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL SHORT T L35 MM FOREFOOT MIDFOOT 2 HOLE VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.253 CDM 270010022 LOCAL 0270 RC outpatient 2578.68 2578.68 2578.68 74 1908.22 percent of total billed charges 2578.68 93 2088.73 percent of total billed charges 2578.68 2578.68 other OPPS APC 2578.68 2578.68 other OPPS APC 2578.68 27.63 712.49 percent of total billed charges 2578.68 2578.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL STANDARD T L42 MM FOREFOOT MIDFOOT 2 HOLE VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.254 CDM 270010022 LOCAL 0270 RC outpatient 2645.76 2645.76 2645.76 74 1957.86 percent of total billed charges 2645.76 93 2143.07 percent of total billed charges 2645.76 2645.76 other OPPS APC 2645.76 2645.76 other OPPS APC 2645.76 27.63 731.02 percent of total billed charges 2645.76 2645.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL LONG T L61 MM FOREFOOT MIDFOOT 2 HOLE VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.255 CDM 270010022 LOCAL 0270 RC outpatient 2189.1 2189.1 2189.1 74 1619.93 percent of total billed charges 2189.1 93 1773.17 percent of total billed charges 2189.1 2189.1 other OPPS APC 2189.1 2189.1 other OPPS APC 2189.1 27.63 604.85 percent of total billed charges 2189.1 2189.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL SHORT L L37 MM FOREFOOT MIDFOOT RIGHT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.256 CDM 270010022 LOCAL 0270 RC outpatient 4960.8 4960.8 4960.8 74 3670.99 percent of total billed charges 4960.8 93 4018.25 percent of total billed charges 4960.8 4960.8 other OPPS APC 4960.8 4960.8 other OPPS APC 4960.8 27.63 1370.67 percent of total billed charges 4960.8 4960.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL SHORT L L37 MM FOREFOOT MIDFOOT LEFT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.257 CDM 270010022 LOCAL 0270 RC outpatient 2578.68 2578.68 2578.68 74 1908.22 percent of total billed charges 2578.68 93 2088.73 percent of total billed charges 2578.68 2578.68 other OPPS APC 2578.68 2578.68 other OPPS APC 2578.68 27.63 712.49 percent of total billed charges 2578.68 2578.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL STANDARD L L44 MM FOREFOOT MIDFOOT RIGHT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.258 CDM 270010022 LOCAL 0270 RC outpatient 2717.52 2717.52 2717.52 74 2010.96 percent of total billed charges 2717.52 93 2201.19 percent of total billed charges 2717.52 2717.52 other OPPS APC 2717.52 2717.52 other OPPS APC 2717.52 27.63 750.85 percent of total billed charges 2717.52 2717.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL STANDARD L L44 MM FOREFOOT MIDFOOT LEFT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.259 CDM 270010022 LOCAL 0270 RC outpatient 2196.66 2196.66 2196.66 74 1625.53 percent of total billed charges 2196.66 93 1779.29 percent of total billed charges 2196.66 2196.66 other OPPS APC 2196.66 2196.66 other OPPS APC 2196.66 27.63 606.94 percent of total billed charges 2196.66 2196.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL LONG L L62 MM FOREFOOT MIDFOOT RIGHT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.260 CDM 270010022 LOCAL 0270 RC outpatient 2789.28 2789.28 2789.28 74 2064.07 percent of total billed charges 2789.28 93 2259.32 percent of total billed charges 2789.28 2789.28 other OPPS APC 2789.28 2789.28 other OPPS APC 2789.28 27.63 770.68 percent of total billed charges 2789.28 2789.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL LONG L L62 MM FOREFOOT MIDFOOT LEFT VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.261 CDM 270010022 LOCAL 0270 RC outpatient 2789.28 2789.28 2789.28 74 2064.07 percent of total billed charges 2789.28 93 2259.32 percent of total billed charges 2789.28 2789.28 other OPPS APC 2789.28 2789.28 other OPPS APC 2789.28 27.63 770.68 percent of total billed charges 2789.28 2789.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL STRAIGHT L27 MM FOREFOOT MIDFOOT 2 HOLE VARIABLE ANGLE FUSION LOCK NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.262 CDM 270010022 LOCAL 0270 RC outpatient 4311.84 4311.84 4311.84 74 3190.76 percent of total billed charges 4311.84 93 3492.59 percent of total billed charges 4311.84 4311.84 other OPPS APC 4311.84 4311.84 other OPPS APC 4311.84 27.63 1191.36 percent of total billed charges 4311.84 4311.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL STRAIGHT L40 MM FOREFOOT MIDFOOT 4 HOLE VARIABLE ANGLE FUSION LOCK NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.263 CDM 270010022 LOCAL 0270 RC outpatient 4563.52 4563.52 4563.52 74 3377 percent of total billed charges 4563.52 93 3696.45 percent of total billed charges 4563.52 4563.52 other OPPS APC 4563.52 4563.52 other OPPS APC 4563.52 27.63 1260.9 percent of total billed charges 4563.52 4563.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL XLONG T L92 MM FOREFOOT MIDFOOT 3 HOLE VARIABLE ANGLE FUSION LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.265 CDM 270010022 LOCAL 0270 RC outpatient 3389.88 3389.88 3389.88 74 2508.51 percent of total billed charges 3389.88 93 2745.8 percent of total billed charges 3389.88 3389.88 other OPPS APC 3389.88 3389.88 other OPPS APC 3389.88 27.63 936.62 percent of total billed charges 3389.88 3389.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L43 MM TARSOMETATARSAL VARIABLE ANGLE FUSION PRECONTOUR LOW PROFILE NONSTERILE 2.4/2.7 MM SCREW SUP-02.211.266 CDM 270010022 LOCAL 0270 RC outpatient 5066.88 5066.88 5066.88 74 3749.49 percent of total billed charges 5066.88 93 4104.17 percent of total billed charges 5066.88 5066.88 other OPPS APC 5066.88 5066.88 other OPPS APC 5066.88 27.63 1399.98 percent of total billed charges 5066.88 5066.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL SMALL L58 MM CALCANEAL RIGHT LOCK LOW PROFILE VARIABLE ANGLE NONSTERILE 2.7 MM SCREW SUP-02.211.400 CDM 0270 RC outpatient 2795.65 2795.65 2795.65 74 2068.78 percent of total billed charges 2795.65 93 2264.48 percent of total billed charges 2795.65 2795.65 other OPPS APC 2795.65 2795.65 other OPPS APC 2795.65 27.63 772.44 percent of total billed charges 2795.65 2795.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL SMALL L58 MM CALCANEAL LEFT LOCK LOW PROFILE VARIABLE ANGLE NONSTERILE 2.7 MM SCREW SUP-02.211.401 CDM 0270 RC outpatient 2795.65 2795.65 2795.65 74 2068.78 percent of total billed charges 2795.65 93 2264.48 percent of total billed charges 2795.65 2795.65 other OPPS APC 2795.65 2795.65 other OPPS APC 2795.65 27.63 772.44 percent of total billed charges 2795.65 2795.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL MEDIUM L64 MM CALCANEAL RIGHT LOCK LOW PROFILE VARIABLE ANGLE NONSTERILE 2.7 MM SCREW SUP-02.211.402 CDM 0270 RC outpatient 2815.8 2815.8 2815.8 74 2083.69 percent of total billed charges 2815.8 93 2280.8 percent of total billed charges 2815.8 2815.8 other OPPS APC 2815.8 2815.8 other OPPS APC 2815.8 27.63 778.01 percent of total billed charges 2815.8 2815.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL MEDIUM L64 MM CALCANEAL LEFT LOCK LOW PROFILE VARIABLE ANGLE NONSTERILE 2.7 MM SCREW SUP-02.211.403 CDM 0270 RC outpatient 2815.8 2815.8 2815.8 74 2083.69 percent of total billed charges 2815.8 93 2280.8 percent of total billed charges 2815.8 2815.8 other OPPS APC 2815.8 2815.8 other OPPS APC 2815.8 27.63 778.01 percent of total billed charges 2815.8 2815.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL LARGE L70 MM CALCANEAL RIGHT LOCK LOW PROFILE VARIABLE ANGLE NONSTERILE 2.7 MM SCREW SUP-02.211.404 CDM 0270 RC outpatient 2836.08 2836.08 2836.08 74 2098.7 percent of total billed charges 2836.08 93 2297.22 percent of total billed charges 2836.08 2836.08 other OPPS APC 2836.08 2836.08 other OPPS APC 2836.08 27.63 783.61 percent of total billed charges 2836.08 2836.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7MM VA LOCKING CALCANEAL PLATE LARGE RIGHT SUP-02.211.405 CDM 0270 RC outpatient 2292.5 2292.5 2292.5 74 1696.45 percent of total billed charges 2292.5 93 1856.93 percent of total billed charges 2292.5 2292.5 other OPPS APC 2292.5 2292.5 other OPPS APC 2292.5 27.63 633.42 percent of total billed charges 2292.5 2292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL SHORT L40 MM CALCANEAL RIGHT ANTEROLATERAL LOCK LOW PROFILE VARIABLE ANGLE NONSTERILE 2.7 MM SCREW SUP-02.211.410 CDM 0270 RC outpatient 2569.84 2569.84 2569.84 74 1901.68 percent of total billed charges 2569.84 93 2081.57 percent of total billed charges 2569.84 2569.84 other OPPS APC 2569.84 2569.84 other OPPS APC 2569.84 27.63 710.05 percent of total billed charges 2569.84 2569.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL SHORT L40 MM CALCANEAL LEFT ANTEROLATERAL LOCK LOW PROFILE VARIABLE ANGLE NONSTERILE 2.7 MM SCREW SUP-02.211.411 CDM 0270 RC outpatient 2569.84 2569.84 2569.84 74 1901.68 percent of total billed charges 2569.84 93 2081.57 percent of total billed charges 2569.84 2569.84 other OPPS APC 2569.84 2569.84 other OPPS APC 2569.84 27.63 710.05 percent of total billed charges 2569.84 2569.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL LONG L56 MM CALCANEAL RIGHT ANTEROLATERAL LOCK LOW PROFILE VARIABLE ANGLE NONSTERILE 2.7 MM SCREW SUP-02.211.412 CDM 0270 RC outpatient 2180.28 2180.28 2180.28 74 1613.41 percent of total billed charges 2180.28 93 1766.03 percent of total billed charges 2180.28 2180.28 other OPPS APC 2180.28 2180.28 other OPPS APC 2180.28 27.63 602.41 percent of total billed charges 2180.28 2180.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL LONG L56 MM CALCANEAL LEFT ANTEROLATERAL LOCK LOW PROFILE VARIABLE ANGLE NONSTERILE 2.7 MM SCREW SUP-02.211.413 CDM 0270 RC outpatient 2180.28 2180.28 2180.28 74 1613.41 percent of total billed charges 2180.28 93 1766.03 percent of total billed charges 2180.28 2180.28 other OPPS APC 2180.28 2180.28 other OPPS APC 2180.28 27.63 602.41 percent of total billed charges 2180.28 2180.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T4 L9 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SET SUP-02.214.109 CDM 270010022 LOCAL 0270 RC outpatient 122.98 122.98 122.98 74 91.01 percent of total billed charges 122.98 93 99.61 percent of total billed charges 122.98 122.98 other OPPS APC 122.98 122.98 other OPPS APC 122.98 27.63 33.98 percent of total billed charges 122.98 122.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T4 L10 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SET SUP-02.214.110 CDM 270010022 LOCAL 0270 RC outpatient 122.98 122.98 122.98 74 91.01 percent of total billed charges 122.98 93 99.61 percent of total billed charges 122.98 122.98 other OPPS APC 122.98 122.98 other OPPS APC 122.98 27.63 33.98 percent of total billed charges 122.98 122.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SET SUP-02.214.112 CDM 270010022 LOCAL 0270 RC outpatient 122.98 122.98 122.98 74 91.01 percent of total billed charges 122.98 93 99.61 percent of total billed charges 122.98 122.98 other OPPS APC 122.98 122.98 other OPPS APC 122.98 27.63 33.98 percent of total billed charges 122.98 122.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T4 L13 MM OD1.5 MM CORTEX SELF TAP RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SET SUP-02.214.113 CDM 270010022 LOCAL 0270 RC outpatient 122.98 122.98 122.98 74 91.01 percent of total billed charges 122.98 93 99.61 percent of total billed charges 122.98 122.98 other OPPS APC 122.98 122.98 other OPPS APC 122.98 27.63 33.98 percent of total billed charges 122.98 122.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T4 L14 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE LOW PROFILE HEAD NONSTERILE MODULAR MINI FRAGMENT SET SUP-02.214.114 CDM 270010022 LOCAL 0270 RC outpatient 122.98 122.98 122.98 74 91.01 percent of total billed charges 122.98 93 99.61 percent of total billed charges 122.98 122.98 other OPPS APC 122.98 122.98 other OPPS APC 122.98 27.63 33.98 percent of total billed charges 122.98 122.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T4 L15 MM OD1.5 MM CORTEX SELF TAP STARDRIVE NONSTERILE HAND SYSTEM SUP-02.214.115 CDM 270010022 LOCAL 0270 RC outpatient 122.98 122.98 122.98 74 91.01 percent of total billed charges 122.98 93 99.61 percent of total billed charges 122.98 122.98 other OPPS APC 122.98 122.98 other OPPS APC 122.98 27.63 33.98 percent of total billed charges 122.98 122.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES PERIPROSTHETIC LOCKING 8MM SUP-02.221.508S CDM 270010022 LOCAL 0270 RC outpatient 689.26 689.26 689.26 74 510.05 percent of total billed charges 689.26 93 558.3 percent of total billed charges 689.26 689.26 other OPPS APC 689.26 689.26 other OPPS APC 689.26 27.63 190.44 percent of total billed charges 689.26 689.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES PERIPROSTHETIC LOCKING 10MM SUP-02.221.510S CDM 270010022 LOCAL 0270 RC outpatient 607.8 607.8 607.8 74 449.77 percent of total billed charges 607.8 93 492.32 percent of total billed charges 607.8 607.8 other OPPS APC 607.8 607.8 other OPPS APC 607.8 27.63 167.94 percent of total billed charges 607.8 607.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 10MM 4MM 3MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.010 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T8 SHORT THREAD FLUTE L12 MM L4 MM OD3 MM ODSEC2 MM SMALL BONE SELF DRILL SELF TAP STARDRIVE HEADLESS COMPRESSION NONSTERILE SUP-02.226.012 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 14MM 4MM 3MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.014 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 16MM 4MM 3MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.016 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 18MM 4MM 3MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.018 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 20MM 4MM 3MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.020 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 22MM 4MM 3MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.022 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL SHORT THREAD T8 L24 MM L5 MM OD3 MM ODSEC2 MM ID1.1 MM SMALL BONE STARDRIVE COMPRESSION CANNULATED HEADLESS NONSTERILE SUP-02.226.024 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 26MM 5MM 3MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.026 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 28MM 6MM 3MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.028 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL SHORT THREAD T8 L30 MM L7 MM OD3 MM ODSEC2 MM ID1.1 MM SMALL BONE STARDRIVE COMPRESSION CANNULATED HEADLESS NONSTERILE SUP-02.226.030 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 32MM 7MM 3MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.032 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 34MM 8MM 3MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.034 CDM 270010022 LOCAL 0270 RC outpatient 711.98 711.98 711.98 74 526.87 percent of total billed charges 711.98 93 576.7 percent of total billed charges 711.98 711.98 other OPPS APC 711.98 711.98 other OPPS APC 711.98 27.63 196.72 percent of total billed charges 711.98 711.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 36MM 9MM 3MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.036 CDM 270010022 LOCAL 0270 RC outpatient 711.98 711.98 711.98 74 526.87 percent of total billed charges 711.98 93 576.7 percent of total billed charges 711.98 711.98 other OPPS APC 711.98 711.98 other OPPS APC 711.98 27.63 196.72 percent of total billed charges 711.98 711.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 38MM 9MM 3MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.038 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL SHORT THREAD T8 L40 MM L10 MM OD3 MM ODSEC2 MM ID1.1 MM SMALL BONE STARDRIVE COMPRESSION CANNULATED HEADLESS NONSTERILE SUP-02.226.040 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL LONG THREAD L16 MM L5 MM OD3 MM ODSEC2 MM SMALL BONE SELF TAP DRILL COMPRESSION CANNULATED NONSTERILE SUP-02.226.116 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL LONG THREAD L18 MM L6 MM OD3 MM ODSEC2 MM ID1.1 MM SMALL BONE T8 STARDRIVE CANNULATED SELF DRILL HEADLESS NONSTERILE SUP-02.226.118 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 3MM 2MM 1.1MM 20MM 7MM SS 2MM CORE LONG THREAD T8 SM BONE STARDRIVE SUP-02.226.120 CDM 270010022 LOCAL 0270 RC outpatient 940.68 940.68 940.68 74 696.1 percent of total billed charges 940.68 93 761.95 percent of total billed charges 940.68 940.68 other OPPS APC 940.68 940.68 other OPPS APC 940.68 27.63 259.91 percent of total billed charges 940.68 940.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL OD2 MM CORE LONG THREAD T8 L20 MM L7 MM OD3 MM ODSEC2 MM ID1.1 MM SMALL BONE STARDRIVE COMPRESSION CANNULATED HEADLESS NONSTERILE SUP-02.226.120 CDM 270010022 LOCAL 0270 RC outpatient 711.98 711.98 711.98 74 526.87 percent of total billed charges 711.98 93 576.7 percent of total billed charges 711.98 711.98 other OPPS APC 711.98 711.98 other OPPS APC 711.98 27.63 196.72 percent of total billed charges 711.98 711.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LONG THREAD T8 22MM 8MM 3MM 2MM 1.1MM SS NS SM BONE COMPRESSION CANNULATED HEADLESS STARDRIVE ACCEPTS 1.1MM SUP-02.226.122 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL LONG THREAD L24 MM L8 MM OD3 MM ODSEC2 MM ID1.1 MM SMALL BONE T8 STARDRIVE CANNULATED SELF DRILL HEADLESS NONSTERILE SUP-02.226.124 CDM 270010022 LOCAL 0270 RC outpatient 711.98 711.98 711.98 74 526.87 percent of total billed charges 711.98 93 576.7 percent of total billed charges 711.98 711.98 other OPPS APC 711.98 711.98 other OPPS APC 711.98 27.63 196.72 percent of total billed charges 711.98 711.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1.1 MM LONG THREAD L26 MM L10 MM OD3 MM ODSEC2 MM SMALL BONE T8 STARDRIVE RECESS HEADLESS COMPRESSION CANNULATED SELF DRILLING AND SELF TAPPING NONSTERILE SUP-02.226.126 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T8 L28 MM L10 MM OD3 MM ODSEC2 MM ID1.1 MM SMALL BONE SELF DRILL SELF TAP CANNULATED COMPRESSION STARDRIVE NONSTERILE SUP-02.226.128 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T8 L30 MM L12 MM OD3 MM ODSEC2 MM ID1.1 MM SMALL BONE SELF DRILL SELF TAP CANNULATED COMPRESSION STARDRIVE NONSTERILE SUP-02.226.130 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL LONG THREAD T8 L32 MM L12 MM OD3 MM ODSEC2 MM ID1.1 MM SMALL BONE STARDRIVE COMPRESSION CANNULATED HEADLESS NONSTERILE SUP-02.226.132 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LONG THREAD 34MM 14MM 3MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.134 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL LONG THREAD L36 MM L14 MM OD3 MM ODSEC2 MM SMALL BONE COMPRESSION CANNULATED T8 STARDRIVE HEADLESS NONSTERILE SUP-02.226.136 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL LONG THREAD T8 L40 MM L16 MM OD3 MM ODSEC2 MM ID1.1 MM SMALL BONE STARDRIVE COMPRESSION CANNULATED HEADLESS NONSTERILE SUP-02.226.140 CDM 270010022 LOCAL 0270 RC outpatient 883.38 883.38 883.38 74 653.7 percent of total billed charges 883.38 93 715.54 percent of total billed charges 883.38 883.38 other OPPS APC 883.38 883.38 other OPPS APC 883.38 27.63 244.08 percent of total billed charges 883.38 883.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 9MM 4MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.209 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 10MM 4MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.210 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 11MM 4MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.211 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 12MM 4MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.212 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 13MM 4MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.213 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 14MM 4MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.214 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL SHORT THREAD L15 MM L4 MM OD2.4 MM HAND FOOT SELF DRILL COMPRESSION CANNULATED HEADLESS NONSTERILE SUP-02.226.215 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 16MM 4MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.216 CDM 270010022 LOCAL 0270 RC outpatient 713.08 713.08 713.08 74 527.68 percent of total billed charges 713.08 93 577.59 percent of total billed charges 713.08 713.08 other OPPS APC 713.08 713.08 other OPPS APC 713.08 27.63 197.02 percent of total billed charges 713.08 713.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 17MM 4MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.217 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 18MM 4MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.218 CDM 270010022 LOCAL 0270 RC outpatient 713.08 713.08 713.08 74 527.68 percent of total billed charges 713.08 93 577.59 percent of total billed charges 713.08 713.08 other OPPS APC 713.08 713.08 other OPPS APC 713.08 27.63 197.02 percent of total billed charges 713.08 713.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 19MM 4MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.219 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 20MM 4MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.220 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 21MM 4MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.221 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 22MM 4MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.222 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 23MM 4MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.223 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 24MM 5MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.224 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 25MM 5MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.225 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 26MM 5MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.226 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 27MM 6MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.227 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 28MM 6MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.228 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 29MM 6MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.229 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 30MM 7MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.230 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 32MM 7MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.232 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 34MM 8MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.234 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 36MM 9MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.236 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 38MM 9MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.238 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 SHORT THREAD 40MM 10MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.240 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LONG THREAD 17MM 6MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.317 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LONG THREAD 18MM 6MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.318 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LONG THREAD 19MM 7MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.319 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LONG THREAD 20MM 7MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.320 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LONG THREAD 21MM 8MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.321 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LONG THREAD 22MM 8MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.322 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LONG THREAD 23MM 8MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.323 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LONG THREAD 24MM 8MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.324 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LONG THREAD 25MM 8MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.325 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LONG THREAD 26MM 10MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.326 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LONG THREAD 27MM 10MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.327 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LONG THREAD 28MM 10MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.328 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LONG THREAD 29MM 10MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.329 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LONG THREAD 30MM 12MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.330 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LONG THREAD 32MM 12MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.332 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LONG THREAD 34MM 14MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.334 CDM 270010022 LOCAL 0270 RC outpatient 713.08 713.08 713.08 74 527.68 percent of total billed charges 713.08 93 577.59 percent of total billed charges 713.08 713.08 other OPPS APC 713.08 713.08 other OPPS APC 713.08 27.63 197.02 percent of total billed charges 713.08 713.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LONG THREAD 36MM 14MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.336 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LONG THREAD 38MM 16MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.338 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LONG THREAD 40MM 16MM 2.4MM 2MM SS NS COMPRESSION CANNULATED SELF TAP HEADLESS ACCEPTS 1.1MM GUIDEWIRE SUP-02.226.340 CDM 270010022 LOCAL 0270 RC outpatient 883.27 883.27 883.27 74 653.62 percent of total billed charges 883.27 93 715.45 percent of total billed charges 883.27 883.27 other OPPS APC 883.27 883.27 other OPPS APC 883.27 27.63 244.05 percent of total billed charges 883.27 883.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T25 L14 MM OD5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PERIPROSTHETIC CURVE CONDYLAR PLATE SYSTEM SUP-02.231.014 CDM 270010022 LOCAL 0270 RC outpatient 636.79 636.79 636.79 74 471.22 percent of total billed charges 636.79 93 515.8 percent of total billed charges 636.79 636.79 other OPPS APC 636.79 636.79 other OPPS APC 636.79 27.63 175.95 percent of total billed charges 636.79 636.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN POSITIONING L5 MM VARIABLE ANGLE STERILE LATEX FREE DISPOSABLE SUP-02.231.022S CDM 270010022 LOCAL 0270 RC outpatient 478.61 478.61 478.61 74 354.17 percent of total billed charges 478.61 93 387.67 percent of total billed charges 478.61 478.61 other OPPS APC 478.61 478.61 other OPPS APC 478.61 27.63 132.24 percent of total billed charges 478.61 478.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L14 MM OD5 MM CONDYLE STARDRIVE LOCKING VARIABLE ANGLE SELF TAPPING NONSTERILE SUP-02.231.214 CDM 270010022 LOCAL 0270 RC outpatient 514.8 514.8 514.8 74 380.95 percent of total billed charges 514.8 93 416.99 percent of total billed charges 514.8 514.8 other OPPS APC 514.8 514.8 other OPPS APC 514.8 27.63 142.24 percent of total billed charges 514.8 514.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L16 MM OD5 MM CONDYLE STARDRIVE SELF TAPPING VARIABLE ANGLE LOCKING NONSTERILE SUP-02.231.216 CDM 270010022 LOCAL 0270 RC outpatient 514.8 514.8 514.8 74 380.95 percent of total billed charges 514.8 93 416.99 percent of total billed charges 514.8 514.8 other OPPS APC 514.8 514.8 other OPPS APC 514.8 27.63 142.24 percent of total billed charges 514.8 514.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T25 L18 MM OD5 MM CONDYLAR VARIABLE ANGLE SELF TAP LOCK STARDRIVE NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-02.231.218 CDM 270010022 LOCAL 0270 RC outpatient 514.8 514.8 514.8 74 380.95 percent of total billed charges 514.8 93 416.99 percent of total billed charges 514.8 514.8 other OPPS APC 514.8 514.8 other OPPS APC 514.8 27.63 142.24 percent of total billed charges 514.8 514.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T25 L20 MM OD5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.220 CDM 270010022 LOCAL 0270 RC outpatient 446.16 446.16 446.16 74 330.16 percent of total billed charges 446.16 93 361.39 percent of total billed charges 446.16 446.16 other OPPS APC 446.16 446.16 other OPPS APC 446.16 27.63 123.27 percent of total billed charges 446.16 446.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T25 L22 MM OD5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.222 CDM 270010022 LOCAL 0270 RC outpatient 446.16 446.16 446.16 74 330.16 percent of total billed charges 446.16 93 361.39 percent of total billed charges 446.16 446.16 other OPPS APC 446.16 446.16 other OPPS APC 446.16 27.63 123.27 percent of total billed charges 446.16 446.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T25 L24 MM OD5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.224 CDM 270010022 LOCAL 0270 RC outpatient 446.16 446.16 446.16 74 330.16 percent of total billed charges 446.16 93 361.39 percent of total billed charges 446.16 446.16 other OPPS APC 446.16 446.16 other OPPS APC 446.16 27.63 123.27 percent of total billed charges 446.16 446.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T25 L26 MM OD5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.226 CDM 270010022 LOCAL 0270 RC outpatient 446.16 446.16 446.16 74 330.16 percent of total billed charges 446.16 93 361.39 percent of total billed charges 446.16 446.16 other OPPS APC 446.16 446.16 other OPPS APC 446.16 27.63 123.27 percent of total billed charges 446.16 446.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T25 L28 MM OD5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.228 CDM 270010022 LOCAL 0270 RC outpatient 908.96 908.96 908.96 74 672.63 percent of total billed charges 908.96 93 736.26 percent of total billed charges 908.96 908.96 other OPPS APC 908.96 908.96 other OPPS APC 908.96 27.63 251.15 percent of total billed charges 908.96 908.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T25 L30 MM OD5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.230 CDM 270010022 LOCAL 0270 RC outpatient 446.16 446.16 446.16 74 330.16 percent of total billed charges 446.16 93 361.39 percent of total billed charges 446.16 446.16 other OPPS APC 446.16 446.16 other OPPS APC 446.16 27.63 123.27 percent of total billed charges 446.16 446.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T25 L32 MM OD5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.232 CDM 270010022 LOCAL 0270 RC outpatient 446.16 446.16 446.16 74 330.16 percent of total billed charges 446.16 93 361.39 percent of total billed charges 446.16 446.16 other OPPS APC 446.16 446.16 other OPPS APC 446.16 27.63 123.27 percent of total billed charges 446.16 446.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T25 L34 MM OD5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.234 CDM 270010022 LOCAL 0270 RC outpatient 446.16 446.16 446.16 74 330.16 percent of total billed charges 446.16 93 361.39 percent of total billed charges 446.16 446.16 other OPPS APC 446.16 446.16 other OPPS APC 446.16 27.63 123.27 percent of total billed charges 446.16 446.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T25 L36 MM OD5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.236 CDM 270010022 LOCAL 0270 RC outpatient 446.16 446.16 446.16 74 330.16 percent of total billed charges 446.16 93 361.39 percent of total billed charges 446.16 446.16 other OPPS APC 446.16 446.16 other OPPS APC 446.16 27.63 123.27 percent of total billed charges 446.16 446.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T25 L38 MM OD5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.238 CDM 270010022 LOCAL 0270 RC outpatient 908.96 908.96 908.96 74 672.63 percent of total billed charges 908.96 93 736.26 percent of total billed charges 908.96 908.96 other OPPS APC 908.96 908.96 other OPPS APC 908.96 27.63 251.15 percent of total billed charges 908.96 908.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T25 L38 MM OD5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.240 CDM 270010022 LOCAL 0270 RC outpatient 446.16 446.16 446.16 74 330.16 percent of total billed charges 446.16 93 361.39 percent of total billed charges 446.16 446.16 other OPPS APC 446.16 446.16 other OPPS APC 446.16 27.63 123.27 percent of total billed charges 446.16 446.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T25 L44 MM OD5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.244 CDM 270010022 LOCAL 0270 RC outpatient 446.16 446.16 446.16 74 330.16 percent of total billed charges 446.16 93 361.39 percent of total billed charges 446.16 446.16 other OPPS APC 446.16 446.16 other OPPS APC 446.16 27.63 123.27 percent of total billed charges 446.16 446.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T25 L60 MM OD5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.260 CDM 270010022 LOCAL 0270 RC outpatient 446.16 446.16 446.16 74 330.16 percent of total billed charges 446.16 93 361.39 percent of total billed charges 446.16 446.16 other OPPS APC 446.16 446.16 other OPPS APC 446.16 27.63 123.27 percent of total billed charges 446.16 446.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T25 L75 MM OD5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.275 CDM 270010022 LOCAL 0270 RC outpatient 446.16 446.16 446.16 74 330.16 percent of total billed charges 446.16 93 361.39 percent of total billed charges 446.16 446.16 other OPPS APC 446.16 446.16 other OPPS APC 446.16 27.63 123.27 percent of total billed charges 446.16 446.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5.0MM VARIABLE ANGLE LOCKNG SCREW/SLF-TPNG/STRDRV/80MM SUP-02.231.280 CDM 270010022 LOCAL 0270 RC outpatient 446.16 446.16 446.16 74 330.16 percent of total billed charges 446.16 93 361.39 percent of total billed charges 446.16 446.16 other OPPS APC 446.16 446.16 other OPPS APC 446.16 27.63 123.27 percent of total billed charges 446.16 446.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L20 MM OD5 MM CANNULATED SELF DRILL LOCK VARIABLE ANGLE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.620 CDM 270010022 LOCAL 0270 RC outpatient 695.76 695.76 695.76 74 514.86 percent of total billed charges 695.76 93 563.57 percent of total billed charges 695.76 695.76 other OPPS APC 695.76 695.76 other OPPS APC 695.76 27.63 192.24 percent of total billed charges 695.76 695.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L25 MM OD5 MM CANNULATED SELF DRILL LOCK VARIABLE ANGLE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.625 CDM 270010022 LOCAL 0270 RC outpatient 695.76 695.76 695.76 74 514.86 percent of total billed charges 695.76 93 563.57 percent of total billed charges 695.76 695.76 other OPPS APC 695.76 695.76 other OPPS APC 695.76 27.63 192.24 percent of total billed charges 695.76 695.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L30 MM OD5 MM CANNULATED SELF DRILL LOCK VARIABLE ANGLE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.630 CDM 270010022 LOCAL 0270 RC outpatient 695.76 695.76 695.76 74 514.86 percent of total billed charges 695.76 93 563.57 percent of total billed charges 695.76 695.76 other OPPS APC 695.76 695.76 other OPPS APC 695.76 27.63 192.24 percent of total billed charges 695.76 695.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L35 MM OD5 MM CANNULATED SELF DRILL LOCK VARIABLE ANGLE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.635 CDM 270010022 LOCAL 0270 RC outpatient 695.76 695.76 695.76 74 514.86 percent of total billed charges 695.76 93 563.57 percent of total billed charges 695.76 695.76 other OPPS APC 695.76 695.76 other OPPS APC 695.76 27.63 192.24 percent of total billed charges 695.76 695.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L40 MM OD5 MM CANNULATED SELF DRILL LOCK VARIABLE ANGLE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.640 CDM 270010022 LOCAL 0270 RC outpatient 695.76 695.76 695.76 74 514.86 percent of total billed charges 695.76 93 563.57 percent of total billed charges 695.76 695.76 other OPPS APC 695.76 695.76 other OPPS APC 695.76 27.63 192.24 percent of total billed charges 695.76 695.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L45 MM OD5 MM CANNULATED SELF DRILL LOCK VARIABLE ANGLE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.645 CDM 270010022 LOCAL 0270 RC outpatient 695.76 695.76 695.76 74 514.86 percent of total billed charges 695.76 93 563.57 percent of total billed charges 695.76 695.76 other OPPS APC 695.76 695.76 other OPPS APC 695.76 27.63 192.24 percent of total billed charges 695.76 695.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L50 MM OD5 MM CANNULATED SELF DRILL LOCK VARIABLE ANGLE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.650 CDM 270010022 LOCAL 0270 RC outpatient 602.99 602.99 602.99 74 446.21 percent of total billed charges 602.99 93 488.42 percent of total billed charges 602.99 602.99 other OPPS APC 602.99 602.99 other OPPS APC 602.99 27.63 166.61 percent of total billed charges 602.99 602.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L55 MM OD5 MM CANNULATED SELF DRILL LOCK VARIABLE ANGLE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.655 CDM 270010022 LOCAL 0270 RC outpatient 695.76 695.76 695.76 74 514.86 percent of total billed charges 695.76 93 563.57 percent of total billed charges 695.76 695.76 other OPPS APC 695.76 695.76 other OPPS APC 695.76 27.63 192.24 percent of total billed charges 695.76 695.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L60 MM OD5 MM CANNULATED SELF DRILL LOCK VARIABLE ANGLE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.660 CDM 270010022 LOCAL 0270 RC outpatient 695.76 695.76 695.76 74 514.86 percent of total billed charges 695.76 93 563.57 percent of total billed charges 695.76 695.76 other OPPS APC 695.76 695.76 other OPPS APC 695.76 27.63 192.24 percent of total billed charges 695.76 695.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L65 MM OD5 MM CANNULATED SELF DRILL LOCK VARIABLE ANGLE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.665 CDM 270010022 LOCAL 0270 RC outpatient 602.99 602.99 602.99 74 446.21 percent of total billed charges 602.99 93 488.42 percent of total billed charges 602.99 602.99 other OPPS APC 602.99 602.99 other OPPS APC 602.99 27.63 166.61 percent of total billed charges 602.99 602.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L70 MM OD5 MM CANNULATED SELF DRILL LOCK VARIABLE ANGLE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.670 CDM 270010022 LOCAL 0270 RC outpatient 695.76 695.76 695.76 74 514.86 percent of total billed charges 695.76 93 563.57 percent of total billed charges 695.76 695.76 other OPPS APC 695.76 695.76 other OPPS APC 695.76 27.63 192.24 percent of total billed charges 695.76 695.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L75 MM OD5 MM CANNULATED SELF DRILL LOCK VARIABLE ANGLE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.675 CDM 270010022 LOCAL 0270 RC outpatient 602.99 602.99 602.99 74 446.21 percent of total billed charges 602.99 93 488.42 percent of total billed charges 602.99 602.99 other OPPS APC 602.99 602.99 other OPPS APC 602.99 27.63 166.61 percent of total billed charges 602.99 602.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L80 MM OD5 MM CANNULATED SELF DRILL LOCK VARIABLE ANGLE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.680 CDM 270010022 LOCAL 0270 RC outpatient 602.99 602.99 602.99 74 446.21 percent of total billed charges 602.99 93 488.42 percent of total billed charges 602.99 602.99 other OPPS APC 602.99 602.99 other OPPS APC 602.99 27.63 166.61 percent of total billed charges 602.99 602.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L85 MM OD5 MM CANNULATED SELF DRILL LOCK VARIABLE ANGLE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.685 CDM 270010022 LOCAL 0270 RC outpatient 602.99 602.99 602.99 74 446.21 percent of total billed charges 602.99 93 488.42 percent of total billed charges 602.99 602.99 other OPPS APC 602.99 602.99 other OPPS APC 602.99 27.63 166.61 percent of total billed charges 602.99 602.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 3.5 MM FLUTE L90 MM OD5 MM CANNULATED SELF DRILL LOCK VARIABLE ANGLE NONSTERILE CURVE CONDYLAR PLATE SYSTEM SUP-02.231.690 CDM 270010022 LOCAL 0270 RC outpatient 695.76 695.76 695.76 74 514.86 percent of total billed charges 695.76 93 563.57 percent of total billed charges 695.76 695.76 other OPPS APC 695.76 695.76 other OPPS APC 695.76 27.63 192.24 percent of total billed charges 695.76 695.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC 5 D RIGHT LOCK ATTACHMENT STERILE RFNA SUP-02.233.100S CDM 0270 RC outpatient 5578.04 5578.04 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 5578.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC 5 D RIGHT LOCK ATTACHMENT STERILE RFNA SUP-02.233.100S CDM 0270 RC outpatient 5578.04 5578.04 5578.04 74 4127.75 percent of total billed charges 5578.04 93 4518.21 percent of total billed charges 5578.04 5578.04 other OPPS APC 5578.04 5578.04 other OPPS APC 5578.04 27.63 1541.21 percent of total billed charges 5578.04 5578.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC 5 D LEFT LOCK STERILE RFNA SUP-02.233.101S CDM 0270 RC outpatient 5578.04 5578.04 5578.04 74 4127.75 percent of total billed charges 5578.04 93 4518.21 percent of total billed charges 5578.04 5578.04 other OPPS APC 5578.04 5578.04 other OPPS APC 5578.04 27.63 1541.21 percent of total billed charges 5578.04 5578.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC 10 D RIGHT LOCK ATTACHMENT STERILE RFNA SUP-02.233.104S CDM 0270 RC outpatient 5578.04 5578.04 5578.04 74 4127.75 percent of total billed charges 5578.04 93 4518.21 percent of total billed charges 5578.04 5578.04 other OPPS APC 5578.04 5578.04 other OPPS APC 5578.04 27.63 1541.21 percent of total billed charges 5578.04 5578.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE JEJUNOSTOMY MIC SECUR-LOK 45CM 12FR 2-3ML SILICONE DISPOSABLE STERILE LF UNIVERSAL FEEDING PORT CONNECTOR TAPER SUP-0200-12LV CDM 0270 RC outpatient 337.74 337.74 337.74 74 249.93 percent of total billed charges 337.74 93 273.57 percent of total billed charges 337.74 337.74 other OPPS APC 337.74 337.74 other OPPS APC 337.74 27.63 93.32 percent of total billed charges 337.74 337.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE JEJUNOSTOMY MIC SECUR-LOK 45CM 14FR 7-10ML SILICONE DISPOSABLE STERILE LF UNIVERSAL FEEDING PORT CONNECTOR TAPER SUP-0200-14 CDM 0270 RC outpatient 337.74 337.74 337.74 74 249.93 percent of total billed charges 337.74 93 273.57 percent of total billed charges 337.74 337.74 other OPPS APC 337.74 337.74 other OPPS APC 337.74 27.63 93.32 percent of total billed charges 337.74 337.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE JEJUNOSTOMY MIC SECUR-LOK SILICONE STANDARD J OD16 FR 7-10 ML TRIMMABLE DISTAL TIP RADIOPAQUE STRIPE UNIVERSAL FEED PORT CONNECTOR INTERNAL RETENTION BALLOON STERILE LATEX FREE DISPOSABLE SUP-0200-16 CDM 0270 RC outpatient 344.5 344.5 344.5 74 254.93 percent of total billed charges 344.5 93 279.05 percent of total billed charges 344.5 344.5 other OPPS APC 344.5 344.5 other OPPS APC 344.5 27.63 95.19 percent of total billed charges 344.5 344.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL PURSTRING MONOSOF STAINLESS STEEL NYLON 2-0 L65 MM NONABSORBABLE RING HANDLE STERILE LATEX FREE DISPOSABLE SUP-020242 CDM 270009086 LOCAL 0270 RC outpatient 134.98 134.98 134.98 74 99.89 percent of total billed charges 134.98 93 109.33 percent of total billed charges 134.98 134.98 other OPPS APC 134.98 134.98 other OPPS APC 134.98 27.63 37.29 percent of total billed charges 134.98 134.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION TRUE DILATATION 110CM 4.5CM 10FR 20MM 2 LUMEN OTW RADIOPAQUE COAXIAL ACCEPTS .035IN SUP-0204511 CDM 0481 RC outpatient 3374.28 3374.28 3374.28 74 2496.97 percent of total billed charges 3374.28 93 2733.17 percent of total billed charges 3374.28 3374.28 other OPPS APC 3374.28 3374.28 other OPPS APC 3374.28 51 1720.88 percent of total billed charges 3374.28 3374.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM BONE CEMENT GRAY MIXEVAC III UNIVERSAL HIGH VACUUM SPATULA TUBE STERILE LF SUP-0206015000 CDM outpatient 119.6 119.6 119.6 119.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOLLOWER URETHRAL HEYMAN PLASTIC L13.35 IN OD10 FR DILATION CATHETER STRAIGHT TIP STERILE LATEX FREE DISPOSABLE SUP-021110 CDM 0270 RC outpatient 31.06 31.06 31.06 74 22.98 percent of total billed charges 31.06 93 25.16 percent of total billed charges 31.06 31.06 other OPPS APC 31.06 31.06 other OPPS APC 31.06 27.63 8.58 percent of total billed charges 31.06 31.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOLLOWER URETHRAL HEYMAN PLASTIC 13.5IN 12FR DILATATION CATHETER STRAIGHT TIP STERILE LATEX FREE DISPOSABLE SINGLE USE SUP-021112 CDM 0270 RC outpatient 31.06 31.06 31.06 74 22.98 percent of total billed charges 31.06 93 25.16 percent of total billed charges 31.06 31.06 other OPPS APC 31.06 31.06 other OPPS APC 31.06 27.63 8.58 percent of total billed charges 31.06 31.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOLLOWER URETHRAL HEYMAN PLASTIC 13.5IN 14FR DILATATION CATHETER STRIGHT TIP DISPOSABLE SUP-021114 CDM 0270 RC outpatient 31.06 31.06 31.06 74 22.98 percent of total billed charges 31.06 93 25.16 percent of total billed charges 31.06 31.06 other OPPS APC 31.06 31.06 other OPPS APC 31.06 27.63 8.58 percent of total billed charges 31.06 31.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOLLOWER URETHRAL HEYMAN PLASTIC L13.35 IN OD16 FR DILATION CATHETER STRAIGHT TIP STERILE LATEX FREE DISPOSABLE SUP-021116 CDM 0270 RC outpatient 31.06 31.06 31.06 74 22.98 percent of total billed charges 31.06 93 25.16 percent of total billed charges 31.06 31.06 other OPPS APC 31.06 31.06 other OPPS APC 31.06 27.63 8.58 percent of total billed charges 31.06 31.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOLLOWER URETHRAL HEYMAN PLASTIC L 13.35 IN OD 18 FR DILATATION CATHETER STRAIGHT TIP STERILE LATEX FREE DISPOSABLE SUP-021118 CDM 0270 RC outpatient 31.06 31.06 31.06 74 22.98 percent of total billed charges 31.06 93 25.16 percent of total billed charges 31.06 31.06 other OPPS APC 31.06 31.06 other OPPS APC 31.06 27.63 8.58 percent of total billed charges 31.06 31.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOLLOWER URETHRAL HEYMAN PLASTIC L13.35 IN OD20 FR DILATION CATHETER STRAIGHT TIP STERILE LATEX FREE DISPOSABLE SUP-021120 CDM 0270 RC outpatient 31.06 31.06 31.06 74 22.98 percent of total billed charges 31.06 93 25.16 percent of total billed charges 31.06 31.06 other OPPS APC 31.06 31.06 other OPPS APC 31.06 27.63 8.58 percent of total billed charges 31.06 31.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOLLOWER URETHRAL HEYMAN PLASTIC L13.35 IN OD24 FR DILATION CATHETER STRAIGHT TIP STERILE LATEX FREE DISPOSABLE SUP-021124 CDM 0270 RC outpatient 31.06 31.06 31.06 74 22.98 percent of total billed charges 31.06 93 25.16 percent of total billed charges 31.06 31.06 other OPPS APC 31.06 31.06 other OPPS APC 31.06 27.63 8.58 percent of total billed charges 31.06 31.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRUE DILATATION BALLOON 21MM X 4.5CM SUP-0214512 CDM 0481 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 51 1591.2 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOLLOWER URETHRAL PHILLIPS 13.5IN 8FR PLASTIC REUSABLE STERILE LF DILATION CATHETER WOVEN SUP-021508 CDM 0270 RC outpatient 161.49 161.49 161.49 74 119.5 percent of total billed charges 161.49 93 130.81 percent of total billed charges 161.49 161.49 other OPPS APC 161.49 161.49 other OPPS APC 161.49 27.63 44.62 percent of total billed charges 161.49 161.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOLLOWER URETHRAL PHILLIPS 13.5IN 10FR PLASTIC REUSABLE STERILE LF DILATION CATHETER WOVEN SUP-021510 CDM 0270 RC outpatient 279.6 279.6 279.6 74 206.9 percent of total billed charges 279.6 93 226.48 percent of total billed charges 279.6 279.6 other OPPS APC 279.6 279.6 other OPPS APC 279.6 27.63 77.25 percent of total billed charges 279.6 279.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOLLOWER URETHRAL PHILLIPS 13.5IN 12FR PLASTIC REUSABLE STERILE LF DILATION CATHETER WOVEN SUP-021512 CDM 0270 RC outpatient 157.48 157.48 157.48 74 116.54 percent of total billed charges 157.48 93 127.56 percent of total billed charges 157.48 157.48 other OPPS APC 157.48 157.48 other OPPS APC 157.48 27.63 43.51 percent of total billed charges 157.48 157.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOLLOWER URETHRAL PHILLIPS 13.5IN 14FR PLASTIC REUSABLE STERILE LF DILATION CATHETER WOVEN SUP-021514 CDM 0270 RC outpatient 153.22 153.22 153.22 74 113.38 percent of total billed charges 153.22 93 124.11 percent of total billed charges 153.22 153.22 other OPPS APC 153.22 153.22 other OPPS APC 153.22 27.63 42.33 percent of total billed charges 153.22 153.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOLLOWER URETHRAL PHILLIPS 13.5IN 16FR PLASTIC REUSABLE STERILE LF DILATION CATHETER WOVEN SUP-021516 CDM 0270 RC outpatient 152.67 152.67 152.67 74 112.98 percent of total billed charges 152.67 93 123.66 percent of total billed charges 152.67 152.67 other OPPS APC 152.67 152.67 other OPPS APC 152.67 27.63 42.18 percent of total billed charges 152.67 152.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOLLOWER URETHRAL PHILLIPS 13.5IN 18FR PLASTIC REUSABLE STERILE LF DILATION CATHETER WOVEN SUP-021518 CDM 0270 RC outpatient 159.17 159.17 159.17 74 117.79 percent of total billed charges 159.17 93 128.93 percent of total billed charges 159.17 159.17 other OPPS APC 159.17 159.17 other OPPS APC 159.17 27.63 43.98 percent of total billed charges 159.17 159.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOLLOWER URETHRAL PHILLIPS 13.5IN 20FR PLASTIC REUSABLE STERILE LF DILATION CATHETER WOVEN SUP-021520 CDM 0270 RC outpatient 279.6 279.6 279.6 74 206.9 percent of total billed charges 279.6 93 226.48 percent of total billed charges 279.6 279.6 other OPPS APC 279.6 279.6 other OPPS APC 279.6 27.63 77.25 percent of total billed charges 279.6 279.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOLLOWER URETHRAL PHILLIPS 13.5IN 22FR PLASTIC REUSABLE STERILE LF DILATION CATHETER WOVEN SUP-021522 CDM 0270 RC outpatient 279.6 279.6 279.6 74 206.9 percent of total billed charges 279.6 93 226.48 percent of total billed charges 279.6 279.6 other OPPS APC 279.6 279.6 other OPPS APC 279.6 27.63 77.25 percent of total billed charges 279.6 279.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOLLOWER URETHRAL PHILLIPS L13.5 IN OD24 FR WOVEN DILATION CATHETER STERILE LATEX FREE REUSABLE SUP-021524 CDM 0270 RC outpatient 155.04 155.04 155.04 74 114.73 percent of total billed charges 155.04 93 125.58 percent of total billed charges 155.04 155.04 other OPPS APC 155.04 155.04 other OPPS APC 155.04 27.63 42.84 percent of total billed charges 155.04 155.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILIFORM URETHRAL WOVEN L18 IN OD4 FR DILATION CATHETER SPIRAL TIP STERILE LATEX FREE REUSABLE SUP-022004 CDM outpatient 186.32 186.32 186.32 186.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILIFORM URETHRAL L12.5 IN OD5 FR DILATION CATHETER WOVEN SPIRAL TIP STERILE LATEX FREE REUSABLE SUP-022105 CDM outpatient 107.09 107.09 107.09 107.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION TRUE L110 CM L4.5 CM OD12 FR ODSEC22 MM AORTA 2 LUMEN 2 RADIOPAQUE OTW COAXIAL STERILE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE VALVULOPLASTY SUP-0224512 CDM 0481 RC outpatient 3374.28 3374.28 3374.28 74 2496.97 percent of total billed charges 3374.28 93 2733.17 percent of total billed charges 3374.28 3374.28 other OPPS APC 3374.28 3374.28 other OPPS APC 3374.28 51 1720.88 percent of total billed charges 3374.28 3374.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON VALVULOPLASTY TRUE DILATION 23MM X 110CM 12 FRENCH SUP-0234512 CDM 0481 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 51 1591.2 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PASTE BONE OSTEOFIL 0.5CC SUP-024005 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STONE DENTAL DURA-WHITE ALUMINUM OXIDE CN1 FRICTION GRIP MICROGRAIN GRIT VIBRATION FREE PERFORMANCE SUP-0241 CDM 0270 RC outpatient 7.65 7.65 7.65 74 5.66 percent of total billed charges 7.65 93 6.2 percent of total billed charges 7.65 7.65 other OPPS APC 7.65 7.65 other OPPS APC 7.65 27.63 2.11 percent of total billed charges 7.65 7.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON VALVULOPLASTY TRUE DILATION 24MM X 110CM 12 FRENCH SUP-0244512 CDM 0481 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 51 1989 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP FINISHING DURA-WHITE 12 RD1 DENTAL FRICTION GRIP POLISHING SUP-0247 CDM 0270 RC outpatient 7.65 7.65 7.65 74 5.66 percent of total billed charges 7.65 93 6.2 percent of total billed charges 7.65 7.65 other OPPS APC 7.65 7.65 other OPPS APC 7.65 27.63 2.11 percent of total billed charges 7.65 7.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE JEJUNOSTOMY MIC SECUR-LOK 45CM 18FR 7-10ML SILICONE DISPOSABLE STERILE LF RADIOPAQUE STRIPE RETENTION BALLOON SUP-0250-18 CDM 0270 RC outpatient 587.18 587.18 587.18 74 434.51 percent of total billed charges 587.18 93 475.62 percent of total billed charges 587.18 587.18 other OPPS APC 587.18 587.18 other OPPS APC 587.18 27.63 162.24 percent of total billed charges 587.18 587.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE JEJUNOSTOMY MIC SECUR-LOK SILICONE L45 CM OD22 FR 7-10 ML RETENTION BALLOON UNIVERSAL FEED PORT CONNECTOR RADIOPAQUE STRIPE TAPER DISTAL TIP STERILE LATEX FREE DISPOSABLE TRANSGASTRIC SUP-0250-22 CDM 0270 RC outpatient 592.98 592.98 592.98 74 438.81 percent of total billed charges 592.98 93 480.31 percent of total billed charges 592.98 592.98 other OPPS APC 592.98 592.98 other OPPS APC 592.98 27.63 163.84 percent of total billed charges 592.98 592.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP SUCTION REGULAR L32 CM OD5 MM IRRIGATION DISPOSABLE SUP-0250070505 CDM 0270 RC outpatient 37.8 37.8 37.8 74 27.97 percent of total billed charges 37.8 93 30.62 percent of total billed charges 37.8 37.8 other OPPS APC 37.8 37.8 other OPPS APC 37.8 27.63 10.44 percent of total billed charges 37.8 37.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING IRRIGATION TIP DISPOSABLE SUP-0250070620 CDM 0270 RC outpatient 84.78 84.78 84.78 74 62.74 percent of total billed charges 84.78 93 68.67 percent of total billed charges 84.78 84.78 other OPPS APC 84.78 84.78 other OPPS APC 84.78 27.63 23.42 percent of total billed charges 84.78 84.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON VALVULOPLASTY TRUE DILATION 25MM X 110CM 13 FRENCH SUP-0254513 CDM 0481 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 51 1591.2 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON VAVLULOPLASTY TRUE DILATION 26MM X 110CM 13 FRENCH SUP-0264513 CDM 0481 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 51 1989 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ENDOTAK RELIANCE L59 CM ENDOCARDIUM SUP-0265 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ENDOTAK RELIANCE L64 CM ENDOCARDIUM SUP-0266 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIDESCOPE SPECTRUM LO PRO S3 SUP-0270-0938 CDM 0270 RC outpatient 95.94 95.94 95.94 74 71 percent of total billed charges 95.94 93 77.71 percent of total billed charges 95.94 95.94 other OPPS APC 95.94 95.94 other OPPS APC 95.94 27.63 26.51 percent of total billed charges 95.94 95.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIDESCOPE SPECTRUM LO PRO S4 SUP-0270-0939 CDM 0270 RC outpatient 95.94 95.94 95.94 74 71 percent of total billed charges 95.94 93 77.71 percent of total billed charges 95.94 95.94 other OPPS APC 95.94 95.94 other OPPS APC 95.94 27.63 26.51 percent of total billed charges 95.94 95.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT JEJUNOSTOMY MIC-KEY SECUR-LOK TUNGSTEN SILICONE L30 CM L1.5 CM OD18 FR 3-5 ML TRANSGASTRIC RADIOPAQUE LOW PROFILE TAPER DISTAL TIP INTERNAL RETENTION BALLOON STERILE LATEX FREE DISPOSABLE SUP-0270-18-2.5-30 CDM 0270 RC outpatient 856.6 856.6 856.6 74 633.88 percent of total billed charges 856.6 93 693.85 percent of total billed charges 856.6 856.6 other OPPS APC 856.6 856.6 other OPPS APC 856.6 27.63 236.68 percent of total billed charges 856.6 856.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING 4-SITE ENDOTAK RELIANCE SILICONE IN-FILL STEROID ELUTING SILICONE STANDARD L64 CM ENDOCARDIUM SUP-0273 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTAINER SPECIMEN LDPE WIDE 16 OZ LEAK SHATTER RESISTANT SNAP ON LID TRANSLUCENT NONSTERILE LATEX FREE DISPOSABLE SUP-02732 CDM outpatient 0.91 0.91 0.91 0.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTAINER LDPE 168OZ LABORATORY LEAK RESISTANT SHATTER RESISTANT SNAP ON LID SUP-02735 CDM outpatient 4.81 4.81 4.81 4.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTAINER LABORATORY 64 OZ SNAP ON LID TRANSLUCENT NONSTERILE SUP-02738A CDM outpatient 2.04 2.04 2.04 2.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ENDOTAK RELIANCE STEROID ELUTING SILICONE L59 CM ENDOCARDIUM SUP-0275 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ENDOTAK RELIANCE L64 CM ENDOCARDIUM SUP-0276 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW STAINLESS STEEL L70 MM X W12.5 MM X H.8 MM 2 SIDED RECIPROCATING STERILE LATEX FREE ARTHROPLASTY SUP-0277096276 CDM 0270 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 27.63 21.55 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW STAINLESS STEEL LONG L75 MM X W12 MM X H.8 MM RECIPROCATING HEAVY DUTY STERILE SUP-0277096325 CDM 0270 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 27.63 21.55 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EAD PACING ENDOTAK RELIANCE 4-SITE GORE STEROID ELUTING SILICONE L59 CM ENDOCARDIUM SUP-0282 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ENDOTAK RELIANCE 4-SITE GORE STEROID ELUTING SILICONE LUBRICIOUS L64 CM ENDOCARDIAL SUP-0283 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON VALVULOPLASTY TRUE DILATION 28MM X 110CM 14 FRENCH SUP-0284514 CDM 0481 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 51 1989 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ENDOTAK RELIANCE 4-SITE GORE STEROID ELUTING SILICONE L59 CM ENDOCARDIUM SUP-0285 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ENDOTAK RELIANCE GORE STEROID ELUTING SILICONE L64 CM ENDOCARDIUM SUP-0286 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE THERMOMETER SURETEMP PLUS L2.7 MR ORAL WELL KIT TEMPERATURE CORD LATEX FREE BLUE VITAL SIGNS MONITOR 300 692 SUP-02895-000 CDM outpatient 210.39 210.39 210.39 210.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET IRRIGATION HUMMER II 2 TUBE HOLDER MICRODEBRIDER LF DISPOSABLE SUP-0290075000 CDM 0270 RC outpatient 119.9 119.9 119.9 74 88.73 percent of total billed charges 119.9 93 97.12 percent of total billed charges 119.9 119.9 other OPPS APC 119.9 119.9 other OPPS APC 119.9 27.63 33.13 percent of total billed charges 119.9 119.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SHAVER 4MM MCDEB AGGRESSIVE IRRIGATE SERRATE STERILE SUP-0290645000 CDM 0270 RC outpatient 280.19 280.19 280.19 74 207.34 percent of total billed charges 280.19 93 226.95 percent of total billed charges 280.19 280.19 other OPPS APC 280.19 280.19 other OPPS APC 280.19 27.63 77.42 percent of total billed charges 280.19 280.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ENDOTAK RELIANCE 4-SITE GORE STEROID ELUTING SILICONE LUBRICIOUS L59 CM ENDOCARDIAL SUP-0295 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ENDOTAK RELIANCE GORE STEROID ELUTING SILICONE L64 CM ENDOCARDIUM SUP-0296 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG BILE SUP-03-00002 CDM 0272 RC outpatient 26.84 26.84 26.84 74 19.86 percent of total billed charges 26.84 93 21.74 percent of total billed charges 26.84 26.84 other OPPS APC 26.84 26.84 other OPPS APC 26.84 27.63 7.42 percent of total billed charges 26.84 26.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET Y-TYPE TUR SUP-03-00013 CDM 0272 RC outpatient 28.95 28.95 28.95 74 21.42 percent of total billed charges 28.95 93 23.45 percent of total billed charges 28.95 28.95 other OPPS APC 28.95 28.95 other OPPS APC 28.95 27.63 8 percent of total billed charges 28.95 28.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG DRAIN METER URINE 350CC SUP-03-00022 CDM 0272 RC outpatient 26.16 26.16 26.16 74 19.36 percent of total billed charges 26.16 93 21.19 percent of total billed charges 26.16 26.16 other OPPS APC 26.16 26.16 other OPPS APC 26.16 27.63 7.23 percent of total billed charges 26.16 26.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG LEG LATEX STRAPS CAP 19 OZ SUP-03-00023 CDM 0272 RC outpatient 1.79 1.79 1.79 74 1.32 percent of total billed charges 1.79 93 1.45 percent of total billed charges 1.79 1.79 other OPPS APC 1.79 1.79 other OPPS APC 1.79 27.63 0.49 percent of total billed charges 1.79 1.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG 4L URINE CONTIN IRRIG DRAINAGE SUP-03-00024 CDM 0272 RC outpatient 3.95 3.95 3.95 74 2.92 percent of total billed charges 3.95 93 3.2 percent of total billed charges 3.95 3.95 other OPPS APC 3.95 3.95 other OPPS APC 3.95 27.63 1.09 percent of total billed charges 3.95 3.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG DRAIN 2L W/ANTIREFLUX CHAMBER SUP-03-00025 CDM 0272 RC outpatient 2.58 2.58 2.58 74 1.91 percent of total billed charges 2.58 93 2.09 percent of total billed charges 2.58 2.58 other OPPS APC 2.58 2.58 other OPPS APC 2.58 27.63 0.71 percent of total billed charges 2.58 2.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY FOLEY CATH 18FR LF 350ML URINMETER SUP-03-00026 CDM C1729 HCPCS 0272 RC outpatient 83.53 83.53 83.53 74 61.81 percent of total billed charges 83.53 93 67.66 percent of total billed charges 83.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 83.53 other OPPS APC 83.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 83.53 other OPPS APC 83.53 27.63 23.08 percent of total billed charges 83.53 83.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY FOLEY CATH 16FR LF 350ML URINEMETER SUP-03-00027 CDM C1729 HCPCS 0272 RC outpatient 81.97 81.97 81.97 74 60.66 percent of total billed charges 81.97 93 66.4 percent of total billed charges 81.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 81.97 other OPPS APC 81.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 81.97 other OPPS APC 81.97 27.63 22.65 percent of total billed charges 81.97 81.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY FOLEY CATH 16FR LF DRAINAGE BAG SUP-03-00028 CDM C1729 HCPCS 0272 RC outpatient 47.19 47.19 47.19 74 34.92 percent of total billed charges 47.19 93 38.22 percent of total billed charges 47.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 47.19 other OPPS APC 47.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 47.19 other OPPS APC 47.19 27.63 13.04 percent of total billed charges 47.19 47.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STATLOCK STABILIZATION DEVICE LEG STRAP SUP-03-00030 CDM 0272 RC outpatient 3.02 3.02 3.02 74 2.23 percent of total billed charges 3.02 93 2.45 percent of total billed charges 3.02 3.02 other OPPS APC 3.02 3.02 other OPPS APC 3.02 27.63 0.83 percent of total billed charges 3.02 3.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY LATEX FOLEY CATH 16FR SUP-03-00031 CDM C1729 HCPCS 0272 RC outpatient 49.85 49.85 49.85 74 36.89 percent of total billed charges 49.85 93 40.38 percent of total billed charges 49.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 49.85 other OPPS APC 49.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 49.85 other OPPS APC 49.85 27.63 13.77 percent of total billed charges 49.85 49.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY LATEX FOLEY CATH 16FR W/URINEMETER SUP-03-00032 CDM C1729 HCPCS 0272 RC outpatient 142.14 142.14 142.14 74 105.18 percent of total billed charges 142.14 93 115.13 percent of total billed charges 142.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 142.14 other OPPS APC 142.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 142.14 other OPPS APC 142.14 27.63 39.27 percent of total billed charges 142.14 142.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY LATEX FOLEY CATH 18FR W/URINEMETER SUP-03-00033 CDM C1729 HCPCS 0272 RC outpatient 77.14 77.14 77.14 74 57.08 percent of total billed charges 77.14 93 62.48 percent of total billed charges 77.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 77.14 other OPPS APC 77.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 77.14 other OPPS APC 77.14 27.63 21.31 percent of total billed charges 77.14 77.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INFANT CATH & GLOVE 5FR SUP-03-00034 CDM 0272 RC outpatient 1.61 1.61 1.61 74 1.19 percent of total billed charges 1.61 93 1.3 percent of total billed charges 1.61 1.61 other OPPS APC 1.61 1.61 other OPPS APC 1.61 27.63 0.44 percent of total billed charges 1.61 1.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY FOLEY LF 16FR TEMP SENSING SUP-03-00035 CDM C1729 HCPCS 0272 RC outpatient 131.82 131.82 131.82 74 97.55 percent of total billed charges 131.82 93 106.77 percent of total billed charges 131.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 131.82 other OPPS APC 131.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 131.82 other OPPS APC 131.82 27.63 36.42 percent of total billed charges 131.82 131.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER KIT PUREWICK SUP-03-00037 CDM 0272 RC outpatient 31.31 31.31 31.31 74 23.17 percent of total billed charges 31.31 93 25.36 percent of total billed charges 31.31 31.31 other OPPS APC 31.31 31.31 other OPPS APC 31.31 27.63 8.65 percent of total billed charges 31.31 31.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER KIT PUREWICK LATEX FREE SUP-03-00038 CDM 0272 RC outpatient 31.91 31.91 31.91 74 23.61 percent of total billed charges 31.91 93 25.85 percent of total billed charges 31.91 31.91 other OPPS APC 31.91 31.91 other OPPS APC 31.91 27.63 8.82 percent of total billed charges 31.91 31.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SURGICAL L45 MM OD3 MM STERILE SUP-03.000.009S CDM 270010022 LOCAL 0270 RC outpatient 128.7 128.7 128.7 74 95.24 percent of total billed charges 128.7 93 104.25 percent of total billed charges 128.7 128.7 other OPPS APC 128.7 128.7 other OPPS APC 128.7 27.63 35.56 percent of total billed charges 128.7 128.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SURGICAL L45 MM L8 MM OD4 MM EGG SHAPE STERILE SUP-03.000.070S CDM 270010022 LOCAL 0270 RC outpatient 176.67 176.67 176.67 74 130.74 percent of total billed charges 176.67 93 143.1 percent of total billed charges 176.67 176.67 other OPPS APC 176.67 176.67 other OPPS APC 176.67 27.63 48.81 percent of total billed charges 176.67 176.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SURGICAL SMALL OD2 MM ROUND STERILE SUP-03.000.230S CDM 270010022 LOCAL 0270 RC outpatient 128.7 128.7 128.7 74 95.24 percent of total billed charges 128.7 93 104.25 percent of total billed charges 128.7 128.7 other OPPS APC 128.7 128.7 other OPPS APC 128.7 27.63 35.56 percent of total billed charges 128.7 128.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW L18 MM X W4 MM X H.38 MM SAGITTAL STERILE SUP-03.000.300S CDM 270010022 LOCAL 0270 RC outpatient 175.5 175.5 175.5 74 129.87 percent of total billed charges 175.5 93 142.16 percent of total billed charges 175.5 175.5 other OPPS APC 175.5 175.5 other OPPS APC 175.5 27.63 48.49 percent of total billed charges 175.5 175.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW THK.38 MM L15 MM X W6 MM SAGITTAL STERILE SAGITTAL ATTACHMENT SUP-03.000.301S CDM 270010022 LOCAL 0270 RC outpatient 211.77 211.77 211.77 74 156.71 percent of total billed charges 211.77 93 171.53 percent of total billed charges 211.77 211.77 other OPPS APC 211.77 211.77 other OPPS APC 211.77 27.63 58.51 percent of total billed charges 211.77 211.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC EXPERT L240 MM OD2 MM DISPOSABLE SUP-03.010.025 CDM 270010022 LOCAL 0270 RC outpatient 90.09 90.09 90.09 74 66.67 percent of total billed charges 90.09 93 72.97 percent of total billed charges 90.09 90.09 other OPPS APC 90.09 90.09 other OPPS APC 90.09 27.63 24.89 percent of total billed charges 90.09 90.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC L13 MM OD3.2 MM TROCAR POINT ANTEGRADE FEMORAL SYSTEM SUP-03.010.031 CDM 270010022 LOCAL 0270 RC outpatient 669.24 669.24 669.24 74 495.24 percent of total billed charges 669.24 93 542.08 percent of total billed charges 669.24 669.24 other OPPS APC 669.24 669.24 other OPPS APC 669.24 27.63 184.91 percent of total billed charges 669.24 669.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INSERTION HANDLE STANDARD CANNULATED CONNECT EXPERT TIBIAL NAIL SUP-03.010.044 CDM 270010022 LOCAL 0270 RC outpatient 1477.19 1477.19 1477.19 74 1093.12 percent of total billed charges 1477.19 93 1196.52 percent of total billed charges 1477.19 1477.19 other OPPS APC 1477.19 1477.19 other OPPS APC 1477.19 27.63 408.15 percent of total billed charges 1477.19 1477.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INSERTER 63MM TITANIUM NS CONNECT CANNULATED EXPERT HUMERAL NAIL SUP-03.010.053 CDM 270010022 LOCAL 0270 RC outpatient 1477.19 1477.19 1477.19 74 1093.12 percent of total billed charges 1477.19 93 1196.52 percent of total billed charges 1477.19 1477.19 other OPPS APC 1477.19 1477.19 other OPPS APC 1477.19 27.63 408.15 percent of total billed charges 1477.19 1477.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL BLUE GOLD 330MM 3.2MM EXPERT SS 3 FLUTE QUICK COUPLING CALIBRATED 100MM NS SUP-03.010.060 CDM 270010022 LOCAL 0270 RC outpatient 608.4 608.4 608.4 74 450.22 percent of total billed charges 608.4 93 492.8 percent of total billed charges 608.4 608.4 other OPPS APC 608.4 608.4 other OPPS APC 608.4 27.63 168.1 percent of total billed charges 608.4 608.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL EXPERT STAINLESS STEEL L330 MM L100 MM OD3.2 MM 3 FLUTE QUICK COUPLING CALIBRATED BLUE GOLD SUP-03.010.060 CDM 270010022 LOCAL 0270 RC outpatient 517.14 517.14 517.14 74 382.68 percent of total billed charges 517.14 93 418.88 percent of total billed charges 517.14 517.14 other OPPS APC 517.14 517.14 other OPPS APC 517.14 27.63 142.89 percent of total billed charges 517.14 517.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL EXPERT STAINLESS STEEL L330 MM L100 MM OD4.2 MM 3 FLUTE QUICK COUPLING CALIBRATED NONSTERILE GREEN SUP-03.010.061 CDM 270010022 LOCAL 0270 RC outpatient 1301.69 1301.69 1301.69 74 963.25 percent of total billed charges 1301.69 93 1054.37 percent of total billed charges 1301.69 1301.69 other OPPS APC 1301.69 1301.69 other OPPS APC 1301.69 27.63 359.66 percent of total billed charges 1301.69 1301.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 330MM 100MM 5MM NS 3 FLUTE QUICK COUPLING CALIBRATED SUP-03.010.062 CDM 270010022 LOCAL 0270 RC outpatient 679.25 679.25 679.25 74 502.65 percent of total billed charges 679.25 93 550.19 percent of total billed charges 679.25 679.25 other OPPS APC 679.25 679.25 other OPPS APC 679.25 27.63 187.68 percent of total billed charges 679.25 679.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L165 MM L135 MM OD4.5 MM CANNULATED STOP NONSTERILE JACOBS CHUCK SUP-03.010.089 CDM 270010022 LOCAL 0270 RC outpatient 1015.3 1015.3 1015.3 74 751.32 percent of total billed charges 1015.3 93 822.39 percent of total billed charges 1015.3 1015.3 other OPPS APC 1015.3 1015.3 other OPPS APC 1015.3 27.63 280.53 percent of total billed charges 1015.3 1015.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 145MM 5MM NS 3 FLUTE QUICK COUPLING NEEDLE POINT RADIOLUCENT DRIVE SUP-03.010.102 CDM 270010022 LOCAL 0270 RC outpatient 676.39 676.39 676.39 74 500.53 percent of total billed charges 676.39 93 547.88 percent of total billed charges 676.39 676.39 other OPPS APC 676.39 676.39 other OPPS APC 676.39 27.63 186.89 percent of total billed charges 676.39 676.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MULTILOC L145 MM OD3.2 MM 3 FLUTED NEEDLE POINT SUP-03.010.103 CDM 270010022 LOCAL 0270 RC outpatient 368.55 368.55 368.55 74 272.73 percent of total billed charges 368.55 93 298.53 percent of total billed charges 368.55 368.55 other OPPS APC 368.55 368.55 other OPPS APC 368.55 27.63 101.83 percent of total billed charges 368.55 368.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 145MM 4.2MM 3 FLUTE QUICK COUPLING NEEDLE POINT STERILE SUP-03.010.104 CDM 270010022 LOCAL 0270 RC outpatient 404.82 404.82 404.82 74 299.57 percent of total billed charges 404.82 93 327.9 percent of total billed charges 404.82 404.82 other OPPS APC 404.82 404.82 other OPPS APC 404.82 27.63 111.85 percent of total billed charges 404.82 404.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L145 MM OD4.2 MM 3 FLUTE QUICK COUPLING NEEDLE POINT STERILE SUP-03.010.104 CDM 270010022 LOCAL 0270 RC outpatient 930.41 930.41 930.41 74 688.5 percent of total billed charges 930.41 93 753.63 percent of total billed charges 930.41 930.41 other OPPS APC 930.41 930.41 other OPPS APC 930.41 27.63 257.07 percent of total billed charges 930.41 930.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL SHORT 145MM 5MM NS 3 FLUTE QUICK COUPLING NEEDLE POINT DISTAL LOCK SCREW SUP-03.010.105 CDM 270010022 LOCAL 0270 RC outpatient 483.34 483.34 483.34 74 357.67 percent of total billed charges 483.34 93 391.51 percent of total billed charges 483.34 483.34 other OPPS APC 483.34 483.34 other OPPS APC 483.34 27.63 133.55 percent of total billed charges 483.34 483.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC L290 MM OD3.2 MM SUP-03.010.115 CDM 270010022 LOCAL 0270 RC outpatient 253.11 253.11 253.11 74 187.3 percent of total billed charges 253.11 93 205.02 percent of total billed charges 253.11 253.11 other OPPS APC 253.11 253.11 other OPPS APC 253.11 27.63 69.93 percent of total billed charges 253.11 253.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE PROTECTION OD12 MM OUTER STERILE SUPRAPATELLAR SUP-03.010.437S CDM 0270 RC outpatient 253.55 253.55 253.55 74 187.63 percent of total billed charges 253.55 93 205.38 percent of total billed charges 253.55 253.55 other OPPS APC 253.55 253.55 other OPPS APC 253.55 27.63 70.06 percent of total billed charges 253.55 253.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE PROTECTION OD14.5 MM OUTER STERILE SUPRAPATELLAR SUP-03.010.438S CDM 0270 RC outpatient 253.55 253.55 253.55 74 187.63 percent of total billed charges 253.55 93 205.38 percent of total billed charges 253.55 253.55 other OPPS APC 253.55 253.55 other OPPS APC 253.55 27.63 70.06 percent of total billed charges 253.55 253.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL LCP 248/95 MM OD2.8 MM QUICK COUPLING CALIBRATED NONSTERILE SUP-03.122.002 CDM 270010022 LOCAL 0270 RC outpatient 451.88 451.88 451.88 74 334.39 percent of total billed charges 451.88 93 366.02 percent of total billed charges 451.88 451.88 other OPPS APC 451.88 451.88 other OPPS APC 451.88 27.63 124.85 percent of total billed charges 451.88 451.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L48 MM OD1.5 MM MINI QUICK COUPLING NONSTERILE GLIDE HOLE SUP-03.130.212 CDM 270010022 LOCAL 0270 RC outpatient 262.08 262.08 262.08 74 193.94 percent of total billed charges 262.08 93 212.28 percent of total billed charges 262.08 262.08 other OPPS APC 262.08 262.08 other OPPS APC 262.08 27.63 72.41 percent of total billed charges 262.08 262.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L74 MM OD1.5 MM MINI QUICK COUPLING NONSTERILE THREAD HOLE SUP-03.130.302 CDM 270010022 LOCAL 0270 RC outpatient 262.08 262.08 262.08 74 193.94 percent of total billed charges 262.08 93 212.28 percent of total billed charges 262.08 262.08 other OPPS APC 262.08 262.08 other OPPS APC 262.08 27.63 72.41 percent of total billed charges 262.08 262.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN HOLDING LCP OD2.4 MM ODSEC2.7 MM VARIABLE ANGLE NONSTERILE SUP-03.211.001 CDM 270010022 LOCAL 0270 RC outpatient 868.92 868.92 868.92 74 643 percent of total billed charges 868.92 93 703.83 percent of total billed charges 868.92 868.92 other OPPS APC 868.92 868.92 other OPPS APC 868.92 27.63 240.08 percent of total billed charges 868.92 868.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION LCP L150 MM L10 MM OD1.6 MM THREAD COMPRESSION NONSTERILE SUP-03.211.410 CDM 270010022 LOCAL 0270 RC outpatient 239.2 239.2 239.2 74 177.01 percent of total billed charges 239.2 93 193.75 percent of total billed charges 239.2 239.2 other OPPS APC 239.2 239.2 other OPPS APC 239.2 27.63 66.09 percent of total billed charges 239.2 239.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION LCP L150 MM L15 MM OD1.6 MM THREAD COMPRESSION NONSTERILE SUP-03.211.415 CDM 270010022 LOCAL 0270 RC outpatient 239.2 239.2 239.2 74 177.01 percent of total billed charges 239.2 93 193.75 percent of total billed charges 239.2 239.2 other OPPS APC 239.2 239.2 other OPPS APC 239.2 27.63 66.09 percent of total billed charges 239.2 239.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION LCP L150 MM L20 MM OD1.6 MM THREAD COMPRESSION NONSTERILE SUP-03.211.420 CDM 0270 RC outpatient 239.2 239.2 239.2 74 177.01 percent of total billed charges 239.2 93 193.75 percent of total billed charges 239.2 239.2 other OPPS APC 239.2 239.2 other OPPS APC 239.2 27.63 66.09 percent of total billed charges 239.2 239.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION LCP L150 MM L25 MM OD1.6 MM THREAD COMPRESSION NONSTERILE SUP-03.211.425 CDM 270010022 LOCAL 0270 RC outpatient 108.45 108.45 108.45 74 80.25 percent of total billed charges 108.45 93 87.84 percent of total billed charges 108.45 108.45 other OPPS APC 108.45 108.45 other OPPS APC 108.45 27.63 29.96 percent of total billed charges 108.45 108.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION LCP L150 MM L30 MM OD1.6 MM THREAD COMPRESSION NONSTERILE SUP-03.211.430 CDM 0270 RC outpatient 108.45 108.45 108.45 74 80.25 percent of total billed charges 108.45 93 87.84 percent of total billed charges 108.45 108.45 other OPPS APC 108.45 108.45 other OPPS APC 108.45 27.63 29.96 percent of total billed charges 108.45 108.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION LCP L150 MM L35 MM OD1.6 MM THREAD COMPRESSION NONSTERILE SUP-03.211.435 CDM 270010022 LOCAL 0270 RC outpatient 137.28 137.28 137.28 74 101.59 percent of total billed charges 137.28 93 111.2 percent of total billed charges 137.28 137.28 other OPPS APC 137.28 137.28 other OPPS APC 137.28 27.63 37.93 percent of total billed charges 137.28 137.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION LCP L150 MM L40 MM OD1.6 MM THREAD COMPRESSION NONSTERILE SUP-03.211.440 CDM 270010022 LOCAL 0270 RC outpatient 137.28 137.28 137.28 74 101.59 percent of total billed charges 137.28 93 111.2 percent of total billed charges 137.28 137.28 other OPPS APC 137.28 137.28 other OPPS APC 137.28 27.63 37.93 percent of total billed charges 137.28 137.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 4.8 MM SUP-03.266.003 CDM 270010022 LOCAL 0270 RC outpatient 217.36 217.36 217.36 74 160.85 percent of total billed charges 217.36 93 176.06 percent of total billed charges 217.36 217.36 other OPPS APC 217.36 217.36 other OPPS APC 217.36 27.63 60.06 percent of total billed charges 217.36 217.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET EXTERNAL FIXATION LARGE ANKLE FRAME STERILE SUP-03.301.010S CDM 270010022 LOCAL 0270 RC outpatient 7446.01 7446.01 7446.01 74 5510.05 percent of total billed charges 7446.01 93 6031.27 percent of total billed charges 7446.01 7446.01 other OPPS APC 7446.01 7446.01 other OPPS APC 7446.01 27.63 2057.33 percent of total billed charges 7446.01 7446.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT TRAUMA LARGE EXTERNAL FIXATOR STERILE SUP-03.301.011S CDM 270010022 LOCAL 0270 RC outpatient 7803.12 7803.12 7803.12 74 5774.31 percent of total billed charges 7803.12 93 6320.53 percent of total billed charges 7803.12 7803.12 other OPPS APC 7803.12 7803.12 other OPPS APC 7803.12 27.63 2156 percent of total billed charges 7803.12 7803.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC L100 MM OD.8 MM SUP-03.333.000 CDM 0270 RC outpatient 146.02 146.02 146.02 74 108.05 percent of total billed charges 146.02 93 118.28 percent of total billed charges 146.02 146.02 other OPPS APC 146.02 146.02 other OPPS APC 146.02 27.63 40.35 percent of total billed charges 146.02 146.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC L150 MM OD1.1 MM SUP-03.333.001 CDM 0270 RC outpatient 331.5 331.5 331.5 74 245.31 percent of total billed charges 331.5 93 268.52 percent of total billed charges 331.5 331.5 other OPPS APC 331.5 331.5 other OPPS APC 331.5 27.63 91.59 percent of total billed charges 331.5 331.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC L150 MM OD1.4 MM SUP-03.333.002 CDM 270010022 LOCAL 0270 RC outpatient 384.54 384.54 384.54 74 284.56 percent of total billed charges 384.54 93 311.48 percent of total billed charges 384.54 384.54 other OPPS APC 384.54 384.54 other OPPS APC 384.54 27.63 106.25 percent of total billed charges 384.54 384.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC L220 MM OD1.6 MM SUP-03.333.003 CDM 270010022 LOCAL 0270 RC outpatient 415.48 415.48 415.48 74 307.46 percent of total billed charges 415.48 93 336.54 percent of total billed charges 415.48 415.48 other OPPS APC 415.48 415.48 other OPPS APC 415.48 27.63 114.8 percent of total billed charges 415.48 415.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC L220 MM OD2.8 MM SUP-03.333.004 CDM 270010022 LOCAL 0270 RC outpatient 552.5 552.5 552.5 74 408.85 percent of total billed charges 552.5 93 447.53 percent of total billed charges 552.5 552.5 other OPPS APC 552.5 552.5 other OPPS APC 552.5 27.63 152.66 percent of total billed charges 552.5 552.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED DRILL BIT 1.6 MM SUP-03.333.100 CDM 0270 RC outpatient 1051.86 1051.86 1051.86 74 778.38 percent of total billed charges 1051.86 93 852.01 percent of total billed charges 1051.86 1051.86 other OPPS APC 1051.86 1051.86 other OPPS APC 1051.86 27.63 290.63 percent of total billed charges 1051.86 1051.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED DRILL BIT 2.0 MM SUP-03.333.101 CDM 0270 RC outpatient 2150.33 2150.33 2150.33 74 1591.24 percent of total billed charges 2150.33 93 1741.77 percent of total billed charges 2150.33 2150.33 other OPPS APC 2150.33 2150.33 other OPPS APC 2150.33 27.63 594.14 percent of total billed charges 2150.33 2150.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL OD2.7 MM CANNULATED SUP-03.333.102 CDM 270010022 LOCAL 0270 RC outpatient 1115.4 1115.4 1115.4 74 825.4 percent of total billed charges 1115.4 93 903.47 percent of total billed charges 1115.4 1115.4 other OPPS APC 1115.4 1115.4 other OPPS APC 1115.4 27.63 308.19 percent of total billed charges 1115.4 1115.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL OD5 MM CANNULATED SUP-03.333.104 CDM 270010022 LOCAL 0270 RC outpatient 2240.94 2240.94 2240.94 74 1658.3 percent of total billed charges 2240.94 93 1815.16 percent of total billed charges 2240.94 2240.94 other OPPS APC 2240.94 2240.94 other OPPS APC 2240.94 27.63 619.17 percent of total billed charges 2240.94 2240.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 5.0MM CANNULATED SUP-03.333.104 CDM 0272 RC outpatient 1587.3 1587.3 1587.3 74 1174.6 percent of total billed charges 1587.3 93 1285.71 percent of total billed charges 1587.3 1587.3 other OPPS APC 1587.3 1587.3 other OPPS APC 1587.3 27.63 438.57 percent of total billed charges 1587.3 1587.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK DRILL CANNULATED 2 MM SCREW SUP-03.333.200 CDM 270010022 LOCAL 0270 RC outpatient 1393.08 1393.08 1393.08 74 1030.88 percent of total billed charges 1393.08 93 1128.39 percent of total billed charges 1393.08 1393.08 other OPPS APC 1393.08 1393.08 other OPPS APC 1393.08 27.63 384.91 percent of total billed charges 1393.08 1393.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INSTRUMENT RADIAL HEAD REPLACEMENT STERILE SUP-03.405.000S CDM 0270 RC outpatient 845 845 845 74 625.3 percent of total billed charges 845 93 684.45 percent of total billed charges 845 845 other OPPS APC 845 845 other OPPS APC 845 27.63 233.47 percent of total billed charges 845 845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MATRIXRIB 82MM 10MM 1.5MM NS STERNUM J LATCH COUPLING SELF STOP STRYKER SUP-03.501.010 CDM 0270 RC outpatient 441.53 441.53 441.53 74 326.73 percent of total billed charges 441.53 93 357.64 percent of total billed charges 441.53 441.53 other OPPS APC 441.53 441.53 other OPPS APC 441.53 27.63 121.99 percent of total billed charges 441.53 441.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MATRIXRIB 82MM 12MM 1.5MM NS STERNUM J LATCH COUPLING SELF STOP STRYKER SUP-03.501.012 CDM 0270 RC outpatient 428.66 428.66 428.66 74 317.21 percent of total billed charges 428.66 93 347.21 percent of total billed charges 428.66 428.66 other OPPS APC 428.66 428.66 other OPPS APC 428.66 27.63 118.44 percent of total billed charges 428.66 428.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MATRIXRIB 82MM 14MM 1.5MM NS STERNUM J LATCH COUPLING SELF STOP STRYKER SUP-03.501.014 CDM 0270 RC outpatient 441.53 441.53 441.53 74 326.73 percent of total billed charges 441.53 93 357.64 percent of total billed charges 441.53 441.53 other OPPS APC 441.53 441.53 other OPPS APC 441.53 27.63 121.99 percent of total billed charges 441.53 441.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MATRIXRIB 82MM 16MM 1.5MM NS STERNUM J LATCH COUPLING SELF STOP STRYKER SUP-03.501.016 CDM 0270 RC outpatient 428.66 428.66 428.66 74 317.21 percent of total billed charges 428.66 93 347.21 percent of total billed charges 428.66 428.66 other OPPS APC 428.66 428.66 other OPPS APC 428.66 27.63 118.44 percent of total billed charges 428.66 428.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MATRIXRIB 82MM 18MM 1.5MM NS STERNUM J LATCH COUPLING SELF STOP STRYKER SUP-03.501.018 CDM 0270 RC outpatient 428.66 428.66 428.66 74 317.21 percent of total billed charges 428.66 93 347.21 percent of total billed charges 428.66 428.66 other OPPS APC 428.66 428.66 other OPPS APC 428.66 27.63 118.44 percent of total billed charges 428.66 428.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MATRIXRIB 88MM 20MM 1.5MM NS STERNUM J LATCH COUPLING SELF STOP STRYKER SUP-03.501.020 CDM 0270 RC outpatient 428.66 428.66 428.66 74 317.21 percent of total billed charges 428.66 93 347.21 percent of total billed charges 428.66 428.66 other OPPS APC 428.66 428.66 other OPPS APC 428.66 27.63 118.44 percent of total billed charges 428.66 428.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES MATRIXRIB 2.9MM X 10MM PK/5 SUP-03.501.020.05 CDM 0270 RC outpatient 2730 2730 2730 74 2020.2 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 2730 other OPPS APC 2730 2730 other OPPS APC 2730 27.63 754.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MATRIXRIB 88MM 22MM 1.5MM NS STERNUM J LATCH COUPLING SELF STOP STRYKER SUP-03.501.022 CDM 0270 RC outpatient 428.66 428.66 428.66 74 317.21 percent of total billed charges 428.66 93 347.21 percent of total billed charges 428.66 428.66 other OPPS APC 428.66 428.66 other OPPS APC 428.66 27.63 118.44 percent of total billed charges 428.66 428.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MATRIXRIB TITANIUM L88 MM L24 MM OD1.5 MM STERNUM J LATCH COUPLING SELF STOP NONSTERILE SUP-03.501.024 CDM 0270 RC outpatient 445.56 445.56 445.56 74 329.71 percent of total billed charges 445.56 93 360.9 percent of total billed charges 445.56 445.56 other OPPS APC 445.56 445.56 other OPPS APC 445.56 27.63 123.11 percent of total billed charges 445.56 445.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MATRIXRIB L135 MM L8 MM OD2.2 MM J LATCH STOP NONSTERILE SUP-03.501.038 CDM 0270 RC outpatient 505.6 505.6 505.6 74 374.14 percent of total billed charges 505.6 93 409.54 percent of total billed charges 505.6 505.6 other OPPS APC 505.6 505.6 other OPPS APC 505.6 27.63 139.7 percent of total billed charges 505.6 505.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MATRIXRIB 135MM 10MM 2.2MM NS STERNUM J LATCH COUPLING STOP STRYKER SUP-03.501.040 CDM 0270 RC outpatient 505.6 505.6 505.6 74 374.14 percent of total billed charges 505.6 93 409.54 percent of total billed charges 505.6 505.6 other OPPS APC 505.6 505.6 other OPPS APC 505.6 27.63 139.7 percent of total billed charges 505.6 505.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MATRIXRIB L135 MM L12 MM OD2.2 MM J LATCH STOP NONSTERILE SUP-03.501.042 CDM 0270 RC outpatient 505.6 505.6 505.6 74 374.14 percent of total billed charges 505.6 93 409.54 percent of total billed charges 505.6 505.6 other OPPS APC 505.6 505.6 other OPPS APC 505.6 27.63 139.7 percent of total billed charges 505.6 505.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MATRIXRIB L135 MM L16 MM OD2.2 MM J LATCH STOP NONSTERILE SUP-03.501.046 CDM 0270 RC outpatient 505.6 505.6 505.6 74 374.14 percent of total billed charges 505.6 93 409.54 percent of total billed charges 505.6 505.6 other OPPS APC 505.6 505.6 other OPPS APC 505.6 27.63 139.7 percent of total billed charges 505.6 505.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MATRIXRIB 125MM 5.5MM NS STERNUM J LATCH COUPLING STOP STRYKER SUP-03.501.070 CDM 0270 RC outpatient 918.53 918.53 918.53 74 679.71 percent of total billed charges 918.53 93 744.01 percent of total billed charges 918.53 918.53 other OPPS APC 918.53 918.53 other OPPS APC 918.53 27.63 253.79 percent of total billed charges 918.53 918.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MATRIXRIB 82MM 12MM 1.8MM NS STERNUM J LATCH COUPLING SELF STOP STRYKER SUP-03.501.212 CDM 0270 RC outpatient 441.53 441.53 441.53 74 326.73 percent of total billed charges 441.53 93 357.64 percent of total billed charges 441.53 441.53 other OPPS APC 441.53 441.53 other OPPS APC 441.53 27.63 121.99 percent of total billed charges 441.53 441.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MATRIXRIB 82MM 14MM 1.8MM NS STERNUM J LATCH COUPLING SELF STOP STRYKER SUP-03.501.214 CDM 0270 RC outpatient 505.6 505.6 505.6 74 374.14 percent of total billed charges 505.6 93 409.54 percent of total billed charges 505.6 505.6 other OPPS APC 505.6 505.6 other OPPS APC 505.6 27.63 139.7 percent of total billed charges 505.6 505.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT SYNTHES STRYKER J LATCH 19MM STOP SUP-03.501.216 CDM 0270 RC outpatient 505.6 505.6 505.6 74 374.14 percent of total billed charges 505.6 93 409.54 percent of total billed charges 505.6 505.6 other OPPS APC 505.6 505.6 other OPPS APC 505.6 27.63 139.7 percent of total billed charges 505.6 505.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MATRIXRIB 82MM 18MM 1.8MM NS STERNUM J LATCH COUPLING SELF STOP STRYKER SUP-03.501.218 CDM 0270 RC outpatient 505.6 505.6 505.6 74 374.14 percent of total billed charges 505.6 93 409.54 percent of total billed charges 505.6 505.6 other OPPS APC 505.6 505.6 other OPPS APC 505.6 27.63 139.7 percent of total billed charges 505.6 505.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MATRIXRIB L88 MM L20 MM OD1.8 MM STERNUM J LATCH COUPLING SELF STOP NONSTERILE STRYKER SUP-03.501.220 CDM 270010022 LOCAL 0270 RC outpatient 520.75 520.75 520.75 74 385.36 percent of total billed charges 520.75 93 421.81 percent of total billed charges 520.75 520.75 other OPPS APC 520.75 520.75 other OPPS APC 520.75 27.63 143.88 percent of total billed charges 520.75 520.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MATRIXRIB L88 MM L22 MM OD1.8 MM STERNUM J LATCH COUPLING SELF STOP NONSTERILE STRYKER SUP-03.501.222 CDM 0270 RC outpatient 505.6 505.6 505.6 74 374.14 percent of total billed charges 505.6 93 409.54 percent of total billed charges 505.6 505.6 other OPPS APC 505.6 505.6 other OPPS APC 505.6 27.63 139.7 percent of total billed charges 505.6 505.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MATRIXRIB TITANIUM L88 MM L24 MM OD1.8 MM STERNUM J LATCH COUPLING SELF STOP NONSTERILE SUP-03.501.224 CDM 0270 RC outpatient 468.23 468.23 468.23 74 346.49 percent of total billed charges 468.23 93 379.27 percent of total billed charges 468.23 468.23 other OPPS APC 468.23 468.23 other OPPS APC 468.23 27.63 129.37 percent of total billed charges 468.23 468.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MATRIXRIB L135 MM L10 MM OD2.2 MM STERNUM STOP AO QUICK COUPLING NONSTERILE SUP-03.501.610 CDM 0270 RC outpatient 505.6 505.6 505.6 74 374.14 percent of total billed charges 505.6 93 409.54 percent of total billed charges 505.6 505.6 other OPPS APC 505.6 505.6 other OPPS APC 505.6 27.63 139.7 percent of total billed charges 505.6 505.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L65 MM OD3.2 MM QUICK COUPLING STOP NONSTERILE SUP-03.614.010 CDM 270010022 LOCAL 0270 RC outpatient 427.7 427.7 427.7 74 316.5 percent of total billed charges 427.7 93 346.44 percent of total billed charges 427.7 427.7 other OPPS APC 427.7 427.7 other OPPS APC 427.7 27.63 118.17 percent of total billed charges 427.7 427.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA INJECTION FOR TFNA STERILE TRAUMACEM (TM) V SUP-03.702.121S CDM 0270 RC outpatient 1014 1014 1014 74 750.36 percent of total billed charges 1014 93 821.34 percent of total billed charges 1014 1014 other OPPS APC 1014 1014 other OPPS APC 1014 27.63 280.17 percent of total billed charges 1014 1014 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT SYRINGE STERILE TRAUMACEM (TM) V SUP-03.702.150S CDM 0270 RC outpatient 374.4 374.4 374.4 74 277.06 percent of total billed charges 374.4 93 303.26 percent of total billed charges 374.4 374.4 other OPPS APC 374.4 374.4 other OPPS APC 374.4 27.63 103.45 percent of total billed charges 374.4 374.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETAINER SCREW PRODISC-C L12 MM OD3.5 MM SPINE NONSTERILE SUP-03.820-102 CDM 270010022 LOCAL 0270 RC outpatient 362.08 362.08 362.08 74 267.94 percent of total billed charges 362.08 93 293.28 percent of total billed charges 362.08 362.08 other OPPS APC 362.08 362.08 other OPPS APC 362.08 27.63 100.04 percent of total billed charges 362.08 362.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES RETAINER 3.5MM X 14MM SUP-03.820.103.02S CDM 270010020 LOCAL 0270 RC outpatient 914.68 914.68 914.68 74 676.86 percent of total billed charges 914.68 93 740.89 percent of total billed charges 914.68 914.68 other OPPS APC 914.68 914.68 other OPPS APC 914.68 27.63 252.73 percent of total billed charges 914.68 914.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETAINER SCREW PRODISC-C L16 MM OD3.5 MM SPINE NONSTERILE SUP-03.820.104 CDM 0270 RC outpatient 457.34 457.34 457.34 74 338.43 percent of total billed charges 457.34 93 370.45 percent of total billed charges 457.34 457.34 other OPPS APC 457.34 457.34 other OPPS APC 457.34 27.63 126.36 percent of total billed charges 457.34 457.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETAINER SCREW PRODISC-C L16 MM OD3.5 MM SPINE STERILE SUP-03.820.104.02S CDM 0270 RC outpatient 914.68 914.68 914.68 74 676.86 percent of total billed charges 914.68 93 740.89 percent of total billed charges 914.68 914.68 other OPPS APC 914.68 914.68 other OPPS APC 914.68 27.63 252.73 percent of total billed charges 914.68 914.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NUT LOCK FIX RETAINER SCREW SYSTEM SUP-03.820.110 CDM 270010020 LOCAL 0270 RC outpatient 218.4 218.4 218.4 74 161.62 percent of total billed charges 218.4 93 176.9 percent of total billed charges 218.4 218.4 other OPPS APC 218.4 218.4 other OPPS APC 218.4 27.63 60.34 percent of total billed charges 218.4 218.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL PRODISC-C OD1.8 MM SPINE MILL STERILE SUP-03.820.117S CDM 270010020 LOCAL 0270 RC outpatient 1209 1209 1209 74 894.66 percent of total billed charges 1209 93 979.29 percent of total billed charges 1209 1209 other OPPS APC 1209 1209 other OPPS APC 1209 27.63 334.05 percent of total billed charges 1209 1209 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP INSERTER PRODISC-C H5 MM SPINE STERILE MEDIUM DEEP SUP-03.820.130S CDM 270010020 LOCAL 0270 RC outpatient 499.2 499.2 499.2 74 369.41 percent of total billed charges 499.2 93 404.35 percent of total billed charges 499.2 499.2 other OPPS APC 499.2 499.2 other OPPS APC 499.2 27.63 137.93 percent of total billed charges 499.2 499.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP INSERTER PRODISC-C H6 MM SPINE STERILE MEDIUM DEEP SUP-03.820.131S CDM 270010020 LOCAL 0270 RC outpatient 315.85 315.85 315.85 74 233.73 percent of total billed charges 315.85 93 255.84 percent of total billed charges 315.85 315.85 other OPPS APC 315.85 315.85 other OPPS APC 315.85 27.63 87.27 percent of total billed charges 315.85 315.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP INSERTER PRODISC-C H5 MM SPINE STERILE LARGE DEEP SUP-03.820.133S CDM 0270 RC outpatient 315.85 315.85 315.85 74 233.73 percent of total billed charges 315.85 93 255.84 percent of total billed charges 315.85 315.85 other OPPS APC 315.85 315.85 other OPPS APC 315.85 27.63 87.27 percent of total billed charges 315.85 315.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP INSERTER PRODISC-C H6 MM SPINE STERILE LARGE DEEP SUP-03.820.134S CDM 0270 RC outpatient 315.85 315.85 315.85 74 233.73 percent of total billed charges 315.85 93 255.84 percent of total billed charges 315.85 315.85 other OPPS APC 315.85 315.85 other OPPS APC 315.85 27.63 87.27 percent of total billed charges 315.85 315.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL PRODISC-C OD2 MM MILLING STERILE SUP-03.820.161S CDM 0270 RC outpatient 764.97 764.97 764.97 74 566.08 percent of total billed charges 764.97 93 619.63 percent of total billed charges 764.97 764.97 other OPPS APC 764.97 764.97 other OPPS APC 764.97 27.63 211.36 percent of total billed charges 764.97 764.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL PRODISC-C OD2 MM SPINE MILL HEXAGONAL COUPLE STERILE SUP-03.820.163S CDM 270010020 LOCAL 0270 RC outpatient 764.97 764.97 764.97 74 566.08 percent of total billed charges 764.97 93 619.63 percent of total billed charges 764.97 764.97 other OPPS APC 764.97 764.97 other OPPS APC 764.97 27.63 211.36 percent of total billed charges 764.97 764.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SUTURING TI-KNOT OD5 MM 1 PORT PLACEMENT ERGONOMIC HANDLE AUTOMATIC CRIMP STERILE SUP-030404 CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ENDO GIA ROTICULATOR TITANIUM UNIVERSAL L45 MM X H2.5 MM OD12 MM VASCULAR TISSUE 6 ROW KNIFE BLADE CARTRIDGE GAP CONTROL STERILE LATEX FREE DISPOSABLE WHITE ENDOSCOPIC SUP-030454 CDM 0270 RC outpatient 444.53 444.53 444.53 74 328.95 percent of total billed charges 444.53 93 360.07 percent of total billed charges 444.53 444.53 other OPPS APC 444.53 444.53 other OPPS APC 444.53 27.63 122.82 percent of total billed charges 444.53 444.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD SUTURE ASSISTANT TK QUICK LOAD TITANIUM KNOT BLUNT CURVE HANDLE WIRE SNARE STERILE DISPOSABLE WHITE SUP-030510 CDM 0270 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 27.63 30.17 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA BONE CEMENT VERTEPORT OD10 GA PRECISE CONTROL TACTILE FEEL STERILE LATEX FREE DISPOSABLE SUP-0306-410-000 CDM 0270 RC outpatient 191.01 191.01 191.01 74 141.35 percent of total billed charges 191.01 93 154.72 percent of total billed charges 191.01 191.01 other OPPS APC 191.01 191.01 other OPPS APC 191.01 27.63 52.78 percent of total billed charges 191.01 191.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STYLET SURGICAL INSTRUMENT IVAS OD 10 GA BEVEL STERILE LATEX FREE DISPOSABLE SUP-0306-531-000 CDM 0270 RC outpatient 229.12 229.12 229.12 74 169.55 percent of total billed charges 229.12 93 185.59 percent of total billed charges 229.12 229.12 other OPPS APC 229.12 229.12 other OPPS APC 229.12 27.63 63.31 percent of total billed charges 229.12 229.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIRECT SUCTION TUBING SET-UROLOGY SUP-030647-10 CDM 0270 RC outpatient 98.77 98.77 98.77 74 73.09 percent of total billed charges 98.77 93 80 percent of total billed charges 98.77 98.77 other OPPS APC 98.77 98.77 other OPPS APC 98.77 27.63 27.29 percent of total billed charges 98.77 98.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SUTURING COR-KNOT STERILE SUP-030800 CDM 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SUTURING COR-KNOT QUICK LOAD TITANIUM BLUNT CURVE RELOAD WIRE SNARE LEVER STERILE PURPLE WHITE SUP-030850 CDM 0270 RC outpatient 117 117 117 74 86.58 percent of total billed charges 117 93 94.77 percent of total billed charges 117 117 other OPPS APC 117 117 other OPPS APC 117 27.63 32.33 percent of total billed charges 117 117 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE QUICK LOAD RUNNING DEVICE 180 COR-KNOT (12 PACKS OF 6 RELOADS) SUP-030874 CDM 0270 RC outpatient 117 117 117 74 86.58 percent of total billed charges 117 93 94.77 percent of total billed charges 117 117 other OPPS APC 117 117 other OPPS APC 117 27.63 32.33 percent of total billed charges 117 117 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT SUTURE COR-KNOT MINI STERILE COMBO SUP-031350 CDM 0270 RC outpatient 1989 1989 1989 74 1471.86 percent of total billed charges 1989 93 1611.09 percent of total billed charges 1989 1989 other OPPS APC 1989 1989 other OPPS APC 1989 27.63 549.56 percent of total billed charges 1989 1989 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID .5CC DBX ALLOGRAFT PUTTY FREEZE DRIED SUP-038005 CDM 270010031 LOCAL 0270 RC outpatient 329 329 329 74 243.46 percent of total billed charges 329 93 266.49 percent of total billed charges 329 329 other OPPS APC 329 329 other OPPS APC 329 27.63 90.9 percent of total billed charges 329 329 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID 1CC DBX ALLOGRAFT PUTTY FREEZE DRIED SUP-038010 CDM 270010031 LOCAL 0270 RC outpatient 584.87 584.87 584.87 74 432.8 percent of total billed charges 584.87 93 473.74 percent of total billed charges 584.87 584.87 other OPPS APC 584.87 584.87 other OPPS APC 584.87 27.63 161.6 percent of total billed charges 584.87 584.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID 5CC DBX ALLOGRAFT PUTTY FREEZE DRIED SUP-038050 CDM 270010031 LOCAL 0270 RC outpatient 2400.42 2400.42 2400.42 74 1776.31 percent of total billed charges 2400.42 93 1944.34 percent of total billed charges 2400.42 2400.42 other OPPS APC 2400.42 2400.42 other OPPS APC 2400.42 27.63 663.24 percent of total billed charges 2400.42 2400.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID 10CC DBX ALLOGRAFT PUTTY FREEZE DRIED SUP-038100 CDM 270010031 LOCAL 0270 RC outpatient 3692.03 3692.03 3692.03 74 2732.1 percent of total billed charges 3692.03 93 2990.54 percent of total billed charges 3692.03 3692.03 other OPPS APC 3692.03 3692.03 other OPPS APC 3692.03 27.63 1020.11 percent of total billed charges 3692.03 3692.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIAPER ADULT LG SUP-04-00005 CDM 0271 RC outpatient 24.27 24.27 24.27 74 17.96 percent of total billed charges 24.27 93 19.66 percent of total billed charges 24.27 24.27 other OPPS APC 24.27 24.27 other OPPS APC 24.27 27.63 6.71 percent of total billed charges 24.27 24.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIAPER ADULT 2XL SUP-04-00010 CDM 0271 RC outpatient 27.56 27.56 27.56 74 20.39 percent of total billed charges 27.56 93 22.32 percent of total billed charges 27.56 27.56 other OPPS APC 27.56 27.56 other OPPS APC 27.56 27.63 7.61 percent of total billed charges 27.56 27.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRIEFS ADULT LG SUP-04-00011 CDM 0271 RC outpatient 29.31 29.31 29.31 74 21.69 percent of total billed charges 29.31 93 23.74 percent of total billed charges 29.31 29.31 other OPPS APC 29.31 29.31 other OPPS APC 29.31 27.63 8.1 percent of total billed charges 29.31 29.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIAPER ADULT MED SUP-04-00012 CDM 0271 RC outpatient 3.03 3.03 3.03 74 2.24 percent of total billed charges 3.03 93 2.45 percent of total billed charges 3.03 3.03 other OPPS APC 3.03 3.03 other OPPS APC 3.03 27.63 0.84 percent of total billed charges 3.03 3.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRIEFS ADULT MED SUP-04-00013 CDM 0271 RC outpatient 29.31 29.31 29.31 74 21.69 percent of total billed charges 29.31 93 23.74 percent of total billed charges 29.31 29.31 other OPPS APC 29.31 29.31 other OPPS APC 29.31 27.63 8.1 percent of total billed charges 29.31 29.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP END TITANIUM T25 0 MM EXTENSION SPIRAL BLADE STARDRIVE STERILE GOLD EXPERT HUMERAL NAIL SUP-04.001.000S CDM 270010022 LOCAL 0270 RC outpatient 497.64 497.64 497.64 74 368.25 percent of total billed charges 497.64 93 403.09 percent of total billed charges 497.64 497.64 other OPPS APC 497.64 497.64 other OPPS APC 497.64 27.63 137.5 percent of total billed charges 497.64 497.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP END NAIL-EX TITANIUM OD10 MM HUMERUS EXTENDED STARDRIVE RECESS STERILE INTRAMEDULLARY NAIL SUP-04.001.002S CDM 270010022 LOCAL 0270 RC outpatient 497.64 497.64 497.64 74 368.25 percent of total billed charges 497.64 93 403.09 percent of total billed charges 497.64 497.64 other OPPS APC 497.64 497.64 other OPPS APC 497.64 27.63 137.5 percent of total billed charges 497.64 497.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP END EXPERT TITANIUM 15 MM OD15 MM HUMERUS EXTENDED SPIRAL BLADE SELF HOLDING T25 STARDRIVE STERILE GOLD INTRAMEDULLARY NAIL SUP-04.001.003S CDM 270010022 LOCAL 0270 RC outpatient 497.64 497.64 497.64 74 368.25 percent of total billed charges 497.64 93 403.09 percent of total billed charges 497.64 497.64 other OPPS APC 497.64 497.64 other OPPS APC 497.64 27.63 137.5 percent of total billed charges 497.64 497.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP END NAIL HUMERAL T40 STARDRIVE TITANIUM STERILE EXTENTION 0MM SUP-04.001.008S CDM 270010022 LOCAL 0270 RC outpatient 881.4 881.4 881.4 74 652.24 percent of total billed charges 881.4 93 713.93 percent of total billed charges 881.4 881.4 other OPPS APC 881.4 881.4 other OPPS APC 881.4 27.63 243.53 percent of total billed charges 881.4 881.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP END NAIL HUMERAL T40 STARDRIVE TITANIUM STERILE EXTENTION 5MM SUP-04.001.009S CDM 270010022 LOCAL 0270 RC outpatient 881.4 881.4 881.4 74 652.24 percent of total billed charges 881.4 93 713.93 percent of total billed charges 881.4 881.4 other OPPS APC 881.4 881.4 other OPPS APC 881.4 27.63 243.53 percent of total billed charges 881.4 881.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP END NAIL HUMERAL T40 STARDRIVE TITANIUM STERILE EXTENTION 10MM SUP-04.001.010S CDM 270010022 LOCAL 0270 RC outpatient 881.4 881.4 881.4 74 652.24 percent of total billed charges 881.4 93 713.93 percent of total billed charges 881.4 881.4 other OPPS APC 881.4 881.4 other OPPS APC 881.4 27.63 243.53 percent of total billed charges 881.4 881.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L150 MM OD7 MM HUMERAL PROXIMAL CANNULATED TRANSVERSE SLOT LOCK HOLE ROUND CROSS SECTION STERILE BLUE SUP-04.001.210S CDM 270010022 LOCAL 0270 RC outpatient 4441.58 4441.58 4441.58 74 3286.77 percent of total billed charges 4441.58 93 3597.68 percent of total billed charges 4441.58 4441.58 other OPPS APC 4441.58 4441.58 other OPPS APC 4441.58 27.63 1227.21 percent of total billed charges 4441.58 4441.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT ROUND 190MM 7MM BLUE TITANIUM STERILE HUMERAL CANNULATED TRANSVERSE SLOT LOCK HOLE SUP-04.001.218S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT ROUND 200MM 7MM BLUE TITANIUM STERILE HUMERAL CANNULATED TRANSVERSE SLOT LOCK HOLE SUP-04.001.220S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L210 MM OD7 MM HUMERAL CANNULATED TRANSVERSE SLOT LOCK HOLE ROUND CROSS SECTION STERILE BLUE SUP-04.001.222S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT ROUND 220MM 7MM BLUE TITANIUM STERILE HUMERAL CANNULATED TRANSVERSE SLOT LOCK HOLE SUP-04.001.224S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L23 CM OD7 MM HUMERAL CANNULATED STERILE BLUE SUP-04.001.226S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM ROUND BARREL UNIVERSAL L24 CM OD7 MM HUMERUS CANNULATED STERILE BLUE SUP-04.001.228S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT ROUND 250MM 7MM BLUE TITANIUM STERILE HUMERAL CANNULATED TRANSVERSE SLOT LOCK HOLE SUP-04.001.230S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM ROUND BARREL UNIVERSAL L26 CM OD7 MM HUMERUS CANNULATED STERILE BLUE SUP-04.001.232S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT ROUND 270MM 7MM BLUE TITANIUM STERILE HUMERAL CANNULATED TRANSVERSE SLOT LOCK HOLE SUP-04.001.234S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT ROUND 280MM 7MM BLUE TITANIUM STERILE HUMERAL CANNULATED TRANSVERSE SLOT LOCK HOLE SUP-04.001.236S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT ROUND 290MM 7MM BLUE TITANIUM STERILE HUMERAL CANNULATED TRANSVERSE SLOT LOCK HOLE SUP-04.001.238S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT ROUND 300MM 7MM BLUE TITANIUM STERILE HUMERAL CANNULATED TRANSVERSE SLOT LOCK HOLE SUP-04.001.240S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT ROUND 150MM 9MM BLUE TITANIUM STERILE HUMERAL CANNULATED TRANSVERSE SLOT LOCK HOLE SUP-04.001.410S CDM 270010022 LOCAL 0270 RC outpatient 4441.58 4441.58 4441.58 74 3286.77 percent of total billed charges 4441.58 93 3597.68 percent of total billed charges 4441.58 4441.58 other OPPS APC 4441.58 4441.58 other OPPS APC 4441.58 27.63 1227.21 percent of total billed charges 4441.58 4441.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT ROUND 190MM 9MM BLUE TITANIUM STERILE HUMERAL CANNULATED TRANSVERSE SLOT LOCK HOLE SUP-04.001.418S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT ROUND 200MM 9MM BLUE TITANIUM STERILE HUMERAL CANNULATED TRANSVERSE SLOT LOCK HOLE SUP-04.001.420S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT ROUND 210MM 9MM BLUE TITANIUM STERILE HUMERAL CANNULATED TRANSVERSE SLOT LOCK HOLE SUP-04.001.422S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT ROUND 220MM 9MM BLUE TITANIUM STERILE HUMERAL CANNULATED TRANSVERSE SLOT LOCK HOLE SUP-04.001.424S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L230 MM OD9 MM HUMERUS CANNULATED IMPLANT STERILE SUP-04.001.426S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT ROUND 240MM 9MM BLUE TITANIUM STERILE HUMERAL CANNULATED TRANSVERSE SLOT LOCK HOLE SUP-04.001.428S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT ROUND 250MM 9MM BLUE TITANIUM STERILE HUMERAL CANNULATED TRANSVERSE SLOT LOCK HOLE SUP-04.001.430S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT ROUND 260MM 9MM BLUE TITANIUM STERILE HUMERAL CANNULATED TRANSVERSE SLOT LOCK HOLE SUP-04.001.432S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L270 MM OD9 MM HUMERAL CANNULATED TRANSVERSE SLOT LOCK HOLE ROUND CROSS SECTION STERILE BLUE SUP-04.001.434S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT ROUND 280MM 9MM BLUE TITANIUM STERILE HUMERAL CANNULATED TRANSVERSE SLOT LOCK HOLE SUP-04.001.436S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT ROUND 300MM 9MM BLUE TITANIUM STERILE HUMERAL CANNULATED TRANSVERSE SLOT LOCK HOLE SUP-04.001.440S CDM 270010022 LOCAL 0270 RC outpatient 4576 4576 4576 74 3386.24 percent of total billed charges 4576 93 3706.56 percent of total billed charges 4576 4576 other OPPS APC 4576 4576 other OPPS APC 4576 27.63 1264.35 percent of total billed charges 4576 4576 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP ORTHOPEDIC TITANIUM 0 MM T40 OD12 MM FEMORAL STARDRIVE CANNULATED STERILE GRAY EXPERT NAIL SYSTEM SUP-04.003.000S CDM 270010022 LOCAL 0270 RC outpatient 646.36 646.36 646.36 74 478.31 percent of total billed charges 646.36 93 523.55 percent of total billed charges 646.36 646.36 other OPPS APC 646.36 646.36 other OPPS APC 646.36 27.63 178.59 percent of total billed charges 646.36 646.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP ORTHOPEDIC TITANIUM 5 MM T40 OD12 MM FEMORAL STARDRIVE CANNULATED STERILE GRAY EXPERT NAIL SYSTEM SUP-04.003.001S CDM 270010022 LOCAL 0270 RC outpatient 646.36 646.36 646.36 74 478.31 percent of total billed charges 646.36 93 523.55 percent of total billed charges 646.36 646.36 other OPPS APC 646.36 646.36 other OPPS APC 646.36 27.63 178.59 percent of total billed charges 646.36 646.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP ORTHOPEDIC TITANIUM 10 MM T40 OD12 MM FEMORAL STARDRIVE CANNULATED STERILE GRAY EXPERT NAIL SYSTEM SUP-04.003.002S CDM 270010022 LOCAL 0270 RC outpatient 646.36 646.36 646.36 74 478.31 percent of total billed charges 646.36 93 523.55 percent of total billed charges 646.36 646.36 other OPPS APC 646.36 646.36 other OPPS APC 646.36 27.63 178.59 percent of total billed charges 646.36 646.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP ORTHOPEDIC TITANIUM 15 MM T40 OD12 MM FEMORAL STARDRIVE CANNULATED STERILE GRAY EXPERT NAIL SYSTEM SUP-04.003.003S CDM 270010022 LOCAL 0270 RC outpatient 646.36 646.36 646.36 74 478.31 percent of total billed charges 646.36 93 523.55 percent of total billed charges 646.36 646.36 other OPPS APC 646.36 646.36 other OPPS APC 646.36 27.63 178.59 percent of total billed charges 646.36 646.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP ORTHOPEDIC TITANIUM 20 MM T40 OD12 MM FEMORAL STARDRIVE CANNULATED STERILE GRAY EXPERT NAIL SYSTEM SUP-04.003.004S CDM 270010022 LOCAL 0270 RC outpatient 646.36 646.36 646.36 74 478.31 percent of total billed charges 646.36 93 523.55 percent of total billed charges 646.36 646.36 other OPPS APC 646.36 646.36 other OPPS APC 646.36 27.63 178.59 percent of total billed charges 646.36 646.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L60 MM OD6.5 MM FEMUR T25 STARDRIVE RECESS SELF TAPPING TIP RECONSTRUCTION STERILE INTRAMEDULLARY NAIL SUP-04.003.022S CDM 270010022 LOCAL 0270 RC outpatient 496.08 496.08 496.08 74 367.1 percent of total billed charges 496.08 93 401.82 percent of total billed charges 496.08 496.08 other OPPS APC 496.08 496.08 other OPPS APC 496.08 27.63 137.07 percent of total billed charges 496.08 496.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L65 MM OD6.5 MM FEMUR T25 STARDRIVE RECESS SELF TAPPING TIP RECONSTRUCTION STERILE INTRAMEDULLARY NAIL SUP-04.003.023S CDM 270010022 LOCAL 0270 RC outpatient 606.32 606.32 606.32 74 448.68 percent of total billed charges 606.32 93 491.12 percent of total billed charges 606.32 606.32 other OPPS APC 606.32 606.32 other OPPS APC 606.32 27.63 167.53 percent of total billed charges 606.32 606.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L70 MM OD6.5 MM FEMUR SELF TAP RECONSTRUCTION STARDRIVE STERILE GOLD INTRAMEDULLARY NAIL SYSTEM SUP-04.003.024S CDM 270010022 LOCAL 0270 RC outpatient 606.32 606.32 606.32 74 448.68 percent of total billed charges 606.32 93 491.12 percent of total billed charges 606.32 606.32 other OPPS APC 606.32 606.32 other OPPS APC 606.32 27.63 167.53 percent of total billed charges 606.32 606.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L75 MM OD6.5 MM FEMUR SELF TAP RECONSTRUCTION STARDRIVE STERILE GOLD INTRAMEDULLARY NAIL SYSTEM SUP-04.003.025S CDM 270010022 LOCAL 0270 RC outpatient 606.32 606.32 606.32 74 448.68 percent of total billed charges 606.32 93 491.12 percent of total billed charges 606.32 606.32 other OPPS APC 606.32 606.32 other OPPS APC 606.32 27.63 167.53 percent of total billed charges 606.32 606.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L80 MM OD6.5 MM FEMUR SELF TAP RECONSTRUCTION STARDRIVE STERILE GOLD INTRAMEDULLARY NAIL SYSTEM SUP-04.003.026S CDM 270010022 LOCAL 0270 RC outpatient 496.08 496.08 496.08 74 367.1 percent of total billed charges 496.08 93 401.82 percent of total billed charges 496.08 496.08 other OPPS APC 496.08 496.08 other OPPS APC 496.08 27.63 137.07 percent of total billed charges 496.08 496.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L85 MM L30 MM OD6.5 MM ODSEC4.5 MM HIP FEMORAL SELF TAP BLUNT TIP STARDRIVE RECONSTRUCTION STERILE GOLD EXPERT SUP-04.003.027S CDM 270010022 LOCAL 0270 RC outpatient 496.08 496.08 496.08 74 367.1 percent of total billed charges 496.08 93 401.82 percent of total billed charges 496.08 496.08 other OPPS APC 496.08 496.08 other OPPS APC 496.08 27.63 137.07 percent of total billed charges 496.08 496.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L90 MM L30 MM OD6.5 MM ODSEC4.5 MM HIP FEMORAL SELF TAP BLUNT TIP STARDRIVE RECONSTRUCTION STERILE GOLD EXPERT SUP-04.003.028S CDM 270010022 LOCAL 0270 RC outpatient 496.08 496.08 496.08 74 367.1 percent of total billed charges 496.08 93 401.82 percent of total billed charges 496.08 496.08 other OPPS APC 496.08 496.08 other OPPS APC 496.08 27.63 137.07 percent of total billed charges 496.08 496.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L95 MM OD6.5 MM FEMUR SELF TAP RECONSTRUCTION STARDRIVE STERILE GOLD INTRAMEDULLARY NAIL SYSTEM SUP-04.003.029S CDM 270010022 LOCAL 0270 RC outpatient 496.08 496.08 496.08 74 367.1 percent of total billed charges 496.08 93 401.82 percent of total billed charges 496.08 496.08 other OPPS APC 496.08 496.08 other OPPS APC 496.08 27.63 137.07 percent of total billed charges 496.08 496.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L105 MM OD6.5 MM FEMUR SELF TAP RECONSTRUCTION STARDRIVE STERILE GOLD INTRAMEDULLARY NAIL SYSTEM SUP-04.003.031S CDM 270010022 LOCAL 0270 RC outpatient 496.08 496.08 496.08 74 367.1 percent of total billed charges 496.08 93 401.82 percent of total billed charges 496.08 496.08 other OPPS APC 496.08 496.08 other OPPS APC 496.08 27.63 137.07 percent of total billed charges 496.08 496.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L110 MM OD6.5 MM FEMUR SELF TAP RECONSTRUCTION STARDRIVE STERILE GOLD INTRAMEDULLARY NAIL SYSTEM SUP-04.003.032S CDM 270010022 LOCAL 0270 RC outpatient 606.32 606.32 606.32 74 448.68 percent of total billed charges 606.32 93 491.12 percent of total billed charges 606.32 606.32 other OPPS APC 606.32 606.32 other OPPS APC 606.32 27.63 167.53 percent of total billed charges 606.32 606.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L115 MM OD6.5 MM FEMUR SELF TAP RECONSTRUCTION STARDRIVE STERILE GOLD INTRAMEDULLARY NAIL SYSTEM SUP-04.003.033S CDM 270010022 LOCAL 0270 RC outpatient 606.32 606.32 606.32 74 448.68 percent of total billed charges 606.32 93 491.12 percent of total billed charges 606.32 606.32 other OPPS APC 606.32 606.32 other OPPS APC 606.32 27.63 167.53 percent of total billed charges 606.32 606.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L120 MM OD6.5 MM FEMUR SELF TAP RECONSTRUCTION STARDRIVE STERILE GOLD INTRAMEDULLARY NAIL SYSTEM SUP-04.003.034S CDM 270010022 LOCAL 0270 RC outpatient 606.32 606.32 606.32 74 448.68 percent of total billed charges 606.32 93 491.12 percent of total billed charges 606.32 606.32 other OPPS APC 606.32 606.32 other OPPS APC 606.32 27.63 167.53 percent of total billed charges 606.32 606.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L125 MM OD6.5 MM FEMUR SELF TAP RECONSTRUCTION STARDRIVE STERILE GOLD INTRAMEDULLARY NAIL SYSTEM SUP-04.003.035S CDM 270010022 LOCAL 0270 RC outpatient 606.32 606.32 606.32 74 448.68 percent of total billed charges 606.32 93 491.12 percent of total billed charges 606.32 606.32 other OPPS APC 606.32 606.32 other OPPS APC 606.32 27.63 167.53 percent of total billed charges 606.32 606.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L130 MM OD6.5 MM FEMUR T25 STARDRIVE RECESS SELF TAPPING TIP RECONSTRUCTION STERILE INTRAMEDULLARY NAIL SUP-04.003.036S CDM 270010022 LOCAL 0270 RC outpatient 606.32 606.32 606.32 74 448.68 percent of total billed charges 606.32 93 491.12 percent of total billed charges 606.32 606.32 other OPPS APC 606.32 606.32 other OPPS APC 606.32 27.63 167.53 percent of total billed charges 606.32 606.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L320 MM OD10 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.344S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L320 MM OD10 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.345S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L340 MM OD10 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.348S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L340 MM OD10 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.349S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L360 MM OD10 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.352S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L360 MM OD10 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.353S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L380 MM OD10 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.356S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L380 MM OD10 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.357S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L400 MM OD10 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.360S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L400 MM OD10 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.361S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L420 MM OD10 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.364S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L420 MM OD10 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.365S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L320 MM OD11 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.444S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L320 MM OD11 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.445S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L340 MM OD11 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.448S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L340 MM OD11 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.449S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L360 MM OD11 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.452S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L360 MM OD11 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.453S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L380 MM OD11 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.456S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L340 MM OD11 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.457S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L400 MM OD11 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.460S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L400 MM OD11 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.461S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L420 MM OD11 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.464S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L420 MM OD11 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.465S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L320 MM OD12 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.544S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L320 MM OD12 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.545S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM HELICAL FLUTE L340 MM OD12 MM FEMORAL RIGHT LATERAL ANATOMIC CANNULATED RECONSTRUCTION STERILE LIGHT GREEN 5 MM LOCK SCREW SUP-04.003.548S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L340 MM OD12 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.549S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L360 MM OD12 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.552S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L360 MM OD12 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.553S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L380 MM OD12 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.556S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM HELICAL FLUTE L380 MM OD12 MM FEMORAL LEFT LATERAL ANATOMIC CANNULATED RECONSTRUCTION STERILE LIGHT GREEN 5 MM LOCK SCREW SUP-04.003.557S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L400 MM OD12 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.560S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L400 MM OD12 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.561S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L420 MM OD12 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.564S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L420 MM OD12 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.565S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L320 MM OD13 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.644S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L320 MM OD13 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.645S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L340 MM OD13 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.648S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L340 MM OD13 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.649S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM HELICAL FLUTE L360 MM OD13 MM FEMORAL RIGHT RECONSTRUCTION CANNULATED LATERAL ENTRY STERILE GREEN SUP-04.003.652S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L360 MM OD13 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.653S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L380 MM OD13 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.656S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L380 MM OD13 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.657S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L400 MM OD13 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.660S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L400 MM OD13 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.661S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L420 MM OD13 MM RIGHT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.664S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L420 MM OD13 MM LEFT FEMUR ANATOMIC CANNULATED HELICAL FLUTED LATERAL ENTRY RECONSTRUCTION STERILE LIGHT GREEN SUP-04.003.665S CDM 270010022 LOCAL 0270 RC outpatient 4900.61 4900.61 4900.61 74 3626.45 percent of total billed charges 4900.61 93 3969.49 percent of total billed charges 4900.61 4900.61 other OPPS APC 4900.61 4900.61 other OPPS APC 4900.61 27.63 1354.04 percent of total billed charges 4900.61 4900.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP ORTHOPEDIC TITANIUM 0 MM T40 TIBIAL STARDRIVE CANNULATED STERILE GOLD EXPERT NAIL SYSTEM SUP-04.004.000S CDM 270010022 LOCAL 0270 RC outpatient 586.3 586.3 586.3 74 433.86 percent of total billed charges 586.3 93 474.9 percent of total billed charges 586.3 586.3 other OPPS APC 586.3 586.3 other OPPS APC 586.3 27.63 161.99 percent of total billed charges 586.3 586.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP ORTHOPEDIC TITANIUM 5 MM T40 TIBIAL STARDRIVE CANNULATED STERILE GOLD EXPERT NAIL SYSTEM SUP-04.004.001S CDM 270010022 LOCAL 0270 RC outpatient 716.43 716.43 716.43 74 530.16 percent of total billed charges 716.43 93 580.31 percent of total billed charges 716.43 716.43 other OPPS APC 716.43 716.43 other OPPS APC 716.43 27.63 197.95 percent of total billed charges 716.43 716.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP END EXPERT TITANIUM 10 MM TIBIA EXTENSION T40 STARDRIVE RECESS STERILE GOLD INTRAMEDULLARY NAIL SUP-04.004.002S CDM 270010022 LOCAL 0270 RC outpatient 716.43 716.43 716.43 74 530.16 percent of total billed charges 716.43 93 580.31 percent of total billed charges 716.43 716.43 other OPPS APC 716.43 716.43 other OPPS APC 716.43 27.63 197.95 percent of total billed charges 716.43 716.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP END EXPERT TITANIUM 15 MM TIBIA EXTENSION T40 STARDRIVE RECESS STERILE GOLD INTRAMEDULLARY NAIL SUP-04.004.003S CDM 270010022 LOCAL 0270 RC outpatient 716.43 716.43 716.43 74 530.16 percent of total billed charges 716.43 93 580.31 percent of total billed charges 716.43 716.43 other OPPS APC 716.43 716.43 other OPPS APC 716.43 27.63 197.95 percent of total billed charges 716.43 716.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP ORTHOPEDIC TITANIUM 0 MM T40 TIBIAL STARDRIVE CANNULATED STERILE GRAY EXPERT NAIL SYSTEM SUP-04.004.008S CDM 270010022 LOCAL 0270 RC outpatient 479.7 479.7 479.7 74 354.98 percent of total billed charges 479.7 93 388.56 percent of total billed charges 479.7 479.7 other OPPS APC 479.7 479.7 other OPPS APC 479.7 27.63 132.54 percent of total billed charges 479.7 479.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP ORTHOPEDIC TITANIUM 5 MM T40 TIBIAL STARDRIVE CANNULATED STERILE GRAY EXPERT NAIL SYSTEM SUP-04.004.009S CDM 270010022 LOCAL 0270 RC outpatient 586.17 586.17 586.17 74 433.77 percent of total billed charges 586.17 93 474.8 percent of total billed charges 586.17 586.17 other OPPS APC 586.17 586.17 other OPPS APC 586.17 27.63 161.96 percent of total billed charges 586.17 586.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP ORTHOPEDIC TITANIUM 10 MM T40 TIBIAL STARDRIVE CANNULATED STERILE GRAY EXPERT NAIL SYSTEM SUP-04.004.010S CDM 270010022 LOCAL 0270 RC outpatient 586.17 586.17 586.17 74 433.77 percent of total billed charges 586.17 93 474.8 percent of total billed charges 586.17 586.17 other OPPS APC 586.17 586.17 other OPPS APC 586.17 27.63 161.96 percent of total billed charges 586.17 586.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP ORTHOPEDIC TITANIUM 15 MM T40 TIBIAL STARDRIVE CANNULATED STERILE GRAY EXPERT NAIL SYSTEM SUP-04.004.011S CDM 270010022 LOCAL 0270 RC outpatient 586.17 586.17 586.17 74 433.77 percent of total billed charges 586.17 93 474.8 percent of total billed charges 586.17 586.17 other OPPS APC 586.17 586.17 other OPPS APC 586.17 27.63 161.96 percent of total billed charges 586.17 586.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L31.5 CM OD8 MM TIBIAL CANNULATED STERILE BLUE SUP-04.004.243S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L315 MM OD9 MM TIBIA CANNULATED ROUND BARREL STERILE DARK BLUE SUP-04.004.343S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT ROUND 285MM 10MM LIGHT GREEN TITANIUM STERILE TIBIAL CANNULATED UNIVERSAL SUP-04.004.437S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L375 MM OD10 MM TIBIAL CANNULATED ROUND BARREL STERILE LIGHT GREEN SUP-04.004.455S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L330 MM OD11 MM TIBIAL CANNULATED STERILE LIGHT GREEN SUP-04.004.546S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L375 MM OD12 MM TIBIA CANNULATED FLUTED BARREL STERILE LIGHT GREEN SUP-04.004.655S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EXPERT TITANIUM FULL THREAD L18 MM OD4 MM ODSEC8 MM TIBIA 2 LEAD THREAD LOCKING SELF TAPPING BLUNT TIP T25 STARDRIVE RECESS STERILE BLUE INTRAMEDULLARY NAIL SUP-04.005.408S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L20 MM OD4 MM ODSEC3.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE BLUE INTRAMEDULLARY NAIL SUP-04.005.410S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L22 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.412S CDM 270010022 LOCAL 0270 RC outpatient 587.73 587.73 587.73 74 434.92 percent of total billed charges 587.73 93 476.06 percent of total billed charges 587.73 587.73 other OPPS APC 587.73 587.73 other OPPS APC 587.73 27.63 162.39 percent of total billed charges 587.73 587.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD T25 L24 MM OD4 MM ODSEC3.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE BLUE EXPERT INTRAMEDULLARY NAIL SUP-04.005.414S CDM 270010022 LOCAL 0270 RC outpatient 587.73 587.73 587.73 74 434.92 percent of total billed charges 587.73 93 476.06 percent of total billed charges 587.73 587.73 other OPPS APC 587.73 587.73 other OPPS APC 587.73 27.63 162.39 percent of total billed charges 587.73 587.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L26 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.416S CDM 270010022 LOCAL 0270 RC outpatient 587.73 587.73 587.73 74 434.92 percent of total billed charges 587.73 93 476.06 percent of total billed charges 587.73 587.73 other OPPS APC 587.73 587.73 other OPPS APC 587.73 27.63 162.39 percent of total billed charges 587.73 587.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L28 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.418S CDM 270010022 LOCAL 0270 RC outpatient 587.73 587.73 587.73 74 434.92 percent of total billed charges 587.73 93 476.06 percent of total billed charges 587.73 587.73 other OPPS APC 587.73 587.73 other OPPS APC 587.73 27.63 162.39 percent of total billed charges 587.73 587.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L30 MM OD4 MM ODSEC3.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE BLUE INTRAMEDULLARY NAIL SUP-04.005.420S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L32 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.422S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L34 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.424S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD T25 36MM 4MM BLUE TITANIUM STERILE SELF TAP LOCK BLUNT TIP STARDRIVE INTRAMEDULLARY NAIL SUP-04.005.426S CDM 270010022 LOCAL 0270 RC outpatient 587.73 587.73 587.73 74 434.92 percent of total billed charges 587.73 93 476.06 percent of total billed charges 587.73 587.73 other OPPS APC 587.73 587.73 other OPPS APC 587.73 27.63 162.39 percent of total billed charges 587.73 587.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L38 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.428S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L40 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.430S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L42 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.432S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L44 MM OD4 MM ODSEC3.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE BLUE INTRAMEDULLARY NAIL SUP-04.005.434S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L46 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.436S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L48 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.438S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L50 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.440S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L52 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.442S CDM 270010022 LOCAL 0270 RC outpatient 587.73 587.73 587.73 74 434.92 percent of total billed charges 587.73 93 476.06 percent of total billed charges 587.73 587.73 other OPPS APC 587.73 587.73 other OPPS APC 587.73 27.63 162.39 percent of total billed charges 587.73 587.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L54 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.444S CDM 270010022 LOCAL 0270 RC outpatient 587.73 587.73 587.73 74 434.92 percent of total billed charges 587.73 93 476.06 percent of total billed charges 587.73 587.73 other OPPS APC 587.73 587.73 other OPPS APC 587.73 27.63 162.39 percent of total billed charges 587.73 587.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L56 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.446S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L58 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.448S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L60 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.450S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L62 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.452S CDM 270010022 LOCAL 0270 RC outpatient 587.73 587.73 587.73 74 434.92 percent of total billed charges 587.73 93 476.06 percent of total billed charges 587.73 587.73 other OPPS APC 587.73 587.73 other OPPS APC 587.73 27.63 162.39 percent of total billed charges 587.73 587.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L64 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.454S CDM 0270 RC outpatient 587.73 587.73 587.73 74 434.92 percent of total billed charges 587.73 93 476.06 percent of total billed charges 587.73 587.73 other OPPS APC 587.73 587.73 other OPPS APC 587.73 27.63 162.39 percent of total billed charges 587.73 587.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L66 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.456S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L68 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.458S CDM 270010022 LOCAL 0270 RC outpatient 587.73 587.73 587.73 74 434.92 percent of total billed charges 587.73 93 476.06 percent of total billed charges 587.73 587.73 other OPPS APC 587.73 587.73 other OPPS APC 587.73 27.63 162.39 percent of total billed charges 587.73 587.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L70 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.460S CDM 270010022 LOCAL 0270 RC outpatient 587.73 587.73 587.73 74 434.92 percent of total billed charges 587.73 93 476.06 percent of total billed charges 587.73 587.73 other OPPS APC 587.73 587.73 other OPPS APC 587.73 27.63 162.39 percent of total billed charges 587.73 587.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L72 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.462S CDM 270010022 LOCAL 0270 RC outpatient 587.73 587.73 587.73 74 434.92 percent of total billed charges 587.73 93 476.06 percent of total billed charges 587.73 587.73 other OPPS APC 587.73 587.73 other OPPS APC 587.73 27.63 162.39 percent of total billed charges 587.73 587.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L74 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.464S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L78 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.468S CDM 270010022 LOCAL 0270 RC outpatient 587.73 587.73 587.73 74 434.92 percent of total billed charges 587.73 93 476.06 percent of total billed charges 587.73 587.73 other OPPS APC 587.73 587.73 other OPPS APC 587.73 27.63 162.39 percent of total billed charges 587.73 587.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L80 MM OD4 MM ODSEC3.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.470S CDM 270010022 LOCAL 0270 RC outpatient 587.73 587.73 587.73 74 434.92 percent of total billed charges 587.73 93 476.06 percent of total billed charges 587.73 587.73 other OPPS APC 587.73 587.73 other OPPS APC 587.73 27.63 162.39 percent of total billed charges 587.73 587.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L26 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.516S CDM 270010022 LOCAL 0270 RC outpatient 1213.29 1213.29 1213.29 74 897.83 percent of total billed charges 1213.29 93 982.76 percent of total billed charges 1213.29 1213.29 other OPPS APC 1213.29 1213.29 other OPPS APC 1213.29 27.63 335.23 percent of total billed charges 1213.29 1213.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD T25 28MM 5MM LIGHT GREEN TITANIUM STERILE SELF TAP LOCK BLUNT TIP STARDRIVE INTRAMEDULLARY NAIL SUP-04.005.518S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD T25 30MM 5MM LIGHT GREEN TITANIUM STERILE SELF TAP LOCK BLUNT TIP STARDRIVE INTRAMEDULLARY NAIL SUP-04.005.520S CDM 270010022 LOCAL 0270 RC outpatient 1213.29 1213.29 1213.29 74 897.83 percent of total billed charges 1213.29 93 982.76 percent of total billed charges 1213.29 1213.29 other OPPS APC 1213.29 1213.29 other OPPS APC 1213.29 27.63 335.23 percent of total billed charges 1213.29 1213.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L32 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.522S CDM 270010022 LOCAL 0270 RC outpatient 1213.29 1213.29 1213.29 74 897.83 percent of total billed charges 1213.29 93 982.76 percent of total billed charges 1213.29 1213.29 other OPPS APC 1213.29 1213.29 other OPPS APC 1213.29 27.63 335.23 percent of total billed charges 1213.29 1213.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L34 MM OD5 MM ODSEC4.3 MM TIBIAL STARDRIVE BLUNT TIP SELF TAP LOCK LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.524 CDM 270010022 LOCAL 0270 RC outpatient 372.06 372.06 372.06 74 275.32 percent of total billed charges 372.06 93 301.37 percent of total billed charges 372.06 372.06 other OPPS APC 372.06 372.06 other OPPS APC 372.06 27.63 102.8 percent of total billed charges 372.06 372.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L34 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.524S CDM 270010022 LOCAL 0270 RC outpatient 1213.29 1213.29 1213.29 74 897.83 percent of total billed charges 1213.29 93 982.76 percent of total billed charges 1213.29 1213.29 other OPPS APC 1213.29 1213.29 other OPPS APC 1213.29 27.63 335.23 percent of total billed charges 1213.29 1213.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L36 MM OD5 MM ODSEC4.3 MM TIBIAL STARDRIVE BLUNT TIP SELF TAP LOCK LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.526 CDM 270010022 LOCAL 0270 RC outpatient 372.06 372.06 372.06 74 275.32 percent of total billed charges 372.06 93 301.37 percent of total billed charges 372.06 372.06 other OPPS APC 372.06 372.06 other OPPS APC 372.06 27.63 102.8 percent of total billed charges 372.06 372.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L36 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.526S CDM 270010022 LOCAL 0270 RC outpatient 1213.29 1213.29 1213.29 74 897.83 percent of total billed charges 1213.29 93 982.76 percent of total billed charges 1213.29 1213.29 other OPPS APC 1213.29 1213.29 other OPPS APC 1213.29 27.63 335.23 percent of total billed charges 1213.29 1213.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L38 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.528S CDM 270010022 LOCAL 0270 RC outpatient 1213.29 1213.29 1213.29 74 897.83 percent of total billed charges 1213.29 93 982.76 percent of total billed charges 1213.29 1213.29 other OPPS APC 1213.29 1213.29 other OPPS APC 1213.29 27.63 335.23 percent of total billed charges 1213.29 1213.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L40 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.530S CDM 270010022 LOCAL 0270 RC outpatient 1213.29 1213.29 1213.29 74 897.83 percent of total billed charges 1213.29 93 982.76 percent of total billed charges 1213.29 1213.29 other OPPS APC 1213.29 1213.29 other OPPS APC 1213.29 27.63 335.23 percent of total billed charges 1213.29 1213.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L42 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.532S CDM 270010022 LOCAL 0270 RC outpatient 1213.29 1213.29 1213.29 74 897.83 percent of total billed charges 1213.29 93 982.76 percent of total billed charges 1213.29 1213.29 other OPPS APC 1213.29 1213.29 other OPPS APC 1213.29 27.63 335.23 percent of total billed charges 1213.29 1213.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L44 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.534S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L46 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.536S CDM 270010022 LOCAL 0270 RC outpatient 1213.29 1213.29 1213.29 74 897.83 percent of total billed charges 1213.29 93 982.76 percent of total billed charges 1213.29 1213.29 other OPPS APC 1213.29 1213.29 other OPPS APC 1213.29 27.63 335.23 percent of total billed charges 1213.29 1213.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L48 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.538S CDM 270010022 LOCAL 0270 RC outpatient 1213.29 1213.29 1213.29 74 897.83 percent of total billed charges 1213.29 93 982.76 percent of total billed charges 1213.29 1213.29 other OPPS APC 1213.29 1213.29 other OPPS APC 1213.29 27.63 335.23 percent of total billed charges 1213.29 1213.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L50 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.540S CDM 270010022 LOCAL 0270 RC outpatient 1213.29 1213.29 1213.29 74 897.83 percent of total billed charges 1213.29 93 982.76 percent of total billed charges 1213.29 1213.29 other OPPS APC 1213.29 1213.29 other OPPS APC 1213.29 27.63 335.23 percent of total billed charges 1213.29 1213.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L52 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.542S CDM 270010022 LOCAL 0270 RC outpatient 1213.29 1213.29 1213.29 74 897.83 percent of total billed charges 1213.29 93 982.76 percent of total billed charges 1213.29 1213.29 other OPPS APC 1213.29 1213.29 other OPPS APC 1213.29 27.63 335.23 percent of total billed charges 1213.29 1213.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L54 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.544S CDM 270010022 LOCAL 0270 RC outpatient 1213.29 1213.29 1213.29 74 897.83 percent of total billed charges 1213.29 93 982.76 percent of total billed charges 1213.29 1213.29 other OPPS APC 1213.29 1213.29 other OPPS APC 1213.29 27.63 335.23 percent of total billed charges 1213.29 1213.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L56 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.546S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L58 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.548S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L60 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.550S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L62 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.552S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L64 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.554S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L66 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.556S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L68 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.558S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L70 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.560S CDM 270010022 LOCAL 0270 RC outpatient 1213.29 1213.29 1213.29 74 897.83 percent of total billed charges 1213.29 93 982.76 percent of total billed charges 1213.29 1213.29 other OPPS APC 1213.29 1213.29 other OPPS APC 1213.29 27.63 335.23 percent of total billed charges 1213.29 1213.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L72 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.562S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L74 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.564S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L76 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.566S CDM 270010022 LOCAL 0270 RC outpatient 1213.29 1213.29 1213.29 74 897.83 percent of total billed charges 1213.29 93 982.76 percent of total billed charges 1213.29 1213.29 other OPPS APC 1213.29 1213.29 other OPPS APC 1213.29 27.63 335.23 percent of total billed charges 1213.29 1213.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM T25 FULL THREAD L78 MM OD5 MM ODSEC4.3 MM TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE LIGHT GREEN INTRAMEDULLARY NAIL SUP-04.005.568S CDM 270010022 LOCAL 0270 RC outpatient 587.73 587.73 587.73 74 434.92 percent of total billed charges 587.73 93 476.06 percent of total billed charges 587.73 587.73 other OPPS APC 587.73 587.73 other OPPS APC 587.73 27.63 162.39 percent of total billed charges 587.73 587.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L80 MM OD5 MM ODSEC4.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.570S CDM 270010022 LOCAL 0270 RC outpatient 480.87 480.87 480.87 74 355.84 percent of total billed charges 480.87 93 389.5 percent of total billed charges 480.87 480.87 other OPPS APC 480.87 480.87 other OPPS APC 480.87 27.63 132.86 percent of total billed charges 480.87 480.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L85 MM OD5 MM ODSEC4.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.575S CDM 270010022 LOCAL 0270 RC outpatient 1213.29 1213.29 1213.29 74 897.83 percent of total billed charges 1213.29 93 982.76 percent of total billed charges 1213.29 1213.29 other OPPS APC 1213.29 1213.29 other OPPS APC 1213.29 27.63 335.23 percent of total billed charges 1213.29 1213.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L95 MM OD5 MM ODSEC4.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.585S CDM 270010022 LOCAL 0270 RC outpatient 587.73 587.73 587.73 74 434.92 percent of total billed charges 587.73 93 476.06 percent of total billed charges 587.73 587.73 other OPPS APC 587.73 587.73 other OPPS APC 587.73 27.63 162.39 percent of total billed charges 587.73 587.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L100 MM OD5 MM ODSEC4.3 MM HUMERUS TIBIAL LOCK SELF TAP BLUNT TIP STARDRIVE STERILE INTRAMEDULLARY NAIL SUP-04.005.590S CDM 270010022 LOCAL 0270 RC outpatient 587.73 587.73 587.73 74 434.92 percent of total billed charges 587.73 93 476.06 percent of total billed charges 587.73 587.73 other OPPS APC 587.73 587.73 other OPPS APC 587.73 27.63 162.39 percent of total billed charges 587.73 587.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP ORTHOPEDIC TITANIUM 0 MM T40 SELF RETAINING STARDRIVE SPIRAL BLADE LOCK STERILE GOLD RETROGRADE FEMORAL NAIL-EX SUP-04.013.000S CDM 270010022 LOCAL 0270 RC outpatient 646.36 646.36 646.36 74 478.31 percent of total billed charges 646.36 93 523.55 percent of total billed charges 646.36 646.36 other OPPS APC 646.36 646.36 other OPPS APC 646.36 27.63 178.59 percent of total billed charges 646.36 646.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL EXPERT TITANIUM SPIRAL L60 MM OD12.5 MM FEMORAL CANNULATED FRONT CUT END RETROGRADE STERILE GOLD SUP-04.013.044S CDM 270010022 LOCAL 0270 RC outpatient 1560.13 1560.13 1560.13 74 1154.5 percent of total billed charges 1560.13 93 1263.71 percent of total billed charges 1560.13 1560.13 other OPPS APC 1560.13 1560.13 other OPPS APC 1560.13 27.63 431.06 percent of total billed charges 1560.13 1560.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 10 X 160MM SUP-04.013.412S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 10 X 200MM SUP-04.013.420S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 10 X 280MM SUP-04.013.428S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 10 X 280MM SUP-04.013.436S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L300 MM OD10 MM FEMUR CANNULATED ROUND BARREL RETROGRADE/ANTEGRADE STERILE GREEN SUP-04.013.440S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL ROUND BENT L320 MM OD10 MM FEMORAL CANNULATED RETROGRADE ANTEGRADE STERILE LIGHT GREEN SUP-04.013.444S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L34 CM OD10 MM FEMUR CANNULATED RETROGRADE ANTEGRADE STERILE SUP-04.013.448S CDM 270010022 LOCAL 0270 RC outpatient 3813.03 3813.03 3813.03 74 2821.64 percent of total billed charges 3813.03 93 3088.55 percent of total billed charges 3813.03 3813.03 other OPPS APC 3813.03 3813.03 other OPPS APC 3813.03 27.63 1053.54 percent of total billed charges 3813.03 3813.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L360 MM OD10 MM FEMUR CANNULATED ROUND BARREL RETROGRADE/ANTEGRADE STERILE GREEN SUP-04.013.452S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL ROUND BENT L380 MM OD10 MM FEMORAL CANNULATED RETROGRADE ANTEGRADE STERILE LIGHT GREEN SUP-04.013.456S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L400 MM OD10 MM FEMUR CANNULATED ROUND BARREL RETROGRADE/ANTEGRADE STERILE GREEN SUP-04.013.460S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL ROUND L420 MM OD10 MM FEMUR CANNULATED RETROGRADE ANTEGRADE STERILE GREEN SUP-04.013.464S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 11 X 160MM SUP-04.013.512S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 11 X 200MM SUP-04.013.520S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 11 X 240MM SUP-04.013.528S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L28 CM OD11 MM FEMUR CANNULATED RETROGRADE ANTEGRADE STERILE GREEN SUP-04.013.536S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 11 X 300MM SUP-04.013.540S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 11 X 320MM SUP-04.013.544S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 11 X 340MM SUP-04.013.548S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L360 MM OD11 MM FEMUR CANNULATED ROUND BARREL RETROGRADE/ANTEGRADE STERILE GREEN SUP-04.013.552S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 11 X 380MM SUP-04.013.556S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L400 MM OD11 MM FEMUR CANNULATED ROUND BARREL RETROGRADE/ANTEGRADE STERILE GREEN SUP-04.013.560S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L42 CM OD11 MM FEMUR CANNULATED RETROGRADE ANTEGRADE STERILE SUP-04.013.564S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 12 X 160MM SUP-04.013.612S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 12 X 200MM SUP-04.013.620S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 12 X 240MM SUP-04.013.628S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 12 X 280MM SUP-04.013.636S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 12 X 300MM SUP-04.013.640S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 12 X 320MM SUP-04.013.644S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L340 MM OD12 MM FEMUR CANNULATED RETROGRADE ANTEGRADE STERILE SUP-04.013.648S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM UNIVERSAL L36 CM OD12 MM FEMUR CANNULATED RETROGRADE ANTEGRADE STERILE SUP-04.013.652S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L420 MM OD12 MM FEMUR CANNULATED ROUND BARREL RETROGRADE/ANTEGRADE STERILE GREEN SUP-04.013.664S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L44 CM OD12 MM FEMUR CANNULATED RETROGRADE ANTEGRADE STERILE SUP-04.013.668S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L46 CM OD12 MM FEMUR CANNULATED RETROGRADE ANTEGRADE STERILE SUP-04.013.672S CDM 270010022 LOCAL 0270 RC outpatient 4803.37 4803.37 4803.37 74 3554.49 percent of total billed charges 4803.37 93 3890.73 percent of total billed charges 4803.37 4803.37 other OPPS APC 4803.37 4803.37 other OPPS APC 4803.37 27.63 1327.17 percent of total billed charges 4803.37 4803.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L48 CM OD12 MM FEMUR CANNULATED RETROGRADE ANTEGRADE STERILE SUP-04.013.676S CDM 270010022 LOCAL 0270 RC outpatient 4964.96 4964.96 4964.96 74 3674.07 percent of total billed charges 4964.96 93 4021.62 percent of total billed charges 4964.96 4964.96 other OPPS APC 4964.96 4964.96 other OPPS APC 4964.96 27.63 1371.82 percent of total billed charges 4964.96 4964.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 13 X 160MM SUP-04.013.712S CDM 270010022 LOCAL 0270 RC outpatient 4803.37 4803.37 4803.37 74 3554.49 percent of total billed charges 4803.37 93 3890.73 percent of total billed charges 4803.37 4803.37 other OPPS APC 4803.37 4803.37 other OPPS APC 4803.37 27.63 1327.17 percent of total billed charges 4803.37 4803.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L200 CM OD13 MM FEMUR CANNULATED RETROGRADE ANTEGRADE STERILE GREEN SUP-04.013.720S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 13 X 240MM SUP-04.013.728S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L26 CM OD13 MM FEMUR CANNULATED RETROGRADE STERILE SUP-04.013.732S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 13 X 280MM SUP-04.013.736S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 13 X 300MM SUP-04.013.740S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL FLUTE BENT L320 MM OD13 MM FEMORAL CANNULATED RETROGRADE ANTEGRADE STERILE LIGHT GREEN SUP-04.013.744S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L340 MM OD13 MM FEMUR CANNULATED RETROGRADE ANTEGRADE STERILE GREEN SUP-04.013.748S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 13 X 360MM SUP-04.013.752S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 13 X 380MM SUP-04.013.756S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 13 X 400MM SUP-04.013.760S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 13 X 420MM SUP-04.013.764S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L44 CM OD13 MM FEMORAL CANNULATED RETROGRADE ANTEGRADE STERILE GREEN SUP-04.013.768S CDM 270010022 LOCAL 0270 RC outpatient 4660.37 4660.37 4660.37 74 3448.67 percent of total billed charges 4660.37 93 3774.9 percent of total billed charges 4660.37 4660.37 other OPPS APC 4660.37 4660.37 other OPPS APC 4660.37 27.63 1287.66 percent of total billed charges 4660.37 4660.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L46 CM OD13 MM FEMUR CANNULATED RETROGRADE ANTEGRADE STERILE SUP-04.013.772S CDM 270010022 LOCAL 0270 RC outpatient 4803.37 4803.37 4803.37 74 3554.49 percent of total billed charges 4803.37 93 3890.73 percent of total billed charges 4803.37 4803.37 other OPPS APC 4803.37 4803.37 other OPPS APC 4803.37 27.63 1327.17 percent of total billed charges 4803.37 4803.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE FEMORAL CANNULATED RETRO ANTEGRADE STERILE TITANIUM 13 X 480MM SUP-04.013.776S CDM 270010022 LOCAL 0270 RC outpatient 4964.96 4964.96 4964.96 74 3674.07 percent of total billed charges 4964.96 93 4021.62 percent of total billed charges 4964.96 4964.96 other OPPS APC 4964.96 4964.96 other OPPS APC 4964.96 27.63 1371.82 percent of total billed charges 4964.96 4964.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP END FOR ADOLESCENT FEMORAL NAIL 5MM SUP-04.031.001S CDM 270010022 LOCAL 0270 RC outpatient 560.56 560.56 560.56 74 414.81 percent of total billed charges 560.56 93 454.05 percent of total billed charges 560.56 560.56 other OPPS APC 560.56 560.56 other OPPS APC 560.56 27.63 154.88 percent of total billed charges 560.56 560.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP END FOR ADOLESCENT FEMORAL NAIL 10MM SUP-04.031.002S CDM 270010022 LOCAL 0270 RC outpatient 560.56 560.56 560.56 74 414.81 percent of total billed charges 560.56 93 454.05 percent of total billed charges 560.56 560.56 other OPPS APC 560.56 560.56 other OPPS APC 560.56 27.63 154.88 percent of total billed charges 560.56 560.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0MM TI RECON 75MM SUP-04.031.025 CDM 270010022 LOCAL 0270 RC outpatient 403.52 403.52 403.52 74 298.6 percent of total billed charges 403.52 93 326.85 percent of total billed charges 403.52 403.52 other OPPS APC 403.52 403.52 other OPPS APC 403.52 27.63 111.49 percent of total billed charges 403.52 403.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL RIGHT 8.2 MM X 280MM SUP-04.031.928S CDM 270010022 LOCAL 0270 RC outpatient 4039.75 4039.75 4039.75 74 2989.42 percent of total billed charges 4039.75 93 3272.2 percent of total billed charges 4039.75 4039.75 other OPPS APC 4039.75 4039.75 other OPPS APC 4039.75 27.63 1116.18 percent of total billed charges 4039.75 4039.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL LEFT 8.2MM X 280MM SUP-04.031.929S CDM 270010022 LOCAL 0270 RC outpatient 4039.75 4039.75 4039.75 74 2989.42 percent of total billed charges 4039.75 93 3272.2 percent of total billed charges 4039.75 4039.75 other OPPS APC 4039.75 4039.75 other OPPS APC 4039.75 27.63 1116.18 percent of total billed charges 4039.75 4039.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL RIGHT 8.2 MM X 300MM SUP-04.031.930S CDM 270010022 LOCAL 0270 RC outpatient 4039.75 4039.75 4039.75 74 2989.42 percent of total billed charges 4039.75 93 3272.2 percent of total billed charges 4039.75 4039.75 other OPPS APC 4039.75 4039.75 other OPPS APC 4039.75 27.63 1116.18 percent of total billed charges 4039.75 4039.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL LEFT 8.2MM X 300MM SUP-04.031.931S CDM 270010022 LOCAL 0270 RC outpatient 4039.75 4039.75 4039.75 74 2989.42 percent of total billed charges 4039.75 93 3272.2 percent of total billed charges 4039.75 4039.75 other OPPS APC 4039.75 4039.75 other OPPS APC 4039.75 27.63 1116.18 percent of total billed charges 4039.75 4039.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL RIGHT 8.2 MM X 320MM SUP-04.031.932S CDM 270010022 LOCAL 0270 RC outpatient 4039.75 4039.75 4039.75 74 2989.42 percent of total billed charges 4039.75 93 3272.2 percent of total billed charges 4039.75 4039.75 other OPPS APC 4039.75 4039.75 other OPPS APC 4039.75 27.63 1116.18 percent of total billed charges 4039.75 4039.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL LEFT 8.2MM X 320MM SUP-04.031.933S CDM 270010022 LOCAL 0270 RC outpatient 4039.75 4039.75 4039.75 74 2989.42 percent of total billed charges 4039.75 93 3272.2 percent of total billed charges 4039.75 4039.75 other OPPS APC 4039.75 4039.75 other OPPS APC 4039.75 27.63 1116.18 percent of total billed charges 4039.75 4039.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL RIGHT 8.2 MM X 340MM SUP-04.031.934S CDM 270010022 LOCAL 0270 RC outpatient 4039.75 4039.75 4039.75 74 2989.42 percent of total billed charges 4039.75 93 3272.2 percent of total billed charges 4039.75 4039.75 other OPPS APC 4039.75 4039.75 other OPPS APC 4039.75 27.63 1116.18 percent of total billed charges 4039.75 4039.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL LEFT 8.2MM X 340MM SUP-04.031.935S CDM 270010022 LOCAL 0270 RC outpatient 3562.34 3562.34 3562.34 74 2636.13 percent of total billed charges 3562.34 93 2885.5 percent of total billed charges 3562.34 3562.34 other OPPS APC 3562.34 3562.34 other OPPS APC 3562.34 27.63 984.27 percent of total billed charges 3562.34 3562.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL RIGHT 8.2 MM X 360MM SUP-04.031.936S CDM 270010022 LOCAL 0270 RC outpatient 3562.34 3562.34 3562.34 74 2636.13 percent of total billed charges 3562.34 93 2885.5 percent of total billed charges 3562.34 3562.34 other OPPS APC 3562.34 3562.34 other OPPS APC 3562.34 27.63 984.27 percent of total billed charges 3562.34 3562.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL LEFT 8.2MM X 360MM SUP-04.031.937S CDM 270010022 LOCAL 0270 RC outpatient 4039.75 4039.75 4039.75 74 2989.42 percent of total billed charges 4039.75 93 3272.2 percent of total billed charges 4039.75 4039.75 other OPPS APC 4039.75 4039.75 other OPPS APC 4039.75 27.63 1116.18 percent of total billed charges 4039.75 4039.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL RIGHT 8.2 MM X 380MM SUP-04.031.938S CDM 270010022 LOCAL 0270 RC outpatient 3562.34 3562.34 3562.34 74 2636.13 percent of total billed charges 3562.34 93 2885.5 percent of total billed charges 3562.34 3562.34 other OPPS APC 3562.34 3562.34 other OPPS APC 3562.34 27.63 984.27 percent of total billed charges 3562.34 3562.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL LEFT 8.2MM X 380MM SUP-04.031.939S CDM 270010022 LOCAL 0270 RC outpatient 4039.75 4039.75 4039.75 74 2989.42 percent of total billed charges 4039.75 93 3272.2 percent of total billed charges 4039.75 4039.75 other OPPS APC 4039.75 4039.75 other OPPS APC 4039.75 27.63 1116.18 percent of total billed charges 4039.75 4039.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL RIGHT 9MM X 280MM SUP-04.031.948S CDM 270010022 LOCAL 0270 RC outpatient 4039.75 4039.75 4039.75 74 2989.42 percent of total billed charges 4039.75 93 3272.2 percent of total billed charges 4039.75 4039.75 other OPPS APC 4039.75 4039.75 other OPPS APC 4039.75 27.63 1116.18 percent of total billed charges 4039.75 4039.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL LEFT 9MM X 280MM SUP-04.031.949S CDM 270010022 LOCAL 0270 RC outpatient 4039.75 4039.75 4039.75 74 2989.42 percent of total billed charges 4039.75 93 3272.2 percent of total billed charges 4039.75 4039.75 other OPPS APC 4039.75 4039.75 other OPPS APC 4039.75 27.63 1116.18 percent of total billed charges 4039.75 4039.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL RIGHT 9MM X 300MM SUP-04.031.950S CDM 270010022 LOCAL 0270 RC outpatient 4039.75 4039.75 4039.75 74 2989.42 percent of total billed charges 4039.75 93 3272.2 percent of total billed charges 4039.75 4039.75 other OPPS APC 4039.75 4039.75 other OPPS APC 4039.75 27.63 1116.18 percent of total billed charges 4039.75 4039.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL LEFT 9MM X 300MM SUP-04.031.951S CDM 270010022 LOCAL 0270 RC outpatient 4039.75 4039.75 4039.75 74 2989.42 percent of total billed charges 4039.75 93 3272.2 percent of total billed charges 4039.75 4039.75 other OPPS APC 4039.75 4039.75 other OPPS APC 4039.75 27.63 1116.18 percent of total billed charges 4039.75 4039.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL RIGHT 9MM X 320MM SUP-04.031.952S CDM 270010022 LOCAL 0270 RC outpatient 4039.75 4039.75 4039.75 74 2989.42 percent of total billed charges 4039.75 93 3272.2 percent of total billed charges 4039.75 4039.75 other OPPS APC 4039.75 4039.75 other OPPS APC 4039.75 27.63 1116.18 percent of total billed charges 4039.75 4039.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL LEFT 9MM X 320MM SUP-04.031.953S CDM 270010022 LOCAL 0270 RC outpatient 4039.75 4039.75 4039.75 74 2989.42 percent of total billed charges 4039.75 93 3272.2 percent of total billed charges 4039.75 4039.75 other OPPS APC 4039.75 4039.75 other OPPS APC 4039.75 27.63 1116.18 percent of total billed charges 4039.75 4039.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL LEFT 9MM X 340MM SUP-04.031.955S CDM 270010022 LOCAL 0270 RC outpatient 4039.75 4039.75 4039.75 74 2989.42 percent of total billed charges 4039.75 93 3272.2 percent of total billed charges 4039.75 4039.75 other OPPS APC 4039.75 4039.75 other OPPS APC 4039.75 27.63 1116.18 percent of total billed charges 4039.75 4039.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL RIGHT 9MM X 360MM SUP-04.031.956S CDM 270010022 LOCAL 0270 RC outpatient 4039.75 4039.75 4039.75 74 2989.42 percent of total billed charges 4039.75 93 3272.2 percent of total billed charges 4039.75 4039.75 other OPPS APC 4039.75 4039.75 other OPPS APC 4039.75 27.63 1116.18 percent of total billed charges 4039.75 4039.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL LEFT 9MM X 360MM SUP-04.031.957S CDM 270010022 LOCAL 0270 RC outpatient 4039.75 4039.75 4039.75 74 2989.42 percent of total billed charges 4039.75 93 3272.2 percent of total billed charges 4039.75 4039.75 other OPPS APC 4039.75 4039.75 other OPPS APC 4039.75 27.63 1116.18 percent of total billed charges 4039.75 4039.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL RIGHT 9MM X 380MM SUP-04.031.958S CDM 270010022 LOCAL 0270 RC outpatient 4039.75 4039.75 4039.75 74 2989.42 percent of total billed charges 4039.75 93 3272.2 percent of total billed charges 4039.75 4039.75 other OPPS APC 4039.75 4039.75 other OPPS APC 4039.75 27.63 1116.18 percent of total billed charges 4039.75 4039.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL LEFT 9MM X 380MM SUP-04.031.959S CDM 270010022 LOCAL 0270 RC outpatient 3562.34 3562.34 3562.34 74 2636.13 percent of total billed charges 3562.34 93 2885.5 percent of total billed charges 3562.34 3562.34 other OPPS APC 3562.34 3562.34 other OPPS APC 3562.34 27.63 984.27 percent of total billed charges 3562.34 3562.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES SET FOR TROCK NAIL 130 DEG SUP-04.032.001S CDM 270010022 LOCAL 0270 RC outpatient 460.46 460.46 460.46 74 340.74 percent of total billed charges 460.46 93 372.97 percent of total billed charges 460.46 460.46 other OPPS APC 460.46 460.46 other OPPS APC 460.46 27.63 127.23 percent of total billed charges 460.46 460.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM THREAD L70 MM X W130 MM OD11 MM PROXIMAL TROCHANTER FEMUR FIXATION SELFTAPPING INVERSE ANGLE STERILE GOLD INTRAMEDULLARY NAIL SUP-04.032.070S CDM 270010022 LOCAL 0270 RC outpatient 1744.6 1744.6 1744.6 74 1291 percent of total billed charges 1744.6 93 1413.13 percent of total billed charges 1744.6 1744.6 other OPPS APC 1744.6 1744.6 other OPPS APC 1744.6 27.63 482.03 percent of total billed charges 1744.6 1744.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L75 MM OD11 MM FEMUR TROCHANTER PROXIMAL FIXATION STERILE INTRAMEDULLARY NAIL SYSTEM SUP-04.032.075S CDM 270010022 LOCAL 0270 RC outpatient 1744.6 1744.6 1744.6 74 1291 percent of total billed charges 1744.6 93 1413.13 percent of total billed charges 1744.6 1744.6 other OPPS APC 1744.6 1744.6 other OPPS APC 1744.6 27.63 482.03 percent of total billed charges 1744.6 1744.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L80 MM OD11 MM FEMUR TROCHANTER PROXIMAL FIXATION STERILE INTRAMEDULLARY NAIL SYSTEM SUP-04.032.080S CDM 270010022 LOCAL 0270 RC outpatient 1744.6 1744.6 1744.6 74 1291 percent of total billed charges 1744.6 93 1413.13 percent of total billed charges 1744.6 1744.6 other OPPS APC 1744.6 1744.6 other OPPS APC 1744.6 27.63 482.03 percent of total billed charges 1744.6 1744.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L85 MM OD11 MM FEMUR TROCHANTERIC PROXIMAL STERILE INTRAMEDULLARY NAIL FIXATION SUP-04.032.085S CDM 270010022 LOCAL 0270 RC outpatient 1744.6 1744.6 1744.6 74 1291 percent of total billed charges 1744.6 93 1413.13 percent of total billed charges 1744.6 1744.6 other OPPS APC 1744.6 1744.6 other OPPS APC 1744.6 27.63 482.03 percent of total billed charges 1744.6 1744.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L90 MM OD11 MM FEMUR TROCHANTER PROXIMAL FIXATION STERILE INTRAMEDULLARY NAIL SYSTEM SUP-04.032.090S CDM 270010022 LOCAL 0270 RC outpatient 1744.6 1744.6 1744.6 74 1291 percent of total billed charges 1744.6 93 1413.13 percent of total billed charges 1744.6 1744.6 other OPPS APC 1744.6 1744.6 other OPPS APC 1744.6 27.63 482.03 percent of total billed charges 1744.6 1744.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L95 MM OD11 MM FEMUR TROCHANTERIC PROXIMAL STERILE INTRAMEDULLARY NAIL FIXATION SUP-04.032.095S CDM 270010022 LOCAL 0270 RC outpatient 1744.6 1744.6 1744.6 74 1291 percent of total billed charges 1744.6 93 1413.13 percent of total billed charges 1744.6 1744.6 other OPPS APC 1744.6 1744.6 other OPPS APC 1744.6 27.63 482.03 percent of total billed charges 1744.6 1744.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L100 MM OD11 MM FEMUR TROCHANTERIC PROXIMAL STERILE INTRAMEDULLARY NAIL FIXATION SUP-04.032.100S CDM 270010022 LOCAL 0270 RC outpatient 1744.6 1744.6 1744.6 74 1291 percent of total billed charges 1744.6 93 1413.13 percent of total billed charges 1744.6 1744.6 other OPPS APC 1744.6 1744.6 other OPPS APC 1744.6 27.63 482.03 percent of total billed charges 1744.6 1744.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L105 MM OD11 MM TROCHANTERIC CANNULATED FEMORAL NECK STERILE GOLD FIXATION NAIL SUP-04.032.105S CDM 270010022 LOCAL 0270 RC outpatient 1744.6 1744.6 1744.6 74 1291 percent of total billed charges 1744.6 93 1413.13 percent of total billed charges 1744.6 1744.6 other OPPS APC 1744.6 1744.6 other OPPS APC 1744.6 27.63 482.03 percent of total billed charges 1744.6 1744.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L110 MM OD11 MM FEMUR TROCHANTERIC PROXIMAL STERILE INTRAMEDULLARY NAIL FIXATION SUP-04.032.110S CDM 270010022 LOCAL 0270 RC outpatient 1744.6 1744.6 1744.6 74 1291 percent of total billed charges 1744.6 93 1413.13 percent of total billed charges 1744.6 1744.6 other OPPS APC 1744.6 1744.6 other OPPS APC 1744.6 27.63 482.03 percent of total billed charges 1744.6 1744.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L115 MM OD11 MM FEMUR TROCHANTER PROXIMAL FIXATION STERILE INTRAMEDULLARY NAIL SYSTEM SUP-04.032.115S CDM 270010022 LOCAL 0270 RC outpatient 1744.6 1744.6 1744.6 74 1291 percent of total billed charges 1744.6 93 1413.13 percent of total billed charges 1744.6 1744.6 other OPPS APC 1744.6 1744.6 other OPPS APC 1744.6 27.63 482.03 percent of total billed charges 1744.6 1744.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L120 MM OD11 MM FEMUR TROCHANTER PROXIMAL FIXATION STERILE INTRAMEDULLARY NAIL SYSTEM SUP-04.032.120S CDM 270010022 LOCAL 0270 RC outpatient 1744.6 1744.6 1744.6 74 1291 percent of total billed charges 1744.6 93 1413.13 percent of total billed charges 1744.6 1744.6 other OPPS APC 1744.6 1744.6 other OPPS APC 1744.6 27.63 482.03 percent of total billed charges 1744.6 1744.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L320 MM OD10 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.063S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L340 MM OD10 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.064S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L340 MM OD10 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.065S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L360 MM OD10 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.066S CDM 0270 RC outpatient 4042.48 4042.48 4042.48 74 2991.44 percent of total billed charges 4042.48 93 3274.41 percent of total billed charges 4042.48 4042.48 other OPPS APC 4042.48 4042.48 other OPPS APC 4042.48 27.63 1116.94 percent of total billed charges 4042.48 4042.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L360 MM OD10 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.067S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT TI CANN FEMORAL RECON NAIL 10MM X 380MM RIGHT SUP-04.033.068S CDM 0270 RC outpatient 4042.48 4042.48 4042.48 74 2991.44 percent of total billed charges 4042.48 93 3274.41 percent of total billed charges 4042.48 4042.48 other OPPS APC 4042.48 4042.48 other OPPS APC 4042.48 27.63 1116.94 percent of total billed charges 4042.48 4042.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L380 MM OD10 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.069S CDM 0270 RC outpatient 4042.48 4042.48 4042.48 74 2991.44 percent of total billed charges 4042.48 93 3274.41 percent of total billed charges 4042.48 4042.48 other OPPS APC 4042.48 4042.48 other OPPS APC 4042.48 27.63 1116.94 percent of total billed charges 4042.48 4042.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L400 MM OD10 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.070S CDM 0270 RC outpatient 4042.48 4042.48 4042.48 74 2991.44 percent of total billed charges 4042.48 93 3274.41 percent of total billed charges 4042.48 4042.48 other OPPS APC 4042.48 4042.48 other OPPS APC 4042.48 27.63 1116.94 percent of total billed charges 4042.48 4042.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L400 MM OD10 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.071S CDM 0270 RC outpatient 4042.48 4042.48 4042.48 74 2991.44 percent of total billed charges 4042.48 93 3274.41 percent of total billed charges 4042.48 4042.48 other OPPS APC 4042.48 4042.48 other OPPS APC 4042.48 27.63 1116.94 percent of total billed charges 4042.48 4042.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L420 MM OD10 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.072S CDM 0270 RC outpatient 4042.48 4042.48 4042.48 74 2991.44 percent of total billed charges 4042.48 93 3274.41 percent of total billed charges 4042.48 4042.48 other OPPS APC 4042.48 4042.48 other OPPS APC 4042.48 27.63 1116.94 percent of total billed charges 4042.48 4042.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L420 MM OD10 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.073S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L440 MM OD10 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.074S CDM 0270 RC outpatient 4042.48 4042.48 4042.48 74 2991.44 percent of total billed charges 4042.48 93 3274.41 percent of total billed charges 4042.48 4042.48 other OPPS APC 4042.48 4042.48 other OPPS APC 4042.48 27.63 1116.94 percent of total billed charges 4042.48 4042.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L440 MM OD10 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.075S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L460 MM OD10 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.076S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L460 MM OD10 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.077S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L320 MM OD11 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.162S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L320 MM OD11 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.163S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L340 MM OD11 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.164S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L340 MM OD11 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.165S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L360 MM OD11 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.166S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L360 MM OD11 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.167S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L380 MM OD11 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.168S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L380 MM OD11 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.169S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L400 MM OD11 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.170S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L400 MM OD11 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.171S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L420 MM OD11 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.172S CDM 0270 RC outpatient 4042.48 4042.48 4042.48 74 2991.44 percent of total billed charges 4042.48 93 3274.41 percent of total billed charges 4042.48 4042.48 other OPPS APC 4042.48 4042.48 other OPPS APC 4042.48 27.63 1116.94 percent of total billed charges 4042.48 4042.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L420 MM OD11 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.173S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L440 MM OD11 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.174S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L440 MM OD11 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.175S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L460 MM OD11 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.176S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L460 MM OD11 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.177S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L320 MM OD12 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.262S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L320 MM OD12 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.263S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L340 MM OD12 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION STERILE LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.264S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L340 MM OD12 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.265S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L360 MM OD12 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.266S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L360 MM OD12 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.267S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L380 MM OD12 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.268S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L380 MM OD12 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.269S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L400 MM OD12 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.270S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L400 MM OD12 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.271S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L420 MM OD12 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.272S CDM 0270 RC outpatient 4042.48 4042.48 4042.48 74 2991.44 percent of total billed charges 4042.48 93 3274.41 percent of total billed charges 4042.48 4042.48 other OPPS APC 4042.48 4042.48 other OPPS APC 4042.48 27.63 1116.94 percent of total billed charges 4042.48 4042.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L420 MM OD12 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.273S CDM 0270 RC outpatient 4042.48 4042.48 4042.48 74 2991.44 percent of total billed charges 4042.48 93 3274.41 percent of total billed charges 4042.48 4042.48 other OPPS APC 4042.48 4042.48 other OPPS APC 4042.48 27.63 1116.94 percent of total billed charges 4042.48 4042.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L440 MM OD12 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.274S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L440 MM OD12 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.275S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L460 MM OD12 MM FEMORAL GREATER TROCHANTER RIGHT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.276S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM NIOBIUM ALUMINUM ADULT 140 D L460 MM OD12 MM FEMORAL GREATER TROCHANTER LEFT 8 HOLE CANNULATED RECONSTRUCTION LIGHT GREEN 5/6.5 MM SCREW SUP-04.033.277S CDM 0270 RC outpatient 5272.8 5272.8 5272.8 74 3901.87 percent of total billed charges 5272.8 93 4270.97 percent of total billed charges 5272.8 5272.8 other OPPS APC 5272.8 5272.8 other OPPS APC 5272.8 27.63 1456.87 percent of total billed charges 5272.8 5272.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L255 MM OD8 MM TIBIA CANNULATED PROXIMAL BEND STERILE SUP-04.034.231S CDM 270010022 LOCAL 0270 RC outpatient 4167.02 4167.02 4167.02 74 3083.59 percent of total billed charges 4167.02 93 3375.29 percent of total billed charges 4167.02 4167.02 other OPPS APC 4167.02 4167.02 other OPPS APC 4167.02 27.63 1151.35 percent of total billed charges 4167.02 4167.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L27 CM OD8 MM TIBIA CANNULATED PROXIMAL BEND STERILE DARK BLUE SUP-04.034.234S CDM 270010022 LOCAL 0270 RC outpatient 3485.14 3485.14 3485.14 74 2579 percent of total billed charges 3485.14 93 2822.96 percent of total billed charges 3485.14 3485.14 other OPPS APC 3485.14 3485.14 other OPPS APC 3485.14 27.63 962.94 percent of total billed charges 3485.14 3485.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L285 MM OD8 MM TIBIA CANNULATED PROXIMAL BEND ROUND BARREL STERILE DARK BLUE SUP-04.034.237S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM ROUND L300 MM OD8 MM TIBIA CANNULATED PROXIMAL BEND UNIVERSAL STERILE DARK BLUE 4 MM LOCK SCREW SUP-04.034.240S CDM 270010022 LOCAL 0270 RC outpatient 3370.33 3370.33 3370.33 74 2494.04 percent of total billed charges 3370.33 93 2729.97 percent of total billed charges 3370.33 3370.33 other OPPS APC 3370.33 3370.33 other OPPS APC 3370.33 27.63 931.22 percent of total billed charges 3370.33 3370.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L315 MM OD8 MM TIBIA CANNULATED PROXIMAL BEND ROUND BARREL STERILE DARK BLUE SUP-04.034.243S CDM 270010022 LOCAL 0270 RC outpatient 3370.33 3370.33 3370.33 74 2494.04 percent of total billed charges 3370.33 93 2729.97 percent of total billed charges 3370.33 3370.33 other OPPS APC 3370.33 3370.33 other OPPS APC 3370.33 27.63 931.22 percent of total billed charges 3370.33 3370.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL ROUND L330 MM OD8 MM TIBIAL CANNULATED PROXIMAL BEND STERILE DARK BLUE 4 MM LOCK SCREW SUP-04.034.246S CDM 270010022 LOCAL 0270 RC outpatient 3370.33 3370.33 3370.33 74 2494.04 percent of total billed charges 3370.33 93 2729.97 percent of total billed charges 3370.33 3370.33 other OPPS APC 3370.33 3370.33 other OPPS APC 3370.33 27.63 931.22 percent of total billed charges 3370.33 3370.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL ROUND L345 MM OD8 MM TIBIAL CANNULATED PROXIMAL BEND STERILE DARK BLUE 4 MM LOCK SCREW SUP-04.034.249S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL ROUND BARREL L36 CM OD8 MM TIBIA CANNULATED PROXIMAL BEND STERILE DARK BLUE SUP-04.034.252S CDM 270010022 LOCAL 0270 RC outpatient 3370.33 3370.33 3370.33 74 2494.04 percent of total billed charges 3370.33 93 2729.97 percent of total billed charges 3370.33 3370.33 other OPPS APC 3370.33 3370.33 other OPPS APC 3370.33 27.63 931.22 percent of total billed charges 3370.33 3370.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L375 MM OD8 MM TIBIA CANNULATED PROXIMAL BEND ROUND BARREL STERILE DARK BLUE SUP-04.034.255S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L390 MM OD8 MM TIBIA CANNULATED PROXIMAL BEND ROUND BARREL STERILE DARK BLUE SUP-04.034.258S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE TIBIAL CANNULATED EX STERILE TITANIUM 8 X 405MM SUP-04.034.261S CDM 270010022 LOCAL 0270 RC outpatient 4152.72 4152.72 4152.72 74 3073.01 percent of total billed charges 4152.72 93 3363.7 percent of total billed charges 4152.72 4152.72 other OPPS APC 4152.72 4152.72 other OPPS APC 4152.72 27.63 1147.4 percent of total billed charges 4152.72 4152.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L25.5 CM OD9 MM TIBIA CANNULATED PROXIMAL BEND STERILE SUP-04.034.331S CDM 270010022 LOCAL 0270 RC outpatient 4294.29 4294.29 4294.29 74 3177.77 percent of total billed charges 4294.29 93 3478.37 percent of total billed charges 4294.29 4294.29 other OPPS APC 4294.29 4294.29 other OPPS APC 4294.29 27.63 1186.51 percent of total billed charges 4294.29 4294.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L27 CM OD9 MM TIBIA CANNULATED PROXIMAL BEND STERILE DARK BLUE SUP-04.034.334S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L285 MM OD9 MM TIBIA CANNULATED PROXIMAL BEND ROUND BARREL STERILE DARK BLUE SUP-04.034.337S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT ROUND BARREL 300MM 9MM DARK BLUE TITANIUM STERILE TIBIA CANNULATED UNIVERSAL PROXIMAL BEND SUP-04.034.340S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L315 MM OD9 MM TIBIA CANNULATED PROXIMAL BEND ROUND BARREL STERILE DARK BLUE SUP-04.034.343S CDM 270010022 LOCAL 0270 RC outpatient 3370.33 3370.33 3370.33 74 2494.04 percent of total billed charges 3370.33 93 2729.97 percent of total billed charges 3370.33 3370.33 other OPPS APC 3370.33 3370.33 other OPPS APC 3370.33 27.63 931.22 percent of total billed charges 3370.33 3370.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L330 MM OD9 MM TIBIA CANNULATED PROXIMAL BEND ROUND BARREL STERILE DARK BLUE SUP-04.034.346S CDM 270010022 LOCAL 0270 RC outpatient 3370.33 3370.33 3370.33 74 2494.04 percent of total billed charges 3370.33 93 2729.97 percent of total billed charges 3370.33 3370.33 other OPPS APC 3370.33 3370.33 other OPPS APC 3370.33 27.63 931.22 percent of total billed charges 3370.33 3370.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT ROUND BARREL 345MM 9MM DARK BLUE TITANIUM STERILE TIBIA CANNULATED PROXIMAL BEND UNIVERSAL SUP-04.034.349S CDM 270010022 LOCAL 0270 RC outpatient 3370.33 3370.33 3370.33 74 2494.04 percent of total billed charges 3370.33 93 2729.97 percent of total billed charges 3370.33 3370.33 other OPPS APC 3370.33 3370.33 other OPPS APC 3370.33 27.63 931.22 percent of total billed charges 3370.33 3370.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM UNIVERSAL ROUND L36 CM OD9 MM TIBIA CANNULATED PROXIMAL BEND STERILE DARK BLUE SUP-04.034.352S CDM 270010022 LOCAL 0270 RC outpatient 3370.33 3370.33 3370.33 74 2494.04 percent of total billed charges 3370.33 93 2729.97 percent of total billed charges 3370.33 3370.33 other OPPS APC 3370.33 3370.33 other OPPS APC 3370.33 27.63 931.22 percent of total billed charges 3370.33 3370.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L375 MM OD9 MM TIBIA CANNULATED PROXIMAL BEND ROUND BARREL STERILE DARK BLUE SUP-04.034.355S CDM 270010022 LOCAL 0270 RC outpatient 3370.33 3370.33 3370.33 74 2494.04 percent of total billed charges 3370.33 93 2729.97 percent of total billed charges 3370.33 3370.33 other OPPS APC 3370.33 3370.33 other OPPS APC 3370.33 27.63 931.22 percent of total billed charges 3370.33 3370.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L39 CM OD9 MM TIBIA PROXIMAL BEND CANNULATED STERILE SUP-04.034.358S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL BONE TIBIAL CANNULATED EX STERILE TITANIUM 10X 405MM SUP-04.034.361S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L255 MM OD10 MM TIBIA CANNULATED PROXIMAL BEND ROUND BARREL STERILE LIGHT GREEN SUP-04.034.431S CDM 270010022 LOCAL 0270 RC outpatient 3591.59 3591.59 3591.59 74 2657.78 percent of total billed charges 3591.59 93 2909.19 percent of total billed charges 3591.59 3591.59 other OPPS APC 3591.59 3591.59 other OPPS APC 3591.59 27.63 992.36 percent of total billed charges 3591.59 3591.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L270 MM OD10 MM TIBIA CANNULATED PROXIMAL BEND ROUND BARREL STERILE LIGHT GREEN SUP-04.034.434S CDM 270010022 LOCAL 0270 RC outpatient 4167.02 4167.02 4167.02 74 3083.59 percent of total billed charges 4167.02 93 3375.29 percent of total billed charges 4167.02 4167.02 other OPPS APC 4167.02 4167.02 other OPPS APC 4167.02 27.63 1151.35 percent of total billed charges 4167.02 4167.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX 300MM 10MM LIGHT GREEN TITANIUM STERILE TIBIAL CANNULATED PROXIMAL BEND SUP-04.034.440S CDM 270010022 LOCAL 0270 RC outpatient 3370.33 3370.33 3370.33 74 2494.04 percent of total billed charges 3370.33 93 2729.97 percent of total billed charges 3370.33 3370.33 other OPPS APC 3370.33 3370.33 other OPPS APC 3370.33 27.63 931.22 percent of total billed charges 3370.33 3370.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L315 MM OD10 MM CANNULATED PROXIMAL BEND STERILE SUP-04.034.443S CDM 270010022 LOCAL 0270 RC outpatient 3370.33 3370.33 3370.33 74 2494.04 percent of total billed charges 3370.33 93 2729.97 percent of total billed charges 3370.33 3370.33 other OPPS APC 3370.33 3370.33 other OPPS APC 3370.33 27.63 931.22 percent of total billed charges 3370.33 3370.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX 330MM 10MM LIGHT GREEN TITANIUM STERILE TIBIAL CANNULATED PROXIMAL BEND SUP-04.034.446S CDM 270010022 LOCAL 0270 RC outpatient 3370.33 3370.33 3370.33 74 2494.04 percent of total billed charges 3370.33 93 2729.97 percent of total billed charges 3370.33 3370.33 other OPPS APC 3370.33 3370.33 other OPPS APC 3370.33 27.63 931.22 percent of total billed charges 3370.33 3370.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX 345CM 10MM LIGHT GREEN TITANIUM STERILE TIBIAL CANNULATED PROXIMAL BEND SUP-04.034.449S CDM 270010022 LOCAL 0270 RC outpatient 3370.33 3370.33 3370.33 74 2494.04 percent of total billed charges 3370.33 93 2729.97 percent of total billed charges 3370.33 3370.33 other OPPS APC 3370.33 3370.33 other OPPS APC 3370.33 27.63 931.22 percent of total billed charges 3370.33 3370.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX 360MM 10MM LIGHT GREEN TITANIUM STERILE TIBIAL CANNULATED PROXIMAL BEND SUP-04.034.452S CDM 270010022 LOCAL 0270 RC outpatient 3370.33 3370.33 3370.33 74 2494.04 percent of total billed charges 3370.33 93 2729.97 percent of total billed charges 3370.33 3370.33 other OPPS APC 3370.33 3370.33 other OPPS APC 3370.33 27.63 931.22 percent of total billed charges 3370.33 3370.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX 375MM 10MM LIGHT GREEN TITANIUM STERILE TIBIAL CANNULATED PROXIMAL BEND SUP-04.034.455S CDM 270010022 LOCAL 0270 RC outpatient 3370.33 3370.33 3370.33 74 2494.04 percent of total billed charges 3370.33 93 2729.97 percent of total billed charges 3370.33 3370.33 other OPPS APC 3370.33 3370.33 other OPPS APC 3370.33 27.63 931.22 percent of total billed charges 3370.33 3370.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL 10MM 390MM TIBIA NAIL-EX INTRAMEDULLARY CANNULATED PROXIMAL BEND TITANIUM SUP-04.034.458S CDM 270010022 LOCAL 0270 RC outpatient 3370.33 3370.33 3370.33 74 2494.04 percent of total billed charges 3370.33 93 2729.97 percent of total billed charges 3370.33 3370.33 other OPPS APC 3370.33 3370.33 other OPPS APC 3370.33 27.63 931.22 percent of total billed charges 3370.33 3370.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L405 MM OD10 MM TIBIAL CANNULATED PROXIMAL BEND ROUND BARREL STERILE LIGHT GREEN SUP-04.034.461S CDM 270010022 LOCAL 0270 RC outpatient 3370.33 3370.33 3370.33 74 2494.04 percent of total billed charges 3370.33 93 2729.97 percent of total billed charges 3370.33 3370.33 other OPPS APC 3370.33 3370.33 other OPPS APC 3370.33 27.63 931.22 percent of total billed charges 3370.33 3370.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L420 MM OD10 MM TIBIA CANNULATED PROXIMAL BEND ROUND BARREL STERILE LIGHT GREEN SUP-04.034.464S CDM 270010022 LOCAL 0270 RC outpatient 4167.02 4167.02 4167.02 74 3083.59 percent of total billed charges 4167.02 93 3375.29 percent of total billed charges 4167.02 4167.02 other OPPS APC 4167.02 4167.02 other OPPS APC 4167.02 27.63 1151.35 percent of total billed charges 4167.02 4167.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L435 MM OD10 MM TIBIA CANNULATED PROXIMAL BEND STERILE SUP-04.034.467S CDM 270010022 LOCAL 0270 RC outpatient 3591.59 3591.59 3591.59 74 2657.78 percent of total billed charges 3591.59 93 2909.19 percent of total billed charges 3591.59 3591.59 other OPPS APC 3591.59 3591.59 other OPPS APC 3591.59 27.63 992.36 percent of total billed charges 3591.59 3591.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L255 MM OD11 MM TIBIA CANNULATED PROXIMAL BEND STERILE SUP-04.034.531S CDM 270010022 LOCAL 0270 RC outpatient 3591.59 3591.59 3591.59 74 2657.78 percent of total billed charges 3591.59 93 2909.19 percent of total billed charges 3591.59 3591.59 other OPPS APC 3591.59 3591.59 other OPPS APC 3591.59 27.63 992.36 percent of total billed charges 3591.59 3591.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L270 MM OD11 MM TIBIA CANNULATED FIXATION PROXIMAL BEND STERILE LIGHT GREEN SUP-04.034.534S CDM 270010022 LOCAL 0270 RC outpatient 3591.59 3591.59 3591.59 74 2657.78 percent of total billed charges 3591.59 93 2909.19 percent of total billed charges 3591.59 3591.59 other OPPS APC 3591.59 3591.59 other OPPS APC 3591.59 27.63 992.36 percent of total billed charges 3591.59 3591.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM L285 MM OD11 MM TIBIAL CANNULATED PROXIMAL BEND STERILE SUP-04.034.537S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L300 MM OD11 MM TIBIA CANNULATED FIXATION PROXIMAL BEND STERILE LIGHT GREEN SUP-04.034.540S CDM 270010022 LOCAL 0270 RC outpatient 3370.33 3370.33 3370.33 74 2494.04 percent of total billed charges 3370.33 93 2729.97 percent of total billed charges 3370.33 3370.33 other OPPS APC 3370.33 3370.33 other OPPS APC 3370.33 27.63 931.22 percent of total billed charges 3370.33 3370.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L315 MM OD11 MM TIBIA CANNULATED PROXIMAL BEND FLUTED BARREL STERILE LIGHT GREEN SUP-04.034.543S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT 330MM 11MM LIGHT GREEN TITANIUM STERILE TIBIA CANNULATED PROXIMAL BEND SUP-04.034.546S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L345 MM OD11 MM TIBIA CANNULATED PROXIMAL BEND STERILE SUP-04.034.549S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L360 MM OD11 MM TIBIA CANNULATED PROXIMAL BEND FLUTED BARREL STERILE LIGHT GREEN SUP-04.034.552S CDM 270010022 LOCAL 0270 RC outpatient 3370.33 3370.33 3370.33 74 2494.04 percent of total billed charges 3370.33 93 2729.97 percent of total billed charges 3370.33 3370.33 other OPPS APC 3370.33 3370.33 other OPPS APC 3370.33 27.63 931.22 percent of total billed charges 3370.33 3370.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L375 MM OD11 MM TIBIA CANNULATED PROXIMAL BEND FLUTED BARREL STERILE LIGHT GREEN SUP-04.034.555S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L390 MM OD11 MM TIBIA CANNULATED PROXIMAL BEND FLUTED BARREL STERILE LIGHT GREEN SUP-04.034.558S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L405 MM OD11 MM TIBIA CANNULATED PROXIMAL BEND FLUTED BARREL STERILE LIGHT GREEN SUP-04.034.561S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L420 MM OD11 MM TIBIA CANNULATED PROXIMAL BEND STERILE SUP-04.034.564S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L255 MM OD12 MM TIBIA CANNULATED PROXIMAL BEND STERILE SUP-04.034.631S CDM 270010022 LOCAL 0270 RC outpatient 4294.29 4294.29 4294.29 74 3177.77 percent of total billed charges 4294.29 93 3478.37 percent of total billed charges 4294.29 4294.29 other OPPS APC 4294.29 4294.29 other OPPS APC 4294.29 27.63 1186.51 percent of total billed charges 4294.29 4294.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L270 MM OD12 MM TIBIA CANNULATED PROXIMAL BEND ROUND BARREL STERILE LIGHT GREEN SUP-04.034.634S CDM 270010022 LOCAL 0270 RC outpatient 4294.29 4294.29 4294.29 74 3177.77 percent of total billed charges 4294.29 93 3478.37 percent of total billed charges 4294.29 4294.29 other OPPS APC 4294.29 4294.29 other OPPS APC 4294.29 27.63 1186.51 percent of total billed charges 4294.29 4294.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L285 MM OD12 MM TIBIA CANNULATED PROXIMAL BEND FLUTED BARREL STERILE LIGHT GREEN SUP-04.034.637S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L300 MM OD12 MM TIBIA CANNULATED PROXIMAL BEND FLUTED BARREL STERILE LIGHT GREEN SUP-04.034.640S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L315 MM OD12 MM TIBIA CANNULATED PROXIMAL BEND FLUTED BARREL STERILE LIGHT GREEN SUP-04.034.643S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY NAIL-EX TITANIUM L33 CM OD12 MM TIBIAL CANNULATED PROXIMAL BEND STERILE GREEN SUP-04.034.646S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L345 MM OD12 MM TIBIA CANNULATED PROXIMAL BEND FLUTED BARREL STERILE LIGHT GREEN SUP-04.034.649S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL FLUTE L360 MM OD12 MM TIBIAL CANNULATED PROXIMAL BEND STERILE LIGHT GREEN 5 MM LOCK SCREW SUP-04.034.652S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL FLUTE L375 MM OD12 MM TIBIAL CANNULATED PROXIMAL BEND STERILE LIGHT GREEN 5 MM LOCK SCREW SUP-04.034.655S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L390 MM OD12 MM TIBIA CANNULATED PROXIMAL BEND FLUTED BARREL STERILE LIGHT GREEN SUP-04.034.658S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L405 MM OD12 MM TIBIAL CANNULATED PROXIMAL BEND ROUND BARREL STERILE LIGHT GREEN SUP-04.034.661S CDM 270010022 LOCAL 0270 RC outpatient 4029.74 4029.74 4029.74 74 2982.01 percent of total billed charges 4029.74 93 3264.09 percent of total billed charges 4029.74 4029.74 other OPPS APC 4029.74 4029.74 other OPPS APC 4029.74 27.63 1113.42 percent of total billed charges 4029.74 4029.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L420 MM OD12 MM TIBIA CANNULATED PROXIMAL BEND ROUND BARREL STERILE LIGHT GREEN SUP-04.034.664S CDM 270010022 LOCAL 0270 RC outpatient 4294.29 4294.29 4294.29 74 3177.77 percent of total billed charges 4294.29 93 3478.37 percent of total billed charges 4294.29 4294.29 other OPPS APC 4294.29 4294.29 other OPPS APC 4294.29 27.63 1186.51 percent of total billed charges 4294.29 4294.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY EXPERT TITANIUM UNIVERSAL L435 MM OD12 MM TIBIA CANNULATED PROXIMAL BEND ROUND BARREL STERILE LIGHT GREEN SUP-04.034.667S CDM 270010022 LOCAL 0270 RC outpatient 4294.29 4294.29 4294.29 74 3177.77 percent of total billed charges 4294.29 93 3478.37 percent of total billed charges 4294.29 4294.29 other OPPS APC 4294.29 4294.29 other OPPS APC 4294.29 27.63 1186.51 percent of total billed charges 4294.29 4294.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D SHORT 170MM 10MM GOLD GREEN TAN TI-15MO STERILE FEMORAL PROXIMAL CANNULATED SUP-04.037.042S CDM 270010022 LOCAL 0270 RC outpatient 8070.92 8070.92 8070.92 74 5972.48 percent of total billed charges 8070.92 93 6537.45 percent of total billed charges 8070.92 8070.92 other OPPS APC 8070.92 8070.92 other OPPS APC 8070.92 27.63 2230 percent of total billed charges 8070.92 8070.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANNULATED TFNA 10MM/130 DEG 235MM RIGHT SUP-04.037.044S CDM 270010022 LOCAL 0270 RC outpatient 3804.84 3804.84 3804.84 74 2815.58 percent of total billed charges 3804.84 93 3081.92 percent of total billed charges 3804.84 3804.84 other OPPS APC 3804.84 3804.84 other OPPS APC 3804.84 27.63 1051.28 percent of total billed charges 3804.84 3804.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANNULATED TFNA 10MM/130 DEG 235MM LEFT SUP-04.037.045S CDM 270010022 LOCAL 0270 RC outpatient 5073.12 5073.12 5073.12 74 3754.11 percent of total billed charges 5073.12 93 4109.23 percent of total billed charges 5073.12 5073.12 other OPPS APC 5073.12 5073.12 other OPPS APC 5073.12 27.63 1401.7 percent of total billed charges 5073.12 5073.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 320MM 10MM GREEN TI-15MO STERILE FEMORAL RIGHT PROXIMAL CANNULATED SUP-04.037.052S CDM 270010022 LOCAL 0270 RC outpatient 4792.32 4792.32 4792.32 74 3546.32 percent of total billed charges 4792.32 93 3881.78 percent of total billed charges 4792.32 4792.32 other OPPS APC 4792.32 4792.32 other OPPS APC 4792.32 27.63 1324.12 percent of total billed charges 4792.32 4792.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 320MM 10MM GREEN TI-15MO STERILE FEMORAL LEFT PROXIMAL CANNULATED PREASSEMBLE SUP-04.037.053S CDM 270010022 LOCAL 0270 RC outpatient 6389.76 6389.76 6389.76 74 4728.42 percent of total billed charges 6389.76 93 5175.71 percent of total billed charges 6389.76 6389.76 other OPPS APC 6389.76 6389.76 other OPPS APC 6389.76 27.63 1765.49 percent of total billed charges 6389.76 6389.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 340MM 10MM GREEN TI-15MO STERILE FEMORAL RIGHT PROXIMAL CANNULATED SUP-04.037.054S CDM 270010022 LOCAL 0270 RC outpatient 4792.32 4792.32 4792.32 74 3546.32 percent of total billed charges 4792.32 93 3881.78 percent of total billed charges 4792.32 4792.32 other OPPS APC 4792.32 4792.32 other OPPS APC 4792.32 27.63 1324.12 percent of total billed charges 4792.32 4792.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 340MM 10MM GREEN TI-15MO STERILE FEMORAL LEFT PROXIMAL CANNULATED PREASSEMBLE SUP-04.037.055S CDM 270010022 LOCAL 0270 RC outpatient 6389.76 6389.76 6389.76 74 4728.42 percent of total billed charges 6389.76 93 5175.71 percent of total billed charges 6389.76 6389.76 other OPPS APC 6389.76 6389.76 other OPPS APC 6389.76 27.63 1765.49 percent of total billed charges 6389.76 6389.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 360MM 10MM GREEN TI-15MO STERILE FEMORAL RIGHT PROXIMAL CANNULATED SUP-04.037.056S CDM 270010022 LOCAL 0270 RC outpatient 4792.32 4792.32 4792.32 74 3546.32 percent of total billed charges 4792.32 93 3881.78 percent of total billed charges 4792.32 4792.32 other OPPS APC 4792.32 4792.32 other OPPS APC 4792.32 27.63 1324.12 percent of total billed charges 4792.32 4792.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 360MM 10MM GREEN TI-15MO STERILE FEMORAL LEFT PROXIMAL CANNULATED PREASSEMBLE SUP-04.037.057S CDM 270010022 LOCAL 0270 RC outpatient 4792.32 4792.32 4792.32 74 3546.32 percent of total billed charges 4792.32 93 3881.78 percent of total billed charges 4792.32 4792.32 other OPPS APC 4792.32 4792.32 other OPPS APC 4792.32 27.63 1324.12 percent of total billed charges 4792.32 4792.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 380MM 10MM GREEN TI-15MO STERILE FEMORAL RIGHT PROXIMAL CANNULATED SUP-04.037.058S CDM 270010022 LOCAL 0270 RC outpatient 4792.32 4792.32 4792.32 74 3546.32 percent of total billed charges 4792.32 93 3881.78 percent of total billed charges 4792.32 4792.32 other OPPS APC 4792.32 4792.32 other OPPS APC 4792.32 27.63 1324.12 percent of total billed charges 4792.32 4792.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 380MM 10MM GREEN TI-15MO STERILE FEMORAL LEFT PROXIMAL CANNULATED PREASSEMBLE SUP-04.037.059S CDM 270010022 LOCAL 0270 RC outpatient 4792.32 4792.32 4792.32 74 3546.32 percent of total billed charges 4792.32 93 3881.78 percent of total billed charges 4792.32 4792.32 other OPPS APC 4792.32 4792.32 other OPPS APC 4792.32 27.63 1324.12 percent of total billed charges 4792.32 4792.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 400MM 10MM GREEN TI-15MO STERILE FEMORAL RIGHT PROXIMAL CANNULATED SUP-04.037.060S CDM 270010022 LOCAL 0270 RC outpatient 4792.32 4792.32 4792.32 74 3546.32 percent of total billed charges 4792.32 93 3881.78 percent of total billed charges 4792.32 4792.32 other OPPS APC 4792.32 4792.32 other OPPS APC 4792.32 27.63 1324.12 percent of total billed charges 4792.32 4792.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 400MM 10MM GREEN TI-15MO STERILE FEMORAL LEFT PROXIMAL CANNULATED PREASSEMBLE SUP-04.037.061S CDM 270010022 LOCAL 0270 RC outpatient 4792.32 4792.32 4792.32 74 3546.32 percent of total billed charges 4792.32 93 3881.78 percent of total billed charges 4792.32 4792.32 other OPPS APC 4792.32 4792.32 other OPPS APC 4792.32 27.63 1324.12 percent of total billed charges 4792.32 4792.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 420MM 10MM GREEN TI-15MO STERILE FEMORAL RIGHT PROXIMAL CANNULATED SUP-04.037.062S CDM 270010022 LOCAL 0270 RC outpatient 4792.32 4792.32 4792.32 74 3546.32 percent of total billed charges 4792.32 93 3881.78 percent of total billed charges 4792.32 4792.32 other OPPS APC 4792.32 4792.32 other OPPS APC 4792.32 27.63 1324.12 percent of total billed charges 4792.32 4792.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 420MM 10MM GREEN TI-15MO STERILE FEMORAL LEFT PROXIMAL CANNULATED PREASSEMBLE SUP-04.037.063S CDM 270010022 LOCAL 0270 RC outpatient 4792.32 4792.32 4792.32 74 3546.32 percent of total billed charges 4792.32 93 3881.78 percent of total billed charges 4792.32 4792.32 other OPPS APC 4792.32 4792.32 other OPPS APC 4792.32 27.63 1324.12 percent of total billed charges 4792.32 4792.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 440MM 10MM GREEN TI-15MO STERILE FEMORAL RIGHT PROXIMAL CANNULATED SUP-04.037.064S CDM 270010022 LOCAL 0270 RC outpatient 4792.32 4792.32 4792.32 74 3546.32 percent of total billed charges 4792.32 93 3881.78 percent of total billed charges 4792.32 4792.32 other OPPS APC 4792.32 4792.32 other OPPS APC 4792.32 27.63 1324.12 percent of total billed charges 4792.32 4792.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 440MM 10MM GREEN TI-15MO STERILE FEMORAL LEFT PROXIMAL CANNULATED PREASSEMBLE SUP-04.037.065S CDM 270010022 LOCAL 0270 RC outpatient 4792.32 4792.32 4792.32 74 3546.32 percent of total billed charges 4792.32 93 3881.78 percent of total billed charges 4792.32 4792.32 other OPPS APC 4792.32 4792.32 other OPPS APC 4792.32 27.63 1324.12 percent of total billed charges 4792.32 4792.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D SHORT 170MM 11MM GREEN TI-15MO STERILE FEMORAL PROXIMAL CANNULATED PREASSEMBLE SUP-04.037.142S CDM 270010022 LOCAL 0270 RC outpatient 8070.92 8070.92 8070.92 74 5972.48 percent of total billed charges 8070.92 93 6537.45 percent of total billed charges 8070.92 8070.92 other OPPS APC 8070.92 8070.92 other OPPS APC 8070.92 27.63 2230 percent of total billed charges 8070.92 8070.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANNULATED TFNA 11MM/130 DEG 235MM RIGHT SUP-04.037.144S CDM 270010022 LOCAL 0270 RC outpatient 5073.12 5073.12 5073.12 74 3754.11 percent of total billed charges 5073.12 93 4109.23 percent of total billed charges 5073.12 5073.12 other OPPS APC 5073.12 5073.12 other OPPS APC 5073.12 27.63 1401.7 percent of total billed charges 5073.12 5073.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANNULATED TFNA 11MM/130 DEG 235MM LEFT SUP-04.037.145S CDM 270010022 LOCAL 0270 RC outpatient 5073.12 5073.12 5073.12 74 3754.11 percent of total billed charges 5073.12 93 4109.23 percent of total billed charges 5073.12 5073.12 other OPPS APC 5073.12 5073.12 other OPPS APC 5073.12 27.63 1401.7 percent of total billed charges 5073.12 5073.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 320MM 11MM GREEN TI-15MO STERILE FEMORAL RIGHT PROXIMAL CANNULATED SUP-04.037.152S CDM 270010022 LOCAL 0270 RC outpatient 6389.76 6389.76 6389.76 74 4728.42 percent of total billed charges 6389.76 93 5175.71 percent of total billed charges 6389.76 6389.76 other OPPS APC 6389.76 6389.76 other OPPS APC 6389.76 27.63 1765.49 percent of total billed charges 6389.76 6389.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 320MM 11MM GREEN TI-15MO STERILE FEMORAL LEFT PROXIMAL CANNULATED PREASSEMBLE SUP-04.037.153S CDM 270010022 LOCAL 0270 RC outpatient 6389.76 6389.76 6389.76 74 4728.42 percent of total billed charges 6389.76 93 5175.71 percent of total billed charges 6389.76 6389.76 other OPPS APC 6389.76 6389.76 other OPPS APC 6389.76 27.63 1765.49 percent of total billed charges 6389.76 6389.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 340MM 11MM GREEN TI-15MO STERILE FEMORAL RIGHT PROXIMAL CANNULATED SUP-04.037.154S CDM 270010022 LOCAL 0270 RC outpatient 12079.9 12079.9 12079.9 74 8939.1 percent of total billed charges 12079.9 93 9784.69 percent of total billed charges 12079.9 12079.9 other OPPS APC 12079.9 12079.9 other OPPS APC 12079.9 27.63 3337.67 percent of total billed charges 12079.9 12079.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 340MM 11MM GREEN TI-15MO STERILE FEMORAL LEFT PROXIMAL CANNULATED PREASSEMBLE SUP-04.037.155S CDM 270010022 LOCAL 0270 RC outpatient 6389.76 6389.76 6389.76 74 4728.42 percent of total billed charges 6389.76 93 5175.71 percent of total billed charges 6389.76 6389.76 other OPPS APC 6389.76 6389.76 other OPPS APC 6389.76 27.63 1765.49 percent of total billed charges 6389.76 6389.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED LATERAL RELIEF CUT 130D LONG 360MM 11MM GREEN TITANIUM COCR STERILE FEMORAL RIGHT SUP-04.037.156S CDM 270010022 LOCAL 0270 RC outpatient 12079.9 12079.9 12079.9 74 8939.1 percent of total billed charges 12079.9 93 9784.69 percent of total billed charges 12079.9 12079.9 other OPPS APC 12079.9 12079.9 other OPPS APC 12079.9 27.63 3337.67 percent of total billed charges 12079.9 12079.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 360MM 11MM GREEN TI-15MO STERILE FEMORAL LEFT PROXIMAL CANNULATED PREASSEMBLE SUP-04.037.157S CDM 270010022 LOCAL 0270 RC outpatient 4792.32 4792.32 4792.32 74 3546.32 percent of total billed charges 4792.32 93 3881.78 percent of total billed charges 4792.32 4792.32 other OPPS APC 4792.32 4792.32 other OPPS APC 4792.32 27.63 1324.12 percent of total billed charges 4792.32 4792.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 380MM 11MM GREEN TI-15MO STERILE FEMORAL RIGHT PROXIMAL CANNULATED SUP-04.037.158S CDM 270010022 LOCAL 0270 RC outpatient 12079.9 12079.9 12079.9 74 8939.1 percent of total billed charges 12079.9 93 9784.69 percent of total billed charges 12079.9 12079.9 other OPPS APC 12079.9 12079.9 other OPPS APC 12079.9 27.63 3337.67 percent of total billed charges 12079.9 12079.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 380MM 11MM GREEN TI-15MO STERILE FEMORAL LEFT PROXIMAL CANNULATED PREASSEMBLE SUP-04.037.159S CDM 270010022 LOCAL 0270 RC outpatient 12079.9 12079.9 12079.9 74 8939.1 percent of total billed charges 12079.9 93 9784.69 percent of total billed charges 12079.9 12079.9 other OPPS APC 12079.9 12079.9 other OPPS APC 12079.9 27.63 3337.67 percent of total billed charges 12079.9 12079.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 400MM 11MM GREEN TITANIUM COCR STERILE FEMORAL RIGHT PROXIMAL DISTAL SUP-04.037.160S CDM 270010022 LOCAL 0270 RC outpatient 4792.32 4792.32 4792.32 74 3546.32 percent of total billed charges 4792.32 93 3881.78 percent of total billed charges 4792.32 4792.32 other OPPS APC 4792.32 4792.32 other OPPS APC 4792.32 27.63 1324.12 percent of total billed charges 4792.32 4792.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 400MM 11MM TITANIUM STERILE LF FEMORAL LEFT DISTAL SUP-04.037.161S CDM 270010022 LOCAL 0270 RC outpatient 12079.9 12079.9 12079.9 74 8939.1 percent of total billed charges 12079.9 93 9784.69 percent of total billed charges 12079.9 12079.9 other OPPS APC 12079.9 12079.9 other OPPS APC 12079.9 27.63 3337.67 percent of total billed charges 12079.9 12079.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 420MM 11MM GREEN TI-15MO STERILE FEMORAL RIGHT PROXIMAL CANNULATED SUP-04.037.162S CDM 270010022 LOCAL 0270 RC outpatient 4792.32 4792.32 4792.32 74 3546.32 percent of total billed charges 4792.32 93 3881.78 percent of total billed charges 4792.32 4792.32 other OPPS APC 4792.32 4792.32 other OPPS APC 4792.32 27.63 1324.12 percent of total billed charges 4792.32 4792.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 420MM 11MM GREEN TI-15MO STERILE FEMORAL LEFT PROXIMAL CANNULATED PREASSEMBLE SUP-04.037.163S CDM 270010022 LOCAL 0270 RC outpatient 6389.76 6389.76 6389.76 74 4728.42 percent of total billed charges 6389.76 93 5175.71 percent of total billed charges 6389.76 6389.76 other OPPS APC 6389.76 6389.76 other OPPS APC 6389.76 27.63 1765.49 percent of total billed charges 6389.76 6389.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 440MM 11MM GREEN TI-15MO STERILE FEMORAL RIGHT PROXIMAL CANNULATED SUP-04.037.164S CDM 270010022 LOCAL 0270 RC outpatient 4792.32 4792.32 4792.32 74 3546.32 percent of total billed charges 4792.32 93 3881.78 percent of total billed charges 4792.32 4792.32 other OPPS APC 4792.32 4792.32 other OPPS APC 4792.32 27.63 1324.12 percent of total billed charges 4792.32 4792.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED 130D LONG 440MM 11MM GREEN TI-15MO STERILE FEMORAL LEFT PROXIMAL CANNULATED PREASSEMBLE SUP-04.037.165S CDM 270010022 LOCAL 0270 RC outpatient 4792.32 4792.32 4792.32 74 3546.32 percent of total billed charges 4792.32 93 3881.78 percent of total billed charges 4792.32 4792.32 other OPPS APC 4792.32 4792.32 other OPPS APC 4792.32 27.63 1324.12 percent of total billed charges 4792.32 4792.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANNULATED TFNA 12MM/130 DEG 235MM RIGHT SUP-04.037.244S CDM 270010022 LOCAL 0270 RC outpatient 5073.12 5073.12 5073.12 74 3754.11 percent of total billed charges 5073.12 93 4109.23 percent of total billed charges 5073.12 5073.12 other OPPS APC 5073.12 5073.12 other OPPS APC 5073.12 27.63 1401.7 percent of total billed charges 5073.12 5073.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANNULATED TFNA 12MM/130 DEG 235MM LEFT SUP-04.037.245S CDM 270010022 LOCAL 0270 RC outpatient 3804.84 3804.84 3804.84 74 2815.58 percent of total billed charges 3804.84 93 3081.92 percent of total billed charges 3804.84 3804.84 other OPPS APC 3804.84 3804.84 other OPPS APC 3804.84 27.63 1051.28 percent of total billed charges 3804.84 3804.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED LATERAL RELIEF CUT TI-15MO TI-6AL-7NB COCR 130 D LONG L380 MM OD12 MM FEMORAL LEFT PROXIMAL CANNULATED PREASSEMBLE LOCK MECHANISM STERILE GREEN SUP-04.037.259S CDM 270010022 LOCAL 0270 RC outpatient 6389.76 6389.76 6389.76 74 4728.42 percent of total billed charges 6389.76 93 5175.71 percent of total billed charges 6389.76 6389.76 other OPPS APC 6389.76 6389.76 other OPPS APC 6389.76 27.63 1765.49 percent of total billed charges 6389.76 6389.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL SYNTHES TFNA 9MM 130DEG 170MM SUP-04.037.942S CDM 0270 RC outpatient 8070.92 8070.92 8070.92 74 5972.48 percent of total billed charges 8070.92 93 6537.45 percent of total billed charges 8070.92 8070.92 other OPPS APC 8070.92 8070.92 other OPPS APC 8070.92 27.63 2230 percent of total billed charges 8070.92 8070.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED LATERAL RELIEF CUT TI L235 MM 9 MM 130 DEG FEMORAL RIGHT STERILE SUP-04.037.944S CDM 270010025 LOCAL 0270 RC outpatient 3804.84 3804.84 3804.84 74 2815.58 percent of total billed charges 3804.84 93 3081.92 percent of total billed charges 3804.84 3804.84 other OPPS APC 3804.84 3804.84 other OPPS APC 3804.84 27.63 1051.28 percent of total billed charges 3804.84 3804.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TFN-ADVANCED LATERAL RELIEF CUT TI L235 MM 9 MM 130 DEG FEMORAL LEFT STERILE SUP-04.037.945S CDM 270010025 LOCAL 0270 RC outpatient 5073.12 5073.12 5073.12 74 3754.11 percent of total billed charges 5073.12 93 4109.23 percent of total billed charges 5073.12 5073.12 other OPPS APC 5073.12 5073.12 other OPPS APC 5073.12 27.63 1401.7 percent of total billed charges 5073.12 5073.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL SYNTHES TFNA 9MM 130DEG 320MM RIGHT SUP-04.037.952S CDM 0270 RC outpatient 6737.64 6737.64 6737.64 74 4985.85 percent of total billed charges 6737.64 93 5457.49 percent of total billed charges 6737.64 6737.64 other OPPS APC 6737.64 6737.64 other OPPS APC 6737.64 27.63 1861.61 percent of total billed charges 6737.64 6737.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL SYNTHES TFNA 9MM 130DEG 320MM LEFT SUP-04.037.953S CDM 0270 RC outpatient 5053.23 5053.23 5053.23 74 3739.39 percent of total billed charges 5053.23 93 4093.12 percent of total billed charges 5053.23 5053.23 other OPPS APC 5053.23 5053.23 other OPPS APC 5053.23 27.63 1396.21 percent of total billed charges 5053.23 5053.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL SYNTHES TFNA 9MM 130DEG 340MM RIGHT SUP-04.037.954S CDM 0270 RC outpatient 6737.64 6737.64 6737.64 74 4985.85 percent of total billed charges 6737.64 93 5457.49 percent of total billed charges 6737.64 6737.64 other OPPS APC 6737.64 6737.64 other OPPS APC 6737.64 27.63 1861.61 percent of total billed charges 6737.64 6737.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL SYNTHES TFNA 9MM 130DEG 340MM LEFT SUP-04.037.955S CDM 0270 RC outpatient 5053.23 5053.23 5053.23 74 3739.39 percent of total billed charges 5053.23 93 4093.12 percent of total billed charges 5053.23 5053.23 other OPPS APC 5053.23 5053.23 other OPPS APC 5053.23 27.63 1396.21 percent of total billed charges 5053.23 5053.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL SYNTHES TFNA 9MM 130DEG 360MM RIGHT SUP-04.037.956S CDM 0270 RC outpatient 5053.23 5053.23 5053.23 74 3739.39 percent of total billed charges 5053.23 93 4093.12 percent of total billed charges 5053.23 5053.23 other OPPS APC 5053.23 5053.23 other OPPS APC 5053.23 27.63 1396.21 percent of total billed charges 5053.23 5053.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL SYNTHES TFNA 9MM 130DEG 360MM LEFT SUP-04.037.957S CDM 0270 RC outpatient 5053.23 5053.23 5053.23 74 3739.39 percent of total billed charges 5053.23 93 4093.12 percent of total billed charges 5053.23 5053.23 other OPPS APC 5053.23 5053.23 other OPPS APC 5053.23 27.63 1396.21 percent of total billed charges 5053.23 5053.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL SYNTHES TFNA 9MM 130DEG 380MM RIGHT SUP-04.037.958S CDM 0270 RC outpatient 5053.23 5053.23 5053.23 74 3739.39 percent of total billed charges 5053.23 93 4093.12 percent of total billed charges 5053.23 5053.23 other OPPS APC 5053.23 5053.23 other OPPS APC 5053.23 27.63 1396.21 percent of total billed charges 5053.23 5053.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL SYNTHES TFNA 9MM 130DEG 380MM LEFT SUP-04.037.959S CDM 0270 RC outpatient 5053.23 5053.23 5053.23 74 3739.39 percent of total billed charges 5053.23 93 4093.12 percent of total billed charges 5053.23 5053.23 other OPPS APC 5053.23 5053.23 other OPPS APC 5053.23 27.63 1396.21 percent of total billed charges 5053.23 5053.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL SYNTHES TFNA 9MM 130DEG 400MM RIGHT SUP-04.037.960S CDM 0270 RC outpatient 5053.23 5053.23 5053.23 74 3739.39 percent of total billed charges 5053.23 93 4093.12 percent of total billed charges 5053.23 5053.23 other OPPS APC 5053.23 5053.23 other OPPS APC 5053.23 27.63 1396.21 percent of total billed charges 5053.23 5053.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL SYNTHES TFNA 9MM 130DEG 400MM LEFT SUP-04.037.961S CDM 0270 RC outpatient 12738.4 12738.4 12738.4 74 9426.45 percent of total billed charges 12738.4 93 10318.1 percent of total billed charges 12738.4 12738.4 other OPPS APC 12738.4 12738.4 other OPPS APC 12738.4 27.63 3519.63 percent of total billed charges 12738.4 12738.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL SYNTHES TFNA 9MM 130DEG 420MM RIGHT SUP-04.037.962S CDM 0270 RC outpatient 12738.4 12738.4 12738.4 74 9426.45 percent of total billed charges 12738.4 93 10318.1 percent of total billed charges 12738.4 12738.4 other OPPS APC 12738.4 12738.4 other OPPS APC 12738.4 27.63 3519.63 percent of total billed charges 12738.4 12738.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL SYNTHES TFNA 9MM 130DEG 420MM LEFT SUP-04.037.963S CDM 0270 RC outpatient 6737.64 6737.64 6737.64 74 4985.85 percent of total billed charges 6737.64 93 5457.49 percent of total billed charges 6737.64 6737.64 other OPPS APC 6737.64 6737.64 other OPPS APC 6737.64 27.63 1861.61 percent of total billed charges 6737.64 6737.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL SYNTHES TFNA 9MM 130DEG 440MM RIGHT SUP-04.037.964S CDM 0270 RC outpatient 6737.64 6737.64 6737.64 74 4985.85 percent of total billed charges 6737.64 93 5457.49 percent of total billed charges 6737.64 6737.64 other OPPS APC 6737.64 6737.64 other OPPS APC 6737.64 27.63 1861.61 percent of total billed charges 6737.64 6737.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL SYNTHES TFNA 9MM 130DEG 440MM LEFT SUP-04.037.965S CDM 0270 RC outpatient 6737.64 6737.64 6737.64 74 4985.85 percent of total billed charges 6737.64 93 5457.49 percent of total billed charges 6737.64 6737.64 other OPPS APC 6737.64 6737.64 other OPPS APC 6737.64 27.63 1861.61 percent of total billed charges 6737.64 6737.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TFN-ADVANCED TITANIUM NIOBIUM ALUMINUM 3.5 MM L70 MM OD10.35 MM CANNULATED STERILE SUP-04.038.170S CDM 0270 RC outpatient 1903.2 1903.2 1903.2 74 1408.37 percent of total billed charges 1903.2 93 1541.59 percent of total billed charges 1903.2 1903.2 other OPPS APC 1903.2 1903.2 other OPPS APC 1903.2 27.63 525.85 percent of total billed charges 1903.2 1903.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TFN-ADVANCED TITANIUM NIOBIUM ALUMINUM 3.5 MM L75 MM OD10.35 MM FEMORAL PROXIMAL CANNULATED STERILE TAN SUP-04.038.175S CDM 0270 RC outpatient 1903.2 1903.2 1903.2 74 1408.37 percent of total billed charges 1903.2 93 1541.59 percent of total billed charges 1903.2 1903.2 other OPPS APC 1903.2 1903.2 other OPPS APC 1903.2 27.63 525.85 percent of total billed charges 1903.2 1903.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TFN-ADVANCED TITANIUM NIOBIUM ALUMINUM 3.5 MM L80 MM OD10.35 MM FEMORAL PROXIMAL CANNULATED STERILE TAN SUP-04.038.180S CDM 0270 RC outpatient 1903.2 1903.2 1903.2 74 1408.37 percent of total billed charges 1903.2 93 1541.59 percent of total billed charges 1903.2 1903.2 other OPPS APC 1903.2 1903.2 other OPPS APC 1903.2 27.63 525.85 percent of total billed charges 1903.2 1903.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TFN-ADVANCED TITANIUM ALUMINUM NIOBIUM 3.5 MM L85 MM OD10.35 MM CANNULATED STERILE TAN SUP-04.038.185S CDM 0270 RC outpatient 1427.4 1427.4 1427.4 74 1056.28 percent of total billed charges 1427.4 93 1156.19 percent of total billed charges 1427.4 1427.4 other OPPS APC 1427.4 1427.4 other OPPS APC 1427.4 27.63 394.39 percent of total billed charges 1427.4 1427.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TFN-ADVANCED TITANIUM NIOBIUM ALUMINUM 3.5 MM L90 MM OD10.35 MM FEMORAL PROXIMAL CANNULATED STERILE TAN SUP-04.038.190S CDM 0270 RC outpatient 1903.2 1903.2 1903.2 74 1408.37 percent of total billed charges 1903.2 93 1541.59 percent of total billed charges 1903.2 1903.2 other OPPS APC 1903.2 1903.2 other OPPS APC 1903.2 27.63 525.85 percent of total billed charges 1903.2 1903.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TFN-ADVANCED TITANIUM ALUMINUM NIOBIUM 3.5 MM L95 MM OD10.35 MM CANNULATED STERILE TAN SUP-04.038.195S CDM 0270 RC outpatient 1427.4 1427.4 1427.4 74 1056.28 percent of total billed charges 1427.4 93 1156.19 percent of total billed charges 1427.4 1427.4 other OPPS APC 1427.4 1427.4 other OPPS APC 1427.4 27.63 394.39 percent of total billed charges 1427.4 1427.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TFN-ADVANCED TITANIUM NIOBIUM ALUMINUM 3.5 MM L100 MM OD10.35 MM CANNULATED STERILE TAN SUP-04.038.200S CDM 0270 RC outpatient 1427.4 1427.4 1427.4 74 1056.28 percent of total billed charges 1427.4 93 1156.19 percent of total billed charges 1427.4 1427.4 other OPPS APC 1427.4 1427.4 other OPPS APC 1427.4 27.63 394.39 percent of total billed charges 1427.4 1427.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TFN-ADVANCED TITANIUM NIOBIUM ALUMINUM 3.5 MM L105 MM OD10.35 MM FEMORAL PROXIMAL CANNULATED STERILE TAN SUP-04.038.205S CDM 0270 RC outpatient 1427.4 1427.4 1427.4 74 1056.28 percent of total billed charges 1427.4 93 1156.19 percent of total billed charges 1427.4 1427.4 other OPPS APC 1427.4 1427.4 other OPPS APC 1427.4 27.63 394.39 percent of total billed charges 1427.4 1427.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TFN-ADVANCED TITANIUM NIOBIUM ALUMINUM 3.5 MM L110 MM OD10.35 MM FEMORAL PROXIMAL CANNULATED STERILE TAN SUP-04.038.210S CDM 0270 RC outpatient 1903.2 1903.2 1903.2 74 1408.37 percent of total billed charges 1903.2 93 1541.59 percent of total billed charges 1903.2 1903.2 other OPPS APC 1903.2 1903.2 other OPPS APC 1903.2 27.63 525.85 percent of total billed charges 1903.2 1903.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TFN-ADVANCED TITANIUM ALUMINUM NIOBIUM 3.5 MM L115 MM OD10.35 MM CANNULATED STERILE TAN SUP-04.038.215S CDM 0270 RC outpatient 1903.2 1903.2 1903.2 74 1408.37 percent of total billed charges 1903.2 93 1541.59 percent of total billed charges 1903.2 1903.2 other OPPS APC 1903.2 1903.2 other OPPS APC 1903.2 27.63 525.85 percent of total billed charges 1903.2 1903.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TFN-ADVANCED TITANIUM ALUMINUM NIOBIUM 3.5 MM L120 MM OD10.35 MM CANNULATED STERILE TAN SUP-04.038.220S CDM 0270 RC outpatient 1903.2 1903.2 1903.2 74 1408.37 percent of total billed charges 1903.2 93 1541.59 percent of total billed charges 1903.2 1903.2 other OPPS APC 1903.2 1903.2 other OPPS APC 1903.2 27.63 525.85 percent of total billed charges 1903.2 1903.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TITANIUM HELIX L75 MM OD10.35 MM FEMUR PROXIMAL CANNULATED STERILE GOLD SUP-04.038.275S CDM 270010022 LOCAL 0270 RC outpatient 2003.04 2003.04 2003.04 74 1482.25 percent of total billed charges 2003.04 93 1622.46 percent of total billed charges 2003.04 2003.04 other OPPS APC 2003.04 2003.04 other OPPS APC 2003.04 27.63 553.44 percent of total billed charges 2003.04 2003.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TITANIUM HELICAL L80 MM OD10.35 MM FEMORAL PROXIMAL CANNULATED STERILE GOLD SUP-04.038.280S CDM 270010022 LOCAL 0270 RC outpatient 2003.04 2003.04 2003.04 74 1482.25 percent of total billed charges 2003.04 93 1622.46 percent of total billed charges 2003.04 2003.04 other OPPS APC 2003.04 2003.04 other OPPS APC 2003.04 27.63 553.44 percent of total billed charges 2003.04 2003.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L85 MM OD10.35 MM FEMORAL PROXIMAL CANNULATED STERILE GOLD SUP-04.038.285S CDM 270010022 LOCAL 0270 RC outpatient 2003.04 2003.04 2003.04 74 1482.25 percent of total billed charges 2003.04 93 1622.46 percent of total billed charges 2003.04 2003.04 other OPPS APC 2003.04 2003.04 other OPPS APC 2003.04 27.63 553.44 percent of total billed charges 2003.04 2003.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TITANIUM HELICAL L90 MM FEMORAL PROXIMAL CANNULATED STERILE SUP-04.038.290S CDM 270010022 LOCAL 0270 RC outpatient 2003.04 2003.04 2003.04 74 1482.25 percent of total billed charges 2003.04 93 1622.46 percent of total billed charges 2003.04 2003.04 other OPPS APC 2003.04 2003.04 other OPPS APC 2003.04 27.63 553.44 percent of total billed charges 2003.04 2003.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L95 MM OD10.35 MM FEMORAL PROXIMAL CANNULATED STERILE GOLD SUP-04.038.295S CDM 270010022 LOCAL 0270 RC outpatient 2003.04 2003.04 2003.04 74 1482.25 percent of total billed charges 2003.04 93 1622.46 percent of total billed charges 2003.04 2003.04 other OPPS APC 2003.04 2003.04 other OPPS APC 2003.04 27.63 553.44 percent of total billed charges 2003.04 2003.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L100 MM OD10.35 MM FEMORAL PROXIMAL CANNULATED STERILE GOLD SUP-04.038.300S CDM 270010022 LOCAL 0270 RC outpatient 2003.04 2003.04 2003.04 74 1482.25 percent of total billed charges 2003.04 93 1622.46 percent of total billed charges 2003.04 2003.04 other OPPS APC 2003.04 2003.04 other OPPS APC 2003.04 27.63 553.44 percent of total billed charges 2003.04 2003.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L105 MM OD10.35 MM FEMORAL PROXIMAL CANNULATED STERILE GOLD SUP-04.038.305S CDM 270010022 LOCAL 0270 RC outpatient 2003.04 2003.04 2003.04 74 1482.25 percent of total billed charges 2003.04 93 1622.46 percent of total billed charges 2003.04 2003.04 other OPPS APC 2003.04 2003.04 other OPPS APC 2003.04 27.63 553.44 percent of total billed charges 2003.04 2003.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TITANIUM HELIX L110 MM OD10.35 MM FEMUR PROXIMAL CANNULATED STERILE GOLD SUP-04.038.310S CDM 270010022 LOCAL 0270 RC outpatient 2003.04 2003.04 2003.04 74 1482.25 percent of total billed charges 2003.04 93 1622.46 percent of total billed charges 2003.04 2003.04 other OPPS APC 2003.04 2003.04 other OPPS APC 2003.04 27.63 553.44 percent of total billed charges 2003.04 2003.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED HELICAL 115MM 10.35MM GOLD TITANIUM STERILE LF CANNULATED SUP-04.038.315S CDM 270010022 LOCAL 0270 RC outpatient 2003.04 2003.04 2003.04 74 1482.25 percent of total billed charges 2003.04 93 1622.46 percent of total billed charges 2003.04 2003.04 other OPPS APC 2003.04 2003.04 other OPPS APC 2003.04 27.63 553.44 percent of total billed charges 2003.04 2003.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY FIXATION TFN-ADVANCED TITANIUM HELIX L120 MM OD10.35 MM CANNULATED STERILE GOLD PROXIMAL FEMORAL NAIL SYSTEM SUP-04.038.320S CDM 270010022 LOCAL 0270 RC outpatient 2003.04 2003.04 2003.04 74 1482.25 percent of total billed charges 2003.04 93 1622.46 percent of total billed charges 2003.04 2003.04 other OPPS APC 2003.04 2003.04 other OPPS APC 2003.04 27.63 553.44 percent of total billed charges 2003.04 2003.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TITANIUM HELIX L125 MM OD10.35 MM FEMUR PROXIMAL CANNULATED STERILE GOLD SUP-04.038.325S CDM 270010022 LOCAL 0270 RC outpatient 2003.04 2003.04 2003.04 74 1482.25 percent of total billed charges 2003.04 93 1622.46 percent of total billed charges 2003.04 2003.04 other OPPS APC 2003.04 2003.04 other OPPS APC 2003.04 27.63 553.44 percent of total billed charges 2003.04 2003.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TITANIUM HELIX L130 MM OD10.35 MM FEMUR PROXIMAL CANNULATED STERILE GOLD SUP-04.038.330S CDM 270010022 LOCAL 0270 RC outpatient 2003.04 2003.04 2003.04 74 1482.25 percent of total billed charges 2003.04 93 1622.46 percent of total billed charges 2003.04 2003.04 other OPPS APC 2003.04 2003.04 other OPPS APC 2003.04 27.63 553.44 percent of total billed charges 2003.04 2003.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L75 MM OD10.35 MM CANNULATED STERILE TAN SUP-04.038.375S CDM 0270 RC outpatient 1502.28 1502.28 1502.28 74 1111.69 percent of total billed charges 1502.28 93 1216.85 percent of total billed charges 1502.28 1502.28 other OPPS APC 1502.28 1502.28 other OPPS APC 1502.28 27.63 415.08 percent of total billed charges 1502.28 1502.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L80 MM OD10.35 MM CANNULATED STERILE TAN SUP-04.038.380S CDM 0270 RC outpatient 3785.73 3785.73 3785.73 74 2801.44 percent of total billed charges 3785.73 93 3066.44 percent of total billed charges 3785.73 3785.73 other OPPS APC 3785.73 3785.73 other OPPS APC 3785.73 27.63 1046 percent of total billed charges 3785.73 3785.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L85 MM OD10.35 MM CANNULATED STERILE TAN SUP-04.038.385S CDM 0270 RC outpatient 3785.73 3785.73 3785.73 74 2801.44 percent of total billed charges 3785.73 93 3066.44 percent of total billed charges 3785.73 3785.73 other OPPS APC 3785.73 3785.73 other OPPS APC 3785.73 27.63 1046 percent of total billed charges 3785.73 3785.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L90 MM OD10.35 MM CANNULATED STERILE TAN SUP-04.038.390S CDM 0270 RC outpatient 3785.73 3785.73 3785.73 74 2801.44 percent of total billed charges 3785.73 93 3066.44 percent of total billed charges 3785.73 3785.73 other OPPS APC 3785.73 3785.73 other OPPS APC 3785.73 27.63 1046 percent of total billed charges 3785.73 3785.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L95 MM OD10.35 MM CANNULATED STERILE TAN SUP-04.038.395S CDM 0270 RC outpatient 3785.73 3785.73 3785.73 74 2801.44 percent of total billed charges 3785.73 93 3066.44 percent of total billed charges 3785.73 3785.73 other OPPS APC 3785.73 3785.73 other OPPS APC 3785.73 27.63 1046 percent of total billed charges 3785.73 3785.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L100 MM OD10.35 MM CANNULATED STERILE TAN SUP-04.038.400S CDM 0270 RC outpatient 3785.73 3785.73 3785.73 74 2801.44 percent of total billed charges 3785.73 93 3066.44 percent of total billed charges 3785.73 3785.73 other OPPS APC 3785.73 3785.73 other OPPS APC 3785.73 27.63 1046 percent of total billed charges 3785.73 3785.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L105 MM OD10.35 MM CANNULATED STERILE TAN SUP-04.038.405S CDM 0270 RC outpatient 3785.73 3785.73 3785.73 74 2801.44 percent of total billed charges 3785.73 93 3066.44 percent of total billed charges 3785.73 3785.73 other OPPS APC 3785.73 3785.73 other OPPS APC 3785.73 27.63 1046 percent of total billed charges 3785.73 3785.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L110 MM OD10.35 MM CANNULATED STERILE TAN SUP-04.038.410S CDM 0270 RC outpatient 1502.28 1502.28 1502.28 74 1111.69 percent of total billed charges 1502.28 93 1216.85 percent of total billed charges 1502.28 1502.28 other OPPS APC 1502.28 1502.28 other OPPS APC 1502.28 27.63 415.08 percent of total billed charges 1502.28 1502.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L115 MM OD10.35 MM CANNULATED STERILE TAN SUP-04.038.415S CDM 0270 RC outpatient 1502.28 1502.28 1502.28 74 1111.69 percent of total billed charges 1502.28 93 1216.85 percent of total billed charges 1502.28 1502.28 other OPPS APC 1502.28 1502.28 other OPPS APC 1502.28 27.63 415.08 percent of total billed charges 1502.28 1502.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L120 MM OD10.35 MM CANNULATED STERILE TAN SUP-04.038.420S CDM 0270 RC outpatient 2003.04 2003.04 2003.04 74 1482.25 percent of total billed charges 2003.04 93 1622.46 percent of total billed charges 2003.04 2003.04 other OPPS APC 2003.04 2003.04 other OPPS APC 2003.04 27.63 553.44 percent of total billed charges 2003.04 2003.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L125 MM OD10.35 MM CANNULATED STERILE TAN SUP-04.038.425S CDM 0270 RC outpatient 1502.28 1502.28 1502.28 74 1111.69 percent of total billed charges 1502.28 93 1216.85 percent of total billed charges 1502.28 1502.28 other OPPS APC 1502.28 1502.28 other OPPS APC 1502.28 27.63 415.08 percent of total billed charges 1502.28 1502.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L26 MM OD5 MM LOCK STERILE INTRAMEDULLARY NAIL SUP-04.045.026S CDM 0270 RC outpatient 654.94 654.94 654.94 74 484.66 percent of total billed charges 654.94 93 530.5 percent of total billed charges 654.94 654.94 other OPPS APC 654.94 654.94 other OPPS APC 654.94 27.63 180.96 percent of total billed charges 654.94 654.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L28 MM OD5 MM LOCK STERILE INTRAMEDULLARY NAIL SUP-04.045.028S CDM 0270 RC outpatient 654.94 654.94 654.94 74 484.66 percent of total billed charges 654.94 93 530.5 percent of total billed charges 654.94 654.94 other OPPS APC 654.94 654.94 other OPPS APC 654.94 27.63 180.96 percent of total billed charges 654.94 654.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM XL25 L30 MM OD5 MM MEDULLARY LOCK STERILE LIGHT GREEN 4.2 MM DRILL TFN-ADVANCED PROXIMAL FEMORAL NAIL SYSTEM SUP-04.045.030S CDM 0270 RC outpatient 1206.66 1206.66 1206.66 74 892.93 percent of total billed charges 1206.66 93 977.39 percent of total billed charges 1206.66 1206.66 other OPPS APC 1206.66 1206.66 other OPPS APC 1206.66 27.63 333.4 percent of total billed charges 1206.66 1206.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L32 MM OD5 MM LOCK STERILE INTRAMEDULLARY NAIL SUP-04.045.032S CDM 0270 RC outpatient 1206.66 1206.66 1206.66 74 892.93 percent of total billed charges 1206.66 93 977.39 percent of total billed charges 1206.66 1206.66 other OPPS APC 1206.66 1206.66 other OPPS APC 1206.66 27.63 333.4 percent of total billed charges 1206.66 1206.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L34 MM OD5 MM LOCK STERILE INTRAMEDULLARY NAIL SUP-04.045.034S CDM 0270 RC outpatient 1206.66 1206.66 1206.66 74 892.93 percent of total billed charges 1206.66 93 977.39 percent of total billed charges 1206.66 1206.66 other OPPS APC 1206.66 1206.66 other OPPS APC 1206.66 27.63 333.4 percent of total billed charges 1206.66 1206.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L36 MM OD5 MM LOCK INTRAMEDULLARY NAIL SUP-04.045.036S CDM 0270 RC outpatient 1206.66 1206.66 1206.66 74 892.93 percent of total billed charges 1206.66 93 977.39 percent of total billed charges 1206.66 1206.66 other OPPS APC 1206.66 1206.66 other OPPS APC 1206.66 27.63 333.4 percent of total billed charges 1206.66 1206.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L38 MM OD5 MM LOCK INTRAMEDULLARY NAIL SUP-04.045.038S CDM 0270 RC outpatient 1206.66 1206.66 1206.66 74 892.93 percent of total billed charges 1206.66 93 977.39 percent of total billed charges 1206.66 1206.66 other OPPS APC 1206.66 1206.66 other OPPS APC 1206.66 27.63 333.4 percent of total billed charges 1206.66 1206.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L40 MM OD5 MM LOCK STERILE INTRAMEDULLARY NAIL SUP-04.045.040S CDM 0270 RC outpatient 1206.66 1206.66 1206.66 74 892.93 percent of total billed charges 1206.66 93 977.39 percent of total billed charges 1206.66 1206.66 other OPPS APC 1206.66 1206.66 other OPPS APC 1206.66 27.63 333.4 percent of total billed charges 1206.66 1206.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L42 MM OD5 MM LOCK STERILE INTRAMEDULLARY NAIL SUP-04.045.042S CDM 0270 RC outpatient 1206.66 1206.66 1206.66 74 892.93 percent of total billed charges 1206.66 93 977.39 percent of total billed charges 1206.66 1206.66 other OPPS APC 1206.66 1206.66 other OPPS APC 1206.66 27.63 333.4 percent of total billed charges 1206.66 1206.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L44 MM OD5 MM LOCK INTRAMEDULLARY NAIL SUP-04.045.044S CDM 0270 RC outpatient 1206.66 1206.66 1206.66 74 892.93 percent of total billed charges 1206.66 93 977.39 percent of total billed charges 1206.66 1206.66 other OPPS APC 1206.66 1206.66 other OPPS APC 1206.66 27.63 333.4 percent of total billed charges 1206.66 1206.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L46 MM OD5 MM LOCK STERILE INTRAMEDULLARY NAIL SUP-04.045.046S CDM 0270 RC outpatient 1206.66 1206.66 1206.66 74 892.93 percent of total billed charges 1206.66 93 977.39 percent of total billed charges 1206.66 1206.66 other OPPS APC 1206.66 1206.66 other OPPS APC 1206.66 27.63 333.4 percent of total billed charges 1206.66 1206.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L48 MM OD5 MM LOCK INTRAMEDULLARY NAIL SUP-04.045.048S CDM 0270 RC outpatient 654.94 654.94 654.94 74 484.66 percent of total billed charges 654.94 93 530.5 percent of total billed charges 654.94 654.94 other OPPS APC 654.94 654.94 other OPPS APC 654.94 27.63 180.96 percent of total billed charges 654.94 654.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L50 MM OD5 MM LOCK STERILE INTRAMEDULLARY NAIL SUP-04.045.050S CDM 0270 RC outpatient 738.3 738.3 738.3 74 546.34 percent of total billed charges 738.3 93 598.02 percent of total billed charges 738.3 738.3 other OPPS APC 738.3 738.3 other OPPS APC 738.3 27.63 203.99 percent of total billed charges 738.3 738.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L52 MM OD5 MM LOCK STERILE LATEX FREE DISPOSABLE INTRAMEDULLARY NAIL SUP-04.045.052S CDM 0270 RC outpatient 738.3 738.3 738.3 74 546.34 percent of total billed charges 738.3 93 598.02 percent of total billed charges 738.3 738.3 other OPPS APC 738.3 738.3 other OPPS APC 738.3 27.63 203.99 percent of total billed charges 738.3 738.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L54 MM OD5 MM LOCK STERILE INTRAMEDULLARY NAIL SUP-04.045.054S CDM 0270 RC outpatient 738.3 738.3 738.3 74 546.34 percent of total billed charges 738.3 93 598.02 percent of total billed charges 738.3 738.3 other OPPS APC 738.3 738.3 other OPPS APC 738.3 27.63 203.99 percent of total billed charges 738.3 738.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L56 MM OD5 MM LOCK STERILE INTRAMEDULLARY NAIL SUP-04.045.056S CDM 0270 RC outpatient 738.3 738.3 738.3 74 546.34 percent of total billed charges 738.3 93 598.02 percent of total billed charges 738.3 738.3 other OPPS APC 738.3 738.3 other OPPS APC 738.3 27.63 203.99 percent of total billed charges 738.3 738.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L58 MM OD5 MM LOCK INTRAMEDULLARY NAIL SUP-04.045.058S CDM 0270 RC outpatient 654.94 654.94 654.94 74 484.66 percent of total billed charges 654.94 93 530.5 percent of total billed charges 654.94 654.94 other OPPS APC 654.94 654.94 other OPPS APC 654.94 27.63 180.96 percent of total billed charges 654.94 654.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L50 MM OD5 MM LOCK STERILE INTRAMEDULLARY NAIL SUP-04.045.060S CDM 0270 RC outpatient 654.94 654.94 654.94 74 484.66 percent of total billed charges 654.94 93 530.5 percent of total billed charges 654.94 654.94 other OPPS APC 654.94 654.94 other OPPS APC 654.94 27.63 180.96 percent of total billed charges 654.94 654.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L62 MM OD5 MM LOCK STERILE INTRAMEDULLARY NAIL SUP-04.045.062S CDM 0270 RC outpatient 738.3 738.3 738.3 74 546.34 percent of total billed charges 738.3 93 598.02 percent of total billed charges 738.3 738.3 other OPPS APC 738.3 738.3 other OPPS APC 738.3 27.63 203.99 percent of total billed charges 738.3 738.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L64 MM OD5 MM LOCK STERILE INTRAMEDULLARY NAIL SUP-04.045.064S CDM 0270 RC outpatient 654.94 654.94 654.94 74 484.66 percent of total billed charges 654.94 93 530.5 percent of total billed charges 654.94 654.94 other OPPS APC 654.94 654.94 other OPPS APC 654.94 27.63 180.96 percent of total billed charges 654.94 654.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L66 MM OD5 MM LOCK STERILE INTRAMEDULLARY NAIL SUP-04.045.066S CDM 0270 RC outpatient 738.3 738.3 738.3 74 546.34 percent of total billed charges 738.3 93 598.02 percent of total billed charges 738.3 738.3 other OPPS APC 738.3 738.3 other OPPS APC 738.3 27.63 203.99 percent of total billed charges 738.3 738.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L68 MM OD5 MM LOCK STERILE INTRAMEDULLARY NAIL SUP-04.045.068S CDM 0270 RC outpatient 1206.66 1206.66 1206.66 74 892.93 percent of total billed charges 1206.66 93 977.39 percent of total billed charges 1206.66 1206.66 other OPPS APC 1206.66 1206.66 other OPPS APC 1206.66 27.63 333.4 percent of total billed charges 1206.66 1206.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L70 MM OD5 MM LOCK STERILE INTRAMEDULLARY NAIL SUP-04.045.070S CDM 0270 RC outpatient 1206.66 1206.66 1206.66 74 892.93 percent of total billed charges 1206.66 93 977.39 percent of total billed charges 1206.66 1206.66 other OPPS APC 1206.66 1206.66 other OPPS APC 1206.66 27.63 333.4 percent of total billed charges 1206.66 1206.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L72 MM OD5 MM LOCK STERILE INTRAMEDULLARY NAIL SUP-04.045.072S CDM 0270 RC outpatient 654.94 654.94 654.94 74 484.66 percent of total billed charges 654.94 93 530.5 percent of total billed charges 654.94 654.94 other OPPS APC 654.94 654.94 other OPPS APC 654.94 27.63 180.96 percent of total billed charges 654.94 654.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM ALUMINUM NIOBIUM XL25 L74 MM OD5 MM MEDULLARY LOCK STERILE LIGHT GREEN 4.2 MM DRILL TFN-ADVANCED PROXIMAL FEMORAL NAIL SYSTEM SUP-04.045.074S CDM 0270 RC outpatient 1206.66 1206.66 1206.66 74 892.93 percent of total billed charges 1206.66 93 977.39 percent of total billed charges 1206.66 1206.66 other OPPS APC 1206.66 1206.66 other OPPS APC 1206.66 27.63 333.4 percent of total billed charges 1206.66 1206.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L76 MM OD5 MM LOCK STERILE INTRAMEDULLARY NAIL SUP-04.045.076S CDM 0270 RC outpatient 1206.66 1206.66 1206.66 74 892.93 percent of total billed charges 1206.66 93 977.39 percent of total billed charges 1206.66 1206.66 other OPPS APC 1206.66 1206.66 other OPPS APC 1206.66 27.63 333.4 percent of total billed charges 1206.66 1206.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L78 MM OD5 MM LOCK STERILE INTRAMEDULLARY NAIL SUP-04.045.078S CDM 0270 RC outpatient 738.3 738.3 738.3 74 546.34 percent of total billed charges 738.3 93 598.02 percent of total billed charges 738.3 738.3 other OPPS APC 738.3 738.3 other OPPS APC 738.3 27.63 203.99 percent of total billed charges 738.3 738.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L80 MM OD5 MM LOCK STERILE INTRAMEDULLARY NAIL SUP-04.045.080S CDM 0270 RC outpatient 1206.66 1206.66 1206.66 74 892.93 percent of total billed charges 1206.66 93 977.39 percent of total billed charges 1206.66 1206.66 other OPPS APC 1206.66 1206.66 other OPPS APC 1206.66 27.63 333.4 percent of total billed charges 1206.66 1206.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XL25 L82 MM OD5 MM LOCK STERILE INTRAMEDULLARY NAIL SUP-04.045.082S CDM 0270 RC outpatient 738.3 738.3 738.3 74 546.34 percent of total billed charges 738.3 93 598.02 percent of total billed charges 738.3 738.3 other OPPS APC 738.3 738.3 other OPPS APC 738.3 27.63 203.99 percent of total billed charges 738.3 738.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM STRAIGHT WRIST 9 HOLE FUSION NONSTERILE SMALL FRAGMENT SET SUP-04.110.152 CDM 270010022 LOCAL 0270 RC outpatient 4889.17 4889.17 4889.17 74 3617.99 percent of total billed charges 4889.17 93 3960.23 percent of total billed charges 4889.17 4889.17 other OPPS APC 4889.17 4889.17 other OPPS APC 4889.17 27.63 1350.88 percent of total billed charges 4889.17 4889.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI TITANIUM L54 MM RADIUS RIGHT DISTAL VOLAR 6 HOLE HEAD 3 HOLE SHAFT 2 COLUMN VARIABLE ANGLE NONSTERILE 2.4 MM SCREW SUP-04.111.630 CDM 270010022 LOCAL 0270 RC outpatient 2853.24 2853.24 2853.24 74 2111.4 percent of total billed charges 2853.24 93 2311.12 percent of total billed charges 2853.24 2853.24 other OPPS APC 2853.24 2853.24 other OPPS APC 2853.24 27.63 788.35 percent of total billed charges 2853.24 2853.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T4 L11 MM OD1.5 MM HAND SELF TAP VARIABLE ANGLE LOCK STARDRIVE NONSTERILE PURPLE SUP-04.130.211 CDM 270010022 LOCAL 0270 RC outpatient 368.16 368.16 368.16 74 272.44 percent of total billed charges 368.16 93 298.21 percent of total billed charges 368.16 368.16 other OPPS APC 368.16 368.16 other OPPS APC 368.16 27.63 101.72 percent of total billed charges 368.16 368.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T6 L11 MM OD2 MM HAND SELF TAP VARIABLE ANGLE LOCK STARDRIVE NONSTERILE PURPLE SUP-04.130.311 CDM 270010022 LOCAL 0270 RC outpatient 382.2 382.2 382.2 74 282.83 percent of total billed charges 382.2 93 309.58 percent of total billed charges 382.2 382.2 other OPPS APC 382.2 382.2 other OPPS APC 382.2 27.63 105.6 percent of total billed charges 382.2 382.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T6 L12 MM OD2 MM HAND SELF TAP VARIABLE ANGLE LOCK STARDRIVE NONSTERILE PURPLE SUP-04.130.312 CDM 270010022 LOCAL 0270 RC outpatient 382.2 382.2 382.2 74 282.83 percent of total billed charges 382.2 93 309.58 percent of total billed charges 382.2 382.2 other OPPS APC 382.2 382.2 other OPPS APC 382.2 27.63 105.6 percent of total billed charges 382.2 382.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T6 L13 MM OD2 MM HAND SELF TAP VARIABLE ANGLE LOCK STARDRIVE NONSTERILE PURPLE SUP-04.130.313 CDM 270010022 LOCAL 0270 RC outpatient 382.2 382.2 382.2 74 282.83 percent of total billed charges 382.2 93 309.58 percent of total billed charges 382.2 382.2 other OPPS APC 382.2 382.2 other OPPS APC 382.2 27.63 105.6 percent of total billed charges 382.2 382.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM FEMUR NECK 1 HOLE STERILE SUP-04.168.000S CDM 0270 RC outpatient 2082.6 2082.6 2082.6 74 1541.12 percent of total billed charges 2082.6 93 1686.91 percent of total billed charges 2082.6 2082.6 other OPPS APC 2082.6 2082.6 other OPPS APC 2082.6 27.63 575.42 percent of total billed charges 2082.6 2082.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOLT ORTHOPEDIC L75 MM STERILE FEMORAL NECK SYSTEM SUP-04.168.275S CDM 0270 RC outpatient 1029.6 1029.6 1029.6 74 761.9 percent of total billed charges 1029.6 93 833.98 percent of total billed charges 1029.6 1029.6 other OPPS APC 1029.6 1029.6 other OPPS APC 1029.6 27.63 284.48 percent of total billed charges 1029.6 1029.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOLT ORTHOPEDIC L80 MM STERILE FEMORAL NECK SYSTEM SUP-04.168.280S CDM 0270 RC outpatient 1029.6 1029.6 1029.6 74 761.9 percent of total billed charges 1029.6 93 833.98 percent of total billed charges 1029.6 1029.6 other OPPS APC 1029.6 1029.6 other OPPS APC 1029.6 27.63 284.48 percent of total billed charges 1029.6 1029.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOLT ORTHOPEDIC TITANIUM ALLOY L85 MM STERILE FEMORAL NECK SYSTEM SUP-04.168.285S CDM 0270 RC outpatient 1029.6 1029.6 1029.6 74 761.9 percent of total billed charges 1029.6 93 833.98 percent of total billed charges 1029.6 1029.6 other OPPS APC 1029.6 1029.6 other OPPS APC 1029.6 27.63 284.48 percent of total billed charges 1029.6 1029.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOLT EXTERNAL FIXATION L90 MM STERILE FEMORAL NECK SYSTEM SUP-04.168.290S CDM 0270 RC outpatient 892.32 892.32 892.32 74 660.32 percent of total billed charges 892.32 93 722.78 percent of total billed charges 892.32 892.32 other OPPS APC 892.32 892.32 other OPPS APC 892.32 27.63 246.55 percent of total billed charges 892.32 892.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOLT EXTERNAL FIXATION L95 MM STERILE FEMORAL NECK SYSTEM SUP-04.168.295S CDM 0270 RC outpatient 1029.6 1029.6 1029.6 74 761.9 percent of total billed charges 1029.6 93 833.98 percent of total billed charges 1029.6 1029.6 other OPPS APC 1029.6 1029.6 other OPPS APC 1029.6 27.63 284.48 percent of total billed charges 1029.6 1029.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOLT EXTERNAL FIXATION L100 MM STERILE FEMORAL NECK SYSTEM SUP-04.168.300S CDM 0270 RC outpatient 1029.6 1029.6 1029.6 74 761.9 percent of total billed charges 1029.6 93 833.98 percent of total billed charges 1029.6 1029.6 other OPPS APC 1029.6 1029.6 other OPPS APC 1029.6 27.63 284.48 percent of total billed charges 1029.6 1029.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOLT EXTERNAL FIXATION L105 MM STERILE FEMORAL NECK SYSTEM SUP-04.168.305S CDM 0270 RC outpatient 1029.6 1029.6 1029.6 74 761.9 percent of total billed charges 1029.6 93 833.98 percent of total billed charges 1029.6 1029.6 other OPPS APC 1029.6 1029.6 other OPPS APC 1029.6 27.63 284.48 percent of total billed charges 1029.6 1029.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOLT EXTERNAL FIXATION L110 MM STERILE FEMORAL NECK SYSTEM SUP-04.168.310S CDM 0270 RC outpatient 1029.6 1029.6 1029.6 74 761.9 percent of total billed charges 1029.6 93 833.98 percent of total billed charges 1029.6 1029.6 other OPPS APC 1029.6 1029.6 other OPPS APC 1029.6 27.63 284.48 percent of total billed charges 1029.6 1029.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOLT EXTERNAL FIXATION L115 MM STERILE FEMORAL NECK SYSTEM SUP-04.168.315S CDM 0270 RC outpatient 1029.6 1029.6 1029.6 74 761.9 percent of total billed charges 1029.6 93 833.98 percent of total billed charges 1029.6 1029.6 other OPPS APC 1029.6 1029.6 other OPPS APC 1029.6 27.63 284.48 percent of total billed charges 1029.6 1029.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOLT EXTERNAL FIXATION L120 MM STERILE FEMORAL NECK SYSTEM SUP-04.168.320S CDM 0270 RC outpatient 1029.6 1029.6 1029.6 74 761.9 percent of total billed charges 1029.6 93 833.98 percent of total billed charges 1029.6 1029.6 other OPPS APC 1029.6 1029.6 other OPPS APC 1029.6 27.63 284.48 percent of total billed charges 1029.6 1029.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOLT EXTERNAL FIXATION L125 MM STERILE FEMORAL NECK SYSTEM SUP-04.168.325S CDM 0270 RC outpatient 1029.6 1029.6 1029.6 74 761.9 percent of total billed charges 1029.6 93 833.98 percent of total billed charges 1029.6 1029.6 other OPPS APC 1029.6 1029.6 other OPPS APC 1029.6 27.63 284.48 percent of total billed charges 1029.6 1029.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOLT ORTHOPEDIC L130 MM STERILE FEMORAL NECK SYSTEM SUP-04.168.330S CDM 0270 RC outpatient 1029.6 1029.6 1029.6 74 761.9 percent of total billed charges 1029.6 93 833.98 percent of total billed charges 1029.6 1029.6 other OPPS APC 1029.6 1029.6 other OPPS APC 1029.6 27.63 284.48 percent of total billed charges 1029.6 1029.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L75 MM ANTIROTATE STERILE FEMORAL NECK SYSTEM SUP-04.168.475S CDM 0270 RC outpatient 694.2 694.2 694.2 74 513.71 percent of total billed charges 694.2 93 562.3 percent of total billed charges 694.2 694.2 other OPPS APC 694.2 694.2 other OPPS APC 694.2 27.63 191.81 percent of total billed charges 694.2 694.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L80 MM ANTIROTATE STERILE FEMORAL NECK SYSTEM SUP-04.168.480S CDM 0270 RC outpatient 694.2 694.2 694.2 74 513.71 percent of total billed charges 694.2 93 562.3 percent of total billed charges 694.2 694.2 other OPPS APC 694.2 694.2 other OPPS APC 694.2 27.63 191.81 percent of total billed charges 694.2 694.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L85 MM ANTIROTATE STERILE FEMORAL NECK SYSTEM SUP-04.168.485S CDM 0270 RC outpatient 694.2 694.2 694.2 74 513.71 percent of total billed charges 694.2 93 562.3 percent of total billed charges 694.2 694.2 other OPPS APC 694.2 694.2 other OPPS APC 694.2 27.63 191.81 percent of total billed charges 694.2 694.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L90 MM ANTIROTATE STERILE FEMORAL NECK SYSTEM SUP-04.168.490S CDM 0270 RC outpatient 601.64 601.64 601.64 74 445.21 percent of total billed charges 601.64 93 487.33 percent of total billed charges 601.64 601.64 other OPPS APC 601.64 601.64 other OPPS APC 601.64 27.63 166.23 percent of total billed charges 601.64 601.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L95 MM ANTIROTATE STERILE FEMORAL NECK SYSTEM SUP-04.168.495S CDM 0270 RC outpatient 694.2 694.2 694.2 74 513.71 percent of total billed charges 694.2 93 562.3 percent of total billed charges 694.2 694.2 other OPPS APC 694.2 694.2 other OPPS APC 694.2 27.63 191.81 percent of total billed charges 694.2 694.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L100 MM ANTIROTATE STERILE FEMORAL NECK SYSTEM SUP-04.168.500S CDM 0270 RC outpatient 694.2 694.2 694.2 74 513.71 percent of total billed charges 694.2 93 562.3 percent of total billed charges 694.2 694.2 other OPPS APC 694.2 694.2 other OPPS APC 694.2 27.63 191.81 percent of total billed charges 694.2 694.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L105 MM ANTIROTATE STERILE FEMORAL NECK SYSTEM SUP-04.168.505S CDM 0270 RC outpatient 694.2 694.2 694.2 74 513.71 percent of total billed charges 694.2 93 562.3 percent of total billed charges 694.2 694.2 other OPPS APC 694.2 694.2 other OPPS APC 694.2 27.63 191.81 percent of total billed charges 694.2 694.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L110 MM ANTIROTATE STERILE FEMORAL NECK SYSTEM SUP-04.168.510S CDM 0270 RC outpatient 694.2 694.2 694.2 74 513.71 percent of total billed charges 694.2 93 562.3 percent of total billed charges 694.2 694.2 other OPPS APC 694.2 694.2 other OPPS APC 694.2 27.63 191.81 percent of total billed charges 694.2 694.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L115 MM ANTIROTATE STERILE FEMORAL NECK SYSTEM SUP-04.168.515S CDM 0270 RC outpatient 694.2 694.2 694.2 74 513.71 percent of total billed charges 694.2 93 562.3 percent of total billed charges 694.2 694.2 other OPPS APC 694.2 694.2 other OPPS APC 694.2 27.63 191.81 percent of total billed charges 694.2 694.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L120 MM ANTIROTATE STERILE FEMORAL NECK SYSTEM SUP-04.168.520S CDM 0270 RC outpatient 694.2 694.2 694.2 74 513.71 percent of total billed charges 694.2 93 562.3 percent of total billed charges 694.2 694.2 other OPPS APC 694.2 694.2 other OPPS APC 694.2 27.63 191.81 percent of total billed charges 694.2 694.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L125 MM ANTIROTATE STERILE FEMORAL NECK SYSTEM SUP-04.168.525S CDM 0270 RC outpatient 694.2 694.2 694.2 74 513.71 percent of total billed charges 694.2 93 562.3 percent of total billed charges 694.2 694.2 other OPPS APC 694.2 694.2 other OPPS APC 694.2 27.63 191.81 percent of total billed charges 694.2 694.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L130 MM ANTIROTATE STERILE FEMORAL NECK SYSTEM SUP-04.168.530S CDM 0270 RC outpatient 694.2 694.2 694.2 74 513.71 percent of total billed charges 694.2 93 562.3 percent of total billed charges 694.2 694.2 other OPPS APC 694.2 694.2 other OPPS APC 694.2 27.63 191.81 percent of total billed charges 694.2 694.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM T8 L16 MM OD2.4 MM RADIUS DISTAL VOLAR VARIABLE ANGLE LOCK STARDRIVE NONSTERILE SUP-04.210.116 CDM 270010022 LOCAL 0270 RC outpatient 425.88 425.88 425.88 74 315.15 percent of total billed charges 425.88 93 344.96 percent of total billed charges 425.88 425.88 other OPPS APC 425.88 425.88 other OPPS APC 425.88 27.63 117.67 percent of total billed charges 425.88 425.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L11 MM OD2 MM QUICK INSERTION SUP-04.228.511 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L12 MM OD2 MM QUICK INSERTION NONSTERILE SUP-04.228.512 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L13 MM OD2 MM QUICK INSERTION NONSTERILE SUP-04.228.513 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L14 MM OD2 MM QUICK INSERTION NONSTERILE SUP-04.228.514 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L15 MM OD2 MM QUICK INSERTION NONSTERILE SUP-04.228.515 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L16 MM OD2 MM QUICK INSERTION NONSTERILE SUP-04.228.516 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L17 MM OD2 MM QUICK INSERTION NONSTERILE SUP-04.228.517 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L18 MM OD2 MM QUICK INSERTION NONSTERILE SUP-04.228.518 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP END 0 MM STERILE RFN-ADVANCED SUP-04.233.000S CDM 0270 RC outpatient 535.6 535.6 535.6 74 396.34 percent of total billed charges 535.6 93 433.84 percent of total billed charges 535.6 535.6 other OPPS APC 535.6 535.6 other OPPS APC 535.6 27.63 147.99 percent of total billed charges 535.6 535.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP END 5 MM STERILE RFN-ADVANCED SUP-04.233.005S CDM 0270 RC outpatient 587.73 587.73 587.73 74 434.92 percent of total billed charges 587.73 93 476.06 percent of total billed charges 587.73 587.73 other OPPS APC 587.73 587.73 other OPPS APC 587.73 27.63 162.39 percent of total billed charges 587.73 587.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP END OD10 MM EXTENSION STERILE RFN-ADVANCED SUP-04.233.010S CDM 0270 RC outpatient 587.73 587.73 587.73 74 434.92 percent of total billed charges 587.73 93 476.06 percent of total billed charges 587.73 587.73 other OPPS APC 587.73 587.73 other OPPS APC 587.73 27.63 162.39 percent of total billed charges 587.73 587.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L160 MM OD10 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.017S CDM 0270 RC outpatient 5947.37 5947.37 5947.37 74 4401.05 percent of total billed charges 5947.37 93 4817.37 percent of total billed charges 5947.37 5947.37 other OPPS APC 5947.37 5947.37 other OPPS APC 5947.37 27.63 1643.26 percent of total billed charges 5947.37 5947.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L200 MM OD10 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.021S CDM 0270 RC outpatient 5947.37 5947.37 5947.37 74 4401.05 percent of total billed charges 5947.37 93 4817.37 percent of total billed charges 5947.37 5947.37 other OPPS APC 5947.37 5947.37 other OPPS APC 5947.37 27.63 1643.26 percent of total billed charges 5947.37 5947.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L240 MM OD10 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.025S CDM 0270 RC outpatient 5947.37 5947.37 5947.37 74 4401.05 percent of total billed charges 5947.37 93 4817.37 percent of total billed charges 5947.37 5947.37 other OPPS APC 5947.37 5947.37 other OPPS APC 5947.37 27.63 1643.26 percent of total billed charges 5947.37 5947.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED 10 D BEND L280 MM OD10 MM FEMORAL RETROGRADE STERILE SUP-04.233.029S CDM 0270 RC outpatient 5947.37 5947.37 5947.37 74 4401.05 percent of total billed charges 5947.37 93 4817.37 percent of total billed charges 5947.37 5947.37 other OPPS APC 5947.37 5947.37 other OPPS APC 5947.37 27.63 1643.26 percent of total billed charges 5947.37 5947.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 5 D BEND L300 MM OD10 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.030S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L300 MM OD10 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.031S CDM 0270 RC outpatient 11162.7 11162.7 11162.7 74 8260.41 percent of total billed charges 11162.7 93 9041.8 percent of total billed charges 11162.7 11162.7 other OPPS APC 11162.7 11162.7 other OPPS APC 11162.7 27.63 3084.26 percent of total billed charges 11162.7 11162.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 5 D BEND L320 MM OD10 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.032S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED 10 D BEND L320 MM OD MM STERILE SUP-04.233.033S CDM 0270 RC outpatient 5724.29 5724.29 5724.29 74 4235.97 percent of total billed charges 5724.29 93 4636.67 percent of total billed charges 5724.29 5724.29 other OPPS APC 5724.29 5724.29 other OPPS APC 5724.29 27.63 1581.62 percent of total billed charges 5724.29 5724.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED 5 D BEND L340 MM OD10 MM FEMORAL RETROGRADE STERILE SUP-04.233.034S CDM 0270 RC outpatient 10053.3 10053.3 10053.3 74 7439.43 percent of total billed charges 10053.3 93 8143.16 percent of total billed charges 10053.3 10053.3 other OPPS APC 10053.3 10053.3 other OPPS APC 10053.3 27.63 2777.72 percent of total billed charges 10053.3 10053.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L340 MM OD10 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.035S CDM 0270 RC outpatient 5724.29 5724.29 5724.29 74 4235.97 percent of total billed charges 5724.29 93 4636.67 percent of total billed charges 5724.29 5724.29 other OPPS APC 5724.29 5724.29 other OPPS APC 5724.29 27.63 1581.62 percent of total billed charges 5724.29 5724.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED 5 D BEND L360 MM OD10 MM FEMORAL RETROGRADE STERILE SUP-04.233.036S CDM 0270 RC outpatient 10053.3 10053.3 10053.3 74 7439.43 percent of total billed charges 10053.3 93 8143.16 percent of total billed charges 10053.3 10053.3 other OPPS APC 10053.3 10053.3 other OPPS APC 10053.3 27.63 2777.72 percent of total billed charges 10053.3 10053.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY 10 D BEND L360 MM OD10 MM STERILE RFNA SUP-04.233.037S CDM 0270 RC outpatient 11162.7 11162.7 11162.7 74 8260.41 percent of total billed charges 11162.7 93 9041.8 percent of total billed charges 11162.7 11162.7 other OPPS APC 11162.7 11162.7 other OPPS APC 11162.7 27.63 3084.26 percent of total billed charges 11162.7 11162.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 5 D BEND L380 MM OD10 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.038S CDM 0270 RC outpatient 10053.3 10053.3 10053.3 74 7439.43 percent of total billed charges 10053.3 93 8143.16 percent of total billed charges 10053.3 10053.3 other OPPS APC 10053.3 10053.3 other OPPS APC 10053.3 27.63 2777.72 percent of total billed charges 10053.3 10053.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L380 MM OD10 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.039S CDM 0270 RC outpatient 5724.29 5724.29 5724.29 74 4235.97 percent of total billed charges 5724.29 93 4636.67 percent of total billed charges 5724.29 5724.29 other OPPS APC 5724.29 5724.29 other OPPS APC 5724.29 27.63 1581.62 percent of total billed charges 5724.29 5724.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 5 D BEND L400 MM OD10 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.040S CDM 0270 RC outpatient 4687.8 4687.8 4687.8 74 3468.97 percent of total billed charges 4687.8 93 3797.12 percent of total billed charges 4687.8 4687.8 other OPPS APC 4687.8 4687.8 other OPPS APC 4687.8 27.63 1295.24 percent of total billed charges 4687.8 4687.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L400 MM OD10 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.041S CDM 0270 RC outpatient 5203.9 5203.9 5203.9 74 3850.89 percent of total billed charges 5203.9 93 4215.16 percent of total billed charges 5203.9 5203.9 other OPPS APC 5203.9 5203.9 other OPPS APC 5203.9 27.63 1437.84 percent of total billed charges 5203.9 5203.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 5 D BEND L420 MM OD10 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.042S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L420 MM OD10 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.043S CDM 0270 RC outpatient 5724.29 5724.29 5724.29 74 4235.97 percent of total billed charges 5724.29 93 4636.67 percent of total billed charges 5724.29 5724.29 other OPPS APC 5724.29 5724.29 other OPPS APC 5724.29 27.63 1581.62 percent of total billed charges 5724.29 5724.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED 5 D BEND L440 MM OD10 MM FEMORAL RETROGRADE STERILE SUP-04.233.044S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L440 MM OD10 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.045S CDM 0270 RC outpatient 5724.29 5724.29 5724.29 74 4235.97 percent of total billed charges 5724.29 93 4636.67 percent of total billed charges 5724.29 5724.29 other OPPS APC 5724.29 5724.29 other OPPS APC 5724.29 27.63 1581.62 percent of total billed charges 5724.29 5724.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L460 MM OD10 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.047S CDM 0270 RC outpatient 5947.37 5947.37 5947.37 74 4401.05 percent of total billed charges 5947.37 93 4817.37 percent of total billed charges 5947.37 5947.37 other OPPS APC 5947.37 5947.37 other OPPS APC 5947.37 27.63 1643.26 percent of total billed charges 5947.37 5947.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L480 MM OD10 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.049S CDM 0270 RC outpatient 5947.37 5947.37 5947.37 74 4401.05 percent of total billed charges 5947.37 93 4817.37 percent of total billed charges 5947.37 5947.37 other OPPS APC 5947.37 5947.37 other OPPS APC 5947.37 27.63 1643.26 percent of total billed charges 5947.37 5947.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 5 D BEND L300 MM OD11 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.130S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 5 D BEND L320 MM OD11 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.132S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED 5 D BEND L340 MM OD11 MM FEMUR STERILE SUP-04.233.134S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED 5 D BEND L360 MM OD11 MM FEMUR STERILE SUP-04.233.136S CDM 0270 RC outpatient 4687.8 4687.8 4687.8 74 3468.97 percent of total billed charges 4687.8 93 3797.12 percent of total billed charges 4687.8 4687.8 other OPPS APC 4687.8 4687.8 other OPPS APC 4687.8 27.63 1295.24 percent of total billed charges 4687.8 4687.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED 5 D BEND L380 MM OD11 MM FEMUR STERILE SUP-04.233.138S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED 5 D BEND L400 MM OD11 MM FEMUR STERILE SUP-04.233.140S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED 5 D BEND L420 MM OD11 MM FEMUR STERILE SUP-04.233.142S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED 5 D BEND L440 MM OD11 MM FEMUR STERILE SUP-04.233.144S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L160 MM OD12 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.217S CDM 0270 RC outpatient 5947.37 5947.37 5947.37 74 4401.05 percent of total billed charges 5947.37 93 4817.37 percent of total billed charges 5947.37 5947.37 other OPPS APC 5947.37 5947.37 other OPPS APC 5947.37 27.63 1643.26 percent of total billed charges 5947.37 5947.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L200 MM OD12 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.221S CDM 0270 RC outpatient 5947.37 5947.37 5947.37 74 4401.05 percent of total billed charges 5947.37 93 4817.37 percent of total billed charges 5947.37 5947.37 other OPPS APC 5947.37 5947.37 other OPPS APC 5947.37 27.63 1643.26 percent of total billed charges 5947.37 5947.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L240 MM OD12 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.225S CDM 0270 RC outpatient 5947.37 5947.37 5947.37 74 4401.05 percent of total billed charges 5947.37 93 4817.37 percent of total billed charges 5947.37 5947.37 other OPPS APC 5947.37 5947.37 other OPPS APC 5947.37 27.63 1643.26 percent of total billed charges 5947.37 5947.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L280 MM OD12 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.229S CDM 0270 RC outpatient 5947.37 5947.37 5947.37 74 4401.05 percent of total billed charges 5947.37 93 4817.37 percent of total billed charges 5947.37 5947.37 other OPPS APC 5947.37 5947.37 other OPPS APC 5947.37 27.63 1643.26 percent of total billed charges 5947.37 5947.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 5 D BEND L300 MM OD12 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.230S CDM 0270 RC outpatient 4687.8 4687.8 4687.8 74 3468.97 percent of total billed charges 4687.8 93 3797.12 percent of total billed charges 4687.8 4687.8 other OPPS APC 4687.8 4687.8 other OPPS APC 4687.8 27.63 1295.24 percent of total billed charges 4687.8 4687.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L300 MM OD12 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.231S CDM 0270 RC outpatient 5724.29 5724.29 5724.29 74 4235.97 percent of total billed charges 5724.29 93 4636.67 percent of total billed charges 5724.29 5724.29 other OPPS APC 5724.29 5724.29 other OPPS APC 5724.29 27.63 1581.62 percent of total billed charges 5724.29 5724.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 5 D BEND L320 MM OD12 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.232S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L320 MM OD12 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.233S CDM 0270 RC outpatient 5724.29 5724.29 5724.29 74 4235.97 percent of total billed charges 5724.29 93 4636.67 percent of total billed charges 5724.29 5724.29 other OPPS APC 5724.29 5724.29 other OPPS APC 5724.29 27.63 1581.62 percent of total billed charges 5724.29 5724.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED 5 D BEND L340 MM OD12 MM FEMORAL STERILE SUP-04.233.234S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L340 MM OD12 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.235S CDM 0270 RC outpatient 5724.29 5724.29 5724.29 74 4235.97 percent of total billed charges 5724.29 93 4636.67 percent of total billed charges 5724.29 5724.29 other OPPS APC 5724.29 5724.29 other OPPS APC 5724.29 27.63 1581.62 percent of total billed charges 5724.29 5724.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 5 D BEND L360 MM OD12 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.236S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L360 MM OD12 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.237S CDM 0270 RC outpatient 5724.29 5724.29 5724.29 74 4235.97 percent of total billed charges 5724.29 93 4636.67 percent of total billed charges 5724.29 5724.29 other OPPS APC 5724.29 5724.29 other OPPS APC 5724.29 27.63 1581.62 percent of total billed charges 5724.29 5724.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 5 D BEND L380 MM OD12 MM FEMUR DISTAL STERILE SUP-04.233.238S CDM 0270 RC outpatient 4687.8 4687.8 4687.8 74 3468.97 percent of total billed charges 4687.8 93 3797.12 percent of total billed charges 4687.8 4687.8 other OPPS APC 4687.8 4687.8 other OPPS APC 4687.8 27.63 1295.24 percent of total billed charges 4687.8 4687.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L380 MM OD12 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.239S CDM 0270 RC outpatient 5724.29 5724.29 5724.29 74 4235.97 percent of total billed charges 5724.29 93 4636.67 percent of total billed charges 5724.29 5724.29 other OPPS APC 5724.29 5724.29 other OPPS APC 5724.29 27.63 1581.62 percent of total billed charges 5724.29 5724.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 5 D BEND L400 MM OD12 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.240S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED 10 D BEND L400 MM OD12 MM FEMORAL STERILE SUP-04.233.241S CDM 0270 RC outpatient 5724.29 5724.29 5724.29 74 4235.97 percent of total billed charges 5724.29 93 4636.67 percent of total billed charges 5724.29 5724.29 other OPPS APC 5724.29 5724.29 other OPPS APC 5724.29 27.63 1581.62 percent of total billed charges 5724.29 5724.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 5 D BEND L420 MM OD12 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.242S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L420 MM OD12 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.243S CDM 0270 RC outpatient 5724.29 5724.29 5724.29 74 4235.97 percent of total billed charges 5724.29 93 4636.67 percent of total billed charges 5724.29 5724.29 other OPPS APC 5724.29 5724.29 other OPPS APC 5724.29 27.63 1581.62 percent of total billed charges 5724.29 5724.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 5 D BEND L440 MM OD12 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.244S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L440 MM OD12 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.245S CDM 0270 RC outpatient 5724.29 5724.29 5724.29 74 4235.97 percent of total billed charges 5724.29 93 4636.67 percent of total billed charges 5724.29 5724.29 other OPPS APC 5724.29 5724.29 other OPPS APC 5724.29 27.63 1581.62 percent of total billed charges 5724.29 5724.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L460 MM OD12 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.247S CDM 0270 RC outpatient 5947.37 5947.37 5947.37 74 4401.05 percent of total billed charges 5947.37 93 4817.37 percent of total billed charges 5947.37 5947.37 other OPPS APC 5947.37 5947.37 other OPPS APC 5947.37 27.63 1643.26 percent of total billed charges 5947.37 5947.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 10 D BEND L480 MM OD12 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.249S CDM 0270 RC outpatient 5947.37 5947.37 5947.37 74 4401.05 percent of total billed charges 5947.37 93 4817.37 percent of total billed charges 5947.37 5947.37 other OPPS APC 5947.37 5947.37 other OPPS APC 5947.37 27.63 1643.26 percent of total billed charges 5947.37 5947.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED 5 D BEND L300 MM OD9 MM FEMORAL STERILE SUP-04.233.930S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 5 D BEND L320 MM OD9 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.932S CDM 0270 RC outpatient 4687.8 4687.8 4687.8 74 3468.97 percent of total billed charges 4687.8 93 3797.12 percent of total billed charges 4687.8 4687.8 other OPPS APC 4687.8 4687.8 other OPPS APC 4687.8 27.63 1295.24 percent of total billed charges 4687.8 4687.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 5 D BEND L340 MM OD9 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.934S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 5 D BEND L360 MM OD9 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.936S CDM 0270 RC outpatient 4687.8 4687.8 4687.8 74 3468.97 percent of total billed charges 4687.8 93 3797.12 percent of total billed charges 4687.8 4687.8 other OPPS APC 4687.8 4687.8 other OPPS APC 4687.8 27.63 1295.24 percent of total billed charges 4687.8 4687.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED POLYETHYLENE TITANIUM ALUMINUM VANADIUM 5 D BEND L380 MM OD9 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.938S CDM 0270 RC outpatient 4687.8 4687.8 4687.8 74 3468.97 percent of total billed charges 4687.8 93 3797.12 percent of total billed charges 4687.8 4687.8 other OPPS APC 4687.8 4687.8 other OPPS APC 4687.8 27.63 1295.24 percent of total billed charges 4687.8 4687.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 5 D BEND L400 MM OD9 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.940S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 9 D BEND L420 MM OD9 MM FEMUR DISTAL RETROGRADE STERILE SUP-04.233.942S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY RFN-ADVANCED TITANIUM ALUMINUM VANADIUM 5 D BEND L440 MM OD9 MM FEMUR RETROGRADE STERILE SUP-04.233.944S CDM 0270 RC outpatient 5156.58 5156.58 5156.58 74 3815.87 percent of total billed charges 5156.58 93 4176.83 percent of total billed charges 5156.58 5156.58 other OPPS APC 5156.58 5156.58 other OPPS APC 5156.58 27.63 1424.76 percent of total billed charges 5156.58 5156.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE TWO HOLE FEMORAL NECK SUP-04.268.000S CDM 0270 RC outpatient 1804.92 1804.92 1804.92 74 1335.64 percent of total billed charges 1804.92 93 1461.99 percent of total billed charges 1804.92 1804.92 other OPPS APC 1804.92 1804.92 other OPPS APC 1804.92 27.63 498.7 percent of total billed charges 1804.92 1804.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LATERAL ENTRY ADOLESCENT FEMORAL RIGHT 8.2 MM X 300MM SUP-04.301.930S CDM 270010022 LOCAL 0270 RC outpatient 3839.26 3839.26 3839.26 74 2841.05 percent of total billed charges 3839.26 93 3109.8 percent of total billed charges 3839.26 3839.26 other OPPS APC 3839.26 3839.26 other OPPS APC 3839.26 27.63 1060.79 percent of total billed charges 3839.26 3839.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L10 MM OD2 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.010 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L12 MM OD2 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.012 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.0 MM HEADLESS CANNULATED COMP 14 MM SUP-04.333.014 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L16 MM OD2 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.016 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L18 MM OD2 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.018 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L20 MM OD2 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.020 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L22 MM OD2 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.022 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L24 MM OD2 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.024 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L26 MM OD2 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.026 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L28 MM OD2 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.028 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L30 MM OD2 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.030 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L10 MM OD2.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.110 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L12 MM OD2.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.112 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L14 MM OD2.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.114 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L16 MM OD2.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.116 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L18 MM OD2.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.1181 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L20 MM L5 MM OD2.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.120 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L22 MM L6 MM OD2.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.122 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L24 MM L6 MM OD2.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.124 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L26 MM L7 MM OD2.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.126 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L28 MM L7 MM OD2.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.128 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L30 MM L8 MM OD2.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.130 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L32 MM L8 MM OD2.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.132 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L34 MM L9 MM OD2.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.134 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L36 MM L9 MM OD2.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.136 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L38 MM L10 MM OD2.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.138 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.5MM CANNULATED COMPRESSION HEADLESS 40MM SUP-04.333.140 CDM 270010022 LOCAL 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L10 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.210 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L12 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.212 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L14 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.214 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L16 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.216 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L18 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.218 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L20 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.220 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L22 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.222 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L24 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.224 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L26 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.226 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L28 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.228 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L30 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.230 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L32 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.232 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L34 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.234 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L36 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.236 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L38 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.238 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L40 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.240 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0MM CANNULATED COMPRESSION HEADLESS 20MM SUP-04.333.320 CDM 270010022 LOCAL 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L22 MM OD3.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.322 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L24 MM L6 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.324 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5MM CANNULATED COMPRESSION HEADLESS 26MM SUP-04.333.326 CDM 270010022 LOCAL 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L28 MM L7 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.328 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L30 MM L8 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.330 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L32 MM L8 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.332 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L34 MM L9 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.334 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L36 MM L9 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.336 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L38 MM L10 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.338 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L40 MM L10 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.340 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L42 MM L11 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.342 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L44 MM L11 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.344 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L46 MM L12 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.346 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L48 MM L12 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.348 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L50 MM L13 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.350 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP 24MM SUP-04.333.424 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATE COMP 26MM SUP-04.333.426 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP 28MM SUP-04.333.428 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP 30MM SUP-04.333.430 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP 32MM SUP-04.333.432 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP 34MM SUP-04.333.434 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP 36MM SUP-04.333.436 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP 38MM SUP-04.333.438 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP 40MM SUP-04.333.440 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP 42MM SUP-04.333.442 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP 44MM SUP-04.333.444 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP 46MM SUP-04.333.446 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP 48MM SUP-04.333.448 CDM 0270 RC outpatient 1108.64 1108.64 1108.64 74 820.39 percent of total billed charges 1108.64 93 898 percent of total billed charges 1108.64 1108.64 other OPPS APC 1108.64 1108.64 other OPPS APC 1108.64 27.63 306.32 percent of total billed charges 1108.64 1108.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP 50MM SUP-04.333.450 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L30 MM OD4.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.530 CDM 270010022 LOCAL 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L34 MM OD4.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.534 CDM 270010022 LOCAL 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L46 MM OD4.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.546 CDM 270010022 LOCAL 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L70 MM OD4.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.570 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L30 MM OD5.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.630 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L34 MM OD5.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.634 CDM 0270 RC outpatient 3390.14 3390.14 3390.14 74 2508.7 percent of total billed charges 3390.14 93 2746.01 percent of total billed charges 3390.14 3390.14 other OPPS APC 3390.14 3390.14 other OPPS APC 3390.14 27.63 936.7 percent of total billed charges 3390.14 3390.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L36 MM OD5.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.636 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L38 MM OD5.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.638 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L48 MM OD5.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.648 CDM 0270 RC outpatient 3390.14 3390.14 3390.14 74 2508.7 percent of total billed charges 3390.14 93 2746.01 percent of total billed charges 3390.14 3390.14 other OPPS APC 3390.14 3390.14 other OPPS APC 3390.14 27.63 936.7 percent of total billed charges 3390.14 3390.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L50 MM OD5.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.650 CDM 270010022 LOCAL 0270 RC outpatient 3390.14 3390.14 3390.14 74 2508.7 percent of total billed charges 3390.14 93 2746.01 percent of total billed charges 3390.14 3390.14 other OPPS APC 3390.14 3390.14 other OPPS APC 3390.14 27.63 936.7 percent of total billed charges 3390.14 3390.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L55 MM OD5.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.655 CDM 270010022 LOCAL 0270 RC outpatient 3390.14 3390.14 3390.14 74 2508.7 percent of total billed charges 3390.14 93 2746.01 percent of total billed charges 3390.14 3390.14 other OPPS APC 3390.14 3390.14 other OPPS APC 3390.14 27.63 936.7 percent of total billed charges 3390.14 3390.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L60 MM OD5.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.660 CDM 0270 RC outpatient 3390.14 3390.14 3390.14 74 2508.7 percent of total billed charges 3390.14 93 2746.01 percent of total billed charges 3390.14 3390.14 other OPPS APC 3390.14 3390.14 other OPPS APC 3390.14 27.63 936.7 percent of total billed charges 3390.14 3390.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L65 MM OD5.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.665 CDM 0270 RC outpatient 3390.14 3390.14 3390.14 74 2508.7 percent of total billed charges 3390.14 93 2746.01 percent of total billed charges 3390.14 3390.14 other OPPS APC 3390.14 3390.14 other OPPS APC 3390.14 27.63 936.7 percent of total billed charges 3390.14 3390.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L65 MM OD5.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.670 CDM 0270 RC outpatient 3390.14 3390.14 3390.14 74 2508.7 percent of total billed charges 3390.14 93 2746.01 percent of total billed charges 3390.14 3390.14 other OPPS APC 3390.14 3390.14 other OPPS APC 3390.14 27.63 936.7 percent of total billed charges 3390.14 3390.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L80 MM OD5.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.680 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L85 MM OD5.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.685 CDM 0270 RC outpatient 3390.14 3390.14 3390.14 74 2508.7 percent of total billed charges 3390.14 93 2746.01 percent of total billed charges 3390.14 3390.14 other OPPS APC 3390.14 3390.14 other OPPS APC 3390.14 27.63 936.7 percent of total billed charges 3390.14 3390.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L110 MM OD6.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.702 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L50 MM OD6.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.750 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM SHORT THREAD L55 MM L16 MM OD6.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.333.755 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L65 MM OD6.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.765 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L110 MM OD7.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.333.802 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM NIOBIUM ALUMINUM T30 SHORT THREAD L80 MM L16 MM OD7.5 MM COMPRESSION SELF TAP SELF DRILL CANNULATED NONSTERILE SUP-04.333.880 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L20 MM L8 MM OD2.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.120 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L22 MM L9 MM OD2.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.122 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L24 MM L10 MM OD2.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.124 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L26 MM L10 MM OD2.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.126 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L28 MM L11 MM OD2.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.128 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L30 MM L12 MM OD2.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.130 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L32 MM L13 MM OD2.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.132 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L34 MM L14 MM OD2.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.134 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L36 MM L14 MM OD2.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.136 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L38 MM L15 MM OD2.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.138 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L40 MM L16 MM OD2.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.140 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L20 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.220 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 MM HEADLESS CANNULATED COMP LONG THREAT 22 MM SUP-04.334.222 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L24 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.224 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L26 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.226 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L28 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.228 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L30 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.230 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L32 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.232 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L34 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.234 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L36 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.236 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L38 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.238 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L40 MM OD3 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.240 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L24 MM L10 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.324 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L26 MM L10 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.326 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L28 MM L11 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.328 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L30 MM L12 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.330 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L32 MM L13 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.332 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5MM CANNULATED COMPRESSION HEADLESS 34MM SUP-04.334.334 CDM 270010022 LOCAL 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L36 MM L14 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.336 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L38 MM L15 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.338 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L40 MM L16 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.340 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L42 MM L17 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.342 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5MM CANNULATED COMPRESSION HEADLESS 44MM SUP-04.334.344 CDM 270010022 LOCAL 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L46 MM L18 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.346 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE TITANIUM LONG THREAD L48 MM L19 MM OD3.5 MM COMPRESSION SELF TAP, SELF DRILL CANNULATED NONSTERILE" SUP-04.334.348 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5MM CANNULATED COMPRESSION HEADLESS 50MM SUP-04.334.350 CDM 270010022 LOCAL 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP LONG THREAD 24MM SUP-04.334.424 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP LONG THREAD 26MM SUP-04.334.426 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP LONG THREAD 28MM SUP-04.334.428 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP LONG THREAD 30MM SUP-04.334.430 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP LONG THREAD 32MM SUP-04.334.432 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP LONG THREAD 34MM SUP-04.334.434 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP LONG THREAD 36MM SUP-04.334.436 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP LONG THREAD 38MM SUP-04.334.438 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP LONG THREAD 40MM SUP-04.334.440 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP LONG THREAD 42MM SUP-04.334.442 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP LONG THREAD 44MM SUP-04.334.444 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP LONG THREAD 46MM SUP-04.334.446 CDM 0270 RC outpatient 2011.1 2011.1 2011.1 74 1488.21 percent of total billed charges 2011.1 93 1628.99 percent of total billed charges 2011.1 2011.1 other OPPS APC 2011.1 2011.1 other OPPS APC 2011.1 27.63 555.67 percent of total billed charges 2011.1 2011.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP LONG THREAD 48MM SUP-04.334.448 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM HEADLESS CANNULATED COMP LONG THREAD 50MM SUP-04.334.450 CDM 0270 RC outpatient 1138.8 1138.8 1138.8 74 842.71 percent of total billed charges 1138.8 93 922.43 percent of total billed charges 1138.8 1138.8 other OPPS APC 1138.8 1138.8 other OPPS APC 1138.8 27.63 314.65 percent of total billed charges 1138.8 1138.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L36 MM OD4.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.536 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L38 MM OD4.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.538 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L40 MM OD4.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.540 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L50 MM OD4.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.550 CDM 0270 RC outpatient 986.96 986.96 986.96 74 730.35 percent of total billed charges 986.96 93 799.44 percent of total billed charges 986.96 986.96 other OPPS APC 986.96 986.96 other OPPS APC 986.96 27.63 272.7 percent of total billed charges 986.96 986.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L36 MM OD5.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.636 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L42 MM OD5.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.642 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L46 MM OD5.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.646 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L50 MM OD5.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.650 CDM 0270 RC outpatient 3390.14 3390.14 3390.14 74 2508.7 percent of total billed charges 3390.14 93 2746.01 percent of total billed charges 3390.14 3390.14 other OPPS APC 3390.14 3390.14 other OPPS APC 3390.14 27.63 936.7 percent of total billed charges 3390.14 3390.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L55 MM OD5.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.655 CDM 0270 RC outpatient 3390.14 3390.14 3390.14 74 2508.7 percent of total billed charges 3390.14 93 2746.01 percent of total billed charges 3390.14 3390.14 other OPPS APC 3390.14 3390.14 other OPPS APC 3390.14 27.63 936.7 percent of total billed charges 3390.14 3390.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L60 MM OD5.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.660 CDM 0270 RC outpatient 3390.14 3390.14 3390.14 74 2508.7 percent of total billed charges 3390.14 93 2746.01 percent of total billed charges 3390.14 3390.14 other OPPS APC 3390.14 3390.14 other OPPS APC 3390.14 27.63 936.7 percent of total billed charges 3390.14 3390.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L65 MM OD5.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.665 CDM 0270 RC outpatient 3390.14 3390.14 3390.14 74 2508.7 percent of total billed charges 3390.14 93 2746.01 percent of total billed charges 3390.14 3390.14 other OPPS APC 3390.14 3390.14 other OPPS APC 3390.14 27.63 936.7 percent of total billed charges 3390.14 3390.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L110 MM OD6.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.702 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L70 MM OD6.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.770 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L75 MM OD6.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.775 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L80 MM OD6.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.780 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L85 MM OD6.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.785 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L50 MM OD7.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.850 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L55 MM OD7.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.855 CDM 0270 RC outpatient 3390.14 3390.14 3390.14 74 2508.7 percent of total billed charges 3390.14 93 2746.01 percent of total billed charges 3390.14 3390.14 other OPPS APC 3390.14 3390.14 other OPPS APC 3390.14 27.63 936.7 percent of total billed charges 3390.14 3390.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L65 MM OD7.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.865 CDM 0270 RC outpatient 3390.14 3390.14 3390.14 74 2508.7 percent of total billed charges 3390.14 93 2746.01 percent of total billed charges 3390.14 3390.14 other OPPS APC 3390.14 3390.14 other OPPS APC 3390.14 27.63 936.7 percent of total billed charges 3390.14 3390.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L75 MM OD7.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.875 CDM 0270 RC outpatient 3390.14 3390.14 3390.14 74 2508.7 percent of total billed charges 3390.14 93 2746.01 percent of total billed charges 3390.14 3390.14 other OPPS APC 3390.14 3390.14 other OPPS APC 3390.14 27.63 936.7 percent of total billed charges 3390.14 3390.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L80 MM OD7.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.880 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L85 MM OD7.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.885 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L90 MM OD7.5 MM COMPRESSION CANNULATED NONSTERILE SUP-04.334.890 CDM 0270 RC outpatient 1662.96 1662.96 1662.96 74 1230.59 percent of total billed charges 1662.96 93 1347 percent of total billed charges 1662.96 1662.96 other OPPS APC 1662.96 1662.96 other OPPS APC 1662.96 27.63 459.48 percent of total billed charges 1662.96 1662.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL TITANIUM STRAIGHT H24 MM OD6 MM STERILE SUP-04.402.006S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL TITANIUM STRAIGHT H26 MM OD7 MM STERILE SUP-04.402.007S CDM 270010022 LOCAL 0270 RC outpatient 74144.2 74144.2 74144.2 74 54866.7 percent of total billed charges 74144.2 93 60056.8 percent of total billed charges 74144.2 74144.2 other OPPS APC 74144.2 74144.2 other OPPS APC 74144.2 27.63 20486 percent of total billed charges 74144.2 74144.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL TITANIUM STRAIGHT H28 MM OD8 MM STERILE SUP-04.402.008S CDM 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL TITANIUM STRAIGHT H30 MM OD9 MM STERILE SUP-04.402.009S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL TITANIUM STRAIGHT FLUTE BEVEL L32 MM OD10 MM ELBOW THIN COLLAR AID ROUGHENED SURFACE STERILE SUP-04.402.010S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HEAD RADIAL 22MM COCR, STD HEIGHT" SUP-04.402.022S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL TITANIUM CURVE H40 MM OD6 MM STERILE SUP-04.402.026 CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL TITANIUM CURVE FLUTE BEVEL L42 MM OD7 MM ELBOW THIN COLLAR AID ROUGHENED SURFACE STERILE SUP-04.402.027S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL TITANIUM CURVE L44 MM OD8 MM STERILE SUP-04.402.028S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL TITANIUM CURVE H46 MM OD9 MM STERILE SUP-04.402.029S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL TITANIUM CURVE FLUTE BEVEL L48 MM OD10 MM ELBOW THIN COLLAR AID ROUGHENED SURFACE STERILE SUP-04.402.030S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HEAD RADIAL 22MM COCR, 6MM HT EXTENSION" SUP-04.402.622S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MATRIXRIB 1.5MM LIGHT BLUE TITANIUM NS SIXTH RIB SEVENTH RIB LEFT 17 HOLE PRECONTOUR LOCK LOW PROFILE SUP-04.501.005 CDM 0270 RC outpatient 4752.62 4752.62 4752.62 74 3516.94 percent of total billed charges 4752.62 93 3849.62 percent of total billed charges 4752.62 4752.62 other OPPS APC 4752.62 4752.62 other OPPS APC 4752.62 27.63 1313.15 percent of total billed charges 4752.62 4752.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MATRIXRIB 1.5MM LIGHT BLUE TITANIUM NS EIGHTH RIB NINTH RIB LEFT 18 HOLE PRECONTOUR LOCK LOW PROFILE SUP-04.501.007 CDM 0270 RC outpatient 4752.62 4752.62 4752.62 74 3516.94 percent of total billed charges 4752.62 93 3849.62 percent of total billed charges 4752.62 4752.62 other OPPS APC 4752.62 4752.62 other OPPS APC 4752.62 27.63 1313.15 percent of total billed charges 4752.62 4752.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MATRIXRIB 1.5MM ROSE RED TITANIUM NS EIGHTH RIB NINTH RIB RIGHT 18 HOLE PRECONTOUR LOCK LOW PROFILE SUP-04.501.008 CDM 0270 RC outpatient 4752.62 4752.62 4752.62 74 3516.94 percent of total billed charges 4752.62 93 3849.62 percent of total billed charges 4752.62 4752.62 other OPPS APC 4752.62 4752.62 other OPPS APC 4752.62 27.63 1313.15 percent of total billed charges 4752.62 4752.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MATRIXRIB TITANIUM UNIVERSAL 8 HOLE NONSTERILE SUP-04.501.009 CDM 0270 RC outpatient 3238.3 3238.3 3238.3 74 2396.34 percent of total billed charges 3238.3 93 2623.02 percent of total billed charges 3238.3 3238.3 other OPPS APC 3238.3 3238.3 other OPPS APC 3238.3 27.63 894.74 percent of total billed charges 3238.3 3238.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT FIXATION MATRIXRIB TITANIUM SMALL W3 MM INTRAMEDULLARY SPLINT NONSTERILE SUP-04.501.010 CDM 0270 RC outpatient 1718.44 1718.44 1718.44 74 1271.65 percent of total billed charges 1718.44 93 1391.94 percent of total billed charges 1718.44 1718.44 other OPPS APC 1718.44 1718.44 other OPPS APC 1718.44 27.63 474.8 percent of total billed charges 1718.44 1718.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT FIXATION MATRIXRIB MED 4MM TITANIUM NS INTRAMEDULLARY SPLINT SUP-04.501.011 CDM 0270 RC outpatient 1718.44 1718.44 1718.44 74 1271.65 percent of total billed charges 1718.44 93 1391.94 percent of total billed charges 1718.44 1718.44 other OPPS APC 1718.44 1718.44 other OPPS APC 1718.44 27.63 474.8 percent of total billed charges 1718.44 1718.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MATRIXRIB TITANIUM L6 MM OD2.9 MM RIB SELF TAP LOCK NONSTERILE SUP-04.501.016.01 CDM 0270 RC outpatient 598.57 598.57 598.57 74 442.94 percent of total billed charges 598.57 93 484.84 percent of total billed charges 598.57 598.57 other OPPS APC 598.57 598.57 other OPPS APC 598.57 27.63 165.38 percent of total billed charges 598.57 598.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MATRIXRIB TITANIUM L8 MM OD2.9 MM RIB SELF TAP LOCK NONSTERILE SUP-04.501.018.01 CDM 0270 RC outpatient 598.57 598.57 598.57 74 442.94 percent of total billed charges 598.57 93 484.84 percent of total billed charges 598.57 598.57 other OPPS APC 598.57 598.57 other OPPS APC 598.57 27.63 165.38 percent of total billed charges 598.57 598.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MATRIXRIB TITANIUM L8 MM OD2.9 MM RIB SELF TAP LOCK NONSTERILE SUP-04.501.018.05 CDM 0270 RC outpatient 2984.51 2984.51 2984.51 74 2208.54 percent of total billed charges 2984.51 93 2417.45 percent of total billed charges 2984.51 2984.51 other OPPS APC 2984.51 2984.51 other OPPS APC 2984.51 27.63 824.62 percent of total billed charges 2984.51 2984.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MATRIXRIB TITANIUM L10 MM OD2.9 MM THORAX SELF TAP LOCK NONSTERILE SUP-04.501.020.01 CDM 0270 RC outpatient 598.57 598.57 598.57 74 442.94 percent of total billed charges 598.57 93 484.84 percent of total billed charges 598.57 598.57 other OPPS APC 598.57 598.57 other OPPS APC 598.57 27.63 165.38 percent of total billed charges 598.57 598.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MATRIXRIB TITANIUM L12 MM OD2.9 MM SELF TAP LOCK NONSTERILE SUP-04.501.022.01 CDM 0270 RC outpatient 598.57 598.57 598.57 74 442.94 percent of total billed charges 598.57 93 484.84 percent of total billed charges 598.57 598.57 other OPPS APC 598.57 598.57 other OPPS APC 598.57 27.63 165.38 percent of total billed charges 598.57 598.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MATRIXRIB TITANIUM L6 MM OD2.9 MM SELF TAPPING LOCKING NONSTERILE SUP-04.501.036.01 CDM 0270 RC outpatient 334.83 334.83 334.83 74 247.77 percent of total billed charges 334.83 93 271.21 percent of total billed charges 334.83 334.83 other OPPS APC 334.83 334.83 other OPPS APC 334.83 27.63 92.51 percent of total billed charges 334.83 334.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MATRIXRIB TITANIUM L10 MM OD2.9 MM RIB SELF TAP NONSTERILE SUP-04.501.040.01 CDM 0270 RC outpatient 344.84 344.84 344.84 74 255.18 percent of total billed charges 344.84 93 279.32 percent of total billed charges 344.84 344.84 other OPPS APC 344.84 344.84 other OPPS APC 344.84 27.63 95.28 percent of total billed charges 344.84 344.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L10 MM OD3 MM STERNAL SELF DRILL LOCK NONSTERILE FIXATION SYSTEM SUP-04.501.110.01 CDM 0270 RC outpatient 297.26 297.26 297.26 74 219.97 percent of total billed charges 297.26 93 240.78 percent of total billed charges 297.26 297.26 other OPPS APC 297.26 297.26 other OPPS APC 297.26 27.63 82.13 percent of total billed charges 297.26 297.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L12 MM OD3 MM STERNAL SELF DRILL LOCK NONSTERILE FIXATION SYSTEM SUP-04.501.112.01 CDM 0270 RC outpatient 297.26 297.26 297.26 74 219.97 percent of total billed charges 297.26 93 240.78 percent of total billed charges 297.26 297.26 other OPPS APC 297.26 297.26 other OPPS APC 297.26 27.63 82.13 percent of total billed charges 297.26 297.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L14 MM OD3 MM STERNAL SELF DRILL LOCK NONSTERILE FIXATION SYSTEM SUP-04.501.114.01 CDM 0270 RC outpatient 954.2 954.2 954.2 74 706.11 percent of total billed charges 954.2 93 772.9 percent of total billed charges 954.2 954.2 other OPPS APC 954.2 954.2 other OPPS APC 954.2 27.63 263.65 percent of total billed charges 954.2 954.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L16 MM OD3 MM STERNAL SELF DRILL LOCK NONSTERILE FIXATION SYSTEM SUP-04.501.116.01 CDM 0270 RC outpatient 759.2 759.2 759.2 74 561.81 percent of total billed charges 759.2 93 614.95 percent of total billed charges 759.2 759.2 other OPPS APC 759.2 759.2 other OPPS APC 759.2 27.63 209.77 percent of total billed charges 759.2 759.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L18 MM OD3 MM STERNAL SELF DRILL LOCK NONSTERILE FIXATION SYSTEM SUP-04.501.118.01 CDM 0270 RC outpatient 759.2 759.2 759.2 74 561.81 percent of total billed charges 759.2 93 614.95 percent of total billed charges 759.2 759.2 other OPPS APC 759.2 759.2 other OPPS APC 759.2 27.63 209.77 percent of total billed charges 759.2 759.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER BURR HOLE MATRIXNEURO TITANIUM H.4 MM OD15 MM CRANIOMAXILLOFACIAL NONSTERILE BLUE SUP-04.503.022 CDM 270010013 LOCAL 0270 RC outpatient 1255.8 1255.8 1255.8 74 929.29 percent of total billed charges 1255.8 93 1017.2 percent of total billed charges 1255.8 1255.8 other OPPS APC 1255.8 1255.8 other OPPS APC 1255.8 27.63 346.98 percent of total billed charges 1255.8 1255.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER BURR HOLE MATRIXNEURO TITANIUM H.4 MM OD17 MM CRANIOMAXILLOFACIAL BLUE SUP-04.503.023 CDM 270010013 LOCAL 0270 RC outpatient 1320.8 1320.8 1320.8 74 977.39 percent of total billed charges 1320.8 93 1069.85 percent of total billed charges 1320.8 1320.8 other OPPS APC 1320.8 1320.8 other OPPS APC 1320.8 27.63 364.94 percent of total billed charges 1320.8 1320.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER BURR HOLE MATRIXNEURO TITANIUM OD24 MM CRANIAL BLUE SUP-04.503.024 CDM 270010013 LOCAL 0270 RC outpatient 1320.8 1320.8 1320.8 74 977.39 percent of total billed charges 1320.8 93 1069.85 percent of total billed charges 1320.8 1320.8 other OPPS APC 1320.8 1320.8 other OPPS APC 1320.8 27.63 364.94 percent of total billed charges 1320.8 1320.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TI MATRIXNEURO BURR HOLE COVER 15MM FOR SHUNT SUP-04.503.027 CDM 270010013 LOCAL 0270 RC outpatient 1255.8 1255.8 1255.8 74 929.29 percent of total billed charges 1255.8 93 1017.2 percent of total billed charges 1255.8 1255.8 other OPPS APC 1255.8 1255.8 other OPPS APC 1255.8 27.63 346.98 percent of total billed charges 1255.8 1255.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER BURR HOLE MATRIXNEURO TITANIUM OD17 MM SHUNT NONSTERILE BLUE SUP-04.503.028 CDM 270010013 LOCAL 0270 RC outpatient 1320.8 1320.8 1320.8 74 977.39 percent of total billed charges 1320.8 93 1069.85 percent of total billed charges 1320.8 1320.8 other OPPS APC 1320.8 1320.8 other OPPS APC 1320.8 27.63 364.94 percent of total billed charges 1320.8 1320.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER BURR HOLE MATRIXNEURO TITANIUM H.4 MM OD24 MM CRANIOMAXILLOFACIAL NONSTERILE BLUE SHUNT SUP-04.503.029 CDM 270010013 LOCAL 0270 RC outpatient 1320.8 1320.8 1320.8 74 977.39 percent of total billed charges 1320.8 93 1069.85 percent of total billed charges 1320.8 1320.8 other OPPS APC 1320.8 1320.8 other OPPS APC 1320.8 27.63 364.94 percent of total billed charges 1320.8 1320.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH CRANIAL MATRIXNEURO TITANIUM CONTOUR H.4 MM TEMPORAL NONSTERILE SILVER SUP-04.503.057 CDM 270010013 LOCAL 0270 RC outpatient 4243.2 4243.2 4243.2 74 3139.97 percent of total billed charges 4243.2 93 3436.99 percent of total billed charges 4243.2 4243.2 other OPPS APC 1883.65 1883.65 other OPPS APC 4243.2 27.63 1172.4 percent of total billed charges 1883.65 4243.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH CRANIAL MATRIXNEURO TITANIUM CONTOUR H.4 MM TEMPORAL NONSTERILE SILVER SUP-04.503.057 CDM 270010013 LOCAL 0270 RC outpatient 4243.2 4243.2 1883.65 74 1393.9 percent of total billed charges 1883.65 93 1525.76 percent of total billed charges 1883.65 1883.65 other OPPS APC 4243.2 4243.2 other OPPS APC 1883.65 27.63 520.45 percent of total billed charges 1883.65 4243.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MATRIXNEURO TITANIUM STRAIGHT L12 MM X H.4 MM CRANIAL 2 HOLE CENTER SPACE RIGID NONSTERILE BLUE SUP-04.503.062 CDM 270010013 LOCAL 0270 RC outpatient 353.6 353.6 353.6 74 261.66 percent of total billed charges 353.6 93 286.42 percent of total billed charges 353.6 353.6 other OPPS APC 353.6 353.6 other OPPS APC 353.6 27.63 97.7 percent of total billed charges 353.6 353.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MATRIXNEURO TITANIUM STRAIGHT L24 MM X H.4 MM CRANIUM 4 HOLE NONSTERILE BLUE SUP-04.503.063 CDM 270010013 LOCAL 0270 RC outpatient 397.8 397.8 397.8 74 294.37 percent of total billed charges 397.8 93 322.22 percent of total billed charges 397.8 397.8 other OPPS APC 397.8 397.8 other OPPS APC 397.8 27.63 109.91 percent of total billed charges 397.8 397.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MATRIXNEURO TITANIUM X H.4 MM CRANIAL 4 HOLE RIGID NONSTERILE BLUE SUP-04.503.064 CDM 270010013 LOCAL 0270 RC outpatient 578.03 578.03 578.03 74 427.74 percent of total billed charges 578.03 93 468.2 percent of total billed charges 578.03 578.03 other OPPS APC 578.03 578.03 other OPPS APC 578.03 27.63 159.71 percent of total billed charges 578.03 578.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MATRIXNEURO TITANIUM Y H.4 MM CRANIAL 5 HOLE RIGID NONSTERILE BLUE SUP-04.503.067 CDM 270010013 LOCAL 0270 RC outpatient 561.18 561.18 561.18 74 415.27 percent of total billed charges 561.18 93 454.56 percent of total billed charges 561.18 561.18 other OPPS APC 561.18 561.18 other OPPS APC 561.18 27.63 155.05 percent of total billed charges 561.18 561.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE MATRIXNEURO Y 5 HOLE SUP-04.503.067 CDM 270010013 LOCAL 0270 RC outpatient 561.18 561.18 561.18 74 415.27 percent of total billed charges 561.18 93 454.56 percent of total billed charges 561.18 561.18 other OPPS APC 561.18 561.18 other OPPS APC 561.18 27.63 155.05 percent of total billed charges 561.18 561.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MATRIXNEURO TITANIUM 2Y L18 MM X H.4 MM CRANIAL 6 HOLE RIGID NONSTERILE BLUE SUP-04.503.068 CDM 270010013 LOCAL 0270 RC outpatient 612.72 612.72 612.72 74 453.41 percent of total billed charges 612.72 93 496.3 percent of total billed charges 612.72 612.72 other OPPS APC 612.72 612.72 other OPPS APC 612.72 27.63 169.29 percent of total billed charges 612.72 612.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MATRIXNEURO TITANIUM 2 Y L21 MM X H.4 MM CRANIOMAXILLOFACIAL 6 HOLE RIGID NONSTERILE BLUE SUP-04.503.069 CDM 270010013 LOCAL 0270 RC outpatient 1279.2 1279.2 1279.2 74 946.61 percent of total billed charges 1279.2 93 1036.15 percent of total billed charges 1279.2 1279.2 other OPPS APC 1279.2 1279.2 other OPPS APC 1279.2 27.63 353.44 percent of total billed charges 1279.2 1279.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MATRIXNEURO TITANIUM H.4 MM CRANIUM 5 HOLE ADAPTION NONSTERILE BLUE SUP-04.503.070 CDM 270010013 LOCAL 0270 RC outpatient 518.91 518.91 518.91 74 383.99 percent of total billed charges 518.91 93 420.32 percent of total billed charges 518.91 518.91 other OPPS APC 518.91 518.91 other OPPS APC 518.91 27.63 143.37 percent of total billed charges 518.91 518.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MATRIXNEURO TITANIUM H.4 MM CRANIUM 7 HOLE ADAPTION NONSTERILE BLUE SUP-04.503.071 CDM 270010013 LOCAL 0270 RC outpatient 681.23 681.23 681.23 74 504.11 percent of total billed charges 681.23 93 551.8 percent of total billed charges 681.23 681.23 other OPPS APC 681.23 681.23 other OPPS APC 681.23 27.63 188.22 percent of total billed charges 681.23 681.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MATRIXNEURO TITANIUM H.4 MM CRANIUM 20 HOLE ADAPTION NONSTERILE BLUE SUP-04.503.072 CDM 270010013 LOCAL 0270 RC outpatient 1279.8 1279.8 1279.8 74 947.05 percent of total billed charges 1279.8 93 1036.64 percent of total billed charges 1279.8 1279.8 other OPPS APC 1279.8 1279.8 other OPPS APC 1279.8 27.63 353.61 percent of total billed charges 1279.8 1279.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MATRIXNEURO TITANIUM RECTANGULAR L16 MM X W10 MM X H.4 MM CRANIAL 4 HOLE FRAME RIGID NONSTERILE BLUE SUP-04.503.073 CDM 270010013 LOCAL 0270 RC outpatient 583.36 583.36 583.36 74 431.69 percent of total billed charges 583.36 93 472.52 percent of total billed charges 583.36 583.36 other OPPS APC 583.36 583.36 other OPPS APC 583.36 27.63 161.18 percent of total billed charges 583.36 583.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MATRIXNEURO TITANIUM L24 MM X W14 MM X H.4 MM CRANIAL 2 X 3 HOLE STRUT RIGID NONSTERILE BLUE SUP-04.503.074 CDM 270010013 LOCAL 0270 RC outpatient 2108.6 2108.6 2108.6 74 1560.36 percent of total billed charges 2108.6 93 1707.97 percent of total billed charges 2108.6 2108.6 other OPPS APC 2108.6 2108.6 other OPPS APC 2108.6 27.63 582.61 percent of total billed charges 2108.6 2108.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MATRIXNEURO TITANIUM L34 MM X W14 MM X H.4 MM CRANIAL 2 X 4 HOLE STRUT RIGID NONSTERILE BLUE SUP-04.503.075 CDM 270010013 LOCAL 0270 RC outpatient 1423.81 1423.81 1423.81 74 1053.62 percent of total billed charges 1423.81 93 1153.29 percent of total billed charges 1423.81 1423.81 other OPPS APC 1423.81 1423.81 other OPPS APC 1423.81 27.63 393.4 percent of total billed charges 1423.81 1423.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH CONTOURABLE 38MM X 35MM SUP-04.503.081 CDM 270010013 LOCAL 0270 RC outpatient 3178.84 3178.84 3178.84 74 2352.34 percent of total billed charges 3178.84 93 2574.86 percent of total billed charges 3178.84 3178.84 other OPPS APC 3178.84 3178.84 other OPPS APC 3178.84 27.63 878.31 percent of total billed charges 3178.84 3178.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MATRIXNEURO TITANIUM L100 MM X W100 MM X H.4 MM CRANIOMAXILLOFACIAL CONTOURABLE MESH MALLEABLE NONSTERILE SILVER SUP-04.503.083 CDM 270010013 LOCAL 0270 RC outpatient 11466 11466 11466 74 8484.84 percent of total billed charges 11466 93 9287.46 percent of total billed charges 11466 11466 other OPPS APC 11466 11466 other OPPS APC 11466 27.63 3168.06 percent of total billed charges 11466 11466 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MATRIXNEURO TITANIUM L100 MM X W100 MM X H.4 MM CRANIAL CONTOURABLE MESH RIGID NONSTERILE BLUE SUP-04.503.084 CDM 270010013 LOCAL 0270 RC outpatient 10920 10920 10920 74 8080.8 percent of total billed charges 10920 93 8845.2 percent of total billed charges 10920 10920 other OPPS APC 10920 10920 other OPPS APC 10920 27.63 3017.2 percent of total billed charges 10920 10920 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MATRIXNEURO TITANIUM L3 MM CRANIOMAXILLOFACIAL SELF DRILL NONSTERILE SUP-04.503.103.01 CDM 270010020 LOCAL 0270 RC outpatient 181.09 181.09 181.09 74 134.01 percent of total billed charges 181.09 93 146.68 percent of total billed charges 181.09 181.09 other OPPS APC 181.09 181.09 other OPPS APC 181.09 27.63 50.04 percent of total billed charges 181.09 181.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MATRIXNEURO 3MM 1.55MM 2.55MM TITANIUM NS CRANIOMAXILLOFACIAL SELF DRILL SUP-04.503.103.05 CDM 270010013 LOCAL 0270 RC outpatient 430.56 430.56 430.56 74 318.61 percent of total billed charges 430.56 93 348.75 percent of total billed charges 430.56 430.56 other OPPS APC 430.56 430.56 other OPPS APC 430.56 27.63 118.96 percent of total billed charges 430.56 430.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MATRIXNEURO TITANIUM L4 MM OD1.5 MM CRANIOMAXILLOFACIAL SELF DRILLING NONSTERILE SUP-04.503.104.01 CDM 270010013 LOCAL 0270 RC outpatient 431.6 431.6 431.6 74 319.38 percent of total billed charges 431.6 93 349.6 percent of total billed charges 431.6 431.6 other OPPS APC 431.6 431.6 other OPPS APC 431.6 27.63 119.25 percent of total billed charges 431.6 431.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MATRIXNEURO TITANIUM L4 MM OD1.55 MM ODSEC2.55 MM CRANIOMAXILLOFACIAL SELF DRILL SUP-04.503.104.05 CDM 270010013 LOCAL 0270 RC outpatient 430.56 430.56 430.56 74 318.61 percent of total billed charges 430.56 93 348.75 percent of total billed charges 430.56 430.56 other OPPS APC 430.56 430.56 other OPPS APC 430.56 27.63 118.96 percent of total billed charges 430.56 430.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MATRIXNEURO TITANIUM L5 MM OD1.55 MM ODSEC2.55 MM CRANIOMAXILLOFACIAL SELF DRILL NONSTERILE SUP-04.503.105.01 CDM 270010013 LOCAL 0270 RC outpatient 374.4 374.4 374.4 74 277.06 percent of total billed charges 374.4 93 303.26 percent of total billed charges 374.4 374.4 other OPPS APC 374.4 374.4 other OPPS APC 374.4 27.63 103.45 percent of total billed charges 374.4 374.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MATRIXNEURO TITANIUM L5 MM OD1.55 MM ODSEC2.55 MM CRANIOMAXILLOFACIAL SELF DRILL NONSTERILE SUP-04.503.105.05 CDM 270010022 LOCAL 0270 RC outpatient 430.56 430.56 430.56 74 318.61 percent of total billed charges 430.56 93 348.75 percent of total billed charges 430.56 430.56 other OPPS APC 430.56 430.56 other OPPS APC 430.56 27.63 118.96 percent of total billed charges 430.56 430.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MATRIXNEURO TITANIUM L3 MM OD1.55 MM ODSEC2.65 MM CRANIOMAXILLOFACIAL EMERGENCY SELF TAP NONSTERILE SUP-04.503.113.01 CDM 270010013 LOCAL 0270 RC outpatient 181.09 181.09 181.09 74 134.01 percent of total billed charges 181.09 93 146.68 percent of total billed charges 181.09 181.09 other OPPS APC 181.09 181.09 other OPPS APC 181.09 27.63 50.04 percent of total billed charges 181.09 181.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MATRIXNEURO TITANIUM L3 MM OD1.85 MM ODSEC2.55 MM CRANIOMAXILLOFACIAL EMERGENCY SUP-04.503.113.05 CDM 270010013 LOCAL 0270 RC outpatient 409.76 409.76 409.76 74 303.22 percent of total billed charges 409.76 93 331.91 percent of total billed charges 409.76 409.76 other OPPS APC 409.76 409.76 other OPPS APC 409.76 27.63 113.22 percent of total billed charges 409.76 409.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MATRIXNEURO EMERGENCY TITANIUM 4MM SUP-04.503.114 CDM 270010013 LOCAL 0270 RC outpatient 130.55 130.55 130.55 74 96.61 percent of total billed charges 130.55 93 105.75 percent of total billed charges 130.55 130.55 other OPPS APC 130.55 130.55 other OPPS APC 130.55 27.63 36.07 percent of total billed charges 130.55 130.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MATRIXNEURO TITANIUM L4 MM OD1.55 MM ODSEC2.65 MM CRANIOMAXILLOFACIAL EMERGENCY SELF TAP NONSTERILE SUP-04.503.114.05 CDM 270010013 LOCAL 0270 RC outpatient 374.4 374.4 374.4 74 277.06 percent of total billed charges 374.4 93 303.26 percent of total billed charges 374.4 374.4 other OPPS APC 374.4 374.4 other OPPS APC 374.4 27.63 103.45 percent of total billed charges 374.4 374.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MATRIXNEURO EMERGENCY TITANIUM 5MM SUP-04.503.115 CDM 270010013 LOCAL 0270 RC outpatient 175.76 175.76 175.76 74 130.06 percent of total billed charges 175.76 93 142.37 percent of total billed charges 175.76 175.76 other OPPS APC 175.76 175.76 other OPPS APC 175.76 27.63 48.56 percent of total billed charges 175.76 175.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MATRIXNEURO EMERGENCY TITANIUM 5MM SUP-04.503.115.01 CDM 270010013 LOCAL 0270 RC outpatient 431.6 431.6 431.6 74 319.38 percent of total billed charges 431.6 93 349.6 percent of total billed charges 431.6 431.6 other OPPS APC 431.6 431.6 other OPPS APC 431.6 27.63 119.25 percent of total billed charges 431.6 431.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE VECTRA BENT GROOVE PREBENT 25X16.5X2.5MM 16MM TITANIUM NS SPINE CERVICAL ANTERIOR 1 LEVEL 1 STEP LOCK SUP-04.613.016 CDM 270010013 LOCAL 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VECTRA 16MM 4MM PURPLE TITANIUM NS SPINE CERVICAL ANTERIOR SELF DRILL SELF RETAINING VARIABLE ANGLE SUP-04.613.516 CDM 270010013 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VECTRA 16MM 4.5MM BLUE TITANIUM NS SPINE CERVICAL ANTERIOR SELF DRILL SELF RETAINING VARIABLE ANGLE SUP-04.613.566 CDM 270010013 LOCAL 0270 RC outpatient 741 741 741 74 548.34 percent of total billed charges 741 93 600.21 percent of total billed charges 741 741 other OPPS APC 741 741 other OPPS APC 741 27.63 204.74 percent of total billed charges 741 741 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VECTRA 16MM 4MM BROWN TITANIUM NS SPINE CERVICAL ANTERIOR SELF DRILL SELF RETAINING FIXED ANGLE SUP-04.613.716 CDM 270010013 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SYNAPSE TITANIUM 50- D T15 L10 MM OD3.5 MM ODSEC2.4 MM SPINE CANCELLOUS STARDRIVE POLYAXIAL SELF TAP SQUARE THREAD LOCK CAP NONSTERILE GOLD 3.5 MM ROD SUP-04.614.010 CDM 270010013 LOCAL 0270 RC outpatient 3103.1 3103.1 3103.1 74 2296.29 percent of total billed charges 3103.1 93 2513.51 percent of total billed charges 3103.1 3103.1 other OPPS APC 3103.1 3103.1 other OPPS APC 3103.1 27.63 857.39 percent of total billed charges 3103.1 3103.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SYNAPSE TITANIUM 50- D T15 L12 MM OD3.5 MM ODSEC2.4 MM SPINE CANCELLOUS STARDRIVE POLYAXIAL SELF TAP SQUARE THREAD LOCK CAP NONSTERILE GOLD 3.5 MM ROD SUP-04.614.012 CDM 270010020 LOCAL 0270 RC outpatient 3103.1 3103.1 3103.1 74 2296.29 percent of total billed charges 3103.1 93 2513.51 percent of total billed charges 3103.1 3103.1 other OPPS APC 3103.1 3103.1 other OPPS APC 3103.1 27.63 857.39 percent of total billed charges 3103.1 3103.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SYNAPSE TITANIUM 50- D T15 L14 MM OD3.5 MM ODSEC2.4 MM SPINE CANCELLOUS STARDRIVE POLYAXIAL SELF TAP SQUARE THREAD LOCK CAP NONSTERILE GOLD 3.5 MM ROD SUP-04.614.014 CDM 270010020 LOCAL 0270 RC outpatient 3103.1 3103.1 3103.1 74 2296.29 percent of total billed charges 3103.1 93 2513.51 percent of total billed charges 3103.1 3103.1 other OPPS APC 3103.1 3103.1 other OPPS APC 3103.1 27.63 857.39 percent of total billed charges 3103.1 3103.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SYNAPSE TITANIUM 50- D T15 L16 MM OD3.5 MM ODSEC2.4 MM SPINE CANCELLOUS STARDRIVE POLYAXIAL SELF TAP SQUARE THREAD LOCK CAP NONSTERILE GOLD SUP-04.614.016 CDM 270010020 LOCAL 0270 RC outpatient 3103.1 3103.1 3103.1 74 2296.29 percent of total billed charges 3103.1 93 2513.51 percent of total billed charges 3103.1 3103.1 other OPPS APC 3103.1 3103.1 other OPPS APC 3103.1 27.63 857.39 percent of total billed charges 3103.1 3103.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SYNAPSE TITANIUM 50- D T15 L18 MM OD3.5 MM ODSEC2.4 MM SPINE CANCELLOUS STARDRIVE POLYAXIAL SELF TAP SQUARE THREAD LOCK CAP NONSTERILE GOLD SUP-04.614.018 CDM 270010020 LOCAL 0270 RC outpatient 3375.84 3375.84 3375.84 74 2498.12 percent of total billed charges 3375.84 93 2734.43 percent of total billed charges 3375.84 3375.84 other OPPS APC 3375.84 3375.84 other OPPS APC 3375.84 27.63 932.74 percent of total billed charges 3375.84 3375.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SYNAPSE TITANIUM 50- D T15 L20 MM OD3.5 MM ODSEC2.4 MM SPINE CANCELLOUS STARDRIVE POLYAXIAL SELF TAP SQUARE THREAD LOCK CAP NONSTERILE GOLD SUP-04.614.020 CDM 270010020 LOCAL 0270 RC outpatient 3103.1 3103.1 3103.1 74 2296.29 percent of total billed charges 3103.1 93 2513.51 percent of total billed charges 3103.1 3103.1 other OPPS APC 3103.1 3103.1 other OPPS APC 3103.1 27.63 857.39 percent of total billed charges 3103.1 3103.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SYNAPSE TITANIUM 50- D T15 L26 MM OD3.5 MM ODSEC2.4 MM SPINE CANCELLOUS STARDRIVE POLYAXIAL SELF TAP SQUARE THREAD LOCK CAP NONSTERILE GOLD SUP-04.614.026 CDM 270010020 LOCAL 0270 RC outpatient 3375.84 3375.84 3375.84 74 2498.12 percent of total billed charges 3375.84 93 2734.43 percent of total billed charges 3375.84 3375.84 other OPPS APC 3375.84 3375.84 other OPPS APC 3375.84 27.63 932.74 percent of total billed charges 3375.84 3375.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SYNAPSE TITANIUM 50- D T15 L12 MM OD4 MM ODSEC2.4 MM SPINE CANCELLOUS STARDRIVE POLYAXIAL SELF TAP SQUARE THREAD LOCK CAP NONSTERILE GREEN GRAY SUP-04.614.112 CDM 270010020 LOCAL 0270 RC outpatient 3375.84 3375.84 3375.84 74 2498.12 percent of total billed charges 3375.84 93 2734.43 percent of total billed charges 3375.84 3375.84 other OPPS APC 3375.84 3375.84 other OPPS APC 3375.84 27.63 932.74 percent of total billed charges 3375.84 3375.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SYNAPSE TITANIUM 50- D T15 L14 MM OD4 MM ODSEC2.4 MM SPINE CANCELLOUS STARDRIVE POLYAXIAL SELF TAP SQUARE THREAD LOCK CAP NONSTERILE GREEN GRAY SUP-04.614.114 CDM 270010013 LOCAL 0270 RC outpatient 3103.1 3103.1 3103.1 74 2296.29 percent of total billed charges 3103.1 93 2513.51 percent of total billed charges 3103.1 3103.1 other OPPS APC 3103.1 3103.1 other OPPS APC 3103.1 27.63 857.39 percent of total billed charges 3103.1 3103.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SYNAPSE TITANIUM 50- D T15 L16 MM OD4 MM ODSEC2.4 MM SPINE CANCELLOUS STARDRIVE POLYAXIAL SELF TAP SQUARE THREAD LOCK CAP NONSTERILE GREEN GRAY SUP-04.614.116 CDM 270010020 LOCAL 0270 RC outpatient 3103.1 3103.1 3103.1 74 2296.29 percent of total billed charges 3103.1 93 2513.51 percent of total billed charges 3103.1 3103.1 other OPPS APC 3103.1 3103.1 other OPPS APC 3103.1 27.63 857.39 percent of total billed charges 3103.1 3103.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SYNAPSE TITANIUM 50- D T15 L18 MM OD4 MM ODSEC2.4 MM SPINE CANCELLOUS STARDRIVE POLYAXIAL SELF TAP SQUARE THREAD LOCK CAP NONSTERILE GREEN GRAY SUP-04.614.118 CDM 270010020 LOCAL 0270 RC outpatient 3103.1 3103.1 3103.1 74 2296.29 percent of total billed charges 3103.1 93 2513.51 percent of total billed charges 3103.1 3103.1 other OPPS APC 3103.1 3103.1 other OPPS APC 3103.1 27.63 857.39 percent of total billed charges 3103.1 3103.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SYNAPSE TITANIUM 50- D T15 L26 MM OD4 MM ODSEC2.4 MM SPINE CANCELLOUS STARDRIVE POLYAXIAL SELF TAP SQUARE THREAD LOCK CAP NONSTERILE GREEN GRAY SUP-04.614.126 CDM 270010020 LOCAL 0270 RC outpatient 3103.1 3103.1 3103.1 74 2296.29 percent of total billed charges 3103.1 93 2513.51 percent of total billed charges 3103.1 3103.1 other OPPS APC 3103.1 3103.1 other OPPS APC 3103.1 27.63 857.39 percent of total billed charges 3103.1 3103.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SYNAPSE TITANIUM L8 MM OD4.5 MM SPINE LOCK NONSTERILE SUP-04.614.508 CDM 270010020 LOCAL 0270 RC outpatient 365.82 365.82 365.82 74 270.71 percent of total billed charges 365.82 93 296.31 percent of total billed charges 365.82 365.82 other OPPS APC 365.82 365.82 other OPPS APC 365.82 27.63 101.08 percent of total billed charges 365.82 365.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SYNAPSE CURVE PREBENT 30MM 3.5MM GOLD TITANIUM NS OCCIPITOCERVICAL SUP-04.614.730 CDM 270010020 LOCAL 0270 RC outpatient 1050.14 1050.14 1050.14 74 777.1 percent of total billed charges 1050.14 93 850.61 percent of total billed charges 1050.14 1050.14 other OPPS APC 1050.14 1050.14 other OPPS APC 1050.14 27.63 290.15 percent of total billed charges 1050.14 1050.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CURVE PREBENT 45MM 3.5MM GOLD TITANIUM NS OCCIPITOCERVICAL SUP-04.614.745 CDM 270010020 LOCAL 0270 RC outpatient 1050.14 1050.14 1050.14 74 777.1 percent of total billed charges 1050.14 93 850.61 percent of total billed charges 1050.14 1050.14 other OPPS APC 1050.14 1050.14 other OPPS APC 1050.14 27.63 290.15 percent of total billed charges 1050.14 1050.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ROD SYNTHES CURVED TI 3.5MM 50MM LENGTH SUP-04.614.750 CDM 270010020 LOCAL 0270 RC outpatient 2516.8 2516.8 2516.8 74 1862.43 percent of total billed charges 2516.8 93 2038.61 percent of total billed charges 2516.8 2516.8 other OPPS APC 2516.8 2516.8 other OPPS APC 2516.8 27.63 695.39 percent of total billed charges 2516.8 2516.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ROD SYNTHES CURVED TI 3.5MM 60MM LENGTH SUP-04.614.760 CDM 270010020 LOCAL 0270 RC outpatient 1050.14 1050.14 1050.14 74 777.1 percent of total billed charges 1050.14 93 850.61 percent of total billed charges 1050.14 1050.14 other OPPS APC 1050.14 1050.14 other OPPS APC 1050.14 27.63 290.15 percent of total billed charges 1050.14 1050.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SYNAPSE CURVE PREBENT 70MM 3.5MM GOLD TITANIUM NS OCCIPITOCERVICAL SUP-04.614.770 CDM 270010020 LOCAL 0270 RC outpatient 1050.14 1050.14 1050.14 74 777.1 percent of total billed charges 1050.14 93 850.61 percent of total billed charges 1050.14 1050.14 other OPPS APC 1050.14 1050.14 other OPPS APC 1050.14 27.63 290.15 percent of total billed charges 1050.14 1050.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CURVE PREBENT 75MM 3.5MM GOLD TITANIUM NS OCCIPITOCERVICAL SUP-04.614.775 CDM 270010020 LOCAL 0270 RC outpatient 1050.14 1050.14 1050.14 74 777.1 percent of total billed charges 1050.14 93 850.61 percent of total billed charges 1050.14 1050.14 other OPPS APC 1050.14 1050.14 other OPPS APC 1050.14 27.63 290.15 percent of total billed charges 1050.14 1050.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SYNAPSE CURVE PREBENT 85MM 3.5MM GOLD TITANIUM NS OCCIPITOCERVICAL SUP-04.614.785 CDM 270010020 LOCAL 0270 RC outpatient 1050.14 1050.14 1050.14 74 777.1 percent of total billed charges 1050.14 93 850.61 percent of total billed charges 1050.14 1050.14 other OPPS APC 1050.14 1050.14 other OPPS APC 1050.14 27.63 290.15 percent of total billed charges 1050.14 1050.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL ZERO-P PEEK-OPTIMA TITANIUM STANDARD LORDOTIC H8 MM RADIOPAQUE PREASSEMBLE STERILE ANTERIOR CERVICAL INTERBODY FUSION SUP-04.617.128S CDM 270010020 LOCAL 0270 RC outpatient 6240 6240 6240 74 4617.6 percent of total billed charges 6240 93 5054.4 percent of total billed charges 6240 6240 other OPPS APC 6240 6240 other OPPS APC 6240 27.63 1724.11 percent of total billed charges 6240 6240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ZERO-P TITANIUM L14 MM OD3 MM SPINE CERVICAL SELF TAP LOCK SELF CENTER STERILE GOLD SUP-04.617.814 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TWISTER WIRE MYO/WIRE II 2 AUTOCLAVABLE SUTURE HIGH STRENGTH CLOSURE NONSTERILE STERNOTOMY SUP-040-400 CDM 0270 RC outpatient 746.2 746.2 746.2 74 552.19 percent of total billed charges 746.2 93 604.42 percent of total billed charges 746.2 746.2 other OPPS APC 746.2 746.2 other OPPS APC 746.2 27.63 206.18 percent of total billed charges 746.2 746.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE STERNAL SINGLE SUP-040-417 CDM 0270 RC outpatient 11.65 11.65 11.65 74 8.62 percent of total billed charges 11.65 93 9.44 percent of total billed charges 11.65 11.65 other OPPS APC 11.65 11.65 other OPPS APC 11.65 27.63 3.22 percent of total billed charges 11.65 11.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOOD SURGEON T4 DISPOSABLE STERILE LF SUP-0400800000 CDM 0270 RC outpatient 46.58 46.58 46.58 74 34.47 percent of total billed charges 46.58 93 37.73 percent of total billed charges 46.58 46.58 other OPPS APC 46.58 46.58 other OPPS APC 46.58 27.63 12.87 percent of total billed charges 46.58 46.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING PRESSURE MONITOR POLYETHYLENE L48 IN MALE TO FEMALE CONNECTOR LUER LOCK TRANSDUCER LINE FIX STERILE DISPOSABLE SUP-040104001A CDM 0270 RC outpatient 25.74 25.74 25.74 74 19.05 percent of total billed charges 25.74 93 20.85 percent of total billed charges 25.74 25.74 other OPPS APC 25.74 25.74 other OPPS APC 25.74 27.63 7.11 percent of total billed charges 25.74 25.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOOD SURGEON FLYTE STERI-SHIELD PEELAWAY FACE SHIELD LATEX FREE PERSONAL PROTECTION SYSTEM SUP-0408800100 CDM 0270 RC outpatient 104.25 104.25 104.25 74 77.15 percent of total billed charges 104.25 93 84.44 percent of total billed charges 104.25 104.25 other OPPS APC 104.25 104.25 other OPPS APC 104.25 27.63 28.8 percent of total billed charges 104.25 104.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOOD FLYTE SURGICOOL SUP-0408801400 CDM 0270 RC outpatient 61.79 61.79 61.79 74 45.72 percent of total billed charges 61.79 93 50.05 percent of total billed charges 61.79 61.79 other OPPS APC 61.79 61.79 other OPPS APC 61.79 27.63 17.07 percent of total billed charges 61.79 61.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOPCOCK INTRAVENOUS ULTRA 4 WAY MALE LUER LOCK STERILE LATEX FREE DISPOSABLE SUP-041210002A CDM 0270 RC outpatient 36.4 36.4 36.4 74 26.94 percent of total billed charges 36.4 93 29.48 percent of total billed charges 36.4 36.4 other OPPS APC 36.4 36.4 other OPPS APC 36.4 27.63 10.06 percent of total billed charges 36.4 36.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAD PROTECTION T7 COMFORT SUP-0416-210-000 CDM 0270 RC outpatient 35.66 35.66 35.66 74 26.39 percent of total billed charges 35.66 93 28.88 percent of total billed charges 35.66 35.66 other OPPS APC 35.66 35.66 other OPPS APC 35.66 27.63 9.85 percent of total billed charges 35.66 35.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOOD SURGEON FLYTE STERI-SHIELD T7 PLUS PEEL AWAY FACE SHIELD STERILE DISPOSABLE SUP-0416-801-100 CDM 0270 RC outpatient 124.13 124.13 124.13 74 91.86 percent of total billed charges 124.13 93 100.55 percent of total billed charges 124.13 124.13 other OPPS APC 124.13 124.13 other OPPS APC 124.13 27.63 34.3 percent of total billed charges 124.13 124.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERSTIM NEEDLES 5IN SUP-041839 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPPORT MAMMARY SURGI-BRA 42-44IN 2XL 96% COTTON 4% SPANDEX VELCRO LF BREAST PAD SUP-0422XL CDM 270009195 LOCAL 0270 RC outpatient 45.24 45.24 45.24 74 33.48 percent of total billed charges 45.24 93 36.64 percent of total billed charges 45.24 45.24 other OPPS APC 45.24 45.24 other OPPS APC 45.24 27.63 12.5 percent of total billed charges 45.24 45.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPPORT MAMMARY SURGI-BRA 44-46IN 3XL 96% COTTON 4% SPANDEX VELCRO LF BREAST PAD SUP-0423XL CDM 270009195 LOCAL 0270 RC outpatient 45.24 45.24 45.24 74 33.48 percent of total billed charges 45.24 93 36.64 percent of total billed charges 45.24 45.24 other OPPS APC 45.24 45.24 other OPPS APC 45.24 27.63 12.5 percent of total billed charges 45.24 45.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRA ELIZABETH PINK SURGICAL SIZE 4XL SUP-0424XL CDM 0270 RC outpatient 83.2 83.2 83.2 74 61.57 percent of total billed charges 83.2 93 67.39 percent of total billed charges 83.2 83.2 other OPPS APC 83.2 83.2 other OPPS APC 83.2 27.63 22.99 percent of total billed charges 83.2 83.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRA ELIZABETH PINK SURGICAL SIZE 5XL SUP-0425XL CDM 0270 RC outpatient 83.2 83.2 83.2 74 61.57 percent of total billed charges 83.2 93 67.39 percent of total billed charges 83.2 83.2 other OPPS APC 83.2 83.2 other OPPS APC 83.2 27.63 22.99 percent of total billed charges 83.2 83.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRA ELIZABETH PINK SURGICAL SIZE LARGE SUP-042L CDM 270009195 LOCAL 0270 RC outpatient 45.24 45.24 45.24 74 33.48 percent of total billed charges 45.24 93 36.64 percent of total billed charges 45.24 45.24 other OPPS APC 45.24 45.24 other OPPS APC 45.24 27.63 12.5 percent of total billed charges 45.24 45.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRA POST SURGICAL SURGI-BRA MED VELCRO NYLON LF PADDED SHOULDER STRAP MACHINE SUP-042M CDM 270009195 LOCAL 0270 RC outpatient 45.24 45.24 45.24 74 33.48 percent of total billed charges 45.24 93 36.64 percent of total billed charges 45.24 45.24 other OPPS APC 45.24 45.24 other OPPS APC 45.24 27.63 12.5 percent of total billed charges 45.24 45.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPPORT MAMMARY SURGI-BRA 34-36IN SM 96% COTTON 4% SPANDEX VELCRO LF BREAST PAD SUP-042S CDM 270009195 LOCAL 0270 RC outpatient 45.24 45.24 45.24 74 33.48 percent of total billed charges 45.24 93 36.64 percent of total billed charges 45.24 45.24 other OPPS APC 45.24 45.24 other OPPS APC 45.24 27.63 12.5 percent of total billed charges 45.24 45.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPPORT MAMMARY SURGI-BRA 40-42IN XL VELCRO COTTON SPANDEX LF FRONT CLOSURE REMOVABLE DRAIN BULB HOLDER ADJUSTABLE STRAP SUP-042XL CDM 270009195 LOCAL 0270 RC outpatient 45.24 45.24 45.24 74 33.48 percent of total billed charges 45.24 93 36.64 percent of total billed charges 45.24 45.24 other OPPS APC 45.24 45.24 other OPPS APC 45.24 27.63 12.5 percent of total billed charges 45.24 45.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EXTERNAL FIXATION END ADAPTER SUP-04410 CDM 0270 RC outpatient 758.03 758.03 758.03 74 560.94 percent of total billed charges 758.03 93 614 percent of total billed charges 758.03 758.03 other OPPS APC 758.03 758.03 other OPPS APC 758.03 27.63 209.44 percent of total billed charges 758.03 758.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RAIL BIOMET 10MM SUP-04411 CDM 0270 RC outpatient 2172.43 2172.43 2172.43 74 1607.6 percent of total billed charges 2172.43 93 1759.67 percent of total billed charges 2172.43 2172.43 other OPPS APC 2172.43 2172.43 other OPPS APC 2172.43 27.63 600.24 percent of total billed charges 2172.43 2172.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RAIL BIOMET 15MM SUP-04416 CDM 0270 RC outpatient 2607.8 2607.8 2607.8 74 1929.77 percent of total billed charges 2607.8 93 2112.32 percent of total billed charges 2607.8 2607.8 other OPPS APC 2607.8 2607.8 other OPPS APC 2607.8 27.63 720.54 percent of total billed charges 2607.8 2607.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP BIOMET XS-T/ARC SUP-04475 CDM 0270 RC outpatient 3474.12 3474.12 3474.12 74 2570.85 percent of total billed charges 3474.12 93 2814.04 percent of total billed charges 3474.12 3474.12 other OPPS APC 3474.12 3474.12 other OPPS APC 3474.12 27.63 959.9 percent of total billed charges 3474.12 3474.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCCLUDER VASCULAR VESSEL-CLUDE MEDIUM L4 IN RADIOPAQUE STERILE LATEX DISPOSABLE SUP-046-1-120A CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE SUTURE DOUBLEWIRE 6 BE-3 1/2 CIRCLE BALL L54 MM STERNOTOMY SUP-046-297 CDM 0270 RC outpatient 281.67 281.67 281.67 74 208.44 percent of total billed charges 281.67 93 228.15 percent of total billed charges 281.67 281.67 other OPPS APC 281.67 281.67 other OPPS APC 281.67 27.63 77.83 percent of total billed charges 281.67 281.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE MYO/WIRE II STAINLESS STEEL 7 TC-1 L18 IN MONOFILAMENT WIRE STERNOTOMY SUP-047-072 CDM 0270 RC outpatient 746.2 746.2 746.2 74 552.19 percent of total billed charges 746.2 93 604.42 percent of total billed charges 746.2 746.2 other OPPS APC 746.2 746.2 other OPPS APC 746.2 27.63 206.18 percent of total billed charges 746.2 746.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE DOUBLEWIRE 8 BE-3 14IN 2 WIRE HIGH STRENGTH STERNOTOMY SUP-048-297 CDM 0270 RC outpatient 281.67 281.67 281.67 74 208.44 percent of total billed charges 281.67 93 228.15 percent of total billed charges 281.67 281.67 other OPPS APC 281.67 281.67 other OPPS APC 281.67 27.63 77.83 percent of total billed charges 281.67 281.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REMOVER ADHESIVE DETACHOL 2/3 ML DISPENSER CAP LATEX FREE SUP-0496-0513-48 CDM 0270 RC outpatient 4.06 4.06 4.06 74 3 percent of total billed charges 4.06 93 3.29 percent of total billed charges 4.06 4.06 other OPPS APC 4.06 4.06 other OPPS APC 4.06 27.63 1.12 percent of total billed charges 4.06 4.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK BATTERY LITHIUM PRECHARGED STERILE DISPOSABLE POWERED DRIVER SUP-05.000.007.01S CDM 0270 RC outpatient 1258.4 1258.4 1258.4 74 931.22 percent of total billed charges 1258.4 93 1019.3 percent of total billed charges 1258.4 1258.4 other OPPS APC 1258.4 1258.4 other OPPS APC 1258.4 27.63 347.7 percent of total billed charges 1258.4 1258.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BATTERY SURGICAL DRIVER MATRIXPRO STERILE DISPOSABLE SUP-05.000.021S CDM 0270 RC outpatient 1188.2 1188.2 1188.2 74 879.27 percent of total billed charges 1188.2 93 962.44 percent of total billed charges 1188.2 1188.2 other OPPS APC 1188.2 1188.2 other OPPS APC 1188.2 27.63 328.3 percent of total billed charges 1188.2 1188.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DETACHOL SUP-051304 CDM outpatient 38.87 38.87 38.87 38.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTROL CHEMISTRY ACCU-CHEK INFORM II 2 LEVEL SUP-05213509001 CDM 0270 RC outpatient 9.1 9.1 9.1 74 6.73 percent of total billed charges 9.1 93 7.37 percent of total billed charges 9.1 9.1 other OPPS APC 9.1 9.1 other OPPS APC 9.1 27.63 2.51 percent of total billed charges 9.1 9.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADHESIVE LIQUID MASTISOL STYRAX GUM MASTIC ALCOHOL METHYL SALICYLATE 2/3 ML SKIN VIAL AMPULE PREP STERILE LATEX FREE NONHAZARDOUS SUP-0523-48 CDM 0270 RC outpatient 4.59 4.59 4.59 74 3.4 percent of total billed charges 4.59 93 3.72 percent of total billed charges 4.59 4.59 other OPPS APC 4.59 4.59 other OPPS APC 4.59 27.63 1.27 percent of total billed charges 4.59 4.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARC BIOMET XS SLOTTED SUP-05244 CDM 0270 RC outpatient 1405.56 1405.56 1405.56 74 1040.11 percent of total billed charges 1405.56 93 1138.5 percent of total billed charges 1405.56 1405.56 other OPPS APC 1405.56 1405.56 other OPPS APC 1405.56 27.63 388.36 percent of total billed charges 1405.56 1405.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELEVIEW SUBMUCOSAL INJECTABLE COMPOSITION (10ML) SUP-05391530190015 CDM 0270 RC outpatient 210.6 210.6 210.6 74 155.84 percent of total billed charges 210.6 93 170.59 percent of total billed charges 210.6 210.6 other OPPS APC 210.6 210.6 other OPPS APC 210.6 27.63 58.19 percent of total billed charges 210.6 210.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BONE MARROW STERILE SUP-06-00001 CDM 0272 RC outpatient 152 152 152 74 112.48 percent of total billed charges 152 93 123.12 percent of total billed charges 152 152 other OPPS APC 152 152 other OPPS APC 152 27.63 42 percent of total billed charges 152 152 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SAFETY GLIDE 25GX 5/8 SUP-06-00021 CDM 0272 RC outpatient 42.04 42.04 42.04 74 31.11 percent of total billed charges 42.04 93 34.05 percent of total billed charges 42.04 42.04 other OPPS APC 42.04 42.04 other OPPS APC 42.04 27.63 11.62 percent of total billed charges 42.04 42.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SPINAL 20X3 SUP-06-00034 CDM 0272 RC outpatient 2.7 2.7 2.7 74 2 percent of total billed charges 2.7 93 2.19 percent of total billed charges 2.7 2.7 other OPPS APC 2.7 2.7 other OPPS APC 2.7 27.63 0.75 percent of total billed charges 2.7 2.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SPINAL 22X1 1/2 SUP-06-00037 CDM 0272 RC outpatient 2.88 2.88 2.88 74 2.13 percent of total billed charges 2.88 93 2.33 percent of total billed charges 2.88 2.88 other OPPS APC 2.88 2.88 other OPPS APC 2.88 27.63 0.8 percent of total billed charges 2.88 2.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SPINAL 20GA X 6 SUP-06-00039 CDM 0272 RC outpatient 29.97 29.97 29.97 74 22.18 percent of total billed charges 29.97 93 24.28 percent of total billed charges 29.97 29.97 other OPPS APC 29.97 29.97 other OPPS APC 29.97 27.63 8.28 percent of total billed charges 29.97 29.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYR 3ML SAFETY 21GX1 1/2 INT SUP-06-00043 CDM 0272 RC outpatient 163.14 163.14 163.14 74 120.72 percent of total billed charges 163.14 93 132.14 percent of total billed charges 163.14 163.14 other OPPS APC 163.14 163.14 other OPPS APC 163.14 27.63 45.08 percent of total billed charges 163.14 163.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYR 3ML SAFETY 23GX1 INT SUP-06-00044 CDM 0272 RC outpatient 166.16 166.16 166.16 74 122.96 percent of total billed charges 166.16 93 134.59 percent of total billed charges 166.16 166.16 other OPPS APC 166.16 166.16 other OPPS APC 166.16 27.63 45.91 percent of total billed charges 166.16 166.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYR 3ML SAFETY 25GX 5/8 INT SUP-06-00045 CDM 0272 RC outpatient 167.87 167.87 167.87 74 124.22 percent of total billed charges 167.87 93 135.97 percent of total billed charges 167.87 167.87 other OPPS APC 167.87 167.87 other OPPS APC 167.87 27.63 46.38 percent of total billed charges 167.87 167.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYR/NDL INSULIN 1CC 29GX 1/2 SUP-06-00047 CDM 0272 RC outpatient 131.2 131.2 131.2 74 97.09 percent of total billed charges 131.2 93 106.27 percent of total billed charges 131.2 131.2 other OPPS APC 131.2 131.2 other OPPS APC 131.2 27.63 36.25 percent of total billed charges 131.2 131.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE ORAL AMBER 3ML 3052 SUP-06-00055 CDM 0272 RC outpatient 39.59 39.59 39.59 74 29.3 percent of total billed charges 39.59 93 32.07 percent of total billed charges 39.59 39.59 other OPPS APC 39.59 39.59 other OPPS APC 39.59 27.63 10.94 percent of total billed charges 39.59 39.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE ORAL AMBER 10ML 305209 SUP-06-00056 CDM 0272 RC outpatient 60.8 60.8 60.8 74 44.99 percent of total billed charges 60.8 93 49.25 percent of total billed charges 60.8 60.8 other OPPS APC 60.8 60.8 other OPPS APC 60.8 27.63 16.8 percent of total billed charges 60.8 60.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HUBER 22G 3/4 SUP-06-00058 CDM 0272 RC outpatient 3.65 3.65 3.65 74 2.7 percent of total billed charges 3.65 93 2.96 percent of total billed charges 3.65 3.65 other OPPS APC 3.65 3.65 other OPPS APC 3.65 27.63 1.01 percent of total billed charges 3.65 3.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HUBER 22G 1.25 SUP-06-00059 CDM 0272 RC outpatient 3.63 3.63 3.63 74 2.69 percent of total billed charges 3.63 93 2.94 percent of total billed charges 3.63 3.63 other OPPS APC 3.63 3.63 other OPPS APC 3.63 27.63 1 percent of total billed charges 3.63 3.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HUBER 19G 3/4 SUP-06-00060 CDM 0272 RC outpatient 3.88 3.88 3.88 74 2.87 percent of total billed charges 3.88 93 3.14 percent of total billed charges 3.88 3.88 other OPPS APC 3.88 3.88 other OPPS APC 3.88 27.63 1.07 percent of total billed charges 3.88 3.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HUBER 19G 1.25 SUP-06-00061 CDM 0272 RC outpatient 3.62 3.62 3.62 74 2.68 percent of total billed charges 3.62 93 2.93 percent of total billed charges 3.62 3.62 other OPPS APC 3.62 3.62 other OPPS APC 3.62 27.63 1 percent of total billed charges 3.62 3.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HUBER 20G X 1 SUP-06-00064 CDM 0272 RC outpatient 3.65 3.65 3.65 74 2.7 percent of total billed charges 3.65 93 2.96 percent of total billed charges 3.65 3.65 other OPPS APC 3.65 3.65 other OPPS APC 3.65 27.63 1.01 percent of total billed charges 3.65 3.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE 1CC LL W/O NEEDLE SUP-06-00065 CDM 0272 RC outpatient 115.05 115.05 115.05 74 85.14 percent of total billed charges 115.05 93 93.19 percent of total billed charges 115.05 115.05 other OPPS APC 115.05 115.05 other OPPS APC 115.05 27.63 31.79 percent of total billed charges 115.05 115.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HUBER 20G X 3/4 SUP-06-00066 CDM 0272 RC outpatient 3.65 3.65 3.65 74 2.7 percent of total billed charges 3.65 93 2.96 percent of total billed charges 3.65 3.65 other OPPS APC 3.65 3.65 other OPPS APC 3.65 27.63 1.01 percent of total billed charges 3.65 3.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE 5F CENTESIS SUP-06-00067 CDM 0272 RC outpatient 65.28 65.28 65.28 74 48.31 percent of total billed charges 65.28 93 52.88 percent of total billed charges 65.28 65.28 other OPPS APC 65.28 65.28 other OPPS APC 65.28 27.63 18.04 percent of total billed charges 65.28 65.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NASAL MUCOSAL ATOMIZATION (MAD) SUP-06-00069 CDM 0272 RC outpatient 554.72 554.72 554.72 74 410.49 percent of total billed charges 554.72 93 449.32 percent of total billed charges 554.72 554.72 other OPPS APC 554.72 554.72 other OPPS APC 554.72 27.63 153.27 percent of total billed charges 554.72 554.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYR/NDL 5CC BLNT LL 18GX1 1/2 SUP-06-00070 CDM 0272 RC outpatient 59.33 59.33 59.33 74 43.9 percent of total billed charges 59.33 93 48.06 percent of total billed charges 59.33 59.33 other OPPS APC 59.33 59.33 other OPPS APC 59.33 27.63 16.39 percent of total billed charges 59.33 59.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL STRYKER CTAPER 22 +0 SUP-06-2200 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL STRYKER CTAPER 22 +5 SUP-06-2205 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL STRYKER CTAPER 22 +10 SUP-06-2210 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT COCR 0 OD26 MM HIP C TAPER SUP-06-2600 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT COCR +5 MM OD26 MM HIP C TAPER OFFSET SUP-06-2605 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT COCR +10 MM OD26 MM HIP C TAPER SUP-06-2610 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT TRITANIUM COCR +0 MM OFFSET C TAPER OD28 MM HIP SUP-06-2800 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT COCR +5 OD28 MM HIP C TAPER SUP-06-2805 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT TRITANIUM COCR +10 MM OFFSET C TAPER OD28 MM HIP SUP-06-2810 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT C TAPER COCR -3 MM OD28 MM HIP SUP-06-2898 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT COCR 0 OD32 MM HIP C TAPER SUP-06-3200 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT COCR +5 MM OFFSET C TAPER L5+ MM OD32 MM HIP SUP-06-3205 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT COCR +10 MM OFFSET C TAPER OD32 MM HIP SUP-06-3210 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. C-TAPER COCR LFIT HEAD 32MM -5 SUP-06-3299 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT TRITANIUM +5 MM OFFSET C TAPER OD36 MM HIP SUP-06-3605 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT TRITANIUM +10 MM OFFSET C TAPER OD36 MM HIP SUP-06-3610 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT TRITANIUM +2.5 MM OFFSET C TAPER OD36 MM HIP SUP-06-3625 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. C-TAPER COCR LFIT HEAD 36MM -2.5 SUP-06-3697 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT TRITANIUM -5 MM OFFSET C TAPER OD36 MM HIP SUP-06-3699 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT COCR +0 MM OD40 MM HIP C TAPER SUP-06-4000 CDM 270010024 LOCAL 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT COCR +5 OD40 MM HIP C TAPER SUP-06-4005 CDM 270010024 LOCAL 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT COCR +10 OD40 MM HIP C TAPER ANATOMIC OFFSET SUP-06-4010 CDM 270010024 LOCAL 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT COCR +7.5 MM OD40 MM HIP C TAPER ANATOMIC SUP-06-4075 CDM 270010024 LOCAL 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT COCR -2.5 MM OD40 MM HIP C TAPER ANATOMIC SUP-06-4097 CDM 270010024 LOCAL 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT COCR -5 MM OD40 MM HIP C TAPER ANATOMIC SUP-06-4099 CDM 270010024 LOCAL 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT COCR +0 MM OD44 MM HIP C TAPER ANATOMIC SUP-06-4400 CDM 270010024 LOCAL 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT COCR +5 MM OD44 MM HIP C TAPER ANATOMIC PRIMARY SUP-06-4405 CDM 270010024 LOCAL 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT V40 COCR -5 MM OD44 MM C TAPER ANATOMIC SUP-06-4499 CDM 270010024 LOCAL 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER CENTRAL VENOUS HICKMAN PEEL-APART SILICONE PEDIATRIC L90CM OD 9.6 FR ODSEC3.2 MM ID 1.6MM 1 LUMEN LOW PROFILE ADAPTER STERILE LATEX FREE SUP-0600560 CDM 0270 RC outpatient 785.23 785.23 785.23 74 581.07 percent of total billed charges 785.23 93 636.04 percent of total billed charges 785.23 785.23 other OPPS APC 785.23 785.23 other OPPS APC 785.23 27.63 216.96 percent of total billed charges 785.23 785.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER HICKMAN PEEL-APART 56CM 9.6FR SILICONE STERILE LF PEDIATRIC 1 LUMEN LOW PROFILE ADAPTER SUP-0600564 CDM 0270 RC outpatient 933.66 933.66 933.66 74 690.91 percent of total billed charges 933.66 93 756.26 percent of total billed charges 933.66 933.66 other OPPS APC 933.66 933.66 other OPPS APC 933.66 27.63 257.97 percent of total billed charges 933.66 933.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM BONE CEMENT REVOLUTION FEMORAL MIX BREAKAWAY NOZZLE LATEX SUP-0606563000 CDM 0270 RC outpatient 226.56 226.56 226.56 74 167.65 percent of total billed charges 226.56 93 183.51 percent of total billed charges 226.56 226.56 other OPPS APC 226.56 226.56 other OPPS APC 226.56 27.63 62.6 percent of total billed charges 226.56 226.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT BONE CEMENT AUTOPLEX VERTAPLEX WITHOUT NEEDLE STERILE LATEX FREE DISPOSABLE SUP-0607-687-000 CDM 0270 RC outpatient 2706.39 2706.39 2706.39 74 2002.73 percent of total billed charges 2706.39 93 2192.18 percent of total billed charges 2706.39 2706.39 other OPPS APC 2706.39 2706.39 other OPPS APC 2706.39 27.63 747.78 percent of total billed charges 2706.39 2706.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MATRIX TISSUE STRATTICE PORCINE DERMIS L8 CM X W6 CM RECONSTRUCTIVE STERILE SUP-0608001 CDM 0270 RC outpatient 3738.8 3738.8 3738.8 74 2766.71 percent of total billed charges 3738.8 93 3028.43 percent of total billed charges 3738.8 3738.8 other OPPS APC 3738.8 3738.8 other OPPS APC 3738.8 27.63 1033.03 percent of total billed charges 3738.8 3738.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MATRIX TISSUE STRATTICE PORCINE DERMIS L16 CM X W6 CM RECONSTRUCTIVE STERILE SUP-0616002 CDM 0270 RC outpatient 7477.6 7477.6 7477.6 74 5533.42 percent of total billed charges 7477.6 93 6056.86 percent of total billed charges 7477.6 7477.6 other OPPS APC 7477.6 7477.6 other OPPS APC 7477.6 27.63 2066.06 percent of total billed charges 7477.6 7477.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING SMOKE EVACUATOR PUREVIEW PLUME-AWAY FILTRATION LAPAROSCOPIC SUP-0620030100 CDM 0270 RC outpatient 55.9 55.9 55.9 74 41.37 percent of total billed charges 55.9 93 45.28 percent of total billed charges 55.9 55.9 other OPPS APC 55.9 55.9 other OPPS APC 55.9 27.63 15.45 percent of total billed charges 55.9 55.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAMP OTOSCOPE DIGITAL MACROVIEW 3.5V HALOGEN BULB REPLACEMENT SUP-06500-U6 CDM 0270 RC outpatient 41.5 41.5 41.5 74 30.71 percent of total billed charges 41.5 93 33.62 percent of total billed charges 41.5 41.5 other OPPS APC 41.5 41.5 other OPPS APC 41.5 27.63 11.47 percent of total billed charges 41.5 41.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET IRRIGATION DEHP C100 ML STANDARD Y 2 BRANCH L100 IN ID.28 IN UROLOGICAL CONNECTOR 2 NONVENT PIERCING PIN 3 PINCH CLAMP STERILE LATEX FREE ARTHROSCOPY SUP-0659901 CDM 0270 RC outpatient 26.08 26.08 26.08 74 19.3 percent of total billed charges 26.08 93 21.12 percent of total billed charges 26.08 26.08 other OPPS APC 26.08 26.08 other OPPS APC 26.08 27.63 7.21 percent of total billed charges 26.08 26.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD 0672 ICD RELIANCE 4-FRONT single coil SUP-0672 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD ICD 0673 RELIANCE 4-FRONT 64 CM SUP-0673 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE IABP 145CM .025IN SENSATION PLUS LINEAR MEGA J SS PTFE 3MM CATHETER STERILE SUP-0684-00-0254-09 CDM 0481 RC outpatient 61.7 61.7 61.7 74 45.66 percent of total billed charges 61.7 93 49.98 percent of total billed charges 61.7 61.7 other OPPS APC 61.7 61.7 other OPPS APC 61.7 51 31.47 percent of total billed charges 61.7 61.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STATLOCK IAB CATHETER STABILIZATION DEVICE SUP-0684-00-0472 CDM 0270 RC outpatient 52.52 52.52 52.52 74 38.86 percent of total billed charges 52.52 93 42.54 percent of total billed charges 52.52 52.52 other OPPS APC 52.52 52.52 other OPPS APC 52.52 27.63 14.51 percent of total billed charges 52.52 52.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 40CC SENSATION PLUS IABP CATHETER SUP-0684-00-0568-01U CDM 0270 RC outpatient 2744.95 2744.95 2744.95 74 2031.26 percent of total billed charges 2744.95 93 2223.41 percent of total billed charges 2744.95 2744.95 other OPPS APC 2744.95 2744.95 other OPPS APC 2744.95 27.63 758.43 percent of total billed charges 2744.95 2744.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER IAB SENSATION PLUS STATLOCK L6 IN L229 MM OD7.5 FR ODSEC16 MM 40 CC CARDIOVASCULAR 2 STATLOCK FIBER OPTIC INSERTION KIT INTRODUCER .025 IN GUIDE WIRE DATASCOPE SYSTEM SUP-0684-00-0568-01U CDM 0270 RC outpatient 2910.18 2910.18 2910.18 74 2153.53 percent of total billed charges 2910.18 93 2357.25 percent of total billed charges 2910.18 2910.18 other OPPS APC 2910.18 2910.18 other OPPS APC 2910.18 27.63 804.08 percent of total billed charges 2910.18 2910.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER IAB SENSATION PLUS L6 IN OD8 FR 50 ML CARDIOVASCULAR 2 STATLOCK DEVICE FIBER OPTIC INSERTION KIT INTRODUCER EXTENDER DATASCOPE SYSTEM SUP-0684-00-0576-01U CDM 0270 RC outpatient 2910.18 2910.18 2910.18 74 2153.53 percent of total billed charges 2910.18 93 2357.25 percent of total billed charges 2910.18 2910.18 other OPPS APC 2910.18 2910.18 other OPPS APC 2910.18 27.63 804.08 percent of total billed charges 2910.18 2910.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHARPS 18GAL NEEDLE & SYRINGE DISPOSAL SUP-07-00020 CDM 0272 RC outpatient 72.26 72.26 72.26 74 53.47 percent of total billed charges 72.26 93 58.53 percent of total billed charges 72.26 72.26 other OPPS APC 72.26 72.26 other OPPS APC 72.26 27.63 19.97 percent of total billed charges 72.26 72.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHARPS 3GAL NEEDLE & SYRINGE DISPOSAL SUP-07-00021 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHARPS 2GAL NEEDLE & SYRINGE DISPOSAL SUP-07-00024 CDM 0272 RC outpatient 2.49 2.49 2.49 74 1.84 percent of total billed charges 2.49 93 2.02 percent of total billed charges 2.49 2.49 other OPPS APC 2.49 2.49 other OPPS APC 2.49 27.63 0.69 percent of total billed charges 2.49 2.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VIRAGE L12 MM OD3.5 MM SPINE SELF TAP POLYAXIAL DARK BLUE SUP-07-01702-005 CDM 270010022 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL VIRAGE TITANIUM CURVE L80 MM OD3.5 MM BLUE OCT FIXATION SYSTEM SUP-07-01710-009 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD TO ROD CONNECTOR 45MM SUP-07-01721-005 CDM 270010020 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VIRAGE SPINE LOCK CAP SUP-07-01728-001 CDM 270010022 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ST360 DEGREE TITANIUM L25 MM OD4.5 MM SPINE PEDICLE POLYAXIAL PIROUETTE TIMED NONSTERILE SUP-07.00319.011 CDM 270010020 LOCAL 0270 RC outpatient 64.87 64.87 64.87 74 48 percent of total billed charges 64.87 93 52.54 percent of total billed charges 64.87 64.87 other OPPS APC 64.87 64.87 other OPPS APC 64.87 27.63 17.92 percent of total billed charges 64.87 64.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENT INJECTABLE BONE STERILE TRAUMACEM (TM) V SUP-07.702.040S CDM 0270 RC outpatient 1123.2 1123.2 1123.2 74 831.17 percent of total billed charges 1123.2 93 909.79 percent of total billed charges 1123.2 1123.2 other OPPS APC 1123.2 1123.2 other OPPS APC 1123.2 27.63 310.34 percent of total billed charges 1123.2 1123.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID NORIAN CALCIUM PHOSPHATE FIBER 3 ML DRILLABLE INJECT REINFORCED BIORESORBABLE BIOCOMPATIBLE ISOTHERMIC STERILE SUP-07.704.003S CDM 270010022 LOCAL 0270 RC outpatient 2176.46 2176.46 2176.46 74 1610.58 percent of total billed charges 2176.46 93 1762.93 percent of total billed charges 2176.46 2176.46 other OPPS APC 2176.46 2176.46 other OPPS APC 2176.46 27.63 601.36 percent of total billed charges 2176.46 2176.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID NORIAN CALCIUM PHOSPHATE FIBER 5 ML DRILLABLE INJECT REINFORCED BIORESORBABLE BIOCOMPATIBLE ISOTHERMIC STERILE SUP-07.704.005S CDM 270010022 LOCAL 0270 RC outpatient 3570.71 3570.71 3570.71 74 2642.33 percent of total billed charges 3570.71 93 2892.28 percent of total billed charges 3570.71 3570.71 other OPPS APC 3570.71 3570.71 other OPPS APC 3570.71 27.63 986.59 percent of total billed charges 3570.71 3570.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID NORIAN CALCIUM PHOSPHATE FIBER 10 CC DRILLABLE INJECT REINFORCE BIORESORBABLE BIOCOMPATIBLE STERILE SUP-07.704.010S CDM 270010022 LOCAL 0270 RC outpatient 7018.44 7018.44 7018.44 74 5193.65 percent of total billed charges 7018.44 93 5684.94 percent of total billed charges 7018.44 7018.44 other OPPS APC 7018.44 7018.44 other OPPS APC 7018.44 27.63 1939.19 percent of total billed charges 7018.44 7018.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID NORIAN CALCIUM PHOSPHATE FIBER 3 ML DRILLABLE FAST SET PUTTY STERILE SUP-07.704.103S CDM 270010012 LOCAL 0270 RC outpatient 2176.46 2176.46 2176.46 74 1610.58 percent of total billed charges 2176.46 93 1762.93 percent of total billed charges 2176.46 2176.46 other OPPS APC 2176.46 2176.46 other OPPS APC 2176.46 27.63 601.36 percent of total billed charges 2176.46 2176.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID NORIAN CALCIUM PHOSPHATE FIBER SODIUM HYALURONATE 5 CC DRILLABLE FAST SET PUTTY STERILE SUP-07.704.105S CDM 270010012 LOCAL 0270 RC outpatient 3570.71 3570.71 3570.71 74 2642.33 percent of total billed charges 3570.71 93 2892.28 percent of total billed charges 3570.71 3570.71 other OPPS APC 3570.71 3570.71 other OPPS APC 3570.71 27.63 986.59 percent of total billed charges 3570.71 3570.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID NORIAN 10 ML DRILLABLE FAST SET PUTTY STERILE SUP-07.704.110S CDM 270010012 LOCAL 0270 RC outpatient 7018.44 7018.44 7018.44 74 5193.65 percent of total billed charges 7018.44 93 5684.94 percent of total billed charges 7018.44 7018.44 other OPPS APC 7018.44 7018.44 other OPPS APC 7018.44 27.63 1939.19 percent of total billed charges 7018.44 7018.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAP SPECIMEN INLINE LATEX FREE SUP-0700-050-000 CDM 0270 RC outpatient 30.42 30.42 30.42 74 22.51 percent of total billed charges 30.42 93 24.64 percent of total billed charges 30.42 30.42 other OPPS APC 30.42 30.42 other OPPS APC 30.42 27.63 8.41 percent of total billed charges 30.42 30.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VIRAGE L12 MM OD4 MM SPINE POLYAXIAL NONSTERILE SUP-0701702048 CDM 270010022 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MANIFOLD 4 PORT SUP-0702020000 CDM 0270 RC outpatient 48.36 48.36 48.36 74 35.79 percent of total billed charges 48.36 93 39.17 percent of total billed charges 48.36 48.36 other OPPS APC 48.36 48.36 other OPPS APC 48.36 27.63 13.36 percent of total billed charges 48.36 48.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MANIFOLD SUCTION NEPTUNE 2 4 PORT SPECIMEN COLLECTION SUP-0702020001 CDM 0270 RC outpatient 69.29 69.29 69.29 74 51.27 percent of total billed charges 69.29 93 56.12 percent of total billed charges 69.29 69.29 other OPPS APC 69.29 69.29 other OPPS APC 69.29 27.63 19.14 percent of total billed charges 69.29 69.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MANIFOLD SUCTION NEPTUNE 2 STANDARD 1 PORT WASTE MANAGEMENT SYSTEM SUP-0702025000 CDM 0270 RC outpatient 26 26 26 74 19.24 percent of total billed charges 26 93 21.06 percent of total billed charges 26 26 other OPPS APC 26 26 other OPPS APC 26 27.63 7.18 percent of total billed charges 26 26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY CATHETER POWERLINE 577ML/HR 5FR POLYURETHANE STERILE LF 2 LUMEN POWER INJECTABLE MICROINTRODUCER SUP-0720515 CDM 0270 RC outpatient 1496.82 1496.82 1496.82 74 1107.65 percent of total billed charges 1496.82 93 1212.42 percent of total billed charges 1496.82 1496.82 other OPPS APC 1496.82 1496.82 other OPPS APC 1496.82 27.63 413.57 percent of total billed charges 1496.82 1496.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAMP SCOPE HALOGEN 6V REPLACEMENT BOX OF 6 SIGMOIDOSCOPE ANOSCOPE LIGHT HANDLE VAGINAL SPECULA ILLUMINATOR SUP-07800-U6 CDM 0270 RC outpatient 45.52 45.52 45.52 74 33.68 percent of total billed charges 45.52 93 36.87 percent of total billed charges 45.52 45.52 other OPPS APC 45.52 45.52 other OPPS APC 45.52 27.63 12.58 percent of total billed charges 45.52 45.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT EAGLE I SPACER 6MM SUP-08-06 CDM 270010020 LOCAL 0270 RC outpatient 3575 3575 3575 74 2645.5 percent of total billed charges 3575 93 2895.75 percent of total billed charges 3575 3575 other OPPS APC 3575 3575 other OPPS APC 3575 27.63 987.77 percent of total billed charges 3575 3575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE SYNPOR TITANIUM POROUS H.8 MM ORBITAL SMOOTH REINFORCE FAN EXPOSE FIXATION HOLE RADIOGRAPHIC VISIBLE STERILE PURPLE 1.3 MM SCREW SUP-08.520.221S CDM 270010013 LOCAL 0270 RC outpatient 4173.36 4173.36 4173.36 74 3088.29 percent of total billed charges 4173.36 93 3380.42 percent of total billed charges 4173.36 4173.36 other OPPS APC 4173.36 4173.36 other OPPS APC 4173.36 27.63 1153.1 percent of total billed charges 4173.36 4173.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE SYNPOR TITANIUM POLYETHYLENE POROUS 43.6 MM RADIUS H1.5 MM ORBITAL FLOOR REINFORCE FAN EXPOSE FIXATION HOLE STERILE TEAL SUP-08.520.231S CDM 270010013 LOCAL 0270 RC outpatient 4173.36 4173.36 4173.36 74 3088.29 percent of total billed charges 4173.36 93 3380.42 percent of total billed charges 4173.36 4173.36 other OPPS APC 4173.36 4173.36 other OPPS APC 4173.36 27.63 1153.1 percent of total billed charges 4173.36 4173.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL OPAL PEEK BULLET NOSE L24 MM X W9 MM X H10 MM REVOLVE 2 RADIOGRAPHIC MARKER PIN SELF DISTRACT NONSTERILE SUP-08.803.050 CDM 270010020 LOCAL 0270 RC outpatient 8190 8190 8190 74 6060.6 percent of total billed charges 8190 93 6633.9 percent of total billed charges 8190 8190 other OPPS APC 8190 8190 other OPPS APC 8190 27.63 2262.9 percent of total billed charges 8190 8190 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL OPAL PEEK-OPTIMA BULLET NOSE L28 MM X W10 MM X H11 MM REVOLVE 2 RADIOGRAPHIC MARKER PIN BEVEL EDGE SELF DISTRACT NONSTERILE SUP-08.803.131 CDM 270010020 LOCAL 0270 RC outpatient 8190 8190 8190 74 6060.6 percent of total billed charges 8190 93 6633.9 percent of total billed charges 8190 8190 other OPPS APC 8190 8190 other OPPS APC 8190 27.63 2262.9 percent of total billed charges 8190 8190 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL T-PAL PEEK TITANIUM 5 D D14 MM LORDOTIC BULLET NOSE L28 MM X W10 MM X H9 MM L8.2 MM .5 CC AUTOGRAFT 2 ANTERIOR RADIOGRAPHIC MARKER PIN PYRAMIDAL TEETH CONNECTION CYLINDER NONSTERILE SUP-08.812.009 CDM 270010012 LOCAL 0270 RC outpatient 13728 13728 13728 74 10158.7 percent of total billed charges 13728 93 11119.7 percent of total billed charges 13728 13728 other OPPS APC 13728 13728 other OPPS APC 13728 27.63 3793.05 percent of total billed charges 13728 13728 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL T-PAL PEEK OPTIMA TITANIUM 5 D D14 MM LORDOTIC BULLET NOSE L28 MM X W10 MM X H12 MM H11.2 MM .77 CC AUTOGRAFT 2 ANTERIOR RADIOGRAPHIC MARKER PIN PYRAMIDAL TEETH CONNECTION CYLINDER NONSTERILE SUP-08.812.012 CDM 270010012 LOCAL 0270 RC outpatient 13728 13728 13728 74 10158.7 percent of total billed charges 13728 93 11119.7 percent of total billed charges 13728 13728 other OPPS APC 13728 13728 other OPPS APC 13728 27.63 3793.05 percent of total billed charges 13728 13728 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETAINER SCREW PRODISC-C L14 MM OD3.5 MM SPINE NONSTERILE SUP-08.820.103 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM DIAGNOSTIC CATHETER IVAS ELITE L10 MM OD10 GA STERILE LATEX FREE SUP-0808-010-800 CDM 0270 RC outpatient 7126.83 7126.83 7126.83 74 5273.85 percent of total billed charges 7126.83 93 5772.73 percent of total billed charges 7126.83 7126.83 other OPPS APC 7126.83 7126.83 other OPPS APC 7126.83 27.63 1969.14 percent of total billed charges 7126.83 7126.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT FRACTURE IVAS L15 MM OD10 GA STERILE LATEX FREE DISPOSABLE ELITE SUP-0808-015-800 CDM 0270 RC outpatient 7126.83 7126.83 7126.83 74 5273.85 percent of total billed charges 7126.83 93 5772.73 percent of total billed charges 7126.83 7126.83 other OPPS APC 7126.83 7126.83 other OPPS APC 7126.83 27.63 1969.14 percent of total billed charges 7126.83 7126.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN LATEX MALECOT 4WING 16FR SUP-086016 CDM 0270 RC outpatient 65.13 65.13 65.13 74 48.2 percent of total billed charges 65.13 93 52.76 percent of total billed charges 65.13 65.13 other OPPS APC 65.13 65.13 other OPPS APC 65.13 27.63 18 percent of total billed charges 65.13 65.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER NEPHROSTOMY MALECOT NATURAL RUBBER OD20 FR 4 WING DRAIN STERILE LATEX DISPOSABLE SUP-086020 CDM 270009008 LOCAL 0270 RC outpatient 11.33 11.33 11.33 74 8.38 percent of total billed charges 11.33 93 9.18 percent of total billed charges 11.33 11.33 other OPPS APC 11.33 11.33 other OPPS APC 11.33 27.63 3.13 percent of total billed charges 11.33 11.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN MALECOT 4-WING 22FR LATEX SUP-086022 CDM 270009008 LOCAL 0270 RC outpatient 11.33 11.33 11.33 74 8.38 percent of total billed charges 11.33 93 9.18 percent of total billed charges 11.33 11.33 other OPPS APC 11.33 11.33 other OPPS APC 11.33 27.63 3.13 percent of total billed charges 11.33 11.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON FULL LENGTH FEMORAL RIGHT 3.5 CURVE L100 CM OD6 FR ID.056 IN ROBUST SHAFT WIRE BRAID SUP-08641-01 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON FEMORAL RIGHT 5 CURVE L100 CM OD6 FR ID.056 IN ROBUST SHAFT FULL LENGTH WIRE BRAID VASCULAR ACCESS SUP-08641-03 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON INTERNAL MAMMARY CURVE L100 CM OD6 FR ID.056 IN ROBUST SHAFT FULL LENGTH WIRE BRAID SUPER SOFT TIP SUP-08641-201 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F FL5 DIAGNOSTIC CATHETER 100CM SUP-08641-24 CDM 0481 RC outpatient 18.85 18.85 18.85 74 13.95 percent of total billed charges 18.85 93 15.27 percent of total billed charges 18.85 18.85 other OPPS APC 18.85 18.85 other OPPS APC 18.85 51 9.61 percent of total billed charges 18.85 18.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON FEMORAL LEFT 6 CURVE L100 CM OD6 FR ID.056 IN ROBUST SHAFT FULL LENGTH WIRE BRAID SUPER SOFT TIP SUP-08641-25 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON AMPLATZ LEFT 1 CURVE L100 CM OD6 FR ID.056 IN ROBUST SHAFT WIRE BRAID SUP-0864196 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INSERTION FOR IABP SUP-0884-00-0019-22 CDM 0270 RC outpatient 410.64 410.64 410.64 74 303.87 percent of total billed charges 410.64 93 332.62 percent of total billed charges 410.64 410.64 other OPPS APC 410.64 410.64 other OPPS APC 410.64 27.63 113.46 percent of total billed charges 410.64 410.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER INSERTION SENSATION PLUS L6 IN OD8 FR 50 ML REINFORCED SHEATH INTRODUCER MALE LUER CAP DILATOR SUP-0884-00-0019-23 CDM 0270 RC outpatient 391.09 391.09 391.09 74 289.41 percent of total billed charges 391.09 93 316.78 percent of total billed charges 391.09 391.09 other OPPS APC 391.09 391.09 other OPPS APC 391.09 27.63 108.06 percent of total billed charges 391.09 391.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT EAGLEII SPACER 5MM SUP-09-05 CDM 0270 RC outpatient 3575 3575 3575 74 2645.5 percent of total billed charges 3575 93 2895.75 percent of total billed charges 3575 3575 other OPPS APC 3575 3575 other OPPS APC 3575 27.63 987.77 percent of total billed charges 3575 3575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CORTICAL CANCELLOUS H6 MM CERVICAL SPINE SERIES CII SUP-09-06 CDM 270010012 LOCAL 0270 RC outpatient 3575 3575 3575 74 2645.5 percent of total billed charges 3575 93 2895.75 percent of total billed charges 3575 3575 other OPPS APC 3575 3575 other OPPS APC 3575 27.63 987.77 percent of total billed charges 3575 3575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE 7MM CORTICAL CANCELLOUS CERVICAL SPINE SERIES CII SUP-09-07 CDM 270010012 LOCAL 0270 RC outpatient 3575 3575 3575 74 2645.5 percent of total billed charges 3575 93 2895.75 percent of total billed charges 3575 3575 other OPPS APC 3575 3575 other OPPS APC 3575 27.63 987.77 percent of total billed charges 3575 3575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CANCELLOUS CORTICAL H8 MM SUP-09-08 CDM 270010020 LOCAL 0270 RC outpatient 3575 3575 3575 74 2645.5 percent of total billed charges 3575 93 2895.75 percent of total billed charges 3575 3575 other OPPS APC 3575 3575 other OPPS APC 3575 27.63 987.77 percent of total billed charges 3575 3575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CORTICAL CANCELLOUS L14 MM X W12 MM X H10 MM CERVICAL SPINE TEXTURED SURFACE DESIGN CII SUP-09-10S CDM 270010020 LOCAL 0270 RC outpatient 3575 3575 3575 74 2645.5 percent of total billed charges 3575 93 2895.75 percent of total billed charges 3575 3575 other OPPS APC 3575 3575 other OPPS APC 3575 27.63 987.77 percent of total billed charges 3575 3575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC TFN-ADVANCED L475 MM OD3.2 MM FEMORAL PROXIMAL NONSTERILE SUP-09.037.010 CDM 270010022 LOCAL 0270 RC outpatient 638.69 638.69 638.69 74 472.63 percent of total billed charges 638.69 93 517.34 percent of total billed charges 638.69 638.69 other OPPS APC 638.69 638.69 other OPPS APC 638.69 27.63 176.47 percent of total billed charges 638.69 638.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR STANDARD SLIGHT TRAPEZOID H11.5 MM OD18 MM ELBOW TAPER LOCKING CONNECTION INTEGRATED CONNECTION SCREW STERILE SUP-09.402.018S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR STANDARD H12.5 MM OD20 MM ELBOW STERILE SUP-09.402.020S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR STANDARD H12 MM OD22 MM ELBOW STERILE SUP-09.402.022S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR STANDARD H13 MM OD24 MM STERILE SUP-09.402.024S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR SLIGHT TRAPEZOID ROUND STANDARD HEIGHT H13.5 MM OD26 MM ELBOW SMOOTH NECK SYMMETRICAL STERILE SUP-09.402.026S CDM 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR STANDARD SLIGHT TRAPEZOID H14 MM OD28 MM ELBOW TAPER LOCKING CONNECTION INTEGRATED CONNECTION SCREW STERILE SUP-09.402.028S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR 2 MM SLIGHT TRAPEZOID H13.5 MM OD18 MM ELBOW TAPER LOCKING CONNECTION INTEGRATED CONNECTION SCREW STERILE SUP-09.402.218S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR STANDARD H14 MM OD20 MM ELBOW STERILE SUP-09.402.220S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR STANDARD H14.5 MM OD22 MM ELBOW STERILE SUP-09.402.222S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR 2 MM SLIGHT TRAPEZOID H15 MM OD24 MM ELBOW TAPER LOCKING CONNECTION INTEGRATED CONNECTION SCREW STERILE SUP-09.402.224S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR 2 MM SLIGHT TRAPEZOID H15.5 MM OD26 MM ELBOW TAPER LOCKING CONNECTION INTEGRATED CONNECTION SCREW STERILE SUP-09.402.226S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR 2 MM SLIGHT TRAPEZOID H16 MM OD28 MM ELBOW TAPER LOCKING CONNECTION INTEGRATED CONNECTION SCREW STERILE SUP-09.402.228S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR 4 MM SLIGHT TRAPEZOID H15.5 MM OD18 MM ELBOW TAPER LOCKING CONNECTION INTEGRATED CONNECTION SCREW STERILE SUP-09.402.418S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR 4 MM SLIGHT TRAPEZOID H16 MM OD20 MM ELBOW TAPER LOCKING CONNECTION INTEGRATED CONNECTION SCREW STERILE SUP-09.402.420S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR 4 MM SLIGHT TRAPEZOID H16.5 MM OD24 MM ELBOW TAPER LOCKING CONNECTION INTEGRATED CONNECTION SCREW STERILE SUP-09.402.422S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR H17 MM OD24 MM STERILE SUP-09.402.424S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR 4 MM SLIGHT TRAPEZOID H17.5 MM OD26 MM ELBOW TAPER LOCKING CONNECTION INTEGRATED CONNECTION SCREW STERILE SUP-09.402.426S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR 4 MM SLIGHT TRAPEZOID H18 MM OD28 MM ELBOW TAPER LOCKING CONNECTION INTEGRATED CONNECTION SCREW STERILE SUP-09.402.428S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL SLIGHT TRAPEZOID 17.5MM 6MM 18MM COCR STERILE ELBOW INTEGRATE CONNECTION SCREW EXTENSION SUP-09.402.618S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR 6 MM SLIGHT TRAPEZOID H18 MM OD20 MM ELBOW TAPER LOCKING CONNECTION INTEGRATED CONNECTION SCREW STERILE SUP-09.402.620S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR 6 MM SLIGHT TRAPEZOID H18.5 MM OD22 MM ELBOW TAPER LOCKING CONNECTION INTEGRATED CONNECTION SCREW STERILE SUP-09.402.622S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR 6 MM SLIGHT TRAPEZOID H19 MM OD24 MM ELBOW TAPER LOCKING CONNECTION INTEGRATED CONNECTION SCREW STERILE SUP-09.402.624S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR 6 MM SLIGHT TRAPEZOID H19.5 MM OD26 MM ELBOW TAPER LOCKING CONNECTION INTEGRATED CONNECTION SCREW STERILE SUP-09.402.626S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL COCR 6 MM SLIGHT TRAPEZOID H20 MM OD28 MM ELBOW TAPER LOCKING CONNECTION INTEGRATED CONNECTION SCREW STERILE SUP-09.402.628S CDM 270010022 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL ELLIPTICAL H10 MM OD22 MM ODSEC5.5 MM STERILE SUP-09.405.250S CDM 0270 RC outpatient 8937.5 8937.5 8937.5 74 6613.75 percent of total billed charges 8937.5 93 7239.38 percent of total billed charges 8937.5 8937.5 other OPPS APC 8937.5 8937.5 other OPPS APC 8937.5 27.63 2469.43 percent of total billed charges 8937.5 8937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL OD+3 MM ELLIPTICAL H10 MM OD22 MM ODSEC5.5 MM STERILE SUP-09.405.253S CDM 0270 RC outpatient 8043.75 8043.75 8043.75 74 5952.38 percent of total billed charges 8043.75 93 6515.44 percent of total billed charges 8043.75 8043.75 other OPPS APC 8043.75 8043.75 other OPPS APC 8043.75 27.63 2222.49 percent of total billed charges 8043.75 8043.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL OD+6 MM ELLIPTICAL H10 MM OD22 MM ODSEC5.5 MM STERILE SUP-09.405.256S CDM 0270 RC outpatient 8937.5 8937.5 8937.5 74 6613.75 percent of total billed charges 8937.5 93 7239.38 percent of total billed charges 8937.5 8937.5 other OPPS APC 8937.5 8937.5 other OPPS APC 8937.5 27.63 2469.43 percent of total billed charges 8937.5 8937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL ELLIPTICAL H10 MM OD22 MM ODSEC6.5 MM STERILE SUP-09.405.260S CDM 0270 RC outpatient 8937.5 8937.5 8937.5 74 6613.75 percent of total billed charges 8937.5 93 7239.38 percent of total billed charges 8937.5 8937.5 other OPPS APC 8937.5 8937.5 other OPPS APC 8937.5 27.63 2469.43 percent of total billed charges 8937.5 8937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL OD+3 MM ELLIPTICAL H10 MM OD22 MM ODSEC6.5 MM ELBOW STERILE SUP-09.405.263S CDM 0270 RC outpatient 8043.75 8043.75 8043.75 74 5952.38 percent of total billed charges 8043.75 93 6515.44 percent of total billed charges 8043.75 8043.75 other OPPS APC 8043.75 8043.75 other OPPS APC 8043.75 27.63 2222.49 percent of total billed charges 8043.75 8043.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL OD+6 MM ELLIPTICAL H10 MM OD22 MM ODSEC6.5 MM STERILE SUP-09.405.266S CDM 0270 RC outpatient 8937.5 8937.5 8937.5 74 6613.75 percent of total billed charges 8937.5 93 7239.38 percent of total billed charges 8937.5 8937.5 other OPPS APC 8937.5 8937.5 other OPPS APC 8937.5 27.63 2469.43 percent of total billed charges 8937.5 8937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL ELLIPTICAL H10 MM OD22 MM ODSEC7.5 MM STERILE SUP-09.405.270S CDM 0270 RC outpatient 8937.5 8937.5 8937.5 74 6613.75 percent of total billed charges 8937.5 93 7239.38 percent of total billed charges 8937.5 8937.5 other OPPS APC 8937.5 8937.5 other OPPS APC 8937.5 27.63 2469.43 percent of total billed charges 8937.5 8937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL OD+3 MM ELLIPTICAL H10 MM OD22 MM ODSEC7.5 MM STERILE SUP-09.405.273S CDM 0270 RC outpatient 8491.34 8491.34 8491.34 74 6283.59 percent of total billed charges 8491.34 93 6877.99 percent of total billed charges 8491.34 8491.34 other OPPS APC 8491.34 8491.34 other OPPS APC 8491.34 27.63 2346.16 percent of total billed charges 8491.34 8491.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL OD+6 MM ELLIPTICAL H10 MM OD22 MM ODSEC7.5 MM STERILE SUP-09.405.276S CDM 0270 RC outpatient 8491.34 8491.34 8491.34 74 6283.59 percent of total billed charges 8491.34 93 6877.99 percent of total billed charges 8491.34 8491.34 other OPPS APC 8491.34 8491.34 other OPPS APC 8491.34 27.63 2346.16 percent of total billed charges 8491.34 8491.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL ELLIPTICAL H10 MM OD22 MM ODSEC8.5 MM ELBOW STERILE SUP-09.405.280S CDM 0270 RC outpatient 8491.34 8491.34 8491.34 74 6283.59 percent of total billed charges 8491.34 93 6877.99 percent of total billed charges 8491.34 8491.34 other OPPS APC 8491.34 8491.34 other OPPS APC 8491.34 27.63 2346.16 percent of total billed charges 8491.34 8491.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL OD+3 MM ELLIPTICAL H10 MM OD22 MM ODSEC8.5 MM STERILE SUP-09.405.283S CDM 0270 RC outpatient 8937.5 8937.5 8937.5 74 6613.75 percent of total billed charges 8937.5 93 7239.38 percent of total billed charges 8937.5 8937.5 other OPPS APC 8937.5 8937.5 other OPPS APC 8937.5 27.63 2469.43 percent of total billed charges 8937.5 8937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL OD+6 MM ELLIPTICAL H10 MM OD22 MM ODSEC8.5 MM STERILE SUP-09.405.286S CDM 0270 RC outpatient 8937.5 8937.5 8937.5 74 6613.75 percent of total billed charges 8937.5 93 7239.38 percent of total billed charges 8937.5 8937.5 other OPPS APC 8937.5 8937.5 other OPPS APC 8937.5 27.63 2469.43 percent of total billed charges 8937.5 8937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL ELLIPTICAL H11 MM OD25 MM ODSEC6.5 MM STERILE SUP-09.405.560S CDM 0270 RC outpatient 8937.5 8937.5 8937.5 74 6613.75 percent of total billed charges 8937.5 93 7239.38 percent of total billed charges 8937.5 8937.5 other OPPS APC 8937.5 8937.5 other OPPS APC 8937.5 27.63 2469.43 percent of total billed charges 8937.5 8937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL OD+3 MM ELLIPTICAL H11 MM OD25 MM ODSEC6.5 MM STERILE SUP-09.405.563S CDM 0270 RC outpatient 8937.5 8937.5 8937.5 74 6613.75 percent of total billed charges 8937.5 93 7239.38 percent of total billed charges 8937.5 8937.5 other OPPS APC 8937.5 8937.5 other OPPS APC 8937.5 27.63 2469.43 percent of total billed charges 8937.5 8937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL OD+6 MM ELLIPTICAL H11 MM OD25 MM ODSEC6.5 MM STERILE SUP-09.405.566S CDM 0270 RC outpatient 8937.5 8937.5 8937.5 74 6613.75 percent of total billed charges 8937.5 93 7239.38 percent of total billed charges 8937.5 8937.5 other OPPS APC 8937.5 8937.5 other OPPS APC 8937.5 27.63 2469.43 percent of total billed charges 8937.5 8937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL ELLIPTICAL H11 MM OD25 MM ODSEC7.5 MM STERILE SUP-09.405.570S CDM 0270 RC outpatient 8937.5 8937.5 8937.5 74 6613.75 percent of total billed charges 8937.5 93 7239.38 percent of total billed charges 8937.5 8937.5 other OPPS APC 8937.5 8937.5 other OPPS APC 8937.5 27.63 2469.43 percent of total billed charges 8937.5 8937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL OD+3 MM ELLIPTICAL H11 MM OD25 MM ODSEC7.5 MM STERILE SUP-09.405.573S CDM 0270 RC outpatient 8043.75 8043.75 8043.75 74 5952.38 percent of total billed charges 8043.75 93 6515.44 percent of total billed charges 8043.75 8043.75 other OPPS APC 8043.75 8043.75 other OPPS APC 8043.75 27.63 2222.49 percent of total billed charges 8043.75 8043.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL OD+6 MM ELLIPTICAL H11 MM OD25 MM ODSEC7.5 MM STERILE SUP-09.405.576S CDM 0270 RC outpatient 8569.34 8569.34 8569.34 74 6341.31 percent of total billed charges 8569.34 93 6941.17 percent of total billed charges 8569.34 8569.34 other OPPS APC 8569.34 8569.34 other OPPS APC 8569.34 27.63 2367.71 percent of total billed charges 8569.34 8569.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL ELLIPTICAL H11 MM OD25 MM ODSEC8.5 MM STERILE SUP-09.405.580S CDM 0270 RC outpatient 8938.54 8938.54 8938.54 74 6614.52 percent of total billed charges 8938.54 93 7240.22 percent of total billed charges 8938.54 8938.54 other OPPS APC 8938.54 8938.54 other OPPS APC 8938.54 27.63 2469.72 percent of total billed charges 8938.54 8938.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL OD+3 MM ELLIPTICAL H11 MM OD25 MM ODSEC8.5 MM STERILE SUP-09.405.583S CDM 0270 RC outpatient 8938.54 8938.54 8938.54 74 6614.52 percent of total billed charges 8938.54 93 7240.22 percent of total billed charges 8938.54 8938.54 other OPPS APC 8938.54 8938.54 other OPPS APC 8938.54 27.63 2469.72 percent of total billed charges 8938.54 8938.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL +6 H11 MM OD25 MM ODSEC8.5 MM ELBOW STEM STERILE SUP-09.405.586S CDM 0270 RC outpatient 8491.34 8491.34 8491.34 74 6283.59 percent of total billed charges 8491.34 93 6877.99 percent of total billed charges 8491.34 8491.34 other OPPS APC 8491.34 8491.34 other OPPS APC 8491.34 27.63 2346.16 percent of total billed charges 8491.34 8491.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL ELLIPTICAL H9 MM OD19 MM ODSEC5.5 MM STERILE SUP-09.405.950S CDM 0270 RC outpatient 8937.5 8937.5 8937.5 74 6613.75 percent of total billed charges 8937.5 93 7239.38 percent of total billed charges 8937.5 8937.5 other OPPS APC 8937.5 8937.5 other OPPS APC 8937.5 27.63 2469.43 percent of total billed charges 8937.5 8937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL OD+3 MM ELLIPTICAL H9 MM OD19 MM ODSEC5.5 MM STERILE SUP-09.405.953S CDM 0270 RC outpatient 8937.5 8937.5 8937.5 74 6613.75 percent of total billed charges 8937.5 93 7239.38 percent of total billed charges 8937.5 8937.5 other OPPS APC 8937.5 8937.5 other OPPS APC 8937.5 27.63 2469.43 percent of total billed charges 8937.5 8937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL OD+6 MM ELLIPTICAL H9 MM OD19 MM ODSEC5.5 MM STERILE SUP-09.405.956S CDM 0270 RC outpatient 8937.5 8937.5 8937.5 74 6613.75 percent of total billed charges 8937.5 93 7239.38 percent of total billed charges 8937.5 8937.5 other OPPS APC 8937.5 8937.5 other OPPS APC 8937.5 27.63 2469.43 percent of total billed charges 8937.5 8937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL ELLIPTICAL H9 MM OD19 MM ODSEC6.5 MM STERILE SUP-09.405.960S CDM 0270 RC outpatient 8491.34 8491.34 8491.34 74 6283.59 percent of total billed charges 8491.34 93 6877.99 percent of total billed charges 8491.34 8491.34 other OPPS APC 8491.34 8491.34 other OPPS APC 8491.34 27.63 2346.16 percent of total billed charges 8491.34 8491.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL OD+3 MM ELLIPTICAL H9 MM OD19 MM ODSEC6.5 MM ELBOW STERILE SUP-09.405.963S CDM 0270 RC outpatient 8491.34 8491.34 8491.34 74 6283.59 percent of total billed charges 8491.34 93 6877.99 percent of total billed charges 8491.34 8491.34 other OPPS APC 8491.34 8491.34 other OPPS APC 8491.34 27.63 2346.16 percent of total billed charges 8491.34 8491.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL OD+6 MM ELLIPTICAL H9 MM OD22 MM ODSEC6.5 MM STERILE SUP-09.405.966S CDM 0270 RC outpatient 8491.34 8491.34 8491.34 74 6283.59 percent of total billed charges 8491.34 93 6877.99 percent of total billed charges 8491.34 8491.34 other OPPS APC 8491.34 8491.34 other OPPS APC 8491.34 27.63 2346.16 percent of total billed charges 8491.34 8491.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL ELLIPTICAL H9 MM OD19 MM ODSEC7.5 MM STERILE SUP-09.405.970S CDM 0270 RC outpatient 8937.5 8937.5 8937.5 74 6613.75 percent of total billed charges 8937.5 93 7239.38 percent of total billed charges 8937.5 8937.5 other OPPS APC 8937.5 8937.5 other OPPS APC 8937.5 27.63 2469.43 percent of total billed charges 8937.5 8937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL OD+3 MM ELLIPTICAL H9 MM OD19 MM ODSEC7.5 MM STERILE SUP-09.405.973S CDM 0270 RC outpatient 8043.75 8043.75 8043.75 74 5952.38 percent of total billed charges 8043.75 93 6515.44 percent of total billed charges 8043.75 8043.75 other OPPS APC 8043.75 8043.75 other OPPS APC 8043.75 27.63 2222.49 percent of total billed charges 8043.75 8043.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL OD+6 MM ELLIPTICAL H9 MM OD19 MM ODSEC7.5 MM STERILE SUP-09.405.976S CDM 0270 RC outpatient 8491.34 8491.34 8491.34 74 6283.59 percent of total billed charges 8491.34 93 6877.99 percent of total billed charges 8491.34 8491.34 other OPPS APC 8491.34 8491.34 other OPPS APC 8491.34 27.63 2346.16 percent of total billed charges 8491.34 8491.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISC INTERVERTEBRAL PRODISC-C COCR TITANIUM UHMWPE D12 MM MEDIUM H5 MM SPINE CERVICAL SEMICONSTRAIN CENTRAL KEEL STERILE SUP-09.820.025S CDM 270010020 LOCAL 0270 RC outpatient 15337.4 15337.4 15337.4 74 11349.7 percent of total billed charges 15337.4 93 12423.3 percent of total billed charges 15337.4 15337.4 other OPPS APC 15337.4 15337.4 other OPPS APC 15337.4 27.63 4237.72 percent of total billed charges 15337.4 15337.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISC INTERVERTEBRAL PRODISC-C COCR TITANIUM UHMWPE MEDIUM H6 MM SPINE CERVICAL SEMICONSTRAIN CENTRAL KEEL STERILE SUP-09.820.026S CDM 270010020 LOCAL 0270 RC outpatient 9704.5 9704.5 9704.5 74 7181.33 percent of total billed charges 9704.5 93 7860.65 percent of total billed charges 9704.5 9704.5 other OPPS APC 9704.5 9704.5 other OPPS APC 9704.5 27.63 2681.35 percent of total billed charges 9704.5 9704.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SYNTHES PRODISC C 6MM MEDIUM DEEP SUP-09.820.036S CDM 270010020 LOCAL 0270 RC outpatient 10120.1 10120.1 10120.1 74 7488.88 percent of total billed charges 10120.1 93 8197.29 percent of total billed charges 10120.1 10120.1 other OPPS APC 10120.1 10120.1 other OPPS APC 10120.1 27.63 2796.19 percent of total billed charges 10120.1 10120.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISC INTERVERTEBRAL PRODISC-C COCR TITANIUM UHMWPE LARGE H5 MM SPINE CERVICAL SEMICONSTRAIN CENTRAL KEEL STERILE SUP-09.820.045S CDM 0270 RC outpatient 9704.5 9704.5 9704.5 74 7181.33 percent of total billed charges 9704.5 93 7860.65 percent of total billed charges 9704.5 9704.5 other OPPS APC 9704.5 9704.5 other OPPS APC 9704.5 27.63 2681.35 percent of total billed charges 9704.5 9704.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISC INTERVERTEBRAL PRODISC-C COCR TITANIUM UHMWPE LARGE H6 MM SPINE CERVICAL SEMICONSTRAIN CENTRAL KEEL STERILE SUP-09.820.046S CDM 0270 RC outpatient 15337.4 15337.4 15337.4 74 11349.7 percent of total billed charges 15337.4 93 12423.3 percent of total billed charges 15337.4 15337.4 other OPPS APC 15337.4 15337.4 other OPPS APC 15337.4 27.63 4237.72 percent of total billed charges 15337.4 15337.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISC INTERVERTEBRAL PRODISC-C COCR TITANIUM UHMWPE LARGE DEEP H5 MM SPINE CERVICAL SEMICONSTRAIN CENTRAL KEEL STERILE SUP-09.820.055S CDM 270010020 LOCAL 0270 RC outpatient 15337.4 15337.4 15337.4 74 11349.7 percent of total billed charges 15337.4 93 12423.3 percent of total billed charges 15337.4 15337.4 other OPPS APC 15337.4 15337.4 other OPPS APC 15337.4 27.63 4237.72 percent of total billed charges 15337.4 15337.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISC INTERVERTEBRAL PRODISC-C COCR TITANIUM UHMWPE LARGE DEEP H6 MM SPINE CERVICAL SEMICONSTRAIN CENTRAL KEEL STERILE SUP-09.820.056S CDM 0270 RC outpatient 9704.5 9704.5 9704.5 74 7181.33 percent of total billed charges 9704.5 93 7860.65 percent of total billed charges 9704.5 9704.5 other OPPS APC 9704.5 9704.5 other OPPS APC 9704.5 27.63 2681.35 percent of total billed charges 9704.5 9704.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH ACETABULAR X-CHANGE RESTORATION FLAT HIP SUP-0942-8-030 CDM 0270 RC outpatient 1385.8 1385.8 1385.8 74 1025.49 percent of total billed charges 1385.8 93 1122.5 percent of total billed charges 1385.8 1385.8 other OPPS APC 1385.8 1385.8 other OPPS APC 1385.8 27.63 382.9 percent of total billed charges 1385.8 1385.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT ORTHOPEDIC MPO ACTIVE SHEEPSKIN LARGE L9-10 IN OD18 IN ANKLE FOOT AMBULATORY ATTACHMENT ORTHOSIS SHEEPSKIN LINER SUP-09MP-L CDM outpatient 203.16 203.16 203.16 203.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRACE ORTHOPEDIC MPO ACTIVE SHEEPSKIN MEDIUM L8-9 IN OD16 IN ANKLE FOOT REMOVABLE AMBULATORY ATTACHMENT TWIST/LOCK MOTION YELLOW SUP-09MP-M CDM outpatient 203.16 203.16 203.16 203.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE GORE-TEX CV-0 THX-36 L36 IN 2 ARM MONOFILAMENT UNDYED SUP-0N07A CDM 0270 RC outpatient 92.3 92.3 92.3 74 68.3 percent of total billed charges 92.3 93 74.76 percent of total billed charges 92.3 92.3 other OPPS APC 92.3 92.3 other OPPS APC 92.3 27.63 25.5 percent of total billed charges 92.3 92.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE GORE-TEX CV-0 TH-50 L48 IN SUP-0U01A CDM 0270 RC outpatient 92.3 92.3 92.3 74 68.3 percent of total billed charges 92.3 93 74.76 percent of total billed charges 92.3 92.3 other OPPS APC 92.3 92.3 other OPPS APC 92.3 27.63 25.5 percent of total billed charges 92.3 92.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CIRCUIT BREATHING AIRLIFE ADULT L72 IN 2 FLEXIBLE CORRUGATE TUBE Y PORT PLUG INSPIRATORY ELBOW CONNECTOR LATEX MR850 MR700 MR600 SERIES HEATER SUP-0Y1778 CDM 0270 RC outpatient 7.18 7.18 7.18 74 5.31 percent of total billed charges 7.18 93 5.82 percent of total billed charges 7.18 7.18 other OPPS APC 7.18 7.18 other OPPS APC 7.18 27.63 1.98 percent of total billed charges 7.18 7.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACKING WOUND GAUZE L72 IN X W2 IN VAGINAL 4 PLY RADIOPAQUE STERILE DISPOSABLE SUP-1-272 CDM 0270 RC outpatient 13.32 13.32 13.32 74 9.86 percent of total billed charges 13.32 93 10.79 percent of total billed charges 13.32 13.32 other OPPS APC 13.32 13.32 other OPPS APC 13.32 27.63 3.68 percent of total billed charges 13.32 13.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FITTING PORT 1 TUBE BAYONET SUP-1-HP CDM outpatient 3.6 3.6 3.6 3.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING HEAVY PACK (D UNIT) SUP-10-00019 CDM 0272 RC outpatient 1.75 1.75 1.75 74 1.3 percent of total billed charges 1.75 93 1.42 percent of total billed charges 1.75 1.75 other OPPS APC 1.75 1.75 other OPPS APC 1.75 27.63 0.48 percent of total billed charges 1.75 1.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING TEGADERM 2 1/4 X 2 3/4 SUP-10-00020 CDM 0272 RC outpatient 0.2 0.2 0.2 74 0.15 percent of total billed charges 0.2 93 0.16 percent of total billed charges 0.2 0.2 other OPPS APC 0.2 0.2 other OPPS APC 0.2 27.63 0.06 percent of total billed charges 0.2 0.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING PRN ACCESS GUARD SUP-10-00027 CDM 0272 RC outpatient 0.35 0.35 0.35 74 0.26 percent of total billed charges 0.35 93 0.28 percent of total billed charges 0.35 0.35 other OPPS APC 0.35 0.35 other OPPS APC 0.35 27.63 0.1 percent of total billed charges 0.35 0.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GAUZE PLAIN 1/2 SUP-10-00036 CDM 0272 RC outpatient 2.03 2.03 2.03 74 1.5 percent of total billed charges 2.03 93 1.64 percent of total billed charges 2.03 2.03 other OPPS APC 2.03 2.03 other OPPS APC 2.03 27.63 0.56 percent of total billed charges 2.03 2.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GAUZE VASELINE 3 X 18 SUP-10-00039 CDM 0272 RC outpatient 0.61 0.61 0.61 74 0.45 percent of total billed charges 0.61 93 0.49 percent of total billed charges 0.61 0.61 other OPPS APC 0.61 0.61 other OPPS APC 0.61 27.63 0.17 percent of total billed charges 0.61 0.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKINETTE IMPERVIOUS SMALL SUP-10-00056 CDM 0271 RC outpatient 23.37 23.37 23.37 74 17.29 percent of total billed charges 23.37 93 18.93 percent of total billed charges 23.37 23.37 other OPPS APC 23.37 23.37 other OPPS APC 23.37 27.63 6.46 percent of total billed charges 23.37 23.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKINETTE STERILE 4 SUP-10-00057 CDM 0272 RC outpatient 26.49 26.49 26.49 74 19.6 percent of total billed charges 26.49 93 21.46 percent of total billed charges 26.49 26.49 other OPPS APC 26.49 26.49 other OPPS APC 26.49 27.63 7.32 percent of total billed charges 26.49 26.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE WEBRIL 2 COTTON SUP-10-00061 CDM 0272 RC outpatient 39.96 39.96 39.96 74 29.57 percent of total billed charges 39.96 93 32.37 percent of total billed charges 39.96 39.96 other OPPS APC 39.96 39.96 other OPPS APC 39.96 27.63 11.04 percent of total billed charges 39.96 39.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAIDS COVERLET/FINGERTIP SUP-10-00066 CDM 0272 RC outpatient 3.77 3.77 3.77 74 2.79 percent of total billed charges 3.77 93 3.05 percent of total billed charges 3.77 3.77 other OPPS APC 3.77 3.77 other OPPS APC 3.77 27.63 1.04 percent of total billed charges 3.77 3.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAIDS PATCH 1.5 SUP-10-00067 CDM 0272 RC outpatient 22.74 22.74 22.74 74 16.83 percent of total billed charges 22.74 93 18.42 percent of total billed charges 22.74 22.74 other OPPS APC 22.74 22.74 other OPPS APC 22.74 27.63 6.28 percent of total billed charges 22.74 22.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAIDS SPOT SUP-10-00068 CDM 0272 RC outpatient 1.35 1.35 1.35 74 1 percent of total billed charges 1.35 93 1.09 percent of total billed charges 1.35 1.35 other OPPS APC 1.35 1.35 other OPPS APC 1.35 27.63 0.37 percent of total billed charges 1.35 1.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KITTNER STERILE SUP-10-00070 CDM 0272 RC outpatient 2.88 2.88 2.88 74 2.13 percent of total billed charges 2.88 93 2.33 percent of total billed charges 2.88 2.88 other OPPS APC 2.88 2.88 other OPPS APC 2.88 27.63 0.8 percent of total billed charges 2.88 2.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING TRACH 4X4 STERILE SUP-10-00091 CDM 0272 RC outpatient 2.22 2.22 2.22 74 1.64 percent of total billed charges 2.22 93 1.8 percent of total billed charges 2.22 2.22 other OPPS APC 2.22 2.22 other OPPS APC 2.22 27.63 0.61 percent of total billed charges 2.22 2.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE 6 STERILE ACE SUP-10-00097 CDM 0272 RC outpatient 3.09 3.09 3.09 74 2.29 percent of total billed charges 3.09 93 2.5 percent of total billed charges 3.09 3.09 other OPPS APC 3.09 3.09 other OPPS APC 3.09 27.63 0.85 percent of total billed charges 3.09 3.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IODOFORM STRIP PACKING 1/2 SUP-10-00101 CDM 0272 RC outpatient 1.95 1.95 1.95 74 1.44 percent of total billed charges 1.95 93 1.58 percent of total billed charges 1.95 1.95 other OPPS APC 1.95 1.95 other OPPS APC 1.95 27.63 0.54 percent of total billed charges 1.95 1.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IODOFORM STRIP PACKING 1/4 SUP-10-00102 CDM 0272 RC outpatient 3.68 3.68 3.68 74 2.72 percent of total billed charges 3.68 93 2.98 percent of total billed charges 3.68 3.68 other OPPS APC 3.68 3.68 other OPPS APC 3.68 27.63 1.02 percent of total billed charges 3.68 3.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IODOFORM STRIP PACKING 2 SUP-10-00103 CDM 0272 RC outpatient 3.66 3.66 3.66 74 2.71 percent of total billed charges 3.66 93 2.96 percent of total billed charges 3.66 3.66 other OPPS APC 3.66 3.66 other OPPS APC 3.66 27.63 1.01 percent of total billed charges 3.66 3.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING PETROLATUM 3 X 9 LF SUP-10-00106 CDM 0272 RC outpatient 1.37 1.37 1.37 74 1.01 percent of total billed charges 1.37 93 1.11 percent of total billed charges 1.37 1.37 other OPPS APC 1.37 1.37 other OPPS APC 1.37 27.63 0.38 percent of total billed charges 1.37 1.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAD ABDOMINAL 5 X 9 STERILE SUP-10-00107 CDM 0272 RC outpatient 2.17 2.17 2.17 74 1.61 percent of total billed charges 2.17 93 1.76 percent of total billed charges 2.17 2.17 other OPPS APC 2.17 2.17 other OPPS APC 2.17 27.63 0.6 percent of total billed charges 2.17 2.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD NEUROSTIMULATOR VNS THERAPY PERENNIAFLEX 2MM STERILE LF MODEL 304 SUP-10-0011-1304 CDM 270010003 LOCAL 0270 RC outpatient 9630.4 9630.4 9630.4 74 7126.5 percent of total billed charges 9630.4 93 7800.62 percent of total billed charges 9630.4 9630.4 other OPPS APC 9630.4 9630.4 other OPPS APC 9630.4 27.63 2660.88 percent of total billed charges 9630.4 9630.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENERATOR ASPIRESR SINGLE PIN SUP-10-0011-2101 CDM 270010003 LOCAL 0270 RC outpatient 57433.7 57433.7 57433.7 74 42501 percent of total billed charges 57433.7 93 46521.3 percent of total billed charges 57433.7 57433.7 other OPPS APC 57433.7 57433.7 other OPPS APC 57433.7 27.63 15868.9 percent of total billed charges 57433.7 57433.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING MEPILEX AG 4X4 (SILVER) SUP-10-00113 CDM 0272 RC outpatient 35.79 35.79 35.79 74 26.48 percent of total billed charges 35.79 93 28.99 percent of total billed charges 35.79 35.79 other OPPS APC 35.79 35.79 other OPPS APC 35.79 27.63 9.89 percent of total billed charges 35.79 35.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING MEPILEX BORDER FLEX 6X6 SUP-10-00114 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WRAP COBAN STERILE 4X5YD SUP-10-00115 CDM 0272 RC outpatient 2.06 2.06 2.06 74 1.52 percent of total billed charges 2.06 93 1.67 percent of total billed charges 2.06 2.06 other OPPS APC 2.06 2.06 other OPPS APC 2.06 27.63 0.57 percent of total billed charges 2.06 2.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING MEPILEX BORDER FLEX 3X3 SUP-10-00131 CDM 0272 RC outpatient 1.81 1.81 1.81 74 1.34 percent of total billed charges 1.81 93 1.47 percent of total billed charges 1.81 1.81 other OPPS APC 1.81 1.81 other OPPS APC 1.81 27.63 0.5 percent of total billed charges 1.81 1.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COBAN 6 X 5YD STERILE SUP-10-00135 CDM 0272 RC outpatient 3.12 3.12 3.12 74 2.31 percent of total billed charges 3.12 93 2.53 percent of total billed charges 3.12 3.12 other OPPS APC 3.12 3.12 other OPPS APC 3.12 27.63 0.86 percent of total billed charges 3.12 3.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING DUODERM 4 X 4 SUP-10-00136 CDM 0272 RC outpatient 1.1 1.1 1.1 74 0.81 percent of total billed charges 1.1 93 0.89 percent of total billed charges 1.1 1.1 other OPPS APC 1.1 1.1 other OPPS APC 1.1 27.63 0.3 percent of total billed charges 1.1 1.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEDIPORE ROLLS SUP-10-00137 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING SORBAVIEW ULTIMATE SUP-10-00138 CDM 0272 RC outpatient 2.4 2.4 2.4 74 1.78 percent of total billed charges 2.4 93 1.94 percent of total billed charges 2.4 2.4 other OPPS APC 2.4 2.4 other OPPS APC 2.4 27.63 0.66 percent of total billed charges 2.4 2.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING IV TEGADERM 1 1/2 X 1 3/4 SUP-10-00139 CDM 0272 RC outpatient 0.67 0.67 0.67 74 0.5 percent of total billed charges 0.67 93 0.54 percent of total billed charges 0.67 0.67 other OPPS APC 0.67 0.67 other OPPS APC 0.67 27.63 0.19 percent of total billed charges 0.67 0.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING IV TEGADERM 2 X 2 1/4 SUP-10-00140 CDM 0272 RC outpatient 0.67 0.67 0.67 74 0.5 percent of total billed charges 0.67 93 0.54 percent of total billed charges 0.67 0.67 other OPPS APC 0.67 0.67 other OPPS APC 0.67 27.63 0.19 percent of total billed charges 0.67 0.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING MEPILEX AG 4X8 (SILVER) SUP-10-00141 CDM 0272 RC outpatient 95.49 95.49 95.49 74 70.66 percent of total billed charges 95.49 93 77.35 percent of total billed charges 95.49 95.49 other OPPS APC 95.49 95.49 other OPPS APC 95.49 27.63 26.38 percent of total billed charges 95.49 95.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING MEPILEX AG 4X10 (SILVER) SUP-10-00142 CDM 0272 RC outpatient 102.87 102.87 102.87 74 76.12 percent of total billed charges 102.87 93 83.32 percent of total billed charges 102.87 102.87 other OPPS APC 102.87 102.87 other OPPS APC 102.87 27.63 28.42 percent of total billed charges 102.87 102.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING MEPILEX AG 4X12 (SILVER) SUP-10-00143 CDM 0272 RC outpatient 117.54 117.54 117.54 74 86.98 percent of total billed charges 117.54 93 95.21 percent of total billed charges 117.54 117.54 other OPPS APC 117.54 117.54 other OPPS APC 117.54 27.63 32.48 percent of total billed charges 117.54 117.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING MEPILEX POST OP 4X8 SUP-10-00144 CDM 0272 RC outpatient 20.81 20.81 20.81 74 15.4 percent of total billed charges 20.81 93 16.86 percent of total billed charges 20.81 20.81 other OPPS APC 20.81 20.81 other OPPS APC 20.81 27.63 5.75 percent of total billed charges 20.81 20.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING MEPILEX POST OP 4X10 SUP-10-00145 CDM 0272 RC outpatient 23.32 23.32 23.32 74 17.26 percent of total billed charges 23.32 93 18.89 percent of total billed charges 23.32 23.32 other OPPS APC 23.32 23.32 other OPPS APC 23.32 27.63 6.44 percent of total billed charges 23.32 23.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING MEPILEX POST OP 4X12 SUP-10-00146 CDM 0272 RC outpatient 23.51 23.51 23.51 74 17.4 percent of total billed charges 23.51 93 19.04 percent of total billed charges 23.51 23.51 other OPPS APC 23.51 23.51 other OPPS APC 23.51 27.63 6.5 percent of total billed charges 23.51 23.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DRESSING BIOPATCH 1"" (2.5CM-4.0MM)" SUP-10-00147 CDM 0272 RC outpatient 194.33 194.33 194.33 74 143.8 percent of total billed charges 194.33 93 157.41 percent of total billed charges 194.33 194.33 other OPPS APC 194.33 194.33 other OPPS APC 194.33 27.63 53.69 percent of total billed charges 194.33 194.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DRESSING BIOPATCH 3/4"" (1.9CM-1.5MM)" SUP-10-00148 CDM 0272 RC outpatient 207.07 207.07 207.07 74 153.23 percent of total billed charges 207.07 93 167.73 percent of total billed charges 207.07 207.07 other OPPS APC 207.07 207.07 other OPPS APC 207.07 27.63 57.21 percent of total billed charges 207.07 207.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE PERICARDIUM L1 CM X W1 CM PATCH (TSH) SUP-10-0053 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOOP VESSEL SURG-I-LOOP SILICONE MINI LATEX FREE SUP-10-1001 CDM outpatient 8.79 8.79 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY FLOWTRIEVER L 115 CM OD 10 MM STERILE LATEX FREE SUP-10-101 CDM 0270 RC outpatient 0.03 0.03 0.03 74 0.02 percent of total billed charges 0.03 93 0.02 percent of total billed charges 0.03 0.03 other OPPS APC 0.03 0.03 other OPPS APC 0.03 27.63 0.01 percent of total billed charges 0.03 0.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOOPS VESSEL RED SUP-10-1010 CDM outpatient 9.13 9.13 9.13 9.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THOMBECTOMY FLOWTRIEVER L 115 CM OD 14 MM STERILE LATEX FREE SUP-10-102 CDM 0270 RC outpatient 0.03 0.03 0.03 74 0.02 percent of total billed charges 0.03 93 0.02 percent of total billed charges 0.03 0.03 other OPPS APC 0.03 0.03 other OPPS APC 0.03 27.63 0.01 percent of total billed charges 0.03 0.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY FLOWTRIEVER L 115 CM OD 18 MM STERILE LATEX FREE SUP-10-103 CDM 0270 RC outpatient 0.03 0.03 0.03 74 0.02 percent of total billed charges 0.03 93 0.02 percent of total billed charges 0.03 0.03 other OPPS APC 0.03 0.03 other OPPS APC 0.03 27.63 0.01 percent of total billed charges 0.03 0.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY FLOWTRIEVER L 115 CM OD 25 MM STERILE LATEX FREE SUP-10-104 CDM 0270 RC outpatient 0.03 0.03 0.03 74 0.02 percent of total billed charges 0.03 93 0.02 percent of total billed charges 0.03 0.03 other OPPS APC 0.03 0.03 other OPPS APC 0.03 27.63 0.01 percent of total billed charges 0.03 0.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P2.9 CM MODERATE PROFILE ROUND OD10.7 CM 180 ML STYLE 10 SMOOTH STERILE SUP-10-180 CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P3 CM MODERATE PROFILE ROUND OD11.2 CM 210 ML STYLE 10 SMOOTH STERILE SUP-10-210 CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P3.2 CM MODERATE PROFILE ROUND OD11.7 CM 240 ML STYLE 10 SMOOTH STERILE SUP-10-240 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P3.3 CM MODERATE PROFILE ROUND OD12.2 CM 270 ML STYLE 10 GEL SMOOTH STERILE SUP-10-270 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P3.5 CM MODERATE PROFILE ROUND OD12.6 CM 300 ML STYLE 10 SMOOTH STERILE SUP-10-300 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P3.6 CM MODERATE PROFILE ROUND OD13 CM 330 ML STYLE 10 SMOOTH STERILE SUP-10-330 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P3.6 CM MODERATE PROFILE ROUND OD13 CM 360 ML STYLE 10 SMOOTH STERILE SUP-10-360 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ALLERGAN SMOOTH ROUND MODERATE PROFILE 390CC SUP-10-390 CDM 270010032 LOCAL 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISPENSER MICRO TWIN TOILET SUP-100-0020 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISPENSER COMBO C-FOLD/MULTI SUP-100-0021 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END BAC II SUP-100-0108 CDM 0272 RC outpatient 271.92 271.92 271.92 74 201.22 percent of total billed charges 271.92 93 220.26 percent of total billed charges 271.92 271.92 other OPPS APC 271.92 271.92 other OPPS APC 271.92 27.63 75.13 percent of total billed charges 271.92 271.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BACTI-STAT SUP-100-0111 CDM 0272 RC outpatient 149.4 149.4 149.4 74 110.56 percent of total billed charges 149.4 93 121.01 percent of total billed charges 149.4 149.4 other OPPS APC 149.4 149.4 other OPPS APC 149.4 27.63 41.28 percent of total billed charges 149.4 149.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSTEOSPAN BONE GRAFT SUBSTITUTE SUP-100-30G CDM 0270 RC outpatient 4615 4615 4615 74 3415.1 percent of total billed charges 4615 93 3738.15 percent of total billed charges 4615 4615 other OPPS APC 4615 4615 other OPPS APC 4615 27.63 1275.12 percent of total billed charges 4615 4615 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET ENDOSCOPIC OTSC 6MM 165CM 10.5-12MM NITINOL DISPOSABLE STERILE LF T CLIP POINT TEETH SUP-100.12 CDM 0270 RC outpatient 1440.4 1440.4 1440.4 74 1065.9 percent of total billed charges 1440.4 93 1166.72 percent of total billed charges 1440.4 1440.4 other OPPS APC 1440.4 1440.4 other OPPS APC 1440.4 27.63 397.98 percent of total billed charges 1440.4 1440.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET ENDOSCOPIC INSTRUMENT OTSC NITINOL ADULT D7 MM L165 CM OD8.5-11 MM GASTROINTESTINAL TRACT T CLIP POINT TEETH STERILE LATEX FREE DISPOSABLE STENTFIX SUP-100.50 CDM 0270 RC outpatient 1687.4 1687.4 1687.4 74 1248.68 percent of total billed charges 1687.4 93 1366.79 percent of total billed charges 1687.4 1687.4 other OPPS APC 1687.4 1687.4 other OPPS APC 1687.4 27.63 466.23 percent of total billed charges 1687.4 1687.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT TRACHEOSTOMY ULTRAPERC PORTEX STAINLESS STEEL ID7.0-9.0 MM PERCUTANEOUS 1 DILATOR ERGONOMIC HANDLE COST EFFECTIVE STERILE LATEX FREE DISPOSABLE SUP-100/573/000 CDM 0270 RC outpatient 612.14 612.14 612.14 74 452.98 percent of total billed charges 612.14 93 495.83 percent of total billed charges 612.14 612.14 other OPPS APC 612.14 612.14 other OPPS APC 612.14 27.63 169.13 percent of total billed charges 612.14 612.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT TRACHEOSTOMY PORTEX ULTRAPERC BLUE LINE ULTRA SOFT SEAL ID 8.0MM PERCUTANEOUS DILATOR CONNECTOR FLANGE STERILE LATEX FREE DISPOSABLE SUP-100/595/080 CDM 0270 RC outpatient 718.45 718.45 718.45 74 531.65 percent of total billed charges 718.45 93 581.94 percent of total billed charges 718.45 718.45 other OPPS APC 718.45 718.45 other OPPS APC 718.45 27.63 198.51 percent of total billed charges 718.45 718.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY BLUE LINE STANDARD REGULAR OD11.0 MM ID8.0 MM CUFFED STERILE LATEX FREE DISPOSABLE SUP-100/782/080 CDM 270009133 LOCAL 0270 RC outpatient 36.61 36.61 36.61 74 27.09 percent of total billed charges 36.61 93 29.65 percent of total billed charges 36.61 36.61 other OPPS APC 36.61 36.61 other OPPS APC 36.61 27.63 10.12 percent of total billed charges 36.61 36.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY BLUE LINE ULTRA SILICONE ADULT OD9.2 MM ID6.0 MM 2 INNER CANNULA CUFFED HOLLOW OBTURATOR CLEANING BRUSH HOLDER STERILE LATEX FREE DISPOSABLE CLEAR SUP-100/815/060 CDM 0270 RC outpatient 82.03 82.03 82.03 74 60.7 percent of total billed charges 82.03 93 66.44 percent of total billed charges 82.03 82.03 other OPPS APC 82.03 82.03 other OPPS APC 82.03 27.63 22.66 percent of total billed charges 82.03 82.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BLUE LINE ULTRA SOFT-SEAL ADULT L70 MM OD10.5 MM ID7.0 MM 2 INNER CANNULA CUFF HOLDER HOLLOW OBTURATOR STERILE LATEX FREE DISPOSABLE CLEAR SUP-100/815/070 CDM 0270 RC outpatient 82.03 82.03 82.03 74 60.7 percent of total billed charges 82.03 93 66.44 percent of total billed charges 82.03 82.03 other OPPS APC 82.03 82.03 other OPPS APC 82.03 27.63 22.66 percent of total billed charges 82.03 82.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BLUE LINE ULTRA SOFT-SEAL ADULT L75.5 MM OD11.9 MM ID8.0 MM 2 INNER CANNULA CUFF HOLDER HOLLOW OBTURATOR STERILE LATEX FREE DISPOSABLE CLEAR SUP-100/815/080 CDM 0270 RC outpatient 82.03 82.03 82.03 74 60.7 percent of total billed charges 82.03 93 66.44 percent of total billed charges 82.03 82.03 other OPPS APC 82.03 82.03 other OPPS APC 82.03 27.63 22.66 percent of total billed charges 82.03 82.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BLUE LINE ULTRA SOFT-SEAL ADULT L81 MM OD13.3 MM ID9.0 MM 2 INNER CANNULA CUFF HOLDER HOLLOW OBTURATOR STERILE LATEX FREE DISPOSABLE CLEAR SUP-100/815/090 CDM 0270 RC outpatient 79.82 79.82 79.82 74 59.07 percent of total billed charges 79.82 93 64.65 percent of total billed charges 79.82 79.82 other OPPS APC 79.82 79.82 other OPPS APC 79.82 27.63 22.05 percent of total billed charges 79.82 79.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BLUE LINE ULTRA SOFT-SEAL 14MM 10MM STERILE LF 2 INNER CANNULA CUFF CLEAN BRUSH HOLDER SUP-100/815/100 CDM 0270 RC outpatient 79.04 79.04 79.04 74 58.49 percent of total billed charges 79.04 93 64.02 percent of total billed charges 79.04 79.04 other OPPS APC 79.04 79.04 other OPPS APC 79.04 27.63 21.84 percent of total billed charges 79.04 79.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BLUE LINE ULTRA 9.2MM 6MM STERILE LF 2 INNER CANNULA UNCUFF CLEAN BRUSH HOLDER SUP-100/816/060 CDM 0270 RC outpatient 71.08 71.08 71.08 74 52.6 percent of total billed charges 71.08 93 57.57 percent of total billed charges 71.08 71.08 other OPPS APC 71.08 71.08 other OPPS APC 71.08 27.63 19.64 percent of total billed charges 71.08 71.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BLUE LINE ULTRA L70 MM OD10.5 MM ID7.0 MM TAPER ARC HOLLOW OBTURATOR RETAIN CLIP HEMISPHERICAL TIP STERILE LATEX FREE DISPOSABLE CLEAR SUP-100/816/070 CDM 0270 RC outpatient 71.08 71.08 71.08 74 52.6 percent of total billed charges 71.08 93 57.57 percent of total billed charges 71.08 71.08 other OPPS APC 71.08 71.08 other OPPS APC 71.08 27.63 19.64 percent of total billed charges 71.08 71.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BLUE LINE ULTRA SOFT SEAL PVC ADULT HOLLOW L4.5 MM OD11.9 MM ID8.0 MM 2 INNER CANNULA HOLDER CLEAN BRUSH OBTURATOR FENESTRATE STERILE LATEX FREE DISPOSABLE SUP-100/816/080 CDM 0270 RC outpatient 71.08 71.08 71.08 74 52.6 percent of total billed charges 71.08 93 57.57 percent of total billed charges 71.08 71.08 other OPPS APC 71.08 71.08 other OPPS APC 71.08 27.63 19.64 percent of total billed charges 71.08 71.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BLUE LINE ULTRA SOFT SEAL PVC ADULT HOLLOW L4.5 MM OD13.3 MM ID9.0 MM 2 INNER CANNULA HOLDER CLEAN BRUSH OBTURATOR FENESTRATE STERILE LATEX FREE DISPOSABLE SUP-100/816/090 CDM 0270 RC outpatient 80.94 80.94 80.94 74 59.9 percent of total billed charges 80.94 93 65.56 percent of total billed charges 80.94 80.94 other OPPS APC 80.94 80.94 other OPPS APC 80.94 27.63 22.36 percent of total billed charges 80.94 80.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BLUE LINE ULTRA SOFT SEAL PVC ADULT HOLLOW L4.5 MM OD14.0 MM ID10.0 MM 2 INNER CANNULA HOLDER CLEAN BRUSH OBTURATOR FENESTRATE STERILE LATEX FREE DISPOSABLE SUP-100/816/100 CDM 0270 RC outpatient 71.08 71.08 71.08 74 52.6 percent of total billed charges 71.08 93 57.57 percent of total billed charges 71.08 71.08 other OPPS APC 71.08 71.08 other OPPS APC 71.08 27.63 19.64 percent of total billed charges 71.08 71.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT TRACHEOSTOMY PORTEX BLUE LINE ULTRA SUCTIONAID PVC 105 D OD 10.5 MM ID 7.0 MM CUFF 2 INNER CANNULA CLEAN BRUSH HOLDER STERILE LATEX FREE DISPOSABLE SUP-100/875/070 CDM 0270 RC outpatient 107.33 107.33 107.33 74 79.42 percent of total billed charges 107.33 93 86.94 percent of total billed charges 107.33 107.33 other OPPS APC 107.33 107.33 other OPPS APC 107.33 27.63 29.66 percent of total billed charges 107.33 107.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT TRACHEOSTOMY PORTEX VLUE LINE ULTRA SUCTIONAID PVC 105 D OD 11.9MM ID 8.0 MM CUFF 2 INNER CANNULA CLEAN BRUSH HOLDER STERILE LATEX FREE DISPOSABLE SUP-100/875/080 CDM 0270 RC outpatient 112.68 112.68 112.68 74 83.38 percent of total billed charges 112.68 93 91.27 percent of total billed charges 112.68 112.68 other OPPS APC 112.68 112.68 other OPPS APC 112.68 27.63 31.13 percent of total billed charges 112.68 112.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CK TEV-S-G SUP-100008 CDM 0270 RC outpatient 31.2 31.2 31.2 74 23.09 percent of total billed charges 31.2 93 25.27 percent of total billed charges 31.2 31.2 other OPPS APC 31.2 31.2 other OPPS APC 31.2 27.63 8.62 percent of total billed charges 31.2 31.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CK TEV-S-W SUP-100009 CDM 0270 RC outpatient 31.2 31.2 31.2 74 23.09 percent of total billed charges 31.2 93 25.27 percent of total billed charges 31.2 31.2 other OPPS APC 31.2 31.2 other OPPS APC 31.2 27.63 8.62 percent of total billed charges 31.2 31.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL PROLITE POLYPROPYLENE STANDARD L4 IN X W1 IN INGUINAL HERNIA SHEET NONABSORBABLE REPAIR STERILE SUP-1000104-00 CDM 0270 RC outpatient 49.22 49.22 49.22 74 36.42 percent of total billed charges 49.22 93 39.87 percent of total billed charges 49.22 49.22 other OPPS APC 49.22 49.22 other OPPS APC 49.22 27.63 13.6 percent of total billed charges 49.22 49.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIGH PRESSURE INDEFLATOR SUP-1000184 CDM 0270 RC outpatient 122.2 122.2 122.2 74 90.43 percent of total billed charges 122.2 93 98.98 percent of total billed charges 122.2 122.2 other OPPS APC 122.2 122.2 other OPPS APC 122.2 27.63 33.76 percent of total billed charges 122.2 122.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT ORTHOPEDIC UNIVERSAL 11IN BLUE CANVAS TRICOT FOAM LF FOREARM WRIST 2 PANEL MALLEABLE PALMAR DORSAL STAY LOOP LOCK SUP-1000285 CDM 270009117 LOCAL 0270 RC outpatient 8.82 8.82 8.82 74 6.53 percent of total billed charges 8.82 93 7.14 percent of total billed charges 8.82 8.82 other OPPS APC 8.82 8.82 other OPPS APC 8.82 27.63 2.44 percent of total billed charges 8.82 8.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL PROLITE POLYPROPYLENE STANDARD L6 IN X W3 IN KNIT INGUINAL INCISIONAL HERNIA REPAIR SUP-1000306-00 CDM 0270 RC outpatient 62.96 62.96 62.96 74 46.59 percent of total billed charges 62.96 93 51 percent of total billed charges 62.96 62.96 other OPPS APC 62.96 62.96 other OPPS APC 62.96 27.63 17.4 percent of total billed charges 62.96 62.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR HI-TORQUE BALANCE HEAVYWEIGHT STRAIGHT 190CM 4.5CM .014IN ELASTINITE HYDROPHILIC DISPOSABLE STERILE SUP-1000462H CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR HI-TORQUE BALANCE HEAVYWEIGHT J CURVE 190CM 4.5CM .014IN ELASTINITE HYDROPHILIC DISPOSABLE STERILE LF SUP-1000462HJ CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR HI-TORQUE BALANCE HEAVYWEIGHT J CURVE 300CM 4.5CM .014IN ELASTINITE HYDROPHILIC DISPOSABLE STERILE LF SUP-1000463HJ CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM STRIP-OFF 231 TRANSPARENT SUP-1000488 CDM 0270 RC outpatient 37.02 37.02 37.02 74 27.39 percent of total billed charges 37.02 93 29.99 percent of total billed charges 37.02 37.02 other OPPS APC 37.02 37.02 other OPPS APC 37.02 27.63 10.23 percent of total billed charges 37.02 37.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL PROLITE POLYPROPYLENE SQUARE ROUND L6 IN X W6 IN HERNIA FLAT SHEET SMOOTH LASER CUT EDGE STRONG KNITTED SUP-1000606-00 CDM 0270 RC outpatient 71.34 71.34 71.34 74 52.79 percent of total billed charges 71.34 93 57.79 percent of total billed charges 71.34 71.34 other OPPS APC 71.34 71.34 other OPPS APC 71.34 27.63 19.71 percent of total billed charges 71.34 71.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM STRIP-OFF 122 TRANSPARENT SUP-1000638 CDM 0270 RC outpatient 37.02 37.02 37.02 74 27.39 percent of total billed charges 37.02 93 29.99 percent of total billed charges 37.02 37.02 other OPPS APC 37.02 37.02 other OPPS APC 37.02 27.63 10.23 percent of total billed charges 37.02 37.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM STRIP-OFF 223 TRANSPARENT SUP-1000658 CDM 0270 RC outpatient 37.02 37.02 37.02 74 27.39 percent of total billed charges 37.02 93 29.99 percent of total billed charges 37.02 37.02 other OPPS APC 37.02 37.02 other OPPS APC 37.02 27.63 10.23 percent of total billed charges 37.02 37.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM STRIP-OFF 114 TRANSPARENT SUP-1000668 CDM 0270 RC outpatient 37.02 37.02 37.02 74 27.39 percent of total billed charges 37.02 93 29.99 percent of total billed charges 37.02 37.02 other OPPS APC 37.02 37.02 other OPPS APC 37.02 27.63 10.23 percent of total billed charges 37.02 37.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP SURGICAL SCANLAN VASCU-STATT BULLDOG PLASTIC 45 D MIDI ATRAUMATIC JAW RADIOPAQUE LIGHTWEIGHT COLOR CODED STERILE DISPOSABLE SUP-1001-501 CDM 0270 RC outpatient 28.44 28.44 28.44 74 21.05 percent of total billed charges 28.44 93 23.04 percent of total billed charges 28.44 28.44 other OPPS APC 28.44 28.44 other OPPS APC 28.44 27.63 7.86 percent of total billed charges 28.44 28.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PUNCH AORTIC VEIN 2.7MM SUP-1001-608 CDM 0270 RC outpatient 143 143 143 74 105.82 percent of total billed charges 143 93 115.83 percent of total billed charges 143 143 other OPPS APC 143 143 other OPPS APC 143 27.63 39.51 percent of total billed charges 143 143 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL PROLITE POLYPROPYLENE RECTANGLE OVAL FLAT L14 IN X W10 IN STRONG KNIT SEE THRU CLARITY TRIMMABLE HERNIA SUP-1001014-00 CDM 0270 RC outpatient 205.51 205.51 205.51 74 152.08 percent of total billed charges 205.51 93 166.46 percent of total billed charges 205.51 205.51 other OPPS APC 205.51 205.51 other OPPS APC 205.51 27.63 56.78 percent of total billed charges 205.51 205.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM STRIP-OFF 121 TRANSPARENT SUP-1001047 CDM 0270 RC outpatient 37.02 37.02 37.02 74 27.39 percent of total billed charges 37.02 93 29.99 percent of total billed charges 37.02 37.02 other OPPS APC 37.02 37.02 other OPPS APC 37.02 27.63 10.23 percent of total billed charges 37.02 37.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMARTCAP AQUASHIELD SUP-100145 CDM 0270 RC outpatient 33.15 33.15 33.15 74 24.53 percent of total billed charges 33.15 93 26.85 percent of total billed charges 33.15 33.15 other OPPS APC 33.15 33.15 other OPPS APC 33.15 27.63 9.16 percent of total billed charges 33.15 33.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM STRIP-OFF 212 TRANSPARENT SUP-1001735 CDM 0270 RC outpatient 37.02 37.02 37.02 74 27.39 percent of total billed charges 37.02 93 29.99 percent of total billed charges 37.02 37.02 other OPPS APC 37.02 37.02 other OPPS APC 37.02 27.63 10.23 percent of total billed charges 37.02 37.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR HI-TORQUE BALANCE MIDDLEWEIGHT STRAIGHT 190CM 3CM .014IN ELASTINITE HYDROPHILIC DISPOSABLE STERILE LF SUP-1001780-HC CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR HI-TORQUE BALANCE MIDDLEWEIGHT J CURVE 190CM 3CM .014IN ELASTINITE HYDROPHILIC DISPOSABLE STERILE LF SUP-1001780J-HC CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR HI-TORQUE BALANCE MIDDLEWEIGHT STRAIGHT 300CM 3CM .014IN ELASTINITE HYDROPHILIC DISPOSABLE STERILE LF SUP-1001782-HC CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR HI-TORQUE BALANCE MIDDLEWEIGHT J RIBBON 300CM 3CM .014IN SUP-1001782J-HC CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER INTERNAL CLIP MULTIFIRE TITANIUM 19 MEDIUM LARGE L10 MM HANDPIECE COLOR CODED CARTRIDGE REUSABLE SUP-1002 CDM outpatient 1950 1950 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM STRIP-OFF 222 TRANSPARENT SUP-1002033 CDM 0270 RC outpatient 37.02 37.02 37.02 74 27.39 percent of total billed charges 37.02 93 29.99 percent of total billed charges 37.02 37.02 other OPPS APC 37.02 37.02 other OPPS APC 37.02 27.63 10.23 percent of total billed charges 37.02 37.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM STRIP-OFF 211 TRANSPARENT SUP-1002082 CDM 0270 RC outpatient 34.92 34.92 34.92 74 25.84 percent of total billed charges 34.92 93 28.29 percent of total billed charges 34.92 34.92 other OPPS APC 34.92 34.92 other OPPS APC 34.92 27.63 9.65 percent of total billed charges 34.92 34.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM STRIP-OFF 214 TRANSPARENT SUP-1002129 CDM 0270 RC outpatient 37.02 37.02 37.02 74 27.39 percent of total billed charges 37.02 93 29.99 percent of total billed charges 37.02 37.02 other OPPS APC 37.02 37.02 other OPPS APC 37.02 27.63 10.23 percent of total billed charges 37.02 37.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR 300CM .035IN STEERABLE STRAIGHT HI-TORQUE SUPRA CORE MICROGLIDE SUP-1002703-02 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK OXYGEN POM ADULT MALE TO MALE MEDIUM CONCENTRATION CO2 MONITOR NONSTERILE LATEX FREE DISPOSABLE SUP-1003-MM CDM 0270 RC outpatient 21.23 21.23 21.23 74 15.71 percent of total billed charges 21.23 93 17.2 percent of total billed charges 21.23 21.23 other OPPS APC 21.23 21.23 other OPPS APC 21.23 27.63 5.87 percent of total billed charges 21.23 21.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM STRIP-OFF 131 TRANSPARENT SUP-1003290 CDM 0270 RC outpatient 37.02 37.02 37.02 74 27.39 percent of total billed charges 37.02 93 29.99 percent of total billed charges 37.02 37.02 other OPPS APC 37.02 37.02 other OPPS APC 37.02 27.63 10.23 percent of total billed charges 37.02 37.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM STRIP-OFF 221 TRANSPARENT SUP-1003337 CDM 0270 RC outpatient 37.02 37.02 37.02 74 27.39 percent of total billed charges 37.02 93 29.99 percent of total billed charges 37.02 37.02 other OPPS APC 37.02 37.02 other OPPS APC 37.02 27.63 10.23 percent of total billed charges 37.02 37.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ULTRA STENT 4.5 X 13 SUP-1003381-13 CDM 0481 RC outpatient 1729 1729 1729 74 1279.46 percent of total billed charges 1729 93 1400.49 percent of total billed charges 1729 1729 other OPPS APC 1729 1729 other OPPS APC 1729 51 881.79 percent of total billed charges 1729 1729 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ULTRA STENT 4.5 X 18 SUP-1003381-18 CDM 0481 RC outpatient 1729 1729 1729 74 1279.46 percent of total billed charges 1729 93 1400.49 percent of total billed charges 1729 1729 other OPPS APC 1729 1729 other OPPS APC 1729 51 881.79 percent of total billed charges 1729 1729 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VISION STENT 4.5 X 28 MM SUP-1003381-28 CDM 0481 RC outpatient 1729 1729 1729 74 1279.46 percent of total billed charges 1729 93 1400.49 percent of total billed charges 1729 1729 other OPPS APC 1729 1729 other OPPS APC 1729 51 881.79 percent of total billed charges 1729 1729 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ULTRA STENT 5.0 X 13 SUP-1003382-13 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ULTRA STENT 5.0 X 18 SUP-1003382-18 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ULTRA STENT 5.0 X 28 SUP-1003382-28 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM STRIP-OFF 112 TRANSPARENT SUP-1003681 CDM 0270 RC outpatient 37.02 37.02 37.02 74 27.39 percent of total billed charges 37.02 93 29.99 percent of total billed charges 37.02 37.02 other OPPS APC 37.02 37.02 other OPPS APC 37.02 27.63 10.23 percent of total billed charges 37.02 37.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM STRIP-OFF 213 TRANSPARENT SUP-1003775 CDM 0270 RC outpatient 37.02 37.02 37.02 74 27.39 percent of total billed charges 37.02 93 29.99 percent of total billed charges 37.02 37.02 other OPPS APC 37.02 37.02 other OPPS APC 37.02 27.63 10.23 percent of total billed charges 37.02 37.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM STRIP-OFF 111 TRANSPARENT SUP-1003790 CDM 0270 RC outpatient 34.92 34.92 34.92 74 25.84 percent of total billed charges 34.92 93 28.29 percent of total billed charges 34.92 34.92 other OPPS APC 34.92 34.92 other OPPS APC 34.92 27.63 9.65 percent of total billed charges 34.92 34.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM STRIP-OFF 113 TRANSPARENT SUP-1004321 CDM 0270 RC outpatient 37.02 37.02 37.02 74 27.39 percent of total billed charges 37.02 93 29.99 percent of total billed charges 37.02 37.02 other OPPS APC 37.02 37.02 other OPPS APC 37.02 27.63 10.23 percent of total billed charges 37.02 37.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ULTRASOUND ACUNAV L90 CM OD10 FR INTRACARDIAC 4 WAY STEERING REAL TIME VISUALIZATION GE SUP-10043342 CDM 0270 RC outpatient 7339.8 7339.8 7339.8 74 5431.45 percent of total billed charges 7339.8 93 5945.24 percent of total billed charges 7339.8 7339.8 other OPPS APC 7339.8 7339.8 other OPPS APC 7339.8 27.63 2027.99 percent of total billed charges 7339.8 7339.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIGATOR ENDOSCOPIC FALOPE-RING O RING BAND REPLACEMENT REUSABLE GUIDE SUP-100441DZ CDM outpatient 1.14 1.14 1.14 1.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SUCTION DLP .25IN SLIP CONNECTOR 6.5IN 6FR STERILE CARDIAC TUBE SUP-10050 CDM 0270 RC outpatient 33.96 33.96 33.96 74 25.13 percent of total billed charges 33.96 93 27.51 percent of total billed charges 33.96 33.96 other OPPS APC 33.96 33.96 other OPPS APC 33.96 27.63 9.38 percent of total billed charges 33.96 33.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EJECTOR SALIVA OPAQUE WHITE SUP-1005205 CDM 0270 RC outpatient 0.06 0.06 0.06 74 0.04 percent of total billed charges 0.06 93 0.05 percent of total billed charges 0.06 0.06 other OPPS APC 0.06 0.06 other OPPS APC 0.06 27.63 0.02 percent of total billed charges 0.06 0.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM STRIP-OFF 233 TRANSPARENT SUP-1005252 CDM 0270 RC outpatient 37.02 37.02 37.02 74 27.39 percent of total billed charges 37.02 93 29.99 percent of total billed charges 37.02 37.02 other OPPS APC 37.02 37.02 other OPPS APC 37.02 27.63 10.23 percent of total billed charges 37.02 37.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WHISPER WIRE 190CM STRAIGHT SUP-1005357H CDM 0481 RC outpatient 6.5 6.5 6.5 74 4.81 percent of total billed charges 6.5 93 5.27 percent of total billed charges 6.5 6.5 other OPPS APC 6.5 6.5 other OPPS APC 6.5 51 3.32 percent of total billed charges 6.5 6.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM STRIP-OFF 132 TRANSPARENT SUP-1005799 CDM 0270 RC outpatient 37.02 37.02 37.02 74 27.39 percent of total billed charges 37.02 93 29.99 percent of total billed charges 37.02 37.02 other OPPS APC 37.02 37.02 other OPPS APC 37.02 27.63 10.23 percent of total billed charges 37.02 37.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM STRIP-OFF 123 TRANSPARENT SUP-1006480 CDM 0270 RC outpatient 37.02 37.02 37.02 74 27.39 percent of total billed charges 37.02 93 29.99 percent of total billed charges 37.02 37.02 other OPPS APC 37.02 37.02 other OPPS APC 37.02 27.63 10.23 percent of total billed charges 37.02 37.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE V 18MM 143CM 2.25MM EVEROLIMUS ELUTING COCR DELIVERY SYSTEM RAPID EXCHANGE RADIOPAQUE TAPER SUP-1006544-18 CDM 0481 RC outpatient 4160 4160 4160 74 3078.4 percent of total billed charges 4160 93 3369.6 percent of total billed charges 4160 4160 other OPPS APC 4160 4160 other OPPS APC 4160 51 2121.6 percent of total billed charges 4160 4160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK MINI VISION 8MM 2MM COCR RAPID EXCHANGE RADIOPAQUE BALLOON EXPAND ACCEPTS .014IN SUP-1007821-08 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK MINI VISION 12MM 2MM COCR RAPID EXCHANGE RADIOPAQUE BALLOON EXPAND ACCEPTS .014IN SUP-1007821-12 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK MINI VISION 15MM 2MM COCR RAPID EXCHANGE RADIOPAQUE BALLOON EXPAND ACCEPTS .014IN SUP-1007821-15 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK MINI VISION 18MM 2MM COCR RAPID EXCHANGE RADIOPAQUE BALLOON EXPAND ACCEPTS .014IN SUP-1007821-18 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK MINI VISION 23MM 2MM COCR RAPID EXCHANGE RADIOPAQUE BALLOON EXPAND ACCEPTS .014IN SUP-1007821-23 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK MINI VISION 28MM 2MM COCR RAPID EXCHANGE RADIOPAQUE BALLOON EXPAND ACCEPTS .014IN SUP-1007821-28 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK MINI VISION 8MM 2.25MM COCR RAPID EXCHANGE RADIOPAQUE BALLOON EXPAND ACCEPTS .014IN SUP-1007822-08 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK MINI VISION 12MM 2.25MM COCR RAPID EXCHANGE RADIOPAQUE BALLOON EXPAND ACCEPTS .014IN SUP-1007822-12 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK MINI VISION 15MM 2.25MM COCR RAPID EXCHANGE RADIOPAQUE BALLOON EXPAND ACCEPTS .014IN SUP-1007822-15 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY MULTI-LINK MINI VISION COCR LOW PROFILE L18 MM OD2.25 MM 2 RADIOPAQUE MARKER BALLOON EXPANDABLE RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE SUP-1007822-18 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK MINI VISION 23MM 2.25MM COCR RAPID EXCHANGE RADIOPAQUE BALLOON EXPAND ACCEPTS .014IN SUP-1007822-23 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK MINI VISION 28MM 2.25MM COCR RAPID EXCHANGE RADIOPAQUE BALLOON EXPAND ACCEPTS .014IN SUP-1007822-28 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK MINI VISION 8MM 2.5MM COCR RAPID EXCHANGE RADIOPAQUE BALLOON EXPAND ACCEPTS .014IN SUP-1007823-08 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK MINI VISION 12MM 2.5MM COCR RAPID EXCHANGE RADIOPAQUE BALLOON EXPAND ACCEPTS .014IN SUP-1007823-12 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK MINI VISION 15MM 2.5MM COCR RAPID EXCHANGE RADIOPAQUE BALLOON EXPAND ACCEPTS .014IN SUP-1007823-15 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK MINI VISION 23MM 2.5MM COCR RAPID EXCHANGE RADIOPAQUE BALLOON EXPAND ACCEPTS .014IN SUP-1007823-23 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY MULTI-LINK MINI VISION COCR LOW PROFILE L28 MM OD2.5 MM 2 RADIOPAQUE MARKER BALLOON EXPANDABLE RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE SUP-1007823-28 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK VISION 8MM 2.75MM COCR RAPID EXCHANGE LOW PROFILE RADIOPAQUE BALLOON EXPAND ACCEPTS SUP-1007847-08 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK VISION 12MM 2.75MM COCR RAPID EXCHANGE LOW PROFILE RADIOPAQUE BALLOON EXPAND ACCEPTS SUP-1007847-12 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK VISION 15MM 2.75MM COCR RAPID EXCHANGE LOW PROFILE RADIOPAQUE BALLOON EXPAND ACCEPTS SUP-1007847-15 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK VISION 18MM 2.75MM COCR RAPID EXCHANGE LOW PROFILE RADIOPAQUE BALLOON EXPAND ACCEPTS SUP-1007847-18 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK VISION 23MM 2.75MM COCR RAPID EXCHANGE LOW PROFILE RADIOPAQUE BALLOON EXPAND ACCEPTS SUP-1007847-23 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK VISION 28MM 2.75MM COCR RAPID EXCHANGE LOW PROFILE RADIOPAQUE BALLOON EXPAND ACCEPTS SUP-1007847-28 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK VISION 8MM 3MM COCR RAPID EXCHANGE LOW PROFILE RADIOPAQUE BALLOON EXPAND ACCEPTS .014IN SUP-1007848-08 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK VISION 12MM 3MM COCR RAPID EXCHANGE LOW PROFILE RADIOPAQUE BALLOON EXPAND ACCEPTS .014 SUP-1007848-12 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK VISION 15MM 3MM COCR RAPID EXCHANGE LOW PROFILE RADIOPAQUE BALLOON EXPAND ACCEPTS .014 SUP-1007848-15 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK VISION 18MM 3MM COCR RAPID EXCHANGE LOW PROFILE RADIOPAQUE BALLOON EXPAND ACCEPTS .014 SUP-1007848-18 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK VISION 23MM 3MM COCR RAPID EXCHANGE LOW PROFILE RADIOPAQUE BALLOON EXPAND ACCEPTS .014 SUP-1007848-23 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK VISION 28MM 3MM COCR RAPID EXCHANGE LOW PROFILE RADIOPAQUE BALLOON EXPAND ACCEPTS .014 SUP-1007848-28 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK VISION 8MM 3.5MM COCR RAPID EXCHANGE LOW PROFILE RADIOPAQUE BALLOON EXPAND ACCEPTS .014 SUP-1007849-08 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY MULTI-LINK VISION COCR LOW PROFILE L12 MM OD3.5 MM 2 RADIOPAQUE MARKER BALLOON EXPANDABLE RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE SUP-1007849-12 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK VISION 15MM 3.5MM COCR RAPID EXCHANGE LOW PROFILE RADIOPAQUE BALLOON EXPAND ACCEPTS SUP-1007849-15 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK VISION 18MM 3.5MM COCR RAPID EXCHANGE LOW PROFILE RADIOPAQUE BALLOON EXPAND ACCEPTS SUP-1007849-18 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY 23MM 3.5MM COCR MULTI-LINK VISION 2 RADIOPAQUE MARKER BALLOON SUP-1007849-23 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK VISION 28MM 3.5MM COCR RAPID EXCHANGE LOW PROFILE RADIOPAQUE BALLOON EXPAND ACCEPTS SUP-1007849-28 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY MULTI-LINK VISION COCR LOW PROFILE L8 MM OD4 MM 2 RADIOPAQUE MARKER BALLOON EXPANDABLE RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE SUP-1007850-08 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK VISION 12MM 4MM COCR RAPID EXCHANGE LOW PROFILE RADIOPAQUE BALLOON EXPAND ACCEPTS .014 SUP-1007850-12 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK VISION 15MM 4MM COCR RAPID EXCHANGE LOW PROFILE RADIOPAQUE BALLOON EXPAND ACCEPTS .014 SUP-1007850-15 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK VISION 18MM 4MM COCR RAPID EXCHANGE LOW PROFILE RADIOPAQUE BALLOON EXPAND ACCEPTS .014 SUP-1007850-18 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK VISION 23MM 4MM COCR RAPID EXCHANGE LOW PROFILE RADIOPAQUE BALLOON EXPAND ACCEPTS .014 SUP-1007850-23 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT MULTI-LINK VISION 28MM 4MM COCR RAPID EXCHANGE LOW PROFILE RADIOPAQUE BALLOON EXPAND ACCEPTS .014 SUP-1007850-28 CDM 0481 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM STRIP-OFF 133 TRANSPARENT SUP-1007921 CDM 0270 RC outpatient 37.02 37.02 37.02 74 27.39 percent of total billed charges 37.02 93 29.99 percent of total billed charges 37.02 37.02 other OPPS APC 37.02 37.02 other OPPS APC 37.02 27.63 10.23 percent of total billed charges 37.02 37.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM STRIP-OFF 232 TRANSPARENT SUP-1008486 CDM 0270 RC outpatient 37.02 37.02 37.02 74 27.39 percent of total billed charges 37.02 93 29.99 percent of total billed charges 37.02 37.02 other OPPS APC 37.02 37.02 other OPPS APC 37.02 27.63 10.23 percent of total billed charges 37.02 37.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STERI DRPE X RAY 22 X 23 1/8 SUP-1009 CDM 0270 RC outpatient 2.68 2.68 2.68 74 1.98 percent of total billed charges 2.68 93 2.17 percent of total billed charges 2.68 2.68 other OPPS APC 2.68 2.68 other OPPS APC 2.68 27.63 0.74 percent of total billed charges 2.68 2.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVULOTOME ANGIOSCOPIC HYDRO LEMAITRE L98 CM OD1.5 MM IRRIGATION PORT CUT BLADE BULLET HEAD HANDLE STERILE DISPOSABLE GREEN WHITE SUP-1009-00 CDM 0270 RC outpatient 7797.4 7797.4 7797.4 74 5770.08 percent of total billed charges 7797.4 93 6315.89 percent of total billed charges 7797.4 7797.4 other OPPS APC 7797.4 7797.4 other OPPS APC 7797.4 27.63 2154.42 percent of total billed charges 7797.4 7797.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE V 8MM 143CM 2.25MM EVEROLIMUS ELUTING COCR DELIVERY SYSTEM RAPID EXCHANGE RADIOPAQUE TAPER BALLOON SUP-1009544-08 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE V 12MM 143CM 2.25MM EVEROLIMUS ELUTING COCR DELIVERY SYSTEM RAPID EXCHANGE RADIOPAQUE TAPER SUP-1009544-12 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE V 15MM 143CM 2.25MM EVEROLIMUS ELUTING COCR DELIVERY SYSTEM RAPID EXCHANGE RADIOPAQUE TAPER SUP-1009544-15 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY 18MM 2.25MM .032-.026IN .056IN EVEROLIMUS ELUTING XIENCE NANO 143CM 2 SUP-1009544-18 CDM 0481 RC outpatient 4160 4160 4160 74 3078.4 percent of total billed charges 4160 93 3369.6 percent of total billed charges 4160 4160 other OPPS APC 4160 4160 other OPPS APC 4160 51 2121.6 percent of total billed charges 4160 4160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE V 23MM 143CM 2.25MM EVEROLIMUS ELUTING COCR DELIVERY SYSTEM RAPID EXCHANGE RADIOPAQUE TAPER SUP-1009544-23 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE V 28MM 143CM 2.25MM EVEROLIMUS ELUTING COCR DELIVERY SYSTEM RAPID EXCHANGE RADIOPAQUE TAPER SUP-1009544-28 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR HI-TORQUE BALANCE MIDDLEWEIGHT UNIVERSAL II STRAIGHT 190CM 3CM .014IN ELASTINITE HYDROPHILIC SUP-1009664 CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION SURPASS STREAMLINE L15MM OD 3MM SUP-100USPH CDM 0270 RC outpatient 38610 38610 38610 74 28571.4 percent of total billed charges 38610 93 31274.1 percent of total billed charges 38610 38610 other OPPS APC 38610 38610 other OPPS APC 38610 27.63 10667.9 percent of total billed charges 38610 38610 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT TRACHEOSTOMY ULTRAPERC PORTEX STAINLESS STEEL ID7.0-9.0 MM PERCUTANEOUS 1 DILATOR ERGONOMIC HANDLE COST EFFECTIVE STERILE LATEX FREE DISPOSABLE SUP-101/573/000 CDM 0270 RC outpatient 762.29 762.29 762.29 74 564.09 percent of total billed charges 762.29 93 617.45 percent of total billed charges 762.29 762.29 other OPPS APC 762.29 762.29 other OPPS APC 762.29 27.63 210.62 percent of total billed charges 762.29 762.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BLUESELECT L 26.74 MM ID 6.0 MM CUFF STERILE LATEX FREE DISPOSABLE SUP-101/815/060 CDM 0270 RC outpatient 82.03 82.03 82.03 74 60.7 percent of total billed charges 82.03 93 66.44 percent of total billed charges 82.03 82.03 other OPPS APC 82.03 82.03 other OPPS APC 82.03 27.63 22.66 percent of total billed charges 82.03 82.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BLUSELECT L 26.74 MM ID 7.0 MM CUFF STERILE LATEX FREE DISPOSABLE SUP-101/815/070 CDM 0270 RC outpatient 82.03 82.03 82.03 74 60.7 percent of total billed charges 82.03 93 66.44 percent of total billed charges 82.03 82.03 other OPPS APC 82.03 82.03 other OPPS APC 82.03 27.63 22.66 percent of total billed charges 82.03 82.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BLUSELECT L 26.74 MM ID 8.0 MM WEDGE CUFF NONFEN STERILE LATEX FREE DISPOSABLE SUP-101/815/080 CDM 0270 RC outpatient 82.03 82.03 82.03 74 60.7 percent of total billed charges 82.03 93 66.44 percent of total billed charges 82.03 82.03 other OPPS APC 82.03 82.03 other OPPS APC 82.03 27.63 22.66 percent of total billed charges 82.03 82.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BLUSELECT L 26.74 MM ID 9.0 MM WEDGE CUFF NONFEN STERILE LATEX FREE DISPOSABLE SUP-101/815/090 CDM 0270 RC outpatient 82.03 82.03 82.03 74 60.7 percent of total billed charges 82.03 93 66.44 percent of total billed charges 82.03 82.03 other OPPS APC 82.03 82.03 other OPPS APC 82.03 27.63 22.66 percent of total billed charges 82.03 82.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BLUSELECT ID 10.0 MM CUFF STERILE LATEX FREE DISPOSABLE SUP-101/815/100 CDM 0270 RC outpatient 82.03 82.03 82.03 74 60.7 percent of total billed charges 82.03 93 66.44 percent of total billed charges 82.03 82.03 other OPPS APC 82.03 82.03 other OPPS APC 82.03 27.63 22.66 percent of total billed charges 82.03 82.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BLUSLECT ID 6.0 MM UNCUFF STERILE LATEX FREE DISPOSABLE SUP-101/816/060 CDM 0270 RC outpatient 73.09 73.09 73.09 74 54.09 percent of total billed charges 73.09 93 59.2 percent of total billed charges 73.09 73.09 other OPPS APC 73.09 73.09 other OPPS APC 73.09 27.63 20.19 percent of total billed charges 73.09 73.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BLUSELECT ID 7.0 MM UNCUFF STERILE LATEX FREE DISPOSABLE SUP-101/816/070 CDM 0270 RC outpatient 73.09 73.09 73.09 74 54.09 percent of total billed charges 73.09 93 59.2 percent of total billed charges 73.09 73.09 other OPPS APC 73.09 73.09 other OPPS APC 73.09 27.63 20.19 percent of total billed charges 73.09 73.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BLUSELECT ID 8.0 MM UNCUFF STERILE LATEX FREE DISPOSABLE SUP-101/816/080 CDM 0270 RC outpatient 73.09 73.09 73.09 74 54.09 percent of total billed charges 73.09 93 59.2 percent of total billed charges 73.09 73.09 other OPPS APC 73.09 73.09 other OPPS APC 73.09 27.63 20.19 percent of total billed charges 73.09 73.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BLUSELECT ID 9.0 MM UNCUFF STERILE LATEX FREE DISPOSABLE SUP-101/816/090 CDM 0270 RC outpatient 73.09 73.09 73.09 74 54.09 percent of total billed charges 73.09 93 59.2 percent of total billed charges 73.09 73.09 other OPPS APC 73.09 73.09 other OPPS APC 73.09 27.63 20.19 percent of total billed charges 73.09 73.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BLUSELECT ID 10.0 MM UNCUFF STERILE LATEX FREE DISPOSABLE SUP-101/816/100 CDM 0270 RC outpatient 73.09 73.09 73.09 74 54.09 percent of total billed charges 73.09 93 59.2 percent of total billed charges 73.09 73.09 other OPPS APC 73.09 73.09 other OPPS APC 73.09 27.63 20.19 percent of total billed charges 73.09 73.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA TRACHEOSTOMY BLUSELECT SUCTIONAID ID 6.0 MM TUBE SUP-101/856/060 CDM outpatient 7.53 7.53 7.53 7.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA TRACHEOSTOMY BLUSELECT SUCTIONAID ID 7.0 MM TUBE SUP-101/856/070 CDM outpatient 7.89 7.89 7.89 7.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA TRACHEOSTOMY PORTEX ID 8 MM INNER STERILE LATEX FREE DISPOSABLE TUBE SUP-101/856/080 CDM outpatient 7.89 7.89 7.89 7.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA TRACHEOSTOMY BLUSELECT SUCTIONAID ID 9.0 MM INNER TUBE SUP-101/856/090 CDM outpatient 7.89 7.89 7.89 7.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA TRACHEOSTOMY BLUSELECT SUCTIONAID ID 10 MM INNER STERILE LATEX FREE DISPOSABLE TUBE SUP-101/856/100 CDM outpatient 7.89 7.89 7.89 7.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY BLUSELECT SUCTIONAID VELCRO L 70 MM OD 10.5 MM ID 7.0 MM CUFF OBTURATOR 2 INNER CANNULA TRACH HOLDER SUP-101/875/070 CDM 0270 RC outpatient 110.27 110.27 110.27 74 81.6 percent of total billed charges 110.27 93 89.32 percent of total billed charges 110.27 110.27 other OPPS APC 110.27 110.27 other OPPS APC 110.27 27.63 30.47 percent of total billed charges 110.27 110.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY BLUSELECT SUCTIONAID VELCRO L 75.5 MM OS 11.9 MM ID 8.0 MM CUFF OBTURATOR 2 INNER CANNULA TRACH HOLDER SUP-101/875/080 CDM 0270 RC outpatient 110.27 110.27 110.27 74 81.6 percent of total billed charges 110.27 93 89.32 percent of total billed charges 110.27 110.27 other OPPS APC 110.27 110.27 other OPPS APC 110.27 27.63 30.47 percent of total billed charges 110.27 110.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL 3M STERI-DRAPE 23X17IN CLEAR POLYETHYLENE DISPOSABLE STERILE LF ADHESIVE STRIP LG TOWEL MATTE FINISH SUP-1010 CDM 0270 RC outpatient 2.11 2.11 2.11 74 1.56 percent of total billed charges 2.11 93 1.71 percent of total billed charges 2.11 2.11 other OPPS APC 2.11 2.11 other OPPS APC 2.11 27.63 0.58 percent of total billed charges 2.11 2.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR HI-TORQUE PILOT 50 J CURVE 190CM 3CM .014IN DURASTEEL POLYMER HYDROPHILIC DISPOSABLE STERILE LF CORE SUP-1010480-HJ CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR HI-TORQUE PILOT 150 J CURVE 190CM 3CM .014IN DURASTEEL POLYMER HYDROPHILIC DISPOSABLE STERILE LF CORE SUP-1010481-HJ CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR HI-TORQUE PILOT 200 DURASTEEL POLYMER HYDROPHILIC L190 CM OD.014 IN CORONARY J TIP CORE TO TIP RADIOPAQUE SUP-1010482-HJ CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE EQUIPMENT 3M STERI-DRAPE VELCRO PLASTIC LARGE L25 IN X W23 IN 1 PIECE XRAY CASSETTE ADHESIVE CLOSURE FILM STERILE LATEX FREE DISPOSABLE CLEAR SUP-1011 CDM 0270 RC outpatient 6.14 6.14 6.14 74 4.54 percent of total billed charges 6.14 93 4.97 percent of total billed charges 6.14 6.14 other OPPS APC 6.14 6.14 other OPPS APC 6.14 27.63 1.7 percent of total billed charges 6.14 6.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION VOYAGER LOFOLD SHORT LOW PROFILE TAPER 143CM 8MM 2-2.4FR SUP-1011392-08 CDM 0481 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 51 152.49 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE PRIME LL EVEROLIMUS ELUTING COCR L38 MM OD4 MM RAPID EXCHANGE SUP-1011735-38 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR HI-TORQUE BALANCE MIDDLEWEIGHT ELITE J CURVE 190CM 3CM .014IN ELASTINITE HYDROPHILIC DISPOSABLE SUP-1011880J CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL TRI-LOCK BPS GRIPTION 2 STANDARD OFFSET L99 MM HIP STERILE SUP-1012-04-020 CDM 270010024 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL TAPER TRILOCK SIZE 6 STD SUP-1012-04-060 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL TRI-LOCK BPS GRIPTION 7 STANDARD OFFSET L109 MM HIP STERILE SUP-1012-04-070 CDM 270010024 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL TRI-LOCK BPS GRIPTION 3 HIGH OFFSET L101 MM HIP STERILE SUP-1012-14-030 CDM 270010024 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL TRI-LOCK BPS GRIPTION 5 HIGH OFFSET L105 MM HIP STERILE SUP-1012-14-050 CDM 270010024 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL TRI-LOCK BPS GRIPTION 7 HIGH OFFSET L109 MM HIP STERILE SUP-1012-14-070 CDM 270010024 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE VENTILATION DONALDSON SILICONE L.9 MM ID1.14 MM IDSEC2.3 MM EAR SEMIPERMEABLE MEMBRANE SHORT TERM RESIDENCE TIME TEMPORARY GREEN SUP-1012015 CDM 0270 RC outpatient 233.48 233.48 233.48 74 172.78 percent of total billed charges 233.48 93 189.12 percent of total billed charges 233.48 233.48 other OPPS APC 233.48 233.48 other OPPS APC 233.48 27.63 64.51 percent of total billed charges 233.48 233.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 1.2 X 6 MM SUP-1012268-06U CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 1.2 X 12 MM SUP-1012268-12U CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 1.2 X 15 MM SUP-1012268-15U CDM 0481 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 51 152.49 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MINI TREK 6MM 1.5MM TUNGSTEN CORONARY RAPID EXCHANGE ULTRA LOW PROFILE RADIOPAQUE FLEXIBLE SUP-1012269-06 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MINI TREK 8MM 1.5MM TUNGSTEN CORONARY RAPID EXCHANGE ULTRA LOW PROFILE RADIOPAQUE FLEXIBLE SUP-1012269-08 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 1.5 X 12 MM SUP-1012269-12 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 1.5 X 15 MM SUP-1012269-15 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MINI TREK 20MM 1.5MM TUNGSTEN CORONARY RAPID EXCHANGE ULTRA LOW PROFILE RADIOPAQUE FLEXIBLE SUP-1012269-20 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MINI TREK SLIM SEAL 6MM 2MM TUNGSTEN CORONARY RAPID EXCHANGE ULTRA LOW PROFILE RADIOPAQUE SUP-1012270-06 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MINI TREK SLIM SEAL 8MM 2MM TUNGSTEN CORONARY RAPID EXCHANGE ULTRA LOW PROFILE RADIOPAQUE SUP-1012270-08 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MINI TREK SLIM SEAL 12MM 2MM TUNGSTEN CORONARY RAPID EXCHANGE ULTRA LOW PROFILE RADIOPAQUE SUP-1012270-12 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 2.0 X 15 MM SUP-1012270-15 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MINI TREK SLIM SEAL 20MM 2MM TUNGSTEN CORONARY RAPID EXCHANGE ULTRA LOW PROFILE RADIOPAQUE SUP-1012270-20 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 2.0 X 30 MM SUP-1012270-30 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION TREK SLIM SEAL 6MM 2.25MM CROSSFLEX2 TUNGSTEN CORONARY RAPID EXCHANGE ULTRA LOW PROFILE SUP-1012271-06 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 2.25 X 12 MM SUP-1012271-12 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 2.25 X 15 MM SUP-1012271-15 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 2.25 X 20 MM SUP-1012271-20 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 2.5 X 6 MM SUP-1012272-06 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION TREK SLIM SEAL 8MM 2.5MM CROSSFLEX2 TUNGSTEN CORONARY RAPID EXCHANGE ULTRA LOW PROFILE SUP-1012272-08 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION TREK SLIM SEAL 12MM 2.5MM CROSSFLEX2 TUNGSTEN CORONARY RAPID EXCHANGE ULTRA LOW PROFILE SUP-1012272-12 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 2.5 X 15 MM SUP-1012272-15 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 2.5 X 20 MM SUP-1012272-20 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 2.5 X 30 MM SUP-1012272-30 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION TREK SLIM SEAL 6MM 2.75MM CROSSFLEX2 TUNGSTEN CORONARY RAPID EXCHANGE ULTRA LOW PROFILE SUP-1012273-06 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 2.75 X 12 MM SUP-1012273-12 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 2.75 X 15 MM SUP-1012273-15 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 2.75 X 20 MM SUP-1012273-20 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 3.0 X 6 MM SUP-1012274-06 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION TREK SLIM SEAL 8MM 3MM CROSSFLEX2 TUNGSTEN CORONARY RAPID EXCHANGE ULTRA LOW PROFILE SUP-1012274-08 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 3.0 X 12 MM SUP-1012274-12 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 3.0 X 15 MM SUP-1012274-15 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 3.0 X 20 MM SUP-1012274-20 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 3.0 X 30 MM SUP-1012274-30 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 3.25 X 6 MM SUP-1012275-06 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION TREK SLIM SEAL 15MM 3.25MM CROSSFLEX2 TUNGSTEN CORONARY RAPID EXCHANGE ULTRA LOW PROFILE SUP-1012275-15 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION TREK SLIM SEAL 20MM 3.25MM CROSSFLEX2 TUNGSTEN CORONARY RAPID EXCHANGE ULTRA LOW PROFILE SUP-1012275-20 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION TREK SLIM SEAL 6MM 3.5MM CROSSFLEX2 TUNGSTEN CORONARY RAPID EXCHANGE ULTRA LOW PROFILE SUP-1012276-06 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 3.5 X 8 MM SUP-1012276-08 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 3.5 X 12 MM SUP-1012276-12 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 3.5 X 15 MM SUP-1012276-15 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 3.5 X 20 MM SUP-1012276-20 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 3.5 X 30 MM SUP-1012276-30 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION TREK SLIM SEAL 6MM 3.75MM CROSSFLEX2 TUNGSTEN CORONARY RAPID EXCHANGE ULTRA LOW PROFILE SUP-1012277-06 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 3.75 X 15 MM SUP-1012277-15 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION TREK SLIM SEAL 20MM 3.75MM CROSSFLEX2 TUNGSTEN CORONARY RAPID EXCHANGE ULTRA LOW PROFILE SUP-1012277-20 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 4.0 X 6 MM SUP-1012278-06 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION TREK SLIM SEAL 8MM 4MM CROSSFLEX2 TUNGSTEN CORONARY RAPID EXCHANGE ULTRA LOW PROFILE SUP-1012278-08 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 4.0 X 12 MM SUP-1012278-12 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION TREK SLIM SEAL 15MM 4MM CROSSFLEX2 TUNGSTEN CORONARY RAPID EXCHANGE ULTRA LOW PROFILE SUP-1012278-15 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 4.0 X 20 MM SUP-1012278-20 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 4.0 X 30 MM SUP-1012278-30 CDM 0481 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 51 198.9 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 4.5 X 12 MM SUP-1012279-12 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 4.5 X 15 MM SUP-1012279-15 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TREK BALLOON 5.0 X 12 MM SUP-1012280-12 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION TREK SLIM SEAL 15MM 5MM CROSSFLEX2 TUNGSTEN CORONARY RAPID EXCHANGE ULTRA LOW PROFILE SUP-1012280-15 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 1.5 X 6 MM SUP-1012444-06 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 1.5 X 8 MM SUP-1012444-08 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 1.5 X 12 MM SUP-1012444-12 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 1.5 X 15 MM SUP-1012444-15 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 1.5 X 20 MM SUP-1012444-20 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 2.0 X 6 MM SUP-1012445-06 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 2.0 X 8 MM SUP-1012445-08 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 2.0 X 12 MM SUP-1012445-12 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 2.0 X 15 MM SUP-1012445-15 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 2.0 X 20 MM SUP-1012445-20 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 2.25 X 6 MM SUP-1012446-06 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 2.25 X 8 MM SUP-1012446-08 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 2.25 X 12 MM SUP-1012446-12 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 2.25 X 15 MM SUP-1012446-15 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 2.25 X 20 MM SUP-1012446-20 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 2.5 X 6 MM SUP-1012447-06 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 2.5 X 8 MM SUP-1012447-08 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 2.5 X 12 MM SUP-1012447-12 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 2.5 X 15 MM SUP-1012447-15 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 2.5 X 20 MM SUP-1012447-20 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 2.75 X 6 MM SUP-1012448-06 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 2.75 X 8 MM SUP-1012448-08 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 2.75 X 12 MM SUP-1012448-12 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 2.75 X 15 MM SUP-1012448-15 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 2.75 X 20 MM SUP-1012448-20 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 3.0 X 6 MM SUP-1012449-06 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 3.0 X 8 MM SUP-1012449-08 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC TREK 12MM 3MM TUNGSTEN CORONARY RAPID EXCHANGE RADIOPAQUE SMOOTH ROUND TIP PTCA SUP-1012449-12 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 3.0 X 15 MM SUP-1012449-15 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 3.0 X 20 MM SUP-1012449-20 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 3.25 X 6 MM SUP-1012450-06 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 3.25 X 8 MM SUP-1012450-08 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 3.25 X 12 MM SUP-1012450-12 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 3.25 X 15 MM SUP-1012450-15 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 3.25 X 20 MM SUP-1012450-20 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 3.5 X 6 MM SUP-1012451-06 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 3.5 X 8 MM SUP-1012451-08 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 3.5 X 12 MM SUP-1012451-12 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 3.5 X 15 MM SUP-1012451-15 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 3.5 X 20 MM SUP-1012451-20 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 3.5 X 25 MM SUP-1012451-25 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 3.75 X 8 MM SUP-1012452-08 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 3.75 X 12 MM SUP-1012452-12 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 3.75 X 15 MM SUP-1012452-15 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 3.75 X 20 MM SUP-1012452-20 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 4.0 X 8 MM SUP-1012453-08 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 4.0 X 12 MM SUP-1012453-12 CDM 0481 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 51 148.51 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 4.0 X 15 MM SUP-1012453-15 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 4.0 X 20 MM SUP-1012453-20 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 4.5 X 8 MM SUP-1012454-08 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 4.5 X 12 MM SUP-1012454-12 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 4.5 X 15 MM SUP-1012454-15 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 4.5 X 20 MM SUP-1012454-20 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 5.0 X 8 MM SUP-1012455-08 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 5.0 X 12 MM SUP-1012455-12 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 5.0 X 15 MM SUP-1012455-15 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC TREK BALLOON 5.0 X 20 MM SUP-1012455-20 CDM 0481 RC outpatient 292.5 292.5 292.5 74 216.45 percent of total billed charges 292.5 93 236.93 percent of total billed charges 292.5 292.5 other OPPS APC 292.5 292.5 other OPPS APC 292.5 51 149.18 percent of total billed charges 292.5 292.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCISSORS SURGICAL CARB-EDGE METZENBAUM STAINLESS STEEL CURVE L7 IN L33 MM TONSIL SATIN FINISH NONSTERILE SUP-101258 CDM 0270 RC outpatient 139.57 139.57 139.57 74 103.28 percent of total billed charges 139.57 93 113.05 percent of total billed charges 139.57 139.57 other OPPS APC 139.57 139.57 other OPPS APC 139.57 27.63 38.56 percent of total billed charges 139.57 139.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFTMASTER STENT 3.5 X 19 SUP-1012581-19 CDM 0270 RC outpatient 6227 6227 6227 74 4607.98 percent of total billed charges 6227 93 5043.87 percent of total billed charges 6227 6227 other OPPS APC 6227 6227 other OPPS APC 6227 27.63 1720.52 percent of total billed charges 6227 6227 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFTMATER STENT 4.0 X 16 SUP-1012582-16 CDM 0270 RC outpatient 6227 6227 6227 74 4607.98 percent of total billed charges 6227 93 5043.87 percent of total billed charges 6227 6227 other OPPS APC 6227 6227 other OPPS APC 6227 27.63 1720.52 percent of total billed charges 6227 6227 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ULTRASOUND ACUNAV L90 CM OD 8FR INTRACARDIAC 4 WAY STEERING REAL TIME VISUALIZATION DOPPLER IMAGING MODULAR SYSTEM SETUP ECHOCARDIOGRAPHY SUP-10135910 CDM 0270 RC outpatient 7339.8 7339.8 7339.8 74 5431.45 percent of total billed charges 7339.8 93 5945.24 percent of total billed charges 7339.8 7339.8 other OPPS APC 7339.8 7339.8 other OPPS APC 7339.8 27.63 2027.99 percent of total billed charges 7339.8 7339.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL 3M STERI-DRAPE 51X47IN CLEAR POLYETHYLENE DISPOSABLE STERILE LF ADHESIVE U DRAPE SUP-1015 CDM 0270 RC outpatient 7.38 7.38 7.38 74 5.46 percent of total billed charges 7.38 93 5.98 percent of total billed charges 7.38 7.38 other OPPS APC 7.38 7.38 other OPPS APC 7.38 27.63 2.04 percent of total billed charges 7.38 7.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE VENTILATION GOODE SILICONE T FLANGE GROMMET L12 MM OD9.5 MM ID1.14 MM EAR SOFT SUP-1016010 CDM 0270 RC outpatient 34.74 34.74 34.74 74 25.71 percent of total billed charges 34.74 93 28.14 percent of total billed charges 34.74 34.74 other OPPS APC 34.74 34.74 other OPPS APC 34.74 27.63 9.6 percent of total billed charges 34.74 34.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FINTER TRAP SMALL SUP-10170051 CDM 0270 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 27.63 31.25 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FINTER TRAP LARGE SUP-10170053 CDM 0270 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 27.63 31.25 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FINTER TRAP XL SUP-10170054 CDM 0270 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 27.63 31.25 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WRIST STRAP SUP-10170060 CDM 0270 RC outpatient 85.8 85.8 85.8 74 63.49 percent of total billed charges 85.8 93 69.5 percent of total billed charges 85.8 85.8 other OPPS APC 85.8 85.8 other OPPS APC 85.8 27.63 23.71 percent of total billed charges 85.8 85.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR CERVICAL VELCRO COTTON FOAM XL SERPENTINE L25.5 IN X H4.5 IN SOFT DENSITY BREATHABLE STOCKINETTE COVER CLOSURE NONSTERILE LATEX FREE SUP-1018-05 CDM 270009109 LOCAL 0270 RC outpatient 4.09 4.09 4.09 74 3.03 percent of total billed charges 4.09 93 3.31 percent of total billed charges 4.09 4.09 other OPPS APC 4.09 4.09 other OPPS APC 4.09 27.63 1.13 percent of total billed charges 4.09 4.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL COCR +5 MM 14/16 LARGE TAPER OD28 MM HIP NECK SUP-1018-13-000 CDM 270010024 LOCAL 0270 RC outpatient 2162.16 2162.16 2162.16 74 1600 percent of total billed charges 2162.16 93 1751.35 percent of total billed charges 2162.16 2162.16 other OPPS APC 2162.16 2162.16 other OPPS APC 2162.16 27.63 597.4 percent of total billed charges 2162.16 2162.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL COCR +8 MM 14/16 BALL TAPER OD28 MM HIP STERILE SUP-1018-14-000 CDM 270010024 LOCAL 0270 RC outpatient 2162.16 2162.16 2162.16 74 1600 percent of total billed charges 2162.16 93 1751.35 percent of total billed charges 2162.16 2162.16 other OPPS APC 2162.16 2162.16 other OPPS APC 2162.16 27.63 597.4 percent of total billed charges 2162.16 2162.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL METAL +11 MM 14/16 LARGE TAPER OD36 MM HIP SUP-1018-36-511 CDM 270010024 LOCAL 0270 RC outpatient 3243.24 3243.24 3243.24 74 2400 percent of total billed charges 3243.24 93 2627.02 percent of total billed charges 3243.24 3243.24 other OPPS APC 3243.24 3243.24 other OPPS APC 3243.24 27.63 896.11 percent of total billed charges 3243.24 3243.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VOLCANO VERRATA PRESSURE GUIDEWIRE SUP-10185 CDM 0481 RC outpatient 1755 1755 1755 74 1298.7 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 1755 other OPPS APC 1755 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION SURPASS STREAMLINE L20MM OD 3MM SUP-101USPH CDM 0270 RC outpatient 38610 38610 38610 74 28571.4 percent of total billed charges 38610 93 31274.1 percent of total billed charges 38610 38610 other OPPS APC 38610 38610 other OPPS APC 38610 27.63 10667.9 percent of total billed charges 38610 38610 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCISSOR METZENBAUM SUPERCUT CURVED 5.75IN SUP-102120 CDM outpatient 125.16 125.16 125.16 125.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK ACCESSORY FRAGMATOME SUP-1021HP CDM 0270 RC outpatient 163.8 163.8 163.8 74 121.21 percent of total billed charges 163.8 93 132.68 percent of total billed charges 163.8 163.8 other OPPS APC 163.8 163.8 other OPPS APC 163.8 27.63 45.26 percent of total billed charges 163.8 163.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BONE CEMENT AVAFLEX CURVE STERILE LATEX FREE DISPOSABLE SUP-1025-011-500 CDM 0270 RC outpatient 1288.72 1288.72 1288.72 74 953.65 percent of total billed charges 1288.72 93 1043.86 percent of total billed charges 1288.72 1288.72 other OPPS APC 1288.72 1288.72 other OPPS APC 1288.72 27.63 356.07 percent of total billed charges 1288.72 1288.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE VENTILATION PAPARELLA SILICONE L1.15 MM ID1.52 MM IDSEC4.45 MM EAR TAB NOTCH STERILE MYRINGOTOMY SUP-1025045 CDM 0270 RC outpatient 117 117 117 74 86.58 percent of total billed charges 117 93 94.77 percent of total billed charges 117 117 other OPPS APC 117 117 other OPPS APC 117 27.63 32.33 percent of total billed charges 117 117 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE VENTILATION SHEPHARD FLUOROPLASTIC ID1.14 MM IDSEC2.4 MM EAR GROMMET SHORT TERM RESIDENCE TIME TAIL TEMPORARY SUP-1028010 CDM 0270 RC outpatient 50.96 50.96 50.96 74 37.71 percent of total billed charges 50.96 93 41.28 percent of total billed charges 50.96 50.96 other OPPS APC 50.96 50.96 other OPPS APC 50.96 27.63 14.08 percent of total billed charges 50.96 50.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PUMP CENTRIMAG BLOOD SUP-102953 CDM 0270 RC outpatient 32760 32760 32760 74 24242.4 percent of total billed charges 32760 93 26535.6 percent of total billed charges 32760 32760 other OPPS APC 32760 32760 other OPPS APC 32760 27.63 9051.59 percent of total billed charges 32760 32760 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SKIN THERASKIN EXTRACELLULAR MATRIX 39 SQ CM L3 IN X W2 IN ALLOGRAFT SUP-102TSL CDM outpatient 3497 3497 3497 3497 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION SURPASS STREAMLINE L25MM OD 3MM SUP-102USPH CDM 0270 RC outpatient 38610 38610 38610 74 28571.4 percent of total billed charges 38610 93 31274.1 percent of total billed charges 38610 38610 other OPPS APC 38610 38610 other OPPS APC 38610 27.63 10667.9 percent of total billed charges 38610 38610 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENERATOR NEUROSTIMULATOR VNS THERAPY .126IN 1.8X1.3X.27IN TECOTHANE SS TITANIUM SILICONE DISPOSABLE STERILE LF .56OZ 1 SUP-103 CDM 270010003 LOCAL 0270 RC outpatient 55142.8 55142.8 55142.8 74 40805.7 percent of total billed charges 55142.8 93 44665.7 percent of total billed charges 55142.8 55142.8 other OPPS APC 55142.8 55142.8 other OPPS APC 55142.8 27.63 15236 percent of total billed charges 55142.8 55142.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE INFLATION CADENCE PRECISION 1 ML SYRINGE INJECTOR THREAD PLUNGER SUP-103-0304 CDM 0270 RC outpatient 323.44 323.44 323.44 74 239.35 percent of total billed charges 323.44 93 261.99 percent of total billed charges 323.44 323.44 other OPPS APC 323.44 323.44 other OPPS APC 323.44 27.63 89.37 percent of total billed charges 323.44 323.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR X-PEDION STAINLESS STEEL PLATINUM HYDROPHILIC L200 CM L10 CM OD.01 IN ODSEC.012 IN SOFT TIP RADIOPAQUE DISTAL COIL POUCH SUP-103-0605-200 CDM 0270 RC outpatient 860.6 860.6 860.6 74 636.84 percent of total billed charges 860.6 93 697.09 percent of total billed charges 860.6 860.6 other OPPS APC 860.6 860.6 other OPPS APC 860.6 27.63 237.78 percent of total billed charges 860.6 860.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR MIRAGE STAINLESS STEEL PLATINUM HYDROPHILIC TAPER L200 CM L10 CM OD.008 IN SOFT TIP EXTRA SUPPORT RADIOPAQUE DISTAL COIL SUP-103-0608 CDM 0270 RC outpatient 1336.4 1336.4 1336.4 74 988.94 percent of total billed charges 1336.4 93 1082.48 percent of total billed charges 1336.4 1336.4 other OPPS APC 1336.4 1336.4 other OPPS APC 1336.4 27.63 369.25 percent of total billed charges 1336.4 1336.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PARTICLES EMBOLIZATION ONYX MIXER SUP-103-1205-001 CDM 0270 RC outpatient 1820 1820 1820 74 1346.8 percent of total billed charges 1820 93 1474.2 percent of total billed charges 1820 1820 other OPPS APC 1820 1820 other OPPS APC 1820 27.63 502.87 percent of total billed charges 1820 1820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH SURGICAL VENTRALEX SEPRA SORBAFLEX SM CIRCLE 1.7IN POLYPROPYLENE EPTFE STERILE MONOFILAMENT SELF EXPAND STRAP SUP-10301 CDM 0270 RC outpatient 1115.4 1115.4 1115.4 74 825.4 percent of total billed charges 1115.4 93 903.47 percent of total billed charges 1115.4 1115.4 other OPPS APC 1115.4 1115.4 other OPPS APC 1115.4 27.63 308.19 percent of total billed charges 1115.4 1115.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET CATHETER DURAFLOW 2 L28 CM OD15.5 FR ODSEC18 GA STERILE LATEX FREE DISPOSABLE CHRONIC HEMODIALYSIS SUP-10301202 CDM 0270 RC outpatient 884 884 884 74 654.16 percent of total billed charges 884 93 716.04 percent of total billed charges 884 884 other OPPS APC 884 884 other OPPS APC 884 27.63 244.25 percent of total billed charges 884 884 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH SURGICAL VENTRALEX SEPRA SORBAFLEX MED CIRCLE 2.5IN POLYPROPYLENE EPTFE STERILE MONOFILAMENT SELF EXPAND STRAP SUP-10302 CDM 0270 RC outpatient 1655.42 1655.42 1655.42 74 1225.01 percent of total billed charges 1655.42 93 1340.89 percent of total billed charges 1655.42 1655.42 other OPPS APC 1655.42 1655.42 other OPPS APC 1655.42 27.63 457.39 percent of total billed charges 1655.42 1655.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER BIOFLO DURAMAX ENDEXO POLYURETHANE ADULT L24 CM L19 CM OD15.5 FR BASIC 2 VALVE CLEAR DIALYSIS SUP-10302803 CDM 0270 RC outpatient 897 897 897 74 663.78 percent of total billed charges 897 93 726.57 percent of total billed charges 897 897 other OPPS APC 897 897 other OPPS APC 897 27.63 247.84 percent of total billed charges 897 897 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIPOLAR SELF CENTERING 28MM X 45MM SUP-1035-45-00 CDM 270010023 LOCAL 0270 RC outpatient 2619.24 2619.24 2619.24 74 1938.24 percent of total billed charges 2619.24 93 2121.58 percent of total billed charges 2619.24 2619.24 other OPPS APC 2619.24 2619.24 other OPPS APC 2619.24 27.63 723.7 percent of total billed charges 2619.24 2619.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLUG DECANNULATION 7 FULL CLOSURE TRACHEOSTOMY LATEX WHITE SUP-1037837 CDM 0270 RC outpatient 133.25 133.25 133.25 74 98.61 percent of total billed charges 133.25 93 107.93 percent of total billed charges 133.25 133.25 other OPPS APC 133.25 133.25 other OPPS APC 133.25 27.63 36.82 percent of total billed charges 133.25 133.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SKIN THERASKIN 116 SQ CM XL L6 IN X W3 IN ALLOGRAFT CRYOPRESERVE PREMESH SUP-103TSXL CDM outpatient 9347 9347 9347 9347 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENERATOR NEUROSTIMULATOR VNS THERAPY .2IN 1.8X1.6X.27IN TECOTHANE SS TITANIUM SILICONE DISPOSABLE STERILE LF .63OZ 2 SUP-104 CDM 270010003 LOCAL 0270 RC outpatient 57525 57525 57525 74 42568.5 percent of total billed charges 57525 93 46595.3 percent of total billed charges 57525 57525 other OPPS APC 57525 57525 other OPPS APC 57525 27.63 15894.2 percent of total billed charges 57525 57525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON OCCLUSION HYPERFORM X-PEDION PLATINUM HYDROPHILIC .01 IN L4 MM L150 CM L20 MM OD2.8-2.2 FR ODSEC4 MM 1 LUMEN GUIDEWIRE COIL TIP SUP-104-4127 CDM 0270 RC outpatient 4560.4 4560.4 4560.4 74 3374.7 percent of total billed charges 4560.4 93 3693.92 percent of total billed charges 4560.4 4560.4 other OPPS APC 4560.4 4560.4 other OPPS APC 4560.4 27.63 1260.04 percent of total billed charges 4560.4 4560.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON OCCLUSION HYPERFORM PLATINUM .01 IN L2 MM L150 CM L7 MM OD2.8-2.2 FR ODSEC3 MM 1 LUMEN GUIDEWIRE LINE EXTENSION COIL TIP SUP-104-4370 CDM 0270 RC outpatient 4570.8 4570.8 4570.8 74 3382.39 percent of total billed charges 4570.8 93 3702.35 percent of total billed charges 4570.8 4570.8 other OPPS APC 4570.8 4570.8 other OPPS APC 4570.8 27.63 1262.91 percent of total billed charges 4570.8 4570.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON OCCLUSION HYPERFORM HYDROPHILIC .01 IN L2 MM L150 CM L7 MM OD2.5-2.8 FR ODSEC4 MM 1 LUMEN GUIDEWIRE COIL TIP LINE EXTENSION SUP-104-4470 CDM 0270 RC outpatient 4570.8 4570.8 4570.8 74 3382.39 percent of total billed charges 4570.8 93 3702.35 percent of total billed charges 4570.8 4570.8 other OPPS APC 4570.8 4570.8 other OPPS APC 4570.8 27.63 1262.91 percent of total billed charges 4570.8 4570.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON OCCLUSION HYPERFORM X-PEDION L4 MM L150 CM L20 MM OD2.8-2.2 FR ODSEC5 MM 1 LUMEN SUP-104-4520 CDM 0270 RC outpatient 4810 4810 4810 74 3559.4 percent of total billed charges 4810 93 3896.1 percent of total billed charges 4810 4810 other OPPS APC 4810 4810 other OPPS APC 4810 27.63 1329 percent of total billed charges 4810 4810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON OCCLUSION HYPERFORM L2 MM L150 CM L15 MM OD2.8-3 FR ODSEC7 MM 1 LUMEN MECHANICAL SEAL ACCEPTS .01 IN GUIDEWIRE SUP-104-4715 CDM 0270 RC outpatient 4570.8 4570.8 4570.8 74 3382.39 percent of total billed charges 4570.8 93 3702.35 percent of total billed charges 4570.8 4570.8 other OPPS APC 4570.8 4570.8 other OPPS APC 4570.8 27.63 1262.91 percent of total billed charges 4570.8 4570.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIGHT RETRACTOR WAVEGUIDE WIDE FLAT FIBER OPTIC STERILE LATEX FREE DISPOSABLE SUP-104015 CDM 0270 RC outpatient 1068.08 1068.08 1068.08 74 790.38 percent of total billed charges 1068.08 93 865.14 percent of total billed charges 1068.08 1068.08 other OPPS APC 1068.08 1068.08 other OPPS APC 1068.08 27.63 295.11 percent of total billed charges 1068.08 1068.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOOP VESSEL RETRACT-O-TAPE STAINLESS STEEL SILICONE MAXI ROUND L12 IN OD18 GA VASCULAR AIR CUSHION CURVE BLUNT TIP THIN WALL NEEDLE LATEX FREE WHITE SUP-1041 CDM 0270 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 27.63 6.47 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ULTRASOUND SOUNDSTAR OD10 FR INTRACARDIAC STEERING HANDLE GE SUP-10439072 CDM 0270 RC outpatient 7007 7007 7007 74 5185.18 percent of total billed charges 7007 93 5675.67 percent of total billed charges 7007 7007 other OPPS APC 7007 7007 other OPPS APC 7007 27.63 1936.03 percent of total billed charges 7007 7007 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC SOUNDSTAR OD 8 FR SUP-10439236 CDM 0270 RC outpatient 7007 7007 7007 74 5185.18 percent of total billed charges 7007 93 5675.67 percent of total billed charges 7007 7007 other OPPS APC 7007 7007 other OPPS APC 7007 27.63 1936.03 percent of total billed charges 7007 7007 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR HI-TORQUE POWERTURN FLEX DURASTEEL HYDROPHILIC STRAIGHT L190 CM L3 CM OD.014 IN SUP-1044592 CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR HI-TORQUE POWERTURN DURASTEEL HYDROPHILIC J CURVE L190 CM OD.014 IN SUP-1044592J CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRIP SKIN CLOSURE L4 IN X W.5 IN ADHERENT HYPOALLERGENIC POROUS REINFORCED FILAMENT STERILE LATEX FREE SUP-1047 CDM 0270 RC outpatient 1.81 1.81 1.81 74 1.34 percent of total billed charges 1.81 93 1.47 percent of total billed charges 1.81 1.81 other OPPS APC 1.81 1.81 other OPPS APC 1.81 27.63 0.5 percent of total billed charges 1.81 1.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VACUUM EXTRACTION JADA HEMORRHAGE CONTROL BLUE SEAL VALVE KIT GREEN BOX SUP-1047196 CDM outpatient 3367 3367 3367 3367 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT THROMBECTOMY ANGIOJET ULTRA L145 CM L15 MM OD1.5 MM ODSEC3-4 FR ULTRA SYSTEM OTW MARKER BAND CONTRAST INJECTION PORT POWER PULSE LATEX FREE ACCEPTS .014 IN GUIDEWIRE ACCEPTS 4 FR SHEATH SUP-104834-002 CDM 0270 RC outpatient 92.82 92.82 92.82 74 68.69 percent of total billed charges 92.82 93 75.18 percent of total billed charges 92.82 92.82 other OPPS APC 92.82 92.82 other OPPS APC 92.82 27.63 25.65 percent of total billed charges 92.82 92.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT THROMBECTOMY POWER PULSE ANGIOJET ULTRA CONSOLE SUP-104834-0021 CDM 0270 RC outpatient 114.92 114.92 114.92 74 85.04 percent of total billed charges 114.92 93 93.09 percent of total billed charges 114.92 114.92 other OPPS APC 114.92 114.92 other OPPS APC 114.92 27.63 31.75 percent of total billed charges 114.92 114.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBER GREENLIGHT LASER XPS-FORTEC MEDICAL SUP-10486 CDM 0270 RC outpatient 3387.8 3387.8 3387.8 74 2506.97 percent of total billed charges 3387.8 93 2744.12 percent of total billed charges 3387.8 3387.8 other OPPS APC 3387.8 3387.8 other OPPS APC 3387.8 27.63 936.05 percent of total billed charges 3387.8 3387.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION MARATHON .010 IN MICRO L165 CM L25 CM OD2.7-1.5 FR ID.015-.013 FR FLOW DIRECT GUIDEWIRE SUP-105-5056 CDM 0270 RC outpatient 2303.6 2303.6 2303.6 74 1704.66 percent of total billed charges 2303.6 93 1865.92 percent of total billed charges 2303.6 2303.6 other OPPS APC 2303.6 2303.6 other OPPS APC 2303.6 27.63 636.48 percent of total billed charges 2303.6 2303.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION ECHELON 10 NITINOL MICRO L155 CM L150 CM OD2.1-1.7 FR ODSEC5 FR ID.017 IN .34 ML STRAIGHT TIP GUIDEWIRE FLEXIBLE STEAM SHAPEABLE ACCEPTS .014 IN SUP-105-5091-150 CDM 0270 RC outpatient 2249 2249 2249 74 1664.26 percent of total billed charges 2249 93 1821.69 percent of total billed charges 2249 2249 other OPPS APC 2249 2249 other OPPS APC 2249 27.63 621.4 percent of total billed charges 2249 2249 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION APOLLO ONYX NITINOL STAINLESS STEEL MICRO L165 CM L1.5 CM OD1.5-2.7 FR ID.013 IN DELIVERY DETACHABLE STRAIGHT TIP SUPERIOR NAVIGATION PROXIMAL COIL ACCEPTS .01- IN GUIDEWIRE SUP-105-5095-000 CDM 0270 RC outpatient 5746 5746 5746 74 4252.04 percent of total billed charges 5746 93 4654.26 percent of total billed charges 5746 5746 other OPPS APC 5746 5746 other OPPS APC 5746 27.63 1587.62 percent of total billed charges 5746 5746 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION APOLLO ONYX NITINOL STAINLESS STEEL MICRO L165 CM L3 CM OD1.5-2.7 FR ID.013 IN DELIVERY DETACHABLE STRAIGHT TIP SUPERIOR NAVIGATION PROXIMAL COIL ACCEPTS .01- IN GUIDEWIRE SUP-105-5096-000 CDM 0270 RC outpatient 5746 5746 5746 74 4252.04 percent of total billed charges 5746 93 4654.26 percent of total billed charges 5746 5746 other OPPS APC 5746 5746 other OPPS APC 5746 27.63 1587.62 percent of total billed charges 5746 5746 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "KIT ONYX 18, AVM, US" SUP-105-7100-060 CDM 0270 RC outpatient 9482.2 9482.2 9482.2 74 7016.83 percent of total billed charges 9482.2 93 7680.58 percent of total billed charges 9482.2 9482.2 other OPPS APC 9482.2 9482.2 other OPPS APC 9482.2 27.63 2619.93 percent of total billed charges 9482.2 9482.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX 18 SUP-105-7100-060 CDM 0270 RC outpatient 6500 6500 6500 74 4810 percent of total billed charges 6500 93 5265 percent of total billed charges 6500 6500 other OPPS APC 6500 6500 other OPPS APC 6500 27.63 1795.95 percent of total billed charges 6500 6500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "KIT ONYX 34, AVM, US" SUP-105-7100-080 CDM 0270 RC outpatient 9482.2 9482.2 9482.2 74 7016.83 percent of total billed charges 9482.2 93 7680.58 percent of total billed charges 9482.2 9482.2 other OPPS APC 9482.2 9482.2 other OPPS APC 9482.2 27.63 2619.93 percent of total billed charges 9482.2 9482.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE TRANSPARENT 3M STERI-DRAPE POLYETHYLENE LARGE L23 IN X W17 IN INCISE ADHESIVE FLEXIBLE FILM STERILE LATEX FREE DISPOSABLE CLEAR SUP-1050 CDM 0270 RC outpatient 6.12 6.12 6.12 74 4.53 percent of total billed charges 6.12 93 4.96 percent of total billed charges 6.12 6.12 other OPPS APC 6.12 6.12 other OPPS APC 6.12 27.63 1.69 percent of total billed charges 6.12 6.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET THROMBECTOMY ANGIOJET ULTRA AVX 15 MM TAPER L50 CM OD6 FR ODSEC3 MM PERIPHERAL OTW SHEATH CATHETER MARKER BAND FLEXIBLE LATEX FREE ACCEPTS .035 IN GUIDEWIRE SUP-105039-001 CDM 0270 RC outpatient 1625 1625 1625 74 1202.5 percent of total billed charges 1625 93 1316.25 percent of total billed charges 1625 1625 other OPPS APC 1625 1625 other OPPS APC 1625 27.63 448.99 percent of total billed charges 1625 1625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILICONE P3.2 CM MODERATE PROJECTION ROUND W11.1 CM 230 ML COHESIVE GEL SMOOTH SILIMED LOW BLEED BARRIER TECHNOLOGY SUP-10512-230MP CDM 0270 RC outpatient 1820 1820 1820 74 1346.8 percent of total billed charges 1820 93 1474.2 percent of total billed charges 1820 1820 other OPPS APC 1820 1820 other OPPS APC 1820 27.63 502.87 percent of total billed charges 1820 1820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILICONE P3.3 CM MODERATE PROJECTION ROUND W11.4 CM 250 ML COHESIVE GEL SMOOTH LOW BLEED BARRIER TECHNOLOGY SUP-10512-250MP CDM 0270 RC outpatient 1820 1820 1820 74 1346.8 percent of total billed charges 1820 93 1474.2 percent of total billed charges 1820 1820 other OPPS APC 1820 1820 other OPPS APC 1820 27.63 502.87 percent of total billed charges 1820 1820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SIENTRA SMOOTH ROUND MODERATE PROJ 300CC SUP-10512-300MP CDM 0270 RC outpatient 1820 1820 1820 74 1346.8 percent of total billed charges 1820 93 1474.2 percent of total billed charges 1820 1820 other OPPS APC 1820 1820 other OPPS APC 1820 27.63 502.87 percent of total billed charges 1820 1820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSHNERS SMALL SUP-105200 CDM 0270 RC outpatient 34.32 34.32 34.32 74 25.4 percent of total billed charges 34.32 93 27.8 percent of total billed charges 34.32 34.32 other OPPS APC 34.32 34.32 other OPPS APC 34.32 27.63 9.48 percent of total billed charges 34.32 34.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ACETABULAR RINGLOC OD22 MM HIP LOCK SUP-105422 CDM 270010025 LOCAL 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ACETABULAR RINGLOC OD24 MM HIP LOCK SUP-105424 CDM 270010024 LOCAL 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE VENTILATION TYTAN PEDIATRIC ID.76 MM SUP-1056101 CDM 0270 RC outpatient 156.52 156.52 156.52 74 115.82 percent of total billed charges 156.52 93 126.78 percent of total billed charges 156.52 156.52 other OPPS APC 156.52 156.52 other OPPS APC 156.52 27.63 43.25 percent of total billed charges 156.52 156.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL ACCOLADE C RING SMALL OD10 MM HIP CEMENT 2 3 STEM SUP-1059-2310 CDM 270010024 LOCAL 0270 RC outpatient 272.61 272.61 272.61 74 201.73 percent of total billed charges 272.61 93 220.81 percent of total billed charges 272.61 272.61 other OPPS APC 272.61 272.61 other OPPS APC 272.61 27.63 75.32 percent of total billed charges 272.61 272.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL ACCOLADE C RING SMALL OD11 MM HIP CEMENT 2 3 STEM SUP-1059-2311 CDM 270010024 LOCAL 0270 RC outpatient 272.61 272.61 272.61 74 201.73 percent of total billed charges 272.61 93 220.81 percent of total billed charges 272.61 272.61 other OPPS APC 272.61 272.61 other OPPS APC 272.61 27.63 75.32 percent of total billed charges 272.61 272.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL ACCOLADE C SMALL OD12 MM HIP RING STYLE CEMENTED 2 3 STEM SUP-1059-2312 CDM 270010024 LOCAL 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL ACCOLADE C MEDIUM OD12 MM HIP RING STYLE CEMENTED 4 5 STEM SUP-1059-4512 CDM 270010024 LOCAL 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL ACCOLADE C LARGE OD14 MM HIP RING STYLE CEMENTED 6 7 STEM SUP-1059-6714 CDM 270010024 LOCAL 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASPIRE GENERATOR SUP-106 CDM 0270 RC outpatient 68548.5 68548.5 68548.5 74 50725.9 percent of total billed charges 68548.5 93 55524.3 percent of total billed charges 68548.5 68548.5 other OPPS APC 68548.5 68548.5 other OPPS APC 68548.5 27.63 18940 percent of total billed charges 68548.5 68548.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENERATOR ASPIRESR SINGLE PIN SUP-106 CDM 270010003 LOCAL 0270 RC outpatient 57433.7 57433.7 57433.7 74 42501 percent of total billed charges 57433.7 93 46521.3 percent of total billed charges 57433.7 57433.7 other OPPS APC 57433.7 57433.7 other OPPS APC 57433.7 27.63 15868.9 percent of total billed charges 57433.7 57433.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS SURGICAL ROCHESTER-PEAN STAINLESS STEEL CURVE L6.25 IN CURVED SATIN FINISH NONSTERILE SUP-106-171 CDM 0270 RC outpatient 26.99 26.99 26.99 74 19.97 percent of total billed charges 26.99 93 21.86 percent of total billed charges 26.99 26.99 other OPPS APC 26.99 26.99 other OPPS APC 26.99 27.63 7.46 percent of total billed charges 26.99 26.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS SURGICAL CRILE JARIT STAINLESS STEEL STRAIGHT L5.5 IN STRAIGHT SATIN NONSTERILE SUP-106120 CDM 0270 RC outpatient 21.89 21.89 21.89 74 16.2 percent of total billed charges 21.89 93 17.73 percent of total billed charges 21.89 21.89 other OPPS APC 21.89 21.89 other OPPS APC 21.89 27.63 6.05 percent of total billed charges 21.89 21.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST P3.9 CM MODERATE PLUS PROJECTION ROUND W10.5 CM 235 CC HIGH STRENGTH COHESIVE SMOOTH SUP-10621-235MP CDM 0270 RC outpatient 1820 1820 1820 74 1346.8 percent of total billed charges 1820 93 1474.2 percent of total billed charges 1820 1820 other OPPS APC 1820 1820 other OPPS APC 1820 27.63 502.87 percent of total billed charges 1820 1820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL ACCOLADE UNIVERSAL OD8 MM HIP CEMENTED SUP-1067-0008 CDM 270010024 LOCAL 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL ACCOLADE UNIVERSAL OD9 MM HIP CEMENTED SUP-1067-0009 CDM 270010024 LOCAL 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL ACCOLADE UNIVERSAL OD10 MM HIP DISTAL CEMENTED SUP-1067-0010 CDM 270010024 LOCAL 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL ACCOLADE UNIVERSAL OD11 MM HIP DISTAL CEMENTED SUP-1067-0011 CDM 270010024 LOCAL 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL ACCOLADE UNIVERSAL OD12 MM HIP DISTAL CEMENTED SUP-1067-0012 CDM 270010024 LOCAL 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL ACCOLADE UNIVERSAL OD13 MM HIP DISTAL CEMENTED SUP-1067-0013 CDM 270010024 LOCAL 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL ACCOLADE UNIVERSAL OD14 MM HIP DISTAL CEMENTED SUP-1067-0014 CDM 270010024 LOCAL 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL ACCOLADE UNIVERSAL OD15 MM HIP CEMENTED SUP-1067-0015 CDM 270010024 LOCAL 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL ACCOLADE UNIVERSAL OD16 MM HIP CEMENTED SUP-1067-0016 CDM 270010024 LOCAL 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER DISTAL CEMENT 17MM SUP-1067-0017 CDM 270010024 LOCAL 0270 RC outpatient 143 143 143 74 105.82 percent of total billed charges 143 93 115.83 percent of total billed charges 143 143 other OPPS APC 143 143 other OPPS APC 143 27.63 39.51 percent of total billed charges 143 143 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL ACCOLADE UNIVERSAL OD18 MM HIP CEMENTED SUP-1067-0018 CDM 270010024 LOCAL 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL C-STEM ACCOLADE OMNIFIT UNIVERSAL OD19 MM HIP CEMENT SUP-1067-0019 CDM 270010024 LOCAL 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL C-STEM UNIVERSAL OD20 MM HIP DISTAL PRIMARY SUP-1067-0020 CDM 270010024 LOCAL 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL C-STEM ACCOLADE OMNIFIT UNIVERSAL OD21 MM HIP CEMENT SUP-1067-0021 CDM 270010024 LOCAL 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL C-STEM ACCOLADE OMNIFIT UNIVERSAL OD22 MM HIP CEMENT SUP-1067-0022 CDM 270010024 LOCAL 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CREO CREO AMP L45 MM OD4.5 MM SPINE MODULAR SUP-1067.1345 CDM 270010020 LOCAL 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CREO CREO AMP L40 MM OD5.5 MM SPINE MODULAR SUP-1067.1540 CDM 270010020 LOCAL 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CREO CREO AMP L45 MM OD5.5 MM SPINAL MODULAR NONSTERILE SUP-1067.1545 CDM 270010020 LOCAL 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CREO CREO AMP L55 MM OD5.5 MM SPINE MODULAR SUP-1067.1555 CDM 270010020 LOCAL 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CREO CREO AMP L45 MM OD6.5 MM SPINE MODULAR NONSTERILE SUP-1067.1645 CDM 270010020 LOCAL 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING RIST L100 CM STERILE LATEX FREE SUP-106F-071-100 CDM 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING RIST L105 CM STERILE LATEX FREE SUP-106F-071-105 CDM 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING RIST L95 CM STERILE LATEX FREE SUP-106F-071-95 CDM 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIAPX SUP-1070512 CDM 27000000 LOCAL 0270 RC outpatient 33.79 33.79 33.79 74 25 percent of total billed charges 33.79 93 27.37 percent of total billed charges 33.79 33.79 other OPPS APC 33.79 33.79 other OPPS APC 33.79 27.63 9.34 percent of total billed charges 33.79 33.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VISTACAL SUP-1071860 CDM 0270 RC outpatient 149.99 149.99 149.99 74 110.99 percent of total billed charges 149.99 93 121.49 percent of total billed charges 149.99 149.99 other OPPS APC 149.99 149.99 other OPPS APC 149.99 27.63 41.44 percent of total billed charges 149.99 149.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER KUMPE 5FR 65CM SUP-10732701 CDM 0270 RC outpatient 85.8 85.8 85.8 74 63.49 percent of total billed charges 85.8 93 69.5 percent of total billed charges 85.8 85.8 other OPPS APC 85.8 85.8 other OPPS APC 85.8 27.63 23.71 percent of total billed charges 85.8 85.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.25X8 SUP-1074225-08 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.25X12 SUP-1074225-12 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.25X15 SUP-1074225-15 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.25X18 SUP-1074225-18 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.25X23 SUP-1074225-23 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.25X28 SUP-1074225-28 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.5X8 SUP-1074250-08 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.5X12 SUP-1074250-12 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.5X15 SUP-1074250-15 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.5X18 SUP-1074250-18 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.5X23 SUP-1074250-23 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.5X28 SUP-1074250-28 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.5X33 SUP-1074250-33 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.5X38 SUP-1074250-38 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.75X8 SUP-1074275-08 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.75X12 SUP-1074275-12 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.75X15 SUP-1074275-15 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.75X18 SUP-1074275-18 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.75X23 SUP-1074275-23 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.75X28 SUP-1074275-28 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.75X33 SUP-1074275-33 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 2.75X38 SUP-1074275-38 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.0X8 SUP-1074300-08 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.0X12 SUP-1074300-12 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.0X15 SUP-1074300-15 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.0X18 SUP-1074300-18 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.0X23 SUP-1074300-23 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.0X28 SUP-1074300-28 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.0X33 SUP-1074300-33 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.0X38 SUP-1074300-38 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.25 X 8 SUP-1074325-08 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.25X12 SUP-1074325-12 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.25X15 SUP-1074325-15 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.25X18 SUP-1074325-18 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.25X23 SUP-1074325-23 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.25X28 SUP-1074325-28 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.25X33 SUP-1074325-33 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.25X38 SUP-1074325-38 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.5X8 SUP-1074350-08 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.5X12 SUP-1074350-12 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.5X15 SUP-1074350-15 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.5X18 SUP-1074350-18 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.5X23 SUP-1074350-23 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.5X28 SUP-1074350-28 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.5X33 SUP-1074350-33 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 3.5X38 SUP-1074350-38 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 4.0X8 SUP-1074400-08 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 4.0X12 SUP-1074400-12 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 4.0X15 SUP-1074400-15 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 4.0X18 SUP-1074400-18 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 4.0X23 SUP-1074400-23 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 4.0X28 SUP-1074400-28 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 4.0X33 SUP-1074400-33 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XIENCE 4.0X38 SUP-1074400-38 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUICK STAT FS GEL SUP-1076407 CDM 0270 RC outpatient 8.32 8.32 8.32 74 6.16 percent of total billed charges 8.32 93 6.74 percent of total billed charges 8.32 8.32 other OPPS APC 8.32 8.32 other OPPS APC 8.32 27.63 2.3 percent of total billed charges 8.32 8.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROBRUSH PLUS REFILL FINE YELLOW SUP-1077764 CDM 0270 RC outpatient 0.21 0.21 0.21 74 0.16 percent of total billed charges 0.21 93 0.17 percent of total billed charges 0.21 0.21 other OPPS APC 0.21 0.21 other OPPS APC 0.21 27.63 0.06 percent of total billed charges 0.21 0.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER LONG L100 CM OD.079 IN ODSEC10.7 FR RADIAL SUP-107F-079-100 CDM 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER LONG L95 CM OD.079 IN ODSEC10.7 FR RADIAL SUP-107F-079-95 CDM 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOPPLER PROBE VTI STERILE 8MHZ SUP-108370 CDM 0270 RC outpatient 579.48 579.48 579.48 74 428.82 percent of total billed charges 579.48 93 469.38 percent of total billed charges 579.48 579.48 other OPPS APC 579.48 579.48 other OPPS APC 579.48 27.63 160.11 percent of total billed charges 579.48 579.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT MONOCANA LICULAR SUP-1085 CDM 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FETCH2 ASPIRATION CATHETER 6F SUP-109400-001 CDM 0270 RC outpatient 975 975 975 74 721.5 percent of total billed charges 975 93 789.75 percent of total billed charges 975 975 other OPPS APC 975 975 other OPPS APC 975 27.63 269.39 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM THROMBECTOMY ANGIOJET ULTRA SOLENT PROXI PERIPHERAL CATHETER WASTE BAG PUMP SET SCALABLE SUP-109676-001 CDM 0270 RC outpatient 6435 6435 6435 74 4761.9 percent of total billed charges 6435 93 5212.35 percent of total billed charges 6435 6435 other OPPS APC 6435 6435 other OPPS APC 6435 27.63 1777.99 percent of total billed charges 6435 6435 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM THROMBECTOMY ANGIOJET ULTRA SOLENT OMNI PERIPHERAL CATHETER WASTE BAG PUMP SET SCALABLE SUP-109681-001 CDM 0270 RC outpatient 6435 6435 6435 74 4761.9 percent of total billed charges 6435 93 5212.35 percent of total billed charges 6435 6435 other OPPS APC 6435 6435 other OPPS APC 6435 27.63 1777.99 percent of total billed charges 6435 6435 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MIDAS REX LEGEND L10 CM OD6 MM ACORN STERILE BURR SUP-10AC60 CDM 270010028 LOCAL 0270 RC outpatient 463.71 463.71 463.71 74 343.15 percent of total billed charges 463.71 93 375.61 percent of total billed charges 463.71 463.71 other OPPS APC 463.71 463.71 other OPPS APC 463.71 27.63 128.12 percent of total billed charges 463.71 463.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MIDAS REX LEGEND BALL FLUTE L10 CM OD2 MM BURR SUP-10BA20 CDM 270010028 LOCAL 0270 RC outpatient 441.09 441.09 441.09 74 326.41 percent of total billed charges 441.09 93 357.28 percent of total billed charges 441.09 441.09 other OPPS APC 441.09 441.09 other OPPS APC 441.09 27.63 121.87 percent of total billed charges 441.09 441.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MIDAS REX LEGEND BALL FLUTE L10 CM OD3 MM BURR SUP-10BA30 CDM 270010028 LOCAL 0270 RC outpatient 441.09 441.09 441.09 74 326.41 percent of total billed charges 441.09 93 357.28 percent of total billed charges 441.09 441.09 other OPPS APC 441.09 441.09 other OPPS APC 441.09 27.63 121.87 percent of total billed charges 441.09 441.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MIDAS REX LEGEND BALL DIAMOND 10CM 3MM STERILE BURR SUP-10BA30D CDM 270010028 LOCAL 0270 RC outpatient 468.23 468.23 468.23 74 346.49 percent of total billed charges 468.23 93 379.27 percent of total billed charges 468.23 468.23 other OPPS APC 468.23 468.23 other OPPS APC 468.23 27.63 129.37 percent of total billed charges 468.23 468.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MIDAS REX LEGEND BALL DIAMOND 10CM 4MM STERILE BURR SUP-10BA40D CDM 270010028 LOCAL 0270 RC outpatient 497.64 497.64 497.64 74 368.25 percent of total billed charges 497.64 93 403.09 percent of total billed charges 497.64 497.64 other OPPS APC 497.64 497.64 other OPPS APC 497.64 27.63 137.5 percent of total billed charges 497.64 497.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MIDAS REX LEGEND BALL FLUTE L10 CM OD5 MM BURR SUP-10BA50 CDM 270010028 LOCAL 0270 RC outpatient 472.76 472.76 472.76 74 349.84 percent of total billed charges 472.76 93 382.94 percent of total billed charges 472.76 472.76 other OPPS APC 472.76 472.76 other OPPS APC 472.76 27.63 130.62 percent of total billed charges 472.76 472.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MIDAS REX LEGEND BALL DIAMOND 10CM 5MM STERILE BURR SUP-10BA50D CDM 270010028 LOCAL 0270 RC outpatient 481.81 481.81 481.81 74 356.54 percent of total billed charges 481.81 93 390.27 percent of total billed charges 481.81 481.81 other OPPS APC 481.81 481.81 other OPPS APC 481.81 27.63 133.12 percent of total billed charges 481.81 481.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP DRINKING STYROFOAM 10 OZ HOT COLD INSULATED DISPOSABLE WHITE SUP-10C8W CDM 0270 RC outpatient 0.14 0.14 0.14 74 0.1 percent of total billed charges 0.14 93 0.11 percent of total billed charges 0.14 0.14 other OPPS APC 0.14 0.14 other OPPS APC 0.14 27.63 0.04 percent of total billed charges 0.14 0.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MIDAS REX LEGEND CYLINDER L10 CM OD4 MM STERILE BURR SUP-10CY40 CDM 0270 RC outpatient 454.66 454.66 454.66 74 336.45 percent of total billed charges 454.66 93 368.27 percent of total billed charges 454.66 454.66 other OPPS APC 454.66 454.66 other OPPS APC 454.66 27.63 125.62 percent of total billed charges 454.66 454.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL 10CY50 LEGEND 10CM 5MM SUP-10CY50_64116 CDM 0270 RC outpatient 454.66 454.66 454.66 74 336.45 percent of total billed charges 454.66 93 368.27 percent of total billed charges 454.66 454.66 other OPPS APC 454.66 454.66 other OPPS APC 454.66 27.63 125.62 percent of total billed charges 454.66 454.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MIDAS REX LEGEND OVAL L10 CM OD4 MM STERILE BURR SUP-10OV40 CDM 270010028 LOCAL 0270 RC outpatient 475.02 475.02 475.02 74 351.51 percent of total billed charges 475.02 93 384.77 percent of total billed charges 475.02 475.02 other OPPS APC 475.02 475.02 other OPPS APC 475.02 27.63 131.25 percent of total billed charges 475.02 475.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND EXCEL 2-0 SH L30 IN 2 ARM BRAIDED 10 STRAND GREEN WHITE SUP-10X82N CDM outpatient 41.76 41.76 41.76 41.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEAVER T-TUBE 10 FR SUP-11-00002 CDM C1729 HCPCS 0272 RC outpatient 27.37 27.37 27.37 74 20.25 percent of total billed charges 27.37 93 22.17 percent of total billed charges 27.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.37 other OPPS APC 27.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.37 other OPPS APC 27.37 27.63 7.56 percent of total billed charges 27.37 27.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEAVER T-TUBE 12 FR SUP-11-00003 CDM C1729 HCPCS 0272 RC outpatient 27.45 27.45 27.45 74 20.31 percent of total billed charges 27.45 93 22.23 percent of total billed charges 27.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.45 other OPPS APC 27.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.45 other OPPS APC 27.45 27.63 7.58 percent of total billed charges 27.45 27.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEAVER T-TUBE 14 FR SUP-11-00004 CDM C1729 HCPCS 0272 RC outpatient 29.98 29.98 29.98 74 22.19 percent of total billed charges 29.98 93 24.28 percent of total billed charges 29.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.98 other OPPS APC 29.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.98 other OPPS APC 29.98 27.63 8.28 percent of total billed charges 29.98 29.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEAVER T-TUBE 16 FR SUP-11-00005 CDM C1729 HCPCS 0278 RC outpatient 49.39 49.39 49.39 57 28.15 percent of total billed charges 49.39 93 40.01 percent of total billed charges 49.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 49.39 other OPPS APC 49.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 49.39 other OPPS APC 49.39 51 25.19 percent of total billed charges 49.39 49.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEAVER T-TUBE 18 FR SUP-11-00006 CDM C1729 HCPCS 0278 RC outpatient 49.39 49.39 49.39 57 28.15 percent of total billed charges 49.39 93 40.01 percent of total billed charges 49.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 49.39 other OPPS APC 49.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 49.39 other OPPS APC 49.39 51 25.19 percent of total billed charges 49.39 49.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THORACIC 10FR W/2 EYES SUP-11-00007 CDM C1729 HCPCS 0272 RC outpatient 26.94 26.94 26.94 74 19.94 percent of total billed charges 26.94 93 21.82 percent of total billed charges 26.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 26.94 other OPPS APC 26.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 26.94 other OPPS APC 26.94 27.63 7.44 percent of total billed charges 26.94 26.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THORACIC 8FR W/2 EYES SUP-11-00008 CDM C1729 HCPCS 0272 RC outpatient 26.94 26.94 26.94 74 19.94 percent of total billed charges 26.94 93 21.82 percent of total billed charges 26.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 26.94 other OPPS APC 26.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 26.94 other OPPS APC 26.94 27.63 7.44 percent of total billed charges 26.94 26.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEAVER T-TUBE 22FR SUP-11-00009 CDM C1729 HCPCS 0272 RC outpatient 49.39 49.39 49.39 74 36.55 percent of total billed charges 49.39 93 40.01 percent of total billed charges 49.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 49.39 other OPPS APC 49.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 49.39 other OPPS APC 49.39 27.63 13.65 percent of total billed charges 49.39 49.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN PENROSE 12 SUP-11-00010 CDM 0272 RC outpatient 0.97 0.97 0.97 74 0.72 percent of total billed charges 0.97 93 0.79 percent of total billed charges 0.97 0.97 other OPPS APC 0.97 0.97 other OPPS APC 0.97 27.63 0.27 percent of total billed charges 0.97 0.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TEMP PROBE ESOPHAGEAL/RECTAL 9FR SUP-11-00013 CDM 0272 RC outpatient 2.11 2.11 2.11 74 1.56 percent of total billed charges 2.11 93 1.71 percent of total billed charges 2.11 2.11 other OPPS APC 2.11 2.11 other OPPS APC 2.11 27.63 0.58 percent of total billed charges 2.11 2.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE EAR-ULCER SUP-11-00014 CDM 0272 RC outpatient 1.31 1.31 1.31 74 0.97 percent of total billed charges 1.31 93 1.06 percent of total billed charges 1.31 1.31 other OPPS APC 1.31 1.31 other OPPS APC 1.31 27.63 0.36 percent of total billed charges 1.31 1.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMOVAC INF CONT EVAC 1/4 PVC SUP-11-00016 CDM 0272 RC outpatient 85.28 85.28 85.28 74 63.11 percent of total billed charges 85.28 93 69.08 percent of total billed charges 85.28 85.28 other OPPS APC 85.28 85.28 other OPPS APC 85.28 27.63 23.56 percent of total billed charges 85.28 85.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM DRAINAGE PLEUR-EVAC 2500 CC COLLECTION CHAMBER SELF SEAL SAMPLE PORT CONNECTOR STERILE LATEX FREE DISPOSABLE A-6000 CACTUS SUP-11-00024 CDM 0272 RC outpatient 162.95 162.95 162.95 74 120.58 percent of total billed charges 162.95 93 131.99 percent of total billed charges 162.95 162.95 other OPPS APC 162.95 162.95 other OPPS APC 162.95 27.63 45.02 percent of total billed charges 162.95 162.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING FRAZIER SUCTION 10 FR SUP-11-00026 CDM 0272 RC outpatient 1.56 1.56 1.56 74 1.15 percent of total billed charges 1.56 93 1.26 percent of total billed charges 1.56 1.56 other OPPS APC 1.56 1.56 other OPPS APC 1.56 27.63 0.43 percent of total billed charges 1.56 1.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUCTION YANKAUER W/TUBING K83A SUP-11-00029 CDM 0272 RC outpatient 1.1 1.1 1.1 74 0.81 percent of total billed charges 1.1 93 0.89 percent of total billed charges 1.1 1.1 other OPPS APC 1.1 1.1 other OPPS APC 1.1 27.63 0.3 percent of total billed charges 1.1 1.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "EVAC KIT 400CC 3-SPRG 1/8"" MDPERF TROCAR" SUP-11-00035 CDM 0272 RC outpatient 32.04 32.04 32.04 74 23.71 percent of total billed charges 32.04 93 25.95 percent of total billed charges 32.04 32.04 other OPPS APC 32.04 32.04 other OPPS APC 32.04 27.63 8.85 percent of total billed charges 32.04 32.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CHEST DRAIN EXPRESS MINI SUP-11-00036 CDM 0272 RC outpatient 318.38 318.38 318.38 74 235.6 percent of total billed charges 318.38 93 257.89 percent of total billed charges 318.38 318.38 other OPPS APC 318.38 318.38 other OPPS APC 318.38 27.63 87.97 percent of total billed charges 318.38 318.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRACE ORTHOPEDIC TELESCOPING TROM UNIVERSAL STANDARD KNEE FLEXION EXTENSION STOP QUICK RELEASE BUCKLE LOCK MECHANISM BLACK SUP-11-0961-9-06000 CDM 0270 RC outpatient 309.58 309.58 309.58 74 229.09 percent of total billed charges 309.58 93 250.76 percent of total billed charges 309.58 309.58 other OPPS APC 309.58 309.58 other OPPS APC 309.58 27.63 85.54 percent of total billed charges 309.58 309.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRACE ORTHOPEDIC TELESCOPING TROM FOAM XL UNIVERSAL KNEE ENHANCE LOCK MECHANISM FLEXION EXTENSION STOP QUICK RELEASE BUCKLE BLACK SUP-11-0964-9-06000 CDM 0270 RC outpatient 309.35 309.35 309.35 74 228.92 percent of total billed charges 309.35 93 250.57 percent of total billed charges 309.35 309.35 other OPPS APC 309.35 309.35 other OPPS APC 309.35 27.63 85.47 percent of total billed charges 309.35 309.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOOT SUTURE STERILE LATEX FREE DISPOSABLE YELLOW SUP-11-1005 CDM outpatient 13.52 13.52 13.52 13.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY FLOWTRIEVER 2 MEDIUM L 120 CM OD 12 FR STERILE LATEX FREE SUP-11-102 CDM 0270 RC outpatient 0.03 0.03 0.03 74 0.02 percent of total billed charges 0.03 93 0.02 percent of total billed charges 0.03 0.03 other OPPS APC 0.03 0.03 other OPPS APC 0.03 27.63 0.01 percent of total billed charges 0.03 0.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL G7 FREEDOM COCR +6 MM OFFSET OD36 MM HIP TYPE 1 MODULAR SUP-11-107020 CDM 270010024 LOCAL 0270 RC outpatient 3475.68 3475.68 3475.68 74 2572 percent of total billed charges 3475.68 93 2815.3 percent of total billed charges 3475.68 3475.68 other OPPS APC 3475.68 3475.68 other OPPS APC 3475.68 27.63 960.33 percent of total billed charges 3475.68 3475.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR FREEDOM ARCOM 24 +5 MM STANDARD FACE ID36 MM HIP CONSTRAIN SUP-11-107023 CDM 270010024 LOCAL 0270 RC outpatient 5676.84 5676.84 5676.84 74 4200.86 percent of total billed charges 5676.84 93 4598.24 percent of total billed charges 5676.84 5676.84 other OPPS APC 5676.84 5676.84 other OPPS APC 5676.84 27.63 1568.51 percent of total billed charges 5676.84 5676.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINEWAVE STAXX 25X9X7 SUP-11-1525 CDM 270010020 LOCAL 0270 RC outpatient 12480 12480 12480 74 9235.2 percent of total billed charges 12480 93 10108.8 percent of total billed charges 12480 12480 other OPPS APC 12480 12480 other OPPS APC 12480 27.63 3448.22 percent of total billed charges 12480 12480 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINEWAVE STAXX 25X9X7 SUP-11-1551 CDM 270010020 LOCAL 0270 RC outpatient 12480 12480 12480 74 9235.2 percent of total billed charges 12480 93 10108.8 percent of total billed charges 12480 12480 other OPPS APC 12480 12480 other OPPS APC 12480 27.63 3448.22 percent of total billed charges 12480 12480 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SPARTAN LOCKING SCREW SUP-11-3000 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SPARTAN ROD 5.5MM SUP-11-3040 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL G7 COCR +3 MM OFFSET OD36 MM HIP TYPE 1 SUP-11-363663 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL G7 COCR +12 MM OFFSET OD36 MM HIP TYPE 1 SKIRT SUP-11-363666 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL COMPREHENSIVE STANDARD 122MM 7MM POROUS SHOULDER REVERSE SYSTEM SUP-11-3647 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL COMPREHENSIVE STANDARD 122MM 12MM POROUS SHOULDER REVERSE SYSTEM SUP-11-3652 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL COMPREHENSIVE STANDARD 122MM 17MM POROUS SHOULDER REVERSE SYSTEM SUP-11-3657 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINEWAVE 60MM SUP-11-4060 CDM 270010020 LOCAL 0270 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINEWAVE 80MM SUP-11-4080 CDM 270010020 LOCAL 0270 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SPINEWAVE 6.5MM X 50 MM SUP-11-4650 CDM 270010020 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRACE ORTHOPEDIC REGULAR FOAM KNEE STREAMLINED HINGE TELE-FIT: SLIDING MECHANISM POSTOPERATIVE BREATHABLE TROM ADVANCE SUP-11-9114-9 CDM 0270 RC outpatient 242.84 242.84 242.84 74 179.7 percent of total billed charges 242.84 93 196.7 percent of total billed charges 242.84 242.84 other OPPS APC 242.84 242.84 other OPPS APC 242.84 27.63 67.1 percent of total billed charges 242.84 242.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRACE ORTHOPEDIC XL 6IN ABOVE MID-PATELLA 26INL FOAM KNEE PADDED STRAPS STREAMLINED HINGE TELESCOPING BARS SNAP BUCKLE STRAPS SUP-11-9116-9 CDM 0270 RC outpatient 261.66 261.66 261.66 74 193.63 percent of total billed charges 261.66 93 211.94 percent of total billed charges 261.66 261.66 other OPPS APC 261.66 261.66 other OPPS APC 261.66 27.63 72.3 percent of total billed charges 261.66 261.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIAL TIBIAL SIZE 4 STANDARD 10-14MM THK POSTERIOR STABILIZED FIXED BEARING GMK PRIMARY SUP-11.00024 CDM 270010025 LOCAL 0270 RC outpatient 143 143 143 143 other OPPS APC 143 143 other OPPS APC 143 27.63 39.51 percent of total billed charges 143 143 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET INSTRUMENT ORTHOPEDIC EXTENSION GMK SUP-11.00102 CDM 270010025 LOCAL 0270 RC outpatient 143 143 143 143 other OPPS APC 143 143 other OPPS APC 143 27.63 39.51 percent of total billed charges 143 143 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KA FEMORAL S5+ INSTRUMENT SET SUP-11.01075 CDM 270010025 LOCAL 0270 RC outpatient 143 143 143 74 105.82 percent of total billed charges 143 93 115.83 percent of total billed charges 143 143 other OPPS APC 143 143 other OPPS APC 143 27.63 39.51 percent of total billed charges 143 143 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE BIOCELL SILICONE P2.8 CM MODERATE PROFILE ROUND OD11.1 CM 210 ML STYLE 110 TEXTURED STERILE SUP-110-210 CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "20MM, BLUNT BLADE & TUBESET" SUP-110-31-1120 CDM 0270 RC outpatient 1356.35 1356.35 1356.35 74 1003.7 percent of total billed charges 1356.35 93 1098.64 percent of total billed charges 1356.35 1356.35 other OPPS APC 1356.35 1356.35 other OPPS APC 1356.35 27.63 374.76 percent of total billed charges 1356.35 1356.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MACRO HOOK SHAVER & TUBESET SUP-110-31-1220 CDM 0270 RC outpatient 1452.27 1452.27 1452.27 74 1074.68 percent of total billed charges 1452.27 93 1176.34 percent of total billed charges 1452.27 1452.27 other OPPS APC 1452.27 1452.27 other OPPS APC 1452.27 27.63 401.26 percent of total billed charges 1452.27 1452.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STYLE 110 MODERATE PROFILE TEXTURED 420CC SUP-110-420 CDM 270010032 LOCAL 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PRESSURE MONITOR CAMINO 4FR STERILE INTRACRANIAL TRANSDUCER TIP CATHETER DRILL BIT BOLT ACCESS DEVICE SUP-110-4B CDM 0270 RC outpatient 1599.47 1599.47 1599.47 74 1183.61 percent of total billed charges 1599.47 93 1295.57 percent of total billed charges 1599.47 1599.47 other OPPS APC 1599.47 1599.47 other OPPS APC 1599.47 27.63 441.93 percent of total billed charges 1599.47 1599.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PRESSURE MONITOR CAMINO MICRO 4FR 12FR STERILE INTRACRANIAL VENTRICULAR TRANSDUCER TIP CATHETER BOLT TWIST DRILL SUP-110-4HM CDM 0270 RC outpatient 1678.07 1678.07 1678.07 74 1241.77 percent of total billed charges 1678.07 93 1359.24 percent of total billed charges 1678.07 1678.07 other OPPS APC 1678.07 1678.07 other OPPS APC 1678.07 27.63 463.65 percent of total billed charges 1678.07 1678.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE RADIOPAQUE GLOW N TELL VASCUTAPE L30 CM CENTIMETER MARKINGS 20 STRIPS NONSTERILE LATEX FREE SUP-1100-20 CDM 0270 RC outpatient 155.87 155.87 155.87 74 115.34 percent of total billed charges 155.87 93 126.25 percent of total billed charges 155.87 155.87 other OPPS APC 155.87 155.87 other OPPS APC 155.87 27.63 43.07 percent of total billed charges 155.87 155.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL COMPREHENSIVE SHORT OD2.7 MM STERILE VRS SUP-110028045 CDM 270010030 LOCAL 0270 RC outpatient 104 104 104 74 76.96 percent of total billed charges 104 93 84.24 percent of total billed charges 104 104 other OPPS APC 104 104 other OPPS APC 104 27.63 28.74 percent of total billed charges 104 104 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER THREADED CARTRIDGE SUP-110030122 CDM 0270 RC outpatient 57.2 57.2 57.2 74 42.33 percent of total billed charges 57.2 93 46.33 percent of total billed charges 57.2 57.2 other OPPS APC 57.2 57.2 other OPPS APC 57.2 27.63 15.8 percent of total billed charges 57.2 57.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER CARTRIDE THREAD SUP-110030166 CDM 0270 RC outpatient 28.6 28.6 28.6 74 21.16 percent of total billed charges 28.6 93 23.17 percent of total billed charges 28.6 28.6 other OPPS APC 28.6 28.6 other OPPS APC 28.6 27.63 7.9 percent of total billed charges 28.6 28.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY HUMERAL COMPREHENSIVE +3 MM STANDARD SHOULDER REVERSE SUP-110031402 CDM 270010030 LOCAL 0270 RC outpatient 3874 3874 3874 74 2866.76 percent of total billed charges 3874 93 3137.94 percent of total billed charges 3874 3874 other OPPS APC 3874 3874 other OPPS APC 3874 27.63 1070.39 percent of total billed charges 3874 3874 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY HUMERAL COMPREHENSIVE +6 MM +5 MM SHOULDER REVERSE SUP-110031406 CDM 270010025 LOCAL 0270 RC outpatient 3874 3874 3874 74 2866.76 percent of total billed charges 3874 93 3137.94 percent of total billed charges 3874 3874 other OPPS APC 3874 3874 other OPPS APC 3874 27.63 1070.39 percent of total billed charges 3874 3874 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEARING HUMERAL COMPREHENSIVE VIVACIT-E STANDARD OD36 MM SHOULDER REVERSE SUP-110031424 CDM 270010030 LOCAL 0270 RC outpatient 3432 3432 3432 74 2539.68 percent of total billed charges 3432 93 2779.92 percent of total billed charges 3432 3432 other OPPS APC 3432 3432 other OPPS APC 3432 27.63 948.26 percent of total billed charges 3432 3432 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEARING HUMERAL COMPREHENSIVE VIVACIT-E +3 MM OD36 MM SHOULDER REVERSE SUP-110031425 CDM 270010030 LOCAL 0270 RC outpatient 3432 3432 3432 74 2539.68 percent of total billed charges 3432 93 2779.92 percent of total billed charges 3432 3432 other OPPS APC 3432 3432 other OPPS APC 3432 27.63 948.26 percent of total billed charges 3432 3432 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONDUIT VALVE KONECT RESILIA OD21 MM AORTIC SUP-11060A21 CDM 0270 RC outpatient 41600 41600 41600 74 30784 percent of total billed charges 41600 93 33696 percent of total billed charges 41600 41600 other OPPS APC 41600 41600 other OPPS APC 41600 27.63 11494.1 percent of total billed charges 41600 41600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC KONECT RESILIA 23 MM AORTIC VALVED CONDUIT STERILE PREASSEMBLED BENTALL PROC SUP-11060A23 CDM 0270 RC outpatient 41600 41600 41600 74 30784 percent of total billed charges 41600 93 33696 percent of total billed charges 41600 41600 other OPPS APC 41600 41600 other OPPS APC 41600 27.63 11494.1 percent of total billed charges 41600 41600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONDUIT VALVE KONECT RESILIA OD25 MM AORTIC SUP-11060A25 CDM 0270 RC outpatient 41600 41600 41600 74 30784 percent of total billed charges 41600 93 33696 percent of total billed charges 41600 41600 other OPPS APC 41600 41600 other OPPS APC 41600 27.63 11494.1 percent of total billed charges 41600 41600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC KONECT RESILIA 27 MM AORTIC VALVED CONDUIT STERILE PREASSEMBLED BENTALL PROC SUP-11060A27 CDM 0270 RC outpatient 41600 41600 41600 74 30784 percent of total billed charges 41600 93 33696 percent of total billed charges 41600 41600 other OPPS APC 41600 41600 other OPPS APC 41600 27.63 11494.1 percent of total billed charges 41600 41600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONDUIT VALVE KONECT RESILIA OD29 MM AORTIC SUP-11060A29 CDM 0270 RC outpatient 41600 41600 41600 74 30784 percent of total billed charges 41600 93 33696 percent of total billed charges 41600 41600 other OPPS APC 41600 41600 other OPPS APC 41600 27.63 11494.1 percent of total billed charges 41600 41600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ARTERIAL LINE SWAN-GANZ HEPARIN POLYMER L110 CM OD5 FR PULMONARY 2 LUMEN SUP-110F5 CDM 0270 RC outpatient 289.22 289.22 289.22 74 214.02 percent of total billed charges 289.22 93 234.27 percent of total billed charges 289.22 289.22 other OPPS APC 289.22 289.22 other OPPS APC 289.22 27.63 79.91 percent of total billed charges 289.22 289.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION SURPASS STREAMLINE L20MM OD 4MM SUP-110USPH CDM 0270 RC outpatient 38610 38610 38610 74 28571.4 percent of total billed charges 38610 93 31274.1 percent of total billed charges 38610 38610 other OPPS APC 38610 38610 other OPPS APC 38610 27.63 10667.9 percent of total billed charges 38610 38610 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN INCISION AXIOM SILICONE OD9 MM MEDIASTINAL EYE ON TOP NONSTERILE SUP-111099 CDM 270009144 LOCAL 0270 RC outpatient 14.3 14.3 14.3 74 10.58 percent of total billed charges 14.3 93 11.58 percent of total billed charges 14.3 14.3 other OPPS APC 14.3 14.3 other OPPS APC 14.3 27.63 3.95 percent of total billed charges 14.3 14.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE SILICONE L12 IN ABDOMEN UNI SUMP SMALL EYE SUP-111177 CDM outpatient 569.4 569.4 569.4 569.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SILICONE SALEM SUMP SUP-111198 CDM 0270 RC outpatient 491.4 491.4 491.4 74 363.64 percent of total billed charges 491.4 93 398.03 percent of total billed charges 491.4 491.4 other OPPS APC 491.4 491.4 other OPPS APC 491.4 27.63 135.77 percent of total billed charges 491.4 491.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER INTERNAL CLIP ENDO CLIP TITANIUM 19 MEDIUM LARGE L10 MM CARTRIDGE STERILE LATEX FREE DISPOSABLE K2 SUP-1112 CDM 0270 RC outpatient 150.2 150.2 150.2 74 111.15 percent of total billed charges 150.2 93 121.66 percent of total billed charges 150.2 150.2 other OPPS APC 150.2 150.2 other OPPS APC 150.2 27.63 41.5 percent of total billed charges 150.2 150.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE QWIX TITANIUM L30 MM OD3 MM INTRAOSSEOUS FIXATION SELF DRILLING SELF TAPPING KIRSCHNER GUIDEWIRE NONSTERILE SUP-111330 CDM 0270 RC outpatient 1081.6 1081.6 1081.6 74 800.38 percent of total billed charges 1081.6 93 876.1 percent of total billed charges 1081.6 1081.6 other OPPS APC 1081.6 1081.6 other OPPS APC 1081.6 27.63 298.85 percent of total billed charges 1081.6 1081.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE COMPRESSION FEMOSTOP PNEUMATIC DOME INTEGRATE DIGITAL MANOMETER ADJUSTABLE BELT HEMOSTATIC DRESSING STOPCOCK GOLD SUP-11165 CDM 270009231 LOCAL 0270 RC outpatient 89.4 89.4 89.4 74 66.16 percent of total billed charges 89.4 93 72.41 percent of total billed charges 89.4 89.4 other OPPS APC 89.4 89.4 other OPPS APC 89.4 27.63 24.7 percent of total billed charges 89.4 89.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP LOCKING CREO 5.5MM NS SPINAL SUP-1119.0000 CDM 270010020 LOCAL 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP LOCKING CREO NS SPINAL THREAD SUP-1119.0010 CDM 270010020 LOCAL 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR ROD CREO L38-50 MM OD5.5 MM SPINE CROSS NONSTERILE SUP-1119.0039 CDM 270010020 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROSS CONNECTOR GLOBUS 48-60MM SUP-1119.0046 CDM 270010020 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CREO CREO AMP OD5.5 MM SPINE POLYAXIAL TULIP THREAD SUP-1119.0110 CDM 270010020 LOCAL 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR ROD CREO L30.5-43 MM OD5.5 MM SPINE CROSS LOW PROFILE SUP-1119.0230 CDM 270010020 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CREO TITANIUM STRAIGHT L85 MM OD5.5MM SUP-1119.5085 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CREO TITANIUM CURVE L35 MM OD5.5 MM SUP-1119.7035 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CREO TITANIUM CURVE L40 MM OD5.5 MM SUP-1119.7040 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CREO TITANIUM CURVE L45 MM OD5.5 MM SUP-1119.7045 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CREO TITANIUM CURVE L50 MM OD5.5 MM SUP-1119.7050 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CREO TITANIUM CURVE L55 MM OD5.5 MM SUP-1119.7055 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CREO TITANIUM CURVE L60 MM OD5.5 MM NONSTERILE SUP-1119.7060 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CREO TITANIUM CURVE L70 MM OD5.5 MM SUP-1119.7070 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PULMONARY ARTERY SWAN-GANZ 110CM 7FR DISPOSABLE STERILE PULMONARY 2 LUMEN MONITOR SUP-111F7P CDM 0270 RC outpatient 289.22 289.22 289.22 74 214.02 percent of total billed charges 289.22 93 234.27 percent of total billed charges 289.22 289.22 other OPPS APC 289.22 289.22 other OPPS APC 289.22 27.63 79.91 percent of total billed charges 289.22 289.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION SURPASS STREAMLINE L25MM OD 4MM SUP-111USPH CDM 0270 RC outpatient 38610 38610 38610 74 28571.4 percent of total billed charges 38610 93 31274.1 percent of total billed charges 38610 38610 other OPPS APC 38610 38610 other OPPS APC 38610 27.63 10667.9 percent of total billed charges 38610 38610 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SUP-112-5129 CDM 27000000 LOCAL 0270 RC outpatient 21.57 21.57 21.57 74 15.96 percent of total billed charges 21.57 93 17.47 percent of total billed charges 21.57 21.57 other OPPS APC 21.57 21.57 other OPPS APC 21.57 27.63 5.96 percent of total billed charges 21.57 21.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT FUSION BONE GRAFT SUBSTITUTE SUP-112-SLF CDM 0270 RC outpatient 7267 7267 7267 74 5377.58 percent of total billed charges 7267 93 5886.27 percent of total billed charges 7267 7267 other OPPS APC 7267 7267 other OPPS APC 7267 27.63 2007.87 percent of total billed charges 7267 7267 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL TUNNELING SPINAL CORD STIM SUP-1120 CDM 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARRIER SKIN NEW IMAGE CERAPLUS CERAMIDE FLAT OD 2 3/4 IN ODSEC 2 1/4 IN 2 PIECE CUT TO FIT INTEGRADE FLOAT FLANGE TAPE BORDER LATEX FREE BLUE SUP-11204 CDM 0270 RC outpatient 1.17 1.17 1.17 74 0.87 percent of total billed charges 1.17 93 0.95 percent of total billed charges 1.17 1.17 other OPPS APC 1.17 1.17 other OPPS APC 1.17 27.63 0.32 percent of total billed charges 1.17 1.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL MAJOR ABDOMINAL PENINSULA REGIONAL MEDICAL CENTER DR IM SUP-112158-005 CDM 0270 RC outpatient 335.08 335.08 335.08 74 247.96 percent of total billed charges 335.08 93 271.41 percent of total billed charges 335.08 335.08 other OPPS APC 335.08 335.08 other OPPS APC 335.08 27.63 92.58 percent of total billed charges 335.08 335.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL ELSA 6 D D20 MM W50 MM X H8-15 MM SUP-1122.0150 CDM 270010020 LOCAL 0270 RC outpatient 22100 22100 22100 74 16354 percent of total billed charges 22100 93 17901 percent of total billed charges 22100 22100 other OPPS APC 22100 22100 other OPPS APC 22100 27.63 6106.23 percent of total billed charges 22100 22100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 8MM 145CM 2.25MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125225-08 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 12MM 145CM 2.25MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125225-12 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 15MM 145CM 2.25MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125225-15 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 18MM 145CM 2.25MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125225-18 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 23MM 145CM 2.25MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125225-23 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 28MM 145CM 2.25MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125225-28 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 8MM 145CM 2.5MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125250-08 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 12MM 145CM 2.5MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125250-12 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 15MM 145CM 2.5MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125250-15 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 18MM 145CM 2.5MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125250-18 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 23MM 145CM 2.5MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125250-23 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 28MM 145CM 2.5MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125250-28 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 33MM 145CM 2.5MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125250-33 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 38MM 145CM 2.5MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125250-38 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 8MM 145CM 2.75MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125275-08 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 12MM 145CM 2.75MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125275-12 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 15MM 145CM 2.75MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125275-15 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 18MM 145CM 2.75MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125275-18 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 23MM 145CM 2.75MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125275-23 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 28MM 145CM 2.75MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125275-28 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 33MM 145CM 2.75MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125275-33 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 38MM 145CM 2.75MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125275-38 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 8MM 145CM 3MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS .014- SUP-1125300-08 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 12MM 145CM 3MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS .014- SUP-1125300-12 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 15MM 145CM 3MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS .014- SUP-1125300-15 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 18MM 145CM 3MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS .014- SUP-1125300-18 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 23MM 145CM 3MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS .014- SUP-1125300-23 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 28MM 145CM 3MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS .014- SUP-1125300-28 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 33MM 145CM 3MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS .014- SUP-1125300-33 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 38MM 145CM 3MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS .014- SUP-1125300-38 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 8MM 145CM 3.25MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125325-08 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 12MM 145CM 3.25MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125325-12 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 15MM 145CM 3.25MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125325-15 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 18MM 145CM 3.25MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125325-18 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 23MM 145CM 3.25MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125325-23 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 28MM 145CM 3.25MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125325-28 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 33MM 145CM 3.25MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125325-33 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 38MM 145CM 3.25MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125325-38 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 8MM 145CM 3.5MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125350-08 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 12MM 145CM 3.5MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125350-12 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 15MM 145CM 3.5MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125350-15 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 18MM 145CM 3.5MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125350-18 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 23MM 145CM 3.5MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125350-23 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 28MM 145CM 3.5MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125350-28 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 33MM 145CM 3.5MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS SUP-1125350-33 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE ALPINE EVEROLIMUS ELUTING COCR TAPER L38 MM L145 CM OD3.5 MM ODSEC.034-.029 IN ID5 FR 2 RADIOPAQUE 1 ACCESS PORT RAPID EXCHANGE BALLOON SUP-1125350-38 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE ALPINE EVEROLIMUS ELUTING COCR TAPER L8 MM L145 CM OD4 MM ODSEC.034-.029 IN ID5 FR 2 RADIOPAQUE 1 ACCESS PORT RAPID EXCHANGE BALLOON EXPAND STERILE ACCEPTS .014 IN GUIDEWIRE SUP-1125400-08 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE ALPINE EVEROLIMUS ELUTING COCR TAPER L12 MM L145 CM OD4 MM ODSEC.034-.029 IN ID5 FR 2 RADIOPAQUE 1 ACCESS PORT RAPID EXCHANGE BALLOON EXPAND STERILE ACCEPTS .014 IN GUIDEWIRE SUP-1125400-12 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 15MM 145CM 4MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS .014- SUP-1125400-15 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 18MM 145CM 4MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS .014- SUP-1125400-18 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 23MM 145CM 4MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS .014- SUP-1125400-23 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 28MM 145CM 4MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS .014- SUP-1125400-28 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 33MM 145CM 4MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS .014- SUP-1125400-33 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT XIENCE ALPINE 38MM 145CM 4MM EVEROLIMUS COCR RAPID EXCHANGE RADIOPAQUE 1 ACCESS PORT ACCEPTS .014- SUP-1125400-38 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL BARD MARLEX RECTANGLE 6X3IN POLYPROPYLENE STERILE GROIN MONOFILAMENT GOLD STANDARD FLAT SHEET INGUINAL SUP-112680 CDM 270009093 LOCAL 0270 RC outpatient 60 60 60 74 44.4 percent of total billed charges 60 93 48.6 percent of total billed charges 60 60 other OPPS APC 60 60 other OPPS APC 60 27.63 16.58 percent of total billed charges 60 60 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR DENTAL MICRO FINE YELLOW SUP-1126875 CDM 0270 RC outpatient 0.3 0.3 0.3 74 0.22 percent of total billed charges 0.3 93 0.24 percent of total billed charges 0.3 0.3 other OPPS APC 0.3 0.3 other OPPS APC 0.3 27.63 0.08 percent of total billed charges 0.3 0.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL PERFIX POLYPROPYLENE MEDIUM L1.3 IN OD1.55 IN GROIN PLUG MONOFILAMENT STERILE HERNIA REPAIR SUP-112760 CDM 0270 RC outpatient 678.89 678.89 678.89 74 502.38 percent of total billed charges 678.89 93 549.9 percent of total billed charges 678.89 678.89 other OPPS APC 678.89 678.89 other OPPS APC 678.89 27.63 187.58 percent of total billed charges 678.89 678.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL BARD PERFIX POLYPROPYLENE LARGE OD1.6 IN ODSEC1.9 IN PLUG MONOFILAMENT STERILE DISPOSABLE GROIN HERNIA SUP-112770 CDM 0270 RC outpatient 685.57 685.57 685.57 74 507.32 percent of total billed charges 685.57 93 555.31 percent of total billed charges 685.57 685.57 other OPPS APC 685.57 685.57 other OPPS APC 685.57 27.63 189.42 percent of total billed charges 685.57 685.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDS TOFFLEMIRE MATRIX .002 #13 SUP-1128241 CDM 0270 RC outpatient 0.71 0.71 0.71 74 0.53 percent of total billed charges 0.71 93 0.58 percent of total billed charges 0.71 0.71 other OPPS APC 0.71 0.71 other OPPS APC 0.71 27.63 0.2 percent of total billed charges 0.71 0.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION ROCKWOOD OD2.5 MM CLAVICLE ASSEMBLY SUP-1129-10-020 CDM 0270 RC outpatient 3030.3 3030.3 3030.3 74 2242.42 percent of total billed charges 3030.3 93 2454.54 percent of total billed charges 3030.3 3030.3 other OPPS APC 3030.3 3030.3 other OPPS APC 3030.3 27.63 837.27 percent of total billed charges 3030.3 3030.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION ROCKWOOD OD3 MM CLAVICLE SUP-1129-12-020 CDM 0270 RC outpatient 4056 4056 4056 74 3001.44 percent of total billed charges 4056 93 3285.36 percent of total billed charges 4056 4056 other OPPS APC 4056 4056 other OPPS APC 4056 27.63 1120.67 percent of total billed charges 4056 4056 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION ROCKWOOD OD3.8 MM CLAVICLE ASSEMBLY SUP-1129-14-020 CDM 0270 RC outpatient 2727.27 2727.27 2727.27 74 2018.18 percent of total billed charges 2727.27 93 2209.09 percent of total billed charges 2727.27 2727.27 other OPPS APC 2727.27 2727.27 other OPPS APC 2727.27 27.63 753.54 percent of total billed charges 2727.27 2727.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION SURPASS STREAMLINE L30MM OD 4MM SUP-112USPH CDM 0270 RC outpatient 38610 38610 38610 74 28571.4 percent of total billed charges 38610 93 31274.1 percent of total billed charges 38610 38610 other OPPS APC 38610 38610 other OPPS APC 38610 27.63 10667.9 percent of total billed charges 38610 38610 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SPINAL COALITION MIS L12 MM SUP-1136.2012 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL COALITION MIS TITANIUM 7 D D12 MM W14 MM X H6 MM STERILE LATEX FREE SUP-1136.2476 CDM 270010020 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL COALITION MIS TITANIUM 7 D D12 MM W14 MM X H7 MM STERILE LATEX FREE SUP-1136.2477 CDM 270010020 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL COALITION MIS TITANIUM 7 D D12 MM W14 MM X H9 MM STERILE LATEX FREE SUP-1136.2479 CDM 270010020 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL COMPREHENSIVE POROUS MICRO L55 MM OD8 MM SHOULDER REVERSE SYSTEM SUP-113608 CDM 270010030 LOCAL 0270 RC outpatient 9646 9646 9646 74 7138.04 percent of total billed charges 9646 93 7813.26 percent of total billed charges 9646 9646 other OPPS APC 9646 9646 other OPPS APC 9646 27.63 2665.19 percent of total billed charges 9646 9646 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL COMPREHENSIVE POROUS MINI L83 MM OD8 MM SHOULDER REVERSE SYSTEM SUP-113628 CDM 270010024 LOCAL 0270 RC outpatient 920.4 920.4 920.4 74 681.1 percent of total billed charges 920.4 93 745.52 percent of total billed charges 920.4 920.4 other OPPS APC 920.4 920.4 other OPPS APC 920.4 27.63 254.31 percent of total billed charges 920.4 920.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION SURPASS STREAMLINE L40MM OD 4MM SUP-113USPH CDM 0270 RC outpatient 41990 41990 41990 74 31072.6 percent of total billed charges 41990 93 34011.9 percent of total billed charges 41990 41990 other OPPS APC 41990 41990 other OPPS APC 41990 27.63 11601.8 percent of total billed charges 41990 41990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK ICE SMALL RECTANGLE L 12IN X W 5 IN 3 LAYER BAG TIE CLOSURE LATEX FREE DISPOSABLE SUP-11400-100 CDM 270009107 LOCAL 0270 RC outpatient 2.77 2.77 2.77 74 2.05 percent of total billed charges 2.77 93 2.24 percent of total billed charges 2.77 2.77 other OPPS APC 2.77 2.77 other OPPS APC 2.77 27.63 0.77 percent of total billed charges 2.77 2.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG ICE CLAMP CLOSE 4TIES WHITE 6.5X14 SUP-11400-300 CDM 0270 RC outpatient 2.15 2.15 2.15 74 1.59 percent of total billed charges 2.15 93 1.74 percent of total billed charges 2.15 2.15 other OPPS APC 2.15 2.15 other OPPS APC 2.15 27.63 0.59 percent of total billed charges 2.15 2.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL MITRIS RESILIA TISSUE 25MM 15MM 25MM STENT LOW-PROFILE COCR BOVINE PERICARDIUM POLYESTER PTFE CLOTH SILICONE RUBBER TRI-LEAFLET MRI-CONDITIONAL SUP-11400M25 CDM 0270 RC outpatient 20410 20410 20410 20410 other OPPS APC 20410 20410 other OPPS APC 20410 27.63 5639.28 percent of total billed charges 20410 20410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL MITRIS RESILIA TISSUE 27MM 16MM 27MM STENT LOW-PROFILE COCR BOVINE PERICARDIUM POLYESTER PTFE CLOTH SILICONE RUBBER TRI-LEAFLET MRI-CONDITIONAL SUP-11400M27 CDM 0270 RC outpatient 20410 20410 20410 20410 other OPPS APC 20410 20410 other OPPS APC 20410 27.63 5639.28 percent of total billed charges 20410 20410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL MITRIS RESILIA TISSUE 29MM 17MM 29MM STENT LOW-PROFILE COCR BOVINE PERICARDIUM POLYESTER PTFE CLOTH SILICONE RUBBER TRI-LEAFLET MRI-CONDITIONAL SUP-11400M29 CDM 0270 RC outpatient 20410 20410 20410 20410 other OPPS APC 20410 20410 other OPPS APC 20410 27.63 5639.28 percent of total billed charges 20410 20410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL MITRIS RESILIA TISSUE 31MM 18MM 31MM STENT LOW-PROFILE COCR BOVINE PERICARDIUM POLYESTER PTFE CLOTH SILICONE RUBBER TRI-LEAFLET MRI-CONDITIONAL SUP-11400M31 CDM 0270 RC outpatient 20410 20410 20410 20410 other OPPS APC 20410 20410 other OPPS APC 20410 27.63 5639.28 percent of total billed charges 20410 20410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL MITRIS RESILIA TISSUE 33MM 18MM 31MM STENT LOW-PROFILE COCR BOVINE PERICARDIUM POLYESTER PTFE CLOTH SILICONE RUBBER TRI-LEAFLET MRI-CONDITIONAL SUP-11400M33 CDM 0270 RC outpatient 20410 20410 20410 20410 other OPPS APC 20410 20410 other OPPS APC 20410 27.63 5639.28 percent of total billed charges 20410 20410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK COLD INSTANT 6 X 9 SUP-11440-900 CDM 0270 RC outpatient 0.98 0.98 0.98 74 0.73 percent of total billed charges 0.98 93 0.79 percent of total billed charges 0.98 0.98 other OPPS APC 0.98 0.98 other OPPS APC 0.98 27.63 0.27 percent of total billed charges 0.98 0.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK THERAPEUTIC MEDIUM L6.5 IN X W6 IN INSTANT HOT CONTROL RELEASE LATEX FREE DISPOSABLE SUP-11450-040B CDM 0270 RC outpatient 1.24 1.24 1.24 74 0.92 percent of total billed charges 1.24 93 1 percent of total billed charges 1.24 1.24 other OPPS APC 1.24 1.24 other OPPS APC 1.24 27.63 0.34 percent of total billed charges 1.24 1.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP QUARTEX THREADED LOCKING SUP-1149.001 CDM 270010020 LOCAL 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE QUARTEX L12 MM OD3.5 MM SPINE POLYAXIAL SUP-1149.3512 CDM 270010020 LOCAL 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE QUARTEX L24 MM OD4.5 MM SPINE POLYAXIAL SUP-1149.4524 CDM 270010020 LOCAL 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL STRAIGHT L120 MM OD4 MM SUP-1149.7120 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION SURPASS STREAMLINE L50MM OD 4MM SUP-114USPH CDM 0270 RC outpatient 41990 41990 41990 74 31072.6 percent of total billed charges 41990 93 34011.9 percent of total billed charges 41990 41990 other OPPS APC 41990 41990 other OPPS APC 41990 27.63 11601.8 percent of total billed charges 41990 41990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC INSPIRIS RESILIA 19MM SUP-11500A19 CDM 0270 RC outpatient 20410 20410 20410 74 15103.4 percent of total billed charges 20410 93 16532.1 percent of total billed charges 20410 20410 other OPPS APC 20410 20410 other OPPS APC 20410 27.63 5639.28 percent of total billed charges 20410 20410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC INSPIRIS RESILIA 21MM SUP-11500A21 CDM 0270 RC outpatient 20410 20410 20410 74 15103.4 percent of total billed charges 20410 93 16532.1 percent of total billed charges 20410 20410 other OPPS APC 20410 20410 other OPPS APC 20410 27.63 5639.28 percent of total billed charges 20410 20410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC INSPIRIS RESILIA 23MM SUP-11500A23 CDM 0270 RC outpatient 20410 20410 20410 74 15103.4 percent of total billed charges 20410 93 16532.1 percent of total billed charges 20410 20410 other OPPS APC 20410 20410 other OPPS APC 20410 27.63 5639.28 percent of total billed charges 20410 20410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC INSPIRIS RESILIA 25MM SUP-11500A25 CDM 0270 RC outpatient 20410 20410 20410 74 15103.4 percent of total billed charges 20410 93 16532.1 percent of total billed charges 20410 20410 other OPPS APC 20410 20410 other OPPS APC 20410 27.63 5639.28 percent of total billed charges 20410 20410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC INSPIRIS RESILIA 27MM SUP-11500A27 CDM 0270 RC outpatient 20410 20410 20410 74 15103.4 percent of total billed charges 20410 93 16532.1 percent of total billed charges 20410 20410 other OPPS APC 20410 20410 other OPPS APC 20410 27.63 5639.28 percent of total billed charges 20410 20410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC INSPIRIS RESILIA 29MM SUP-11500A29 CDM 0270 RC outpatient 20410 20410 20410 74 15103.4 percent of total billed charges 20410 93 16532.1 percent of total billed charges 20410 20410 other OPPS APC 20410 20410 other OPPS APC 20410 27.63 5639.28 percent of total billed charges 20410 20410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KWIRE INTEGRA 100MM SUP-115101 CDM 0270 RC outpatient 105.92 105.92 105.92 74 78.38 percent of total billed charges 105.92 93 85.8 percent of total billed charges 105.92 105.92 other OPPS APC 105.92 105.92 other OPPS APC 105.92 27.63 29.27 percent of total billed charges 105.92 105.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE INTEGRA SUP-115101ND CDM 0270 RC outpatient 88.4 88.4 88.4 74 65.42 percent of total billed charges 88.4 93 71.6 percent of total billed charges 88.4 88.4 other OPPS APC 88.4 88.4 other OPPS APC 88.4 27.63 24.42 percent of total billed charges 88.4 88.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER L150 MM OD1.6 MM SUP-115116 CDM 0270 RC outpatient 122.56 122.56 122.56 74 90.69 percent of total billed charges 122.56 93 99.27 percent of total billed charges 122.56 122.56 other OPPS APC 122.56 122.56 other OPPS APC 122.56 27.63 33.86 percent of total billed charges 122.56 122.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW COMP REVERSE SHOULDER CENTRAL 6.5MM X 30 SUP-115396 CDM 270010030 LOCAL 0270 RC outpatient 351 351 351 74 259.74 percent of total billed charges 351 93 284.31 percent of total billed charges 351 351 other OPPS APC 351 351 other OPPS APC 351 27.63 96.98 percent of total billed charges 351 351 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION SURPASS STREAMLINE L15MM OD 4MM SUP-115USPH CDM 0270 RC outpatient 38610 38610 38610 74 28571.4 percent of total billed charges 38610 93 31274.1 percent of total billed charges 38610 38610 other OPPS APC 38610 38610 other OPPS APC 38610 27.63 10667.9 percent of total billed charges 38610 38610 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL XPAND 0D SM 74-89X14X12MM TITANIUM CORPECTOMY SUP-116.114 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL XPAND 15-18MM SUP-116.121 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL XPAND TITANIUM 0 D MEDIUM L24-28 MM X W23 MM X H21 MM SMOOTH SELF DISTRACTING SUP-116.205 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PILLOW ABDUCTION FOAM MEDIUM L17 IN X W6.5 IN SHOULDER PADDED SLING SHOULDER WAIST STRAP PILLOW ABDUCTION DEVICE NONSTERILE LATEX FREE DISPOSABLE SUP-11640006 CDM 270009116 LOCAL 0270 RC outpatient 3.89 3.89 3.89 74 2.88 percent of total billed charges 3.89 93 3.15 percent of total billed charges 3.89 3.89 other OPPS APC 3.89 3.89 other OPPS APC 3.89 27.63 1.07 percent of total billed charges 3.89 3.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PILLOW ABDUCTION FOAM LARGE SHOULDER ENVELOPE SLING THUMB LOOP PAD D RING CLOSURE NONSTERILE LATEX FREE SUP-11640007 CDM 270009116 LOCAL 0270 RC outpatient 3.89 3.89 3.89 74 2.88 percent of total billed charges 3.89 93 3.15 percent of total billed charges 3.89 3.89 other OPPS APC 3.89 3.89 other OPPS APC 3.89 27.63 1.07 percent of total billed charges 3.89 3.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE POSITIONING CANVAS FOAM XL L20.5 IN X W7.5 IN SHOULDER PILLOW ABDUCTION SUP-11640008 CDM 270009116 LOCAL 0270 RC outpatient 3.89 3.89 3.89 74 2.88 percent of total billed charges 3.89 93 3.15 percent of total billed charges 3.89 3.89 other OPPS APC 3.89 3.89 other OPPS APC 3.89 27.63 1.07 percent of total billed charges 3.89 3.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARRIER OSTOMY NEW IMAGE CERAPLUS CERAMIDE 2-IN OPEN CONVEX OD 2 3/4 IN SOFT ADHESIVE TAPE BORDER INTEGRATE FLOAT FLANGE CUT TO FIT LATEX FREE BLUE SUP-11704 CDM 0270 RC outpatient 1.96 1.96 1.96 74 1.45 percent of total billed charges 1.96 93 1.59 percent of total billed charges 1.96 1.96 other OPPS APC 1.96 1.96 other OPPS APC 1.96 27.63 0.54 percent of total billed charges 1.96 1.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL LUBRICATH 16FR 5CC RED RUBBER DISPOSABLE STERILE LATEX FOLEY COUDE TIP TEMPERATURE SENSE EXTENSION SUP-117416 CDM 0270 RC outpatient 29.51 29.51 29.51 74 21.84 percent of total billed charges 29.51 93 23.9 percent of total billed charges 29.51 29.51 other OPPS APC 29.51 29.51 other OPPS APC 29.51 27.63 8.15 percent of total billed charges 29.51 29.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE ALLOMAX HUMAN DERMAL COLLAGEN RECTANGULAR L6.3 IN X W1.6 IN REGENERATIVE STERILE HERNIA ABDOMINAL WALL REPAIR SUP-1180050 CDM 0270 RC outpatient 4771 4771 4771 74 3530.54 percent of total billed charges 4771 93 3864.51 percent of total billed charges 4771 4771 other OPPS APC 4771 4771 other OPPS APC 4771 27.63 1318.23 percent of total billed charges 4771 4771 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE ALLOMAX TUTOPLAST HUMAN DERMAL COLLAGEN 1 MM RECTANGULAR L6.3 IN X W2.4 IN TIGHT TOLERANCE STERILE 2 LATERAL BREAST RECONSTRUCTION SUP-1180616M CDM 0270 RC outpatient 7672.98 7672.98 7672.98 74 5678.01 percent of total billed charges 7672.98 93 6215.11 percent of total billed charges 7672.98 7672.98 other OPPS APC 7672.98 7672.98 other OPPS APC 7672.98 27.63 2120.04 percent of total billed charges 7672.98 7672.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL PHASIX POLY 4-HYDROXYBUTYRATE SQUARE L 12IN X W 12IN MONOFILAMENT SCAFFOLD FULL RESORBABLE HERNIA REPAIR SUP-1193030 CDM 0270 RC outpatient 36956.4 36956.4 36956.4 74 27347.7 percent of total billed charges 36956.4 93 29934.7 percent of total billed charges 36956.4 36956.4 other OPPS APC 36956.4 36956.4 other OPPS APC 36956.4 27.63 10211 percent of total billed charges 36956.4 36956.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL LUBRI-SIL IC SILICONE L6 FT OD16 FR 5 CC FOLEY TEMPERATURE SENSE EXTENSION CABLE STERILE LATEX FREE DISPOSABLE 400 SERIES SUP-119316 CDM 0270 RC outpatient 52.68 52.68 52.68 74 38.98 percent of total billed charges 52.68 93 42.67 percent of total billed charges 52.68 52.68 other OPPS APC 52.68 52.68 other OPPS APC 52.68 27.63 14.56 percent of total billed charges 52.68 52.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE DEFIBRILLATOR EDGE SYSTEM QUIK-PACE ADULT RECTANGLE L15.1 CM X W13.3 CM LEADWIRE RADIOTRANSLUCENT DISPOSABLE SUP-11996-000090 CDM 0270 RC outpatient 97.68 97.68 97.68 74 72.28 percent of total billed charges 97.68 93 79.12 percent of total billed charges 97.68 97.68 other OPPS APC 97.68 97.68 other OPPS APC 97.68 27.63 26.99 percent of total billed charges 97.68 97.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ADMISSION SUP-12-00001 CDM 0271 RC outpatient 31.2 31.2 31.2 74 23.09 percent of total billed charges 31.2 93 25.27 percent of total billed charges 31.2 31.2 other OPPS APC 31.2 31.2 other OPPS APC 31.2 27.63 8.62 percent of total billed charges 31.2 31.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ADMISSION PEDIATRIC SUP-12-00002 CDM 0271 RC outpatient 33.98 33.98 33.98 74 25.15 percent of total billed charges 33.98 93 27.52 percent of total billed charges 33.98 33.98 other OPPS APC 33.98 33.98 other OPPS APC 33.98 27.63 9.39 percent of total billed charges 33.98 33.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ENEMA SUP-12-00011 CDM 0271 RC outpatient 1.22 1.22 1.22 74 0.9 percent of total billed charges 1.22 93 0.99 percent of total billed charges 1.22 1.22 other OPPS APC 1.22 1.22 other OPPS APC 1.22 27.63 0.34 percent of total billed charges 1.22 1.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT EPISTAT SUP-12-00014 CDM 0272 RC outpatient 509.25 509.25 509.25 74 376.85 percent of total billed charges 509.25 93 412.49 percent of total billed charges 509.25 509.25 other OPPS APC 509.25 509.25 other OPPS APC 509.25 27.63 140.71 percent of total billed charges 509.25 509.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT MONITOR SINGLE LINE VAMP SUP-12-00016 CDM 0272 RC outpatient 196.2 196.2 196.2 74 145.19 percent of total billed charges 196.2 93 158.92 percent of total billed charges 196.2 196.2 other OPPS APC 196.2 196.2 other OPPS APC 196.2 27.63 54.21 percent of total billed charges 196.2 196.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT SUTURE REMOVAL SUP-12-00020 CDM 0272 RC outpatient 0.84 0.84 0.84 74 0.62 percent of total billed charges 0.84 93 0.68 percent of total billed charges 0.84 0.84 other OPPS APC 0.84 0.84 other OPPS APC 0.84 27.63 0.23 percent of total billed charges 0.84 0.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOUTHCARE SWABS 20/PK SUP-12-00022 CDM 0272 RC outpatient 3.86 3.86 3.86 74 2.86 percent of total billed charges 3.86 93 3.13 percent of total billed charges 3.86 3.86 other OPPS APC 3.86 3.86 other OPPS APC 3.86 27.63 1.07 percent of total billed charges 3.86 3.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET RADIAL ARTERY CATHETER SUP-12-00027 CDM 0272 RC outpatient 37.88 37.88 37.88 74 28.03 percent of total billed charges 37.88 93 30.68 percent of total billed charges 37.88 37.88 other OPPS APC 37.88 37.88 other OPPS APC 37.88 27.63 10.47 percent of total billed charges 37.88 37.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY LUMBAR PUNCTURE SUP-12-00029 CDM 0272 RC outpatient 41.49 41.49 41.49 74 30.7 percent of total billed charges 41.49 93 33.61 percent of total billed charges 41.49 41.49 other OPPS APC 41.49 41.49 other OPPS APC 41.49 27.63 11.46 percent of total billed charges 41.49 41.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY LUMBAR PUNCTURE PED. SUP-12-00030 CDM 0272 RC outpatient 37.44 37.44 37.44 74 27.71 percent of total billed charges 37.44 93 30.33 percent of total billed charges 37.44 37.44 other OPPS APC 37.44 37.44 other OPPS APC 37.44 27.63 10.34 percent of total billed charges 37.44 37.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY PACK 5/6 FR SUP-12-00031 CDM 0272 RC outpatient 126.4 126.4 126.4 74 93.54 percent of total billed charges 126.4 93 102.38 percent of total billed charges 126.4 126.4 other OPPS APC 126.4 126.4 other OPPS APC 126.4 27.63 34.92 percent of total billed charges 126.4 126.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY PACK 8 SUP-12-00033 CDM 0272 RC outpatient 276.18 276.18 276.18 74 204.37 percent of total billed charges 276.18 93 223.71 percent of total billed charges 276.18 276.18 other OPPS APC 276.18 276.18 other OPPS APC 276.18 27.63 76.31 percent of total billed charges 276.18 276.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TRACH CLEANING SUP-12-00039 CDM 0272 RC outpatient 1.83 1.83 1.83 74 1.35 percent of total billed charges 1.83 93 1.48 percent of total billed charges 1.83 1.83 other OPPS APC 1.83 1.83 other OPPS APC 1.83 27.63 0.51 percent of total billed charges 1.83 1.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SKIN STAPLE REMOVER SUP-12-00041 CDM 0272 RC outpatient 0.78 0.78 0.78 74 0.58 percent of total billed charges 0.78 93 0.63 percent of total billed charges 0.78 0.78 other OPPS APC 0.78 0.78 other OPPS APC 0.78 27.63 0.22 percent of total billed charges 0.78 0.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CO-SETS SUP-12-00042 CDM 0272 RC outpatient 1350 1350 1350 74 999 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 1350 other OPPS APC 1350 1350 other OPPS APC 1350 27.63 373.01 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT MOUTHCARE FLAVORED SUP-12-00046 CDM 0272 RC outpatient 0.44 0.44 0.44 74 0.33 percent of total billed charges 0.44 93 0.36 percent of total billed charges 0.44 0.44 other OPPS APC 0.44 0.44 other OPPS APC 0.44 27.63 0.12 percent of total billed charges 0.44 0.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY SPINAL BUPIVACAINE 25G SUP-12-00047 CDM 0272 RC outpatient 53.86 53.86 53.86 74 39.86 percent of total billed charges 53.86 93 43.63 percent of total billed charges 53.86 53.86 other OPPS APC 53.86 53.86 other OPPS APC 53.86 27.63 14.88 percent of total billed charges 53.86 53.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY EPIDURAL SUP-12-00048 CDM 0272 RC outpatient 91.2 91.2 91.2 74 67.49 percent of total billed charges 91.2 93 73.87 percent of total billed charges 91.2 91.2 other OPPS APC 91.2 91.2 other OPPS APC 91.2 27.63 25.2 percent of total billed charges 91.2 91.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "FEEDING SET, BAG 1000 FLUSH" SUP-12-00056 CDM 0272 RC outpatient 24.27 24.27 24.27 74 17.96 percent of total billed charges 24.27 93 19.66 percent of total billed charges 24.27 24.27 other OPPS APC 24.27 24.27 other OPPS APC 24.27 27.63 6.71 percent of total billed charges 24.27 24.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER ARROWG+ARD BLUE PLUS CHLORHEXIDINE LIDOCAINE PHTHALATE DEHP L20 CM OD7 FR PRESSURE INJECTABLE 3 LUMEN ANTIMICROBIAL LATEX FREE SUP-12-00058 CDM 0272 RC outpatient 493.5 493.5 493.5 74 365.19 percent of total billed charges 493.5 93 399.74 percent of total billed charges 493.5 493.5 other OPPS APC 493.5 493.5 other OPPS APC 493.5 27.63 136.35 percent of total billed charges 493.5 493.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT LACERATION SUP-12-00062 CDM 0272 RC outpatient 3.64 3.64 3.64 74 2.69 percent of total billed charges 3.64 93 2.95 percent of total billed charges 3.64 3.64 other OPPS APC 3.64 3.64 other OPPS APC 3.64 27.63 1.01 percent of total billed charges 3.64 3.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY PNEUMOTHOROX WAYNE 10.2F SUP-12-00063 CDM 0272 RC outpatient 788.1 788.1 788.1 74 583.19 percent of total billed charges 788.1 93 638.36 percent of total billed charges 788.1 788.1 other OPPS APC 788.1 788.1 other OPPS APC 788.1 27.63 217.75 percent of total billed charges 788.1 788.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTERIAL A-LINE KIT SUP-12-00072 CDM 0272 RC outpatient 109.6 109.6 109.6 74 81.1 percent of total billed charges 109.6 93 88.78 percent of total billed charges 109.6 109.6 other OPPS APC 109.6 109.6 other OPPS APC 109.6 27.63 30.28 percent of total billed charges 109.6 109.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PLEURA-SEAL THORACENTESIS SUP-12-00073 CDM 0272 RC outpatient 243.25 243.25 243.25 74 180.01 percent of total billed charges 243.25 93 197.03 percent of total billed charges 243.25 243.25 other OPPS APC 243.25 243.25 other OPPS APC 243.25 27.63 67.21 percent of total billed charges 243.25 243.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY CENTRAL QUAD 8.5FR X 16CM ARROW SUP-12-00074 CDM C1751 HCPCS 0272 RC outpatient 396.48 396.48 396.48 74 293.4 percent of total billed charges 396.48 93 321.15 percent of total billed charges 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 27.63 109.55 percent of total billed charges 396.48 396.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT FATHERS XL SUP-12-00080 CDM 0272 RC outpatient 2.14 2.14 2.14 74 1.58 percent of total billed charges 2.14 93 1.73 percent of total billed charges 2.14 2.14 other OPPS APC 2.14 2.14 other OPPS APC 2.14 27.63 0.59 percent of total billed charges 2.14 2.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER L6 IN OD7 FR CENTRAL VENOUS 3 LUMEN PRESSURE INJECTABLE SUP-12-00082 CDM 0272 RC outpatient 296.1 296.1 296.1 74 219.11 percent of total billed charges 296.1 93 239.84 percent of total billed charges 296.1 296.1 other OPPS APC 296.1 296.1 other OPPS APC 296.1 27.63 81.81 percent of total billed charges 296.1 296.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEEDING SET 1000ML NEW CAP SUP-12-00083 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY UROLOGIST HEYMAN SYSTEM SUP-12-00087 CDM 0272 RC outpatient 963.54 963.54 963.54 74 713.02 percent of total billed charges 963.54 93 780.47 percent of total billed charges 963.54 963.54 other OPPS APC 963.54 963.54 other OPPS APC 963.54 27.63 266.23 percent of total billed charges 963.54 963.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CLEAN CATCH AMM570 SUP-12-00089 CDM 0272 RC outpatient 3.67 3.67 3.67 74 2.72 percent of total billed charges 3.67 93 2.97 percent of total billed charges 3.67 3.67 other OPPS APC 3.67 3.67 other OPPS APC 3.67 27.63 1.01 percent of total billed charges 3.67 3.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER ARROWG+ARD BLUE PLUS CHLORHEXIDINE L20 CM OD8.5 FR CENTRAL VENOUS 4 LUMEN PRESSURE INJECTABLE LATEX FREE SUP-12-00090 CDM 0272 RC outpatient 555.8 555.8 555.8 74 411.29 percent of total billed charges 555.8 93 450.2 percent of total billed charges 555.8 555.8 other OPPS APC 555.8 555.8 other OPPS APC 555.8 27.63 153.57 percent of total billed charges 555.8 555.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER ARROWG+ARD BLUE PLUS DEHP L16 CM OD8.5 FR CENTRAL VENOUS 4 LUMEN ANTIMICROBIAL PRESSURE INJECTABLE LATEX FREE SUP-12-00091 CDM 0272 RC outpatient 555.8 555.8 555.8 74 411.29 percent of total billed charges 555.8 93 450.2 percent of total billed charges 555.8 555.8 other OPPS APC 555.8 555.8 other OPPS APC 555.8 27.63 153.57 percent of total billed charges 555.8 555.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRES QUAD LUMEN 8.5FR X 16CM-SUB SUP-12-00094 CDM 0272 RC outpatient 455.49 455.49 455.49 74 337.06 percent of total billed charges 455.49 93 368.95 percent of total billed charges 455.49 455.49 other OPPS APC 455.49 455.49 other OPPS APC 455.49 27.63 125.85 percent of total billed charges 455.49 455.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY UMBILICAL VESSEL W/O CATH SUP-12-00095 CDM 0272 RC outpatient 179.33 179.33 179.33 74 132.7 percent of total billed charges 179.33 93 145.26 percent of total billed charges 179.33 179.33 other OPPS APC 179.33 179.33 other OPPS APC 179.33 27.63 49.55 percent of total billed charges 179.33 179.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET POWERLOC 20 X 1 W/O Y-SITE SUP-12-00096 CDM 0272 RC outpatient 36 36 36 74 26.64 percent of total billed charges 36 93 29.16 percent of total billed charges 36 36 other OPPS APC 36 36 other OPPS APC 36 27.63 9.95 percent of total billed charges 36 36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET POWERLOC 20 X .75 W/O Y-SITE SUP-12-00097 CDM 0272 RC outpatient 36 36 36 74 26.64 percent of total billed charges 36 93 29.16 percent of total billed charges 36 36 other OPPS APC 36 36 other OPPS APC 36 27.63 9.95 percent of total billed charges 36 36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY PNEUMOTHOROX WAYNE 14FR SUP-12-00100 CDM 0272 RC outpatient 817.8 817.8 817.8 74 605.17 percent of total billed charges 817.8 93 662.42 percent of total billed charges 817.8 817.8 other OPPS APC 817.8 817.8 other OPPS APC 817.8 27.63 225.96 percent of total billed charges 817.8 817.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD PRECONTOURED 5.5X30 SUP-12-1030 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL L45 MM OD5.5 MM PRECONTOURED SUP-12-1045 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD PRECONTOURED MALIBU 5.5MM X 50MM SUP-12-1050 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD MARINER PRECONTOURED 5.5X55 SUP-12-1055 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL L60 MM OD5.5 MM PRECONTOURED SUP-12-1060 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD PRECONTOURED 5.5MM X65MM SUP-12-1065 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD MARNIER PRECONTOURED 5.5MM X 70 SUP-12-1070 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL L80 MM OD5.5 MM PRECONTOURED SUP-12-1080 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT CONTOUR CROSSBAR SMALL SUP-12-2041 CDM 270010020 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROSSBAR SPINAL MALIBU MEDIUM CONTOUR 5.5 MM ROD SUP-12-2052 CDM 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL MALIBU CROSSBAR LARGE CONTOUR OD5.5 MM SUP-12-2075 CDM 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MALIBU L45 MM OD5.5 MM SPINE PEDICLE POLYAXIAL SUP-12-5545 CDM 270010020 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MALIBU POLYAXIAL 6.5MM X 45MM SUP-12-6545 CDM 270010020 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION EXTREME .014 IN L135 CM OD2 MM OTW LASER SUP-120-001 CDM 0270 RC outpatient 3835 3835 3835 74 2837.9 percent of total billed charges 3835 93 3106.35 percent of total billed charges 3835 3835 other OPPS APC 3835 3835 other OPPS APC 3835 27.63 1059.61 percent of total billed charges 3835 3835 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOLOGIX AFX LIMB EXTENSION SUP-120-13/C70FSA CDM 270010015 LOCAL 0270 RC outpatient 8515 8515 8515 74 6301.1 percent of total billed charges 8515 93 6897.15 percent of total billed charges 8515 8515 other OPPS APC 8515 8515 other OPPS APC 8515 27.63 2352.69 percent of total billed charges 8515 8515 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT AFX ACTIVESEAL STRATA EPTFE STRAIGHT L88 MM OD20-13 MM ID17 FR ENDOVASCULAR ILIUM SELF EXPANDABLE FLEXIBLE LIMB EXTENSION INTRODUCER AAA SUP-120-13/C88FSA CDM 270010015 LOCAL 0270 RC outpatient 8515 8515 8515 74 6301.1 percent of total billed charges 8515 93 6897.15 percent of total billed charges 8515 8515 other OPPS APC 8515 8515 other OPPS APC 8515 27.63 2352.69 percent of total billed charges 8515 8515 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE BIOCELL SILICONE P4.5 CM HIGH PROFILE ROUND OD12.1 CM 4000 ML STYLE 120 TEXTURE STERILE SUP-120-400 CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE BIOCELL SILICONE P4.7 CM HIGH PROFILE ROUND OD13.5 CM 500 ML STYLE 115 TEXTURE STERILE LATEX FREE SUP-120-500 CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAG SAW MICROAIRE SUP-1200-005 CDM 0270 RC outpatient 43.68 43.68 43.68 74 32.32 percent of total billed charges 43.68 93 35.38 percent of total billed charges 43.68 43.68 other OPPS APC 43.68 43.68 other OPPS APC 43.68 27.63 12.07 percent of total billed charges 43.68 43.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROAIRE SAG SAW BLADE SUP-1200-006 CDM 0270 RC outpatient 43.68 43.68 43.68 74 32.32 percent of total billed charges 43.68 93 35.38 percent of total billed charges 43.68 43.68 other OPPS APC 43.68 43.68 other OPPS APC 43.68 27.63 12.07 percent of total billed charges 43.68 43.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW THK.3 MM SMALL L10.2 MM X W18 MM SAGITTAL STERILE SUP-1200-018 CDM 0270 RC outpatient 43.68 43.68 43.68 74 32.32 percent of total billed charges 43.68 93 35.38 percent of total billed charges 43.68 43.68 other OPPS APC 43.68 43.68 other OPPS APC 43.68 27.63 12.07 percent of total billed charges 43.68 43.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ALTIUS M-INI TITANIUM L14 MM OD3.5 MM SPINE CERVICOTHORACIC MULTIAXIAL SUP-1200-2714 CDM 270010020 LOCAL 0270 RC outpatient 3115.84 3115.84 3115.84 74 2305.72 percent of total billed charges 3115.84 93 2523.83 percent of total billed charges 3115.84 3115.84 other OPPS APC 3115.84 3115.84 other OPPS APC 3115.84 27.63 860.91 percent of total billed charges 3115.84 3115.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ALTIUS M-INI TITANIUM L16 MM OD3.5 MM OCCIPITOCERVICOTHORACIC SPINE MULTIAXIAL SUP-1200-2716 CDM 270010020 LOCAL 0270 RC outpatient 3115.84 3115.84 3115.84 74 2305.72 percent of total billed charges 3115.84 93 2523.83 percent of total billed charges 3115.84 3115.84 other OPPS APC 3115.84 3115.84 other OPPS APC 3115.84 27.63 860.91 percent of total billed charges 3115.84 3115.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ALTIUS M-INI TITANIUM L18 MM OD3.5 MM OCCIPITOCERVICOTHORACIC SPINE MULTIAXIAL SUP-1200-2718 CDM 270010020 LOCAL 0270 RC outpatient 3115.84 3115.84 3115.84 74 2305.72 percent of total billed charges 3115.84 93 2523.83 percent of total billed charges 3115.84 3115.84 other OPPS APC 3115.84 3115.84 other OPPS APC 3115.84 27.63 860.91 percent of total billed charges 3115.84 3115.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL PHASIX POLY-4-HYDROXYBUTYRATE RECTANGLE L4 IN X W3 IN MONOFILAMENT SCAFFOLD RESORBABLE HERNIA REPAIR INTRAABDOMINAL PLACEMENT SUP-1200710 CDM 0270 RC outpatient 4353.44 4353.44 4353.44 74 3221.55 percent of total billed charges 4353.44 93 3526.29 percent of total billed charges 4353.44 4353.44 other OPPS APC 4353.44 4353.44 other OPPS APC 4353.44 27.63 1202.86 percent of total billed charges 4353.44 4353.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION SURPASS STREAMLINE L25MM OD 5MM SUP-120USPH CDM 0270 RC outpatient 38610 38610 38610 74 28571.4 percent of total billed charges 38610 93 31274.1 percent of total billed charges 38610 38610 other OPPS APC 38610 38610 other OPPS APC 38610 27.63 10667.9 percent of total billed charges 38610 38610 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOLDER NEEDLE CARB-BITE TUNGSTEN CARBIDE STRAIGHT MICRO L7 IN SERRATED LOCK NONSTERILE SUP-121229 CDM 0270 RC outpatient 367.38 367.38 367.38 74 271.86 percent of total billed charges 367.38 93 297.58 percent of total billed charges 367.38 367.38 other OPPS APC 367.38 367.38 other OPPS APC 367.38 27.63 101.51 percent of total billed charges 367.38 367.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SWAB ORAL TOOTHETTE GLYCERIN FOAM STICK RIDGE LEMON SUP-1216 CDM 0270 RC outpatient 0.16 0.16 0.16 74 0.12 percent of total billed charges 0.16 93 0.13 percent of total billed charges 0.16 0.16 other OPPS APC 0.16 0.16 other OPPS APC 0.16 27.63 0.04 percent of total billed charges 0.16 0.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC OD 12.7 MM ID 6.5 MM SUP-121680 CDM 0270 RC outpatient 123.55 123.55 123.55 74 91.43 percent of total billed charges 123.55 93 100.08 percent of total billed charges 123.55 123.55 other OPPS APC 123.55 123.55 other OPPS APC 123.55 27.63 34.14 percent of total billed charges 123.55 123.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR PINNACLE POROCOAT OD50 MM HIP 100 SERIES SUP-1217-01-050 CDM 270010024 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL PINACLE ACETABULAR 100 SERIES 52MM SUP-1217-01-052 CDM 270010024 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ACETABULAR SHELL MULTI HOLE 60MM SUP-1217-20-050 CDM 270010024 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ACETABULAR SHELL DEPUY PINNACLE MUTLI HOLE 52MM SUP-1217-20-052 CDM 270010024 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR PINNACLE POROCOAT OD48 MM HIP SECTOR SUP-1217-22-048 CDM 270010024 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR PINNACLE 52MM POROCOAT STERILE LF HIP SECTOR SUP-1217-22-052 CDM 270010024 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR PINNACLE POROCOAT OD56 MM HIP SECTOR SUP-1217-22-056 CDM 270010024 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP ACETABULAR PINNACLE 52MM GRIPTION STERILE LF HIP 10 DOME SCREW MULTIHOLE II REVISION SYSTEM SUP-1217-30-052 CDM 270010024 LOCAL 0270 RC outpatient 7695.48 7695.48 7695.48 74 5694.66 percent of total billed charges 7695.48 93 6233.34 percent of total billed charges 7695.48 7695.48 other OPPS APC 7695.48 7695.48 other OPPS APC 7695.48 27.63 2126.26 percent of total billed charges 7695.48 7695.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PINNACLE 30MM 6.5MM ACETABULAR CANCELLOUS REVISION SYSTEM SUP-1217-30-500 CDM 270010024 LOCAL 0270 RC outpatient 394.68 394.68 394.68 74 292.06 percent of total billed charges 394.68 93 319.69 percent of total billed charges 394.68 394.68 other OPPS APC 394.68 394.68 other OPPS APC 394.68 27.63 109.05 percent of total billed charges 394.68 394.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PINNACLE CANCELLOUS BONE 6.5MM X 35MM SUP-1217-35-500 CDM 270010024 LOCAL 0270 RC outpatient 394.68 394.68 394.68 74 292.06 percent of total billed charges 394.68 93 319.69 percent of total billed charges 394.68 394.68 other OPPS APC 394.68 394.68 other OPPS APC 394.68 27.63 109.05 percent of total billed charges 394.68 394.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PINNACLE 45MM 6.5MM STERILE ACETABULAR CANCELLOUS REVISION SYSTEM SUP-1217-45-500 CDM 270010024 LOCAL 0270 RC outpatient 394.68 394.68 394.68 74 292.06 percent of total billed charges 394.68 93 319.69 percent of total billed charges 394.68 394.68 other OPPS APC 394.68 394.68 other OPPS APC 394.68 27.63 109.05 percent of total billed charges 394.68 394.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM 28MM CANNULATED 10MM L PARTIALLY THREADED SELF-TAPPING STANDARD STAINLESS STEEL HEXAGONAL DRIVE SOCKETSPHERICAL HEAD SUPRACONDYLAR REVERSE EXTRACTION FLUTE TROCARTIP GUIDE SUP-121828 CDM 0270 RC outpatient 481.78 481.78 481.78 74 356.52 percent of total billed charges 481.78 93 390.24 percent of total billed charges 481.78 481.78 other OPPS APC 481.78 481.78 other OPPS APC 481.78 27.63 133.12 percent of total billed charges 481.78 481.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC STAINLESS STEEL 2.5MM FLUTE L 32MM L 14MM OD 4MM ODSEC 6MM HIP CANNULATED SELF TAP TROCAR STERILE SUP-121832 CDM 0270 RC outpatient 481.78 481.78 481.78 74 356.52 percent of total billed charges 481.78 93 390.24 percent of total billed charges 481.78 481.78 other OPPS APC 481.78 481.78 other OPPS APC 481.78 27.63 133.12 percent of total billed charges 481.78 481.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC STAINLESS STEEL 2.5MM FLUTE L 34 MM L 14MM OD 4 MM ODSEC 6 MM HIP CANNULATED SELF TAP TROCAR STERILE SUP-121834 CDM 0270 RC outpatient 481.78 481.78 481.78 74 356.52 percent of total billed charges 481.78 93 390.24 percent of total billed charges 481.78 481.78 other OPPS APC 481.78 481.78 other OPPS APC 481.78 27.63 133.12 percent of total billed charges 481.78 481.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC STAINLESS STEEL 2.5 MM FLUTE L 36MM L 14MM OD 4MM ODSEC 6MM HIP SELF TAP CANNULATED TROCAR STERILE SUP-121836 CDM 0270 RC outpatient 481.78 481.78 481.78 74 356.52 percent of total billed charges 481.78 93 390.24 percent of total billed charges 481.78 481.78 other OPPS APC 481.78 481.78 other OPPS APC 481.78 27.63 133.12 percent of total billed charges 481.78 481.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOCK STAINLESS STEEL 2.5 MM FLUTE L 38 MM L 14 MM OD 4 MM ODSEC 6 MM HIP CANNULATED SELF TAP TROCAR STERILE SUP-121838 CDM 0270 RC outpatient 481.78 481.78 481.78 74 356.52 percent of total billed charges 481.78 93 390.24 percent of total billed charges 481.78 481.78 other OPPS APC 481.78 481.78 other OPPS APC 481.78 27.63 133.12 percent of total billed charges 481.78 481.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 40 MM OD 4 MM CANNULATED SUP-121840 CDM 0270 RC outpatient 481.78 481.78 481.78 74 356.52 percent of total billed charges 481.78 93 390.24 percent of total billed charges 481.78 481.78 other OPPS APC 481.78 481.78 other OPPS APC 481.78 27.63 133.12 percent of total billed charges 481.78 481.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC STAINLESS STEEL 2.5 MM FLUTE L42 MM L14 MM OD4 MM ODSEC6 MM HIP SELF TAP CANNULATED TROCAR STERILE SUP-121842 CDM 0270 RC outpatient 481.78 481.78 481.78 74 356.52 percent of total billed charges 481.78 93 390.24 percent of total billed charges 481.78 481.78 other OPPS APC 481.78 481.78 other OPPS APC 481.78 27.63 133.12 percent of total billed charges 481.78 481.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L46 MM L15 MM OD4 MM HIP CANNULATED STERILE SUP-121846 CDM 0270 RC outpatient 481.78 481.78 481.78 74 356.52 percent of total billed charges 481.78 93 390.24 percent of total billed charges 481.78 481.78 other OPPS APC 481.78 481.78 other OPPS APC 481.78 27.63 133.12 percent of total billed charges 481.78 481.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC STAINLESS STEEL 2.5MM FLUTE PARTIAL THREAD L 48 MM L 15 MM OD 4 MM ODSEC 6 MM HIP SELF TAP CANNUALTED TROCAR LOW PROFILE STERILE SUP-121848 CDM 0270 RC outpatient 481.78 481.78 481.78 74 356.52 percent of total billed charges 481.78 93 390.24 percent of total billed charges 481.78 481.78 other OPPS APC 481.78 481.78 other OPPS APC 481.78 27.63 133.12 percent of total billed charges 481.78 481.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 50 MM OD 4 MM CANNULATED SUP-121850 CDM 0270 RC outpatient 481.78 481.78 481.78 74 356.52 percent of total billed charges 481.78 93 390.24 percent of total billed charges 481.78 481.78 other OPPS APC 481.78 481.78 other OPPS APC 481.78 27.63 133.12 percent of total billed charges 481.78 481.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC STAINLESS STEEL 2.5 MM FLUTE L 60 MM L 15 MM OD 4 MM ODSEC MM HIP SELF TAP CANNUALTED TROCAR STERILE SUP-121860 CDM 0270 RC outpatient 481.78 481.78 481.78 74 356.52 percent of total billed charges 481.78 93 390.24 percent of total billed charges 481.78 481.78 other OPPS APC 481.78 481.78 other OPPS APC 481.78 27.63 133.12 percent of total billed charges 481.78 481.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION SURPASS STREAMLINE L30MM OD 5MM SUP-121USPH CDM 0270 RC outpatient 38610 38610 38610 74 28571.4 percent of total billed charges 38610 93 31274.1 percent of total billed charges 38610 38610 other OPPS APC 38610 38610 other OPPS APC 38610 27.63 10667.9 percent of total billed charges 38610 38610 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR DURALOC +4MM OFFSET NEUTRAL 52MM 32MM MARATHON STERILE LF HIP SUP-1220-32-452 CDM 270010024 LOCAL 0270 RC outpatient 4452.24 4452.24 4452.24 74 3294.66 percent of total billed charges 4452.24 93 3606.31 percent of total billed charges 4452.24 4452.24 other OPPS APC 4452.24 4452.24 other OPPS APC 4452.24 27.63 1230.15 percent of total billed charges 4452.24 4452.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR DURALOC MARATHON +4 MM NEUTRAL OD56 MM ID36 MM HIP SUP-1220-36-456 CDM 270010024 LOCAL 0270 RC outpatient 3532.1 3532.1 3532.1 74 2613.75 percent of total billed charges 3532.1 93 2861 percent of total billed charges 3532.1 3532.1 other OPPS APC 3532.1 3532.1 other OPPS APC 3532.1 27.63 975.92 percent of total billed charges 3532.1 3532.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR DURALOC MARATHON 10 D +4 MM NEUTRAL OD56 MM ID36 MM HIP SUP-1220-36-556 CDM 270010024 LOCAL 0270 RC outpatient 4238.52 4238.52 4238.52 74 3136.5 percent of total billed charges 4238.52 93 3433.2 percent of total billed charges 4238.52 4238.52 other OPPS APC 4238.52 4238.52 other OPPS APC 4238.52 27.63 1171.1 percent of total billed charges 4238.52 4238.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER PINNACLE ACETABULAR NEUTRAL 32MM SUP-1221-32-052 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ACETABULAR LINER PINNACLE 10 DEG 32MM X60MM SUP-1221-32-150 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR PINNACLE 48MM 32MM DIAMETER SUP-1221-32-448 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR PINNACLE +4MM NEUTRAL 52MM 32MM ALTRX STERILE LF HIP SUP-1221-32-452 CDM 270010024 LOCAL 0270 RC outpatient 3926.52 3926.52 3926.52 74 2905.62 percent of total billed charges 3926.52 93 3180.48 percent of total billed charges 3926.52 3926.52 other OPPS APC 3926.52 3926.52 other OPPS APC 3926.52 27.63 1084.9 percent of total billed charges 3926.52 3926.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER PINNACLE ACETABULAR NEUTRAL +4 54MM SUP-1221-36-454 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER PINNACLE ALTRX 28MM +4 58MM NEUTRAL SUP-1221-36-458 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS SURGICAL STAINLESS STEEL TUNGSTEN CARBIDE L6 IN L12 MM X W3 MM 1 X 2 TEETH GENERAL NEEDLE CARB BITE TISSUE PULL NONSTERILE SUP-122560 CDM outpatient 150.67 150.67 150.67 150.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION SURPASS STREAMLINE L40MM OD 5MM SUP-122USPH CDM 0270 RC outpatient 41990 41990 41990 74 31072.6 percent of total billed charges 41990 93 34011.9 percent of total billed charges 41990 41990 other OPPS APC 41990 41990 other OPPS APC 41990 27.63 11601.8 percent of total billed charges 41990 41990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEUROMONITORING CHARGES SUP-123-2967 CDM 0270 RC outpatient 416 416 416 74 307.84 percent of total billed charges 416 93 336.96 percent of total billed charges 416 416 other OPPS APC 416 416 other OPPS APC 416 27.63 114.94 percent of total billed charges 416 416 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT REFILL ALGINOT 50 ML FAST SET SUP-1234539 CDM outpatient 44.96 44.96 44.96 44.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT FOR X3 LINER 22.2MM SIZE36C SUP-1236-2-242 CDM 270010024 LOCAL 0270 RC outpatient 3559.4 3559.4 3559.4 74 2633.96 percent of total billed charges 3559.4 93 2883.11 percent of total billed charges 3559.4 3559.4 other OPPS APC 3559.4 3559.4 other OPPS APC 3559.4 27.63 983.46 percent of total billed charges 3559.4 3559.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR MDM ADM X3 COCR POLYETHYLENE 38 D H22.2 MM HIP SUP-1236-2-244 CDM 270010024 LOCAL 0270 RC outpatient 3559.4 3559.4 3559.4 74 2633.96 percent of total billed charges 3559.4 93 2883.11 percent of total billed charges 3559.4 3559.4 other OPPS APC 3559.4 3559.4 other OPPS APC 3559.4 27.63 983.46 percent of total billed charges 3559.4 3559.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR ADM MOBILE BEARING HIP RESTORATION X3 POLYETHYLENE H6.9 MM OD42 MM ODSEC48 MM ID28 MM HIP SUP-1236-2-848 CDM 270010024 LOCAL 0270 RC outpatient 3559.4 3559.4 3559.4 74 2633.96 percent of total billed charges 3559.4 93 2883.11 percent of total billed charges 3559.4 3559.4 other OPPS APC 3559.4 3559.4 other OPPS APC 3559.4 27.63 983.46 percent of total billed charges 3559.4 3559.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR ADM MOBILE BEARING HIP RESTORATION X3 POLYETHYLENE H8.9 MM OD46 MM ODSEC52 MM ID28 MM HIP SUP-1236-2-852 CDM 270010024 LOCAL 0270 RC outpatient 3559.4 3559.4 3559.4 74 2633.96 percent of total billed charges 3559.4 93 2883.11 percent of total billed charges 3559.4 3559.4 other OPPS APC 3559.4 3559.4 other OPPS APC 3559.4 27.63 983.46 percent of total billed charges 3559.4 3559.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR ADM MOBILE BEARING HIP RESTORATION X3 POLYETHYLENE H9.9 MM OD48 MM ODSEC54 MM ID28 MM HIP SUP-1236-2-854 CDM 270010024 LOCAL 0270 RC outpatient 3559.4 3559.4 3559.4 74 2633.96 percent of total billed charges 3559.4 93 2883.11 percent of total billed charges 3559.4 3559.4 other OPPS APC 3559.4 3559.4 other OPPS APC 3559.4 27.63 983.46 percent of total billed charges 3559.4 3559.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT FOR X3 LINER 28MM /58 SIZE 52H SUP-1236-2-858 CDM 270010024 LOCAL 0270 RC outpatient 3559.4 3559.4 3559.4 74 2633.96 percent of total billed charges 3559.4 93 2883.11 percent of total billed charges 3559.4 3559.4 other OPPS APC 3559.4 3559.4 other OPPS APC 3559.4 27.63 983.46 percent of total billed charges 3559.4 3559.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT FOR X3 LINER 28MM 60 SIZE54I SUP-1236-2-860 CDM 270010024 LOCAL 0270 RC outpatient 3559.4 3559.4 3559.4 74 2633.96 percent of total billed charges 3559.4 93 2883.11 percent of total billed charges 3559.4 3559.4 other OPPS APC 3559.4 3559.4 other OPPS APC 3559.4 27.63 983.46 percent of total billed charges 3559.4 3559.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR ADM MOBILE BEARING HIP RESTORATION X3 0 D H14.9 MM OD64 MM ID28 MM SUP-1236-2-864 CDM 270010024 LOCAL 0270 RC outpatient 3559.4 3559.4 3559.4 74 2633.96 percent of total billed charges 3559.4 93 2883.11 percent of total billed charges 3559.4 3559.4 other OPPS APC 3559.4 3559.4 other OPPS APC 3559.4 27.63 983.46 percent of total billed charges 3559.4 3559.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION SURPASS STREAMLINE L50MM OD 5MM SUP-123USPH CDM 0270 RC outpatient 41990 41990 41990 74 31072.6 percent of total billed charges 41990 93 34011.9 percent of total billed charges 41990 41990 other OPPS APC 41990 41990 other OPPS APC 41990 27.63 11601.8 percent of total billed charges 41990 41990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP LOCKING REVERE NS SPINAL SUP-124.000 CDM 270010020 LOCAL 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE REVERE TITANIUM L45 MM OD5.5 MM SPINE PEDICLE POLYAXIAL SUP-124.455 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE REVERE TITANIUM L40 MM OD6.5 MM SPINE PEDICLE POLYAXIAL SUP-124.464 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.5MM 45MM REVERE TITANIUM SPINE PEDICLE POLYAXIAL SUP-124.465 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE REVERE TITANIUM L50 MM OD6.5 MM SPINE PEDICLE POLYAXIAL SUP-124.466 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.5MM 55MM REVERE TITANIUM SPINE PEDICLE POLYAXIAL SUP-124.467 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.5MM 60MM REVERE TITANIUM SPINE PEDICLE POLYAXIAL SUP-124.468 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE REVERE TITANIUM L35 MM OD7.5 MM SPINE PEDICLE POLYAXIAL SUP-124.473 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE REVERE 40MM 7.5MM TITANIUM NS SPINE PEDICLE SUP-124.474 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE REVERE TITANIUM L45 MM OD7.5 MM SPINE PEDICLE POLYAXIAL SUP-124.475 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE REVERE TITANIUM L50 MM OD7.5 MM SPINE PEDICLE POLYAXIAL SUP-124.476 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE REVERE L55 MM OD7.5 MM SPINE PEDICLE SUP-124.477 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE REVERE TITANIUM L30 MM OD8.5 MM SPINE PEDICLE POLYAXIAL SUP-124.482 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE REVERE TITANIUM L50 MM OD8.5 MM SPINE PEDICLE POLYAXIAL SUP-124.486 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL REVERE STRAIGHT 125MM 5.5MM TITANIUM NS PEDICLE SUP-124.512 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL REVERE STRAIGHT 150MM 5.5MM TITANIUM NS PEDICLE SUP-124.515 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL REVERE TITANIUM L45 MM OD5.5 MM PEDICLE STRAIGHT SUP-124.545 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD GLOBUS 125MM REVERE SUP-124.612 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL REVERE TITANIUM L45 MM OD5.5 MM PEDICLE CURVED SUP-124.645 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL REVERE TITANIUM L55 MM OD5.5 MM PEDICLE CURVED SUP-124.655 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL REVERE TITANIUM L75 MM OD5.5 MM PEDICLE CURVED SUP-124.675 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL REVERE TITANIUM L85 MM OD5.5 MM PEDICLE CURVED SUP-124.685 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL REVERE TITANIUM L90 MM OD5.5 MM CURVED SUP-124.690 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL TITANIUM L95 MM OD5.5 MM CURVED SUP-124.695 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR ROD REVERE TITANIUM L38-51 MM SPINE PEDICLE TRANSVERSE ADJUSTABLE SUP-124.914 CDM 270010020 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR DURALOC 50MM 28MM ENDURON STERILE LF HIP CONSTRAIN SUP-1241-10-527 CDM 270010024 LOCAL 0270 RC outpatient 7414.68 7414.68 7414.68 74 5486.86 percent of total billed charges 7414.68 93 6005.89 percent of total billed charges 7414.68 7414.68 other OPPS APC 7414.68 7414.68 other OPPS APC 7414.68 27.63 2048.68 percent of total billed charges 7414.68 7414.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR DURALOC 56/68MM 32MM ENDURON STERILE LF HIP CONSTRAIN SUP-1242-16-527 CDM 270010024 LOCAL 0270 RC outpatient 7413.38 7413.38 7413.38 74 5485.9 percent of total billed charges 7413.38 93 6004.84 percent of total billed charges 7413.38 7413.38 other OPPS APC 7413.38 7413.38 other OPPS APC 7413.38 27.63 2048.32 percent of total billed charges 7413.38 7413.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTROL STERILIZATION 3M COMPLY STERIGAGE 17.8X1.8CM PAPER CLASS 5 STEAM CHEMICAL SUP-1243E CDM 0270 RC outpatient 0.23 0.23 0.23 74 0.17 percent of total billed charges 0.23 93 0.19 percent of total billed charges 0.23 0.23 other OPPS APC 0.23 0.23 other OPPS APC 0.23 27.63 0.06 percent of total billed charges 0.23 0.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INDICATOR STERILIZATION 3M COMPLY STERIGAGE PAPER 250-275 F L9 IN X W3/4 IN STEAM CHEMICAL INTEGRATOR EXTENDER MOVE FRONT INK SUP-1243RE CDM 0270 RC outpatient 0.21 0.21 0.21 74 0.16 percent of total billed charges 0.21 93 0.17 percent of total billed charges 0.21 0.21 other OPPS APC 0.21 0.21 other OPPS APC 0.21 27.63 0.06 percent of total billed charges 0.21 0.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELIMINATOR HOLE PINNACLE MARATHON STERILE HIP APEX SUP-1246-03-000 CDM 270010024 LOCAL 0270 RC outpatient 500.76 500.76 500.76 74 370.56 percent of total billed charges 500.76 93 405.62 percent of total billed charges 500.76 500.76 other OPPS APC 500.76 500.76 other OPPS APC 500.76 27.63 138.36 percent of total billed charges 500.76 500.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ACETABULAR DURALOC DYNAMIC 60/72MM STERILE LF HIP LOCK SUP-1249-50-000 CDM 270010024 LOCAL 0270 RC outpatient 778.44 778.44 778.44 74 576.05 percent of total billed charges 778.44 93 630.54 percent of total billed charges 778.44 778.44 other OPPS APC 778.44 778.44 other OPPS APC 778.44 27.63 215.08 percent of total billed charges 778.44 778.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ACETABULAR DURALOC DYNAMIC 52MM STERILE LF HIP LOCK SUP-1249-52-000 CDM 270010024 LOCAL 0270 RC outpatient 778.44 778.44 778.44 74 576.05 percent of total billed charges 778.44 93 630.54 percent of total billed charges 778.44 778.44 other OPPS APC 778.44 778.44 other OPPS APC 778.44 27.63 215.08 percent of total billed charges 778.44 778.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ACETABULAR DURALOC DYNAMIC OD56 MM HIP LOCK SUP-1249-56-000 CDM 270010024 LOCAL 0270 RC outpatient 634.92 634.92 634.92 74 469.84 percent of total billed charges 634.92 93 514.29 percent of total billed charges 634.92 634.92 other OPPS APC 634.92 634.92 other OPPS APC 634.92 27.63 175.43 percent of total billed charges 634.92 634.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION SURPASS STREAMLINE L20MM OD 5MM SUP-124USPH CDM 0270 RC outpatient 38610 38610 38610 74 28571.4 percent of total billed charges 38610 93 31274.1 percent of total billed charges 38610 38610 other OPPS APC 38610 38610 other OPPS APC 38610 27.63 10667.9 percent of total billed charges 38610 38610 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCRUB SURGICAL CLOTH CHG L10.5 IN X W9 IN RINSE FREE NONSTERILE LATEX FREE FRAGRANCE FREE SUP-12536 CDM outpatient 1.92 1.92 1.92 1.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING QUICKFLEX STEROID ELUTING MICRO S CURVE L75 CM OD4.3 FR VENTRICLE LEFT BIPOLAR STEERABLE TIP OPTIM INSULATION IS-1 SUP-1258T/75 CDM 0275 RC outpatient 2995.2 2995.2 2995.2 57 1707.26 percent of total billed charges 2995.2 93 2426.11 percent of total billed charges 2995.2 2995.2 other OPPS APC 2995.2 2995.2 other OPPS APC 2995.2 51 1527.55 percent of total billed charges 2995.2 2995.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING QUICKFLEX STEROID ELUTING MICRO S CURVE L86 CM OD4.3 FR VENTRICLE LEFT BIPOLAR STEERABLE TIP OPTIM INSULATION IS-1 SUP-1258T/86 CDM 0275 RC outpatient 2995.2 2995.2 2995.2 57 1707.26 percent of total billed charges 2995.2 93 2426.11 percent of total billed charges 2995.2 2995.2 other OPPS APC 2995.2 2995.2 other OPPS APC 2995.2 51 1527.55 percent of total billed charges 2995.2 2995.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET ADMINISTRATION LIFESHIELD CAIR CLAVE OPTION-LOK 15 GTT/ML L100 IN ID.1 IN 16 ML CONVERTIBLE PIERCE PIN FILTER VENT COVER SLIDE CLAMP PRIMARY NONSTERILE LATEX FREE SUP-1266128 CDM 0270 RC outpatient 8.61 8.61 8.61 74 6.37 percent of total billed charges 8.61 93 6.97 percent of total billed charges 8.61 8.61 other OPPS APC 8.61 8.61 other OPPS APC 8.61 27.63 2.38 percent of total billed charges 8.61 8.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE PERCLOSE OD6 FR VASCULAR SUTURE MEDIATE KNOT PUSH STERILE DISPOSABLE SUP-12673-03 CDM 0270 RC outpatient 652.6 652.6 652.6 74 482.92 percent of total billed charges 652.6 93 528.61 percent of total billed charges 652.6 652.6 other OPPS APC 652.6 652.6 other OPPS APC 652.6 27.63 180.31 percent of total billed charges 652.6 652.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISP 27G REPLACEMENT INSERTER SUP-1272.EDPP4 CDM 0270 RC outpatient 266.93 266.93 266.93 74 197.53 percent of total billed charges 266.93 93 216.21 percent of total billed charges 266.93 266.93 other OPPS APC 266.93 266.93 other OPPS APC 266.93 27.63 73.75 percent of total billed charges 266.93 266.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROWATER STRAIGHT TIP GUIDEWIRE 180CM SUP-12776-01 CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAND SLAM STRAIGHT TIP GUIDEWIRE 180CM SUP-12781-01 CDM 0481 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 51 152.49 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONFIANZA WIRE 180CM STRAIGHT SUP-12784-01 CDM 0481 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 51 265.2 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE PIN ORTHOPEDIC BAYONET L 140MM OD 1.3MM STERILE DIPOSABLE 4MM 5MM CANNULATED SCREW SUP-128039 CDM 0270 RC outpatient 57.9 57.9 57.9 74 42.85 percent of total billed charges 57.9 93 46.9 percent of total billed charges 57.9 57.9 other OPPS APC 57.9 57.9 other OPPS APC 57.9 27.63 16 percent of total billed charges 57.9 57.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESERVOIR OPHTHALMIC REPLACEMENT BACKFLUSH STERILE SUP-1281.A1D CDM 0270 RC outpatient 92.56 92.56 92.56 74 68.49 percent of total billed charges 92.56 93 74.97 percent of total billed charges 92.56 92.56 other OPPS APC 92.56 92.56 other OPPS APC 92.56 27.63 25.57 percent of total billed charges 92.56 92.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL TRAY ROTATING PLATFORM SIZE 4 SUP-1284-35-140 CDM 270010025 LOCAL 0270 RC outpatient 9505.08 9505.08 9505.08 74 7033.76 percent of total billed charges 9505.08 93 7699.11 percent of total billed charges 9505.08 9505.08 other OPPS APC 9505.08 9505.08 other OPPS APC 9505.08 27.63 2626.25 percent of total billed charges 9505.08 9505.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER CATHETER ACQGUIDE MINI-S 8.5FR ID 12FR OD 65CM 90DEG L2 FIXED CURVED SUP-12852_72395 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS SURGICAL MICRO OD27 GA EXTEND WIDE GRIP STERILE DISPOSABLE SUP-1286.WRD04 CDM 0270 RC outpatient 536.12 536.12 536.12 74 396.73 percent of total billed charges 536.12 93 434.26 percent of total billed charges 536.12 536.12 other OPPS APC 536.12 536.12 other OPPS APC 536.12 27.63 148.13 percent of total billed charges 536.12 536.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCISSOR MICRO HORIZONTAL CURVED STERILE DISPOSABLE 20GA X 0.5MM SUP-1286MD05 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL MBT 2.5MM 67.1X44.2X4.8MM STERILE LF KNEE CEMENTED REVISION ROTATE PLATFORM SUP-1294-35-125 CDM 270010025 LOCAL 0270 RC outpatient 12328.7 12328.7 12328.7 74 9123.22 percent of total billed charges 12328.7 93 9986.23 percent of total billed charges 12328.7 12328.7 other OPPS APC 12328.7 12328.7 other OPPS APC 12328.7 27.63 3406.41 percent of total billed charges 12328.7 12328.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL MBT 3MM 69.6X45.8X4.8MM STERILE LF KNEE CEMENTED REVISION ROTATE PLATFORM SUP-1294-35-130 CDM 270010025 LOCAL 0270 RC outpatient 12328.7 12328.7 12328.7 74 9123.22 percent of total billed charges 12328.7 93 9986.23 percent of total billed charges 12328.7 12328.7 other OPPS APC 12328.7 12328.7 other OPPS APC 12328.7 27.63 3406.41 percent of total billed charges 12328.7 12328.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL MBT 4MM 74.9X49.3X4.8MM STERILE LF KNEE CEMENTED REVISION ROTATE PLATFORM SUP-1294-35-140 CDM 270010025 LOCAL 0270 RC outpatient 12328.7 12328.7 12328.7 74 9123.22 percent of total billed charges 12328.7 93 9986.23 percent of total billed charges 12328.7 12328.7 other OPPS APC 12328.7 12328.7 other OPPS APC 12328.7 27.63 3406.41 percent of total billed charges 12328.7 12328.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE TIBIAL MBT 37X27X40MM POROUS STERILE LF KNEE METAPHYSEAL REVISION SUP-1294-51-100 CDM 270010025 LOCAL 0270 RC outpatient 6776.64 6776.64 6776.64 74 5014.71 percent of total billed charges 6776.64 93 5489.08 percent of total billed charges 6776.64 6776.64 other OPPS APC 6776.64 6776.64 other OPPS APC 6776.64 27.63 1872.39 percent of total billed charges 6776.64 6776.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE ADAPTER UNIVERSAL 31MM POROUS STERILE LF KNEE FEMORAL SIGMA LCS S-ROM LPS SUP-1294-53-215 CDM 270010025 LOCAL 0270 RC outpatient 6595.68 6595.68 6595.68 74 4880.8 percent of total billed charges 6595.68 93 5342.5 percent of total billed charges 6595.68 6595.68 other OPPS APC 6595.68 6595.68 other OPPS APC 6595.68 27.63 1822.39 percent of total billed charges 6595.68 6595.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE ADAPTER UNIVERSAL 31MM POROUS STERILE LF KNEE FEMORAL SIGMA LCS S-ROM LPS SUP-1294-53-216 CDM 270010025 LOCAL 0270 RC outpatient 7773.48 7773.48 7773.48 74 5752.38 percent of total billed charges 7773.48 93 6296.52 percent of total billed charges 7773.48 7773.48 other OPPS APC 7773.48 7773.48 other OPPS APC 7773.48 27.63 2147.81 percent of total billed charges 7773.48 7773.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT DEPUY SLEEVE UNIV FEMORAL POROUS 34MM SUP-1294-53-226 CDM 270010025 LOCAL 0270 RC outpatient 7773.48 7773.48 7773.48 74 5752.38 percent of total billed charges 7773.48 93 6296.52 percent of total billed charges 7773.48 7773.48 other OPPS APC 7773.48 7773.48 other OPPS APC 7773.48 27.63 2147.81 percent of total billed charges 7773.48 7773.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE ADAPTER UNIVERSAL 46MM POROUS STERILE LF KNEE FEMORAL SIGMA LCS S-ROM LPS SUP-1294-53-246 CDM 270010025 LOCAL 0270 RC outpatient 7773.48 7773.48 7773.48 74 5752.38 percent of total billed charges 7773.48 93 6296.52 percent of total billed charges 7773.48 7773.48 other OPPS APC 7773.48 7773.48 other OPPS APC 7773.48 27.63 2147.81 percent of total billed charges 7773.48 7773.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE TIBIAL MBT 29X26X40MM POROUS STERILE LF KNEE METAPHYSEAL REVISION SUP-1294-54-000 CDM 270010025 LOCAL 0270 RC outpatient 6776.64 6776.64 6776.64 74 5014.71 percent of total billed charges 6776.64 93 5489.08 percent of total billed charges 6776.64 6776.64 other OPPS APC 6776.64 6776.64 other OPPS APC 6776.64 27.63 1872.39 percent of total billed charges 6776.64 6776.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE TIBIAL MBT 37X27X40MM POROUS STERILE LF KNEE METAPHYSEAL REVISION SUP-1294-54-100 CDM 270010025 LOCAL 0270 RC outpatient 6776.64 6776.64 6776.64 74 5014.71 percent of total billed charges 6776.64 93 5489.08 percent of total billed charges 6776.64 6776.64 other OPPS APC 6776.64 6776.64 other OPPS APC 6776.64 27.63 1872.39 percent of total billed charges 6776.64 6776.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE TIBIAL MBT POROUS L45 MM KNEE REVISION SUP-1294-54-110 CDM 270010025 LOCAL 0270 RC outpatient 6776.64 6776.64 6776.64 74 5014.71 percent of total billed charges 6776.64 93 5489.08 percent of total billed charges 6776.64 6776.64 other OPPS APC 6776.64 6776.64 other OPPS APC 6776.64 27.63 1872.39 percent of total billed charges 6776.64 6776.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE TIBIAL MBT 61X34X40MM POROUS STERILE LF KNEE METAPHYSEAL REVISION SUP-1294-54-130 CDM 270010025 LOCAL 0270 RC outpatient 6776.64 6776.64 6776.64 74 5014.71 percent of total billed charges 6776.64 93 5489.08 percent of total billed charges 6776.64 6776.64 other OPPS APC 6776.64 6776.64 other OPPS APC 6776.64 27.63 1872.39 percent of total billed charges 6776.64 6776.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT TIBIAL MBT 3 5MM STERILE LF KNEE REVISION STEP WEDGE SUP-1294-56-130 CDM 270010025 LOCAL 0270 RC outpatient 4873.44 4873.44 4873.44 74 3606.35 percent of total billed charges 4873.44 93 3947.49 percent of total billed charges 4873.44 4873.44 other OPPS APC 4873.44 4873.44 other OPPS APC 4873.44 27.63 1346.53 percent of total billed charges 4873.44 4873.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARD BARDEX IC 6FT 16FR 5CC BACTI-GUARD HYDROGEL DISPOSABLE STERILE SUP-129416 CDM outpatient 50.46 50.46 50.46 50.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL CONVERTORS TIBURON L55.5 IN X W28 IN OD8 IN HIP FENESTRATED ARMBOARD COVER TUBE HOLDER ABSORBENT IMPERVIOUS REINFORCEMENT PAD STERILE LATEX FREE DISPOSABLE SUP-129430A CDM 0270 RC outpatient 14.63 14.63 14.63 74 10.83 percent of total billed charges 14.63 93 11.85 percent of total billed charges 14.63 14.63 other OPPS APC 14.63 14.63 other OPPS APC 14.63 27.63 4.04 percent of total billed charges 14.63 14.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER INTEGRA METATARSAL SUP-129722 CDM 0270 RC outpatient 1554.8 1554.8 1554.8 74 1150.55 percent of total billed charges 1554.8 93 1259.39 percent of total billed charges 1554.8 1554.8 other OPPS APC 1554.8 1554.8 other OPPS APC 1554.8 27.63 429.59 percent of total billed charges 1554.8 1554.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER INTEGRA PHALANX SUP-129752 CDM 0270 RC outpatient 1554.8 1554.8 1554.8 74 1150.55 percent of total billed charges 1554.8 93 1259.39 percent of total billed charges 1554.8 1554.8 other OPPS APC 1554.8 1554.8 other OPPS APC 1554.8 27.63 429.59 percent of total billed charges 1554.8 1554.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK EMBOLECTOMY FOGARTY L80 CM OD3 FR ARTERY BALLOON SYRINGE FLAT STERILE SUP-12A0803F CDM outpatient 797.55 797.55 797.55 797.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REINFORCEMENT STAPLE LINE SEAMGUARD BIOABSORBABLE STERILE LATEX FREE DISPOSABLE BLUE GOLD GREEN WHITE ENDOPATH ECHELON FLEX 60 SUP-12BSGEC60A CDM 0270 RC outpatient 433.33 433.33 433.33 74 320.66 percent of total billed charges 433.33 93 351 percent of total billed charges 433.33 433.33 other OPPS APC 433.33 433.33 other OPPS APC 433.33 27.63 119.73 percent of total billed charges 433.33 433.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EMBOLECTOMY FOGARTY THRULUMEN STAINLESS STEEL SILICONE NATURAL RUBBER L80 CM OD5.5 FR ODSEC11 MM ARTERIAL OTW RADIOPAQUE STERILE LATEX ACCEPTS .035 IN GUIDEWIRE 6 FR INTRODUCER SUP-12TLW805F35 CDM 0270 RC outpatient 249.6 249.6 249.6 74 184.7 percent of total billed charges 249.6 93 202.18 percent of total billed charges 249.6 249.6 other OPPS APC 249.6 249.6 other OPPS APC 249.6 27.63 68.96 percent of total billed charges 249.6 249.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VISTASEAL FIBRIN SEALANT (HUMAN) 10 ML-12 PACK KIT SUP-12VST10 CDM 0270 RC outpatient 1383.99 1383.99 1383.99 74 1024.15 percent of total billed charges 1383.99 93 1121.03 percent of total billed charges 1383.99 1383.99 other OPPS APC 1383.99 1383.99 other OPPS APC 1383.99 27.63 382.4 percent of total billed charges 1383.99 1383.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POUCH UROSTOMY W/WAFER SUP-13-00004 CDM 0272 RC outpatient 0.75 0.75 0.75 74 0.56 percent of total billed charges 0.75 93 0.61 percent of total billed charges 0.75 0.75 other OPPS APC 0.75 0.75 other OPPS APC 0.75 27.63 0.21 percent of total billed charges 0.75 0.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLOSTOMY/ILEOSTOMY CUT TO FIT SUP-13-00006 CDM 0272 RC outpatient 0.32 0.32 0.32 74 0.24 percent of total billed charges 0.32 93 0.26 percent of total billed charges 0.32 0.32 other OPPS APC 0.32 0.32 other OPPS APC 0.32 27.63 0.09 percent of total billed charges 0.32 0.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOLLISTER PREMIUM PASTE SUP-13-00007 CDM 0271 RC outpatient 2.3 2.3 2.3 74 1.7 percent of total billed charges 2.3 93 1.86 percent of total billed charges 2.3 2.3 other OPPS APC 2.3 2.3 other OPPS APC 2.3 27.63 0.64 percent of total billed charges 2.3 2.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARRIER SKIN NEW IMAGE CERAPLUS CERAMIDE FLAT OD 2 3./4 IN ODSEC 2 1/4 IN 2 PIECE CUT TO FIT INTEGRATE FLOAT FLANGE TAPE BORDER LATEX FREE BLUE SUP-13-00008 CDM 0272 RC outpatient 0.45 0.45 0.45 74 0.33 percent of total billed charges 0.45 93 0.36 percent of total billed charges 0.45 0.45 other OPPS APC 0.45 0.45 other OPPS APC 0.45 27.63 0.12 percent of total billed charges 0.45 0.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXI-SEAL BAGS SUP-13-00009 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT FLEXI-SEAL SUP-13-00010 CDM 0272 RC outpatient 394.63 394.63 394.63 74 292.03 percent of total billed charges 394.63 93 319.65 percent of total billed charges 394.63 394.63 other OPPS APC 394.63 394.63 other OPPS APC 394.63 27.63 109.04 percent of total billed charges 394.63 394.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALER BIPOLAR DS30 TRANSCOLLATION 10 D CYLINDER L.438 IN L4.33 IN OD.118 IN DISSECT ELECTRODE DISPOSABLE SUP-13-101-1 CDM 0270 RC outpatient 2508.79 2508.79 2508.79 74 1856.5 percent of total billed charges 2508.79 93 2032.12 percent of total billed charges 2508.79 2508.79 other OPPS APC 2508.79 2508.79 other OPPS APC 2508.79 27.63 693.18 percent of total billed charges 2508.79 2508.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TISSUELINK ENDO SH 2.0 SEALING HOOK SUP-13-201-1 CDM 0270 RC outpatient 2508.79 2508.79 2508.79 74 1856.5 percent of total billed charges 2508.79 93 2032.12 percent of total billed charges 2508.79 2508.79 other OPPS APC 2508.79 2508.79 other OPPS APC 2508.79 27.63 693.18 percent of total billed charges 2508.79 2508.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.1MM PRECISION LONG CURVED TIP & TUBESET SUP-130-33-2411 CDM 0270 RC outpatient 1965.6 1965.6 1965.6 74 1454.54 percent of total billed charges 1965.6 93 1592.14 percent of total billed charges 1965.6 1965.6 other OPPS APC 1965.6 1965.6 other OPPS APC 1965.6 27.63 543.1 percent of total billed charges 1965.6 1965.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.9MM STANDARD LONG CURVED TIP & TUBESET SUP-130-33-2419 CDM 0270 RC outpatient 1965.6 1965.6 1965.6 74 1454.54 percent of total billed charges 1965.6 93 1592.14 percent of total billed charges 1965.6 1965.6 other OPPS APC 1965.6 1965.6 other OPPS APC 1965.6 27.63 543.1 percent of total billed charges 1965.6 1965.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.9MM STANDARD SHORT TIP & TUBESET SUP-130-35-1419 CDM 0270 RC outpatient 1965.6 1965.6 1965.6 74 1454.54 percent of total billed charges 1965.6 93 1592.14 percent of total billed charges 1965.6 1965.6 other OPPS APC 1965.6 1965.6 other OPPS APC 1965.6 27.63 543.1 percent of total billed charges 1965.6 1965.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "1.9MM NOTCHED, STANDARD SHORT TIP & TUBESET" SUP-130-35-1499 CDM 0270 RC outpatient 2031.12 2031.12 2031.12 74 1503.03 percent of total billed charges 2031.12 93 1645.21 percent of total billed charges 2031.12 2031.12 other OPPS APC 2031.12 2031.12 other OPPS APC 2031.12 27.63 561.2 percent of total billed charges 2031.12 2031.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COAGULATOR SUCTION L6 IN OD10 FR MONOPOLAR FOOTSWITCH STERILE SUP-130187 CDM outpatient 16.74 16.74 16.74 16.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL GOLDLINE PENCIL BLADE 1 IN STANDARD L10 FT ROCKER SWITCH SAFETY HOLSTER CORD STERILE LATEX FREE DISPOSABLE YELLOW SUP-130307A CDM outpatient 125.53 125.53 125.53 125.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH SURGICAL GORE-TEX THK2 MM L10 CM X W5 CM SOFT CONFORMABLE TRIM STRONG STERILE HERNIA REPAIR SUP-1305010020 CDM 0270 RC outpatient 1393.6 1393.6 1393.6 74 1031.26 percent of total billed charges 1393.6 93 1128.82 percent of total billed charges 1393.6 1393.6 other OPPS APC 1393.6 1393.6 other OPPS APC 1393.6 27.63 385.05 percent of total billed charges 1393.6 1393.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH SOFT TISSUE GORE-TEX THK2 MM L15 CM X W10 CM SOFT CONFORMABLE TRIM STRONG STERILE HERNIA REPAIR SUP-1310015020 CDM 0270 RC outpatient 3400.8 3400.8 3400.8 74 2516.59 percent of total billed charges 3400.8 93 2754.65 percent of total billed charges 3400.8 3400.8 other OPPS APC 3400.8 3400.8 other OPPS APC 3400.8 27.63 939.64 percent of total billed charges 3400.8 3400.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG MULTIDIRECTIONAL THREADED 14MM SUP-131211114 CDM 0270 RC outpatient 421.67 421.67 421.67 74 312.04 percent of total billed charges 421.67 93 341.55 percent of total billed charges 421.67 421.67 other OPPS APC 421.67 421.67 other OPPS APC 421.67 27.63 116.51 percent of total billed charges 421.67 421.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG MULTIDIRECTIONAL THREADED 16MM SUP-131211116 CDM 0270 RC outpatient 421.67 421.67 421.67 74 312.04 percent of total billed charges 421.67 93 341.55 percent of total billed charges 421.67 421.67 other OPPS APC 421.67 421.67 other OPPS APC 421.67 27.63 116.51 percent of total billed charges 421.67 421.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG MULTIDIRECTIONAL THREADED 18MM SUP-131211118 CDM 0270 RC outpatient 421.67 421.67 421.67 74 312.04 percent of total billed charges 421.67 93 341.55 percent of total billed charges 421.67 421.67 other OPPS APC 421.67 421.67 other OPPS APC 421.67 27.63 116.51 percent of total billed charges 421.67 421.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION DVR L20 MM OD2.5 MM KNEE THREAD MULTIDIRECTIONAL NONSTERILE SUP-131211120 CDM outpatient 421.67 421.67 421.67 421.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG MULTIDIRECTIONAL THREADED 20MM SUP-131211120 CDM 0270 RC outpatient 421.67 421.67 421.67 74 312.04 percent of total billed charges 421.67 93 341.55 percent of total billed charges 421.67 421.67 other OPPS APC 421.67 421.67 other OPPS APC 421.67 27.63 116.51 percent of total billed charges 421.67 421.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG MULTIDIRECTIONAL THREADED 22MM SUP-131211122 CDM 0270 RC outpatient 421.67 421.67 421.67 74 312.04 percent of total billed charges 421.67 93 341.55 percent of total billed charges 421.67 421.67 other OPPS APC 421.67 421.67 other OPPS APC 421.67 27.63 116.51 percent of total billed charges 421.67 421.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG MULTIDIRECTIONAL THREADED 24MM SUP-131211124 CDM 0270 RC outpatient 421.67 421.67 421.67 74 312.04 percent of total billed charges 421.67 93 341.55 percent of total billed charges 421.67 421.67 other OPPS APC 421.67 421.67 other OPPS APC 421.67 27.63 116.51 percent of total billed charges 421.67 421.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG MULTIDIRECTIONAL THREADED 26MM SUP-131211126 CDM 0270 RC outpatient 421.67 421.67 421.67 74 312.04 percent of total billed charges 421.67 93 341.55 percent of total billed charges 421.67 421.67 other OPPS APC 421.67 421.67 other OPPS APC 421.67 27.63 116.51 percent of total billed charges 421.67 421.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG MULTIDIRECTIONAL THREADED 28MM SUP-131211128 CDM 0270 RC outpatient 421.67 421.67 421.67 74 312.04 percent of total billed charges 421.67 93 341.55 percent of total billed charges 421.67 421.67 other OPPS APC 421.67 421.67 other OPPS APC 421.67 27.63 116.51 percent of total billed charges 421.67 421.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG MULTIDIRECTIONAL THREADED 30MM SUP-131211130 CDM 0270 RC outpatient 421.67 421.67 421.67 74 312.04 percent of total billed charges 421.67 93 341.55 percent of total billed charges 421.67 421.67 other OPPS APC 421.67 421.67 other OPPS APC 421.67 27.63 116.51 percent of total billed charges 421.67 421.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOLD SHOULDER 10 STD 50X21X57 SUP-131410 CDM 0270 RC outpatient 10002.2 10002.2 10002.2 74 7401.63 percent of total billed charges 10002.2 93 8101.78 percent of total billed charges 10002.2 10002.2 other OPPS APC 10002.2 10002.2 other OPPS APC 10002.2 27.63 2763.61 percent of total billed charges 10002.2 10002.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POST FIXATION TITANIUM L45 MM OD4.5 MM SUTURE STERILE ACL/PCL SYSTEM SUP-13144 CDM 0270 RC outpatient 335.4 335.4 335.4 74 248.2 percent of total billed charges 335.4 93 271.67 percent of total billed charges 335.4 335.4 other OPPS APC 335.4 335.4 other OPPS APC 335.4 27.63 92.67 percent of total billed charges 335.4 335.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS ENDOSCOPIC RADIAL JAW 4 LARGE CAPACITY L240 CM NEEDLE STERILE DISPOSABLE SUP-1333-40 CDM outpatient 32.4 32.4 32.4 32.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL SALINE P5.7 CM FULL HEIGHT VARIABLE PROJECTION W13.5 CM X H13 CM 500 ML BREAST STYLE 133 TEXTURED MAGNA-SITE INJECTION SITE TAB SUP-133FV-13-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER FULL HEIGHT VARIABLE PROJECTION WITH TABS SUP-133FV-15T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER FULL HEIGHT VARIABLE PROJECTION WITH TABS SUP-133FV-16T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL SALINE P6.3 CM FULL HEIGHT EXTRA PROJECTION W12 CM X H12.5 CM 450 ML BREAST STYLE 133FX 133FX-T TEXTURED TAB STERILE SUP-133FX-12-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL SALINE P6.7 CM FULL HEIGHT EXTRA PROJECTION W13 CM X H13.5 CM 550 ML BREAST STYLE 133FX 133FX-T TEXTURED TAB STERILE SUP-133FX-13-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE ALLERGAN LOW HEIGHT VARIABLE PROJECTION 350CC WITH TABS SUP-133LV-14-T CDM 0270 RC outpatient 2938 2938 2938 74 2174.12 percent of total billed charges 2938 93 2379.78 percent of total billed charges 2938 2938 other OPPS APC 2938 2938 other OPPS APC 2938 27.63 811.77 percent of total billed charges 2938 2938 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL MAGNA-SITE P6.3 CM W15 CM X H9 CM 400 ML BREAST STYLE 133LV AND 133LV T LOW HEIGHT VARIABLE PROJECTION TABBED TEXTURED SUP-133LV-15-T CDM 0270 RC outpatient 3887 3887 3887 74 2876.38 percent of total billed charges 3887 93 3148.47 percent of total billed charges 3887 3887 other OPPS APC 3887 3887 other OPPS APC 3887 27.63 1073.98 percent of total billed charges 3887 3887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE ALLODERM NATRELLE MODERATE HEIGHT 300 CC SUP-133MV-11-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL MAGNA-SITE SALINE P5.2 CM MODERATE HEIGHT VARIABLE PROJECTION W12 CM X H11 CM 300 ML BREAST STYLE 133MV-T TEXTURE STERILE LATEX FREE SUP-133MV-12T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL MAGNA-SITE P5.6CM MODERATE HEIGHT VARIABLE PROJECTION 13X12CM 400ML SALINE STERILE LF SUP-133MV-13T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL MAGNA-SITE SALINE P6 CM MODERATE HEIGHT VARIABLE PROJECTION W14 CM X H13 CM 500 ML BREAST STYLE 133MV-T TEXTURE STERILE LATEX FREE SUP-133MV-14-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE 600CC WITH TABS SUP-133MV-15-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL MAGNA-SITE P5.9CM MODERATE HEIGHT EXTRA FULL PROJECTION 11X10CM 300CC SALINE STERILE LF SUP-133MX-11 CDM 0270 RC outpatient 3159 3159 3159 74 2337.66 percent of total billed charges 3159 93 2558.79 percent of total billed charges 3159 3159 other OPPS APC 3159 3159 other OPPS APC 3159 27.63 872.83 percent of total billed charges 3159 3159 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL P5.9CM MODERATE HEIGHT EXTRA PROJECTION 11X10CM 300CC STERILE LF BREAST TEXTURED SUP-133MX-11-T CDM 0270 RC outpatient 3887 3887 3887 74 2876.38 percent of total billed charges 3887 93 3148.47 percent of total billed charges 3887 3887 other OPPS APC 3887 3887 other OPPS APC 3887 27.63 1073.98 percent of total billed charges 3887 3887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL MAGNA-SITE SALINE P6.3 CM MODERATE HEIGHT EXTRA PROJECTION W12 CM X H11 CM 400 ML BREAST STYLE 133MX TEXTURED STERILE SUP-133MX-12 CDM 0270 RC outpatient 3159 3159 3159 74 2337.66 percent of total billed charges 3159 93 2558.79 percent of total billed charges 3159 3159 other OPPS APC 3159 3159 other OPPS APC 3159 27.63 872.83 percent of total billed charges 3159 3159 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL MAGNA-SITE SALINE P6.3 CM MODERATE HEIGHT EXTRA PROJECTION W12 CM X H11 CM 400 ML BREAST STYLE 133MX-T TEXTURED TAB STERILE SUP-133MX-12-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL MAGNA-SITE P6.7CM MODERATE HEIGHT EXTRA PROJECTION 13X12CM 500ML SALINE STERILE LF SUP-133MX-13 CDM 0270 RC outpatient 3159 3159 3159 74 2337.66 percent of total billed charges 3159 93 2558.79 percent of total billed charges 3159 3159 other OPPS APC 3159 3159 other OPPS APC 3159 27.63 872.83 percent of total billed charges 3159 3159 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL MAGNA-SITE SALINE P6.7 CM MODERATE HEIGHT XPROJECTION W13 CM X H12 CM 500 ML BREAST STYLE 133MX-T SUTURE TAB STERILE SUP-133MX-13-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL MAGNA-SITE SALINE P7.1 CM MODERATE HEIGHT EXTRA PROJECTION W14 CM X H13 CM 600 ML BREAST STYLE 133MX TEXTURED STERILE SUP-133MX-14 CDM 0270 RC outpatient 3094 3094 3094 74 2289.56 percent of total billed charges 3094 93 2506.14 percent of total billed charges 3094 3094 other OPPS APC 3094 3094 other OPPS APC 3094 27.63 854.87 percent of total billed charges 3094 3094 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL MAGNA-SITE SALINE P7.1 CM MODERATE HEIGHT EXTRA PROJECTION W14 CM X H13 CM 600 ML BREAST STYLE 133MX TEXTURED TAB STERILE SUP-133MX-14T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL MAGNA-SITE P7.6CM MODERATE HEIGHT EXTRA PROJECTION 15X14CM 700ML SALINE STERILE LF SUP-133MX-15T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 850CC 133 STYLE SUP-133MX-16 CDM 0270 RC outpatient 2938 2938 2938 74 2174.12 percent of total billed charges 2938 93 2379.78 percent of total billed charges 2938 2938 other OPPS APC 2938 2938 other OPPS APC 2938 27.63 811.77 percent of total billed charges 2938 2938 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE ALLERGAN 850CC WITH TABS SUP-133MX-16T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE SALINE P8.1 CM MODERATE HEIGHT EXTRA PROJECTION W15.5 CM X H14.5 CM 850 ML BREAST STYLE 133MX-T TEXTURED TAB STERILE SUP-133MX-16T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 12CM X 12.5CM 5.3CM 400ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SFVT MRI-UNSAFE FULL HEIGHT VARIABLE PROJECTION SUP-133S-FV-12-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 13CM X 13.5CM 5.7CM 500ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SFVT MRI-UNSAFE FULL HEIGHT VARIABLE PROJECTION SUP-133S-FV-13-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 14CM X 14.5CM 6.2CM 600ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SFVT MRI-UNSAFE FULL HEIGHT VARIABLE PROJECTION SUP-133S-FV-14-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 12CM X 12.5CM 6.3CM 450ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SFXT MRI-UNSAFE FULL HEIGHT EXTRA PROJECTION SUP-133S-FX-12-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 13CM X 13.5CM 6.7CM 550ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SFXT MRI-UNSAFE FULL HEIGHT EXTRA PROJECTION SUP-133S-FX-13-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 14CM X 14.5CM 7.1CM 650ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SFXT MRI-UNSAFE FULL HEIGHT EXTRA PROJECTION SUP-133S-FX-14-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 15CM X 15.5CM 7.6CM 800ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SFXT MRI-UNSAFE FULL HEIGHT EXTRA PROJECTION SUP-133S-FX-15-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 12CM X 11CM 5.2CM 300ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SMVT MRI-UNSAFE MODERATE HEIGHT VARIABLE PROJECTION SUP-133S-MV-12-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 13CM X 12CM 7.6CM 400ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SMVT MRI-UNSAFE MODERATE HEIGHT VARIABLE PROJECTION SUP-133S-MV-13-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 14CM X 13CM 6CM 500ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SMVT MRI-UNSAFE MODERATE HEIGHT VARIABLE PROJECTION SUP-133S-MV-14-T CDM 0270 RC outpatient 3616.6 3616.6 3616.6 74 2676.28 percent of total billed charges 3616.6 93 2929.45 percent of total billed charges 3616.6 3616.6 other OPPS APC 3616.6 3616.6 other OPPS APC 3616.6 27.63 999.27 percent of total billed charges 3616.6 3616.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 12CM X 11CM 6.3CM 400ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SMXT MRI-UNSAFE MODERATE HEIGHT EXTRA PROJECTION SUP-133S-MX-12-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 13CM X 12CM 6.7CM 500ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SMXT MRI-UNSAFE MODERATE HEIGHT EXTRA PROJECTION SUP-133S-MX-13-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE MAGNA-FINDER P6.7 CM MODERATE HEIGHT EXTRA PROJECTION W13 CM X H12 CM 500 CC STYLE 133S SMOOTH SUTURE TAB SUP-133S-MX-13-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 14CM X 13CM 7.1CM 600ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SMXT MRI-UNSAFE MODERATE HEIGHT EXTRA PROJECTION SUP-133S-MX-14-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 15CM X 14CM 7.6CM 700ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SMXT MRI-UNSAFE MODERATE HEIGHT EXTRA PROJECTION SUP-133S-MX-15-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 12CM X 8.4CM 5.3CM 250ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SSVT MRI-UNSAFE SHORT HEIGHT VARIABLE PROJECTION SUP-133S-SV-12-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 13CM X 9.1CM 5.7CM 300ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SSVT MRI-UNSAFE SHORT HEIGHT VARIABLE PROJECTION SUP-133S-SV-13-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 14CM X 9.7CM 6CM 375ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SSVT MRI-UNSAFE SHORT HEIGHT VARIABLE PROJECTION SUP-133S-SV-14-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 15CM X 10.5CM 6.3CM 450ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SSVT MRI-UNSAFE SHORT HEIGHT VARIABLE PROJECTION SUP-133S-SV-15-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 12CM X 10CM 6.3CM 350ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SSXT MRI-UNSAFE SHORT HEIGHT EXTRA PROJECTION SUP-133S-SX-12-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 13CM X 11CM 11CM 400ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SSXT MRI-UNSAFE SHORT HEIGHT EXTRA PROJECTION SUP-133S-SX-13-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 14CM X 12CM 7.1CM 500ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SSXT MRI-UNSAFE SHORT HEIGHT EXTRA PROJECTION SUP-133S-SX-14-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 15CM X 13CM 7.6CM 650ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SSXT MRI-UNSAFE SHORT HEIGHT EXTRA PROJECTION SUP-133S-SX-15-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE 15.5CM X 13.5CM 8.1CM 800ML SALINE-FILLED SMOOTH BREAST W/SUTURE TAB FOURTE FILL SYSTEM STYLE 133SSXT MRI-UNSAFE SHORT HEIGHT EXTRA PROJECTION SUP-133S-SX-16-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE WITH TABS SUP-133SV-12T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL P5.7CM SHORT HEIGHT EXTRA PROJECTION 13X9.1CM 300CC STERILE LF BREAST TEXTURED SUP-133SV-13-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL P6CM SHORT HEIGHT VARIABLE PROJECTION 14X9.7CM 375CC STERILE LF BREAST TEXTURED SUP-133SV-14-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL MAGNA-SITE P6.3 CM W15 CM X H10.5 CM 450 ML BREAST STYLE 133SV AND 133SV T SHORT HEIGHT VARIABLE PROJECTION TABBED TEXTURED SUP-133SV-15-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL MAGNA-SITE SALINE P6.3 CM SHORT HEIGHT EXTRA PROJECTION W12 CM X H10 CM 350 ML BREAST STYLE 133SX-T TEXTURED TAB MAGNASITE INJECTION SITE STERILE SUP-133SX-12-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL MAGNA-SITE P6.7CM SHORT HEIGHT EXTRA PROJECTION 13X11CM 400ML SALINE STERILE LF BREAST SUP-133SX-13-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL MAGNA-SITE P7.1CM SHORT HEIGHT EXTRA PROJECTION 14X12CM 500ML SALINE STERILE LF BREAST SUP-133SX-14 CDM 0270 RC outpatient 3094 3094 3094 74 2289.56 percent of total billed charges 3094 93 2506.14 percent of total billed charges 3094 3094 other OPPS APC 3094 3094 other OPPS APC 3094 27.63 854.87 percent of total billed charges 3094 3094 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL MAGNA-SITE P7.1CM SHORT HEIGHT EXTRA PROJECTION 14X12CM 500ML SALINE STERILE LF BREAST SUP-133SX-14-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL SALINE P7.6 CM SHORT HEIGHT EXTRA PROJECTION W15 CM X H13 CM 650 ML BREAST STYLE 133SX-T TEXTURED TAB STERILE SUP-133SX-15T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE NATRELLE BIOCELL MAGNA-SITE P8.1CM SHORT HEIGHT EXTRA PROJECTION 15.5X13.5CM 800ML SALINE STERILE LF SUP-133SX-16-T CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HANDPIECE ELECTROSURGICAL ABC BEND-A-BEAM 6IN 10FT CABLE SINGLE FUNCTION HAND CONTROL MALLEABLE STERILE SINGLE-USE 10PK/CA 1/PK SUP-134006 CDM 0270 RC outpatient 202.18 202.18 202.18 74 149.61 percent of total billed charges 202.18 93 163.77 percent of total billed charges 202.18 202.18 other OPPS APC 202.18 202.18 other OPPS APC 202.18 27.63 55.86 percent of total billed charges 202.18 202.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS SURGICAL ALLIS STAINLESS STEEL L6 IN TISSUE 4 X 5 TEETH MIRROR FINISH NONSTERILE SUP-135100 CDM outpatient 38.82 38.82 38.82 38.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BABCOCK 9.5 INCH SUP-135195 CDM outpatient 110.4 110.4 110.4 110.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ROTICULATOR 55 POLY LACTOMER TITANIUM L55 MM X W.2 MM VASCULAR LINEAR CUTTER RADIOTRANSPARENT STERILE LATEX FREE DISPOSABLE BROWN ENDOSCOPIC SUP-13601 CDM 0270 RC outpatient 2168.5 2168.5 2168.5 74 1604.69 percent of total billed charges 2168.5 93 1756.49 percent of total billed charges 2168.5 2168.5 other OPPS APC 2168.5 2168.5 other OPPS APC 2168.5 27.63 599.16 percent of total billed charges 2168.5 2168.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL ARTICUL/EZE +1.5MM 12/14 TAPER 28MM COCR STERILE LF HIP SUP-1365-11-000 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL ARTICUL/EZE METAL +8.5 MM 12/14 STANDARD BALL OD28 MM HIP SUP-1365-13-000 CDM 270010014 LOCAL 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL ARTICUL/EZE +9MM 12/14 STANDARD 32MM COCR STERILE LF HIP CEMENTLESS SUP-1365-23-000 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIOLOX DELTA CERAMIC 28MM SUP-1365-28-330 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL ARTICUL/EZE +9MM 12/14 TAPER 32MM BIOLOX DELTA HIP SUP-1365-32-330 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL ARTICUL/EZE +1.5MM 12/14 TAPER 36MM COCR STERILE LF HIP CEMENTLESS M SPECIFICATION NO SKIRT POLISH NECK SUP-1365-51-000 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL ARTICUL/EZE +5MM 12/14 TAPER 36MM COCR STERILE LF HIP CEMENTLESS M SPECIFICATION NO SKIRT POLISH NECK SUP-1365-52-000 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL ARTICUL/EZE +8.5MM 12/14 TAPER 36MM COCR STERILE LF HIP CEMENTLESS M SPECIFICATION NO SKIRT POLISH NECK SUP-1365-53-000 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL ARTICUL/EZE +12MM 12/14 TAPER 36MM COCR STERILE LF HIP CEMENTLESS M SPECIFICATION NO SKIRT POLISH NECK SUP-1365-54-000 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT DEPUY FEMORAL HEAD ARTICULEZE 35MM SUP-1365-55-000 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR ROTAWIRE WIRECLIP .014 IN L330 CM OD.009 IN PERIPHERAL TORQUER XSUPPORT SPRING TIP SUP-137-3321 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL FORTIFY I 0 D D14 MM W16 MM X H12 MM FOOTPRINT LOWER ENDPLATE NO SPIKE NONSTERILE LATEX FREE SUP-137.360 CDM 270010020 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL FORTIFY I 7 D D14 MM W16 MM X H12 MM FOOTPRINT LOWER ENDPLATE NO SPIKE NONSTERILE LATEX FREE SUP-137.362 CDM 270010020 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC ACCU-VU PLATINUM .035 IN PIGTAIL CURVE L70 CM L20 CM OD5 FR 21 BAND SIZING FLUSH RADIOPAQUE GUIDEWIRE STERILE DISPOSABLE SUP-13709801 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC ACCU-VU .035 IN PIGTAIL FLUSH L100 CM L20 CM OD5 FR SIZING 21 PLATINUM BAND SUP-13709803 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CENTRALIZER STEM CEMENTRALIZER PMMA OD11 MM HIP FEMUR STERILE ENDURANCE LUSTER EXCEL SUMMIT SYSTEM SUP-1376-20-000 CDM 0270 RC outpatient 454.27 454.27 454.27 74 336.16 percent of total billed charges 454.27 93 367.96 percent of total billed charges 454.27 454.27 other OPPS APC 454.27 454.27 other OPPS APC 454.27 27.63 125.51 percent of total billed charges 454.27 454.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CENTRALIZER STEM CEMENTRALIZER PMMA OD13 MM HIP FEMUR STERILE ENDURANCE LUSTER EXCEL SUMMIT SYSTEM SUP-1376-22-000 CDM 270010014 LOCAL 0270 RC outpatient 387.4 387.4 387.4 74 286.68 percent of total billed charges 387.4 93 313.79 percent of total billed charges 387.4 387.4 other OPPS APC 387.4 387.4 other OPPS APC 387.4 27.63 107.04 percent of total billed charges 387.4 387.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CENTRALIZER STEM CEMENTRALIZER PMMA OD9.25 MM HIP FEMUR CEMENT STERILE LATEX FREE SUMMIT SYSTEM SUP-137647000 CDM 270010024 LOCAL 0270 RC outpatient 317.2 317.2 317.2 74 234.73 percent of total billed charges 317.2 93 256.93 percent of total billed charges 317.2 317.2 other OPPS APC 317.2 317.2 other OPPS APC 317.2 27.63 87.64 percent of total billed charges 317.2 317.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETERAL HEYMAN POLYURETHANE L70 CM OD4 FR SPIRAL TIP 2 SIDE EYE STYLET KINK RESISTANCE STERILE LATEX FREE DISPOSABLE SUP-137904 CDM 0270 RC outpatient 32.35 32.35 32.35 74 23.94 percent of total billed charges 32.35 93 26.2 percent of total billed charges 32.35 32.35 other OPPS APC 32.35 32.35 other OPPS APC 32.35 27.63 8.94 percent of total billed charges 32.35 32.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETERAL BARD 70CM 5FR POLYURETHANE DISPOSABLE STERILE LF CONE TIP ADAPTER KINK RESISTANT GRADUATE SUP-138008 CDM 270009007 LOCAL 0270 RC outpatient 14.4 14.4 14.4 74 10.66 percent of total billed charges 14.4 93 11.66 percent of total billed charges 14.4 14.4 other OPPS APC 14.4 14.4 other OPPS APC 14.4 27.63 3.98 percent of total billed charges 14.4 14.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETERAL BARD 70CM 6FR POLYURETHANE DISPOSABLE STERILE LF CONE TIP ADAPTER KINK RESISTANCE GRADUATED SUP-138010 CDM 0270 RC outpatient 38.06 38.06 38.06 74 28.16 percent of total billed charges 38.06 93 30.83 percent of total billed charges 38.06 38.06 other OPPS APC 38.06 38.06 other OPPS APC 38.06 27.63 10.52 percent of total billed charges 38.06 38.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL ULTRACLEAN STAINLESS STEEL NEEDLE PENCIL STANDARD L1 IN HEXAGONAL HUB STERILE DISPOSABLE SUP-138102 CDM outpatient 2.39 2.39 2.39 2.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL STAINLESS STEEL BLADE FLAT L6 IN HEXAGONAL HUB STERILE LATEX FREE DISPOSABLE SUP-138107 CDM outpatient 5.93 5.93 5.93 5.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL ULTRACLEAN TUNGSTEN NEEDLE MICRO STRAIGHT L4 CM DISPOSABLE SUP-138506-10 CDM 0270 RC outpatient 65.08 65.08 65.08 74 48.16 percent of total billed charges 65.08 93 52.71 percent of total billed charges 65.08 65.08 other OPPS APC 65.08 65.08 other OPPS APC 65.08 27.63 17.98 percent of total billed charges 65.08 65.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL PENCIL BLADE 1IN STANDARD 10FT GOLDLINE ULTRACLEAN STERILE SUP-138659A CDM outpatient 6.71 6.71 6.71 6.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL ULTRACLEAN PTFE BLADE 90 D L1 IN L4 IN X W4 IN HEXAGONAL HUB STERILE LATEX FREE DISPOSABLE SUP-139100 CDM 0270 RC outpatient 7.88 7.88 7.88 74 5.83 percent of total billed charges 7.88 93 6.38 percent of total billed charges 7.88 7.88 other OPPS APC 7.88 7.88 other OPPS APC 7.88 27.63 2.18 percent of total billed charges 7.88 7.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL ULTRACLEAN BLADE 1IN DISPOSABLE STERILE EXTEND INSULATE SUP-139104EXT CDM 0270 RC outpatient 8.97 8.97 8.97 74 6.64 percent of total billed charges 8.97 93 7.27 percent of total billed charges 8.97 8.97 other OPPS APC 8.97 8.97 other OPPS APC 8.97 27.63 2.48 percent of total billed charges 8.97 8.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL ULTRACLEAN PTFE BLADE 90 D L6 IN L4 IN X W4 IN HEXAGONAL HUB BENDABLE WIPE CLEAN ACTIVE STERILE LATEX FREE DISPOSABLE SUP-139107 CDM outpatient 8.01 8.01 8.01 8.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL ULTRACLEAN PTFE BLADE 90 D HEXAGON L6 IN L4 IN X W4 IN EXTEND INSULATION HUB BENDABLE WIPE CLEAN STERILE DISPOSABLE SUP-139110EXT CDM outpatient 9.46 9.46 9.46 9.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BINDER ABDOMINAL COMFORT LARGE L46-62 IN X W12 IN 4 ELASTIC PANEL CONTACT CLOSURE LATEX SUP-1398200 CDM 270009158 LOCAL 0270 RC outpatient 41.03 41.03 41.03 74 30.36 percent of total billed charges 41.03 93 33.23 percent of total billed charges 41.03 41.03 other OPPS APC 41.03 41.03 other OPPS APC 41.03 27.63 11.34 percent of total billed charges 41.03 41.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PULMONARY ARTERY SWAN-GANZ CCO VIP 110CM 7.5FR HEPARIN POLYMER PULMONARY SUP-139F75 CDM 0481 RC outpatient 148.18 148.18 148.18 74 109.65 percent of total billed charges 148.18 93 120.03 percent of total billed charges 148.18 148.18 other OPPS APC 148.18 148.18 other OPPS APC 148.18 51 75.57 percent of total billed charges 148.18 148.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPONGE SUPER FLUFF SUP-14-00023 CDM 0272 RC outpatient 1.19 1.19 1.19 74 0.88 percent of total billed charges 1.19 93 0.96 percent of total billed charges 1.19 1.19 other OPPS APC 1.19 1.19 other OPPS APC 1.19 27.63 0.33 percent of total billed charges 1.19 1.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAUTERY NEEDLE 23GA SUP-14-5007 CDM 0270 RC outpatient 101.4 101.4 101.4 74 75.04 percent of total billed charges 101.4 93 82.13 percent of total billed charges 101.4 101.4 other OPPS APC 101.4 101.4 other OPPS APC 101.4 27.63 28.02 percent of total billed charges 101.4 101.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL LINEUM TITANIUM UNIVERSAL L80 MM OD3.5 MM OCCIPITOCERVICOTHORACIC PRECUT NONSTERILE BLUE SUP-14-524008 CDM 270010020 LOCAL 0270 RC outpatient 764.4 764.4 764.4 74 565.66 percent of total billed charges 764.4 93 619.16 percent of total billed charges 764.4 764.4 other OPPS APC 764.4 764.4 other OPPS APC 764.4 27.63 211.2 percent of total billed charges 764.4 764.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD ITE 3.5 X 180MM SUP-14-524018 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL LINEUM TITANIUM UNIVERSAL L240 MM OD3.5 MM OCCIPITOCERVICOTHORACIC PRECUT NONSTERILE BLUE SUP-14-524024 CDM 270010020 LOCAL 0270 RC outpatient 832 832 832 74 615.68 percent of total billed charges 832 93 673.92 percent of total billed charges 832 832 other OPPS APC 832 832 other OPPS APC 832 27.63 229.88 percent of total billed charges 832 832 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLUG SPINAL LINEUM HELICAL FLANGE TITANIUM SPINE CERVICAL UPPER THORACIC NONSTERILE SUP-14-524038 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 12MM SUP-14-524212 CDM 270010020 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LINEUM TITANIUM STANDARD HELIX L16 MM OD3.5 MM SPINE OCCIPITOCERVICOTHORACIC SELF TAP TOP LOAD FRICTION FIT SMOOTH SHANK FLANGE THREAD GOLD SUP-14-524216 CDM 270010020 LOCAL 0270 RC outpatient 4648.8 4648.8 4648.8 74 3440.11 percent of total billed charges 4648.8 93 3765.53 percent of total billed charges 4648.8 4648.8 other OPPS APC 4648.8 4648.8 other OPPS APC 4648.8 27.63 1284.46 percent of total billed charges 4648.8 4648.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LINEUM TITANIUM STANDARD L18 MM OD3.5 MM OCCIPITOCERVICOTHORACIC SPINE SELF TAPPING TOP LOADING FRICTION FIT SMOOTH SHANK HELICAL FLANGE THREAD GOLD SUP-14-524218 CDM 270010020 LOCAL 0270 RC outpatient 4648.8 4648.8 4648.8 74 3440.11 percent of total billed charges 4648.8 93 3765.53 percent of total billed charges 4648.8 4648.8 other OPPS APC 4648.8 4648.8 other OPPS APC 4648.8 27.63 1284.46 percent of total billed charges 4648.8 4648.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRANSLATION LINEUM TITANIUM L16 MM OD4 MM SPINE OCCIPITOCERVICOTHORACIC GREEN SUP-14-524516 CDM 270010020 LOCAL 0270 RC outpatient 4648.8 4648.8 4648.8 74 3440.11 percent of total billed charges 4648.8 93 3765.53 percent of total billed charges 4648.8 4648.8 other OPPS APC 4648.8 4648.8 other OPPS APC 4648.8 27.63 1284.46 percent of total billed charges 4648.8 4648.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LINEUM TITANIUM L30 MM OD4 MM OCCIPITOCERVICOTHORACIC SPINE TRANSLATION TECHNOLOGY GREEN HEAD SUP-14-524530 CDM 270010020 LOCAL 0270 RC outpatient 4271.54 4271.54 4271.54 74 3160.94 percent of total billed charges 4271.54 93 3459.95 percent of total billed charges 4271.54 4271.54 other OPPS APC 4271.54 4271.54 other OPPS APC 4271.54 27.63 1180.23 percent of total billed charges 4271.54 4271.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LINEUM TITANIUM L34 MM OD4 MM OCCIPITOCERVICOTHORACIC SPINE TRANSLATION TECHNOLOGY GREEN HEAD SUP-14-524534 CDM 270010020 LOCAL 0270 RC outpatient 4648.8 4648.8 4648.8 74 3440.11 percent of total billed charges 4648.8 93 3765.53 percent of total billed charges 4648.8 4648.8 other OPPS APC 4648.8 4648.8 other OPPS APC 4648.8 27.63 1284.46 percent of total billed charges 4648.8 4648.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP INTERNAL WILLIAMS MICRO .13MM 1.27MM SS STERILE EAR DISLODGE SUP-14-5285 CDM outpatient 33.65 33.65 33.65 33.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION XXL L120 CM L40 MM OD5.8 FR ODSEC18 MM LARGE VESSEL SCRATCH RESISTANT QUADRA FOLD TECHNOLOGY HIGH STRENGTH SHAFT ACCEPTS .035 IN GUIDEWIRE PTA SUP-14-558 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE VENTILATION ARMSTRONG FLUOROPLASTIC BEVEL GROMMET ID1.14 MM EAR SUP-14-5700 CDM 0270 RC outpatient 2035.02 2035.02 2035.02 74 1505.91 percent of total billed charges 2035.02 93 1648.37 percent of total billed charges 2035.02 2035.02 other OPPS APC 2035.02 2035.02 other OPPS APC 2035.02 27.63 562.28 percent of total billed charges 2035.02 2035.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOLDER DRESSING FULLER SHIELD VELCRO OD24-48 IN PERINEAL TAILORED FIT LIGHTWEIGHT FRONT OPEN SUP-14-7012-1 CDM 0270 RC outpatient 28.38 28.38 28.38 74 21 percent of total billed charges 28.38 93 22.99 percent of total billed charges 28.38 28.38 other OPPS APC 28.38 28.38 other OPPS APC 28.38 27.63 7.84 percent of total billed charges 28.38 28.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM ATHERECTOMY ROTALINK PLUS 1.75 MM 6F SUP-140-175 CDM 0270 RC outpatient 3770 3770 3770 74 2789.8 percent of total billed charges 3770 93 3053.7 percent of total billed charges 3770 3770 other OPPS APC 3770 3770 other OPPS APC 3770 27.63 1041.65 percent of total billed charges 3770 3770 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR CATHETER ROTABLATOR ROTALINK PLUS 135CM 2.5MM DIAMOND PERIPHERAL OTW PROTECTIVE SHEATH ROTATIONAL SUP-140-250 CDM 0270 RC outpatient 3770 3770 3770 74 2789.8 percent of total billed charges 3770 93 3053.7 percent of total billed charges 3770 3770 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.9MM X 30XM LONG LAPAROSCOPIC TIP & TUBESET SUP-140-33-4420 CDM 0270 RC outpatient 2620.8 2620.8 2620.8 74 1939.39 percent of total billed charges 2620.8 93 2122.85 percent of total billed charges 2620.8 2620.8 other OPPS APC 2620.8 2620.8 other OPPS APC 2620.8 27.63 724.13 percent of total billed charges 2620.8 2620.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER CATHETER PLASTIC OD4-6 FR URETERAL LATEX FREE DISPOSABLE SUP-140000 CDM outpatient 2.56 2.56 2.56 2.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE SILICONE STRAIGHT L20 IN OD20 FR THORACIC 5 EYELET KINK RESISTANT RADIOPAQUE STRIPE TAPERED TIP STERILE LATEX FREE DISPOSABLE CLEAR SUP-14020 CDM 0270 RC outpatient 32.89 32.89 32.89 74 24.34 percent of total billed charges 32.89 93 26.64 percent of total billed charges 32.89 32.89 other OPPS APC 32.89 32.89 other OPPS APC 32.89 27.63 9.09 percent of total billed charges 32.89 32.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL AGILITY POLYETHYLENE 2 ANKLE LOW PROFILE SUP-1404-32-000 CDM 270010025 LOCAL 0270 RC outpatient 2613 2613 2613 74 1933.62 percent of total billed charges 2613 93 2116.53 percent of total billed charges 2613 2613 other OPPS APC 2613 2613 other OPPS APC 2613 27.63 721.97 percent of total billed charges 2613 2613 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTAINER SPECIMEN POLYETHYLENE C64 OZ MULTIPURPOSE CAP SNAP ON LID NONSTERILE TRANSLUCENT SUP-140460 CDM 0270 RC outpatient 2.78 2.78 2.78 74 2.06 percent of total billed charges 2.78 93 2.25 percent of total billed charges 2.78 2.78 other OPPS APC 2.78 2.78 other OPPS APC 2.78 27.63 0.77 percent of total billed charges 2.78 2.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRIP INDICATOR STERRAD CHEMICAL LATEX FREE STERILIZATION SYSTEM SUP-14100 CDM outpatient 0.3 0.3 0.3 0.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAR BIOMET TIBIAL LOCKING SUP-141205 CDM 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PADDING CAST KENDALL WEBRIL 4YDX2IN COTTON NS LF UNDERCAST MILD STRETCH COHESIVE REGULAR FINISH SUP-1418 CDM 0270 RC outpatient 1 1 1 74 0.74 percent of total billed charges 1 93 0.81 percent of total billed charges 1 1 other OPPS APC 1 1 other OPPS APC 1 27.63 0.28 percent of total billed charges 1 1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE INDICATOR STERRAD SEALSURE 60YD LF CHEMICAL SPECIAL INK ROLL SUP-14202 CDM outpatient 157.87 157.87 157.87 157.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE INDICATOR STERRAD SEALSURE 60YD LF CHEMICAL SPECIAL INK ROLL SUP-14202NL CDM outpatient 157.87 157.87 157.87 157.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARRIER SKIN NEW IMAGE FLEXWEAR OD1 3/4 IN ODSEC2 1/4 IN CUT TO FIT TAPE BORDER FLOAT FLANGE 2 PIECE RED SUP-14203 CDM 0270 RC outpatient 1.03 1.03 1.03 74 0.76 percent of total billed charges 1.03 93 0.83 percent of total billed charges 1.03 1.03 other OPPS APC 1.03 1.03 other OPPS APC 1.03 27.63 0.28 percent of total billed charges 1.03 1.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARRIER SKIN NEW IMAGE FLEXWEAR FLAT 2.25- IN 2.75IN BLUE LF 2 PIECE CUT TO FIT TAPE BORDER INTEGRATE FLOAT FLANGE SUP-14204 CDM 0270 RC outpatient 1.03 1.03 1.03 74 0.76 percent of total billed charges 1.03 93 0.83 percent of total billed charges 1.03 1.03 other OPPS APC 1.03 1.03 other OPPS APC 1.03 27.63 0.28 percent of total billed charges 1.03 1.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA LOCKING DELIVERY 3.0-11.5-ED WITH DIAMOND TIPPED SYLET SUP-1426 CDM 0270 RC outpatient 610.09 610.09 610.09 74 451.47 percent of total billed charges 610.09 93 494.17 percent of total billed charges 610.09 610.09 other OPPS APC 610.09 610.09 other OPPS APC 610.09 27.63 168.57 percent of total billed charges 610.09 610.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HANDPIECE LASER ENDOPROBE 45 D TAPER OD23 GA SMOOTH RIGID SUP-14400 CDM 0270 RC outpatient 502.67 502.67 502.67 74 371.98 percent of total billed charges 502.67 93 407.16 percent of total billed charges 502.67 502.67 other OPPS APC 502.67 502.67 other OPPS APC 502.67 27.63 138.89 percent of total billed charges 502.67 502.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION ECHELON 10 NITINOL 45 D .014 IN MICRO L155 CM L150 CM OD2.1-1.7 FR ID.017 IN 2 RADIOPAQUE 1 LUMEN GUIDEWIRE OTW SUP-145-5091-150 CDM 0270 RC outpatient 2202.2 2202.2 2202.2 74 1629.63 percent of total billed charges 2202.2 93 1783.78 percent of total billed charges 2202.2 2202.2 other OPPS APC 2202.2 2202.2 other OPPS APC 2202.2 27.63 608.47 percent of total billed charges 2202.2 2202.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEN SURGICAL MARKING MINI XL FINE PREP RESISTANT INK NONSTERILE SUP-1450XL-1000 CDM 0270 RC outpatient 0.82 0.82 0.82 74 0.61 percent of total billed charges 0.82 93 0.66 percent of total billed charges 0.82 0.82 other OPPS APC 0.82 0.82 other OPPS APC 0.82 27.63 0.23 percent of total billed charges 0.82 0.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEN SURGICAL MARKING MINI XL PREP RESISTANT INK FINE TIP NONSTERILE LATEX FREE SUP-1450XL-200 CDM 0270 RC outpatient 1.04 1.04 1.04 74 0.77 percent of total billed charges 1.04 93 0.84 percent of total billed charges 1.04 1.04 other OPPS APC 1.04 1.04 other OPPS APC 1.04 27.63 0.29 percent of total billed charges 1.04 1.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUADRIPOLAR QUARTET LV LEAD 86CM SUP-1456Q/58 CDM 0275 RC outpatient 3120 3120 3120 57 1778.4 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 51 1591.2 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING QUARTET OPTIM LOW PROFILE S CURVE NARROW L86 CM X H16 MM OD5 FR LEFT HEART 4 ELECTRODE IS-4 CONNECTOR SUP-1457Q CDM 0275 RC outpatient 2995.2 2995.2 2995.2 57 1707.26 percent of total billed charges 2995.2 93 2426.11 percent of total billed charges 2995.2 2995.2 other OPPS APC 2995.2 2995.2 other OPPS APC 2995.2 51 1527.55 percent of total billed charges 2995.2 2995.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING QUARTET L92 CM SUP-1458Q-92 CDM 0275 RC outpatient 2995.2 2995.2 2995.2 57 1707.26 percent of total billed charges 2995.2 93 2426.11 percent of total billed charges 2995.2 2995.2 other OPPS APC 2995.2 2995.2 other OPPS APC 2995.2 51 1527.55 percent of total billed charges 2995.2 2995.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING QUARTET OPTIM LOW PROFILE S CURVE NARROW L75 CM X H16 MM OD5 FR LEFT HEART 4 ELECTRODE IS4 CONNECTOR SUP-1458Q/75 CDM 0275 RC outpatient 2995.2 2995.2 2995.2 57 1707.26 percent of total billed charges 2995.2 93 2426.11 percent of total billed charges 2995.2 2995.2 other OPPS APC 2995.2 2995.2 other OPPS APC 2995.2 51 1527.55 percent of total billed charges 2995.2 2995.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARRIER SKIN NEW IMAGE FLEXTEND OD1 3/4- IN ODSEC2 1/4 IN 2 PIECE CUT TO FIT TAPE BORDER INTEGRATE FLOAT FLANGE LATEX FREE RED SUP-14603 CDM 0270 RC outpatient 1.17 1.17 1.17 74 0.87 percent of total billed charges 1.17 93 0.95 percent of total billed charges 1.17 1.17 other OPPS APC 1.17 1.17 other OPPS APC 1.17 27.63 0.32 percent of total billed charges 1.17 1.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARRIER SKIN OSTOMY NEW IMAGE FLEXTEND EXTENDED WEAR 4 IN FLANGE OD3 1/2 IN STOMA CUT TO FIT YELLOW COLLAR SUP-14606 CDM 0270 RC outpatient 1.2 1.2 1.2 74 0.89 percent of total billed charges 1.2 93 0.97 percent of total billed charges 1.2 1.2 other OPPS APC 1.2 1.2 other OPPS APC 1.2 27.63 0.33 percent of total billed charges 1.2 1.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACIST NAVVUS CATHETER SUP-14667 CDM 0481 RC outpatient 1625 1625 1625 74 1202.5 percent of total billed charges 1625 93 1316.25 percent of total billed charges 1625 1625 other OPPS APC 1625 1625 other OPPS APC 1625 51 828.75 percent of total billed charges 1625 1625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 10.5CM TUBE LENGTH INNER DIAMETER 3.0MM OUTER DIAMETER 3.6MM 10G SUP-1467 CDM outpatient 660.4 660.4 660.4 660.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE STARCLOSE SE VASCULAR STERILE DISPOSABLE SUP-14679-01 CDM 0270 RC outpatient 587.6 587.6 587.6 74 434.82 percent of total billed charges 587.6 93 475.96 percent of total billed charges 587.6 587.6 other OPPS APC 587.6 587.6 other OPPS APC 587.6 27.63 162.35 percent of total billed charges 587.6 587.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER ORTHOPEDIC LONG DIAMOND SUP-1472 CDM 0270 RC outpatient 587.86 587.86 587.86 74 435.02 percent of total billed charges 587.86 93 476.17 percent of total billed charges 587.86 587.86 other OPPS APC 587.86 587.86 other OPPS APC 587.86 27.63 162.43 percent of total billed charges 587.86 587.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SOLERA COCR MOLYBDENUM STRAIGHT L500 MM OD4.75 MM NONSTERILE SUP-1475000500 CDM 270010020 LOCAL 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD MEDTRONIC LUMBAR 50CM SUP-1475200500 CDM 270010020 LOCAL 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD MEDTRONIC 10CM SUP-147550100 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SOLERA MOLYBDENUM COCR CURVE L30 MM OD4.75 MM SUP-1475501030 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SOLERA COCR MOLYBDENUM CURVE L35 MM OD4.75 MM SUP-1475501035 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD MEDTRONIC 40MM SUP-1475501040 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SOLERA COCR MOLYBDENUM L45 MM OD4.75 MM CURVED SUP-1475501045 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SOLERA COCR MOLYBDENUM CURVE L50 MM OD4.75 MM SUP-1475501050 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SOLERA CD HORIZON COCRMO CURVE L55 MM OD4.75 MM SUP-1475501055 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SOLERA COCR MOLYBDENUM CURVE L60 MM OD4.75 MM SUP-1475501060 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SOLERA COCR MOLYBDENUM L70 MM OD4.75 MM CURVED SUP-1475501070 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SOLERA COCR MOLYBDENUM L80 MM OD4.75 MM CURVED SUP-1475501080 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SOLERA COCR MOLYBDENUM CURVE L90 MM OD4.75 MM NONSTERILE SUP-1475501090 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SOLERA CD HORIZON COCRMO CURVE L100 MM OD4.75 MM SUP-1475501100 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SOLERA COCR MOLYBDENUM CURVE L110 MM OD4.75 MM SUP-1475501110 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CCM PLUS STRAIGHT L120 MM OD4.75 MM PERCUTANEOUS SUP-1476006120 CDM 270010020 LOCAL 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SOLERA COCR MOLYBDENUM STRAIGHT L170 MM OD4.75 MM PERCUTANEOUS SUP-1476006170 CDM 270010020 LOCAL 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CCM PLUS STRAIGHT L180 MM OD4.75 MM PERCUTANEOUS SUP-1476006180 CDM 270010020 LOCAL 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARRIER SKIN NEW IMAGE FLEXTEND CONVEX OD1 1/2 IN ODSEC2 1/4 IN CUT TO FIT FLOAT FLANGE 2 PIECE RED SUP-14803 CDM 0270 RC outpatient 1.93 1.93 1.93 74 1.43 percent of total billed charges 1.93 93 1.56 percent of total billed charges 1.93 1.93 other OPPS APC 1.93 1.93 other OPPS APC 1.93 27.63 0.53 percent of total billed charges 1.93 1.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARRIER SKIN NEW IMAGE FLEXTEND CONVEX OD2 IN ODSEC2 3/4 IN 2 PIECE CUT TO FIT FLOAT FLANGE BLUE SUP-14804 CDM 0270 RC outpatient 1.96 1.96 1.96 74 1.45 percent of total billed charges 1.96 93 1.59 percent of total billed charges 1.96 1.96 other OPPS APC 1.96 1.96 other OPPS APC 1.96 27.63 0.54 percent of total billed charges 1.96 1.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ARTHROSCOPIC CANNU-FLEX L12 IN OD1.5 MM ACL PCL BLUNT TIP STERILE DISPOSABLE SUP-14859 CDM 0270 RC outpatient 106.6 106.6 106.6 74 78.88 percent of total billed charges 106.6 93 86.35 percent of total billed charges 106.6 106.6 other OPPS APC 106.6 106.6 other OPPS APC 106.6 27.63 29.45 percent of total billed charges 106.6 106.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE SURGICAL ENDOBUTTON L24 IN ACL PCL PASSING NEEDLE ARTHROSCOPIC STERILE ACCESSORY SUP-14868 CDM 0270 RC outpatient 254.37 254.37 254.37 74 188.23 percent of total billed charges 254.37 93 206.04 percent of total billed charges 254.37 254.37 other OPPS APC 254.37 254.37 other OPPS APC 254.37 27.63 70.28 percent of total billed charges 254.37 254.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROWATER WIRE 300CM STRAIGHT SUP-14935-01 CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRANDSLAM WIRE 300CM SUP-14940-01 CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MIDAS REX LEGEND MATCH HEAD FLUTE L14 CM OD3 MM BURR SUP-14MH30 CDM 0270 RC outpatient 481.81 481.81 481.81 74 356.54 percent of total billed charges 481.81 93 390.27 percent of total billed charges 481.81 481.81 other OPPS APC 481.81 481.81 other OPPS APC 481.81 27.63 133.12 percent of total billed charges 481.81 481.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAC MED. DRESSING KIT SUP-15-00007 CDM 0272 RC outpatient 157.17 157.17 157.17 74 116.31 percent of total billed charges 157.17 93 127.31 percent of total billed charges 157.17 157.17 other OPPS APC 157.17 157.17 other OPPS APC 157.17 27.63 43.43 percent of total billed charges 157.17 157.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NO-STING SPRAY 3M SUP-15-00011 CDM 0271 RC outpatient 23.75 23.75 23.75 74 17.58 percent of total billed charges 23.75 93 19.24 percent of total billed charges 23.75 23.75 other OPPS APC 23.75 23.75 other OPPS APC 23.75 27.63 6.56 percent of total billed charges 23.75 23.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NO-STING STICKS 3M SUP-15-00012 CDM 0271 RC outpatient 1.42 1.42 1.42 74 1.05 percent of total billed charges 1.42 93 1.15 percent of total billed charges 1.42 1.42 other OPPS APC 1.42 1.42 other OPPS APC 1.42 27.63 0.39 percent of total billed charges 1.42 1.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING TEGADERM 3 1/2 X 6 SUP-15-00014 CDM 0272 RC outpatient 1.05 1.05 1.05 74 0.78 percent of total billed charges 1.05 93 0.85 percent of total billed charges 1.05 1.05 other OPPS APC 1.05 1.05 other OPPS APC 1.05 27.63 0.29 percent of total billed charges 1.05 1.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROGEL SILVASORB .25OZ SUP-15-00020 CDM 0272 RC outpatient 23.33 23.33 23.33 74 17.26 percent of total billed charges 23.33 93 18.9 percent of total billed charges 23.33 23.33 other OPPS APC 23.33 23.33 other OPPS APC 23.33 27.63 6.45 percent of total billed charges 23.33 23.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Y CONNECTOR TRAC SUP-15-00021 CDM 0272 RC outpatient 1.77 1.77 1.77 74 1.31 percent of total billed charges 1.77 93 1.43 percent of total billed charges 1.77 1.77 other OPPS APC 1.77 1.77 other OPPS APC 1.77 27.63 0.49 percent of total billed charges 1.77 1.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANISTER INFO VAC SUP-15-00024 CDM 0272 RC outpatient 134.92 134.92 134.92 74 99.84 percent of total billed charges 134.92 93 109.29 percent of total billed charges 134.92 134.92 other OPPS APC 134.92 134.92 other OPPS APC 134.92 27.63 37.28 percent of total billed charges 134.92 134.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLEANSER WOUND 80Z SUP-15-00025 CDM 0272 RC outpatient 3.25 3.25 3.25 74 2.41 percent of total billed charges 3.25 93 2.63 percent of total billed charges 3.25 3.25 other OPPS APC 3.25 3.25 other OPPS APC 3.25 27.63 0.9 percent of total billed charges 3.25 3.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "OINTMENT, SECURA PROTECTIVE" SUP-15-00026 CDM 0271 RC outpatient 1.85 1.85 1.85 74 1.37 percent of total billed charges 1.85 93 1.5 percent of total billed charges 1.85 1.85 other OPPS APC 1.85 1.85 other OPPS APC 1.85 27.63 0.51 percent of total billed charges 1.85 1.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING MEPILEX LITE 4X4 SUP-15-00028 CDM 0272 RC outpatient 3.45 3.45 3.45 74 2.55 percent of total billed charges 3.45 93 2.79 percent of total billed charges 3.45 3.45 other OPPS APC 3.45 3.45 other OPPS APC 3.45 27.63 0.95 percent of total billed charges 3.45 3.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BACTOSHIELD 4% 4OZ SUP-15-00029 CDM 0271 RC outpatient 1.99 1.99 1.99 74 1.47 percent of total billed charges 1.99 93 1.61 percent of total billed charges 1.99 1.99 other OPPS APC 1.99 1.99 other OPPS APC 1.99 27.63 0.55 percent of total billed charges 1.99 1.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING WHITE FOAM SM 10 X 7.5 SUP-15-00031 CDM 0272 RC outpatient 39.07 39.07 39.07 74 28.91 percent of total billed charges 39.07 93 31.65 percent of total billed charges 39.07 39.07 other OPPS APC 39.07 39.07 other OPPS APC 39.07 27.63 10.8 percent of total billed charges 39.07 39.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING MEPILEX FOAM SACRUM SUP-15-00037 CDM 0272 RC outpatient 24.93 24.93 24.93 74 18.45 percent of total billed charges 24.93 93 20.19 percent of total billed charges 24.93 24.93 other OPPS APC 24.93 24.93 other OPPS APC 24.93 27.63 6.89 percent of total billed charges 24.93 24.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL TAPERLOC MICROPLASTY LATERALIZE OFFSET OD16 MM HIP SUP-15-103215 CDM 270010024 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL LARGE HEX 1.1 X 3.5MM STOP SUP-15-1723 CDM 0270 RC outpatient 288.6 288.6 288.6 74 213.56 percent of total billed charges 288.6 93 233.77 percent of total billed charges 288.6 288.6 other OPPS APC 288.6 288.6 other OPPS APC 288.6 27.63 79.74 percent of total billed charges 288.6 288.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P3.6 CM MODERATE PLUS PROFILE ROUND OD10.9 CM 234 ML STYLE 15 SMOOTH STERILE LATEX FREE SUP-15-234 CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ALLERGAN MIDRANGE PROFILE 265CC SUP-15-265 CDM 0270 RC outpatient 2015 2015 2015 74 1491.1 percent of total billed charges 2015 93 1632.15 percent of total billed charges 2015 2015 other OPPS APC 2015 2015 other OPPS APC 2015 27.63 556.74 percent of total billed charges 2015 2015 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EPISTAXIS EPISTAT SILICONE BEVEL NASAL INFLATABLE CUFF BALLOON SUP-15-27031 CDM outpatient 468 468 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P3.8 CM MODERATE PLUS PROFILE ROUND OD11.7 CM 286 ML STYLE 15 SMOOTH STERILE SUP-15-286 CDM 0270 RC outpatient 2015 2015 2015 74 1491.1 percent of total billed charges 2015 93 1632.15 percent of total billed charges 2015 2015 other OPPS APC 2015 2015 other OPPS APC 2015 27.63 556.74 percent of total billed charges 2015 2015 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT NASAL EXTERNAL THERMA SINGLE SMALL SUP-15-29000 CDM 0270 RC outpatient 50.18 50.18 50.18 74 37.13 percent of total billed charges 50.18 93 40.65 percent of total billed charges 50.18 50.18 other OPPS APC 50.18 50.18 other OPPS APC 50.18 27.63 13.86 percent of total billed charges 50.18 50.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P4 CM MODERATE PLUS PROFILE ROUND OD11.9 CM 304 ML STYLE 15 SMOOTH STERILE SUP-15-304 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P4 CM MIDRANGE PROFILE ROUND OD12.4 CM 339 ML STYLE 15 SMOOTH STERILE SUP-15-339 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P4.1 CM MODERATE PLUS PROFILE ROUND OD12.9 CM 371 ML STYLE 15 SMOOTH STERILE SUP-15-371 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE MATRIX P4.2 CM MIDRANGE PROJECTION ROUND OD13.1 CM 397 ML STYLE 15 SMOOTH SHELL GEL STERILE LATEX FREE SUP-15-397 CDM 0270 RC outpatient 2015 2015 2015 74 1491.1 percent of total billed charges 2015 93 1632.15 percent of total billed charges 2015 2015 other OPPS APC 2015 2015 other OPPS APC 2015 27.63 556.74 percent of total billed charges 2015 2015 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P4.3 CM MODERATE PLUS PROFILE ROUND OD13.3 CM 421 ML STYLE 15 SMOOTH STERILE SUP-15-421 CDM 0270 RC outpatient 2015 2015 2015 74 1491.1 percent of total billed charges 2015 93 1632.15 percent of total billed charges 2015 2015 other OPPS APC 2015 2015 other OPPS APC 2015 27.63 556.74 percent of total billed charges 2015 2015 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P4.5 CM MODERATE PLUS PROFILE ROUND OD13.7 CM 457 ML STYLE 15 SMOOTH STERILE SUP-15-457 CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P4.6 CM MODERATE PLUS PROFILE ROUND OD14 CM 492 ML STYLE 15 SMOOTH STERILE SUP-15-492 CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P4.7 CM MODERATE PLUS PROFILE ROUND OD14.4 CM 533 ML STYLE 15 SMOOTH STERILE SUP-15-533 CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P4.9 CM MODERATE PLUS PROFILE ROUND OD15.2 CM 616 ML STYLE 15 SMOOTH STERILE SUP-15-616 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P5 CM MODERATE PLUS PROFILE ROUND OD15.4 CM 659 ML STYLE 15 GEL SMOOTH STERILE SUP-15-659 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P5.1 CM MIDRANGE PROFILE ROUND OD15.8 CM 700 ML STYLE 15 GEL SMOOTH STERILE LATEX FREE SUP-15-700 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE ANGIOGRAPHY MEDRAD FASTURN 150ML DISPOSABLE STERILE LF FILL TUBE MARK V PROVIS SUP-150-FT-Q CDM 0270 RC outpatient 13.36 13.36 13.36 74 9.89 percent of total billed charges 13.36 93 10.82 percent of total billed charges 13.36 13.36 other OPPS APC 13.36 13.36 other OPPS APC 13.36 27.63 3.69 percent of total billed charges 13.36 13.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPHERE EMBOLIZATION EMBOZENE POLYZENE-F HYDROGEL 500 UM 2 ML SYRINGE STERILE DISPOSABLE RED SUP-15020-S1 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPHERE EMBOLIZATION EMBOZENE POLYZENE-F HYDROGEL 700 UM 2 ML SYRINGE STERILE DISPOSABLE GREEN SUP-15020-S1 CDM 0270 RC outpatient 520 520 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WAX BONE OSTENE ALKALINE OXIDE 2.5 GM WATER SOLUBLE HEMOSTATIC AGENT STERILE LATEX FREE SUP-1503832 CDM 0270 RC outpatient 250.07 250.07 250.07 74 185.05 percent of total billed charges 250.07 93 202.56 percent of total billed charges 250.07 250.07 other OPPS APC 250.07 250.07 other OPPS APC 250.07 27.63 69.09 percent of total billed charges 250.07 250.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR ATTUNE CRS RIGHT SIZE 8 CEMENTED SUP-1504-40-208 CDM 270010024 LOCAL 0270 RC outpatient 18068.7 18068.7 18068.7 74 13370.8 percent of total billed charges 18068.7 93 14635.7 percent of total billed charges 18068.7 18068.7 other OPPS APC 18068.7 18068.7 other OPPS APC 18068.7 27.63 4992.38 percent of total billed charges 18068.7 18068.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEARING TIBIAL OSS STANDARD 18MM POLY STERILE LF KNEE SUP-150413 CDM 0270 RC outpatient 4303 4303 4303 74 3184.22 percent of total billed charges 4303 93 3485.43 percent of total billed charges 4303 4303 other OPPS APC 4303 4303 other OPPS APC 4303 27.63 1188.92 percent of total billed charges 4303 4303 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUSHING TIBIAL OSS POLYETHYLENE KNEE LOW FRICTION INTERFACE SUP-150476 CDM 0270 RC outpatient 1136.2 1136.2 1136.2 74 840.79 percent of total billed charges 1136.2 93 920.32 percent of total billed charges 1136.2 1136.2 other OPPS APC 1136.2 1136.2 other OPPS APC 1136.2 27.63 313.93 percent of total billed charges 1136.2 1136.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION OSS POLYETHYLENE KNEE LOCK COMPRESSION MOLD SUP-150478 CDM 0270 RC outpatient 839.8 839.8 839.8 74 621.45 percent of total billed charges 839.8 93 680.24 percent of total billed charges 839.8 839.8 other OPPS APC 839.8 839.8 other OPPS APC 839.8 27.63 232.04 percent of total billed charges 839.8 839.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AXLE TIBIAL OSS KNEE LOW FRICTION INTERFACE SUP-150480 CDM 0270 RC outpatient 1723.8 1723.8 1723.8 74 1275.61 percent of total billed charges 1723.8 93 1396.28 percent of total billed charges 1723.8 1723.8 other OPPS APC 1723.8 1723.8 other OPPS APC 1723.8 27.63 476.29 percent of total billed charges 1723.8 1723.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. YOKE TIBIAL OSS KNEE REINFORCE SUP-150493 CDM 0270 RC outpatient 4019.6 4019.6 4019.6 74 2974.5 percent of total billed charges 4019.6 93 3255.88 percent of total billed charges 4019.6 4019.6 other OPPS APC 4019.6 4019.6 other OPPS APC 4019.6 27.63 1110.62 percent of total billed charges 4019.6 4019.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BASE ATTUNE REVISION SIZE 9 CEMENTED SUP-1506-60-009 CDM 270010024 LOCAL 0270 RC outpatient 13115.7 13115.7 13115.7 74 9705.62 percent of total billed charges 13115.7 93 10623.7 percent of total billed charges 13115.7 13115.7 other OPPS APC 13115.7 13115.7 other OPPS APC 13115.7 27.63 3623.87 percent of total billed charges 13115.7 13115.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIBBON STERIS CARTRIDGE SUP-150828-440 CDM outpatient 76.01 76.01 76.01 76.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL FORTIFY 0 D D12 MM W12 MM X H16 MM NONSTERILE LATEX FREE SUP-151.002 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL FORTIFY D12 MM W12 MM X H21 MM NONSTERILE LATEX FREE SUP-151.052 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL FORTIFY D12 MM W12 MM X H25 MM NONSTERILE LATEX FREE SUP-151.053 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL FORTIFY D16 MM W16 MM X H24 MM STERILE LATEX FREE SUP-151.102 CDM 270010020 LOCAL 0270 RC outpatient 14300 14300 14300 74 10582 percent of total billed charges 14300 93 11583 percent of total billed charges 14300 14300 other OPPS APC 14300 14300 other OPPS APC 14300 27.63 3951.09 percent of total billed charges 14300 14300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL FORTIFY 3.5 D D12 MM W14 MM X H12 MM FOOTPRINT UPPER ENDPLATE SAGITTAL PROFILE NONSTERILE LATEX FREE SUP-151.323 CDM 270010020 LOCAL 0270 RC outpatient 1300 1300 1300 74 962 percent of total billed charges 1300 93 1053 percent of total billed charges 1300 1300 other OPPS APC 1300 1300 other OPPS APC 1300 27.63 359.19 percent of total billed charges 1300 1300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL FORTIFY 0 D D16 MM W16 MM X H16 MM FOOTPRINT UPPER ENDPLATE SAGITTAL PROFILE STERILE LATEX FREE SUP-151.501 CDM 270010020 LOCAL 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL FORTIFY 0 D D16 MM W16 MM X H16 MM FOOTPRINT LOWER ENDPLATE SAGITTAL PROFILE STERILE LATEX FREE SUP-151.551 CDM 270010020 LOCAL 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL FORTIFY 0 D D14 MM W16 MM X H12 MM UPPER ENDPLATE SAGITTAL PROFILE NONSTERILE LATEX FREE SUP-151.701 CDM 270010020 LOCAL 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL FORTIFY 0 D D14 MM W16 MM X H12 MM LOWER ENDPLATE SAGITTAL PROFILE NONSTERILE LATEX FREE SUP-151.751 CDM 270010020 LOCAL 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL SLEEVE M/L 40MM SUP-1511-01-204 CDM 270010024 LOCAL 0270 RC outpatient 8790.6 8790.6 8790.6 74 6505.04 percent of total billed charges 8790.6 93 7120.39 percent of total billed charges 8790.6 8790.6 other OPPS APC 8790.6 8790.6 other OPPS APC 8790.6 27.63 2428.84 percent of total billed charges 8790.6 8790.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL SLEEVE M/L 37MM SUP-1511-11-202 CDM 270010024 LOCAL 0270 RC outpatient 9922.9 9922.9 9922.9 74 7342.95 percent of total billed charges 9922.9 93 8037.55 percent of total billed charges 9922.9 9922.9 other OPPS APC 9922.9 9922.9 other OPPS APC 9922.9 27.63 2741.7 percent of total billed charges 9922.9 9922.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM ATTUNE PRESSFIT 20X60MM SUP-1513-20-060 CDM 270010024 LOCAL 0270 RC outpatient 4416.1 4416.1 4416.1 74 3267.91 percent of total billed charges 4416.1 93 3577.04 percent of total billed charges 4416.1 4416.1 other OPPS APC 4416.1 4416.1 other OPPS APC 4416.1 27.63 1220.17 percent of total billed charges 4416.1 4416.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ATTUNE CRS SIZE 8 10MM SUP-1517-10-810 CDM 270010024 LOCAL 0270 RC outpatient 7828.6 7828.6 7828.6 74 5793.16 percent of total billed charges 7828.6 93 6341.17 percent of total billed charges 7828.6 7828.6 other OPPS APC 7828.6 7828.6 other OPPS APC 7828.6 27.63 2163.04 percent of total billed charges 7828.6 7828.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MATRIX TISSUE ALLODERM ALLOGRAFT PERFORATE SUP-1518320P CDM 0270 RC outpatient 27586 27586 27586 74 20413.6 percent of total billed charges 27586 93 22344.7 percent of total billed charges 27586 27586 other OPPS APC 27586 27586 other OPPS APC 27586 27.63 7622.01 percent of total billed charges 27586 27586 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MATRIX TISSUE ALLODERM SELECT THK.4-1.6 MM MEDIUM L16 CM X W6 CM ALLOGRAFT REGENERATIVE SUP-1518616 CDM 270010031 LOCAL 0270 RC outpatient 8036.6 8036.6 8036.6 74 5947.08 percent of total billed charges 8036.6 93 6509.65 percent of total billed charges 8036.6 8036.6 other OPPS APC 8036.6 8036.6 other OPPS APC 8036.6 27.63 2220.51 percent of total billed charges 8036.6 8036.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ARTERIAL LINE SWAN-GANZ CONTROLCATH HEPARIN POLYMER S L110 CM OD7 FR PULMONARY SUP-151F7 CDM 0481 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 51 218.79 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK SURGICAL STANDARD CLASSIC LATEX FREE BLUE SUP-15201 CDM 0270 RC outpatient 0.24 0.24 0.24 74 0.18 percent of total billed charges 0.24 93 0.19 percent of total billed charges 0.24 0.24 other OPPS APC 0.24 0.24 other OPPS APC 0.24 27.63 0.07 percent of total billed charges 0.24 0.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MATRIX TISSUE ALLODERM THICK 16X6CM ACELLULAR DERMIS ALLOGRAFT REGENERATIVE READY TO USE SUP-1520616 CDM 270010031 LOCAL 0270 RC outpatient 8036.6 8036.6 8036.6 74 5947.08 percent of total billed charges 8036.6 93 6509.65 percent of total billed charges 8036.6 8036.6 other OPPS APC 8036.6 8036.6 other OPPS APC 8036.6 27.63 2220.51 percent of total billed charges 8036.6 8036.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ENDURANCE LUSTER 2 12/14 TAPER L180 MM HIP CEMENTED REVISION SUP-1521-21-000 CDM 270010024 LOCAL 0270 RC outpatient 11913.2 11913.2 11913.2 74 8815.77 percent of total billed charges 11913.2 93 9649.69 percent of total billed charges 11913.2 11913.2 other OPPS APC 11913.2 11913.2 other OPPS APC 11913.2 27.63 3291.62 percent of total billed charges 11913.2 11913.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ENDURANCE 3 12/14 TAPER 190MM STERILE HIP REVISION CEMENTED MODULAR SUP-1521-22-000 CDM 270010024 LOCAL 0270 RC outpatient 11915.3 11915.3 11915.3 74 8817.31 percent of total billed charges 11915.3 93 9651.38 percent of total billed charges 11915.3 11915.3 other OPPS APC 11915.3 11915.3 other OPPS APC 11915.3 27.63 3292.19 percent of total billed charges 11915.3 11915.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ENDURANCE LUSTER 2 12/14 TAPER L230 MM HIP CEMENTED REVISION SUP-1521-24-000 CDM 270010014 LOCAL 0270 RC outpatient 11915.3 11915.3 11915.3 74 8817.31 percent of total billed charges 11915.3 93 9651.38 percent of total billed charges 11915.3 11915.3 other OPPS APC 11915.3 11915.3 other OPPS APC 11915.3 27.63 3292.19 percent of total billed charges 11915.3 11915.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ENDURANCE LUSTER 3 12/14 TAPER L240 MM HIP CEMENTED REVISION SUP-1521-25-000 CDM 270010014 LOCAL 0270 RC outpatient 10240.7 10240.7 10240.7 74 7578.1 percent of total billed charges 10240.7 93 8294.94 percent of total billed charges 10240.7 10240.7 other OPPS APC 10240.7 10240.7 other OPPS APC 10240.7 27.63 2829.5 percent of total billed charges 10240.7 10240.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK SURGICAL DEXTER ANTIFOG TIE LATEX FREE GREEN SUP-15211 CDM 0270 RC outpatient 0.26 0.26 0.26 74 0.19 percent of total billed charges 0.26 93 0.21 percent of total billed charges 0.26 0.26 other OPPS APC 0.26 0.26 other OPPS APC 0.26 27.63 0.07 percent of total billed charges 0.26 0.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK SURGICAL DEXTER POLY EXTRA SOFT TIE COOL BREATHABLE PLEAT LATEX FREE WHITE SENSITIVE SKIN SUP-15215 CDM 0270 RC outpatient 0.2 0.2 0.2 74 0.15 percent of total billed charges 0.2 93 0.16 percent of total billed charges 0.2 0.2 other OPPS APC 0.2 0.2 other OPPS APC 0.2 27.63 0.06 percent of total billed charges 0.2 0.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAC CORRECTION MOD SUP-15230 CDM 0270 RC outpatient 9633.13 9633.13 9633.13 74 7128.52 percent of total billed charges 9633.13 93 7802.84 percent of total billed charges 9633.13 9633.13 other OPPS APC 9633.13 9633.13 other OPPS APC 9633.13 27.63 2661.63 percent of total billed charges 9633.13 9633.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT NASAL DOYLE II SILICONE SEPTUM COMPRESS ANTERIOR TIP INTEGRAL AIRWAY STERILE LATEX FREE DISPOSABLE WHITE SUP-1524050 CDM 0270 RC outpatient 210.6 210.6 210.6 74 155.84 percent of total billed charges 210.6 93 170.59 percent of total billed charges 210.6 210.6 other OPPS APC 210.6 210.6 other OPPS APC 210.6 27.63 58.19 percent of total billed charges 210.6 210.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOLT EXTERNAL FIXATION RING XS FIXATOR SUP-15245 CDM 0270 RC outpatient 225.42 225.42 225.42 74 166.81 percent of total billed charges 225.42 93 182.59 percent of total billed charges 225.42 225.42 other OPPS APC 225.42 225.42 other OPPS APC 225.42 27.63 62.28 percent of total billed charges 225.42 225.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE SURGICAL 3M TRANSPORE 10YDX1IN CLEAR PLASTIC DISPOSABLE LF HYPOALLERGENIC WATER RESISTANT BIDIRECTIONAL TEAR SUP-1527-1 CDM 0270 RC outpatient 1.35 1.35 1.35 74 1 percent of total billed charges 1.35 93 1.09 percent of total billed charges 1.35 1.35 other OPPS APC 1.35 1.35 other OPPS APC 1.35 27.63 0.37 percent of total billed charges 1.35 1.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE SURGICAL 3M TRANSPORE 10YDX2IN CLEAR PLASTIC DISPOSABLE LF HYPOALLERGENIC WATER RESISTANT BIDIRECTION TEAR SUP-1527-2 CDM 0270 RC outpatient 2.86 2.86 2.86 74 2.12 percent of total billed charges 2.86 93 2.32 percent of total billed charges 2.86 2.86 other OPPS APC 2.86 2.86 other OPPS APC 2.86 27.63 0.79 percent of total billed charges 2.86 2.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT NASAL REUTER FLUOROPLASTIC THK.5 MM STANDARD SEPTUM PREPUNCH HOLE SUP-1527005 CDM 0270 RC outpatient 188.24 188.24 188.24 74 139.3 percent of total billed charges 188.24 93 152.47 percent of total billed charges 188.24 188.24 other OPPS APC 188.24 188.24 other OPPS APC 188.24 27.63 52.01 percent of total billed charges 188.24 188.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EXTERNAL FIXATION FEMALE ADAPTER SUP-15275 CDM 0270 RC outpatient 1606.67 1606.67 1606.67 74 1188.94 percent of total billed charges 1606.67 93 1301.4 percent of total billed charges 1606.67 1606.67 other OPPS APC 1606.67 1606.67 other OPPS APC 1606.67 27.63 443.92 percent of total billed charges 1606.67 1606.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE SURGICAL 3M MICROFOAM 5.5YDX3IN WHITE FOAM LF HYPOALLERGENIC WATER RESISTANT MULTIDIRECTIONAL STRETCH ELASTIC SUP-1528-3 CDM 0270 RC outpatient 8.17 8.17 8.17 74 6.05 percent of total billed charges 8.17 93 6.62 percent of total billed charges 8.17 8.17 other OPPS APC 8.17 8.17 other OPPS APC 8.17 27.63 2.26 percent of total billed charges 8.17 8.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT NASAL THERMASPLINT SM 2.25X1.25IN WHITE THERMOPLASTIC DISPOSABLE STERILE LF SEPTUM KIT EXTERNAL SUP-1529000 CDM 0270 RC outpatient 79.3 79.3 79.3 74 58.68 percent of total billed charges 79.3 93 64.23 percent of total billed charges 79.3 79.3 other OPPS APC 79.3 79.3 other OPPS APC 79.3 27.63 21.91 percent of total billed charges 79.3 79.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT NASAL THERMASPLINT THERMOPLASTIC MEDIUM W2.38 IN X H1.53 IN SEPTUM KIT EXTERNAL STERILE LATEX FREE DISPOSABLE WHITE SUP-1529010_62787 CDM 0270 RC outpatient 81.12 81.12 81.12 74 60.03 percent of total billed charges 81.12 93 65.71 percent of total billed charges 81.12 81.12 other OPPS APC 81.12 81.12 other OPPS APC 81.12 27.63 22.41 percent of total billed charges 81.12 81.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP BIOMET ANGULATING SUP-15295 CDM 0270 RC outpatient 1432.08 1432.08 1432.08 74 1059.74 percent of total billed charges 1432.08 93 1159.98 percent of total billed charges 1432.08 1432.08 other OPPS APC 1432.08 1432.08 other OPPS APC 1432.08 27.63 395.68 percent of total billed charges 1432.08 1432.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE SURGICAL 3M MICROPORE 10YDX1IN WHITE PAPER DISPOSABLE LF HYPOALLERGENIC BREATHABLE SUP-1530-1 CDM 0270 RC outpatient 0.78 0.78 0.78 74 0.58 percent of total billed charges 0.78 93 0.63 percent of total billed charges 0.78 0.78 other OPPS APC 0.78 0.78 other OPPS APC 0.78 27.63 0.22 percent of total billed charges 0.78 0.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE SURGICAL 3M MICROPORE 10YDX2IN WHITE PAPER DISPOSABLE LF HYPOALLERGENIC BREATHABLE SUP-1530-2 CDM 0270 RC outpatient 1.52 1.52 1.52 74 1.12 percent of total billed charges 1.52 93 1.23 percent of total billed charges 1.52 1.52 other OPPS APC 1.52 1.52 other OPPS APC 1.52 27.63 0.42 percent of total billed charges 1.52 1.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE SURGICAL 3M MICROPORE 10YDX3IN WHITE PAPER DISPOSABLE LF HYPOALLERGENIC BREATHABLE SUP-1530-3 CDM 0270 RC outpatient 2.28 2.28 2.28 74 1.69 percent of total billed charges 2.28 93 1.85 percent of total billed charges 2.28 2.28 other OPPS APC 2.28 2.28 other OPPS APC 2.28 27.63 0.63 percent of total billed charges 2.28 2.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. URINE METER BARD 8FR KIT SUP-1531 CDM 270009031 LOCAL 0270 RC outpatient 9.91 9.91 9.91 74 7.33 percent of total billed charges 9.91 93 8.03 percent of total billed charges 9.91 9.91 other OPPS APC 9.91 9.91 other OPPS APC 9.91 27.63 2.74 percent of total billed charges 9.91 9.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METER URINE BARD EZ-LOK 350 ML 2500 ML INFECTION CONTROL SAMPLE PORT DRAINAGE BAG STERILE LATEX FREE DISPOSABLE SUP-153214 CDM 270009006 LOCAL 0270 RC outpatient 12.49 12.49 12.49 74 9.24 percent of total billed charges 12.49 93 10.12 percent of total billed charges 12.49 12.49 other OPPS APC 12.49 12.49 other OPPS APC 12.49 27.63 3.45 percent of total billed charges 12.49 12.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METER URINE BARD EZ-LOK 350 ML 2500 ML INFECTION CONTROL SAMPLE PORT DRAINAGE BAG STERILE LATEX FREE DISPOSABLE SUP-153214A CDM 270009006 LOCAL 0270 RC outpatient 18.88 18.88 18.88 74 13.97 percent of total billed charges 18.88 93 15.29 percent of total billed charges 18.88 18.88 other OPPS APC 18.88 18.88 other OPPS APC 18.88 27.63 5.22 percent of total billed charges 18.88 18.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE SURGICAL 3M DURAPORE 10YDX1IN WHITE CLOTH LF HYPOALLERGENIC WATER RESISTANT BIDIRECTIONAL TEAR SUP-1538-1 CDM 0270 RC outpatient 1.25 1.25 1.25 74 0.93 percent of total billed charges 1.25 93 1.01 percent of total billed charges 1.25 1.25 other OPPS APC 1.25 1.25 other OPPS APC 1.25 27.63 0.35 percent of total billed charges 1.25 1.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE SURGICAL 3M DURAPORE 10YDX3IN WHITE CLOTH LF HYPOALLERGENIC WATER RESISTANT BIDIRECTIONAL TEAR SUP-1538-3 CDM 0270 RC outpatient 3.94 3.94 3.94 74 2.92 percent of total billed charges 3.94 93 3.19 percent of total billed charges 3.94 3.94 other OPPS APC 3.94 3.94 other OPPS APC 3.94 27.63 1.09 percent of total billed charges 3.94 3.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG DRAINAGE ROUND TEARDROP 2000ML DISPOSABLE STERILE LF ANTIREFLUX CHAMBER OUTLET TUBE SUP-154002 CDM 270009001 LOCAL 0270 RC outpatient 6.7 6.7 6.7 74 4.96 percent of total billed charges 6.7 93 5.43 percent of total billed charges 6.7 6.7 other OPPS APC 6.7 6.7 other OPPS APC 6.7 27.63 1.85 percent of total billed charges 6.7 6.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG DRAINAGE URINARY LATEX FREE 2000CC SUP-154002 CDM 270009001 LOCAL 0270 RC outpatient 6.7 6.7 6.7 74 4.96 percent of total billed charges 6.7 93 5.43 percent of total billed charges 6.7 6.7 other OPPS APC 6.7 6.7 other OPPS APC 6.7 27.63 1.85 percent of total billed charges 6.7 6.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG DRAINAGE ROUND TEARDROP 2000ML DISPOSABLE STERILE LF ANTIREFLUX CHAMBER MICROBICIDAL OUTLET TUBE SUP-154004 CDM 270009001 LOCAL 0270 RC outpatient 3.34 3.34 3.34 74 2.47 percent of total billed charges 3.34 93 2.71 percent of total billed charges 3.34 3.34 other OPPS APC 3.34 3.34 other OPPS APC 3.34 27.63 0.92 percent of total billed charges 3.34 3.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUSHING FEMORAL OSS POLYETHYLENE KNEE AUXILIARY SUP-1540477 CDM 0270 RC outpatient 1588.6 1588.6 1588.6 74 1175.56 percent of total billed charges 1588.6 93 1286.77 percent of total billed charges 1588.6 1588.6 other OPPS APC 1588.6 1588.6 other OPPS APC 1588.6 27.63 438.93 percent of total billed charges 1588.6 1588.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG DRAINAGE URINARY LATEX FREE 2000CC SUP-154102 CDM 270009001 LOCAL 0270 RC outpatient 3.34 3.34 3.34 74 2.47 percent of total billed charges 3.34 93 2.71 percent of total billed charges 3.34 3.34 other OPPS APC 3.34 3.34 other OPPS APC 3.34 27.63 0.92 percent of total billed charges 3.34 3.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENT OSTEOTOME STAGING STRAIGHT LINE SUP-1545 CDM 0270 RC outpatient 523.15 523.15 523.15 74 387.13 percent of total billed charges 523.15 93 423.75 percent of total billed charges 523.15 523.15 other OPPS APC 523.15 523.15 other OPPS APC 523.15 27.63 144.55 percent of total billed charges 523.15 523.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL AUGMENT ATTUNE SIZE 8 4MM SUP-1547-08-001 CDM 270010024 LOCAL 0270 RC outpatient 3243.5 3243.5 3243.5 74 2400.19 percent of total billed charges 3243.5 93 2627.24 percent of total billed charges 3243.5 3243.5 other OPPS APC 3243.5 3243.5 other OPPS APC 3243.5 27.63 896.18 percent of total billed charges 3243.5 3243.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK LASER SUP-15525 CDM 0270 RC outpatient 0.69 0.69 0.69 74 0.51 percent of total billed charges 0.69 93 0.56 percent of total billed charges 0.69 0.69 other OPPS APC 0.69 0.69 other OPPS APC 0.69 27.63 0.19 percent of total billed charges 0.69 0.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CD HORIZON TITANIUM CURVE L40 MM OD5.5 MM SUP-1553201040 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SOLERA TITANIUM CURVE L70 MM OD5.5 MM SUP-1553201070 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CD HORIZON TITANIUM STRAIGHT L500 MM OD5.5 MM LINE SUP-1554200500 CDM 270010020 LOCAL 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CCM STRAIGHT L230 MM OD5.5 MM PERCUTANEOUS SUP-1555006230 CDM 270010020 LOCAL 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CCM STRAIGHT L240 MM OD5.5 MM PERCUTANEOUS SUP-1555006240 CDM 270010020 LOCAL 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD MEDTRONIC 60MM SUP-1556001060 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE RECTAL PLASTIC L20 IN OD24 FR FLEXIBLE CONNECTOR LUBRICANT NONSTERILE LATEX FREE DISPOSABLE SUP-155731 CDM 270009047 LOCAL 0270 RC outpatient 4.71 4.71 4.71 74 3.49 percent of total billed charges 4.71 93 3.82 percent of total billed charges 4.71 4.71 other OPPS APC 4.71 4.71 other OPPS APC 4.71 27.63 1.3 percent of total billed charges 4.71 4.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL SUMMIT 4 12/14 HIGH OFFSET TAPER L114 MM HIP CEMENT STERILE SUP-157013100 CDM 270010024 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL SIGMA GVF 2 H8 MM KNEE STABILIZE SUP-1581-21-008 CDM 270010025 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL SIGMA GVF 2.5 H10 MM KNEE STABILIZE SUP-1581-22-010 CDM 270010025 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL SIGMA GVF 2.5 H12.5 MM KNEE STABILIZE SUP-1581-22-012 CDM 270010025 LOCAL 0270 RC outpatient 2061.8 2061.8 2061.8 74 1525.73 percent of total billed charges 2061.8 93 1670.06 percent of total billed charges 2061.8 2061.8 other OPPS APC 2061.8 2061.8 other OPPS APC 2061.8 27.63 569.68 percent of total billed charges 2061.8 2061.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL SIGMA GVF 3 H12.5 MM KNEE STABILIZE SUP-1581-23-012 CDM 270010025 LOCAL 0270 RC outpatient 3549 3549 3549 74 2626.26 percent of total billed charges 3549 93 2874.69 percent of total billed charges 3549 3549 other OPPS APC 3549 3549 other OPPS APC 3549 27.63 980.59 percent of total billed charges 3549 3549 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL SIGMA GVF 3 H15 MM KNEE STABILIZE SUP-1581-23-015 CDM 270010025 LOCAL 0270 RC outpatient 2061.8 2061.8 2061.8 74 1525.73 percent of total billed charges 2061.8 93 1670.06 percent of total billed charges 2061.8 2061.8 other OPPS APC 2061.8 2061.8 other OPPS APC 2061.8 27.63 569.68 percent of total billed charges 2061.8 2061.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL SIGMA GVF 4 H15 MM KNEE STABILIZE STERILE SUP-1581-24-015 CDM 270010025 LOCAL 0270 RC outpatient 2061.8 2061.8 2061.8 74 1525.73 percent of total billed charges 2061.8 93 1670.06 percent of total billed charges 2061.8 2061.8 other OPPS APC 2061.8 2061.8 other OPPS APC 2061.8 27.63 569.68 percent of total billed charges 2061.8 2061.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL SIGMA GVF 5 H10 MM KNEE STABILIZE SUP-1581-25-010 CDM 270010025 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL SIGMA GVF 6 H8 MM KNEE STABILIZE STERILE SUP-1581-26-008 CDM 270010025 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL SIGMA COCR 6 KNEE CEMENTED MODULAR SUP-1581-60-000 CDM 270010025 LOCAL 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKINETTE ORTHOPEDIC CONVERTORS POLYESTER LARGE L48 IN X W9 IN IMPERVIOUS BARRIER DRAPE WOVEN STERILE LATEX FREE SUP-1586 CDM 0270 RC outpatient 7.69 7.69 7.69 74 5.69 percent of total billed charges 7.69 93 6.23 percent of total billed charges 7.69 7.69 other OPPS APC 7.69 7.69 other OPPS APC 7.69 27.63 2.12 percent of total billed charges 7.69 7.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKINETTE ORTHOPEDIC CONVERTORS POLYESTER XL L48 IN X W12 IN IMPERVIOUS DRAPE STERILE LATEX FREE DISPOSABLE SUP-1587 CDM 0270 RC outpatient 8.14 8.14 8.14 74 6.02 percent of total billed charges 8.14 93 6.59 percent of total billed charges 8.14 8.14 other OPPS APC 8.14 8.14 other OPPS APC 8.14 27.63 2.25 percent of total billed charges 8.14 8.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MIDAS REX LEGEND BALL L15 CM OD4 MM DIAMOND STERILE BURR SUP-15BA40D CDM 0270 RC outpatient 560.98 560.98 560.98 74 415.13 percent of total billed charges 560.98 93 454.39 percent of total billed charges 560.98 560.98 other OPPS APC 560.98 560.98 other OPPS APC 560.98 27.63 155 percent of total billed charges 560.98 560.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 23 UPPER FLEXIBLE SUP-160-146 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 24 UPPER FLEXIBLE SUP-160-148 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 25 1/2 UPPER FLEXIBLE SUP-160-151 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 26 UPPER SUP-160-152 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 26 1/2 UPPER FLEXIBLE SUP-160-153 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 27 UPPER SUP-160-154 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 27 1/2 UPPER FLEXIBLE SUP-160-155 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 28 UPPER SUP-160-156 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 29 UPPER SUP-160-158 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 29 1/2 UPPER SUP-160-159 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 30 UPPER SUP-160-160 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 30 1/2 UPPER SUP-160-161 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 31 1/2 UPPER FLEXIBLE SUP-160-163 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 32 UPPER FLEXIBLE SUP-160-164 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 32 1/2 UPPER FLEXIBLE SUP-160-165 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 33 UPPER FLEXIBLE SUP-160-166 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 33 1/2 UPPER FLEXIBLE SUP-160-167 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 34 UPPER FLEXIBLE SUP-160-168 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 34 1/2 UPPER SUP-160-169 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 35 UPPER SUP-160-170 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 35 1/2 UPPER SUP-160-171 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 36 NARROW UPPER MAXILLARY GENERAL PURPOSE STRONG FULLY PROPORTIONED SUP-160-172 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 36 1/2 UPPER SUP-160-173 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 37 UPPER SUP-160-174 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 37 1/2 UPPER SUP-160-175 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 38 UPPER SUP-160-176 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 38 1/2 UPPER FLEXIBLE SUP-160-177 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 39 UPPER SUP-160-178 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 39 1/2 UPPER SUP-160-179 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 40 UPPER SUP-160-180 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 40 1/2 UPPER SUP-160-181 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 41 UPPER SUP-160-182 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 41 1/2 UPPER SUP-160-183 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 42 UPPER SUP-160-184 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 23 LOWER FLEXIBLE SUP-160-246 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 23 1/2 LOWER FLEXIBLE SUP-160-247 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 24 LOWER FLEXIBLE SUP-160-248 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND INDIVIDUAL MOLAR LOWAR SIZE 24 1/2 SUP-160-249 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 25 LOWER SUP-160-250 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 25 1/2 LOWER FLEXIBLE SUP-160-251 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 26 LOWER SUP-160-252 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 26 1/2 LOWER FLEXIBLE SUP-160-253 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 27 LOWER SUP-160-254 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 27 1/2 LOWER FLEXIBLE SUP-160-255 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 28 LOWER SUP-160-256 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 28 1/2 LOWER SUP-160-257 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 29 LOWER SUP-160-258 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 29 1/2 LOWER SUP-160-259 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 30 LOWER FLEXIBLE SUP-160-260 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 30 1/2 LOWER FLEXIBLE SUP-160-261 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 31 LOWER FLEXIBLE SUP-160-262 CDM 0270 RC outpatient 10.92 10.92 10.92 74 8.08 percent of total billed charges 10.92 93 8.85 percent of total billed charges 10.92 10.92 other OPPS APC 10.92 10.92 other OPPS APC 10.92 27.63 3.02 percent of total billed charges 10.92 10.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 31 1/2 LOWER FLEXIBLE SUP-160-263 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 32 LOWER FLEXIBLE SUP-160-264 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 32 1/2 LOWER SUP-160-265 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 33 LOWER FLEXIBLE SUP-160-266 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 33 1/2 LOWER SUP-160-267 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 34 LOWER FLEXIBLE SUP-160-268 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 34 1/2 LOWER FLEXIBLE SUP-160-269 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 35 LOWER FLEXIBLE SUP-160-270 CDM 0270 RC outpatient 10.92 10.92 10.92 74 8.08 percent of total billed charges 10.92 93 8.85 percent of total billed charges 10.92 10.92 other OPPS APC 10.92 10.92 other OPPS APC 10.92 27.63 3.02 percent of total billed charges 10.92 10.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 35 1/2 LOWER SUP-160-271 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 36 1/2 LOWER SUP-160-273 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 37 NARROW LOWER MAXILLARY GENERAL PURPOSE STRONG FULLY PROPORTIONED SUP-160-274 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 37 1/2 LOWER SUP-160-275 CDM 0270 RC outpatient 10.01 10.01 10.01 74 7.41 percent of total billed charges 10.01 93 8.11 percent of total billed charges 10.01 10.01 other OPPS APC 10.01 10.01 other OPPS APC 10.01 27.63 2.77 percent of total billed charges 10.01 10.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 38 LOWER FLEXIBLE SUP-160-276 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 38 1/2 LOWER FLEXIBLE SUP-160-277 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 39 LOWER SUP-160-278 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 39 1/2 LOWER SUP-160-279 CDM 0270 RC outpatient 8.79 8.79 8.79 74 6.5 percent of total billed charges 8.79 93 7.12 percent of total billed charges 8.79 8.79 other OPPS APC 8.79 8.79 other OPPS APC 8.79 27.63 2.43 percent of total billed charges 8.79 8.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 40 LOWER SUP-160-280 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 40 1/2 LOWER SUP-160-281 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 41 LOWER SUP-160-282 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 41 1/2 LOWER SUP-160-283 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL PEDIATRIC 42 LOWER SUP-160-284 CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLUG CATHETER CURITY CAP STERILE SUP-1600 CDM 0270 RC outpatient 1.3 1.3 1.3 74 0.96 percent of total billed charges 1.3 93 1.05 percent of total billed charges 1.3 1.3 other OPPS APC 1.3 1.3 other OPPS APC 1.3 27.63 0.36 percent of total billed charges 1.3 1.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP PROTECTIVE HEAD STERILE YELLOW .028 IN PIN SUP-1601-028 CDM 0270 RC outpatient 7.17 7.17 7.17 74 5.31 percent of total billed charges 7.17 93 5.81 percent of total billed charges 7.17 7.17 other OPPS APC 7.17 7.17 other OPPS APC 7.17 27.63 1.98 percent of total billed charges 7.17 7.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP PROTECTIVE .035 IN OD.9 MM PIN STERILE BLUE SUP-1601-035 CDM 0270 RC outpatient 7.17 7.17 7.17 74 5.31 percent of total billed charges 7.17 93 5.81 percent of total billed charges 7.17 7.17 other OPPS APC 7.17 7.17 other OPPS APC 7.17 27.63 1.98 percent of total billed charges 7.17 7.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP PROTECTIVE L1.1 MM OD.045 IN ORTHOPEDIC HEAD STERILE WHITE .045 IN PIN SUP-1601-045 CDM 0270 RC outpatient 7.17 7.17 7.17 74 5.31 percent of total billed charges 7.17 93 5.81 percent of total billed charges 7.17 7.17 other OPPS APC 7.17 7.17 other OPPS APC 7.17 27.63 1.98 percent of total billed charges 7.17 7.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION L.42 IN OD.062 IN PROTECTOR GREEN YELLOW SUP-1601-062 CDM 0270 RC outpatient 7.17 7.17 7.17 74 5.31 percent of total billed charges 7.17 93 5.81 percent of total billed charges 7.17 7.17 other OPPS APC 7.17 7.17 other OPPS APC 7.17 27.63 1.98 percent of total billed charges 7.17 7.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER L9 IN OD.028 IN 2 BAYONET POINT SUP-160137000 CDM 0270 RC outpatient 43.33 43.33 43.33 74 32.06 percent of total billed charges 43.33 93 35.1 percent of total billed charges 43.33 43.33 other OPPS APC 43.33 43.33 other OPPS APC 43.33 27.63 11.97 percent of total billed charges 43.33 43.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER L9 IN OD.035 IN 2 END BAYONET POINT SUP-160138000 CDM 0270 RC outpatient 16.28 16.28 16.28 74 12.05 percent of total billed charges 16.28 93 13.19 percent of total billed charges 16.28 16.28 other OPPS APC 16.28 16.28 other OPPS APC 16.28 27.63 4.5 percent of total billed charges 16.28 16.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL L9 IN OD.045 IN 2 BAYONET POINT SMOOTH SUP-160139000 CDM 0270 RC outpatient 16.66 16.66 16.66 74 12.33 percent of total billed charges 16.66 93 13.49 percent of total billed charges 16.66 16.66 other OPPS APC 16.66 16.66 other OPPS APC 16.66 27.63 4.6 percent of total billed charges 16.66 16.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL L9 IN OD.054 IN BAYONET POINT BOTH END SUP-160140000 CDM 0270 RC outpatient 16.91 16.91 16.91 74 12.51 percent of total billed charges 16.91 93 13.7 percent of total billed charges 16.91 16.91 other OPPS APC 16.91 16.91 other OPPS APC 16.91 27.63 4.67 percent of total billed charges 16.91 16.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL L9 IN OD.062 IN 2 BAYONET POINT SMOOTH SUP-160141000 CDM 0270 RC outpatient 1.46 1.46 1.46 74 1.08 percent of total billed charges 1.46 93 1.18 percent of total billed charges 1.46 1.46 other OPPS APC 1.46 1.46 other OPPS APC 1.46 27.63 0.4 percent of total billed charges 1.46 1.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY FOGARTY COIL L50 CM OD5 FR VASCULAR GRAFT FLEXIBLE CLOT MANAGEMENT WIRE STERILE LATEX SUP-160245F CDM 0270 RC outpatient 1131.55 1131.55 1131.55 74 837.35 percent of total billed charges 1131.55 93 916.56 percent of total billed charges 1131.55 1131.55 other OPPS APC 1131.55 1131.55 other OPPS APC 1131.55 27.63 312.65 percent of total billed charges 1131.55 1131.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY FOGARTY COIL L50 CM OD6 FR VASCULAR GRAFT FLEXIBLE CLOT MANAGEMENT WIRE STERILE LATEX SUP-160246F CDM 0270 RC outpatient 1077.67 1077.67 1077.67 74 797.48 percent of total billed charges 1077.67 93 872.91 percent of total billed charges 1077.67 1077.67 other OPPS APC 1077.67 1077.67 other OPPS APC 1077.67 27.63 297.76 percent of total billed charges 1077.67 1077.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE LAPAROSCOPIC ABC ELECTROSURGICAL 5MM 44CM WORKING 10FT CABLE HAND SWITCH STERILE DISPOSABLE 1/PK SUP-160644 CDM 0270 RC outpatient 298.01 298.01 298.01 74 220.53 percent of total billed charges 298.01 93 241.39 percent of total billed charges 298.01 298.01 other OPPS APC 298.01 298.01 other OPPS APC 298.01 27.63 82.34 percent of total billed charges 298.01 298.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE DRAINAGE PNEUMOSTAT 30ML THORAX 1 WAY DRY SEAL STERILE DISPOSABLE SUP-16100 CDM 0270 RC outpatient 81.51 81.51 81.51 74 60.32 percent of total billed charges 81.51 93 66.02 percent of total billed charges 81.51 81.51 other OPPS APC 81.51 81.51 other OPPS APC 81.51 27.63 22.52 percent of total billed charges 81.51 81.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 70MM 16MM 7.3MM 2.9MM SS NS LG BONE CANNULATED SELF TAP SELF DRILL HEXAGONAL SUP-161157 CDM C1713 HCPCS 0278 RC outpatient 733.5 733.5 733.5 57 418.1 percent of total billed charges 733.5 93 594.14 percent of total billed charges 733.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 733.5 other OPPS APC 733.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 733.5 other OPPS APC 733.5 51 374.09 percent of total billed charges 733.5 733.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON MULTIPASS 4-0 PS-2 18IN UNDYED MONOFILAMENT SUP-1611G CDM 0270 RC outpatient 9.39 9.39 9.39 74 6.95 percent of total billed charges 9.39 93 7.61 percent of total billed charges 9.39 9.39 other OPPS APC 9.39 9.39 other OPPS APC 9.39 27.63 2.59 percent of total billed charges 9.39 9.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP SURGICAL DLP L3 MM CORONARY ARTERY RETRACTION SUP-16130 CDM 0270 RC outpatient 38.69 38.69 38.69 74 28.63 percent of total billed charges 38.69 93 31.34 percent of total billed charges 38.69 38.69 other OPPS APC 38.69 38.69 other OPPS APC 38.69 27.63 10.69 percent of total billed charges 38.69 38.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE COMPRESSION REB L5 YD X W2 IN REINFORCE ELASTIC LIGHTWEIGHT STRETCH LATEX FREE STANDARD SUP-16200000 CDM outpatient 1.92 1.92 1.92 1.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING TRANSPARENT 3M TEGADERM STANDARD 2.75INX2 3/8IN POLYURETHANE STERILE LF SACRAL FRAME STYLE ADHESIVE SUP-1624W CDM outpatient 0.55 0.55 0.55 0.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING TRANSPARENT 3M TEGADERM STANDARD 4.75X4IN POLYURETHANE STERILE LF SACRAL FRAME STYLE ADHESIVE HYPOALLERGENIC SUP-1626W CDM outpatient 1.55 1.55 1.55 1.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING TRANSPARENT 3M TEGADERM 8X6IN STERILE LF FRAME STYLE ADHESIVE HYPOALLERGENIC WATERPROOF SUP-1628 CDM 270009020 LOCAL 0270 RC outpatient 4.14 4.14 4.14 74 3.06 percent of total billed charges 4.14 93 3.35 percent of total billed charges 4.14 4.14 other OPPS APC 4.14 4.14 other OPPS APC 4.14 27.63 1.14 percent of total billed charges 4.14 4.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING TRANSPARENT 3M TEGADERM 12X8IN POLYURETHANE STERILE LF FRAME STYLE ADHESIVE HYPOALLERGENIC WATERPROOF SUP-1629 CDM 0270 RC outpatient 4.45 4.45 4.45 74 3.29 percent of total billed charges 4.45 93 3.6 percent of total billed charges 4.45 4.45 other OPPS APC 4.45 4.45 other OPPS APC 4.45 27.63 1.23 percent of total billed charges 4.45 4.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING TRANSPARENT 3M TEGADERM OVAL 4.5X4IN POLYURETHANE STERILE LF ADHESIVE WATERPROOF SUP-1630 CDM 0270 RC outpatient 1.84 1.84 1.84 74 1.36 percent of total billed charges 1.84 93 1.49 percent of total billed charges 1.84 1.84 other OPPS APC 1.84 1.84 other OPPS APC 1.84 27.63 0.51 percent of total billed charges 1.84 1.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE COMPRESSION REB L5 YD X W3 IN REINFORCE ELASTIC LIGHTWEIGHT STRETCH LATEX FREE STANDARD SUP-16300000 CDM 0270 RC outpatient 1.9 1.9 1.9 74 1.41 percent of total billed charges 1.9 93 1.54 percent of total billed charges 1.9 1.9 other OPPS APC 1.9 1.9 other OPPS APC 1.9 27.63 0.52 percent of total billed charges 1.9 1.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MULTIPASS 5-0 PS-4 18IN YELLOWISH TAN PLAIN MONOFILAMENT SUP-1632G CDM 0270 RC outpatient 14.19 14.19 14.19 74 10.5 percent of total billed charges 14.19 93 11.49 percent of total billed charges 14.19 14.19 other OPPS APC 14.19 14.19 other OPPS APC 14.19 27.63 3.92 percent of total billed charges 14.19 14.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE CHR GUT 6-0 PS-3 18 INCH SUP-1635G CDM 0270 RC outpatient 14 14 14 74 10.36 percent of total billed charges 14 93 11.34 percent of total billed charges 14 14 other OPPS APC 14 14 other OPPS APC 14 27.63 3.87 percent of total billed charges 14 14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL G7 COCR -3 MM OFFSET OD32 MM HIP TYPE 1 SUP-163668 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL G7 COCR STANDARD OFFSET OD32 MM HIP TYPE 1 SUP-163669 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND MULTIPASS 6-0 P-3 18IN BLACK SILK BRAID SUP-1639G CDM 0270 RC outpatient 9.45 9.45 9.45 74 6.99 percent of total billed charges 9.45 93 7.65 percent of total billed charges 9.45 9.45 other OPPS APC 9.45 9.45 other OPPS APC 9.45 27.63 2.61 percent of total billed charges 9.45 9.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN INCISION EXPRESS C500 ML MINI CHEST 1 WAY VALVE VACUUM INDICATOR AIR LEAK DETECTOR WINDOW NEEDLELESS ACCESS SAMPLE PORT STERILE LATEX FREE DISPOSABLE SUP-16400 CDM 270009063 LOCAL 0270 RC outpatient 190.93 190.93 190.93 74 141.29 percent of total billed charges 190.93 93 154.65 percent of total billed charges 190.93 190.93 other OPPS APC 190.93 190.93 other OPPS APC 190.93 27.63 52.75 percent of total billed charges 190.93 190.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE COMPRESSION REB L5 YD X W4 IN REINFORCE ELASTIC LIGHTWEIGHT STRETCH LATEX FREE STANDARD SUP-16400000 CDM 0270 RC outpatient 1.98 1.98 1.98 74 1.47 percent of total billed charges 1.98 93 1.6 percent of total billed charges 1.98 1.98 other OPPS APC 1.98 1.98 other OPPS APC 1.98 27.63 0.55 percent of total billed charges 1.98 1.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER L6 IN OD.28 IN 2 TROCAR POINT SUP-164206028 CDM 0270 RC outpatient 17.74 17.74 17.74 74 13.13 percent of total billed charges 17.74 93 14.37 percent of total billed charges 17.74 17.74 other OPPS APC 17.74 17.74 other OPPS APC 17.74 27.63 4.9 percent of total billed charges 17.74 17.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER L6 IN OD.035 IN HAND TROCAR POINT ALPS SUP-164206035 CDM 0270 RC outpatient 17.29 17.29 17.29 74 12.79 percent of total billed charges 17.29 93 14 percent of total billed charges 17.29 17.29 other OPPS APC 17.29 17.29 other OPPS APC 17.29 27.63 4.78 percent of total billed charges 17.29 17.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER L6 IN OD.045 IN HAND TROCAR POINT ALPS SUP-164206045 CDM 0270 RC outpatient 16.51 16.51 16.51 74 12.22 percent of total billed charges 16.51 93 13.37 percent of total billed charges 16.51 16.51 other OPPS APC 16.51 16.51 other OPPS APC 16.51 27.63 4.56 percent of total billed charges 16.51 16.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 MM OD.054 IN 2 END TROCAR POINT SUP-164206054 CDM 0270 RC outpatient 17.83 17.83 17.83 74 13.19 percent of total billed charges 17.83 93 14.44 percent of total billed charges 17.83 17.83 other OPPS APC 17.83 17.83 other OPPS APC 17.83 27.63 4.93 percent of total billed charges 17.83 17.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER L6 IN OD.062 IN TROCAR POINT SUP-164206062 CDM 0270 RC outpatient 16.34 16.34 16.34 74 12.09 percent of total billed charges 16.34 93 13.24 percent of total billed charges 16.34 16.34 other OPPS APC 16.34 16.34 other OPPS APC 16.34 27.63 4.51 percent of total billed charges 16.34 16.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AV ISO-FLEX S SUP-1642T CDM 0275 RC outpatient 1170 1170 1170 57 666.9 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EMBOLECTOMY FOGARTY THRULUMEN 80CM 3FR 5MM SS SILICONE NATURAL RUBBER STERILE LATEX ARTERY OTW RADIOPAQUE SUP-1651-48 CDM 0270 RC outpatient 309.4 309.4 309.4 74 228.96 percent of total billed charges 309.4 93 250.61 percent of total billed charges 309.4 309.4 other OPPS APC 309.4 309.4 other OPPS APC 309.4 27.63 85.49 percent of total billed charges 309.4 309.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EMBOLECTOMY LEMAITRE .035 IN C1.6 ML L80 CM OD6 FR ODSEC13 MM 1 LUMEN BALLOON OTW GUIDEWIRE RAPID EXCHANGE STERILE LATEX DISPOSABLE BLUE SUP-1651-68 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EMBOLECTOMY FOGARTY THRULUMEN 80CM 5.5FR 11MM SS SILICONE NATURAL RUBBER LATEX ARTERIAL OTW RADIOPAQUE ACCEPTS SUP-1651-88 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL BARD 8FR 3CC SILICONE DISPOSABLE STERILE LF 2 WAY FOLEY BALLOON UNCOAT SUP-165808 CDM 270009029 LOCAL 0270 RC outpatient 13.54 13.54 13.54 74 10.02 percent of total billed charges 13.54 93 10.97 percent of total billed charges 13.54 13.54 other OPPS APC 13.54 13.54 other OPPS APC 13.54 27.63 3.74 percent of total billed charges 13.54 13.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE COMPRESSION REB L5 YD X W6 IN REINFORCE ELASTIC LIGHTWEIGHT STRETCH LATEX FREE STANDARD SUP-16600000 CDM 0270 RC outpatient 3.41 3.41 3.41 74 2.52 percent of total billed charges 3.41 93 2.76 percent of total billed charges 3.41 3.41 other OPPS APC 3.41 3.41 other OPPS APC 3.41 27.63 0.94 percent of total billed charges 3.41 3.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON MULTIPASS 5-0 PS-4 18IN BLACK MONOFILAMENT SUP-1661G CDM 0270 RC outpatient 9.49 9.49 9.49 74 7.02 percent of total billed charges 9.49 93 7.69 percent of total billed charges 9.49 9.49 other OPPS APC 9.49 9.49 other OPPS APC 9.49 27.63 2.62 percent of total billed charges 9.49 9.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON MULTIPASS 4-0 PS-4 18IN BLACK MONOFILAMENT SUP-1662G CDM 0270 RC outpatient 9.3 9.3 9.3 74 6.88 percent of total billed charges 9.3 93 7.53 percent of total billed charges 9.3 9.3 other OPPS APC 9.3 9.3 other OPPS APC 9.3 27.63 2.57 percent of total billed charges 9.3 9.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ETHILON MONOFILAMENT BLACK NEEDLE:PS-1 SIZE:3-0 LENGTH:18IN SUP-1663G CDM 0270 RC outpatient 10.25 10.25 10.25 74 7.59 percent of total billed charges 10.25 93 8.3 percent of total billed charges 10.25 10.25 other OPPS APC 10.25 10.25 other OPPS APC 10.25 27.63 2.83 percent of total billed charges 10.25 10.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON MULTIPASS 3-0 PS-1 18IN BLACK MONOFILAMENT SUP-1663H CDM 0270 RC outpatient 10.25 10.25 10.25 74 7.59 percent of total billed charges 10.25 93 8.3 percent of total billed charges 10.25 10.25 other OPPS APC 10.25 10.25 other OPPS APC 10.25 27.63 2.83 percent of total billed charges 10.25 10.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON MULTIPASS 6-0 PS-3 L18 IN MONOFILAMENT PLIABILIZED BLACK SUP-1665G CDM outpatient 9.04 9.04 9.04 9.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT SECOND FRACTURE STABILITI SUP-1666-01 CDM 0270 RC outpatient 5891.6 5891.6 5891.6 74 4359.78 percent of total billed charges 5891.6 93 4772.2 percent of total billed charges 5891.6 5891.6 other OPPS APC 5891.6 5891.6 other OPPS APC 5891.6 27.63 1627.85 percent of total billed charges 5891.6 5891.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON MULTIPASS 5-0 PS-2 18IN BLACK MONOFILAMENT SUP-1666H CDM 0270 RC outpatient 9.49 9.49 9.49 74 7.02 percent of total billed charges 9.49 93 7.69 percent of total billed charges 9.49 9.49 other OPPS APC 9.49 9.49 other OPPS APC 9.49 27.63 2.62 percent of total billed charges 9.49 9.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON 4-0 PS-2 L18 IN BLACK SUP-1667H CDM 0270 RC outpatient 8.9 8.9 8.9 74 6.59 percent of total billed charges 8.9 93 7.21 percent of total billed charges 8.9 8.9 other OPPS APC 8.9 8.9 other OPPS APC 8.9 27.63 2.46 percent of total billed charges 8.9 8.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON 4-0 PS-2 L18 IN BLACK SUP-1667ZH CDM 0270 RC outpatient 9.39 9.39 9.39 74 6.95 percent of total billed charges 9.39 93 7.61 percent of total billed charges 9.39 9.39 other OPPS APC 9.39 9.39 other OPPS APC 9.39 27.63 2.59 percent of total billed charges 9.39 9.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON 3-0 FSLX L30 IN MONOFILAMENT BLACK SUP-1673BH CDM 0270 RC outpatient 4.62 4.62 4.62 74 3.42 percent of total billed charges 4.62 93 3.74 percent of total billed charges 4.62 4.62 other OPPS APC 4.62 4.62 other OPPS APC 4.62 27.63 1.28 percent of total billed charges 4.62 4.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON 2-0 FSLX L30 IN MONOFILAMENT BLACK SUP-1674BH CDM 0270 RC outpatient 4.78 4.78 4.78 74 3.54 percent of total billed charges 4.78 93 3.87 percent of total billed charges 4.78 4.78 other OPPS APC 4.78 4.78 other OPPS APC 4.78 27.63 1.32 percent of total billed charges 4.78 4.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON 2-0 FSLX L30 IN MONOFILAMENT BLACK SUP-1674H CDM 0270 RC outpatient 4.53 4.53 4.53 74 3.35 percent of total billed charges 4.53 93 3.67 percent of total billed charges 4.53 4.53 other OPPS APC 4.53 4.53 other OPPS APC 4.53 27.63 1.25 percent of total billed charges 4.53 4.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND MULTIPASS 4-0 PS-2 18IN BLACK SILK BRAID SUP-1677G CDM 0270 RC outpatient 8.37 8.37 8.37 74 6.19 percent of total billed charges 8.37 93 6.78 percent of total billed charges 8.37 8.37 other OPPS APC 8.37 8.37 other OPPS APC 8.37 27.63 2.31 percent of total billed charges 8.37 8.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCATHETER VASCULAR EXCELSIOR SL-10 2.4/1.7FR P/D 0.0165IN ID 150CM STR 6CM NON-BRAIDED LOW-PROFILE 2-TIP MARKER HYDROLENE 0.014/0.038IN GW SUP-168189 CDM 0270 RC outpatient 3382.6 3382.6 3382.6 74 2503.12 percent of total billed charges 3382.6 93 2739.91 percent of total billed charges 3382.6 3382.6 other OPPS APC 3382.6 3382.6 other OPPS APC 3382.6 27.63 934.61 percent of total billed charges 3382.6 3382.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCATHETER VASCULAR EXCELSIOR SL-10 2.4/1.7FR P/D 0.0165IN ID 150CM 45DEG PRESHAPED 6CM NON-BRAIDED LOW-PROFILE 2-TIP MARKER HYDROLENE 0.014/0.038IN GW SUP-168190 CDM 0270 RC outpatient 3055 3055 3055 74 2260.7 percent of total billed charges 3055 93 2474.55 percent of total billed charges 3055 3055 other OPPS APC 3055 3055 other OPPS APC 3055 27.63 844.1 percent of total billed charges 3055 3055 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCATHETER VASCULAR EXCELSIOR SL-10 0.0165IN ID 150CM J-PRE-SHAPED 6CM DISTAL 0.014/0.038IN GW SUP-168192 CDM 0270 RC outpatient 3382.6 3382.6 3382.6 3382.6 other OPPS APC 3382.6 3382.6 other OPPS APC 3382.6 27.63 934.61 percent of total billed charges 3382.6 3382.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON 3-0 PSLX L30 IN MONOFILAMENT BLACK SUP-1683H CDM 0270 RC outpatient 9.49 9.49 9.49 74 7.02 percent of total billed charges 9.49 93 7.69 percent of total billed charges 9.49 9.49 other OPPS APC 9.49 9.49 other OPPS APC 9.49 27.63 2.62 percent of total billed charges 9.49 9.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND MULTIPASS SILK 3-0 PS-1 L18 IN BRAID BLACK SUP-1684G CDM 0270 RC outpatient 9.25 9.25 9.25 74 6.85 percent of total billed charges 9.25 93 7.49 percent of total billed charges 9.25 9.25 other OPPS APC 9.25 9.25 other OPPS APC 9.25 27.63 2.56 percent of total billed charges 9.25 9.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON 7-0 P-1 L18 IN MONOFILAMENT BLACK SUP-1696G CDM 0270 RC outpatient 10.79 10.79 10.79 74 7.98 percent of total billed charges 10.79 93 8.74 percent of total billed charges 10.79 10.79 other OPPS APC 10.79 10.79 other OPPS APC 10.79 27.63 2.98 percent of total billed charges 10.79 10.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON MULTIPASS 6-0 P-3 18IN BLACK MONOFILAMENT SUP-1698G CDM 0270 RC outpatient 8.36 8.36 8.36 74 6.19 percent of total billed charges 8.36 93 6.77 percent of total billed charges 8.36 8.36 other OPPS APC 8.36 8.36 other OPPS APC 8.36 27.63 2.31 percent of total billed charges 8.36 8.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE ADAPTER V40 TITANIUM ALUMINA CERAMIC SUP-17-0000E CDM 270010024 LOCAL 0270 RC outpatient 462.8 462.8 462.8 74 342.47 percent of total billed charges 462.8 93 374.87 percent of total billed charges 462.8 462.8 other OPPS APC 462.8 462.8 other OPPS APC 462.8 27.63 127.87 percent of total billed charges 462.8 462.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM PERMANENT SILVER SUP-17-001-01 CDM 0270 RC outpatient 1266.2 1266.2 1266.2 74 936.99 percent of total billed charges 1266.2 93 1025.62 percent of total billed charges 1266.2 1266.2 other OPPS APC 1266.2 1266.2 other OPPS APC 1266.2 27.63 349.85 percent of total billed charges 1266.2 1266.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM PERMANENT SILVER SUP-17-001-02 CDM 0270 RC outpatient 1271.4 1271.4 1271.4 74 940.84 percent of total billed charges 1271.4 93 1029.83 percent of total billed charges 1271.4 1271.4 other OPPS APC 1271.4 1271.4 other OPPS APC 1271.4 27.63 351.29 percent of total billed charges 1271.4 1271.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM PERMANENT SILVER SUP-17-001-08 CDM 0270 RC outpatient 1310.4 1310.4 1310.4 74 969.7 percent of total billed charges 1310.4 93 1061.42 percent of total billed charges 1310.4 1310.4 other OPPS APC 1310.4 1310.4 other OPPS APC 1310.4 27.63 362.06 percent of total billed charges 1310.4 1310.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM STRAIGHT SUP-17-001-10 CDM 0270 RC outpatient 1229.8 1229.8 1229.8 74 910.05 percent of total billed charges 1229.8 93 996.14 percent of total billed charges 1229.8 1229.8 other OPPS APC 1229.8 1229.8 other OPPS APC 1229.8 27.63 339.79 percent of total billed charges 1229.8 1229.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM PERMANENT SILVER SUP-17-001-21 CDM 0270 RC outpatient 1229.8 1229.8 1229.8 74 910.05 percent of total billed charges 1229.8 93 996.14 percent of total billed charges 1229.8 1229.8 other OPPS APC 1229.8 1229.8 other OPPS APC 1229.8 27.63 339.79 percent of total billed charges 1229.8 1229.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM PERMANENT SILVER SUP-17-001-30 CDM 0270 RC outpatient 1229.8 1229.8 1229.8 74 910.05 percent of total billed charges 1229.8 93 996.14 percent of total billed charges 1229.8 1229.8 other OPPS APC 1229.8 1229.8 other OPPS APC 1229.8 27.63 339.79 percent of total billed charges 1229.8 1229.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM PERMANENT SILVER SUP-17-001-42 CDM 0270 RC outpatient 1229.8 1229.8 1229.8 74 910.05 percent of total billed charges 1229.8 93 996.14 percent of total billed charges 1229.8 1229.8 other OPPS APC 1229.8 1229.8 other OPPS APC 1229.8 27.63 339.79 percent of total billed charges 1229.8 1229.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM PERMANENT SILVER SUP-17-001-48 CDM 0270 RC outpatient 1229.8 1229.8 1229.8 74 910.05 percent of total billed charges 1229.8 93 996.14 percent of total billed charges 1229.8 1229.8 other OPPS APC 1229.8 1229.8 other OPPS APC 1229.8 27.63 339.79 percent of total billed charges 1229.8 1229.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM TEMP SILVER SUP-17-001-52 CDM 0270 RC outpatient 1229.8 1229.8 1229.8 74 910.05 percent of total billed charges 1229.8 93 996.14 percent of total billed charges 1229.8 1229.8 other OPPS APC 1229.8 1229.8 other OPPS APC 1229.8 27.63 339.79 percent of total billed charges 1229.8 1229.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM TEMP GOLD SUP-17-001-55 CDM 0270 RC outpatient 1229.8 1229.8 1229.8 74 910.05 percent of total billed charges 1229.8 93 996.14 percent of total billed charges 1229.8 1229.8 other OPPS APC 1229.8 1229.8 other OPPS APC 1229.8 27.63 339.79 percent of total billed charges 1229.8 1229.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM PERMANENT SILVER SUP-17-001-81 CDM 0270 RC outpatient 1266.2 1266.2 1266.2 74 936.99 percent of total billed charges 1266.2 93 1025.62 percent of total billed charges 1266.2 1266.2 other OPPS APC 1266.2 1266.2 other OPPS APC 1266.2 27.63 349.85 percent of total billed charges 1266.2 1266.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM PERMANENT SILVER SUP-17-002-17 CDM 0270 RC outpatient 1271.4 1271.4 1271.4 74 940.84 percent of total billed charges 1271.4 93 1029.83 percent of total billed charges 1271.4 1271.4 other OPPS APC 1271.4 1271.4 other OPPS APC 1271.4 27.63 351.29 percent of total billed charges 1271.4 1271.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA OPHTHALMIC ULTRAFLOW SET BIMANUAL POLISHED DISPOSABLE SUP-170.72 CDM 0270 RC outpatient 60.06 60.06 60.06 74 44.44 percent of total billed charges 60.06 93 48.65 percent of total billed charges 60.06 60.06 other OPPS APC 60.06 60.06 other OPPS APC 60.06 27.63 16.59 percent of total billed charges 60.06 60.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD SUTURE ASSISTANT ENDO STITCH SOFSILK FIBROIN STAINLESS STEEL 2-0 ES-9 L48 IN NONABSORBABLE NONMUTAGENIC STERILE DISPOSABLE BLACK SUP-170004 CDM 0270 RC outpatient 178.91 178.91 178.91 74 132.39 percent of total billed charges 178.91 93 144.92 percent of total billed charges 178.91 178.91 other OPPS APC 178.91 178.91 other OPPS APC 178.91 27.63 49.43 percent of total billed charges 178.91 178.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD SUTURE ASSISTANT ENDO STITCH POLYSORB BRALON LACTOMER NYLON 3-0 ES-9 L48 IN 1 STITCH STERILE DISPOSABLE VIOLET SUP-170071 CDM 0270 RC outpatient 178.91 178.91 178.91 74 132.39 percent of total billed charges 178.91 93 144.92 percent of total billed charges 178.91 178.91 other OPPS APC 178.91 178.91 other OPPS APC 178.91 27.63 49.43 percent of total billed charges 178.91 178.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP SUCTION POOLE 32FR 8.75IN STRAIGHT GENTLE SUMP SUP-170102 CDM 0270 RC outpatient 49.69 49.69 49.69 74 36.77 percent of total billed charges 49.69 93 40.25 percent of total billed charges 49.69 49.69 other OPPS APC 49.69 49.69 other OPPS APC 49.69 27.63 13.73 percent of total billed charges 49.69 49.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE TROCAR HANCOCK 16MM SUP-1701A-16 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPHERE EMBOLIZATION EMBOZENE POLYZENE-F HYDROGEL 500 UM 2 ML SYRINGE STERILE DISPOSABLE RED SUP-17020-S1 CDM 0270 RC outpatient 520 520 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE SABRELOC 10-0 STC-6 8IN BLUE 2 ARM MONOFILAMENT SUP-1713G CDM 0270 RC outpatient 43.46 43.46 43.46 74 32.16 percent of total billed charges 43.46 93 35.2 percent of total billed charges 43.46 43.46 other OPPS APC 43.46 43.46 other OPPS APC 43.46 27.63 12.01 percent of total billed charges 43.46 43.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DRAINAGE PLEURAGUIDE THORACIC ALL IN ONE CHEST TUBE STERILE LATEX FREE DISPOSABLE SUP-17200 CDM 270009127 LOCAL 0270 RC outpatient 69.59 69.59 69.59 74 51.5 percent of total billed charges 69.59 93 56.37 percent of total billed charges 69.59 69.59 other OPPS APC 69.59 69.59 other OPPS APC 69.59 27.63 19.23 percent of total billed charges 69.59 69.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SUTURING ENDO STITCH L15 IN OD10 MM SOFT TISSUE PUSH BUTTON GRIP HANDLE STERILE LATEX FREE DISPOSABLE ENDOSCOPIC SUP-173016 CDM 0270 RC outpatient 1125.77 1125.77 1125.77 74 833.07 percent of total billed charges 1125.77 93 911.87 percent of total billed charges 1125.77 1125.77 other OPPS APC 1125.77 1125.77 other OPPS APC 1125.77 27.63 311.05 percent of total billed charges 1125.77 1125.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD SUTURE ENDO STITCH SURGIDAC LACTOMER 2-0 ES-9 L7 IN 1 STITCH DISPOSABLE GREEN SUP-173021 CDM 0270 RC outpatient 2444.49 2444.49 2444.49 74 1808.92 percent of total billed charges 2444.49 93 1980.04 percent of total billed charges 2444.49 2444.49 other OPPS APC 2444.49 2444.49 other OPPS APC 2444.49 27.63 675.41 percent of total billed charges 2444.49 2444.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD SUTURE ASSISTANT ENDO STITCH SURGIDAC 0 ES-9 48IN GREEN LACTOMER DISPOSABLE STERILE 1 STITCH SUP-173024 CDM 0270 RC outpatient 178.91 178.91 178.91 74 132.39 percent of total billed charges 178.91 93 144.92 percent of total billed charges 178.91 178.91 other OPPS APC 178.91 178.91 other OPPS APC 178.91 27.63 49.43 percent of total billed charges 178.91 178.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POUCH SPECIMEN RETRIEVAL ENDO CATCH II 34.5CM 29.5CM 15MM METAL POLYURETHANE DISPOSABLE LF FLEXIBLE ERGONOMIC HANDLE SUP-173049 CDM 270009147 LOCAL 0270 RC outpatient 80.4 80.4 80.4 74 59.5 percent of total billed charges 80.4 93 65.12 percent of total billed charges 80.4 80.4 other OPPS APC 80.4 80.4 other OPPS APC 80.4 27.63 22.21 percent of total billed charges 80.4 80.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ABSORBENT DENTAL NEODRYS SMALL SALIVA REFLECTIVE SUPER CORE SOFT EDGE YELLOW SUP-1731798 CDM 0270 RC outpatient 0.75 0.75 0.75 74 0.56 percent of total billed charges 0.75 93 0.61 percent of total billed charges 0.75 0.75 other OPPS APC 0.75 0.75 other OPPS APC 0.75 27.63 0.21 percent of total billed charges 0.75 0.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL PROTACK TITANIUM L35.5 MM X W5 MM VASCULAR 30 HELICAL FASTENER STERILE LATEX FREE DISPOSABLE HERNIA MESH SUP-174006 CDM 0270 RC outpatient 1959.94 1959.94 1959.94 74 1450.36 percent of total billed charges 1959.94 93 1587.55 percent of total billed charges 1959.94 1959.94 other OPPS APC 1959.94 1959.94 other OPPS APC 1959.94 27.63 541.53 percent of total billed charges 1959.94 1959.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE ULTIMA CHROMIC 7-0 CS175-8 L18 IN 2 ARM MONOFILAMENT BROWN SUP-1745G CDM 0270 RC outpatient 50.29 50.29 50.29 74 37.21 percent of total billed charges 50.29 93 40.73 percent of total billed charges 50.29 50.29 other OPPS APC 50.29 50.29 other OPPS APC 50.29 27.63 13.9 percent of total billed charges 50.29 50.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR PERFUSION LEFT VENTRICULAR ACCESSORY SUP-174A-16 CDM 0270 RC outpatient 9100 9100 9100 74 6734 percent of total billed charges 9100 93 7371 percent of total billed charges 9100 9100 other OPPS APC 9100 9100 other OPPS APC 9100 27.63 2514.33 percent of total billed charges 9100 9100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE INDEPENDENCE L30 MM OD5.5 MM SPINE SELF DRILL FIX ANGLE NONSTERILE SUP-176.630 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE INDEPENDENCE L35 MM OD5.5 MM SPINE SELF DRILL FIX ANGLE NONSTERILE SUP-176.635 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE INDEPENDENCE L40 MM OD5.5 MM SPINE SELF DRILL FIX ANGLE NONSTERILE SUP-176.640 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE MERSILENE SABRELOC 5-0 S-14 18IN WHITE 2 ARM BRAID SUP-1760G CDM 0270 RC outpatient 31.12 31.12 31.12 74 23.03 percent of total billed charges 31.12 93 25.21 percent of total billed charges 31.12 31.12 other OPPS APC 31.12 31.12 other OPPS APC 31.12 27.63 8.6 percent of total billed charges 31.12 31.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ROTICULATOR TITANIUM L30 MM X W3.5 MM REGULAR THICK TISSUE LINEAR CUTTER SQUEEZE HANDLE STERILE LATEX FREE DISPOSABLE BLUE SUP-17615 CDM 0270 RC outpatient 1363.65 1363.65 1363.65 74 1009.1 percent of total billed charges 1363.65 93 1104.56 percent of total billed charges 1363.65 1363.65 other OPPS APC 1363.65 1363.65 other OPPS APC 1363.65 27.63 376.78 percent of total billed charges 1363.65 1363.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING WOUND HYDROFIBER AQUACEL WITH IONIC SILVER 4.0 X 4.0IN SUP-177902 CDM 270009019 LOCAL 0270 RC outpatient 4.68 4.68 4.68 74 3.46 percent of total billed charges 4.68 93 3.79 percent of total billed charges 4.68 4.68 other OPPS APC 4.68 4.68 other OPPS APC 4.68 27.63 1.29 percent of total billed charges 4.68 4.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE MERSILENE SABRELOC 4-0 S-2 18IN WHITE 2 ARM BRAID SUP-1779G CDM 0270 RC outpatient 33.25 33.25 33.25 74 24.61 percent of total billed charges 33.25 93 26.93 percent of total billed charges 33.25 33.25 other OPPS APC 33.25 33.25 other OPPS APC 33.25 27.63 9.19 percent of total billed charges 33.25 33.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIXED J SUP-1782TC CDM 0275 RC outpatient 1170 1170 1170 57 666.9 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE SABRELOC 5-0 S-14 18IN BROWN CHROMIC 2 ARM MONOFILAMENT SUP-1792G CDM 0270 RC outpatient 40.13 40.13 40.13 74 29.7 percent of total billed charges 40.13 93 32.51 percent of total billed charges 40.13 40.13 other OPPS APC 40.13 40.13 other OPPS APC 40.13 27.63 11.09 percent of total billed charges 40.13 40.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES EXPEDIUM 7MM X 45MM SUP-179712745 CDM 270010020 LOCAL 0270 RC outpatient 2445.3 2445.3 2445.3 74 1809.52 percent of total billed charges 2445.3 93 1980.69 percent of total billed charges 2445.3 2445.3 other OPPS APC 2445.3 2445.3 other OPPS APC 2445.3 27.63 675.64 percent of total billed charges 2445.3 2445.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES EXPEDIUM 7MM X 55MM SUP-179712755 CDM 270010020 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SYNTHES 5.5MM X 45MM RODS SUP-179777045 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIPE CHLORHEXIDINE 2% (3PK) SUP-18-00014 CDM 0272 RC outpatient 21.75 21.75 21.75 74 16.1 percent of total billed charges 21.75 93 17.62 percent of total billed charges 21.75 21.75 other OPPS APC 21.75 21.75 other OPPS APC 21.75 27.63 6.01 percent of total billed charges 21.75 21.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CTAPER BIOLOX DELTA HEAD 32MM -2.5 SUP-18-32-3 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL BIOLOX DELTA +0 MM OFFSET C TAPER OD32 MM HIP HIGH PERFORMANCE SUP-18-3200 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CTAPER BIOLOX DELTA HEAD 32MM +5 SUP-18-3205 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CTAPER BIOLOX DELTA HEAD 32MM +2.5 SUP-18-3225 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL BIOLOX DELTA -2.5 MM OFFSET C TAPER OD36 MM HIP HIGH PERFORMANCE SUP-18-36-3 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL BIOLOX DELTA -5 MM OFFSET C TAPER OD36 MM HIP HIGH PERFORMANCE SUP-18-36-5 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL BIOLOX DELTA 0 MM OFFSET C TAPER OD36 MM HIP HIGH PERFORMANCE SUP-18-3600 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL BIOLOX DELTA +5 MM OFFSET C TAPER OD36 MM HIP HIGH PERFORMANCE SUP-18-3605 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL BIOLOX DELTA +2.5 MM OFFSET C TAPER OD36 MM HIP HIGH PERFORMANCE SUP-18-3625 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ENDOTAK RELIANCE SG STEROID ELUTING SILICONE EPTFE L59 CM ENDOCARDIUM 1 COIL ACTIVE FIXATION CARDIOVERTER DEFIBRILLATOR EXTENDABLE SUP-180 CDM 275001005 LOCAL 0275 RC outpatient 12350 12350 12350 57 7039.5 percent of total billed charges 12350 93 10003.5 percent of total billed charges 12350 12350 other OPPS APC 12350 12350 other OPPS APC 12350 51 6298.5 percent of total billed charges 12350 12350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS BIPOLAR HET HEMORRHOID SUP-180-1022 CDM 0270 RC outpatient 1547 1547 1547 74 1144.78 percent of total billed charges 1547 93 1253.07 percent of total billed charges 1547 1547 other OPPS APC 1547 1547 other OPPS APC 1547 27.63 427.44 percent of total billed charges 1547 1547 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL CONTOUR PIGTAIL CURVE 26CM 7FR PERCUFLEX HYDROPLUS LF TAPER TIP SUP-180-233 CDM 0270 RC outpatient 403 403 403 74 298.22 percent of total billed charges 403 93 326.43 percent of total billed charges 403 403 other OPPS APC 403 403 other OPPS APC 403 27.63 111.35 percent of total billed charges 403 403 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POUCH OSTOMY NEW IMAGE LOCK N ROLL COMFORTWEAR L12 IN OD4 IN 2 PIECE DRAINABLE TRANSPARENT BELT TAB LATEX ULTRA CLEAR SUP-18006 CDM 0270 RC outpatient 0.75 0.75 0.75 74 0.56 percent of total billed charges 0.75 93 0.61 percent of total billed charges 0.75 0.75 other OPPS APC 0.75 0.75 other OPPS APC 0.75 27.63 0.21 percent of total billed charges 0.75 0.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POUCH OSTOMY NEW IMAGE COMFORTWEAR L 12 IN OD 2 3/4 IN 2 PIECE DRAINABLE HIGH OUTPUT ODOR BARRIER FILM BLUE ULTRACLEAR SUP-18014 CDM 0270 RC outpatient 0.65 0.65 0.65 74 0.48 percent of total billed charges 0.65 93 0.53 percent of total billed charges 0.65 0.65 other OPPS APC 0.65 0.65 other OPPS APC 0.65 27.63 0.18 percent of total billed charges 0.65 0.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE SURGICAL STAINLESS STEEL L6 IN EYE END NONSTERILE SUP-180203 CDM 0270 RC outpatient 10.01 10.01 10.01 74 7.41 percent of total billed charges 10.01 93 8.11 percent of total billed charges 10.01 10.01 other OPPS APC 10.01 10.01 other OPPS APC 10.01 27.63 2.77 percent of total billed charges 10.01 10.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 8MM OD 2.25MM SUP-1804225-08 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 12MM OD 2.25MM SUP-1804225-12 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 15MM OD 2.25MM SUP-1804225-15 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 18MM OD 2.25MM SUP-1804225-18 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 23MM OD 2.25MM SUP-1804225-23 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 28MM OD 2.25MM SUP-1804225-28 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 33MM OD 2.25MM SUP-1804225-33 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 38MM OD 2.25MM SUP-1804225-38 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 8MM OD 2.50MM SUP-1804250-08 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 12MM OD 2.50MM SUP-1804250-12 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 15MM OD 2.50MM SUP-1804250-15 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 18MM OD 2.50MM SUP-1804250-18 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 23MM OD 2.50MM SUP-1804250-23 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 28MM OD 2.50MM SUP-1804250-28 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 33MM OD 2.50MM SUP-1804250-33 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 38MM OD 2.50MM SUP-1804250-38 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 8MM OD 2.75MM SUP-1804275-08 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 12MM OD 2.75MM SUP-1804275-12 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 15MM OD 2.75MM SUP-1804275-15 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 18MM OD 2.75MM SUP-1804275-18 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 23MM OD 2.75MM SUP-1804275-23 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 28MM OD 2.75MM SUP-1804275-28 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 33MM OD 2.75MM SUP-1804275-33 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 38MM OD 2.75MM SUP-1804275-38 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 8MM OD 3.0MM SUP-1804300-08 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 12MM OD 3.0MM SUP-1804300-12 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 15MM OD 3.0MM SUP-1804300-15 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 18MM OD 3.0MM SUP-1804300-18 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 23MM OD 3.0MM SUP-1804300-23 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 28MM OD 3.0MM SUP-1804300-28 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 33MM OD 3.0MM SUP-1804300-33 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 38MM OD 3.0MM SUP-1804300-38 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 8MM OD 3.25MM SUP-1804325-08 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 12MM OD 3.25MM SUP-1804325-12 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 15MM OD 3.25MM SUP-1804325-15 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 18MM OD 3.25MM SUP-1804325-18 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 23MM OD 3.25MM SUP-1804325-23 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 28MM OD 3.25MM SUP-1804325-28 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 33MM OD 3.25MM SUP-1804325-33 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 38MM OD 3.25MM SUP-1804325-38 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 8MM OD 3.50MM SUP-1804350-08 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 12MM OD 3.50MM SUP-1804350-12 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 15MM OD 3.50MM SUP-1804350-15 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 18MM OD 3.50MM SUP-1804350-18 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 23MM OD 3.50MM SUP-1804350-23 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 28MM OD 3.50MM SUP-1804350-28 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 33MM OD 3.50MM SUP-1804350-33 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 38MM OD 3.50MM SUP-1804350-38 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 8MM OD 4.0MM SUP-1804400-08 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 12MM OD 4.0MM SUP-1804400-12 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 15MM OD 4.0MM SUP-1804400-15 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 18MM OD 4.0MM SUP-1804400-18 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 23MM OD 4.0MM SUP-1804400-23 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 28MM OD 4.0MM SUP-1804400-28 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 33MM OD 4.0MM SUP-1804400-33 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY XIENCE SKYPOINT L 38MM OD 4.0MM SUP-1804400-38 CDM 0481 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 51 1127.1 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE COMPREHENSIVE TITANIUM 3.5 MM L25 MM OD4.75 MM LOCK FIX ANGLE HEXAGONAL STERILE REVERSE SHOULDER SYSTEM SUP-180552 CDM 270010030 LOCAL 0270 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE COMPREHENSIVE TITANIUM 3.5 MM L30 MM OD4.75 MM LOCK FIX ANGLE HEXAGONAL STERILE REVERSE SHOULDER SYSTEM SUP-180553 CDM 270010030 LOCAL 0270 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE COMPREHENSIVE TITANIUM 3.5 MM L25 MM OD4.75 MM VARIABLE ANGLE HEXAGONAL STERILE REVERSE SHOULDER SYSTEM SUP-180559 CDM 270010030 LOCAL 0270 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE COMPREHENSIVE TITANIUM 3.5 MM L35 MM OD4.75 MM VARIABLE ANGLE HEX HEAD STERILE REVERSE SHOULDER SYSTEM SUP-180561 CDM 270010025 LOCAL 0270 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER T2 STAINLESS STEEL L285 MM OD3 MM SUPRACONDYLAR RETROGRADE STERILE SUP-1806-0050S CDM 0270 RC outpatient 451.36 451.36 451.36 74 334.01 percent of total billed charges 451.36 93 365.6 percent of total billed charges 451.36 451.36 other OPPS APC 451.36 451.36 other OPPS APC 451.36 27.63 124.71 percent of total billed charges 451.36 451.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC T2 TITANIUM L800 MM OD3 MM BALL TIP STERILE FEMORAL NAIL SYSTEM SUP-1806-0080S CDM 0270 RC outpatient 690.56 690.56 690.56 74 511.01 percent of total billed charges 690.56 93 559.35 percent of total billed charges 690.56 690.56 other OPPS APC 690.56 690.56 other OPPS APC 690.56 27.63 190.8 percent of total billed charges 690.56 690.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC T2 TITANIUM L1000 MM OD3 MM FEMUR BALL TIP STERILE FEMORAL NAIL SYSTEM SUP-1806-0085S CDM 0270 RC outpatient 517.4 517.4 517.4 74 382.88 percent of total billed charges 517.4 93 419.09 percent of total billed charges 517.4 517.4 other OPPS APC 517.4 517.4 other OPPS APC 517.4 27.63 142.96 percent of total billed charges 517.4 517.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC T2 TITANIUM L800 MM OD3 MM TIBIA SMOOTH TIP STERILE FEMORAL NAIL SYSTEM SUP-1806-0090S CDM 0270 RC outpatient 644.8 644.8 644.8 74 477.15 percent of total billed charges 644.8 93 522.29 percent of total billed charges 644.8 644.8 other OPPS APC 644.8 644.8 other OPPS APC 644.8 27.63 178.16 percent of total billed charges 644.8 644.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL STRYKER AO SUP-1806-4260S CDM 0270 RC outpatient 655.2 655.2 655.2 74 484.85 percent of total billed charges 655.2 93 530.71 percent of total billed charges 655.2 655.2 other OPPS APC 655.2 655.2 other OPPS APC 655.2 27.63 181.03 percent of total billed charges 655.2 655.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL T2 L130 MM OD4.2 MM AO COUPLING CENTER TIPPED CALIBRATED STERILE SUP-1806-4280S CDM 0270 RC outpatient 624 624 624 74 461.76 percent of total billed charges 624 93 505.44 percent of total billed charges 624 624 other OPPS APC 624 624 other OPPS APC 624 27.63 172.41 percent of total billed charges 624 624 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ALLOGRAFT HTO WEDGE 6 DEGREE X 12M SUP-180672 CDM 270010031 LOCAL 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE 8 D L72 MM ALLOGRAFT WEDGE STERILE HIGH TIBIAL OSTEOTOMY SUP-180872 CDM 270010031 LOCAL 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CORNERSTONE CORTICAL L72 MM X H10 MM FREEZE DRIED SPACER WEDGE ANTERIOR CERVICAL INTERBODY FUSION SUP-181072 CDM 270010031 LOCAL 0270 RC outpatient 2574 2574 2574 74 1904.76 percent of total billed charges 2574 93 2084.94 percent of total billed charges 2574 2574 other OPPS APC 2574 2574 other OPPS APC 2574 27.63 711.2 percent of total billed charges 2574 2574 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE 12 D WEDGE OSTEOTOMY SUP-181272 CDM 270010031 LOCAL 0270 RC outpatient 3315 3315 3315 74 2453.1 percent of total billed charges 3315 93 2685.15 percent of total billed charges 3315 3315 other OPPS APC 3315 3315 other OPPS APC 3315 27.63 915.93 percent of total billed charges 3315 3315 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE 14 D WEDGE OSTEOTOMY SUP-181472 CDM 270010031 LOCAL 0270 RC outpatient 3770 3770 3770 74 2789.8 percent of total billed charges 3770 93 3053.7 percent of total billed charges 3770 3770 other OPPS APC 3770 3770 other OPPS APC 3770 27.63 1041.65 percent of total billed charges 3770 3770 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L14.5 MM OD8 MM ANKLE CANNULATED COMPRESSION STERILE T2 NAIL SYSTEM ARTHRODESIS SUP-1818-0001S CDM 0270 RC outpatient 642.72 642.72 642.72 74 475.61 percent of total billed charges 642.72 93 520.6 percent of total billed charges 642.72 642.72 other OPPS APC 642.72 642.72 other OPPS APC 642.72 27.63 177.58 percent of total billed charges 642.72 642.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP END T2 ANKLE SYSTEM SUP-1818-0010S CDM 0270 RC outpatient 1032.2 1032.2 1032.2 74 763.83 percent of total billed charges 1032.2 93 836.08 percent of total billed charges 1032.2 1032.2 other OPPS APC 1032.2 1032.2 other OPPS APC 1032.2 27.63 285.2 percent of total billed charges 1032.2 1032.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY T2 TITANIUM L15 CM OD10 MM ANKLE LEFT LOCK STERILE ARTHRODESIS SUP-1818-1015S CDM 0270 RC outpatient 11453 11453 11453 74 8475.22 percent of total billed charges 11453 93 9276.93 percent of total billed charges 11453 11453 other OPPS APC 11453 11453 other OPPS APC 11453 27.63 3164.46 percent of total billed charges 11453 11453 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL STRYKER ANKLE ARTHRODESIS LEFT 11 X 150MM SUP-1818-1115S CDM 0270 RC outpatient 8003.84 8003.84 8003.84 74 5922.84 percent of total billed charges 8003.84 93 6483.11 percent of total billed charges 8003.84 8003.84 other OPPS APC 8003.84 8003.84 other OPPS APC 8003.84 27.63 2211.46 percent of total billed charges 8003.84 8003.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY T2 TITANIUM L20 CM OD11 MM ANKLE LEFT LOCK STERILE ARTHRODESIS SUP-1818-1120S CDM 0270 RC outpatient 6021.47 6021.47 6021.47 74 4455.89 percent of total billed charges 6021.47 93 4877.39 percent of total billed charges 6021.47 6021.47 other OPPS APC 6021.47 6021.47 other OPPS APC 6021.47 27.63 1663.73 percent of total billed charges 6021.47 6021.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY T2 TITANIUM L20 CM OD10 MM ANKLE RIGHT LOCK STERILE ARTHRODESIS SUP-1819-1020S CDM 0270 RC outpatient 8003.84 8003.84 8003.84 74 5922.84 percent of total billed charges 8003.84 93 6483.11 percent of total billed charges 8003.84 8003.84 other OPPS APC 8003.84 8003.84 other OPPS APC 8003.84 27.63 2211.46 percent of total billed charges 8003.84 8003.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL ANKLE ARTHRODESIS RIGHT 12MM X 200MM SUP-1819-1220S CDM 0270 RC outpatient 8563.36 8563.36 8563.36 74 6336.89 percent of total billed charges 8563.36 93 6936.32 percent of total billed charges 8563.36 8563.36 other OPPS APC 8563.36 8563.36 other OPPS APC 8563.36 27.63 2366.06 percent of total billed charges 8563.36 8563.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ELLIPSE L28 MM OD3.5 MM SPINAL SHOULDER POLYAXIAL SUP-182.228 CDM 270010020 LOCAL 0270 RC outpatient 2145 2145 2145 74 1587.3 percent of total billed charges 2145 93 1737.45 percent of total billed charges 2145 2145 other OPPS APC 2145 2145 other OPPS APC 2145 27.63 592.66 percent of total billed charges 2145 2145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ELLIPSE L30 MM OD3.5 MM SPINE POLYAXIAL SHOULDER SUP-182.230 CDM 270010020 LOCAL 0270 RC outpatient 2145 2145 2145 74 1587.3 percent of total billed charges 2145 93 1737.45 percent of total billed charges 2145 2145 other OPPS APC 2145 2145 other OPPS APC 2145 27.63 592.66 percent of total billed charges 2145 2145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ELLIPSE TITANIUM L16 MM OD3.5 MM SPINE POLYAXIAL SUP-182.316 CDM 270010020 LOCAL 0270 RC outpatient 2145 2145 2145 74 1587.3 percent of total billed charges 2145 93 1737.45 percent of total billed charges 2145 2145 other OPPS APC 2145 2145 other OPPS APC 2145 27.63 592.66 percent of total billed charges 2145 2145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ELLIPSE TITANIUM L18 MM OD3.5 MM SPINE POLYAXIAL SUP-182.318 CDM 270010020 LOCAL 0270 RC outpatient 2145 2145 2145 74 1587.3 percent of total billed charges 2145 93 1737.45 percent of total billed charges 2145 2145 other OPPS APC 2145 2145 other OPPS APC 2145 27.63 592.66 percent of total billed charges 2145 2145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP LOCKING ELLIPSE TITANIUM SPINE OCCIPITOCERVICOTHORACIC POSTERIOR NONTHREAD SUP-182.500 CDM 270010020 LOCAL 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL ELLIPSE L40 MM OD3.5 MM STERILE SUP-182.804 CDM 270010020 LOCAL 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SCLEROTHERAPY STAR CATHETER INTERJECT L4 MM L240 CM OD25 GA ODSEC2.3 MM BEVEL STRONG PUSHABLE CONTRAST SHEATH SPACER CLIP DISPOSABLE RED SUP-1836 CDM 0270 RC outpatient 97.47 97.47 97.47 74 72.13 percent of total billed charges 97.47 93 78.95 percent of total billed charges 97.47 97.47 other OPPS APC 97.47 97.47 other OPPS APC 97.47 27.63 26.93 percent of total billed charges 97.47 97.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL BIOLOX DELTA +7.5 MM OD36 MM HIP C TAPER SUP-183675 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 22G X 6 QUINKE SPINAL NEEDLE SUP-18397 CDM 0270 RC outpatient 11.21 11.21 11.21 74 8.3 percent of total billed charges 11.21 93 9.08 percent of total billed charges 11.21 11.21 other OPPS APC 11.21 11.21 other OPPS APC 11.21 27.63 3.1 percent of total billed charges 11.21 11.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE EPIDURAL TUOHY METAL PLASTIC BEVEL L3.5 IN OD18 GA STYLET REMOVABLE WING SLIDE DEPTH INDICATOR STERILE LATEX FREE DISPOSABLE PINK SUP-183A07 CDM 0270 RC outpatient 10.45 10.45 10.45 74 7.73 percent of total billed charges 10.45 93 8.46 percent of total billed charges 10.45 10.45 other OPPS APC 10.45 10.45 other OPPS APC 10.45 27.63 2.89 percent of total billed charges 10.45 10.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE TUOHY 20GA. X 3.5 SUP-183A12 CDM 0270 RC outpatient 10.45 10.45 10.45 74 7.73 percent of total billed charges 10.45 93 8.46 percent of total billed charges 10.45 10.45 other OPPS APC 10.45 10.45 other OPPS APC 10.45 27.63 2.89 percent of total billed charges 10.45 10.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L12 MM OD4.2 MM SPINE SELF DRILLING VARIABLE ANGLE SUP-184.052 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE COALITION L14 MM OD4.2 MM SPINE SELF DRILL VARIABLE ANGLE NONSTERILE SUP-184.054 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE COALITION L18 MM OD4.2 MM SPINE SELF DRILL VARIABLE ANGLE NONSTERILE SUP-184.058 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L12 MM OD4.2 MM SPINE SELF DRILLING FIXED ANGLE SUP-184.072 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE COALITION L14 MM OD4.2 MM SPINE SELF DRILL FIX ANGLE NONSTERILE SUP-184.074 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STANDARD L12 MM OD3.6 MM SPINE VARIABLE ANGLE SELF DRILL STERILE SUP-184.152 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STANDARD L14 MM OD3.6 MM SPINE VARIABLE ANGLE SELF DRILL STERILE SUP-184.154 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L16 MM OD3.6 MM SPINE SELF DRILLING VARIABLE ANGLE SUP-184.156 CDM 270010022 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L18 MM OD3.6 MM SPINE SELF DRILLING VARIABLE ANGLE SUP-184.158 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE COALITION L16 MM OD3.6 MM SPINE SELF DRILL FIX ANGLE NONSTERILE SUP-184.176 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POUCH UROSTOMY NEW IMAGE COMFORTWEAR 9IN 2.25IN RED 2 PIECE TRANSPARENT ODOR BARRIER BELT TAB SUP-18403 CDM 0270 RC outpatient 0.89 0.89 0.89 74 0.66 percent of total billed charges 0.89 93 0.72 percent of total billed charges 0.89 0.89 other OPPS APC 0.89 0.89 other OPPS APC 0.89 27.63 0.25 percent of total billed charges 0.89 0.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP INTEGRA LOCKING SUP-185100 CDM 0270 RC outpatient 18.93 18.93 18.93 74 14.01 percent of total billed charges 18.93 93 15.33 percent of total billed charges 18.93 18.93 other OPPS APC 18.93 18.93 other OPPS APC 18.93 27.63 5.23 percent of total billed charges 18.93 18.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP INTEGRA LOCKING SUP-185200 CDM 0270 RC outpatient 431.6 431.6 431.6 74 319.38 percent of total billed charges 431.6 93 349.6 percent of total billed charges 431.6 431.6 other OPPS APC 431.6 431.6 other OPPS APC 431.6 27.63 119.25 percent of total billed charges 431.6 431.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON MULTIPASS 4-0 PC-1 18IN BLACK MONOFILAMENT SUP-1854G CDM 0270 RC outpatient 10.32 10.32 10.32 74 7.64 percent of total billed charges 10.32 93 8.36 percent of total billed charges 10.32 10.32 other OPPS APC 10.32 10.32 other OPPS APC 10.32 27.63 2.85 percent of total billed charges 10.32 10.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT WASHER SUP-186300 CDM 0270 RC outpatient 364.65 364.65 364.65 74 269.84 percent of total billed charges 364.65 93 295.37 percent of total billed charges 364.65 364.65 other OPPS APC 364.65 364.65 other OPPS APC 364.65 27.63 100.75 percent of total billed charges 364.65 364.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE INTERCONTINENTAL 0 D L20 MM X H8 MM SPINE NONSTERILE SUP-187.008 CDM 270010020 LOCAL 0270 RC outpatient 7540 7540 7540 74 5579.6 percent of total billed charges 7540 93 6107.4 percent of total billed charges 7540 7540 other OPPS APC 7540 7540 other OPPS APC 7540 27.63 2083.3 percent of total billed charges 7540 7540 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE INTERCONTINENTAL 6 D W20 MM X H8 MM SPINE NONSTERILE SUP-187.058 CDM 270010020 LOCAL 0270 RC outpatient 6500 6500 6500 74 4810 percent of total billed charges 6500 93 5265 percent of total billed charges 6500 6500 other OPPS APC 6500 6500 other OPPS APC 6500 27.63 1795.95 percent of total billed charges 6500 6500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE INTERCONTINENTAL 6 D W20 MM X H9 MM SPINE NONSTERILE SUP-187.059 CDM 270010020 LOCAL 0270 RC outpatient 7020 7020 7020 74 5194.8 percent of total billed charges 7020 93 5686.2 percent of total billed charges 7020 7020 other OPPS APC 7020 7020 other OPPS APC 7020 27.63 1939.63 percent of total billed charges 7020 7020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE INTERCONTINENTAL 6 D W20 MM X H11 MM SPINE NONSTERILE SUP-187.061 CDM 270010020 LOCAL 0270 RC outpatient 7020 7020 7020 74 5194.8 percent of total billed charges 7020 93 5686.2 percent of total billed charges 7020 7020 other OPPS APC 7020 7020 other OPPS APC 7020 27.63 1939.63 percent of total billed charges 7020 7020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR SAFE-T-J STANDARD CURVE TAPER 145CM 1.5CM .035IN SS PTFE DISPOSABLE STERILE FIX CORE FLEXIBLE TIP SUP-18736 CDM 0272 RC outpatient 51.96 51.96 51.96 51.96 other OPPS APC 51.96 51.96 other OPPS APC 51.96 27.63 14.36 percent of total billed charges 51.96 51.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING HYDROCOLLOID DUODERM XTHIN SQUARE L4 IN X W4 IN VAPOR PERMEABLE FILM FLEXIBLE MOISTURE RESISTANT TRANSLUCENT BACK STERILE LATEX FREE BEIGE SUP-187955 CDM 270009019 LOCAL 0270 RC outpatient 4.68 4.68 4.68 74 3.46 percent of total billed charges 4.68 93 3.79 percent of total billed charges 4.68 4.68 other OPPS APC 4.68 4.68 other OPPS APC 4.68 27.63 1.29 percent of total billed charges 4.68 4.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING HYDROCOLLOID DUODERM XTHIN SQUARE L4 IN X W4 IN VAPOR PERMEABLE FILM FLEXIBLE MOISTURE RESISTANT TRANSLUCENT BACK STERILE LATEX FREE BEIGE ULCER SUP-187955 CDM outpatient 2.99 2.99 2.99 2.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SHAVER QUADCUT L13 CM OD4.3 MM SUP-18804380HR CDM 0270 RC outpatient 860.6 860.6 860.6 74 636.84 percent of total billed charges 860.6 93 697.09 percent of total billed charges 860.6 860.6 other OPPS APC 860.6 860.6 other OPPS APC 860.6 27.63 237.78 percent of total billed charges 860.6 860.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SHAVER XPS STRAIGHT L110 MM OD3.5 MM SINUS STERILE LATEX FREE STRAIGHTSHOT M4 SUP-1883504HR CDM 0270 RC outpatient 820.56 820.56 820.56 74 607.21 percent of total billed charges 820.56 93 664.65 percent of total billed charges 820.56 820.56 other OPPS APC 820.56 820.56 other OPPS APC 820.56 27.63 226.72 percent of total billed charges 820.56 820.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE RAD60 M4 .3.5MM ROTATE SUP-1883516HRE CDM 0270 RC outpatient 865.8 865.8 865.8 74 640.69 percent of total billed charges 865.8 93 701.3 percent of total billed charges 865.8 865.8 other OPPS APC 865.8 865.8 other OPPS APC 865.8 27.63 239.22 percent of total billed charges 865.8 865.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SHAVER XPS TRICUT 360 D 5000 RPM L11 CM OD4 MM SINUS M4 ROTATABLE STRAIGHT SHAFT OFFSET CUTTING SURFACE IRRIGATION TUBING OSCILLATE STERILE SUP-1884004HR CDM 0270 RC outpatient 824.72 824.72 824.72 74 610.29 percent of total billed charges 824.72 93 668.02 percent of total billed charges 824.72 824.72 other OPPS APC 824.72 824.72 other OPPS APC 824.72 27.63 227.87 percent of total billed charges 824.72 824.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0MM RAD60 BLADE SUP-1884016HR CDM 0270 RC outpatient 793.52 793.52 793.52 74 587.2 percent of total billed charges 793.52 93 642.75 percent of total billed charges 793.52 793.52 other OPPS APC 793.52 793.52 other OPPS APC 793.52 27.63 219.25 percent of total billed charges 793.52 793.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SHAVER TRICUT 2 CURVE L22 CM OD4 MM LARYNGEAL ANGLED TIP IRRIGATION TUBING SUP-1884030HRE_60229 CDM 0270 RC outpatient 1583.4 1583.4 1583.4 74 1171.72 percent of total billed charges 1583.4 93 1282.55 percent of total billed charges 1583.4 1583.4 other OPPS APC 1583.4 1583.4 other OPPS APC 1583.4 27.63 437.49 percent of total billed charges 1583.4 1583.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SHAVER XPS TRICUT L27 CM OD4 MM SUBGLOTTIC LARYNGEAL M4 ROTATABLE ANGLED TIP IRRIGATION TUBING SUP-1884031HRE CDM 0270 RC outpatient 1973.4 1973.4 1973.4 74 1460.32 percent of total billed charges 1973.4 93 1598.45 percent of total billed charges 1973.4 1973.4 other OPPS APC 1973.4 1973.4 other OPPS APC 1973.4 27.63 545.25 percent of total billed charges 1973.4 1973.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SHAVER QUADCUT L13 CM OD4.3 MM SUP-1884380HR CDM 0270 RC outpatient 860.6 860.6 860.6 74 636.84 percent of total billed charges 860.6 93 697.09 percent of total billed charges 860.6 860.6 other OPPS APC 860.6 860.6 other OPPS APC 860.6 27.63 237.78 percent of total billed charges 860.6 860.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD TENDRIL 1888 SUP-1888 CDM 0275 RC outpatient 1170 1170 1170 57 666.9 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE MANTA OD8 FR DEPTH LOCATOR SUP-188F CDM 0481 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 51 66.3 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT CANNULATED SUP-189027 CDM 0270 RC outpatient 730.6 730.6 730.6 74 540.64 percent of total billed charges 730.6 93 591.79 percent of total billed charges 730.6 730.6 other OPPS APC 730.6 730.6 other OPPS APC 730.6 27.63 201.86 percent of total billed charges 730.6 730.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT VANGUARD ANT STABILIBED BRD 16X75 SUP-189086 CDM 0270 RC outpatient 5590 5590 5590 74 4136.6 percent of total billed charges 5590 93 4527.9 percent of total billed charges 5590 5590 other OPPS APC 5590 5590 other OPPS APC 5590 27.63 1544.52 percent of total billed charges 5590 5590 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM PARTIAL THREAD L40 MM OD5 MM LOCK SHAFT STERILE T2 NAIL SYSTEM UNIVERSAL SYSTEM SUP-1891-5040S CDM 0270 RC outpatient 498.55 498.55 498.55 74 368.93 percent of total billed charges 498.55 93 403.83 percent of total billed charges 498.55 498.55 other OPPS APC 498.55 498.55 other OPPS APC 498.55 27.63 137.75 percent of total billed charges 498.55 498.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POUCH UROSTOMY NEW IMAGE COMFORTWEAR L 9 IN OD 2 3/4 IN 2 PIECE TAP TEARDROP INDICATOR ANTIREFLUX LATEX FREE BLUE ULTRACLEAR SUP-18924 CDM 0270 RC outpatient 0.82 0.82 0.82 74 0.61 percent of total billed charges 0.82 93 0.66 percent of total billed charges 0.82 0.82 other OPPS APC 0.82 0.82 other OPPS APC 0.82 27.63 0.23 percent of total billed charges 0.82 0.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L25 MM OD5 MM LOCK STERILE T2 NAIL SYSTEM UNIVERSAL SYSTEM SUP-1896-5025S CDM 0270 RC outpatient 642.72 642.72 642.72 74 475.61 percent of total billed charges 642.72 93 520.6 percent of total billed charges 642.72 642.72 other OPPS APC 642.72 642.72 other OPPS APC 642.72 27.63 177.58 percent of total billed charges 642.72 642.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L30 MM OD5 MM LOCK STERILE T2 NAIL SYSTEM UNIVERSAL SYSTEM SUP-1896-5030S CDM 0270 RC outpatient 642.72 642.72 642.72 74 475.61 percent of total billed charges 642.72 93 520.6 percent of total billed charges 642.72 642.72 other OPPS APC 642.72 642.72 other OPPS APC 642.72 27.63 177.58 percent of total billed charges 642.72 642.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L32.5 MM OD5 MM LOCK STERILE T2 NAIL SYSTEM UNIVERSAL SYSTEM SUP-1896-5032S CDM 0270 RC outpatient 673.92 673.92 673.92 74 498.7 percent of total billed charges 673.92 93 545.88 percent of total billed charges 673.92 673.92 other OPPS APC 673.92 673.92 other OPPS APC 673.92 27.63 186.2 percent of total billed charges 673.92 673.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L35 MM OD5 MM LOCK STERILE T2 NAIL SYSTEM UNIVERSAL SYSTEM SUP-1896-5035S CDM 0270 RC outpatient 498.55 498.55 498.55 74 368.93 percent of total billed charges 498.55 93 403.83 percent of total billed charges 498.55 498.55 other OPPS APC 498.55 498.55 other OPPS APC 498.55 27.63 137.75 percent of total billed charges 498.55 498.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T2 TITANIUM FULL THREAD L37.5 MM OD5 MM HUMERUS PROXIMAL LOCK STERILE INTRAMEDULLARY NAIL SYSTEM SUP-1896-5037S CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L42.5 MM OD5 MM LOCK STERILE T2 NAIL SYSTEM UNIVERSAL SYSTEM SUP-1896-5042S CDM 0270 RC outpatient 728 728 728 74 538.72 percent of total billed charges 728 93 589.68 percent of total billed charges 728 728 other OPPS APC 728 728 other OPPS APC 728 27.63 201.15 percent of total billed charges 728 728 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L50 MM OD5 MM LOCK STERILE T2 NAIL SYSTEM UNIVERSAL SYSTEM SUP-1896-5050S CDM 0270 RC outpatient 673.92 673.92 673.92 74 498.7 percent of total billed charges 673.92 93 545.88 percent of total billed charges 673.92 673.92 other OPPS APC 673.92 673.92 other OPPS APC 673.92 27.63 186.2 percent of total billed charges 673.92 673.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L55 MM OD5 MM LOCK STERILE T2 NAIL SYSTEM UNIVERSAL SYSTEM SUP-1896-5055S CDM 0270 RC outpatient 642.72 642.72 642.72 74 475.61 percent of total billed charges 642.72 93 520.6 percent of total billed charges 642.72 642.72 other OPPS APC 642.72 642.72 other OPPS APC 642.72 27.63 177.58 percent of total billed charges 642.72 642.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L70 MM OD5 MM LOCK STERILE T2 NAIL SYSTEM UNIVERSAL SYSTEM SUP-1896-5070S CDM 0270 RC outpatient 642.72 642.72 642.72 74 475.61 percent of total billed charges 642.72 93 520.6 percent of total billed charges 642.72 642.72 other OPPS APC 642.72 642.72 other OPPS APC 642.72 27.63 177.58 percent of total billed charges 642.72 642.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L80 MM OD5 MM LOCK STERILE T2 NAIL SYSTEM UNIVERSAL SYSTEM SUP-1896-5080S CDM 0270 RC outpatient 728 728 728 74 538.72 percent of total billed charges 728 93 589.68 percent of total billed charges 728 728 other OPPS APC 728 728 other OPPS APC 728 27.63 201.15 percent of total billed charges 728 728 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L85 MM OD5 MM LOCK STERILE T2 NAIL SYSTEM UNIVERSAL SYSTEM SUP-1896-5085S CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CTAPER +0MM ADAPTER SLEEVE SUP-19-0000T CDM 270010024 LOCAL 0270 RC outpatient 462.8 462.8 462.8 74 342.47 percent of total billed charges 462.8 93 374.87 percent of total billed charges 462.8 462.8 other OPPS APC 462.8 462.8 other OPPS APC 462.8 27.63 127.87 percent of total billed charges 462.8 462.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CTAPER +5MM ADAPTER SLEEVE SUP-19-0005T CDM 270010024 LOCAL 0270 RC outpatient 462.8 462.8 462.8 74 342.47 percent of total billed charges 462.8 93 374.87 percent of total billed charges 462.8 462.8 other OPPS APC 462.8 462.8 other OPPS APC 462.8 27.63 127.87 percent of total billed charges 462.8 462.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE ADAPTER TITANIUM +2.5 MM OFFSET UNIVERSAL C TAPER SUP-19-0025T CDM 270010024 LOCAL 0270 RC outpatient 462.8 462.8 462.8 74 342.47 percent of total billed charges 462.8 93 374.87 percent of total billed charges 462.8 462.8 other OPPS APC 462.8 462.8 other OPPS APC 462.8 27.63 127.87 percent of total billed charges 462.8 462.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CTAPER -2.5MM ADAPTER SLEEVE SUP-19-0325T CDM 270010024 LOCAL 0270 RC outpatient 462.8 462.8 462.8 74 342.47 percent of total billed charges 462.8 93 374.87 percent of total billed charges 462.8 462.8 other OPPS APC 462.8 462.8 other OPPS APC 462.8 27.63 127.87 percent of total billed charges 462.8 462.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE THINFLAP TITANIUM THIN CRANIOMAXILLOFACIAL 2 HOLE STRAIGHT SUP-19-1005 CDM 0270 RC outpatient 150.8 150.8 150.8 74 111.59 percent of total billed charges 150.8 93 122.15 percent of total billed charges 150.8 150.8 other OPPS APC 150.8 150.8 other OPPS APC 150.8 27.63 41.67 percent of total billed charges 150.8 150.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE THINFLAP TITANIUM WIDE CRANIOMAXILLOFACIAL 2 HOLE SUP-19-1010 CDM 0270 RC outpatient 226.2 226.2 226.2 74 167.39 percent of total billed charges 226.2 93 183.22 percent of total billed charges 226.2 226.2 other OPPS APC 226.2 226.2 other OPPS APC 226.2 27.63 62.5 percent of total billed charges 226.2 226.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE THINFLAP TITANIUM CRANIOMAXILLOFACIAL 4 HOLE SQUARE SUP-19-1015 CDM 0270 RC outpatient 595.4 595.4 595.4 74 440.6 percent of total billed charges 595.4 93 482.27 percent of total billed charges 595.4 595.4 other OPPS APC 595.4 595.4 other OPPS APC 595.4 27.63 164.51 percent of total billed charges 595.4 595.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER BURR HOLE OD13.5 MM SPINE BENT SUP-19-1019 CDM 0270 RC outpatient 566.8 566.8 566.8 74 419.43 percent of total billed charges 566.8 93 459.11 percent of total billed charges 566.8 566.8 other OPPS APC 566.8 566.8 other OPPS APC 566.8 27.63 156.61 percent of total billed charges 566.8 566.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE THINFLAP TITANIUM L18.5 MM CRANIOMAXILLOFACIAL BURR HOLE SUP-19-1020 CDM 0270 RC outpatient 566.8 566.8 566.8 74 419.43 percent of total billed charges 566.8 93 459.11 percent of total billed charges 566.8 566.8 other OPPS APC 566.8 566.8 other OPPS APC 566.8 27.63 156.61 percent of total billed charges 566.8 566.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER BURR HOLE THINFLAP BENT H.3 MM OD18.5 MM CRANIOMAXILLOFACIAL STERILE SUP-19-1020B CDM 0270 RC outpatient 566.8 566.8 566.8 74 419.43 percent of total billed charges 566.8 93 459.11 percent of total billed charges 566.8 566.8 other OPPS APC 566.8 566.8 other OPPS APC 566.8 27.63 156.61 percent of total billed charges 566.8 566.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 24MM BENT BURR HOLE SUP-19-1021 CDM 0270 RC outpatient 566.8 566.8 566.8 74 419.43 percent of total billed charges 566.8 93 459.11 percent of total billed charges 566.8 566.8 other OPPS APC 566.8 566.8 other OPPS APC 566.8 27.63 156.61 percent of total billed charges 566.8 566.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE THINFLAP TITANIUM L35 MM CRANIOMAXILLOFACIAL GAP SUP-19-1025 CDM 0270 RC outpatient 1084.2 1084.2 1084.2 74 802.31 percent of total billed charges 1084.2 93 878.2 percent of total billed charges 1084.2 1084.2 other OPPS APC 1084.2 1084.2 other OPPS APC 1084.2 27.63 299.56 percent of total billed charges 1084.2 1084.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE THINFLAP TITANIUM L85 MM X W53 MM X H.5 MM CRANIOMAXILLOFACIAL GRID PANEL SUP-19-1030 CDM 0270 RC outpatient 3094 3094 3094 74 2289.56 percent of total billed charges 3094 93 2506.14 percent of total billed charges 3094 3094 other OPPS APC 3094 3094 other OPPS APC 3094 27.63 854.87 percent of total billed charges 3094 3094 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE THINFLAP TITANIUM STANDARD CRANIOMAXILLOFACIAL 16 HOLE STRAIGHT SUP-19-1035 CDM 0270 RC outpatient 676 676 676 74 500.24 percent of total billed charges 676 93 547.56 percent of total billed charges 676 676 other OPPS APC 676 676 other OPPS APC 676 27.63 186.78 percent of total billed charges 676 676 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE THINFLAP TITANIUM LONG CRANIOMAXILLOFACIAL 6 HOLE STRAIGHT SUP-19-1040 CDM 0270 RC outpatient 629.2 629.2 629.2 74 465.61 percent of total billed charges 629.2 93 509.65 percent of total billed charges 629.2 629.2 other OPPS APC 629.2 629.2 other OPPS APC 629.2 27.63 173.85 percent of total billed charges 629.2 629.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE THINFLAP TITANIUM LONG CRANIOMAXILLOFACIAL 4 HOLE STRAIGHT SUP-19-1045 CDM 0270 RC outpatient 309.4 309.4 309.4 74 228.96 percent of total billed charges 309.4 93 250.61 percent of total billed charges 309.4 309.4 other OPPS APC 309.4 309.4 other OPPS APC 309.4 27.63 85.49 percent of total billed charges 309.4 309.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE THINFLAP TITANIUM STANDARD CRANIOFACIAL 6 HOLE CURVED STERILE SUP-19-1050 CDM 0270 RC outpatient 629.2 629.2 629.2 74 465.61 percent of total billed charges 629.2 93 509.65 percent of total billed charges 629.2 629.2 other OPPS APC 629.2 629.2 other OPPS APC 629.2 27.63 173.85 percent of total billed charges 629.2 629.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE THINFLAP TITANIUM STANDARD CRANIOMAXILLOFACIAL 10 HOLE CURVED SUP-19-1055 CDM 0270 RC outpatient 629.2 629.2 629.2 74 465.61 percent of total billed charges 629.2 93 509.65 percent of total billed charges 629.2 629.2 other OPPS APC 629.2 629.2 other OPPS APC 629.2 27.63 173.85 percent of total billed charges 629.2 629.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE THINFLAP TITANIUM STANDARD CRANIOMAXILLOFACIAL 6 HOLE 2 Y STERILE SUP-19-1060 CDM 0270 RC outpatient 629.2 629.2 629.2 74 465.61 percent of total billed charges 629.2 93 509.65 percent of total billed charges 629.2 629.2 other OPPS APC 629.2 629.2 other OPPS APC 629.2 27.63 173.85 percent of total billed charges 629.2 629.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE THINFLAP TITANIUM STANDARD CRANIOMAXILLOFACIAL 6 HOLE Y SUP-19-1065 CDM 0270 RC outpatient 670.8 670.8 670.8 74 496.39 percent of total billed charges 670.8 93 543.35 percent of total billed charges 670.8 670.8 other OPPS APC 670.8 670.8 other OPPS APC 670.8 27.63 185.34 percent of total billed charges 670.8 670.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE THINFLAP TITANIUM 100 D STANDARD LEFT CRANIOFACIAL 7 HOLE L STERILE SUP-19-1070 CDM 0270 RC outpatient 629.2 629.2 629.2 74 465.61 percent of total billed charges 629.2 93 509.65 percent of total billed charges 629.2 629.2 other OPPS APC 629.2 629.2 other OPPS APC 629.2 27.63 173.85 percent of total billed charges 629.2 629.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE THINFLAP TITANIUM 100 D STANDARD RIGHT CRANIOFACIAL 7 HOLE L STERILE SUP-19-1075 CDM 0270 RC outpatient 629.2 629.2 629.2 74 465.61 percent of total billed charges 629.2 93 509.65 percent of total billed charges 629.2 629.2 other OPPS APC 629.2 629.2 other OPPS APC 629.2 27.63 173.85 percent of total billed charges 629.2 629.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FABRIC VASCULAR HEMASHIELD THK.76 MM L3 IN X W.2 IN KNIT SUP-19-525 CDM 0270 RC outpatient 1509.3 1509.3 1509.3 74 1116.88 percent of total billed charges 1509.3 93 1222.53 percent of total billed charges 1509.3 1509.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FABRIC CARDIOVASCULAR HEMASHIELD 2 VELOUR THK.76 MM L6 IN X W2 IN KNIT SUP-19-527 CDM 0270 RC outpatient 1509.3 1509.3 1509.3 74 1116.88 percent of total billed charges 1509.3 93 1222.53 percent of total billed charges 1509.3 1509.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION DIREXION HI-FLO NITINOL .027 IN MICRO BERN L155 CM OD2.8 FR 1 RADIOPAQUE TORQUEABLE FLEXIBLE SUP-19-545 CDM 0270 RC outpatient 1754.3 1754.3 1754.3 74 1298.18 percent of total billed charges 1754.3 93 1420.98 percent of total billed charges 1754.3 1754.3 other OPPS APC 1754.3 1754.3 other OPPS APC 1754.3 27.63 484.71 percent of total billed charges 1754.3 1754.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION DIREXION FATHOM NITINOL .016 IN MICRO BERN L130 CM L180 CM OD2.4 FR TORQUEABLE FLEXIBLE GUIDEWIRE SUP-19-564 CDM 0270 RC outpatient 2054 2054 2054 74 1519.96 percent of total billed charges 2054 93 1663.74 percent of total billed charges 2054 2054 other OPPS APC 2054 2054 other OPPS APC 2054 27.63 567.52 percent of total billed charges 2054 2054 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION DIREXION HI-FLO FATHOM-16 NITINOL PTFE MICRO STRAIGHT L130 CM L180 CM OD2.8-3 FR ID.027 IN PRELOAD TORQUEABLE GUIDEWIRE INNER LUMEN SUP-19-571 CDM 0270 RC outpatient 2730 2730 2730 74 2020.2 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 2730 other OPPS APC 2730 2730 other OPPS APC 2730 27.63 754.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION DIREXION HI-FLO FATHOM NITINOL .027 IN MICRO BERN L130 CM L180 CM OD2.4 FR TORQUEABLE FLEXIBLE GUIDEWIRE PRELOAD SUP-19-574 CDM 0270 RC outpatient 2054 2054 2054 74 1519.96 percent of total billed charges 2054 93 1663.74 percent of total billed charges 2054 2054 other OPPS APC 2054 2054 other OPPS APC 2054 27.63 567.52 percent of total billed charges 2054 2054 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION ECHELON 10 NITINOL 90 D L5 MM MICRO L155 CM L150 CM OD2.1-1.7 FR ID.017 IN .34 ML 1 LUMEN 2 RADIOPAQUE REINFORCE ENDHOLE ACCEPTS .014 IN GUIDEWIRE SUP-190-5091-150 CDM 0270 RC outpatient 2202.2 2202.2 2202.2 74 1629.63 percent of total billed charges 2202.2 93 1783.78 percent of total billed charges 2202.2 2202.2 other OPPS APC 2202.2 2202.2 other OPPS APC 2202.2 27.63 608.47 percent of total billed charges 2202.2 2202.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BONE GRAFT SUBSTITUTE, FUSION KIT" SUP-190-SLF CDM 0270 RC outpatient 7267 7267 7267 74 5377.58 percent of total billed charges 7267 93 5886.27 percent of total billed charges 7267 7267 other OPPS APC 7267 7267 other OPPS APC 7267 27.63 2007.87 percent of total billed charges 7267 7267 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPHERE EMBOLIZATION EMBOZENE POLYZENE F HYDROGEL 900 UM 2 ML SYRINGE STERILE DISPOSABLE PURPLE SUP-19020-S1 CDM 0270 RC outpatient 520 520 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPHERE EMBOLIZATION EMBOZENE POLYZENE-F HYDROGEL 900 UM 2 ML SYRINGE STERILE DISPOSABLE PURPLE SUP-19020-S1 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT OSTOMY NEW IMAGE 3.5- IN L12 IN OD4 IN 2 PIECE DRAINABLE LOCK N ROLL CLOSURE FLOAT FLANGE FLEXWEAR SKIN BARRIER STERILE DISPOSABLE YELLOW SUP-19056 CDM 0270 RC outpatient 4.71 4.71 4.71 74 3.49 percent of total billed charges 4.71 93 3.82 percent of total billed charges 4.71 4.71 other OPPS APC 4.71 4.71 other OPPS APC 4.71 27.63 1.3 percent of total billed charges 4.71 4.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH 1 X 6 HEMOSHIELD SUP-191616 CDM 0270 RC outpatient 95 95 95 74 70.3 percent of total billed charges 95 93 76.95 percent of total billed charges 95 95 other OPPS APC 95 95 other OPPS APC 95 27.63 26.25 percent of total billed charges 95 95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION PREP 3M 5% PVP IODINE .14 OZ NASAL 4 SWAB ANTISEPTIC DRIP RESISTANTNONIRRITATE STERILE LATEX FREE PREOPERATIVE SUP-192401 CDM outpatient 28.23 28.23 28.23 28.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL RISE 10 D LORDOTIC L22 MM X W10 MM X H8 MM NONSTERILE SUP-193.121 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL RISE 10 D LORDOTIC L26 MM X W10 MM X H8 MM NONSTERILE SUP-193.122 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PILLOW POSITIONING INSITE GENTLETOUCH FOAM CONTOUR L7 FT PRONE HEADREST RIGHT INTUBATION SLOT LATEX FREE DISPOSABLE SUP-1937DZ CDM 0270 RC outpatient 17.53 17.53 17.53 74 12.97 percent of total billed charges 17.53 93 14.2 percent of total billed charges 17.53 17.53 other OPPS APC 17.53 17.53 other OPPS APC 17.53 27.63 4.84 percent of total billed charges 17.53 17.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CALIBER L26 MM X W10 MM X H8-12 MM SUP-194.126 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CALIBER 12 D LORDOTIC L22 MM X W10 MM X H9-13 MM SUP-194.610 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMOSTAT ABSORBABLE SURGICEL NU-KNIT L9 IN X W6 IN PLIABLE WEAVE SUP-1946 CDM 0270 RC outpatient 335.46 335.46 330.46 74 244.54 percent of total billed charges 335.46 93 271.72 percent of total billed charges 330.46 330.46 other OPPS APC 335.46 335.46 other OPPS APC 335.46 27.63 92.69 percent of total billed charges 330.46 335.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMOSTAT ABSORBABLE SURGICEL NU-KNIT L9 IN X W6 IN PLIABLE WEAVE SUP-1946 CDM 0270 RC outpatient 335.46 335.46 335.46 74 248.24 percent of total billed charges 330.46 93 267.67 percent of total billed charges 335.46 335.46 other OPPS APC 330.46 330.46 other OPPS APC 330.46 27.63 91.31 percent of total billed charges 330.46 335.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMOSTAT ABSORBABLE L14 IN X W2 IN SUP-1951 CDM 270009023 LOCAL 0270 RC outpatient 21 21 21 74 15.54 percent of total billed charges 21 93 17.01 percent of total billed charges 21 21 other OPPS APC 21 21 other OPPS APC 21 27.63 5.8 percent of total billed charges 21 21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER INTEGRA LOCKING SUP-195100 CDM 0270 RC outpatient 411.84 411.84 411.84 74 304.76 percent of total billed charges 411.84 93 333.59 percent of total billed charges 411.84 411.84 other OPPS APC 411.84 411.84 other OPPS APC 411.84 27.63 113.79 percent of total billed charges 411.84 411.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMOSTAT ABSORBABLE L14 IN X W2 IN SUP-1951S CDM 270009023 LOCAL 0270 RC outpatient 172.31 172.31 172.31 74 127.51 percent of total billed charges 172.31 93 139.57 percent of total billed charges 172.31 172.31 other OPPS APC 172.31 172.31 other OPPS APC 172.31 27.63 47.61 percent of total billed charges 172.31 172.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMOSTAT ABSORBABLE SURGICEL L8 IN X W4 IN SHEER WEAVE STERILE DISPOSABLE SUP-1952 CDM 270009023 LOCAL 0270 RC outpatient 21 21 21 74 15.54 percent of total billed charges 21 93 17.01 percent of total billed charges 21 21 other OPPS APC 21 21 other OPPS APC 21 27.63 5.8 percent of total billed charges 21 21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMOSTAT ABSORBABLE SURGICEL L8 IN X W4 IN SHEER WEAVE STERILE DISPOSABLE SUP-1952S CDM 270009023 LOCAL 0270 RC outpatient 166.97 166.97 166.97 74 123.56 percent of total billed charges 166.97 93 135.25 percent of total billed charges 166.97 166.97 other OPPS APC 166.97 166.97 other OPPS APC 166.97 27.63 46.13 percent of total billed charges 166.97 166.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMOSTAT ABSORBABLE SURGICEL 3X2IN STERILE FLEXIBLE SUP-1953 CDM 270009023 LOCAL 0270 RC outpatient 21 21 21 74 15.54 percent of total billed charges 21 93 17.01 percent of total billed charges 21 21 other OPPS APC 21 21 other OPPS APC 21 27.63 5.8 percent of total billed charges 21 21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMOSTAT ABSORBABLE SURGICEL 3X2IN STERILE FLEXIBLE SUP-1953S CDM 270009023 LOCAL 0270 RC outpatient 101.14 101.14 101.14 74 74.84 percent of total billed charges 101.14 93 81.92 percent of total billed charges 101.14 101.14 other OPPS APC 101.14 101.14 other OPPS APC 101.14 27.63 27.94 percent of total billed charges 101.14 101.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON MULTIPASS 4-0 PC-1 L18 IN MONOFILAMENT PLIABILIZE BLACK SUP-1954G CDM 0270 RC outpatient 9.78 9.78 9.78 74 7.24 percent of total billed charges 9.78 93 7.92 percent of total billed charges 9.78 9.78 other OPPS APC 9.78 9.78 other OPPS APC 9.78 27.63 2.7 percent of total billed charges 9.78 9.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL PFC SIGMA COCR 2 KNEE LEFT CEMENTED POSTERIOR STABILIZE SUP-1960-40-200 CDM 270010025 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL PFC SIGMA COCR 2 KNEE RIGHT CEMENTED POSTERIOR STABILIZE SUP-1960-50-200 CDM 270010025 LOCAL 0270 RC outpatient 3998.8 3998.8 3998.8 74 2959.11 percent of total billed charges 3998.8 93 3239.03 percent of total billed charges 3998.8 3998.8 other OPPS APC 3998.8 3998.8 other OPPS APC 3998.8 27.63 1104.87 percent of total billed charges 3998.8 3998.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMOSTAT ABSORBABLE SURGICEL FIBRILLAR 2X1IN STERILE LIGHTWEIGHT LAYER TUFT SUP-1961 CDM 0270 RC outpatient 141.23 141.23 141.23 74 104.51 percent of total billed charges 141.23 93 114.4 percent of total billed charges 141.23 141.23 other OPPS APC 141.23 141.23 other OPPS APC 141.23 27.63 39.02 percent of total billed charges 141.23 141.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMOSTAT ABSORBABLE FIBRILLAR SURGICEL L4 IN X W2 IN LIGHTWEIGHT LAYER STERILE DISPOSABLE SUP-1962 CDM 0270 RC outpatient 257.35 257.35 257.35 74 190.44 percent of total billed charges 257.35 93 208.45 percent of total billed charges 257.35 257.35 other OPPS APC 257.35 257.35 other OPPS APC 257.35 27.63 71.11 percent of total billed charges 257.35 257.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP DRAINAGE PLASTIC CHEST STERILE LATEX FREE RED SUP-19910 CDM 0270 RC outpatient 26.86 26.86 26.86 74 19.88 percent of total billed charges 26.86 93 21.76 percent of total billed charges 26.86 26.86 other OPPS APC 26.86 26.86 other OPPS APC 26.86 27.63 7.42 percent of total billed charges 26.86 26.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING OPTISENSE SUP-1999 CDM 0275 RC outpatient 1131 1131 1131 57 644.67 percent of total billed charges 1131 93 916.11 percent of total billed charges 1131 1131 other OPPS APC 1131 1131 other OPPS APC 1131 51 576.81 percent of total billed charges 1131 1131 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING OPTISENSE OPTIM STEROID ELUTING HELIX L40 CM OD7 FR ENDOCARDIUM IS-1 CONNECTOR BIPOLAR ACTIVE FIXATION EXTENDABLE RETRACTABLE SUP-1999/40 CDM 0275 RC outpatient 780 780 780 57 444.6 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 51 397.8 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING OPTISENSE OPTIM STEROID ELUTING HELIX L46 CM OD7 FR ENDOCARDIUM IS-1 CONNECTOR BIPOLAR ACTIVE FIXATION EXTENDABLE RETRACTABLE SUP-1999/46 CDM 0275 RC outpatient 780 780 780 57 444.6 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 51 397.8 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING OPTISENSE OPTIM STEROID ELUTING HELIX L52 CM OD7 FR ENDOCARDIUM IS-1 CONNECTOR BIPOLAR ACTIVE FIXATION EXTENDABLE RETRACTABLE SUP-1999/52 CDM 0275 RC outpatient 780 780 780 57 444.6 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 51 397.8 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC REGENT FLEXCUFF PTFE PYROLYTIC CARBON 85 D OD19 MM ID17.8 MM SUPRA ANNULAR 1 DIGIT GRADIENT MECHANICAL LEAFLET OPEN SUP-19AGFN-756 CDM 0270 RC outpatient 12708.8 12708.8 12708.8 74 9404.51 percent of total billed charges 12708.8 93 10294.1 percent of total billed charges 12708.8 12708.8 other OPPS APC 12708.8 12708.8 other OPPS APC 12708.8 27.63 3511.44 percent of total billed charges 12708.8 12708.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REINFORCEMENT STAPLE LINE SEAMGUARD BIOABSORBABLE STERILE LATEX FREE DISPOSABLE BLUE GOLD GREEN WHITE ENDOPATH ECHELON FLEX 60 SUP-1BGSEC60A CDM 0270 RC outpatient 517.4 517.4 517.4 74 382.88 percent of total billed charges 517.4 93 419.09 percent of total billed charges 517.4 517.4 other OPPS APC 517.4 517.4 other OPPS APC 517.4 27.63 142.96 percent of total billed charges 517.4 517.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REINFORCEMENT STAPLE LINE SEAMGUARD BIOABSORBABLE STERILE LATEX FREE DISPOSABLE DST SERIES CEEA 25 CIRCLE STAPLER SUP-1BSGC25 CDM 0270 RC outpatient 767 767 767 74 567.58 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 27.63 211.92 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET ADMINISTRATION 10 GTT L101IN 10ML INTRAVENOUS PRIMARY INFUSION LUER LOCK ADAPTER LATEX FREE FLO GARD 6201 SUP-1C8109 CDM 0270 RC outpatient 4.96 4.96 4.96 74 3.67 percent of total billed charges 4.96 93 4.02 percent of total billed charges 4.96 4.96 other OPPS APC 4.96 4.96 other OPPS APC 4.96 27.63 1.37 percent of total billed charges 4.96 4.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH CARDIOVASCULAR ACUSEAL GORE-TEX THK.5 MM L7.5 CM X W.8 CM LOW THROMBOGENICITY CONFORMABLE HIGH STRENGTH RECONSTRUCTION STERILE SUTURE LINE BLEEDING SUP-1CVX003 CDM 0270 RC outpatient 569.4 569.4 569.4 74 421.36 percent of total billed charges 569.4 93 461.21 percent of total billed charges 569.4 569.4 other OPPS APC 569.4 569.4 other OPPS APC 569.4 27.63 157.33 percent of total billed charges 569.4 569.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL DUALMESH GORE-TEX THK2 MM L34 CM X W26 CM SOFT TISSUE BIOMATERIAL STERILE HERNIA REPAIR SUP-1DLMC204 CDM 0270 RC outpatient 11986 11986 11986 74 8869.64 percent of total billed charges 11986 93 9708.66 percent of total billed charges 11986 11986 other OPPS APC 11986 11986 other OPPS APC 11986 27.63 3311.73 percent of total billed charges 11986 11986 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL DUALMESH PLUS GORE-TEX CHLORHEXIDINE DIACETATE SILVER CARBONATE THK1 MM L12 CM X W8 CM SOFT TISSUE BIOMATERIAL ANTIMICROBIAL STERILE HERNIA REPAIR SUP-1DLMCP02 CDM 0270 RC outpatient 982.8 982.8 982.8 74 727.27 percent of total billed charges 982.8 93 796.07 percent of total billed charges 982.8 982.8 other OPPS APC 982.8 982.8 other OPPS APC 982.8 27.63 271.55 percent of total billed charges 982.8 982.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL DUALMESH PLUS GORE-TEX CHLORHEXIDINE DIACETATE SILVER CARBONATE THK1 MM L19 CM X W15 CM SOFT TISSUE BIOMATERIAL ANTIMICROBIAL STERILE HERNIA REPAIR SUP-1DLMCP04 CDM 0270 RC outpatient 3611.4 3611.4 3611.4 74 2672.44 percent of total billed charges 3611.4 93 2925.23 percent of total billed charges 3611.4 3611.4 other OPPS APC 3611.4 3611.4 other OPPS APC 3611.4 27.63 997.83 percent of total billed charges 3611.4 3611.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL DUALMESH PLUS GORE-TEX CHLORHEXIDINE DIACETATE SILVER CARBONATE THK1 MM L24 CM X W18 CM SOFT TISSUE BIOMATERIAL ANTIMICROBIAL STERILE HERNIA REPAIR SUP-1DLMCP06 CDM 0270 RC outpatient 4953 4953 4953 74 3665.22 percent of total billed charges 4953 93 4011.93 percent of total billed charges 4953 4953 other OPPS APC 4953 4953 other OPPS APC 4953 27.63 1368.51 percent of total billed charges 4953 4953 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL DUALMESH PLUS GORE-TEX CHLORHEXIDINE DIACETATE SILVER CARBONATE THK1 MM L30 CM X W20 CM SOFT TISSUE BIOMATERIAL ANTIMICROBIAL STERILE HERNIA REPAIR SUP-1DLMCP07 CDM 0270 RC outpatient 6487 6487 6487 74 4800.38 percent of total billed charges 6487 93 5254.47 percent of total billed charges 6487 6487 other OPPS APC 6487 6487 other OPPS APC 6487 27.63 1792.36 percent of total billed charges 6487 6487 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL DUALMESH PLUS GORE-TEX CHLORHEXIDINE DIACETATE SILVER CARBONATE THK1 MM L34 CM X W24 CM SOFT TISSUE BIOMATERIAL ANTIMICROBIAL STERILE HERNIA REPAIR SUP-1DLMCP08 CDM 0270 RC outpatient 5028.4 5028.4 5028.4 74 3721.02 percent of total billed charges 5028.4 93 4073 percent of total billed charges 5028.4 5028.4 other OPPS APC 5028.4 5028.4 other OPPS APC 5028.4 27.63 1389.35 percent of total billed charges 5028.4 5028.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL DUALMESH PLUS GORE-TEX CHLORHEXIDINE DIACETATE SILVER CARBONATE THK1 MM L10 CM X W6 CM SOFT TISSUE BIOMATERIAL ANTIMICROBIAL STERILE HERNIA REPAIR SUP-1DLMCP12 CDM 0270 RC outpatient 665.6 665.6 665.6 74 492.54 percent of total billed charges 665.6 93 539.14 percent of total billed charges 665.6 665.6 other OPPS APC 665.6 665.6 other OPPS APC 665.6 27.63 183.91 percent of total billed charges 665.6 665.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP CONVERTER ENDOSCOPIC ONE SEAL 5 TO 12MM SUP-1SEAL CDM 0270 RC outpatient 12.97 12.97 12.97 74 9.6 percent of total billed charges 12.97 93 10.51 percent of total billed charges 12.97 12.97 other OPPS APC 12.97 12.97 other OPPS APC 12.97 27.63 3.58 percent of total billed charges 12.97 12.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARMBOARD PLASTIC ADULT SUPPORT SUP-20-00003 CDM 0272 RC outpatient 3.25 3.25 3.25 74 2.41 percent of total billed charges 3.25 93 2.63 percent of total billed charges 3.25 3.25 other OPPS APC 3.25 3.25 other OPPS APC 3.25 27.63 0.9 percent of total billed charges 3.25 3.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRESSURE INFUSOR 500CC SUP-20-00014 CDM 0272 RC outpatient 41.52 41.52 41.52 74 30.72 percent of total billed charges 41.52 93 33.63 percent of total billed charges 41.52 41.52 other OPPS APC 41.52 41.52 other OPPS APC 41.52 27.63 11.47 percent of total billed charges 41.52 41.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURETROL SOLUTION SET SUP-20-00015 CDM 0272 RC outpatient 21.22 21.22 21.22 74 15.7 percent of total billed charges 21.22 93 17.19 percent of total billed charges 21.22 21.22 other OPPS APC 21.22 21.22 other OPPS APC 21.22 27.63 5.86 percent of total billed charges 21.22 21.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET BARD UNIVERSAL SUP-20-00017 CDM 0272 RC outpatient 2.1 2.1 2.1 74 1.55 percent of total billed charges 2.1 93 1.7 percent of total billed charges 2.1 2.1 other OPPS APC 2.1 2.1 other OPPS APC 2.1 27.63 0.58 percent of total billed charges 2.1 2.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET EXT T CONNECTOR #6 SUP-20-00021 CDM 0272 RC outpatient 0.61 0.61 0.61 74 0.45 percent of total billed charges 0.61 93 0.49 percent of total billed charges 0.61 0.61 other OPPS APC 0.61 0.61 other OPPS APC 0.61 27.63 0.17 percent of total billed charges 0.61 0.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET EXTENSION 20 SUP-20-00022 CDM 0272 RC outpatient 0.47 0.47 0.47 74 0.35 percent of total billed charges 0.47 93 0.38 percent of total billed charges 0.47 0.47 other OPPS APC 0.47 0.47 other OPPS APC 0.47 27.63 0.13 percent of total billed charges 0.47 0.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MANIFOLD EXTENSION SET SUP-20-00024 CDM 0272 RC outpatient 26.5 26.5 26.5 74 19.61 percent of total billed charges 26.5 93 21.47 percent of total billed charges 26.5 26.5 other OPPS APC 26.5 26.5 other OPPS APC 26.5 27.63 7.32 percent of total billed charges 26.5 26.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PUMP BLOOD SET SUP-20-00026 CDM 0272 RC outpatient 24.53 24.53 24.53 74 18.15 percent of total billed charges 24.53 93 19.87 percent of total billed charges 24.53 24.53 other OPPS APC 24.53 24.53 other OPPS APC 24.53 27.63 6.78 percent of total billed charges 24.53 24.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET MINIDRIP ADMIN SUP-20-00031 CDM 0272 RC outpatient 2.17 2.17 2.17 74 1.61 percent of total billed charges 2.17 93 1.76 percent of total billed charges 2.17 2.17 other OPPS APC 2.17 2.17 other OPPS APC 2.17 27.63 0.6 percent of total billed charges 2.17 2.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET PCA SUP-20-00032 CDM 0272 RC outpatient 22.88 22.88 22.88 74 16.93 percent of total billed charges 22.88 93 18.53 percent of total billed charges 22.88 22.88 other OPPS APC 22.88 22.88 other OPPS APC 22.88 27.63 6.32 percent of total billed charges 22.88 22.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET Y TYPE DLB. COMPONENT SUP-20-00036 CDM 0272 RC outpatient 32.54 32.54 32.54 74 24.08 percent of total billed charges 32.54 93 26.36 percent of total billed charges 32.54 32.54 other OPPS APC 32.54 32.54 other OPPS APC 32.54 27.63 8.99 percent of total billed charges 32.54 32.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARMBOARD IV (PADDED) SUP-20-00041 CDM 0272 RC outpatient 1.07 1.07 1.07 74 0.79 percent of total billed charges 1.07 93 0.87 percent of total billed charges 1.07 1.07 other OPPS APC 1.07 1.07 other OPPS APC 1.07 27.63 0.3 percent of total billed charges 1.07 1.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATH PROTECTIV PLUS IV 22 X 1 SUP-20-00055 CDM 0272 RC outpatient 270.89 270.89 270.89 74 200.46 percent of total billed charges 270.89 93 219.42 percent of total billed charges 270.89 270.89 other OPPS APC 270.89 270.89 other OPPS APC 270.89 27.63 74.85 percent of total billed charges 270.89 270.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATH PROTECTIV-W IV 24G X 5/8 SUP-20-00057 CDM 0272 RC outpatient 289.66 289.66 289.66 74 214.35 percent of total billed charges 289.66 93 234.62 percent of total billed charges 289.66 289.66 other OPPS APC 289.66 289.66 other OPPS APC 289.66 27.63 80.03 percent of total billed charges 289.66 289.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPIDURAL IV SET SUP-20-00058 CDM 0272 RC outpatient 2.66 2.66 2.66 74 1.97 percent of total billed charges 2.66 93 2.15 percent of total billed charges 2.66 2.66 other OPPS APC 2.66 2.66 other OPPS APC 2.66 27.63 0.73 percent of total billed charges 2.66 2.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEPLOCK EXTENSION SET SUP-20-00059 CDM 0272 RC outpatient 1.74 1.74 1.74 74 1.29 percent of total billed charges 1.74 93 1.41 percent of total billed charges 1.74 1.74 other OPPS APC 1.74 1.74 other OPPS APC 1.74 27.63 0.48 percent of total billed charges 1.74 1.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET EXTENSION 60 MICRO VOLUME SUP-20-00062 CDM 0272 RC outpatient 0.9 0.9 0.9 74 0.67 percent of total billed charges 0.9 93 0.73 percent of total billed charges 0.9 0.9 other OPPS APC 0.9 0.9 other OPPS APC 0.9 27.63 0.25 percent of total billed charges 0.9 0.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SET, SECONDARY VENTED" SUP-20-00064 CDM 0272 RC outpatient 1.05 1.05 1.05 74 0.78 percent of total billed charges 1.05 93 0.85 percent of total billed charges 1.05 1.05 other OPPS APC 1.05 1.05 other OPPS APC 1.05 27.63 0.29 percent of total billed charges 1.05 1.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IV PRIMARY SET 2 VALVE UNVENT SUP-20-00066 CDM 0272 RC outpatient 3.03 3.03 3.03 74 2.24 percent of total billed charges 3.03 93 2.45 percent of total billed charges 3.03 3.03 other OPPS APC 3.03 3.03 other OPPS APC 3.03 27.63 0.84 percent of total billed charges 3.03 3.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLEARLINK VALVE SUP-20-00067 CDM 0272 RC outpatient 1.1 1.1 1.1 74 0.81 percent of total billed charges 1.1 93 0.89 percent of total billed charges 1.1 1.1 other OPPS APC 1.1 1.1 other OPPS APC 1.1 27.63 0.3 percent of total billed charges 1.1 1.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOOD SOLUTION SET Y TYPE SUP-20-00068 CDM 0272 RC outpatient 40.34 40.34 40.34 74 29.85 percent of total billed charges 40.34 93 32.68 percent of total billed charges 40.34 40.34 other OPPS APC 40.34 40.34 other OPPS APC 40.34 27.63 11.15 percent of total billed charges 40.34 40.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOPCOCK 4 WAY SUP-20-00073 CDM 0272 RC outpatient 0.99 0.99 0.99 74 0.73 percent of total billed charges 0.99 93 0.8 percent of total billed charges 0.99 0.99 other OPPS APC 0.99 0.99 other OPPS APC 0.99 27.63 0.27 percent of total billed charges 0.99 0.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATH PROTECTIV PLUS IV 20 X 1 SUP-20-00074 CDM 0272 RC outpatient 275.25 275.25 275.25 74 203.69 percent of total billed charges 275.25 93 222.95 percent of total billed charges 275.25 275.25 other OPPS APC 275.25 275.25 other OPPS APC 275.25 27.63 76.05 percent of total billed charges 275.25 275.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACTASEPT LATEX FREE IV START SUP-20-00075 CDM 0272 RC outpatient 0.81 0.81 0.81 74 0.6 percent of total billed charges 0.81 93 0.66 percent of total billed charges 0.81 0.81 other OPPS APC 0.81 0.81 other OPPS APC 0.81 27.63 0.22 percent of total billed charges 0.81 0.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER IV INTROCAN 24G .55IN SUP-20-00076 CDM 0272 RC outpatient 392.87 392.87 392.87 74 290.72 percent of total billed charges 392.87 93 318.22 percent of total billed charges 392.87 392.87 other OPPS APC 392.87 392.87 other OPPS APC 392.87 27.63 108.55 percent of total billed charges 392.87 392.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET CADD EPIDURAL TUBING SUP-20-00081 CDM 0272 RC outpatient 35.1 35.1 35.1 74 25.97 percent of total billed charges 35.1 93 28.43 percent of total billed charges 35.1 35.1 other OPPS APC 35.1 35.1 other OPPS APC 35.1 27.63 9.7 percent of total billed charges 35.1 35.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE NASOGASTRIC CORFLO-CONTROLLER ADULT L43 IN OD8 FR 3 GM STYLET PILL BOLUS FEED GREEN SUP-20-2438 CDM 270009048 LOCAL 0270 RC outpatient 21 21 21 74 15.54 percent of total billed charges 21 93 17.01 percent of total billed charges 21 21 other OPPS APC 21 21 other OPPS APC 21 27.63 5.8 percent of total billed charges 21 21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P4.3 CM HIGH PROFILE ROUND OD10.4 CM 260 ML STYLE 20 SMOOTH STERILE LATEX FREE SUP-20-260 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P4.5 CM HIGH PROFILE ROUND OD10.6 CM 280 ML STYLE 20 SMOOTH STERILE SUP-20-280 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P4.5 CM HIGH PROFILE ROUND OD10.9 CM 300 ML STYLE 20 SMOOTH STERILE SUP-20-300 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE HIGH PROFILE STYLE 20 325CC SUP-20-325 CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE P4.9CM HIGH PROFILE ROUND 11.4CM 350ML SILICONE STERILE LF STYLE 20 GEL SMOOTH SUP-20-350 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P4.9 CM HIGH PROFILE ROUND OD11.7 CM 375 ML STYLE 20 GEL SMOOTH STERILE LATEX FREE SUP-20-375 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE P5CM HIGH PROFILE ROUND 11.9CM 400ML SILICONE STERILE LF STYLE 20 GEL SMOOTH SUP-20-400 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE P5.2CM HIGH PROFILE ROUND 12CM 425ML SILICONE STERILE LF STYLE 20 GEL SMOOTH SUP-20-425 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE MATRIX SILICONE P5.2 CM HIGH PROFILE ROUND OD12.4 CM 450 ML STYLE 20 GEL SMOOTH STERILE LATEX FREE SUP-20-450 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P5.5 CM HIGH PROFILE ROUND OD12.6 CM 475 ML STYLE 20 SMOOTH STERILE SUP-20-475 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE P5.2CM HIGH PROFILE ROUND 13CM 500ML SILICONE STERILE LF STYLE 20 GEL SMOOTH SUP-20-500 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER SUCTION SORENSON 1.9 L ASPIRATION DISPOSABLE SUP-20-5158-00 CDM outpatient 46.54 46.54 46.54 46.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE P5.6CM HIGH PROFILE ROUND 13.5CM 550ML SILICONE STERILE LF STYLE 20 GEL SMOOTH SUP-20-550 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P5.7 CM HIGH PROFILE ROUND OD13.8 CM 600 ML STYLE 20 SMOOTH STERILE SUP-20-600 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P5.9 CM HIGH PROFILE ROUND OD14.2 CM 650 ML STYLE 20 GEL SMOOTH STERILE LATEX FREE SUP-20-650 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P6.2 CM HIGH PROFILE ROUND OD14.5 CM 700 ML STYLE 20 GEL SMOOTH STERILE SUP-20-700 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE MATRIX P6 CM FULL PROJECTION ROUND OD15 CM 750 ML STYLE 20 SMOOTH SHELL GEL STERILE LATEX FREE SUP-20-750 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P6.1 CM HIGH PROFILE ROUND OD15.3 CM 800 ML STYLE 20 SMOOTH STERILE LATEX FREE SUP-20-800 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER PROBE KOVERS L24 IN X W4 IN GEL STERILE SUP-20-P3D424 CDM outpatient 8.37 8.37 8.37 8.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCRAPER OPHTHALMIC DDMS L80 MM OD20 GA DIAMOND DUSTED MEMBRANE SOFT SILICONEE TIP STERILE DISPOSABLE SUP-20.07 CDM 0270 RC outpatient 297.44 297.44 297.44 74 220.11 percent of total billed charges 297.44 93 240.93 percent of total billed charges 297.44 297.44 other OPPS APC 297.44 297.44 other OPPS APC 297.44 27.63 82.18 percent of total billed charges 297.44 297.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR KIT FOR FEMORAL VENOUS CANNULAS SUP-200-120 CDM 0270 RC outpatient 489.29 489.29 489.29 74 362.07 percent of total billed charges 489.29 93 396.32 percent of total billed charges 489.29 489.29 other OPPS APC 489.29 489.29 other OPPS APC 489.29 27.63 135.19 percent of total billed charges 489.29 489.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA RAP FEMORAL VENOUS 23/25FR SUP-200-150 CDM 0270 RC outpatient 928.2 928.2 928.2 74 686.87 percent of total billed charges 928.2 93 751.84 percent of total billed charges 928.2 928.2 other OPPS APC 928.2 928.2 other OPPS APC 928.2 27.63 256.46 percent of total billed charges 928.2 928.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERFORATOR SURGICAL DGR-II PEDIATRIC 11 MM 7 MM STERILE DISPOSABLE SUP-200-331 CDM 0270 RC outpatient 598 598 598 74 442.52 percent of total billed charges 598 93 484.38 percent of total billed charges 598 598 other OPPS APC 598 598 other OPPS APC 598 27.63 165.23 percent of total billed charges 598 598 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRASPER ENDOSCOPIC OTSC L 220CM TWIN SUP-200.45 CDM 0270 RC outpatient 1658.8 1658.8 1658.8 74 1227.51 percent of total billed charges 1658.8 93 1343.63 percent of total billed charges 1658.8 1658.8 other OPPS APC 1658.8 1658.8 other OPPS APC 1658.8 27.63 458.33 percent of total billed charges 1658.8 1658.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP STAINLESS STEEL LOW PROFILE L18 MM OD1.5 MM ODSEC3 MM HAND PHALANX CORTICAL DISTAL MIDDLE SELF TAP CRUCIFORM MINI FRAGMENT SET MODULAR SYSTEM SUP-200.818 CDM 270010022 LOCAL 0270 RC outpatient 99.58 99.58 99.58 74 73.69 percent of total billed charges 99.58 93 80.66 percent of total billed charges 99.58 99.58 other OPPS APC 99.58 99.58 other OPPS APC 99.58 27.63 27.51 percent of total billed charges 99.58 99.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLUG SPINAL SOLITAIRE LOCK SUP-2000-1005 CDM 270010020 LOCAL 0270 RC outpatient 814.32 814.32 814.32 74 602.6 percent of total billed charges 814.32 93 659.6 percent of total billed charges 814.32 814.32 other OPPS APC 814.32 814.32 other OPPS APC 814.32 27.63 225 percent of total billed charges 814.32 814.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE POLARIS TITANIUM L50 MM OD6.5 MM SPINE MULTIAXIAL SUP-2000-2450 CDM 270010020 LOCAL 0270 RC outpatient 3522.48 3522.48 3522.48 74 2606.64 percent of total billed charges 3522.48 93 2853.21 percent of total billed charges 3522.48 3522.48 other OPPS APC 3522.48 3522.48 other OPPS APC 3522.48 27.63 973.26 percent of total billed charges 3522.48 3522.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE POLARIS TITANIUM L35 MM OD7.5 MM SPINE MULTIAXIAL SUP-2000-2535 CDM 270010020 LOCAL 0270 RC outpatient 3522.48 3522.48 3522.48 74 2606.64 percent of total billed charges 3522.48 93 2853.21 percent of total billed charges 3522.48 3522.48 other OPPS APC 3522.48 3522.48 other OPPS APC 3522.48 27.63 973.26 percent of total billed charges 3522.48 3522.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL POLARIS TITANIUM ALLOY L510 MM HEXAGON SUP-2000-5405 CDM 270010020 LOCAL 0270 RC outpatient 1190.8 1190.8 1190.8 74 881.19 percent of total billed charges 1190.8 93 964.55 percent of total billed charges 1190.8 1190.8 other OPPS APC 1190.8 1190.8 other OPPS APC 1190.8 27.63 329.02 percent of total billed charges 1190.8 1190.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN DRILL OD3.2 MM MENISCAL TRANSPLANT SLOT SUP-2000004043 CDM 270010025 LOCAL 0270 RC outpatient 471.9 471.9 471.9 74 349.21 percent of total billed charges 471.9 93 382.24 percent of total billed charges 471.9 471.9 other OPPS APC 471.9 471.9 other OPPS APC 471.9 27.63 130.39 percent of total billed charges 471.9 471.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE SUP-20004530016 CDM outpatient 6240 6240 6240 6240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE SUP-200045300171520 CDM outpatient 3952 3952 3952 3952 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE SUP-20004530084700 CDM outpatient 6110 6110 6110 6110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT NITINOL RECTANGLE HELIX L137 CM L10 MM ODSEC2 MM RADIOPAQUE RAPID EXCHANGE FLEXIBLE ELECTROPOLISH ACCEPTS .014 IN GUIDEWIRE 6 FR GUIDE CATHETER PTCA SUP-2001-2010 CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT NITINOL RECTANGLE HELIX L137 CM L15 MM ODSEC2 MM RADIOPAQUE RAPID EXCHANGE FLEXIBLE ELECTROPOLISH ACCEPTS .014 IN GUIDEWIRE 6 FR GUIDE CATHETER PTCA SUP-2001-2015 CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT NITINOL RECTANGLE HELIX L137 CM L10 MM ODSEC2.5 MM RADIOPAQUE RAPID EXCHANGE FLEXIBLE ELECTROPOLISH ACCEPTS .014 IN GUIDEWIRE 6 FR GUIDE CATHETER PTCA SUP-2001-2510 CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT NITINOL RECTANGLE HELIX L137 CM L15 MM ODSEC2.5 MM RADIOPAQUE RAPID EXCHANGE FLEXIBLE ELECTROPOLISH ACCEPTS .014 IN GUIDEWIRE 6 FR GUIDE CATHETER PTCA SUP-2001-2515 CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT NITINOL RECTANGLE HELIX L137 CM L10 MM ODSEC3 MM RADIOPAQUE RAPID EXCHANGE FLEXIBLE ELECTROPOLISH ACCEPTS .014 IN GUIDEWIRE 6 FR GUIDE CATHETER PTCA SUP-2001-3010 CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT NITINOL RECTANGLE HELIX L137 CM L10 MM ODSEC3.5 MM RADIOPAQUE RAPID EXCHANGE FLEXIBLE ELECTROPOLISH ACCEPTS .014 IN GUIDEWIRE 6 FR GUIDE CATHETER PTCA SUP-2001-3510 CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHAMBER HUMIDIFYING MOISTAR SUP-20010 CDM 0270 RC outpatient 128.7 128.7 128.7 74 95.24 percent of total billed charges 128.7 93 104.25 percent of total billed charges 128.7 128.7 other OPPS APC 128.7 128.7 other OPPS APC 128.7 27.63 35.56 percent of total billed charges 128.7 128.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR RIBBON MALLEABLE 1 1/2IN SUP-200223 CDM outpatient 24.86 24.86 24.86 24.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT FIRST FRACTURE STABILIT SUP-2003 CDM 0270 RC outpatient 6955 6955 6955 74 5146.7 percent of total billed charges 6955 93 5633.55 percent of total billed charges 6955 6955 other OPPS APC 6955 6955 other OPPS APC 6955 27.63 1921.67 percent of total billed charges 6955 6955 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT FIRST FRACTURE STABILIT SUP-2003-01 CDM 0270 RC outpatient 8112.1 8112.1 8112.1 74 6002.95 percent of total billed charges 8112.1 93 6570.8 percent of total billed charges 8112.1 8112.1 other OPPS APC 8112.1 8112.1 other OPPS APC 8112.1 27.63 2241.37 percent of total billed charges 8112.1 8112.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DECANTER FLUID EMPTY BOTTLE NONSTERILE LATEX FREE SUP-2004S CDM 0270 RC outpatient 3.76 3.76 3.76 74 2.78 percent of total billed charges 3.76 93 3.05 percent of total billed charges 3.76 3.76 other OPPS APC 3.76 3.76 other OPPS APC 3.76 27.63 1.04 percent of total billed charges 3.76 3.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CORTICAL CORNERSTONE SM PURPLE 5X11X11 SUP-200511 CDM 270010012 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CORNERSTONE CORTICAL MED GREEN 5X14X11MM SUP-200541 CDM 270010012 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE POSTOPERATIVE SUEDE MALE XL RUBBER BOTTOM WOOD SOLE LACE UP CLOSURE OPEN TOE CLOSED HEEL SUP-2006-05 CDM 0270 RC outpatient 21.14 21.14 21.14 74 15.64 percent of total billed charges 21.14 93 17.12 percent of total billed charges 21.14 21.14 other OPPS APC 21.14 21.14 other OPPS APC 21.14 27.63 5.84 percent of total billed charges 21.14 21.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR OMNIFIT 20D 52MM 32MM HIP SERIES I SUP-2006-3252 CDM 270010024 LOCAL 0270 RC outpatient 2159.3 2159.3 2159.3 74 1597.88 percent of total billed charges 2159.3 93 1749.03 percent of total billed charges 2159.3 2159.3 other OPPS APC 2159.3 2159.3 other OPPS APC 2159.3 27.63 596.61 percent of total billed charges 2159.3 2159.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CORNERSTONE-SR CORTICAL LORDOTIC L11 MM X W11 MM X H6 MM CERVICAL SPINE SUP-200611 CDM 270010012 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CORNERSTONE SR CORTICAL L14 MM X W11 MM X H6 MM BLOCK FREEZE DRIED SUP-200641 CDM 270010012 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE POSTOPERATIVE SUEDE RUBBER WOOD MALE 11 1/2-13 XL HOOK LOOP CLOSURE OPEN TOE LATEX FREE SUP-2007-05 CDM 0270 RC outpatient 20.31 20.31 20.31 74 15.03 percent of total billed charges 20.31 93 16.45 percent of total billed charges 20.31 20.31 other OPPS APC 20.31 20.31 other OPPS APC 20.31 27.63 5.61 percent of total billed charges 20.31 20.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CORNERSTONE SR CORTICAL L11 MM X W11 MM X H7 MM BLOCK SUP-200711 CDM 270010012 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BLOCK BONE CORTICAL FD 7 X 14 X 11 SUP-200741 CDM 270010012 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CORNERSTONE SR CORTICAL L11 MM X W11 MM X H8 MM BLOCK SUP-200811 CDM 270010012 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BLOCK BONE CORTICAL CORNERSTONE 8MM X 11 X 14 SUP-200841 CDM 270010012 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BLOCK BONE CORTICAL 9 X 14 X 11MM SUP-200911 CDM 270010012 LOCAL 0270 RC outpatient 2597.4 2597.4 2597.4 74 1922.08 percent of total billed charges 2597.4 93 2103.89 percent of total billed charges 2597.4 2597.4 other OPPS APC 2597.4 2597.4 other OPPS APC 2597.4 27.63 717.66 percent of total billed charges 2597.4 2597.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CORNERSTONE SR CERVICAL SPINE CORTICAL L14 MM X W11 MM X H9 MM BLOCK FREEZE DRIED SUP-200941 CDM 270010020 LOCAL 0270 RC outpatient 2743 2743 2743 74 2029.82 percent of total billed charges 2743 93 2221.83 percent of total billed charges 2743 2743 other OPPS APC 2743 2743 other OPPS APC 2743 27.63 757.89 percent of total billed charges 2743 2743 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 6MM 2MM SS NS CORTEX SELF TAP STARDRIVE MINI FRAGMENT SYSTEM SUP-201.356.97 CDM 270010022 LOCAL 0270 RC outpatient 122.98 122.98 122.98 74 91.01 percent of total billed charges 122.98 93 99.61 percent of total billed charges 122.98 122.98 other OPPS APC 122.98 122.98 other OPPS APC 122.98 27.63 33.98 percent of total billed charges 122.98 122.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 7MM 2MM SS NS CORTEX SELF TAP STARDRIVE MINI FRAGMENT SYSTEM SUP-201.357.97 CDM 270010022 LOCAL 0270 RC outpatient 122.98 122.98 122.98 74 91.01 percent of total billed charges 122.98 93 99.61 percent of total billed charges 122.98 122.98 other OPPS APC 122.98 122.98 other OPPS APC 122.98 27.63 33.98 percent of total billed charges 122.98 122.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 8MM 2MM SS NS CORTEX SELF TAP STARDRIVE MINI FRAGMENT SYSTEM SUP-201.358.97 CDM 270010022 LOCAL 0270 RC outpatient 108.45 108.45 108.45 74 80.25 percent of total billed charges 108.45 93 87.84 percent of total billed charges 108.45 108.45 other OPPS APC 108.45 108.45 other OPPS APC 108.45 27.63 29.96 percent of total billed charges 108.45 108.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 9MM 2MM SS NS CORTEX SELF TAP STARDRIVE MINI FRAGMENT SYSTEM SUP-201.359.97 CDM 270010022 LOCAL 0270 RC outpatient 108.45 108.45 108.45 74 80.25 percent of total billed charges 108.45 93 87.84 percent of total billed charges 108.45 108.45 other OPPS APC 108.45 108.45 other OPPS APC 108.45 27.63 29.96 percent of total billed charges 108.45 108.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T6 L10 MM OD2 MM FOOT HAND WRIST CORTEX SELF TAP SELF RETAINING STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-201.360.97 CDM 270010022 LOCAL 0270 RC outpatient 108.45 108.45 108.45 74 80.25 percent of total billed charges 108.45 93 87.84 percent of total billed charges 108.45 108.45 other OPPS APC 108.45 108.45 other OPPS APC 108.45 27.63 29.96 percent of total billed charges 108.45 108.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 11MM 2MM SS NS CORTEX SELF TAP STARDRIVE MINI FRAGMENT SYSTEM SUP-201.361.97 CDM 270010022 LOCAL 0270 RC outpatient 331.5 331.5 331.5 74 245.31 percent of total billed charges 331.5 93 268.52 percent of total billed charges 331.5 331.5 other OPPS APC 331.5 331.5 other OPPS APC 331.5 27.63 91.59 percent of total billed charges 331.5 331.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T6 L12 MM OD2 MM FOOT HAND WRIST CORTEX SELF TAP SELF RETAINING STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-201.362.97 CDM 270010022 LOCAL 0270 RC outpatient 108.45 108.45 108.45 74 80.25 percent of total billed charges 108.45 93 87.84 percent of total billed charges 108.45 108.45 other OPPS APC 108.45 108.45 other OPPS APC 108.45 27.63 29.96 percent of total billed charges 108.45 108.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 13MM 2MM SS NS CORTEX SELF TAP STARDRIVE MINI FRAGMENT SYSTEM SUP-201.363.97 CDM 270010022 LOCAL 0270 RC outpatient 108.45 108.45 108.45 74 80.25 percent of total billed charges 108.45 93 87.84 percent of total billed charges 108.45 108.45 other OPPS APC 108.45 108.45 other OPPS APC 108.45 27.63 29.96 percent of total billed charges 108.45 108.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T6 L14 MM OD2 MM FOOT HAND WRIST CORTEX SELF TAP SELF RETAINING STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-201.364.97 CDM 270010022 LOCAL 0270 RC outpatient 108.45 108.45 108.45 74 80.25 percent of total billed charges 108.45 93 87.84 percent of total billed charges 108.45 108.45 other OPPS APC 108.45 108.45 other OPPS APC 108.45 27.63 29.96 percent of total billed charges 108.45 108.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T6 L15 MM OD2 MM SMALL BONE CORTEX STARDRIVE SELF TAP SELF RETAINING SUP-201.365.97 CDM 270010022 LOCAL 0270 RC outpatient 108.45 108.45 108.45 74 80.25 percent of total billed charges 108.45 93 87.84 percent of total billed charges 108.45 108.45 other OPPS APC 108.45 108.45 other OPPS APC 108.45 27.63 29.96 percent of total billed charges 108.45 108.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 16MM 2MM SS NS CORTEX SELF TAP STARDRIVE MINI FRAGMENT SYSTEM SUP-201.366.97 CDM 270010022 LOCAL 0270 RC outpatient 108.45 108.45 108.45 74 80.25 percent of total billed charges 108.45 93 87.84 percent of total billed charges 108.45 108.45 other OPPS APC 108.45 108.45 other OPPS APC 108.45 27.63 29.96 percent of total billed charges 108.45 108.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 18MM 2MM SS NS CORTEX SELF TAP STARDRIVE MINI FRAGMENT SYSTEM SUP-201.368.97 CDM 270010022 LOCAL 0270 RC outpatient 108.45 108.45 108.45 74 80.25 percent of total billed charges 108.45 93 87.84 percent of total billed charges 108.45 108.45 other OPPS APC 108.45 108.45 other OPPS APC 108.45 27.63 29.96 percent of total billed charges 108.45 108.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T6 L20 MM OD2 MM HAND CORTEX SELF TAP SELF RETAINING STARDRIVE NONSTERILE SUP-201.370.97 CDM 270010022 LOCAL 0270 RC outpatient 108.45 108.45 108.45 74 80.25 percent of total billed charges 108.45 93 87.84 percent of total billed charges 108.45 108.45 other OPPS APC 108.45 108.45 other OPPS APC 108.45 27.63 29.96 percent of total billed charges 108.45 108.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 22MM 2MM SS NS CORTEX SELF TAP STARDRIVE MINI FRAGMENT SYSTEM SUP-201.372.97 CDM 270010022 LOCAL 0270 RC outpatient 122.98 122.98 122.98 74 91.01 percent of total billed charges 122.98 93 99.61 percent of total billed charges 122.98 122.98 other OPPS APC 122.98 122.98 other OPPS APC 122.98 27.63 33.98 percent of total billed charges 122.98 122.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 24MM 2MM SS NS CORTEX SELF TAP STARDRIVE MINI FRAGMENT SYSTEM SUP-201.374.97 CDM 270010022 LOCAL 0270 RC outpatient 108.45 108.45 108.45 74 80.25 percent of total billed charges 108.45 93 87.84 percent of total billed charges 108.45 108.45 other OPPS APC 108.45 108.45 other OPPS APC 108.45 27.63 29.96 percent of total billed charges 108.45 108.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 26MM 2MM SS NS CORTEX SELF TAP STARDRIVE MINI FRAGMENT SYSTEM SUP-201.375.97 CDM 270010022 LOCAL 0270 RC outpatient 108.45 108.45 108.45 74 80.25 percent of total billed charges 108.45 93 87.84 percent of total billed charges 108.45 108.45 other OPPS APC 108.45 108.45 other OPPS APC 108.45 27.63 29.96 percent of total billed charges 108.45 108.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 28MM 2MM SS NS CORTEX SELF TAP SELF RETAINING STARDRIVE MINI FRAGMENT SET SUP-201.376.97 CDM 270010022 LOCAL 0270 RC outpatient 108.45 108.45 108.45 74 80.25 percent of total billed charges 108.45 93 87.84 percent of total billed charges 108.45 108.45 other OPPS APC 108.45 108.45 other OPPS APC 108.45 27.63 29.96 percent of total billed charges 108.45 108.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 30MM 2MM SS NS CORTEX SELF TAP SELF RETAINING STARDRIVE MINI FRAGMENT SET SUP-201.377.97 CDM 270010022 LOCAL 0270 RC outpatient 108.45 108.45 108.45 74 80.25 percent of total billed charges 108.45 93 87.84 percent of total billed charges 108.45 108.45 other OPPS APC 108.45 108.45 other OPPS APC 108.45 27.63 29.96 percent of total billed charges 108.45 108.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 32MM 2MM SS NS CORTEX SELF TAP SELF RETAINING STARDRIVE MINI FRAGMENT SYSTEM SUP-201.378.97 CDM 270010022 LOCAL 0270 RC outpatient 108.45 108.45 108.45 74 80.25 percent of total billed charges 108.45 93 87.84 percent of total billed charges 108.45 108.45 other OPPS APC 108.45 108.45 other OPPS APC 108.45 27.63 29.96 percent of total billed charges 108.45 108.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 34MM 2MM SS NS CORTEX SELF TAP SELF RETAINING STARDRIVE MINI FRAGMENT SET SUP-201.379.97 CDM 270010022 LOCAL 0270 RC outpatient 108.45 108.45 108.45 74 80.25 percent of total billed charges 108.45 93 87.84 percent of total billed charges 108.45 108.45 other OPPS APC 108.45 108.45 other OPPS APC 108.45 27.63 29.96 percent of total billed charges 108.45 108.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 36MM 2MM SS NS CORTEX SELF TAP SELF RETAINING STARDRIVE MINI FRAGMENT SET SUP-201.380.97 CDM 270010022 LOCAL 0270 RC outpatient 122.98 122.98 122.98 74 91.01 percent of total billed charges 122.98 93 99.61 percent of total billed charges 122.98 122.98 other OPPS APC 122.98 122.98 other OPPS APC 122.98 27.63 33.98 percent of total billed charges 122.98 122.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 38MM 2MM SS NS CORTEX SELF TAP STARDRIVE MINI FRAGMENT SYSTEM SUP-201.381.97 CDM 270010022 LOCAL 0270 RC outpatient 331.5 331.5 331.5 74 245.31 percent of total billed charges 331.5 93 268.52 percent of total billed charges 331.5 331.5 other OPPS APC 331.5 331.5 other OPPS APC 331.5 27.63 91.59 percent of total billed charges 331.5 331.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 40MM 2MM SS NS CORTEX SELF TAP SELF RETAINING STARDRIVE MINI FRAGMENT SET SUP-201.382.97 CDM 270010022 LOCAL 0270 RC outpatient 108.45 108.45 108.45 74 80.25 percent of total billed charges 108.45 93 87.84 percent of total billed charges 108.45 108.45 other OPPS APC 108.45 108.45 other OPPS APC 108.45 27.63 29.96 percent of total billed charges 108.45 108.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L18 MM OD2.4 MM ODSEC3.5 MM RADIUS CORTICAL DISTAL SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR SYSTEM SUP-201.618 CDM 270010022 LOCAL 0270 RC outpatient 127.27 127.27 127.27 74 94.18 percent of total billed charges 127.27 93 103.09 percent of total billed charges 127.27 127.27 other OPPS APC 127.27 127.27 other OPPS APC 127.27 27.63 35.16 percent of total billed charges 127.27 127.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 30MM 2.4MM 3.5MM SS NS CORTEX SELF TAP CRUCIFORM SUP-201.63 CDM 270010022 LOCAL 0270 RC outpatient 143.91 143.91 143.91 74 106.49 percent of total billed charges 143.91 93 116.57 percent of total billed charges 143.91 143.91 other OPPS APC 143.91 143.91 other OPPS APC 143.91 27.63 39.76 percent of total billed charges 143.91 143.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 2.4MM 3.5MM 30MM SS CORTICAL SELF TAPPING CRUCIFORM RECESS NS SUP-201.630 CDM 270010022 LOCAL 0270 RC outpatient 143.91 143.91 143.91 74 106.49 percent of total billed charges 143.91 93 116.57 percent of total billed charges 143.91 143.91 other OPPS APC 143.91 143.91 other OPPS APC 143.91 27.63 39.76 percent of total billed charges 143.91 143.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L6 MM OD2.4 MM SMALL BONE CORTEX SELF TAP SELF RETAINING STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-201.756 CDM 270010022 LOCAL 0270 RC outpatient 128.62 128.62 128.62 74 95.18 percent of total billed charges 128.62 93 104.18 percent of total billed charges 128.62 128.62 other OPPS APC 128.62 128.62 other OPPS APC 128.62 27.63 35.54 percent of total billed charges 128.62 128.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L7 MM OD2.4 MM SMALL BONE CORTEX SELF TAP SELF RETAINING STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-201.757 CDM 270010022 LOCAL 0270 RC outpatient 145.86 145.86 145.86 74 107.94 percent of total billed charges 145.86 93 118.15 percent of total billed charges 145.86 145.86 other OPPS APC 145.86 145.86 other OPPS APC 145.86 27.63 40.3 percent of total billed charges 145.86 145.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L8 MM OD2.4 MM SMALL BONE CORTEX SELF TAP SELF RETAINING STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-201.758 CDM 270010022 LOCAL 0270 RC outpatient 128.62 128.62 128.62 74 95.18 percent of total billed charges 128.62 93 104.18 percent of total billed charges 128.62 128.62 other OPPS APC 128.62 128.62 other OPPS APC 128.62 27.63 35.54 percent of total billed charges 128.62 128.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L9 MM OD2.4 MM SMALL BONE STARDRIVE SELF TAP LOCK THREAD HEAD PROFILE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-201.759 CDM 270010022 LOCAL 0270 RC outpatient 128.62 128.62 128.62 74 95.18 percent of total billed charges 128.62 93 104.18 percent of total billed charges 128.62 128.62 other OPPS APC 128.62 128.62 other OPPS APC 128.62 27.63 35.54 percent of total billed charges 128.62 128.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 LOW PROFILE L10 MM OD2.4 MM ODSEC4 MM RADIUS CORTICAL DISTAL VOLAR SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET MODULAR SYSTEM SUP-201.760 CDM 270010022 LOCAL 0270 RC outpatient 128.62 128.62 128.62 74 95.18 percent of total billed charges 128.62 93 104.18 percent of total billed charges 128.62 128.62 other OPPS APC 128.62 128.62 other OPPS APC 128.62 27.63 35.54 percent of total billed charges 128.62 128.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 LOW PROFILE L11 MM OD2.4 MM ODSEC4 MM RADIUS CORTICAL DISTAL VOLAR SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET MODULAR SYSTEM SUP-201.761 CDM 270010022 LOCAL 0270 RC outpatient 128.62 128.62 128.62 74 95.18 percent of total billed charges 128.62 93 104.18 percent of total billed charges 128.62 128.62 other OPPS APC 128.62 128.62 other OPPS APC 128.62 27.63 35.54 percent of total billed charges 128.62 128.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 LOW PROFILE L12 MM OD2.4 MM ODSEC4 MM RADIUS CORTICAL DISTAL VOLAR SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET MODULAR SYSTEM SUP-201.762 CDM 270010022 LOCAL 0270 RC outpatient 128.62 128.62 128.62 74 95.18 percent of total billed charges 128.62 93 104.18 percent of total billed charges 128.62 128.62 other OPPS APC 128.62 128.62 other OPPS APC 128.62 27.63 35.54 percent of total billed charges 128.62 128.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L13 MM OD2.4 MM RADIUS CORTEX DISTAL VOLAR SELF TAP STARDRIVE LOW PROFILE NONSTERILE SUP-201.763 CDM 270010022 LOCAL 0270 RC outpatient 128.62 128.62 128.62 74 95.18 percent of total billed charges 128.62 93 104.18 percent of total billed charges 128.62 128.62 other OPPS APC 128.62 128.62 other OPPS APC 128.62 27.63 35.54 percent of total billed charges 128.62 128.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 LOW PROFILE L14 MM OD2.4 MM ODSEC4 MM RADIUS CORTICAL DISTAL VOLAR SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET MODULAR SYSTEM SUP-201.764 CDM 270010022 LOCAL 0270 RC outpatient 128.62 128.62 128.62 74 95.18 percent of total billed charges 128.62 93 104.18 percent of total billed charges 128.62 128.62 other OPPS APC 128.62 128.62 other OPPS APC 128.62 27.63 35.54 percent of total billed charges 128.62 128.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L16 MM OD2.4 MM ODSEC4 MM RADIUS CORTEX DISTAL T8 STARDRIVE SELF TAP LOW PROFILE HEAD VARIABLE ANGLE NONSTERILE PLATE SYSTEM SUP-201.766 CDM 270010022 LOCAL 0270 RC outpatient 128.62 128.62 128.62 74 95.18 percent of total billed charges 128.62 93 104.18 percent of total billed charges 128.62 128.62 other OPPS APC 128.62 128.62 other OPPS APC 128.62 27.63 35.54 percent of total billed charges 128.62 128.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 LOW PROFILE L18 MM OD2.4 MM ODSEC4 MM RADIUS CORTICAL DISTAL VOLAR SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET MODULAR SYSTEM SUP-201.768 CDM 270010022 LOCAL 0270 RC outpatient 128.62 128.62 128.62 74 95.18 percent of total billed charges 128.62 93 104.18 percent of total billed charges 128.62 128.62 other OPPS APC 128.62 128.62 other OPPS APC 128.62 27.63 35.54 percent of total billed charges 128.62 128.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 LOW PROFILE L20 MM OD2.4 MM ODSEC4 MM RADIUS CORTICAL DISTAL VOLAR SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET MODULAR SYSTEM SUP-201.770 CDM 270010022 LOCAL 0270 RC outpatient 128.62 128.62 128.62 74 95.18 percent of total billed charges 128.62 93 104.18 percent of total billed charges 128.62 128.62 other OPPS APC 128.62 128.62 other OPPS APC 128.62 27.63 35.54 percent of total billed charges 128.62 128.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 22MM 2.4MM SS NS CORTEX SM BONE SELF TAP SELF RETAINING STARDRIVE MODULAR MINI FRAGMENT SYSTEM SUP-201.772 CDM 270010022 LOCAL 0270 RC outpatient 128.62 128.62 128.62 74 95.18 percent of total billed charges 128.62 93 104.18 percent of total billed charges 128.62 128.62 other OPPS APC 128.62 128.62 other OPPS APC 128.62 27.63 35.54 percent of total billed charges 128.62 128.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L24 MM OD2.4 MM SMALL BONE CORTEX SELF TAP SELF RETAINING STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-201.774 CDM 270010022 LOCAL 0270 RC outpatient 128.62 128.62 128.62 74 95.18 percent of total billed charges 128.62 93 104.18 percent of total billed charges 128.62 128.62 other OPPS APC 128.62 128.62 other OPPS APC 128.62 27.63 35.54 percent of total billed charges 128.62 128.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L26 MM OD2.4 MM SMALL BONE CORTEX SELF TAP SELF RETAINING STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-201.776 CDM 270010022 LOCAL 0270 RC outpatient 342.55 342.55 342.55 74 253.49 percent of total billed charges 342.55 93 277.47 percent of total billed charges 342.55 342.55 other OPPS APC 342.55 342.55 other OPPS APC 342.55 27.63 94.65 percent of total billed charges 342.55 342.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L28 MM OD2.4 MM SMALL BONE CORTEX SELF TAP SELF RETAINING STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-201.778 CDM 270010022 LOCAL 0270 RC outpatient 128.62 128.62 128.62 74 95.18 percent of total billed charges 128.62 93 104.18 percent of total billed charges 128.62 128.62 other OPPS APC 128.62 128.62 other OPPS APC 128.62 27.63 35.54 percent of total billed charges 128.62 128.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 LOW PROFILE L30 MM OD2.4 MM ODSEC4 MM RADIUS CORTICAL DISTAL VOLAR SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET MODULAR SYSTEM SUP-201.780 CDM 270010022 LOCAL 0270 RC outpatient 128.62 128.62 128.62 74 95.18 percent of total billed charges 128.62 93 104.18 percent of total billed charges 128.62 128.62 other OPPS APC 128.62 128.62 other OPPS APC 128.62 27.63 35.54 percent of total billed charges 128.62 128.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L32 MM OD2.4 MM ODSEC3.5 MM FOREFOOT MIDFOOT CORTICAL SELF TAP CRUCIFORM T8 STARDRIVE RECESS NONSTERILE MINI FRAGMENT SET MODULAR SYSTEM SUP-201.782 CDM 270010022 LOCAL 0270 RC outpatient 128.62 128.62 128.62 74 95.18 percent of total billed charges 128.62 93 104.18 percent of total billed charges 128.62 128.62 other OPPS APC 128.62 128.62 other OPPS APC 128.62 27.63 35.54 percent of total billed charges 128.62 128.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 LOW PROFILE L34 MM OD2.4 MM ODSEC4 MM RADIUS CORTICAL DISTAL VOLAR SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET MODULAR SYSTEM SUP-201.784 CDM 270010022 LOCAL 0270 RC outpatient 128.62 128.62 128.62 74 95.18 percent of total billed charges 128.62 93 104.18 percent of total billed charges 128.62 128.62 other OPPS APC 128.62 128.62 other OPPS APC 128.62 27.63 35.54 percent of total billed charges 128.62 128.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L36 MM OD2.4 MM SMALL BONE CORTEX SELF TAP SELF RETAINING STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-201.786 CDM 270010022 LOCAL 0270 RC outpatient 128.62 128.62 128.62 74 95.18 percent of total billed charges 128.62 93 104.18 percent of total billed charges 128.62 128.62 other OPPS APC 128.62 128.62 other OPPS APC 128.62 27.63 35.54 percent of total billed charges 128.62 128.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L38 MM OD2.4 MM ODSEC4 MM CORTICAL SMALL BONE VARIABLESELF TAPPING T8 STARDRIVE RECESS NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-201.788 CDM 270010022 LOCAL 0270 RC outpatient 128.62 128.62 128.62 74 95.18 percent of total billed charges 128.62 93 104.18 percent of total billed charges 128.62 128.62 other OPPS APC 128.62 128.62 other OPPS APC 128.62 27.63 35.54 percent of total billed charges 128.62 128.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 LOW PROFILE L40 MM OD2.4 MM ODSEC4 MM RADIUS CORTICAL DISTAL VOLAR SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET MODULAR SYSTEM SUP-201.790 CDM 270010022 LOCAL 0270 RC outpatient 128.62 128.62 128.62 74 95.18 percent of total billed charges 128.62 93 104.18 percent of total billed charges 128.62 128.62 other OPPS APC 128.62 128.62 other OPPS APC 128.62 27.63 35.54 percent of total billed charges 128.62 128.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6MM 2MM SS NS CORTEX HAND FOOT SELF TAP CRUCIFORM MODULAR MINI FRAGMENT SYSTEM SUP-201.806 CDM 270010022 LOCAL 0270 RC outpatient 99.58 99.58 99.58 74 73.69 percent of total billed charges 99.58 93 80.66 percent of total billed charges 99.58 99.58 other OPPS APC 99.58 99.58 other OPPS APC 99.58 27.63 27.51 percent of total billed charges 99.58 99.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM FOOT HAND CORTICAL SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR SYSTEM SUP-201.812 CDM 270010022 LOCAL 0270 RC outpatient 113.23 113.23 113.23 74 83.79 percent of total billed charges 113.23 93 91.72 percent of total billed charges 113.23 113.23 other OPPS APC 113.23 113.23 other OPPS APC 113.23 27.63 31.29 percent of total billed charges 113.23 113.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 6MM 2MM SS NS SM BONE SELF TAP LOCK STARDRIVE MODULAR MINI FRAGMENT SYSTEM SUP-201.876 CDM 270010022 LOCAL 0270 RC outpatient 263.56 263.56 263.56 74 195.03 percent of total billed charges 263.56 93 213.48 percent of total billed charges 263.56 263.56 other OPPS APC 263.56 263.56 other OPPS APC 263.56 27.63 72.82 percent of total billed charges 263.56 263.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T6 L7 MM OD2 MM SMALL BONE SELF TAP SELF RETAINING STARDRIVE THREAD HEAD PROFILE LOCK NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-201.877 CDM 270010022 LOCAL 0270 RC outpatient 263.56 263.56 263.56 74 195.03 percent of total billed charges 263.56 93 213.48 percent of total billed charges 263.56 263.56 other OPPS APC 263.56 263.56 other OPPS APC 263.56 27.63 72.82 percent of total billed charges 263.56 263.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T6 L8 MM OD2 MM SMALL BONE SELF TAP SELF RETAINING STARDRIVE THREAD HEAD PROFILE LOCK NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-201.878 CDM 270010022 LOCAL 0270 RC outpatient 263.56 263.56 263.56 74 195.03 percent of total billed charges 263.56 93 213.48 percent of total billed charges 263.56 263.56 other OPPS APC 263.56 263.56 other OPPS APC 263.56 27.63 72.82 percent of total billed charges 263.56 263.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T6 L9 MM OD2 MM SMALL BONE SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-201.879 CDM 270010022 LOCAL 0270 RC outpatient 263.56 263.56 263.56 74 195.03 percent of total billed charges 263.56 93 213.48 percent of total billed charges 263.56 263.56 other OPPS APC 263.56 263.56 other OPPS APC 263.56 27.63 72.82 percent of total billed charges 263.56 263.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 10MM 2MM SS NS SM BONE SELF TAP LOCK STARDRIVE MODULAR MINI FRAGMENT SYSTEM SUP-201.880 CDM 270010022 LOCAL 0270 RC outpatient 609.96 609.96 609.96 74 451.37 percent of total billed charges 609.96 93 494.07 percent of total billed charges 609.96 609.96 other OPPS APC 609.96 609.96 other OPPS APC 609.96 27.63 168.53 percent of total billed charges 609.96 609.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T6 L11 MM OD2 MM SMALL BONE LOCK SELF TAP STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-201.881 CDM 270010022 LOCAL 0270 RC outpatient 609.96 609.96 609.96 74 451.37 percent of total billed charges 609.96 93 494.07 percent of total billed charges 609.96 609.96 other OPPS APC 609.96 609.96 other OPPS APC 609.96 27.63 168.53 percent of total billed charges 609.96 609.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T6 L12 MM OD2 MM SMALL BONE LOCK SELF TAP STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-201.882 CDM 270010022 LOCAL 0270 RC outpatient 609.96 609.96 609.96 74 451.37 percent of total billed charges 609.96 93 494.07 percent of total billed charges 609.96 609.96 other OPPS APC 609.96 609.96 other OPPS APC 609.96 27.63 168.53 percent of total billed charges 609.96 609.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T6 L13 MM OD2 MM SMALL BONE LOCK SELF TAP STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-201.883 CDM 270010022 LOCAL 0270 RC outpatient 263.56 263.56 263.56 74 195.03 percent of total billed charges 263.56 93 213.48 percent of total billed charges 263.56 263.56 other OPPS APC 263.56 263.56 other OPPS APC 263.56 27.63 72.82 percent of total billed charges 263.56 263.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T6 L14 MM OD2 MM SMALL BONE LOCK SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-201.884 CDM 270010022 LOCAL 0270 RC outpatient 609.96 609.96 609.96 74 451.37 percent of total billed charges 609.96 93 494.07 percent of total billed charges 609.96 609.96 other OPPS APC 609.96 609.96 other OPPS APC 609.96 27.63 168.53 percent of total billed charges 609.96 609.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 16MM 2MM SS NS SM BONE SELF TAP LOCK STARDRIVE MODULAR MINI FRAGMENT SYSTEM SUP-201.886 CDM 270010022 LOCAL 0270 RC outpatient 263.56 263.56 263.56 74 195.03 percent of total billed charges 263.56 93 213.48 percent of total billed charges 263.56 263.56 other OPPS APC 263.56 263.56 other OPPS APC 263.56 27.63 72.82 percent of total billed charges 263.56 263.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T6 L18 MM OD2 MM SMALL BONE LOCK SELF TAP STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-201.888 CDM 270010022 LOCAL 0270 RC outpatient 263.56 263.56 263.56 74 195.03 percent of total billed charges 263.56 93 213.48 percent of total billed charges 263.56 263.56 other OPPS APC 263.56 263.56 other OPPS APC 263.56 27.63 72.82 percent of total billed charges 263.56 263.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 20MM 2MM SS NS SM BONE SELF TAP LOCK SELF RETAINING STARDRIVE MODULAR MINI FRAGMENT SYSTEM SUP-201.890 CDM 270010022 LOCAL 0270 RC outpatient 263.56 263.56 263.56 74 195.03 percent of total billed charges 263.56 93 213.48 percent of total billed charges 263.56 263.56 other OPPS APC 263.56 263.56 other OPPS APC 263.56 27.63 72.82 percent of total billed charges 263.56 263.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T6 L22 MM OD2 MM SMALL BONE SELF TAP SELF RETAINING STARDRIVE THREAD HEAD PROFILE LOCK NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-201.892 CDM 270010022 LOCAL 0270 RC outpatient 263.56 263.56 263.56 74 195.03 percent of total billed charges 263.56 93 213.48 percent of total billed charges 263.56 263.56 other OPPS APC 263.56 263.56 other OPPS APC 263.56 27.63 72.82 percent of total billed charges 263.56 263.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T6 L24 MM OD2 MM SMALL BONE SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-201.894 CDM 270010022 LOCAL 0270 RC outpatient 263.56 263.56 263.56 74 195.03 percent of total billed charges 263.56 93 213.48 percent of total billed charges 263.56 263.56 other OPPS APC 263.56 263.56 other OPPS APC 263.56 27.63 72.82 percent of total billed charges 263.56 263.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T6 L26 MM OD2 MM SMALL BONE SELF TAP SELF RETAINING STARDRIVE THREAD HEAD PROFILE LOCK NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-201.896 CDM 270010022 LOCAL 0270 RC outpatient 263.56 263.56 263.56 74 195.03 percent of total billed charges 263.56 93 213.48 percent of total billed charges 263.56 263.56 other OPPS APC 263.56 263.56 other OPPS APC 263.56 27.63 72.82 percent of total billed charges 263.56 263.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T6 L28 MM OD2 MM SMALL BONE SELF TAP SELF RETAINING STARDRIVE THREAD HEAD PROFILE LOCK NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-201.898 CDM 270010022 LOCAL 0270 RC outpatient 263.56 263.56 263.56 74 195.03 percent of total billed charges 263.56 93 213.48 percent of total billed charges 263.56 263.56 other OPPS APC 263.56 263.56 other OPPS APC 263.56 27.63 72.82 percent of total billed charges 263.56 263.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 30MM 2MM SS NS SM BONE SELF TAP LOCK THREAD HEAD PROFILE STARDRIVE MODULAR MINI FRAGMENT SYSTEM SUP-201.900 CDM 270010022 LOCAL 0270 RC outpatient 298.87 298.87 298.87 74 221.16 percent of total billed charges 298.87 93 242.08 percent of total billed charges 298.87 298.87 other OPPS APC 298.87 298.87 other OPPS APC 298.87 27.63 82.58 percent of total billed charges 298.87 298.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L12 MM OD2 MM MANDIBLE SELF DRILL NONSTERILE INTERMAXILLARY FIXATION SUP-201.932 CDM 270010022 LOCAL 0270 RC outpatient 1737.19 1737.19 1737.19 74 1285.52 percent of total billed charges 1737.19 93 1407.12 percent of total billed charges 1737.19 1737.19 other OPPS APC 1737.19 1737.19 other OPPS APC 1737.19 27.63 479.99 percent of total billed charges 1737.19 1737.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION STAINLESS STEEL L16 MM OD1.8 MM DISTAL RADIUS BUTTRESS NONSTERILE SUP-201.966 CDM 270010022 LOCAL 0270 RC outpatient 171.6 171.6 171.6 74 126.98 percent of total billed charges 171.6 93 139 percent of total billed charges 171.6 171.6 other OPPS APC 171.6 171.6 other OPPS APC 171.6 27.63 47.41 percent of total billed charges 171.6 171.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION LCP STAINLESS STEEL L18 MM OD1.8 MM DISTAL RADIUS BUTTRESS NONSTERILE SUP-201.968 CDM 270010022 LOCAL 0270 RC outpatient 171.6 171.6 171.6 74 126.98 percent of total billed charges 171.6 93 139 percent of total billed charges 171.6 171.6 other OPPS APC 171.6 171.6 other OPPS APC 171.6 27.63 47.41 percent of total billed charges 171.6 171.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION LCP STAINLESS STEEL L20 MM OD1.8 MM DISTAL RADIUS BUTTRESS NONSTERILE SUP-201.970 CDM 270010022 LOCAL 0270 RC outpatient 171.6 171.6 171.6 74 126.98 percent of total billed charges 171.6 93 139 percent of total billed charges 171.6 171.6 other OPPS APC 171.6 171.6 other OPPS APC 171.6 27.63 47.41 percent of total billed charges 171.6 171.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION STAINLESS STEEL L22 MM OD1.8 MM DISTAL RADIUS BUTTRESS NONSTERILE SUP-201.972 CDM 270010022 LOCAL 0270 RC outpatient 171.6 171.6 171.6 74 126.98 percent of total billed charges 171.6 93 139 percent of total billed charges 171.6 171.6 other OPPS APC 171.6 171.6 other OPPS APC 171.6 27.63 47.41 percent of total billed charges 171.6 171.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LARYNGECTOMY PULMONARY KIT 9/55 SUP-2010-07E1 CDM 0270 RC outpatient 2849.6 2849.6 2849.6 74 2108.7 percent of total billed charges 2849.6 93 2308.18 percent of total billed charges 2849.6 2849.6 other OPPS APC 2849.6 2849.6 other OPPS APC 2849.6 27.63 787.34 percent of total billed charges 2849.6 2849.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE EMG I-PAS III DIAMOND DISPOSABLE NS LF SUP-2010028 CDM 270010020 LOCAL 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE JAMSHIDI I-PASS III SUP-2010029 CDM 270010020 LOCAL 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE BIO-OSS CANCELLOUS BOVINE BONE MINERAL MATRIX .25-1 MM 2 GM SMALL GRANULE SUP-20113 CDM 270010031 LOCAL 0270 RC outpatient 1058.2 1058.2 1058.2 74 783.07 percent of total billed charges 1058.2 93 857.14 percent of total billed charges 1058.2 1058.2 other OPPS APC 1058.2 1058.2 other OPPS APC 1058.2 27.63 292.38 percent of total billed charges 1058.2 1058.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHUNT CAROTID PRUITT INAHARA BALLOON OUTLYING 9FR X 31CM SUP-2012-11 CDM 270009143 LOCAL 0270 RC outpatient 126 126 126 74 93.24 percent of total billed charges 126 93 102.06 percent of total billed charges 126 126 other OPPS APC 126 126 other OPPS APC 126 27.63 34.81 percent of total billed charges 126 126 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE ELECTROSURGICAL FIAPC L220 CM OD2.3 MM FLEXIBLE STRAIGHT FIRE STERILE DISPOSABLE ARGON PLASMA COAGULATION SUP-20132-214 CDM 0270 RC outpatient 612.3 612.3 612.3 74 453.1 percent of total billed charges 612.3 93 495.96 percent of total billed charges 612.3 612.3 other OPPS APC 612.3 612.3 other OPPS APC 612.3 27.63 169.18 percent of total billed charges 612.3 612.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE ENDOSCOPIC FIAPC L7.2 IN OD9.6 FR FLEXIBLE FILTER INTEGRATED STERILE DISPOSABLE SUP-20132-215 CDM 0270 RC outpatient 569.27 569.27 569.27 74 421.26 percent of total billed charges 569.27 93 461.11 percent of total billed charges 569.27 569.27 other OPPS APC 569.27 569.27 other OPPS APC 569.27 27.63 157.29 percent of total billed charges 569.27 569.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE ELECTROSURGICAL FIAPC L7 FT 2 IN OD2.3 MM CIRCUMFERENTIAL PLUG AND PLAY FUNCTIONALITY SUP-20132-218 CDM 0270 RC outpatient 631.28 631.28 631.28 74 467.15 percent of total billed charges 631.28 93 511.34 percent of total billed charges 631.28 631.28 other OPPS APC 631.28 631.28 other OPPS APC 631.28 27.63 174.42 percent of total billed charges 631.28 631.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPPORT SCROTAL BAUER & BLACK COTTON ADULT XL SUSPENSORY LEG STRAP ELASTIC WAISTBAND NONSTERILE LATEX REUSABLE WHITE SUP-201352 CDM outpatient 39.86 39.86 39.86 39.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOAP LIQUID PALMOLIVE 3 OZ- 72 PER CASE SUP-201417 CDM 0270 RC outpatient 3.88 3.88 3.88 74 2.87 percent of total billed charges 3.88 93 3.14 percent of total billed charges 3.88 3.88 other OPPS APC 3.88 3.88 other OPPS APC 3.88 27.63 1.07 percent of total billed charges 3.88 3.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEMBRANE PERIODONTAL BIO-GIDE PORCINE COLLAGEN L25 MM X W25 MM RESORBABLE BILAYER SMOOTH ROUGH SUP-20152 CDM 0270 RC outpatient 517.4 517.4 517.4 74 382.88 percent of total billed charges 517.4 93 419.09 percent of total billed charges 517.4 517.4 other OPPS APC 517.4 517.4 other OPPS APC 517.4 27.63 142.96 percent of total billed charges 517.4 517.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE GEISTLICH BIO-GIDE PORCINE COLLAGEN MEMBRANE L50 MM X W40 MM 2 BLISTER 2 LAYER RESORBABLE STERILE SUP-20153 CDM 0270 RC outpatient 1357.2 1357.2 1357.2 74 1004.33 percent of total billed charges 1357.2 93 1099.33 percent of total billed charges 1357.2 1357.2 other OPPS APC 1357.2 1357.2 other OPPS APC 1357.2 27.63 374.99 percent of total billed charges 1357.2 1357.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM SUNDT-KEYS SLIM-LINE MP35N STAINLESS STEEL 4 MM OPENING L4 CM X W3 CM OD4 MM GRAFT ENCIRCLING STERILE LATEX FREE DISPOSABLE SUP-201715 CDM 0270 RC outpatient 2935.4 2935.4 2935.4 74 2172.2 percent of total billed charges 2935.4 93 2377.67 percent of total billed charges 2935.4 2935.4 other OPPS APC 2935.4 2935.4 other OPPS APC 2935.4 27.63 811.05 percent of total billed charges 2935.4 2935.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM SUNDT-KEES SLIM-LINE MP35N STAINLESS STEEL 90 D 5 MM OPENING L5 MM X W1.5 MM GRAFT ENCIRCLING STERILE LATEX FREE DISPOSABLE SUP-201716 CDM 0270 RC outpatient 2935.4 2935.4 2935.4 74 2172.2 percent of total billed charges 2935.4 93 2377.67 percent of total billed charges 2935.4 2935.4 other OPPS APC 2935.4 2935.4 other OPPS APC 2935.4 27.63 811.05 percent of total billed charges 2935.4 2935.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM SUNDT-KEES SLIM-LINE MP35N STAINLESS STEEL 8 MM OPENING L9 MM X W1.88 MM STRAIGHT FENESTRATED STERILE LATEX FREE DISPOSABLE SUP-201722 CDM 0270 RC outpatient 1840.8 1840.8 1840.8 74 1362.19 percent of total billed charges 1840.8 93 1491.05 percent of total billed charges 1840.8 1840.8 other OPPS APC 1840.8 1840.8 other OPPS APC 1840.8 27.63 508.61 percent of total billed charges 1840.8 1840.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM SUNDT-KEES SLIM-LINE L3 MM OD3 MM GRAFT ENCIRCLING SUP-201765 CDM 0270 RC outpatient 3029 3029 3029 74 2241.46 percent of total billed charges 3029 93 2453.49 percent of total billed charges 3029 3029 other OPPS APC 3029 3029 other OPPS APC 3029 27.63 836.91 percent of total billed charges 3029 3029 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM FABRIC W5 MM OD3 MM GRAFT SUP-201766 CDM 0270 RC outpatient 3029 3029 3029 74 2241.46 percent of total billed charges 3029 93 2453.49 percent of total billed charges 3029 3029 other OPPS APC 3029 3029 other OPPS APC 3029 27.63 836.91 percent of total billed charges 3029 3029 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM FABRIC W5 MM OD5 MM GRAFT SUP-201772 CDM 0270 RC outpatient 3029 3029 3029 74 2241.46 percent of total billed charges 3029 93 2453.49 percent of total billed charges 3029 3029 other OPPS APC 3029 3029 other OPPS APC 3029 27.63 836.91 percent of total billed charges 3029 3029 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAD ELECTROSURGICAL GROUNDING NESSY ADULT L168 CM L10 FT CABLE MONITORING SPLIT DISPOSABLE SUP-20193-074 CDM 0270 RC outpatient 10.92 10.92 10.92 74 8.08 percent of total billed charges 10.92 93 8.85 percent of total billed charges 10.92 10.92 other OPPS APC 10.92 10.92 other OPPS APC 10.92 27.63 3.02 percent of total billed charges 10.92 10.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 8MM 2.7MM SS NS SM BONE SELF TAP LOCK STARDRIVE MODULAR MINI FRAGMENT SYSTEM SUP-202.208 CDM 270010022 LOCAL 0270 RC outpatient 271.13 271.13 271.13 74 200.64 percent of total billed charges 271.13 93 219.62 percent of total billed charges 271.13 271.13 other OPPS APC 271.13 271.13 other OPPS APC 271.13 27.63 74.91 percent of total billed charges 271.13 271.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOCKING SELF TAPPING WITH T8 STARDRIVE RECESS STAINLESS STEEL 2.7 X 10MM SUP-202.21 CDM 270010022 LOCAL 0270 RC outpatient 355.68 355.68 355.68 74 263.2 percent of total billed charges 355.68 93 288.1 percent of total billed charges 355.68 355.68 other OPPS APC 355.68 355.68 other OPPS APC 355.68 27.63 98.27 percent of total billed charges 355.68 355.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L10 MM OD2.7 MM DISTAL FIBULA LOCKING SELF TAPPING T8 STARDRIVE RECESS NONSTERILE SUP-202.210 CDM 270010022 LOCAL 0270 RC outpatient 647.53 647.53 647.53 74 479.17 percent of total billed charges 647.53 93 524.5 percent of total billed charges 647.53 647.53 other OPPS APC 647.53 647.53 other OPPS APC 647.53 27.63 178.91 percent of total billed charges 647.53 647.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L12 MM OD2.7 MM SMALL BONE SELF TAP SELF RETAINING STARDRIVE THREAD HEAD PROFILE LOCK NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.212 CDM 270010022 LOCAL 0270 RC outpatient 647.53 647.53 647.53 74 479.17 percent of total billed charges 647.53 93 524.5 percent of total billed charges 647.53 647.53 other OPPS APC 647.53 647.53 other OPPS APC 647.53 27.63 178.91 percent of total billed charges 647.53 647.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L14 MM OD2.7 MM SMALL BONE SELF TAP SELF RETAINING STARDRIVE THREAD HEAD PROFILE LOCK NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.214 CDM 270010022 LOCAL 0270 RC outpatient 271.13 271.13 271.13 74 200.64 percent of total billed charges 271.13 93 219.62 percent of total billed charges 271.13 271.13 other OPPS APC 271.13 271.13 other OPPS APC 271.13 27.63 74.91 percent of total billed charges 271.13 271.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 16MM 2.7MM SS NS SM BONE SELF TAP LOCK STARDRIVE MODULAR MINI FRAGMENT SYSTEM SUP-202.216 CDM 270010022 LOCAL 0270 RC outpatient 271.13 271.13 271.13 74 200.64 percent of total billed charges 271.13 93 219.62 percent of total billed charges 271.13 271.13 other OPPS APC 271.13 271.13 other OPPS APC 271.13 27.63 74.91 percent of total billed charges 271.13 271.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L18 MM OD2.7 MM ODSEC2.1 MM FEMUR HUMERUS DISTAL SELF TAP MODULAR STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-202.218 CDM 270010022 LOCAL 0270 RC outpatient 271.13 271.13 271.13 74 200.64 percent of total billed charges 271.13 93 219.62 percent of total billed charges 271.13 271.13 other OPPS APC 271.13 271.13 other OPPS APC 271.13 27.63 74.91 percent of total billed charges 271.13 271.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 2.7MM 20MM LCP SS T8 SM BONE LOCK SELF TAP SELF RETAINING STARDRIVE SUP-202.220 CDM 270010022 LOCAL 0270 RC outpatient 355.68 355.68 355.68 74 263.2 percent of total billed charges 355.68 93 288.1 percent of total billed charges 355.68 355.68 other OPPS APC 355.68 355.68 other OPPS APC 355.68 27.63 98.27 percent of total billed charges 355.68 355.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L20 MM OD2.7 MM SMALL BONE SELF TAP SELF RETAINING STARDRIVE THREAD HEAD PROFILE LOCK NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.220 CDM 270010022 LOCAL 0270 RC outpatient 271.13 271.13 271.13 74 200.64 percent of total billed charges 271.13 93 219.62 percent of total billed charges 271.13 271.13 other OPPS APC 271.13 271.13 other OPPS APC 271.13 27.63 74.91 percent of total billed charges 271.13 271.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L22 MM OD2.7 MM ODSEC2.1 MM FEMUR HUMERUS DISTAL SELF TAP MODULAR STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-202.222 CDM 270010022 LOCAL 0270 RC outpatient 271.13 271.13 271.13 74 200.64 percent of total billed charges 271.13 93 219.62 percent of total billed charges 271.13 271.13 other OPPS APC 271.13 271.13 other OPPS APC 271.13 27.63 74.91 percent of total billed charges 271.13 271.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 24MM 2.7MM SS NS SM BONE SELF TAP LOCK STARDRIVE MODULAR MINI FRAGMENT SYSTEM SUP-202.224 CDM 270010022 LOCAL 0270 RC outpatient 271.13 271.13 271.13 74 200.64 percent of total billed charges 271.13 93 219.62 percent of total billed charges 271.13 271.13 other OPPS APC 271.13 271.13 other OPPS APC 271.13 27.63 74.91 percent of total billed charges 271.13 271.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L26 MM OD2.7 MM DISTAL FIBULA LOCKING SELF TAPPING T8 STARDRIVE RECESS NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.226 CDM 270010022 LOCAL 0270 RC outpatient 271.13 271.13 271.13 74 200.64 percent of total billed charges 271.13 93 219.62 percent of total billed charges 271.13 271.13 other OPPS APC 271.13 271.13 other OPPS APC 271.13 27.63 74.91 percent of total billed charges 271.13 271.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 2.7MM 28MM LCP SS T8 SM BONE STARDRIVE SELF TAP LOCK THREAD HEAD PROFILE SUP-202.228 CDM 270010022 LOCAL 0270 RC outpatient 271.13 271.13 271.13 74 200.64 percent of total billed charges 271.13 93 219.62 percent of total billed charges 271.13 271.13 other OPPS APC 271.13 271.13 other OPPS APC 271.13 27.63 74.91 percent of total billed charges 271.13 271.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L30 MM OD2.7 MM SMALL BONE STARDRIVE SELF TAP LOCK THREAD HEAD PROFILE MODULAR MINI FRAGMENT SYSTEM SUP-202.230 CDM 270010022 LOCAL 0270 RC outpatient 271.13 271.13 271.13 74 200.64 percent of total billed charges 271.13 93 219.62 percent of total billed charges 271.13 271.13 other OPPS APC 271.13 271.13 other OPPS APC 271.13 27.63 74.91 percent of total billed charges 271.13 271.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 2.7MM 32MM LCP SS T8 SM BONE STARDRIVE SELF TAP LOCK THREAD HEAD PROFILE SUP-202.232 CDM 270010022 LOCAL 0270 RC outpatient 271.13 271.13 271.13 74 200.64 percent of total billed charges 271.13 93 219.62 percent of total billed charges 271.13 271.13 other OPPS APC 271.13 271.13 other OPPS APC 271.13 27.63 74.91 percent of total billed charges 271.13 271.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 2.7MM 2.1MM 34MM LCP SS T8 HUMERUS FEMUR DISTAL SELF TAP LOCK STARDRIVE NS SUP-202.234 CDM 270010022 LOCAL 0270 RC outpatient 271.13 271.13 271.13 74 200.64 percent of total billed charges 271.13 93 219.62 percent of total billed charges 271.13 271.13 other OPPS APC 271.13 271.13 other OPPS APC 271.13 27.63 74.91 percent of total billed charges 271.13 271.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L36 MM OD2.7 MM SMALL BONE STARDRIVE SELF TAP LOCK THREAD HEAD PROFILE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.236 CDM 270010022 LOCAL 0270 RC outpatient 647.53 647.53 647.53 74 479.17 percent of total billed charges 647.53 93 524.5 percent of total billed charges 647.53 647.53 other OPPS APC 647.53 647.53 other OPPS APC 647.53 27.63 178.91 percent of total billed charges 647.53 647.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L38 MM OD2.7 MM SMALL BONE STARDRIVE SELF TAP LOCK THREAD HEAD PROFILE MODULAR MINI FRAGMENT SYSTEM SUP-202.238 CDM 270010022 LOCAL 0270 RC outpatient 271.13 271.13 271.13 74 200.64 percent of total billed charges 271.13 93 219.62 percent of total billed charges 271.13 271.13 other OPPS APC 271.13 271.13 other OPPS APC 271.13 27.63 74.91 percent of total billed charges 271.13 271.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L40 MM OD2.7 MM SMALL BONE SELF TAP STARDRIVE LOCK NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.240 CDM 270010022 LOCAL 0270 RC outpatient 647.53 647.53 647.53 74 479.17 percent of total billed charges 647.53 93 524.5 percent of total billed charges 647.53 647.53 other OPPS APC 647.53 647.53 other OPPS APC 647.53 27.63 178.91 percent of total billed charges 647.53 647.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 2.7MM 42MM LCP SS ULNA T8 STARDRIVE RECESS SELF TAPPING LOCKING NS MODULAR SUP-202.242 CDM 270010022 LOCAL 0270 RC outpatient 647.53 647.53 647.53 74 479.17 percent of total billed charges 647.53 93 524.5 percent of total billed charges 647.53 647.53 other OPPS APC 647.53 647.53 other OPPS APC 647.53 27.63 178.91 percent of total billed charges 647.53 647.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L44 MM OD2.7 MM SMALL BONE STARDRIVE SELF TAP LOCK THREAD HEAD PROFILE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.244 CDM 270010022 LOCAL 0270 RC outpatient 271.13 271.13 271.13 74 200.64 percent of total billed charges 271.13 93 219.62 percent of total billed charges 271.13 271.13 other OPPS APC 271.13 271.13 other OPPS APC 271.13 27.63 74.91 percent of total billed charges 271.13 271.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 2.7MM 46MM LCP SS T8 SM BONE STARDRIVE SELF TAP LOCK THREAD HEAD PROFILE SUP-202.246 CDM 270010022 LOCAL 0270 RC outpatient 271.13 271.13 271.13 74 200.64 percent of total billed charges 271.13 93 219.62 percent of total billed charges 271.13 271.13 other OPPS APC 271.13 271.13 other OPPS APC 271.13 27.63 74.91 percent of total billed charges 271.13 271.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L48 MM OD2.7 MM SMALL BONE STARDRIVE SELF TAP LOCK THREAD HEAD PROFILE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.248 CDM 270010022 LOCAL 0270 RC outpatient 647.53 647.53 647.53 74 479.17 percent of total billed charges 647.53 93 524.5 percent of total billed charges 647.53 647.53 other OPPS APC 647.53 647.53 other OPPS APC 647.53 27.63 178.91 percent of total billed charges 647.53 647.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L50 MM OD2.7 MM SMALL BONE SELF TAP STARDRIVE LOCK NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.250 CDM 270010022 LOCAL 0270 RC outpatient 307.45 307.45 307.45 74 227.51 percent of total billed charges 307.45 93 249.03 percent of total billed charges 307.45 307.45 other OPPS APC 307.45 307.45 other OPPS APC 307.45 27.63 84.95 percent of total billed charges 307.45 307.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L55 MM OD2.7 MM SMALL BONE STARDRIVE SELF TAP LOCK THREAD HEAD PROFILE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.255 CDM 270010022 LOCAL 0270 RC outpatient 271.13 271.13 271.13 74 200.64 percent of total billed charges 271.13 93 219.62 percent of total billed charges 271.13 271.13 other OPPS APC 271.13 271.13 other OPPS APC 271.13 27.63 74.91 percent of total billed charges 271.13 271.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 60MM 2.7MM SS NS SM BONE SELF TAP LOCK STARDRIVE MODULAR MINI FRAGMENT SYSTEM SUP-202.260 CDM 270010022 LOCAL 0270 RC outpatient 271.13 271.13 271.13 74 200.64 percent of total billed charges 271.13 93 219.62 percent of total billed charges 271.13 271.13 other OPPS APC 271.13 271.13 other OPPS APC 271.13 27.63 74.91 percent of total billed charges 271.13 271.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL SHORT THREAD L8 MM OD3 MM SMALL BONE CANNULATED SELF DRILL SELF TAP LOW PROFILE HEAD ACCEPTS 1.1 MM GUIDEWIRE SUP-202.608 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL SHORT THREAD L9 MM OD3 MM SMALL BONE CANNULATED SELF DRILL SELF TAP LOW PROFILE HEAD ACCEPTS 1.1 MM GUIDEWIRE SUP-202.609 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL SHORT THREAD L10 MM OD3 MM SMALL BONE CANNULATED SELF DRILL SELF TAP LOW PROFILE HEAD ACCEPTS 1.1 MM GUIDEWIRE SUP-202.61 CDM 270010022 LOCAL 0270 RC outpatient 641.16 641.16 641.16 74 474.46 percent of total billed charges 641.16 93 519.34 percent of total billed charges 641.16 641.16 other OPPS APC 641.16 641.16 other OPPS APC 641.16 27.63 177.15 percent of total billed charges 641.16 641.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 3MM 10MM SS SHORT THREAD SM BONE CANNULATED SELF DRILL SELF TAP LOW SUP-202.610 CDM 270010022 LOCAL 0270 RC outpatient 641.16 641.16 641.16 74 474.46 percent of total billed charges 641.16 93 519.34 percent of total billed charges 641.16 641.16 other OPPS APC 641.16 641.16 other OPPS APC 641.16 27.63 177.15 percent of total billed charges 641.16 641.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL SHORT THREAD L11 MM OD3 MM SMALL BONE CANNULATED SELF DRILL SELF TAP LOW PROFILE HEAD ACCEPTS 1.1 MM GUIDEWIRE SUP-202.611 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL SHORT THREAD L12 MM OD3 MM SMALL BONE CANNULATED SELF DRILL SELF TAP LOW PROFILE HEAD ACCEPTS 1.1 MM GUIDEWIRE SUP-202.612 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL SHORT THREAD L13 MM OD3 MM SMALL BONE CANNULATED SELF DRILL SELF TAP LOW PROFILE HEAD ACCEPTS 1.1 MM GUIDEWIRE SUP-202.613 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LOW PROFILE L14 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.614 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LOW PROFILE L15 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.615 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LOW PROFILE L16 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.616 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LOW PROFILE L17 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.617 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL SHORT THREAD L18 MM OD3 MM WRIST HAND FOOT CANNULATED NONSTERILE SUP-202.618 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LOW PROFILE L19 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.619 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LOW PROFILE L20 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.62 CDM 270010022 LOCAL 0270 RC outpatient 641.16 641.16 641.16 74 474.46 percent of total billed charges 641.16 93 519.34 percent of total billed charges 641.16 641.16 other OPPS APC 641.16 641.16 other OPPS APC 641.16 27.63 177.15 percent of total billed charges 641.16 641.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 3MM 4MM 1.2MM 20MM SS 1/3 THREAD LOW PROFILE FOREFOOT HAND WRIST SELF SUP-202.620 CDM 270010022 LOCAL 0270 RC outpatient 641.16 641.16 641.16 74 474.46 percent of total billed charges 641.16 93 519.34 percent of total billed charges 641.16 641.16 other OPPS APC 641.16 641.16 other OPPS APC 641.16 27.63 177.15 percent of total billed charges 641.16 641.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LOW PROFILE L21 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.621 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LOW PROFILE L22 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.622 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LOW PROFILE L23 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.623 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LOW PROFILE L24 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.624 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LOW PROFILE L25 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.625 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LOW PROFILE L26 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.626 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LOW PROFILE L27 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.627 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LOW PROFILE L28 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.628 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LOW PROFILE L29 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.629 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LOW PROFILE L30 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.630 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LOW PROFILE L32 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.632 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LOW PROFILE L34 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.634 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LOW PROFILE L36 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.636 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LOW PROFILE L38 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.638 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LOW PROFILE L40 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.640 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/2 THREAD LOW PROFILE L14 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.714 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/2 THREAD LOW PROFILE L15 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.715 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/2 THREAD LOW PROFILE L16 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.716 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/2 THREAD LOW PROFILE L17 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.717 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/2 THREAD LOW PROFILE L18 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.718 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/2 THREAD LOW PROFILE L19 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.719 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL LONG THREAD L20 MM OD3 MM ODSEC4 MM SMALL BONE CANNULATED SELF DRIL SELF TAP LOW PROFILE HEAD NONSTERILE SUP-202.720 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/2 THREAD LOW PROFILE L21 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.721 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/2 THREAD LOW PROFILE L22 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.722 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL LONG THREAD L23 MM OD3 MM ODSEC4 MM CANCELLOUS CANNULATED SELF DRILLING SELF TAPPING COMPRESSION LOW PROFILE HEAD NONSTERILE SUP-202.723 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/2 THREAD LOW PROFILE L24 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.724 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL LONG THREAD L25 MM OD3 MM ODSEC4 MM CANCELLOUS CANNULATED CRUCIFORM RECESS SELF DRILLING SELF TAPPING COMPRESSION NONSTERILE SUP-202.725 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL LONG THREAD L26 MM OD3 MM WRIST HAND FOOT CANNULATED NONSTERILE SUP-202.726 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL LONG THREAD L27 MM OD3 MM WRIST HAND FOOT CANNULATED NONSTERILE SUP-202.727 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/2 THREAD LOW PROFILE L28 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.728 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL LONG THREAD L29 MM OD3 MM WRIST HAND FOOT CANNULATED NONSTERILE SUP-202.729 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/2 THREAD LOW PROFILE L30 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.730 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/2 THREAD LOW PROFILE L32 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.732 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL LONG THREAD L34 MM OD3 MM WRIST HAND FOOT CANNULATED NONSTERILE SUP-202.734 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/2 THREAD LOW PROFILE L36 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.736 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/2 THREAD LOW PROFILE L38 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.738 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/2 THREAD LOW PROFILE L40 MM OD3 MM ODSEC4 MM ID1.2 MM FOREFOOT HAND WRIST SELF DRILL SELF TAP CANNULATED WASHER NONSTERILE ACCEPTS 1.1 MM GUIDEWIRE SUP-202.740 CDM 270010022 LOCAL 0270 RC outpatient 513.84 513.84 513.84 74 380.24 percent of total billed charges 513.84 93 416.21 percent of total billed charges 513.84 513.84 other OPPS APC 513.84 513.84 other OPPS APC 513.84 27.63 141.97 percent of total billed charges 513.84 513.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP STAINLESS STEEL L6 MM OD2.7 MM ODSEC5 MM FOOT HAND CORTICAL SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR SYSTEM SUP-202.806 CDM 270010022 LOCAL 0270 RC outpatient 99.58 99.58 99.58 74 73.69 percent of total billed charges 99.58 93 80.66 percent of total billed charges 99.58 99.58 other OPPS APC 99.58 99.58 other OPPS APC 99.58 27.63 27.51 percent of total billed charges 99.58 99.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP STAINLESS STEEL L8 MM OD2.7 MM ODSEC5 MM FOOT HAND CORTICAL SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR SYSTEM SUP-202.808 CDM 270010022 LOCAL 0270 RC outpatient 99.58 99.58 99.58 74 73.69 percent of total billed charges 99.58 93 80.66 percent of total billed charges 99.58 99.58 other OPPS APC 99.58 99.58 other OPPS APC 99.58 27.63 27.51 percent of total billed charges 99.58 99.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP 10MM 2.7MM 5MM SS NS FOOT CORTICAL SELF TAPPING SM HEXAGONAL SOCKET SUP-202.81 CDM 270010022 LOCAL 0270 RC outpatient 105.3 105.3 105.3 74 77.92 percent of total billed charges 105.3 93 85.29 percent of total billed charges 105.3 105.3 other OPPS APC 105.3 105.3 other OPPS APC 105.3 27.63 29.09 percent of total billed charges 105.3 105.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L10 MM OD2.7 MM ODSEC5 MM FOOT CORTICAL SELF TAPPING SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MINI FRAGMENT SET SUP-202.810 CDM 270010022 LOCAL 0270 RC outpatient 99.58 99.58 99.58 74 73.69 percent of total billed charges 99.58 93 80.66 percent of total billed charges 99.58 99.58 other OPPS APC 99.58 99.58 other OPPS APC 99.58 27.63 27.51 percent of total billed charges 99.58 99.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP STAINLESS STEEL SHORT THREAD L12 MM OD2.7 MM RADIUS CORTICAL DISTAL SELF TAPPING NONSTERILE SMALL FRAGMENT SET SUP-202.812 CDM 270010022 LOCAL 0270 RC outpatient 94.59 94.59 94.59 74 70 percent of total billed charges 94.59 93 76.62 percent of total billed charges 94.59 94.59 other OPPS APC 94.59 94.59 other OPPS APC 94.59 27.63 26.14 percent of total billed charges 94.59 94.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP STAINLESS STEEL L14 MM OD2.7 MM ODSEC5 MM FOOT HAND CORTICAL SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR SYSTEM SUP-202.814 CDM 270010022 LOCAL 0270 RC outpatient 94.59 94.59 94.59 74 70 percent of total billed charges 94.59 93 76.62 percent of total billed charges 94.59 94.59 other OPPS APC 94.59 94.59 other OPPS APC 94.59 27.63 26.14 percent of total billed charges 94.59 94.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LC-DCP STAINLESS STEEL L16 MM OD2.7 MM CORTICAL SELF TAPPING NONSTERILE SMALL FRAGMENT SET SUP-202.816 CDM 270010022 LOCAL 0270 RC outpatient 99.58 99.58 99.58 74 73.69 percent of total billed charges 99.58 93 80.66 percent of total billed charges 99.58 99.58 other OPPS APC 99.58 99.58 other OPPS APC 99.58 27.63 27.51 percent of total billed charges 99.58 99.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP STAINLESS STEEL L18 MM OD2.7 MM ODSEC5 MM FOOT HAND CORTICAL SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR SYSTEM SUP-202.818 CDM 270010022 LOCAL 0270 RC outpatient 94.59 94.59 94.59 74 70 percent of total billed charges 94.59 93 76.62 percent of total billed charges 94.59 94.59 other OPPS APC 94.59 94.59 other OPPS APC 94.59 27.63 26.14 percent of total billed charges 94.59 94.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP STAINLESS STEEL SHORT THREAD L20 MM OD2.7 MM RADIUS CORTICAL DISTAL SELF TAPPING NONSTERILE SMALL FRAGMENT SET SUP-202.820 CDM 270010022 LOCAL 0270 RC outpatient 94.59 94.59 94.59 74 70 percent of total billed charges 94.59 93 76.62 percent of total billed charges 94.59 94.59 other OPPS APC 94.59 94.59 other OPPS APC 94.59 27.63 26.14 percent of total billed charges 94.59 94.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP DCP STAINLESS STEEL L22 MM OD2.7 MM CORTICAL SELF TAPPING NONSTERILE MINI/SMALL FRAGMENT SET SUP-202.822 CDM 270010022 LOCAL 0270 RC outpatient 99.58 99.58 99.58 74 73.69 percent of total billed charges 99.58 93 80.66 percent of total billed charges 99.58 99.58 other OPPS APC 99.58 99.58 other OPPS APC 99.58 27.63 27.51 percent of total billed charges 99.58 99.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 2.7MM 24MM SUP-202.824 CDM 270010022 LOCAL 0270 RC outpatient 99.58 99.58 99.58 74 73.69 percent of total billed charges 99.58 93 80.66 percent of total billed charges 99.58 99.58 other OPPS APC 99.58 99.58 other OPPS APC 99.58 27.63 27.51 percent of total billed charges 99.58 99.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP STAINLESS STEEL SHORT THREAD L26 MM OD2.7 MM RADIUS CORTICAL DISTAL SELF TAPPING NONSTERILE SMALL FRAGMENT SET SUP-202.826 CDM 270010022 LOCAL 0270 RC outpatient 99.58 99.58 99.58 74 73.69 percent of total billed charges 99.58 93 80.66 percent of total billed charges 99.58 99.58 other OPPS APC 99.58 99.58 other OPPS APC 99.58 27.63 27.51 percent of total billed charges 99.58 99.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L28 MM OD2.7 MM ODSEC5 MM RADIUS ULNA FIBULA CORTICAL SELF TAPPING SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE SUP-202.828 CDM 270010022 LOCAL 0270 RC outpatient 99.58 99.58 99.58 74 73.69 percent of total billed charges 99.58 93 80.66 percent of total billed charges 99.58 99.58 other OPPS APC 99.58 99.58 other OPPS APC 99.58 27.63 27.51 percent of total billed charges 99.58 99.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP STAINLESS STEEL FULL THREAD SMALL HEXAGON SPHERE L30 MM OD2.7 MM ODSEC5 MM FIBULA RADIUS ULNA CORTICAL SELF TAP SOCKET NONSTERILE MINI FRAGMENT SUP-202.830 CDM 270010022 LOCAL 0270 RC outpatient 99.58 99.58 99.58 74 73.69 percent of total billed charges 99.58 93 80.66 percent of total billed charges 99.58 99.58 other OPPS APC 99.58 99.58 other OPPS APC 99.58 27.63 27.51 percent of total billed charges 99.58 99.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP STAINLESS STEEL L32 MM OD2.7 MM ODSEC5 MM CLAVICLE SCAPULA OLECRANON HUMERUS CORTICAL SELF TAPPING SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MINI FRAGMENT SUP-202.832 CDM 270010022 LOCAL 0270 RC outpatient 99.58 99.58 99.58 74 73.69 percent of total billed charges 99.58 93 80.66 percent of total billed charges 99.58 99.58 other OPPS APC 99.58 99.58 other OPPS APC 99.58 27.63 27.51 percent of total billed charges 99.58 99.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP STAINLESS STEEL L34 MM OD2.7 MM ODSEC5 MM CLAVICLE SCAPULA OLECRANON HUMERUS CORTICAL SELF TAPPING SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MINI FRAGMENT SUP-202.834 CDM 270010022 LOCAL 0270 RC outpatient 99.58 99.58 99.58 74 73.69 percent of total billed charges 99.58 93 80.66 percent of total billed charges 99.58 99.58 other OPPS APC 99.58 99.58 other OPPS APC 99.58 27.63 27.51 percent of total billed charges 99.58 99.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP STAINLESS STEEL L36 MM OD2.7 MM ODSEC5 MM CLAVICLE SCAPULA OLECRANON HUMERUS CORTICAL SELF TAPPING SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MINI FRAGMENT SUP-202.836 CDM 270010022 LOCAL 0270 RC outpatient 99.58 99.58 99.58 74 73.69 percent of total billed charges 99.58 93 80.66 percent of total billed charges 99.58 99.58 other OPPS APC 99.58 99.58 other OPPS APC 99.58 27.63 27.51 percent of total billed charges 99.58 99.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP STAINLESS STEEL L38 MM OD2.7 MM ODSEC5 MM CLAVICLE SCAPULA OLECRANON HUMERUS CORTICAL SELF TAPPING SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MINI FRAGMENT SUP-202.838 CDM 270010022 LOCAL 0270 RC outpatient 99.58 99.58 99.58 74 73.69 percent of total billed charges 99.58 93 80.66 percent of total billed charges 99.58 99.58 other OPPS APC 99.58 99.58 other OPPS APC 99.58 27.63 27.51 percent of total billed charges 99.58 99.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP DCP STAINLESS STEEL L40 MM OD2.7 MM CORTICAL SELF TAPPING NONSTERILE MINI FRAGMENT SET SUP-202.840 CDM 270010022 LOCAL 0270 RC outpatient 99.58 99.58 99.58 74 73.69 percent of total billed charges 99.58 93 80.66 percent of total billed charges 99.58 99.58 other OPPS APC 99.58 99.58 other OPPS APC 99.58 27.63 27.51 percent of total billed charges 99.58 99.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP STAINLESS STEEL SHORT THREAD L50 MM OD2.7 MM RADIUS CORTICAL DISTAL SELF TAPPING NONSTERILE SMALL FRAGMENT SET SUP-202.850 CDM 270010022 LOCAL 0270 RC outpatient 99.58 99.58 99.58 74 73.69 percent of total billed charges 99.58 93 80.66 percent of total billed charges 99.58 99.58 other OPPS APC 99.58 99.58 other OPPS APC 99.58 27.63 27.51 percent of total billed charges 99.58 99.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP DCP STAINLESS STEEL L55 MM OD2.7 MM CORTICAL SELF TAPPING NONSTERILE MINI/SMALL FRAGMENT SET SUP-202.855 CDM 270010022 LOCAL 0270 RC outpatient 116.74 116.74 116.74 74 86.39 percent of total billed charges 116.74 93 94.56 percent of total billed charges 116.74 116.74 other OPPS APC 116.74 116.74 other OPPS APC 116.74 27.63 32.26 percent of total billed charges 116.74 116.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L60 MM OD2.7 MM CALCANEUS CORTICAL SELF TAPPING NONSTERILE SUP-202.860 CDM 270010022 LOCAL 0270 RC outpatient 93.6 93.6 93.6 74 69.26 percent of total billed charges 93.6 93 75.82 percent of total billed charges 93.6 93.6 other OPPS APC 93.6 93.6 other OPPS APC 93.6 27.63 25.86 percent of total billed charges 93.6 93.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L10 MM OD2.7 MM ODSEC5 MM FOREFOOT MIDFOOT CORTICAL VARIABLE ANGLE SELF TAP MODULAR STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-202.870 CDM 270010022 LOCAL 0270 RC outpatient 88.27 88.27 88.27 74 65.32 percent of total billed charges 88.27 93 71.5 percent of total billed charges 88.27 88.27 other OPPS APC 88.27 88.27 other OPPS APC 88.27 27.63 24.39 percent of total billed charges 88.27 88.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L12 MM OD2.7 MM CORTEX STARDRIVE SELF TAP NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.872 CDM 270010022 LOCAL 0270 RC outpatient 88.27 88.27 88.27 74 65.32 percent of total billed charges 88.27 93 71.5 percent of total billed charges 88.27 88.27 other OPPS APC 88.27 88.27 other OPPS APC 88.27 27.63 24.39 percent of total billed charges 88.27 88.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L14 MM OD2.7 MM CORTEX STARDRIVE SELF TAP NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.874 CDM 270010022 LOCAL 0270 RC outpatient 247.52 247.52 247.52 74 183.16 percent of total billed charges 247.52 93 200.49 percent of total billed charges 247.52 247.52 other OPPS APC 247.52 247.52 other OPPS APC 247.52 27.63 68.39 percent of total billed charges 247.52 247.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L16 MM OD2.7 MM CORTEX STARDRIVE SELF TAP NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.876 CDM 270010022 LOCAL 0270 RC outpatient 88.27 88.27 88.27 74 65.32 percent of total billed charges 88.27 93 71.5 percent of total billed charges 88.27 88.27 other OPPS APC 88.27 88.27 other OPPS APC 88.27 27.63 24.39 percent of total billed charges 88.27 88.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L18 MM OD2.7 MM CORTEX STARDRIVE SELF TAP NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.878 CDM 270010022 LOCAL 0270 RC outpatient 247.52 247.52 247.52 74 183.16 percent of total billed charges 247.52 93 200.49 percent of total billed charges 247.52 247.52 other OPPS APC 247.52 247.52 other OPPS APC 247.52 27.63 68.39 percent of total billed charges 247.52 247.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L20 MM OD2.7 MM CORTEX STARDRIVE SELF TAP NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.880 CDM 270010022 LOCAL 0270 RC outpatient 88.27 88.27 88.27 74 65.32 percent of total billed charges 88.27 93 71.5 percent of total billed charges 88.27 88.27 other OPPS APC 88.27 88.27 other OPPS APC 88.27 27.63 24.39 percent of total billed charges 88.27 88.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L22 MM OD2.7 MM CORTEX STARDRIVE SELF TAP NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.882 CDM 270010022 LOCAL 0270 RC outpatient 88.27 88.27 88.27 74 65.32 percent of total billed charges 88.27 93 71.5 percent of total billed charges 88.27 88.27 other OPPS APC 88.27 88.27 other OPPS APC 88.27 27.63 24.39 percent of total billed charges 88.27 88.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L24 MM OD2.7 MM CORTEX STARDRIVE SELF TAP NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.884 CDM 270010022 LOCAL 0270 RC outpatient 247.52 247.52 247.52 74 183.16 percent of total billed charges 247.52 93 200.49 percent of total billed charges 247.52 247.52 other OPPS APC 247.52 247.52 other OPPS APC 247.52 27.63 68.39 percent of total billed charges 247.52 247.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 26MM 2.7MM SS NS CORTEX SELF TAP STARDRIVE MODULAR MINI FRAGMENT SYSTEM SUP-202.886 CDM 270010022 LOCAL 0270 RC outpatient 88.27 88.27 88.27 74 65.32 percent of total billed charges 88.27 93 71.5 percent of total billed charges 88.27 88.27 other OPPS APC 88.27 88.27 other OPPS APC 88.27 27.63 24.39 percent of total billed charges 88.27 88.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L28 MM OD2.7 MM CORTEX STARDRIVE SELF TAP NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.888 CDM 270010022 LOCAL 0270 RC outpatient 88.27 88.27 88.27 74 65.32 percent of total billed charges 88.27 93 71.5 percent of total billed charges 88.27 88.27 other OPPS APC 88.27 88.27 other OPPS APC 88.27 27.63 24.39 percent of total billed charges 88.27 88.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L30 MM OD2.7 MM CORTEX STARDRIVE SELF TAP NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.890 CDM 270010022 LOCAL 0270 RC outpatient 88.27 88.27 88.27 74 65.32 percent of total billed charges 88.27 93 71.5 percent of total billed charges 88.27 88.27 other OPPS APC 88.27 88.27 other OPPS APC 88.27 27.63 24.39 percent of total billed charges 88.27 88.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L32 MM OD2.7 MM ODSEC5 MM FOREFOOT MIDFOOT CORTEX VARIABLE ANGLE SELF TAP MODULAR STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-202.892 CDM 270010022 LOCAL 0270 RC outpatient 88.27 88.27 88.27 74 65.32 percent of total billed charges 88.27 93 71.5 percent of total billed charges 88.27 88.27 other OPPS APC 88.27 88.27 other OPPS APC 88.27 27.63 24.39 percent of total billed charges 88.27 88.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 34MM 2.7MM SS NS CORTEX SELF TAP STARDRIVE MODULAR MINI FRAGMENT SYSTEM SUP-202.894 CDM 270010022 LOCAL 0270 RC outpatient 88.27 88.27 88.27 74 65.32 percent of total billed charges 88.27 93 71.5 percent of total billed charges 88.27 88.27 other OPPS APC 88.27 88.27 other OPPS APC 88.27 27.63 24.39 percent of total billed charges 88.27 88.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 2.7MM 36MM LCP SS T8 CORTEX SELF TAP STARDRIVE NS MODULAR MINI FRAGMENT SUP-202.896 CDM 270010022 LOCAL 0270 RC outpatient 88.27 88.27 88.27 74 65.32 percent of total billed charges 88.27 93 71.5 percent of total billed charges 88.27 88.27 other OPPS APC 88.27 88.27 other OPPS APC 88.27 27.63 24.39 percent of total billed charges 88.27 88.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L38 MM OD2.7 MM CORTEX SELF TAP STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.898 CDM 270010022 LOCAL 0270 RC outpatient 247.52 247.52 247.52 74 183.16 percent of total billed charges 247.52 93 200.49 percent of total billed charges 247.52 247.52 other OPPS APC 247.52 247.52 other OPPS APC 247.52 27.63 68.39 percent of total billed charges 247.52 247.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 40MM 2.7MM SS NS CORTEX SELF TAP STARDRIVE MODULAR MINI FRAGMENT SYSTEM SUP-202.900 CDM 270010022 LOCAL 0270 RC outpatient 88.27 88.27 88.27 74 65.32 percent of total billed charges 88.27 93 71.5 percent of total billed charges 88.27 88.27 other OPPS APC 88.27 88.27 other OPPS APC 88.27 27.63 24.39 percent of total billed charges 88.27 88.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L42 MM OD2.7 MM CORTEX SELF TAP STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.962 CDM 270010022 LOCAL 0270 RC outpatient 247.52 247.52 247.52 74 183.16 percent of total billed charges 247.52 93 200.49 percent of total billed charges 247.52 247.52 other OPPS APC 247.52 247.52 other OPPS APC 247.52 27.63 68.39 percent of total billed charges 247.52 247.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L44 MM OD2.7 MM CORTEX SELF TAP STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.963 CDM 270010022 LOCAL 0270 RC outpatient 88.27 88.27 88.27 74 65.32 percent of total billed charges 88.27 93 71.5 percent of total billed charges 88.27 88.27 other OPPS APC 88.27 88.27 other OPPS APC 88.27 27.63 24.39 percent of total billed charges 88.27 88.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L46 MM OD2.7 MM CORTEX SELF TAP STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.965 CDM 270010022 LOCAL 0270 RC outpatient 88.27 88.27 88.27 74 65.32 percent of total billed charges 88.27 93 71.5 percent of total billed charges 88.27 88.27 other OPPS APC 88.27 88.27 other OPPS APC 88.27 27.63 24.39 percent of total billed charges 88.27 88.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 48MM 2.7MM CORTEX SELF TAP SUP-202.966 CDM 270010022 LOCAL 0270 RC outpatient 100.1 100.1 100.1 74 74.07 percent of total billed charges 100.1 93 81.08 percent of total billed charges 100.1 100.1 other OPPS APC 100.1 100.1 other OPPS APC 100.1 27.63 27.66 percent of total billed charges 100.1 100.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 2.7MM 50MM LCP SS T8 CORTEX SELF TAP STARDRIVE NS MODULAR MINI FRAGMENT SUP-202.967 CDM 270010022 LOCAL 0270 RC outpatient 88.27 88.27 88.27 74 65.32 percent of total billed charges 88.27 93 71.5 percent of total billed charges 88.27 88.27 other OPPS APC 88.27 88.27 other OPPS APC 88.27 27.63 24.39 percent of total billed charges 88.27 88.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L55 MM OD2.7 MM CORTEX SELF TAP STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.968 CDM 270010022 LOCAL 0270 RC outpatient 100.1 100.1 100.1 74 74.07 percent of total billed charges 100.1 93 81.08 percent of total billed charges 100.1 100.1 other OPPS APC 100.1 100.1 other OPPS APC 100.1 27.63 27.66 percent of total billed charges 100.1 100.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 L60 MM OD2.7 MM CORTEX SELF TAP STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-202.969 CDM 270010022 LOCAL 0270 RC outpatient 88.27 88.27 88.27 74 65.32 percent of total billed charges 88.27 93 71.5 percent of total billed charges 88.27 88.27 other OPPS APC 88.27 88.27 other OPPS APC 88.27 27.63 24.39 percent of total billed charges 88.27 88.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MATRIX TISSUE STRATTICE PORCINE DERMIS L20 CM X W20 CM RECONSTRUCTIVE STERILE SUP-2020002 CDM 0270 RC outpatient 30251 30251 30251 74 22385.7 percent of total billed charges 30251 93 24503.3 percent of total billed charges 30251 30251 other OPPS APC 30251 30251 other OPPS APC 30251 27.63 8358.35 percent of total billed charges 30251 30251 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR CERVICAL VELCRO FOAM SMALL LOW CONTOUR L13-15 IN X H3 IN FIRM DENSITY STOCKINETTE COVER CLOSURE SUP-20202 CDM 270009109 LOCAL 0270 RC outpatient 4.09 4.09 4.09 74 3.03 percent of total billed charges 4.09 93 3.31 percent of total billed charges 4.09 4.09 other OPPS APC 4.09 4.09 other OPPS APC 4.09 27.63 1.13 percent of total billed charges 4.09 4.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR CERVICAL MED LOW CONTOUR 17.5INX3IN FOAM VELCRO FIRM DENSITY STOCKINETTE COVER SUP-20203 CDM 270009109 LOCAL 0270 RC outpatient 4.09 4.09 4.09 74 3.03 percent of total billed charges 4.09 93 3.31 percent of total billed charges 4.09 4.09 other OPPS APC 4.09 4.09 other OPPS APC 4.09 27.63 1.13 percent of total billed charges 4.09 4.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR CERVICAL LG 18.5INX3IN FOAM VELCRO FIRM DENSITY STOCKINETTE COVER SUP-20204 CDM 270009109 LOCAL 0270 RC outpatient 4.09 4.09 4.09 74 3.03 percent of total billed charges 4.09 93 3.31 percent of total billed charges 4.09 4.09 other OPPS APC 4.09 4.09 other OPPS APC 4.09 27.63 1.13 percent of total billed charges 4.09 4.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SINUS KENNEDY SUP-20210C CDM 0270 RC outpatient 48.1 48.1 48.1 74 35.59 percent of total billed charges 48.1 93 38.96 percent of total billed charges 48.1 48.1 other OPPS APC 48.1 48.1 other OPPS APC 48.1 27.63 13.29 percent of total billed charges 48.1 48.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAD SANITARY CURITY 12.25INX4 3/10IN PVC NS MOISTURE BARRIER SOFTNESS LIGHT POSTPARTUM CARE FLUID DISPERSEMENT SYSTEM SUP-2022A CDM 0270 RC outpatient 0.16 0.16 0.16 74 0.12 percent of total billed charges 0.16 93 0.13 percent of total billed charges 0.16 0.16 other OPPS APC 0.16 0.16 other OPPS APC 0.16 27.63 0.04 percent of total billed charges 0.16 0.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPPORT SCROTAL BAUER & BLACK SECUREFIT COTTON ADULT SMALL WIDE L18 IN X W11.3 IN X H8.9 IN OD26-32 IN ELASTIC WAISTBAND SOFT KNIT NONSTERILE LATEX REUSABLE WHITE A3 SUP-202460 CDM 270009039 LOCAL 0270 RC outpatient 4.98 4.98 4.98 74 3.69 percent of total billed charges 4.98 93 4.03 percent of total billed charges 4.98 4.98 other OPPS APC 4.98 4.98 other OPPS APC 4.98 27.63 1.38 percent of total billed charges 4.98 4.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPPORT ATHLETIC ADULT MALE MEDIUM L3 IN X W2.5 IN OD33-38 IN ELASTIC WAISTBAND KNIT POUCH TUBULAR LEG STRAP SUP-202549 CDM 270009039 LOCAL 0270 RC outpatient 4.98 4.98 4.98 74 3.69 percent of total billed charges 4.98 93 4.03 percent of total billed charges 4.98 4.98 other OPPS APC 4.98 4.98 other OPPS APC 4.98 27.63 1.38 percent of total billed charges 4.98 4.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPPORTER ATHLETIC BAUER & BLACK LG 39-44IN 3IN LATEX ADULT ELASTIC WAISTBAND SUP-202636 CDM 270009039 LOCAL 0270 RC outpatient 4.98 4.98 4.98 74 3.69 percent of total billed charges 4.98 93 4.03 percent of total billed charges 4.98 4.98 other OPPS APC 4.98 4.98 other OPPS APC 4.98 27.63 1.38 percent of total billed charges 4.98 4.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOOT CAST VINYL SMALL L8.75 IN X W4.5 IN HEEL ROCKER BOTTOM CLOSED OPEN TOE HOOK LOOP CLOSURE SUP-2027-02 CDM 270009113 LOCAL 0270 RC outpatient 5.6 5.6 5.6 74 4.14 percent of total billed charges 5.6 93 4.54 percent of total billed charges 5.6 5.6 other OPPS APC 5.6 5.6 other OPPS APC 5.6 27.63 1.55 percent of total billed charges 5.6 5.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOOT CAST VINYL MEDIUM L10 IN X W4.75 IN UPPER ROCKER SOLE CLOSED HEEL OPEN TOE HOOK LOOP CLOSURE SUP-2027-03 CDM 270009113 LOCAL 0270 RC outpatient 5.6 5.6 5.6 74 4.14 percent of total billed charges 5.6 93 4.54 percent of total billed charges 5.6 5.6 other OPPS APC 5.6 5.6 other OPPS APC 5.6 27.63 1.55 percent of total billed charges 5.6 5.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOOT CAST VINYL LARGE L11.5 IN X W5.25 IN UPPER ROCKER SOLE CLOSED HEEL OPEN TOE HOOK LOOP CLOSURE SUP-2027-04 CDM 270009113 LOCAL 0270 RC outpatient 5.6 5.6 5.6 74 4.14 percent of total billed charges 5.6 93 4.54 percent of total billed charges 5.6 5.6 other OPPS APC 5.6 5.6 other OPPS APC 5.6 27.63 1.55 percent of total billed charges 5.6 5.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIDENT TITANIUM HEMISPHERE L16 MM OD6.5 MM ACETABULAR CANCELLOUS SUP-2030-6516-1 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TORX TITANIUM L20 MM OD6.5 MM ACETABULAR CANCELLOUS FLUSH SEAT SUP-2030-6520-1 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SECUR-FIT TRIDENT TITANIUM L25 MM OD6.5 MM ACETABULAR CANCELLOUS SUP-2030-6525-1 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIDENT SECUR-FIT TORX TITANIUM L30 MM OD6.5 MM ACETABULAR STERILE SUP-2030-6530-1 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TORX TITANIUM L35 MM OD6.5 MM CANCELLOUS SUP-2030-6535-1 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SECUR-FIT TRIDENT TITANIUM L40 MM OD6.5 MM ACETABULAR CANCELLOUS SUP-2030-6540-1 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANCELLOUS 6.5MM X 45MM SUP-2030-6545-1 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIDENT TITANIUM HEMISPHERE L50 MM OD6.5 MM ACETABULAR CANCELLOUS SUP-2030-6550-1 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIDENT TITANIUM HEMISPHERE L55 MM OD6.5 MM ACETABULAR CANCELLOUS SUP-2030-6555-1 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIDENT TITANIUM HEMISPHERE L60 MM OD6.5 MM ACETABULAR CANCELLOUS SUP-2030-6560-1 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT EX NITINOL LONG RECTANGLE HELIX TAPER L139 CM L15 MM ODSEC3 MM RADIOPAQUE EASY EXCHANGE FLEXIBLE ELECTROPOLISH ACCEPTS .014 IN GUIDEWIRE 6 FR GUIDE CATHETER PTCA SUP-2034-3015 CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT EX NITINOL LONG RECTANGLE HELIX TAPER L139 CM L15 MM ODSEC3.5 MM RADIOPAQUE EASY EXCHANGE FLEXIBLE ELECTROPOLISH ACCEPTS .014 IN GUIDEWIRE 6 FR GUIDE CATHETER PTCA SUP-2034-3515 CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CRYOTHERAPY DISPOSABLE STERILE LF ELECTRICAL UMBILICAL SUP-2035UC CDM 0270 RC outpatient 433.33 433.33 433.33 74 320.66 percent of total billed charges 433.33 93 351 percent of total billed charges 433.33 433.33 other OPPS APC 433.33 433.33 other OPPS APC 433.33 27.63 119.73 percent of total billed charges 433.33 433.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CATHETER COAXIAL UMBILICAL DISPOSABLE SUP-203CXC CDM 0270 RC outpatient 216.67 216.67 216.67 74 160.34 percent of total billed charges 216.67 93 175.5 percent of total billed charges 216.67 216.67 other OPPS APC 216.67 216.67 other OPPS APC 216.67 27.63 59.87 percent of total billed charges 216.67 216.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT TIBIAL TRAY OPTETRAK POLYETHYLENE 3F/3T KNEE CEMENTED TRAPEZOID SUP-204-04-33 CDM 270010025 LOCAL 0270 RC outpatient 5148 5148 5148 74 3809.52 percent of total billed charges 5148 93 4169.88 percent of total billed charges 5148 5148 other OPPS APC 5148 5148 other OPPS APC 5148 27.63 1422.39 percent of total billed charges 5148 5148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL OPTETRAK 2 H13 MM KNEE POSTERIOR STABILIZE SUP-204-22-13 CDM 270010025 LOCAL 0270 RC outpatient 3517.8 3517.8 3517.8 74 2603.17 percent of total billed charges 3517.8 93 2849.42 percent of total billed charges 3517.8 3517.8 other OPPS APC 3517.8 3517.8 other OPPS APC 3517.8 27.63 971.97 percent of total billed charges 3517.8 3517.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL OPTETRACK 2 H22 MM KNEE POSTERIOR STABILIZE SUP-204-22-22 CDM 270010025 LOCAL 0270 RC outpatient 3385.2 3385.2 3385.2 74 2505.05 percent of total billed charges 3385.2 93 2742.01 percent of total billed charges 3385.2 3385.2 other OPPS APC 3385.2 3385.2 other OPPS APC 3385.2 27.63 935.33 percent of total billed charges 3385.2 3385.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL OPTETRAK 3 H15 MM KNEE POSTERIOR STABILIZE SUP-204-23-15 CDM 270010025 LOCAL 0270 RC outpatient 3018.6 3018.6 3018.6 74 2233.76 percent of total billed charges 3018.6 93 2445.07 percent of total billed charges 3018.6 3018.6 other OPPS APC 3018.6 3018.6 other OPPS APC 3018.6 27.63 834.04 percent of total billed charges 3018.6 3018.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL OPTETRACK 3 H18 MM KNEE POSTERIOR STABILIZE SUP-204-23-18 CDM 270010025 LOCAL 0270 RC outpatient 3517.8 3517.8 3517.8 74 2603.17 percent of total billed charges 3517.8 93 2849.42 percent of total billed charges 3517.8 3517.8 other OPPS APC 3517.8 3517.8 other OPPS APC 3517.8 27.63 971.97 percent of total billed charges 3517.8 3517.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL OPTETRACK 4 H22 MM KNEE POSTERIOR STABILIZE SUP-204-24-22 CDM 270010025 LOCAL 0270 RC outpatient 3385.2 3385.2 3385.2 74 2505.05 percent of total billed charges 3385.2 93 2742.01 percent of total billed charges 3385.2 3385.2 other OPPS APC 3385.2 3385.2 other OPPS APC 3385.2 27.63 935.33 percent of total billed charges 3385.2 3385.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM OPTETRAK L12 MM OD11 MM TIBIAL KNEE FLUTED SUP-204-32-01 CDM 270010025 LOCAL 0270 RC outpatient 2667.6 2667.6 2667.6 74 1974.02 percent of total billed charges 2667.6 93 2160.76 percent of total billed charges 2667.6 2667.6 other OPPS APC 2667.6 2667.6 other OPPS APC 2667.6 27.63 737.06 percent of total billed charges 2667.6 2667.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM OPTETRAK L80 MM OD12 MM TIBIAL KNEE FLUTED SUP-204-32-08 CDM 270010025 LOCAL 0270 RC outpatient 2667.6 2667.6 2667.6 74 1974.02 percent of total billed charges 2667.6 93 2160.76 percent of total billed charges 2667.6 2667.6 other OPPS APC 2667.6 2667.6 other OPPS APC 2667.6 27.63 737.06 percent of total billed charges 2667.6 2667.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM OPTETRAK L25 MM OD14 MM TIBIAL KNEE FLUTED SUP-204-34-02 CDM 270010025 LOCAL 0270 RC outpatient 2667.6 2667.6 2667.6 74 1974.02 percent of total billed charges 2667.6 93 2160.76 percent of total billed charges 2667.6 2667.6 other OPPS APC 2667.6 2667.6 other OPPS APC 2667.6 27.63 737.06 percent of total billed charges 2667.6 2667.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM OPTETRAK L40 MM OD14 MM TIBIAL KNEE FLUTED SUP-204-34-04 CDM 270010025 LOCAL 0270 RC outpatient 2667.6 2667.6 2667.6 74 1974.02 percent of total billed charges 2667.6 93 2160.76 percent of total billed charges 2667.6 2667.6 other OPPS APC 2667.6 2667.6 other OPPS APC 2667.6 27.63 737.06 percent of total billed charges 2667.6 2667.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM OPTETRAK L80 MM OD16 MM TIBIAL KNEE FLUTED SUP-204-36-08 CDM 270010025 LOCAL 0270 RC outpatient 2667.6 2667.6 2667.6 74 1974.02 percent of total billed charges 2667.6 93 2160.76 percent of total billed charges 2667.6 2667.6 other OPPS APC 2667.6 2667.6 other OPPS APC 2667.6 27.63 737.06 percent of total billed charges 2667.6 2667.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM OPTETRAK L120 MM OD16 MM TIBIAL KNEE FLUTED SLOTTED SUP-204-36-12 CDM 270010025 LOCAL 0270 RC outpatient 2667.6 2667.6 2667.6 74 1974.02 percent of total billed charges 2667.6 93 2160.76 percent of total billed charges 2667.6 2667.6 other OPPS APC 2667.6 2667.6 other OPPS APC 2667.6 27.63 737.06 percent of total billed charges 2667.6 2667.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM OPTETRAK L80 MM OD18 MM TIBIAL KNEE FLUTED SUP-204-38-08 CDM 270010025 LOCAL 0270 RC outpatient 2667.6 2667.6 2667.6 74 1974.02 percent of total billed charges 2667.6 93 2160.76 percent of total billed charges 2667.6 2667.6 other OPPS APC 2667.6 2667.6 other OPPS APC 2667.6 27.63 737.06 percent of total billed charges 2667.6 2667.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM OPTETRAK L120 MM OD18 MM TIBIAL KNEE FLUTED SLOTTED SUP-204-38-12 CDM 270010025 LOCAL 0270 RC outpatient 2667.6 2667.6 2667.6 74 1974.02 percent of total billed charges 2667.6 93 2160.76 percent of total billed charges 2667.6 2667.6 other OPPS APC 2667.6 2667.6 other OPPS APC 2667.6 27.63 737.06 percent of total billed charges 2667.6 2667.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM OPTETRAK L120 MM OD20 MM KNEE FLUTED SLOTTED SUP-204-40-12 CDM 270010025 LOCAL 0270 RC outpatient 2667.6 2667.6 2667.6 74 1974.02 percent of total billed charges 2667.6 93 2160.76 percent of total billed charges 2667.6 2667.6 other OPPS APC 2667.6 2667.6 other OPPS APC 2667.6 27.63 737.06 percent of total billed charges 2667.6 2667.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION OPTETRAK 3 OD11 MM KNEE TIBIA LEFT MEDIAL RIGHT LATERAL SUP-204-43-88 CDM 270010025 LOCAL 0270 RC outpatient 2168.4 2168.4 2168.4 74 1604.62 percent of total billed charges 2168.4 93 1756.4 percent of total billed charges 2168.4 2168.4 other OPPS APC 2168.4 2168.4 other OPPS APC 2168.4 27.63 599.13 percent of total billed charges 2168.4 2168.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION OPTETRAK 3 1/3 H11 MM RIGHT MEDIAL LEFT LATERAL KNEE ONE THIRD SUP-204-43-89 CDM 270010025 LOCAL 0270 RC outpatient 2168.4 2168.4 2168.4 74 1604.62 percent of total billed charges 2168.4 93 1756.4 percent of total billed charges 2168.4 2168.4 other OPPS APC 2168.4 2168.4 other OPPS APC 2168.4 27.63 599.13 percent of total billed charges 2168.4 2168.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE OPTETRAK OD7 MM TIBIAL KNEE EXTENSION EXTENSION STEM SUP-204-70-00 CDM 270010025 LOCAL 0270 RC outpatient 163.8 163.8 163.8 74 121.21 percent of total billed charges 163.8 93 132.68 percent of total billed charges 163.8 163.8 other OPPS APC 163.8 163.8 other OPPS APC 163.8 27.63 45.26 percent of total billed charges 163.8 163.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LC-DCP DCP STAINLESS STEEL STANDARD L55 MM OD3.5 MM ODSEC6 MM CORTEX HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-204.055 CDM 270010022 LOCAL 0270 RC outpatient 55.15 55.15 55.15 74 40.81 percent of total billed charges 55.15 93 44.67 percent of total billed charges 55.15 55.15 other OPPS APC 55.15 55.15 other OPPS APC 55.15 27.63 15.24 percent of total billed charges 55.15 55.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STANDARD 60MM 3.5MM 6MM SS NS CORTEX SELF TAP SM HEXAGONAL SOCKET SUP-204.060 CDM 270010022 LOCAL 0270 RC outpatient 55.15 55.15 55.15 74 40.81 percent of total billed charges 55.15 93 44.67 percent of total billed charges 55.15 55.15 other OPPS APC 55.15 55.15 other OPPS APC 55.15 27.63 15.24 percent of total billed charges 55.15 55.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LC-DCP DCP STAINLESS STEEL PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM CLAVICLE SCAPULA OLECRANON HUMERUS SHAFT SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SUP-204.216 CDM 270010022 LOCAL 0270 RC outpatient 52.05 52.05 52.05 74 38.52 percent of total billed charges 52.05 93 42.16 percent of total billed charges 52.05 52.05 other OPPS APC 52.05 52.05 other OPPS APC 52.05 27.63 14.38 percent of total billed charges 52.05 52.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP LC-DCP STAINLESS STEEL SMALL HEXAGON L18 MM L6 MM OD3.5 MM ODSEC6 MM TIBIA MEDIAL PROXIMAL SELF TAP SOCKET NONSTERILE SMALL FRAGMENT SET SUP-204.218 CDM 270010022 LOCAL 0270 RC outpatient 67.86 67.86 67.86 74 50.22 percent of total billed charges 67.86 93 54.97 percent of total billed charges 67.86 67.86 other OPPS APC 67.86 67.86 other OPPS APC 67.86 27.63 18.75 percent of total billed charges 67.86 67.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 20MM 6MM 3.5MM 6MM SS NS SHAFT SM HEXAGONAL SOCKET SUP-204.22 CDM 270010022 LOCAL 0270 RC outpatient 67.86 67.86 67.86 74 50.22 percent of total billed charges 67.86 93 54.97 percent of total billed charges 67.86 67.86 other OPPS APC 67.86 67.86 other OPPS APC 67.86 27.63 18.75 percent of total billed charges 67.86 67.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 3.5MM 6MM 20MM 6MM LC-DCP DCP SS PARTIAL THREAD CLAVICLE SCAPULA OLECRANON SUP-204.220 CDM 270010022 LOCAL 0270 RC outpatient 67.86 67.86 67.86 74 50.22 percent of total billed charges 67.86 93 54.97 percent of total billed charges 67.86 67.86 other OPPS APC 67.86 67.86 other OPPS APC 67.86 27.63 18.75 percent of total billed charges 67.86 67.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 22MM 6MM 3.5MM 6MM SS NS SHAFT SM HEXAGONAL SOCKET SUP-204.222 CDM 270010022 LOCAL 0270 RC outpatient 67.86 67.86 67.86 74 50.22 percent of total billed charges 67.86 93 54.97 percent of total billed charges 67.86 67.86 other OPPS APC 67.86 67.86 other OPPS APC 67.86 27.63 18.75 percent of total billed charges 67.86 67.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 24MM 10MM 3.5MM 6MM SS NS SHAFT SM HEXAGONAL SOCKET SUP-204.224 CDM 270010022 LOCAL 0270 RC outpatient 67.86 67.86 67.86 74 50.22 percent of total billed charges 67.86 93 54.97 percent of total billed charges 67.86 67.86 other OPPS APC 67.86 67.86 other OPPS APC 67.86 27.63 18.75 percent of total billed charges 67.86 67.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 26MM 10MM 3.5MM 6MM SS NS SHAFT SM HEXAGONAL SOCKET SUP-204.226 CDM 270010022 LOCAL 0270 RC outpatient 67.86 67.86 67.86 74 50.22 percent of total billed charges 67.86 93 54.97 percent of total billed charges 67.86 67.86 other OPPS APC 67.86 67.86 other OPPS APC 67.86 27.63 18.75 percent of total billed charges 67.86 67.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 28MM 10MM 3.5MM 6MM SS NS SHAFT SM HEXAGONAL SOCKET SUP-204.228 CDM 270010022 LOCAL 0270 RC outpatient 67.86 67.86 67.86 74 50.22 percent of total billed charges 67.86 93 54.97 percent of total billed charges 67.86 67.86 other OPPS APC 67.86 67.86 other OPPS APC 67.86 27.63 18.75 percent of total billed charges 67.86 67.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 30MM 10MM 3.5MM 6MM SS NS SHAFT SM HEXAGONAL SOCKET SUP-204.23 CDM 270010022 LOCAL 0270 RC outpatient 67.86 67.86 67.86 74 50.22 percent of total billed charges 67.86 93 54.97 percent of total billed charges 67.86 67.86 other OPPS APC 67.86 67.86 other OPPS APC 67.86 27.63 18.75 percent of total billed charges 67.86 67.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 3.5MM 6MM 30MM 10MM DCP LC-DCP SS SM HEXAGON TIBIA PROXIMAL MEDIAL SELF SUP-204.230 CDM 270010022 LOCAL 0270 RC outpatient 67.86 67.86 67.86 74 50.22 percent of total billed charges 67.86 93 54.97 percent of total billed charges 67.86 67.86 other OPPS APC 67.86 67.86 other OPPS APC 67.86 27.63 18.75 percent of total billed charges 67.86 67.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 32MM 12MM 3.5MM 6MM SS NS SHAFT SM HEXAGONAL SOCKET SUP-204.232 CDM 270010022 LOCAL 0270 RC outpatient 67.86 67.86 67.86 74 50.22 percent of total billed charges 67.86 93 54.97 percent of total billed charges 67.86 67.86 other OPPS APC 67.86 67.86 other OPPS APC 67.86 27.63 18.75 percent of total billed charges 67.86 67.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 34MM 12MM 3.5MM 6MM SS NS SHAFT SM HEXAGONAL SOCKET SUP-204.234 CDM 270010022 LOCAL 0270 RC outpatient 67.86 67.86 67.86 74 50.22 percent of total billed charges 67.86 93 54.97 percent of total billed charges 67.86 67.86 other OPPS APC 67.86 67.86 other OPPS APC 67.86 27.63 18.75 percent of total billed charges 67.86 67.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 36MM 12MM 3.5MM 6MM SS NS SHAFT SM HEXAGONAL SOCKET SUP-204.236 CDM 270010022 LOCAL 0270 RC outpatient 67.86 67.86 67.86 74 50.22 percent of total billed charges 67.86 93 54.97 percent of total billed charges 67.86 67.86 other OPPS APC 67.86 67.86 other OPPS APC 67.86 27.63 18.75 percent of total billed charges 67.86 67.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LC-DCP DCP STAINLESS STEEL PARTIAL THREAD L38 MM L12 MM OD3.5 MM ODSEC6 MM CLAVICLE SCAPULA OLECRANON HUMERUS SHAFT SMALL HEXAGONAL SOCKET SMALL FRAGMENT SUP-204.238 CDM 270010022 LOCAL 0270 RC outpatient 67.86 67.86 67.86 74 50.22 percent of total billed charges 67.86 93 54.97 percent of total billed charges 67.86 67.86 other OPPS APC 67.86 67.86 other OPPS APC 67.86 27.63 18.75 percent of total billed charges 67.86 67.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L40 MM OD3.5 MM ODSEC6 MM PELVIC CORTEX SELF TAP SMALL HEXAGONAL SOCKET SUP-204.640 CDM 270010022 LOCAL 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L45 MM OD3.5 MM PELVIC CORTEX SELF TAP SUP-204.645 CDM 270010022 LOCAL 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L50 MM OD3.5 MM PELVIC CORTEX SELF TAP SUP-204.650 CDM 270010022 LOCAL 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L55 MM OD3.5 MM PELVIC CORTEX SELF TAP SUP-204.655 CDM 270010022 LOCAL 0270 RC outpatient 78.65 78.65 78.65 74 58.2 percent of total billed charges 78.65 93 63.71 percent of total billed charges 78.65 78.65 other OPPS APC 78.65 78.65 other OPPS APC 78.65 27.63 21.73 percent of total billed charges 78.65 78.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L60 MM OD3.5 MM PELVIC CORTEX SELF TAP SUP-204.660 CDM 270010022 LOCAL 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L65 MM OD3.5 MM PELVIC CORTEX SELF TAP SUP-204.665 CDM 270010022 LOCAL 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 70MM 3.5MM SS NS CORTEX PELVIS SELF TAP SM FRAGMENT SET SUP-204.670 CDM 270010022 LOCAL 0270 RC outpatient 78.65 78.65 78.65 74 58.2 percent of total billed charges 78.65 93 63.71 percent of total billed charges 78.65 78.65 other OPPS APC 78.65 78.65 other OPPS APC 78.65 27.63 21.73 percent of total billed charges 78.65 78.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L75 MM OD3.5 MM PELVIC CORTEX SELF TAP SUP-204.675 CDM 270010022 LOCAL 0270 RC outpatient 74.02 74.02 74.02 74 54.77 percent of total billed charges 74.02 93 59.96 percent of total billed charges 74.02 74.02 other OPPS APC 74.02 74.02 other OPPS APC 74.02 27.63 20.45 percent of total billed charges 74.02 74.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L80 MM OD3.5 MM PELVIC CORTEX SELF TAP SUP-204.680 CDM 270010022 LOCAL 0270 RC outpatient 74.02 74.02 74.02 74 54.77 percent of total billed charges 74.02 93 59.96 percent of total billed charges 74.02 74.02 other OPPS APC 74.02 74.02 other OPPS APC 74.02 27.63 20.45 percent of total billed charges 74.02 74.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 85MM 3.5MM SS NS CORTEX PELVIS SELF TAP SM FRAGMENT SET SUP-204.685 CDM 270010022 LOCAL 0270 RC outpatient 69.37 69.37 69.37 74 51.33 percent of total billed charges 69.37 93 56.19 percent of total billed charges 69.37 69.37 other OPPS APC 69.37 69.37 other OPPS APC 69.37 27.63 19.17 percent of total billed charges 69.37 69.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LC-DCP STAINLESS STEEL L90 MM OD3.5 MM ODSEC6 MM PELVIC CORTEX SELF TAP SMALL HEXAGONAL SOCKET LOW PROFILE NONSTERILE SUP-204.690 CDM 270010022 LOCAL 0270 RC outpatient 69.37 69.37 69.37 74 51.33 percent of total billed charges 69.37 93 56.19 percent of total billed charges 69.37 69.37 other OPPS APC 69.37 69.37 other OPPS APC 69.37 27.63 19.17 percent of total billed charges 69.37 69.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L95 MM OD3.5 MM PELVIC CORTEX SELF TAP SUP-204.695 CDM 270010022 LOCAL 0270 RC outpatient 69.37 69.37 69.37 74 51.33 percent of total billed charges 69.37 93 56.19 percent of total billed charges 69.37 69.37 other OPPS APC 69.37 69.37 other OPPS APC 69.37 27.63 19.17 percent of total billed charges 69.37 69.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 3.5MM 6MM 100MM LC-DCP SS PELVIC CORTEX SELF TAP SM HEXAGONAL SOCKET LOW SUP-204.700 CDM 270010022 LOCAL 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L105 MM OD3.5 MM PELVIC CORTEX SELF TAP SUP-204.705 CDM 270010022 LOCAL 0270 RC outpatient 74.02 74.02 74.02 74 54.77 percent of total billed charges 74.02 93 59.96 percent of total billed charges 74.02 74.02 other OPPS APC 74.02 74.02 other OPPS APC 74.02 27.63 20.45 percent of total billed charges 74.02 74.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L110 MM OD3.5 MM PELVIC CORTEX SELF TAP SUP-204.710 CDM 270010022 LOCAL 0270 RC outpatient 74.02 74.02 74.02 74 54.77 percent of total billed charges 74.02 93 59.96 percent of total billed charges 74.02 74.02 other OPPS APC 74.02 74.02 other OPPS APC 74.02 27.63 20.45 percent of total billed charges 74.02 74.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LC-DCP DCP STAINLESS STEEL SMALL HEXAGON LOW PROFILE L115 MM OD3.5 MM ODSEC6 MM PELVIS CORTICAL SELF TAP SOCKET NONSTERILE SUP-204.715 CDM 270010022 LOCAL 0270 RC outpatient 74.02 74.02 74.02 74 54.77 percent of total billed charges 74.02 93 59.96 percent of total billed charges 74.02 74.02 other OPPS APC 74.02 74.02 other OPPS APC 74.02 27.63 20.45 percent of total billed charges 74.02 74.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L120 MM OD3.5 MM PELVIC CORTEX SELF TAP SUP-204.720 CDM 270010022 LOCAL 0270 RC outpatient 74.02 74.02 74.02 74 54.77 percent of total billed charges 74.02 93 59.96 percent of total billed charges 74.02 74.02 other OPPS APC 74.02 74.02 other OPPS APC 74.02 27.63 20.45 percent of total billed charges 74.02 74.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L125 MM OD3.5 MM PELVIC CORTEX SELF TAP SUP-204.725 CDM 270010022 LOCAL 0270 RC outpatient 74.02 74.02 74.02 74 54.77 percent of total billed charges 74.02 93 59.96 percent of total billed charges 74.02 74.02 other OPPS APC 74.02 74.02 other OPPS APC 74.02 27.63 20.45 percent of total billed charges 74.02 74.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP LC-DCP STAINLESS STEEL L130 MM OD3.5 MM ODSEC6 MM CORTEX PELVIS SELF TAPPING LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SUP-204.730 CDM 270010022 LOCAL 0270 RC outpatient 235.64 235.64 235.64 74 174.37 percent of total billed charges 235.64 93 190.87 percent of total billed charges 235.64 235.64 other OPPS APC 235.64 235.64 other OPPS APC 235.64 27.63 65.11 percent of total billed charges 235.64 235.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L135 MM OD3.5 MM PELVIC CORTEX SELF TAP SUP-204.735 CDM 270010022 LOCAL 0270 RC outpatient 235.64 235.64 235.64 74 174.37 percent of total billed charges 235.64 93 190.87 percent of total billed charges 235.64 235.64 other OPPS APC 235.64 235.64 other OPPS APC 235.64 27.63 65.11 percent of total billed charges 235.64 235.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L140 MM OD3.5 MM PELVIC CORTEX SELF TAP SUP-204.740 CDM 270010022 LOCAL 0270 RC outpatient 235.64 235.64 235.64 74 174.37 percent of total billed charges 235.64 93 190.87 percent of total billed charges 235.64 235.64 other OPPS APC 235.64 235.64 other OPPS APC 235.64 27.63 65.11 percent of total billed charges 235.64 235.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L145 MM OD3.5 MM PELVIC CORTEX SELF TAP SUP-204.745 CDM 270010022 LOCAL 0270 RC outpatient 235.64 235.64 235.64 74 174.37 percent of total billed charges 235.64 93 190.87 percent of total billed charges 235.64 235.64 other OPPS APC 235.64 235.64 other OPPS APC 235.64 27.63 65.11 percent of total billed charges 235.64 235.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L150 MM OD3.5 MM PELVIC CORTEX SELF TAP SUP-204.750 CDM 270010022 LOCAL 0270 RC outpatient 211.85 211.85 211.85 74 156.77 percent of total billed charges 211.85 93 171.6 percent of total billed charges 211.85 211.85 other OPPS APC 211.85 211.85 other OPPS APC 211.85 27.63 58.53 percent of total billed charges 211.85 211.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LC-DCP DCP STAINLESS STEEL FULL THREAD HEXAGON L10 MM OD3.5 MM ODSEC6 MM CLAVICLE HUMERUS TIBIA CORTICAL SELF TAP NONSTERILE SMALL FRAGMENT SET SUP-204.810 CDM 270010022 LOCAL 0270 RC outpatient 56.76 56.76 56.76 74 42 percent of total billed charges 56.76 93 45.98 percent of total billed charges 56.76 56.76 other OPPS APC 56.76 56.76 other OPPS APC 56.76 27.63 15.68 percent of total billed charges 56.76 56.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP LC-DCP STAINLESS STEEL FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CLAVICLE HUMERUS TIBIA CORTICAL SELF TAPPING SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-204.812 CDM 270010022 LOCAL 0270 RC outpatient 56.76 56.76 56.76 74 42 percent of total billed charges 56.76 93 45.98 percent of total billed charges 56.76 56.76 other OPPS APC 56.76 56.76 other OPPS APC 56.76 27.63 15.68 percent of total billed charges 56.76 56.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LC-DCP DCP STAINLESS STEEL FULL THREAD L14 MM OD3.5 MM ODSEC6 MM CORTICAL SELF TAP SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-204.814 CDM 270010022 LOCAL 0270 RC outpatient 56.76 56.76 56.76 74 42 percent of total billed charges 56.76 93 45.98 percent of total billed charges 56.76 56.76 other OPPS APC 56.76 56.76 other OPPS APC 56.76 27.63 15.68 percent of total billed charges 56.76 56.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LC-DCP DCP STAINLESS STEEL FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CLAVICLE HUMERUS TIBIA CORTICAL SELF TAPPING SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-204.816 CDM 270010022 LOCAL 0270 RC outpatient 56.76 56.76 56.76 74 42 percent of total billed charges 56.76 93 45.98 percent of total billed charges 56.76 56.76 other OPPS APC 56.76 56.76 other OPPS APC 56.76 27.63 15.68 percent of total billed charges 56.76 56.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L18 MM OD3.5 MM CORTICAL SELF TAPPING NONSTERILE SUP-204.818 CDM 270010022 LOCAL 0270 RC outpatient 56.76 56.76 56.76 74 42 percent of total billed charges 56.76 93 45.98 percent of total billed charges 56.76 56.76 other OPPS APC 56.76 56.76 other OPPS APC 56.76 27.63 15.68 percent of total billed charges 56.76 56.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LC-DCP DCP STAINLESS STEEL FULL THREAD HEXAGON L20 MM OD3.5 MM ODSEC6 MM CLAVICLE HUMERUS TIBIA CORTICAL SELF TAP NONSTERILE SMALL FRAGMENT SET SUP-204.820 CDM 270010022 LOCAL 0270 RC outpatient 56.76 56.76 56.76 74 42 percent of total billed charges 56.76 93 45.98 percent of total billed charges 56.76 56.76 other OPPS APC 56.76 56.76 other OPPS APC 56.76 27.63 15.68 percent of total billed charges 56.76 56.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 22MM 3.5MM SS NS CORTICAL SELF TAPPING SM FRAGMENT SET SUP-204.822 CDM 270010022 LOCAL 0270 RC outpatient 56.76 56.76 56.76 74 42 percent of total billed charges 56.76 93 45.98 percent of total billed charges 56.76 56.76 other OPPS APC 56.76 56.76 other OPPS APC 56.76 27.63 15.68 percent of total billed charges 56.76 56.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 24MM 3.5MM SS NS CORTICAL SELF TAPPING SM FRAGMENT SET SUP-204.824 CDM 270010022 LOCAL 0270 RC outpatient 56.76 56.76 56.76 74 42 percent of total billed charges 56.76 93 45.98 percent of total billed charges 56.76 56.76 other OPPS APC 56.76 56.76 other OPPS APC 56.76 27.63 15.68 percent of total billed charges 56.76 56.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 26MM 3.5MM SS NS CORTICAL SELF TAPPING SM FRAGMENT SET SUP-204.826 CDM 270010022 LOCAL 0270 RC outpatient 56.76 56.76 56.76 74 42 percent of total billed charges 56.76 93 45.98 percent of total billed charges 56.76 56.76 other OPPS APC 56.76 56.76 other OPPS APC 56.76 27.63 15.68 percent of total billed charges 56.76 56.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP LC-DCP STAINLESS STEEL L28 MM OD3.5 MM HUMERUS RADIUS CORTICAL DISTAL SELF TAPPING HEXAGONAL RECESS NONSTERILE SMALL FRAGMENT SET SUP-204.828 CDM 270010022 LOCAL 0270 RC outpatient 56.76 56.76 56.76 74 42 percent of total billed charges 56.76 93 45.98 percent of total billed charges 56.76 56.76 other OPPS APC 56.76 56.76 other OPPS APC 56.76 27.63 15.68 percent of total billed charges 56.76 56.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LC-DCP DCP STAINLESS STEEL FULL THREAD HEXAGON L30 MM OD3.5 MM ODSEC6 MM CLAVICLE HUMERUS TIBIA CORTICAL SELF TAP NONSTERILE SMALL FRAGMENT SET SUP-204.830 CDM 270010022 LOCAL 0270 RC outpatient 56.76 56.76 56.76 74 42 percent of total billed charges 56.76 93 45.98 percent of total billed charges 56.76 56.76 other OPPS APC 56.76 56.76 other OPPS APC 56.76 27.63 15.68 percent of total billed charges 56.76 56.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LC-DCP DCP STAINLESS STEEL FULL THREAD L32 MM OD3.5 MM ODSEC6 MM CLAVICLE HUMERUS TIBIA CORTICAL SELF TAPPING SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-204.832 CDM 270010022 LOCAL 0270 RC outpatient 56.76 56.76 56.76 74 42 percent of total billed charges 56.76 93 45.98 percent of total billed charges 56.76 56.76 other OPPS APC 56.76 56.76 other OPPS APC 56.76 27.63 15.68 percent of total billed charges 56.76 56.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LC-DCP DCP STAINLESS STEEL FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CLAVICLE HUMERUS TIBIA CORTICAL SELF TAPPING SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-204.834 CDM 270010022 LOCAL 0270 RC outpatient 56.76 56.76 56.76 74 42 percent of total billed charges 56.76 93 45.98 percent of total billed charges 56.76 56.76 other OPPS APC 56.76 56.76 other OPPS APC 56.76 27.63 15.68 percent of total billed charges 56.76 56.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LC-DCP DCP STAINLESS STEEL FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CLAVICLE HUMERUS TIBIA CORTICAL SELF TAPPING SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-204.836 CDM 270010022 LOCAL 0270 RC outpatient 179.01 179.01 179.01 74 132.47 percent of total billed charges 179.01 93 145 percent of total billed charges 179.01 179.01 other OPPS APC 179.01 179.01 other OPPS APC 179.01 27.63 49.46 percent of total billed charges 179.01 179.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 38MM 3.5MM SS NS CORTEX SELF TAP SM FRAGMENT SET SUP-204.838 CDM 270010022 LOCAL 0270 RC outpatient 56.76 56.76 56.76 74 42 percent of total billed charges 56.76 93 45.98 percent of total billed charges 56.76 56.76 other OPPS APC 56.76 56.76 other OPPS APC 56.76 27.63 15.68 percent of total billed charges 56.76 56.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LC-DCP DCP STAINLESS STEEL FULL THREAD HEXAGON L40 MM OD3.5 MM ODSEC6 MM CLAVICLE HUMERUS TIBIA CORTICAL SELF TAP NONSTERILE SMALL FRAGMENT SET SUP-204.840 CDM 270010022 LOCAL 0270 RC outpatient 56.76 56.76 56.76 74 42 percent of total billed charges 56.76 93 45.98 percent of total billed charges 56.76 56.76 other OPPS APC 56.76 56.76 other OPPS APC 56.76 27.63 15.68 percent of total billed charges 56.76 56.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L45 MM OD3.5 MM CORTICAL SELF TAPPING NONSTERILE SMALL FRAGMENT SET SUP-204.845 CDM 270010022 LOCAL 0270 RC outpatient 56.76 56.76 56.76 74 42 percent of total billed charges 56.76 93 45.98 percent of total billed charges 56.76 56.76 other OPPS APC 56.76 56.76 other OPPS APC 56.76 27.63 15.68 percent of total billed charges 56.76 56.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LC-DCP DCP STAINLESS STEEL FULL THREAD L50 MM OD3.5 MM ODSEC6 MM CLAVICLE HUMERUS TIBIA CORTICAL SELF TAPPING SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-204.850 CDM 270010022 LOCAL 0270 RC outpatient 56.76 56.76 56.76 74 42 percent of total billed charges 56.76 93 45.98 percent of total billed charges 56.76 56.76 other OPPS APC 56.76 56.76 other OPPS APC 56.76 27.63 15.68 percent of total billed charges 56.76 56.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP LC-DCP STAINLESS STEEL L55 MM OD3.5 MM HUMERUS RADIUS CORTICAL DISTAL SELF TAPPING HEXAGONAL RECESS SMALL FRAGMENT SET SUP-204.855 CDM 270010022 LOCAL 0270 RC outpatient 56.76 56.76 56.76 74 42 percent of total billed charges 56.76 93 45.98 percent of total billed charges 56.76 56.76 other OPPS APC 56.76 56.76 other OPPS APC 56.76 27.63 15.68 percent of total billed charges 56.76 56.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LC-DCP DCP STAINLESS STEEL FULL THREAD L60 MM OD3.5 MM ODSEC6 MM CLAVICLE HUMERUS TIBIA CORTICAL SELF TAPPING SMALL HEXAGONAL SOCKET SMALL FRAGMENT SET SUP-204.860 CDM 270010022 LOCAL 0270 RC outpatient 56.76 56.76 56.76 74 42 percent of total billed charges 56.76 93 45.98 percent of total billed charges 56.76 56.76 other OPPS APC 56.76 56.76 other OPPS APC 56.76 27.63 15.68 percent of total billed charges 56.76 56.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP LC-DCP STAINLESS STEEL FULL THREAD HEXAGON L65 MM OD3.5 MM ODSEC6 MM SMALL BONE CORTICAL SELF TAP SOCKET NONSTERILE SMALL FRAGMENT SET SUP-204.865 CDM 270010022 LOCAL 0270 RC outpatient 55.15 55.15 55.15 74 40.81 percent of total billed charges 55.15 93 44.67 percent of total billed charges 55.15 55.15 other OPPS APC 55.15 55.15 other OPPS APC 55.15 27.63 15.24 percent of total billed charges 55.15 55.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LC-DCP DCP STAINLESS STEEL FULL THREAD L70 MM OD3.5 MM ODSEC6 MM CLAVICLE HUMERUS TIBIA CORTICAL SELF TAPPING SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-204.870 CDM 270010022 LOCAL 0270 RC outpatient 55.15 55.15 55.15 74 40.81 percent of total billed charges 55.15 93 44.67 percent of total billed charges 55.15 55.15 other OPPS APC 55.15 55.15 other OPPS APC 55.15 27.63 15.24 percent of total billed charges 55.15 55.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LC-DCP DCP STAINLESS STEEL FULL THREAD L75 MM OD3.5 MM ODSEC6 MM CLAVICLE HUMERUS TIBIA CORTICAL SELF TAPPING SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-204.875 CDM 270010022 LOCAL 0270 RC outpatient 56.76 56.76 56.76 74 42 percent of total billed charges 56.76 93 45.98 percent of total billed charges 56.76 56.76 other OPPS APC 56.76 56.76 other OPPS APC 56.76 27.63 15.68 percent of total billed charges 56.76 56.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP LC-DCP STAINLESS STEEL FULL THREAD HEXAGON L80 MM OD3.5 MM ODSEC6 MM SMALL BONE CORTICAL SELF TAP SOCKET NONSTERILE SMALL FRAGMENT SET SUP-204.880 CDM 270010022 LOCAL 0270 RC outpatient 55.15 55.15 55.15 74 40.81 percent of total billed charges 55.15 93 44.67 percent of total billed charges 55.15 55.15 other OPPS APC 55.15 55.15 other OPPS APC 55.15 27.63 15.24 percent of total billed charges 55.15 55.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP LC-DCP STAINLESS STEEL FULL THREAD HEXAGON L85 MM OD3.5 MM ODSEC6 MM SMALL BONE CORTICAL SELF TAP SOCKET NONSTERILE SMALL FRAGMENT SET SUP-204.885 CDM 270010022 LOCAL 0270 RC outpatient 55.15 55.15 55.15 74 40.81 percent of total billed charges 55.15 93 44.67 percent of total billed charges 55.15 55.15 other OPPS APC 55.15 55.15 other OPPS APC 55.15 27.63 15.24 percent of total billed charges 55.15 55.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DCP LC-DCP STAINLESS STEEL FULL THREAD HEXAGON L90 MM OD3.5 MM ODSEC6 MM SMALL BONE CORTICAL SELF TAP SOCKET NONSTERILE SMALL FRAGMENT SET SUP-204.890 CDM 270010022 LOCAL 0270 RC outpatient 55.15 55.15 55.15 74 40.81 percent of total billed charges 55.15 93 44.67 percent of total billed charges 55.15 55.15 other OPPS APC 55.15 55.15 other OPPS APC 55.15 27.63 15.24 percent of total billed charges 55.15 55.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE CRYOSURGICAL ERBECRYO L1.15 MM OD1.7 MM FLEXIBLE LIGHT PLUG DISPOSABLE SUP-20402-410 CDM 0270 RC outpatient 790.4 790.4 790.4 74 584.9 percent of total billed charges 790.4 93 640.22 percent of total billed charges 790.4 790.4 other OPPS APC 790.4 790.4 other OPPS APC 790.4 27.63 218.39 percent of total billed charges 790.4 790.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE CRYOSURGERY CRYOPROBE L1.15 MR OD2.4 MM FLEXIBLE DISPOSABLE ERBECRYO 2 SUP-20402-411 CDM 0270 RC outpatient 790.4 790.4 790.4 74 584.9 percent of total billed charges 790.4 93 640.22 percent of total billed charges 790.4 790.4 other OPPS APC 790.4 790.4 other OPPS APC 790.4 27.63 218.39 percent of total billed charges 790.4 790.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLING ORTHOPEDIC COTTON SMALL L12.5 IN ARM SHOULDER ABDUCTION SNAP ON STRAP LENGTH ADJUST BREATHABLE SUP-204053 CDM 270009116 LOCAL 0270 RC outpatient 33.1 33.1 33.1 74 24.49 percent of total billed charges 33.1 93 26.81 percent of total billed charges 33.1 33.1 other OPPS APC 33.1 33.1 other OPPS APC 33.1 27.63 9.15 percent of total billed charges 33.1 33.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE POSTOPERATIVE CANVAS RUBBER MALE 6-8 SMALL BOTTOM RIGID SOLE HOOK LOOP CLOSURE OPEN TOE NONSTERILE LATEX FREE BEIGE SUP-2041-01 CDM 270009115 LOCAL 0270 RC outpatient 5.83 5.83 5.83 74 4.31 percent of total billed charges 5.83 93 4.72 percent of total billed charges 5.83 5.83 other OPPS APC 5.83 5.83 other OPPS APC 5.83 27.63 1.61 percent of total billed charges 5.83 5.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE POSTOPERATIVE CANVAS RUBBER FEMALE 4-6 SMALL UNIVERSAL FOOT BILATERAL RIGID SOLE HOOK LOOP CLOSURE CLOSED HEEL NONSTERILE LATEX FREE BEIGE SUP-2041-07 CDM 270009115 LOCAL 0270 RC outpatient 5.83 5.83 5.83 74 4.31 percent of total billed charges 5.83 93 4.72 percent of total billed charges 5.83 5.83 other OPPS APC 5.83 5.83 other OPPS APC 5.83 27.63 1.61 percent of total billed charges 5.83 5.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR CROSSFIRE 10 D OD50-52 MM ID32 MM HIP SERIES II SUP-2041C-3250 CDM 270010024 LOCAL 0270 RC outpatient 2931.5 2931.5 2931.5 74 2169.31 percent of total billed charges 2931.5 93 2374.52 percent of total billed charges 2931.5 2931.5 other OPPS APC 2931.5 2931.5 other OPPS APC 2931.5 27.63 809.97 percent of total billed charges 2931.5 2931.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE POSTOPERATIVE AEGIS 8.5-10 MED RUBBER NS LF MALE FOOT BILATERAL SEMIRIGID SOLE LOOP LOCK CLOSURE REINFORCED PAD SUP-2044-02 CDM 270009115 LOCAL 0270 RC outpatient 5.83 5.83 5.83 74 4.31 percent of total billed charges 5.83 93 4.72 percent of total billed charges 5.83 5.83 other OPPS APC 5.83 5.83 other OPPS APC 5.83 27.63 1.61 percent of total billed charges 5.83 5.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE POSTOPERATIVE AEGIS 10.5-12 LG RUBBER NS LF MALE FOOT BILATERAL SEMIRIGID SOLE LOOP LOCK CLOSURE REINFORCED PAD SUP-2044-03 CDM 270009115 LOCAL 0270 RC outpatient 5.83 5.83 5.83 74 4.31 percent of total billed charges 5.83 93 4.72 percent of total billed charges 5.83 5.83 other OPPS APC 5.83 5.83 other OPPS APC 5.83 27.63 1.61 percent of total billed charges 5.83 5.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE POSTOPERATIVE AEGIS 6.5-8 MED RUBBER NS LF FEMALE FOOT BILATERAL SEMIRIGID SOLE LOOP LOCK CLOSURE REINFORCED PAD SUP-2044-08 CDM 270009115 LOCAL 0270 RC outpatient 5.83 5.83 5.83 74 4.31 percent of total billed charges 5.83 93 4.72 percent of total billed charges 5.83 5.83 other OPPS APC 5.83 5.83 other OPPS APC 5.83 27.63 1.61 percent of total billed charges 5.83 5.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE POSTOPERATIVE AEGIS 8.5-10 LG RUBBER NS LF FEMALE FOOT BILATERAL SEMIRIGID SOLE LOOP LOCK CLOSURE REINFORCED PAD SUP-2044-09 CDM 270009115 LOCAL 0270 RC outpatient 5.83 5.83 5.83 74 4.31 percent of total billed charges 5.83 93 4.72 percent of total billed charges 5.83 5.83 other OPPS APC 5.83 5.83 other OPPS APC 5.83 27.63 1.61 percent of total billed charges 5.83 5.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM WASTE MANAGEMENT AVETA CAP NONSTERILE LATEX FREE DISPOSABLE SUP-205-2001 CDM 0270 RC outpatient 104 104 104 74 76.96 percent of total billed charges 104 93 84.24 percent of total billed charges 104 104 other OPPS APC 104 104 other OPPS APC 104 27.63 28.74 percent of total billed charges 104 104 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AVETA WASTE MANAGEMENT ACCESSORY 3.0 SUP-205-2036 CDM 0270 RC outpatient 124.8 124.8 124.8 74 92.35 percent of total billed charges 124.8 93 101.09 percent of total billed charges 124.8 124.8 other OPPS APC 124.8 124.8 other OPPS APC 124.8 27.63 34.48 percent of total billed charges 124.8 124.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM FLUID MANAGEMENT AVETA STERILE LATEX FREE DISPOSABLE SUP-205-212 CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR BRACHYTHERAPY MAMMOSITE SPHERE L5-6 CM BREAST TRAY CATHETER SUP-2056 CDM 0270 RC outpatient 7150 7150 7150 74 5291 percent of total billed charges 7150 93 5791.5 percent of total billed charges 7150 7150 other OPPS APC 7150 7150 other OPPS APC 7150 27.63 1975.55 percent of total billed charges 7150 7150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PADDING CAST KENDALL WEBRIL 4YDX3IN COTTON NS LF UNDERCAST MILD STRETCH COHESIVE REGULAR FINISH SUP-2059- CDM 0270 RC outpatient 1.48 1.48 1.48 74 1.1 percent of total billed charges 1.48 93 1.2 percent of total billed charges 1.48 1.48 other OPPS APC 1.48 1.48 other OPPS APC 1.48 27.63 0.41 percent of total billed charges 1.48 1.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 10MM 4MM SS NS CANCELLOUS SM FRAGMENT SET SUP-206.010 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L12 MM OD4 MM CANCELLOUS FULLY THREADED SMALL FRAGMENT SUP-206.012 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 14MM 4MM SS NS CANCELLOUS SM FRAGMENT SET SUP-206.014 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 16MM 4MM SS NS CANCELLOUS SM FRAGMENT SET SUP-206.016 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 18MM 4MM SS NS CANCELLOUS SM FRAGMENT SET SUP-206.018 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L20 MM OD4 MM CANCELLOUS SMALL FRAGMENT SET SUP-206.020 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 22MM 4MM SS NS CANCELLOUS SM FRAGMENT SET SUP-206.022 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 24MM 4MM SS NS CANCELLOUS SM FRAGMENT SET SUP-206.024 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 26MM 4MM SS NS CANCELLOUS SM FRAGMENT SET SUP-206.026 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 28MM 4MM SS NS CANCELLOUS SM FRAGMENT SET SUP-206.028 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L30 MM OD4 MM CANCELLOUS SMALL FRAGMENT SET SUP-206.030 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 32MM 4MM SS NS CANCELLOUS SM FRAGMENT SET SUP-206.032 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 2.5 MM FULL THREAD L35 MM OD4 MM CANCELLOUS SELF TAP HEXAGONAL SHAFT YELLOW SMALL FRAGMENT SET SUP-206.035 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD4 MM CANCELLOUS SELF TAP HEXAGONAL SHAFT YELLOW SMALL FRAGMENT SET SUP-206.036 CDM 270010022 LOCAL 0270 RC outpatient 45.34 45.34 45.34 74 33.55 percent of total billed charges 45.34 93 36.73 percent of total billed charges 45.34 45.34 other OPPS APC 45.34 45.34 other OPPS APC 45.34 27.63 12.53 percent of total billed charges 45.34 45.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CANCELLOUS FULLY THREADED HEX HEAD STAINLESS STEEL 4.0 X 38MM SUP-206.038 CDM 270010022 LOCAL 0270 RC outpatient 48.62 48.62 48.62 74 35.98 percent of total billed charges 48.62 93 39.38 percent of total billed charges 48.62 48.62 other OPPS APC 48.62 48.62 other OPPS APC 48.62 27.63 13.43 percent of total billed charges 48.62 48.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 40MM 4MM SS NS CANCELLOUS SM FRAGMENT SET SUP-206.040 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 45MM 4MM SS NS CANCELLOUS SM FRAGMENT SET SUP-206.045 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L50 MM OD4 MM CANCELLOUS SMALL FRAGMENT SET SUP-206.050 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 55MM 4MM SS NS CANCELLOUS SM FRAGMENT SET SUP-206.055 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L60 MM OD4 MM CANCELLOUS SMALL FRAGMENT SET SUP-206.060 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L40 MM OD4 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-206.440 CDM 0270 RC outpatient 68.3 68.3 68.3 74 50.54 percent of total billed charges 68.3 93 55.32 percent of total billed charges 68.3 68.3 other OPPS APC 68.3 68.3 other OPPS APC 68.3 27.63 18.87 percent of total billed charges 68.3 68.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L42 MM OD4 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-206.442 CDM 0270 RC outpatient 68.3 68.3 68.3 74 50.54 percent of total billed charges 68.3 93 55.32 percent of total billed charges 68.3 68.3 other OPPS APC 68.3 68.3 other OPPS APC 68.3 27.63 18.87 percent of total billed charges 68.3 68.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L44 MM OD4 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-206.444 CDM 0270 RC outpatient 68.3 68.3 68.3 74 50.54 percent of total billed charges 68.3 93 55.32 percent of total billed charges 68.3 68.3 other OPPS APC 68.3 68.3 other OPPS APC 68.3 27.63 18.87 percent of total billed charges 68.3 68.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L46 MM OD4 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE SMALL FRAGMENT SET SUP-206.446 CDM 0270 RC outpatient 68.3 68.3 68.3 74 50.54 percent of total billed charges 68.3 93 55.32 percent of total billed charges 68.3 68.3 other OPPS APC 68.3 68.3 other OPPS APC 68.3 27.63 18.87 percent of total billed charges 68.3 68.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L48 MM OD4 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-206.448 CDM 0270 RC outpatient 68.3 68.3 68.3 74 50.54 percent of total billed charges 68.3 93 55.32 percent of total billed charges 68.3 68.3 other OPPS APC 68.3 68.3 other OPPS APC 68.3 27.63 18.87 percent of total billed charges 68.3 68.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L50 MM OD4 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SUP-206.450 CDM 0270 RC outpatient 68.3 68.3 68.3 74 50.54 percent of total billed charges 68.3 93 55.32 percent of total billed charges 68.3 68.3 other OPPS APC 68.3 68.3 other OPPS APC 68.3 27.63 18.87 percent of total billed charges 68.3 68.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L52 MM OD4 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE SMALL FRAGMENT SET SUP-206.452 CDM 0270 RC outpatient 68.3 68.3 68.3 74 50.54 percent of total billed charges 68.3 93 55.32 percent of total billed charges 68.3 68.3 other OPPS APC 68.3 68.3 other OPPS APC 68.3 27.63 18.87 percent of total billed charges 68.3 68.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L54 MM OD4 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-206.454 CDM 0270 RC outpatient 68.3 68.3 68.3 74 50.54 percent of total billed charges 68.3 93 55.32 percent of total billed charges 68.3 68.3 other OPPS APC 68.3 68.3 other OPPS APC 68.3 27.63 18.87 percent of total billed charges 68.3 68.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L56 MM OD4 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE SMALL FRAGMENT SET SUP-206.456 CDM 0270 RC outpatient 68.3 68.3 68.3 74 50.54 percent of total billed charges 68.3 93 55.32 percent of total billed charges 68.3 68.3 other OPPS APC 68.3 68.3 other OPPS APC 68.3 27.63 18.87 percent of total billed charges 68.3 68.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L58 MM OD4 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE SMALL FRAGMENT SET SUP-206.458 CDM 0270 RC outpatient 68.3 68.3 68.3 74 50.54 percent of total billed charges 68.3 93 55.32 percent of total billed charges 68.3 68.3 other OPPS APC 68.3 68.3 other OPPS APC 68.3 27.63 18.87 percent of total billed charges 68.3 68.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L60 MM OD4 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-206.460 CDM 0270 RC outpatient 68.3 68.3 68.3 74 50.54 percent of total billed charges 68.3 93 55.32 percent of total billed charges 68.3 68.3 other OPPS APC 68.3 68.3 other OPPS APC 68.3 27.63 18.87 percent of total billed charges 68.3 68.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L65 MM OD4 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-206.465 CDM 0270 RC outpatient 68.3 68.3 68.3 74 50.54 percent of total billed charges 68.3 93 55.32 percent of total billed charges 68.3 68.3 other OPPS APC 68.3 68.3 other OPPS APC 68.3 27.63 18.87 percent of total billed charges 68.3 68.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L70 MM OD4 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-206.470 CDM 0270 RC outpatient 68.3 68.3 68.3 74 50.54 percent of total billed charges 68.3 93 55.32 percent of total billed charges 68.3 68.3 other OPPS APC 68.3 68.3 other OPPS APC 68.3 27.63 18.87 percent of total billed charges 68.3 68.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L75 MM OD4 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE SMALL FRAGMENT SET SUP-206.475 CDM 0270 RC outpatient 68.3 68.3 68.3 74 50.54 percent of total billed charges 68.3 93 55.32 percent of total billed charges 68.3 68.3 other OPPS APC 68.3 68.3 other OPPS APC 68.3 27.63 18.87 percent of total billed charges 68.3 68.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L80 MM OD4 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-206.480 CDM 0270 RC outpatient 68.3 68.3 68.3 74 50.54 percent of total billed charges 68.3 93 55.32 percent of total billed charges 68.3 68.3 other OPPS APC 68.3 68.3 other OPPS APC 68.3 27.63 18.87 percent of total billed charges 68.3 68.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L85 MM OD4 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-206.485 CDM 0270 RC outpatient 68.3 68.3 68.3 74 50.54 percent of total billed charges 68.3 93 55.32 percent of total billed charges 68.3 68.3 other OPPS APC 68.3 68.3 other OPPS APC 68.3 27.63 18.87 percent of total billed charges 68.3 68.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLUG DOME HOLE ACETABULUM SUP-2060-0000-1 CDM 270010024 LOCAL 0270 RC outpatient 270.4 270.4 270.4 74 200.1 percent of total billed charges 270.4 93 219.02 percent of total billed charges 270.4 270.4 other OPPS APC 270.4 270.4 other OPPS APC 270.4 27.63 74.71 percent of total billed charges 270.4 270.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR DENTAL CARBIDE 330 FRICTION GRIP SUP-206100254400 CDM 0270 RC outpatient 6.89 6.89 6.89 74 5.1 percent of total billed charges 6.89 93 5.58 percent of total billed charges 6.89 6.89 other OPPS APC 6.89 6.89 other OPPS APC 6.89 27.63 1.9 percent of total billed charges 6.89 6.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILICONE P3.9 CM MODERATE PROJECTION ROUND W11 CM 255 ML COHESIVE GEL SILIMED TEXTURED HIGH STRENGTH LOW BLEED BARRIER TECHNOLOGY SUP-20621-255MP CDM 0270 RC outpatient 1820 1820 1820 74 1346.8 percent of total billed charges 1820 93 1474.2 percent of total billed charges 1820 1820 other OPPS APC 1820 1820 other OPPS APC 1820 27.63 502.87 percent of total billed charges 1820 1820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT TEXTURED MODERATE PROJECTION SIENTRA 435CC SUP-20621-435MD CDM 0270 RC outpatient 1820 1820 1820 74 1346.8 percent of total billed charges 1820 93 1474.2 percent of total billed charges 1820 1820 other OPPS APC 1820 1820 other OPPS APC 1820 27.63 502.87 percent of total billed charges 1820 1820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILICONE P4.5 CM MODERATE PROJECTION OVAL BASE W12.3 CM X H10.7 CM 290 ML COHESIVE GEL TEXTURE HIGH STRENGTH LOW BLEED BARRIER TECHNOLOGY SUP-20645-290MP CDM 0270 RC outpatient 2587 2587 2587 74 1914.38 percent of total billed charges 2587 93 2095.47 percent of total billed charges 2587 2587 other OPPS APC 2587 2587 other OPPS APC 2587 27.63 714.79 percent of total billed charges 2587 2587 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILICONE P4.5 CM MODERATE PROJECTION OVAL BASE W13 CM X H11.2 CM 330 ML COHESIVE GEL TEXTURE HIGH STRENGTH LOW BLEED BARRIER TECHNOLOGY SUP-20645-330MP CDM 0270 RC outpatient 2587 2587 2587 74 1914.38 percent of total billed charges 2587 93 2095.47 percent of total billed charges 2587 2587 other OPPS APC 2587 2587 other OPPS APC 2587 27.63 714.79 percent of total billed charges 2587 2587 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT TEXTURED HIGH PROJECTION SIENTRA 370CC SUP-20645-370HP CDM 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT TEXTURED HIGH PROJECTION SIENTRA 400CC SUP-20645-400MP CDM 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILICONE P5.1 CM OVAL BASE W14.1 CM X H12.2 CM 450 ML COHESIVE GEL SILIMED TEXTURE HIGH STRENGTH LOW BLEED BARRIER TECHNOLOGY SUP-20645-450MP CDM 0270 RC outpatient 2587 2587 2587 74 1914.38 percent of total billed charges 2587 93 2095.47 percent of total billed charges 2587 2587 other OPPS APC 2587 2587 other OPPS APC 2587 27.63 714.79 percent of total billed charges 2587 2587 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILICONE P5.7 CM HIGH PROJECTION OVAL BASE 480 ML TEXTURED COHESIVE GEL SUP-20645-480HP CDM 0270 RC outpatient 2587 2587 2587 74 1914.38 percent of total billed charges 2587 93 2095.47 percent of total billed charges 2587 2587 other OPPS APC 2587 2587 other OPPS APC 2587 27.63 714.79 percent of total billed charges 2587 2587 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILICONE P5.3 CM MODERATE PROJECTION OVAL BASE W14.7 CM X H12.8 CM 500 ML COHESIVE GEL SILIMED TEXTURED HIGH STRENGTH LOW BLEED BARRIER TECHNOLOGY SUP-20645-500MP CDM 0270 RC outpatient 2587 2587 2587 74 1914.38 percent of total billed charges 2587 93 2095.47 percent of total billed charges 2587 2587 other OPPS APC 2587 2587 other OPPS APC 2587 27.63 714.79 percent of total billed charges 2587 2587 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILICONE P5.8 CM OVAL BASE HIGH PROJECTION W14.6 CM X H12.4 CM 550 ML TEXTURED GEL SUP-20645-550HP CDM 0270 RC outpatient 2587 2587 2587 74 1914.38 percent of total billed charges 2587 93 2095.47 percent of total billed charges 2587 2587 other OPPS APC 2587 2587 other OPPS APC 2587 27.63 714.79 percent of total billed charges 2587 2587 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILICONE P5.5 CM MODERATE PROJECTION OVAL BASE W16 CM X H13.8 CM 600 ML COHESIVE GEL SILIM TEXTURE HIGH STRENGTH LOW BLEED BARRIER TECHNOLOGY SUP-20645-600MP CDM 0270 RC outpatient 2587 2587 2587 74 1914.38 percent of total billed charges 2587 93 2095.47 percent of total billed charges 2587 2587 other OPPS APC 2587 2587 other OPPS APC 2587 27.63 714.79 percent of total billed charges 2587 2587 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILICONE P5.9 CM MODERATE PROJECTION OVAL BASE W16.9 CM X H14.5 CM 700 ML COHESIVE GEL SILIMED TEXTURED HIGH STRENGTH LOW BLEED BARRIER TECHNOLOGY SUP-20645-700MP CDM 0270 RC outpatient 2587 2587 2587 74 1914.38 percent of total billed charges 2587 93 2095.47 percent of total billed charges 2587 2587 other OPPS APC 2587 2587 other OPPS APC 2587 27.63 714.79 percent of total billed charges 2587 2587 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILICONE P5.7 CM HIGH PROJECTION ROUND W11.9 CM 370 ML SMOOTH COHESIVE GEL SUP-20646-370RB CDM 0270 RC outpatient 2587 2587 2587 74 1914.38 percent of total billed charges 2587 93 2095.47 percent of total billed charges 2587 2587 other OPPS APC 2587 2587 other OPPS APC 2587 27.63 714.79 percent of total billed charges 2587 2587 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILICONE P5.8 CM HIGH PROJECTION ROUND W12.5 CM 425 ML GEL SMOOTH TEXTURED SUP-20646-425RB CDM 0270 RC outpatient 2587 2587 2587 74 1914.38 percent of total billed charges 2587 93 2095.47 percent of total billed charges 2587 2587 other OPPS APC 2587 2587 other OPPS APC 2587 27.63 714.79 percent of total billed charges 2587 2587 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALANT TISSUE CLOSURE DURASEAL EXACT 5ML DISPOSABLE STERILE LF SPINE SUP-206520 CDM 0270 RC outpatient 3558.17 3558.17 3558.17 74 2633.05 percent of total billed charges 3558.17 93 2882.12 percent of total billed charges 3558.17 3558.17 other OPPS APC 3558.17 3558.17 other OPPS APC 3558.17 27.63 983.12 percent of total billed charges 3558.17 3558.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 10MM 5MM 4MM SS NS CANCELLOUS HEXAGONAL SM FRAGMENT SET SUP-207.01 CDM 270010022 LOCAL 0270 RC outpatient 46.33 46.33 46.33 74 34.28 percent of total billed charges 46.33 93 37.53 percent of total billed charges 46.33 46.33 other OPPS APC 46.33 46.33 other OPPS APC 46.33 27.63 12.8 percent of total billed charges 46.33 46.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM 2.5MM 10MM 7MM LCP SS PARTIAL THREAD PELVIS RADIUS ULNA CANCELLOUS SM SUP-207.010 CDM 270010022 LOCAL 0270 RC outpatient 46.33 46.33 46.33 74 34.28 percent of total billed charges 46.33 93 37.53 percent of total billed charges 46.33 46.33 other OPPS APC 46.33 46.33 other OPPS APC 46.33 27.63 12.8 percent of total billed charges 46.33 46.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 12MM 5MM 4MM SS NS CANCELLOUS HEXAGONAL SUP-207.012 CDM 270010022 LOCAL 0270 RC outpatient 42.33 42.33 42.33 74 31.32 percent of total billed charges 42.33 93 34.29 percent of total billed charges 42.33 42.33 other OPPS APC 42.33 42.33 other OPPS APC 42.33 27.63 11.7 percent of total billed charges 42.33 42.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 14MM 5MM 4MM SS NS CANCELLOUS HEXAGONAL SM FRAGMENT SET SUP-207.014 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 16MM 6MM 4MM SS NS CANCELLOUS HEXAGONAL SM FRAGMENT SET SUP-207.016 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 18MM 7MM 4MM SS NS CANCELLOUS HEXAGONAL SM FRAGMENT SET SUP-207.018 CDM 270010022 LOCAL 0270 RC outpatient 42.33 42.33 42.33 74 31.32 percent of total billed charges 42.33 93 34.29 percent of total billed charges 42.33 42.33 other OPPS APC 42.33 42.33 other OPPS APC 42.33 27.63 11.7 percent of total billed charges 42.33 42.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 20MM 8MM 4MM SS NS CANCELLOUS HEXAGONAL SM FRAGMENT SET SUP-207.02 CDM 270010022 LOCAL 0270 RC outpatient 46.33 46.33 46.33 74 34.28 percent of total billed charges 46.33 93 37.53 percent of total billed charges 46.33 46.33 other OPPS APC 46.33 46.33 other OPPS APC 46.33 27.63 12.8 percent of total billed charges 46.33 46.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM 20MM LCP SS PARTIAL THREAD CANCELLOUS SM FRAGMENT SET SUP-207.020 CDM 270010022 LOCAL 0270 RC outpatient 46.33 46.33 46.33 74 34.28 percent of total billed charges 46.33 93 37.53 percent of total billed charges 46.33 46.33 other OPPS APC 46.33 46.33 other OPPS APC 46.33 27.63 12.8 percent of total billed charges 46.33 46.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD L22 MM L9 MM OD4 MM CANCELLOUS RADIUS ULNA PELVIS SMALL HEXAGONAL SOCKET SMALL FRAGMENT SET SUP-207.022 CDM 270010022 LOCAL 0270 RC outpatient 42.33 42.33 42.33 74 31.32 percent of total billed charges 42.33 93 34.29 percent of total billed charges 42.33 42.33 other OPPS APC 42.33 42.33 other OPPS APC 42.33 27.63 11.7 percent of total billed charges 42.33 42.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 24MM 7MM 4MM SS NS CANCELLOUS SM HEXAGONAL SOCKET SUP-207.024 CDM 270010022 LOCAL 0270 RC outpatient 42.33 42.33 42.33 74 31.32 percent of total billed charges 42.33 93 34.29 percent of total billed charges 42.33 42.33 other OPPS APC 42.33 42.33 other OPPS APC 42.33 27.63 11.7 percent of total billed charges 42.33 42.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM 26MM LCP SS PARTIAL THREAD CANCELLOUS SM FRAGMENT SET SUP-207.026 CDM 270010022 LOCAL 0270 RC outpatient 42.33 42.33 42.33 74 31.32 percent of total billed charges 42.33 93 34.29 percent of total billed charges 42.33 42.33 other OPPS APC 42.33 42.33 other OPPS APC 42.33 27.63 11.7 percent of total billed charges 42.33 42.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD L28 MM L14 MM OD4 MM CANCELLOUS RADIUS ULNA PELVIS SMALL HEXAGONAL SOCKET SMALL FRAGMENT SET SUP-207.028 CDM 270010022 LOCAL 0270 RC outpatient 42.33 42.33 42.33 74 31.32 percent of total billed charges 42.33 93 34.29 percent of total billed charges 42.33 42.33 other OPPS APC 42.33 42.33 other OPPS APC 42.33 27.63 11.7 percent of total billed charges 42.33 42.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 30MM 14MM 4MM SS NS CANCELLOUS HEXAGONAL SM FRAGMENT SET SUP-207.03 CDM 270010022 LOCAL 0270 RC outpatient 46.33 46.33 46.33 74 34.28 percent of total billed charges 46.33 93 37.53 percent of total billed charges 46.33 46.33 other OPPS APC 46.33 46.33 other OPPS APC 46.33 27.63 12.8 percent of total billed charges 46.33 46.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM 30MM LCP SS PARTIAL THREAD CANCELLOUS SM FRAGMENT SET SUP-207.030 CDM 270010022 LOCAL 0270 RC outpatient 46.33 46.33 46.33 74 34.28 percent of total billed charges 46.33 93 37.53 percent of total billed charges 46.33 46.33 other OPPS APC 46.33 46.33 other OPPS APC 46.33 27.63 12.8 percent of total billed charges 46.33 46.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 35MM 14MM 4MM SS NS CANCELLOUS HEXAGONAL SM FRAGMENT SET SUP-207.035 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 40MM 14MM 4MM SS NS CANCELLOUS HEXAGONAL SM FRAGMENT SET SUP-207.040 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LC-DCP STAINLESS STEEL PARTIAL THREAD L45 MM OD4 MM CANCELLOUS SELF TAP HEXAGONAL SHAFT SMALL FRAGMENT SET SUP-207.045 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 50MM 15MM 4MM SS NS CANCELLOUS HEXAGONAL SM FRAGMENT SET SUP-207.050 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL SMALL HEXAGON L55 MM L15 MM OD4 MM ODSEC6 MM SMALL BONE CANCELLOUS SOCKET NONSTERILE SMALL FRAGMENT SET SUP-207.055 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL SMALL HEXAGON L60 MM L15 MM OD4 MM ODSEC6 MM SMALL BONE CANCELLOUS SOCKET NONSTERILE SMALL FRAGMENT SET SUP-207.060 CDM 270010022 LOCAL 0270 RC outpatient 46.67 46.67 46.67 74 34.54 percent of total billed charges 46.67 93 37.8 percent of total billed charges 46.67 46.67 other OPPS APC 46.67 46.67 other OPPS APC 46.67 27.63 12.89 percent of total billed charges 46.67 46.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SHORT THREAD 10MM 4MM SS NS SM BONE CANNULATED SELF TAP SELF DRILL HEXAGONAL ACCEPTS 1.25MM GUIDEWIRE SUP-207.610 CDM 270010022 LOCAL 0270 RC outpatient 511.55 511.55 511.55 74 378.55 percent of total billed charges 511.55 93 414.36 percent of total billed charges 511.55 511.55 other OPPS APC 511.55 511.55 other OPPS APC 511.55 27.63 141.34 percent of total billed charges 511.55 511.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SHORT THREAD 12MM 4MM 5MM 1.35MM SS NS CANNULATED SELF TAP SELF DRILL SM HEXAGONAL SOCKET ACCEPTS 1.25MM SUP-207.612 CDM 270010022 LOCAL 0270 RC outpatient 511.55 511.55 511.55 74 378.55 percent of total billed charges 511.55 93 414.36 percent of total billed charges 511.55 511.55 other OPPS APC 511.55 511.55 other OPPS APC 511.55 27.63 141.34 percent of total billed charges 511.55 511.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SHORT THREAD 14MM 4MM SS NS SM BONE CANNULATED SELF TAP SELF DRILL HEXAGONAL ACCEPTS 1.25MM GUIDEWIRE SUP-207.614 CDM 270010022 LOCAL 0270 RC outpatient 511.55 511.55 511.55 74 378.55 percent of total billed charges 511.55 93 414.36 percent of total billed charges 511.55 511.55 other OPPS APC 511.55 511.55 other OPPS APC 511.55 27.63 141.34 percent of total billed charges 511.55 511.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SHORT THREAD 16MM 4MM SS NS SM BONE CANNULATED SELF TAP SELF DRILL HEXAGONAL ACCEPTS 1.25MM GUIDEWIRE SUP-207.616 CDM 270010022 LOCAL 0270 RC outpatient 511.55 511.55 511.55 74 378.55 percent of total billed charges 511.55 93 414.36 percent of total billed charges 511.55 511.55 other OPPS APC 511.55 511.55 other OPPS APC 511.55 27.63 141.34 percent of total billed charges 511.55 511.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SHORT THREAD 18MM 4MM SS NS SM BONE CANNULATED SELF TAP SELF DRILL HEXAGONAL ACCEPTS 1.25MM GUIDEWIRE SUP-207.618 CDM 270010022 LOCAL 0270 RC outpatient 511.55 511.55 511.55 74 378.55 percent of total billed charges 511.55 93 414.36 percent of total billed charges 511.55 511.55 other OPPS APC 511.55 511.55 other OPPS APC 511.55 27.63 141.34 percent of total billed charges 511.55 511.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SHORT THREAD 20MM 4MM SS NS SM BONE CANNULATED SELF TAP SELF DRILL HEXAGONAL ACCEPTS 1.25MM GUIDEWIRE SUP-207.62 CDM 270010022 LOCAL 0270 RC outpatient 519.38 519.38 519.38 74 384.34 percent of total billed charges 519.38 93 420.7 percent of total billed charges 519.38 519.38 other OPPS APC 519.38 519.38 other OPPS APC 519.38 27.63 143.5 percent of total billed charges 519.38 519.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM 20MM LCP SS SHORT THREAD REVERSE CUT FLUTE SM BONE CANNULATED SELF SUP-207.620 CDM 270010022 LOCAL 0270 RC outpatient 519.38 519.38 519.38 74 384.34 percent of total billed charges 519.38 93 420.7 percent of total billed charges 519.38 519.38 other OPPS APC 519.38 519.38 other OPPS APC 519.38 27.63 143.5 percent of total billed charges 519.38 519.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SHORT THREAD REVERSE CUT FLUTE 22MM 4MM 5MM 1.35MM SS NS CANNULATED SELF TAP SELF DRILL SM HEXAGONAL SOCKET SUP-207.622 CDM 270010022 LOCAL 0270 RC outpatient 411.68 411.68 411.68 74 304.64 percent of total billed charges 411.68 93 333.46 percent of total billed charges 411.68 411.68 other OPPS APC 411.68 411.68 other OPPS APC 411.68 27.63 113.75 percent of total billed charges 411.68 411.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SHORT THREAD 24MM 4MM SS NS SM BONE CANNULATED SELF TAP SELF DRILL HEXAGONAL ACCEPTS 1.25MM GUIDEWIRE SUP-207.624 CDM 270010022 LOCAL 0270 RC outpatient 511.55 511.55 511.55 74 378.55 percent of total billed charges 511.55 93 414.36 percent of total billed charges 511.55 511.55 other OPPS APC 511.55 511.55 other OPPS APC 511.55 27.63 141.34 percent of total billed charges 511.55 511.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SHORT THREAD 26MM 4MM SS NS SM BONE CANNULATED SELF TAP SELF DRILL HEXAGONAL ACCEPTS 1.25MM GUIDEWIRE SUP-207.626 CDM 270010022 LOCAL 0270 RC outpatient 511.55 511.55 511.55 74 378.55 percent of total billed charges 511.55 93 414.36 percent of total billed charges 511.55 511.55 other OPPS APC 511.55 511.55 other OPPS APC 511.55 27.63 141.34 percent of total billed charges 511.55 511.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SHORT THREAD 28MM 4MM SS NS SM BONE CANNULATED SELF TAP SELF DRILL HEXAGONAL ACCEPTS 1.25MM GUIDEWIRE SUP-207.628 CDM 270010022 LOCAL 0270 RC outpatient 511.55 511.55 511.55 74 378.55 percent of total billed charges 511.55 93 414.36 percent of total billed charges 511.55 511.55 other OPPS APC 511.55 511.55 other OPPS APC 511.55 27.63 141.34 percent of total billed charges 511.55 511.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SHORT THREAD 30MM 4MM SS NS SM BONE CANNULATED SELF TAP SELF DRILL HEXAGONAL ACCEPTS 1.25MM GUIDEWIRE SUP-207.630 CDM 270010022 LOCAL 0270 RC outpatient 411.68 411.68 411.68 74 304.64 percent of total billed charges 411.68 93 333.46 percent of total billed charges 411.68 411.68 other OPPS APC 411.68 411.68 other OPPS APC 411.68 27.63 113.75 percent of total billed charges 411.68 411.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SHORT THREAD 32MM 4MM SS NS SM BONE CANNULATED SELF TAP SELF DRILL HEXAGONAL ACCEPTS 1.25MM GUIDEWIRE SUP-207.632 CDM 270010022 LOCAL 0270 RC outpatient 411.68 411.68 411.68 74 304.64 percent of total billed charges 411.68 93 333.46 percent of total billed charges 411.68 411.68 other OPPS APC 411.68 411.68 other OPPS APC 411.68 27.63 113.75 percent of total billed charges 411.68 411.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SHORT THREAD 34MM 4MM SS NS SM BONE CANNULATED SELF TAP SELF DRILL HEXAGONAL ACCEPTS 1.25MM GUIDEWIRE SUP-207.634 CDM 270010022 LOCAL 0270 RC outpatient 1051.96 1051.96 1051.96 74 778.45 percent of total billed charges 1051.96 93 852.09 percent of total billed charges 1051.96 1051.96 other OPPS APC 1051.96 1051.96 other OPPS APC 1051.96 27.63 290.66 percent of total billed charges 1051.96 1051.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL SHORT THREAD L36 MM OD4 MM RADIUS ULNA PELVIS CANNULATED NONSTERILE SMALL FRAGMENT SET SUP-207.636 CDM 270010022 LOCAL 0270 RC outpatient 411.68 411.68 411.68 74 304.64 percent of total billed charges 411.68 93 333.46 percent of total billed charges 411.68 411.68 other OPPS APC 411.68 411.68 other OPPS APC 411.68 27.63 113.75 percent of total billed charges 411.68 411.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL SHORT THREAD L38 MM OD4 MM CANCELLOUS CANNULATED NONSTERILE SMALL FRAGMENT SUP-207.638 CDM 270010022 LOCAL 0270 RC outpatient 411.68 411.68 411.68 74 304.64 percent of total billed charges 411.68 93 333.46 percent of total billed charges 411.68 411.68 other OPPS APC 411.68 411.68 other OPPS APC 411.68 27.63 113.75 percent of total billed charges 411.68 411.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL SHORT THREAD L40 MM OD4 MM RADIUS ULNA PELVIS CANNULATED NONSTERILE SMALL FRAGMENT SET SUP-207.64 CDM 270010022 LOCAL 0270 RC outpatient 519.38 519.38 519.38 74 384.34 percent of total billed charges 519.38 93 420.7 percent of total billed charges 519.38 519.38 other OPPS APC 519.38 519.38 other OPPS APC 519.38 27.63 143.5 percent of total billed charges 519.38 519.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM 40MM LCP SS SHORT THREAD RADIUS ULNA PELVIS CANNULATED NS SM FRAGMENT SUP-207.640 CDM 270010022 LOCAL 0270 RC outpatient 519.38 519.38 519.38 74 384.34 percent of total billed charges 519.38 93 420.7 percent of total billed charges 519.38 519.38 other OPPS APC 519.38 519.38 other OPPS APC 519.38 27.63 143.5 percent of total billed charges 519.38 519.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SHORT THREAD 42MM 4MM SS NS SM BONE CANNULATED SELF TAP SELF DRILL HEXAGONAL ACCEPTS 1.25MM GUIDEWIRE SUP-207.642 CDM 270010022 LOCAL 0270 RC outpatient 511.55 511.55 511.55 74 378.55 percent of total billed charges 511.55 93 414.36 percent of total billed charges 511.55 511.55 other OPPS APC 511.55 511.55 other OPPS APC 511.55 27.63 141.34 percent of total billed charges 511.55 511.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL SHORT THREAD L44 MM L1/3 MM OD4 MM RADIUS ULNA PELVIS CANNULATED NONSTERILE SMALL FRAGMENT SET SUP-207.644 CDM 270010022 LOCAL 0270 RC outpatient 511.55 511.55 511.55 74 378.55 percent of total billed charges 511.55 93 414.36 percent of total billed charges 511.55 511.55 other OPPS APC 511.55 511.55 other OPPS APC 511.55 27.63 141.34 percent of total billed charges 511.55 511.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL SHORT THREAD L46 MM OD4 MM RADIUS ULNA PELVIS CANNULATED NONSTERILE SMALL FRAGMENT SET SUP-207.646 CDM 270010022 LOCAL 0270 RC outpatient 511.55 511.55 511.55 74 378.55 percent of total billed charges 511.55 93 414.36 percent of total billed charges 511.55 511.55 other OPPS APC 511.55 511.55 other OPPS APC 511.55 27.63 141.34 percent of total billed charges 511.55 511.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SHORT THREAD 48MM 4MM SS NS SM BONE CANNULATED SELF TAP SELF DRILL HEXAGONAL ACCEPTS 1.25MM GUIDEWIRE SUP-207.648 CDM 270010022 LOCAL 0270 RC outpatient 511.55 511.55 511.55 74 378.55 percent of total billed charges 511.55 93 414.36 percent of total billed charges 511.55 511.55 other OPPS APC 511.55 511.55 other OPPS APC 511.55 27.63 141.34 percent of total billed charges 511.55 511.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL SHORT THREAD HEXAGON LOW PROFILE L50 MM OD4 MM ODSEC5 MM SMALL BONE SELF DRILL SELF TAP CANNULATED REVERSE CUT FLUTE NONSTERILE SUP-207.65 CDM 270010022 LOCAL 0270 RC outpatient 511.55 511.55 511.55 74 378.55 percent of total billed charges 511.55 93 414.36 percent of total billed charges 511.55 511.55 other OPPS APC 511.55 511.55 other OPPS APC 511.55 27.63 141.34 percent of total billed charges 511.55 511.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM 5MM 50MM LCP SS SHORT THREAD HEXAGON LOW PROFILE SM BONE SELF DRILL SUP-207.650 CDM 270010022 LOCAL 0270 RC outpatient 519.38 519.38 519.38 74 384.34 percent of total billed charges 519.38 93 420.7 percent of total billed charges 519.38 519.38 other OPPS APC 519.38 519.38 other OPPS APC 519.38 27.63 143.5 percent of total billed charges 519.38 519.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE .5 THREAD REVERSE CUT FLUTE 16MM 4MM 5MM 1.35MM SS NS CANNULATED SELF TAP SELF DRILL SM HEXAGONAL SOCKET SUP-207.716 CDM 270010022 LOCAL 0270 RC outpatient 511.55 511.55 511.55 74 378.55 percent of total billed charges 511.55 93 414.36 percent of total billed charges 511.55 511.55 other OPPS APC 511.55 511.55 other OPPS APC 511.55 27.63 141.34 percent of total billed charges 511.55 511.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE .5 THREAD REVERSE CUT FLUTE 18MM 4MM 5MM 1.35MM SS NS CANNULATED SELF TAP SELF DRILL SM HEXAGONAL SOCKET SUP-207.718 CDM 270010022 LOCAL 0270 RC outpatient 511.55 511.55 511.55 74 378.55 percent of total billed charges 511.55 93 414.36 percent of total billed charges 511.55 511.55 other OPPS APC 511.55 511.55 other OPPS APC 511.55 27.63 141.34 percent of total billed charges 511.55 511.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE .5 THREAD REVERSE CUT FLUTE 20MM 4MM 5MM 1.35MM SS NS CANNULATED SELF TAP SELF DRILL SM HEXAGONAL SOCKET SUP-207.720 CDM 270010022 LOCAL 0270 RC outpatient 511.55 511.55 511.55 74 378.55 percent of total billed charges 511.55 93 414.36 percent of total billed charges 511.55 511.55 other OPPS APC 511.55 511.55 other OPPS APC 511.55 27.63 141.34 percent of total billed charges 511.55 511.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE .5 THREAD REVERSE CUT FLUTE 22MM 4MM 5MM 1.35MM SS NS CANNULATED SELF TAP SELF DRILL SM HEXAGONAL SOCKET SUP-207.722 CDM 270010022 LOCAL 0270 RC outpatient 511.55 511.55 511.55 74 378.55 percent of total billed charges 511.55 93 414.36 percent of total billed charges 511.55 511.55 other OPPS APC 511.55 511.55 other OPPS APC 511.55 27.63 141.34 percent of total billed charges 511.55 511.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE .5 THREAD REVERSE CUT FLUTE 24MM 4MM 5MM 1.35MM SS NS CANNULATED SELF TAP SELF DRILL SM HEXAGONAL SOCKET SUP-207.724 CDM 270010022 LOCAL 0270 RC outpatient 511.55 511.55 511.55 74 378.55 percent of total billed charges 511.55 93 414.36 percent of total billed charges 511.55 511.55 other OPPS APC 511.55 511.55 other OPPS APC 511.55 27.63 141.34 percent of total billed charges 511.55 511.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 1/2 THREAD SMALL HEXAGON REVERSE CUT FLUTE L26 MM OD4 MM ODSEC5 MM ID1.35 MM SMALL BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SMALL FRAGMENT SET SUP-207.726 CDM 270010022 LOCAL 0270 RC outpatient 511.55 511.55 511.55 74 378.55 percent of total billed charges 511.55 93 414.36 percent of total billed charges 511.55 511.55 other OPPS APC 511.55 511.55 other OPPS APC 511.55 27.63 141.34 percent of total billed charges 511.55 511.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 1/2 THREAD SMALL HEXAGON REVERSE CUT FLUTE L28 MM OD4 MM ODSEC5 MM ID1.35 MM SMALL BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SMALL FRAGMENT SET SUP-207.728 CDM 270010022 LOCAL 0270 RC outpatient 511.55 511.55 511.55 74 378.55 percent of total billed charges 511.55 93 414.36 percent of total billed charges 511.55 511.55 other OPPS APC 511.55 511.55 other OPPS APC 511.55 27.63 141.34 percent of total billed charges 511.55 511.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 1/2 THREAD SMALL HEXAGON REVERSE CUT FLUTE L30 MM OD4 MM ODSEC5 MM ID1.35 MM SMALL BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SMALL FRAGMENT SET SUP-207.73 CDM 270010022 LOCAL 0270 RC outpatient 411.68 411.68 411.68 74 304.64 percent of total billed charges 411.68 93 333.46 percent of total billed charges 411.68 411.68 other OPPS APC 411.68 411.68 other OPPS APC 411.68 27.63 113.75 percent of total billed charges 411.68 411.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM 5MM 1.35MM 30MM LCP SS .5 THREAD SM HEXAGON REVERSE CUT FLUTE SM BONE SUP-207.730 CDM 270010022 LOCAL 0270 RC outpatient 519.38 519.38 519.38 74 384.34 percent of total billed charges 519.38 93 420.7 percent of total billed charges 519.38 519.38 other OPPS APC 519.38 519.38 other OPPS APC 519.38 27.63 143.5 percent of total billed charges 519.38 519.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 1/2 THREAD SMALL HEXAGON REVERSE CUT FLUTE L32 MM OD4 MM ODSEC5 MM ID1.35 MM SMALL BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SMALL FRAGMENT SET SUP-207.732 CDM 270010022 LOCAL 0270 RC outpatient 411.68 411.68 411.68 74 304.64 percent of total billed charges 411.68 93 333.46 percent of total billed charges 411.68 411.68 other OPPS APC 411.68 411.68 other OPPS APC 411.68 27.63 113.75 percent of total billed charges 411.68 411.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LONG THREAD 34MM 17MM 4MM 1.35MM SS NS SM BONE CANNULATED SELF TAP SELF DRILL HEXAGONAL SUP-207.734 CDM 270010022 LOCAL 0270 RC outpatient 411.68 411.68 411.68 74 304.64 percent of total billed charges 411.68 93 333.46 percent of total billed charges 411.68 411.68 other OPPS APC 411.68 411.68 other OPPS APC 411.68 27.63 113.75 percent of total billed charges 411.68 411.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 1/2 THREAD SMALL HEXAGON REVERSE CUT FLUTE L36 MM OD4 MM ODSEC5 MM ID1.35 MM SMALL BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SMALL FRAGMENT SET SUP-207.736 CDM 270010022 LOCAL 0270 RC outpatient 411.68 411.68 411.68 74 304.64 percent of total billed charges 411.68 93 333.46 percent of total billed charges 411.68 411.68 other OPPS APC 411.68 411.68 other OPPS APC 411.68 27.63 113.75 percent of total billed charges 411.68 411.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 1/2 THREAD SMALL HEXAGON REVERSE CUT FLUTE L38 MM OD4 MM ODSEC5 MM ID1.35 MM SMALL BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SMALL FRAGMENT SET SUP-207.738 CDM 270010022 LOCAL 0270 RC outpatient 411.68 411.68 411.68 74 304.64 percent of total billed charges 411.68 93 333.46 percent of total billed charges 411.68 411.68 other OPPS APC 411.68 411.68 other OPPS APC 411.68 27.63 113.75 percent of total billed charges 411.68 411.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 1/2 THREAD SMALL HEXAGON REVERSE CUT FLUTE L40 MM OD4 MM ODSEC5 MM ID1.35 MM SMALL BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SMALL FRAGMENT SET SUP-207.740 CDM 270010022 LOCAL 0270 RC outpatient 411.68 411.68 411.68 74 304.64 percent of total billed charges 411.68 93 333.46 percent of total billed charges 411.68 411.68 other OPPS APC 411.68 411.68 other OPPS APC 411.68 27.63 113.75 percent of total billed charges 411.68 411.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 1/2 THREAD SMALL HEXAGON REVERSE CUT FLUTE L42 MM OD4 MM ODSEC5 MM ID1.35 MM SMALL BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SMALL FRAGMENT SET SUP-207.742 CDM 270010022 LOCAL 0270 RC outpatient 411.68 411.68 411.68 74 304.64 percent of total billed charges 411.68 93 333.46 percent of total billed charges 411.68 411.68 other OPPS APC 411.68 411.68 other OPPS APC 411.68 27.63 113.75 percent of total billed charges 411.68 411.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LONG THREAD L44 MM OD4 MM ODSEC5 MM CANCELLOUS SMALL BONE CANNULATED SELF DRILLING SELF TAPPING SMALL HEXAGONAL SOCKET LOW PROFILE HEAD NONSTERILE SMALL FRAGMENT SUP-207.744 CDM 270010022 LOCAL 0270 RC outpatient 411.68 411.68 411.68 74 304.64 percent of total billed charges 411.68 93 333.46 percent of total billed charges 411.68 411.68 other OPPS APC 411.68 411.68 other OPPS APC 411.68 27.63 113.75 percent of total billed charges 411.68 411.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 1/2 THREAD SMALL HEXAGON REVERSE CUT FLUTE L46 MM OD4 MM ODSEC5 MM ID1.35 MM SMALL BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SMALL FRAGMENT SET SUP-207.746 CDM 270010022 LOCAL 0270 RC outpatient 411.68 411.68 411.68 74 304.64 percent of total billed charges 411.68 93 333.46 percent of total billed charges 411.68 411.68 other OPPS APC 411.68 411.68 other OPPS APC 411.68 27.63 113.75 percent of total billed charges 411.68 411.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 1/2 THREAD SMALL HEXAGON REVERSE CUT FLUTE L48 MM OD4 MM ODSEC5 MM ID1.35 MM SMALL BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SMALL FRAGMENT SET SUP-207.748 CDM 270010022 LOCAL 0270 RC outpatient 511.55 511.55 511.55 74 378.55 percent of total billed charges 511.55 93 414.36 percent of total billed charges 511.55 511.55 other OPPS APC 511.55 511.55 other OPPS APC 511.55 27.63 141.34 percent of total billed charges 511.55 511.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LONG THREAD L50 MM OD4 MM ODSEC5 MM CANCELLOUS SMALL BONE CANNULATED SELF DRILLING SELF TAPPING SMALL HEXAGONAL SOCKET LOW PROFILE HEAD NONSTERILE SMALL FRAGMENT SUP-207.75 CDM 270010022 LOCAL 0270 RC outpatient 519.38 519.38 519.38 74 384.34 percent of total billed charges 519.38 93 420.7 percent of total billed charges 519.38 519.38 other OPPS APC 519.38 519.38 other OPPS APC 519.38 27.63 143.5 percent of total billed charges 519.38 519.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LONG THREAD L50 MM OD4 MM ODSEC5 MM CANCELLOUS SMALL BONE CANNULATED SELF DRILLING SELF TAPPING SMALL HEXAGONAL SOCKET LOW PROFILE HEAD NONSTERILE SMALL FRAGMENT SUP-207.750 CDM 270010022 LOCAL 0270 RC outpatient 411.68 411.68 411.68 74 304.64 percent of total billed charges 411.68 93 333.46 percent of total billed charges 411.68 411.68 other OPPS APC 411.68 411.68 other OPPS APC 411.68 27.63 113.75 percent of total billed charges 411.68 411.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING SUCTION BERKELEY SAFETOUCH L18 IN BOTTLE TO BOTTLE HOSE CONNECT LATEX FREE DISPOSABLE SUP-20714 CDM 0270 RC outpatient 6.48 6.48 6.48 74 4.8 percent of total billed charges 6.48 93 5.25 percent of total billed charges 6.48 6.48 other OPPS APC 6.48 6.48 other OPPS APC 6.48 27.63 1.79 percent of total billed charges 6.48 6.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE ACX SILICONE P5.7 CM MODERATE HEIGHT W12 CM X H11 CM 340 CC BREAST TEXTURE SURFACE INTEGRATE MAGNETIC INJECTION PORT SUP-20719-340ACX CDM 0270 RC outpatient 2730 2730 2730 74 2020.2 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 2730 other OPPS APC 2730 2730 other OPPS APC 2730 27.63 754.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE ACX P6.1 CM W13 CM X H12 CM 430 ML BREAST TEXTURED SURFACE INTEGRATED VALVE SUP-20719-430ACX CDM 0270 RC outpatient 2730 2730 2730 74 2020.2 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 2730 other OPPS APC 2730 2730 other OPPS APC 2730 27.63 754.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT XL NITINOL RECTANGLE HELIX L137 CM L40 MM ODSEC4 MM FEMOROPOPLITEAL ARTERY RADIOPAQUE OTW FLEXIBLE ELECTROPOLISH ACCEPTS .018 IN GUIDEWIRE 6 FR SHEATH PTA SUP-2076-4040 CDM 0481 RC outpatient 2535 2535 2535 74 1875.9 percent of total billed charges 2535 93 2053.35 percent of total billed charges 2535 2535 other OPPS APC 2535 2535 other OPPS APC 2535 51 1292.85 percent of total billed charges 2535 2535 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT XL NITINOL RECTANGLE HELIX L137 CM L20 MM ODSEC5 MM FEMOROPOPLITEAL ARTERY RADIOPAQUE OTW FLEXIBLE ELECTROPOLISH ACCEPTS .018 IN GUIDEWIRE 6 FR SHEATH PTA SUP-2076-5020 CDM 0481 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 51 1193.4 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT XL NITINOL RECTANGLE HELIX L137 CM L40 MM ODSEC5 MM FEMOROPOPLITEAL ARTERY RADIOPAQUE OTW FLEXIBLE ELECTROPOLISH ACCEPTS .018 IN GUIDEWIRE 6 FR SHEATH PTA SUP-2076-5040 CDM 0481 RC outpatient 2535 2535 2535 74 1875.9 percent of total billed charges 2535 93 2053.35 percent of total billed charges 2535 2535 other OPPS APC 2535 2535 other OPPS APC 2535 51 1292.85 percent of total billed charges 2535 2535 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT XL NITINOL RECTANGLE HELIX L137 CM L40 MM ODSEC6 MM FEMOROPOPLITEAL ARTERY RADIOPAQUE OTW FLEXIBLE ELECTROPOLISH ACCEPTS .018 IN GUIDEWIRE 6 FR SHEATH PTA SUP-2076-6040 CDM 0481 RC outpatient 2535 2535 2535 74 1875.9 percent of total billed charges 2535 93 2053.35 percent of total billed charges 2535 2535 other OPPS APC 2535 2535 other OPPS APC 2535 51 1292.85 percent of total billed charges 2535 2535 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE LOW HEIGHT TEXTURED 470CC SUP-20789-470ACX CDM 0270 RC outpatient 2730 2730 2730 74 2020.2 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 2730 other OPPS APC 2730 2730 other OPPS APC 2730 27.63 754.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL OPTETRAK 3 CONDYLE CEMENTED CONSTRAIN SUP-208-01-03 CDM 270010025 LOCAL 0270 RC outpatient 13634.4 13634.4 13634.4 74 10089.5 percent of total billed charges 13634.4 93 11043.9 percent of total billed charges 13634.4 13634.4 other OPPS APC 13634.4 13634.4 other OPPS APC 13634.4 27.63 3767.18 percent of total billed charges 13634.4 13634.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL OPTETRAK 4 CONDYLE CEMENTED CONSTRAIN SUP-208-01-04 CDM 270010025 LOCAL 0270 RC outpatient 13634.4 13634.4 13634.4 74 10089.5 percent of total billed charges 13634.4 93 11043.9 percent of total billed charges 13634.4 13634.4 other OPPS APC 13634.4 13634.4 other OPPS APC 13634.4 27.63 3767.18 percent of total billed charges 13634.4 13634.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION OPTETRAK 4 H5 MM KNEE FEMUR SUP-208-05-04 CDM 270010025 LOCAL 0270 RC outpatient 2678 2678 2678 74 1981.72 percent of total billed charges 2678 93 2169.18 percent of total billed charges 2678 2678 other OPPS APC 2678 2678 other OPPS APC 2678 27.63 739.93 percent of total billed charges 2678 2678 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK AUGMENTATION OPTETRAK 4 H5 MM KNEE FEMUR POSTERIOR SUP-208-07-04 CDM 270010025 LOCAL 0270 RC outpatient 2168.4 2168.4 2168.4 74 1604.62 percent of total billed charges 2168.4 93 1756.4 percent of total billed charges 2168.4 2168.4 other OPPS APC 2168.4 2168.4 other OPPS APC 2168.4 27.63 599.13 percent of total billed charges 2168.4 2168.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER HEAD 2 D HUMERUS STEM SUP-208-09-02 CDM 270010025 LOCAL 0270 RC outpatient 795.6 795.6 795.6 74 588.74 percent of total billed charges 795.6 93 644.44 percent of total billed charges 795.6 795.6 other OPPS APC 795.6 795.6 other OPPS APC 795.6 27.63 219.82 percent of total billed charges 795.6 795.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADATPER OPTETRAK CC STEM EXT AND SCREW 5 DEG SUP-208-09-05 CDM 270010025 LOCAL 0270 RC outpatient 912.6 912.6 912.6 74 675.32 percent of total billed charges 912.6 93 739.21 percent of total billed charges 912.6 912.6 other OPPS APC 912.6 912.6 other OPPS APC 912.6 27.63 252.15 percent of total billed charges 912.6 912.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL OPTETRAK 3 H15 MM KNEE CONDYLE CONSTRAINED SCREW SUP-208-23-15 CDM 270010025 LOCAL 0270 RC outpatient 4422.6 4422.6 4422.6 74 3272.72 percent of total billed charges 4422.6 93 3582.31 percent of total billed charges 4422.6 4422.6 other OPPS APC 4422.6 4422.6 other OPPS APC 4422.6 27.63 1221.96 percent of total billed charges 4422.6 4422.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL OPTETRACK 4 H18 MM KNEE CONDYLE CONSTRAINED SCREW SUP-208-24-18 CDM 270010025 LOCAL 0270 RC outpatient 4422.6 4422.6 4422.6 74 3272.72 percent of total billed charges 4422.6 93 3582.31 percent of total billed charges 4422.6 4422.6 other OPPS APC 4422.6 4422.6 other OPPS APC 4422.6 27.63 1221.96 percent of total billed charges 4422.6 4422.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL HEMISPHERE REVERSE CUT FLUTE L35 MM L16 MM OD6.5 MM ODSEC7.9 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-208.402 CDM 270010022 LOCAL 0270 RC outpatient 672.98 672.98 672.98 74 498.01 percent of total billed charges 672.98 93 545.11 percent of total billed charges 672.98 672.98 other OPPS APC 672.98 672.98 other OPPS APC 672.98 27.63 185.94 percent of total billed charges 672.98 672.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL HEMISPHERE REVERSE CUT FLUTE L50 MM L16 MM OD6.5 MM ODSEC7.9 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-208.405 CDM 270010022 LOCAL 0270 RC outpatient 672.98 672.98 672.98 74 498.01 percent of total billed charges 672.98 93 545.11 percent of total billed charges 672.98 672.98 other OPPS APC 672.98 672.98 other OPPS APC 672.98 27.63 185.94 percent of total billed charges 672.98 672.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 60MM 16MM 6.5MM 2.9MM SS NS LG BONE CANNULATED HEXAGONAL SUP-208.407 CDM 270010022 LOCAL 0270 RC outpatient 672.98 672.98 672.98 74 498.01 percent of total billed charges 672.98 93 545.11 percent of total billed charges 672.98 672.98 other OPPS APC 672.98 672.98 other OPPS APC 672.98 27.63 185.94 percent of total billed charges 672.98 672.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL HEMISPHERE REVERSE CUT FLUTE L65 MM L16 MM OD6.5 MM ODSEC7.9 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-208.408 CDM 270010022 LOCAL 0270 RC outpatient 672.98 672.98 672.98 74 498.01 percent of total billed charges 672.98 93 545.11 percent of total billed charges 672.98 672.98 other OPPS APC 672.98 672.98 other OPPS APC 672.98 27.63 185.94 percent of total billed charges 672.98 672.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 4 MM REVERSE CUT FLUTE L70 MM L16 MM OD6.5 MM ODSEC4.8 MM LARGE BONE SELF DRILL SELF TAP CANNULATED HEMISPHERICAL HEAD NONSTERILE SUP-208.409 CDM 270010022 LOCAL 0270 RC outpatient 672.98 672.98 672.98 74 498.01 percent of total billed charges 672.98 93 545.11 percent of total billed charges 672.98 672.98 other OPPS APC 672.98 672.98 other OPPS APC 672.98 27.63 185.94 percent of total billed charges 672.98 672.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 4 MM REVERSE CUT FLUTE L75 MM L16 MM OD6.5 MM ODSEC4.8 MM LARGE BONE SELF DRILL SELF TAP CANNULATED HEMISPHERICAL HEAD NONSTERILE SUP-208.410 CDM 270010022 LOCAL 0270 RC outpatient 672.98 672.98 672.98 74 498.01 percent of total billed charges 672.98 93 545.11 percent of total billed charges 672.98 672.98 other OPPS APC 672.98 672.98 other OPPS APC 672.98 27.63 185.94 percent of total billed charges 672.98 672.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL HEMISPHERE REVERSE CUT FLUTE L80 MM L16 MM OD6.5 MM ODSEC7.9 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-208.411 CDM 270010022 LOCAL 0270 RC outpatient 672.98 672.98 672.98 74 498.01 percent of total billed charges 672.98 93 545.11 percent of total billed charges 672.98 672.98 other OPPS APC 672.98 672.98 other OPPS APC 672.98 27.63 185.94 percent of total billed charges 672.98 672.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL HEMISPHERE REVERSE CUT FLUTE L85 MM L16 MM OD6.5 MM ODSEC7.9 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-208.412 CDM 270010022 LOCAL 0270 RC outpatient 672.98 672.98 672.98 74 498.01 percent of total billed charges 672.98 93 545.11 percent of total billed charges 672.98 672.98 other OPPS APC 672.98 672.98 other OPPS APC 672.98 27.63 185.94 percent of total billed charges 672.98 672.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL HEMISPHERE REVERSE CUT FLUTE L100 MM L16 MM OD6.5 MM ODSEC7.9 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-208.415 CDM 270010022 LOCAL 0270 RC outpatient 672.98 672.98 672.98 74 498.01 percent of total billed charges 672.98 93 545.11 percent of total billed charges 672.98 672.98 other OPPS APC 672.98 672.98 other OPPS APC 672.98 27.63 185.94 percent of total billed charges 672.98 672.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD REVERSE CUT FLUTE 50MM 32MM 6.5MM 7.9MM 2.9MM SS NS CANNULATED SELF TAP SELF DRILL SUP-208.432 CDM 270010022 LOCAL 0270 RC outpatient 672.98 672.98 672.98 74 498.01 percent of total billed charges 672.98 93 545.11 percent of total billed charges 672.98 672.98 other OPPS APC 672.98 672.98 other OPPS APC 672.98 27.63 185.94 percent of total billed charges 672.98 672.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL HEMISPHERE REVERSE CUT FLUTE L55 MM L32 MM OD6.5 MM ODSEC7.9 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-208.433 CDM 270010022 LOCAL 0270 RC outpatient 537.26 537.26 537.26 74 397.57 percent of total billed charges 537.26 93 435.18 percent of total billed charges 537.26 537.26 other OPPS APC 537.26 537.26 other OPPS APC 537.26 27.63 148.44 percent of total billed charges 537.26 537.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL HEMISPHERE REVERSE CUT FLUTE L70 MM L32 MM OD6.5 MM ODSEC7.9 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-208.436 CDM 270010022 LOCAL 0270 RC outpatient 672.98 672.98 672.98 74 498.01 percent of total billed charges 672.98 93 545.11 percent of total billed charges 672.98 672.98 other OPPS APC 672.98 672.98 other OPPS APC 672.98 27.63 185.94 percent of total billed charges 672.98 672.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL HEMISPHERE REVERSE CUT FLUTE L75 MM L32 MM OD6.5 MM ODSEC7.9 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-208.437 CDM 270010022 LOCAL 0270 RC outpatient 537.26 537.26 537.26 74 397.57 percent of total billed charges 537.26 93 435.18 percent of total billed charges 537.26 537.26 other OPPS APC 537.26 537.26 other OPPS APC 537.26 27.63 148.44 percent of total billed charges 537.26 537.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL HEMISPHERE REVERSE CUT FLUTE L80 MM L32 MM OD6.5 MM ODSEC7.9 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-208.438 CDM 270010022 LOCAL 0270 RC outpatient 672.98 672.98 672.98 74 498.01 percent of total billed charges 672.98 93 545.11 percent of total billed charges 672.98 672.98 other OPPS APC 672.98 672.98 other OPPS APC 672.98 27.63 185.94 percent of total billed charges 672.98 672.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL HEMISPHERE REVERSE CUT FLUTE L85 MM L32 MM OD6.5 MM ODSEC7.9 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-208.439 CDM 270010022 LOCAL 0270 RC outpatient 672.98 672.98 672.98 74 498.01 percent of total billed charges 672.98 93 545.11 percent of total billed charges 672.98 672.98 other OPPS APC 672.98 672.98 other OPPS APC 672.98 27.63 185.94 percent of total billed charges 672.98 672.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL HEMISPHERE REVERSE CUT FLUTE L90 MM L32 MM OD6.5 MM ODSEC7.9 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-208.440 CDM 270010022 LOCAL 0270 RC outpatient 672.98 672.98 672.98 74 498.01 percent of total billed charges 672.98 93 545.11 percent of total billed charges 672.98 672.98 other OPPS APC 672.98 672.98 other OPPS APC 672.98 27.63 185.94 percent of total billed charges 672.98 672.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL HEMISPHERE REVERSE CUT FLUTE L95 MM L32 MM OD6.5 MM ODSEC7.9 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-208.441 CDM 270010022 LOCAL 0270 RC outpatient 672.98 672.98 672.98 74 498.01 percent of total billed charges 672.98 93 545.11 percent of total billed charges 672.98 672.98 other OPPS APC 672.98 672.98 other OPPS APC 672.98 27.63 185.94 percent of total billed charges 672.98 672.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL HEMISPHERE REVERSE CUT FLUTE L100 MM L32 MM OD6.5 MM ODSEC7.9 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-208.442 CDM 270010022 LOCAL 0270 RC outpatient 672.98 672.98 672.98 74 498.01 percent of total billed charges 672.98 93 545.11 percent of total billed charges 672.98 672.98 other OPPS APC 672.98 672.98 other OPPS APC 672.98 27.63 185.94 percent of total billed charges 672.98 672.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANNULATED 6.5MM PARTIALLY THREADED 110MM SUP-208.444 CDM 270010022 LOCAL 0270 RC outpatient 672.98 672.98 672.98 74 498.01 percent of total billed charges 672.98 93 545.11 percent of total billed charges 672.98 672.98 other OPPS APC 672.98 672.98 other OPPS APC 672.98 27.63 185.94 percent of total billed charges 672.98 672.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL HEMISPHERE REVERSE CUT FLUTE L120 MM L32 MM OD6.5 MM ODSEC7.9 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-208.446 CDM 270010022 LOCAL 0270 RC outpatient 672.98 672.98 672.98 74 498.01 percent of total billed charges 672.98 93 545.11 percent of total billed charges 672.98 672.98 other OPPS APC 672.98 672.98 other OPPS APC 672.98 27.63 185.94 percent of total billed charges 672.98 672.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L60 MM L16 MM OD7.3 MM LARGE BONE CANNULATED SELF DRILLING SELF TAPPING HEMISPHERICAL HEAD REVERSE CUTTING FLUTE NONSTERILE SUP-208.60 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD REVERSE CUT FLUTE 30MM 16MM 7.3MM 8.2MM 2.9MM SS NS CANNULATED SELF TAP SELF DRILL SUP-208.83 CDM 270010022 LOCAL 0270 RC outpatient 811.98 811.98 811.98 74 600.87 percent of total billed charges 811.98 93 657.7 percent of total billed charges 811.98 811.98 other OPPS APC 811.98 811.98 other OPPS APC 811.98 27.63 224.35 percent of total billed charges 811.98 811.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 7.3MM 30MM 16MM SS PARTIAL THREAD LG BONE CANNULATED SELF DRILLING SELF SUP-208.830 CDM 270010022 LOCAL 0270 RC outpatient 811.98 811.98 811.98 74 600.87 percent of total billed charges 811.98 93 657.7 percent of total billed charges 811.98 811.98 other OPPS APC 811.98 811.98 other OPPS APC 811.98 27.63 224.35 percent of total billed charges 811.98 811.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L35 MM L16 MM OD7.3 MM LARGE BONE CANNULATED SELF DRILLING SELF TAPPING HEMISPHERICAL HEAD REVERSE CUTTING FLUTE NONSTERILE SUP-208.835 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L40 MM L16 MM OD7.3 MM FEMUR CANNULATED NONSTERILE SUP-208.84 CDM 270010022 LOCAL 0270 RC outpatient 811.98 811.98 811.98 74 600.87 percent of total billed charges 811.98 93 657.7 percent of total billed charges 811.98 811.98 other OPPS APC 811.98 811.98 other OPPS APC 811.98 27.63 224.35 percent of total billed charges 811.98 811.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 7.3MM 40MM 16MM SS FEMUR CANNULATED NS SUP-208.840 CDM 270010022 LOCAL 0270 RC outpatient 811.98 811.98 811.98 74 600.87 percent of total billed charges 811.98 93 657.7 percent of total billed charges 811.98 811.98 other OPPS APC 811.98 811.98 other OPPS APC 811.98 27.63 224.35 percent of total billed charges 811.98 811.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L45 MM L16 MM OD7.3 MM LARGE BONE CANNULATED SELF DRILLING SELF TAPPING HEMISPHERICAL HEAD REVERSE CUTTING FLUTE NONSTERILE SUP-208.845 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L50 MM L16 MM OD7.3 MM CANCELLOUS CANNULATED NONSTERILE SUP-208.850 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L55 MM L16 MM OD7.3 MM LARGE BONE CANNULATED SELF DRILLING SELF TAPPING HEMISPHERICAL HEAD REVERSE CUTTING FLUTE NONSTERILE SUP-208.855 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L65 MM L16 MM OD7.3 MM LARGE BONE CANNULATED SELF DRILLING SELF TAPPING HEMISPHERICAL HEAD REVERSE CUTTING FLUTE NONSTERILE SUP-208.865 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 70MM 16MM 7.3MM 2.9MM SS NS LG BONE CANNULATED SELF TAP SELF DRILL HEXAGONAL SUP-208.870 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L75 MM L16 MM OD7.3 MM LARGE BONE CANNULATED SELF DRILLING SELF TAPPING HEMISPHERICAL HEAD REVERSE CUTTING FLUTE NONSTERILE SUP-208.875 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L80 MM L16 MM OD7.3 MM LARGE BONE CANNULATED SELF DRILLING SELF TAPPING HEMISPHERICAL HEAD REVERSE CUTTING FLUTE NONSTERILE SUP-208.880 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L85 MM L16 MM OD7.3 MM LARGE BONE CANNULATED SELF DRILLING SELF TAPPING HEMISPHERICAL HEAD REVERSE CUTTING FLUTE NONSTERILE SUP-208.885 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 90MM 16MM 7.3MM 2.9MM SS NS LG BONE CANNULATED SELF TAP SELF DRILL HEXAGONAL SUP-208.890 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L95 MM L16 MM OD7.3 MM LARGE BONE CANNULATED SELF DRILLING SELF TAPPING HEMISPHERICAL HEAD REVERSE CUTTING FLUTE NONSTERILE SUP-208.895 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L100 MM L16 MM OD7.3 MM LARGE BONE CANNULATED SELF DRILLING SELF TAPPING HEMISPHERICAL HEAD REVERSE CUTTING FLUTE NONSTERILE SUP-208.9 CDM 270010022 LOCAL 0270 RC outpatient 684.11 684.11 684.11 74 506.24 percent of total billed charges 684.11 93 554.13 percent of total billed charges 684.11 684.11 other OPPS APC 684.11 684.11 other OPPS APC 684.11 27.63 189.02 percent of total billed charges 684.11 684.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 7.3MM 100MM 16MM SS PARTIAL THREAD LG BONE CANNULATED SELF DRILLING SELF SUP-208.900 CDM 270010022 LOCAL 0270 RC outpatient 684.11 684.11 684.11 74 506.24 percent of total billed charges 684.11 93 554.13 percent of total billed charges 684.11 684.11 other OPPS APC 684.11 684.11 other OPPS APC 684.11 27.63 189.02 percent of total billed charges 684.11 684.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L105 MM L16 MM OD7.3 MM LARGE BONE CANNULATED SELF DRILLING SELF TAPPING HEMISPHERICAL HEAD REVERSE CUTTING FLUTE NONSTERILE SUP-208.905 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L110 MM L16 MM OD7.3 MM LARGE BONE CANNULATED SELF DRILLING SELF TAPPING HEMISPHERICAL HEAD REVERSE CUTTING FLUTE NONSTERILE SUP-208.91 CDM 270010022 LOCAL 0270 RC outpatient 684.11 684.11 684.11 74 506.24 percent of total billed charges 684.11 93 554.13 percent of total billed charges 684.11 684.11 other OPPS APC 684.11 684.11 other OPPS APC 684.11 27.63 189.02 percent of total billed charges 684.11 684.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 7.3MM 110MM 16MM SS PARTIAL THREAD LG BONE CANNULATED SELF DRILLING SELF SUP-208.910 CDM 270010022 LOCAL 0270 RC outpatient 684.11 684.11 684.11 74 506.24 percent of total billed charges 684.11 93 554.13 percent of total billed charges 684.11 684.11 other OPPS APC 684.11 684.11 other OPPS APC 684.11 27.63 189.02 percent of total billed charges 684.11 684.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L115 MM L16 MM OD7.3 MM LARGE BONE CANNULATED SELF DRILLING SELF TAPPING HEMISPHERICAL HEAD REVERSE CUTTING FLUTE NONSTERILE SUP-208.915 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L120 MM L16 MM OD7.3 MM LARGE BONE CANNULATED SELF DRILLING SELF TAPPING HEMISPHERICAL HEAD REVERSE CUTTING FLUTE NONSTERILE SUP-208.92 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 7.3MM 120MM 16MM SS PARTIAL THREAD LG BONE CANNULATED SELF DRILLING SELF SUP-208.920 CDM 270010022 LOCAL 0270 RC outpatient 811.98 811.98 811.98 74 600.87 percent of total billed charges 811.98 93 657.7 percent of total billed charges 811.98 811.98 other OPPS APC 811.98 811.98 other OPPS APC 811.98 27.63 224.35 percent of total billed charges 811.98 811.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L125 MM L16 MM OD7.3 MM LARGE BONE CANNULATED SELF DRILLING SELF TAPPING HEMISPHERICAL HEAD REVERSE CUTTING FLUTE NONSTERILE FEMORAL NAIL SUP-208.925 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD REVERSE CUT FLUTE 130MM 16MM 7.3MM 8.2MM 2.9MM SS NS CANNULATED SELF TAP SELF DRILL SUP-208.93 CDM 270010022 LOCAL 0270 RC outpatient 811.98 811.98 811.98 74 600.87 percent of total billed charges 811.98 93 657.7 percent of total billed charges 811.98 811.98 other OPPS APC 811.98 811.98 other OPPS APC 811.98 27.63 224.35 percent of total billed charges 811.98 811.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 7.3MM 130MM 16MM SS PARTIAL THREAD LG BONE CANNULATED SELF DRILLING SELF SUP-208.930 CDM 270010022 LOCAL 0270 RC outpatient 811.98 811.98 811.98 74 600.87 percent of total billed charges 811.98 93 657.7 percent of total billed charges 811.98 811.98 other OPPS APC 811.98 811.98 other OPPS APC 811.98 27.63 224.35 percent of total billed charges 811.98 811.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD REVERSE CUT FLUTE 135MM 16MM 7.3MM 8.2MM 2.9MM SS NS CANNULATED SELF TAP SELF DRILL SUP-208.935 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 7.3MM 8.2MM 2.9MM 140MM 16MM SS LG HEXAGON HEMISPHERE REVERSE CUT FLUTE LG SUP-208.94 CDM 0270 RC outpatient 684.11 684.11 684.11 74 506.24 percent of total billed charges 684.11 93 554.13 percent of total billed charges 684.11 684.11 other OPPS APC 684.11 684.11 other OPPS APC 684.11 27.63 189.02 percent of total billed charges 684.11 684.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 7.3MM 8.2MM 2.9MM 140MM 16MM SS LG HEXAGON HEMISPHERE REVERSE CUT FLUTE LG SUP-208.940 CDM outpatient 684.11 684.11 684.11 684.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD REVERSE CUT FLUTE 145MM 16MM 7.3MM 8.2MM 2.9MM SS NS CANNULATED SELF TAP SELF DRILL SUP-208.945 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS SUP-2080-0015 CDM 270010024 LOCAL 0270 RC outpatient 308.1 308.1 308.1 74 227.99 percent of total billed charges 308.1 93 249.56 percent of total billed charges 308.1 308.1 other OPPS APC 308.1 308.1 other OPPS APC 308.1 27.63 85.13 percent of total billed charges 308.1 308.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS SUP-2080-0020 CDM 270010024 LOCAL 0270 RC outpatient 308.1 308.1 308.1 74 227.99 percent of total billed charges 308.1 93 249.56 percent of total billed charges 308.1 308.1 other OPPS APC 308.1 308.1 other OPPS APC 308.1 27.63 85.13 percent of total billed charges 308.1 308.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS SUP-2080-0025 CDM 270010024 LOCAL 0270 RC outpatient 308.1 308.1 308.1 74 227.99 percent of total billed charges 308.1 93 249.56 percent of total billed charges 308.1 308.1 other OPPS APC 308.1 308.1 other OPPS APC 308.1 27.63 85.13 percent of total billed charges 308.1 308.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS SUP-2080-0030 CDM 270010024 LOCAL 0270 RC outpatient 308.1 308.1 308.1 74 227.99 percent of total billed charges 308.1 93 249.56 percent of total billed charges 308.1 308.1 other OPPS APC 308.1 308.1 other OPPS APC 308.1 27.63 85.13 percent of total billed charges 308.1 308.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS SUP-2080-0035 CDM 270010024 LOCAL 0270 RC outpatient 308.1 308.1 308.1 74 227.99 percent of total billed charges 308.1 93 249.56 percent of total billed charges 308.1 308.1 other OPPS APC 308.1 308.1 other OPPS APC 308.1 27.63 85.13 percent of total billed charges 308.1 308.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS SUP-2080-0040 CDM 270010024 LOCAL 0270 RC outpatient 308.1 308.1 308.1 74 227.99 percent of total billed charges 308.1 93 249.56 percent of total billed charges 308.1 308.1 other OPPS APC 308.1 308.1 other OPPS APC 308.1 27.63 85.13 percent of total billed charges 308.1 308.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS SUP-2080-0045 CDM 270010024 LOCAL 0270 RC outpatient 308.1 308.1 308.1 74 227.99 percent of total billed charges 308.1 93 249.56 percent of total billed charges 308.1 308.1 other OPPS APC 308.1 308.1 other OPPS APC 308.1 27.63 85.13 percent of total billed charges 308.1 308.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TORX GAP L50 MM OD6.5 MM HIP CANCELLOUS PLATE TRITANIUM MULTIHOLE SHELL SUP-2080-0050 CDM 270010024 LOCAL 0270 RC outpatient 308.1 308.1 308.1 74 227.99 percent of total billed charges 308.1 93 249.56 percent of total billed charges 308.1 308.1 other OPPS APC 308.1 308.1 other OPPS APC 308.1 27.63 85.13 percent of total billed charges 308.1 308.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE GAP II L55 MM OD6.5 MM ACETABULAR CANCELLOUS PLATE TORX SUP-2080-0055 CDM 270010024 LOCAL 0270 RC outpatient 308.1 308.1 308.1 74 227.99 percent of total billed charges 308.1 93 249.56 percent of total billed charges 308.1 308.1 other OPPS APC 308.1 308.1 other OPPS APC 308.1 27.63 85.13 percent of total billed charges 308.1 308.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MDM X3 RESTORATION L60 MM OD6.5 MM ACETABULAR CANCELLOUS TORX DRIVE TRITANIUM MULTIHOLE SHELL SUP-2080-0060 CDM 270010024 LOCAL 0270 RC outpatient 308.1 308.1 308.1 74 227.99 percent of total billed charges 308.1 93 249.56 percent of total billed charges 308.1 308.1 other OPPS APC 308.1 308.1 other OPPS APC 308.1 27.63 85.13 percent of total billed charges 308.1 308.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING TENDRIL STS STEROID ELUTING SILICONE HELIX L46 CM OD6 FR ENDOCARDIUM IS-1 CONNECTOR SUP-2088TC/46 CDM 0275 RC outpatient 780 780 780 57 444.6 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 51 397.8 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING TENDRIL STS STEROID ELUTING SILICONE HELIX L52 CM OD6 FR ENDOCARDIUM IS-1 CONNECTOR SUP-2088TC/52 CDM 0275 RC outpatient 780 780 780 57 444.6 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 51 397.8 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING TENDRIL STS STEROID ELUTING SILICONE HELIX L58 CM OD6 FR ENDOCARDIUM IS-1 CONNECTOR SUP-2088TC/58 CDM 0275 RC outpatient 780 780 780 57 444.6 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 51 397.8 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JELLY LUBRICANT SURGILUBE CLEAR STERILE LF 5GM WATER SOLUBLE PACKET SUP-209 CDM 0270 RC outpatient 0.14 0.14 0.14 74 0.1 percent of total billed charges 0.14 93 0.11 percent of total billed charges 0.14 0.14 other OPPS APC 0.14 0.14 other OPPS APC 0.14 27.63 0.04 percent of total billed charges 0.14 0.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIAL SURGICAL OPTETRAK 5 D TAPER ADAPTER CROSS CUT SUP-209-09-05 CDM 270010025 LOCAL 0270 RC outpatient 912.6 912.6 912.6 74 675.32 percent of total billed charges 912.6 93 739.21 percent of total billed charges 912.6 912.6 other OPPS APC 912.6 912.6 other OPPS APC 912.6 27.63 252.15 percent of total billed charges 912.6 912.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 7.3MM FULL THREADED CANNULATED 20MM SUP-209.620 CDM 270010022 LOCAL 0270 RC outpatient 1387.88 1387.88 1387.88 74 1027.03 percent of total billed charges 1387.88 93 1124.18 percent of total billed charges 1387.88 1387.88 other OPPS APC 1387.88 1387.88 other OPPS APC 1387.88 27.63 383.47 percent of total billed charges 1387.88 1387.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 7.3MM FULL THREADED CANNULATED 25MM SUP-209.625 CDM 270010022 LOCAL 0270 RC outpatient 1387.88 1387.88 1387.88 74 1027.03 percent of total billed charges 1387.88 93 1124.18 percent of total billed charges 1387.88 1387.88 other OPPS APC 1387.88 1387.88 other OPPS APC 1387.88 27.63 383.47 percent of total billed charges 1387.88 1387.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L30 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-209.630 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L35 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-209.635 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L40 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-209.640 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L45 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-209.645 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L50 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-209.650 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L55 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-209.655 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULLY THREAD LARGE HEXAGON L60 MM OD7.3 MM ODSEC4 MM LARGE BONE CANNULATED SELF DRILL SELF TAP SOCKET NONSTERILE SUP-209.660 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L65 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-209.665 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L70 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-209.670 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L75 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-209.675 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L80 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-209.680 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L85 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-209.685 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L90 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-209.690 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L95 MM OD7.3 MM ODSEC8.2 MM LARGE BONE CANNULATED SHAFT LOW PROFILE HEAD SELF DRILLING SELF TAPPING TIP LARGE HEXAGONAL SOCKET NONSTERILE SUP-209.695 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L100 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-209.700 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L105 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-209.705 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L110 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-209.710 CDM 270010022 LOCAL 0270 RC outpatient 1387.88 1387.88 1387.88 74 1027.03 percent of total billed charges 1387.88 93 1124.18 percent of total billed charges 1387.88 1387.88 other OPPS APC 1387.88 1387.88 other OPPS APC 1387.88 27.63 383.47 percent of total billed charges 1387.88 1387.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L115 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-209.715 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L120 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-209.720 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L125 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-209.725 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L130 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE ACCEPTS 2.8 MM GUIDEWIRE SUP-209.730 CDM 270010022 LOCAL 0270 RC outpatient 1387.88 1387.88 1387.88 74 1027.03 percent of total billed charges 1387.88 93 1124.18 percent of total billed charges 1387.88 1387.88 other OPPS APC 1387.88 1387.88 other OPPS APC 1387.88 27.63 383.47 percent of total billed charges 1387.88 1387.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD L135 MM OD7.3 MM CANNULATED STERILE SUP-209.735S CDM 270010022 LOCAL 0270 RC outpatient 823.21 823.21 823.21 74 609.18 percent of total billed charges 823.21 93 666.8 percent of total billed charges 823.21 823.21 other OPPS APC 823.21 823.21 other OPPS APC 823.21 27.63 227.45 percent of total billed charges 823.21 823.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L140 MM OD7.3 MM CANNULATED STERILE SUP-209.740S CDM 270010022 LOCAL 0270 RC outpatient 650.83 650.83 650.83 74 481.61 percent of total billed charges 650.83 93 527.17 percent of total billed charges 650.83 650.83 other OPPS APC 650.83 650.83 other OPPS APC 650.83 27.63 179.82 percent of total billed charges 650.83 650.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L145 MM OD7.3 MM CANNULATED STERILE SUP-209.745S CDM 270010022 LOCAL 0270 RC outpatient 823.21 823.21 823.21 74 609.18 percent of total billed charges 823.21 93 666.8 percent of total billed charges 823.21 823.21 other OPPS APC 823.21 823.21 other OPPS APC 823.21 27.63 227.45 percent of total billed charges 823.21 823.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L150 MM OD7.3 MM CANNULATED STERILE SUP-209.750S CDM 270010022 LOCAL 0270 RC outpatient 650.83 650.83 650.83 74 481.61 percent of total billed charges 650.83 93 527.17 percent of total billed charges 650.83 650.83 other OPPS APC 650.83 650.83 other OPPS APC 650.83 27.63 179.82 percent of total billed charges 650.83 650.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L155 MM OD7.3 MM CANNULATED STERILE SUP-209.755S CDM 270010022 LOCAL 0270 RC outpatient 823.21 823.21 823.21 74 609.18 percent of total billed charges 823.21 93 666.8 percent of total billed charges 823.21 823.21 other OPPS APC 823.21 823.21 other OPPS APC 823.21 27.63 227.45 percent of total billed charges 823.21 823.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L160 MM OD7.3 MM CANNULATED STERILE SUP-209.760S CDM 270010022 LOCAL 0270 RC outpatient 650.83 650.83 650.83 74 481.61 percent of total billed charges 650.83 93 527.17 percent of total billed charges 650.83 650.83 other OPPS APC 650.83 650.83 other OPPS APC 650.83 27.63 179.82 percent of total billed charges 650.83 650.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L165 MM OD7.3 MM CANNULATED STERILE SUP-209.765S CDM 270010022 LOCAL 0270 RC outpatient 650.83 650.83 650.83 74 481.61 percent of total billed charges 650.83 93 527.17 percent of total billed charges 650.83 650.83 other OPPS APC 650.83 650.83 other OPPS APC 650.83 27.63 179.82 percent of total billed charges 650.83 650.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L170 MM OD7.3 MM CANNULATED STERILE SUP-209.770S CDM 270010022 LOCAL 0270 RC outpatient 650.83 650.83 650.83 74 481.61 percent of total billed charges 650.83 93 527.17 percent of total billed charges 650.83 650.83 other OPPS APC 650.83 650.83 other OPPS APC 650.83 27.63 179.82 percent of total billed charges 650.83 650.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L175 MM OD7.3 MM CANNULATED STERILE SUP-209.775S CDM 270010022 LOCAL 0270 RC outpatient 823.21 823.21 823.21 74 609.18 percent of total billed charges 823.21 93 666.8 percent of total billed charges 823.21 823.21 other OPPS APC 823.21 823.21 other OPPS APC 823.21 27.63 227.45 percent of total billed charges 823.21 823.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L180 MM OD7.3 MM CANNULATED STERILE SUP-209.780S CDM 270010022 LOCAL 0270 RC outpatient 823.21 823.21 823.21 74 609.18 percent of total billed charges 823.21 93 666.8 percent of total billed charges 823.21 823.21 other OPPS APC 823.21 823.21 other OPPS APC 823.21 27.63 227.45 percent of total billed charges 823.21 823.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD REVERSE CUT FLUTE 45MM 32MM 7.3MM 8.2MM 2.9MM SS NS CANNULATED SELF TAP SELF DRILL LG SUP-209.845 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L50 MM L32 MM OD7.3 MM ODSEC8.2 MM LARGE BONE CANNULATED SHAFT LOW PROFILE HEAD SELF DRILLING SELF TAPPING TIP THREADED NONSTERILE SUP-209.85 CDM 270010022 LOCAL 0270 RC outpatient 811.98 811.98 811.98 74 600.87 percent of total billed charges 811.98 93 657.7 percent of total billed charges 811.98 811.98 other OPPS APC 811.98 811.98 other OPPS APC 811.98 27.63 224.35 percent of total billed charges 811.98 811.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L50 MM L32 MM OD7.3 MM ODSEC8.2 MM LARGE BONE CANNULATED SHAFT LOW PROFILE HEAD SELF DRILLING SELF TAPPING TIP THREADED NONSTERILE SUP-209.850 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 4 MM L55 MM L32 MM OD7.3 MM ODSEC8.2 MM LARGE BONE CANNULATED SHAFT LOW PROFILE HEAD SELF DRILLING SELF TAPPING TIP THREADED NONSTERILE SUP-209.855 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L60 MM L32 MM OD7.3 MM ODSEC8.2 MM LARGE BONE CANNULATED SHAFT LOW PROFILE HEAD SELF DRILLING SELF TAPPING TIP THREADED NONSTERILE SUP-209.86 CDM 270010022 LOCAL 0270 RC outpatient 811.98 811.98 811.98 74 600.87 percent of total billed charges 811.98 93 657.7 percent of total billed charges 811.98 811.98 other OPPS APC 811.98 811.98 other OPPS APC 811.98 27.63 224.35 percent of total billed charges 811.98 811.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 7.3MM 8.2MM 60MM 32MM SS PARTIAL THREAD LG BONE CANNULATED SHAFT LOW SUP-209.860 CDM 270010022 LOCAL 0270 RC outpatient 811.98 811.98 811.98 74 600.87 percent of total billed charges 811.98 93 657.7 percent of total billed charges 811.98 811.98 other OPPS APC 811.98 811.98 other OPPS APC 811.98 27.63 224.35 percent of total billed charges 811.98 811.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 4 MM L65 MM L32 MM OD7.3 MM ODSEC8.2 MM LARGE BONE CANNULATED SHAFT LOW PROFILE HEAD SELF DRILLING SELF TAPPING TIP THREADED NONSTERILE SUP-209.865 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L70 MM L32 MM OD7.3 MM ODSEC8.2 MM LARGE BONE CANNULATED SHAFT LOW PROFILE HEAD SELF DRILLING SELF TAPPING TIP THREADED NONSTERILE SUP-209.870 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 4 MM L75 MM L32 MM OD7.3 MM ODSEC8.2 MM LARGE BONE CANNULATED SHAFT LOW PROFILE HEAD SELF DRILLING SELF TAPPING TIP THREADED NONSTERILE SUP-209.875 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 80MM 32MM 7.3MM 8.2MM SS NS LG BONE CANNULATED SHAFT LOW SUP-209.88 CDM 270010022 LOCAL 0270 RC outpatient 684.11 684.11 684.11 74 506.24 percent of total billed charges 684.11 93 554.13 percent of total billed charges 684.11 684.11 other OPPS APC 684.11 684.11 other OPPS APC 684.11 27.63 189.02 percent of total billed charges 684.11 684.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L80 MM L32 MM OD7.3 MM ODSEC8.2 MM LARGE BONE CANNULATED SHAFT LOW PROFILE HEAD SELF DRILLING SELF TAPPING TIP THREADED NONSTERILE SUP-209.880 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 4 MM PARTIAL THREAD L85 MM L32 MM OD7.3 MM ODSEC8.2 MM LARGE BONE CANNULATED SHAFT LOW PROFILE HEAD SELF DRILLING SELF TAPPING TIP THREADED NONSTERILE SUP-209.885 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 4 MM PARTIAL THREAD L90 MM L32 MM OD7.3 MM ODSEC8.2 MM LARGE BONE CANNULATED SHAFT LOW PROFILE HEAD SELF DRILLING SELF TAPPING TIP THREADED NONSTERILE SUP-209.89 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 7.3MM 8.2MM 90MM 32MM SS 4MM PARTIAL THREAD LG BONE CANNULATED SHAFT LOW SUP-209.890 CDM 270010022 LOCAL 0270 RC outpatient 684.11 684.11 684.11 74 506.24 percent of total billed charges 684.11 93 554.13 percent of total billed charges 684.11 684.11 other OPPS APC 684.11 684.11 other OPPS APC 684.11 27.63 189.02 percent of total billed charges 684.11 684.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 4 MM PARTIAL THREAD L95 MM L32 MM OD7.3 MM ODSEC8.2 MM LARGE BONE CANNULATED SHAFT LOW PROFILE HEAD SELF DRILLING SELF TAPPING TIP THREADED NONSTERILE SUP-209.895 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 4 MM PARTIAL THREAD L100 MM L32 MM OD7.3 MM ODSEC8.2 MM LARGE BONE CANNULATED SHAFT LOW PROFILE HEAD SELF DRILLING SELF TAPPING TIP THREADED NONSTERILE SUP-209.900 CDM 270010022 LOCAL 0270 RC outpatient 699.27 699.27 699.27 74 517.46 percent of total billed charges 699.27 93 566.41 percent of total billed charges 699.27 699.27 other OPPS APC 699.27 699.27 other OPPS APC 699.27 27.63 193.21 percent of total billed charges 699.27 699.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 4 MM L105 MM L32 MM OD7.3 MM ODSEC8.2 MM LARGE BONE CANNULATED SHAFT LOW PROFILE HEAD SELF DRILLING SELF TAPPING TIP THREADED NONSTERILE SUP-209.905 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 4 MM PARTIAL THREAD L110 MM L32 MM OD7.3 MM ODSEC8.2 MM LARGE BONE CANNULATED SHAFT LOW PROFILE HEAD SELF DRILLING SELF TAPPING TIP THREADED NONSTERILE SUP-209.91 CDM 270010022 LOCAL 0270 RC outpatient 684.11 684.11 684.11 74 506.24 percent of total billed charges 684.11 93 554.13 percent of total billed charges 684.11 684.11 other OPPS APC 684.11 684.11 other OPPS APC 684.11 27.63 189.02 percent of total billed charges 684.11 684.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 7.3MM 8.2MM 110MM 32MM SS 4MM PARTIAL THREAD LG BONE CANNULATED SHAFT LOW SUP-209.910 CDM 270010022 LOCAL 0270 RC outpatient 684.11 684.11 684.11 74 506.24 percent of total billed charges 684.11 93 554.13 percent of total billed charges 684.11 684.11 other OPPS APC 684.11 684.11 other OPPS APC 684.11 27.63 189.02 percent of total billed charges 684.11 684.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD REVERSE CUT FLUTE 115MM 32MM 7.3MM 8.2MM 2.9MM SS NS CANNULATED SELF TAP SELF DRILL LG SUP-209.915 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD REVERSE CUT FLUTE 120MM 32MM 7.3MM 8.2MM 2.9MM SS NS CANNULATED SELF TAP SELF DRILL LG SUP-209.920 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD REVERSE CUT FLUTE 125MM 32MM 7.3MM 8.2MM 2.9MM SS NS CANNULATED SELF TAP SELF DRILL LG SUP-209.925 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD REVERSE CUT FLUTE 130MM 32MM 7.3MM 8.2MM 2.9MM SS NS CANNULATED SELF TAP SELF DRILL LG SUP-209.93 CDM 270010022 LOCAL 0270 RC outpatient 533.99 533.99 533.99 74 395.15 percent of total billed charges 533.99 93 432.53 percent of total billed charges 533.99 533.99 other OPPS APC 533.99 533.99 other OPPS APC 533.99 27.63 147.54 percent of total billed charges 533.99 533.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 7.3MM 8.2MM 130MM 32MM SS 4MM PARTIAL THREAD LG BONE CANNULATED SHAFT LOW SUP-209.930 CDM 270010022 LOCAL 0270 RC outpatient 684.11 684.11 684.11 74 506.24 percent of total billed charges 684.11 93 554.13 percent of total billed charges 684.11 684.11 other OPPS APC 684.11 684.11 other OPPS APC 684.11 27.63 189.02 percent of total billed charges 684.11 684.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD REVERSE CUT FLUTE 135MM 32MM 7.3MM 8.2MM 2.9MM SS NS CANNULATED SELF TAP SELF DRILL LG SUP-209.935 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD REVERSE CUT FLUTE 140MM 32MM 7.3MM 8.2MM 2.9MM SS NS CANNULATED SELF TAP SELF DRILL LG SUP-209.94 CDM 270010022 LOCAL 0270 RC outpatient 811.98 811.98 811.98 74 600.87 percent of total billed charges 811.98 93 657.7 percent of total billed charges 811.98 811.98 other OPPS APC 811.98 811.98 other OPPS APC 811.98 27.63 224.35 percent of total billed charges 811.98 811.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 7.3MM 4MM 140MM 32MM SS HEXAGON LG BONE CANNULATED SELF DRILL SELF TAP LG SUP-209.940 CDM 270010022 LOCAL 0270 RC outpatient 811.98 811.98 811.98 74 600.87 percent of total billed charges 811.98 93 657.7 percent of total billed charges 811.98 811.98 other OPPS APC 811.98 811.98 other OPPS APC 811.98 27.63 224.35 percent of total billed charges 811.98 811.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 145MM 32MM 7.3MM 2.9MM SS NS LG BONE CANNULATED SELF TAP SELF DRILL HEXAGONAL SUP-209.945 CDM 270010022 LOCAL 0270 RC outpatient 670.2 670.2 670.2 74 495.95 percent of total billed charges 670.2 93 542.86 percent of total billed charges 670.2 670.2 other OPPS APC 670.2 670.2 other OPPS APC 670.2 27.63 185.18 percent of total billed charges 670.2 670.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD REVERSE CUT FLUTE 150MM 32MM 7.3MM 8.2MM 2.9MM SS NS CANNULATED SELF TAP SELF DRILL LG SUP-209.95 CDM 270010022 LOCAL 0270 RC outpatient 811.98 811.98 811.98 74 600.87 percent of total billed charges 811.98 93 657.7 percent of total billed charges 811.98 811.98 other OPPS APC 811.98 811.98 other OPPS APC 811.98 27.63 224.35 percent of total billed charges 811.98 811.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 7.3MM 4MM 150MM 32MM SS HEXAGON LG BONE CANNULATED SELF DRILL SELF TAP LG SUP-209.950 CDM 270010022 LOCAL 0270 RC outpatient 811.98 811.98 811.98 74 600.87 percent of total billed charges 811.98 93 657.7 percent of total billed charges 811.98 811.98 other OPPS APC 811.98 811.98 other OPPS APC 811.98 27.63 224.35 percent of total billed charges 811.98 811.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ASPEN BX/72 SUP-209109 CDM 0270 RC outpatient 11.19 11.19 11.19 74 8.28 percent of total billed charges 11.19 93 9.06 percent of total billed charges 11.19 11.19 other OPPS APC 11.19 11.19 other OPPS APC 11.19 27.63 3.09 percent of total billed charges 11.19 11.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NEEDLE SURGEONS 16 REGULAR L1.22 IN OD.034 IN 1/2 CIRCLE REVERSE CUTTING STERILE DISPOSABLE SUP-209116 CDM 0270 RC outpatient 10.83 10.83 10.83 74 8.01 percent of total billed charges 10.83 93 8.77 percent of total billed charges 10.83 10.83 other OPPS APC 10.83 10.83 other OPPS APC 10.83 27.63 2.99 percent of total billed charges 10.83 10.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SUTURE FERGUSON RICHARD-ALLAN STAINLESS STEEL 1/2 CIRCLE L2.323 IN OD.05 IN REGULAR FREE EYE TAPER POINT STERILE LATEX FREE SUP-209506 CDM 0270 RC outpatient 11.55 11.55 11.55 74 8.55 percent of total billed charges 11.55 93 9.36 percent of total billed charges 11.55 11.55 other OPPS APC 11.55 11.55 other OPPS APC 11.55 27.63 3.19 percent of total billed charges 11.55 11.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ABLATION ARCTIC FRONT MANUAL RETRACTION LATEX FREE SUP-20MRK CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEX 10% INJ 1000ML 2B0164X SUP-21-00002 CDM 0272 RC outpatient 2.11 2.11 2.11 74 1.56 percent of total billed charges 2.11 93 1.71 percent of total billed charges 2.11 2.11 other OPPS APC 2.11 2.11 other OPPS APC 2.11 27.63 0.58 percent of total billed charges 2.11 2.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEX 5% & .2% SOD CHL 1000ML SUP-21-00003 CDM 0272 RC outpatient 1.62 1.62 1.62 74 1.2 percent of total billed charges 1.62 93 1.31 percent of total billed charges 1.62 1.62 other OPPS APC 1.62 1.62 other OPPS APC 1.62 27.63 0.45 percent of total billed charges 1.62 1.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEX 5% & .2% SOD CHL 250ML SUP-21-00004 CDM 0272 RC outpatient 1.37 1.37 1.37 74 1.01 percent of total billed charges 1.37 93 1.11 percent of total billed charges 1.37 1.37 other OPPS APC 1.37 1.37 other OPPS APC 1.37 27.63 0.38 percent of total billed charges 1.37 1.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEX 5% & .45% SOD CHL 1000ML 2B1074X SUP-21-00009 CDM 0272 RC outpatient 1.67 1.67 1.67 74 1.24 percent of total billed charges 1.67 93 1.35 percent of total billed charges 1.67 1.67 other OPPS APC 1.67 1.67 other OPPS APC 1.67 27.63 0.46 percent of total billed charges 1.67 1.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEX 5% & .45% SOD CHL 500ML SUP-21-00011 CDM 0272 RC outpatient 1.58 1.58 1.58 74 1.17 percent of total billed charges 1.58 93 1.28 percent of total billed charges 1.58 1.58 other OPPS APC 1.58 1.58 other OPPS APC 1.58 27.63 0.44 percent of total billed charges 1.58 1.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEX 5% & .9% SOD CHL 1000ML 2B1064X SUP-21-00012 CDM 0272 RC outpatient 1.6 1.6 1.6 74 1.18 percent of total billed charges 1.6 93 1.3 percent of total billed charges 1.6 1.6 other OPPS APC 1.6 1.6 other OPPS APC 1.6 27.63 0.44 percent of total billed charges 1.6 1.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEX 5% INJ 500ML 2B0063Q SUP-21-00015 CDM 0272 RC outpatient 1.41 1.41 1.41 74 1.04 percent of total billed charges 1.41 93 1.14 percent of total billed charges 1.41 1.41 other OPPS APC 1.41 1.41 other OPPS APC 1.41 27.63 0.39 percent of total billed charges 1.41 1.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEX 5% INJ 1000ML 2B0064X SUP-21-00016 CDM 0272 RC outpatient 1.53 1.53 1.53 74 1.13 percent of total billed charges 1.53 93 1.24 percent of total billed charges 1.53 1.53 other OPPS APC 1.53 1.53 other OPPS APC 1.53 27.63 0.42 percent of total billed charges 1.53 1.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEX INJ 10% 250ML 2B0162Q SUP-21-00017 CDM 0272 RC outpatient 1.88 1.88 1.88 74 1.39 percent of total billed charges 1.88 93 1.52 percent of total billed charges 1.88 1.88 other OPPS APC 1.88 1.88 other OPPS APC 1.88 27.63 0.52 percent of total billed charges 1.88 1.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEX INJ 10% 500ML 2B0163Q SUP-21-00018 CDM 0272 RC outpatient 1.92 1.92 1.92 74 1.42 percent of total billed charges 1.92 93 1.56 percent of total billed charges 1.92 1.92 other OPPS APC 1.92 1.92 other OPPS APC 1.92 27.63 0.53 percent of total billed charges 1.92 1.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEX INJ 5% 100/150 2B0087 SUP-21-00019 CDM 0272 RC outpatient 1.43 1.43 1.43 74 1.06 percent of total billed charges 1.43 93 1.16 percent of total billed charges 1.43 1.43 other OPPS APC 1.43 1.43 other OPPS APC 1.43 27.63 0.4 percent of total billed charges 1.43 1.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEX INJ 5% 250ML 2B0062Q SUP-21-00020 CDM 0272 RC outpatient 1.42 1.42 1.42 74 1.05 percent of total billed charges 1.42 93 1.15 percent of total billed charges 1.42 1.42 other OPPS APC 1.42 1.42 other OPPS APC 1.42 27.63 0.39 percent of total billed charges 1.42 1.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEX INJ 5% 50/150 2B0086 SUP-21-00021 CDM 0272 RC outpatient 1.39 1.39 1.39 74 1.03 percent of total billed charges 1.39 93 1.13 percent of total billed charges 1.39 1.39 other OPPS APC 1.39 1.39 other OPPS APC 1.39 27.63 0.38 percent of total billed charges 1.39 1.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLYCINE IRR 1.5% 3000ML 2B7317 SUP-21-00025 CDM 0272 RC outpatient 33.96 33.96 33.96 74 25.13 percent of total billed charges 33.96 93 27.51 percent of total billed charges 33.96 33.96 other OPPS APC 33.96 33.96 other OPPS APC 33.96 27.63 9.38 percent of total billed charges 33.96 33.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LACT RINGER INJ 1000ML 2B2324X SUP-21-00026 CDM 0272 RC outpatient 1.72 1.72 1.72 74 1.27 percent of total billed charges 1.72 93 1.39 percent of total billed charges 1.72 1.72 other OPPS APC 1.72 1.72 other OPPS APC 1.72 27.63 0.48 percent of total billed charges 1.72 1.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LACT RINGER INJ 500ML 2B2323Q SUP-21-00027 CDM 0272 RC outpatient 1.41 1.41 1.41 74 1.04 percent of total billed charges 1.41 93 1.14 percent of total billed charges 1.41 1.41 other OPPS APC 1.41 1.41 other OPPS APC 1.41 27.63 0.39 percent of total billed charges 1.41 1.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LACT RINGER W/5% DEX 1000ML 2B2074X SUP-21-00028 CDM 0272 RC outpatient 1.69 1.69 1.69 74 1.25 percent of total billed charges 1.69 93 1.37 percent of total billed charges 1.69 1.69 other OPPS APC 1.69 1.69 other OPPS APC 1.69 27.63 0.47 percent of total billed charges 1.69 1.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOD CHL INJ .45% 1000ML 2B1314X SUP-21-00032 CDM 0272 RC outpatient 1.66 1.66 1.66 74 1.23 percent of total billed charges 1.66 93 1.34 percent of total billed charges 1.66 1.66 other OPPS APC 1.66 1.66 other OPPS APC 1.66 27.63 0.46 percent of total billed charges 1.66 1.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOD CHL INJ .45% 500ML 2B1313 SUP-21-00033 CDM 0272 RC outpatient 1.43 1.43 1.43 74 1.06 percent of total billed charges 1.43 93 1.16 percent of total billed charges 1.43 1.43 other OPPS APC 1.43 1.43 other OPPS APC 1.43 27.63 0.4 percent of total billed charges 1.43 1.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOD CHL INJ 0.9% 100/150 2B1307 SUP-21-00034 CDM 0272 RC outpatient 1.41 1.41 1.41 74 1.04 percent of total billed charges 1.41 93 1.14 percent of total billed charges 1.41 1.41 other OPPS APC 1.41 1.41 other OPPS APC 1.41 27.63 0.39 percent of total billed charges 1.41 1.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOD CHL INJ 0.9% 1000ML 2B1324 SUP-21-00035 CDM 0272 RC outpatient 1.57 1.57 1.57 74 1.16 percent of total billed charges 1.57 93 1.27 percent of total billed charges 1.57 1.57 other OPPS APC 1.57 1.57 other OPPS APC 1.57 27.63 0.43 percent of total billed charges 1.57 1.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOD CHL INJ 0.9% 250ML 2B1322 SUP-21-00036 CDM 0272 RC outpatient 1.26 1.26 1.26 74 0.93 percent of total billed charges 1.26 93 1.02 percent of total billed charges 1.26 1.26 other OPPS APC 1.26 1.26 other OPPS APC 1.26 27.63 0.35 percent of total billed charges 1.26 1.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOD CHL INJ 0.9% 50/150 2B1306 SUP-21-00038 CDM 0272 RC outpatient 1.39 1.39 1.39 74 1.03 percent of total billed charges 1.39 93 1.13 percent of total billed charges 1.39 1.39 other OPPS APC 1.39 1.39 other OPPS APC 1.39 27.63 0.38 percent of total billed charges 1.39 1.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOD CHL IRR. 0.9% 3000ML 2B7127 SUP-21-00041 CDM 0272 RC outpatient 24.88 24.88 24.88 74 18.41 percent of total billed charges 24.88 93 20.15 percent of total billed charges 24.88 24.88 other OPPS APC 24.88 24.88 other OPPS APC 24.88 27.63 6.87 percent of total billed charges 24.88 24.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOD CHL IRR 0.9% 500ML 2F7123 SUP-21-00043 CDM 0272 RC outpatient 1.72 1.72 1.72 74 1.27 percent of total billed charges 1.72 93 1.39 percent of total billed charges 1.72 1.72 other OPPS APC 1.72 1.72 other OPPS APC 1.72 27.63 0.48 percent of total billed charges 1.72 1.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SORBITOL 3% IRR 3000ML SUP-21-00044 CDM 0272 RC outpatient 32 32 32 74 23.68 percent of total billed charges 32 93 25.92 percent of total billed charges 32 32 other OPPS APC 32 32 other OPPS APC 32 27.63 8.84 percent of total billed charges 32 32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STERILE WATER IRR. 500ML SUP-21-00046 CDM 0272 RC outpatient 1.93 1.93 1.93 74 1.43 percent of total billed charges 1.93 93 1.56 percent of total billed charges 1.93 1.93 other OPPS APC 1.93 1.93 other OPPS APC 1.93 27.63 0.53 percent of total billed charges 1.93 1.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STER. WATER IRR. BAG 3000ML 2B7117 SUP-21-00048 CDM 0272 RC outpatient 26.54 26.54 26.54 74 19.64 percent of total billed charges 26.54 93 21.5 percent of total billed charges 26.54 26.54 other OPPS APC 26.54 26.54 other OPPS APC 26.54 27.63 7.33 percent of total billed charges 26.54 26.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SKIN STAPLER, PRECISE SZ 5" SUP-21-00050 CDM 0272 RC outpatient 3.81 3.81 3.81 74 2.82 percent of total billed charges 3.81 93 3.09 percent of total billed charges 3.81 3.81 other OPPS APC 3.81 3.81 other OPPS APC 3.81 27.63 1.05 percent of total billed charges 3.81 3.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WATER DISTILLED SUP-21-00070 CDM 0272 RC outpatient 1.95 1.95 1.95 74 1.44 percent of total billed charges 1.95 93 1.58 percent of total billed charges 1.95 1.95 other OPPS APC 1.95 1.95 other OPPS APC 1.95 27.63 0.54 percent of total billed charges 1.95 1.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NORMAL SALINE PREFILLED SYR 10ML POSI FL SUP-21-00071 CDM 0272 RC outpatient 34.54 34.54 34.54 74 25.56 percent of total billed charges 34.54 93 27.98 percent of total billed charges 34.54 34.54 other OPPS APC 34.54 34.54 other OPPS APC 34.54 27.63 9.54 percent of total billed charges 34.54 34.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVACUATED CONTAINER 1000ML SUP-21-00073 CDM 0272 RC outpatient 63.53 63.53 63.53 74 47.01 percent of total billed charges 63.53 93 51.46 percent of total billed charges 63.53 63.53 other OPPS APC 63.53 63.53 other OPPS APC 63.53 27.63 17.55 percent of total billed charges 63.53 63.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOD CHL IRR 0.9% 2000ML SUP-21-00078 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOD CHL IRR. 0.9% 5000ML ARTHROSCOPY SUP-21-00081 CDM 0272 RC outpatient 44.22 44.22 44.22 74 32.72 percent of total billed charges 44.22 93 35.82 percent of total billed charges 44.22 44.22 other OPPS APC 44.22 44.22 other OPPS APC 44.22 27.63 12.22 percent of total billed charges 44.22 44.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INARI ASPIRATION TRIEVER 20 L 95 CM OD 20 FR SUP-21-101 CDM 0270 RC outpatient 31200 31200 31200 74 23088 percent of total billed charges 31200 93 25272 percent of total billed charges 31200 31200 other OPPS APC 31200 31200 other OPPS APC 31200 27.63 8620.56 percent of total billed charges 31200 31200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE PORT DELTEC PORT-A-CATH STRAIGHT 1IN 22GA PLASTIC HUB NONCORING NONSILICONE SUP-21-2005-24 CDM outpatient 4.52 4.52 4.52 4.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE PORT DELTEC HUBER GRIPPER PLUS 90 D L.75 IN OD20 GA PLASTICIZE TUBE COLOR CODED REMOVABLE SLIT SPLIT SEPTUM STERILE LATEX FREE DISPOSABLE SUP-21-2767-24 CDM 0270 RC outpatient 9.9 9.9 9.9 74 7.33 percent of total billed charges 9.9 93 8.02 percent of total billed charges 9.9 9.9 other OPPS APC 9.9 9.9 other OPPS APC 9.9 27.63 2.74 percent of total billed charges 9.9 9.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE PORT GRIPPER PLUS DELTEC HUBER L.75 IN OD22 GA Y SITE PLASTICIZE TUBE COLOR CODED REMOVABLE SLIT STERILE LATEX FREE DISPOSABLE SUP-21-2861-24 CDM 0270 RC outpatient 9.9 9.9 9.9 74 7.33 percent of total billed charges 9.9 93 8.02 percent of total billed charges 9.9 9.9 other OPPS APC 9.9 9.9 other OPPS APC 9.9 27.63 2.74 percent of total billed charges 9.9 9.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE PORT DELTEC GRIPPER PLUS PLASTIC L1 1/4 IN OD20 GA HUBER Y SITE SPLIT SEPTUM DEHP FREE STERILE LATEX FREE DISPOSABLE SUP-21-2867-24 CDM outpatient 9.9 9.9 9.9 9.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 1.0 X 5MM SEMICOMPLIANT SUP-210-053-5UU CDM 0481 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 51 265.2 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE TISSUE REMOVAL AVETA OD2.9 MM RESECT FLEX STERILE LATEX FREE DISPOSABLE SUP-210-080 CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 1.0 X 8MM SEMICOMPLIANT SUP-210-083-5UU CDM 0481 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 51 265.2 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE TISSUE REMOVAL AVETA OD2.9 MM RESECT SMOL STERILE LATEX FREE DISPOSABLE SUP-210-100 CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 1.0 X 10MM SEMICOMPLIANT SUP-210-103-5UU CDM 0481 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 51 265.2 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 1.0 X 15MM SEMICOMPLIANT SUP-210-153-5UU CDM 0481 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 51 265.2 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE TISSUE REMOVAL AVETA OD3.9 MM RESECT STERILE DISPOSABLE SUP-210-2005 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 2.0MM 22MM SUP-210.372.97 CDM 270010022 LOCAL 0270 RC outpatient 88.92 88.92 88.92 74 65.8 percent of total billed charges 88.92 93 72.03 percent of total billed charges 88.92 88.92 other OPPS APC 88.92 88.92 other OPPS APC 88.92 27.63 24.57 percent of total billed charges 88.92 88.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 2.0MM 26MM SUP-210.375.97 CDM 270010022 LOCAL 0270 RC outpatient 93.24 93.24 93.24 74 69 percent of total billed charges 93.24 93 75.52 percent of total billed charges 93.24 93.24 other OPPS APC 93.24 93.24 other OPPS APC 93.24 27.63 25.76 percent of total billed charges 93.24 93.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUBSTITUTE BONE GRAFT VITOSS BTCP COLLAGEN POROUS OD64 MM ID56 MM VOID FILLER FOAM CUP SUP-2102-1056 CDM 270010024 LOCAL 0270 RC outpatient 10400 10400 10400 74 7696 percent of total billed charges 10400 93 8424 percent of total billed charges 10400 10400 other OPPS APC 10400 10400 other OPPS APC 10400 27.63 2873.52 percent of total billed charges 10400 10400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Sheath 8Fr x 63cm Cook 210338 _106142_ SUP-210338 CDM 0270 RC outpatient 139 139 139 74 102.86 percent of total billed charges 139 93 112.59 percent of total billed charges 139 139 other OPPS APC 139 139 other OPPS APC 139 27.63 38.41 percent of total billed charges 139 139 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CATHETER L110 CM LUMBOPERITONEAL SUP-21059 C CDM 0270 RC outpatient 1279.1 1279.1 1279.1 74 946.53 percent of total billed charges 1279.1 93 1036.07 percent of total billed charges 1279.1 1279.1 other OPPS APC 1279.1 1279.1 other OPPS APC 1279.1 27.63 353.42 percent of total billed charges 1279.1 1279.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE LUPINE BR ORTHOCORD DS SUP-210712 CDM 0270 RC outpatient 982.8 982.8 982.8 74 727.27 percent of total billed charges 982.8 93 796.07 percent of total billed charges 982.8 982.8 other OPPS APC 982.8 982.8 other OPPS APC 982.8 27.63 271.55 percent of total billed charges 982.8 982.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW MEDIUM LONG SAGITTAL STERILE SYSTEM 2000 MT SUP-2108-109-000S8 CDM 0270 RC outpatient 139.2 139.2 139.2 74 103.01 percent of total billed charges 139.2 93 112.75 percent of total billed charges 139.2 139.2 other OPPS APC 139.2 139.2 other OPPS APC 139.2 27.63 38.46 percent of total billed charges 139.2 139.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW STAINLESS STEEL THK.8 MM MEDIUM NARROW L73.8 MM X W18.6 MM SAGITTAL STERILE LATEX FREE DISPOSABLE SUP-2108-115-000 CDM 0270 RC outpatient 71.97 71.97 71.97 74 53.26 percent of total billed charges 71.97 93 58.3 percent of total billed charges 71.97 71.97 other OPPS APC 71.97 71.97 other OPPS APC 71.97 27.63 19.89 percent of total billed charges 71.97 71.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW SHORT THIN XWIDE SAGITTAL SUP-2108-140-000 CDM 0270 RC outpatient 71.97 71.97 71.97 74 53.26 percent of total billed charges 71.97 93 58.3 percent of total billed charges 71.97 71.97 other OPPS APC 71.97 71.97 other OPPS APC 71.97 27.63 19.89 percent of total billed charges 71.97 71.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW MEDIUM LONG L85 MM X W21 MM X H.9 MM SAGITTAL STERILE SUP-2108109000S9 CDM 0270 RC outpatient 126.83 126.83 126.83 74 93.85 percent of total billed charges 126.83 93 102.73 percent of total billed charges 126.83 126.83 other OPPS APC 126.83 126.83 other OPPS APC 126.83 27.63 35.04 percent of total billed charges 126.83 126.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW STAINLESS STEEL THK.64 MM XSHORT NARROW THIN L24.5 MM X W9 MM SAGITTAL STERILE SUP-2108145000 CDM 0270 RC outpatient 71.97 71.97 71.97 74 53.26 percent of total billed charges 71.97 93 58.3 percent of total billed charges 71.97 71.97 other OPPS APC 71.97 71.97 other OPPS APC 71.97 27.63 19.89 percent of total billed charges 71.97 71.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SAGITTAL BLADE SUP-2108148000 CDM 0270 RC outpatient 83.15 83.15 83.15 74 61.53 percent of total billed charges 83.15 93 67.35 percent of total billed charges 83.15 83.15 other OPPS APC 83.15 83.15 other OPPS APC 83.15 27.63 22.97 percent of total billed charges 83.15 83.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW POLYETHYLENE THK.64 MM L73 MM X W12.5 MM HUMERUS HEAD SUP-2108150000 CDM 0270 RC outpatient 71.97 71.97 71.97 74 53.26 percent of total billed charges 71.97 93 58.3 percent of total billed charges 71.97 71.97 other OPPS APC 71.97 71.97 other OPPS APC 71.97 27.63 19.89 percent of total billed charges 71.97 71.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SAGITTAL BLADE SUP-2108151000 CDM 0270 RC outpatient 71.97 71.97 71.97 74 53.26 percent of total billed charges 71.97 93 58.3 percent of total billed charges 71.97 71.97 other OPPS APC 71.97 71.97 other OPPS APC 71.97 27.63 19.89 percent of total billed charges 71.97 71.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW STAINLESS STEEL THK1.19 MM NARROW THICK L81.5 MM X W12.5 MM SAGITTAL STERILE SUP-2108152000 CDM 0270 RC outpatient 71.97 71.97 71.97 74 53.26 percent of total billed charges 71.97 93 58.3 percent of total billed charges 71.97 71.97 other OPPS APC 71.97 71.97 other OPPS APC 71.97 27.63 19.89 percent of total billed charges 71.97 71.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SAGITTAL BLADE EA SUP-21081821 CDM 0270 RC outpatient 52 52 52 74 38.48 percent of total billed charges 52 93 42.12 percent of total billed charges 52 52 other OPPS APC 52 52 other OPPS APC 52 27.63 14.37 percent of total billed charges 52 52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES COMPRESSION SUP-211.890S CDM 270010022 LOCAL 0270 RC outpatient 247.39 247.39 247.39 74 183.07 percent of total billed charges 247.39 93 200.39 percent of total billed charges 247.39 247.39 other OPPS APC 247.39 247.39 other OPPS APC 247.39 27.63 68.35 percent of total billed charges 247.39 247.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE EEG CORTAC THK.76MM 4.5MM PLATINUM DISPOSABLE STERILE LF SUBDURAL 6 CONTACT STRIP RADIOPAQUE IOM CONNECTOR SUP-2110-06-077 CDM 0270 RC outpatient 1578.2 1578.2 1578.2 74 1167.87 percent of total billed charges 1578.2 93 1278.34 percent of total billed charges 1578.2 1578.2 other OPPS APC 1578.2 1578.2 other OPPS APC 1578.2 27.63 436.06 percent of total billed charges 1578.2 1578.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CABLE, CORTICAL AND GRID 8 CONTACT" SUP-2110-08-077 CDM 0270 RC outpatient 1921.4 1921.4 1921.4 74 1421.84 percent of total billed charges 1921.4 93 1556.33 percent of total billed charges 1921.4 1921.4 other OPPS APC 1921.4 1921.4 other OPPS APC 1921.4 27.63 530.88 percent of total billed charges 1921.4 1921.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT LUPINE SUP-211042 CDM 0270 RC outpatient 353.6 353.6 353.6 74 261.66 percent of total billed charges 353.6 93 286.42 percent of total billed charges 353.6 353.6 other OPPS APC 353.6 353.6 other OPPS APC 353.6 27.63 97.7 percent of total billed charges 353.6 353.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRAINER SPECIMEN DOVER 2 OZ CALCULI MOISTURE RESISTANT PLASTISOL LINER SEQUENTIAL PACK STERILE LATEX FREE SUP-2110SA CDM 0270 RC outpatient 7.16 7.16 7.16 74 5.3 percent of total billed charges 7.16 93 5.8 percent of total billed charges 7.16 7.16 other OPPS APC 7.16 7.16 other OPPS APC 7.16 27.63 1.98 percent of total billed charges 7.16 7.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BODY HUMERAL COMPREHENSIVE LARGE LATERAL OFFSET L42 MM SHOULDER POLISH FINISH NECK ANGLE SEGMENTAL REVISION SYSTEM SUP-211218 CDM 270010030 LOCAL 0270 RC outpatient 10140 10140 10140 74 7503.6 percent of total billed charges 10140 93 8213.4 percent of total billed charges 10140 10140 other OPPS APC 10140 10140 other OPPS APC 10140 27.63 2801.68 percent of total billed charges 10140 10140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL COMPREHENSIVE TITANIUM ALUMINUM VANADIUM POROUS L75 MM OD9 MM INTRAMEDULLARY MODULAR SCREW TAPER ASYMMETRIC PROFILE GRIT BLAST SEGMENTAL REVISION SYSTEM SUP-211258 CDM 270010030 LOCAL 0270 RC outpatient 8203 8203 8203 74 6070.22 percent of total billed charges 8203 93 6644.43 percent of total billed charges 8203 8203 other OPPS APC 8203 8203 other OPPS APC 8203 27.63 2266.49 percent of total billed charges 8203 8203 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE VASCULAR MANTA 18 FR SUP-2115 CDM 0481 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 51 1259.7 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SELF-CATH SUP-212 CDM 0270 RC outpatient 1.61 1.61 1.61 74 1.19 percent of total billed charges 1.61 93 1.3 percent of total billed charges 1.61 1.61 other OPPS APC 1.61 1.61 other OPPS APC 1.61 27.63 0.44 percent of total billed charges 1.61 1.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L10 MM OD3.5 MM ODSEC2.9 MM PELVIS T15 STARDRIVE RECESS LOCKING SELF TAPPING THREADED CONICAL HEAD NONSTERILE SMALL FRAGMENT COMPRESSION PLATE SUP-212.101 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L12 MM OD3.5 MM PELVIS STARDRIVE RECESS SELF TAPPING TIP LOCKING FIXED ANGLE LOW PROFILE NONSTERILE SMALL FRAGMENT SUP-212.102 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L14 MM OD3.5 MM PELVIS STARDRIVE RECESS SELF TAPPING TIP LOCKING FIXED ANGLE LOW PROFILE NONSTERILE SMALL FRAGMENT SUP-212.103 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L16 MM OD3.5 MM PELVIS STARDRIVE RECESS SELF TAPPING TIP LOCKING FIXED ANGLE LOW PROFILE NONSTERILE SMALL FRAGMENT SUP-212.104 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L18 MM OD3.5 MM PROXIMAL MEDIAL TIBIA LOCKING SELF TAPPING T15 STAR DRIVE RECESS NONSTERILE SMALL FRAGMENT SET SUP-212.105 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L20 MM OD3.5 MM TIBIA PROXIMAL MEDIAL LOCKING SELF TAPPING STARDRIVE RECESS NONSTERILE SMALL FRAGMENT SET SUP-212.106 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T15 FULL THREAD CONE LOW PROFILE L22 MM OD3.5 MM PELVIS TIBIA MEDIAL PROXIMAL FIX ANGLE SELF TAP STARDRIVE NONSTERILE SMALL FRAGMENT SET SUP-212.107 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T15 24MM 3.5MM SS NS SELF TAP LOCK STARDRIVE SM FRAGMENT SET SUP-212.108 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L26 MM OD3.5 MM PELVIS STARDRIVE RECESS SELF TAPPING TIP LOCKING FIXED ANGLE LOW PROFILE NONSTERILE SMALL FRAGMENT SUP-212.109 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L28 MM OD3.5 MM TIBIA PROXIMAL MEDIAL LOCKING STARDRIVE SELF TAPPING NONSTERILE SMALL FRAGMENT SET SUP-212.110 CDM 270010022 LOCAL 0270 RC outpatient 742.56 742.56 742.56 74 549.49 percent of total billed charges 742.56 93 601.47 percent of total billed charges 742.56 742.56 other OPPS APC 742.56 742.56 other OPPS APC 742.56 27.63 205.17 percent of total billed charges 742.56 742.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L30 MM OD3.5 MM TIBIA PROXIMAL MEDIAL LOCKING SELF TAPPING STARDRIVE RECESS NONSTERILE SMALL FRAGMENT SET SUP-212.111 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L32 MM OD3.5 MM PELVIS STARDRIVE RECESS SELF TAPPING TIP LOCKING FIXED ANGLE LOW PROFILE NONSTERILE SMALL FRAGMENT SUP-212.112 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T15 34MM 3.5MM SS NS SELF TAP LOCK STARDRIVE SM FRAGMENT SET SUP-212.113 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L36 MM OD3.5 MM PELVIS T15 STARDRIVE SELF TAP FIX ANGLE LOW PROFILE NONSTERILE SMALL FRAGMENT SUP-212.115 CDM 270010022 LOCAL 0270 RC outpatient 742.56 742.56 742.56 74 549.49 percent of total billed charges 742.56 93 601.47 percent of total billed charges 742.56 742.56 other OPPS APC 742.56 742.56 other OPPS APC 742.56 27.63 205.17 percent of total billed charges 742.56 742.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L38 MM OD3.5 MM PELVIS T15 STARDRIVE SELF TAP FIX ANGLE LOW PROFILE NONSTERILE SMALL FRAGMENT SUP-212.116 CDM 270010022 LOCAL 0270 RC outpatient 742.56 742.56 742.56 74 549.49 percent of total billed charges 742.56 93 601.47 percent of total billed charges 742.56 742.56 other OPPS APC 742.56 742.56 other OPPS APC 742.56 27.63 205.17 percent of total billed charges 742.56 742.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L40 MM OD3.5 MM TIBIA PROXIMAL MEDIAL LOCKING STARDRIVE SELF TAPPING NONSTERILE SMALL FRAGMENT SET SUP-212.117 CDM 270010022 LOCAL 0270 RC outpatient 742.56 742.56 742.56 74 549.49 percent of total billed charges 742.56 93 601.47 percent of total billed charges 742.56 742.56 other OPPS APC 742.56 742.56 other OPPS APC 742.56 27.63 205.17 percent of total billed charges 742.56 742.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L45 MM OD3.5 MM TIBIA STARDRIVE SELF TAP LOCK LOW PROFILE NONSTERILE SMALL FRAGMENT SET SUP-212.119 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L50 MM OD3.5 MM PROXIMAL MEDIAL TIBIA LOCKING SELF TAPPING T15 STAR DRIVE RECESS NONSTERILE SMALL FRAGMENT SET SUP-212.121 CDM 270010022 LOCAL 0270 RC outpatient 742.56 742.56 742.56 74 549.49 percent of total billed charges 742.56 93 601.47 percent of total billed charges 742.56 742.56 other OPPS APC 742.56 742.56 other OPPS APC 742.56 27.63 205.17 percent of total billed charges 742.56 742.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T15 FULL THREAD CONE LOW PROFILE L55 MM OD3.5 MM PELVIS TIBIA MEDIAL PROXIMAL FIX ANGLE SELF TAP STARDRIVE NONSTERILE SMALL FRAGMENT SET SUP-212.123 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L60 MM OD3.5 MM PELVIS STARDRIVE RECESS SELF TAPPING TIP LOCKING FIXED ANGLE LOW PROFILE NONSTERILE SMALL FRAGMENT SUP-212.124 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T15 FULL THREAD L65 MM OD3.5 MM TIBIAL PROXIMAL MEDIAL FIX ANGLE LOCK SELF TAP STARDRIVE NONSTERILE SMALL FRAGMENT SET SUP-212.125 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T15 FULL THREAD L70 MM OD3.5 MM TIBIAL PROXIMAL MEDIAL FIX ANGLE LOCK SELF TAP STARDRIVE NONSTERILE SMALL FRAGMENT SET SUP-212.126 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T15 FULL THREAD L75 MM OD3.5 MM TIBIA PROXIMAL MEDIAL LOCK SELF TAP STARDRIVE COMPRESSION NONSTERILE SMALL FRAGMENT SUP-212.127 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T15 FULL THREAD L80 MM OD3.5 MM TIBIAL PROXIMAL MEDIAL FIX ANGLE LOCK SELF TAP STARDRIVE NONSTERILE SMALL FRAGMENT SET SUP-212.128 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T15 FULL THREAD CONE LOW PROFILE L85 MM OD3.5 MM PELVIS TIBIA MEDIAL PROXIMAL FIX ANGLE SELF TAP STARDRIVE NONSTERILE SMALL FRAGMENT SET SUP-212.129 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T15 FULL THREAD L90 MM OD3.5 MM TIBIA PROXIMAL MEDIAL SELF TAP LOCK STARDRIVE CONICAL HEAD NONSTERILE SMALL FRAGMENT SUP-212.130 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T25 L95 MM OD3.5 MM PELVIC TIBIA PROXIMAL MEDIAL LOCK SELF TAP STARDRIVE THREAD CONICAL HEAD NONSTERILE SMALL FRAGMENT SET SUP-212.131 CDM 270010022 LOCAL 0270 RC outpatient 327.47 327.47 327.47 74 242.33 percent of total billed charges 327.47 93 265.25 percent of total billed charges 327.47 327.47 other OPPS APC 327.47 327.47 other OPPS APC 327.47 27.63 90.48 percent of total billed charges 327.47 327.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T25 FULL THREAD L14 MM OD5 MM ODSEC4.4 MM LOCK SELF TAP STARDRIVE CONICAL HEAD NONSTERILE LARGE FRAGMENT SET SUP-212.201 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T25 FULL THREAD L16 MM OD5 MM ODSEC4.4 MM LOCK SELF TAP STARDRIVE CONICAL HEAD LARGE FRAGMENT SET SUP-212.202 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD T25 18MM 5MM SS NS SELF TAP LOCK STARDRIVE LG FRAGMENT SET SUP-212.203 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD T25 20MM 5MM SS NS SELF TAP LOCK STARDRIVE LG FRAGMENT SET SUP-212.204 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD T25 22MM 5MM SS NS SELF TAP LOCK STARDRIVE LG FRAGMENT SET SUP-212.205 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T25 FULL THREAD L24 MM OD5 MM ODSEC4.4 MM LOCK SELF TAP STARDRIVE CONICAL HEAD NONSTERILE LARGE FRAGMENT SET SUP-212.206 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD T25 26MM 5MM SS NS SELF TAP LOCK STARDRIVE LG FRAGMENT SET SUP-212.207 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD T25 28MM 5MM SS NS SELF TAP LOCK STARDRIVE LG FRAGMENT SET SUP-212.208 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD T25 30MM 5MM SS NS SELF TAP LOCK STARDRIVE LG FRAGMENT SET SUP-212.209 CDM 270010022 LOCAL 0270 RC outpatient 753.61 753.61 753.61 74 557.67 percent of total billed charges 753.61 93 610.42 percent of total billed charges 753.61 753.61 other OPPS APC 753.61 753.61 other OPPS APC 753.61 27.63 208.22 percent of total billed charges 753.61 753.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD T25 32MM 5MM SS NS SELF TAP LOCK STARDRIVE LG FRAGMENT SET SUP-212.210 CDM 270010022 LOCAL 0270 RC outpatient 753.61 753.61 753.61 74 557.67 percent of total billed charges 753.61 93 610.42 percent of total billed charges 753.61 753.61 other OPPS APC 753.61 753.61 other OPPS APC 753.61 27.63 208.22 percent of total billed charges 753.61 753.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD T25 34MM 5MM SS NS SELF TAP LOCK STARDRIVE LG FRAGMENT SET SUP-212.211 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD T25 36MM 5MM SS NS SELF TAP LOCK STARDRIVE LG FRAGMENT SET SUP-212.212 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD T25 38MM 5MM SS NS SELF TAP LOCK STARDRIVE LG FRAGMENT SET SUP-212.213 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T25 FULL THREAD L40 MM OD5 MM ODSEC4.4 MM LOCK SELF TAP STARDRIVE CONICAL HEAD LARGE FRAGMENT SET SUP-212.214 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD T25 42MM 5MM SS NS SELF TAP LOCK STARDRIVE LG FRAGMENT SET SUP-212.215 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD T25 44MM 5MM SS NS SELF TAP LOCK STARDRIVE LG FRAGMENT SET SUP-212.216 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD T25 46MM 5MM SS NS SELF TAP LOCK STARDRIVE LG FRAGMENT SET SUP-212.217 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD T25 48MM 5MM SS NS SELF TAP LOCK STARDRIVE LG FRAGMENT SET SUP-212.218 CDM 270010022 LOCAL 0270 RC outpatient 378.95 378.95 378.95 74 280.42 percent of total billed charges 378.95 93 306.95 percent of total billed charges 378.95 378.95 other OPPS APC 378.95 378.95 other OPPS APC 378.95 27.63 104.7 percent of total billed charges 378.95 378.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 5MM 50MM LCP SS T25 FULL THREAD CONE PERIARTICULAR CORTICAL FIX ANGLE SELF SUP-212.219 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD T25 L55 MM OD5 MM PERIARTICULAR LOCK SELF TAP TIP STARDRIVE CONICAL HEAD LARGE FRAGMENT SET SUP-212.22 CDM 270010022 LOCAL 0270 RC outpatient 384.38 384.38 384.38 74 284.44 percent of total billed charges 384.38 93 311.35 percent of total billed charges 384.38 384.38 other OPPS APC 384.38 384.38 other OPPS APC 384.38 27.63 106.2 percent of total billed charges 384.38 384.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 5MM 55MM LCP SS FULL THREAD T25 PERIARTICULAR LOCK SELF TAP TIP STARDRIVE SUP-212.220 CDM 270010022 LOCAL 0270 RC outpatient 384.38 384.38 384.38 74 284.44 percent of total billed charges 384.38 93 311.35 percent of total billed charges 384.38 384.38 other OPPS APC 384.38 384.38 other OPPS APC 384.38 27.63 106.2 percent of total billed charges 384.38 384.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD T25 60MM 5MM SS NS SELF TAP LOCK STARDRIVE CONICAL HEAD SUP-212.221 CDM 270010022 LOCAL 0270 RC outpatient 378.95 378.95 378.95 74 280.42 percent of total billed charges 378.95 93 306.95 percent of total billed charges 378.95 378.95 other OPPS APC 378.95 378.95 other OPPS APC 378.95 27.63 104.7 percent of total billed charges 378.95 378.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD T25 65MM 5MM SS NS SELF TAP LOCK STARDRIVE LG FRAGMENT SET SUP-212.222 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T25 FULL THREAD L70 MM OD5 MM ODSEC4.4 MM LOCK SELF TAP STARDRIVE CONICAL HEAD LARGE FRAGMENT SET SUP-212.223 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T25 FULL THREAD L75 MM OD5 MM ODSEC4.4 MM LOCK SELF TAP STARDRIVE CONICAL HEAD LARGE FRAGMENT SET SUP-212.224 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T25 FULL THREAD 80MM 5MM 4.4MM SS NS SELF TAP LOCK STARDRIVE CONICAL HEAD SUP-212.225 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T25 FULL THREAD L85 MM OD5 MM ODSEC4.4 MM LOCK SELF TAP STARDRIVE CONICAL HEAD NONSTERILE LARGE FRAGMENT SET SUP-212.226 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T25 FULL THREAD 90MM 5MM 4.4MM SS NS SELF TAP LOCK STARDRIVE CONICAL HEAD SUP-212.227 CDM 270010022 LOCAL 0270 RC outpatient 334.18 334.18 334.18 74 247.29 percent of total billed charges 334.18 93 270.69 percent of total billed charges 334.18 334.18 other OPPS APC 334.18 334.18 other OPPS APC 334.18 27.63 92.33 percent of total billed charges 334.18 334.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T15 FULL THREAD 65MM 3.5MM 2.9MM SS NS SELF TAP STARDRIVE CONICAL HEAD SUP-212.325 CDM 270010022 LOCAL 0270 RC outpatient 314 314 314 74 232.36 percent of total billed charges 314 93 254.34 percent of total billed charges 314 314 other OPPS APC 314 314 other OPPS APC 314 27.63 86.76 percent of total billed charges 314 314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T15 FULL THREAD 70MM 3.5MM 2.9MM SS NS SELF TAP STARDRIVE CONICAL HEAD SUP-212.326 CDM 270010022 LOCAL 0270 RC outpatient 314 314 314 74 232.36 percent of total billed charges 314 93 254.34 percent of total billed charges 314 314 other OPPS APC 314 314 other OPPS APC 314 27.63 86.76 percent of total billed charges 314 314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T15 FULL THREAD 75MM 3.5MM 2.9MM SS NS SELF TAP STARDRIVE CONICAL HEAD SUP-212.327 CDM 270010022 LOCAL 0270 RC outpatient 314 314 314 74 232.36 percent of total billed charges 314 93 254.34 percent of total billed charges 314 314 other OPPS APC 314 314 other OPPS APC 314 27.63 86.76 percent of total billed charges 314 314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T15 FULL THREAD 80MM 3.5MM 2.9MM SS NS SELF TAP STARDRIVE CONICAL HEAD SUP-212.328 CDM 270010022 LOCAL 0270 RC outpatient 314 314 314 74 232.36 percent of total billed charges 314 93 254.34 percent of total billed charges 314 314 other OPPS APC 314 314 other OPPS APC 314 27.63 86.76 percent of total billed charges 314 314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T15 FULL THREAD 85MM 3.5MM 2.9MM SS NS SELF TAP STARDRIVE CONICAL HEAD SUP-212.329 CDM 270010022 LOCAL 0270 RC outpatient 314 314 314 74 232.36 percent of total billed charges 314 93 254.34 percent of total billed charges 314 314 other OPPS APC 314 314 other OPPS APC 314 27.63 86.76 percent of total billed charges 314 314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T15 FULL THREAD 90MM 3.5MM 2.9MM SS NS SELF TAP STARDRIVE CONICAL HEAD SUP-212.330 CDM 270010022 LOCAL 0270 RC outpatient 314 314 314 74 232.36 percent of total billed charges 314 93 254.34 percent of total billed charges 314 314 other OPPS APC 314 314 other OPPS APC 314 27.63 86.76 percent of total billed charges 314 314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T15 FULL THREAD 95MM 3.5MM 2.9MM SS NS SELF TAP STARDRIVE CONICAL HEAD SUP-212.331 CDM 270010022 LOCAL 0270 RC outpatient 356.07 356.07 356.07 74 263.49 percent of total billed charges 356.07 93 288.42 percent of total billed charges 356.07 356.07 other OPPS APC 356.07 356.07 other OPPS APC 356.07 27.63 98.38 percent of total billed charges 356.07 356.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T15 PARTIAL THREAD 65MM 3.5MM 2.9MM SS NS SELF TAP STARDRIVE SMOOTH CONICAL HEAD SUP-212.425 CDM 270010022 LOCAL 0270 RC outpatient 314 314 314 74 232.36 percent of total billed charges 314 93 254.34 percent of total billed charges 314 314 other OPPS APC 314 314 other OPPS APC 314 27.63 86.76 percent of total billed charges 314 314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD CONICAL L70 MM OD3.5 MM TIBIA PROXIMAL SELF TAP STARDRIVE NONSTERILE SUP-212.426 CDM 270010022 LOCAL 0270 RC outpatient 314 314 314 74 232.36 percent of total billed charges 314 93 254.34 percent of total billed charges 314 314 other OPPS APC 314 314 other OPPS APC 314 27.63 86.76 percent of total billed charges 314 314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T15 PARTIAL THREAD 75MM 3.5MM 2.9MM SS NS SELF TAP STARDRIVE SMOOTH CONICAL HEAD SUP-212.427 CDM 270010022 LOCAL 0270 RC outpatient 314 314 314 74 232.36 percent of total billed charges 314 93 254.34 percent of total billed charges 314 314 other OPPS APC 314 314 other OPPS APC 314 27.63 86.76 percent of total billed charges 314 314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T15 PARTIAL THREAD 80MM 3.5MM 2.9MM SS NS SELF TAP STARDRIVE SMOOTH CONICAL HEAD SUP-212.428 CDM 270010022 LOCAL 0270 RC outpatient 356.07 356.07 356.07 74 263.49 percent of total billed charges 356.07 93 288.42 percent of total billed charges 356.07 356.07 other OPPS APC 356.07 356.07 other OPPS APC 356.07 27.63 98.38 percent of total billed charges 356.07 356.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T15 PARTIAL THREAD 85MM 3.5MM 2.9MM SS NS SELF TAP STARDRIVE SMOOTH CONICAL HEAD SUP-212.429 CDM 270010022 LOCAL 0270 RC outpatient 356.07 356.07 356.07 74 263.49 percent of total billed charges 356.07 93 288.42 percent of total billed charges 356.07 356.07 other OPPS APC 356.07 356.07 other OPPS APC 356.07 27.63 98.38 percent of total billed charges 356.07 356.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T15 PARTIAL THREAD 90MM 3.5MM 2.9MM SS NS SELF TAP STARDRIVE SMOOTH CONICAL HEAD SUP-212.430 CDM 270010022 LOCAL 0270 RC outpatient 356.07 356.07 356.07 74 263.49 percent of total billed charges 356.07 93 288.42 percent of total billed charges 356.07 356.07 other OPPS APC 356.07 356.07 other OPPS APC 356.07 27.63 98.38 percent of total billed charges 356.07 356.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T15 PARTIAL THREAD 95MM 3.5MM 2.9MM SS NS SELF TAP STARDRIVE SMOOTH CONICAL HEAD SUP-212.431 CDM 270010022 LOCAL 0270 RC outpatient 356.07 356.07 356.07 74 263.49 percent of total billed charges 356.07 93 288.42 percent of total billed charges 356.07 356.07 other OPPS APC 356.07 356.07 other OPPS APC 356.07 27.63 98.38 percent of total billed charges 356.07 356.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 6MM 2.4MM 1.9MM SS NS SELF TAP LOCK STARDRIVE CONICAL HEAD MINI FRAGMENT SET SUP-212.806 CDM 270010022 LOCAL 0270 RC outpatient 268.61 268.61 268.61 74 198.77 percent of total billed charges 268.61 93 217.57 percent of total billed charges 268.61 268.61 other OPPS APC 268.61 268.61 other OPPS APC 268.61 27.63 74.22 percent of total billed charges 268.61 268.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 7MM 2.4MM 1.9MM SS NS SELF TAP LOCK STARDRIVE CONICAL HEAD MINI FRAGMENT SET SUP-212.807 CDM 270010022 LOCAL 0270 RC outpatient 304.59 304.59 304.59 74 225.4 percent of total billed charges 304.59 93 246.72 percent of total billed charges 304.59 304.59 other OPPS APC 304.59 304.59 other OPPS APC 304.59 27.63 84.16 percent of total billed charges 304.59 304.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 8MM 2.4MM 1.9MM SS NS SELF TAP LOCK STARDRIVE CONICAL HEAD MINI FRAGMENT SET SUP-212.808 CDM 270010022 LOCAL 0270 RC outpatient 268.61 268.61 268.61 74 198.77 percent of total billed charges 268.61 93 217.57 percent of total billed charges 268.61 268.61 other OPPS APC 268.61 268.61 other OPPS APC 268.61 27.63 74.22 percent of total billed charges 268.61 268.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 9MM 2.4MM 1.9MM SS NS SELF TAP LOCK STARDRIVE CONICAL HEAD MINI FRAGMENT SET SUP-212.809 CDM 270010022 LOCAL 0270 RC outpatient 268.61 268.61 268.61 74 198.77 percent of total billed charges 268.61 93 217.57 percent of total billed charges 268.61 268.61 other OPPS APC 268.61 268.61 other OPPS APC 268.61 27.63 74.22 percent of total billed charges 268.61 268.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 10MM 2.4MM 1.9MM SS NS SELF TAP LOCK STARDRIVE CONICAL HEAD MINI FRAGMENT SET SUP-212.810 CDM 270010022 LOCAL 0270 RC outpatient 268.61 268.61 268.61 74 198.77 percent of total billed charges 268.61 93 217.57 percent of total billed charges 268.61 268.61 other OPPS APC 268.61 268.61 other OPPS APC 268.61 27.63 74.22 percent of total billed charges 268.61 268.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL T8 CONE L11 MM OD2.4 MM ODSEC1.9 MM FIBULA RADIUS DISTAL FIX ANGLE SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-212.811 CDM 270010022 LOCAL 0270 RC outpatient 304.59 304.59 304.59 74 225.4 percent of total billed charges 304.59 93 246.72 percent of total billed charges 304.59 304.59 other OPPS APC 304.59 304.59 other OPPS APC 304.59 27.63 84.16 percent of total billed charges 304.59 304.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 12MM 2.4MM 1.9MM SS NS SELF TAP LOCK STARDRIVE CONICAL HEAD MINI FRAGMENT SET SUP-212.812 CDM 270010022 LOCAL 0270 RC outpatient 268.61 268.61 268.61 74 198.77 percent of total billed charges 268.61 93 217.57 percent of total billed charges 268.61 268.61 other OPPS APC 268.61 268.61 other OPPS APC 268.61 27.63 74.22 percent of total billed charges 268.61 268.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 13MM 2.4MM 1.9MM SS NS SELF TAP LOCK STARDRIVE CONICAL HEAD MINI FRAGMENT SET SUP-212.813 CDM 270010022 LOCAL 0270 RC outpatient 693.94 693.94 693.94 74 513.52 percent of total billed charges 693.94 93 562.09 percent of total billed charges 693.94 693.94 other OPPS APC 693.94 693.94 other OPPS APC 693.94 27.63 191.74 percent of total billed charges 693.94 693.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 14MM 2.4MM 1.9MM SS NS SELF TAP LOCK STARDRIVE CONICAL HEAD MINI FRAGMENT SET SUP-212.814 CDM 270010022 LOCAL 0270 RC outpatient 693.94 693.94 693.94 74 513.52 percent of total billed charges 693.94 93 562.09 percent of total billed charges 693.94 693.94 other OPPS APC 693.94 693.94 other OPPS APC 693.94 27.63 191.74 percent of total billed charges 693.94 693.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 16MM 2.4MM 1.9MM SS NS SELF TAP LOCK STARDRIVE CONICAL HEAD MINI FRAGMENT SET SUP-212.816 CDM 270010022 LOCAL 0270 RC outpatient 268.61 268.61 268.61 74 198.77 percent of total billed charges 268.61 93 217.57 percent of total billed charges 268.61 268.61 other OPPS APC 268.61 268.61 other OPPS APC 268.61 27.63 74.22 percent of total billed charges 268.61 268.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 18MM 2.4MM 1.9MM SS NS SELF TAP LOCK STARDRIVE CONICAL HEAD MINI FRAGMENT SET SUP-212.818 CDM 270010022 LOCAL 0270 RC outpatient 268.61 268.61 268.61 74 198.77 percent of total billed charges 268.61 93 217.57 percent of total billed charges 268.61 268.61 other OPPS APC 268.61 268.61 other OPPS APC 268.61 27.63 74.22 percent of total billed charges 268.61 268.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 20MM 2.4MM 1.9MM SS NS SELF TAP LOCK STARDRIVE CONICAL HEAD MINI FRAGMENT SET SUP-212.820 CDM 270010022 LOCAL 0270 RC outpatient 268.61 268.61 268.61 74 198.77 percent of total billed charges 268.61 93 217.57 percent of total billed charges 268.61 268.61 other OPPS APC 268.61 268.61 other OPPS APC 268.61 27.63 74.22 percent of total billed charges 268.61 268.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 22MM 2.4MM 1.9MM SS NS SELF TAP LOCK STARDRIVE CONICAL HEAD MINI FRAGMENT SET SUP-212.822 CDM 270010022 LOCAL 0270 RC outpatient 268.61 268.61 268.61 74 198.77 percent of total billed charges 268.61 93 217.57 percent of total billed charges 268.61 268.61 other OPPS APC 268.61 268.61 other OPPS APC 268.61 27.63 74.22 percent of total billed charges 268.61 268.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 24MM 2.4MM 1.9MM SS NS SELF TAP LOCK STARDRIVE CONICAL HEAD MINI FRAGMENT SET SUP-212.824 CDM 270010022 LOCAL 0270 RC outpatient 268.61 268.61 268.61 74 198.77 percent of total billed charges 268.61 93 217.57 percent of total billed charges 268.61 268.61 other OPPS APC 268.61 268.61 other OPPS APC 268.61 27.63 74.22 percent of total billed charges 268.61 268.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 26MM 2.4MM 1.9MM SS NS SELF TAP LOCK STARDRIVE CONICAL HEAD MINI FRAGMENT SET SUP-212.826 CDM 270010022 LOCAL 0270 RC outpatient 268.61 268.61 268.61 74 198.77 percent of total billed charges 268.61 93 217.57 percent of total billed charges 268.61 268.61 other OPPS APC 268.61 268.61 other OPPS APC 268.61 27.63 74.22 percent of total billed charges 268.61 268.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 28MM 2.4MM 1.9MM SS NS SELF TAP LOCK STARDRIVE CONICAL HEAD MINI FRAGMENT SET SUP-212.828 CDM 270010022 LOCAL 0270 RC outpatient 268.61 268.61 268.61 74 198.77 percent of total billed charges 268.61 93 217.57 percent of total billed charges 268.61 268.61 other OPPS APC 268.61 268.61 other OPPS APC 268.61 27.63 74.22 percent of total billed charges 268.61 268.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 30MM 2.4MM 1.9MM SS NS SELF TAP LOCK STARDRIVE CONICAL HEAD MINI FRAGMENT SET SUP-212.830 CDM 270010022 LOCAL 0270 RC outpatient 268.61 268.61 268.61 74 198.77 percent of total billed charges 268.61 93 217.57 percent of total billed charges 268.61 268.61 other OPPS APC 268.61 268.61 other OPPS APC 268.61 27.63 74.22 percent of total billed charges 268.61 268.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE 0 OS-2 MINI QUICKANCHOR PLUS SOFT TISSUE SHOULDER ARTHROSCOPIC TITANIUM SUP-212133 CDM 0270 RC outpatient 1705.6 1705.6 1705.6 74 1262.14 percent of total billed charges 1705.6 93 1381.54 percent of total billed charges 1705.6 1705.6 other OPPS APC 1705.6 1705.6 other OPPS APC 1705.6 27.63 471.26 percent of total billed charges 1705.6 1705.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SUTURE RICHARD-ALLAN 3 1/2 CIRCLE L1.654 IN OD.043 IN FISTULA HEAVY REVERSE CUT STERILE LATEX FREE DISPOSABLE SUP-212804 CDM 0270 RC outpatient 15.48 15.48 15.48 74 11.46 percent of total billed charges 15.48 93 12.54 percent of total billed charges 15.48 15.48 other OPPS APC 15.48 15.48 other OPPS APC 15.48 27.63 4.28 percent of total billed charges 15.48 15.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE QUICKANCHOR PLUS ETHIBOND MICROFIX TITANIUM 4-0 C-1 OD1.3 MM SMALL JOINT BIOABSORBABLE DRILL BIT STERILE ARTHROSCOPIC SUP-212856 CDM 0270 RC outpatient 1237.6 1237.6 1237.6 74 915.82 percent of total billed charges 1237.6 93 1002.46 percent of total billed charges 1237.6 1237.6 other OPPS APC 1237.6 1237.6 other OPPS APC 1237.6 27.63 341.95 percent of total billed charges 1237.6 1237.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE QUICKANCHOR PLUS ETHIBOND 4-0 C-1 MICRO ROTATOR CUFF LATEX FREE 1.3 MM DRILL BIT SUP-212866 CDM 0270 RC outpatient 1630.2 1630.2 1630.2 74 1206.35 percent of total billed charges 1630.2 93 1320.46 percent of total billed charges 1630.2 1630.2 other OPPS APC 1630.2 1630.2 other OPPS APC 1630.2 27.63 450.42 percent of total billed charges 1630.2 1630.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL BONE 2.8MM SUP-2129-57-010 CDM 0270 RC outpatient 160.68 160.68 160.68 74 118.9 percent of total billed charges 160.68 93 130.15 percent of total billed charges 160.68 160.68 other OPPS APC 160.68 160.68 other OPPS APC 160.68 27.63 44.4 percent of total billed charges 160.68 160.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL BONE 3.2MM SUP-2129-57-012 CDM 0270 RC outpatient 231.4 231.4 231.4 74 171.24 percent of total billed charges 231.4 93 187.43 percent of total billed charges 231.4 231.4 other OPPS APC 231.4 231.4 other OPPS APC 231.4 27.63 63.94 percent of total billed charges 231.4 231.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 4.0MM SUP-2129-57-014 CDM 0270 RC outpatient 144.61 144.61 144.61 74 107.01 percent of total billed charges 144.61 93 117.13 percent of total billed charges 144.61 144.61 other OPPS APC 144.61 144.61 other OPPS APC 144.61 27.63 39.96 percent of total billed charges 144.61 144.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ASPEN BX/72 SUP-212902 CDM 0270 RC outpatient 11.93 11.93 11.93 74 8.83 percent of total billed charges 11.93 93 9.66 percent of total billed charges 11.93 11.93 other OPPS APC 11.93 11.93 other OPPS APC 11.93 27.63 3.3 percent of total billed charges 11.93 11.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SUTURE RICHARD-ALLAN STAINLESS STEEL 3 1/2 CIRCLE REGULAR L.984 IN OD.024 IN INTESTINAL TAPER POINT FREE EYE STERILE LATEX FREE TISSUE CLOSURE SUP-212903 CDM 0270 RC outpatient 15.48 15.48 15.48 74 11.46 percent of total billed charges 15.48 93 12.54 percent of total billed charges 15.48 15.48 other OPPS APC 15.48 15.48 other OPPS APC 15.48 27.63 4.28 percent of total billed charges 15.48 15.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE NASOGASTRIC TUM-E-VAC ADULT L48 IN OD32 FR 1 LUMEN RADIOPAQUE NONSTERILE LATEX FREE DISPOSABLE SUP-2132 CDM 0270 RC outpatient 22.82 22.82 22.82 74 16.89 percent of total billed charges 22.82 93 18.48 percent of total billed charges 22.82 22.82 other OPPS APC 22.82 22.82 other OPPS APC 22.82 27.63 6.31 percent of total billed charges 22.82 22.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SUTURE RICHARD-ALLAN KEITH SURGEONS REGULAR 2.457IN .034IN SS DISPOSABLE STERILE LF ABDOMINAL STRAIGHT CUT POINT SUP-213406 CDM 0270 RC outpatient 15.48 15.48 15.48 74 11.46 percent of total billed charges 15.48 93 12.54 percent of total billed charges 15.48 15.48 other OPPS APC 15.48 15.48 other OPPS APC 15.48 27.63 4.28 percent of total billed charges 15.48 15.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE TISSUE REMOVAL AVETA HYSTEROSCOPE PEARL STERILE LATEX FREE DISPOSABLE SUP-214-228 CDM 0270 RC outpatient 496.6 496.6 496.6 74 367.48 percent of total billed charges 496.6 93 402.25 percent of total billed charges 496.6 496.6 other OPPS APC 496.6 496.6 other OPPS APC 496.6 27.63 137.21 percent of total billed charges 496.6 496.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE TISSUE REMOVAL AVETA HYSTEROSCOPE CORAL STERILE LATEX FREE DISPOSABLE SUP-214-251 CDM 0270 RC outpatient 496.6 496.6 496.6 74 367.48 percent of total billed charges 496.6 93 402.25 percent of total billed charges 496.6 496.6 other OPPS APC 496.6 496.6 other OPPS APC 496.6 27.63 137.21 percent of total billed charges 496.6 496.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD REVERSE CUT FLUTE 60MM 4.5MM 6.5MM 1.75MM SS NS CANNULATED SELF TAP SELF DRILL HEMISPHERICAL HEAD SUP-214.076 CDM 270010022 LOCAL 0270 RC outpatient 528.53 528.53 528.53 74 391.11 percent of total billed charges 528.53 93 428.11 percent of total billed charges 528.53 528.53 other OPPS APC 528.53 528.53 other OPPS APC 528.53 27.63 146.03 percent of total billed charges 528.53 528.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STANDARD 28MM 12MM 4.5MM 8MM SS NS SHAFT LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-214.228 CDM 270010022 LOCAL 0270 RC outpatient 56.73 56.73 56.73 74 41.98 percent of total billed charges 56.73 93 45.95 percent of total billed charges 56.73 56.73 other OPPS APC 56.73 56.73 other OPPS APC 56.73 27.63 15.67 percent of total billed charges 56.73 56.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STANDARD 30MM 12MM 4.5MM 8MM SS NS SHAFT LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-214.23 CDM 270010022 LOCAL 0270 RC outpatient 45.76 45.76 45.76 74 33.86 percent of total billed charges 45.76 93 37.07 percent of total billed charges 45.76 45.76 other OPPS APC 45.76 45.76 other OPPS APC 45.76 27.63 12.64 percent of total billed charges 45.76 45.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4.5MM 8MM 30MM 12MM DCP LC-DCP SS LG HEXAGON PERIARTICULAR CONDYLE SUP-214.230 CDM outpatient 45.76 45.76 45.76 45.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STANDARD 32MM 12MM 4.5MM 8MM SS NS SHAFT LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-214.232 CDM 270010022 LOCAL 0270 RC outpatient 45.76 45.76 45.76 74 33.86 percent of total billed charges 45.76 93 37.07 percent of total billed charges 45.76 45.76 other OPPS APC 45.76 45.76 other OPPS APC 45.76 27.63 12.64 percent of total billed charges 45.76 45.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STANDARD 34MM 12MM 4.5MM 8MM SS NS SHAFT LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-214.234 CDM 270010022 LOCAL 0270 RC outpatient 45.76 45.76 45.76 74 33.86 percent of total billed charges 45.76 93 37.07 percent of total billed charges 45.76 45.76 other OPPS APC 45.76 45.76 other OPPS APC 45.76 27.63 12.64 percent of total billed charges 45.76 45.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STANDARD 36MM 12MM 4.5MM 8MM SS NS SHAFT LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-214.236 CDM 270010022 LOCAL 0270 RC outpatient 45.76 45.76 45.76 74 33.86 percent of total billed charges 45.76 93 37.07 percent of total billed charges 45.76 45.76 other OPPS APC 45.76 45.76 other OPPS APC 45.76 27.63 12.64 percent of total billed charges 45.76 45.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STANDARD 38MM 12MM 4.5MM 8MM SS NS SHAFT LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-214.238 CDM 270010022 LOCAL 0270 RC outpatient 56.73 56.73 56.73 74 41.98 percent of total billed charges 56.73 93 45.95 percent of total billed charges 56.73 56.73 other OPPS APC 56.73 56.73 other OPPS APC 56.73 27.63 15.67 percent of total billed charges 56.73 56.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STANDARD 40MM 12MM 4.5MM 8MM SS NS SHAFT LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-214.24 CDM 270010022 LOCAL 0270 RC outpatient 45.76 45.76 45.76 74 33.86 percent of total billed charges 45.76 93 37.07 percent of total billed charges 45.76 45.76 other OPPS APC 45.76 45.76 other OPPS APC 45.76 27.63 12.64 percent of total billed charges 45.76 45.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4.5MM 8MM 40MM 12MM DCP LC-DCP SS LG HEXAGON PERIARTICULAR CONDYLE SUP-214.240 CDM outpatient 45.76 45.76 45.76 45.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STANDARD 42MM 12MM 4.5MM 8MM SS NS SHAFT LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-214.242 CDM 270010022 LOCAL 0270 RC outpatient 66.69 66.69 66.69 74 49.35 percent of total billed charges 66.69 93 54.02 percent of total billed charges 66.69 66.69 other OPPS APC 66.69 66.69 other OPPS APC 66.69 27.63 18.43 percent of total billed charges 66.69 66.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STANDARD 44MM 12MM 4.5MM 8MM SS NS SHAFT LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-214.244 CDM 270010022 LOCAL 0270 RC outpatient 66.69 66.69 66.69 74 49.35 percent of total billed charges 66.69 93 54.02 percent of total billed charges 66.69 66.69 other OPPS APC 66.69 66.69 other OPPS APC 66.69 27.63 18.43 percent of total billed charges 66.69 66.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4.5MM 8MM 46MM 12MM DCP LC-DCP SS LG HEXAGON PERIARTICULAR CONDYLE SUP-214.246 CDM 270010022 LOCAL 0270 RC outpatient 49.76 49.76 49.76 74 36.82 percent of total billed charges 49.76 93 40.31 percent of total billed charges 49.76 49.76 other OPPS APC 49.76 49.76 other OPPS APC 49.76 27.63 13.75 percent of total billed charges 49.76 49.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STANDARD 48MM 12MM 4.5MM 8MM SS NS SHAFT LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-214.248 CDM 270010022 LOCAL 0270 RC outpatient 49.76 49.76 49.76 74 36.82 percent of total billed charges 49.76 93 40.31 percent of total billed charges 49.76 49.76 other OPPS APC 49.76 49.76 other OPPS APC 49.76 27.63 13.75 percent of total billed charges 49.76 49.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STANDARD 50MM 12MM 4.5MM SS NS SHAFT LG HEXAGONAL SOCKET SUP-214.25 CDM 270010022 LOCAL 0270 RC outpatient 66.69 66.69 66.69 74 49.35 percent of total billed charges 66.69 93 54.02 percent of total billed charges 66.69 66.69 other OPPS APC 66.69 66.69 other OPPS APC 66.69 27.63 18.43 percent of total billed charges 66.69 66.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4.5MM 8MM 50MM 12MM DCP LC-DCP SS PARTIAL THREAD LONG BONE LG HEXAGONAL SUP-214.250 CDM outpatient 66.69 66.69 66.69 66.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1/3 THREAD REVERSE CUT FLUTE 20MM 4.5MM 6.5MM 1.75MM SS NS CANNULATED SELF TAP SELF DRILL HEMISPHERICAL HEAD SUP-214.52 CDM 270010022 LOCAL 0270 RC outpatient 636.48 636.48 636.48 74 471 percent of total billed charges 636.48 93 515.55 percent of total billed charges 636.48 636.48 other OPPS APC 636.48 636.48 other OPPS APC 636.48 27.63 175.86 percent of total billed charges 636.48 636.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4.5MM 6.5MM 7.5MM 20MM SS 1/3 THREAD LG HEXAGON HEMISPHERE REVERSE CUT SUP-214.520 CDM 270010022 LOCAL 0270 RC outpatient 636.48 636.48 636.48 74 471 percent of total billed charges 636.48 93 515.55 percent of total billed charges 636.48 636.48 other OPPS APC 636.48 636.48 other OPPS APC 636.48 27.63 175.86 percent of total billed charges 636.48 636.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1/3 THREAD REVERSE CUT FLUTE 22MM 4.5MM 6.5MM 1.75MM SS NS CANNULATED SELF TAP SELF DRILL HEMISPHERICAL HEAD SUP-214.522 CDM 270010022 LOCAL 0270 RC outpatient 520.26 520.26 520.26 74 384.99 percent of total billed charges 520.26 93 421.41 percent of total billed charges 520.26 520.26 other OPPS APC 520.26 520.26 other OPPS APC 520.26 27.63 143.75 percent of total billed charges 520.26 520.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1/3 THREAD REVERSE CUT FLUTE 24MM 4.5MM 6.5MM 1.75MM SS NS CANNULATED SELF TAP SELF DRILL HEMISPHERICAL HEAD SUP-214.524 CDM 270010022 LOCAL 0270 RC outpatient 520.26 520.26 520.26 74 384.99 percent of total billed charges 520.26 93 421.41 percent of total billed charges 520.26 520.26 other OPPS APC 520.26 520.26 other OPPS APC 520.26 27.63 143.75 percent of total billed charges 520.26 520.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L26 MM OD4.5 MM ODSEC6.5 MM ID7.5 MM LONG BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SUP-214.526 CDM 270010022 LOCAL 0270 RC outpatient 520.26 520.26 520.26 74 384.99 percent of total billed charges 520.26 93 421.41 percent of total billed charges 520.26 520.26 other OPPS APC 520.26 520.26 other OPPS APC 520.26 27.63 143.75 percent of total billed charges 520.26 520.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L28 MM OD4.5 MM ODSEC6.5 MM ID7.5 MM LONG BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SUP-214.528 CDM 270010022 LOCAL 0270 RC outpatient 520.26 520.26 520.26 74 384.99 percent of total billed charges 520.26 93 421.41 percent of total billed charges 520.26 520.26 other OPPS APC 520.26 520.26 other OPPS APC 520.26 27.63 143.75 percent of total billed charges 520.26 520.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L30 MM OD4.5 MM ODSEC6.5 MM ID7.5 MM LONG BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SUP-214.53 CDM 270010022 LOCAL 0270 RC outpatient 636.48 636.48 636.48 74 471 percent of total billed charges 636.48 93 515.55 percent of total billed charges 636.48 636.48 other OPPS APC 636.48 636.48 other OPPS APC 636.48 27.63 175.86 percent of total billed charges 636.48 636.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4.5MM 6.5MM 7.5MM 30MM SS 1/3 THREAD LG HEXAGON HEMISPHERE REVERSE CUT SUP-214.530 CDM 270010022 LOCAL 0270 RC outpatient 636.48 636.48 636.48 74 471 percent of total billed charges 636.48 93 515.55 percent of total billed charges 636.48 636.48 other OPPS APC 636.48 636.48 other OPPS APC 636.48 27.63 175.86 percent of total billed charges 636.48 636.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L32 MM OD4.5 MM ODSEC6.5 MM ID7.5 MM LONG BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SUP-214.532 CDM 270010022 LOCAL 0270 RC outpatient 520.26 520.26 520.26 74 384.99 percent of total billed charges 520.26 93 421.41 percent of total billed charges 520.26 520.26 other OPPS APC 520.26 520.26 other OPPS APC 520.26 27.63 143.75 percent of total billed charges 520.26 520.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L34 MM OD4.5 MM ODSEC6.5 MM ID7.5 MM LONG BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SUP-214.534 CDM 270010022 LOCAL 0270 RC outpatient 520.26 520.26 520.26 74 384.99 percent of total billed charges 520.26 93 421.41 percent of total billed charges 520.26 520.26 other OPPS APC 520.26 520.26 other OPPS APC 520.26 27.63 143.75 percent of total billed charges 520.26 520.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L36 MM OD4.5 MM ODSEC6.5 MM LONG BONE CANNULATED SELF TAPPING SELF DRILLING LARGE HEXAGONAL SOCKET HEMISPHERICAL HEAD NONSTERILE SUP-214.536 CDM 270010022 LOCAL 0270 RC outpatient 520.26 520.26 520.26 74 384.99 percent of total billed charges 520.26 93 421.41 percent of total billed charges 520.26 520.26 other OPPS APC 520.26 520.26 other OPPS APC 520.26 27.63 143.75 percent of total billed charges 520.26 520.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L38 MM OD4.5 MM ODSEC6.5 MM LONG BONE CANNULATED LARGE HEXAGONAL SOCKET SELF DRILLING SELF TAPPING HEMISPHERICAL HEAD NONSTERILE SUP-214.538 CDM 270010022 LOCAL 0270 RC outpatient 520.26 520.26 520.26 74 384.99 percent of total billed charges 520.26 93 421.41 percent of total billed charges 520.26 520.26 other OPPS APC 520.26 520.26 other OPPS APC 520.26 27.63 143.75 percent of total billed charges 520.26 520.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD REVERSE CUT FLUTE 40MM 4.5MM 6.5MM 1.75MM SS NS CANNULATED SELF TAP SELF DRILL HEMISPHERICAL SUP-214.54 CDM 270010022 LOCAL 0270 RC outpatient 636.48 636.48 636.48 74 471 percent of total billed charges 636.48 93 515.55 percent of total billed charges 636.48 636.48 other OPPS APC 636.48 636.48 other OPPS APC 636.48 27.63 175.86 percent of total billed charges 636.48 636.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4.5MM 6.5MM 40MM SS PARTIAL THREAD LONG BONE CANNULATED REVERSE CUTTING SUP-214.540 CDM 270010022 LOCAL 0270 RC outpatient 636.48 636.48 636.48 74 471 percent of total billed charges 636.48 93 515.55 percent of total billed charges 636.48 636.48 other OPPS APC 636.48 636.48 other OPPS APC 636.48 27.63 175.86 percent of total billed charges 636.48 636.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L42 MM OD4.5 MM ODSEC6.5 MM ID7.5 MM LONG BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SUP-214.542 CDM 270010022 LOCAL 0270 RC outpatient 520.26 520.26 520.26 74 384.99 percent of total billed charges 520.26 93 421.41 percent of total billed charges 520.26 520.26 other OPPS APC 520.26 520.26 other OPPS APC 520.26 27.63 143.75 percent of total billed charges 520.26 520.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L44 MM OD4.5 MM ODSEC6.5 MM LONG BONE CANNULATED SELF TAPPING SELF DRILLING LARGE HEXAGONAL SOCKET HEMISPHERICAL HEAD NONSTERILE SUP-214.544 CDM 270010022 LOCAL 0270 RC outpatient 520.26 520.26 520.26 74 384.99 percent of total billed charges 520.26 93 421.41 percent of total billed charges 520.26 520.26 other OPPS APC 520.26 520.26 other OPPS APC 520.26 27.63 143.75 percent of total billed charges 520.26 520.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L46 MM OD4.5 MM ODSEC6.5 MM LONG BONE CANNULATED LOW PROFILE HEMISPHERICAL HEAD SELF DRILLING SELF TAPPING NONSTERILE SUP-214.546 CDM 270010022 LOCAL 0270 RC outpatient 520.26 520.26 520.26 74 384.99 percent of total billed charges 520.26 93 421.41 percent of total billed charges 520.26 520.26 other OPPS APC 520.26 520.26 other OPPS APC 520.26 27.63 143.75 percent of total billed charges 520.26 520.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L48 MM OD4.5 MM ODSEC6.5 MM LONG BONE CANNULATED SELF TAPPING SELF DRILLING LARGE HEXAGONAL SOCKET HEMISPHERICAL HEAD NONSTERILE SUP-214.548 CDM 270010022 LOCAL 0270 RC outpatient 520.26 520.26 520.26 74 384.99 percent of total billed charges 520.26 93 421.41 percent of total billed charges 520.26 520.26 other OPPS APC 520.26 520.26 other OPPS APC 520.26 27.63 143.75 percent of total billed charges 520.26 520.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L50 MM OD4.5 MM ODSEC6.5 MM ID7.5 MM LONG BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SUP-214.55 CDM 270010022 LOCAL 0270 RC outpatient 528.53 528.53 528.53 74 391.11 percent of total billed charges 528.53 93 428.11 percent of total billed charges 528.53 528.53 other OPPS APC 528.53 528.53 other OPPS APC 528.53 27.63 146.03 percent of total billed charges 528.53 528.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4.5MM 6.5MM 7.5MM 50MM SS 1/3 THREAD LG HEXAGON HEMISPHERE REVERSE CUT SUP-214.550 CDM 270010022 LOCAL 0270 RC outpatient 528.53 528.53 528.53 74 391.11 percent of total billed charges 528.53 93 428.11 percent of total billed charges 528.53 528.53 other OPPS APC 528.53 528.53 other OPPS APC 528.53 27.63 146.03 percent of total billed charges 528.53 528.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L52 MM OD4.5 MM ODSEC6.5 MM ID7.5 MM LONG BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SUP-214.552 CDM 270010022 LOCAL 0270 RC outpatient 520.26 520.26 520.26 74 384.99 percent of total billed charges 520.26 93 421.41 percent of total billed charges 520.26 520.26 other OPPS APC 520.26 520.26 other OPPS APC 520.26 27.63 143.75 percent of total billed charges 520.26 520.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L54 MM OD4.5 MM ODSEC6.5 MM ID7.5 MM LONG BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SUP-214.554 CDM 270010022 LOCAL 0270 RC outpatient 520.26 520.26 520.26 74 384.99 percent of total billed charges 520.26 93 421.41 percent of total billed charges 520.26 520.26 other OPPS APC 520.26 520.26 other OPPS APC 520.26 27.63 143.75 percent of total billed charges 520.26 520.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L56 MM OD4.5 MM ODSEC6.5 MM LONG BONE CANNULATED SELF TAPPING SELF DRILLING LARGE HEXAGONAL SOCKET HEMISPHERICAL HEAD NONSTERILE SUP-214.556 CDM 270010022 LOCAL 0270 RC outpatient 520.26 520.26 520.26 74 384.99 percent of total billed charges 520.26 93 421.41 percent of total billed charges 520.26 520.26 other OPPS APC 520.26 520.26 other OPPS APC 520.26 27.63 143.75 percent of total billed charges 520.26 520.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L60 MM OD4.5 MM ODSEC6.5 MM ID7.5 MM LONG BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SUP-214.56 CDM 270010022 LOCAL 0270 RC outpatient 528.53 528.53 528.53 74 391.11 percent of total billed charges 528.53 93 428.11 percent of total billed charges 528.53 528.53 other OPPS APC 528.53 528.53 other OPPS APC 528.53 27.63 146.03 percent of total billed charges 528.53 528.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4.5MM 6.5MM 7.5MM 60MM SS 1/3 THREAD LG HEXAGON HEMISPHERE REVERSE CUT SUP-214.560 CDM 270010022 LOCAL 0270 RC outpatient 528.53 528.53 528.53 74 391.11 percent of total billed charges 528.53 93 428.11 percent of total billed charges 528.53 528.53 other OPPS APC 528.53 528.53 other OPPS APC 528.53 27.63 146.03 percent of total billed charges 528.53 528.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L64 MM OD4.5 MM ODSEC6.5 MM ID7.5 MM LONG BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SUP-214.564 CDM 270010022 LOCAL 0270 RC outpatient 520.26 520.26 520.26 74 384.99 percent of total billed charges 520.26 93 421.41 percent of total billed charges 520.26 520.26 other OPPS APC 520.26 520.26 other OPPS APC 520.26 27.63 143.75 percent of total billed charges 520.26 520.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L68 MM OD4.5 MM ODSEC6.5 MM ID7.5 MM LONG BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SUP-214.568 CDM 270010022 LOCAL 0270 RC outpatient 520.26 520.26 520.26 74 384.99 percent of total billed charges 520.26 93 421.41 percent of total billed charges 520.26 520.26 other OPPS APC 520.26 520.26 other OPPS APC 520.26 27.63 143.75 percent of total billed charges 520.26 520.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L72 MM L24 MM OD4.5 MM ORTHOPEDIC CANNULATED PARTIALLY THREADED NONSTERILE SUP-214.572 CDM 270010022 LOCAL 0270 RC outpatient 520.26 520.26 520.26 74 384.99 percent of total billed charges 520.26 93 421.41 percent of total billed charges 520.26 520.26 other OPPS APC 520.26 520.26 other OPPS APC 520.26 27.63 143.75 percent of total billed charges 520.26 520.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L20 MM OD4.5 MM ODSEC6.5 MM ID7.5 MM LONG BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SUP-214.72 CDM 270010022 LOCAL 0270 RC outpatient 655.2 655.2 655.2 74 484.85 percent of total billed charges 655.2 93 530.71 percent of total billed charges 655.2 655.2 other OPPS APC 655.2 655.2 other OPPS APC 655.2 27.63 181.03 percent of total billed charges 655.2 655.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4.5MM 6.5MM 7.5MM 20MM SS FULL THREAD LG HEXAGON HEMISPHERE REVERSE CUT SUP-214.720 CDM 270010022 LOCAL 0270 RC outpatient 655.2 655.2 655.2 74 484.85 percent of total billed charges 655.2 93 530.71 percent of total billed charges 655.2 655.2 other OPPS APC 655.2 655.2 other OPPS APC 655.2 27.63 181.03 percent of total billed charges 655.2 655.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD REVERSE CUT FLUTE 22MM 4.5MM 6.5MM 1.75MM SS NS CANNULATED SELF TAP SELF DRILL HEMISPHERICAL HEAD SUP-214.722 CDM 270010022 LOCAL 0270 RC outpatient 535.96 535.96 535.96 74 396.61 percent of total billed charges 535.96 93 434.13 percent of total billed charges 535.96 535.96 other OPPS APC 535.96 535.96 other OPPS APC 535.96 27.63 148.09 percent of total billed charges 535.96 535.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD REVERSE CUT FLUTE 24MM 4.5MM 6.5MM 1.75MM SS NS CANNULATED SELF TAP SELF DRILL HEMISPHERICAL HEAD SUP-214.724 CDM 270010022 LOCAL 0270 RC outpatient 535.96 535.96 535.96 74 396.61 percent of total billed charges 535.96 93 434.13 percent of total billed charges 535.96 535.96 other OPPS APC 535.96 535.96 other OPPS APC 535.96 27.63 148.09 percent of total billed charges 535.96 535.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD REVERSE CUT FLUTE 26MM 4.5MM 6.5MM 1.75MM SS NS CANNULATED SELF TAP SELF DRILL HEMISPHERICAL HEAD SUP-214.726 CDM 270010022 LOCAL 0270 RC outpatient 535.96 535.96 535.96 74 396.61 percent of total billed charges 535.96 93 434.13 percent of total billed charges 535.96 535.96 other OPPS APC 535.96 535.96 other OPPS APC 535.96 27.63 148.09 percent of total billed charges 535.96 535.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L28 MM OD4.5 MM ODSEC6.5 MM ID7.5 MM LONG BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SUP-214.728 CDM 270010022 LOCAL 0270 RC outpatient 535.96 535.96 535.96 74 396.61 percent of total billed charges 535.96 93 434.13 percent of total billed charges 535.96 535.96 other OPPS APC 535.96 535.96 other OPPS APC 535.96 27.63 148.09 percent of total billed charges 535.96 535.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L30 MM OD4.5 MM ODSEC6.5 MM ID7.5 MM LONG BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SUP-214.73 CDM 270010022 LOCAL 0270 RC outpatient 655.2 655.2 655.2 74 484.85 percent of total billed charges 655.2 93 530.71 percent of total billed charges 655.2 655.2 other OPPS APC 655.2 655.2 other OPPS APC 655.2 27.63 181.03 percent of total billed charges 655.2 655.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4.5MM 6.5MM 7.5MM 30MM SS FULL THREAD LG HEXAGON HEMISPHERE REVERSE CUT SUP-214.730 CDM 270010022 LOCAL 0270 RC outpatient 655.2 655.2 655.2 74 484.85 percent of total billed charges 655.2 93 530.71 percent of total billed charges 655.2 655.2 other OPPS APC 655.2 655.2 other OPPS APC 655.2 27.63 181.03 percent of total billed charges 655.2 655.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L32 MM OD4.5 MM ODSEC6.5 MM ID1.75 MM LONG BONE CANNULATED SELF TAP SELF DRILL LARGE HEXAGONAL SOCKET NONSTERILE SUP-214.732 CDM 270010022 LOCAL 0270 RC outpatient 429.16 429.16 429.16 74 317.58 percent of total billed charges 429.16 93 347.62 percent of total billed charges 429.16 429.16 other OPPS APC 429.16 429.16 other OPPS APC 429.16 27.63 118.58 percent of total billed charges 429.16 429.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L34 MM OD4.5 MM ODSEC6.5 MM ID7.5 MM LONG BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SUP-214.734 CDM 270010022 LOCAL 0270 RC outpatient 535.96 535.96 535.96 74 396.61 percent of total billed charges 535.96 93 434.13 percent of total billed charges 535.96 535.96 other OPPS APC 535.96 535.96 other OPPS APC 535.96 27.63 148.09 percent of total billed charges 535.96 535.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD REVERSE CUT FLUTE 36MM 4.5MM 6.5MM 1.75MM SS NS CANNULATED SELF TAP SELF DRILL HEMISPHERICAL HEAD SUP-214.736 CDM 270010022 LOCAL 0270 RC outpatient 535.96 535.96 535.96 74 396.61 percent of total billed charges 535.96 93 434.13 percent of total billed charges 535.96 535.96 other OPPS APC 535.96 535.96 other OPPS APC 535.96 27.63 148.09 percent of total billed charges 535.96 535.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD REVERSE CUT FLUTE 38MM 4.5MM 6.5MM 1.75MM SS NS CANNULATED SELF TAP SELF DRILL HEMISPHERICAL HEAD SUP-214.738 CDM 270010022 LOCAL 0270 RC outpatient 535.96 535.96 535.96 74 396.61 percent of total billed charges 535.96 93 434.13 percent of total billed charges 535.96 535.96 other OPPS APC 535.96 535.96 other OPPS APC 535.96 27.63 148.09 percent of total billed charges 535.96 535.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 40MM 4.5MM 1.75MM SS NS CANNULATED SELF TAP SELF DRILL LG HEXAGONAL SUP-214.74 CDM 270010022 LOCAL 0270 RC outpatient 655.2 655.2 655.2 74 484.85 percent of total billed charges 655.2 93 530.71 percent of total billed charges 655.2 655.2 other OPPS APC 655.2 655.2 other OPPS APC 655.2 27.63 181.03 percent of total billed charges 655.2 655.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4.5MM 6.5MM 40MM SS 3.5MM FULL THREAD LONG BONE CANNULATED SELF DRILL SELF SUP-214.740 CDM 270010022 LOCAL 0270 RC outpatient 655.2 655.2 655.2 74 484.85 percent of total billed charges 655.2 93 530.71 percent of total billed charges 655.2 655.2 other OPPS APC 655.2 655.2 other OPPS APC 655.2 27.63 181.03 percent of total billed charges 655.2 655.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD REVERSE CUT FLUTE 42MM 4.5MM 6.5MM 1.75MM SS NS CANNULATED SELF TAP SELF DRILL HEMISPHERICAL HEAD SUP-214.742 CDM 270010022 LOCAL 0270 RC outpatient 535.96 535.96 535.96 74 396.61 percent of total billed charges 535.96 93 434.13 percent of total billed charges 535.96 535.96 other OPPS APC 535.96 535.96 other OPPS APC 535.96 27.63 148.09 percent of total billed charges 535.96 535.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD REVERSE CUT FLUTE 44MM 4.5MM 6.5MM 1.75MM SS NS CANNULATED SELF TAP SELF DRILL HEMISPHERICAL HEAD SUP-214.744 CDM 270010022 LOCAL 0270 RC outpatient 535.96 535.96 535.96 74 396.61 percent of total billed charges 535.96 93 434.13 percent of total billed charges 535.96 535.96 other OPPS APC 535.96 535.96 other OPPS APC 535.96 27.63 148.09 percent of total billed charges 535.96 535.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 46MM 4.5MM 1.75MM SS NS CANNULATED SELF TAP SELF DRILL LG HEXAGONAL SUP-214.746 CDM 270010022 LOCAL 0270 RC outpatient 535.96 535.96 535.96 74 396.61 percent of total billed charges 535.96 93 434.13 percent of total billed charges 535.96 535.96 other OPPS APC 535.96 535.96 other OPPS APC 535.96 27.63 148.09 percent of total billed charges 535.96 535.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L48 MM OD4.5 MM ODSEC6.5 MM ID7.5 MM LONG BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SUP-214.748 CDM 270010022 LOCAL 0270 RC outpatient 535.96 535.96 535.96 74 396.61 percent of total billed charges 535.96 93 434.13 percent of total billed charges 535.96 535.96 other OPPS APC 535.96 535.96 other OPPS APC 535.96 27.63 148.09 percent of total billed charges 535.96 535.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD REVERSE CUT FLUTE 50MM 4.5MM 6.5MM 1.75MM SS NS CANNULATED SELF TAP SELF DRILL HEMISPHERICAL HEAD SUP-214.75 CDM 270010022 LOCAL 0270 RC outpatient 528.53 528.53 528.53 74 391.11 percent of total billed charges 528.53 93 428.11 percent of total billed charges 528.53 528.53 other OPPS APC 528.53 528.53 other OPPS APC 528.53 27.63 146.03 percent of total billed charges 528.53 528.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4.5MM 6.5MM 7.5MM 50MM SS FULL THREAD LG HEXAGON HEMISPHERE REVERSE CUT SUP-214.750 CDM 270010022 LOCAL 0270 RC outpatient 528.53 528.53 528.53 74 391.11 percent of total billed charges 528.53 93 428.11 percent of total billed charges 528.53 528.53 other OPPS APC 528.53 528.53 other OPPS APC 528.53 27.63 146.03 percent of total billed charges 528.53 528.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L52 MM OD4.5 MM ODSEC6.5 MM ID7.5 MM LONG BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SUP-214.752 CDM 270010022 LOCAL 0270 RC outpatient 535.96 535.96 535.96 74 396.61 percent of total billed charges 535.96 93 434.13 percent of total billed charges 535.96 535.96 other OPPS APC 535.96 535.96 other OPPS APC 535.96 27.63 148.09 percent of total billed charges 535.96 535.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD REVERSE CUT FLUTE 54MM 4.5MM 6.5MM 1.75MM SS NS CANNULATED SELF TAP SELF DRILL HEMISPHERICAL HEAD SUP-214.754 CDM 270010022 LOCAL 0270 RC outpatient 535.96 535.96 535.96 74 396.61 percent of total billed charges 535.96 93 434.13 percent of total billed charges 535.96 535.96 other OPPS APC 535.96 535.96 other OPPS APC 535.96 27.63 148.09 percent of total billed charges 535.96 535.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD REVERSE CUT FLUTE 56MM 4.5MM 6.5MM 1.75MM SS NS CANNULATED SELF TAP SELF DRILL HEMISPHERICAL HEAD SUP-214.756 CDM 270010022 LOCAL 0270 RC outpatient 535.96 535.96 535.96 74 396.61 percent of total billed charges 535.96 93 434.13 percent of total billed charges 535.96 535.96 other OPPS APC 535.96 535.96 other OPPS APC 535.96 27.63 148.09 percent of total billed charges 535.96 535.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD REVERSE CUT FLUTE 64MM 4.5MM 6.5MM 1.75MM SS NS CANNULATED SELF TAP SELF DRILL HEMISPHERICAL HEAD SUP-214.764 CDM 270010022 LOCAL 0270 RC outpatient 535.96 535.96 535.96 74 396.61 percent of total billed charges 535.96 93 434.13 percent of total billed charges 535.96 535.96 other OPPS APC 535.96 535.96 other OPPS APC 535.96 27.63 148.09 percent of total billed charges 535.96 535.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L68 MM OD4.5 MM ODSEC6.5 MM ID7.5 MM LONG BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SUP-214.768 CDM 270010022 LOCAL 0270 RC outpatient 535.96 535.96 535.96 74 396.61 percent of total billed charges 535.96 93 434.13 percent of total billed charges 535.96 535.96 other OPPS APC 535.96 535.96 other OPPS APC 535.96 27.63 148.09 percent of total billed charges 535.96 535.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE L72 MM OD4.5 MM ODSEC6.5 MM ID7.5 MM LONG BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE SUP-214.772 CDM 270010022 LOCAL 0270 RC outpatient 535.96 535.96 535.96 74 396.61 percent of total billed charges 535.96 93 434.13 percent of total billed charges 535.96 535.96 other OPPS APC 535.96 535.96 other OPPS APC 535.96 27.63 148.09 percent of total billed charges 535.96 535.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 14MM 4.5MM SS NS CORTICAL SELF TAP LG HEXAGONAL LG FRAGMENT SET SUP-214.814 CDM 270010022 LOCAL 0270 RC outpatient 55.48 55.48 55.48 74 41.06 percent of total billed charges 55.48 93 44.94 percent of total billed charges 55.48 55.48 other OPPS APC 55.48 55.48 other OPPS APC 55.48 27.63 15.33 percent of total billed charges 55.48 55.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 16MM 4.5MM SS NS CORTEX SELF TAP LG HEXAGONAL LG FRAGMENT SET SUP-214.816 CDM 270010022 LOCAL 0270 RC outpatient 55.48 55.48 55.48 74 41.06 percent of total billed charges 55.48 93 44.94 percent of total billed charges 55.48 55.48 other OPPS APC 55.48 55.48 other OPPS APC 55.48 27.63 15.33 percent of total billed charges 55.48 55.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 18MM 4.5MM SS NS CORTEX SELF TAP LG HEXAGONAL LG FRAGMENT SET SUP-214.818 CDM 270010022 LOCAL 0270 RC outpatient 201.11 201.11 201.11 74 148.82 percent of total billed charges 201.11 93 162.9 percent of total billed charges 201.11 201.11 other OPPS APC 201.11 201.11 other OPPS APC 201.11 27.63 55.57 percent of total billed charges 201.11 201.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LARGE HEXAGON L20 MM OD4.5 MM ODSEC8 MM PERIARTICULAR CONDYLE CORTICAL SELF TAP SOCKET NONSTERILE LARGE FRAGMENT SET SUP-214.82 CDM 270010022 LOCAL 0270 RC outpatient 59.49 59.49 59.49 74 44.02 percent of total billed charges 59.49 93 48.19 percent of total billed charges 59.49 59.49 other OPPS APC 59.49 59.49 other OPPS APC 59.49 27.63 16.44 percent of total billed charges 59.49 59.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LARGE HEXAGON L20 MM OD4.5 MM ODSEC8 MM PERIARTICULAR CONDYLE CORTICAL SELF TAP SOCKET NONSTERILE LARGE FRAGMENT SET SUP-214.820 CDM 270010022 LOCAL 0270 RC outpatient 55.48 55.48 55.48 74 41.06 percent of total billed charges 55.48 93 44.94 percent of total billed charges 55.48 55.48 other OPPS APC 55.48 55.48 other OPPS APC 55.48 27.63 15.33 percent of total billed charges 55.48 55.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 22MM 4.5MM SS NS CORTICAL SELF TAP LG HEXAGONAL LG FRAGMENT SET SUP-214.822 CDM 270010022 LOCAL 0270 RC outpatient 55.48 55.48 55.48 74 41.06 percent of total billed charges 55.48 93 44.94 percent of total billed charges 55.48 55.48 other OPPS APC 55.48 55.48 other OPPS APC 55.48 27.63 15.33 percent of total billed charges 55.48 55.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 24MM 4.5MM SS NS CORTICAL SELF TAP LG HEXAGONAL LG FRAGMENT SET SUP-214.824 CDM 270010022 LOCAL 0270 RC outpatient 55.48 55.48 55.48 74 41.06 percent of total billed charges 55.48 93 44.94 percent of total billed charges 55.48 55.48 other OPPS APC 55.48 55.48 other OPPS APC 55.48 27.63 15.33 percent of total billed charges 55.48 55.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 26MM 4.5MM SS NS CORTICAL SELF TAP LG HEXAGONAL LG FRAGMENT SET SUP-214.826 CDM 270010022 LOCAL 0270 RC outpatient 55.48 55.48 55.48 74 41.06 percent of total billed charges 55.48 93 44.94 percent of total billed charges 55.48 55.48 other OPPS APC 55.48 55.48 other OPPS APC 55.48 27.63 15.33 percent of total billed charges 55.48 55.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 28MM 4.5MM SS NS CORTICAL SELF TAP LG HEXAGONAL LG FRAGMENT SET SUP-214.828 CDM 270010022 LOCAL 0270 RC outpatient 55.48 55.48 55.48 74 41.06 percent of total billed charges 55.48 93 44.94 percent of total billed charges 55.48 55.48 other OPPS APC 55.48 55.48 other OPPS APC 55.48 27.63 15.33 percent of total billed charges 55.48 55.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP 30MM 4.5MM 8MM SS NS PERIARTICULAR CONDYLE CORTICAL SELF TAPPING LG SUP-214.83 CDM outpatient 59.49 59.49 59.49 59.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L30 MM OD4.5 MM ODSEC8 MM PERIARTICULAR CONDYLE CORTICAL SELF TAPPING LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET SUP-214.830 CDM 270010022 LOCAL 0270 RC outpatient 55.48 55.48 55.48 74 41.06 percent of total billed charges 55.48 93 44.94 percent of total billed charges 55.48 55.48 other OPPS APC 55.48 55.48 other OPPS APC 55.48 27.63 15.33 percent of total billed charges 55.48 55.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 32MM 4.5MM SS NS CORTICAL SELF TAP LG HEXAGONAL LG FRAGMENT SET SUP-214.832 CDM 270010022 LOCAL 0270 RC outpatient 55.48 55.48 55.48 74 41.06 percent of total billed charges 55.48 93 44.94 percent of total billed charges 55.48 55.48 other OPPS APC 55.48 55.48 other OPPS APC 55.48 27.63 15.33 percent of total billed charges 55.48 55.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 34MM 4.5MM SS NS CORTICAL SELF TAP LG HEXAGONAL LG FRAGMENT SET SUP-214.834 CDM 270010022 LOCAL 0270 RC outpatient 201.11 201.11 201.11 74 148.82 percent of total billed charges 201.11 93 162.9 percent of total billed charges 201.11 201.11 other OPPS APC 201.11 201.11 other OPPS APC 201.11 27.63 55.57 percent of total billed charges 201.11 201.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 36MM 4.5MM SS NS CORTICAL SELF TAP LG HEXAGONAL LG FRAGMENT SET SUP-214.836 CDM 270010022 LOCAL 0270 RC outpatient 55.48 55.48 55.48 74 41.06 percent of total billed charges 55.48 93 44.94 percent of total billed charges 55.48 55.48 other OPPS APC 55.48 55.48 other OPPS APC 55.48 27.63 15.33 percent of total billed charges 55.48 55.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 38MM 4.5MM SS NS CORTICAL SELF TAP LG HEXAGONAL LG FRAGMENT SET SUP-214.838 CDM 270010022 LOCAL 0270 RC outpatient 201.11 201.11 201.11 74 148.82 percent of total billed charges 201.11 93 162.9 percent of total billed charges 201.11 201.11 other OPPS APC 201.11 201.11 other OPPS APC 201.11 27.63 55.57 percent of total billed charges 201.11 201.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL STANDARD L40 MM OD4.5 MM CORTICAL SELF TAPPING TIP NONSTERILE SUP-214.840 CDM 270010022 LOCAL 0270 RC outpatient 55.48 55.48 55.48 74 41.06 percent of total billed charges 55.48 93 44.94 percent of total billed charges 55.48 55.48 other OPPS APC 55.48 55.48 other OPPS APC 55.48 27.63 15.33 percent of total billed charges 55.48 55.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 42MM 4.5MM SS NS CORTICAL SELF TAP LG HEXAGONAL LG FRAGMENT SET SUP-214.842 CDM 270010022 LOCAL 0270 RC outpatient 201.11 201.11 201.11 74 148.82 percent of total billed charges 201.11 93 162.9 percent of total billed charges 201.11 201.11 other OPPS APC 201.11 201.11 other OPPS APC 201.11 27.63 55.57 percent of total billed charges 201.11 201.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 44MM 4.5MM SS NS CORTEX SELF TAP LG HEXAGONAL LG FRAGMENT SET SUP-214.844 CDM 270010022 LOCAL 0270 RC outpatient 55.48 55.48 55.48 74 41.06 percent of total billed charges 55.48 93 44.94 percent of total billed charges 55.48 55.48 other OPPS APC 55.48 55.48 other OPPS APC 55.48 27.63 15.33 percent of total billed charges 55.48 55.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 46MM 4.5MM SS NS CORTICAL SELF TAP LG HEXAGONAL LG FRAGMENT SET SUP-214.846 CDM 270010022 LOCAL 0270 RC outpatient 55.48 55.48 55.48 74 41.06 percent of total billed charges 55.48 93 44.94 percent of total billed charges 55.48 55.48 other OPPS APC 55.48 55.48 other OPPS APC 55.48 27.63 15.33 percent of total billed charges 55.48 55.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 48MM 4.5MM SS NS CORTICAL SELF TAP LG HEXAGONAL LG FRAGMENT SET SUP-214.848 CDM 270010022 LOCAL 0270 RC outpatient 55.48 55.48 55.48 74 41.06 percent of total billed charges 55.48 93 44.94 percent of total billed charges 55.48 55.48 other OPPS APC 55.48 55.48 other OPPS APC 55.48 27.63 15.33 percent of total billed charges 55.48 55.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L50 MM OD4.5 MM ODSEC8 MM PERIARTICULAR CONDYLE CORTICAL SELF TAPPING LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET SUP-214.850 CDM 270010022 LOCAL 0270 RC outpatient 201.11 201.11 201.11 74 148.82 percent of total billed charges 201.11 93 162.9 percent of total billed charges 201.11 201.11 other OPPS APC 201.11 201.11 other OPPS APC 201.11 27.63 55.57 percent of total billed charges 201.11 201.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4.5MM 52MM LC-DCP DHS DCS SS CORTEX SELF TAP NS LG FRAGMENT SET SUP-214.852 CDM 270010022 LOCAL 0270 RC outpatient 56.78 56.78 56.78 74 42.02 percent of total billed charges 56.78 93 45.99 percent of total billed charges 56.78 56.78 other OPPS APC 56.78 56.78 other OPPS APC 56.78 27.63 15.69 percent of total billed charges 56.78 56.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 54MM 4.5MM SS NS CORTICAL SELF TAP LG HEXAGONAL LG FRAGMENT SET SUP-214.854 CDM 270010022 LOCAL 0270 RC outpatient 55.48 55.48 55.48 74 41.06 percent of total billed charges 55.48 93 44.94 percent of total billed charges 55.48 55.48 other OPPS APC 55.48 55.48 other OPPS APC 55.48 27.63 15.33 percent of total billed charges 55.48 55.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 56MM 4.5MM SS NS CORTEX SELF TAP LG HEXAGONAL LG FRAGMENT SET SUP-214.856 CDM 270010022 LOCAL 0270 RC outpatient 201.11 201.11 201.11 74 148.82 percent of total billed charges 201.11 93 162.9 percent of total billed charges 201.11 201.11 other OPPS APC 201.11 201.11 other OPPS APC 201.11 27.63 55.57 percent of total billed charges 201.11 201.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LARGE HEXAGON L58 MM OD4.5 MM ODSEC8 MM PERIARTICULAR CONDYLE CORTICAL SELF TAP SOCKET NONSTERILE LARGE FRAGMENT SET SUP-214.858 CDM 270010022 LOCAL 0270 RC outpatient 201.11 201.11 201.11 74 148.82 percent of total billed charges 201.11 93 162.9 percent of total billed charges 201.11 201.11 other OPPS APC 201.11 201.11 other OPPS APC 201.11 27.63 55.57 percent of total billed charges 201.11 201.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 60MM 4.5MM SS NS CORTEX SELF TAP LG HEXAGONAL LG FRAGMENT SET SUP-214.860 CDM 270010022 LOCAL 0270 RC outpatient 201.11 201.11 201.11 74 148.82 percent of total billed charges 201.11 93 162.9 percent of total billed charges 201.11 201.11 other OPPS APC 201.11 201.11 other OPPS APC 201.11 27.63 55.57 percent of total billed charges 201.11 201.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LARGE HEXAGON L62 MM OD4.5 MM ODSEC8 MM PERIARTICULAR CONDYLE CORTICAL SELF TAP SOCKET NONSTERILE LARGE FRAGMENT SET SUP-214.862 CDM 270010022 LOCAL 0270 RC outpatient 55.48 55.48 55.48 74 41.06 percent of total billed charges 55.48 93 44.94 percent of total billed charges 55.48 55.48 other OPPS APC 55.48 55.48 other OPPS APC 55.48 27.63 15.33 percent of total billed charges 55.48 55.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L64 MM OD4.5 MM ODSEC8 MM PERIARTICULAR CONDYLE CORTICAL SELF TAPPING LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET SUP-214.864 CDM 270010022 LOCAL 0270 RC outpatient 55.48 55.48 55.48 74 41.06 percent of total billed charges 55.48 93 44.94 percent of total billed charges 55.48 55.48 other OPPS APC 55.48 55.48 other OPPS APC 55.48 27.63 15.33 percent of total billed charges 55.48 55.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 66MM 4.5MM 8MM SS NS CORTEX SELF TAP LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-214.866 CDM 270010022 LOCAL 0270 RC outpatient 201.11 201.11 201.11 74 148.82 percent of total billed charges 201.11 93 162.9 percent of total billed charges 201.11 201.11 other OPPS APC 201.11 201.11 other OPPS APC 201.11 27.63 55.57 percent of total billed charges 201.11 201.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L68 MM OD4.5 MM ODSEC8 MM PERIARTICULAR CONDYLE CORTICAL SELF TAPPING LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET SUP-214.868 CDM 270010022 LOCAL 0270 RC outpatient 55.48 55.48 55.48 74 41.06 percent of total billed charges 55.48 93 44.94 percent of total billed charges 55.48 55.48 other OPPS APC 55.48 55.48 other OPPS APC 55.48 27.63 15.33 percent of total billed charges 55.48 55.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LARGE HEXAGON L70 MM OD4.5 MM ODSEC8 MM PERIARTICULAR CONDYLE CORTICAL SELF TAP SOCKET NONSTERILE LARGE FRAGMENT SET SUP-214.87 CDM 270010022 LOCAL 0270 RC outpatient 59.49 59.49 59.49 74 44.02 percent of total billed charges 59.49 93 48.19 percent of total billed charges 59.49 59.49 other OPPS APC 59.49 59.49 other OPPS APC 59.49 27.63 16.44 percent of total billed charges 59.49 59.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4.5MM 8MM 70MM LCP SS LG HEXAGON PERIARTICULAR CONDYLE CORTICAL SELF TAP SUP-214.870 CDM outpatient 59.49 59.49 59.49 59.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET SUP-214.870 CDM 270010022 LOCAL 0270 RC outpatient 55.48 55.48 55.48 74 41.06 percent of total billed charges 55.48 93 44.94 percent of total billed charges 55.48 55.48 other OPPS APC 55.48 55.48 other OPPS APC 55.48 27.63 15.33 percent of total billed charges 55.48 55.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 72MM 4.5MM SS NS CORTEX SELF TAP LG HEXAGONAL LG FRAGMENT SET SUP-214.872 CDM 270010022 LOCAL 0270 RC outpatient 55.48 55.48 55.48 74 41.06 percent of total billed charges 55.48 93 44.94 percent of total billed charges 55.48 55.48 other OPPS APC 55.48 55.48 other OPPS APC 55.48 27.63 15.33 percent of total billed charges 55.48 55.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L76 MM OD4.5 MM ODSEC8 MM PERIARTICULAR CONDYLE CORTICAL SELF TAP HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET SUP-214.876 CDM 270010022 LOCAL 0270 RC outpatient 97.11 97.11 97.11 74 71.86 percent of total billed charges 97.11 93 78.66 percent of total billed charges 97.11 97.11 other OPPS APC 97.11 97.11 other OPPS APC 97.11 27.63 26.83 percent of total billed charges 97.11 97.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 80MM 4.5MM SS NS CORTEX SELF TAP LG HEXAGONAL LG FRAGMENT SET SUP-214.880 CDM 270010022 LOCAL 0270 RC outpatient 97.11 97.11 97.11 74 71.86 percent of total billed charges 97.11 93 78.66 percent of total billed charges 97.11 97.11 other OPPS APC 97.11 97.11 other OPPS APC 97.11 27.63 26.83 percent of total billed charges 97.11 97.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L85 MM OD4.5 MM ODSEC8 MM PERIARTICULAR CONDYLE CORTICAL SELF TAP HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET SUP-214.885 CDM 270010022 LOCAL 0270 RC outpatient 91.75 91.75 91.75 74 67.9 percent of total billed charges 91.75 93 74.32 percent of total billed charges 91.75 91.75 other OPPS APC 91.75 91.75 other OPPS APC 91.75 27.63 25.35 percent of total billed charges 91.75 91.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 90MM 4.5MM SS NS CORTEX SELF TAP LG HEXAGONAL LG FRAGMENT SET SUP-214.890 CDM 270010022 LOCAL 0270 RC outpatient 110.11 110.11 110.11 74 81.48 percent of total billed charges 110.11 93 89.19 percent of total billed charges 110.11 110.11 other OPPS APC 110.11 110.11 other OPPS APC 110.11 27.63 30.42 percent of total billed charges 110.11 110.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM SELF-TAPPING CORTEX 95MM SUP-214.895 CDM 270010025 LOCAL 0270 RC outpatient 97.11 97.11 97.11 74 71.86 percent of total billed charges 97.11 93 78.66 percent of total billed charges 97.11 97.11 other OPPS APC 97.11 97.11 other OPPS APC 97.11 27.63 26.83 percent of total billed charges 97.11 97.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5 MM SELF-TAPPING CORTEX 100MM SUP-214.900 CDM 270010025 LOCAL 0270 RC outpatient 97.11 97.11 97.11 74 71.86 percent of total billed charges 97.11 93 78.66 percent of total billed charges 97.11 97.11 other OPPS APC 97.11 97.11 other OPPS APC 97.11 27.63 26.83 percent of total billed charges 97.11 97.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5 MM SELF-TAPPING CORTEX 105MM SUP-214.905 CDM 270010025 LOCAL 0270 RC outpatient 97.11 97.11 97.11 74 71.86 percent of total billed charges 97.11 93 78.66 percent of total billed charges 97.11 97.11 other OPPS APC 97.11 97.11 other OPPS APC 97.11 27.63 26.83 percent of total billed charges 97.11 97.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM SELF-TAPPING CORTEX 110MM SUP-214.910 CDM 270010025 LOCAL 0270 RC outpatient 91.75 91.75 91.75 74 67.9 percent of total billed charges 91.75 93 74.32 percent of total billed charges 91.75 91.75 other OPPS APC 91.75 91.75 other OPPS APC 91.75 27.63 25.35 percent of total billed charges 91.75 91.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM SELF-TAPPING CORTEX 115MM SUP-214.915 CDM 270010025 LOCAL 0270 RC outpatient 91.75 91.75 91.75 74 67.9 percent of total billed charges 91.75 93 74.32 percent of total billed charges 91.75 91.75 other OPPS APC 91.75 91.75 other OPPS APC 91.75 27.63 25.35 percent of total billed charges 91.75 91.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM SELF-TAPPING CORTEX 120MM SUP-214.920 CDM 270010025 LOCAL 0270 RC outpatient 91.75 91.75 91.75 74 67.9 percent of total billed charges 91.75 93 74.32 percent of total billed charges 91.75 91.75 other OPPS APC 91.75 91.75 other OPPS APC 91.75 27.63 25.35 percent of total billed charges 91.75 91.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM SELF-TAPPING CORTEX 125MM SUP-214.925 CDM 270010025 LOCAL 0270 RC outpatient 91.75 91.75 91.75 74 67.9 percent of total billed charges 91.75 93 74.32 percent of total billed charges 91.75 91.75 other OPPS APC 91.75 91.75 other OPPS APC 91.75 27.63 25.35 percent of total billed charges 91.75 91.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM SELF-TAPPING CORTEX 130MM SUP-214.930 CDM 270010025 LOCAL 0270 RC outpatient 91.75 91.75 91.75 74 67.9 percent of total billed charges 91.75 93 74.32 percent of total billed charges 91.75 91.75 other OPPS APC 91.75 91.75 other OPPS APC 91.75 27.63 25.35 percent of total billed charges 91.75 91.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM SELF-TAPPING CORTEX 135MM SUP-214.935 CDM 270010025 LOCAL 0270 RC outpatient 97.11 97.11 97.11 74 71.86 percent of total billed charges 97.11 93 78.66 percent of total billed charges 97.11 97.11 other OPPS APC 97.11 97.11 other OPPS APC 97.11 27.63 26.83 percent of total billed charges 97.11 97.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SUTURE RICHARD-ALLAN KELLY STAINLESS STEEL 1/2 CIRCLE L1.53 IN OD.037 IN INTESTINAL TAPER POINT FREE EYE STERILE LATEX FREE SUP-214001 CDM 0270 RC outpatient 15.48 15.48 15.48 74 11.46 percent of total billed charges 15.48 93 12.54 percent of total billed charges 15.48 15.48 other OPPS APC 15.48 15.48 other OPPS APC 15.48 27.63 4.28 percent of total billed charges 15.48 15.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA ARTHROSCOPIC L75 MM ID7 MM SUP-214115 CDM 270010022 LOCAL 0270 RC outpatient 89.44 89.44 89.44 74 66.19 percent of total billed charges 89.44 93 72.45 percent of total billed charges 89.44 89.44 other OPPS APC 89.44 89.44 other OPPS APC 89.44 27.63 24.71 percent of total billed charges 89.44 89.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA ARTHROSCOPIC POLYCARBONATE L75 MM ID7 MM 3 SEAL DAM THREAD OBTURATOR PRESSURE CONTROL STERILE LATEX FREE DISPOSABLE CLEAR SUP-214116 CDM 0270 RC outpatient 103.33 103.33 103.33 74 76.46 percent of total billed charges 103.33 93 83.7 percent of total billed charges 103.33 103.33 other OPPS APC 103.33 103.33 other OPPS APC 103.33 27.63 28.55 percent of total billed charges 103.33 103.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA ARTHROSCOPIC POLYCARBONATE L75 MM ID8.5 MM 3 SEAL DAM THREAD OBTURATOR STABILITY PRESSURE CONTROL STERILE LATEX FREE DISPOSABLE SUP-214120 CDM 0270 RC outpatient 95.68 95.68 95.68 74 70.8 percent of total billed charges 95.68 93 77.5 percent of total billed charges 95.68 95.68 other OPPS APC 95.68 95.68 other OPPS APC 95.68 27.63 26.44 percent of total billed charges 95.68 95.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA 8.5X90MM SUP-214122 CDM 0270 RC outpatient 103.33 103.33 103.33 74 76.46 percent of total billed charges 103.33 93 83.7 percent of total billed charges 103.33 103.33 other OPPS APC 103.33 103.33 other OPPS APC 103.33 27.63 28.55 percent of total billed charges 103.33 103.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SUTURE EXPRESSEW III DISPOSABLE FLEX SUP-214141 CDM 0270 RC outpatient 837.72 837.72 837.72 74 619.91 percent of total billed charges 837.72 93 678.55 percent of total billed charges 837.72 837.72 other OPPS APC 837.72 837.72 other OPPS APC 837.72 27.63 231.46 percent of total billed charges 837.72 837.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 25MM 12MM 4.5MM 8MM SS NS MALLEOLAR HEXAGONAL SOCKET LG FRAGMENT SET SUP-215.025 CDM 270010022 LOCAL 0270 RC outpatient 109.38 109.38 109.38 74 80.94 percent of total billed charges 109.38 93 88.6 percent of total billed charges 109.38 109.38 other OPPS APC 109.38 109.38 other OPPS APC 109.38 27.63 30.22 percent of total billed charges 109.38 109.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD L30 MM L15 MM OD4.5 MM ODSEC8 MM MALLEOLUS TIBIA HEXAGONAL SOCKET NONSTERILE SUP-215.03 CDM 270010022 LOCAL 0270 RC outpatient 109.38 109.38 109.38 74 80.94 percent of total billed charges 109.38 93 88.6 percent of total billed charges 109.38 109.38 other OPPS APC 109.38 109.38 other OPPS APC 109.38 27.63 30.22 percent of total billed charges 109.38 109.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4.5MM 8MM 30MM 15MM LCP SS PARTIAL THREAD MALLEOLUS TIBIA HEXAGONAL SOCKET SUP-215.030 CDM outpatient 109.38 109.38 109.38 109.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 35MM 12MM 4.5MM 8MM SS NS MALLEOLAR HEXAGONAL SOCKET LG FRAGMENT SET SUP-215.035 CDM 270010022 LOCAL 0270 RC outpatient 109.38 109.38 109.38 74 80.94 percent of total billed charges 109.38 93 88.6 percent of total billed charges 109.38 109.38 other OPPS APC 109.38 109.38 other OPPS APC 109.38 27.63 30.22 percent of total billed charges 109.38 109.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 40MM 12MM 4.5MM 8MM SS NS MALLEOLAR HEXAGONAL SOCKET LG FRAGMENT SET SUP-215.04 CDM 270010022 LOCAL 0270 RC outpatient 109.38 109.38 109.38 74 80.94 percent of total billed charges 109.38 93 88.6 percent of total billed charges 109.38 109.38 other OPPS APC 109.38 109.38 other OPPS APC 109.38 27.63 30.22 percent of total billed charges 109.38 109.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4.5MM 40MM DCP LC-DCP SS MALLEOLAR NS LG FRAGMENT SET SUP-215.040 CDM outpatient 109.38 109.38 109.38 109.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 45MM 22MM 4.5MM 8MM SS NS MALLEOLAR HEXAGONAL SOCKET LG FRAGMENT SET SUP-215.045 CDM 270010022 LOCAL 0270 RC outpatient 109.38 109.38 109.38 74 80.94 percent of total billed charges 109.38 93 88.6 percent of total billed charges 109.38 109.38 other OPPS APC 109.38 109.38 other OPPS APC 109.38 27.63 30.22 percent of total billed charges 109.38 109.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 50MM 24MM 4.5MM SS NS MALLEOLUS HEXAGONAL LG FRAGMENT SET SUP-215.05 CDM 270010022 LOCAL 0270 RC outpatient 109.38 109.38 109.38 74 80.94 percent of total billed charges 109.38 93 88.6 percent of total billed charges 109.38 109.38 other OPPS APC 109.38 109.38 other OPPS APC 109.38 27.63 30.22 percent of total billed charges 109.38 109.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4.5MM 8MM 50MM 24MM LCP SS PARTIAL THREAD MALLEOLAR TIBIA HEXAGONAL SOCKET SUP-215.050 CDM outpatient 109.38 109.38 109.38 109.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 55MM 26MM 4.5MM 8MM SS NS MALLEOLAR HEXAGONAL SOCKET LG FRAGMENT SET SUP-215.055 CDM 270010022 LOCAL 0270 RC outpatient 109.38 109.38 109.38 74 80.94 percent of total billed charges 109.38 93 88.6 percent of total billed charges 109.38 109.38 other OPPS APC 109.38 109.38 other OPPS APC 109.38 27.63 30.22 percent of total billed charges 109.38 109.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL 3.5 MM L60 MM L28 MM OD4.5 MM ODSEC8 MM MALLEOLAR HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET SUP-215.06 CDM 270010022 LOCAL 0270 RC outpatient 109.38 109.38 109.38 74 80.94 percent of total billed charges 109.38 93 88.6 percent of total billed charges 109.38 109.38 other OPPS APC 109.38 109.38 other OPPS APC 109.38 27.63 30.22 percent of total billed charges 109.38 109.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4.5MM 8MM 60MM 28MM LCP SS 3.5MM MALLEOLAR HEXAGONAL SOCKET NS LG FRAGMENT SUP-215.060 CDM outpatient 109.38 109.38 109.38 109.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 65MM 30MM 4.5MM 8MM SS NS MALLEOLAR HEXAGONAL SOCKET LG FRAGMENT SET SUP-215.065 CDM 270010022 LOCAL 0270 RC outpatient 109.38 109.38 109.38 74 80.94 percent of total billed charges 109.38 93 88.6 percent of total billed charges 109.38 109.38 other OPPS APC 109.38 109.38 other OPPS APC 109.38 27.63 30.22 percent of total billed charges 109.38 109.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 70MM 32MM 4.5MM 8MM SS NS MALLEOLAR HEXAGONAL SOCKET LG FRAGMENT SET SUP-215.07 CDM 270010022 LOCAL 0270 RC outpatient 85.8 85.8 85.8 74 63.49 percent of total billed charges 85.8 93 69.5 percent of total billed charges 85.8 85.8 other OPPS APC 85.8 85.8 other OPPS APC 85.8 27.63 23.71 percent of total billed charges 85.8 85.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4.5MM 8MM 70MM 32MM LCP SS 3.5MM MALLEOLAR HEXAGONAL SOCKET NS LG FRAGMENT SUP-215.070 CDM outpatient 85.8 85.8 85.8 85.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER LUMBAR SUP-21509D CDM 0270 RC outpatient 1388.4 1388.4 1388.4 74 1027.42 percent of total billed charges 1388.4 93 1124.6 percent of total billed charges 1388.4 1388.4 other OPPS APC 1388.4 1388.4 other OPPS APC 1388.4 27.63 383.61 percent of total billed charges 1388.4 1388.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON ANGIOSCULPT OTW US PTA 2.5 X 40MM 137MM SUP-2155-2540 CDM 0481 RC outpatient 2535 2535 2535 74 1875.9 percent of total billed charges 2535 93 2053.35 percent of total billed charges 2535 2535 other OPPS APC 2535 2535 other OPPS APC 2535 51 1292.85 percent of total billed charges 2535 2535 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE VASCULAR MANTA 14 FR SUP-2156 CDM 0481 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 51 1259.7 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP DCP LC-DCP STAINLESS STEEL LARGE HEXAGON L30 MM L16 MM OD6.5 MM ODSEC8 MM LONG BONE CANCELLOUS SOCKET NONSTERILE LARGE FRAGMENT SET SUP-216.03 CDM 270010022 LOCAL 0270 RC outpatient 116.4 116.4 116.4 74 86.14 percent of total billed charges 116.4 93 94.28 percent of total billed charges 116.4 116.4 other OPPS APC 116.4 116.4 other OPPS APC 116.4 27.63 32.16 percent of total billed charges 116.4 116.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.5MM 8MM 30MM 16MM LCP DCP LC-DCP SS LG HEXAGON LONG BONE CANCELLOUS SUP-216.030 CDM outpatient 116.4 116.4 116.4 116.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 35MM 16MM 6.5MM 8MM SS NS CANCELLOUS LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-216.035 CDM 270010022 LOCAL 0270 RC outpatient 84.6 84.6 84.6 74 62.6 percent of total billed charges 84.6 93 68.53 percent of total billed charges 84.6 84.6 other OPPS APC 84.6 84.6 other OPPS APC 84.6 27.63 23.37 percent of total billed charges 84.6 84.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 40MM 16MM 6.5MM SS NS CANCELLOUS LG HEXAGONAL LG FRAGMENT SET SUP-216.04 CDM 270010022 LOCAL 0270 RC outpatient 116.4 116.4 116.4 74 86.14 percent of total billed charges 116.4 93 94.28 percent of total billed charges 116.4 116.4 other OPPS APC 116.4 116.4 other OPPS APC 116.4 27.63 32.16 percent of total billed charges 116.4 116.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.5MM 8MM 40MM 16MM LCP SS PARTIAL THREAD CANCELLOUS LG HEXAGONAL SOCKET SUP-216.040 CDM outpatient 116.4 116.4 116.4 116.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD L45 MM L16 MM OD6.5 MM ODSEC8 MM CANCELLOUS LONG BONE LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET SUP-216.045 CDM 270010022 LOCAL 0270 RC outpatient 84.6 84.6 84.6 74 62.6 percent of total billed charges 84.6 93 68.53 percent of total billed charges 84.6 84.6 other OPPS APC 84.6 84.6 other OPPS APC 84.6 27.63 23.37 percent of total billed charges 84.6 84.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 50MM 16MM 6.5MM 8MM SS NS CANCELLOUS LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-216.05 CDM 270010022 LOCAL 0270 RC outpatient 89.23 89.23 89.23 74 66.03 percent of total billed charges 89.23 93 72.28 percent of total billed charges 89.23 89.23 other OPPS APC 89.23 89.23 other OPPS APC 89.23 27.63 24.65 percent of total billed charges 89.23 89.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.5MM 8MM 50MM 16MM LCP DCP LC-DCP SS LG HEXAGON LONG BONE CANCELLOUS SUP-216.050 CDM outpatient 89.23 89.23 89.23 89.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD L55 MM L16 MM OD6.5 MM ODSEC8 MM CANCELLOUS LONG BONE LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET SUP-216.055 CDM 270010022 LOCAL 0270 RC outpatient 84.6 84.6 84.6 74 62.6 percent of total billed charges 84.6 93 68.53 percent of total billed charges 84.6 84.6 other OPPS APC 84.6 84.6 other OPPS APC 84.6 27.63 23.37 percent of total billed charges 84.6 84.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 60MM 16MM 6.5MM 8MM SS NS CANCELLOUS LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-216.06 CDM 270010022 LOCAL 0270 RC outpatient 89.23 89.23 89.23 74 66.03 percent of total billed charges 89.23 93 72.28 percent of total billed charges 89.23 89.23 other OPPS APC 89.23 89.23 other OPPS APC 89.23 27.63 24.65 percent of total billed charges 89.23 89.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.5MM 8MM 60MM 16MM LCP SS PARTIAL THREAD CANCELLOUS LONG BONE LG SUP-216.060 CDM outpatient 89.23 89.23 89.23 89.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 65MM 16MM 6.5MM 8MM SS NS CANCELLOUS LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-216.065 CDM 270010022 LOCAL 0270 RC outpatient 84.6 84.6 84.6 74 62.6 percent of total billed charges 84.6 93 68.53 percent of total billed charges 84.6 84.6 other OPPS APC 84.6 84.6 other OPPS APC 84.6 27.63 23.37 percent of total billed charges 84.6 84.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 70MM 16MM 6.5MM 8MM SS NS CANCELLOUS LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-216.07 CDM 270010022 LOCAL 0270 RC outpatient 116.4 116.4 116.4 74 86.14 percent of total billed charges 116.4 93 94.28 percent of total billed charges 116.4 116.4 other OPPS APC 116.4 116.4 other OPPS APC 116.4 27.63 32.16 percent of total billed charges 116.4 116.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.5MM 8MM 70MM 16MM LCP SS PARTIAL THREAD CANCELLOUS LONG BONE LG SUP-216.070 CDM outpatient 116.4 116.4 116.4 116.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD L75 MM L16 MM OD6.5 MM ODSEC8 MM CANCELLOUS LONG BONE LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET SUP-216.075 CDM 270010022 LOCAL 0270 RC outpatient 84.6 84.6 84.6 74 62.6 percent of total billed charges 84.6 93 68.53 percent of total billed charges 84.6 84.6 other OPPS APC 84.6 84.6 other OPPS APC 84.6 27.63 23.37 percent of total billed charges 84.6 84.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 80MM 16MM 6.5MM 8MM SS NS CANCELLOUS LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-216.08 CDM 270010022 LOCAL 0270 RC outpatient 116.4 116.4 116.4 74 86.14 percent of total billed charges 116.4 93 94.28 percent of total billed charges 116.4 116.4 other OPPS APC 116.4 116.4 other OPPS APC 116.4 27.63 32.16 percent of total billed charges 116.4 116.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.5MM 8MM 80MM 16MM LCP SS PARTIAL THREAD CANCELLOUS LONG BONE LG SUP-216.080 CDM outpatient 116.4 116.4 116.4 116.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 85MM 16MM 6.5MM 8MM SS NS CANCELLOUS LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-216.085 CDM 270010022 LOCAL 0270 RC outpatient 91.75 91.75 91.75 74 67.9 percent of total billed charges 91.75 93 74.32 percent of total billed charges 91.75 91.75 other OPPS APC 91.75 91.75 other OPPS APC 91.75 27.63 25.35 percent of total billed charges 91.75 91.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 90MM 16MM 6.5MM 8MM SS NS CANCELLOUS LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-216.09 CDM 270010022 LOCAL 0270 RC outpatient 127.53 127.53 127.53 74 94.37 percent of total billed charges 127.53 93 103.3 percent of total billed charges 127.53 127.53 other OPPS APC 127.53 127.53 other OPPS APC 127.53 27.63 35.24 percent of total billed charges 127.53 127.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.5MM 8MM 90MM 16MM LCP SS PARTIAL THREAD CANCELLOUS LONG BONE LG SUP-216.090 CDM outpatient 127.53 127.53 127.53 127.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 95MM 16MM 6.5MM 8MM SS NS CANCELLOUS LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-216.095 CDM 270010022 LOCAL 0270 RC outpatient 91.75 91.75 91.75 74 67.9 percent of total billed charges 91.75 93 74.32 percent of total billed charges 91.75 91.75 other OPPS APC 91.75 91.75 other OPPS APC 91.75 27.63 25.35 percent of total billed charges 91.75 91.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 100MM 16MM 6.5MM 8MM SS NS CANCELLOUS LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-216.1 CDM 270010022 LOCAL 0270 RC outpatient 127.53 127.53 127.53 74 94.37 percent of total billed charges 127.53 93 103.3 percent of total billed charges 127.53 127.53 other OPPS APC 127.53 127.53 other OPPS APC 127.53 27.63 35.24 percent of total billed charges 127.53 127.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.5MM 8MM 100MM 16MM LCP SS PARTIAL THREAD CANCELLOUS LONG BONE LG SUP-216.100 CDM outpatient 127.53 127.53 127.53 127.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 105MM 16MM 6.5MM 8MM SS NS CANCELLOUS LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-216.105 CDM 270010022 LOCAL 0270 RC outpatient 91.75 91.75 91.75 74 67.9 percent of total billed charges 91.75 93 74.32 percent of total billed charges 91.75 91.75 other OPPS APC 91.75 91.75 other OPPS APC 91.75 27.63 25.35 percent of total billed charges 91.75 91.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 110MM 16MM 6.5MM 8MM SS NS CANCELLOUS LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-216.11 CDM 270010022 LOCAL 0270 RC outpatient 127.53 127.53 127.53 74 94.37 percent of total billed charges 127.53 93 103.3 percent of total billed charges 127.53 127.53 other OPPS APC 127.53 127.53 other OPPS APC 127.53 27.63 35.24 percent of total billed charges 127.53 127.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 110MM 16MM 6.5MM 8MM SS NS CANCELLOUS LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-216.110 CDM 270010022 LOCAL 0270 RC outpatient 419.9 419.9 419.9 74 310.73 percent of total billed charges 419.9 93 340.12 percent of total billed charges 419.9 419.9 other OPPS APC 419.9 419.9 other OPPS APC 419.9 27.63 116.02 percent of total billed charges 419.9 419.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 45MM 32MM 6.5MM SS NS CANCELLOUS LG HEXAGONAL SUP-217.045 CDM 270010022 LOCAL 0270 RC outpatient 84.6 84.6 84.6 74 62.6 percent of total billed charges 84.6 93 68.53 percent of total billed charges 84.6 84.6 other OPPS APC 84.6 84.6 other OPPS APC 84.6 27.63 23.37 percent of total billed charges 84.6 84.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD L50 MM L32 MM OD6.5 MM ODSEC8 MM CANCELLOUS LONG BONE LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET SUP-217.05 CDM 270010022 LOCAL 0270 RC outpatient 116.4 116.4 116.4 74 86.14 percent of total billed charges 116.4 93 94.28 percent of total billed charges 116.4 116.4 other OPPS APC 116.4 116.4 other OPPS APC 116.4 27.63 32.16 percent of total billed charges 116.4 116.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.5MM 8MM 50MM 32MM LCP SS PARTIAL THREAD CANCELLOUS LONG BONE LG SUP-217.050 CDM outpatient 116.4 116.4 116.4 116.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 55MM 32MM 6.5MM SS NS CANCELLOUS LG HEXAGONAL SUP-217.055 CDM 270010022 LOCAL 0270 RC outpatient 84.6 84.6 84.6 74 62.6 percent of total billed charges 84.6 93 68.53 percent of total billed charges 84.6 84.6 other OPPS APC 84.6 84.6 other OPPS APC 84.6 27.63 23.37 percent of total billed charges 84.6 84.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD L60 MM L32 MM OD6.5 MM HUMERUS FEMUR CANCELLOUS NONSTERILE LARGE FRAGMENT SET SUP-217.06 CDM 270010022 LOCAL 0270 RC outpatient 116.4 116.4 116.4 74 86.14 percent of total billed charges 116.4 93 94.28 percent of total billed charges 116.4 116.4 other OPPS APC 116.4 116.4 other OPPS APC 116.4 27.63 32.16 percent of total billed charges 116.4 116.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD L60 MM L32 MM OD6.5 MM HUMERUS FEMUR CANCELLOUS NONSTERILE LARGE FRAGMENT SET SUP-217.060 CDM 270010022 LOCAL 0270 RC outpatient 388.96 388.96 388.96 74 287.83 percent of total billed charges 388.96 93 315.06 percent of total billed charges 388.96 388.96 other OPPS APC 388.96 388.96 other OPPS APC 388.96 27.63 107.47 percent of total billed charges 388.96 388.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD L65 MM L32 MM OD6.5 MM ODSEC8 MM CANCELLOUS LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET SUP-217.065 CDM 270010022 LOCAL 0270 RC outpatient 89.54 89.54 89.54 74 66.26 percent of total billed charges 89.54 93 72.53 percent of total billed charges 89.54 89.54 other OPPS APC 89.54 89.54 other OPPS APC 89.54 27.63 24.74 percent of total billed charges 89.54 89.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD L70 MM L32 MM OD6.5 MM ODSEC8 MM CANCELLOUS LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET SUP-217.07 CDM 270010022 LOCAL 0270 RC outpatient 116.4 116.4 116.4 74 86.14 percent of total billed charges 116.4 93 94.28 percent of total billed charges 116.4 116.4 other OPPS APC 116.4 116.4 other OPPS APC 116.4 27.63 32.16 percent of total billed charges 116.4 116.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.5MM 8MM 70MM 32MM LCP SS PARTIAL THREAD CANCELLOUS LG HEXAGONAL SOCKET SUP-217.070 CDM outpatient 116.4 116.4 116.4 116.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD L75 MM L32 MM OD6.5 MM ODSEC8 MM CANCELLOUS LONG BONE LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET SUP-217.075 CDM 270010022 LOCAL 0270 RC outpatient 84.6 84.6 84.6 74 62.6 percent of total billed charges 84.6 93 68.53 percent of total billed charges 84.6 84.6 other OPPS APC 84.6 84.6 other OPPS APC 84.6 27.63 23.37 percent of total billed charges 84.6 84.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD L80 MM L32 MM OD6.5 MM HUMERUS FEMUR CANCELLOUS NONSTERILE LARGE FRAGMENT SET SUP-217.08 CDM 270010022 LOCAL 0270 RC outpatient 89.23 89.23 89.23 74 66.03 percent of total billed charges 89.23 93 72.28 percent of total billed charges 89.23 89.23 other OPPS APC 89.23 89.23 other OPPS APC 89.23 27.63 24.65 percent of total billed charges 89.23 89.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD L80 MM L32 MM OD6.5 MM HUMERUS FEMUR CANCELLOUS NONSTERILE LARGE FRAGMENT SET SUP-217.080 CDM 270010022 LOCAL 0270 RC outpatient 89.54 89.54 89.54 74 66.26 percent of total billed charges 89.54 93 72.53 percent of total billed charges 89.54 89.54 other OPPS APC 89.54 89.54 other OPPS APC 89.54 27.63 24.74 percent of total billed charges 89.54 89.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD L85 MM L32 MM OD6.5 MM ODSEC8 MM CANCELLOUS LONG BONE LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET SUP-217.085 CDM 270010022 LOCAL 0270 RC outpatient 91.75 91.75 91.75 74 67.9 percent of total billed charges 91.75 93 74.32 percent of total billed charges 91.75 91.75 other OPPS APC 91.75 91.75 other OPPS APC 91.75 27.63 25.35 percent of total billed charges 91.75 91.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP DCP LC-DCP STAINLESS STEEL LARGE HEXAGON L90 MM L32 MM OD6.5 MM ODSEC8 MM LONG BONE CANCELLOUS SOCKET NONSTERILE LARGE FRAGMENT SET SUP-217.09 CDM 270010022 LOCAL 0270 RC outpatient 127.53 127.53 127.53 74 94.37 percent of total billed charges 127.53 93 103.3 percent of total billed charges 127.53 127.53 other OPPS APC 127.53 127.53 other OPPS APC 127.53 27.63 35.24 percent of total billed charges 127.53 127.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.5MM 8MM 90MM 32MM LCP DCP LC-DCP SS LG HEXAGON LONG BONE CANCELLOUS SUP-217.090 CDM outpatient 127.53 127.53 127.53 127.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 95MM 32MM 6.5MM 8MM SS NS CANCELLOUS LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-217.095 CDM 270010022 LOCAL 0270 RC outpatient 91.75 91.75 91.75 74 67.9 percent of total billed charges 91.75 93 74.32 percent of total billed charges 91.75 91.75 other OPPS APC 91.75 91.75 other OPPS APC 91.75 27.63 25.35 percent of total billed charges 91.75 91.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD 100MM 32MM 6.5MM 8MM SS NS CANCELLOUS LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-217.1 CDM 270010022 LOCAL 0270 RC outpatient 127.53 127.53 127.53 74 94.37 percent of total billed charges 127.53 93 103.3 percent of total billed charges 127.53 127.53 other OPPS APC 127.53 127.53 other OPPS APC 127.53 27.63 35.24 percent of total billed charges 127.53 127.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.5MM 8MM 100MM 32MM LCP SS PARTIAL THREAD CANCELLOUS LONG BONE LG SUP-217.100 CDM outpatient 127.53 127.53 127.53 127.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP DCP LC-DCP STAINLESS STEEL LARGE HEXAGON L105 MM L32 MM OD6.5 MM ODSEC8 MM LONG BONE CANCELLOUS SOCKET NONSTERILE LARGE FRAGMENT SET SUP-217.105 CDM 270010022 LOCAL 0270 RC outpatient 91.75 91.75 91.75 74 67.9 percent of total billed charges 91.75 93 74.32 percent of total billed charges 91.75 91.75 other OPPS APC 91.75 91.75 other OPPS APC 91.75 27.63 25.35 percent of total billed charges 91.75 91.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP DCP LC-DCP STAINLESS STEEL LARGE HEXAGON L110 MM L32 MM OD6.5 MM ODSEC8 MM LONG BONE CANCELLOUS SOCKET NONSTERILE LARGE FRAGMENT SET SUP-217.11 CDM 270010022 LOCAL 0270 RC outpatient 127.53 127.53 127.53 74 94.37 percent of total billed charges 127.53 93 103.3 percent of total billed charges 127.53 127.53 other OPPS APC 127.53 127.53 other OPPS APC 127.53 27.63 35.24 percent of total billed charges 127.53 127.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP DCP LC-DCP STAINLESS STEEL LARGE HEXAGON L110 MM L32 MM OD6.5 MM ODSEC8 MM LONG BONE CANCELLOUS SOCKET NONSTERILE LARGE FRAGMENT SET SUP-217.110 CDM 270010022 LOCAL 0270 RC outpatient 127.53 127.53 127.53 74 94.37 percent of total billed charges 127.53 93 103.3 percent of total billed charges 127.53 127.53 other OPPS APC 127.53 127.53 other OPPS APC 127.53 27.63 35.24 percent of total billed charges 127.53 127.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER 217F5 FREEZOR XTRA5 LG ORANGE7F SUP-217F5 CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP DCP LC-DCP STAINLESS STEEL FULL THREAD LARGE HEXAGON L20 MM OD6.5 MM ODSEC8 MM LONG BONE CANCELLOUS SOCKET NONSTERILE LARGE FRAGMENT SET SUP-218.02 CDM 270010022 LOCAL 0270 RC outpatient 116.4 116.4 116.4 74 86.14 percent of total billed charges 116.4 93 94.28 percent of total billed charges 116.4 116.4 other OPPS APC 116.4 116.4 other OPPS APC 116.4 27.63 32.16 percent of total billed charges 116.4 116.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.5MM 8MM 20MM LCP DCP LC-DCP SS FULL THREAD LG HEXAGON LONG BONE SUP-218.020 CDM outpatient 116.4 116.4 116.4 116.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 30MM 6.5MM SS NS CANCELLOUS LG HEXAGONAL SUP-218.03 CDM 270010022 LOCAL 0270 RC outpatient 116.4 116.4 116.4 74 86.14 percent of total billed charges 116.4 93 94.28 percent of total billed charges 116.4 116.4 other OPPS APC 116.4 116.4 other OPPS APC 116.4 27.63 32.16 percent of total billed charges 116.4 116.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 35MM 6.5MM SS NS CANCELLOUS LG HEXAGONAL SUP-218.035 CDM 270010022 LOCAL 0270 RC outpatient 84.6 84.6 84.6 74 62.6 percent of total billed charges 84.6 93 68.53 percent of total billed charges 84.6 84.6 other OPPS APC 84.6 84.6 other OPPS APC 84.6 27.63 23.37 percent of total billed charges 84.6 84.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 40MM 6.5MM SS NS CANCELLOUS LG HEXAGONAL SUP-218.04 CDM 270010022 LOCAL 0270 RC outpatient 89.23 89.23 89.23 74 66.03 percent of total billed charges 89.23 93 72.28 percent of total billed charges 89.23 89.23 other OPPS APC 89.23 89.23 other OPPS APC 89.23 27.63 24.65 percent of total billed charges 89.23 89.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 45MM 6.5MM SS NS CANCELLOUS LG HEXAGONAL SUP-218.045 CDM 270010022 LOCAL 0270 RC outpatient 84.6 84.6 84.6 74 62.6 percent of total billed charges 84.6 93 68.53 percent of total billed charges 84.6 84.6 other OPPS APC 84.6 84.6 other OPPS APC 84.6 27.63 23.37 percent of total billed charges 84.6 84.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 50MM 6.5MM 8MM SS NS CANCELLOUS LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-218.050 CDM 270010022 LOCAL 0270 RC outpatient 84.6 84.6 84.6 74 62.6 percent of total billed charges 84.6 93 68.53 percent of total billed charges 84.6 84.6 other OPPS APC 84.6 84.6 other OPPS APC 84.6 27.63 23.37 percent of total billed charges 84.6 84.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 55MM 6.5MM SS NS CANCELLOUS LG HEXAGONAL SUP-218.055 CDM 270010022 LOCAL 0270 RC outpatient 84.6 84.6 84.6 74 62.6 percent of total billed charges 84.6 93 68.53 percent of total billed charges 84.6 84.6 other OPPS APC 84.6 84.6 other OPPS APC 84.6 27.63 23.37 percent of total billed charges 84.6 84.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 60MM 6.5MM 8MM SS NS CANCELLOUS LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-218.060 CDM 270010022 LOCAL 0270 RC outpatient 84.6 84.6 84.6 74 62.6 percent of total billed charges 84.6 93 68.53 percent of total billed charges 84.6 84.6 other OPPS APC 84.6 84.6 other OPPS APC 84.6 27.63 23.37 percent of total billed charges 84.6 84.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 65MM 6.5MM 8MM SS NS CANCELLOUS LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-218.065 CDM 270010022 LOCAL 0270 RC outpatient 84.6 84.6 84.6 74 62.6 percent of total billed charges 84.6 93 68.53 percent of total billed charges 84.6 84.6 other OPPS APC 84.6 84.6 other OPPS APC 84.6 27.63 23.37 percent of total billed charges 84.6 84.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 70MM 6.5MM 8MM SS NS CANCELLOUS LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-218.070 CDM 270010022 LOCAL 0270 RC outpatient 84.6 84.6 84.6 74 62.6 percent of total billed charges 84.6 93 68.53 percent of total billed charges 84.6 84.6 other OPPS APC 84.6 84.6 other OPPS APC 84.6 27.63 23.37 percent of total billed charges 84.6 84.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 75MM 6.5MM 8MM SS NS CANCELLOUS LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-218.075 CDM 270010022 LOCAL 0270 RC outpatient 84.6 84.6 84.6 74 62.6 percent of total billed charges 84.6 93 68.53 percent of total billed charges 84.6 84.6 other OPPS APC 84.6 84.6 other OPPS APC 84.6 27.63 23.37 percent of total billed charges 84.6 84.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 80MM 6.5MM 8MM SS NS CANCELLOUS LG HEXAGONAL SOCKET LG FRAGMENT SET SUP-218.080 CDM 270010022 LOCAL 0270 RC outpatient 84.6 84.6 84.6 74 62.6 percent of total billed charges 84.6 93 68.53 percent of total billed charges 84.6 84.6 other OPPS APC 84.6 84.6 other OPPS APC 84.6 27.63 23.37 percent of total billed charges 84.6 84.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE COMPRESSION DHS DCS STANDARD BARREL 135 DEG 2 HOLE SUP-218.102S CDM 270010022 LOCAL 0270 RC outpatient 1455.17 1455.17 1455.17 74 1076.83 percent of total billed charges 1455.17 93 1178.69 percent of total billed charges 1455.17 1455.17 other OPPS APC 1455.17 1455.17 other OPPS APC 1455.17 27.63 402.06 percent of total billed charges 1455.17 1455.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC 3MM 5.5MM SS NS THREAD INTERNAL HEXAGONAL DRIVE 3MM CANNULATED SCREW SUP-219.89 CDM 270010022 LOCAL 0270 RC outpatient 367.51 367.51 367.51 74 271.96 percent of total billed charges 367.51 93 297.68 percent of total billed charges 367.51 367.51 other OPPS APC 367.51 367.51 other OPPS APC 367.51 27.63 101.54 percent of total billed charges 367.51 367.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC 10MM SS NS 4.5MM CANNULATED SCREW SUP-219.91 CDM 270010022 LOCAL 0270 RC outpatient 71.5 71.5 71.5 74 52.91 percent of total billed charges 71.5 93 57.92 percent of total billed charges 71.5 71.5 other OPPS APC 71.5 71.5 other OPPS APC 71.5 27.63 19.76 percent of total billed charges 71.5 71.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NUT ORTHOPEDIC 11MM SS NS 4.5MM CORTEX SCREW SUP-219.96 CDM 270010022 LOCAL 0270 RC outpatient 78.65 78.65 78.65 74 58.2 percent of total billed charges 78.65 93 63.71 percent of total billed charges 78.65 78.65 other OPPS APC 78.65 78.65 other OPPS APC 78.65 27.63 21.73 percent of total billed charges 78.65 78.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC DCP STAINLESS STEEL OD4.5 MM FRAGMENT NONSTERILE MINI SCREW SUP-219.97 CDM 270010022 LOCAL 0270 RC outpatient 60.06 60.06 60.06 74 44.44 percent of total billed charges 60.06 93 48.65 percent of total billed charges 60.06 60.06 other OPPS APC 60.06 60.06 other OPPS APC 60.06 27.63 16.59 percent of total billed charges 60.06 60.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC LCP STAINLESS STEEL OD6.5 MM ID3.3 MM NONSTERILE 3 MM CANNULATED SCREW SUP-219.972 CDM 270010022 LOCAL 0270 RC outpatient 78.65 78.65 78.65 74 58.2 percent of total billed charges 78.65 93 63.71 percent of total billed charges 78.65 78.65 other OPPS APC 78.65 78.65 other OPPS APC 78.65 27.63 21.73 percent of total billed charges 78.65 78.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC 7MM SS NS SUP-219.98 CDM 270010022 LOCAL 0270 RC outpatient 58.01 58.01 58.01 74 42.93 percent of total billed charges 58.01 93 46.99 percent of total billed charges 58.01 58.01 other OPPS APC 58.01 58.01 other OPPS APC 58.01 27.63 16.03 percent of total billed charges 58.01 58.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC 13MM SS NS 6.5/7/7.3MM CANNULATED SCREW SUP-219.99 CDM 270010022 LOCAL 0270 RC outpatient 64.32 64.32 64.32 74 47.6 percent of total billed charges 64.32 93 52.1 percent of total billed charges 64.32 64.32 other OPPS APC 64.32 64.32 other OPPS APC 64.32 27.63 17.77 percent of total billed charges 64.32 64.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.7 SUP-219535 CDM 0270 RC outpatient 607.75 607.75 607.75 74 449.74 percent of total billed charges 607.75 93 492.28 percent of total billed charges 607.75 607.75 other OPPS APC 607.75 607.75 other OPPS APC 607.75 27.63 167.92 percent of total billed charges 607.75 607.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC REGENT FLEXCUFF PTFE PYROLYTIC CARBON 85 D OD21 MM ID19.6 MM SUPRA ANNULAR 1 DIGIT GRADIENT MECHANICAL LEAFLET OPEN SUP-21AGFN-756 CDM 0270 RC outpatient 12708.8 12708.8 12708.8 74 9404.51 percent of total billed charges 12708.8 93 10294.1 percent of total billed charges 12708.8 12708.8 other OPPS APC 12708.8 12708.8 other OPPS APC 12708.8 27.63 3511.44 percent of total billed charges 12708.8 12708.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC GRAFT 21MM SUP-21CAVGJ21MM CDM 0270 RC outpatient 15262 15262 15262 74 11293.9 percent of total billed charges 15262 93 12362.2 percent of total billed charges 15262 15262 other OPPS APC 15262 15262 other OPPS APC 15262 27.63 4216.89 percent of total billed charges 15262 15262 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE SZ 0 OB-GYN 924H SUP-22-00004 CDM 0272 RC outpatient 348.15 348.15 348.15 74 257.63 percent of total billed charges 348.15 93 282 percent of total billed charges 348.15 348.15 other OPPS APC 348.15 348.15 other OPPS APC 348.15 27.63 96.19 percent of total billed charges 348.15 348.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE SZ 0 SILK 680H SUP-22-00005 CDM 0272 RC outpatient 227.75 227.75 227.75 74 168.54 percent of total billed charges 227.75 93 184.48 percent of total billed charges 227.75 227.75 other OPPS APC 227.75 227.75 other OPPS APC 227.75 27.63 62.93 percent of total billed charges 227.75 227.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE CHROMIC 2-0 923H SUP-22-00008 CDM 0272 RC outpatient 386.93 386.93 386.93 74 286.33 percent of total billed charges 386.93 93 313.41 percent of total billed charges 386.93 386.93 other OPPS APC 386.93 386.93 other OPPS APC 386.93 27.63 106.91 percent of total billed charges 386.93 386.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE SZ 2-0 SILK 623H SUP-22-00009 CDM 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE SZ 4-0 ETHILON 1894G SUP-22-00026 CDM 0272 RC outpatient 190.44 190.44 190.44 74 140.93 percent of total billed charges 190.44 93 154.26 percent of total billed charges 190.44 190.44 other OPPS APC 190.44 190.44 other OPPS APC 190.44 27.63 52.62 percent of total billed charges 190.44 190.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY TRIEVER 24 OD 24 FR SUP-22-101 CDM 0270 RC outpatient 31200 31200 31200 74 23088 percent of total billed charges 31200 93 25272 percent of total billed charges 31200 31200 other OPPS APC 31200 31200 other OPPS APC 31200 27.63 8620.56 percent of total billed charges 31200 31200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NEPHROURETERAL SUP-22-138 CDM 0270 RC outpatient 249 249 249 74 184.26 percent of total billed charges 249 93 201.69 percent of total billed charges 249 249 other OPPS APC 249 249 other OPPS APC 249 27.63 68.8 percent of total billed charges 249 249 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR ALPHATEC SHORT PEGASUS ACI DEVICE SUP-22-9211SHORT CDM 270010020 LOCAL 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALPHATEC INCITE ACI DEVICE 7MM SUP-22-9222 CDM 270010020 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRIP RETINAL SILICONE 2.5 MM GROOVE L100 MM X W6 MM X H1.5 MM STERILE SUP-220 CDM 0270 RC outpatient 35.36 35.36 35.36 74 26.17 percent of total billed charges 35.36 93 28.64 percent of total billed charges 35.36 35.36 other OPPS APC 35.36 35.36 other OPPS APC 35.36 27.63 9.77 percent of total billed charges 35.36 35.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.0 X 10MM SEMICOMPLIANT SUP-220-103-5UU CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.0 X 12MM SEMICOMPLIANT SUP-220-123-5UU CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.0 X 15MM SEMICOMPLIANT SUP-220-153-5UU CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.0 X 20MM SEMICOMPLIANT SUP-220-203-5UU CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANGIOSCULPT SCORING BALLOON 2.0 X 6 SUP-2200-2006 CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT EVO HYDROPHILIC L6 MM ODSEC2 MM RAPID EXCHANGE STERILE LATEX FREE PTCA SUP-2200-2006-B CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION RECTANGLE HELIX TAPER 2MM 137CM 10MM RADIOPAQUE RAPID SUP-2200-2010 CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT EVO HYDROPHILIC L10 MM ODSEC2 MM RAPID EXCHANGE STERILE LATEX FREE PTCA SUP-2200-2010-B CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT NITINOL NYLON RECTANGLE HELIX TAPER L137 CM L15 MM ODSEC2 MM RADIOPAQUE RAPID EXCHANGE FLEXIBLE ELECTROPOLISH ACCEPTS .014 IN GUIDEWIRE 6 FR GUIDE CATHETER PTCA SUP-2200-2015 CDM outpatient 2080 2080 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT EVO HYDROPHILIC L15 MM ODSEC2 MM RAPID EXCHANGE STERILE LATEX FREE PTCA SUP-2200-2015-B CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT EVO HYDROPHILIC L20 MM ODSEC2 MM RAPID EXCHANGE STERILE LATEX FREE PTCA SUP-2200-2020-B CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANGIOSCULPT SCORING BALLOON 2.5 X 6 SUP-2200-2506 CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT EVO HYDROPHILIC L6 MM ODSEC2.5 MM RAPID EXCHANGE STERILE LATEX FREE PTCA SUP-2200-2506-B CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANGIOSCULPT SCORING BALLOON 2.5 X 10 MM SUP-2200-2510 CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT EVO HYDROPHILIC L10 MM ODSEC2.5 MM RAPID EXCHANGE STERILE LATEX FREE PTCA SUP-2200-2510-B CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT NITINOL NYLON RECTANGLE HELIX TAPER L137 CM L15 MM ODSEC2.5 MM RADIOPAQUE RAPID EXCHANGE FLEXIBLE ELECTROPOLISH ACCEPTS .014 IN GUIDEWIRE 6 FR GUIDE CATHETER PTCA SUP-2200-2515 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT EVO HYDROPHILIC L15 MM ODSEC2.5 MM RAPID EXCHANGE STERILE LATEX FREE PTCA SUP-2200-2515-B CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT EVO HYDROPHILIC L20 MM ODSEC2.5 MM RAPID EXCHANGE STERILE LATEX FREE PTCA SUP-2200-2520-B CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANGIOSCULPT SCORING BALLOON 3.0 X 6 SUP-2200-3006 CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT EVO HYDROPHILIC L6 MM ODSEC3 MM RAPID EXCHANGE STERILE LATEX FREE PTCA SUP-2200-3006-B CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT NITINOL NYLON RECTANGLE HELIX TAPER L137 CM L10 MM ODSEC3 MM RADIOPAQUE RAPID EXCHANGE FLEXIBLE ELECTROPOLISH ACCEPTS .014 IN GUIDEWIRE 6 FR GUIDE CATHETER PTCA SUP-2200-3010 CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT EVO HYDROPHILIC L10 MM ODSEC3 MM RAPID EXCHANGE STERILE LATEX FREE PTCA SUP-2200-3010-B CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT NITINOL NYLON RECTANGLE HELIX TAPER L137 CM L15 MM ODSEC3 MM RADIOPAQUE RAPID EXCHANGE FLEXIBLE ELECTROPOLISH ACCEPTS .014 IN GUIDEWIRE 6 FR GUIDE CATHETER PTCA SUP-2200-3015 CDM outpatient 2080 2080 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT EVO HYDROPHILIC L15 MM ODSEC3 MM RAPID EXCHANGE STERILE LATEX FREE PTCA SUP-2200-3015-B CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT EVO HYDROPHILIC L20 MM ODSEC3 MM RAPID EXCHANGE STERILE LATEX FREE PTCA SUP-2200-3020-B CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANGIOSCULPT SCORING BALLOON 3.5 X 6 SUP-2200-3506 CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT EVO HYDROPHILIC L6 MM ODSEC3.5 MM RAPID EXCHANGE STERILE LATEX FREE PTCA SUP-2200-3506-B CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANGIOSCULPT SCORING BALLOON 3.5 X 10 SUP-2200-3510 CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT EVO HYDROPHILIC L10 MM ODSEC3.5 MM RAPID EXCHANGE STERILE LATEX FREE PTCA SUP-2200-3510-B CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT NITINOL NYLON RECTANGLE HELIX TAPER L137 CM L15 MM ODSEC3.5 MM RADIOPAQUE RAPID EXCHANGE FLEXIBLE ELECTROPOLISH ACCEPTS .014 IN GUIDEWIRE 6 FR GUIDE CATHETER PTCA SUP-2200-3515 CDM outpatient 2080 2080 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT EVO HYDROPHILIC L15 MM ODSEC3.5 MM RAPID EXCHANGE STERILE LATEX FREE PTCA SUP-2200-3515-B CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT EVO HYDROPHILIC L20 MM ODSEC3.5 MM RAPID EXCHANGE STERILE LATEX FREE PTCA SUP-2200-3520-B CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVERALLS ELAST CUFF & ANKLE XL WHT SUP-2201CV CDM outpatient 5.77 5.77 5.77 5.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE HEMOSTATIC ERASER WET-FIELD ERASER STRAIGHT TAPER 20-23GA BIPOLAR HOLLOW CORE TARGET COAGULATION FINE TIP SUP-221265 CDM 0270 RC outpatient 96.83 96.83 96.83 74 71.65 percent of total billed charges 96.83 93 78.43 percent of total billed charges 96.83 96.83 other OPPS APC 96.83 96.83 other OPPS APC 96.83 27.63 26.75 percent of total billed charges 96.83 96.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE HEMOSTATIC ERASER WET-FIELD 150 D ANGLE TAPER OD25 GA BIPOLAR FINE TIP HOLLOW CORE TARGET COAGULATION STERILE LATEX FREE SUP-221267 CDM 0270 RC outpatient 158.26 158.26 158.26 74 117.11 percent of total billed charges 158.26 93 128.19 percent of total billed charges 158.26 158.26 other OPPS APC 158.26 158.26 other OPPS APC 158.26 27.63 43.73 percent of total billed charges 158.26 158.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.25 X 8MM NON COMPLIANT PLUS SUP-222-083-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.25 X 10MM NON COMPLIANT PLUS SUP-222-103-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.25 X 12MM NON COMPLIANT PLUS SUP-222-123-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.25 X 15MM NON COMPLIANT PLUS SUP-222-153-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.25 X 18MM NON COMPLIANT PLUS SUP-222-183-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SEMI TUBULAR 4 HOLE SUP-222.04 CDM 270010022 LOCAL 0270 RC outpatient 194.48 194.48 194.48 74 143.92 percent of total billed charges 194.48 93 157.53 percent of total billed charges 194.48 194.48 other OPPS APC 194.48 194.48 other OPPS APC 194.48 27.63 53.73 percent of total billed charges 194.48 194.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE SEMITUBULAR 87X12X1MM SS NS 5 HOLE 3.5/4.5MM SCREW LG FRAGMENT SUP-222.05 CDM 270010022 LOCAL 0270 RC outpatient 236.34 236.34 236.34 74 174.89 percent of total billed charges 236.34 93 191.44 percent of total billed charges 236.34 236.34 other OPPS APC 236.34 236.34 other OPPS APC 236.34 27.63 65.3 percent of total billed charges 236.34 236.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE SEMITUBULAR 103X12X1MM SS NS 6 HOLE 3.5/4.5MM SCREW LG FRAGMENT SUP-222.06 CDM 270010022 LOCAL 0270 RC outpatient 252.72 252.72 252.72 74 187.01 percent of total billed charges 252.72 93 204.7 percent of total billed charges 252.72 252.72 other OPPS APC 252.72 252.72 other OPPS APC 252.72 27.63 69.83 percent of total billed charges 252.72 252.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE SEMITUBULAR 119X12X1MM SS NS 7 HOLE 3.5/4.5MM SCREW LG FRAGMENT SUP-222.07 CDM 270010022 LOCAL 0270 RC outpatient 227.66 227.66 227.66 74 168.47 percent of total billed charges 227.66 93 184.4 percent of total billed charges 227.66 227.66 other OPPS APC 227.66 227.66 other OPPS APC 227.66 27.63 62.9 percent of total billed charges 227.66 227.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L45 MM OD5 MM FEMUR PROXIMAL CANNULATED LOCKING NONSTERILE 4.5 MM ROD SUP-222.539 CDM 270010022 LOCAL 0270 RC outpatient 559.26 559.26 559.26 74 413.85 percent of total billed charges 559.26 93 453 percent of total billed charges 559.26 559.26 other OPPS APC 559.26 559.26 other OPPS APC 559.26 27.63 154.52 percent of total billed charges 559.26 559.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE NARROW LC-DCP 4 HOLE SUP-222.54 CDM 270010022 LOCAL 0270 RC outpatient 434.72 434.72 434.72 74 321.69 percent of total billed charges 434.72 93 352.12 percent of total billed charges 434.72 434.72 other OPPS APC 434.72 434.72 other OPPS APC 434.72 27.63 120.11 percent of total billed charges 434.72 434.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L60 MM OD5 MM PERIARTICULAR FEMUR TIBIA CANNULATED NONSTERILE SUP-222.542 CDM 270010022 LOCAL 0270 RC outpatient 479.7 479.7 479.7 74 354.98 percent of total billed charges 479.7 93 388.56 percent of total billed charges 479.7 479.7 other OPPS APC 479.7 479.7 other OPPS APC 479.7 27.63 132.54 percent of total billed charges 479.7 479.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L70 MM OD5 MM PERIARTICULAR FEMUR TIBIA CANNULATED NONSTERILE SUP-222.544 CDM 270010022 LOCAL 0270 RC outpatient 503.1 503.1 503.1 74 372.29 percent of total billed charges 503.1 93 407.51 percent of total billed charges 503.1 503.1 other OPPS APC 503.1 503.1 other OPPS APC 503.1 27.63 139.01 percent of total billed charges 503.1 503.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L80 MM OD5 MM PROXIMAL PERIARTICULAR FEMUR TIBIA CANNULATED LOCKING NONSTERILE SUP-222.546 CDM 270010022 LOCAL 0270 RC outpatient 446.94 446.94 446.94 74 330.74 percent of total billed charges 446.94 93 362.02 percent of total billed charges 446.94 446.94 other OPPS APC 446.94 446.94 other OPPS APC 446.94 27.63 123.49 percent of total billed charges 446.94 446.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L85 MM OD5 MM PERIARTICULAR FEMUR TIBIA CANNULATED NONSTERILE SUP-222.547 CDM 270010022 LOCAL 0270 RC outpatient 503.1 503.1 503.1 74 372.29 percent of total billed charges 503.1 93 407.51 percent of total billed charges 503.1 503.1 other OPPS APC 503.1 503.1 other OPPS APC 503.1 27.63 139.01 percent of total billed charges 503.1 503.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L70 MM OD5 MM PROXIMAL FEMUR TIBIA PERIARTICULAR CANNULATED CONICAL HEAD NONSTERILE SUP-222.560 CDM 270010022 LOCAL 0270 RC outpatient 442.26 442.26 442.26 74 327.27 percent of total billed charges 442.26 93 358.23 percent of total billed charges 442.26 442.26 other OPPS APC 442.26 442.26 other OPPS APC 442.26 27.63 122.2 percent of total billed charges 442.26 442.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L65 MM OD7.3 MM PERIARTICULAR FEMUR TIBIA CANNULATED NONSTERILE SUP-222.570 CDM 270010022 LOCAL 0270 RC outpatient 631.49 631.49 631.49 74 467.3 percent of total billed charges 631.49 93 511.51 percent of total billed charges 631.49 631.49 other OPPS APC 631.49 631.49 other OPPS APC 631.49 27.63 174.48 percent of total billed charges 631.49 631.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L70 MM OD7.3 MM PERIARTICULAR FEMUR TIBIA CANNULATED NONSTERILE SUP-222.571 CDM 270010022 LOCAL 0270 RC outpatient 631.49 631.49 631.49 74 467.3 percent of total billed charges 631.49 93 511.51 percent of total billed charges 631.49 631.49 other OPPS APC 631.49 631.49 other OPPS APC 631.49 27.63 174.48 percent of total billed charges 631.49 631.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L75 MM OD7.3 MM PERIARTICULAR FEMUR TIBIA CANNULATED NONSTERILE SUP-222.572 CDM 270010022 LOCAL 0270 RC outpatient 744.12 744.12 744.12 74 550.65 percent of total billed charges 744.12 93 602.74 percent of total billed charges 744.12 744.12 other OPPS APC 744.12 744.12 other OPPS APC 744.12 27.63 205.6 percent of total billed charges 744.12 744.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L80 MM OD7.3 MM PERIARTICULAR FEMUR TIBIA CANNULATED NONSTERILE SUP-222.573 CDM 270010022 LOCAL 0270 RC outpatient 631.49 631.49 631.49 74 467.3 percent of total billed charges 631.49 93 511.51 percent of total billed charges 631.49 631.49 other OPPS APC 631.49 631.49 other OPPS APC 631.49 27.63 174.48 percent of total billed charges 631.49 631.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L85 MM OD7.3 MM PERIARTICULAR FEMUR TIBIA CANNULATED NONSTERILE SUP-222.574 CDM 270010022 LOCAL 0270 RC outpatient 631.49 631.49 631.49 74 467.3 percent of total billed charges 631.49 93 511.51 percent of total billed charges 631.49 631.49 other OPPS APC 631.49 631.49 other OPPS APC 631.49 27.63 174.48 percent of total billed charges 631.49 631.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L90 MM OD7.3 MM PROXIMAL FEMUR CANNULATED LOCKING NONSTERILE SUP-222.575 CDM 270010022 LOCAL 0270 RC outpatient 631.49 631.49 631.49 74 467.3 percent of total billed charges 631.49 93 511.51 percent of total billed charges 631.49 631.49 other OPPS APC 631.49 631.49 other OPPS APC 631.49 27.63 174.48 percent of total billed charges 631.49 631.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL L95 MM OD7.3 MM PERIARTICULAR FEMUR TIBIA CANNULATED NONSTERILE SUP-222.576 CDM 270010022 LOCAL 0270 RC outpatient 631.49 631.49 631.49 74 467.3 percent of total billed charges 631.49 93 511.51 percent of total billed charges 631.49 631.49 other OPPS APC 631.49 631.49 other OPPS APC 631.49 27.63 174.48 percent of total billed charges 631.49 631.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NUT ORTHOPEDIC 12MM 4MM SS NS SELF CUT SERRATE TIP LCP 5MM SCREW SUP-222.578 CDM 270010022 LOCAL 0270 RC outpatient 418.99 418.99 418.99 74 310.05 percent of total billed charges 418.99 93 339.38 percent of total billed charges 418.99 418.99 other OPPS APC 418.99 418.99 other OPPS APC 418.99 27.63 115.77 percent of total billed charges 418.99 418.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LARGE CONE HEXAGON L14 MM OD4 MM ODSEC3.4 MM FEMUR TIBIA PROXIMAL SELF TAP NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-222.580 CDM 270010022 LOCAL 0270 RC outpatient 432.9 432.9 432.9 74 320.35 percent of total billed charges 432.9 93 350.65 percent of total billed charges 432.9 432.9 other OPPS APC 432.9 432.9 other OPPS APC 432.9 27.63 119.61 percent of total billed charges 432.9 432.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LARGE CONE HEXAGON L16 MM OD4 MM ODSEC3.4 MM FEMUR TIBIA PROXIMAL SELF TAP NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-222.581 CDM 270010022 LOCAL 0270 RC outpatient 432.9 432.9 432.9 74 320.35 percent of total billed charges 432.9 93 350.65 percent of total billed charges 432.9 432.9 other OPPS APC 432.9 432.9 other OPPS APC 432.9 27.63 119.61 percent of total billed charges 432.9 432.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LARGE CONE HEXAGON L18 MM OD4 MM ODSEC3.4 MM FEMUR TIBIA PROXIMAL SELF TAP NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-222.582 CDM 270010022 LOCAL 0270 RC outpatient 432.9 432.9 432.9 74 320.35 percent of total billed charges 432.9 93 350.65 percent of total billed charges 432.9 432.9 other OPPS APC 432.9 432.9 other OPPS APC 432.9 27.63 119.61 percent of total billed charges 432.9 432.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LARGE CONE HEXAGON L22 MM OD4 MM ODSEC3.4 MM FEMUR TIBIA PROXIMAL SELF TAP NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-222.583 CDM 270010022 LOCAL 0270 RC outpatient 432.9 432.9 432.9 74 320.35 percent of total billed charges 432.9 93 350.65 percent of total billed charges 432.9 432.9 other OPPS APC 432.9 432.9 other OPPS APC 432.9 27.63 119.61 percent of total billed charges 432.9 432.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LARGE CONE HEXAGON L26 MM OD4 MM ODSEC3.4 MM FEMUR TIBIA PROXIMAL SELF TAP NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-222.584 CDM 270010022 LOCAL 0270 RC outpatient 432.9 432.9 432.9 74 320.35 percent of total billed charges 432.9 93 350.65 percent of total billed charges 432.9 432.9 other OPPS APC 432.9 432.9 other OPPS APC 432.9 27.63 119.61 percent of total billed charges 432.9 432.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LARGE CONE HEXAGON L30 MM OD4 MM ODSEC3.4 MM FEMUR TIBIA PROXIMAL SELF TAP NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-222.585 CDM 270010022 LOCAL 0270 RC outpatient 432.9 432.9 432.9 74 320.35 percent of total billed charges 432.9 93 350.65 percent of total billed charges 432.9 432.9 other OPPS APC 432.9 432.9 other OPPS APC 432.9 27.63 119.61 percent of total billed charges 432.9 432.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LARGE CONE HEXAGON L34 MM OD4 MM ODSEC3.4 MM FEMUR TIBIA PROXIMAL SELF TAP NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-222.586 CDM 270010022 LOCAL 0270 RC outpatient 432.9 432.9 432.9 74 320.35 percent of total billed charges 432.9 93 350.65 percent of total billed charges 432.9 432.9 other OPPS APC 432.9 432.9 other OPPS APC 432.9 27.63 119.61 percent of total billed charges 432.9 432.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LARGE CONE HEXAGON L38 MM OD4 MM ODSEC3.4 MM FEMUR TIBIA PROXIMAL SELF TAP NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-222.587 CDM 270010022 LOCAL 0270 RC outpatient 432.9 432.9 432.9 74 320.35 percent of total billed charges 432.9 93 350.65 percent of total billed charges 432.9 432.9 other OPPS APC 432.9 432.9 other OPPS APC 432.9 27.63 119.61 percent of total billed charges 432.9 432.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LARGE CONE HEXAGON L42 MM OD4 MM ODSEC3.4 MM FEMUR TIBIA PROXIMAL SELF TAP NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-222.588 CDM 270010022 LOCAL 0270 RC outpatient 432.9 432.9 432.9 74 320.35 percent of total billed charges 432.9 93 350.65 percent of total billed charges 432.9 432.9 other OPPS APC 432.9 432.9 other OPPS APC 432.9 27.63 119.61 percent of total billed charges 432.9 432.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LARGE CONE HEXAGON L46 MM OD4 MM ODSEC3.4 MM FEMUR TIBIA PROXIMAL SELF TAP NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-222.589 CDM 270010022 LOCAL 0270 RC outpatient 432.9 432.9 432.9 74 320.35 percent of total billed charges 432.9 93 350.65 percent of total billed charges 432.9 432.9 other OPPS APC 432.9 432.9 other OPPS APC 432.9 27.63 119.61 percent of total billed charges 432.9 432.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LARGE CONE HEXAGON L50 MM OD4 MM ODSEC3.4 MM FEMUR TIBIA PROXIMAL SELF TAP NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-222.590 CDM 270010022 LOCAL 0270 RC outpatient 432.9 432.9 432.9 74 320.35 percent of total billed charges 432.9 93 350.65 percent of total billed charges 432.9 432.9 other OPPS APC 432.9 432.9 other OPPS APC 432.9 27.63 119.61 percent of total billed charges 432.9 432.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LARGE CONE HEXAGON L54 MM OD4 MM ODSEC3.4 MM FEMUR TIBIA PROXIMAL SELF TAP NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-222.591 CDM 270010022 LOCAL 0270 RC outpatient 432.9 432.9 432.9 74 320.35 percent of total billed charges 432.9 93 350.65 percent of total billed charges 432.9 432.9 other OPPS APC 432.9 432.9 other OPPS APC 432.9 27.63 119.61 percent of total billed charges 432.9 432.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LARGE CONE HEXAGON L58 MM OD4 MM ODSEC3.4 MM FEMUR TIBIA PROXIMAL SELF TAP NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-222.592 CDM 270010022 LOCAL 0270 RC outpatient 432.9 432.9 432.9 74 320.35 percent of total billed charges 432.9 93 350.65 percent of total billed charges 432.9 432.9 other OPPS APC 432.9 432.9 other OPPS APC 432.9 27.63 119.61 percent of total billed charges 432.9 432.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL LARGE CONE HEXAGON L62 MM OD4 MM ODSEC3.4 MM FEMUR TIBIA PROXIMAL SELF TAP NONSTERILE PERIARTICULAR PLATE SYSTEM SUP-222.593 CDM 270010022 LOCAL 0270 RC outpatient 432.9 432.9 432.9 74 320.35 percent of total billed charges 432.9 93 350.65 percent of total billed charges 432.9 432.9 other OPPS APC 432.9 432.9 other OPPS APC 432.9 27.63 119.61 percent of total billed charges 432.9 432.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L60 MM OD7.3 MM PERIARTICULAR FEMUR TIBIA PROXIMAL CANNULATED CONICAL NONSTERILE SUP-222.603 CDM 270010022 LOCAL 0270 RC outpatient 664.56 664.56 664.56 74 491.77 percent of total billed charges 664.56 93 538.29 percent of total billed charges 664.56 664.56 other OPPS APC 664.56 664.56 other OPPS APC 664.56 27.63 183.62 percent of total billed charges 664.56 664.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD CONE L65 MM OD7.3 MM PERIARTICULAR FEMUR TIBIA CANNULATED NONSTERILE SUP-222.604 CDM 270010022 LOCAL 0270 RC outpatient 664.56 664.56 664.56 74 491.77 percent of total billed charges 664.56 93 538.29 percent of total billed charges 664.56 664.56 other OPPS APC 664.56 664.56 other OPPS APC 664.56 27.63 183.62 percent of total billed charges 664.56 664.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL FULL THREAD L80 MM OD7.3 MM PERIARTICULAR FEMUR TIBIA PROXIMAL CANNULATED CONICAL NONSTERILE SUP-222.607 CDM 270010022 LOCAL 0270 RC outpatient 634.14 634.14 634.14 74 469.26 percent of total billed charges 634.14 93 513.65 percent of total billed charges 634.14 634.14 other OPPS APC 634.14 634.14 other OPPS APC 634.14 27.63 175.21 percent of total billed charges 634.14 634.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL CONE PARTIAL THREAD L70 MM OD7.3 MM FEMUR PROXIMAL CANNULATED NONSTERILE SUP-222.644 CDM 270010022 LOCAL 0270 RC outpatient 664.56 664.56 664.56 74 491.77 percent of total billed charges 664.56 93 538.29 percent of total billed charges 664.56 664.56 other OPPS APC 664.56 664.56 other OPPS APC 664.56 27.63 183.62 percent of total billed charges 664.56 664.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP STAINLESS STEEL PARTIAL THREAD CONE L85 MM OD7.3 MM PERIARTICULAR FEMUR TIBIA CANNULATED NONSTERILE SUP-222.647 CDM 270010022 LOCAL 0270 RC outpatient 634.14 634.14 634.14 74 469.26 percent of total billed charges 634.14 93 513.65 percent of total billed charges 634.14 634.14 other OPPS APC 634.14 634.14 other OPPS APC 634.14 27.63 175.21 percent of total billed charges 634.14 634.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L170 MM X W17.5 MM X H5.2 MM RIGHT 6 HOLE LOW PROFILE LIMIT CONTACT CONTOUR HEAD NONSTERILE 4.5 MM SCREW LARGE FRAGMENT SET SUP-222.656 CDM 270010022 LOCAL 0270 RC outpatient 3965.39 3965.39 3965.39 74 2934.39 percent of total billed charges 3965.39 93 3211.97 percent of total billed charges 3965.39 3965.39 other OPPS APC 3965.39 3965.39 other OPPS APC 3965.39 27.63 1095.64 percent of total billed charges 3965.39 3965.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CURVE L170 MM X W17.5 MM X H5.2 MM FEMUR LEFT CONDYLAR 6 HOLE LOW PROFILE LIMIT CONTACT CONTOUR HEAD NONSTERILE 4.5 MM SCREW SUP-222.657 CDM 270010022 LOCAL 0270 RC outpatient 3965.39 3965.39 3965.39 74 2934.39 percent of total billed charges 3965.39 93 3211.97 percent of total billed charges 3965.39 3965.39 other OPPS APC 3965.39 3965.39 other OPPS APC 3965.39 27.63 1095.64 percent of total billed charges 3965.39 3965.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CURVE L206 MM X W17.5 MM X H5.2 MM FEMUR RIGHT CONDYLAR 8 HOLE LOW PROFILE LIMIT CONTACT CONTOUR HEAD NONSTERILE 4.5 MM SCREW SUP-222.658 CDM 270010022 LOCAL 0270 RC outpatient 4038.32 4038.32 4038.32 74 2988.36 percent of total billed charges 4038.32 93 3271.04 percent of total billed charges 4038.32 4038.32 other OPPS APC 4038.32 4038.32 other OPPS APC 4038.32 27.63 1115.79 percent of total billed charges 4038.32 4038.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 206X17.5X5.2MM SS NS FEMUR LEFT CONDYLAR 8 HOLE LOW PROFILE LIMIT CONTACT CONTOUR HEAD 4.5MM SCREW SUP-222.659 CDM 270010022 LOCAL 0270 RC outpatient 4038.32 4038.32 4038.32 74 2988.36 percent of total billed charges 4038.32 93 3271.04 percent of total billed charges 4038.32 4038.32 other OPPS APC 4038.32 4038.32 other OPPS APC 4038.32 27.63 1115.79 percent of total billed charges 4038.32 4038.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SUTURE MAYO CATGUT 3 1/2 CIRCLE TAPER STERILE DISPOSABLE SUP-222203 CDM 0270 RC outpatient 15.48 15.48 15.48 74 11.46 percent of total billed charges 15.48 93 12.54 percent of total billed charges 15.48 15.48 other OPPS APC 15.48 15.48 other OPPS APC 15.48 27.63 4.28 percent of total billed charges 15.48 15.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SUTURE RICHARD-ALLAN MAYO STAINLESS STEEL CATGUT 5 1/2 CIRCLE REGULAR TAPER L1.26 IN OD.043 IN TEMPER STRENGTH DEPENDABLE LIGHT STERILE LATEX FREE DISPOSABLE TISSUE CLOSURE SUP-222204 CDM 0270 RC outpatient 15.48 15.48 15.48 74 11.46 percent of total billed charges 15.48 93 12.54 percent of total billed charges 15.48 15.48 other OPPS APC 15.48 15.48 other OPPS APC 15.48 27.63 4.28 percent of total billed charges 15.48 15.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ASPEN BX/72 SUP-222205 CDM 0270 RC outpatient 11.55 11.55 11.55 74 8.55 percent of total billed charges 11.55 93 9.36 percent of total billed charges 11.55 11.55 other OPPS APC 11.55 11.55 other OPPS APC 11.55 27.63 3.19 percent of total billed charges 11.55 11.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR HI-TORQUE EXTRA SPORT STAINLESS STEEL HYDROPHOBIC STRAIGHT L175 CM L3 CM OD.014 SUP-22225M CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM PERCANNULA SUP-222274 CDM 0270 RC outpatient 800.8 800.8 800.8 74 592.59 percent of total billed charges 800.8 93 648.65 percent of total billed charges 800.8 800.8 other OPPS APC 800.8 800.8 other OPPS APC 800.8 27.63 221.26 percent of total billed charges 800.8 800.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE HEALIX ADVANCE BR ORTHOCORD OD5.5 MM SUP-222297 CDM 0270 RC outpatient 1027.73 1027.73 1027.73 74 760.52 percent of total billed charges 1027.73 93 832.46 percent of total billed charges 1027.73 1027.73 other OPPS APC 1027.73 1027.73 other OPPS APC 1027.73 27.63 283.96 percent of total billed charges 1027.73 1027.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE HEALIX ADVANCE BR ORTHOCORD 3 OD5.5 MM SUP-222298 CDM 0270 RC outpatient 1044.58 1044.58 1044.58 74 772.99 percent of total billed charges 1044.58 93 846.11 percent of total billed charges 1044.58 1044.58 other OPPS APC 1044.58 1044.58 other OPPS APC 1044.58 27.63 288.62 percent of total billed charges 1044.58 1044.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE HEALIX ADVANCE BR BIOCRYL OD6.5 MM ORTHOCORD SUP-222300 CDM 0270 RC outpatient 951.6 951.6 951.6 74 704.18 percent of total billed charges 951.6 93 770.8 percent of total billed charges 951.6 951.6 other OPPS APC 951.6 951.6 other OPPS APC 951.6 27.63 262.93 percent of total billed charges 951.6 951.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR HEALIX BR 3.4MM SUP-222343 CDM 0270 RC outpatient 863.2 863.2 863.2 74 638.77 percent of total billed charges 863.2 93 699.19 percent of total billed charges 863.2 863.2 other OPPS APC 863.2 863.2 other OPPS APC 863.2 27.63 238.5 percent of total billed charges 863.2 863.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR 3.4MM HEALIX PEEK SUP-222344 CDM 0270 RC outpatient 951.6 951.6 951.6 74 704.18 percent of total billed charges 951.6 93 770.8 percent of total billed charges 951.6 951.6 other OPPS APC 951.6 951.6 other OPPS APC 951.6 27.63 262.93 percent of total billed charges 951.6 951.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BONE 3.0 SUP-2224 CDM 0270 RC outpatient 587.6 587.6 587.6 74 434.82 percent of total billed charges 587.6 93 475.96 percent of total billed charges 587.6 587.6 other OPPS APC 587.6 587.6 other OPPS APC 587.6 27.63 162.35 percent of total billed charges 587.6 587.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE FASTIN ETHIBOND 2 OD4 MM LATEX FREE SUP-222540 CDM 270010022 LOCAL 0270 RC outpatient 503.1 503.1 503.1 74 372.29 percent of total billed charges 503.1 93 407.51 percent of total billed charges 503.1 503.1 other OPPS APC 503.1 503.1 other OPPS APC 503.1 27.63 139.01 percent of total billed charges 503.1 503.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOC GUIDEWIRE EXTENSION 145CM SUP-22260S CDM 0481 RC outpatient 234 234 234 74 173.16 percent of total billed charges 234 93 189.54 percent of total billed charges 234 234 other OPPS APC 234 234 other OPPS APC 234 51 119.34 percent of total billed charges 234 234 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EXCEL STAINLESS STEEL FULL THREAD FLUTE L 60 MM OD $ MM HIP SELF TAP CANNUALTED TROCAR STERILE SUP-222860 CDM 0270 RC outpatient 481.78 481.78 481.78 74 356.52 percent of total billed charges 481.78 93 390.24 percent of total billed charges 481.78 481.78 other OPPS APC 481.78 481.78 other OPPS APC 481.78 27.63 133.12 percent of total billed charges 481.78 481.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE ACCESSORY KIT SUP-22295 CDM 0481 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 51 46.41 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE FASTIN RC ORTHOCORD OD5 MM THREAD NEEDLE ROTATOR CUFF STERILE LATEX FREE SUP-222993 CDM 0270 RC outpatient 716.04 716.04 716.04 74 529.87 percent of total billed charges 716.04 93 579.99 percent of total billed charges 716.04 716.04 other OPPS APC 716.04 716.04 other OPPS APC 716.04 27.63 197.84 percent of total billed charges 716.04 716.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE FASTIN RC OD6.5 MM ROTATOR CUFF ORTHOCORD THREADED NEEDLE STERILE SUP-222994 CDM 0270 RC outpatient 618.8 618.8 618.8 74 457.91 percent of total billed charges 618.8 93 501.23 percent of total billed charges 618.8 618.8 other OPPS APC 618.8 618.8 other OPPS APC 618.8 27.63 170.97 percent of total billed charges 618.8 618.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIGGLE STRAIGHT TIP GUIDEWIRE 190CM SUP-22299MW30 CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ETERNA 16-CHANNEL IPG PENTA SYSTEM SUP-222ETPENSY33 CDM 0270 RC outpatient 55900 55900 55900 74 41366 percent of total billed charges 55900 93 45279 percent of total billed charges 55900 55900 other OPPS APC 55900 55900 other OPPS APC 55900 27.63 15445.2 percent of total billed charges 55900 55900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L95 MM X W10.2 MM X H2.2 MM W11 MM X H3.3 MM TIBIA RIGHT DISTAL MEDIAL 6 HOLE NONSTERILE 3.5 MM SCREW SUP-223.506 CDM 270010022 LOCAL 0270 RC outpatient 2493.01 2493.01 2493.01 74 1844.83 percent of total billed charges 2493.01 93 2019.34 percent of total billed charges 2493.01 2493.01 other OPPS APC 2493.01 2493.01 other OPPS APC 2493.01 27.63 688.82 percent of total billed charges 2493.01 2493.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L95 MM TIBIA LEFT DISTAL MEDIAL 6 HOLE NONSTERILE 3.5 MM SCREWS SUP-223.507 CDM 270010022 LOCAL 0270 RC outpatient 2827.11 2827.11 2827.11 74 2092.06 percent of total billed charges 2827.11 93 2289.96 percent of total billed charges 2827.11 2827.11 other OPPS APC 2827.11 2827.11 other OPPS APC 2827.11 27.63 781.13 percent of total billed charges 2827.11 2827.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L121 MM X W10.2 MM X H2.2 MM W11 MM X H3.3 MM TIBIA RIGHT DISTAL MEDIAL 8 HOLE NONSTERILE 3.5 MM SCREW SUP-223.508 CDM 270010022 LOCAL 0270 RC outpatient 6680.83 6680.83 6680.83 74 4943.81 percent of total billed charges 6680.83 93 5411.47 percent of total billed charges 6680.83 6680.83 other OPPS APC 6680.83 6680.83 other OPPS APC 6680.83 27.63 1845.91 percent of total billed charges 6680.83 6680.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L121 MM X W10.2 MM X H2.2 MM W11 MM X H3.3 MM TIBIA LEFT DISTAL MEDIAL 8 HOLE NONSTERILE 3.5 MM SCREW SUP-223.509 CDM 270010022 LOCAL 0270 RC outpatient 3286.14 3286.14 3286.14 74 2431.74 percent of total billed charges 3286.14 93 2661.77 percent of total billed charges 3286.14 3286.14 other OPPS APC 3286.14 3286.14 other OPPS APC 3286.14 27.63 907.96 percent of total billed charges 3286.14 3286.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L147 MM X W10.2 MM X H2.2 MM W11 MM X H3.3 MM TIBIA RIGHT DISTAL MEDIAL 10 HOLE NONSTERILE 3.5 MM SCREW SUP-223.510 CDM 270010022 LOCAL 0270 RC outpatient 3748.03 3748.03 3748.03 74 2773.54 percent of total billed charges 3748.03 93 3035.9 percent of total billed charges 3748.03 3748.03 other OPPS APC 3748.03 3748.03 other OPPS APC 3748.03 27.63 1035.58 percent of total billed charges 3748.03 3748.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L147 MM X W10.2 MM X H2.2 MM W11 MM X H3.3 MM TIBIA LEFT DISTAL MEDIAL 10 HOLE NONSTERILE 3.5 MM SCREW SUP-223.511 CDM 270010022 LOCAL 0270 RC outpatient 3748.03 3748.03 3748.03 74 2773.54 percent of total billed charges 3748.03 93 3035.9 percent of total billed charges 3748.03 3748.03 other OPPS APC 3748.03 3748.03 other OPPS APC 3748.03 27.63 1035.58 percent of total billed charges 3748.03 3748.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L173 MM X W10.2 MM X H2.2 MM W11 MM X H3.3 MM TIBIA RIGHT DISTAL MEDIAL 12 HOLE NONSTERILE 3.5 MM SCREW SUP-223.512 CDM 270010022 LOCAL 0270 RC outpatient 4185.61 4185.61 4185.61 74 3097.35 percent of total billed charges 4185.61 93 3390.34 percent of total billed charges 4185.61 4185.61 other OPPS APC 4185.61 4185.61 other OPPS APC 4185.61 27.63 1156.48 percent of total billed charges 4185.61 4185.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L173 MM X W10.2 MM X H2.2 MM W11 MM X H3.3 MM TIBIA LEFT DISTAL MEDIAL 12 HOLE NONSTERILE 3.5 MM SCREW SUP-223.513 CDM 270010022 LOCAL 0270 RC outpatient 4185.61 4185.61 4185.61 74 3097.35 percent of total billed charges 4185.61 93 3390.34 percent of total billed charges 4185.61 4185.61 other OPPS APC 4185.61 4185.61 other OPPS APC 4185.61 27.63 1156.48 percent of total billed charges 4185.61 4185.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L199 MM X W10.2 MM X H2.2 MM W11 MM X H3.3 MM TIBIA RIGHT DISTAL MEDIAL 14 HOLE NONSTERILE 3.5 MM SCREW SUP-223.514 CDM 270010022 LOCAL 0270 RC outpatient 4673.24 4673.24 4673.24 74 3458.2 percent of total billed charges 4673.24 93 3785.32 percent of total billed charges 4673.24 4673.24 other OPPS APC 4673.24 4673.24 other OPPS APC 4673.24 27.63 1291.22 percent of total billed charges 4673.24 4673.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L199 MM X W10.2 MM X H2.2 MM W11 MM X H3.3 MM TIBIA LEFT DISTAL MEDIAL 14 HOLE NONSTERILE 3.5 MM SCREW SUP-223.515 CDM 270010022 LOCAL 0270 RC outpatient 4673.24 4673.24 4673.24 74 3458.2 percent of total billed charges 4673.24 93 3785.32 percent of total billed charges 4673.24 4673.24 other OPPS APC 4673.24 4673.24 other OPPS APC 4673.24 27.63 1291.22 percent of total billed charges 4673.24 4673.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L225 MM TIBIA RIGHT DISTAL MEDIAL 16 HOLE NONSTERILE 3.5 MM SCREWS SUP-223.516 CDM 270010022 LOCAL 0270 RC outpatient 4663.18 4663.18 4663.18 74 3450.75 percent of total billed charges 4663.18 93 3777.18 percent of total billed charges 4663.18 4663.18 other OPPS APC 4663.18 4663.18 other OPPS APC 4663.18 27.63 1288.44 percent of total billed charges 4663.18 4663.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L225 MM TIBIA LEFT DISTAL MEDIAL 16 HOLE NONSTERILE 3.5 MM SCREWS SUP-223.517 CDM 270010022 LOCAL 0270 RC outpatient 4663.18 4663.18 4663.18 74 3450.75 percent of total billed charges 4663.18 93 3777.18 percent of total billed charges 4663.18 4663.18 other OPPS APC 4663.18 4663.18 other OPPS APC 4663.18 27.63 1288.44 percent of total billed charges 4663.18 4663.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L251 MM TIBIA RIGHT DISTAL MEDIAL 18 HOLE NONSTERILE 3.5 MM SCREWS SUP-223.518 CDM 270010022 LOCAL 0270 RC outpatient 5772.91 5772.91 5772.91 74 4271.95 percent of total billed charges 5772.91 93 4676.06 percent of total billed charges 5772.91 5772.91 other OPPS APC 5772.91 5772.91 other OPPS APC 5772.91 27.63 1595.06 percent of total billed charges 5772.91 5772.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L251 MM TIBIA LEFT DISTAL MEDIAL 18 HOLE NONSTERILE 3.5 MM SCREWS SUP-223.519 CDM 270010022 LOCAL 0270 RC outpatient 5090.67 5090.67 5090.67 74 3767.1 percent of total billed charges 5090.67 93 4123.44 percent of total billed charges 5090.67 5090.67 other OPPS APC 5090.67 5090.67 other OPPS APC 5090.67 27.63 1406.55 percent of total billed charges 5090.67 5090.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 25X11X3.3MM SS 3.5MM SCREW 2 HOLE LC-DCP BONE NS SUP-223.52 CDM outpatient 372.06 372.06 372.06 372.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL L25 MM X W11 MM X H3.3 MM 2 HOLE NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SUP-223.520 CDM 270010022 LOCAL 0270 RC outpatient 372.06 372.06 372.06 74 275.32 percent of total billed charges 372.06 93 301.37 percent of total billed charges 372.06 372.06 other OPPS APC 372.06 372.06 other OPPS APC 372.06 27.63 102.8 percent of total billed charges 372.06 372.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL L38 MM X W11 MM X H3.3 MM 3 HOLE NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SUP-223.53 CDM 270010022 LOCAL 0270 RC outpatient 757.9 757.9 757.9 74 560.85 percent of total billed charges 757.9 93 613.9 percent of total billed charges 757.9 757.9 other OPPS APC 757.9 757.9 other OPPS APC 757.9 27.63 209.41 percent of total billed charges 757.9 757.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL L51 MM X W11 MM X H3.3 MM 4 HOLE NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SUP-223.54 CDM 270010022 LOCAL 0270 RC outpatient 789.36 789.36 789.36 74 584.13 percent of total billed charges 789.36 93 639.38 percent of total billed charges 789.36 789.36 other OPPS APC 789.36 789.36 other OPPS APC 789.36 27.63 218.1 percent of total billed charges 789.36 789.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL L64 MM X W11 MM X H3.3 MM 5 HOLE NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SUP-223.55 CDM 270010022 LOCAL 0270 RC outpatient 717.52 717.52 717.52 74 530.96 percent of total billed charges 717.52 93 581.19 percent of total billed charges 717.52 717.52 other OPPS APC 717.52 717.52 other OPPS APC 717.52 27.63 198.25 percent of total billed charges 717.52 717.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 72X11X3.4MM SS NS 5 HOLE 3.5MM SCREW SM FRAGMENT SUP-223.551 CDM 270010022 LOCAL 0270 RC outpatient 1655.29 1655.29 1655.29 74 1224.91 percent of total billed charges 1655.29 93 1340.78 percent of total billed charges 1655.29 1655.29 other OPPS APC 1655.29 1655.29 other OPPS APC 1655.29 27.63 457.36 percent of total billed charges 1655.29 1655.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL L77 MM X W11 MM X H3.3 MM 6 HOLE NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SUP-223.56 CDM 270010022 LOCAL 0270 RC outpatient 868.01 868.01 868.01 74 642.33 percent of total billed charges 868.01 93 703.09 percent of total billed charges 868.01 868.01 other OPPS APC 868.01 868.01 other OPPS APC 868.01 27.63 239.83 percent of total billed charges 868.01 868.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 85X11X3.4MM SS NS 6 HOLE 3.5MM SCREW SM FRAGMENT SUP-223.561 CDM 270010022 LOCAL 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL L90 MM X W11 MM X H3.3 MM 7 HOLE NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SUP-223.57 CDM 270010022 LOCAL 0270 RC outpatient 900.9 900.9 900.9 74 666.67 percent of total billed charges 900.9 93 729.73 percent of total billed charges 900.9 900.9 other OPPS APC 900.9 900.9 other OPPS APC 900.9 27.63 248.92 percent of total billed charges 900.9 900.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 98X11X3.4MM SS NS 7 HOLE 3.5MM SCREW SM FRAGMENT SUP-223.571 CDM 270010022 LOCAL 0270 RC outpatient 742.74 742.74 742.74 74 549.63 percent of total billed charges 742.74 93 601.62 percent of total billed charges 742.74 742.74 other OPPS APC 742.74 742.74 other OPPS APC 742.74 27.63 205.22 percent of total billed charges 742.74 742.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL L103 MM X W11 MM X H3.3 MM 8 HOLE NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SUP-223.58 CDM 270010022 LOCAL 0270 RC outpatient 946.66 946.66 946.66 74 700.53 percent of total billed charges 946.66 93 766.79 percent of total billed charges 946.66 946.66 other OPPS APC 946.66 946.66 other OPPS APC 946.66 27.63 261.56 percent of total billed charges 946.66 946.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 111X11X3.4MM SS NS 8 HOLE 3.5MM SCREW SM FRAGMENT SUP-223.581 CDM 270010022 LOCAL 0270 RC outpatient 779.3 779.3 779.3 74 576.68 percent of total billed charges 779.3 93 631.23 percent of total billed charges 779.3 779.3 other OPPS APC 779.3 779.3 other OPPS APC 779.3 27.63 215.32 percent of total billed charges 779.3 779.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL L116 MM X W11 MM X H3.3 MM 9 HOLE NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SUP-223.59 CDM 270010022 LOCAL 0270 RC outpatient 985.27 985.27 985.27 74 729.1 percent of total billed charges 985.27 93 798.07 percent of total billed charges 985.27 985.27 other OPPS APC 985.27 985.27 other OPPS APC 985.27 27.63 272.23 percent of total billed charges 985.27 985.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 124X11X3.4MM SS 3.5MM SCREW SM FRAGMENT SET 9 HOLE LCP BONE NS SUP-223.591 CDM 270010022 LOCAL 0270 RC outpatient 812.08 812.08 812.08 74 600.94 percent of total billed charges 812.08 93 657.78 percent of total billed charges 812.08 812.08 other OPPS APC 812.08 812.08 other OPPS APC 812.08 27.63 224.38 percent of total billed charges 812.08 812.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL L129 MM X W11 MM X H3.3 MM 10 HOLE NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SUP-223.60 CDM 270010022 LOCAL 0270 RC outpatient 1015.3 1015.3 1015.3 74 751.32 percent of total billed charges 1015.3 93 822.39 percent of total billed charges 1015.3 1015.3 other OPPS APC 1015.3 1015.3 other OPPS APC 1015.3 27.63 280.53 percent of total billed charges 1015.3 1015.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 137X11X3.4MM SS NS 10 HOLE 3.5MM SCREW SM FRAGMENT SUP-223.601 CDM 270010022 LOCAL 0270 RC outpatient 836.06 836.06 836.06 74 618.68 percent of total billed charges 836.06 93 677.21 percent of total billed charges 836.06 836.06 other OPPS APC 836.06 836.06 other OPPS APC 836.06 27.63 231 percent of total billed charges 836.06 836.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL L155 MM X W11 MM X H3.3 MM 12 HOLE NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SUP-223.62 CDM 270010022 LOCAL 0270 RC outpatient 1118.26 1118.26 1118.26 74 827.51 percent of total billed charges 1118.26 93 905.79 percent of total billed charges 1118.26 1118.26 other OPPS APC 1118.26 1118.26 other OPPS APC 1118.26 27.63 308.98 percent of total billed charges 1118.26 1118.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L163 MM X W11 MM X H3.4 MM 12 HOLE LIMIT CONTACT TAPER END NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SUP-223.621 CDM 270010022 LOCAL 0270 RC outpatient 2267.46 2267.46 2267.46 74 1677.92 percent of total billed charges 2267.46 93 1836.64 percent of total billed charges 2267.46 2267.46 other OPPS APC 2267.46 2267.46 other OPPS APC 2267.46 27.63 626.5 percent of total billed charges 2267.46 2267.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL L181 MM X W11 MM X H3.3 MM 14 HOLE NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SUP-223.64 CDM 270010022 LOCAL 0270 RC outpatient 1678.82 1678.82 1678.82 74 1242.33 percent of total billed charges 1678.82 93 1359.84 percent of total billed charges 1678.82 1678.82 other OPPS APC 1678.82 1678.82 other OPPS APC 1678.82 27.63 463.86 percent of total billed charges 1678.82 1678.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L189 MM X W11 MM X H3.4 MM 14 HOLE LIMIT CONTACT TAPER END NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SUP-223.641 CDM 270010022 LOCAL 0270 RC outpatient 1384.58 1384.58 1384.58 74 1024.59 percent of total billed charges 1384.58 93 1121.51 percent of total billed charges 1384.58 1384.58 other OPPS APC 1384.58 1384.58 other OPPS APC 1384.58 27.63 382.56 percent of total billed charges 1384.58 1384.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE COMPRESSION CURITY 75X1IN POLYESTER COTTON STRETCH LOW LINT HIGH ABSORBENCY SUP-2230 CDM 0270 RC outpatient 0.71 0.71 0.71 74 0.53 percent of total billed charges 0.71 93 0.58 percent of total billed charges 0.71 0.71 other OPPS APC 0.71 0.71 other OPPS APC 0.71 27.63 0.2 percent of total billed charges 0.71 0.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE COMPRESSION CURITY CONFORM 75X2IN POLYESTER COTTON STERILE LF 1 PLY HIGH ABSORBENT LOW LINT SOFT POUCH SUP-2231 CDM 0270 RC outpatient 0.75 0.75 0.75 74 0.56 percent of total billed charges 0.75 93 0.61 percent of total billed charges 0.75 0.75 other OPPS APC 0.75 0.75 other OPPS APC 0.75 27.63 0.21 percent of total billed charges 0.75 0.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE COMPRESSION CURITY CONFORM POLYESTER COTTON L75 IN X W3 IN MODERATE STRETCH LOW PROFILE LOW LINT HIGH ABSORBENCY STERILE LATEX FREE SUP-2232 CDM 0270 RC outpatient 0.79 0.79 0.79 74 0.58 percent of total billed charges 0.79 93 0.64 percent of total billed charges 0.79 0.79 other OPPS APC 0.79 0.79 other OPPS APC 0.79 27.63 0.22 percent of total billed charges 0.79 0.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR HI-TORQUE TRAVERSE STRAIGHT SPRING TAPER 190CM 3CM .014IN MICROGLIDE SS PTFE LF PTCA SUP-22349M CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE COMPRESSION CURITY CONFORM 75X4IN POLYESTER COTTON STERILE LF 1 PLY HIGH ABSORBENT LOW LINT SOFT POUCH SUP-2236 CDM 0270 RC outpatient 0.91 0.91 0.91 74 0.67 percent of total billed charges 0.91 93 0.74 percent of total billed charges 0.91 0.91 other OPPS APC 0.91 0.91 other OPPS APC 0.91 27.63 0.25 percent of total billed charges 0.91 0.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT EYE MEROCEL WIPE EYE DRAIN CORNEAL LIGHT SHIELD STERILE SUP-223622 CDM 0270 RC outpatient 10.3 10.3 10.3 74 7.62 percent of total billed charges 10.3 93 8.34 percent of total billed charges 10.3 10.3 other OPPS APC 10.3 10.3 other OPPS APC 10.3 27.63 2.85 percent of total billed charges 10.3 10.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANGIOSCULPT OTW US PTA 4.0 X 100MM 137CM SUP-2237-40100 CDM 0481 RC outpatient 3055 3055 3055 74 2260.7 percent of total billed charges 3055 93 2474.55 percent of total billed charges 3055 3055 other OPPS APC 3055 3055 other OPPS APC 3055 51 1558.05 percent of total billed charges 3055 3055 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR HI-TORQUE TRAVERSE STRAIGHT SPRING TAPER 300CM 3CM .014IN HYDROCOAT SS PTFE LF PTCA SUP-22379H CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL NARROW L80 MM X W13.5 MM X H4.2 MM 4 HOLE LIMIT CONTACT TAPER END 4.5 MM SCREW LARGE FRAGMENT SUP-224.541 CDM 270010022 LOCAL 0270 RC outpatient 898.04 898.04 898.04 74 664.55 percent of total billed charges 898.04 93 727.41 percent of total billed charges 898.04 898.04 other OPPS APC 898.04 898.04 other OPPS APC 898.04 27.63 248.13 percent of total billed charges 898.04 898.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE NARROW LC-DCP 5 HOLE SUP-224.55 CDM 270010022 LOCAL 0270 RC outpatient 434.72 434.72 434.72 74 321.69 percent of total billed charges 434.72 93 352.12 percent of total billed charges 434.72 434.72 other OPPS APC 434.72 434.72 other OPPS APC 434.72 27.63 120.11 percent of total billed charges 434.72 434.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP NARROW 98X13.5X4.2MM SS NS 5 HOLE LIMIT CONTACT TAPER END 4.5MM SCREW LG FRAGMENT SET SUP-224.551 CDM 270010022 LOCAL 0270 RC outpatient 960.96 960.96 960.96 74 711.11 percent of total billed charges 960.96 93 778.38 percent of total billed charges 960.96 960.96 other OPPS APC 960.96 960.96 other OPPS APC 960.96 27.63 265.51 percent of total billed charges 960.96 960.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL NARROW L106 MM X W13.5 MM X H4.2 MM 6 HOLE NONSTERILE 4.5 MM SCREW LARGE FRAGMENT SUP-224.56 CDM 270010022 LOCAL 0270 RC outpatient 559.26 559.26 559.26 74 413.85 percent of total billed charges 559.26 93 453 percent of total billed charges 559.26 559.26 other OPPS APC 559.26 559.26 other OPPS APC 559.26 27.63 154.52 percent of total billed charges 559.26 559.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL NARROW L116 MM X W13.5 MM X H4.2 MM 6 HOLE LIMIT CONTACT TAPER END NONSTERILE 4.5 MM SCREW LARGE FRAGMENT SUP-224.561 CDM 270010022 LOCAL 0270 RC outpatient 1015.3 1015.3 1015.3 74 751.32 percent of total billed charges 1015.3 93 822.39 percent of total billed charges 1015.3 1015.3 other OPPS APC 1015.3 1015.3 other OPPS APC 1015.3 27.63 280.53 percent of total billed charges 1015.3 1015.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL NARROW L124 MM X W13.5 MM X H4.2 MM 7 HOLE NONSTERILE 4.5 MM SCREW LARGE FRAGMENT SUP-224.57 CDM 270010022 LOCAL 0270 RC outpatient 559.26 559.26 559.26 74 413.85 percent of total billed charges 559.26 93 453 percent of total billed charges 559.26 559.26 other OPPS APC 559.26 559.26 other OPPS APC 559.26 27.63 154.52 percent of total billed charges 559.26 559.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL NARROW L134 MM X W13.5 MM X H4.2 MM 7 HOLE LIMIT CONTACT TAPER END NONSTERILE 4.5 MM SCREW LARGE FRAGMENT SUP-224.571 CDM 270010022 LOCAL 0270 RC outpatient 1176.89 1176.89 1176.89 74 870.9 percent of total billed charges 1176.89 93 953.28 percent of total billed charges 1176.89 1176.89 other OPPS APC 1176.89 1176.89 other OPPS APC 1176.89 27.63 325.17 percent of total billed charges 1176.89 1176.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE NARROW LC-DCP 8 HOLE SUP-224.58 CDM 270010022 LOCAL 0270 RC outpatient 489.63 489.63 489.63 74 362.33 percent of total billed charges 489.63 93 396.6 percent of total billed charges 489.63 489.63 other OPPS APC 489.63 489.63 other OPPS APC 489.63 27.63 135.28 percent of total billed charges 489.63 489.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL NARROW L152 MM X W13.5 MM X H4.2 MM 8 HOLE LIMIT CONTACT TAPER END 4.5 MM SCREW LARGE FRAGMENT SUP-224.581 CDM 270010022 LOCAL 0270 RC outpatient 1245.53 1245.53 1245.53 74 921.69 percent of total billed charges 1245.53 93 1008.88 percent of total billed charges 1245.53 1245.53 other OPPS APC 1245.53 1245.53 other OPPS APC 1245.53 27.63 344.14 percent of total billed charges 1245.53 1245.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE NARROW LC-DCP 9 HOLE SUP-224.59 CDM 270010022 LOCAL 0270 RC outpatient 489.63 489.63 489.63 74 362.33 percent of total billed charges 489.63 93 396.6 percent of total billed charges 489.63 489.63 other OPPS APC 489.63 489.63 other OPPS APC 489.63 27.63 135.28 percent of total billed charges 489.63 489.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL NARROW L170 MM X W13.5 MM X H4.2 MM 9 HOLE LIMIT CONTACT TAPER END 4.5 MM SCREW LARGE FRAGMENT SET SUP-224.591 CDM 270010022 LOCAL 0270 RC outpatient 1148.78 1148.78 1148.78 74 850.1 percent of total billed charges 1148.78 93 930.51 percent of total billed charges 1148.78 1148.78 other OPPS APC 1148.78 1148.78 other OPPS APC 1148.78 27.63 317.41 percent of total billed charges 1148.78 1148.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE NARROW LC-DCP 10 HOLE SUP-224.60 CDM 270010022 LOCAL 0270 RC outpatient 638.35 638.35 638.35 74 472.38 percent of total billed charges 638.35 93 517.06 percent of total billed charges 638.35 638.35 other OPPS APC 638.35 638.35 other OPPS APC 638.35 27.63 176.38 percent of total billed charges 638.35 638.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL NARROW L188 MM X W13.5 MM X H4.2 MM 10 HOLE LIMIT CONTACT TAPER END 4.5 MM SCREW LARGE FRAGMENT SUP-224.601 CDM 270010022 LOCAL 0270 RC outpatient 1248.39 1248.39 1248.39 74 923.81 percent of total billed charges 1248.39 93 1011.2 percent of total billed charges 1248.39 1248.39 other OPPS APC 1248.39 1248.39 other OPPS APC 1248.39 27.63 344.93 percent of total billed charges 1248.39 1248.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE NARROW LC-DCP 11 HOLE SUP-224.61 CDM 270010022 LOCAL 0270 RC outpatient 638.35 638.35 638.35 74 472.38 percent of total billed charges 638.35 93 517.06 percent of total billed charges 638.35 638.35 other OPPS APC 638.35 638.35 other OPPS APC 638.35 27.63 176.38 percent of total billed charges 638.35 638.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP NARROW 206X13.5X4.2MM SS NS 11 HOLE LIMIT CONTACT TAPER END 4.5MM SCREW LG FRAGMENT SUP-224.611 CDM 270010022 LOCAL 0270 RC outpatient 1522.95 1522.95 1522.95 74 1126.98 percent of total billed charges 1522.95 93 1233.59 percent of total billed charges 1522.95 1522.95 other OPPS APC 1522.95 1522.95 other OPPS APC 1522.95 27.63 420.79 percent of total billed charges 1522.95 1522.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE NARROW LC-DCP 12 HOLE SUP-224.62 CDM 270010022 LOCAL 0270 RC outpatient 638.35 638.35 638.35 74 472.38 percent of total billed charges 638.35 93 517.06 percent of total billed charges 638.35 638.35 other OPPS APC 638.35 638.35 other OPPS APC 638.35 27.63 176.38 percent of total billed charges 638.35 638.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL NARROW L224 MM X W13.5 MM X H4.2 MM 12 HOLE LIMIT CONTACT TAPER END 4.5 MM SCREW LARGE FRAGMENT SUP-224.621 CDM 270010022 LOCAL 0270 RC outpatient 1638.78 1638.78 1638.78 74 1212.7 percent of total billed charges 1638.78 93 1327.41 percent of total billed charges 1638.78 1638.78 other OPPS APC 1638.78 1638.78 other OPPS APC 1638.78 27.63 452.79 percent of total billed charges 1638.78 1638.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP NARROW 260X13.5X4.2MM SS NS 14 HOLE LIMIT CONTACT TAPER END 4.5MM SCREW LG FRAGMENT SET SUP-224.641 CDM 270010022 LOCAL 0270 RC outpatient 1620.4 1620.4 1620.4 74 1199.1 percent of total billed charges 1620.4 93 1312.52 percent of total billed charges 1620.4 1620.4 other OPPS APC 1620.4 1620.4 other OPPS APC 1620.4 27.63 447.72 percent of total billed charges 1620.4 1620.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP NARROW 296X13.5X4.2MM SS NS 16 HOLE LIMIT CONTACT TAPER END 4.5MM SCREW LG FRAGMENT SET SUP-224.661 CDM 270010022 LOCAL 0270 RC outpatient 1892.77 1892.77 1892.77 74 1400.65 percent of total billed charges 1892.77 93 1533.14 percent of total billed charges 1892.77 1892.77 other OPPS APC 1892.77 1892.77 other OPPS APC 1892.77 27.63 522.97 percent of total billed charges 1892.77 1892.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L118 MM X W11 MM X H4.2 MM 8 HOLE LIMIT CONTACT TAPER END NONSTERILE 4.5/3.5 MM SCREW LARGE FRAGMENT SET SUP-224.753 CDM 270010022 LOCAL 0270 RC outpatient 2388.1 2388.1 2388.1 74 1767.19 percent of total billed charges 2388.1 93 1934.36 percent of total billed charges 2388.1 2388.1 other OPPS APC 2388.1 2388.1 other OPPS APC 2388.1 27.63 659.83 percent of total billed charges 2388.1 2388.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L154 MM X W11 MM X H4.2 MM 10 HOLE NONSTERILE 4.5/3.5 MM SCREW LARGE FRAGMENT SUP-224.755 CDM 270010022 LOCAL 0270 RC outpatient 2471.04 2471.04 2471.04 74 1828.57 percent of total billed charges 2471.04 93 2001.54 percent of total billed charges 2471.04 2471.04 other OPPS APC 2471.04 2471.04 other OPPS APC 2471.04 27.63 682.75 percent of total billed charges 2471.04 2471.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP NARROW 190X11X4.2MM SS NS 12 HOLE 4.5/3.5MM SCREW LG FRAGMENT SUP-224.757 CDM 270010022 LOCAL 0270 RC outpatient 6685.25 6685.25 6685.25 74 4947.09 percent of total billed charges 6685.25 93 5415.05 percent of total billed charges 6685.25 6685.25 other OPPS APC 6685.25 6685.25 other OPPS APC 6685.25 27.63 1847.13 percent of total billed charges 6685.25 6685.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L226 MM X W11 MM X H4.2 MM 14 HOLE NONSTERILE 4.5/3.5 MM SCREW LARGE FRAGMENT SUP-224.759 CDM 270010022 LOCAL 0270 RC outpatient 3343.34 3343.34 3343.34 74 2474.07 percent of total billed charges 3343.34 93 2708.11 percent of total billed charges 3343.34 3343.34 other OPPS APC 3343.34 3343.34 other OPPS APC 3343.34 27.63 923.76 percent of total billed charges 3343.34 3343.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L262 MM X W11 MM X H4.2 MM 16 HOLE NONSTERILE 4.5/3.5 MM SCREW LARGE FRAGMENT SUP-224.761 CDM 270010022 LOCAL 0270 RC outpatient 3512.08 3512.08 3512.08 74 2598.94 percent of total billed charges 3512.08 93 2844.78 percent of total billed charges 3512.08 3512.08 other OPPS APC 3512.08 3512.08 other OPPS APC 3512.08 27.63 970.39 percent of total billed charges 3512.08 3512.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L298 MM X W11 MM X H4.2 MM 18 HOLE NONSTERILE 4.5/3.5 MM SCREW LARGE FRAGMENT SUP-224.763 CDM 270010022 LOCAL 0270 RC outpatient 3577.86 3577.86 3577.86 74 2647.62 percent of total billed charges 3577.86 93 2898.07 percent of total billed charges 3577.86 3577.86 other OPPS APC 3577.86 3577.86 other OPPS APC 3577.86 27.63 988.56 percent of total billed charges 3577.86 3577.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM EMBOLIC PROTECTION EMBOSHEILD NAV6 STAINLESS STEEL PTFE SMALL L190CM OD 2.5-4.8MM SUP-22437-19 CDM 0270 RC outpatient 3481.4 3481.4 3481.4 74 2576.24 percent of total billed charges 3481.4 93 2819.93 percent of total billed charges 3481.4 3481.4 other OPPS APC 3481.4 3481.4 other OPPS APC 3481.4 27.63 961.91 percent of total billed charges 3481.4 3481.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM EMBOLIC PROTECTION EMBOSHIELD NAV6 STAINLESS STEEL PTFE .014 IN LARGE L190 CM OD4-7 MM SUP-22438-19 CDM 0270 RC outpatient 3481.4 3481.4 3481.4 74 2576.24 percent of total billed charges 3481.4 93 2819.93 percent of total billed charges 3481.4 3481.4 other OPPS APC 3481.4 3481.4 other OPPS APC 3481.4 27.63 961.91 percent of total billed charges 3481.4 3481.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR BAREWIRE L 190 CM OD .014 IN DISTAL ACCESS FILTER DELIVERY SUP-22439-19 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR EMBOSHIELD NAV6 BAREWIRE WORKHORSE STAINLESS STEEL L190 CM OD.014 IN SUP-22440-19 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR NITINOL L 315CM OD .014 IN WORKHORSE FILTER DELIVERY RADIOPAQUE FRAME COIL SUP-22440-31 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR BAREWIRE L190CM SUPPORT FILTER DELIVERY SUP-22441-19 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.5 X 8MM NON COMPLIANT PLUS SUP-225-083-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.5 X 10MM NON COMPLIANT PLUS SUP-225-103-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.5 X 10MM SEMICOMPLIANT SUP-225-103-5UU CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.5 X 12MM NON COMPLIANT PLUS SUP-225-123-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.5 X 12MM SEMICOMPLIANT SUP-225-123-5UU CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.5 X 15MM NON COMPLIANT PLUS SUP-225-153-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.5 X 15MM SEMICOMPLIANT SUP-225-153-5UU CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.5 X 18MM NON COMPLIANT PLUS SUP-225-183-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.5 X 20MM SEMICOMPLIANT SUP-225-203-5UU CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL VAPR 21 D OD2.3 MM ARTHROSCOPY RADIOFREQUENCY WEDGE EFFECT STERILE DISPOSABLE SUP-225203 CDM 0270 RC outpatient 613.6 613.6 613.6 74 454.06 percent of total billed charges 613.6 93 497.02 percent of total billed charges 613.6 613.6 other OPPS APC 613.6 613.6 other OPPS APC 613.6 27.63 169.54 percent of total billed charges 613.6 613.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL VAPR ANGLED OD2.3 MM SIDE EFFECT THERMAL MODIFICATION ARTHROSCOPIC STERILE DISPOSABLE SUP-225252 CDM 0270 RC outpatient 1060.8 1060.8 1060.8 74 784.99 percent of total billed charges 1060.8 93 859.25 percent of total billed charges 1060.8 1060.8 other OPPS APC 1060.8 1060.8 other OPPS APC 1060.8 27.63 293.1 percent of total billed charges 1060.8 1060.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL VAPR 90D 40MM DISPOSABLE STERILE LF SUCTION INTEGRATE HANDPIECE SUP-225370 CDM 0270 RC outpatient 702 702 702 74 519.48 percent of total billed charges 702 93 568.62 percent of total billed charges 702 702 other OPPS APC 702 702 other OPPS APC 702 27.63 193.96 percent of total billed charges 702 702 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE DEFIBRILLATOR MEDI-TRACE CADENCE ADULT MULTIFUNCTION RADIOLUCENT MEDTRONIC PAD SUP-22550R CDM 0270 RC outpatient 40.59 40.59 40.59 74 30.04 percent of total billed charges 40.59 93 32.88 percent of total billed charges 40.59 40.59 other OPPS APC 40.59 40.59 other OPPS APC 40.59 27.63 11.22 percent of total billed charges 40.59 40.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI BROAD 116X17.5X5.2MM SS NS 6 HOLE LIMIT CONTACT TAPER END 4.5MM SCREW LG FRAGMENT SET SUP-226.561 CDM 270010022 LOCAL 0270 RC outpatient 1086.8 1086.8 1086.8 74 804.23 percent of total billed charges 1086.8 93 880.31 percent of total billed charges 1086.8 1086.8 other OPPS APC 1086.8 1086.8 other OPPS APC 1086.8 27.63 300.28 percent of total billed charges 1086.8 1086.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BROAD LC-DCP 7 HOLE SUP-226.57 CDM 270010022 LOCAL 0270 RC outpatient 720.72 720.72 720.72 74 533.33 percent of total billed charges 720.72 93 583.78 percent of total billed charges 720.72 720.72 other OPPS APC 720.72 720.72 other OPPS APC 720.72 27.63 199.13 percent of total billed charges 720.72 720.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL BROAD L134 MM X W17.5 MM X H5.2 MM 7 HOLE LIMIT CONTACT TAPER END 4.5 MM SCREW LARGE FRAGMENT SET SUP-226.571 CDM 270010022 LOCAL 0270 RC outpatient 1152.58 1152.58 1152.58 74 852.91 percent of total billed charges 1152.58 93 933.59 percent of total billed charges 1152.58 1152.58 other OPPS APC 1152.58 1152.58 other OPPS APC 1152.58 27.63 318.46 percent of total billed charges 1152.58 1152.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL BROAD L142 MM X W17.5 MM X H5.2 MM 8 HOLE NONSTERILE 4.5 MM SCREW LARGE FRAGMENT SUP-226.58 CDM 270010022 LOCAL 0270 RC outpatient 914.94 914.94 914.94 74 677.06 percent of total billed charges 914.94 93 741.1 percent of total billed charges 914.94 914.94 other OPPS APC 914.94 914.94 other OPPS APC 914.94 27.63 252.8 percent of total billed charges 914.94 914.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL BROAD L152 MM X W17.5 MM X H5.2 MM 8 HOLE LIMIT CONTACT TAPER END 4.5 MM SCREW LARGE FRAGMENT SET SUP-226.581 CDM 270010022 LOCAL 0270 RC outpatient 1407.12 1407.12 1407.12 74 1041.27 percent of total billed charges 1407.12 93 1139.77 percent of total billed charges 1407.12 1407.12 other OPPS APC 1407.12 1407.12 other OPPS APC 1407.12 27.63 388.79 percent of total billed charges 1407.12 1407.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL BROAD L170 MM X W17.5 MM X H5.2 MM 9 HOLE LIMIT CONTACT TAPER END 4.5 MM SCREW LARGE FRAGMENT SET SUP-226.591 CDM 270010022 LOCAL 0270 RC outpatient 1522.95 1522.95 1522.95 74 1126.98 percent of total billed charges 1522.95 93 1233.59 percent of total billed charges 1522.95 1522.95 other OPPS APC 1522.95 1522.95 other OPPS APC 1522.95 27.63 420.79 percent of total billed charges 1522.95 1522.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BROAD LC-DCP 10 HOLE SUP-226.60 CDM 270010022 LOCAL 0270 RC outpatient 803.09 803.09 803.09 74 594.29 percent of total billed charges 803.09 93 650.5 percent of total billed charges 803.09 803.09 other OPPS APC 803.09 803.09 other OPPS APC 803.09 27.63 221.89 percent of total billed charges 803.09 803.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL BROAD L188 MM X W17.5 MM X H5.2 MM 10 HOLE LIMIT CONTACT TAPER END 4.5 MM SCREW LARGE FRAGMENT SET SUP-226.601 CDM 270010022 LOCAL 0270 RC outpatient 1638.78 1638.78 1638.78 74 1212.7 percent of total billed charges 1638.78 93 1327.41 percent of total billed charges 1638.78 1638.78 other OPPS APC 1638.78 1638.78 other OPPS APC 1638.78 27.63 452.79 percent of total billed charges 1638.78 1638.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BROAD LC-DCP 11 HOLE SUP-226.61 CDM 270010022 LOCAL 0270 RC outpatient 862.58 862.58 862.58 74 638.31 percent of total billed charges 862.58 93 698.69 percent of total billed charges 862.58 862.58 other OPPS APC 862.58 862.58 other OPPS APC 862.58 27.63 238.33 percent of total billed charges 862.58 862.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP BROAD 206X17.5X5.2MM SS NS 11 HOLE 4.5MM SCREW LG FRAGMENT SUP-226.611 CDM 270010022 LOCAL 0270 RC outpatient 1744.6 1744.6 1744.6 74 1291 percent of total billed charges 1744.6 93 1413.13 percent of total billed charges 1744.6 1744.6 other OPPS APC 1744.6 1744.6 other OPPS APC 1744.6 27.63 482.03 percent of total billed charges 1744.6 1744.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BROAD LC-DCP 12 HOLE SUP-226.62 CDM 270010022 LOCAL 0270 RC outpatient 862.58 862.58 862.58 74 638.31 percent of total billed charges 862.58 93 698.69 percent of total billed charges 862.58 862.58 other OPPS APC 862.58 862.58 other OPPS APC 862.58 27.63 238.33 percent of total billed charges 862.58 862.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL BROAD L224 MM X W17.5 MM X H5.2 MM 12 HOLE LIMIT CONTACT TAPER END 4.5 MM SCREW LARGE FRAGMENT SET SUP-226.621 CDM 270010022 LOCAL 0270 RC outpatient 1850.42 1850.42 1850.42 74 1369.31 percent of total billed charges 1850.42 93 1498.84 percent of total billed charges 1850.42 1850.42 other OPPS APC 1850.42 1850.42 other OPPS APC 1850.42 27.63 511.27 percent of total billed charges 1850.42 1850.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI BROAD CURVE 229X17.5X5.2MM SS NS 12 HOLE PRECONTOUR LIMIT CONTACT TAPER TIP 4.5MM SCREW LG FRAGMENT SUP-226.622 CDM 270010022 LOCAL 0270 RC outpatient 1850.42 1850.42 1850.42 74 1369.31 percent of total billed charges 1850.42 93 1498.84 percent of total billed charges 1850.42 1850.42 other OPPS APC 1850.42 1850.42 other OPPS APC 1850.42 27.63 511.27 percent of total billed charges 1850.42 1850.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL BROAD CURVE L247 MM X W17.5 MM X H5.2 MM 13 HOLE PRECONTOUR LIMIT CONTACT TAPER TIP NONSTERILE 4.5 MM SCREW LARGE FRAGMENT SUP-226.632 CDM 270010022 LOCAL 0270 RC outpatient 1960.53 1960.53 1960.53 74 1450.79 percent of total billed charges 1960.53 93 1588.03 percent of total billed charges 1960.53 1960.53 other OPPS APC 1960.53 1960.53 other OPPS APC 1960.53 27.63 541.69 percent of total billed charges 1960.53 1960.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL BROAD L250 MM X W17.5 MM X H5.2 MM 14 HOLE NONSTERILE 4.5 MM SCREW LARGE FRAGMENT SUP-226.64 CDM 270010022 LOCAL 0270 RC outpatient 982.8 982.8 982.8 74 727.27 percent of total billed charges 982.8 93 796.07 percent of total billed charges 982.8 982.8 other OPPS APC 982.8 982.8 other OPPS APC 982.8 27.63 271.55 percent of total billed charges 982.8 982.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL BROAD L260 MM X W17.5 MM X H5.2 MM 14 HOLE LIMIT CONTACT TAPER END NONSTERILE 4.5 MM SCREW LARGE FRAGMENT SET SUP-226.641 CDM 270010022 LOCAL 0270 RC outpatient 2059.2 2059.2 2059.2 74 1523.81 percent of total billed charges 2059.2 93 1667.95 percent of total billed charges 2059.2 2059.2 other OPPS APC 2059.2 2059.2 other OPPS APC 2059.2 27.63 568.96 percent of total billed charges 2059.2 2059.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL BROAD CURVE L265 MM X W17.5 MM X H5.2 MM 14 HOLE PRECONTOUR LIMIT CONTACT TAPER TIP NONSTERILE 4.5 MM SCREW LARGE FRAGMENT SUP-226.642 CDM 270010022 LOCAL 0270 RC outpatient 2059.2 2059.2 2059.2 74 1523.81 percent of total billed charges 2059.2 93 1667.95 percent of total billed charges 2059.2 2059.2 other OPPS APC 2059.2 2059.2 other OPPS APC 2059.2 27.63 568.96 percent of total billed charges 2059.2 2059.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL BROAD CURVE L282 MM X W17.5 MM X H5.2 MM 15 HOLE PRECONTOUR LIMIT CONTACT TAPER TIP NONSTERILE 4.5 MM SCREW LARGE FRAGMENT SUP-226.652 CDM 270010022 LOCAL 0270 RC outpatient 2286.57 2286.57 2286.57 74 1692.06 percent of total billed charges 2286.57 93 1852.12 percent of total billed charges 2286.57 2286.57 other OPPS APC 2286.57 2286.57 other OPPS APC 2286.57 27.63 631.78 percent of total billed charges 2286.57 2286.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL BROAD L286 MM X W17.5 MM X H5.2 MM 16 HOLE NONSTERILE 4.5 MM SCREW LARGE FRAGMENT SUP-226.66 CDM 270010022 LOCAL 0270 RC outpatient 1116.18 1116.18 1116.18 74 825.97 percent of total billed charges 1116.18 93 904.11 percent of total billed charges 1116.18 1116.18 other OPPS APC 1116.18 1116.18 other OPPS APC 1116.18 27.63 308.4 percent of total billed charges 1116.18 1116.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL BROAD L296 MM X W17.5 MM X H5.2 MM 16 HOLE LIMIT CONTACT TAPER END NONSTERILE 4.5 MM SCREW LARGE FRAGMENT SET SUP-226.661 CDM 270010022 LOCAL 0270 RC outpatient 2205.5 2205.5 2205.5 74 1632.07 percent of total billed charges 2205.5 93 1786.46 percent of total billed charges 2205.5 2205.5 other OPPS APC 2205.5 2205.5 other OPPS APC 2205.5 27.63 609.38 percent of total billed charges 2205.5 2205.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL BROAD CURVE L300 MM X W17.5 MM X H5.2 MM 16 HOLE PRECONTOUR LIMIT CONTACT TAPER TIP NONSTERILE 4.5 MM SCREW LARGE FRAGMENT SUP-226.662 CDM 270010022 LOCAL 0270 RC outpatient 2501.07 2501.07 2501.07 74 1850.79 percent of total billed charges 2501.07 93 2025.87 percent of total billed charges 2501.07 2501.07 other OPPS APC 2501.07 2501.07 other OPPS APC 2501.07 27.63 691.05 percent of total billed charges 2501.07 2501.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL BROAD L332 MM X W17.5 MM X H5.2 MM 18 HOLE NONSTERILE 4.5 MM SCREW LARGE FRAGMENT SUP-226.68 CDM 270010022 LOCAL 0270 RC outpatient 1228.5 1228.5 1228.5 74 909.09 percent of total billed charges 1228.5 93 995.09 percent of total billed charges 1228.5 1228.5 other OPPS APC 1228.5 1228.5 other OPPS APC 1228.5 27.63 339.43 percent of total billed charges 1228.5 1228.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI BROAD CURVE 336X17.5X5.2MM SS NS 18 HOLE PRECONTOUR LIMIT CONTACT TAPER TIP 4.5MM SCREW LG FRAGMENT SUP-226.682 CDM 270010022 LOCAL 0270 RC outpatient 2857.14 2857.14 2857.14 74 2114.28 percent of total billed charges 2857.14 93 2314.28 percent of total billed charges 2857.14 2857.14 other OPPS APC 2857.14 2857.14 other OPPS APC 2857.14 27.63 789.43 percent of total billed charges 2857.14 2857.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.75 X 8MM NON COMPLIANT PLUS SUP-227-083-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.75 X 10MM NON COMPLIANT PLUS SUP-227-103-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.75 X 12MM NON COMPLIANT PLUS SUP-227-123-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.75 X 15MM NON COMPLIANT PLUS SUP-227-153-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 2.75 X 18MM NON COMPLIANT PLUS SUP-227-183-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID G2 AFT .75ML SODIUM HYALURONATE TISSUE ALLOGRAFT DIVERT TUBE MORSELIZE SUP-227005 CDM 270010031 LOCAL 0270 RC outpatient 673.4 673.4 673.4 74 498.32 percent of total billed charges 673.4 93 545.45 percent of total billed charges 673.4 673.4 other OPPS APC 673.4 673.4 other OPPS APC 673.4 27.63 186.06 percent of total billed charges 673.4 673.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID G2 AFT STRAIGHT TUBE .5ML SODIUM HYALURONATE TISSUE ALLOGRAFT MORSELIZE SUP-227010 CDM 270010031 LOCAL 0270 RC outpatient 457.6 457.6 457.6 74 338.62 percent of total billed charges 457.6 93 370.66 percent of total billed charges 457.6 457.6 other OPPS APC 457.6 457.6 other OPPS APC 457.6 27.63 126.43 percent of total billed charges 457.6 457.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL VAPR 90 D OD3.5 MM HOOK INTEGRATED HANDPIECE SUP-227305 CDM 0270 RC outpatient 725.4 725.4 725.4 74 536.8 percent of total billed charges 725.4 93 587.57 percent of total billed charges 725.4 725.4 other OPPS APC 725.4 725.4 other OPPS APC 725.4 27.63 200.43 percent of total billed charges 725.4 725.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE DEFIBRILLATOR MEDITRACE CADENCE SILVER CHLORIDE ADULT OVAL L6.25IN X W4.5IN MULTIFUNCTION ADHESIVE RADIOTRANSPARENT CONNECTOR LATEX FREE ZOLL 8900-2100-01/8900-4005 SUP-22770R CDM 0270 RC outpatient 37.17 37.17 37.17 74 27.51 percent of total billed charges 37.17 93 30.11 percent of total billed charges 37.17 37.17 other OPPS APC 37.17 37.17 other OPPS APC 37.17 27.63 10.27 percent of total billed charges 37.17 37.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER CRYOABLATION FREEZOR XTRA 5 2-5-2 MM SPACE 60 MM REACH LONG L108 CM L6 MM OD7 FR CARDIAC UNIDIRECTIONAL STEERABLE FLEXIBLE ORANGE SUP-227F5 CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBES EHL 9FR SUP-2280.0915 CDM 0270 RC outpatient 2292.99 2292.99 2292.99 74 1696.81 percent of total billed charges 2292.99 93 1857.32 percent of total billed charges 2292.99 2292.99 other OPPS APC 2292.99 2292.99 other OPPS APC 2292.99 27.63 633.55 percent of total billed charges 2292.99 2292.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OMNISPAN MENISCAL REPAIR 0 DEGREE SUP-228140 CDM 0270 RC outpatient 683.8 683.8 683.8 74 506.01 percent of total billed charges 683.8 93 553.88 percent of total billed charges 683.8 683.8 other OPPS APC 683.8 683.8 other OPPS APC 683.8 27.63 188.93 percent of total billed charges 683.8 683.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OMNISPAN MENISCAL REPAIR 12 DEGREE SUP-228141 CDM 0270 RC outpatient 720.2 720.2 720.2 74 532.95 percent of total billed charges 720.2 93 583.36 percent of total billed charges 720.2 720.2 other OPPS APC 720.2 720.2 other OPPS APC 720.2 27.63 198.99 percent of total billed charges 720.2 720.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ARTHROSCOPIC FIXATION OMNISPAN 27D MENISCAL REPAIR SYSTEM SUP-228142 CDM 0270 RC outpatient 683.8 683.8 683.8 74 506.01 percent of total billed charges 683.8 93 553.88 percent of total billed charges 683.8 683.8 other OPPS APC 683.8 683.8 other OPPS APC 683.8 27.63 188.93 percent of total billed charges 683.8 683.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER INTERNAL CLIP MALLEABLE GRAFT RETRACTOR DEPLOYMENT GUN OMNISPAN MENISCAL SUP-228143 CDM 0270 RC outpatient 416 416 416 74 307.84 percent of total billed charges 416 93 336.96 percent of total billed charges 416 416 other OPPS APC 416 416 other OPPS APC 416 27.63 114.94 percent of total billed charges 416 416 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PADDING CAST WEBRIL COTTON L12 FT X W2 IN UNDERCAST MILD STRETCH COHESIVE REGULAR FINISH STERILE LATEX FREE SUP-2283 CDM outpatient 1.45 1.45 1.45 1.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL STRAIGHT L141 MM X W12 MM X H3 MM 9 HOLE RECONSTRUCTION NONSTERILE 4.5 MM CORTICAL SCREW LARGE FRAGMENT SUP-229.39 CDM 270010022 LOCAL 0270 RC outpatient 1863.29 1863.29 1863.29 74 1378.83 percent of total billed charges 1863.29 93 1509.26 percent of total billed charges 1863.29 1863.29 other OPPS APC 1863.29 1863.29 other OPPS APC 1863.29 27.63 514.83 percent of total billed charges 1863.29 1863.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER POWERED ECH FLEX 60 SUP-2299PLE60A CDM 0270 RC outpatient 1187.7 1187.7 1187.7 74 878.9 percent of total billed charges 1187.7 93 962.04 percent of total billed charges 1187.7 1187.7 other OPPS APC 1187.7 1187.7 other OPPS APC 1187.7 27.63 328.16 percent of total billed charges 1187.7 1187.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STERI DRAPE STERI BLU PUNCT 1092 SUP-23-00002 CDM 0272 RC outpatient 1.42 1.42 1.42 74 1.05 percent of total billed charges 1.42 93 1.15 percent of total billed charges 1.42 1.42 other OPPS APC 1.42 1.42 other OPPS APC 1.42 27.63 0.39 percent of total billed charges 1.42 1.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK RESUSCITATOR SUP-23-00023 CDM 0272 RC outpatient 3.77 3.77 3.77 74 2.79 percent of total billed charges 3.77 93 3.05 percent of total billed charges 3.77 3.77 other OPPS APC 3.77 3.77 other OPPS APC 3.77 27.63 1.04 percent of total billed charges 3.77 3.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE BILATERAL EXTREMITY SUP-23-00027 CDM 0272 RC outpatient 31.36 31.36 31.36 74 23.21 percent of total billed charges 31.36 93 25.4 percent of total billed charges 31.36 31.36 other OPPS APC 31.36 31.36 other OPPS APC 31.36 27.63 8.66 percent of total billed charges 31.36 31.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "EENT PACK,I EVOL" SUP-23-00032 CDM 0272 RC outpatient 74.66 74.66 74.66 74 55.25 percent of total billed charges 74.66 93 60.47 percent of total billed charges 74.66 74.66 other OPPS APC 74.66 74.66 other OPPS APC 74.66 27.63 20.63 percent of total billed charges 74.66 74.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEET NECK AND THYROID SUP-23-00057 CDM 0272 RC outpatient 34 34 34 74 25.16 percent of total billed charges 34 93 27.54 percent of total billed charges 34 34 other OPPS APC 34 34 other OPPS APC 34 27.63 9.39 percent of total billed charges 34 34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOULDER POSITIONER PACK 3 SUP-23-00064 CDM 0272 RC outpatient 129.93 129.93 129.93 74 96.15 percent of total billed charges 129.93 93 105.24 percent of total billed charges 129.93 129.93 other OPPS APC 129.93 129.93 other OPPS APC 129.93 27.63 35.9 percent of total billed charges 129.93 129.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOWEL DISP STERILE CLOTH 1/PK SUP-23-00069 CDM 0272 RC outpatient 0.57 0.57 0.57 74 0.42 percent of total billed charges 0.57 93 0.46 percent of total billed charges 0.57 0.57 other OPPS APC 0.57 0.57 other OPPS APC 0.57 27.63 0.16 percent of total billed charges 0.57 0.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CPT CARDIAC CATH SUP-23-00094 CDM 0272 RC outpatient 195.14 195.14 195.14 74 144.4 percent of total billed charges 195.14 93 158.06 percent of total billed charges 195.14 195.14 other OPPS APC 195.14 195.14 other OPPS APC 195.14 27.63 53.92 percent of total billed charges 195.14 195.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE LIMB BILATERAL SUP-23-00104 CDM 0272 RC outpatient 45.32 45.32 45.32 74 33.54 percent of total billed charges 45.32 93 36.71 percent of total billed charges 45.32 45.32 other OPPS APC 45.32 45.32 other OPPS APC 45.32 27.63 12.52 percent of total billed charges 45.32 45.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOGA SURGICAL T7 PLUS ZIPPER PEEL AWAY FACE SHIELD STERILE LATEX FREE DISPOSABLE SUP-23-00111 CDM 0272 RC outpatient 329.11 329.11 329.11 74 243.54 percent of total billed charges 329.11 93 266.58 percent of total billed charges 329.11 329.11 other OPPS APC 329.11 329.11 other OPPS APC 329.11 27.63 90.93 percent of total billed charges 329.11 329.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK PROCEDURE - EAR LOOP SUP-23-00139 CDM 0272 RC outpatient 2.14 2.14 2.14 74 1.58 percent of total billed charges 2.14 93 1.73 percent of total billed charges 2.14 2.14 other OPPS APC 2.14 2.14 other OPPS APC 2.14 27.63 0.59 percent of total billed charges 2.14 2.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK FACE CHILD EARLOOP SUP-23-00140 CDM 0272 RC outpatient 53.61 53.61 53.61 74 39.67 percent of total billed charges 53.61 93 43.42 percent of total billed charges 53.61 53.61 other OPPS APC 53.61 53.61 other OPPS APC 53.61 27.63 14.81 percent of total billed charges 53.61 53.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK LAPAROTOMY SUP-23-00150 CDM 0272 RC outpatient 34.43 34.43 34.43 74 25.48 percent of total billed charges 34.43 93 27.89 percent of total billed charges 34.43 34.43 other OPPS APC 34.43 34.43 other OPPS APC 34.43 27.63 9.51 percent of total billed charges 34.43 34.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "KIT, DELIVERY" SUP-23-00152 CDM 0272 RC outpatient 84.64 84.64 84.64 74 62.63 percent of total billed charges 84.64 93 68.56 percent of total billed charges 84.64 84.64 other OPPS APC 84.64 84.64 other OPPS APC 84.64 27.63 23.39 percent of total billed charges 84.64 84.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GOWN BAIR PAWS XLG SUP-23-00160 CDM 0272 RC outpatient 62.41 62.41 62.41 74 46.18 percent of total billed charges 62.41 93 50.55 percent of total billed charges 62.41 62.41 other OPPS APC 62.41 62.41 other OPPS APC 62.41 27.63 17.24 percent of total billed charges 62.41 62.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOULDER SUSPENSION KIT SUP-23-00161 CDM 0272 RC outpatient 326.62 326.62 326.62 74 241.7 percent of total billed charges 326.62 93 264.56 percent of total billed charges 326.62 326.62 other OPPS APC 326.62 326.62 other OPPS APC 326.62 27.63 90.25 percent of total billed charges 326.62 326.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK ORTHO SPLIT SHEET SUP-23-00164 CDM 0272 RC outpatient 55.1 55.1 55.1 74 40.77 percent of total billed charges 55.1 93 44.63 percent of total billed charges 55.1 55.1 other OPPS APC 55.1 55.1 other OPPS APC 55.1 27.63 15.22 percent of total billed charges 55.1 55.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUIT STRYKER LG FLYTE T7 PLUS SUP-23-00173 CDM 0272 RC outpatient 322.58 322.58 322.58 74 238.71 percent of total billed charges 322.58 93 261.29 percent of total billed charges 322.58 322.58 other OPPS APC 322.58 322.58 other OPPS APC 322.58 27.63 89.13 percent of total billed charges 322.58 322.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALER BIPOLAR AQUAMANTYS 6.0 TRANSCOLLATION 30 D .236 IN SPACE L.226 IN L5.1 IN OD.137 IN 2 ELECTRODE HEMOSTATIC STERILE LATEX FREE DISPOSABLE SUP-23-112-1 CDM 0270 RC outpatient 506.22 506.22 506.22 74 374.6 percent of total billed charges 506.22 93 410.04 percent of total billed charges 506.22 506.22 other OPPS APC 506.22 506.22 other OPPS APC 506.22 27.63 139.87 percent of total billed charges 506.22 506.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALER BIPOLAR AQUAMANTYS 2.3 TRANSCOLLATION 30 D .173 IN SPACE L.226 IN L5.1 IN OD.092 IN 2 ELECTRODE CONFIGURATION HEMOSTATIC MULTILEVEL STERILE LATEX FREE DISPOSABLE SUP-23-113-1 CDM 0270 RC outpatient 1400.49 1400.49 1400.49 74 1036.36 percent of total billed charges 1400.49 93 1134.4 percent of total billed charges 1400.49 1400.49 other OPPS APC 1400.49 1400.49 other OPPS APC 1400.49 27.63 386.96 percent of total billed charges 1400.49 1400.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALER BIPOLAR AQUAMANTYS MBS TRANSCOLLATION 30 D .236 SPACE LARGE L.226 IN L5.1 IN OD.137 IN MALLEABLE LIGHT STERILE LATEX FREE DISPOSABLE SUP-23-301-1 CDM outpatient 1434.73 1434.73 1434.73 1434.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHIELD EYE SURGICAL DISPOSABLE Z KIT SUP-23-500 CDM 0270 RC outpatient 34.76 34.76 34.76 74 25.72 percent of total billed charges 34.76 93 28.16 percent of total billed charges 34.76 34.76 other OPPS APC 34.76 34.76 other OPPS APC 34.76 27.63 9.6 percent of total billed charges 34.76 34.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.0 X 8MM NON COMPLIANT PLUS SUP-230-083-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.0 X 10MM NON COMPLIANT PLUS SUP-230-103-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.0 X 10MM SEMICOMPLIANT SUP-230-103-5UU CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.0 X 12MM NON COMPLIANT PLUS SUP-230-123-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.0 X 12MM SEMICOMPLIANT SUP-230-123-5UU CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.0 X 15MM NON COMPLIANT PLUS SUP-230-153-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.0 X 15MM SEMICOMPLIANT SUP-230-153-5UU CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.0 X 18MM NON COMPLIANT PLUS SUP-230-183-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.0 X 20MM SEMICOMPLIANT SUP-230-203-5UU CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE INTERFERENCE MILAGRO ABSORBABLE 7.0 X 23MM SUP-231800 CDM 0270 RC outpatient 642.2 642.2 642.2 74 475.23 percent of total billed charges 642.2 93 520.18 percent of total billed charges 642.2 642.2 other OPPS APC 642.2 642.2 other OPPS APC 642.2 27.63 177.44 percent of total billed charges 642.2 642.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE INTERFERENCE MILAGRO 7 X 30MM SUP-231805 CDM 0270 RC outpatient 611 611 611 74 452.14 percent of total billed charges 611 93 494.91 percent of total billed charges 611 611 other OPPS APC 611 611 other OPPS APC 611 27.63 168.82 percent of total billed charges 611 611 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE INTERFERENCE MILAGRO 8 X 23MM SUP-231810 CDM 0270 RC outpatient 642.2 642.2 642.2 74 475.23 percent of total billed charges 642.2 93 520.18 percent of total billed charges 642.2 642.2 other OPPS APC 642.2 642.2 other OPPS APC 642.2 27.63 177.44 percent of total billed charges 642.2 642.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE INTERFERENCE MILAGRO 8 X 30MM SUP-231815 CDM 0270 RC outpatient 642.2 642.2 642.2 74 475.23 percent of total billed charges 642.2 93 520.18 percent of total billed charges 642.2 642.2 other OPPS APC 642.2 642.2 other OPPS APC 642.2 27.63 177.44 percent of total billed charges 642.2 642.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE INTERFERENCE MILAGRO 7 X 23MM SUP-231816 CDM 0270 RC outpatient 738.4 738.4 738.4 74 546.42 percent of total billed charges 738.4 93 598.1 percent of total billed charges 738.4 738.4 other OPPS APC 738.4 738.4 other OPPS APC 738.4 27.63 204.02 percent of total billed charges 738.4 738.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE MILAGRO ADVANCE 23MM 8MM TCP PLGA STERILE LF ACL ABSORBABLE SUP-231817 CDM 0270 RC outpatient 702 702 702 74 519.48 percent of total billed charges 702 93 568.62 percent of total billed charges 702 702 other OPPS APC 702 702 other OPPS APC 702 27.63 193.96 percent of total billed charges 702 702 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE MILAGRO ADVANCE 23MM 9MM TCP PLGA STERILE LF ACL ABSORBABLE SUP-231818 CDM 0270 RC outpatient 702 702 702 74 519.48 percent of total billed charges 702 93 568.62 percent of total billed charges 702 702 other OPPS APC 702 702 other OPPS APC 702 27.63 193.96 percent of total billed charges 702 702 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE INTERFERENCE MILAGRO 10 X 23MM SUP-231819 CDM 0270 RC outpatient 738.4 738.4 738.4 74 546.42 percent of total billed charges 738.4 93 598.1 percent of total billed charges 738.4 738.4 other OPPS APC 738.4 738.4 other OPPS APC 738.4 27.63 204.02 percent of total billed charges 738.4 738.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE INTERFERENCE MILAGRO 9 X 23MM SUP-231820 CDM 0270 RC outpatient 642.2 642.2 642.2 74 475.23 percent of total billed charges 642.2 93 520.18 percent of total billed charges 642.2 642.2 other OPPS APC 642.2 642.2 other OPPS APC 642.2 27.63 177.44 percent of total billed charges 642.2 642.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE INTERFERENCE MILAGRO 9 X 30MM SUP-231825 CDM 0270 RC outpatient 642.2 642.2 642.2 74 475.23 percent of total billed charges 642.2 93 520.18 percent of total billed charges 642.2 642.2 other OPPS APC 642.2 642.2 other OPPS APC 642.2 27.63 177.44 percent of total billed charges 642.2 642.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE MILAGRO BIOCRYL RAPIDE L35 MM OD9 MM ACL BIOREPLACEABLE CHAMFERED PROXIMAL END ATRAUMATIC THREADFORM SUP-231830 CDM 0270 RC outpatient 642.2 642.2 642.2 74 475.23 percent of total billed charges 642.2 93 520.18 percent of total billed charges 642.2 642.2 other OPPS APC 642.2 642.2 other OPPS APC 642.2 27.63 177.44 percent of total billed charges 642.2 642.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE INTERFERENCE MILAGRO 10 X 23MM SUP-231835 CDM 0270 RC outpatient 642.2 642.2 642.2 74 475.23 percent of total billed charges 642.2 93 520.18 percent of total billed charges 642.2 642.2 other OPPS APC 642.2 642.2 other OPPS APC 642.2 27.63 177.44 percent of total billed charges 642.2 642.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE MILAGRO L30 MM OD10 MM SUP-231840 CDM 0270 RC outpatient 611 611 611 74 452.14 percent of total billed charges 611 93 494.91 percent of total billed charges 611 611 other OPPS APC 611 611 other OPPS APC 611 27.63 168.82 percent of total billed charges 611 611 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE MILAGRO BIOCRYL RAPIDE L35 MM OD10 MM ACL BIOREPLACEABLE CHAMFERED PROXIMAL END ATRAUMATIC THREADFORM SUP-231845 CDM 0270 RC outpatient 611 611 611 74 452.14 percent of total billed charges 611 93 494.91 percent of total billed charges 611 611 other OPPS APC 611 611 other OPPS APC 611 27.63 168.82 percent of total billed charges 611 611 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE INTERFERENCE MILAGRO 11 X 30MM SUP-231850 CDM 0270 RC outpatient 642.2 642.2 642.2 74 475.23 percent of total billed charges 642.2 93 520.18 percent of total billed charges 642.2 642.2 other OPPS APC 642.2 642.2 other OPPS APC 642.2 27.63 177.44 percent of total billed charges 642.2 642.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MILLAGRO 12 X 30 SUP-231860 CDM 0270 RC outpatient 642.2 642.2 642.2 74 475.23 percent of total billed charges 642.2 93 520.18 percent of total billed charges 642.2 642.2 other OPPS APC 642.2 642.2 other OPPS APC 642.2 27.63 177.44 percent of total billed charges 642.2 642.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.25 X 8MM NON COMPLIANT PLUS SUP-232-083-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.25 X 10MM NON COMPLIANT PLUS SUP-232-103-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.25 X 12MM NON COMPLIANT PLUS SUP-232-123-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.25 X 15MM NON COMPLIANT PLUS SUP-232-153-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.25 X 18MM NON COMPLIANT PLUS SUP-232-183-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER LEAD L10 CM 8 CHANNEL B SUP-2321 CDM 0270 RC outpatient 3814.2 3814.2 3814.2 74 2822.51 percent of total billed charges 3814.2 93 3089.5 percent of total billed charges 3814.2 3814.2 other OPPS APC 3814.2 3814.2 other OPPS APC 3814.2 27.63 1053.86 percent of total billed charges 3814.2 3814.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ACL KNIFE 9 MM SUP-232109 CDM 0270 RC outpatient 377.52 377.52 377.52 74 279.36 percent of total billed charges 377.52 93 305.79 percent of total billed charges 377.52 377.52 other OPPS APC 377.52 377.52 other OPPS APC 377.52 27.63 104.31 percent of total billed charges 377.52 377.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNIFE ARTHROSCOPIC L10 MM ACL GRAFT STERILE DISPOSABLE GREEN SUP-232110 CDM 0270 RC outpatient 697.58 697.58 697.58 74 516.21 percent of total billed charges 697.58 93 565.04 percent of total billed charges 697.58 697.58 other OPPS APC 697.58 697.58 other OPPS APC 697.58 27.63 192.74 percent of total billed charges 697.58 697.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNIFE GRAFT ACL 11MM SUP-232111 CDM 0270 RC outpatient 313.82 313.82 313.82 74 232.23 percent of total billed charges 313.82 93 254.19 percent of total billed charges 313.82 313.82 other OPPS APC 313.82 313.82 other OPPS APC 313.82 27.63 86.71 percent of total billed charges 313.82 313.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PASSER SURGICAL STRAIGHTSHOT ACCORD OD8.5 MM ACL CALIBRATED TUBE TAPE ACL GRAFT LIGAMENT SUP-232205 CDM 0270 RC outpatient 39.21 39.21 39.21 74 29.02 percent of total billed charges 39.21 93 31.76 percent of total billed charges 39.21 39.21 other OPPS APC 39.21 39.21 other OPPS APC 39.21 27.63 10.83 percent of total billed charges 39.21 39.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PASSER SURGICAL STRAIGHTSHOT OD9.5 MM ACL GRAFT SUP-232210 CDM 0270 RC outpatient 410.8 410.8 410.8 74 303.99 percent of total billed charges 410.8 93 332.75 percent of total billed charges 410.8 410.8 other OPPS APC 410.8 410.8 other OPPS APC 410.8 27.63 113.5 percent of total billed charges 410.8 410.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL OPTETRAK 3 KNEE RIGHT CEMENTED POSTERIOR STABILIZE ASYMMETRIC SUP-234-03-03 CDM 270010025 LOCAL 0270 RC outpatient 8845.2 8845.2 8845.2 74 6545.45 percent of total billed charges 8845.2 93 7164.61 percent of total billed charges 8845.2 8845.2 other OPPS APC 8845.2 8845.2 other OPPS APC 8845.2 27.63 2443.93 percent of total billed charges 8845.2 8845.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAD DEFIBRILLATOR 3M 4.5X4.5IN BRIGHT ORANGE FABRIC POROUS DISPOSABLE NS LF ELECTRO CONDUCTIVE GEL SELF CONTAIN WOVEN SUP-2345N CDM 0270 RC outpatient 3.46 3.46 3.46 74 2.56 percent of total billed charges 3.46 93 2.8 percent of total billed charges 3.46 3.46 other OPPS APC 3.46 3.46 other OPPS APC 3.46 27.63 0.96 percent of total billed charges 3.46 3.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.5 X 8MM NON COMPLIANT PLUS SUP-235-083-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.5 X 10MM NON COMPLIANT PLUS SUP-235-103-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.5 X 10MM SEMICOMPLIANT SUP-235-103-5UU CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.5 X 12MM NON COMPLIANT PLUS SUP-235-123-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.5 X 15MM NON COMPLIANT PLUS SUP-235-153-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.5 X 15MM SEMICOMPLIANT SUP-235-153-5UU CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.5 X 18MM NON COMPLIANT PLUS SUP-235-183-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.5 X 20MM SEMICOMPLIANT SUP-235-203-5UU CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L86 MM OLECRANON RIGHT 2 HOLE ELONGATE HOLE PROXIMAL TAB NONSTERILE 3.5 MM SCREW SUP-236.502 CDM 270010022 LOCAL 0270 RC outpatient 2782.78 2782.78 2782.78 74 2059.26 percent of total billed charges 2782.78 93 2254.05 percent of total billed charges 2782.78 2782.78 other OPPS APC 2782.78 2782.78 other OPPS APC 2782.78 27.63 768.88 percent of total billed charges 2782.78 2782.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L86 MM OLECRANON LEFT 2 HOLE ELONGATE HOLE PROXIMAL TAB NONSTERILE 3.5 MM SCREW SUP-236.503 CDM 270010022 LOCAL 0270 RC outpatient 2782.78 2782.78 2782.78 74 2059.26 percent of total billed charges 2782.78 93 2254.05 percent of total billed charges 2782.78 2782.78 other OPPS APC 2782.78 2782.78 other OPPS APC 2782.78 27.63 768.88 percent of total billed charges 2782.78 2782.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L112 MM OLECRANON RIGHT 4 HOLE ELONGATE HOLE PROXIMAL TAB NONSTERILE 3.5 MM SCREW SUP-236.504 CDM 270010022 LOCAL 0270 RC outpatient 2904.33 2904.33 2904.33 74 2149.2 percent of total billed charges 2904.33 93 2352.51 percent of total billed charges 2904.33 2904.33 other OPPS APC 2904.33 2904.33 other OPPS APC 2904.33 27.63 802.47 percent of total billed charges 2904.33 2904.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L112 MM OLECRANON LEFT 4 HOLE ELONGATE HOLE PROXIMAL TAB NONSTERILE 3.5 MM SCREW SUP-236.505 CDM 270010022 LOCAL 0270 RC outpatient 2904.33 2904.33 2904.33 74 2149.2 percent of total billed charges 2904.33 93 2352.51 percent of total billed charges 2904.33 2904.33 other OPPS APC 2904.33 2904.33 other OPPS APC 2904.33 27.63 802.47 percent of total billed charges 2904.33 2904.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L138 MM OLECRANON RIGHT 6 HOLE ELONGATE HOLE PROXIMAL TAB NONSTERILE 3.5 MM SCREW SUP-236.506 CDM 270010022 LOCAL 0270 RC outpatient 2992.99 2992.99 2992.99 74 2214.81 percent of total billed charges 2992.99 93 2424.32 percent of total billed charges 2992.99 2992.99 other OPPS APC 2992.99 2992.99 other OPPS APC 2992.99 27.63 826.96 percent of total billed charges 2992.99 2992.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L164 MM OLECRANON RIGHT 8 HOLE ELONGATE HOLE PROXIMAL TAB NONSTERILE 3.5 MM SCREW SUP-236.508 CDM 270010022 LOCAL 0270 RC outpatient 3085.94 3085.94 3085.94 74 2283.6 percent of total billed charges 3085.94 93 2499.61 percent of total billed charges 3085.94 3085.94 other OPPS APC 3085.94 3085.94 other OPPS APC 3085.94 27.63 852.65 percent of total billed charges 3085.94 3085.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L164 MM OLECRANON LEFT 8 HOLE ELONGATE HOLE PROXIMAL TAB NONSTERILE 3.5 MM SCREW SUP-236.509 CDM 270010022 LOCAL 0270 RC outpatient 3085.94 3085.94 3085.94 74 2283.6 percent of total billed charges 3085.94 93 2499.61 percent of total billed charges 3085.94 3085.94 other OPPS APC 3085.94 3085.94 other OPPS APC 3085.94 27.63 852.65 percent of total billed charges 3085.94 3085.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L190 MM OLECRANON RIGHT 10 HOLE ELONGATE HOLE PROXIMAL TAB NONSTERILE 3.5 MM SCREW SUP-236.510 CDM 270010022 LOCAL 0270 RC outpatient 3176.03 3176.03 3176.03 74 2350.26 percent of total billed charges 3176.03 93 2572.58 percent of total billed charges 3176.03 3176.03 other OPPS APC 3176.03 3176.03 other OPPS APC 3176.03 27.63 877.54 percent of total billed charges 3176.03 3176.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L190 MM OLECRANON LEFT 10 HOLE ELONGATE HOLE PROXIMAL TAB NONSTERILE 3.5 MM SCREW SUP-236.511 CDM 270010022 LOCAL 0270 RC outpatient 3176.03 3176.03 3176.03 74 2350.26 percent of total billed charges 3176.03 93 2572.58 percent of total billed charges 3176.03 3176.03 other OPPS APC 3176.03 3176.03 other OPPS APC 3176.03 27.63 877.54 percent of total billed charges 3176.03 3176.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L216 MM OLECRANON RIGHT 12 HOLE ELONGATE HOLE PROXIMAL TAB STERILE 3.5 MM SCREW SUP-236.512S CDM 270010022 LOCAL 0270 RC outpatient 3550.69 3550.69 3550.69 74 2627.51 percent of total billed charges 3550.69 93 2876.06 percent of total billed charges 3550.69 3550.69 other OPPS APC 3550.69 3550.69 other OPPS APC 3550.69 27.63 981.06 percent of total billed charges 3550.69 3550.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 3.5MM LCP OLECRANON LEFT 12 HOLE SUP-236.513 CDM 270010022 LOCAL 0270 RC outpatient 3227.51 3227.51 3227.51 74 2388.36 percent of total billed charges 3227.51 93 2614.28 percent of total billed charges 3227.51 3227.51 other OPPS APC 3227.51 3227.51 other OPPS APC 3227.51 27.63 891.76 percent of total billed charges 3227.51 3227.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUFF BLOOD PRESSURE CRITIKON SOFT-CUF ADULT L23-33 CM 1 TUBE BAYONET CONNECTOR ROUND CORNER REPOSABLE LATEX FREE NAVY WHITE SUP-2363 CDM 0270 RC outpatient 5.15 5.15 5.15 74 3.81 percent of total billed charges 5.15 93 4.17 percent of total billed charges 5.15 5.15 other OPPS APC 5.15 5.15 other OPPS APC 5.15 27.63 1.42 percent of total billed charges 5.15 5.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLECTOR SPECIMEN VACUTAINER BD BBL ANAEROBIC SWAB NEEDLE SYRINGE STERILE LATEX FREE SUP-236500 CDM 0270 RC outpatient 9.57 9.57 9.57 74 7.08 percent of total billed charges 9.57 93 7.75 percent of total billed charges 9.57 9.57 other OPPS APC 9.57 9.57 other OPPS APC 9.57 27.63 2.64 percent of total billed charges 9.57 9.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.75 X 8MM NON COMPLIANT PLUS SUP-237-083-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.75 X 10MM NON COMPLIANT PLUS SUP-237-103-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.75 X 12MM NON COMPLIANT PLUS SUP-237-123-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.75 X 15MM NON COMPLIANT PLUS SUP-237-153-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 3.75 X 18MM NON COMPLIANT PLUS SUP-237-183-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCP STAINLESS STEEL 95 D L50 MM CONDYLE 12 HOLE ANGLED BLADE NONSTERILE SUP-237.20 CDM 270010022 LOCAL 0270 RC outpatient 3118.83 3118.83 3118.83 74 2307.93 percent of total billed charges 3118.83 93 2526.25 percent of total billed charges 3118.83 3118.83 other OPPS APC 3118.83 3118.83 other OPPS APC 3118.83 27.63 861.73 percent of total billed charges 3118.83 3118.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCP STAINLESS STEEL 95 D L204 MM L60 MM CONDYLE 12 HOLE NONSTERILE SUP-237.22 CDM 270010022 LOCAL 0270 RC outpatient 3118.83 3118.83 3118.83 74 2307.93 percent of total billed charges 3118.83 93 2526.25 percent of total billed charges 3118.83 3118.83 other OPPS APC 3118.83 3118.83 other OPPS APC 3118.83 27.63 861.73 percent of total billed charges 3118.83 3118.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCP STAINLESS STEEL 95 D L70 MM L240 MM CONDYLE 12 HOLE NONSTERILE SUP-237.24 CDM 270010022 LOCAL 0270 RC outpatient 3118.83 3118.83 3118.83 74 2307.93 percent of total billed charges 3118.83 93 2526.25 percent of total billed charges 3118.83 3118.83 other OPPS APC 3118.83 3118.83 other OPPS APC 3118.83 27.63 861.73 percent of total billed charges 3118.83 3118.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCP STAINLESS STEEL L204 MM L80 MM CONDYLE 12 HOLE NONSTERILE 3.5 MM SCREW SUP-237.26 CDM 270010022 LOCAL 0270 RC outpatient 3118.83 3118.83 3118.83 74 2307.93 percent of total billed charges 3118.83 93 2526.25 percent of total billed charges 3118.83 3118.83 other OPPS APC 3118.83 3118.83 other OPPS APC 3118.83 27.63 861.73 percent of total billed charges 3118.83 3118.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCP STAINLESS STEEL 95 D L50 MM L92 MM CONDYLE 5 HOLE NONSTERILE SUP-237.50 CDM 270010022 LOCAL 0270 RC outpatient 2592.59 2592.59 2592.59 74 1918.52 percent of total billed charges 2592.59 93 2100 percent of total billed charges 2592.59 2592.59 other OPPS APC 2592.59 2592.59 other OPPS APC 2592.59 27.63 716.33 percent of total billed charges 2592.59 2592.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCP STAINLESS STEEL 95 D L60 MM L92 MM CONDYLE 5 HOLE NONSTERILE SUP-237.52 CDM 270010022 LOCAL 0270 RC outpatient 2592.59 2592.59 2592.59 74 1918.52 percent of total billed charges 2592.59 93 2100 percent of total billed charges 2592.59 2592.59 other OPPS APC 2592.59 2592.59 other OPPS APC 2592.59 27.63 716.33 percent of total billed charges 2592.59 2592.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCP STAINLESS STEEL 95 D L70 MM L92 MM CONDYLE 5 HOLE NONSTERILE SUP-237.54 CDM 270010022 LOCAL 0270 RC outpatient 2592.59 2592.59 2592.59 74 1918.52 percent of total billed charges 2592.59 93 2100 percent of total billed charges 2592.59 2592.59 other OPPS APC 2592.59 2592.59 other OPPS APC 2592.59 27.63 716.33 percent of total billed charges 2592.59 2592.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCP STAINLESS STEEL 95 D L80 MM L92 MM CONDYLE 5 HOLE NONSTERILE SUP-237.56 CDM 270010022 LOCAL 0270 RC outpatient 2592.59 2592.59 2592.59 74 1918.52 percent of total billed charges 2592.59 93 2100 percent of total billed charges 2592.59 2592.59 other OPPS APC 2592.59 2592.59 other OPPS APC 2592.59 27.63 716.33 percent of total billed charges 2592.59 2592.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCP STAINLESS STEEL 95 D L124 MM L50 MM CONDYLE 7 HOLE BLADE NONSTERILE SUP-237.70 CDM 270010022 LOCAL 0270 RC outpatient 2732.73 2732.73 2732.73 74 2022.22 percent of total billed charges 2732.73 93 2213.51 percent of total billed charges 2732.73 2732.73 other OPPS APC 2732.73 2732.73 other OPPS APC 2732.73 27.63 755.05 percent of total billed charges 2732.73 2732.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCP 95D 124X16X4.8MM 60MM SS NS CONDYLAR 7 HOLE BLADE SUP-237.72 CDM 270010022 LOCAL 0270 RC outpatient 2732.73 2732.73 2732.73 74 2022.22 percent of total billed charges 2732.73 93 2213.51 percent of total billed charges 2732.73 2732.73 other OPPS APC 2732.73 2732.73 other OPPS APC 2732.73 27.63 755.05 percent of total billed charges 2732.73 2732.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCP STAINLESS STEEL 95 D L70 MM L124 MM CONDYLE 7 HOLE NONSTERILE SUP-237.74 CDM 270010022 LOCAL 0270 RC outpatient 2732.73 2732.73 2732.73 74 2022.22 percent of total billed charges 2732.73 93 2213.51 percent of total billed charges 2732.73 2732.73 other OPPS APC 2732.73 2732.73 other OPPS APC 2732.73 27.63 755.05 percent of total billed charges 2732.73 2732.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCP STAINLESS STEEL L124 MM L80 MM CONDYLE 7 HOLE NONSTERILE 3.5 MM SCREW SUP-237.76 CDM 270010022 LOCAL 0270 RC outpatient 2732.73 2732.73 2732.73 74 2022.22 percent of total billed charges 2732.73 93 2213.51 percent of total billed charges 2732.73 2732.73 other OPPS APC 2732.73 2732.73 other OPPS APC 2732.73 27.63 755.05 percent of total billed charges 2732.73 2732.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCP 95D 156X16X4.8MM 50MM SS NS CONDYLAR 9 HOLE BLADE SUP-237.90 CDM 270010022 LOCAL 0270 RC outpatient 2864.29 2864.29 2864.29 74 2119.57 percent of total billed charges 2864.29 93 2320.07 percent of total billed charges 2864.29 2864.29 other OPPS APC 2864.29 2864.29 other OPPS APC 2864.29 27.63 791.4 percent of total billed charges 2864.29 2864.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCP 95D 156X16X4.8MM 60MM SS NS CONDYLAR 9 HOLE BLADE SUP-237.92 CDM 270010022 LOCAL 0270 RC outpatient 2864.29 2864.29 2864.29 74 2119.57 percent of total billed charges 2864.29 93 2320.07 percent of total billed charges 2864.29 2864.29 other OPPS APC 2864.29 2864.29 other OPPS APC 2864.29 27.63 791.4 percent of total billed charges 2864.29 2864.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCP STAINLESS STEEL 95 D L156 MM X W16 MM X H4.8 MM L70 MM CONDYLAR 9 HOLE U PROFILE BLADE NONSTERILE 4.5 MM CORTICAL SCREW SUP-237.94 CDM 270010022 LOCAL 0270 RC outpatient 2864.29 2864.29 2864.29 74 2119.57 percent of total billed charges 2864.29 93 2320.07 percent of total billed charges 2864.29 2864.29 other OPPS APC 2864.29 2864.29 other OPPS APC 2864.29 27.63 791.4 percent of total billed charges 2864.29 2864.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCP STAINLESS STEEL 90 D L80 MM CONDYLE 9 HOLE ANGLED BLADE NONSTERILE SUP-237.96 CDM 270010022 LOCAL 0270 RC outpatient 8004.62 8004.62 8004.62 74 5923.42 percent of total billed charges 8004.62 93 6483.74 percent of total billed charges 8004.62 8004.62 other OPPS APC 8004.62 8004.62 other OPPS APC 8004.62 27.63 2211.68 percent of total billed charges 8004.62 8004.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE COMPRESSION SOFT-WRAP 5YDX6IN BEIGE POLYESTER COTTON STERILE LF ELASTIC CLIP CLOSURE STRETCH BREATHABLE SUP-23700-66LF CDM 0270 RC outpatient 5.51 5.51 5.51 74 4.08 percent of total billed charges 5.51 93 4.46 percent of total billed charges 5.51 5.51 other OPPS APC 5.51 5.51 other OPPS APC 5.51 27.63 1.52 percent of total billed charges 5.51 5.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L116 MM X W11 MM X H3.7 MM TIBIA RIGHT DISTAL MEDIAL 4 HOLE LIMIT CONTACT MALLEOLUS TAB BULLET NOSE TIP NONSTERILE 3.5 MM SCREW SUP-239.900 CDM 270010022 LOCAL 0270 RC outpatient 3943.94 3943.94 3943.94 74 2918.52 percent of total billed charges 3943.94 93 3194.59 percent of total billed charges 3943.94 3943.94 other OPPS APC 3943.94 3943.94 other OPPS APC 3943.94 27.63 1089.71 percent of total billed charges 3943.94 3943.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L142 MM X W11 MM X H3.7 MM TIBIA RIGHT DISTAL MEDIAL 6 HOLE LIMIT CONTACT MALLEOLUS TAB BULLET NOSE TIP NONSTERILE 3.5 MM SCREW SUP-239.904 CDM 270010022 LOCAL 0270 RC outpatient 3983.98 3983.98 3983.98 74 2948.15 percent of total billed charges 3983.98 93 3227.02 percent of total billed charges 3983.98 3983.98 other OPPS APC 3983.98 3983.98 other OPPS APC 3983.98 27.63 1100.77 percent of total billed charges 3983.98 3983.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L168 MM X W11 MM X H3.7 MM TIBIA RIGHT DISTAL MEDIAL 8 HOLE LIMIT CONTACT MALLEOLUS TAB BULLET NOSE TIP NONSTERILE 3.5 MM SCREW SUP-239.908 CDM 270010022 LOCAL 0270 RC outpatient 4022.59 4022.59 4022.59 74 2976.72 percent of total billed charges 4022.59 93 3258.3 percent of total billed charges 4022.59 4022.59 other OPPS APC 4022.59 4022.59 other OPPS APC 4022.59 27.63 1111.44 percent of total billed charges 4022.59 4022.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L168 MM X W11 MM X H3.7 MM TIBIA LEFT DISTAL MEDIAL 8 HOLE LIMIT CONTACT MALLEOLUS TAB BULLET NOSE TIP NONSTERILE 3.5 MM SCREW SUP-239.909 CDM 270010022 LOCAL 0270 RC outpatient 4022.59 4022.59 4022.59 74 2976.72 percent of total billed charges 4022.59 93 3258.3 percent of total billed charges 4022.59 4022.59 other OPPS APC 4022.59 4022.59 other OPPS APC 4022.59 27.63 1111.44 percent of total billed charges 4022.59 4022.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L194 MM X W11 MM X H3.7 MM TIBIA LEFT DISTAL MEDIAL 10 HOLE LIMIT CONTACT MALLEOLUS TAB BULLET NOSE TIP NONSTERILE 3.5 MM SCREW SUP-239.913 CDM 270010022 LOCAL 0270 RC outpatient 4068.35 4068.35 4068.35 74 3010.58 percent of total billed charges 4068.35 93 3295.36 percent of total billed charges 4068.35 4068.35 other OPPS APC 4068.35 4068.35 other OPPS APC 4068.35 27.63 1124.09 percent of total billed charges 4068.35 4068.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L81 MM TIBIA RIGHT PROXIMAL 4 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.934 CDM 270010022 LOCAL 0270 RC outpatient 3662.23 3662.23 3662.23 74 2710.05 percent of total billed charges 3662.23 93 2966.41 percent of total billed charges 3662.23 3662.23 other OPPS APC 3662.23 3662.23 other OPPS APC 3662.23 27.63 1011.87 percent of total billed charges 3662.23 3662.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L81 MM TIBIA LEFT PROXIMAL 4 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.935 CDM 270010022 LOCAL 0270 RC outpatient 3229.43 3229.43 3229.43 74 2389.78 percent of total billed charges 3229.43 93 2615.84 percent of total billed charges 3229.43 3229.43 other OPPS APC 3229.43 3229.43 other OPPS APC 3229.43 27.63 892.29 percent of total billed charges 3229.43 3229.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L107 MM TIBIA RIGHT PROXIMAL 6 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.936 CDM 270010022 LOCAL 0270 RC outpatient 3268.51 3268.51 3268.51 74 2418.7 percent of total billed charges 3268.51 93 2647.49 percent of total billed charges 3268.51 3268.51 other OPPS APC 3268.51 3268.51 other OPPS APC 3268.51 27.63 903.09 percent of total billed charges 3268.51 3268.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L107 MM TIBIA LEFT PROXIMAL 6 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.937 CDM 270010022 LOCAL 0270 RC outpatient 3268.51 3268.51 3268.51 74 2418.7 percent of total billed charges 3268.51 93 2647.49 percent of total billed charges 3268.51 3268.51 other OPPS APC 3268.51 3268.51 other OPPS APC 3268.51 27.63 903.09 percent of total billed charges 3268.51 3268.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L133 MM TIBIA RIGHT PROXIMAL 8 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.938 CDM 270010022 LOCAL 0270 RC outpatient 3746.6 3746.6 3746.6 74 2772.48 percent of total billed charges 3746.6 93 3034.75 percent of total billed charges 3746.6 3746.6 other OPPS APC 3746.6 3746.6 other OPPS APC 3746.6 27.63 1035.19 percent of total billed charges 3746.6 3746.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L133 MM TIBIA LEFT PROXIMAL 8 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.939 CDM 270010022 LOCAL 0270 RC outpatient 3303.82 3303.82 3303.82 74 2444.83 percent of total billed charges 3303.82 93 2676.09 percent of total billed charges 3303.82 3303.82 other OPPS APC 3303.82 3303.82 other OPPS APC 3303.82 27.63 912.85 percent of total billed charges 3303.82 3303.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L159 MM TIBIA RIGHT PROXIMAL 10 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.940 CDM 270010022 LOCAL 0270 RC outpatient 3788.07 3788.07 3788.07 74 2803.17 percent of total billed charges 3788.07 93 3068.34 percent of total billed charges 3788.07 3788.07 other OPPS APC 3788.07 3788.07 other OPPS APC 3788.07 27.63 1046.64 percent of total billed charges 3788.07 3788.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L159 MM TIBIA LEFT PROXIMAL 10 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.941 CDM 270010022 LOCAL 0270 RC outpatient 3788.07 3788.07 3788.07 74 2803.17 percent of total billed charges 3788.07 93 3068.34 percent of total billed charges 3788.07 3788.07 other OPPS APC 3788.07 3788.07 other OPPS APC 3788.07 27.63 1046.64 percent of total billed charges 3788.07 3788.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L185 MM TIBIA RIGHT PROXIMAL 12 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.942 CDM 270010022 LOCAL 0270 RC outpatient 3385.8 3385.8 3385.8 74 2505.49 percent of total billed charges 3385.8 93 2742.5 percent of total billed charges 3385.8 3385.8 other OPPS APC 3385.8 3385.8 other OPPS APC 3385.8 27.63 935.5 percent of total billed charges 3385.8 3385.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L185 MM TIBIA LEFT PROXIMAL 12 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.943 CDM 270010022 LOCAL 0270 RC outpatient 3385.8 3385.8 3385.8 74 2505.49 percent of total billed charges 3385.8 93 2742.5 percent of total billed charges 3385.8 3385.8 other OPPS APC 3385.8 3385.8 other OPPS APC 3385.8 27.63 935.5 percent of total billed charges 3385.8 3385.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L211 MM TIBIA RIGHT PROXIMAL 14 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.944 CDM 270010022 LOCAL 0270 RC outpatient 3419.83 3419.83 3419.83 74 2530.67 percent of total billed charges 3419.83 93 2770.06 percent of total billed charges 3419.83 3419.83 other OPPS APC 3419.83 3419.83 other OPPS APC 3419.83 27.63 944.9 percent of total billed charges 3419.83 3419.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L211 MM TIBIA LEFT PROXIMAL 14 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.945 CDM 270010022 LOCAL 0270 RC outpatient 3878.16 3878.16 3878.16 74 2869.84 percent of total billed charges 3878.16 93 3141.31 percent of total billed charges 3878.16 3878.16 other OPPS APC 3878.16 3878.16 other OPPS APC 3878.16 27.63 1071.54 percent of total billed charges 3878.16 3878.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L237 MM TIBIA RIGHT PROXIMAL 16 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.946 CDM 270010022 LOCAL 0270 RC outpatient 3659.42 3659.42 3659.42 74 2707.97 percent of total billed charges 3659.42 93 2964.13 percent of total billed charges 3659.42 3659.42 other OPPS APC 3659.42 3659.42 other OPPS APC 3659.42 27.63 1011.1 percent of total billed charges 3659.42 3659.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L237 MM TIBIA LEFT PROXIMAL 16 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.947 CDM 270010022 LOCAL 0270 RC outpatient 4149.86 4149.86 4149.86 74 3070.9 percent of total billed charges 4149.86 93 3361.39 percent of total billed charges 4149.86 4149.86 other OPPS APC 4149.86 4149.86 other OPPS APC 4149.86 27.63 1146.61 percent of total billed charges 4149.86 4149.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROXIMAL MEDIAL TIBIAL 10 HOLE RIGHT SUP-239.950 CDM 270010022 LOCAL 0270 RC outpatient 4378.14 4378.14 4378.14 74 3239.82 percent of total billed charges 4378.14 93 3546.29 percent of total billed charges 4378.14 4378.14 other OPPS APC 4378.14 4378.14 other OPPS APC 4378.14 27.63 1209.68 percent of total billed charges 4378.14 4378.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L93 MM TIBIA RIGHT PROXIMAL MEDIAL 4 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.954 CDM 270010022 LOCAL 0270 RC outpatient 3450.3 3450.3 3450.3 74 2553.22 percent of total billed charges 3450.3 93 2794.74 percent of total billed charges 3450.3 3450.3 other OPPS APC 3450.3 3450.3 other OPPS APC 3450.3 27.63 953.32 percent of total billed charges 3450.3 3450.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L93 MM TIBIA LEFT PROXIMAL MEDIAL 4 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.955 CDM 270010022 LOCAL 0270 RC outpatient 3649.36 3649.36 3649.36 74 2700.53 percent of total billed charges 3649.36 93 2955.98 percent of total billed charges 3649.36 3649.36 other OPPS APC 3649.36 3649.36 other OPPS APC 3649.36 27.63 1008.32 percent of total billed charges 3649.36 3649.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L119 MM TIBIA RIGHT PROXIMAL MEDIAL 6 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.956 CDM 270010022 LOCAL 0270 RC outpatient 3496.27 3496.27 3496.27 74 2587.24 percent of total billed charges 3496.27 93 2831.98 percent of total billed charges 3496.27 3496.27 other OPPS APC 3496.27 3496.27 other OPPS APC 3496.27 27.63 966.02 percent of total billed charges 3496.27 3496.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L119 MM TIBIA LEFT PROXIMAL MEDIAL 6 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.957 CDM 270010022 LOCAL 0270 RC outpatient 3496.27 3496.27 3496.27 74 2587.24 percent of total billed charges 3496.27 93 2831.98 percent of total billed charges 3496.27 3496.27 other OPPS APC 3496.27 3496.27 other OPPS APC 3496.27 27.63 966.02 percent of total billed charges 3496.27 3496.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L145 MM TIBIA RIGHT PROXIMAL MEDIAL 8 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.958 CDM 270010022 LOCAL 0270 RC outpatient 3742.31 3742.31 3742.31 74 2769.31 percent of total billed charges 3742.31 93 3031.27 percent of total billed charges 3742.31 3742.31 other OPPS APC 3742.31 3742.31 other OPPS APC 3742.31 27.63 1034 percent of total billed charges 3742.31 3742.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L145 MM TIBIA LEFT PROXIMAL MEDIAL 8 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.959 CDM 270010022 LOCAL 0270 RC outpatient 3742.31 3742.31 3742.31 74 2769.31 percent of total billed charges 3742.31 93 3031.27 percent of total billed charges 3742.31 3742.31 other OPPS APC 3742.31 3742.31 other OPPS APC 3742.31 27.63 1034 percent of total billed charges 3742.31 3742.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L171 MM TIBIA RIGHT PROXIMAL MEDIAL 10 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.960 CDM 270010022 LOCAL 0270 RC outpatient 3785.21 3785.21 3785.21 74 2801.06 percent of total billed charges 3785.21 93 3066.02 percent of total billed charges 3785.21 3785.21 other OPPS APC 3785.21 3785.21 other OPPS APC 3785.21 27.63 1045.85 percent of total billed charges 3785.21 3785.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L171 MM TIBIA LEFT PROXIMAL MEDIAL 10 HOLE LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-239.961 CDM 270010022 LOCAL 0270 RC outpatient 3785.21 3785.21 3785.21 74 2801.06 percent of total billed charges 3785.21 93 3066.02 percent of total billed charges 3785.21 3785.21 other OPPS APC 3785.21 3785.21 other OPPS APC 3785.21 27.63 1045.85 percent of total billed charges 3785.21 3785.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID OSTEOFIL 90MM DEMINERALIZED BONE MATRIX ALLOGRAFT FROZEN STRIP SUP-2390 CDM 270010012 LOCAL 0270 RC outpatient 6487 6487 6487 74 4800.38 percent of total billed charges 6487 93 5254.47 percent of total billed charges 6487 6487 other OPPS APC 6487 6487 other OPPS APC 6487 27.63 1792.36 percent of total billed charges 6487 6487 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PADDING CAST WEBRIL COTTON L4 YD X W3 IN UNDERCAST MILD STRETCH COHESIVE STERILE LATEX FREE SUP-2394 CDM 0270 RC outpatient 2.16 2.16 2.16 74 1.6 percent of total billed charges 2.16 93 1.75 percent of total billed charges 2.16 2.16 other OPPS APC 2.16 2.16 other OPPS APC 2.16 27.63 0.6 percent of total billed charges 2.16 2.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE TENDON L27.5 CM OD4.5 MM FRESH FROZEN SUP-239404 CDM 270010031 LOCAL 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER CRYOABLATION FREEZOR MAX 3-5-2 MM SPACE 66 MM LONG L90 CM L8 MM OD9 FR QUADRIPOLAR THERMOCOUPLE VECTOR MAP COOL TIP ELECTROPHYSIOLOGY ORANGE SUP-239F5 CDM 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC REGENT FLEXCUFF PTFE PYROLYTIC CARBON 85 D OD23 MM ID21.4 MM SUPRA ANNULAR 1 DIGIT GRADIENT MECHANICAL LEAFLET OPEN SUP-23AGFN-756 CDM 0270 RC outpatient 12708.8 12708.8 12708.8 74 9404.51 percent of total billed charges 12708.8 93 10294.1 percent of total billed charges 12708.8 12708.8 other OPPS APC 12708.8 12708.8 other OPPS APC 12708.8 27.63 3511.44 percent of total billed charges 12708.8 12708.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR LAPAROSCOPIC ENDOPATH LONG L100 MM OD2/3 MM SMOOTH SLEEVE RADIOPAQUE STERILE DISPOSABLE SUP-23NBL CDM 27000000 LOCAL 0270 RC outpatient 75.4 75.4 75.4 74 55.8 percent of total billed charges 75.4 93 61.07 percent of total billed charges 75.4 75.4 other OPPS APC 75.4 75.4 other OPPS APC 75.4 27.63 20.83 percent of total billed charges 75.4 75.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR LAPAROSCOPIC ENDOPATH SHORT L65 MM OD2/3 MM SMOOTH SLEEVE RADIOPAQUE STERILE DISPOSABLE SUP-23NBS CDM 27000000 LOCAL 0270 RC outpatient 75.4 75.4 75.4 74 55.8 percent of total billed charges 75.4 93 61.07 percent of total billed charges 75.4 75.4 other OPPS APC 75.4 75.4 other OPPS APC 75.4 27.63 20.83 percent of total billed charges 75.4 75.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISPOSABLE FOOT CAUTERY SUP-24-00001 CDM 0272 RC outpatient 2.67 2.67 2.67 74 1.98 percent of total billed charges 2.67 93 2.16 percent of total billed charges 2.67 2.67 other OPPS APC 2.67 2.67 other OPPS APC 2.67 27.63 0.74 percent of total billed charges 2.67 2.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SURGICAL CAUTERY- BATTERY OPER SUP-24-00004 CDM 0272 RC outpatient 54.75 54.75 54.75 74 40.52 percent of total billed charges 54.75 93 44.35 percent of total billed charges 54.75 54.75 other OPPS APC 54.75 54.75 other OPPS APC 54.75 27.63 15.13 percent of total billed charges 54.75 54.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DUAL FOIL UNIVERSAL GROUNDING SUP-24-00007 CDM 0272 RC outpatient 2.32 2.32 2.32 74 1.72 percent of total billed charges 2.32 93 1.88 percent of total billed charges 2.32 2.32 other OPPS APC 2.32 2.32 other OPPS APC 2.32 27.63 0.64 percent of total billed charges 2.32 2.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IOBAN 23 X 23 SUP-24-00014 CDM 0272 RC outpatient 26.99 26.99 26.99 74 19.97 percent of total billed charges 26.99 93 21.86 percent of total billed charges 26.99 26.99 other OPPS APC 26.99 26.99 other OPPS APC 26.99 27.63 7.46 percent of total billed charges 26.99 26.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OMNI JUGS SUP-24-00015 CDM 0271 RC outpatient 72.06 72.06 72.06 74 53.32 percent of total billed charges 72.06 93 58.37 percent of total billed charges 72.06 72.06 other OPPS APC 72.06 72.06 other OPPS APC 72.06 27.63 19.91 percent of total billed charges 72.06 72.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIWI PUMPS SUP-24-00019 CDM 0272 RC outpatient 95.95 95.95 95.95 74 71 percent of total billed charges 95.95 93 77.72 percent of total billed charges 95.95 95.95 other OPPS APC 95.95 95.95 other OPPS APC 95.95 27.63 26.51 percent of total billed charges 95.95 95.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IOBAN 23 X 33 SUP-24-00020 CDM 0272 RC outpatient 37.62 37.62 37.62 74 27.84 percent of total billed charges 37.62 93 30.47 percent of total billed charges 37.62 37.62 other OPPS APC 37.62 37.62 other OPPS APC 37.62 27.63 10.39 percent of total billed charges 37.62 37.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE HIP ABDUCTION SUP-24-00021 CDM 0272 RC outpatient 88.7 88.7 88.7 74 65.64 percent of total billed charges 88.7 93 71.85 percent of total billed charges 88.7 88.7 other OPPS APC 88.7 88.7 other OPPS APC 88.7 27.63 24.51 percent of total billed charges 88.7 88.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RED MAXI LOOPS SUP-24-00022 CDM 0272 RC outpatient 1.71 1.71 1.71 74 1.27 percent of total billed charges 1.71 93 1.39 percent of total billed charges 1.71 1.71 other OPPS APC 1.71 1.71 other OPPS APC 1.71 27.63 0.47 percent of total billed charges 1.71 1.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE-AID BOOTIES SUP-24-00023 CDM 0272 RC outpatient 3.14 3.14 3.14 74 2.32 percent of total billed charges 3.14 93 2.54 percent of total billed charges 3.14 3.14 other OPPS APC 3.14 3.14 other OPPS APC 3.14 27.63 0.87 percent of total billed charges 3.14 3.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DRILL-FREE MAXDRIVE TITANIUM L7 MM OD2.3 MM STERNAL LOCK SELF RETAIN NONSTERILE SUP-24-023-07-91 CDM 0270 RC outpatient 148.2 148.2 148.2 74 109.67 percent of total billed charges 148.2 93 120.04 percent of total billed charges 148.2 148.2 other OPPS APC 148.2 148.2 other OPPS APC 148.2 27.63 40.95 percent of total billed charges 148.2 148.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DRILL-FREE MAXDRIVE TITANIUM L11 MM OD2.3 MM STERNAL LOCK SELF RETAIN NONSTERILE SUP-24-023-09-91 CDM 0270 RC outpatient 148.2 148.2 148.2 74 109.67 percent of total billed charges 148.2 93 120.04 percent of total billed charges 148.2 148.2 other OPPS APC 148.2 148.2 other OPPS APC 148.2 27.63 40.95 percent of total billed charges 148.2 148.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DRILL-FREE MAXDRIVE TITANIUM L11 MM OD2.3 MM STERNAL LOCK SELF RETAIN NONSTERILE SUP-24-023-11-91 CDM 0270 RC outpatient 148.2 148.2 148.2 74 109.67 percent of total billed charges 148.2 93 120.04 percent of total billed charges 148.2 148.2 other OPPS APC 148.2 148.2 other OPPS APC 148.2 27.63 40.95 percent of total billed charges 148.2 148.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DRILL-FREE MAXDRIVE TITANIUM L13 MM OD2.3 MM STERNAL LOCK SELF RETAIN NONSTERILE SUP-24-023-13-91 CDM 0270 RC outpatient 148.2 148.2 148.2 74 109.67 percent of total billed charges 148.2 93 120.04 percent of total billed charges 148.2 148.2 other OPPS APC 148.2 148.2 other OPPS APC 148.2 27.63 40.95 percent of total billed charges 148.2 148.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DRILL-FREE MAXDRIVE TITANIUM L15 MM OD2.3 MM STERNAL LOCK SELF RETAIN NONSTERILE SUP-24-023-15-91 CDM 0270 RC outpatient 148.2 148.2 148.2 74 109.67 percent of total billed charges 148.2 93 120.04 percent of total billed charges 148.2 148.2 other OPPS APC 148.2 148.2 other OPPS APC 148.2 27.63 40.95 percent of total billed charges 148.2 148.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DRILL-FREE MAXDRIVE THREADLOCK TS TITANIUM L17 MM OD2.3 MM MANDIBLE SELF RETAINING EMERGENCY SUP-24-023-17-91 CDM 0270 RC outpatient 148.2 148.2 148.2 74 109.67 percent of total billed charges 148.2 93 120.04 percent of total billed charges 148.2 148.2 other OPPS APC 148.2 148.2 other OPPS APC 148.2 27.63 40.95 percent of total billed charges 148.2 148.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DRILL-FREE MAXDRIVE TITANIUM L9 MM OD2.5 MM STERNAL SELF RETAIN EMERGENCY NONSTERILE SUP-24-024-09-91 CDM 0270 RC outpatient 148.2 148.2 148.2 74 109.67 percent of total billed charges 148.2 93 120.04 percent of total billed charges 148.2 148.2 other OPPS APC 148.2 148.2 other OPPS APC 148.2 27.63 40.95 percent of total billed charges 148.2 148.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DRILL-FREE MAXDRIVE TITANIUM L13 MM OD2.5 MM STERNAL SELF RETAIN EMERGENCY NONSTERILE SUP-24-024-13-91 CDM 0270 RC outpatient 148.2 148.2 148.2 74 109.67 percent of total billed charges 148.2 93 120.04 percent of total billed charges 148.2 148.2 other OPPS APC 148.2 148.2 other OPPS APC 148.2 27.63 40.95 percent of total billed charges 148.2 148.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DRILL-FREE MAXDRIVE TITANIUM L17 MM OD2.5 MM STERNAL SELF RETAIN EMERGENCY NONSTERILE SUP-24-024-17-91 CDM 0270 RC outpatient 148.2 148.2 148.2 74 109.67 percent of total billed charges 148.2 93 120.04 percent of total billed charges 148.2 148.2 other OPPS APC 148.2 148.2 other OPPS APC 148.2 27.63 40.95 percent of total billed charges 148.2 148.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM STRAIGHT T H2 MM STERNAL 20 HOLE LOCK NONSTERILE 2.3 MM SCREW MIDLINE MINI VALVE STERNOTOMY SUP-24-025-07-09 CDM 0270 RC outpatient 2509.65 2509.65 2509.65 74 1857.14 percent of total billed charges 2509.65 93 2032.82 percent of total billed charges 2509.65 2509.65 other OPPS APC 2509.65 2509.65 other OPPS APC 2509.65 27.63 693.42 percent of total billed charges 2509.65 2509.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM FOOTBALL H1.8 MM STERNAL 6 HOLE LOCK NONSTERILE 2.3 MM SCREW MIDLINE MINI VALVE STERNOTOMY SUP-24-025-42-09 CDM 0270 RC outpatient 1320.15 1320.15 1320.15 74 976.91 percent of total billed charges 1320.15 93 1069.32 percent of total billed charges 1320.15 1320.15 other OPPS APC 1320.15 1320.15 other OPPS APC 1320.15 27.63 364.76 percent of total billed charges 1320.15 1320.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM H1.8 MM STERNAL 10 HOLE LOCK BODY NONSTERILE 2.3 MM SCREW MIDLINE MINI VALVE STERNOTOMY SUP-24-025-43-09 CDM 0270 RC outpatient 1795.95 1795.95 1795.95 74 1329 percent of total billed charges 1795.95 93 1454.72 percent of total billed charges 1795.95 1795.95 other OPPS APC 1795.95 1795.95 other OPPS APC 1795.95 27.63 496.22 percent of total billed charges 1795.95 1795.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM X H1.8 MM STERNAL 8 HOLE LOCK NONSTERILE 2.3 MM SCREW MIDLINE MINI VALVE STERNOTOMY SUP-24-025-44-09 CDM 0270 RC outpatient 1795.95 1795.95 1795.95 74 1329 percent of total billed charges 1795.95 93 1454.72 percent of total billed charges 1795.95 1795.95 other OPPS APC 1795.95 1795.95 other OPPS APC 1795.95 27.63 496.22 percent of total billed charges 1795.95 1795.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM J L T H1.8 MM STERNAL 7 HOLE LOCK NONSTERILE 2.3 MM SCREW MIDLINE MINI VALVE STERNOTOMY SUP-24-025-46-09 CDM 0270 RC outpatient 1795.95 1795.95 1795.95 74 1329 percent of total billed charges 1795.95 93 1454.72 percent of total billed charges 1795.95 1795.95 other OPPS APC 1795.95 1795.95 other OPPS APC 1795.95 27.63 496.22 percent of total billed charges 1795.95 1795.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM LADDER H1.8 MM STERNAL 18 HOLE LOCK NONSTERILE 2.3 MM SCREW MIDLINE MINI VALVE STERNOTOMY SUP-24-025-47-09 CDM 0270 RC outpatient 2104.05 2104.05 2104.05 74 1557 percent of total billed charges 2104.05 93 1704.28 percent of total billed charges 2104.05 2104.05 other OPPS APC 2104.05 2104.05 other OPPS APC 2104.05 27.63 581.35 percent of total billed charges 2104.05 2104.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM STRAIGHT H1.8 MM STERNAL 4 HOLE LOCK NONSTERILE 2.3 MM SCREW MIDLINE MINI VALVE STERNOTOMY SUP-24-025-48-09 CDM 0270 RC outpatient 1331.85 1331.85 1331.85 74 985.57 percent of total billed charges 1331.85 93 1078.8 percent of total billed charges 1331.85 1331.85 other OPPS APC 1331.85 1331.85 other OPPS APC 1331.85 27.63 367.99 percent of total billed charges 1331.85 1331.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM STRAIGHT H1.8 MM STERNAL 6 HOLE LOCK NONSTERILE 2.3 MM SCREW MIDLINE MINI VALVE STERNOTOMY SUP-24-025-49-09 CDM 0270 RC outpatient 1464.45 1464.45 1464.45 74 1083.69 percent of total billed charges 1464.45 93 1186.2 percent of total billed charges 1464.45 1464.45 other OPPS APC 1464.45 1464.45 other OPPS APC 1464.45 27.63 404.63 percent of total billed charges 1464.45 1464.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM STRAIGHT H1.8 MM STERNAL 8 HOLE LOCK NONSTERILE 2.3 MM SCREW MIDLINE MINI VALVE STERNOTOMY SUP-24-025-50-09 CDM 0270 RC outpatient 1595.1 1595.1 1595.1 74 1180.37 percent of total billed charges 1595.1 93 1292.03 percent of total billed charges 1595.1 1595.1 other OPPS APC 1595.1 1595.1 other OPPS APC 1595.1 27.63 440.73 percent of total billed charges 1595.1 1595.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM STRAIGHT H1.8 MM STERNAL 10 HOLE LOCK NONSTERILE 2.3 MM SCREW MIDLINE MINI VALVE STERNOTOMY SUP-24-025-51-09 CDM 0270 RC outpatient 1733.55 1733.55 1733.55 74 1282.83 percent of total billed charges 1733.55 93 1404.18 percent of total billed charges 1733.55 1733.55 other OPPS APC 1733.55 1733.55 other OPPS APC 1733.55 27.63 478.98 percent of total billed charges 1733.55 1733.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM Y H1.8 MM STERNAL 9 HOLE LOCK NONSTERILE 2.3 MM SCREW MIDLINE MINI VALVE STERNOTOMY SUP-24-025-52-09 CDM 0270 RC outpatient 1595.1 1595.1 1595.1 74 1180.37 percent of total billed charges 1595.1 93 1292.03 percent of total billed charges 1595.1 1595.1 other OPPS APC 1595.1 1595.1 other OPPS APC 1595.1 27.63 440.73 percent of total billed charges 1595.1 1595.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM ANGLE STERNAL 8 HOLE LOCK NONSTERILE 2.3 MM SCREW MIDLINE MINI VALVE STERNOTOMY SUP-24-025-59-09 CDM 0270 RC outpatient 1062.75 1062.75 1062.75 74 786.44 percent of total billed charges 1062.75 93 860.83 percent of total billed charges 1062.75 1062.75 other OPPS APC 1062.75 1062.75 other OPPS APC 1062.75 27.63 293.64 percent of total billed charges 1062.75 1062.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM L208 MM SPINE THORACIC STERNAL 14 HOLE STERILE 2.3 MM SCREW 2.1/2.5 MM PEEK SUP-24-039-30-72 CDM 0270 RC outpatient 1365 1365 1365 74 1010.1 percent of total billed charges 1365 93 1105.65 percent of total billed charges 1365 1365 other OPPS APC 1365 1365 other OPPS APC 1365 27.63 377.15 percent of total billed charges 1365 1365 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 4.0 X 8MM NON COMPLIANT PLUS SUP-240-083-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 4.0 X 10MM NON COMPLIANT PLUS SUP-240-103-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 4.0 X 10MM SEMICOMPLIANT SUP-240-103-5UU CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 4.0 X 12MM NON COMPLIANT PLUS SUP-240-123-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 4.0 X 15MM NON COMPLIANT PLUS SUP-240-153-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 4.0 X 15MM SEMICOMPLIANT SUP-240-153-5UU CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 4.0 X 18MM NON COMPLIANT PLUS SUP-240-183-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE II PRO 4.0 X 20MM SEMICOMPLIANT SUP-240-203-5UU CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L82 MM RIGHT PROXIMAL 4 HOLE LIMIT CONTACT TAPER END NONSTERILE 4.5 MM SCREW LARGE FRAGMENT SET SUP-240.036 CDM 270010022 LOCAL 0270 RC outpatient 3985.41 3985.41 3985.41 74 2949.2 percent of total billed charges 3985.41 93 3228.18 percent of total billed charges 3985.41 3985.41 other OPPS APC 3985.41 3985.41 other OPPS APC 3985.41 27.63 1101.17 percent of total billed charges 3985.41 3985.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L82 MM TIBIA LEFT PROXIMAL 4 HOLE LIMIT CONTACT NONSTERILE 4.5 MM SCREW SUP-240.037 CDM 270010022 LOCAL 0270 RC outpatient 3985.41 3985.41 3985.41 74 2949.2 percent of total billed charges 3985.41 93 3228.18 percent of total billed charges 3985.41 3985.41 other OPPS APC 3985.41 3985.41 other OPPS APC 3985.41 27.63 1101.17 percent of total billed charges 3985.41 3985.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L118 MM TIBIA RIGHT PROXIMAL 6 HOLE LIMIT CONTACT NONSTERILE 4.5 MM SCREW SUP-240.038 CDM 270010022 LOCAL 0270 RC outpatient 4036.89 4036.89 4036.89 74 2987.3 percent of total billed charges 4036.89 93 3269.88 percent of total billed charges 4036.89 4036.89 other OPPS APC 4036.89 4036.89 other OPPS APC 4036.89 27.63 1115.39 percent of total billed charges 4036.89 4036.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L118 MM LEFT PROXIMAL 6 HOLE LIMIT CONTACT TAPER END NONSTERILE 4.5 MM SCREW LARGE FRAGMENT SET SUP-240.039 CDM 270010022 LOCAL 0270 RC outpatient 4036.89 4036.89 4036.89 74 2987.3 percent of total billed charges 4036.89 93 3269.88 percent of total billed charges 4036.89 4036.89 other OPPS APC 4036.89 4036.89 other OPPS APC 4036.89 27.63 1115.39 percent of total billed charges 4036.89 4036.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L154 MM TIBIA RIGHT PROXIMAL 8 HOLE LIMIT CONTACT NONSTERILE 4.5 MM SCREW SUP-240.040 CDM 270010022 LOCAL 0270 RC outpatient 4082.65 4082.65 4082.65 74 3021.16 percent of total billed charges 4082.65 93 3306.95 percent of total billed charges 4082.65 4082.65 other OPPS APC 4082.65 4082.65 other OPPS APC 4082.65 27.63 1128.04 percent of total billed charges 4082.65 4082.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L154 MM TIBIA LEFT PROXIMAL 8 HOLE LIMIT CONTACT NONSTERILE 4.5 MM SCREW SUP-240.041 CDM 270010022 LOCAL 0270 RC outpatient 4082.65 4082.65 4082.65 74 3021.16 percent of total billed charges 4082.65 93 3306.95 percent of total billed charges 4082.65 4082.65 other OPPS APC 4082.65 4082.65 other OPPS APC 4082.65 27.63 1128.04 percent of total billed charges 4082.65 4082.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L190 MM TIBIA RIGHT PROXIMAL 10 HOLE LIMIT CONTACT NONSTERILE 4.5 MM SCREW SUP-240.042 CDM 270010022 LOCAL 0270 RC outpatient 4125.55 4125.55 4125.55 74 3052.91 percent of total billed charges 4125.55 93 3341.7 percent of total billed charges 4125.55 4125.55 other OPPS APC 4125.55 4125.55 other OPPS APC 4125.55 27.63 1139.89 percent of total billed charges 4125.55 4125.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L190 MM TIBIA LEFT PROXIMAL 10 HOLE LIMIT CONTACT NONSTERILE 4.5 MM SCREW SUP-240.043 CDM 270010022 LOCAL 0270 RC outpatient 4125.55 4125.55 4125.55 74 3052.91 percent of total billed charges 4125.55 93 3341.7 percent of total billed charges 4125.55 4125.55 other OPPS APC 4125.55 4125.55 other OPPS APC 4125.55 27.63 1139.89 percent of total billed charges 4125.55 4125.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L226 MM TIBIA RIGHT PROXIMAL 12 HOLE LIMIT CONTACT NONSTERILE 4.5 MM SCREW SUP-240.044 CDM 270010022 LOCAL 0270 RC outpatient 4174.17 4174.17 4174.17 74 3088.89 percent of total billed charges 4174.17 93 3381.08 percent of total billed charges 4174.17 4174.17 other OPPS APC 4174.17 4174.17 other OPPS APC 4174.17 27.63 1153.32 percent of total billed charges 4174.17 4174.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L226 MM TIBIA LEFT PROXIMAL 12 HOLE LIMIT CONTACT NONSTERILE 4.5 MM SCREW SUP-240.045 CDM 270010022 LOCAL 0270 RC outpatient 4174.17 4174.17 4174.17 74 3088.89 percent of total billed charges 4174.17 93 3381.08 percent of total billed charges 4174.17 4174.17 other OPPS APC 4174.17 4174.17 other OPPS APC 4174.17 27.63 1153.32 percent of total billed charges 4174.17 4174.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL CONTOUR L262 MM TIBIA RIGHT PROXIMAL 14 HOLE LIMIT CONTACT NONSTERILE 4.5 MM SCREW SUP-240.046 CDM 270010022 LOCAL 0270 RC outpatient 4217.07 4217.07 4217.07 74 3120.63 percent of total billed charges 4217.07 93 3415.83 percent of total billed charges 4217.07 4217.07 other OPPS APC 4217.07 4217.07 other OPPS APC 4217.07 27.63 1165.18 percent of total billed charges 4217.07 4217.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI CONTOUR 262MM SS NS TIBIA LEFT PROXIMAL 14 HOLE LIMIT CONTACT 4.5MM SCREW SUP-240.047 CDM 270010022 LOCAL 0270 RC outpatient 4217.07 4217.07 4217.07 74 3120.63 percent of total billed charges 4217.07 93 3415.83 percent of total billed charges 4217.07 4217.07 other OPPS APC 4217.07 4217.07 other OPPS APC 4217.07 27.63 1165.18 percent of total billed charges 4217.07 4217.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L147 MM TIBIA DISTAL MEDIAL 7 HOLE PILON PRECONTOUR ROUND EDGE NONSTERILE 3.5 MM SCREW SUP-240.082 CDM 270010022 LOCAL 0270 RC outpatient 4710.42 4710.42 4710.42 74 3485.71 percent of total billed charges 4710.42 93 3815.44 percent of total billed charges 4710.42 4710.42 other OPPS APC 4710.42 4710.42 other OPPS APC 4710.42 27.63 1301.49 percent of total billed charges 4710.42 4710.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L173 MM TIBIA DISTAL MEDIAL 9 HOLE PILON PRECONTOUR ROUND EDGE NONSTERILE 3.5 MM SCREW SUP-240.083 CDM 270010022 LOCAL 0270 RC outpatient 4959.24 4959.24 4959.24 74 3669.84 percent of total billed charges 4959.24 93 4016.98 percent of total billed charges 4959.24 4959.24 other OPPS APC 4959.24 4959.24 other OPPS APC 4959.24 27.63 1370.24 percent of total billed charges 4959.24 4959.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE T PLATE 4 HOLE SUP-240.14 CDM 270010022 LOCAL 0270 RC outpatient 750.46 750.46 750.46 74 555.34 percent of total billed charges 750.46 93 607.87 percent of total billed charges 750.46 750.46 other OPPS APC 750.46 750.46 other OPPS APC 750.46 27.63 207.35 percent of total billed charges 750.46 750.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI T 83MM SS NS 4 HOLE 4.5MM SCREW LG FRAGMENT SET SUP-240.141 CDM 270010022 LOCAL 0270 RC outpatient 1573 1573 1573 74 1164.02 percent of total billed charges 1573 93 1274.13 percent of total billed charges 1573 1573 other OPPS APC 1573 1573 other OPPS APC 1573 27.63 434.62 percent of total billed charges 1573 1573 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL T L116 MM 6 HOLE SHAFT NONSTERILE 4.5 MM SCREW LARGE FRAGMENT SUP-240.16 CDM 270010022 LOCAL 0270 RC outpatient 1022.58 1022.58 1022.58 74 756.71 percent of total billed charges 1022.58 93 828.29 percent of total billed charges 1022.58 1022.58 other OPPS APC 1022.58 1022.58 other OPPS APC 1022.58 27.63 282.54 percent of total billed charges 1022.58 1022.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL T L148 MM 8 HOLE SHAFT NONSTERILE 4.5 MM SCREW LARGE FRAGMENT SUP-240.18 CDM 270010022 LOCAL 0270 RC outpatient 1347.84 1347.84 1347.84 74 997.4 percent of total billed charges 1347.84 93 1091.75 percent of total billed charges 1347.84 1347.84 other OPPS APC 1347.84 1347.84 other OPPS APC 1347.84 27.63 372.41 percent of total billed charges 1347.84 1347.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP ANGLE LEFT L BUTTRESS 86X14X3.8MM SS NS 4 HOLE SHAFT 4.5MM SCREW LG FRAGMENT SET SUP-240.44 CDM 270010022 LOCAL 0270 RC outpatient 1174.68 1174.68 1174.68 74 869.26 percent of total billed charges 1174.68 93 951.49 percent of total billed charges 1174.68 1174.68 other OPPS APC 1174.68 1174.68 other OPPS APC 1174.68 27.63 324.56 percent of total billed charges 1174.68 1174.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ANGLE RIGHT L 86X14X3.8MM SS NS TIBIA LEFT 4 HOLE SHAFT BUTTRESS 4.5MM SCREW LG FRAGMENT SUP-240.54 CDM 270010022 LOCAL 0270 RC outpatient 1174.68 1174.68 1174.68 74 869.26 percent of total billed charges 1174.68 93 951.49 percent of total billed charges 1174.68 1174.68 other OPPS APC 1174.68 1174.68 other OPPS APC 1174.68 27.63 324.56 percent of total billed charges 1174.68 1174.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CURETTE SUP-240161 CDM outpatient 112.76 112.76 112.76 112.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CURETTE SURGICAL COBB STAINLESS STEEL 3-0 STRAIGHT L11 IN OVAL CUP HOLLOW KNURLED HANDLE NONSTERILE SUP-240175 CDM outpatient 245.57 245.57 245.57 245.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR LAPAROSCOPIC AUTOSUTURE WOODFORD SPIKE PEDIPORT SHORT OD5.5 MM LOCK CANNULA HUB STERILE DISPOSABLE SUP-24055 CDM 0270 RC outpatient 233.61 233.61 233.61 74 172.87 percent of total billed charges 233.61 93 189.22 percent of total billed charges 233.61 233.61 other OPPS APC 233.61 233.61 other OPPS APC 233.61 27.63 64.55 percent of total billed charges 233.61 233.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL OBLIQUE RIGHT T L52 MM X W10 MM X H1.5 MM 3 HOLE HEAD 3 HOLE SHAFT NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.031 CDM 270010022 LOCAL 0270 RC outpatient 918.06 918.06 918.06 74 679.36 percent of total billed charges 918.06 93 743.63 percent of total billed charges 918.06 918.06 other OPPS APC 918.06 918.06 other OPPS APC 918.06 27.63 253.66 percent of total billed charges 918.06 918.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP T OBLIQUE RIGHT 63X10X1.5MM SS NS 3 HOLE HEAD 4 HOLE SHAFT 3.5MM SCREW SM FRAGMENT SUP-241.041 CDM 270010022 LOCAL 0270 RC outpatient 959.53 959.53 959.53 74 710.05 percent of total billed charges 959.53 93 777.22 percent of total billed charges 959.53 959.53 other OPPS APC 959.53 959.53 other OPPS APC 959.53 27.63 265.12 percent of total billed charges 959.53 959.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL OBLIQUE RIGHT T L74 MM X W10 MM X H1.5 MM 3 HOLE HEAD 5 HOLE SHAFT NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.051 CDM 270010022 LOCAL 0270 RC outpatient 1002.43 1002.43 1002.43 74 741.8 percent of total billed charges 1002.43 93 811.97 percent of total billed charges 1002.43 1002.43 other OPPS APC 1002.43 1002.43 other OPPS APC 1002.43 27.63 276.97 percent of total billed charges 1002.43 1002.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL OBLIQUE RIGHT T L96 MM X W10 MM X H1.5 MM 3 HOLE HEAD 7 HOLE SHAFT NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.071 CDM 270010022 LOCAL 0270 RC outpatient 1088.23 1088.23 1088.23 74 805.29 percent of total billed charges 1088.23 93 881.47 percent of total billed charges 1088.23 1088.23 other OPPS APC 1088.23 1088.23 other OPPS APC 1088.23 27.63 300.68 percent of total billed charges 1088.23 1088.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL D12 MM L70 MM CLAVICLE LEFT 4 HOLE HOOK PRECONTOUR ROUND SHAFT PROFILE STERILE 3.5 MM SCREW SUP-241.073S CDM 0270 RC outpatient 3040.18 3040.18 3040.18 74 2249.73 percent of total billed charges 3040.18 93 2462.55 percent of total billed charges 3040.18 3040.18 other OPPS APC 3040.18 3040.18 other OPPS APC 3040.18 27.63 840 percent of total billed charges 3040.18 3040.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL D12 MM L85 MM CLAVICLE RIGHT 5 HOLE HOOK PRECONTOUR ROUND SHAFT PROFILE STERILE 3.5 MM SCREW SUP-241.082S CDM 270010022 LOCAL 0270 RC outpatient 3180.32 3180.32 3180.32 74 2353.44 percent of total billed charges 3180.32 93 2576.06 percent of total billed charges 3180.32 3180.32 other OPPS APC 3180.32 3180.32 other OPPS APC 3180.32 27.63 878.72 percent of total billed charges 3180.32 3180.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP RIGHT ANGLE T 50X10X1.2MM SS NS 3 HOLE HEAD 3 HOLE SHAFT 3.5MM SCREW SM FRAGMENT SUP-241.13 CDM 270010022 LOCAL 0270 RC outpatient 876.59 876.59 876.59 74 648.68 percent of total billed charges 876.59 93 710.04 percent of total billed charges 876.59 876.59 other OPPS APC 876.59 876.59 other OPPS APC 876.59 27.63 242.2 percent of total billed charges 876.59 876.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL RIGHT ANGLE T L50 MM X W10 MM X H1.5 MM 3 HOLE HEAD 3 HOLE SHAFT NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.131 CDM 270010022 LOCAL 0270 RC outpatient 817.96 817.96 817.96 74 605.29 percent of total billed charges 817.96 93 662.55 percent of total billed charges 817.96 817.96 other OPPS APC 817.96 817.96 other OPPS APC 817.96 27.63 226 percent of total billed charges 817.96 817.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP RIGHT ANGLE T 56X10X1.2MM SS NS 4 HOLE HEAD 4 HOLE SHAFT 3.5MM SCREW SM FRAGMENT SUP-241.14 CDM 270010022 LOCAL 0270 RC outpatient 903.76 903.76 903.76 74 668.78 percent of total billed charges 903.76 93 732.05 percent of total billed charges 903.76 903.76 other OPPS APC 903.76 903.76 other OPPS APC 903.76 27.63 249.71 percent of total billed charges 903.76 903.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL RIGHT ANGLE T L56 MM X W11 MM X H1.5 MM 4 HOLE HEAD 4 HOLE SHAFT NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.141 CDM 270010022 LOCAL 0270 RC outpatient 746.51 746.51 746.51 74 552.42 percent of total billed charges 746.51 93 604.67 percent of total billed charges 746.51 746.51 other OPPS APC 746.51 746.51 other OPPS APC 746.51 27.63 206.26 percent of total billed charges 746.51 746.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP ANGLE RIGHT T 67X10X1.2MM SS NS 3 HOLE HEAD 5 HOLE SHAFT 3.5MM SCREW SM FRAGMENT SET SUP-241.15 CDM 270010022 LOCAL 0270 RC outpatient 995.28 995.28 995.28 74 736.51 percent of total billed charges 995.28 93 806.18 percent of total billed charges 995.28 995.28 other OPPS APC 995.28 995.28 other OPPS APC 995.28 27.63 275 percent of total billed charges 995.28 995.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL RIGHT ANGLE T L67 MM X W10 MM X H1.5 MM 3 HOLE HEAD 5 HOLE SHAFT NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.151 CDM 270010022 LOCAL 0270 RC outpatient 818.4 818.4 818.4 74 605.62 percent of total billed charges 818.4 93 662.9 percent of total billed charges 818.4 818.4 other OPPS APC 818.4 818.4 other OPPS APC 818.4 27.63 226.12 percent of total billed charges 818.4 818.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL RIGHT ANGLE T L75 MM X W10 MM X H1.2 MM 4 HOLE HEAD 6 HOLE SHAFT NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.16 CDM 270010022 LOCAL 0270 RC outpatient 1159.73 1159.73 1159.73 74 858.2 percent of total billed charges 1159.73 93 939.38 percent of total billed charges 1159.73 1159.73 other OPPS APC 1159.73 1159.73 other OPPS APC 1159.73 27.63 320.43 percent of total billed charges 1159.73 1159.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI ANGLE RIGHT T 78X11X1.5MM SS NS 4 HOLE HEAD 6 HOLE SHAFT 3.5MM SCREW SM FRAGMENT SET SUP-241.161 CDM 270010022 LOCAL 0270 RC outpatient 955.84 955.84 955.84 74 707.32 percent of total billed charges 955.84 93 774.23 percent of total billed charges 955.84 955.84 other OPPS APC 955.84 955.84 other OPPS APC 955.84 27.63 264.1 percent of total billed charges 955.84 955.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL RIGHT ANGLE T L87 MM X W10 MM X H1.5 MM 3 HOLE HEAD 7 HOLE SHAFT NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.171 CDM 270010022 LOCAL 0270 RC outpatient 2873 2873 2873 74 2126.02 percent of total billed charges 2873 93 2327.13 percent of total billed charges 2873 2873 other OPPS APC 2873 2873 other OPPS APC 2873 27.63 793.81 percent of total billed charges 2873 2873 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL OBLIQUE ANGLE T L53 MM X W10 MM X H1.5 MM 3 HOLE HEAD 3 HOLE SHAFT NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.23 CDM 270010022 LOCAL 0270 RC outpatient 641.16 641.16 641.16 74 474.46 percent of total billed charges 641.16 93 519.34 percent of total billed charges 641.16 641.16 other OPPS APC 641.16 641.16 other OPPS APC 641.16 27.63 177.15 percent of total billed charges 641.16 641.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL OBLIQUE ANGLE T L63 MM X W10 MM X H1.5 MM 3 HOLE HEAD 4 HOLE SHAFT NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.24 CDM 270010022 LOCAL 0270 RC outpatient 678.6 678.6 678.6 74 502.16 percent of total billed charges 678.6 93 549.67 percent of total billed charges 678.6 678.6 other OPPS APC 678.6 678.6 other OPPS APC 678.6 27.63 187.5 percent of total billed charges 678.6 678.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL OBLIQUE ANGLE T L75 MM X W10 MM X H1.5 MM 3 HOLE HEAD 5 HOLE SHAFT NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.25 CDM 270010022 LOCAL 0270 RC outpatient 699.66 699.66 699.66 74 517.75 percent of total billed charges 699.66 93 566.72 percent of total billed charges 699.66 699.66 other OPPS APC 699.66 699.66 other OPPS APC 699.66 27.63 193.32 percent of total billed charges 699.66 699.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 55X11X2.5MM SS NS HUMERUS RIGHT DISTAL POSTEROLATERAL 3 HOLE PRECONTOUR LIMIT CONTACT 3.5MM SCREW SUP-241.262 CDM 270010022 LOCAL 0270 RC outpatient 2225.08 2225.08 2225.08 74 1646.56 percent of total billed charges 2225.08 93 1802.31 percent of total billed charges 2225.08 2225.08 other OPPS APC 2225.08 2225.08 other OPPS APC 2225.08 27.63 614.79 percent of total billed charges 2225.08 2225.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 55X11X2.5MM SS NS HUMERUS LEFT DISTAL POSTEROLATERAL 3 HOLE PRECONTOUR LIMIT CONTACT 3.5MM SCREW SUP-241.263 CDM 270010022 LOCAL 0270 RC outpatient 2225.08 2225.08 2225.08 74 1646.56 percent of total billed charges 2225.08 93 1802.31 percent of total billed charges 2225.08 2225.08 other OPPS APC 2225.08 2225.08 other OPPS APC 2225.08 27.63 614.79 percent of total billed charges 2225.08 2225.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L90 MM X W11 MM X H2.5 MM ELBOW RIGHT HUMERUS 5 HOLE PRECONTOUR LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-241.264 CDM 270010022 LOCAL 0270 RC outpatient 2469.61 2469.61 2469.61 74 1827.51 percent of total billed charges 2469.61 93 2000.38 percent of total billed charges 2469.61 2469.61 other OPPS APC 2469.61 2469.61 other OPPS APC 2469.61 27.63 682.35 percent of total billed charges 2469.61 2469.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L90 MM X W11 MM X H2.5 MM ELBOW LEFT HUMERUS 5 HOLE PRECONTOUR LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-241.265 CDM 270010022 LOCAL 0270 RC outpatient 2469.61 2469.61 2469.61 74 1827.51 percent of total billed charges 2469.61 93 2000.38 percent of total billed charges 2469.61 2469.61 other OPPS APC 2469.61 2469.61 other OPPS APC 2469.61 27.63 682.35 percent of total billed charges 2469.61 2469.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 116X11X2.5MM SS NS HUMERUS RIGHT DISTAL POSTEROLATERAL 7 HOLE PRECONTOUR LIMIT CONTACT 3.5MM SCREW SUP-241.266 CDM 270010022 LOCAL 0270 RC outpatient 2715.57 2715.57 2715.57 74 2009.52 percent of total billed charges 2715.57 93 2199.61 percent of total billed charges 2715.57 2715.57 other OPPS APC 2715.57 2715.57 other OPPS APC 2715.57 27.63 750.31 percent of total billed charges 2715.57 2715.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 116X11X2.5MM SS NS HUMERUS LEFT DISTAL POSTEROLATERAL 7 HOLE PRECONTOUR LIMIT CONTACT 3.5MM SCREW SUP-241.267 CDM 270010022 LOCAL 0270 RC outpatient 2715.57 2715.57 2715.57 74 2009.52 percent of total billed charges 2715.57 93 2199.61 percent of total billed charges 2715.57 2715.57 other OPPS APC 2715.57 2715.57 other OPPS APC 2715.57 27.63 750.31 percent of total billed charges 2715.57 2715.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 143X11X2.5MM SS NS HUMERUS RIGHT DISTAL POSTEROLATERAL 9 HOLE PRECONTOUR LIMIT CONTACT 3.5MM SCREW SUP-241.268 CDM 270010022 LOCAL 0270 RC outpatient 2931.5 2931.5 2931.5 74 2169.31 percent of total billed charges 2931.5 93 2374.52 percent of total billed charges 2931.5 2931.5 other OPPS APC 2931.5 2931.5 other OPPS APC 2931.5 27.63 809.97 percent of total billed charges 2931.5 2931.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 143X11X2.5MM SS NS HUMERUS LEFT DISTAL POSTEROLATERAL 9 HOLE PRECONTOUR LIMIT CONTACT 3.5MM SCREW SUP-241.269 CDM 270010022 LOCAL 0270 RC outpatient 2931.5 2931.5 2931.5 74 2169.31 percent of total billed charges 2931.5 93 2374.52 percent of total billed charges 2931.5 2931.5 other OPPS APC 2931.5 2931.5 other OPPS APC 2931.5 27.63 809.97 percent of total billed charges 2931.5 2931.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 55X11X2.5MM SS NS HUMERUS RIGHT DISTAL POSTEROLATERAL 3 HOLE LATERAL SUPPORT PRECONTOUR LIMIT SUP-241.272 CDM 270010022 LOCAL 0270 RC outpatient 2552.55 2552.55 2552.55 74 1888.89 percent of total billed charges 2552.55 93 2067.57 percent of total billed charges 2552.55 2552.55 other OPPS APC 2552.55 2552.55 other OPPS APC 2552.55 27.63 705.27 percent of total billed charges 2552.55 2552.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L55 MM X W11 MM X H2.5 MM ELBOW LEFT HUMERUS 3 HOLE LATERAL SUPPORT PRECONTOUR LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-241.273 CDM 270010022 LOCAL 0270 RC outpatient 2552.55 2552.55 2552.55 74 1888.89 percent of total billed charges 2552.55 93 2067.57 percent of total billed charges 2552.55 2552.55 other OPPS APC 2552.55 2552.55 other OPPS APC 2552.55 27.63 705.27 percent of total billed charges 2552.55 2552.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 90X11X2.5MM SS NS HUMERUS RIGHT DISTAL POSTEROLATERAL 5 HOLE LATERAL SUPPORT PRECONTOUR LIMIT SUP-241.274 CDM 270010022 LOCAL 0270 RC outpatient 2782.78 2782.78 2782.78 74 2059.26 percent of total billed charges 2782.78 93 2254.05 percent of total billed charges 2782.78 2782.78 other OPPS APC 2782.78 2782.78 other OPPS APC 2782.78 27.63 768.88 percent of total billed charges 2782.78 2782.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 90X11X2.5MM SS 3.5MM SCREW 5 HOLE LATERAL SUPPORT LCP BONE LEFT DISTAL SUP-241.275 CDM 270010022 LOCAL 0270 RC outpatient 2782.78 2782.78 2782.78 74 2059.26 percent of total billed charges 2782.78 93 2254.05 percent of total billed charges 2782.78 2782.78 other OPPS APC 2782.78 2782.78 other OPPS APC 2782.78 27.63 768.88 percent of total billed charges 2782.78 2782.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 116X11X2.5MM SS NS HUMERUS RIGHT DISTAL POSTEROLATERAL 7 HOLE LATERAL SUPPORT PRECONTOUR LIMIT SUP-241.276 CDM 270010022 LOCAL 0270 RC outpatient 3015.87 3015.87 3015.87 74 2231.74 percent of total billed charges 3015.87 93 2442.85 percent of total billed charges 3015.87 3015.87 other OPPS APC 3015.87 3015.87 other OPPS APC 3015.87 27.63 833.28 percent of total billed charges 3015.87 3015.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L116 MM X W11 MM X H2.5 MM ELBOW LEFT HUMERUS 7 HOLE LATERAL SUPPORT PRECONTOUR LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-241.277 CDM 270010022 LOCAL 0270 RC outpatient 3015.87 3015.87 3015.87 74 2231.74 percent of total billed charges 3015.87 93 2442.85 percent of total billed charges 3015.87 3015.87 other OPPS APC 3015.87 3015.87 other OPPS APC 3015.87 27.63 833.28 percent of total billed charges 3015.87 3015.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 3.5MM CLP POSTEROLATERAL DISTAL HUMERUS RIGHT 9 HOLE SUP-241.278 CDM 270010022 LOCAL 0270 RC outpatient 3271.84 3271.84 3271.84 74 2421.16 percent of total billed charges 3271.84 93 2650.19 percent of total billed charges 3271.84 3271.84 other OPPS APC 3271.84 3271.84 other OPPS APC 3271.84 27.63 904.01 percent of total billed charges 3271.84 3271.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L58 MM X W11 MM X H2.5 MM ELBOW RIGHT HUMERUS 3 HOLE PRECONTOUR LIMIT CONTACT 3.5 MM SCREW SUP-241.282 CDM 270010022 LOCAL 0270 RC outpatient 2225.08 2225.08 2225.08 74 1646.56 percent of total billed charges 2225.08 93 1802.31 percent of total billed charges 2225.08 2225.08 other OPPS APC 2225.08 2225.08 other OPPS APC 2225.08 27.63 614.79 percent of total billed charges 2225.08 2225.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 58X11X2.5MM SS 3.5MM SCREW 3 HOLE FIX ANGLE PRECONTOUR LIMIT CONTACT LCP BONE SUP-241.283 CDM 270010022 LOCAL 0270 RC outpatient 2225.08 2225.08 2225.08 74 1646.56 percent of total billed charges 2225.08 93 1802.31 percent of total billed charges 2225.08 2225.08 other OPPS APC 2225.08 2225.08 other OPPS APC 2225.08 27.63 614.79 percent of total billed charges 2225.08 2225.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 83X11X2.5MM SS NS HUMERUS RIGHT MEDIAL POSTEROLATERAL 5 HOLE PRECONTOUR LIMIT CONTACT 3.5MM SCREW SUP-241.284 CDM 270010022 LOCAL 0270 RC outpatient 2469.61 2469.61 2469.61 74 1827.51 percent of total billed charges 2469.61 93 2000.38 percent of total billed charges 2469.61 2469.61 other OPPS APC 2469.61 2469.61 other OPPS APC 2469.61 27.63 682.35 percent of total billed charges 2469.61 2469.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L83 MM X W11 MM X H2.5 MM ELBOW LEFT HUMERUS 5 HOLE PRECONTOUR LIMIT CONTACT 3.5 MM SCREW SUP-241.285 CDM 270010022 LOCAL 0270 RC outpatient 2469.61 2469.61 2469.61 74 1827.51 percent of total billed charges 2469.61 93 2000.38 percent of total billed charges 2469.61 2469.61 other OPPS APC 2469.61 2469.61 other OPPS APC 2469.61 27.63 682.35 percent of total billed charges 2469.61 2469.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 110X11X2.5MM SS NS HUMERUS RIGHT MEDIAL POSTEROLATERAL 7 HOLE PRECONTOUR LIMIT CONTACT 3.5MM SCREW SUP-241.286 CDM 270010022 LOCAL 0270 RC outpatient 2715.57 2715.57 2715.57 74 2009.52 percent of total billed charges 2715.57 93 2199.61 percent of total billed charges 2715.57 2715.57 other OPPS APC 2715.57 2715.57 other OPPS APC 2715.57 27.63 750.31 percent of total billed charges 2715.57 2715.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 110X11X2.5MM SS NS HUMERUS LEFT MEDIAL POSTEROLATERAL 7 HOLE PRECONTOUR LIMIT CONTACT 3.5MM SCREW SUP-241.287 CDM 270010022 LOCAL 0270 RC outpatient 2715.57 2715.57 2715.57 74 2009.52 percent of total billed charges 2715.57 93 2199.61 percent of total billed charges 2715.57 2715.57 other OPPS APC 2715.57 2715.57 other OPPS APC 2715.57 27.63 750.31 percent of total billed charges 2715.57 2715.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L149 MM X W11 MM X H2.5 MM ELBOW RIGHT HUMERUS 9 HOLE PRECONTOUR LIMIT CONTACT NONSTERILE 3.5 MM SCREW SUP-241.288 CDM 270010022 LOCAL 0270 RC outpatient 2931.5 2931.5 2931.5 74 2169.31 percent of total billed charges 2931.5 93 2374.52 percent of total billed charges 2931.5 2931.5 other OPPS APC 2931.5 2931.5 other OPPS APC 2931.5 27.63 809.97 percent of total billed charges 2931.5 2931.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 149X11X2.5MM SS NS HUMERUS LEFT MEDIAL POSTEROLATERAL 9 HOLE PRECONTOUR LIMIT CONTACT 3.5MM SCREW SUP-241.289 CDM 270010022 LOCAL 0270 RC outpatient 2931.5 2931.5 2931.5 74 2169.31 percent of total billed charges 2931.5 93 2374.52 percent of total billed charges 2931.5 2931.5 other OPPS APC 2931.5 2931.5 other OPPS APC 2931.5 27.63 809.97 percent of total billed charges 2931.5 2931.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 208X11X2.5MM SS NS HUMERUS RIGHT DISTAL POSTEROLATERAL 14 HOLE PRECONTOUR FIX ANGLE LIMIT CONTACT SUP-241.300 CDM 270010022 LOCAL 0270 RC outpatient 3015.87 3015.87 3015.87 74 2231.74 percent of total billed charges 3015.87 93 2442.85 percent of total billed charges 3015.87 3015.87 other OPPS APC 3015.87 3015.87 other OPPS APC 3015.87 27.63 833.28 percent of total billed charges 3015.87 3015.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 208X11X2.5MM SS NS HUMERUS LEFT DISTAL POSTEROLATERAL 14 HOLE PRECONTOUR FIX ANGLE LIMIT CONTACT SUP-241.301 CDM 270010022 LOCAL 0270 RC outpatient 3015.87 3015.87 3015.87 74 2231.74 percent of total billed charges 3015.87 93 2442.85 percent of total billed charges 3015.87 3015.87 other OPPS APC 3015.87 3015.87 other OPPS APC 3015.87 27.63 833.28 percent of total billed charges 3015.87 3015.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 3.5MM CLP POSTEROLATERAL DISTAL HUMERUS RIGHT 14 HOLE SUP-241.302 CDM 270010022 LOCAL 0270 RC outpatient 3187.47 3187.47 3187.47 74 2358.73 percent of total billed charges 3187.47 93 2581.85 percent of total billed charges 3187.47 3187.47 other OPPS APC 3187.47 3187.47 other OPPS APC 3187.47 27.63 880.7 percent of total billed charges 3187.47 3187.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 208X11X2.5MM SS NS HUMERUS RIGHT DISTAL MEDIAL 14 HOLE PRECONTOUR LIMIT CONTACT 3.5MM SCREW SUP-241.304 CDM 270010022 LOCAL 0270 RC outpatient 3015.87 3015.87 3015.87 74 2231.74 percent of total billed charges 3015.87 93 2442.85 percent of total billed charges 3015.87 3015.87 other OPPS APC 3015.87 3015.87 other OPPS APC 3015.87 27.63 833.28 percent of total billed charges 3015.87 3015.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI 208X11X2.5MM SS NS HUMERUS LEFT DISTAL MEDIAL 14 HOLE PRECONTOUR LIMIT CONTACT 3.5MM SCREW SUP-241.305 CDM 270010022 LOCAL 0270 RC outpatient 3015.87 3015.87 3015.87 74 2231.74 percent of total billed charges 3015.87 93 2442.85 percent of total billed charges 3015.87 3015.87 other OPPS APC 3015.87 3015.87 other OPPS APC 3015.87 27.63 833.28 percent of total billed charges 3015.87 3015.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP 1/3 TUBULAR 25X9X1MM .5MM 12MM SS NS 2 HOLE COLLAR 3.5MM SCREW SM FRAGMENT SUP-241.32 CDM 270010022 LOCAL 0270 RC outpatient 330.38 330.38 330.38 74 244.48 percent of total billed charges 330.38 93 267.61 percent of total billed charges 330.38 330.38 other OPPS APC 330.38 330.38 other OPPS APC 330.38 27.63 91.28 percent of total billed charges 330.38 330.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP 1/3 TUBULAR 37X9X1MM .5MM 12MM SS NS 3 HOLE COLLAR 3.5MM SCREW SM FRAGMENT SUP-241.33 CDM 270010022 LOCAL 0270 RC outpatient 813.28 813.28 813.28 74 601.83 percent of total billed charges 813.28 93 658.76 percent of total billed charges 813.28 813.28 other OPPS APC 813.28 813.28 other OPPS APC 813.28 27.63 224.71 percent of total billed charges 813.28 813.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL 1/3 TUBULAR L33 MM X W9 MM X H1 MM H.7 MM OD12 MM 3 HOLE COLLAR NONSTERILE 2.7/3.5 MM CORTEX 3.5 MM LOCK SCREW SMALL FRAGMENT SET SUP-241.331 CDM 270010022 LOCAL 0270 RC outpatient 1005.55 1005.55 1005.55 74 744.11 percent of total billed charges 1005.55 93 814.5 percent of total billed charges 1005.55 1005.55 other OPPS APC 1005.55 1005.55 other OPPS APC 1005.55 27.63 277.83 percent of total billed charges 1005.55 1005.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP 1/3 TUBULAR 49X9X1MM .5MM 12MM SS NS 4 HOLE COLLAR 3.5MM SCREW SM FRAGMENT SUP-241.34 CDM 270010022 LOCAL 0270 RC outpatient 443.3 443.3 443.3 74 328.04 percent of total billed charges 443.3 93 359.07 percent of total billed charges 443.3 443.3 other OPPS APC 443.3 443.3 other OPPS APC 443.3 27.63 122.48 percent of total billed charges 443.3 443.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 1/3 TUBE 61X9X1MM SS 3.5MM SCREW SM FRAGMENT SET 5 HOLE COLLAR DCP LC-DCP BONE SUP-241.35 CDM 270010022 LOCAL 0270 RC outpatient 443.3 443.3 443.3 74 328.04 percent of total billed charges 443.3 93 359.07 percent of total billed charges 443.3 443.3 other OPPS APC 443.3 443.3 other OPPS APC 443.3 27.63 122.48 percent of total billed charges 443.3 443.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL 1/3 TUBULAR L57 MM X W9 MM X H1 MM H.7 MM OD12 MM 5 HOLE COLLAR NONSTERILE 2.7/3.5 MM CORTEX 3.5 MM LOCK SCREW SMALL FRAGMENT SET SUP-241.351 CDM 270010022 LOCAL 0270 RC outpatient 387.14 387.14 387.14 74 286.48 percent of total billed charges 387.14 93 313.58 percent of total billed charges 387.14 387.14 other OPPS APC 387.14 387.14 other OPPS APC 387.14 27.63 106.97 percent of total billed charges 387.14 387.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP 1/3 TUBULAR 73X9X1MM .5MM 12MM SS NS 6 HOLE COLLAR 3.5MM SCREW SM FRAGMENT SUP-241.36 CDM 270010022 LOCAL 0270 RC outpatient 402.27 402.27 402.27 74 297.68 percent of total billed charges 402.27 93 325.84 percent of total billed charges 402.27 402.27 other OPPS APC 402.27 402.27 other OPPS APC 402.27 27.63 111.15 percent of total billed charges 402.27 402.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL 1/3 TUBULAR L69 MM X W9 MM X H1 MM H.7 MM OD12 MM 6 HOLE COLLAR NONSTERILE 2.7/3.5 MM CORTEX 3.5 MM LOCK SCREW SMALL FRAGMENT SET SUP-241.361 CDM 270010022 LOCAL 0270 RC outpatient 387.14 387.14 387.14 74 286.48 percent of total billed charges 387.14 93 313.58 percent of total billed charges 387.14 387.14 other OPPS APC 387.14 387.14 other OPPS APC 387.14 27.63 106.97 percent of total billed charges 387.14 387.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP 1/3 TUBULAR 85X9X1MM .5MM 12MM SS NS 7 HOLE COLLAR 3.5MM SCREW SM FRAGMENT SUP-241.37 CDM 270010022 LOCAL 0270 RC outpatient 402.27 402.27 402.27 74 297.68 percent of total billed charges 402.27 93 325.84 percent of total billed charges 402.27 402.27 other OPPS APC 402.27 402.27 other OPPS APC 402.27 27.63 111.15 percent of total billed charges 402.27 402.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL 1/3 TUBULAR L81 MM X W9 MM X H1 MM H.7 MM OD12 MM 7 HOLE COLLAR NONSTERILE 2.7/3.5 MM CORTEX 3.5 MM LOCK SCREW SMALL FRAGMENT SET SUP-241.371 CDM 270010022 LOCAL 0270 RC outpatient 393.43 393.43 393.43 74 291.14 percent of total billed charges 393.43 93 318.68 percent of total billed charges 393.43 393.43 other OPPS APC 393.43 393.43 other OPPS APC 393.43 27.63 108.7 percent of total billed charges 393.43 393.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP 1/3 TUBULAR 97X9X1MM .5MM 12MM SS NS 8 HOLE COLLAR 3.5MM SCREW SM FRAGMENT SUP-241.38 CDM 270010022 LOCAL 0270 RC outpatient 473.33 473.33 473.33 74 350.26 percent of total billed charges 473.33 93 383.4 percent of total billed charges 473.33 473.33 other OPPS APC 473.33 473.33 other OPPS APC 473.33 27.63 130.78 percent of total billed charges 473.33 473.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL 1/3 TUBULAR L93 MM X W9 MM X H1 MM H.7 MM OD12 MM 8 HOLE COLLAR NONSTERILE 2.7/3.5 MM CORTEX 3.5 MM LOCK SCREW SMALL FRAGMENT SET SUP-241.381 CDM 270010022 LOCAL 0270 RC outpatient 417.4 417.4 417.4 74 308.88 percent of total billed charges 417.4 93 338.09 percent of total billed charges 417.4 417.4 other OPPS APC 417.4 417.4 other OPPS APC 417.4 27.63 115.33 percent of total billed charges 417.4 417.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL 1/3 TUBULAR L109 MM X W9 MM X H1 MM H.5 MM OD12 MM 9 HOLE COLLAR NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.39 CDM 270010022 LOCAL 0270 RC outpatient 491.92 491.92 491.92 74 364.02 percent of total billed charges 491.92 93 398.46 percent of total billed charges 491.92 491.92 other OPPS APC 491.92 491.92 other OPPS APC 491.92 27.63 135.92 percent of total billed charges 491.92 491.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP 1/3 TUBULAR 121X9X1MM .5MM 12MM SS NS 10 HOLE COLLAR 3.5MM SCREW SM FRAGMENT SUP-241.40 CDM 270010022 LOCAL 0270 RC outpatient 491.92 491.92 491.92 74 364.02 percent of total billed charges 491.92 93 398.46 percent of total billed charges 491.92 491.92 other OPPS APC 491.92 491.92 other OPPS APC 491.92 27.63 135.92 percent of total billed charges 491.92 491.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL 1/3 TUBULAR L117 MM X W9 MM X H1 MM H.7 MM OD12 MM 10 HOLE COLLAR NONSTERILE 2.7/3.5 MM CORTEX 3.5 MM LOCK SCREW SMALL FRAGMENT SET SUP-241.401 CDM 270010022 LOCAL 0270 RC outpatient 417.4 417.4 417.4 74 308.88 percent of total billed charges 417.4 93 338.09 percent of total billed charges 417.4 417.4 other OPPS APC 417.4 417.4 other OPPS APC 417.4 27.63 115.33 percent of total billed charges 417.4 417.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP 1/3 TUBULAR 145X9X1MM .5MM 12MM SS NS 12 HOLE COLLAR 3.5MM SCREW SM FRAGMENT SUP-241.42 CDM 270010022 LOCAL 0270 RC outpatient 513.37 513.37 513.37 74 379.89 percent of total billed charges 513.37 93 415.83 percent of total billed charges 513.37 513.37 other OPPS APC 513.37 513.37 other OPPS APC 513.37 27.63 141.84 percent of total billed charges 513.37 513.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL 1/3 TUBULAR L141 MM X W9 MM X H1 MM H.7 MM OD12 MM 12 HOLE COLLAR NONSTERILE 2.7/3.5 MM CORTEX 3.5 MM LOCK SCREW SMALL FRAGMENT SET SUP-241.421 CDM 270010022 LOCAL 0270 RC outpatient 430.01 430.01 430.01 74 318.21 percent of total billed charges 430.01 93 348.31 percent of total billed charges 430.01 430.01 other OPPS APC 430.01 430.01 other OPPS APC 430.01 27.63 118.81 percent of total billed charges 430.01 430.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L80 MM TIBIA RIGHT DISTAL ANTEROLATERAL 5 HOLE LOW PROFILE LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-241.440 CDM 270010022 LOCAL 0270 RC outpatient 3530.8 3530.8 3530.8 74 2612.79 percent of total billed charges 3530.8 93 2859.95 percent of total billed charges 3530.8 3530.8 other OPPS APC 3530.8 3530.8 other OPPS APC 3530.8 27.63 975.56 percent of total billed charges 3530.8 3530.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L80 MM TIBIA LEFT DISTAL ANTEROLATERAL 5 HOLE LOW PROFILE LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-241.441 CDM 270010022 LOCAL 0270 RC outpatient 4004 4004 4004 74 2962.96 percent of total billed charges 4004 93 3243.24 percent of total billed charges 4004 4004 other OPPS APC 4004 4004 other OPPS APC 4004 27.63 1106.31 percent of total billed charges 4004 4004 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L106 MM TIBIA RIGHT DISTAL ANTEROLATERAL 7 HOLE LOW PROFILE LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-241.442 CDM 270010022 LOCAL 0270 RC outpatient 3455.14 3455.14 3455.14 74 2556.8 percent of total billed charges 3455.14 93 2798.66 percent of total billed charges 3455.14 3455.14 other OPPS APC 3455.14 3455.14 other OPPS APC 3455.14 27.63 954.66 percent of total billed charges 3455.14 3455.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L106 MM TIBIA LEFT DISTAL ANTEROLATERAL 7 HOLE LOW PROFILE LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-241.443 CDM 270010022 LOCAL 0270 RC outpatient 3455.14 3455.14 3455.14 74 2556.8 percent of total billed charges 3455.14 93 2798.66 percent of total billed charges 3455.14 3455.14 other OPPS APC 3455.14 3455.14 other OPPS APC 3455.14 27.63 954.66 percent of total billed charges 3455.14 3455.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L132 MM TIBIA RIGHT DISTAL ANTEROLATERAL 9 HOLE LOW PROFILE LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-241.444 CDM 270010022 LOCAL 0270 RC outpatient 3958.24 3958.24 3958.24 74 2929.1 percent of total billed charges 3958.24 93 3206.17 percent of total billed charges 3958.24 3958.24 other OPPS APC 3958.24 3958.24 other OPPS APC 3958.24 27.63 1093.66 percent of total billed charges 3958.24 3958.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L132 MM TIBIA LEFT DISTAL ANTEROLATERAL 9 HOLE LOW PROFILE LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-241.445 CDM 270010022 LOCAL 0270 RC outpatient 3490.45 3490.45 3490.45 74 2582.93 percent of total billed charges 3490.45 93 2827.26 percent of total billed charges 3490.45 3490.45 other OPPS APC 3490.45 3490.45 other OPPS APC 3490.45 27.63 964.41 percent of total billed charges 3490.45 3490.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L158 MM TIBIA RIGHT DISTAL ANTEROLATERAL 11 HOLE LOW PROFILE LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-241.446 CDM 270010022 LOCAL 0270 RC outpatient 3993.99 3993.99 3993.99 74 2955.55 percent of total billed charges 3993.99 93 3235.13 percent of total billed charges 3993.99 3993.99 other OPPS APC 3993.99 3993.99 other OPPS APC 3993.99 27.63 1103.54 percent of total billed charges 3993.99 3993.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L158 MM TIBIA LEFT DISTAL ANTEROLATERAL 11 HOLE LOW PROFILE LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-241.447 CDM 270010022 LOCAL 0270 RC outpatient 3993.99 3993.99 3993.99 74 2955.55 percent of total billed charges 3993.99 93 3235.13 percent of total billed charges 3993.99 3993.99 other OPPS APC 3993.99 3993.99 other OPPS APC 3993.99 27.63 1103.54 percent of total billed charges 3993.99 3993.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L184 MM TIBIA RIGHT DISTAL ANTEROLATERAL 13 HOLE LOW PROFILE LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-241.448 CDM 270010022 LOCAL 0270 RC outpatient 4039.75 4039.75 4039.75 74 2989.42 percent of total billed charges 4039.75 93 3272.2 percent of total billed charges 4039.75 4039.75 other OPPS APC 4039.75 4039.75 other OPPS APC 4039.75 27.63 1116.18 percent of total billed charges 4039.75 4039.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L184 MM TIBIA LEFT DISTAL ANTEROLATERAL 13 HOLE LOW PROFILE LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-241.449 CDM 270010022 LOCAL 0270 RC outpatient 4039.75 4039.75 4039.75 74 2989.42 percent of total billed charges 4039.75 93 3272.2 percent of total billed charges 4039.75 4039.75 other OPPS APC 4039.75 4039.75 other OPPS APC 4039.75 27.63 1116.18 percent of total billed charges 4039.75 4039.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L210 MM TIBIA RIGHT DISTAL ANTEROLATERAL 15 HOLE LOW PROFILE LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-241.450 CDM 270010022 LOCAL 0270 RC outpatient 4094.09 4094.09 4094.09 74 3029.63 percent of total billed charges 4094.09 93 3316.21 percent of total billed charges 4094.09 4094.09 other OPPS APC 4094.09 4094.09 other OPPS APC 4094.09 27.63 1131.2 percent of total billed charges 4094.09 4094.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L210 MM TIBIA LEFT DISTAL ANTEROLATERAL 15 HOLE LOW PROFILE LIMIT CONTACT TAPER TIP NONSTERILE 3.5 MM SCREW SUP-241.451 CDM 270010022 LOCAL 0270 RC outpatient 4094.09 4094.09 4094.09 74 3029.63 percent of total billed charges 4094.09 93 3316.21 percent of total billed charges 4094.09 4094.09 other OPPS APC 4094.09 4094.09 other OPPS APC 4094.09 27.63 1131.2 percent of total billed charges 4094.09 4094.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP 60MMX1.2MM SS NS CALCANEAL 3.5MM CORTEX 3.5MM CANNULATED 4MM CANCELLOUS SCREW SM FRAGMENT SET SUP-241.61 CDM 270010022 LOCAL 0270 RC outpatient 2769.91 2769.91 2769.91 74 2049.73 percent of total billed charges 2769.91 93 2243.63 percent of total billed charges 2769.91 2769.91 other OPPS APC 2769.91 2769.91 other OPPS APC 2769.91 27.63 765.33 percent of total billed charges 2769.91 2769.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL L70 MM X H1.2 MM NONSTERILE 3.5 MM CORTEX 3.5 MM CANNULATED 4 MM CANCELLOUS SCREW SMALL FRAGMENT SET SUP-241.62 CDM 270010022 LOCAL 0270 RC outpatient 2788.5 2788.5 2788.5 74 2063.49 percent of total billed charges 2788.5 93 2258.69 percent of total billed charges 2788.5 2788.5 other OPPS APC 2788.5 2788.5 other OPPS APC 2788.5 27.63 770.46 percent of total billed charges 2788.5 2788.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LOCKING CALCANEAL SHORT RIGHT 69MM SUP-241.622 CDM 270010022 LOCAL 0270 RC outpatient 3807.83 3807.83 3807.83 74 2817.79 percent of total billed charges 3807.83 93 3084.34 percent of total billed charges 3807.83 3807.83 other OPPS APC 3807.83 3807.83 other OPPS APC 3807.83 27.63 1052.1 percent of total billed charges 3807.83 3807.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP SHORT 69MMX2MM SS NS CALCANEAL LEFT LOCK 2.7/3.5MM CORTEX SCREW SUP-241.623 CDM 270010022 LOCAL 0270 RC outpatient 1909.05 1909.05 1909.05 74 1412.7 percent of total billed charges 1909.05 93 1546.33 percent of total billed charges 1909.05 1909.05 other OPPS APC 1909.05 1909.05 other OPPS APC 1909.05 27.63 527.47 percent of total billed charges 1909.05 1909.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP LONG 76MMX2MM SS NS CALCANEAL RIGHT LOCK 2.7/3.5MM CORTEX SCREW SUP-241.624 CDM 270010022 LOCAL 0270 RC outpatient 2036.32 2036.32 2036.32 74 1506.88 percent of total billed charges 2036.32 93 1649.42 percent of total billed charges 2036.32 2036.32 other OPPS APC 2036.32 2036.32 other OPPS APC 2036.32 27.63 562.64 percent of total billed charges 2036.32 2036.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP LONG 76MMX2MM SS NS CALCANEAL LEFT LOCK 2.7/3.5MM CORTEX SCREW SUP-241.625 CDM 270010022 LOCAL 0270 RC outpatient 2036.32 2036.32 2036.32 74 1506.88 percent of total billed charges 2036.32 93 1649.42 percent of total billed charges 2036.32 2036.32 other OPPS APC 2036.32 2036.32 other OPPS APC 2036.32 27.63 562.64 percent of total billed charges 2036.32 2036.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP Y 87MMX2MM SS NS CALCANEAL 3.5MM CORTEX 3.5MM CANNULATED 4MM CANCELLOUS SCREW SM FRAGMENT SET SUP-241.65 CDM 270010022 LOCAL 0270 RC outpatient 2809.95 2809.95 2809.95 74 2079.36 percent of total billed charges 2809.95 93 2276.06 percent of total billed charges 2809.95 2809.95 other OPPS APC 2809.95 2809.95 other OPPS APC 2809.95 27.63 776.39 percent of total billed charges 2809.95 2809.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L34 MM RADIAL HEAD RIGHT PROXIMAL 2 HOLE RIM PRECONTOUR LIMIT CONTACT NONSTERILE 2.4 MM SCREW SUP-241.680 CDM 270010022 LOCAL 0270 RC outpatient 1691.69 1691.69 1691.69 74 1251.85 percent of total billed charges 1691.69 93 1370.27 percent of total billed charges 1691.69 1691.69 other OPPS APC 1691.69 1691.69 other OPPS APC 1691.69 27.63 467.41 percent of total billed charges 1691.69 1691.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L34 MM RADIAL HEAD LEFT PROXIMAL 2 HOLE RIM PRECONTOUR LIMIT CONTACT NONSTERILE 2.4 MM SCREW SUP-241.681 CDM 270010022 LOCAL 0270 RC outpatient 1691.69 1691.69 1691.69 74 1251.85 percent of total billed charges 1691.69 93 1370.27 percent of total billed charges 1691.69 1691.69 other OPPS APC 1691.69 1691.69 other OPPS APC 1691.69 27.63 467.41 percent of total billed charges 1691.69 1691.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L46 MM RADIAL HEAD RIGHT PROXIMAL 3 HOLE RIM PRECONTOUR LIMIT CONTACT NONSTERILE 2.4 MM SCREW SUP-241.682 CDM 270010022 LOCAL 0270 RC outpatient 1743.17 1743.17 1743.17 74 1289.95 percent of total billed charges 1743.17 93 1411.97 percent of total billed charges 1743.17 1743.17 other OPPS APC 1743.17 1743.17 other OPPS APC 1743.17 27.63 481.64 percent of total billed charges 1743.17 1743.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L46 MM RADIAL HEAD LEFT PROXIMAL 3 HOLE RIM PRECONTOUR LIMIT CONTACT NONSTERILE 2.4 MM SCREW SUP-241.683 CDM 270010022 LOCAL 0270 RC outpatient 1743.17 1743.17 1743.17 74 1289.95 percent of total billed charges 1743.17 93 1411.97 percent of total billed charges 1743.17 1743.17 other OPPS APC 1743.17 1743.17 other OPPS APC 1743.17 27.63 481.64 percent of total billed charges 1743.17 1743.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L56 MM RADIAL HEAD RIGHT PROXIMAL 4 HOLE RIM PRECONTOUR LIMIT CONTACT NONSTERILE 2.4 MM SCREW SUP-241.684 CDM 270010022 LOCAL 0270 RC outpatient 1771.77 1771.77 1771.77 74 1311.11 percent of total billed charges 1771.77 93 1435.13 percent of total billed charges 1771.77 1771.77 other OPPS APC 1771.77 1771.77 other OPPS APC 1771.77 27.63 489.54 percent of total billed charges 1771.77 1771.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L56 MM RADIAL HEAD LEFT PROXIMAL 4 HOLE RIM PRECONTOUR LIMIT CONTACT NONSTERILE 2.4 MM SCREW SUP-241.685 CDM 270010022 LOCAL 0270 RC outpatient 1771.77 1771.77 1771.77 74 1311.11 percent of total billed charges 1771.77 93 1435.13 percent of total billed charges 1771.77 1771.77 other OPPS APC 1771.77 1771.77 other OPPS APC 1771.77 27.63 489.54 percent of total billed charges 1771.77 1771.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L28 MM RADIAL HEAD PROXIMAL 2 HOLE NECK PRECONTOUR LIMIT CONTACT NONSTERILE 2.4 MM SCREW SUP-241.690 CDM 270010022 LOCAL 0270 RC outpatient 1491.78 1491.78 1491.78 74 1103.92 percent of total billed charges 1491.78 93 1208.34 percent of total billed charges 1491.78 1491.78 other OPPS APC 1491.78 1491.78 other OPPS APC 1491.78 27.63 412.18 percent of total billed charges 1491.78 1491.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L40 MM RADIAL HEAD PROXIMAL 3 HOLE NECK PRECONTOUR LIMIT CONTACT NONSTERILE 2.4 MM SCREW SUP-241.691 CDM 270010022 LOCAL 0270 RC outpatient 1743.17 1743.17 1743.17 74 1289.95 percent of total billed charges 1743.17 93 1411.97 percent of total billed charges 1743.17 1743.17 other OPPS APC 1743.17 1743.17 other OPPS APC 1743.17 27.63 481.64 percent of total billed charges 1743.17 1743.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L50 MM RADIAL HEAD PROXIMAL 4 HOLE NECK PRECONTOUR LIMIT CONTACT NONSTERILE 2.4 MM SCREW SUP-241.692 CDM 270010022 LOCAL 0270 RC outpatient 1773.2 1773.2 1773.2 74 1312.17 percent of total billed charges 1773.2 93 1436.29 percent of total billed charges 1773.2 1773.2 other OPPS APC 1773.2 1773.2 other OPPS APC 1773.2 27.63 489.94 percent of total billed charges 1773.2 1773.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CLOVERLEAF 88X15X2MM 1.2MM SS NS 3 HOLE SHAFT THIN BLADE 3.5MM CORTEX 4MM CONCELLOUS SCREW SM FRAGMENT SUP-241.83 CDM 270010022 LOCAL 0270 RC outpatient 914.94 914.94 914.94 74 677.06 percent of total billed charges 914.94 93 741.1 percent of total billed charges 914.94 914.94 other OPPS APC 914.94 914.94 other OPPS APC 914.94 27.63 252.8 percent of total billed charges 914.94 914.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL CLOVERLEAF L104 MM X W15 MM X H2 MM H1.2 MM 4 HOLE THIN BLADE NONSTERILE 3.5 MM CORTEX 3.5 MM SHAFT 4 MM CONCELLOUS SCREW SMALL FRAGMENT SET SUP-241.84 CDM 270010022 LOCAL 0270 RC outpatient 978.12 978.12 978.12 74 723.81 percent of total billed charges 978.12 93 792.28 percent of total billed charges 978.12 978.12 other OPPS APC 978.12 978.12 other OPPS APC 978.12 27.63 270.25 percent of total billed charges 978.12 978.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP CLOVERLEAF 152X15X2MM 1.2MM SS NS 7 HOLE THIN BLADE LOW PROFILE 3.5MM CORTEX 3.5MM SHAFT 4MM SUP-241.87 CDM 270010022 LOCAL 0270 RC outpatient 1485.9 1485.9 1485.9 74 1099.57 percent of total billed charges 1485.9 93 1203.58 percent of total billed charges 1485.9 1485.9 other OPPS APC 1485.9 1485.9 other OPPS APC 1485.9 27.63 410.55 percent of total billed charges 1485.9 1485.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PHILOS STAINLESS STEEL STANDARD L90 MM PROXIMAL HUMERUS 3 HOLE LOCKING COMPRESSION PRECONTOUR NONSTERILE 3.5 MM SCREWS SUP-241.901 CDM 270010022 LOCAL 0270 RC outpatient 3841.03 3841.03 3841.03 74 2842.36 percent of total billed charges 3841.03 93 3111.23 percent of total billed charges 3841.03 3841.03 other OPPS APC 3841.03 3841.03 other OPPS APC 3841.03 27.63 1061.28 percent of total billed charges 3841.03 3841.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PHILOS STAINLESS STEEL STANDARD L114 MM PROXIMAL HUMERUS 5 HOLE LOCKING COMPRESSION PRECONTOUR NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.903 CDM 270010022 LOCAL 0270 RC outpatient 3961.36 3961.36 3961.36 74 2931.41 percent of total billed charges 3961.36 93 3208.7 percent of total billed charges 3961.36 3961.36 other OPPS APC 3961.36 3961.36 other OPPS APC 3961.36 27.63 1094.52 percent of total billed charges 3961.36 3961.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL LONG L142 MM X W12 MM X H3.7 MM PROXIMAL 5 HOLE SHAFT NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.918 CDM 270010022 LOCAL 0270 RC outpatient 4231.37 4231.37 4231.37 74 3131.21 percent of total billed charges 4231.37 93 3427.41 percent of total billed charges 4231.37 4231.37 other OPPS APC 4231.37 4231.37 other OPPS APC 4231.37 27.63 1169.13 percent of total billed charges 4231.37 4231.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL LONG L160 MM X W12 MM X H3.7 MM PROXIMAL 6 HOLE SHAFT NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.919 CDM 270010022 LOCAL 0270 RC outpatient 4158.75 4158.75 4158.75 74 3077.48 percent of total billed charges 4158.75 93 3368.59 percent of total billed charges 4158.75 4158.75 other OPPS APC 4158.75 4158.75 other OPPS APC 4158.75 27.63 1149.06 percent of total billed charges 4158.75 4158.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL LONG L196 MM X W12 MM X H3.7 MM PROXIMAL 8 HOLE SHAFT NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.921 CDM 270010022 LOCAL 0270 RC outpatient 10137.3 10137.3 10137.3 74 7501.58 percent of total billed charges 10137.3 93 8211.19 percent of total billed charges 10137.3 10137.3 other OPPS APC 10137.3 10137.3 other OPPS APC 10137.3 27.63 2800.93 percent of total billed charges 10137.3 10137.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL LONG L232 MM X W12 MM X H3.7 MM PROXIMAL 10 HOLE SHAFT NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.923 CDM 270010022 LOCAL 0270 RC outpatient 4481.88 4481.88 4481.88 74 3316.59 percent of total billed charges 4481.88 93 3630.32 percent of total billed charges 4481.88 4481.88 other OPPS APC 4481.88 4481.88 other OPPS APC 4481.88 27.63 1238.34 percent of total billed charges 4481.88 4481.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL LONG L268 MM X W12 MM X H3.7 MM PROXIMAL 12 HOLE SHAFT NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.925 CDM 270010022 LOCAL 0270 RC outpatient 4902.04 4902.04 4902.04 74 3627.51 percent of total billed charges 4902.04 93 3970.65 percent of total billed charges 4902.04 4902.04 other OPPS APC 4902.04 4902.04 other OPPS APC 4902.04 27.63 1354.43 percent of total billed charges 4902.04 4902.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL OBLIQUE LEFT T L52 MM X W10 MM X H1.5 MM 3 HOLE HEAD 3 HOLE SHAFT NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.931 CDM 270010022 LOCAL 0270 RC outpatient 919.49 919.49 919.49 74 680.42 percent of total billed charges 919.49 93 744.79 percent of total billed charges 919.49 919.49 other OPPS APC 919.49 919.49 other OPPS APC 919.49 27.63 254.06 percent of total billed charges 919.49 919.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL OBLIQUE LEFT T L63 MM X W10 MM X H1.5 MM 3 HOLE HEAD 4 HOLE SHAFT NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.941 CDM 270010022 LOCAL 0270 RC outpatient 962.39 962.39 962.39 74 712.17 percent of total billed charges 962.39 93 779.54 percent of total billed charges 962.39 962.39 other OPPS APC 962.39 962.39 other OPPS APC 962.39 27.63 265.91 percent of total billed charges 962.39 962.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL OBLIQUE LEFT T L74 MM X W10 MM X H1.5 MM 3 HOLE HEAD 5 HOLE SHAFT NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.951 CDM 270010022 LOCAL 0270 RC outpatient 1005.29 1005.29 1005.29 74 743.91 percent of total billed charges 1005.29 93 814.28 percent of total billed charges 1005.29 1005.29 other OPPS APC 1005.29 1005.29 other OPPS APC 1005.29 27.63 277.76 percent of total billed charges 1005.29 1005.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL OBLIQUE LEFT T L96 MM X W10 MM X H1.5 MM 3 HOLE HEAD 7 HOLE SHAFT NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-241.971 CDM 270010022 LOCAL 0270 RC outpatient 1089.66 1089.66 1089.66 74 806.35 percent of total billed charges 1089.66 93 882.62 percent of total billed charges 1089.66 1089.66 other OPPS APC 1089.66 1089.66 other OPPS APC 1089.66 27.63 301.07 percent of total billed charges 1089.66 1089.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAMPON CARDBOARD SLEEVE BULK VENDING SUP-241288 CDM outpatient 0.75 0.75 0.75 0.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L175 MM FEMUR LEFT PROXIMAL 4 HOLE NONSTERILE 4.5 MM SCREW SUP-242.104 CDM 270010022 LOCAL 0270 RC outpatient 3665.09 3665.09 3665.09 74 2712.17 percent of total billed charges 3665.09 93 2968.72 percent of total billed charges 3665.09 3665.09 other OPPS APC 3665.09 3665.09 other OPPS APC 3665.09 27.63 1012.66 percent of total billed charges 3665.09 3665.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L211 MM FEMUR LEFT PROXIMAL 6 HOLE NONSTERILE 4.5 MM SCREW SUP-242.106 CDM 270010022 LOCAL 0270 RC outpatient 3738.02 3738.02 3738.02 74 2766.13 percent of total billed charges 3738.02 93 3027.8 percent of total billed charges 3738.02 3738.02 other OPPS APC 3738.02 3738.02 other OPPS APC 3738.02 27.63 1032.81 percent of total billed charges 3738.02 3738.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L169 MM FEMUR PROXIMAL 4 HOLE HOOK NONSTERILE 4.5 MM SCREW SUP-242.121 CDM 270010022 LOCAL 0270 RC outpatient 4219.93 4219.93 4219.93 74 3122.75 percent of total billed charges 4219.93 93 3418.14 percent of total billed charges 4219.93 4219.93 other OPPS APC 4219.93 4219.93 other OPPS APC 4219.93 27.63 1165.97 percent of total billed charges 4219.93 4219.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L205 MM FEMUR PROXIMAL 6 HOLE HOOK NONSTERILE 4.5 MM SCREW SUP-242.122 CDM 270010022 LOCAL 0270 RC outpatient 4287.14 4287.14 4287.14 74 3172.48 percent of total billed charges 4287.14 93 3472.58 percent of total billed charges 4287.14 4287.14 other OPPS APC 4287.14 4287.14 other OPPS APC 4287.14 27.63 1184.54 percent of total billed charges 4287.14 4287.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L241 MM FEMUR PROXIMAL 8 HOLE HOOK NONSTERILE 4.5 MM SCREW SUP-242.123 CDM 270010022 LOCAL 0270 RC outpatient 4444.44 4444.44 4444.44 74 3288.89 percent of total billed charges 4444.44 93 3600 percent of total billed charges 4444.44 4444.44 other OPPS APC 4444.44 4444.44 other OPPS APC 4444.44 27.63 1228 percent of total billed charges 4444.44 4444.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L277 MM FEMUR PROXIMAL 10 HOLE HOOK NONSTERILE 4.5 MM SCREW SUP-242.124 CDM 270010022 LOCAL 0270 RC outpatient 4673.24 4673.24 4673.24 74 3458.2 percent of total billed charges 4673.24 93 3785.32 percent of total billed charges 4673.24 4673.24 other OPPS APC 4673.24 4673.24 other OPPS APC 4673.24 27.63 1291.22 percent of total billed charges 4673.24 4673.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L313 MM FEMUR PROXIMAL 12 HOLE HOOK NONSTERILE 4.5 MM SCREW SUP-242.125 CDM 270010022 LOCAL 0270 RC outpatient 4824.82 4824.82 4824.82 74 3570.37 percent of total billed charges 4824.82 93 3908.1 percent of total billed charges 4824.82 4824.82 other OPPS APC 4824.82 4824.82 other OPPS APC 4824.82 27.63 1333.1 percent of total billed charges 4824.82 4824.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L349 MM FEMUR PROXIMAL 14 HOLE HOOK NONSTERILE 4.5 MM SCREW SUP-242.126 CDM 270010022 LOCAL 0270 RC outpatient 4882.02 4882.02 4882.02 74 3612.69 percent of total billed charges 4882.02 93 3954.44 percent of total billed charges 4882.02 4882.02 other OPPS APC 4882.02 4882.02 other OPPS APC 4882.02 27.63 1348.9 percent of total billed charges 4882.02 4882.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L48 MM X W6.3 MM X H1.6 MM RADIUS RIGHT DISTAL VOLAR 5 HOLE HEAD 3 HOLE SHAFT NONSTERILE 2.4 MM SCREW SUP-242.458 CDM 270010022 LOCAL 0270 RC outpatient 4249.83 4249.83 4249.83 74 3144.87 percent of total billed charges 4249.83 93 3442.36 percent of total billed charges 4249.83 4249.83 other OPPS APC 4249.83 4249.83 other OPPS APC 4249.83 27.63 1174.23 percent of total billed charges 4249.83 4249.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L66 MM X W6.3 MM X H1.6 MM RADIUS RIGHT DISTAL VOLAR 5 HOLE HEAD 5 HOLE SHAFT NONSTERILE 2.4 MM SCREW SUP-242.459 CDM 270010022 LOCAL 0270 RC outpatient 2070.56 2070.56 2070.56 74 1532.21 percent of total billed charges 2070.56 93 1677.15 percent of total billed charges 2070.56 2070.56 other OPPS APC 2070.56 2070.56 other OPPS APC 2070.56 27.63 572.1 percent of total billed charges 2070.56 2070.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L48 MM X W6.3 MM X H1.6 MM RADIUS LEFT DISTAL VOLAR 5 HOLE HEAD 3 HOLE SHAFT NONSTERILE 2.4 MM SCREW SUP-242.461 CDM 270010022 LOCAL 0270 RC outpatient 1954.55 1954.55 1954.55 74 1446.37 percent of total billed charges 1954.55 93 1583.19 percent of total billed charges 1954.55 1954.55 other OPPS APC 1954.55 1954.55 other OPPS APC 1954.55 27.63 540.04 percent of total billed charges 1954.55 1954.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L66 MM X W6.3 MM X H1.6 MM RADIUS LEFT DISTAL VOLAR 5 HOLE HEAD 5 HOLE SHAFT NONSTERILE 2.4 MM SCREW SUP-242.462 CDM 270010022 LOCAL 0270 RC outpatient 2348.06 2348.06 2348.06 74 1737.56 percent of total billed charges 2348.06 93 1901.93 percent of total billed charges 2348.06 2348.06 other OPPS APC 2348.06 2348.06 other OPPS APC 2348.06 27.63 648.77 percent of total billed charges 2348.06 2348.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L47 MM X W6.3 MM X H1.6 MM RADIUS RIGHT DISTAL VOLAR 4 HOLE HEAD 3 HOLE SHAFT NONSTERILE 2.4 MM SCREW SUP-242.464 CDM 270010022 LOCAL 0270 RC outpatient 1954.55 1954.55 1954.55 74 1446.37 percent of total billed charges 1954.55 93 1583.19 percent of total billed charges 1954.55 1954.55 other OPPS APC 1954.55 1954.55 other OPPS APC 1954.55 27.63 540.04 percent of total billed charges 1954.55 1954.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L65 MM X W6.3 MM X H1.6 MM RADIUS RIGHT DISTAL VOLAR 4 HOLE HEAD 5 HOLE SHAFT NONSTERILE 2.4 MM SCREW SUP-242.465 CDM 270010022 LOCAL 0270 RC outpatient 2070.56 2070.56 2070.56 74 1532.21 percent of total billed charges 2070.56 93 1677.15 percent of total billed charges 2070.56 2070.56 other OPPS APC 2070.56 2070.56 other OPPS APC 2070.56 27.63 572.1 percent of total billed charges 2070.56 2070.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L47 MM X W6.3 MM X H1.6 MM RADIUS LEFT DISTAL VOLAR 4 HOLE HEAD 3 HOLE SHAFT NONSTERILE 2.4 MM SCREW SUP-242.467 CDM 270010022 LOCAL 0270 RC outpatient 1954.55 1954.55 1954.55 74 1446.37 percent of total billed charges 1954.55 93 1583.19 percent of total billed charges 1954.55 1954.55 other OPPS APC 1954.55 1954.55 other OPPS APC 1954.55 27.63 540.04 percent of total billed charges 1954.55 1954.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L65 MM X W6.3 MM X H1.6 MM RADIUS LEFT DISTAL VOLAR 4 HOLE HEAD 5 HOLE SHAFT NONSTERILE 2.4 MM SCREW SUP-242.468 CDM 270010022 LOCAL 0270 RC outpatient 2070.56 2070.56 2070.56 74 1532.21 percent of total billed charges 2070.56 93 1677.15 percent of total billed charges 2070.56 2070.56 other OPPS APC 2070.56 2070.56 other OPPS APC 2070.56 27.63 572.1 percent of total billed charges 2070.56 2070.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL T L40 MM X W6.3 MM X H1.6 MM RADIUS DISTAL 3 HOLE HEAD 3 HOLE SHAFT LOW PROFILE ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-242.477 CDM 270010022 LOCAL 0270 RC outpatient 1637.35 1637.35 1637.35 74 1211.64 percent of total billed charges 1637.35 93 1326.25 percent of total billed charges 1637.35 1637.35 other OPPS APC 1637.35 1637.35 other OPPS APC 1637.35 27.63 452.4 percent of total billed charges 1637.35 1637.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL T L49 MM X W6.3 MM X H1.6 MM RADIUS DISTAL 3 HOLE HEAD 4 HOLE SHAFT LOW PROFILE ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-242.478 CDM 270010022 LOCAL 0270 RC outpatient 1503.11 1503.11 1503.11 74 1112.3 percent of total billed charges 1503.11 93 1217.52 percent of total billed charges 1503.11 1503.11 other OPPS APC 1503.11 1503.11 other OPPS APC 1503.11 27.63 415.31 percent of total billed charges 1503.11 1503.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL STRAIGHT L48 MM X W6.3 MM X H1.6 MM RADIUS DISTAL 5 HOLE LOW PROFILE ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-242.479 CDM 270010022 LOCAL 0270 RC outpatient 1551.55 1551.55 1551.55 74 1148.15 percent of total billed charges 1551.55 93 1256.76 percent of total billed charges 1551.55 1551.55 other OPPS APC 1551.55 1551.55 other OPPS APC 1551.55 27.63 428.69 percent of total billed charges 1551.55 1551.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL RADIUS LEFT DISTAL DORSAL NONSTERILE 2.4/2.7 MM CORTEX SCREW 1.8 MM BUTTRESS PIN SUP-242.482 CDM 270010022 LOCAL 0270 RC outpatient 2562.3 2562.3 2562.3 74 1896.1 percent of total billed charges 2562.3 93 2075.46 percent of total billed charges 2562.3 2562.3 other OPPS APC 2562.3 2562.3 other OPPS APC 2562.3 27.63 707.96 percent of total billed charges 2562.3 2562.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4MM LCP DISTAL RADIUS PLATE STRAIGHT/LONG SUP-242.490 CDM 270010022 LOCAL 0270 RC outpatient 1637.35 1637.35 1637.35 74 1211.64 percent of total billed charges 1637.35 93 1326.25 percent of total billed charges 1637.35 1637.35 other OPPS APC 1637.35 1637.35 other OPPS APC 1637.35 27.63 452.4 percent of total billed charges 1637.35 1637.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L43 MM X W7.5 MM X H1.6 MM RADIUS LEFT DISTAL VOLAR 5 HOLE HEAD 3 HOLE SHAFT PRECONTOUR NONSTERILE 2.4 MM SCREW SUP-242.491 CDM 270010022 LOCAL 0270 RC outpatient 1954.55 1954.55 1954.55 74 1446.37 percent of total billed charges 1954.55 93 1583.19 percent of total billed charges 1954.55 1954.55 other OPPS APC 1954.55 1954.55 other OPPS APC 1954.55 27.63 540.04 percent of total billed charges 1954.55 1954.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L61 MM X W7.5 MM X H1.6 MM RADIUS LEFT DISTAL VOLAR 5 HOLE HEAD 5 HOLE SHAFT PRECONTOUR NONSTERILE 2.4 MM SCREW SUP-242.492 CDM 270010022 LOCAL 0270 RC outpatient 2348.06 2348.06 2348.06 74 1737.56 percent of total billed charges 2348.06 93 1901.93 percent of total billed charges 2348.06 2348.06 other OPPS APC 2348.06 2348.06 other OPPS APC 2348.06 27.63 648.77 percent of total billed charges 2348.06 2348.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L43 MM X W7.5 MM X H1.6 MM RADIUS RIGHT DISTAL VOLAR 5 HOLE HEAD 3 HOLE SHAFT PRECONTOUR NONSTERILE 2.4 MM SCREW SUP-242.493 CDM 270010022 LOCAL 0270 RC outpatient 1954.55 1954.55 1954.55 74 1446.37 percent of total billed charges 1954.55 93 1583.19 percent of total billed charges 1954.55 1954.55 other OPPS APC 1954.55 1954.55 other OPPS APC 1954.55 27.63 540.04 percent of total billed charges 1954.55 1954.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L61 MM X W7.5 MM X H1.6 MM RADIUS RIGHT DISTAL VOLAR 5 HOLE HEAD 5 HOLE SHAFT PRECONTOUR NONSTERILE 2.4 MM SCREW SUP-242.494 CDM 270010022 LOCAL 0270 RC outpatient 2348.06 2348.06 2348.06 74 1737.56 percent of total billed charges 2348.06 93 1901.93 percent of total billed charges 2348.06 2348.06 other OPPS APC 2348.06 2348.06 other OPPS APC 2348.06 27.63 648.77 percent of total billed charges 2348.06 2348.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4MM LCP DISTAL RADIUS L PLATE SUP-242.500 CDM 270010022 LOCAL 0270 RC outpatient 1394.67 1394.67 1394.67 74 1032.06 percent of total billed charges 1394.67 93 1129.68 percent of total billed charges 1394.67 1394.67 other OPPS APC 1394.67 1394.67 other OPPS APC 1394.67 27.63 385.35 percent of total billed charges 1394.67 1394.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL -90 D L L49 MM X W6.3 MM X H1.6 MM RADIUS DISTAL 2 HOLE HEAD 4 HOLE SHAFT LOW PROFILE ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-242.501 CDM 270010022 LOCAL 0270 RC outpatient 1461.51 1461.51 1461.51 74 1081.52 percent of total billed charges 1461.51 93 1183.82 percent of total billed charges 1461.51 1461.51 other OPPS APC 1461.51 1461.51 other OPPS APC 1461.51 27.63 403.82 percent of total billed charges 1461.51 1461.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL +90 D L L40 MM X W6.3 MM X H1.6 MM RADIUS DISTAL 2 HOLE HEAD 3 HOLE SHAFT LOW PROFILE ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-242.502 CDM 270010022 LOCAL 0270 RC outpatient 1581.58 1581.58 1581.58 74 1170.37 percent of total billed charges 1581.58 93 1281.08 percent of total billed charges 1581.58 1581.58 other OPPS APC 1581.58 1581.58 other OPPS APC 1581.58 27.63 436.99 percent of total billed charges 1581.58 1581.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL +90 D L L49 MM X W6.3 MM X H1.6 MM RADIUS DISTAL 2 HOLE HEAD 4 HOLE SHAFT LOW PROFILE ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-242.503 CDM 270010022 LOCAL 0270 RC outpatient 1461.51 1461.51 1461.51 74 1081.52 percent of total billed charges 1461.51 93 1183.82 percent of total billed charges 1461.51 1461.51 other OPPS APC 1461.51 1461.51 other OPPS APC 1461.51 27.63 403.82 percent of total billed charges 1461.51 1461.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL +90 D L L40 MM X W6.3 MM X H1.6 MM RADIUS DISTAL 3 HOLE HEAD 3 HOLE SHAFT LOW PROFILE ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-242.504 CDM 270010022 LOCAL 0270 RC outpatient 1581.58 1581.58 1581.58 74 1170.37 percent of total billed charges 1581.58 93 1281.08 percent of total billed charges 1581.58 1581.58 other OPPS APC 1581.58 1581.58 other OPPS APC 1581.58 27.63 436.99 percent of total billed charges 1581.58 1581.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL +90 D L L49 MM X W6.3 MM X H1.6 MM RADIUS DISTAL 3 HOLE HEAD 4 HOLE SHAFT LOW PROFILE ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-242.505 CDM 270010022 LOCAL 0270 RC outpatient 1461.51 1461.51 1461.51 74 1081.52 percent of total billed charges 1461.51 93 1183.82 percent of total billed charges 1461.51 1461.51 other OPPS APC 1461.51 1461.51 other OPPS APC 1461.51 27.63 403.82 percent of total billed charges 1461.51 1461.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL -90 D L L40 MM X W6.3 MM X H1.6 MM RADIUS DISTAL 3 HOLE HEAD 3 HOLE SHAFT LOW PROFILE ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-242.506 CDM 270010022 LOCAL 0270 RC outpatient 1581.58 1581.58 1581.58 74 1170.37 percent of total billed charges 1581.58 93 1281.08 percent of total billed charges 1581.58 1581.58 other OPPS APC 1581.58 1581.58 other OPPS APC 1581.58 27.63 436.99 percent of total billed charges 1581.58 1581.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL -90 D L L49 MM X W6.3 MM X H1.6 MM RADIUS DISTAL 3 HOLE HEAD 4 HOLE SHAFT LOW PROFILE ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-242.507 CDM 270010022 LOCAL 0270 RC outpatient 1657.37 1657.37 1657.37 74 1226.45 percent of total billed charges 1657.37 93 1342.47 percent of total billed charges 1657.37 1657.37 other OPPS APC 1657.37 1657.37 other OPPS APC 1657.37 27.63 457.93 percent of total billed charges 1657.37 1657.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL +20 D L L43 MM X W6.3 MM X H1.6 MM RADIUS DISTAL 3 HOLE HEAD 3 HOLE SHAFT LOW PROFILE ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-242.508 CDM 270010022 LOCAL 0270 RC outpatient 1581.58 1581.58 1581.58 74 1170.37 percent of total billed charges 1581.58 93 1281.08 percent of total billed charges 1581.58 1581.58 other OPPS APC 1581.58 1581.58 other OPPS APC 1581.58 27.63 436.99 percent of total billed charges 1581.58 1581.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL +20 D L L52 MM X W6.3 MM X H1.6 MM RADIUS DISTAL 3 HOLE HEAD 4 HOLE SHAFT LOW PROFILE ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-242.509 CDM 270010022 LOCAL 0270 RC outpatient 1657.37 1657.37 1657.37 74 1226.45 percent of total billed charges 1657.37 93 1342.47 percent of total billed charges 1657.37 1657.37 other OPPS APC 1657.37 1657.37 other OPPS APC 1657.37 27.63 457.93 percent of total billed charges 1657.37 1657.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL -20 D L L43 MM X W6.3 MM X H1.6 MM RADIUS DISTAL 3 HOLE HEAD 3 HOLE SHAFT LOW PROFILE ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-242.511 CDM 270010022 LOCAL 0270 RC outpatient 1581.58 1581.58 1581.58 74 1170.37 percent of total billed charges 1581.58 93 1281.08 percent of total billed charges 1581.58 1581.58 other OPPS APC 1581.58 1581.58 other OPPS APC 1581.58 27.63 436.99 percent of total billed charges 1581.58 1581.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL -20 D L L52 MM X W6.3 MM X H1.6 MM RADIUS DISTAL 3 HOLE HEAD 4 HOLE SHAFT LOW PROFILE ROUND EDGE NONSTERILE 2.4 MM SCREW SUP-242.512 CDM 270010022 LOCAL 0270 RC outpatient 1657.37 1657.37 1657.37 74 1226.45 percent of total billed charges 1657.37 93 1342.47 percent of total billed charges 1657.37 1657.37 other OPPS APC 1657.37 1657.37 other OPPS APC 1657.37 27.63 457.93 percent of total billed charges 1657.37 1657.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L46 MM ULNA DISTAL 7 HOLE HOOK POINT PRECONTOUR STERILE 2 MM SCREW SUP-242.531S CDM 270010022 LOCAL 0270 RC outpatient 4742.66 4742.66 4742.66 74 3509.57 percent of total billed charges 4742.66 93 3841.55 percent of total billed charges 4742.66 4742.66 other OPPS APC 4742.66 4742.66 other OPPS APC 4742.66 27.63 1310.4 percent of total billed charges 4742.66 4742.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L175 MM FEMUR RIGHT PROXIMAL 4 HOLE NONSTERILE 4.5 MM SCREW SUP-242.804 CDM 270010022 LOCAL 0270 RC outpatient 3665.09 3665.09 3665.09 74 2712.17 percent of total billed charges 3665.09 93 2968.72 percent of total billed charges 3665.09 3665.09 other OPPS APC 3665.09 3665.09 other OPPS APC 3665.09 27.63 1012.66 percent of total billed charges 3665.09 3665.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L211 MM FEMUR RIGHT PROXIMAL 6 HOLE NONSTERILE 4.5 MM SCREW SUP-242.806 CDM 270010022 LOCAL 0270 RC outpatient 3738.02 3738.02 3738.02 74 2766.13 percent of total billed charges 3738.02 93 3027.8 percent of total billed charges 3738.02 3738.02 other OPPS APC 3738.02 3738.02 other OPPS APC 3738.02 27.63 1032.81 percent of total billed charges 3738.02 3738.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L247 MM FEMUR RIGHT PROXIMAL 8 HOLE NONSTERILE 4.5 MM SCREW SUP-242.808 CDM 270010022 LOCAL 0270 RC outpatient 3919.63 3919.63 3919.63 74 2900.53 percent of total billed charges 3919.63 93 3174.9 percent of total billed charges 3919.63 3919.63 other OPPS APC 3919.63 3919.63 other OPPS APC 3919.63 27.63 1082.99 percent of total billed charges 3919.63 3919.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L283 MM FEMUR RIGHT PROXIMAL 10 HOLE NONSTERILE 4.5 MM SCREW SUP-242.810 CDM 270010022 LOCAL 0270 RC outpatient 4199.91 4199.91 4199.91 74 3107.93 percent of total billed charges 4199.91 93 3401.93 percent of total billed charges 4199.91 4199.91 other OPPS APC 4199.91 4199.91 other OPPS APC 4199.91 27.63 1160.44 percent of total billed charges 4199.91 4199.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT OPHTHALMIC RETISERT FLUOCINOLONE ACETONIDE 3 MM X 2 MM X 5 MM .59 MG POSTERIOR SEGMENT ELASTOMER CUP SUTURE TAB STERILE UVEITIS SUP-24208-416-01 CDM 0270 RC outpatient 47450 47450 47450 74 35113 percent of total billed charges 47450 93 38434.5 percent of total billed charges 47450 47450 other OPPS APC 47450 47450 other OPPS APC 47450 27.63 13110.4 percent of total billed charges 47450 47450 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE PRO 4.5 X 8MM NON COMPLIANT SUP-245-083-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE PRO 4.5 X 10MM NON COMPLIANT SUP-245-103-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE PRO 4.5 X 12 MM NON COMPLIANT SUP-245-123-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE PRO 4.5 X 15 MM NON COMPLIANT SUP-245-153-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE PRO 4.5 X 18 MM NON COMPLIANT SUP-245-183-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP 118MM SS NS 10 HOLE RECONSTRUCTION 3.5MM SCREW SM FRAGMENT SUP-245.00 CDM 270010022 LOCAL 0270 RC outpatient 1468.61 1468.61 1468.61 74 1086.77 percent of total billed charges 1468.61 93 1189.57 percent of total billed charges 1468.61 1468.61 other OPPS APC 1468.61 1468.61 other OPPS APC 1468.61 27.63 405.78 percent of total billed charges 1468.61 1468.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL L142 MM 12 HOLE RECONSTRUCTION 3.5 MM SCREW SMALL FRAGMENT SUP-245.02 CDM 270010022 LOCAL 0270 RC outpatient 1625.91 1625.91 1625.91 74 1203.17 percent of total billed charges 1625.91 93 1316.99 percent of total billed charges 1625.91 1625.91 other OPPS APC 1625.91 1625.91 other OPPS APC 1625.91 27.63 449.24 percent of total billed charges 1625.91 1625.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L39 MM X W10.2 MM X H2.7 MM CALCANEUS 3 HOLE NONSTERILE 3.5 MM SCREW LOW PROFILE PELVIC SYSTEM SUP-245.023 CDM 270010022 LOCAL 0270 RC outpatient 2289.56 2289.56 2289.56 74 1694.27 percent of total billed charges 2289.56 93 1854.54 percent of total billed charges 2289.56 2289.56 other OPPS APC 2289.56 2289.56 other OPPS APC 2289.56 27.63 632.61 percent of total billed charges 2289.56 2289.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L52 MM PELVIS 4 HOLE LOW PROFILE RECONSTRUCTION 3.5 MM SCREW SUP-245.024 CDM 270010022 LOCAL 0270 RC outpatient 1098.24 1098.24 1098.24 74 812.7 percent of total billed charges 1098.24 93 889.57 percent of total billed charges 1098.24 1098.24 other OPPS APC 1098.24 1098.24 other OPPS APC 1098.24 27.63 303.44 percent of total billed charges 1098.24 1098.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L65 MM X W10.2 MM X H2.7 MM PELVIC 5 HOLE LOW PROFILE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SUP-245.025 CDM 270010022 LOCAL 0270 RC outpatient 1148.29 1148.29 1148.29 74 849.73 percent of total billed charges 1148.29 93 930.11 percent of total billed charges 1148.29 1148.29 other OPPS APC 1148.29 1148.29 other OPPS APC 1148.29 27.63 317.27 percent of total billed charges 1148.29 1148.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L78 MM X W10.2 MM X H2.7 MM PELVIS 6 HOLE LOW PROFILE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SUP-245.026 CDM 270010022 LOCAL 0270 RC outpatient 1269.84 1269.84 1269.84 74 939.68 percent of total billed charges 1269.84 93 1028.57 percent of total billed charges 1269.84 1269.84 other OPPS APC 1269.84 1269.84 other OPPS APC 1269.84 27.63 350.86 percent of total billed charges 1269.84 1269.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L91 MM X W10.2 MM X H2.7 MM PELVIS 7 HOLE LOW PROFILE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SUP-245.027 CDM 270010022 LOCAL 0270 RC outpatient 1331.33 1331.33 1331.33 74 985.18 percent of total billed charges 1331.33 93 1078.38 percent of total billed charges 1331.33 1331.33 other OPPS APC 1331.33 1331.33 other OPPS APC 1331.33 27.63 367.85 percent of total billed charges 1331.33 1331.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL STRAIGHT L104 MM PELVIS 8 HOLE LOW PROFILE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SUP-245.028 CDM 270010022 LOCAL 0270 RC outpatient 1387.1 1387.1 1387.1 74 1026.45 percent of total billed charges 1387.1 93 1123.55 percent of total billed charges 1387.1 1387.1 other OPPS APC 1387.1 1387.1 other OPPS APC 1387.1 27.63 383.26 percent of total billed charges 1387.1 1387.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE STRAIGHT 104MM SS 3.5MM SCREW 8 HOLE LOW PROFILE RECONSTRUCTION BONE PELVIS NS SUP-245.028 CDM 270010022 LOCAL 0270 RC outpatient 821.34 821.34 821.34 74 607.79 percent of total billed charges 821.34 93 665.29 percent of total billed charges 821.34 821.34 other OPPS APC 821.34 821.34 other OPPS APC 821.34 27.63 226.94 percent of total billed charges 821.34 821.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L117 MM X W10.2 MM X H2.7 MM PELVIS 9 HOLE LOW PROFILE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SUP-245.029 CDM 270010022 LOCAL 0270 RC outpatient 1422.85 1422.85 1422.85 74 1052.91 percent of total billed charges 1422.85 93 1152.51 percent of total billed charges 1422.85 1422.85 other OPPS APC 1422.85 1422.85 other OPPS APC 1422.85 27.63 393.13 percent of total billed charges 1422.85 1422.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L130 MM PELVIC 10 HOLE LOW PROFILE NONSTERILE 3.5 MM SCREW SUP-245.030 CDM 270010022 LOCAL 0270 RC outpatient 1428.57 1428.57 1428.57 74 1057.14 percent of total billed charges 1428.57 93 1157.14 percent of total billed charges 1428.57 1428.57 other OPPS APC 1428.57 1428.57 other OPPS APC 1428.57 27.63 394.71 percent of total billed charges 1428.57 1428.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L143 MM PELVIC 11 HOLE LOW PROFILE RECONSTRUCTION NONSTERILE 3.5 MM SCREWS SUP-245.031 CDM 270010022 LOCAL 0270 RC outpatient 1507.22 1507.22 1507.22 74 1115.34 percent of total billed charges 1507.22 93 1220.85 percent of total billed charges 1507.22 1507.22 other OPPS APC 1507.22 1507.22 other OPPS APC 1507.22 27.63 416.44 percent of total billed charges 1507.22 1507.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL STRAIGHT L156 MM X W10.2 MM X H2.7 MM PELVIS 12 HOLE LOW PROFILE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SUP-245.032 CDM 270010022 LOCAL 0270 RC outpatient 1565.85 1565.85 1565.85 74 1158.73 percent of total billed charges 1565.85 93 1268.34 percent of total billed charges 1565.85 1565.85 other OPPS APC 1565.85 1565.85 other OPPS APC 1565.85 27.63 432.64 percent of total billed charges 1565.85 1565.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L169 MM PELVIC 13 HOLE LOW PROFILE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-245.033 CDM 270010022 LOCAL 0270 RC outpatient 1643.07 1643.07 1643.07 74 1215.87 percent of total billed charges 1643.07 93 1330.89 percent of total billed charges 1643.07 1643.07 other OPPS APC 1643.07 1643.07 other OPPS APC 1643.07 27.63 453.98 percent of total billed charges 1643.07 1643.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L182 MM PELVIC 14 HOLE LOW PROFILE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-245.034 CDM 270010022 LOCAL 0270 RC outpatient 1703.13 1703.13 1703.13 74 1260.32 percent of total billed charges 1703.13 93 1379.54 percent of total billed charges 1703.13 1703.13 other OPPS APC 1703.13 1703.13 other OPPS APC 1703.13 27.63 470.57 percent of total billed charges 1703.13 1703.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L195 MM PELVIC 15 HOLE LOW PROFILE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-245.035 CDM 270010022 LOCAL 0270 RC outpatient 1788.93 1788.93 1788.93 74 1323.81 percent of total billed charges 1788.93 93 1449.03 percent of total billed charges 1788.93 1788.93 other OPPS APC 1788.93 1788.93 other OPPS APC 1788.93 27.63 494.28 percent of total billed charges 1788.93 1788.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L208 MM PELVIC 16 HOLE LOW PROFILE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-245.036 CDM 270010022 LOCAL 0270 RC outpatient 1867.58 1867.58 1867.58 74 1382.01 percent of total billed charges 1867.58 93 1512.74 percent of total billed charges 1867.58 1867.58 other OPPS APC 1867.58 1867.58 other OPPS APC 1867.58 27.63 516.01 percent of total billed charges 1867.58 1867.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L234 MM PELVIC 18 HOLE LOW PROFILE RECONSTRUCTION NONSTERILE 3.5 MM SCREWS SUP-245.038 CDM 270010022 LOCAL 0270 RC outpatient 1946.23 1946.23 1946.23 74 1440.21 percent of total billed charges 1946.23 93 1576.45 percent of total billed charges 1946.23 1946.23 other OPPS APC 1946.23 1946.23 other OPPS APC 1946.23 27.63 537.74 percent of total billed charges 1946.23 1946.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L260 MM PELVIC 20 HOLE LOW PROFILE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-245.039 CDM 270010022 LOCAL 0270 RC outpatient 2338.05 2338.05 2338.05 74 1730.16 percent of total billed charges 2338.05 93 1893.82 percent of total billed charges 2338.05 2338.05 other OPPS APC 2338.05 2338.05 other OPPS APC 2338.05 27.63 646 percent of total billed charges 2338.05 2338.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL L166 MM 14 HOLE RECONSTRUCTION 3.5 MM SCREW SMALL FRAGMENT SUP-245.04 CDM 270010022 LOCAL 0270 RC outpatient 1827.54 1827.54 1827.54 74 1352.38 percent of total billed charges 1827.54 93 1480.31 percent of total billed charges 1827.54 1827.54 other OPPS APC 1827.54 1827.54 other OPPS APC 1827.54 27.63 504.95 percent of total billed charges 1827.54 1827.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L70 MM X W10.1 MM X H3.5 MM 5 HOLE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SYSTEM SUP-245.051 CDM 270010022 LOCAL 0270 RC outpatient 987.38 987.38 987.38 74 730.66 percent of total billed charges 987.38 93 799.78 percent of total billed charges 987.38 987.38 other OPPS APC 987.38 987.38 other OPPS APC 987.38 27.63 272.81 percent of total billed charges 987.38 987.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL L190 MM 16 HOLE RECONSTRUCTION 3.5 MM SCREW SMALL FRAGMENT SYSTEM SUP-245.06 CDM 270010022 LOCAL 0270 RC outpatient 1980.55 1980.55 1980.55 74 1465.61 percent of total billed charges 1980.55 93 1604.25 percent of total billed charges 1980.55 1980.55 other OPPS APC 1980.55 1980.55 other OPPS APC 1980.55 27.63 547.23 percent of total billed charges 1980.55 1980.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L84 MM X W10.1 MM X H3.5 MM 6 HOLE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SYSTEM SUP-245.061 CDM 270010022 LOCAL 0270 RC outpatient 1294.15 1294.15 1294.15 74 957.67 percent of total billed charges 1294.15 93 1048.26 percent of total billed charges 1294.15 1294.15 other OPPS APC 1294.15 1294.15 other OPPS APC 1294.15 27.63 357.57 percent of total billed charges 1294.15 1294.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L98 MM X W10.1 MM X H3.5 MM 7 HOLE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SYSTEM SUP-245.071 CDM 270010022 LOCAL 0270 RC outpatient 1357.07 1357.07 1357.07 74 1004.23 percent of total billed charges 1357.07 93 1099.23 percent of total billed charges 1357.07 1357.07 other OPPS APC 1357.07 1357.07 other OPPS APC 1357.07 27.63 374.96 percent of total billed charges 1357.07 1357.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L112 MM X W10.1 MM X H3.5 MM 8 HOLE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SYSTEM SUP-245.081 CDM 270010022 LOCAL 0270 RC outpatient 1417.13 1417.13 1417.13 74 1048.68 percent of total billed charges 1417.13 93 1147.88 percent of total billed charges 1417.13 1417.13 other OPPS APC 1417.13 1417.13 other OPPS APC 1417.13 27.63 391.55 percent of total billed charges 1417.13 1417.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L140 MM X W10.1 MM X H3.5 MM 10 HOLE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SYSTEM SUP-245.101 CDM 270010022 LOCAL 0270 RC outpatient 1468.61 1468.61 1468.61 74 1086.77 percent of total billed charges 1468.61 93 1189.57 percent of total billed charges 1468.61 1468.61 other OPPS APC 1468.61 1468.61 other OPPS APC 1468.61 27.63 405.78 percent of total billed charges 1468.61 1468.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI STAINLESS STEEL L168 MM X W10.1 MM X H3.5 MM 12 HOLE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SYSTEM SUP-245.121 CDM 270010022 LOCAL 0270 RC outpatient 1625.91 1625.91 1625.91 74 1203.17 percent of total billed charges 1625.91 93 1316.99 percent of total billed charges 1625.91 1625.91 other OPPS APC 1625.91 1625.91 other OPPS APC 1625.91 27.63 449.24 percent of total billed charges 1625.91 1625.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL L58 MM 5 HOLE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SYSTEM SUP-245.15 CDM 270010022 LOCAL 0270 RC outpatient 1119.69 1119.69 1119.69 74 828.57 percent of total billed charges 1119.69 93 906.95 percent of total billed charges 1119.69 1119.69 other OPPS APC 1119.69 1119.69 other OPPS APC 1119.69 27.63 309.37 percent of total billed charges 1119.69 1119.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL L70 MM 6 HOLE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SYSTEM SUP-245.16 CDM 270010022 LOCAL 0270 RC outpatient 1294.15 1294.15 1294.15 74 957.67 percent of total billed charges 1294.15 93 1048.26 percent of total billed charges 1294.15 1294.15 other OPPS APC 1294.15 1294.15 other OPPS APC 1294.15 27.63 357.57 percent of total billed charges 1294.15 1294.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL L82 MM 7 HOLE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SYSTEM SUP-245.17 CDM 270010022 LOCAL 0270 RC outpatient 1357.07 1357.07 1357.07 74 1004.23 percent of total billed charges 1357.07 93 1099.23 percent of total billed charges 1357.07 1357.07 other OPPS APC 1357.07 1357.07 other OPPS APC 1357.07 27.63 374.96 percent of total billed charges 1357.07 1357.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL L94 MM 8 HOLE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SYSTEM SUP-245.18 CDM 270010022 LOCAL 0270 RC outpatient 1415.7 1415.7 1415.7 74 1047.62 percent of total billed charges 1415.7 93 1146.72 percent of total billed charges 1415.7 1415.7 other OPPS APC 1415.7 1415.7 other OPPS APC 1415.7 27.63 391.16 percent of total billed charges 1415.7 1415.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP STAINLESS STEEL L106 MM 9 HOLE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SYSTEM SUP-245.19 CDM 270010022 LOCAL 0270 RC outpatient 1492.92 1492.92 1492.92 74 1104.76 percent of total billed charges 1492.92 93 1209.27 percent of total billed charges 1492.92 1492.92 other OPPS APC 1492.92 1492.92 other OPPS APC 1492.92 27.63 412.49 percent of total billed charges 1492.92 1492.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL 108 MM RADIUS L78 MM PELVIC 6 HOLE LOW PROFILE CURVED RECONSTRUCTION NONSTERILE 3.5 MM SCREW SUP-245.876 CDM 270010022 LOCAL 0270 RC outpatient 4207.84 4207.84 4207.84 74 3113.8 percent of total billed charges 4207.84 93 3408.35 percent of total billed charges 4207.84 4207.84 other OPPS APC 4207.84 4207.84 other OPPS APC 4207.84 27.63 1162.63 percent of total billed charges 4207.84 4207.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL 108 MM RADIUS CURVE L104 MM X W10.2 MM X H2.7 MM PELVIC 8 HOLE LOW PROFILE NONSTERILE 3.5 MM SCREW SUP-245.878 CDM 270010022 LOCAL 0270 RC outpatient 4568.07 4568.07 4568.07 74 3380.37 percent of total billed charges 4568.07 93 3700.14 percent of total billed charges 4568.07 4568.07 other OPPS APC 4568.07 4568.07 other OPPS APC 4568.07 27.63 1262.16 percent of total billed charges 4568.07 4568.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 108MM RADIUS CURVED 130MM SS NS PELVIS 10 HOLE LOW PROFILE RECONSTRUCTION 3.5MM SCREW SUP-245.880 CDM 270010022 LOCAL 0270 RC outpatient 2193.62 2193.62 2193.62 74 1623.28 percent of total billed charges 2193.62 93 1776.83 percent of total billed charges 2193.62 2193.62 other OPPS APC 2193.62 2193.62 other OPPS APC 2193.62 27.63 606.1 percent of total billed charges 2193.62 2193.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL 108 MM RADIUS L156 MM PELVIC 12 HOLE LOW PROFILE CURVED RECONSTRUCTION NONSTERILE 3.5 MM SCREW SUP-245.882 CDM 270010022 LOCAL 0270 RC outpatient 2298.01 2298.01 2298.01 74 1700.53 percent of total billed charges 2298.01 93 1861.39 percent of total billed charges 2298.01 2298.01 other OPPS APC 2298.01 2298.01 other OPPS APC 2298.01 27.63 634.94 percent of total billed charges 2298.01 2298.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL 108 MM RADIUS L182 MM X W10.2 MM X H2.7 MM PELVIC 14 HOLE LOW PROFILE CURVE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SUP-245.884 CDM 270010022 LOCAL 0270 RC outpatient 2579.72 2579.72 2579.72 74 1908.99 percent of total billed charges 2579.72 93 2089.57 percent of total billed charges 2579.72 2579.72 other OPPS APC 2579.72 2579.72 other OPPS APC 2579.72 27.63 712.78 percent of total billed charges 2579.72 2579.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL 108 MM RADIUS L208 MM PELVIC 16 HOLE LOW PROFILE CURVED RECONSTRUCTION NONSTERILE 3.5 MM SCREW SUP-245.886 CDM 270010022 LOCAL 0270 RC outpatient 6008.99 6008.99 6008.99 74 4446.65 percent of total billed charges 6008.99 93 4867.28 percent of total billed charges 6008.99 6008.99 other OPPS APC 6008.99 6008.99 other OPPS APC 6008.99 27.63 1660.28 percent of total billed charges 6008.99 6008.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL 88 MM RADIUS L78 MM PELVIC 6 HOLE LOW PROFILE CURVED RECONSTRUCTION NONSTERILE 3.5 MM SCREW SUP-245.906 CDM 270010022 LOCAL 0270 RC outpatient 1702.35 1702.35 1702.35 74 1259.74 percent of total billed charges 1702.35 93 1378.9 percent of total billed charges 1702.35 1702.35 other OPPS APC 1702.35 1702.35 other OPPS APC 1702.35 27.63 470.36 percent of total billed charges 1702.35 1702.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL 88 MM RADIUS L104 MM PELVIC 8 HOLE LOW PROFILE CURVED RECONSTRUCTION NONSTERILE 3.5 MM SCREW SUP-245.908 CDM 270010022 LOCAL 0270 RC outpatient 2096.38 2096.38 2096.38 74 1551.32 percent of total billed charges 2096.38 93 1698.07 percent of total billed charges 2096.38 2096.38 other OPPS APC 2096.38 2096.38 other OPPS APC 2096.38 27.63 579.23 percent of total billed charges 2096.38 2096.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL 88 MM RADIUS LOW PROFILE CURVE L130 MM PELVIS 10 HOLE RECONSTRUCTION NONSTERILE 3.5 MM SCREW SUP-245.910 CDM 270010022 LOCAL 0270 RC outpatient 2193.62 2193.62 2193.62 74 1623.28 percent of total billed charges 2193.62 93 1776.83 percent of total billed charges 2193.62 2193.62 other OPPS APC 2193.62 2193.62 other OPPS APC 2193.62 27.63 606.1 percent of total billed charges 2193.62 2193.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL 88 MM RADIUS L156 MM PELVIC 12 HOLE LOW PROFILE CURVED RECONSTRUCTION NONSTERILE 3.5 MM SCREWS SUP-245.912 CDM 270010022 LOCAL 0270 RC outpatient 2298.01 2298.01 2298.01 74 1700.53 percent of total billed charges 2298.01 93 1861.39 percent of total billed charges 2298.01 2298.01 other OPPS APC 2298.01 2298.01 other OPPS APC 2298.01 27.63 634.94 percent of total billed charges 2298.01 2298.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL 88 MM RADIUS L182 MM PELVIC 14 HOLE LOW PROFILE CURVED RECONSTRUCTION NONSTERILE 3.5 MM SCREWS SUP-245.914 CDM 270010022 LOCAL 0270 RC outpatient 2579.72 2579.72 2579.72 74 1908.99 percent of total billed charges 2579.72 93 2089.57 percent of total billed charges 2579.72 2579.72 other OPPS APC 2579.72 2579.72 other OPPS APC 2579.72 27.63 712.78 percent of total billed charges 2579.72 2579.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL 88 MM RADIUS L208 MM PELVIC 16 HOLE LOW PROFILE CURVED RECONSTRUCTION NONSTERILE 3.5 MM SCREWS SUP-245.916 CDM 270010022 LOCAL 0270 RC outpatient 2757.04 2757.04 2757.04 74 2040.21 percent of total billed charges 2757.04 93 2233.2 percent of total billed charges 2757.04 2757.04 other OPPS APC 2757.04 2757.04 other OPPS APC 2757.04 27.63 761.77 percent of total billed charges 2757.04 2757.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR BRACHYTHERAPY MAMMOSITE 8 MM L4-5 CM BREAST CATHETER RADIATION SUP-2456 CDM 0270 RC outpatient 7150 7150 7150 74 5291 percent of total billed charges 7150 93 5791.5 percent of total billed charges 7150 7150 other OPPS APC 7150 7150 other OPPS APC 7150 27.63 1975.55 percent of total billed charges 7150 7150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L31 MM 4 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-247.344 CDM 270010022 LOCAL 0270 RC outpatient 586.38 586.38 586.38 74 433.92 percent of total billed charges 586.38 93 474.97 percent of total billed charges 586.38 586.38 other OPPS APC 586.38 586.38 other OPPS APC 586.38 27.63 162.02 percent of total billed charges 586.38 586.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L38 MM 5 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-247.345 CDM 270010022 LOCAL 0270 RC outpatient 586.38 586.38 586.38 74 433.92 percent of total billed charges 586.38 93 474.97 percent of total billed charges 586.38 586.38 other OPPS APC 586.38 586.38 other OPPS APC 586.38 27.63 162.02 percent of total billed charges 586.38 586.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP 52MM SS NS 7 HOLE LOW PROFILE 2MM SCREW MODULAR SYSTEM SUP-247.347 CDM 270010022 LOCAL 0270 RC outpatient 586.38 586.38 586.38 74 433.92 percent of total billed charges 586.38 93 474.97 percent of total billed charges 586.38 586.38 other OPPS APC 586.38 586.38 other OPPS APC 586.38 27.63 162.02 percent of total billed charges 586.38 586.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L59 MM 8 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-247.348 CDM 270010022 LOCAL 0270 RC outpatient 664.95 664.95 664.95 74 492.06 percent of total billed charges 664.95 93 538.61 percent of total billed charges 664.95 664.95 other OPPS APC 664.95 664.95 other OPPS APC 664.95 27.63 183.73 percent of total billed charges 664.95 664.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L54 MM 7 HOLE SHAFT LOW PROFILE CUT TO LENGTH NONSTERILE 2 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-247.349 CDM 270010022 LOCAL 0270 RC outpatient 4232.15 4232.15 4232.15 74 3131.79 percent of total billed charges 4232.15 93 3428.04 percent of total billed charges 4232.15 4232.15 other OPPS APC 4232.15 4232.15 other OPPS APC 4232.15 27.63 1169.34 percent of total billed charges 4232.15 4232.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP Y 55MM SS NS 3 HOLE HEAD 7 HOLE SHAFT LOW PROFILE 2MM SCREW MODULAR MINI FRAGMENT SUP-247.350 CDM 270010022 LOCAL 0270 RC outpatient 2377.96 2377.96 2377.96 74 1759.69 percent of total billed charges 2377.96 93 1926.15 percent of total billed charges 2377.96 2377.96 other OPPS APC 2377.96 2377.96 other OPPS APC 2377.96 27.63 657.03 percent of total billed charges 2377.96 2377.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL T L53 MM 2 HOLE HEAD 7 HOLE SHAFT LOW PROFILE CUT TO LENGTH NONSTERILE 2 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-247.351 CDM 270010022 LOCAL 0270 RC outpatient 2377.96 2377.96 2377.96 74 1759.69 percent of total billed charges 2377.96 93 1926.15 percent of total billed charges 2377.96 2377.96 other OPPS APC 2377.96 2377.96 other OPPS APC 2377.96 27.63 657.03 percent of total billed charges 2377.96 2377.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. USE 30772 - PLATE BONE LCP STAINLESS STEEL L73 MM 10 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-247.36 CDM 270010022 LOCAL 0270 RC outpatient 737.1 737.1 737.1 74 545.45 percent of total billed charges 737.1 93 597.05 percent of total billed charges 737.1 737.1 other OPPS APC 737.1 737.1 other OPPS APC 737.1 27.63 203.66 percent of total billed charges 737.1 737.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP 73MM SS NS 10 HOLE LOW PROFILE 2MM SCREW MODULAR MINI FRAGMENT SUP-247.360 CDM 270010022 LOCAL 0270 RC outpatient 636.35 636.35 636.35 74 470.9 percent of total billed charges 636.35 93 515.44 percent of total billed charges 636.35 636.35 other OPPS APC 636.35 636.35 other OPPS APC 636.35 27.63 175.82 percent of total billed charges 636.35 636.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP 81MM SS NS 12 HOLE ADAPTION LOW PROFILE 2MM SCREW MODULAR MINI FRAGMENT SUP-247.362 CDM 270010022 LOCAL 0270 RC outpatient 947.02 947.02 947.02 74 700.79 percent of total billed charges 947.02 93 767.09 percent of total billed charges 947.02 947.02 other OPPS APC 947.02 947.02 other OPPS APC 947.02 27.63 261.66 percent of total billed charges 947.02 947.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP 84MM SS NS 10 HOLE LOW PROFILE 2.4MM SCREW MODULAR MINI FRAGMENT SUP-247.364 CDM 270010022 LOCAL 0270 RC outpatient 895.31 895.31 895.31 74 662.53 percent of total billed charges 895.31 93 725.2 percent of total billed charges 895.31 895.31 other OPPS APC 895.31 895.31 other OPPS APC 895.31 27.63 247.37 percent of total billed charges 895.31 895.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP 88MM SS NS 12 HOLE ADAPTION LOW PROFILE 2.4MM SCREW MODULAR MINI FRAGMENT SUP-247.366 CDM 270010022 LOCAL 0270 RC outpatient 1044.11 1044.11 1044.11 74 772.64 percent of total billed charges 1044.11 93 845.73 percent of total billed charges 1044.11 1044.11 other OPPS APC 1044.11 1044.11 other OPPS APC 1044.11 27.63 288.49 percent of total billed charges 1044.11 1044.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L97 MM 12 HOLE ADAPTION LOW PROFILE CUT TO LENGTH NONSTERILE 2.7 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-247.370 CDM 270010022 LOCAL 0270 RC outpatient 1044.11 1044.11 1044.11 74 772.64 percent of total billed charges 1044.11 93 845.73 percent of total billed charges 1044.11 1044.11 other OPPS APC 1044.11 1044.11 other OPPS APC 1044.11 27.63 288.49 percent of total billed charges 1044.11 1044.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L76 MM 8 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2.7 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-247.372 CDM 270010022 LOCAL 0270 RC outpatient 1072.5 1072.5 1072.5 74 793.65 percent of total billed charges 1072.5 93 868.73 percent of total billed charges 1072.5 1072.5 other OPPS APC 1072.5 1072.5 other OPPS APC 1072.5 27.63 296.33 percent of total billed charges 1072.5 1072.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP 94MM SS NS 10 HOLE LOW PROFILE 2.7MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-247.374 CDM 270010022 LOCAL 0270 RC outpatient 945.75 945.75 945.75 74 699.86 percent of total billed charges 945.75 93 766.06 percent of total billed charges 945.75 945.75 other OPPS APC 945.75 945.75 other OPPS APC 945.75 27.63 261.31 percent of total billed charges 945.75 945.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP 44MM SS NS 5 HOLE LOW PROFILE 2.4MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-247.375 CDM 270010022 LOCAL 0270 RC outpatient 895.31 895.31 895.31 74 662.53 percent of total billed charges 895.31 93 725.2 percent of total billed charges 895.31 895.31 other OPPS APC 895.31 895.31 other OPPS APC 895.31 27.63 247.37 percent of total billed charges 895.31 895.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP 60MM SS NS 7 HOLE LOW PROFILE 2.4MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-247.377 CDM 270010022 LOCAL 0270 RC outpatient 895.31 895.31 895.31 74 662.53 percent of total billed charges 895.31 93 725.2 percent of total billed charges 895.31 895.31 other OPPS APC 895.31 895.31 other OPPS APC 895.31 27.63 247.37 percent of total billed charges 895.31 895.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL T L53 MM 3 HOLE HEAD 7 HOLE SHAFT LOW PROFILE CUT TO LENGTH NONSTERILE 2 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-247.615 CDM 270010022 LOCAL 0270 RC outpatient 2377.96 2377.96 2377.96 74 1759.69 percent of total billed charges 2377.96 93 1926.15 percent of total billed charges 2377.96 2377.96 other OPPS APC 2377.96 2377.96 other OPPS APC 2377.96 27.63 657.03 percent of total billed charges 2377.96 2377.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP T 58MM SS NS 3 HOLE HEAD 7 HOLE SHAFT LOW PROFILE 2.4MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-249.615 CDM 270010022 LOCAL 0270 RC outpatient 1645.62 1645.62 1645.62 74 1217.76 percent of total billed charges 1645.62 93 1332.95 percent of total billed charges 1645.62 1645.62 other OPPS APC 1645.62 1645.62 other OPPS APC 1645.62 27.63 454.68 percent of total billed charges 1645.62 1645.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL Y L60 MM 3 HOLE HEAD 7 HOLE SHAFT LOW PROFILE CUT TO LENGTH NONSTERILE 2.4 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-249.669 CDM 270010022 LOCAL 0270 RC outpatient 1645.62 1645.62 1645.62 74 1217.76 percent of total billed charges 1645.62 93 1332.95 percent of total billed charges 1645.62 1645.62 other OPPS APC 1645.62 1645.62 other OPPS APC 1645.62 27.63 454.68 percent of total billed charges 1645.62 1645.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL T L58 MM 2 HOLE HEAD 7 HOLE SHAFT LOW PROFILE CUT TO LENGTH NONSTERILE 2.4 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-249.670 CDM 270010022 LOCAL 0270 RC outpatient 1866.15 1866.15 1866.15 74 1380.95 percent of total billed charges 1866.15 93 1511.58 percent of total billed charges 1866.15 1866.15 other OPPS APC 1866.15 1866.15 other OPPS APC 1866.15 27.63 515.62 percent of total billed charges 1866.15 1866.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP 36MM SS NS 4 HOLE LOW PROFILE 2.4MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-249.674 CDM 270010022 LOCAL 0270 RC outpatient 895.31 895.31 895.31 74 662.53 percent of total billed charges 895.31 93 725.2 percent of total billed charges 895.31 895.31 other OPPS APC 895.31 895.31 other OPPS APC 895.31 27.63 247.37 percent of total billed charges 895.31 895.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP 52MM SS NS 6 HOLE LOW PROFILE 2.4MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-249.676 CDM 270010022 LOCAL 0270 RC outpatient 895.31 895.31 895.31 74 662.53 percent of total billed charges 895.31 93 725.2 percent of total billed charges 895.31 895.31 other OPPS APC 895.31 895.31 other OPPS APC 895.31 27.63 247.37 percent of total billed charges 895.31 895.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP 68MM SS NS 8 HOLE LOW PROFILE 2.4MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-249.678 CDM 270010022 LOCAL 0270 RC outpatient 1015.3 1015.3 1015.3 74 751.32 percent of total billed charges 1015.3 93 822.39 percent of total billed charges 1015.3 1015.3 other OPPS APC 1015.3 1015.3 other OPPS APC 1015.3 27.63 280.53 percent of total billed charges 1015.3 1015.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP 59MM SS NS CONDYLE 7 HOLE SHAFT LOW PROFILE 2.4MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-249.679 CDM 270010022 LOCAL 0270 RC outpatient 3233.23 3233.23 3233.23 74 2392.59 percent of total billed charges 3233.23 93 2618.92 percent of total billed charges 3233.23 3233.23 other OPPS APC 3233.23 3233.23 other OPPS APC 3233.23 27.63 893.34 percent of total billed charges 3233.23 3233.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP 40MM SS NS 4 HOLE LOW PROFILE 2.7MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-249.680 CDM 270010022 LOCAL 0270 RC outpatient 1072.5 1072.5 1072.5 74 793.65 percent of total billed charges 1072.5 93 868.73 percent of total billed charges 1072.5 1072.5 other OPPS APC 1072.5 1072.5 other OPPS APC 1072.5 27.63 296.33 percent of total billed charges 1072.5 1072.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L49 MM 5 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2.7 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-249.681 CDM 270010022 LOCAL 0270 RC outpatient 945.75 945.75 945.75 74 699.86 percent of total billed charges 945.75 93 766.06 percent of total billed charges 945.75 945.75 other OPPS APC 945.75 945.75 other OPPS APC 945.75 27.63 261.31 percent of total billed charges 945.75 945.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L58 MM 6 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2.7 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-249.682 CDM 270010022 LOCAL 0270 RC outpatient 945.75 945.75 945.75 74 699.86 percent of total billed charges 945.75 93 766.06 percent of total billed charges 945.75 945.75 other OPPS APC 945.75 945.75 other OPPS APC 945.75 27.63 261.31 percent of total billed charges 945.75 945.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L67 MM 7 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2.7 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-249.683 CDM 270010022 LOCAL 0270 RC outpatient 945.75 945.75 945.75 74 699.86 percent of total billed charges 945.75 93 766.06 percent of total billed charges 945.75 945.75 other OPPS APC 945.75 945.75 other OPPS APC 945.75 27.63 261.31 percent of total billed charges 945.75 945.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 66MM SS 2.7MM SCREW MODULAR MINI FRAGMENT SYSTEM 7 HOLE LOW PROFILE CUT TO SUP-249.684 CDM 270010022 LOCAL 0270 RC outpatient 1466.56 1466.56 1466.56 74 1085.25 percent of total billed charges 1466.56 93 1187.91 percent of total billed charges 1466.56 1466.56 other OPPS APC 1466.56 1466.56 other OPPS APC 1466.56 27.63 405.21 percent of total billed charges 1466.56 1466.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP T 32MM SS NS 2 HOLE HEAD 3 HOLE SHAFT LOW PROFILE 2.7MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-249.685 CDM 270010022 LOCAL 0270 RC outpatient 1645.62 1645.62 1645.62 74 1217.76 percent of total billed charges 1645.62 93 1332.95 percent of total billed charges 1645.62 1645.62 other OPPS APC 1645.62 1645.62 other OPPS APC 1645.62 27.63 454.68 percent of total billed charges 1645.62 1645.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP OBLIQUE RIGHT L 35MM SS NS 2 HOLE HEAD 3 HOLE SHAFT LOW PROFILE 2.7MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-249.686 CDM 270010022 LOCAL 0270 RC outpatient 1018.16 1018.16 1018.16 74 753.44 percent of total billed charges 1018.16 93 824.71 percent of total billed charges 1018.16 1018.16 other OPPS APC 1018.16 1018.16 other OPPS APC 1018.16 27.63 281.32 percent of total billed charges 1018.16 1018.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP OBLIQUE LEFT L 35MM SS NS 2 HOLE HEAD 3 HOLE SHAFT LOW PROFILE 2.7MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-249.687 CDM 270010022 LOCAL 0270 RC outpatient 1018.16 1018.16 1018.16 74 753.44 percent of total billed charges 1018.16 93 824.71 percent of total billed charges 1018.16 1018.16 other OPPS APC 1018.16 1018.16 other OPPS APC 1018.16 27.63 281.32 percent of total billed charges 1018.16 1018.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP L 32MM SS NS RIGHT 2 HOLE HEAD 3 HOLE SHAFT LOW PROFILE 2.7MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-249.688 CDM 270010022 LOCAL 0270 RC outpatient 1018.16 1018.16 1018.16 74 753.44 percent of total billed charges 1018.16 93 824.71 percent of total billed charges 1018.16 1018.16 other OPPS APC 1018.16 1018.16 other OPPS APC 1018.16 27.63 281.32 percent of total billed charges 1018.16 1018.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L L32 MM 2 HOLE HEAD 3 HOLE SHAFT LOW PROFILE CUT TO LENGTH NONSTERILE 2.7 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-249.689 CDM 270010022 LOCAL 0270 RC outpatient 1018.16 1018.16 1018.16 74 753.44 percent of total billed charges 1018.16 93 824.71 percent of total billed charges 1018.16 1018.16 other OPPS APC 1018.16 1018.16 other OPPS APC 1018.16 27.63 281.32 percent of total billed charges 1018.16 1018.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL T L32 MM 2 HOLE HEAD 4 HOLE SHAFT LOW PROFILE CUT TO LENGTH NONSTERILE 2.7 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-249.697 CDM 270010022 LOCAL 0270 RC outpatient 1645.62 1645.62 1645.62 74 1217.76 percent of total billed charges 1645.62 93 1332.95 percent of total billed charges 1645.62 1645.62 other OPPS APC 1645.62 1645.62 other OPPS APC 1645.62 27.63 454.68 percent of total billed charges 1645.62 1645.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL OBLIQUE RIGHT L L42 MM 2 HOLE HEAD 4 HOLE SHAFT LOW PROFILE CUT TO LENGTH NONSTERILE 2.7 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-249.698 CDM 270010022 LOCAL 0270 RC outpatient 1029.6 1029.6 1029.6 74 761.9 percent of total billed charges 1029.6 93 833.98 percent of total billed charges 1029.6 1029.6 other OPPS APC 1029.6 1029.6 other OPPS APC 1029.6 27.63 284.48 percent of total billed charges 1029.6 1029.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL OBLIQUE LEFT L L42 MM 2 HOLE HEAD 4 HOLE SHAFT LOW PROFILE CUT TO LENGTH NONSTERILE 2.7 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-249.699 CDM 270010022 LOCAL 0270 RC outpatient 1029.6 1029.6 1029.6 74 761.9 percent of total billed charges 1029.6 93 833.98 percent of total billed charges 1029.6 1029.6 other OPPS APC 1029.6 1029.6 other OPPS APC 1029.6 27.63 284.48 percent of total billed charges 1029.6 1029.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L L40 MM RIGHT 2 HOLE HEAD 4 HOLE SHAFT LOW PROFILE CUT TO LENGTH NONSTERILE 2.7 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-249.701 CDM 270010022 LOCAL 0270 RC outpatient 907.92 907.92 907.92 74 671.86 percent of total billed charges 907.92 93 735.42 percent of total billed charges 907.92 907.92 other OPPS APC 907.92 907.92 other OPPS APC 907.92 27.63 250.86 percent of total billed charges 907.92 907.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP STAINLESS STEEL L L40 MM LEFT 2 HOLE HEAD 4 HOLE SHAFT LOW PROFILE CUT TO LENGTH NONSTERILE 2.7 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-249.702 CDM 270010022 LOCAL 0270 RC outpatient 1029.6 1029.6 1029.6 74 761.9 percent of total billed charges 1029.6 93 833.98 percent of total billed charges 1029.6 1029.6 other OPPS APC 1029.6 1029.6 other OPPS APC 1029.6 27.63 284.48 percent of total billed charges 1029.6 1029.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ASPIRATION TRIEVER 16 L 113 CM OD 16 FR SUP-25-101 CDM 0270 RC outpatient 31200 31200 31200 74 23088 percent of total billed charges 31200 93 25272 percent of total billed charges 31200 31200 other OPPS APC 31200 31200 other OPPS APC 31200 27.63 8620.56 percent of total billed charges 31200 31200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE CORONARY RUNTHROUGH EXTRA FLOPPY 180 CM SUP-25-1011 CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE CORONARY EXTRA FLOPPY 300CM SUP-25-1013 CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM CRANIOFACIAL 4 HOLE ULTRA LOW PROFILE NONSTERILE SUP-25-153-01-09 CDM 0270 RC outpatient 439.19 439.19 439.19 74 325 percent of total billed charges 439.19 93 355.74 percent of total billed charges 439.19 439.19 other OPPS APC 439.19 439.19 other OPPS APC 439.19 27.63 121.35 percent of total billed charges 439.19 439.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM SHORT CRANIOFACIAL 2 HOLE ULTRA LOW PROFILE NONSTERILE SUP-25-153-02-09 CDM 0270 RC outpatient 142.84 142.84 142.84 74 105.7 percent of total billed charges 142.84 93 115.7 percent of total billed charges 142.84 142.84 other OPPS APC 142.84 142.84 other OPPS APC 142.84 27.63 39.47 percent of total billed charges 142.84 142.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM CRANIOFACIAL 6 HOLE ULTRA LOW PROFILE NONSTERILE SUP-25-153-06-09 CDM 0270 RC outpatient 439.19 439.19 439.19 74 325 percent of total billed charges 439.19 93 355.74 percent of total billed charges 439.19 439.19 other OPPS APC 439.19 439.19 other OPPS APC 439.19 27.63 121.35 percent of total billed charges 439.19 439.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM Y CRANIOFACIAL ULTRA LOW PROFILE NONSTERILE SUP-25-153-07-09 CDM 0270 RC outpatient 439.19 439.19 439.19 74 325 percent of total billed charges 439.19 93 355.74 percent of total billed charges 439.19 439.19 other OPPS APC 439.19 439.19 other OPPS APC 439.19 27.63 121.35 percent of total billed charges 439.19 439.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM CRANIOFACIAL 8 HOLE ULTRA LOW PROFILE NONSTERILE SUP-25-153-08-09 CDM 0270 RC outpatient 377.36 377.36 377.36 74 279.25 percent of total billed charges 377.36 93 305.66 percent of total billed charges 377.36 377.36 other OPPS APC 377.36 377.36 other OPPS APC 377.36 27.63 104.26 percent of total billed charges 377.36 377.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM LONG CRANIOFACIAL 2 HOLE ULTRA LOW PROFILE NONSTERILE SUP-25-153-12-09 CDM 0270 RC outpatient 162.03 162.03 162.03 74 119.9 percent of total billed charges 162.03 93 131.24 percent of total billed charges 162.03 162.03 other OPPS APC 162.03 162.03 other OPPS APC 162.03 27.63 44.77 percent of total billed charges 162.03 162.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM SHORT CRANIOFACIAL 4 HOLE ULTRA LOW PROFILE NONSTERILE SUP-25-153-14-09 CDM 0270 RC outpatient 241.98 241.98 241.98 74 179.07 percent of total billed charges 241.98 93 196 percent of total billed charges 241.98 241.98 other OPPS APC 241.98 241.98 other OPPS APC 241.98 27.63 66.86 percent of total billed charges 241.98 241.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM SMALL CURVE CRANIOFACIAL ULTRA LOW PROFILE BUR HOLE C NONSTERILE SUP-25-153-15-09 CDM 0270 RC outpatient 465.84 465.84 465.84 74 344.72 percent of total billed charges 465.84 93 377.33 percent of total billed charges 465.84 465.84 other OPPS APC 465.84 465.84 other OPPS APC 465.84 27.63 128.71 percent of total billed charges 465.84 465.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM MEDIUM CURVE CRANIOFACIAL ULTRA LOW PROFILE BUR HOLE DRAIN NONSTERILE SUP-25-153-20-09 CDM 0270 RC outpatient 465.84 465.84 465.84 74 344.72 percent of total billed charges 465.84 93 377.33 percent of total billed charges 465.84 465.84 other OPPS APC 465.84 465.84 other OPPS APC 465.84 27.63 128.71 percent of total billed charges 465.84 465.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM MEDIUM CURVE CRANIOFACIAL ULTRA LOW PROFILE BUR HOLE C NONSTERILE SUP-25-153-21-09 CDM 0270 RC outpatient 465.84 465.84 465.84 74 344.72 percent of total billed charges 465.84 93 377.33 percent of total billed charges 465.84 465.84 other OPPS APC 465.84 465.84 other OPPS APC 465.84 27.63 128.71 percent of total billed charges 465.84 465.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM SQUARE CRANIOFACIAL 2 X 2 HOLE ULTRA LOW PROFILE NONSTERILE SUP-25-153-22-09 CDM 0270 RC outpatient 414.67 414.67 414.67 74 306.86 percent of total billed charges 414.67 93 335.88 percent of total billed charges 414.67 414.67 other OPPS APC 414.67 414.67 other OPPS APC 414.67 27.63 114.57 percent of total billed charges 414.67 414.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM LONG CURVE CRANIOFACIAL ULTRA LOW PROFILE BUR HOLE C NONSTERILE SUP-25-153-25-09 CDM 0270 RC outpatient 465.84 465.84 465.84 74 344.72 percent of total billed charges 465.84 93 377.33 percent of total billed charges 465.84 465.84 other OPPS APC 465.84 465.84 other OPPS APC 465.84 27.63 128.71 percent of total billed charges 465.84 465.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEVEL ONE TITANIUM CURVE CRANIOFACIAL 3 X 2 HOLE ULTRA LOW PROFILE NONSTERILE SUP-25-153-32-09 CDM 0270 RC outpatient 536.2 536.2 536.2 74 396.79 percent of total billed charges 536.2 93 434.32 percent of total billed charges 536.2 536.2 other OPPS APC 536.2 536.2 other OPPS APC 536.2 27.63 148.15 percent of total billed charges 536.2 536.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR FIBER TIPPED SCOPETTES JR RAYON POLYSTYRENE REGULAR L8 IN OD5/32 IN 11 LB HANDLE EXTRA ABSORBENT STERILE LATEX FREE OB/GYN SUP-25-808 2PR CDM 0270 RC outpatient 1.36 1.36 1.36 74 1.01 percent of total billed charges 1.36 93 1.1 percent of total billed charges 1.36 1.36 other OPPS APC 1.36 1.36 other OPPS APC 1.36 27.63 0.38 percent of total billed charges 1.36 1.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEVEL ONE TITANIUM MICRO L3.5 MM OD1.5 MM CRANIOMAXILLOFACIAL SELF RETAIN LOW PROFILE DRILL FREE MAXDRIVE NONSTERILE LATEX FREE SUP-25-975-03-91 CDM 0270 RC outpatient 73.19 73.19 73.19 74 54.16 percent of total billed charges 73.19 93 59.28 percent of total billed charges 73.19 73.19 other OPPS APC 73.19 73.19 other OPPS APC 73.19 27.63 20.22 percent of total billed charges 73.19 73.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEVEL ONE TI-6AL-4V MICRO L4 MM OD1.5 MM NEURO DRILL FREE MAXDRIVE NONSTERILE LATEX FREE SUP-25-975-04-91 CDM 0270 RC outpatient 73.19 73.19 73.19 74 54.16 percent of total billed charges 73.19 93 59.28 percent of total billed charges 73.19 73.19 other OPPS APC 73.19 73.19 other OPPS APC 73.19 27.63 20.22 percent of total billed charges 73.19 73.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEVEL ONE MAXDRIVE TI-6AL-4V MICRO L5 MM OD1.5 MM NEURO DRILL FREE NONSTERILE SUP-25-975-05-91 CDM 0270 RC outpatient 73.19 73.19 73.19 74 54.16 percent of total billed charges 73.19 93 59.28 percent of total billed charges 73.19 73.19 other OPPS APC 73.19 73.19 other OPPS APC 73.19 27.63 20.22 percent of total billed charges 73.19 73.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEVEL ONE TI-6AL-4V MICRO L4 MM OD1.8 MM CRANIOMAXILLOFACIAL SELF RETAIN EMERGENCY DRILL FREE MAXDRIVE NONSTERILE LATEX FREE SUP-25-976-04-91 CDM 0270 RC outpatient 73.19 73.19 73.19 74 54.16 percent of total billed charges 73.19 93 59.28 percent of total billed charges 73.19 73.19 other OPPS APC 73.19 73.19 other OPPS APC 73.19 27.63 20.22 percent of total billed charges 73.19 73.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEVEL ONE TI-6AL-4V L5 MM OD1.8 MM NEURO EMERGENCY DRILL FREE MAXDRIVE NONSTERILE LATEX FREE SUP-25-976-05-91 CDM 0270 RC outpatient 73.19 73.19 73.19 74 54.16 percent of total billed charges 73.19 93 59.28 percent of total billed charges 73.19 73.19 other OPPS APC 73.19 73.19 other OPPS APC 73.19 27.63 20.22 percent of total billed charges 73.19 73.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE PRO 5.0 X 8 MM NON COMPLIANT SUP-250-083-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE PRO 5.0 X 10 MM NON COMPLIANT SUP-250-103-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE PRO 5.0 X 12 MM NON COMPLIANT SUP-250-123-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE PRO 5.0 X 15 MM NON COMPLIANT SUP-250-153-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SAPPHIRE PRO 5.0 X 18 MM NON COMPLIANT SUP-250-183-2U CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE OSTEOTOME FLAT SHORT SUP-2500-10-750 CDM 0270 RC outpatient 543.4 543.4 543.4 74 402.12 percent of total billed charges 543.4 93 440.15 percent of total billed charges 543.4 543.4 other OPPS APC 543.4 543.4 other OPPS APC 543.4 27.63 150.14 percent of total billed charges 543.4 543.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE OSTEOTOME FLAT MED SUP-2500-10-751 CDM 0270 RC outpatient 568.1 568.1 568.1 74 420.39 percent of total billed charges 568.1 93 460.16 percent of total billed charges 568.1 568.1 other OPPS APC 568.1 568.1 other OPPS APC 568.1 27.63 156.97 percent of total billed charges 568.1 568.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE OSTEOTOME FLAT LONG SUP-2500-10-752 CDM 0270 RC outpatient 592.8 592.8 592.8 74 438.67 percent of total billed charges 592.8 93 480.17 percent of total billed charges 592.8 592.8 other OPPS APC 592.8 592.8 other OPPS APC 592.8 27.63 163.79 percent of total billed charges 592.8 592.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE OSTEOTOME RADIAL SHORT SUP-2500-10-753 CDM 0270 RC outpatient 543.4 543.4 543.4 74 402.12 percent of total billed charges 543.4 93 440.15 percent of total billed charges 543.4 543.4 other OPPS APC 543.4 543.4 other OPPS APC 543.4 27.63 150.14 percent of total billed charges 543.4 543.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE OSTEOTOME RADIAL MEDIUM SUP-2500-10-754 CDM 0270 RC outpatient 568.1 568.1 568.1 74 420.39 percent of total billed charges 568.1 93 460.16 percent of total billed charges 568.1 568.1 other OPPS APC 568.1 568.1 other OPPS APC 568.1 27.63 156.97 percent of total billed charges 568.1 568.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE OSTEOTOME RADIAL LONG SUP-2500-10-755 CDM 0270 RC outpatient 592.8 592.8 592.8 74 438.67 percent of total billed charges 592.8 93 480.17 percent of total billed charges 592.8 592.8 other OPPS APC 592.8 592.8 other OPPS APC 592.8 27.63 163.79 percent of total billed charges 592.8 592.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE OSTEOTOME FIN SHORT SUP-2500-10-756 CDM 0270 RC outpatient 568.1 568.1 568.1 74 420.39 percent of total billed charges 568.1 93 460.16 percent of total billed charges 568.1 568.1 other OPPS APC 568.1 568.1 other OPPS APC 568.1 27.63 156.97 percent of total billed charges 568.1 568.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING IRRIGATION TIP DISPOSABLE SUP-250070620 CDM 0270 RC outpatient 82.92 82.92 82.92 74 61.36 percent of total billed charges 82.92 93 67.17 percent of total billed charges 82.92 82.92 other OPPS APC 82.92 82.92 other OPPS APC 82.92 27.63 22.91 percent of total billed charges 82.92 82.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PADDING CAST WEBRIL COTTON L4 YD X W4 IN UNDERCAST MILD STRETCH COHESIVE REGULAR FINISH STERILE LATEX FREE SUP-2502- CDM 0270 RC outpatient 2.59 2.59 2.59 74 1.92 percent of total billed charges 2.59 93 2.1 percent of total billed charges 2.59 2.59 other OPPS APC 2.59 2.59 other OPPS APC 2.59 27.63 0.72 percent of total billed charges 2.59 2.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSTEOTOME SURGICAL LAMBOTTE STAINLESS STEEL .25 MM L9 IN X W.25 IN BONE INSTRUMENT CURVED NONSTERILE SUP-250260 CDM outpatient 82.5 82.5 82.5 82.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSTEOTOME SURGICAL LAMBOTTE .5 MM L9 IN X W.5 IN INSTRUMENT CURVED SUP-250261 CDM outpatient 84.08 84.08 84.08 84.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR SURGICAL STAINLESS STEEL PROTECTOR SHEATH SUP-25123 CDM 0270 RC outpatient 312.21 312.21 312.21 74 231.04 percent of total billed charges 312.21 93 252.89 percent of total billed charges 312.21 312.21 other OPPS APC 312.21 312.21 other OPPS APC 312.21 27.63 86.26 percent of total billed charges 312.21 312.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR CARBIDE CUTTER SUP-251E-11-040 CDM 0270 RC outpatient 42.9 42.9 42.9 74 31.75 percent of total billed charges 42.9 93 34.75 percent of total billed charges 42.9 42.9 other OPPS APC 42.9 42.9 other OPPS APC 42.9 27.63 11.85 percent of total billed charges 42.9 42.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL LUBRICATH NATURAL RUBBER NYLON OD22 FR 30 CC 3 WAY FOLEY 2 OPPOSING DRAINAGE EYE LONG ROUND TIP STERILE LATEX DISPOSABLE AMBER HEMATURIA SUP-2551H22 CDM 270009000 LOCAL 0270 RC outpatient 27.32 27.32 27.32 74 20.22 percent of total billed charges 27.32 93 22.13 percent of total billed charges 27.32 27.32 other OPPS APC 27.32 27.32 other OPPS APC 27.32 27.63 7.55 percent of total billed charges 27.32 27.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL LUBRICATH NATURAL RUBBER NYLON OD24 FR 30 CC 3 WAY FOLEY 2 OPPOSING DRAINAGE EYE LONG ROUND TIP STERILE LATEX DISPOSABLE AMBER HEMATURIA SUP-2551H24 CDM 270009000 LOCAL 0270 RC outpatient 27.32 27.32 27.32 74 20.22 percent of total billed charges 27.32 93 22.13 percent of total billed charges 27.32 27.32 other OPPS APC 27.32 27.32 other OPPS APC 27.32 27.63 7.55 percent of total billed charges 27.32 27.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PADDING CAST WEBRIL COTTON L4 YD X W6 IN UNDERCAST MILD STRETCH COHESIVE REGULAR FINISH STERILE LATEX FREE SUP-2554 CDM outpatient 5.72 5.72 5.72 5.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 1/16IN SUP-256-01-21 CDM 0270 RC outpatient 120.9 120.9 120.9 74 89.47 percent of total billed charges 120.9 93 97.93 percent of total billed charges 120.9 120.9 other OPPS APC 120.9 120.9 other OPPS APC 120.9 27.63 33.4 percent of total billed charges 120.9 120.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 5/64IN SUP-256-01-22 CDM 0270 RC outpatient 120.9 120.9 120.9 74 89.47 percent of total billed charges 120.9 93 97.93 percent of total billed charges 120.9 120.9 other OPPS APC 120.9 120.9 other OPPS APC 120.9 27.63 33.4 percent of total billed charges 120.9 120.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3/32IN SUP-256-01-23 CDM 0270 RC outpatient 120.9 120.9 120.9 74 89.47 percent of total billed charges 120.9 93 97.93 percent of total billed charges 120.9 120.9 other OPPS APC 120.9 120.9 other OPPS APC 120.9 27.63 33.4 percent of total billed charges 120.9 120.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 7/64IN SUP-256-01-24 CDM 0270 RC outpatient 120.9 120.9 120.9 74 89.47 percent of total billed charges 120.9 93 97.93 percent of total billed charges 120.9 120.9 other OPPS APC 120.9 120.9 other OPPS APC 120.9 27.63 33.4 percent of total billed charges 120.9 120.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 1/8 IN SUP-256-01-25 CDM 0270 RC outpatient 120.9 120.9 120.9 74 89.47 percent of total billed charges 120.9 93 97.93 percent of total billed charges 120.9 120.9 other OPPS APC 120.9 120.9 other OPPS APC 120.9 27.63 33.4 percent of total billed charges 120.9 120.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 9/64IN SUP-256-01-26 CDM 0270 RC outpatient 120.9 120.9 120.9 74 89.47 percent of total billed charges 120.9 93 97.93 percent of total billed charges 120.9 120.9 other OPPS APC 120.9 120.9 other OPPS APC 120.9 27.63 33.4 percent of total billed charges 120.9 120.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 5/32IN SUP-256-01-27 CDM 0270 RC outpatient 120.9 120.9 120.9 74 89.47 percent of total billed charges 120.9 93 97.93 percent of total billed charges 120.9 120.9 other OPPS APC 120.9 120.9 other OPPS APC 120.9 27.63 33.4 percent of total billed charges 120.9 120.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 11/64IN SUP-256-01-28 CDM 0270 RC outpatient 120.9 120.9 120.9 74 89.47 percent of total billed charges 120.9 93 97.93 percent of total billed charges 120.9 120.9 other OPPS APC 120.9 120.9 other OPPS APC 120.9 27.63 33.4 percent of total billed charges 120.9 120.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3/16IN SUP-256-01-29 CDM 0270 RC outpatient 120.9 120.9 120.9 74 89.47 percent of total billed charges 120.9 93 97.93 percent of total billed charges 120.9 120.9 other OPPS APC 120.9 120.9 other OPPS APC 120.9 27.63 33.4 percent of total billed charges 120.9 120.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING WOUND TELFA MYLAR L7 IN X W6 IN ABSORBENT ADHESIVE STRIP BACK SHEET FILM NONWOVEN STERILE LATEX FREE DISPOSABLE SUP-2563 CDM 0270 RC outpatient 3.17 3.17 3.17 74 2.35 percent of total billed charges 3.17 93 2.57 percent of total billed charges 3.17 3.17 other OPPS APC 3.17 3.17 other OPPS APC 3.17 27.63 0.88 percent of total billed charges 3.17 3.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE EKG 3M RED DOT FOAM ADULT L1.36 IN X W1.6 IN MONITOR FLUID RESISTANT STICKY GEL RADIOLUCENT SUP-2570-5 CDM 0481 RC outpatient 0.19 0.19 0.19 74 0.14 percent of total billed charges 0.19 93 0.15 percent of total billed charges 0.19 0.19 other OPPS APC 0.19 0.19 other OPPS APC 0.19 51 0.1 percent of total billed charges 0.19 0.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC REGENT FLEXCUFF PTFE PYROLYTIC CARBON 85 D OD25 MM ID23 MM SUPRA ANNULAR 1 DIGIT GRADIENT MECHANICAL LEAFLET OPEN SUP-25AGFN-756 CDM 0270 RC outpatient 12708.8 12708.8 12708.8 74 9404.51 percent of total billed charges 12708.8 93 10294.1 percent of total billed charges 12708.8 12708.8 other OPPS APC 12708.8 12708.8 other OPPS APC 12708.8 27.63 3511.44 percent of total billed charges 12708.8 12708.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AROTIC GRAFT 25MM SUP-25CAVGJ25MM CDM 0270 RC outpatient 15262 15262 15262 74 11293.9 percent of total billed charges 15262 93 12362.2 percent of total billed charges 15262 15262 other OPPS APC 15262 15262 other OPPS APC 15262 27.63 4216.89 percent of total billed charges 15262 15262 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL MASTERS-SERIES PYROLYTIC CARBON 85 D STANDARD OD25 MM ID20.4 MM MECHANICAL CUFF ROTATABLE SUP-25MJ-501 CDM 0270 RC outpatient 12708.8 12708.8 12708.8 74 9404.51 percent of total billed charges 12708.8 93 10294.1 percent of total billed charges 12708.8 12708.8 other OPPS APC 12708.8 12708.8 other OPPS APC 12708.8 27.63 3511.44 percent of total billed charges 12708.8 12708.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODES ADULT SUP-26-00004 CDM 0272 RC outpatient 273.39 273.39 273.39 74 202.31 percent of total billed charges 273.39 93 221.45 percent of total billed charges 273.39 273.39 other OPPS APC 273.39 273.39 other OPPS APC 273.39 27.63 75.54 percent of total billed charges 273.39 273.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAPNOLINE SMART 02 PLUS ADULT SUP-26-00021 CDM 0272 RC outpatient 63.68 63.68 63.68 74 47.12 percent of total billed charges 63.68 93 51.58 percent of total billed charges 63.68 63.68 other OPPS APC 63.68 63.68 other OPPS APC 63.68 27.63 17.59 percent of total billed charges 63.68 63.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAPNOLINE SMART 02 PLUS PED SUP-26-00022 CDM 0272 RC outpatient 54.68 54.68 54.68 74 40.46 percent of total billed charges 54.68 93 44.29 percent of total billed charges 54.68 54.68 other OPPS APC 54.68 54.68 other OPPS APC 54.68 27.63 15.11 percent of total billed charges 54.68 54.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ONESTEP CPR COMPLETE SUP-26-00024 CDM 0272 RC outpatient 297.09 297.09 297.09 74 219.85 percent of total billed charges 297.09 93 240.64 percent of total billed charges 297.09 297.09 other OPPS APC 297.09 297.09 other OPPS APC 297.09 27.63 82.09 percent of total billed charges 297.09 297.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERFORATOR 14MM 14MM 11MM SHARP HUDSON END CRANIAL SS STERILE DISPOSABLE SUP-26-1221 CDM 0270 RC outpatient 673.4 673.4 673.4 74 498.32 percent of total billed charges 673.4 93 545.45 percent of total billed charges 673.4 673.4 other OPPS APC 673.4 673.4 other OPPS APC 673.4 27.63 186.06 percent of total billed charges 673.4 673.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR PREP CHLORAPREP FREPP ENTURIA 70% ISOPROPYL ALCOHOL 2% CHLORHEXIDINE GLUCONATE 1.5 ML 1 STEP AMPULE DRIP RESISTANT STERILE LATEX FREE DISPOSABLE SUP-260299 CDM 270009040 LOCAL 0270 RC outpatient 3.42 3.42 3.42 74 2.53 percent of total billed charges 3.42 93 2.77 percent of total billed charges 3.42 3.42 other OPPS APC 3.42 3.42 other OPPS APC 3.42 27.63 0.94 percent of total billed charges 3.42 3.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DRAINAGE BECKER EDMS II VENTRICULAR MONITOR SYSTEM RADIOPAQUE STERILE LATEX FREE DISPOSABLE SUP-26040 CDM 0270 RC outpatient 1071.54 1071.54 1071.54 74 792.94 percent of total billed charges 1071.54 93 867.95 percent of total billed charges 1071.54 1071.54 other OPPS APC 1071.54 1071.54 other OPPS APC 1071.54 27.63 296.07 percent of total billed charges 1071.54 1071.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELEMENT WORKING ANGLE OD24 FR CUT SHEATH YELLOW RESECTOSCOPE SUP-26050 G CDM 0270 RC outpatient 346.23 346.23 346.23 74 256.21 percent of total billed charges 346.23 93 280.45 percent of total billed charges 346.23 346.23 other OPPS APC 346.23 346.23 other OPPS APC 346.23 27.63 95.66 percent of total billed charges 346.23 346.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELEMENT WORKING ANGLE OD24 FR CUT SHEATH YELLOW RESECTOSCOPE SUP-26050G-S CDM 0270 RC outpatient 386.94 386.94 386.94 74 286.34 percent of total billed charges 386.94 93 313.42 percent of total billed charges 386.94 386.94 other OPPS APC 386.94 386.94 other OPPS APC 386.94 27.63 106.91 percent of total billed charges 386.94 386.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR PREP CHLORAPREP HI-LITE ORANGE 70% ISOPROPYL ALCOHOL 2% CHLORHEXIDINE GLUCONATE 10.5 ML ANTIMICROBIAL 1 STEP DEHP FREE STERILE LATEX FREE DISPOSABLE SUP-260715 CDM 270009040 LOCAL 0270 RC outpatient 3.42 3.42 3.42 74 2.53 percent of total billed charges 3.42 93 2.77 percent of total billed charges 3.42 3.42 other OPPS APC 3.42 3.42 other OPPS APC 3.42 27.63 0.94 percent of total billed charges 3.42 3.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR PREP CHLORAPREP HI-LITE ORANGE 70% ISOPROPYL ALCOHOL 2% CHLORHEXIDINE GLUCONATE 26 ML ANTIMICROBIAL 1 STEP DEHP FREE STERILE LATEX FREE DISPOSABLE SUP-260815 CDM 0270 RC outpatient 16.6 16.6 16.6 74 12.28 percent of total billed charges 16.6 93 13.45 percent of total billed charges 16.6 16.6 other OPPS APC 16.6 16.6 other OPPS APC 16.6 27.63 4.59 percent of total billed charges 16.6 16.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY RHINO TRACH NBR 6 BLUE SUP-263567 CDM 270009013 LOCAL 0270 RC outpatient 352.2 352.2 352.2 74 260.63 percent of total billed charges 352.2 93 285.28 percent of total billed charges 352.2 352.2 other OPPS APC 352.2 352.2 other OPPS APC 352.2 27.63 97.31 percent of total billed charges 352.2 352.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE SCLERAL SILICONE OD1.65 MM ID.76 MM BUCKLING COMPONENT STERILE SUP-270 CDM 0270 RC outpatient 27.56 27.56 27.56 74 20.39 percent of total billed charges 27.56 93 22.32 percent of total billed charges 27.56 27.56 other OPPS APC 27.56 27.56 other OPPS APC 27.56 27.63 7.61 percent of total billed charges 27.56 27.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC CARPENTIER-EDWARDS PERIMOUNT THEON BOVINE PERICARDIAL COCR SILICONE RUBBER POLYESTER H14 MM OD21 MM ODSEC31 MM ID20 MM BIOPROSTHESIS SUPRA ANNULAR DESIGN HEMODYNAMIC STABILITY LONG TERM DURABILITY THERMAFIX PROC SUP-2700TFX21MM CDM 0270 RC outpatient 2.6 2.6 2.6 74 1.92 percent of total billed charges 2.6 93 2.11 percent of total billed charges 2.6 2.6 other OPPS APC 2.6 2.6 other OPPS APC 2.6 27.63 0.72 percent of total billed charges 2.6 2.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOOT TRACTION FOAM UNIVERSAL BUCKS LINER SUP-27101 CDM 0270 RC outpatient 34.89 34.89 34.89 74 25.82 percent of total billed charges 34.89 93 28.26 percent of total billed charges 34.89 34.89 other OPPS APC 34.89 34.89 other OPPS APC 34.89 27.63 9.64 percent of total billed charges 34.89 34.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DRILLBIT, 2.1 CANNULATED" SUP-272000000 CDM 0272 RC outpatient 595 595 595 74 440.3 percent of total billed charges 595 93 481.95 percent of total billed charges 595 595 other OPPS APC 595 595 other OPPS APC 595 27.63 164.4 percent of total billed charges 595 595 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PASTE ENDOSCOPIC CLEANING 5 GM AGENT DISTAL OR PROXIMAL LENS SUP-27661 CDM outpatient 50.83 50.83 50.83 50.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR DRILL CUTTER CRANIAL FAST CUTTING ROUND 4.0MM SUP-277-140-240 CDM 0270 RC outpatient 395.46 395.46 395.46 74 292.64 percent of total billed charges 395.46 93 320.32 percent of total billed charges 395.46 395.46 other OPPS APC 395.46 395.46 other OPPS APC 395.46 27.63 109.27 percent of total billed charges 395.46 395.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR BONE CUTTING CRANIAL FAST ROUND 6.0MM SUP-277-140-260 CDM 0270 RC outpatient 395.46 395.46 395.46 74 292.64 percent of total billed charges 395.46 93 320.32 percent of total billed charges 395.46 395.46 other OPPS APC 395.46 395.46 other OPPS APC 395.46 27.63 109.27 percent of total billed charges 395.46 395.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR BONE CUTTING DIAMOND ROUND 3.0MM SUP-277-140-330 CDM 0270 RC outpatient 457.99 457.99 457.99 74 338.91 percent of total billed charges 457.99 93 370.97 percent of total billed charges 457.99 457.99 other OPPS APC 457.99 457.99 other OPPS APC 457.99 27.63 126.54 percent of total billed charges 457.99 457.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYMFONY ZXT 300LENS 14.0 SUP-278C17801 CDM C1780 HCPCS 0278 RC outpatient 2955 2955 2955 57 1684.35 percent of total billed charges 2955 93 2393.55 percent of total billed charges 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 51 1507.05 percent of total billed charges 2955 2955 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC REGENT FLEXCUFF 85 D OD27 MM ID24.9 MM SUPRA ANNULAR 1 DIGIT GRADIENT MECHANICAL LEAFLET OPEN SUP-27AGFN-756 CDM 0270 RC outpatient 12708.8 12708.8 12708.8 74 9404.51 percent of total billed charges 12708.8 93 10294.1 percent of total billed charges 12708.8 12708.8 other OPPS APC 12708.8 12708.8 other OPPS APC 12708.8 27.63 3511.44 percent of total billed charges 12708.8 12708.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC GRAFT 27MM SUP-27CAVGJ27MM CDM 0270 RC outpatient 15028 15028 15028 74 11120.7 percent of total billed charges 15028 93 12172.7 percent of total billed charges 15028 15028 other OPPS APC 15028 15028 other OPPS APC 15028 27.63 4152.24 percent of total billed charges 15028 15028 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL MASTERS SERIES PYROLYTIC CARBON 85 D 3.67 SQ CM STANDARD RING OD27 MM ID22.5 MM ANNULUS LEAFLET ORIFICE CONTROL TORQUE ROTATION MECHANISM CUFF SUP-27MJ-501 CDM 0270 RC outpatient 12708.8 12708.8 12708.8 74 9404.51 percent of total billed charges 12708.8 93 10294.1 percent of total billed charges 12708.8 12708.8 other OPPS APC 12708.8 12708.8 other OPPS APC 12708.8 27.63 3511.44 percent of total billed charges 12708.8 12708.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ELBOW IMMOBILIZER, ADULT" SUP-28-00001 CDM 0271 RC outpatient 36.08 36.08 36.08 74 26.7 percent of total billed charges 36.08 93 29.22 percent of total billed charges 36.08 36.08 other OPPS APC 36.08 36.08 other OPPS APC 36.08 27.63 9.97 percent of total billed charges 36.08 36.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MITT PROTECTIVE SUP-28-00005 CDM 0271 RC outpatient 48.48 48.48 48.48 74 35.88 percent of total billed charges 48.48 93 39.27 percent of total billed charges 48.48 48.48 other OPPS APC 48.48 48.48 other OPPS APC 48.48 27.63 13.4 percent of total billed charges 48.48 48.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIMB HOLDER WRIST & ANKLE SUP-28-00006 CDM 0271 RC outpatient 3.55 3.55 3.55 74 2.63 percent of total billed charges 3.55 93 2.88 percent of total billed charges 3.55 3.55 other OPPS APC 3.55 3.55 other OPPS APC 3.55 27.63 0.98 percent of total billed charges 3.55 3.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESTRAINT WRIST HOOK & LOOP CLOSURE SUP-28-00008 CDM 0271 RC outpatient 186 186 186 74 137.64 percent of total billed charges 186 93 150.66 percent of total billed charges 186 186 other OPPS APC 186 186 other OPPS APC 186 27.63 51.39 percent of total billed charges 186 186 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESTRAINT ANKLE HOOK & LOOP CLOSURE SUP-28-00009 CDM 0271 RC outpatient 186 186 186 74 137.64 percent of total billed charges 186 93 150.66 percent of total billed charges 186 186 other OPPS APC 186 186 other OPPS APC 186 27.63 51.39 percent of total billed charges 186 186 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET INTUBATION CRAWFORD OLIVE OD.025 IN ODSEC.016 IN EYE 2 FLEXIBLE STAINLESS STEEL PROBE SUTURE SILICONE TUBING STERILE LATEX FREE SUP-28-0184 CDM 0270 RC outpatient 107.9 107.9 107.9 74 79.85 percent of total billed charges 107.9 93 87.4 percent of total billed charges 107.9 107.9 other OPPS APC 107.9 107.9 other OPPS APC 107.9 27.63 29.81 percent of total billed charges 107.9 107.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. O RING LIGATOR MCGIVNEY HEMORROID BAND SUP-28-155 CDM 0270 RC outpatient 0.99 0.99 0.99 74 0.73 percent of total billed charges 0.99 93 0.8 percent of total billed charges 0.99 0.99 other OPPS APC 0.99 0.99 other OPPS APC 0.99 27.63 0.27 percent of total billed charges 0.99 0.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE RADFX TITANIUM STANDARD L12 MM OD2.7 MM FOREFOOT TARSUS LOCK NONSTERILE SUP-28.25.012 CDM 0270 RC outpatient 670.8 670.8 670.8 74 496.39 percent of total billed charges 670.8 93 543.35 percent of total billed charges 670.8 670.8 other OPPS APC 670.8 670.8 other OPPS APC 670.8 27.63 185.34 percent of total billed charges 670.8 670.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CURETTE VACUUM 8MM CLEAR PLASTIC DISPOSABLE STERILE LF UTERINE CURVE OPEN TIP MOLD MARK FROST SOUND LINE SUP-280 CDM outpatient 3.52 3.52 3.52 3.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LAG DHS DCS STERILE THREAD 115MM SUP-280.150S CDM 270010022 LOCAL 0270 RC outpatient 1036.75 1036.75 1036.75 74 767.2 percent of total billed charges 1036.75 93 839.77 percent of total billed charges 1036.75 1036.75 other OPPS APC 1036.75 1036.75 other OPPS APC 1036.75 27.63 286.45 percent of total billed charges 1036.75 1036.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LAG DHS DCS STERILE THREAD 50MM SUP-280.251S CDM 270010022 LOCAL 0270 RC outpatient 1036.75 1036.75 1036.75 74 767.2 percent of total billed charges 1036.75 93 839.77 percent of total billed charges 1036.75 1036.75 other OPPS APC 1036.75 1036.75 other OPPS APC 1036.75 27.63 286.45 percent of total billed charges 1036.75 1036.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LAG DHS DCS STERILE THREAD 55MM SUP-280.255S CDM 270010022 LOCAL 0270 RC outpatient 1036.75 1036.75 1036.75 74 767.2 percent of total billed charges 1036.75 93 839.77 percent of total billed charges 1036.75 1036.75 other OPPS APC 1036.75 1036.75 other OPPS APC 1036.75 27.63 286.45 percent of total billed charges 1036.75 1036.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LAG DHS DCS STERILE THREAD 60MM SUP-280.260S CDM 270010022 LOCAL 0270 RC outpatient 1036.75 1036.75 1036.75 74 767.2 percent of total billed charges 1036.75 93 839.77 percent of total billed charges 1036.75 1036.75 other OPPS APC 1036.75 1036.75 other OPPS APC 1036.75 27.63 286.45 percent of total billed charges 1036.75 1036.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LAG DHS DCS STERILE THREAD 65MM SUP-280.265S CDM 270010022 LOCAL 0270 RC outpatient 1036.75 1036.75 1036.75 74 767.2 percent of total billed charges 1036.75 93 839.77 percent of total billed charges 1036.75 1036.75 other OPPS APC 1036.75 1036.75 other OPPS APC 1036.75 27.63 286.45 percent of total billed charges 1036.75 1036.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LAG DHS DCS STERILE THREAD 70MM SUP-280.270 CDM 270010022 LOCAL 0270 RC outpatient 908.05 908.05 908.05 74 671.96 percent of total billed charges 908.05 93 735.52 percent of total billed charges 908.05 908.05 other OPPS APC 908.05 908.05 other OPPS APC 908.05 27.63 250.89 percent of total billed charges 908.05 908.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LAG DHS DCS STERILE THREAD 75MM SUP-280.275S CDM 270010022 LOCAL 0270 RC outpatient 1036.75 1036.75 1036.75 74 767.2 percent of total billed charges 1036.75 93 839.77 percent of total billed charges 1036.75 1036.75 other OPPS APC 1036.75 1036.75 other OPPS APC 1036.75 27.63 286.45 percent of total billed charges 1036.75 1036.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DHS/DCS 80MM 22MM 12.7MM 2.7MM SS NS LAG CANNULATED THREAD 1 STEP SYSTEM SUP-280.280 CDM 270010022 LOCAL 0270 RC outpatient 908.05 908.05 908.05 74 671.96 percent of total billed charges 908.05 93 735.52 percent of total billed charges 908.05 908.05 other OPPS APC 908.05 908.05 other OPPS APC 908.05 27.63 250.89 percent of total billed charges 908.05 908.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DHS/DCS STAINLESS STEEL OCTAGONAL L80 MM OD13 MM HIP CONDYLE STERILE SUP-280.280S CDM 270010022 LOCAL 0270 RC outpatient 1036.75 1036.75 1036.75 74 767.2 percent of total billed charges 1036.75 93 839.77 percent of total billed charges 1036.75 1036.75 other OPPS APC 1036.75 1036.75 other OPPS APC 1036.75 27.63 286.45 percent of total billed charges 1036.75 1036.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DHS/DCS STAINLESS STEEL L85 MM OD12.7 MM HIP CONDYLE LAG STERILE 1 STEP SYSTEM SUP-280.285S CDM 270010022 LOCAL 0270 RC outpatient 1036.75 1036.75 1036.75 74 767.2 percent of total billed charges 1036.75 93 839.77 percent of total billed charges 1036.75 1036.75 other OPPS APC 1036.75 1036.75 other OPPS APC 1036.75 27.63 286.45 percent of total billed charges 1036.75 1036.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DHS/DCS STAINLESS STEEL L90 MM OD12.7 MM HIP CONDYLE LAG STERILE 1 STEP SYSTEM SUP-280.290S CDM 270010022 LOCAL 0270 RC outpatient 1036.75 1036.75 1036.75 74 767.2 percent of total billed charges 1036.75 93 839.77 percent of total billed charges 1036.75 1036.75 other OPPS APC 1036.75 1036.75 other OPPS APC 1036.75 27.63 286.45 percent of total billed charges 1036.75 1036.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LAG DHS DCS STERILE THREAD 95MM SUP-280.295S CDM 270010022 LOCAL 0270 RC outpatient 1036.75 1036.75 1036.75 74 767.2 percent of total billed charges 1036.75 93 839.77 percent of total billed charges 1036.75 1036.75 other OPPS APC 1036.75 1036.75 other OPPS APC 1036.75 27.63 286.45 percent of total billed charges 1036.75 1036.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LAG DHS DCS STERILE THREAD 100MM SUP-280.301S CDM 270010022 LOCAL 0270 RC outpatient 1036.75 1036.75 1036.75 74 767.2 percent of total billed charges 1036.75 93 839.77 percent of total billed charges 1036.75 1036.75 other OPPS APC 1036.75 1036.75 other OPPS APC 1036.75 27.63 286.45 percent of total billed charges 1036.75 1036.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LAG DHS DCS STERILE THREAD 105MM SUP-280.305S CDM 270010022 LOCAL 0270 RC outpatient 1036.75 1036.75 1036.75 74 767.2 percent of total billed charges 1036.75 93 839.77 percent of total billed charges 1036.75 1036.75 other OPPS APC 1036.75 1036.75 other OPPS APC 1036.75 27.63 286.45 percent of total billed charges 1036.75 1036.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DHS/DCS STAINLESS STEEL L110 MM OD12.7 MM HIP CONDYLE LAG THREAD OCTAGONAL RECESS STERILE 1 STEP SYSTEM SUP-280.310S CDM 270010022 LOCAL 0270 RC outpatient 1036.75 1036.75 1036.75 74 767.2 percent of total billed charges 1036.75 93 839.77 percent of total billed charges 1036.75 1036.75 other OPPS APC 1036.75 1036.75 other OPPS APC 1036.75 27.63 286.45 percent of total billed charges 1036.75 1036.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LAG DHS DCS STERILE THREAD 115MM SUP-280.315S CDM 270010022 LOCAL 0270 RC outpatient 1036.75 1036.75 1036.75 74 767.2 percent of total billed charges 1036.75 93 839.77 percent of total billed charges 1036.75 1036.75 other OPPS APC 1036.75 1036.75 other OPPS APC 1036.75 27.63 286.45 percent of total billed charges 1036.75 1036.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LAG DHS DCS STERILE THREAD 120MM SUP-280.320S CDM 270010022 LOCAL 0270 RC outpatient 1036.75 1036.75 1036.75 74 767.2 percent of total billed charges 1036.75 93 839.77 percent of total billed charges 1036.75 1036.75 other OPPS APC 1036.75 1036.75 other OPPS APC 1036.75 27.63 286.45 percent of total billed charges 1036.75 1036.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LAG DHS DCS STERILE THREAD 125MM SUP-280.325S CDM 270010022 LOCAL 0270 RC outpatient 1036.75 1036.75 1036.75 74 767.2 percent of total billed charges 1036.75 93 839.77 percent of total billed charges 1036.75 1036.75 other OPPS APC 1036.75 1036.75 other OPPS APC 1036.75 27.63 286.45 percent of total billed charges 1036.75 1036.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LAG DHS DCS STERILE THREAD 130MM SUP-280.330 CDM 270010022 LOCAL 0270 RC outpatient 908.05 908.05 908.05 74 671.96 percent of total billed charges 908.05 93 735.52 percent of total billed charges 908.05 908.05 other OPPS APC 908.05 908.05 other OPPS APC 908.05 27.63 250.89 percent of total billed charges 908.05 908.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LAG DHS DCS STERILE THREAD 135MM SUP-280.335S CDM 270010022 LOCAL 0270 RC outpatient 1036.75 1036.75 1036.75 74 767.2 percent of total billed charges 1036.75 93 839.77 percent of total billed charges 1036.75 1036.75 other OPPS APC 1036.75 1036.75 other OPPS APC 1036.75 27.63 286.45 percent of total billed charges 1036.75 1036.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LAG DHS DCS STERILE THREAD 140MM SUP-280.340S CDM 270010022 LOCAL 0270 RC outpatient 1036.75 1036.75 1036.75 74 767.2 percent of total billed charges 1036.75 93 839.77 percent of total billed charges 1036.75 1036.75 other OPPS APC 1036.75 1036.75 other OPPS APC 1036.75 27.63 286.45 percent of total billed charges 1036.75 1036.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LAG DHS DCS STERILE THREAD 145MM SUP-280.345 CDM outpatient 908.05 908.05 908.05 908.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DHS/DCS STAINLESS STEEL L36 MM OD12.7 MM HIP CONDYLE COMPRESSION SOCKET STERILE 1 STEP SYSTEM SUP-280.990S CDM 270010022 LOCAL 0270 RC outpatient 247.39 247.39 247.39 74 183.07 percent of total billed charges 247.39 93 200.39 percent of total billed charges 247.39 247.39 other OPPS APC 247.39 247.39 other OPPS APC 247.39 27.63 68.35 percent of total billed charges 247.39 247.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EXTREMITIES STRAIGHT 4 HOLE TOTAL FOOT SYSTEM SUP-2807004 CDM 0270 RC outpatient 3923.4 3923.4 3923.4 74 2903.32 percent of total billed charges 3923.4 93 3177.95 percent of total billed charges 3923.4 3923.4 other OPPS APC 3923.4 3923.4 other OPPS APC 3923.4 27.63 1084.04 percent of total billed charges 3923.4 3923.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW GIGLI STAINLESS STEEL L510 MM STERILE LATEX FREE SUP-2808-02 CDM 0270 RC outpatient 32.85 32.85 32.85 74 24.31 percent of total billed charges 32.85 93 26.61 percent of total billed charges 32.85 32.85 other OPPS APC 32.85 32.85 other OPPS APC 32.85 27.63 9.08 percent of total billed charges 32.85 32.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON MULTIPASS 8-0 BV130-5 L5 IN MONOFILAMENT BLACK SUP-2808G CDM 0270 RC outpatient 36.59 36.59 36.59 74 27.08 percent of total billed charges 36.59 93 29.64 percent of total billed charges 36.59 36.59 other OPPS APC 36.59 36.59 other OPPS APC 36.59 27.63 10.11 percent of total billed charges 36.59 36.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE COMPRESSION DHS DCS STANDARD BARREL 130 DEG 2 HOLE SUP-281.021S CDM 270010022 LOCAL 0270 RC outpatient 1678.82 1678.82 1678.82 74 1242.33 percent of total billed charges 1678.82 93 1359.84 percent of total billed charges 1678.82 1678.82 other OPPS APC 1678.82 1678.82 other OPPS APC 1678.82 27.63 463.86 percent of total billed charges 1678.82 1678.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DHS/DCP STAINLESS STEEL 130 D STANDARD BARREL L62 MM L38 MM HIP 3 HOLE COMPRESSION STERILE 1 STEP SYSTEM SUP-281.031S CDM 270010022 LOCAL 0270 RC outpatient 1678.82 1678.82 1678.82 74 1242.33 percent of total billed charges 1678.82 93 1359.84 percent of total billed charges 1678.82 1678.82 other OPPS APC 1678.82 1678.82 other OPPS APC 1678.82 27.63 463.86 percent of total billed charges 1678.82 1678.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DHS/DCP STAINLESS STEEL 130 D STANDARD BARREL L78 MM L38 MM HIP CONDYLE 4 HOLE LOW PROFILE STERILE 1 STEP SYSTEM SUP-281.040S CDM 270010022 LOCAL 0270 RC outpatient 1678.82 1678.82 1678.82 74 1242.33 percent of total billed charges 1678.82 93 1359.84 percent of total billed charges 1678.82 1678.82 other OPPS APC 1678.82 1678.82 other OPPS APC 1678.82 27.63 463.86 percent of total billed charges 1678.82 1678.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE COMPRESSION DHS DCS STANDARD BARREL 130 DEG 3 HOLE SUP-281.131S CDM 270010022 LOCAL 0270 RC outpatient 1678.82 1678.82 1678.82 74 1242.33 percent of total billed charges 1678.82 93 1359.84 percent of total billed charges 1678.82 1678.82 other OPPS APC 1678.82 1678.82 other OPPS APC 1678.82 27.63 463.86 percent of total billed charges 1678.82 1678.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE COMPRESSION DHS DCS STANDARD BARREL 135 DEG 4 HOLE SUP-281.140S CDM 270010022 LOCAL 0270 RC outpatient 1678.82 1678.82 1678.82 74 1242.33 percent of total billed charges 1678.82 93 1359.84 percent of total billed charges 1678.82 1678.82 other OPPS APC 1678.82 1678.82 other OPPS APC 1678.82 27.63 463.86 percent of total billed charges 1678.82 1678.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DHS STAINLESS STEEL 135 D STANDARD BARREL L94 MM L38 MM PROXIMAL FEMUR 5 HOLE STERILE 4.5 MM CORTICAL SCREW SUP-281.150S CDM 270010022 LOCAL 0270 RC outpatient 1678.82 1678.82 1678.82 74 1242.33 percent of total billed charges 1678.82 93 1359.84 percent of total billed charges 1678.82 1678.82 other OPPS APC 1678.82 1678.82 other OPPS APC 1678.82 27.63 463.86 percent of total billed charges 1678.82 1678.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE COMPRESSION DHS DCS STANDARD BARREL 135 DEG 6 HOLE SUP-281.160S CDM 270010022 LOCAL 0270 RC outpatient 1678.82 1678.82 1678.82 74 1242.33 percent of total billed charges 1678.82 93 1359.84 percent of total billed charges 1678.82 1678.82 other OPPS APC 1678.82 1678.82 other OPPS APC 1678.82 27.63 463.86 percent of total billed charges 1678.82 1678.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE COMPRESSION DHS DCS STANDARD BARREL 140 DEG 4 HOLE SUP-281.240S CDM 270010022 LOCAL 0270 RC outpatient 1678.82 1678.82 1678.82 74 1242.33 percent of total billed charges 1678.82 93 1359.84 percent of total billed charges 1678.82 1678.82 other OPPS APC 1678.82 1678.82 other OPPS APC 1678.82 27.63 463.86 percent of total billed charges 1678.82 1678.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE DHS COMPRESSION 140DEG 5 HOLE SUP-281.250 CDM 270010022 LOCAL 0270 RC outpatient 1525.81 1525.81 1525.81 74 1129.1 percent of total billed charges 1525.81 93 1235.91 percent of total billed charges 1525.81 1525.81 other OPPS APC 1525.81 1525.81 other OPPS APC 1525.81 27.63 421.58 percent of total billed charges 1525.81 1525.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE DHS COMPRESSION 145 DEG 5 HOLE SUP-281.350 CDM 270010022 LOCAL 0270 RC outpatient 1525.81 1525.81 1525.81 74 1129.1 percent of total billed charges 1525.81 93 1235.91 percent of total billed charges 1525.81 1525.81 other OPPS APC 1525.81 1525.81 other OPPS APC 1525.81 27.63 421.58 percent of total billed charges 1525.81 1525.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE DHS SYNTHES 135DEG 4 HOLE SUP-281.540 CDM 270010022 LOCAL 0270 RC outpatient 1525.81 1525.81 1525.81 74 1129.1 percent of total billed charges 1525.81 93 1235.91 percent of total billed charges 1525.81 1525.81 other OPPS APC 1525.81 1525.81 other OPPS APC 1525.81 27.63 421.58 percent of total billed charges 1525.81 1525.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCS DCP STAINLESS STEEL 95 D SHORT BARREL L178 MM L25 MM HIP CONDYLE 10 HOLE STERILE SUP-281.90S CDM 270010022 LOCAL 0270 RC outpatient 2468.7 2468.7 2468.7 74 1826.84 percent of total billed charges 2468.7 93 1999.65 percent of total billed charges 2468.7 2468.7 other OPPS APC 2468.7 2468.7 other OPPS APC 2468.7 27.63 682.1 percent of total billed charges 2468.7 2468.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CURETTE VACUUM 10MM CLEAR PLASTIC DISPOSABLE STERILE LF UTERINE CURVE OPEN TIP MOLD MARK FROST SOUND LINE SUP-282 CDM outpatient 3.36 3.36 3.36 3.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOWEL SURGICAL ALLEGIANCE COTTON L24 IN X W17 IN HIGH ABSORBENT WOVEN DELINT PREWASH STERILE LATEX FREE DISPOSABLE GREEN SUP-28200-004 CDM 0270 RC outpatient 1.62 1.62 1.62 74 1.2 percent of total billed charges 1.62 93 1.31 percent of total billed charges 1.62 1.62 other OPPS APC 1.62 1.62 other OPPS APC 1.62 27.63 0.45 percent of total billed charges 1.62 1.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTEGRA LOCKING 10MM SUP-2825010 CDM 0270 RC outpatient 670.8 670.8 670.8 74 496.39 percent of total billed charges 670.8 93 543.35 percent of total billed charges 670.8 670.8 other OPPS APC 670.8 670.8 other OPPS APC 670.8 27.63 185.34 percent of total billed charges 670.8 670.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTEGRA LOCKING 14MM SUP-2825014 CDM 0270 RC outpatient 670.8 670.8 670.8 74 496.39 percent of total billed charges 670.8 93 543.35 percent of total billed charges 670.8 670.8 other OPPS APC 670.8 670.8 other OPPS APC 670.8 27.63 185.34 percent of total billed charges 670.8 670.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTEGRA LOCKING 18MM SUP-2825018 CDM 0270 RC outpatient 670.8 670.8 670.8 74 496.39 percent of total billed charges 670.8 93 543.35 percent of total billed charges 670.8 670.8 other OPPS APC 670.8 670.8 other OPPS APC 670.8 27.63 185.34 percent of total billed charges 670.8 670.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CURETTE VACUUM CURVE 12MM CLEAR PLASTIC DISPOSABLE STERILE UTERINE OPEN TIP MOLD MARK FROST SOUND LINE SUP-284 CDM 0270 RC outpatient 3.52 3.52 3.52 74 2.6 percent of total billed charges 3.52 93 2.85 percent of total billed charges 3.52 3.52 other OPPS APC 3.52 3.52 other OPPS APC 3.52 27.63 0.97 percent of total billed charges 3.52 3.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON 10-0 BV75-4 L5 IN MONOFILAMENT BLACK SUP-2850G CDM 0270 RC outpatient 59.45 59.45 59.45 74 43.99 percent of total billed charges 59.45 93 48.15 percent of total billed charges 59.45 59.45 other OPPS APC 59.45 59.45 other OPPS APC 59.45 27.63 16.43 percent of total billed charges 59.45 59.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTEGRA 3.0MM X 10MM SUP-285110 CDM 0270 RC outpatient 517.19 517.19 517.19 74 382.72 percent of total billed charges 517.19 93 418.92 percent of total billed charges 517.19 517.19 other OPPS APC 517.19 517.19 other OPPS APC 517.19 27.63 142.9 percent of total billed charges 517.19 517.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCISSORS SURGICAL DECKER MICRO L5.5 IN STRAIGHT SUP-285112 CDM 0270 RC outpatient 713.54 713.54 713.54 74 528.02 percent of total billed charges 713.54 93 577.97 percent of total billed charges 713.54 713.54 other OPPS APC 713.54 713.54 other OPPS APC 713.54 27.63 197.15 percent of total billed charges 713.54 713.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS SURGICAL WILLIAMS L5.5 IN DISCECTOMY SUP-285114 CDM 0270 RC outpatient 902.04 902.04 902.04 74 667.51 percent of total billed charges 902.04 93 730.65 percent of total billed charges 902.04 902.04 other OPPS APC 902.04 902.04 other OPPS APC 902.04 27.63 249.23 percent of total billed charges 902.04 902.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS SURGICAL HOEN STAINLESS STEEL L7 3/4 IN L19 MM BAYONET HANDLE SERRATE NONSTERILE SUP-285116 CDM 0270 RC outpatient 166.5 166.5 166.5 74 123.21 percent of total billed charges 166.5 93 134.87 percent of total billed charges 166.5 166.5 other OPPS APC 166.5 166.5 other OPPS APC 166.5 27.63 46 percent of total billed charges 166.5 166.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS SURGICAL L7 IN BRAIN DRESSING SERRATED SUP-285118 CDM 0270 RC outpatient 57.15 57.15 57.15 74 42.29 percent of total billed charges 57.15 93 46.29 percent of total billed charges 57.15 57.15 other OPPS APC 57.15 57.15 other OPPS APC 57.15 27.63 15.79 percent of total billed charges 57.15 57.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS SURGICAL GERALD STAINLESS STEEL STRAIGHT L7 IN SERRATED TIP DELICATE STERILE SUP-285120 CDM 0270 RC outpatient 47.76 47.76 47.76 74 35.34 percent of total billed charges 47.76 93 38.69 percent of total billed charges 47.76 47.76 other OPPS APC 47.76 47.76 other OPPS APC 47.76 27.63 13.2 percent of total billed charges 47.76 47.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS SURGICAL GERALD L7 IN DRESSING BAYONET SERRATED SUP-285122 CDM 0270 RC outpatient 76.28 76.28 76.28 74 56.45 percent of total billed charges 76.28 93 61.79 percent of total billed charges 76.28 76.28 other OPPS APC 76.28 76.28 other OPPS APC 76.28 27.63 21.08 percent of total billed charges 76.28 76.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELEVATOR SURGICAL FREER L7.75 IN X W4.5 MM SHARP/BLUNT 2 END SUP-285380 CDM outpatient 52.18 52.18 52.18 52.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE SUCTION FRAZIER STAINLESS STEEL ANGLE L7 IN L4.25 IN OD10 FR NONSTERILE SUP-285454 CDM 0270 RC outpatient 45.89 45.89 45.89 74 33.96 percent of total billed charges 45.89 93 37.17 percent of total billed charges 45.89 45.89 other OPPS APC 45.89 45.89 other OPPS APC 45.89 27.63 12.68 percent of total billed charges 45.89 45.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNI-CP STAINLESS STEEL L34 MM OD3.5 MM FOOT LOCKING REPLACEMENT STERILE SUP-286 334 SND CDM 0270 RC outpatient 817.7 817.7 817.7 74 605.1 percent of total billed charges 817.7 93 662.34 percent of total billed charges 817.7 817.7 other OPPS APC 817.7 817.7 other OPPS APC 817.7 27.63 225.93 percent of total billed charges 817.7 817.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTEGRA 12MM STAINLESS SUP-286312 CDM 0270 RC outpatient 912.6 912.6 912.6 74 675.32 percent of total billed charges 912.6 93 739.21 percent of total billed charges 912.6 912.6 other OPPS APC 912.6 912.6 other OPPS APC 912.6 27.63 252.15 percent of total billed charges 912.6 912.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW INTEGRA 3.5MM X14MM SUP-286314 CDM 0270 RC outpatient 817.7 817.7 817.7 74 605.1 percent of total billed charges 817.7 93 662.34 percent of total billed charges 817.7 817.7 other OPPS APC 817.7 817.7 other OPPS APC 817.7 27.63 225.93 percent of total billed charges 817.7 817.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW INTEGRA 3.5MM X16MM SUP-286316 CDM 0270 RC outpatient 912.6 912.6 912.6 74 675.32 percent of total billed charges 912.6 93 739.21 percent of total billed charges 912.6 912.6 other OPPS APC 912.6 912.6 other OPPS APC 912.6 27.63 252.15 percent of total billed charges 912.6 912.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW INTEGRA 3.5MM X18MM SUP-286318 CDM 0270 RC outpatient 817.7 817.7 817.7 74 605.1 percent of total billed charges 817.7 93 662.34 percent of total billed charges 817.7 817.7 other OPPS APC 817.7 817.7 other OPPS APC 817.7 27.63 225.93 percent of total billed charges 817.7 817.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTEGRA 3.5MM X 20MM SUP-286320 CDM 0270 RC outpatient 817.7 817.7 817.7 74 605.1 percent of total billed charges 817.7 93 662.34 percent of total billed charges 817.7 817.7 other OPPS APC 817.7 817.7 other OPPS APC 817.7 27.63 225.93 percent of total billed charges 817.7 817.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTEGRA 3.5MM X 22MM SUP-286322 CDM 0270 RC outpatient 817.7 817.7 817.7 74 605.1 percent of total billed charges 817.7 93 662.34 percent of total billed charges 817.7 817.7 other OPPS APC 817.7 817.7 other OPPS APC 817.7 27.63 225.93 percent of total billed charges 817.7 817.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW INTEGRA 3.5MM X24MM SUP-286324 CDM 0270 RC outpatient 817.7 817.7 817.7 74 605.1 percent of total billed charges 817.7 93 662.34 percent of total billed charges 817.7 817.7 other OPPS APC 817.7 817.7 other OPPS APC 817.7 27.63 225.93 percent of total billed charges 817.7 817.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW INTEGRA 3.5MM X26MM SUP-286326 CDM 0270 RC outpatient 817.7 817.7 817.7 74 605.1 percent of total billed charges 817.7 93 662.34 percent of total billed charges 817.7 817.7 other OPPS APC 817.7 817.7 other OPPS APC 817.7 27.63 225.93 percent of total billed charges 817.7 817.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW INTEGRA 3.5MM X28MM SUP-286328 CDM 0270 RC outpatient 817.7 817.7 817.7 74 605.1 percent of total billed charges 817.7 93 662.34 percent of total billed charges 817.7 817.7 other OPPS APC 817.7 817.7 other OPPS APC 817.7 27.63 225.93 percent of total billed charges 817.7 817.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW INTEGRA 3.5MM X30MM SUP-286330 CDM 0270 RC outpatient 817.7 817.7 817.7 74 605.1 percent of total billed charges 817.7 93 662.34 percent of total billed charges 817.7 817.7 other OPPS APC 817.7 817.7 other OPPS APC 817.7 27.63 225.93 percent of total billed charges 817.7 817.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW INTEGRA 3.5MM X32MM SUP-286332 CDM 0270 RC outpatient 912.6 912.6 912.6 74 675.32 percent of total billed charges 912.6 93 739.21 percent of total billed charges 912.6 912.6 other OPPS APC 912.6 912.6 other OPPS APC 912.6 27.63 252.15 percent of total billed charges 912.6 912.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW INTEGRA 3.5MM X36MM SUP-286336 CDM 0270 RC outpatient 912.6 912.6 912.6 74 675.32 percent of total billed charges 912.6 93 739.21 percent of total billed charges 912.6 912.6 other OPPS APC 912.6 912.6 other OPPS APC 912.6 27.63 252.15 percent of total billed charges 912.6 912.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW INTEGRA 3.5MM X38MM SUP-286338 CDM 0270 RC outpatient 912.6 912.6 912.6 74 675.32 percent of total billed charges 912.6 93 739.21 percent of total billed charges 912.6 912.6 other OPPS APC 912.6 912.6 other OPPS APC 912.6 27.63 252.15 percent of total billed charges 912.6 912.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW INTEGRA 3.5MM X40MM SUP-286340 CDM 0270 RC outpatient 912.6 912.6 912.6 74 675.32 percent of total billed charges 912.6 93 739.21 percent of total billed charges 912.6 912.6 other OPPS APC 912.6 912.6 other OPPS APC 912.6 27.63 252.15 percent of total billed charges 912.6 912.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT NEEDLE HOLDER SUTURE RETENTION SLOT DISPOSABLE OCTOBASE RETRACTOR SUP-28707 CDM 0270 RC outpatient 150.8 150.8 150.8 74 111.59 percent of total billed charges 150.8 93 122.15 percent of total billed charges 150.8 150.8 other OPPS APC 150.8 150.8 other OPPS APC 150.8 27.63 41.67 percent of total billed charges 150.8 150.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE 3 MM X 40 CM SUP-29-00001 CDM 0272 RC outpatient 48.76 48.76 48.76 74 36.08 percent of total billed charges 48.76 93 39.5 percent of total billed charges 48.76 48.76 other OPPS APC 48.76 48.76 other OPPS APC 48.76 27.63 13.47 percent of total billed charges 48.76 48.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR SILVER NITRATE 47-1 SUP-29-00003 CDM 0272 RC outpatient 130.07 130.07 130.07 74 96.25 percent of total billed charges 130.07 93 105.36 percent of total billed charges 130.07 130.07 other OPPS APC 130.07 130.07 other OPPS APC 130.07 27.63 35.94 percent of total billed charges 130.07 130.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CIV-FLEX TRANSDUCER COVER 14X147 SUP-29-00004 CDM 0272 RC outpatient 34.34 34.34 34.34 74 25.41 percent of total billed charges 34.34 93 27.82 percent of total billed charges 34.34 34.34 other OPPS APC 34.34 34.34 other OPPS APC 34.34 27.63 9.49 percent of total billed charges 34.34 34.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2 LEVEL RACK SUP-29-13900 CDM 0270 RC outpatient 4693 4693 4693 74 3472.82 percent of total billed charges 4693 93 3801.33 percent of total billed charges 4693 4693 other OPPS APC 4693 4693 other OPPS APC 4693 27.63 1296.68 percent of total billed charges 4693 4693 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY HMMF INSTRUMENTS SUP-29-13908 CDM 0270 RC outpatient 1749.8 1749.8 1749.8 74 1294.85 percent of total billed charges 1749.8 93 1417.34 percent of total billed charges 1749.8 1749.8 other OPPS APC 1749.8 1749.8 other OPPS APC 1749.8 27.63 483.47 percent of total billed charges 1749.8 1749.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.0 HMMF PLT/SCR MODULE W/LID SUP-29-23907 CDM 0270 RC outpatient 9695.4 9695.4 9695.4 74 7174.6 percent of total billed charges 9695.4 93 7853.27 percent of total billed charges 9695.4 9695.4 other OPPS APC 9695.4 9695.4 other OPPS APC 9695.4 27.63 2678.84 percent of total billed charges 9695.4 9695.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE EQUIPMENT UNIVERSAL L96 IN X W7 IN VIDEO CAMERA TELESCOPIC FOLDED CUFF ADHESIVE CLOSURE STRIP NONSTERILE DISPOSABLE SUP-29-29049 CDM 0270 RC outpatient 13.2 13.2 13.2 74 9.77 percent of total billed charges 13.2 93 10.69 percent of total billed charges 13.2 13.2 other OPPS APC 13.2 13.2 other OPPS APC 13.2 27.63 3.65 percent of total billed charges 13.2 13.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEPITEL 2 X 3 SUP-290-510 CDM 0270 RC outpatient 15.94 15.94 15.94 74 11.8 percent of total billed charges 15.94 93 12.91 percent of total billed charges 15.94 15.94 other OPPS APC 15.94 15.94 other OPPS APC 15.94 27.63 4.4 percent of total billed charges 15.94 15.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER NCB STAINLESS STEEL STANDARD L280 MM OD2 MM FEMUR DISTAL NONSTERILE SUP-290.20.280 CDM 0270 RC outpatient 59.9 59.9 59.9 74 44.33 percent of total billed charges 59.9 93 48.52 percent of total billed charges 59.9 59.9 other OPPS APC 59.9 59.9 other OPPS APC 59.9 27.63 16.55 percent of total billed charges 59.9 59.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE 3.2 290MM SUP-290.69 CDM 270010022 LOCAL 0270 RC outpatient 236.34 236.34 236.34 74 174.89 percent of total billed charges 236.34 93 191.44 percent of total billed charges 236.34 236.34 other OPPS APC 236.34 236.34 other OPPS APC 236.34 27.63 65.3 percent of total billed charges 236.34 236.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE HALLULOCK 10IN SUP-290155 CDM 0270 RC outpatient 4690.4 4690.4 4690.4 74 3470.9 percent of total billed charges 4690.4 93 3799.22 percent of total billed charges 4690.4 4690.4 other OPPS APC 4690.4 4690.4 other OPPS APC 4690.4 27.63 1295.96 percent of total billed charges 4690.4 4690.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE INTEGRA 4 HOLE RIGHT SUP-290338 CDM 0270 RC outpatient 4261.4 4261.4 4261.4 74 3153.44 percent of total billed charges 4261.4 93 3451.73 percent of total billed charges 4261.4 4261.4 other OPPS APC 4261.4 4261.4 other OPPS APC 4261.4 27.63 1177.42 percent of total billed charges 4261.4 4261.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE INTEGRA HALLULOCK S SIZE 3 RIGHT SUP-290560 CDM 0270 RC outpatient 4558.32 4558.32 4558.32 74 3373.16 percent of total billed charges 4558.32 93 3692.24 percent of total billed charges 4558.32 4558.32 other OPPS APC 4558.32 4558.32 other OPPS APC 4558.32 27.63 1259.46 percent of total billed charges 4558.32 4558.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SHAVER MCDEB OD4 MM AGGRESSIVE IRRIGATE SERRATE STERILE SUP-290645000 CDM 0270 RC outpatient 303.84 303.84 303.84 74 224.84 percent of total billed charges 303.84 93 246.11 percent of total billed charges 303.84 303.84 other OPPS APC 303.84 303.84 other OPPS APC 303.84 27.63 83.95 percent of total billed charges 303.84 303.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE INTEGRA HALLULAH S PLATE SIZE 3 SUP-290660 CDM 0270 RC outpatient 4549.69 4549.69 4549.69 74 3366.77 percent of total billed charges 4549.69 93 3685.25 percent of total billed charges 4549.69 4549.69 other OPPS APC 4549.69 4549.69 other OPPS APC 4549.69 27.63 1257.08 percent of total billed charges 4549.69 4549.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE BLOWER/MISTER ACCUMIST ATTACHED TUBING SET SUP-29150 CDM 0270 RC outpatient 117 117 117 74 86.58 percent of total billed charges 117 93 94.77 percent of total billed charges 117 117 other OPPS APC 117 117 other OPPS APC 117 27.63 32.33 percent of total billed charges 117 117 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER 70MM .8MM SS NS TROCAR POINT SUP-292.08 CDM 270010022 LOCAL 0270 RC outpatient 20.59 20.59 20.59 74 15.24 percent of total billed charges 20.59 93 16.68 percent of total billed charges 20.59 20.59 other OPPS APC 20.59 20.59 other OPPS APC 20.59 27.63 5.69 percent of total billed charges 20.59 20.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL L150 MM OD1.25 MM TROCAR POINT NONSTERILE SUP-292.12 CDM 270010022 LOCAL 0270 RC outpatient 20.93 20.93 20.93 74 15.49 percent of total billed charges 20.93 93 16.95 percent of total billed charges 20.93 20.93 other OPPS APC 20.93 20.93 other OPPS APC 20.93 27.63 5.78 percent of total billed charges 20.93 20.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL L150 MM OD1.6 MM TROCAR POINT NONSTERILE SUP-292.16 CDM 270010022 LOCAL 0270 RC outpatient 20.93 20.93 20.93 74 15.49 percent of total billed charges 20.93 93 16.95 percent of total billed charges 20.93 20.93 other OPPS APC 20.93 20.93 other OPPS APC 20.93 27.63 5.78 percent of total billed charges 20.93 20.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER 150MM 2MM SS NS TROCAR POINT SUP-292.20 CDM 270010022 LOCAL 0270 RC outpatient 20.93 20.93 20.93 74 15.49 percent of total billed charges 20.93 93 16.95 percent of total billed charges 20.93 20.93 other OPPS APC 20.93 20.93 other OPPS APC 20.93 27.63 5.78 percent of total billed charges 20.93 20.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL L150 MM OD2.5 MM TROCAR POINT NONSTERILE SUP-292.25 CDM 270010022 LOCAL 0270 RC outpatient 237.38 237.38 237.38 74 175.66 percent of total billed charges 237.38 93 192.28 percent of total billed charges 237.38 237.38 other OPPS APC 237.38 237.38 other OPPS APC 237.38 27.63 65.59 percent of total billed charges 237.38 237.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL L285 MM OD2.5 MM TROCAR POINT SUP-292.26 CDM 270010022 LOCAL 0270 RC outpatient 29.6 29.6 29.6 74 21.9 percent of total billed charges 29.6 93 23.98 percent of total billed charges 29.6 29.6 other OPPS APC 29.6 29.6 other OPPS APC 29.6 27.63 8.18 percent of total billed charges 29.6 29.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER 150MM 3MM SS NS TROCAR POINT SUP-292.30 CDM 270010022 LOCAL 0270 RC outpatient 49.06 49.06 49.06 74 36.3 percent of total billed charges 49.06 93 39.74 percent of total billed charges 49.06 49.06 other OPPS APC 49.06 49.06 other OPPS APC 49.06 27.63 13.56 percent of total billed charges 49.06 49.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL L350 MM OD2 MM SPADE POINT NONSTERILE SUP-292.40 CDM 270010022 LOCAL 0270 RC outpatient 210.21 210.21 210.21 74 155.56 percent of total billed charges 210.21 93 170.27 percent of total billed charges 210.21 210.21 other OPPS APC 210.21 210.21 other OPPS APC 210.21 27.63 58.08 percent of total billed charges 210.21 210.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER 150MM 1.6MM SS NS 2 END TROCAR POINT SUP-292.56 CDM 270010022 LOCAL 0270 RC outpatient 57.68 57.68 57.68 74 42.68 percent of total billed charges 57.68 93 46.72 percent of total billed charges 57.68 57.68 other OPPS APC 57.68 57.68 other OPPS APC 57.68 27.63 15.94 percent of total billed charges 57.68 57.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL L100 MM OD1.25 MM CORTICAL LASER ETCH THREAD TIP NONSTERILE MINI EXTERNAL FIXATOR SUP-292.600 CDM 270010022 LOCAL 0270 RC outpatient 121.98 121.98 121.98 74 90.27 percent of total billed charges 121.98 93 98.8 percent of total billed charges 121.98 121.98 other OPPS APC 121.98 121.98 other OPPS APC 121.98 27.63 33.7 percent of total billed charges 121.98 121.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC STAINLESS STEEL L150 MM OD1.1 MM THREAD NONSTERILE 3 MM CANNULATED SCREW SUP-292.622 CDM 270010022 LOCAL 0270 RC outpatient 61.15 61.15 61.15 74 45.25 percent of total billed charges 61.15 93 49.53 percent of total billed charges 61.15 61.15 other OPPS APC 61.15 61.15 other OPPS APC 61.15 27.63 16.9 percent of total billed charges 61.15 61.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC STAINLESS STEEL L150 MM OD1.1 MM NONTHREADED NONSTERILE CANNULATED SCREW SET SUP-292.623 CDM 270010022 LOCAL 0270 RC outpatient 74.36 74.36 74.36 74 55.03 percent of total billed charges 74.36 93 60.23 percent of total billed charges 74.36 74.36 other OPPS APC 74.36 74.36 other OPPS APC 74.36 27.63 20.55 percent of total billed charges 74.36 74.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC 230MM 2MM SS NS THREAD SUP-292.65 CDM 270010022 LOCAL 0270 RC outpatient 108.68 108.68 108.68 74 80.42 percent of total billed charges 108.68 93 88.03 percent of total billed charges 108.68 108.68 other OPPS APC 108.68 108.68 other OPPS APC 108.68 27.63 30.03 percent of total billed charges 108.68 108.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC L410 MM OD1.6 MM SUP-292.655 CDM 270010022 LOCAL 0270 RC outpatient 145.86 145.86 145.86 74 107.94 percent of total billed charges 145.86 93 118.15 percent of total billed charges 145.86 145.86 other OPPS APC 145.86 145.86 other OPPS APC 145.86 27.63 40.3 percent of total billed charges 145.86 145.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC 230MM 2MM SS NS NONTHREADED SPADE POINT CANNULATED SCREW SYSTEM SUP-292.656 CDM 270010022 LOCAL 0270 RC outpatient 78.62 78.62 78.62 74 58.18 percent of total billed charges 78.62 93 63.68 percent of total billed charges 78.62 78.62 other OPPS APC 78.62 78.62 other OPPS APC 78.62 27.63 21.72 percent of total billed charges 78.62 78.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC 300MM 2.8MM SS NS THREAD TROCAR POINT SUP-292.68 CDM 270010022 LOCAL 0270 RC outpatient 254.15 254.15 254.15 74 188.07 percent of total billed charges 254.15 93 205.86 percent of total billed charges 254.15 254.15 other OPPS APC 254.15 254.15 other OPPS APC 254.15 27.63 70.22 percent of total billed charges 254.15 254.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC 300MM 3.2MM SS NS CALIBRATED SUP-292.69 CDM 270010022 LOCAL 0270 RC outpatient 318.89 318.89 318.89 74 235.98 percent of total billed charges 318.89 93 258.3 percent of total billed charges 318.89 318.89 other OPPS APC 318.89 318.89 other OPPS APC 318.89 27.63 88.11 percent of total billed charges 318.89 318.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL L280 MM OD2 MM THREAD SPADE POINT TIP NONSTERILE SUP-292.699 CDM 270010022 LOCAL 0270 RC outpatient 110.11 110.11 110.11 74 81.48 percent of total billed charges 110.11 93 89.19 percent of total billed charges 110.11 110.11 other OPPS APC 110.11 110.11 other OPPS APC 110.11 27.63 30.42 percent of total billed charges 110.11 110.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL L100 MM OD1.6 MM THREADED TIP NONSTERILE SUP-292.708 CDM 270010022 LOCAL 0270 RC outpatient 121.98 121.98 121.98 74 90.27 percent of total billed charges 121.98 93 98.8 percent of total billed charges 121.98 121.98 other OPPS APC 121.98 121.98 other OPPS APC 121.98 27.63 33.7 percent of total billed charges 121.98 121.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER 150MM 5MM 1.6MM SS NS TROCAR POINT THREAD SUP-292.71 CDM 270010022 LOCAL 0270 RC outpatient 44.19 44.19 44.19 74 32.7 percent of total billed charges 44.19 93 35.79 percent of total billed charges 44.19 44.19 other OPPS APC 44.19 44.19 other OPPS APC 44.19 27.63 12.21 percent of total billed charges 44.19 44.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC 150MM 1.6MM YELLOW SS NS SPADE POINT THREAD SUP-292.72 CDM 270010022 LOCAL 0270 RC outpatient 90.09 90.09 90.09 74 66.67 percent of total billed charges 90.09 93 72.97 percent of total billed charges 90.09 90.09 other OPPS APC 90.09 90.09 other OPPS APC 90.09 27.63 24.89 percent of total billed charges 90.09 90.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC L150 MM OD1.6 MM NONTHREAD SPADE POINT NONSTERILE 4.5 MM CANNULATED SCREW SUP-292.727 CDM 270010022 LOCAL 0270 RC outpatient 74.36 74.36 74.36 74 55.03 percent of total billed charges 74.36 93 60.23 percent of total billed charges 74.36 74.36 other OPPS APC 74.36 74.36 other OPPS APC 74.36 27.63 20.55 percent of total billed charges 74.36 74.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL L150 MM L15 MM OD2.5 MM TROCAR THREAD NONSTERILE SUP-292.75 CDM 270010022 LOCAL 0270 RC outpatient 48.76 48.76 48.76 74 36.08 percent of total billed charges 48.76 93 39.5 percent of total billed charges 48.76 48.76 other OPPS APC 48.76 48.76 other OPPS APC 48.76 27.63 13.47 percent of total billed charges 48.76 48.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL L150 MM L15 MM OD2 MM THREAD TROCAR POINT NONSTERILE SUP-292.79 CDM 270010022 LOCAL 0270 RC outpatient 45.76 45.76 45.76 74 33.86 percent of total billed charges 45.76 93 37.07 percent of total billed charges 45.76 45.76 other OPPS APC 45.76 45.76 other OPPS APC 45.76 27.63 12.64 percent of total billed charges 45.76 45.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC 300MM 150MM 2.8MM SS NS CALIBRATED FLUTE DRILL POINT TIP NONTHREAD 6.5/7.3MM CANNULATED SCREW SUP-292.81 CDM 270010022 LOCAL 0270 RC outpatient 270.27 270.27 270.27 74 200 percent of total billed charges 270.27 93 218.92 percent of total billed charges 270.27 270.27 other OPPS APC 270.27 270.27 other OPPS APC 270.27 27.63 74.68 percent of total billed charges 270.27 270.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION STEINMANN STAINLESS STEEL L200 MM OD5 MM ODSEC5.5 MM CENTRAL THREAD NONSTERILE LARGE EXTERNAL FIXATOR SUP-293.74 CDM 270010022 LOCAL 0270 RC outpatient 236.6 236.6 236.6 74 175.08 percent of total billed charges 236.6 93 191.65 percent of total billed charges 236.6 236.6 other OPPS APC 236.6 236.6 other OPPS APC 236.6 27.63 65.37 percent of total billed charges 236.6 236.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION STEINMANN STAINLESS STEEL CENTRAL THREAD L225 MM OD5 MM ODSEC5.5 MM NONSTERILE LARGE EXTERNAL FIXATOR SUP-293.790 CDM 270010022 LOCAL 0270 RC outpatient 236.6 236.6 236.6 74 175.08 percent of total billed charges 236.6 93 191.65 percent of total billed charges 236.6 236.6 other OPPS APC 236.6 236.6 other OPPS APC 236.6 27.63 65.37 percent of total billed charges 236.6 236.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION STEINMANN STAINLESS STEEL L250 MM OD5 MM ODSEC5.5 MM 3 FLAT END CENTRAL THREAD ROUND TROCAR POINT NONSTERILE LARGE EXTERNAL FIXATOR SUP-293.840 CDM 270010022 LOCAL 0270 RC outpatient 236.6 236.6 236.6 74 175.08 percent of total billed charges 236.6 93 191.65 percent of total billed charges 236.6 236.6 other OPPS APC 236.6 236.6 other OPPS APC 236.6 27.63 65.37 percent of total billed charges 236.6 236.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN TRACTION STEINMANN L275 MM OD5 MM ODSEC5.5 MM CENTRAL THREAD LARGE EXTERNAL FIXATOR SUP-293.890 CDM 270010022 LOCAL 0270 RC outpatient 236.6 236.6 236.6 74 175.08 percent of total billed charges 236.6 93 191.65 percent of total billed charges 236.6 236.6 other OPPS APC 236.6 236.6 other OPPS APC 236.6 27.63 65.37 percent of total billed charges 236.6 236.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SELF DRILLING SCHANZ 5.0 X 175 SUP-294.285 CDM 270010022 LOCAL 0270 RC outpatient 409.5 409.5 409.5 74 303.03 percent of total billed charges 409.5 93 331.7 percent of total billed charges 409.5 409.5 other OPPS APC 409.5 409.5 other OPPS APC 409.5 27.63 113.14 percent of total billed charges 409.5 409.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SCHANZ 170MM 50MM 5MM SS NS BLUNT TROCAR POINT LG EXTERNAL FIXATOR SUP-294.55 CDM 270010022 LOCAL 0270 RC outpatient 182 182 182 74 134.68 percent of total billed charges 182 93 147.42 percent of total billed charges 182 182 other OPPS APC 182 182 other OPPS APC 182 27.63 50.29 percent of total billed charges 182 182 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SCHANZ STAINLESS STEEL LARGE L200 MM OD5 MM HIP CONDYLE BLUNT TROCAR POINT NONSTERILE SUP-294.56 CDM 270009127 LOCAL 0270 RC outpatient 34.01 34.01 34.01 74 25.17 percent of total billed charges 34.01 93 27.55 percent of total billed charges 34.01 34.01 other OPPS APC 34.01 34.01 other OPPS APC 34.01 27.63 9.4 percent of total billed charges 34.01 34.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL BLUNT SPADE L160 MM L50 MM OD6 MM TROCAR NONSTERILE LARGE EXTERNAL FIXATOR SUP-294.67 CDM 270010022 LOCAL 0270 RC outpatient 163.8 163.8 163.8 74 121.21 percent of total billed charges 163.8 93 132.68 percent of total billed charges 163.8 163.8 other OPPS APC 163.8 163.8 other OPPS APC 163.8 27.63 45.26 percent of total billed charges 163.8 163.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL BLUNT SPADE L190 MM L50 MM OD6 MM TROCAR NONSTERILE LARGE EXTERNAL FIXATOR SUP-294.68 CDM 270010022 LOCAL 0270 RC outpatient 163.8 163.8 163.8 74 121.21 percent of total billed charges 163.8 93 132.68 percent of total billed charges 163.8 163.8 other OPPS APC 163.8 163.8 other OPPS APC 163.8 27.63 45.26 percent of total billed charges 163.8 163.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SCHANZ STAINLESS STEEL L80 MM L20 MM OD4 MM ODSEC3 MM HIP CONDYLE RADIUS SELF DRILL NONSTERILE LARGE EXTERNAL FIXATION SYSTEM SUP-294.771 CDM 270010022 LOCAL 0270 RC outpatient 325.13 325.13 325.13 74 240.6 percent of total billed charges 325.13 93 263.36 percent of total billed charges 325.13 325.13 other OPPS APC 325.13 325.13 other OPPS APC 325.13 27.63 89.83 percent of total billed charges 325.13 325.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SCHANZ STAINLESS STEEL L125 MM L40 MM OD4 MM HIP CONDYLE RADIUS SELF DRILL NONSTERILE LARGE EXTERNAL FIXATION SYSTEM SUP-294.777 CDM 270010022 LOCAL 0270 RC outpatient 436.15 436.15 436.15 74 322.75 percent of total billed charges 436.15 93 353.28 percent of total billed charges 436.15 436.15 other OPPS APC 436.15 436.15 other OPPS APC 436.15 27.63 120.51 percent of total billed charges 436.15 436.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EXTERNAL FIXATION SCHANZ STAINLESS STEEL L150 MM L40 MM OD4 MM HIP CONDYLE SELF DRILL NONSTERILE SUP-294.778 CDM 270010022 LOCAL 0270 RC outpatient 436.15 436.15 436.15 74 322.75 percent of total billed charges 436.15 93 353.28 percent of total billed charges 436.15 436.15 other OPPS APC 436.15 436.15 other OPPS APC 436.15 27.63 120.51 percent of total billed charges 436.15 436.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SCHANZ 150MM 60MM 5MM SS NS SELF DRILL EXTERNAL FIXATION SUP-294.784 CDM 270010022 LOCAL 0270 RC outpatient 312.13 312.13 312.13 74 230.98 percent of total billed charges 312.13 93 252.83 percent of total billed charges 312.13 312.13 other OPPS APC 312.13 312.13 other OPPS APC 312.13 27.63 86.24 percent of total billed charges 312.13 312.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SCHANZ STAINLESS STEEL L175 MM L60 MM OD5 MM RADIUS DISTAL SELF DRILL NONSTERILE SUP-294.785 CDM 270010022 LOCAL 0270 RC outpatient 1012.18 1012.18 1012.18 74 749.01 percent of total billed charges 1012.18 93 819.87 percent of total billed charges 1012.18 1012.18 other OPPS APC 1012.18 1012.18 other OPPS APC 1012.18 27.63 279.67 percent of total billed charges 1012.18 1012.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW FIXATION SCHANZ STAINLESS STEEL L200 MM L80 MM OD5 MM SELF DRILLING NONSTERILE SUP-294.786 CDM 270010022 LOCAL 0270 RC outpatient 1012.18 1012.18 1012.18 74 749.01 percent of total billed charges 1012.18 93 819.87 percent of total billed charges 1012.18 1012.18 other OPPS APC 1012.18 1012.18 other OPPS APC 1012.18 27.63 279.67 percent of total billed charges 1012.18 1012.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SCHANZ STAINLESS STEEL L175 MM L60 MM OD6 MM DISTAL RADIUS SELF DRILLING NONSTERILE SUP-294.795 CDM 0270 RC outpatient 523.38 523.38 523.38 74 387.3 percent of total billed charges 523.38 93 423.94 percent of total billed charges 523.38 523.38 other OPPS APC 523.38 523.38 other OPPS APC 523.38 27.63 144.61 percent of total billed charges 523.38 523.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION STEINMANN STAINLESS STEEL L225 MM OD6 MM TRANSFIXATION NONSTERILE SUP-294.950 CDM 270010022 LOCAL 0270 RC outpatient 237.51 237.51 237.51 74 175.76 percent of total billed charges 237.51 93 192.38 percent of total billed charges 237.51 237.51 other OPPS APC 237.51 237.51 other OPPS APC 237.51 27.63 65.62 percent of total billed charges 237.51 237.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL CONVERTORS 122X106X77IN TIBURON VELCRO FOAM STERILE LF CESAREAN BIRTH 360D FLUID CONTROL POUCH ARMBOARD SUP-29449 CDM 0270 RC outpatient 38.37 38.37 38.37 74 28.39 percent of total billed charges 38.37 93 31.08 percent of total billed charges 38.37 38.37 other OPPS APC 38.37 38.37 other OPPS APC 38.37 27.63 10.6 percent of total billed charges 38.37 38.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL CONVERTORS TIBURON VELCRO L110 IN X W109 IN X H100 IN L18 IN X W16 IN FLUID CONTROL POUCH FENESTRATION ABSORBENT IMPERVIOUS REINFORCEMENT ARMBOARD COVER STERILE DISPOSABLE LAVH SUP-29474 CDM 0270 RC outpatient 33.67 33.67 33.67 74 24.92 percent of total billed charges 33.67 93 27.27 percent of total billed charges 33.67 33.67 other OPPS APC 33.67 33.67 other OPPS APC 33.67 27.63 9.3 percent of total billed charges 33.67 33.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL CONVERTORS TIBURON NEONATE L4 IN W3 IN L60 IN X W44 IN L19 IN X W18 1/2 IN REINFORCE FENESTRATE ABSORBENT ADHESIVE STRIP STERILE LATEX FREE DISPOSABLE SUP-29494 CDM 0270 RC outpatient 6.11 6.11 6.11 74 4.52 percent of total billed charges 6.11 93 4.95 percent of total billed charges 6.11 6.11 other OPPS APC 6.11 6.11 other OPPS APC 6.11 27.63 1.69 percent of total billed charges 6.11 6.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTEGRA VARIABLE 2.7MM X 12MM SUP-295212 CDM 0270 RC outpatient 975 975 975 74 721.5 percent of total billed charges 975 93 789.75 percent of total billed charges 975 975 other OPPS APC 975 975 other OPPS APC 975 27.63 269.39 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTEGRA VARIABLE 2.7MM X 14MM SUP-295214 CDM 0270 RC outpatient 975 975 975 74 721.5 percent of total billed charges 975 93 789.75 percent of total billed charges 975 975 other OPPS APC 975 975 other OPPS APC 975 27.63 269.39 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTEGRA VARIABLE 2.7MM X 16MM SUP-295216 CDM 0270 RC outpatient 975 975 975 74 721.5 percent of total billed charges 975 93 789.75 percent of total billed charges 975 975 other OPPS APC 975 975 other OPPS APC 975 27.63 269.39 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTEGRA VARIABLE 2.7MM X 18MM SUP-295218 CDM 0270 RC outpatient 975 975 975 74 721.5 percent of total billed charges 975 93 789.75 percent of total billed charges 975 975 other OPPS APC 975 975 other OPPS APC 975 27.63 269.39 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL CLYDESDALE PEEK-OPTIMA 6 D L55 MM X W14 MM LUMBAR INTERBODY FUSION SUP-2968455 CDM 0270 RC outpatient 9672 9672 9672 74 7157.28 percent of total billed charges 9672 93 7834.32 percent of total billed charges 9672 9672 other OPPS APC 9672 9672 other OPPS APC 9672 27.63 2672.37 percent of total billed charges 9672 9672 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SELF DRILL SCHANZ SUP-297.784 CDM 270010022 LOCAL 0270 RC outpatient 439.92 439.92 439.92 74 325.54 percent of total billed charges 439.92 93 356.34 percent of total billed charges 439.92 439.92 other OPPS APC 439.92 439.92 other OPPS APC 439.92 27.63 121.55 percent of total billed charges 439.92 439.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN POSITIONING LCP STAINLESS STEEL OD4.5 MM CERCLAGE THREADED STERILE SUP-298.803S CDM 270010022 LOCAL 0270 RC outpatient 424.97 424.97 424.97 74 314.48 percent of total billed charges 424.97 93 344.23 percent of total billed charges 424.97 424.97 other OPPS APC 424.97 424.97 other OPPS APC 424.97 27.63 117.42 percent of total billed charges 424.97 424.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN SYNTHES 3.5MM CERLAGE THREADED SUP-298.838S CDM 270010022 LOCAL 0270 RC outpatient 481.91 481.91 481.91 74 356.61 percent of total billed charges 481.91 93 390.35 percent of total billed charges 481.91 481.91 other OPPS APC 481.91 481.91 other OPPS APC 481.91 27.63 133.15 percent of total billed charges 481.91 481.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL TWIST HALLU-LOCK L100 MM OD2 MM AO STERILE SUP-299050 CDM 0270 RC outpatient 676.26 676.26 676.26 74 500.43 percent of total billed charges 676.26 93 547.77 percent of total billed charges 676.26 676.26 other OPPS APC 676.26 676.26 other OPPS APC 676.26 27.63 186.85 percent of total billed charges 676.26 676.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CAPSTONE PEEK L22 MM X H7 MM SUP-2990722 CDM 270010020 LOCAL 0270 RC outpatient 7061.6 7061.6 7061.6 74 5225.58 percent of total billed charges 7061.6 93 5719.9 percent of total billed charges 7061.6 7061.6 other OPPS APC 7061.6 7061.6 other OPPS APC 7061.6 27.63 1951.12 percent of total billed charges 7061.6 7061.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CAPSTONE PEEK-OPTIMA L22 MM X H9 MM LUMBAR INTERBODY FUSION SUP-2990922 CDM 270010020 LOCAL 0270 RC outpatient 7062.12 7062.12 7062.12 74 5225.97 percent of total billed charges 7062.12 93 5720.32 percent of total billed charges 7062.12 7062.12 other OPPS APC 7062.12 7062.12 other OPPS APC 7062.12 27.63 1951.26 percent of total billed charges 7062.12 7062.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CAPSTONE PEEK-OPTIMA L26 MM X H9 MM LUMBAR INTERBODY FUSION SUP-2990926 CDM 270010020 LOCAL 0270 RC outpatient 9516 9516 9516 74 7041.84 percent of total billed charges 9516 93 7707.96 percent of total billed charges 9516 9516 other OPPS APC 9516 9516 other OPPS APC 9516 27.63 2629.27 percent of total billed charges 9516 9516 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CAPSTONE PEEK-OPTIMA L22 MM X H10 MM LUMBAR INTERBODY FUSION SUP-2991022 CDM 270010020 LOCAL 0270 RC outpatient 7061.6 7061.6 7061.6 74 5225.58 percent of total billed charges 7061.6 93 5719.9 percent of total billed charges 7061.6 7061.6 other OPPS APC 7061.6 7061.6 other OPPS APC 7061.6 27.63 1951.12 percent of total billed charges 7061.6 7061.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CAPSTONE PEEK-OPTIMA CONVEX L26 MM X H10 MM BULLETED TIP SELF DISTRACTING SUP-2991026 CDM 270010020 LOCAL 0270 RC outpatient 9516 9516 9516 74 7041.84 percent of total billed charges 9516 93 7707.96 percent of total billed charges 9516 9516 other OPPS APC 9516 9516 other OPPS APC 9516 27.63 2629.27 percent of total billed charges 9516 9516 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CAPSTONE PEEK-OPTIMA L22 MM X W11 MM LUMBAR INTERBODY FUSION SUP-2991122 CDM 270010020 LOCAL 0270 RC outpatient 7062.12 7062.12 7062.12 74 5225.97 percent of total billed charges 7062.12 93 5720.32 percent of total billed charges 7062.12 7062.12 other OPPS APC 7062.12 7062.12 other OPPS APC 7062.12 27.63 1951.26 percent of total billed charges 7062.12 7062.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AGENT HEMOSTATIC SURGIFLO THROMBIN 8 ML KIT MATRIX STERILE SUP-2994 CDM 0270 RC outpatient 471.32 471.32 471.32 74 348.78 percent of total billed charges 471.32 93 381.77 percent of total billed charges 471.32 471.32 other OPPS APC 471.32 471.32 other OPPS APC 471.32 27.63 130.23 percent of total billed charges 471.32 471.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC MASTERS 85 D 4.41 SQ CM OD29 MM ID24.2 MM ANNULUS MECHANICAL HEART PYROLYTIC CARBON LEAFLET STANDARD CUFF ORIFICE RING SUP-29AJ-501 CDM 0270 RC outpatient 13891.8 13891.8 13891.8 74 10279.9 percent of total billed charges 13891.8 93 11252.4 percent of total billed charges 13891.8 13891.8 other OPPS APC 13891.8 13891.8 other OPPS APC 13891.8 27.63 3838.3 percent of total billed charges 13891.8 13891.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC MASTERS HEMASHIELD 12CM 29MM COLLAGEN STERILE LF MECHANICAL LOW POROSITY GRAFT MR CONDITIONAL SUP-29CAVGJ-514 CDM 0270 RC outpatient 18070 18070 18070 74 13371.8 percent of total billed charges 18070 93 14636.7 percent of total billed charges 18070 18070 other OPPS APC 18070 18070 other OPPS APC 18070 27.63 4992.74 percent of total billed charges 18070 18070 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT VALVE HEART MITRAL MECHANICAL MASTER STANDARD CUFF ROTATABLE PTFE 29MM SUP-29MJ-501 CDM 0270 RC outpatient 12708.8 12708.8 12708.8 74 9404.51 percent of total billed charges 12708.8 93 10294.1 percent of total billed charges 12708.8 12708.8 other OPPS APC 12708.8 12708.8 other OPPS APC 12708.8 27.63 3511.44 percent of total billed charges 12708.8 12708.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER CRYOABLATION ARCTIC FRONT ADVANCE L23 CM SUP-2AF234 CDM 0270 RC outpatient 11700 11700 11700 74 8658 percent of total billed charges 11700 93 9477 percent of total billed charges 11700 11700 other OPPS APC 11700 11700 other OPPS APC 11700 27.63 3232.71 percent of total billed charges 11700 11700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER CRYOABLATION ARCTIC FRONT ADVANCE L28 CM SUP-2AF284 CDM 0270 RC outpatient 11180 11180 11180 74 8273.2 percent of total billed charges 11180 93 9055.8 percent of total billed charges 11180 11180 other OPPS APC 11180 11180 other OPPS APC 11180 27.63 3089.03 percent of total billed charges 11180 11180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV INJECTION DEXTROSE 5% IN WATER PLASTIC BAG 250ML SUP-2B0062Q CDM 0270 RC outpatient 3.82 3.82 3.82 74 2.83 percent of total billed charges 3.82 93 3.09 percent of total billed charges 3.82 3.82 other OPPS APC 3.82 3.82 other OPPS APC 3.82 27.63 1.06 percent of total billed charges 3.82 3.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV INJECTION DEXTROSE 5% IN PLASTIC BAG 500ML SUP-2B0063Q CDM 0270 RC outpatient 3.74 3.74 3.74 74 2.77 percent of total billed charges 3.74 93 3.03 percent of total billed charges 3.74 3.74 other OPPS APC 3.74 3.74 other OPPS APC 3.74 27.63 1.03 percent of total billed charges 3.74 3.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV DEXTROSE/WATER 5% 1000ML SUP-2B0064X CDM 0270 RC outpatient 4.08 4.08 4.08 74 3.02 percent of total billed charges 4.08 93 3.3 percent of total billed charges 4.08 4.08 other OPPS APC 4.08 4.08 other OPPS APC 4.08 27.63 1.13 percent of total billed charges 4.08 4.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV INJECTION DEXTROSE 5% IN WATER QUAD PACK MINI BAG 50ML SUP-2B0081 CDM 0270 RC outpatient 3.5 3.5 3.5 74 2.59 percent of total billed charges 3.5 93 2.84 percent of total billed charges 3.5 3.5 other OPPS APC 3.5 3.5 other OPPS APC 3.5 27.63 0.97 percent of total billed charges 3.5 3.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV INJECTION DEXTROSE 5% IN WATER QUAD PACK MINI BAG 100ML SUP-2B0082 CDM 0270 RC outpatient 3.5 3.5 3.5 74 2.59 percent of total billed charges 3.5 93 2.84 percent of total billed charges 3.5 3.5 other OPPS APC 3.5 3.5 other OPPS APC 3.5 27.63 0.97 percent of total billed charges 3.5 3.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV INJECTION DEXTROSE 5% SODIUM CHLORIDE 0.9% 500ML SUP-2B1063Q CDM 0270 RC outpatient 4.05 4.05 4.05 74 3 percent of total billed charges 4.05 93 3.28 percent of total billed charges 4.05 4.05 other OPPS APC 4.05 4.05 other OPPS APC 4.05 27.63 1.12 percent of total billed charges 4.05 4.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV INJECTION 5% DEXTROSE 0.9% SODIUM CHLORIDE INJECTION USP 1000ML SUP-2B1064X CDM 0270 RC outpatient 4.35 4.35 4.35 74 3.22 percent of total billed charges 4.35 93 3.52 percent of total billed charges 4.35 4.35 other OPPS APC 4.35 4.35 other OPPS APC 4.35 27.63 1.2 percent of total billed charges 4.35 4.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV INJECTION SODIUM CHLORIDE 5% DEXTROSE 0.45% 500ML SUP-2B1073Q CDM 0270 RC outpatient 4.11 4.11 4.11 74 3.04 percent of total billed charges 4.11 93 3.33 percent of total billed charges 4.11 4.11 other OPPS APC 4.11 4.11 other OPPS APC 4.11 27.63 1.14 percent of total billed charges 4.11 4.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV INJECTION DEXTROSE 5% 0.45% 1000ML SUP-2B1074X CDM 0270 RC outpatient 4.41 4.41 4.41 74 3.26 percent of total billed charges 4.41 93 3.57 percent of total billed charges 4.41 4.41 other OPPS APC 4.41 4.41 other OPPS APC 4.41 27.63 1.22 percent of total billed charges 4.41 4.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV INJECTION DEXTROSE 5% PLUS SODIUM CHLORIDE 0.2% 1000ML SUP-2B1094X CDM outpatient 4.46 4.46 4.46 4.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV INJECTION SODIUM CHLORIDE 0.9% QUAD PACK VISIV 50ML SUP-2B1301 CDM 0270 RC outpatient 3.49 3.49 3.49 74 2.58 percent of total billed charges 3.49 93 2.83 percent of total billed charges 3.49 3.49 other OPPS APC 3.49 3.49 other OPPS APC 3.49 27.63 0.96 percent of total billed charges 3.49 3.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV INJECTION SODIUM CHLORIDE 0.9% 100ML SUP-2B1302 CDM 0270 RC outpatient 3.49 3.49 3.49 74 2.58 percent of total billed charges 3.49 93 2.83 percent of total billed charges 3.49 3.49 other OPPS APC 3.49 3.49 other OPPS APC 3.49 27.63 0.96 percent of total billed charges 3.49 3.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV INJECTION SODIUM CHLORIDE 0.45% SUP-2B1314X CDM 0270 RC outpatient 4.4 4.4 4.4 74 3.26 percent of total billed charges 4.4 93 3.56 percent of total billed charges 4.4 4.4 other OPPS APC 4.4 4.4 other OPPS APC 4.4 27.63 1.22 percent of total billed charges 4.4 4.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV INJECTION SODIUM CHLORIDE 0.9% 250ML SUP-2B1322Q CDM 0270 RC outpatient 3.37 3.37 3.37 74 2.49 percent of total billed charges 3.37 93 2.73 percent of total billed charges 3.37 3.37 other OPPS APC 3.37 3.37 other OPPS APC 3.37 27.63 0.93 percent of total billed charges 3.37 3.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV VIAFLEX 500ML 0.9% SODIUM CHLORIDE LF PLASTIC CONTAINER SUP-2B1323Q CDM 0270 RC outpatient 3.54 3.54 3.54 74 2.62 percent of total billed charges 3.54 93 2.87 percent of total billed charges 3.54 3.54 other OPPS APC 3.54 3.54 other OPPS APC 3.54 27.63 0.98 percent of total billed charges 3.54 3.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV INJECTION SODIUM CHLORIDE 0.9% 1000ML SUP-2B1324X CDM 0270 RC outpatient 4.1 4.1 4.1 74 3.03 percent of total billed charges 4.1 93 3.32 percent of total billed charges 4.1 4.1 other OPPS APC 4.1 4.1 other OPPS APC 4.1 27.63 1.13 percent of total billed charges 4.1 4.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV 1L 20 MEQ POTASSIUM CHLORIDE 5% DEXTROSE 0.2% SODIUM CHLORIDE LF VIAFLEX SUP-2B1614X CDM outpatient 7.65 7.65 7.65 7.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV INJECTION DEXTROSE 5% LACTATED RINGER 1000ML SUP-2B2074X CDM 0270 RC outpatient 4.36 4.36 4.36 74 3.23 percent of total billed charges 4.36 93 3.53 percent of total billed charges 4.36 4.36 other OPPS APC 4.36 4.36 other OPPS APC 4.36 27.63 1.2 percent of total billed charges 4.36 4.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV VIAFLEX 500ML LACTATED RINGERS LF PLASTIC CONTAINER SUP-2B2323Q CDM 0270 RC outpatient 3.79 3.79 3.79 74 2.8 percent of total billed charges 3.79 93 3.07 percent of total billed charges 3.79 3.79 other OPPS APC 3.79 3.79 other OPPS APC 3.79 27.63 1.05 percent of total billed charges 3.79 3.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV INJECTION LACTATED RINGER 1000ML SUP-2B2324X CDM 0270 RC outpatient 4.54 4.54 4.54 74 3.36 percent of total billed charges 4.54 93 3.68 percent of total billed charges 4.54 4.54 other OPPS APC 4.54 4.54 other OPPS APC 4.54 27.63 1.25 percent of total billed charges 4.54 4.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV INJECTION SODIUM CHLORIDE 0.15% KCL DEXTROSE 5% 0.9% 20MEQ 1000ML SUP-2B2434X CDM 0270 RC outpatient 6.41 6.41 6.41 74 4.74 percent of total billed charges 6.41 93 5.19 percent of total billed charges 6.41 6.41 other OPPS APC 6.41 6.41 other OPPS APC 6.41 27.63 1.77 percent of total billed charges 6.41 6.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV POTASSIUM CHL DEX SOL 40MEQ 5% 1000ML SUP-2B2454X CDM outpatient 7.3 7.3 7.3 7.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR LAPAROSCOPIC ENDOPATH XCEL OPTIVIEW 100MM 5MM DISPOSABLE STERILE STABILITY SLEEVE BLADELESS OBTURATOR RADIOLUCENT SUP-2B5LT CDM 0270 RC outpatient 63.72 63.72 63.72 74 47.15 percent of total billed charges 63.72 93 51.61 percent of total billed charges 63.72 63.72 other OPPS APC 63.72 63.72 other OPPS APC 63.72 27.63 17.61 percent of total billed charges 63.72 63.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IRRIGATION UROMATIC 1000ML WATER STERILE LF PLASTIC CONTAINER SUP-2B7114X CDM 0270 RC outpatient 8.24 8.24 8.24 74 6.1 percent of total billed charges 8.24 93 6.67 percent of total billed charges 8.24 8.24 other OPPS APC 8.24 8.24 other OPPS APC 8.24 27.63 2.28 percent of total billed charges 8.24 8.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IRRIGATION UROMATIC 2000ML WATER STERILE LF PLASTIC CONTAINER SUP-2B7116 CDM 270009079 LOCAL 0270 RC outpatient 12.2 12.2 12.2 74 9.03 percent of total billed charges 12.2 93 9.88 percent of total billed charges 12.2 12.2 other OPPS APC 12.2 12.2 other OPPS APC 12.2 27.63 3.37 percent of total billed charges 12.2 12.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV IRRIGATION WATER STERILE 3000ML SUP-2B7117 CDM 270009077 LOCAL 0270 RC outpatient 5.06 5.06 5.06 74 3.74 percent of total billed charges 5.06 93 4.1 percent of total billed charges 5.06 5.06 other OPPS APC 5.06 5.06 other OPPS APC 5.06 27.63 1.4 percent of total billed charges 5.06 5.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV IRRIGATION SODIUM CHLORIDE 0.9% 3000ML SUP-2B7127 CDM 270009079 LOCAL 0270 RC outpatient 5.56 5.56 5.56 74 4.11 percent of total billed charges 5.56 93 4.5 percent of total billed charges 5.56 5.56 other OPPS APC 5.56 5.56 other OPPS APC 5.56 27.63 1.54 percent of total billed charges 5.56 5.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV IRRIGATION GLYCINE 1.5% UROMATIC PLASTIC BAG 3000ML SUP-2B7317 CDM 270009078 LOCAL 0270 RC outpatient 7.01 7.01 7.01 74 5.19 percent of total billed charges 7.01 93 5.68 percent of total billed charges 7.01 7.01 other OPPS APC 7.01 7.01 other OPPS APC 7.01 27.63 1.94 percent of total billed charges 7.01 7.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTAINER IV INTRAVIA 1000ML PVC STERILE LF EMPTY EVACUATE NONPYROGENIC PORT SUP-2B8014 CDM 0270 RC outpatient 6.44 6.44 6.44 74 4.77 percent of total billed charges 6.44 93 5.22 percent of total billed charges 6.44 6.44 other OPPS APC 6.44 6.44 other OPPS APC 6.44 27.63 1.78 percent of total billed charges 6.44 6.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET EXTENSION DEHP L30 IN 4 ML INTRAVENOUS MALE LUER LOCK ADAPTER STERILE LATEX FREE SUP-2C5645 CDM 0270 RC outpatient 1.87 1.87 1.87 74 1.38 percent of total billed charges 1.87 93 1.51 percent of total billed charges 1.87 1.87 other OPPS APC 1.87 1.87 other OPPS APC 1.87 27.63 0.52 percent of total billed charges 1.87 1.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET ADMINISTRATION DUO-VENT CLEARLINK DEHP 10 GTT/ML L37 IN SECONDARY MEDICATION MALE LUER LOCK ADAPTER SPIKE STERILE LATEX FREE SUP-2C7462 CDM 0270 RC outpatient 2.76 2.76 2.76 74 2.04 percent of total billed charges 2.76 93 2.24 percent of total billed charges 2.76 2.76 other OPPS APC 2.76 2.76 other OPPS APC 2.76 27.63 0.76 percent of total billed charges 2.76 2.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET ADMINISTRATION CLEARLINK CONTINU-FLO 10 GTT L105 IN INTRAVENOUS PRIMARY INFUSION MALE LUER LOCK ADAPTER 3 LUER ACTIVATED VALVE RETRACTABLE COLLAR STERILE LATEX FREE SUP-2C8541 CDM 0270 RC outpatient 8.58 8.58 8.58 74 6.35 percent of total billed charges 8.58 93 6.95 percent of total billed charges 8.58 8.58 other OPPS APC 8.58 8.58 other OPPS APC 8.58 27.63 2.37 percent of total billed charges 8.58 8.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WATER SOL F/INHALATION 2000ML BAG SUP-2D0737 CDM 0270 RC outpatient 21.09 21.09 21.09 74 15.61 percent of total billed charges 21.09 93 17.08 percent of total billed charges 21.09 21.09 other OPPS APC 21.09 21.09 other OPPS APC 21.09 27.63 5.83 percent of total billed charges 21.09 21.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR LAPAROSCOPIC ENDOPATH XCEL OPTIVIEW L100 MM OD5 MM STABILITY SLEEVE DILAT TIP STERILE DISPOSABLE SUP-2D5LT CDM 0270 RC outpatient 63.72 63.72 63.72 74 47.15 percent of total billed charges 63.72 93 51.61 percent of total billed charges 63.72 63.72 other OPPS APC 63.72 63.72 other OPPS APC 63.72 27.63 17.61 percent of total billed charges 63.72 63.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IRRIGATION 500ML WATER STERILE LF PLASTIC POUR BOTTLE SUP-2F7113 CDM 0270 RC outpatient 4.39 4.39 4.39 74 3.25 percent of total billed charges 4.39 93 3.56 percent of total billed charges 4.39 4.39 other OPPS APC 4.39 4.39 other OPPS APC 4.39 27.63 1.21 percent of total billed charges 4.39 4.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IRRIGATION 1000ML WATER STERILE LF PLASTIC POUR BOTTLE SUP-2F7114 CDM 0270 RC outpatient 4.45 4.45 4.45 74 3.29 percent of total billed charges 4.45 93 3.6 percent of total billed charges 4.45 4.45 other OPPS APC 4.45 4.45 other OPPS APC 4.45 27.63 1.23 percent of total billed charges 4.45 4.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IRRIGATION SODIUM CHLORIDE 0.9% POUR BOTTLE 500ML SUP-2F7123 CDM 0270 RC outpatient 4.43 4.43 4.43 74 3.28 percent of total billed charges 4.43 93 3.59 percent of total billed charges 4.43 4.43 other OPPS APC 4.43 4.43 other OPPS APC 4.43 27.63 1.22 percent of total billed charges 4.43 4.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IRRIGATION SODIUM CHLORIDE 0.9% POUR BOTTLE 1000ML SUP-2F7124 CDM 0270 RC outpatient 4.62 4.62 4.62 74 3.42 percent of total billed charges 4.62 93 3.74 percent of total billed charges 4.62 4.62 other OPPS APC 4.62 4.62 other OPPS APC 4.62 27.63 1.28 percent of total billed charges 4.62 4.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY TRU-CUT THIN WALL L4 1/2 IN OD14 GA DEPTH MARK REMOVABLE STYLET SCALPEL SHARP EDGE STANDARD HANDLE STERILE LATEX FREE DISPOSABLE SUP-2N2702X CDM 0270 RC outpatient 151.58 151.58 151.58 74 112.17 percent of total billed charges 151.58 93 122.78 percent of total billed charges 151.58 151.58 other OPPS APC 151.58 151.58 other OPPS APC 151.58 27.63 41.88 percent of total billed charges 151.58 151.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY TRU-CUT THIN WALL 6IN 20MM 14GA STEEL DISPOSABLE KIDNEY LIVER SPECIMEN NOTCH REMOVABLE STYLET DEPTH MARK SUP-2N2704X CDM 270009055 LOCAL 0270 RC outpatient 18.56 18.56 18.56 74 13.73 percent of total billed charges 18.56 93 15.03 percent of total billed charges 18.56 18.56 other OPPS APC 18.56 18.56 other OPPS APC 18.56 27.63 5.13 percent of total billed charges 18.56 18.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY TRU-CUT THIN WALL 6IN 20MM 14GA STEEL DISPOSABLE KIDNEY LIVER SPECIMEN NOTCH REMOVABLE STYLET DEPTH MARK SUP-2N2704XA CDM 270009055 LOCAL 0270 RC outpatient 124.82 124.82 124.82 74 92.37 percent of total billed charges 124.82 93 101.1 percent of total billed charges 124.82 124.82 other OPPS APC 124.82 124.82 other OPPS APC 124.82 27.63 34.49 percent of total billed charges 124.82 124.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BINDER BREAST LINED 2XL SUP-2XL-L-BBIND CDM 0270 RC outpatient 95.52 95.52 95.52 74 70.68 percent of total billed charges 95.52 93 77.37 percent of total billed charges 95.52 95.52 other OPPS APC 95.52 95.52 other OPPS APC 95.52 27.63 26.39 percent of total billed charges 95.52 95.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SHILEY PEDIATRIC TRACH TUBE, CUFFLESS, 3.0 MM" SUP-3.0PEF_178001 CDM outpatient 104.81 104.81 104.81 104.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALL COTTON 6 MM XRAY DETECTABLE MARKER STRUNG PREMIUM HIGHLY ABSORBENT SUP-30-00 CDM 0270 RC outpatient 4.13 4.13 4.13 74 3.06 percent of total billed charges 4.13 93 3.35 percent of total billed charges 4.13 4.13 other OPPS APC 4.13 4.13 other OPPS APC 4.13 27.63 1.14 percent of total billed charges 4.13 4.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NASAL TRUMPET SZ-6 24FR SUP-30-00001 CDM 0272 RC outpatient 1.89 1.89 1.89 74 1.4 percent of total billed charges 1.89 93 1.53 percent of total billed charges 1.89 1.89 other OPPS APC 1.89 1.89 other OPPS APC 1.89 27.63 0.52 percent of total billed charges 1.89 1.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NASAL TRUMPET SZ-7 28FR SUP-30-00002 CDM 0272 RC outpatient 1.89 1.89 1.89 74 1.4 percent of total billed charges 1.89 93 1.53 percent of total billed charges 1.89 1.89 other OPPS APC 1.89 1.89 other OPPS APC 1.89 27.63 0.52 percent of total billed charges 1.89 1.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NASAL TRUMPET SZ-8 32FR SUP-30-00003 CDM 0272 RC outpatient 1.95 1.95 1.95 74 1.44 percent of total billed charges 1.95 93 1.58 percent of total billed charges 1.95 1.95 other OPPS APC 1.95 1.95 other OPPS APC 1.95 27.63 0.54 percent of total billed charges 1.95 1.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CO2 DETECTORS SUP-30-00010 CDM 0272 RC outpatient 57.57 57.57 57.57 74 42.6 percent of total billed charges 57.57 93 46.63 percent of total billed charges 57.57 57.57 other OPPS APC 57.57 57.57 other OPPS APC 57.57 27.63 15.91 percent of total billed charges 57.57 57.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPIROMETER WITH VALVE SUP-30-00023 CDM 0272 RC outpatient 2.09 2.09 2.09 74 1.55 percent of total billed charges 2.09 93 1.69 percent of total billed charges 2.09 2.09 other OPPS APC 2.09 2.09 other OPPS APC 2.09 27.63 0.58 percent of total billed charges 2.09 2.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MASK, FULL FACE SMALL W/HG" SUP-30-00033 CDM 0272 RC outpatient 95.29 95.29 95.29 74 70.51 percent of total billed charges 95.29 93 77.18 percent of total billed charges 95.29 95.29 other OPPS APC 95.29 95.29 other OPPS APC 95.29 27.63 26.33 percent of total billed charges 95.29 95.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MASK, FULL FACE MED W/HG" SUP-30-00034 CDM 0272 RC outpatient 96.15 96.15 96.15 74 71.15 percent of total billed charges 96.15 93 77.88 percent of total billed charges 96.15 96.15 other OPPS APC 96.15 96.15 other OPPS APC 96.15 27.63 26.57 percent of total billed charges 96.15 96.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MASK, FULL FACE LARGE W/HG" SUP-30-00035 CDM 0272 RC outpatient 96.38 96.38 96.38 74 71.32 percent of total billed charges 96.38 93 78.07 percent of total billed charges 96.38 96.38 other OPPS APC 96.38 96.38 other OPPS APC 96.38 27.63 26.63 percent of total billed charges 96.38 96.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK CONTOUR SMALL DISP NASAL MASK SUP-30-00036 CDM 0272 RC outpatient 49.24 49.24 49.24 74 36.44 percent of total billed charges 49.24 93 39.88 percent of total billed charges 49.24 49.24 other OPPS APC 49.24 49.24 other OPPS APC 49.24 27.63 13.61 percent of total billed charges 49.24 49.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK CONTOUR PETITE DISP NASAL MASK SUP-30-00037 CDM 0272 RC outpatient 49.04 49.04 49.04 74 36.29 percent of total billed charges 49.04 93 39.72 percent of total billed charges 49.04 49.04 other OPPS APC 49.04 49.04 other OPPS APC 49.04 27.63 13.55 percent of total billed charges 49.04 49.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK CONTOUR MED/LG DISP NASAL MASK SUP-30-00038 CDM 0272 RC outpatient 46.78 46.78 46.78 74 34.62 percent of total billed charges 46.78 93 37.89 percent of total billed charges 46.78 46.78 other OPPS APC 46.78 46.78 other OPPS APC 46.78 27.63 12.93 percent of total billed charges 46.78 46.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK VENTURI SUP-30-00068 CDM 0272 RC outpatient 1.41 1.41 1.41 74 1.04 percent of total billed charges 1.41 93 1.14 percent of total billed charges 1.41 1.41 other OPPS APC 1.41 1.41 other OPPS APC 1.41 27.63 0.39 percent of total billed charges 1.41 1.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEBULIZER HAND-HELD SUP-30-00069 CDM 0272 RC outpatient 0.91 0.91 0.91 74 0.67 percent of total billed charges 0.91 93 0.74 percent of total billed charges 0.91 0.91 other OPPS APC 0.91 0.91 other OPPS APC 0.91 27.63 0.25 percent of total billed charges 0.91 0.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LMA DISP SZ 3 SUP-30-00082 CDM 0272 RC outpatient 47.39 47.39 47.39 74 35.07 percent of total billed charges 47.39 93 38.39 percent of total billed charges 47.39 47.39 other OPPS APC 47.39 47.39 other OPPS APC 47.39 27.63 13.09 percent of total billed charges 47.39 47.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LMA DISP SZ 5 SUP-30-00083 CDM 0272 RC outpatient 47.13 47.13 47.13 74 34.88 percent of total billed charges 47.13 93 38.18 percent of total billed charges 47.13 47.13 other OPPS APC 47.13 47.13 other OPPS APC 47.13 27.63 13.02 percent of total billed charges 47.13 47.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LMA DISP SZ 4 SUP-30-00084 CDM 0272 RC outpatient 46.76 46.76 46.76 74 34.6 percent of total billed charges 46.76 93 37.88 percent of total billed charges 46.76 46.76 other OPPS APC 46.76 46.76 other OPPS APC 46.76 27.63 12.92 percent of total billed charges 46.76 46.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SUCTION IN-LINE 14FR SUP-30-00088 CDM 0272 RC outpatient 35.59 35.59 35.59 74 26.34 percent of total billed charges 35.59 93 28.83 percent of total billed charges 35.59 35.59 other OPPS APC 35.59 35.59 other OPPS APC 35.59 27.63 9.83 percent of total billed charges 35.59 35.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESUSCITATOR INFANT SUP-30-00089 CDM 0272 RC outpatient 61.64 61.64 61.64 74 45.61 percent of total billed charges 61.64 93 49.93 percent of total billed charges 61.64 61.64 other OPPS APC 61.64 61.64 other OPPS APC 61.64 27.63 17.03 percent of total billed charges 61.64 61.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LMA MASK SZ 2 SUP-30-00096 CDM 0272 RC outpatient 47.62 47.62 47.62 74 35.24 percent of total billed charges 47.62 93 38.57 percent of total billed charges 47.62 47.62 other OPPS APC 47.62 47.62 other OPPS APC 47.62 27.63 13.16 percent of total billed charges 47.62 47.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "RESUSCITATION BAG, ADULT" SUP-30-00097 CDM 0272 RC outpatient 47.45 47.45 47.45 74 35.11 percent of total billed charges 47.45 93 38.43 percent of total billed charges 47.45 47.45 other OPPS APC 47.45 47.45 other OPPS APC 47.45 27.63 13.11 percent of total billed charges 47.45 47.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "RESUSCITATION BAG, PEDIATRIC" SUP-30-00098 CDM 0272 RC outpatient 57.87 57.87 57.87 74 42.82 percent of total billed charges 57.87 93 46.87 percent of total billed charges 57.87 57.87 other OPPS APC 57.87 57.87 other OPPS APC 57.87 27.63 15.99 percent of total billed charges 57.87 57.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AEROCHAMBER Z-STAT PLUS SUP-30-00103 CDM 0272 RC outpatient 23.24 23.24 23.24 74 17.2 percent of total billed charges 23.24 93 18.82 percent of total billed charges 23.24 23.24 other OPPS APC 23.24 23.24 other OPPS APC 23.24 27.63 6.42 percent of total billed charges 23.24 23.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SENSOR ADULT SPO2 SUP-30-00104 CDM 0272 RC outpatient 31.92 31.92 31.92 74 23.62 percent of total billed charges 31.92 93 25.86 percent of total billed charges 31.92 31.92 other OPPS APC 31.92 31.92 other OPPS APC 31.92 27.63 8.82 percent of total billed charges 31.92 31.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SENSOR PEDIATRIC SPO2 SUP-30-00105 CDM 0272 RC outpatient 39.79 39.79 39.79 74 29.44 percent of total billed charges 39.79 93 32.23 percent of total billed charges 39.79 39.79 other OPPS APC 39.79 39.79 other OPPS APC 39.79 27.63 10.99 percent of total billed charges 39.79 39.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SENSOR INFANT SPO2 SUP-30-00106 CDM 0272 RC outpatient 40.17 40.17 40.17 74 29.73 percent of total billed charges 40.17 93 32.54 percent of total billed charges 40.17 40.17 other OPPS APC 40.17 40.17 other OPPS APC 40.17 27.63 11.1 percent of total billed charges 40.17 40.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SENSOR NEONATAL SPO2 SUP-30-00107 CDM 0272 RC outpatient 39.76 39.76 39.76 74 29.42 percent of total billed charges 39.76 93 32.21 percent of total billed charges 39.76 39.76 other OPPS APC 39.76 39.76 other OPPS APC 39.76 27.63 10.99 percent of total billed charges 39.76 39.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AEROBIKA OPEP SUP-30-00112 CDM outpatient 169.12 169.12 169.12 169.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER H INLINE NEONATE SUP-30-00122 CDM 0272 RC outpatient 67.28 67.28 67.28 74 49.79 percent of total billed charges 67.28 93 54.5 percent of total billed charges 67.28 67.28 other OPPS APC 67.28 67.28 other OPPS APC 67.28 27.63 18.59 percent of total billed charges 67.28 67.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "FILTER LINE SET, PHILIPS" SUP-30-00123 CDM 0272 RC outpatient 59.59 59.59 59.59 74 44.1 percent of total billed charges 59.59 93 48.27 percent of total billed charges 59.59 59.59 other OPPS APC 59.59 59.59 other OPPS APC 59.59 27.63 16.46 percent of total billed charges 59.59 59.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY I-GEL SIZE 3 SUP-30-00126 CDM 0272 RC outpatient 35.22 35.22 35.22 74 26.06 percent of total billed charges 35.22 93 28.53 percent of total billed charges 35.22 35.22 other OPPS APC 35.22 35.22 other OPPS APC 35.22 27.63 9.73 percent of total billed charges 35.22 35.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY I-GEL SIZE 4 SUP-30-00127 CDM 0272 RC outpatient 35.47 35.47 35.47 74 26.25 percent of total billed charges 35.47 93 28.73 percent of total billed charges 35.47 35.47 other OPPS APC 35.47 35.47 other OPPS APC 35.47 27.63 9.8 percent of total billed charges 35.47 35.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY I-GEL SIZE 5 SUP-30-00128 CDM 0272 RC outpatient 35.6 35.6 35.6 74 26.34 percent of total billed charges 35.6 93 28.84 percent of total billed charges 35.6 35.6 other OPPS APC 35.6 35.6 other OPPS APC 35.6 27.63 9.84 percent of total billed charges 35.6 35.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SENSOR RD SET 2FT SUP-30-00144 CDM 0272 RC outpatient 38.02 38.02 38.02 74 28.13 percent of total billed charges 38.02 93 30.8 percent of total billed charges 38.02 38.02 other OPPS APC 38.02 38.02 other OPPS APC 38.02 27.63 10.5 percent of total billed charges 38.02 38.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L10 MM OD3.5 MM CORTEX LOCK HEXALOBE NONSTERILE SMALL FRAGMENT BASE SET SUP-30-0233 CDM 0270 RC outpatient 213.2 213.2 213.2 74 157.77 percent of total billed charges 213.2 93 172.69 percent of total billed charges 213.2 213.2 other OPPS APC 213.2 213.2 other OPPS APC 213.2 27.63 58.91 percent of total billed charges 213.2 213.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L12 MM OD3.5 MM CORTEX LOCK HEXALOBE NONSTERILE SMALL FRAGMENT BASE SET SUP-30-0234 CDM 0270 RC outpatient 356.2 356.2 356.2 74 263.59 percent of total billed charges 356.2 93 288.52 percent of total billed charges 356.2 356.2 other OPPS APC 356.2 356.2 other OPPS APC 356.2 27.63 98.42 percent of total billed charges 356.2 356.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L14 MM OD3.5 MM CORTEX LOCK HEXALOBE NONSTERILE SMALL FRAGMENT BASE SET SUP-30-0235 CDM 0270 RC outpatient 356.2 356.2 356.2 74 263.59 percent of total billed charges 356.2 93 288.52 percent of total billed charges 356.2 356.2 other OPPS APC 356.2 356.2 other OPPS APC 356.2 27.63 98.42 percent of total billed charges 356.2 356.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L10 MM OD3.5 MM CORTEX HEXALOBE NONSTERILE SMALL FRAGMENT BASE SET SUP-30-0256 CDM 0270 RC outpatient 213.2 213.2 213.2 74 157.77 percent of total billed charges 213.2 93 172.69 percent of total billed charges 213.2 213.2 other OPPS APC 213.2 213.2 other OPPS APC 213.2 27.63 58.91 percent of total billed charges 213.2 213.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L12 MM OD3.5 MM CORTEX HEXALOBE NONSTERILE SMALL FRAGMENT BASE SET SUP-30-0257 CDM 0270 RC outpatient 213.2 213.2 213.2 74 157.77 percent of total billed charges 213.2 93 172.69 percent of total billed charges 213.2 213.2 other OPPS APC 213.2 213.2 other OPPS APC 213.2 27.63 58.91 percent of total billed charges 213.2 213.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L14 MM OD3.5 MM CORTEX HEXALOBE NONSTERILE SMALL FRAGMENT BASE SET SUP-30-0258 CDM 0270 RC outpatient 213.2 213.2 213.2 74 157.77 percent of total billed charges 213.2 93 172.69 percent of total billed charges 213.2 213.2 other OPPS APC 213.2 213.2 other OPPS APC 213.2 27.63 58.91 percent of total billed charges 213.2 213.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L16 MM OD3.5 MM CORTEX HEXALOBE NONSTERILE SMALL FRAGMENT BASE SET SUP-30-0259 CDM 0270 RC outpatient 213.2 213.2 213.2 74 157.77 percent of total billed charges 213.2 93 172.69 percent of total billed charges 213.2 213.2 other OPPS APC 213.2 213.2 other OPPS APC 213.2 27.63 58.91 percent of total billed charges 213.2 213.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALL COTTON STERILE SUP-30-030 CDM 0270 RC outpatient 0.55 0.55 0.55 74 0.41 percent of total billed charges 0.55 93 0.45 percent of total billed charges 0.55 0.55 other OPPS APC 0.55 0.55 other OPPS APC 0.55 27.63 0.15 percent of total billed charges 0.55 0.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALL COTTON SILK SMALL L15 IN OD1/2 IN 2 STRUNG RADIOPAQUE STERILE LATEX FREE BLUE SUP-30-032 CDM 0270 RC outpatient 10.49 10.49 10.49 74 7.76 percent of total billed charges 10.49 93 8.5 percent of total billed charges 10.49 10.49 other OPPS APC 10.49 10.49 other OPPS APC 10.49 27.63 2.9 percent of total billed charges 10.49 10.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALL COTTON OD1/8 IN SURGICAL XRAY DETECTABLE HIGH ABSORPTION SUP-30-07 CDM outpatient 4.47 4.47 4.47 4.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L18 MM OD2.3 MM VARIABLE ANGLE LOCK NONSTERILE ORANGE ACU-LOC 2 WRIST PLATE SYSTEM SUP-30-2318 CDM 0270 RC outpatient 371.8 371.8 371.8 74 275.13 percent of total billed charges 371.8 93 301.16 percent of total billed charges 371.8 371.8 other OPPS APC 371.8 371.8 other OPPS APC 371.8 27.63 102.73 percent of total billed charges 371.8 371.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTRODUCER GLIDESHEATH PLASTIC HYDROPHILIC .021 IN L80 CM L25 CM L1.25 IN OD6 FR ODSEC22 GA NEEDLE JACKET SHORT TAPER ANGLE GUIDEWIRE STERILE DISPOSABLE 2 WALL PUNCTURE RADIAL ACCESS SUP-30-2560 CDM 0270 RC outpatient 171.6 171.6 171.6 74 126.98 percent of total billed charges 171.6 93 139 percent of total billed charges 171.6 171.6 other OPPS APC 171.6 171.6 other OPPS APC 171.6 27.63 47.41 percent of total billed charges 171.6 171.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE PESSARY 1 L29 MM CUBE DRAIN SUP-30-CUD1 CDM 0270 RC outpatient 94.82 94.82 94.82 74 70.17 percent of total billed charges 94.82 93 76.8 percent of total billed charges 94.82 94.82 other OPPS APC 94.82 94.82 other OPPS APC 94.82 27.63 26.2 percent of total billed charges 94.82 94.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HUMERAL STEM PRESSFIT 7MM SUP-300-30-07 CDM 270010030 LOCAL 0270 RC outpatient 6521.58 6521.58 6521.58 74 4825.97 percent of total billed charges 6521.58 93 5282.48 percent of total billed charges 6521.58 6521.58 other OPPS APC 6521.58 6521.58 other OPPS APC 6521.58 27.63 1801.91 percent of total billed charges 6521.58 6521.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. D-STAT TOPICAL HEMOSTAT SUP-3000 CDM 0270 RC outpatient 112.58 112.58 112.58 74 83.31 percent of total billed charges 112.58 93 91.19 percent of total billed charges 112.58 112.58 other OPPS APC 112.58 112.58 other OPPS APC 112.58 27.63 31.11 percent of total billed charges 112.58 112.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Fix This SUP-300005127551 CDM 0481 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 51 961.35 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC CARPENTIER-EDWARDS PERIMOUNT MAGNA PERICARDIAL OD23 MM BIOPROSTHESIS SUP-3000TFX-23 CDM 0270 RC outpatient 13780 13780 13780 74 10197.2 percent of total billed charges 13780 93 11161.8 percent of total billed charges 13780 13780 other OPPS APC 13780 13780 other OPPS APC 13780 27.63 3807.41 percent of total billed charges 13780 13780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC CARPENTIER-EDWARDS PERIMOUNT MAGNA PERICARDIAL OD29 MM BIOPROSTHESIS SUP-3000TFX-29 CDM 0270 RC outpatient 13780 13780 13780 74 10197.2 percent of total billed charges 13780 93 11161.8 percent of total billed charges 13780 13780 other OPPS APC 13780 13780 other OPPS APC 13780 27.63 3807.41 percent of total billed charges 13780 13780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC CARPENTIER-EDWARDS PERIMOUNT OD19 MM SUP-3000TFX19MM CDM 0270 RC outpatient 13780 13780 13780 74 10197.2 percent of total billed charges 13780 93 11161.8 percent of total billed charges 13780 13780 other OPPS APC 13780 13780 other OPPS APC 13780 27.63 3807.41 percent of total billed charges 13780 13780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC CARPENTIER-EDWARDS PERIMOUNT MAGNA PERICARDIAL OD21 MM BIOPROSTHESIS SUP-3000TFX21MM CDM 0270 RC outpatient 13780 13780 13780 74 10197.2 percent of total billed charges 13780 93 11161.8 percent of total billed charges 13780 13780 other OPPS APC 13780 13780 other OPPS APC 13780 27.63 3807.41 percent of total billed charges 13780 13780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC CARPENTIER-EDWARDS PERIMOUNT MAGNA THERMAFIX PERICARDIAL OD23 MM BIOPROSTHESIS SUP-3000TFX23MM CDM 0270 RC outpatient 13780 13780 13780 74 10197.2 percent of total billed charges 13780 93 11161.8 percent of total billed charges 13780 13780 other OPPS APC 13780 13780 other OPPS APC 13780 27.63 3807.41 percent of total billed charges 13780 13780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC CARPENTIER-EDWARDS PERIMOUNT MAGNA PERICARDIAL OD25 MM BIOPROSTHESIS SUP-3000TFX25MM CDM 0270 RC outpatient 13780 13780 13780 74 10197.2 percent of total billed charges 13780 93 11161.8 percent of total billed charges 13780 13780 other OPPS APC 13780 13780 other OPPS APC 13780 27.63 3807.41 percent of total billed charges 13780 13780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC CARPENTIER-EDWARDS PERIMOUNT MAGNA PERICARDIAL OD27 MM BIOPROSTHESES SUP-3000TFX27MM CDM 0270 RC outpatient 13780 13780 13780 74 10197.2 percent of total billed charges 13780 93 11161.8 percent of total billed charges 13780 13780 other OPPS APC 13780 13780 other OPPS APC 13780 27.63 3807.41 percent of total billed charges 13780 13780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC CARPENTIER-EDWARDS PERIMOUNT MAGNA BOVINE PERICARDIAL COCR SILICONE RUBBER POLYESTER LOW PROFILE CONTOUR H19 MM OD29 MM ODSEC34 MM ID28 MM SLEEK COMMISSURE POST THERMAFIX SUTURE MARKER LOW STENT BASE LONG TERM DURABILITY SUP-3000TFX29MM CDM 0270 RC outpatient 13780 13780 13780 74 10197.2 percent of total billed charges 13780 93 11161.8 percent of total billed charges 13780 13780 other OPPS APC 13780 13780 other OPPS APC 13780 27.63 3807.41 percent of total billed charges 13780 13780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC CARPENTIER-EDWARDS PERIMOUNT MAGNA PERICARDIAL OD29 MM BIOPROSTHESIS SUP-3000TFX29MM CDM 0270 RC outpatient 13780 13780 13780 74 10197.2 percent of total billed charges 13780 93 11161.8 percent of total billed charges 13780 13780 other OPPS APC 13780 13780 other OPPS APC 13780 27.63 3807.41 percent of total billed charges 13780 13780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMOSTAT ABSORBABLED-STAT TOPICAL DRY STERILE LATEX FREE DISPOSABLE SUP-3001 CDM 0270 RC outpatient 36.4 36.4 36.4 74 26.94 percent of total billed charges 36.4 93 29.48 percent of total billed charges 36.4 36.4 other OPPS APC 36.4 36.4 other OPPS APC 36.4 27.63 10.06 percent of total billed charges 36.4 36.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ZEVO TITANIUM L19 MM SPINE CERVICAL ANTERIOR 1 LEVEL SUP-3001019 CDM 270010020 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ZEVO TITANIUM L21 MM SPINE CERVICAL ANTERIOR LEVEL 1 SUP-3001021 CDM 270010020 LOCAL 0270 RC outpatient 2990 2990 2990 74 2212.6 percent of total billed charges 2990 93 2421.9 percent of total billed charges 2990 2990 other OPPS APC 2990 2990 other OPPS APC 2990 27.63 826.14 percent of total billed charges 2990 2990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE ZEVO 23MM SUP-3001023 CDM 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ZEVO TITANIUM L35 MM SPINE CERVICAL ANTERIOR 2 LEVEL SUP-3002035 CDM 270010020 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ZEVO TITANIUM L37 MM SPINE CERVICAL ANTERIOR LEVEL 2 SUP-3002037 CDM 270010020 LOCAL 0270 RC outpatient 3250 3250 3250 74 2405 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 3250 other OPPS APC 3250 3250 other OPPS APC 3250 27.63 897.98 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ZEVO TITANIUM L39 MM SPINE CERVICAL ANTERIOR LEVEL 2 SUP-3002039 CDM 270010020 LOCAL 0270 RC outpatient 3250 3250 3250 74 2405 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 3250 other OPPS APC 3250 3250 other OPPS APC 3250 27.63 897.98 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ZEVO TITANIUM L41 MM SPINE CERVICAL ANTERIOR LEVEL 2 SUP-3002041 CDM 270010020 LOCAL 0270 RC outpatient 3250 3250 3250 74 2405 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 3250 other OPPS APC 3250 3250 other OPPS APC 3250 27.63 897.98 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE MEDTRONIC CERVICAL 3 LEVEL 57MM SUP-3002057 CDM 270010020 LOCAL 0270 RC outpatient 4550 4550 4550 74 3367 percent of total billed charges 4550 93 3685.5 percent of total billed charges 4550 4550 other OPPS APC 4550 4550 other OPPS APC 4550 27.63 1257.17 percent of total billed charges 4550 4550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY CATHETERIZATION COMPLETE CARE BARDEX IC STATLOCK BARD 60IN 16FR 5ML BACTI-GUARD NATURAL RUBBER HYDROGEL DISPOSABLE SUP-300316A CDM 270009004 LOCAL 0270 RC outpatient 8.5 8.5 8.5 74 6.29 percent of total billed charges 8.5 93 6.89 percent of total billed charges 8.5 8.5 other OPPS APC 8.5 8.5 other OPPS APC 8.5 27.63 2.35 percent of total billed charges 8.5 8.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY CATHETERIZATION COMPLETE CARE BARDEX IC STATLOCK BARD BACTI-GUARD NATURAL RUBBER HYDROGEL L60 IN OD18 FR 5 ML ADVANCE FOLEY ANTIREFLUX CHAMBER DRAINAGE BAG STERILE LATEX DISPOSABLE SUP-300318A CDM 270009004 LOCAL 0270 RC outpatient 8.5 8.5 8.5 74 6.29 percent of total billed charges 8.5 93 6.89 percent of total billed charges 8.5 8.5 other OPPS APC 8.5 8.5 other OPPS APC 8.5 27.63 2.35 percent of total billed charges 8.5 8.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ESYSUIT MEDENVISION SUP-301-641-S CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE LARYNGOSCOPE GREENLINE STAINLESS STEEL ADULT 4 LARGE L155 MM MACINTOSH FIBER OPTIC HANDLE STERILE LATEX FREE DISPOSABLE SUP-301-B3040EA CDM 0270 RC outpatient 11.44 11.44 11.44 74 8.47 percent of total billed charges 11.44 93 9.27 percent of total billed charges 11.44 11.44 other OPPS APC 11.44 11.44 other OPPS APC 11.44 27.63 3.16 percent of total billed charges 11.44 11.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE LARYNGOSCOPE GREENLINE STAINLESS STEEL 0 L77 MM MILLER FIBER OPTIC COMPATIBLE HANDLE STERILE LATEX FREE DISPOSABLE SUP-301-B3100EA CDM 0270 RC outpatient 15.82 15.82 15.82 74 11.71 percent of total billed charges 15.82 93 12.81 percent of total billed charges 15.82 15.82 other OPPS APC 15.82 15.82 other OPPS APC 15.82 27.63 4.37 percent of total billed charges 15.82 15.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE LARYNGOSCOPE MILLER STAINLESS STEEL 1 FIBEROPTIC ENGLISH PROFILE STERILE LATEX FREE DISPOSABLE ISO 7376 HANDLE SUP-301-B3110EA CDM 0270 RC outpatient 14.15 14.15 14.15 74 10.47 percent of total billed charges 14.15 93 11.46 percent of total billed charges 14.15 14.15 other OPPS APC 14.15 14.15 other OPPS APC 14.15 27.63 3.91 percent of total billed charges 14.15 14.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE LARYNGOSCOPE GREENLINE STAINLESS STEEL ADULT 3 L195 MM MILLER FIBER OPTIC COMPATIBLE HANDLE STERILE LATEX FREE DISPOSABLE SUP-301-B3130EA CDM 0270 RC outpatient 13.28 13.28 13.28 74 9.83 percent of total billed charges 13.28 93 10.76 percent of total billed charges 13.28 13.28 other OPPS APC 13.28 13.28 other OPPS APC 13.28 27.63 3.67 percent of total billed charges 13.28 13.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE LARYNGOSCOPE GREENLINE STAINLESS STEEL ADULT 4 L205 MM MILLER FIBER OPTIC COMPATIBLE SYSTEM HANDLE STERILE LATEX FREE DISPOSABLE SUP-301-B3140EA CDM 0270 RC outpatient 14.61 14.61 14.61 74 10.81 percent of total billed charges 14.61 93 11.83 percent of total billed charges 14.61 14.61 other OPPS APC 14.61 14.61 other OPPS APC 14.61 27.63 4.04 percent of total billed charges 14.61 14.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK OXYGEN CURAPLEX ADULT 10-15 LPM 86-97% O2 ETCO2 MALE TO MALE HIGH CONCENTRATION RESERVOIR BAG SUP-301-PRO2LT CDM 0270 RC outpatient 19.76 19.76 19.76 74 14.62 percent of total billed charges 19.76 93 16.01 percent of total billed charges 19.76 19.76 other OPPS APC 19.76 19.76 other OPPS APC 19.76 27.63 5.46 percent of total billed charges 19.76 19.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH GUIDING PREFACE MULTIPURPOSE CURVE L62 CM OD8 FR ID.11 IN 2 WIRE BRAID MULTISEGMENT OBLIQUE CUT VALVE SUP-301803M CDM 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER INSUFFLATION HYDROPHOBIC BULB RECTUM HIGHLY VISIBLE LATEX FREE DISPOSABLE FLEX SIGMOIDOSCOPE SUP-30210 CDM 0270 RC outpatient 51.1 51.1 51.1 74 37.81 percent of total billed charges 51.1 93 41.39 percent of total billed charges 51.1 51.1 other OPPS APC 51.1 51.1 other OPPS APC 51.1 27.63 14.12 percent of total billed charges 51.1 51.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE MEDICAL BD LUER-LOK 30ML 1ML DISPOSABLE STERILE LF CONCENTRIC TIP 1ML GRADUATION NONPYROGENIC DEHP FREE SUP-302832 CDM 0270 RC outpatient 0.72 0.72 0.72 74 0.53 percent of total billed charges 0.72 93 0.58 percent of total billed charges 0.72 0.72 other OPPS APC 0.72 0.72 other OPPS APC 0.72 27.63 0.2 percent of total billed charges 0.72 0.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE MEDICAL BD 30 ML GRADUATED SLIP TIP STERILE LATEX FREE DISPOSABLE SUP-302833 CDM 0270 RC outpatient 0.54 0.54 0.54 74 0.4 percent of total billed charges 0.54 93 0.44 percent of total billed charges 0.54 0.54 other OPPS APC 0.54 0.54 other OPPS APC 0.54 27.63 0.15 percent of total billed charges 0.54 0.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE MEDICAL BD 10ML DISPOSABLE STERILE SLIP TIP SUP-303134 CDM 0270 RC outpatient 0.43 0.43 0.43 74 0.32 percent of total billed charges 0.43 93 0.35 percent of total billed charges 0.43 0.43 other OPPS APC 0.43 0.43 other OPPS APC 0.43 27.63 0.12 percent of total billed charges 0.43 0.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENERATOR EXTERNAL PULSE 2 PORT HEADER SUP-3032 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE MEDICAL BD LUER-LOK 20ML DISPOSABLE SUP-303310 CDM 0270 RC outpatient 0.59 0.59 0.59 74 0.44 percent of total billed charges 0.59 93 0.48 percent of total billed charges 0.59 0.59 other OPPS APC 0.59 0.59 other OPPS APC 0.59 27.63 0.16 percent of total billed charges 0.59 0.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY CATHETERIZATION BARDEX STATLOCK 16FR BACTI-GUARD HYDROGEL NATURAL RUBBER DISPOSABLE STERILE LATEX FOLEY URINE METER SUP-303316A CDM 270009006 LOCAL 0270 RC outpatient 12.49 12.49 12.49 74 9.24 percent of total billed charges 12.49 93 10.12 percent of total billed charges 12.49 12.49 other OPPS APC 12.49 12.49 other OPPS APC 12.49 27.63 3.45 percent of total billed charges 12.49 12.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY CATHETERIZATION LUBRI-SIL COMPLETE CARE STATLOCK 60IN 16FR BACTI-GUARD HYDROGEL DISPOSABLE STERILE LF FOLEY URINE SUP-303416A CDM 0270 RC outpatient 51.47 51.47 51.47 74 38.09 percent of total billed charges 51.47 93 41.69 percent of total billed charges 51.47 51.47 other OPPS APC 51.47 51.47 other OPPS APC 51.47 27.63 14.22 percent of total billed charges 51.47 51.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROGRAMMER NEUROSTIMULATOR INTERSTIM THERMOPLASTIC RESIN MAGNESIUM 5 L L22 CM X W10 CM X H4 CM 680 GM SACRAL 240 X 640 PIXELS PATIENT SLIM SUP-3037 CDM 0270 RC outpatient 3094 3094 3094 74 2289.56 percent of total billed charges 3094 93 2506.14 percent of total billed charges 3094 3094 other OPPS APC 3094 3094 other OPPS APC 3094 27.63 854.87 percent of total billed charges 3094 3094 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD MODEL 304 PERENNIAL FLEX SUP-304 CDM 0270 RC outpatient 16204.5 16204.5 16204.5 74 11991.3 percent of total billed charges 16204.5 93 13125.7 percent of total billed charges 16204.5 16204.5 other OPPS APC 16204.5 16204.5 other OPPS APC 16204.5 27.63 4477.3 percent of total billed charges 16204.5 16204.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD NEUROSTIMULATOR VNS THERAPY PERENNIAFLEX 2MM STERILE LF MODEL 304 SUP-304-20 CDM 270010003 LOCAL 0270 RC outpatient 9630.4 9630.4 9630.4 74 7126.5 percent of total billed charges 9630.4 93 7800.62 percent of total billed charges 9630.4 9630.4 other OPPS APC 9630.4 9630.4 other OPPS APC 9630.4 27.63 2660.88 percent of total billed charges 9630.4 9630.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL EQUINOXE OD6.5 MM LEFT SHOULDER FRACTURE SUP-304-21-07 CDM 270010030 LOCAL 0270 RC outpatient 6942 6942 6942 74 5137.08 percent of total billed charges 6942 93 5623.02 percent of total billed charges 6942 6942 other OPPS APC 6942 6942 other OPPS APC 6942 27.63 1918.07 percent of total billed charges 6942 6942 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL EQUINOXE LONG L200 MM OD6.5 MM LEFT SHOULDER FRACTURE SUP-304-23-07 CDM 270010030 LOCAL 0270 RC outpatient 23920 23920 23920 74 17700.8 percent of total billed charges 23920 93 19375.2 percent of total billed charges 23920 23920 other OPPS APC 23920 23920 other OPPS APC 23920 27.63 6609.1 percent of total billed charges 23920 23920 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL EQUINOXE LONG L200 MM OD6.5 MM RIGHT SHOULDER FRACTURE SUP-304-24-07 CDM 270010030 LOCAL 0270 RC outpatient 12818 12818 12818 74 9485.32 percent of total billed charges 12818 93 10382.6 percent of total billed charges 12818 12818 other OPPS APC 12818 12818 other OPPS APC 12818 27.63 3541.61 percent of total billed charges 12818 12818 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RACK SUPPLEMENTAL SCREW W/LID 3.5 AND 4.5MM SUP-304.380 CDM 270010025 LOCAL 0270 RC outpatient 2124.98 2124.98 2124.98 74 1572.49 percent of total billed charges 2124.98 93 1721.23 percent of total billed charges 2124.98 2124.98 other OPPS APC 2124.98 2124.98 other OPPS APC 2124.98 27.63 587.13 percent of total billed charges 2124.98 2124.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN WOUND PENROSE 70 STANDARD L12 IN OD3/8 IN SUP-30414-038 CDM 0270 RC outpatient 2.44 2.44 2.44 74 1.81 percent of total billed charges 2.44 93 1.98 percent of total billed charges 2.44 2.44 other OPPS APC 2.44 2.44 other OPPS APC 2.44 27.63 0.67 percent of total billed charges 2.44 2.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN WOUND PENROSE 5/8INW X 12INL LATEX NON-RADIOLUCENT STERILE 10/BX SUP-30414-058 CDM 0270 RC outpatient 5.03 5.03 5.03 74 3.72 percent of total billed charges 5.03 93 4.07 percent of total billed charges 5.03 5.03 other OPPS APC 5.03 5.03 other OPPS APC 5.03 27.63 1.39 percent of total billed charges 5.03 5.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL 6 285X77MM STRAW NATURAL RUBBER STERILE LATEX POWDER FREE BEAD CUFF MICRO ROUGHENED NON PYROGENIC SUP-30460 CDM 0270 RC outpatient 1.03 1.03 1.03 74 0.76 percent of total billed charges 1.03 93 0.83 percent of total billed charges 1.03 1.03 other OPPS APC 1.03 1.03 other OPPS APC 1.03 27.63 0.28 percent of total billed charges 1.03 1.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL 6.5 285X85MM STRAW NATURAL RUBBER STERILE LATEX POWDER FREE BEAD CUFF MICRO ROUGHENED NON SUP-30465 CDM 0270 RC outpatient 1.03 1.03 1.03 74 0.76 percent of total billed charges 1.03 93 0.83 percent of total billed charges 1.03 1.03 other OPPS APC 1.03 1.03 other OPPS APC 1.03 27.63 0.28 percent of total billed charges 1.03 1.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL 7 STRAW NATURAL RUBBER STERILE LATEX POWDER FREE MICRO ROUGHENED BEAD CUFF NONPYROGENIC CURVE SUP-30470 CDM 0270 RC outpatient 1.03 1.03 1.03 74 0.76 percent of total billed charges 1.03 93 0.83 percent of total billed charges 1.03 1.03 other OPPS APC 1.03 1.03 other OPPS APC 1.03 27.63 0.28 percent of total billed charges 1.03 1.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL 7.5 298X96MM STRAW NATURAL RUBBER STERILE LATEX POWDER FREE BEAD CUFF MICRO ROUGHENED NON SUP-30475 CDM 0270 RC outpatient 1.03 1.03 1.03 74 0.76 percent of total billed charges 1.03 93 0.83 percent of total billed charges 1.03 1.03 other OPPS APC 1.03 1.03 other OPPS APC 1.03 27.63 0.28 percent of total billed charges 1.03 1.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL 8 299X103MM STRAW NATURAL RUBBER STERILE LATEX POWDER FREE BEAD CUFF MICRO ROUGHENED NON PYROGENIC SUP-30480 CDM 0270 RC outpatient 1.03 1.03 1.03 74 0.76 percent of total billed charges 1.03 93 0.83 percent of total billed charges 1.03 1.03 other OPPS APC 1.03 1.03 other OPPS APC 1.03 27.63 0.28 percent of total billed charges 1.03 1.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL 8.5 301X109MM STRAW NATURAL RUBBER STERILE LATEX POWDER FREE BEAD CUFF MICRO ROUGHENED NON SUP-30485 CDM 0270 RC outpatient 1.03 1.03 1.03 74 0.76 percent of total billed charges 1.03 93 0.83 percent of total billed charges 1.03 1.03 other OPPS APC 1.03 1.03 other OPPS APC 1.03 27.63 0.28 percent of total billed charges 1.03 1.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL 9 301X115MM STRAW NATURAL RUBBER STERILE LATEX POWDER FREE BEAD CUFF MICRO ROUGHENED NON PYROGENIC SUP-30490 CDM 0270 RC outpatient 1.03 1.03 1.03 74 0.76 percent of total billed charges 1.03 93 0.83 percent of total billed charges 1.03 1.03 other OPPS APC 1.03 1.03 other OPPS APC 1.03 27.63 0.28 percent of total billed charges 1.03 1.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ACCULIF TL 6-9MM X 11MM X34MM 0 DEG SUP-305006 CDM 270010020 LOCAL 0270 RC outpatient 15600 15600 15600 74 11544 percent of total billed charges 15600 93 12636 percent of total billed charges 15600 15600 other OPPS APC 15600 15600 other OPPS APC 15600 27.63 4310.28 percent of total billed charges 15600 15600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ACCULIF TL 8-12MM X 11MM X34MM 0 DEG SUP-305008 CDM 270010020 LOCAL 0270 RC outpatient 15600 15600 15600 74 11544 percent of total billed charges 15600 93 12636 percent of total billed charges 15600 15600 other OPPS APC 15600 15600 other OPPS APC 15600 27.63 4310.28 percent of total billed charges 15600 15600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ACCULIF TL 10-16MM X 11MM X34MM 0 DEG SUP-305010 CDM 270010020 LOCAL 0270 RC outpatient 15600 15600 15600 74 11544 percent of total billed charges 15600 93 12636 percent of total billed charges 15600 15600 other OPPS APC 15600 15600 other OPPS APC 15600 27.63 4310.28 percent of total billed charges 15600 15600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE HEART AORTIC PORCINE MOSAIC 19MM SUP-30501901 CDM 0270 RC outpatient 14040 14040 14040 74 10389.6 percent of total billed charges 14040 93 11372.4 percent of total billed charges 14040 14040 other OPPS APC 14040 14040 other OPPS APC 14040 27.63 3879.25 percent of total billed charges 14040 14040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE MEDICAL BD BD LUER-LOK REGULAR WALL 1.5IN 18GA 3ML RED POLYPROPYLENE DISPOSABLE STERILE LF BLUNT FILL NEEDLE SUP-305060 CDM 0270 RC outpatient 0.39 0.39 0.39 74 0.29 percent of total billed charges 0.39 93 0.32 percent of total billed charges 0.39 0.39 other OPPS APC 0.39 0.39 other OPPS APC 0.39 27.63 0.11 percent of total billed charges 0.39 0.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE MEDICAL BD BD LUER-LOK REGULAR WALL 1.5IN 18GA 5ML RED POLYPROPYLENE DISPOSABLE STERILE LF BLUNT FILL NEEDLE SUP-305062 CDM 0270 RC outpatient 0.53 0.53 0.53 74 0.39 percent of total billed charges 0.53 93 0.43 percent of total billed charges 0.53 0.53 other OPPS APC 0.53 0.53 other OPPS APC 0.53 27.63 0.15 percent of total billed charges 0.53 0.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BLUNT BD BD LUER-LOK 1.5IN 18GA 10ML RED POLYPROPYLENE DISPOSABLE STERILE LF BLUNT FILL NEEDLE CONCENTRIC TIP SUP-305064 CDM 0270 RC outpatient 0.6 0.6 0.6 74 0.44 percent of total billed charges 0.6 93 0.49 percent of total billed charges 0.6 0.6 other OPPS APC 0.6 0.6 other OPPS APC 0.6 27.63 0.17 percent of total billed charges 0.6 0.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HYPODERMIC BD REGULAR WALL .5IN 30GA TAN POLYPROPYLENE DISPOSABLE STERILE LF REGULAR BEVEL LUER HUB DEHP FREE SUP-305106 CDM 0270 RC outpatient 0.53 0.53 0.53 74 0.39 percent of total billed charges 0.53 93 0.43 percent of total billed charges 0.53 0.53 other OPPS APC 0.53 0.53 other OPPS APC 0.53 27.63 0.15 percent of total billed charges 0.53 0.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HYPODERMIC BD REGULAR WALL 1.5IN 25GA BLUE POLYPROPYLENE DISPOSABLE STERILE LF REGULAR BEVEL LUER HUB DEHP FREE SUP-305127 CDM 0270 RC outpatient 0.19 0.19 0.19 74 0.14 percent of total billed charges 0.19 93 0.15 percent of total billed charges 0.19 0.19 other OPPS APC 0.19 0.19 other OPPS APC 0.19 27.63 0.05 percent of total billed charges 0.19 0.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HYPODERMIC BD REGULAR WALL 1.5IN 22GA BLACK POLYPROPYLENE DISPOSABLE STERILE LF REGULAR BEVEL LUER HUB DEHP FREE SUP-305156 CDM 0270 RC outpatient 0.08 0.08 0.08 74 0.06 percent of total billed charges 0.08 93 0.06 percent of total billed charges 0.08 0.08 other OPPS APC 0.08 0.08 other OPPS APC 0.08 27.63 0.02 percent of total billed charges 0.08 0.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HYPODERMIC SHORT BEVEL STERILE DISPOSABLE 20GA X 1.5IN SUP-305179 CDM outpatient 0.16 0.16 0.16 0.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BLUNT BD REGULAR WALL 1.5IN 18GA RED POLYPROPYLENE DISPOSABLE STERILE LF FILL LUER HUB DEHP FREE SUP-305180 CDM 0270 RC outpatient 0.18 0.18 0.18 74 0.13 percent of total billed charges 0.18 93 0.15 percent of total billed charges 0.18 0.18 other OPPS APC 0.18 0.18 other OPPS APC 0.18 27.63 0.05 percent of total billed charges 0.18 0.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HYPODERMIC BD PRECISIONGLIDE THIN WALL 1.5IN 19GA BROWN DISPOSABLE STERILE LF SHORT BEVEL SUP-305189 CDM outpatient 14.22 14.22 14.22 14.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HYPODERMIC BD REGULAR WALL 1.5IN 23GA BLACK POLYPROPYLENE DISPOSABLE STERILE LF REGULAR BEVEL LUER HUB DEHP FREE SUP-305194 CDM 0270 RC outpatient 0.08 0.08 0.08 74 0.06 percent of total billed charges 0.08 93 0.06 percent of total billed charges 0.08 0.08 other OPPS APC 0.08 0.08 other OPPS APC 0.08 27.63 0.02 percent of total billed charges 0.08 0.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HYPODERMIC BD PRECISIONGLIDE THIN WALL 1.5IN 18GA BROWN DISPOSABLE STERILE LF SHORT BEVEL SUP-305196 CDM 0270 RC outpatient 0.13 0.13 0.13 74 0.1 percent of total billed charges 0.13 93 0.11 percent of total billed charges 0.13 0.13 other OPPS APC 0.13 0.13 other OPPS APC 0.13 27.63 0.04 percent of total billed charges 0.13 0.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HYPODERMIC BD REGULAR WALL 1.5IN 18GA PINK POLYPROPYLENE DISPOSABLE STERILE LF REGULAR BEVEL LUER HUB DEHP FREE SUP-305196 CDM 0270 RC outpatient 13.34 13.34 13.34 74 9.87 percent of total billed charges 13.34 93 10.81 percent of total billed charges 13.34 13.34 other OPPS APC 13.34 13.34 other OPPS APC 13.34 27.63 3.69 percent of total billed charges 13.34 13.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HYPODERMIC BD REGULAR WALL 1.5IN 16GA LAVENDER POLYPROPYLENE DISPOSABLE STERILE LF REGULAR BEVEL LUER HUB DEHP SUP-305198 CDM 0270 RC outpatient 0.29 0.29 0.29 74 0.21 percent of total billed charges 0.29 93 0.23 percent of total billed charges 0.29 0.29 other OPPS APC 0.29 0.29 other OPPS APC 0.29 27.63 0.08 percent of total billed charges 0.29 0.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE FILTER BD 5UM REGULAR WALL 1.5IN 18GA PURPLE POLYCARBONATE DISPOSABLE STERILE LF BLUNT BEVEL LUER HUB DEHP FREE SUP-305211 CDM 0270 RC outpatient 0.71 0.71 0.71 74 0.53 percent of total billed charges 0.71 93 0.58 percent of total billed charges 0.71 0.71 other OPPS APC 0.71 0.71 other OPPS APC 0.71 27.63 0.2 percent of total billed charges 0.71 0.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL 7.5 285X96MM STRAW BIOGEL M NATURAL RUBBER STERILE LATEX POWDER FREE TEXTURE BEAD CUFF NONPYROGENIC SUP-30575 CDM 0270 RC outpatient 1.16 1.16 1.16 74 0.86 percent of total billed charges 1.16 93 0.94 percent of total billed charges 1.16 1.16 other OPPS APC 1.16 1.16 other OPPS APC 1.16 27.63 0.32 percent of total billed charges 1.16 1.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HYPODERMIC BD ECLIPSE BD PRECISIONGLIDE 1IN 25GA STERILE LF BEVEL 1 HAND SUP-305761 CDM 0270 RC outpatient 0.39 0.39 0.39 74 0.29 percent of total billed charges 0.39 93 0.32 percent of total billed charges 0.39 0.39 other OPPS APC 0.39 0.39 other OPPS APC 0.39 27.63 0.11 percent of total billed charges 0.39 0.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HYPODERMIC BD ECLIPSE THIN WALL 1.5IN 22GA BLUE POLYPROPYLENE DISPOSABLE STERILE LF REGULAR BEVEL LUER HUB PIVOT SUP-305763 CDM 0270 RC outpatient 0.39 0.39 0.39 74 0.29 percent of total billed charges 0.39 93 0.32 percent of total billed charges 0.39 0.39 other OPPS APC 0.39 0.39 other OPPS APC 0.39 27.63 0.11 percent of total billed charges 0.39 0.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HYPODERMIC BD ECLIPSE THIN WALL 1.5IN 25GA ORANGE POLYPROPYLENE DISPOSABLE STERILE LF REGULAR BEVEL LUER HUB SUP-305767 CDM 0270 RC outpatient 0.4 0.4 0.4 74 0.3 percent of total billed charges 0.4 93 0.32 percent of total billed charges 0.4 0.4 other OPPS APC 0.4 0.4 other OPPS APC 0.4 27.63 0.11 percent of total billed charges 0.4 0.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE MEDICAL BD LUER-LOK BD ECLIPSE L1/2 IN OD30 GA 1 ML 1 HAND ACTIVATION DETACHABLE NEEDLE HYPODERMIC PIVOT SHIELD MECHANISM STERILE LATEX FREE SUP-305778 CDM 0270 RC outpatient 0.92 0.92 0.92 74 0.68 percent of total billed charges 0.92 93 0.75 percent of total billed charges 0.92 0.92 other OPPS APC 0.92 0.92 other OPPS APC 0.92 27.63 0.25 percent of total billed charges 0.92 0.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE MEDICAL BD LUER-LOK BD ECLIPSE THIN WALL 5/8IN .5IN 25GA 30GA 1ML ORANGE POLYPROPYLENE DISPOSABLE STERILE LF SUP-305780 CDM 0270 RC outpatient 0.92 0.92 0.92 74 0.68 percent of total billed charges 0.92 93 0.75 percent of total billed charges 0.92 0.92 other OPPS APC 0.92 0.92 other OPPS APC 0.92 27.63 0.25 percent of total billed charges 0.92 0.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEUROSTIMULATOR IMPLANTABLE INTERSTIM II THK.3 IN 10-14HZ L2 IN X H1.7 IN 14 CC 22 GM SACRAL NERVE 4 ELECTRODE LEAD 1 SCREW NO RECHARGEABLE SUP-3058 CDM 0270 RC outpatient 30368 30368 30368 74 22472.3 percent of total billed charges 30368 93 24598.1 percent of total billed charges 30368 30368 other OPPS APC 30368 30368 other OPPS APC 30368 27.63 8390.68 percent of total billed charges 30368 30368 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL M 8 295X101MM STRAW NATURAL RUBBER STERILE LATEX POWDER FREE BEAD CUFF TEXTURE NONPYROGENIC SUP-30580 CDM outpatient 1.32 1.32 1.32 1.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HYPODERMIC BD SAFETYGLIDE REGULAR WALL 5/8IN 25GA BLUE POLYPROPYLENE DISPOSABLE STERILE LF REGULAR BEVEL LUER HUB SUP-305901 CDM 0270 RC outpatient 0.54 0.54 0.54 74 0.4 percent of total billed charges 0.54 93 0.44 percent of total billed charges 0.54 0.54 other OPPS APC 0.54 0.54 other OPPS APC 0.54 27.63 0.15 percent of total billed charges 0.54 0.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE INSULIN BD SAFETYGLIDE U-100 .5IN 29GA 1ML DISPOSABLE STERILE LF PERMANENT ATTACH NEEDLE VISIBLE LOCK SUP-305930 CDM 0270 RC outpatient 0.83 0.83 0.83 74 0.61 percent of total billed charges 0.83 93 0.67 percent of total billed charges 0.83 0.83 other OPPS APC 0.83 0.83 other OPPS APC 0.83 27.63 0.23 percent of total billed charges 0.83 0.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE TUBERCULIN BD SAFETYGLIDE .5IN 27GA 1ML STERILE LF REGULAR BEVEL PERMANENT ATTACH NEEDLE SHIELD SUP-305945 CDM 0270 RC outpatient 0.73 0.73 0.73 74 0.54 percent of total billed charges 0.73 93 0.59 percent of total billed charges 0.73 0.73 other OPPS APC 0.73 0.73 other OPPS APC 0.73 27.63 0.2 percent of total billed charges 0.73 0.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC MOSAIC ULTRA CINCH PORCINE RING H13.5 MM OD19 MM STENT HOLDER SEW 305 SUP-305U19 CDM 0270 RC outpatient 14040 14040 14040 74 10389.6 percent of total billed charges 14040 93 11372.4 percent of total billed charges 14040 14040 other OPPS APC 14040 14040 other OPPS APC 14040 27.63 3879.25 percent of total billed charges 14040 14040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC MOSAIC ULTRA CINCH PORCINE RING H16 MM OD23 MM STENT HOLDER SEW 305 SUP-305U23 CDM 0270 RC outpatient 14040 14040 14040 74 10389.6 percent of total billed charges 14040 93 11372.4 percent of total billed charges 14040 14040 other OPPS APC 14040 14040 other OPPS APC 14040 27.63 3879.25 percent of total billed charges 14040 14040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL EQUINOXE LONG L175 MM OD8 MM SHOULDER CEMENTED REVISION SUP-306-01-08 CDM 270010030 LOCAL 0270 RC outpatient 7956 7956 7956 74 5887.44 percent of total billed charges 7956 93 6444.36 percent of total billed charges 7956 7956 other OPPS APC 7956 7956 other OPPS APC 7956 27.63 2198.24 percent of total billed charges 7956 7956 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL EQUINOXE LONG L175 MM OD12 MM SHOULDER CEMENTED REVISION SUP-306-02-12 CDM 270010030 LOCAL 0270 RC outpatient 7956 7956 7956 74 5887.44 percent of total billed charges 7956 93 6444.36 percent of total billed charges 7956 7956 other OPPS APC 7956 7956 other OPPS APC 7956 27.63 2198.24 percent of total billed charges 7956 7956 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER IV PROTECTIV PLUS STRAIGHT 1IN 22GA BLUE POLYURETHANE DISPOSABLE STERILE LF PERIPHERAL RADIOPAQUE SAFETY SUP-3060 CDM 0270 RC outpatient 4.19 4.19 4.19 74 3.1 percent of total billed charges 4.19 93 3.39 percent of total billed charges 4.19 4.19 other OPPS APC 4.19 4.19 other OPPS APC 4.19 27.63 1.16 percent of total billed charges 4.19 4.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE EQUIPMENT OPMI VISIONGUARD L154 IN X W52 IN MICROSCOPE 2 LONG BRIDGE STEREO OBSERVATION STERILE LATEX FREE DISPOSABLE PENTERO SUP-306026 CDM 0270 RC outpatient 76.31 76.31 76.31 74 56.47 percent of total billed charges 76.31 93 61.81 percent of total billed charges 76.31 76.31 other OPPS APC 76.31 76.31 other OPPS APC 76.31 27.63 21.08 percent of total billed charges 76.31 76.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE EQUIPMENT SMARTDRAPE STERILE LATEX FREE DISPOSABLE SUP-306028-0000-000 CDM 0270 RC outpatient 100.36 100.36 100.36 74 74.27 percent of total billed charges 100.36 93 81.29 percent of total billed charges 100.36 100.36 other OPPS APC 100.36 100.36 other OPPS APC 100.36 27.63 27.73 percent of total billed charges 100.36 100.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE EQUIPMENT SMARTDRAPE STERILE LATEX FREE DISPOSABLE SUP-306029-0000-000 CDM 0270 RC outpatient 100.36 100.36 100.36 74 74.27 percent of total billed charges 100.36 93 81.29 percent of total billed charges 100.36 100.36 other OPPS APC 100.36 100.36 other OPPS APC 100.36 27.63 27.73 percent of total billed charges 100.36 100.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE MICROSCOPE STERILE EXTRA LONG 48 X 118IN SUP-306071 CDM outpatient 62.44 62.44 62.44 62.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER IV PROTECTIV PLUS STRAIGHT 1.25IN 16GA GRAY POLYURETHANE DISPOSABLE STERILE LF PERIPHERAL RADIOPAQUE SUP-306201 CDM 0270 RC outpatient 4.19 4.19 4.19 74 3.1 percent of total billed charges 4.19 93 3.39 percent of total billed charges 4.19 4.19 other OPPS APC 4.19 4.19 other OPPS APC 4.19 27.63 1.16 percent of total billed charges 4.19 4.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER IV PROTECTIV PLUS STRAIGHT .75IN 24GA YELLOW POLYURETHANE DISPOSABLE STERILE LF PERIPHERAL RADIOPAQUE SAFETY SUP-3063 CDM 0270 RC outpatient 4.19 4.19 4.19 74 3.1 percent of total billed charges 4.19 93 3.39 percent of total billed charges 4.19 4.19 other OPPS APC 4.19 4.19 other OPPS APC 4.19 27.63 1.16 percent of total billed charges 4.19 4.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER IV PROTECTIV PLUS STRAIGHT .75IN 24GA YELLOW POLYURETHANE DISPOSABLE STERILE LF PERIPHERAL RADIOPAQUE SAFETY SUP-306301 CDM 0270 RC outpatient 4.19 4.19 4.19 74 3.1 percent of total billed charges 4.19 93 3.39 percent of total billed charges 4.19 4.19 other OPPS APC 4.19 4.19 other OPPS APC 4.19 27.63 1.16 percent of total billed charges 4.19 4.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER IV PROTECTIV PLUS STRAIGHT 1.25IN 18GA GREEN POLYURETHANE DISPOSABLE STERILE LF PERIPHERAL RADIOPAQUE SAFETY SUP-306501 CDM 0270 RC outpatient 4.19 4.19 4.19 74 3.1 percent of total billed charges 4.19 93 3.39 percent of total billed charges 4.19 4.19 other OPPS APC 4.19 4.19 other OPPS APC 4.19 27.63 1.16 percent of total billed charges 4.19 4.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE INTRAVENOUS BD POSIFLUSH NORMAL SALINE 5 ML PRESERVATIVE FREE FILL STERILE LATEX FREE SUP-306545 CDM 0270 RC outpatient 0.74 0.74 0.74 74 0.55 percent of total billed charges 0.74 93 0.6 percent of total billed charges 0.74 0.74 other OPPS APC 0.74 0.74 other OPPS APC 0.74 27.63 0.2 percent of total billed charges 0.74 0.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER IV PROTECTIV PLUS STRAIGHT 1.25IN 20GA PINK POLYURETHANE DISPOSABLE STERILE LF PERIPHERAL RADIOPAQUE SAFETY SUP-3066 CDM 0270 RC outpatient 4.19 4.19 4.19 74 3.1 percent of total billed charges 4.19 93 3.39 percent of total billed charges 4.19 4.19 other OPPS APC 4.19 4.19 other OPPS APC 4.19 27.63 1.16 percent of total billed charges 4.19 4.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER IV PROTECTIV PLUS STRAIGHT 1.25IN 14GA ORANGE POLYURETHANE DISPOSABLE STERILE LF PERIPHERAL RADIOPAQUE SAFETY SUP-306801 CDM 0270 RC outpatient 4.19 4.19 4.19 74 3.1 percent of total billed charges 4.19 93 3.39 percent of total billed charges 4.19 4.19 other OPPS APC 4.19 4.19 other OPPS APC 4.19 27.63 1.16 percent of total billed charges 4.19 4.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER CRYOABLATION FREEZOR 2-5-2 MM SPACE 47 MM CURVE L108 CM L4 MM OD7 FR CARDIAC 1 THERMOCOUPLE FLEXIBLE STEERABLE STERILE DISPOSABLE SUP-307F1 CDM 0270 RC outpatient 2730 2730 2730 74 2020.2 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 2730 other OPPS APC 2730 2730 other OPPS APC 2730 27.63 754.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER CRYOABLATION FREEZOR 2-5-2 MM SPACE 58 MM L108 CM L4 MM OD7 FR 4 TIP ELECTRODE THERMOCOUPLE FLEXIBLE STEERABLE STERILE DISPOSABLE SUP-307F5 CDM 0270 RC outpatient 2730 2730 2730 74 2020.2 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 2730 other OPPS APC 2730 2730 other OPPS APC 2730 27.63 754.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD OCTRODE SUP-3086 CDM 0270 RC outpatient 4238 4238 4238 74 3136.12 percent of total billed charges 4238 93 3432.78 percent of total billed charges 4238 4238 other OPPS APC 4238 4238 other OPPS APC 4238 27.63 1170.96 percent of total billed charges 4238 4238 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE REAMER HOLLOW SPARE 309.250 SCREW REMOVAL SUP-309.280 CDM 0270 RC outpatient 519.17 519.17 519.17 74 384.19 percent of total billed charges 519.17 93 420.53 percent of total billed charges 519.17 519.17 other OPPS APC 519.17 519.17 other OPPS APC 519.17 27.63 143.45 percent of total billed charges 519.17 519.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL PROLOOP POLYPROPYLENE SMALL W1.1 IN X H1.3 IN L3.5 IN X W1.8 IN 3 DIMENSIONAL PLUG PREFORMED ONLAY NONABSORBABLE STERILE HERNIA SUP-30900 CDM 0270 RC outpatient 290.81 290.81 290.81 74 215.2 percent of total billed charges 290.81 93 235.56 percent of total billed charges 290.81 290.81 other OPPS APC 290.81 290.81 other OPPS APC 290.81 27.63 80.35 percent of total billed charges 290.81 290.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL PROLOOP POLYPROPYLENE MEDIUM W1.55 IN X H1.3 IN L3.5 IN X W1.8 IN PREFORMED PLUG ONLAY NONABSORBABLE STERILE HERNIA SUP-30901 CDM 0270 RC outpatient 290.81 290.81 290.81 74 215.2 percent of total billed charges 290.81 93 235.56 percent of total billed charges 290.81 290.81 other OPPS APC 290.81 290.81 other OPPS APC 290.81 27.63 80.35 percent of total billed charges 290.81 290.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL PROLOOP POLYPROPYLENE LARGE W1.9 IN X H1.6 IN L3.5 IN X W1.8 IN 3 DIMENSIONAL PLUG PREFORMED ONLAY NONABSORBABLE STERILE HERNIA SUP-30902 CDM 0270 RC outpatient 290.81 290.81 290.81 74 215.2 percent of total billed charges 290.81 93 235.56 percent of total billed charges 290.81 290.81 other OPPS APC 290.81 290.81 other OPPS APC 290.81 27.63 80.35 percent of total billed charges 290.81 290.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL PROLOOP POLYPROPYLENE XL W2 IN X H1.6 IN L3.5 IN X W1.8 IN 3 DIMENSIONAL PLUG PREFORMED ONLAY NONABSORBABLE STERILE HERNIA SUP-30903 CDM 0270 RC outpatient 314.82 314.82 314.82 74 232.97 percent of total billed charges 314.82 93 255 percent of total billed charges 314.82 314.82 other OPPS APC 314.82 314.82 other OPPS APC 314.82 27.63 86.98 percent of total billed charges 314.82 314.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE TI-CRON CARDIOPOINT 2-0CV-331 L30IN 2 ARM BRAID 8 STRAND COATED BLUE WHITE SUP-3091-56 CDM 0270 RC outpatient 552.73 552.73 552.73 74 409.02 percent of total billed charges 552.73 93 447.71 percent of total billed charges 552.73 552.73 other OPPS APC 552.73 552.73 other OPPS APC 552.73 27.63 152.72 percent of total billed charges 552.73 552.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HYPODERMIC SHORT BEVEL STERILE DISPOSABLE 21GA X 1.5IN SUP-309577 CDM 0270 RC outpatient 0.16 0.16 0.16 74 0.12 percent of total billed charges 0.16 93 0.13 percent of total billed charges 0.16 0.16 other OPPS APC 0.16 0.16 other OPPS APC 0.16 27.63 0.04 percent of total billed charges 0.16 0.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE TUBERCULIN BD BD PRECISIONGLIDE REGULAR BEVEL REGULAR WALL L1/2 IN OD27 GA 1 ML DETACHABLE NEEDLE SLIP TIP HUB STERILE LATEX FREE DISPOSABLE GRAY SUP-309623 CDM 0270 RC outpatient 39.75 39.75 39.75 74 29.42 percent of total billed charges 39.75 93 32.2 percent of total billed charges 39.75 39.75 other OPPS APC 39.75 39.75 other OPPS APC 39.75 27.63 10.98 percent of total billed charges 39.75 39.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE MEDICAL BD BD LUER-LOK 5ML CLEAR POLYPROPYLENE DISPOSABLE STERILE LF GRADUATE NONPYROGENIC DEHP FREE PVC FREE SUP-309646 CDM 0270 RC outpatient 0.27 0.27 0.27 74 0.2 percent of total billed charges 0.27 93 0.22 percent of total billed charges 0.27 0.27 other OPPS APC 0.27 0.27 other OPPS APC 0.27 27.63 0.07 percent of total billed charges 0.27 0.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE MEDICAL BD 5ML POLYPROPYLENE DISPOSABLE STERILE LF SLIP TIP GRADUATED SUP-309647 CDM 0270 RC outpatient 0.23 0.23 0.23 74 0.17 percent of total billed charges 0.23 93 0.19 percent of total billed charges 0.23 0.23 other OPPS APC 0.23 0.23 other OPPS APC 0.23 27.63 0.06 percent of total billed charges 0.23 0.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE MEDICAL BD 50ML CLEAR POLYPROPYLENE DISPOSABLE STERILE LF GRADUATE SLIP TIP NONPYROGENIC DEHP FREE SUP-309654 CDM 0270 RC outpatient 1.15 1.15 1.15 74 0.85 percent of total billed charges 1.15 93 0.93 percent of total billed charges 1.15 1.15 other OPPS APC 1.15 1.15 other OPPS APC 1.15 27.63 0.32 percent of total billed charges 1.15 1.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE MEDICAL BD 3 ML GRADUATE NONPYROGENIC DEHP FREE PVC FREE STERILE LATEX FREE DISPOSABLE SUP-309656 CDM 0270 RC outpatient 0.25 0.25 0.25 74 0.19 percent of total billed charges 0.25 93 0.2 percent of total billed charges 0.25 0.25 other OPPS APC 0.25 0.25 other OPPS APC 0.25 27.63 0.07 percent of total billed charges 0.25 0.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE MEDICAL BD BD LUER-LOK 3ML CLEAR POLYPROPYLENE DISPOSABLE STERILE LF GRADUATE NONPYROGENIC DEHP FREE PVC FREE SUP-309657 CDM 0270 RC outpatient 0.17 0.17 0.17 74 0.13 percent of total billed charges 0.17 93 0.14 percent of total billed charges 0.17 0.17 other OPPS APC 0.17 0.17 other OPPS APC 0.17 27.63 0.05 percent of total billed charges 0.17 0.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE MEDICAL BD BD LUER-LOK 10ML CLEAR POLYPROPYLENE DISPOSABLE STERILE LF GRADUATE CONTROL NONPYROGENIC DEHP FREE SUP-309695 CDM 0270 RC outpatient 1.89 1.89 1.89 74 1.4 percent of total billed charges 1.89 93 1.53 percent of total billed charges 1.89 1.89 other OPPS APC 1.89 1.89 other OPPS APC 1.89 27.63 0.52 percent of total billed charges 1.89 1.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH CUFFED SHILEY FLEX 8.0MM SUP-31-00003 CDM 0272 RC outpatient 206.08 206.08 206.08 74 152.5 percent of total billed charges 206.08 93 166.92 percent of total billed charges 206.08 206.08 other OPPS APC 206.08 206.08 other OPPS APC 206.08 27.63 56.94 percent of total billed charges 206.08 206.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH CUFF FENSTRATED LOW PRES SUP-31-00004 CDM 0272 RC outpatient 194.76 194.76 194.76 74 144.12 percent of total billed charges 194.76 93 157.76 percent of total billed charges 194.76 194.76 other OPPS APC 194.76 194.76 other OPPS APC 194.76 27.63 53.81 percent of total billed charges 194.76 194.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH CUFF LOW PRESSURE 4 SUP-31-00005 CDM 0272 RC outpatient 211.69 211.69 211.69 74 156.65 percent of total billed charges 211.69 93 171.47 percent of total billed charges 211.69 211.69 other OPPS APC 211.69 211.69 other OPPS APC 211.69 27.63 58.49 percent of total billed charges 211.69 211.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH CUFFLESS FENSTRATED 6CFN SUP-31-00007 CDM 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH CUFFLESS FENSTRATED 8CFN SUP-31-00008 CDM 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH DISPOSABLE INNER CANNULA 6 SUP-31-00009 CDM 0272 RC outpatient 3.84 3.84 3.84 74 2.84 percent of total billed charges 3.84 93 3.11 percent of total billed charges 3.84 3.84 other OPPS APC 3.84 3.84 other OPPS APC 3.84 27.63 1.06 percent of total billed charges 3.84 3.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH DISPOSABLE INNER CANNULA 8 SUP-31-00010 CDM 0272 RC outpatient 3.91 3.91 3.91 74 2.89 percent of total billed charges 3.91 93 3.17 percent of total billed charges 3.91 3.91 other OPPS APC 3.91 3.91 other OPPS APC 3.91 27.63 1.08 percent of total billed charges 3.91 3.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH DISPOSABLE INNER CANNULA 10 SUP-31-00011 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH TUBE FOAM CUFFED #7 SUP-31-00015 CDM 0272 RC outpatient 357.76 357.76 357.76 74 264.74 percent of total billed charges 357.76 93 289.79 percent of total billed charges 357.76 357.76 other OPPS APC 357.76 357.76 other OPPS APC 357.76 27.63 98.85 percent of total billed charges 357.76 357.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH TUBE FOAM CUFFED #8 SUP-31-00016 CDM 0272 RC outpatient 359.1 359.1 359.1 74 265.73 percent of total billed charges 359.1 93 290.87 percent of total billed charges 359.1 359.1 other OPPS APC 359.1 359.1 other OPPS APC 359.1 27.63 99.22 percent of total billed charges 359.1 359.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE CUFFLESS TRACH #6 SUP-31-00019 CDM 0272 RC outpatient 182.16 182.16 182.16 74 134.8 percent of total billed charges 182.16 93 147.55 percent of total billed charges 182.16 182.16 other OPPS APC 182.16 182.16 other OPPS APC 182.16 27.63 50.33 percent of total billed charges 182.16 182.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE CUFFLESS TRACH #8 SUP-31-00020 CDM 0272 RC outpatient 173.54 173.54 173.54 74 128.42 percent of total billed charges 173.54 93 140.57 percent of total billed charges 173.54 173.54 other OPPS APC 173.54 173.54 other OPPS APC 173.54 27.63 47.95 percent of total billed charges 173.54 173.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDO TRACH 2.5 UNCUFFED SUP-31-00021 CDM 0272 RC outpatient 0.99 0.99 0.99 74 0.73 percent of total billed charges 0.99 93 0.8 percent of total billed charges 0.99 0.99 other OPPS APC 0.99 0.99 other OPPS APC 0.99 27.63 0.27 percent of total billed charges 0.99 0.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDO TRACH 3.0 CUFFED SUP-31-00022 CDM 0272 RC outpatient 1.38 1.38 1.38 74 1.02 percent of total billed charges 1.38 93 1.12 percent of total billed charges 1.38 1.38 other OPPS APC 1.38 1.38 other OPPS APC 1.38 27.63 0.38 percent of total billed charges 1.38 1.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDO TRACH 3.0 UNCUFFED SUP-31-00023 CDM 0272 RC outpatient 1 1 1 74 0.74 percent of total billed charges 1 93 0.81 percent of total billed charges 1 1 other OPPS APC 1 1 other OPPS APC 1 27.63 0.28 percent of total billed charges 1 1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDO TRACH 3.5 UNCUFFED SUP-31-00024 CDM 0272 RC outpatient 0.99 0.99 0.99 74 0.73 percent of total billed charges 0.99 93 0.8 percent of total billed charges 0.99 0.99 other OPPS APC 0.99 0.99 other OPPS APC 0.99 27.63 0.27 percent of total billed charges 0.99 0.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDO TRACH 4.0 CUFFED SUP-31-00025 CDM 0272 RC outpatient 1.52 1.52 1.52 74 1.12 percent of total billed charges 1.52 93 1.23 percent of total billed charges 1.52 1.52 other OPPS APC 1.52 1.52 other OPPS APC 1.52 27.63 0.42 percent of total billed charges 1.52 1.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDO TRACH 4.0 UNCUFFED SUP-31-00026 CDM 0272 RC outpatient 0.99 0.99 0.99 74 0.73 percent of total billed charges 0.99 93 0.8 percent of total billed charges 0.99 0.99 other OPPS APC 0.99 0.99 other OPPS APC 0.99 27.63 0.27 percent of total billed charges 0.99 0.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDO TRACH 4.5 UNCUFFED SUP-31-00027 CDM 0272 RC outpatient 0.97 0.97 0.97 74 0.72 percent of total billed charges 0.97 93 0.79 percent of total billed charges 0.97 0.97 other OPPS APC 0.97 0.97 other OPPS APC 0.97 27.63 0.27 percent of total billed charges 0.97 0.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDO TRACH 5.0 CUFFED SUP-31-00028 CDM 0272 RC outpatient 1.64 1.64 1.64 74 1.21 percent of total billed charges 1.64 93 1.33 percent of total billed charges 1.64 1.64 other OPPS APC 1.64 1.64 other OPPS APC 1.64 27.63 0.45 percent of total billed charges 1.64 1.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDO TRACH 5.0 UNCUFFED SUP-31-00029 CDM 0272 RC outpatient 1.11 1.11 1.11 74 0.82 percent of total billed charges 1.11 93 0.9 percent of total billed charges 1.11 1.11 other OPPS APC 1.11 1.11 other OPPS APC 1.11 27.63 0.31 percent of total billed charges 1.11 1.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDO TRACH 6.0 CUFFED SUP-31-00030 CDM 0272 RC outpatient 1.56 1.56 1.56 74 1.15 percent of total billed charges 1.56 93 1.26 percent of total billed charges 1.56 1.56 other OPPS APC 1.56 1.56 other OPPS APC 1.56 27.63 0.43 percent of total billed charges 1.56 1.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDO TRACH 7.0 CUFFED SUP-31-00031 CDM 0272 RC outpatient 1.47 1.47 1.47 74 1.09 percent of total billed charges 1.47 93 1.19 percent of total billed charges 1.47 1.47 other OPPS APC 1.47 1.47 other OPPS APC 1.47 27.63 0.41 percent of total billed charges 1.47 1.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDO TRACH 8.0 CUFFED SUP-31-00032 CDM 0272 RC outpatient 1.48 1.48 1.48 74 1.1 percent of total billed charges 1.48 93 1.2 percent of total billed charges 1.48 1.48 other OPPS APC 1.48 1.48 other OPPS APC 1.48 27.63 0.41 percent of total billed charges 1.48 1.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDO TRACH 9.0 CUFFED SUP-31-00033 CDM 0272 RC outpatient 2.41 2.41 2.41 74 1.78 percent of total billed charges 2.41 93 1.95 percent of total billed charges 2.41 2.41 other OPPS APC 2.41 2.41 other OPPS APC 2.41 27.63 0.67 percent of total billed charges 2.41 2.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY GUEDEL #9 SUP-31-00034 CDM 0272 RC outpatient 0.44 0.44 0.44 74 0.33 percent of total billed charges 0.44 93 0.36 percent of total billed charges 0.44 0.44 other OPPS APC 0.44 0.44 other OPPS APC 0.44 27.63 0.12 percent of total billed charges 0.44 0.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY DISPOSABLE 100MM SUP-31-00035 CDM 0272 RC outpatient 0.24 0.24 0.24 74 0.18 percent of total billed charges 0.24 93 0.19 percent of total billed charges 0.24 0.24 other OPPS APC 0.24 0.24 other OPPS APC 0.24 27.63 0.07 percent of total billed charges 0.24 0.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY GUEDEL #7 SUP-31-00036 CDM 0272 RC outpatient 0.43 0.43 0.43 74 0.32 percent of total billed charges 0.43 93 0.35 percent of total billed charges 0.43 0.43 other OPPS APC 0.43 0.43 other OPPS APC 0.43 27.63 0.12 percent of total billed charges 0.43 0.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY DISPOSABLE 60MM SUP-31-00037 CDM 0272 RC outpatient 0.3 0.3 0.3 74 0.22 percent of total billed charges 0.3 93 0.24 percent of total billed charges 0.3 0.3 other OPPS APC 0.3 0.3 other OPPS APC 0.3 27.63 0.08 percent of total billed charges 0.3 0.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY GUEDEL #8 SUP-31-00038 CDM 0272 RC outpatient 0.58 0.58 0.58 74 0.43 percent of total billed charges 0.58 93 0.47 percent of total billed charges 0.58 0.58 other OPPS APC 0.58 0.58 other OPPS APC 0.58 27.63 0.16 percent of total billed charges 0.58 0.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY DISPOSABLE 80MM SUP-31-00039 CDM 0272 RC outpatient 0.25 0.25 0.25 74 0.19 percent of total billed charges 0.25 93 0.2 percent of total billed charges 0.25 0.25 other OPPS APC 0.25 0.25 other OPPS APC 0.25 27.63 0.07 percent of total billed charges 0.25 0.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY GUEDEL #6 SUP-31-00040 CDM 0272 RC outpatient 0.39 0.39 0.39 74 0.29 percent of total billed charges 0.39 93 0.32 percent of total billed charges 0.39 0.39 other OPPS APC 0.39 0.39 other OPPS APC 0.39 27.63 0.11 percent of total billed charges 0.39 0.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY DISPOSABLE 90MM SUP-31-00041 CDM 0272 RC outpatient 0.24 0.24 0.24 74 0.18 percent of total billed charges 0.24 93 0.19 percent of total billed charges 0.24 0.24 other OPPS APC 0.24 0.24 other OPPS APC 0.24 27.63 0.07 percent of total billed charges 0.24 0.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY GUEDEL #5 SUP-31-00042 CDM 0272 RC outpatient 0.42 0.42 0.42 74 0.31 percent of total billed charges 0.42 93 0.34 percent of total billed charges 0.42 0.42 other OPPS APC 0.42 0.42 other OPPS APC 0.42 27.63 0.12 percent of total billed charges 0.42 0.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY INFANT 40MM SUP-31-00043 CDM 0272 RC outpatient 0.22 0.22 0.22 74 0.16 percent of total billed charges 0.22 93 0.18 percent of total billed charges 0.22 0.22 other OPPS APC 0.22 0.22 other OPPS APC 0.22 27.63 0.06 percent of total billed charges 0.22 0.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH PEDIATRIC 3.5 SUP-31-00045 CDM 0272 RC outpatient 147 147 147 74 108.78 percent of total billed charges 147 93 119.07 percent of total billed charges 147 147 other OPPS APC 147 147 other OPPS APC 147 27.63 40.62 percent of total billed charges 147 147 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH PEDIATRIC 4.0 SUP-31-00046 CDM 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH PEDIATRIC 5.0 SUP-31-00047 CDM 0272 RC outpatient 108.04 108.04 108.04 74 79.95 percent of total billed charges 108.04 93 87.51 percent of total billed charges 108.04 108.04 other OPPS APC 108.04 108.04 other OPPS APC 108.04 27.63 29.85 percent of total billed charges 108.04 108.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDO TRACH 7.5 CUFFED SUP-31-00049 CDM 0272 RC outpatient 1.47 1.47 1.47 74 1.09 percent of total billed charges 1.47 93 1.19 percent of total billed charges 1.47 1.47 other OPPS APC 1.47 1.47 other OPPS APC 1.47 27.63 0.41 percent of total billed charges 1.47 1.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDO TRACH 8.5 CUFFED SUP-31-00050 CDM 0272 RC outpatient 1.47 1.47 1.47 74 1.09 percent of total billed charges 1.47 93 1.19 percent of total billed charges 1.47 1.47 other OPPS APC 1.47 1.47 other OPPS APC 1.47 27.63 0.41 percent of total billed charges 1.47 1.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH CARE ELBOW SUP-31-00051 CDM 0272 RC outpatient 35.47 35.47 35.47 74 26.25 percent of total billed charges 35.47 93 28.73 percent of total billed charges 35.47 35.47 other OPPS APC 35.47 35.47 other OPPS APC 35.47 27.63 9.8 percent of total billed charges 35.47 35.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY GUEDEL #10 SUP-31-00054 CDM 0272 RC outpatient 0.49 0.49 0.49 74 0.36 percent of total billed charges 0.49 93 0.4 percent of total billed charges 0.49 0.49 other OPPS APC 0.49 0.49 other OPPS APC 0.49 27.63 0.14 percent of total billed charges 0.49 0.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH CUFFED- FENESTRATED 4 SUP-31-00056 CDM 0272 RC outpatient 209.67 209.67 209.67 74 155.16 percent of total billed charges 209.67 93 169.83 percent of total billed charges 209.67 209.67 other OPPS APC 209.67 209.67 other OPPS APC 209.67 27.63 57.93 percent of total billed charges 209.67 209.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH CUFFED- FENESTRATED 6 SUP-31-00057 CDM 0272 RC outpatient 209.65 209.65 209.65 74 155.14 percent of total billed charges 209.65 93 169.82 percent of total billed charges 209.65 209.65 other OPPS APC 209.65 209.65 other OPPS APC 209.65 27.63 57.93 percent of total billed charges 209.65 209.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH DISPOSABLE INNER CANNULA 4 SUP-31-00059 CDM 0272 RC outpatient 20.2 20.2 20.2 74 14.95 percent of total billed charges 20.2 93 16.36 percent of total billed charges 20.2 20.2 other OPPS APC 20.2 20.2 other OPPS APC 20.2 27.63 5.58 percent of total billed charges 20.2 20.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH CUFFED NONFEN 4 SUP-31-00060 CDM 0272 RC outpatient 180.44 180.44 180.44 74 133.53 percent of total billed charges 180.44 93 146.16 percent of total billed charges 180.44 180.44 other OPPS APC 180.44 180.44 other OPPS APC 180.44 27.63 49.86 percent of total billed charges 180.44 180.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH CUFFLESS FENESTRATED 4 SUP-31-00061 CDM 0272 RC outpatient 192.88 192.88 192.88 74 142.73 percent of total billed charges 192.88 93 156.23 percent of total billed charges 192.88 192.88 other OPPS APC 192.88 192.88 other OPPS APC 192.88 27.63 53.29 percent of total billed charges 192.88 192.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIDESCOPE COVER #3 COBALT/RANGER SUP-31-00062 CDM 0272 RC outpatient 72 72 72 74 53.28 percent of total billed charges 72 93 58.32 percent of total billed charges 72 72 other OPPS APC 72 72 other OPPS APC 72 27.63 19.89 percent of total billed charges 72 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIDESCOPE COVER #4 COBALT/RANGER SUP-31-00063 CDM 0272 RC outpatient 72 72 72 74 53.28 percent of total billed charges 72 93 58.32 percent of total billed charges 72 72 other OPPS APC 72 72 other OPPS APC 72 27.63 19.89 percent of total billed charges 72 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DISH PETRI STERILE SIZE M 3.5""" SUP-31-019 CDM 0270 RC outpatient 3.35 3.35 3.35 74 2.48 percent of total billed charges 3.35 93 2.71 percent of total billed charges 3.35 3.35 other OPPS APC 3.35 3.35 other OPPS APC 3.35 27.63 0.93 percent of total billed charges 3.35 3.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOTTLE MEDICINE PLASTIC TALL 1 L GRADUATE PITCHER STERILE LATEX FREE SUP-31-026 CDM 0270 RC outpatient 6.95 6.95 6.95 74 5.14 percent of total billed charges 6.95 93 5.63 percent of total billed charges 6.95 6.95 other OPPS APC 6.95 6.95 other OPPS APC 6.95 27.63 1.92 percent of total billed charges 6.95 6.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG SPECIMEN POLYETHYLENE L14 IN X W8 IN TRANSPORT STERILE SUP-31-218 CDM 0270 RC outpatient 3.53 3.53 3.53 74 2.61 percent of total billed charges 3.53 93 2.86 percent of total billed charges 3.53 3.53 other OPPS APC 3.53 3.53 other OPPS APC 3.53 27.63 0.98 percent of total billed charges 3.53 3.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE UMBILICAL COTTON FLAT L30 IN X W1/8 IN STERILE LATEX FREE SUP-31-251 CDM 0270 RC outpatient 2.06 2.06 2.06 74 1.52 percent of total billed charges 2.06 93 1.67 percent of total billed charges 2.06 2.06 other OPPS APC 2.06 2.06 other OPPS APC 2.06 27.63 0.57 percent of total billed charges 2.06 2.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC IMAGER II MEDI-GLIDE TUNGSTEN BERENSTEIN CURVE L100 CM OD5 FR CEREBRAL BRAID TORQUE SELECTIVE RADIOPAQUE ACCEPTS .038 IN GUIDEWIRE SUP-31-405 CDM 0270 RC outpatient 33.8 33.8 33.8 74 25.01 percent of total billed charges 33.8 93 27.38 percent of total billed charges 33.8 33.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC IMAGER II MEDI-GLIDE TUNGSTEN BERENSTEIN CURVE L65 CM OD5 FR CEREBRAL BRAID TORQUE SELECTIVE RADIOPAQUE ACCEPTS .038 IN GUIDEWIRE SUP-31-410 CDM 0270 RC outpatient 33.8 33.8 33.8 74 25.01 percent of total billed charges 33.8 93 27.38 percent of total billed charges 33.8 33.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC IMAGER II MEDI-GLIDE TUNGSTEN COBRA 2 CURVE L65 CM OD5 FR VISCERAL BRAID TORQUE SELECTIVE RADIOPAQUE ACCEPTS .038 IN GUIDEWIRE SUP-31-466 CDM 0270 RC outpatient 25.95 25.95 25.95 74 19.2 percent of total billed charges 25.95 93 21.02 percent of total billed charges 25.95 25.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC IMAGER II PIGTAIL CURVE L65 CM OD4 FR BRAID TORQUE SELECTIVE RADIOPAQUE SOFT ACCEPTS .035 IN GUIDEWIRE SUP-31-509 CDM 0270 RC outpatient 25.95 25.95 25.95 74 19.2 percent of total billed charges 25.95 93 21.02 percent of total billed charges 25.95 25.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC IMAGER II CONTRALATERAL CURVE L65 CM OD4 FR BRAID TORQUE SELECTIVE RADIOPAQUE SOFT ACCEPTS .035 IN GUIDEWIRE SUP-31-525 CDM 0270 RC outpatient 24.96 24.96 24.96 74 18.47 percent of total billed charges 24.96 93 20.22 percent of total billed charges 24.96 24.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD HUMERAL EQUINOXE SHORT OD41 MM SUP-310-01-41 CDM 270010030 LOCAL 0270 RC outpatient 3744 3744 3744 74 2770.56 percent of total billed charges 3744 93 3032.64 percent of total billed charges 3744 3744 other OPPS APC 3744 3744 other OPPS APC 3744 27.63 1034.47 percent of total billed charges 3744 3744 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L60 MM OD1.1 MM QUICK COUPLING 1.3 MM SCREW SUP-310.11.98 CDM 270010022 LOCAL 0270 RC outpatient 250.2 250.2 250.2 74 185.15 percent of total billed charges 250.2 93 202.66 percent of total billed charges 250.2 250.2 other OPPS APC 250.2 250.2 other OPPS APC 250.2 27.63 69.13 percent of total billed charges 250.2 250.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MINI L55 MM OD1.1 MM QUICK COUPLING NONSTERILE SUP-310.111 CDM 270010022 LOCAL 0270 RC outpatient 435.37 435.37 435.37 74 322.17 percent of total billed charges 435.37 93 352.65 percent of total billed charges 435.37 435.37 other OPPS APC 435.37 435.37 other OPPS APC 435.37 27.63 120.29 percent of total billed charges 435.37 435.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL STAINLESS STEEL L65 MM OD1.5 MM MINI QUICK COUPLING NONSTERILE LCP MODULAR MINI FRAGMENT SYSTEM SUP-310.141 CDM 270010022 LOCAL 0270 RC outpatient 186.63 186.63 186.63 74 138.11 percent of total billed charges 186.63 93 151.17 percent of total billed charges 186.63 186.63 other OPPS APC 186.63 186.63 other OPPS APC 186.63 27.63 51.57 percent of total billed charges 186.63 186.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 85MM 1.5MM NS QUICK COUPLING SUP-310.15 CDM 270010022 LOCAL 0270 RC outpatient 207.35 207.35 207.35 74 153.44 percent of total billed charges 207.35 93 167.95 percent of total billed charges 207.35 207.35 other OPPS APC 207.35 207.35 other OPPS APC 207.35 27.63 57.29 percent of total billed charges 207.35 207.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L85 MM OD1.5 MM QUICK COUPLING 2 MM SCREW SUP-310.15.98 CDM 270010022 LOCAL 0270 RC outpatient 250.2 250.2 250.2 74 185.15 percent of total billed charges 250.2 93 202.66 percent of total billed charges 250.2 250.2 other OPPS APC 250.2 250.2 other OPPS APC 250.2 27.63 69.13 percent of total billed charges 250.2 250.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 110MM 1.5MM NS QUICK COUPLING SUP-310.16 CDM 270010022 LOCAL 0270 RC outpatient 207.35 207.35 207.35 74 153.44 percent of total billed charges 207.35 93 167.95 percent of total billed charges 207.35 207.35 other OPPS APC 207.35 207.35 other OPPS APC 207.35 27.63 57.29 percent of total billed charges 207.35 207.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 8 MM STOP L125 MM L8 MM OD1.5 MM J LATCH COUPLING SELF STOP NONSTERILE 1.5 MM SCREW SUP-310.172 CDM 270010014 LOCAL 0270 RC outpatient 453.75 453.75 453.75 74 335.78 percent of total billed charges 453.75 93 367.54 percent of total billed charges 453.75 453.75 other OPPS APC 453.75 453.75 other OPPS APC 453.75 27.63 125.37 percent of total billed charges 453.75 453.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 100MM 2MM NS QUICK COUPLING SUP-310.19 CDM 270010022 LOCAL 0270 RC outpatient 181.58 181.58 181.58 74 134.37 percent of total billed charges 181.58 93 147.08 percent of total billed charges 181.58 181.58 other OPPS APC 181.58 181.58 other OPPS APC 181.58 27.63 50.17 percent of total billed charges 181.58 181.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL JACOBS CHUCK STAINLESS STEEL STANDARD L85 MM OD2 MM SET BASIC ARTICULATE TENSION DEVICE NONSTERILE SUP-310.20 CDM 270010022 LOCAL 0270 RC outpatient 207.35 207.35 207.35 74 153.44 percent of total billed charges 207.35 93 167.95 percent of total billed charges 207.35 207.35 other OPPS APC 207.35 207.35 other OPPS APC 207.35 27.63 57.29 percent of total billed charges 207.35 207.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL LCP STAINLESS STEEL L65 MM OD2 MM MINI QUICK COUPLING NONSTERILE SUP-310.201 CDM 270010022 LOCAL 0270 RC outpatient 186.63 186.63 186.63 74 138.11 percent of total billed charges 186.63 93 151.17 percent of total billed charges 186.63 186.63 other OPPS APC 186.63 186.63 other OPPS APC 186.63 27.63 51.57 percent of total billed charges 186.63 186.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L150 MM OD2 MM QUICK COUPLING CANNULATED NONSTERILE SUP-310.221 CDM 270010022 LOCAL 0270 RC outpatient 851.76 851.76 851.76 74 630.3 percent of total billed charges 851.76 93 689.93 percent of total billed charges 851.76 851.76 other OPPS APC 851.76 851.76 other OPPS APC 851.76 27.63 235.34 percent of total billed charges 851.76 851.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 180MM 2.5MM GOLD NS QUICK COUPLING SUP-310.23 CDM 270010022 LOCAL 0270 RC outpatient 217.36 217.36 217.36 74 160.85 percent of total billed charges 217.36 93 176.06 percent of total billed charges 217.36 217.36 other OPPS APC 217.36 217.36 other OPPS APC 217.36 27.63 60.06 percent of total billed charges 217.36 217.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC LCP STAINLESS STEEL L200 MM OD2.5 MM DRILL TIP TOMOFIX OSTEOTOMY SYSTEM SUP-310.243 CDM 270010022 LOCAL 0270 RC outpatient 152.59 152.59 152.59 74 112.92 percent of total billed charges 152.59 93 123.6 percent of total billed charges 152.59 152.59 other OPPS APC 152.59 152.59 other OPPS APC 152.59 27.63 42.16 percent of total billed charges 152.59 152.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 110MM 2.5MM GOLD NS QUICK COUPLING SUP-310.25 CDM 270010022 LOCAL 0270 RC outpatient 395.59 395.59 395.59 74 292.74 percent of total billed charges 395.59 93 320.43 percent of total billed charges 395.59 395.59 other OPPS APC 395.59 395.59 other OPPS APC 395.59 27.63 109.3 percent of total billed charges 395.59 395.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 100MM 2.7MM NS QUICK COUPLING SUP-310.26 CDM 270010022 LOCAL 0270 RC outpatient 182.86 182.86 182.86 74 135.32 percent of total billed charges 182.86 93 148.12 percent of total billed charges 182.86 182.86 other OPPS APC 182.86 182.86 other OPPS APC 182.86 27.63 50.52 percent of total billed charges 182.86 182.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL LCP TITANIUM L165 MM OD2.8 MM QUICK COUPLING NONSTERILE SUP-310.288 CDM 270010022 LOCAL 0270 RC outpatient 497.25 497.25 497.25 74 367.97 percent of total billed charges 497.25 93 402.77 percent of total billed charges 497.25 497.25 other OPPS APC 497.25 497.25 other OPPS APC 497.25 27.63 137.39 percent of total billed charges 497.25 497.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 195MM 3.2MM NS QUICK COUPLING SUP-310.29 CDM 270010013 LOCAL 0270 RC outpatient 340.34 340.34 340.34 74 251.85 percent of total billed charges 340.34 93 275.68 percent of total billed charges 340.34 340.34 other OPPS APC 340.34 340.34 other OPPS APC 340.34 27.63 94.04 percent of total billed charges 340.34 340.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 145MM 3.2MM NS QUICK COUPLING SUP-310.31 CDM 270010022 LOCAL 0270 RC outpatient 391.17 391.17 391.17 74 289.47 percent of total billed charges 391.17 93 316.85 percent of total billed charges 391.17 391.17 other OPPS APC 391.17 391.17 other OPPS APC 391.17 27.63 108.08 percent of total billed charges 391.17 391.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL STAINLESS STEEL L130 MM OD3.2 MM NONSTERILE JACOBS CHUCK SUP-310.32 CDM 270010022 LOCAL 0270 RC outpatient 201.63 201.63 201.63 74 149.21 percent of total billed charges 201.63 93 163.32 percent of total billed charges 201.63 201.63 other OPPS APC 201.63 201.63 other OPPS APC 201.63 27.63 55.71 percent of total billed charges 201.63 201.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 110MM 3.5MM NS QUICK COUPLING SUP-310.35 CDM 270010022 LOCAL 0270 RC outpatient 181.58 181.58 181.58 74 134.37 percent of total billed charges 181.58 93 147.08 percent of total billed charges 181.58 181.58 other OPPS APC 181.58 181.58 other OPPS APC 181.58 27.63 50.17 percent of total billed charges 181.58 181.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 195MM 3.5MM NS QUICK COUPLING SUP-310.37 CDM 270010022 LOCAL 0270 RC outpatient 448.63 448.63 448.63 74 331.99 percent of total billed charges 448.63 93 363.39 percent of total billed charges 448.63 448.63 other OPPS APC 448.63 448.63 other OPPS APC 448.63 27.63 123.96 percent of total billed charges 448.63 448.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL LCP L180 MM OD4.3 MM QUICK COUPLING 5 MM LOCK SCREW LARGE FRAGMENT SET SUP-310.431 CDM 270010022 LOCAL 0270 RC outpatient 288.78 288.78 288.78 74 213.7 percent of total billed charges 288.78 93 233.91 percent of total billed charges 288.78 288.78 other OPPS APC 288.78 288.78 other OPPS APC 288.78 27.63 79.79 percent of total billed charges 288.78 288.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 145MM 4.5MM NS QUICK COUPLING SUP-310.44 CDM 270010022 LOCAL 0270 RC outpatient 422.11 422.11 422.11 74 312.36 percent of total billed charges 422.11 93 341.91 percent of total billed charges 422.11 422.11 other OPPS APC 422.11 422.11 other OPPS APC 422.11 27.63 116.63 percent of total billed charges 422.11 422.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL STAINLESS STEEL L130 MM OD4.5 MM JACOBS CHUCK COUPLING NONSTERILE JACOB CHUCK SUP-310.45 CDM 270010022 LOCAL 0270 RC outpatient 201.63 201.63 201.63 74 149.21 percent of total billed charges 201.63 93 163.32 percent of total billed charges 201.63 201.63 other OPPS APC 201.63 201.63 other OPPS APC 201.63 27.63 55.71 percent of total billed charges 201.63 201.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL STAINLESS STEEL L195 MM OD4.5 MM QUICK COUPLING NONSTERILE SUP-310.48 CDM 270010022 LOCAL 0270 RC outpatient 340.34 340.34 340.34 74 251.85 percent of total billed charges 340.34 93 275.68 percent of total billed charges 340.34 340.34 other OPPS APC 340.34 340.34 other OPPS APC 340.34 27.63 94.04 percent of total billed charges 340.34 340.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL STAINLESS STEEL L300 MM OD7.3 MM ID2.9 MM LARGE QUICK COUPLING CANNULATED NONSTERILE SUP-310.495 CDM 270010022 LOCAL 0270 RC outpatient 1271.27 1271.27 1271.27 74 940.74 percent of total billed charges 1271.27 93 1029.73 percent of total billed charges 1271.27 1271.27 other OPPS APC 1271.27 1271.27 other OPPS APC 1271.27 27.63 351.25 percent of total billed charges 1271.27 1271.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL LCP STAINLESS STEEL L96 MM OD1.5 MM MINI QUICK COUPLING DEPTH MARK NONSTERILE SUP-310.507 CDM 270010022 LOCAL 0270 RC outpatient 817.7 817.7 817.7 74 605.1 percent of total billed charges 817.7 93 662.34 percent of total billed charges 817.7 817.7 other OPPS APC 817.7 817.7 other OPPS APC 817.7 27.63 225.93 percent of total billed charges 817.7 817.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL LCP STAINLESS STEEL L110 MM OD1.8 MM MINI QUICK COUPLING DEPTH MARK NONSTERILE SUP-310.509 CDM 270010022 LOCAL 0270 RC outpatient 817.7 817.7 817.7 74 605.1 percent of total billed charges 817.7 93 662.34 percent of total billed charges 817.7 817.7 other OPPS APC 817.7 817.7 other OPPS APC 817.7 27.63 225.93 percent of total billed charges 817.7 817.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL STAINLESS STEEL L100 MM OD1.8 MM QUICK COUPLING DEPTH MARK SUP-310.51 CDM 270010022 LOCAL 0270 RC outpatient 440.54 440.54 440.54 74 326 percent of total billed charges 440.54 93 356.84 percent of total billed charges 440.54 440.54 other OPPS APC 440.54 440.54 other OPPS APC 440.54 27.63 121.72 percent of total billed charges 440.54 440.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 100MM 1.8MM SS QUICK COUPLING DEPTH MARK NS SUP-310.510 CDM 270010022 LOCAL 0270 RC outpatient 440.54 440.54 440.54 74 326 percent of total billed charges 440.54 93 356.84 percent of total billed charges 440.54 440.54 other OPPS APC 440.54 440.54 other OPPS APC 440.54 27.63 121.72 percent of total billed charges 440.54 440.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 100MM 1.8MM NS J LATCH STRYKER SUP-310.512 CDM 270010014 LOCAL 0270 RC outpatient 453.75 453.75 453.75 74 335.78 percent of total billed charges 453.75 93 367.54 percent of total billed charges 453.75 453.75 other OPPS APC 453.75 453.75 other OPPS APC 453.75 27.63 125.37 percent of total billed charges 453.75 453.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL LONG 125MM 1.8MM NS J LATCH STRYKER SUP-310.522 CDM 270010014 LOCAL 0270 RC outpatient 453.75 453.75 453.75 74 335.78 percent of total billed charges 453.75 93 367.54 percent of total billed charges 453.75 453.75 other OPPS APC 453.75 453.75 other OPPS APC 453.75 27.63 125.37 percent of total billed charges 453.75 453.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL LCP 100MM 2.4MM SS NS MINI QUICK COUPLING SUP-310.53 CDM 270010022 LOCAL 0270 RC outpatient 440.54 440.54 440.54 74 326 percent of total billed charges 440.54 93 356.84 percent of total billed charges 440.54 440.54 other OPPS APC 440.54 440.54 other OPPS APC 440.54 27.63 121.72 percent of total billed charges 440.54 440.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL LCP STAINLESS STEEL L100 MM OD2.4 MM MINI QUICK COUPLING SUP-310.530 CDM 270010022 LOCAL 0270 RC outpatient 709.8 709.8 709.8 74 525.25 percent of total billed charges 709.8 93 574.94 percent of total billed charges 709.8 709.8 other OPPS APC 709.8 709.8 other OPPS APC 709.8 27.63 196.12 percent of total billed charges 709.8 709.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L195 MM OD6 MM QUICK COUPLING NONSTERILE SUP-310.60 CDM 270010022 LOCAL 0270 RC outpatient 474.76 474.76 474.76 74 351.32 percent of total billed charges 474.76 93 384.56 percent of total billed charges 474.76 474.76 other OPPS APC 474.76 474.76 other OPPS APC 474.76 27.63 131.18 percent of total billed charges 474.76 474.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 300MM 5MM 2.9MM NS LG QUICK COUPLING CANNULATED SUP-310.63 CDM 270010022 LOCAL 0270 RC outpatient 888.89 888.89 888.89 74 657.78 percent of total billed charges 888.89 93 720 percent of total billed charges 888.89 888.89 other OPPS APC 888.89 888.89 other OPPS APC 888.89 27.63 245.6 percent of total billed charges 888.89 888.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL LCP LARGE L200 MM OD5 MM ODSEC2.6 MM CANNULATED QUICK COUPLING SHORT FLUTE NONSTERILE 7.3 MM SCREW SUP-310.632 CDM 270010022 LOCAL 0270 RC outpatient 1001 1001 1001 74 740.74 percent of total billed charges 1001 93 810.81 percent of total billed charges 1001 1001 other OPPS APC 1001 1001 other OPPS APC 1001 27.63 276.58 percent of total billed charges 1001 1001 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL LCP L200 MM OD4.3 MM ODSEC2.6 MM LARGE QUICK COUPLING CANNULATED 5 MM SCREW SUP-310.634 CDM 270010022 LOCAL 0270 RC outpatient 1001 1001 1001 74 740.74 percent of total billed charges 1001 93 810.81 percent of total billed charges 1001 1001 other OPPS APC 1001 1001 other OPPS APC 1001 27.63 276.58 percent of total billed charges 1001 1001 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 170MM 3.2MM 1.7MM NS QUICK COUPLING CANNULATED SUP-310.65 CDM 270010022 LOCAL 0270 RC outpatient 1156.87 1156.87 1156.87 74 856.08 percent of total billed charges 1156.87 93 937.06 percent of total billed charges 1156.87 1156.87 other OPPS APC 1156.87 1156.87 other OPPS APC 1156.87 27.63 319.64 percent of total billed charges 1156.87 1156.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 170MM 4.5MM 1.7MM NS QUICK COUPLING CANNULATED SUP-310.66 CDM 270010022 LOCAL 0270 RC outpatient 1242.67 1242.67 1242.67 74 919.58 percent of total billed charges 1242.67 93 1006.56 percent of total billed charges 1242.67 1242.67 other OPPS APC 1242.67 1242.67 other OPPS APC 1242.67 27.63 343.35 percent of total billed charges 1242.67 1242.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 160MM 2.7MM 1.35MM NS QUICK COUPLING CANNULATED SUP-310.67 CDM 270010022 LOCAL 0270 RC outpatient 900.9 900.9 900.9 74 666.67 percent of total billed charges 900.9 93 729.73 percent of total billed charges 900.9 900.9 other OPPS APC 900.9 900.9 other OPPS APC 900.9 27.63 248.92 percent of total billed charges 900.9 900.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT COUNTERSINK CANNULATED 3.5 MM 4 MM SCREW SUP-310.86 CDM 270010022 LOCAL 0270 RC outpatient 1092.52 1092.52 1092.52 74 808.46 percent of total billed charges 1092.52 93 884.94 percent of total billed charges 1092.52 1092.52 other OPPS APC 1092.52 1092.52 other OPPS APC 1092.52 27.63 301.86 percent of total billed charges 1092.52 1092.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SUCTION ARGYLE SAFE-T-VAC ADULT ANGLE L21 IN OD10 FR GRADUATE STRAIGHT PACK CHIMNEY STYLE VALVE WHISTLE TIP STERILE LATEX FREE SUP-31000 CDM 0270 RC outpatient 1.57 1.57 1.57 74 1.16 percent of total billed charges 1.57 93 1.27 percent of total billed charges 1.57 1.57 other OPPS APC 1.57 1.57 other OPPS APC 1.57 27.63 0.43 percent of total billed charges 1.57 1.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL MOSAIC ACETAL HOMOPOLYMER POLYESTER H20.5 MM OD29 MM ODSEC35 MM ID24 MM FLEXIBLE SCALLOPED SUTURE RING POLYESTER SEWING GREEN SUTURE RADIOPAQUE EYELET SUP-31002901 CDM 0270 RC outpatient 14040 14040 14040 74 10389.6 percent of total billed charges 14040 93 11372.4 percent of total billed charges 14040 14040 other OPPS APC 14040 14040 other OPPS APC 14040 27.63 3879.25 percent of total billed charges 14040 14040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE HEMOSTATIC INTERVENTIONAL QUICKCLOT SUP-3101 CDM 0270 RC outpatient 52 52 52 74 38.48 percent of total billed charges 52 93 42.12 percent of total billed charges 52 52 other OPPS APC 52 52 other OPPS APC 52 27.63 14.37 percent of total billed charges 52 52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE HEMOSTATIC THROMBIX SILVER LF TOPICAL PATCH SUP-3101 CDM 0270 RC outpatient 38.48 38.48 38.48 74 28.48 percent of total billed charges 38.48 93 31.17 percent of total billed charges 38.48 38.48 other OPPS APC 38.48 38.48 other OPPS APC 38.48 27.63 10.63 percent of total billed charges 38.48 38.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL MOSAIC CINCH OD27 MM SUP-310C27 CDM 0270 RC outpatient 14040 14040 14040 74 10389.6 percent of total billed charges 14040 93 11372.4 percent of total billed charges 14040 14040 other OPPS APC 14040 14040 other OPPS APC 14040 27.63 3879.25 percent of total billed charges 14040 14040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAP SURGICAL 25MM 54MM MINI QUICK COUPLING 2MM CORTEX SCREW 1.5MM DRILL BIT SUP-311.19 CDM 270010022 LOCAL 0270 RC outpatient 473.33 473.33 473.33 74 350.26 percent of total billed charges 473.33 93 383.4 percent of total billed charges 473.33 473.33 other OPPS APC 473.33 473.33 other OPPS APC 473.33 27.63 130.78 percent of total billed charges 473.33 473.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAP SURGICAL 34MM 100MM QUICK COUPLING 2.7MM CORTEX SCREW 2MM DRILL BIT SUP-311.26 CDM 270010022 LOCAL 0270 RC outpatient 556.27 556.27 556.27 74 411.64 percent of total billed charges 556.27 93 450.58 percent of total billed charges 556.27 556.27 other OPPS APC 556.27 556.27 other OPPS APC 556.27 27.63 153.7 percent of total billed charges 556.27 556.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAP SURGICAL 46MM 111MM GOLD QUICK COUPLING 3.5MM CORTEX SHAFT SCREW 2.5MM DRILL BIT SUP-311.32 CDM 270010022 LOCAL 0270 RC outpatient 556.27 556.27 556.27 74 411.64 percent of total billed charges 556.27 93 450.58 percent of total billed charges 556.27 556.27 other OPPS APC 556.27 556.27 other OPPS APC 556.27 27.63 153.7 percent of total billed charges 556.27 556.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAP SURGICAL L110 MM NONSTERILE 4 MM CANCELLOUS SCREW SUP-311.34 CDM 270010022 LOCAL 0270 RC outpatient 525.93 525.93 525.93 74 389.19 percent of total billed charges 525.93 93 426 percent of total billed charges 525.93 525.93 other OPPS APC 525.93 525.93 other OPPS APC 525.93 27.63 145.31 percent of total billed charges 525.93 525.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAP SURGICAL L50 MM SPINE CANCELLOUS CALIBRATE NONSTERILE 3.5 MM CANCELLOUS SCREW SUP-311.349 CDM 270010022 LOCAL 0270 RC outpatient 413.92 413.92 413.92 74 306.3 percent of total billed charges 413.92 93 335.28 percent of total billed charges 413.92 413.92 other OPPS APC 413.92 413.92 other OPPS APC 413.92 27.63 114.37 percent of total billed charges 413.92 413.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAP SURGICAL D57 MM L130 MM NONSTERILE 4.5 MM CORTEX 4.5 MM SHAFT SCREW 3.2 MM DRILL BIT LARGE FRAGMENT SET SUP-311.46 CDM 270010022 LOCAL 0270 RC outpatient 564.85 564.85 564.85 74 417.99 percent of total billed charges 564.85 93 457.53 percent of total billed charges 564.85 564.85 other OPPS APC 564.85 564.85 other OPPS APC 564.85 27.63 156.07 percent of total billed charges 564.85 564.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAP SURGICAL 197MM 150MM CALIBRATED 6.5MM CANCELLOUS SCREW 3.2MM DRILL BIT SUP-311.66 CDM 270010022 LOCAL 0270 RC outpatient 1234.09 1234.09 1234.09 74 913.23 percent of total billed charges 1234.09 93 999.61 percent of total billed charges 1234.09 1234.09 other OPPS APC 1234.09 1234.09 other OPPS APC 1234.09 27.63 340.98 percent of total billed charges 1234.09 1234.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHUNT CARDIOVASCULAR CLEARVIEW SILICONE L14 MM OD1 MM INTRACORONARY BULB TAPERED TIP RADIOPAQUE STERILE ARTERIOTOMY SUP-31100 CDM 0270 RC outpatient 215.8 215.8 215.8 74 159.69 percent of total billed charges 215.8 93 174.8 percent of total billed charges 215.8 215.8 other OPPS APC 215.8 215.8 other OPPS APC 215.8 27.63 59.63 percent of total billed charges 215.8 215.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SURGICAL MEDIUM ROUND FINE L67 MM OD2 MM DIAMOND CUTTING STERILE SUP-31132065 CDM 0270 RC outpatient 434.2 434.2 434.2 74 321.31 percent of total billed charges 434.2 93 351.7 percent of total billed charges 434.2 434.2 other OPPS APC 434.2 434.2 other OPPS APC 434.2 27.63 119.97 percent of total billed charges 434.2 434.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SURGICAL MEDIUM ROUND FINE L68 MM OD3 MM DIAMOND CUTTING STERILE SUP-31133065 CDM 0270 RC outpatient 512.2 512.2 512.2 74 379.03 percent of total billed charges 512.2 93 414.88 percent of total billed charges 512.2 512.2 other OPPS APC 512.2 512.2 other OPPS APC 512.2 27.63 141.52 percent of total billed charges 512.2 512.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SURGICAL STAINLESS STEEL 80000 RPM MEDIUM FINE ROUND L69 MM OD4 MM DIAMOND CUTTING STERILE SUP-31134065 CDM 0270 RC outpatient 512.2 512.2 512.2 74 379.03 percent of total billed charges 512.2 93 414.88 percent of total billed charges 512.2 512.2 other OPPS APC 512.2 512.2 other OPPS APC 512.2 27.63 141.52 percent of total billed charges 512.2 512.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SURGICAL STAINLESS STEEL 80000 RPM MEDIUM FINE ROUND L64 MM OD5 MM DIAMOND CUTTING STERILE SUP-31135059 CDM 0270 RC outpatient 512.2 512.2 512.2 74 379.03 percent of total billed charges 512.2 93 414.88 percent of total billed charges 512.2 512.2 other OPPS APC 512.2 512.2 other OPPS APC 512.2 27.63 141.52 percent of total billed charges 512.2 512.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SURGICAL STAINLESS STEEL 80000 RPM MEDIUM FINE ROUND L64 MM OD6 MM DIAMOND CUTTING STERILE SUP-31136058 CDM 0270 RC outpatient 512.2 512.2 512.2 74 379.03 percent of total billed charges 512.2 93 414.88 percent of total billed charges 512.2 512.2 other OPPS APC 512.2 512.2 other OPPS APC 512.2 27.63 141.52 percent of total billed charges 512.2 512.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL DEVON HANDS-FREE TRANSFER FOAM L16 IN X W10 IN FLEXIBLE MAGNET NONSLIP BACK LATEX FREE REUSABLE 116 SUP-31140588 CDM 0270 RC outpatient 192.59 192.59 192.59 74 142.52 percent of total billed charges 192.59 93 156 percent of total billed charges 192.59 192.59 other OPPS APC 192.59 192.59 other OPPS APC 192.59 27.63 53.21 percent of total billed charges 192.59 192.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION ANTIFOG DEVON DEFOGGER FOG-OUT ISOPROPANOL FOAM PAD NONTOXIC NONFLAMMABLE STERILE DISPOSABLE SUP-31142527 CDM 0270 RC outpatient 3.91 3.91 3.91 74 2.89 percent of total billed charges 3.91 93 3.17 percent of total billed charges 3.91 3.91 other OPPS APC 3.91 3.91 other OPPS APC 3.91 27.63 1.08 percent of total billed charges 3.91 3.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRAP POSITIONING DEVON L60 IN X W4 IN BODY KNEE LATEX FREE REUSABLE SUP-31142964 CDM 0270 RC outpatient 70.35 70.35 70.35 74 52.06 percent of total billed charges 70.35 93 56.98 percent of total billed charges 70.35 70.35 other OPPS APC 70.35 70.35 other OPPS APC 70.35 27.63 19.44 percent of total billed charges 70.35 70.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTER SPONGE DEVON BAG-IT OPAQUE BACK TRANSPARENT FRONT BAG SUP-31144127 CDM outpatient 0.47 0.47 0.47 0.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MARKER SURGICAL DEVON GENTIAN VIOLET DISPOSABLE STERILE LF SKIN 2 TIP RULER CAP LABEL NONTOXIC SUP-31145868 CDM 0270 RC outpatient 1.7 1.7 1.7 74 1.26 percent of total billed charges 1.7 93 1.38 percent of total billed charges 1.7 1.7 other OPPS APC 1.7 1.7 other OPPS APC 1.7 27.63 0.47 percent of total billed charges 1.7 1.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL C-QUR V-PATCH PROLITE OMEGA 3 FATTY ACID SMALL L1.7 IN X W1.7 IN 2 EXTEND STRAP STABILITY RING HERNIA SUP-31200 CDM 0270 RC outpatient 796.82 796.82 796.82 74 589.65 percent of total billed charges 796.82 93 645.42 percent of total billed charges 796.82 796.82 other OPPS APC 796.82 796.82 other OPPS APC 796.82 27.63 220.16 percent of total billed charges 796.82 796.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL C-QUR V-PATCH MEDIUM OD2.5 IN FASCIA 2 EXTENDED STRAP BIORESORBABLE STABILITY RING STERILE SUP-31201 CDM 0270 RC outpatient 1009.29 1009.29 1009.29 74 746.87 percent of total billed charges 1009.29 93 817.52 percent of total billed charges 1009.29 1009.29 other OPPS APC 1009.29 1009.29 other OPPS APC 1009.29 27.63 278.87 percent of total billed charges 1009.29 1009.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MATERIAL FILLING 35% CRESOL 19% FORMOCRESOL 17.5% GLYCERIN 1 OZ DEVITALIZE BUCKLEYS SUP-3120158 CDM 0270 RC outpatient 126.74 126.74 126.74 74 93.79 percent of total billed charges 126.74 93 102.66 percent of total billed charges 126.74 126.74 other OPPS APC 126.74 126.74 other OPPS APC 126.74 27.63 35.02 percent of total billed charges 126.74 126.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL C-QUR V-PATCH PROLITE OMEGA 3 FATTY ACID LARGE L3.2 IN X W3.2 IN 2 EXTEND STRAP STABILITY RING HERNIA SUP-31202 CDM 0270 RC outpatient 1312.01 1312.01 1312.01 74 970.89 percent of total billed charges 1312.01 93 1062.73 percent of total billed charges 1312.01 1312.01 other OPPS APC 1312.01 1312.01 other OPPS APC 1312.01 27.63 362.51 percent of total billed charges 1312.01 1312.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L12 MM OD4 MM SPINE CERVICAL ANTERIOR FIX ANGLE SELF TAP SUP-3120212 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L13 MM OD4 MM SPINE CERVICAL ANTERIOR FIX ANGLE SELF TAP SUP-3120213 CDM 270010020 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L14 MM OD4 MM SPINE CERVICAL ANTERIOR SELF TAP FIX ANGLE SUP-3120214 CDM 270010020 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L15 MM OD4 MM SPINE CERVICAL ANTERIOR FIX ANGLE SELF TAP SUP-3120215 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L16 MM OD4 MM SPINE CERVICAL ANTERIOR FIX ANGLE SELF TAP SUP-3120216 CDM 270010020 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L17 MM OD4 MM SPINE CERVICAL ANTERIOR FIX ANGLE SELF TAP SUP-3120217 CDM 270010020 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L14 MM OD4 MM SPINE CERVICAL ANTERIOR SELF TAP VARIABLE ANGLE DISPOSABLE SUP-3120314 CDM 270010020 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L15 MM OD4 MM SPINE CERVICAL ANTERIOR VARIABLE ANGLE SELF TAP SUP-3120315 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM 16MM ATLANTIS TITANIUM SPINE CERVICAL ANTERIOR VARIABLE ANGLE SELF TAP SUP-3120316 CDM 270010020 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MEDTRONIC SCREW FIXED ANGLE 4MM 11MM SUP-3120411 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MEDTRONIC SCREW FIXED ANGLE 4MM 12MM SUP-3120412 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L13 MM OD4 MM SPINE CERVICAL ANTERIOR FIX ANGLE SELF DRILL SUP-3120413 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L14 MM OD4 MM SPINE CERVICAL ANTERIOR FIX ANGLE SELF DRILL SUP-3120414 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L15 MM OD4 MM SPINE CERVICAL ANTERIOR FIX ANGLE SELF DRILL SUP-3120415 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L16 MM OD4 MM SPINE CERVICAL ANTERIOR FIX ANGLE SELF DRILL SUP-3120416 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L17 MM OD4 MM SPINE CERVICAL ANTERIOR SELF DRILL FIX ANGLE SUP-3120417 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L18 MM OD4 MM SPINE SELF DRILLING FIXED ANGLE SUP-3120418 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM ANGLE FIX L19 MM OD1 MM SPINE CERVICAL ANTERIOR SELF DRILL SUP-3120419 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM ANGLE FIX L20 MM OD1 MM SPINE CERVICAL ANTERIOR SELF DRILL SUP-3120420 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MEDTRONIC SCREW VARIABLE ANGLE 4MM 11MM SUP-3120511 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MEDTRONIC SCREW VARIABLE ANGLE 4MM 12MM SUP-3120512 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L13 MM OD4 MM SPINE CERVICAL ANTERIOR VARIABLE ANGLE SELF DRILL SUP-3120513 CDM 270010020 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L14 MM OD4 MM SPINE CERVICAL ANTERIOR VARIABLE ANGLE SELF DRILL SUP-3120514 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L15 MM OD4 MM SPINE CERVICAL ANTERIOR VARIABLE ANGLE SELF DRILL SUP-3120515 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L16 MM OD4 MM SPINE CERVICAL ANTERIOR VARIABLE ANGLE SELF DRILL SUP-3120516 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L17 MM OD4 MM SPINE CERVICAL ANTERIOR VARIABLE ANGLE SELF DRILL SUP-3120517 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L13 MM OD4.5 MM SPINE CERVICAL ANTERIOR VARIABLE ANGLE SELF TAP SUP-3125313 CDM 270010024 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L17 MM OD4.5 MM SPINE CERVICAL ANTERIOR VARIABLE ANGLE SELF TAP SUP-3125317 CDM 270010020 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L11 MM OD4.5 MM SPINE CERVICAL ANTERIOR SELF DRILL FIX ANGLE SUP-3125411 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L13 MM OD4.5 MM SPINE CERVICAL ANTERIOR FIX ANGLE SELF DRILL SUP-3125413 CDM 270010020 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L15 MM OD4.5 MM SPINE CERVICAL ANTERIOR FIX ANGLE SELF DRILL SUP-3125415 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L13 MM OD4.5 MM SPINE CERVICAL ANTERIOR VARIABLE ANGLE SELF DRILL SUP-3125513 CDM 270010020 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L15 MM OD4.5 MM SPINE CERVICAL ANTERIOR VARIABLE ANGLE SELF DRILL SUP-3125515 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L17 MM OD4.5 MM SPINE CERVICAL ANTERIOR VARIABLE ANGLE SELF DRILL SUP-3125517 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER GLOVE BIOGEL INDICATOR NATURAL RUBBER 6 L285 MM X W77 MM POWDER FREE BEAD CUFF SMOOTH SURFACE NONPYROGENIC STERILE LATEX GREEN CURVE FINGER SUP-31260 CDM 0270 RC outpatient 404.4 404.4 404.4 74 299.26 percent of total billed charges 404.4 93 327.56 percent of total billed charges 404.4 404.4 other OPPS APC 404.4 404.4 other OPPS APC 404.4 27.63 111.74 percent of total billed charges 404.4 404.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER GLOVE BIOGEL INDICATOR NATURAL RUBBER 6 1/2 L285 MM X W85 MM POWDER FREE BEAD CUFF SMOOTH SURFACE NONPYROGENIC STERILE LATEX GREEN CURVE FINGER SUP-31265 CDM 0270 RC outpatient 2.28 2.28 2.28 74 1.69 percent of total billed charges 2.28 93 1.85 percent of total billed charges 2.28 2.28 other OPPS APC 2.28 2.28 other OPPS APC 2.28 27.63 0.63 percent of total billed charges 2.28 2.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER GLOVE BIOGEL INDICATOR NATURAL RUBBER 7 L288 MM X W91 MM POWDER FREE BEAD CUFF SMOOTH SURFACE NONPYROGENIC STERILE LATEX GREEN CURVE FINGER SUP-31270 CDM 0270 RC outpatient 2.08 2.08 2.08 74 1.54 percent of total billed charges 2.08 93 1.68 percent of total billed charges 2.08 2.08 other OPPS APC 2.08 2.08 other OPPS APC 2.08 27.63 0.57 percent of total billed charges 2.08 2.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER GLOVE BIOGEL INDICATOR NATURAL RUBBER 7 1/2 L298 MM X W96 MM POWDER FREE BEAD CUFF SMOOTH SURFACE NONPYROGENIC STERILE LATEX GREEN CURVE FINGER SUP-31275 CDM 0270 RC outpatient 1.16 1.16 1.16 74 0.86 percent of total billed charges 1.16 93 0.94 percent of total billed charges 1.16 1.16 other OPPS APC 1.16 1.16 other OPPS APC 1.16 27.63 0.32 percent of total billed charges 1.16 1.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER GLOVE BIOGEL INDICATOR NATURAL RUBBER 8 L299 MM X W103 MM POWDER FREE BEAD CUFF SMOOTH SURFACE NONPYROGENIC STERILE LATEX GREEN CURVE FINGER SUP-31280 CDM 0270 RC outpatient 1.03 1.03 1.03 74 0.76 percent of total billed charges 1.03 93 0.83 percent of total billed charges 1.03 1.03 other OPPS APC 1.03 1.03 other OPPS APC 1.03 27.63 0.28 percent of total billed charges 1.03 1.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER GLOVE BIOGEL INDICATOR NATURAL RUBBER 8 1/2 L301 MM X W109 MM POWDER FREE SMOOTH BEAD CUFF NONPYROGENIC STERILE LATEX DISPOSABLE GREEN CURVE SUP-31285 CDM 0270 RC outpatient 1.16 1.16 1.16 74 0.86 percent of total billed charges 1.16 93 0.94 percent of total billed charges 1.16 1.16 other OPPS APC 1.16 1.16 other OPPS APC 1.16 27.63 0.32 percent of total billed charges 1.16 1.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER GLOVE BIOGEL INDICATOR NATURAL RUBBER 9 L301 MM X W115 MM POWDER FREE BEAD CUFF SMOOTH SURFACE NONPYROGENIC STERILE LATEX GREEN CURVE FINGER SUP-31290 CDM 0270 RC outpatient 1.16 1.16 1.16 74 0.86 percent of total billed charges 1.16 93 0.94 percent of total billed charges 1.16 1.16 other OPPS APC 1.16 1.16 other OPPS APC 1.16 27.63 0.32 percent of total billed charges 1.16 1.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION CARBON FIBER L75 MM OD3 MM CONNECTING RADIOLUCENT NONSTERILE MINI EXTERNAL FIXATOR SUP-31292 CDM C1713 HCPCS 0278 RC outpatient 188.8 188.8 188.8 57 107.62 percent of total billed charges 188.8 93 152.93 percent of total billed charges 188.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188.8 other OPPS APC 188.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188.8 other OPPS APC 188.8 51 96.29 percent of total billed charges 188.8 188.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION OD1.6 MM HOLD NONSTERILE 1.6 MM K WIRE MINI EXTERNAL FIXATOR SUP-31294 CDM C1713 HCPCS 0278 RC outpatient 2454.99 2454.99 2454.99 57 1399.34 percent of total billed charges 2454.99 93 1988.54 percent of total billed charges 2454.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2454.99 other OPPS APC 2454.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2454.99 other OPPS APC 2454.99 51 1252.04 percent of total billed charges 2454.99 2454.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SCREWDRIVER STARDRIVE 1.3 MM SHORT SELF RETAINING MINI QUICK COUPLING SUP-313.822 CDM 270010022 LOCAL 0270 RC outpatient 1573.86 1573.86 1573.86 74 1164.66 percent of total billed charges 1573.86 93 1274.83 percent of total billed charges 1573.86 1573.86 other OPPS APC 1573.86 1573.86 other OPPS APC 1573.86 27.63 434.86 percent of total billed charges 1573.86 1573.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SCREWDRIVER STARDRIVE 1.5 MM SHORT SELF RETAINING NONSTERILE SUP-313.832 CDM 270010022 LOCAL 0270 RC outpatient 1573.86 1573.86 1573.86 74 1164.66 percent of total billed charges 1573.86 93 1274.83 percent of total billed charges 1573.86 1573.86 other OPPS APC 1573.86 1573.86 other OPPS APC 1573.86 27.63 434.86 percent of total billed charges 1573.86 1573.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SCREWDRIVER STARDRIVE SHORT MINI SELF RETAINING QUICK COUPLING NONSTERILE 2 MM SCREWS SUP-313.842 CDM 270010022 LOCAL 0270 RC outpatient 1573.86 1573.86 1573.86 74 1164.66 percent of total billed charges 1573.86 93 1274.83 percent of total billed charges 1573.86 1573.86 other OPPS APC 1573.86 1573.86 other OPPS APC 1573.86 27.63 434.86 percent of total billed charges 1573.86 1573.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SCREWDRIVER PLUSDRIVE SHORT SELF RETAINING LOW PROFILE HEXAGONAL COUPLING CRUCIFORM NONSTERILE NEURO SUP-313.931 CDM 270010013 LOCAL 0270 RC outpatient 2852.2 2852.2 2852.2 74 2110.63 percent of total billed charges 2852.2 93 2310.28 percent of total billed charges 2852.2 2852.2 other OPPS APC 2852.2 2852.2 other OPPS APC 2852.2 27.63 788.06 percent of total billed charges 2852.2 2852.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SURGICAL STAINLESS STEEL MEDIUM OD2 MM STERILE SUP-31312070 CDM 0270 RC outpatient 280.8 280.8 280.8 74 207.79 percent of total billed charges 280.8 93 227.45 percent of total billed charges 280.8 280.8 other OPPS APC 280.8 280.8 other OPPS APC 280.8 27.63 77.59 percent of total billed charges 280.8 280.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SURGICAL STEEL MEDIUM LENGTH OD3 MM ULTRA SUP-31313065UE CDM 0270 RC outpatient 226.2 226.2 226.2 74 167.39 percent of total billed charges 226.2 93 183.22 percent of total billed charges 226.2 226.2 other OPPS APC 226.2 226.2 other OPPS APC 226.2 27.63 62.5 percent of total billed charges 226.2 226.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SURGICAL ULTRAPOWER STAINLESS STEEL MEDIUM ROUND L69 MM OD4 MM AGGRESSIVE CUT TOOL STERILE SUP-31314065U CDM 0270 RC outpatient 1287 1287 1287 74 952.38 percent of total billed charges 1287 93 1042.47 percent of total billed charges 1287 1287 other OPPS APC 1287 1287 other OPPS APC 1287 27.63 355.6 percent of total billed charges 1287 1287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTAINER SHARPS GATORGUARD PLASTIC 3 GL COUNTER BALANCED DOOR TRANSLUCENT RED SUP-31314886 CDM 0270 RC outpatient 10.36 10.36 10.36 74 7.67 percent of total billed charges 10.36 93 8.39 percent of total billed charges 10.36 10.36 other OPPS APC 10.36 10.36 other OPPS APC 10.36 27.63 2.86 percent of total billed charges 10.36 10.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SURGICAL ULTRAPOWER STAINLESS STEEL MEDIUM ROUND L64 MM OD5 MM AGGRESSIVE CUTTING TOOL STERILE SUP-31315059U CDM 0270 RC outpatient 1349.4 1349.4 1349.4 74 998.56 percent of total billed charges 1349.4 93 1093.01 percent of total billed charges 1349.4 1349.4 other OPPS APC 1349.4 1349.4 other OPPS APC 1349.4 27.63 372.84 percent of total billed charges 1349.4 1349.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SURGICAL VISAO STAINLESS STEEL MEDIUM ROUND L64 MM OD6 MM CUT TOOL STERILE DISPOSABLE SUP-31316058U CDM 0270 RC outpatient 1349.4 1349.4 1349.4 74 998.56 percent of total billed charges 1349.4 93 1093.01 percent of total billed charges 1349.4 1349.4 other OPPS APC 1349.4 1349.4 other OPPS APC 1349.4 27.63 372.84 percent of total billed charges 1349.4 1349.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SURGICAL VISAO STEEL 80000 RPM MEDIUM STRAIGHT ROUND L17 MM OD7 MM AGGRESSIVE CUT GUARD STERILE OTOLOGY SUP-31317057U CDM 0270 RC outpatient 1287 1287 1287 74 952.38 percent of total billed charges 1287 93 1042.47 percent of total billed charges 1287 1287 other OPPS APC 1287 1287 other OPPS APC 1287 27.63 355.6 percent of total billed charges 1287 1287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL COALITION MIS 7 D D12 MM W14 MM X H6 MM STERILE LATEX FREE SUP-3136.1106 CDM 270010020 LOCAL 0270 RC outpatient 6240 6240 6240 74 4617.6 percent of total billed charges 6240 93 5054.4 percent of total billed charges 6240 6240 other OPPS APC 6240 6240 other OPPS APC 6240 27.63 1724.11 percent of total billed charges 6240 6240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SCREWDRIVER CRUCIFORM HOLDING SLEEVE MINI QUICK COUPLING 1.3 MM SCREWS SUP-314.411 CDM 270010022 LOCAL 0270 RC outpatient 3054.38 3054.38 3054.38 74 2260.24 percent of total billed charges 3054.38 93 2474.05 percent of total billed charges 3054.38 3054.38 other OPPS APC 3054.38 3054.38 other OPPS APC 3054.38 27.63 843.93 percent of total billed charges 3054.38 3054.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE PED ECL 135 MEDI-TRC MINI FOAM SUP-31439766 CDM 0270 RC outpatient 0.23 0.23 0.23 74 0.17 percent of total billed charges 0.23 93 0.19 percent of total billed charges 0.23 0.23 other OPPS APC 0.23 0.23 other OPPS APC 0.23 27.63 0.06 percent of total billed charges 0.23 0.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 3 FLUTE 125MM 2.7MM QUICK COUPLING OSCILLATE ATTACHMENT SUP-315.28 CDM 0270 RC outpatient 271.13 271.13 271.13 74 200.64 percent of total billed charges 271.13 93 219.62 percent of total billed charges 271.13 271.13 other OPPS APC 271.13 271.13 other OPPS APC 271.13 27.63 74.91 percent of total billed charges 271.13 271.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL STAINLESS STEEL L195 MM OD3.2 MM 3 FLUTE QUICK COUPLING NONSTERILE SUP-315.29 CDM 270010022 LOCAL 0270 RC outpatient 394.68 394.68 394.68 74 292.06 percent of total billed charges 394.68 93 319.69 percent of total billed charges 394.68 394.68 other OPPS APC 394.68 394.68 other OPPS APC 394.68 27.63 109.05 percent of total billed charges 394.68 394.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 3 FLUTE 145MM 3.2MM NS QUICK COUPLING SUP-315.31 CDM 270010022 LOCAL 0270 RC outpatient 265.98 265.98 265.98 74 196.83 percent of total billed charges 265.98 93 215.44 percent of total billed charges 265.98 265.98 other OPPS APC 265.98 265.98 other OPPS APC 265.98 27.63 73.49 percent of total billed charges 265.98 265.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 3 FLUTE 195MM 4MM NS QUICK COUPLING SUP-315.40 CDM 270010022 LOCAL 0270 RC outpatient 420.42 420.42 420.42 74 311.11 percent of total billed charges 420.42 93 340.54 percent of total billed charges 420.42 420.42 other OPPS APC 420.42 420.42 other OPPS APC 420.42 27.63 116.16 percent of total billed charges 420.42 420.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL STAINLESS STEEL L195 MM OD4.5 MM 3 FLUTE QUICK COUPLING NONSTERILE SUP-315.48 CDM 270010022 LOCAL 0270 RC outpatient 394.68 394.68 394.68 74 292.06 percent of total billed charges 394.68 93 319.69 percent of total billed charges 394.68 394.68 other OPPS APC 394.68 394.68 other OPPS APC 394.68 27.63 109.05 percent of total billed charges 394.68 394.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 3 FLUTE 230MM 200MM 2.5MM NS CALIBRATED QUICK COUPLING SUP-315.92 CDM 270010022 LOCAL 0270 RC outpatient 1021.02 1021.02 1021.02 74 755.55 percent of total billed charges 1021.02 93 827.03 percent of total billed charges 1021.02 1021.02 other OPPS APC 1021.02 1021.02 other OPPS APC 1021.02 27.63 282.11 percent of total billed charges 1021.02 1021.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL C-QUR OMEGA 3 FATTY ACID OBLONG L6 IN X W4 IN BIORESORBABLE HERNIA SUP-31528 CDM 0270 RC outpatient 709.8 709.8 709.8 74 525.25 percent of total billed charges 709.8 93 574.94 percent of total billed charges 709.8 709.8 other OPPS APC 709.8 709.8 other OPPS APC 709.8 27.63 196.12 percent of total billed charges 709.8 709.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL C-QUR POLYPROPYLENE L8 IN X W6 IN BIORESORBABLE HERNIA SUP-31533 CDM 0270 RC outpatient 1476.85 1476.85 1476.85 74 1092.87 percent of total billed charges 1476.85 93 1196.25 percent of total billed charges 1476.85 1476.85 other OPPS APC 1476.85 1476.85 other OPPS APC 1476.85 27.63 408.05 percent of total billed charges 1476.85 1476.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH C-QUR 7X9 SUP-31535 CDM 0270 RC outpatient 2035.54 2035.54 2035.54 74 1506.3 percent of total billed charges 2035.54 93 1648.79 percent of total billed charges 2035.54 2035.54 other OPPS APC 2035.54 2035.54 other OPPS APC 2035.54 27.63 562.42 percent of total billed charges 2035.54 2035.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL C-QUR POLYPROPYLENE L10 IN X W8 IN HERNIA BIORESORBABLE SUP-31536 CDM 0270 RC outpatient 2587.34 2587.34 2587.34 74 1914.63 percent of total billed charges 2587.34 93 2095.75 percent of total billed charges 2587.34 2587.34 other OPPS APC 2587.34 2587.34 other OPPS APC 2587.34 27.63 714.88 percent of total billed charges 2587.34 2587.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL C-QUR POLYPROPYLENE L12 IN X W8 IN HERNIA BIORESORBABLE SUP-31537 CDM 0270 RC outpatient 2633.15 2633.15 2633.15 74 1948.53 percent of total billed charges 2633.15 93 2132.85 percent of total billed charges 2633.15 2633.15 other OPPS APC 2633.15 2633.15 other OPPS APC 2633.15 27.63 727.54 percent of total billed charges 2633.15 2633.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL C-QUR POLYPROPYLENE L5 IN X W5 IN HERNIA BIOABSORBABLE SUP-31544 CDM 0270 RC outpatient 799.11 799.11 799.11 74 591.34 percent of total billed charges 799.11 93 647.28 percent of total billed charges 799.11 799.11 other OPPS APC 799.11 799.11 other OPPS APC 799.11 27.63 220.79 percent of total billed charges 799.11 799.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOLDER CATHETER HOLD-N-PLACE ADULT UNIVERSAL W2 IN OD20- IN LEG FOLEY ELASTICITY LATEX FREE REUSABLE SUP-316 CDM 0270 RC outpatient 9.19 9.19 9.19 74 6.8 percent of total billed charges 9.19 93 7.44 percent of total billed charges 9.19 9.19 other OPPS APC 9.19 9.19 other OPPS APC 9.19 27.63 2.54 percent of total billed charges 9.19 9.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CAGE XPAND 20-22,MM" SUP-316.101 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL XPAND-R PEEK 3.5/3.5 D SMALL L20-22 MM X W15 MM X H13 MM INTERBODY FUSION RADIOLUCENT SMOOTH SELF DISTRACTING SUP-316.113 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL XPAND-R 3.5/3.5D SM 22-26X15X13MM PEEK RADIOLUCENT SELF DISTRACT CORPECTOMY SUP-316.114 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL XPAND-R 3.5/3.5D SM 38-46X15X13MM PEEK RADIOLUCENT SELF DISTRACT CORPECTOMY SUP-316.118 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 3 MM STOP L44.5 MM OD.7 MM J LATCH NONSTERILE SUP-316.13 CDM 270010022 LOCAL 0270 RC outpatient 453.75 453.75 453.75 74 335.78 percent of total billed charges 453.75 93 367.54 percent of total billed charges 453.75 453.75 other OPPS APC 453.75 453.75 other OPPS APC 453.75 27.63 125.37 percent of total billed charges 453.75 453.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE GLOBUS XPAND R 22-26MM 7 DEG SUP-316.131 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE GLOBUS XPAND R 22-26MM 7 DEG SUP-316.132 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 44.5MM 5MM .76MM NS J LATCH COUPLING STOP 1MM SCREW STRYKER SUP-316.15 CDM 270010022 LOCAL 0270 RC outpatient 453.75 453.75 453.75 74 335.78 percent of total billed charges 453.75 93 367.54 percent of total billed charges 453.75 453.75 other OPPS APC 453.75 453.75 other OPPS APC 453.75 27.63 125.37 percent of total billed charges 453.75 453.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L44.5 MM L8 MM OD.76 MM J LATCH STOP NONSTERILE 1 MM SCREW SUP-316.18 CDM 270010022 LOCAL 0270 RC outpatient 453.75 453.75 453.75 74 335.78 percent of total billed charges 453.75 93 367.54 percent of total billed charges 453.75 453.75 other OPPS APC 453.75 453.75 other OPPS APC 453.75 27.63 125.37 percent of total billed charges 453.75 453.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 44.5MM 6MM .76MM NS MINI QUICK COUPLING SELF STOP MODULAR HAND SYSTEM SUP-316.286 CDM 270010022 LOCAL 0270 RC outpatient 424.71 424.71 424.71 74 314.29 percent of total billed charges 424.71 93 344.02 percent of total billed charges 424.71 424.71 other OPPS APC 424.71 424.71 other OPPS APC 424.71 27.63 117.35 percent of total billed charges 424.71 424.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 44.5MM 8MM .76MM NS MINI QUICK COUPLING SELF STOP MODULAR HAND SYSTEM SUP-316.288 CDM 270010022 LOCAL 0270 RC outpatient 424.71 424.71 424.71 74 314.29 percent of total billed charges 424.71 93 344.02 percent of total billed charges 424.71 424.71 other OPPS APC 424.71 424.71 other OPPS APC 424.71 27.63 117.35 percent of total billed charges 424.71 424.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 44.5MM 10MM .76MM NS MINI QUICK COUPLING SELF STOP 1MM SCREW MODULAR HAND SYSTEM SUP-316.29 CDM 270010022 LOCAL 0270 RC outpatient 374.53 374.53 374.53 74 277.15 percent of total billed charges 374.53 93 303.37 percent of total billed charges 374.53 374.53 other OPPS APC 374.53 374.53 other OPPS APC 374.53 27.63 103.48 percent of total billed charges 374.53 374.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 10MM .76MM MINI SS QUICK COUPLING NS SUP-316.290 CDM 270010022 LOCAL 0270 RC outpatient 446.94 446.94 446.94 74 330.74 percent of total billed charges 446.94 93 362.02 percent of total billed charges 446.94 446.94 other OPPS APC 446.94 446.94 other OPPS APC 446.94 27.63 123.49 percent of total billed charges 446.94 446.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 44.5MM 12MM .76MM NS MINI QUICK COUPLING SELF STOP 1MM SCREW MODULAR HAND SYSTEM SUP-316.292 CDM 270010022 LOCAL 0270 RC outpatient 424.71 424.71 424.71 74 314.29 percent of total billed charges 424.71 93 344.02 percent of total billed charges 424.71 424.71 other OPPS APC 424.71 424.71 other OPPS APC 424.71 27.63 117.35 percent of total billed charges 424.71 424.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 44.5MM 14MM .76MM NS MINI QUICK COUPLING SELF STOP 1MM SCREW MODULAR HAND SYSTEM SUP-316.294 CDM 270010022 LOCAL 0270 RC outpatient 424.71 424.71 424.71 74 314.29 percent of total billed charges 424.71 93 344.02 percent of total billed charges 424.71 424.71 other OPPS APC 424.71 424.71 other OPPS APC 424.71 27.63 117.35 percent of total billed charges 424.71 424.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 50MM 1MM NS MINI QUICK COUPLING SELF STOP 2.4MM SCREW MODULAR HAND SYSTEM SUP-316.396 CDM 270010022 LOCAL 0270 RC outpatient 186.63 186.63 186.63 74 138.11 percent of total billed charges 186.63 93 151.17 percent of total billed charges 186.63 186.63 other OPPS APC 186.63 186.63 other OPPS APC 186.63 27.63 51.57 percent of total billed charges 186.63 186.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 55MM 1.3MM NS MINI QUICK COUPLING SELF STOP 2.4MM SCREW MODULAR HAND SYSTEM SUP-316.402 CDM 270010022 LOCAL 0270 RC outpatient 211.64 211.64 211.64 74 156.61 percent of total billed charges 211.64 93 171.43 percent of total billed charges 211.64 211.64 other OPPS APC 211.64 211.64 other OPPS APC 211.64 27.63 58.48 percent of total billed charges 211.64 211.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 44.5MM 4MM 1MM NS J LATCH STOP 1.3MM SCREW STRYKER SUP-316.446 CDM 270010022 LOCAL 0270 RC outpatient 453.75 453.75 453.75 74 335.78 percent of total billed charges 453.75 93 367.54 percent of total billed charges 453.75 453.75 other OPPS APC 453.75 453.75 other OPPS APC 453.75 27.63 125.37 percent of total billed charges 453.75 453.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 44.5MM 6MM 1MM NS J LATCH STOP 1.3MM SCREW STRYKER SUP-316.447 CDM 270010022 LOCAL 0270 RC outpatient 453.75 453.75 453.75 74 335.78 percent of total billed charges 453.75 93 367.54 percent of total billed charges 453.75 453.75 other OPPS APC 453.75 453.75 other OPPS APC 453.75 27.63 125.37 percent of total billed charges 453.75 453.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L44.5 MM L8 MM OD1 MM J LATCH STOP NONSTERILE 1.3 MM SCREW STRYKER SUP-316.448 CDM 270010022 LOCAL 0270 RC outpatient 453.75 453.75 453.75 74 335.78 percent of total billed charges 453.75 93 367.54 percent of total billed charges 453.75 453.75 other OPPS APC 453.75 453.75 other OPPS APC 453.75 27.63 125.37 percent of total billed charges 453.75 453.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 44.5MM 6MM 1.1MM NS SELF STOP STRYKER J LATCH COUPLING SUP-317.16 CDM 270010014 LOCAL 0270 RC outpatient 453.75 453.75 453.75 74 335.78 percent of total billed charges 453.75 93 367.54 percent of total billed charges 453.75 453.75 other OPPS APC 453.75 453.75 other OPPS APC 453.75 27.63 125.37 percent of total billed charges 453.75 453.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 44.5MM 8MM 1.1MM NS SELF STOP STRYKER J LATCH COUPLING SUP-317.18 CDM 270010022 LOCAL 0270 RC outpatient 453.75 453.75 453.75 74 335.78 percent of total billed charges 453.75 93 367.54 percent of total billed charges 453.75 453.75 other OPPS APC 453.75 453.75 other OPPS APC 453.75 27.63 125.37 percent of total billed charges 453.75 453.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 44.5MM 12MM 1.1MM NS SELF STOP STRYKER J LATCH COUPLING SUP-317.22 CDM 270010014 LOCAL 0270 RC outpatient 453.75 453.75 453.75 74 335.78 percent of total billed charges 453.75 93 367.54 percent of total billed charges 453.75 453.75 other OPPS APC 453.75 453.75 other OPPS APC 453.75 27.63 125.37 percent of total billed charges 453.75 453.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L110 MM OD1.1 MM J LATCH COUPLING 1/1.5 MM SCREW STRYKER SUP-317.335 CDM 270010022 LOCAL 0270 RC outpatient 453.75 453.75 453.75 74 335.78 percent of total billed charges 453.75 93 367.54 percent of total billed charges 453.75 453.75 other OPPS APC 453.75 453.75 other OPPS APC 453.75 27.63 125.37 percent of total billed charges 453.75 453.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L85 MM L60 MM OD1.5 MM J LATCH STOP STRYKER SUP-317.435 CDM 270010022 LOCAL 0270 RC outpatient 453.75 453.75 453.75 74 335.78 percent of total billed charges 453.75 93 367.54 percent of total billed charges 453.75 453.75 other OPPS APC 453.75 453.75 other OPPS APC 453.75 27.63 125.37 percent of total billed charges 453.75 453.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L44.5 MM L4 MM OD1.5 MM STOP J LATCH COUPLING SUP-317.64 CDM 270010022 LOCAL 0270 RC outpatient 523.61 523.61 523.61 74 387.47 percent of total billed charges 523.61 93 424.12 percent of total billed charges 523.61 523.61 other OPPS APC 523.61 523.61 other OPPS APC 523.61 27.63 144.67 percent of total billed charges 523.61 523.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 44.5MM 6MM 1.5MM NS SELF STOP STRYKER J LATCH COUPLING SUP-317.66 CDM 270010022 LOCAL 0270 RC outpatient 523.61 523.61 523.61 74 387.47 percent of total billed charges 523.61 93 424.12 percent of total billed charges 523.61 523.61 other OPPS APC 523.61 523.61 other OPPS APC 523.61 27.63 144.67 percent of total billed charges 523.61 523.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 44.5MM 8MM 1.5MM NS SELF STOP STRYKER J LATCH COUPLING SUP-317.68 CDM 270010022 LOCAL 0270 RC outpatient 523.61 523.61 523.61 74 387.47 percent of total billed charges 523.61 93 424.12 percent of total billed charges 523.61 523.61 other OPPS APC 523.61 523.61 other OPPS APC 523.61 27.63 144.67 percent of total billed charges 523.61 523.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 44.5MM 12MM 1.5MM NS SELF STOP STRYKER J LATCH COUPLING SUP-317.720 CDM 270010022 LOCAL 0270 RC outpatient 318.5 318.5 318.5 74 235.69 percent of total billed charges 318.5 93 257.99 percent of total billed charges 318.5 318.5 other OPPS APC 318.5 318.5 other OPPS APC 318.5 27.63 88 percent of total billed charges 318.5 318.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL STAINLESS STEEL L80 MM OD1.8 MM MINI QUICK COUPLING NONSTERILE MODULAR HAND SYSTEM 2.4 MM SCREW SUP-317.861 CDM 270010022 LOCAL 0270 RC outpatient 207.35 207.35 207.35 74 153.44 percent of total billed charges 207.35 93 167.95 percent of total billed charges 207.35 207.35 other OPPS APC 207.35 207.35 other OPPS APC 207.35 27.63 57.29 percent of total billed charges 207.35 207.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL STAINLESS STEEL L80 MM OD2.4 MM MINI QUICK COUPLING NONSTERILE MODULAR HAND SYSTEM 2.4 MM SCREW SUP-317.871 CDM 270010022 LOCAL 0270 RC outpatient 207.35 207.35 207.35 74 153.44 percent of total billed charges 207.35 93 167.95 percent of total billed charges 207.35 207.35 other OPPS APC 207.35 207.35 other OPPS APC 207.35 27.63 57.29 percent of total billed charges 207.35 207.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PADDING CAST KENDALL WEBRIL 4YDX4IN COTTON NS LF UNDERCAST MILD STRETCH COHESIVE REGULAR FINISH SUP-3175 CDM 0270 RC outpatient 1.93 1.93 1.93 74 1.43 percent of total billed charges 1.93 93 1.56 percent of total billed charges 1.93 1.93 other OPPS APC 1.93 1.93 other OPPS APC 1.93 27.63 0.53 percent of total billed charges 1.93 1.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL L108 IN X W77 IN L90 IN X W56 IN 2 SHEET 1 PILLOW CASE BURN CARE DRAPE STERILE SUP-3185 CDM 270009036 LOCAL 0270 RC outpatient 7.44 7.44 7.44 74 5.51 percent of total billed charges 7.44 93 6.03 percent of total billed charges 7.44 7.44 other OPPS APC 7.44 7.44 other OPPS APC 7.44 27.63 2.06 percent of total billed charges 7.44 7.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT NEUROSTIMULATOR OCTRODE L60 CM PERCUTANEOUS 8 ELECTRODE LEAD SUP-3186 CDM 0270 RC outpatient 8359 8359 8359 74 6185.66 percent of total billed charges 8359 93 6770.79 percent of total billed charges 8359 8359 other OPPS APC 8359 8359 other OPPS APC 8359 27.63 2309.59 percent of total billed charges 8359 8359 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION STEINMANN L178 MM OD3.2 MM STERILE SUP-319-01-32 CDM 270010030 LOCAL 0270 RC outpatient 149.76 149.76 149.76 74 110.82 percent of total billed charges 149.76 93 121.31 percent of total billed charges 149.76 149.76 other OPPS APC 149.76 149.76 other OPPS APC 149.76 27.63 41.38 percent of total billed charges 149.76 149.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE HPS TITANIUM PARTIAL THREAD LOW PROFILE L18 MM OD3 MM HAND LAG CANNULATED SELF RETAIN SUP-319-3018 CDM 27000000 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY CATHETERIZATION BARDEX COMPLETE CARE OD16 FR FOLEY URINE METER ADVANCE STERILE 400 SUP-319416A CDM 270009006 LOCAL 0270 RC outpatient 12.49 12.49 12.49 74 9.24 percent of total billed charges 12.49 93 10.12 percent of total billed charges 12.49 12.49 other OPPS APC 12.49 12.49 other OPPS APC 12.49 27.63 3.45 percent of total billed charges 12.49 12.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY CATHETERIZATION LUBRI SIL ADVANCE 16 FR 2 CONNECTOR FOLEY URINE METER TEMP SENSING LATEX FREE SUP-319516A CDM 0270 RC outpatient 98.62 98.62 98.62 74 72.98 percent of total billed charges 98.62 93 79.88 percent of total billed charges 98.62 98.62 other OPPS APC 98.62 98.62 other OPPS APC 98.62 27.63 27.25 percent of total billed charges 98.62 98.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC MASTERS 85 D 5.18 SQ CM OD31 MM ID26.1 MM MECHANICAL HEART PYROLYTIC CARBON LEAFLET STANDARD CUFF ORIFICE RING SUP-31AJ-501 CDM 0270 RC outpatient 13891.8 13891.8 13891.8 74 10279.9 percent of total billed charges 13891.8 93 11252.4 percent of total billed charges 13891.8 13891.8 other OPPS APC 13891.8 13891.8 other OPPS APC 13891.8 27.63 3838.3 percent of total billed charges 13891.8 13891.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC GRAFT 31 MM SUP-31CAVGJ31MM CDM 0270 RC outpatient 15262 15262 15262 74 11293.9 percent of total billed charges 15262 93 12362.2 percent of total billed charges 15262 15262 other OPPS APC 15262 15262 other OPPS APC 15262 27.63 4216.89 percent of total billed charges 15262 15262 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL MASTER-SERIES PYROLYTIC CARBON 85 D 5.18 SQ CM STANDARD OD31 MM ID26.1 MM HEART CUFF LEAFLET OPEN CONTROL TORQUE ROTATION MECHANISM SUP-31MJ-501 CDM 0270 RC outpatient 12708.8 12708.8 12708.8 74 9404.51 percent of total billed charges 12708.8 93 10294.1 percent of total billed charges 12708.8 12708.8 other OPPS APC 12708.8 12708.8 other OPPS APC 12708.8 27.63 3511.44 percent of total billed charges 12708.8 12708.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND SURGICAL RUBBER L2.5 IN X W.25 IN GENERAL PURPOSE STERILE SUP-32-1150 CDM outpatient 4.69 4.69 4.69 4.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RULER SURGICAL PLASTIC PAPER L6 IN FLEXIBLE FIBER FREE STERILE LATEX FREE SUP-32-345 CDM 0270 RC outpatient 2.93 2.93 2.93 74 2.17 percent of total billed charges 2.93 93 2.37 percent of total billed charges 2.93 2.93 other OPPS APC 2.93 2.93 other OPPS APC 2.93 27.63 0.81 percent of total billed charges 2.93 2.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY HUMERAL ADAPTER EQUINOXE +10 MM SHOULDER REVERSE SUP-320-10-10 CDM 270010030 LOCAL 0270 RC outpatient 5746 5746 5746 74 4252.04 percent of total billed charges 5746 93 4654.26 percent of total billed charges 5746 5746 other OPPS APC 5746 5746 other OPPS APC 5746 27.63 1587.62 percent of total billed charges 5746 5746 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EQUINOXE L26 MM OD4.5 MM SHOULDER KIT COMPRESSION LOCK CAP REVERSE ORANGE SUP-320-20-26 CDM 270010030 LOCAL 0270 RC outpatient 338.13 338.13 338.13 74 250.22 percent of total billed charges 338.13 93 273.89 percent of total billed charges 338.13 338.13 other OPPS APC 338.13 338.13 other OPPS APC 338.13 27.63 93.43 percent of total billed charges 338.13 338.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EQUINOXE L42 MM OD4.5 MM SHOULDER KIT COMPRESSION LOCK CAP REVERSE YELLOW SUP-320-20-42 CDM 270010030 LOCAL 0270 RC outpatient 335.4 335.4 335.4 74 248.2 percent of total billed charges 335.4 93 271.67 percent of total billed charges 335.4 335.4 other OPPS APC 335.4 335.4 other OPPS APC 335.4 27.63 92.67 percent of total billed charges 335.4 335.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EQUINOXE L46 MM OD4.5 MM SHOULDER KIT COMPRESSION LOCK CAP REVERSE PURPLE SUP-320-20-46 CDM 270010025 LOCAL 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPHERE GLENOID EQUINOXE H28.1 MM OD40 MM SHOULDER EXPAND SMALL REVERSE SUP-320-32-40 CDM 270010030 LOCAL 0270 RC outpatient 5538.78 5538.78 5538.78 74 4098.7 percent of total billed charges 5538.78 93 4486.41 percent of total billed charges 5538.78 5538.78 other OPPS APC 5538.78 5538.78 other OPPS APC 5538.78 27.63 1530.36 percent of total billed charges 5538.78 5538.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE GLENOID EQUINOXE SHOULDER SMALL REVERSE SUP-320-35-01 CDM 270010030 LOCAL 0270 RC outpatient 4319.64 4319.64 4319.64 74 3196.53 percent of total billed charges 4319.64 93 3498.91 percent of total billed charges 4319.64 4319.64 other OPPS APC 4319.64 4319.64 other OPPS APC 4319.64 27.63 1193.52 percent of total billed charges 4319.64 4319.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT EXACTECH HUMERAL LINER CONSTRAINED +2.5MM SUP-320-38-13 CDM 270010030 LOCAL 0270 RC outpatient 2160.6 2160.6 2160.6 74 1598.84 percent of total billed charges 2160.6 93 1750.09 percent of total billed charges 2160.6 2160.6 other OPPS APC 2160.6 2160.6 other OPPS APC 2160.6 27.63 596.97 percent of total billed charges 2160.6 2160.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER HUMERAL EQUINOXE +0 MM OD40 MM SHOULDER SMALL REVERSE SUP-320-40-00 CDM 270010030 LOCAL 0270 RC outpatient 2266.29 2266.29 2266.29 74 1677.05 percent of total billed charges 2266.29 93 1835.69 percent of total billed charges 2266.29 2266.29 other OPPS APC 2266.29 2266.29 other OPPS APC 2266.29 27.63 626.18 percent of total billed charges 2266.29 2266.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER HUMERAL EXACTECH CONSTRAINED 42MM +2.5MM SUP-320-42-13 CDM 270010030 LOCAL 0270 RC outpatient 2160.6 2160.6 2160.6 74 1598.84 percent of total billed charges 2160.6 93 1750.09 percent of total billed charges 2160.6 2160.6 other OPPS APC 2160.6 2160.6 other OPPS APC 2160.6 27.63 596.97 percent of total billed charges 2160.6 2160.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SIZER 5MM 24MM SUP-3200201 CDM 0270 RC outpatient 24.79 24.79 24.79 74 18.34 percent of total billed charges 24.79 93 20.08 percent of total billed charges 24.79 24.79 other OPPS APC 24.79 24.79 other OPPS APC 24.79 27.63 6.85 percent of total billed charges 24.79 24.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PICK RETINAL ILM MICROPICK 45DEG TIP 25GA X 32MM SUP-3204 CDM outpatient 23.92 23.92 23.92 23.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION HALO360+ 360D 4CM 3CM 18MM ESOPHAGUS HALOFLEX ENERGY GENERATOR BIPOLAR ELECTRODE BALLOON SUP-32041-18 CDM 0270 RC outpatient 4914 4914 4914 74 3636.36 percent of total billed charges 4914 93 3980.34 percent of total billed charges 4914 4914 other OPPS APC 4914 4914 other OPPS APC 4914 27.63 1357.74 percent of total billed charges 4914 4914 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION BARRX 360 L3 CM L85 CM L4 CM OD22 MM ODSEC33.7 MM ESOPHAGEAL BIPOLAR ELECTRODE BALLOON RADIOFREQUENCY SUP-32041-22 CDM 0270 RC outpatient 4062.53 4062.53 4062.53 74 3006.27 percent of total billed charges 4062.53 93 3290.65 percent of total billed charges 4062.53 4062.53 other OPPS APC 4062.53 4062.53 other OPPS APC 4062.53 27.63 1122.48 percent of total billed charges 4062.53 4062.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION HALO360+ 360 D L4 CM L3 CM OD25 MM ESOPHAGUS HALOFLEX ENERGY GENERATOR BIPOLAR ELECTRODE BALLOON DISPOSABLE SUP-32041-25 CDM 0270 RC outpatient 3944.2 3944.2 3944.2 74 2918.71 percent of total billed charges 3944.2 93 3194.8 percent of total billed charges 3944.2 3944.2 other OPPS APC 3944.2 3944.2 other OPPS APC 3944.2 27.63 1089.78 percent of total billed charges 3944.2 3944.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION BARRX 360 L3 CM L85 CM L4 CM OD7 MM ODSEC28 MM ESOPHAGEAL BIPOLAR ELECTRODE BALLOON RADIOFREQUENCY SUP-32041-28 CDM 0270 RC outpatient 4062.53 4062.53 4062.53 74 3006.27 percent of total billed charges 4062.53 93 3290.65 percent of total billed charges 4062.53 4062.53 other OPPS APC 4062.53 4062.53 other OPPS APC 4062.53 27.63 1122.48 percent of total billed charges 4062.53 4062.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION BARRX 360 L3 CM L85 CM L4 CM OD7 MM ODSEC31 MM ESOPHAGEAL BIPOLAR ELECTRODE BALLOON RADIOFREQUENCY SUP-32041-31 CDM 0270 RC outpatient 4062.53 4062.53 4062.53 74 3006.27 percent of total billed charges 4062.53 93 3290.65 percent of total billed charges 4062.53 4062.53 other OPPS APC 4062.53 4062.53 other OPPS APC 4062.53 27.63 1122.48 percent of total billed charges 4062.53 4062.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETAINER INTERNAL ORGAN FISH GLASSMAN XL L10.5 IN X W7 IN VISCERAL RADIOPAQUE STERILE LATEX FREE DISPOSABLE SUP-3207 CDM 0270 RC outpatient 104 104 104 74 76.96 percent of total billed charges 104 93 84.24 percent of total billed charges 104 104 other OPPS APC 104 104 other OPPS APC 104 27.63 28.74 percent of total billed charges 104 104 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEDIAL HEMI CONDYLE LEFT SUP-32247002 CDM 270010031 LOCAL 0270 RC outpatient 30342 30342 30342 74 22453.1 percent of total billed charges 30342 93 24577 percent of total billed charges 30342 30342 other OPPS APC 30342 30342 other OPPS APC 30342 27.63 8383.49 percent of total billed charges 30342 30342 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD SCS SUP-3228 SCSCAPL CDM 0270 RC outpatient 13650 13650 13650 74 10101 percent of total billed charges 13650 93 11056.5 percent of total billed charges 13650 13650 other OPPS APC 13650 13650 other OPPS APC 13650 27.63 3771.5 percent of total billed charges 13650 13650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PICK SURGICAL MICRO L32 MM OD23 GA ASPIRATION SUP-3229 CDM 0270 RC outpatient 23.92 23.92 23.92 74 17.7 percent of total billed charges 23.92 93 19.38 percent of total billed charges 23.92 23.92 other OPPS APC 23.92 23.92 other OPPS APC 23.92 27.63 6.61 percent of total billed charges 23.92 23.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE DRILL SHORT OD1.8 MM THREAD NONSTERILE SUP-323.035 CDM 270010022 LOCAL 0270 RC outpatient 60.92 60.92 60.92 74 45.08 percent of total billed charges 60.92 93 49.35 percent of total billed charges 60.92 60.92 other OPPS APC 60.92 60.92 other OPPS APC 60.92 27.63 16.83 percent of total billed charges 60.92 60.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE DRILL LCP OD2 MM THREAD DEPTH GAUGE NONSTERILE SMALL FRAGMENT SET SUP-323.061 CDM 270010022 LOCAL 0270 RC outpatient 1764.62 1764.62 1764.62 74 1305.82 percent of total billed charges 1764.62 93 1429.34 percent of total billed charges 1764.62 1764.62 other OPPS APC 1764.62 1764.62 other OPPS APC 1764.62 27.63 487.56 percent of total billed charges 1764.62 1764.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 3 FLUTE L140 MM OD2 MM QUICK COUPLING DEPTH MARK SUP-323.062 CDM 0270 RC outpatient 817.7 817.7 817.7 74 605.1 percent of total billed charges 817.7 93 662.34 percent of total billed charges 817.7 817.7 other OPPS APC 817.7 817.7 other OPPS APC 817.7 27.63 225.93 percent of total billed charges 817.7 817.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MAMMARY GEL LUMERA 225CC SUP-324-1051 CDM 0270 RC outpatient 2990 2990 2990 74 2212.6 percent of total billed charges 2990 93 2421.9 percent of total billed charges 2990 2990 other OPPS APC 2990 2990 other OPPS APC 2990 27.63 826.14 percent of total billed charges 2990 2990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MAMMARY GEL LUMERA 180CC SUP-324-1057 CDM 0270 RC outpatient 2730 2730 2730 74 2020.2 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 2730 other OPPS APC 2730 2730 other OPPS APC 2730 27.63 754.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MAMMARY GEL LUMERA 265CC SUP-324-1101 CDM 0270 RC outpatient 2990 2990 2990 74 2212.6 percent of total billed charges 2990 93 2421.9 percent of total billed charges 2990 2990 other OPPS APC 2990 2990 other OPPS APC 2990 27.63 826.14 percent of total billed charges 2990 2990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MAMMARY GEL LUMERA PROFILE 220CC SUP-324-1107 CDM 0270 RC outpatient 2730 2730 2730 74 2020.2 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 2730 other OPPS APC 2730 2730 other OPPS APC 2730 27.63 754.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILICONE GEL LUMERA HIGH PROFILE 395CC SUP-324-1251 CDM 0270 RC outpatient 2990 2990 2990 74 2212.6 percent of total billed charges 2990 93 2421.9 percent of total billed charges 2990 2990 other OPPS APC 2990 2990 other OPPS APC 2990 27.63 826.14 percent of total billed charges 2990 2990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILICONE GEL LUMERA MODERATE PROFILE 375CC SUP-324-1307 CDM 0270 RC outpatient 2990 2990 2990 74 2212.6 percent of total billed charges 2990 93 2421.9 percent of total billed charges 2990 2990 other OPPS APC 2990 2990 other OPPS APC 2990 27.63 826.14 percent of total billed charges 2990 2990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MAMMARY GEL LUMERA SILTEX CONTOUR 485CC SUP-324-1351 CDM 0270 RC outpatient 2730 2730 2730 74 2020.2 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 2730 other OPPS APC 2730 2730 other OPPS APC 2730 27.63 754.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MAMMARY GEL LUMERA SILTEX CONTOUR 535CC SUP-324-1401 CDM 0270 RC outpatient 2730 2730 2730 74 2020.2 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 2730 other OPPS APC 2730 2730 other OPPS APC 2730 27.63 754.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MAMMARY GEL LUMERA PROFILE 610CC SUP-324-1451 CDM 0270 RC outpatient 2990 2990 2990 74 2212.6 percent of total billed charges 2990 93 2421.9 percent of total billed charges 2990 2990 other OPPS APC 2990 2990 other OPPS APC 2990 27.63 826.14 percent of total billed charges 2990 2990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET ORTHOPEDIC 5 MM STOPPER SUP-324.019 CDM 270010022 LOCAL 0270 RC outpatient 333.71 333.71 333.71 74 246.95 percent of total billed charges 333.71 93 270.31 percent of total billed charges 333.71 333.71 other OPPS APC 333.71 333.71 other OPPS APC 333.71 27.63 92.2 percent of total billed charges 333.71 333.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET ORTHOPEDIC 1.25 MM INSERT K WIRE SUP-324.084 CDM 270010022 LOCAL 0270 RC outpatient 832.26 832.26 832.26 74 615.87 percent of total billed charges 832.26 93 674.13 percent of total billed charges 832.26 832.26 other OPPS APC 832.26 832.26 other OPPS APC 832.26 27.63 229.95 percent of total billed charges 832.26 832.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC OD2.5 MM NONSTERILE 5 MM SCREW SUP-324.174 CDM 270010022 LOCAL 0270 RC outpatient 707.85 707.85 707.85 74 523.81 percent of total billed charges 707.85 93 573.36 percent of total billed charges 707.85 707.85 other OPPS APC 707.85 707.85 other OPPS APC 707.85 27.63 195.58 percent of total billed charges 707.85 707.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE SURGICAL 2.5MM NS WIRE 7.3MM SCREW SUP-324.175 CDM 270010022 LOCAL 0270 RC outpatient 707.85 707.85 707.85 74 523.81 percent of total billed charges 707.85 93 573.36 percent of total billed charges 707.85 707.85 other OPPS APC 707.85 707.85 other OPPS APC 707.85 27.63 195.58 percent of total billed charges 707.85 707.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L300 MM L200 MM OD2.5 MM PERCUTANEOUS QUICK COUPLING CALIBRATION NONSTERILE SUP-324.210 CDM 270010022 LOCAL 0270 RC outpatient 471.61 471.61 471.61 74 348.99 percent of total billed charges 471.61 93 382 percent of total billed charges 471.61 471.61 other OPPS APC 471.61 471.61 other OPPS APC 471.61 27.63 130.31 percent of total billed charges 471.61 471.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L300 MM L200 MM OD2.8 MM PERCUTANEOUS QUICK COUPLING CALIBRATED SUP-324.211 CDM 270010013 LOCAL 0270 RC outpatient 471.61 471.61 471.61 74 348.99 percent of total billed charges 471.61 93 382 percent of total billed charges 471.61 471.61 other OPPS APC 471.61 471.61 other OPPS APC 471.61 27.63 130.31 percent of total billed charges 471.61 471.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL LCP L300 MM OD3.2 MM PERCUTANEOUS QUICK COUPLING CALIBRATED NONSTERILE SUP-324.212 CDM 270009127 LOCAL 0270 RC outpatient 34.01 34.01 34.01 74 25.17 percent of total billed charges 34.01 93 27.55 percent of total billed charges 34.01 34.01 other OPPS APC 34.01 34.01 other OPPS APC 34.01 27.63 9.4 percent of total billed charges 34.01 34.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL LCP L300/200 MM OD4.3 MM PERCUTANEOUS QUICK COUPLING CALIBRATED NONSTERILE SUP-324.213 CDM 270010022 LOCAL 0270 RC outpatient 438.83 438.83 438.83 74 324.73 percent of total billed charges 438.83 93 355.45 percent of total billed charges 438.83 438.83 other OPPS APC 438.83 438.83 other OPPS APC 438.83 27.63 121.25 percent of total billed charges 438.83 438.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL LCP L200 MM OD2.8 MM PERCUTANEOUS 3 FLUTE SCALE QUICK COUPLING CALIBRATED NONSTERILE SUP-324.214 CDM 270010022 LOCAL 0270 RC outpatient 952.51 952.51 952.51 74 704.86 percent of total billed charges 952.51 93 771.53 percent of total billed charges 952.51 952.51 other OPPS APC 952.51 952.51 other OPPS APC 952.51 27.63 263.18 percent of total billed charges 952.51 952.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA INFUSION OD23 GA VISCOUS FLUID HANDS FREE SILICONE OIL BIMANUAL SURGERY SUP-3246 CDM 0270 RC outpatient 72.28 72.28 72.28 74 53.49 percent of total billed charges 72.28 93 58.55 percent of total billed charges 72.28 72.28 other OPPS APC 72.28 72.28 other OPPS APC 72.28 27.63 19.97 percent of total billed charges 72.28 72.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION L270 MM OD3 MM THREAD SELF DRILL NONSTERILE SUP-325.160 CDM 270010022 LOCAL 0270 RC outpatient 806.52 806.52 806.52 74 596.82 percent of total billed charges 806.52 93 653.28 percent of total billed charges 806.52 806.52 other OPPS APC 806.52 806.52 other OPPS APC 806.52 27.63 222.84 percent of total billed charges 806.52 806.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA SUCTION/IRRIGATION POLYTIP BLUNT THIN WALL L28 MM L2 MM OD25-38 GA LUER LOCK HUB SEMIFLEXIBLE TIP GREEN SUP-3255 CDM outpatient 128.44 128.44 128.44 128.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE TICRON 2-0 CV-305 L36 IN 2 ARM BRAIDED COATED BLUE SUP-3256-51 CDM 0270 RC outpatient 44.64 44.64 44.64 74 33.03 percent of total billed charges 44.64 93 36.16 percent of total billed charges 44.64 44.64 other OPPS APC 44.64 44.64 other OPPS APC 44.64 27.63 12.33 percent of total billed charges 44.64 44.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPPORT ARM RADIAL LEFT EXTEND SUP-3261 CDM 0481 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 51 265.2 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPPORT WRIST EXTEND SUP-3262 CDM 0481 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 51 132.6 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT FRESH FROZEN TALUS SUP-32647002 CDM 270010031 LOCAL 0270 RC outpatient 16900 16900 16900 74 12506 percent of total billed charges 16900 93 13689 percent of total billed charges 16900 16900 other OPPS APC 16900 16900 other OPPS APC 16900 27.63 4669.47 percent of total billed charges 16900 16900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICRODOSE INJECTION KIT SUP-3275 CDM 0270 RC outpatient 67.6 67.6 67.6 74 50.02 percent of total billed charges 67.6 93 54.76 percent of total billed charges 67.6 67.6 other OPPS APC 67.6 67.6 other OPPS APC 67.6 27.63 18.68 percent of total billed charges 67.6 67.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY CATHETER POWERPICC NITINOL .018 IN L70 CM OD5 FR 2 LUMEN GUIDEWIRE SUP-3275355 CDM 0270 RC outpatient 246.97 246.97 246.97 74 182.76 percent of total billed charges 246.97 93 200.05 percent of total billed charges 246.97 246.97 other OPPS APC 246.97 246.97 other OPPS APC 246.97 27.63 68.24 percent of total billed charges 246.97 246.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAP BONE L195 MM CANNULATED NONSTERILE 5 MM THREAD ROD SUP-328.140 CDM 270010022 LOCAL 0270 RC outpatient 1175.46 1175.46 1175.46 74 869.84 percent of total billed charges 1175.46 93 952.12 percent of total billed charges 1175.46 1175.46 other OPPS APC 1175.46 1175.46 other OPPS APC 1175.46 27.63 324.78 percent of total billed charges 1175.46 1175.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION L380 MM OD5 MM THREAD SELF DRILL TIP NONSTERILE SUP-328.16 CDM 270010022 LOCAL 0270 RC outpatient 858 858 858 74 634.92 percent of total billed charges 858 93 694.98 percent of total billed charges 858 858 other OPPS APC 858 858 other OPPS APC 858 27.63 237.07 percent of total billed charges 858 858 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION BLUNT L335 MM OD5 MM ODSEC1.6 MM THREAD CANNULATED NONSTERILE SUP-328.170 CDM 270010022 LOCAL 0270 RC outpatient 1471.47 1471.47 1471.47 74 1088.89 percent of total billed charges 1471.47 93 1191.89 percent of total billed charges 1471.47 1471.47 other OPPS APC 1471.47 1471.47 other OPPS APC 1471.47 27.63 406.57 percent of total billed charges 1471.47 1471.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT NEUROSTIMULATOR LAMITRODE S-SERIES L60 CM 8 2 LEAD 8 ELECTRODE SUP-3286 CDM 0270 RC outpatient 8580 8580 8580 74 6349.2 percent of total billed charges 8580 93 6949.8 percent of total billed charges 8580 8580 other OPPS APC 8580 8580 other OPPS APC 8580 27.63 2370.65 percent of total billed charges 8580 8580 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN EXTERNAL FIXATION OD2 MM THREADED BENDING LCD PLATES SUP-329.921 CDM 270010022 LOCAL 0270 RC outpatient 852.28 852.28 852.28 74 630.69 percent of total billed charges 852.28 93 690.35 percent of total billed charges 852.28 852.28 other OPPS APC 852.28 852.28 other OPPS APC 852.28 27.63 235.48 percent of total billed charges 852.28 852.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN BENDING 2.4 MM LOCKING PLATE SUP-329.922 CDM 270010022 LOCAL 0270 RC outpatient 607.05 607.05 607.05 74 449.22 percent of total billed charges 607.05 93 491.71 percent of total billed charges 607.05 607.05 other OPPS APC 607.05 607.05 other OPPS APC 607.05 27.63 167.73 percent of total billed charges 607.05 607.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP BOUFFANT DESIGNER RAYON 1 LARGE NURSE NONSTERILE LATEX FREE DISPOSABLE CELEBRATION SUP-3290 CDM outpatient 0.51 0.51 0.51 0.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT VENTURA NM LORDOTIC PEEL SPACER SUP-33-7809 CDM 270010020 LOCAL 0270 RC outpatient 7800 7800 7800 74 5772 percent of total billed charges 7800 93 6318 percent of total billed charges 7800 7800 other OPPS APC 7800 7800 other OPPS APC 7800 27.63 2155.14 percent of total billed charges 7800 7800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT VENTURA NM LORDOTIC PEEL SPACER SUP-33-7810 CDM 270010020 LOCAL 0270 RC outpatient 7800 7800 7800 74 5772 percent of total billed charges 7800 93 6318 percent of total billed charges 7800 7800 other OPPS APC 7800 7800 other OPPS APC 7800 27.63 2155.14 percent of total billed charges 7800 7800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT VENTURA LORDOTIC PEEK SUP-33-7811 CDM 270010020 LOCAL 0270 RC outpatient 7800 7800 7800 74 5772 percent of total billed charges 7800 93 6318 percent of total billed charges 7800 7800 other OPPS APC 7800 7800 other OPPS APC 7800 27.63 2155.14 percent of total billed charges 7800 7800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNI-CP STAINLESS STEEL L30 MM 4 HOLE UNICOMPRESSION SUP-330 430 SND CDM 0270 RC outpatient 4976.4 4976.4 4976.4 74 3682.54 percent of total billed charges 4976.4 93 4030.88 percent of total billed charges 4976.4 4976.4 other OPPS APC 4976.4 4976.4 other OPPS APC 4976.4 27.63 1374.98 percent of total billed charges 4976.4 4976.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL OPTIMESH POLYETHYLENE TEREPHTHALATE L20 MM X W17 MM L5 MM SPINE KNIT STERILE SUP-330-2005 CDM 0270 RC outpatient 12480 12480 12480 74 9235.2 percent of total billed charges 12480 93 10108.8 percent of total billed charges 12480 12480 other OPPS APC 12480 12480 other OPPS APC 12480 27.63 3448.22 percent of total billed charges 12480 12480 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL OPTIMESH POLYETHYLENE TEREPHTHALATE L22 MM X W19 MM L5 MM SPINE KNIT STERILE SUP-330-2205 CDM 0270 RC outpatient 12480 12480 12480 74 9235.2 percent of total billed charges 12480 93 10108.8 percent of total billed charges 12480 12480 other OPPS APC 12480 12480 other OPPS APC 12480 27.63 3448.22 percent of total billed charges 12480 12480 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL OPTIMESH POLYETHYLENE TEREPHTHALATE L25 MM X W20 MM L5 MM SPINE KNIT STERILE SUP-330-2505 CDM 270010020 LOCAL 0270 RC outpatient 12480 12480 12480 74 9235.2 percent of total billed charges 12480 93 10108.8 percent of total billed charges 12480 12480 other OPPS APC 12480 12480 other OPPS APC 12480 27.63 3448.22 percent of total billed charges 12480 12480 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROGEL AIR SEALANT SUP-33001 CDM 0270 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT INTEGRA COMPRESSION PLATE U SHAPED SUP-330021 CDM 0270 RC outpatient 9171.5 9171.5 9171.5 74 6786.91 percent of total billed charges 9171.5 93 7428.92 percent of total billed charges 9171.5 9171.5 other OPPS APC 9171.5 9171.5 other OPPS APC 9171.5 27.63 2534.09 percent of total billed charges 9171.5 9171.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT INTEGRA COMPRESSION PLATE U SHAPED SUP-330023 CDM 0270 RC outpatient 10010 10010 10010 74 7407.4 percent of total billed charges 10010 93 8108.1 percent of total billed charges 10010 10010 other OPPS APC 10010 10010 other OPPS APC 10010 27.63 2765.76 percent of total billed charges 10010 10010 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT INTEGRA COMPRESSION PLATE U SHAPED SUP-330025 CDM 0270 RC outpatient 10010 10010 10010 74 7407.4 percent of total billed charges 10010 93 8108.1 percent of total billed charges 10010 10010 other OPPS APC 10010 10010 other OPPS APC 10010 27.63 2765.76 percent of total billed charges 10010 10010 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE T COMPRESSION SUP-330030 CDM 0270 RC outpatient 4976.4 4976.4 4976.4 74 3682.54 percent of total billed charges 4976.4 93 4030.88 percent of total billed charges 4976.4 4976.4 other OPPS APC 4976.4 4976.4 other OPPS APC 4976.4 27.63 1374.98 percent of total billed charges 4976.4 4976.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC CARPENTIER-EDWARDS PERIMOUNT MAGNA EASE THERMAFIX 21MM BOVINE PERICARDIUM COCR POLYESTER SILICONE RUBBER SUP-3300TFX21MM CDM 0270 RC outpatient 15860 15860 15860 74 11736.4 percent of total billed charges 15860 93 12846.6 percent of total billed charges 15860 15860 other OPPS APC 15860 15860 other OPPS APC 15860 27.63 4382.12 percent of total billed charges 15860 15860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC CARPENTIER-EDWARDS PERIMOUNT MAGNA EASE PERICARDIAL LOW PROFILE OD23 MM BIOPROSTHESIS THERMAFIX PROCESS STENT BASE AORTOTOMY CLOSURE SUP-3300TFX23MM CDM 0270 RC outpatient 15860 15860 15860 74 11736.4 percent of total billed charges 15860 93 12846.6 percent of total billed charges 15860 15860 other OPPS APC 15860 15860 other OPPS APC 15860 27.63 4382.12 percent of total billed charges 15860 15860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC CARPENTIER-EDWARDS PERIMOUNT MAGNA EASE PERICARDIAL LOW PROFILE OD25 MM BIOPROSTHESIS THERMAFIX PROCESS STENT BASE AORTOTOMY CLOSURE SUP-3300TFX25MM CDM 0270 RC outpatient 15860 15860 15860 74 11736.4 percent of total billed charges 15860 93 12846.6 percent of total billed charges 15860 15860 other OPPS APC 15860 15860 other OPPS APC 15860 27.63 4382.12 percent of total billed charges 15860 15860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC CARPENTIER-EDWARDS PERIMOUNT MAGNA EASE PERICARDIAL LOW PROFILE OD27 MM BIOPROSTHESIS THERMAFIX PROCESS STENT BASE AORTOTOMY CLOSURE SUP-3300TFX27MM CDM 0270 RC outpatient 15860 15860 15860 74 11736.4 percent of total billed charges 15860 93 12846.6 percent of total billed charges 15860 15860 other OPPS APC 15860 15860 other OPPS APC 15860 27.63 4382.12 percent of total billed charges 15860 15860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC CARPENTIER-EDWARDS PERIMOUNT MAGNA EASE PERICARDIAL LOW PROFILE OD29 MM BIOPROSTHESIS THERMAFIX PROCESS STENT BASE AORTOTOMY CLOSURE SUP-3300TFX29MM CDM 0270 RC outpatient 15860 15860 15860 74 11736.4 percent of total billed charges 15860 93 12846.6 percent of total billed charges 15860 15860 other OPPS APC 15860 15860 other OPPS APC 15860 27.63 4382.12 percent of total billed charges 15860 15860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT INTEGRA COMPRESSION PLATE 2 HOLE SUP-330217 CDM 0270 RC outpatient 4378.4 4378.4 4378.4 74 3240.02 percent of total billed charges 4378.4 93 3546.5 percent of total billed charges 4378.4 4378.4 other OPPS APC 4378.4 4378.4 other OPPS APC 4378.4 27.63 1209.75 percent of total billed charges 4378.4 4378.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT INTEGRA COMPRESSION PLATE 2 HOLE SUP-330220 CDM 0270 RC outpatient 4210.05 4210.05 4210.05 74 3115.44 percent of total billed charges 4210.05 93 3410.14 percent of total billed charges 4210.05 4210.05 other OPPS APC 4210.05 4210.05 other OPPS APC 4210.05 27.63 1163.24 percent of total billed charges 4210.05 4210.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE INTEGRA COMPRESSION 2 HOLE SUP-330225 CDM 0270 RC outpatient 4210.05 4210.05 4210.05 74 3115.44 percent of total billed charges 4210.05 93 3410.14 percent of total billed charges 4210.05 4210.05 other OPPS APC 4210.05 4210.05 other OPPS APC 4210.05 27.63 1163.24 percent of total billed charges 4210.05 4210.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE INTEGRA COMPRESSION 2 HOLE SUP-330230 CDM 0270 RC outpatient 4210.05 4210.05 4210.05 74 3115.44 percent of total billed charges 4210.05 93 3410.14 percent of total billed charges 4210.05 4210.05 other OPPS APC 4210.05 4210.05 other OPPS APC 4210.05 27.63 1163.24 percent of total billed charges 4210.05 4210.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ZEVO TITANIUM L59 MM SPINE CERVICAL ANTERIOR LEVEL 3 SUP-3303059 CDM 270010020 LOCAL 0270 RC outpatient 4550 4550 4550 74 3367 percent of total billed charges 4550 93 3685.5 percent of total billed charges 4550 4550 other OPPS APC 4550 4550 other OPPS APC 4550 27.63 1257.17 percent of total billed charges 4550 4550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT INTEGRA COMPRESSION PLATE 4 HOLE SUP-330420 CDM 0270 RC outpatient 4976.4 4976.4 4976.4 74 3682.54 percent of total billed charges 4976.4 93 4030.88 percent of total billed charges 4976.4 4976.4 other OPPS APC 4976.4 4976.4 other OPPS APC 4976.4 27.63 1374.98 percent of total billed charges 4976.4 4976.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNI-CP L25 MM LOWER EXTREMITY 4 HOLE COMPRESSION SUP-330425SND CDM 0270 RC outpatient 4751.5 4751.5 4751.5 74 3516.11 percent of total billed charges 4751.5 93 3848.72 percent of total billed charges 4751.5 4751.5 other OPPS APC 4751.5 4751.5 other OPPS APC 4751.5 27.63 1312.84 percent of total billed charges 4751.5 4751.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING RETRACTOR LONE STAR NORYL PLASTIC L32.5 CM X W18.3 CM SELF RETAIN 2 CATHETER CLIP STERILE LATEX FREE DISPOSABLE SUP-3304G CDM 0270 RC outpatient 249.26 249.26 249.26 74 184.45 percent of total billed charges 249.26 93 201.9 percent of total billed charges 249.26 249.26 other OPPS APC 249.26 249.26 other OPPS APC 249.26 27.63 68.87 percent of total billed charges 249.26 249.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING RETRACTOR LONE STAR NORYL PLASTIC L14.1 CM X W14.1 CM 2 PEEL POUCH SELF RETAINING FLEXIBLE LIGHTWEIGHT ELASTIC STAY STERILE LATEX FREE DISPOSABLE SUP-3307G CDM 0270 RC outpatient 249.26 249.26 249.26 74 184.45 percent of total billed charges 249.26 93 201.9 percent of total billed charges 249.26 249.26 other OPPS APC 249.26 249.26 other OPPS APC 249.26 27.63 68.87 percent of total billed charges 249.26 249.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK ICE 12X5IN DISPOSABLE NS LF FACE BILATERAL SOFT OUTER COVER HOOK LOOP CLOSURE SUP-33101 CDM 270009107 LOCAL 0270 RC outpatient 2.77 2.77 2.77 74 2.05 percent of total billed charges 2.77 93 2.24 percent of total billed charges 2.77 2.77 other OPPS APC 2.77 2.77 other OPPS APC 2.77 27.63 0.77 percent of total billed charges 2.77 2.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING RETRACTOR LONE STAR NORYL RESIN L25 CM X W25 CM ELASTIC STAY SELF RETAINING STERILE LATEX FREE DISPOSABLE SUP-3310G CDM 0270 RC outpatient 231.58 231.58 231.58 74 171.37 percent of total billed charges 231.58 93 187.58 percent of total billed charges 231.58 231.58 other OPPS APC 231.58 231.58 other OPPS APC 231.58 27.63 63.99 percent of total billed charges 231.58 231.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOOK RETRACTION LONE STAR STAINLESS STEEL 5 MM SHARP ELASTIC STAY STERILE LATEX FREE DISPOSABLE INDIVIDUALLY WRAPPED SUP-3311-1G CDM 0270 RC outpatient 28.3 28.3 28.3 74 20.94 percent of total billed charges 28.3 93 22.92 percent of total billed charges 28.3 28.3 other OPPS APC 28.3 28.3 other OPPS APC 28.3 27.63 7.82 percent of total billed charges 28.3 28.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOOK RETRACTOR LONE STAR STAINLESS STEEL 5 MM SHARP ELASTIC STAY STERILE LATEX FREE DISPOSABLE SUP-3311-8G CDM 0270 RC outpatient 153.32 153.32 153.32 74 113.46 percent of total billed charges 153.32 93 124.19 percent of total billed charges 153.32 153.32 other OPPS APC 153.32 153.32 other OPPS APC 153.32 27.63 42.36 percent of total billed charges 153.32 153.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETERAL PLASTIC WHISTLE L65 CM OD3 FR 2 STAGGER EYE LUER FIT ADAPTER COLOR CODED XRAY OPAQUE STERILE LATEX FREE DISPOSABLE SUP-331103 CDM outpatient 22.1 22.1 22.1 22.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETERAL PLASTIC WHISTLE L65 CM OD4 FR 2 STAGGER EYE LUER FIT ADAPTER COLOR CODED XRAY OPAQUE STERILE LATEX FREE DISPOSABLE SUP-331104 CDM 0270 RC outpatient 22.1 22.1 22.1 74 16.35 percent of total billed charges 22.1 93 17.9 percent of total billed charges 22.1 22.1 other OPPS APC 22.1 22.1 other OPPS APC 22.1 27.63 6.11 percent of total billed charges 22.1 22.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOOK RETRACTION 5 MM BLUNT ELASTIC STAY DISPOSABLE SUP-3316-1G CDM 0270 RC outpatient 28.3 28.3 28.3 74 20.94 percent of total billed charges 28.3 93 22.92 percent of total billed charges 28.3 28.3 other OPPS APC 28.3 28.3 other OPPS APC 28.3 27.63 7.82 percent of total billed charges 28.3 28.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY EPIDURAL PERIFIX TUOHY PVC DEHP GLASS L3 1/2 IN L1.25 IN OD18 GA ODSEC20 GA 5 ML CLOSED END CATHETER CONTINUOUS NERVE BLOCK HYPODERMIC NEEDLE LUER LOCK SYRINGE STERILE LATEX FREE SUP-332081 CDM 270009010 LOCAL 0270 RC outpatient 54.2 54.2 54.2 74 40.11 percent of total billed charges 54.2 93 43.9 percent of total billed charges 54.2 54.2 other OPPS APC 54.2 54.2 other OPPS APC 54.2 27.63 14.98 percent of total billed charges 54.2 54.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE MEDICAL PERIFIX BISPHENOL A PLASTIC 8 ML LOSS OF RESISTANCE LUER LOCK DEHP FREE PVC FREE LATEX FREE SUP-332152 CDM 0270 RC outpatient 4.34 4.34 4.34 74 3.21 percent of total billed charges 4.34 93 3.52 percent of total billed charges 4.34 4.34 other OPPS APC 4.34 4.34 other OPPS APC 4.34 27.63 1.2 percent of total billed charges 4.34 4.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE EPIDURAL PERIFIX TUOHY BISPHENOL A L3 1/2 IN OD18 GA WING HUB PVC FREE DEHP FREE LATEX FREE CLEAR SUP-332166 CDM 0270 RC outpatient 15.59 15.59 15.59 74 11.54 percent of total billed charges 15.59 93 12.63 percent of total billed charges 15.59 15.59 other OPPS APC 15.59 15.59 other OPPS APC 15.59 27.63 4.31 percent of total billed charges 15.59 15.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE EPIDURAL PERIFIX TUOHY BISPHENOL A L3 1/2 IN OD20 GA WING HUB PVC FREE DEHP FREE LATEX FREE CLEAR SUP-332168 CDM 0270 RC outpatient 15.59 15.59 15.59 74 11.54 percent of total billed charges 15.59 93 12.63 percent of total billed charges 15.59 15.59 other OPPS APC 15.59 15.59 other OPPS APC 15.59 27.63 4.31 percent of total billed charges 15.59 15.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GC FUGICEM AUTOMIX (CARTRIDGE ONLY) SUP-333-3665 CDM 0270 RC outpatient 441.99 441.99 441.99 74 327.07 percent of total billed charges 441.99 93 358.01 percent of total billed charges 441.99 441.99 other OPPS APC 441.99 441.99 other OPPS APC 441.99 27.63 122.12 percent of total billed charges 441.99 441.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SUCTION ARGYLE SAFE-T-VAC STRAIGHT SMALL STATURE L21 IN OD14 FR CONNECTOR COIL CHIMNEY VALVE 2 TIP STERILE LATEX FREE DISPOSABLE SUP-33400 CDM 0270 RC outpatient 2.31 2.31 2.31 74 1.71 percent of total billed charges 2.31 93 1.87 percent of total billed charges 2.31 2.31 other OPPS APC 2.31 2.31 other OPPS APC 2.31 27.63 0.64 percent of total billed charges 2.31 2.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOOK RETRACTION LONE STAR 12 MM BLUNT ELASTIC STAY STERILE LATEX FREE DISPOSABLE SUP-3350-1G CDM 0270 RC outpatient 28.3 28.3 28.3 74 20.94 percent of total billed charges 28.3 93 22.92 percent of total billed charges 28.3 28.3 other OPPS APC 28.3 28.3 other OPPS APC 28.3 27.63 7.82 percent of total billed charges 28.3 28.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP PHACOEMULSIFICATION GRIESHABER REVOLUTION DSP POLYMERIC 360 D OD 25 GA TISSUE BACK FLUSH LIGHTWEIGHT ERGONOMIC HANDLE STERILE DISPOSABLE SUP-337.84 CDM 0270 RC outpatient 264.76 264.76 264.76 74 195.92 percent of total billed charges 264.76 93 214.46 percent of total billed charges 264.76 264.76 other OPPS APC 264.76 264.76 other OPPS APC 264.76 27.63 73.15 percent of total billed charges 264.76 264.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC COCR L300 MM L12 MM OD2.5 MM DRILL TIP THREAD NONSTERILE SUP-338.002 CDM 270010022 LOCAL 0270 RC outpatient 188.76 188.76 188.76 74 139.68 percent of total billed charges 188.76 93 152.9 percent of total billed charges 188.76 188.76 other OPPS APC 188.76 188.76 other OPPS APC 188.76 27.63 52.15 percent of total billed charges 188.76 188.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 25+ FINESSE FLEX LOOP SUP-338.25P CDM 0270 RC outpatient 331.6 331.6 331.6 74 245.38 percent of total billed charges 331.6 93 268.6 percent of total billed charges 331.6 331.6 other OPPS APC 331.6 331.6 other OPPS APC 331.6 27.63 91.62 percent of total billed charges 331.6 331.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCRAPPER CURVED MEMBRANE 27G SUP-338.27 CDM 0270 RC outpatient 321.91 321.91 321.91 74 238.21 percent of total billed charges 321.91 93 260.75 percent of total billed charges 321.91 321.91 other OPPS APC 321.91 321.91 other OPPS APC 321.91 27.63 88.94 percent of total billed charges 321.91 321.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION SPINAL CORD STIM SUP-3383 CDM 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE VITRECTOMY GRIESHABER 30 D OD25 GA DSP POINTED TIP DIATHERMY ERGONOMIC HANDLE ACCURUS CONSTELLATION SUP-339.21 CDM 0270 RC outpatient 130.16 130.16 130.16 74 96.32 percent of total billed charges 130.16 93 105.43 percent of total billed charges 130.16 130.16 other OPPS APC 130.16 130.16 other OPPS APC 130.16 27.63 35.96 percent of total billed charges 130.16 130.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE VITRECTOMY GRIESHABER 30 D OD27+ GA DSP POINTED TIP DIATHERMY ERGONOMIC HANDLE ACCURUS CONSTELLATION SUP-339.31 CDM 0270 RC outpatient 128.52 128.52 128.52 74 95.1 percent of total billed charges 128.52 93 104.1 percent of total billed charges 128.52 128.52 other OPPS APC 128.52 128.52 other OPPS APC 128.52 27.63 35.51 percent of total billed charges 128.52 128.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL MASTERS-SERIES 85 D 5.18 SQ CM OD33 MM ID26.1 MM HEART MECHANICAL STANDARD CUFF STYLE PYROLYTIC CARBON LEAFLET OPEN ORIFICE RING CONTROLLED TORQUE ROTATION MECHANISM SUP-33MJ-501 CDM 0270 RC outpatient 12708.8 12708.8 12708.8 74 9404.51 percent of total billed charges 12708.8 93 10294.1 percent of total billed charges 12708.8 12708.8 other OPPS APC 12708.8 12708.8 other OPPS APC 12708.8 27.63 3511.44 percent of total billed charges 12708.8 12708.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL HOLLYWOOD LORDOTIC 7MM PEEK-OPTIMA INTERBODY FUSION SUP-34-5007 CDM 270010020 LOCAL 0270 RC outpatient 10342.8 10342.8 10342.8 74 7653.67 percent of total billed charges 10342.8 93 8377.67 percent of total billed charges 10342.8 10342.8 other OPPS APC 10342.8 10342.8 other OPPS APC 10342.8 27.63 2857.72 percent of total billed charges 10342.8 10342.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT HOLLYWOOD 8MM LORDOTIC SUP-34-5008 CDM 270010020 LOCAL 0270 RC outpatient 10342.8 10342.8 10342.8 74 7653.67 percent of total billed charges 10342.8 93 8377.67 percent of total billed charges 10342.8 10342.8 other OPPS APC 10342.8 10342.8 other OPPS APC 10342.8 27.63 2857.72 percent of total billed charges 10342.8 10342.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL HOLLYWOOD LORDOTIC 27X11X9MM PEEK-OPTIMA TLIF SUP-34-5009 CDM 270010020 LOCAL 0270 RC outpatient 10342.8 10342.8 10342.8 74 7653.67 percent of total billed charges 10342.8 93 8377.67 percent of total billed charges 10342.8 10342.8 other OPPS APC 10342.8 10342.8 other OPPS APC 10342.8 27.63 2857.72 percent of total billed charges 10342.8 10342.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL HOLLYWOOD PEEK-OPTIMA L27 MM X W11 MM X H10 MM TLIF LORDOTIC SUP-34-5010 CDM 270010012 LOCAL 0270 RC outpatient 10342.8 10342.8 10342.8 74 7653.67 percent of total billed charges 10342.8 93 8377.67 percent of total billed charges 10342.8 10342.8 other OPPS APC 10342.8 10342.8 other OPPS APC 10342.8 27.63 2857.72 percent of total billed charges 10342.8 10342.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL HOLLYWOOD PEEK-OPTIMA L27 MM X W11 MM X H11 MM INTERBODY FUSION LORDOTIC SUP-34-5011 CDM 270010020 LOCAL 0270 RC outpatient 10342.8 10342.8 10342.8 74 7653.67 percent of total billed charges 10342.8 93 8377.67 percent of total billed charges 10342.8 10342.8 other OPPS APC 10342.8 10342.8 other OPPS APC 10342.8 27.63 2857.72 percent of total billed charges 10342.8 10342.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL HOLLYWOOD PEEK-OPTIMA L27 MM X W11 MM X H12 MM TLIF LORDOTIC SUP-34-5012 CDM 270010020 LOCAL 0270 RC outpatient 10342.8 10342.8 10342.8 74 7653.67 percent of total billed charges 10342.8 93 8377.67 percent of total billed charges 10342.8 10342.8 other OPPS APC 10342.8 10342.8 other OPPS APC 10342.8 27.63 2857.72 percent of total billed charges 10342.8 10342.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL HOLLYWOOD LORDOTIC 27X11X13MM PEEK-OPTIMA TLIF SUP-34-5013 CDM 270010020 LOCAL 0270 RC outpatient 10342.8 10342.8 10342.8 74 7653.67 percent of total billed charges 10342.8 93 8377.67 percent of total billed charges 10342.8 10342.8 other OPPS APC 10342.8 10342.8 other OPPS APC 10342.8 27.63 2857.72 percent of total billed charges 10342.8 10342.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL HOLLYWOOD LORDOTIC 27X11X14MM PEEK-OPTIMA TLIF SUP-34-5014 CDM 270010020 LOCAL 0270 RC outpatient 10342.8 10342.8 10342.8 74 7653.67 percent of total billed charges 10342.8 93 8377.67 percent of total billed charges 10342.8 10342.8 other OPPS APC 10342.8 10342.8 other OPPS APC 10342.8 27.63 2857.72 percent of total billed charges 10342.8 10342.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL HOLLYWOOD LORDOTIC 27X11X15MM PEEK-OPTIMA TLIF SUP-34-5015 CDM 270010020 LOCAL 0270 RC outpatient 10342.8 10342.8 10342.8 74 7653.67 percent of total billed charges 10342.8 93 8377.67 percent of total billed charges 10342.8 10342.8 other OPPS APC 10342.8 10342.8 other OPPS APC 10342.8 27.63 2857.72 percent of total billed charges 10342.8 10342.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL VBR L27 MM X W16 MM X H11 MM SUP-34-5016 CDM 270010020 LOCAL 0270 RC outpatient 10342.8 10342.8 10342.8 74 7653.67 percent of total billed charges 10342.8 93 8377.67 percent of total billed charges 10342.8 10342.8 other OPPS APC 10342.8 10342.8 other OPPS APC 10342.8 27.63 2857.72 percent of total billed charges 10342.8 10342.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL HOLLYWOOD LORDOTIC 27X11X17MM PEEK-OPTIMA TLIF SUP-34-5017 CDM 270010020 LOCAL 0270 RC outpatient 10342.8 10342.8 10342.8 74 7653.67 percent of total billed charges 10342.8 93 8377.67 percent of total billed charges 10342.8 10342.8 other OPPS APC 10342.8 10342.8 other OPPS APC 10342.8 27.63 2857.72 percent of total billed charges 10342.8 10342.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL HOLLYWOOD LORDOTIC 27X11X18MM PEEK-OPTIMA TLIF SUP-34-5018 CDM 270010020 LOCAL 0270 RC outpatient 10342.8 10342.8 10342.8 74 7653.67 percent of total billed charges 10342.8 93 8377.67 percent of total billed charges 10342.8 10342.8 other OPPS APC 10342.8 10342.8 other OPPS APC 10342.8 27.63 2857.72 percent of total billed charges 10342.8 10342.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL HOLLYWOOD NANOMETALENE LORDOTIC L27 MM X W11 MM X H7 MM SUP-34-5107-S CDM 0270 RC outpatient 10764 10764 10764 74 7965.36 percent of total billed charges 10764 93 8718.84 percent of total billed charges 10764 10764 other OPPS APC 10764 10764 other OPPS APC 10764 27.63 2974.09 percent of total billed charges 10764 10764 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL HOLLYWOOD NANOMETALENE LORDOTIC L27 MM X W11 MM X H8 MM SUP-34-5108-S CDM 0270 RC outpatient 10764 10764 10764 74 7965.36 percent of total billed charges 10764 93 8718.84 percent of total billed charges 10764 10764 other OPPS APC 10764 10764 other OPPS APC 10764 27.63 2974.09 percent of total billed charges 10764 10764 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL HOLLYWOOD NANOMETALENE LORDOTIC L27 MM X W11 MM X H9 MM SUP-34-5109-S CDM 0270 RC outpatient 10764 10764 10764 74 7965.36 percent of total billed charges 10764 93 8718.84 percent of total billed charges 10764 10764 other OPPS APC 10764 10764 other OPPS APC 10764 27.63 2974.09 percent of total billed charges 10764 10764 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL HOLLYWOOD NANOMETALENE LORDOTIC L27 MM X W11 MM X H10 MM SUP-34-5110-S CDM 0270 RC outpatient 10764 10764 10764 74 7965.36 percent of total billed charges 10764 93 8718.84 percent of total billed charges 10764 10764 other OPPS APC 10764 10764 other OPPS APC 10764 27.63 2974.09 percent of total billed charges 10764 10764 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL HOLLYWOOD NANOMETALENE LORDOTIC L27 MM X W11 MM X H11 MM SUP-34-5111-S CDM 0270 RC outpatient 10764 10764 10764 74 7965.36 percent of total billed charges 10764 93 8718.84 percent of total billed charges 10764 10764 other OPPS APC 10764 10764 other OPPS APC 10764 27.63 2974.09 percent of total billed charges 10764 10764 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL HOLLYWOOD NANOMETALENE LORDOTIC L27 MM X W11 MM X H12 MM SUP-34-5112-S CDM 0270 RC outpatient 10764 10764 10764 74 7965.36 percent of total billed charges 10764 93 8718.84 percent of total billed charges 10764 10764 other OPPS APC 10764 10764 other OPPS APC 10764 27.63 2974.09 percent of total billed charges 10764 10764 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL HOLLYWOOD NANOMETALENE LORDOTIC L27 MM X W11 MM X H13 MM SUP-34-5113-S CDM 0270 RC outpatient 10764 10764 10764 74 7965.36 percent of total billed charges 10764 93 8718.84 percent of total billed charges 10764 10764 other OPPS APC 10764 10764 other OPPS APC 10764 27.63 2974.09 percent of total billed charges 10764 10764 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL HOLLYWOOD NANOMETALENE LORDOTIC L27 MM X W11 MM X H14 MM SUP-34-5114-S CDM 0270 RC outpatient 10764 10764 10764 74 7965.36 percent of total billed charges 10764 93 8718.84 percent of total billed charges 10764 10764 other OPPS APC 10764 10764 other OPPS APC 10764 27.63 2974.09 percent of total billed charges 10764 10764 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL HOLLYWOOD NANOMETALENE LORDOTIC L27 MM X W11 MM X H15 MM SUP-34-5115-S CDM 0270 RC outpatient 10764 10764 10764 74 7965.36 percent of total billed charges 10764 93 8718.84 percent of total billed charges 10764 10764 other OPPS APC 10764 10764 other OPPS APC 10764 27.63 2974.09 percent of total billed charges 10764 10764 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL HOLLYWOOD NANOMETALENE LORDOTIC L27 MM X W11 MM X H16 MM SUP-34-5116-S CDM 0270 RC outpatient 10764 10764 10764 74 7965.36 percent of total billed charges 10764 93 8718.84 percent of total billed charges 10764 10764 other OPPS APC 10764 10764 other OPPS APC 10764 27.63 2974.09 percent of total billed charges 10764 10764 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE DEFIBRILLATOR EMBLEM S-ICD MP35N POLYURETHANE L45 CM OD9 FR ODSEC7 FR SUBCUTANEOUS 3 POLAR COIL CONNECTOR PIN STERILE DISPOSABLE SUP-3401 CDM 0275 RC outpatient 10400 10400 10400 57 5928 percent of total billed charges 10400 93 8424 percent of total billed charges 10400 10400 other OPPS APC 10400 10400 other OPPS APC 10400 51 5304 percent of total billed charges 10400 10400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CORTICAL L11 MM X W11 MM X H5 SPINE BLOCK SUP-345511 CDM 270010012 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CORNERSTONE LASR CANCELLOUS CORTICAL LORDOTIC L11 MM X W11 MM X H6 MM BLOCK SUP-345611 CDM 270010012 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CORNERSTONE LASER CANCELLOUS CORTICAL LORDOTIC 7 X 11 X 11MM SUP-345711_57533 CDM 270010012 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CORNERSTONE LASR CANCELLOUS CORTICAL LORDOTIC L11 MM X W11 MM X H8 MM SPINE CERVICAL ALLOGRAFT SUP-345811 CDM 270010012 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE FAMILY FRIENDLY C-SECTION VIEWING SUP-3464 CDM 0270 RC outpatient 109.58 109.58 109.58 74 81.09 percent of total billed charges 109.58 93 88.76 percent of total billed charges 109.58 109.58 other OPPS APC 109.58 109.58 other OPPS APC 109.58 27.63 30.28 percent of total billed charges 109.58 109.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STYLETS ALL SUP-34749 CDM 0275 RC outpatient 20.66 20.66 20.66 57 11.78 percent of total billed charges 20.66 93 16.73 percent of total billed charges 20.66 20.66 other OPPS APC 20.66 20.66 other OPPS APC 20.66 51 10.54 percent of total billed charges 20.66 20.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOWEL WIPER REINFORCED DISPOSABLE 9.1X16.8 SUP-34790 CDM 0270 RC outpatient 12.75 12.75 12.75 74 9.44 percent of total billed charges 12.75 93 10.33 percent of total billed charges 12.75 12.75 other OPPS APC 12.75 12.75 other OPPS APC 12.75 27.63 3.52 percent of total billed charges 12.75 12.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PADDING CAST KENDALL WEBRIL 4YDX6IN COTTON NS LF UNDERCAST MILD STRETCH COHESIVE REGULAR FINISH SUP-3489 CDM 0270 RC outpatient 2.82 2.82 2.82 74 2.09 percent of total billed charges 2.82 93 2.28 percent of total billed charges 2.82 2.82 other OPPS APC 2.82 2.82 other OPPS APC 2.82 27.63 0.78 percent of total billed charges 2.82 2.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMALL PRO-STEP WALKER SUP-35-00001 CDM 0271 RC outpatient 81 81 81 74 59.94 percent of total billed charges 81 93 65.61 percent of total billed charges 81 81 other OPPS APC 81 81 other OPPS APC 81 27.63 22.38 percent of total billed charges 81 81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEDIUM PRO-STEP WALKER SUP-35-00002 CDM 0271 RC outpatient 76.19 76.19 76.19 74 56.38 percent of total billed charges 76.19 93 61.71 percent of total billed charges 76.19 76.19 other OPPS APC 76.19 76.19 other OPPS APC 76.19 27.63 21.05 percent of total billed charges 76.19 76.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LARGE PRO-STEP WALKER SUP-35-00003 CDM 0271 RC outpatient 81.64 81.64 81.64 74 60.41 percent of total billed charges 81.64 93 66.13 percent of total billed charges 81.64 81.64 other OPPS APC 81.64 81.64 other OPPS APC 81.64 27.63 22.56 percent of total billed charges 81.64 81.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXT STEP SHORTIE WALKER SM BOOT SUP-35-00004 CDM 0271 RC outpatient 95.35 95.35 95.35 74 70.56 percent of total billed charges 95.35 93 77.23 percent of total billed charges 95.35 95.35 other OPPS APC 95.35 95.35 other OPPS APC 95.35 27.63 26.35 percent of total billed charges 95.35 95.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXT STEP SHORTIE WALKER MD BOOT SUP-35-00005 CDM 0271 RC outpatient 107.56 107.56 107.56 74 79.59 percent of total billed charges 107.56 93 87.12 percent of total billed charges 107.56 107.56 other OPPS APC 107.56 107.56 other OPPS APC 107.56 27.63 29.72 percent of total billed charges 107.56 107.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXT STEP SHORTIE WALKER LG BOOT SUP-35-00006 CDM 0271 RC outpatient 112.92 112.92 112.92 74 83.56 percent of total billed charges 112.92 93 91.47 percent of total billed charges 112.92 112.92 other OPPS APC 112.92 112.92 other OPPS APC 112.92 27.63 31.2 percent of total billed charges 112.92 112.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRACE ANKLE AIR-STIRRUP STANDA SUP-35-00007 CDM 0271 RC outpatient 75.73 75.73 75.73 74 56.04 percent of total billed charges 75.73 93 61.34 percent of total billed charges 75.73 75.73 other OPPS APC 75.73 75.73 other OPPS APC 75.73 27.63 20.92 percent of total billed charges 75.73 75.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRACE ANKLE AIR-STIRRUP STANDA SUP-35-00008 CDM 0271 RC outpatient 75.72 75.72 75.72 74 56.03 percent of total billed charges 75.72 93 61.33 percent of total billed charges 75.72 75.72 other OPPS APC 75.72 75.72 other OPPS APC 75.72 27.63 20.92 percent of total billed charges 75.72 75.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRACE ANKLE AIR-STIRRUP SM/LEFT SUP-35-00010 CDM 0271 RC outpatient 77.1 77.1 77.1 74 57.05 percent of total billed charges 77.1 93 62.45 percent of total billed charges 77.1 77.1 other OPPS APC 77.1 77.1 other OPPS APC 77.1 27.63 21.3 percent of total billed charges 77.1 77.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRACE ANKLE AIR-STIRRUP SM/RIGHT SUP-35-00011 CDM 0271 RC outpatient 75.79 75.79 75.79 74 56.08 percent of total billed charges 75.79 93 61.39 percent of total billed charges 75.79 75.79 other OPPS APC 75.79 75.79 other OPPS APC 75.79 27.63 20.94 percent of total billed charges 75.79 75.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE CAST LARGE SUP-35-00013 CDM 0271 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE CAST MEDIUM SUP-35-00014 CDM 0271 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE CAST SMALL SUP-35-00016 CDM 0271 RC outpatient 3.76 3.76 3.76 74 2.78 percent of total billed charges 3.76 93 3.05 percent of total billed charges 3.76 3.76 other OPPS APC 3.76 3.76 other OPPS APC 3.76 27.63 1.04 percent of total billed charges 3.76 3.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE POST OP VELCRO MAN/LRG SUP-35-00024 CDM 0271 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE POST OP VELCRO MAN/MED SUP-35-00025 CDM 0271 RC outpatient 3.81 3.81 3.81 74 2.82 percent of total billed charges 3.81 93 3.09 percent of total billed charges 3.81 3.81 other OPPS APC 3.81 3.81 other OPPS APC 3.81 27.63 1.05 percent of total billed charges 3.81 3.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE POST OP VELCRO WOMAN/LRG SUP-35-00026 CDM 0271 RC outpatient 3.84 3.84 3.84 74 2.84 percent of total billed charges 3.84 93 3.11 percent of total billed charges 3.84 3.84 other OPPS APC 3.84 3.84 other OPPS APC 3.84 27.63 1.06 percent of total billed charges 3.84 3.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE POST OP VELCRO WOMAN/MED SUP-35-00027 CDM 0271 RC outpatient 3.84 3.84 3.84 74 2.84 percent of total billed charges 3.84 93 3.11 percent of total billed charges 3.84 3.84 other OPPS APC 3.84 3.84 other OPPS APC 3.84 27.63 1.06 percent of total billed charges 3.84 3.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE POST OP VELCRO WOMAN/SM SUP-35-00028 CDM 0271 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMOBILIZER ORTHOPEDIC FOAM THK3/8 IN UNIVERSAL L19 IN OD29 IN ODSEC21 IN KNEE CUT AWAY HOOK OUTER LAYER 3 POSTERIOR STAY LATEX FREE SUP-35-00034 CDM 0271 RC outpatient 65.68 65.68 65.68 74 48.6 percent of total billed charges 65.68 93 53.2 percent of total billed charges 65.68 65.68 other OPPS APC 65.68 65.68 other OPPS APC 65.68 27.63 18.15 percent of total billed charges 65.68 65.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT POST TIB/FIB W/ PADDING SUP-35-00035 CDM 0271 RC outpatient 70.28 70.28 70.28 74 52.01 percent of total billed charges 70.28 93 56.93 percent of total billed charges 70.28 70.28 other OPPS APC 70.28 70.28 other OPPS APC 70.28 27.63 19.42 percent of total billed charges 70.28 70.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT TIBIA/FIBULA W/PADDING SUP-35-00039 CDM 0271 RC outpatient 102.6 102.6 102.6 74 75.92 percent of total billed charges 102.6 93 83.11 percent of total billed charges 102.6 102.6 other OPPS APC 102.6 102.6 other OPPS APC 102.6 27.63 28.35 percent of total billed charges 102.6 102.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AFO MULTI PODUS BOOT M/L SUP-35-00041 CDM 0271 RC outpatient 192.24 192.24 192.24 74 142.26 percent of total billed charges 192.24 93 155.71 percent of total billed charges 192.24 192.24 other OPPS APC 192.24 192.24 other OPPS APC 192.24 27.63 53.12 percent of total billed charges 192.24 192.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOOT CAST SLIMLINE XSM SUP-35-00042 CDM 0271 RC outpatient 35.91 35.91 35.91 74 26.57 percent of total billed charges 35.91 93 29.09 percent of total billed charges 35.91 35.91 other OPPS APC 35.91 35.91 other OPPS APC 35.91 27.63 9.92 percent of total billed charges 35.91 35.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOOT CAST SLIMLINE SM SUP-35-00043 CDM 0271 RC outpatient 34.34 34.34 34.34 74 25.41 percent of total billed charges 34.34 93 27.82 percent of total billed charges 34.34 34.34 other OPPS APC 34.34 34.34 other OPPS APC 34.34 27.63 9.49 percent of total billed charges 34.34 34.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOOT CAST SLIMLINE MED SUP-35-00044 CDM 0271 RC outpatient 36.42 36.42 36.42 74 26.95 percent of total billed charges 36.42 93 29.5 percent of total billed charges 36.42 36.42 other OPPS APC 36.42 36.42 other OPPS APC 36.42 27.63 10.06 percent of total billed charges 36.42 36.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOOT CAST SLIMLINE LG SUP-35-00045 CDM 0271 RC outpatient 34.4 34.4 34.4 74 25.46 percent of total billed charges 34.4 93 27.86 percent of total billed charges 34.4 34.4 other OPPS APC 34.4 34.4 other OPPS APC 34.4 27.63 9.5 percent of total billed charges 34.4 34.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOOT CAST SLIMLINE XLG SUP-35-00046 CDM 0271 RC outpatient 59.7 59.7 59.7 74 44.18 percent of total billed charges 59.7 93 48.36 percent of total billed charges 59.7 59.7 other OPPS APC 59.7 59.7 other OPPS APC 59.7 27.63 16.5 percent of total billed charges 59.7 59.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE FRONT OFFLOADING SMALL SUP-35-00048 CDM 0271 RC outpatient 48.34 48.34 48.34 74 35.77 percent of total billed charges 48.34 93 39.16 percent of total billed charges 48.34 48.34 other OPPS APC 48.34 48.34 other OPPS APC 48.34 27.63 13.36 percent of total billed charges 48.34 48.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE FRONT OFFLOADING MEDIUM SUP-35-00049 CDM 0271 RC outpatient 47.08 47.08 47.08 74 34.84 percent of total billed charges 47.08 93 38.13 percent of total billed charges 47.08 47.08 other OPPS APC 47.08 47.08 other OPPS APC 47.08 27.63 13.01 percent of total billed charges 47.08 47.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE FRONT OFFLOADING LARGE SUP-35-00050 CDM 0271 RC outpatient 47.08 47.08 47.08 74 34.84 percent of total billed charges 47.08 93 38.13 percent of total billed charges 47.08 47.08 other OPPS APC 47.08 47.08 other OPPS APC 47.08 27.63 13.01 percent of total billed charges 47.08 47.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE FRONT OFFLOADING XL SUP-35-00051 CDM 0271 RC outpatient 47.08 47.08 47.08 74 34.84 percent of total billed charges 47.08 93 38.13 percent of total billed charges 47.08 47.08 other OPPS APC 47.08 47.08 other OPPS APC 47.08 27.63 13.01 percent of total billed charges 47.08 47.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE HEEL OFFLOADING SM SUP-35-00052 CDM 0271 RC outpatient 102.36 102.36 102.36 74 75.75 percent of total billed charges 102.36 93 82.91 percent of total billed charges 102.36 102.36 other OPPS APC 102.36 102.36 other OPPS APC 102.36 27.63 28.28 percent of total billed charges 102.36 102.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE HEEL OFFLOADING MED SUP-35-00053 CDM 0271 RC outpatient 96.64 96.64 96.64 74 71.51 percent of total billed charges 96.64 93 78.28 percent of total billed charges 96.64 96.64 other OPPS APC 96.64 96.64 other OPPS APC 96.64 27.63 26.7 percent of total billed charges 96.64 96.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE HEEL OFFLOADING LG SUP-35-00054 CDM 0271 RC outpatient 106.12 106.12 106.12 74 78.53 percent of total billed charges 106.12 93 85.96 percent of total billed charges 106.12 106.12 other OPPS APC 106.12 106.12 other OPPS APC 106.12 27.63 29.32 percent of total billed charges 106.12 106.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SALINE SMOOTH ROUND MODERATE PROFILE 200 PLUS 25CC SUP-350-1625 CDM 0270 RC outpatient 2.6 2.6 2.6 74 1.92 percent of total billed charges 2.6 93 2.11 percent of total billed charges 2.6 2.6 other OPPS APC 2.6 2.6 other OPPS APC 2.6 27.63 0.72 percent of total billed charges 2.6 2.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SALINE P3.7-4.2 CM MODERATE PROFILE ROUND OD11.7-12.3 CM 275-300 ML STYLE 1600 SMOOTH SUP-350-1640 CDM 0270 RC outpatient 1495 1495 1495 74 1106.3 percent of total billed charges 1495 93 1210.95 percent of total billed charges 1495 1495 other OPPS APC 1495 1495 other OPPS APC 1495 27.63 413.07 percent of total billed charges 1495 1495 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SALINE P3.9-4.7 CM MODERATE PROFILE ROUND OD12.6-13.3 CM 350-400 ML STYLE 1600 SMOOTH SUP-350-1655 CDM 0270 RC outpatient 858 858 858 74 634.92 percent of total billed charges 858 93 694.98 percent of total billed charges 858 858 other OPPS APC 858 858 other OPPS APC 858 27.63 237.07 percent of total billed charges 858 858 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST MAMMARY SALINE SMOOTH ROUND MODERATE PROFILE 425 TO 375CC SUP-350-1670 CDM 0270 RC outpatient 858 858 858 74 634.92 percent of total billed charges 858 93 694.98 percent of total billed charges 858 858 other OPPS APC 858 858 other OPPS APC 858 27.63 237.07 percent of total billed charges 858 858 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SALINE SMOOTH ROUND MODERATE PROFILE 475 TO 525CC SUP-350-1680 CDM 0270 RC outpatient 2.6 2.6 2.6 74 1.92 percent of total billed charges 2.6 93 2.11 percent of total billed charges 2.6 2.6 other OPPS APC 2.6 2.6 other OPPS APC 2.6 27.63 0.72 percent of total billed charges 2.6 2.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING ARTHROSCOPY FOR PUMP SUP-350-202-000 CDM 0270 RC outpatient 9.1 9.1 9.1 74 6.73 percent of total billed charges 9.1 93 7.37 percent of total billed charges 9.1 9.1 other OPPS APC 9.1 9.1 other OPPS APC 9.1 27.63 2.51 percent of total billed charges 9.1 9.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SALINE ROUND SMOOTH MODERATE PROFILE 325CC SUP-350-2325 CDM 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P3.5 CM ROUND MODERATE PLUS PROFILE MODERATE BASE OD11.7 CM 275 ML GEL SMOOTH SUP-350-2751 BC CDM 0270 RC outpatient 2483 2483 2483 74 1837.42 percent of total billed charges 2483 93 2011.23 percent of total billed charges 2483 2483 other OPPS APC 2483 2483 other OPPS APC 2483 27.63 686.05 percent of total billed charges 2483 2483 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MAMMARY GEL ROUND MINUS PLUS 50 12.3 X 3.7 275CC SUP-350-275S CDM 0270 RC outpatient 117 117 117 74 86.58 percent of total billed charges 117 93 94.77 percent of total billed charges 117 117 other OPPS APC 117 117 other OPPS APC 117 27.63 32.33 percent of total billed charges 117 117 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST GEL SMOOTH ROUND SILICONE MODERATE PROFILE PLUS 300CC SUP-350-3001BC CDM 0270 RC outpatient 2483 2483 2483 74 1837.42 percent of total billed charges 2483 93 2011.23 percent of total billed charges 2483 2483 other OPPS APC 2483 2483 other OPPS APC 2483 27.63 686.05 percent of total billed charges 2483 2483 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST P3.8 CM MODERATE PLUS PROFILE OD12.3 CM 325 ML SMOOTH SUP-350-3251 CDM 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SALINE SMOOTH ROUND HIGH PROFILE 460CC SUP-350-3460 CDM 0270 RC outpatient 2.6 2.6 2.6 74 1.92 percent of total billed charges 2.6 93 2.11 percent of total billed charges 2.6 2.6 other OPPS APC 2.6 2.6 other OPPS APC 2.6 27.63 0.72 percent of total billed charges 2.6 2.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST MEMORYGEL SILICONE P4.8 CM HIGH PROFILE ROUND NARROW BASE OD11.7 CM 350 ML GEL SMOOTH STERILE SUP-350-3504 BC CDM 0270 RC outpatient 2548 2548 2548 74 1885.52 percent of total billed charges 2548 93 2063.88 percent of total billed charges 2548 2548 other OPPS APC 2548 2548 other OPPS APC 2548 27.63 704.01 percent of total billed charges 2548 2548 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P4 CM ROUND MODERATE PLUS PROFILE MODERATE BASE OD12.8 CM 375 ML GEL SMOOTH SUP-350-3751 BC CDM 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST MEMORYGEL SILICONE P5 CM HIGH PROFILE ROUND NARROW BASE OD12.2 CM 400 ML GEL SMOOTH SUP-350-4004 BC CDM 0270 RC outpatient 2548 2548 2548 74 1885.52 percent of total billed charges 2548 93 2063.88 percent of total billed charges 2548 2548 other OPPS APC 2548 2548 other OPPS APC 2548 27.63 704.01 percent of total billed charges 2548 2548 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST COHESIVE I MEMORYGEL SILICONE P5 CM MODERATE PLUS HIGH PROFILE ROUND OD12.5 CM 425 ML SHELL BARRIER LAYER GEL STERILE SUP-350-4254BC CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE RADOVAN P4.3CM 14.6X7.5CM 200ML SALINE BREAST SMOOTH CRESCENT SUP-350-4314M CDM 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT HIGH PROFILE GEL 450CC SUP-350-4504 BC CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST MEMORYGEL SILICONE P5.3 CM HIGH PROFILE ROUND OD13 CM 475 ML GEL SMOOTH SURFACE SHELL BARRIER LAYER STERILE SUP-350-4754 CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST MEMORYGEL SILICONE P5.3 CM HIGH PROFILE ROUND NARROW BASE OD13.2 CM 500 ML GEL SMOOTH SUP-350-5004 BC CDM 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST MEMORYGEL COHESIVE I SILICONE P5.5 CM HIGH PROFILE ROUND OD13.6 CM 550 ML SMOOTH SUP-350-5504 BC CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST GEL ULTRA HIGH PROFILE 535CC SUP-350-5535 CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET TUBING ARTHROSCOPY PUMP INTEGRATED FLOCONTROL DISPOSABLE SUP-350-600-006 CDM 0270 RC outpatient 180.7 180.7 180.7 74 133.72 percent of total billed charges 180.7 93 146.37 percent of total billed charges 180.7 180.7 other OPPS APC 180.7 180.7 other OPPS APC 180.7 27.63 49.93 percent of total billed charges 180.7 180.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST MEMORYGEL SILICONE P5.6 CM HIGH PROFILE ROUND NARROW BASE OD14 CM 600 ML GEL SMOOTH SUP-350-6004 BC CDM 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST GEL HIGH PROFILE SMOOTH ROUND 700CC SUP-350-7004 BC CDM 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST MAMMARY SILICONE GEL ROUND SMOOTH MODERATE PROFILE 300CC SUP-350-7300 BC CDM 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILICONE GEL MODERATE PROFILE SMOOTH ROUND 400CC SUP-350-7400BC CDM 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREASTSILICONE GEL MODERATE PROFILE SMOOTH ROUND 500CC SUP-350-7500BC CDM 0270 RC outpatient 2535 2535 2535 74 1875.9 percent of total billed charges 2535 93 2053.35 percent of total billed charges 2535 2535 other OPPS APC 2535 2535 other OPPS APC 2535 27.63 700.42 percent of total billed charges 2535 2535 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE LARYNGOSCOPE MCGRATH MACINTOSH POLYMER 3 SLIM FOG FREE STERILE DISPOSABLE SUP-350005000_68713 CDM 0270 RC outpatient 38.13 38.13 38.13 74 28.22 percent of total billed charges 38.13 93 30.89 percent of total billed charges 38.13 38.13 other OPPS APC 38.13 38.13 other OPPS APC 38.13 27.63 10.54 percent of total billed charges 38.13 38.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE LARYNGOSCOPE MCGRATH MACINTOSH POLYMER 4 SLIM FOG FREE STERILE DISPOSABLE SUP-350013000_68714 CDM 0270 RC outpatient 38.13 38.13 38.13 74 28.22 percent of total billed charges 38.13 93 30.89 percent of total billed charges 38.13 38.13 other OPPS APC 38.13 38.13 other OPPS APC 38.13 27.63 10.54 percent of total billed charges 38.13 38.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE SQ EMBLEM S-ICD SUP-3501 CDM 0275 RC outpatient 10400 10400 10400 57 5928 percent of total billed charges 10400 93 8424 percent of total billed charges 10400 10400 other OPPS APC 10400 10400 other OPPS APC 10400 51 5304 percent of total billed charges 10400 10400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST COHESIVE I MEMORYGEL SILICONE P4.8 CM HIGH PROFILE ROUND OD12 CM 375 ML GEL SMOOTH SURFACE SHELL BARRIER LAYER STERILE SUP-3503754 BC CDM 0270 RC outpatient 2548 2548 2548 74 1885.52 percent of total billed charges 2548 93 2063.88 percent of total billed charges 2548 2548 other OPPS APC 2548 2548 other OPPS APC 2548 27.63 704.01 percent of total billed charges 2548 2548 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT FRACTURE STABILIT COMPLETE SINGLE LEVEL LONG SUP-3506-01 CDM 0270 RC outpatient 5409.95 5409.95 5409.95 74 4003.36 percent of total billed charges 5409.95 93 4382.06 percent of total billed charges 5409.95 5409.95 other OPPS APC 5409.95 5409.95 other OPPS APC 5409.95 27.63 1494.77 percent of total billed charges 5409.95 5409.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST COHESIVE I MEMORYGEL SILICONE P5.7 CM MODERATE PLUS HIGH PROFILE ROUND OD14.4 CM 650 ML SHELL BARRIER LAYER GEL STERILE SUP-3506504 BC CDM 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST MEMORYGEL SILICONE P3.6 CM MODERATE PROFILE OD15.9 CM 550 ML GEL ROUND SMOOTH SUP-3507550 BC CDM 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT FLUID TRANSFER SPIKE L48 IN 60 ML 2 CHECK VALVE LUER CONNECTOR SYRINGE ASEPTIC STERILE DISPOSABLE TISSUE EXPANDER SUP-3508400 CDM 0270 RC outpatient 49.83 49.83 49.83 74 36.87 percent of total billed charges 49.83 93 40.36 percent of total billed charges 49.83 49.83 other OPPS APC 49.83 49.83 other OPPS APC 49.83 27.63 13.77 percent of total billed charges 49.83 49.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR TUBING PLASTIC 5 IN 1 CLEAN LIGHTWEIGHT AUTOCLAVABLE NONSTERILE LATEX FREE SUP-350A CDM 0270 RC outpatient 2.15 2.15 2.15 74 1.59 percent of total billed charges 2.15 93 1.74 percent of total billed charges 2.15 2.15 other OPPS APC 2.15 2.15 other OPPS APC 2.15 27.63 0.59 percent of total billed charges 2.15 2.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIZER IMPLANT MEMORYGEL SILTEX SALINE P5.3 CM HIGH PROJECTION CONTOUR PROFILE W12.3 CM X H10.5 CM 350-400 ML BREAST 2 WAY CHECK VALVE SMOOTH INTEGRAL FILL TUBE LUER ADAPTER STERILE DISPOSABLE SUP-351-0712SZ CDM 0270 RC outpatient 117 117 117 74 86.58 percent of total billed charges 117 93 94.77 percent of total billed charges 117 117 other OPPS APC 117 117 other OPPS APC 117 27.63 32.33 percent of total billed charges 117 117 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 300MM 13MM NS CANNULATED SUP-351.27 CDM 270010022 LOCAL 0270 RC outpatient 1521.52 1521.52 1521.52 74 1125.92 percent of total billed charges 1521.52 93 1232.43 percent of total billed charges 1521.52 1521.52 other OPPS APC 1521.52 1521.52 other OPPS APC 1521.52 27.63 420.4 percent of total billed charges 1521.52 1521.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD REAMING L950 MM OD2.5 MM BALL TIP STERILE DISPOSABLE SUP-351.706S CDM 270010022 LOCAL 0270 RC outpatient 678.47 678.47 678.47 74 502.07 percent of total billed charges 678.47 93 549.56 percent of total billed charges 678.47 678.47 other OPPS APC 678.47 678.47 other OPPS APC 678.47 27.63 187.46 percent of total billed charges 678.47 678.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD REAMING L950 MM OD2.5 MM BALL TIP EXTENSION STERILE DISPOSABLE INTRAMEDULLARY NAIL SUP-351.707S CDM 270010022 LOCAL 0270 RC outpatient 328.9 328.9 328.9 74 243.39 percent of total billed charges 328.9 93 266.41 percent of total billed charges 328.9 328.9 other OPPS APC 328.9 328.9 other OPPS APC 328.9 27.63 90.88 percent of total billed charges 328.9 328.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD REAMING L1150 MM OD2.5 MM BALL TIP STERILE SUP-351.708S CDM 0270 RC outpatient 819.91 819.91 819.91 74 606.73 percent of total billed charges 819.91 93 664.13 percent of total billed charges 819.91 819.91 other OPPS APC 819.91 819.91 other OPPS APC 819.91 27.63 226.54 percent of total billed charges 819.91 819.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD REAMING L950 MM OD3 MM OFFSET BALL TIP STERILE INTRAMEDULLARY NAIL SUP-351.71S CDM 270010022 LOCAL 0270 RC outpatient 497.64 497.64 497.64 74 368.25 percent of total billed charges 497.64 93 403.09 percent of total billed charges 497.64 497.64 other OPPS APC 497.64 497.64 other OPPS APC 497.64 27.63 137.5 percent of total billed charges 497.64 497.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD REAMING 950MM 3MM STERILE STRAIGHT BALL TIP EXPERT NAIL SYSTEM SUP-351.76S CDM 270010022 LOCAL 0270 RC outpatient 1023.23 1023.23 1023.23 74 757.19 percent of total billed charges 1023.23 93 828.82 percent of total billed charges 1023.23 1023.23 other OPPS APC 1023.23 1023.23 other OPPS APC 1023.23 27.63 282.72 percent of total billed charges 1023.23 1023.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIZER IMPLANT MEMORYGEL SILTEX SALINE P5.9-7.4 CM HIGH PROFILE ROUND OD13.4-13.8 CM 630-750 ML BREAST STYLE 3000 SMOOTH SURFACE SHELL ANTERIOR DIAPHRAGM VALVE REINFORCE FILL TUBE STERILE DISPOSABLE SUP-3513630SZ CDM 0270 RC outpatient 117 117 117 74 86.58 percent of total billed charges 117 93 94.77 percent of total billed charges 117 117 other OPPS APC 117 117 other OPPS APC 117 27.63 32.33 percent of total billed charges 117 117 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR VISIONWIRE STERILE LATEX FREE DISPOSABLE SUP-352023_72343 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEUROSTIMULATOR VERIFT EXTERNAL SUP-353101 CDM 0270 RC outpatient 971.88 971.88 971.88 74 719.19 percent of total billed charges 971.88 93 787.22 percent of total billed charges 971.88 971.88 other OPPS APC 971.88 971.88 other OPPS APC 971.88 27.63 268.53 percent of total billed charges 971.88 971.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR TUBING PLASTIC OD1/4 IN STRAIGHT LIGHTWEIGHT AUTOCLAVABLE TRANSPARENT NONSTERILE LATEX FREE SUP-353A CDM outpatient 1.16 1.16 1.16 1.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILTEX SPECTRUM SALINE P6.1-7.5 CM ROUND CONTOUR PROFILE W12.7-13.2 CM X H11 CM 380-540 ML POSTERIOR VALVE PREPLACE FILL TUBE REMOTE INJECTION DOME POSTOPERATIVE ADJUSTABLE STERILE SUP-354-2513 CDM 0270 RC outpatient 2990 2990 2990 74 2212.6 percent of total billed charges 2990 93 2421.9 percent of total billed charges 2990 2990 other OPPS APC 2990 2990 other OPPS APC 2990 27.63 826.14 percent of total billed charges 2990 2990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILTEX P6.1 CM CONTOUR PROFILE HIGH PROFILE W13.2 CM X H11 CM 450-500 ML STYLE 2700 TEXTURED ANTERIOR DIAPHRAGM VALVE POSTERIOR ORIENTATION TAB SELF SEALING STERILE SUP-354-2713 CDM 0270 RC outpatient 2145 2145 2145 74 1587.3 percent of total billed charges 2145 93 1737.45 percent of total billed charges 2145 2145 other OPPS APC 2145 2145 other OPPS APC 2145 27.63 592.66 percent of total billed charges 2145 2145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILTEX SALINE P6.6 CM CONTOUR PROFILE HIGH PROJECTION W15 CM X H12.7 CM 650-725 ML TEXTURED SELF SEALING DIAPHRAGM VALVE SUP-354-2715 CDM 0270 RC outpatient 2145 2145 2145 74 1587.3 percent of total billed charges 2145 93 1737.45 percent of total billed charges 2145 2145 other OPPS APC 2145 2145 other OPPS APC 2145 27.63 592.66 percent of total billed charges 2145 2145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILTEX SALINE P4.5 CM CONTOUR PROFILE MODERATE PROJECTION WIDE BASE W11.2 CM X H9.4 CM 225-250 ML SUP-354-2911 CDM 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILTEX SALINE P4.5 CM CONTOUR PROFILE MODERATE PROJECTION WIDE BASE W12.2 CM X H10.3 CM 275-300 ML SUP-354-2912 CDM 0270 RC outpatient 2015 2015 2015 74 1491.1 percent of total billed charges 2015 93 1632.15 percent of total billed charges 2015 2015 other OPPS APC 2015 2015 other OPPS APC 2015 27.63 556.74 percent of total billed charges 2015 2015 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST MEMORYGEL SILTEX SALINE P3.7 CM ROUND MODERATE PROFILE OD13.4 CM 350 ML TEXTURE STERILE SUP-354-3507 CDM 0270 RC outpatient 2.6 2.6 2.6 74 1.92 percent of total billed charges 2.6 93 2.11 percent of total billed charges 2.6 2.6 other OPPS APC 2.6 2.6 other OPPS APC 2.6 27.63 0.72 percent of total billed charges 2.6 2.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILTEX SILICONE P5.2 CM HIGH PROFILE ROUND OD12.7 CM 450 ML GEL TEXTURED SUP-354-4450 CDM 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST MEMORYGEL SILTEX P5.7 CM HIGH PROFILE ROUND OD14 CM 600 ML GEL SHELL BARRIER LAYER STERILE SUP-354-4600 CDM 0270 RC outpatient 2535 2535 2535 74 1875.9 percent of total billed charges 2535 93 2053.35 percent of total billed charges 2535 2535 other OPPS APC 2535 2535 other OPPS APC 2535 27.63 700.42 percent of total billed charges 2535 2535 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILTEX SILICONE P6 CM HIGH PROFILE ROUND OD14.7 CM 700 ML GEL TEXTURED SUP-354-4700 CDM 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SILTEX SILICONE P6.3 CM ROUND HIGH PROFILE OD15.4 CM 800 CC GEL TEXTURE SUP-354-4800 CDM 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE SILTEX CPX2 P6.5 CM LOW HEIGHT CONTOUR PROFILE W12.7 CM X H9.4 CM 350 ML BREAST STYLE 6100 LOW HEIGHT CENTERSCOPE INJECTION DOME SELF SEALING SUP-354-6112 CDM 0270 RC outpatient 3705 3705 3705 74 2741.7 percent of total billed charges 3705 93 3001.05 percent of total billed charges 3705 3705 other OPPS APC 3705 3705 other OPPS APC 3705 27.63 1023.69 percent of total billed charges 3705 3705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE SILTEX CPX2 P7.1 CM CONTOUR PROFILE W14 CM X H10.2 CM 450 ML BREAST STYLE 6100 LOW HEIGHT CENTERSCOPE INJECTION DOME SELF SEALING STERILE DISPOSABLE SUP-354-6113 CDM 0270 RC outpatient 3705 3705 3705 74 2741.7 percent of total billed charges 3705 93 3001.05 percent of total billed charges 3705 3705 other OPPS APC 3705 3705 other OPPS APC 3705 27.63 1023.69 percent of total billed charges 3705 3705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE SILTEX CPX2 P7.9 CM CONTOUR PROFILE W15.7 CM X H11.2 CM 650 ML BREAST STYLE 6100 LOW HEIGHT CENTERSCOPE INJECTION DOME SELF SEALING SUP-354-6115 CDM 0270 RC outpatient 3822 3822 3822 74 2828.28 percent of total billed charges 3822 93 3095.82 percent of total billed charges 3822 3822 other OPPS APC 3822 3822 other OPPS APC 3822 27.63 1056.02 percent of total billed charges 3822 3822 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE CPX2 P8.1 CM CONTOUR PROFILE W16.5 CM X H11.9 CM 750 ML BREAST STYLE 6100 LOW HEIGHT CENTERSCOPE INJECTION DOME SELF SEALING SUP-354-6116 CDM 0270 RC outpatient 3445 3445 3445 74 2549.3 percent of total billed charges 3445 93 2790.45 percent of total billed charges 3445 3445 other OPPS APC 3445 3445 other OPPS APC 3445 27.63 951.85 percent of total billed charges 3445 3445 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE CONTOUR PROFILE SILTEX CPX2 P6.6 CM MEDIUM W11.7 CM X H10 CM 350 ML BREAST STYLE 6200 CENTERSCOPE INJECTION DOME SELF SEAL STERILE DISPOSABLE SUP-354-6212 CDM 0270 RC outpatient 2.6 2.6 2.6 74 1.92 percent of total billed charges 2.6 93 2.11 percent of total billed charges 2.6 2.6 other OPPS APC 2.6 2.6 other OPPS APC 2.6 27.63 0.72 percent of total billed charges 2.6 2.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE CONTOUR PROFILE SILTEX CPX2 P7 CM MEDIUM W12.7 CM X H10.8 CM 450 ML BREAST STYLE 6200 CENTERSCOPE INJECTION DOME SELF SEAL STERILE DISPOSABLE SUP-354-6213 CDM 0270 RC outpatient 3705 3705 3705 74 2741.7 percent of total billed charges 3705 93 3001.05 percent of total billed charges 3705 3705 other OPPS APC 3705 3705 other OPPS APC 3705 27.63 1023.69 percent of total billed charges 3705 3705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE SILTEX CPX2 P7.4 CM CONTOUR PROFILE W13.5 CM X H11.7 CM 550 ML BREAST STYLE 6200 MEDIUM HEIGHT CENTERSCOPE INJECTION DOME SELF SEALING STERILE DISPOSABLE SUP-354-6214 CDM 0270 RC outpatient 3705 3705 3705 74 2741.7 percent of total billed charges 3705 93 3001.05 percent of total billed charges 3705 3705 other OPPS APC 3705 3705 other OPPS APC 3705 27.63 1023.69 percent of total billed charges 3705 3705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE SILTEX CPX2 P7.6 CM CONTOUR PROFILE W14.6 CM X H12.6 CM 650 ML BREAST STYLE 6200 MEDIUM HEIGHT CENTERSCOPE INJECTION DOME SELF SEALING SUP-354-6215 CDM 0270 RC outpatient 3705 3705 3705 74 2741.7 percent of total billed charges 3705 93 3001.05 percent of total billed charges 3705 3705 other OPPS APC 3705 3705 other OPPS APC 3705 27.63 1023.69 percent of total billed charges 3705 3705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE SILTEX CPX2 P6.5 CM CONTOUR PROFILE W12.3 CM X H12.9 CM 450 ML BREAST STYLE 6300 TALL HEIGHT CENTERSCOPE INJECTION DOME SELF SEALING SUP-354-6313 CDM 0270 RC outpatient 3575 3575 3575 74 2645.5 percent of total billed charges 3575 93 2895.75 percent of total billed charges 3575 3575 other OPPS APC 3575 3575 other OPPS APC 3575 27.63 987.77 percent of total billed charges 3575 3575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE SILTEX CPX2 P7.3 CM CONTOUR PROFILE W14 CM X H14.6 CM 650 ML BREAST STYLE 6300 TALL HEIGHT CENTERSCOPE INJECTION DOME SELF SEALING SUP-354-6315 CDM 0270 RC outpatient 3575 3575 3575 74 2645.5 percent of total billed charges 3575 93 2895.75 percent of total billed charges 3575 3575 other OPPS APC 3575 3575 other OPPS APC 3575 27.63 987.77 percent of total billed charges 3575 3575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE SILTEX P7.6 CM CONTOUR PROFILE TALL HEIGHT W14.6 CM X H15.3 CM OD21 GA 750 ML BREAST STYLE 6300 TEXTURED NEEDLE CENTERSCOPE REINFORCED SUP-354-6316 CDM 0270 RC outpatient 3705 3705 3705 74 2741.7 percent of total billed charges 3705 93 3001.05 percent of total billed charges 3705 3705 other OPPS APC 3705 3705 other OPPS APC 3705 27.63 1023.69 percent of total billed charges 3705 3705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE SILTEX CPX3 P7.4 CM CONTOUR PROFILE W15 CM X H10.9 CM 550 ML BREAST STYLE 7100 LOW HEIGHT CENTERSCOPE INJECTION DOME SELF SEALING STERILE DISPOSABLE SUP-354-7114 CDM 0270 RC outpatient 3315 3315 3315 74 2453.1 percent of total billed charges 3315 93 2685.15 percent of total billed charges 3315 3315 other OPPS APC 3315 3315 other OPPS APC 3315 27.63 915.93 percent of total billed charges 3315 3315 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE SILTEX CPX3 P6.6 CM MEDIUM CONTOUR PROFILE W11.7 CM X H10 CM 350 ML BREAST STYLE 7200 CENTERSCOPE INJECTION DOME SELF SEAL STERILE DISPOSABLE SUP-354-7212 CDM 0270 RC outpatient 4095 4095 4095 74 3030.3 percent of total billed charges 4095 93 3316.95 percent of total billed charges 4095 4095 other OPPS APC 4095 4095 other OPPS APC 4095 27.63 1131.45 percent of total billed charges 4095 4095 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE SILTEX CONTOUR PROFILE CPX3 P7 CM MEDIUM HEIGHT W12.7 CM X H10.8 CM 450 CC BREAST STYLE 7200 INJECTION DOME SELF SEAL STERILE DISPOSABLE SUP-354-7213 CDM 0270 RC outpatient 4147 4147 4147 74 3068.78 percent of total billed charges 4147 93 3359.07 percent of total billed charges 4147 4147 other OPPS APC 4147 4147 other OPPS APC 4147 27.63 1145.82 percent of total billed charges 4147 4147 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE SILTEX CPX3 P7.4 CM MEDIUM CONTOUR PROFILE W13.5 CM X H11.7 CM 550 ML BREAST STYLE 7200 CENTERSCOPE INJECTION DOME SELF SEAL STERILE DISPOSABLE SUP-354-7214 CDM 0270 RC outpatient 3315 3315 3315 74 2453.1 percent of total billed charges 3315 93 2685.15 percent of total billed charges 3315 3315 other OPPS APC 3315 3315 other OPPS APC 3315 27.63 915.93 percent of total billed charges 3315 3315 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE SILTEX CONTOUR PROFILE CPX3 P7.6 CM MEDIUM HEIGHT W14.6 CM X H12.6 CM 650 CC BREAST STYLE 7200 INJECTION DOME SELF SEAL STERILE DISPOSABLE SUP-354-7215 CDM 0270 RC outpatient 3315 3315 3315 74 2453.1 percent of total billed charges 3315 93 2685.15 percent of total billed charges 3315 3315 other OPPS APC 3315 3315 other OPPS APC 3315 27.63 915.93 percent of total billed charges 3315 3315 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE SILTEX CONTOUR PROFILE CPX3 P8 CM MEDIUM HEIGHT W15.6 CM X H13.3 CM 800 CC BREAST STYLE 7200 INJECTION DOME SELF SEAL STERILE DISPOSABLE SUP-354-7216 CDM 0270 RC outpatient 4147 4147 4147 74 3068.78 percent of total billed charges 4147 93 3359.07 percent of total billed charges 4147 4147 other OPPS APC 4147 4147 other OPPS APC 4147 27.63 1145.82 percent of total billed charges 4147 4147 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE CPX4 SILTEX P6.5 CM CONTOUR PROFILE LOW HEIGHT W12.7 CM X H9.4 CM 350 ML BREAST STYLE 9100 TEXTURED SELF SEALING PATCH FLEXIBLE SUTURE TAB SUP-354-9112 CDM 0270 RC outpatient 3575 3575 3575 74 2645.5 percent of total billed charges 3575 93 2895.75 percent of total billed charges 3575 3575 other OPPS APC 3575 3575 other OPPS APC 3575 27.63 987.77 percent of total billed charges 3575 3575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE CPX4 SILTEX P7.1 CM CONTOUR PROFILE LOW HEIGHT W14 CM X H7.1 CM 450 ML BREAST STYLE 9100 TEXTURED SELF SEALING PATCH FLEXIBLE SUTURE TAB SUP-354-9113 CDM 0270 RC outpatient 3575 3575 3575 74 2645.5 percent of total billed charges 3575 93 2895.75 percent of total billed charges 3575 3575 other OPPS APC 3575 3575 other OPPS APC 3575 27.63 987.77 percent of total billed charges 3575 3575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE CPX4 SILTEX P7.4 CM CONTOUR PROFILE MEDIUM HEIGHT W13.5 CM X H11.7 CM 550 ML BREAST STYLE 9200 TEXTURED SELF SEALING PATCH FLEXIBLE SUTURE TAB SUP-354-9214 CDM 0270 RC outpatient 3575 3575 3575 74 2645.5 percent of total billed charges 3575 93 2895.75 percent of total billed charges 3575 3575 other OPPS APC 3575 3575 other OPPS APC 3575 27.63 987.77 percent of total billed charges 3575 3575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE CPX4 SILTEX P7.6 CM CONTOUR PROFILE MEDIUM HEIGHT W14.6 CM X H12.6 CM 650 ML BREAST STYLE 9200 TEXTURED SELF SEALING PATCH FLEXIBLE SUTURE TAB SUP-354-9215 CDM 0270 RC outpatient 3575 3575 3575 74 2645.5 percent of total billed charges 3575 93 2895.75 percent of total billed charges 3575 3575 other OPPS APC 3575 3575 other OPPS APC 3575 27.63 987.77 percent of total billed charges 3575 3575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST MEMORYGEL SILTEX P5.4 CM HIGH PROFILE ROUND OD13.2 CM 500 ML GEL SHELL BARRIER LAYER STERILE SUP-3544500 CDM 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE CPX2 SILTEX P8 CM TALL HEIGHT W13.2 CM X H13.8 CM 550 ML STYLE 6300 SELF SEALING TECHNOLOGY CENTERSCOPE DACRON PATCH BUFFERZONE STERILE SUP-3546314 CDM 0270 RC outpatient 3575 3575 3575 74 2645.5 percent of total billed charges 3575 93 2895.75 percent of total billed charges 3575 3575 other OPPS APC 3575 3575 other OPPS APC 3575 27.63 987.77 percent of total billed charges 3575 3575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ORTHOPEDIC MEDULLARY NONSTERILE SUP-355.006 CDM 270010022 LOCAL 0270 RC outpatient 203.06 203.06 203.06 74 150.26 percent of total billed charges 203.06 93 164.48 percent of total billed charges 203.06 203.06 other OPPS APC 203.06 203.06 other OPPS APC 203.06 27.63 56.11 percent of total billed charges 203.06 203.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ORTHOPEDIC MEDULLA SUP-355.01 CDM 270010022 LOCAL 0270 RC outpatient 229.32 229.32 229.32 74 169.7 percent of total billed charges 229.32 93 185.75 percent of total billed charges 229.32 229.32 other OPPS APC 229.32 229.32 other OPPS APC 229.32 27.63 63.36 percent of total billed charges 229.32 229.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE ROD ORTHOPEDIC 950MM 3MM STERILE SMOOTH TIP DISTAL FEMORAL NAIL SYSTEM SUP-355.041S CDM 270010022 LOCAL 0270 RC outpatient 497.64 497.64 497.64 74 368.25 percent of total billed charges 497.64 93 403.09 percent of total billed charges 497.64 497.64 other OPPS APC 497.64 497.64 other OPPS APC 497.64 27.63 137.5 percent of total billed charges 497.64 497.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOOK EXTRACTION L650 MM STERILE CANNULATED INTRAMEDULLARY NAIL SUP-355.399S CDM 0270 RC outpatient 1346.7 1346.7 1346.7 74 996.56 percent of total billed charges 1346.7 93 1090.83 percent of total billed charges 1346.7 1346.7 other OPPS APC 1346.7 1346.7 other OPPS APC 1346.7 27.63 372.09 percent of total billed charges 1346.7 1346.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT NEUROSTIMULATOR INTERSTIM L3.5 IN LEAD INTRODUCER NEEDLE DILATOR GROUND PAD LONG TEST CABLE SUP-3550-18 CDM 0270 RC outpatient 728 728 728 74 538.72 percent of total billed charges 728 93 589.68 percent of total billed charges 728 728 other OPPS APC 728 728 other OPPS APC 728 27.63 201.15 percent of total billed charges 728 728 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 3 FLUTE 215MM 80MM 3.2MM NS CALIBRATED QUICK COUPLING SUP-356.97 CDM 270010022 LOCAL 0270 RC outpatient 600.6 600.6 600.6 74 444.44 percent of total billed charges 600.6 93 486.49 percent of total billed charges 600.6 600.6 other OPPS APC 600.6 600.6 other OPPS APC 600.6 27.63 165.95 percent of total billed charges 600.6 600.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 3 FLUTE 270MM 95MM 4MM NS CALIBRATED QUICK COUPLING SUP-356.98 CDM 270010022 LOCAL 0270 RC outpatient 699.27 699.27 699.27 74 517.46 percent of total billed charges 699.27 93 566.41 percent of total billed charges 699.27 699.27 other OPPS APC 699.27 699.27 other OPPS APC 699.27 27.63 193.21 percent of total billed charges 699.27 699.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L215 MM L80 MM OD4 MM 3 FLUTED CALIBRATED QUICK COUPLING NONSTERILE SUP-356.982 CDM 270010022 LOCAL 0270 RC outpatient 679.25 679.25 679.25 74 502.65 percent of total billed charges 679.25 93 550.19 percent of total billed charges 679.25 679.25 other OPPS APC 679.25 679.25 other OPPS APC 679.25 27.63 187.68 percent of total billed charges 679.25 679.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT NEUROSTIMULATOR INTERSTIM L100 CM PERCUTANEOUS ELECTRODE INSULATED STERILE DISPOSABLE SUP-3560022 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE NEUROSTIMULATOR INTERSTIM L100 CM 2.16MM SPACING STERILE DISPOSABLE SUP-3560030 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT NEUROSURGICAL INTERSTIM PROCEDURE SUPPLIES DISPOSABLE SUP-3560031 CDM 0270 RC outpatient 1027 1027 1027 74 759.98 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 27.63 283.76 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 3 FLUTE L330 MM L100 MM OD5 MM CALIBRATED QUICK COUPLING NONSTERILE SUP-357.099 CDM 270010022 LOCAL 0270 RC outpatient 858 858 858 74 634.92 percent of total billed charges 858 93 694.98 percent of total billed charges 858 858 other OPPS APC 858 858 other OPPS APC 858 27.63 237.07 percent of total billed charges 858 858 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EXTERNAL FIXATION COUPLING HELICAL BLADE NONSTERILE SUP-357.377 CDM 0270 RC outpatient 2748.46 2748.46 2748.46 74 2033.86 percent of total billed charges 2748.46 93 2226.25 percent of total billed charges 2748.46 2748.46 other OPPS APC 2748.46 2748.46 other OPPS APC 2748.46 27.63 759.4 percent of total billed charges 2748.46 2748.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE SURGICAL 222MM 3.2MM 11MM NS WIRE SUP-357.381 CDM 270010013 LOCAL 0270 RC outpatient 1474.33 1474.33 1474.33 74 1091 percent of total billed charges 1474.33 93 1194.21 percent of total billed charges 1474.33 1474.33 other OPPS APC 1474.33 1474.33 other OPPS APC 1474.33 27.63 407.36 percent of total billed charges 1474.33 1474.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE SURGICAL 161MM 3.2MM 17MM NS WIRE SUP-357.392 CDM 270010022 LOCAL 0270 RC outpatient 1195.48 1195.48 1195.48 74 884.66 percent of total billed charges 1195.48 93 968.34 percent of total billed charges 1195.48 1195.48 other OPPS APC 1195.48 1195.48 other OPPS APC 1195.48 27.63 330.31 percent of total billed charges 1195.48 1195.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC L400 MM OD3.2 MM TIBIA THREAD NONSTERILE SUP-357.399 CDM 270010022 LOCAL 0270 RC outpatient 532.61 532.61 532.61 74 394.13 percent of total billed charges 532.61 93 431.41 percent of total billed charges 532.61 532.61 other OPPS APC 532.61 532.61 other OPPS APC 532.61 27.63 147.16 percent of total billed charges 532.61 532.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L260 MM L65 MM OD4 MM 3 FLUTED QUICK COUPLING CALIBRATED SUP-357.407 CDM 270010022 LOCAL 0270 RC outpatient 537.68 537.68 537.68 74 397.88 percent of total billed charges 537.68 93 435.52 percent of total billed charges 537.68 537.68 other OPPS APC 537.68 537.68 other OPPS APC 537.68 27.63 148.56 percent of total billed charges 537.68 537.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE SURGICAL L198 MM OD5.6-3.2 MM DRILL SUP-357.413 CDM 270010013 LOCAL 0270 RC outpatient 674.96 674.96 674.96 74 499.47 percent of total billed charges 674.96 93 546.72 percent of total billed charges 674.96 674.96 other OPPS APC 674.96 674.96 other OPPS APC 674.96 27.63 186.49 percent of total billed charges 674.96 674.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE VERIFT TEST SIMULATION SUP-3575 CDM 0270 RC outpatient 104 104 104 74 76.96 percent of total billed charges 104 93 84.24 percent of total billed charges 104 104 other OPPS APC 104 104 other OPPS APC 104 27.63 28.74 percent of total billed charges 104 104 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE VERIFY TEST STIMULATION CABLE SUP-357501 CDM 0270 RC outpatient 104 104 104 74 76.96 percent of total billed charges 104 93 84.24 percent of total billed charges 104 104 other OPPS APC 104 104 other OPPS APC 104 27.63 28.74 percent of total billed charges 104 104 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE VERIFY TWIST LOCK SUP-357625 CDM 0270 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 27.63 57.47 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR TUBING SUCTION Y TYPE NON STERILE PLASTIC 1/4IN SUP-358A CDM outpatient 3.13 3.13 3.13 3.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR TUBING MEDI-VAC PLASTIC Y OD3/8 IN LIGHTWEIGHT AUTOCLAVABLE TRANSPARENT SHATTER RESISTANT NONSTERILE LATEX SUP-359 CDM outpatient 3.47 3.47 3.47 3.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD REAMING TITANIUM L850 MM OD2.5 MM CALIBRATED STERILE SUP-359.083S CDM 270010022 LOCAL 0270 RC outpatient 461.89 461.89 461.89 74 341.8 percent of total billed charges 461.89 93 374.13 percent of total billed charges 461.89 461.89 other OPPS APC 461.89 461.89 other OPPS APC 461.89 27.63 127.62 percent of total billed charges 461.89 461.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPHINCTEROTOME ENDOSCOPIC ULTRATOME XL L5 MM L200 CM L5 MM OD5.5 FR BILIARY PANCREAS 3 LUMEN CUT WIRE SHORT NOSE STERILE DISPOSABLE ACCEPTS .035 IN DREAMWIRE SUP-3590 CDM 0270 RC outpatient 373.02 373.02 373.02 74 276.03 percent of total billed charges 373.02 93 302.15 percent of total billed charges 373.02 373.02 other OPPS APC 373.02 373.02 other OPPS APC 373.02 27.63 103.07 percent of total billed charges 373.02 373.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCISSORS SURGICAL IRIS L4.5 IN STRAIGHT MATTE SUP-359100 CDM 0270 RC outpatient 23.04 23.04 23.04 74 17.05 percent of total billed charges 23.04 93 18.66 percent of total billed charges 23.04 23.04 other OPPS APC 23.04 23.04 other OPPS APC 23.04 27.63 6.37 percent of total billed charges 23.04 23.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMOBILE SHOULDER MAN/LARGE SUP-36-00001 CDM 0271 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMOBILE SHOULDER MAN/MEDIUM SUP-36-00002 CDM 0271 RC outpatient 21.16 21.16 21.16 74 15.66 percent of total billed charges 21.16 93 17.14 percent of total billed charges 21.16 21.16 other OPPS APC 21.16 21.16 other OPPS APC 21.16 27.63 5.85 percent of total billed charges 21.16 21.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMOBILE SHOULDER WOMAN/LG SUP-36-00004 CDM 0271 RC outpatient 23.38 23.38 23.38 74 17.3 percent of total billed charges 23.38 93 18.94 percent of total billed charges 23.38 23.38 other OPPS APC 23.38 23.38 other OPPS APC 23.38 27.63 6.46 percent of total billed charges 23.38 23.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMOBILE SHOULDER WOMAN/MED SUP-36-00005 CDM 0271 RC outpatient 23.72 23.72 23.72 74 17.55 percent of total billed charges 23.72 93 19.21 percent of total billed charges 23.72 23.72 other OPPS APC 23.72 23.72 other OPPS APC 23.72 27.63 6.55 percent of total billed charges 23.72 23.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMOBILE SHOULDER WOMAN/SM SUP-36-00006 CDM 0271 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMOBILE SHOULDER X-LARGE SUP-36-00007 CDM 0271 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLING ARM INFANT SUP-36-00009 CDM 0271 RC outpatient 3.88 3.88 3.88 74 2.87 percent of total billed charges 3.88 93 3.14 percent of total billed charges 3.88 3.88 other OPPS APC 3.88 3.88 other OPPS APC 3.88 27.63 1.07 percent of total billed charges 3.88 3.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT ALUMAFOAM FINGER 1 SUP-36-00018 CDM 0271 RC outpatient 0.77 0.77 0.77 74 0.57 percent of total billed charges 0.77 93 0.62 percent of total billed charges 0.77 0.77 other OPPS APC 0.77 0.77 other OPPS APC 0.77 27.63 0.21 percent of total billed charges 0.77 0.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT ALUMAFOAM FINGER 1/2 SUP-36-00019 CDM 0271 RC outpatient 0.42 0.42 0.42 74 0.31 percent of total billed charges 0.42 93 0.34 percent of total billed charges 0.42 0.42 other OPPS APC 0.42 0.42 other OPPS APC 0.42 27.63 0.12 percent of total billed charges 0.42 0.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT ALUMAFOAM FINGER 3/4 SUP-36-00020 CDM 0271 RC outpatient 0.76 0.76 0.76 74 0.56 percent of total billed charges 0.76 93 0.62 percent of total billed charges 0.76 0.76 other OPPS APC 0.76 0.76 other OPPS APC 0.76 27.63 0.21 percent of total billed charges 0.76 0.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT FINGER VELCRO LARGE SUP-36-00025 CDM 0271 RC outpatient 3.83 3.83 3.83 74 2.83 percent of total billed charges 3.83 93 3.1 percent of total billed charges 3.83 3.83 other OPPS APC 3.83 3.83 other OPPS APC 3.83 27.63 1.06 percent of total billed charges 3.83 3.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT FINGER VELCRO MEDIUM SUP-36-00026 CDM 0271 RC outpatient 3.76 3.76 3.76 74 2.78 percent of total billed charges 3.76 93 3.05 percent of total billed charges 3.76 3.76 other OPPS APC 3.76 3.76 other OPPS APC 3.76 27.63 1.04 percent of total billed charges 3.76 3.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT WRIST & FOREARM LEFT SUP-36-00028 CDM 0271 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT WRIST & FOREARM RIGHT SUP-36-00029 CDM 0271 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT WRIST/FOREARM UNIVERSAL SUP-36-00032 CDM 0271 RC outpatient 20.64 20.64 20.64 74 15.27 percent of total billed charges 20.64 93 16.72 percent of total billed charges 20.64 20.64 other OPPS APC 20.64 20.64 other OPPS APC 20.64 27.63 5.7 percent of total billed charges 20.64 20.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRAP CLAVICLE LARGE SUP-36-00033 CDM 0271 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRAP CLAVICLE SMALL SUP-36-00034 CDM 0271 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRAP CLAVICLE MEDIUM SUP-36-00036 CDM 0271 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLING DELUXE ARM LARGE SUP-36-00040 CDM 0271 RC outpatient 2.09 2.09 2.09 74 1.55 percent of total billed charges 2.09 93 1.69 percent of total billed charges 2.09 2.09 other OPPS APC 2.09 2.09 other OPPS APC 2.09 27.63 0.58 percent of total billed charges 2.09 2.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLING DELUXE ARM MEDIUM SUP-36-00041 CDM 0271 RC outpatient 2.41 2.41 2.41 74 1.78 percent of total billed charges 2.41 93 1.95 percent of total billed charges 2.41 2.41 other OPPS APC 2.41 2.41 other OPPS APC 2.41 27.63 0.67 percent of total billed charges 2.41 2.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLING DELUXE ARM SMALL SUP-36-00042 CDM 0271 RC outpatient 2.41 2.41 2.41 74 1.78 percent of total billed charges 2.41 93 1.95 percent of total billed charges 2.41 2.41 other OPPS APC 2.41 2.41 other OPPS APC 2.41 27.63 0.67 percent of total billed charges 2.41 2.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMOBILIZER SHOULDER MED W/ABDUCT SUP-36-00046 CDM 0271 RC outpatient 134.6 134.6 134.6 74 99.6 percent of total billed charges 134.6 93 109.03 percent of total billed charges 134.6 134.6 other OPPS APC 134.6 134.6 other OPPS APC 134.6 27.63 37.19 percent of total billed charges 134.6 134.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMOBILIZER SHOULDER LG W/ABDUCT SUP-36-00047 CDM 0271 RC outpatient 149.76 149.76 149.76 74 110.82 percent of total billed charges 149.76 93 121.31 percent of total billed charges 149.76 149.76 other OPPS APC 149.76 149.76 other OPPS APC 149.76 27.63 41.38 percent of total billed charges 149.76 149.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMOBILIZER SHOULDER XLG W/ABDUCT SUP-36-00048 CDM 0271 RC outpatient 93.76 93.76 93.76 74 69.38 percent of total billed charges 93.76 93 75.95 percent of total billed charges 93.76 93.76 other OPPS APC 93.76 93.76 other OPPS APC 93.76 27.63 25.91 percent of total billed charges 93.76 93.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLING ARM DELUXE XLG SUP-36-00049 CDM 0271 RC outpatient 2.09 2.09 2.09 74 1.55 percent of total billed charges 2.09 93 1.69 percent of total billed charges 2.09 2.09 other OPPS APC 2.09 2.09 other OPPS APC 2.09 27.63 0.58 percent of total billed charges 2.09 2.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION INTERLOCK IDC PLATINUM FIBER .018 IN STANDARD LENGTH 2D L6 CM OD2 MM OCCLUSION SYSTEM SUP-36-149 CDM 0270 RC outpatient 1286.22 1286.22 1286.22 74 951.8 percent of total billed charges 1286.22 93 1041.84 percent of total billed charges 1286.22 1286.22 other OPPS APC 1286.22 1286.22 other OPPS APC 1286.22 27.63 355.38 percent of total billed charges 1286.22 1286.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOLDER NEEDLE CLASSIC PLUS STAINLESS STEEL TUNGSTEN CARBIDE L7 IN MICROVASCULAR INSERT JAW SUP-36-3010 CDM outpatient 522.6 522.6 522.6 522.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN INCISION OASIS PLASTIC DISPOSABLE STERILE LF CHEST COLLECTION TUBE DRY SUCTION CONTROL CHAMBER SUP-3600-100 CDM 270009127 LOCAL 0270 RC outpatient 100.78 100.78 100.78 74 74.58 percent of total billed charges 100.78 93 81.63 percent of total billed charges 100.78 100.78 other OPPS APC 100.78 100.78 other OPPS APC 100.78 27.63 27.85 percent of total billed charges 100.78 100.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE INTEGRA P4CM CURVE 9.25X2.5CM 100CL STERILE LF SMOOTH SUP-3614-10 CDM 0270 RC outpatient 2392 2392 2392 74 1770.08 percent of total billed charges 2392 93 1937.52 percent of total billed charges 2392 2392 other OPPS APC 2392 2392 other OPPS APC 2392 27.63 660.91 percent of total billed charges 2392 2392 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE INTEGRA P6CM CURVE 9.25X2.5CM 170CL STERILE LF 2 STAGE SMOOTH SUP-3614-10-2 CDM 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXPANDER TISSUE INTEGRA ENHANCED P4CM CURVE 11X3CM 115CL STERILE LF TEXTURE SURFACE SUP-3614ES-05 CDM 0270 RC outpatient 2522 2522 2522 74 1866.28 percent of total billed charges 2522 93 2042.82 percent of total billed charges 2522 2522 other OPPS APC 2522 2522 other OPPS APC 2522 27.63 696.83 percent of total billed charges 2522 2522 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RECEPTACLE DRAIN THORACIC WATERSEAL PLASTIC DOUBLE CHAMBER SUCTION CONTROL 2 TUBES 200ML SUP-3620-100 CDM 270009032 LOCAL 0270 RC outpatient 130.45 130.45 130.45 74 96.53 percent of total billed charges 130.45 93 105.66 percent of total billed charges 130.45 130.45 other OPPS APC 130.45 130.45 other OPPS APC 130.45 27.63 36.04 percent of total billed charges 130.45 130.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET ADMINISTRATION INFUSOMAT 15GTT/ML L122IN 22ML SPACE PUMP FREE FLOW PROTECTION CLAMP SPIN LOCK CONNECTOR UNIVERSAL SPIKE LATEX FREE SUP-362035 CDM 0270 RC outpatient 21.13 21.13 21.13 74 15.64 percent of total billed charges 21.13 93 17.12 percent of total billed charges 21.13 21.13 other OPPS APC 21.13 21.13 other OPPS APC 21.13 27.63 5.84 percent of total billed charges 21.13 21.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD ELLIPSE DR 36 DF4 CONNECTOR SYSTEM SUP-362311-36QS CDM 0275 RC outpatient 35304 35304 35304 57 20123.3 percent of total billed charges 35304 93 28596.2 percent of total billed charges 35304 35304 other OPPS APC 35304 35304 other OPPS APC 35304 51 18005 percent of total billed charges 35304 35304 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN INCISION OASIS PLASTIC THORACIC BLOOD RECOVERY DRY SUCTION ATS COMPATIBLE 1 PATIENT TUBE STERILE LATEX FREE DISPOSABLE SUP-3650-100 CDM 270009032 LOCAL 0270 RC outpatient 130.45 130.45 130.45 74 96.53 percent of total billed charges 130.45 93 105.66 percent of total billed charges 130.45 130.45 other OPPS APC 130.45 130.45 other OPPS APC 130.45 27.63 36.04 percent of total billed charges 130.45 130.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 2.0 X 8 MM SUP-366991_65345 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 2.25 X 8 MM SUP-366992_65346 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 2.5 X 8 MM SUP-366993_65347 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 2.75 X 8 MM SUP-366994_65348 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 3.0 X 8 MM SUP-366995_65349 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 3.25 X 8 MM SUP-366996_65350 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 3.5 X 8 MM SUP-366997_65351 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 3.75 X 8 MM SUP-366998_65352 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 4.0 X 8 MM SUP-366999_65353 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 4.5 X 8 MM SUP-367000_65354 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 5.0 X 8 MM SUP-367001_65355 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 2.0 X 12 MM SUP-367002_65356 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION PANTERA LEO NON-COMPLAINT SEMI-CRYSTALLINE COPOLYMER HYDROPHILIC L12 MM OD 2.25 SUP-367003_65357 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION PANTERA LEO NON-COMPLAINT SEMI-CRYSTALLINE COPOLYMER HYDROPHILIC L12MM OD 2.5 SUP-367004_65358 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 2.75 X 12 MM SUP-367005_65359 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 3.0 X 12 MM SUP-367006_65360 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 3.25 X 12 MM SUP-367007_65361 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 3.5 X 12 MM SUP-367008_65362 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 3.75 X 12 MM SUP-367009_65363 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 4.0 X 12 MM SUP-367010_65364 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 4.5 X 12 MM SUP-367011_65369 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 5.0 X 12 MM SUP-367012_65370 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 2.0 X 15 MM SUP-367013_65371 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 2.25 X 15 MM SUP-367014_65372 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 2.5 X 15 MM SUP-367015_65373 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 2.75 X 15 MM SUP-367016_65374 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 3.0 X 15 MM SUP-367017_65375 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 3.25 X 15 MM SUP-367018_65376 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 3.5 X 15 MM SUP-367019_65377 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 3.75 X 15 MM SUP-367020_65378 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 4.0 X 15 MM SUP-367021_65379 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 4.5 X 15 MM SUP-367022_65380 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 5.0 X 15 MM SUP-367023_65381 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 2.0 X 20 MM SUP-367024_65382 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 2.25 X 20 MM SUP-367025_65383 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 2.5 X 20 MM SUP-367026_65384 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 2.75 X 20 MM SUP-367027_65385 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 3.0 X 20 MM SUP-367028_65386 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 3.25 X 20 MM SUP-367029_65387 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 3.5 X 20 MM SUP-367030_65388 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 3.75 X 20 MM SUP-367031_65389 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION PANTERA LEO NON-COMPLIANT SEMICRYSTALLINE COPOLYMER HYDROPHILIC L20 MM OD 4.0 SUP-367032_65390 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 4.5 X 20 MM SUP-367033_65391 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 5.0 X 20 MM SUP-367034_65392 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 2.0 X 30 MM SUP-367035_65393 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 2.25 X 30 MM SUP-367036_65394 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 2.5 X 30 MM SUP-367037_65395 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 2.75 X 30 MM SUP-367038_65396 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 3.0 X 30 MM SUP-367039_65397 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 3.25 X 30 MM SUP-367040_65398 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 3.5 X 30 MM SUP-367041_65399 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 3.75 X 30 MM SUP-367042_65400 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 4.0 X 30 MM SUP-367043_65401 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 4.5 X 30 MM SUP-367044_65402 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA LEO NC BALLOON 5.0 X 30 MM SUP-367045_65403 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET BLOOD COLLECTION BD VACUTAINER BD SAFETY-LOK 12IN .75IN 21GA GREEN YELLOW DISPOSABLE STERILE LF INFUSION WITHOUT SUP-367296 CDM 0270 RC outpatient 2.78 2.78 2.78 74 2.06 percent of total billed charges 2.78 93 2.25 percent of total billed charges 2.78 2.78 other OPPS APC 2.78 2.78 other OPPS APC 2.78 27.63 0.77 percent of total billed charges 2.78 2.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET BLOOD COLLECTION BD VACUTAINER BD SAFETY-LOK 12IN .75IN 25GA ROYAL BLUE DISPOSABLE STERILE LF INFUSION WITHOUT LUER SUP-367298 CDM 0270 RC outpatient 2.66 2.66 2.66 74 1.97 percent of total billed charges 2.66 93 2.15 percent of total billed charges 2.66 2.66 other OPPS APC 2.66 2.66 other OPPS APC 2.66 27.63 0.73 percent of total billed charges 2.66 2.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR EXTENDED SPRAY TIP FOR PROGEL 16CM SUP-36766 CDM 0270 RC outpatient 511 511 511 74 378.14 percent of total billed charges 511 93 413.91 percent of total billed charges 511 511 other OPPS APC 511 511 other OPPS APC 511 27.63 141.19 percent of total billed charges 511 511 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE BLOOD COLLECTION BD VACUTAINER BD HEMOGARD 4ML GREEN SODIUM HEPARIN PLASTIC SUP-367871 CDM 0270 RC outpatient 0.42 0.42 0.42 74 0.31 percent of total billed charges 0.42 93 0.34 percent of total billed charges 0.42 0.42 other OPPS APC 0.42 0.42 other OPPS APC 0.42 27.63 0.12 percent of total billed charges 0.42 0.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE BLOOD COLLECTION BD VACUTAINER PLUS CLOT ACTIVATOR PLASTIC L100 MM OD16 MM 8.5 ML CONVENTIONAL CLOSURE PAPER LABEL STERILE LATEX FREE GRAY RED SUP-367988 CDM 0270 RC outpatient 0.45 0.45 0.45 74 0.33 percent of total billed charges 0.45 93 0.36 percent of total billed charges 0.45 0.45 other OPPS APC 0.45 0.45 other OPPS APC 0.45 27.63 0.12 percent of total billed charges 0.45 0.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENERATOR NEUROSTIMULATOR EONC 16 CHANNEL IMPLANTABLE PULSE IPG SUP-3688 SCS EON CDM 0270 RC outpatient 41160.6 41160.6 41160.6 74 30458.8 percent of total billed charges 41160.6 93 33340.1 percent of total billed charges 41160.6 41160.6 other OPPS APC 41160.6 41160.6 other OPPS APC 41160.6 27.63 11372.7 percent of total billed charges 41160.6 41160.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR ADULT NO NECK SUP-37-00001 CDM 0271 RC outpatient 20.84 20.84 20.84 74 15.42 percent of total billed charges 20.84 93 16.88 percent of total billed charges 20.84 20.84 other OPPS APC 20.84 20.84 other OPPS APC 20.84 27.63 5.76 percent of total billed charges 20.84 20.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR BABY NO NECK SUP-37-00002 CDM 0271 RC outpatient 22.08 22.08 22.08 74 16.34 percent of total billed charges 22.08 93 17.88 percent of total billed charges 22.08 22.08 other OPPS APC 22.08 22.08 other OPPS APC 22.08 27.63 6.1 percent of total billed charges 22.08 22.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR CERVICAL CHILD SUP-37-00003 CDM 0271 RC outpatient 3.08 3.08 3.08 74 2.28 percent of total billed charges 3.08 93 2.49 percent of total billed charges 3.08 3.08 other OPPS APC 3.08 3.08 other OPPS APC 3.08 27.63 0.85 percent of total billed charges 3.08 3.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR CERVICAL LARGE SUP-37-00005 CDM 0271 RC outpatient 3.44 3.44 3.44 74 2.55 percent of total billed charges 3.44 93 2.79 percent of total billed charges 3.44 3.44 other OPPS APC 3.44 3.44 other OPPS APC 3.44 27.63 0.95 percent of total billed charges 3.44 3.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR CERVICAL UNIVERSAL SUP-37-00006 CDM 0271 RC outpatient 3.42 3.42 3.42 74 2.53 percent of total billed charges 3.42 93 2.77 percent of total billed charges 3.42 3.42 other OPPS APC 3.42 3.42 other OPPS APC 3.42 27.63 0.94 percent of total billed charges 3.42 3.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR PHILADELPHIA LARGE SUP-37-00007 CDM 0271 RC outpatient 43.49 43.49 43.49 74 32.18 percent of total billed charges 43.49 93 35.23 percent of total billed charges 43.49 43.49 other OPPS APC 43.49 43.49 other OPPS APC 43.49 27.63 12.02 percent of total billed charges 43.49 43.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR PHILADELPHIA MED SUP-37-00008 CDM 0271 RC outpatient 42.87 42.87 42.87 74 31.72 percent of total billed charges 42.87 93 34.72 percent of total billed charges 42.87 42.87 other OPPS APC 42.87 42.87 other OPPS APC 42.87 27.63 11.84 percent of total billed charges 42.87 42.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR PHILADELPHIA SM SUP-37-00009 CDM 0271 RC outpatient 39.11 39.11 39.11 74 28.94 percent of total billed charges 39.11 93 31.68 percent of total billed charges 39.11 39.11 other OPPS APC 39.11 39.11 other OPPS APC 39.11 27.63 10.81 percent of total billed charges 39.11 39.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR STIFF NECK PEDIATRIC SUP-37-00010 CDM 0271 RC outpatient 22.98 22.98 22.98 74 17.01 percent of total billed charges 22.98 93 18.61 percent of total billed charges 22.98 22.98 other OPPS APC 22.98 22.98 other OPPS APC 22.98 27.63 6.35 percent of total billed charges 22.98 22.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR STIFF NECK SHORT SUP-37-00012 CDM 0271 RC outpatient 22.08 22.08 22.08 74 16.34 percent of total billed charges 22.08 93 17.88 percent of total billed charges 22.08 22.08 other OPPS APC 22.08 22.08 other OPPS APC 22.08 27.63 6.1 percent of total billed charges 22.08 22.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR STIFF NECK TALL SUP-37-00013 CDM 0271 RC outpatient 33.17 33.17 33.17 74 24.55 percent of total billed charges 33.17 93 26.87 percent of total billed charges 33.17 33.17 other OPPS APC 33.17 33.17 other OPPS APC 33.17 27.63 9.16 percent of total billed charges 33.17 33.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE/SLEEVE ORTHOPEDIC DALL-MILES STAINLESS STEEL OD2 MM HIP SET BEAD SUP-3704-0-050 CDM 0270 RC outpatient 781.56 781.56 781.56 74 578.35 percent of total billed charges 781.56 93 633.06 percent of total billed charges 781.56 781.56 other OPPS APC 781.56 781.56 other OPPS APC 781.56 27.63 215.95 percent of total billed charges 781.56 781.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DALL-MILES STAINLESS STEEL BROAD L8 IN HIP 7 HOLE 8 GROOVE COMPRESSION ROUND END 4.5 MM SCREW SUP-3704-3-110 CDM 270010022 LOCAL 0270 RC outpatient 1284.4 1284.4 1284.4 74 950.46 percent of total billed charges 1284.4 93 1040.36 percent of total billed charges 1284.4 1284.4 other OPPS APC 1284.4 1284.4 other OPPS APC 1284.4 27.63 354.88 percent of total billed charges 1284.4 1284.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DALL-MILES STAINLESS STEEL BROAD L12 IN HIP 11 HOLE 12 GROOVE COMPRESSION ROUND END 4.5 MM SCREW SUP-3704-3-130 CDM 0270 RC outpatient 1284.4 1284.4 1284.4 74 950.46 percent of total billed charges 1284.4 93 1040.36 percent of total billed charges 1284.4 1284.4 other OPPS APC 1284.4 1284.4 other OPPS APC 1284.4 27.63 354.88 percent of total billed charges 1284.4 1284.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE/SLEEVE ORTHOPEDIC DALL-MILES STAINLESS STEEL OD1.6 MM HIP SET BEAD SUP-37040040 CDM 0270 RC outpatient 845.52 845.52 845.52 74 625.68 percent of total billed charges 845.52 93 684.87 percent of total billed charges 845.52 845.52 other OPPS APC 845.52 845.52 other OPPS APC 845.52 27.63 233.62 percent of total billed charges 845.52 845.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROGRAMMER NEUROSTIMULATOR ACTIVA PATIENT ANTENNA EXTERNAL TELEMETRY STERILE DEEP BRAIN STIMULATION SYSTEM SUP-37092 CDM 0270 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 27.63 57.47 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SURGICAL BARD-PARKER RIB-BACK CARBON STEEL 10 TISSUE SHARPNESS STERILE LATEX FREE SUP-371110 CDM 0270 RC outpatient 0.86 0.86 0.86 74 0.64 percent of total billed charges 0.86 93 0.7 percent of total billed charges 0.86 0.86 other OPPS APC 0.86 0.86 other OPPS APC 0.86 27.63 0.24 percent of total billed charges 0.86 0.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SURGICAL BARD-PARKER RIB-BACK CARBON STEEL 11 SHARPNESS STERILE LATEX FREE SUP-371111 CDM 0270 RC outpatient 0.83 0.83 0.83 74 0.61 percent of total billed charges 0.83 93 0.67 percent of total billed charges 0.83 0.83 other OPPS APC 0.83 0.83 other OPPS APC 0.83 27.63 0.23 percent of total billed charges 0.83 0.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SURGICAL BARD-PARKER RIB-BACK CARBON STEEL 15 SHARPNESS STERILE LATEX FREE SUP-371115 CDM 0270 RC outpatient 0.83 0.83 0.83 74 0.61 percent of total billed charges 0.83 93 0.67 percent of total billed charges 0.83 0.83 other OPPS APC 0.83 0.83 other OPPS APC 0.83 27.63 0.23 percent of total billed charges 0.83 0.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRUSH SURGICAL SCRUB BD E-Z SCRUB BLUE 3% CHLOROXYLENOL POLYETHYLENE DISPOSABLE STERILE LF IMPREGNATE SOFT BRISTLE SUP-371163 CDM 0270 RC outpatient 1.04 1.04 1.04 74 0.77 percent of total billed charges 1.04 93 0.84 percent of total billed charges 1.04 1.04 other OPPS APC 1.04 1.04 other OPPS APC 1.04 27.63 0.29 percent of total billed charges 1.04 1.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRUSH SURGICAL SCRUB BD E-Z SCRUB POLYETHYLENE DRY SOFT SPONGE ANTIMICROBIAL STERILE LATEX FREE DISPOSABLE GREEN SUP-371603 CDM 0270 RC outpatient 0.82 0.82 0.82 74 0.61 percent of total billed charges 0.82 93 0.66 percent of total billed charges 0.82 0.82 other OPPS APC 0.82 0.82 other OPPS APC 0.82 27.63 0.23 percent of total billed charges 0.82 0.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE ENERGY ACTIVATION ETHICON GEN 11 SUP-371870 CDM outpatient 2594.8 2594.8 2594.8 2594.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRUSH SURGICAL SCRUB BD E-Z SCRUB BROWN PVP IODINE POLYETHYLENE DISPOSABLE NS LF IMPREGNATE SOFT BRISTLE SPONGE SUP-372053 CDM 0270 RC outpatient 1.17 1.17 1.17 74 0.87 percent of total billed charges 1.17 93 0.95 percent of total billed charges 1.17 1.17 other OPPS APC 1.17 1.17 other OPPS APC 1.17 27.63 0.32 percent of total billed charges 1.17 1.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RECHARGER NEUROSTIMULATOR EON MINI CHARGE SYSTEM SUP-3722 SCSCAP CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCALPEL SURGICAL BARD-PARKER STAINLESS STEEL 10 1 HAND ACTIVATION LOCK RETRACTABLE SHIELD BLADE STERILE LATEX FREE SUP-372610 CDM 0270 RC outpatient 4.5 4.5 4.5 74 3.33 percent of total billed charges 4.5 93 3.65 percent of total billed charges 4.5 4.5 other OPPS APC 4.5 4.5 other OPPS APC 4.5 27.63 1.24 percent of total billed charges 4.5 4.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHARGING SYSTEM SJM PRODIGY SUP-3730-SCSCAPC CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL COBALT 0 HIP SUP-3740 CDM 270010024 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL TRANSCONTINENTAL M PEEK 6 D L50 MM X W20 MM X H8 MM NONSTERILE LATEX FREE LATERAL LUMBAR INTERBODY FUSION SUP-375.378 CDM 270010020 LOCAL 0270 RC outpatient 7800 7800 7800 74 5772 percent of total billed charges 7800 93 6318 percent of total billed charges 7800 7800 other OPPS APC 7800 7800 other OPPS APC 7800 27.63 2155.14 percent of total billed charges 7800 7800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL TRANSCONTINENTAL M PEEK L55 MM X W20 MM X H8 MM NONSTERILE LATEX FREE LATERAL LUMBAR INTERBODY FUSION SUP-375.428 CDM 270010020 LOCAL 0270 RC outpatient 9100 9100 9100 74 6734 percent of total billed charges 9100 93 7371 percent of total billed charges 9100 9100 other OPPS APC 9100 9100 other OPPS APC 9100 27.63 2514.33 percent of total billed charges 9100 9100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL TRANSCONTINENTAL M PEEK 6 D L55 MM X W20 MM X H8 MM NONSTERILE LATEX FREE LATERAL LUMBAR INTERBODY FUSION SUP-375.478 CDM 270010020 LOCAL 0270 RC outpatient 7800 7800 7800 74 5772 percent of total billed charges 7800 93 6318 percent of total billed charges 7800 7800 other OPPS APC 7800 7800 other OPPS APC 7800 27.63 2155.14 percent of total billed charges 7800 7800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL TRANSCONTINENTAL M PEEK 6 D L55 MM X W20 MM X H11 MM NONSTERILE LATEX FREE LATERAL LUMBAR INTERBODY FUSION SUP-375.481 CDM 270010020 LOCAL 0270 RC outpatient 9100 9100 9100 74 6734 percent of total billed charges 9100 93 7371 percent of total billed charges 9100 9100 other OPPS APC 9100 9100 other OPPS APC 9100 27.63 2514.33 percent of total billed charges 9100 9100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL TRANSCONTINENTAL PEEK 6 D MEDIUM L60 MM X W20 MM X H9 MM NONSTERILE LATEX FREE LATERAL LUMBAR INTERBODY FUSION SUP-375.579 CDM 270010020 LOCAL 0270 RC outpatient 9100 9100 9100 74 6734 percent of total billed charges 9100 93 7371 percent of total billed charges 9100 9100 other OPPS APC 9100 9100 other OPPS APC 9100 27.63 2514.33 percent of total billed charges 9100 9100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNIFE OPHTHALMIC BD EDGEAHEAD STRAIGHT W1.1 MM OD20 GA MVR SIDEPORT STERILE LATEX FREE DISPOSABLE SUP-376630 CDM 0270 RC outpatient 82.23 82.23 82.23 74 60.85 percent of total billed charges 82.23 93 66.61 percent of total billed charges 82.23 82.23 other OPPS APC 82.23 82.23 other OPPS APC 82.23 27.63 22.72 percent of total billed charges 82.23 82.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING PROMRI SOLIA S STEROID L45 CM ENDOCARDIAL BIPOLAR ACTIVE FIXATION SUP-377176_74448 CDM 0270 RC outpatient 845 845 845 74 625.3 percent of total billed charges 845 93 684.45 percent of total billed charges 845 845 other OPPS APC 845 845 other OPPS APC 845 27.63 233.47 percent of total billed charges 845 845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING PROMRI SOLIA S STEROID L53 CM ENDOCARDIAL BIPOLAR ACTIVE FIXATION SUP-377177_74449 CDM 0270 RC outpatient 845 845 845 74 625.3 percent of total billed charges 845 93 684.45 percent of total billed charges 845 845 other OPPS APC 845 845 other OPPS APC 845 27.63 233.47 percent of total billed charges 845 845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING PROMRI SOLIA S STEROID ELUTING L60 CM ENDOCARDIAL BIPOLAR ACTIVE FIXATION SUP-377179_74450 CDM 0270 RC outpatient 845 845 845 74 625.3 percent of total billed charges 845 93 684.45 percent of total billed charges 845 845 other OPPS APC 845 845 other OPPS APC 845 27.63 233.47 percent of total billed charges 845 845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE PROBE ISOSILK STRAIGHT L96 IN X W5 IN FOLD TAPE STRIP GEL STERILE LATEX SUP-3787 CDM 0270 RC outpatient 49.64 49.64 49.64 74 36.73 percent of total billed charges 49.64 93 40.21 percent of total billed charges 49.64 49.64 other OPPS APC 49.64 49.64 other OPPS APC 49.64 27.63 13.72 percent of total billed charges 49.64 49.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHARGER SPINAL CORD STIMULATOR SUP-3788 SCSCAPC CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENERATOR SPINAL CORD STIMULATOR EON MINI SUP-3788-SCSCAP CDM 0270 RC outpatient 44200 44200 44200 74 32708 percent of total billed charges 44200 93 35802 percent of total billed charges 44200 44200 other OPPS APC 44200 44200 other OPPS APC 44200 27.63 12212.5 percent of total billed charges 44200 44200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENERATOR SPINAL CORD STIM PROTEGE SUP-3789-SCCAP CDM 0270 RC outpatient 44200 44200 44200 74 32708 percent of total billed charges 44200 93 35802 percent of total billed charges 44200 44200 other OPPS APC 44200 44200 other OPPS APC 44200 27.63 12212.5 percent of total billed charges 44200 44200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS SD MONORAIL STAINLESS STEEL L14 MM L150 CM OD6 MM RENAL PREMOUNT BALLOON EXPAND CATHETER RADIOPAQUE STERILE DISPOSABLE ACCEPTS 5 FR SHEATH 6 FR GUIDE PTRA SUP-37911-61415 CDM 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS SD MONORAIL STAINLESS STEEL L19 MM L150 CM OD5 MM RENAL PREMOUNT BALLOON EXPAND CATHETER RADIOPAQUE STERILE DISPOSABLE ACCEPTS 5 FR SHEATH 6 FR GUIDE PTRA SUP-37912-51915 CDM 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS SD MONORAIL STAINLESS STEEL L18 MM L150 CM OD6 MM RENAL PREMOUNT BALLOON EXPAND CATHETER RADIOPAQUE STERILE DISPOSABLE ACCEPTS 5 FR SHEATH 6 FR GUIDE PTRA SUP-37912-61815 CDM 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANE ALUMINUM OFFSET HANDLE SUP-38-00003 CDM 0271 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANE ALUMINUM ROUND HANDLE SUP-38-00004 CDM 0271 RC outpatient 30.56 30.56 30.56 74 22.61 percent of total billed charges 30.56 93 24.75 percent of total billed charges 30.56 30.56 other OPPS APC 30.56 30.56 other OPPS APC 30.56 27.63 8.44 percent of total billed charges 30.56 30.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANE QUAD OFFSET HANDLE SUP-38-00005 CDM 0271 RC outpatient 39.98 39.98 39.98 74 29.59 percent of total billed charges 39.98 93 32.38 percent of total billed charges 39.98 39.98 other OPPS APC 39.98 39.98 other OPPS APC 39.98 27.63 11.05 percent of total billed charges 39.98 39.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRUTCHES CHILD SUP-38-00007 CDM 0271 RC outpatient 47.06 47.06 47.06 74 34.82 percent of total billed charges 47.06 93 38.12 percent of total billed charges 47.06 47.06 other OPPS APC 47.06 47.06 other OPPS APC 47.06 27.63 13 percent of total billed charges 47.06 47.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WALKER ADULT FOLDING SUP-38-00010 CDM 0271 RC outpatient 91.88 91.88 91.88 74 67.99 percent of total billed charges 91.88 93 74.42 percent of total billed charges 91.88 91.88 other OPPS APC 91.88 91.88 other OPPS APC 91.88 27.63 25.39 percent of total billed charges 91.88 91.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRUTCHES ADULT MEDIUM SUP-38-00011 CDM 0271 RC outpatient 46.94 46.94 46.94 74 34.74 percent of total billed charges 46.94 93 38.02 percent of total billed charges 46.94 46.94 other OPPS APC 46.94 46.94 other OPPS APC 46.94 27.63 12.97 percent of total billed charges 46.94 46.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRUTCHES ADULT TALL SUP-38-00012 CDM 0271 RC outpatient 46.94 46.94 46.94 74 34.74 percent of total billed charges 46.94 93 38.02 percent of total billed charges 46.94 46.94 other OPPS APC 46.94 46.94 other OPPS APC 46.94 27.63 12.97 percent of total billed charges 46.94 46.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRUTCHES YOUTH SUP-38-00013 CDM 0271 RC outpatient 46.94 46.94 46.94 74 34.74 percent of total billed charges 46.94 93 38.02 percent of total billed charges 46.94 46.94 other OPPS APC 46.94 46.94 other OPPS APC 46.94 27.63 12.97 percent of total billed charges 46.94 46.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WALKER FOLDING WITH WHEELS SUP-38-00015 CDM 0271 RC outpatient 94.84 94.84 94.84 74 70.18 percent of total billed charges 94.84 93 76.82 percent of total billed charges 94.84 94.84 other OPPS APC 94.84 94.84 other OPPS APC 94.84 27.63 26.2 percent of total billed charges 94.84 94.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROTECTOR HEELMEDIX W/WEDGE SUP-38-00016 CDM 0271 RC outpatient 252.32 252.32 252.32 74 186.72 percent of total billed charges 252.32 93 204.38 percent of total billed charges 252.32 252.32 other OPPS APC 252.32 252.32 other OPPS APC 252.32 27.63 69.72 percent of total billed charges 252.32 252.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CORTICAL LORDOTIC H7 MM CERVICAL SUP-38-1107 CDM 270010020 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CERVICAL LORDOTIC H8 MM ALLOGRAFT SPACER SUP-38-1108 CDM 270010020 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE IV CATHETER SHIELDED STRAIGHT 20 GAUGE ANGIOCATH AUTOGUARD SUP-381702 CDM 0481 RC outpatient 6.63 6.63 6.63 74 4.91 percent of total billed charges 6.63 93 5.37 percent of total billed charges 6.63 6.63 other OPPS APC 6.63 6.63 other OPPS APC 6.63 51 3.38 percent of total billed charges 6.63 6.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE RETRACTING PERIPHERAL IV CATHETER INSYTE AUTOGUARD BC 20 GAUGE 1 IN BUTTON SUP-382533 CDM 0481 RC outpatient 4.88 4.88 4.88 74 3.61 percent of total billed charges 4.88 93 3.95 percent of total billed charges 4.88 4.88 other OPPS APC 4.88 4.88 other OPPS APC 4.88 51 2.49 percent of total billed charges 4.88 4.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD 3830-59 SELECT SURE _51413_ SUP-383059 CDM 0275 RC outpatient 1027 1027 1027 57 585.39 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 51 523.77 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD CATHETER DELIVERED PACING SUP-383059 CDM 0275 RC outpatient 1027 1027 1027 57 585.39 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 51 523.77 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING SELECTSECURE L69 CM ATRIUM VENTRICLE BIPOLAR FIXED SCREW IN CATHETER DELIVER SUP-383069 CDM 0275 RC outpatient 1027 1027 1027 57 585.39 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 51 523.77 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - LEAD - SELECTSECURE 3830-69 SUP-383069 CDM C1898 HCPCS 0275 RC outpatient 1185 1185 1185 57 675.45 percent of total billed charges 1185 93 959.85 percent of total billed charges 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 51 604.35 percent of total billed charges 1185 1185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL COALITION 0 D L14MM X W12 MM X H5 MM SUP-384.005 CDM 270010020 LOCAL 0270 RC outpatient 6240 6240 6240 74 4617.6 percent of total billed charges 6240 93 5054.4 percent of total billed charges 6240 6240 other OPPS APC 6240 6240 other OPPS APC 6240 27.63 1724.11 percent of total billed charges 6240 6240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL COALITION ANTERIOR CERVICAL DISCECTOMY AND FUSION PLATE SYSTEM STERILE SUP-384.006 CDM 270010020 LOCAL 0270 RC outpatient 6240 6240 6240 74 4617.6 percent of total billed charges 6240 93 5054.4 percent of total billed charges 6240 6240 other OPPS APC 6240 6240 other OPPS APC 6240 27.63 1724.11 percent of total billed charges 6240 6240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL COALITION 0 D W14 MM X H12 MM SUP-384.007 CDM 270010020 LOCAL 0270 RC outpatient 6240 6240 6240 74 4617.6 percent of total billed charges 6240 93 5054.4 percent of total billed charges 6240 6240 other OPPS APC 6240 6240 other OPPS APC 6240 27.63 1724.11 percent of total billed charges 6240 6240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL COALITION 7 D L14MM X W12 MM X H5 MM SUP-384.105 CDM 270010020 LOCAL 0270 RC outpatient 6240 6240 6240 74 4617.6 percent of total billed charges 6240 93 5054.4 percent of total billed charges 6240 6240 other OPPS APC 6240 6240 other OPPS APC 6240 27.63 1724.11 percent of total billed charges 6240 6240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL COALITION ANTERIOR CERVICAL DISCECTOMY AND FUSION PLATE SYSTEM SUP-384.106 CDM 270010020 LOCAL 0270 RC outpatient 6240 6240 6240 74 4617.6 percent of total billed charges 6240 93 5054.4 percent of total billed charges 6240 6240 other OPPS APC 6240 6240 other OPPS APC 6240 27.63 1724.11 percent of total billed charges 6240 6240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL COALITION TITANIUM L14 MM X W12 MM X H7 MM ANTERIOR CERVICAL DISCECTOMY AND FUSION PLATE SYSTEM SUP-384.107 CDM 270010020 LOCAL 0270 RC outpatient 6240 6240 6240 74 4617.6 percent of total billed charges 6240 93 5054.4 percent of total billed charges 6240 6240 other OPPS APC 6240 6240 other OPPS APC 6240 27.63 1724.11 percent of total billed charges 6240 6240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL COALITION 7D 12X14X8MM PEEK SUP-384.108 CDM 270010020 LOCAL 0270 RC outpatient 6240 6240 6240 74 4617.6 percent of total billed charges 6240 93 5054.4 percent of total billed charges 6240 6240 other OPPS APC 6240 6240 other OPPS APC 6240 27.63 1724.11 percent of total billed charges 6240 6240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L14 MM OD3.6 MM SPINE FIX ANGLE SELF DRILL SUP-384.174 CDM 270010020 LOCAL 0270 RC outpatient 6240 6240 6240 74 4617.6 percent of total billed charges 6240 93 5054.4 percent of total billed charges 6240 6240 other OPPS APC 6240 6240 other OPPS APC 6240 27.63 1724.11 percent of total billed charges 6240 6240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL COALITION 7 D L16 MM X W14 MM X H5 MM SUP-384.205 CDM 270010020 LOCAL 0270 RC outpatient 6240 6240 6240 74 4617.6 percent of total billed charges 6240 93 5054.4 percent of total billed charges 6240 6240 other OPPS APC 6240 6240 other OPPS APC 6240 27.63 1724.11 percent of total billed charges 6240 6240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL COALITION 0 D L16 MM X W14 MM X H6 MM SUP-384.206 CDM 270010020 LOCAL 0270 RC outpatient 6240 6240 6240 74 4617.6 percent of total billed charges 6240 93 5054.4 percent of total billed charges 6240 6240 other OPPS APC 6240 6240 other OPPS APC 6240 27.63 1724.11 percent of total billed charges 6240 6240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL COALITION TITANIUM L16 MM X W14 MM X H7 MM ANTERIOR CERVICAL DISCECTOMY AND FUSION PLATE SYSTEM SUP-384.207 CDM 270010020 LOCAL 0270 RC outpatient 6240 6240 6240 74 4617.6 percent of total billed charges 6240 93 5054.4 percent of total billed charges 6240 6240 other OPPS APC 6240 6240 other OPPS APC 6240 27.63 1724.11 percent of total billed charges 6240 6240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL COALITION 7D L 14MMX16MMX6MM SUP-384.306 CDM 270010020 LOCAL 0270 RC outpatient 6240 6240 6240 74 4617.6 percent of total billed charges 6240 93 5054.4 percent of total billed charges 6240 6240 other OPPS APC 6240 6240 other OPPS APC 6240 27.63 1724.11 percent of total billed charges 6240 6240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL COALITION 7 D L16 MM X W14 MM X H7 MM SUP-384.307 CDM 270010020 LOCAL 0270 RC outpatient 6240 6240 6240 74 4617.6 percent of total billed charges 6240 93 5054.4 percent of total billed charges 6240 6240 other OPPS APC 6240 6240 other OPPS APC 6240 27.63 1724.11 percent of total billed charges 6240 6240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL COALITION L16 MM X W14 MM X H8 MM CERVICAL INTERBODY SVN DEGREE SUP-384.308 CDM 270010020 LOCAL 0270 RC outpatient 6240 6240 6240 74 4617.6 percent of total billed charges 6240 93 5054.4 percent of total billed charges 6240 6240 other OPPS APC 6240 6240 other OPPS APC 6240 27.63 1724.11 percent of total billed charges 6240 6240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL COALITION H9 MM GS SUP-384.309 CDM 270010020 LOCAL 0270 RC outpatient 6240 6240 6240 74 4617.6 percent of total billed charges 6240 93 5054.4 percent of total billed charges 6240 6240 other OPPS APC 6240 6240 other OPPS APC 6240 27.63 1724.11 percent of total billed charges 6240 6240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL L16 MM X W14 MM X H10 MM COALITION ACDF SUP-384.310 CDM 270010020 LOCAL 0270 RC outpatient 6240 6240 6240 74 4617.6 percent of total billed charges 6240 93 5054.4 percent of total billed charges 6240 6240 other OPPS APC 6240 6240 other OPPS APC 6240 27.63 1724.11 percent of total billed charges 6240 6240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACTIVA BASE/LINER SUP-3840157 CDM 27000000 LOCAL 0270 RC outpatient 36.92 36.92 36.92 74 27.32 percent of total billed charges 36.92 93 29.91 percent of total billed charges 36.92 36.92 other OPPS APC 36.92 36.92 other OPPS APC 36.92 27.63 10.2 percent of total billed charges 36.92 36.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACTIVA PEDO SUP-3840164 CDM 27000000 LOCAL 0270 RC outpatient 361.37 361.37 361.37 74 267.41 percent of total billed charges 361.37 93 292.71 percent of total billed charges 361.37 361.37 other OPPS APC 361.37 361.37 other OPPS APC 361.37 27.63 99.85 percent of total billed charges 361.37 361.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT HUMERAL UNIVERS REVERS +3 MM MEDIUM OD39 MM SHOULDER CONSTRAIN STERILE ARTHROPLASTY SUP-38455 CDM C1776 HCPCS 0278 RC outpatient 2017.17 2017.17 2017.17 57 1149.79 percent of total billed charges 2017.17 93 1633.91 percent of total billed charges 2017.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2017.17 other OPPS APC 2017.17 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2017.17 other OPPS APC 2017.17 51 1028.76 percent of total billed charges 2017.17 2017.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROGRAMMER PT SJM EON SUP-3851 SCS CDM 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROGRAMMER SJM SUP-3852 SCSCAP CDM 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SURFIX HALLU TITANIUM STANDARD L14 MM OD2.7 MM METATARSOPHALANGEAL COLOR CODED NONSTERILE SUP-385214 CDM 0270 RC outpatient 975 975 975 74 721.5 percent of total billed charges 975 93 789.75 percent of total billed charges 975 975 other OPPS APC 975 975 other OPPS APC 975 27.63 269.39 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L65 MM OD2.4 MM 2 FLUTE QUICK COUPLING STOP NONSTERILE 3.5/4 MM ROD SUP-388.394 CDM 270010020 LOCAL 0270 RC outpatient 380.38 380.38 380.38 74 281.48 percent of total billed charges 380.38 93 308.11 percent of total billed charges 380.38 380.38 other OPPS APC 380.38 380.38 other OPPS APC 380.38 27.63 105.1 percent of total billed charges 380.38 380.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD NEUROSTIMULATOR INTERSTIM 3 MM SPACE STRAIGHT L33 CM OD1.27 MM INLINE CONNECTOR TINE SUP-3889-33 CDM 0270 RC outpatient 9243 9243 9243 74 6839.82 percent of total billed charges 9243 93 7486.83 percent of total billed charges 9243 9243 other OPPS APC 9243 9243 other OPPS APC 9243 27.63 2553.84 percent of total billed charges 9243 9243 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR DENTAL MIDWEST CARBIDE ROUND L1.4 MM OD1.4 MM LATCH SUP-389105 CDM 0270 RC outpatient 8.66 8.66 8.66 74 6.41 percent of total billed charges 8.66 93 7.01 percent of total billed charges 8.66 8.66 other OPPS APC 8.66 8.66 other OPPS APC 8.66 27.63 2.39 percent of total billed charges 8.66 8.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR DENTAL CARBIDE 6 LATCH SHANK ROUND SUP-389106 CDM 0270 RC outpatient 14.95 14.95 14.95 74 11.06 percent of total billed charges 14.95 93 12.11 percent of total billed charges 14.95 14.95 other OPPS APC 14.95 14.95 other OPPS APC 14.95 27.63 4.13 percent of total billed charges 14.95 14.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR DENTAL MIDWEST CARBIDE LONG TAPER L4.9 MM OD.9 MM FRICTION GRIP ROUND END SUP-389242 CDM 0270 RC outpatient 8.32 8.32 8.32 74 6.16 percent of total billed charges 8.32 93 6.74 percent of total billed charges 8.32 8.32 other OPPS APC 8.32 8.32 other OPPS APC 8.32 27.63 2.3 percent of total billed charges 8.32 8.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BINDER ABDOMINAL 12 UNIV 45""- 62""" SUP-39-00004 CDM 0271 RC outpatient 21 21 21 74 15.54 percent of total billed charges 21 93 17.01 percent of total billed charges 21 21 other OPPS APC 21 21 other OPPS APC 21 27.63 5.8 percent of total billed charges 21 21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BINDER ABDOMINAL 9 SUP-39-00005 CDM 0271 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTACHMENT ROD NS ATTACHMENT LG MULTIPIN CLAMP SUP-390.003 CDM 0270 RC outpatient 1178.32 1178.32 1178.32 74 871.96 percent of total billed charges 1178.32 93 954.44 percent of total billed charges 1178.32 1178.32 other OPPS APC 1178.32 1178.32 other OPPS APC 1178.32 27.63 325.57 percent of total billed charges 1178.32 1178.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION LARGE COMBINATION NONSTERILE SUP-390.005 CDM 270010022 LOCAL 0270 RC outpatient 3792.36 3792.36 3792.36 74 2806.35 percent of total billed charges 3792.36 93 3071.81 percent of total billed charges 3792.36 3792.36 other OPPS APC 3792.36 3792.36 other OPPS APC 3792.36 27.63 1047.83 percent of total billed charges 3792.36 3792.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION LG NS OPEN ADJUSTABLE MR CONDITIONAL SUP-390.008 CDM 270010022 LOCAL 0270 RC outpatient 969.15 969.15 969.15 74 717.17 percent of total billed charges 969.15 93 785.01 percent of total billed charges 969.15 969.15 other OPPS APC 969.15 969.15 other OPPS APC 969.15 27.63 267.78 percent of total billed charges 969.15 969.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION LG NS 4 POSITION PIN MR CONDITIONAL SUP-390.009 CDM 270010022 LOCAL 0270 RC outpatient 809.9 809.9 809.9 74 599.33 percent of total billed charges 809.9 93 656.02 percent of total billed charges 809.9 809.9 other OPPS APC 809.9 809.9 other OPPS APC 809.9 27.63 223.78 percent of total billed charges 809.9 809.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION LG NS 6 POSITION PIN MR CONDITIONAL SUP-390.010 CDM 270010022 LOCAL 0270 RC outpatient 2702.83 2702.83 2702.83 74 2000.09 percent of total billed charges 2702.83 93 2189.29 percent of total billed charges 2702.83 2702.83 other OPPS APC 2702.83 2702.83 other OPPS APC 2702.83 27.63 746.79 percent of total billed charges 2702.83 2702.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POST EXTERNAL FIXATION STRAIGHT 11MM NS OUTRIGGER MR SAFE SUP-390.011 CDM 270010022 LOCAL 0270 RC outpatient 220.22 220.22 220.22 74 162.96 percent of total billed charges 220.22 93 178.38 percent of total billed charges 220.22 220.22 other OPPS APC 220.22 220.22 other OPPS APC 220.22 27.63 60.85 percent of total billed charges 220.22 220.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POST EXTERNAL FIXATION 30 D OD11 MM OUTRIGGER MR SAFE NONSTERILE SUP-390.012 CDM 270010022 LOCAL 0270 RC outpatient 713.83 713.83 713.83 74 528.23 percent of total billed charges 713.83 93 578.2 percent of total billed charges 713.83 713.83 other OPPS APC 713.83 713.83 other OPPS APC 713.83 27.63 197.23 percent of total billed charges 713.83 713.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION MEDIUM COMBINATION SELF HOLD CLIP ON MR SAFE NONSTERILE 3 MM THREAD ROD SUP-390.031 CDM 270010022 LOCAL 0270 RC outpatient 1495.78 1495.78 1495.78 74 1106.88 percent of total billed charges 1495.78 93 1211.58 percent of total billed charges 1495.78 1495.78 other OPPS APC 1495.78 1495.78 other OPPS APC 1495.78 27.63 413.28 percent of total billed charges 1495.78 1495.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION MEDIUM 4 POSISTION MULTIPIN MR SAFE NONSTERILE SUP-390.033 CDM 270010022 LOCAL 0270 RC outpatient 1810.38 1810.38 1810.38 74 1339.68 percent of total billed charges 1810.38 93 1466.41 percent of total billed charges 1810.38 1810.38 other OPPS APC 1810.38 1810.38 other OPPS APC 1810.38 27.63 500.21 percent of total billed charges 1810.38 1810.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION MEDIUM MULTIPIN ROD ATTACHMENT MRI SAFE NONSTERILE SUP-390.034 CDM 270010022 LOCAL 0270 RC outpatient 1041.04 1041.04 1041.04 74 770.37 percent of total billed charges 1041.04 93 843.24 percent of total billed charges 1041.04 1041.04 other OPPS APC 1041.04 1041.04 other OPPS APC 1041.04 27.63 287.64 percent of total billed charges 1041.04 1041.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION MEDIUM OPEN ADJUSTABLE NONSTERILE SUP-390.035 CDM 270010022 LOCAL 0270 RC outpatient 1234.09 1234.09 1234.09 74 913.23 percent of total billed charges 1234.09 93 999.61 percent of total billed charges 1234.09 1234.09 other OPPS APC 1234.09 1234.09 other OPPS APC 1234.09 27.63 340.98 percent of total billed charges 1234.09 1234.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION MEDIUM 6 POSISTION MULTIPIN MR SAFE NONSTERILE SUP-390.036 CDM 270010022 LOCAL 0270 RC outpatient 1970.54 1970.54 1970.54 74 1458.2 percent of total billed charges 1970.54 93 1596.14 percent of total billed charges 1970.54 1970.54 other OPPS APC 1970.54 1970.54 other OPPS APC 1970.54 27.63 544.46 percent of total billed charges 1970.54 1970.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION OD11 MM ODSEC8 MM COMBINATION CLIP ON SELF HOLD MR SAFE NONSTERILE MEDIUM SUP-390.037 CDM 270010022 LOCAL 0270 RC outpatient 1720.29 1720.29 1720.29 74 1273.01 percent of total billed charges 1720.29 93 1393.43 percent of total billed charges 1720.29 1720.29 other OPPS APC 1720.29 1720.29 other OPPS APC 1720.29 27.63 475.32 percent of total billed charges 1720.29 1720.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION OD4 MM ADJUSTABLE NONSTERILE DISTAL RADIAL FIXATOR SUP-390.051 CDM 270010022 LOCAL 0270 RC outpatient 1611.79 1611.79 1611.79 74 1192.72 percent of total billed charges 1611.79 93 1305.55 percent of total billed charges 1611.79 1611.79 other OPPS APC 1611.79 1611.79 other OPPS APC 1611.79 27.63 445.34 percent of total billed charges 1611.79 1611.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC ASNIS III STAINLESS STEEL 4 MM CANNULATED SCREW SUP-390018 CDM 0270 RC outpatient 108.16 108.16 108.16 74 80.04 percent of total billed charges 108.16 93 87.61 percent of total billed charges 108.16 108.16 other OPPS APC 108.16 108.16 other OPPS APC 108.16 27.63 29.88 percent of total billed charges 108.16 108.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL L150 MM OD1.2 MM PREDRILL SUP-390152 CDM 270010022 LOCAL 0270 RC outpatient 27.04 27.04 27.04 74 20.01 percent of total billed charges 27.04 93 21.9 percent of total billed charges 27.04 27.04 other OPPS APC 27.04 27.04 other OPPS APC 27.04 27.63 7.47 percent of total billed charges 27.04 27.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER HOFFMANN II MICRO L150 MM OD1.4 MM SUP-390162 CDM 0270 RC outpatient 33.28 33.28 33.28 74 24.63 percent of total billed charges 33.28 93 26.96 percent of total billed charges 33.28 33.28 other OPPS APC 33.28 33.28 other OPPS APC 33.28 27.63 9.2 percent of total billed charges 33.28 33.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVICEL 1 APPLICATOR 1 BIOLOGIC 2ML - NEED TO ADD PMM 101 AND 102 SUP-3902 CDM 0270 RC outpatient 580.42 580.42 580.42 74 429.51 percent of total billed charges 580.42 93 470.14 percent of total billed charges 580.42 580.42 other OPPS APC 580.42 580.42 other OPPS APC 580.42 27.63 160.37 percent of total billed charges 580.42 580.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING PEBAX BIOSLIDE LOW PROFILE TAPER L150 CM L40 MM OD4 FR ODSEC3 MM OTW INFLATION WIRE PORT ACCEPTS .018 IN GUIDEWIRE PTA SUP-39032-30041 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING PEBAX BIOSLIDE L150 CM L150 MM OD7 FR ODSEC5 MM ID5 FR OTW INFLATION PORT LOW PROFILE TAPER TIP ACCEPTS .018 IN GUIDEWIRE PTA SUP-39032-50151 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING PEBAX BIOSLIDE L150 CM L220 MM OD7 FR ODSEC5 MM ID5 FR OTW INFLATION PORT LOW PROFILE TAPER TIP ACCEPTS .018 IN GUIDEWIRE PTA SUP-39032-50221 CDM 0270 RC outpatient 863.2 863.2 863.2 74 638.77 percent of total billed charges 863.2 93 699.19 percent of total billed charges 863.2 863.2 other OPPS APC 863.2 863.2 other OPPS APC 863.2 27.63 238.5 percent of total billed charges 863.2 863.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING PEBAX BIOSLIDE L150 CM L150 MM OD7 FR ODSEC6 MM ID5 FR OTW INFLATION PORT LOW PROFILE TAPER TIP ACCEPTS .018 IN GUIDEWIRE PTA SUP-39032-60151 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING PEBAX BIOSLIDE L150 CM L220 MM OD7 FR ODSEC6 MM ID5 FR OTW INFLATION PORT LOW PROFILE TAPER TIP ACCEPTS .018 IN GUIDEWIRE PTA SUP-39032-60221 CDM 0270 RC outpatient 754 754 754 74 557.96 percent of total billed charges 754 93 610.74 percent of total billed charges 754 754 other OPPS APC 754 754 other OPPS APC 754 27.63 208.33 percent of total billed charges 754 754 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING PEBAX BIOSLIDE L135 CM L40 MM OD7 FR ODSEC9 MM ID5 FR OTW INFLATION PORT LOW PROFILE TAPER TIP ACCEPTS .018 IN GUIDEWIRE PTA SUP-39032-90401 CDM 0270 RC outpatient 702 702 702 74 519.48 percent of total billed charges 702 93 568.62 percent of total billed charges 702 702 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GOWN SURGICAL SMARTGOWN 2XL XLONG LEVEL 4 RAGLAN SLEEVE BREATHABLE STERILE LATEX FREE DISPOSABLE SUP-39079 CDM 0270 RC outpatient 13.35 13.35 13.35 74 9.88 percent of total billed charges 13.35 93 10.81 percent of total billed charges 13.35 13.35 other OPPS APC 13.35 13.35 other OPPS APC 13.35 27.63 3.69 percent of total billed charges 13.35 13.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP APPLICATOR EVICEL L35 CM RIGID FIBRIN SEALANT SUP-3908 CDM 0270 RC outpatient 112.64 112.64 112.64 74 83.35 percent of total billed charges 112.64 93 91.24 percent of total billed charges 112.64 112.64 other OPPS APC 112.64 112.64 other OPPS APC 112.64 27.63 31.12 percent of total billed charges 112.64 112.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XBRAID 1.2MM TT SUP-3910900017 CDM 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KINETIX STRAIGHT TIP GUIDEWIRE 185CM SUP-39122-01 CDM 0481 RC outpatient 182 182 182 74 134.68 percent of total billed charges 182 93 147.42 percent of total billed charges 182 182 other OPPS APC 182 182 other OPPS APC 182 51 92.82 percent of total billed charges 182 182 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KINETIX J-TIP GUIDEWIRE 185CM SUP-39122-01J CDM 0481 RC outpatient 182 182 182 74 134.68 percent of total billed charges 182 93 147.42 percent of total billed charges 182 182 other OPPS APC 182 182 other OPPS APC 182 51 92.82 percent of total billed charges 182 182 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG 135CM 60MM 6MM 5FR NYBAX MEDIGLIDE HIGH PRESSURE SUP-39171-06061 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG LOW PROFILE 75CM 80MM 5.3FR 7MM NYBAX HIGH SUP-39171-07087 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG 135CM 20MM 8MM 6FR NYBAX MEDIGLIDE HIGH PRESSURE SUP-39171-08021 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG 135CM 40MM 8MM 6FR NYBAX MEDIGLIDE HIGH PRESSURE SUP-39171-08041 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG .035IN 75CM 60MM 8MM NYBAX HIGH PRESSURE LOW SUP-39171-08067 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE ULTRA LOW PROFILE TAPER 150CM 60MM 6FR 3MM NYBAX SUP-39186-30061 CDM 0270 RC outpatient 767 767 767 74 567.58 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 27.63 211.92 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE ULTRA LOW PROFILE TAPER 150CM 220MM 6FR 4MM NYBAX SUP-39186-40221 CDM 0270 RC outpatient 819 819 819 74 606.06 percent of total billed charges 819 93 663.39 percent of total billed charges 819 819 other OPPS APC 819 819 other OPPS APC 819 27.63 226.29 percent of total billed charges 819 819 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP PROTECTIVE NONSTERILE 2.5 MM KIRSCHNER WIRE SUP-392.24 CDM 270010022 LOCAL 0270 RC outpatient 15.3 15.3 15.3 74 11.32 percent of total billed charges 15.3 93 12.39 percent of total billed charges 15.3 15.3 other OPPS APC 15.3 15.3 other OPPS APC 15.3 27.63 4.23 percent of total billed charges 15.3 15.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L75 CM L80 MM L114 CM OD6 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-39200-06807 CDM 0270 RC outpatient 2457 2457 2457 74 1818.18 percent of total billed charges 2457 93 1990.17 percent of total billed charges 2457 2457 other OPPS APC 2457 2457 other OPPS APC 2457 27.63 678.87 percent of total billed charges 2457 2457 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR VICTORY STAINLESS STEEL PTFE HYDROPHILIC STRAIGHT L300 CM OD.014 IN ODSEC12 GA BROAD MATRIX PUSHABILITY EXCELLENT CROSS ENHANCE TORQUE RADIOPAQUE SUP-39230-30012 CDM 0270 RC outpatient 385.06 385.06 385.06 74 284.94 percent of total billed charges 385.06 93 311.9 percent of total billed charges 385.06 385.06 other OPPS APC 385.06 385.06 other OPPS APC 385.06 27.63 106.39 percent of total billed charges 385.06 385.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR VICTORY STAINLESS STEEL PTFE HYDROPHILIC STRAIGHT L300 CM OD.014 IN ODSEC18 GA PERIPHERAL BROAD MATRIX EXCELLENT CROSS ENHANCE TORQUE RADIOPAQUE SUP-39230-30018 CDM 0270 RC outpatient 385.06 385.06 385.06 74 284.94 percent of total billed charges 385.06 93 311.9 percent of total billed charges 385.06 385.06 other OPPS APC 385.06 385.06 other OPPS APC 385.06 27.63 106.39 percent of total billed charges 385.06 385.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING RUBICON NYLON HYDROPHILIC 15 MM SPACE L135 CM OD4 FR ODSEC1.7 FR RADIOPAQUE STRAIGHT TIP HUB SHAFT CLEAR PURPLE ACCEPTS .018 IN GUIDEWIRE 4 FR SHEATH SUP-39239-01813 CDM 0270 RC outpatient 351 351 351 74 259.74 percent of total billed charges 351 93 284.31 percent of total billed charges 351 351 other OPPS APC 351 351 other OPPS APC 351 27.63 96.98 percent of total billed charges 351 351 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION NS RING TO ROD SUP-393.436 CDM 270010022 LOCAL 0270 RC outpatient 2506.79 2506.79 2506.79 74 1855.02 percent of total billed charges 2506.79 93 2030.5 percent of total billed charges 2506.79 2506.79 other OPPS APC 2506.79 2506.79 other OPPS APC 2506.79 27.63 692.63 percent of total billed charges 2506.79 2506.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION NS ADJUSTABLE WIRE PIN SUP-393.464 CDM 270010022 LOCAL 0270 RC outpatient 2237.95 2237.95 2237.95 74 1656.08 percent of total billed charges 2237.95 93 1812.74 percent of total billed charges 2237.95 2237.95 other OPPS APC 2237.95 2237.95 other OPPS APC 2237.95 27.63 618.35 percent of total billed charges 2237.95 2237.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION ADJUSTABLE NONSTERILE 4/6 MM SCHANZ SCREW LARGE EXTERNAL FIXATOR SUP-393.640 CDM 270010022 LOCAL 0270 RC outpatient 1319.76 1319.76 1319.76 74 976.62 percent of total billed charges 1319.76 93 1069.01 percent of total billed charges 1319.76 1319.76 other OPPS APC 1319.76 1319.76 other OPPS APC 1319.76 27.63 364.65 percent of total billed charges 1319.76 1319.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING EXTERNAL FIXATION .75 205MM NS SUP-393.722 CDM 270010022 LOCAL 0270 RC outpatient 1552.98 1552.98 1552.98 74 1149.21 percent of total billed charges 1552.98 93 1257.91 percent of total billed charges 1552.98 1552.98 other OPPS APC 1552.98 1552.98 other OPPS APC 1552.98 27.63 429.09 percent of total billed charges 1552.98 1552.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING EXTERNAL FIXATION .75 115MM NS SUP-393.732 CDM 270010022 LOCAL 0270 RC outpatient 1142.57 1142.57 1142.57 74 845.5 percent of total billed charges 1142.57 93 925.48 percent of total billed charges 1142.57 1142.57 other OPPS APC 1142.57 1142.57 other OPPS APC 1142.57 27.63 315.69 percent of total billed charges 1142.57 1142.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING EXTERNAL FIXATION .75 140MM NS SUP-393.734 CDM 270010022 LOCAL 0270 RC outpatient 1248.39 1248.39 1248.39 74 923.81 percent of total billed charges 1248.39 93 1011.2 percent of total billed charges 1248.39 1248.39 other OPPS APC 1248.39 1248.39 other OPPS APC 1248.39 27.63 344.93 percent of total billed charges 1248.39 1248.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING EXTERNAL FIXATION .75 165MM NS SUP-393.736 CDM 270010022 LOCAL 0270 RC outpatient 1311.31 1311.31 1311.31 74 970.37 percent of total billed charges 1311.31 93 1062.16 percent of total billed charges 1311.31 1311.31 other OPPS APC 1311.31 1311.31 other OPPS APC 1311.31 27.63 362.31 percent of total billed charges 1311.31 1311.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 1.25 x 6 MM SUP-393289_57339 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 1.5 x 6 MM SUP-393290_57340 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 1.25 x 10 MM SUP-393291_57341 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 1.5 x 10 MM SUP-393292_57342 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 2.0 x 10 MM SUP-393293_57343 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 2.5 x 10 MM SUP-393294_57344 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 3.0 x 10 MM SUP-393295_57345 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 3.5 x 10 MM SUP-393296_57346 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 4.0 x 10 MM SUP-393297_57347 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 1.25 x 15 MM SUP-393298_57348 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 1.5 x 15 MM SUP-393299_57349 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 2.0 x 15 MM SUP-393300_57350 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 2.5 x 15 MM SUP-393301_57351 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 3.0 x 15 MM SUP-393302_57352 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION PANTERA PRO SEMICRYSTALLINE COPOLYMER HYDROPHILIC .014 IN L 140 CM L15MM ODSEC 3.50MM 2 FOLD HYPO TUBE GUIDEWIRE RADIOPAQUE LATEX FREE ACCEPTS 5 FRENCH GUIDE CATHETER PTCA SUP-393303_57353 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 4.0 x 15 MM SUP-393304_57354 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION PANTERA PRO SEMICRYSTALLINE COPOLYMER HYDROPHILIC .014 IN L 140 CM L20MM ODSEC 1.25MM 2 FOLD HYPO TUBE GUIDEWIRE RADIOPAQUE LATEX FREE ACCEPTS 5 FRENCH GUIDE CATHETER PTCA SUP-393305_57355 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 1.5 x 20 MM SUP-393306_57356 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 2.0 x 20 MM SUP-393307_57357 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION PANTERA PRO SEMICRYSTALLINE COPOLYMER HYDROPHILIC .014 IN L 140 CM L20MM ODSEC 2.50MM 2 FOLD HYPO TUBE GUIDEWIRE RADIOPAQUE LATEX FREE ACCEPTS 5 FRENCH GUIDE CATHETER PTCA SUP-393308_57358 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION PANTERA PRO SEMICRYSTALLINE COPOLYMER HYDROPHILIC .014 IN L 140 CM L20MM ODSEC 3.00MM 2 FOLD HYPO TUBE GUIDEWIRE RADIOPAQUE LATEX FREE ACCEPTS 5 FRENCH GUIDE CATHETER PTCA SUP-393309_57359 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 3.5 x 20 MM SUP-393310_57360 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 4.0 x 20 MM SUP-393311_57361 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 2.0 x 25 MM SUP-393312_57362 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 2.5 x 25 MM SUP-393313_57363 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 3.0 x 25 MM SUP-393314_57364 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 3.5 x 25 MM SUP-393315_57365 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 4.0 x 25 MM SUP-393316_57366 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 2.0 x 30 MM SUP-393317_57367 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 2.5 x 30 MM SUP-393318_57368 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 3.0 x 30 MM SUP-393319_57369 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 3.5 x 30 MM SUP-393320_57370 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTERA BALLOON 4.0 x 30 MM SUP-393321_57371 CDM 0481 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIXATOR EXTERNAL FIXATION DISTAL ADJUSTABLE NONSTERILE SUP-394.050 CDM 270010022 LOCAL 0270 RC outpatient 5266.69 5266.69 5266.69 74 3897.35 percent of total billed charges 5266.69 93 4266.02 percent of total billed charges 5266.69 5266.69 other OPPS APC 5266.69 5266.69 other OPPS APC 5266.69 27.63 1455.19 percent of total billed charges 5266.69 5266.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD CARBON FIBER 11MM X 190MM SUP-394.797 CDM 270010022 LOCAL 0270 RC outpatient 1968.51 1968.51 1968.51 74 1456.7 percent of total billed charges 1968.51 93 1594.49 percent of total billed charges 1968.51 1968.51 other OPPS APC 1968.51 1968.51 other OPPS APC 1968.51 27.63 543.9 percent of total billed charges 1968.51 1968.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION 100MM 11MM CARBON FIBER NS SELF DRILL MR CONDITIONAL SUP-394.800 CDM 270010022 LOCAL 0270 RC outpatient 632.06 632.06 632.06 74 467.72 percent of total billed charges 632.06 93 511.97 percent of total billed charges 632.06 632.06 other OPPS APC 632.06 632.06 other OPPS APC 632.06 27.63 174.64 percent of total billed charges 632.06 632.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION 150MM 11MM CARBON FIBER NS MR CONDITIONAL SUP-394.82 CDM 270010022 LOCAL 0270 RC outpatient 632.06 632.06 632.06 74 467.72 percent of total billed charges 632.06 93 511.97 percent of total billed charges 632.06 632.06 other OPPS APC 632.06 632.06 other OPPS APC 632.06 27.63 174.64 percent of total billed charges 632.06 632.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION 200MM 11MM CARBON FIBER NS MR CONDITIONAL SUP-394.83 CDM 270010022 LOCAL 0270 RC outpatient 402.22 402.22 402.22 74 297.64 percent of total billed charges 402.22 93 325.8 percent of total billed charges 402.22 402.22 other OPPS APC 402.22 402.22 other OPPS APC 402.22 27.63 111.13 percent of total billed charges 402.22 402.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION 250MM 11MM CARBON FIBER NS MR CONDITIONAL SUP-394.840 CDM 270010022 LOCAL 0270 RC outpatient 431.34 431.34 431.34 74 319.19 percent of total billed charges 431.34 93 349.39 percent of total billed charges 431.34 431.34 other OPPS APC 431.34 431.34 other OPPS APC 431.34 27.63 119.18 percent of total billed charges 431.34 431.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION CARBON FIBER L300 MM OD11 MM MR CONDITIONAL NONSTERILE SUP-394.85 CDM 270010022 LOCAL 0270 RC outpatient 1398.93 1398.93 1398.93 74 1035.21 percent of total billed charges 1398.93 93 1133.13 percent of total billed charges 1398.93 1398.93 other OPPS APC 1398.93 1398.93 other OPPS APC 1398.93 27.63 386.52 percent of total billed charges 1398.93 1398.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION 350MM 11MM CARBON FIBER NS MR CONDITIONAL SUP-394.86 CDM 270010022 LOCAL 0270 RC outpatient 1398.93 1398.93 1398.93 74 1035.21 percent of total billed charges 1398.93 93 1133.13 percent of total billed charges 1398.93 1398.93 other OPPS APC 1398.93 1398.93 other OPPS APC 1398.93 27.63 386.52 percent of total billed charges 1398.93 1398.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION CARBON FIBER L400 MM OD11 MM MR CONDITIONAL NONSTERILE SUP-394.87 CDM 270010022 LOCAL 0270 RC outpatient 473.2 473.2 473.2 74 350.17 percent of total billed charges 473.2 93 383.29 percent of total billed charges 473.2 473.2 other OPPS APC 473.2 473.2 other OPPS APC 473.2 27.63 130.75 percent of total billed charges 473.2 473.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP PROTECTIVE NONSTERILE 11 MM CARBON FIBER ROD SUP-394.97 CDM 270010022 LOCAL 0270 RC outpatient 8.15 8.15 8.15 74 6.03 percent of total billed charges 8.15 93 6.6 percent of total billed charges 8.15 8.15 other OPPS APC 8.15 8.15 other OPPS APC 8.15 27.63 2.25 percent of total billed charges 8.15 8.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP PROTECTIVE NONSTERILE YELLOW 4 MM FIXATION PIN SUP-394.991 CDM 270010022 LOCAL 0270 RC outpatient 16.16 16.16 16.16 74 11.96 percent of total billed charges 16.16 93 13.09 percent of total billed charges 16.16 16.16 other OPPS APC 16.16 16.16 other OPPS APC 16.16 27.63 4.47 percent of total billed charges 16.16 16.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP PROTECTIVE NONSTERILE BLUE 5 MM FIXATION PIN SUP-394.993 CDM 270010022 LOCAL 0270 RC outpatient 14.33 14.33 14.33 74 10.6 percent of total billed charges 14.33 93 11.61 percent of total billed charges 14.33 14.33 other OPPS APC 14.33 14.33 other OPPS APC 14.33 27.63 3.96 percent of total billed charges 14.33 14.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP PROTECTIVE 6MM FIXATION PIN NS GREEN SUP-394.994 CDM 270010022 LOCAL 0270 RC outpatient 15.28 15.28 15.28 74 11.31 percent of total billed charges 15.28 93 12.38 percent of total billed charges 15.28 15.28 other OPPS APC 15.28 15.28 other OPPS APC 15.28 27.63 4.22 percent of total billed charges 15.28 15.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAR EXTERNAL FIXATION ANGLE 3MM NS CONNECT SUP-395.103 CDM 270010022 LOCAL 0270 RC outpatient 145.86 145.86 145.86 74 107.94 percent of total billed charges 145.86 93 118.15 percent of total billed charges 145.86 145.86 other OPPS APC 145.86 145.86 other OPPS APC 145.86 27.63 40.3 percent of total billed charges 145.86 145.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION 25MM 3MM CARBON FIBER NS CONNECT RADIOLUCENT SUP-395.105 CDM 270010022 LOCAL 0270 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 27.63 31.61 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION CARBON FIBER L45 MM OD3 MM NONSTERILE MINI EXTERNAL FIXATOR SUP-395.107 CDM 270010022 LOCAL 0270 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 27.63 31.61 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION 60MM 3MM CARBON FIBER NS SUP-395.109 CDM 270010022 LOCAL 0270 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 27.63 31.61 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION CARBON FIBER L75 MM OD3 MM CONNECTING RADIOLUCENT NONSTERILE MINI EXTERNAL FIXATOR SUP-395.111 CDM 270010022 LOCAL 0270 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 27.63 31.61 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION NS HOLD 1.25 MM K WIRE SUP-395.125 CDM 270010022 LOCAL 0270 RC outpatient 1983.41 1983.41 1983.41 74 1467.72 percent of total billed charges 1983.41 93 1606.56 percent of total billed charges 1983.41 1983.41 other OPPS APC 1983.41 1983.41 other OPPS APC 1983.41 27.63 548.02 percent of total billed charges 1983.41 1983.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION OD1.6 MM HOLD NONSTERILE 1.6 MM K WIRE MINI EXTERNAL FIXATOR SUP-395.126 CDM 270010022 LOCAL 0270 RC outpatient 1983.41 1983.41 1983.41 74 1467.72 percent of total billed charges 1983.41 93 1606.56 percent of total billed charges 1983.41 1983.41 other OPPS APC 1983.41 1983.41 other OPPS APC 1983.41 27.63 548.02 percent of total billed charges 1983.41 1983.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION OD3 MM CONNECTING NONSTERILE MINI EXTERNAL FIXATOR SUP-395.133 CDM 270010022 LOCAL 0270 RC outpatient 1843.27 1843.27 1843.27 74 1364.02 percent of total billed charges 1843.27 93 1493.05 percent of total billed charges 1843.27 1843.27 other OPPS APC 1843.27 1843.27 other OPPS APC 1843.27 27.63 509.3 percent of total billed charges 1843.27 1843.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION SMALL OD2.5 MM ODSEC4 MM NONSTERILE SMALL EXTERNAL FIXATOR SUP-395.56 CDM 270010022 LOCAL 0270 RC outpatient 846.56 846.56 846.56 74 626.45 percent of total billed charges 846.56 93 685.71 percent of total billed charges 846.56 846.56 other OPPS APC 846.56 846.56 other OPPS APC 846.56 27.63 233.9 percent of total billed charges 846.56 846.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NUT EXTERNAL FIXATION SPRING LOADED LIGHT TIGHTENING NONSTERILE SUP-395.58 CDM 270010022 LOCAL 0270 RC outpatient 115.83 115.83 115.83 74 85.71 percent of total billed charges 115.83 93 93.82 percent of total billed charges 115.83 115.83 other OPPS APC 115.83 115.83 other OPPS APC 115.83 27.63 32 percent of total billed charges 115.83 115.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION CARBON FIBER L60 MM OD4 MM SUP-395.6 CDM 270010022 LOCAL 0270 RC outpatient 124.02 124.02 124.02 74 91.77 percent of total billed charges 124.02 93 100.46 percent of total billed charges 124.02 124.02 other OPPS APC 124.02 124.02 other OPPS APC 124.02 27.63 34.27 percent of total billed charges 124.02 124.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION 60MM 4MM CARBON FIBER NS SUP-395.600 CDM 270010022 LOCAL 0270 RC outpatient 124.02 124.02 124.02 74 91.77 percent of total billed charges 124.02 93 100.46 percent of total billed charges 124.02 124.02 other OPPS APC 124.02 124.02 other OPPS APC 124.02 27.63 34.27 percent of total billed charges 124.02 124.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION CARBON FIBER L80 MM OD4 MM NONSTERILE SMALL EXTERNAL FIXATOR SUP-395.61 CDM 270010022 LOCAL 0270 RC outpatient 107.25 107.25 107.25 74 79.37 percent of total billed charges 107.25 93 86.87 percent of total billed charges 107.25 107.25 other OPPS APC 107.25 107.25 other OPPS APC 107.25 27.63 29.63 percent of total billed charges 107.25 107.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION CARBON FIBER L100 MM OD4 MM NONSTERILE SMALL EXTERNAL FIXATOR SUP-395.62 CDM 270010022 LOCAL 0270 RC outpatient 107.25 107.25 107.25 74 79.37 percent of total billed charges 107.25 93 86.87 percent of total billed charges 107.25 107.25 other OPPS APC 107.25 107.25 other OPPS APC 107.25 27.63 29.63 percent of total billed charges 107.25 107.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION CARBON FIBER L120 MM OD4 MM NONSTERILE SMALL EXTERNAL FIXATOR SUP-395.63 CDM 270010022 LOCAL 0270 RC outpatient 107.25 107.25 107.25 74 79.37 percent of total billed charges 107.25 93 86.87 percent of total billed charges 107.25 107.25 other OPPS APC 107.25 107.25 other OPPS APC 107.25 27.63 29.63 percent of total billed charges 107.25 107.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION CARBON FIBER L140 MM OD4 MM NONSTERILE SMALL EXTERNAL FIXATOR SUP-395.64 CDM 270010022 LOCAL 0270 RC outpatient 147.29 147.29 147.29 74 108.99 percent of total billed charges 147.29 93 119.3 percent of total billed charges 147.29 147.29 other OPPS APC 147.29 147.29 other OPPS APC 147.29 27.63 40.7 percent of total billed charges 147.29 147.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION CARBON FIBER L160 MM OD4 MM NONSTERILE SMALL EXTERNAL FIXATOR SUP-395.65 CDM 270010022 LOCAL 0270 RC outpatient 147.29 147.29 147.29 74 108.99 percent of total billed charges 147.29 93 119.3 percent of total billed charges 147.29 147.29 other OPPS APC 147.29 147.29 other OPPS APC 147.29 27.63 40.7 percent of total billed charges 147.29 147.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION CARBON FIBER L180 MM OD4 MM NONSTERILE SMALL EXTERNAL FIXATOR SUP-395.66 CDM 270010022 LOCAL 0270 RC outpatient 147.29 147.29 147.29 74 108.99 percent of total billed charges 147.29 93 119.3 percent of total billed charges 147.29 147.29 other OPPS APC 147.29 147.29 other OPPS APC 147.29 27.63 40.7 percent of total billed charges 147.29 147.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION CARBON FIBER L200 MM OD4 MM NONSTERILE SUP-395.67 CDM 270010022 LOCAL 0270 RC outpatient 147.29 147.29 147.29 74 108.99 percent of total billed charges 147.29 93 119.3 percent of total billed charges 147.29 147.29 other OPPS APC 147.29 147.29 other OPPS APC 147.29 27.63 40.7 percent of total billed charges 147.29 147.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION CARBON FIBER MEDIUM L160 MM OD8 MM NONSTERILE SUP-395.779 CDM 270010022 LOCAL 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION CARBON FIBER MEDIUM L120 MM OD8 MM NONSTERILE MEDIUM EXTERNAL FIXATOR SUP-395.780 CDM 270010022 LOCAL 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP PROTECTIVE NONSTERILE 8 MM CARBON FIBER ROD SUP-395.781 CDM 270010022 LOCAL 0270 RC outpatient 20.02 20.02 20.02 74 14.81 percent of total billed charges 20.02 93 16.22 percent of total billed charges 20.02 20.02 other OPPS APC 20.02 20.02 other OPPS APC 20.02 27.63 5.53 percent of total billed charges 20.02 20.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION CARBON FIBER L200 MM OD8 MM DISTAL RADIUS NONSTERILE SUP-395.782 CDM 270010022 LOCAL 0270 RC outpatient 315.54 315.54 315.54 74 233.5 percent of total billed charges 315.54 93 255.59 percent of total billed charges 315.54 315.54 other OPPS APC 315.54 315.54 other OPPS APC 315.54 27.63 87.18 percent of total billed charges 315.54 315.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION CARBON FIBER L220 MM OD8 MM DISTAL RADIUS NONSTERILE SUP-395.784 CDM 270010022 LOCAL 0270 RC outpatient 315.54 315.54 315.54 74 233.5 percent of total billed charges 315.54 93 255.59 percent of total billed charges 315.54 315.54 other OPPS APC 315.54 315.54 other OPPS APC 315.54 27.63 87.18 percent of total billed charges 315.54 315.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION CARBON FIBER L240 MM OD8 MM DISTAL RADIUS NONSTERILE SUP-395.786 CDM 270010022 LOCAL 0270 RC outpatient 315.54 315.54 315.54 74 233.5 percent of total billed charges 315.54 93 255.59 percent of total billed charges 315.54 315.54 other OPPS APC 315.54 315.54 other OPPS APC 315.54 27.63 87.18 percent of total billed charges 315.54 315.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION CARBON FIBER L280 MM OD8 MM DISTAL RADIUS NONSTERILE SUP-395.788 CDM 270010022 LOCAL 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION CARBON FIBER MEDIUM L320 MM OD8 MM NONSTERILE SUP-395.792 CDM 270010022 LOCAL 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION CARBON FIBER L360 MM OD8 MM NONSTERILE SUP-395.796 CDM 270010022 LOCAL 0270 RC outpatient 463.32 463.32 463.32 74 342.86 percent of total billed charges 463.32 93 375.29 percent of total billed charges 463.32 463.32 other OPPS APC 463.32 463.32 other OPPS APC 463.32 27.63 128.02 percent of total billed charges 463.32 463.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD EXTERNAL FIXATION 400MM 8MM CARBON FIBER NS SUP-395.797 CDM 270010022 LOCAL 0270 RC outpatient 463.32 463.32 463.32 74 342.86 percent of total billed charges 463.32 93 375.29 percent of total billed charges 463.32 463.32 other OPPS APC 463.32 463.32 other OPPS APC 463.32 27.63 128.02 percent of total billed charges 463.32 463.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.25 X 8 SUP-39528-0822 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.5 X 8 SUP-39528-0825 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.75 X 8 SUP-39528-0827 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 3.0 X 8 SUP-39528-0830 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 3.5 X 8 SUP-39528-0835 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 4.0 X 8 SUP-39528-0840 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.25 X 12 SUP-39528-1222 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.5 X 12 SUP-39528-1225 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.75 X 12 SUP-39528-1227 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 3.0 X 12 SUP-39528-1230 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 3.5 X 12 SUP-39528-1235 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 4.0 X 12 SUP-39528-1240 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.25 X 16 SUP-39528-1622 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.5 X 16 SUP-39528-1625 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.75 X 16 SUP-39528-1627 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 3.0 X 16 SUP-39528-1630 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 3.5 X 16 SUP-39528-1635 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 4.0 X 16 SUP-39528-1640 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.25 X 20 SUP-39528-2022 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.5 X 20 SUP-39528-2025 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.75 X 20 SUP-39528-2027 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 3.0 X 20 SUP-39528-2030 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 3.5 X 20 SUP-39528-2035 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 4.0 X 20 SUP-39528-2040 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.25 X 24 SUP-39528-2422 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.5 X 24 SUP-39528-2425 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.75 X 24 SUP-39528-2427 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 3.0 X 24 SUP-39528-2430 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 3.5 X 24 SUP-39528-2435 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 4.0 X 24 SUP-39528-2440 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.25 X 28 SUP-39528-2822 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.5 X 28 SUP-39528-2825 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.75 X 28 SUP-39528-2827 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 3.0 X 28 SUP-39528-2830 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 3.5 X 28 SUP-39528-2835 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 4.0 X 28 SUP-39528-2840 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.25 X 32 SUP-39528-3222 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.5 X 32 SUP-39528-3225 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.75 X 32 SUP-39528-3227 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 3.0 X 32 SUP-39528-3230 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 3.5 X 32 SUP-39528-3235 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 4.0 X 32 SUP-39528-3240 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.5 X 38 SUP-39528-3825 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 2.75 X 38 SUP-39528-3827 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 3.0 X 38 SUP-39528-3830 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 3.5 X 38 SUP-39528-3835 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS PREMIER STENT 4.0 X 38 SUP-39528-3840 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 140 MM L400 MM OD2.5 MM JACOBS CHUCK NONSTERILE SUP-397.342 CDM 270010022 LOCAL 0270 RC outpatient 1475.76 1475.76 1475.76 74 1092.06 percent of total billed charges 1475.76 93 1195.37 percent of total billed charges 1475.76 1475.76 other OPPS APC 1475.76 1475.76 other OPPS APC 1475.76 27.63 407.75 percent of total billed charges 1475.76 1475.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L380 MM OD3.5 MM PERCUTANEOUS JACOBS CHUCK NONSTERILE SUP-397.343 CDM 270010022 LOCAL 0270 RC outpatient 1547.26 1547.26 1547.26 74 1144.97 percent of total billed charges 1547.26 93 1253.28 percent of total billed charges 1547.26 1547.26 other OPPS APC 1547.26 1547.26 other OPPS APC 1547.26 27.63 427.51 percent of total billed charges 1547.26 1547.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENT BONE HYDROSET CALCIUM PHOSPHATE 5 CC SELF SET INJECTABLE BIOCOMPATIBLE OSTEOCONDUCTIVE SUBSTITUTE VOID FILLER SUP-397005 CDM 0270 RC outpatient 4179.11 4179.11 4179.11 74 3092.54 percent of total billed charges 4179.11 93 3385.08 percent of total billed charges 4179.11 4179.11 other OPPS APC 4179.11 4179.11 other OPPS APC 4179.11 27.63 1154.69 percent of total billed charges 4179.11 4179.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROSET 10CC SUP-397010 CDM 0270 RC outpatient 7651.02 7651.02 7651.02 74 5661.75 percent of total billed charges 7651.02 93 6197.33 percent of total billed charges 7651.02 7651.02 other OPPS APC 7651.02 7651.02 other OPPS APC 7651.02 27.63 2113.98 percent of total billed charges 7651.02 7651.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET ORTHOPEDIC PELVIS SPIKED DISK NONSTERILE SUP-398.71 CDM 270010022 LOCAL 0270 RC outpatient 537.68 537.68 537.68 74 397.88 percent of total billed charges 537.68 93 435.52 percent of total billed charges 537.68 537.68 other OPPS APC 537.68 537.68 other OPPS APC 537.68 27.63 148.56 percent of total billed charges 537.68 537.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CAPSTONE CONTROL PEEK 0 D L22 MM X H10 MM STERILE INTERBODY FUSION SUP-3991022 CDM 270010020 LOCAL 0270 RC outpatient 6999.2 6999.2 6999.2 74 5179.41 percent of total billed charges 6999.2 93 5669.35 percent of total billed charges 6999.2 6999.2 other OPPS APC 6999.2 6999.2 other OPPS APC 6999.2 27.63 1933.88 percent of total billed charges 6999.2 6999.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CAPSTONE CONTROL PEEK 0 D L22 MM X H11 MM STERILE INTERBODY FUSION SUP-3991122 CDM 270010020 LOCAL 0270 RC outpatient 7703.28 7703.28 7703.28 74 5700.43 percent of total billed charges 7703.28 93 6239.66 percent of total billed charges 7703.28 7703.28 other OPPS APC 7703.28 7703.28 other OPPS APC 7703.28 27.63 2128.42 percent of total billed charges 7703.28 7703.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CAPSTONE CONTROL PEEK 0 D L22 MM X H12 MM STERILE INTERBODY FUSION SUP-3991222 CDM 270010020 LOCAL 0270 RC outpatient 7703.28 7703.28 7703.28 74 5700.43 percent of total billed charges 7703.28 93 6239.66 percent of total billed charges 7703.28 7703.28 other OPPS APC 7703.28 7703.28 other OPPS APC 7703.28 27.63 2128.42 percent of total billed charges 7703.28 7703.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER MULTIMED PENINSULA SUP-3K20C1827NL CDM 270009030 LOCAL 0270 RC outpatient 94.98 94.98 94.98 74 70.29 percent of total billed charges 94.98 93 76.93 percent of total billed charges 94.98 94.98 other OPPS APC 94.98 94.98 other OPPS APC 94.98 27.63 26.24 percent of total billed charges 94.98 94.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL CORAIL ARTICUL/EZE 135D 41.5MM 12/14 MINI TAPER STANDARD OFFSET 135MM SUP-3L92513 CDM 270010024 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STEM DEPUY FEMORAL CORAIL SUP-3L93709 CDM 270010024 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE GORE-TEX CV-3 TH-26 L36IN MONOFILAMENT WHITE SUP-3N07B CDM 0270 RC outpatient 79.08 79.08 79.08 74 58.52 percent of total billed charges 79.08 93 64.05 percent of total billed charges 79.08 79.08 other OPPS APC 79.08 79.08 other OPPS APC 79.08 27.63 21.85 percent of total billed charges 79.08 79.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE GORE-TEX 2-0 36IN 1/2 CIRCLE CV-3/TH-26 DOUBLE-ARM TAPER POINT WHITE 12/BX 3N08A MONOFILAMENT EPTFE 26MM NONABSORBABLE SUP-3N08A CDM 0270 RC outpatient 86.88 86.88 86.88 74 64.29 percent of total billed charges 86.88 93 70.37 percent of total billed charges 86.88 86.88 other OPPS APC 86.88 86.88 other OPPS APC 86.88 27.63 24 percent of total billed charges 86.88 86.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE ALLOQUENT CORTICAL 5 D H7 MM ALLOGRAFT LATEX FREE SUP-3W3007 CDM 270010020 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE ALLOQUENT CORTICAL 5 D H8 MM ALLOGRAFT LATEX FREE SUP-3W3008 CDM 270010020 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BINDER BREAST LINED 3XL SUP-3XL-L-BBIND CDM 0270 RC outpatient 110.34 110.34 110.34 74 81.65 percent of total billed charges 110.34 93 89.38 percent of total billed charges 110.34 110.34 other OPPS APC 110.34 110.34 other OPPS APC 110.34 27.63 30.49 percent of total billed charges 110.34 110.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARTRIDGE STERILIZATION 3M STERI-GAS ETHYLENE OXIDE 100 GM 1 DOSE NONINCINERATE WASTE GS5-2D 5XL GS5-1D SUP-4-100 CDM outpatient 8.91 8.91 8.91 8.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY SHILEY 4 41MM 5.9MM 4MM PVC DISPOSABLE STERILE LF PEDIATRIC GENTLE CYLINDRICAL CUFF SMOOTH ROUND SUP-4.0PDC CDM 0270 RC outpatient 121.76 121.76 121.76 74 90.1 percent of total billed charges 121.76 93 98.63 percent of total billed charges 121.76 121.76 other OPPS APC 121.76 121.76 other OPPS APC 121.76 27.63 33.64 percent of total billed charges 121.76 121.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY SHILEY 4 41MM 5.9MM 4MM DISPOSABLE STERILE LF PEDIATRIC UNCUFF SOFT FLANGE ROUND TIP OBTURATOR SUP-4.0PED CDM 270009156 LOCAL 0270 RC outpatient 50.7 50.7 50.7 74 37.52 percent of total billed charges 50.7 93 41.07 percent of total billed charges 50.7 50.7 other OPPS APC 50.7 50.7 other OPPS APC 50.7 27.63 14.01 percent of total billed charges 50.7 50.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SHILEY PEDIATRIC TRACH TUBE, CUFFLESS, 4.0MM" SUP-4.0PEF_603625 CDM 270009156 LOCAL 0270 RC outpatient 123.53 123.53 123.53 74 91.41 percent of total billed charges 123.53 93 100.06 percent of total billed charges 123.53 123.53 other OPPS APC 123.53 123.53 other OPPS APC 123.53 27.63 34.13 percent of total billed charges 123.53 123.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANESTHESIA CIR PEDIATRIC VITAL SUP-40-00002 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK ADULT MED SZ 5 SUP-40-00006 CDM 0272 RC outpatient 1.77 1.77 1.77 74 1.31 percent of total billed charges 1.77 93 1.43 percent of total billed charges 1.77 1.77 other OPPS APC 1.77 1.77 other OPPS APC 1.77 27.63 0.49 percent of total billed charges 1.77 1.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK INFANT SZ 2 SUP-40-00007 CDM 0272 RC outpatient 2.08 2.08 2.08 74 1.54 percent of total billed charges 2.08 93 1.68 percent of total billed charges 2.08 2.08 other OPPS APC 2.08 2.08 other OPPS APC 2.08 27.63 0.57 percent of total billed charges 2.08 2.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK NEONATAL SUP-40-00008 CDM 0272 RC outpatient 1.5 1.5 1.5 74 1.11 percent of total billed charges 1.5 93 1.22 percent of total billed charges 1.5 1.5 other OPPS APC 1.5 1.5 other OPPS APC 1.5 27.63 0.41 percent of total billed charges 1.5 1.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK SM ADULT/CHILD SZ 4 SUP-40-00010 CDM 0272 RC outpatient 2.16 2.16 2.16 74 1.6 percent of total billed charges 2.16 93 1.75 percent of total billed charges 2.16 2.16 other OPPS APC 2.16 2.16 other OPPS APC 2.16 27.63 0.6 percent of total billed charges 2.16 2.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK TODDLER SZ-3 ANESTHESIA/P SUP-40-00011 CDM 0272 RC outpatient 2.28 2.28 2.28 74 1.69 percent of total billed charges 2.28 93 1.85 percent of total billed charges 2.28 2.28 other OPPS APC 2.28 2.28 other OPPS APC 2.28 27.63 0.63 percent of total billed charges 2.28 2.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THERMOMETER SHEATH/ DISP PROBE SUP-40-00012 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET STANDARD FLOW RANGER SUP-40-00018 CDM 0272 RC outpatient 35.09 35.09 35.09 74 25.97 percent of total billed charges 35.09 93 28.42 percent of total billed charges 35.09 35.09 other OPPS APC 35.09 35.09 other OPPS APC 35.09 27.63 9.7 percent of total billed charges 35.09 35.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET FILTER ACCESSORY HIGH FLOW SUP-40-00019 CDM 0272 RC outpatient 40 40 40 74 29.6 percent of total billed charges 40 93 32.4 percent of total billed charges 40 40 other OPPS APC 40 40 other OPPS APC 40 27.63 11.05 percent of total billed charges 40 40 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GAS SAMPLING INTERFACE SUP-40-00065 CDM 0272 RC outpatient 1.52 1.52 1.52 74 1.12 percent of total billed charges 1.52 93 1.23 percent of total billed charges 1.52 1.52 other OPPS APC 1.52 1.52 other OPPS APC 1.52 27.63 0.42 percent of total billed charges 1.52 1.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANESTHESIA SOLUTION = EXTENSIO SUP-40-00066 CDM 0272 RC outpatient 1132.35 1132.35 1132.35 74 837.94 percent of total billed charges 1132.35 93 917.2 percent of total billed charges 1132.35 1132.35 other OPPS APC 1132.35 1132.35 other OPPS APC 1132.35 27.63 312.87 percent of total billed charges 1132.35 1132.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANESTHESIA CIRCUIT ADULT SUP-40-00067 CDM 0272 RC outpatient 47.49 47.49 47.49 74 35.14 percent of total billed charges 47.49 93 38.47 percent of total billed charges 47.49 47.49 other OPPS APC 47.49 47.49 other OPPS APC 47.49 27.63 13.12 percent of total billed charges 47.49 47.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THERM SHEATH/DISP PROBE 18FR SUP-40-00069 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK CAP CO2 ADULT CAPNOXYGEN SUP-40-00070 CDM 0272 RC outpatient 21.39 21.39 21.39 74 15.83 percent of total billed charges 21.39 93 17.33 percent of total billed charges 21.39 21.39 other OPPS APC 21.39 21.39 other OPPS APC 21.39 27.63 5.91 percent of total billed charges 21.39 21.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA ADULT DIVIDED W/7' 02 LINE SUP-40-00071 CDM 0272 RC outpatient 1.32 1.32 1.32 74 0.98 percent of total billed charges 1.32 93 1.07 percent of total billed charges 1.32 1.32 other OPPS APC 1.32 1.32 other OPPS APC 1.32 27.63 0.36 percent of total billed charges 1.32 1.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK ADULT LRG 6 SUP-40-00074 CDM 0272 RC outpatient 1.33 1.33 1.33 74 0.98 percent of total billed charges 1.33 93 1.08 percent of total billed charges 1.33 1.33 other OPPS APC 1.33 1.33 other OPPS APC 1.33 27.63 0.37 percent of total billed charges 1.33 1.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE SKIN TEMPERATURE 400 SERIES SUP-40-00075 CDM 0272 RC outpatient 1.54 1.54 1.54 74 1.14 percent of total billed charges 1.54 93 1.25 percent of total billed charges 1.54 1.54 other OPPS APC 1.54 1.54 other OPPS APC 1.54 27.63 0.43 percent of total billed charges 1.54 1.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE MCGRATH MAC SIZE 3 SUP-40-00076 CDM 0272 RC outpatient 56.43 56.43 56.43 74 41.76 percent of total billed charges 56.43 93 45.71 percent of total billed charges 56.43 56.43 other OPPS APC 56.43 56.43 other OPPS APC 56.43 27.63 15.59 percent of total billed charges 56.43 56.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE MCGRATH MAC SIZE 4 SUP-40-00077 CDM 0272 RC outpatient 56.42 56.42 56.42 74 41.75 percent of total billed charges 56.42 93 45.7 percent of total billed charges 56.42 56.42 other OPPS APC 56.42 56.42 other OPPS APC 56.42 27.63 15.59 percent of total billed charges 56.42 56.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH STRYKER CALCANEAL SMALL SUP-40-10102 CDM 0270 RC outpatient 2733.12 2733.12 2733.12 74 2022.51 percent of total billed charges 2733.12 93 2213.83 percent of total billed charges 2733.12 2733.12 other OPPS APC 2733.12 2733.12 other OPPS APC 2733.12 27.63 755.16 percent of total billed charges 2733.12 2733.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH STRYKER CALCANEAL MEDIUM SUP-40-10104 CDM 0270 RC outpatient 2733.12 2733.12 2733.12 74 2022.51 percent of total billed charges 2733.12 93 2213.83 percent of total billed charges 2733.12 2733.12 other OPPS APC 2733.12 2733.12 other OPPS APC 2733.12 27.63 755.16 percent of total billed charges 2733.12 2733.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH STRYKER CALCANEAL LARGE SUP-40-10106 CDM 0270 RC outpatient 2733.12 2733.12 2733.12 74 2022.51 percent of total billed charges 2733.12 93 2213.83 percent of total billed charges 2733.12 2733.12 other OPPS APC 2733.12 2733.12 other OPPS APC 2733.12 27.63 755.16 percent of total billed charges 2733.12 2733.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE CALCANEUS STANDARD SMALL SUP-40-10112 CDM 0270 RC outpatient 2733.12 2733.12 2733.12 74 2022.51 percent of total billed charges 2733.12 93 2213.83 percent of total billed charges 2733.12 2733.12 other OPPS APC 2733.12 2733.12 other OPPS APC 2733.12 27.63 755.16 percent of total billed charges 2733.12 2733.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE CALCANEUS STANDARD MEDIUM SUP-40-10114 CDM 0270 RC outpatient 2733.12 2733.12 2733.12 74 2022.51 percent of total billed charges 2733.12 93 2213.83 percent of total billed charges 2733.12 2733.12 other OPPS APC 2733.12 2733.12 other OPPS APC 2733.12 27.63 755.16 percent of total billed charges 2733.12 2733.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE CALCANEUS STANDARD LARGE SUP-40-10116 CDM 0270 RC outpatient 2733.12 2733.12 2733.12 74 2022.51 percent of total billed charges 2733.12 93 2213.83 percent of total billed charges 2733.12 2733.12 other OPPS APC 2733.12 2733.12 other OPPS APC 2733.12 27.63 755.16 percent of total billed charges 2733.12 2733.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER 16MM 105CM CLOTTRIEVER FIXED LENGTH SUP-40-102 CDM 0270 RC outpatient 15600 15600 15600 74 11544 percent of total billed charges 15600 93 12636 percent of total billed charges 15600 15600 other OPPS APC 15600 15600 other OPPS APC 15600 27.63 4310.28 percent of total billed charges 15600 15600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE VARIAX SMARTLOCK TITANIUM CURVE FOOT 4 HOLE LOW PROFILE NONSTERILE SUP-40-15011 CDM 0270 RC outpatient 2250.56 2250.56 2250.56 74 1665.41 percent of total billed charges 2250.56 93 1822.95 percent of total billed charges 2250.56 2250.56 other OPPS APC 2250.56 2250.56 other OPPS APC 2250.56 27.63 621.83 percent of total billed charges 2250.56 2250.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE STRYKER 5 HOLE BOWED SUP-40-15012 CDM 0270 RC outpatient 2444 2444 2444 74 1808.56 percent of total billed charges 2444 93 1979.64 percent of total billed charges 2444 2444 other OPPS APC 2444 2444 other OPPS APC 2444 27.63 675.28 percent of total billed charges 2444 2444 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX 5 HOLE CURVED LEFT SUP-40-15013 CDM 0270 RC outpatient 2217.28 2217.28 2217.28 74 1640.79 percent of total billed charges 2217.28 93 1796 percent of total billed charges 2217.28 2217.28 other OPPS APC 2217.28 2217.28 other OPPS APC 2217.28 27.63 612.63 percent of total billed charges 2217.28 2217.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX 6 HOLE CURVED SUP-40-15014 CDM 0270 RC outpatient 1711.84 1711.84 1711.84 74 1266.76 percent of total billed charges 1711.84 93 1386.59 percent of total billed charges 1711.84 1711.84 other OPPS APC 1711.84 1711.84 other OPPS APC 1711.84 27.63 472.98 percent of total billed charges 1711.84 1711.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX H SMALL SUP-40-15021 CDM 0270 RC outpatient 1730.56 1730.56 1730.56 74 1280.61 percent of total billed charges 1730.56 93 1401.75 percent of total billed charges 1730.56 1730.56 other OPPS APC 1730.56 1730.56 other OPPS APC 1730.56 27.63 478.15 percent of total billed charges 1730.56 1730.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE VARIAX SMARTLOCK TITANIUM MEDIUM H FOOT LOW PROFILE SUP-40-15022 CDM 0270 RC outpatient 2036.32 2036.32 2036.32 74 1506.88 percent of total billed charges 2036.32 93 1649.42 percent of total billed charges 2036.32 2036.32 other OPPS APC 2036.32 2036.32 other OPPS APC 2036.32 27.63 562.64 percent of total billed charges 2036.32 2036.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX H LARGE SUP-40-15023 CDM 0270 RC outpatient 2069.6 2069.6 2069.6 74 1531.5 percent of total billed charges 2069.6 93 1676.38 percent of total billed charges 2069.6 2069.6 other OPPS APC 2069.6 2069.6 other OPPS APC 2069.6 27.63 571.83 percent of total billed charges 2069.6 2069.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX RECTANGULAR COMPRESSION SIZE 1 SUP-40-15031 CDM 0270 RC outpatient 2040.48 2040.48 2040.48 74 1509.96 percent of total billed charges 2040.48 93 1652.79 percent of total billed charges 2040.48 2040.48 other OPPS APC 2040.48 2040.48 other OPPS APC 2040.48 27.63 563.78 percent of total billed charges 2040.48 2040.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX RECTANGULAR LOCKING SIZE 2 SUP-40-15032 CDM 0270 RC outpatient 2069.6 2069.6 2069.6 74 1531.5 percent of total billed charges 2069.6 93 1676.38 percent of total billed charges 2069.6 2069.6 other OPPS APC 2069.6 2069.6 other OPPS APC 2069.6 27.63 571.83 percent of total billed charges 2069.6 2069.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX RECTANGULAR COMPRESSION SIZE 2 SUP-40-15033 CDM 0270 RC outpatient 2244.32 2244.32 2244.32 74 1660.8 percent of total billed charges 2244.32 93 1817.9 percent of total billed charges 2244.32 2244.32 other OPPS APC 2244.32 2244.32 other OPPS APC 2244.32 27.63 620.11 percent of total billed charges 2244.32 2244.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX 5 HOLE STRAIGHT SHORT SUP-40-15041 CDM 0270 RC outpatient 1967.68 1967.68 1967.68 74 1456.08 percent of total billed charges 1967.68 93 1593.82 percent of total billed charges 1967.68 1967.68 other OPPS APC 1967.68 1967.68 other OPPS APC 1967.68 27.63 543.67 percent of total billed charges 1967.68 1967.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX 5 HOLE STRAIGHT MEDIUM SUP-40-15042 CDM 0270 RC outpatient 2052.96 2052.96 2052.96 74 1519.19 percent of total billed charges 2052.96 93 1662.9 percent of total billed charges 2052.96 2052.96 other OPPS APC 2052.96 2052.96 other OPPS APC 2052.96 27.63 567.23 percent of total billed charges 2052.96 2052.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX 6 HOLE STRAIGHT LONG SUP-40-15043 CDM 0270 RC outpatient 2258.88 2258.88 2258.88 74 1671.57 percent of total billed charges 2258.88 93 1829.69 percent of total billed charges 2258.88 2258.88 other OPPS APC 2258.88 2258.88 other OPPS APC 2258.88 27.63 624.13 percent of total billed charges 2258.88 2258.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX 3-D LEFT SUP-40-15061 CDM 0270 RC outpatient 2491.84 2491.84 2491.84 74 1843.96 percent of total billed charges 2491.84 93 2018.39 percent of total billed charges 2491.84 2491.84 other OPPS APC 2491.84 2491.84 other OPPS APC 2491.84 27.63 688.5 percent of total billed charges 2491.84 2491.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX 3-D RIGHT SUP-40-15062 CDM 0270 RC outpatient 2491.84 2491.84 2491.84 74 1843.96 percent of total billed charges 2491.84 93 2018.39 percent of total billed charges 2491.84 2491.84 other OPPS APC 2491.84 2491.84 other OPPS APC 2491.84 27.63 688.5 percent of total billed charges 2491.84 2491.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE VARIAX SMARTLOCK TITANIUM T OBLIQUE FOOT LEFT LOW PROFILE SUP-40-15071 CDM 0270 RC outpatient 1728.48 1728.48 1728.48 74 1279.08 percent of total billed charges 1728.48 93 1400.07 percent of total billed charges 1728.48 1728.48 other OPPS APC 1728.48 1728.48 other OPPS APC 1728.48 27.63 477.58 percent of total billed charges 1728.48 1728.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE VARIAX SMARTLOCK TITANIUM T OBLIQUE FOOT RIGHT LOW PROFILE SUP-40-15072 CDM 0270 RC outpatient 1515.93 1515.93 1515.93 74 1121.79 percent of total billed charges 1515.93 93 1227.9 percent of total billed charges 1515.93 1515.93 other OPPS APC 1515.93 1515.93 other OPPS APC 1515.93 27.63 418.85 percent of total billed charges 1515.93 1515.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX T SUP-40-15081 CDM 0270 RC outpatient 1468.48 1468.48 1468.48 74 1086.68 percent of total billed charges 1468.48 93 1189.47 percent of total billed charges 1468.48 1468.48 other OPPS APC 1468.48 1468.48 other OPPS APC 1468.48 27.63 405.74 percent of total billed charges 1468.48 1468.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX 5 HOLE LEFT SUP-40-15091 CDM 0270 RC outpatient 1468.48 1468.48 1468.48 74 1086.68 percent of total billed charges 1468.48 93 1189.47 percent of total billed charges 1468.48 1468.48 other OPPS APC 1468.48 1468.48 other OPPS APC 1468.48 27.63 405.74 percent of total billed charges 1468.48 1468.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX 5 HOLE RIGHT SUP-40-15092 CDM 0270 RC outpatient 1468.48 1468.48 1468.48 74 1086.68 percent of total billed charges 1468.48 93 1189.47 percent of total billed charges 1468.48 1468.48 other OPPS APC 1468.48 1468.48 other OPPS APC 1468.48 27.63 405.74 percent of total billed charges 1468.48 1468.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS TITANIUM MICRO PARTIAL THREAD L12 MM L5 MM OD2 MM ODSEC2.75 MM FOOT ANKLE CANNULATED SELF DRILL SELF TAP T6 TORX DRIVE STERILE SUP-40-20112S CDM 0270 RC outpatient 663 663 663 74 490.62 percent of total billed charges 663 93 537.03 percent of total billed charges 663 663 other OPPS APC 663 663 other OPPS APC 663 27.63 183.19 percent of total billed charges 663 663 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS TITANIUM MICRO PARTIAL THREAD L14 MM L6 MM OD2 MM ODSEC2.75 MM FOOT ANKLE CANNULATED SELF DRILL SELF TAP T6 TORX DRIVE STERILE SUP-40-20114S CDM 0270 RC outpatient 611.52 611.52 611.52 74 452.52 percent of total billed charges 611.52 93 495.33 percent of total billed charges 611.52 611.52 other OPPS APC 611.52 611.52 other OPPS APC 611.52 27.63 168.96 percent of total billed charges 611.52 611.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS TITANIUM MICRO PARTIAL THREAD L16 MM L7 MM OD2 MM ODSEC2.75 MM FOOT ANKLE CANNULATED SELF DRILL SELF TAP T6 TORX DRIVE STERILE SUP-40-20116S CDM 0270 RC outpatient 663 663 663 74 490.62 percent of total billed charges 663 93 537.03 percent of total billed charges 663 663 other OPPS APC 663 663 other OPPS APC 663 27.63 183.19 percent of total billed charges 663 663 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS TITANIUM MICRO PARTIAL THREAD L18 MM L5 MM OD2 MM ODSEC2.75 MM FOOT ANKLE CANNULATED SELF DRILL SELF TAP T6 TORX DRIVE STERILE SUP-40-20118S CDM 0270 RC outpatient 611.52 611.52 611.52 74 452.52 percent of total billed charges 611.52 93 495.33 percent of total billed charges 611.52 611.52 other OPPS APC 611.52 611.52 other OPPS APC 611.52 27.63 168.96 percent of total billed charges 611.52 611.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS TITANIUM MICRO L22 MM L5 MM OD2 MM FOOT HAND CANNULATED THREADED STERILE SUP-40-20122S CDM 0270 RC outpatient 472.68 472.68 472.68 74 349.78 percent of total billed charges 472.68 93 382.87 percent of total billed charges 472.68 472.68 other OPPS APC 472.68 472.68 other OPPS APC 472.68 27.63 130.6 percent of total billed charges 472.68 472.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS TITANIUM MICRO PARTIAL THREAD L20 MM L9 MM OD2 MM ODSEC2.75 MM FOOT ANKLE CANNULATED SELF DRILL SELF TAP T6 TORX DRIVE STERILE SUP-40-20220S CDM 0270 RC outpatient 472.68 472.68 472.68 74 349.78 percent of total billed charges 472.68 93 382.87 percent of total billed charges 472.68 472.68 other OPPS APC 472.68 472.68 other OPPS APC 472.68 27.63 130.6 percent of total billed charges 472.68 472.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX DISTAL LATERAL FIBULA 6 HOLE SUP-40-20903 CDM 0270 RC outpatient 2156.96 2156.96 2156.96 74 1596.15 percent of total billed charges 2156.96 93 1747.14 percent of total billed charges 2156.96 2156.96 other OPPS APC 2156.96 2156.96 other OPPS APC 2156.96 27.63 595.97 percent of total billed charges 2156.96 2156.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX DISTAL LATERAL FIBULA 7 HOLE SUP-40-20904 CDM 0270 RC outpatient 2156.96 2156.96 2156.96 74 1596.15 percent of total billed charges 2156.96 93 1747.14 percent of total billed charges 2156.96 2156.96 other OPPS APC 2156.96 2156.96 other OPPS APC 2156.96 27.63 595.97 percent of total billed charges 2156.96 2156.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX DISTAL LATERAL FIBULA 8 HOLE SUP-40-20905 CDM 0270 RC outpatient 2156.96 2156.96 2156.96 74 1596.15 percent of total billed charges 2156.96 93 1747.14 percent of total billed charges 2156.96 2156.96 other OPPS APC 2156.96 2156.96 other OPPS APC 2156.96 27.63 595.97 percent of total billed charges 2156.96 2156.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX DISTAL LATERAL FIBULA 9 HOLE SUP-40-20906 CDM 0270 RC outpatient 2238.08 2238.08 2238.08 74 1656.18 percent of total billed charges 2238.08 93 1812.84 percent of total billed charges 2238.08 2238.08 other OPPS APC 2238.08 2238.08 other OPPS APC 2238.08 27.63 618.38 percent of total billed charges 2238.08 2238.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX DISTAL LATERAL FIBULA 10 HOLE SUP-40-20907 CDM 0270 RC outpatient 2431.52 2431.52 2431.52 74 1799.32 percent of total billed charges 2431.52 93 1969.53 percent of total billed charges 2431.52 2431.52 other OPPS APC 2431.52 2431.52 other OPPS APC 2431.52 27.63 671.83 percent of total billed charges 2431.52 2431.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX DISTAL LATERAL FIBULA 11 HOLE SUP-40-20908 CDM 0270 RC outpatient 2431.52 2431.52 2431.52 74 1799.32 percent of total billed charges 2431.52 93 1969.53 percent of total billed charges 2431.52 2431.52 other OPPS APC 2431.52 2431.52 other OPPS APC 2431.52 27.63 671.83 percent of total billed charges 2431.52 2431.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX DISTAL LATERAL FIBULA 12 HOLE SUP-40-20909 CDM 0270 RC outpatient 2431.52 2431.52 2431.52 74 1799.32 percent of total billed charges 2431.52 93 1969.53 percent of total billed charges 2431.52 2431.52 other OPPS APC 2431.52 2431.52 other OPPS APC 2431.52 27.63 671.83 percent of total billed charges 2431.52 2431.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER NON LOCKING 2.7MM X 14MM SUP-40-27014 CDM 0270 RC outpatient 247.52 247.52 247.52 74 183.16 percent of total billed charges 247.52 93 200.49 percent of total billed charges 247.52 247.52 other OPPS APC 247.52 247.52 other OPPS APC 247.52 27.63 68.39 percent of total billed charges 247.52 247.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VARIAX TITANIUM T7 L16 MM OD2.7 MM FOOT NONLOCK SELF TAP SCREWDRIVER YELLOW LOCK PLATE SYSTEM SUP-40-27016 CDM 0270 RC outpatient 247.52 247.52 247.52 74 183.16 percent of total billed charges 247.52 93 200.49 percent of total billed charges 247.52 247.52 other OPPS APC 247.52 247.52 other OPPS APC 247.52 27.63 68.39 percent of total billed charges 247.52 247.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VARIAX TITANIUM T7 L18 MM OD2.7 MM FOOT NONLOCK SELF TAP SCREWDRIVER YELLOW LOCK PLATE SYSTEM SUP-40-27018 CDM 0270 RC outpatient 197.6 197.6 197.6 74 146.22 percent of total billed charges 197.6 93 160.06 percent of total billed charges 197.6 197.6 other OPPS APC 197.6 197.6 other OPPS APC 197.6 27.63 54.6 percent of total billed charges 197.6 197.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VARIAX TITANIUM T7 L20 MM OD2.7 MM FOOT NONLOCK SELF TAP SCREWDRIVER NONSTERILE YELLOW LOCK PLATE SYSTEM SUP-40-27020 CDM 0270 RC outpatient 299.52 299.52 299.52 74 221.64 percent of total billed charges 299.52 93 242.61 percent of total billed charges 299.52 299.52 other OPPS APC 299.52 299.52 other OPPS APC 299.52 27.63 82.76 percent of total billed charges 299.52 299.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VARIAX TITANIUM T7 L22 MM OD2.7 MM FOOT NONLOCK SELF TAP SCREWDRIVER NONSTERILE YELLOW LOCK PLATE SYSTEM SUP-40-27022 CDM 0270 RC outpatient 299.52 299.52 299.52 74 221.64 percent of total billed charges 299.52 93 242.61 percent of total billed charges 299.52 299.52 other OPPS APC 299.52 299.52 other OPPS APC 299.52 27.63 82.76 percent of total billed charges 299.52 299.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER NON LOCKING 2.7MM X 24MM SUP-40-27024 CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VARIAX TITANIUM T7 L26 MM OD2.7 MM FOOT NONLOCK SELF TAP SCREWDRIVER NONSTERILE YELLOW LOCK PLATE SYSTEM SUP-40-27026 CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 2.7MM LOCKING 8MM SUP-40-27608 CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VARIAX TITANIUM T7 L10 MM OD2.7 MM FOOT LOCK SELF TAP SCREWDRIVER BLUE LOCK PLATE SYSTEM SUP-40-27610 CDM 0270 RC outpatient 392.08 392.08 392.08 74 290.14 percent of total billed charges 392.08 93 317.58 percent of total billed charges 392.08 392.08 other OPPS APC 392.08 392.08 other OPPS APC 392.08 27.63 108.33 percent of total billed charges 392.08 392.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VARIAX TITANIUM T7 L12 MM OD2.7 MM FOOT LOCK SELF TAP SCREWDRIVER BLUE LOCK PLATE SYSTEM SUP-40-27612 CDM 0270 RC outpatient 392.08 392.08 392.08 74 290.14 percent of total billed charges 392.08 93 317.58 percent of total billed charges 392.08 392.08 other OPPS APC 392.08 392.08 other OPPS APC 392.08 27.63 108.33 percent of total billed charges 392.08 392.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 2.7MM LOCKING 14MM SUP-40-27614 CDM 0270 RC outpatient 540.8 540.8 540.8 74 400.19 percent of total billed charges 540.8 93 438.05 percent of total billed charges 540.8 540.8 other OPPS APC 540.8 540.8 other OPPS APC 540.8 27.63 149.42 percent of total billed charges 540.8 540.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VARIAX TITANIUM T7 L16 MM OD2.7 MM FOOT LOCK PLATING SYSTEM SUP-40-27616 CDM 0270 RC outpatient 657.28 657.28 657.28 74 486.39 percent of total billed charges 657.28 93 532.4 percent of total billed charges 657.28 657.28 other OPPS APC 657.28 657.28 other OPPS APC 657.28 27.63 181.61 percent of total billed charges 657.28 657.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VARIAX TITANIUM T7 L18 MM OD2.7 MM FOOT LOCK SELF TAP SCREWDRIVER BLUE LOCK PLATE SYSTEM SUP-40-27618 CDM 0270 RC outpatient 657.28 657.28 657.28 74 486.39 percent of total billed charges 657.28 93 532.4 percent of total billed charges 657.28 657.28 other OPPS APC 657.28 657.28 other OPPS APC 657.28 27.63 181.61 percent of total billed charges 657.28 657.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VARIAX TITANIUM T7 L20 MM OD2.7 MM FOOT LOCK SELF TAP SCREWDRIVER BLUE LOCK PLATE SYSTEM SUP-40-27620 CDM 0270 RC outpatient 657.28 657.28 657.28 74 486.39 percent of total billed charges 657.28 93 532.4 percent of total billed charges 657.28 657.28 other OPPS APC 657.28 657.28 other OPPS APC 657.28 27.63 181.61 percent of total billed charges 657.28 657.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 2.7MM LOCKING 22MM SUP-40-27622 CDM 0270 RC outpatient 657.28 657.28 657.28 74 486.39 percent of total billed charges 657.28 93 532.4 percent of total billed charges 657.28 657.28 other OPPS APC 657.28 657.28 other OPPS APC 657.28 27.63 181.61 percent of total billed charges 657.28 657.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VARIAX TITANIUM T7 L24 MM OD2.7 MM FOOT LOCK SELF TAP SCREWDRIVER BLUE LOCK PLATE SYSTEM SUP-40-27624 CDM 0270 RC outpatient 420.16 420.16 420.16 74 310.92 percent of total billed charges 420.16 93 340.33 percent of total billed charges 420.16 420.16 other OPPS APC 420.16 420.16 other OPPS APC 420.16 27.63 116.09 percent of total billed charges 420.16 420.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 2.7MM LOCKING 26MM SUP-40-27626 CDM 0270 RC outpatient 566.8 566.8 566.8 74 419.43 percent of total billed charges 566.8 93 459.11 percent of total billed charges 566.8 566.8 other OPPS APC 566.8 566.8 other OPPS APC 566.8 27.63 156.61 percent of total billed charges 566.8 566.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VARIAX TITANIUM T7 L30 MM OD2.7 MM FOOT LOCK SELF TAP SCREWDRIVER BLUE LOCK PLATE SYSTEM SUP-40-27630 CDM 0270 RC outpatient 420.16 420.16 420.16 74 310.92 percent of total billed charges 420.16 93 340.33 percent of total billed charges 420.16 420.16 other OPPS APC 420.16 420.16 other OPPS APC 420.16 27.63 116.09 percent of total billed charges 420.16 420.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS TITANIUM MICRO L16 MM L4 MM OD3 MM FOOT HAND CANNULATED THREADED STERILE SUP-40-30116S CDM 0270 RC outpatient 576.16 576.16 576.16 74 426.36 percent of total billed charges 576.16 93 466.69 percent of total billed charges 576.16 576.16 other OPPS APC 576.16 576.16 other OPPS APC 576.16 27.63 159.19 percent of total billed charges 576.16 576.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS TITANIUM MICRO PARTIAL THREAD L18 MM L5 MM OD3 MM ODSEC3.75 MM FOOT ANKLE CANNULATED SELF DRILL SELF TAP T10 TORX DRIVE STERILE SUP-40-30118S CDM 0270 RC outpatient 576.16 576.16 576.16 74 426.36 percent of total billed charges 576.16 93 466.69 percent of total billed charges 576.16 576.16 other OPPS APC 576.16 576.16 other OPPS APC 576.16 27.63 159.19 percent of total billed charges 576.16 576.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS TITANIUM MICRO L20 MM L5 MM OD3 MM FOOT HAND CANNULATED THREADED STERILE SUP-40-30120S CDM 0270 RC outpatient 663 663 663 74 490.62 percent of total billed charges 663 93 537.03 percent of total billed charges 663 663 other OPPS APC 663 663 other OPPS APC 663 27.63 183.19 percent of total billed charges 663 663 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 3.0MM X24MM SUP-40-301245 CDM 0270 RC outpatient 576.16 576.16 576.16 74 426.36 percent of total billed charges 576.16 93 466.69 percent of total billed charges 576.16 576.16 other OPPS APC 576.16 576.16 other OPPS APC 576.16 27.63 159.19 percent of total billed charges 576.16 576.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS TITANIUM MICRO REVERSE CUT FLUTE L26 MM L6 MM OD3 MM FOOT HAND SELF CUT CANNULATED COLOR CODED LOW PROFILE HEAD NONSTERILE SUP-40-30126 CDM 0270 RC outpatient 631.8 631.8 631.8 74 467.53 percent of total billed charges 631.8 93 511.76 percent of total billed charges 631.8 631.8 other OPPS APC 631.8 631.8 other OPPS APC 631.8 27.63 174.57 percent of total billed charges 631.8 631.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS TITANIUM MICRO REVERSE CUT FLUTE L32 MM L6 MM OD3 MM FOOT HAND SELF CUT CANNULATED COLOR CODED LOW PROFILE HEAD SUP-40-30132 CDM 0270 RC outpatient 556.92 556.92 556.92 74 412.12 percent of total billed charges 556.92 93 451.11 percent of total billed charges 556.92 556.92 other OPPS APC 556.92 556.92 other OPPS APC 556.92 27.63 153.88 percent of total billed charges 556.92 556.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC ASNIS MICRO L32 MM OD3 MM STERILE SUP-40-30132S CDM 0270 RC outpatient 576.16 576.16 576.16 74 426.36 percent of total billed charges 576.16 93 466.69 percent of total billed charges 576.16 576.16 other OPPS APC 576.16 576.16 other OPPS APC 576.16 27.63 159.19 percent of total billed charges 576.16 576.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS TITANIUM MICRO REVERSE CUT FLUTE L34 MM L7 MM OD3 MM FOOT HAND SELF CUT CANNULATED COLOR CODED LOW PROFILE HEAD SUP-40-30134 CDM 0270 RC outpatient 576.16 576.16 576.16 74 426.36 percent of total billed charges 576.16 93 466.69 percent of total billed charges 576.16 576.16 other OPPS APC 576.16 576.16 other OPPS APC 576.16 27.63 159.19 percent of total billed charges 576.16 576.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER ASNIS 3.0MM X 36 SUP-40-30136 CDM 0270 RC outpatient 576.16 576.16 576.16 74 426.36 percent of total billed charges 576.16 93 466.69 percent of total billed charges 576.16 576.16 other OPPS APC 576.16 576.16 other OPPS APC 576.16 27.63 159.19 percent of total billed charges 576.16 576.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS TITANIUM MICRO REVERSE CUT FLUTE L38 MM L8 MM OD3 MM FOOT HAND SELF CUT CANNULATED COLOR CODED LOW PROFILE HEAD NONSTERILE SUP-40-30138 CDM 0270 RC outpatient 576.16 576.16 576.16 74 426.36 percent of total billed charges 576.16 93 466.69 percent of total billed charges 576.16 576.16 other OPPS APC 576.16 576.16 other OPPS APC 576.16 27.63 159.19 percent of total billed charges 576.16 576.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS TITANIUM MICRO REVERSE CUT FLUTE L40 MM L8 MM OD3 MM FOOT HAND SELF CUT CANNULATED COLOR CODED LOW PROFILE HEAD SUP-40-30140 CDM 0270 RC outpatient 556.92 556.92 556.92 74 412.12 percent of total billed charges 556.92 93 451.11 percent of total billed charges 556.92 556.92 other OPPS APC 556.92 556.92 other OPPS APC 556.92 27.63 153.88 percent of total billed charges 556.92 556.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS TITANIUM MICRO L18 MM L8 MM OD3 MM FOOT HAND CANNULATED THREADED SUP-40-30218 CDM 0270 RC outpatient 576.16 576.16 576.16 74 426.36 percent of total billed charges 576.16 93 466.69 percent of total billed charges 576.16 576.16 other OPPS APC 576.16 576.16 other OPPS APC 576.16 27.63 159.19 percent of total billed charges 576.16 576.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 3.0MM X 20MM SUP-40-302205 CDM 0270 RC outpatient 576.16 576.16 576.16 74 426.36 percent of total billed charges 576.16 93 466.69 percent of total billed charges 576.16 576.16 other OPPS APC 576.16 576.16 other OPPS APC 576.16 27.63 159.19 percent of total billed charges 576.16 576.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 3.0 CANNULATED SUP-40-30226 CDM 0270 RC outpatient 630.24 630.24 630.24 74 466.38 percent of total billed charges 630.24 93 510.49 percent of total billed charges 630.24 630.24 other OPPS APC 630.24 630.24 other OPPS APC 630.24 27.63 174.14 percent of total billed charges 630.24 630.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS TITANIUM MICRO L34 MM L16 MM OD3 MM FOOT HAND CANNULATED THREADED SUP-40-30234 CDM 0270 RC outpatient 576.16 576.16 576.16 74 426.36 percent of total billed charges 576.16 93 466.69 percent of total billed charges 576.16 576.16 other OPPS APC 576.16 576.16 other OPPS APC 576.16 27.63 159.19 percent of total billed charges 576.16 576.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS TITANIUM MICRO L36 MM L16 MM OD3 MM FOOT HAND CANNULATED THREADED STERILE SUP-40-30236 CDM 0270 RC outpatient 576.16 576.16 576.16 74 426.36 percent of total billed charges 576.16 93 466.69 percent of total billed charges 576.16 576.16 other OPPS APC 576.16 576.16 other OPPS APC 576.16 27.63 159.19 percent of total billed charges 576.16 576.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER ASNIS 3.0MM CANNULATED 40MM SUP-40-30240 CDM 0270 RC outpatient 500.76 500.76 500.76 74 370.56 percent of total billed charges 500.76 93 405.62 percent of total billed charges 500.76 500.76 other OPPS APC 500.76 500.76 other OPPS APC 500.76 27.63 138.36 percent of total billed charges 500.76 500.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 38MM SUP-40-30538 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 10MM SUP-40-35010 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 12MM SUP-40-35012 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 14MM SUP-40-35014 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 16MM SUP-40-35016 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 18MM SUP-40-35018 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 20MM SUP-40-35020 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 22MM SUP-40-35022 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 24MM SUP-40-35024 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 26MM SUP-40-35026 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 28MM SUP-40-35028 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 30MM SUP-40-35030 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 32MM SUP-40-35032 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 34MM SUP-40-35034 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 36MM SUP-40-35036 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 40MM SUP-40-35040 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 42MM SUP-40-35042 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 46MM SUP-40-35046 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 48MM SUP-40-35048 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 50MM SUP-40-35050 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 55MM SUP-40-35055 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 60MM SUP-40-35060 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 65MM SUP-40-35065 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM NON LOCKING 70MM SUP-40-35070 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 10MM SUP-40-35610 CDM 0270 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 12MM SUP-40-35612 CDM 0270 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 14MM SUP-40-35614 CDM 0270 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 16MM SUP-40-35616 CDM 0270 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 18MM SUP-40-35618 CDM 0270 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 20MM SUP-40-35620 CDM 0270 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 22MM SUP-40-35622 CDM 0270 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 24MM SUP-40-35624 CDM 0270 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 28MM SUP-40-35628 CDM 0270 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 30MM SUP-40-35630 CDM 0270 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 32MM SUP-40-35632 CDM 0270 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 36MM SUP-40-35636 CDM 0270 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 38MM SUP-40-35638 CDM 0270 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 40MM SUP-40-35640 CDM 0270 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 42MM SUP-40-35642 CDM 0270 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 46MM SUP-40-35646 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 48MM SUP-40-35648 CDM 0270 RC outpatient 287.04 287.04 287.04 74 212.41 percent of total billed charges 287.04 93 232.5 percent of total billed charges 287.04 287.04 other OPPS APC 287.04 287.04 other OPPS APC 287.04 27.63 79.31 percent of total billed charges 287.04 287.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 50MM SUP-40-35650 CDM 0270 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 55MM SUP-40-35655 CDM 0270 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 60MM SUP-40-35660 CDM 0270 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 65MM SUP-40-35665 CDM 0270 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 70MM SUP-40-35670 CDM 0270 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC OPTITORQUE STAINLESS STEEL NYLON POLYURETHANE RADIAL TIGER 4.1 CURVE L110 CM OD5 FR CORONARY 1 SIDE TIP SUP-40-5013 CDM 0481 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 51 46.41 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC OPTITORQUE STAINLESS STEEL NYLON POLYURETHANE RADIAL TIGER 4.5 CURVE L110 CM OD5 FR CORONARY 1 SIDE TIP SUP-40-5014 CDM 0481 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 51 46.41 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC OPTITORQUE STAINLESS STEEL NYLON POLYURETHANE JACKY RADIAL 3.5 CURVE L110 CM OD5 FR CORONARY 2 SIDE TIP SUP-40-5023 CDM 0481 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 51 46.41 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC OPTITORQUE STAINLESS STEEL NYLON POLYURETHANE SARAH RADIAL 4.0 CURVE L110 CM OD5 FR CORONARY 2 SIDE TIP SUP-40-5024 CDM 0481 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 51 46.41 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC OPTITORQUE RADIALTIGER CURVE 6 FR TIGER 4.0 (100) SUP-40-6011 CDM 0481 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 51 46.41 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRPAHIC OPTITORQUE RADIAL JACKY 6 FR 3.5 (100) SUP-40-6021 CDM 0481 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 51 46.41 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC OPTITORQUE 155 D ANGLED PIGTAIL CURVE L110 CM OD6 FR CORONARY 6 SIDEHOLE DIAGNOSTIC SOFT TIP SUP-40-6031 CDM 0481 RC outpatient 59.8 59.8 59.8 74 44.25 percent of total billed charges 59.8 93 48.44 percent of total billed charges 59.8 59.8 other OPPS APC 59.8 59.8 other OPPS APC 59.8 51 30.5 percent of total billed charges 59.8 59.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING HEARTRAIL III IL3.5 CURVE L100 CM OD6 FR CORONARY FLEXIBLE SHAFT DESIGN SUPERIOR TORQUE CONTROL HIGH RADIOPACITY ATRAUMATIC TIP SUP-40-6370 CDM 0481 RC outpatient 182 182 182 74 134.68 percent of total billed charges 182 93 147.42 percent of total billed charges 182 182 other OPPS APC 182 182 other OPPS APC 182 51 92.82 percent of total billed charges 182 182 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING HEARTRAIL III IL3.75 CURVE L100 CM OD6 FR CORONARY FLEXIBLE SHAFT DESIGN SUPERIOR TORQUE CONTROL HIGH RADIOPACITY ATRAUMATIC TIP SUP-40-6372 CDM 0481 RC outpatient 182 182 182 74 134.68 percent of total billed charges 182 93 147.42 percent of total billed charges 182 182 other OPPS APC 182 182 other OPPS APC 182 51 92.82 percent of total billed charges 182 182 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING HEARTRAIL III IL4 CURVE L100 CM OD6 FR CORONARY FLEXIBLE SHAFT DESIGN SUPERIOR TORQUE CONTROL HIGH RADIOPACITY ATRAUMATIC TIP SUP-40-6373 CDM 0270 RC outpatient 182 182 182 74 134.68 percent of total billed charges 182 93 147.42 percent of total billed charges 182 182 other OPPS APC 182 182 other OPPS APC 182 27.63 50.29 percent of total billed charges 182 182 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SLUSH MACHINE POLY 66X66 SUP-40-SD100 CDM outpatient 39.16 39.16 39.16 39.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE WARMER 66X44IN SLUSH MACHINE SUP-40-SD200 CDM 0270 RC outpatient 28.16 28.16 28.16 74 20.84 percent of total billed charges 28.16 93 22.81 percent of total billed charges 28.16 28.16 other OPPS APC 28.16 28.16 other OPPS APC 28.16 27.63 7.78 percent of total billed charges 28.16 28.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DRAPE SLUSH 44"" X 66"" W/DISC" SUP-40-SD220 CDM 0270 RC outpatient 43.29 43.29 43.29 74 32.03 percent of total billed charges 43.29 93 35.06 percent of total billed charges 43.29 43.29 other OPPS APC 43.29 43.29 other OPPS APC 43.29 27.63 11.96 percent of total billed charges 43.29 43.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE EQUIPMENT POLYURETHANE L44 IN X W44 IN SLUSH MACHINE WITHOUT DISC FLUID WARMER SUP-40-SD300 CDM 0270 RC outpatient 13.64 13.64 13.64 74 10.09 percent of total billed charges 13.64 93 11.05 percent of total billed charges 13.64 13.64 other OPPS APC 13.64 13.64 other OPPS APC 13.64 27.63 3.77 percent of total billed charges 13.64 13.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MACROLYTE SINGLE DISPERSIVE ELECTRODE WITH ADHEISIVE HYDROGEL, 10' CABLE, ADULT" SUP-400-2100 CDM 0270 RC outpatient 4.71 4.71 4.71 74 3.49 percent of total billed charges 4.71 93 3.82 percent of total billed charges 4.71 4.71 other OPPS APC 4.71 4.71 other OPPS APC 4.71 27.63 1.3 percent of total billed charges 4.71 4.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CRIMPS SUP-400-401 CDM 0270 RC outpatient 52 52 52 74 38.48 percent of total billed charges 52 93 42.12 percent of total billed charges 52 52 other OPPS APC 52 52 other OPPS APC 52 27.63 14.37 percent of total billed charges 52 52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CABLE STAINLESS STEEL TITANIUM STERNUM CUTTING EDGE NEEDLE MULTISTRAND SMOOTH FLEXIBLE MONOFILAMENT STERILE SUP-400-689 CDM 0270 RC outpatient 436.8 436.8 436.8 74 323.23 percent of total billed charges 436.8 93 353.81 percent of total billed charges 436.8 436.8 other OPPS APC 436.8 436.8 other OPPS APC 436.8 27.63 120.69 percent of total billed charges 436.8 436.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL SELF TAPPING MODULAR HAND SYSTEM TITANIUM 1.5 X 20MM SUP-400-820.96 CDM 270010022 LOCAL 0270 RC outpatient 128.13 128.13 128.13 74 94.82 percent of total billed charges 128.13 93 103.79 percent of total billed charges 128.13 128.13 other OPPS APC 128.13 128.13 other OPPS APC 128.13 27.63 35.4 percent of total billed charges 128.13 128.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET ENDOSCOPIC INSTRUMENT REMOVE L220 CM OD9.5-12 MM DC BIPOLAR CUTTER STERILE LATEX FREE 2.8 MM WORKING CHANNEL OTSC FTRD CLIP SUP-400.02.01S CDM 0270 RC outpatient 1271.4 1271.4 1271.4 74 940.84 percent of total billed charges 1271.4 93 1029.83 percent of total billed charges 1271.4 1271.4 other OPPS APC 1271.4 1271.4 other OPPS APC 1271.4 27.63 351.29 percent of total billed charges 1271.4 1271.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.3MM TI CORTEX SCREW SLF DRLG WITH STARDRIVE TM RECESS 4MM SUP-400.124E CDM 270010022 LOCAL 0270 RC outpatient 204.07 204.07 204.07 74 151.01 percent of total billed charges 204.07 93 165.3 percent of total billed charges 204.07 204.07 other OPPS APC 204.07 204.07 other OPPS APC 204.07 27.63 56.38 percent of total billed charges 204.07 204.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM 1.3MM 2.4MM GOLD TITANIUM NS CRANIOMAXILLOFACIAL CORTEX SELF TAP PLUSDRIVE SUP-400.434 CDM 270010014 LOCAL 0270 RC outpatient 1199.17 1199.17 1199.17 74 887.39 percent of total billed charges 1199.17 93 971.33 percent of total billed charges 1199.17 1199.17 other OPPS APC 1199.17 1199.17 other OPPS APC 1199.17 27.63 331.33 percent of total billed charges 1199.17 1199.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L10 MM OD1.7 MM MANDIBLE EMERGENCY PLUSDRIVE STERILE TEAL ORTHOGNATHIC MODULAR FIXATION SYSTEM SUP-400.490E CDM 270010022 LOCAL 0270 RC outpatient 248.92 248.92 248.92 74 184.2 percent of total billed charges 248.92 93 201.63 percent of total billed charges 248.92 248.92 other OPPS APC 248.92 248.92 other OPPS APC 248.92 27.63 68.78 percent of total billed charges 248.92 248.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FLUTE L3 MM OD1 MM ODSEC1.6 MM CRANIOFACIAL CORTICAL SELF TAPPING STERILE GOLD SUP-400.503E CDM 270010022 LOCAL 0270 RC outpatient 248.92 248.92 248.92 74 184.2 percent of total billed charges 248.92 93 201.63 percent of total billed charges 248.92 248.92 other OPPS APC 248.92 248.92 other OPPS APC 248.92 27.63 68.78 percent of total billed charges 248.92 248.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FLUTE L4 MM OD1 MM ODSEC1.6 MM CRANIOFACIAL CORTICAL SELF TAP CRUCIFORM GOLD SUP-400.504 CDM 270010014 LOCAL 0270 RC outpatient 248.91 248.91 248.91 74 184.19 percent of total billed charges 248.91 93 201.62 percent of total billed charges 248.91 248.91 other OPPS APC 248.91 248.91 other OPPS APC 248.91 27.63 68.77 percent of total billed charges 248.91 248.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L4 MM OD1 MM CORTICAL CRANIOFACIAL SELF TAPPING FLUTED TIP STERILE GOLD SUP-400.504E CDM 270010014 LOCAL 0270 RC outpatient 248.92 248.92 248.92 74 184.2 percent of total billed charges 248.92 93 201.63 percent of total billed charges 248.92 248.92 other OPPS APC 248.92 248.92 other OPPS APC 248.92 27.63 68.78 percent of total billed charges 248.92 248.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FLUTE L4 MM OD1 MM ODSEC1.6 MM CRANIOFACIAL CORTICAL SELF TAPPING STERILE GOLD SUP-400.505E CDM 270010022 LOCAL 0270 RC outpatient 248.92 248.92 248.92 74 184.2 percent of total billed charges 248.92 93 201.63 percent of total billed charges 248.92 248.92 other OPPS APC 248.92 248.92 other OPPS APC 248.92 27.63 68.78 percent of total billed charges 248.92 248.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FLUTE L6 MM OD1 MM ODSEC1.6 MM CRANIOFACIAL CORTICAL SELF TAPPING STERILE GOLD SUP-400.506E CDM 270010022 LOCAL 0270 RC outpatient 248.92 248.92 248.92 74 184.2 percent of total billed charges 248.92 93 201.63 percent of total billed charges 248.92 248.92 other OPPS APC 248.92 248.92 other OPPS APC 248.92 27.63 68.78 percent of total billed charges 248.92 248.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L7 MM OD1 MM MAXILLOFACIAL CORTEX SELF TAP FLUTE TIP SUP-400.507E CDM 270010022 LOCAL 0270 RC outpatient 248.92 248.92 248.92 74 184.2 percent of total billed charges 248.92 93 201.63 percent of total billed charges 248.92 248.92 other OPPS APC 248.92 248.92 other OPPS APC 248.92 27.63 68.78 percent of total billed charges 248.92 248.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FLUTE L8 MM OD1 MM MAXILLOFACIAL CORTEX SELF TAP SUP-400.508E CDM 270010022 LOCAL 0270 RC outpatient 248.92 248.92 248.92 74 184.2 percent of total billed charges 248.92 93 201.63 percent of total billed charges 248.92 248.92 other OPPS APC 248.92 248.92 other OPPS APC 248.92 27.63 68.78 percent of total billed charges 248.92 248.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 1.0MM CORTEX 9MM SUP-400.509 CDM 270010022 LOCAL 0270 RC outpatient 1244.57 1244.57 1244.57 74 920.98 percent of total billed charges 1244.57 93 1008.1 percent of total billed charges 1244.57 1244.57 other OPPS APC 1244.57 1244.57 other OPPS APC 1244.57 27.63 343.87 percent of total billed charges 1244.57 1244.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6MM 1MM 1.6MM TITANIUM NS CORTEX SELF TAP CRUCIFORM SUP-400.526 CDM 270010022 LOCAL 0270 RC outpatient 211.64 211.64 211.64 74 156.61 percent of total billed charges 211.64 93 171.43 percent of total billed charges 211.64 211.64 other OPPS APC 211.64 211.64 other OPPS APC 211.64 27.63 58.48 percent of total billed charges 211.64 211.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 7MM 1MM 1.6MM TITANIUM NS CORTEX SELF TAP CRUCIFORM SUP-400.527 CDM 270010022 LOCAL 0270 RC outpatient 211.64 211.64 211.64 74 156.61 percent of total billed charges 211.64 93 171.43 percent of total billed charges 211.64 211.64 other OPPS APC 211.64 211.64 other OPPS APC 211.64 27.63 58.48 percent of total billed charges 211.64 211.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 8MM 1MM 1.6MM TITANIUM NS CORTEX SELF TAP CRUCIFORM SUP-400.528 CDM 270010022 LOCAL 0270 RC outpatient 211.64 211.64 211.64 74 156.61 percent of total billed charges 211.64 93 171.43 percent of total billed charges 211.64 211.64 other OPPS APC 211.64 211.64 other OPPS APC 211.64 27.63 58.48 percent of total billed charges 211.64 211.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 9MM 1MM 1.6MM TITANIUM NS CORTEX SELF TAP CRUCIFORM SUP-400.529 CDM 270010022 LOCAL 0270 RC outpatient 211.64 211.64 211.64 74 156.61 percent of total billed charges 211.64 93 171.43 percent of total billed charges 211.64 211.64 other OPPS APC 211.64 211.64 other OPPS APC 211.64 27.63 58.48 percent of total billed charges 211.64 211.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 10MM 1MM 1.6MM TITANIUM NS CORTEX SELF TAP CRUCIFORM SUP-400.53 CDM 270010022 LOCAL 0270 RC outpatient 219.96 219.96 219.96 74 162.77 percent of total billed charges 219.96 93 178.17 percent of total billed charges 219.96 219.96 other OPPS APC 219.96 219.96 other OPPS APC 219.96 27.63 60.77 percent of total billed charges 219.96 219.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1MM 1.6MM 10MM TITANIUM HAND CORTICAL SELF TAP CRUCIFORM NS SUP-400.530 CDM 270010022 LOCAL 0270 RC outpatient 219.96 219.96 219.96 74 162.77 percent of total billed charges 219.96 93 178.17 percent of total billed charges 219.96 219.96 other OPPS APC 219.96 219.96 other OPPS APC 219.96 27.63 60.77 percent of total billed charges 219.96 219.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 11MM 1MM 1.6MM TITANIUM NS CORTEX SELF TAP CRUCIFORM SUP-400.531 CDM 270010022 LOCAL 0270 RC outpatient 211.64 211.64 211.64 74 156.61 percent of total billed charges 211.64 93 171.43 percent of total billed charges 211.64 211.64 other OPPS APC 211.64 211.64 other OPPS APC 211.64 27.63 58.48 percent of total billed charges 211.64 211.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1MM 1.6MM 12MM TITANIUM HAND CORTICAL SELF TAP CRUCIFORM NS SUP-400.532 CDM 270010022 LOCAL 0270 RC outpatient 211.64 211.64 211.64 74 156.61 percent of total billed charges 211.64 93 171.43 percent of total billed charges 211.64 211.64 other OPPS APC 211.64 211.64 other OPPS APC 211.64 27.63 58.48 percent of total billed charges 211.64 211.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1MM 1.6MM 13MM TITANIUM HAND CORTICAL SELF TAP CRUCIFORM NS SUP-400.533 CDM 270010022 LOCAL 0270 RC outpatient 211.64 211.64 211.64 74 156.61 percent of total billed charges 211.64 93 171.43 percent of total billed charges 211.64 211.64 other OPPS APC 211.64 211.64 other OPPS APC 211.64 27.63 58.48 percent of total billed charges 211.64 211.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 14MM 1MM 1.6MM TITANIUM NS CORTEX SELF TAP CRUCIFORM SUP-400.534 CDM 270010022 LOCAL 0270 RC outpatient 211.64 211.64 211.64 74 156.61 percent of total billed charges 211.64 93 171.43 percent of total billed charges 211.64 211.64 other OPPS APC 211.64 211.64 other OPPS APC 211.64 27.63 58.48 percent of total billed charges 211.64 211.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L3 MM OD1.2 MM ODSEC1.6 MM CRANIOFACIAL SELF TAPPING EMERGENCY CRUCIFORM RECESS STERILE TEAL SUP-400.603E CDM 270010022 LOCAL 0270 RC outpatient 259.27 259.27 259.27 74 191.86 percent of total billed charges 259.27 93 210.01 percent of total billed charges 259.27 259.27 other OPPS APC 259.27 259.27 other OPPS APC 259.27 27.63 71.64 percent of total billed charges 259.27 259.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L4 MM OD1.2 MM ODSEC1.6 MM CRANIOFACIAL CORTICAL EMERGENCY CRUCIFORM RECESS THREADED STERILE TEAL SUP-400.604E CDM 270010022 LOCAL 0270 RC outpatient 259.27 259.27 259.27 74 191.86 percent of total billed charges 259.27 93 210.01 percent of total billed charges 259.27 259.27 other OPPS APC 259.27 259.27 other OPPS APC 259.27 27.63 71.64 percent of total billed charges 259.27 259.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L5 MM OD1.2 MM ODSEC1.6 MM CRANIOFACIAL SELF TAPPING EMERGENCY CRUCIFORM RECESS STERILE TEAL SUP-400.605E CDM 270010022 LOCAL 0270 RC outpatient 259.27 259.27 259.27 74 191.86 percent of total billed charges 259.27 93 210.01 percent of total billed charges 259.27 259.27 other OPPS APC 259.27 259.27 other OPPS APC 259.27 27.63 71.64 percent of total billed charges 259.27 259.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L6 MM OD1.2 MM ODSEC1.6 MM CRANIOMAXILLOFACIAL FLUTED TIP EMERGENCY CRUCIFORM RECESS STERILE TEAL SUP-400.606E CDM 270010022 LOCAL 0270 RC outpatient 259.27 259.27 259.27 74 191.86 percent of total billed charges 259.27 93 210.01 percent of total billed charges 259.27 259.27 other OPPS APC 259.27 259.27 other OPPS APC 259.27 27.63 71.64 percent of total billed charges 259.27 259.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FLUTE CRUCIFORM L3 MM OD1.3 MM ODSEC2.4 MM CORTICAL CRANIOFACIAL SELF TAP STERILE GOLD SUP-400.623E CDM 270010022 LOCAL 0270 RC outpatient 237.25 237.25 237.25 74 175.57 percent of total billed charges 237.25 93 192.17 percent of total billed charges 237.25 237.25 other OPPS APC 237.25 237.25 other OPPS APC 237.25 27.63 65.55 percent of total billed charges 237.25 237.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FLUTE L4 MM OD1.3 MM CORTICAL MAXILLOFACIAL SELF TAPPING STERILE SUP-400.624E CDM 270010022 LOCAL 0270 RC outpatient 237.25 237.25 237.25 74 175.57 percent of total billed charges 237.25 93 192.17 percent of total billed charges 237.25 237.25 other OPPS APC 237.25 237.25 other OPPS APC 237.25 27.63 65.55 percent of total billed charges 237.25 237.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L5 MM OD1.3 MM CRANIOMAXILLOFACIAL CORTICAL SELF TAP FLUTE TIP STERILE SUP-400.625E CDM 270010022 LOCAL 0270 RC outpatient 237.25 237.25 237.25 74 175.57 percent of total billed charges 237.25 93 192.17 percent of total billed charges 237.25 237.25 other OPPS APC 237.25 237.25 other OPPS APC 237.25 27.63 65.55 percent of total billed charges 237.25 237.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L8 MM OD1.3 MM CRANIOFACIAL SELF TAPPING FLUTED TIP CRUCIFORM STERILE SUP-400.628E CDM 270010022 LOCAL 0270 RC outpatient 237.25 237.25 237.25 74 175.57 percent of total billed charges 237.25 93 192.17 percent of total billed charges 237.25 237.25 other OPPS APC 237.25 237.25 other OPPS APC 237.25 27.63 65.55 percent of total billed charges 237.25 237.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L12 MM OD1.3 MM CORTICAL CRANIOFACIAL SELF TAPPING FLUTED TIP CRUCIFORM STERILE SUP-400.632E CDM 270010022 LOCAL 0270 RC outpatient 237.25 237.25 237.25 74 175.57 percent of total billed charges 237.25 93 192.17 percent of total billed charges 237.25 237.25 other OPPS APC 237.25 237.25 other OPPS APC 237.25 27.63 65.55 percent of total billed charges 237.25 237.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L4 MM OD1.7 MM ODSEC2.4 MM CRANIOMAXILLOFACIAL EMERGENCY CRUCIFORM RECESS NONSTERILE TEAL SUP-400.653 CDM 270010022 LOCAL 0270 RC outpatient 1231.62 1231.62 1231.62 74 911.4 percent of total billed charges 1231.62 93 997.61 percent of total billed charges 1231.62 1231.62 other OPPS APC 1231.62 1231.62 other OPPS APC 1231.62 27.63 340.3 percent of total billed charges 1231.62 1231.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L4 MM OD1.7 MM ODSEC2.4 MM CRANIOMAXILLOFACIAL EMERGENCY CRUCIFORM RECESS NONSTERILE TEAL SUP-400.654 CDM 270010022 LOCAL 0270 RC outpatient 1231.62 1231.62 1231.62 74 911.4 percent of total billed charges 1231.62 93 997.61 percent of total billed charges 1231.62 1231.62 other OPPS APC 1231.62 1231.62 other OPPS APC 1231.62 27.63 340.3 percent of total billed charges 1231.62 1231.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FLUTE L5 MM OD1.7 MM CRANIOFACIAL EMERGENCY CRUCIFORM STERILE SUP-400.655E CDM 270010022 LOCAL 0270 RC outpatient 246.32 246.32 246.32 74 182.28 percent of total billed charges 246.32 93 199.52 percent of total billed charges 246.32 246.32 other OPPS APC 246.32 246.32 other OPPS APC 246.32 27.63 68.06 percent of total billed charges 246.32 246.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FLUTE L6 MM OD1.7 MM CRANIOFACIAL EMERGENCY CRUCIFORM STERILE SUP-400.656E CDM 270010022 LOCAL 0270 RC outpatient 246.32 246.32 246.32 74 182.28 percent of total billed charges 246.32 93 199.52 percent of total billed charges 246.32 246.32 other OPPS APC 246.32 246.32 other OPPS APC 246.32 27.63 68.06 percent of total billed charges 246.32 246.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L8 MM OD1.7 MM EMERGENCY FLUTED TIP NONSTERILE SUP-400.658E CDM 270010022 LOCAL 0270 RC outpatient 246.32 246.32 246.32 74 182.28 percent of total billed charges 246.32 93 199.52 percent of total billed charges 246.32 246.32 other OPPS APC 246.32 246.32 other OPPS APC 246.32 27.63 68.06 percent of total billed charges 246.32 246.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6MM 1.3MM 2.4MM TITANIUM NS CORTEX SELF TAP CRUCIFORM MODULAR HAND SYSTEM SUP-400.686 CDM 270010022 LOCAL 0270 RC outpatient 220.22 220.22 220.22 74 162.96 percent of total billed charges 220.22 93 178.38 percent of total billed charges 220.22 220.22 other OPPS APC 220.22 220.22 other OPPS APC 220.22 27.63 60.85 percent of total billed charges 220.22 220.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L7 MM OD1.3 MM ODSEC2.4 MM HAND CORTICAL SELF TAP CRUCIFORM NONSTERILE SUP-400.687 CDM 270010022 LOCAL 0270 RC outpatient 220.22 220.22 220.22 74 162.96 percent of total billed charges 220.22 93 178.38 percent of total billed charges 220.22 220.22 other OPPS APC 220.22 220.22 other OPPS APC 220.22 27.63 60.85 percent of total billed charges 220.22 220.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L8 MM OD1.3 MM ODSEC2.4 MM HAND CORTICAL SELF TAP CRUCIFORM NONSTERILE SUP-400.688 CDM 270010022 LOCAL 0270 RC outpatient 220.22 220.22 220.22 74 162.96 percent of total billed charges 220.22 93 178.38 percent of total billed charges 220.22 220.22 other OPPS APC 220.22 220.22 other OPPS APC 220.22 27.63 60.85 percent of total billed charges 220.22 220.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 9MM 1.3MM 2.4MM TITANIUM NS CORTEX SELF TAP CRUCIFORM MODULAR HAND SYSTEM SUP-400.689 CDM 270010022 LOCAL 0270 RC outpatient 220.22 220.22 220.22 74 162.96 percent of total billed charges 220.22 93 178.38 percent of total billed charges 220.22 220.22 other OPPS APC 220.22 220.22 other OPPS APC 220.22 27.63 60.85 percent of total billed charges 220.22 220.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 10MM 1.3MM 2.4MM TITANIUM NS CORTEX SELF TAP CRUCIFORM MODULAR HAND SYSTEM SUP-400.69 CDM 270010022 LOCAL 0270 RC outpatient 199.06 199.06 199.06 74 147.3 percent of total billed charges 199.06 93 161.24 percent of total billed charges 199.06 199.06 other OPPS APC 199.06 199.06 other OPPS APC 199.06 27.63 55 percent of total billed charges 199.06 199.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1.3MM 2.4MM 10MM TITANIUM HAND CORTICAL SELF TAPPING CRUCIFORM RECESS NS SUP-400.690 CDM 270010022 LOCAL 0270 RC outpatient 229.32 229.32 229.32 74 169.7 percent of total billed charges 229.32 93 185.75 percent of total billed charges 229.32 229.32 other OPPS APC 229.32 229.32 other OPPS APC 229.32 27.63 63.36 percent of total billed charges 229.32 229.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 11MM 1.3MM 2.4MM TITANIUM NS CORTEX SELF TAP CRUCIFORM MODULAR HAND SYSTEM SUP-400.691 CDM 270010022 LOCAL 0270 RC outpatient 220.22 220.22 220.22 74 162.96 percent of total billed charges 220.22 93 178.38 percent of total billed charges 220.22 220.22 other OPPS APC 220.22 220.22 other OPPS APC 220.22 27.63 60.85 percent of total billed charges 220.22 220.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L12 MM OD1.3 MM ODSEC2.4 MM HAND CORTICAL SELF TAP CRUCIFORM NONSTERILE SUP-400.692 CDM 270010022 LOCAL 0270 RC outpatient 220.22 220.22 220.22 74 162.96 percent of total billed charges 220.22 93 178.38 percent of total billed charges 220.22 220.22 other OPPS APC 220.22 220.22 other OPPS APC 220.22 27.63 60.85 percent of total billed charges 220.22 220.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L13 MM OD1.3 MM ODSEC2.4 MM HAND CORTICAL SELF TAP CRUCIFORM NONSTERILE SUP-400.693 CDM 270010022 LOCAL 0270 RC outpatient 220.22 220.22 220.22 74 162.96 percent of total billed charges 220.22 93 178.38 percent of total billed charges 220.22 220.22 other OPPS APC 220.22 220.22 other OPPS APC 220.22 27.63 60.85 percent of total billed charges 220.22 220.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 14MM 1.3MM 2.4MM TITANIUM NS CORTEX SELF TAP CRUCIFORM MODULAR HAND SYSTEM SUP-400.694 CDM 270010022 LOCAL 0270 RC outpatient 220.22 220.22 220.22 74 162.96 percent of total billed charges 220.22 93 178.38 percent of total billed charges 220.22 220.22 other OPPS APC 220.22 220.22 other OPPS APC 220.22 27.63 60.85 percent of total billed charges 220.22 220.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 16MM 1.3MM 2.4MM TITANIUM NS CORTEX SELF TAP CRUCIFORM MODULAR HAND SYSTEM SUP-400.696 CDM 270010022 LOCAL 0270 RC outpatient 220.22 220.22 220.22 74 162.96 percent of total billed charges 220.22 93 178.38 percent of total billed charges 220.22 220.22 other OPPS APC 220.22 220.22 other OPPS APC 220.22 27.63 60.85 percent of total billed charges 220.22 220.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 18MM 1.3MM 2.4MM TITANIUM NS CORTEX SELF TAP CRUCIFORM MODULAR HAND SYSTEM SUP-400.698 CDM 270010022 LOCAL 0270 RC outpatient 220.22 220.22 220.22 74 162.96 percent of total billed charges 220.22 93 178.38 percent of total billed charges 220.22 220.22 other OPPS APC 220.22 220.22 other OPPS APC 220.22 27.63 60.85 percent of total billed charges 220.22 220.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L4 MM OD1.5 MM ODSEC3 MM CRANIOFACIAL CORTICAL SELF TAPPING FLUTED TIP CRUCIFORM RECESS GOLD MODULAR FIXATION SYSTEM SUP-400.734 CDM 270010014 LOCAL 0270 RC outpatient 842.69 842.69 842.69 74 623.59 percent of total billed charges 842.69 93 682.58 percent of total billed charges 842.69 842.69 other OPPS APC 842.69 842.69 other OPPS APC 842.69 27.63 232.84 percent of total billed charges 842.69 842.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FLUTE L4 MM OD1.5 MM CRANIOMAXILLOFACIAL CORTEX SELF TAP CRUCIFORM STERILE SUP-400.734E CDM 270010022 LOCAL 0270 RC outpatient 168.53 168.53 168.53 74 124.71 percent of total billed charges 168.53 93 136.51 percent of total billed charges 168.53 168.53 other OPPS APC 168.53 168.53 other OPPS APC 168.53 27.63 46.56 percent of total billed charges 168.53 168.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FLUTE L6 MM OD1.5 MM ODSEC3 MM CRANIOFACIAL CORTICAL SELF TAP CRUCIFORM NONSTERILE GOLD MODULAR FIXATION SYSTEM SUP-400.736 CDM 270010014 LOCAL 0270 RC outpatient 842.69 842.69 842.69 74 623.59 percent of total billed charges 842.69 93 682.58 percent of total billed charges 842.69 842.69 other OPPS APC 842.69 842.69 other OPPS APC 842.69 27.63 232.84 percent of total billed charges 842.69 842.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FLUTE L6 MM OD1.5 MM CRANIOMAXILLOFACIAL CORTEX SELF TAP CRUCIFORM STERILE SUP-400.736E CDM 270010022 LOCAL 0270 RC outpatient 168.53 168.53 168.53 74 124.71 percent of total billed charges 168.53 93 136.51 percent of total billed charges 168.53 168.53 other OPPS APC 168.53 168.53 other OPPS APC 168.53 27.63 46.56 percent of total billed charges 168.53 168.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L10 MM OD1.5 MM CORTICAL CRANIOFACIAL SELF TAPPING FLUTED TIP NONSTERILE SUP-400.740E CDM 270010022 LOCAL 0270 RC outpatient 168.53 168.53 168.53 74 124.71 percent of total billed charges 168.53 93 136.51 percent of total billed charges 168.53 168.53 other OPPS APC 168.53 168.53 other OPPS APC 168.53 27.63 46.56 percent of total billed charges 168.53 168.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FLUTE L12 MM OD1.5 MM ODSEC3 MM CORTICAL CRANIOFACIAL SELF TAPPING CRUCIFORM RECESS STERILE GOLD MODULAR FIXATION SYSTEM SUP-400.742E CDM 0270 RC outpatient 168.53 168.53 168.53 74 124.71 percent of total billed charges 168.53 93 136.51 percent of total billed charges 168.53 168.53 other OPPS APC 168.53 168.53 other OPPS APC 168.53 27.63 46.56 percent of total billed charges 168.53 168.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L4 MM OD1.5 MM CORTICAL CRANIOFACIAL SELF DRILLING STARDRIVE RECESS STERILE SUP-400.754E CDM 270010022 LOCAL 0270 RC outpatient 171.08 171.08 171.08 74 126.6 percent of total billed charges 171.08 93 138.57 percent of total billed charges 171.08 171.08 other OPPS APC 171.08 171.08 other OPPS APC 171.08 27.63 47.27 percent of total billed charges 171.08 171.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L4 MM OD3 MM ODSEC2 MM CRANIOMAXILLOFACIAL CORTICAL EMERGENCY CRUCIFORM RECESS NONSTERILE TEAL SUP-400.784 CDM 270010014 LOCAL 0270 RC outpatient 894.53 894.53 894.53 74 661.95 percent of total billed charges 894.53 93 724.57 percent of total billed charges 894.53 894.53 other OPPS APC 894.53 894.53 other OPPS APC 894.53 27.63 247.16 percent of total billed charges 894.53 894.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L4 MM OD2 MM CRANIOFACIAL EMERGENCY CRUCIFORM STERILE SUP-400.784E CDM 270010022 LOCAL 0270 RC outpatient 178.91 178.91 178.91 74 132.39 percent of total billed charges 178.91 93 144.92 percent of total billed charges 178.91 178.91 other OPPS APC 178.91 178.91 other OPPS APC 178.91 27.63 49.43 percent of total billed charges 178.91 178.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L6 MM OD2 MM CRANIOFACIAL EMERGENCY CRUCIFORM STERILE SUP-400.786E CDM 270010022 LOCAL 0270 RC outpatient 178.91 178.91 178.91 74 132.39 percent of total billed charges 178.91 93 144.92 percent of total billed charges 178.91 178.91 other OPPS APC 178.91 178.91 other OPPS APC 178.91 27.63 49.43 percent of total billed charges 178.91 178.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L8 MM OD2 MM CRANIOFACIAL EMERGENCY CRUCIFORM STERILE SUP-400.788E CDM 270010022 LOCAL 0270 RC outpatient 178.91 178.91 178.91 74 132.39 percent of total billed charges 178.91 93 144.92 percent of total billed charges 178.91 178.91 other OPPS APC 178.91 178.91 other OPPS APC 178.91 27.63 49.43 percent of total billed charges 178.91 178.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L12 MM OD2 MM MAXILLOFACIAL EMERGENCY STERILE SUP-400.792E CDM 270010022 LOCAL 0270 RC outpatient 178.91 178.91 178.91 74 132.39 percent of total billed charges 178.91 93 144.92 percent of total billed charges 178.91 178.91 other OPPS APC 178.91 178.91 other OPPS APC 178.91 27.63 49.43 percent of total billed charges 178.91 178.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM LOW PROFILE L6 MM OD1.5 MM ODSEC3 MM HAND CORTICAL SELF TAP THREAD NONSTERILE PERCUTANEOUS REDUCTION FORCEPS MINI FRAGMENT SET SUP-400.806.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L7 MM OD1.5 MM CORTICAL SELF TAP BROW LIFT NONSTERILE ORTHOGNATHIC MODULAR FIXATION SYSTEM SUP-400.807.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L8 MM OD1.5 MM ODSEC3 MM HAND CORTICAL SELF TAPPING NONSTERILE MINI FRAGMENT SET SUP-400.808.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L9 MM OD1.5 MM CORTICAL HAND SELF TAPPING NONSTERILE SUP-400.809.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM LOW PROFILE L10 MM OD1.5 MM ODSEC3 MM HAND CORTICAL SELF TAP THREAD NONSTERILE PERCUTANEOUS REDUCTION FORCEPS MINI FRAGMENT SET SUP-400.810.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L11 MM OD1.5 MM ODSEC3 MM HAND CORTEX SELF TAP LOW PROFILE HEAD THREAD NONSTERILE MINI FRAGMENT SET SUP-400.811.96 CDM 270010022 LOCAL 0270 RC outpatient 83.23 83.23 83.23 74 61.59 percent of total billed charges 83.23 93 67.42 percent of total billed charges 83.23 83.23 other OPPS APC 83.23 83.23 other OPPS APC 83.23 27.63 23 percent of total billed charges 83.23 83.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L12 MM OD1.5 MM ODSEC3 MM HAND CORTICAL SELF TAPPING NONSTERILE PERCUTANEOUS REDUCTION FORCEPS SUP-400.812.96 CDM 270010022 LOCAL 0270 RC outpatient 83.23 83.23 83.23 74 61.59 percent of total billed charges 83.23 93 67.42 percent of total billed charges 83.23 83.23 other OPPS APC 83.23 83.23 other OPPS APC 83.23 27.63 23 percent of total billed charges 83.23 83.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 13MM 1.5MM 3MM TITANIUM NS CORTEX SELF TAP MODULAR HAND SYSTEM SUP-400.813.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM LOW PROFILE L14 MM OD1.5 MM ODSEC3 MM HAND CORTICAL SELF TAP THREAD NONSTERILE PERCUTANEOUS REDUCTION FORCEPS MINI FRAGMENT SET SUP-400.814.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L16 MM OD1.5 MM CORTICAL HAND SELF TAPPING NONSTERILE SUP-400.816.96 CDM 270010022 LOCAL 0270 RC outpatient 83.23 83.23 83.23 74 61.59 percent of total billed charges 83.23 93 67.42 percent of total billed charges 83.23 83.23 other OPPS APC 83.23 83.23 other OPPS APC 83.23 27.63 23 percent of total billed charges 83.23 83.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM LOW PROFILE L18 MM OD1.5 MM ODSEC3 MM HAND CORTICAL SELF TAP THREAD NONSTERILE PERCUTANEOUS REDUCTION FORCEPS MINI FRAGMENT SET SUP-400.818.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM LOW PROFILE L22 MM OD1.5 MM ODSEC3 MM HAND CORTICAL SELF TAP THREAD NONSTERILE PERCUTANEOUS REDUCTION FORCEPS MINI FRAGMENT SET SUP-400.822.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM LOW PROFILE L24 MM OD1.5 MM ODSEC3 MM HAND CORTICAL SELF TAP THREAD NONSTERILE PERCUTANEOUS REDUCTION FORCEPS MINI FRAGMENT SET SUP-400.824.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM LOW PROFILE L4 MM OD1.6 MM ODSEC2.9 MM CRANIOMAXILLOFACIAL SELF DRILL SELF RETAINING HIGH STRENGTH CRUCIFORM SUP-400.834 CDM 270010014 LOCAL 0270 RC outpatient 820.27 820.27 820.27 74 607 percent of total billed charges 820.27 93 664.42 percent of total billed charges 820.27 820.27 other OPPS APC 820.27 820.27 other OPPS APC 820.27 27.63 226.64 percent of total billed charges 820.27 820.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM LOW PROFILE L5 MM OD1.6 MM ODSEC2.9 MM CRANIOMAXILLOFACIAL SELF DRILL SELF RETAINING HIGH STRENGTH CRUCIFORM SUP-400.835 CDM 270010014 LOCAL 0270 RC outpatient 820.27 820.27 820.27 74 607 percent of total billed charges 820.27 93 664.42 percent of total billed charges 820.27 820.27 other OPPS APC 820.27 820.27 other OPPS APC 820.27 27.63 226.64 percent of total billed charges 820.27 820.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L4 MM OD1.9 MM ODSEC2.9 MM CRANIOMAXILLOFACIAL LOW PROFILE SELF TAP SELF RETAINING CRUCIFORM NEURO PLATE SYSTEM SUP-400.854 CDM 270010014 LOCAL 0270 RC outpatient 820.27 820.27 820.27 74 607 percent of total billed charges 820.27 93 664.42 percent of total billed charges 820.27 820.27 other OPPS APC 820.27 820.27 other OPPS APC 820.27 27.63 226.64 percent of total billed charges 820.27 820.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM LOW PROFILE L5 MM OD1.9 MM ODSEC2.9 MM CRANIOMAXILLOFACIAL EMERGENCY SELF TAP SELF RETAINING CRUCIFORM NONSTERILE SUP-400.855 CDM 270010013 LOCAL 0270 RC outpatient 820.27 820.27 820.27 74 607 percent of total billed charges 820.27 93 664.42 percent of total billed charges 820.27 820.27 other OPPS APC 820.27 820.27 other OPPS APC 820.27 27.63 226.64 percent of total billed charges 820.27 820.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PADS CLOSURE D-STAT 4000 SUP-4000 CDM 0270 RC outpatient 353.6 353.6 353.6 74 261.66 percent of total billed charges 353.6 93 286.42 percent of total billed charges 353.6 353.6 other OPPS APC 353.6 353.6 other OPPS APC 353.6 27.63 97.7 percent of total billed charges 353.6 353.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPELLA CP WITH SMARTASSIST PLUS IMPELLA 7FR LOW PROFILE COMPANION SHEATH BUNDLE SUP-4000021 CDM outpatient 65000 65000 65000 65000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE EQUIPMENT S ENDOWRIST STANDARD CAMERA HEAD DISPOSABLE SUP-400027 CDM 0270 RC outpatient 65 65 65 74 48.1 percent of total billed charges 65 93 52.65 percent of total billed charges 65 65 other OPPS APC 65 65 other OPPS APC 65 27.63 17.96 percent of total billed charges 65 65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEAL CANNULA DA VINCI ENDOWRIST OD8 MM DISPOSABLE SUP-400077 CDM 0270 RC outpatient 41.08 41.08 41.08 74 30.4 percent of total billed charges 41.08 93 33.27 percent of total billed charges 41.08 41.08 other OPPS APC 41.08 41.08 other OPPS APC 41.08 27.63 11.35 percent of total billed charges 41.08 41.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP CAUTERY DA VINCI ENDOWRIST OD5 MM HOOK MONOPOLAR PERMANENT DISPOSABLE SUP-400156 CDM outpatient 232.18 232.18 232.18 232.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER ENDOSCOPE TIP HOT SHEARS DA VINCI ENDOWRIST 8 MM STANDARD CAUTERY MONOPOLAR DISPOSABLE SUP-400180 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT SHEARS DA VINCI S/SI ENDOWRIST HARMONIC ACE CURVE DISPOSABLE SUP-400272 CDM 0270 RC outpatient 1118 1118 1118 74 827.32 percent of total billed charges 1118 93 905.58 percent of total billed charges 1118 1118 other OPPS APC 1118 1118 other OPPS APC 1118 27.63 308.9 percent of total billed charges 1118 1118 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5.5F PRONTO V4 EXTRACTION CATHETER SUP-4005 CDM 0270 RC outpatient 865.8 865.8 865.8 74 640.69 percent of total billed charges 865.8 93 701.3 percent of total billed charges 865.8 865.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY PRONTO V4 SILVA L138 CM OD5.5 FR CORONARY PERIPHERAL LARGE EXTRACTION LUMEN DISTAL TIP EMBED LONGITUDINAL WIRE STERILE ACCEPTS .014 IN GUIDEWIRE SUP-4005 CDM 0270 RC outpatient 865.8 865.8 865.8 865.8 other OPPS APC 865.8 865.8 other OPPS APC 865.8 27.63 239.22 percent of total billed charges 865.8 865.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK THROAT INTRA OP OROPAK MEROCEL WITH STRING SUP-400520 CDM 0270 RC outpatient 55.9 55.9 55.9 74 41.37 percent of total billed charges 55.9 93 45.28 percent of total billed charges 55.9 55.9 other OPPS APC 55.9 55.9 other OPPS APC 55.9 27.63 15.45 percent of total billed charges 55.9 55.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CORTICAL WEDGE L3-6 CM X H8 MM 2 PIECE ALLOGRAFT FREEZE DRIED HIGH TIBIAL OSTEOTOMY SUP-400539 CDM 270010031 LOCAL 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CORTICAL WEDGE L5.5 CM X H12 MM 2 PIECE ALLOGRAFT FREEZE DRIED HIGH TIBIAL OSTEOTOMY SUP-400541 CDM 270010031 LOCAL 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CORNERSTONE 5 X 14MM SUP-400541 CDM 270010012 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F PRONTO V4 EXTRACTION CATHETER SUP-4006 CDM 0270 RC outpatient 774.8 774.8 774.8 74 573.35 percent of total billed charges 774.8 93 627.59 percent of total billed charges 774.8 774.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EXTRACTION PRONTO V4 6F SUP-4006 CDM 0270 RC outpatient 774.8 774.8 774.8 774.8 other OPPS APC 774.8 774.8 other OPPS APC 774.8 27.63 214.08 percent of total billed charges 774.8 774.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CORNERSTONE L14 MM X W11 MM X H6 MM LASER SUP-400641 CDM 270010012 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLANKET WARMING 3M BAIR HUGGER 84X36IN 24IN LF PEDIATRIC FULL BODY AIR FORCE INTEGRATE TUCK FLAP FOOT DRAPE SUP-40068 CDM 0270 RC outpatient 12 12 12 74 8.88 percent of total billed charges 12 93 9.72 percent of total billed charges 12 12 other OPPS APC 12 12 other OPPS APC 12 27.63 3.32 percent of total billed charges 12 12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE FIBULA SHAFT L40 MM X W14-18 MM ALLOGRAFT FREEZE DRIED SUP-400720 CDM 270010031 LOCAL 0270 RC outpatient 1631.71 1631.71 1631.71 74 1207.47 percent of total billed charges 1631.71 93 1321.69 percent of total billed charges 1631.71 1631.71 other OPPS APC 1631.71 1631.71 other OPPS APC 1631.71 27.63 450.84 percent of total billed charges 1631.71 1631.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE FIBULA SHAFT ROUND L40 MM X W9-14 MM ALLOGRAFT FREEZE DRIED SUP-400722 CDM 270010031 LOCAL 0270 RC outpatient 1631.71 1631.71 1631.71 74 1207.47 percent of total billed charges 1631.71 93 1321.69 percent of total billed charges 1631.71 1631.71 other OPPS APC 1631.71 1631.71 other OPPS APC 1631.71 27.63 450.84 percent of total billed charges 1631.71 1631.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE FIBULA SHAFT ALLOGRAFT FREEZE DRIED 60X14-18MM SUP-400730 CDM 270010031 LOCAL 0270 RC outpatient 1479.09 1479.09 1479.09 74 1094.53 percent of total billed charges 1479.09 93 1198.06 percent of total billed charges 1479.09 1479.09 other OPPS APC 1479.09 1479.09 other OPPS APC 1479.09 27.63 408.67 percent of total billed charges 1479.09 1479.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE FIBULA SHAFT L60 MM X W14-18 MM ALLOGRAFT FREEZE DRY SUP-400730 CDM 270010031 LOCAL 0270 RC outpatient 1749.8 1749.8 1749.8 74 1294.85 percent of total billed charges 1749.8 93 1417.34 percent of total billed charges 1749.8 1749.8 other OPPS APC 1749.8 1749.8 other OPPS APC 1749.8 27.63 483.47 percent of total billed charges 1749.8 1749.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE FIBULA SHAFT L60 MM X W12-13 MM ALLOGRAFT FREEZE DRIED SUP-400731 CDM 270010031 LOCAL 0270 RC outpatient 1749.8 1749.8 1749.8 74 1294.85 percent of total billed charges 1749.8 93 1417.34 percent of total billed charges 1749.8 1749.8 other OPPS APC 1749.8 1749.8 other OPPS APC 1749.8 27.63 483.47 percent of total billed charges 1749.8 1749.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE FIBULA SHAFT L80 MM X W14-18 MM ALLOGRAFT FREEZE DRIED SUP-400740 CDM 270010031 LOCAL 0270 RC outpatient 1867.92 1867.92 1867.92 74 1382.26 percent of total billed charges 1867.92 93 1513.02 percent of total billed charges 1867.92 1867.92 other OPPS APC 1867.92 1867.92 other OPPS APC 1867.92 27.63 516.11 percent of total billed charges 1867.92 1867.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT CORNERSTONE L-SR 7X14X11 SUP-400741 CDM 270010020 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE RADIUS ULNA SHAFT L40 MM X W15-18 MM ALLOGRAFT FREEZE DRIED SUP-400800 CDM 270010031 LOCAL 0270 RC outpatient 1778.74 1778.74 1778.74 74 1316.27 percent of total billed charges 1778.74 93 1440.78 percent of total billed charges 1778.74 1778.74 other OPPS APC 1778.74 1778.74 other OPPS APC 1778.74 27.63 491.47 percent of total billed charges 1778.74 1778.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCK LORDOTIC SR CORTICAL 8X14X11MM SUP-400841 CDM 270010012 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER ALLOGRAFT CORNERSTONE-SR LORDOTIC 14X11X9MM CORTICAL SUP-400941 CDM 270010012 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE TEMPERATURE ESOPHAGEAL OR RECTAL SUP-401 CDM outpatient 143 143 143 143 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER BRITE TIP L11 CM OD6 FR CANNULA INTERVENTIONAL LATEX FREE GREEN ACCEPTS .035 IN GUIDEWIRE SUP-401-611M CDM 0270 RC outpatient 33.8 33.8 33.8 74 25.01 percent of total billed charges 33.8 93 27.38 percent of total billed charges 33.8 33.8 other OPPS APC 33.8 33.8 other OPPS APC 33.8 27.63 9.34 percent of total billed charges 33.8 33.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH CORDIS BRITE TIP 45CM 35MM 6FR GREEN SILICONE DISPOSABLE STERILE LF ENDOVASCULAR KINK RESISTANT SUP-401-645M CDM 0270 RC outpatient 59.8 59.8 59.8 74 44.25 percent of total billed charges 59.8 93 48.44 percent of total billed charges 59.8 59.8 other OPPS APC 59.8 59.8 other OPPS APC 59.8 27.63 16.52 percent of total billed charges 59.8 59.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL SELF TAPPING STARDRIVE RECESS MANDIBULAR 2.0 X 5.0MM SUP-401.135E CDM 270010022 LOCAL 0270 RC outpatient 166.19 166.19 166.19 74 122.98 percent of total billed charges 166.19 93 134.61 percent of total billed charges 166.19 166.19 other OPPS APC 166.19 166.19 other OPPS APC 166.19 27.63 45.92 percent of total billed charges 166.19 166.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FLUTE L4 MM OD2 MM ODSEC3.5 MM CORTICAL CRANIOMAXILLOFACIAL SELF TAPPING CRUCIFORM RECESS STERILE GOLD MODULAR FIXATION SYSTEM SUP-401.154E CDM 270010022 LOCAL 0270 RC outpatient 171.13 171.13 171.13 74 126.64 percent of total billed charges 171.13 93 138.62 percent of total billed charges 171.13 171.13 other OPPS APC 171.13 171.13 other OPPS APC 171.13 27.63 47.28 percent of total billed charges 171.13 171.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L6 MM OD2 MM CORTICAL CRANIOFACIAL SELF TAPPING FLUTED TIP NONSTERILE SUP-401.156E CDM 270010022 LOCAL 0270 RC outpatient 171.13 171.13 171.13 74 126.64 percent of total billed charges 171.13 93 138.62 percent of total billed charges 171.13 171.13 other OPPS APC 171.13 171.13 other OPPS APC 171.13 27.63 47.28 percent of total billed charges 171.13 171.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L8 MM OD2 MM CORTICAL CRANIOFACIAL SELF TAPPING FLUTED TIP NONSTERILE SUP-401.158E CDM 270010022 LOCAL 0270 RC outpatient 171.13 171.13 171.13 74 126.64 percent of total billed charges 171.13 93 138.62 percent of total billed charges 171.13 171.13 other OPPS APC 171.13 171.13 other OPPS APC 171.13 27.63 47.28 percent of total billed charges 171.13 171.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FLUTE L10 MM OD2 MM ODSEC3.5 MM CRANIOFACIAL CORTICAL SELF TAP CRUCIFORM GOLD SUP-401.16 CDM 270010014 LOCAL 0270 RC outpatient 830.73 830.73 830.73 74 614.74 percent of total billed charges 830.73 93 672.89 percent of total billed charges 830.73 830.73 other OPPS APC 830.73 830.73 other OPPS APC 830.73 27.63 229.53 percent of total billed charges 830.73 830.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 2MM 3.5MM 10MM TITANIUM FLUTE CRANIOFACIAL CORTICAL SELF TAP CRUCIFORM NS SUP-401.160 CDM 270010014 LOCAL 0270 RC outpatient 830.73 830.73 830.73 74 614.74 percent of total billed charges 830.73 93 672.89 percent of total billed charges 830.73 830.73 other OPPS APC 830.73 830.73 other OPPS APC 830.73 27.63 229.53 percent of total billed charges 830.73 830.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FLUTE L10 MM OD2 MM ODSEC3.5 MM CORTICAL CRANIOMAXILLOFACIAL SELF TAPPING CRUCIFORM RECESS STERILE GOLD MODULAR FIXATION SYSTEM SUP-401.160E CDM 270010022 LOCAL 0270 RC outpatient 171.13 171.13 171.13 74 126.64 percent of total billed charges 171.13 93 138.62 percent of total billed charges 171.13 171.13 other OPPS APC 171.13 171.13 other OPPS APC 171.13 27.63 47.28 percent of total billed charges 171.13 171.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L12 MM OD2 MM ODSEC3.5 MM CRANIOFACIAL CORTICAL SELF TAPPING CRUCIFORM RECESS FLUTED TIP GOLD SUP-401.162 CDM 270010014 LOCAL 0270 RC outpatient 855.66 855.66 855.66 74 633.19 percent of total billed charges 855.66 93 693.08 percent of total billed charges 855.66 855.66 other OPPS APC 855.66 855.66 other OPPS APC 855.66 27.63 236.42 percent of total billed charges 855.66 855.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L12 MM OD2 MM ODSEC3.5 MM MAXILLOFACIAL CORTICAL SELF TAP STERILE MODULAR FIXATION SYSTEM SUP-401.162E CDM 270010022 LOCAL 0270 RC outpatient 171.13 171.13 171.13 74 126.64 percent of total billed charges 171.13 93 138.62 percent of total billed charges 171.13 171.13 other OPPS APC 171.13 171.13 other OPPS APC 171.13 27.63 47.28 percent of total billed charges 171.13 171.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FLUTE L14 MM OD2 MM ODSEC3.5 MM CORTICAL CRANIOMAXILLOFACIAL SELF TAPPING CRUCIFORM RECESS STERILE GOLD MODULAR FIXATION SYSTEM SUP-401.164E CDM 270010022 LOCAL 0270 RC outpatient 171.13 171.13 171.13 74 126.64 percent of total billed charges 171.13 93 138.62 percent of total billed charges 171.13 171.13 other OPPS APC 171.13 171.13 other OPPS APC 171.13 27.63 47.28 percent of total billed charges 171.13 171.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L16 MM OD2 MM ODSEC3.5 MM CRANIOMAXILLOFACIAL CORTICAL SELF TAPPING TRIFLUTED TIP FINE PITCH CRUCIFORM RECESS STERILE GOLD MODULAR FIXATION SYSTEM SUP-401.166E CDM 270010022 LOCAL 0270 RC outpatient 171.13 171.13 171.13 74 126.64 percent of total billed charges 171.13 93 138.62 percent of total billed charges 171.13 171.13 other OPPS APC 171.13 171.13 other OPPS APC 171.13 27.63 47.28 percent of total billed charges 171.13 171.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L18 MM OD2 MM CORTICAL SELF TAPPING SUP-401.168E CDM 270010022 LOCAL 0270 RC outpatient 171.13 171.13 171.13 74 126.64 percent of total billed charges 171.13 93 138.62 percent of total billed charges 171.13 171.13 other OPPS APC 171.13 171.13 other OPPS APC 171.13 27.63 47.28 percent of total billed charges 171.13 171.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L6 MM OD2.4 MM CRANIOFACIAL EMERGENCY CRUCIFORM STERILE TEAL 2 MM STRIP SUP-401.306E CDM 270010022 LOCAL 0270 RC outpatient 178.91 178.91 178.91 74 132.39 percent of total billed charges 178.91 93 144.92 percent of total billed charges 178.91 178.91 other OPPS APC 178.91 178.91 other OPPS APC 178.91 27.63 49.43 percent of total billed charges 178.91 178.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L8 MM OD2.4 MM CRANIOFACIAL EMERGENCY CRUCIFORM STERILE TEAL 2 MM STRIP SUP-401.308E CDM 270010022 LOCAL 0270 RC outpatient 178.91 178.91 178.91 74 132.39 percent of total billed charges 178.91 93 144.92 percent of total billed charges 178.91 178.91 other OPPS APC 178.91 178.91 other OPPS APC 178.91 27.63 49.43 percent of total billed charges 178.91 178.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L12 MM OD2.4 MM CRANIOFACIAL EMERGENCY CRUCIFORM RECESS NONSTERILE TEAL 2 MM STRIPPED SUP-401.312E CDM 270010022 LOCAL 0270 RC outpatient 178.91 178.91 178.91 74 132.39 percent of total billed charges 178.91 93 144.92 percent of total billed charges 178.91 178.91 other OPPS APC 178.91 178.91 other OPPS APC 178.91 27.63 49.43 percent of total billed charges 178.91 178.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L14 MM OD2.4 MM MANDIBLE EMERGENCY CRUCIFORM STERILE TEAL 2 MM STRIP SUP-401.314E CDM 270010022 LOCAL 0270 RC outpatient 178.91 178.91 178.91 74 132.39 percent of total billed charges 178.91 93 144.92 percent of total billed charges 178.91 178.91 other OPPS APC 178.91 178.91 other OPPS APC 178.91 27.63 49.43 percent of total billed charges 178.91 178.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L16 MM OD2.4 MM CRANIOFACIAL EMERGENCY CRUCIFORM RECESS NONSTERILE SUP-401.316E CDM 270010022 LOCAL 0270 RC outpatient 178.91 178.91 178.91 74 132.39 percent of total billed charges 178.91 93 144.92 percent of total billed charges 178.91 178.91 other OPPS APC 178.91 178.91 other OPPS APC 178.91 27.63 49.43 percent of total billed charges 178.91 178.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L18 MM OD2.4 MM EMERGENCY CRUCIFORM RECESS SUP-401.318E CDM 270010014 LOCAL 0270 RC outpatient 178.91 178.91 178.91 74 132.39 percent of total billed charges 178.91 93 144.92 percent of total billed charges 178.91 178.91 other OPPS APC 178.91 178.91 other OPPS APC 178.91 27.63 49.43 percent of total billed charges 178.91 178.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES CORTEX TITANIUM 2.0MM x 6MM SUP-401.356.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES CORTEX TITANIUM 2.0MM x 7MM SUP-401.357.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES CORTEX TITANIUM 2.0MM x 8MM SUP-401.358.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES CORTEX TITANIUM 2.0MM x 9MM SUP-401.359.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM T6 L10 MM OD2 MM RADIUS CORTICAL PROXIMAL SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-401.360.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES CORTEX TITANIUM 2.0MM x 11MM SUP-401.361.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM T6 L12 MM OD2 MM RADIUS CORTICAL PROXIMAL SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-401.362.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM T6 L13 MM OD2 MM RADIUS CORTICAL PROXIMAL SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-401.363.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L14 MM OD2 MM CORTICAL T6 STARDRIVE RECESS SELF TAPPING NONSTERILE MINI FRAGMENT SET SUP-401.364.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.0MM CORTEX 16MM SUP-401.366.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES CORTEX TITANIUM 2.0MM x 18MM SUP-401.368.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES CORTEX TITANIUM 2.0MM x 20MM SUP-401.370.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES CORTEX TITANIUM 2.0MM x 22MM SUP-401.372.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES CORTEX TITANIUM 2.0MM x 24MM SUP-401.374.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES CORTEX TITANIUM 2.0MM x26MM SUP-401.375.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES CORTEX TITANIUM 2.0MM x 28MM SUP-401.376.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES CORTEX TITANIUM 2.0MM x 30MM SUP-401.377.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES CORTEX TITANIUM 2.0MM x 32MM SUP-401.378.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES CORTEX TITANIUM 2.0MM x 34MM SUP-401.379.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES CORTEX TITANIUM 2.0MM x 36MM SUP-401.380.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES CORTEX TITANIUM 2.0MM x38MM SUP-401.381.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES CORTEX TITANIUM 2.0MM x 40MM SUP-401.382.97 CDM 270010022 LOCAL 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6MM 2.4MM 4MM TITANIUM NS HAND CORTEX SELF TAP CRUCIFORM MODULAR SYSTEM SUP-401.506.96 CDM 270010022 LOCAL 0270 RC outpatient 218.79 218.79 218.79 74 161.9 percent of total billed charges 218.79 93 177.22 percent of total billed charges 218.79 218.79 other OPPS APC 218.79 218.79 other OPPS APC 218.79 27.63 60.45 percent of total billed charges 218.79 218.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 7MM 2.4MM 4MM TITANIUM NS HAND CORTEX SELF TAP CRUCIFORM MODULAR SYSTEM SUP-401.507.96 CDM 270010022 LOCAL 0270 RC outpatient 218.79 218.79 218.79 74 161.9 percent of total billed charges 218.79 93 177.22 percent of total billed charges 218.79 218.79 other OPPS APC 218.79 218.79 other OPPS APC 218.79 27.63 60.45 percent of total billed charges 218.79 218.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L8 MM OD2.4 MM ODSEC4.5 MM HAND CORTICAL SELF TAPPING CRUCIFORM RECESS NONSTERILE SUP-401.508.96 CDM 270010022 LOCAL 0270 RC outpatient 218.79 218.79 218.79 74 161.9 percent of total billed charges 218.79 93 177.22 percent of total billed charges 218.79 218.79 other OPPS APC 218.79 218.79 other OPPS APC 218.79 27.63 60.45 percent of total billed charges 218.79 218.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 9MM 2.4MM 4.5MM TITANIUM NS HAND CORTEX SELF TAP CRUCIFORM MODULAR SYSTEM SUP-401.509.96 CDM 270010022 LOCAL 0270 RC outpatient 218.79 218.79 218.79 74 161.9 percent of total billed charges 218.79 93 177.22 percent of total billed charges 218.79 218.79 other OPPS APC 218.79 218.79 other OPPS APC 218.79 27.63 60.45 percent of total billed charges 218.79 218.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L10 MM OD2.4 MM MANDIBLE CORTICAL SELF TAP MODULAR FIXATION SYSTEM SUP-401.51 CDM 270010014 LOCAL 0270 RC outpatient 1346.77 1346.77 1346.77 74 996.61 percent of total billed charges 1346.77 93 1090.88 percent of total billed charges 1346.77 1346.77 other OPPS APC 1346.77 1346.77 other OPPS APC 1346.77 27.63 372.11 percent of total billed charges 1346.77 1346.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TITANIUM 10MM 2.4MM MANDIBLE CORTICAL SELF TAP BONE NS MODULAR FIXATION SYSTEM SUP-401.510 CDM 270010014 LOCAL 0270 RC outpatient 1346.77 1346.77 1346.77 74 996.61 percent of total billed charges 1346.77 93 1090.88 percent of total billed charges 1346.77 1346.77 other OPPS APC 1346.77 1346.77 other OPPS APC 1346.77 27.63 372.11 percent of total billed charges 1346.77 1346.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L10 MM OD2.4 MM ODSEC4.5 MM HAND CORTEX SELF TAP CRUCIFORM RECESS NONSTERILE MODULAR SYSTEM SUP-401.510.96 CDM 270010022 LOCAL 0270 RC outpatient 218.79 218.79 218.79 74 161.9 percent of total billed charges 218.79 93 177.22 percent of total billed charges 218.79 218.79 other OPPS APC 218.79 218.79 other OPPS APC 218.79 27.63 60.45 percent of total billed charges 218.79 218.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L11 MM OD2.4 MM ODSEC4.5 MM HAND CORTICAL SELF TAP CRUCIFORM NONSTERILE SUP-401.511.96 CDM 270010022 LOCAL 0270 RC outpatient 218.79 218.79 218.79 74 161.9 percent of total billed charges 218.79 93 177.22 percent of total billed charges 218.79 218.79 other OPPS APC 218.79 218.79 other OPPS APC 218.79 27.63 60.45 percent of total billed charges 218.79 218.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 12MM 2.4MM 4MM TITANIUM NS MANDIBLE CORTEX SELF TAP CRUCIFORM MODULAR FIXATION SYSTEM SUP-401.512 CDM 270010014 LOCAL 0270 RC outpatient 1387.18 1387.18 1387.18 74 1026.51 percent of total billed charges 1387.18 93 1123.62 percent of total billed charges 1387.18 1387.18 other OPPS APC 1387.18 1387.18 other OPPS APC 1387.18 27.63 383.28 percent of total billed charges 1387.18 1387.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L12 MM OD2.4 MM ODSEC4.5 MM HAND CORTEX SELF TAP CRUCIFORM RECESS NONSTERILE MODULAR SYSTEM SUP-401.512.96 CDM 270010022 LOCAL 0270 RC outpatient 218.79 218.79 218.79 74 161.9 percent of total billed charges 218.79 93 177.22 percent of total billed charges 218.79 218.79 other OPPS APC 218.79 218.79 other OPPS APC 218.79 27.63 60.45 percent of total billed charges 218.79 218.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L13 MM OD2.4 MM ODSEC4.5 MM HAND CORTICAL SELF TAPPING CRUCIFORM RECESS NONSTERILE SUP-401.513.96 CDM 270010022 LOCAL 0270 RC outpatient 218.79 218.79 218.79 74 161.9 percent of total billed charges 218.79 93 177.22 percent of total billed charges 218.79 218.79 other OPPS APC 218.79 218.79 other OPPS APC 218.79 27.63 60.45 percent of total billed charges 218.79 218.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L14 MM OD2.4 MM ODSEC4.5 MM HAND CORTICAL SELF TAP CRUCIFORM NONSTERILE SUP-401.514.96 CDM 270010022 LOCAL 0270 RC outpatient 218.79 218.79 218.79 74 161.9 percent of total billed charges 218.79 93 177.22 percent of total billed charges 218.79 218.79 other OPPS APC 218.79 218.79 other OPPS APC 218.79 27.63 60.45 percent of total billed charges 218.79 218.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L16 MM OD2.4 MM ODSEC4.5 MM HAND CORTICAL SELF TAPPING CRUCIFORM RECESS NONSTERILE SUP-401.516.96 CDM 270010022 LOCAL 0270 RC outpatient 218.79 218.79 218.79 74 161.9 percent of total billed charges 218.79 93 177.22 percent of total billed charges 218.79 218.79 other OPPS APC 218.79 218.79 other OPPS APC 218.79 27.63 60.45 percent of total billed charges 218.79 218.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 18MM 2.4MM 4.5MM TITANIUM NS CORTICAL SELF TAP CRUCIFORM SUP-401.518.96 CDM 270010022 LOCAL 0270 RC outpatient 218.79 218.79 218.79 74 161.9 percent of total billed charges 218.79 93 177.22 percent of total billed charges 218.79 218.79 other OPPS APC 218.79 218.79 other OPPS APC 218.79 27.63 60.45 percent of total billed charges 218.79 218.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L20 MM OD2.4 MM ODSEC4.5 MM HAND CORTICAL SELF TAP CRUCIFORM NONSTERILE SUP-401.520.96 CDM 270010022 LOCAL 0270 RC outpatient 218.79 218.79 218.79 74 161.9 percent of total billed charges 218.79 93 177.22 percent of total billed charges 218.79 218.79 other OPPS APC 218.79 218.79 other OPPS APC 218.79 27.63 60.45 percent of total billed charges 218.79 218.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L22 MM OD2.4 MM ODSEC4.5 MM HAND CORTICAL SELF TAP CRUCIFORM NONSTERILE SUP-401.522.96 CDM 270010022 LOCAL 0270 RC outpatient 218.79 218.79 218.79 74 161.9 percent of total billed charges 218.79 93 177.22 percent of total billed charges 218.79 218.79 other OPPS APC 218.79 218.79 other OPPS APC 218.79 27.63 60.45 percent of total billed charges 218.79 218.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 24MM 2.4MM 4.5MM TITANIUM NS CORTICAL SELF TAP CRUCIFORM SUP-401.524.96 CDM 270010022 LOCAL 0270 RC outpatient 218.79 218.79 218.79 74 161.9 percent of total billed charges 218.79 93 177.22 percent of total billed charges 218.79 218.79 other OPPS APC 218.79 218.79 other OPPS APC 218.79 27.63 60.45 percent of total billed charges 218.79 218.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 26MM 2.4MM 4.5MM TITANIUM NS CORTICAL SELF TAP CRUCIFORM SUP-401.526.96 CDM 270010022 LOCAL 0270 RC outpatient 218.79 218.79 218.79 74 161.9 percent of total billed charges 218.79 93 177.22 percent of total billed charges 218.79 218.79 other OPPS APC 218.79 218.79 other OPPS APC 218.79 27.63 60.45 percent of total billed charges 218.79 218.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 28MM 2.4MM 4.5MM TITANIUM NS CORTICAL SELF TAP CRUCIFORM SUP-401.528.96 CDM 270010022 LOCAL 0270 RC outpatient 218.79 218.79 218.79 74 161.9 percent of total billed charges 218.79 93 177.22 percent of total billed charges 218.79 218.79 other OPPS APC 218.79 218.79 other OPPS APC 218.79 27.63 60.45 percent of total billed charges 218.79 218.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L30 MM OD2.4 MM ODSEC4.5 MM HAND CORTICAL SELF TAP CRUCIFORM NONSTERILE SUP-401.530.96 CDM 270010022 LOCAL 0270 RC outpatient 218.79 218.79 218.79 74 161.9 percent of total billed charges 218.79 93 177.22 percent of total billed charges 218.79 218.79 other OPPS APC 218.79 218.79 other OPPS APC 218.79 27.63 60.45 percent of total billed charges 218.79 218.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 32MM 2.4MM 4.5MM TITANIUM NS CORTICAL SELF TAP CRUCIFORM SUP-401.532.96 CDM 270010022 LOCAL 0270 RC outpatient 218.79 218.79 218.79 74 161.9 percent of total billed charges 218.79 93 177.22 percent of total billed charges 218.79 218.79 other OPPS APC 218.79 218.79 other OPPS APC 218.79 27.63 60.45 percent of total billed charges 218.79 218.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L10 MM OD2.7 MM MANDIBLE EMERGENCY BLUE MODULAR FIXATION SYSTEM SUP-401.56 CDM 270010014 LOCAL 0270 RC outpatient 1485.22 1485.22 1485.22 74 1099.06 percent of total billed charges 1485.22 93 1203.03 percent of total billed charges 1485.22 1485.22 other OPPS APC 1485.22 1485.22 other OPPS APC 1485.22 27.63 410.37 percent of total billed charges 1485.22 1485.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TITANIUM 10MM 2.7MM MANDIBLE EMERGENCY BONE NS BLUE MODULAR FIXATION SYSTEM SUP-401.560 CDM 270010014 LOCAL 0270 RC outpatient 1485.22 1485.22 1485.22 74 1099.06 percent of total billed charges 1485.22 93 1203.03 percent of total billed charges 1485.22 1485.22 other OPPS APC 1485.22 1485.22 other OPPS APC 1485.22 27.63 410.37 percent of total billed charges 1485.22 1485.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L6 MM OD2.4 MM RADIUS HUMERUS CORTICAL DISTAL SELF TAPPING STARDRIVE RECESS NONSTERILE MINI FRAGMENT SET SUP-401.756 CDM 270010022 LOCAL 0270 RC outpatient 141.23 141.23 141.23 74 104.51 percent of total billed charges 141.23 93 114.4 percent of total billed charges 141.23 141.23 other OPPS APC 141.23 141.23 other OPPS APC 141.23 27.63 39.02 percent of total billed charges 141.23 141.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L7 MM OD2.4 MM CORTICAL SELF TAPPING NONSTERILE MINI FRAGMENT SET SUP-401.757 CDM 270010024 LOCAL 0270 RC outpatient 141.23 141.23 141.23 74 104.51 percent of total billed charges 141.23 93 114.4 percent of total billed charges 141.23 141.23 other OPPS APC 141.23 141.23 other OPPS APC 141.23 27.63 39.02 percent of total billed charges 141.23 141.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L8 MM OD2.4 MM RADIUS HUMERUS CORTICAL DISTAL SELF TAPPING STARDRIVE RECESS NONSTERILE MINI FRAGMENT SET SUP-401.758 CDM 270010022 LOCAL 0270 RC outpatient 141.23 141.23 141.23 74 104.51 percent of total billed charges 141.23 93 114.4 percent of total billed charges 141.23 141.23 other OPPS APC 141.23 141.23 other OPPS APC 141.23 27.63 39.02 percent of total billed charges 141.23 141.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L9 MM OD2.4 MM CORTICAL SELF TAPPING NONSTERILE MINI FRAGMENT SET SUP-401.759 CDM 270010022 LOCAL 0270 RC outpatient 141.23 141.23 141.23 74 104.51 percent of total billed charges 141.23 93 114.4 percent of total billed charges 141.23 141.23 other OPPS APC 141.23 141.23 other OPPS APC 141.23 27.63 39.02 percent of total billed charges 141.23 141.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L10 MM OD2.4 MM ODSEC4 MM HUMERUS RADIUS CORTICAL DISTAL SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-401.760 CDM 270010022 LOCAL 0270 RC outpatient 141.23 141.23 141.23 74 104.51 percent of total billed charges 141.23 93 114.4 percent of total billed charges 141.23 141.23 other OPPS APC 141.23 141.23 other OPPS APC 141.23 27.63 39.02 percent of total billed charges 141.23 141.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L11 MM OD2.4 MM CORTICAL SELF TAPPING NONSTERILE MINI FRAGMENT SET SUP-401.761 CDM 270010022 LOCAL 0270 RC outpatient 141.23 141.23 141.23 74 104.51 percent of total billed charges 141.23 93 114.4 percent of total billed charges 141.23 141.23 other OPPS APC 141.23 141.23 other OPPS APC 141.23 27.63 39.02 percent of total billed charges 141.23 141.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM T8 L12 MM OD2.4 MM RADIUS CORTEX DISTAL SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-401.762 CDM 270010022 LOCAL 0270 RC outpatient 141.23 141.23 141.23 74 104.51 percent of total billed charges 141.23 93 114.4 percent of total billed charges 141.23 141.23 other OPPS APC 141.23 141.23 other OPPS APC 141.23 27.63 39.02 percent of total billed charges 141.23 141.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES TI 2.4MM CORTEX 13MM SUP-401.763 CDM 270010022 LOCAL 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM T8 L14 MM OD2.4 MM RADIUS CORTEX DISTAL SELF TAP STARDRIVE NONSTERILE SUP-401.764 CDM 270010022 LOCAL 0270 RC outpatient 141.23 141.23 141.23 74 104.51 percent of total billed charges 141.23 93 114.4 percent of total billed charges 141.23 141.23 other OPPS APC 141.23 141.23 other OPPS APC 141.23 27.63 39.02 percent of total billed charges 141.23 141.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM T8 L16 MM OD2.4 MM RADIUS CORTEX DISTAL SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-401.766 CDM 270010022 LOCAL 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES TI 2.4MM CORTEX 18MM SUP-401.768 CDM 270010022 LOCAL 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES TI 2.4MM CORTEX 20MM SUP-401.770 CDM 270010022 LOCAL 0270 RC outpatient 141.23 141.23 141.23 74 104.51 percent of total billed charges 141.23 93 114.4 percent of total billed charges 141.23 141.23 other OPPS APC 141.23 141.23 other OPPS APC 141.23 27.63 39.02 percent of total billed charges 141.23 141.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L22 MM OD2.4 MM ODSEC4 MM HUMERUS RADIUS CORTICAL DISTAL SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-401.772 CDM 270010022 LOCAL 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES TI 2.4MM CORTEX 24MM SUP-401.774 CDM 270010022 LOCAL 0270 RC outpatient 141.23 141.23 141.23 74 104.51 percent of total billed charges 141.23 93 114.4 percent of total billed charges 141.23 141.23 other OPPS APC 141.23 141.23 other OPPS APC 141.23 27.63 39.02 percent of total billed charges 141.23 141.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES TI 2.4MM CORTEX 26MM SUP-401.776 CDM 270010022 LOCAL 0270 RC outpatient 141.23 141.23 141.23 74 104.51 percent of total billed charges 141.23 93 114.4 percent of total billed charges 141.23 141.23 other OPPS APC 141.23 141.23 other OPPS APC 141.23 27.63 39.02 percent of total billed charges 141.23 141.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES TI 2.4MM CORTEX 28MM SUP-401.778 CDM 270010022 LOCAL 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L36 MM OD2.4 MM HUMERUS CORTICAL DISTAL SELF TAPPING STARDRIVE RECESS SUP-401.786 CDM 270010022 LOCAL 0270 RC outpatient 141.23 141.23 141.23 74 104.51 percent of total billed charges 141.23 93 114.4 percent of total billed charges 141.23 141.23 other OPPS APC 141.23 141.23 other OPPS APC 141.23 27.63 39.02 percent of total billed charges 141.23 141.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L38 MM OD2.4 MM ODSEC4 MM HUMERUS CORTEX DISTAL T8 STARDRIVE RECESS SELF TAP SUP-401.788 CDM 270010022 LOCAL 0270 RC outpatient 141.23 141.23 141.23 74 104.51 percent of total billed charges 141.23 93 114.4 percent of total billed charges 141.23 141.23 other OPPS APC 141.23 141.23 other OPPS APC 141.23 27.63 39.02 percent of total billed charges 141.23 141.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L40 MM OD2 MM CORTICAL SELF TAPPING LOCKING NONSTERILE MINI FRAGMENT SET SUP-401.790 CDM 270010022 LOCAL 0270 RC outpatient 141.23 141.23 141.23 74 104.51 percent of total billed charges 141.23 93 114.4 percent of total billed charges 141.23 141.23 other OPPS APC 141.23 141.23 other OPPS APC 141.23 27.63 39.02 percent of total billed charges 141.23 141.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L6 MM OD2 MM ODSEC3.5 MM HAND CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE SUP-401.806.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L7 MM OD2 MM ODSEC3.5 MM HAND CORTEX SELF TAP CRUCIFORM NONSTERILE SUP-401.807.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L8 MM OD2 MM ODSEC3.5 MM HAND CORTEX SELF TAP CRUCIFORM RECESS NONSTERILE MINI FRAGMENT SET SUP-401.808 CDM 270010022 LOCAL 0270 RC outpatient 117.26 117.26 117.26 74 86.77 percent of total billed charges 117.26 93 94.98 percent of total billed charges 117.26 117.26 other OPPS APC 117.26 117.26 other OPPS APC 117.26 27.63 32.4 percent of total billed charges 117.26 117.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L8 MM OD2 MM ODSEC3.5 MM HAND CORTEX SELF TAP NONSTERILE MODULAR SYSTEM SUP-401.808.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L9 MM OD2 MM ODSEC3.5 MM HAND CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET SUP-401.809.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L10 MM OD2.0 MM CORTICAL SELF TAPPING NONSTERILE SUP-401.810.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L11 MM OD2 MM ODSEC3.5 MM HAND CORTICAL SELF TAP CRUCIFORM NONSTERILE SUP-401.811.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L12 MM OD2 MM ODSEC3.5 MM HAND CORTEX SELF TAP NONSTERILE MODULAR SYSTEM SUP-401.812.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L13 MM OD2 MM ODSEC3.5 MM HAND CORTICAL SELF TAP CRUCIFORM NONSTERILE SUP-401.813.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L14 MM OD2 MM ODSEC3.5 MM HAND CORTICAL SELF TAP CRUCIFORM NONSTERILE SUP-401.814.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L16 MM OD2 MM ODSEC3.5 MM CRANIOMAXILLOFACIAL CORTICAL SELF TAPPING CRUCIFORM RECESS NONSTERILE MODULAR HAND SYSTEM SUP-401.816.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L18 MM OD2 MM ODSEC3.5 MM HAND CORTICAL SELF TAP CRUCIFORM NONSTERILE SUP-401.818.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 20MM 2MM 3.5MM TITANIUM NS CORTEX SELF TAP CRUCIFORM MODULAR HAND SYSTEM SUP-401.820.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 22MM 2MM 3.5MM TITANIUM NS CORTEX SELF TAP CRUCIFORM MODULAR HAND SYSTEM SUP-401.822.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L24 MM OD2 MM ODSEC3.5 MM HAND CORTICAL SELF TAP CRUCIFORM NONSTERILE SUP-401.824.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L26 MM OD2 MM ODSEC3.5 MM HAND CORTICAL SELF TAP CRUCIFORM NONSTERILE SUP-401.826.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L28 MM OD2 MM ODSEC3.5 MM HAND CORTICAL SELF TAP CRUCIFORM NONSTERILE SUP-401.828.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 30MM 2MM 3.5MM TITANIUM NS CORTEX SELF TAP CRUCIFORM MODULAR HAND SYSTEM SUP-401.830.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 32MM 2MM 3.5MM TITANIUM NS CORTEX SELF TAP CRUCIFORM MODULAR HAND SYSTEM SUP-401.832.96 CDM 270010022 LOCAL 0270 RC outpatient 94.38 94.38 94.38 74 69.84 percent of total billed charges 94.38 93 76.45 percent of total billed charges 94.38 94.38 other OPPS APC 94.38 94.38 other OPPS APC 94.38 27.63 26.08 percent of total billed charges 94.38 94.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES LOCKING TITANIUM 2.0MM X 6MM SUP-401.876 CDM 270010022 LOCAL 0270 RC outpatient 290.03 290.03 290.03 74 214.62 percent of total billed charges 290.03 93 234.92 percent of total billed charges 290.03 290.03 other OPPS APC 290.03 290.03 other OPPS APC 290.03 27.63 80.14 percent of total billed charges 290.03 290.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L7 MM OD2 MM ORTHOPEDIC SELF TAPPING LOCKING MINI FRAGMENT SET SUP-401.877 CDM 270010022 LOCAL 0270 RC outpatient 328.9 328.9 328.9 74 243.39 percent of total billed charges 328.9 93 266.41 percent of total billed charges 328.9 328.9 other OPPS APC 328.9 328.9 other OPPS APC 328.9 27.63 90.88 percent of total billed charges 328.9 328.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES LOCKING TITANIUM 2.0MM X 8MM SUP-401.878 CDM 270010022 LOCAL 0270 RC outpatient 290.03 290.03 290.03 74 214.62 percent of total billed charges 290.03 93 234.92 percent of total billed charges 290.03 290.03 other OPPS APC 290.03 290.03 other OPPS APC 290.03 27.63 80.14 percent of total billed charges 290.03 290.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES LOCKING TITANIUM 2.0MM X 9MM SUP-401.879 CDM 270010022 LOCAL 0270 RC outpatient 328.9 328.9 328.9 74 243.39 percent of total billed charges 328.9 93 266.41 percent of total billed charges 328.9 328.9 other OPPS APC 328.9 328.9 other OPPS APC 328.9 27.63 90.88 percent of total billed charges 328.9 328.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L10 MM OD2 MM SMALL BONE CORTICAL SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-401.880 CDM 270010022 LOCAL 0270 RC outpatient 328.9 328.9 328.9 74 243.39 percent of total billed charges 328.9 93 266.41 percent of total billed charges 328.9 328.9 other OPPS APC 328.9 328.9 other OPPS APC 328.9 27.63 90.88 percent of total billed charges 328.9 328.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES LOCKING TITANIUM 2.0MM X 11MM SUP-401.881 CDM 270010022 LOCAL 0270 RC outpatient 290.03 290.03 290.03 74 214.62 percent of total billed charges 290.03 93 234.92 percent of total billed charges 290.03 290.03 other OPPS APC 290.03 290.03 other OPPS APC 290.03 27.63 80.14 percent of total billed charges 290.03 290.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES LOCKING TITANIUM 2.0MM X 12MM SUP-401.882 CDM 270010022 LOCAL 0270 RC outpatient 328.9 328.9 328.9 74 243.39 percent of total billed charges 328.9 93 266.41 percent of total billed charges 328.9 328.9 other OPPS APC 328.9 328.9 other OPPS APC 328.9 27.63 90.88 percent of total billed charges 328.9 328.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES LOCKING TITANIUM 2.0MM X 13MM SUP-401.883 CDM 270010022 LOCAL 0270 RC outpatient 328.9 328.9 328.9 74 243.39 percent of total billed charges 328.9 93 266.41 percent of total billed charges 328.9 328.9 other OPPS APC 328.9 328.9 other OPPS APC 328.9 27.63 90.88 percent of total billed charges 328.9 328.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L14 MM OD2 MM SMALL BONE CORTICAL SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-401.884 CDM 270010022 LOCAL 0270 RC outpatient 328.9 328.9 328.9 74 243.39 percent of total billed charges 328.9 93 266.41 percent of total billed charges 328.9 328.9 other OPPS APC 328.9 328.9 other OPPS APC 328.9 27.63 90.88 percent of total billed charges 328.9 328.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES LOCKING TITANIUM 2.0MM X 16MM SUP-401.886 CDM 270010022 LOCAL 0270 RC outpatient 328.9 328.9 328.9 74 243.39 percent of total billed charges 328.9 93 266.41 percent of total billed charges 328.9 328.9 other OPPS APC 328.9 328.9 other OPPS APC 328.9 27.63 90.88 percent of total billed charges 328.9 328.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES LOCKING TITANIUM 2.0MM X18MM SUP-401.888 CDM 270010022 LOCAL 0270 RC outpatient 328.9 328.9 328.9 74 243.39 percent of total billed charges 328.9 93 266.41 percent of total billed charges 328.9 328.9 other OPPS APC 328.9 328.9 other OPPS APC 328.9 27.63 90.88 percent of total billed charges 328.9 328.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES LOCKING TITANIUM 2.0MM X 20MM SUP-401.890 CDM 270010022 LOCAL 0270 RC outpatient 328.9 328.9 328.9 74 243.39 percent of total billed charges 328.9 93 266.41 percent of total billed charges 328.9 328.9 other OPPS APC 328.9 328.9 other OPPS APC 328.9 27.63 90.88 percent of total billed charges 328.9 328.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES LOCKING TITANIUM 2.0MM X 22MM SUP-401.892 CDM 270010022 LOCAL 0270 RC outpatient 328.9 328.9 328.9 74 243.39 percent of total billed charges 328.9 93 266.41 percent of total billed charges 328.9 328.9 other OPPS APC 328.9 328.9 other OPPS APC 328.9 27.63 90.88 percent of total billed charges 328.9 328.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES LOCKING TITANIUM 2.0MM X 24MM SUP-401.894 CDM 270010022 LOCAL 0270 RC outpatient 328.9 328.9 328.9 74 243.39 percent of total billed charges 328.9 93 266.41 percent of total billed charges 328.9 328.9 other OPPS APC 328.9 328.9 other OPPS APC 328.9 27.63 90.88 percent of total billed charges 328.9 328.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES LOCKING TITANIUM 2.0MM X 26MM SUP-401.896 CDM 270010022 LOCAL 0270 RC outpatient 328.9 328.9 328.9 74 243.39 percent of total billed charges 328.9 93 266.41 percent of total billed charges 328.9 328.9 other OPPS APC 328.9 328.9 other OPPS APC 328.9 27.63 90.88 percent of total billed charges 328.9 328.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES LOCKING TITANIUM 2.0MM X 28MM SUP-401.898 CDM 270010022 LOCAL 0270 RC outpatient 328.9 328.9 328.9 74 243.39 percent of total billed charges 328.9 93 266.41 percent of total billed charges 328.9 328.9 other OPPS APC 328.9 328.9 other OPPS APC 328.9 27.63 90.88 percent of total billed charges 328.9 328.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES LOCKING TITANIUM 2.0MM X 30MM SUP-401.900 CDM 270010022 LOCAL 0270 RC outpatient 328.9 328.9 328.9 74 243.39 percent of total billed charges 328.9 93 266.41 percent of total billed charges 328.9 328.9 other OPPS APC 328.9 328.9 other OPPS APC 328.9 27.63 90.88 percent of total billed charges 328.9 328.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L5 MM OD2 MM MANDIBLE CORTICAL SELF TAP COARSE PITCH CRUCIFORM NONSTERILE GOLD MODULAR FIXATION SYSTEM SUP-401.935 CDM 270010014 LOCAL 0270 RC outpatient 985.3 985.3 985.3 74 729.12 percent of total billed charges 985.3 93 798.09 percent of total billed charges 985.3 985.3 other OPPS APC 985.3 985.3 other OPPS APC 985.3 27.63 272.24 percent of total billed charges 985.3 985.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION 18MM 1.8MM TITANIUM NS BUTTRESS SUP-401.968.96 CDM 270010022 LOCAL 0270 RC outpatient 190.19 190.19 190.19 74 140.74 percent of total billed charges 190.19 93 154.05 percent of total billed charges 190.19 190.19 other OPPS APC 190.19 190.19 other OPPS APC 190.19 27.63 52.55 percent of total billed charges 190.19 190.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CAPSTONE CONTROL PEEK 12 D L22 MM X H10 MM STERILE INTERBODY FUSION SUP-4011022 CDM 270010020 LOCAL 0270 RC outpatient 7703.28 7703.28 7703.28 74 5700.43 percent of total billed charges 7703.28 93 6239.66 percent of total billed charges 7703.28 7703.28 other OPPS APC 7703.28 7703.28 other OPPS APC 7703.28 27.63 2128.42 percent of total billed charges 7703.28 7703.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CAPSTONE CONTROL PEEK 12 D L22 MM X H13 MM STERILE INTERBODY FUSION SUP-4011322 CDM 270010020 LOCAL 0270 RC outpatient 7703.28 7703.28 7703.28 74 5700.43 percent of total billed charges 7703.28 93 6239.66 percent of total billed charges 7703.28 7703.28 other OPPS APC 7703.28 7703.28 other OPPS APC 7703.28 27.63 2128.42 percent of total billed charges 7703.28 7703.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY RESPONSE 1 MM 5 MM SPACE JSN CURVE L120 CM OD6 FR QUADRIPOLAR SUPERB TORQUE CONTROL BAND ELECTRODE CONVENIENT CABLE SUP-401227 CDM 0270 RC outpatient 236.6 236.6 236.6 74 175.08 percent of total billed charges 236.6 93 191.65 percent of total billed charges 236.6 236.6 other OPPS APC 236.6 236.6 other OPPS APC 236.6 27.63 65.37 percent of total billed charges 236.6 236.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY RESPONSE 2-8-2 MM SPACING CSL CURVE L65 CM OD6 FR DECAPOLAR SUP-401353 CDM 0270 RC outpatient 936 936 936 74 692.64 percent of total billed charges 936 93 758.16 percent of total billed charges 936 936 other OPPS APC 936 936 other OPPS APC 936 27.63 258.62 percent of total billed charges 936 936 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH CORDIS BRITE TIP 35CM 25MM 5FR GRAY SILICONE DISPOSABLE STERILE LF ENDOVASCULAR KINK RESISTANT CANNULA SUP-401535M CDM 0270 RC outpatient 59.8 59.8 59.8 74 44.25 percent of total billed charges 59.8 93 48.44 percent of total billed charges 59.8 59.8 other OPPS APC 59.8 59.8 other OPPS APC 59.8 27.63 16.52 percent of total billed charges 59.8 59.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH CORDIS BRITE TIP 45CM 25MM 5FR GRAY SILICONE DISPOSABLE STERILE LF ENDOVASCULAR KINK RESISTANT CANNULA SUP-401545M CDM 0270 RC outpatient 59.8 59.8 59.8 74 44.25 percent of total billed charges 59.8 93 48.44 percent of total billed charges 59.8 59.8 other OPPS APC 59.8 59.8 other OPPS APC 59.8 27.63 16.52 percent of total billed charges 59.8 59.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH CORDIS BRITE TIP 35CM 35MM 6FR GREEN SILICONE DISPOSABLE STERILE LF ENDOVASCULAR KINK RESISTANT SUP-401635M_41405 CDM 0270 RC outpatient 59.8 59.8 59.8 74 44.25 percent of total billed charges 59.8 93 48.44 percent of total billed charges 59.8 59.8 other OPPS APC 59.8 59.8 other OPPS APC 59.8 27.63 16.52 percent of total billed charges 59.8 59.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.25x9 SUP-401729_57270 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.5x9 SUP-401730_57271 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.75X9 SUP-401731_57272 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 3.0X9 SUP-401732_57275 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 3.5X9 SUP-401733_57276 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 4.0X9 SUP-401734_57277 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY ORSIRO SIROLIMUS ELUTING COCR L13MM OD 2.25MM SUP-401735_57278 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH CORDIS BRITE TIP 35CM 35MM 7FR ORANGE SILICONE DISPOSABLE STERILE LF ENDOVASCULAR KINK RESISTANT SUP-401735M_41404 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.5X13 SUP-401736_57279 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.75X13 SUP-401737_57280 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 3.0X13 SUP-401738_57281 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 3.5X13 SUP-401739_57282 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 4.0X13 SUP-401740_57283 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.25X15 SUP-401741_57284 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.5X15 SUP-401742_57285 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.75X15 SUP-401743_57286 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 3.0X15 SUP-401744_57287 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 3.5X15 SUP-401745_57288 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 4.0X15 SUP-401746_57289 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.25X18 SUP-401747_57305 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.5X18 SUP-401748_57306 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.75X18 SUP-401749_57307 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 3.0X18 SUP-401750_57308 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 3.5X18 SUP-401751_57309 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 4.0X18 SUP-401752_57310 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.25X22 SUP-401753_57311 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.5X22 SUP-401754_57312 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.75X22 SUP-401755_57313 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 3.0X22 SUP-401756_57314 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 3.5X22 SUP-401757_57315 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 4.0X22 SUP-401758_57316 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.25X26 SUP-401759_57317 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.5X26 SUP-401760_57318 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.75X26 SUP-401761_57319 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 3.0X26 SUP-401762_57320 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 3.5X26 SUP-401763_57321 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 4.0X26 SUP-401764_57322 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.25X30 SUP-401765_57323 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.5X30 SUP-401766_57324 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.75X30 SUP-401767_57325 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 3.0X30 SUP-401768_57326 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 3.5X30 SUP-401769_57327 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 4.0X30 SUP-401770_57328 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CATHETER RESPONSE L150 CM ELECTROPHYSIOLOGY BIPOLAR TRIPOLAR QUADRIPOLAR BLUE SUP-401973 CDM 0270 RC outpatient 171.6 171.6 171.6 74 126.98 percent of total billed charges 171.6 93 139 percent of total billed charges 171.6 171.6 other OPPS APC 171.6 171.6 other OPPS APC 171.6 27.63 47.41 percent of total billed charges 171.6 171.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUNNELER SURGICAL DISPOSABLE SUP-402 CDM 0270 RC outpatient 1015.95 1015.95 1015.95 74 751.8 percent of total billed charges 1015.95 93 822.92 percent of total billed charges 1015.95 1015.95 other OPPS APC 1015.95 1015.95 other OPPS APC 1015.95 27.63 280.71 percent of total billed charges 1015.95 1015.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ZIMMER SUBCHONDROPLASTY SIDE TARGETED ACCUPORT SUP-402.202 CDM 0270 RC outpatient 6487 6487 6487 74 4800.38 percent of total billed charges 6487 93 5254.47 percent of total billed charges 6487 6487 other OPPS APC 6487 6487 other OPPS APC 6487 27.63 1792.36 percent of total billed charges 6487 6487 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L10 MM OD2.7 MM CORTICAL T8 STARDRIVE RECESS SELF TAPPING LOCKING NONSTERILE MINI FRAGMENT SET SUP-402.210 CDM 270010022 LOCAL 0270 RC outpatient 713.83 713.83 713.83 74 528.23 percent of total billed charges 713.83 93 578.2 percent of total billed charges 713.83 713.83 other OPPS APC 713.83 713.83 other OPPS APC 713.83 27.63 197.23 percent of total billed charges 713.83 713.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L12 MM OD2.7 MM CORTICAL T8 STARDRIVE RECESS SELF TAP LOCK NONSTERILE SUP-402.212 CDM 270010022 LOCAL 0270 RC outpatient 713.83 713.83 713.83 74 528.23 percent of total billed charges 713.83 93 578.2 percent of total billed charges 713.83 713.83 other OPPS APC 713.83 713.83 other OPPS APC 713.83 27.63 197.23 percent of total billed charges 713.83 713.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L14 MM OD2.7 MM CORTICAL T8 STARDRIVE RECESS SELF TAP LOCK NONSTERILE SUP-402.214 CDM 270010022 LOCAL 0270 RC outpatient 216.58 216.58 216.58 74 160.27 percent of total billed charges 216.58 93 175.43 percent of total billed charges 216.58 216.58 other OPPS APC 216.58 216.58 other OPPS APC 216.58 27.63 59.84 percent of total billed charges 216.58 216.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T8 L16 MM OD2.7 MM ID2.1 MM SELF TAP LOCK STARDRIVE THREAD HEAD NONSTERILE MODULAR MINI FRAGMENT SET SUP-402.216 CDM 270010022 LOCAL 0270 RC outpatient 340.34 340.34 340.34 74 251.85 percent of total billed charges 340.34 93 275.68 percent of total billed charges 340.34 340.34 other OPPS APC 340.34 340.34 other OPPS APC 340.34 27.63 94.04 percent of total billed charges 340.34 340.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW, LOCKING, TITANIUM, HEXAGONAL, SELF TAPPING, 2.7MM X 18MM, W/ T8 STARDRIVE" SUP-402.218 CDM 270010022 LOCAL 0270 RC outpatient 340.34 340.34 340.34 74 251.85 percent of total billed charges 340.34 93 275.68 percent of total billed charges 340.34 340.34 other OPPS APC 340.34 340.34 other OPPS APC 340.34 27.63 94.04 percent of total billed charges 340.34 340.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T8 L20 MM OD2.7 MM ID2.1 MM SELF TAP LOCK STARDRIVE THREAD HEAD NONSTERILE MODULAR MINI FRAGMENT SET SUP-402.220 CDM 270010022 LOCAL 0270 RC outpatient 340.34 340.34 340.34 74 251.85 percent of total billed charges 340.34 93 275.68 percent of total billed charges 340.34 340.34 other OPPS APC 340.34 340.34 other OPPS APC 340.34 27.63 94.04 percent of total billed charges 340.34 340.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW, LOCKING, TITANIUM, HEXAGONAL, SELF TAPPING, 2.7MM X 22MM, W/ T8 STARDRIVE" SUP-402.222 CDM 270010022 LOCAL 0270 RC outpatient 340.34 340.34 340.34 74 251.85 percent of total billed charges 340.34 93 275.68 percent of total billed charges 340.34 340.34 other OPPS APC 340.34 340.34 other OPPS APC 340.34 27.63 94.04 percent of total billed charges 340.34 340.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T8 L24 MM OD2.7 MM ID2.1 MM SELF TAP LOCK STARDRIVE THREAD HEAD NONSTERILE MODULAR MINI FRAGMENT SET SUP-402.224 CDM 270010022 LOCAL 0270 RC outpatient 340.34 340.34 340.34 74 251.85 percent of total billed charges 340.34 93 275.68 percent of total billed charges 340.34 340.34 other OPPS APC 340.34 340.34 other OPPS APC 340.34 27.63 94.04 percent of total billed charges 340.34 340.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L26 MM OD2.7 MM HUMERUS DISTAL CANNULATED SELF TAP LOCK STARDRIVE RECESS STERILE SUP-402.226 CDM 270010022 LOCAL 0270 RC outpatient 340.34 340.34 340.34 74 251.85 percent of total billed charges 340.34 93 275.68 percent of total billed charges 340.34 340.34 other OPPS APC 340.34 340.34 other OPPS APC 340.34 27.63 94.04 percent of total billed charges 340.34 340.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L28 MM OD2.7 MM HUMERUS DISTAL CANNULATED SELF TAP LOCK STARDRIVE RECESS NONSTERILE SUP-402.228 CDM 270010022 LOCAL 0270 RC outpatient 340.34 340.34 340.34 74 251.85 percent of total billed charges 340.34 93 275.68 percent of total billed charges 340.34 340.34 other OPPS APC 340.34 340.34 other OPPS APC 340.34 27.63 94.04 percent of total billed charges 340.34 340.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L30 MM OD2.7 MM HUMERUS DISTAL SELF TAPPING LOCKING STARDRIVE RECESS NONSTERILE SUP-402.230 CDM 270010022 LOCAL 0270 RC outpatient 340.34 340.34 340.34 74 251.85 percent of total billed charges 340.34 93 275.68 percent of total billed charges 340.34 340.34 other OPPS APC 340.34 340.34 other OPPS APC 340.34 27.63 94.04 percent of total billed charges 340.34 340.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L32 MM OD2.7 MM HUMERUS DISTAL CANNULATED SELF TAP LOCK STARDRIVE RECESS NONSTERILE SUP-402.232 CDM 270010022 LOCAL 0270 RC outpatient 340.34 340.34 340.34 74 251.85 percent of total billed charges 340.34 93 275.68 percent of total billed charges 340.34 340.34 other OPPS APC 340.34 340.34 other OPPS APC 340.34 27.63 94.04 percent of total billed charges 340.34 340.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L34 MM OD2.7 MM HUMERUS DISTAL SELF TAPPING LOCKING STARDRIVE RECESS NONSTERILE SUP-402.234 CDM 270010022 LOCAL 0270 RC outpatient 340.34 340.34 340.34 74 251.85 percent of total billed charges 340.34 93 275.68 percent of total billed charges 340.34 340.34 other OPPS APC 340.34 340.34 other OPPS APC 340.34 27.63 94.04 percent of total billed charges 340.34 340.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L36 MM OD2.7 MM HUMERUS DISTAL CANNULATED SELF TAP LOCK STARDRIVE RECESS NONSTERILE SUP-402.236 CDM 270010022 LOCAL 0270 RC outpatient 340.34 340.34 340.34 74 251.85 percent of total billed charges 340.34 93 275.68 percent of total billed charges 340.34 340.34 other OPPS APC 340.34 340.34 other OPPS APC 340.34 27.63 94.04 percent of total billed charges 340.34 340.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L38 MM OD2.7 MM SELF TAPPING LOCKING T8 STARDRIVE RECESS SUP-402.238 CDM 270010022 LOCAL 0270 RC outpatient 340.34 340.34 340.34 74 251.85 percent of total billed charges 340.34 93 275.68 percent of total billed charges 340.34 340.34 other OPPS APC 340.34 340.34 other OPPS APC 340.34 27.63 94.04 percent of total billed charges 340.34 340.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T8 L40 MM OD2.7 MM SELF TAP LOCK STARDRIVE NONSTERILE SUP-402.240 CDM 270010022 LOCAL 0270 RC outpatient 340.34 340.34 340.34 74 251.85 percent of total billed charges 340.34 93 275.68 percent of total billed charges 340.34 340.34 other OPPS APC 340.34 340.34 other OPPS APC 340.34 27.63 94.04 percent of total billed charges 340.34 340.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L42 MM OD2.7 MM HUMERUS DISTAL SELF TAPPING LOCKING STARDRIVE RECESS NONSTERILE SUP-402.242 CDM 270010022 LOCAL 0270 RC outpatient 340.34 340.34 340.34 74 251.85 percent of total billed charges 340.34 93 275.68 percent of total billed charges 340.34 340.34 other OPPS APC 340.34 340.34 other OPPS APC 340.34 27.63 94.04 percent of total billed charges 340.34 340.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L44 MM OD2.7 MM SELF TAPPING LOCKING T8 STARDRIVE RECESS SUP-402.244 CDM 270010022 LOCAL 0270 RC outpatient 340.34 340.34 340.34 74 251.85 percent of total billed charges 340.34 93 275.68 percent of total billed charges 340.34 340.34 other OPPS APC 340.34 340.34 other OPPS APC 340.34 27.63 94.04 percent of total billed charges 340.34 340.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T8 L46 MM OD2.7 MM SELF TAP LOCK STARDRIVE NONSTERILE SUP-402.246 CDM 270010022 LOCAL 0270 RC outpatient 311.17 311.17 311.17 74 230.27 percent of total billed charges 311.17 93 252.05 percent of total billed charges 311.17 311.17 other OPPS APC 311.17 311.17 other OPPS APC 311.17 27.63 85.98 percent of total billed charges 311.17 311.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L48 MM OD2.7 MM HUMERUS DISTAL SELF TAPPING LOCKING STARDRIVE RECESS NONSTERILE SUP-402.248 CDM 270010022 LOCAL 0270 RC outpatient 340.34 340.34 340.34 74 251.85 percent of total billed charges 340.34 93 275.68 percent of total billed charges 340.34 340.34 other OPPS APC 340.34 340.34 other OPPS APC 340.34 27.63 94.04 percent of total billed charges 340.34 340.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L50 MM OD2 MM CORTICAL T6 STARDRIVE RECESS SELF TAPPING LOCKING NONSTERILE MINI FRAGMENT SET SUP-402.250 CDM 270010022 LOCAL 0270 RC outpatient 311.17 311.17 311.17 74 230.27 percent of total billed charges 311.17 93 252.05 percent of total billed charges 311.17 311.17 other OPPS APC 311.17 311.17 other OPPS APC 311.17 27.63 85.98 percent of total billed charges 311.17 311.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L55 MM OD2.7 MM HUMERUS DISTAL SELF TAPPING LOCKING STARDRIVE RECESS NONSTERILE SUP-402.255 CDM 270010022 LOCAL 0270 RC outpatient 340.34 340.34 340.34 74 251.85 percent of total billed charges 340.34 93 275.68 percent of total billed charges 340.34 340.34 other OPPS APC 340.34 340.34 other OPPS APC 340.34 27.63 94.04 percent of total billed charges 340.34 340.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L60 MM OD2 MM CORTICAL T6 STARDRIVE RECESS SELF TAPPING LOCKING NONSTERILE MINI FRAGMENT SET SUP-402.260 CDM 270010022 LOCAL 0270 RC outpatient 311.17 311.17 311.17 74 230.27 percent of total billed charges 311.17 93 252.05 percent of total billed charges 311.17 311.17 other OPPS APC 311.17 311.17 other OPPS APC 311.17 27.63 85.98 percent of total billed charges 311.17 311.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 10MM 2.5MM 2.7MM 5MM TITANIUM NS CORTEX SELF TAP SM HEXAGONAL SOCKET SPHERICAL HEAD MINI FRAGMENT SUP-402.81 CDM 270010022 LOCAL 0270 RC outpatient 103.4 103.4 103.4 74 76.52 percent of total billed charges 103.4 93 83.75 percent of total billed charges 103.4 103.4 other OPPS APC 103.4 103.4 other OPPS APC 103.4 27.63 28.57 percent of total billed charges 103.4 103.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 2.7MM 5MM 10MM LCP TITANIUM RADIUS CORTEX DISTAL SELF TAP SPHERICAL HEAD SUP-402.810 CDM outpatient 105.3 105.3 105.3 105.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM FULL THREAD HEXAGON SPHERE L12 MM OD2.7 MM ODSEC5 MM RADIUS CORTICAL DISTAL SELF TAP SOCKET NONSTERILE SMALL FRAGMENT SET SUP-402.812 CDM 270010022 LOCAL 0270 RC outpatient 117.26 117.26 117.26 74 86.77 percent of total billed charges 117.26 93 94.98 percent of total billed charges 117.26 117.26 other OPPS APC 117.26 117.26 other OPPS APC 117.26 27.63 32.4 percent of total billed charges 117.26 117.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM FULL THREAD HEXAGON SPHERE L14 MM OD2.7 MM ODSEC5 MM RADIUS CORTICAL DISTAL SELF TAP SOCKET NONSTERILE SMALL FRAGMENT SET SUP-402.814 CDM 270010022 LOCAL 0270 RC outpatient 117.26 117.26 117.26 74 86.77 percent of total billed charges 117.26 93 94.98 percent of total billed charges 117.26 117.26 other OPPS APC 117.26 117.26 other OPPS APC 117.26 27.63 32.4 percent of total billed charges 117.26 117.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 16MM 2.7MM 5MM TITANIUM NS CORTEX SELF TAP SPHERICAL HEAD SM HEXAGONAL SM FRAGMENT SET SUP-402.816 CDM 270010022 LOCAL 0270 RC outpatient 109.64 109.64 109.64 74 81.13 percent of total billed charges 109.64 93 88.81 percent of total billed charges 109.64 109.64 other OPPS APC 109.64 109.64 other OPPS APC 109.64 27.63 30.29 percent of total billed charges 109.64 109.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 18MM 2.5MM 2.7MM 5MM TITANIUM NS CORTEX SELF TAP SM HEXAGONAL SOCKET SPHERICAL HEAD MINI FRAGMENT SUP-402.818 CDM 270010022 LOCAL 0270 RC outpatient 109.64 109.64 109.64 74 81.13 percent of total billed charges 109.64 93 88.81 percent of total billed charges 109.64 109.64 other OPPS APC 109.64 109.64 other OPPS APC 109.64 27.63 30.29 percent of total billed charges 109.64 109.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 20MM 2.5MM 2.7MM 5MM TITANIUM NS CORTEX SELF TAP SM HEXAGONAL SOCKET SPHERICAL HEAD MINI FRAGMENT SUP-402.82 CDM 270010022 LOCAL 0270 RC outpatient 109.64 109.64 109.64 74 81.13 percent of total billed charges 109.64 93 88.81 percent of total billed charges 109.64 109.64 other OPPS APC 109.64 109.64 other OPPS APC 109.64 27.63 30.29 percent of total billed charges 109.64 109.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 2.7MM 5MM 20MM LCP TITANIUM FULL THREAD HEXAGON SPHERE RADIUS CORTICAL SUP-402.820 CDM outpatient 88.09 88.09 88.09 88.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM FULL THREAD HEXAGON SPHERE L22 MM OD2.7 MM ODSEC5 MM RADIUS CORTICAL DISTAL SELF TAP SOCKET NONSTERILE SMALL FRAGMENT SET SUP-402.822 CDM 270010022 LOCAL 0270 RC outpatient 109.64 109.64 109.64 74 81.13 percent of total billed charges 109.64 93 88.81 percent of total billed charges 109.64 109.64 other OPPS APC 109.64 109.64 other OPPS APC 109.64 27.63 30.29 percent of total billed charges 109.64 109.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM FULL THREAD L24 MM OD2.7 MM ODSEC5 MM RADIUS CORTICAL DISTAL SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-402.824 CDM 270010022 LOCAL 0270 RC outpatient 109.64 109.64 109.64 74 81.13 percent of total billed charges 109.64 93 88.81 percent of total billed charges 109.64 109.64 other OPPS APC 109.64 109.64 other OPPS APC 109.64 27.63 30.29 percent of total billed charges 109.64 109.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM T8 L10 MM OD2.7 MM RADIUS CORTICAL DISTAL SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-402.870 CDM 270010022 LOCAL 0270 RC outpatient 97.11 97.11 97.11 74 71.86 percent of total billed charges 97.11 93 78.66 percent of total billed charges 97.11 97.11 other OPPS APC 97.11 97.11 other OPPS APC 97.11 27.63 26.83 percent of total billed charges 97.11 97.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM T8 L12 MM OD2.7 MM RADIUS CORTICAL DISTAL SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-402.872 CDM 270010022 LOCAL 0270 RC outpatient 110.11 110.11 110.11 74 81.48 percent of total billed charges 110.11 93 89.19 percent of total billed charges 110.11 110.11 other OPPS APC 110.11 110.11 other OPPS APC 110.11 27.63 30.42 percent of total billed charges 110.11 110.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM T8 L14 MM OD2.7 MM ODSEC5 MM RADIUS CORTEX DISTAL STARDRIVE SELF TAP NONSTERILE MINI FRAGMENT SET SUP-402.874 CDM 270010022 LOCAL 0270 RC outpatient 97.11 97.11 97.11 74 71.86 percent of total billed charges 97.11 93 78.66 percent of total billed charges 97.11 97.11 other OPPS APC 97.11 97.11 other OPPS APC 97.11 27.63 26.83 percent of total billed charges 97.11 97.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM T8 L16 MM OD2.7 MM ODSEC5 MM RADIUS CORTEX DISTAL STARDRIVE SELF TAP NONSTERILE MINI FRAGMENT SET SUP-402.876 CDM 270010022 LOCAL 0270 RC outpatient 97.11 97.11 97.11 74 71.86 percent of total billed charges 97.11 93 78.66 percent of total billed charges 97.11 97.11 other OPPS APC 97.11 97.11 other OPPS APC 97.11 27.63 26.83 percent of total billed charges 97.11 97.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM T8 L18 MM OD2.7 MM ODSEC5 MM RADIUS CORTEX DISTAL STARDRIVE SELF TAP NONSTERILE MINI FRAGMENT SET SUP-402.878 CDM 270010022 LOCAL 0270 RC outpatient 97.11 97.11 97.11 74 71.86 percent of total billed charges 97.11 93 78.66 percent of total billed charges 97.11 97.11 other OPPS APC 97.11 97.11 other OPPS APC 97.11 27.63 26.83 percent of total billed charges 97.11 97.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM PEDIATRIC T8 L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SET SUP-402.880 CDM 270010022 LOCAL 0270 RC outpatient 110.11 110.11 110.11 74 81.48 percent of total billed charges 110.11 93 89.19 percent of total billed charges 110.11 110.11 other OPPS APC 110.11 110.11 other OPPS APC 110.11 27.63 30.42 percent of total billed charges 110.11 110.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM PEDIATRIC T8 L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SET SUP-402.882 CDM 270010022 LOCAL 0270 RC outpatient 148.72 148.72 148.72 74 110.05 percent of total billed charges 148.72 93 120.46 percent of total billed charges 148.72 148.72 other OPPS APC 148.72 148.72 other OPPS APC 148.72 27.63 41.09 percent of total billed charges 148.72 148.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM PEDIATRIC T8 L24 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SET SUP-402.884 CDM 270010022 LOCAL 0270 RC outpatient 97.11 97.11 97.11 74 71.86 percent of total billed charges 97.11 93 78.66 percent of total billed charges 97.11 97.11 other OPPS APC 97.11 97.11 other OPPS APC 97.11 27.63 26.83 percent of total billed charges 97.11 97.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW, CORTEX, TITANIUM, HEXAGONAL, SELF TAPPING, 2.7MM X 26MM, W/ T8 STARDRIVE" SUP-402.886 CDM 270010022 LOCAL 0270 RC outpatient 110.11 110.11 110.11 74 81.48 percent of total billed charges 110.11 93 89.19 percent of total billed charges 110.11 110.11 other OPPS APC 110.11 110.11 other OPPS APC 110.11 27.63 30.42 percent of total billed charges 110.11 110.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM PEDIATRIC T8 L28 MM W2.5 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-402.888 CDM 270010022 LOCAL 0270 RC outpatient 148.72 148.72 148.72 74 110.05 percent of total billed charges 148.72 93 120.46 percent of total billed charges 148.72 148.72 other OPPS APC 148.72 148.72 other OPPS APC 148.72 27.63 41.09 percent of total billed charges 148.72 148.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L30 MM OD2.7 MM RADIUS CORTEX DISTAL T8 STARDRIVE SELF TAP NONSTERILE MINI FRAGMENT SET SUP-402.890 CDM 270010022 LOCAL 0270 RC outpatient 110.11 110.11 110.11 74 81.48 percent of total billed charges 110.11 93 89.19 percent of total billed charges 110.11 110.11 other OPPS APC 110.11 110.11 other OPPS APC 110.11 27.63 30.42 percent of total billed charges 110.11 110.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L32 MM W2.5 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MINI FRAGMENT SET SUP-402.892 CDM 270010022 LOCAL 0270 RC outpatient 110.11 110.11 110.11 74 81.48 percent of total billed charges 110.11 93 89.19 percent of total billed charges 110.11 110.11 other OPPS APC 110.11 110.11 other OPPS APC 110.11 27.63 30.42 percent of total billed charges 110.11 110.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM PEDIATRIC T8 L34 MM W2.5 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-402.894 CDM 270010022 LOCAL 0270 RC outpatient 110.11 110.11 110.11 74 81.48 percent of total billed charges 110.11 93 89.19 percent of total billed charges 110.11 110.11 other OPPS APC 110.11 110.11 other OPPS APC 110.11 27.63 30.42 percent of total billed charges 110.11 110.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW, CORTEX, TITANIUM, HEXAGONAL, SELF TAPPING, 2.7MM X 36MM, W/ T8 STARDRIVE" SUP-402.896 CDM 270010022 LOCAL 0270 RC outpatient 110.11 110.11 110.11 74 81.48 percent of total billed charges 110.11 93 89.19 percent of total billed charges 110.11 110.11 other OPPS APC 110.11 110.11 other OPPS APC 110.11 27.63 30.42 percent of total billed charges 110.11 110.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM PEDIATRIC T8 L38 MM W2.5 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM SUP-402.898 CDM 270010022 LOCAL 0270 RC outpatient 110.11 110.11 110.11 74 81.48 percent of total billed charges 110.11 93 89.19 percent of total billed charges 110.11 110.11 other OPPS APC 110.11 110.11 other OPPS APC 110.11 27.63 30.42 percent of total billed charges 110.11 110.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L40 MM OD2.7 MM HUMERUS DISTAL SELF TAPPING LOCKING STARDRIVE RECESS NONSTERILE SMALL FRAGMENT SET SUP-402.900 CDM 270010022 LOCAL 0270 RC outpatient 110.11 110.11 110.11 74 81.48 percent of total billed charges 110.11 93 89.19 percent of total billed charges 110.11 110.11 other OPPS APC 110.11 110.11 other OPPS APC 110.11 27.63 30.42 percent of total billed charges 110.11 110.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW, CORTEX, TITANIUM, HEXAGONAL, SELF TAPPING, 2.7MM X 42MM, W/ T8 STARDRIVE" SUP-402.962 CDM 270010022 LOCAL 0270 RC outpatient 110.11 110.11 110.11 74 81.48 percent of total billed charges 110.11 93 89.19 percent of total billed charges 110.11 110.11 other OPPS APC 110.11 110.11 other OPPS APC 110.11 27.63 30.42 percent of total billed charges 110.11 110.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW, CORTEX TITANIUM, HEXAGONAL, SELF TAPPING, 2.7MM X 44MM, W/ T8 STARDRIVE" SUP-402.963 CDM 270010022 LOCAL 0270 RC outpatient 110.11 110.11 110.11 74 81.48 percent of total billed charges 110.11 93 89.19 percent of total billed charges 110.11 110.11 other OPPS APC 110.11 110.11 other OPPS APC 110.11 27.63 30.42 percent of total billed charges 110.11 110.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T8 L46 MM OD2.7 MM CORTEX SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-402.965 CDM 270010022 LOCAL 0270 RC outpatient 148.72 148.72 148.72 74 110.05 percent of total billed charges 148.72 93 120.46 percent of total billed charges 148.72 148.72 other OPPS APC 148.72 148.72 other OPPS APC 148.72 27.63 41.09 percent of total billed charges 148.72 148.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM T8 L48 MM OD2.7 MM RADIUS CORTICAL DISTAL SELF TAP STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-402.966 CDM 270010022 LOCAL 0270 RC outpatient 148.72 148.72 148.72 74 110.05 percent of total billed charges 148.72 93 120.46 percent of total billed charges 148.72 148.72 other OPPS APC 148.72 148.72 other OPPS APC 148.72 27.63 41.09 percent of total billed charges 148.72 148.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L50 MM OD2.7 MM CORTICAL SELF TAPPING NONSTERILE MINI FRAGMENT SET SUP-402.967 CDM 270010022 LOCAL 0270 RC outpatient 148.72 148.72 148.72 74 110.05 percent of total billed charges 148.72 93 120.46 percent of total billed charges 148.72 148.72 other OPPS APC 148.72 148.72 other OPPS APC 148.72 27.63 41.09 percent of total billed charges 148.72 148.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L55 MM OD2.7 MM CORTICAL SELF TAPPING NONSTERILE MINI FRAGMENT SET SUP-402.968 CDM 270010022 LOCAL 0270 RC outpatient 148.72 148.72 148.72 74 110.05 percent of total billed charges 148.72 93 120.46 percent of total billed charges 148.72 148.72 other OPPS APC 148.72 148.72 other OPPS APC 148.72 27.63 41.09 percent of total billed charges 148.72 148.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L60 MM OD2.7 MM CORTICAL SELF TAPPING NONSTERILE MINI FRAGMENT SET SUP-402.969 CDM 270010022 LOCAL 0270 RC outpatient 110.11 110.11 110.11 74 81.48 percent of total billed charges 110.11 93 89.19 percent of total billed charges 110.11 110.11 other OPPS APC 110.11 110.11 other OPPS APC 110.11 27.63 30.42 percent of total billed charges 110.11 110.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING GAUZE QUICK C LOT CONTROL + 3IN X 2 YD Z-FOLD SUP-4020 CDM 0270 RC outpatient 382.92 382.92 382.92 74 283.36 percent of total billed charges 382.92 93 310.17 percent of total billed charges 382.92 382.92 other OPPS APC 382.92 382.92 other OPPS APC 382.92 27.63 105.8 percent of total billed charges 382.92 382.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD ICD PLEXA PROMRI S 65 SUP-402266_74453 CDM 0270 RC outpatient 5850 5850 5850 74 4329 percent of total billed charges 5850 93 4738.5 percent of total billed charges 5850 5850 other OPPS APC 5850 5850 other OPPS APC 5850 27.63 1616.36 percent of total billed charges 5850 5850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REMOVER ADHESIVE UNI-SOLVE ALOE WIPE SUP-402300 CDM 0270 RC outpatient 0.16 0.16 0.16 74 0.12 percent of total billed charges 0.16 93 0.13 percent of total billed charges 0.16 0.16 other OPPS APC 0.16 0.16 other OPPS APC 0.16 27.63 0.04 percent of total billed charges 0.16 0.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW WRIGHT MEDICAL 2.7MM X 12MM SUP-40232712 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC STAINLESS STEEL L14 MM OD2.7 MM CORTICAL ANKLE FOOT LOCKING SELF TAPPING 3DSI TECHNOLOGY POLYAXIAL GREEN COMPRESSION PLATING SYSTEM SUP-40232714 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC 15D 16MM 2.7MM GREEN SS FOOT ANKLE CORTICAL POLYAXIAL LOCK SELF TAP COMPRESSION PLATE SYSTEM SUP-40232716 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC 15D 18MM 2.7MM GREEN SS FOOT ANKLE CORTICAL POLYAXIAL LOCK SELF TAP COMPRESSION PLATE SYSTEM SUP-40232718 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC STAINLESS STEEL L20 MM OD2.7 MM FOOT ANKLE CORTICAL 3DSI TECHNOLOGY LOCK SELF TAP POLYAXIAL GREEN COMPRESSION PLATE SYSTEM SUP-40232720 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC STAINLESS STEEL L22 MM OD2.7 MM FOOT ANKLE CORTICAL 3DSI TECHNOLOGY LOCK SELF TAP POLYAXIAL GREEN COMPRESSION PLATE SYSTEM SUP-40232722 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CLAW II ORTHOLOC L24 MM OD2.7 MM CORTICAL ANKLE FOOT 3DSI TECHNOLOGY LOCKING POLYAXIAL COMPRESSION PLATING SYSTEM SUP-40232724 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC 15D 26MM 2.7MM GREEN SS FOOT ANKLE CORTICAL POLYAXIAL LOCK SELF TAP COMPRESSION PLATE SYSTEM SUP-40232726 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC 15D 28MM 2.7MM GREEN SS FOOT ANKLE CORTICAL POLYAXIAL LOCK SELF TAP COMPRESSION PLATE SYSTEM SUP-40232728 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC CLAW II STAINLESS STEEL 15 D L30 MM OD2.7 MM FOOT ANKLE CORTICAL 3DSI TECHNOLOGY POLYAXIAL LOCKING SELF TAPPING GREEN COMPRESSION PLATING SYSTEM SUP-40232730 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW WRIGHT MEDICAL 2.7MM X 30MM SUP-40232732 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC CLAW II STAINLESS STEEL 15 D L34 MM OD2.7 MM FOOT ANKLE CORTICAL 3DSI TECHNOLOGY POLYAXIAL LOCKING SELF TAPPING GREEN COMPRESSION PLATING SYSTEM SUP-40232734 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW WRIGHT MEDICAL 2.7MM X 36MM SUP-40232736 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC STAINLESS STEEL L12 MM OD3.5 MM CORTICAL ANKLE FOOT LOCKING SELF TAPPING 3DSI TECHNOLOGY POLYAXIAL GREEN COMPRESSION PLATING SYSTEM SUP-40233512 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC CLAW II STAINLESS STEEL L14 MM OD3.5 MM FOOT ANKLE CORTICAL LOCKING SELF TAPPING 3DSI TECHNOLOGY POLYAXIAL PURPLE COMPRESSION PLATING SYSTEM SUP-40233514 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC 3DSI STAINLESS STEEL L16 MM OD3.5 MM FOOT ANKLE CORTICAL LOCK SUP-40233516 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC CLAW II STAINLESS STEEL 15 D L18 MM OD3.5 MM FOOT ANKLE CORTICAL 3DSI TECHNOLOGY POLYAXIAL LOCKING SELF TAPPING PURPLE COMPRESSION PLATING SYSTEM SUP-40233518 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC CLAW II STAINLESS STEEL 15 D L20 MM OD3.5 MM FOOT ANKLE CORTICAL 3DSI TECHNOLOGY POLYAXIAL LOCKING SELF TAPPING PURPLE COMPRESSION PLATING SYSTEM SUP-40233520 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC STAINLESS STEEL L22 MM OD3.5 MM FOOT ANKLE CORTICAL 3DSI TECHNOLOGY LOCK SELF TAP POLYAXIAL PURPLE COMPRESSION PLATE SYSTEM SUP-40233522 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC CLAW II L24 MM OD3.5 MM FOOT ANKLE CORTICAL 3DSI TECHNOLOGY LOCK SELF TAP POLYAXIAL COMPRESSION PLATING SYSTEM SUP-40233524 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC CLAW II STAINLESS STEEL 15 D L26 MM OD3.5 MM FOOT ANKLE CORTICAL 3DSI TECHNOLOGY POLYAXIAL LOCKING SELF TAPPING PURPLE COMPRESSION PLATING SYSTEM SUP-40233526 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC 15D 28MM 3.5MM PURPLE SS FOOT ANKLE CORTICAL POLYAXIAL LOCK SELF TAP COMPRESSION PLATE SYSTEM SUP-40233528 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC 15D 30MM 3.5MM PURPLE SS FOOT ANKLE CORTICAL POLYAXIAL LOCK SELF TAP COMPRESSION PLATE SYSTEM SUP-40233530 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC CLAW II STAINLESS STEEL 15 D L32 MM OD3.5 MM FOOT ANKLE CORTICAL 3DSI TECHNOLOGY POLYAXIAL LOCKING SELF TAPPING PURPLE COMPRESSION PLATING SYSTEM SUP-40233532 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC CLAW II STAINLESS STEEL 15 D L34 MM OD3.5 MM FOOT ANKLE CORTICAL 3DSI TECHNOLOGY POLYAXIAL LOCKING SELF TAPPING PURPLE COMPRESSION PLATING SYSTEM SUP-40233534 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC 15D 36MM 3.5MM PURPLE SS FOOT ANKLE CORTICAL POLYAXIAL LOCK SELF TAP COMPRESSION PLATE SYSTEM SUP-40233536 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC STAINLESS STEEL L38 MM OD3.5 MM CORTICAL ANKLE FOOT LOCKING SELF TAPPING 3DSI TECHNOLOGY POLYAXIAL GREEN COMPRESSION PLATING SYSTEM SUP-40233538 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW WRIGHT MEDICAL LOCKING 3.5MM X 40 SUP-40233540 CDM 0270 RC outpatient 722.8 722.8 722.8 74 534.87 percent of total billed charges 722.8 93 585.47 percent of total billed charges 722.8 722.8 other OPPS APC 722.8 722.8 other OPPS APC 722.8 27.63 199.71 percent of total billed charges 722.8 722.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CLAW II L15 MM FOOT ANKLE 2 HOLE SUP-40240215 CDM 0270 RC outpatient 4643.6 4643.6 4643.6 74 3436.26 percent of total billed charges 4643.6 93 3761.32 percent of total billed charges 4643.6 4643.6 other OPPS APC 4643.6 4643.6 other OPPS APC 4643.6 27.63 1283.03 percent of total billed charges 4643.6 4643.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CLAW II 20MM SS ANKLE FOOT 2 HOLE POLYAXIAL COMPRESSION SUP-40240220 CDM 0270 RC outpatient 4643.6 4643.6 4643.6 74 3436.26 percent of total billed charges 4643.6 93 3761.32 percent of total billed charges 4643.6 4643.6 other OPPS APC 4643.6 4643.6 other OPPS APC 4643.6 27.63 1283.03 percent of total billed charges 4643.6 4643.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CLAW II STAINLESS STEEL MEDIUM UNIVERSAL L25 MM ANKLE FOOT 2 HOLE POLYAXIAL COMPRESSION ORTHOLOC 3DSI LOCKING SCREW TECHNOLOGY 2.7/3.5 MM SCREW SUP-40240225 CDM 0270 RC outpatient 4643.6 4643.6 4643.6 74 3436.26 percent of total billed charges 4643.6 93 3761.32 percent of total billed charges 4643.6 4643.6 other OPPS APC 4643.6 4643.6 other OPPS APC 4643.6 27.63 1283.03 percent of total billed charges 4643.6 4643.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CLAW II STAINLESS STEEL LARGE UNIVERSAL L30 MM ANKLE FOOT 2 HOLE POLYAXIAL COMPRESSION ORTHOLOC 3DSI LOCKING SCREW TECHNOLOGY 2.7/3.5 MM SCREW SUP-40240230 CDM 0270 RC outpatient 4643.6 4643.6 4643.6 74 3436.26 percent of total billed charges 4643.6 93 3761.32 percent of total billed charges 4643.6 4643.6 other OPPS APC 4643.6 4643.6 other OPPS APC 4643.6 27.63 1283.03 percent of total billed charges 4643.6 4643.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CLAW II STAINLESS STEEL SMALL UNIVERSAL L20 MM ANKLE FOOT 4 HOLE POLYAXIAL COMPRESSION ORTHOLOC 3DSI LOCKING SCREW TECHNOLOGY 2.7/3.5 MM SCREW SUP-40240420 CDM 0270 RC outpatient 5662.8 5662.8 5662.8 74 4190.47 percent of total billed charges 5662.8 93 4586.87 percent of total billed charges 5662.8 5662.8 other OPPS APC 5662.8 5662.8 other OPPS APC 5662.8 27.63 1564.63 percent of total billed charges 5662.8 5662.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CLAW II STAINLESS STEEL MEDIUM UNIVERSAL L25 MM ANKLE FOOT 4 HOLE POLYAXIAL COMPRESSION ORTHOLOC 3DSI LOCKING SCREW TECHNOLOGY 2.7/3.5 MM SCREW SUP-40240425 CDM 0270 RC outpatient 5662.8 5662.8 5662.8 74 4190.47 percent of total billed charges 5662.8 93 4586.87 percent of total billed charges 5662.8 5662.8 other OPPS APC 5662.8 5662.8 other OPPS APC 5662.8 27.63 1564.63 percent of total billed charges 5662.8 5662.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CLAW II STAINLESS STEEL LARGE UNIVERSAL L30 MM ANKLE FOOT 4 HOLE POLYAXIAL COMPRESSION ORTHOLOC 3DSI LOCKING SCREW TECHNOLOGY 2.7/3.5 MM SCREW SUP-40240430 CDM 0270 RC outpatient 5662.8 5662.8 5662.8 74 4190.47 percent of total billed charges 5662.8 93 4586.87 percent of total billed charges 5662.8 5662.8 other OPPS APC 5662.8 5662.8 other OPPS APC 5662.8 27.63 1564.63 percent of total billed charges 5662.8 5662.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE T CLAW 3 HOLE 20MM SUP-40241320 CDM 0270 RC outpatient 5155.8 5155.8 5155.8 74 3815.29 percent of total billed charges 5155.8 93 4176.2 percent of total billed charges 5155.8 5155.8 other OPPS APC 5155.8 5155.8 other OPPS APC 5155.8 27.63 1424.55 percent of total billed charges 5155.8 5155.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CLAW II STAINLESS STEEL MEDIUM UNIVERSAL L25 MM ANKLE FOOT 3 HOLE T LOCKING THREAD POLYAXIAL COMPRESSION 2.7/3.5 MM SCREW SUP-40241325 CDM 0270 RC outpatient 5155.8 5155.8 5155.8 74 3815.29 percent of total billed charges 5155.8 93 4176.2 percent of total billed charges 5155.8 5155.8 other OPPS APC 5155.8 5155.8 other OPPS APC 5155.8 27.63 1424.55 percent of total billed charges 5155.8 5155.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE T CLAW 3 HOLE 30MM SUP-40241330 CDM 0270 RC outpatient 5155.8 5155.8 5155.8 74 3815.29 percent of total billed charges 5155.8 93 4176.2 percent of total billed charges 5155.8 5155.8 other OPPS APC 5155.8 5155.8 other OPPS APC 5155.8 27.63 1424.55 percent of total billed charges 5155.8 5155.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE CLAW T 4 HOLE 25MM SUP-40241420 CDM 0270 RC outpatient 5662.8 5662.8 5662.8 74 4190.47 percent of total billed charges 5662.8 93 4586.87 percent of total billed charges 5662.8 5662.8 other OPPS APC 5662.8 5662.8 other OPPS APC 5662.8 27.63 1564.63 percent of total billed charges 5662.8 5662.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CLAW II STAINLESS STEEL MEDIUM UNIVERSAL L25 MM ANKLE FOOT 4 HOLE POLYAXIAL COMPRESSION ORTHOLOC 3DSI LOCKING TECHNOLOGY 2.7/3.5 MM SCREW SUP-40241425 CDM 0270 RC outpatient 5662.8 5662.8 5662.8 74 4190.47 percent of total billed charges 5662.8 93 4586.87 percent of total billed charges 5662.8 5662.8 other OPPS APC 5662.8 5662.8 other OPPS APC 5662.8 27.63 1564.63 percent of total billed charges 5662.8 5662.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CLAW II T L30 MM 4 HOLE SUP-40241430 CDM 0270 RC outpatient 5662.8 5662.8 5662.8 74 4190.47 percent of total billed charges 5662.8 93 4586.87 percent of total billed charges 5662.8 5662.8 other OPPS APC 5662.8 5662.8 other OPPS APC 5662.8 27.63 1564.63 percent of total billed charges 5662.8 5662.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CLAW II STAINLESS STEEL SMALL STRAIGHT UNIVERSAL L20 MM L20 MM ANKLE FOOT SERIES LOCKING THREAD POLYAXIAL COMPRESSION 2.7/3.5 MM SCREW SUP-40242020 CDM 0270 RC outpatient 5155.8 5155.8 5155.8 74 3815.29 percent of total billed charges 5155.8 93 4176.2 percent of total billed charges 5155.8 5155.8 other OPPS APC 5155.8 5155.8 other OPPS APC 5155.8 27.63 1424.55 percent of total billed charges 5155.8 5155.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CLAW II STAINLESS STEEL MEDIUM STRAIGHT UNIVERSAL L20 MM L25 MM ANKLE FOOT SERIES LOCKING THREAD POLYAXIAL COMPRESSION 2.7/3.5 MM SCREW SUP-40242025 CDM 0270 RC outpatient 5155.8 5155.8 5155.8 74 3815.29 percent of total billed charges 5155.8 93 4176.2 percent of total billed charges 5155.8 5155.8 other OPPS APC 5155.8 5155.8 other OPPS APC 5155.8 27.63 1424.55 percent of total billed charges 5155.8 5155.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE CLAW STRAIGHT 25X25 SUP-40242525 CDM 0270 RC outpatient 5155.8 5155.8 5155.8 74 3815.29 percent of total billed charges 5155.8 93 4176.2 percent of total billed charges 5155.8 5155.8 other OPPS APC 5155.8 5155.8 other OPPS APC 5155.8 27.63 1424.55 percent of total billed charges 5155.8 5155.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE CLAW SMALL U SUP-40243010 CDM 0270 RC outpatient 6445.4 6445.4 6445.4 74 4769.6 percent of total billed charges 6445.4 93 5220.77 percent of total billed charges 6445.4 6445.4 other OPPS APC 6445.4 6445.4 other OPPS APC 6445.4 27.63 1780.86 percent of total billed charges 6445.4 6445.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CLAW II STAINLESS STEEL U MEDIUM UNIVERSAL ANKLE FOOT LOCKING THREAD POLYAXIAL COMPRESSION 2.7/3.5 MM SCREW SUP-40243020 CDM 0270 RC outpatient 6445.4 6445.4 6445.4 74 4769.6 percent of total billed charges 6445.4 93 5220.77 percent of total billed charges 6445.4 6445.4 other OPPS APC 6445.4 6445.4 other OPPS APC 6445.4 27.63 1780.86 percent of total billed charges 6445.4 6445.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CLAW II STAINLESS STEEL U LARGE UNIVERSAL RIGHT ANKLE FOOT LOCKING THREAD POLYAXIAL COMPRESSION 2.7/3.5 MM SCREW SUP-4024303L CDM 0270 RC outpatient 5722.6 5722.6 5722.6 74 4234.72 percent of total billed charges 5722.6 93 4635.31 percent of total billed charges 5722.6 5722.6 other OPPS APC 5722.6 5722.6 other OPPS APC 5722.6 27.63 1581.15 percent of total billed charges 5722.6 5722.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CLAW II STAINLESS STEEL U LARGE UNIVERSAL LEFT ANKLE FOOT LOCKING THREAD POLYAXIAL COMPRESSION 2.7/3.5 MM SCREW SUP-4024303R CDM 0270 RC outpatient 5722.6 5722.6 5722.6 74 4234.72 percent of total billed charges 5722.6 93 4635.31 percent of total billed charges 5722.6 5722.6 other OPPS APC 5722.6 5722.6 other OPPS APC 5722.6 27.63 1581.15 percent of total billed charges 5722.6 5722.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL CLAW II OD2 MM GREEN 2.7 MM SCREW POLYAXIAL COMPRESSION PLATING SYSTEM SUP-40250020 CDM 0270 RC outpatient 834.6 834.6 834.6 74 617.6 percent of total billed charges 834.6 93 676.03 percent of total billed charges 834.6 834.6 other OPPS APC 834.6 834.6 other OPPS APC 834.6 27.63 230.6 percent of total billed charges 834.6 834.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL CLAW OD2.8 MM SUP-40250028 CDM 0270 RC outpatient 834.6 834.6 834.6 74 617.6 percent of total billed charges 834.6 93 676.03 percent of total billed charges 834.6 834.6 other OPPS APC 834.6 834.6 other OPPS APC 834.6 27.63 230.6 percent of total billed charges 834.6 834.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH AVANTI L5.5 CM OD6 FR ENDOVASCULAR ATRAUMATIC INSERTION KINK RESISTANT CANNULA SMOOTH TRANSITION NO GUIDEWIRE GREEN ACCEPTS .035 IN GUIDEWIRE SUP-402606R CDM 0270 RC outpatient 27.4 27.4 27.4 74 20.28 percent of total billed charges 27.4 93 22.19 percent of total billed charges 27.4 27.4 other OPPS APC 27.4 27.4 other OPPS APC 27.4 27.63 7.57 percent of total billed charges 27.4 27.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION SAFIRE COMFORTGRIP 2-5-2 MM SPACE 1 MM MEDIUM CURL L115 CM L4 MM OD7 FR QUADRIPOLAR BIDIRECTIONAL SUP-402810 CDM 0270 RC outpatient 1625 1625 1625 74 1202.5 percent of total billed charges 1625 93 1316.25 percent of total billed charges 1625 1625 other OPPS APC 1625 1625 other OPPS APC 1625 27.63 448.99 percent of total billed charges 1625 1625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION SAFIRE COMFORTGRIP 2-5-2 MM SPACING 1 MM MEDIUM CURL L115 CM L5 MM OD7 FR QUADRIPOLAR BIDIRECTIONAL UNIVERSAL TEMPERATURE MONITORING STEERING LOCK SUP-402816 CDM 0270 RC outpatient 1625 1625 1625 74 1202.5 percent of total billed charges 1625 93 1316.25 percent of total billed charges 1625 1625 other OPPS APC 1625 1625 other OPPS APC 1625 27.63 448.99 percent of total billed charges 1625 1625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION SAFIRE COMFORTGRIP 2-5-2 MM SPACING 1 MM LARGE CURL L115 CM L5 MM OD7 FR QUADRIPOLAR BIDIRECTIONAL UNIVERSAL TEMPERATURE MONITORING STEERING LOCK SUP-402817 CDM 0270 RC outpatient 1625 1625 1625 74 1202.5 percent of total billed charges 1625 93 1316.25 percent of total billed charges 1625 1625 other OPPS APC 1625 1625 other OPPS APC 1625 27.63 448.99 percent of total billed charges 1625 1625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION SAFIRE TX COMFORTGRIP QUADRIPOLAR 2-5-2 MM SPACE 1 MM UNIVERSAL MEDIUM CURVE L110 CM L8 MM OD7 FR BIDIRECTIONAL TEMPERATURE MONITOR STEER LOCK SUP-402839 CDM 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION SAFIRE TX COMFORTGRIP QUADRIPOLAR 2-5-2 MM SPACE 1 MM UNIVERSAL LARGE CURVE L110 CM L8 MM OD7 FR BIDIRECTIONAL TEMPERATURE MONITOR STEER LOCK SUP-402840 CDM 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENTURE SUP-402852 CDM 0275 RC outpatient 1430 1430 1430 57 815.1 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 51 729.3 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING GUAZE QUICK CLOT CONTROL 12X12 SUP-4030 CDM 0270 RC outpatient 691.38 691.38 691.38 74 511.62 percent of total billed charges 691.38 93 560.02 percent of total billed charges 691.38 691.38 other OPPS APC 691.38 691.38 other OPPS APC 691.38 27.63 191.03 percent of total billed charges 691.38 691.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP LEAD TERMINAL QUADRIPOLAR IS-1 SUP-4033 CDM 0275 RC outpatient 111.15 111.15 111.15 57 63.36 percent of total billed charges 111.15 93 90.03 percent of total billed charges 111.15 111.15 other OPPS APC 111.15 111.15 other OPPS APC 111.15 51 56.69 percent of total billed charges 111.15 111.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 12MM 3.5MM 6MM TITANIUM NS CORTEX SELF TAP HEXAGONAL SM FRAGMENT SET SUP-404.812 CDM 270010022 LOCAL 0270 RC outpatient 60.94 60.94 60.94 74 45.1 percent of total billed charges 60.94 93 49.36 percent of total billed charges 60.94 60.94 other OPPS APC 60.94 60.94 other OPPS APC 60.94 27.63 16.84 percent of total billed charges 60.94 60.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 14MM 3.5MM 6MM TITANIUM NS CORTEX SELF TAP HEXAGONAL SM FRAGMENT SET SUP-404.814 CDM 270010022 LOCAL 0270 RC outpatient 70.07 70.07 70.07 74 51.85 percent of total billed charges 70.07 93 56.76 percent of total billed charges 70.07 70.07 other OPPS APC 70.07 70.07 other OPPS APC 70.07 27.63 19.36 percent of total billed charges 70.07 70.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 16MM 3.5MM 6MM TITANIUM NS CORTEX SELF TAP HEXAGONAL SM FRAGMENT SET SUP-404.816 CDM 270010022 LOCAL 0270 RC outpatient 70.07 70.07 70.07 74 51.85 percent of total billed charges 70.07 93 56.76 percent of total billed charges 70.07 70.07 other OPPS APC 70.07 70.07 other OPPS APC 70.07 27.63 19.36 percent of total billed charges 70.07 70.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP LC-DCP TITANIUM FULL THREAD HEXAGON L18 MM OD3.5 MM ODSEC6 MM TIBIA CORTICAL MEDIAL PROXIMAL SELF TAP SOCKET NONSTERILE SMALL FRAGMENT SET SUP-404.818 CDM 270010022 LOCAL 0270 RC outpatient 70.07 70.07 70.07 74 51.85 percent of total billed charges 70.07 93 56.76 percent of total billed charges 70.07 70.07 other OPPS APC 70.07 70.07 other OPPS APC 70.07 27.63 19.36 percent of total billed charges 70.07 70.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP LC-DCP TITANIUM FULL THREAD HEXAGON L20 MM OD3.5 MM ODSEC6 MM TIBIA CORTICAL MEDIAL PROXIMAL SELF TAP SOCKET NONSTERILE SMALL FRAGMENT SET SUP-404.82 CDM 270010022 LOCAL 0270 RC outpatient 60.94 60.94 60.94 74 45.1 percent of total billed charges 60.94 93 49.36 percent of total billed charges 60.94 60.94 other OPPS APC 60.94 60.94 other OPPS APC 60.94 27.63 16.84 percent of total billed charges 60.94 60.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 3.5MM 6MM 20MM LCP LC-DCP TITANIUM FULL THREAD HEXAGON TIBIA CORTICAL SUP-404.820 CDM outpatient 58.92 58.92 58.92 58.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP LC-DCP TITANIUM FULL THREAD HEXAGON L22 MM OD3.5 MM ODSEC6 MM TIBIA CORTICAL MEDIAL PROXIMAL SELF TAP SOCKET NONSTERILE SMALL FRAGMENT SET SUP-404.822 CDM 270010022 LOCAL 0270 RC outpatient 60.94 60.94 60.94 74 45.1 percent of total billed charges 60.94 93 49.36 percent of total billed charges 60.94 60.94 other OPPS APC 60.94 60.94 other OPPS APC 60.94 27.63 16.84 percent of total billed charges 60.94 60.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP LC-DCP TITANIUM FULL THREAD HEXAGON L24 MM OD3.5 MM ODSEC6 MM TIBIA CORTICAL MEDIAL PROXIMAL SELF TAP SOCKET NONSTERILE SMALL FRAGMENT SET SUP-404.824 CDM 270010022 LOCAL 0270 RC outpatient 60.94 60.94 60.94 74 45.1 percent of total billed charges 60.94 93 49.36 percent of total billed charges 60.94 60.94 other OPPS APC 60.94 60.94 other OPPS APC 60.94 27.63 16.84 percent of total billed charges 60.94 60.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD 26MM 3.5MM 6MM TITANIUM NS CORTEX SELF TAP HEXAGONAL SM FRAGMENT SET SUP-404.826 CDM 270010022 LOCAL 0270 RC outpatient 60.94 60.94 60.94 74 45.1 percent of total billed charges 60.94 93 49.36 percent of total billed charges 60.94 60.94 other OPPS APC 60.94 60.94 other OPPS APC 60.94 27.63 16.84 percent of total billed charges 60.94 60.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP LC-DCP TITANIUM FULL THREAD HEXAGON L28 MM OD3.5 MM ODSEC6 MM TIBIA CORTICAL MEDIAL PROXIMAL SELF TAP SOCKET NONSTERILE SMALL FRAGMENT SET SUP-404.828 CDM 270010022 LOCAL 0270 RC outpatient 60.94 60.94 60.94 74 45.1 percent of total billed charges 60.94 93 49.36 percent of total billed charges 60.94 60.94 other OPPS APC 60.94 60.94 other OPPS APC 60.94 27.63 16.84 percent of total billed charges 60.94 60.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-404.828 CDM 0270 RC outpatient 60.94 60.94 60.94 74 45.1 percent of total billed charges 60.94 93 49.36 percent of total billed charges 60.94 60.94 other OPPS APC 60.94 60.94 other OPPS APC 60.94 27.63 16.84 percent of total billed charges 60.94 60.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM 2.5 MM FULL THREAD L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET SUP-404.830 CDM 0270 RC outpatient 60.94 60.94 60.94 74 45.1 percent of total billed charges 60.94 93 49.36 percent of total billed charges 60.94 60.94 other OPPS APC 60.94 60.94 other OPPS APC 60.94 27.63 16.84 percent of total billed charges 60.94 60.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPONGE EYE SURGICAL SPEAR STERILE CELLULOSE SUP-40410 CDM 0270 RC outpatient 7.15 7.15 7.15 74 5.29 percent of total billed charges 7.15 93 5.79 percent of total billed charges 7.15 7.15 other OPPS APC 7.15 7.15 other OPPS APC 7.15 27.63 1.98 percent of total billed charges 7.15 7.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL 175 MM 200 MM 1 WIDE FIELD LENS 1 CORRECTION LENS BIOM THUMBSCREW CAP STERILE DISPOSABLE SUP-40411 CDM 0270 RC outpatient 375.88 375.88 375.88 74 278.15 percent of total billed charges 375.88 93 304.46 percent of total billed charges 375.88 375.88 other OPPS APC 375.88 375.88 other OPPS APC 375.88 27.63 103.86 percent of total billed charges 375.88 375.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS WALLSTENT UNISTEP PLUS METAL L100 CM L55 MM L75 CM OD20 MM TRACHEOBRONCHIAL FLEXIBLE DELIVERY SYSTEM ACCEPTS 11 FR SHEATH SUP-40431 CDM 0270 RC outpatient 3365.6 3365.6 3365.6 74 2490.54 percent of total billed charges 3365.6 93 2726.14 percent of total billed charges 3365.6 3365.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GuideRight wire 0.032 180cm SUP-404569 CDM 0270 RC outpatient 14.3 14.3 14.3 74 10.58 percent of total billed charges 14.3 93 11.58 percent of total billed charges 14.3 14.3 other OPPS APC 14.3 14.3 other OPPS APC 14.3 27.63 3.95 percent of total billed charges 14.3 14.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD EPICARDIAL SUP-4046 CDM 0275 RC outpatient 1300 1300 1300 57 741 percent of total billed charges 1300 93 1053 percent of total billed charges 1300 1300 other OPPS APC 1300 1300 other OPPS APC 1300 51 663 percent of total billed charges 1300 1300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING INNOMEDICA L35 CM MYOCARDIAL SUP-4046 CDM 0275 RC outpatient 1697.8 1697.8 1697.8 57 967.75 percent of total billed charges 1697.8 93 1375.22 percent of total billed charges 1697.8 1697.8 other OPPS APC 1697.8 1697.8 other OPPS APC 1697.8 51 865.88 percent of total billed charges 1697.8 1697.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.5X35 SUP-404667_57329 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.75X35 SUP-404668_57330 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 3.0X35 SUP-404669_57331 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 3.5X35 SUP-404670_57332 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 4.0X35 SUP-404671_57333 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.5X40 SUP-404673_57334 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 2.75X40 SUP-404674_57335 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 3.0X40 SUP-404675_57336 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 3.5X40 SUP-404676_57337 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO DES 4.0X40 SUP-404677_57338 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING INNOMEDICA SILICONE L54 CM MYOCARDIAL BIPOLAR SUTURELESS SUP-4047 CDM 0275 RC outpatient 1697.8 1697.8 1697.8 57 967.75 percent of total billed charges 1697.8 93 1375.22 percent of total billed charges 1697.8 1697.8 other OPPS APC 1697.8 1697.8 other OPPS APC 1697.8 51 865.88 percent of total billed charges 1697.8 1697.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 0.032 X 260 GUIDEWIRE GUIDERIGHT J 260 CM SUP-404878 CDM 0270 RC outpatient 48.1 48.1 48.1 74 35.59 percent of total billed charges 48.1 93 38.96 percent of total billed charges 48.1 48.1 other OPPS APC 48.1 48.1 other OPPS APC 48.1 27.63 13.29 percent of total billed charges 48.1 48.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SPINAL BD QUINCKE STANDARD LENGTH L2 1/2 IN OD20 GA SPINE BEVEL FIT STYLET UNIQUE TRANSLUCENT WINDOW CANNULA STERILE LATEX FREE DISPOSABLE YELLOW ANESTHESIA SUP-405071 CDM 0270 RC outpatient 10.02 10.02 10.02 74 7.41 percent of total billed charges 10.02 93 8.12 percent of total billed charges 10.02 10.02 other OPPS APC 10.02 10.02 other OPPS APC 10.02 27.63 2.77 percent of total billed charges 10.02 10.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SPINAL BD QUINCKE POLYPROPYLENE NEONATE SHORT LENGTH REGULAR WALL L2 IN OD25 GA QUINCKE TIP STERILE LATEX FREE DISPOSABLE BLUE SUP-405078 CDM 0270 RC outpatient 25.71 25.71 25.71 74 19.03 percent of total billed charges 25.71 93 20.83 percent of total billed charges 25.71 25.71 other OPPS APC 25.71 25.71 other OPPS APC 25.71 27.63 7.1 percent of total billed charges 25.71 25.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SPINAL BD QUINCKE REGULAR WALL 1.5IN 22GA BLACK POLYPROPYLENE DISPOSABLE STERILE LF REGULAR BEVEL LUER HUB DEHP SUP-405161 CDM outpatient 10.4 10.4 10.4 10.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SPINAL BD QUINCKE REGULAR WALL 3.5IN 25GA BLUE POLYPROPYLENE DISPOSABLE STERILE LF REGULAR BEVEL LUER HUB DEHP SUP-405180 CDM 0270 RC outpatient 7.09 7.09 7.09 74 5.25 percent of total billed charges 7.09 93 5.74 percent of total billed charges 7.09 7.09 other OPPS APC 7.09 7.09 other OPPS APC 7.09 27.63 1.96 percent of total billed charges 7.09 7.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SPINAL BD QUINCKE REGULAR WALL 3.5IN 22GA BLACK POLYPROPYLENE DISPOSABLE STERILE LF REGULAR BEVEL LUER HUB DEHP SUP-405181 CDM 0270 RC outpatient 7.3 7.3 7.3 74 5.4 percent of total billed charges 7.3 93 5.91 percent of total billed charges 7.3 7.3 other OPPS APC 7.3 7.3 other OPPS APC 7.3 27.63 2.02 percent of total billed charges 7.3 7.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SPINAL BD QUINCKE REGULAR WALL 3.5IN 20GA YELLOW POLYPROPYLENE DISPOSABLE STERILE LF REGULAR BEVEL LUER HUB DEHP SUP-405182 CDM 0270 RC outpatient 7.75 7.75 7.75 74 5.74 percent of total billed charges 7.75 93 6.28 percent of total billed charges 7.75 7.75 other OPPS APC 7.75 7.75 other OPPS APC 7.75 27.63 2.14 percent of total billed charges 7.75 7.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SPINAL BD QUINCKE REGULAR WALL 3.5IN 18GA PINK POLYPROPYLENE DISPOSABLE STERILE LF REGULAR BEVEL LUER HUB DEHP SUP-405184 CDM 0270 RC outpatient 7.25 7.25 7.25 74 5.37 percent of total billed charges 7.25 93 5.87 percent of total billed charges 7.25 7.25 other OPPS APC 7.25 7.25 other OPPS APC 7.25 27.63 2 percent of total billed charges 7.25 7.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE PACING SJM L 12FT TEMPORARY EXTENSION STERILE LAXTEX FREE DISPOSABLE SUP-4051L CDM 0275 RC outpatient 74.1 74.1 74.1 57 42.24 percent of total billed charges 74.1 93 60.02 percent of total billed charges 74.1 74.1 other OPPS APC 74.1 74.1 other OPPS APC 74.1 51 37.79 percent of total billed charges 74.1 74.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING INNOMEDICA STEROID ELUTING L35 CM MYOCARDIAL SUP-4058 CDM 0275 RC outpatient 1697.8 1697.8 1697.8 57 967.75 percent of total billed charges 1697.8 93 1375.22 percent of total billed charges 1697.8 1697.8 other OPPS APC 1697.8 1697.8 other OPPS APC 1697.8 51 865.88 percent of total billed charges 1697.8 1697.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING L110 CM ATRIUM BIPOLAR SCREW IN IS-1 SUP-4058 CDM 0275 RC outpatient 2371.2 2371.2 2371.2 57 1351.58 percent of total billed charges 2371.2 93 1920.67 percent of total billed charges 2371.2 2371.2 other OPPS APC 2371.2 2371.2 other OPPS APC 2371.2 51 1209.31 percent of total billed charges 2371.2 2371.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL OD3.2 MM CENTRAL SCREW COMPREHENSIVE REVERSE SHOULDER SYSTEM SUP-405883 CDM 270010030 LOCAL 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL OD2.7 MM PERIPHERAL SCREW COMPREHENSIVE REVERSE SHOULDER SYSTEM SUP-405889 CDM 270010030 LOCAL 0270 RC outpatient 377 377 377 74 278.98 percent of total billed charges 377 93 305.37 percent of total billed charges 377 377 other OPPS APC 377 377 other OPPS APC 377 27.63 104.17 percent of total billed charges 377 377 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LANTERN NAVIGATION UNIT SUP-406000 CDM 270010025 LOCAL 0270 RC outpatient 6227 6227 6227 74 4607.98 percent of total billed charges 6227 93 5043.87 percent of total billed charges 6227 6227 other OPPS APC 6227 6227 other OPPS APC 6227 27.63 1720.52 percent of total billed charges 6227 6227 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER HEMOSTASIS FAST CATH LUER LOCK GUIDEWIRE AND REPOSITIONING SLEEVE 7 FR 12CM 0.038 IN SUP-406107 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH FAST-CATH STRAIGHT J L12 CM OD12 FR INTRACARDIAC LARGE LUMEN HEMOSTASIS VALVE SIDEPORT DILATOR ACCEPTS .038 IN GUIDEWIRE SUP-406128 CDM 0481 RC outpatient 70.2 70.2 70.2 74 51.95 percent of total billed charges 70.2 93 56.86 percent of total billed charges 70.2 70.2 other OPPS APC 70.2 70.2 other OPPS APC 70.2 51 35.8 percent of total billed charges 70.2 70.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER HEMOSTATSIS FAST CATH LUER LOCK GUIDEWIRE AND REPOSITIONING SLEEVE 8.5 FR 12 CM 0.038 IN SUP-406137 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE LUER LOCK 60CM SUP-406503 CDM 0481 RC outpatient 67.6 67.6 67.6 74 50.02 percent of total billed charges 67.6 93 54.76 percent of total billed charges 67.6 67.6 other OPPS APC 67.6 67.6 other OPPS APC 67.6 51 34.48 percent of total billed charges 67.6 67.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD CAPSURE EPI SUP-4068 SERIES CDM 0275 RC outpatient 1131 1131 1131 57 644.67 percent of total billed charges 1131 93 916.11 percent of total billed charges 1131 1131 other OPPS APC 1131 1131 other OPPS APC 1131 51 576.81 percent of total billed charges 1131 1131 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH SWARTZ .032 IN SL1 CURVE L63 CM OD8 FR TRANSSEPTAL HEMOSTASIS GUIDEWIRE SUP-406840 CDM 0270 RC outpatient 395.2 395.2 395.2 74 292.45 percent of total billed charges 395.2 93 320.11 percent of total billed charges 395.2 395.2 other OPPS APC 395.2 395.2 other OPPS APC 395.2 27.63 109.19 percent of total billed charges 395.2 395.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH FAST-CATH SWARTZ .032 IN SL2 CURVE L63 CM L180 CM OD8 FR TRANSSEPTAL HEMOSTASIS VALVE J TIP SUPER STIFF GUIDEWIRE SIDEPORT DILATOR SUP-406841 CDM 0270 RC outpatient 395.2 395.2 395.2 74 292.45 percent of total billed charges 395.2 93 320.11 percent of total billed charges 395.2 395.2 other OPPS APC 395.2 395.2 other OPPS APC 395.2 27.63 109.19 percent of total billed charges 395.2 395.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SL3 SUP-406842 CDM 0270 RC outpatient 462.8 462.8 462.8 74 342.47 percent of total billed charges 462.8 93 374.87 percent of total billed charges 462.8 462.8 other OPPS APC 462.8 462.8 other OPPS APC 462.8 27.63 127.87 percent of total billed charges 462.8 462.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH FAST-CATH SWARTZ .038 IN SR2 CURVE L63 CM OD8 FR TRANSSEPTAL HEMOSTASIS GUIDEWIRE SUP-406846 CDM 0270 RC outpatient 462.8 462.8 462.8 74 342.47 percent of total billed charges 462.8 93 374.87 percent of total billed charges 462.8 462.8 other OPPS APC 462.8 462.8 other OPPS APC 462.8 27.63 127.87 percent of total billed charges 462.8 462.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH FAST-CATH SWARTZ .038 IN SR3 CURVE L63 CM OD8 FR TRANSSEPTAL HEMOSTASIS GUIDEWIRE SUP-406847 CDM 0270 RC outpatient 462.8 462.8 462.8 74 342.47 percent of total billed charges 462.8 93 374.87 percent of total billed charges 462.8 462.8 other OPPS APC 462.8 462.8 other OPPS APC 462.8 27.63 127.87 percent of total billed charges 462.8 462.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH FAST-CATH L63CM OD8.5 FR GUIDE STERILE LATEX FREE DISPOSABLE SUP-406853 CDM 0270 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH FAST-CATH SWARTZ SR .038 IN J SR0 CURVE L63 CM L145 CM OD8 FR TRANSSEPTAL GUIDE HEMOSTASIS VALVE SIDEPORT DILATOR RADIOPAQUE TIP MARKER SUP-406853 CDM 0270 RC outpatient 462.8 462.8 462.8 74 342.47 percent of total billed charges 462.8 93 374.87 percent of total billed charges 462.8 462.8 other OPPS APC 462.8 462.8 other OPPS APC 462.8 27.63 127.87 percent of total billed charges 462.8 462.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH FAST-CATH SAFL .038 IN SL2 CURVE L60 CM OD8 FR HEMOSTASIS VALVE J TIP SUPER STIFF GUIDEWIRE SIDEPORT DILATOR SUP-406871 CDM 0270 RC outpatient 462.8 462.8 462.8 74 342.47 percent of total billed charges 462.8 93 374.87 percent of total billed charges 462.8 462.8 other OPPS APC 462.8 462.8 other OPPS APC 462.8 27.63 127.87 percent of total billed charges 462.8 462.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH FAST-CATH SWARTZ .038 IN RAMP L60 CM OD8 FR ODSEC18 MM HEMOSTASIS VALVE J TIP GUIDEWIRE SIDEPORT DILATOR SUP-406898 CDM 0270 RC outpatient 462.8 462.8 462.8 74 342.47 percent of total billed charges 462.8 93 374.87 percent of total billed charges 462.8 462.8 other OPPS APC 462.8 462.8 other OPPS APC 462.8 27.63 127.87 percent of total billed charges 462.8 462.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC EDORA 2 CHAMBER DR-T SUP-407145_74447 CDM 0270 RC outpatient 7280 7280 7280 74 5387.2 percent of total billed charges 7280 93 5896.8 percent of total billed charges 7280 7280 other OPPS APC 7280 7280 other OPPS APC 7280 27.63 2011.46 percent of total billed charges 7280 7280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE TRANSSEPTAL BRK 1 98CM SUP-407207 CDM 0270 RC outpatient 652.6 652.6 652.6 74 482.92 percent of total billed charges 652.6 93 528.61 percent of total billed charges 652.6 652.6 other OPPS APC 652.6 652.6 other OPPS APC 652.6 27.63 180.31 percent of total billed charges 652.6 652.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAPSURE SENSE PASSIVE SUP-4073/4074/4574 SERIE CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAMP EP GUIDING SHEATH SUP-407358 CDM 0270 RC outpatient 585 585 585 74 432.9 percent of total billed charges 585 93 473.85 percent of total billed charges 585 585 other OPPS APC 585 585 other OPPS APC 585 27.63 161.64 percent of total billed charges 585 585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH LAMP 45 CURVE SUP-407362 CDM 0270 RC outpatient 621.4 621.4 621.4 74 459.84 percent of total billed charges 621.4 93 503.33 percent of total billed charges 621.4 621.4 other OPPS APC 621.4 621.4 other OPPS APC 621.4 27.63 171.69 percent of total billed charges 621.4 621.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH ULTIMUM SWARTZ LAMP 45 CURVE L81 CM L180 CM OD8.5 FR TRANSSEPTAL BRAID ULTRASOFT TIP ACCEPTS .032 IN SUPER STIFF SUP-407363 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING 4076-35 CAPSUREFIX NOVUS _42997_ SUP-407635 CDM 0275 RC outpatient 1027 1027 1027 57 585.39 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 51 523.77 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING CAPSUREFIX NOVUS MRI SURESCAN STEROID ELUTING POLYURETHANE L45 CM SUP-407645 CDM 0275 RC outpatient 1027 1027 1027 57 585.39 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 51 523.77 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING CAPSUREFIX NOVUS MRI SURESCAN STEROID ELUTING POLYURETHANE L52 CM SUP-407652 CDM 0275 RC outpatient 1027 1027 1027 57 585.39 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 51 523.77 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING CAPSUREFIX NOVUS MRI SURESCAN STEROID ELUTING POLYURETHANE L58 CM SUP-407658 CDM 0275 RC outpatient 1027 1027 1027 57 585.39 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 51 523.77 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING CAPSUREFIX NOVUS STEROID ELUTING POLYURETHANE SILICONE L65 CM SUP-407665 CDM 0275 RC outpatient 1027 1027 1027 57 585.39 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 51 523.77 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING CAPSUREFIX NOVUS STEROID ELUTING POLYURETHANE SILICONE L85 CM SUP-407685 CDM 0275 RC outpatient 1027 1027 1027 57 585.39 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 51 523.77 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING SUCTION L6 FT OD1/2 IN UTERINE SWIVEL HANDLE STERILE LATEX DISPOSABLE AMUVAC SUP-40788-010 CDM 0270 RC outpatient 38.6 38.6 38.6 74 28.56 percent of total billed charges 38.6 93 31.27 percent of total billed charges 38.6 38.6 other OPPS APC 38.6 38.6 other OPPS APC 38.6 27.63 10.67 percent of total billed charges 38.6 38.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L40 MM L16 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE GOLD INTRAMEDULLARY NAIL SYSTEM SUP-408.840 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L45 MM L16 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE GOLD INTRAMEDULLARY NAIL SYSTEM SUP-408.845 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L50 MM L16 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE GOLD INTRAMEDULLARY NAIL SYSTEM SUP-408.850 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L70 MM L16 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE CANNULATED SELF TAP SELF DRILL HEMISPHERICAL HEAD NONSTERILE GOLD INTRAMEDULLARY NAIL SUP-408.870 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L75 MM L16 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE GOLD INTRAMEDULLARY NAIL SYSTEM SUP-408.875 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L80 MM L16 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET NONSTERILE GOLD INTRAMEDULLARY NAIL SYSTEM SUP-408.880 CDM 270010022 LOCAL 0270 RC outpatient 587.5 587.5 587.5 74 434.75 percent of total billed charges 587.5 93 475.88 percent of total billed charges 587.5 587.5 other OPPS APC 587.5 587.5 other OPPS APC 587.5 27.63 162.33 percent of total billed charges 587.5 587.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L85 MM L16 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET GOLD INTRAMEDULLARY NAIL SYSTEM SUP-408.885 CDM 270010020 LOCAL 0270 RC outpatient 587.5 587.5 587.5 74 434.75 percent of total billed charges 587.5 93 475.88 percent of total billed charges 587.5 587.5 other OPPS APC 587.5 587.5 other OPPS APC 587.5 27.63 162.33 percent of total billed charges 587.5 587.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L90 MM L16 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET GOLD INTRAMEDULLARY NAIL SYSTEM SUP-408.890 CDM 270010022 LOCAL 0270 RC outpatient 587.5 587.5 587.5 74 434.75 percent of total billed charges 587.5 93 475.88 percent of total billed charges 587.5 587.5 other OPPS APC 587.5 587.5 other OPPS APC 587.5 27.63 162.33 percent of total billed charges 587.5 587.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 7.3MM TI CANNULATED 95MM SUP-408.895 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM LARGE HEXAGON HEMISPHERE L100 MM L16 MM OD7.3 MM ODSEC8.2 MM ID2.9 MM LARGE BONE SELF DRILL SELF TAP CANNULATED SOCKET GOLD INTRAMEDULLARY NAIL SYSTEM SUP-408.900 CDM 270010020 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 7.3MM TI CANNULATED 105MM SUP-408.905 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH AGILIS NXT .032 IN SMALL CURL L71 CM OD8.5 FR TRANSSEPTAL 2 REACH STEERABLE BIDIRECTIONAL ERGONOMIC HANDLE GUIDEWIRE SUP-408309 CDM 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH AGILIS NXT .032 IN 22.4 MM MEDIUM CURL CURVE L71 CM L91 CM OD8.5 FR TRANSSEPTAL 2 REACH BIDIRECTIONAL ATRAUMATIC ERGONOMIC HANDLE GUIDEWIRE RADIOPAQUE SUP-408310 CDM 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING FLEXTEND SILICONE STEROID ELUTING HELIX L45 CM ENDOCARDIUM ATRIUM VENTRICLE BIPOLAR EXTENDABLE RETRACTABLE SCREW FIXATION IS-1 SUP-4086 CDM 0275 RC outpatient 1666.6 1666.6 1666.6 57 949.96 percent of total billed charges 1666.6 93 1349.95 percent of total billed charges 1666.6 1666.6 other OPPS APC 1666.6 1666.6 other OPPS APC 1666.6 51 849.97 percent of total billed charges 1666.6 1666.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING FLEXTEND STEROID ELUTING SILICONE L52 CM OD2.4 MM ENDOCARDIAL ATRIAL VENTRICULAR BIPOLAR STRAIGHT EXTENDABLE RETRACTABLE SCREW FIXATION HELIX TIP IS-1 RED SUP-4087 CDM 0275 RC outpatient 1666.6 1666.6 1666.6 57 949.96 percent of total billed charges 1666.6 93 1349.95 percent of total billed charges 1666.6 1666.6 other OPPS APC 1666.6 1666.6 other OPPS APC 1666.6 51 849.97 percent of total billed charges 1666.6 1666.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING FLEXTEND STEROID ELUTING SILICONE ENDOCARDIAL ATRIAL VENTRICULAR BIPOLAR EXTENDABLE RETRACTABLE SCREW FIXATION HELIX TIP IS-1 SUP-4088 CDM 0275 RC outpatient 1666.6 1666.6 1666.6 57 949.96 percent of total billed charges 1666.6 93 1349.95 percent of total billed charges 1666.6 1666.6 other OPPS APC 1666.6 1666.6 other OPPS APC 1666.6 51 849.97 percent of total billed charges 1666.6 1666.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L30 MM OD7.3 MM FEMUR TIBIA ANKLE CANNULATED NONSTERILE SUP-409.630 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L35 MM OD7.3 MM ORTHOPEDIC CANNULATED NONSTERILE SUP-409.635 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L40 MM OD7.3 MM FEMUR TIBIA ANKLE CANNULATED NONSTERILE SUP-409.640 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L50 MM OD7.3 MM FEMUR TIBIA ANKLE CANNULATED NONSTERILE SUP-409.650 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L55 MM OD7.3 MM ORTHOPEDIC CANNULATED NONSTERILE SUP-409.655 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L60 MM OD7.3 MM FEMUR TIBIA ANKLE CANNULATED NONSTERILE SUP-409.660 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L65 MM OD7.3 MM ORTHOPEDIC CANNULATED NONSTERILE SUP-409.665 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L70 MM OD7.3 MM FEMUR TIBIA ANKLE CANNULATED NONSTERILE SUP-409.670 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L75 MM OD7.3 MM ODSEC8 MM ID2.9 MM FOOT ANKLE CANNULATED SELF DRILL GOLD SUP-409.675 CDM 270010022 LOCAL 0270 RC outpatient 587.5 587.5 587.5 74 434.75 percent of total billed charges 587.5 93 475.88 percent of total billed charges 587.5 587.5 other OPPS APC 587.5 587.5 other OPPS APC 587.5 27.63 162.33 percent of total billed charges 587.5 587.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L80 MM OD7.3 MM ODSEC8.2 MM LARGE BONE CANNULATED SELF DRILLING SELF TAPPING REVERSE CUTTING FLUTE LOW PROFILE NONSTERILE SUP-409.680 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L85 MM OD7.3 MM ORTHOPEDIC CANNULATED NONSTERILE SUP-409.685 CDM 270010022 LOCAL 0270 RC outpatient 587.5 587.5 587.5 74 434.75 percent of total billed charges 587.5 93 475.88 percent of total billed charges 587.5 587.5 other OPPS APC 587.5 587.5 other OPPS APC 587.5 27.63 162.33 percent of total billed charges 587.5 587.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L90 MM OD7.3 MM ODSEC8 MM ID2.9 MM FOOT ANKLE CANNULATED SELF DRILL NONSTERILE GOLD SUP-409.690 CDM 270010022 LOCAL 0270 RC outpatient 587.5 587.5 587.5 74 434.75 percent of total billed charges 587.5 93 475.88 percent of total billed charges 587.5 587.5 other OPPS APC 587.5 587.5 other OPPS APC 587.5 27.63 162.33 percent of total billed charges 587.5 587.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L95 MM OD7.3 MM ODSEC8 MM ID2.9 MM FOOT ANKLE CANNULATED SELF DRILL NONSTERILE GOLD SUP-409.695 CDM 270010022 LOCAL 0270 RC outpatient 587.5 587.5 587.5 74 434.75 percent of total billed charges 587.5 93 475.88 percent of total billed charges 587.5 587.5 other OPPS APC 587.5 587.5 other OPPS APC 587.5 27.63 162.33 percent of total billed charges 587.5 587.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L100 MM OD7.3 MM ORTHOPEDIC CANNULATED NONSTERILE SUP-409.700 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L105 MM OD7.3 MM ORTHOPEDIC CANNULATED NONSTERILE SUP-409.705 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L110 MM OD7.3 MM ORTHOPEDIC CANNULATED NONSTERILE SUP-409.710 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L115 MM OD7.3 MM ORTHOPEDIC CANNULATED NONSTERILE SUP-409.715 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L120 MM OD7.3 MM ORTHOPEDIC CANNULATED NONSTERILE SUP-409.720 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L125 MM OD7.3 MM ORTHOPEDIC CANNULATED NONSTERILE SUP-409.725 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L130 MM OD7.3 MM ORTHOPEDIC CANNULATED NONSTERILE SUP-409.730 CDM 270010022 LOCAL 0270 RC outpatient 587.5 587.5 587.5 74 434.75 percent of total billed charges 587.5 93 475.88 percent of total billed charges 587.5 587.5 other OPPS APC 587.5 587.5 other OPPS APC 587.5 27.63 162.33 percent of total billed charges 587.5 587.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 7.3MM TI CANNULATED SCREW 32MM THREAD/100MM SUP-409.9 CDM 270010022 LOCAL 0270 RC outpatient 737.23 737.23 737.23 74 545.55 percent of total billed charges 737.23 93 597.16 percent of total billed charges 737.23 737.23 other OPPS APC 737.23 737.23 other OPPS APC 737.23 27.63 203.7 percent of total billed charges 737.23 737.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAPSURE SP NOVUS SUP-4092/5092 SERIES CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEADWIRE EKG ENSITE L50 CM STACK SPLITTER BLACK SUP-41-04319-005 CDM 0270 RC outpatient 2.6 2.6 2.6 74 1.92 percent of total billed charges 2.6 93 2.11 percent of total billed charges 2.6 2.6 other OPPS APC 2.6 2.6 other OPPS APC 2.6 27.63 0.72 percent of total billed charges 2.6 2.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET MARINER SCREWS SUP-41-1000 CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET MARINER SCREWS SUP-41-1010 CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD MARINER POLYAXIAL SUP-41-3000 CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD MARINER POLYAXIAL SUP-41-3010 CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEAT SCREW SPINAL POLYAXIAL EXTEND SUP-41-4000 CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD MARINER EXTENDED POLYAXIAL SUP-41-4010 CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MARINER L30 MM OD4.5 MM SPINAL SOLID SUP-41-4530-1 CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MARINER SOLID 5.5MM X 35MM SUP-41-4535-1 CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MARINER L40 MM OD4.5 MM SPINAL SOLID NONSTERILE SUP-41-4540-1 CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MARINER L30 MM OD5.5 MM SPINAL SOLID SUP-41-5530-1 CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MARINER L35 MM OD5.5 MM SPINAL SOLID SUP-41-5535-1 CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MARINER L40 MM OD5.5 MM SPINAL SOLID NONSTERILE SUP-41-5540-1 CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MARINER SOLID 5.5MM X 45MM SUP-41-5545-1 CDM 270010020 LOCAL 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MARINER L50 MM OD5.5 MM SPINAL SOLID NONSTERILE SUP-41-5550-1 CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MARINER L35 MM OD6.5 MM SPINAL SOLID NONSTERILE SUP-41-6535-1 CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MARINER L40 MM OD6.5 MM SPINAL SOLID SUP-41-6540-1 CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MARINER SOLID 6.5MM X 45MM SUP-41-6545-1 CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MARINER SOLID 6.5MM X 50MM SUP-41-6550-1 CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MARINER L55 MM OD6.5 MM SPINAL SOLID SUP-41-6555-1 CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MARINER NONSTERILE TRAUMA SUP-41-7000 CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MARINER TRAUMA HEAD SUP-41-7010 CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MARINER L40 MM OD7.5 MM SPINAL SOLID NONSTERILE SUP-41-7540-1 CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MARINER L45 MM OD7.5 MM SPINAL SOLID NONSTERILE SUP-41-7545-1 CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE MARINER L50 MM OD7.5 MM SPINAL SOLID NONSTERILE SUP-41-7550-1 CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ATHERECTOMY TURBO-ELITE OD.047 IN L150 CM OD.9 MM ODSEC.038 IN PERIPHERAL OTW LASER ACCEPTS .014 IN GUIDEWIRE 4 FR SHEATH SUP-410-152 CDM 0270 RC outpatient 7280 7280 7280 74 5387.2 percent of total billed charges 7280 93 5896.8 percent of total billed charges 7280 7280 other OPPS APC 7280 7280 other OPPS APC 7280 27.63 2011.46 percent of total billed charges 7280 7280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL SUREFIT L10 FT 2 DISPERSIVE ADHESIVE BORDER PULL TAB CABLE NONSTERILE DISPOSABLE SUP-410-2000 CDM 0270 RC outpatient 6.08 6.08 6.08 74 4.5 percent of total billed charges 6.08 93 4.92 percent of total billed charges 6.08 6.08 other OPPS APC 6.08 6.08 other OPPS APC 6.08 27.63 1.68 percent of total billed charges 6.08 6.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY CARPENTIER-MCCARTHY-ADAMS IMR ETLOGIX TITANIUM ASYMMETRIC OD24 MM MITRAL 3D REDUCE CURVATURE SEWING MARGIN HEART VALVE REPAIR SUP-4100-24MM CDM 0270 RC outpatient 7228 7228 7228 74 5348.72 percent of total billed charges 7228 93 5854.68 percent of total billed charges 7228 7228 other OPPS APC 7228 7228 other OPPS APC 7228 27.63 1997.1 percent of total billed charges 7228 7228 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY CARPENTIER-MCCARTHY-ADAMS IMR ETLOGIX ASYMMETRIC OD32 MM MITRAL 3D REDUCE CURVE SEWING MARGIN HEART VALVE REPAIR SUP-4100-32 CDM 0270 RC outpatient 7228 7228 7228 74 5348.72 percent of total billed charges 7228 93 5854.68 percent of total billed charges 7228 7228 other OPPS APC 7228 7228 other OPPS APC 7228 27.63 1997.1 percent of total billed charges 7228 7228 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY CARPENTIER-MCCARTHY-ADAMS IMR ETLOGIX ASYMMETRIC OD34 MM MITRAL 3D REDUCE CURVE SEWING MARGIN HEART VALVE REPAIR SUP-4100-34 CDM 0270 RC outpatient 7228 7228 7228 74 5348.72 percent of total billed charges 7228 93 5854.68 percent of total billed charges 7228 7228 other OPPS APC 7228 7228 other OPPS APC 7228 27.63 1997.1 percent of total billed charges 7228 7228 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY 26MM SUP-410026MM CDM 0270 RC outpatient 7228 7228 7228 74 5348.72 percent of total billed charges 7228 93 5854.68 percent of total billed charges 7228 7228 other OPPS APC 7228 7228 other OPPS APC 7228 27.63 1997.1 percent of total billed charges 7228 7228 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY MITRAL 28MM SUP-410028MM CDM 0270 RC outpatient 7228 7228 7228 74 5348.72 percent of total billed charges 7228 93 5854.68 percent of total billed charges 7228 7228 other OPPS APC 7228 7228 other OPPS APC 7228 27.63 1997.1 percent of total billed charges 7228 7228 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC IMPRESS .038 IN BERN CURVE L100 CM OD4 FR ID.040 IN BRAID SUP-410038BER-H CDM 0270 RC outpatient 83.2 83.2 83.2 74 61.57 percent of total billed charges 83.2 93 67.39 percent of total billed charges 83.2 83.2 other OPPS APC 83.2 83.2 other OPPS APC 83.2 27.63 22.99 percent of total billed charges 83.2 83.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC IMPRESS LEGATO HYDROPHILIC .038 IN MPA1 CURVE L100 CM L40 CM OD4 FR ID.04 IN PERIPHERAL MULTIPURPOSE SUP-410038MPA1-H CDM 0270 RC outpatient 536.9 536.9 536.9 74 397.31 percent of total billed charges 536.9 93 434.89 percent of total billed charges 536.9 536.9 other OPPS APC 536.9 536.9 other OPPS APC 536.9 27.63 148.35 percent of total billed charges 536.9 536.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SL STRAIGHT 47CM SUP-410110 CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SL MULTIPURPOSE 47CM SUP-410111 CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD CPS DIRECT SL SL135* 47CM SUP-410113 CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SL WIDE 47CM SUP-410114 CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SL EXTRA WIDE 47CM SUP-410115 CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SL RIGHT SIDED 47CM SUP-410116 CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SL STRAIGHT 54CM SUP-410120 CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SL MULTIPURPOSE 54CM SUP-410121 CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SL 115 54CM SUP-410122 CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SL 135 54CM SUP-410123 CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SL WIDE 54CM SUP-410124 CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SL EXTRA WIDE 54CM SUP-410125 CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SL RIGHT SIDED 54CM SUP-410126 CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATOR CSL SUP-410140 CDM 0275 RC outpatient 205 205 205 57 116.85 percent of total billed charges 205 93 166.05 percent of total billed charges 205 205 other OPPS APC 205 205 other OPPS APC 205 51 104.55 percent of total billed charges 205 205 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATOR 90 CURVE SUP-410141 CDM 0275 RC outpatient 533 533 533 57 303.81 percent of total billed charges 533 93 431.73 percent of total billed charges 533 533 other OPPS APC 533 533 other OPPS APC 533 51 271.83 percent of total billed charges 533 533 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATOR HS SUP-410142 CDM 0275 RC outpatient 533 533 533 57 303.81 percent of total billed charges 533 93 431.73 percent of total billed charges 533 533 other OPPS APC 533 533 other OPPS APC 533 51 271.83 percent of total billed charges 533 533 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUBSELECTOR 90 STAND. SUP-410144 CDM 0275 RC outpatient 533 533 533 57 303.81 percent of total billed charges 533 93 431.73 percent of total billed charges 533 533 other OPPS APC 533 533 other OPPS APC 533 51 271.83 percent of total billed charges 533 533 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUBSELECTOR 90 FLEX SUP-410145 CDM 0275 RC outpatient 533 533 533 57 303.81 percent of total billed charges 533 93 431.73 percent of total billed charges 533 533 other OPPS APC 533 533 other OPPS APC 533 51 271.83 percent of total billed charges 533 533 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUBSELECTOR ACUTE SUP-410146 CDM 0275 RC outpatient 533 533 533 57 303.81 percent of total billed charges 533 93 431.73 percent of total billed charges 533 533 other OPPS APC 533 533 other OPPS APC 533 51 271.83 percent of total billed charges 533 533 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUBSELECTOR OBTUSE SUP-410147 CDM 0275 RC outpatient 533 533 533 57 303.81 percent of total billed charges 533 93 431.73 percent of total billed charges 533 533 other OPPS APC 533 533 other OPPS APC 533 51 271.83 percent of total billed charges 533 533 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUBLESECTOR 90 SUPP. SUP-410148 CDM 0275 RC outpatient 533 533 533 57 303.81 percent of total billed charges 533 93 431.73 percent of total billed charges 533 533 other OPPS APC 533 533 other OPPS APC 533 51 271.83 percent of total billed charges 533 533 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT IMPLANT CPS SUP-410190 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLITTER SUP-410191 CDM 0270 RC outpatient 52 52 52 74 38.48 percent of total billed charges 52 93 42.12 percent of total billed charges 52 52 other OPPS APC 52 52 other OPPS APC 52 27.63 14.37 percent of total billed charges 52 52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE BYPASS TOOL SUP-410192 CDM 0270 RC outpatient 39 39 39 74 28.86 percent of total billed charges 39 93 31.59 percent of total billed charges 39 39 other OPPS APC 39 39 other OPPS APC 39 27.63 10.78 percent of total billed charges 39 39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE BALLOON DILATATION FOGARTY L23 CM OD6 FR 1.25 ML BILIARY LIQUID SUP-410236F CDM 0270 RC outpatient 225.73 225.73 225.73 74 167.04 percent of total billed charges 225.73 93 182.84 percent of total billed charges 225.73 225.73 other OPPS APC 225.73 225.73 other OPPS APC 225.73 27.63 62.37 percent of total billed charges 225.73 225.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION CRAGG-MCNAMARA CRAGG MICROVALVE .035 IN L65 CM L5 CM OD4 FR 1 LUMEN RADIOPAQUE MARKER SIDEHOLE VALVE TIP SUP-41034-01 CDM 0270 RC outpatient 244.69 244.69 244.69 74 181.07 percent of total billed charges 244.69 93 198.2 percent of total billed charges 244.69 244.69 other OPPS APC 244.69 244.69 other OPPS APC 244.69 27.63 67.61 percent of total billed charges 244.69 244.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION CRAGG-MCNAMARA CRAGG MICROVALVE L65 CM L10 CM OD4 FR 1 LUMEN RADIOPAQUE VALVE TIP LARGE INNER DIAMETER ACCEPTS .035 IN GUIDEWIRE SUP-4103501_32441 CDM 0270 RC outpatient 244.69 244.69 244.69 74 181.07 percent of total billed charges 244.69 93 198.2 percent of total billed charges 244.69 244.69 other OPPS APC 244.69 244.69 other OPPS APC 244.69 27.63 67.61 percent of total billed charges 244.69 244.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION CRAGG-MCNAMARA CRAGG MICROVALVE L100 CM L5 CM OD4 FR 1 LUMEN RADIOPAQUE VALVE TIP LARGE INNER DIAMETER ACCEPTS .035 IN GUIDEWIRE SUP-41037-01 CDM 0270 RC outpatient 244.69 244.69 244.69 74 181.07 percent of total billed charges 244.69 93 198.2 percent of total billed charges 244.69 244.69 other OPPS APC 244.69 244.69 other OPPS APC 244.69 27.63 67.61 percent of total billed charges 244.69 244.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH LAPAROSCOPIC L45 MM STAPLER SUP-410370 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ENDOLOGIX SUP-4104 CDM 270010015 LOCAL 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION CRAGG-MCNAMARA CRAGG-MICROVALVE L135 CM L20 CM OD4 FR 1 LUMEN RADIOPAQUE SIDEHOLE VALVE TIP ACCEPTS .035 IN GUIDEWIRE SUP-4104201_66888 CDM 0270 RC outpatient 244.69 244.69 244.69 74 181.07 percent of total billed charges 244.69 93 198.2 percent of total billed charges 244.69 244.69 other OPPS APC 244.69 244.69 other OPPS APC 244.69 27.63 67.61 percent of total billed charges 244.69 244.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION CRAGG-MCNAMARA .038 IN L100 CM L40 CM OD5 FR 1 LUMEN RADIOPAQUE VALVE TIP SUP-41053-01 CDM 0270 RC outpatient 244.69 244.69 244.69 74 181.07 percent of total billed charges 244.69 93 198.2 percent of total billed charges 244.69 244.69 other OPPS APC 244.69 244.69 other OPPS APC 244.69 27.63 67.61 percent of total billed charges 244.69 244.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION CRAGG-MCNAMARA L100 CM L50 CM OD5 FR 1 LUMEN RADIOPAQUE VALVE TIP SUP-41054-01 CDM 0270 RC outpatient 244.69 244.69 244.69 74 181.07 percent of total billed charges 244.69 93 198.2 percent of total billed charges 244.69 244.69 other OPPS APC 244.69 244.69 other OPPS APC 244.69 27.63 67.61 percent of total billed charges 244.69 244.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE INPUT TS BARIUM SILICONE STANDARD L23 CM OD4 FR VENTRICULAR CSF IMPREGNATE SHUNT STERILE LATEX FREE DISPOSABLE SUP-41101 CDM 0270 RC outpatient 495.79 495.79 495.79 74 366.88 percent of total billed charges 495.79 93 401.59 percent of total billed charges 495.79 495.79 other OPPS APC 495.79 495.79 other OPPS APC 495.79 27.63 136.99 percent of total billed charges 495.79 495.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG FECAL FLEXI-SEAL 16/45 MM COLLECTION LATEX FREE FECAL MANAGEMENT SYSTEM SUP-411102 CDM 270009015 LOCAL 0270 RC outpatient 9.33 9.33 9.33 74 6.9 percent of total billed charges 9.33 93 7.56 percent of total billed charges 9.33 9.33 other OPPS APC 9.33 9.33 other OPPS APC 9.33 27.63 2.58 percent of total billed charges 9.33 9.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL ENDOSKELETON TT 4 D D11 MM LARGE W30 MM X H12 MM INTERBODY FUSION DEVICE LORDOSIS SUP-4114-3012 CDM 270010020 LOCAL 0270 RC outpatient 12472.2 12472.2 12472.2 74 9229.43 percent of total billed charges 12472.2 93 10102.5 percent of total billed charges 12472.2 12472.2 other OPPS APC 12472.2 12472.2 other OPPS APC 12472.2 27.63 3446.07 percent of total billed charges 12472.2 12472.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL ULTRATOUCH 6 285X77MM STRAW POLYISOPRENE STERILE LF POWDER FREE BEAD CUFF MICRO ROUGHENED NON SUP-41160 CDM 0270 RC outpatient 1.75 1.75 1.75 74 1.3 percent of total billed charges 1.75 93 1.42 percent of total billed charges 1.75 1.75 other OPPS APC 1.75 1.75 other OPPS APC 1.75 27.63 0.48 percent of total billed charges 1.75 1.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL ULTRATOUCH 6.5 285X85MM STRAW POLYISOPRENE STERILE LF POWDER FREE BEAD CUFF MICRO ROUGHENED NON SUP-41165 CDM 0270 RC outpatient 1.75 1.75 1.75 74 1.3 percent of total billed charges 1.75 93 1.42 percent of total billed charges 1.75 1.75 other OPPS APC 1.75 1.75 other OPPS APC 1.75 27.63 0.48 percent of total billed charges 1.75 1.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL ULTRATOUCH 7 288X91MM STRAW POLYISOPRENE STERILE LF POWDER FREE BEAD CUFF MICRO ROUGHENED NON SUP-41170 CDM 0270 RC outpatient 1.75 1.75 1.75 74 1.3 percent of total billed charges 1.75 93 1.42 percent of total billed charges 1.75 1.75 other OPPS APC 1.75 1.75 other OPPS APC 1.75 27.63 0.48 percent of total billed charges 1.75 1.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL ULTRATOUCH 7.5 298X96MM STRAW POLYISOPRENE STERILE LF POWDER FREE BEAD CUFF MICRO ROUGHENED NON SUP-41175 CDM 0270 RC outpatient 3.54 3.54 3.54 74 2.62 percent of total billed charges 3.54 93 2.87 percent of total billed charges 3.54 3.54 other OPPS APC 3.54 3.54 other OPPS APC 3.54 27.63 0.98 percent of total billed charges 3.54 3.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW L90 MM X W18 MM X H1.19 MM SAGITTAL 2 CUT STERILE SUP-4118-119-090 CDM 0270 RC outpatient 130.47 130.47 130.47 74 96.55 percent of total billed charges 130.47 93 105.68 percent of total billed charges 130.47 130.47 other OPPS APC 130.47 130.47 other OPPS APC 130.47 27.63 36.05 percent of total billed charges 130.47 130.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW STAINLESS STEEL THK.05 IN L3.543 IN X W.709 IN 2 CUT SAGITTAL STERILE LATEX FREE SUP-4118-127-090 CDM 0270 RC outpatient 127.82 127.82 127.82 74 94.59 percent of total billed charges 127.82 93 103.53 percent of total billed charges 127.82 127.82 other OPPS APC 127.82 127.82 other OPPS APC 127.82 27.63 35.32 percent of total billed charges 127.82 127.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL ULTRATOUCH 8 299X103MM STRAW POLYISOPRENE STERILE LF POWDER FREE BEAD CUFF MICRO ROUGHENED NON SUP-41180 CDM 0270 RC outpatient 1.75 1.75 1.75 74 1.3 percent of total billed charges 1.75 93 1.42 percent of total billed charges 1.75 1.75 other OPPS APC 1.75 1.75 other OPPS APC 1.75 27.63 0.48 percent of total billed charges 1.75 1.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL ULTRATOUCH 8.5 301X109MM STRAW POLYISOPRENE STERILE LF POWDER FREE BEAD CUFF MICRO ROUGHENED NON SUP-41185 CDM outpatient 1.93 1.93 1.93 1.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL ULTRATOUCH 9 301X115MM STRAW POLYISOPRENE STERILE LF POWDER FREE BEAD CUFF MICRO ROUGHENED NON SUP-41190 CDM 0270 RC outpatient 1.75 1.75 1.75 74 1.3 percent of total billed charges 1.75 93 1.42 percent of total billed charges 1.75 1.75 other OPPS APC 1.75 1.75 other OPPS APC 1.75 27.63 0.48 percent of total billed charges 1.75 1.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T15 FULL THREAD L18 MM OD3.5 MM ID2.9 MM SELF TAP LOCK CONICAL HEAD STARDRIVE NONSTERILE SMALL FRAGMENT SET SUP-412.105 CDM 0270 RC outpatient 363.22 363.22 363.22 74 268.78 percent of total billed charges 363.22 93 294.21 percent of total billed charges 363.22 363.22 other OPPS APC 363.22 363.22 other OPPS APC 363.22 27.63 100.36 percent of total billed charges 363.22 363.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T15 FULL THREAD L38 MM OD3.5 MM ID2.9 MM SELF TAP LOCK CONICAL HEAD STARDRIVE NONSTERILE SMALL FRAGMENT SET SUP-412.116 CDM 0270 RC outpatient 363.22 363.22 363.22 74 268.78 percent of total billed charges 363.22 93 294.21 percent of total billed charges 363.22 363.22 other OPPS APC 363.22 363.22 other OPPS APC 363.22 27.63 100.36 percent of total billed charges 363.22 363.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T15 FULL THREAD L40 MM OD3.5 MM ID2.9 MM SELF TAP LOCK CONICAL HEAD STARDRIVE NONSTERILE SMALL FRAGMENT SET SUP-412.117 CDM 0270 RC outpatient 363.22 363.22 363.22 74 268.78 percent of total billed charges 363.22 93 294.21 percent of total billed charges 363.22 363.22 other OPPS APC 363.22 363.22 other OPPS APC 363.22 27.63 100.36 percent of total billed charges 363.22 363.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T15 FULL THREAD L45 MM OD3.5 MM ID2.9 MM SELF TAP LOCK CONICAL HEAD STARDRIVE NONSTERILE SMALL FRAGMENT SET SUP-412.119 CDM 0270 RC outpatient 363.22 363.22 363.22 74 268.78 percent of total billed charges 363.22 93 294.21 percent of total billed charges 363.22 363.22 other OPPS APC 363.22 363.22 other OPPS APC 363.22 27.63 100.36 percent of total billed charges 363.22 363.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 FULL THREAD L30 MM OD5 MM ODSEC4.4 MM SELF TAP LOCK STARDRIVE CONICAL STERILE LARGE FRAGMENT SET SUP-412.209S CDM 0270 RC outpatient 418.6 418.6 418.6 74 309.76 percent of total billed charges 418.6 93 339.07 percent of total billed charges 418.6 418.6 other OPPS APC 418.6 418.6 other OPPS APC 418.6 27.63 115.66 percent of total billed charges 418.6 418.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L32 MM OD5 MM SELF TAP LOCK STARDRIVE STERILE SUP-412.210S CDM 0270 RC outpatient 1056.38 1056.38 1056.38 74 781.72 percent of total billed charges 1056.38 93 855.67 percent of total billed charges 1056.38 1056.38 other OPPS APC 1056.38 1056.38 other OPPS APC 1056.38 27.63 291.88 percent of total billed charges 1056.38 1056.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L34 MM OD5 MM SELF TAP LOCK STARDRIVE STERILE SUP-412.211S CDM 0270 RC outpatient 418.6 418.6 418.6 74 309.76 percent of total billed charges 418.6 93 339.07 percent of total billed charges 418.6 418.6 other OPPS APC 418.6 418.6 other OPPS APC 418.6 27.63 115.66 percent of total billed charges 418.6 418.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L36 MM OD5 MM SELF TAP LOCK STARDRIVE STERILE SUP-412.212S CDM 0270 RC outpatient 1056.38 1056.38 1056.38 74 781.72 percent of total billed charges 1056.38 93 855.67 percent of total billed charges 1056.38 1056.38 other OPPS APC 1056.38 1056.38 other OPPS APC 1056.38 27.63 291.88 percent of total billed charges 1056.38 1056.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L38 MM OD5 MM SELF TAP LOCK STARDRIVE STERILE SUP-412.213S CDM 0270 RC outpatient 418.6 418.6 418.6 74 309.76 percent of total billed charges 418.6 93 339.07 percent of total billed charges 418.6 418.6 other OPPS APC 418.6 418.6 other OPPS APC 418.6 27.63 115.66 percent of total billed charges 418.6 418.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0MM TI LOCKING SELF TAPING 40MM SUP-412.214S CDM 0270 RC outpatient 452.71 452.71 452.71 74 335.01 percent of total billed charges 452.71 93 366.7 percent of total billed charges 452.71 452.71 other OPPS APC 452.71 452.71 other OPPS APC 452.71 27.63 125.08 percent of total billed charges 452.71 452.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L42 MM OD5 MM SELF TAP LOCK STARDRIVE STERILE SUP-412.215S CDM 0270 RC outpatient 418.6 418.6 418.6 74 309.76 percent of total billed charges 418.6 93 339.07 percent of total billed charges 418.6 418.6 other OPPS APC 418.6 418.6 other OPPS APC 418.6 27.63 115.66 percent of total billed charges 418.6 418.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L44 MM OD5 MM SELF TAP LOCK STARDRIVE STERILE SUP-412.216S CDM 0270 RC outpatient 418.6 418.6 418.6 74 309.76 percent of total billed charges 418.6 93 339.07 percent of total billed charges 418.6 418.6 other OPPS APC 418.6 418.6 other OPPS APC 418.6 27.63 115.66 percent of total billed charges 418.6 418.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L46 MM OD5 MM SELF TAP LOCK STARDRIVE STERILE SUP-412.217S CDM 0270 RC outpatient 418.6 418.6 418.6 74 309.76 percent of total billed charges 418.6 93 339.07 percent of total billed charges 418.6 418.6 other OPPS APC 418.6 418.6 other OPPS APC 418.6 27.63 115.66 percent of total billed charges 418.6 418.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L48 MM OD5 MM SELF TAP LOCK STARDRIVE STERILE SUP-412.218S CDM 0270 RC outpatient 418.6 418.6 418.6 74 309.76 percent of total billed charges 418.6 93 339.07 percent of total billed charges 418.6 418.6 other OPPS APC 418.6 418.6 other OPPS APC 418.6 27.63 115.66 percent of total billed charges 418.6 418.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L50 MM OD5 MM SELF TAP LOCK STARDRIVE STERILE SUP-412.219S CDM 0270 RC outpatient 418.6 418.6 418.6 74 309.76 percent of total billed charges 418.6 93 339.07 percent of total billed charges 418.6 418.6 other OPPS APC 418.6 418.6 other OPPS APC 418.6 27.63 115.66 percent of total billed charges 418.6 418.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L55 MM OD5 MM SELF TAP LOCK STARDRIVE STERILE SUP-412.220S CDM 0270 RC outpatient 418.6 418.6 418.6 74 309.76 percent of total billed charges 418.6 93 339.07 percent of total billed charges 418.6 418.6 other OPPS APC 418.6 418.6 other OPPS APC 418.6 27.63 115.66 percent of total billed charges 418.6 418.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T25 L60 MM OD5 MM SELF TAP LOCK STARDRIVE STERILE SUP-412.221S CDM 0270 RC outpatient 418.6 418.6 418.6 74 309.76 percent of total billed charges 418.6 93 339.07 percent of total billed charges 418.6 418.6 other OPPS APC 418.6 418.6 other OPPS APC 418.6 27.63 115.66 percent of total billed charges 418.6 418.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L6 MM OD2.4 MM DISTAL RADIUS T8 STARDRIVE RECESS SELF TAPPING LOCKING THREADED CONICAL HEAD NONSTERILE MINI FRAGMENT SET SUP-412.806 CDM 270010022 LOCAL 0270 RC outpatient 764.66 764.66 764.66 74 565.85 percent of total billed charges 764.66 93 619.37 percent of total billed charges 764.66 764.66 other OPPS APC 764.66 764.66 other OPPS APC 764.66 27.63 211.28 percent of total billed charges 764.66 764.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L7 MM OD2.4 MM ORTHOPEDIC SELF TAPPING LOCKING NONSTERILE MINI FRAGMENT SET SUP-412.807 CDM 270010022 LOCAL 0270 RC outpatient 764.66 764.66 764.66 74 565.85 percent of total billed charges 764.66 93 619.37 percent of total billed charges 764.66 764.66 other OPPS APC 764.66 764.66 other OPPS APC 764.66 27.63 211.28 percent of total billed charges 764.66 764.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L8 MM OD2.4 MM DISTAL RADIUS T8 STARDRIVE RECESS SELF TAPPING LOCKING THREADED CONICAL HEAD NONSTERILE MINI FRAGMENT SET SUP-412.808 CDM 270010022 LOCAL 0270 RC outpatient 296.35 296.35 296.35 74 219.3 percent of total billed charges 296.35 93 240.04 percent of total billed charges 296.35 296.35 other OPPS APC 296.35 296.35 other OPPS APC 296.35 27.63 81.88 percent of total billed charges 296.35 296.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM L9 MM OD2.4 MM ORTHOPEDIC SELF TAPPING LOCKING NONSTERILE MINI FRAGMENT SET SUP-412.809 CDM 270010022 LOCAL 0270 RC outpatient 296.35 296.35 296.35 74 219.3 percent of total billed charges 296.35 93 240.04 percent of total billed charges 296.35 296.35 other OPPS APC 296.35 296.35 other OPPS APC 296.35 27.63 81.88 percent of total billed charges 296.35 296.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM T8 CONE L10 MM OD2.4 MM RADIUS DISTAL SELF TAP THREAD STARDRIVE NONSTERILE MINI FRAGMENT SET SUP-412.810 CDM 270010022 LOCAL 0270 RC outpatient 764.66 764.66 764.66 74 565.85 percent of total billed charges 764.66 93 619.37 percent of total billed charges 764.66 764.66 other OPPS APC 764.66 764.66 other OPPS APC 764.66 27.63 211.28 percent of total billed charges 764.66 764.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES 2.4MM LOCKING 11MM SUP-412.811 CDM 270010022 LOCAL 0270 RC outpatient 296.35 296.35 296.35 74 219.3 percent of total billed charges 296.35 93 240.04 percent of total billed charges 296.35 296.35 other OPPS APC 296.35 296.35 other OPPS APC 296.35 27.63 81.88 percent of total billed charges 296.35 296.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES 2.4MM LOCKING 12MM SUP-412.812 CDM 270010022 LOCAL 0270 RC outpatient 296.35 296.35 296.35 74 219.3 percent of total billed charges 296.35 93 240.04 percent of total billed charges 296.35 296.35 other OPPS APC 296.35 296.35 other OPPS APC 296.35 27.63 81.88 percent of total billed charges 296.35 296.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM T8 L14 MM OD2.4 MM ODSEC1.9 MM RADIUS DISTAL SELF TAP LOCK STARDRIVE CONICAL HEAD NONSTERILE MINI FRAGMENT SET SUP-412.814 CDM 270010022 LOCAL 0270 RC outpatient 296.35 296.35 296.35 74 219.3 percent of total billed charges 296.35 93 240.04 percent of total billed charges 296.35 296.35 other OPPS APC 296.35 296.35 other OPPS APC 296.35 27.63 81.88 percent of total billed charges 296.35 296.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM T8 L16 MM OD2.4 MM ODSEC1.9 MM RADIUS DISTAL SELF TAP LOCK STARDRIVE CONICAL HEAD NONSTERILE MINI FRAGMENT SET SUP-412.816 CDM 270010022 LOCAL 0270 RC outpatient 336.05 336.05 336.05 74 248.68 percent of total billed charges 336.05 93 272.2 percent of total billed charges 336.05 336.05 other OPPS APC 336.05 336.05 other OPPS APC 336.05 27.63 92.85 percent of total billed charges 336.05 336.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES 2.4MM LOCKING 18MM SUP-412.818 CDM 270010022 LOCAL 0270 RC outpatient 296.35 296.35 296.35 74 219.3 percent of total billed charges 296.35 93 240.04 percent of total billed charges 296.35 296.35 other OPPS APC 296.35 296.35 other OPPS APC 296.35 27.63 81.88 percent of total billed charges 296.35 296.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES 2.4MM LOCKING 20MM SUP-412.820 CDM 270010022 LOCAL 0270 RC outpatient 336.05 336.05 336.05 74 248.68 percent of total billed charges 336.05 93 272.2 percent of total billed charges 336.05 336.05 other OPPS APC 336.05 336.05 other OPPS APC 336.05 27.63 92.85 percent of total billed charges 336.05 336.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES 2.4MM LOCKING 22MM SUP-412.822 CDM 270010022 LOCAL 0270 RC outpatient 336.05 336.05 336.05 74 248.68 percent of total billed charges 336.05 93 272.2 percent of total billed charges 336.05 336.05 other OPPS APC 336.05 336.05 other OPPS APC 336.05 27.63 92.85 percent of total billed charges 336.05 336.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES 2.4MM LOCKING 24MM SUP-412.824 CDM 270010022 LOCAL 0270 RC outpatient 336.05 336.05 336.05 74 248.68 percent of total billed charges 336.05 93 272.2 percent of total billed charges 336.05 336.05 other OPPS APC 336.05 336.05 other OPPS APC 336.05 27.63 92.85 percent of total billed charges 336.05 336.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES 2.4MM LOCKING 26MM SUP-412.826 CDM 270010022 LOCAL 0270 RC outpatient 336.05 336.05 336.05 74 248.68 percent of total billed charges 336.05 93 272.2 percent of total billed charges 336.05 336.05 other OPPS APC 336.05 336.05 other OPPS APC 336.05 27.63 92.85 percent of total billed charges 336.05 336.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES 2.4MM LOCKING 28MM SUP-412.828 CDM 270010022 LOCAL 0270 RC outpatient 336.05 336.05 336.05 74 248.68 percent of total billed charges 336.05 93 272.2 percent of total billed charges 336.05 336.05 other OPPS APC 336.05 336.05 other OPPS APC 336.05 27.63 92.85 percent of total billed charges 336.05 336.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SYNTHES 2.4MM LOCKING MM SUP-412.830 CDM 270010022 LOCAL 0270 RC outpatient 336.05 336.05 336.05 74 248.68 percent of total billed charges 336.05 93 272.2 percent of total billed charges 336.05 336.05 other OPPS APC 336.05 336.05 other OPPS APC 336.05 27.63 92.85 percent of total billed charges 336.05 336.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PULMONARY ARTERY PENTALUMEN MULTIFLEX STANDARD L110 CM OD8 FR 3 LUMEN EXTRA INFUSION PORT THERMODILUTION VENTRICULAR PACE LATEX SUP-41217-01 CDM 0270 RC outpatient 99.5 99.5 99.5 74 73.63 percent of total billed charges 99.5 93 80.6 percent of total billed charges 99.5 99.5 other OPPS APC 99.5 99.5 other OPPS APC 99.5 27.63 27.49 percent of total billed charges 99.5 99.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW STAINLESS STEEL THK.038 IN MEDIUM L3.543 IN X W.984 IN 2 CUT SAGITTAL STERILE SUP-4125-097-090 CDM 0270 RC outpatient 130.47 130.47 130.47 74 96.55 percent of total billed charges 130.47 93 105.68 percent of total billed charges 130.47 130.47 other OPPS APC 130.47 130.47 other OPPS APC 130.47 27.63 36.05 percent of total billed charges 130.47 130.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW STAINLESS STEEL THK1.37 MM L90 MM X W25 MM SAGITTAL 2 CUT STERILE LATEX FREE DISPOSABLE SUP-4125-137-090 CDM 0270 RC outpatient 130.47 130.47 130.47 74 96.55 percent of total billed charges 130.47 93 105.68 percent of total billed charges 130.47 130.47 other OPPS APC 130.47 130.47 other OPPS APC 130.47 27.63 36.05 percent of total billed charges 130.47 130.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC IMPRESS .038 IN MPA1 CURVE L125 CM OD4 FR ID.04 IN PERIPHERAL MULTIPURPOSE RADIOLOGY SUP-412538MPA1 CDM 0270 RC outpatient 28.6 28.6 28.6 74 21.16 percent of total billed charges 28.6 93 23.17 percent of total billed charges 28.6 28.6 other OPPS APC 28.6 28.6 other OPPS APC 28.6 27.63 7.9 percent of total billed charges 28.6 28.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM CANNULATED SCREW PARTIALLY THREADED 44MM SUP-413.544 CDM 270010022 LOCAL 0270 RC outpatient 528.53 528.53 528.53 74 391.11 percent of total billed charges 528.53 93 428.11 percent of total billed charges 528.53 528.53 other OPPS APC 528.53 528.53 other OPPS APC 528.53 27.63 146.03 percent of total billed charges 528.53 528.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0MM LOCKING TI STERNAL 8MM SUP-413.578E CDM 0270 RC outpatient 557.18 557.18 557.18 74 412.31 percent of total billed charges 557.18 93 451.32 percent of total billed charges 557.18 557.18 other OPPS APC 557.18 557.18 other OPPS APC 557.18 27.63 153.95 percent of total billed charges 557.18 557.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L10 MM OD3 MM STERNUM SELF TAP LOCK STERILE FIXATION SYSTEM SET SUP-413.580E CDM 0270 RC outpatient 445.82 445.82 445.82 74 329.91 percent of total billed charges 445.82 93 361.11 percent of total billed charges 445.82 445.82 other OPPS APC 445.82 445.82 other OPPS APC 445.82 27.63 123.18 percent of total billed charges 445.82 445.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNILOCK TITANIUM L12 MM OD3 MM STERNUM SELF TAP LOCK NONSTERILE STABLE INTERNAL FIXATION SUP-413.582E CDM 0270 RC outpatient 472.58 472.58 472.58 74 349.71 percent of total billed charges 472.58 93 382.79 percent of total billed charges 472.58 472.58 other OPPS APC 472.58 472.58 other OPPS APC 472.58 27.63 130.57 percent of total billed charges 472.58 472.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L14 MM OD3 MM STERNUM SELF TAP LOCK STERILE FIXATION SYSTEM SET SUP-413.584E CDM 0270 RC outpatient 920.4 920.4 920.4 74 681.1 percent of total billed charges 920.4 93 745.52 percent of total billed charges 920.4 920.4 other OPPS APC 920.4 920.4 other OPPS APC 920.4 27.63 254.31 percent of total billed charges 920.4 920.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L16 MM OD3 MM STERNUM SELF TAP LOCK STERILE STABLE INTERNAL FIXATION SUP-413.586E CDM 0270 RC outpatient 920.4 920.4 920.4 74 681.1 percent of total billed charges 920.4 93 745.52 percent of total billed charges 920.4 920.4 other OPPS APC 920.4 920.4 other OPPS APC 920.4 27.63 254.31 percent of total billed charges 920.4 920.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L18 MM OD3 MM STERNUM SELF TAP LOCK STERILE STABLE INTERNAL FIXATION SUP-413.588E CDM 0270 RC outpatient 751.4 751.4 751.4 74 556.04 percent of total billed charges 751.4 93 608.63 percent of total billed charges 751.4 751.4 other OPPS APC 751.4 751.4 other OPPS APC 751.4 27.63 207.61 percent of total billed charges 751.4 751.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L20 MM OD3 MM STERNUM LOCK NONSTERILE SUP-413.590E CDM 0270 RC outpatient 472.58 472.58 472.58 74 349.71 percent of total billed charges 472.58 93 382.79 percent of total billed charges 472.58 472.58 other OPPS APC 472.58 472.58 other OPPS APC 472.58 27.63 130.57 percent of total billed charges 472.58 472.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0MM LOCKING TI STERNAL 22MM SUP-413.592E CDM 0270 RC outpatient 432.85 432.85 432.85 74 320.31 percent of total billed charges 432.85 93 350.61 percent of total billed charges 432.85 432.85 other OPPS APC 432.85 432.85 other OPPS APC 432.85 27.63 119.6 percent of total billed charges 432.85 432.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0MM LOCKING TI STERNAL 24MM SUP-413.594E CDM 0270 RC outpatient 557.18 557.18 557.18 74 412.31 percent of total billed charges 557.18 93 451.32 percent of total billed charges 557.18 557.18 other OPPS APC 557.18 557.18 other OPPS APC 557.18 27.63 153.95 percent of total billed charges 557.18 557.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING DEXTRUS SILICONE 10 MM SPACE HELIX L45 CM OD6.7 FR ATRIUM VENTRICLE RIGHT EXTENDABLE RETRACTABLE ACTIVE FIXATION RADIOPAQUE BIPOLAR SUP-4135 CDM 0275 RC outpatient 1157 1157 1157 57 659.49 percent of total billed charges 1157 93 937.17 percent of total billed charges 1157 1157 other OPPS APC 1157 1157 other OPPS APC 1157 51 590.07 percent of total billed charges 1157 1157 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING DEXTRUS SILICONE 10 MM SPACE HELIX L45 CM OD6.7 FR ATRIUM VENTRICLE RIGHT EXTENDABLE RETRACTABLE ACTIVE FIXATION RADIOPAQUE BIPOLAR SUP-4135-45CM CDM 0275 RC outpatient 1666.6 1666.6 1666.6 57 949.96 percent of total billed charges 1666.6 93 1349.95 percent of total billed charges 1666.6 1666.6 other OPPS APC 1666.6 1666.6 other OPPS APC 1666.6 51 849.97 percent of total billed charges 1666.6 1666.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING DEXTRUS SILICONE 10 MM SPACE HELIX L53 CM OD6.7 FR ATRIUM VENTRICLE RIGHT BIPOLAR EXTENDABLE RETRACTABLE IS-1 CONNECTOR SUP-4136 CDM 0275 RC outpatient 1157 1157 1157 57 659.49 percent of total billed charges 1157 93 937.17 percent of total billed charges 1157 1157 other OPPS APC 1157 1157 other OPPS APC 1157 51 590.07 percent of total billed charges 1157 1157 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING DEXTRUS SILICONE 10 MM SPACE L60 CM OD6.7 FR ATRIUM ENDOCARDIUM VENTRICLE RIGHT IS-1 CONNECTOR OTHER THAN TRANSVENOUS VDD 1 PASS BIPOLAR ACTIVE FIXATION EXTENDABLE SUP-4137 CDM 0275 RC outpatient 1157 1157 1157 57 659.49 percent of total billed charges 1157 93 937.17 percent of total billed charges 1157 1157 other OPPS APC 1157 1157 other OPPS APC 1157 51 590.07 percent of total billed charges 1157 1157 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM CANNULATED SCREW PARTIALLY THREADED 20MM SUP-414.520 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM CANNULATED SCREW PARTIALLY THREADED 24MM SUP-414.524 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM CANNULATED SCREW PARTIALLY THREADED 26MM SUP-414.526 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM CANNULATED SCREW PARTIALLY THREADED 28MM SUP-414.528 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM CANNULATED SCREW PARTIALLY THREADED 30MM SUP-414.530 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM CANNULATED SCREW PARTIALLY THREADED 32MM SUP-414.532 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM CANNULATED SCREW PARTIALLY THREADED 34MM SUP-414.534 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM CANNULATED SCREW PARTIALLY THREADED 36MM SUP-414.536 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM CANNULATED SCREW PARTIALLY THREADED 38MM SUP-414.538 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM CANNULATED SCREW PARTIALLY THREADED 40MM SUP-414.540 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM CANNULATED SCREW PARTIALLY THREADED 42MM SUP-414.542 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1/3 THREAD 44MM 4.5MM 6.5MM 1.75MM GOLD TITANIUM NS CANNULATED SELF TAP SELF DRILL LG HEXAGONAL SOCKET LG SUP-414.544 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM CANNULATED SCREW PARTIALLY THREADED 46MM SUP-414.546 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM CANNULATED SCREW PARTIALLY THREADED 48MM SUP-414.548 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM SHORT THREAD REVERSE CUT FLUTE L50 MM L17 MM OD4.5 MM ODSEC6.5 MM ID1.7 MM LONG BONE CANNULATED SELF DRILL NONSTERILE GOLD SUP-414.550 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM CANNULATED SCREW PARTIALLY THREADED 52MM SUP-414.552 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM CANNULATED SCREW PARTIALLY THREADED 54MM SUP-414.554 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM CANNULATED SCREW PARTIALLY THREADED 56MM SUP-414.556 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM CANNULATED SCREW PARTIALLY THREADED 60MM SUP-414.560 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM CANNULATED SCREW PARTIALLY THREADED 64MM SUP-414.564 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM CANNULATED SCREW PARTIALLY THREADED 68MM SUP-414.568 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM CANNULATED SCREW PARTIALLY THREADED 72MM SUP-414.572 CDM 270010022 LOCAL 0270 RC outpatient 575.8 575.8 575.8 74 426.09 percent of total billed charges 575.8 93 466.4 percent of total billed charges 575.8 575.8 other OPPS APC 575.8 575.8 other OPPS APC 575.8 27.63 159.09 percent of total billed charges 575.8 575.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER DA VINCI SI ENDOWRIST 45MM GREEN STERILE LF 1 FIRING SUP-41445G CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING GERMICIDAL BIOPATCH DISC 1IN 4MM WHITE CHG STERILE LF PERCUTANEOUS ANTIMICROBIAL ADHERENT CENTER HOLE SLIT SUP-4150 CDM 0481 RC outpatient 21.29 21.29 21.29 74 15.75 percent of total billed charges 21.29 93 17.24 percent of total billed charges 21.29 21.29 other OPPS APC 21.29 21.29 other OPPS APC 21.29 51 10.86 percent of total billed charges 21.29 21.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER DA VINCI SI ENDOWRIST 45MM BLUE STERILE LF 1 FIRING SUP-41645B CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOGEL PI INDICATOR SYNTHETIC UNDERGLOVE SIZE 7 BOX SUP-41670 CDM 0270 RC outpatient 3.39 3.39 3.39 74 2.51 percent of total billed charges 3.39 93 2.75 percent of total billed charges 3.39 3.39 other OPPS APC 3.39 3.39 other OPPS APC 3.39 27.63 0.94 percent of total billed charges 3.39 3.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNDERGLOVE SURGICAL BIOGEL PI INDICATOR SIZE 7.5 BLUE POLYISOPRENE POLYMER COAT POWDER-FREE SMOOTH BEADED CUFF PUNCTURE INDICATOR LATEX-FREE STERILE PR SUP-41675 CDM 0270 RC outpatient 3.44 3.44 3.44 74 2.55 percent of total billed charges 3.44 93 2.79 percent of total billed charges 3.44 3.44 other OPPS APC 3.44 3.44 other OPPS APC 3.44 27.63 0.95 percent of total billed charges 3.44 3.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL PI INDICATOR 8 299X103MM BLUE BIOGEL POLYISOPRENE STERILE LF POWDER FREE SMOOTH BEAD CUFF UNDERGLOVE SUP-41680 CDM 0270 RC outpatient 1.72 1.72 1.72 74 1.27 percent of total billed charges 1.72 93 1.39 percent of total billed charges 1.72 1.72 other OPPS APC 1.72 1.72 other OPPS APC 1.72 27.63 0.48 percent of total billed charges 1.72 1.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING SUCTION/IRRIGATION FLUID MANAGER INFLOW STERILE DISPOSABLE SUP-4170.223 CDM 0270 RC outpatient 89.76 89.76 89.76 74 66.42 percent of total billed charges 89.76 93 72.71 percent of total billed charges 89.76 89.76 other OPPS APC 89.76 89.76 other OPPS APC 89.76 27.63 24.8 percent of total billed charges 89.76 89.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE EAR PVC 2 OZ SOFT PLIABLE IRRIGATION SUCTION STERILE LATEX FREE DISPOSABLE SUP-4172 CDM 0270 RC outpatient 1.61 1.61 1.61 74 1.19 percent of total billed charges 1.61 93 1.3 percent of total billed charges 1.61 1.61 other OPPS APC 1.61 1.61 other OPPS APC 1.61 27.63 0.44 percent of total billed charges 1.61 1.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRAIN LAB SPHERES 41773B SUP-41773B CDM 0270 RC outpatient 22.19 22.19 22.19 74 16.42 percent of total billed charges 22.19 93 17.97 percent of total billed charges 22.19 22.19 other OPPS APC 22.19 22.19 other OPPS APC 22.19 27.63 6.13 percent of total billed charges 22.19 22.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE DISPOSABLE BIOPSY BRAINLAB 1.8MM SUP-41779 CDM 0270 RC outpatient 1222 1222 1222 74 904.28 percent of total billed charges 1222 93 989.82 percent of total billed charges 1222 1222 other OPPS APC 1222 1222 other OPPS APC 1222 27.63 337.64 percent of total billed charges 1222 1222 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM FECAL MANAGEMENT FLEXI-SEAL SIGNAL KIT CATHETER SYRINGE COLLECTION BAG LATEX FREE SUP-418000 CDM 270009014 LOCAL 0270 RC outpatient 318 318 318 74 235.32 percent of total billed charges 318 93 257.58 percent of total billed charges 318 318 other OPPS APC 318 318 other OPPS APC 318 27.63 87.86 percent of total billed charges 318 318 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC TITANIUM OD10 MM NONSTERILE 4.5 MM CANNULATED SCREW SUP-419.91 CDM 270010022 LOCAL 0270 RC outpatient 78.65 78.65 78.65 74 58.2 percent of total billed charges 78.65 93 63.71 percent of total billed charges 78.65 78.65 other OPPS APC 78.65 78.65 other OPPS APC 78.65 27.63 21.73 percent of total billed charges 78.65 78.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC 13MM TITANIUM NS LG SCREW SUP-419.99 CDM 270010022 LOCAL 0270 RC outpatient 64.32 64.32 64.32 74 47.6 percent of total billed charges 64.32 93 52.1 percent of total billed charges 64.32 64.32 other OPPS APC 64.32 64.32 other OPPS APC 64.32 27.63 17.77 percent of total billed charges 64.32 64.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ATTAIN STEROID ELUTING DISTAL 2 CURVE L78 OD6 FR HEART LEFT IS-1 OTW BIPOLAR SUP-4194-78 CDM 0275 RC outpatient 4641 4641 4641 57 2645.37 percent of total billed charges 4641 93 3759.21 percent of total billed charges 4641 4641 other OPPS APC 4641 4641 other OPPS APC 4641 51 2366.91 percent of total billed charges 4641 4641 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD ATTAIN 4194 OTW SUP-4194-88 CDM 0275 RC outpatient 4641 4641 4641 57 2645.37 percent of total billed charges 4641 93 3759.21 percent of total billed charges 4641 4641 other OPPS APC 4641 4641 other OPPS APC 4641 51 2366.91 percent of total billed charges 4641 4641 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Fix This SUP-4195103 CDM 0275 RC outpatient 3900 3900 3900 57 2223 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 51 1989 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ATTAIN STARFIX STEROID ELUTING POLYURETHANE L78 CM SUP-419578 CDM 0275 RC outpatient 5200 5200 5200 57 2964 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 51 2652 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Fix This SUP-419588 CDM 0275 RC outpatient 3900 3900 3900 57 2223 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 51 1989 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ATTAIN ABILITY L78 CM VEIN 2 ELECTRODE OTW SUP-419678 CDM 0275 RC outpatient 3463.2 3463.2 3463.2 57 1974.02 percent of total billed charges 3463.2 93 2805.19 percent of total billed charges 3463.2 3463.2 other OPPS APC 3463.2 3463.2 other OPPS APC 3463.2 51 1766.23 percent of total billed charges 3463.2 3463.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING L88 CM VEIN 2 ELECTRODE OTW SUP-419688 CDM 0275 RC outpatient 3463.2 3463.2 3463.2 57 1974.02 percent of total billed charges 3463.2 93 2805.19 percent of total billed charges 3463.2 3463.2 other OPPS APC 3463.2 3463.2 other OPPS APC 3463.2 51 1766.23 percent of total billed charges 3463.2 3463.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRIP RETINAL SILICONE FLAT L125 MM X W4 MM X H1.25 MM SLEEVE SPONGE STERILE SUP-42 CDM 0270 RC outpatient 37.96 37.96 37.96 74 28.09 percent of total billed charges 37.96 93 30.75 percent of total billed charges 37.96 37.96 other OPPS APC 37.96 37.96 other OPPS APC 37.96 27.63 10.49 percent of total billed charges 37.96 37.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY CLOTTRIEVER BOLD 16MM CORING ELEMENT MECHANICAL F/DVT SUP-42-102 CDM 0270 RC outpatient 15600 15600 15600 15600 other OPPS APC 15600 15600 other OPPS APC 15600 27.63 4310.28 percent of total billed charges 15600 15600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL PERSONA COCR 5 NARROW KNEE RIGHT CEMENTED POSTERIOR STABILIZE SUP-42-5000-058-02 CDM 270010025 LOCAL 0270 RC outpatient 15238.4 15238.4 15238.4 74 11276.4 percent of total billed charges 15238.4 93 12343.1 percent of total billed charges 15238.4 15238.4 other OPPS APC 15238.4 15238.4 other OPPS APC 15238.4 27.63 4210.38 percent of total billed charges 15238.4 15238.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERSONA 2.5MM 25MM CORTICAL TITANIUM FEMALE HEX SUP-42-5099-025-25 CDM 270010025 LOCAL 0270 RC outpatient 401.39 401.39 401.39 401.39 other OPPS APC 401.39 401.39 other OPPS APC 401.39 27.63 110.9 percent of total billed charges 401.39 401.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW GUIDE PERSONA L25 MM OD2.5 MM KNEE FEMALE HEX HEAD STERILE DISPOSABLE SUP-42-5099-025-25 CDM 270010025 LOCAL 0270 RC outpatient 401.39 401.39 401.39 74 297.03 percent of total billed charges 401.39 93 325.13 percent of total billed charges 401.39 401.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PERSONA 2.5MM FEMAL 48MM PK/2 SUP-42-5099-025-48 CDM 270010025 LOCAL 0270 RC outpatient 340.76 340.76 340.76 74 252.16 percent of total billed charges 340.76 93 276.02 percent of total billed charges 340.76 340.76 other OPPS APC 340.76 340.76 other OPPS APC 340.76 27.63 94.15 percent of total billed charges 340.76 340.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SURFACE ARTICULAR VIVACIT-E 10-12 GH H18 MM KNEE SUP-42-5124-010-18 CDM 270010025 LOCAL 0270 RC outpatient 4069 4069 4069 74 3011.06 percent of total billed charges 4069 93 3295.89 percent of total billed charges 4069 4069 other OPPS APC 4069 4069 other OPPS APC 4069 27.63 1124.26 percent of total billed charges 4069 4069 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA ALL POLY 32MM SUP-42-5402-000-32 CDM 270010025 LOCAL 0270 RC outpatient 2301 2301 2301 74 1702.74 percent of total billed charges 2301 93 1863.81 percent of total billed charges 2301 2301 other OPPS APC 2301 2301 other OPPS APC 2301 27.63 635.77 percent of total billed charges 2301 2301 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM PERSONA TAPER L30+ MM OD14 MM KNEE TIBIA SUP-42-5570-001-14 CDM 270010025 LOCAL 0270 RC outpatient 2776.8 2776.8 2776.8 74 2054.83 percent of total billed charges 2776.8 93 2249.21 percent of total billed charges 2776.8 2776.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM TIBIAL EXTENSION PERSONA 14MM 30MM CEMENTED STRAIGHT TAPERED HYBRID LEFT STERILE SUP-42-5570-001-14 CDM 270010025 LOCAL 0270 RC outpatient 2776.8 2776.8 2776.8 2776.8 other OPPS APC 2776.8 2776.8 other OPPS APC 2776.8 27.63 767.23 percent of total billed charges 2776.8 2776.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE OPTILINK L55 MM OD5 MM SELF TAP VARIABLE ANGLE STARDRIVE SUP-42.231.255 CDM 0270 RC outpatient 940.16 940.16 940.16 74 695.72 percent of total billed charges 940.16 93 761.53 percent of total billed charges 940.16 940.16 other OPPS APC 940.16 940.16 other OPPS APC 940.16 27.63 259.77 percent of total billed charges 940.16 940.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5MM VA LOCKING SCREW 65MM SUP-42.231.265 CDM 0270 RC outpatient 940.16 940.16 940.16 74 695.72 percent of total billed charges 940.16 93 761.53 percent of total billed charges 940.16 940.16 other OPPS APC 940.16 940.16 other OPPS APC 940.16 27.63 259.77 percent of total billed charges 940.16 940.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L75 MM OD5 MM SELF TAP VARIABLE ANGLE STARDRIVE 25 LOCK SUP-42.231.275 CDM 0270 RC outpatient 940.16 940.16 940.16 74 695.72 percent of total billed charges 940.16 93 761.53 percent of total billed charges 940.16 940.16 other OPPS APC 940.16 940.16 other OPPS APC 940.16 27.63 259.77 percent of total billed charges 940.16 940.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5MM VA LOCKING SCREW 85MM SUP-42.231.285 CDM 0270 RC outpatient 940.16 940.16 940.16 74 695.72 percent of total billed charges 940.16 93 761.53 percent of total billed charges 940.16 940.16 other OPPS APC 940.16 940.16 other OPPS APC 940.16 27.63 259.77 percent of total billed charges 940.16 940.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5MM VA LOCKING SCREW 95MM SUP-42.231.295 CDM 0270 RC outpatient 484.77 484.77 484.77 74 358.73 percent of total billed charges 484.77 93 392.66 percent of total billed charges 484.77 484.77 other OPPS APC 484.77 484.77 other OPPS APC 484.77 27.63 133.94 percent of total billed charges 484.77 484.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ATHERECTOMY TURBO-ELITE OD.081 IN L150 CM OD2 MM ODSEC.08 IN PERIPHERAL OTW LASER ACCEPTS .018 IN GUIDEWIRE 6 FR SHEATH SUP-420-006 CDM 0270 RC outpatient 7280 7280 7280 74 5387.2 percent of total billed charges 7280 93 5896.8 percent of total billed charges 7280 7280 other OPPS APC 7280 7280 other OPPS APC 7280 27.63 2011.46 percent of total billed charges 7280 7280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ATHERECTOMY TURBO-POWER 2.3MM DISPOSABLE STERILE LF LASER SUP-420-050 CDM 0270 RC outpatient 9100 9100 9100 74 6734 percent of total billed charges 9100 93 7371 percent of total billed charges 9100 9100 other OPPS APC 9100 9100 other OPPS APC 9100 27.63 2514.33 percent of total billed charges 9100 9100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STRUT 30X6X.5MM TITANIUM NS CRANIOFACIAL 16 HOLE 1MM CORTEX SCREW SUP-420.010 CDM 270010022 LOCAL 0270 RC outpatient 1319.08 1319.08 1319.08 74 976.12 percent of total billed charges 1319.08 93 1068.45 percent of total billed charges 1319.08 1319.08 other OPPS APC 1319.08 1319.08 other OPPS APC 1319.08 27.63 364.46 percent of total billed charges 1319.08 1319.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM L42 MM X W38 MM X H.4 MM CRANIOFACIAL MESH NONSTERILE 1 MM SCREWS SUP-420.02 CDM 270010022 LOCAL 0270 RC outpatient 3775.17 3775.17 3775.17 74 2793.63 percent of total billed charges 3775.17 93 3057.89 percent of total billed charges 3775.17 3775.17 other OPPS APC 3775.17 3775.17 other OPPS APC 3775.17 27.63 1043.08 percent of total billed charges 3775.17 3775.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STRUT 42X6X.5MM TITANIUM NS CRANIOFACIAL 22 HOLE 1MM CORTEX SCREW SUP-420.040 CDM 270010022 LOCAL 0270 RC outpatient 1482.7 1482.7 1482.7 74 1097.2 percent of total billed charges 1482.7 93 1200.99 percent of total billed charges 1482.7 1482.7 other OPPS APC 1482.7 1482.7 other OPPS APC 1482.7 27.63 409.67 percent of total billed charges 1482.7 1482.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 100X2.2X.7MM TITANIUM NS CRANIOFACIAL 34 HOLE ADAPTION 1MM CORTEX SCREW SUP-420.10 CDM 270010022 LOCAL 0270 RC outpatient 1674.97 1674.97 1674.97 74 1239.48 percent of total billed charges 1674.97 93 1356.73 percent of total billed charges 1674.97 1674.97 other OPPS APC 1674.97 1674.97 other OPPS APC 1674.97 27.63 462.79 percent of total billed charges 1674.97 1674.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 33X2.2X.5MM TITANIUM NS CRANIOMAXILLOFACIAL ORBITAL RIM 11 HOLE 1MM CORTEX SCREW SUP-420.21 CDM 270010013 LOCAL 0270 RC outpatient 741.57 741.57 741.57 74 548.76 percent of total billed charges 741.57 93 600.67 percent of total billed charges 741.57 741.57 other OPPS APC 741.57 741.57 other OPPS APC 741.57 27.63 204.9 percent of total billed charges 741.57 741.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE ORBITAL RIM 11 HOLE 1 MM SCREW BONE TITANIUM NS SUP-420.210 CDM 270010013 LOCAL 0270 RC outpatient 719.97 719.97 719.97 74 532.78 percent of total billed charges 719.97 93 583.18 percent of total billed charges 719.97 719.97 other OPPS APC 719.97 719.97 other OPPS APC 719.97 27.63 198.93 percent of total billed charges 719.97 719.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM H.2 MM ORBITAL FLOOR MESH NONSTERILE PURPLE 1 MM SCREW SUP-420.302 CDM 270010022 LOCAL 0270 RC outpatient 3466.61 3466.61 3466.61 74 2565.29 percent of total billed charges 3466.61 93 2807.95 percent of total billed charges 3466.61 3466.61 other OPPS APC 3466.61 3466.61 other OPPS APC 3466.61 27.63 957.82 percent of total billed charges 3466.61 3466.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE .3MM TEAL TITANIUM NS CRANIOMAXILLOFACIAL ORBITAL MESH 1MM CORTEX SCREW SUP-420.303 CDM 270010022 LOCAL 0270 RC outpatient 3466.61 3466.61 3466.61 74 2565.29 percent of total billed charges 3466.61 93 2807.95 percent of total billed charges 3466.61 3466.61 other OPPS APC 3466.61 3466.61 other OPPS APC 3466.61 27.63 957.82 percent of total billed charges 3466.61 3466.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM H.4 MM ORBITAL FLOOR MESH NONSTERILE GOLD 1 MM SCREW SUP-420.304 CDM 270010022 LOCAL 0270 RC outpatient 3466.61 3466.61 3466.61 74 2565.29 percent of total billed charges 3466.61 93 2807.95 percent of total billed charges 3466.61 3466.61 other OPPS APC 3466.61 3466.61 other OPPS APC 3466.61 27.63 957.82 percent of total billed charges 3466.61 3466.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE L 18X12X.5MM TITANIUM NS CRANIOFACIAL LEFT 9 HOLE 1MM CORTEX SCREW SUP-420.540 CDM 270010022 LOCAL 0270 RC outpatient 3229.72 3229.72 3229.72 74 2389.99 percent of total billed charges 3229.72 93 2616.07 percent of total billed charges 3229.72 3229.72 other OPPS APC 3229.72 3229.72 other OPPS APC 3229.72 27.63 892.37 percent of total billed charges 3229.72 3229.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE L 18X12X.5MM TITANIUM NS CRANIOFACIAL RIGHT 4X5 HOLE 1MM CORTEX SCREW SUP-420.55 CDM 270010022 LOCAL 0270 RC outpatient 668.95 668.95 668.95 74 495.02 percent of total billed charges 668.95 93 541.85 percent of total billed charges 668.95 668.95 other OPPS APC 668.95 668.95 other OPPS APC 668.95 27.63 184.83 percent of total billed charges 668.95 668.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE Y 18X11X.5MM TITANIUM NS CRANIOFACIAL 2X5 HOLE 1MM CORTEX SCREW SUP-420.620 CDM 270010022 LOCAL 0270 RC outpatient 651.98 651.98 651.98 74 482.47 percent of total billed charges 651.98 93 528.1 percent of total billed charges 651.98 651.98 other OPPS APC 651.98 651.98 other OPPS APC 651.98 27.63 180.14 percent of total billed charges 651.98 651.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE Y 27X15X.5MM TITANIUM NS CRANIOFACIAL 3X7 HOLE 1MM CORTEX SCREW SUP-420.63 CDM 270010022 LOCAL 0270 RC outpatient 671.53 671.53 671.53 74 496.93 percent of total billed charges 671.53 93 543.94 percent of total billed charges 671.53 671.53 other OPPS APC 671.53 671.53 other OPPS APC 671.53 27.63 185.54 percent of total billed charges 671.53 671.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 2Y 14X10X.5MM TITANIUM NS CRANIOFACIAL 1X2 HOLE 1MM CORTEX SCREW SUP-420.68 CDM 270010022 LOCAL 0270 RC outpatient 710.45 710.45 710.45 74 525.73 percent of total billed charges 710.45 93 575.46 percent of total billed charges 710.45 710.45 other OPPS APC 710.45 710.45 other OPPS APC 710.45 27.63 196.3 percent of total billed charges 710.45 710.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE T 18X14X.5MM TITANIUM NS CRANIOFACIAL 5X5 HOLE 1MM CORTEX SCREW SUP-420.700 CDM 270010022 LOCAL 0270 RC outpatient 601.64 601.64 601.64 74 445.21 percent of total billed charges 601.64 93 487.33 percent of total billed charges 601.64 601.64 other OPPS APC 601.64 601.64 other OPPS APC 601.64 27.63 166.23 percent of total billed charges 601.64 601.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE T 24X14X.5MM TITANIUM NS CRANIOFACIAL 5X7 HOLE 1MM CORTEX SCREW SUP-420.710 CDM 270010022 LOCAL 0270 RC outpatient 689.75 689.75 689.75 74 510.42 percent of total billed charges 689.75 93 558.7 percent of total billed charges 689.75 689.75 other OPPS APC 689.75 689.75 other OPPS APC 689.75 27.63 190.58 percent of total billed charges 689.75 689.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE X 10X7X.5MM TITANIUM NS CRANIOFACIAL 5 HOLE 1MM CORTEX SCREW SUP-420.81 CDM 270010022 LOCAL 0270 RC outpatient 601.54 601.54 601.54 74 445.14 percent of total billed charges 601.54 93 487.25 percent of total billed charges 601.54 601.54 other OPPS APC 601.54 601.54 other OPPS APC 601.54 27.63 166.21 percent of total billed charges 601.54 601.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM H CRANIOFACIAL 6 HOLE NONSTERILE 1 MM SCREW SUP-420.840 CDM 270010022 LOCAL 0270 RC outpatient 616.75 616.75 616.75 74 456.4 percent of total billed charges 616.75 93 499.57 percent of total billed charges 616.75 616.75 other OPPS APC 616.75 616.75 other OPPS APC 616.75 27.63 170.41 percent of total billed charges 616.75 616.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE H 14X10X.5MM TITANIUM NS CRANIOFACIAL 11 HOLE 1MM CORTEX SCREW SUP-420.850 CDM 270010022 LOCAL 0270 RC outpatient 689.75 689.75 689.75 74 510.42 percent of total billed charges 689.75 93 558.7 percent of total billed charges 689.75 689.75 other OPPS APC 689.75 689.75 other OPPS APC 689.75 27.63 190.58 percent of total billed charges 689.75 689.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY GEOFORM TITANIUM SILICONE RUBBER POLYESTER OD26 MM MITRAL OPTIMAL ORIFICE AREA RESTORE LEAFLET COAPTATION HEART VALVE REPAIR SUP-4200 M26 CDM 0270 RC outpatient 6422 6422 6422 74 4752.28 percent of total billed charges 6422 93 5201.82 percent of total billed charges 6422 6422 other OPPS APC 6422 6422 other OPPS APC 6422 27.63 1774.4 percent of total billed charges 6422 6422 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY GEOFORM TITANIUM SILICONE RUBBER POLYESTER OD28 MM MITRAL RIGID HEART VALVE REPAIR SUP-4200 M28 CDM 0270 RC outpatient 6422 6422 6422 74 4752.28 percent of total billed charges 6422 93 5201.82 percent of total billed charges 6422 6422 other OPPS APC 6422 6422 other OPPS APC 6422 27.63 1774.4 percent of total billed charges 6422 6422 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY GEOFORM TITANIUM SILICONE RUBBER POLYESTER OD32 MM MITRAL RIGID HEART VALVE REPAIR SUP-4200 M32 CDM 0270 RC outpatient 6422 6422 6422 74 4752.28 percent of total billed charges 6422 93 5201.82 percent of total billed charges 6422 6422 other OPPS APC 6422 6422 other OPPS APC 6422 27.63 1774.4 percent of total billed charges 6422 6422 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISSECTOR SURGICAL PERISCOPE SUP-4200-00 CDM 0270 RC outpatient 5197.4 5197.4 5197.4 74 3846.08 percent of total billed charges 5197.4 93 4209.89 percent of total billed charges 5197.4 5197.4 other OPPS APC 5197.4 5197.4 other OPPS APC 5197.4 27.63 1436.04 percent of total billed charges 5197.4 5197.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISSECTOR SURGICAL MARTIN UNBALLOON MODELING CATHETER SUP-4200-10 CDM 0270 RC outpatient 5197.4 5197.4 5197.4 74 3846.08 percent of total billed charges 5197.4 93 4209.89 percent of total billed charges 5197.4 5197.4 other OPPS APC 5197.4 5197.4 other OPPS APC 5197.4 27.63 1436.04 percent of total billed charges 5197.4 5197.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE RETRIEVAL REMOVAL ENDOSCOPIC HELIX SUP-4200-20 CDM 0270 RC outpatient 6757.4 6757.4 6757.4 74 5000.48 percent of total billed charges 6757.4 93 5473.49 percent of total billed charges 6757.4 6757.4 other OPPS APC 6757.4 6757.4 other OPPS APC 6757.4 27.63 1867.07 percent of total billed charges 6757.4 6757.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER ENDARTERECTOMY MOLLRING L44 CM OD5 MM TRANSECTION DEVICE REMOTE SUP-4200-40 CDM 0270 RC outpatient 6679.4 6679.4 6679.4 74 4942.76 percent of total billed charges 6679.4 93 5410.31 percent of total billed charges 6679.4 6679.4 other OPPS APC 6679.4 6679.4 other OPPS APC 6679.4 27.63 1845.52 percent of total billed charges 6679.4 6679.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER ENDARTERECTOMY MOLLRING L44 CM OD6 MM TRANSECTION DEVICE REMOTE SUP-4200-41 CDM 0270 RC outpatient 7797.4 7797.4 7797.4 74 5770.08 percent of total billed charges 7797.4 93 6315.89 percent of total billed charges 7797.4 7797.4 other OPPS APC 7797.4 7797.4 other OPPS APC 7797.4 27.63 2154.42 percent of total billed charges 7797.4 7797.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER ENDARTERECTOMY MOLLRING L44 CM OD7 MM TRANSECTION DEVICE REMOTE SUP-4200-42 CDM 0270 RC outpatient 7797.4 7797.4 7797.4 74 5770.08 percent of total billed charges 7797.4 93 6315.89 percent of total billed charges 7797.4 7797.4 other OPPS APC 7797.4 7797.4 other OPPS APC 7797.4 27.63 2154.42 percent of total billed charges 7797.4 7797.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER ENDARTERECTOMY MOLLRING L44 CM OD8 MM TRANSECTION DEVICE REMOTE SUP-4200-43 CDM 0270 RC outpatient 7797.4 7797.4 7797.4 74 5770.08 percent of total billed charges 7797.4 93 6315.89 percent of total billed charges 7797.4 7797.4 other OPPS APC 7797.4 7797.4 other OPPS APC 7797.4 27.63 2154.42 percent of total billed charges 7797.4 7797.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER ENDARTERECTOMY MOLLRING L44 CM OD9 MM TRANSECTION DEVICE REMOTE SUP-4200-44 CDM 0270 RC outpatient 7797.4 7797.4 7797.4 74 5770.08 percent of total billed charges 7797.4 93 6315.89 percent of total billed charges 7797.4 7797.4 other OPPS APC 7797.4 7797.4 other OPPS APC 7797.4 27.63 2154.42 percent of total billed charges 7797.4 7797.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER ENDARTERECTOMY MOLLRING L44 CM OD10 MM TRANSECTION DEVICE REMOTE SUP-4200-45 CDM 0270 RC outpatient 7797.4 7797.4 7797.4 74 5770.08 percent of total billed charges 7797.4 93 6315.89 percent of total billed charges 7797.4 7797.4 other OPPS APC 7797.4 7797.4 other OPPS APC 7797.4 27.63 2154.42 percent of total billed charges 7797.4 7797.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY GEOFORM TITANIUM SILICONE RUBBER POLYESTER OD30 MM MITRAL OPTIMAL ORIFICE AREA RESTORE LEAFLET COAPTATION HEART VALVE REPAIR SUP-4200-M30 CDM 0270 RC outpatient 6422 6422 6422 74 4752.28 percent of total billed charges 6422 93 5201.82 percent of total billed charges 6422 6422 other OPPS APC 6422 6422 other OPPS APC 6422 27.63 1774.4 percent of total billed charges 6422 6422 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRIVER NEEDLE S/SI ENDOWRIST 0-30 D LARGE L54.4 CM L1 CM OD8 MM SUP-420006 CDM outpatient 6006 6006 6006 6006 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE EQUIPMENT DA VINCI S/SI ARM SUP-420015 CDM 0270 RC outpatient 122.85 122.85 122.85 74 90.91 percent of total billed charges 122.85 93 99.51 percent of total billed charges 122.85 122.85 other OPPS APC 122.85 122.85 other OPPS APC 122.85 27.63 33.94 percent of total billed charges 122.85 122.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE EQUIPMENT DA VINCI S CAMERA ARM DISPOSABLE SUP-420022 CDM 0270 RC outpatient 76.7 76.7 76.7 74 56.76 percent of total billed charges 76.7 93 62.13 percent of total billed charges 76.7 76.7 other OPPS APC 76.7 76.7 other OPPS APC 76.7 27.63 21.19 percent of total billed charges 76.7 76.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OBTURATOR LAPAROSCOPIC DA VINCI S/SI ENDOWRIST SHORT OD8 MM STERILE DISPOSABLE SUP-420023 CDM 0270 RC outpatient 68.25 68.25 68.25 74 50.51 percent of total billed charges 68.25 93 55.28 percent of total billed charges 68.25 68.25 other OPPS APC 68.25 68.25 other OPPS APC 68.25 27.63 18.86 percent of total billed charges 68.25 68.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OBTURATOR LAPAROSCOPIC DA VINCI S/SI ENDOWRIST LONG OD8 MM STERILE DISPOSABLE SUP-420024 CDM 0270 RC outpatient 68.25 68.25 68.25 74 50.51 percent of total billed charges 68.25 93 55.28 percent of total billed charges 68.25 68.25 other OPPS APC 68.25 68.25 other OPPS APC 68.25 27.63 18.86 percent of total billed charges 68.25 68.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE EQUIPMENT DA VINCI S MONITOR VISION CART DISPOSABLE SUP-420026 CDM 0270 RC outpatient 65 65 65 74 48.1 percent of total billed charges 65 93 52.65 percent of total billed charges 65 65 other OPPS APC 65 65 other OPPS APC 65 27.63 17.96 percent of total billed charges 65 65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS LAPAROSCOPIC DA VINCI S/SI ENDOWRIST CADIERE OD8 MM FINGERTIP CONTROL LOW STERILE DISPOSABLE SUP-420049 CDM outpatient 5460 5460 5460 5460 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS LAPAROSCOPIC PROGRASP DA VINCI S/SI ENDOWRIST 38- D L56.2 CM L2.8 CM OD8 MM GRASPER HIGH JAW CLOSE LOW JAW OPEN SUP-420093 CDM outpatient 6006 6006 6006 6006 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS BIPOLAR S/SI ENDOWRIST MARYLAND 0-45 D L55.8 CM L2 CM OD8 MM SUP-420172 CDM outpatient 7371 7371 7371 7371 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCISSORS LAPAROSCOPIC DA VINCI S/SI ENDOWRIST 38- D MEDIUM CURVE L54.7 CM L1.3 CM OD8 MM STERILE DISPOSABLE SUP-420178 CDM outpatient 5460 5460 5460 5460 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCISSORS LAPAROSCOPIC HOT SHEARS DA VINCI S/SI ENDOWRIST 38- D CURVE L55.9 CM L1.3 CM OD8 MM CAUTERY MONOPOLAR STERILE DISPOSABLE SUP-420179 CDM outpatient 8736 8736 8736 8736 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS LAPAROSCOPIC DA VINCI S/SI ENDOWRIST RESANO 30- D MEDIUM L54.5 CM L1.1 CM OD8 MM RESANO STYLE JAW TIP CLOSE GRIP STERILE DISPOSABLE SUP-420181 CDM outpatient 6006 6006 6006 6006 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOOK LAPAROSCOPIC DA VINCI S/SI ENDOWRIST L55.2 CM L1.6 CM OD8 MM CAUTERY MONOPOLAR PERMANENT STERILE DISPOSABLE SUP-420183 CDM outpatient 5460 5460 5460 5460 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS LAPAROSCOPIC DA VINCI S/SI ENDOWRIST 45- D MEDIUM L55.9 CM L2.1 CM OD8 MM CAUTERY FENESTRATE STERILE DISPOSABLE SUP-420205 CDM outpatient 7371 7371 7371 7371 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEAL ENDOSCOPIC INSTRUMENT S/SI ENDOWRIST 8.5-13MM CANNULA HD SD VISION SYSTEM SUP-420206 CDM 0270 RC outpatient 104 104 104 74 76.96 percent of total billed charges 104 93 84.24 percent of total billed charges 104 104 other OPPS APC 104 104 other OPPS APC 104 27.63 28.74 percent of total billed charges 104 104 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS LAPAROSCOPIC DA VINCI S/SI ENDOWRIST OD8 MM TENACULUM STERILE DISPOSABLE SUP-420207 CDM outpatient 6006 6006 6006 6006 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ACCESSORY DA VINCI S 4 ARM DRAPE DISPOSABLE SUP-420258 CDM 0270 RC outpatient 608.4 608.4 608.4 74 450.22 percent of total billed charges 608.4 93 492.8 percent of total billed charges 608.4 608.4 other OPPS APC 608.4 608.4 other OPPS APC 608.4 27.63 168.1 percent of total billed charges 608.4 608.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE EQUIPMENT DA VINCI SI CAMERA HEAD DISPOSABLE SUP-420273 CDM outpatient 111.93 111.93 111.93 111.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEARS SURGICAL DA VINCI S/SI ENDOWRIST HARMONIC ACE CURVE OD8 MM SUP-420275 CDM 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE EQUIPMENT DA VINCI SI CAMERA ARM DISPOSABLE SUP-420279 CDM outpatient 114.66 114.66 114.66 114.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRIVER NEEDLE SUTURECUT DA VINCI S/SI ENDOWRIST 30- D LARGE L54.5 CM L1.1 CM OD8 MM VERY HIGH SUP-420296 CDM outpatient 6552 6552 6552 6552 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRIVER NEEDLE SUTURECUT S/SI ENDOWRIST 0-23 D MEGA L54.8 CM L1.4 CM SUP-420309 CDM outpatient 6552 6552 6552 6552 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM L45 MM X W38 MM X H.4 MM CRANIOFACIAL CONTOURABLE MESH MALLEABLE NONSTERILE TEAL 1.3 MM CORTICAL SCREW SUP-421.004 CDM 270010022 LOCAL 0270 RC outpatient 4301.52 4301.52 4301.52 74 3183.12 percent of total billed charges 4301.52 93 3484.23 percent of total billed charges 4301.52 4301.52 other OPPS APC 4301.52 4301.52 other OPPS APC 4301.52 27.63 1188.51 percent of total billed charges 4301.52 4301.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 95X3.3X.5MM TITANIUM NS CRANIOFACIAL 24 HOLE ADAPTION 1.3MM CORTEX SCREW SUP-421.010 CDM 270010022 LOCAL 0270 RC outpatient 1737.19 1737.19 1737.19 74 1285.52 percent of total billed charges 1737.19 93 1407.12 percent of total billed charges 1737.19 1737.19 other OPPS APC 1737.19 1737.19 other OPPS APC 1737.19 27.63 479.99 percent of total billed charges 1737.19 1737.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 35X3.3X.5MM TITANIUM NS CRANIOMAXILLOFACIAL ORBITAL RIM 9 HOLE 1.3MM CORTEX SCREW SUP-421.021 CDM 270010014 LOCAL 0270 RC outpatient 692.3 692.3 692.3 74 512.3 percent of total billed charges 692.3 93 560.76 percent of total billed charges 692.3 692.3 other OPPS APC 692.3 692.3 other OPPS APC 692.3 27.63 191.28 percent of total billed charges 692.3 692.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 100D 9MM SPACE L OBLIQUE 20X11X.5MM TITANIUM NS CRANIOFACIAL LEFT 3 HOLE BASE 3 HOLE SHAFT 1.3MM CORTEX SCREW SUP-421.050 CDM 270010014 LOCAL 0270 RC outpatient 692.3 692.3 692.3 74 512.3 percent of total billed charges 692.3 93 560.76 percent of total billed charges 692.3 692.3 other OPPS APC 692.3 692.3 other OPPS APC 692.3 27.63 191.28 percent of total billed charges 692.3 692.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 100D 9MM SPACE L OBLIQUE 20X11X.5MM TITANIUM NS CRANIOFACIAL RIGHT 3 HOLE BASE 3 HOLE SHAFT 1.3MM CORTEX SUP-421.051 CDM 270010013 LOCAL 0270 RC outpatient 692.3 692.3 692.3 74 512.3 percent of total billed charges 692.3 93 560.76 percent of total billed charges 692.3 692.3 other OPPS APC 692.3 692.3 other OPPS APC 692.3 27.63 191.28 percent of total billed charges 692.3 692.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 100D 5MM SPACE L OBLIQUE 20X11X.5MM TITANIUM NS CRANIOFACIAL LEFT 3 HOLE BASE 4 HOLE SHAFT 1.3MM CORTEX SCREW SUP-421.052 CDM 270010014 LOCAL 0270 RC outpatient 692.3 692.3 692.3 74 512.3 percent of total billed charges 692.3 93 560.76 percent of total billed charges 692.3 692.3 other OPPS APC 692.3 692.3 other OPPS APC 692.3 27.63 191.28 percent of total billed charges 692.3 692.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 100D 5MM SPACE L OBLIQUE 20X11X.5MM TITANIUM NS CRANIOFACIAL RIGHT 3 HOLE BASE 4 HOLE SHAFT 1.3MM CORTEX SUP-421.053 CDM 270010022 LOCAL 0270 RC outpatient 692.3 692.3 692.3 74 512.3 percent of total billed charges 692.3 93 560.76 percent of total billed charges 692.3 692.3 other OPPS APC 692.3 692.3 other OPPS APC 692.3 27.63 191.28 percent of total billed charges 692.3 692.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 13MM SPACE 2Y 15X9X.5MM TITANIUM NS CRANIOFACIAL 2 HOLE SHAFT 1 HOLE ARM 1.3MM CORTEX SCREW SUP-421.061 CDM 270010022 LOCAL 0270 RC outpatient 627.46 627.46 627.46 74 464.32 percent of total billed charges 627.46 93 508.24 percent of total billed charges 627.46 627.46 other OPPS APC 627.46 627.46 other OPPS APC 627.46 27.63 173.37 percent of total billed charges 627.46 627.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2Y 15X9X.5MM CRANIOFACIAL 2 HOLE SHAFT 1 ARM 1.3MM CORTICAL SCREW BONE TITANIUM SUP-421.068 CDM 270010022 LOCAL 0270 RC outpatient 609.18 609.18 609.18 74 450.79 percent of total billed charges 609.18 93 493.44 percent of total billed charges 609.18 609.18 other OPPS APC 609.18 609.18 other OPPS APC 609.18 27.63 168.32 percent of total billed charges 609.18 609.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 13MM SPACE 2Y 15X9X.5MM TITANIUM NS CRANIOFACIAL 2 HOLE SHAFT 1 HOLE ARM 1.3MM CORTEX SCREW SUP-421.068 CDM 270010022 LOCAL 0270 RC outpatient 687.1 687.1 687.1 74 508.45 percent of total billed charges 687.1 93 556.55 percent of total billed charges 687.1 687.1 other OPPS APC 687.1 687.1 other OPPS APC 687.1 27.63 189.85 percent of total billed charges 687.1 687.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE T 20X11X.5MM TITANIUM NS CRANIOFACIAL 3X4 HOLE 1.3MM CORTEX SCREW SUP-421.069 CDM 270010022 LOCAL 0270 RC outpatient 687.1 687.1 687.1 74 508.45 percent of total billed charges 687.1 93 556.55 percent of total billed charges 687.1 687.1 other OPPS APC 687.1 687.1 other OPPS APC 687.1 27.63 189.85 percent of total billed charges 687.1 687.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 20X11X.5MM T CRANIOMAXILLOFACIAL TITANIUM 3X4 HOLE 1.3MM SCREW NS SUP-421.071 CDM 270010022 LOCAL 0270 RC outpatient 667.08 667.08 667.08 74 493.64 percent of total billed charges 667.08 93 540.33 percent of total billed charges 667.08 667.08 other OPPS APC 667.08 667.08 other OPPS APC 667.08 27.63 184.31 percent of total billed charges 667.08 667.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE T 20X11X.5MM TITANIUM NS CRANIOFACIAL 3X4 HOLE 1.3MM CORTEX SCREW SUP-421.071 CDM 270010022 LOCAL 0270 RC outpatient 692.3 692.3 692.3 74 512.3 percent of total billed charges 692.3 93 560.76 percent of total billed charges 692.3 692.3 other OPPS APC 692.3 692.3 other OPPS APC 692.3 27.63 191.28 percent of total billed charges 692.3 692.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE T STRUT 43X8X.5MM TITANIUM NS CRANIOFACIAL 2X9 HOLE 1.3MM CORTEX SCREW SUP-421.080 CDM 270010022 LOCAL 0270 RC outpatient 1341.6 1341.6 1341.6 74 992.78 percent of total billed charges 1341.6 93 1086.7 percent of total billed charges 1341.6 1341.6 other OPPS APC 1341.6 1341.6 other OPPS APC 1341.6 27.63 370.68 percent of total billed charges 1341.6 1341.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE X TITANIUM NS CRANIOFACIAL 4 HOLE 1.3MM SCREW SUP-421.081 CDM 270010022 LOCAL 0270 RC outpatient 627.46 627.46 627.46 74 464.32 percent of total billed charges 627.46 93 508.24 percent of total billed charges 627.46 627.46 other OPPS APC 627.46 627.46 other OPPS APC 627.46 27.63 173.37 percent of total billed charges 627.46 627.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE BOX 13X8MM TITANIUM NS CRANIOFACIAL 4 HOLE 1.3MM SCREW SUP-421.095 CDM 270010022 LOCAL 0270 RC outpatient 614.48 614.48 614.48 74 454.72 percent of total billed charges 614.48 93 497.73 percent of total billed charges 614.48 614.48 other OPPS APC 614.48 614.48 other OPPS APC 614.48 27.63 169.78 percent of total billed charges 614.48 614.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE BOX 13X13MM TITANIUM NS CRANIOFACIAL 4 HOLE 1.3MM SCREW SUP-421.096 CDM 270010022 LOCAL 0270 RC outpatient 614.48 614.48 614.48 74 454.72 percent of total billed charges 614.48 93 497.73 percent of total billed charges 614.48 614.48 other OPPS APC 614.48 614.48 other OPPS APC 614.48 27.63 169.78 percent of total billed charges 614.48 614.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STRAIGHT 23MM TITANIUM NS HAND 6 HOLE LOW PROFILE PRECONTOUR RECONSTRUCTION 1.3MM SCREW SUP-421.306 CDM 270010022 LOCAL 0270 RC outpatient 985.27 985.27 985.27 74 729.1 percent of total billed charges 985.27 93 798.07 percent of total billed charges 985.27 985.27 other OPPS APC 985.27 985.27 other OPPS APC 985.27 27.63 272.23 percent of total billed charges 985.27 985.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STRAIGHT 47MM TITANIUM NS HAND 12 HOLE LOW PROFILE PRECONTOUR RECONSTRUCTION 1.3MM SCREW SUP-421.312 CDM 270010022 LOCAL 0270 RC outpatient 1086.8 1086.8 1086.8 74 804.23 percent of total billed charges 1086.8 93 880.31 percent of total billed charges 1086.8 1086.8 other OPPS APC 1086.8 1086.8 other OPPS APC 1086.8 27.63 300.28 percent of total billed charges 1086.8 1086.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE H 19MMX.5MM TITANIUM NS HAND RIGHT 8 HOLE EXTEND LOW PROFILE PRECONTOUR 1.3MM SCREW SUP-421.32 CDM 270010022 LOCAL 0270 RC outpatient 713.7 713.7 713.7 74 528.14 percent of total billed charges 713.7 93 578.1 percent of total billed charges 713.7 713.7 other OPPS APC 713.7 713.7 other OPPS APC 713.7 27.63 197.2 percent of total billed charges 713.7 713.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE H 19MMX.5MM TITANIUM 1.3MM SCREW 8 HOLE EXTENDED BONE RIGHT HAND NS SUP-421.320 CDM 270010022 LOCAL 0270 RC outpatient 713.7 713.7 713.7 74 528.14 percent of total billed charges 713.7 93 578.1 percent of total billed charges 713.7 713.7 other OPPS APC 713.7 713.7 other OPPS APC 713.7 27.63 197.2 percent of total billed charges 713.7 713.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE H 19MMX.5MM TITANIUM NS HAND LEFT 8 HOLE EXTEND LOW PROFILE PRECONTOUR 1.3MM SCREW SUP-421.321 CDM 270010022 LOCAL 0270 RC outpatient 1199.77 1199.77 1199.77 74 887.83 percent of total billed charges 1199.77 93 971.81 percent of total billed charges 1199.77 1199.77 other OPPS APC 1199.77 1199.77 other OPPS APC 1199.77 27.63 331.5 percent of total billed charges 1199.77 1199.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE T 32MM TITANIUM NS HAND 3 HOLE HEAD 8 HOLE SHAFT PRECONTOUR LOW PROFILE 1.3MM SCREW SUP-421.333 CDM 270010022 LOCAL 0270 RC outpatient 1079.65 1079.65 1079.65 74 798.94 percent of total billed charges 1079.65 93 874.52 percent of total billed charges 1079.65 1079.65 other OPPS APC 1079.65 1079.65 other OPPS APC 1079.65 27.63 298.31 percent of total billed charges 1079.65 1079.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE T 32MM TITANIUM NS HAND 4 HOLE HEAD 8 HOLE SHAFT PRECONTOUR LOW PROFILE 1.3MM SCREW SUP-421.334 CDM 270010022 LOCAL 0270 RC outpatient 1109.68 1109.68 1109.68 74 821.16 percent of total billed charges 1109.68 93 898.84 percent of total billed charges 1109.68 1109.68 other OPPS APC 1109.68 1109.68 other OPPS APC 1109.68 27.63 306.6 percent of total billed charges 1109.68 1109.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE Y 37MM TITANIUM NS HAND 3 HOLE HEAD 8 HOLE SHAFT PRECONTOUR LOW PROFILE 1.3MM SCREW SUP-421.335 CDM 270010022 LOCAL 0270 RC outpatient 1079.65 1079.65 1079.65 74 798.94 percent of total billed charges 1079.65 93 874.52 percent of total billed charges 1079.65 1079.65 other OPPS APC 1079.65 1079.65 other OPPS APC 1079.65 27.63 298.31 percent of total billed charges 1079.65 1079.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MESH TEMPORAL TITANIM MALMIUM SUP-421.5 CDM 270010013 LOCAL 0270 RC outpatient 1463.96 1463.96 1463.96 74 1083.33 percent of total billed charges 1463.96 93 1185.81 percent of total billed charges 1463.96 1463.96 other OPPS APC 1463.96 1463.96 other OPPS APC 1463.96 27.63 404.49 percent of total billed charges 1463.96 1463.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM STRAIGHT L12 MM X H.5 MM CRANIOMAXILLOFACIAL 2 HOLE CENTRE SPACE LOW PROFILE NONSTERILE SUP-421.502 CDM 270010013 LOCAL 0270 RC outpatient 103.97 103.97 103.97 74 76.94 percent of total billed charges 103.97 93 84.22 percent of total billed charges 103.97 103.97 other OPPS APC 103.97 103.97 other OPPS APC 103.97 27.63 28.73 percent of total billed charges 103.97 103.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM STRAIGHT H.5 MM CRANIOMAXILLOFACIAL 4 HOLE CENTRE SPACE LOW PROFILE SUP-421.504 CDM 270010013 LOCAL 0270 RC outpatient 132.68 132.68 132.68 74 98.18 percent of total billed charges 132.68 93 107.47 percent of total billed charges 132.68 132.68 other OPPS APC 132.68 132.68 other OPPS APC 132.68 27.63 36.66 percent of total billed charges 132.68 132.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM X H.5 MM CRANIOMAXILLOFACIAL 4 HOLE LOW PROFILE 1.3 SCREW SUP-421.51 CDM 270010013 LOCAL 0270 RC outpatient 508.35 508.35 508.35 74 376.18 percent of total billed charges 508.35 93 411.76 percent of total billed charges 508.35 508.35 other OPPS APC 508.35 508.35 other OPPS APC 508.35 27.63 140.46 percent of total billed charges 508.35 508.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE .5MM X CRANIOMAXILLOFACIAL TITANIUM 4 HOLE LOW PROFILE 1.3 SCREW NS SUP-421.510 CDM 270010013 LOCAL 0270 RC outpatient 508.35 508.35 508.35 74 376.18 percent of total billed charges 508.35 93 411.76 percent of total billed charges 508.35 508.35 other OPPS APC 508.35 508.35 other OPPS APC 508.35 27.63 140.46 percent of total billed charges 508.35 508.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM BOX L14 MM X W14 MM X H.5 MM CRANIOMAXILLOFACIAL 4 HOLE LOW PROFILE SUP-421.511 CDM 270010013 LOCAL 0270 RC outpatient 528.92 528.92 528.92 74 391.4 percent of total billed charges 528.92 93 428.43 percent of total billed charges 528.92 528.92 other OPPS APC 528.92 528.92 other OPPS APC 528.92 27.63 146.14 percent of total billed charges 528.92 528.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 2Y LOW PROFILE L18 MM X H.5 MM CRANIOMAXILLOFACIAL 6 HOLE SUP-421.516 CDM 270010013 LOCAL 0270 RC outpatient 528.92 528.92 528.92 74 391.4 percent of total billed charges 528.92 93 428.43 percent of total billed charges 528.92 528.92 other OPPS APC 528.92 528.92 other OPPS APC 528.92 27.63 146.14 percent of total billed charges 528.92 528.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM THK.5 MM 2Y L21 MM CRANIOMAXILLOFACIAL 6 HOLE LOW PROFILE SUP-421.517 CDM 270010013 LOCAL 0270 RC outpatient 528.92 528.92 528.92 74 391.4 percent of total billed charges 528.92 93 428.43 percent of total billed charges 528.92 528.92 other OPPS APC 528.92 528.92 other OPPS APC 528.92 27.63 146.14 percent of total billed charges 528.92 528.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM H.5 MM CRANIOMAXILLOFACIAL 5 HOLE LOW PROFILE ADAPTATION SUP-421.518 CDM 270010013 LOCAL 0270 RC outpatient 484.09 484.09 484.09 74 358.23 percent of total billed charges 484.09 93 392.11 percent of total billed charges 484.09 484.09 other OPPS APC 484.09 484.09 other OPPS APC 484.09 27.63 133.75 percent of total billed charges 484.09 484.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM H.5 MM CRANIOMAXILLOFACIAL 7 HOLE LOW PROFILE ADAPTATION NONSTERILE SUP-421.519 CDM 270010013 LOCAL 0270 RC outpatient 593.45 593.45 593.45 74 439.15 percent of total billed charges 593.45 93 480.69 percent of total billed charges 593.45 593.45 other OPPS APC 593.45 593.45 other OPPS APC 593.45 27.63 163.97 percent of total billed charges 593.45 593.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM RECTANGLE L16 MM X W10 MM X H.5 MM CRANIOFACIAL 4 HOLE LOW PROFILE FRAME SUP-421.521 CDM 270010013 LOCAL 0270 RC outpatient 507.39 507.39 507.39 74 375.47 percent of total billed charges 507.39 93 410.99 percent of total billed charges 507.39 507.39 other OPPS APC 507.39 507.39 other OPPS APC 507.39 27.63 140.19 percent of total billed charges 507.39 507.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM H.5 MM CRANIOMAXILLOFACIAL 6 HOLE STRUT LOW PROFILE SUP-421.522 CDM 270010013 LOCAL 0270 RC outpatient 921.54 921.54 921.54 74 681.94 percent of total billed charges 921.54 93 746.45 percent of total billed charges 921.54 921.54 other OPPS APC 921.54 921.54 other OPPS APC 921.54 27.63 254.62 percent of total billed charges 921.54 921.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM H.5 MM CRANIOMAXILLOFACIAL 8 HOLE STRUT LOW PROFILE SUP-421.523 CDM 270010013 LOCAL 0270 RC outpatient 1305.25 1305.25 1305.25 74 965.89 percent of total billed charges 1305.25 93 1057.25 percent of total billed charges 1305.25 1305.25 other OPPS APC 1305.25 1305.25 other OPPS APC 1305.25 27.63 360.64 percent of total billed charges 1305.25 1305.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER BURR HOLE TITANIUM H.5 MM OD12 MM CRANIOMAXILLOFACIAL LOW PROFILE SUP-421.525 CDM 270010013 LOCAL 0270 RC outpatient 550.45 550.45 550.45 74 407.33 percent of total billed charges 550.45 93 445.86 percent of total billed charges 550.45 550.45 other OPPS APC 550.45 550.45 other OPPS APC 550.45 27.63 152.09 percent of total billed charges 550.45 550.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER BURR HOLE TITANIUM H.5 MM OD15 MM CRANIOFACIAL 6 HOLE LOW PROFILE NONSTERILE SUP-421.526 CDM 0270 RC outpatient 550.45 550.45 550.45 74 407.33 percent of total billed charges 550.45 93 445.86 percent of total billed charges 550.45 550.45 other OPPS APC 550.45 550.45 other OPPS APC 550.45 27.63 152.09 percent of total billed charges 550.45 550.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER BURR HOLE TITANIUM H.5 MM OD17 MM CRANIOMAXILLOFACIAL LOW PROFILE NONSTERILE SUP-421.527 CDM 0270 RC outpatient 550.45 550.45 550.45 74 407.33 percent of total billed charges 550.45 93 445.86 percent of total billed charges 550.45 550.45 other OPPS APC 550.45 550.45 other OPPS APC 550.45 27.63 152.09 percent of total billed charges 550.45 550.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER BURR HOLE TITANIUM H.5 MM OD24 MM CRANIOFACIAL 6 HOLE LOW PROFILE NONSTERILE SUP-421.528 CDM 270010013 LOCAL 0270 RC outpatient 550.45 550.45 550.45 74 407.33 percent of total billed charges 550.45 93 445.86 percent of total billed charges 550.45 550.45 other OPPS APC 550.45 550.45 other OPPS APC 550.45 27.63 152.09 percent of total billed charges 550.45 550.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM THK.6 MM L45 MM X W38 MM CONTOURABLE MESH RIGID SILVER SUP-421.532 CDM 270010013 LOCAL 0270 RC outpatient 3004.92 3004.92 3004.92 74 2223.64 percent of total billed charges 3004.92 93 2433.99 percent of total billed charges 3004.92 3004.92 other OPPS APC 3004.92 3004.92 other OPPS APC 3004.92 27.63 830.26 percent of total billed charges 3004.92 3004.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH DYNAMIC TITANIUM L100 MM X W100 MM X H.4 MM CRANIOFACIAL CONTOURABLE MALLEABLE LOW PROFILE BLUE SUP-421.533 CDM 270010013 LOCAL 0270 RC outpatient 4674.15 4674.15 4674.15 74 3458.87 percent of total billed charges 4674.15 93 3786.06 percent of total billed charges 4674.15 4674.15 other OPPS APC 4674.15 4674.15 other OPPS APC 4674.15 27.63 1291.47 percent of total billed charges 4674.15 4674.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER BURR HOLE TITANIUM H.5 MM OD24 MM 6 HOLE LOW PROFILE NONSTERILE SUP-421.553 CDM 270010013 LOCAL 0270 RC outpatient 550.45 550.45 550.45 74 407.33 percent of total billed charges 550.45 93 445.86 percent of total billed charges 550.45 550.45 other OPPS APC 550.45 550.45 other OPPS APC 550.45 27.63 152.09 percent of total billed charges 550.45 550.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER BURR HOLE TITANIUM H.5 MM OD17 MM CRANIOMAXILLOFACIAL LOW PROFILE NONSTERILE SHUNT SUP-421.554 CDM 270010013 LOCAL 0270 RC outpatient 550.45 550.45 550.45 74 407.33 percent of total billed charges 550.45 93 445.86 percent of total billed charges 550.45 550.45 other OPPS APC 550.45 550.45 other OPPS APC 550.45 27.63 152.09 percent of total billed charges 550.45 550.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LISS 140MM TITANIUM NS TIBIA RIGHT PROXIMAL 5 HOLE 5MM LOCK SCREW SUP-422.3 CDM 270010022 LOCAL 0270 RC outpatient 4974.84 4974.84 4974.84 74 3681.38 percent of total billed charges 4974.84 93 4029.62 percent of total billed charges 4974.84 4974.84 other OPPS APC 4974.84 4974.84 other OPPS APC 4974.84 27.63 1374.55 percent of total billed charges 4974.84 4974.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LISS TIBIAL PROXIMAL TITANIUM RIGHT 5 HOLE SUP-422.3 CDM 270010022 LOCAL 0270 RC outpatient 4974.84 4974.84 4974.84 74 3681.38 percent of total billed charges 4974.84 93 4029.62 percent of total billed charges 4974.84 4974.84 other OPPS APC 4974.84 4974.84 other OPPS APC 4974.84 27.63 1374.55 percent of total billed charges 4974.84 4974.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 140MM TITANIUM 5MM LOCKING SCREW 5 HOLE LISS BONE RIGHT PROXIMAL TIBIA NS SUP-422.300 CDM outpatient 4974.84 4974.84 4974.84 4974.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LISS 140MM TITANIUM NS TIBIA LEFT PROXIMAL 5 HOLE 5MM LOCK SCREW SUP-422.301 CDM 270010022 LOCAL 0270 RC outpatient 4974.84 4974.84 4974.84 74 3681.38 percent of total billed charges 4974.84 93 4029.62 percent of total billed charges 4974.84 4974.84 other OPPS APC 4974.84 4974.84 other OPPS APC 4974.84 27.63 1374.55 percent of total billed charges 4974.84 4974.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LISS TITANIUM L220 MM OD3.5 MM RIGHT PROXIMAL TIBIA 9 HOLE NONSTERILE 5 MM LOCKING SCREW SUP-422.304 CDM 270010022 LOCAL 0270 RC outpatient 4974.84 4974.84 4974.84 74 3681.38 percent of total billed charges 4974.84 93 4029.62 percent of total billed charges 4974.84 4974.84 other OPPS APC 4974.84 4974.84 other OPPS APC 4974.84 27.63 1374.55 percent of total billed charges 4974.84 4974.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LISS TITANIUM L220 MM LEFT PROXIMAL TIBIA 9 HOLE NONSTERILE 5 MM LOCKING SCREW SUP-422.305 CDM 270010022 LOCAL 0270 RC outpatient 4974.84 4974.84 4974.84 74 3681.38 percent of total billed charges 4974.84 93 4029.62 percent of total billed charges 4974.84 4974.84 other OPPS APC 4974.84 4974.84 other OPPS APC 4974.84 27.63 1374.55 percent of total billed charges 4974.84 4974.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LISS TITANIUM L300 MM RIGHT PROXIMAL TIBIA 13 HOLE NONSTERILE 5 MM LOCKING SCREW SUP-422.308 CDM 270010022 LOCAL 0270 RC outpatient 4974.84 4974.84 4974.84 74 3681.38 percent of total billed charges 4974.84 93 4029.62 percent of total billed charges 4974.84 4974.84 other OPPS APC 4974.84 4974.84 other OPPS APC 4974.84 27.63 1374.55 percent of total billed charges 4974.84 4974.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LISS 300MM TITANIUM NS TIBIA LEFT PROXIMAL 13 HOLE 5MM LOCK SCREW SUP-422.309 CDM 270010022 LOCAL 0270 RC outpatient 4974.84 4974.84 4974.84 74 3681.38 percent of total billed charges 4974.84 93 4029.62 percent of total billed charges 4974.84 4974.84 other OPPS APC 4974.84 4974.84 other OPPS APC 4974.84 27.63 1374.55 percent of total billed charges 4974.84 4974.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LISS TITANIUM L156 MM FEMUR RIGHT DISTAL 5 HOLE NONSTERILE 5 MM LOCK SCREW SUP-422.34 CDM 270010022 LOCAL 0270 RC outpatient 4454.74 4454.74 4454.74 74 3296.51 percent of total billed charges 4454.74 93 3608.34 percent of total billed charges 4454.74 4454.74 other OPPS APC 4454.74 4454.74 other OPPS APC 4454.74 27.63 1230.84 percent of total billed charges 4454.74 4454.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 156MM TITANIUM 5MM LOCK SCREW 5 HOLE LISS BONE FEMUR RIGHT DISTAL NS SUP-422.340 CDM outpatient 4454.74 4454.74 4454.74 4454.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LISS TITANIUM L156 MM LEFT DISTAL FEMUR 5 HOLE NONSTERILE 5 MM LOCKING SCREW SUP-422.341 CDM 270010022 LOCAL 0270 RC outpatient 4974.84 4974.84 4974.84 74 3681.38 percent of total billed charges 4974.84 93 4029.62 percent of total billed charges 4974.84 4974.84 other OPPS APC 4974.84 4974.84 other OPPS APC 4974.84 27.63 1374.55 percent of total billed charges 4974.84 4974.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LISS TITANIUM L236 MM RIGHT DISTAL FEMUR 9 HOLE NONSTERILE 5 MM LOCKING SCREW SUP-422.344 CDM 270010022 LOCAL 0270 RC outpatient 4974.84 4974.84 4974.84 74 3681.38 percent of total billed charges 4974.84 93 4029.62 percent of total billed charges 4974.84 4974.84 other OPPS APC 4974.84 4974.84 other OPPS APC 4974.84 27.63 1374.55 percent of total billed charges 4974.84 4974.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LISS TITANIUM LEFT ANGLE L236 MM LEFT DISTAL FEMUR 9 HOLE NONSTERILE 5 MM LOCKING SCREW SUP-422.345 CDM 270010022 LOCAL 0270 RC outpatient 4974.84 4974.84 4974.84 74 3681.38 percent of total billed charges 4974.84 93 4029.62 percent of total billed charges 4974.84 4974.84 other OPPS APC 4974.84 4974.84 other OPPS APC 4974.84 27.63 1374.55 percent of total billed charges 4974.84 4974.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LISS TITANIUM L316 MM RIGHT DISTAL FEMUR 13 HOLE NONSTERILE 5 MM LOCKING SCREW SUP-422.348 CDM 270010022 LOCAL 0270 RC outpatient 4974.84 4974.84 4974.84 74 3681.38 percent of total billed charges 4974.84 93 4029.62 percent of total billed charges 4974.84 4974.84 other OPPS APC 4974.84 4974.84 other OPPS APC 4974.84 27.63 1374.55 percent of total billed charges 4974.84 4974.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LISS TITANIUM L316 MM LEFT DISTAL FEMUR 13 HOLE NONSTERILE 5 MM LOCKING SCREW SUP-422.349 CDM 270010022 LOCAL 0270 RC outpatient 4454.74 4454.74 4454.74 74 3296.51 percent of total billed charges 4454.74 93 3608.34 percent of total billed charges 4454.74 4454.74 other OPPS APC 4454.74 4454.74 other OPPS APC 4454.74 27.63 1230.84 percent of total billed charges 4454.74 4454.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT SCREW HOLE LISS 5MM TITANIUM NS SUP-422.39 CDM 270010022 LOCAL 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT SCREW HOLE 5MM LISS FEMUR TITANIUM NS SUP-422.390 CDM outpatient 290.16 290.16 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM 3.5 MM CONE HEXAGON L18 MM OD5 MM ODSEC4.4 MM FEMUR TIBIA SELF DRILL THREAD NONSTERILE LISS SUP-422.391 CDM 270010022 LOCAL 0270 RC outpatient 560.56 560.56 560.56 74 414.81 percent of total billed charges 560.56 93 454.05 percent of total billed charges 560.56 560.56 other OPPS APC 560.56 560.56 other OPPS APC 560.56 27.63 154.88 percent of total billed charges 560.56 560.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM OD4.4 MM L26 MM OD5 MM ODSEC3.5 MM FEMUR DISTAL SELF DRILL LOCK THREAD CONICAL HEAD HEXAGONAL NONSTERILE LISS SUP-422.392 CDM 270010022 LOCAL 0270 RC outpatient 560.56 560.56 560.56 74 414.81 percent of total billed charges 560.56 93 454.05 percent of total billed charges 560.56 560.56 other OPPS APC 560.56 560.56 other OPPS APC 560.56 27.63 154.88 percent of total billed charges 560.56 560.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 40MM 5MM TITANIUM NS FEMUR DISTAL SELF DRILL LOCK THREAD CONICAL HEAD HEXAGONAL LISS SUP-422.393 CDM 270010022 LOCAL 0270 RC outpatient 560.56 560.56 560.56 74 414.81 percent of total billed charges 560.56 93 454.05 percent of total billed charges 560.56 560.56 other OPPS APC 560.56 560.56 other OPPS APC 560.56 27.63 154.88 percent of total billed charges 560.56 560.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM OD4.4 MM L55 MM OD5 MM ODSEC3.5 MM FEMUR DISTAL SELF DRILL LOCK THREAD CONICAL HEAD HEXAGONAL NONSTERILE LISS SUP-422.394 CDM 270010022 LOCAL 0270 RC outpatient 569.14 569.14 569.14 74 421.16 percent of total billed charges 569.14 93 461 percent of total billed charges 569.14 569.14 other OPPS APC 569.14 569.14 other OPPS APC 569.14 27.63 157.25 percent of total billed charges 569.14 569.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 65MM 5MM TITANIUM NS FEMUR DISTAL SELF DRILL LOCK THREAD CONICAL HEAD HEXAGONAL LISS SUP-422.395 CDM 270010022 LOCAL 0270 RC outpatient 569.14 569.14 569.14 74 421.16 percent of total billed charges 569.14 93 461 percent of total billed charges 569.14 569.14 other OPPS APC 569.14 569.14 other OPPS APC 569.14 27.63 157.25 percent of total billed charges 569.14 569.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP TITANIUM OD4.4 MM L75 MM OD5 MM ODSEC3.5 MM FEMUR DISTAL SELF DRILL LOCK THREAD CONICAL HEAD HEXAGONAL NONSTERILE LISS SUP-422.396 CDM 270010022 LOCAL 0270 RC outpatient 569.14 569.14 569.14 74 421.16 percent of total billed charges 569.14 93 461 percent of total billed charges 569.14 569.14 other OPPS APC 569.14 569.14 other OPPS APC 569.14 27.63 157.25 percent of total billed charges 569.14 569.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCP LISS TITANIUM 3.5 MM L85 MM OD5 MM ODSEC4.4 MM FEMUR TIBIA SELF DRILLING LOCKING THREADED CONICAL HEAD HEXAGONAL RECESS NONSTERILE SUP-422.397 CDM 270010022 LOCAL 0270 RC outpatient 569.14 569.14 569.14 74 421.16 percent of total billed charges 569.14 93 461 percent of total billed charges 569.14 569.14 other OPPS APC 569.14 569.14 other OPPS APC 569.14 27.63 157.25 percent of total billed charges 569.14 569.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE STRATA NSC REGULAR SUP-42365_62190 CDM 0270 RC outpatient 13784.7 13784.7 13784.7 74 10200.7 percent of total billed charges 13784.7 93 11165.6 percent of total billed charges 13784.7 13784.7 other OPPS APC 13784.7 13784.7 other OPPS APC 13784.7 27.63 3808.71 percent of total billed charges 13784.7 13784.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR PINNACLE 58MM POROCOAT STERILE LF HIP MULTIHOLE SUP-42395 CDM C1713 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANESTHESIA TUBING SUP-42401E-07 CDM 0270 RC outpatient 11.53 11.53 11.53 74 8.53 percent of total billed charges 11.53 93 9.34 percent of total billed charges 11.53 11.53 other OPPS APC 11.53 11.53 other OPPS APC 11.53 27.63 3.19 percent of total billed charges 11.53 11.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANESTHESIA SET SMART SITE 2 CHECKVALVES 4 NEEDLE-FREE VALVES 3 PORT MANIFOLD VENTED/NONVENTED SUP-42504E CDM 0270 RC outpatient 12.53 12.53 12.53 74 9.27 percent of total billed charges 12.53 93 10.15 percent of total billed charges 12.53 12.53 other OPPS APC 12.53 12.53 other OPPS APC 12.53 27.63 3.46 percent of total billed charges 12.53 12.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION CORDIS SLEEK RX 150CM 40MM 4FR 2MM QUADFLEX LF INFRAPOPLITEAL VESSEL 2 LUMEN RAPID EXCHANGE SUP-4252004X CDM 0270 RC outpatient 767 767 767 74 567.58 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 27.63 211.92 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION CORDIS SLEEK RX 150CM 100MM 4FR 2MM QUADFLEX LF INFRAPOPLITEAL VESSEL 2 LUMEN RAPID EXCHANGE SUP-4252010X CDM 0270 RC outpatient 767 767 767 74 567.58 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 27.63 211.92 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION CORDIS SLEEK RX 150CM 100MM 4FR 3MM QUADFLEX LF INFRAPOPLITEAL VESSEL 2 LUMEN RAPID EXCHANGE SUP-4253010X CDM 0270 RC outpatient 767 767 767 74 567.58 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 27.63 211.92 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION CORDIS SLEEK RX 150CM 40MM 4FR 4MM QUADFLEX LF INFRAPOPLITEAL VESSEL 2 LUMEN RAPID EXCHANGE SUP-4254004X CDM 0270 RC outpatient 767 767 767 74 567.58 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 27.63 211.92 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLANKET WARMING 3M BAIR HUGGER 60X36IN WHITE POLYMER DISPOSABLE STERILE LF ADULT 4OZ LOWER BODY AIR SYSTEM LIGHTWEIGHT SUP-42568 CDM 0270 RC outpatient 11.5 11.5 11.5 74 8.51 percent of total billed charges 11.5 93 9.32 percent of total billed charges 11.5 11.5 other OPPS APC 11.5 11.5 other OPPS APC 11.5 27.63 3.18 percent of total billed charges 11.5 11.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE DELTA REG PRESS LEVEL 1 IMP SUP-42822 CDM 0270 RC outpatient 5164.54 5164.54 5164.54 74 3821.76 percent of total billed charges 5164.54 93 4183.28 percent of total billed charges 5164.54 5164.54 other OPPS APC 5164.54 5164.54 other OPPS APC 5164.54 27.63 1426.96 percent of total billed charges 5164.54 5164.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE DELTA REG LEVEL 1.5 SUP-42823 CDM 0270 RC outpatient 4996.99 4996.99 4996.99 74 3697.77 percent of total billed charges 4996.99 93 4047.56 percent of total billed charges 4996.99 4996.99 other OPPS APC 4996.99 4996.99 other OPPS APC 4996.99 27.63 1380.67 percent of total billed charges 4996.99 4996.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE DELTA REG PRESS LEVEL 2 IMP SUP-42824 CDM 0270 RC outpatient 5007.37 5007.37 5007.37 74 3705.45 percent of total billed charges 5007.37 93 4055.97 percent of total billed charges 5007.37 5007.37 other OPPS APC 5007.37 5007.37 other OPPS APC 5007.37 27.63 1383.54 percent of total billed charges 5007.37 5007.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE SHUNT STRATA II REGULAR CSF PROGRAMMABLE FLOW CONTROL BALL SPRING MECHANISM BIOGLIDE STERILE SUP-42866 CDM 0270 RC outpatient 16191 16191 16191 74 11981.4 percent of total billed charges 16191 93 13114.7 percent of total billed charges 16191 16191 other OPPS APC 16191 16191 other OPPS APC 16191 27.63 4473.58 percent of total billed charges 16191 16191 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC ACTICOR 7 HF-T SUP-429523_74454 CDM 0270 RC outpatient 35100 35100 35100 74 25974 percent of total billed charges 35100 93 28431 percent of total billed charges 35100 35100 other OPPS APC 35100 35100 other OPPS APC 35100 27.63 9698.13 percent of total billed charges 35100 35100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC ACTICOR 7 VR-T DX SUP-429525_74451 CDM 0270 RC outpatient 22100 22100 22100 74 16354 percent of total billed charges 22100 93 17901 percent of total billed charges 22100 22100 other OPPS APC 22100 22100 other OPPS APC 22100 27.63 6106.23 percent of total billed charges 22100 22100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ATTAIN ABILITY PLUS L78 CM OD5.3 FR LEFT HEART 2 ELECTRODE OTW SUP-429678 CDM 0275 RC outpatient 3463.2 3463.2 3463.2 57 1974.02 percent of total billed charges 3463.2 93 2805.19 percent of total billed charges 3463.2 3463.2 other OPPS APC 3463.2 3463.2 other OPPS APC 3463.2 51 1766.23 percent of total billed charges 3463.2 3463.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ATTAIN ABILITY PLUS STEROID ELUTING POLYURETHANE 2 CURVE L88 CM SUP-429688 CDM 0275 RC outpatient 3463.2 3463.2 3463.2 57 1974.02 percent of total billed charges 3463.2 93 2805.19 percent of total billed charges 3463.2 3463.2 other OPPS APC 3463.2 3463.2 other OPPS APC 3463.2 51 1766.23 percent of total billed charges 3463.2 3463.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ATTAIN PERFORMA STARFIX STEROID ELUTING PLATINUM IRIDIUM SI POLYIMIDE POLYURETHANE .014-.018 IN L78 CM OD5.3 FR ODSEC5.1 FR LEFT VENTRICLE QUADRIPOLAR IS4-LLLL CONNECTOR PASSIVE DUAL CANT FIXATION LATEX FREE SUP-429878 CDM 0275 RC outpatient 4420 4420 4420 57 2519.4 percent of total billed charges 4420 93 3580.2 percent of total billed charges 4420 4420 other OPPS APC 4420 4420 other OPPS APC 4420 51 2254.2 percent of total billed charges 4420 4420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD ATTAIN PERFORMA QUADPOLE SUP-429878/88 CDM 0275 RC outpatient 5428.8 5428.8 5428.8 57 3094.42 percent of total billed charges 5428.8 93 4397.33 percent of total billed charges 5428.8 5428.8 other OPPS APC 5428.8 5428.8 other OPPS APC 5428.8 51 2768.69 percent of total billed charges 5428.8 5428.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ATTAIN STARFIX LEFT VENTRICLE SUP-429888 CDM 0275 RC outpatient 4420 4420 4420 57 2519.4 percent of total billed charges 4420 93 3580.2 percent of total billed charges 4420 4420 other OPPS APC 4420 4420 other OPPS APC 4420 51 2254.2 percent of total billed charges 4420 4420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5MM VA LOCKING SCREW 80MM SUP-43.231.280 CDM 0270 RC outpatient 484.77 484.77 484.77 74 358.73 percent of total billed charges 484.77 93 392.66 percent of total billed charges 484.77 484.77 other OPPS APC 484.77 484.77 other OPPS APC 484.77 27.63 133.94 percent of total billed charges 484.77 484.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5MM VA LOCKING SCREW 90MM SUP-43.231.290 CDM 0270 RC outpatient 484.77 484.77 484.77 74 358.73 percent of total billed charges 484.77 93 392.66 percent of total billed charges 484.77 484.77 other OPPS APC 484.77 484.77 other OPPS APC 484.77 27.63 133.94 percent of total billed charges 484.77 484.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARRIER ADHESION SEPRAFILM 6X5IN DISPOSABLE STERILE LF SUP-4301-02 CDM 0270 RC outpatient 756.4 756.4 756.4 74 559.74 percent of total billed charges 756.4 93 612.68 percent of total billed charges 756.4 756.4 other OPPS APC 756.4 756.4 other OPPS APC 756.4 27.63 208.99 percent of total billed charges 756.4 756.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY SPINAL STANDARD 3.5IN 20GA CLEAR STERILE LF ADULT SPINAL NEEDLE LUMBAR PUNCTURE SUP-4301C CDM 270009046 LOCAL 0270 RC outpatient 26.2 26.2 26.2 74 19.39 percent of total billed charges 26.2 93 21.22 percent of total billed charges 26.2 26.2 other OPPS APC 26.2 26.2 other OPPS APC 26.2 27.63 7.24 percent of total billed charges 26.2 26.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY SPINAL 350 MM STANDARD L2 1/2 IN OD21 GA 5 ML NEEDLE MANOMETER SYRINGE 3 WAY STOPCOCK STERILE LATEX FREE LUMBAR PUNCTURE SUP-4304C CDM 270009046 LOCAL 0270 RC outpatient 26.2 26.2 26.2 74 19.39 percent of total billed charges 26.2 93 21.22 percent of total billed charges 26.2 26.2 other OPPS APC 26.2 26.2 other OPPS APC 26.2 27.63 7.24 percent of total billed charges 26.2 26.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOLD SHOULDER 6 STD 42X18X46 SUP-431406 CDM 0270 RC outpatient 5657.6 5657.6 5657.6 74 4186.62 percent of total billed charges 5657.6 93 4582.66 percent of total billed charges 5657.6 5657.6 other OPPS APC 5657.6 5657.6 other OPPS APC 5657.6 27.63 1563.19 percent of total billed charges 5657.6 5657.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOLD SHOULDER 8 STD 42X18X53 SUP-431408 CDM 0270 RC outpatient 5657.6 5657.6 5657.6 74 4186.62 percent of total billed charges 5657.6 93 4582.66 percent of total billed charges 5657.6 5657.6 other OPPS APC 5657.6 5657.6 other OPPS APC 5657.6 27.63 1563.19 percent of total billed charges 5657.6 5657.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOLD SHOULDER 10 STD 50X21X57 SUP-431410 CDM 0270 RC outpatient 5657.6 5657.6 5657.6 74 4186.62 percent of total billed charges 5657.6 93 4582.66 percent of total billed charges 5657.6 5657.6 other OPPS APC 5657.6 5657.6 other OPPS APC 5657.6 27.63 1563.19 percent of total billed charges 5657.6 5657.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOLD SHOULDER 612STD 54X21X64 SUP-431412 CDM 0270 RC outpatient 5748.6 5748.6 5748.6 74 4253.96 percent of total billed charges 5748.6 93 4656.37 percent of total billed charges 5748.6 5748.6 other OPPS APC 5748.6 5748.6 other OPPS APC 5748.6 27.63 1588.34 percent of total billed charges 5748.6 5748.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOLD SHOULDER 14 STD 58X24X64 SUP-431414 CDM 0270 RC outpatient 5748.6 5748.6 5748.6 74 4253.96 percent of total billed charges 5748.6 93 4656.37 percent of total billed charges 5748.6 5748.6 other OPPS APC 5748.6 5748.6 other OPPS APC 5748.6 27.63 1588.34 percent of total billed charges 5748.6 5748.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER IMPRESS KA 2 40CM .038 SUP-43312 CDM 0272 RC outpatient 45.76 45.76 45.76 45.76 other OPPS APC 45.76 45.76 other OPPS APC 45.76 27.63 12.64 percent of total billed charges 45.76 45.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER APR HOODED STANDARD POLY 55MM X 32MM SUP-4338-32-055 CDM 270010024 LOCAL 0270 RC outpatient 2262 2262 2262 74 1673.88 percent of total billed charges 2262 93 1832.22 percent of total billed charges 2262 2262 other OPPS APC 2262 2262 other OPPS APC 2262 27.63 624.99 percent of total billed charges 2262 2262 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT COVERED CORONARY PAPYRUS PK 2.5 X 20 SUP-434893_64031 CDM 0481 RC outpatient 7020 7020 7020 74 5194.8 percent of total billed charges 7020 93 5686.2 percent of total billed charges 7020 7020 other OPPS APC 7020 7020 other OPPS APC 7020 51 3580.2 percent of total billed charges 7020 7020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY COVERED PAPYRUS PK 3.5 X 20 SUP-434895_64032 CDM 0481 RC outpatient 7020 7020 7020 74 5194.8 percent of total billed charges 7020 93 5686.2 percent of total billed charges 7020 7020 other OPPS APC 7020 7020 other OPPS APC 7020 51 3580.2 percent of total billed charges 7020 7020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORNARY COVERED PAPYRUS PK 4.5 X 20 SUP-434897_64033 CDM 0481 RC outpatient 7020 7020 7020 74 5194.8 percent of total billed charges 7020 93 5686.2 percent of total billed charges 7020 7020 other OPPS APC 7020 7020 other OPPS APC 7020 51 3580.2 percent of total billed charges 7020 7020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARRIER ADHESION INTERCEED L4 IN X W3 IN PELVIS ABSORBABLE STERILE SUP-4350 CDM 0270 RC outpatient 834.87 834.87 834.87 74 617.8 percent of total billed charges 834.87 93 676.24 percent of total billed charges 834.87 834.87 other OPPS APC 834.87 834.87 other OPPS APC 834.87 27.63 230.67 percent of total billed charges 834.87 834.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER NEUROSURGICAL STANDARD PERITONEUM CSF STERILE CP SUP-43522 CDM 0270 RC outpatient 584.06 584.06 584.06 74 432.2 percent of total billed charges 584.06 93 473.09 percent of total billed charges 584.06 584.06 other OPPS APC 584.06 584.06 other OPPS APC 584.06 27.63 161.38 percent of total billed charges 584.06 584.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD DEFIBRILLATOR PLEXA PROMRI L65 CM L15 CM CARDIAC DF4 STERILE LATEX FREE DISPOSABLE S DX SUP-436909_74452 CDM 0270 RC outpatient 5850 5850 5850 74 4329 percent of total billed charges 5850 93 4738.5 percent of total billed charges 5850 5850 other OPPS APC 5850 5850 other OPPS APC 5850 27.63 1616.36 percent of total billed charges 5850 5850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER STEM MODULAR HIP SIZE 27MM +0 SUP-43792 CDM C1776 HCPCS 0278 RC outpatient 8284 8284 8284 57 4721.88 percent of total billed charges 8284 93 6710.04 percent of total billed charges 8284 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8284 other OPPS APC 8284 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8284 other OPPS APC 8284 51 4224.84 percent of total billed charges 8284 8284 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER STEM MODULAR HIP SIZE 27MM +20 SUP-43794 CDM C1776 HCPCS 0278 RC outpatient 8284 8284 8284 57 4721.88 percent of total billed charges 8284 93 6710.04 percent of total billed charges 8284 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8284 other OPPS APC 8284 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8284 other OPPS APC 8284 51 4224.84 percent of total billed charges 8284 8284 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI TITANIUM CONTOUR L81 MM TIBIA LEFT PROXIMAL 4 HOLE LIMIT CONTACT 3.5 MM SCREW SUP-439.935 CDM 270010022 LOCAL 0270 RC outpatient 4026.88 4026.88 4026.88 74 2979.89 percent of total billed charges 4026.88 93 3261.77 percent of total billed charges 4026.88 4026.88 other OPPS APC 4026.88 4026.88 other OPPS APC 4026.88 27.63 1112.63 percent of total billed charges 4026.88 4026.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS BIPOLAR L31 CM OD5 MM CONNECTOR POWERBLADE SUP-4393.3865 CDM 0270 RC outpatient 709.97 709.97 709.97 74 525.38 percent of total billed charges 709.97 93 575.08 percent of total billed charges 709.97 709.97 other OPPS APC 709.97 709.97 other OPPS APC 709.97 27.63 196.16 percent of total billed charges 709.97 709.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ATTAIN ABILITY STRAIGHT L78 CM CORONARY VEIN 2 ELECTRODE TINED OTW SUP-439678 CDM 0275 RC outpatient 3463.2 3463.2 3463.2 57 1974.02 percent of total billed charges 3463.2 93 2805.19 percent of total billed charges 3463.2 3463.2 other OPPS APC 3463.2 3463.2 other OPPS APC 3463.2 51 1766.23 percent of total billed charges 3463.2 3463.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ATTAIN ABILITY STRAIGHT L88 CM CORONARY VEIN 2 ELECTRODE TINED OTW SUP-439688 CDM 0275 RC outpatient 3463.2 3463.2 3463.2 57 1974.02 percent of total billed charges 3463.2 93 2805.19 percent of total billed charges 3463.2 3463.2 other OPPS APC 3463.2 3463.2 other OPPS APC 3463.2 51 1766.23 percent of total billed charges 3463.2 3463.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ATTAIN PERFORMA STARFIX STEROID PLATINUM IRIDIUM SI POLYIMIDE POLYURETHANE OD3.9 FR .36-.46 MM L78 CM OD5.3 FR ODSEC5.1 FR LEFT VENTRICLE QUADRIPOLAR IS4-LLLL CONNECTOR PASSIVE TINE FIXATION GUIDEWIRE LATEX FREE SUP-439878 CDM 0275 RC outpatient 4420 4420 4420 57 2519.4 percent of total billed charges 4420 93 3580.2 percent of total billed charges 4420 4420 other OPPS APC 4420 4420 other OPPS APC 4420 51 2254.2 percent of total billed charges 4420 4420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD ATTAIN PERFORMA QUADRAPOLE SUP-439878/88 CDM 0275 RC outpatient 5428.8 5428.8 5428.8 57 3094.42 percent of total billed charges 5428.8 93 4397.33 percent of total billed charges 5428.8 5428.8 other OPPS APC 5428.8 5428.8 other OPPS APC 5428.8 51 2768.69 percent of total billed charges 5428.8 5428.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ATTAIN PERFORMA STARFIX STEROID PLATINUM IRIDIUM SI POLYIMIDE POLYURETHANE OD3.9 FR .36-.46 MM L88 CM OD5.3 FR ODSEC5.1 FR LEFT VENTRICLE QUADRIPOLAR IS4-LLLL CONNECTOR PASSIVE TINE FIXATION GUIDEWIRE LATEX FREE SUP-439888 CDM 0275 RC outpatient 4420 4420 4420 57 2519.4 percent of total billed charges 4420 93 3580.2 percent of total billed charges 4420 4420 other OPPS APC 4420 4420 other OPPS APC 4420 51 2254.2 percent of total billed charges 4420 4420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE FLOW CONTROL FLOSWITCH 1050 PSI 1 WAY HIGH PRESSURE SUP-44-200 CDM 0270 RC outpatient 11.16 11.16 11.16 74 8.26 percent of total billed charges 11.16 93 9.04 percent of total billed charges 11.16 11.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL MACROLYTE NEONATE L10 FT DISPERSIVE PREATTACH CABLE STERILE LATEX FREE DISPOSABLE SUP-440-2400 CDM outpatient 6.99 6.99 6.99 6.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION POWERFLEX PRO DURALYN L135 CM L150 MM OD5 FR ODSEC4 MM PERIPHERAL OTW LOW PROFILE MODERATE TO HIGH PRESSURE MARKER BAND ACCEPTS .035 IN GUIDEWIRE 5 FR SHEATH PTA SUP-4400415X CDM 0270 RC outpatient 369.2 369.2 369.2 74 273.21 percent of total billed charges 369.2 93 299.05 percent of total billed charges 369.2 369.2 other OPPS APC 369.2 369.2 other OPPS APC 369.2 27.63 102.01 percent of total billed charges 369.2 369.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION CORDIS POWERFLEX PRO DURALYN MDX L135 CM L100 MM OD5 FR ODSEC5 MM PERIPHERAL 2 LUMEN OTW LOW PROFILE RADIOPAQUE LATEX FREE ACCEPTS .035 IN GUIDEWIRE 5 FR SHEATH PTA SUP-4400510X CDM 0270 RC outpatient 340.6 340.6 340.6 74 252.04 percent of total billed charges 340.6 93 275.89 percent of total billed charges 340.6 340.6 other OPPS APC 340.6 340.6 other OPPS APC 340.6 27.63 94.11 percent of total billed charges 340.6 340.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION POWERFLEX PRO DURALYN .035 IN LOW PROFILE L135 CM L80 MM OD5 FR ODSEC7 MM PERIPHERAL OTW MODERATE TO HIGH PRESSURE GUIDEWIRE MARKER BAND PTA SUP-4400708X CDM 0270 RC outpatient 340.6 340.6 340.6 74 252.04 percent of total billed charges 340.6 93 275.89 percent of total billed charges 340.6 340.6 other OPPS APC 340.6 340.6 other OPPS APC 340.6 27.63 94.11 percent of total billed charges 340.6 340.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SURGICAL CLIPPER SENSICLIP NARROW W25 MM X H.23 MM 3 EASY TO CHANGE TAPER HEAD LATEX FREE DISPOSABLE PINK SUP-4403A CDM 0270 RC outpatient 7.75 7.75 7.75 74 5.74 percent of total billed charges 7.75 93 6.28 percent of total billed charges 7.75 7.75 other OPPS APC 7.75 7.75 other OPPS APC 7.75 27.63 2.14 percent of total billed charges 7.75 7.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACKING NASAL MEROCEL POPE EPISTAXIS SUP-440406 CDM 0270 RC outpatient 105.56 105.56 105.56 74 78.11 percent of total billed charges 105.56 93 85.5 percent of total billed charges 105.56 105.56 other OPPS APC 105.56 105.56 other OPPS APC 105.56 27.63 29.17 percent of total billed charges 105.56 105.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SURGICAL CLIPPER WIDE W37.2 MM H.23 MM GENERAL PURPOSE EXIST HANDLE DROP IN CHARGE NONSTERILE LATEX FREE DISPOSABLE SUP-4406 CDM 0270 RC outpatient 5.12 5.12 5.12 74 3.79 percent of total billed charges 5.12 93 4.15 percent of total billed charges 5.12 5.12 other OPPS APC 5.12 5.12 other OPPS APC 5.12 27.63 1.41 percent of total billed charges 5.12 5.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP COMBI PHILOS TITANIUM STANDARD L90 MM X W12 MM X H2.5 MM HUMERUS PROXIMAL 3 HOLE SHAFT LOCK COMPRESSION PRECONTOUR NONSTERILE 3.5 MM SCREW SMALL FRAGMENT SET SUP-441.901 CDM 0270 RC outpatient 4468.75 4468.75 4468.75 74 3306.88 percent of total billed charges 4468.75 93 3619.69 percent of total billed charges 4468.75 4468.75 other OPPS APC 4468.75 4468.75 other OPPS APC 4468.75 27.63 1234.72 percent of total billed charges 4468.75 4468.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE ADHESIVE COVERLET 3.75 X 2IN FABRIC STERILE LF PATCH XL WOUND PAD ABSORBENT ELASTIC SUP-44102- CDM 270009017 LOCAL 0270 RC outpatient 0.11 0.11 0.11 74 0.08 percent of total billed charges 0.11 93 0.09 percent of total billed charges 0.11 0.11 other OPPS APC 0.11 0.11 other OPPS APC 0.11 27.63 0.03 percent of total billed charges 0.11 0.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION CHARLOTTE 150MM 1.6MM DISPOSABLE NS 1 TROCAR MULTIUSE COMPRESSION SUP-44112008 CDM 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE ADHESIVE BIOCLONE ANTI C L3 IN X W1 IN L1 IN X W7/8 IN 5 ML SHEER STERILE LATEX FREE SUP-44119 CDM 0270 RC outpatient 0.04 0.04 0.04 74 0.03 percent of total billed charges 0.04 93 0.03 percent of total billed charges 0.04 0.04 other OPPS APC 0.04 0.04 other OPPS APC 0.04 27.63 0.01 percent of total billed charges 0.04 0.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE ADHESIVE CURITY 3/8X3/8IN 7/8IN PLASTIC STERILE LF SHEER SPOT PAD SUP-44120 CDM 0270 RC outpatient 0.02 0.02 0.02 74 0.01 percent of total billed charges 0.02 93 0.02 percent of total billed charges 0.02 0.02 other OPPS APC 0.02 0.02 other OPPS APC 0.02 27.63 0.01 percent of total billed charges 0.02 0.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPONGE GAUZE DERMACEA L2 IN X W2 IN 8 PLY USP TYPE VII STERILE LATEX FREE DISPOSABLE SUP-441204 CDM 0270 RC outpatient 0.03 0.03 0.03 74 0.02 percent of total billed charges 0.03 93 0.02 percent of total billed charges 0.03 0.03 other OPPS APC 0.03 0.03 other OPPS APC 0.03 27.63 0.01 percent of total billed charges 0.03 0.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SURGICAL CLIPPER DISPOSABLE NS LF SPECIALTY SURGICAL COARSE HAIR SUP-4412A CDM 0270 RC outpatient 20.75 20.75 20.75 74 15.36 percent of total billed charges 20.75 93 16.81 percent of total billed charges 20.75 20.75 other OPPS APC 20.75 20.75 other OPPS APC 20.75 27.63 5.73 percent of total billed charges 20.75 20.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WRENCH SURGICAL HEXAGON LEAD SUP-442-2 CDM 0270 RC outpatient 58.5 58.5 58.5 74 43.29 percent of total billed charges 58.5 93 47.39 percent of total billed charges 58.5 58.5 other OPPS APC 58.5 58.5 other OPPS APC 58.5 27.63 16.16 percent of total billed charges 58.5 58.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STANDARD BEND TITANIUM WRIST 8 HOLE FUSION 2.7/3.5MM CORTEX SCREW SUP-442.51 CDM 270010022 LOCAL 0270 RC outpatient 3161.34 3161.34 3161.34 74 2339.39 percent of total billed charges 3161.34 93 2560.69 percent of total billed charges 3161.34 3161.34 other OPPS APC 3161.34 3161.34 other OPPS APC 3161.34 27.63 873.48 percent of total billed charges 3161.34 3161.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE SHORT BEND TITANIUM WRIST 8 HOLE FUSION 2.7/3.5MM CORTEX SCREW SUP-442.52 CDM 270010022 LOCAL 0270 RC outpatient 3161.34 3161.34 3161.34 74 2339.39 percent of total billed charges 3161.34 93 2560.69 percent of total billed charges 3161.34 3161.34 other OPPS APC 3161.34 3161.34 other OPPS APC 3161.34 27.63 873.48 percent of total billed charges 3161.34 3161.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INTRAVENOUS CATHLON TEFLON L1.75 IN OD18 GA NONRADIOPAQUE STERILE LATEX FREE GREEN SUP-442411 CDM outpatient 7.45 7.45 7.45 7.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INTRAVENOUS CATHLON JELCO FEP POLYMER L1.25 IN OD20 GA PERIPHERAL NONRADIOPAQUE STRAIGHT METAL HUB SUTURE RING TAPERED TIP SELF VENTING FLASH PLUG STERILE LATEX FREE DISPOSABLE CLEAR SUP-442611 CDM 0270 RC outpatient 6.68 6.68 6.68 74 4.94 percent of total billed charges 6.68 93 5.41 percent of total billed charges 6.68 6.68 other OPPS APC 6.68 6.68 other OPPS APC 6.68 27.63 1.85 percent of total billed charges 6.68 6.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INTRAVENOUS CATHLON JELCO FEP POLYMER L1.25 IN OD20 GA PERIPHERAL NONRADIOPAQUE STRAIGHT METAL HUB SUTURE RING TAPERED TIP SELF VENTING FLASH PLUG STERILE LATEX FREE DISPOSABLE CLEAR SUP-442620 CDM 0270 RC outpatient 6.68 6.68 6.68 74 4.94 percent of total billed charges 6.68 93 5.41 percent of total billed charges 6.68 6.68 other OPPS APC 6.68 6.68 other OPPS APC 6.68 27.63 1.85 percent of total billed charges 6.68 6.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCP TITANIUM L22 MM X W5 MM X H.9 MM ZYGOMATIC 4 HOLE 2 MM CORTICAL SCREW SUP-443.44 CDM 270010014 LOCAL 0270 RC outpatient 668.95 668.95 668.95 74 495.02 percent of total billed charges 668.95 93 541.85 percent of total billed charges 668.95 668.95 other OPPS APC 668.95 668.95 other OPPS APC 668.95 27.63 184.83 percent of total billed charges 668.95 668.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCP TITANIUM L27 MM X W5 MM X H.9 MM ZYGOMATIC 5 HOLE NONSTERILE 2 MM CORTICAL SCREW SUP-443.45 CDM 270010014 LOCAL 0270 RC outpatient 694.88 694.88 694.88 74 514.21 percent of total billed charges 694.88 93 562.85 percent of total billed charges 694.88 694.88 other OPPS APC 694.88 694.88 other OPPS APC 694.88 27.63 192 percent of total billed charges 694.88 694.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCP 32X5X.9MM TITANIUM NS ZYGOMATIC 6 HOLE 2MM CORTICAL SCREW SUP-443.46 CDM 270010014 LOCAL 0270 RC outpatient 746.75 746.75 746.75 74 552.6 percent of total billed charges 746.75 93 604.87 percent of total billed charges 746.75 746.75 other OPPS APC 746.75 746.75 other OPPS APC 746.75 27.63 206.33 percent of total billed charges 746.75 746.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 39X5X1.2MM TITANIUM NS HAND LEFT CONDYLE 7 HOLE MODULAR 2MM SCREW MINI FRAGMENT SUP-443.61.96 CDM 270010022 LOCAL 0270 RC outpatient 2199.34 2199.34 2199.34 74 1627.51 percent of total billed charges 2199.34 93 1781.47 percent of total billed charges 2199.34 2199.34 other OPPS APC 2199.34 2199.34 other OPPS APC 2199.34 27.63 607.68 percent of total billed charges 2199.34 2199.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 39X5X1.2MM TITANIUM NS HAND RIGHT CONDYLE 7 HOLE MODULAR 2MM SCREW MINI FRAGMENT SUP-443.62.96 CDM 270010022 LOCAL 0270 RC outpatient 2199.34 2199.34 2199.34 74 1627.51 percent of total billed charges 2199.34 93 1781.47 percent of total billed charges 2199.34 2199.34 other OPPS APC 2199.34 2199.34 other OPPS APC 2199.34 27.63 607.68 percent of total billed charges 2199.34 2199.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BTB HEMI SUP-443008 CDM 270010031 LOCAL 0270 RC outpatient 8320 8320 8320 74 6156.8 percent of total billed charges 8320 93 6739.2 percent of total billed charges 8320 8320 other OPPS APC 8320 8320 other OPPS APC 8320 27.63 2298.82 percent of total billed charges 8320 8320 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERONSUS LONGUS 220-300 6.5-8.5MM DIAMETER SUP-443043 CDM 270010031 LOCAL 0270 RC outpatient 4160 4160 4160 74 3078.4 percent of total billed charges 4160 93 3369.6 percent of total billed charges 4160 4160 other OPPS APC 4160 4160 other OPPS APC 4160 27.63 1149.41 percent of total billed charges 4160 4160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CATHETER PS MEDICAL BARIUM C14-24 CM H2O L84 CM OD20 GA ODSEC14 GA LUMBOPERITONEAL CONNECTOR 3 FIXATION TAB 2 NEEDLE SUP-44410 CDM 0270 RC outpatient 2303.81 2303.81 2303.81 74 1704.82 percent of total billed charges 2303.81 93 1866.09 percent of total billed charges 2303.81 2303.81 other OPPS APC 2303.81 2303.81 other OPPS APC 2303.81 27.63 636.54 percent of total billed charges 2303.81 2303.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY CARPENTIER EDWARDS 30MM SUP-4450-T30 CDM 0270 RC outpatient 7589.4 7589.4 7589.4 74 5616.16 percent of total billed charges 7589.4 93 6147.41 percent of total billed charges 7589.4 7589.4 other OPPS APC 7589.4 7589.4 other OPPS APC 7589.4 27.63 2096.95 percent of total billed charges 7589.4 7589.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING FINELINE II STEROX SUP-4456 CDM 0275 RC outpatient 1131 1131 1131 57 644.67 percent of total billed charges 1131 93 916.11 percent of total billed charges 1131 1131 other OPPS APC 1131 1131 other OPPS APC 1131 51 576.81 percent of total billed charges 1131 1131 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING FINELINE II STEROX SUP-4457 CDM 0275 RC outpatient 1131 1131 1131 57 644.67 percent of total billed charges 1131 93 916.11 percent of total billed charges 1131 1131 other OPPS APC 1131 1131 other OPPS APC 1131 51 576.81 percent of total billed charges 1131 1131 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING FINELINE II STEROX SILICONE L52 CM OD9 FR RIGHT VENTRICLE ENDOCARDIUM BIPOLAR IS-1 PASSIVE FIXATION TRANSVENOUS VDD 1 PASS PASSIVE FIXATION STERILE DISPOSABLE SUP-4458 CDM 0275 RC outpatient 1157 1157 1157 57 659.49 percent of total billed charges 1157 93 937.17 percent of total billed charges 1157 1157 other OPPS APC 1157 1157 other OPPS APC 1157 51 590.07 percent of total billed charges 1157 1157 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLEACH CLOROX 96OZ SUP-4458410 CDM 0270 RC outpatient 10.37 10.37 10.37 74 7.67 percent of total billed charges 10.37 93 8.4 percent of total billed charges 10.37 10.37 other OPPS APC 10.37 10.37 other OPPS APC 10.37 27.63 2.87 percent of total billed charges 10.37 10.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING FINELINE II STEROX STEROID ELUTING SILICONE L58 CM OD7 FR ENDOCARDIAL BIPOLAR PASSIVE FIXATION IS-1 SUP-4459 CDM 0275 RC outpatient 1157 1157 1157 57 659.49 percent of total billed charges 1157 93 937.17 percent of total billed charges 1157 1157 other OPPS APC 1157 1157 other OPPS APC 1157 51 590.07 percent of total billed charges 1157 1157 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM RECTANGLE L100 MM X W100 MM X H.3 MM CRANIOFACIAL CONTOURABLE MESH MALLEABLE ANATOMIC REDUCTION NONSTERILE TEAL 1.5 MM SCREW SUP-446.017 CDM 270010022 LOCAL 0270 RC outpatient 6401.72 6401.72 6401.72 74 4737.27 percent of total billed charges 6401.72 93 5185.39 percent of total billed charges 6401.72 6401.72 other OPPS APC 6401.72 6401.72 other OPPS APC 6401.72 27.63 1768.8 percent of total billed charges 6401.72 6401.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE RECTANGLE 100X100X.6MM GOLD TITANIUM NS CRANIOFACIAL CONTOURABLE MESH RIGID ANATOMIC REDUCTION 1.5MM SCREW SUP-446.018 CDM 270010022 LOCAL 0270 RC outpatient 6401.72 6401.72 6401.72 74 4737.27 percent of total billed charges 6401.72 93 5185.39 percent of total billed charges 6401.72 6401.72 other OPPS APC 6401.72 6401.72 other OPPS APC 6401.72 27.63 1768.8 percent of total billed charges 6401.72 6401.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM STRAIGHT L29 MM X W3.8 MM X H.8 MM HAND 6 HOLE LOW PROFILE PRECONTOUR CUT TO LENGTH MODULAR NONSTERILE 1.5 MM SCREW SUP-446.031 CDM 270010022 LOCAL 0270 RC outpatient 1262.69 1262.69 1262.69 74 934.39 percent of total billed charges 1262.69 93 1022.78 percent of total billed charges 1262.69 1262.69 other OPPS APC 1262.69 1262.69 other OPPS APC 1262.69 27.63 348.88 percent of total billed charges 1262.69 1262.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STRAIGHT 59X3.8X.8MM TITANIUM NS HAND 12 HOLE LOW PROFILE PRECONTOUR CUT TO LENGTH 1.5MM SCREW SUP-446.032 CDM 270010022 LOCAL 0270 RC outpatient 1072.5 1072.5 1072.5 74 793.65 percent of total billed charges 1072.5 93 868.73 percent of total billed charges 1072.5 1072.5 other OPPS APC 1072.5 1072.5 other OPPS APC 1072.5 27.63 296.33 percent of total billed charges 1072.5 1072.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 90MM TITANIUM CRANIOFACIAL 20 HOLE ADAPTION 1.5MM SCREW SUP-446.1 CDM 270010014 LOCAL 0270 RC outpatient 1001.88 1001.88 1001.88 74 741.39 percent of total billed charges 1001.88 93 811.52 percent of total billed charges 1001.88 1001.88 other OPPS APC 1001.88 1001.88 other OPPS APC 1001.88 27.63 276.82 percent of total billed charges 1001.88 1001.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 90MM CRANIOMAXILLOFACIAL TITANIUM 20 HOLE ADAPTION 1.5MM SCREW NS SUP-446.100 CDM 270010014 LOCAL 0270 RC outpatient 1001.88 1001.88 1001.88 74 741.39 percent of total billed charges 1001.88 93 811.52 percent of total billed charges 1001.88 1001.88 other OPPS APC 1001.88 1001.88 other OPPS APC 1001.88 27.63 276.82 percent of total billed charges 1001.88 1001.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM ORBITAL RIM 12 HOLE 1.5 MM SCREW SUP-446.22 CDM 270010014 LOCAL 0270 RC outpatient 933.43 933.43 933.43 74 690.74 percent of total billed charges 933.43 93 756.08 percent of total billed charges 933.43 933.43 other OPPS APC 933.43 933.43 other OPPS APC 933.43 27.63 257.91 percent of total billed charges 933.43 933.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CURVE ORBITAL RIM TITANIUM 12 HOLE 1.5MM SCREW NS SUP-446.220 CDM 270010014 LOCAL 0270 RC outpatient 567.01 567.01 567.01 74 419.59 percent of total billed charges 567.01 93 459.28 percent of total billed charges 567.01 567.01 other OPPS APC 567.01 567.01 other OPPS APC 567.01 27.63 156.66 percent of total billed charges 567.01 567.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM T L44 MM X W4 MM X H1 MM HAND 3 X 8 HOLE LOW PROFILE PRECONTOUR NONSTERILE 1.5 MM SCREW MINI FRAGMENT SET SUP-446.233 CDM 270010022 LOCAL 0270 RC outpatient 1238.38 1238.38 1238.38 74 916.4 percent of total billed charges 1238.38 93 1003.09 percent of total billed charges 1238.38 1238.38 other OPPS APC 1238.38 1238.38 other OPPS APC 1238.38 27.63 342.16 percent of total billed charges 1238.38 1238.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE T 44X4X1MM TITANIUM NS HAND 4X8 HOLE LOW PROFILE PRECONTOUR 1.5MM SCREW MINI FRAGMENT SET SUP-446.234 CDM 270010022 LOCAL 0270 RC outpatient 1238.38 1238.38 1238.38 74 916.4 percent of total billed charges 1238.38 93 1003.09 percent of total billed charges 1238.38 1238.38 other OPPS APC 1238.38 1238.38 other OPPS APC 1238.38 27.63 342.16 percent of total billed charges 1238.38 1238.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM H L22 MM RIGHT HAND 8 HOLE EXTENDED NONSTERILE 1.5 MM SCREW SUP-446.482 CDM 270010022 LOCAL 0270 RC outpatient 1192.62 1192.62 1192.62 74 882.54 percent of total billed charges 1192.62 93 966.02 percent of total billed charges 1192.62 1192.62 other OPPS APC 1192.62 1192.62 other OPPS APC 1192.62 27.63 329.52 percent of total billed charges 1192.62 1192.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM H L22 MM LEFT HAND 8 HOLE EXTENDED NONSTERILE 1.5 MM SCREW SUP-446.483 CDM 270010022 LOCAL 0270 RC outpatient 1192.62 1192.62 1192.62 74 882.54 percent of total billed charges 1192.62 93 966.02 percent of total billed charges 1192.62 1192.62 other OPPS APC 1192.62 1192.62 other OPPS APC 1192.62 27.63 329.52 percent of total billed charges 1192.62 1192.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE L LEFT OBLIQUE TITANIUM CRANIOFACIAL 2X3 HOLE 1.5MM SCREW SUP-446.5 CDM 270010014 LOCAL 0270 RC outpatient 719.97 719.97 719.97 74 532.78 percent of total billed charges 719.97 93 583.18 percent of total billed charges 719.97 719.97 other OPPS APC 719.97 719.97 other OPPS APC 719.97 27.63 198.93 percent of total billed charges 719.97 719.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE GOLD 100D L LEFT OBLIQUE CRANIOMAXILLOFACIAL TITANIUM 5 HOLE 1.5MM SCREW SUP-446.500 CDM 270010014 LOCAL 0270 RC outpatient 719.97 719.97 719.97 74 532.78 percent of total billed charges 719.97 93 583.18 percent of total billed charges 719.97 719.97 other OPPS APC 719.97 719.97 other OPPS APC 719.97 27.63 198.93 percent of total billed charges 719.97 719.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 100D L RIGHT OBLIQUE GOLD TITANIUM NS CRANIOFACIAL 2X3 HOLE RIGID 1.5MM SCREW SUP-446.510 CDM 270010022 LOCAL 0270 RC outpatient 719.97 719.97 719.97 74 532.78 percent of total billed charges 719.97 93 583.18 percent of total billed charges 719.97 719.97 other OPPS APC 719.97 719.97 other OPPS APC 719.97 27.63 198.93 percent of total billed charges 719.97 719.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 100D L LEFT OBLIQUE GOLD TITANIUM NS CRANIOFACIAL 3X4 HOLE RIGID 1.5MM SCREW SUP-446.520 CDM 270010013 LOCAL 0270 RC outpatient 760.24 760.24 760.24 74 562.58 percent of total billed charges 760.24 93 615.79 percent of total billed charges 760.24 760.24 other OPPS APC 760.24 760.24 other OPPS APC 760.24 27.63 210.05 percent of total billed charges 760.24 760.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE L RIGHT OBLIQUE TITANIUM CRANIOFACIAL 3X4 HOLE 1.5MM SCREW SUP-446.530 CDM 270010014 LOCAL 0270 RC outpatient 760.24 760.24 760.24 74 562.58 percent of total billed charges 760.24 93 615.79 percent of total billed charges 760.24 760.24 other OPPS APC 760.24 760.24 other OPPS APC 760.24 27.63 210.05 percent of total billed charges 760.24 760.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE Y 22X4X.9MM 11MM GOLD TITANIUM NS CRANIOFACIAL 1X3 HOLE 1.5MM SCREW SUP-446.61 CDM 270010022 LOCAL 0270 RC outpatient 741.57 741.57 741.57 74 548.76 percent of total billed charges 741.57 93 600.67 percent of total billed charges 741.57 741.57 other OPPS APC 741.57 741.57 other OPPS APC 741.57 27.63 204.9 percent of total billed charges 741.57 741.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 1.5 MM Y HAND 3 X 8 HOLE NONSTERILE 1.5 MM SCREW SUP-446.612 CDM 270010022 LOCAL 0270 RC outpatient 1191.19 1191.19 1191.19 74 881.48 percent of total billed charges 1191.19 93 964.86 percent of total billed charges 1191.19 1191.19 other OPPS APC 1191.19 1191.19 other OPPS APC 1191.19 27.63 329.13 percent of total billed charges 1191.19 1191.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 2Y L18 MM X W3.7 MM X H.6 MM CRANIOFACIAL 6 HOLE NONSTERILE 1.5 MM SCREW SUP-446.614 CDM 270010022 LOCAL 0270 RC outpatient 741.57 741.57 741.57 74 548.76 percent of total billed charges 741.57 93 600.67 percent of total billed charges 741.57 741.57 other OPPS APC 741.57 741.57 other OPPS APC 741.57 27.63 204.9 percent of total billed charges 741.57 741.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 2Y L21 MM X W3.7 MM X H.6 MM CRANIOFACIAL 6 HOLE NONSTERILE 1.5 MM SCREW SUP-446.615 CDM 270010022 LOCAL 0270 RC outpatient 741.57 741.57 741.57 74 548.76 percent of total billed charges 741.57 93 600.67 percent of total billed charges 741.57 741.57 other OPPS APC 741.57 741.57 other OPPS APC 741.57 27.63 204.9 percent of total billed charges 741.57 741.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP TITANIUM L36 MM X W3.5 MM X H.9 MM CONDYLAR LEFT 7 HOLE PRECONTOUR LOW PROFILE CUT TO LENGTH NONSTERILE 1.5 MM SCREW MODULAR HAND SYSTEM SUP-446.63.96 CDM 270010022 LOCAL 0270 RC outpatient 1480.05 1480.05 1480.05 74 1095.24 percent of total billed charges 1480.05 93 1198.84 percent of total billed charges 1480.05 1480.05 other OPPS APC 1480.05 1480.05 other OPPS APC 1480.05 27.63 408.94 percent of total billed charges 1480.05 1480.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LEFT CONDYLAR SUP-446.63.96 CDM 270010022 LOCAL 0270 RC outpatient 1480.05 1480.05 1480.05 74 1095.24 percent of total billed charges 1480.05 93 1198.84 percent of total billed charges 1480.05 1480.05 other OPPS APC 1480.05 1480.05 other OPPS APC 1480.05 27.63 408.94 percent of total billed charges 1480.05 1480.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP 36X3.5X.9MM TITANIUM NS HAND RIGHT CONDYLE 7 HOLE PRECONTOUR LOW PROFILE CUT TO LENGTH 1.5MM SCREW SUP-446.64.96 CDM 270010022 LOCAL 0270 RC outpatient 1480.05 1480.05 1480.05 74 1095.24 percent of total billed charges 1480.05 93 1198.84 percent of total billed charges 1480.05 1480.05 other OPPS APC 1480.05 1480.05 other OPPS APC 1480.05 27.63 408.94 percent of total billed charges 1480.05 1480.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE X 400MM GOLD TITANIUM NS CRANIOFACIAL 4 HOLE 1.5MM SCREW SUP-446.81 CDM 270010022 LOCAL 0270 RC outpatient 741.57 741.57 741.57 74 548.76 percent of total billed charges 741.57 93 600.67 percent of total billed charges 741.57 741.57 other OPPS APC 741.57 741.57 other OPPS APC 741.57 27.63 204.9 percent of total billed charges 741.57 741.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY SKIN PREP PVP-1 SCRUB CARE SUP-4468 CDM 270009183 LOCAL 0270 RC outpatient 5.76 5.76 5.76 74 4.26 percent of total billed charges 5.76 93 4.67 percent of total billed charges 5.76 5.76 other OPPS APC 5.76 5.76 other OPPS APC 5.76 27.63 1.59 percent of total billed charges 5.76 5.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD 4469 PACING FINELINE II STEROX SUP-4469 CDM 0275 RC outpatient 1040 1040 1040 57 592.8 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE PERICARDIUM L1 CM X W1 CM PATCH (TSH) SUP-447-13605 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM STRAIGHT L35 MM X W5 MM X H1.2 MM HAND 6 HOLE NONSTERILE 2 MM SCREW SUP-447.031 CDM 270010022 LOCAL 0270 RC outpatient 1289.86 1289.86 1289.86 74 954.5 percent of total billed charges 1289.86 93 1044.79 percent of total billed charges 1289.86 1289.86 other OPPS APC 1289.86 1289.86 other OPPS APC 1289.86 27.63 356.39 percent of total billed charges 1289.86 1289.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STRAIGHT 71X5X1.2MM TITANIUM NS HAND 12 HOLE LOW PROFILE PRECONTOUR CUT TO LENGTH 2MM SCREW SUP-447.032 CDM 270010022 LOCAL 0270 RC outpatient 1062.49 1062.49 1062.49 74 786.24 percent of total billed charges 1062.49 93 860.62 percent of total billed charges 1062.49 1062.49 other OPPS APC 1062.49 1062.49 other OPPS APC 1062.49 27.63 293.57 percent of total billed charges 1062.49 1062.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 5MM SPACE 100X4.8X.9MM TITANIUM NS CRANIOFACIAL 20 HOLE ADAPTION 2MM SCREW SUP-447.100 CDM 270010014 LOCAL 0270 RC outpatient 1236.01 1236.01 1236.01 74 914.65 percent of total billed charges 1236.01 93 1001.17 percent of total billed charges 1236.01 1236.01 other OPPS APC 1236.01 1236.01 other OPPS APC 1236.01 27.63 341.51 percent of total billed charges 1236.01 1236.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 5MM SPACE 53X4.8X.9MM TITANIUM NS ORBITAL RIM 12 HOLE 2MM SCREW SUP-447.22 CDM 270010014 LOCAL 0270 RC outpatient 707.85 707.85 707.85 74 523.81 percent of total billed charges 707.85 93 573.36 percent of total billed charges 707.85 707.85 other OPPS APC 707.85 707.85 other OPPS APC 707.85 27.63 195.58 percent of total billed charges 707.85 707.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM T L53 MM X W5 MM X H1.2 MM HAND 2 X 8 HOLE LOW PROFILE PRECONTOUR NONSTERILE 2 MM SCREW SUP-447.232 CDM 270010022 LOCAL 0270 RC outpatient 1112.54 1112.54 1112.54 74 823.28 percent of total billed charges 1112.54 93 901.16 percent of total billed charges 1112.54 1112.54 other OPPS APC 1112.54 1112.54 other OPPS APC 1112.54 27.63 307.39 percent of total billed charges 1112.54 1112.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM T L53 MM X W5 MM X H1.2 MM HAND 3 X 8 HOLE LOW PROFILE NONSTERILE 2 MM SCREW SUP-447.233 CDM 270010022 LOCAL 0270 RC outpatient 1129.7 1129.7 1129.7 74 835.98 percent of total billed charges 1129.7 93 915.06 percent of total billed charges 1129.7 1129.7 other OPPS APC 1129.7 1129.7 other OPPS APC 1129.7 27.63 312.14 percent of total billed charges 1129.7 1129.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SYNTHES 2.0MM LCP 4 HOLE SUP-447.344` CDM 270010022 LOCAL 0270 RC outpatient 646.91 646.91 646.91 74 478.71 percent of total billed charges 646.91 93 524 percent of total billed charges 646.91 646.91 other OPPS APC 646.91 646.91 other OPPS APC 646.91 27.63 178.74 percent of total billed charges 646.91 646.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SYNTHES 2.0MM LCP 5 HOLE SUP-447.345 CDM 270010022 LOCAL 0270 RC outpatient 733.59 733.59 733.59 74 542.86 percent of total billed charges 733.59 93 594.21 percent of total billed charges 733.59 733.59 other OPPS APC 733.59 733.59 other OPPS APC 733.59 27.63 202.69 percent of total billed charges 733.59 733.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2.0MM LCP 6 HOLE SUP-447.346 CDM 270010022 LOCAL 0270 RC outpatient 733.59 733.59 733.59 74 542.86 percent of total billed charges 733.59 93 594.21 percent of total billed charges 733.59 733.59 other OPPS APC 733.59 733.59 other OPPS APC 733.59 27.63 202.69 percent of total billed charges 733.59 733.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP TITANIUM L52 MM 7 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-447.347 CDM 270010022 LOCAL 0270 RC outpatient 733.59 733.59 733.59 74 542.86 percent of total billed charges 733.59 93 594.21 percent of total billed charges 733.59 733.59 other OPPS APC 733.59 733.59 other OPPS APC 733.59 27.63 202.69 percent of total billed charges 733.59 733.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP TITANIUM L54 MM 7 HOLE SHAFT LOW PROFILE CUT TO LENGTH NONSTERILE 2 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-447.349 CDM 270010022 LOCAL 0270 RC outpatient 2199.34 2199.34 2199.34 74 1627.51 percent of total billed charges 2199.34 93 1781.47 percent of total billed charges 2199.34 2199.34 other OPPS APC 2199.34 2199.34 other OPPS APC 2199.34 27.63 607.68 percent of total billed charges 2199.34 2199.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SYNTHES 2.0MM 7 HOLE LCP CONDYLAR SUP-447.349 CDM 270010022 LOCAL 0270 RC outpatient 2199.34 2199.34 2199.34 74 1627.51 percent of total billed charges 2199.34 93 1781.47 percent of total billed charges 2199.34 2199.34 other OPPS APC 2199.34 2199.34 other OPPS APC 2199.34 27.63 607.68 percent of total billed charges 2199.34 2199.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP TITANIUM Y L55 MM 3 HOLE HEAD 7 HOLE SHAFT LOW PROFILE CUT TO LENGTH NONSTERILE 2 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-447.350 CDM 270010022 LOCAL 0270 RC outpatient 1236.95 1236.95 1236.95 74 915.34 percent of total billed charges 1236.95 93 1001.93 percent of total billed charges 1236.95 1236.95 other OPPS APC 1236.95 1236.95 other OPPS APC 1236.95 27.63 341.77 percent of total billed charges 1236.95 1236.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP TITANIUM T L53 MM 2 HOLE HEAD 7 HOLE SHAFT LOW PROFILE CUT TO LENGTH NONSTERILE 2 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-447.351 CDM 270010022 LOCAL 0270 RC outpatient 1236.95 1236.95 1236.95 74 915.34 percent of total billed charges 1236.95 93 1001.93 percent of total billed charges 1236.95 1236.95 other OPPS APC 1236.95 1236.95 other OPPS APC 1236.95 27.63 341.77 percent of total billed charges 1236.95 1236.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP TITANIUM L73 MM 10 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-447.360 CDM 270010022 LOCAL 0270 RC outpatient 700.7 700.7 700.7 74 518.52 percent of total billed charges 700.7 93 567.57 percent of total billed charges 700.7 700.7 other OPPS APC 700.7 700.7 other OPPS APC 700.7 27.63 193.6 percent of total billed charges 700.7 700.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2.0MM LCP 12 HOLE SUP-447.362 CDM 270010022 LOCAL 0270 RC outpatient 1181.18 1181.18 1181.18 74 874.07 percent of total billed charges 1181.18 93 956.76 percent of total billed charges 1181.18 1181.18 other OPPS APC 1181.18 1181.18 other OPPS APC 1181.18 27.63 326.36 percent of total billed charges 1181.18 1181.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP TITANIUM L84 MM 10 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2.4 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-447.364 CDM 270010022 LOCAL 0270 RC outpatient 1118.26 1118.26 1118.26 74 827.51 percent of total billed charges 1118.26 93 905.79 percent of total billed charges 1118.26 1118.26 other OPPS APC 1118.26 1118.26 other OPPS APC 1118.26 27.63 308.98 percent of total billed charges 1118.26 1118.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP PRO-PAK TITANIUM L88 MM 12 HOLE ADAPTION LOW PROFILE CUT TO LENGTH NONSTERILE 2.4 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-447.366 CDM 270010022 LOCAL 0270 RC outpatient 1302.73 1302.73 1302.73 74 964.02 percent of total billed charges 1302.73 93 1055.21 percent of total billed charges 1302.73 1302.73 other OPPS APC 1302.73 1302.73 other OPPS APC 1302.73 27.63 359.94 percent of total billed charges 1302.73 1302.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 76MM TITANIUM 2.7MM SCREWS MINI FRAGMENT SET 8 HOLE LCP BONE ORTHOPEDIC NS SUP-447.372 CDM 270010022 LOCAL 0270 RC outpatient 2501.72 2501.72 2501.72 74 1851.27 percent of total billed charges 2501.72 93 2026.39 percent of total billed charges 2501.72 2501.72 other OPPS APC 2501.72 2501.72 other OPPS APC 2501.72 27.63 691.23 percent of total billed charges 2501.72 2501.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP TITANIUM L94 MM 10 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2.7 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-447.374 CDM 270010022 LOCAL 0270 RC outpatient 1179.75 1179.75 1179.75 74 873.02 percent of total billed charges 1179.75 93 955.6 percent of total billed charges 1179.75 1179.75 other OPPS APC 1179.75 1179.75 other OPPS APC 1179.75 27.63 325.96 percent of total billed charges 1179.75 1179.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP TITANIUM L44 MM 5 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2.4 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-447.375 CDM 270010022 LOCAL 0270 RC outpatient 986.1 986.1 986.1 74 729.71 percent of total billed charges 986.1 93 798.74 percent of total billed charges 986.1 986.1 other OPPS APC 986.1 986.1 other OPPS APC 986.1 27.63 272.46 percent of total billed charges 986.1 986.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP TITANIUM L60 MM 7 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2.4 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-447.377 CDM 270010022 LOCAL 0270 RC outpatient 986.1 986.1 986.1 74 729.71 percent of total billed charges 986.1 93 798.74 percent of total billed charges 986.1 986.1 other OPPS APC 986.1 986.1 other OPPS APC 986.1 27.63 272.46 percent of total billed charges 986.1 986.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 193X4.8X.9MM TITANIUM NS CRANIOFACIAL 30 BROAD SPACE HOLE ADAPTION 2MM SCREW SUP-447.38 CDM 270010014 LOCAL 0270 RC outpatient 1389.78 1389.78 1389.78 74 1028.44 percent of total billed charges 1389.78 93 1125.72 percent of total billed charges 1389.78 1389.78 other OPPS APC 1389.78 1389.78 other OPPS APC 1389.78 27.63 384 percent of total billed charges 1389.78 1389.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 193MMX.9MM 6.5MM SPACING CRANIOFACIAL TITANIUM 30 HOLE ADAPTION SUP-447.380 CDM 270010014 LOCAL 0270 RC outpatient 965.38 965.38 965.38 74 714.38 percent of total billed charges 965.38 93 781.96 percent of total billed charges 965.38 965.38 other OPPS APC 965.38 965.38 other OPPS APC 965.38 27.63 266.73 percent of total billed charges 965.38 965.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 100D L RIGHT OBLIQUE 41X20X.9MM BLUE TITANIUM NS CRANIOMAXILLOFACIAL 4X6 HOLE 2MM SCREW SUP-447.55 CDM 270010014 LOCAL 0270 RC outpatient 770.09 770.09 770.09 74 569.87 percent of total billed charges 770.09 93 623.77 percent of total billed charges 770.09 770.09 other OPPS APC 770.09 770.09 other OPPS APC 770.09 27.63 212.78 percent of total billed charges 770.09 770.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE Y 48X5X1.2MM TITANIUM NS HAND 3X8 HOLE LOW PROFILE PRECONTOUR CUT TO LENGTH 2MM SCREW SUP-447.612 CDM 270010022 LOCAL 0270 RC outpatient 1538.68 1538.68 1538.68 74 1138.62 percent of total billed charges 1538.68 93 1246.33 percent of total billed charges 1538.68 1538.68 other OPPS APC 1538.68 1538.68 other OPPS APC 1538.68 27.63 425.14 percent of total billed charges 1538.68 1538.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SYNTHES 2.0MM LCP T SUP-447.615 CDM 270010022 LOCAL 0270 RC outpatient 1236.95 1236.95 1236.95 74 915.34 percent of total billed charges 1236.95 93 1001.93 percent of total billed charges 1236.95 1236.95 other OPPS APC 1236.95 1236.95 other OPPS APC 1236.95 27.63 341.77 percent of total billed charges 1236.95 1236.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM Y L32 MM X W19 MM X H.9 MM CRANIOFACIAL 2 X 4 HOLE 2 ARM NONSTERILE 2 MM SCREW SUP-447.62 CDM 270010014 LOCAL 0270 RC outpatient 697.48 697.48 697.48 74 516.14 percent of total billed charges 697.48 93 564.96 percent of total billed charges 697.48 697.48 other OPPS APC 697.48 697.48 other OPPS APC 697.48 27.63 192.71 percent of total billed charges 697.48 697.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM Y L30 MM X H.9 MM L19 MM CRANIOFACIAL 2 HOLE 2 ARM NONSTERILE 2 MM SCREW SUP-447.68 CDM 270010014 LOCAL 0270 RC outpatient 720.8 720.8 720.8 74 533.39 percent of total billed charges 720.8 93 583.85 percent of total billed charges 720.8 720.8 other OPPS APC 720.8 720.8 other OPPS APC 720.8 27.63 199.16 percent of total billed charges 720.8 720.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE X 18X4.8X.9MM TITANIUM NS CRANIOFACIAL 4 HOLE 2MM SCREW SUP-447.81 CDM 270010014 LOCAL 0270 RC outpatient 635.26 635.26 635.26 74 470.09 percent of total billed charges 635.26 93 514.56 percent of total billed charges 635.26 635.26 other OPPS APC 635.26 635.26 other OPPS APC 635.26 27.63 175.52 percent of total billed charges 635.26 635.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM H L22 MM X W4.8 MM X H.9 MM L17 MM CRANIOFACIAL 8 HOLE NONSTERILE 2 MM SCREW SUP-447.86 CDM 270010014 LOCAL 0270 RC outpatient 713.05 713.05 713.05 74 527.66 percent of total billed charges 713.05 93 577.57 percent of total billed charges 713.05 713.05 other OPPS APC 713.05 713.05 other OPPS APC 713.05 27.63 197.02 percent of total billed charges 713.05 713.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD 4470 PACING FINELINE II STEROX EZ 52 cm SUP-4470 CDM 0275 RC outpatient 1040 1040 1040 57 592.8 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING FINELINE II STEROX EZ SUP-4471 CDM 0275 RC outpatient 1131 1131 1131 57 644.67 percent of total billed charges 1131 93 916.11 percent of total billed charges 1131 1131 other OPPS APC 1131 1131 other OPPS APC 1131 51 576.81 percent of total billed charges 1131 1131 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING FINELINE II STEROX EZ SILICONE L45 CM OD6 FR ENDOCARDIAL OTHER THAN TRANSVENOUS VDD 1 PASS BIPOLAR IMPLANTABLE SUP-4472 CDM 0275 RC outpatient 1557.4 1557.4 1557.4 57 887.72 percent of total billed charges 1557.4 93 1261.49 percent of total billed charges 1557.4 1557.4 other OPPS APC 1557.4 1557.4 other OPPS APC 1557.4 51 794.27 percent of total billed charges 1557.4 1557.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING FINELINE II STEROX EZ STEROID ELUTING L52 CM OD7 FR RIGHT ATRIUM VENTRICLE ENDOCARDIUM IS-1 CONNECTOR BIPOLAR SCREW FIXATION SILICONE INSULATION STERILE DISPOSABLE SUP-4473 CDM 0275 RC outpatient 1157 1157 1157 57 659.49 percent of total billed charges 1157 93 937.17 percent of total billed charges 1157 1157 other OPPS APC 1157 1157 other OPPS APC 1157 51 590.07 percent of total billed charges 1157 1157 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING FINELINE II STEROX EZ STEROID ELUTING SILICONE L58 CM OD7 FR ENDOCARDIAL BIPOLAR ACTIVE FIXATION IS-1 SUP-4474 CDM 0275 RC outpatient 1157 1157 1157 57 659.49 percent of total billed charges 1157 93 937.17 percent of total billed charges 1157 1157 other OPPS APC 1157 1157 other OPPS APC 1157 51 590.07 percent of total billed charges 1157 1157 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING FINELINE II STEROX STEROID ELUTING POLYURETHANE L45 CM OD7 FR ATRIAL ENDOCARDIAL IMPLANTABLE BIPOLAR SLOTTED TIP ELECTRODE ANODE SLEEVE SUP-4479 CDM 0275 RC outpatient 1557.4 1557.4 1557.4 57 887.72 percent of total billed charges 1557.4 93 1261.49 percent of total billed charges 1557.4 1557.4 other OPPS APC 1557.4 1557.4 other OPPS APC 1557.4 51 794.27 percent of total billed charges 1557.4 1557.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING FINELINE II STEROX L52 CM OTHER THAN TRANSVENOUS VDD 1 PASS IMPLANTABLE SUP-4480 CDM 0275 RC outpatient 1157 1157 1157 57 659.49 percent of total billed charges 1157 93 937.17 percent of total billed charges 1157 1157 other OPPS APC 1157 1157 other OPPS APC 1157 51 590.07 percent of total billed charges 1157 1157 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM STRAIGHT NARROW L29 MM X W4.8 MM X H1 MM MANDIBLE 4 HOLE LOW PROFILE EASILY CONTOUR NONSTERILE 2 MM SCREW MODULAR FIXATION SYSTEM SUP-449.004 CDM 270010014 LOCAL 0270 RC outpatient 866.01 866.01 866.01 74 640.85 percent of total billed charges 866.01 93 701.47 percent of total billed charges 866.01 866.01 other OPPS APC 866.01 866.01 other OPPS APC 866.01 27.63 239.28 percent of total billed charges 866.01 866.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM STRAIGHT BROAD L29 MM X W4.8 MM X H1.25 MM MANDIBLE 4 HOLE LOW PROFILE EASILY CONTOUR NONSTERILE 2 MM SCREW MODULAR FIXATION SYSTEM SUP-449.024 CDM 270010014 LOCAL 0270 RC outpatient 1101.96 1101.96 1101.96 74 815.45 percent of total billed charges 1101.96 93 892.59 percent of total billed charges 1101.96 1101.96 other OPPS APC 1101.96 1101.96 other OPPS APC 1101.96 27.63 304.47 percent of total billed charges 1101.96 1101.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCP TITANIUM L30 MM X W5 MM X H1.25 MM MANDIBLE 4 HOLE LOW PROFILE EASILY CONTOUR 2 MM SCREW MODULAR FIXATION SYSTEM SUP-449.034 CDM 270010014 LOCAL 0270 RC outpatient 941.2 941.2 941.2 74 696.49 percent of total billed charges 941.2 93 762.37 percent of total billed charges 941.2 941.2 other OPPS APC 941.2 941.2 other OPPS APC 941.2 27.63 260.05 percent of total billed charges 941.2 941.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DCP TITANIUM L32 MM X W5 MM X H1.25 MM MANDIBLE 5 HOLE LOW PROFILE EASILY CONTOUR NONSTERILE 2 MM SCREW MODULAR FIXATION SYSTEM SUP-449.035 CDM 270010014 LOCAL 0270 RC outpatient 1021.57 1021.57 1021.57 74 755.96 percent of total billed charges 1021.57 93 827.47 percent of total billed charges 1021.57 1021.57 other OPPS APC 1021.57 1021.57 other OPPS APC 1021.57 27.63 282.26 percent of total billed charges 1021.57 1021.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM STRAIGHT L22 MM MANDIBLE 4 HOLE TENSION BAND NONSTERILE 2 MM SCREW SUP-449.04 CDM 270010014 LOCAL 0270 RC outpatient 1031.94 1031.94 1031.94 74 763.64 percent of total billed charges 1031.94 93 835.87 percent of total billed charges 1031.94 1031.94 other OPPS APC 1031.94 1031.94 other OPPS APC 1031.94 27.63 285.13 percent of total billed charges 1031.94 1031.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM STRAIGHT L25 MM MANDIBLE 4 HOLE TENSION BAND NONSTERILE 2 MM SCREW SUP-449.05 CDM 270010014 LOCAL 0270 RC outpatient 1076.01 1076.01 1076.01 74 796.25 percent of total billed charges 1076.01 93 871.57 percent of total billed charges 1076.01 1076.01 other OPPS APC 1076.01 1076.01 other OPPS APC 1076.01 27.63 297.3 percent of total billed charges 1076.01 1076.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP TITANIUM L35 MM X W6.5 MM X H1.25 MM MANDIBLE 4 HOLE 2.4 MM SCREW SUP-449.14 CDM 270010014 LOCAL 0270 RC outpatient 1563.46 1563.46 1563.46 74 1156.96 percent of total billed charges 1563.46 93 1266.4 percent of total billed charges 1563.46 1563.46 other OPPS APC 1563.46 1563.46 other OPPS APC 1563.46 27.63 431.98 percent of total billed charges 1563.46 1563.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP TITANIUM L39 MM X W6.5 MM X H1.25 MM MANDIBLE 5 HOLE 2.4 MM SCREW SUP-449.15 CDM 270010014 LOCAL 0270 RC outpatient 1721.64 1721.64 1721.64 74 1274.01 percent of total billed charges 1721.64 93 1394.53 percent of total billed charges 1721.64 1721.64 other OPPS APC 1721.64 1721.64 other OPPS APC 1721.64 27.63 475.69 percent of total billed charges 1721.64 1721.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE STRAIGHT 64MM MANDIBLE 8 HOLE 2.4MM SCREW UNIVERSAL FRACTURE BONE TITANIUM NS SUP-449.380 CDM 270010014 LOCAL 0270 RC outpatient 1104.69 1104.69 1104.69 74 817.47 percent of total billed charges 1104.69 93 894.8 percent of total billed charges 1104.69 1104.69 other OPPS APC 1104.69 1104.69 other OPPS APC 1104.69 27.63 305.23 percent of total billed charges 1104.69 1104.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL STRAIGHT 80X6.5X2MM TITANIUM NS MANDIBLE 10 HOLE 2.4MM SCREW SUP-449.400 CDM 270010014 LOCAL 0270 RC outpatient 1092.47 1092.47 1092.47 74 808.43 percent of total billed charges 1092.47 93 884.9 percent of total billed charges 1092.47 1092.47 other OPPS APC 1092.47 1092.47 other OPPS APC 1092.47 27.63 301.85 percent of total billed charges 1092.47 1092.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP TITANIUM 2.4 MM SUP-449.615 CDM 270010022 LOCAL 0270 RC outpatient 1810.8 1810.8 1810.8 74 1339.99 percent of total billed charges 1810.8 93 1466.75 percent of total billed charges 1810.8 1810.8 other OPPS APC 1810.8 1810.8 other OPPS APC 1810.8 27.63 500.32 percent of total billed charges 1810.8 1810.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP TITANIUM L36 MM 4 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2.4 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-449.674 CDM 270010022 LOCAL 0270 RC outpatient 986.1 986.1 986.1 74 729.71 percent of total billed charges 986.1 93 798.74 percent of total billed charges 986.1 986.1 other OPPS APC 986.1 986.1 other OPPS APC 986.1 27.63 272.46 percent of total billed charges 986.1 986.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP TITANIUM L52 MM 6 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2.4 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-449.676 CDM 270010022 LOCAL 0270 RC outpatient 986.1 986.1 986.1 74 729.71 percent of total billed charges 986.1 93 798.74 percent of total billed charges 986.1 986.1 other OPPS APC 986.1 986.1 other OPPS APC 986.1 27.63 272.46 percent of total billed charges 986.1 986.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP TITANIUM L68 MM 8 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2.4 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-449.678 CDM 270010022 LOCAL 0270 RC outpatient 2371.33 2371.33 2371.33 74 1754.78 percent of total billed charges 2371.33 93 1920.78 percent of total billed charges 2371.33 2371.33 other OPPS APC 2371.33 2371.33 other OPPS APC 2371.33 27.63 655.2 percent of total billed charges 2371.33 2371.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP TITANIUM L59 MM 7 HOLE SHAFT LOW PROFILE CUT TO LENGTH NONSTERILE 2.4 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-449.679 CDM 270010022 LOCAL 0270 RC outpatient 1479.17 1479.17 1479.17 74 1094.59 percent of total billed charges 1479.17 93 1198.13 percent of total billed charges 1479.17 1479.17 other OPPS APC 1479.17 1479.17 other OPPS APC 1479.17 27.63 408.69 percent of total billed charges 1479.17 1479.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP TITANIUM L49 MM 5 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2.7 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-449.681 CDM 270010022 LOCAL 0270 RC outpatient 1179.75 1179.75 1179.75 74 873.02 percent of total billed charges 1179.75 93 955.6 percent of total billed charges 1179.75 1179.75 other OPPS APC 1179.75 1179.75 other OPPS APC 1179.75 27.63 325.96 percent of total billed charges 1179.75 1179.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP TITANIUM L58 MM 6 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2.7 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-449.682 CDM 270010022 LOCAL 0270 RC outpatient 1179.75 1179.75 1179.75 74 873.02 percent of total billed charges 1179.75 93 955.6 percent of total billed charges 1179.75 1179.75 other OPPS APC 1179.75 1179.75 other OPPS APC 1179.75 27.63 325.96 percent of total billed charges 1179.75 1179.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LCP TITANIUM L67 MM 7 HOLE LOW PROFILE CUT TO LENGTH NONSTERILE 2.7 MM SCREW MODULAR MINI FRAGMENT SYSTEM SUP-449.683 CDM 270010022 LOCAL 0270 RC outpatient 1179.75 1179.75 1179.75 74 873.02 percent of total billed charges 1179.75 93 955.6 percent of total billed charges 1179.75 1179.75 other OPPS APC 1179.75 1179.75 other OPPS APC 1179.75 27.63 325.96 percent of total billed charges 1179.75 1179.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MANDIBULAR UNIVERSAL FRACTURE ANGLED TITANIUM 3 X 3 HOLE 2.4 X 25MM SUP-449.82 CDM 270010014 LOCAL 0270 RC outpatient 2867.67 2867.67 2867.67 74 2122.08 percent of total billed charges 2867.67 93 2322.81 percent of total billed charges 2867.67 2867.67 other OPPS APC 2867.67 2867.67 other OPPS APC 2867.67 27.63 792.34 percent of total billed charges 2867.67 2867.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM STRAIGHT L36 MM HAND 6 HOLE NONSTERILE 2.4 MM SCREW SUP-449.906 CDM 270010022 LOCAL 0270 RC outpatient 1172.6 1172.6 1172.6 74 867.72 percent of total billed charges 1172.6 93 949.81 percent of total billed charges 1172.6 1172.6 other OPPS APC 1172.6 1172.6 other OPPS APC 1172.6 27.63 323.99 percent of total billed charges 1172.6 1172.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM STRAIGHT L72 MM X W6.3 MM X H1.25 MM HAND 12 HOLE LOW PROFILE PRECONTOUR NONSTERILE 2.4 MM SCREW SUP-449.912 CDM 270010022 LOCAL 0270 RC outpatient 1295.58 1295.58 1295.58 74 958.73 percent of total billed charges 1295.58 93 1049.42 percent of total billed charges 1295.58 1295.58 other OPPS APC 1295.58 1295.58 other OPPS APC 1295.58 27.63 357.97 percent of total billed charges 1295.58 1295.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM T L54 MM X W6.3 MM X H1.25 MM HAND 2 X 8 HOLE LOW PROFILE PRECONTOUR NONSTERILE 2.4 MM SCREW SUP-449.913 CDM 270010022 LOCAL 0270 RC outpatient 1847.56 1847.56 1847.56 74 1367.19 percent of total billed charges 1847.56 93 1496.52 percent of total billed charges 1847.56 1847.56 other OPPS APC 1847.56 1847.56 other OPPS APC 1847.56 27.63 510.48 percent of total billed charges 1847.56 1847.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM T L54 MM X W6.3 MM X H1.25 MM HAND 3 X 8 HOLE LOW PROFILE PRECONTOUR NONSTERILE 2.4 MM SCREW SUP-449.914 CDM 270010022 LOCAL 0270 RC outpatient 1847.56 1847.56 1847.56 74 1367.19 percent of total billed charges 1847.56 93 1496.52 percent of total billed charges 1847.56 1847.56 other OPPS APC 1847.56 1847.56 other OPPS APC 1847.56 27.63 510.48 percent of total billed charges 1847.56 1847.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM Y L56 MM X W6.3 MM X H1.25 MM HAND 3 X 8 HOLE LOW PROFILE PRECONTOUR NONSTERILE 2.4 MM SCREW SUP-449.915 CDM 270010022 LOCAL 0270 RC outpatient 1847.56 1847.56 1847.56 74 1367.19 percent of total billed charges 1847.56 93 1496.52 percent of total billed charges 1847.56 1847.56 other OPPS APC 1847.56 1847.56 other OPPS APC 1847.56 27.63 510.48 percent of total billed charges 1847.56 1847.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 57X6.3X1.25MM TITANIUM NS HAND RIGHT CONDYLE 8 HOLE 2.4MM SCREW SUP-449.916 CDM 270010022 LOCAL 0270 RC outpatient 1677.39 1677.39 1677.39 74 1241.27 percent of total billed charges 1677.39 93 1358.69 percent of total billed charges 1677.39 1677.39 other OPPS APC 1677.39 1677.39 other OPPS APC 1677.39 27.63 463.46 percent of total billed charges 1677.39 1677.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONDYLAR PLATE SUP-449.917 CDM 270010022 LOCAL 0270 RC outpatient 1677.39 1677.39 1677.39 74 1241.27 percent of total billed charges 1677.39 93 1358.69 percent of total billed charges 1677.39 1677.39 other OPPS APC 1677.39 1677.39 other OPPS APC 1677.39 27.63 463.46 percent of total billed charges 1677.39 1677.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP TITANIUM L35 MM X H1.7 MM 4 HOLE NONSTERILE 2.4 MM SCREW MODULAR HAND SYSTEM SUP-449.924 CDM 270010022 LOCAL 0270 RC outpatient 1581.58 1581.58 1581.58 74 1170.37 percent of total billed charges 1581.58 93 1281.08 percent of total billed charges 1581.58 1581.58 other OPPS APC 1581.58 1581.58 other OPPS APC 1581.58 27.63 436.99 percent of total billed charges 1581.58 1581.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP TITANIUM L51 MM X H1.7 MM 6 HOLE NONSTERILE 2.4 MM SCREW MODULAR HAND SYSTEM SUP-449.926 CDM 270010022 LOCAL 0270 RC outpatient 1784.64 1784.64 1784.64 74 1320.63 percent of total billed charges 1784.64 93 1445.56 percent of total billed charges 1784.64 1784.64 other OPPS APC 1784.64 1784.64 other OPPS APC 1784.64 27.63 493.1 percent of total billed charges 1784.64 1784.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP TITANIUM L67 MM X H1.7 MM 8 HOLE NONSTERILE 2.4 MM SCREW MODULAR HAND SYSTEM SUP-449.928 CDM 270010022 LOCAL 0270 RC outpatient 1929.07 1929.07 1929.07 74 1427.51 percent of total billed charges 1929.07 93 1562.55 percent of total billed charges 1929.07 1929.07 other OPPS APC 1929.07 1929.07 other OPPS APC 1929.07 27.63 533 percent of total billed charges 1929.07 1929.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP TITANIUM L24 MM X W5.5 MM X H1.25 MM HAND 4 HOLE NONSTERILE 2 MM SCREW SUP-449.931 CDM 270010022 LOCAL 0270 RC outpatient 983.84 983.84 983.84 74 728.04 percent of total billed charges 983.84 93 796.91 percent of total billed charges 983.84 983.84 other OPPS APC 983.84 983.84 other OPPS APC 983.84 27.63 271.83 percent of total billed charges 983.84 983.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP TITANIUM L36 MM X W5.5 MM X H1.25 MM HAND 6 HOLE NONSTERILE 2 MM SCREW SUP-449.936 CDM 270010022 LOCAL 0270 RC outpatient 1159.73 1159.73 1159.73 74 858.2 percent of total billed charges 1159.73 93 939.38 percent of total billed charges 1159.73 1159.73 other OPPS APC 1159.73 1159.73 other OPPS APC 1159.73 27.63 320.43 percent of total billed charges 1159.73 1159.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LC-DCP TITANIUM L48 MM X W5.5 MM X H1.25 MM HAND 8 HOLE NONSTERILE 2 MM SCREW SUP-449.938 CDM 270010022 LOCAL 0270 RC outpatient 1312.74 1312.74 1312.74 74 971.43 percent of total billed charges 1312.74 93 1063.32 percent of total billed charges 1312.74 1312.74 other OPPS APC 1312.74 1312.74 other OPPS APC 1312.74 27.63 362.71 percent of total billed charges 1312.74 1312.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER IV CATHLON 16 X 2.25 SUP-449211 CDM outpatient 7.2 7.2 7.2 7.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INTRAVENOUS CATHLON TEFLON L2 IN OD14 GA NONRADIOPAQUE STERILE LATEX FREE ORANGE SUP-449811 CDM 0270 RC outpatient 7.45 7.45 7.45 74 5.51 percent of total billed charges 7.45 93 6.03 percent of total billed charges 7.45 7.45 other OPPS APC 7.45 7.45 other OPPS APC 7.45 27.63 2.06 percent of total billed charges 7.45 7.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L ANEURYSM CLIP TEMP STR 5MM NARROW JAQ SUP-45-190 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER ASNIS MICRO L100 MM OD.8 MM STERILE 2 MM SCREW SUP-45-20015S CDM 0270 RC outpatient 81.12 81.12 81.12 74 60.03 percent of total billed charges 81.12 93 65.71 percent of total billed charges 81.12 81.12 other OPPS APC 81.12 81.12 other OPPS APC 81.12 27.63 22.41 percent of total billed charges 81.12 81.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L ANEURYSM CLIP MINI TEMP STR 7 MM SUP-45-220 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L ANEURYSM CLIP MINI TEMP STRONG CVD 5MM SUP-45-224 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L ANEURYSM CLIP MINI TEMP CVD 5MM SUP-45-226 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L ANEURYSM CLIP MINI TEMP ST 7MM SUP-45-240 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L ANEURYSM CLIP TEMP ST 9MM SUP-45-250 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L ANEURYSM CLIP TEMP ST 12MM SUP-45-260 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L ANEURYSM CLIP TEMP CVD 11MM SUP-45-262 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL TWIST VARIAX L102 MM L50 MM OD2 MM AO SHAFT END NONSTERILE SUP-45-27010 CDM 0270 RC outpatient 443.04 443.04 443.04 74 327.85 percent of total billed charges 443.04 93 358.86 percent of total billed charges 443.04 443.04 other OPPS APC 443.04 443.04 other OPPS APC 443.04 27.63 122.41 percent of total billed charges 443.04 443.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L ANEURYSM CLIP ST 15MM SUP-45-280 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL ASNIS MICRO OD2.1 MM AO COUPLING CANNULATED STERILE DISPOSABLE SUP-45-30005 CDM 0270 RC outpatient 1024.4 1024.4 1024.4 74 758.06 percent of total billed charges 1024.4 93 829.76 percent of total billed charges 1024.4 1024.4 other OPPS APC 1024.4 1024.4 other OPPS APC 1024.4 27.63 283.04 percent of total billed charges 1024.4 1024.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL OD2.1 MM AO COUPLING CANNULATED STERILE DISPOSABLE 3 MM ASNIS MICRO SCREW SUP-45-30005S CDM 0270 RC outpatient 770.64 770.64 770.64 74 570.27 percent of total billed charges 770.64 93 624.22 percent of total billed charges 770.64 770.64 other OPPS APC 770.64 770.64 other OPPS APC 770.64 27.63 212.93 percent of total billed charges 770.64 770.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER ASNIS MICRO L100 MM OD1.2 MM NONSTERILE 3 MM SCREW SUP-45-30015 CDM 0270 RC outpatient 99.84 99.84 99.84 74 73.88 percent of total billed charges 99.84 93 80.87 percent of total billed charges 99.84 99.84 other OPPS APC 99.84 99.84 other OPPS APC 99.84 27.63 27.59 percent of total billed charges 99.84 99.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER ASNIS MICRO L100 MM OD1.2 MM STERILE 3 MM SCREW SUP-45-30015S CDM 0270 RC outpatient 81.12 81.12 81.12 74 60.03 percent of total billed charges 81.12 93 65.71 percent of total billed charges 81.12 81.12 other OPPS APC 81.12 81.12 other OPPS APC 81.12 27.63 22.41 percent of total billed charges 81.12 81.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L ANEURYSM CLIP TEMP RT ANGLE 5MM SUP-45-309 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL STRYKER VARIAX 1.9MM SUP-45-35010 CDM 0270 RC outpatient 474.24 474.24 474.24 74 350.94 percent of total billed charges 474.24 93 384.13 percent of total billed charges 474.24 474.24 other OPPS APC 474.24 474.24 other OPPS APC 474.24 27.63 131.03 percent of total billed charges 474.24 474.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILBIT FOR OVERDRILL 3.5MM X 122MM SUP-45-35020 CDM 0270 RC outpatient 447.2 447.2 447.2 74 330.93 percent of total billed charges 447.2 93 362.23 percent of total billed charges 447.2 447.2 other OPPS APC 447.2 447.2 other OPPS APC 447.2 27.63 123.56 percent of total billed charges 447.2 447.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER VARIAX 3.5MM LOCKING 26MM SUP-45-35626 CDM 0270 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P5.1 CM XHIGH PROFILE ROUND OD10.8 CM 360 ML STYLE 45 SMOOTH STERILE SUP-45-360 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST 400ML STYLE 45 SMOOTH NATRELLE SILICONE P5.1CM EXTRA HIGH PROFILE SUP-45-400 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE P5.9CM EXTRA HIGH PROFILE ROUND 11.4CM 460ML SILICONE STERILE LF STYLE 20 GEL SMOOTH SUP-45-460 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE P5.7CM EXTRA HIGH PROFILE ROUND 11.9CM 500ML SILICONE STERILE LF STYLE 20 GEL SMOOTH SUP-45-500 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P6 CM XHIGH PROFILE ROUND OD12.4 CM 550 ML STYLE 45 SMOOTH STERILE LATEX FREE SUP-45-550 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE P6.1CM EXTRA HIGH PROFILE ROUND 12.8CM 600ML SILICONE STERILE LF STYLE 20 GEL SMOOTH SUP-45-600 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP PERM 45DEG ANGLED 7.5MM SUP-45-613 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "L CLIP PERM FENES 5MM,3MM ST" SUP-45-637 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "L CLIP PERM FENES 5MM,5MM ST" SUP-45-639 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "L CLIP PERM 5NN, 5MM ANGLED 45 DEG" SUP-45-642 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE P6.2CM EXTRA HIGH PROFILE ROUND 13.2CM 650ML SILICONE STERILE LF STYLE 20 GEL SMOOTH SUP-45-650 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "L CLIP PERM FENES 5NN,9MM STR" SUP-45-650 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "L CLIP PERM FENES 5NN,7.5MM ANGLED 90" SUP-45-654 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "L CLIP PERM FENES 5NN,10MM ANGLED 90" SUP-45-664 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP PERM FENES 5 MM 10 MM ANGLED 90 DEG SUP-45-680 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP MINI PERM CURV 3MM NARROW JAW SUP-45-682 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP MINI PERM STR 5MM NARROW JAW SUP-45-690 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP MINI PERM CRV 4MM NARROW JAW SUP-45-692 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE P6.4CM EXTRA HIGH PROFILE ROUND 13.5CM 700ML SILICONE STERILE LF STYLE 20 GEL SMOOTH SUP-45-700 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP MINI PERM LIGHT CVD 5MM SUP-45-712 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP MINI PERM STR 7MM SUP-45-720 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP MINI PERM CVD 7MM SUP-45-722 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP MINI PERM CVD 5MM SUP-45-726 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP MINI PERM BAY 4MM SUP-45-727 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP MINI PERM BAY 7MM SUP-45-728 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP MINI PERM STR 7MM SUP-45-740 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP MINI PERM BAY 7MM SUP-45-742 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP MINI PERM BAY 9MM SUP-45-748 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP MINI PERM STR 9MM SUP-45-750 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP PERM LIGHT CDS 9MM SUP-45-752 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP MINI PERM BAY 10MM SUP-45-758 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP MINI PERM STR 12MM SUP-45-760 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP MINI PERM LIGHT CVD 11MM SUP-45-762 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP PERM STR 15MM SUP-45-780 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP PERM STRONG CVD 15MM SUP-45-784 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P6.7 CM EXTRA HIGH PROFILE ROUND OD14.2 CM 800 ML STYLE 45 SMOOTH STERILE SUP-45-800 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK FOR 2.7MM/3.5MM SCREWS SUP-45-80040 CDM 0270 RC outpatient 474.24 474.24 474.24 74 350.94 percent of total billed charges 474.24 93 384.13 percent of total billed charges 474.24 474.24 other OPPS APC 474.24 474.24 other OPPS APC 474.24 27.63 131.03 percent of total billed charges 474.24 474.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER FULL THREAD L200 MM OD1.6 MM FOOT NONSTERILE VARIAX LOCK PLATE SYSTEM SUP-45-80100 CDM 0270 RC outpatient 191.36 191.36 191.36 74 141.61 percent of total billed charges 191.36 93 155 percent of total billed charges 191.36 191.36 other OPPS APC 191.36 191.36 other OPPS APC 191.36 27.63 52.87 percent of total billed charges 191.36 191.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER L100 MM OD1.4 MM FOOT SMOOTH NONSTERILE VARIAX LOCK PLATE SYSTEM SUP-45-80200 CDM 0270 RC outpatient 81.12 81.12 81.12 74 60.03 percent of total billed charges 81.12 93 65.71 percent of total billed charges 81.12 81.12 other OPPS APC 81.12 81.12 other OPPS APC 81.12 27.63 22.41 percent of total billed charges 81.12 81.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KWIRE STRYKER 1.6MM SUP-45-80200S CDM 0270 RC outpatient 66.56 66.56 66.56 74 49.25 percent of total billed charges 66.56 93 53.91 percent of total billed charges 66.56 66.56 other OPPS APC 66.56 66.56 other OPPS APC 66.56 27.63 18.39 percent of total billed charges 66.56 66.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION STEINMANN STAINLESS STEEL L100 MM OD2.5 MM SMOOTH SUP-45-80300 CDM 0270 RC outpatient 92.95 92.95 92.95 74 68.78 percent of total billed charges 92.95 93 75.29 percent of total billed charges 92.95 92.95 other OPPS APC 92.95 92.95 other OPPS APC 92.95 27.63 25.68 percent of total billed charges 92.95 92.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP MINI PERM CVD AND SDW ANGLED 5 MM SUP-45-807 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP MINI PERM CVD L ANGLED 5 MM SUP-45-808 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP PERM 90 DEG ANGLED 7.5MM SUP-45-820 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP PERM J CVD 7MM SUP-45-823 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP PERM ANGLED 45 DEG W RADIUS 7.5MM SUP-45-850 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP PERM ANGLED 45 DEG W RADIUS 10MM SUP-45-851 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L CLIP PERM FENESTRATED 5MM SUP-45-944 CDM 0270 RC outpatient 1214.62 1214.62 1214.62 74 898.82 percent of total billed charges 1214.62 93 983.84 percent of total billed charges 1214.62 1214.62 other OPPS APC 1214.62 1214.62 other OPPS APC 1214.62 27.63 335.6 percent of total billed charges 1214.62 1214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER CLIP MINI & STANDARD L-CLIP APPLIER 210 MM BAJONET RIGID TITANIUM JAW DOUBLE ACTION SUP-45.411 CDM 0270 RC outpatient 2392 2392 2392 74 1770.08 percent of total billed charges 2392 93 1937.52 percent of total billed charges 2392 2392 other OPPS APC 2392 2392 other OPPS APC 2392 27.63 660.91 percent of total billed charges 2392 2392 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER ANEURYSM CLIP L-ANEURYSM-CLIP LAZIC TITANIUM MINI STANDARD BAYONET L70 MM L210 MM JAW VARIABLE 2 ACTION REMOVER FORCEPS SUP-45.421 CDM 0270 RC outpatient 2392 2392 2392 74 1770.08 percent of total billed charges 2392 93 1937.52 percent of total billed charges 2392 2392 other OPPS APC 2392 2392 other OPPS APC 2392 27.63 660.91 percent of total billed charges 2392 2392 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER/REMOVER 90MM WL MEMORY SHAFT SUP-45.441 CDM 0270 RC outpatient 4407 4407 4407 74 3261.18 percent of total billed charges 4407 93 3569.67 percent of total billed charges 4407 4407 other OPPS APC 4407 4407 other OPPS APC 4407 27.63 1217.65 percent of total billed charges 4407 4407 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE VECTRA-T BENT GROOVE PREBENT 23X19X2.5MM 14MM BLUE TITANIUM NS SPINE CERVICAL ANTERIOR 1 LEVEL 1 STEP LOCK SUP-450.551 CDM 270010013 LOCAL 0270 RC outpatient 4968.6 4968.6 4968.6 74 3676.76 percent of total billed charges 4968.6 93 4024.57 percent of total billed charges 4968.6 4968.6 other OPPS APC 4968.6 4968.6 other OPPS APC 4968.6 27.63 1372.82 percent of total billed charges 4968.6 4968.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L360 MM OD13 MM DISTAL FEMUR CANNULATED FLUTED BARREL STERILE AQUA RETROGRADE INSERTION SUP-450.848S CDM 270010022 LOCAL 0270 RC outpatient 5143.32 5143.32 5143.32 74 3806.06 percent of total billed charges 5143.32 93 4166.09 percent of total billed charges 5143.32 5143.32 other OPPS APC 5143.32 5143.32 other OPPS APC 5143.32 27.63 1421.1 percent of total billed charges 5143.32 5143.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EXPERT TITANIUM 3.5 MM FULL THREAD BLUNT HEXAGON L65 MM OD6 MM ODSEC8 MM FEMUR TIBIA DISTAL 2 LEAD SELF TAP LOCK AQUA INTRAMEDULLARY NAIL SYSTEM SUP-450.865 CDM 270010022 LOCAL 0270 RC outpatient 577.98 577.98 577.98 74 427.71 percent of total billed charges 577.98 93 468.16 percent of total billed charges 577.98 577.98 other OPPS APC 577.98 577.98 other OPPS APC 577.98 27.63 159.7 percent of total billed charges 577.98 577.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L40 MM OD6 MM ODSEC4.8 MM DISTAL FEMUR 2 LEAD THREAD LOCKING HEXAGONAL RECESS SELF TAPPING BLUNT TIP AQUA INTRAMEDULLARY NAIL SUP-450.875 CDM 270010022 LOCAL 0270 RC outpatient 577.98 577.98 577.98 74 427.71 percent of total billed charges 577.98 93 468.16 percent of total billed charges 577.98 577.98 other OPPS APC 577.98 577.98 other OPPS APC 577.98 27.63 159.7 percent of total billed charges 577.98 577.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP END TITANIUM 6 MM FEMORAL DISTAL AQUA INTRAMEDULLARY NAIL SUP-450.896 CDM 270010022 LOCAL 0270 RC outpatient 587.34 587.34 587.34 74 434.63 percent of total billed charges 587.34 93 475.75 percent of total billed charges 587.34 587.34 other OPPS APC 587.34 587.34 other OPPS APC 587.34 27.63 162.28 percent of total billed charges 587.34 587.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RECORDER CARDIAC BIOMONITOR III STERILE LATEX FREE SUP-450218_73669 CDM 0270 RC outpatient 9620 9620 9620 74 7118.8 percent of total billed charges 9620 93 7792.2 percent of total billed charges 9620 9620 other OPPS APC 9620 9620 other OPPS APC 9620 27.63 2658.01 percent of total billed charges 9620 9620 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE RIGHT PROXIMAL HUMERUS ALLOGRAFT FROZEN SUP-450400 CDM 270010031 LOCAL 0270 RC outpatient 12084.8 12084.8 12084.8 74 8942.75 percent of total billed charges 12084.8 93 9788.69 percent of total billed charges 12084.8 12084.8 other OPPS APC 12084.8 12084.8 other OPPS APC 12084.8 27.63 3339.03 percent of total billed charges 12084.8 12084.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE THK3-12MM HALVED 200MMX10+ MM FEMORAL CORTICAL ALLOGRAFT STRUT FROZEN SUP-450495 CDM 270010031 LOCAL 0270 RC outpatient 2923.57 2923.57 2923.57 74 2163.44 percent of total billed charges 2923.57 93 2368.09 percent of total billed charges 2923.57 2923.57 other OPPS APC 2923.57 2923.57 other OPPS APC 2923.57 27.63 807.78 percent of total billed charges 2923.57 2923.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP UNIVERSAL REVERSE SUTURE 36 NEUTRAL SUP-45050 CDM C1776 HCPCS 0278 RC outpatient 4462.5 4462.5 4462.5 57 2543.63 percent of total billed charges 4462.5 93 3614.63 percent of total billed charges 4462.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4462.5 other OPPS APC 4462.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4462.5 other OPPS APC 4462.5 51 2275.88 percent of total billed charges 4462.5 4462.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM DETACHMENT INZONE SUP-4510094 CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR SHUNT ACCU-FLO STRAIGHT CSF RADIOPAQUE CATHETER PLASTIC STERILE SUP-45103 CDM 0270 RC outpatient 256.83 256.83 256.83 74 190.05 percent of total billed charges 256.83 93 208.03 percent of total billed charges 256.83 256.83 other OPPS APC 256.83 256.83 other OPPS APC 256.83 27.63 70.96 percent of total billed charges 256.83 256.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW VELYS SUP-451570000 CDM 270010025 LOCAL 0270 RC outpatient 145.6 145.6 145.6 74 107.74 percent of total billed charges 145.6 93 117.94 percent of total billed charges 145.6 145.6 other OPPS APC 145.6 145.6 other OPPS APC 145.6 27.63 40.23 percent of total billed charges 145.6 145.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VELYS L100 MM OD4 MM STERILE SUP-451570004 CDM 270010025 LOCAL 0270 RC outpatient 88.4 88.4 88.4 74 65.42 percent of total billed charges 88.4 93 71.6 percent of total billed charges 88.4 88.4 other OPPS APC 88.4 88.4 other OPPS APC 88.4 27.63 24.42 percent of total billed charges 88.4 88.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VELYS L125 MM OD4 MM STERILE SUP-451570005 CDM 270010025 LOCAL 0270 RC outpatient 88.4 88.4 88.4 74 65.42 percent of total billed charges 88.4 93 71.6 percent of total billed charges 88.4 88.4 other OPPS APC 88.4 88.4 other OPPS APC 88.4 27.63 24.42 percent of total billed charges 88.4 88.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN DRILL VELYS L175 MM OD4 MM ARRAY SUP-451570006 CDM 270010025 LOCAL 0270 RC outpatient 62.4 62.4 62.4 74 46.18 percent of total billed charges 62.4 93 50.54 percent of total billed charges 62.4 62.4 other OPPS APC 62.4 62.4 other OPPS APC 62.4 27.63 17.24 percent of total billed charges 62.4 62.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARRAY TRACKER VELYS KNEEE SET SUP-451570011 CDM 270010025 LOCAL 0270 RC outpatient 865.8 865.8 865.8 74 640.69 percent of total billed charges 865.8 93 701.3 percent of total billed charges 865.8 865.8 other OPPS APC 865.8 865.8 other OPPS APC 865.8 27.63 239.22 percent of total billed charges 865.8 865.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE EQUIPMENT VELYS STERILE SUP-451570018 CDM 0270 RC outpatient 193.83 193.83 193.83 74 143.43 percent of total billed charges 193.83 93 157 percent of total billed charges 193.83 193.83 other OPPS APC 193.83 193.83 other OPPS APC 193.83 27.63 53.56 percent of total billed charges 193.83 193.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE EQUIPMENT VELYS SATELLITE STATION STERILE SUP-451570019 CDM 0270 RC outpatient 126.62 126.62 126.62 74 93.7 percent of total billed charges 126.62 93 102.56 percent of total billed charges 126.62 126.62 other OPPS APC 126.62 126.62 other OPPS APC 126.62 27.63 34.99 percent of total billed charges 126.62 126.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING EASYTRAK 2 STEROID ELUTING SILICONE L80 CM OD5.4 FR SUP-4517 CDM 0275 RC outpatient 5322.2 5322.2 5322.2 57 3033.65 percent of total billed charges 5322.2 93 4310.98 percent of total billed charges 5322.2 5322.2 other OPPS APC 5322.2 5322.2 other OPPS APC 5322.2 51 2714.32 percent of total billed charges 5322.2 5322.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING EASYTRAK 2 SUP-4518 CDM 0275 RC outpatient 5200 5200 5200 57 2964 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 51 2652 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING EASYTRAK 2 SUP-4520 CDM 0275 RC outpatient 5200 5200 5200 57 2964 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 51 2652 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING EASYTRAK 3 STEROID ELUTING SILICONE POLYURETHANE L80 CM CORONARY VENOUS LEFT VENTRICLE 2 ELECTRODE SPIRAL PASSIVE FIXATION LV-1 SUP-4524 CDM 0275 RC outpatient 5322.2 5322.2 5322.2 57 3033.65 percent of total billed charges 5322.2 93 4310.98 percent of total billed charges 5322.2 5322.2 other OPPS APC 5322.2 5322.2 other OPPS APC 5322.2 51 2714.32 percent of total billed charges 5322.2 5322.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING EASYTRAK 3 SUP-4525 CDM 0275 RC outpatient 5200 5200 5200 57 2964 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 51 2652 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING EASYTRAK 3 SUP-4527 CDM 0275 RC outpatient 5200 5200 5200 57 2964 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 51 2652 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE PATELLA LIGAMENT BTB SUP-453008 CDM 270010031 LOCAL 0270 RC outpatient 5187 5187 5187 74 3838.38 percent of total billed charges 5187 93 4201.47 percent of total billed charges 5187 5187 other OPPS APC 5187 5187 other OPPS APC 5187 27.63 1433.17 percent of total billed charges 5187 5187 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE GRACILIS TENDON L200 MM FROZEN SUP-453014 CDM 270010031 LOCAL 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE SEMITENDINOSUS TENDON L220-300 MM FROZEN STERILE SUP-453015 CDM 270010031 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE ANTERIOR TIBIALIS TENDON H200 MM SUP-453017 CDM 270010031 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE ACHILLES TENDON SUP-453042 CDM 270010031 LOCAL 0270 RC outpatient 4160 4160 4160 74 3078.4 percent of total billed charges 4160 93 3369.6 percent of total billed charges 4160 4160 other OPPS APC 4160 4160 other OPPS APC 4160 27.63 1149.41 percent of total billed charges 4160 4160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERONSUS LONGUS 220-300 9-11 M DIAMETER SUP-453043 CDM 270010031 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE ACHILLES TENDON SUP-453142 CDM 270010031 LOCAL 0270 RC outpatient 5460 5460 5460 74 4040.4 percent of total billed charges 5460 93 4422.6 percent of total billed charges 5460 5460 other OPPS APC 5460 5460 other OPPS APC 5460 27.63 1508.6 percent of total billed charges 5460 5460 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE BIOCLEANSE LEFT MEDIAL MENISCUS BONE BRIDGE FROZEN SUP-453201 CDM 270010031 LOCAL 0270 RC outpatient 14040 14040 14040 74 10389.6 percent of total billed charges 14040 93 11372.4 percent of total billed charges 14040 14040 other OPPS APC 14040 14040 other OPPS APC 14040 27.63 3879.25 percent of total billed charges 14040 14040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE BIOCLEANSE RIGHT MEDIAL MENISCUS RIGHT MEDIAL KNEE BONE BRIDGE FROZEN SUP-453202 CDM 270010031 LOCAL 0270 RC outpatient 14040 14040 14040 74 10389.6 percent of total billed charges 14040 93 11372.4 percent of total billed charges 14040 14040 other OPPS APC 14040 14040 other OPPS APC 14040 27.63 3879.25 percent of total billed charges 14040 14040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE BIOCLEANSE POSTERIOR TIBIALIS TENDON L200 MM FROZEN SUP-453316 CDM 270010031 LOCAL 0270 RC outpatient 4810 4810 4810 74 3559.4 percent of total billed charges 4810 93 3896.1 percent of total billed charges 4810 4810 other OPPS APC 4810 4810 other OPPS APC 4810 27.63 1329 percent of total billed charges 4810 4810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.25 X 9 MM SUP-453925_65276 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.5 X 9 MM SUP-453926_65277 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.75 X 9 MM SUP-453927_65278 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY ORSIRO MISSION SIROLIMUS ELUTING COCR L9.0MM OD3.0 SUP-453928_65279 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 3.5 X 9 MM SUP-453929_65280 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 4.0 X 9 MM SUP-453930_65281 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.25 X 13 MM SUP-453931_65282 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.5 X 13 MM SUP-453932_65283 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY ORSIRO MISSION SIROLIMUS ELUTING COCR L13MM OD 2.75 SUP-453933_65284 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 3.0 X 13 MM SUP-453934_65285 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 3.5 X 13 MM SUP-453935_65286 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 4.0 X 13 MM SUP-453936_65287 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.25 X 15 MM SUP-453937_65288 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.5 X 15 MM SUP-453938_65289 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.75 X 15 MM SUP-453939_65290 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 3.0 X 15 MM SUP-453940_65291 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 3.5 X 15 MM SUP-453941_65292 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 4.0 X 15 MM SUP-453942_65293 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.25 X 18 MM SUP-453943_65294 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.5 X 18 MM SUP-453944_65295 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.75 X 18 MM SUP-453945_65296 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 3.0 X 18 MM SUP-453946_65297 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 3.5 X 18 MM SUP-453947_65298 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 4.0 X 18 MM SUP-453948_65299 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.25 X 22 MM SUP-453949_65300 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.5 X 22 MM SUP-453950_65304 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.75 X 22 MM SUP-453951_65305 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 3.0 X 22 MM SUP-453952_65306 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 3.5 X 22 MM SUP-453953_65307 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 4.0 X 22 MM SUP-453954_65308 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.25 X 26 MM SUP-453955_65309 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.5 X 26 MM SUP-453956_65310 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.75 X 26 MM SUP-453957_65311 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 3.0 X 26 MM SUP-453958_65312 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 3.5 X 26 MM SUP-453959_65313 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 4.0 X 26 MM SUP-453960_65314 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.25 X 30 MM SUP-453961_65315 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.5 X 30 MM SUP-453962_65316 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.75 X 30 MM SUP-453963_65317 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 3.0 X 30 MM SUP-453964_65318 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 3.5 X 30 MM SUP-453965_65319 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 4.0 X 30 MM SUP-453966_65320 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.5 X 35 MM SUP-453968_65321 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.75 X 35 MM SUP-453969_65322 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 3.0 X 35 MM SUP-453970_65323 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 3.5 X 35 MM SUP-453971_65324 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 4.0 X 35 MM SUP-453972_65325 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.5 X 40 MM SUP-453974_65326 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 2.75 X 40 MM SUP-453975_65327 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 3.0 X 40 MM SUP-453976_65328 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 3.5 X 40 MM SUP-453977_65329 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORSIRO MISSION DES STENT 4.0 X 40 MM SUP-453978_65330 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING EASYTRAK 2 SUP-4543 CDM 0275 RC outpatient 5200 5200 5200 57 2964 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 51 2652 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING EASYTRAK 2 SUP-4544 CDM 0275 RC outpatient 5200 5200 5200 57 2964 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 51 2652 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING EASYTRAK 3 80CM STEROID ELUTING SILICONE POLYURETHANE CORONARY VENOUS SUP-4548 CDM 0275 RC outpatient 5322.2 5322.2 5322.2 57 3033.65 percent of total billed charges 5322.2 93 4310.98 percent of total billed charges 5322.2 5322.2 other OPPS APC 5322.2 5322.2 other OPPS APC 5322.2 51 2714.32 percent of total billed charges 5322.2 5322.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING EASYTRAK 3 80CM STEROID ELUTING SILICONE POLYURETHANE CORONARY VENOUS SUP-4548/49/50 CDM 0275 RC outpatient 5200 5200 5200 57 2964 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 51 2652 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING EASYTRAK 3 SUP-4549 CDM 0275 RC outpatient 5200 5200 5200 57 2964 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 51 2652 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING EASYTRAK 3 SUP-4550 CDM 0275 RC outpatient 5200 5200 5200 57 2964 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 51 2652 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ACUITY STEROID ELUTING L80 CM CORONARY VENOUS STEERABLE BIPOLAR SUP-4554 CDM 0275 RC outpatient 5200 5200 5200 57 2964 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 51 2652 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AD PACING ACUITY SILICONE POLYESTER L90 CM CORONARY VENOUS LEFT VENTRICLE IS-1 CONNECTOR STEERABLE SUP-4555 CDM 0275 RC outpatient 5322.2 5322.2 5322.2 57 3033.65 percent of total billed charges 5322.2 93 4310.98 percent of total billed charges 5322.2 5322.2 other OPPS APC 5322.2 5322.2 other OPPS APC 5322.2 51 2714.32 percent of total billed charges 5322.2 5322.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY FIXATION TITANIUM HELICAL L80 MM OD11 MM TROCHANTERIC CANNULATED STERILE GOLD SUP-456.301S CDM 270010022 LOCAL 0270 RC outpatient 1836.12 1836.12 1836.12 74 1358.73 percent of total billed charges 1836.12 93 1487.26 percent of total billed charges 1836.12 1836.12 other OPPS APC 1836.12 1836.12 other OPPS APC 1836.12 27.63 507.32 percent of total billed charges 1836.12 1836.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY FIXATION TITANIUM HELIX L85 MM OD11 MM TROCHANTER CANNULATED STERILE GOLD SUP-456.302S CDM 270010022 LOCAL 0270 RC outpatient 1836.12 1836.12 1836.12 74 1358.73 percent of total billed charges 1836.12 93 1487.26 percent of total billed charges 1836.12 1836.12 other OPPS APC 1836.12 1836.12 other OPPS APC 1836.12 27.63 507.32 percent of total billed charges 1836.12 1836.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY FIXATION TITANIUM HELICAL L90 MM OD11 MM TROCHANTERIC CANNULATED STERILE GOLD SUP-456.303S CDM 270010022 LOCAL 0270 RC outpatient 1836.12 1836.12 1836.12 74 1358.73 percent of total billed charges 1836.12 93 1487.26 percent of total billed charges 1836.12 1836.12 other OPPS APC 1836.12 1836.12 other OPPS APC 1836.12 27.63 507.32 percent of total billed charges 1836.12 1836.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY FIXATION TITANIUM HELICAL L95 MM OD11 MM TROCHANTERIC CANNULATED STERILE GOLD SUP-456.304S CDM 270010022 LOCAL 0270 RC outpatient 1836.12 1836.12 1836.12 74 1358.73 percent of total billed charges 1836.12 93 1487.26 percent of total billed charges 1836.12 1836.12 other OPPS APC 1836.12 1836.12 other OPPS APC 1836.12 27.63 507.32 percent of total billed charges 1836.12 1836.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY FIXATION TITANIUM HELICAL L100 MM OD11 MM TROCHANTERIC CANNULATED STERILE GOLD SUP-456.305S CDM 270010022 LOCAL 0270 RC outpatient 1836.12 1836.12 1836.12 74 1358.73 percent of total billed charges 1836.12 93 1487.26 percent of total billed charges 1836.12 1836.12 other OPPS APC 1836.12 1836.12 other OPPS APC 1836.12 27.63 507.32 percent of total billed charges 1836.12 1836.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY FIXATION TITANIUM HELICAL L105 MM OD11 MM TROCHANTERIC CANNULATED STERILE GOLD SUP-456.306S CDM 270010022 LOCAL 0270 RC outpatient 1836.12 1836.12 1836.12 74 1358.73 percent of total billed charges 1836.12 93 1487.26 percent of total billed charges 1836.12 1836.12 other OPPS APC 1836.12 1836.12 other OPPS APC 1836.12 27.63 507.32 percent of total billed charges 1836.12 1836.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY FIXATION TITANIUM HELIX L110 MM OD11 MM TROCHANTER CANNULATED STERILE GOLD SUP-456.307S CDM 270010022 LOCAL 0270 RC outpatient 1836.12 1836.12 1836.12 74 1358.73 percent of total billed charges 1836.12 93 1487.26 percent of total billed charges 1836.12 1836.12 other OPPS APC 1836.12 1836.12 other OPPS APC 1836.12 27.63 507.32 percent of total billed charges 1836.12 1836.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY FIXATION TITANIUM HELIX L115 MM OD11 MM TROCHANTER CANNULATED NONSTERILE GOLD SUP-456.308 CDM 270010022 LOCAL 0270 RC outpatient 1668.81 1668.81 1668.81 74 1234.92 percent of total billed charges 1668.81 93 1351.74 percent of total billed charges 1668.81 1668.81 other OPPS APC 1668.81 1668.81 other OPPS APC 1668.81 27.63 461.09 percent of total billed charges 1668.81 1668.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY FIXATION TITANIUM HELIX L115 MM OD11 MM TROCHANTER STERILE GOLD SUP-456.308S CDM 270010022 LOCAL 0270 RC outpatient 1836.12 1836.12 1836.12 74 1358.73 percent of total billed charges 1836.12 93 1487.26 percent of total billed charges 1836.12 1836.12 other OPPS APC 1836.12 1836.12 other OPPS APC 1836.12 27.63 507.32 percent of total billed charges 1836.12 1836.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY FIXATION GOLD 120MM 11MM HELIX TROCHANTER TITANIUM STERILE SUP-456.309S CDM 270010022 LOCAL 0270 RC outpatient 1836.12 1836.12 1836.12 74 1358.73 percent of total billed charges 1836.12 93 1487.26 percent of total billed charges 1836.12 1836.12 other OPPS APC 1836.12 1836.12 other OPPS APC 1836.12 27.63 507.32 percent of total billed charges 1836.12 1836.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM 130 D SHORT L170 MM OD10-17 MM FEMUR TROCHANTERIC CANNULATED PREASSEMBLE LOCK MECHANISM FIXATION STATIC INTERLOCK STERILE GREEN SUP-456.315S CDM 270010022 LOCAL 0270 RC outpatient 3514.94 3514.94 3514.94 74 2601.06 percent of total billed charges 3514.94 93 2847.1 percent of total billed charges 3514.94 3514.94 other OPPS APC 3514.94 3514.94 other OPPS APC 3514.94 27.63 971.18 percent of total billed charges 3514.94 3514.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL FIXATION TITANIUM 130 D SHORT L170 MM OD11-17 MM FEMUR TROCHANTERIC CANNULATED PREASSEMBLE LOCK MECHANISM STERILE GREEN SUP-456.318S CDM 270010022 LOCAL 0270 RC outpatient 3514.94 3514.94 3514.94 74 2601.06 percent of total billed charges 3514.94 93 2847.1 percent of total billed charges 3514.94 3514.94 other OPPS APC 3514.94 3514.94 other OPPS APC 3514.94 27.63 971.18 percent of total billed charges 3514.94 3514.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM 130 D SHORT L170 MM OD12-17 MM FEMUR TROCHANTERIC CANNULATED PREASSEMBLE LOCK MECHANISM FIXATION STATIC INTERLOCK STERILE GREEN SUP-456.322S CDM 270010022 LOCAL 0270 RC outpatient 3514.94 3514.94 3514.94 74 2601.06 percent of total billed charges 3514.94 93 2847.1 percent of total billed charges 3514.94 3514.94 other OPPS APC 3514.94 3514.94 other OPPS APC 3514.94 27.63 971.18 percent of total billed charges 3514.94 3514.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM 130 D SHORT UNIVERSAL L235 MM OD10 MM TROCHANTERIC CANNULATED PREASSEMBLE LOCK MECHANISM STATIC INTERLOCK STERILE GREEN SUP-456.325S CDM 270010022 LOCAL 0270 RC outpatient 3629.34 3629.34 3629.34 74 2685.71 percent of total billed charges 3629.34 93 2939.77 percent of total billed charges 3629.34 3629.34 other OPPS APC 3629.34 3629.34 other OPPS APC 3629.34 27.63 1002.79 percent of total billed charges 3629.34 3629.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM 130 D SHORT UNIVERSAL L235 MM OD11 MM TROCHANTERIC CANNULATED PREASSEMBLED LOCKING MECHANISM STATIC INTERLOCKING ANATOMIC STERILE GREEN SUP-456.328S CDM 270010022 LOCAL 0270 RC outpatient 3514.94 3514.94 3514.94 74 2601.06 percent of total billed charges 3514.94 93 2847.1 percent of total billed charges 3514.94 3514.94 other OPPS APC 3514.94 3514.94 other OPPS APC 3514.94 27.63 971.18 percent of total billed charges 3514.94 3514.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY 130D LONG 320MM 10-17MM GREEN TITANIUM STERILE TROCHANTERIC RIGHT CANNULATED SUP-456.352S CDM 270010022 LOCAL 0270 RC outpatient 5282.42 5282.42 5282.42 74 3908.99 percent of total billed charges 5282.42 93 4278.76 percent of total billed charges 5282.42 5282.42 other OPPS APC 5282.42 5282.42 other OPPS APC 5282.42 27.63 1459.53 percent of total billed charges 5282.42 5282.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL 10MM 320MM LEFT TROCHANTER INTRAMEDULLARY 130D LONG CANNULATED PREASSEMBLED SUP-456.353S CDM 270010022 LOCAL 0270 RC outpatient 5282.42 5282.42 5282.42 74 3908.99 percent of total billed charges 5282.42 93 4278.76 percent of total billed charges 5282.42 5282.42 other OPPS APC 5282.42 5282.42 other OPPS APC 5282.42 27.63 1459.53 percent of total billed charges 5282.42 5282.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY 130D LONG 340MM 10-17MM GREEN TITANIUM STERILE TROCHANTERIC RIGHT CANNULATED SUP-456.354S CDM 270010022 LOCAL 0270 RC outpatient 5282.42 5282.42 5282.42 74 3908.99 percent of total billed charges 5282.42 93 4278.76 percent of total billed charges 5282.42 5282.42 other OPPS APC 5282.42 5282.42 other OPPS APC 5282.42 27.63 1459.53 percent of total billed charges 5282.42 5282.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY 130D LONG 340MM 10-17MM GREEN TITANIUM STERILE TROCHANTERIC LEFT CANNULATED SUP-456.355S CDM 270010022 LOCAL 0270 RC outpatient 5282.42 5282.42 5282.42 74 3908.99 percent of total billed charges 5282.42 93 4278.76 percent of total billed charges 5282.42 5282.42 other OPPS APC 5282.42 5282.42 other OPPS APC 5282.42 27.63 1459.53 percent of total billed charges 5282.42 5282.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY 130D LONG 360MM 10-17MM GREEN TITANIUM STERILE TROCHANTERIC RIGHT CANNULATED SUP-456.356S CDM 270010022 LOCAL 0270 RC outpatient 5282.42 5282.42 5282.42 74 3908.99 percent of total billed charges 5282.42 93 4278.76 percent of total billed charges 5282.42 5282.42 other OPPS APC 5282.42 5282.42 other OPPS APC 5282.42 27.63 1459.53 percent of total billed charges 5282.42 5282.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY 130D LONG 360MM 10-17MM GREEN TITANIUM STERILE TROCHANTERIC LEFT CANNULATED SUP-456.357S CDM 270010022 LOCAL 0270 RC outpatient 5282.42 5282.42 5282.42 74 3908.99 percent of total billed charges 5282.42 93 4278.76 percent of total billed charges 5282.42 5282.42 other OPPS APC 5282.42 5282.42 other OPPS APC 5282.42 27.63 1459.53 percent of total billed charges 5282.42 5282.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY 130D LONG 380MM 10-17MM GREEN TITANIUM STERILE TROCHANTERIC RIGHT CANNULATED SUP-456.358S CDM 270010022 LOCAL 0270 RC outpatient 5282.42 5282.42 5282.42 74 3908.99 percent of total billed charges 5282.42 93 4278.76 percent of total billed charges 5282.42 5282.42 other OPPS APC 5282.42 5282.42 other OPPS APC 5282.42 27.63 1459.53 percent of total billed charges 5282.42 5282.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY 130D LONG 380MM 10-17MM GREEN TITANIUM STERILE TROCHANTERIC LEFT CANNULATED SUP-456.359S CDM 270010022 LOCAL 0270 RC outpatient 5282.42 5282.42 5282.42 74 3908.99 percent of total billed charges 5282.42 93 4278.76 percent of total billed charges 5282.42 5282.42 other OPPS APC 5282.42 5282.42 other OPPS APC 5282.42 27.63 1459.53 percent of total billed charges 5282.42 5282.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY 130D LONG 400MM 10-17MM GREEN TITANIUM STERILE TROCHANTERIC RIGHT CANNULATED SUP-456.360S CDM 270010022 LOCAL 0270 RC outpatient 5282.42 5282.42 5282.42 74 3908.99 percent of total billed charges 5282.42 93 4278.76 percent of total billed charges 5282.42 5282.42 other OPPS APC 5282.42 5282.42 other OPPS APC 5282.42 27.63 1459.53 percent of total billed charges 5282.42 5282.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY 130D LONG 400MM 10-17MM GREEN TITANIUM STERILE TROCHANTERIC LEFT CANNULATED SUP-456.361S CDM 270010022 LOCAL 0270 RC outpatient 5282.42 5282.42 5282.42 74 3908.99 percent of total billed charges 5282.42 93 4278.76 percent of total billed charges 5282.42 5282.42 other OPPS APC 5282.42 5282.42 other OPPS APC 5282.42 27.63 1459.53 percent of total billed charges 5282.42 5282.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY 130D LONG 420MM 10-17MM GREEN TITANIUM STERILE TROCHANTERIC RIGHT CANNULATED SUP-456.362S CDM 270010022 LOCAL 0270 RC outpatient 5282.42 5282.42 5282.42 74 3908.99 percent of total billed charges 5282.42 93 4278.76 percent of total billed charges 5282.42 5282.42 other OPPS APC 5282.42 5282.42 other OPPS APC 5282.42 27.63 1459.53 percent of total billed charges 5282.42 5282.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL 10-17MM 420MM TROCHANTERIC LEFT FEMUR INTRAMEDULLARY 130D CANNULATED PREASSEMBLE SUP-456.363S CDM 270010022 LOCAL 0270 RC outpatient 5282.42 5282.42 5282.42 74 3908.99 percent of total billed charges 5282.42 93 4278.76 percent of total billed charges 5282.42 5282.42 other OPPS APC 5282.42 5282.42 other OPPS APC 5282.42 27.63 1459.53 percent of total billed charges 5282.42 5282.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY 130D LONG 440MM 10-17MM GREEN TITANIUM STERILE TROCHANTERIC RIGHT CANNULATED SUP-456.364S CDM 270010022 LOCAL 0270 RC outpatient 5282.42 5282.42 5282.42 74 3908.99 percent of total billed charges 5282.42 93 4278.76 percent of total billed charges 5282.42 5282.42 other OPPS APC 5282.42 5282.42 other OPPS APC 5282.42 27.63 1459.53 percent of total billed charges 5282.42 5282.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL 10MM 44CM LEFT TROCHANTERIC INTRAMEDULLARY 130D LONG CANNULATED TITANIUM STERILE SUP-456.365S CDM 270010022 LOCAL 0270 RC outpatient 5282.42 5282.42 5282.42 74 3908.99 percent of total billed charges 5282.42 93 4278.76 percent of total billed charges 5282.42 5282.42 other OPPS APC 5282.42 5282.42 other OPPS APC 5282.42 27.63 1459.53 percent of total billed charges 5282.42 5282.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL 11-17MM 320MM FEMUR TROCHANTERIC RIGHT INTRAMEDULLARY 130D LONG CANNULATED SUP-456.412S CDM 270010022 LOCAL 0270 RC outpatient 4960.67 4960.67 4960.67 74 3670.9 percent of total billed charges 4960.67 93 4018.14 percent of total billed charges 4960.67 4960.67 other OPPS APC 4960.67 4960.67 other OPPS APC 4960.67 27.63 1370.63 percent of total billed charges 4960.67 4960.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM 130 D LONG L320 MM OD11-17 MM FEMUR TROCHANTERIC LEFT CANNULATED PREASSEMBLE LOCK MECHANISM FIXATION STERILE GREEN SUP-456.413S CDM 270010022 LOCAL 0270 RC outpatient 4960.67 4960.67 4960.67 74 3670.9 percent of total billed charges 4960.67 93 4018.14 percent of total billed charges 4960.67 4960.67 other OPPS APC 4960.67 4960.67 other OPPS APC 4960.67 27.63 1370.63 percent of total billed charges 4960.67 4960.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM 130 D LONG L340 MM OD11-17 MM FEMUR TROCHANTERIC RIGHT CANNULATED PREASSEMBLE LOCK MECHANISM FIXATION STERILE GREEN SUP-456.414S CDM 270010022 LOCAL 0270 RC outpatient 4960.67 4960.67 4960.67 74 3670.9 percent of total billed charges 4960.67 93 4018.14 percent of total billed charges 4960.67 4960.67 other OPPS APC 4960.67 4960.67 other OPPS APC 4960.67 27.63 1370.63 percent of total billed charges 4960.67 4960.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL FIXATION GREEN 340MM 11-17MM 130D LONG FEMUR TROCHANTERIC LEFT TITANIUM SUP-456.415S CDM 270010022 LOCAL 0270 RC outpatient 4960.67 4960.67 4960.67 74 3670.9 percent of total billed charges 4960.67 93 4018.14 percent of total billed charges 4960.67 4960.67 other OPPS APC 4960.67 4960.67 other OPPS APC 4960.67 27.63 1370.63 percent of total billed charges 4960.67 4960.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM 130 D LONG L360 MM OD11 MM FEMUR RIGHT TROCHANTERIC CANNULATED PREASSEMBLE LOCK MECHANISM FIXATION STERILE GREEN SUP-456.416S CDM 270010022 LOCAL 0270 RC outpatient 4960.67 4960.67 4960.67 74 3670.9 percent of total billed charges 4960.67 93 4018.14 percent of total billed charges 4960.67 4960.67 other OPPS APC 4960.67 4960.67 other OPPS APC 4960.67 27.63 1370.63 percent of total billed charges 4960.67 4960.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL FIXATION TITANIUM 130 D SHORT L360 MM OD11 MM LEFT DISTAL TROCHANTER CANNULATED PREASSEMBLED LOCKING MECHANISM STERILE GREEN SUP-456.417S CDM 270010022 LOCAL 0270 RC outpatient 4960.67 4960.67 4960.67 74 3670.9 percent of total billed charges 4960.67 93 4018.14 percent of total billed charges 4960.67 4960.67 other OPPS APC 4960.67 4960.67 other OPPS APC 4960.67 27.63 1370.63 percent of total billed charges 4960.67 4960.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM 130 D LONG L380 MM OD11-17 MM FEMUR TROCHANTERIC RIGHT CANNULATED PREASSEMBLE LOCK MECHANISM FIXATION STERILE GREEN SUP-456.418S CDM 270010022 LOCAL 0270 RC outpatient 4960.67 4960.67 4960.67 74 3670.9 percent of total billed charges 4960.67 93 4018.14 percent of total billed charges 4960.67 4960.67 other OPPS APC 4960.67 4960.67 other OPPS APC 4960.67 27.63 1370.63 percent of total billed charges 4960.67 4960.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM 130 D LONG L380 MM OD11-17 MM FEMUR TROCHANTERIC LEFT CANNULATED PREASSEMBLE LOCK MECHANISM FIXATION STERILE GREEN SUP-456.419S CDM 270010022 LOCAL 0270 RC outpatient 4960.67 4960.67 4960.67 74 3670.9 percent of total billed charges 4960.67 93 4018.14 percent of total billed charges 4960.67 4960.67 other OPPS APC 4960.67 4960.67 other OPPS APC 4960.67 27.63 1370.63 percent of total billed charges 4960.67 4960.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL 11-17MM 400MM FEMUR TROCHANTERIC RIGHT INTRAMEDULLARY 130D LONG CANNULATED SUP-456.420S CDM 270010022 LOCAL 0270 RC outpatient 4960.67 4960.67 4960.67 74 3670.9 percent of total billed charges 4960.67 93 4018.14 percent of total billed charges 4960.67 4960.67 other OPPS APC 4960.67 4960.67 other OPPS APC 4960.67 27.63 1370.63 percent of total billed charges 4960.67 4960.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM 130 D LONG L400 MM OD11-17 MM FEMUR TROCHANTERIC LEFT CANNULATED PREASSEMBLE LOCK MECHANISM FIXATION STERILE GREEN SUP-456.421S CDM 270010022 LOCAL 0270 RC outpatient 4960.67 4960.67 4960.67 74 3670.9 percent of total billed charges 4960.67 93 4018.14 percent of total billed charges 4960.67 4960.67 other OPPS APC 4960.67 4960.67 other OPPS APC 4960.67 27.63 1370.63 percent of total billed charges 4960.67 4960.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL FIXATION TITANIUM 130 D LONG L420 MM OD11-17 MM FEMUR TROCHANTERIC RIGHT CANNULATED PREASSEMBLE LOCK MECHANISM STERILE GREEN SUP-456.422S CDM 270010022 LOCAL 0270 RC outpatient 4960.67 4960.67 4960.67 74 3670.9 percent of total billed charges 4960.67 93 4018.14 percent of total billed charges 4960.67 4960.67 other OPPS APC 4960.67 4960.67 other OPPS APC 4960.67 27.63 1370.63 percent of total billed charges 4960.67 4960.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL FIXATION TITANIUM 130 D SHORT L420 MM OD11 MM LEFT DISTAL TROCHANTER CANNULATED PREASSEMBLED LOCKING MECHANISM STERILE GREEN SUP-456.423S CDM 270010022 LOCAL 0270 RC outpatient 4960.67 4960.67 4960.67 74 3670.9 percent of total billed charges 4960.67 93 4018.14 percent of total billed charges 4960.67 4960.67 other OPPS APC 4960.67 4960.67 other OPPS APC 4960.67 27.63 1370.63 percent of total billed charges 4960.67 4960.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM 130 D LONG L440 MM OD11-17 MM FEMUR TROCHANTERIC RIGHT CANNULATED PREASSEMBLE LOCK MECHANISM FIXATION STERILE GREEN SUP-456.424S CDM 270010022 LOCAL 0270 RC outpatient 4960.67 4960.67 4960.67 74 3670.9 percent of total billed charges 4960.67 93 4018.14 percent of total billed charges 4960.67 4960.67 other OPPS APC 4960.67 4960.67 other OPPS APC 4960.67 27.63 1370.63 percent of total billed charges 4960.67 4960.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM 130 D LONG L440 MM OD11 MM LEFT TROCHANTER FEMUR CANNULATED PREASSEMBLED LOCKING MECHANISM STATIC/DYNAMIC INTERLOCKING ANATOMIC STERILE GREEN SUP-456.425S CDM 270010022 LOCAL 0270 RC outpatient 4960.67 4960.67 4960.67 74 3670.9 percent of total billed charges 4960.67 93 4018.14 percent of total billed charges 4960.67 4960.67 other OPPS APC 4960.67 4960.67 other OPPS APC 4960.67 27.63 1370.63 percent of total billed charges 4960.67 4960.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY 130D SHORT 235MM 12-17MM GREEN TITANIUM STERILE TROCHANTERIC CANNULATED SUP-456.511S CDM 270010022 LOCAL 0270 RC outpatient 3769.48 3769.48 3769.48 74 2789.42 percent of total billed charges 3769.48 93 3053.28 percent of total billed charges 3769.48 3769.48 other OPPS APC 3769.48 3769.48 other OPPS APC 3769.48 27.63 1041.51 percent of total billed charges 3769.48 3769.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE 12MM ALLOGRAFT PRECUT CORE MATURE HYALINE CARTILAGE SUP-45647010 CDM 270010031 LOCAL 0270 RC outpatient 6487 6487 6487 74 4800.38 percent of total billed charges 6487 93 5254.47 percent of total billed charges 6487 6487 other OPPS APC 6487 6487 other OPPS APC 6487 27.63 1792.36 percent of total billed charges 6487 6487 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE OSTEOCHONDRAL CORE OD16 MM ALLOGRAFT SUP-45647016 CDM 0270 RC outpatient 11700 11700 11700 74 8658 percent of total billed charges 11700 93 9477 percent of total billed charges 11700 11700 other OPPS APC 11700 11700 other OPPS APC 11700 27.63 3232.71 percent of total billed charges 11700 11700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERSAL REVERSE 6MM SUP-45650 CDM C1776 HCPCS 0278 RC outpatient 6212.5 6212.5 6212.5 57 3541.13 percent of total billed charges 6212.5 93 5032.13 percent of total billed charges 6212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6212.5 other OPPS APC 6212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6212.5 other OPPS APC 6212.5 51 3168.38 percent of total billed charges 6212.5 6212.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L36 MM OD4 MM ODSEC3.5 MM HUMERAL SELF CUT TROCAR TIP LOCK HEXAGONAL DRIVER NONSTERILE BLUE INTRAMEDULLARY NAIL SUP-458.836 CDM 270010022 LOCAL 0270 RC outpatient 540.54 540.54 540.54 74 400 percent of total billed charges 540.54 93 437.84 percent of total billed charges 540.54 540.54 other OPPS APC 540.54 540.54 other OPPS APC 540.54 27.63 149.35 percent of total billed charges 540.54 540.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EXPERT TITANIUM 3.5 MM FULL THREAD BLUNT HEXAGON L46 MM OD4 MM ODSEC8 MM FEMUR HUMERUS TIBIA DISTAL PROXIMAL 2 LEAD SELF TAP SELF CUT TROCAR TIP LOCK NONSTERILE BLUE CANNULATED INTRAMEDULLARY NAIL SYSTEM SUP-458.846 CDM 270010022 LOCAL 0270 RC outpatient 540.54 540.54 540.54 74 400 percent of total billed charges 540.54 93 437.84 percent of total billed charges 540.54 540.54 other OPPS APC 540.54 540.54 other OPPS APC 540.54 27.63 149.35 percent of total billed charges 540.54 540.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EXPERT TITANIUM 3.5 MM FULL THREAD BLUNT HEXAGON L54 MM OD4 MM ODSEC8 MM FEMUR HUMERUS TIBIA DISTAL PROXIMAL 2 LEAD SELF TAP SELF CUT TROCAR TIP LOCK NONSTERILE BLUE CANNULATED INTRAMEDULLARY NAIL SYSTEM SUP-458.854 CDM 270010022 LOCAL 0270 RC outpatient 540.54 540.54 540.54 74 400 percent of total billed charges 540.54 93 437.84 percent of total billed charges 540.54 540.54 other OPPS APC 540.54 540.54 other OPPS APC 540.54 27.63 149.35 percent of total billed charges 540.54 540.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EXPERT TITANIUM 3.5 MM FULL THREAD BLUNT HEXAGON L30 MM OD5 MM ODSEC8 MM FEMUR TIBIA DISTAL 2 LEAD SELF TAP LOCK NONSTERILE GREEN INTRAMEDULLARY NAIL SYSTEM SUP-458.93 CDM 270010022 LOCAL 0270 RC outpatient 540.54 540.54 540.54 74 400 percent of total billed charges 540.54 93 437.84 percent of total billed charges 540.54 540.54 other OPPS APC 540.54 540.54 other OPPS APC 540.54 27.63 149.35 percent of total billed charges 540.54 540.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 5MM 8MM 30MM EXPERT TITANIUM 3.5MM FULL THREAD BLUNT HEXAGON FEMUR TIBIA SUP-458.930 CDM outpatient 540.54 540.54 540.54 540.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L32 MM OD5 MM ODSEC8 MM FEMUR BLUNT TIP SELF TAP LOCK HEXAGONAL DRIVE NONSTERILE LIGHT GREEN TFN-ADVANCED SUP-458.932 CDM 270010022 LOCAL 0270 RC outpatient 466.18 466.18 466.18 74 344.97 percent of total billed charges 466.18 93 377.61 percent of total billed charges 466.18 466.18 other OPPS APC 466.18 466.18 other OPPS APC 466.18 27.63 128.81 percent of total billed charges 466.18 466.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EXPERT TITANIUM 3.5 MM FULL THREAD BLUNT HEXAGON L34 MM OD5 MM ODSEC8 MM FEMUR TIBIA DISTAL 2 LEAD SELF TAP LOCK NONSTERILE GREEN INTRAMEDULLARY NAIL SYSTEM SUP-458.934 CDM 270010022 LOCAL 0270 RC outpatient 466.18 466.18 466.18 74 344.97 percent of total billed charges 466.18 93 377.61 percent of total billed charges 466.18 466.18 other OPPS APC 466.18 466.18 other OPPS APC 466.18 27.63 128.81 percent of total billed charges 466.18 466.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L36 MM OD5 MM ODSEC8 MM FEMUR BLUNT TIP SELF TAP LOCK HEXAGONAL DRIVE NONSTERILE LIGHT GREEN TFN-ADVANCED SUP-458.936 CDM 270010022 LOCAL 0270 RC outpatient 466.18 466.18 466.18 74 344.97 percent of total billed charges 466.18 93 377.61 percent of total billed charges 466.18 466.18 other OPPS APC 466.18 466.18 other OPPS APC 466.18 27.63 128.81 percent of total billed charges 466.18 466.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EXPERT TITANIUM 3.5 MM FULL THREAD BLUNT HEXAGON L38 MM OD5 MM ODSEC8 MM FEMUR TIBIA DISTAL 2 LEAD SELF TAP LOCK NONSTERILE GREEN INTRAMEDULLARY NAIL SYSTEM SUP-458.938 CDM 270010022 LOCAL 0270 RC outpatient 466.18 466.18 466.18 74 344.97 percent of total billed charges 466.18 93 377.61 percent of total billed charges 466.18 466.18 other OPPS APC 466.18 466.18 other OPPS APC 466.18 27.63 128.81 percent of total billed charges 466.18 466.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L40 MM OD5 MM ODSEC8 MM FEMUR BLUNT TIP SELF TAP LOCK HEXAGONAL DRIVE NONSTERILE LIGHT GREEN TFN-ADVANCED SUP-458.94 CDM 270010022 LOCAL 0270 RC outpatient 540.54 540.54 540.54 74 400 percent of total billed charges 540.54 93 437.84 percent of total billed charges 540.54 540.54 other OPPS APC 540.54 540.54 other OPPS APC 540.54 27.63 149.35 percent of total billed charges 540.54 540.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 5MM 8MM 40MM TITANIUM FULL THREAD FEMUR BLUNT TIP SELF TAP LOCK HEXAGONAL SUP-458.940 CDM outpatient 540.54 540.54 540.54 540.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EXPERT TITANIUM 3.5 MM FULL THREAD BLUNT HEXAGON L42 MM OD5 MM ODSEC8 MM FEMUR TIBIA DISTAL 2 LEAD SELF TAP LOCK NONSTERILE GREEN INTRAMEDULLARY NAIL SYSTEM SUP-458.942 CDM 270010022 LOCAL 0270 RC outpatient 466.18 466.18 466.18 74 344.97 percent of total billed charges 466.18 93 377.61 percent of total billed charges 466.18 466.18 other OPPS APC 466.18 466.18 other OPPS APC 466.18 27.63 128.81 percent of total billed charges 466.18 466.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L44 MM OD5 MM ODSEC8 MM FEMUR BLUNT TIP SELF TAP LOCK HEXAGONAL DRIVE NONSTERILE LIGHT GREEN TFN-ADVANCED SUP-458.944 CDM 270010022 LOCAL 0270 RC outpatient 466.18 466.18 466.18 74 344.97 percent of total billed charges 466.18 93 377.61 percent of total billed charges 466.18 466.18 other OPPS APC 466.18 466.18 other OPPS APC 466.18 27.63 128.81 percent of total billed charges 466.18 466.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EXPERT TITANIUM 3.5 MM FULL THREAD BLUNT HEXAGON L46 MM OD5 MM ODSEC8 MM FEMUR TIBIA DISTAL 2 LEAD SELF TAP LOCK NONSTERILE GREEN INTRAMEDULLARY NAIL SYSTEM SUP-458.946 CDM 270010022 LOCAL 0270 RC outpatient 466.18 466.18 466.18 74 344.97 percent of total billed charges 466.18 93 377.61 percent of total billed charges 466.18 466.18 other OPPS APC 466.18 466.18 other OPPS APC 466.18 27.63 128.81 percent of total billed charges 466.18 466.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L48 MM OD5 MM ODSEC8 MM FEMUR BLUNT TIP SELF TAP LOCK HEXAGONAL DRIVE NONSTERILE LIGHT GREEN TFN-ADVANCED SUP-458.948 CDM 270010022 LOCAL 0270 RC outpatient 466.18 466.18 466.18 74 344.97 percent of total billed charges 466.18 93 377.61 percent of total billed charges 466.18 466.18 other OPPS APC 466.18 466.18 other OPPS APC 466.18 27.63 128.81 percent of total billed charges 466.18 466.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L50 MM OD5 MM ODSEC8 MM FEMUR BLUNT TIP SELF TAP LOCK HEXAGONAL DRIVE NONSTERILE LIGHT GREEN TFN-ADVANCED SUP-458.95 CDM 270010022 LOCAL 0270 RC outpatient 540.54 540.54 540.54 74 400 percent of total billed charges 540.54 93 437.84 percent of total billed charges 540.54 540.54 other OPPS APC 540.54 540.54 other OPPS APC 540.54 27.63 149.35 percent of total billed charges 540.54 540.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 5MM 8MM 50MM TITANIUM FULL THREAD FEMUR BLUNT TIP SELF TAP LOCK HEXAGONAL SUP-458.950 CDM outpatient 540.54 540.54 540.54 540.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 3.5MM FULL THREAD 68MM 5MM 8MM GREEN TITANIUM NS SELF TAP LOCK BLUNT TIP HEXAGONAL DRIVE INTRAMEDULLARY NAIL SUP-458.968 CDM 270010022 LOCAL 0270 RC outpatient 466.18 466.18 466.18 74 344.97 percent of total billed charges 466.18 93 377.61 percent of total billed charges 466.18 466.18 other OPPS APC 466.18 466.18 other OPPS APC 466.18 27.63 128.81 percent of total billed charges 466.18 466.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING GAUZE QUIKCLOT KAOLIN L4 IN X W4 IN 6 PLY NONWOVEN FLEXIBLE XRAY LATEX FREE SUP-459 CDM 0270 RC outpatient 46.77 46.77 46.77 74 34.61 percent of total billed charges 46.77 93 37.88 percent of total billed charges 46.77 46.77 other OPPS APC 46.77 46.77 other OPPS APC 46.77 27.63 12.92 percent of total billed charges 46.77 46.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP END TITANIUM 20 MM L12 MM OD12 MM FEMUR EXTENDED STANDARD LOCKING STERILE GREEN INTRAMEDULLARY NAIL STANDARD LOCKING SUP-459.014S CDM 270010022 LOCAL 0270 RC outpatient 699.66 699.66 699.66 74 517.75 percent of total billed charges 699.66 93 566.72 percent of total billed charges 699.66 699.66 other OPPS APC 699.66 699.66 other OPPS APC 699.66 27.63 193.32 percent of total billed charges 699.66 699.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ACUITY SPIRAL 80CM 4.1-2.6FR LEFT VENTRICLE CORONARY VENOUS SUP-4591/92/93 CDM 0275 RC outpatient 5322.2 5322.2 5322.2 57 3033.65 percent of total billed charges 5322.2 93 4310.98 percent of total billed charges 5322.2 5322.2 other OPPS APC 5322.2 5322.2 other OPPS APC 5322.2 51 2714.32 percent of total billed charges 5322.2 5322.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ATTAIN PERFORMA STARFIX STEROID PLATINUM IRIDIUM SI POLYIMIDE POLYURETHANE OD3.9 FR .36-.46 MM L78 CM OD5.3 FR ODSEC5.1 FR LEFT VENTRICLE QUADRIPOLAR IS4-LLLL CONNECTOR PASSIVE OFFSET S FIXATION GUIDEWIRE LATEX FREE SUP-459878 CDM 0275 RC outpatient 4420 4420 4420 57 2519.4 percent of total billed charges 4420 93 3580.2 percent of total billed charges 4420 4420 other OPPS APC 4420 4420 other OPPS APC 4420 51 2254.2 percent of total billed charges 4420 4420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING ATTAIN PERFORMA STARFIX STEROID PLATINUM IRIDIUM SI POLYIMIDE POLYURETHANE .36-.46 MM OD3.9 FR L88 CM OD5.3 FR ODSEC5.1 FR VENTRICLE LEFT QUADRIPOLAR IS4-LLLL CONNECTOR PASSIVE OFFSET S FIXATION GUIDEWIRE LATEX FREE SUP-459888 CDM 0275 RC outpatient 4420 4420 4420 57 2519.4 percent of total billed charges 4420 93 3580.2 percent of total billed charges 4420 4420 other OPPS APC 4420 4420 other OPPS APC 4420 51 2254.2 percent of total billed charges 4420 4420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE SPINAL SOFWIRE TITANIUM 1 CINCH TIGHTENER CENTRAL LEADER STERILE SUP-46-4040 CDM 0270 RC outpatient 1898 1898 1898 74 1404.52 percent of total billed charges 1898 93 1537.38 percent of total billed charges 1898 1898 other OPPS APC 1898 1898 other OPPS APC 1898 27.63 524.42 percent of total billed charges 1898 1898 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE STRAIGHT AMPLATZ 180CM -- USE PMM 100541 SUP-46-525 CDM 0270 RC outpatient 99.14 99.14 99.14 74 73.36 percent of total billed charges 99.14 93 80.3 percent of total billed charges 99.14 99.14 other OPPS APC 99.14 99.14 other OPPS APC 99.14 27.63 27.39 percent of total billed charges 99.14 99.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR V-18 CONTROLWIRE STRAIGHT L200 CM L8 CM OD.018 IN SUP-46-852 CDM 0270 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STRAIGHT TITANIUM NS STERNUM 12 HOLE LOCK 3MM SCREW SUP-460.019 CDM 0270 RC outpatient 7402.2 7402.2 7402.2 74 5477.63 percent of total billed charges 7402.2 93 5995.78 percent of total billed charges 7402.2 7402.2 other OPPS APC 7402.2 7402.2 other OPPS APC 7402.2 27.63 2045.23 percent of total billed charges 7402.2 7402.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STRAIGHT TITANIUM NS STERNAL 20 HOLE LOCK 2.4MM SCREW SUP-460.023 CDM 0270 RC outpatient 5064.49 5064.49 5064.49 74 3747.72 percent of total billed charges 5064.49 93 4102.24 percent of total billed charges 5064.49 5064.49 other OPPS APC 5064.49 5064.49 other OPPS APC 5064.49 27.63 1399.32 percent of total billed charges 5064.49 5064.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE SM H TITANIUM NS STERNAL 8 HOLE LOCK 2.4MM SCREW SUP-460.027 CDM 0270 RC outpatient 1274.36 1274.36 1274.36 74 943.03 percent of total billed charges 1274.36 93 1032.23 percent of total billed charges 1274.36 1274.36 other OPPS APC 1274.36 1274.36 other OPPS APC 1274.36 27.63 352.11 percent of total billed charges 1274.36 1274.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE STERNAL LOCKING H 8 HOLE SUP-460.028 CDM 0270 RC outpatient 1274.36 1274.36 1274.36 74 943.03 percent of total billed charges 1274.36 93 1032.23 percent of total billed charges 1274.36 1274.36 other OPPS APC 1274.36 1274.36 other OPPS APC 1274.36 27.63 352.11 percent of total billed charges 1274.36 1274.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE STERNAL LOCKING STAR 6 HOLE SUP-460.035 CDM 0270 RC outpatient 1210.64 1210.64 1210.64 74 895.87 percent of total billed charges 1210.64 93 980.62 percent of total billed charges 1210.64 1210.64 other OPPS APC 1210.64 1210.64 other OPPS APC 1210.64 27.63 334.5 percent of total billed charges 1210.64 1210.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE STERNAL LOCKING STAR 12 HOLE SUP-460.036 CDM 0270 RC outpatient 1333.75 1333.75 1333.75 74 986.98 percent of total billed charges 1333.75 93 1080.34 percent of total billed charges 1333.75 1333.75 other OPPS APC 1333.75 1333.75 other OPPS APC 1333.75 27.63 368.52 percent of total billed charges 1333.75 1333.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM X STERNAL 10 HOLE LOCK NONSTERILE 2.4 MM SCREW SUP-460.037 CDM 0270 RC outpatient 1373.76 1373.76 1373.76 74 1016.58 percent of total billed charges 1373.76 93 1112.75 percent of total billed charges 1373.76 1373.76 other OPPS APC 1373.76 1373.76 other OPPS APC 1373.76 27.63 379.57 percent of total billed charges 1373.76 1373.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 2 T STERNAL 14 HOLE LOCK NONSTERILE 2.4 MM SCREW SUP-460.038 CDM 0270 RC outpatient 1513.3 1513.3 1513.3 74 1119.84 percent of total billed charges 1513.3 93 1225.77 percent of total billed charges 1513.3 1513.3 other OPPS APC 1513.3 1513.3 other OPPS APC 1513.3 27.63 418.12 percent of total billed charges 1513.3 1513.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM ANGLE STERNAL 12 HOLE LOCK NONSTERILE 2.4 MM SCREW SUP-460.039 CDM 0270 RC outpatient 2106.1 2106.1 2106.1 74 1558.51 percent of total billed charges 2106.1 93 1705.94 percent of total billed charges 2106.1 2106.1 other OPPS APC 2106.1 2106.1 other OPPS APC 2106.1 27.63 581.92 percent of total billed charges 2106.1 2106.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM X STERNAL 10 HOLE LOCK NONSTERILE 2.4 MM SCREW SUP-460.040 CDM 0270 RC outpatient 4537 4537 4537 74 3357.38 percent of total billed charges 4537 93 3674.97 percent of total billed charges 4537 4537 other OPPS APC 4537 4537 other OPPS APC 4537 27.63 1253.57 percent of total billed charges 4537 4537 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM STRAIGHT STERNAL 13 HOLE LOCK WITHOUT RELEASE PIN NONSTERILE 2.4 MM SCREW SUP-460.046 CDM 0270 RC outpatient 2643.55 2643.55 2643.55 74 1956.23 percent of total billed charges 2643.55 93 2141.28 percent of total billed charges 2643.55 2643.55 other OPPS APC 2643.55 2643.55 other OPPS APC 2643.55 27.63 730.41 percent of total billed charges 2643.55 2643.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM STERILE 2T TALL STERNUM 18 HOLE LOCKING STERILE SUP-460.048S CDM 0270 RC outpatient 5943.6 5943.6 5943.6 74 4398.26 percent of total billed charges 5943.6 93 4814.32 percent of total billed charges 5943.6 5943.6 other OPPS APC 5943.6 5943.6 other OPPS APC 5943.6 27.63 1642.22 percent of total billed charges 5943.6 5943.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY COSGROVE-EDWARDS BARIUM SULFATE SILICONE RUBBER 3D C CONTOUR L57.9 MM OD26 MM ODSEC33.6 MM ID25.9 MM MITRAL TRICUSPID FLEXIBLE BAND TEMPLATE HANDLE STERILE HEART VALVE REPAIR SUP-460026MM CDM 0270 RC outpatient 4225 4225 4225 74 3126.5 percent of total billed charges 4225 93 3422.25 percent of total billed charges 4225 4225 other OPPS APC 4225 4225 other OPPS APC 4225 27.63 1167.37 percent of total billed charges 4225 4225 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY COSGROVE-EDWARDS BARIUM SULFATE SILICONE RUBBER 3D C CONTOUR L62 MM OD28 MM ODSEC35.6 MM ID28 MM MITRAL TRICUSPID FLEXIBLE BAND TEMPLATE HANDLE STERILE HEART VALVE REPAIR SUP-460028MM CDM 0270 RC outpatient 4225 4225 4225 74 3126.5 percent of total billed charges 4225 93 3422.25 percent of total billed charges 4225 4225 other OPPS APC 4225 4225 other OPPS APC 4225 27.63 1167.37 percent of total billed charges 4225 4225 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY COSGROVE-EDWARDS BARIUM SULFATE SILICONE RUBBER 3D C CONTOUR L66.3 MM OD30 MM ODSEC37.6 MM ID30 MM MITRAL TRICUSPID FLEXIBLE BAND TEMPLATE HANDLE STERILE HEART VALVE REPAIR SUP-460030MM CDM 0270 RC outpatient 4225 4225 4225 74 3126.5 percent of total billed charges 4225 93 3422.25 percent of total billed charges 4225 4225 other OPPS APC 4225 4225 other OPPS APC 4225 27.63 1167.37 percent of total billed charges 4225 4225 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY COSGROVE-EDWARDS BARIUM SULFATE SILICONE RUBBER 3D C CONTOUR L70.4 MM OD32 MM ODSEC39.6 MM ID31.9 MM MITRAL TRICUSPID FLEXIBLE BAND TEMPLATE HANDLE STERILE HEART VALVE REPAIR SUP-460032MM CDM 0270 RC outpatient 4940 4940 4940 74 3655.6 percent of total billed charges 4940 93 4001.4 percent of total billed charges 4940 4940 other OPPS APC 4940 4940 other OPPS APC 4940 27.63 1364.92 percent of total billed charges 4940 4940 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY COSGROVE-EDWARDS BARIUM SULFATE SILICONE RUBBER 3D C CONTOUR L74.7 MM OD34 MM ODSEC41.6 MM ID34 MM MITRAL TRICUSPID FLEXIBLE BAND TEMPLATE HANDLE STERILE HEART VALVE REPAIR SUP-460034MM CDM 0270 RC outpatient 4940 4940 4940 74 3655.6 percent of total billed charges 4940 93 4001.4 percent of total billed charges 4940 4940 other OPPS APC 4940 4940 other OPPS APC 4940 27.63 1364.92 percent of total billed charges 4940 4940 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY COSGROVE-EDWARDS BARIUM SULFATE SILICONE RUBBER POLYESTER L78.7 MM OD36 MM ODSEC43.6 MM ID35.9 MM MITRAL TRICUSPID FLEXIBLE TEMPLATE HANDLE STERILE HEART VALVE REPAIR SUP-460036MM CDM 0270 RC outpatient 4940 4940 4940 74 3655.6 percent of total billed charges 4940 93 4001.4 percent of total billed charges 4940 4940 other OPPS APC 4940 4940 other OPPS APC 4940 27.63 1364.92 percent of total billed charges 4940 4940 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY COSGROVE-EDWARDS BARIUM SULFATE SILICONE RUBBER POLYESTER L83.1 MM OD38 MM ODSEC45.6 MM ID37.9 MM MITRAL TRICUSPID FLEXIBLE TEMPLATE HANDLE STERILE HEART VALVE REPAIR SUP-460038MM CDM 0270 RC outpatient 4940 4940 4940 74 3655.6 percent of total billed charges 4940 93 4001.4 percent of total billed charges 4940 4940 other OPPS APC 4940 4940 other OPPS APC 4940 27.63 1364.92 percent of total billed charges 4940 4940 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHUNT NEUROSURGICAL SMALL CSF LOW PRESSURE UNITIZED KIT STERILE SUP-46012 CDM 0270 RC outpatient 3824.6 3824.6 3824.6 74 2830.2 percent of total billed charges 3824.6 93 3097.93 percent of total billed charges 3824.6 3824.6 other OPPS APC 3824.6 3824.6 other OPPS APC 3824.6 27.63 1056.74 percent of total billed charges 3824.6 3824.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHUNT NEUROSURGICAL SMALL CSF MEDIUM PRESSURE UNITIZED KIT STERILE SUP-46014 CDM 0270 RC outpatient 2316.13 2316.13 2316.13 74 1713.94 percent of total billed charges 2316.13 93 1876.07 percent of total billed charges 2316.13 2316.13 other OPPS APC 2316.13 2316.13 other OPPS APC 2316.13 27.63 639.95 percent of total billed charges 2316.13 2316.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHUNT NEUROSURGICAL REGULAR CSF HIGH PRESSURE UNITIZED KIT STERILE SUP-46026 CDM 0270 RC outpatient 2479.2 2479.2 2479.2 74 1834.61 percent of total billed charges 2479.2 93 2008.15 percent of total billed charges 2479.2 2479.2 other OPPS APC 2479.2 2479.2 other OPPS APC 2479.2 27.63 685 percent of total billed charges 2479.2 2479.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE FEEDING KANGAROO PVC L16 IN OD 5 FR ENTERAL CONNECT RADIOPAQUE DEHP FREE TRANSPARENT STERILE LATEX FREE PURPLE SUP-460802 CDM 0270 RC outpatient 1.52 1.52 1.52 74 1.12 percent of total billed charges 1.52 93 1.23 percent of total billed charges 1.52 1.52 other OPPS APC 1.52 1.52 other OPPS APC 1.52 27.63 0.42 percent of total billed charges 1.52 1.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON 2 LR 20IN BLACK MONOFILAMENT SUP-460T CDM 0270 RC outpatient 5.18 5.18 5.18 74 3.83 percent of total billed charges 5.18 93 4.2 percent of total billed charges 5.18 5.18 other OPPS APC 5.18 5.18 other OPPS APC 5.18 27.63 1.43 percent of total billed charges 5.18 5.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG DRAINAGE BECKER EDMS 700 ML VENTRICULAR EXTERNAL MONITOR SYSTEM STERILE LATEX FREE DISPOSABLE SUP-46124_72881 CDM 0270 RC outpatient 150.8 150.8 150.8 74 111.59 percent of total billed charges 150.8 93 122.15 percent of total billed charges 150.8 150.8 other OPPS APC 150.8 150.8 other OPPS APC 150.8 27.63 41.67 percent of total billed charges 150.8 150.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM DRAINAGE BECKER EDMS II L35 CM 700 ML VENTRICULAR MONITOR TRANSDUCER ATTACHMENT STERILE LATEX FREE DISPOSABLE BLUE SUP-46128 CDM 0270 RC outpatient 690.53 690.53 690.53 74 510.99 percent of total billed charges 690.53 93 559.33 percent of total billed charges 690.53 690.53 other OPPS APC 690.53 690.53 other OPPS APC 690.53 27.63 190.79 percent of total billed charges 690.53 690.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE NASOGASTRIC KANGAROO SENTINEL LINE SENTINEL EYE 20IN 5FR PURPLE POLYURETHANE SAFE ENTERAL CONNECTION RADIOPAQUE SUP-461412 CDM 0270 RC outpatient 10.69 10.69 10.69 74 7.91 percent of total billed charges 10.69 93 8.66 percent of total billed charges 10.69 10.69 other OPPS APC 10.69 10.69 other OPPS APC 10.69 27.63 2.95 percent of total billed charges 10.69 10.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY FIXATION TITANIUM L34 MM HUMERUS SPIRAL GOLD SUP-462.634 CDM 270010022 LOCAL 0270 RC outpatient 1401.4 1401.4 1401.4 74 1037.04 percent of total billed charges 1401.4 93 1135.13 percent of total billed charges 1401.4 1401.4 other OPPS APC 1401.4 1401.4 other OPPS APC 1401.4 27.63 387.21 percent of total billed charges 1401.4 1401.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL TITANIUM SPIRAL L36 MM HUMERUS NONSTERILE GOLD SUP-462.636 CDM 270010022 LOCAL 0270 RC outpatient 1401.4 1401.4 1401.4 74 1037.04 percent of total billed charges 1401.4 93 1135.13 percent of total billed charges 1401.4 1401.4 other OPPS APC 1401.4 1401.4 other OPPS APC 1401.4 27.63 387.21 percent of total billed charges 1401.4 1401.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY FIXATION TITANIUM L38 MM HUMERUS SPIRAL NONSTERILE GOLD SUP-462.638 CDM 0270 RC outpatient 1401.4 1401.4 1401.4 74 1037.04 percent of total billed charges 1401.4 93 1135.13 percent of total billed charges 1401.4 1401.4 other OPPS APC 1401.4 1401.4 other OPPS APC 1401.4 27.63 387.21 percent of total billed charges 1401.4 1401.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY FIXATION TITANIUM L40 MM HUMERUS SPIRAL GOLD SUP-462.64 CDM 270010022 LOCAL 0270 RC outpatient 1523.81 1523.81 1523.81 74 1127.62 percent of total billed charges 1523.81 93 1234.29 percent of total billed charges 1523.81 1523.81 other OPPS APC 1523.81 1523.81 other OPPS APC 1523.81 27.63 421.03 percent of total billed charges 1523.81 1523.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY FIXATION GOLD 40MM HUMERUS TITANIUM SPIRAL NS SUP-462.640 CDM 270010022 LOCAL 0270 RC outpatient 1523.81 1523.81 1523.81 74 1127.62 percent of total billed charges 1523.81 93 1234.29 percent of total billed charges 1523.81 1523.81 other OPPS APC 1523.81 1523.81 other OPPS APC 1523.81 27.63 421.03 percent of total billed charges 1523.81 1523.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY FIXATION TITANIUM THK3.9 MM SPIRAL L42 MM OD13 MM 4 SUTURE HOLE CANNULATED CUT FLUTE SMOOTH SURFACE GOLD HUMERAL NAIL SUP-462.642 CDM 270010022 LOCAL 0270 RC outpatient 1401.4 1401.4 1401.4 74 1037.04 percent of total billed charges 1401.4 93 1135.13 percent of total billed charges 1401.4 1401.4 other OPPS APC 1401.4 1401.4 other OPPS APC 1401.4 27.63 387.21 percent of total billed charges 1401.4 1401.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL EXPERT TITANIUM SPIRAL L46 MM HUMERAL CANNULATED SUP-462.646 CDM 270010022 LOCAL 0270 RC outpatient 1401.4 1401.4 1401.4 74 1037.04 percent of total billed charges 1401.4 93 1135.13 percent of total billed charges 1401.4 1401.4 other OPPS APC 1401.4 1401.4 other OPPS APC 1401.4 27.63 387.21 percent of total billed charges 1401.4 1401.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY FIXATION TITANIUM L48 MM HUMERUS SPIRAL NONSTERILE GOLD SUP-462.648 CDM 270010022 LOCAL 0270 RC outpatient 1401.4 1401.4 1401.4 74 1037.04 percent of total billed charges 1401.4 93 1135.13 percent of total billed charges 1401.4 1401.4 other OPPS APC 1401.4 1401.4 other OPPS APC 1401.4 27.63 387.21 percent of total billed charges 1401.4 1401.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL THK3.9MM SPIRAL 50MM 13MM GOLD TITANIUM NS 4 SUTURE HOLE CANNULATED CUT FLUTE SMOOTH SURFACE SUP-462.650 CDM 270010022 LOCAL 0270 RC outpatient 1401.4 1401.4 1401.4 74 1037.04 percent of total billed charges 1401.4 93 1135.13 percent of total billed charges 1401.4 1401.4 other OPPS APC 1401.4 1401.4 other OPPS APC 1401.4 27.63 387.21 percent of total billed charges 1401.4 1401.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY FIXATION TITANIUM THK3.9 MM SPIRAL L52 MM OD13 MM 4 SUTURE HOLE CANNULATED CUT FLUTE SMOOTH SURFACE NONSTERILE GOLD HUMERAL NAIL SUP-462.652 CDM 270010022 LOCAL 0270 RC outpatient 1401.4 1401.4 1401.4 74 1037.04 percent of total billed charges 1401.4 93 1135.13 percent of total billed charges 1401.4 1401.4 other OPPS APC 1401.4 1401.4 other OPPS APC 1401.4 27.63 387.21 percent of total billed charges 1401.4 1401.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE INTRAMEDULLARY NAIL THK3.9MM SPIRAL 54MM 13MM GOLD TITANIUM NS 4 SUTURE HOLE CANNULATED CUT FLUTE SMOOTH SURFACE SUP-462.654 CDM 270010022 LOCAL 0270 RC outpatient 1401.4 1401.4 1401.4 74 1037.04 percent of total billed charges 1401.4 93 1135.13 percent of total billed charges 1401.4 1401.4 other OPPS APC 1401.4 1401.4 other OPPS APC 1401.4 27.63 387.21 percent of total billed charges 1401.4 1401.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE LOOP OD.3 MM ODSEC22 FR CUT DISPOSABLE SUP-4622.1313 CDM 0270 RC outpatient 944.46 944.46 944.46 74 698.9 percent of total billed charges 944.46 93 765.01 percent of total billed charges 944.46 944.46 other OPPS APC 944.46 944.46 other OPPS APC 944.46 27.63 260.95 percent of total billed charges 944.46 944.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE LOOP OD.3 MM ODSEC22 FR CUT DISPOSABLE SUP-462201313US CDM 0270 RC outpatient 944.46 944.46 944.46 74 698.9 percent of total billed charges 944.46 93 765.01 percent of total billed charges 944.46 944.46 other OPPS APC 944.46 944.46 other OPPS APC 944.46 27.63 260.95 percent of total billed charges 944.46 944.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE LOOP OD.3 MM ODSEC22 FR CUT DISPOSABLE SUP-46221313US CDM 0270 RC outpatient 944.46 944.46 944.46 74 698.9 percent of total billed charges 944.46 93 765.01 percent of total billed charges 944.46 944.46 other OPPS APC 944.46 944.46 other OPPS APC 944.46 27.63 260.95 percent of total billed charges 944.46 944.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE COAG BIPOLAR SUP-4623.0223 CDM 0270 RC outpatient 944.46 944.46 944.46 74 698.9 percent of total billed charges 944.46 93 765.01 percent of total billed charges 944.46 944.46 other OPPS APC 944.46 944.46 other OPPS APC 944.46 27.63 260.95 percent of total billed charges 944.46 944.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE COAG BIPOLAR SUP-46230223US CDM 0270 RC outpatient 944.46 944.46 944.46 74 698.9 percent of total billed charges 944.46 93 765.01 percent of total billed charges 944.46 944.46 other OPPS APC 944.46 944.46 other OPPS APC 944.46 27.63 260.95 percent of total billed charges 944.46 944.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE RESECTOSCOPIC SHARK BIPOLAR 1.2MM WIRE CYLINDRICAL COAGULATING BLUE BRANCH/STEM STERILE SINGLE-USE F/22/24FR CONTINUOUS IRRIGATION SHEATH SUP-46230243US CDM 0270 RC outpatient 944.46 944.46 944.46 74 698.9 percent of total billed charges 944.46 93 765.01 percent of total billed charges 944.46 944.46 other OPPS APC 944.46 944.46 other OPPS APC 944.46 27.63 260.95 percent of total billed charges 944.46 944.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SURGICAL KARLIN 1.5 MM ULTRA TIP STERILE DISPOSABLE SUP-463178 CDM 0270 RC outpatient 1029.66 1029.66 1029.66 74 761.95 percent of total billed charges 1029.66 93 834.02 percent of total billed charges 1029.66 1029.66 other OPPS APC 1029.66 1029.66 other OPPS APC 1029.66 27.63 284.5 percent of total billed charges 1029.66 1029.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOOP SPLINT VELCRO L25 YD X W2 IN ADHESIVE BACK REMOTE CONTROL XRAY CASSETTE BLACK SUP-4634 CDM 0270 RC outpatient 289.59 289.59 289.59 74 214.3 percent of total billed charges 289.59 93 234.57 percent of total billed charges 289.59 289.59 other OPPS APC 289.59 289.59 other OPPS APC 289.59 27.63 80.01 percent of total billed charges 289.59 289.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EXTERNAL DRAINAGE EDM SILICONE L80 CM LUMBAR CLOSED TIP BARIUM IMPREGNATED STERILE SUP-46419 CDM 0270 RC outpatient 643.97 643.97 643.97 74 476.54 percent of total billed charges 643.97 93 521.62 percent of total billed charges 643.97 643.97 other OPPS APC 643.97 643.97 other OPPS APC 643.97 27.63 177.93 percent of total billed charges 643.97 643.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRA ELIZABETH PINK SURGICAL SIZE SMALL SUP-46518-01LF CDM 270009195 LOCAL 0270 RC outpatient 45.24 45.24 45.24 74 33.48 percent of total billed charges 45.24 93 36.64 percent of total billed charges 45.24 45.24 other OPPS APC 45.24 45.24 other OPPS APC 45.24 27.63 12.5 percent of total billed charges 45.24 45.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRA ELIZABETH PINK SURGICAL SIZE MED SUP-46518-02LF CDM 270009195 LOCAL 0270 RC outpatient 45.24 45.24 45.24 74 33.48 percent of total billed charges 45.24 93 36.64 percent of total billed charges 45.24 45.24 other OPPS APC 45.24 45.24 other OPPS APC 45.24 27.63 12.5 percent of total billed charges 45.24 45.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRA ELIZABETH PINK SURGICAL SIZE LARGE SUP-46518-03LF CDM 270009195 LOCAL 0270 RC outpatient 45.24 45.24 45.24 74 33.48 percent of total billed charges 45.24 93 36.64 percent of total billed charges 45.24 45.24 other OPPS APC 45.24 45.24 other OPPS APC 45.24 27.63 12.5 percent of total billed charges 45.24 45.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRA ELIZABETH PINK SURGICAL SIZE EXTRA LARGE SUP-46518-04LF CDM 270009195 LOCAL 0270 RC outpatient 45.24 45.24 45.24 74 33.48 percent of total billed charges 45.24 93 36.64 percent of total billed charges 45.24 45.24 other OPPS APC 45.24 45.24 other OPPS APC 45.24 27.63 12.5 percent of total billed charges 45.24 45.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRA ELIZABETH PINK SURGICAL SIZE 2XL SUP-46518-05LF CDM 270009195 LOCAL 0270 RC outpatient 45.24 45.24 45.24 74 33.48 percent of total billed charges 45.24 93 36.64 percent of total billed charges 45.24 45.24 other OPPS APC 45.24 45.24 other OPPS APC 45.24 27.63 12.5 percent of total billed charges 45.24 45.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRA ELIZABETH PINK SURGICAL SIZE 3XL SUP-46518-06LF CDM 270009195 LOCAL 0270 RC outpatient 45.24 45.24 45.24 74 33.48 percent of total billed charges 45.24 93 36.64 percent of total billed charges 45.24 45.24 other OPPS APC 45.24 45.24 other OPPS APC 45.24 27.63 12.5 percent of total billed charges 45.24 45.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FLUSH PIGTAIL NO BRAIDED 4F .04X65CM SUP-4653510PIG-NB CDM 0270 RC outpatient 28.6 28.6 28.6 74 21.16 percent of total billed charges 28.6 93 23.17 percent of total billed charges 28.6 28.6 other OPPS APC 28.6 28.6 other OPPS APC 28.6 27.63 7.9 percent of total billed charges 28.6 28.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC IMPRESS FLUSH 4FR 65CM PIGTAIL TAPERED 10SP PERIPHERAL NON-BRAIDED WINGED HUB STAINLESS STEEL POLYURETHANE 0.035IN GW RADIOPAQUE SUP-4653510PIGNB CDM 0270 RC outpatient 29.74 29.74 29.74 74 22.01 percent of total billed charges 29.74 93 24.09 percent of total billed charges 29.74 29.74 other OPPS APC 29.74 29.74 other OPPS APC 29.74 27.63 8.22 percent of total billed charges 29.74 29.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC .035IN SNB CURVE 4FR .040IN 65CM NONBRAIDED 6 SIDEPORT IMPRESS SUP-465356SHP-NB CDM 0270 RC outpatient 36.27 36.27 36.27 74 26.84 percent of total billed charges 36.27 93 29.38 percent of total billed charges 36.27 36.27 other OPPS APC 36.27 36.27 other OPPS APC 36.27 27.63 10.02 percent of total billed charges 36.27 36.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC IMPRESS STAINLESS STEEL POLYURETHANE RIM CURVE L65 CM OD4 FR PERIPHERAL RADIOPAQUE BRAID TAPER TIP STERILE LATEX FREE ACCEPTS .035 IN GUIDEWIRE SUP-46535RIM CDM 0270 RC outpatient 29.74 29.74 29.74 74 22.01 percent of total billed charges 29.74 93 24.09 percent of total billed charges 29.74 29.74 other OPPS APC 29.74 29.74 other OPPS APC 29.74 27.63 8.22 percent of total billed charges 29.74 29.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC IMPRESS .035 IN SNB CURVE L65 CM OD4 FR ID.040 IN NONBRAIDED 6 SIDEPORT SUP-46536SHP-NB CDM 0270 RC outpatient 29.74 29.74 29.74 74 22.01 percent of total billed charges 29.74 93 24.09 percent of total billed charges 29.74 29.74 other OPPS APC 29.74 29.74 other OPPS APC 29.74 27.63 8.22 percent of total billed charges 29.74 29.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC IMPRESS LEGATO STAINLESS STEEL POLYURETHANE KA2 CURVE L65 CM OD4 FR PERIPHERAL RADIOPAQUE BRAID TAPER TIP STERILE LATEX FREE ACCEPTS .038 IN GUIDEWIRE SUP-46538KA2-H CDM 0481 RC outpatient 80.6 80.6 80.6 74 59.64 percent of total billed charges 80.6 93 65.29 percent of total billed charges 80.6 80.6 other OPPS APC 80.6 80.6 other OPPS APC 80.6 51 41.11 percent of total billed charges 80.6 80.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER EMBOLIZATION OPTEASE L55 CM VENA CAVA INTRODUCTION KIT RETRIEVABLE DISPOSABLE SUP-466F220A CDM 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT EMBOLIC PROTECTION CORDIS TRAPEASE 55CM 30- MM 6FR NITINOL DISPOSABLE STERILE LF VENA CAVA FEMORAL JUGULAR 2 BASKET SUP-466P306AU CDM 0270 RC outpatient 2339.97 2339.97 2339.97 74 1731.58 percent of total billed charges 2339.97 93 1895.38 percent of total billed charges 2339.97 2339.97 other OPPS APC 2339.97 2339.97 other OPPS APC 2339.97 27.63 646.53 percent of total billed charges 2339.97 2339.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD ACUITY X4 QUADRAPOLAR SUP-4671 CDM 0275 RC outpatient 5428.8 5428.8 5428.8 57 3094.42 percent of total billed charges 5428.8 93 4397.33 percent of total billed charges 5428.8 5428.8 other OPPS APC 5428.8 5428.8 other OPPS APC 5428.8 51 2768.69 percent of total billed charges 5428.8 5428.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD ACUITY X4 QUADRAPOLAR SUP-4672 CDM 0275 RC outpatient 5428.8 5428.8 5428.8 57 3094.42 percent of total billed charges 5428.8 93 4397.33 percent of total billed charges 5428.8 5428.8 other OPPS APC 5428.8 5428.8 other OPPS APC 5428.8 51 2768.69 percent of total billed charges 5428.8 5428.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD 4674 ACUITY X4 QUADRAPOLAR _44881_ SUP-4674 CDM 0275 RC outpatient 5428.8 5428.8 5428.8 57 3094.42 percent of total billed charges 5428.8 93 4397.33 percent of total billed charges 5428.8 5428.8 other OPPS APC 5428.8 5428.8 other OPPS APC 5428.8 51 2768.69 percent of total billed charges 5428.8 5428.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD ACUITY X4 QUADRAPOLAR SUP-4675 CDM 0275 RC outpatient 5428.8 5428.8 5428.8 57 3094.42 percent of total billed charges 5428.8 93 4397.33 percent of total billed charges 5428.8 5428.8 other OPPS APC 5428.8 5428.8 other OPPS APC 5428.8 51 2768.69 percent of total billed charges 5428.8 5428.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE CUTTING 26FR SUP-46762635 CDM 0270 RC outpatient 204.8 204.8 204.8 74 151.55 percent of total billed charges 204.8 93 165.89 percent of total billed charges 204.8 204.8 other OPPS APC 204.8 204.8 other OPPS APC 204.8 27.63 56.59 percent of total billed charges 204.8 204.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD ACUITY X4 QUADRAPOLAR SUP-4677 CDM 0275 RC outpatient 5428.8 5428.8 5428.8 57 3094.42 percent of total billed charges 5428.8 93 4397.33 percent of total billed charges 5428.8 5428.8 other OPPS APC 5428.8 5428.8 other OPPS APC 5428.8 51 2768.69 percent of total billed charges 5428.8 5428.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD ACUITY X4 QUADRAPOLAR SUP-4678 CDM 0275 RC outpatient 5428.8 5428.8 5428.8 57 3094.42 percent of total billed charges 5428.8 93 4397.33 percent of total billed charges 5428.8 5428.8 other OPPS APC 5428.8 5428.8 other OPPS APC 5428.8 51 2768.69 percent of total billed charges 5428.8 5428.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE MONOPOLAR 12 D 30 D ROLLER TRANSPARENT STEM COAGULATION DISPOSABLE GREEN SUP-46782201 CDM 0270 RC outpatient 1299.3 1299.3 1299.3 74 961.48 percent of total billed charges 1299.3 93 1052.43 percent of total billed charges 1299.3 1299.3 other OPPS APC 1299.3 1299.3 other OPPS APC 1299.3 27.63 359 percent of total billed charges 1299.3 1299.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNIFE ELECTRODE 22-24FR SUP-46782204 CDM 0270 RC outpatient 224.57 224.57 224.57 74 166.18 percent of total billed charges 224.57 93 181.9 percent of total billed charges 224.57 224.57 other OPPS APC 224.57 224.57 other OPPS APC 224.57 27.63 62.05 percent of total billed charges 224.57 224.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE CUTTING 24FR SUP-46782435 CDM 0270 RC outpatient 217.64 217.64 217.64 74 161.05 percent of total billed charges 217.64 93 176.29 percent of total billed charges 217.64 217.64 other OPPS APC 217.64 217.64 other OPPS APC 217.64 27.63 60.13 percent of total billed charges 217.64 217.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE MONOPOLAR 12 D 30 D OD.8 IN TRANSPARENT STEM CUT DISPOSABLE YELLOW SUP-46782480 CDM 0270 RC outpatient 207.1 207.1 207.1 74 153.25 percent of total billed charges 207.1 93 167.75 percent of total billed charges 207.1 207.1 other OPPS APC 207.1 207.1 other OPPS APC 207.1 27.63 57.22 percent of total billed charges 207.1 207.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE MONOPOLAR 12 D 30 D OD.35 IN TRANSPARENT STEM CUT DISPOSABLE BLACK SUP-46782635 CDM 0270 RC outpatient 261.17 261.17 261.17 74 193.27 percent of total billed charges 261.17 93 211.55 percent of total billed charges 261.17 261.17 other OPPS APC 261.17 261.17 other OPPS APC 261.17 27.63 72.16 percent of total billed charges 261.17 261.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUTTON CABLE TI6AL4V OD2.5 MM FEMUR POLYAXIAL HEXAGON DRIVE STERILE BLUE NCB LOCK PLATE SUP-47-2232-060-01 CDM 0270 RC outpatient 449.28 449.28 449.28 74 332.47 percent of total billed charges 449.28 93 363.92 percent of total billed charges 449.28 449.28 other OPPS APC 449.28 449.28 other OPPS APC 449.28 27.63 124.14 percent of total billed charges 449.28 449.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC L100 CM OD3 MM BALL TIP STERILE LATEX FREE NATURAL NAIL SYSTEM SUP-47-2255-008-01 CDM 0270 RC outpatient 318.24 318.24 318.24 74 235.5 percent of total billed charges 318.24 93 257.77 percent of total billed charges 318.24 318.24 other OPPS APC 318.24 318.24 other OPPS APC 318.24 27.63 87.93 percent of total billed charges 318.24 318.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TM CANNULATED DRILL WITH STOP SUP-47-4307-61 CDM 0270 RC outpatient 748.8 748.8 748.8 74 554.11 percent of total billed charges 748.8 93 606.53 percent of total billed charges 748.8 748.8 other OPPS APC 748.8 748.8 other OPPS APC 748.8 27.63 206.89 percent of total billed charges 748.8 748.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA 8MM SUP-470002 CDM outpatient 1638 1638 1638 1638 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA 8MM LONG SUP-470004 CDM outpatient 1775.8 1775.8 1775.8 1775.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OBTURATOR 8MM BLUNT SUP-470008 CDM outpatient 1502.8 1502.8 1502.8 1502.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OBTURATOR 8MM BLUNT LONG SUP-470009 CDM outpatient 1612 1612 1612 1612 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE ARM SUP-470015 CDM 0270 RC outpatient 141.96 141.96 141.96 74 105.05 percent of total billed charges 141.96 93 114.99 percent of total billed charges 141.96 141.96 other OPPS APC 141.96 141.96 other OPPS APC 141.96 27.63 39.22 percent of total billed charges 141.96 141.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROFORCEPS BLACK DIAMOND SUP-470033 CDM outpatient 8190 8190 8190 8190 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOOK CAUTERY PERMANENT SUP-470183 CDM outpatient 3276 3276 3276 3276 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPATULA PERMANENT MONOPOLAR CAUTERY SUP-470184 CDM outpatient 3276 3276 3276 3276 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRIVER NEEDLE DA VINCI XI ENDOWRIST MEGA 38 D L31.75 CM L1.3 CM OD8 MM REPOSABLE NONSTERILE LATEX FREE 10 USE SUP-470194 CDM 0270 RC outpatient 6006 6006 6006 74 4444.44 percent of total billed charges 6006 93 4864.86 percent of total billed charges 6006 6006 other OPPS APC 6006 6006 other OPPS APC 6006 27.63 1659.46 percent of total billed charges 6006 6006 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLEDRIVER MEGA DAVINCI SUP-470194 CDM 0270 RC outpatient 6006 6006 6006 74 4444.44 percent of total billed charges 6006 93 4864.86 percent of total billed charges 6006 6006 other OPPS APC 6006 6006 other OPPS APC 6006 27.63 1659.46 percent of total billed charges 6006 6006 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAPTOR SMALL SUP-470318 CDM outpatient 6552 6552 6552 6552 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER CLIP MEDIUM-LARGE SUP-470327 CDM outpatient 2730 2730 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE COLUMN SUP-470341 CDM 0270 RC outpatient 98.28 98.28 98.28 74 72.73 percent of total billed charges 98.28 93 79.61 percent of total billed charges 98.28 98.28 other OPPS APC 98.28 98.28 other OPPS APC 98.28 27.63 27.15 percent of total billed charges 98.28 98.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRASPER TIP UP FENESTRATED SUP-470347 CDM outpatient 6006 6006 6006 6006 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OBSOLETE PER VENDOR - OBTURATOR 8MM BLADELESS SUP-470357 CDM 0270 RC outpatient 65 65 65 74 48.1 percent of total billed charges 65 93 52.65 percent of total billed charges 65 65 other OPPS APC 65 65 other OPPS APC 65 27.63 17.96 percent of total billed charges 65 65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OBTURATOR 8MM BLADELESS OPTICAL SUP-470359 CDM 0270 RC outpatient 81.9 81.9 81.9 74 60.61 percent of total billed charges 81.9 93 66.34 percent of total billed charges 81.9 81.9 other OPPS APC 81.9 81.9 other OPPS APC 81.9 27.63 22.63 percent of total billed charges 81.9 81.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OBTURATOR 8MM BLADELESS OPTICAL LONG SUP-470360 CDM 0270 RC outpatient 81.9 81.9 81.9 74 60.61 percent of total billed charges 81.9 93 66.34 percent of total billed charges 81.9 81.9 other OPPS APC 81.9 81.9 other OPPS APC 81.9 27.63 22.63 percent of total billed charges 81.9 81.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEAL 5-8MM UNIVERSAL SUP-470361 CDM 0270 RC outpatient 49.14 49.14 49.14 74 36.36 percent of total billed charges 49.14 93 39.8 percent of total billed charges 49.14 49.14 other OPPS APC 49.14 49.14 other OPPS APC 49.14 27.63 13.58 percent of total billed charges 49.14 49.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEAL 12MM STAPLER CANNULA SUP-470380 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOWRIST 12-8MM CANNULA REDUCER SUP-470381 CDM 0270 RC outpatient 68.47 68.47 68.47 74 50.67 percent of total billed charges 68.47 93 55.46 percent of total billed charges 68.47 68.47 other OPPS APC 68.47 68.47 other OPPS APC 68.47 27.63 18.92 percent of total billed charges 68.47 68.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CORD MONOPOLAR ENERGY INSTRUMENT CORD SUP-470383 CDM outpatient 738.4 738.4 738.4 738.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CORD BIPOLAR ENERGY INSTRUMENT CORD SUP-470384 CDM outpatient 738.4 738.4 738.4 738.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER SMALL CLIP SUP-470401 CDM outpatient 7644 7644 7644 7644 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRIVER NEEDLE LARGE SUP-471006 CDM outpatient 6962.8 6962.8 6962.8 6962.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS CARDIERE SUP-471049 CDM outpatient 7371 7371 7371 7371 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS PROGRASP SUP-471093 CDM outpatient 7371 7371 7371 7371 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEP MICROBIPOLAR SUP-471171 CDM outpatient 11083.8 11083.8 11083.8 11083.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS BIPOLAR MARYLAND SUP-471172 CDM outpatient 8983 8983 8983 8983 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRASPER COBRA DAVINCI SUP-471190 CDM 0270 RC outpatient 8845.2 8845.2 8845.2 74 6545.45 percent of total billed charges 8845.2 93 7164.61 percent of total billed charges 8845.2 8845.2 other OPPS APC 8845.2 8845.2 other OPPS APC 8845.2 27.63 2443.93 percent of total billed charges 8845.2 8845.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRASPER LAPAROSCOPIC COBRA ENDOWRIST DA VINCI XI 60 D L32.51 CM L2 CM OD8 MM 10 USE SUP-471190 CDM 0270 RC outpatient 8845.2 8845.2 8845.2 74 6545.45 percent of total billed charges 8845.2 93 7164.61 percent of total billed charges 8845.2 8845.2 other OPPS APC 8845.2 8845.2 other OPPS APC 8845.2 27.63 2443.93 percent of total billed charges 8845.2 8845.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL LEAD DELIVERY EMBLEM STERILE LATEX FREE DISPOSABLE ELECTRODE SUP-4712 CDM 0275 RC outpatient 2600 2600 2600 57 1482 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS BIPOLAR FENESTRATED SUP-471205 CDM outpatient 7644 7644 7644 7644 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRIVER NEEDLE SUTURECUT LARGE SUP-471296 CDM outpatient 6962.8 6962.8 6962.8 6962.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRIVER NEEDLE MEGA SUTURE CUT ENDOWRIST 0-35 D L1.4 CM VERY HIGH GRASP FORCE SUP-471309 CDM outpatient 7168.2 7168.2 7168.2 7168.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR DENTAL MIDWEST DIAMOND SUPER COARSE WHEEL ROUND L1.4 MM OD4 MM FRICTION GRIP SUP-471385 CDM outpatient 34.73 34.73 34.73 34.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SKIN FLEXHD STRUCTURAL ACELLULAR DERMAL MATRIX THK.8-1.7 MM THICK L16 CM X W6 CM ALLOGRAFT SUP-471616 CDM 0270 RC outpatient 8707.22 8707.22 8707.22 74 6443.34 percent of total billed charges 8707.22 93 7052.85 percent of total billed charges 8707.22 8707.22 other OPPS APC 8707.22 8707.22 other OPPS APC 8707.22 27.63 2405.8 percent of total billed charges 8707.22 8707.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SENSOR ENDOSCOPIC CAMERA RIWO D-URS L600 MM OD9 FR ODSEC3 MM FLEXIBLE URETERORENOSCOPE STERILE LATEX FREE DISPOSABLE 1.65 FR 3.6 FR WORK CHANNEL SUP-473572076 CDM 0270 RC outpatient 3458 3458 3458 74 2558.92 percent of total billed charges 3458 93 2800.98 percent of total billed charges 3458 3458 other OPPS APC 3458 3458 other OPPS APC 3458 27.63 955.45 percent of total billed charges 3458 3458 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK OXYGEN CAPNOVUE STANDARD CO2 O2 TRUMPET FEMALE LUER CONNECTOR CAPNOGRAPHY SUP-4737-7-0-50 CDM 0270 RC outpatient 5.86 5.86 5.86 74 4.34 percent of total billed charges 5.86 93 4.75 percent of total billed charges 5.86 5.86 other OPPS APC 5.86 5.86 other OPPS APC 5.86 27.63 1.62 percent of total billed charges 5.86 5.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L400 MM OD10 MM FEMUR CANNULATED ROUND BARREL STERILE GREEN SUP-474.041S CDM 270010022 LOCAL 0270 RC outpatient 4090.32 4090.32 4090.32 74 3026.84 percent of total billed charges 4090.32 93 3313.16 percent of total billed charges 4090.32 4090.32 other OPPS APC 4090.32 4090.32 other OPPS APC 4090.32 27.63 1130.16 percent of total billed charges 4090.32 4090.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L380 MM OD11 MM FEMUR CANNULATED FLUTED BARREL STERILE GREEN SUP-474.138S CDM 270010022 LOCAL 0270 RC outpatient 4090.32 4090.32 4090.32 74 3026.84 percent of total billed charges 4090.32 93 3313.16 percent of total billed charges 4090.32 4090.32 other OPPS APC 4090.32 4090.32 other OPPS APC 4090.32 27.63 1130.16 percent of total billed charges 4090.32 4090.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L420 MM OD11 MM FEMUR CANNULATED FLUTED BARREL STERILE GREEN SUP-474.142S CDM 270010022 LOCAL 0270 RC outpatient 4090.32 4090.32 4090.32 74 3026.84 percent of total billed charges 4090.32 93 3313.16 percent of total billed charges 4090.32 4090.32 other OPPS APC 4090.32 4090.32 other OPPS APC 4090.32 27.63 1130.16 percent of total billed charges 4090.32 4090.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L440 MM OD11 MM FEMUR CANNULATED FLUTED BARREL STERILE GREEN SUP-474.144S CDM 270010022 LOCAL 0270 RC outpatient 4090.32 4090.32 4090.32 74 3026.84 percent of total billed charges 4090.32 93 3313.16 percent of total billed charges 4090.32 4090.32 other OPPS APC 4090.32 4090.32 other OPPS APC 4090.32 27.63 1130.16 percent of total billed charges 4090.32 4090.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM UNIVERSAL L340 MM OD12 MM FEMUR CANNULATED FLUTED BARREL STERILE GREEN SUP-474.234S CDM 270010022 LOCAL 0270 RC outpatient 4090.32 4090.32 4090.32 74 3026.84 percent of total billed charges 4090.32 93 3313.16 percent of total billed charges 4090.32 4090.32 other OPPS APC 4090.32 4090.32 other OPPS APC 4090.32 27.63 1130.16 percent of total billed charges 4090.32 4090.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP END TITANIUM STERILE GREEN 3-4 MM ELASTIC INTRAMEDULLARY NAILS SUP-475.900S CDM 270010022 LOCAL 0270 RC outpatient 337.48 337.48 337.48 74 249.74 percent of total billed charges 337.48 93 273.36 percent of total billed charges 337.48 337.48 other OPPS APC 337.48 337.48 other OPPS APC 337.48 27.63 93.25 percent of total billed charges 337.48 337.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY 300MM 1.5MM PURPLE TITANIUM NS PEDIATRIC DIAPHYSIS EPIPHYSIS METAPHYSIS ELASTIC SYMMETRICAL BRACE SUP-475.915 CDM 270010022 LOCAL 0270 RC outpatient 696.41 696.41 696.41 74 515.34 percent of total billed charges 696.41 93 564.09 percent of total billed charges 696.41 696.41 other OPPS APC 696.41 696.41 other OPPS APC 696.41 27.63 192.42 percent of total billed charges 696.41 696.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM PEDIATRIC L440 MM OD2 MM DIAPHYSIS METAPHYSIS EPIPHYSIS ELASTIC SYMMETRICAL BRACING ACTION NONSTERILE GREEN SUP-475.920 CDM 270010022 LOCAL 0270 RC outpatient 1522.69 1522.69 1522.69 74 1126.79 percent of total billed charges 1522.69 93 1233.38 percent of total billed charges 1522.69 1522.69 other OPPS APC 1522.69 1522.69 other OPPS APC 1522.69 27.63 420.72 percent of total billed charges 1522.69 1522.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM L440 MM OD2 MM OLECRANON ELASTIC STERILE GREEN SUP-475.920S CDM 270010022 LOCAL 0270 RC outpatient 807.95 807.95 807.95 74 597.88 percent of total billed charges 807.95 93 654.44 percent of total billed charges 807.95 807.95 other OPPS APC 807.95 807.95 other OPPS APC 807.95 27.63 223.24 percent of total billed charges 807.95 807.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM PEDIATRIC L440 MM OD2.5 MM DIAPHYSIS METAPHYSIS EPIPHYSIS ELASTIC SYMMETRICAL BRACING ACTION NONSTERILE PINK DIAPHYSEAL METAPHYSEAL FRACTURE SUP-475.925 CDM 270010022 LOCAL 0270 RC outpatient 1639.82 1639.82 1639.82 74 1213.47 percent of total billed charges 1639.82 93 1328.25 percent of total billed charges 1639.82 1639.82 other OPPS APC 1639.82 1639.82 other OPPS APC 1639.82 27.63 453.08 percent of total billed charges 1639.82 1639.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM L440 MM OD2.5 MM OLECRANON ELASTIC STERILE PINK SUP-475.925S CDM 270010022 LOCAL 0270 RC outpatient 859.43 859.43 859.43 74 635.98 percent of total billed charges 859.43 93 696.14 percent of total billed charges 859.43 859.43 other OPPS APC 859.43 859.43 other OPPS APC 859.43 27.63 237.46 percent of total billed charges 859.43 859.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM 6-8 YR L440 MM OD3 MM DIAPHYSIS METAPHYSIS EPIPHYSIS ELASTIC SYMMETRICAL BRACING ACTION NONSTERILE GOLD SUP-475.930 CDM 270010022 LOCAL 0270 RC outpatient 1730.43 1730.43 1730.43 74 1280.52 percent of total billed charges 1730.43 93 1401.65 percent of total billed charges 1730.43 1730.43 other OPPS APC 1730.43 1730.43 other OPPS APC 1730.43 27.63 478.12 percent of total billed charges 1730.43 1730.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM L440 MM OD3 MM OLECRANON ELASTIC STERILE GOLD SUP-475.930S CDM 270010022 LOCAL 0270 RC outpatient 794.43 794.43 794.43 74 587.88 percent of total billed charges 794.43 93 643.49 percent of total billed charges 794.43 794.43 other OPPS APC 794.43 794.43 other OPPS APC 794.43 27.63 219.5 percent of total billed charges 794.43 794.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM 9-11 YR L440 MM OD3.5 MM DIAPHYSIS METAPHYSIS EPIPHYSIS ELASTIC SYMMETRICAL BRACING ACTION NONSTERILE BLUE SUP-475.935 CDM 270010022 LOCAL 0270 RC outpatient 1836.51 1836.51 1836.51 74 1359.02 percent of total billed charges 1836.51 93 1487.57 percent of total billed charges 1836.51 1836.51 other OPPS APC 1836.51 1836.51 other OPPS APC 1836.51 27.63 507.43 percent of total billed charges 1836.51 1836.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM L440 MM OD3.5 MM OLECRANON ELASTIC STERILE BLUE SUP-475.935S CDM 270010022 LOCAL 0270 RC outpatient 976.69 976.69 976.69 74 722.75 percent of total billed charges 976.69 93 791.12 percent of total billed charges 976.69 976.69 other OPPS APC 976.69 976.69 other OPPS APC 976.69 27.63 269.86 percent of total billed charges 976.69 976.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM 12-14 YR L440 MM OD4 MM DIAPHYSIS METAPHYSIS EPIPHYSIS ELASTIC SYMMETRICAL BRACING ACTION NONSTERILE PURPLE SUP-475.940 CDM 270010022 LOCAL 0270 RC outpatient 1966.9 1966.9 1966.9 74 1455.51 percent of total billed charges 1966.9 93 1593.19 percent of total billed charges 1966.9 1966.9 other OPPS APC 1966.9 1966.9 other OPPS APC 1966.9 27.63 543.45 percent of total billed charges 1966.9 1966.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TITANIUM L440 MM OD4 MM OLECRANON ELASTIC STERILE PURPLE SUP-475.940S CDM 270010022 LOCAL 0270 RC outpatient 1005.29 1005.29 1005.29 74 743.91 percent of total billed charges 1005.29 93 814.28 percent of total billed charges 1005.29 1005.29 other OPPS APC 1005.29 1005.29 other OPPS APC 1005.29 27.63 277.76 percent of total billed charges 1005.29 1005.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL ORTHOPRO 6.5 295X85MM BROWN POLYISOPRENE STERILE LF POWDER FREE BEAD CUFF MICRO ROUGHENED NON SUP-47665 CDM 0270 RC outpatient 2.16 2.16 2.16 74 1.6 percent of total billed charges 2.16 93 1.75 percent of total billed charges 2.16 2.16 other OPPS APC 2.16 2.16 other OPPS APC 2.16 27.63 0.6 percent of total billed charges 2.16 2.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL ORTHOPRO POLYISOPRENE 7 1/2 SUP-47675 CDM 0270 RC outpatient 182.29 182.29 182.29 74 134.89 percent of total billed charges 182.29 93 147.65 percent of total billed charges 182.29 182.29 other OPPS APC 182.29 182.29 other OPPS APC 182.29 27.63 50.37 percent of total billed charges 182.29 182.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL ORTHOPRO POLYISOPRENE 8 SUP-47680 CDM 0270 RC outpatient 204.52 204.52 204.52 74 151.34 percent of total billed charges 204.52 93 165.66 percent of total billed charges 204.52 204.52 other OPPS APC 204.52 204.52 other OPPS APC 204.52 27.63 56.51 percent of total billed charges 204.52 204.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL ORTHOPRO POLYISOPRENE 8.5 SUP-47685 CDM 0270 RC outpatient 170.16 170.16 170.16 74 125.92 percent of total billed charges 170.16 93 137.83 percent of total billed charges 170.16 170.16 other OPPS APC 170.16 170.16 other OPPS APC 170.16 27.63 47.02 percent of total billed charges 170.16 170.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TRACHEOSTOMY CARE ARGYLE HYDROGEN PEROXIDE SALINE COMPACT DESIGN KIT GLOVE LATEX FREE SUP-47802 CDM 270009135 LOCAL 0270 RC outpatient 17.16 17.16 17.16 74 12.7 percent of total billed charges 17.16 93 13.9 percent of total billed charges 17.16 17.16 other OPPS APC 17.16 17.16 other OPPS APC 17.16 27.63 4.74 percent of total billed charges 17.16 17.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ENDOSCOPIC L10 IN OD1.25 MM ODSEC18 GA SPINE BLUNT GUIDEWIRE DILATOR STERILE DISPOSABLE SUP-4792.802 CDM 0270 RC outpatient 139.1 139.1 139.1 74 102.93 percent of total billed charges 139.1 93 112.67 percent of total billed charges 139.1 139.1 other OPPS APC 139.1 139.1 other OPPS APC 139.1 27.63 38.43 percent of total billed charges 139.1 139.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ENDOSCOPIC L6 IN OD1.25 MM ODSEC18 GA SPINE BLUNT GUIDEWIRE DILATOR STERILE DISPOSABLE SUP-4792.803 CDM 0270 RC outpatient 107.9 107.9 107.9 74 79.85 percent of total billed charges 107.9 93 87.4 percent of total billed charges 107.9 107.9 other OPPS APC 107.9 107.9 other OPPS APC 107.9 27.63 29.81 percent of total billed charges 107.9 107.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD LV 4798-78 ATTAIN STABILITY QUADPOLE_60813_ SUP-479878 CDM 0275 RC outpatient 5252 5252 5252 57 2993.64 percent of total billed charges 5252 93 4254.12 percent of total billed charges 5252 5252 other OPPS APC 5252 5252 other OPPS APC 5252 51 2678.52 percent of total billed charges 5252 5252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD ATTAIN SUP-479888 CDM 0275 RC outpatient 5252 5252 5252 57 2993.64 percent of total billed charges 5252 93 4254.12 percent of total billed charges 5252 5252 other OPPS APC 5252 5252 other OPPS APC 5252 51 2678.52 percent of total billed charges 5252 5252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION CORDIS SABER 150CM 40MM 3.9-4.7FR 2.5MM DURALYN HYDROPHILIC OTW LOW PROFILE MORE RADIOPAQUE SUP-48002504X_41526 CDM 0270 RC outpatient 598 598 598 74 442.52 percent of total billed charges 598 93 484.38 percent of total billed charges 598 598 other OPPS APC 598 598 other OPPS APC 598 27.63 165.23 percent of total billed charges 598 598 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION CORDIS SABER 150CM 80MM 3.9-4.7FR 2.5MM DURALYN HYDROPHILIC OTW LOW PROFILE MORE RADIOPAQUE SUP-48002508X_41525 CDM 0270 RC outpatient 598 598 598 74 442.52 percent of total billed charges 598 93 484.38 percent of total billed charges 598 598 other OPPS APC 598 598 other OPPS APC 598 27.63 165.23 percent of total billed charges 598 598 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION CORDIS SABER 150CM 40MM 3.9-4.7FR 4MM DURALYN HYDROPHILIC OTW LOW PROFILE MORE RADIOPAQUE SUP-48004004X_41524 CDM 0270 RC outpatient 598 598 598 74 442.52 percent of total billed charges 598 93 484.38 percent of total billed charges 598 598 other OPPS APC 598 598 other OPPS APC 598 27.63 165.23 percent of total billed charges 598 598 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SABER DURALYN HYDROPHILIC L150 CM L40 MM OD4.7 FR ODSEC7 MM 1 PIECE HUB OTW HIGH PRESSURE LOW PROFILE ACCEPTS .018 IN GUIDEWIRE 4 FR SHEATH PTA SUP-48007004X CDM 0270 RC outpatient 598 598 598 74 442.52 percent of total billed charges 598 93 484.38 percent of total billed charges 598 598 other OPPS APC 598 598 other OPPS APC 598 27.63 165.23 percent of total billed charges 598 598 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEARS HARMONIC ACE CURVED SUP-480275 CDM 0270 RC outpatient 1488.07 1488.07 1488.07 74 1101.17 percent of total billed charges 1488.07 93 1205.34 percent of total billed charges 1488.07 1488.07 other OPPS APC 1488.07 1488.07 other OPPS APC 1488.07 27.63 411.15 percent of total billed charges 1488.07 1488.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IRRIGATOR SUCTION SUP-480299 CDM 0270 RC outpatient 723.67 723.67 723.67 74 535.52 percent of total billed charges 723.67 93 586.17 percent of total billed charges 723.67 723.67 other OPPS APC 723.67 723.67 other OPPS APC 723.67 27.63 199.95 percent of total billed charges 723.67 723.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALER VESSEL SUP-480422 CDM 0270 RC outpatient 1706.47 1706.47 1706.47 74 1262.79 percent of total billed charges 1706.47 93 1382.24 percent of total billed charges 1706.47 1706.47 other OPPS APC 1706.47 1706.47 other OPPS APC 1706.47 27.63 471.5 percent of total billed charges 1706.47 1706.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALER TISSUE SYNCHROSEAL DA VINCI L8MM SUP-480440 CDM 0270 RC outpatient 1883.7 1883.7 1883.7 74 1393.94 percent of total billed charges 1883.7 93 1525.8 percent of total billed charges 1883.7 1883.7 other OPPS APC 1883.7 1883.7 other OPPS APC 1883.7 27.63 520.47 percent of total billed charges 1883.7 1883.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL SUREFORM 45 OD14 MM STERILE LATEX FREE DISPOSABLE SUP-480445 CDM 0270 RC outpatient 1255.8 1255.8 1255.8 74 929.29 percent of total billed charges 1255.8 93 1017.2 percent of total billed charges 1255.8 1255.8 other OPPS APC 1255.8 1255.8 other OPPS APC 1255.8 27.63 346.98 percent of total billed charges 1255.8 1255.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUREFORM 60 STAPLER SUP-480460 CDM 0270 RC outpatient 1446.9 1446.9 1446.9 74 1070.71 percent of total billed charges 1446.9 93 1171.99 percent of total billed charges 1446.9 1446.9 other OPPS APC 1446.9 1446.9 other OPPS APC 1446.9 27.63 399.78 percent of total billed charges 1446.9 1446.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT SPILL SMALL FORMALDEHYDE SOLIDIFER SUP-481001 CDM outpatient 202.75 202.75 202.75 202.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XIA TITANIUM L30 MM OD4.5 MM SPINE THORACOLUMBAR POLYAXIAL 4.5 MM ROD SUP-48144530 CDM 270010020 LOCAL 0270 RC outpatient 4831.03 4831.03 4831.03 74 3574.96 percent of total billed charges 4831.03 93 3913.13 percent of total billed charges 4831.03 4831.03 other OPPS APC 4831.03 4831.03 other OPPS APC 4831.03 27.63 1334.81 percent of total billed charges 4831.03 4831.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XIA 3 TITANIUM L40 MM OD7.5 MM SPINE THORACOLUMBAR POLYAXIAL SUP-482317540 CDM 270010020 LOCAL 0270 RC outpatient 4618.02 4618.02 4618.02 74 3417.33 percent of total billed charges 4618.02 93 3740.6 percent of total billed charges 4618.02 4618.02 other OPPS APC 4618.02 4618.02 other OPPS APC 4618.02 27.63 1275.96 percent of total billed charges 4618.02 4618.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE XIA L80 MM OD9.5 MM SPINE POLYAXIAL REDUCED PROFILE REVISION SUP-482319580 CDM 270010020 LOCAL 0270 RC outpatient 4156.98 4156.98 4156.98 74 3076.17 percent of total billed charges 4156.98 93 3367.15 percent of total billed charges 4156.98 4156.98 other OPPS APC 4156.98 4156.98 other OPPS APC 4156.98 27.63 1148.57 percent of total billed charges 4156.98 4156.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOLD SHOULDER 8 STD 46X18X53 SUP-48236053 CDM 0270 RC outpatient 10002.2 10002.2 10002.2 74 7401.63 percent of total billed charges 10002.2 93 8101.78 percent of total billed charges 10002.2 10002.2 other OPPS APC 10002.2 10002.2 other OPPS APC 10002.2 27.63 2763.61 percent of total billed charges 10002.2 10002.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK SURGICAL FLUIDSHIELD ORANGE SO SOFT FOAM NS LF LEVEL 3 PLEAT STYLE FOG FREE VISOR SUP-48237 CDM outpatient 1.9 1.9 1.9 1.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L90 MM OD9.5 MM ILIOSACRAL REVISION POLYAXIAL SUP-4823719590 CDM 270010020 LOCAL 0270 RC outpatient 5408 5408 5408 74 4001.92 percent of total billed charges 5408 93 4380.48 percent of total billed charges 5408 5408 other OPPS APC 5408 5408 other OPPS APC 5408 27.63 1494.23 percent of total billed charges 5408 5408 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ES2 LITE XIA 3 SHORT BLADE LOW PROFILE L50 MM L15 MM OD6.5 MM SPINE 6 POINT STAR CANNULATED SECURE RING NOTCH ACCEPTS 1.3 MM KIRSCHNER WIRE SUP-482802650 CDM 270010020 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ES2 LITE XIA 3 LONG BLADE LOW PROFILE L50 MM L15 MM OD6.5 MM SPINE 6 POINT STAR CANNULATED SECURE RING NOTCH ACCEPTS 1.3 MM KIRSCHNER WIRE SUP-482804650 CDM 270010020 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL ES2 RADIUS TITANIUM HEXAGON L50 MM OD5.5 MM SUP-482806050 CDM 270010020 LOCAL 0270 RC outpatient 1778.4 1778.4 1778.4 74 1316.02 percent of total billed charges 1778.4 93 1440.5 percent of total billed charges 1778.4 1778.4 other OPPS APC 1778.4 1778.4 other OPPS APC 1778.4 27.63 491.37 percent of total billed charges 1778.4 1778.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL ES2 TITANIUM STRAIGHT HEXAGON L110 MM OD5.5 MM SUP-482807110 CDM 270010020 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP SPINAL VLIFT 8D 18MM NS SUP-48291188 CDM 270010020 LOCAL 0270 RC outpatient 849.86 849.86 849.86 74 628.9 percent of total billed charges 849.86 93 688.39 percent of total billed charges 849.86 849.86 other OPPS APC 849.86 849.86 other OPPS APC 849.86 27.63 234.82 percent of total billed charges 849.86 849.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION SPINAL VLIFT 18MM NS SUP-48291800 CDM 270010020 LOCAL 0270 RC outpatient 675.3 675.3 675.3 74 499.72 percent of total billed charges 675.3 93 546.99 percent of total billed charges 675.3 675.3 other OPPS APC 675.3 675.3 other OPPS APC 675.3 27.63 186.59 percent of total billed charges 675.3 675.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL VLIFT TITANIUM H32 MM OD18 MM LUMBAR INTERBODY FUSION SUP-48291832 CDM 270010020 LOCAL 0270 RC outpatient 20894.7 20894.7 20894.7 74 15462.1 percent of total billed charges 20894.7 93 16924.7 percent of total billed charges 20894.7 20894.7 other OPPS APC 20894.7 20894.7 other OPPS APC 20894.7 27.63 5773.22 percent of total billed charges 20894.7 20894.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP SPINAL VLIFT 15D 22MM NS SUP-48292215 CDM 270010020 LOCAL 0270 RC outpatient 1214.43 1214.43 1214.43 74 898.68 percent of total billed charges 1214.43 93 983.69 percent of total billed charges 1214.43 1214.43 other OPPS APC 1214.43 1214.43 other OPPS APC 1214.43 27.63 335.55 percent of total billed charges 1214.43 1214.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL VLIFT TITANIUM L37 MM OD22 MM LUMBAR INTERBODY FUSION SUP-48292237 CDM 270010020 LOCAL 0270 RC outpatient 20961.5 20961.5 20961.5 74 15511.5 percent of total billed charges 20961.5 93 16978.8 percent of total billed charges 20961.5 20961.5 other OPPS APC 20961.5 20961.5 other OPPS APC 20961.5 27.63 5791.66 percent of total billed charges 20961.5 20961.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER SUREFORM 45 D3.5 MM STERILE LATEX FREE DISPOSABLE BLUE SUP-48345B CDM 0270 RC outpatient 546 546 546 74 404.04 percent of total billed charges 546 93 442.26 percent of total billed charges 546 546 other OPPS APC 546 546 other OPPS APC 546 27.63 150.86 percent of total billed charges 546 546 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER SUREFORM 45 D4.3 MM STERILE LATEX FREE DISPOSABLE GREEN SUP-48345G CDM 0270 RC outpatient 546 546 546 74 404.04 percent of total billed charges 546 93 442.26 percent of total billed charges 546 546 other OPPS APC 546 546 other OPPS APC 546 27.63 150.86 percent of total billed charges 546 546 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER SUREFORM 45 D4.6 MM STERILE LATEX FREE DISPOSABLE BLACK SUP-48345T CDM 0270 RC outpatient 546 546 546 74 404.04 percent of total billed charges 546 93 442.26 percent of total billed charges 546 546 other OPPS APC 546 546 other OPPS APC 546 27.63 150.86 percent of total billed charges 546 546 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER SUREFORM 45 D2.5 MM STERILE LATEX FREE DISPOSABLE WHITE SUP-48345W CDM 0270 RC outpatient 546 546 546 74 404.04 percent of total billed charges 546 93 442.26 percent of total billed charges 546 546 other OPPS APC 546 546 other OPPS APC 546 27.63 150.86 percent of total billed charges 546 546 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUREFORM 60 RELOAD BLUE SUP-48360B CDM 0270 RC outpatient 627.9 627.9 627.9 74 464.65 percent of total billed charges 627.9 93 508.6 percent of total billed charges 627.9 627.9 other OPPS APC 627.9 627.9 other OPPS APC 627.9 27.63 173.49 percent of total billed charges 627.9 627.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUREFORM 60 RELOAD GREEN SUP-48360G CDM 0270 RC outpatient 627.9 627.9 627.9 74 464.65 percent of total billed charges 627.9 93 508.6 percent of total billed charges 627.9 627.9 other OPPS APC 627.9 627.9 other OPPS APC 627.9 27.63 173.49 percent of total billed charges 627.9 627.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUREFORM 60 RELOAD BLACK SUP-48360T CDM 0270 RC outpatient 627.9 627.9 627.9 74 464.65 percent of total billed charges 627.9 93 508.6 percent of total billed charges 627.9 627.9 other OPPS APC 627.9 627.9 other OPPS APC 627.9 27.63 173.49 percent of total billed charges 627.9 627.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUREFORM 60 RELOAD WHITE SUP-48360W CDM 0270 RC outpatient 627.9 627.9 627.9 74 464.65 percent of total billed charges 627.9 93 508.6 percent of total billed charges 627.9 627.9 other OPPS APC 627.9 627.9 other OPPS APC 627.9 27.63 173.49 percent of total billed charges 627.9 627.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE EQUIPMENT ZEISS CLEARLENS STANDARD L120 IN X W46 IN OD65 MM OCULAR COVER LENS PATENT GLARE REDUCE STEREO STERILE LATEX FREE DISPOSABLE SUP-4838CL CDM 0270 RC outpatient 60.67 60.67 60.67 74 44.9 percent of total billed charges 60.67 93 49.14 percent of total billed charges 60.67 60.67 other OPPS APC 60.67 60.67 other OPPS APC 60.67 27.63 16.76 percent of total billed charges 60.67 60.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK SURGICAL HALYARD WHITE NS LF 3 LAYER PLEAT STYLE TIES NO FLUID RESISTANT SUP-48390 CDM outpatient 0.36 0.36 0.36 0.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL AVS NAVIGATOR PEEK TANTALUM 4 D HOLLOW L31 MM X H13 MM RADIOPAQUE NONSTERILE TLIF SUP-4839134 CDM 270010020 LOCAL 0270 RC outpatient 11605.3 11605.3 11605.3 74 8587.93 percent of total billed charges 11605.3 93 9400.3 percent of total billed charges 11605.3 11605.3 other OPPS APC 11605.3 11605.3 other OPPS APC 11605.3 27.63 3206.55 percent of total billed charges 11605.3 11605.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL AVS NAVIGATOR PEEK TANTALUM 4 D HOLLOW L26 MM X W9 MM RADIOPAQUE NONSTERILE TLIF SUP-48392094 CDM 270010020 LOCAL 0270 RC outpatient 12654.6 12654.6 12654.6 74 9364.37 percent of total billed charges 12654.6 93 10250.2 percent of total billed charges 12654.6 12654.6 other OPPS APC 12654.6 12654.6 other OPPS APC 12654.6 27.63 3496.45 percent of total billed charges 12654.6 12654.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL AVS NAVIGATOR PEEK TANTALUM 4 D HOLLOW L26 MM X W10 MM RADIOPAQUE NONSTERILE TLIF SUP-48392104 CDM 270010020 LOCAL 0270 RC outpatient 12654.6 12654.6 12654.6 74 9364.37 percent of total billed charges 12654.6 93 10250.2 percent of total billed charges 12654.6 12654.6 other OPPS APC 12654.6 12654.6 other OPPS APC 12654.6 27.63 3496.45 percent of total billed charges 12654.6 12654.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL AVS NAVIGATOR PEEK TANTALUM 4 D HOLLOW L26 MM X W13 MM RADIOPAQUE NONSTERILE TLIF SUP-48392134 CDM 270010024 LOCAL 0270 RC outpatient 11605.3 11605.3 11605.3 74 8587.93 percent of total billed charges 11605.3 93 9400.3 percent of total billed charges 11605.3 11605.3 other OPPS APC 11605.3 11605.3 other OPPS APC 11605.3 27.63 3206.55 percent of total billed charges 11605.3 11605.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE STRYKER 9X31X4DEG SUP-48393044 CDM 270010020 LOCAL 0270 RC outpatient 11605.3 11605.3 11605.3 74 8587.93 percent of total billed charges 11605.3 93 9400.3 percent of total billed charges 11605.3 11605.3 other OPPS APC 11605.3 11605.3 other OPPS APC 11605.3 27.63 3206.55 percent of total billed charges 11605.3 11605.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL AVS NAVIGATOR PEEK TANTALUM 4 D HOLLOW L31 MM X H8 MM RADIOPAQUE NONSTERILE TLIF SUP-48393084 CDM 270010020 LOCAL 0270 RC outpatient 11605.3 11605.3 11605.3 74 8587.93 percent of total billed charges 11605.3 93 9400.3 percent of total billed charges 11605.3 11605.3 other OPPS APC 11605.3 11605.3 other OPPS APC 11605.3 27.63 3206.55 percent of total billed charges 11605.3 11605.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE STRYKER 9MM SUP-48393094 CDM 270010020 LOCAL 0270 RC outpatient 11605.3 11605.3 11605.3 74 8587.93 percent of total billed charges 11605.3 93 9400.3 percent of total billed charges 11605.3 11605.3 other OPPS APC 11605.3 11605.3 other OPPS APC 11605.3 27.63 3206.55 percent of total billed charges 11605.3 11605.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL AVS NAVIGATOR PEEK TANTALUM 4 D HOLLOW L31 MM X H10 MM RADIOPAQUE NONSTERILE TLIF SUP-48393104 CDM 270010020 LOCAL 0270 RC outpatient 12654.6 12654.6 12654.6 74 9364.37 percent of total billed charges 12654.6 93 10250.2 percent of total billed charges 12654.6 12654.6 other OPPS APC 12654.6 12654.6 other OPPS APC 12654.6 27.63 3496.45 percent of total billed charges 12654.6 12654.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER RELOAD ENDOWRIST 45 RELOAD GREEN SUP-48445G CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOCKER SPINAL OASYS OCCIPITO CERVICO THORACIC SUP-48551000 CDM 270010020 LOCAL 0270 RC outpatient 375.65 375.65 375.65 74 277.98 percent of total billed charges 375.65 93 304.28 percent of total billed charges 375.65 375.65 other OPPS APC 375.65 375.65 other OPPS APC 375.65 27.63 103.79 percent of total billed charges 375.65 375.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL OASYS TITANIUM L25 MM OD3.5 MM OCCIPITOCERVICOTHORACIC SPINE SUP-48552025 CDM 270010020 LOCAL 0270 RC outpatient 643.6 643.6 643.6 74 476.26 percent of total billed charges 643.6 93 521.32 percent of total billed charges 643.6 643.6 other OPPS APC 643.6 643.6 other OPPS APC 643.6 27.63 177.83 percent of total billed charges 643.6 643.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL OASYS TITANIUM L40 MM OD3.5 MM OCCIPITOCERVICOTHORACIC SPINE SUP-48552040 CDM 270010020 LOCAL 0270 RC outpatient 839.8 839.8 839.8 74 621.45 percent of total billed charges 839.8 93 680.24 percent of total billed charges 839.8 839.8 other OPPS APC 839.8 839.8 other OPPS APC 839.8 27.63 232.04 percent of total billed charges 839.8 839.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL OASYS TITANIUM L50 MM OD3.5 MM OCCIPITO CERVICO THORACIC SPINE SUP-48552050 CDM 270010020 LOCAL 0270 RC outpatient 611.13 611.13 611.13 74 452.24 percent of total billed charges 611.13 93 495.02 percent of total billed charges 611.13 611.13 other OPPS APC 611.13 611.13 other OPPS APC 611.13 27.63 168.86 percent of total billed charges 611.13 611.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD STRYKER SPINE 3.5MM X 60MM SUP-48552060 CDM 270010020 LOCAL 0270 RC outpatient 643.6 643.6 643.6 74 476.26 percent of total billed charges 643.6 93 521.32 percent of total billed charges 643.6 643.6 other OPPS APC 643.6 643.6 other OPPS APC 643.6 27.63 177.83 percent of total billed charges 643.6 643.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL OASYS TITANIUM L70 MM OD3.5 MM OCCIPITOCERVICOTHORACIC SPINE SUP-48552070 CDM 270010020 LOCAL 0270 RC outpatient 643.6 643.6 643.6 74 476.26 percent of total billed charges 643.6 93 521.32 percent of total billed charges 643.6 643.6 other OPPS APC 643.6 643.6 other OPPS APC 643.6 27.63 177.83 percent of total billed charges 643.6 643.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE OASYS TITANIUM LOW PROFILE L26 MM OD4 MM SPINE OCCIPITOCERVICOTHORACIC BIAS ANGLE POLYAXIAL SUP-48552426 CDM 270010020 LOCAL 0270 RC outpatient 3641.9 3641.9 3641.9 74 2695.01 percent of total billed charges 3641.9 93 2949.94 percent of total billed charges 3641.9 3641.9 other OPPS APC 3641.9 3641.9 other OPPS APC 3641.9 27.63 1006.26 percent of total billed charges 3641.9 3641.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL OASYS VITALLIUM LARGE L80 MM OD3.5 MM OCCIPITOCERVICOTHORACIC SPINE SUP-48553080 CDM 270010020 LOCAL 0270 RC outpatient 1861.03 1861.03 1861.03 74 1377.16 percent of total billed charges 1861.03 93 1507.43 percent of total billed charges 1861.03 1861.03 other OPPS APC 1861.03 1861.03 other OPPS APC 1861.03 27.63 514.2 percent of total billed charges 1861.03 1861.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL OASYS VITALLIUM LARGE L240 MM OD3.5 MM OCCIPITOCERVICOTHORACIC SPINE SUP-48553240 CDM 270010020 LOCAL 0270 RC outpatient 3103.05 3103.05 3103.05 74 2296.26 percent of total billed charges 3103.05 93 2513.47 percent of total billed charges 3103.05 3103.05 other OPPS APC 3103.05 3103.05 other OPPS APC 3103.05 27.63 857.37 percent of total billed charges 3103.05 3103.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE OASYS TITANIUM LOW PROFILE L22 MM OD3.5 MM SPINE OCCIPITOCERVICOTHORACIC MEDIAL BIAS ANGLE POLYAXIAL SUP-48555322 CDM 270010020 LOCAL 0270 RC outpatient 3380.49 3380.49 3380.49 74 2501.56 percent of total billed charges 3380.49 93 2738.2 percent of total billed charges 3380.49 3380.49 other OPPS APC 3380.49 3380.49 other OPPS APC 3380.49 27.63 934.03 percent of total billed charges 3380.49 3380.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE OASYS TITANIUM LOW PROFILE L10 MM OD3.5 MM SPINE OCCIPITOCERVICOTHORACIC CANCELLOUS BIAS ANGLE POLYAXIAL SUP-48557310 CDM 0270 RC outpatient 3380.49 3380.49 3380.49 74 2501.56 percent of total billed charges 3380.49 93 2738.2 percent of total billed charges 3380.49 3380.49 other OPPS APC 3380.49 3380.49 other OPPS APC 3380.49 27.63 934.03 percent of total billed charges 3380.49 3380.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE OASYS TITANIUM LOW PROFILE L12 MM OD3.5 MM SPINE OCCIPITOCERVICOTHORACIC CANCELLOUS BIAS ANGLE POLYAXIAL SUP-48557312 CDM 270010020 LOCAL 0270 RC outpatient 3380.49 3380.49 3380.49 74 2501.56 percent of total billed charges 3380.49 93 2738.2 percent of total billed charges 3380.49 3380.49 other OPPS APC 3380.49 3380.49 other OPPS APC 3380.49 27.63 934.03 percent of total billed charges 3380.49 3380.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE QUICKFIX T15 SHORT THREAD 48MM 4MM TITANIUM CANCELLOUS CANNULATED SELF TAP SELF DRILL HEXALOBE ACCEPTS .053IN SUP-48557312 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE OASYS TITANIUM LOW PROFILE L22 MM OD3.5 MM SPINE OCCIPITOCERVICOTHORACIC CANCELLOUS BIAS ANGLE POLYAXIAL SUP-48557322 CDM 0270 RC outpatient 3380.49 3380.49 3380.49 74 2501.56 percent of total billed charges 3380.49 93 2738.2 percent of total billed charges 3380.49 3380.49 other OPPS APC 3380.49 3380.49 other OPPS APC 3380.49 27.63 934.03 percent of total billed charges 3380.49 3380.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE OASYS TITANIUM LOW PROFILE L20 MM OD4 MM SPINE OCCIPITOCERVICOTHORACIC CANCELLOUS BIAS ANGLE POLYAXIAL SUP-48557420 CDM 270010020 LOCAL 0270 RC outpatient 3641.9 3641.9 3641.9 74 2695.01 percent of total billed charges 3641.9 93 2949.94 percent of total billed charges 3641.9 3641.9 other OPPS APC 3641.9 3641.9 other OPPS APC 3641.9 27.63 1006.26 percent of total billed charges 3641.9 3641.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE OASYS TITANIUM LOW PROFILE L22 MM OD4 MM SPINE OCCIPITOCERVICOTHORACIC CANCELLOUS BIAS ANGLE POLYAXIAL SUP-48557422 CDM 0270 RC outpatient 3458.03 3458.03 3458.03 74 2558.94 percent of total billed charges 3458.03 93 2801 percent of total billed charges 3458.03 3458.03 other OPPS APC 3458.03 3458.03 other OPPS APC 3458.03 27.63 955.45 percent of total billed charges 3458.03 3458.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GLOVE, EXAM EUDERMIC MP HIGH-RISK POWDER-FREE LATEX SIZE M 12 INCH CUFF LENGTH" SUP-485602 CDM 0270 RC outpatient 0.52 0.52 0.52 74 0.38 percent of total billed charges 0.52 93 0.42 percent of total billed charges 0.52 0.52 other OPPS APC 0.52 0.52 other OPPS APC 0.52 27.63 0.14 percent of total billed charges 0.52 0.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAP SPINAL OASYS OD3.5 MM DRILL BIT SUP-48560314 CDM 270010020 LOCAL 0270 RC outpatient 1154.17 1154.17 1154.17 74 854.09 percent of total billed charges 1154.17 93 934.88 percent of total billed charges 1154.17 1154.17 other OPPS APC 1154.17 1154.17 other OPPS APC 1154.17 27.63 318.9 percent of total billed charges 1154.17 1154.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL OASYS OD2.5 MM SPINE TETHER STERILE 3.5 MM SCREW SUP-48560323 CDM 270010020 LOCAL 0270 RC outpatient 848.82 848.82 848.82 74 628.13 percent of total billed charges 848.82 93 687.54 percent of total billed charges 848.82 848.82 other OPPS APC 848.82 848.82 other OPPS APC 848.82 27.63 234.53 percent of total billed charges 848.82 848.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE PEDICLE SUP-48562118 CDM 0270 RC outpatient 2125.53 2125.53 2125.53 74 1572.89 percent of total billed charges 2125.53 93 1721.68 percent of total billed charges 2125.53 2125.53 other OPPS APC 2125.53 2125.53 other OPPS APC 2125.53 27.63 587.28 percent of total billed charges 2125.53 2125.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER RELOAD ENDOWRIST 30 RELOAD BLUE SUP-48630B CDM 0270 RC outpatient 466.48 466.48 466.48 74 345.2 percent of total billed charges 466.48 93 377.85 percent of total billed charges 466.48 466.48 other OPPS APC 466.48 466.48 other OPPS APC 466.48 27.63 128.89 percent of total billed charges 466.48 466.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER RELOAD ENDOWRIST 30 RELOAD GREEN SUP-48630G CDM 0270 RC outpatient 466.48 466.48 466.48 74 345.2 percent of total billed charges 466.48 93 377.85 percent of total billed charges 466.48 466.48 other OPPS APC 466.48 466.48 other OPPS APC 466.48 27.63 128.89 percent of total billed charges 466.48 466.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER RELOAD ENDOWRIST 30 RELOAD GRAY SUP-48630M CDM 0270 RC outpatient 466.48 466.48 466.48 74 345.2 percent of total billed charges 466.48 93 377.85 percent of total billed charges 466.48 466.48 other OPPS APC 466.48 466.48 other OPPS APC 466.48 27.63 128.89 percent of total billed charges 466.48 466.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER RELOAD ENDOWRIST 30 RELOAD WHITE SUP-48630W CDM 0270 RC outpatient 466.48 466.48 466.48 74 345.2 percent of total billed charges 466.48 93 377.85 percent of total billed charges 466.48 466.48 other OPPS APC 466.48 466.48 other OPPS APC 466.48 27.63 128.89 percent of total billed charges 466.48 466.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER RELOAD ENDOWRIST 45 RELOAD WHITE SUP-48645W CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING GAUZE QUIKCLOT L4 YD X W3 IN Z FOLD HEMOSTATIC SUP-487 CDM 0270 RC outpatient 113.26 113.26 113.26 74 83.81 percent of total billed charges 113.26 93 91.74 percent of total billed charges 113.26 113.26 other OPPS APC 113.26 113.26 other OPPS APC 113.26 27.63 31.29 percent of total billed charges 113.26 113.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL ARIA AVS 8D LORDOTIC 55X18X12MM PEEK-OPTIMA SUP-48751312 CDM 270010020 LOCAL 0270 RC outpatient 14868.3 14868.3 14868.3 74 11002.5 percent of total billed charges 14868.3 93 12043.3 percent of total billed charges 14868.3 14868.3 other OPPS APC 14868.3 14868.3 other OPPS APC 14868.3 27.63 4108.11 percent of total billed charges 14868.3 14868.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL ARIA AVS 0D LORDOTIC 50X22X12MM PEEK-OPTIMA SUP-48752212 CDM 270010020 LOCAL 0270 RC outpatient 14866.8 14866.8 14866.8 74 11001.4 percent of total billed charges 14866.8 93 12042.1 percent of total billed charges 14866.8 14866.8 other OPPS APC 14866.8 14866.8 other OPPS APC 14866.8 27.63 4107.7 percent of total billed charges 14866.8 14866.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC SHARP DISPOSABLE ARIA SPINAL SYSTEM SUP-48755007 CDM 270010020 LOCAL 0270 RC outpatient 156.47 156.47 156.47 74 115.79 percent of total billed charges 156.47 93 126.74 percent of total billed charges 156.47 156.47 other OPPS APC 156.47 156.47 other OPPS APC 156.47 27.63 43.23 percent of total billed charges 156.47 156.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL TRITANIUM 6 D CURVE L27 MM X W10 MM X H10 MM LUMBAR POSTERIOR STERILE LATEX FREE TLIF SUP-48930106 CDM 270010020 LOCAL 0270 RC outpatient 15600 15600 15600 74 11544 percent of total billed charges 15600 93 12636 percent of total billed charges 15600 15600 other OPPS APC 15600 15600 other OPPS APC 15600 27.63 4310.28 percent of total billed charges 15600 15600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL TRITANIUM 6 D LORDOTIC L28 MM X W9 MM X H16 MM STERILE LATEX FREE PLIF SUP-48954106 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE POSTERIOR LUMBAR 8MM SUP-48955086 CDM 270010020 LOCAL 0270 RC outpatient 15600 15600 15600 74 11544 percent of total billed charges 15600 93 12636 percent of total billed charges 15600 15600 other OPPS APC 15600 15600 other OPPS APC 15600 27.63 4310.28 percent of total billed charges 15600 15600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER POST LUMBAR CAGE 9MM X 28MMX6 DEG 11MM SUP-48955096 CDM 270010020 LOCAL 0270 RC outpatient 15600 15600 15600 74 11544 percent of total billed charges 15600 93 12636 percent of total billed charges 15600 15600 other OPPS APC 15600 15600 other OPPS APC 15600 27.63 4310.28 percent of total billed charges 15600 15600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER POST LUMBAR CAGE 10MM X 28MMX6 DEG 11MM SUP-48955106 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER POST LUMBAR CAGE 11MM X 28MMX6 DEG 11MM SUP-48955116 CDM 270010020 LOCAL 0270 RC outpatient 15600 15600 15600 74 11544 percent of total billed charges 15600 93 12636 percent of total billed charges 15600 15600 other OPPS APC 15600 15600 other OPPS APC 15600 27.63 4310.28 percent of total billed charges 15600 15600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE POSTERIOR LUMBAR TRITANIUM 12X28X6DEG 11MM SUP-48955126 CDM 270010020 LOCAL 0270 RC outpatient 15600 15600 15600 74 11544 percent of total billed charges 15600 93 12636 percent of total billed charges 15600 15600 other OPPS APC 15600 15600 other OPPS APC 15600 27.63 4310.28 percent of total billed charges 15600 15600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL TRITANIUM 6 D LORDOTIC L32 MM X W11 MM X H9 MM STERILE LATEX FREE PLIF SUP-48956096 CDM 0270 RC outpatient 15600 15600 15600 74 11544 percent of total billed charges 15600 93 12636 percent of total billed charges 15600 15600 other OPPS APC 15600 15600 other OPPS APC 15600 27.63 4310.28 percent of total billed charges 15600 15600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE CHROMIC 1 BP L27 IN MONOFILAMENT BROWN SUP-48G CDM 0270 RC outpatient 22.71 22.71 22.71 74 16.81 percent of total billed charges 22.71 93 18.4 percent of total billed charges 22.71 22.71 other OPPS APC 22.71 22.71 other OPPS APC 22.71 27.63 6.27 percent of total billed charges 22.71 22.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM ANNULOPLASTY EDWARDS MC3 TITANIUM SILICONE RUBBER POLYESTER TRICUSPID 1 SEAM 2 WRAP ANATOMIC STERILE SUP-4900 CDM 0270 RC outpatient 2.6 2.6 2.6 74 1.92 percent of total billed charges 2.6 93 2.11 percent of total billed charges 2.6 2.6 other OPPS APC 2.6 2.6 other OPPS APC 2.6 27.63 0.72 percent of total billed charges 2.6 2.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY EDWARDS MC3 26MM TITANIUM POLYESTER SILICONE RUBBER STERILE TRICUSPID SEAM 2 WRAP SUP-4900T26 CDM 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY EDWARDS MC3 TITANIUM SILICONE RUBBER POLYESTER OD28 MM TRICUSPID 1 SEAM 2 WRAP ANATOMIC STERILE SUP-4900T28 CDM 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY EDWARDS MC3 TITANIUM SILICONE RUBBER POLYESTER OD30 MM TRICUSPID 1 SEAM 2 WRAP ANATOMIC STERILE SUP-4900T30 CDM 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY EDWARDS MC3 3D ANGLE DOWN OD32 MM TRICUSPID SUP-4900T32 CDM 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY EDWARDS MC3 TITANIUM SILICONE RUBBER POLYESTER OD34 MM TRICUSPID 1 SEAM 2 WRAP ANATOMIC STERILE SUP-4900T34 CDM 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY EDWARDS MC3 TITANIUM SILICONE RUBBER POLYESTER OD36 MM TRICUSPID 1 SEAM 2 WRAP ANATOMIC STERILE SUP-4900T36 CDM 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON 2 LR L30 IN 2 ARM MONOFILAMENT BLACK SUP-490T CDM 0270 RC outpatient 8.87 8.87 8.87 74 6.56 percent of total billed charges 8.87 93 7.18 percent of total billed charges 8.87 8.87 other OPPS APC 8.87 8.87 other OPPS APC 8.87 27.63 2.45 percent of total billed charges 8.87 8.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER TITANIUM L70 MM OD0.8 MM ORTHOPEDIC TROCAR POINT NONSTERILE SUP-492.08 CDM 270010022 LOCAL 0270 RC outpatient 24.21 24.21 24.21 74 17.92 percent of total billed charges 24.21 93 19.61 percent of total billed charges 24.21 24.21 other OPPS APC 24.21 24.21 other OPPS APC 24.21 27.63 6.69 percent of total billed charges 24.21 24.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER TITANIUM TROCAR L150 MM OD1 MM NONSTERILE SUP-492.10 CDM 270010022 LOCAL 0270 RC outpatient 24.21 24.21 24.21 74 17.92 percent of total billed charges 24.21 93 19.61 percent of total billed charges 24.21 24.21 other OPPS APC 24.21 24.21 other OPPS APC 24.21 27.63 6.69 percent of total billed charges 24.21 24.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER TITANIUM L150 MM OD1.25 MM RADIUS DISTAL TROCAR NONSTERILE MINI FRAGMENT SET SUP-492.12 CDM 270010022 LOCAL 0270 RC outpatient 24.21 24.21 24.21 74 17.92 percent of total billed charges 24.21 93 19.61 percent of total billed charges 24.21 24.21 other OPPS APC 24.21 24.21 other OPPS APC 24.21 27.63 6.69 percent of total billed charges 24.21 24.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER TITANIUM L150 MM OD1.6 MM RADIUS DISTAL TROCAR NONSTERILE MINI FRAGMENT SET SUP-492.16 CDM 270010022 LOCAL 0270 RC outpatient 56.58 56.58 56.58 74 41.87 percent of total billed charges 56.58 93 45.83 percent of total billed charges 56.58 56.58 other OPPS APC 56.58 56.58 other OPPS APC 56.58 27.63 15.63 percent of total billed charges 56.58 56.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER 150MM 2MM TITANIUM TROCAR POINT SUP-492.20 CDM 270010022 LOCAL 0270 RC outpatient 56.58 56.58 56.58 74 41.87 percent of total billed charges 56.58 93 45.83 percent of total billed charges 56.58 56.58 other OPPS APC 56.58 56.58 other OPPS APC 56.58 27.63 15.63 percent of total billed charges 56.58 56.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MANDIBLE LC DCP CRESCENT TITANIUM 4 HOLE 2.4 X 35MM SUP-492.56 CDM 270010014 LOCAL 0270 RC outpatient 1021.59 1021.59 1021.59 74 755.98 percent of total billed charges 1021.59 93 827.49 percent of total billed charges 1021.59 1021.59 other OPPS APC 1021.59 1021.59 other OPPS APC 1021.59 27.63 282.27 percent of total billed charges 1021.59 1021.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL EVOLVE +4 MM OD9.5 MM ELBOW MODULAR STERILE SUP-496-S495 CDM 0270 RC outpatient 9531.6 9531.6 9531.6 74 7053.38 percent of total billed charges 9531.6 93 7720.6 percent of total billed charges 9531.6 9531.6 other OPPS APC 9531.6 9531.6 other OPPS APC 9531.6 27.63 2633.58 percent of total billed charges 9531.6 9531.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP PIN TO ROD SUP-4960-1-020 CDM 270010022 LOCAL 0270 RC outpatient 1734.72 1734.72 1734.72 74 1283.69 percent of total billed charges 1734.72 93 1405.12 percent of total billed charges 1734.72 1734.72 other OPPS APC 1734.72 1734.72 other OPPS APC 1734.72 27.63 479.3 percent of total billed charges 1734.72 1734.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASSEMBLY LENGTHENING SUP-4960-3-000 CDM 270010022 LOCAL 0270 RC outpatient 95754.9 95754.9 95754.9 74 70858.6 percent of total billed charges 95754.9 93 77561.4 percent of total billed charges 95754.9 95754.9 other OPPS APC 95754.9 95754.9 other OPPS APC 95754.9 27.63 26457.1 percent of total billed charges 95754.9 95754.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION HOFFMANN II MICRO MULTIPIN LENGTHENER COMPONENT SUP-4960-3-020 CDM 270010022 LOCAL 0270 RC outpatient 3138.72 3138.72 3138.72 74 2322.65 percent of total billed charges 3138.72 93 2542.36 percent of total billed charges 3138.72 3138.72 other OPPS APC 3138.72 3138.72 other OPPS APC 3138.72 27.63 867.23 percent of total billed charges 3138.72 3138.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WHEEL THUMB LENGTHENING SUP-4960-3-030 CDM 270010022 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING FOAM MEPILEX BORDER POLYURETHANE L10 IN X W4 IN SELF ADHERENT SHOWER PROOF BREATHABLE STERILE ASSORTED SUP-496455 CDM 0270 RC outpatient 13.87 13.87 13.87 74 10.26 percent of total billed charges 13.87 93 11.23 percent of total billed charges 13.87 13.87 other OPPS APC 13.87 13.87 other OPPS APC 13.87 27.63 3.83 percent of total billed charges 13.87 13.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING CAPSURE EPI STEROID ELUTING SILICONE OD4.5 FR EPICARDIUM MYOCARDIUM UNIPOLAR SUTURE FIXATION IS-1 SUP-4965 CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING WOUND MEPILEX BORDER POST OP 4 X 12IN SUP-496605 CDM 0270 RC outpatient 15.28 15.28 15.28 74 11.31 percent of total billed charges 15.28 93 12.38 percent of total billed charges 15.28 15.28 other OPPS APC 15.28 15.28 other OPPS APC 15.28 27.63 4.22 percent of total billed charges 15.28 15.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL EVOLVE PROLINE STANDARD OD20 MM ELBOW MODULAR SUP-496H020 CDM 0270 RC outpatient 8021 8021 8021 74 5935.54 percent of total billed charges 8021 93 6497.01 percent of total billed charges 8021 8021 other OPPS APC 8021 8021 other OPPS APC 8021 27.63 2216.2 percent of total billed charges 8021 8021 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL EVOLVE PROLINE STANDARD OD22 MM ELBOW MODULAR SUP-496H022 CDM 0270 RC outpatient 8502 8502 8502 74 6291.48 percent of total billed charges 8502 93 6886.62 percent of total billed charges 8502 8502 other OPPS APC 8502 8502 other OPPS APC 8502 27.63 2349.1 percent of total billed charges 8502 8502 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL EVOLVE PROLINE STANDARD OD24 MM ELBOW MODULAR SUP-496H024 CDM 0270 RC outpatient 8021 8021 8021 74 5935.54 percent of total billed charges 8021 93 6497.01 percent of total billed charges 8021 8021 other OPPS APC 8021 8021 other OPPS APC 8021 27.63 2216.2 percent of total billed charges 8021 8021 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL EVOLVE PROLINE STANDARD OD26 MM ELBOW MODULAR SUP-496H026 CDM 0270 RC outpatient 7638.8 7638.8 7638.8 74 5652.71 percent of total billed charges 7638.8 93 6187.43 percent of total billed charges 7638.8 7638.8 other OPPS APC 7638.8 7638.8 other OPPS APC 7638.8 27.63 2110.6 percent of total billed charges 7638.8 7638.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL EVOLVE PROLINE STANDARD OD28 MM ELBOW MODULAR SUP-496H028 CDM 0270 RC outpatient 7638.8 7638.8 7638.8 74 5652.71 percent of total billed charges 7638.8 93 6187.43 percent of total billed charges 7638.8 7638.8 other OPPS APC 7638.8 7638.8 other OPPS APC 7638.8 27.63 2110.6 percent of total billed charges 7638.8 7638.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL EVOLVE PROLINE +2 OD22 MM ELBOW ELBOW MODULAR SUP-496H220 CDM 0270 RC outpatient 6994 6994 6994 74 5175.56 percent of total billed charges 6994 93 5665.14 percent of total billed charges 6994 6994 other OPPS APC 6994 6994 other OPPS APC 6994 27.63 1932.44 percent of total billed charges 6994 6994 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL EVOLVE PROLINE 2+ MM OD22 MM ELBOW MODULAR STERILE SUP-496H222 CDM 0270 RC outpatient 8502 8502 8502 74 6291.48 percent of total billed charges 8502 93 6886.62 percent of total billed charges 8502 8502 other OPPS APC 8502 8502 other OPPS APC 8502 27.63 2349.1 percent of total billed charges 8502 8502 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL EVOLVE PROLINE 2 MM OD24 MM SUP-496H224 CDM 0270 RC outpatient 6994 6994 6994 74 5175.56 percent of total billed charges 6994 93 5665.14 percent of total billed charges 6994 6994 other OPPS APC 6994 6994 other OPPS APC 6994 27.63 1932.44 percent of total billed charges 6994 6994 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL EVOLVE +2MM 26MM SS STERILE ELBOW SUP-496H226 CDM 0270 RC outpatient 7638.8 7638.8 7638.8 74 5652.71 percent of total billed charges 7638.8 93 6187.43 percent of total billed charges 7638.8 7638.8 other OPPS APC 7638.8 7638.8 other OPPS APC 7638.8 27.63 2110.6 percent of total billed charges 7638.8 7638.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL EVOLVE PROLINE +2 MM OD28 MM ELBOW MODULAR SUP-496H228 CDM 0270 RC outpatient 6994 6994 6994 74 5175.56 percent of total billed charges 6994 93 5665.14 percent of total billed charges 6994 6994 other OPPS APC 6994 6994 other OPPS APC 6994 27.63 1932.44 percent of total billed charges 6994 6994 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL EVOLVE PROLINE +4 MM OD20 MM ELBOW MODULAR SUP-496H420 CDM 0270 RC outpatient 6994 6994 6994 74 5175.56 percent of total billed charges 6994 93 5665.14 percent of total billed charges 6994 6994 other OPPS APC 6994 6994 other OPPS APC 6994 27.63 1932.44 percent of total billed charges 6994 6994 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL EVOLVE PROLINE +4 MM OD22 MM ELBOW MODULAR STERILE SUP-496H422 CDM 0270 RC outpatient 8502 8502 8502 74 6291.48 percent of total billed charges 8502 93 6886.62 percent of total billed charges 8502 8502 other OPPS APC 8502 8502 other OPPS APC 8502 27.63 2349.1 percent of total billed charges 8502 8502 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL EVOLVE PROLINE +4 MM OD24 MM ELBOW MODULAR STERILE SUP-496H424 CDM 0270 RC outpatient 6994 6994 6994 74 5175.56 percent of total billed charges 6994 93 5665.14 percent of total billed charges 6994 6994 other OPPS APC 6994 6994 other OPPS APC 6994 27.63 1932.44 percent of total billed charges 6994 6994 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL EVOLVE PROLINE +4 MM OD26 MM ELBOW MODULAR STERILE SUP-496H426 CDM 0270 RC outpatient 8741.2 8741.2 8741.2 74 6468.49 percent of total billed charges 8741.2 93 7080.37 percent of total billed charges 8741.2 8741.2 other OPPS APC 8741.2 8741.2 other OPPS APC 8741.2 27.63 2415.19 percent of total billed charges 8741.2 8741.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD RADIAL EVOLVE STAINLESS STEEL +4 MM OD28 MM ELBOW MODULAR SUP-496H428 CDM 0270 RC outpatient 8741.2 8741.2 8741.2 74 6468.49 percent of total billed charges 8741.2 93 7080.37 percent of total billed charges 8741.2 8741.2 other OPPS APC 8741.2 8741.2 other OPPS APC 8741.2 27.63 2415.19 percent of total billed charges 8741.2 8741.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL EVOLVE PROLINE STANDARD OD5.5 MM ELBOW MODULAR HEAD SUP-496S055 CDM 0270 RC outpatient 9531.6 9531.6 9531.6 74 7053.38 percent of total billed charges 9531.6 93 7720.6 percent of total billed charges 9531.6 9531.6 other OPPS APC 9531.6 9531.6 other OPPS APC 9531.6 27.63 2633.58 percent of total billed charges 9531.6 9531.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL EVOLVE PROLINE STANDARD OD6.5 MM ELBOW HEAD SYSTEM SUP-496S065 CDM 0270 RC outpatient 9531.6 9531.6 9531.6 74 7053.38 percent of total billed charges 9531.6 93 7720.6 percent of total billed charges 9531.6 9531.6 other OPPS APC 9531.6 9531.6 other OPPS APC 9531.6 27.63 2633.58 percent of total billed charges 9531.6 9531.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL EVOLVE PROLINE STANDARD H23 MM OD7.5 MM ELBOW MODULAR HEAD SYSTEM SUP-496S075 CDM 0270 RC outpatient 10103.6 10103.6 10103.6 74 7476.66 percent of total billed charges 10103.6 93 8183.92 percent of total billed charges 10103.6 10103.6 other OPPS APC 10103.6 10103.6 other OPPS APC 10103.6 27.63 2791.62 percent of total billed charges 10103.6 10103.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL EVOLVE STANDARD 8.5MM SS STERILE ELBOW SUP-496S085 CDM 0270 RC outpatient 8312.2 8312.2 8312.2 74 6151.03 percent of total billed charges 8312.2 93 6732.88 percent of total billed charges 8312.2 8312.2 other OPPS APC 8312.2 8312.2 other OPPS APC 8312.2 27.63 2296.66 percent of total billed charges 8312.2 8312.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL EVOLVE PROLINE STANDARD OD9.5 MM ELBOW MODULAR SUP-496S095 CDM 0270 RC outpatient 10387 10387 10387 74 7686.38 percent of total billed charges 10387 93 8413.47 percent of total billed charges 10387 10387 other OPPS APC 10387 10387 other OPPS APC 10387 27.63 2869.93 percent of total billed charges 10387 10387 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL EVOLVE PROLINE +2 MM OD5.5 MM ELBOW MODULAR SUP-496S255 CDM 0270 RC outpatient 9076.6 9076.6 9076.6 74 6716.68 percent of total billed charges 9076.6 93 7352.05 percent of total billed charges 9076.6 9076.6 other OPPS APC 9076.6 9076.6 other OPPS APC 9076.6 27.63 2507.86 percent of total billed charges 9076.6 9076.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL EVOLVE PROLINE +2 MM OD6.5 MM ELBOW MODULAR SUP-496S265 CDM 0270 RC outpatient 9076.6 9076.6 9076.6 74 6716.68 percent of total billed charges 9076.6 93 7352.05 percent of total billed charges 9076.6 9076.6 other OPPS APC 9076.6 9076.6 other OPPS APC 9076.6 27.63 2507.86 percent of total billed charges 9076.6 9076.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL EVOLVE PROLINE +2 MM OD7.5 MM ELBOW MODULAR SUP-496S275 CDM 0270 RC outpatient 10387 10387 10387 74 7686.38 percent of total billed charges 10387 93 8413.47 percent of total billed charges 10387 10387 other OPPS APC 10387 10387 other OPPS APC 10387 27.63 2869.93 percent of total billed charges 10387 10387 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL EVOLVE PROLINE +2 MM OD8.5 MM ELBOW MODULAR SUP-496S285 CDM 0270 RC outpatient 9076.6 9076.6 9076.6 74 6716.68 percent of total billed charges 9076.6 93 7352.05 percent of total billed charges 9076.6 9076.6 other OPPS APC 9076.6 9076.6 other OPPS APC 9076.6 27.63 2507.86 percent of total billed charges 9076.6 9076.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL EVOLVE PROLINE +2 MM OD9.5 MM ELBOW MODULAR SUP-496S295 CDM 0270 RC outpatient 9076.6 9076.6 9076.6 74 6716.68 percent of total billed charges 9076.6 93 7352.05 percent of total billed charges 9076.6 9076.6 other OPPS APC 9076.6 9076.6 other OPPS APC 9076.6 27.63 2507.86 percent of total billed charges 9076.6 9076.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL EVOLVE PROLINE 4+ MM OD5.5 MM ELBOW MODULAR HEAD STERILE SUP-496S455 CDM 0270 RC outpatient 8312.2 8312.2 8312.2 74 6151.03 percent of total billed charges 8312.2 93 6732.88 percent of total billed charges 8312.2 8312.2 other OPPS APC 8312.2 8312.2 other OPPS APC 8312.2 27.63 2296.66 percent of total billed charges 8312.2 8312.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL EVOLVE PROLINE 4+ MM OD6.5 MM ELBOW MODULAR HEAD SUP-496S465 CDM 0270 RC outpatient 9076.6 9076.6 9076.6 74 6716.68 percent of total billed charges 9076.6 93 7352.05 percent of total billed charges 9076.6 9076.6 other OPPS APC 9076.6 9076.6 other OPPS APC 9076.6 27.63 2507.86 percent of total billed charges 9076.6 9076.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL EVOLVE PROLINE +4 MM OD7.5 MM ELBOW HEAD SYSTEM SMOOTH SUP-496S475 CDM 0270 RC outpatient 9531.6 9531.6 9531.6 74 7053.38 percent of total billed charges 9531.6 93 7720.6 percent of total billed charges 9531.6 9531.6 other OPPS APC 9531.6 9531.6 other OPPS APC 9531.6 27.63 2633.58 percent of total billed charges 9531.6 9531.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM RADIAL EVOLVE PROLINE 4+ MM OD8.5 MM ELBOW MODULAR HEAD SUP-496S485 CDM 0270 RC outpatient 9076.6 9076.6 9076.6 74 6716.68 percent of total billed charges 9076.6 93 7352.05 percent of total billed charges 9076.6 9076.6 other OPPS APC 9076.6 9076.6 other OPPS APC 9076.6 27.63 2507.86 percent of total billed charges 9076.6 9076.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL TI-6AL-7NB STRAIGHT L80 MM OD3.5 MM CERVICAL EXTRA HARD SUP-498.12 CDM 270010013 LOCAL 0270 RC outpatient 386.88 386.88 386.88 74 286.29 percent of total billed charges 386.88 93 313.37 percent of total billed charges 386.88 386.88 other OPPS APC 386.88 386.88 other OPPS APC 386.88 27.63 106.89 percent of total billed charges 386.88 386.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL 80MM 3.5MM STRAIGHT CERVICAL TI-6AL-7NB EXTRA HARD NS SUP-498.120 CDM 270010013 LOCAL 0270 RC outpatient 386.88 386.88 386.88 74 286.29 percent of total billed charges 386.88 93 313.37 percent of total billed charges 386.88 386.88 other OPPS APC 386.88 386.88 other OPPS APC 386.88 27.63 106.89 percent of total billed charges 386.88 386.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR ROD USS TITANIUM STRAIGHT L120 MM OD3.5 MM SPINE THORACOLUMBAR POSTERIOR SET UPPER BAR SUP-498.125 CDM 270010013 LOCAL 0270 RC outpatient 544.96 544.96 544.96 74 403.27 percent of total billed charges 544.96 93 441.42 percent of total billed charges 544.96 544.96 other OPPS APC 544.96 544.96 other OPPS APC 544.96 27.63 150.57 percent of total billed charges 544.96 544.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL AXON TITANIUM L40 MM OD3.5 MM CURVED NONSTERILE SUP-498.136 CDM 270010022 LOCAL 0270 RC outpatient 429.52 429.52 429.52 74 317.84 percent of total billed charges 429.52 93 347.91 percent of total billed charges 429.52 429.52 other OPPS APC 429.52 429.52 other OPPS APC 429.52 27.63 118.68 percent of total billed charges 429.52 429.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL AXON TITANIUM CURVE L80 MM OD3.5 MM PREBENT NONSTERILE SUP-498.137 CDM 270010020 LOCAL 0270 RC outpatient 429.52 429.52 429.52 74 317.84 percent of total billed charges 429.52 93 347.91 percent of total billed charges 429.52 429.52 other OPPS APC 429.52 429.52 other OPPS APC 429.52 27.63 118.68 percent of total billed charges 429.52 429.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL AXON CERVIFIX TITANIUM L240 MM OD3.5 MM OCIPITOCERVICOTHORACIC FUSION GOLD SUP-498.957 CDM 270010013 LOCAL 0270 RC outpatient 795.34 795.34 795.34 74 588.55 percent of total billed charges 795.34 93 644.23 percent of total billed charges 795.34 795.34 other OPPS APC 795.34 795.34 other OPPS APC 795.34 27.63 219.75 percent of total billed charges 795.34 795.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ARTERIAL PTFE .028 IN 40 CM MINI L6 IN L2.25 IN OD18 GA ODSEC19 GA RADIOPAQUE FEMALE LUER HUB GUIDEWIRE NEEDLE SUP-498105 CDM 270009171 LOCAL 0270 RC outpatient 29.86 29.86 29.86 74 22.1 percent of total billed charges 29.86 93 24.19 percent of total billed charges 29.86 29.86 other OPPS APC 29.86 29.86 other OPPS APC 29.86 27.63 8.25 percent of total billed charges 29.86 29.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING SILVER POST OP MEPILEX 10 X 25 CM (4 X 10 INCH) SUP-498450 CDM 0270 RC outpatient 66.87 66.87 66.87 74 49.48 percent of total billed charges 66.87 93 54.16 percent of total billed charges 66.87 66.87 other OPPS APC 66.87 66.87 other OPPS APC 66.87 27.63 18.48 percent of total billed charges 66.87 66.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING SILVER POST OP MEPILEX 10 X 30 CM (4 X 12 INCH) SUP-498600 CDM 0270 RC outpatient 76.4 76.4 76.4 74 56.54 percent of total billed charges 76.4 93 61.88 percent of total billed charges 76.4 76.4 other OPPS APC 76.4 76.4 other OPPS APC 76.4 27.63 21.11 percent of total billed charges 76.4 76.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OPSITE DRESSING LG SUP-4988 CDM 270009208 LOCAL 0270 RC outpatient 47.89 47.89 47.89 74 35.44 percent of total billed charges 47.89 93 38.79 percent of total billed charges 47.89 47.89 other OPPS APC 47.89 47.89 other OPPS APC 47.89 27.63 13.23 percent of total billed charges 47.89 47.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HANDPIECE TRIPOLAR TRIGGER-FLEX SUP-49936921 CDM 0270 RC outpatient 1417 1417 1417 74 1048.58 percent of total billed charges 1417 93 1147.77 percent of total billed charges 1417 1417 other OPPS APC 1417 1417 other OPPS APC 1417 27.63 391.52 percent of total billed charges 1417 1417 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA INNER SHILEY PVC 4 OD15 MM SNAP LOCK CONNECTOR STERILE LATEX FREE DISPOSABLE 4DCT 4DFEN SUP-4DIC CDM 0270 RC outpatient 10.18 10.18 10.18 74 7.53 percent of total billed charges 10.18 93 8.25 percent of total billed charges 10.18 10.18 other OPPS APC 10.18 10.18 other OPPS APC 10.18 27.63 2.81 percent of total billed charges 10.18 10.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER FLEXCATH PEBAX BARIUM SULFATE 135 D L65 CM L81 CM OD15 FR ID12 FR STERRABLE ARCTIC FRONT ADVANCE CRYOBALLOON ACHIEVE MAPPING CATHETER DILATOR RADIOPAQUE MARKER STERILE REUSABLE SUP-4FC12 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINE MONITOR SALTERSTAT L13 FT ETCO2 SAMPLE REFLECTIVE CONNECTOR FILTER CAPNOGRAPHY ORANGE SERIES SUP-4MSF8-13-25 CDM 0270 RC outpatient 10.77 10.77 10.77 74 7.97 percent of total billed charges 10.77 93 8.72 percent of total billed charges 10.77 10.77 other OPPS APC 10.77 10.77 other OPPS APC 10.77 27.63 2.98 percent of total billed charges 10.77 10.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE GORE-TEX CV-4 TH-18 L36 IN 2 ARM MONOFILAMENT WHITE SUP-4N02A CDM 0270 RC outpatient 86.45 86.45 86.45 74 63.97 percent of total billed charges 86.45 93 70.02 percent of total billed charges 86.45 86.45 other OPPS APC 86.45 86.45 other OPPS APC 86.45 27.63 23.89 percent of total billed charges 86.45 86.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE LARYNGOSCOPE MACINTOSH GREENLINE D STAINLESS STEEL ACRYLIC PEDIATRIC 2 L100 MM POLISH STEM FIBER OPTIC STERILE DISPOSABLE SUP-5-5332-02 CDM outpatient 8.4 8.4 8.4 8.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE LARYNGOSCOPE GREENLINE D MACINTOSH STAINLESS STEEL ACRYLIC ADULT 3 MEDIUM L130 MM X H22 MM FIBER OPTIC POLISH STEM STERILE LATEX FREE DISPOSABLE SUP-5-5332-03 CDM outpatient 8.4 8.4 8.4 8.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE LARYNGOSCOPE GREENLINE D MACINTOSH STAINLESS STEEL ACRYLIC ADULT 4 LARGE L155 MM X H25 MM FIBER OPTIC POLISH STEM STERILE LATEX FREE DISPOSABLE SUP-5-5332-04 CDM 0270 RC outpatient 8.4 8.4 8.4 74 6.22 percent of total billed charges 8.4 93 6.8 percent of total billed charges 8.4 8.4 other OPPS APC 8.4 8.4 other OPPS APC 8.4 27.63 2.32 percent of total billed charges 8.4 8.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE LARYNGOSCOPE GREENLINE D MILLER STAINLESS STEEL ACRYLIC NEONATE 0 L77 MM X H10 MM FIBER OPTIC POLISH STEM STERILE LATEX FREE DISPOSABLE SUP-5-5333-00 CDM 0270 RC outpatient 8.4 8.4 8.4 74 6.22 percent of total billed charges 8.4 93 6.8 percent of total billed charges 8.4 8.4 other OPPS APC 8.4 8.4 other OPPS APC 8.4 27.63 2.32 percent of total billed charges 8.4 8.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE LARYNGOSCOPE GREENLINE D MILLER STAINLESS STEEL ACRYLIC INFANT 1 L102 MM X H10 MM FIBER OPTIC POLISH STEM STERILE LATEX FREE DISPOSABLE SUP-5-5333-01 CDM 0270 RC outpatient 8.4 8.4 8.4 74 6.22 percent of total billed charges 8.4 93 6.8 percent of total billed charges 8.4 8.4 other OPPS APC 8.4 8.4 other OPPS APC 8.4 27.63 2.32 percent of total billed charges 8.4 8.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE LARYNGOSCOPE GREENLINE D MILLER STAINLESS STEEL ACRYLIC PEDIATRIC 2 L153 MM X H12 MM FIBER OPTIC POLISH STEM STERILE LATEX FREE DISPOSABLE SUP-5-5333-02 CDM outpatient 8.4 8.4 8.4 8.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE LARYNGOSCOPE GREENLINE D MILLER STAINLESS STEEL ACRYLIC ADULT 3 MEDIUM L195 MM X H14 MM FIBER OPTIC POLISH STEM STERILE LATEX FREE DISPOSABLE SUP-5-5333-03 CDM 0270 RC outpatient 13.28 13.28 13.28 74 9.83 percent of total billed charges 13.28 93 10.76 percent of total billed charges 13.28 13.28 other OPPS APC 13.28 13.28 other OPPS APC 13.28 27.63 3.67 percent of total billed charges 13.28 13.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE LARYNGOSCOPE GREENLINE D MILLER STAINLESS STEEL ACRYLIC ADULT 4 LARGE L205 MM X H18 MM FIBER OPTIC POLISH STEM STERILE LATEX FREE DISPOSABLE SUP-5-5333-04 CDM 0270 RC outpatient 8.4 8.4 8.4 74 6.22 percent of total billed charges 8.4 93 6.8 percent of total billed charges 8.4 8.4 other OPPS APC 8.4 8.4 other OPPS APC 8.4 27.63 2.32 percent of total billed charges 8.4 8.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE LARYNGOSCOPE GREENLINE D MILLER STAINLESS STEEL ACRYLIC NEONATE 00 L67 MM X H10 MM FIBER OPTIC POLISH STEM STERILE LATEX FREE DISPOSABLE SUP-5-5333-20 CDM outpatient 8.4 8.4 8.4 8.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ULTRASOUND SHEATHES3D CONTOUR CURVE L48 IN X W6 IN PROBE COVER GEL 2 ELASTIC STERILE LATEX FREE SUP-5-IH486 KIT CDM 0270 RC outpatient 20.83 20.83 20.83 74 15.41 percent of total billed charges 20.83 93 16.87 percent of total billed charges 20.83 20.83 other OPPS APC 20.83 20.83 other OPPS APC 20.83 27.63 5.76 percent of total billed charges 20.83 20.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DRAINAGE PLEURX 1000 ML STARTER CATHETER SUP-50-0071 CDM 0270 RC outpatient 819 819 819 74 606.06 percent of total billed charges 819 93 663.39 percent of total billed charges 819 819 other OPPS APC 819 819 other OPPS APC 819 27.63 226.29 percent of total billed charges 819 819 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP LOCKING SIERRA SUP-50-1000 CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH CLOTTRIEVER 13 FR 15 CM SUP-50-101 CDM 0270 RC outpatient 7800 7800 7800 74 5772 percent of total billed charges 7800 93 6318 percent of total billed charges 7800 7800 other OPPS APC 7800 7800 other OPPS APC 7800 27.63 2155.14 percent of total billed charges 7800 7800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BATTERY SURGICAL DRIVER POWER DRIVER STERNALOCK 1.5 MM RAPIDFIRE TECHNOLOGY SUP-50-1010 CDM 0270 RC outpatient 353.6 353.6 353.6 74 261.66 percent of total billed charges 353.6 93 286.42 percent of total billed charges 353.6 353.6 other OPPS APC 353.6 353.6 other OPPS APC 353.6 27.63 97.7 percent of total billed charges 353.6 353.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTRODUCER GLIDESHEATH SLENDER NITINOL L10 CM OD5 FR RADIAL SUP-50-1050 CDM 0270 RC outpatient 175.5 175.5 175.5 74 129.87 percent of total billed charges 175.5 93 142.16 percent of total billed charges 175.5 175.5 other OPPS APC 175.5 175.5 other OPPS APC 175.5 27.63 48.49 percent of total billed charges 175.5 175.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTRODUCER GLIDESHEATH SLENDER NITINOL L10 CM OD6 FR RADIAL SUP-50-1060 CDM 0270 RC outpatient 175.5 175.5 175.5 74 129.87 percent of total billed charges 175.5 93 142.16 percent of total billed charges 175.5 175.5 other OPPS APC 175.5 175.5 other OPPS APC 175.5 27.63 48.49 percent of total billed charges 175.5 175.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTRODUCER GLIDESHEATH SLENDER TERUMO GLIDE TECHNOLOGY NITINOL L10 CM OD7 FR SUP-50-1070 CDM 0270 RC outpatient 175.5 175.5 175.5 74 129.87 percent of total billed charges 175.5 93 142.16 percent of total billed charges 175.5 175.5 other OPPS APC 175.5 175.5 other OPPS APC 175.5 27.63 48.49 percent of total billed charges 175.5 175.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 4MM 1.7MM NS SELF TAP CROSS PIN EMERGENCY SUP-50-17304 CDM 0270 RC outpatient 36.41 36.41 36.41 74 26.94 percent of total billed charges 36.41 93 29.49 percent of total billed charges 36.41 36.41 other OPPS APC 36.41 36.41 other OPPS APC 36.41 27.63 10.06 percent of total billed charges 36.41 36.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCR/MMF 8MM SUP-50-20358 CDM 0270 RC outpatient 81.32 81.32 81.32 74 60.18 percent of total billed charges 81.32 93 65.87 percent of total billed charges 81.32 81.32 other OPPS APC 81.32 81.32 other OPPS APC 81.32 27.63 22.47 percent of total billed charges 81.32 81.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCR/MMF 12MM SUP-50-20362 CDM 0270 RC outpatient 81.32 81.32 81.32 74 60.18 percent of total billed charges 81.32 93 65.87 percent of total billed charges 81.32 81.32 other OPPS APC 81.32 81.32 other OPPS APC 81.32 27.63 22.47 percent of total billed charges 81.32 81.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2MM 4 MM CROSS-PIN HEAD TITANIUM SELF-TAPPING GOLD F/FIXATION MODULE MANDIBULAR NON-STERILE SUP-50-20404 CDM 0270 RC outpatient 136.01 136.01 136.01 74 100.65 percent of total billed charges 136.01 93 110.17 percent of total billed charges 136.01 136.01 other OPPS APC 136.01 136.01 other OPPS APC 136.01 27.63 37.58 percent of total billed charges 136.01 136.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2MM 5 MM CROSS-PIN HEAD TITANIUM SELF-TAPPING GOLD F/FIXATION MODULE MANDIBULAR NON-STERILE SUP-50-20405 CDM 0270 RC outpatient 136.01 136.01 136.01 74 100.65 percent of total billed charges 136.01 93 110.17 percent of total billed charges 136.01 136.01 other OPPS APC 136.01 136.01 other OPPS APC 136.01 27.63 37.58 percent of total billed charges 136.01 136.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2MM 6 MM CROSS-PIN HEAD TITANIUM SELF-TAPPING GOLD F/FIXATION MODULE MANDIBULAR NON-STERILE SUP-50-20406 CDM 0270 RC outpatient 136.01 136.01 136.01 74 100.65 percent of total billed charges 136.01 93 110.17 percent of total billed charges 136.01 136.01 other OPPS APC 136.01 136.01 other OPPS APC 136.01 27.63 37.58 percent of total billed charges 136.01 136.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2MM 8 MM CROSS-PIN HEAD TITANIUM SELF-TAPPING GOLD F/FIXATION MODULE MANDIBULAR NON-STERILE SUP-50-20408 CDM 0270 RC outpatient 136.01 136.01 136.01 74 100.65 percent of total billed charges 136.01 93 110.17 percent of total billed charges 136.01 136.01 other OPPS APC 136.01 136.01 other OPPS APC 136.01 27.63 37.58 percent of total billed charges 136.01 136.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2MM 10 MM CROSS-PIN HEAD TITANIUM SELF-TAPPING GOLD F/FIXATION MODULE MANDIBULAR NON-STERILE SUP-50-20410 CDM 0270 RC outpatient 136.01 136.01 136.01 74 100.65 percent of total billed charges 136.01 93 110.17 percent of total billed charges 136.01 136.01 other OPPS APC 136.01 136.01 other OPPS APC 136.01 27.63 37.58 percent of total billed charges 136.01 136.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2MM 12 MM CROSS-PIN HEAD TITANIUM SELF-TAPPING GOLD F/FIXATION MODULE MANDIBULAR NON-STERILE SUP-50-20412 CDM 0270 RC outpatient 136.01 136.01 136.01 74 100.65 percent of total billed charges 136.01 93 110.17 percent of total billed charges 136.01 136.01 other OPPS APC 136.01 136.01 other OPPS APC 136.01 27.63 37.58 percent of total billed charges 136.01 136.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2MM 14 MM CROSS-PIN HEAD TITANIUM SELF-TAPPING GOLD F/FIXATION MODULE MANDIBULAR NON-STERILE SUP-50-20414 CDM 0270 RC outpatient 136.01 136.01 136.01 74 100.65 percent of total billed charges 136.01 93 110.17 percent of total billed charges 136.01 136.01 other OPPS APC 136.01 136.01 other OPPS APC 136.01 27.63 37.58 percent of total billed charges 136.01 136.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2MM 16 MM CROSS-PIN HEAD TITANIUM SELF-TAPPING GOLD F/FIXATION MODULE MANDIBULAR NON-STERILE SUP-50-20416 CDM 0270 RC outpatient 136.01 136.01 136.01 74 100.65 percent of total billed charges 136.01 93 110.17 percent of total billed charges 136.01 136.01 other OPPS APC 136.01 136.01 other OPPS APC 136.01 27.63 37.58 percent of total billed charges 136.01 136.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2MM 4MM CROSS-PIN HEAD LOCKING TITANIUM SELF-TAPPING GRAY F/FIXATION MODULE MANDIBULAR NON-STERILE SUP-50-20504 CDM 0270 RC outpatient 249.26 249.26 249.26 74 184.45 percent of total billed charges 249.26 93 201.9 percent of total billed charges 249.26 249.26 other OPPS APC 249.26 249.26 other OPPS APC 249.26 27.63 68.87 percent of total billed charges 249.26 249.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2MM 5MM CROSS-PIN HEAD LOCKING TITANIUM SELF-TAPPING GRAY F/FIXATION MODULE MANDIBULAR NON-STERILE SUP-50-20505 CDM 0270 RC outpatient 249.29 249.29 249.29 74 184.47 percent of total billed charges 249.29 93 201.92 percent of total billed charges 249.29 249.29 other OPPS APC 249.29 249.29 other OPPS APC 249.29 27.63 68.88 percent of total billed charges 249.29 249.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2MM 6MM CROSS-PIN HEAD LOCKING TITANIUM SELF-TAPPING GRAY F/FIXATION MODULE MANDIBULAR NON-STERILE SUP-50-20506 CDM 0270 RC outpatient 249.26 249.26 249.26 74 184.45 percent of total billed charges 249.26 93 201.9 percent of total billed charges 249.26 249.26 other OPPS APC 249.26 249.26 other OPPS APC 249.26 27.63 68.87 percent of total billed charges 249.26 249.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2MM 8MM CROSS-PIN HEAD LOCKING TITANIUM SELF-TAPPING GRAY F/FIXATION MODULE MANDIBULAR NON-STERILE SUP-50-20508 CDM 0270 RC outpatient 249.26 249.26 249.26 74 184.45 percent of total billed charges 249.26 93 201.9 percent of total billed charges 249.26 249.26 other OPPS APC 249.26 249.26 other OPPS APC 249.26 27.63 68.87 percent of total billed charges 249.26 249.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2MM 10MM CROSS-PIN HEAD LOCKING TITANIUM SELF-TAPPING GRAY F/FIXATION MODULE MANDIBULAR NON-STERILE SUP-50-20510 CDM 0270 RC outpatient 249.26 249.26 249.26 74 184.45 percent of total billed charges 249.26 93 201.9 percent of total billed charges 249.26 249.26 other OPPS APC 249.26 249.26 other OPPS APC 249.26 27.63 68.87 percent of total billed charges 249.26 249.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2MM 12MM CROSS-PIN HEAD LOCKING TITANIUM SELF-TAPPING GRAY F/FIXATION MODULE MANDIBULAR NON-STERILE SUP-50-20512 CDM 0270 RC outpatient 249.26 249.26 249.26 74 184.45 percent of total billed charges 249.26 93 201.9 percent of total billed charges 249.26 249.26 other OPPS APC 249.26 249.26 other OPPS APC 249.26 27.63 68.87 percent of total billed charges 249.26 249.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2MM 14MM CROSS-PIN HEAD LOCKING TITANIUM SELF-TAPPING GRAY F/FIXATION MODULE MANDIBULAR NON-STERILE SUP-50-20514 CDM 0270 RC outpatient 249.26 249.26 249.26 74 184.45 percent of total billed charges 249.26 93 201.9 percent of total billed charges 249.26 249.26 other OPPS APC 249.26 249.26 other OPPS APC 249.26 27.63 68.87 percent of total billed charges 249.26 249.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2MM 16MM CROSS-PIN HEAD LOCKING TITANIUM SELF-TAPPING GRAY F/FIXATION MODULE MANDIBULAR NON-STERILE SUP-50-20516 CDM 0270 RC outpatient 249.26 249.26 249.26 74 184.45 percent of total billed charges 249.26 93 201.9 percent of total billed charges 249.26 249.26 other OPPS APC 249.26 249.26 other OPPS APC 249.26 27.63 68.87 percent of total billed charges 249.26 249.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMARTLOCK HMMF SCR/2.0X6MM SUP-50-20596 CDM 0270 RC outpatient 378.14 378.14 378.14 74 279.82 percent of total billed charges 378.14 93 306.29 percent of total billed charges 378.14 378.14 other OPPS APC 378.14 378.14 other OPPS APC 378.14 27.63 104.48 percent of total billed charges 378.14 378.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMARTLOCK HMMF SCR/2.0X8MM SUP-50-20598 CDM 0270 RC outpatient 378.14 378.14 378.14 74 279.82 percent of total billed charges 378.14 93 306.29 percent of total billed charges 378.14 378.14 other OPPS APC 378.14 378.14 other OPPS APC 378.14 27.63 104.48 percent of total billed charges 378.14 378.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2.3MM 4MM CROSS-PIN HEAD TITANIUM SELF-TAPPING GOLD F/FIXATION MODULE MAXILLOMANDIBULAR NON-STERILE SUP-50-23404 CDM 0270 RC outpatient 166.22 166.22 166.22 74 123 percent of total billed charges 166.22 93 134.64 percent of total billed charges 166.22 166.22 other OPPS APC 166.22 166.22 other OPPS APC 166.22 27.63 45.93 percent of total billed charges 166.22 166.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2.3MM 6MM CROSS-PIN HEAD TITANIUM SELF-TAPPING GOLD F/FIXATION MODULE MAXILLOMANDIBULAR NON-STERILE SUP-50-23406 CDM 0270 RC outpatient 166.22 166.22 166.22 74 123 percent of total billed charges 166.22 93 134.64 percent of total billed charges 166.22 166.22 other OPPS APC 166.22 166.22 other OPPS APC 166.22 27.63 45.93 percent of total billed charges 166.22 166.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2.3MM 8MM CROSS-PIN HEAD TITANIUM SELF-TAPPING GOLD F/FIXATION MODULE MAXILLOMANDIBULAR NON-STERILE SUP-50-23408 CDM 0270 RC outpatient 166.22 166.22 166.22 74 123 percent of total billed charges 166.22 93 134.64 percent of total billed charges 166.22 166.22 other OPPS APC 166.22 166.22 other OPPS APC 166.22 27.63 45.93 percent of total billed charges 166.22 166.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2.3MM 10MM CROSS-PIN HEAD TITANIUM SELF-TAPPING GOLD F/FIXATION MODULE MAXILLOMANDIBULAR NON-STERILE SUP-50-23410 CDM 0270 RC outpatient 166.22 166.22 166.22 74 123 percent of total billed charges 166.22 93 134.64 percent of total billed charges 166.22 166.22 other OPPS APC 166.22 166.22 other OPPS APC 166.22 27.63 45.93 percent of total billed charges 166.22 166.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2.3MM 12MM CROSS-PIN HEAD TITANIUM SELF-TAPPING GOLD F/FIXATION MODULE MAXILLOMANDIBULAR NON-STERILE SUP-50-23412 CDM 0270 RC outpatient 166.22 166.22 166.22 74 123 percent of total billed charges 166.22 93 134.64 percent of total billed charges 166.22 166.22 other OPPS APC 166.22 166.22 other OPPS APC 166.22 27.63 45.93 percent of total billed charges 166.22 166.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2.3MM 14MM CROSS-PIN HEAD TITANIUM SELF-TAPPING GOLD F/FIXATION MODULE MAXILLOMANDIBULAR NON-STERILE SUP-50-23414 CDM 0270 RC outpatient 166.22 166.22 166.22 74 123 percent of total billed charges 166.22 93 134.64 percent of total billed charges 166.22 166.22 other OPPS APC 166.22 166.22 other OPPS APC 166.22 27.63 45.93 percent of total billed charges 166.22 166.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2.3MM 16MM CROSS-PIN HEAD TITANIUM SELF-TAPPING GOLD F/FIXATION MODULE MAXILLOMANDIBULAR NON-STERILE SUP-50-23416 CDM 0270 RC outpatient 166.22 166.22 166.22 74 123 percent of total billed charges 166.22 93 134.64 percent of total billed charges 166.22 166.22 other OPPS APC 166.22 166.22 other OPPS APC 166.22 27.63 45.93 percent of total billed charges 166.22 166.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCR/2.3X4MM LCKNG CROSS PIN SUP-50-23504 CDM 0270 RC outpatient 57.49 57.49 57.49 74 42.54 percent of total billed charges 57.49 93 46.57 percent of total billed charges 57.49 57.49 other OPPS APC 57.49 57.49 other OPPS APC 57.49 27.63 15.88 percent of total billed charges 57.49 57.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCR/2.3X6MM LCKNG CROSS PIN SUP-50-23506 CDM 0270 RC outpatient 57.49 57.49 57.49 74 42.54 percent of total billed charges 57.49 93 46.57 percent of total billed charges 57.49 57.49 other OPPS APC 57.49 57.49 other OPPS APC 57.49 27.63 15.88 percent of total billed charges 57.49 57.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCR/2.3X8MM LCKNG CROSS PIN SUP-50-23508 CDM 0270 RC outpatient 57.49 57.49 57.49 74 42.54 percent of total billed charges 57.49 93 46.57 percent of total billed charges 57.49 57.49 other OPPS APC 57.49 57.49 other OPPS APC 57.49 27.63 15.88 percent of total billed charges 57.49 57.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCR/2.3X10MM LCKNG CROSS PIN SUP-50-23510 CDM 0270 RC outpatient 57.49 57.49 57.49 74 42.54 percent of total billed charges 57.49 93 46.57 percent of total billed charges 57.49 57.49 other OPPS APC 57.49 57.49 other OPPS APC 57.49 27.63 15.88 percent of total billed charges 57.49 57.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCR/2.3X12MM LCKNG CROSS PIN SUP-50-23512 CDM 0270 RC outpatient 57.49 57.49 57.49 74 42.54 percent of total billed charges 57.49 93 46.57 percent of total billed charges 57.49 57.49 other OPPS APC 57.49 57.49 other OPPS APC 57.49 27.63 15.88 percent of total billed charges 57.49 57.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCR/2.3X14MM LCKNG CROSS PIN SUP-50-23514 CDM 0270 RC outpatient 57.49 57.49 57.49 74 42.54 percent of total billed charges 57.49 93 46.57 percent of total billed charges 57.49 57.49 other OPPS APC 57.49 57.49 other OPPS APC 57.49 27.63 15.88 percent of total billed charges 57.49 57.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCR/2.3X16MM LCKNG CROSS PIN SUP-50-23516 CDM 0270 RC outpatient 57.49 57.49 57.49 74 42.54 percent of total billed charges 57.49 93 46.57 percent of total billed charges 57.49 57.49 other OPPS APC 57.49 57.49 other OPPS APC 57.49 27.63 15.88 percent of total billed charges 57.49 57.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2.7MM 5MM CROSS-PIN HEAD EMERGENCY TITANIUM SELF-TAPPING GOLD MANDIBULAR NON-STERILE SUP-50-27405 CDM 0270 RC outpatient 188.29 188.29 188.29 74 139.33 percent of total billed charges 188.29 93 152.51 percent of total billed charges 188.29 188.29 other OPPS APC 188.29 188.29 other OPPS APC 188.29 27.63 52.02 percent of total billed charges 188.29 188.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2.7MM 8MM CROSS-PIN HEAD EMERGENCY TITANIUM SELF-TAPPING GOLD MANDIBULAR NON-STERILE SUP-50-27408 CDM 0270 RC outpatient 188.29 188.29 188.29 74 139.33 percent of total billed charges 188.29 93 152.51 percent of total billed charges 188.29 188.29 other OPPS APC 188.29 188.29 other OPPS APC 188.29 27.63 52.02 percent of total billed charges 188.29 188.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2.7MM 10MM CROSS-PIN HEAD EMERGENCY TITANIUM SELF-TAPPING GOLD MANDIBULAR NON-STERILE SUP-50-27410 CDM 0270 RC outpatient 188.29 188.29 188.29 74 139.33 percent of total billed charges 188.29 93 152.51 percent of total billed charges 188.29 188.29 other OPPS APC 188.29 188.29 other OPPS APC 188.29 27.63 52.02 percent of total billed charges 188.29 188.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERSAL NEURO 2 2.7MM 12MM CROSS-PIN HEAD EMERGENCY TITANIUM SELF-TAPPING GOLD MANDIBULAR NON-STERILE SUP-50-27412 CDM 0270 RC outpatient 188.29 188.29 188.29 74 139.33 percent of total billed charges 188.29 93 152.51 percent of total billed charges 188.29 188.29 other OPPS APC 188.29 188.29 other OPPS APC 188.29 27.63 52.02 percent of total billed charges 188.29 188.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCR/2.7X5MM ER LCKNG CRS PIN SUP-50-27505 CDM 0270 RC outpatient 64.11 64.11 64.11 74 47.44 percent of total billed charges 64.11 93 51.93 percent of total billed charges 64.11 64.11 other OPPS APC 64.11 64.11 other OPPS APC 64.11 27.63 17.71 percent of total billed charges 64.11 64.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCR/2.7X8MM ER LCKNG CRS PIN SUP-50-27508 CDM 0270 RC outpatient 64.11 64.11 64.11 74 47.44 percent of total billed charges 64.11 93 51.93 percent of total billed charges 64.11 64.11 other OPPS APC 64.11 64.11 other OPPS APC 64.11 27.63 17.71 percent of total billed charges 64.11 64.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCR/2.7X10MM ER LCKNG CRS PIN SUP-50-27510 CDM 0270 RC outpatient 320.53 320.53 320.53 74 237.19 percent of total billed charges 320.53 93 259.63 percent of total billed charges 320.53 320.53 other OPPS APC 320.53 320.53 other OPPS APC 320.53 27.63 88.56 percent of total billed charges 320.53 320.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCR/2.7X12MM ER LCKNG CRS PN SUP-50-27512 CDM 0270 RC outpatient 64.11 64.11 64.11 74 47.44 percent of total billed charges 64.11 93 51.93 percent of total billed charges 64.11 64.11 other OPPS APC 64.11 64.11 other OPPS APC 64.11 27.63 17.71 percent of total billed charges 64.11 64.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCR/2.7X14MM ER LCKNG CRS PN SUP-50-27514 CDM 0270 RC outpatient 64.11 64.11 64.11 74 47.44 percent of total billed charges 64.11 93 51.93 percent of total billed charges 64.11 64.11 other OPPS APC 64.11 64.11 other OPPS APC 64.11 27.63 17.71 percent of total billed charges 64.11 64.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCR/2.7X16MM ER LCKNG CRS PN SUP-50-27516 CDM 0270 RC outpatient 64.11 64.11 64.11 74 47.44 percent of total billed charges 64.11 93 51.93 percent of total billed charges 64.11 64.11 other OPPS APC 64.11 64.11 other OPPS APC 64.11 27.63 17.71 percent of total billed charges 64.11 64.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SIERRA L12 MM OD3.5 MM SPINE OCCIPITOCERVICOTHORACIC CANNULATED LATEX FREE SUP-50-3512 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE RETRACTOR BOOKWALTER 6X3IN SS MALLEABLE SUP-50-4567 CDM outpatient 1145.9 1145.9 1145.9 1145.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SIERRA PRECONTOUR L60 MM OD3.5 MM POSTERIOR CERVICAL SPINE LASER MARKED SUP-50-6160 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PLEURX SUP-50-70000B CDM 0270 RC outpatient 1495 1495 1495 74 1106.3 percent of total billed charges 1495 93 1210.95 percent of total billed charges 1495 1495 other OPPS APC 1495 1495 other OPPS APC 1495 27.63 413.07 percent of total billed charges 1495 1495 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DRAINAGE PLEURX POLYESTER OD15.5 FR PLEURAL CATHETER ACTIVE VACCUM TECHNOLOGY PROPRIETARY SAFETY VALVE CUFF STERILE DISPOSABLE SUP-50-7000B CDM 0270 RC outpatient 1757.6 1757.6 1757.6 74 1300.62 percent of total billed charges 1757.6 93 1423.66 percent of total billed charges 1757.6 1757.6 other OPPS APC 1757.6 1757.6 other OPPS APC 1757.6 27.63 485.62 percent of total billed charges 1757.6 1757.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP DRAINAGE PLEURX THORACIC VALVE CAP KIT LATEX FREE DISPOSABLE PLEURAL EFFUSION SUP-50-7235 CDM 0270 RC outpatient 37.69 37.69 37.69 74 27.89 percent of total billed charges 37.69 93 30.53 percent of total billed charges 37.69 37.69 other OPPS APC 37.69 37.69 other OPPS APC 37.69 27.63 10.41 percent of total billed charges 37.69 37.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET DRAINAGE PLEURX PERITONEUM LINE LOCKABLE STERILE LATEX FREE DISPOSABLE CATHETER SYSTEM SUP-50-7245 CDM 0270 RC outpatient 45.34 45.34 45.34 74 33.55 percent of total billed charges 45.34 93 36.73 percent of total billed charges 45.34 45.34 other OPPS APC 45.34 45.34 other OPPS APC 45.34 27.63 12.53 percent of total billed charges 45.34 45.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DRAINAGE PLEURX ALCOHOL PLASTIC GAUZE FOAM L4 IN X W4 IN 1000 ML THORACIC CATHETER VACUUM BOTTLE SELF ADHESIVE DRESSING VALVE CAP STERILE LATEX FREE DISPOSABLE BLUE PLEURAL EFFUSION SUP-50-7510 CDM 0270 RC outpatient 250.43 250.43 250.43 74 185.32 percent of total billed charges 250.43 93 202.85 percent of total billed charges 250.43 250.43 other OPPS APC 250.43 250.43 other OPPS APC 250.43 27.63 69.19 percent of total billed charges 250.43 250.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK BATTERY STERILE LATEX FREE DISPOSABLE SUP-50-800-02-71 CDM 0270 RC outpatient 212.16 212.16 212.16 74 157 percent of total billed charges 212.16 93 171.85 percent of total billed charges 212.16 212.16 other OPPS APC 212.16 212.16 other OPPS APC 212.16 27.63 58.62 percent of total billed charges 212.16 212.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR FATHOM L300 CM L10 CM OD.014 IN PERIPHERAL STEERABLE PRESHAPED EMBOLIZATION SUP-50-814 CDM 0270 RC outpatient 628.86 628.86 628.86 74 465.36 percent of total billed charges 628.86 93 509.38 percent of total billed charges 628.86 628.86 other OPPS APC 628.86 628.86 other OPPS APC 628.86 27.63 173.75 percent of total billed charges 628.86 628.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR FATHOM L300 CM L10 CM OD.014 IN PERIPHERAL STEERABLE PRESHAPED EMBOLIZATION SUP-50-815 CDM 0270 RC outpatient 901.68 901.68 901.68 74 667.24 percent of total billed charges 901.68 93 730.36 percent of total billed charges 901.68 901.68 other OPPS APC 901.68 901.68 other OPPS APC 901.68 27.63 249.13 percent of total billed charges 901.68 901.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH LASER L43 CM OD16.4 FR ID13 FR OUTER SUP-500-001 CDM 0481 RC outpatient 7904 7904 7904 74 5848.96 percent of total billed charges 7904 93 6402.24 percent of total billed charges 7904 7904 other OPPS APC 7904 7904 other OPPS APC 7904 51 4031.04 percent of total billed charges 7904 7904 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH LASER SLS II TEFLON 15 D 25-40HZ BEVEL L50 CM OD14 FR ODSEC9.5 FR FISH TAPE LUBRICIOUS STERILE DISPOSABLE SUP-500-012 CDM 0481 RC outpatient 7904 7904 7904 74 5848.96 percent of total billed charges 7904 93 6402.24 percent of total billed charges 7904 7904 other OPPS APC 7904 7904 other OPPS APC 7904 51 4031.04 percent of total billed charges 7904 7904 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH LEAD SLS II TEFLON 25-40HZ L50 CM OD16 FR BELEVED END SUP-500-013 CDM 0481 RC outpatient 7904 7904 7904 74 5848.96 percent of total billed charges 7904 93 6402.24 percent of total billed charges 7904 7904 other OPPS APC 7904 7904 other OPPS APC 7904 51 4031.04 percent of total billed charges 7904 7904 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SHELL STRYKER TRITANIUM SOLID 48MM SUP-500-03-48C CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRITANIUM D HEMISPHERICAL OD50 MM HIP SOLID BACK SUP-500-03-50D CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRITANIUM D HEMISPHERICAL OD52 MM HIP SOLID BACK SUP-500-03-52D CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRITANIUM E HEMISPHERICAL OD54 MM SOLID BACK PRIMARY SUP-500-03-54E CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRITANIUM E HEMISPHERICAL OD56 MM SOLID BACK PRIMARY SUP-500-03-56E CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRITANIUM F HEMISPHERICAL OD58 MM SOLID BACK PRIMARY SUP-500-03-58F CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SHELL STRYKER TRITANIUM SOLID 60MM SUP-500-03-60F CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SHELL STRYKER TRITANIUM SOLID 62MM SUP-500-03-62G CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT METAL HA D HEMISPHERICAL OD50 MM HIP SOLID BACK SUP-500-11-50D CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT METAL HA E HEMISPHERICAL OD52 MM HIP SOLID BACK SUP-500-11-52E CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT METAL HA E HEMISPHERICAL OD54 MM HIP SOLID BACK SUP-500-11-54E CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT METAL HA F HEMISPHERICAL OD56 MM HIP SOLID BACK SUP-500-11-56F CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT METAL HA F HEMISPHERICAL OD58 MM HIP SOLID BACK SUP-500-11-58F CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT METAL HA G HEMISPHERICAL OD60 MM HIP SOLID BACK SUP-500-11-60G CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH LASER GUIDELIGHT 25-80 HZ L 50 CM OD 12 FR ODSEC7.5 FR ID8.3FRIDSEC12.5FR KIT SUP-500-301 CDM 0481 RC outpatient 8567 8567 8567 74 6339.58 percent of total billed charges 8567 93 6939.27 percent of total billed charges 8567 8567 other OPPS APC 8567 8567 other OPPS APC 8567 51 4369.17 percent of total billed charges 8567 8567 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH LASER GUIDELIGHT 25-80 HZ L 50 CM OD 14FR ODSEC9.5 FR ID10.2FR IDSEC14.7FR KIT SUP-500-302 CDM 0481 RC outpatient 8567 8567 8567 74 6339.58 percent of total billed charges 8567 93 6939.27 percent of total billed charges 8567 8567 other OPPS APC 8567 8567 other OPPS APC 8567 51 4369.17 percent of total billed charges 8567 8567 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH LASER GUIDELIGHT 25-80 HZ L 50 CM OD 16FR ODSEC11.5 FR ID12.5 FR IDSEC17.2FR KIT SUP-500-303 CDM 0481 RC outpatient 8567 8567 8567 74 6339.58 percent of total billed charges 8567 93 6939.27 percent of total billed charges 8567 8567 other OPPS APC 8567 8567 other OPPS APC 8567 51 4369.17 percent of total billed charges 8567 8567 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE DRUG DELIVERY EKOSONIC MACH 4 106CM 18CM 5.4FR ENDOVASCULAR INFUSION CATHETER ULTRASONIC CORE TREATMENT ZONE SUP-500-55118 CDM 0270 RC outpatient 7787 7787 7787 74 5762.38 percent of total billed charges 7787 93 6307.47 percent of total billed charges 7787 7787 other OPPS APC 7787 7787 other OPPS APC 7787 27.63 2151.55 percent of total billed charges 7787 7787 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE THROMBECTOMY EKOSONIC L106 CM L24 CM OD5.4 FR ENDOVASCULAR INFUSION CATHETER ULTRASONIC CORE RADIOPAQUE COOLANT ACCEPTS .035 IN GUIDEWIRE SUP-500-55124 CDM 0270 RC outpatient 9357.4 9357.4 9357.4 74 6924.48 percent of total billed charges 9357.4 93 7579.49 percent of total billed charges 9357.4 9357.4 other OPPS APC 9357.4 9357.4 other OPPS APC 9357.4 27.63 2585.45 percent of total billed charges 9357.4 9357.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM DRUG DELIVERY EKOSONIC .035 IN L106 CM L30 CM OD5.4 FR INTELLIGENT CATHETER MICROSONIC DEVICE SUP-500-55130 CDM 0270 RC outpatient 9357.4 9357.4 9357.4 74 6924.48 percent of total billed charges 9357.4 93 7579.49 percent of total billed charges 9357.4 9357.4 other OPPS APC 9357.4 9357.4 other OPPS APC 9357.4 27.63 2585.45 percent of total billed charges 9357.4 9357.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM DRUG DELIVERY EKOSONIC MACH 4 .035 IN L106 CM L50 CM OD5.4 FR INTELLIGENT CATHETER MICROSONIC DEVICE SUP-500-55150 CDM 0270 RC outpatient 9357.4 9357.4 9357.4 74 6924.48 percent of total billed charges 9357.4 93 7579.49 percent of total billed charges 9357.4 9357.4 other OPPS APC 9357.4 9357.4 other OPPS APC 9357.4 27.63 2585.45 percent of total billed charges 9357.4 9357.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM DRUG DELIVERY EKOSONIC MACH 4 MICROSONIC L135 CM L12 CM OD5.4 FR TREATMENT ZONE INTELLIGENT CATHETER ENDOVASCULAR DEVICE ACCEPTS .035 IN GUIDEWIRE SUP-500-56112 CDM 0270 RC outpatient 9357.4 9357.4 9357.4 74 6924.48 percent of total billed charges 9357.4 93 7579.49 percent of total billed charges 9357.4 9357.4 other OPPS APC 9357.4 9357.4 other OPPS APC 9357.4 27.63 2585.45 percent of total billed charges 9357.4 9357.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE DRUG DELIVERY EKOSONIC MACH 4 106CM 40CM 5.4FR ENDOVASCULAR INFUSION CATHETER ULTRASONIC CORE TREATMENT ZONE SUP-500-56140 CDM 0270 RC outpatient 7787 7787 7787 74 5762.38 percent of total billed charges 7787 93 6307.47 percent of total billed charges 7787 7787 other OPPS APC 7787 7787 other OPPS APC 7787 27.63 2151.55 percent of total billed charges 7787 7787 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM DRUG DELIVERY .035IN EKOSONIC TREATMENT ZONE ENDOVASCULAR DEVICE CATHETER SUP-500-56150 CDM 0270 RC outpatient 9357.4 9357.4 9357.4 74 6924.48 percent of total billed charges 9357.4 93 7579.49 percent of total billed charges 9357.4 9357.4 other OPPS APC 9357.4 9357.4 other OPPS APC 9357.4 27.63 2585.45 percent of total billed charges 9357.4 9357.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BULKAMID URETHRAL BULKING SYSTEM SUP-50050 CDM 0270 RC outpatient 2730 2730 2730 74 2020.2 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 2730 other OPPS APC 2730 2730 other OPPS APC 2730 27.63 754.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE FIBULA SHAFT L60 MM X W14-18 MM ALLOGRAFT FREEZE DRIED SUP-500730 CDM 270010031 LOCAL 0270 RC outpatient 1479.09 1479.09 1479.09 74 1094.53 percent of total billed charges 1479.09 93 1198.06 percent of total billed charges 1479.09 1479.09 other OPPS APC 1479.09 1479.09 other OPPS APC 1479.09 27.63 408.67 percent of total billed charges 1479.09 1479.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY PRONTO LP SILVA HYDROPHILIC L140 CM OD6 FR CORONARY PERIPHERAL 2 LOCK SYRINGE RAPID EXCHANGE EXTRACTION PRELOAD STYLET STERILE DISPOSABLE ACCEPTS .014 IN GUIDEWIRE SUP-5010 CDM 0270 RC outpatient 806 806 806 74 596.44 percent of total billed charges 806 93 652.86 percent of total billed charges 806 806 other OPPS APC 806 806 other OPPS APC 806 27.63 222.7 percent of total billed charges 806 806 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH DILATOR VISISHEATH 43CM 6FR SUP-501012 CDM 0481 RC outpatient 936 936 936 74 692.64 percent of total billed charges 936 93 758.16 percent of total billed charges 936 936 other OPPS APC 936 936 other OPPS APC 936 51 477.36 percent of total billed charges 936 936 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH DILATOR VISISHEATH 43CM 14FR SUP-501014 CDM 0481 RC outpatient 936 936 936 74 692.64 percent of total billed charges 936 93 758.16 percent of total billed charges 936 936 other OPPS APC 936 936 other OPPS APC 936 51 477.36 percent of total billed charges 936 936 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH DILATOR VISISHEATH L43 CM OD16 FR SUP-501016 CDM 0481 RC outpatient 936 936 936 74 692.64 percent of total billed charges 936 93 758.16 percent of total billed charges 936 936 other OPPS APC 936 936 other OPPS APC 936 51 477.36 percent of total billed charges 936 936 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L3 MM OD1.2 MM UPPERFACE SELF TAP CROSS PIN GOLD SUP-5012003 CDM 0270 RC outpatient 131.04 131.04 131.04 74 96.97 percent of total billed charges 131.04 93 106.14 percent of total billed charges 131.04 131.04 other OPPS APC 131.04 131.04 other OPPS APC 131.04 27.63 36.21 percent of total billed charges 131.04 131.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L4 MM OD1.2 MM UPPERFACE SELF TAP CROSS PIN GOLD SUP-5012004 CDM 0270 RC outpatient 131.04 131.04 131.04 74 96.97 percent of total billed charges 131.04 93 106.14 percent of total billed charges 131.04 131.04 other OPPS APC 131.04 131.04 other OPPS APC 131.04 27.63 36.21 percent of total billed charges 131.04 131.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L5 MM OD1.2 MM UPPERFACE SELF TAP CROSS PIN GOLD SUP-5012005 CDM 0270 RC outpatient 131.04 131.04 131.04 74 96.97 percent of total billed charges 131.04 93 106.14 percent of total billed charges 131.04 131.04 other OPPS APC 131.04 131.04 other OPPS APC 131.04 27.63 36.21 percent of total billed charges 131.04 131.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L6 MM OD1.2 MM UPPERFACE SELF TAP CROSS PIN NONSTERILE GOLD SUP-5012006 CDM 0270 RC outpatient 131.04 131.04 131.04 74 96.97 percent of total billed charges 131.04 93 106.14 percent of total billed charges 131.04 131.04 other OPPS APC 131.04 131.04 other OPPS APC 131.04 27.63 36.21 percent of total billed charges 131.04 131.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L8 MM OD1.2 MM UPPERFACE SELF TAP CROSS PIN NONSTERILE GOLD SUP-5012008 CDM 0270 RC outpatient 131.04 131.04 131.04 74 96.97 percent of total billed charges 131.04 93 106.14 percent of total billed charges 131.04 131.04 other OPPS APC 131.04 131.04 other OPPS APC 131.04 27.63 36.21 percent of total billed charges 131.04 131.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L10 MM OD1.2 MM UPPERFACE SELF TAP CROSS PIN NONSTERILE GOLD SUP-5012010 CDM 0270 RC outpatient 131.04 131.04 131.04 74 96.97 percent of total billed charges 131.04 93 106.14 percent of total billed charges 131.04 131.04 other OPPS APC 131.04 131.04 other OPPS APC 131.04 27.63 36.21 percent of total billed charges 131.04 131.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L12 MM OD1.2 MM UPPERFACE SELF TAP CROSS PIN NONSTERILE GOLD SUP-5012012 CDM 0270 RC outpatient 131.04 131.04 131.04 74 96.97 percent of total billed charges 131.04 93 106.14 percent of total billed charges 131.04 131.04 other OPPS APC 131.04 131.04 other OPPS APC 131.04 27.63 36.21 percent of total billed charges 131.04 131.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L3 MM OD1.2 MM UPPERFACE SELF DRILL CROSS PIN NONSTERILE SUP-5012903 CDM 0270 RC outpatient 146.64 146.64 146.64 74 108.51 percent of total billed charges 146.64 93 118.78 percent of total billed charges 146.64 146.64 other OPPS APC 146.64 146.64 other OPPS APC 146.64 27.63 40.52 percent of total billed charges 146.64 146.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L4 MM OD1.2 MM UPPERFACE SELF DRILL CROSS PIN NONSTERILE SUP-5012904 CDM 0270 RC outpatient 146.64 146.64 146.64 74 108.51 percent of total billed charges 146.64 93 118.78 percent of total billed charges 146.64 146.64 other OPPS APC 146.64 146.64 other OPPS APC 146.64 27.63 40.52 percent of total billed charges 146.64 146.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L3 MM OD1.4 MM UPPERFACE SELF TAP EMERGENCY CROSS PIN NONSTERILE SUP-5014003 CDM 0270 RC outpatient 135.72 135.72 135.72 74 100.43 percent of total billed charges 135.72 93 109.93 percent of total billed charges 135.72 135.72 other OPPS APC 135.72 135.72 other OPPS APC 135.72 27.63 37.5 percent of total billed charges 135.72 135.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L5 MM OD1.4 MM UPPER FACIAL CRANIOMAXILLOFACIAL SELF TAP CROSS PIN HEAD EMERGENCY NONSTERILE SUP-5014005 CDM 0270 RC outpatient 135.72 135.72 135.72 74 100.43 percent of total billed charges 135.72 93 109.93 percent of total billed charges 135.72 135.72 other OPPS APC 135.72 135.72 other OPPS APC 135.72 27.63 37.5 percent of total billed charges 135.72 135.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.5X6MM LP CROSS-PIN SELF TAPPING SCRE SUP-5015006 CDM 0270 RC outpatient 32.91 32.91 32.91 74 24.35 percent of total billed charges 32.91 93 26.66 percent of total billed charges 32.91 32.91 other OPPS APC 32.91 32.91 other OPPS APC 32.91 27.63 9.09 percent of total billed charges 32.91 32.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L3 MM OD1.7 MM MIDFACE SELF TAP CROSS PIN SUP-5017003 CDM 0270 RC outpatient 110.76 110.76 110.76 74 81.96 percent of total billed charges 110.76 93 89.72 percent of total billed charges 110.76 110.76 other OPPS APC 110.76 110.76 other OPPS APC 110.76 27.63 30.6 percent of total billed charges 110.76 110.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L4 MM OD1.7 MM MIDFACE SELF TAP CROSS PIN SUP-5017004 CDM 0270 RC outpatient 110.76 110.76 110.76 74 81.96 percent of total billed charges 110.76 93 89.72 percent of total billed charges 110.76 110.76 other OPPS APC 110.76 110.76 other OPPS APC 110.76 27.63 30.6 percent of total billed charges 110.76 110.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L5 MM OD1.7 MM MIDFACE SELF TAP CROSS PIN SUP-5017005 CDM 0270 RC outpatient 110.76 110.76 110.76 74 81.96 percent of total billed charges 110.76 93 89.72 percent of total billed charges 110.76 110.76 other OPPS APC 110.76 110.76 other OPPS APC 110.76 27.63 30.6 percent of total billed charges 110.76 110.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L6 MM OD1.7 MM MIDFACE SELF TAP CROSS PIN SUP-5017006 CDM 0270 RC outpatient 110.76 110.76 110.76 74 81.96 percent of total billed charges 110.76 93 89.72 percent of total billed charges 110.76 110.76 other OPPS APC 110.76 110.76 other OPPS APC 110.76 27.63 30.6 percent of total billed charges 110.76 110.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L8 MM OD1.7 MM MIDFACE SELF TAP CROSS PIN SUP-5017008 CDM 0270 RC outpatient 110.76 110.76 110.76 74 81.96 percent of total billed charges 110.76 93 89.72 percent of total billed charges 110.76 110.76 other OPPS APC 110.76 110.76 other OPPS APC 110.76 27.63 30.6 percent of total billed charges 110.76 110.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L10 MM OD1.7 MM MIDFACE SELF TAP CROSS PIN SUP-5017010 CDM 0270 RC outpatient 110.76 110.76 110.76 74 81.96 percent of total billed charges 110.76 93 89.72 percent of total billed charges 110.76 110.76 other OPPS APC 110.76 110.76 other OPPS APC 110.76 27.63 30.6 percent of total billed charges 110.76 110.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L12 MM OD1.7 MM MIDFACE SELF TAP CROSS PIN SUP-5017012 CDM 0270 RC outpatient 110.76 110.76 110.76 74 81.96 percent of total billed charges 110.76 93 89.72 percent of total billed charges 110.76 110.76 other OPPS APC 110.76 110.76 other OPPS APC 110.76 27.63 30.6 percent of total billed charges 110.76 110.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L4 MM OD1.7 MM MIDFACE LOCK CROSS PIN GRAY SUP-5017504 CDM 0270 RC outpatient 145.08 145.08 145.08 74 107.36 percent of total billed charges 145.08 93 117.51 percent of total billed charges 145.08 145.08 other OPPS APC 145.08 145.08 other OPPS APC 145.08 27.63 40.09 percent of total billed charges 145.08 145.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L5 MM OD1.7 MM MIDFACE LOCK CROSS PIN GRAY SUP-5017505 CDM 0270 RC outpatient 145.08 145.08 145.08 74 107.36 percent of total billed charges 145.08 93 117.51 percent of total billed charges 145.08 145.08 other OPPS APC 145.08 145.08 other OPPS APC 145.08 27.63 40.09 percent of total billed charges 145.08 145.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L6 MM OD1.7 MM MIDFACE LOCK CROSS PIN GRAY SUP-5017506 CDM 0270 RC outpatient 145.08 145.08 145.08 74 107.36 percent of total billed charges 145.08 93 117.51 percent of total billed charges 145.08 145.08 other OPPS APC 145.08 145.08 other OPPS APC 145.08 27.63 40.09 percent of total billed charges 145.08 145.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L3 MM OD1.7 MM MIDFACE SELF DRILL CROSS PIN SUP-5017903 CDM 0270 RC outpatient 124.8 124.8 124.8 74 92.35 percent of total billed charges 124.8 93 101.09 percent of total billed charges 124.8 124.8 other OPPS APC 124.8 124.8 other OPPS APC 124.8 27.63 34.48 percent of total billed charges 124.8 124.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L4 MM OD1.7 MM MIDFACE SELF DRILL CROSS PIN SUP-5017904 CDM 0270 RC outpatient 124.8 124.8 124.8 74 92.35 percent of total billed charges 124.8 93 101.09 percent of total billed charges 124.8 124.8 other OPPS APC 124.8 124.8 other OPPS APC 124.8 27.63 34.48 percent of total billed charges 124.8 124.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L5 MM OD1.7 MM MIDFACE SELF DRILL CROSS PIN SUP-5017905 CDM 0270 RC outpatient 124.8 124.8 124.8 74 92.35 percent of total billed charges 124.8 93 101.09 percent of total billed charges 124.8 124.8 other OPPS APC 124.8 124.8 other OPPS APC 124.8 27.63 34.48 percent of total billed charges 124.8 124.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L3 MM OD1.9 MM MIDFACE SELF TAP EMERGENCY CROSS PIN SUP-5019003 CDM 0270 RC outpatient 121.68 121.68 121.68 74 90.04 percent of total billed charges 121.68 93 98.56 percent of total billed charges 121.68 121.68 other OPPS APC 121.68 121.68 other OPPS APC 121.68 27.63 33.62 percent of total billed charges 121.68 121.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEIBINGER UNIVERSAL 2 TITANIUM L5 MM OD1.9 MM MIDFACE SELF TAP EMERGENCY CROSS PIN SUP-5019005 CDM 0270 RC outpatient 121.68 121.68 121.68 74 90.04 percent of total billed charges 121.68 93 98.56 percent of total billed charges 121.68 121.68 other OPPS APC 121.68 121.68 other OPPS APC 121.68 27.63 33.62 percent of total billed charges 121.68 121.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRITANIUM B HEMISPHERICAL OD46 MM PRIMARY RIM CLUSTER HOLE SUP-502-03-46B CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRITANIUM C HEMISPHERICAL OD48 MM HIP PRIMARY RIM CLUSTER HOLE SUP-502-03-48C CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRITANIUM D HEMISPHERICAL OD50 MM PRIMARY RIM CLUSTER HOLE SUP-502-03-50D CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRITANIUM D HEMISPHERICAL OD52 MM HIP PRIMARY RIM CLUSTER HOLE SUP-502-03-52D CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRITANIUM E HEMISPHERICAL OD54 MM HIP PRIMARY RIM CLUSTER HOLE SUP-502-03-54E CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRITANIUM E HEMISPHERICAL OD56 MM PRIMARY RIM CLUSTER HOLE SUP-502-03-56E CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRITANIUM F HEMISPHERICAL OD58 MM HIP PRIMARY RIM CLUSTER HOLE SUP-502-03-58F CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRITANIUM F HEMISPHERICAL OD60 MM HIP PRIMARY RIM CLUSTER HOLE SUP-502-03-60F CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR H HEMISPHERICAL 66MM TRITANIUM PRIMARY RIM CLUSTER HOLE SUP-502-03-62G CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRITANIUM G HEMISPHERICAL OD64 MM PRIMARY RIM CLUSTER HOLE SUP-502-03-64G CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRITANIUM H HEMISPHERICAL OD66 MM PRIMARY RIM CLUSTER HOLE SUP-502-03-66H CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL TRIDENT HEMISPHERICAL 44MM SUP-502-11-44B CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL TRIDENT HEMISPHERICAL 46MM SUP-502-11-46C CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL TRIDENT HEMISPHERICAL 48MM SUP-502-11-48D CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL TRIDENT HEMISPHERICAL 50MM SUP-502-11-50D CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL TRIDENT HEMISPHERICAL 52MM SUP-502-11-52E CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL TRIDENT HEMISPHERICAL 54MM SUP-502-11-54E CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL TRIDENT HEMISPHERICAL 56MM SUP-502-11-56F CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL TRIDENT HEMISPHERICAL 58MM SUP-502-11-58F CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL TRIDENT HEMISPHERICAL 60MM SUP-502-11-60G CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR HEMISPHERICAL 62MM SUP-502-11-62G CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL TRIDENT HEMISPHERICAL 64MM SUP-502-11-64H CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL TRIDENT HEMISPHERICAL 66MM SUP-502-11-66H CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL TRIDENT HEMISPHERICAL 68MM SUP-502-11-68I CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT INTEGRA SUP-502015206 CDM 0270 RC outpatient 416 416 416 74 307.84 percent of total billed charges 416 93 336.96 percent of total billed charges 416 416 other OPPS APC 416 416 other OPPS APC 416 27.63 114.94 percent of total billed charges 416 416 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRITANIUM G OD62 MM PRIMARY HEMISPHERICAL CLUSTER HOLE SUP-5020362G CDM 270010024 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW MICRO 100 MICROPOWER 90 D L15.5 MM X W14 MM SAGITTAL COARSE TOOTH ANGLED SUP-5023-136 CDM 0270 RC outpatient 26.18 26.18 26.18 74 19.37 percent of total billed charges 26.18 93 21.21 percent of total billed charges 26.18 26.18 other OPPS APC 26.18 26.18 other OPPS APC 26.18 27.63 7.23 percent of total billed charges 26.18 26.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW BONE SAGITTAL COARSE MICRO STERILE 5.5 X 25.5 X 0.4MM SUP-5023-232 CDM 0270 RC outpatient 41.6 41.6 41.6 74 30.78 percent of total billed charges 41.6 93 33.7 percent of total billed charges 41.6 41.6 other OPPS APC 41.6 41.6 other OPPS APC 41.6 27.63 11.49 percent of total billed charges 41.6 41.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW 41X14X.4MM MICRO SS COARSE STERILE SUP-5023-233 CDM 0270 RC outpatient 34.63 34.63 34.63 74 25.63 percent of total billed charges 34.63 93 28.05 percent of total billed charges 34.63 34.63 other OPPS APC 34.63 34.63 other OPPS APC 34.63 27.63 9.57 percent of total billed charges 34.63 34.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROSAGITTAL BLADE SUP-5023-235 CDM 0270 RC outpatient 33.9 33.9 33.9 74 25.09 percent of total billed charges 33.9 93 27.46 percent of total billed charges 33.9 33.9 other OPPS APC 33.9 33.9 other OPPS APC 33.9 27.63 9.37 percent of total billed charges 33.9 33.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW SAGITTAL MICRO FINE FLAT STAINLESS STEEL 9.5 X 25.5 X 0.4MM SUP-5023-238 CDM 0270 RC outpatient 41.6 41.6 41.6 74 30.78 percent of total billed charges 41.6 93 33.7 percent of total billed charges 41.6 41.6 other OPPS APC 41.6 41.6 other OPPS APC 41.6 27.63 11.49 percent of total billed charges 41.6 41.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE MICRO SUP-5023-262 CDM 0270 RC outpatient 41.6 41.6 41.6 74 30.78 percent of total billed charges 41.6 93 33.7 percent of total billed charges 41.6 41.6 other OPPS APC 41.6 41.6 other OPPS APC 41.6 27.63 11.49 percent of total billed charges 41.6 41.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE MICRO SUP-5023-263 CDM 0270 RC outpatient 41.6 41.6 41.6 74 30.78 percent of total billed charges 41.6 93 33.7 percent of total billed charges 41.6 41.6 other OPPS APC 41.6 41.6 other OPPS APC 41.6 27.63 11.49 percent of total billed charges 41.6 41.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR CORDIS EMERALD 3MM RADIUS J 260CM 7CM .025IN HEPARIN PTFE DISPOSABLE STERILE LF PERCUTANEOUS FLEXIBLE SUP-502452 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR CORDIS EMERALD 3MM RADIUS J 150CM 7CM .025IN HEPARIN PTFE DISPOSABLE STERILE LF PERCUTANEOUS FLEXIBLE SUP-502524 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. .065 X 150 6MM EMERALD ROPE J SUP-502530 CDM 0481 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 51 46.41 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. .025 X 150 EMERALD ST SUP-502549 CDM 0481 RC outpatient 16.9 16.9 16.9 74 12.51 percent of total billed charges 16.9 93 13.69 percent of total billed charges 16.9 16.9 other OPPS APC 16.9 16.9 other OPPS APC 16.9 51 8.62 percent of total billed charges 16.9 16.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. .035 X 175 3MM EMERALD SUP-502585 CDM 0481 RC outpatient 16.9 16.9 16.9 74 12.51 percent of total billed charges 16.9 93 13.69 percent of total billed charges 16.9 16.9 other OPPS APC 16.9 16.9 other OPPS APC 16.9 51 8.62 percent of total billed charges 16.9 16.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD BONE CONNECTING EXTERNAL FIXATION CARBON BRAIDED HOFFMAN II 8 X 250MM SUP-5029-8-825 CDM 270010022 LOCAL 0270 RC outpatient 426.4 426.4 426.4 74 315.54 percent of total billed charges 426.4 93 345.38 percent of total billed charges 426.4 426.4 other OPPS APC 426.4 426.4 other OPPS APC 426.4 27.63 117.81 percent of total billed charges 426.4 426.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD BONE CONNECTING EXTERNAL FIXATION CARBON BRAIDED HOFFMAN II 8 X 300MM SUP-5029-8-830 CDM 270010022 LOCAL 0270 RC outpatient 426.4 426.4 426.4 74 315.54 percent of total billed charges 426.4 93 345.38 percent of total billed charges 426.4 426.4 other OPPS APC 426.4 426.4 other OPPS APC 426.4 27.63 117.81 percent of total billed charges 426.4 426.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD BONE CONNECTING EXTERNAL FIXATION CARBON BRAIDED HOFFMAN II 8 X 350MM SUP-5029-8-835 CDM 270010022 LOCAL 0270 RC outpatient 413.4 413.4 413.4 74 305.92 percent of total billed charges 413.4 93 334.85 percent of total billed charges 413.4 413.4 other OPPS APC 413.4 413.4 other OPPS APC 413.4 27.63 114.22 percent of total billed charges 413.4 413.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD BONE CONNECTING EXTERNAL FIXATION CARBON BRAIDED HOFFMAN II STRAIGHT 8 X 400MM SUP-5029-8-840 CDM 270010022 LOCAL 0270 RC outpatient 351 351 351 74 259.74 percent of total billed charges 351 93 284.31 percent of total billed charges 351 351 other OPPS APC 351 351 other OPPS APC 351 27.63 96.98 percent of total billed charges 351 351 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD BONE CONNECTING EXTERNAL FIXATION CARBON BRAIDED HOFFMAN II 8 X 500MM SUP-5029-8-850 CDM 270010022 LOCAL 0270 RC outpatient 403 403 403 74 298.22 percent of total billed charges 403 93 326.43 percent of total billed charges 403 403 other OPPS APC 403 403 other OPPS APC 403 27.63 111.35 percent of total billed charges 403 403 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRANS-ORAL NEEDLE SUP-5030496 CDM 0270 RC outpatient 169 169 169 74 125.06 percent of total billed charges 169 93 136.89 percent of total billed charges 169 169 other OPPS APC 169 169 other OPPS APC 169 27.63 46.69 percent of total billed charges 169 169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EXTERNAL DRAINAGE BARIUM 1.1 MM L32 CM OD2.8 MM ID1.5 MM VENTRICULAR TRANSLUCENT STRIPE NUMERIC LENGTH MARKER ANTIBIOTIC IMPREGNATE SUP-50318 CDM 0270 RC outpatient 941.36 941.36 941.36 74 696.61 percent of total billed charges 941.36 93 762.5 percent of total billed charges 941.36 941.36 other OPPS APC 941.36 941.36 other OPPS APC 941.36 27.63 260.1 percent of total billed charges 941.36 941.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR CORDIS SV STRAIGHT DISTAL TAPER 180CM 5CM .018IN PLATINUM NICKEL SS PTFE DISPOSABLE STERILE LF SUP-503558 CDM 0270 RC outpatient 179.4 179.4 179.4 74 132.76 percent of total billed charges 179.4 93 145.31 percent of total billed charges 179.4 179.4 other OPPS APC 179.4 179.4 other OPPS APC 179.4 27.63 49.57 percent of total billed charges 179.4 179.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR CORDIS SV STRAIGHT DISTAL TAPER 300CM 5CM .018IN PLATINUM NICKEL SS PTFE DISPOSABLE STERILE LF SUP-503558X CDM 0270 RC outpatient 188.37 188.37 188.37 74 139.39 percent of total billed charges 188.37 93 152.58 percent of total billed charges 188.37 188.37 other OPPS APC 188.37 188.37 other OPPS APC 188.37 27.63 52.05 percent of total billed charges 188.37 188.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENT BONE PALACOS R 40 GM GREEN SUP-5036963 CDM 0270 RC outpatient 140.4 140.4 140.4 74 103.9 percent of total billed charges 140.4 93 113.72 percent of total billed charges 140.4 140.4 other OPPS APC 140.4 140.4 other OPPS APC 140.4 27.63 38.79 percent of total billed charges 140.4 140.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENT BONE PALACOS R+G GENTAMICIN 40 GM LATEX FREE GREEN SUP-5036964 CDM 0270 RC outpatient 432.25 432.25 432.25 74 319.87 percent of total billed charges 432.25 93 350.12 percent of total billed charges 432.25 432.25 other OPPS APC 432.25 432.25 other OPPS APC 432.25 27.63 119.43 percent of total billed charges 432.25 432.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PALACOS LV 1 X 40 SINGLE SUP-5036965 CDM 0270 RC outpatient 135.2 135.2 135.2 74 100.05 percent of total billed charges 135.2 93 109.51 percent of total billed charges 135.2 135.2 other OPPS APC 135.2 135.2 other OPPS APC 135.2 27.63 37.36 percent of total billed charges 135.2 135.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PALACOS LVG 1 X 40 SINGLE SUP-5036966 CDM 0270 RC outpatient 432.25 432.25 432.25 74 319.87 percent of total billed charges 432.25 93 350.12 percent of total billed charges 432.25 432.25 other OPPS APC 432.25 432.25 other OPPS APC 432.25 27.63 119.43 percent of total billed charges 432.25 432.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING CAPSURE VDD-2 STEROID ELUTING SILICONE OD8.1 FR RIGHT VENTRICLE TRANSVENOUS 1 PASS 2 IS-1 BIPOLAR TINE SUP-5038 CDM 0275 RC outpatient 1131 1131 1131 57 644.67 percent of total billed charges 1131 93 916.11 percent of total billed charges 1131 1131 other OPPS APC 1131 1131 other OPPS APC 1131 51 576.81 percent of total billed charges 1131 1131 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING CAPSURE VDD-2 STEROID ELUTING SILICONE OD9 FR ATRIUM VENTRICLE 1 PASS IS-1 QUADRIPOLAR SUP-5038L CDM 0275 RC outpatient 1131 1131 1131 57 644.67 percent of total billed charges 1131 93 916.11 percent of total billed charges 1131 1131 other OPPS APC 1131 1131 other OPPS APC 1131 51 576.81 percent of total billed charges 1131 1131 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING CAPSURE VDD-2 STEROID ELUTING SILICONE SHORT OD8.1 FR RIGHT VENTRICLE TRANSVENOUS 1 PASS 2 IS-1 BIPOLAR TINE SUP-5038S CDM 0275 RC outpatient 1131 1131 1131 57 644.67 percent of total billed charges 1131 93 916.11 percent of total billed charges 1131 1131 other OPPS APC 1131 1131 other OPPS APC 1131 51 576.81 percent of total billed charges 1131 1131 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SHELL SOLID SIZE 48 D SUP-504-11-48D CDM 270010024 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SHELL SOLID SIZE 54 F SUP-504-11-54F CDM 270010024 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR VASCULAR L17.8 CM OD4 FR VESSEL ACCEPTS .035 IN GUIDEWIRE SUP-504-404X CDM 0270 RC outpatient 16.9 16.9 16.9 74 12.51 percent of total billed charges 16.9 93 13.69 percent of total billed charges 16.9 16.9 other OPPS APC 16.9 16.9 other OPPS APC 16.9 27.63 4.67 percent of total billed charges 16.9 16.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH AVANTI+ .038IN 11CM 17CM 6FR GREEN FEP SILICONE DISPOSABLE MINI GUIDEWIRE ROTATE SUTURE COLLAR KINK SUP-504-606X CDM 270009027 LOCAL 0270 RC outpatient 17.28 17.28 17.28 74 12.79 percent of total billed charges 17.28 93 14 percent of total billed charges 17.28 17.28 other OPPS APC 17.28 17.28 other OPPS APC 17.28 27.63 4.77 percent of total billed charges 17.28 17.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIRENA SUP-50419-421-01 CDM outpatient 1827.93 1827.93 1827.93 1827.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH AVANTI+ STAINLESS STEEL .038 IN STANDARD HEXACUSPID L11 CM OD8 FR HEXCUSPID VALVE KINK RESISTANT CANNULA MINI GUIDEWIRE NO OBTURATOR DISPOSABLE BLUE SUP-504608X CDM 0270 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 27.63 6.47 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 9F SHORT SHEATH SUP-504609A CDM 0481 RC outpatient 19.94 19.94 19.94 74 14.76 percent of total billed charges 19.94 93 16.15 percent of total billed charges 19.94 19.94 other OPPS APC 19.94 19.94 other OPPS APC 19.94 51 10.17 percent of total billed charges 19.94 19.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 10F SHORT SHEATH SUP-504610X CDM 0481 RC outpatient 20.8 20.8 20.8 74 15.39 percent of total billed charges 20.8 93 16.85 percent of total billed charges 20.8 20.8 other OPPS APC 20.8 20.8 other OPPS APC 20.8 51 10.61 percent of total billed charges 20.8 20.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOWL BONE CEMENT QUICK-VAC VACUUM MIX LATEX FREE DISPOSABLE SUP-5050166 CDM 0270 RC outpatient 121.33 121.33 121.33 74 89.78 percent of total billed charges 121.33 93 98.28 percent of total billed charges 121.33 121.33 other OPPS APC 121.33 121.33 other OPPS APC 121.33 27.63 33.52 percent of total billed charges 121.33 121.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD CAPSURE Z NOVUS SUP-5054/5554 SERIES CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUBSTITUTE BONE GRAFT ACTIFUSE ABX SILICATED CALCIUM PHOSPHATE 1-2 MM 5 ML RESORBABLE SCAFFOLD OSTEOSTIMULATIVE GRANULE STERILE SUP-506005078051 CDM 270010012 LOCAL 0270 RC outpatient 2665 2665 2665 74 1972.1 percent of total billed charges 2665 93 2158.65 percent of total billed charges 2665 2665 other OPPS APC 2665 2665 other OPPS APC 2665 27.63 736.34 percent of total billed charges 2665 2665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUBSTITUTE BONE GRAFT ACTIFUSE ABX SYNTHETIC 1-2 MM 10 ML GRANULE SUP-506005078052 CDM 270010012 LOCAL 0270 RC outpatient 4550 4550 4550 74 3367 percent of total billed charges 4550 93 3685.5 percent of total billed charges 4550 4550 other OPPS APC 4550 4550 other OPPS APC 4550 27.63 1257.17 percent of total billed charges 4550 4550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID ACTIFUSE SHAPE CALCIUM PHOSPHATE POROUS MEDIUM GRANULE CYLINDER L15 MM D X W15 MM 2.6 ML RESORBABLE STERILE SUP-506005078064 CDM 0270 RC outpatient 1385.8 1385.8 1385.8 74 1025.49 percent of total billed charges 1385.8 93 1122.5 percent of total billed charges 1385.8 1385.8 other OPPS APC 1385.8 1385.8 other OPPS APC 1385.8 27.63 382.9 percent of total billed charges 1385.8 1385.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUBSTITUTE BONE GRAFT ACTIFUSE SYNTHETIC 1-2 MM LARGE GRANULE CYLINDER L45 MM OD15 MM 8 ML RESORBABLE VOID FILLER SUP-506005078066 CDM 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING HYDROCOLLOID RESTORE L8 IN X W6 IN TRIACT TECHNOLOGY CONTACT LAYER FLEXIBLE HIGHLY CONFORMABLE NONADHERENT STERILE SUP-506489 CDM 0270 RC outpatient 22.92 22.92 22.92 74 16.96 percent of total billed charges 22.92 93 18.57 percent of total billed charges 22.92 22.92 other OPPS APC 22.92 22.92 other OPPS APC 22.92 27.63 6.33 percent of total billed charges 22.92 22.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER COMPRESSION A-V IMPULSE IMPAD 4.5-8 5.5-9 MED BLADDER LF FOOT RIGID SOLE LG DORSUM WRAP VENT HOLE SUP-5065 CDM 270009155 LOCAL 0270 RC outpatient 88.8 88.8 88.8 74 65.71 percent of total billed charges 88.8 93 71.93 percent of total billed charges 88.8 88.8 other OPPS APC 88.8 88.8 other OPPS APC 88.8 27.63 24.54 percent of total billed charges 88.8 88.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPICARDIAL UNIPOLAR SUP-5071 SERIES CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD EPICARDIAL SCREW IN 5071 SUP-5071-35 CDM 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING SILICONE L53 CM OD6.6 FR MYOCARDIUM UNIPOLAR FIXED SCREW IS-1 SUP-5071-53 CDM 0275 RC outpatient 1040 1040 1040 57 592.8 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING SUREFIX STEROID ELUTING SILICONE OD7.2 FR ATRIUM RIGHT VENTRICLE TRANSVENOUS BIPOLAR FIX SCREW SUP-5072 SERIES CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT ORTHOPEDIC FOAM SMALL L8 IN RIGHT WRIST LOW PROFILE PALMAR STAY D-RING CLOSURE NONSTERILE BLACK SUP-5073-02 CDM 270009117 LOCAL 0270 RC outpatient 8.82 8.82 8.82 74 6.53 percent of total billed charges 8.82 93 7.14 percent of total billed charges 8.82 8.82 other OPPS APC 8.82 8.82 other OPPS APC 8.82 27.63 2.44 percent of total billed charges 8.82 8.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT ORTHOPEDIC FOAM MEDIUM L8 IN RIGHT WRIST LATEX SAFE LOW PROFILE LIGHTWEIGHT DESIGN MALLEABLE PALMAR STAY D-RING CLOSURE NONSTERILE LATEX FREE BLACK SUP-5073-03 CDM 270009117 LOCAL 0270 RC outpatient 8.82 8.82 8.82 74 6.53 percent of total billed charges 8.82 93 7.14 percent of total billed charges 8.82 8.82 other OPPS APC 8.82 8.82 other OPPS APC 8.82 27.63 2.44 percent of total billed charges 8.82 8.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT ORTHOPEDIC FOAM LARGE L8 IN RIGHT WRIST LOW PROFILE PALMAR STAY D-RING CLOSURE NONSTERILE LATEX FREE BLACK SUP-5073-04 CDM 270009117 LOCAL 0270 RC outpatient 8.82 8.82 8.82 74 6.53 percent of total billed charges 8.82 93 7.14 percent of total billed charges 8.82 8.82 other OPPS APC 8.82 8.82 other OPPS APC 8.82 27.63 2.44 percent of total billed charges 8.82 8.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT ORTHOPEDIC SM 8IN BLACK FOAM NS LF LEFT WRIST LATEX SAFE LOW PROFILE SUP-5073-07 CDM 270009117 LOCAL 0270 RC outpatient 8.82 8.82 8.82 74 6.53 percent of total billed charges 8.82 93 7.14 percent of total billed charges 8.82 8.82 other OPPS APC 8.82 8.82 other OPPS APC 8.82 27.63 2.44 percent of total billed charges 8.82 8.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT ORTHOPEDIC MED 8IN BLACK FOAM NS LF LEFT WRIST LATEX SAFE LOW PROFILE SUP-5073-08 CDM 270009117 LOCAL 0270 RC outpatient 8.82 8.82 8.82 74 6.53 percent of total billed charges 8.82 93 7.14 percent of total billed charges 8.82 8.82 other OPPS APC 8.82 8.82 other OPPS APC 8.82 27.63 2.44 percent of total billed charges 8.82 8.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT ORTHOPEDIC FOAM LARGE L8 IN LEFT WRIST LOW PROFILE PALMAR STAY D-RING CLOSURE BLACK SUP-5073-09 CDM 270009117 LOCAL 0270 RC outpatient 8.82 8.82 8.82 74 6.53 percent of total billed charges 8.82 93 7.14 percent of total billed charges 8.82 8.82 other OPPS APC 8.82 8.82 other OPPS APC 8.82 27.63 2.44 percent of total billed charges 8.82 8.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER COMPRESSION IMPAD AV IMPULSE SYSTEM LARGE FOOT RIGID SOLE ANATOMICAL SHAPED LATEX FREE SUP-5075 CDM 270009155 LOCAL 0270 RC outpatient 88.8 88.8 88.8 74 65.71 percent of total billed charges 88.8 93 71.93 percent of total billed charges 88.8 88.8 other OPPS APC 88.8 88.8 other OPPS APC 88.8 27.63 24.54 percent of total billed charges 88.8 88.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING 5076-110 CAPSUREFIX NOVUS _42998_ SUP-5076-110 CDM 0275 RC outpatient 1027 1027 1027 57 585.39 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 51 523.77 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING CAPSUREFIX NOVUS STEROID ELUTING PLATINUM SILICONE 10 MM SPACE SMALL STRAIGHT L35 CM L20-110 CM OD6.2 FR ODSEC2 MM ATRIUM VENTRICLE BIPOLAR SCREW IN ACTIVE FIXATION STERILE DISPOSABLE SUP-5076-35 CDM 0275 RC outpatient 1027 1027 1027 57 585.39 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 51 523.77 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING CAPSUREFIX NOVUS STEROID ELUTING PLATINUM SILICONE 10 MM SPACE SMALL STRAIGHT L45 CM L20-110 CM OD6.2 FR ODSEC2 MM ATRIUM VENTRICLE BIPOLAR SCREW IN IMPLANTABLE ACTIVE FIXATION SUP-5076-45 CDM 0275 RC outpatient 1027 1027 1027 57 585.39 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 51 523.77 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING CAPSUREFIX NOVUS STEROID ELUTING PLATINUM SILICONE 10 MM SPACE SMALL STRAIGHT L52 CM L20-110 CM OD6.2 FR ODSEC2 MM ATRIUM VENTRICLE BIPOLAR SCREW IN IMPLANTABLE ACTIVE FIXATION SUP-5076-52 CDM 0275 RC outpatient 1027 1027 1027 57 585.39 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 51 523.77 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING CAPSUREFIX NOVUS STEROID ELUTING PLATINUM SILICONE 10 MM SPACE SMALL STRAIGHT L58 CM L20-110 CM OD6.2 FR ODSEC2 MM ATRIUM VENTRICLE BIPOLAR SCREW IN IMPLANTABLE ACTIVE FIXATION SUP-5076-58 CDM 0275 RC outpatient 1027 1027 1027 57 585.39 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 51 523.77 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING CAPSUREFIX NOVUS STEROID ELUTING SILICONE L65 CM OD6 FR ATRIUM VENTRICLE RIGHT IS-1 BIPOLAR ACTIVE FIXATION SCREW IN SUP-5076-65 CDM 0275 RC outpatient 1027 1027 1027 57 585.39 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 51 523.77 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING CAPSUREFIX NOVUS STEROID ELUTING SILICONE SILOXANE 10 MM SPACING STRAIGHT L85 CM L1.8 MM OD6.2 FR ODSEC7 FR ATRIUM VENTRICLE BIPOLAR POLARITY ACTIVE FIXATION PLATINIZED ELECTRODE SCREW IN SIDE BY SIDE SUP-5076-85 CDM 0275 RC outpatient 1027 1027 1027 57 585.39 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 51 523.77 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOUGIE SURGICAL HURST TUNGSTEN ROUND OD38 FR ESOPHAGEAL FILL SUP-507604 CDM 0270 RC outpatient 1092 1092 1092 74 808.08 percent of total billed charges 1092 93 884.52 percent of total billed charges 1092 1092 other OPPS APC 1092 1092 other OPPS APC 1092 27.63 301.72 percent of total billed charges 1092 1092 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT D HEMISPHERE OD48 MM HIP MULTIHOLE SUP-508-11-48D CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT D HEMISPHERE OD50 MM HIP MULTIHOLE SUP-508-11-50D CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT E HEMISPHERE OD52 MM HIP MULTIHOLE SUP-508-11-52E CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT E HEMISPHERE OD54 MM HIP MULTIHOLE SUP-508-11-54E CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT F HEMISPHERE OD56 MM HIP MULTIHOLE SUP-508-11-56F CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT F HEMISPHERE OD58 MM HIP MULTIHOLE SUP-508-11-58F CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT G HEMISPHERE OD60 MM HIP MULTIHOLE SUP-508-11-60G CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT G HEMISPHERE OD62 MM HIP MULTIHOLE SUP-508-11-62G CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT H HEMISPHERE OD64 MM HIP MULTIHOLE SUP-508-11-64H CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT H HEMISPHERE OD66 MM HIP MULTIHOLE SUP-508-11-66H CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN HALF APEX HOFFMANN II STAINLESS STEEL MICRO L45 MM L12 MM OD1.65 MM SELF DRILL SELF TAP THREAD SUP-5080-1-612 CDM 270010022 LOCAL 0270 RC outpatient 243.36 243.36 243.36 74 180.09 percent of total billed charges 243.36 93 197.12 percent of total billed charges 243.36 243.36 other OPPS APC 243.36 243.36 other OPPS APC 243.36 27.63 67.24 percent of total billed charges 243.36 243.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN HALF HOFFMANN II APEX STAINLESS STEEL MICRO L45 MM L12 MM OD2 MM SELF DRILLING SELF TAPPING SUP-5080-2-012 CDM 270010022 LOCAL 0270 RC outpatient 243.36 243.36 243.36 74 180.09 percent of total billed charges 243.36 93 197.12 percent of total billed charges 243.36 243.36 other OPPS APC 243.36 243.36 other OPPS APC 243.36 27.63 67.24 percent of total billed charges 243.36 243.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARRIER ADHESION SEPRAFILM SODIUM HYALURONATE CARBOXYMETHYLCELLULOSE L3 IN X W5 IN ABDOMEN PELVIS PROCEDURE PACK BIORESORBABLE MEMBRANE STERILE TRANSLUCENT SUP-5086-02 CDM 0270 RC outpatient 2260.82 2260.82 2260.82 74 1673.01 percent of total billed charges 2260.82 93 1831.26 percent of total billed charges 2260.82 2260.82 other OPPS APC 2260.82 2260.82 other OPPS APC 2260.82 27.63 624.66 percent of total billed charges 2260.82 2260.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD 5086-45 MRI PACING 8/17/16 SUP-5086MRI45 CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD 5086-52 MRI PACING 8/17/16 SUP-5086MRI52 CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD 5086-58 MRI PACING 8/17/16 SUP-5086MRI58 CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INTRAVENOUS OPTIVA POLYURETHANE L2.25 IN OD14 GA RADIOPAQUE STERILE LATEX FREE ORANGE SUP-508811 CDM outpatient 4.43 4.43 4.43 4.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MDM TRIDENT TRITANIUM X3 E HEMISPHERE OD54 MM ODSEC54 MM HIP MULTIHOLE RIM SUP-509-02-54E CDM 270010024 LOCAL 0270 RC outpatient 7367.1 7367.1 7367.1 74 5451.65 percent of total billed charges 7367.1 93 5967.35 percent of total billed charges 7367.1 7367.1 other OPPS APC 7367.1 7367.1 other OPPS APC 7367.1 27.63 2035.53 percent of total billed charges 7367.1 7367.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MDM TRIDENT TRITANIUM X3 E HEMISPHERE OD56 MM ODSEC56 MM HIP MULTIHOLE RIM SUP-509-02-56E CDM 270010024 LOCAL 0270 RC outpatient 7367.1 7367.1 7367.1 74 5451.65 percent of total billed charges 7367.1 93 5967.35 percent of total billed charges 7367.1 7367.1 other OPPS APC 7367.1 7367.1 other OPPS APC 7367.1 27.63 2035.53 percent of total billed charges 7367.1 7367.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MDM TRIDENT TRITANIUM X3 F HEMISPHERE OD58 MM ODSEC58 MM HIP MULTIHOLE RIM SUP-509-02-58F CDM 270010024 LOCAL 0270 RC outpatient 7367.1 7367.1 7367.1 74 5451.65 percent of total billed charges 7367.1 93 5967.35 percent of total billed charges 7367.1 7367.1 other OPPS APC 7367.1 7367.1 other OPPS APC 7367.1 27.63 2035.53 percent of total billed charges 7367.1 7367.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MDM TRIDENT TRITANIUM X3 F HEMISPHERE OD60 MM ODSEC60 MM HIP MULTIHOLE RIM SUP-509-02-60F CDM 270010024 LOCAL 0270 RC outpatient 7367.1 7367.1 7367.1 74 5451.65 percent of total billed charges 7367.1 93 5967.35 percent of total billed charges 7367.1 7367.1 other OPPS APC 7367.1 7367.1 other OPPS APC 7367.1 27.63 2035.53 percent of total billed charges 7367.1 7367.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MDM TRIDENT TRITANIUM X3 G HEMISPHERE OD62 MM ODSEC62 MM HIP MULTIHOLE RIM SUP-509-02-62G CDM 270010024 LOCAL 0270 RC outpatient 7367.1 7367.1 7367.1 74 5451.65 percent of total billed charges 7367.1 93 5967.35 percent of total billed charges 7367.1 7367.1 other OPPS APC 7367.1 7367.1 other OPPS APC 7367.1 27.63 2035.53 percent of total billed charges 7367.1 7367.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MDM TRIDENT TRITANIUM X3 G HEMISPHERE OD64 MM HIP MULTIHOLE RIM SUP-509-02-64G CDM 270010024 LOCAL 0270 RC outpatient 7367.1 7367.1 7367.1 74 5451.65 percent of total billed charges 7367.1 93 5967.35 percent of total billed charges 7367.1 7367.1 other OPPS APC 7367.1 7367.1 other OPPS APC 7367.1 27.63 2035.53 percent of total billed charges 7367.1 7367.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MDM TRIDENT TRITANIUM X3 H HEMISPHERE OD66 MM HIP MULTIHOLE RIM SUP-509-02-66H CDM 270010024 LOCAL 0270 RC outpatient 7367.1 7367.1 7367.1 74 5451.65 percent of total billed charges 7367.1 93 5967.35 percent of total billed charges 7367.1 7367.1 other OPPS APC 7367.1 7367.1 other OPPS APC 7367.1 27.63 2035.53 percent of total billed charges 7367.1 7367.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MDM TRIDENT TRITANIUM X3 H HEMISPHERE OD68 MM HIP MULTIHOLE RIM SUP-509-02-68H CDM 270010024 LOCAL 0270 RC outpatient 7367.1 7367.1 7367.1 74 5451.65 percent of total billed charges 7367.1 93 5967.35 percent of total billed charges 7367.1 7367.1 other OPPS APC 7367.1 7367.1 other OPPS APC 7367.1 27.63 2035.53 percent of total billed charges 7367.1 7367.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MDM TRIDENT TRITANIUM X3 I HEMISPHERE OD70 MM HIP MULTIHOLE RIM SUP-509-02-70I CDM 270010024 LOCAL 0270 RC outpatient 7367.1 7367.1 7367.1 74 5451.65 percent of total billed charges 7367.1 93 5967.35 percent of total billed charges 7367.1 7367.1 other OPPS APC 7367.1 7367.1 other OPPS APC 7367.1 27.63 2035.53 percent of total billed charges 7367.1 7367.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MDM TRIDENT TRITANIUM X3 I HEMISPHERE OD72 MM HIP MULTIHOLE RIM SUP-509-02-72I CDM 270010024 LOCAL 0270 RC outpatient 7367.1 7367.1 7367.1 74 5451.65 percent of total billed charges 7367.1 93 5967.35 percent of total billed charges 7367.1 7367.1 other OPPS APC 7367.1 7367.1 other OPPS APC 7367.1 27.63 2035.53 percent of total billed charges 7367.1 7367.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR MDM TRIDENT TRITANIUM X3 J HEMISPHERE OD74 MM HIP MULTIHOLE RIM SUP-509-02-74J CDM 270010024 LOCAL 0270 RC outpatient 7367.1 7367.1 7367.1 74 5451.65 percent of total billed charges 7367.1 93 5967.35 percent of total billed charges 7367.1 7367.1 other OPPS APC 7367.1 7367.1 other OPPS APC 7367.1 27.63 2035.53 percent of total billed charges 7367.1 7367.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD CAPSURE SP NOVUS 5092 SUP-5092 CDM 0275 RC outpatient 1131 1131 1131 57 644.67 percent of total billed charges 1131 93 916.11 percent of total billed charges 1131 1131 other OPPS APC 1131 1131 other OPPS APC 1131 51 576.81 percent of total billed charges 1131 1131 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING CAPSURE SP NOVUS STEROID ELUTING SILICONE STRAIGHT L58 CM OD6 FR RIGHT VENTRICLE BIPOLAR TIN IS-1 SUP-5092-58 CDM 275001001 LOCAL 0275 RC outpatient 1027 1027 1027 57 585.39 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 51 523.77 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING WOUND RESTORE TRIACT SILVER L8 IN X W6 IN CONTACT LAYER NONADHESIVE NONOCCULSIVE SUP-509342 CDM 0270 RC outpatient 40.39 40.39 40.39 74 29.89 percent of total billed charges 40.39 93 32.72 percent of total billed charges 40.39 40.39 other OPPS APC 40.39 40.39 other OPPS APC 40.39 27.63 11.16 percent of total billed charges 40.39 40.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING PRESSURE MONITOR TRUWAVE L12 IN MALE TO FEMALE CONNECTOR TRANSDUCER DISPOSABLE SUP-50P112 CDM 0270 RC outpatient 7.28 7.28 7.28 74 5.39 percent of total billed charges 7.28 93 5.9 percent of total billed charges 7.28 7.28 other OPPS APC 7.28 7.28 other OPPS APC 7.28 27.63 2.01 percent of total billed charges 7.28 7.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING PRESSURE MONITOR TRUWAVE L48 IN MALE TO FEMALE CONNECTOR TRANSDUCER STERILE DISPOSABLE SUP-50P148 CDM outpatient 6.89 6.89 6.89 6.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH CLOTTRIEVER 16 FR 15 CM SUP-51-101 CDM 0270 RC outpatient 7800 7800 7800 74 5772 percent of total billed charges 7800 93 6318 percent of total billed charges 7800 7800 other OPPS APC 7800 7800 other OPPS APC 7800 27.63 2155.14 percent of total billed charges 7800 7800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL THERMOGARD PEDIATRIC L10 FT 80 LB 2 DISPERSIVE PREATTACH CABLE STERILE LATEX FREE DISPOSABLE SUP-51-7710 CDM outpatient 9.53 9.53 9.53 9.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPONGE RETINAL SILICONE L80 MM X W5 MM X H2.5 MM SCLERAL HALF CYLINDER STERILE SUP-510 CDM 0270 RC outpatient 122.2 122.2 122.2 74 90.43 percent of total billed charges 122.2 93 98.98 percent of total billed charges 122.2 122.2 other OPPS APC 122.2 122.2 other OPPS APC 122.2 27.63 33.76 percent of total billed charges 122.2 122.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CASSETTE IRRIGATION TPS 2 NONSTERILE LATEX FREE DISPOSABLE SUP-5100-050-001 CDM 0270 RC outpatient 119.08 119.08 119.08 74 88.12 percent of total billed charges 119.08 93 96.45 percent of total billed charges 119.08 119.08 other OPPS APC 119.08 119.08 other OPPS APC 119.08 27.63 32.9 percent of total billed charges 119.08 119.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERFORATOR CRANIAL ZYPHR DISPOSABLE LARGE 14/11 MM SUP-5100-060-001 CDM 0270 RC outpatient 545.14 545.14 545.14 74 403.4 percent of total billed charges 545.14 93 441.56 percent of total billed charges 545.14 545.14 other OPPS APC 545.14 545.14 other OPPS APC 545.14 27.63 150.62 percent of total billed charges 545.14 545.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC PERFORMA PEBAX POLYCARBONATE NYLON PIGTAIL CURVE L100 CM OD5 FR PERIPHERAL 2 SIDEHOLE RADIOPAQUE VESSEL SIZING STERILE LATEX FREE ACCEPTS .035 IN GUIDEWIRE SUP-510035AVS20PIG CDM 0270 RC outpatient 234 234 234 74 173.16 percent of total billed charges 234 93 189.54 percent of total billed charges 234 234 other OPPS APC 234 234 other OPPS APC 234 27.63 64.65 percent of total billed charges 234 234 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING COMPRESSION CAP NYLON SMALL REGULAR KNEE HIGH ANTIEMBOLISM INSPECTION TOE LATEX FREE NATURAL SUP-511 CDM 270009044 LOCAL 0270 RC outpatient 4.32 4.32 4.32 74 3.2 percent of total billed charges 4.32 93 3.5 percent of total billed charges 4.32 4.32 other OPPS APC 4.32 4.32 other OPPS APC 4.32 27.63 1.19 percent of total billed charges 4.32 4.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAD PREP WEBCOL 70% ISOPROPYL ALCOHOL LARGE L3.25 IN X W1.75 IN 2 PLY NONWOVEN PREMIUM SATURATE STERILE LATEX FREE SUP-5110 CDM 0270 RC outpatient 0.03 0.03 0.03 74 0.02 percent of total billed charges 0.03 93 0.02 percent of total billed charges 0.03 0.03 other OPPS APC 0.03 0.03 other OPPS APC 0.03 27.63 0.01 percent of total billed charges 0.03 0.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PILLOW PATIENT L 27 IN X W21 IN 18 OZ REUSABLE BLUE SUP-51108-101/24 CDM 0270 RC outpatient 7.7 7.7 7.7 74 5.7 percent of total billed charges 7.7 93 6.24 percent of total billed charges 7.7 7.7 other OPPS APC 7.7 7.7 other OPPS APC 7.7 27.63 2.13 percent of total billed charges 7.7 7.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHIELD RADIOLOGY LEG COVER SUP-5110AO CDM 0270 RC outpatient 152.65 152.65 152.65 74 112.96 percent of total billed charges 152.65 93 123.65 percent of total billed charges 152.65 152.65 other OPPS APC 152.65 152.65 other OPPS APC 152.65 27.63 42.18 percent of total billed charges 152.65 152.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING MYOPORE SILICONE L54 CM ENDOCARDIUM BIPOLAR ACTIVE FIXATION IS-1 VS-1 SUP-511212 CDM 275001005 LOCAL 0275 RC outpatient 780 780 780 57 444.6 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 51 397.8 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW GLOBUS CREO 6.5MM X 40MM SUP-5119.1640 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CREO L40 MM OD6.5 MM SPINE PREASSEMBLE THREAD SUP-5119.1642 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CREO L45 MM OD6.5 MM SPINE MULTIAXIAL SUP-5119.1645 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CREO 6.5 45MM SUP-5119.1647 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CREO L50 MM OD6.5 MM SPINE PREASSEMBLE 5.5 MM ROD SUP-5119.1650 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CREO L50 MM OD6.5 MM SPINE PREASSEMBLE THREAD SUP-5119.1652 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CREO L55 MM OD6.5 MM SPINE PREASSEMBLE 5.5 MM ROD SUP-5119.1655 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CREO L55 MM OD6.5 MM SPINE PREASSEMBLE THREAD SUP-5119.1657 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CREO L60 MM OD6.5 MM SPINE PREASSEMBLE 5.5 MM ROD SUP-5119.1660 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CREO 7.5 40MM SUP-5119.1742 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CREO L35 MM OD6-5 MM SPINE CORTICAL PREASSEMBLE 5.5 MM ROD SUP-5119.3437 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CREO L40 MM OD6-5 MM SPINE CORTICAL PREASSEMBLE 5.5 MM ROD SUP-5119.3442 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CREO L45 MM OD6.5 MM SPINE REDUCTION PREASSEMBLE STERILE 5.5 MM ROD SUP-5119.6645 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CREO L50 MM OD6.5 MM SPINE REDUCTION PREASSEMBLE STERILE 5.5 MM ROD SUP-5119.6650 CDM 270010020 LOCAL 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING COMPRESSION CAP NYLON SMALL LONG KNEE HIGH ANTIEMBOLISM LATEX FREE NATURAL SUP-512 CDM 270009044 LOCAL 0270 RC outpatient 4.32 4.32 4.32 74 3.2 percent of total billed charges 4.32 93 3.5 percent of total billed charges 4.32 4.32 other OPPS APC 4.32 4.32 other OPPS APC 4.32 27.63 1.19 percent of total billed charges 4.32 4.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR METAL CUTTING HELIOCOIDAL RASP 3.2 X 18.3 MM SUP-5120080030 CDM 0270 RC outpatient 347.31 347.31 347.31 74 257.01 percent of total billed charges 347.31 93 281.32 percent of total billed charges 347.31 347.31 other OPPS APC 347.31 347.31 other OPPS APC 347.31 27.63 95.96 percent of total billed charges 347.31 347.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR METAL CUTTING DIAMOND DISC 25.4 X 0.8 MM SUP-5120130250 CDM 0270 RC outpatient 337.56 337.56 337.56 74 249.79 percent of total billed charges 337.56 93 273.42 percent of total billed charges 337.56 337.56 other OPPS APC 337.56 337.56 other OPPS APC 337.56 27.63 93.27 percent of total billed charges 337.56 337.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRAP ADHERENT DERMICEL SILK 8 HOLE SHEET NONSTERILE SUP-5129 CDM outpatient 4.25 4.25 4.25 4.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR ENDOSCOPIC ENDOPATH BLADELESS 10 TO 12MM SUP-512HT CDM 0270 RC outpatient 167.81 167.81 167.81 74 124.18 percent of total billed charges 167.81 93 135.93 percent of total billed charges 167.81 167.81 other OPPS APC 167.81 167.81 other OPPS APC 167.81 27.63 46.37 percent of total billed charges 167.81 167.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET ADMINISTRATION MULTI-AD PVC L41 IN 10 ML INTRAVENOUS 2 CHECK VALVE LUER LOCK SYRINGE UNIVERSAL SPIKE DEHP FREE STERILE LATEX FREE SUP-513506 CDM 0270 RC outpatient 36.76 36.76 36.76 74 27.2 percent of total billed charges 36.76 93 29.78 percent of total billed charges 36.76 36.76 other OPPS APC 36.76 36.76 other OPPS APC 36.76 27.63 10.16 percent of total billed charges 36.76 36.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT GASTROSTOMY LAP J SILICONE OD10 FR BROWN MUELLER T FASTENER NONSTERILE LATEX FREE SUP-51442 CDM 0270 RC outpatient 488.8 488.8 488.8 74 361.71 percent of total billed charges 488.8 93 395.93 percent of total billed charges 488.8 488.8 other OPPS APC 488.8 488.8 other OPPS APC 488.8 27.63 135.06 percent of total billed charges 488.8 488.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT TITAN CAGE CERVICAL SMALL 8MM SUP-5146-1208 CDM 270010020 LOCAL 0270 RC outpatient 8572.2 8572.2 8572.2 74 6343.43 percent of total billed charges 8572.2 93 6943.48 percent of total billed charges 8572.2 8572.2 other OPPS APC 8572.2 8572.2 other OPPS APC 8572.2 27.63 2368.5 percent of total billed charges 8572.2 8572.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET EXTERNAL FIXATION MONOTUBE TRIAX L310 MM X W130 MM X H36 MM OD15 MM WRIST T WRENCH PIN CLAMP CARBON FIBER TUBE SOFT TISSUE PROTECTOR PIN DRIVER STERILE YELLOW SUP-5150-9-960 CDM 0270 RC outpatient 4172.53 4172.53 4172.53 74 3087.67 percent of total billed charges 4172.53 93 3379.75 percent of total billed charges 4172.53 4172.53 other OPPS APC 4172.53 4172.53 other OPPS APC 4172.53 27.63 1152.87 percent of total billed charges 4172.53 4172.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC VERITY ADX XL SR M/S THK6 MM W52 MM X H42 MM 11 ML 23.5 GM ATRIUM VENTRICLE 1 CHAMBER RATE RESPONSIVE UNIPOLAR SUP-5157M/S D CDM 0275 RC outpatient 4927.5 4927.5 4927.5 57 2808.68 percent of total billed charges 4927.5 93 3991.28 percent of total billed charges 4927.5 4927.5 other OPPS APC 4927.5 4927.5 other OPPS APC 4927.5 51 2513.03 percent of total billed charges 4927.5 4927.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STYLET LEAD LOCKING KIT SIZE 1 SUP-518-018 CDM 0481 RC outpatient 1599 1599 1599 74 1183.26 percent of total billed charges 1599 93 1295.19 percent of total billed charges 1599 1599 other OPPS APC 1599 1599 other OPPS APC 1599 51 815.49 percent of total billed charges 1599 1599 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING QUICK-CROSS .014 IN 15 MM SPACE L135 CM OD1.5 FR RADIOPAQUE MARKER SEAMLESS LOW PROFILE TAPER TIP GUIDEWIRE SUP-518-032 CDM 0270 RC outpatient 434.2 434.2 434.2 74 321.31 percent of total billed charges 434.2 93 351.7 percent of total billed charges 434.2 434.2 other OPPS APC 434.2 434.2 other OPPS APC 434.2 27.63 119.97 percent of total billed charges 434.2 434.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING QUICK-CROSS .018 IN L135 CM OD3.4-2.3 FR RADIOPAQUE MARKER GUIDEWIRE SHAFT INJECTION PRESSURE INFUSION SUP-518-034 CDM 0270 RC outpatient 434.2 434.2 434.2 74 321.31 percent of total billed charges 434.2 93 351.7 percent of total billed charges 434.2 434.2 other OPPS APC 434.2 434.2 other OPPS APC 434.2 27.63 119.97 percent of total billed charges 434.2 434.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING QUICK-CROSS .035 IN 50 MM SPACE L135 CM OD3.1 FR RADIOPAQUE MARKER SEAMLESS LOW PROFILE TAPER TIP GUIDEWIRE SUP-518-037 CDM 0270 RC outpatient 434.2 434.2 434.2 74 321.31 percent of total billed charges 434.2 93 351.7 percent of total billed charges 434.2 434.2 other OPPS APC 434.2 434.2 other OPPS APC 434.2 27.63 119.97 percent of total billed charges 434.2 434.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT LLD E SUP-518-039 CDM 0481 RC outpatient 1490.67 1490.67 1490.67 74 1103.1 percent of total billed charges 1490.67 93 1207.44 percent of total billed charges 1490.67 1490.67 other OPPS APC 1490.67 1490.67 other OPPS APC 1490.67 51 760.24 percent of total billed charges 1490.67 1490.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE LEAD LOCKING LLD 65CM .015-.023IN PLATINUM IRIDIUM DISPOSABLE 19LB LOW PROFILE RADIOPAQUE SUP-518-062 CDM 0481 RC outpatient 1599 1599 1599 74 1183.26 percent of total billed charges 1599 93 1295.19 percent of total billed charges 1599 1599 other OPPS APC 1599 1599 other OPPS APC 1599 51 815.49 percent of total billed charges 1599 1599 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STYLET LEAD LOCKING KIT SIZE 2 LLD SUP-518019 CDM 0481 RC outpatient 1599 1599 1599 74 1183.26 percent of total billed charges 1599 93 1295.19 percent of total billed charges 1599 1599 other OPPS APC 1599 1599 other OPPS APC 1599 51 815.49 percent of total billed charges 1599 1599 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE LEAD LOCKING SIZE 3 LLD SUP-518020 CDM 0481 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 51 729.3 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ACCESSORY LIMB LEAD LOCKING DEVICE SUP-518027 CDM 0270 RC outpatient 442 442 442 74 327.08 percent of total billed charges 442 93 358.02 percent of total billed charges 442 442 other OPPS APC 442 442 other OPPS APC 442 27.63 122.12 percent of total billed charges 442 442 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY CARPENTIER-EDWARDS PHYSIO II OD26 MM MITRAL SUP-5200M26 CDM 0270 RC outpatient 6760 6760 6760 74 5002.4 percent of total billed charges 6760 93 5475.6 percent of total billed charges 6760 6760 other OPPS APC 6760 6760 other OPPS APC 6760 27.63 1867.79 percent of total billed charges 6760 6760 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY CARPENTIER-EDWARDS PHYSIO II OD28 MM MITRAL SUP-5200M28 CDM 0270 RC outpatient 6760 6760 6760 74 5002.4 percent of total billed charges 6760 93 5475.6 percent of total billed charges 6760 6760 other OPPS APC 6760 6760 other OPPS APC 6760 27.63 1867.79 percent of total billed charges 6760 6760 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY CARPENTIER-EDWARDS PHYSIO II OD30 MM MITRAL SUP-5200M30 CDM 0270 RC outpatient 6760 6760 6760 74 5002.4 percent of total billed charges 6760 93 5475.6 percent of total billed charges 6760 6760 other OPPS APC 6760 6760 other OPPS APC 6760 27.63 1867.79 percent of total billed charges 6760 6760 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY CARPENTIER-EDWARDS PHYSIO II OD32 MM MITRAL SUP-5200M32 CDM 0270 RC outpatient 6760 6760 6760 74 5002.4 percent of total billed charges 6760 93 5475.6 percent of total billed charges 6760 6760 other OPPS APC 6760 6760 other OPPS APC 6760 27.63 1867.79 percent of total billed charges 6760 6760 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY CARPENTIER-EDWARDS PHYSIO II OD34 MM MITRAL SUP-5200M34 CDM 0270 RC outpatient 6760 6760 6760 74 5002.4 percent of total billed charges 6760 93 5475.6 percent of total billed charges 6760 6760 other OPPS APC 6760 6760 other OPPS APC 6760 27.63 1867.79 percent of total billed charges 6760 6760 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY CARPENTIER-EDWARDS PHYSIO II 36MM COCR SILICONE POLYESTER STERILE MITRAL HOLDER SUP-5200M36 CDM 0270 RC outpatient 6760 6760 6760 74 5002.4 percent of total billed charges 6760 93 5475.6 percent of total billed charges 6760 6760 other OPPS APC 6760 6760 other OPPS APC 6760 27.63 1867.79 percent of total billed charges 6760 6760 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY CARPENTIER-EDWARDS PHYSIO II OD38 MM MITRAL SUP-5200M38 CDM 0270 RC outpatient 6760 6760 6760 74 5002.4 percent of total billed charges 6760 93 5475.6 percent of total billed charges 6760 6760 other OPPS APC 6760 6760 other OPPS APC 6760 27.63 1867.79 percent of total billed charges 6760 6760 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SIDE BY SIDE4MMX12MM SUP-520112 CDM 270010020 LOCAL 0270 RC outpatient 2457 2457 2457 74 1818.18 percent of total billed charges 2457 93 1990.17 percent of total billed charges 2457 2457 other OPPS APC 2457 2457 other OPPS APC 2457 27.63 678.87 percent of total billed charges 2457 2457 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL DOUBLE-J SILICONE PTFE .028 IN L26 CM L100 CM OD6 FR 1 STEP INSERT PUSH CATHETER TRAIL SUTURE RADIOPAQUE CLOSED TIP STERILE DISPOSABLE SUP-5202100 CDM 0270 RC outpatient 508.2 508.2 508.2 74 376.07 percent of total billed charges 508.2 93 411.64 percent of total billed charges 508.2 508.2 other OPPS APC 508.2 508.2 other OPPS APC 508.2 27.63 140.42 percent of total billed charges 508.2 508.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESUSCITATOR MANUAL SPUR II SEBS ADULT 5 L40 IN OD30 MM MEDIUM MASK O2 RESERVOIR BAG VALVE LATEX FREE DISPOSABLE SUP-520211000 CDM 0270 RC outpatient 15.54 15.54 15.54 74 11.5 percent of total billed charges 15.54 93 12.59 percent of total billed charges 15.54 15.54 other OPPS APC 15.54 15.54 other OPPS APC 15.54 27.63 4.29 percent of total billed charges 15.54 15.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL DOUBLE-J SILICONE PTFE .028 IN L28 CM L100 CM OD6 FR 1 STEP INSERT PUSH CATHETER TRAIL SUTURE RADIOPAQUE CLOSED TIP STERILE DISPOSABLE SUP-5202200 CDM 0270 RC outpatient 508.2 508.2 508.2 74 376.07 percent of total billed charges 508.2 93 411.64 percent of total billed charges 508.2 508.2 other OPPS APC 508.2 508.2 other OPPS APC 508.2 27.63 140.42 percent of total billed charges 508.2 508.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL DOUBLE-J SILICONE PTFE .028 IN L24 CM L100 CM OD6 FR 1 STEP INSERT PUSH CATHETER TRAIL SUTURE RADIOPAQUE CLOSED TIP STERILE DISPOSABLE SUP-5202800 CDM 0270 RC outpatient 508.2 508.2 508.2 74 376.07 percent of total billed charges 508.2 93 411.64 percent of total billed charges 508.2 508.2 other OPPS APC 508.2 508.2 other OPPS APC 508.2 27.63 140.42 percent of total billed charges 508.2 508.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN CENTER THREADED TRACTION SUP-5204-090-28 CDM 0270 RC outpatient 511.03 511.03 511.03 74 378.16 percent of total billed charges 511.03 93 413.93 percent of total billed charges 511.03 511.03 other OPPS APC 511.03 511.03 other OPPS APC 511.03 27.63 141.2 percent of total billed charges 511.03 511.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUTTON SUTURE POLYPROPYLENE OD14 MM TENDOR REPAIR SUP-520G CDM 0270 RC outpatient 6.99 6.99 6.99 74 5.17 percent of total billed charges 6.99 93 5.66 percent of total billed charges 6.99 6.99 other OPPS APC 6.99 6.99 other OPPS APC 6.99 27.63 1.93 percent of total billed charges 6.99 6.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING COMPRESSION CAP NYLON MEDIUM REGULAR KNEE HIGH COOL LIGHTWEIGHT DURABLE FLOATING DESIGN LATEX FREE NATURAL SUP-521 CDM 270009044 LOCAL 0270 RC outpatient 4.32 4.32 4.32 74 3.2 percent of total billed charges 4.32 93 3.5 percent of total billed charges 4.32 4.32 other OPPS APC 4.32 4.32 other OPPS APC 4.32 27.63 1.19 percent of total billed charges 4.32 4.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SIDE BY SIDE6MMX10MM SUP-521110 CDM 270010020 LOCAL 0270 RC outpatient 2457 2457 2457 74 1818.18 percent of total billed charges 2457 93 1990.17 percent of total billed charges 2457 2457 other OPPS APC 2457 2457 other OPPS APC 2457 27.63 678.87 percent of total billed charges 2457 2457 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SIDE BY SIDE6MMX12MM SUP-521112 CDM 270010020 LOCAL 0270 RC outpatient 2457 2457 2457 74 1818.18 percent of total billed charges 2457 93 1990.17 percent of total billed charges 2457 2457 other OPPS APC 2457 2457 other OPPS APC 2457 27.63 678.87 percent of total billed charges 2457 2457 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISPOSABLE REGISTRATION MARKER O.R. SUP-52152 CDM outpatient 1.21 1.21 1.21 1.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING COMPRESSION CAP NYLON MEDIUM LONG KNEE HIGH ANTIEMBOLISM LATEX FREE NATURAL SUP-522 CDM 270009044 LOCAL 0270 RC outpatient 4.32 4.32 4.32 74 3.2 percent of total billed charges 4.32 93 3.5 percent of total billed charges 4.32 4.32 other OPPS APC 4.32 4.32 other OPPS APC 4.32 27.63 1.19 percent of total billed charges 4.32 4.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER 28 TROCAR SUP-522228 CDM 270009135 LOCAL 0270 RC outpatient 17.16 17.16 17.16 74 12.7 percent of total billed charges 17.16 93 13.9 percent of total billed charges 17.16 17.16 other OPPS APC 17.16 17.16 other OPPS APC 17.16 27.63 4.74 percent of total billed charges 17.16 17.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SELF DRILLING LAMINA 2.7MM X 5MM SUP-522705 CDM 270010020 LOCAL 0270 RC outpatient 273 273 273 74 202.02 percent of total billed charges 273 93 221.13 percent of total billed charges 273 273 other OPPS APC 273 273 other OPPS APC 273 27.63 75.43 percent of total billed charges 273 273 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SELF DRILLING LAMINA 2.7MM X 7MM SUP-522707 CDM 270010020 LOCAL 0270 RC outpatient 273 273 273 74 202.02 percent of total billed charges 273 93 221.13 percent of total billed charges 273 273 other OPPS APC 273 273 other OPPS APC 273 27.63 75.43 percent of total billed charges 273 273 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM GASTRIC LAVAGE VISIGI 3D OD36 FR SELECTION VALVE SHORT HOLE BYPASS SUP-5236S CDM 0270 RC outpatient 507.52 507.52 507.52 74 375.56 percent of total billed charges 507.52 93 411.09 percent of total billed charges 507.52 507.52 other OPPS APC 507.52 507.52 other OPPS APC 507.52 27.63 140.23 percent of total billed charges 507.52 507.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP INTERNAL WECK HEMOCLIP SM CHEVRON HEART TAN TITANIUM DISPOSABLE STERILE LF LIGATE TRIANGULATE CROSS SECTION WIRE SUP-523835 CDM 0270 RC outpatient 8.87 8.87 8.87 74 6.56 percent of total billed charges 8.87 93 7.18 percent of total billed charges 8.87 8.87 other OPPS APC 8.87 8.87 other OPPS APC 8.87 27.63 2.45 percent of total billed charges 8.87 8.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE REVERE L35 MM OD6.5 MM SPINE REDUCTION SUP-524.463 CDM 270010020 LOCAL 0270 RC outpatient 3465.8 3465.8 3465.8 74 2564.69 percent of total billed charges 3465.8 93 2807.3 percent of total billed charges 3465.8 3465.8 other OPPS APC 3465.8 3465.8 other OPPS APC 3465.8 27.63 957.6 percent of total billed charges 3465.8 3465.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE REVERE L40 MM OD6.5 MM SPINE REDUCTION SUP-524.464 CDM 270010020 LOCAL 0270 RC outpatient 3465.8 3465.8 3465.8 74 2564.69 percent of total billed charges 3465.8 93 2807.3 percent of total billed charges 3465.8 3465.8 other OPPS APC 3465.8 3465.8 other OPPS APC 3465.8 27.63 957.6 percent of total billed charges 3465.8 3465.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLASTIC POSTS FOR INST CONTAINER SUP-5241 CDM outpatient 26 26 26 26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRAP POSITIONING TECLIN L19 IN X W3.5 IN STIRRUP SLIP RING NONSTERILE LATEX FREE DISPOSABLE SUP-52712 CDM 0270 RC outpatient 8.11 8.11 8.11 74 6 percent of total billed charges 8.11 93 6.57 percent of total billed charges 8.11 8.11 other OPPS APC 8.11 8.11 other OPPS APC 8.11 27.63 2.24 percent of total billed charges 8.11 8.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL ARTHREX UNIVERS REVERS 10 SHOULDER STERILE SUP-52733 CDM C1776 HCPCS 0278 RC outpatient 3638.83 3638.83 3638.83 57 2074.13 percent of total billed charges 3638.83 93 2947.45 percent of total billed charges 3638.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3638.83 other OPPS APC 3638.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3638.83 other OPPS APC 3638.83 51 1855.8 percent of total billed charges 3638.83 3638.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK BATTERY SCREWDRIVER STERILE SINGLE USE SUP-530.407.01S CDM 270010013 LOCAL 0270 RC outpatient 405.7 405.7 405.7 74 300.22 percent of total billed charges 405.7 93 328.62 percent of total billed charges 405.7 405.7 other OPPS APC 405.7 405.7 other OPPS APC 405.7 27.63 112.09 percent of total billed charges 405.7 405.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BLUE LINE L87 MM OD12.4 MM ID9.0 MM CUFF SOFT FLANGE STERILE LATEX FREE DISPOSABLE SUP-530090 CDM 270009133 LOCAL 0270 RC outpatient 36.61 36.61 36.61 74 27.09 percent of total billed charges 36.61 93 29.65 percent of total billed charges 36.61 36.61 other OPPS APC 36.61 36.61 other OPPS APC 36.61 27.63 10.12 percent of total billed charges 36.61 36.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW SAGITTAL HEAVY DUTY SUP-5301110051 CDM 0270 RC outpatient 61.18 61.18 61.18 74 45.27 percent of total billed charges 61.18 93 49.56 percent of total billed charges 61.18 61.18 other OPPS APC 61.18 61.18 other OPPS APC 61.18 27.63 16.9 percent of total billed charges 61.18 61.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INTERVENTIONAL SUPERCROSS PTFE HYDROPHILIC 45D .014IN MICRO L 130CM L 40 CM OD 2.1-2.5 FR ID .017-.021 IN DISTAL TIP FLEXIBLE KINK RESISTANT STEERABLE SUP-5302 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INTERVENTIONAL SUPERCROSS PTFE HYDROPHILIC 45D .014IN MICRO L 130CM L 40 CM OD 2.1-2.5 FR ID .017-.021 IN DISTAL TIP FLEXIBLE KINK RESISTANT STEERABLE SUP-5304 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM STRAIGHT LOW PROFILE CRANIOMAXILLOFACIAL 16 HOLE SUP-5305164 CDM 0270 RC outpatient 635.7 635.7 635.7 74 470.42 percent of total billed charges 635.7 93 514.92 percent of total billed charges 635.7 635.7 other OPPS APC 635.7 635.7 other OPPS APC 635.7 27.63 175.64 percent of total billed charges 635.7 635.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM L12 MM CRANIOMAXILLOFACIAL 2 HOLE LOW PROFILE BAR 1.5 MM SCREW SUP-5305212 CDM 0270 RC outpatient 296.4 296.4 296.4 74 219.34 percent of total billed charges 296.4 93 240.08 percent of total billed charges 296.4 296.4 other OPPS APC 296.4 296.4 other OPPS APC 296.4 27.63 81.9 percent of total billed charges 296.4 296.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM L16 MM CRANIOMAXILLOFACIAL 2 HOLE LOW PROFILE BAR 1.5 MM SCREW SUP-5305216 CDM 0270 RC outpatient 354.74 354.74 354.74 74 262.51 percent of total billed charges 354.74 93 287.34 percent of total billed charges 354.74 354.74 other OPPS APC 354.74 354.74 other OPPS APC 354.74 27.63 98.01 percent of total billed charges 354.74 354.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 3D BOX CRANIOMAXILLOFACIAL 2 X 2 HOLE LOW PROFILE 1.5 MM SCREW SUP-5305228 CDM 0270 RC outpatient 443.4 443.4 443.4 74 328.12 percent of total billed charges 443.4 93 359.15 percent of total billed charges 443.4 443.4 other OPPS APC 443.4 443.4 other OPPS APC 443.4 27.63 122.51 percent of total billed charges 443.4 443.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 3D LARGE BOX CRANIOMAXILLOFACIAL 2 X 2 HOLE LOW PROFILE 1.5 MM SCREW SUP-5305240 CDM 0270 RC outpatient 711.8 711.8 711.8 74 526.73 percent of total billed charges 711.8 93 576.56 percent of total billed charges 711.8 711.8 other OPPS APC 711.8 711.8 other OPPS APC 711.8 27.63 196.67 percent of total billed charges 711.8 711.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM L6 MM CRANIUM 4 HOLE LOW PROFILE BAR 1.5 MM SCREW SUP-5305406 CDM 0270 RC outpatient 265.2 265.2 265.2 74 196.25 percent of total billed charges 265.2 93 214.81 percent of total billed charges 265.2 265.2 other OPPS APC 265.2 265.2 other OPPS APC 265.2 27.63 73.27 percent of total billed charges 265.2 265.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER BURR HOLE TITANIUM OD7 MM CRANIOMAXILLOFACIAL LOW PROFILE TAB LATEX FREE 1.5 MM SCREW SUP-5305507 CDM 0270 RC outpatient 501.15 501.15 501.15 74 370.85 percent of total billed charges 501.15 93 405.93 percent of total billed charges 501.15 501.15 other OPPS APC 501.15 501.15 other OPPS APC 501.15 27.63 138.47 percent of total billed charges 501.15 501.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER BURR HOLE TITANIUM MEDIUM OD10 MM CRANIOMAXILLOFACIAL LOW PROFILE TAB LATEX FREE 1.5 MM SCREW SUP-5305510 CDM 0270 RC outpatient 501.15 501.15 501.15 74 370.85 percent of total billed charges 501.15 93 405.93 percent of total billed charges 501.15 501.15 other OPPS APC 501.15 501.15 other OPPS APC 501.15 27.63 138.47 percent of total billed charges 501.15 501.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER BURR HOLE TITANIUM OD14 MM CRANIOMAXILLOFACIAL LOW PROFILE TAB LATEX FREE 1.5 MM SCREW SUP-5305514 CDM 0270 RC outpatient 600.5 600.5 600.5 74 444.37 percent of total billed charges 600.5 93 486.41 percent of total billed charges 600.5 600.5 other OPPS APC 600.5 600.5 other OPPS APC 600.5 27.63 165.92 percent of total billed charges 600.5 600.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER BURR HOLE TITANIUM OD20 MM CRANIOMAXILLOFACIAL LOW PROFILE TAB LATEX FREE SUP-5305520 CDM 0270 RC outpatient 663.03 663.03 663.03 74 490.64 percent of total billed charges 663.03 93 537.05 percent of total billed charges 663.03 663.03 other OPPS APC 663.03 663.03 other OPPS APC 663.03 27.63 183.2 percent of total billed charges 663.03 663.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE GAP TITANIUM 2Y LOW PROFILE L8 MM CRANIOMAXILLOFACIAL 6 HOLE SUP-5305608 CDM 0270 RC outpatient 618.44 618.44 618.44 74 457.65 percent of total billed charges 618.44 93 500.94 percent of total billed charges 618.44 618.44 other OPPS APC 618.44 618.44 other OPPS APC 618.44 27.63 170.87 percent of total billed charges 618.44 618.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE GAP TITANIUM SMALL LOW PROFILE CRANIOMAXILLOFACIAL SUP-5305612 CDM 0270 RC outpatient 737.46 737.46 737.46 74 545.72 percent of total billed charges 737.46 93 597.34 percent of total billed charges 737.46 737.46 other OPPS APC 737.46 737.46 other OPPS APC 737.46 27.63 203.76 percent of total billed charges 737.46 737.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM LARGE CRANIOMAXILLOFACIAL LOW PROFILE GAP SUP-5305622 CDM 0270 RC outpatient 727.35 727.35 727.35 74 538.24 percent of total billed charges 727.35 93 589.15 percent of total billed charges 727.35 727.35 other OPPS APC 727.35 727.35 other OPPS APC 727.35 27.63 200.97 percent of total billed charges 727.35 727.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM X LOW PROFILE CRANIOMAXILLOFACIAL SUP-5305630 CDM 0270 RC outpatient 553.8 553.8 553.8 74 409.81 percent of total billed charges 553.8 93 448.58 percent of total billed charges 553.8 553.8 other OPPS APC 553.8 553.8 other OPPS APC 553.8 27.63 153.01 percent of total billed charges 553.8 553.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LOW PROFILE 8 HOLE SUP-5305804 CDM 0270 RC outpatient 360.75 360.75 360.75 74 266.96 percent of total billed charges 360.75 93 292.21 percent of total billed charges 360.75 360.75 other OPPS APC 360.75 360.75 other OPPS APC 360.75 27.63 99.68 percent of total billed charges 360.75 360.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INTERVENTIONAL SUPERCROSS PTFE HYDROPHILIC 45D .014IN MICRO L 130CM L 40 CM OD 2.1-2.5 FR ID .017-.021 IN DISTAL TIP FLEXIBLE KINK RESISTANT STEERABLE SUP-5306 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM L12 MM CRANIOMAXILLOFACIAL 2 HOLE BAR EXTRA RIGID LOW PROFILE 1.5 MM SCREW SUP-5306212 CDM 0270 RC outpatient 252.04 252.04 252.04 74 186.51 percent of total billed charges 252.04 93 204.15 percent of total billed charges 252.04 252.04 other OPPS APC 252.04 252.04 other OPPS APC 252.04 27.63 69.64 percent of total billed charges 252.04 252.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INTERVENTIONAL SUPERCROSS PTFE HYDROPHILIC 45D .014IN MICRO L 130CM L 40 CM OD 2.1-2.5 FR ID .017-.021 IN DISTAL TIP FLEXIBLE KINK RESISTANT STEERABLE SUP-5308 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING COMPRESSION CAP NYLON LARGE REGULAR KNEE HIGH ANTIEMBOLISM LATEX FREE NATURAL SUP-531 CDM 270009044 LOCAL 0270 RC outpatient 4.32 4.32 4.32 74 3.2 percent of total billed charges 4.32 93 3.5 percent of total billed charges 4.32 4.32 other OPPS APC 4.32 4.32 other OPPS APC 4.32 27.63 1.19 percent of total billed charges 4.32 4.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DRILL EXACTECHGPS OD2-3.2 MM REVERSE DISPOSABLE SUP-531-20-00 CDM 270010030 LOCAL 0270 RC outpatient 851.76 851.76 851.76 74 630.3 percent of total billed charges 851.76 93 689.93 percent of total billed charges 851.76 851.76 other OPPS APC 851.76 851.76 other OPPS APC 851.76 27.63 235.34 percent of total billed charges 851.76 851.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION HEXAGON KIT SUP-531-78-20 CDM 270010030 LOCAL 0270 RC outpatient 234 234 234 74 173.16 percent of total billed charges 234 93 189.54 percent of total billed charges 234 234 other OPPS APC 234 234 other OPPS APC 234 27.63 64.65 percent of total billed charges 234 234 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIGMOIDOSCOPE RIGID KLEENSPEC HALOGEN 35V L25 CM OD19 MM HIGHLY VISIBLE GRADUATION EXAM OBTURATOR ILLUMINATION SYSTEM DISPOSABLE SUP-53130 CDM 0270 RC outpatient 6.34 6.34 6.34 74 4.69 percent of total billed charges 6.34 93 5.14 percent of total billed charges 6.34 6.34 other OPPS APC 6.34 6.34 other OPPS APC 6.34 27.63 1.75 percent of total billed charges 6.34 6.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPECULUM VAGINAL PREMIERPRO PLASTIC MEDIUM 1 HAND ADJUSTABLE WIDE CONTOUR HANDLE LIGHT HEAVY DUTY NONSTERILE LATEX FREE DISPOSABLE GREEN SUP-5314 CDM 0270 RC outpatient 2.53 2.53 2.53 74 1.87 percent of total billed charges 2.53 93 2.05 percent of total billed charges 2.53 2.53 other OPPS APC 2.53 2.53 other OPPS APC 2.53 27.63 0.7 percent of total billed charges 2.53 2.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING COMPRESSION CAP NYLON LARGE LONG KNEE HIGH L18-20 IN OD14-17 IN ODSEC9-10 IN LATEX FREE WHITE SUP-532 CDM 270009044 LOCAL 0270 RC outpatient 4.32 4.32 4.32 74 3.2 percent of total billed charges 4.32 93 3.5 percent of total billed charges 4.32 4.32 other OPPS APC 4.32 4.32 other OPPS APC 4.32 27.63 1.19 percent of total billed charges 4.32 4.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW THK.6 MM L27 MM X W6 MM SMOOTH COARSE TEETH SAGITTAL SLOTTED STERILE SMALL BATTERY DRIVE SUP-532.061S CDM 0270 RC outpatient 154.28 154.28 154.28 74 114.17 percent of total billed charges 154.28 93 124.97 percent of total billed charges 154.28 154.28 other OPPS APC 154.28 154.28 other OPPS APC 154.28 27.63 42.63 percent of total billed charges 154.28 154.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT POSITIONING WILSON L7 IN PATIENT CARE FRAME SUP-5326 CDM 0270 RC outpatient 59.61 59.61 59.61 74 44.11 percent of total billed charges 59.61 93 48.28 percent of total billed charges 59.61 59.61 other OPPS APC 59.61 59.61 other OPPS APC 59.61 27.63 16.47 percent of total billed charges 59.61 59.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL PICC LINE PENINSULA REGIONAL MEDICAL CENTER SUP-532767-001 CDM 270009026 LOCAL 0270 RC outpatient 16.25 16.25 16.25 74 12.03 percent of total billed charges 16.25 93 13.16 percent of total billed charges 16.25 16.25 other OPPS APC 16.25 16.25 other OPPS APC 16.25 27.63 4.49 percent of total billed charges 16.25 16.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC INFINITI THRULUMEN VESTAN JUDKINS RIGHT CORONARY 5 CURVE L100 CM OD5 FR ID.047 IN SELECTIVE RADIOPAQUE DILATE TORQUE CONTROL DISPOSABLE ACCEPTS .038 IN GUIDEWIRE SUP-534-523T CDM 0481 RC outpatient 20.15 20.15 20.15 74 14.91 percent of total billed charges 20.15 93 16.32 percent of total billed charges 20.15 20.15 other OPPS APC 20.15 20.15 other OPPS APC 20.15 51 10.28 percent of total billed charges 20.15 20.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC INFINITI THRULUMEN STANDARD AMPLATZ LEFT 1 CURVE 100CM 5FR VESTAN BRAID ATRAUMATIC SELECTIVE SUP-534-545T CDM 0481 RC outpatient 21.71 21.71 21.71 74 16.07 percent of total billed charges 21.71 93 17.59 percent of total billed charges 21.71 21.71 other OPPS APC 21.71 21.71 other OPPS APC 21.71 51 11.07 percent of total billed charges 21.71 21.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC INFINITI THRULUMEN VESTAN AMPLATZ LEFT 2 CURVE L100 CM OD5 FR ID.048 IN IDSEC.047 IN SELECTIVE RADIOPAQUE THIN WALL DISPOSABLE ACCEPTS .038 IN GUIDEWIRE SUP-534-546T CDM 0481 RC outpatient 21.71 21.71 21.71 74 16.07 percent of total billed charges 21.71 93 17.59 percent of total billed charges 21.71 21.71 other OPPS APC 21.71 21.71 other OPPS APC 21.71 51 11.07 percent of total billed charges 21.71 21.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5F AL3 DIAGNOSTIC CATHETER SUP-534-547T CDM 0481 RC outpatient 22.1 22.1 22.1 74 16.35 percent of total billed charges 22.1 93 17.9 percent of total billed charges 22.1 22.1 other OPPS APC 22.1 22.1 other OPPS APC 22.1 51 11.27 percent of total billed charges 22.1 22.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5F JL4 DIAGNOSTIC CATHETER SUP-534520T CDM 0481 RC outpatient 21.71 21.71 21.71 74 16.07 percent of total billed charges 21.71 93 17.59 percent of total billed charges 21.71 21.71 other OPPS APC 21.71 21.71 other OPPS APC 21.71 51 11.07 percent of total billed charges 21.71 21.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC INFINITI THRULUMEN VESTAN JR6 CURVE L100 CM OD5 FR POSTSTENOTIC SUP-534525T CDM 0481 RC outpatient 22.1 22.1 22.1 74 16.35 percent of total billed charges 22.1 93 17.9 percent of total billed charges 22.1 22.1 other OPPS APC 22.1 22.1 other OPPS APC 22.1 51 11.27 percent of total billed charges 22.1 22.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC INFINITI THRULUMEN AMPLATZ RIGHT 1 MODIFIED CURVE 100CM 5FR .067IN .047IN VESTAN RADIOPAQUE THIN SUP-534541T CDM 0481 RC outpatient 21.71 21.71 21.71 74 16.07 percent of total billed charges 21.71 93 17.59 percent of total billed charges 21.71 21.71 other OPPS APC 21.71 21.71 other OPPS APC 21.71 51 11.07 percent of total billed charges 21.71 21.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC INFINITI THRULUMEN AMPLATZ RIGHT 2 MODIFIED CURVE 100CM 5FR .047IN VESTAN RADIOPAQUE THIN WALL SUP-534543T CDM 0481 RC outpatient 21.71 21.71 21.71 74 16.07 percent of total billed charges 21.71 93 17.59 percent of total billed charges 21.71 21.71 other OPPS APC 21.71 21.71 other OPPS APC 21.71 51 11.07 percent of total billed charges 21.71 21.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC INFINITI THRULUMEN INTERNAL MAMMARY CURVE 100CM 5FR VESTAN RADIOPAQUE THIN WALL TORQUE CONTROL LG SUP-534560T CDM 0481 RC outpatient 21.71 21.71 21.71 74 16.07 percent of total billed charges 21.71 93 17.59 percent of total billed charges 21.71 21.71 other OPPS APC 21.71 21.71 other OPPS APC 21.71 51 11.07 percent of total billed charges 21.71 21.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F AR MOD DIAGNOSTIC CATHETER 100CM SUP-534641T CDM 0481 RC outpatient 22.75 22.75 22.75 74 16.84 percent of total billed charges 22.75 93 18.43 percent of total billed charges 22.75 22.75 other OPPS APC 22.75 22.75 other OPPS APC 22.75 51 11.6 percent of total billed charges 22.75 22.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F MPA2 DIAGNOSTIC CATHETER 100CM SUP-534642T CDM 0481 RC outpatient 21.71 21.71 21.71 74 16.07 percent of total billed charges 21.71 93 17.59 percent of total billed charges 21.71 21.71 other OPPS APC 21.71 21.71 other OPPS APC 21.71 51 11.07 percent of total billed charges 21.71 21.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC INFINITI THRULUMEN VESTAN STAINLESS STEEL AMPLATZ RIGHT 2 MODIFY CURVE L100 CM OD6 FR ODSEC.079 IN ID.057 IN 3 STAGE BRAID RADIOPAQUE SOFT DISPOSABLE ACCEPTS .038 IN GUIDEWIRE SUP-534643T CDM 0481 RC outpatient 21.71 21.71 21.71 74 16.07 percent of total billed charges 21.71 93 17.59 percent of total billed charges 21.71 21.71 other OPPS APC 21.71 21.71 other OPPS APC 21.71 51 11.07 percent of total billed charges 21.71 21.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F AL2 DIAGNOSTIC CATHETER 100CM SUP-534646T CDM 0481 RC outpatient 21.71 21.71 21.71 74 16.07 percent of total billed charges 21.71 93 17.59 percent of total billed charges 21.71 21.71 other OPPS APC 21.71 21.71 other OPPS APC 21.71 51 11.07 percent of total billed charges 21.71 21.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F AL3 DIAGNOSTIC CATHETER 100CM SUP-534647T CDM 0481 RC outpatient 22.1 22.1 22.1 74 16.35 percent of total billed charges 22.1 93 17.9 percent of total billed charges 22.1 22.1 other OPPS APC 22.1 22.1 other OPPS APC 22.1 51 11.27 percent of total billed charges 22.1 22.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC INFINITI VESTAN PIGTAIL CURVE STRAIGHT L110 CM OD6 FR VENTRICULAR 6 SIDEHOLE ACCEPTS .038 IN GUIDEWIRE SUP-534650S CDM 0270 RC outpatient 22.75 22.75 22.75 74 16.84 percent of total billed charges 22.75 93 18.43 percent of total billed charges 22.75 22.75 other OPPS APC 22.75 22.75 other OPPS APC 22.75 27.63 6.29 percent of total billed charges 22.75 22.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F RCB SUP-534670T CDM 0481 RC outpatient 22.1 22.1 22.1 74 16.35 percent of total billed charges 22.1 93 17.9 percent of total billed charges 22.1 22.1 other OPPS APC 22.1 22.1 other OPPS APC 22.1 51 11.27 percent of total billed charges 22.1 22.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC FASTPATH VERITY ADX XL DR M/S OMNISENSE THK6 MM 5 MM 6 MM W52 MM X H45 MM 11 ML 23 GM ATRIUM VENTRICLE 2 CHAMBER RATE RESPONSIVE ACCELEROMETER SENSOR CONNECTOR SUP-5357M/S D CDM 0275 RC outpatient 6480 6480 6480 57 3693.6 percent of total billed charges 6480 93 5248.8 percent of total billed charges 6480 6480 other OPPS APC 6480 6480 other OPPS APC 6480 51 3304.8 percent of total billed charges 6480 6480 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4F JL3.5 CORDIS DIAGNOSTIC CATHETER SUP-538418 CDM 0481 RC outpatient 20.15 20.15 20.15 74 14.91 percent of total billed charges 20.15 93 16.32 percent of total billed charges 20.15 20.15 other OPPS APC 20.15 20.15 other OPPS APC 20.15 51 10.28 percent of total billed charges 20.15 20.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4F JL4 CORDIS DIAGNOSTIC CATHETER SUP-538420 CDM 0481 RC outpatient 162.76 162.76 162.76 74 120.44 percent of total billed charges 162.76 93 131.84 percent of total billed charges 162.76 162.76 other OPPS APC 162.76 162.76 other OPPS APC 162.76 51 83.01 percent of total billed charges 162.76 162.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4F JR4 CORDIS DIAGNOSTIC CATHETER SUP-538421 CDM 0481 RC outpatient 21.71 21.71 21.71 74 16.07 percent of total billed charges 21.71 93 17.59 percent of total billed charges 21.71 21.71 other OPPS APC 21.71 21.71 other OPPS APC 21.71 51 11.07 percent of total billed charges 21.71 21.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4F AR2 CORDIS DIAGNOSTIC CATHETER SUP-538443 CDM 0481 RC outpatient 20.15 20.15 20.15 74 14.91 percent of total billed charges 20.15 93 16.32 percent of total billed charges 20.15 20.15 other OPPS APC 20.15 20.15 other OPPS APC 20.15 51 10.28 percent of total billed charges 20.15 20.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4F AL1 CORDIS DIAGNOSTIC CATHETER SUP-538445 CDM 0481 RC outpatient 20.15 20.15 20.15 74 14.91 percent of total billed charges 20.15 93 16.32 percent of total billed charges 20.15 20.15 other OPPS APC 20.15 20.15 other OPPS APC 20.15 51 10.28 percent of total billed charges 20.15 20.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4F AL2 CORDIS DIAGNOSTIC CATHETER SUP-538446 CDM 0481 RC outpatient 20.15 20.15 20.15 74 14.91 percent of total billed charges 20.15 93 16.32 percent of total billed charges 20.15 20.15 other OPPS APC 20.15 20.15 other OPPS APC 20.15 51 10.28 percent of total billed charges 20.15 20.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4F AL3 CORDIS DIAGNOSTIC CATHETER SUP-538447 CDM 0481 RC outpatient 20.15 20.15 20.15 74 14.91 percent of total billed charges 20.15 93 16.32 percent of total billed charges 20.15 20.15 other OPPS APC 20.15 20.15 other OPPS APC 20.15 51 10.28 percent of total billed charges 20.15 20.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CORDIS 4F 145 PIGTAIL SUP-538453S_45736 CDM 0481 RC outpatient 767 767 767 74 567.58 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 51 391.17 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER HEMODIALYSIS GLIDEPATH POLYURETHANE STRAIGHT L55 CM L50 CM OD14.5 FR STANDARD KIT AIRGUARD VALVED INTRODUCER SYMMETRIC TIP PRELOADED LONG TERM NONSTERILE DISPOSABLE SUP-5393500 CDM 0270 RC outpatient 1138.41 1138.41 1138.41 74 842.42 percent of total billed charges 1138.41 93 922.11 percent of total billed charges 1138.41 1138.41 other OPPS APC 1138.41 1138.41 other OPPS APC 1138.41 27.63 314.54 percent of total billed charges 1138.41 1138.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "3D ORBITAL FLR PLT, RIGHT,SM" SUP-54-04004 CDM 0270 RC outpatient 3554.3 3554.3 3554.3 74 2630.18 percent of total billed charges 3554.3 93 2878.98 percent of total billed charges 3554.3 3554.3 other OPPS APC 3554.3 3554.3 other OPPS APC 3554.3 27.63 982.05 percent of total billed charges 3554.3 3554.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "3D ORBITAL FLR PLT, RIGHT, LG" SUP-54-04005 CDM 0270 RC outpatient 3554.3 3554.3 3554.3 74 2630.18 percent of total billed charges 3554.3 93 2878.98 percent of total billed charges 3554.3 3554.3 other OPPS APC 3554.3 3554.3 other OPPS APC 3554.3 27.63 982.05 percent of total billed charges 3554.3 3554.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "3D ORBITAL FLR PLT, LEFT, SM" SUP-54-04006 CDM 0270 RC outpatient 3554.3 3554.3 3554.3 74 2630.18 percent of total billed charges 3554.3 93 2878.98 percent of total billed charges 3554.3 3554.3 other OPPS APC 3554.3 3554.3 other OPPS APC 3554.3 27.63 982.05 percent of total billed charges 3554.3 3554.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "3D ORBITAL FLR PLT, LEFT, LG" SUP-54-04007 CDM 0270 RC outpatient 3554.3 3554.3 3554.3 74 2630.18 percent of total billed charges 3554.3 93 2878.98 percent of total billed charges 3554.3 3554.3 other OPPS APC 3554.3 3554.3 other OPPS APC 3554.3 27.63 982.05 percent of total billed charges 3554.3 3554.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH GUIDING PINNACLE DESTINATION STAINLESS STEEL PTFE NYLON HYDROPHILIC STRAIGHT L90 CM L60 CM OD8 FR RADIOPAQUE CROSS CUT VALVE SUP-54-89001 CDM 0270 RC outpatient 239.2 239.2 239.2 74 177.01 percent of total billed charges 239.2 93 193.75 percent of total billed charges 239.2 239.2 other OPPS APC 239.2 239.2 other OPPS APC 239.2 27.63 66.09 percent of total billed charges 239.2 239.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT PSL HA D OD48 MM ODSEC49.8 MM HIP SOLID BACK RIM SUP-540-11-48D CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR 50MM 51.8MM HIP SOLID BACK RIM HA TRIDENT PSL E SUP-540-11-50E CDM 270010025 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT PSL HA E OD52 MM HIP SOLID BACK DOME HOLE PLUG SUP-540-11-52E CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT PSL HA F OD54 MM ODSEC55.8 MM HIP SOLID BACK RIM SUP-540-11-54F CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT PSL HA F OD56 MM ODSEC57.8 MM HIP SOLID BACK RIM SUP-540-11-56F CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARTRIDGE OIL MAESTRO CORE SUP-5400-005-000 CDM 0270 RC outpatient 60.05 60.05 60.05 74 44.44 percent of total billed charges 60.05 93 48.64 percent of total billed charges 60.05 60.05 other OPPS APC 60.05 60.05 other OPPS APC 60.05 27.63 16.59 percent of total billed charges 60.05 60.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIFFUSER MAESTRO CORE SUP-5400006000 CDM 0270 RC outpatient 33.36 33.36 33.36 74 24.69 percent of total billed charges 33.36 93 27.02 percent of total billed charges 33.36 33.36 other OPPS APC 33.36 33.36 other OPPS APC 33.36 27.63 9.22 percent of total billed charges 33.36 33.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH CRANIAL UNIVERSAL NEURO 2 MICRO ULTRA THIN 60X60X.1MM BLUE TITANIUM NS LF CRANIOMAXILLOFACIAL SUP-5400262 CDM 0270 RC outpatient 1285.91 1285.91 1285.91 74 951.57 percent of total billed charges 1285.91 93 1041.59 percent of total billed charges 1285.91 1285.91 other OPPS APC 1285.91 1285.91 other OPPS APC 1285.91 27.63 355.3 percent of total billed charges 1285.91 1285.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEIBINGER UNIVERSAL 2 MICRO 60X60X.2MM TITANIUM STERILE LF CRANIOMAXILLOFACIAL MICROMESH 1.2MM SCREW SUP-5400272 CDM 0270 RC outpatient 1260.69 1260.69 1260.69 74 932.91 percent of total billed charges 1260.69 93 1021.16 percent of total billed charges 1260.69 1260.69 other OPPS APC 1260.69 1260.69 other OPPS APC 1260.69 27.63 348.33 percent of total billed charges 1260.69 1260.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DYNAMIC MESH TITANIUM L120 MM X W120 MM X H.3 MM CRANIOMAXILLOFACIAL DYNAMIC MESH MALLEABLE 1/1.2 MM SCREWS SUP-5400343 CDM 0270 RC outpatient 4968.6 4968.6 4968.6 74 3676.76 percent of total billed charges 4968.6 93 4024.57 percent of total billed charges 4968.6 4968.6 other OPPS APC 4968.6 4968.6 other OPPS APC 4968.6 27.63 1372.82 percent of total billed charges 4968.6 4968.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH DYNAMIC TITANIUM LOW PROFILE L120 MM X W120 MM X H.3 MM CRANIOMAXILLOFACIAL MALLEABLE BLUE SUP-5400345 CDM 0270 RC outpatient 5065.32 5065.32 5065.32 74 3748.34 percent of total billed charges 5065.32 93 4102.91 percent of total billed charges 5065.32 5065.32 other OPPS APC 5065.32 5065.32 other OPPS APC 5065.32 27.63 1399.55 percent of total billed charges 5065.32 5065.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH CRANIAL LEIBINGER UNIVERSAL 2 GSP 90X90X.3MM BLUE TITANIUM MIDFACE DYNAMIC 1.7MM SCREW SUP-5400346 CDM 0270 RC outpatient 3146.52 3146.52 3146.52 74 2328.42 percent of total billed charges 3146.52 93 2548.68 percent of total billed charges 3146.52 3146.52 other OPPS APC 3146.52 3146.52 other OPPS APC 3146.52 27.63 869.38 percent of total billed charges 3146.52 3146.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH DYNAMIC TITANIUM STANDARD L200 MM X W200 MM X H.6 MM CRANIOMAXILLOFACIAL 1.2 MM SCREW SUP-5400641 CDM 0270 RC outpatient 14456.5 14456.5 14456.5 74 10697.8 percent of total billed charges 14456.5 93 11709.8 percent of total billed charges 14456.5 14456.5 other OPPS APC 14456.5 14456.5 other OPPS APC 14456.5 27.63 3994.34 percent of total billed charges 14456.5 14456.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH DYNAMIC TITANIUM STANDARD L90 MM X W90 MM X H.6 MM CRANIOMAXILLOFACIAL 1.2 MM SCREW SUP-5400642 CDM 0270 RC outpatient 3146.52 3146.52 3146.52 74 2328.42 percent of total billed charges 3146.52 93 2548.68 percent of total billed charges 3146.52 3146.52 other OPPS APC 3146.52 3146.52 other OPPS APC 3146.52 27.63 869.38 percent of total billed charges 3146.52 3146.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH CRANIAL 120X120X.6MM CRANIOMAXILLOFACIAL DYNAMIC 1/1.2MM SCREWS SUP-5400643 CDM 0270 RC outpatient 5065.32 5065.32 5065.32 74 3748.34 percent of total billed charges 5065.32 93 4102.91 percent of total billed charges 5065.32 5065.32 other OPPS APC 5065.32 5065.32 other OPPS APC 5065.32 27.63 1399.55 percent of total billed charges 5065.32 5065.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH DYNAMIC TITANIUM STANDARD L120 MM X W120 MM X H.6 MM CRANIOMAXILLOFACIAL GOLD SUP-5400645 CDM 0270 RC outpatient 5065.32 5065.32 5065.32 74 3748.34 percent of total billed charges 5065.32 93 4102.91 percent of total billed charges 5065.32 5065.32 other OPPS APC 5065.32 5065.32 other OPPS APC 5065.32 27.63 1399.55 percent of total billed charges 5065.32 5065.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH CRANIAL GSP STANDARD 90X90X.6MM GOLD TITANIUM MIDFACE DYNAMIC 1.7MM SCREW SUP-5400646 CDM 0270 RC outpatient 3146.52 3146.52 3146.52 74 2328.42 percent of total billed charges 3146.52 93 2548.68 percent of total billed charges 3146.52 3146.52 other OPPS APC 3146.52 3146.52 other OPPS APC 3146.52 27.63 869.38 percent of total billed charges 3146.52 3146.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH DYNAMIC TITANIUM STANDARD L200 MM X W200 MM X H.6 MM CRANIOMAXILLOFACIAL GOLD SUP-5400647 CDM 0270 RC outpatient 14456.5 14456.5 14456.5 74 10697.8 percent of total billed charges 14456.5 93 11709.8 percent of total billed charges 14456.5 14456.5 other OPPS APC 14456.5 14456.5 other OPPS APC 14456.5 27.63 3994.34 percent of total billed charges 14456.5 14456.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RAD PADS WITH CUTOUT SUP-5400A-Y CDM 0270 RC outpatient 57.2 57.2 57.2 74 42.33 percent of total billed charges 57.2 93 46.33 percent of total billed charges 57.2 57.2 other OPPS APC 57.2 57.2 other OPPS APC 57.2 27.63 15.8 percent of total billed charges 57.2 57.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COHEN-BENNER CONTACT LENS SUP-54013 CDM 0270 RC outpatient 127.4 127.4 127.4 74 94.28 percent of total billed charges 127.4 93 103.19 percent of total billed charges 127.4 127.4 other OPPS APC 127.4 127.4 other OPPS APC 127.4 27.63 35.2 percent of total billed charges 127.4 127.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORBITAL FLOOR PLATE COMPLEX LARGE .3MM BLUE SUP-5403000 CDM 0270 RC outpatient 88.92 88.92 88.92 74 65.8 percent of total billed charges 88.92 93 72.03 percent of total billed charges 88.92 88.92 other OPPS APC 88.92 88.92 other OPPS APC 88.92 27.63 24.57 percent of total billed charges 88.92 88.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM LARGE L39 MM X W34 MM X H.3 MM ORBITAL FLOOR COMPLEX 1.2 MM SCREW SUP-5403001 CDM 0270 RC outpatient 1638 1638 1638 74 1212.12 percent of total billed charges 1638 93 1326.78 percent of total billed charges 1638 1638 other OPPS APC 1638 1638 other OPPS APC 1638 27.63 452.58 percent of total billed charges 1638 1638 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MED .3MM BLUE TITANIUM UPPER FACE ORBITAL FLOOR BASIC MALLEABLE 1.2MM SCREW SUP-5403002 CDM 0270 RC outpatient 1535.04 1535.04 1535.04 74 1135.93 percent of total billed charges 1535.04 93 1243.38 percent of total billed charges 1535.04 1535.04 other OPPS APC 1535.04 1535.04 other OPPS APC 1535.04 27.63 424.13 percent of total billed charges 1535.04 1535.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM SMALL L20 MM X W18 MM X H.3 MM ORBITAL FLOOR ISOLATED 1.2 MM SCREWS SUP-5403003 CDM 0270 RC outpatient 1467.96 1467.96 1467.96 74 1086.29 percent of total billed charges 1467.96 93 1189.05 percent of total billed charges 1467.96 1467.96 other OPPS APC 1467.96 1467.96 other OPPS APC 1467.96 27.63 405.6 percent of total billed charges 1467.96 1467.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER IMPRESS KA 2 40CM .038 SUP-54038KA2 CDM outpatient 29.74 29.74 29.74 29.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORBITAL FLOOR TEMPLATE LARGE SUP-5404000 CDM 0270 RC outpatient 85.8 85.8 85.8 74 63.49 percent of total billed charges 85.8 93 69.5 percent of total billed charges 85.8 85.8 other OPPS APC 85.8 85.8 other OPPS APC 85.8 27.63 23.71 percent of total billed charges 85.8 85.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LG COMPLEX .4MM GOLD TITANIUM ORBITAL FLOOR 1.2MM SCREW SUP-5404001 CDM 0270 RC outpatient 1638 1638 1638 74 1212.12 percent of total billed charges 1638 93 1326.78 percent of total billed charges 1638 1638 other OPPS APC 1638 1638 other OPPS APC 1638 27.63 452.58 percent of total billed charges 1638 1638 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MED BASIC STANDARD .4MM GOLD TITANIUM ORBITAL FLOOR 1.2MM SCREW SUP-5404002 CDM 0270 RC outpatient 1536.6 1536.6 1536.6 74 1137.08 percent of total billed charges 1536.6 93 1244.65 percent of total billed charges 1536.6 1536.6 other OPPS APC 1536.6 1536.6 other OPPS APC 1536.6 27.63 424.56 percent of total billed charges 1536.6 1536.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP FIXATION TITANIUM CRANIAL 1.5 MM 1.7 MM SCREW SUP-5405100 CDM 270010029 LOCAL 0270 RC outpatient 298.35 298.35 298.35 74 220.78 percent of total billed charges 298.35 93 241.66 percent of total billed charges 298.35 298.35 other OPPS APC 298.35 298.35 other OPPS APC 298.35 27.63 82.43 percent of total billed charges 298.35 298.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROUTER TAPERED 2.3 MM SUP-5407FA2023 CDM 0270 RC outpatient 336.21 336.21 336.21 74 248.8 percent of total billed charges 336.21 93 272.33 percent of total billed charges 336.21 336.21 other OPPS APC 336.21 336.21 other OPPS APC 336.21 27.63 92.89 percent of total billed charges 336.21 336.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROUTER SPIRAL 2.3 MM SUP-5407FA2023SP CDM 0270 RC outpatient 336.21 336.21 336.21 74 248.8 percent of total billed charges 336.21 93 272.33 percent of total billed charges 336.21 336.21 other OPPS APC 336.21 336.21 other OPPS APC 336.21 27.63 92.89 percent of total billed charges 336.21 336.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE STAINLESS STEEL 4-0 V-26 TS L14 IN 2 ARM MONOFILAMENT 2 STRAND BUTTON SUP-540G CDM 0270 RC outpatient 21.9 21.9 21.9 74 16.21 percent of total billed charges 21.9 93 17.74 percent of total billed charges 21.9 21.9 other OPPS APC 21.9 21.9 other OPPS APC 21.9 27.63 6.05 percent of total billed charges 21.9 21.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING COMPRESSION CAP NYLON 19 MMHG REGULAR XL KNEE LENGTH OD18-21 IN ODSEC11-12 IN COOL LIGHTWEIGHT INSPECTION TOE FLOAT DESIGN LATEX FREE GREEN SUP-541 CDM 270009044 LOCAL 0270 RC outpatient 4.32 4.32 4.32 74 3.2 percent of total billed charges 4.32 93 3.5 percent of total billed charges 4.32 4.32 other OPPS APC 4.32 4.32 other OPPS APC 4.32 27.63 1.19 percent of total billed charges 4.32 4.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING COMPRESSION CAP NYLON XL LONG KNEE HIGH LATEX FREE NATURAL SUP-542 CDM 270009044 LOCAL 0270 RC outpatient 4.32 4.32 4.32 74 3.2 percent of total billed charges 4.32 93 3.5 percent of total billed charges 4.32 4.32 other OPPS APC 4.32 4.32 other OPPS APC 4.32 27.63 1.19 percent of total billed charges 4.32 4.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT PSL HA C OD44 MM ODSEC45.8 MM HIP 3 SCREW HOLE CLUSTER RIM SUP-542-11-44C CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT PSL HA D OD46 MM ODSEC47.8 MM HIP 3 SCREW HOLE CLUSTER RIM SUP-542-11-46D CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT PSL HA D OD48 MM ODSEC49.8 MM HIP 3 SCREW HOLE CLUSTER RIM SUP-542-11-48D CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT PSL HA E OD50 MM ODSEC51.8 MM HIP 5 SCREW HOLE CLUSTER RIM SUP-542-11-50E CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT PSL HA E OD52 MM ODSEC53.8 MM HIP 5 SCREW HOLE CLUSTER RIM SUP-542-11-52E CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT PSL HA F OD54 MM ODSEC55.8 MM HIP 5 SCREW HOLE CLUSTER RIM SUP-542-11-54F CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT PSL HA F OD56 MM ODSEC57.8 MM HIP 5 SCREW HOLE CLUSTER RIM SUP-542-11-56F CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT PSL HA G OD58 MM ODSEC59.8 MM HIP 5 SCREW HOLE CLUSTER RIM SUP-542-11-58G CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT PSL HA G OD60 MM ODSEC61.8 MM HIP 5 SCREW HOLE CLUSTER RIM STERILE SUP-542-11-60G CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 NANO 1MM X 2CM SUP-542102 CDM 0270 RC outpatient 6019 6019 6019 74 4454.06 percent of total billed charges 6019 93 4875.39 percent of total billed charges 6019 6019 other OPPS APC 6019 6019 other OPPS APC 6019 27.63 1663.05 percent of total billed charges 6019 6019 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 NANO 1MM X 3CM SUP-542103 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 NANO 1.5MM X 2CM SUP-542152 CDM 0270 RC outpatient 6019 6019 6019 74 4454.06 percent of total billed charges 6019 93 4875.39 percent of total billed charges 6019 6019 other OPPS APC 6019 6019 other OPPS APC 6019 27.63 1663.05 percent of total billed charges 6019 6019 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 NANO 1.5MM X 3CM SUP-542153 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 NANO 1.5MM X 4CM SUP-542154 CDM 0270 RC outpatient 6019 6019 6019 74 4454.06 percent of total billed charges 6019 93 4875.39 percent of total billed charges 6019 6019 other OPPS APC 6019 6019 other OPPS APC 6019 27.63 1663.05 percent of total billed charges 6019 6019 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 ULTRA 2MM X 3CM SUP-542203 CDM 0270 RC outpatient 6214 6214 6214 74 4598.36 percent of total billed charges 6214 93 5033.34 percent of total billed charges 6214 6214 other OPPS APC 6214 6214 other OPPS APC 6214 27.63 1716.93 percent of total billed charges 6214 6214 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 ULTRA 2MM X 4CM SUP-542204 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 ULTRA 2MM X 6CM SUP-542206 CDM 0270 RC outpatient 5967 5967 5967 74 4415.58 percent of total billed charges 5967 93 4833.27 percent of total billed charges 5967 5967 other OPPS APC 5967 5967 other OPPS APC 5967 27.63 1648.68 percent of total billed charges 5967 5967 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 ULTRA 2.5MM X 4CM SUP-542254 CDM 0270 RC outpatient 5967 5967 5967 74 4415.58 percent of total billed charges 5967 93 4833.27 percent of total billed charges 5967 5967 other OPPS APC 5967 5967 other OPPS APC 5967 27.63 1648.68 percent of total billed charges 5967 5967 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 ULTRA 3MM X 4CM SUP-542304 CDM 0270 RC outpatient 5707 5707 5707 74 4223.18 percent of total billed charges 5707 93 4622.67 percent of total billed charges 5707 5707 other OPPS APC 5707 5707 other OPPS APC 5707 27.63 1576.84 percent of total billed charges 5707 5707 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 ULTRA 3MM X 6CM SUP-542306 CDM 0270 RC outpatient 5967 5967 5967 74 4415.58 percent of total billed charges 5967 93 4833.27 percent of total billed charges 5967 5967 other OPPS APC 5967 5967 other OPPS APC 5967 27.63 1648.68 percent of total billed charges 5967 5967 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 ULTRA 3MM X 8CM SUP-542308 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 ULTRA 3MM X 10CM SUP-542310 CDM 0270 RC outpatient 5707 5707 5707 74 4223.18 percent of total billed charges 5707 93 4622.67 percent of total billed charges 5707 5707 other OPPS APC 5707 5707 other OPPS APC 5707 27.63 1576.84 percent of total billed charges 5707 5707 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TARGET 360 ULTRA 4MM X 10MM SUP-542410 CDM 0270 RC outpatient 6882.2 6882.2 6882.2 74 5092.83 percent of total billed charges 6882.2 93 5574.58 percent of total billed charges 6882.2 6882.2 other OPPS APC 6882.2 6882.2 other OPPS APC 6882.2 27.63 1901.55 percent of total billed charges 6882.2 6882.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TARGET 360 ULTRA 5MM X 10MM SUP-542510 CDM 0270 RC outpatient 6214 6214 6214 74 4598.36 percent of total billed charges 6214 93 5033.34 percent of total billed charges 6214 6214 other OPPS APC 6214 6214 other OPPS APC 6214 27.63 1716.93 percent of total billed charges 6214 6214 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER VACUUM DISPOSA-FILTER UTERUS ASPIRATION STERILE LATEX FREE DISPOSABLE SUP-54298 CDM outpatient 19.2 19.2 19.2 19.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SET TITANIUM OD4.75 MM SPINE SUP-5440030 CDM 270010020 LOCAL 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SET SOLERA SEXTANT CD HORIZON TITANIUM SPINE BREAKOFF 4.75 MM ROD SUP-5440430 CDM 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIRE RETINAL 2.5MM GROOVE CONCAVE 7MM SILICONE STERILE ASYMMETRICAL STYLE 276 SUP-5442 CDM 0270 RC outpatient 46.57 46.57 46.57 74 34.46 percent of total billed charges 46.57 93 37.72 percent of total billed charges 46.57 46.57 other OPPS APC 46.57 46.57 other OPPS APC 46.57 27.63 12.87 percent of total billed charges 46.57 46.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 NANO 2MM X 3CM SUP-544203 CDM 0270 RC outpatient 5707 5707 5707 74 4223.18 percent of total billed charges 5707 93 4622.67 percent of total billed charges 5707 5707 other OPPS APC 5707 5707 other OPPS APC 5707 27.63 1576.84 percent of total billed charges 5707 5707 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TARGET 360 NANO 2MM X 3MM SUP-544203 CDM 0270 RC outpatient 6882.2 6882.2 6882.2 74 5092.83 percent of total billed charges 6882.2 93 5574.58 percent of total billed charges 6882.2 6882.2 other OPPS APC 6882.2 6882.2 other OPPS APC 6882.2 27.63 1901.55 percent of total billed charges 6882.2 6882.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 NANO 2MM X 4CM SUP-544204 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE SOLERA MULTI-SPAN X10 CROSSLINK CD HORIZON TITANIUM L38-42 MM SPINE 4.75 MM SCREW SUP-5442138 CDM 270010020 LOCAL 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE SOLERA MULTI-SPAN X10 CROSSLINK CD HORIZON TITANIUM L41-48 MM SPINE 4.75 MM SCREW SUP-5442141 CDM 270010020 LOCAL 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE SOLERA MULTI-SPAN X10 CROSSLINK CD HORIZON TITANIUM L47-60 MM SPINE 4.75 MM SCREW SUP-5442147 CDM 270010020 LOCAL 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP LIGATING ENDOSCOPIC HEMOLOK POLYMER GREEN MEDIUM LARGE 5.0MM SUP-544230 CDM 0270 RC outpatient 67.97 67.97 67.97 74 50.3 percent of total billed charges 67.97 93 55.06 percent of total billed charges 67.97 67.97 other OPPS APC 67.97 67.97 other OPPS APC 67.97 27.63 18.78 percent of total billed charges 67.97 67.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP INTERNAL WECK HEM-O-LOK LG CHEVRON HEART PURPLE POLYMER DISPOSABLE STERILE LF LIGATE NONABSORBABLE CARTRIDGE SUP-544240 CDM 0270 RC outpatient 61.17 61.17 61.17 74 45.27 percent of total billed charges 61.17 93 49.55 percent of total billed charges 61.17 61.17 other OPPS APC 61.17 61.17 other OPPS APC 61.17 27.63 16.9 percent of total billed charges 61.17 61.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP INTERNAL WECK HEM-O-LOK XL CHEVRON HEART GOLD POLYMER DISPOSABLE STERILE LF LIGATE NONABSORBABLE CARTRIDGE SUP-544250 CDM 0270 RC outpatient 79.3 79.3 79.3 74 58.68 percent of total billed charges 79.3 93 64.23 percent of total billed charges 79.3 79.3 other OPPS APC 79.3 79.3 other OPPS APC 79.3 27.63 21.91 percent of total billed charges 79.3 79.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TARGET 360 NANO 2.5MM X 4MM SUP-544254 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TARGET 360 NANO 3MM X 4MM SUP-544304 CDM 0270 RC outpatient 6214 6214 6214 74 4598.36 percent of total billed charges 6214 93 5033.34 percent of total billed charges 6214 6214 other OPPS APC 6214 6214 other OPPS APC 6214 27.63 1716.93 percent of total billed charges 6214 6214 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TARGET 360 NANO 3MM X 6MM SUP-544306 CDM 0270 RC outpatient 6214 6214 6214 74 4598.36 percent of total billed charges 6214 93 5033.34 percent of total billed charges 6214 6214 other OPPS APC 6214 6214 other OPPS APC 6214 27.63 1716.93 percent of total billed charges 6214 6214 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TARGET 360 NANO 3.5MM X 6MM SUP-544356 CDM 0270 RC outpatient 6214 6214 6214 74 4598.36 percent of total billed charges 6214 93 5033.34 percent of total billed charges 6214 6214 other OPPS APC 6214 6214 other OPPS APC 6214 27.63 1716.93 percent of total billed charges 6214 6214 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH DILATOR TIGHTRAIL 11 FR ROTATE FLEXIBLE BIDIRECTIONAL MECHANISM EXTRACTION DEVICE SUP-545-511 CDM outpatient 6461 6461 6461 6461 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH DILATOR TIGHTRAIL 13 FR ROTATE FLEXIBLE BIDIRECTIONAL MECHANISM EXTRACTION DEVICE SUP-545-513 CDM outpatient 6461 6461 6461 6461 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOSTOP G SIZE 8 SUP-5463-08-00 CDM 0270 RC outpatient 533 533 533 74 394.42 percent of total billed charges 533 93 431.73 percent of total billed charges 533 533 other OPPS APC 533 533 other OPPS APC 533 27.63 147.27 percent of total billed charges 533 533 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOSTOP G 12MM SUP-5463-12-000 CDM 0270 RC outpatient 533 533 533 74 394.42 percent of total billed charges 533 93 431.73 percent of total billed charges 533 533 other OPPS APC 533 533 other OPPS APC 533 27.63 147.27 percent of total billed charges 533 533 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOSTOP G SIZE 16 SUP-5463-16-000 CDM 0270 RC outpatient 533 533 533 74 394.42 percent of total billed charges 533 93 431.73 percent of total billed charges 533 533 other OPPS APC 533 533 other OPPS APC 533 27.63 147.27 percent of total billed charges 533 533 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOSTOP G 18 SUP-5463-18-000 CDM 0270 RC outpatient 533 533 533 74 394.42 percent of total billed charges 533 93 431.73 percent of total billed charges 533 533 other OPPS APC 533 533 other OPPS APC 533 27.63 147.27 percent of total billed charges 533 533 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOSTOP G 20MM SUP-5463-20-000 CDM 0270 RC outpatient 533 533 533 74 394.42 percent of total billed charges 533 93 431.73 percent of total billed charges 533 533 other OPPS APC 533 533 other OPPS APC 533 27.63 147.27 percent of total billed charges 533 533 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CD HORIZON HA L45 MM OD5.5 MM SPINAL PEDICLE MULTIAXIAL 4.75 MM ROD SUP-54740105545 CDM 270010020 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA HA COCR L50 MM OD5.5 MM SPINE MULTIAXIAL 5.5/6 MM ROD SUP-54740105550 CDM 270010020 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 SOFT 4MM X 6CM SUP-547406 CDM 0270 RC outpatient 5850 5850 5850 74 4329 percent of total billed charges 5850 93 4738.5 percent of total billed charges 5850 5850 other OPPS APC 5850 5850 other OPPS APC 5850 27.63 1616.36 percent of total billed charges 5850 5850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 SOFT 4MM X 8CM SUP-547408 CDM 0270 RC outpatient 5850 5850 5850 74 4329 percent of total billed charges 5850 93 4738.5 percent of total billed charges 5850 5850 other OPPS APC 5850 5850 other OPPS APC 5850 27.63 1616.36 percent of total billed charges 5850 5850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 SOFT 4MM X 10CM SUP-547410 CDM 0270 RC outpatient 5850 5850 5850 74 4329 percent of total billed charges 5850 93 4738.5 percent of total billed charges 5850 5850 other OPPS APC 5850 5850 other OPPS APC 5850 27.63 1616.36 percent of total billed charges 5850 5850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLENOSPHERE 39 +4 LATERAL/24 SUP-54747 CDM C1776 HCPCS 0278 RC outpatient 3737.9 3737.9 3737.9 57 2130.6 percent of total billed charges 3737.9 93 3027.7 percent of total billed charges 3737.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.9 other OPPS APC 3737.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.9 other OPPS APC 3737.9 51 1906.33 percent of total billed charges 3737.9 3737.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 SOFT 5MM X 10CM SUP-547510 CDM 0270 RC outpatient 6214 6214 6214 74 4598.36 percent of total billed charges 6214 93 5033.34 percent of total billed charges 6214 6214 other OPPS APC 6214 6214 other OPPS APC 6214 27.63 1716.93 percent of total billed charges 6214 6214 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 SOFT 5MM X 15CM SUP-547515 CDM 0270 RC outpatient 6019 6019 6019 74 4454.06 percent of total billed charges 6019 93 4875.39 percent of total billed charges 6019 6019 other OPPS APC 6019 6019 other OPPS APC 6019 27.63 1663.05 percent of total billed charges 6019 6019 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 SOFT 5MM X 20CM SUP-547520 CDM 0270 RC outpatient 5850 5850 5850 74 4329 percent of total billed charges 5850 93 4738.5 percent of total billed charges 5850 5850 other OPPS APC 5850 5850 other OPPS APC 5850 27.63 1616.36 percent of total billed charges 5850 5850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L25 MM OD4.5 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840004525 CDM 270010020 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L30 MM OD4.5 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840004530 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L35 MM OD4.5 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840004535 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L40 MM OD4.5 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840004540 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L45 MM OD4.5 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840004545 CDM 270010020 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L30 MM OD5 MM SPINAL 2 LEAD THREAD FORM MULTIAXIAL COLOR CODED CANNULATED 4.75 MM ROD SUP-54840005030 CDM 270010020 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L35 MM OD5 MM SPINAL 2 LEAD THREAD FORM MULTIAXIAL COLOR CODED CANNULATED 4.75 MM ROD SUP-54840005035 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR L40 MM OD5 MM SPINE 2 LEAD THREAD FORM MULTIAXIAL COLOR CODED NONSTERILE 4.75 MM ROD SUP-54840005040 CDM 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L45 MM OD5 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840005045 CDM 270010020 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L25 MM OD5.5 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840005525 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA COCR L45 MM OD5.5 MM SPINE MULTIAXIAL CANNULATED SUP-54840005545 CDM 270010020 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L50 MM OD5.5 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840005550 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L55 MM OD5.5 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840005555 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L30 MM OD6 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840006030 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L35 MM OD6 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840006035 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L45 MM OD6 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840006045 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L50 MM OD6 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840006050 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L30 MM OD6.5 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840006530 CDM 270010020 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L35 MM OD6.5 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840006535 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L40 MM OD6.5 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840006540 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L45 MM OD6.5 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840006545 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L50 MM OD6.5 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840006550 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L55 MM OD6.5 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840006555 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L35 MM OD7.5 MM SPINAL 2 LEAD THREAD FORM MULTIAXIAL COLOR CODED SELF RETAIN BREAK OFF DRIVER 4.75 MM ROD SUP-54840007535 CDM 270010022 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L40 MM OD7.5 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840007540 CDM 270010024 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L40 MM OD8.5 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840008540 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP TITANIUM COCR LOW PROFILE L50 MM OD8.5 MM SPINE 2 LEAD MULTIAXIAL COLOR CODED 4.75 MM ROD SUP-54840008550 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON TITANIUM COCR L45 MM OD5.5 MM SPINE MULTIAXIAL CANNULATED SUP-54840015545 CDM 270010020 LOCAL 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON TITANIUM COCR L50 MM OD5.5 MM SPINE MULTIAXIAL CANNULATED SUP-54840015550 CDM 270010020 LOCAL 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON COCR L40 MM OD6.5 MM SPINE MULTIAXIAL CANNULATED SUP-54840016540 CDM 270010020 LOCAL 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA CD HORIZON OSTEOGRIP COCR TITANIUM LOW PROFILE L45 MM OD6.5 MM SPINE 2 LEAD THREAD FORM CANNULATED MULTIAXIAL COLOR CODED HIGH STRENGTH 4.75 MM ROD SUP-54840016545 CDM 270010020 LOCAL 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA COCR L50 MM OD6.5 MM SPINE MULTIAXIAL CANNULATED SUP-54840016550 CDM 270010020 LOCAL 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PERIPHERAL NON LOCKING 4.5MM X 40MM SUP-54850 CDM C1776 HCPCS 0278 RC outpatient 303.38 303.38 303.38 57 172.93 percent of total billed charges 303.38 93 245.74 percent of total billed charges 303.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 303.38 other OPPS APC 303.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 303.38 other OPPS APC 303.38 51 154.72 percent of total billed charges 303.38 303.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CENTRAL MODULAR 25MM SUP-54853 CDM C1776 HCPCS 0278 RC outpatient 1852.68 1852.68 1852.68 57 1056.03 percent of total billed charges 1852.68 93 1500.67 percent of total billed charges 1852.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1852.68 other OPPS APC 1852.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1852.68 other OPPS APC 1852.68 51 944.87 percent of total billed charges 1852.68 1852.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PERIPHERAL LOCKING 5.5MM X 16MM SUP-54855 CDM C1776 HCPCS 0278 RC outpatient 303.38 303.38 303.38 57 172.93 percent of total billed charges 303.38 93 245.74 percent of total billed charges 303.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 303.38 other OPPS APC 303.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 303.38 other OPPS APC 303.38 51 154.72 percent of total billed charges 303.38 303.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE COROENT 40MM 5.5MM NS SPINE VARIABLE ANGLE XLF SYSTEM SUP-5485540 CDM 270010020 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MEDTRONIC 5.5MM X 40MM SUP-54860005540 CDM 270010020 LOCAL 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE PACING L6 FT ATRIUM VENTRICLE EXTERNAL TEMPORARY RECESS PIN NONSTERILE REUSABLE BLUE SUP-5492AL CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE PACING L6 FT ATRIUM VENTRICLE EXTERNAL TEMPORARY RECESS PIN NONSTERILE REUSABLE WHITE SUP-5492VL CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 9-HOLE LOCKING TITANIUM HYBRID F/2MM SCREW MAXILLOMANDIBULAR SUP-55-02950 CDM 0270 RC outpatient 867.57 867.57 867.57 74 642 percent of total billed charges 867.57 93 702.73 percent of total billed charges 867.57 867.57 other OPPS APC 867.57 867.57 other OPPS APC 867.57 27.63 239.71 percent of total billed charges 867.57 867.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE SMALL 9-HOLE LOCKING TITANIUM HYBRID F/2MM SCREW MAXILLOMANDIBULAR SUP-55-02951 CDM 0270 RC outpatient 867.57 867.57 867.57 74 642 percent of total billed charges 867.57 93 702.73 percent of total billed charges 867.57 867.57 other OPPS APC 867.57 867.57 other OPPS APC 867.57 27.63 239.71 percent of total billed charges 867.57 867.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3D PLATE/2X2 HL MDFC MALLEABLE SUP-55-03731 CDM 0270 RC outpatient 467.51 467.51 467.51 74 345.96 percent of total billed charges 467.51 93 378.68 percent of total billed charges 467.51 467.51 other OPPS APC 467.51 467.51 other OPPS APC 467.51 27.63 129.17 percent of total billed charges 467.51 467.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 18-HOLE 0.5MM THK STRAIGHT TITANIUM MALLEABLE BLUE F/1.2MM SCREW UPPER FACE NON-STERILE SUP-55-04218 CDM 0270 RC outpatient 1298.91 1298.91 1298.91 74 961.19 percent of total billed charges 1298.91 93 1052.12 percent of total billed charges 1298.91 1298.91 other OPPS APC 1298.91 1298.91 other OPPS APC 1298.91 27.63 358.89 percent of total billed charges 1298.91 1298.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 2/2-HOLE 0.5MM THK 3D TITANIUM MALLEABLE BLUE F/1.2MM SCREW UPPER FACE NON-STERILE SUP-55-04231 CDM 0270 RC outpatient 593.84 593.84 593.84 74 439.44 percent of total billed charges 593.84 93 481.01 percent of total billed charges 593.84 593.84 other OPPS APC 593.84 593.84 other OPPS APC 593.84 27.63 164.08 percent of total billed charges 593.84 593.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 6/2-HOLE 0.5MM THK 3D TITANIUM MALLEABLE BLUE F/1.2MM SCREW UPPER FACE NON-STERILE SUP-55-04233 CDM 0270 RC outpatient 1068.94 1068.94 1068.94 74 791.02 percent of total billed charges 1068.94 93 865.84 percent of total billed charges 1068.94 1068.94 other OPPS APC 1068.94 1068.94 other OPPS APC 1068.94 27.63 295.35 percent of total billed charges 1068.94 1068.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/7 HOLE DOUBLE Y UPFC MLBL SUP-55-04240 CDM 0270 RC outpatient 510.46 510.46 510.46 74 377.74 percent of total billed charges 510.46 93 413.47 percent of total billed charges 510.46 510.46 other OPPS APC 510.46 510.46 other OPPS APC 510.46 27.63 141.04 percent of total billed charges 510.46 510.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 10-HOLE 0.5MM THK CURVED TITANIUM CONDENSED MALLEABLE BLUE F/1.7MM SCREW ORBITAL NON-STERILE SUP-55-04250 CDM 0270 RC outpatient 576.16 576.16 576.16 74 426.36 percent of total billed charges 576.16 93 466.69 percent of total billed charges 576.16 576.16 other OPPS APC 576.16 576.16 other OPPS APC 576.16 27.63 159.19 percent of total billed charges 576.16 576.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/24 HOLE STRT UP MALL CNDSD SUP-55-04424 CDM 0270 RC outpatient 1382.26 1382.26 1382.26 74 1022.87 percent of total billed charges 1382.26 93 1119.63 percent of total billed charges 1382.26 1382.26 other OPPS APC 1382.26 1382.26 other OPPS APC 1382.26 27.63 381.92 percent of total billed charges 1382.26 1382.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/20 HL STRT MDFC MALLEABLE SUP-55-04720 CDM 0270 RC outpatient 1364.61 1364.61 1364.61 74 1009.81 percent of total billed charges 1364.61 93 1105.33 percent of total billed charges 1364.61 1364.61 other OPPS APC 1364.61 1364.61 other OPPS APC 1364.61 27.63 377.04 percent of total billed charges 1364.61 1364.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/24 HL STRT MDFC MLBL CNDS SUP-55-04724 CDM 0270 RC outpatient 1412.61 1412.61 1412.61 74 1045.33 percent of total billed charges 1412.61 93 1144.21 percent of total billed charges 1412.61 1412.61 other OPPS APC 1412.61 1412.61 other OPPS APC 1412.61 27.63 390.3 percent of total billed charges 1412.61 1412.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/5 HOLE L 2MM ADVMT 100D LT SUP-55-04760 CDM 0270 RC outpatient 510.54 510.54 510.54 74 377.8 percent of total billed charges 510.54 93 413.54 percent of total billed charges 510.54 510.54 other OPPS APC 510.54 510.54 other OPPS APC 510.54 27.63 141.06 percent of total billed charges 510.54 510.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/5 HOLE L 2MM ADVMT 100D RT SUP-55-04761 CDM 0270 RC outpatient 510.54 510.54 510.54 74 377.8 percent of total billed charges 510.54 93 413.54 percent of total billed charges 510.54 510.54 other OPPS APC 510.54 510.54 other OPPS APC 510.54 27.63 141.06 percent of total billed charges 510.54 510.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/5 HOLE L 5MM ADVMT 100D LT SUP-55-04762 CDM 0270 RC outpatient 528.24 528.24 528.24 74 390.9 percent of total billed charges 528.24 93 427.87 percent of total billed charges 528.24 528.24 other OPPS APC 528.24 528.24 other OPPS APC 528.24 27.63 145.95 percent of total billed charges 528.24 528.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/5 HOLE L 5MM ADVMT 100D RT SUP-55-04763 CDM 0270 RC outpatient 528.24 528.24 528.24 74 390.9 percent of total billed charges 528.24 93 427.87 percent of total billed charges 528.24 528.24 other OPPS APC 528.24 528.24 other OPPS APC 528.24 27.63 145.95 percent of total billed charges 528.24 528.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/6 HOLE L 8MM ADVMT 100D LT SUP-55-04764 CDM 0270 RC outpatient 543.4 543.4 543.4 74 402.12 percent of total billed charges 543.4 93 440.15 percent of total billed charges 543.4 543.4 other OPPS APC 543.4 543.4 other OPPS APC 543.4 27.63 150.14 percent of total billed charges 543.4 543.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/6 HOLE L 8MM ADVMT 100D RT SUP-55-04765 CDM 0270 RC outpatient 543.4 543.4 543.4 74 402.12 percent of total billed charges 543.4 93 440.15 percent of total billed charges 543.4 543.4 other OPPS APC 543.4 543.4 other OPPS APC 543.4 27.63 150.14 percent of total billed charges 543.4 543.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 HOLEX6 12MM BAR 0.55MM THK 100DEG ANGLED L-SHAPED TITANIUM MALLEABLE BLUE F/1.7MM SCREW LEFT MIDFACE NON-STERILE SUP-55-04766 CDM 0270 RC outpatient 561.11 561.11 561.11 74 415.22 percent of total billed charges 561.11 93 454.5 percent of total billed charges 561.11 561.11 other OPPS APC 561.11 561.11 other OPPS APC 561.11 27.63 155.03 percent of total billed charges 561.11 561.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/6 HOLE L 12MMADVMT 100D RT SUP-55-04767 CDM 0270 RC outpatient 561.11 561.11 561.11 74 415.22 percent of total billed charges 561.11 93 454.5 percent of total billed charges 561.11 561.11 other OPPS APC 561.11 561.11 other OPPS APC 561.11 27.63 155.03 percent of total billed charges 561.11 561.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/5 HOLE Y W/4MM BAR MDFC SUP-55-05151 CDM 0270 RC outpatient 444.76 444.76 444.76 74 329.12 percent of total billed charges 444.76 93 360.26 percent of total billed charges 444.76 444.76 other OPPS APC 444.76 444.76 other OPPS APC 444.76 27.63 122.89 percent of total billed charges 444.76 444.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/7 HOLE DOUBLE Y MDFC SUP-55-05164 CDM 0270 RC outpatient 528.16 528.16 528.16 74 390.84 percent of total billed charges 528.16 93 427.81 percent of total billed charges 528.16 528.16 other OPPS APC 528.16 528.16 other OPPS APC 528.16 27.63 145.93 percent of total billed charges 528.16 528.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 6-HOLE RIM 0.6MM THK CURVED TITANIUM REVERSIBLE BAR GOLD F/1.7MM SCREW ORBITAL MIDFACE NON-STERILE SUP-55-05188 CDM 27000000 LOCAL 0270 RC outpatient 625.43 625.43 625.43 74 462.82 percent of total billed charges 625.43 93 506.6 percent of total billed charges 625.43 625.43 other OPPS APC 625.43 625.43 other OPPS APC 625.43 27.63 172.81 percent of total billed charges 625.43 625.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 16-HOLE STRAIGHT LOCKING TITANIUM GRAY F/1.7MM SCREW MIDFACE NON-STERILE SUP-55-05716 CDM 0270 RC outpatient 988.05 988.05 988.05 74 731.16 percent of total billed charges 988.05 93 800.32 percent of total billed charges 988.05 988.05 other OPPS APC 988.05 988.05 other OPPS APC 988.05 27.63 273 percent of total billed charges 988.05 988.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 HOLE2X2 0.8MM THK 3D LOCKING TITANIUM GRAY F/1.7MM SCREW MIDFACE NON-STERILE SUP-55-05731 CDM outpatient 692.41 692.41 692.41 692.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "3D PLATE/2X6 HL MDFACE, LOCK" SUP-55-05733 CDM 0270 RC outpatient 1559.17 1559.17 1559.17 74 1153.79 percent of total billed charges 1559.17 93 1262.93 percent of total billed charges 1559.17 1559.17 other OPPS APC 1559.17 1559.17 other OPPS APC 1559.17 27.63 430.8 percent of total billed charges 1559.17 1559.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 HOLEX7 0.8MM THK DOUBLE Y-SHAPED LOCKING TITANIUM REVERSIBLE GRAY F/1.7MM SCREW MIDFACE NON-STERILE SUP-55-05742 CDM 0270 RC outpatient 775.79 775.79 775.79 74 574.08 percent of total billed charges 775.79 93 628.39 percent of total billed charges 775.79 775.79 other OPPS APC 775.79 775.79 other OPPS APC 775.79 27.63 214.35 percent of total billed charges 775.79 775.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 5-HOLE 4MM BAR 0.8MM THK Y-SHAPED LOCKING TITANIUM GRAY F/1.7MM SCREW MIDFACE NON-STERILE SUP-55-05751 CDM 0270 RC outpatient 609.02 609.02 609.02 74 450.67 percent of total billed charges 609.02 93 493.31 percent of total billed charges 609.02 609.02 other OPPS APC 609.02 609.02 other OPPS APC 609.02 27.63 168.27 percent of total billed charges 609.02 609.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 5-HOLE 8MM BAR 0.8MM THK Y-SHAPED LOCKING TITANIUM GRAY F/1.7MM SCREW MIDFACE NON-STERILE SUP-55-05752 CDM 0270 RC outpatient 609.02 609.02 609.02 74 450.67 percent of total billed charges 609.02 93 493.31 percent of total billed charges 609.02 609.02 other OPPS APC 609.02 609.02 other OPPS APC 609.02 27.63 168.27 percent of total billed charges 609.02 609.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PLT/8 HOLE CURV MDFACE, LOCK" SUP-55-05758 CDM 0270 RC outpatient 477.62 477.62 477.62 74 353.44 percent of total billed charges 477.62 93 386.87 percent of total billed charges 477.62 477.62 other OPPS APC 477.62 477.62 other OPPS APC 477.62 27.63 131.97 percent of total billed charges 477.62 477.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/5 HOLE L 2MM ADV MDFC LOC SUP-55-05761 CDM 0270 RC outpatient 561.03 561.03 561.03 74 415.16 percent of total billed charges 561.03 93 454.43 percent of total billed charges 561.03 561.03 other OPPS APC 561.03 561.03 other OPPS APC 561.03 27.63 155.01 percent of total billed charges 561.03 561.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 5-HOLE 5MM BAR 0.8MM THK 100DEG ANGLED L-SHAPED LOCKING TITANIUM REVERSIBLE GRAY F/1.7MM SCREW MIDFACE NON-STERILE SUP-55-05763 CDM 0270 RC outpatient 593.84 593.84 593.84 74 439.44 percent of total billed charges 593.84 93 481.01 percent of total billed charges 593.84 593.84 other OPPS APC 593.84 593.84 other OPPS APC 593.84 27.63 164.08 percent of total billed charges 593.84 593.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 6-HOLE 8MM BAR 0.8MM THK 100DEG ANGLED L-SHAPED LOCKING TITANIUM GRAY F/1.7MM SCREW MIDFACE NON-STERILE SUP-55-05765 CDM 0270 RC outpatient 626.7 626.7 626.7 74 463.76 percent of total billed charges 626.7 93 507.63 percent of total billed charges 626.7 626.7 other OPPS APC 626.7 626.7 other OPPS APC 626.7 27.63 173.16 percent of total billed charges 626.7 626.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 6-HOLE 12MM BAR 0.8MM THK 100DEG ANGLED L-SHAPED LOCKING TITANIUM GRAY F/1.7MM SCREW MIDFACE NON-STERILE SUP-55-05767 CDM 0270 RC outpatient 641.86 641.86 641.86 74 474.98 percent of total billed charges 641.86 93 519.91 percent of total billed charges 641.86 641.86 other OPPS APC 641.86 641.86 other OPPS APC 641.86 27.63 177.35 percent of total billed charges 641.86 641.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 8-HOLE 0.8MM THK Y-SHAPED LOCKING TITANIUM GRAY F/1.7MM SCREW MIDFACE NON-STERILE SUP-55-05779 CDM 0270 RC outpatient 710.09 710.09 710.09 74 525.47 percent of total billed charges 710.09 93 575.17 percent of total billed charges 710.09 710.09 other OPPS APC 710.09 710.09 other OPPS APC 710.09 27.63 196.2 percent of total billed charges 710.09 710.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 HOLEX8 0.6MM THK STRAIGHT LOCKING TITANIUM STANDARD GOLD F/1.2MM SCREW CRANIOFACIAL NON-STERILE SUP-55-06208 CDM 0270 RC outpatient 691.96 691.96 691.96 74 512.05 percent of total billed charges 691.96 93 560.49 percent of total billed charges 691.96 691.96 other OPPS APC 691.96 691.96 other OPPS APC 691.96 27.63 191.19 percent of total billed charges 691.96 691.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 HOLEX24 0.6MM THK STRAIGHT TITANIUM STANDARD GOLD F/1.2MM SCREW UPPER FACE NON-STERILE SUP-55-06224 CDM 0270 RC outpatient 1200.34 1200.34 1200.34 74 888.25 percent of total billed charges 1200.34 93 972.28 percent of total billed charges 1200.34 1200.34 other OPPS APC 1200.34 1200.34 other OPPS APC 1200.34 27.63 331.65 percent of total billed charges 1200.34 1200.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3D PLATE/2X2 HL UPPERFACE SUP-55-06231 CDM 0270 RC outpatient 558.48 558.48 558.48 74 413.28 percent of total billed charges 558.48 93 452.37 percent of total billed charges 558.48 558.48 other OPPS APC 558.48 558.48 other OPPS APC 558.48 27.63 154.31 percent of total billed charges 558.48 558.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 6-HOLE2 0.6MM THK 3D TITANIUM STANDARD GOLD F/1.2MM SCREW UPPER FACE NON-STERILE SUP-55-06233 CDM 0270 RC outpatient 1003.21 1003.21 1003.21 74 742.38 percent of total billed charges 1003.21 93 812.6 percent of total billed charges 1003.21 1003.21 other OPPS APC 1003.21 1003.21 other OPPS APC 1003.21 27.63 277.19 percent of total billed charges 1003.21 1003.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3D PLATE/10X10 HL UPPERFACE SUP-55-06237 CDM 0270 RC outpatient 3216.9 3216.9 3216.9 74 2380.51 percent of total billed charges 3216.9 93 2605.69 percent of total billed charges 3216.9 3216.9 other OPPS APC 3216.9 3216.9 other OPPS APC 3216.9 27.63 888.83 percent of total billed charges 3216.9 3216.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/7 HOLE DOUBLE Y UPPERFACE SUP-55-06240 CDM 0270 RC outpatient 462.46 462.46 462.46 74 342.22 percent of total billed charges 462.46 93 374.59 percent of total billed charges 462.46 462.46 other OPPS APC 462.46 462.46 other OPPS APC 462.46 27.63 127.78 percent of total billed charges 462.46 462.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 10-HOLE 0.6MM THK CURVED TITANIUM STANDARD GOLD F/1.2MM SCREW ORBITAL NON-STERILE SUP-55-06250 CDM 0270 RC outpatient 576.16 576.16 576.16 74 426.36 percent of total billed charges 576.16 93 466.69 percent of total billed charges 576.16 576.16 other OPPS APC 576.16 576.16 other OPPS APC 576.16 27.63 159.19 percent of total billed charges 576.16 576.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/4 HOLE ORBITAL UPPERFACE SUP-55-06254 CDM 0270 RC outpatient 283.04 283.04 283.04 74 209.45 percent of total billed charges 283.04 93 229.26 percent of total billed charges 283.04 283.04 other OPPS APC 283.04 283.04 other OPPS APC 283.04 27.63 78.2 percent of total billed charges 283.04 283.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/8 HOLE L 90D LFT UPPERFC SUP-55-06260 CDM 0270 RC outpatient 444.76 444.76 444.76 74 329.12 percent of total billed charges 444.76 93 360.26 percent of total billed charges 444.76 444.76 other OPPS APC 444.76 444.76 other OPPS APC 444.76 27.63 122.89 percent of total billed charges 444.76 444.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/8 HOLE L 90D RGHT UPPFC SUP-55-06261 CDM 0270 RC outpatient 444.76 444.76 444.76 74 329.12 percent of total billed charges 444.76 93 360.26 percent of total billed charges 444.76 444.76 other OPPS APC 444.76 444.76 other OPPS APC 444.76 27.63 122.89 percent of total billed charges 444.76 444.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/7 HOLE T UPPERFACE SUP-55-06270 CDM 0270 RC outpatient 454.87 454.87 454.87 74 336.6 percent of total billed charges 454.87 93 368.44 percent of total billed charges 454.87 454.87 other OPPS APC 454.87 454.87 other OPPS APC 454.87 27.63 125.68 percent of total billed charges 454.87 454.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/4 HOLE STRT W/BAR MDFC SUP-55-06704 CDM 0270 RC outpatient 295.67 295.67 295.67 74 218.8 percent of total billed charges 295.67 93 239.49 percent of total billed charges 295.67 295.67 other OPPS APC 295.67 295.67 other OPPS APC 295.67 27.63 81.69 percent of total billed charges 295.67 295.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 8-HOLE 0.6MM THK STRAIGHT TITANIUM STANDARD GOLD F/1.7MM SCREW MIDFACE NON-STERILE SUP-55-06708 CDM 0270 RC outpatient 657.02 657.02 657.02 74 486.19 percent of total billed charges 657.02 93 532.19 percent of total billed charges 657.02 657.02 other OPPS APC 657.02 657.02 other OPPS APC 657.02 27.63 181.53 percent of total billed charges 657.02 657.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 24-HOLE 0.6MM THK STRAIGHT TITANIUM STANDARD BAR GOLD F/1.7MM SCREW MIDFACE NON-STERILE SUP-55-06724 CDM 0270 RC outpatient 1258.45 1258.45 1258.45 74 931.25 percent of total billed charges 1258.45 93 1019.34 percent of total billed charges 1258.45 1258.45 other OPPS APC 1258.45 1258.45 other OPPS APC 1258.45 27.63 347.71 percent of total billed charges 1258.45 1258.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 2/2-HOLE 0.6MM THK 3D TITANIUM GOLD F/1.7MM SCREW MIDFACE NON-STERILE SUP-55-06731 CDM 0270 RC outpatient 601.43 601.43 601.43 74 445.06 percent of total billed charges 601.43 93 487.16 percent of total billed charges 601.43 601.43 other OPPS APC 601.43 601.43 other OPPS APC 601.43 27.63 166.18 percent of total billed charges 601.43 601.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 HOLEX2X6 0.6MM THK 3D TITANIUM GOLD F/1.7MM SCREW MIDFACE NON-STERILE SUP-55-06733 CDM 0270 RC outpatient 1086.64 1086.64 1086.64 74 804.11 percent of total billed charges 1086.64 93 880.18 percent of total billed charges 1086.64 1086.64 other OPPS APC 1086.64 1086.64 other OPPS APC 1086.64 27.63 300.24 percent of total billed charges 1086.64 1086.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEIBINGER UNIVERSAL 2 STANDARD CURVE H.6 MM MIDFACE 10 HOLE 1.7 MM SCREW SUP-55-06750 CDM 0270 RC outpatient 527.28 527.28 527.28 74 390.19 percent of total billed charges 527.28 93 427.1 percent of total billed charges 527.28 527.28 other OPPS APC 527.28 527.28 other OPPS APC 527.28 27.63 145.69 percent of total billed charges 527.28 527.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 10-HOLE 0.6MM THK CURVED TITANIUM STANDARD GOLD F/1.7MM SCREW MIDFACE NON-STERILE SUP-55-06750 CDM 0270 RC outpatient 692.41 692.41 692.41 74 512.38 percent of total billed charges 692.41 93 560.85 percent of total billed charges 692.41 692.41 other OPPS APC 692.41 692.41 other OPPS APC 692.41 27.63 191.31 percent of total billed charges 692.41 692.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/4 HOLE CRVD W/BAR MDFC SUP-55-06754 CDM 0270 RC outpatient 363.9 363.9 363.9 74 269.29 percent of total billed charges 363.9 93 294.76 percent of total billed charges 363.9 363.9 other OPPS APC 363.9 363.9 other OPPS APC 363.9 27.63 100.55 percent of total billed charges 363.9 363.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/5 HOLE T MIDFACE SUP-55-06771 CDM 0270 RC outpatient 414.44 414.44 414.44 74 306.69 percent of total billed charges 414.44 93 335.7 percent of total billed charges 414.44 414.44 other OPPS APC 414.44 414.44 other OPPS APC 414.44 27.63 114.51 percent of total billed charges 414.44 414.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/5 HOLE L 2MM ADVMT 100D LT SUP-55-07760 CDM 0270 RC outpatient 518.08 518.08 518.08 74 383.38 percent of total billed charges 518.08 93 419.64 percent of total billed charges 518.08 518.08 other OPPS APC 518.08 518.08 other OPPS APC 518.08 27.63 143.15 percent of total billed charges 518.08 518.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/5 HOLE L 2MM ADVMT 100D RT SUP-55-07761 CDM 0270 RC outpatient 518.08 518.08 518.08 74 383.38 percent of total billed charges 518.08 93 419.64 percent of total billed charges 518.08 518.08 other OPPS APC 518.08 518.08 other OPPS APC 518.08 27.63 143.15 percent of total billed charges 518.08 518.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/5 HOLE L 5MM ADVMT 100D LT SUP-55-07762 CDM 0270 RC outpatient 533.26 533.26 533.26 74 394.61 percent of total billed charges 533.26 93 431.94 percent of total billed charges 533.26 533.26 other OPPS APC 533.26 533.26 other OPPS APC 533.26 27.63 147.34 percent of total billed charges 533.26 533.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/5 HOLE L 5MM ADVMT 100D RT SUP-55-07763 CDM 0270 RC outpatient 533.26 533.26 533.26 74 394.61 percent of total billed charges 533.26 93 431.94 percent of total billed charges 533.26 533.26 other OPPS APC 533.26 533.26 other OPPS APC 533.26 27.63 147.34 percent of total billed charges 533.26 533.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/6 HOLE L 8MM ADVMT 100D LT SUP-55-07764 CDM 0270 RC outpatient 553.46 553.46 553.46 74 409.56 percent of total billed charges 553.46 93 448.3 percent of total billed charges 553.46 553.46 other OPPS APC 553.46 553.46 other OPPS APC 553.46 27.63 152.92 percent of total billed charges 553.46 553.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/6 HOLE L 8MM ADVMT 100D RT SUP-55-07765 CDM 0270 RC outpatient 553.46 553.46 553.46 74 409.56 percent of total billed charges 553.46 93 448.3 percent of total billed charges 553.46 553.46 other OPPS APC 553.46 553.46 other OPPS APC 553.46 27.63 152.92 percent of total billed charges 553.46 553.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 HOLEX6 12MM BAR 100DEG ANGLED L-SHAPED TITANIUM GRADUATED STABILITY GOLD F/1.7MM SCREW LEFT MIDFACE NON-STERILE SUP-55-07766 CDM 0270 RC outpatient 566.1 566.1 566.1 74 418.91 percent of total billed charges 566.1 93 458.54 percent of total billed charges 566.1 566.1 other OPPS APC 566.1 566.1 other OPPS APC 566.1 27.63 156.41 percent of total billed charges 566.1 566.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 HOLEX6 12MM BAR 100DEG ANGLED L-SHAPED TITANIUM GRADUATED STABILITY GOLD F/1.7MM SCREW RIGHT MIDFACE NON-STERILE SUP-55-07767 CDM 0270 RC outpatient 566.1 566.1 566.1 74 418.91 percent of total billed charges 566.1 93 458.54 percent of total billed charges 566.1 566.1 other OPPS APC 566.1 566.1 other OPPS APC 566.1 27.63 156.41 percent of total billed charges 566.1 566.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PLT/4 HL ST LNG BAR,MAND,LOCK" SUP-55-10503 CDM 0270 RC outpatient 348.76 348.76 348.76 74 258.08 percent of total billed charges 348.76 93 282.5 percent of total billed charges 348.76 348.76 other OPPS APC 348.76 348.76 other OPPS APC 348.76 27.63 96.36 percent of total billed charges 348.76 348.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 4-HOLE STRAIGHT LOCKING TITANIUM BLUE F/2MM SCREW MINI PLATING MANDIBULAR SUP-55-10504 CDM 0270 RC outpatient 232.49 232.49 232.49 74 172.04 percent of total billed charges 232.49 93 188.32 percent of total billed charges 232.49 232.49 other OPPS APC 232.49 232.49 other OPPS APC 232.49 27.63 64.24 percent of total billed charges 232.49 232.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/MINI 4 HOLES WITH BAR SUP-55-10505 CDM 0270 RC outpatient 265.33 265.33 265.33 74 196.34 percent of total billed charges 265.33 93 214.92 percent of total billed charges 265.33 265.33 other OPPS APC 265.33 265.33 other OPPS APC 265.33 27.63 73.31 percent of total billed charges 265.33 265.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/MINI 6 HOLES SUP-55-10506 CDM 0270 RC outpatient 295.72 295.72 295.72 74 218.83 percent of total billed charges 295.72 93 239.53 percent of total billed charges 295.72 295.72 other OPPS APC 295.72 295.72 other OPPS APC 295.72 27.63 81.71 percent of total billed charges 295.72 295.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 6-HOLE STRAIGHT LOCKING TITANIUM BLUE F/2MM SCREW MINI PLATING MANDIBULAR W/8MM BAR SUP-55-10507 CDM 0270 RC outpatient 593.84 593.84 593.84 74 439.44 percent of total billed charges 593.84 93 481.01 percent of total billed charges 593.84 593.84 other OPPS APC 593.84 593.84 other OPPS APC 593.84 27.63 164.08 percent of total billed charges 593.84 593.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 HOLEX16 STRAIGHT LOCKING TITANIUM CONDENSED BLUE F/2MM SCREW MINI PLATING MANDIBULAR SUP-55-10515 CDM 0270 RC outpatient 1036.15 1036.15 1036.15 74 766.75 percent of total billed charges 1036.15 93 839.28 percent of total billed charges 1036.15 1036.15 other OPPS APC 1036.15 1036.15 other OPPS APC 1036.15 27.63 286.29 percent of total billed charges 1036.15 1036.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/MINI 16 HOLES SUP-55-10516 CDM 0270 RC outpatient 414.44 414.44 414.44 74 306.69 percent of total billed charges 414.44 93 335.7 percent of total billed charges 414.44 414.44 other OPPS APC 414.44 414.44 other OPPS APC 414.44 27.63 114.51 percent of total billed charges 414.44 414.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 3/2-HOLE 1MM THK 3D RECTANGULAR LOCKING TITANIUM BLUE F/2MM SCREW MANDIBULAR STERILE SUP-55-10532 CDM 0270 RC outpatient 821.29 821.29 821.29 74 607.75 percent of total billed charges 821.29 93 665.24 percent of total billed charges 821.29 821.29 other OPPS APC 821.29 821.29 other OPPS APC 821.29 27.63 226.92 percent of total billed charges 821.29 821.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 HOLEX4 1.5MM THK STRAIGHT TITANIUM RECONSTRUCTION GOLD F/2MM/2.3MM SCREW MANDIBULAR SUP-55-15504 CDM 0270 RC outpatient 922.4 922.4 922.4 74 682.58 percent of total billed charges 922.4 93 747.14 percent of total billed charges 922.4 922.4 other OPPS APC 922.4 922.4 other OPPS APC 922.4 27.63 254.86 percent of total billed charges 922.4 922.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 4-HOLE 6MM BAR STRAIGHT TITANIUM RECONSTRUCTION GOLD F/2MM/2.3MM SCREW MANDIBULAR SUP-55-15505 CDM 0270 RC outpatient 955.21 955.21 955.21 74 706.86 percent of total billed charges 955.21 93 773.72 percent of total billed charges 955.21 955.21 other OPPS APC 955.21 955.21 other OPPS APC 955.21 27.63 263.92 percent of total billed charges 955.21 955.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 6-HOLE 1.5MM THK STRAIGHT TITANIUM RECONSTRUCTION GOLD F/2MM/2.3MM FRACTURE SCREW MANDIBULAR SUP-55-15506 CDM 0270 RC outpatient 1119.48 1119.48 1119.48 74 828.42 percent of total billed charges 1119.48 93 906.78 percent of total billed charges 1119.48 1119.48 other OPPS APC 1119.48 1119.48 other OPPS APC 1119.48 27.63 309.31 percent of total billed charges 1119.48 1119.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 6-HOLE 6MM BAR STRAIGHT TITANIUM RECONSTRUCTION GOLD F/2MM/2.3MM SCREW MANDIBULAR SUP-55-15507 CDM 0270 RC outpatient 1215.5 1215.5 1215.5 74 899.47 percent of total billed charges 1215.5 93 984.56 percent of total billed charges 1215.5 1215.5 other OPPS APC 1215.5 1215.5 other OPPS APC 1215.5 27.63 335.84 percent of total billed charges 1215.5 1215.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/FRACTURE 14 HOLES SUP-55-15514 CDM 0270 RC outpatient 1741.17 1741.17 1741.17 74 1288.47 percent of total billed charges 1741.17 93 1410.35 percent of total billed charges 1741.17 1741.17 other OPPS APC 1741.17 1741.17 other OPPS APC 1741.17 27.63 481.09 percent of total billed charges 1741.17 1741.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL NEURO 2 4-HOLE C-SHAPED TITANIUM RECONSTRUCTION GOLD F/2MM/2.3MM SCREW MANDIBULAR SUP-55-15524 CDM 0270 RC outpatient 988.1 988.1 988.1 74 731.19 percent of total billed charges 988.1 93 800.36 percent of total billed charges 988.1 988.1 other OPPS APC 988.1 988.1 other OPPS APC 988.1 27.63 273.01 percent of total billed charges 988.1 988.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/ANGLE FRACTRE 6 HOLES 115 SUP-55-15526 CDM 0270 RC outpatient 1642.63 1642.63 1642.63 74 1215.55 percent of total billed charges 1642.63 93 1330.53 percent of total billed charges 1642.63 1642.63 other OPPS APC 1642.63 1642.63 other OPPS APC 1642.63 27.63 453.86 percent of total billed charges 1642.63 1642.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLT/ANGLE FRACTURE 6 HOLES 140 SUP-55-15536 CDM 0270 RC outpatient 1675.41 1675.41 1675.41 74 1239.8 percent of total billed charges 1675.41 93 1357.08 percent of total billed charges 1675.41 1675.41 other OPPS APC 1675.41 1675.41 other OPPS APC 1675.41 27.63 462.92 percent of total billed charges 1675.41 1675.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE LASER IRIDEX DIRECTIONAL 90 D STRAIGHT L89 CM OD20 GA ENDOOCULAR STERILE DISPOSABLE SUP-55.26 CDM 0270 RC outpatient 437.02 437.02 437.02 74 323.39 percent of total billed charges 437.02 93 353.99 percent of total billed charges 437.02 437.02 other OPPS APC 437.02 437.02 other OPPS APC 437.02 27.63 120.75 percent of total billed charges 437.02 437.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE LASER IRIDEX OD23 GA ENDOOCULAR DIRECTIONAL ILLUMINATED CURVED STERILE DISPOSABLE SUP-55.26.23 CDM 0270 RC outpatient 460.9 460.9 460.9 74 341.07 percent of total billed charges 460.9 93 373.33 percent of total billed charges 460.9 460.9 other OPPS APC 460.9 460.9 other OPPS APC 460.9 27.63 127.35 percent of total billed charges 460.9 460.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG SPECIMEN RETRIEVAL GENISTRONG NYLON PLASTIC POLYMER LARGE L22 CM L12 MM OD11 CM 750 ML RADIOPAQUE TRANSPARENT INTRODUCER PRELOAD SPRING RIGID SHAFT LATEX FREE DISPOSABLE SUP-550-000-005 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG SPECIMEN RETRIEVAL GENISTRONG METAL NYLON XL L29 CM L15 MM OD15 CM 2000 ML RIGID SHAFT PRELOAD SPRING RING INTRODUCER LATEX FREE DISPOSABLE TRANSPARENT SUP-550-000-008 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PLAIN 3-0 CT-1 L18 IN MONOFILAMENT 3 STRAND SUP-5503T CDM 0270 RC outpatient 20.35 20.35 20.35 74 15.06 percent of total billed charges 20.35 93 16.48 percent of total billed charges 20.35 20.35 other OPPS APC 20.35 20.35 other OPPS APC 20.35 27.63 5.62 percent of total billed charges 20.35 20.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL 2 TITANIUM STRAIGHT LOW PROFILE H.5 MM UPPERFACE 18 HOLE MALLEABLE 1.2 MM SCREW SUP-5504218 CDM 0270 RC outpatient 984.36 984.36 984.36 74 728.43 percent of total billed charges 984.36 93 797.33 percent of total billed charges 984.36 984.36 other OPPS APC 984.36 984.36 other OPPS APC 984.36 27.63 271.98 percent of total billed charges 984.36 984.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 3D H.5 MM UPPERFACIAL 2 X 2 HOLE MALLEABLE 3D 1.2 MM SCREW SUP-5504231 CDM 0270 RC outpatient 450.84 450.84 450.84 74 333.62 percent of total billed charges 450.84 93 365.18 percent of total billed charges 450.84 450.84 other OPPS APC 450.84 450.84 other OPPS APC 450.84 27.63 124.57 percent of total billed charges 450.84 450.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM H.5 MM UPPERFACIAL 6 X 2 HOLE MALLEABLE 3D 1.2 MM SCREW SUP-5504233 CDM 0270 RC outpatient 809.64 809.64 809.64 74 599.13 percent of total billed charges 809.64 93 655.81 percent of total billed charges 809.64 809.64 other OPPS APC 809.64 809.64 other OPPS APC 809.64 27.63 223.7 percent of total billed charges 809.64 809.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL 2 TITANIUM 2Y LOW PROFILE H.5 MM UPPERFACE 7 HOLE MALLEABLE 1.2 MM SCREW SUP-5504240 CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL 2 TITANIUM CURVE H.5 MM UPPERFACE ORBITAL 10 HOLE MALLEABLE 1.2 MM SCREW SUP-5504250 CDM 0270 RC outpatient 438.36 438.36 438.36 74 324.39 percent of total billed charges 438.36 93 355.07 percent of total billed charges 438.36 438.36 other OPPS APC 438.36 438.36 other OPPS APC 438.36 27.63 121.12 percent of total billed charges 438.36 438.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM H.5 MM UPPERFACIAL 24 HOLE STRAIGHT MALLEABLE CONDENSED 1.2 MM SCREW SUP-5504424 CDM 0270 RC outpatient 1048.32 1048.32 1048.32 74 775.76 percent of total billed charges 1048.32 93 849.14 percent of total billed charges 1048.32 1048.32 other OPPS APC 1048.32 1048.32 other OPPS APC 1048.32 27.63 289.65 percent of total billed charges 1048.32 1048.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM STRAIGHT H.5 MM MIDFACE 20 HOLE MALLEABLE 1.7 MM SCREW SUP-5504720 CDM 0270 RC outpatient 1034.28 1034.28 1034.28 74 765.37 percent of total billed charges 1034.28 93 837.77 percent of total billed charges 1034.28 1034.28 other OPPS APC 1034.28 1034.28 other OPPS APC 1034.28 27.63 285.77 percent of total billed charges 1034.28 1034.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STRAIGHT .5MM BLUE TITANIUM MID FACE 24 HOLE CONDENSE MALLEABLE 1.7MM SCREW SUP-5504724 CDM 0270 RC outpatient 1070.16 1070.16 1070.16 74 791.92 percent of total billed charges 1070.16 93 866.83 percent of total billed charges 1070.16 1070.16 other OPPS APC 1070.16 1070.16 other OPPS APC 1070.16 27.63 295.69 percent of total billed charges 1070.16 1070.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 100 D 2 MM ADVANCEMENT LEFT MIDFACIAL 5 HOLE L MALLEABLE 1.7 MM SCREW SUP-5504760 CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 100 D 2 MM ADVANCEMENT L MIDFACIAL 5 HOLE MALLEABLE RIGHT ANGLED 1.7 MM SCREW SUP-5504761 CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL 2 TITANIUM STANDARD Y L4 MM X H.6 MM MIDFACE 5 HOLE BAR 1.7 MM SCREW SUP-5505151 CDM 0270 RC outpatient 340.08 340.08 340.08 74 251.66 percent of total billed charges 340.08 93 275.46 percent of total billed charges 340.08 340.08 other OPPS APC 340.08 340.08 other OPPS APC 340.08 27.63 93.96 percent of total billed charges 340.08 340.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL 2 TITANIUM STANDARD 2Y H.6 MM MIDFACE 7 HOLE MALLEABLE 1.7 MM SCREW SUP-5505164 CDM 0270 RC outpatient 400.92 400.92 400.92 74 296.68 percent of total billed charges 400.92 93 324.75 percent of total billed charges 400.92 400.92 other OPPS APC 400.92 400.92 other OPPS APC 400.92 27.63 110.77 percent of total billed charges 400.92 400.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL 2 TITANIUM STANDARD CURVE H.6 MM MIDFACE 6 HOLE BAR 1.7 MM SCREW SUP-5505188 CDM 0270 RC outpatient 450.84 450.84 450.84 74 333.62 percent of total billed charges 450.84 93 365.18 percent of total billed charges 450.84 450.84 other OPPS APC 450.84 450.84 other OPPS APC 450.84 27.63 124.57 percent of total billed charges 450.84 450.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM MIDFACIAL 16 HOLE LOCKING 1.7 MM SCREW SUP-5505716 CDM 0270 RC outpatient 750.36 750.36 750.36 74 555.27 percent of total billed charges 750.36 93 607.79 percent of total billed charges 750.36 750.36 other OPPS APC 750.36 750.36 other OPPS APC 750.36 27.63 207.32 percent of total billed charges 750.36 750.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL 2 TITANIUM 3D H.8 MM MIDFACE 2 X 2 HOLE LOCK 1.7 MM SCREW SUP-5505731 CDM 0270 RC outpatient 527.28 527.28 527.28 74 390.19 percent of total billed charges 527.28 93 427.1 percent of total billed charges 527.28 527.28 other OPPS APC 527.28 527.28 other OPPS APC 527.28 27.63 145.69 percent of total billed charges 527.28 527.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM MIDFACIAL 2 X 6 HOLE LOCKING 3D 1.7 MM SCREW SUP-5505733 CDM 0270 RC outpatient 1182.48 1182.48 1182.48 74 875.04 percent of total billed charges 1182.48 93 957.81 percent of total billed charges 1182.48 1182.48 other OPPS APC 1182.48 1182.48 other OPPS APC 1182.48 27.63 326.72 percent of total billed charges 1182.48 1182.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL 2 TITANIUM 2Y H.8 MM MIDFACE 7 HOLE LOCK 1.7 MM SCREW SUP-5505742 CDM 0270 RC outpatient 589.68 589.68 589.68 74 436.36 percent of total billed charges 589.68 93 477.64 percent of total billed charges 589.68 589.68 other OPPS APC 589.68 589.68 other OPPS APC 589.68 27.63 162.93 percent of total billed charges 589.68 589.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL 2 TITANIUM Y L4 MM X H.8 MM MIDFACE 5 HOLE LOCK BAR 1.7 MM SCREW SUP-5505751 CDM 0270 RC outpatient 463.32 463.32 463.32 74 342.86 percent of total billed charges 463.32 93 375.29 percent of total billed charges 463.32 463.32 other OPPS APC 463.32 463.32 other OPPS APC 463.32 27.63 128.02 percent of total billed charges 463.32 463.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 8 MM ADVANCEMENT L8 MM MIDFACIAL 5 HOLE Y LOCKING BAR 1.7 MM SCREW SUP-5505752 CDM 0270 RC outpatient 463.32 463.32 463.32 74 342.86 percent of total billed charges 463.32 93 375.29 percent of total billed charges 463.32 463.32 other OPPS APC 463.32 463.32 other OPPS APC 463.32 27.63 128.02 percent of total billed charges 463.32 463.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM MIDFACIAL 8 HOLE CURVED LOCKING 1.7 MM SCREW SUP-5505758 CDM 0270 RC outpatient 365.04 365.04 365.04 74 270.13 percent of total billed charges 365.04 93 295.68 percent of total billed charges 365.04 365.04 other OPPS APC 365.04 365.04 other OPPS APC 365.04 27.63 100.86 percent of total billed charges 365.04 365.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 2 MM ADVANCEMENT L2 MM X H.8 MM MIDFACIAL 5 HOLE L LOCKING 1.7 MM SCREWS SUP-5505761 CDM 0270 RC outpatient 425.88 425.88 425.88 74 315.15 percent of total billed charges 425.88 93 344.96 percent of total billed charges 425.88 425.88 other OPPS APC 425.88 425.88 other OPPS APC 425.88 27.63 117.67 percent of total billed charges 425.88 425.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 5 MM ADVANCEMENT L L5 MM X H.8 MM MIDFACE 5 HOLE LOCK 1.7 MM SCREW SUP-5505763 CDM 0270 RC outpatient 450.84 450.84 450.84 74 333.62 percent of total billed charges 450.84 93 365.18 percent of total billed charges 450.84 450.84 other OPPS APC 450.84 450.84 other OPPS APC 450.84 27.63 124.57 percent of total billed charges 450.84 450.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL 2 TITANIUM 100 D L L8 MM X H.8 MM MIDFACE 6 HOLE LOCK BAR 1.7 MM SCREW SUP-5505765 CDM 0270 RC outpatient 475.8 475.8 475.8 74 352.09 percent of total billed charges 475.8 93 385.4 percent of total billed charges 475.8 475.8 other OPPS APC 475.8 475.8 other OPPS APC 475.8 27.63 131.46 percent of total billed charges 475.8 475.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL 2 TITANIUM 100 D L L12 MM X H.8 MM MIDFACE 6 HOLE LOCK BAR 1.7 MM SCREW SUP-5505767 CDM 0270 RC outpatient 488.28 488.28 488.28 74 361.33 percent of total billed charges 488.28 93 395.51 percent of total billed charges 488.28 488.28 other OPPS APC 488.28 488.28 other OPPS APC 488.28 27.63 134.91 percent of total billed charges 488.28 488.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL 2 TITANIUM Y H.8 MM MIDFACE 8 HOLE LOCK 1.7 MM SCREW SUP-5505779 CDM 0270 RC outpatient 539.76 539.76 539.76 74 399.42 percent of total billed charges 539.76 93 437.21 percent of total billed charges 539.76 539.76 other OPPS APC 539.76 539.76 other OPPS APC 539.76 27.63 149.14 percent of total billed charges 539.76 539.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL 2 TITANIUM STANDARD STRAIGHT H.6 MM UPPERFACE 8 HOLE 1.2 MM SCREW SUP-5506208 CDM 0270 RC outpatient 499.2 499.2 499.2 74 369.41 percent of total billed charges 499.2 93 404.35 percent of total billed charges 499.2 499.2 other OPPS APC 499.2 499.2 other OPPS APC 499.2 27.63 137.93 percent of total billed charges 499.2 499.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL 2 TITANIUM STANDARD STRAIGHT H.6 MM UPPERFACE 24 HOLE 1.2 MM SCREW SUP-5506224 CDM 0270 RC outpatient 911.04 911.04 911.04 74 674.17 percent of total billed charges 911.04 93 737.94 percent of total billed charges 911.04 911.04 other OPPS APC 911.04 911.04 other OPPS APC 911.04 27.63 251.72 percent of total billed charges 911.04 911.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STANDARD 3D .6MM GOLD TITANIUM UPPER FACE 2X2 HOLE 1.2MM SCREW SUP-5506231 CDM 0270 RC outpatient 424.32 424.32 424.32 74 314 percent of total billed charges 424.32 93 343.7 percent of total billed charges 424.32 424.32 other OPPS APC 424.32 424.32 other OPPS APC 424.32 27.63 117.24 percent of total billed charges 424.32 424.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM STANDARD H.6 MM UPPERFACIAL 6 X 2 HOLE 3D 1.2 MM SCREWS SUP-5506233 CDM 0270 RC outpatient 759.72 759.72 759.72 74 562.19 percent of total billed charges 759.72 93 615.37 percent of total billed charges 759.72 759.72 other OPPS APC 759.72 759.72 other OPPS APC 759.72 27.63 209.91 percent of total billed charges 759.72 759.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL 2 TITANIUM STANDARD 2Y H.6 MM UPPERFACE 7 HOLE 1.2 MM SCREW SUP-5506240 CDM 0270 RC outpatient 351 351 351 74 259.74 percent of total billed charges 351 93 284.31 percent of total billed charges 351 351 other OPPS APC 351 351 other OPPS APC 351 27.63 96.98 percent of total billed charges 351 351 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STANDARD CURVE .6MM GOLD TITANIUM UPPER FACE 10 HOLE 1.2MM SCREW SUP-5506250 CDM 0270 RC outpatient 438.36 438.36 438.36 74 324.39 percent of total billed charges 438.36 93 355.07 percent of total billed charges 438.36 438.36 other OPPS APC 438.36 438.36 other OPPS APC 438.36 27.63 121.12 percent of total billed charges 438.36 438.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEIBINGER UNIVERSAL 2 TITANIUM STANDARD CURVE H.6 MM UPPERFACE ORBITAL 4 HOLE 1.2 MM SCREW SUP-5506254 CDM 0270 RC outpatient 216.84 216.84 216.84 74 160.46 percent of total billed charges 216.84 93 175.64 percent of total billed charges 216.84 216.84 other OPPS APC 216.84 216.84 other OPPS APC 216.84 27.63 59.91 percent of total billed charges 216.84 216.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 90 D H.6 MM LEFT UPPERFACIAL 8 HOLE L 1.2 MM SCREWS SUP-5506260 CDM 0270 RC outpatient 340.08 340.08 340.08 74 251.66 percent of total billed charges 340.08 93 275.46 percent of total billed charges 340.08 340.08 other OPPS APC 340.08 340.08 other OPPS APC 340.08 27.63 93.96 percent of total billed charges 340.08 340.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL 2 TITANIUM 90 D STANDARD L H.6 MM UPPERFACE RIGHT 8 HOLE 1.2 MM SCREW SUP-5506261 CDM 0270 RC outpatient 340.08 340.08 340.08 74 251.66 percent of total billed charges 340.08 93 275.46 percent of total billed charges 340.08 340.08 other OPPS APC 340.08 340.08 other OPPS APC 340.08 27.63 93.96 percent of total billed charges 340.08 340.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL 2 TITANIUM STANDARD T H.6 MM UPPERFACE 7 HOLE 1.2 MM SCREW SUP-5506270 CDM 0270 RC outpatient 346.32 346.32 346.32 74 256.28 percent of total billed charges 346.32 93 280.52 percent of total billed charges 346.32 346.32 other OPPS APC 346.32 346.32 other OPPS APC 346.32 27.63 95.69 percent of total billed charges 346.32 346.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM STANDARD L14 MM MAXILLOFACIAL BURR HOLE COVER 1.2 MM SCREW SUP-5506370 CDM 0270 RC outpatient 504.09 504.09 504.09 74 373.03 percent of total billed charges 504.09 93 408.31 percent of total billed charges 504.09 504.09 other OPPS APC 504.09 504.09 other OPPS APC 504.09 27.63 139.28 percent of total billed charges 504.09 504.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER BURR HOLE LEIBINGER UNIVERSAL 2 TITANIUM STANDARD H.6 MM OD10 MM CRANIOMAXILLOFACIAL PLATE 1.2 MM SCREW SUP-5506372 CDM 0270 RC outpatient 519.22 519.22 519.22 74 384.22 percent of total billed charges 519.22 93 420.57 percent of total billed charges 519.22 519.22 other OPPS APC 519.22 519.22 other OPPS APC 519.22 27.63 143.46 percent of total billed charges 519.22 519.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM STANDARD L7 MM MAXILLOFACIAL BURR HOLE COVER 1.2 MM SCREW SUP-5506375 CDM 0270 RC outpatient 504.09 504.09 504.09 74 373.03 percent of total billed charges 504.09 93 408.31 percent of total billed charges 504.09 504.09 other OPPS APC 504.09 504.09 other OPPS APC 504.09 27.63 139.28 percent of total billed charges 504.09 504.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL 2 TITANIUM STANDARD STRAIGHT H.55 MM MIDFACE 4 HOLE BAR 1.7 MM SCREW SUP-5506704 CDM 0270 RC outpatient 226.2 226.2 226.2 74 167.39 percent of total billed charges 226.2 93 183.22 percent of total billed charges 226.2 226.2 other OPPS APC 226.2 226.2 other OPPS APC 226.2 27.63 62.5 percent of total billed charges 226.2 226.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL 2 TITANIUM STANDARD STRAIGHT MIDFACE 8 HOLE 1.7 MM SCREW SUP-5506708 CDM 0270 RC outpatient 499.2 499.2 499.2 74 369.41 percent of total billed charges 499.2 93 404.35 percent of total billed charges 499.2 499.2 other OPPS APC 499.2 499.2 other OPPS APC 499.2 27.63 137.93 percent of total billed charges 499.2 499.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM STANDARD H.6 MM MIDFACIAL 24 HOLE STRAIGHT 1.7 MM SCREWS SUP-5506724 CDM 0270 RC outpatient 953.16 953.16 953.16 74 705.34 percent of total billed charges 953.16 93 772.06 percent of total billed charges 953.16 953.16 other OPPS APC 953.16 953.16 other OPPS APC 953.16 27.63 263.36 percent of total billed charges 953.16 953.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE UNIVERSAL 2 TITANIUM STANDARD CURVE H.6 MM MIDFACE 4 HOLE BAR 1.7 MM SCREW SUP-5506754 CDM 0270 RC outpatient 277.68 277.68 277.68 74 205.48 percent of total billed charges 277.68 93 224.92 percent of total billed charges 277.68 277.68 other OPPS APC 277.68 277.68 other OPPS APC 277.68 27.63 76.72 percent of total billed charges 277.68 277.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM STANDARD T MIDFACIAL 5 HOLE T 1.7 MM SCREWS SUP-5506771 CDM 0270 RC outpatient 316.68 316.68 316.68 74 234.34 percent of total billed charges 316.68 93 256.51 percent of total billed charges 316.68 316.68 other OPPS APC 316.68 316.68 other OPPS APC 316.68 27.63 87.5 percent of total billed charges 316.68 316.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 100 D 2 MM ADVANCEMENT H.6 MM LEFT MIDFACIAL 5 HOLE L 1.7 MM SCREWS SUP-5507760 CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 100 D 2 MM ADVANCEMENT H.6 MM RIGHT MIDFACIAL 5 HOLE L 1.7 MM SCREWS SUP-5507761 CDM 0270 RC outpatient 394.68 394.68 394.68 74 292.06 percent of total billed charges 394.68 93 319.69 percent of total billed charges 394.68 394.68 other OPPS APC 394.68 394.68 other OPPS APC 394.68 27.63 109.05 percent of total billed charges 394.68 394.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 100 D 5 MM ADVANCEMENT H.6 MM LEFT MIDFACIAL 5 HOLE L 1.7 MM SCREWS SUP-5507762 CDM 0270 RC outpatient 394.68 394.68 394.68 74 292.06 percent of total billed charges 394.68 93 319.69 percent of total billed charges 394.68 394.68 other OPPS APC 394.68 394.68 other OPPS APC 394.68 27.63 109.05 percent of total billed charges 394.68 394.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 100 D 5 MM ADVANCEMENT H.6 MM RIGHT MIDFACIAL 5 HOLE L 1.7 MM SCREWS SUP-5507763 CDM 0270 RC outpatient 404.04 404.04 404.04 74 298.99 percent of total billed charges 404.04 93 327.27 percent of total billed charges 404.04 404.04 other OPPS APC 404.04 404.04 other OPPS APC 404.04 27.63 111.64 percent of total billed charges 404.04 404.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 100 D 8 MM ADVANCEMENT H.8 MM LEFT MIDFACIAL 6 HOLE L GRADUATED STABILIZATION SUP-5507764 CDM 0270 RC outpatient 421.2 421.2 421.2 74 311.69 percent of total billed charges 421.2 93 341.17 percent of total billed charges 421.2 421.2 other OPPS APC 421.2 421.2 other OPPS APC 421.2 27.63 116.38 percent of total billed charges 421.2 421.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 100 D 8 MM ADVANCEMENT H.8 MM RIGHT MIDFACIAL 6 HOLE L 1.7 MM SCREWS SUP-5507765 CDM 0270 RC outpatient 421.2 421.2 421.2 74 311.69 percent of total billed charges 421.2 93 341.17 percent of total billed charges 421.2 421.2 other OPPS APC 421.2 421.2 other OPPS APC 421.2 27.63 116.38 percent of total billed charges 421.2 421.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 100 D 12 MM ADVANCEMENT H.55 MM LEFT MIDFACIAL 6 HOLE L 1.7 MM SCREW SUP-5507766 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM 100 D 12 MM ADVANCEMENT H.55 MM RIGHT MIDFACIAL 6 HOLE L 1.7 MM SCREW SUP-5507767 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING COMPRESSION CAP 2XL REGULAR KNEE LENGTH SUP-551 CDM 0270 RC outpatient 3.41 3.41 3.41 74 2.52 percent of total billed charges 3.41 93 2.76 percent of total billed charges 3.41 3.41 other OPPS APC 3.41 3.41 other OPPS APC 3.41 27.63 0.94 percent of total billed charges 3.41 3.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER CATHETER AIRGUARD L15 CM OD6.5 FR LONG TERM VALVE HEMODIALYSIS SUP-5515160 CDM 0270 RC outpatient 3432 3432 3432 74 2539.68 percent of total billed charges 3432 93 2779.92 percent of total billed charges 3432 3432 other OPPS APC 3432 3432 other OPPS APC 3432 27.63 948.26 percent of total billed charges 3432 3432 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING COMPRESSION CAP 2XL LONG KNEE HIGH ANTIEMBOLISM KNEE LENGTH SUP-552 CDM 0270 RC outpatient 3.41 3.41 3.41 74 2.52 percent of total billed charges 3.41 93 2.76 percent of total billed charges 3.41 3.41 other OPPS APC 3.41 3.41 other OPPS APC 3.41 27.63 0.94 percent of total billed charges 3.41 3.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK TRENGUARD PROCEDURE 450 PAC 450LBS SUP-55201 CDM 0270 RC outpatient 170.95 170.95 170.95 74 126.5 percent of total billed charges 170.95 93 138.47 percent of total billed charges 170.95 170.95 other OPPS APC 170.95 170.95 other OPPS APC 170.95 27.63 47.23 percent of total billed charges 170.95 170.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE EQUIPMENT C-ARMOR EXPANDABLE COLLAPSIBLE STERILE C ARM FLUOROSCOPE SUP-5523 CDM 0270 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 27.63 31.61 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK ASPIRATOR TX1 TISSUE REMOVAL TX SYSTEM CONSOLE SUP-554-1003-001 CDM 0270 RC outpatient 1989 1989 1989 74 1471.86 percent of total billed charges 1989 93 1611.09 percent of total billed charges 1989 1989 other OPPS APC 1989 1989 other OPPS APC 1989 27.63 549.56 percent of total billed charges 1989 1989 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LANGSTON 6F 145 PIGTAIL DIAGNOSTIC CATHETER SUP-5540 CDM 0481 RC outpatient 409.76 409.76 409.76 74 303.22 percent of total billed charges 409.76 93 331.91 percent of total billed charges 409.76 409.76 other OPPS APC 409.76 409.76 other OPPS APC 409.76 51 208.98 percent of total billed charges 409.76 409.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SET CD HORIZON TITANIUM SPINAL BREAK OFF 5.5 MM ROD SUP-5540030 CDM 270010020 LOCAL 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SET SOLERA SEXTANT CD HORIZON TITANIUM OD5.5-6 MM NONSTERILE SUP-5540430 CDM 270010020 LOCAL 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR DELTON DDS SUP-555-6991 CDM outpatient 44.17 44.17 44.17 44.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LANGSTON 6F MULTIPURPOSE DIAGNOSTIC CATHETER SUP-5550 CDM 0481 RC outpatient 403 403 403 74 298.22 percent of total billed charges 403 93 326.43 percent of total billed charges 403 403 other OPPS APC 403 403 other OPPS APC 403 51 205.53 percent of total billed charges 403 403 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLANKET WARMING 3M BAIR HUGGER 36X33IN 24X24IN LF PEDIATRIC 3OZ UNDERBODY FULL ACCESS FLUID OUTLET 2 DRAPE SUP-55501 CDM 0270 RC outpatient 29.79 29.79 29.79 74 22.04 percent of total billed charges 29.79 93 24.13 percent of total billed charges 29.79 29.79 other OPPS APC 29.79 29.79 other OPPS APC 29.79 27.63 8.23 percent of total billed charges 29.79 29.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5F VISTA GUIDE JL 4 LBT SUP-5560040L CDM 0481 RC outpatient 96.2 96.2 96.2 74 71.19 percent of total billed charges 96.2 93 77.92 percent of total billed charges 96.2 96.2 other OPPS APC 96.2 96.2 other OPPS APC 96.2 51 49.06 percent of total billed charges 96.2 96.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5F VISTA GUIDE AL2 LBT SUP-5560400L CDM 0270 RC outpatient 96.2 96.2 96.2 74 71.19 percent of total billed charges 96.2 93 77.92 percent of total billed charges 96.2 96.2 other OPPS APC 96.2 96.2 other OPPS APC 96.2 27.63 26.58 percent of total billed charges 96.2 96.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN LONG EXTRA BACKUP 3.5 CURVE 100CM .62IN 5FR .056IN BLUE YELLOW SS NYLON PTFE SUP-5560540L CDM 0270 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 27.63 31.61 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN STAINLESS STEEL NYLON PTFE LONG XBACKUP 4 CURVE L100 CM L.62 IN OD5 FR ID.056 IN PERIPHERAL HYBRID BRAID RADIOPAQUE ULTRA SOFT MULTISEGMENT LATEX FREE DISPOSABLE BLUE YELLOW SUP-5560560L CDM 0270 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 27.63 31.61 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN STAINLESS STEEL NYLON PTFE LONG JUDKINS RIGHT CORONARY 4 CURVE L110 CM L.62 IN OD5 FR ID.056 IN PERIPHERAL HYBRID BRAID RADIOPAQUE ULTRA SOFT MULTISEGMENT LATEX FREE DISPOSABLE BLUE YELLOW SUP-5560820L CDM 0481 RC outpatient 119.6 119.6 119.6 74 88.5 percent of total billed charges 119.6 93 96.88 percent of total billed charges 119.6 119.6 other OPPS APC 119.6 119.6 other OPPS APC 119.6 51 61 percent of total billed charges 119.6 119.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5F VISTA GUIDE JFL LBT SUP-5561620L CDM 0481 RC outpatient 96.2 96.2 96.2 74 71.19 percent of total billed charges 96.2 93 77.92 percent of total billed charges 96.2 96.2 other OPPS APC 96.2 96.2 other OPPS APC 96.2 51 49.06 percent of total billed charges 96.2 96.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5F VISTA GUIDE RB LBT SUP-5561720L CDM 0270 RC outpatient 96.2 96.2 96.2 74 71.19 percent of total billed charges 96.2 93 77.92 percent of total billed charges 96.2 96.2 other OPPS APC 96.2 96.2 other OPPS APC 96.2 27.63 26.58 percent of total billed charges 96.2 96.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5F VISTA GUIDE BARBEAU LBT SUP-5561740L CDM 0270 RC outpatient 96.2 96.2 96.2 74 71.19 percent of total billed charges 96.2 93 77.92 percent of total billed charges 96.2 96.2 other OPPS APC 96.2 96.2 other OPPS APC 96.2 27.63 26.58 percent of total billed charges 96.2 96.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN STAINLESS STEEL NYLON PTFE LONG HOCKEY STICK CURVE L100 CM L.62 IN OD5 FR ID.056 IN PERIPHERAL HYBRID BRAID RADIOPAQUE ULTRA SOFT MULTISEGMENT LATEX FREE DISPOSABLE BLUE YELLOW SUP-5562780L CDM 0270 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 27.63 31.61 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAPSURE FIX SUP-5568 CDM 0270 RC outpatient 1066 1066 1066 74 788.84 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 27.63 294.54 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING CAPSUREFIX STEROID ELUTING SILICONE J L53 CM OD7.2 FR ATRIUM BIPOLAR ACTIVE FIXATION SCREW IN IS-1 SUP-5568-53 CDM 275001001 LOCAL 0275 RC outpatient 1027 1027 1027 57 585.39 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 51 523.77 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INTERVENTIONAL GUIDELINER STAINLESS STEEL POLYMER L150CM L 25CMOD 5 FR ID .056 IN IDSEC .046 IN RAPID EXCHANGE COAXIAL GUIDE EXTENSION FLEXIBLE COLLAR RADIOPAQUE SUP-5569 CDM 0270 RC outpatient 1034.8 1034.8 1034.8 74 765.75 percent of total billed charges 1034.8 93 838.19 percent of total billed charges 1034.8 1034.8 other OPPS APC 1034.8 1034.8 other OPPS APC 1034.8 27.63 285.92 percent of total billed charges 1034.8 1034.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDELINER 5.5F CATHETER SUP-5570 CDM 0270 RC outpatient 1034.8 1034.8 1034.8 74 765.75 percent of total billed charges 1034.8 93 838.19 percent of total billed charges 1034.8 1034.8 other OPPS APC 1034.8 1034.8 other OPPS APC 1034.8 27.63 285.92 percent of total billed charges 1034.8 1034.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F GUIDELINER SUP-5571 CDM 0270 RC outpatient 1034.8 1034.8 1034.8 74 765.75 percent of total billed charges 1034.8 93 838.19 percent of total billed charges 1034.8 1034.8 other OPPS APC 1034.8 1034.8 other OPPS APC 1034.8 27.63 285.92 percent of total billed charges 1034.8 1034.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F GUIDELINER SUP-5573 CDM 0270 RC outpatient 1034.8 1034.8 1034.8 74 765.75 percent of total billed charges 1034.8 93 838.19 percent of total billed charges 1034.8 1034.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INTERVENTIONAL GUIDELINER L150 CM L25 CM OD8 FR ID.088 IN IDSEC.071 IN RAPID EXCHANGE GUIDE EXTENSION FLEXIBLE COAXIAL SUP-5573 CDM 0270 RC outpatient 1034.8 1034.8 1034.8 1034.8 other OPPS APC 1034.8 1034.8 other OPPS APC 1034.8 27.63 285.92 percent of total billed charges 1034.8 1034.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STYLET DISPOSABLE SUP-55797 CDM 0270 RC outpatient 1163.5 1163.5 1163.5 74 860.99 percent of total billed charges 1163.5 93 942.44 percent of total billed charges 1163.5 1163.5 other OPPS APC 1163.5 1163.5 other OPPS APC 1163.5 27.63 321.48 percent of total billed charges 1163.5 1163.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING CORDIS ADROIT STAINLESS STEEL PTFE JL3 CURVE L 100 CM OD 5 FR CORONARY PERIPHERAL RADIOPAQUE KINK RESISTANCE STERILE LATEX FREE BLUE YELLOW SUP-55800000_66627 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC PERFORMA .035 IN VERT CURVE L100 CM OD5 FR ID.046 IN SUP-5583-A3 CDM 0270 RC outpatient 27.56 27.56 27.56 74 20.39 percent of total billed charges 27.56 93 22.32 percent of total billed charges 27.56 27.56 other OPPS APC 27.56 27.56 other OPPS APC 27.56 27.63 7.61 percent of total billed charges 27.56 27.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA COCR L50 MM OD6.5 MM SPINE MULTIAXIAL SUP-55840006550 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE COCR L55 MM OD6.5 MM SPINE MULTIAXIAL 5.5 MM ROD SUP-55840006555 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA COCR L45 MM OD6.5 MM SPINE MULTIAXIAL CANNULATED 5.5 MM ROD SUP-55840016545 CDM 270010020 LOCAL 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SOLERA COCR L50 MM OD6.5 MM SPINE MULTIAXIAL CANNULATED 5.5 MM ROD SUP-55840016550 CDM 270010020 LOCAL 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE COCR L55 MM OD6.5 MM SPINE MULTIAXIAL CANNULATED 5.5 ROD SUP-55840016555 CDM 270010020 LOCAL 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC PERFORMA PEBAX POLYCARBONATE NYLON BERN1 CURVE L65 CM OD5 FR PERIPHERAL RADIOPAQUE BRAID STERILE LATEX FREE ACCEPTS .038 IN GUIDEWIRE SUP-5592-23 CDM 0270 RC outpatient 28.76 28.76 28.76 74 21.28 percent of total billed charges 28.76 93 23.3 percent of total billed charges 28.76 28.76 other OPPS APC 28.76 28.76 other OPPS APC 28.76 27.63 7.95 percent of total billed charges 28.76 28.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING CAPSURE SP NOVUS STEROID ELUTING SILICONE 9 MM J SHORT THIN OD6 FR ATRIUM PASSIVE FIXATION BIPOLAR SUP-5594 SERIES CDM 0275 RC outpatient 1066 1066 1066 57 607.62 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 51 543.66 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BONESCREW,AXS,ST,1.2X3MM,5P" SUP-56-12003 CDM 0270 RC outpatient 51.79 51.79 51.79 74 38.32 percent of total billed charges 51.79 93 41.95 percent of total billed charges 51.79 51.79 other OPPS APC 51.79 51.79 other OPPS APC 51.79 27.63 14.31 percent of total billed charges 51.79 51.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BONESCREW,AXS,ST,1.2X4MM,5P" SUP-56-12004 CDM 0270 RC outpatient 51.79 51.79 51.79 74 38.32 percent of total billed charges 51.79 93 41.95 percent of total billed charges 51.79 51.79 other OPPS APC 51.79 51.79 other OPPS APC 51.79 27.63 14.31 percent of total billed charges 51.79 51.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BONESCREW,AXS,ST,1.2X5MM,5P" SUP-56-12005 CDM 0270 RC outpatient 51.79 51.79 51.79 74 38.32 percent of total billed charges 51.79 93 41.95 percent of total billed charges 51.79 51.79 other OPPS APC 51.79 51.79 other OPPS APC 51.79 27.63 14.31 percent of total billed charges 51.79 51.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BONESCREW,AXS,ST,1.2X6MM,5P" SUP-56-12006 CDM 0270 RC outpatient 51.79 51.79 51.79 74 38.32 percent of total billed charges 51.79 93 41.95 percent of total billed charges 51.79 51.79 other OPPS APC 51.79 51.79 other OPPS APC 51.79 27.63 14.31 percent of total billed charges 51.79 51.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE AXS 1.2MM 8MM SELF-TAPPING CRANIOMAXILLOFACIAL SUP-56-12008 CDM 0270 RC outpatient 258.96 258.96 258.96 74 191.63 percent of total billed charges 258.96 93 209.76 percent of total billed charges 258.96 258.96 other OPPS APC 258.96 258.96 other OPPS APC 258.96 27.63 71.55 percent of total billed charges 258.96 258.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE AXS 1.2MM 10MM SELF-TAPPING CRANIOMAXILLOFACIAL SUP-56-12010 CDM 0270 RC outpatient 258.96 258.96 258.96 74 191.63 percent of total billed charges 258.96 93 209.76 percent of total billed charges 258.96 258.96 other OPPS APC 258.96 258.96 other OPPS APC 258.96 27.63 71.55 percent of total billed charges 258.96 258.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE AXS 1.2MM 12MM SELF-TAPPING CRANIOMAXILLOFACIAL SUP-56-12012 CDM 0270 RC outpatient 258.96 258.96 258.96 74 191.63 percent of total billed charges 258.96 93 209.76 percent of total billed charges 258.96 258.96 other OPPS APC 258.96 258.96 other OPPS APC 258.96 27.63 71.55 percent of total billed charges 258.96 258.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BONESCREW,AXS,SD,1.2X3MM,5P" SUP-56-12903 CDM 0270 RC outpatient 57.4 57.4 57.4 74 42.48 percent of total billed charges 57.4 93 46.49 percent of total billed charges 57.4 57.4 other OPPS APC 57.4 57.4 other OPPS APC 57.4 27.63 15.86 percent of total billed charges 57.4 57.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BONESCREW,AXS,SD,1.2X4MM,5P" SUP-56-12904 CDM 0270 RC outpatient 287.01 287.01 287.01 74 212.39 percent of total billed charges 287.01 93 232.48 percent of total billed charges 287.01 287.01 other OPPS APC 287.01 287.01 other OPPS APC 287.01 27.63 79.3 percent of total billed charges 287.01 287.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BONESCREW,ER,AXS,ST,1.4X3MM,5P" SUP-56-14003 CDM 0270 RC outpatient 53.52 53.52 53.52 74 39.6 percent of total billed charges 53.52 93 43.35 percent of total billed charges 53.52 53.52 other OPPS APC 53.52 53.52 other OPPS APC 53.52 27.63 14.79 percent of total billed charges 53.52 53.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BONESCREW,ER,AXS,ST,1.4X5MM,5P" SUP-56-14005 CDM 0270 RC outpatient 53.52 53.52 53.52 74 39.6 percent of total billed charges 53.52 93 43.35 percent of total billed charges 53.52 53.52 other OPPS APC 53.52 53.52 other OPPS APC 53.52 27.63 14.79 percent of total billed charges 53.52 53.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE AXS 1.7MM 3 MM SELF-TAPPING CRAINIOMAXILLOFACIAL SUP-56-17003 CDM 0270 RC outpatient 230.91 230.91 230.91 74 170.87 percent of total billed charges 230.91 93 187.04 percent of total billed charges 230.91 230.91 other OPPS APC 230.91 230.91 other OPPS APC 230.91 27.63 63.8 percent of total billed charges 230.91 230.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE AXS 1.7MM 4 MM SELF-TAPPING CRAINIOMAXILLOFACIAL SUP-56-17004 CDM 0270 RC outpatient 230.91 230.91 230.91 74 170.87 percent of total billed charges 230.91 93 187.04 percent of total billed charges 230.91 230.91 other OPPS APC 230.91 230.91 other OPPS APC 230.91 27.63 63.8 percent of total billed charges 230.91 230.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE AXS 1.7MM 5 MM SELF-TAPPING CRAINIOMAXILLOFACIAL SUP-56-17005 CDM 0270 RC outpatient 230.91 230.91 230.91 74 170.87 percent of total billed charges 230.91 93 187.04 percent of total billed charges 230.91 230.91 other OPPS APC 230.91 230.91 other OPPS APC 230.91 27.63 63.8 percent of total billed charges 230.91 230.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE AXS 1.7MM 6 MM SELF-TAPPING CRAINIOMAXILLOFACIAL SUP-56-17006 CDM 0270 RC outpatient 230.91 230.91 230.91 74 170.87 percent of total billed charges 230.91 93 187.04 percent of total billed charges 230.91 230.91 other OPPS APC 230.91 230.91 other OPPS APC 230.91 27.63 63.8 percent of total billed charges 230.91 230.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE AXS 1.7MM 8 MM SELF-TAPPING CRAINIOMAXILLOFACIAL SUP-56-17008 CDM 0270 RC outpatient 230.91 230.91 230.91 74 170.87 percent of total billed charges 230.91 93 187.04 percent of total billed charges 230.91 230.91 other OPPS APC 230.91 230.91 other OPPS APC 230.91 27.63 63.8 percent of total billed charges 230.91 230.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE AXS 1.7MM 10 MM SELF-TAPPING CRAINIOMAXILLOFACIAL SUP-56-17010 CDM 0270 RC outpatient 230.91 230.91 230.91 74 170.87 percent of total billed charges 230.91 93 187.04 percent of total billed charges 230.91 230.91 other OPPS APC 230.91 230.91 other OPPS APC 230.91 27.63 63.8 percent of total billed charges 230.91 230.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE AXS 1.7MM 12 MM SELF-TAPPING CRAINIOMAXILLOFACIAL SUP-56-17012 CDM 0270 RC outpatient 230.91 230.91 230.91 74 170.87 percent of total billed charges 230.91 93 187.04 percent of total billed charges 230.91 230.91 other OPPS APC 230.91 230.91 other OPPS APC 230.91 27.63 63.8 percent of total billed charges 230.91 230.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LOCKSCREW,AXS,1.7X4MM,5P" SUP-56-17504 CDM 0270 RC outpatient 59.99 59.99 59.99 74 44.39 percent of total billed charges 59.99 93 48.59 percent of total billed charges 59.99 59.99 other OPPS APC 59.99 59.99 other OPPS APC 59.99 27.63 16.58 percent of total billed charges 59.99 59.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LOCKSCREW,AXS,1.7X5MM,5P" SUP-56-17505 CDM 0270 RC outpatient 59.99 59.99 59.99 74 44.39 percent of total billed charges 59.99 93 48.59 percent of total billed charges 59.99 59.99 other OPPS APC 59.99 59.99 other OPPS APC 59.99 27.63 16.58 percent of total billed charges 59.99 59.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LOCKSCREW,AXS,1.7X6MM,5P" SUP-56-17506 CDM 0270 RC outpatient 59.99 59.99 59.99 74 44.39 percent of total billed charges 59.99 93 48.59 percent of total billed charges 59.99 59.99 other OPPS APC 59.99 59.99 other OPPS APC 59.99 27.63 16.58 percent of total billed charges 59.99 59.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE AXS 1.7MM 3MM SELF-DRILLING F/NON-BIOABSORBABLE SYSTEM CRANIOMAXILLOFACIAL SUP-56-17903 CDM 0270 RC outpatient 258.96 258.96 258.96 74 191.63 percent of total billed charges 258.96 93 209.76 percent of total billed charges 258.96 258.96 other OPPS APC 258.96 258.96 other OPPS APC 258.96 27.63 71.55 percent of total billed charges 258.96 258.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE AXS 1.7MM 4MM SELF-DRILLING CRANIOMAXILLOFACIAL SUP-56-17904 CDM outpatient 258.96 258.96 258.96 258.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE AXS 1.7MM 5MM SELF-DRILLING CRANIOMAXILLOFACIAL SUP-56-17905 CDM 0270 RC outpatient 258.96 258.96 258.96 74 191.63 percent of total billed charges 258.96 93 209.76 percent of total billed charges 258.96 258.96 other OPPS APC 258.96 258.96 other OPPS APC 258.96 27.63 71.55 percent of total billed charges 258.96 258.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE AXS 1.7MM 6MM SELF-DRILLING CRANIOMAXILLOFACIAL SUP-56-17906 CDM 0270 RC outpatient 258.96 258.96 258.96 74 191.63 percent of total billed charges 258.96 93 209.76 percent of total billed charges 258.96 258.96 other OPPS APC 258.96 258.96 other OPPS APC 258.96 27.63 71.55 percent of total billed charges 258.96 258.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE AXS 1.9MM 3MM EMERGENCY SELF-TAPPING F/NON-BIODEGRADABLE SYSTEM MAXILLOFACIAL SUP-56-19003 CDM 0270 RC outpatient 254.64 254.64 254.64 74 188.43 percent of total billed charges 254.64 93 206.26 percent of total billed charges 254.64 254.64 other OPPS APC 254.64 254.64 other OPPS APC 254.64 27.63 70.36 percent of total billed charges 254.64 254.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE AXS 1.9MM 5MM EMERGENCY SELF-TAPPING F/NON-BIODEGRADABLE SYSTEM MAXILLOFACIAL SUP-56-19005 CDM 0270 RC outpatient 254.64 254.64 254.64 74 188.43 percent of total billed charges 254.64 93 206.26 percent of total billed charges 254.64 254.64 other OPPS APC 254.64 254.64 other OPPS APC 254.64 27.63 70.36 percent of total billed charges 254.64 254.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "1.2MM DYNAMIC MESH,MALL, MED" SUP-56-90324 CDM 0270 RC outpatient 8041.8 8041.8 8041.8 74 5950.93 percent of total billed charges 8041.8 93 6513.86 percent of total billed charges 8041.8 8041.8 other OPPS APC 8041.8 8041.8 other OPPS APC 8041.8 27.63 2221.95 percent of total billed charges 8041.8 8041.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "1.2MM DYNAMIC MESH, STD, MED" SUP-56-90624 CDM 0270 RC outpatient 8564.4 8564.4 8564.4 74 6337.66 percent of total billed charges 8564.4 93 6937.16 percent of total billed charges 8564.4 8564.4 other OPPS APC 8564.4 8564.4 other OPPS APC 8564.4 27.63 2366.34 percent of total billed charges 8564.4 8564.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH DILATOR TIGHTRAIL SUB-C ID .145 IN ROTATE STERILE LATEX FREE DISPOSABLE SUP-560-011 CDM 0481 RC outpatient 5057 5057 5057 74 3742.18 percent of total billed charges 5057 93 4096.17 percent of total billed charges 5057 5057 other OPPS APC 5057 5057 other OPPS APC 5057 51 2579.07 percent of total billed charges 5057 5057 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASEPLATE GLENOID ARTHREX L24 MM SHOULDER MODULAR STERILE LATEX FREE SUP-56008 CDM C1776 HCPCS 0278 RC outpatient 3575.38 3575.38 3575.38 57 2037.97 percent of total billed charges 3575.38 93 2896.06 percent of total billed charges 3575.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3575.38 other OPPS APC 3575.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3575.38 other OPPS APC 3575.38 51 1823.44 percent of total billed charges 3575.38 3575.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP UNIVERSAL REVERSE NEUTRAL 36MM SUP-56020 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT PUTTY OSTESTRUX 5CC SUP-56070050 CDM 270010031 LOCAL 0270 RC outpatient 1988.66 1988.66 1988.66 74 1471.61 percent of total billed charges 1988.66 93 1610.81 percent of total billed charges 1988.66 1988.66 other OPPS APC 1988.66 1988.66 other OPPS APC 1988.66 27.63 549.47 percent of total billed charges 1988.66 1988.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT PUTTY OSTEOSTRUX 10CC SUP-56070100 CDM 270010031 LOCAL 0270 RC outpatient 3304.6 3304.6 3304.6 74 2445.4 percent of total billed charges 3304.6 93 2676.73 percent of total billed charges 3304.6 3304.6 other OPPS APC 3304.6 3304.6 other OPPS APC 3304.6 27.63 913.06 percent of total billed charges 3304.6 3304.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PORT IMPLANTABLE INFUSION POWERPORT CLEARVUE OD6 FR SLIM SUTURE PLUG SUP-5616000 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING COMPRESSION 3XL LONG KNEE LENGTH SUP-562 CDM 0270 RC outpatient 6.83 6.83 6.83 74 5.05 percent of total billed charges 6.83 93 5.53 percent of total billed charges 6.83 6.83 other OPPS APC 6.83 6.83 other OPPS APC 6.83 27.63 1.89 percent of total billed charges 6.83 6.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER SINGLE CHAMBER ZEPHR XL SR DEVICE SUP-5626/5620 D CDM 0275 RC outpatient 6891.75 6891.75 6891.75 57 3928.3 percent of total billed charges 6891.75 93 5582.32 percent of total billed charges 6891.75 6891.75 other OPPS APC 6891.75 6891.75 other OPPS APC 6891.75 51 3514.79 percent of total billed charges 6891.75 6891.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER SINGLE CHAMBER ZEPHR XL SR SYSTEM SUP-5626/5620 S CDM 0275 RC outpatient 7087.5 7087.5 7087.5 57 4039.88 percent of total billed charges 7087.5 93 5740.88 percent of total billed charges 7087.5 7087.5 other OPPS APC 7087.5 7087.5 other OPPS APC 7087.5 51 3614.63 percent of total billed charges 7087.5 7087.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL LITHOSTENT RAMROD TECOFLEX NYLON HYDROPHILIC SPIRAL GROVE L24CM OD 7FR RADIOPAQUE OPEN TIP DRAIN HOLE BRAID TETHER STERILE DISPOSABLE SUP-5637024 CDM 0270 RC outpatient 452.09 452.09 452.09 74 334.55 percent of total billed charges 452.09 93 366.19 percent of total billed charges 452.09 452.09 other OPPS APC 452.09 452.09 other OPPS APC 452.09 27.63 124.91 percent of total billed charges 452.09 452.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL LITHOSTENT RAMROD TECOFLEX NYLON HYDROPHILIC SPIRAL GROVE L 26CM OD 7FR RADIOPAQUE OPEN TIP DRAIN HOLE STERILE DISPOSABLE BRAID TETHER SUP-5637026 CDM 0270 RC outpatient 430.56 430.56 430.56 74 318.61 percent of total billed charges 430.56 93 348.75 percent of total billed charges 430.56 430.56 other OPPS APC 430.56 430.56 other OPPS APC 430.56 27.63 118.96 percent of total billed charges 430.56 430.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK TRENGUARD PROCEDURE 600 PAC UP TO 550 LBS SUP-56401 CDM 0270 RC outpatient 230.1 230.1 230.1 74 170.27 percent of total billed charges 230.1 93 186.38 percent of total billed charges 230.1 230.1 other OPPS APC 230.1 230.1 other OPPS APC 230.1 27.63 63.58 percent of total billed charges 230.1 230.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC PERFORMA PIGTAIL 20 BAND SUP-56535AVS20PIG CDM 0270 RC outpatient 234 234 234 74 173.16 percent of total billed charges 234 93 189.54 percent of total billed charges 234 234 other OPPS APC 234 234 other OPPS APC 234 27.63 64.65 percent of total billed charges 234 234 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC IMPRESS STAINLESS STEEL POLYURETHANE RIM CURVE L65 CM OD5 FR PERIPHERAL RADIOPAQUE BRAID TAPER TIP STERILE LATEX FREE ACCEPTS .035 IN GUIDEWIRE SUP-56535RIM CDM 0270 RC outpatient 29.74 29.74 29.74 74 22.01 percent of total billed charges 29.74 93 24.09 percent of total billed charges 29.74 29.74 other OPPS APC 29.74 29.74 other OPPS APC 29.74 27.63 8.22 percent of total billed charges 29.74 29.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5-FRENCH IMPRESS KA 2 HYDROPHILIC ANGIOGRAPHIC CATHETER 5-FRENCH 65CM SUP-56538KA2-H CDM 0481 RC outpatient 94.59 94.59 94.59 74 70 percent of total billed charges 94.59 93 76.62 percent of total billed charges 94.59 94.59 other OPPS APC 94.59 94.59 other OPPS APC 94.59 51 48.24 percent of total billed charges 94.59 94.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PORT POWER INFUSION CLEARVUE SLIM 6FR SUP-5676300 CDM 0270 RC outpatient 3112.2 3112.2 3112.2 74 2303.03 percent of total billed charges 3112.2 93 2520.88 percent of total billed charges 3112.2 3112.2 other OPPS APC 3112.2 3112.2 other OPPS APC 3112.2 27.63 859.9 percent of total billed charges 3112.2 3112.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSTEOBALLAST 45X17.5MM SUP-56800095 CDM 0270 RC outpatient 3972.8 3972.8 3972.8 74 2939.87 percent of total billed charges 3972.8 93 3217.97 percent of total billed charges 3972.8 3972.8 other OPPS APC 3972.8 3972.8 other OPPS APC 3972.8 27.63 1097.68 percent of total billed charges 3972.8 3972.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING MINNIE HYDROPHILIC .014 IN L150 CM OD6 FR 1 LUMEN INECTION PRESSURE SUPPORT GUIDEWIRE SUP-5701 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR DENTAL MICRO FINE YELLOW SUP-5702053 CDM 0270 RC outpatient 0.29 0.29 0.29 74 0.21 percent of total billed charges 0.29 93 0.23 percent of total billed charges 0.29 0.29 other OPPS APC 0.29 0.29 other OPPS APC 0.29 27.63 0.08 percent of total billed charges 0.29 0.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING MINNIE HYDROPHILIC .018 IN L150 CM OD6 FR 1 LUMEN INECTION PRESSURE SUPPORT GUIDEWIRE SUP-5704 CDM 0270 RC outpatient 288.6 288.6 288.6 74 213.56 percent of total billed charges 288.6 93 233.77 percent of total billed charges 288.6 288.6 other OPPS APC 288.6 288.6 other OPPS APC 288.6 27.63 79.74 percent of total billed charges 288.6 288.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SUPPORT MINNIE .035IN 25MM SPACING 90CM 6FR GUIDEWIRE RADIOPAQUE SUP-5706 CDM 0270 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PINS THREADED SUP-57404 CDM 0272 RC outpatient 192.5 192.5 192.5 192.5 other OPPS APC 192.5 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L20 MM OD5.5 MM LOCK PERIPHERAL STERILE SUP-57408 CDM C1776 HCPCS 0278 RC outpatient 303.38 303.38 303.38 57 172.93 percent of total billed charges 303.38 93 245.74 percent of total billed charges 303.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 303.38 other OPPS APC 303.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 303.38 other OPPS APC 303.38 51 154.72 percent of total billed charges 303.38 303.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION SURGICAL SCRUB HIBICLENS 4% CHLORHEXIDINE GLUCONATE 4 OZ SKIN BOTTLE LIQUID ANTIMICROBIAL CLEAR PINK SCENTED SUP-57504 CDM 0270 RC outpatient 5.18 5.18 5.18 74 3.83 percent of total billed charges 5.18 93 4.2 percent of total billed charges 5.18 5.18 other OPPS APC 5.18 5.18 other OPPS APC 5.18 27.63 1.43 percent of total billed charges 5.18 5.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WORLEY STANDARD VEIN SELECTER 5FR X 75CM _62561_ SUP-57538CS-WOR CDM 0275 RC outpatient 312 312 312 57 177.84 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 51 159.12 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER LEAD WORLEY VERTEBRAL CURVE TAPER L75 CM OD5 FR ID.046 IN ERGONOMIC WING HUB BRAID SHAFT HOOK VEIN SELECTOR SUP-57538CSV-WOR CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR FIBER TIPPED SOLON CARE 8IN RAYON DISPOSABLE NS LF MOUTH THROAT SUP-57600 CDM 0270 RC outpatient 0.29 0.29 0.29 74 0.21 percent of total billed charges 0.29 93 0.23 percent of total billed charges 0.29 0.29 other OPPS APC 0.29 0.29 other OPPS APC 0.29 27.63 0.08 percent of total billed charges 0.29 0.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL PROLIFT 15 D L28 MM X W10 MM X H8 MM EXPAND STERILE LATEX FREE SUP-58-1028-1508K CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL PROLIFT OSSEO LOC LARGE 10MM X 28MM X 10-16MM POST PACK EXPANDABLE TITANIUM POSTERIOR LUMBAR 15DEG STERILE SUP-58-1028-1510K CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL PROLIFT TITANIUM 7 D SMALL L28 MM X W12 MM X H8 MM EXPAND POST PACK STERILE LATEX FREE SUP-58-1228-0708D CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL PROLIFT TITANIUM 7 D LARGE L28 MM X W12 MM X H10 MM EXPAND POST PACK STERILE LATEX FREE SUP-58-1228-0710D CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRIP POCKET DBM 10CC SUP-58050100 CDM 270010031 LOCAL 0270 RC outpatient 4038.42 4038.42 4038.42 74 2988.43 percent of total billed charges 4038.42 93 3271.12 percent of total billed charges 4038.42 4038.42 other OPPS APC 4038.42 4038.42 other OPPS APC 4038.42 27.63 1115.82 percent of total billed charges 4038.42 4038.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT POSITIONING JACKSON L7 IN PILLOW COVER ARM CRADLE 4 HIP THIGH PAD COVER JACKSON TABLE SUP-5808 CDM 0270 RC outpatient 70.65 70.65 70.65 74 52.28 percent of total billed charges 70.65 93 57.23 percent of total billed charges 70.65 70.65 other OPPS APC 70.65 70.65 other OPPS APC 70.65 27.63 19.52 percent of total billed charges 70.65 70.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRIP POCKET DBM 20CC SUP-58100200 CDM 270010031 LOCAL 0270 RC outpatient 8075.6 8075.6 8075.6 74 5975.94 percent of total billed charges 8075.6 93 6541.24 percent of total billed charges 8075.6 8075.6 other OPPS APC 8075.6 8075.6 other OPPS APC 8075.6 27.63 2231.29 percent of total billed charges 8075.6 8075.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIPE SURGICAL INSTRUMENT VISIWIPE L2 7/8 IN X W2 7/8 IN CLEAN SUP-581047 CDM 0270 RC outpatient 3.87 3.87 3.87 74 2.86 percent of total billed charges 3.87 93 3.13 percent of total billed charges 3.87 3.87 other OPPS APC 3.87 3.87 other OPPS APC 3.87 27.63 1.07 percent of total billed charges 3.87 3.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WICK SURGICAL BD VISIDRAIN L5 7/8 IN X W5/32 IN EYE FLUID COLLECTION BAG ADHESIVE BACK STERILE LATEX FREE SUP-581048 CDM 0270 RC outpatient 3.07 3.07 3.07 74 2.27 percent of total billed charges 3.07 93 2.49 percent of total billed charges 3.07 3.07 other OPPS APC 3.07 3.07 other OPPS APC 3.07 27.63 0.85 percent of total billed charges 3.07 3.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIDE LENS THK6 MIL L30 MM X W5 MM L10 MM X W2.6 MM OD2.5 MM OPHTHALMIC PHACO STERILE LATEX FREE SUP-581049 CDM 0270 RC outpatient 4.09 4.09 4.09 74 3.03 percent of total billed charges 4.09 93 3.31 percent of total billed charges 4.09 4.09 other OPPS APC 4.09 4.09 other OPPS APC 4.09 27.63 1.13 percent of total billed charges 4.09 4.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHIELD OPHTHALMIC VISITEC POROUS OD8 MM CORNEAL ABSORBENT PAD EASY TO REMOVE LIGHT STERILE LATEX FREE SUP-581062 CDM 0270 RC outpatient 2.03 2.03 2.03 74 1.5 percent of total billed charges 2.03 93 1.64 percent of total billed charges 2.03 2.03 other OPPS APC 2.03 2.03 other OPPS APC 2.03 27.63 0.56 percent of total billed charges 2.03 2.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SWAB CULTURE BD VISISWAB COTTON L3 IN OPHTHALMIC ROUNDED END POINTED TIP STERILE LATEX FREE SUP-581069 CDM outpatient 0.33 0.33 0.33 0.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VENTURE .014 IN L145 CM OD6 FR RAPID EXCHANGE WIRE CONTROL RADIOPAQUE STEERABLE MULTILAYER COIL TORQUE SHAFT SUP-5820 CDM 0481 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 51 1060.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR 4.0MM ROUND DIAMOND SUP-5820-012-040D CDM 0270 RC outpatient 358.1 358.1 358.1 74 264.99 percent of total billed charges 358.1 93 290.06 percent of total billed charges 358.1 358.1 other OPPS APC 358.1 358.1 other OPPS APC 358.1 27.63 98.94 percent of total billed charges 358.1 358.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD MATCH 3.0MM PRECISION NEURO SUP-5820-107-530 CDM 0270 RC outpatient 372.06 372.06 372.06 74 275.32 percent of total billed charges 372.06 93 301.37 percent of total billed charges 372.06 372.06 other OPPS APC 372.06 372.06 other OPPS APC 372.06 27.63 102.8 percent of total billed charges 372.06 372.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR ROUND FLUTED SOFT TOUCH 2.0 MM SUP-5820010120 CDM 0270 RC outpatient 372.06 372.06 372.06 74 275.32 percent of total billed charges 372.06 93 301.37 percent of total billed charges 372.06 372.06 other OPPS APC 372.06 372.06 other OPPS APC 372.06 27.63 102.8 percent of total billed charges 372.06 372.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR DIAMOND ROUND 3.0 MM SUP-5820012030 CDM 0270 RC outpatient 358.1 358.1 358.1 74 264.99 percent of total billed charges 358.1 93 290.06 percent of total billed charges 358.1 358.1 other OPPS APC 358.1 358.1 other OPPS APC 358.1 27.63 98.94 percent of total billed charges 358.1 358.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARREL 4.0MM SUP-5820017040 CDM 0270 RC outpatient 358.1 358.1 358.1 74 264.99 percent of total billed charges 358.1 93 290.06 percent of total billed charges 358.1 358.1 other OPPS APC 358.1 358.1 other OPPS APC 358.1 27.63 98.94 percent of total billed charges 358.1 358.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN SHORT THREAD SUP-58304 CDM 0272 RC outpatient 192.5 192.5 192.5 192.5 other OPPS APC 192.5 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BINDER ABDOMINAL MEDIUM L30-45 IN X W12 IN 4 ELASTIC PANEL COMFORT CONTACT CLOSURE SUP-584-041 CDM 270009158 LOCAL 0270 RC outpatient 18.59 18.59 18.59 74 13.76 percent of total billed charges 18.59 93 15.06 percent of total billed charges 18.59 18.59 other OPPS APC 18.59 18.59 other OPPS APC 18.59 27.63 5.14 percent of total billed charges 18.59 18.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BINDER ABDOMINAL COMFORT LARGE L46-62 IN X W12 IN 4 ELASTIC PANEL CONTACT CLOSURE LATEX SUP-584-042 CDM 270009158 LOCAL 0270 RC outpatient 18.59 18.59 18.59 74 13.76 percent of total billed charges 18.59 93 15.06 percent of total billed charges 18.59 18.59 other OPPS APC 18.59 18.59 other OPPS APC 18.59 27.63 5.14 percent of total billed charges 18.59 18.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA OPHTHALMIC ATKINSON L32 MM OD.5 MM RETROBULBAR PERIBULBAR ANESTHESIA SUP-585108 CDM 0270 RC outpatient 19.55 19.55 19.55 74 14.47 percent of total billed charges 19.55 93 15.84 percent of total billed charges 19.55 19.55 other OPPS APC 19.55 19.55 other OPPS APC 19.55 27.63 5.4 percent of total billed charges 19.55 19.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ORTHOLOC FULL THREAD L30 MM OD3.5 MM CORTICAL ANKLE FOOT 3DI TECHNOLOGY LOW PROFILE SELF TAPPING BRONZE SUP-58813530 CDM 0270 RC outpatient 533 533 533 74 394.42 percent of total billed charges 533 93 431.73 percent of total billed charges 533 533 other OPPS APC 533 533 other OPPS APC 533 27.63 147.27 percent of total billed charges 533 533 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE IM S/H SUP-588802 CDM 0481 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 51 66.3 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE XBLAD 4 SUP-5888101 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN STAINLESS STEEL PTFE NYLON EXTRA BACKUP LAD 4 CURVE L100 CM L.1 IN OD8 FR ID.088 IN RADIOPAQUE HYBRID BRAID MULTISEGMENT TORQUE CONTROL DISPOSABLE BLUE YELLOW SUP-5888101 CDM 0481 RC outpatient 113.1 113.1 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN EXTRA BACKUP LAD 3.5 CURVE 100CM .1IN 8FR .088IN BLUE YELLOW SS PTFE NYLON SUP-5888103 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN XBLAD4 CURVE 100CM .1IN 8FR .088IN BLUE YELLOW SS NYLON PTFE SIDEHOLE SUP-5888104 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE IM SUP-588817 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE JL 4 SUP-588823 CDM 0270 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 27.63 31.25 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE JL 4.0 90CM SUP-588823T CDM 0481 RC outpatient 128.7 128.7 128.7 74 95.24 percent of total billed charges 128.7 93 104.25 percent of total billed charges 128.7 128.7 other OPPS APC 128.7 128.7 other OPPS APC 128.7 51 65.64 percent of total billed charges 128.7 128.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN EXTRA BACKUP 3 CURVE 100CM .1IN 8FR .088IN BLUE YELLOW SS PTFE NYLON SUP-588829 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE JR 4 S/H SUP-588831 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE JL 3.5 S/H SUP-588832 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE JL 4 S/H SUP-588834 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE AR 1 S/H SUP-588836 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE AR 2 S/H SUP-588837 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE H-STICK SUP-588841 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE MPA 1 SUP-588842 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE AL 1 SUP-588843 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE AL 2 SUP-588844 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE AR 1 SUP-588845 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE AR 2 SUP-588846 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE AL 1 S/H SUP-588847 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE AL 2 S/H SUP-588848 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE H-STICK S/H SUP-588850 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE JL 3.5 SUP-588851 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE JL 4.5 SUP-588852 CDM 0481 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 51 66.3 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN STAINLESS STEEL PTFE NYLON EXTRA BACKUP 3 CURVE L100 CM L.1 IN OD8 FR ID.088 IN SIDEHOLE RADIOPAQUE HYBRID BRAID MULTISEGMENT DISPOSABLE BLUE YELLOW SUP-588875 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN EXTRA BACKUP 3.5 CURVE 100CM .1IN 8FR .088IN BLUE YELLOW SS PTFE NYLON SUP-588882 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN EXTRA BACKUP 3.5 CURVE 100CM .1IN 8FR .088IN BLUE YELLOW SS PTFE NYLON SUP-588885 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN STAINLESS STEEL PTFE NYLON EXTRA BACKUP 4 CURVE L100 CM L.1 IN OD8 FR ID.088 IN RADIOPAQUE HYBRID BRAID MULTISEGMENT TORQUE CONTROL DISPOSABLE BLUE YELLOW SUP-588894 CDM 0481 RC outpatient 118.77 118.77 118.77 74 87.89 percent of total billed charges 118.77 93 96.2 percent of total billed charges 118.77 118.77 other OPPS APC 118.77 118.77 other OPPS APC 118.77 51 60.57 percent of total billed charges 118.77 118.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F VISTA GUIDE XB 4.5 SUP-588898 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8F GUIDE XB 4.5 S/H SUP-588899 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON OCCLUSION BRIDGE L90 CM L80 MM OD20 MM 60 CC LASER LEAD EXTRACTION LATEX FREE SUP-590-001 CDM 0481 RC outpatient 2483 2483 2483 74 1837.42 percent of total billed charges 2483 93 2011.23 percent of total billed charges 2483 2483 other OPPS APC 2483 2483 other OPPS APC 2483 51 1266.33 percent of total billed charges 2483 2483 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER IMPRESS PIGTAIN FLUSH 5FR 90CM .035 10 SIDE PORTS NON-BRAIDED SUP-5903510PIG-NB CDM 0270 RC outpatient 28.6 28.6 28.6 74 21.16 percent of total billed charges 28.6 93 23.17 percent of total billed charges 28.6 28.6 other OPPS APC 28.6 28.6 other OPPS APC 28.6 27.63 7.9 percent of total billed charges 28.6 28.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER BRIDGE GUIDEWIRE SYRINGE STOPCOCK OCCLUSION BALLOON PREP SUP-591-001 CDM 0481 RC outpatient 806 806 806 74 596.44 percent of total billed charges 806 93 652.86 percent of total billed charges 806 806 other OPPS APC 806 806 other OPPS APC 806 51 411.06 percent of total billed charges 806 806 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BURR, PFJ MILL , STANDARD" SUP-5927-050-00 CDM 0270 RC outpatient 327.6 327.6 327.6 74 242.42 percent of total billed charges 327.6 93 265.36 percent of total billed charges 327.6 327.6 other OPPS APC 327.6 327.6 other OPPS APC 327.6 27.63 90.52 percent of total billed charges 327.6 327.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIPE PREP NO-STING SKIN-PREP 1ML FRAGRANCE FREE STERILE LATEX ALCOHOL FREE WATERPROOF LIQUID FILM PROTECTIVE DRESSING SUP-59420600 CDM 0270 RC outpatient 0.55 0.55 0.55 74 0.41 percent of total billed charges 0.55 93 0.45 percent of total billed charges 0.55 0.55 other OPPS APC 0.55 0.55 other OPPS APC 0.55 27.63 0.15 percent of total billed charges 0.55 0.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL CONVERTORS TIBURON L40 IN X W4 IN HIP REINFORCE EMERALD ADHESIVE STRIP SPLIT SHEET STERILE LATEX FREE DISPOSABLE SUP-59438 CDM 0270 RC outpatient 30.71 30.71 30.71 74 22.73 percent of total billed charges 30.71 93 24.88 percent of total billed charges 30.71 30.71 other OPPS APC 30.71 30.71 other OPPS APC 30.71 27.63 8.49 percent of total billed charges 30.71 30.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL ABSORBABLE PATCH 1.7 IN DIAMETER SUP-5950007 CDM 0270 RC outpatient 1027.52 1027.52 1027.52 74 760.36 percent of total billed charges 1027.52 93 832.29 percent of total billed charges 1027.52 1027.52 other OPPS APC 1027.52 1027.52 other OPPS APC 1027.52 27.63 283.9 percent of total billed charges 1027.52 1027.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL ABSORBABLE PATCH 2.5 IN DIAMETER SUP-5950008 CDM 0270 RC outpatient 1243.84 1243.84 1243.84 74 920.44 percent of total billed charges 1243.84 93 1007.51 percent of total billed charges 1243.84 1243.84 other OPPS APC 1243.84 1243.84 other OPPS APC 1243.84 27.63 343.67 percent of total billed charges 1243.84 1243.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL ABSORBABLE PATCH 3.2 IN DIAMETER SUP-5950009 CDM 0270 RC outpatient 1608.88 1608.88 1608.88 74 1190.57 percent of total billed charges 1608.88 93 1303.19 percent of total billed charges 1608.88 1608.88 other OPPS APC 1608.88 1608.88 other OPPS APC 1608.88 27.63 444.53 percent of total billed charges 1608.88 1608.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL ABSORBABLE PATCH 3.2 IN DIAMETER SUP-595009 CDM 0270 RC outpatient 1547 1547 1547 74 1144.78 percent of total billed charges 1547 93 1253.07 percent of total billed charges 1547 1547 other OPPS APC 1547 1547 other OPPS APC 1547 27.63 427.44 percent of total billed charges 1547 1547 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING WOUND MEPILEX BORDER FLEX 3 IN X 3 IN SUP-595200 CDM 0270 RC outpatient 4.7 4.7 4.7 74 3.48 percent of total billed charges 4.7 93 3.81 percent of total billed charges 4.7 4.7 other OPPS APC 4.7 4.7 other OPPS APC 4.7 27.63 1.3 percent of total billed charges 4.7 4.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING WOUND MEPILEX BORDER FLEX 4 X 4 IN SUP-595300 CDM 0270 RC outpatient 6.41 6.41 6.41 74 4.74 percent of total billed charges 6.41 93 5.19 percent of total billed charges 6.41 6.41 other OPPS APC 6.41 6.41 other OPPS APC 6.41 27.63 1.77 percent of total billed charges 6.41 6.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE ELLIPSE L13IN x W 10IN MONOFILAMENT LOW PROFILE MEDIUM WEIGHT UNCOATED STERILE LATEX FREE LAPROSCOPIC VENTRAL HERNIA REPAIR SUP-5954113 CDM 0270 RC outpatient 4485.26 4485.26 4485.26 74 3319.09 percent of total billed charges 4485.26 93 3633.06 percent of total billed charges 4485.26 4485.26 other OPPS APC 4485.26 4485.26 other OPPS APC 4485.26 27.63 1239.28 percent of total billed charges 4485.26 4485.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE ELLIPSE L6IN x W 4IN MONOFILAMENT LOW PROFILE MEDIUM WEIGHT UNCOATED STERILE LATEX FREE LAPROSCOPIC VENTRAL HERNIA REPAIR SUP-5954460 CDM 0270 RC outpatient 1031.16 1031.16 1031.16 74 763.06 percent of total billed charges 1031.16 93 835.24 percent of total billed charges 1031.16 1031.16 other OPPS APC 1031.16 1031.16 other OPPS APC 1031.16 27.63 284.91 percent of total billed charges 1031.16 1031.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE ELLIPSE L8IN x W 6IN MONOFILAMENT LOW PROFILE MEDIUM WEIGHT UNCOATED STERILE LATEX FREE LAPROSCOPIC VENTRAL HERNIA REPAIR SUP-5954680 CDM 0270 RC outpatient 2188.42 2188.42 2188.42 74 1619.43 percent of total billed charges 2188.42 93 1772.62 percent of total billed charges 2188.42 2188.42 other OPPS APC 2188.42 2188.42 other OPPS APC 2188.42 27.63 604.66 percent of total billed charges 2188.42 2188.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE ELLIPSE L10IN x W 8IN MONOFILAMENT LOW PROFILE MEDIUM WEIGHT UNCOATED STERILE LATEX FREE LAPROSCOPIC VENTRAL HERNIA REPAIR SUP-5954810 CDM 0270 RC outpatient 3434.08 3434.08 3434.08 74 2541.22 percent of total billed charges 3434.08 93 2781.6 percent of total billed charges 3434.08 3434.08 other OPPS APC 3434.08 3434.08 other OPPS APC 3434.08 27.63 948.84 percent of total billed charges 3434.08 3434.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MARKER WIRE 195CM J SUP-595MEJ014 CDM 0481 RC outpatient 186.55 186.55 186.55 74 138.05 percent of total billed charges 186.55 93 151.11 percent of total billed charges 186.55 186.55 other OPPS APC 186.55 186.55 other OPPS APC 186.55 51 95.14 percent of total billed charges 186.55 186.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MARKER WIRE 300CM STRAIGHT SUP-595MX014 CDM 0481 RC outpatient 186.55 186.55 186.55 74 138.05 percent of total billed charges 186.55 93 151.11 percent of total billed charges 186.55 186.55 other OPPS APC 186.55 186.55 other OPPS APC 186.55 51 95.14 percent of total billed charges 186.55 186.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL OCCULAR OCLUDER ADHESIVE STERILE SUP-5971 CDM 0270 RC outpatient 10.36 10.36 10.36 74 7.67 percent of total billed charges 10.36 93 8.39 percent of total billed charges 10.36 10.36 other OPPS APC 10.36 10.36 other OPPS APC 10.36 27.63 2.86 percent of total billed charges 10.36 10.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK CARDIOLOGY FEM POP BYPASS SUP-597607-016 CDM 0270 RC outpatient 476.03 476.03 476.03 74 352.26 percent of total billed charges 476.03 93 385.58 percent of total billed charges 476.03 476.03 other OPPS APC 476.03 476.03 other OPPS APC 476.03 27.63 131.53 percent of total billed charges 476.03 476.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA REAMING BLADE 41MM SUP-5979-95-41 CDM 270010025 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA REAMING BLADE 46MM SUP-5979-95-46 CDM 270010025 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING OPERATING TABLE ADVANCE CONTROL PAD SYSTEM QUICK CONNECT SUP-5996-12 CDM 0270 RC outpatient 65.25 65.25 65.25 74 48.29 percent of total billed charges 65.25 93 52.85 percent of total billed charges 65.25 65.25 other OPPS APC 65.25 65.25 other OPPS APC 65.25 27.63 18.03 percent of total billed charges 65.25 65.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTAINER HISTOLOGY STS BIO-TITE 10% NEUTRAL BUFFER FORMALIN POLYPROPYLENE 960 ML 2 THREAD PREFILL PREVENT LEAKAGE SCREW TOP LID NONSTERILE BRIGHT YELLOW SUP-599601-9 CDM outpatient 10.77 10.77 10.77 10.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS BIPOLAR 33CM 5MM ENDOPATH BABCOCK 360D RATCHET HANDLE ROTATION KNOB LARGER SUP-5BB CDM 0270 RC outpatient 195.14 195.14 195.14 74 144.4 percent of total billed charges 195.14 93 158.06 percent of total billed charges 195.14 195.14 other OPPS APC 195.14 195.14 other OPPS APC 195.14 27.63 53.92 percent of total billed charges 195.14 195.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER DIALYSIS VALUELINK TITANIUM PERITONEAL 2 PIECE LOCKING STERILE LATEX FREE SUP-5C4129 CDM 0270 RC outpatient 851.27 851.27 851.27 74 629.94 percent of total billed charges 851.27 93 689.53 percent of total billed charges 851.27 851.27 other OPPS APC 851.27 851.27 other OPPS APC 851.27 27.63 235.21 percent of total billed charges 851.27 851.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCISSORS LAPAROSCOPIC ENDOPATH 360D CURVE 21CM 5MM DISPOSABLE STERILE LF RATCHET HANDLE MONOPOLAR CAUTERY INSULATE SHAFT SUP-5DCS CDM 0270 RC outpatient 140.24 140.24 140.24 74 103.78 percent of total billed charges 140.24 93 113.59 percent of total billed charges 140.24 140.24 other OPPS APC 140.24 140.24 other OPPS APC 140.24 27.63 38.75 percent of total billed charges 140.24 140.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING PERFUSION PUMP CUSTOM PRIME PACK LATEX FREE SUP-5G91R7 CDM 0270 RC outpatient 546 546 546 74 404.04 percent of total billed charges 546 93 442.26 percent of total billed charges 546 546 other OPPS APC 546 546 other OPPS APC 546 27.63 150.86 percent of total billed charges 546 546 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT THROMBECTOMY ACE 68 L132 CM OD6 FR REPERFUSION CATHETER SUP-5MAXACE068KIT CDM 0270 RC outpatient 7371 7371 7371 74 5454.54 percent of total billed charges 7371 93 5970.51 percent of total billed charges 7371 7371 other OPPS APC 7371 7371 other OPPS APC 7371 27.63 2036.61 percent of total billed charges 7371 7371 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE GORE-TEX CV-5 TTC-13 L36 IN 2 ARM MONOFILAMENT WHITE SUP-5N02A CDM 0270 RC outpatient 95.33 95.33 95.33 74 70.54 percent of total billed charges 95.33 93 77.22 percent of total billed charges 95.33 95.33 other OPPS APC 95.33 95.33 other OPPS APC 95.33 27.63 26.34 percent of total billed charges 95.33 95.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE GORETEX MONOFILAMENT ABSORBABLE DOUBLE ARMED NEEDLE:TTC-13 SIZE:CV-5 LENGTH:36IN SUP-5N02B CDM 0270 RC outpatient 2277.6 2277.6 2277.6 74 1685.42 percent of total billed charges 2277.6 93 1844.86 percent of total billed charges 2277.6 2277.6 other OPPS APC 2277.6 2277.6 other OPPS APC 2277.6 27.63 629.3 percent of total billed charges 2277.6 2277.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE EPIDURAL TUOHY CURVE 6IN 17GA PLASTIC DISPOSABLE STERILE LF BLUNT TIP LUER LOCK FIRM CANNULA BUFF HEEL SUP-6-2150-17 CDM 0270 RC outpatient 39 39 39 74 28.86 percent of total billed charges 39 93 31.59 percent of total billed charges 39 39 other OPPS APC 39 39 other OPPS APC 39 27.63 10.78 percent of total billed charges 39 39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TW DRL/.9X46MM DRL,4MMSTOP,END" SUP-60-09504 CDM 0270 RC outpatient 329.29 329.29 329.29 74 243.67 percent of total billed charges 329.29 93 266.72 percent of total billed charges 329.29 329.29 other OPPS APC 329.29 329.29 other OPPS APC 329.29 27.63 90.98 percent of total billed charges 329.29 329.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TW DRL/1X50MM DRL,6MMSTOP,END" SUP-60-10506 CDM 0270 RC outpatient 320.29 320.29 320.29 74 237.01 percent of total billed charges 320.29 93 259.43 percent of total billed charges 320.29 320.29 other OPPS APC 320.29 320.29 other OPPS APC 320.29 27.63 88.5 percent of total billed charges 320.29 320.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TW DRL/1X54MMDRL12MM STOP,END" SUP-60-10512 CDM 0270 RC outpatient 329.29 329.29 329.29 74 243.67 percent of total billed charges 329.29 93 266.72 percent of total billed charges 329.29 329.29 other OPPS APC 329.29 329.29 other OPPS APC 329.29 27.63 90.98 percent of total billed charges 329.29 329.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIDESHEATH SLENDER 6FR 10CM SUP-60-1060 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIDESHEATH SLENDER 7FR 10 CM DOUBLEWALL SUP-60-1070 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TW DRL/5MM S 1.35X50MM SUP-60-13505 CDM 0270 RC outpatient 362.21 362.21 362.21 74 268.04 percent of total billed charges 362.21 93 293.39 percent of total billed charges 362.21 362.21 other OPPS APC 362.21 362.21 other OPPS APC 362.21 27.63 100.08 percent of total billed charges 362.21 362.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TW DRL/1.35X50MM/WL/6MM/STRYKER SUP-60-13506 CDM 0270 RC outpatient 326.3 326.3 326.3 74 241.46 percent of total billed charges 326.3 93 264.3 percent of total billed charges 326.3 326.3 other OPPS APC 326.3 326.3 other OPPS APC 326.3 27.63 90.16 percent of total billed charges 326.3 326.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TW DRL/1.4X54MM/12MMSTOP EN SUP-60-13512 CDM 0270 RC outpatient 326.3 326.3 326.3 74 241.46 percent of total billed charges 326.3 93 264.3 percent of total billed charges 326.3 326.3 other OPPS APC 326.3 326.3 other OPPS APC 326.3 27.63 90.16 percent of total billed charges 326.3 326.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TW DRL/1.3X79MM/12MM/ST/EN SUP-60-13570 CDM 0270 RC outpatient 326.3 326.3 326.3 74 241.46 percent of total billed charges 326.3 93 264.3 percent of total billed charges 326.3 326.3 other OPPS APC 326.3 326.3 other OPPS APC 326.3 27.63 90.16 percent of total billed charges 326.3 326.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TW DRL/F. 8MM SCREWS, 1.4X54MM" SUP-60-14008 CDM 0270 RC outpatient 363.71 363.71 363.71 74 269.15 percent of total billed charges 363.71 93 294.61 percent of total billed charges 363.71 363.71 other OPPS APC 363.71 363.71 other OPPS APC 363.71 27.63 100.49 percent of total billed charges 363.71 363.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TW DRL/1.6MM 5MM SUP-60-16005 CDM 0270 RC outpatient 319.57 319.57 319.57 74 236.48 percent of total billed charges 319.57 93 258.85 percent of total billed charges 319.57 319.57 other OPPS APC 319.57 319.57 other OPPS APC 319.57 27.63 88.3 percent of total billed charges 319.57 319.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TW DRL/1.6MM 7MM STRYKER SUP-60-16007 CDM 0270 RC outpatient 335.95 335.95 335.95 74 248.6 percent of total billed charges 335.95 93 272.12 percent of total billed charges 335.95 335.95 other OPPS APC 335.95 335.95 other OPPS APC 335.95 27.63 92.82 percent of total billed charges 335.95 335.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TW DRL/1.6X58MM WKLG 26M SUP-60-16526 CDM 0270 RC outpatient 359.03 359.03 359.03 74 265.68 percent of total billed charges 359.03 93 290.81 percent of total billed charges 359.03 359.03 other OPPS APC 359.03 359.03 other OPPS APC 359.03 27.63 99.2 percent of total billed charges 359.03 359.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIDESHEATH SLENDER 6FR 16CM DOUBLE WALL SUP-60-1660 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIDESHEATH SLENDER 7 FR 16 CM DOUBLE WALL SUP-60-1670 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TW DRL/2X62MM WL 13MM REP PIN SUP-60-20012 CDM 0270 RC outpatient 415.48 415.48 415.48 74 307.46 percent of total billed charges 415.48 93 336.54 percent of total billed charges 415.48 415.48 other OPPS APC 415.48 415.48 other OPPS APC 415.48 27.63 114.8 percent of total billed charges 415.48 415.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE MONOPOLAR L10 FT TUR STERILE LATEX FREE DISPOSABLE ACMI ENDOSCOPIC SUP-60-2121-001 CDM outpatient 7.72 7.72 7.72 7.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAP ELECTRODE 32CM SUP-60-5163-001 CDM 0270 RC outpatient 69.73 69.73 69.73 74 51.6 percent of total billed charges 69.73 93 56.48 percent of total billed charges 69.73 69.73 other OPPS APC 69.73 69.73 other OPPS APC 69.73 27.63 19.27 percent of total billed charges 69.73 69.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MANIPULATOR ENDOSCOPIC VCARE DX CURVE UTERINE GRADUATED SHAFT LUER CHANNEL LOCK SCREW LAPAROSCOPIC HYSTERECTOMY SUP-60-6080-000A CDM 0270 RC outpatient 159.9 159.9 159.9 74 118.33 percent of total billed charges 159.9 93 129.52 percent of total billed charges 159.9 159.9 other OPPS APC 159.9 159.9 other OPPS APC 159.9 27.63 44.18 percent of total billed charges 159.9 159.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MANIPULATOR ENDOSCOPIC VCARE SM 32MM DISPOSABLE STERILE LF CERVIX UTERUS 2 CUP LOCK SCREW HOLE INFLATE BALLOON SUP-60-6085-200A CDM 0270 RC outpatient 185.12 185.12 185.12 74 136.99 percent of total billed charges 185.12 93 149.95 percent of total billed charges 185.12 185.12 other OPPS APC 185.12 185.12 other OPPS APC 185.12 27.63 51.15 percent of total billed charges 185.12 185.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR/ELEVATOR LAPAROSCOPIC VCARE MED 34MM DISPOSABLE STERILE LF CERVIX UTERUS 2 CUP LOCK SCREW HYSTERECTOMY SUP-60-6085-201A CDM 0270 RC outpatient 185.12 185.12 185.12 74 136.99 percent of total billed charges 185.12 93 149.95 percent of total billed charges 185.12 185.12 other OPPS APC 185.12 185.12 other OPPS APC 185.12 27.63 51.15 percent of total billed charges 185.12 185.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR/ELEVATOR LAPAROSCOPIC VCARE LG 37MM DISPOSABLE STERILE LF CERVIX UTERUS 2 CUP HOLE MANIPULATOR INFLATABLE SUP-60-6085-202 CDM 0270 RC outpatient 228.8 228.8 228.8 74 169.31 percent of total billed charges 228.8 93 185.33 percent of total billed charges 228.8 228.8 other OPPS APC 228.8 228.8 other OPPS APC 228.8 27.63 63.22 percent of total billed charges 228.8 228.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR/ELEVATOR LAPAROSCOPIC VCARE LG 37MM DISPOSABLE STERILE LF CERVIX UTERUS 2 CUP HOLE MANIPULATOR INFLATABLE SUP-60-6085-202A CDM 0270 RC outpatient 185.12 185.12 185.12 74 136.99 percent of total billed charges 185.12 93 149.95 percent of total billed charges 185.12 185.12 other OPPS APC 185.12 185.12 other OPPS APC 185.12 27.63 51.15 percent of total billed charges 185.12 185.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING SMOKE EVACUATOR 6FT 7/8IN SUP-60-6805-001A CDM outpatient 30.26 30.26 30.26 30.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUFF TOURNIQUET ATS 3000 CYLINDER L42 IN X W4 IN 2 PORT 1 BLADDER POSITIVE LOCK CONNECTOR CONTACT CLOSURE STERILE LATEX FREE DISPOSABLE RUBY SUP-60-7070-107-00 CDM 0270 RC outpatient 44.19 44.19 44.19 44.19 other OPPS APC 44.19 44.19 other OPPS APC 44.19 27.63 12.21 percent of total billed charges 44.19 44.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER SMOKE EVACUATOR GOLDVAC DISPOSABLE STRYKER NEPTUNE 2 FILTER SUP-60-7509-001 CDM 0270 RC outpatient 4.12 4.12 4.12 74 3.05 percent of total billed charges 4.12 93 3.34 percent of total billed charges 4.12 4.12 other OPPS APC 4.12 4.12 other OPPS APC 4.12 27.63 1.14 percent of total billed charges 4.12 4.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL GOLDVAC ULTRACLEAN BLADE PENCIL 1 IN L10 FT OD11 MM PUSH BUTTON HANDCONTROL TUBE SUP-60-7520-005 CDM 0270 RC outpatient 58.5 58.5 58.5 74 43.29 percent of total billed charges 58.5 93 47.39 percent of total billed charges 58.5 58.5 other OPPS APC 58.5 58.5 other OPPS APC 58.5 27.63 16.16 percent of total billed charges 58.5 58.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE OPTEFORM DEMINERALIZED BONE MATRIX L90 MM X H5 MM 32 ML FROZEN CHIPS FULL DISC SUP-600-05-90 CDM 270010031 LOCAL 0270 RC outpatient 13884 13884 13884 74 10274.2 percent of total billed charges 13884 93 11246 percent of total billed charges 13884 13884 other OPPS APC 13884 13884 other OPPS APC 13884 27.63 3836.15 percent of total billed charges 13884 13884 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM IMAGING NAVIGATION BATTERY SUP-6000006000 CDM 0270 RC outpatient 72.59 72.59 72.59 74 53.72 percent of total billed charges 72.59 93 58.8 percent of total billed charges 72.59 72.59 other OPPS APC 72.59 72.59 other OPPS APC 72.59 27.63 20.06 percent of total billed charges 72.59 72.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER DIALYSIS VALUELINK TITANIUM PERITONEAL 2 PIECE LOCKING STERILE LATEX FREE SUP-600045 CDM outpatient 982.23 982.23 982.23 982.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN NAVIGATION PRECISION NAVIGATION SYSTEM L150 MM OD3 MM KNEE SUP-60007003150 CDM 0270 RC outpatient 2019.55 2019.55 2019.55 74 1494.47 percent of total billed charges 2019.55 93 1635.84 percent of total billed charges 2019.55 2019.55 other OPPS APC 2019.55 2019.55 other OPPS APC 2019.55 27.63 558 percent of total billed charges 2019.55 2019.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT NASAL PROPEL MOMETASONE FUROATE CONTOUR 370 MCG MINI L16 MM SUP-60011 CDM 0270 RC outpatient 2665 2665 2665 74 1972.1 percent of total billed charges 2665 93 2158.65 percent of total billed charges 2665 2665 other OPPS APC 2665 2665 other OPPS APC 2665 27.63 736.34 percent of total billed charges 2665 2665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRANSIT INFUSION CATHETER SUP-600350A CDM 0481 RC outpatient 1391 1391 1391 74 1029.34 percent of total billed charges 1391 93 1126.71 percent of total billed charges 1391 1391 other OPPS APC 1391 1391 other OPPS APC 1391 51 709.41 percent of total billed charges 1391 1391 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG EQUIPMENT MICROSHIELD L40 IN X W20 IN OD40 IN CIRCULAR SEWN ELASTIC BAND STERILE LATEX FREE DISPOSABLE SUP-60040S CDM 0270 RC outpatient 5.22 5.22 5.22 74 3.86 percent of total billed charges 5.22 93 4.23 percent of total billed charges 5.22 5.22 other OPPS APC 5.22 5.22 other OPPS APC 5.22 27.63 1.44 percent of total billed charges 5.22 5.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROHEMOSTASIS GOLD PROBE 300CM 7FR HEMOGLIDE DISPOSABLE STERILE BIPOLAR ROUND DISTAL TIP FIRM SHAFT SUP-6007 CDM 0270 RC outpatient 374.91 374.91 374.91 74 277.43 percent of total billed charges 374.91 93 303.68 percent of total billed charges 374.91 374.91 other OPPS APC 374.91 374.91 other OPPS APC 374.91 27.63 103.59 percent of total billed charges 374.91 374.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 0.9 X 46MM DRILL 4MM STOP STRYKER END SUP-6009504 CDM 0270 RC outpatient 240.24 240.24 240.24 74 177.78 percent of total billed charges 240.24 93 194.59 percent of total billed charges 240.24 240.24 other OPPS APC 240.24 240.24 other OPPS APC 240.24 27.63 66.38 percent of total billed charges 240.24 240.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.0 X 50MM DRILL 6MM STOP STRYKER END SUP-6010506 CDM 0270 RC outpatient 240.24 240.24 240.24 74 177.78 percent of total billed charges 240.24 93 194.59 percent of total billed charges 240.24 240.24 other OPPS APC 240.24 240.24 other OPPS APC 240.24 27.63 66.38 percent of total billed charges 240.24 240.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.0 X 54MM DRILL 12MM STOP STRYKER END SUP-6010512 CDM 0270 RC outpatient 240.24 240.24 240.24 74 177.78 percent of total billed charges 240.24 93 194.59 percent of total billed charges 240.24 240.24 other OPPS APC 240.24 240.24 other OPPS APC 240.24 27.63 66.38 percent of total billed charges 240.24 240.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 7 L155 MM OD11 MM HIP SUP-6012-0711 CDM 270010024 LOCAL 0270 RC outpatient 14279.2 14279.2 14279.2 74 10566.6 percent of total billed charges 14279.2 93 11566.2 percent of total billed charges 14279.2 14279.2 other OPPS APC 14279.2 14279.2 other OPPS APC 14279.2 27.63 3945.34 percent of total billed charges 14279.2 14279.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 7 L155 MM OD13 MM HIP SUP-6012-0713 CDM 270010024 LOCAL 0270 RC outpatient 14279.2 14279.2 14279.2 74 10566.6 percent of total billed charges 14279.2 93 11566.2 percent of total billed charges 14279.2 14279.2 other OPPS APC 14279.2 14279.2 other OPPS APC 14279.2 27.63 3945.34 percent of total billed charges 14279.2 14279.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 8 L155 MM OD12 MM HIP SUP-6012-0812 CDM 270010024 LOCAL 0270 RC outpatient 14279.2 14279.2 14279.2 74 10566.6 percent of total billed charges 14279.2 93 11566.2 percent of total billed charges 14279.2 14279.2 other OPPS APC 14279.2 14279.2 other OPPS APC 14279.2 27.63 3945.34 percent of total billed charges 14279.2 14279.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 8 L155 MM OD14 MM HIP SUP-6012-0814 CDM 270010024 LOCAL 0270 RC outpatient 14279.2 14279.2 14279.2 74 10566.6 percent of total billed charges 14279.2 93 11566.2 percent of total billed charges 14279.2 14279.2 other OPPS APC 14279.2 14279.2 other OPPS APC 14279.2 27.63 3945.34 percent of total billed charges 14279.2 14279.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 9 L155 MM OD13 MM HIP SUP-6012-0913 CDM 270010024 LOCAL 0270 RC outpatient 14279.2 14279.2 14279.2 74 10566.6 percent of total billed charges 14279.2 93 11566.2 percent of total billed charges 14279.2 14279.2 other OPPS APC 14279.2 14279.2 other OPPS APC 14279.2 27.63 3945.34 percent of total billed charges 14279.2 14279.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 9 L155 MM OD15 MM HIP SUP-6012-0915 CDM 270010024 LOCAL 0270 RC outpatient 14279.2 14279.2 14279.2 74 10566.6 percent of total billed charges 14279.2 93 11566.2 percent of total billed charges 14279.2 14279.2 other OPPS APC 14279.2 14279.2 other OPPS APC 14279.2 27.63 3945.34 percent of total billed charges 14279.2 14279.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 10 L155 MM OD14 MM HIP SUP-6012-1014 CDM 270010024 LOCAL 0270 RC outpatient 14279.2 14279.2 14279.2 74 10566.6 percent of total billed charges 14279.2 93 11566.2 percent of total billed charges 14279.2 14279.2 other OPPS APC 14279.2 14279.2 other OPPS APC 14279.2 27.63 3945.34 percent of total billed charges 14279.2 14279.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 10 L155 MM OD16 MM HIP SUP-6012-1016 CDM 270010024 LOCAL 0270 RC outpatient 14279.2 14279.2 14279.2 74 10566.6 percent of total billed charges 14279.2 93 11566.2 percent of total billed charges 14279.2 14279.2 other OPPS APC 14279.2 14279.2 other OPPS APC 14279.2 27.63 3945.34 percent of total billed charges 14279.2 14279.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 11 L155 MM OD15 MM HIP SUP-6012-1115 CDM 270010024 LOCAL 0270 RC outpatient 14279.2 14279.2 14279.2 74 10566.6 percent of total billed charges 14279.2 93 11566.2 percent of total billed charges 14279.2 14279.2 other OPPS APC 14279.2 14279.2 other OPPS APC 14279.2 27.63 3945.34 percent of total billed charges 14279.2 14279.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 11 L155 MM OD17 MM HIP SUP-6012-1117 CDM 270010024 LOCAL 0270 RC outpatient 14279.2 14279.2 14279.2 74 10566.6 percent of total billed charges 14279.2 93 11566.2 percent of total billed charges 14279.2 14279.2 other OPPS APC 14279.2 14279.2 other OPPS APC 14279.2 27.63 3945.34 percent of total billed charges 14279.2 14279.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 12 L155 MM OD16 MM HIP SUP-6012-1216 CDM 270010024 LOCAL 0270 RC outpatient 14279.2 14279.2 14279.2 74 10566.6 percent of total billed charges 14279.2 93 11566.2 percent of total billed charges 14279.2 14279.2 other OPPS APC 14279.2 14279.2 other OPPS APC 14279.2 27.63 3945.34 percent of total billed charges 14279.2 14279.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 12 L155 MM OD18 MM HIP SUP-6012-1218 CDM 270010024 LOCAL 0270 RC outpatient 14279.2 14279.2 14279.2 74 10566.6 percent of total billed charges 14279.2 93 11566.2 percent of total billed charges 14279.2 14279.2 other OPPS APC 14279.2 14279.2 other OPPS APC 14279.2 27.63 3945.34 percent of total billed charges 14279.2 14279.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCCLUDER VASCULAR FLO-RESTER SILICONE L30 MM OD1.25 MM CORONARY ARTERY 2 RADIOPAQUE BULB FLEXIBLE SHAFT STERILE DISPOSABLE SUP-60125BIOS CDM 270009179 LOCAL 0270 RC outpatient 52.8 52.8 52.8 74 39.07 percent of total billed charges 52.8 93 42.77 percent of total billed charges 52.8 52.8 other OPPS APC 52.8 52.8 other OPPS APC 52.8 27.63 14.59 percent of total billed charges 52.8 52.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 8 L205 MM OD12 MM HIP SUP-6013-0812 CDM 270010024 LOCAL 0270 RC outpatient 13520 13520 13520 74 10004.8 percent of total billed charges 13520 93 10951.2 percent of total billed charges 13520 13520 other OPPS APC 13520 13520 other OPPS APC 13520 27.63 3735.58 percent of total billed charges 13520 13520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 8 L205 MM OD14 MM HIP SUP-6013-0814 CDM 270010024 LOCAL 0270 RC outpatient 13520 13520 13520 74 10004.8 percent of total billed charges 13520 93 10951.2 percent of total billed charges 13520 13520 other OPPS APC 13520 13520 other OPPS APC 13520 27.63 3735.58 percent of total billed charges 13520 13520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 9 L205 MM OD13 MM HIP SUP-6013-0913 CDM 270010024 LOCAL 0270 RC outpatient 13520 13520 13520 74 10004.8 percent of total billed charges 13520 93 10951.2 percent of total billed charges 13520 13520 other OPPS APC 13520 13520 other OPPS APC 13520 27.63 3735.58 percent of total billed charges 13520 13520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 9 L205 MM OD15 MM HIP SUP-6013-0915 CDM 270010024 LOCAL 0270 RC outpatient 13520 13520 13520 74 10004.8 percent of total billed charges 13520 93 10951.2 percent of total billed charges 13520 13520 other OPPS APC 13520 13520 other OPPS APC 13520 27.63 3735.58 percent of total billed charges 13520 13520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 10 L205 MM OD14 MM HIP SUP-6013-1014 CDM 270010024 LOCAL 0270 RC outpatient 13520 13520 13520 74 10004.8 percent of total billed charges 13520 93 10951.2 percent of total billed charges 13520 13520 other OPPS APC 13520 13520 other OPPS APC 13520 27.63 3735.58 percent of total billed charges 13520 13520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 10 L205 MM OD16 MM HIP SUP-6013-1016 CDM 270010024 LOCAL 0270 RC outpatient 13520 13520 13520 74 10004.8 percent of total billed charges 13520 93 10951.2 percent of total billed charges 13520 13520 other OPPS APC 13520 13520 other OPPS APC 13520 27.63 3735.58 percent of total billed charges 13520 13520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 11 L205 MM OD15 MM HIP SUP-6013-1115 CDM 270010024 LOCAL 0270 RC outpatient 13520 13520 13520 74 10004.8 percent of total billed charges 13520 93 10951.2 percent of total billed charges 13520 13520 other OPPS APC 13520 13520 other OPPS APC 13520 27.63 3735.58 percent of total billed charges 13520 13520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 11 L205 MM OD17 MM HIP SUP-6013-1117 CDM 270010024 LOCAL 0270 RC outpatient 13520 13520 13520 74 10004.8 percent of total billed charges 13520 93 10951.2 percent of total billed charges 13520 13520 other OPPS APC 13520 13520 other OPPS APC 13520 27.63 3735.58 percent of total billed charges 13520 13520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 12 L205 MM OD16 MM HIP SUP-6013-1216 CDM 270010024 LOCAL 0270 RC outpatient 13520 13520 13520 74 10004.8 percent of total billed charges 13520 93 10951.2 percent of total billed charges 13520 13520 other OPPS APC 13520 13520 other OPPS APC 13520 27.63 3735.58 percent of total billed charges 13520 13520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 12 L205 MM OD18 MM HIP SUP-6013-1218 CDM 270010024 LOCAL 0270 RC outpatient 13520 13520 13520 74 10004.8 percent of total billed charges 13520 93 10951.2 percent of total billed charges 13520 13520 other OPPS APC 13520 13520 other OPPS APC 13520 27.63 3735.58 percent of total billed charges 13520 13520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 13 L205 MM OD17 MM HIP SUP-6013-1317 CDM 270010024 LOCAL 0270 RC outpatient 13520 13520 13520 74 10004.8 percent of total billed charges 13520 93 10951.2 percent of total billed charges 13520 13520 other OPPS APC 13520 13520 other OPPS APC 13520 27.63 3735.58 percent of total billed charges 13520 13520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 13 L205 MM OD19 MM HIP SUP-6013-1319 CDM 270010024 LOCAL 0270 RC outpatient 13520 13520 13520 74 10004.8 percent of total billed charges 13520 93 10951.2 percent of total billed charges 13520 13520 other OPPS APC 13520 13520 other OPPS APC 13520 27.63 3735.58 percent of total billed charges 13520 13520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 14 L205 MM OD18 MM HIP SUP-6013-1418 CDM 270010024 LOCAL 0270 RC outpatient 13520 13520 13520 74 10004.8 percent of total billed charges 13520 93 10951.2 percent of total billed charges 13520 13520 other OPPS APC 13520 13520 other OPPS APC 13520 27.63 3735.58 percent of total billed charges 13520 13520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION TITANIUM HA 14 L205 MM OD20 MM HIP SUP-6013-1420 CDM 270010024 LOCAL 0270 RC outpatient 13520 13520 13520 74 10004.8 percent of total billed charges 13520 93 10951.2 percent of total billed charges 13520 13520 other OPPS APC 13520 13520 other OPPS APC 13520 27.63 3735.58 percent of total billed charges 13520 13520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 5MM STOP STRYK END 1.35X60MM SUP-6013505 CDM 0270 RC outpatient 273 273 273 74 202.02 percent of total billed charges 273 93 221.13 percent of total billed charges 273 273 other OPPS APC 273 273 other OPPS APC 273 27.63 75.43 percent of total billed charges 273 273 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL STOP STRYKER END 12MM 1.4X54MM SUP-6013512 CDM 0270 RC outpatient 246.48 246.48 246.48 74 182.4 percent of total billed charges 246.48 93 199.65 percent of total billed charges 246.48 246.48 other OPPS APC 246.48 246.48 other OPPS APC 246.48 27.63 68.1 percent of total billed charges 246.48 246.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 122 STOP STRYKER END 1.3X79MM SUP-6013570 CDM 0270 RC outpatient 246.48 246.48 246.48 74 182.4 percent of total billed charges 246.48 93 199.65 percent of total billed charges 246.48 246.48 other OPPS APC 246.48 246.48 other OPPS APC 246.48 27.63 68.1 percent of total billed charges 246.48 246.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL STOP STRYK END 8MM 1.4X54MM SUP-6014008 CDM 0270 RC outpatient 273 273 273 74 202.02 percent of total billed charges 273 93 221.13 percent of total billed charges 273 273 other OPPS APC 273 273 other OPPS APC 273 27.63 75.43 percent of total billed charges 273 273 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VESSEL OCCLUDER SUP-60150BIOS CDM 270009179 LOCAL 0270 RC outpatient 52.8 52.8 52.8 74 39.07 percent of total billed charges 52.8 93 42.77 percent of total billed charges 52.8 52.8 other OPPS APC 52.8 52.8 other OPPS APC 52.8 27.63 14.59 percent of total billed charges 52.8 52.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INJECTION RS PENINSULA REGIONAL MEDICAL SUP-60160423 CDM 0270 RC outpatient 76.85 76.85 76.85 74 56.87 percent of total billed charges 56.68 93 45.91 percent of total billed charges 76.85 76.85 other OPPS APC 76.85 76.85 other OPPS APC 56.68 27.63 15.66 percent of total billed charges 56.68 76.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INJECTION RS PENINSULA REGIONAL MEDICAL SUP-60160423 CDM 0270 RC outpatient 76.85 76.85 56.68 74 41.94 percent of total billed charges 76.85 93 62.25 percent of total billed charges 56.68 56.68 other OPPS APC 56.68 56.68 other OPPS APC 76.85 27.63 21.23 percent of total billed charges 56.68 76.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATH LAB ELECTROPHYSIOLOGY RS PENINSULA REGIONAL SUP-60160424 CDM 0481 RC outpatient 20.11 20.11 20.11 74 14.88 percent of total billed charges 20.11 93 16.29 percent of total billed charges 20.11 20.11 other OPPS APC 20.11 20.11 other OPPS APC 20.11 51 10.26 percent of total billed charges 20.11 20.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT RIGHT HEART SUP-60160427 CDM 0481 RC outpatient 103.42 103.42 103.42 74 76.53 percent of total billed charges 103.42 93 83.77 percent of total billed charges 103.42 103.42 other OPPS APC 103.42 103.42 other OPPS APC 103.42 51 52.74 percent of total billed charges 103.42 103.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT LEFT HEART SUP-60160428 CDM 0481 RC outpatient 110.36 110.36 110.36 74 81.67 percent of total billed charges 110.36 93 89.39 percent of total billed charges 110.36 110.36 other OPPS APC 110.36 110.36 other OPPS APC 110.36 51 56.28 percent of total billed charges 110.36 110.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VESSEL OCCLUDER SUP-60175 CDM 270009179 LOCAL 0270 RC outpatient 52.8 52.8 52.8 74 39.07 percent of total billed charges 52.8 93 42.77 percent of total billed charges 52.8 52.8 other OPPS APC 52.8 52.8 other OPPS APC 52.8 27.63 14.59 percent of total billed charges 52.8 52.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE OPTEFORM DEMINERALIZED BONE MATRIX CORTICAL CANCELLOUS L75 MM X H5 MM 14.7 ML CHIP FROZEN PARTIAL DISK SUP-602-05-75 CDM 270010031 LOCAL 0270 RC outpatient 8598.2 8598.2 8598.2 74 6362.67 percent of total billed charges 8598.2 93 6964.54 percent of total billed charges 8598.2 8598.2 other OPPS APC 8598.2 8598.2 other OPPS APC 8598.2 27.63 2375.68 percent of total billed charges 8598.2 8598.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 132 D 0 33 MM OFFSET L86 MM L30 MM HIP CEMENTLESS NECK SUP-6020-0030 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 132 D 1 34 MM OFFSET L110 MM L30 MM HIP CEMENTLESS NECK SUP-6020-0130 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 130 D 2 35 MM OFFSET L115 MM L30 MM HIP CEMENTLESS NECK SUP-6020-0230 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 132 D 3 39 MM OFFSET L120 MM L35 MM HIP CEMENTLESS NECK SUP-6020-0335 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 132 D 4 40 MM OFFSET L125 MM L35 MM HIP CEMENTLESS NECK SUP-6020-0435 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 132 D 5 44 MM OFFSET L130 MM L37 MM HIP CEMENTLESS NECK SUP-6020-0537 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 132 D 6 45 MM OFFSET L135 MM L37 MM HIP CEMENTLESS SUP-6020-0637 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 132 D 7 48 MM OFFSET L140 MM L40 MM HIP CEMENTLESS NECK SUP-6020-0740 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 132 D 2.5 36 MM OFFSET L118 MM L30 MM HIP CEMENTLESS NECK SUP-6020-2530 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 132 D 3.5 39 MM OFFSET L124 MM L35 MM HIP CEMENTLESS NECK SUP-6020-3535 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 132 D 4.5 41 MM OFFSET L129 MM L35 MM HIP CEMENTLESS NECK SUP-6020-4535 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 132 D 5.5 45 MM OFFSET L133 MM L37 MM HIP CEMENTLESS NECK SUP-6020-5537 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCCLUDER VASCULAR FLO-RESTER L30 MM OD2 MM CORONARY ARTERY 2 BULB FLEXIBLE SHAFT STERILE DISPOSABLE SUP-60200BIOS CDM 270009179 LOCAL 0270 RC outpatient 52.8 52.8 52.8 74 39.07 percent of total billed charges 52.8 93 42.77 percent of total billed charges 52.8 52.8 other OPPS APC 52.8 52.8 other OPPS APC 52.8 27.63 14.59 percent of total billed charges 52.8 52.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 127 D 0 37 MM OFFSET L86 MM L30 MM HIP CEMENTLESS NECK SUP-6021-0030 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 127 D 1 38 MM OFFSET L110 MM L30 MM HIP CEMENTLESS NECK SUP-6021-0130 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 127 D 2 39 MM OFFSET L115 MM L30 MM HIP CEMENTLESS NECK SUP-6021-0230 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 127 D 3 43 MM OFFSET L120 MM L35 MM HIP CEMENTLESS NECK SUP-6021-0335 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 127 D 4 44 MM OFFSET L125 MM L35 MM HIP CEMENTLESS NECK SUP-6021-0435 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 127 D 5 48 MM OFFSET L130 MM L37 MM HIP CEMENTLESS NECK SUP-6021-0537 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 127 D 6 49 MM OFFSET L135 MM L37 MM HIP CEMENTLESS NECK SUP-6021-0637 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 127 D 7 53 MM OFFSET L140 MM L40 MM HIP CEMENTLESS NECK SUP-6021-0740 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 127 D 2.5 40 MM OFFSET L118 MM L30 MM HIP CEMENTLESS NECK SUP-6021-2530 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 127 D 3.5 43 MM OFFSET L124 MM L35 MM HIP CEMENTLESS NECK SUP-6021-3535 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 127 D 4.5 45 MM OFFSET L129 MM L35 MM HIP CEMENTLESS NECK SUP-6021-4535 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE TMZF 127 D 5.5 49 MM OFFSET L133 MM L37 MM HIP CEMENTLESS NECK SUP-6021-5537 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCCLUDER VASCULAR FLO-RESTER T L30 MM OD2.25 MM VESSEL 2 BULB FLEXIBLE SHAFT RADIOPAQUE STERILE DISPOSABLE SUP-60225BIOS CDM 270009179 LOCAL 0270 RC outpatient 52.8 52.8 52.8 74 39.07 percent of total billed charges 52.8 93 42.77 percent of total billed charges 52.8 52.8 other OPPS APC 52.8 52.8 other OPPS APC 52.8 27.63 14.59 percent of total billed charges 52.8 52.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCCLUDER VASCULAR FLO-RESTER L30 MM OD2.5 MM CORONARY ARTERY 2 BULB FLEXIBLE SHAFT STERILE DISPOSABLE SUP-60250BIOS CDM 270009179 LOCAL 0270 RC outpatient 52.8 52.8 52.8 74 39.07 percent of total billed charges 52.8 93 42.77 percent of total billed charges 52.8 52.8 other OPPS APC 52.8 52.8 other OPPS APC 52.8 27.63 14.59 percent of total billed charges 52.8 52.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 6.5MM CANNULATED PARTIAL THREAD 40MM SUP-602640 CDM 270010022 LOCAL 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 6.5MM CANNULATED PARTIAL THREAD 45MM SUP-602645 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 6.5MM CANNULATED PARTIAL THREAD 50MM SUP-602650 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS III TITANIUM L55 MM L20 MM OD6.5 MM LONG BONE SMALL BONE SELF DRILL SELF TAP CANNULATED STERILE SUP-602655 CDM 270010020 LOCAL 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS III TITANIUM L85 MM L20 MM OD6.5 MM LONG BONE SMALL BONE SELF DRILL SELF TAP CANNULATED STERILE SUP-602658S CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS III TITANIUM PARTIAL THREAD LOW PROFILE REVERSE CUT FLUTE L60 MM L20 MM OD6.5 MM SMALL BONE LONG BONE CANNULATED SELF DRILLING NONSTERILE SUP-602660 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS III TITANIUM L65 MM L20 MM OD6.5 MM HIP FEMUR SELF TAP SELF DRILL CANNULATED STERILE SUP-602665 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS III TITANIUM PARTIAL THREAD L70 MM L20 MM OD6.5 MM HIP FEMUR CANNULATED STERILE SUP-602670 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS III TITANIUM L75 MM L20 MM OD6.5 MM HIP FEMUR SELF TAP SELF DRILL CANNULATED STERILE SUP-602675 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS III TITANIUM L80 MM L20 MM OD6.5 MM LONG BONE SMALL BONE SELF DRILL SELF TAP CANNULATED STERILE SUP-602680 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS III TITANIUM L85 MM L20 MM OD6.5 MM HIP FEMUR SELF TAPPING SELF DRILLING CANNULATED SUP-602685 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS III TITANIUM PARTIAL THREAD L90 MM L20 MM OD6.5 MM HIP FEMUR LOW PROFILE CANNULATED SELF DRILLING STERILE SUP-602690 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS III TITANIUM L95 MM L20 MM OD6.5 MM HIP FEMORAL SELF TAP SELF DRILL CANNULATED STERILE SUP-602695 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 6.5MM CANNULATED PARTIAL THREAD 100MM SUP-602700 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 6.5MM CANNULATED PARTIAL THREAD 105M SUP-602705 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 6.5MM CANNULATED PARTIAL THREAD 110MM SUP-602710 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 6.5MM CANNULATED PARTIAL THREAD 115MM SUP-602715 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 6.5MM CANNULATED PARTIAL THREAD 120MM SUP-602720 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCCLUDER VASCULAR SYNOVIS FLO-RESTER GLOBAL SILICONE RUBBER L30 MM OD2.75 MM CORONARY ARTERY RADIOPAQUE ATRAUMATIC BULB FLEXIBLE SHAFT INTERNAL STERILE DISPOSABLE SUP-60275 CDM 270009179 LOCAL 0270 RC outpatient 52.8 52.8 52.8 74 39.07 percent of total billed charges 52.8 93 42.77 percent of total billed charges 52.8 52.8 other OPPS APC 52.8 52.8 other OPPS APC 52.8 27.63 14.59 percent of total billed charges 52.8 52.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 6.5MM CANNULATED FULLY THREAD 55MM SUP-602855 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 6.5MM CANNULATED FULLY THREAD 60MM SUP-602860 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 6.5MM CANNULATED FULLY THREAD 65MM SUP-602865 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 6.5MM CANNULATED FULLY THREAD 70MM SUP-602870 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 6.5MM CANNULATED FULLY THREAD 75MM SUP-602875 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 6.5MM CANNULATED FULLY THREAD 80MM SUP-602880 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 6.5MM CANNULATED FULLY THREAD 85MM SUP-602885 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 6.5MM CANNULATED 90MM LT SUP-602890 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 6.5MM CANNULATED FULLY THREAD 95MM SUP-602895 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 6.5MM CANNULATED FULLY THREAD 100MM SUP-602900 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 6.5MM CANNULATED FULLY THREAD 105MM SUP-602905 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 6.5MM CANNULATED FULLY THREAD 110MM SUP-602910 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 6.5MM CANNULATED FULLY THREAD 115MM SUP-602915 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 6.5MM CANNULATED FULLY THREAD 120MM SUP-602920 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION SCRUB SURGICAL HAND 2% CHG 4ML LIQUID POUR BOTTLE ANTIMICROBIAL W/EMOLLIENT FLORAL SCRUB-STAT SUP-603-0604 CDM 0270 RC outpatient 4.3 4.3 4.3 74 3.18 percent of total billed charges 4.3 93 3.48 percent of total billed charges 4.3 4.3 other OPPS APC 4.3 4.3 other OPPS APC 4.3 27.63 1.19 percent of total billed charges 4.3 4.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCCLUDER VASCULAR SYNOVIS FLO-RESTER GLOBAL SILICONE RUBBER L30 MM OD3 MM CORONARY ARTERY RADIOPAQUE ATRAUMATIC BULB FLEXIBLE SHAFT INTERNAL STERILE DISPOSABLE SUP-60300 CDM 270009179 LOCAL 0270 RC outpatient 52.8 52.8 52.8 74 39.07 percent of total billed charges 52.8 93 42.77 percent of total billed charges 52.8 52.8 other OPPS APC 52.8 52.8 other OPPS APC 52.8 27.63 14.59 percent of total billed charges 52.8 52.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCCLUDER VASCULAR SYNOVIS FLO-RESTER GLOBAL SILICONE RUBBER L30 MM OD3.5 MM CORONARY ARTERY RADIOPAQUE ATRAUMATIC BULB FLEXIBLE SHAFT INTERNAL STERILE DISPOSABLE SUP-60350 CDM 270009179 LOCAL 0270 RC outpatient 52.8 52.8 52.8 74 39.07 percent of total billed charges 52.8 93 42.77 percent of total billed charges 52.8 52.8 other OPPS APC 52.8 52.8 other OPPS APC 52.8 27.63 14.59 percent of total billed charges 52.8 52.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HALTER TRACTION HEAD DELUXE XCOMFORTABLE PERSPIRATION ABSORBING PAD DISPOSABLE SUP-60383 CDM 0270 RC outpatient 128.7 128.7 128.7 74 95.24 percent of total billed charges 128.7 93 104.25 percent of total billed charges 128.7 128.7 other OPPS APC 128.7 128.7 other OPPS APC 128.7 27.63 35.56 percent of total billed charges 128.7 128.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCCLUDER VASCULAR FLO-RESTER SILICONE L30 MM OD4 MM VESSEL 2 RUBBER BULB RADIOPAQUE FLEXIBLE SHAFT INTERNAL STERILE DISPOSABLE SUP-60400 CDM 0270 RC outpatient 220.27 220.27 220.27 74 163 percent of total billed charges 220.27 93 178.42 percent of total billed charges 220.27 220.27 other OPPS APC 220.27 220.27 other OPPS APC 220.27 27.63 60.86 percent of total billed charges 220.27 220.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCCLUDER VASCULAR 30MM 4MM FLO-RESTER VESSEL SILICONE 2 RUBBER BULB RADIOPAQUE SUP-60400BIOS CDM 0270 RC outpatient 180.96 180.96 180.96 74 133.91 percent of total billed charges 180.96 93 146.58 percent of total billed charges 180.96 180.96 other OPPS APC 180.96 180.96 other OPPS APC 180.96 27.63 50 percent of total billed charges 180.96 180.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 4.0MM PARTIALLY THREADED 14MM SUP-604614 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 4.0MM PARTIALLY THREADED 16MM SUP-604616 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 4.0MM PARTIALLY THREADED 18MM SUP-604618 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 4.0MM PARTIALLY THREADED 20MM SUP-604620 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 4.0MM PARTIALLY THREADED 22MM SUP-604622 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 4.0MM PARTIALLY THREADED 24MM SUP-604624 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 4.0MM PARTIALLY THREADED 26MM SUP-604626 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 4.0MM PARTIALLY THREADED 28MM SUP-604628 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS III TITANIUM 1/3 THREAD REVERSE CUT FLUTE L32 MM OD4 MM LONG BONE SMALL BONE SELF DRILL SELF TAP CANNULATED STERILE SUP-604630S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS III TITANIUM PARTIAL THREAD REVERSE CUT FLUTE L32 MM OD4 MM TARSUS METATARSAL CANNULATED SELF DRILL LOW PROFILE SUP-604632 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 4.0MM PARTIALLY THREADED 34MM SUP-604634S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 4.0MM PARTIALLY THREADED 36MM SUP-604636 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 4.0MM PARTIALLY THREADED 38MM SUP-604638 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 4.0MM PARTIALLY THREADED 40MM SUP-604640 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 4.0MM PARTIALLY THREADED 42MM SUP-604642 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 4.0MM PARTIALLY THREADED 44MM SUP-604644S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS III TITANIUM 1/3 THREAD REVERSE CUT FLUTE L46 MM OD4 MM LONG BONE SMALL BONE SELF DRILL SELF TAP CANNULATED STERILE SUP-604646S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS III TITANIUM PARTIAL THREAD L48 MM OD4 MM DISTAL CANCELLOUS RADIUS TIBIA FIBULA CANNULATED REVERSE CUTTING FLUTE SELF DRILLING SELF TAPPING STERILE SUP-604648S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS III TITANIUM 1/3 THREAD REVERSE CUT FLUTE L50 MM OD4 MM LONG BONE SMALL BONE SELF DRILL SELF TAP CANNULATED STERILE SUP-604650S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS III TITANIUM PARTIAL THREAD REVERSE CUT FLUTE L55 MM OD4 MM TARSUS METATARSAL CANNULATED SELF DRILL LOW PROFILE SUP-604655 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS III TITANIUM PARTIAL THREAD REVERSE CUT FLUTE L50 MM OD4 MM TARSUS METATARSAL CANNULATED SELF DRILL LOW PROFILE SUP-604660 CDM 270010020 LOCAL 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 4.0MM PARTIALLY THREADED 65MM SUP-604665 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER 4.0MM PARTIALLY THREADED 70MM SUP-604670 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM FULLY THREADED 12MM SUP-604712S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM FULLY THREADED 14MM SUP-604714S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM FULLY THREADED 16MM SUP-604716S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM FULLY THREADED 18MM SUP-604718S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM FULLY THREADED 20MM SUP-604720S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM FULLY THREADED 22MM SUP-604722S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM FULLY THREADED 24MM SUP-604724S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM FULLY THREADED 26MM SUP-604726S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM FULLY THREADED 28MM SUP-604728S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM FULLY THREADED 30MM SUP-604730S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM FULLY THREADED 32MM SUP-604732S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM FULLY THREADED 34MM SUP-604734S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM FULLY THREADED 36MM SUP-604736S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM FULLY THREADED 38MM SUP-604738S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS III TITANIUM FULL THREAD REVERSE CUT FLUTE L40 MM OD4 MM TARSAL METATARSAL CANNULATED SELF DRILL SELF TAP LOW PROFILE HEAD STERILE SUP-604740S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM FULLY THREADED 42MM SUP-604742S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM FULLY THREADED 44MM SUP-604744S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM FULLY THREADED 48MM SUP-604748S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS III TITANIUM PARTIAL THREAD REVERSE CUT FLUTE L50 MM OD4 MM PELVIS CANNULATED SELF DRILL SELF TAP LOW PROFILE HEAD STERILE SUP-604750S CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL SECURE FIT 132 DEG REDUCED NECK SIZE 5 SUP-6051-0525S CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL SECURE FIT 132 DEG REDUCED NECK SIZE 6 SUP-6051-0625S CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL SECUR-FIT MAX HA 132 D 9 40.8 MM L15 CM L35 MM OD11.9 MM HIP STERILE SUP-6051-0935S CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL SECURE FIT 132 DEG REDUCED NECK SIZE 10 SUP-6051-1035S CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL SECURE FIT 132 DEG REDUCED NECK SIZE 13 SUP-6051-1340S CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STYLET LEAD OD.014 IN KIT J TIP BLUNT WHITE KNOB SUP-6052 CDM 0270 RC outpatient 79.04 79.04 79.04 74 58.49 percent of total billed charges 79.04 93 64.02 percent of total billed charges 79.04 79.04 other OPPS APC 79.04 79.04 other OPPS APC 79.04 27.63 21.84 percent of total billed charges 79.04 79.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE 127 D 2 39 MM OFFSET L124 MM L30 MM HIP CEMENTED NECK SUP-6057-0230D CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE 127 D 3 43 MM OFFSET L131 MM L35 MM HIP CEMENTED NECK SUP-6057-0335D CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE 127 D 4 46 MM OFFSET L137 MM L35 MM HIP CEMENTED SUP-6057-0435D CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL SIZE 5 48MM ACCOLADE C PRIMARY EXTENDED OFFSET COBALT CHROMIUM CEMENTED 127DEG ANGLED HIP REDUCED NECK GEOMETRY 145MM 37MM NECK SUP-6057-0537D CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE 127 D 6 49 MM OFFSET L158 MM L37 MM HIP CEMENTED NECK SUP-6057-0637D CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE 127 D 7 52 MM OFFSET L158 MM L40 MM HIP CEMENTED NECK SUP-6057-0740D CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE C 132 D 2 L30 MM HIP CEMENT SUP-6058-0230D CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE 132 D 3 39 MM OFFSET L131 MM L35 MM HIP CEMENTED NECK SUP-6058-0335D CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE 132 D 4 42 MM OFFSET L137 MM L35 MM HIP CEMENTED NECK SUP-6058-0435D CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE 132DEG CEMENTED SIZE 5 SUP-6058-0537D CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE C 132 D 6 L37 MM HIP CEMENT SUP-6058-0637D CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE C 7 L40 MM HIP CEMENT SUP-6058-0740D CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE SURGIMEND FETAL BOVINE COLLAGEN MATRIX L16 CM X W6 CM SUP-606-001-015 CDM 0270 RC outpatient 4992 4992 4992 74 3694.08 percent of total billed charges 4992 93 4043.52 percent of total billed charges 4992 4992 other OPPS APC 4992 4992 other OPPS APC 4992 27.63 1379.29 percent of total billed charges 4992 4992 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SURGIMEND PRS SUP-606-007-001 CDM 0270 RC outpatient 17940 17940 17940 74 13275.6 percent of total billed charges 17940 93 14531.4 percent of total billed charges 17940 17940 other OPPS APC 17940 17940 other OPPS APC 17940 27.63 4956.82 percent of total billed charges 17940 17940 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NOZZLE BONE CEMENT REVOLUTION THIN FLEXIBLE STERILE SUP-606-515 CDM outpatient 46.8 46.8 46.8 46.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROWLER SELECT PLUS SUP-606-S255FX CDM 0270 RC outpatient 3333.49 3333.49 3333.49 74 2466.78 percent of total billed charges 3333.49 93 2700.13 percent of total billed charges 3333.49 3333.49 other OPPS APC 3333.49 3333.49 other OPPS APC 3333.49 27.63 921.04 percent of total billed charges 3333.49 3333.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE SURGIMEND FETAL BOVINE DERMIS COLLAGEN MATRIX THK.75-1.54 MM L20 CM X W16 CM SHEET SUP-606001008 CDM 0270 RC outpatient 20376.2 20376.2 20376.2 74 15078.4 percent of total billed charges 20376.2 93 16504.7 percent of total billed charges 20376.2 20376.2 other OPPS APC 20376.2 20376.2 other OPPS APC 20376.2 27.63 5629.94 percent of total billed charges 20376.2 20376.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCATHETER CEREBROVASCULAR PROWLER 10 NYLON PTFE HYDROPHILIC 45 D L150CM OD1.7-2.3 FR ID .015IN CORONARY PERIPHERAL 2 MARKER BRAID REINFORCE COIL ACCEPTS .012 IN GUIDEWIRE SUP-606051FX CDM 0270 RC outpatient 3120.16 3120.16 3120.16 74 2308.92 percent of total billed charges 3120.16 93 2527.33 percent of total billed charges 3120.16 3120.16 other OPPS APC 3120.16 3120.16 other OPPS APC 3120.16 27.63 862.1 percent of total billed charges 3120.16 3120.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCATHETER CEREBROVASCULAR PROWLER 14 TRUELUMEN NYLON PFTE HYDROPHILIC 45 D L150CM L50CM OD 1.9-2.3FR ID .015IN CORONARY PERIPHERAL MARKER BRAID REINFORCE COIL ACCEPTS .014IN GUIDEWIRE SUP-606151FX CDM 0270 RC outpatient 3333.49 3333.49 3333.49 74 2466.78 percent of total billed charges 3333.49 93 2700.13 percent of total billed charges 3333.49 3333.49 other OPPS APC 3333.49 3333.49 other OPPS APC 3333.49 27.63 921.04 percent of total billed charges 3333.49 3333.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCATHETER CEREBROVASCULAR PROWLER 14 TRUELUMEN NYLON PTFEHYDROPHILIC J L150CM L50CM OD 1.9-2.3FR ID .015IN CORONARY PERIPHERAL 2 MARKER BRAID REINFORCE COIL ACCEPTS .014IN GUIDEWIRE SUP-606151JX CDM 0270 RC outpatient 2494.44 2494.44 2494.44 74 1845.89 percent of total billed charges 2494.44 93 2020.5 percent of total billed charges 2494.44 2494.44 other OPPS APC 2494.44 2494.44 other OPPS APC 2494.44 27.63 689.21 percent of total billed charges 2494.44 2494.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCATHETER CEREBROVASCULAR PROWLER 14 TRUELUMEN NYLON PFTE HYDROPHILIC 90 D L150CM L50CM OD 1.9-2.3FR ID .015IN CORONARY PERIPHERAL 2 MARKER BRAID REINFORCE COIL ACCEPTS .014IN GUIDEWIRE SUP-606151MX CDM 0270 RC outpatient 2938 2938 2938 74 2174.12 percent of total billed charges 2938 93 2379.78 percent of total billed charges 2938 2938 other OPPS APC 2938 2938 other OPPS APC 2938 27.63 811.77 percent of total billed charges 2938 2938 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUFF TOURNIQUET ATS 3000 CYLINDER L12 IN X W3.5 IN 2 PORT 1 BLADDER POSITIVE LOCK CONNECTOR CONTACT CLOSURE STERILE LATEX FREE DISPOSABLE BLACK SUP-60707010200 CDM 0270 RC outpatient 44.19 44.19 44.19 74 32.7 percent of total billed charges 44.19 93 35.79 percent of total billed charges 44.19 44.19 other OPPS APC 44.19 44.19 other OPPS APC 44.19 27.63 12.21 percent of total billed charges 44.19 44.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUFF TOURNIQUET ATS 3000 CYLINDER L18 IN X W4 IN 2 PORT 1 BLADDER POSITIVE LOCK CONNECTOR CONTACT CLOSURE STERILE LATEX FREE DISPOSABLE RED SUP-60707010300 CDM 0270 RC outpatient 44.19 44.19 44.19 74 32.7 percent of total billed charges 44.19 93 35.79 percent of total billed charges 44.19 44.19 other OPPS APC 44.19 44.19 other OPPS APC 44.19 27.63 12.21 percent of total billed charges 44.19 44.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUFF TOURNIQUET ATS 3000 CYLINDER L24 IN X W4 IN 2 PORT 1 BLADDER POSITIVE LOCK CONNECTOR CONTACT CLOSURE STERILE LATEX FREE DISPOSABLE GREEN SUP-60707010400 CDM 0270 RC outpatient 44.19 44.19 44.19 74 32.7 percent of total billed charges 44.19 93 35.79 percent of total billed charges 44.19 44.19 other OPPS APC 44.19 44.19 other OPPS APC 44.19 27.63 12.21 percent of total billed charges 44.19 44.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUFF TOURNIQUET ATS 3000 CYLINDER L30 IN X W4 IN 2 PORT 1 BLADDER POSITIVE LOCK CONNECTOR CONTACT CLOSURE STERILE LATEX FREE DISPOSABLE BLUE SUP-60707010500 CDM 0270 RC outpatient 44.19 44.19 44.19 74 32.7 percent of total billed charges 44.19 93 35.79 percent of total billed charges 44.19 44.19 other OPPS APC 44.19 44.19 other OPPS APC 44.19 27.63 12.21 percent of total billed charges 44.19 44.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUFF TOURNIQUET ATS 3000 CYLINDER L34 IN X W4 IN 2 PORT 1 BLADDER POSITIVE LOCK CONNECTOR CONTACT CLOSURE STERILE LATEX FREE DISPOSABLE BROWN SUP-60707010600 CDM 0270 RC outpatient 44.19 44.19 44.19 74 32.7 percent of total billed charges 44.19 93 35.79 percent of total billed charges 44.19 44.19 other OPPS APC 44.19 44.19 other OPPS APC 44.19 27.63 12.21 percent of total billed charges 44.19 44.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUFF TOURNIQUET ATS 3000 CYLINDER L42 IN X W4 IN 2 PORT 1 BLADDER POSITIVE LOCK CONNECTOR CONTACT CLOSURE STERILE LATEX FREE DISPOSABLE RUBY SUP-60707010700 CDM 0270 RC outpatient 44.19 44.19 44.19 74 32.7 percent of total billed charges 44.19 93 35.79 percent of total billed charges 44.19 44.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE COROENT LG SUP-6080928 CDM 270010020 LOCAL 0270 RC outpatient 8317.4 8317.4 8317.4 74 6154.88 percent of total billed charges 8317.4 93 6737.09 percent of total billed charges 8317.4 8317.4 other OPPS APC 8317.4 8317.4 other OPPS APC 8317.4 27.63 2298.1 percent of total billed charges 8317.4 8317.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL COROENT 8 D L23 MM X W10 MM X H9 MM MAS PLIF SUP-6081023 CDM 270010020 LOCAL 0270 RC outpatient 8317.4 8317.4 8317.4 74 6154.88 percent of total billed charges 8317.4 93 6737.09 percent of total billed charges 8317.4 8317.4 other OPPS APC 8317.4 8317.4 other OPPS APC 8317.4 27.63 2298.1 percent of total billed charges 8317.4 8317.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JELTRATE FAST SET 1LB SUP-608522 CDM outpatient 70.95 70.95 70.95 70.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL OMNIFIT 5 LONG L250 MM DISTAL NECK CEMENTED REVISION SUP-6088-0525-250R CDM 270010024 LOCAL 0270 RC outpatient 12789.4 12789.4 12789.4 74 9464.16 percent of total billed charges 12789.4 93 10359.4 percent of total billed charges 12789.4 12789.4 other OPPS APC 12789.4 12789.4 other OPPS APC 12789.4 27.63 3533.71 percent of total billed charges 12789.4 12789.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILLS AND REAMERS SPHERE INST SUP-60899 CDM 0272 RC outpatient 192.5 192.5 192.5 192.5 other OPPS APC 192.5 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET INSTRUMENT GMK 2 SPHERE TIBIAL LEFT INSERT SUP-60901 CDM 0272 RC outpatient 192.5 192.5 192.5 192.5 other OPPS APC 192.5 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET INSTRUMENT GMK SPHERE SWORD PIN PACK SUP-60905 CDM 0272 RC outpatient 192.5 192.5 192.5 192.5 other OPPS APC 192.5 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STYLET LEAD OD.014 IN KIT J TIP BALL TIP EXTENDED TAPER GRAY KNOB SUP-6091 CDM 0270 RC outpatient 79.04 79.04 79.04 74 58.49 percent of total billed charges 79.04 93 64.02 percent of total billed charges 79.04 79.04 other OPPS APC 79.04 79.04 other OPPS APC 79.04 27.63 21.84 percent of total billed charges 79.04 79.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM L25 MM OD8.1 MM HIP CEMENTED NECK TAPER CONDYLAR STABILIZE SUP-6097-0425 CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL OMNIFIT EON COCR 127 D 5 39 MM OFFSET L110 MM L30 MM OD8.9 MM HIP CEMENTED NECK TAPER CONDYLAR STABILIZE SUP-6097-0530 CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL OMNIFIT EON COCR 127 D 6 40 MM OFFSET L120 MM L30 MM OD9.6 MM HIP CEMENTED NECK TAPER CONDYLAR STABILIZE SUP-6097-0630 CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM L35 MM OD10.4 MM HIP CEMENTED NECK TAPER CONDYLAR STABILIZE SUP-6097-0735 CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM L35 MM OD11.3 MM HIP CEMENTED NECK TAPER CONDYLAR STABILIZE SUP-6097-0835 CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL OMNIFIT EON COCR 127 D 9 51 MM OFFSET L140 MM L40 MM OD12.6 MM HIP CEMENTED NECK TAPER CONDYLAR STABILIZE SUP-6097-0940 CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL OMNIFIT EON COCR 127 D 10 52 MM OFFSET L145 MM L40 MM OD13.8 MM HIP CEMENTED NECK TAPER CONDYLAR STABILIZE SUP-6097-1040 CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM L25 MM OD8.1 MM HIP CEMENTED NECK TAPER CONDYLAR STABILIZE SUP-6098-0425 CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL OMNIFIT EON COCR 132 D 5 35 MM OFFSET L110 MM L30 MM OD8.9 MM HIP CEMENTED NECK TAPER CONDYLAR STABILIZE SUP-6098-0530 CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL OMNIFIT EON COCR 132 D 6 36 MM OFFSET L120 MM L30 MM OD9.6 MM HIP CEMENTED NECK TAPER CONDYLAR STABILIZE SUP-6098-0630 CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL OMNIFIT EON COCR 132 D 7 41 MM OFFSET L130 MM L35 MM OD10.4 MM HIP CEMENTED NECK TAPER CONDYLAR STABILIZE SUP-6098-0735 CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM L35 MM OD11.3 MM HIP CEMENTED NECK TAPER CONDYLAR STABILIZE SUP-6098-0835 CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL OMNIFIT EON COCR 132 D 9 46 MM OFFSET L140 MM L40 MM OD12.6 MM HIP CEMENTED NECK TAPER CONDYLAR STABILIZE SUP-6098-0940 CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL OMNIFIT EON COCR 132 D 10 47 MM OFFSET L145 MM L40 MM OD13.8 MM HIP CEMENTED NECK TAPER CONDYLAR STABILIZE SUP-6098-1040 CDM 270010024 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPONGE RAY-COT RAYON 1/2INX 6 IN SUP-61-02 CDM 0270 RC outpatient 27 27 27 74 19.98 percent of total billed charges 27 93 21.87 percent of total billed charges 27 27 other OPPS APC 27 27 other OPPS APC 27 27.63 7.46 percent of total billed charges 27 27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER PROBE ULTRASOUND WIRELESS TRANSDUCER CIV-FLEX 14IN X 29.2IN 3D TELESCOPICALLY FOLDED W/GEL LATEX-FREE STERILE SUP-610-1212 CDM 0270 RC outpatient 21.99 21.99 21.99 21.99 other OPPS APC 21.99 21.99 other OPPS APC 21.99 27.63 6.08 percent of total billed charges 21.99 21.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER PROBE CIV-FLEX L58 IN X W5.5 IN EXTENDED LENGTH STERILE LATEX FREE SUP-610-575 CDM 0481 RC outpatient 25.42 25.42 25.42 74 18.81 percent of total billed charges 25.42 93 20.59 percent of total billed charges 25.42 25.42 other OPPS APC 25.42 25.42 other OPPS APC 25.42 51 12.96 percent of total billed charges 25.42 25.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE PLEXUR M LARGE SUP-6100-010INT CDM 270010031 LOCAL 0270 RC outpatient 5946.54 5946.54 5946.54 74 4400.44 percent of total billed charges 5946.54 93 4816.7 percent of total billed charges 5946.54 5946.54 other OPPS APC 5946.54 5946.54 other OPPS APC 5946.54 27.63 1643.03 percent of total billed charges 5946.54 5946.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE ANGIO-SEAL VIP COLLAGEN .035 IN L70 CM OD6 FR VASCULAR VALUELINK GUIDEWIRE INSERTION SHEATH J STRAIGHTENER SUP-610130 CDM 0481 RC outpatient 533 533 533 74 394.42 percent of total billed charges 533 93 431.73 percent of total billed charges 533 533 other OPPS APC 533 533 other OPPS APC 533 51 271.83 percent of total billed charges 533 533 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE ANGIO-SEAL VIP BONDEK-PLUS POLYGLYD L70 CM OD8 FR ODSEC.038 IN VASCULAR HEMOSTATIC BIOABSORBABLE INSERTION SHEATH GUIDEWIRE STERILE LATEX FREE DISPOSABLE SUP-610131 CDM 0481 RC outpatient 533 533 533 74 394.42 percent of total billed charges 533 93 431.73 percent of total billed charges 533 533 other OPPS APC 533 533 other OPPS APC 533 51 271.83 percent of total billed charges 533 533 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 STD XL 22MM X 50CM SUP-610225 CDM 0270 RC outpatient 7540 7540 7540 74 5579.6 percent of total billed charges 7540 93 6107.4 percent of total billed charges 7540 7540 other OPPS APC 7540 7540 other OPPS APC 7540 27.63 2083.3 percent of total billed charges 7540 7540 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 STD XL 24MM X 50CM SUP-610245 CDM 0270 RC outpatient 7540 7540 7540 74 5579.6 percent of total billed charges 7540 93 6107.4 percent of total billed charges 7540 7540 other OPPS APC 7540 7540 other OPPS APC 7540 27.63 2083.3 percent of total billed charges 7540 7540 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Z-MED BALLOON 22MM X 4CM SUP-610488 CDM 0481 RC outpatient 1242.46 1242.46 1242.46 74 919.42 percent of total billed charges 1242.46 93 1006.39 percent of total billed charges 1242.46 1242.46 other OPPS APC 1242.46 1242.46 other OPPS APC 1242.46 51 633.65 percent of total billed charges 1242.46 1242.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAVR Z-MED BALLOON 25MM X 4CM SUP-610489 CDM 0481 RC outpatient 1188.95 1188.95 1188.95 74 879.82 percent of total billed charges 1188.95 93 963.05 percent of total billed charges 1188.95 1188.95 other OPPS APC 1188.95 1188.95 other OPPS APC 1188.95 51 606.36 percent of total billed charges 1188.95 1188.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING COMPRESSION SMALL THIGH LENGTH ANTIEMBOLISM SUP-611 CDM 270009042 LOCAL 0270 RC outpatient 7.62 7.62 7.62 74 5.64 percent of total billed charges 7.62 93 6.17 percent of total billed charges 7.62 7.62 other OPPS APC 7.62 7.62 other OPPS APC 7.62 27.63 2.11 percent of total billed charges 7.62 7.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL IRIS GRIESHABER FLEXIBLE STERILE LATEX FREE DISPOSABLE SUP-611.75 CDM 0270 RC outpatient 296.37 296.37 296.37 74 219.31 percent of total billed charges 296.37 93 240.06 percent of total billed charges 296.37 296.37 other OPPS APC 296.37 296.37 other OPPS APC 296.37 27.63 81.89 percent of total billed charges 296.37 296.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 8.0MM CANNULATED PARTIALLY THREAD 40MM SUP-611040 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS III TITANIUM L45 MM L25 MM OD8 MM ORTHOPEDIC SELF TAPPING SELF DRILLING CANNULATED SUP-611045 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ASNIS III TITANIUM L50 MM L25 MM OD8 MM ORTHOPEDIC SELF TAPPING SELF DRILLING CANNULATED SUP-611050 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 8.0MM CANNULATED PARTIALLY THREAD 55MM SUP-611055 CDM 0270 RC outpatient 385.63 385.63 385.63 74 285.37 percent of total billed charges 385.63 93 312.36 percent of total billed charges 385.63 385.63 other OPPS APC 385.63 385.63 other OPPS APC 385.63 27.63 106.55 percent of total billed charges 385.63 385.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 8.0MM CANNULATED PARTIALLY THREAD 60MM SUP-611060 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 8.0MM CANNULATED PARTIALLY THREAD 65MM SUP-611065 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 8.0MM CANNULATED PARTIALLY THREAD 70MM SUP-611070 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 8.0MM CANNULATED PARTIALLY THREAD 75MM SUP-611075 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 8.0MM CANNULATED PARTIALLY THREAD 80MM SUP-611080 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 8.0MM CANNULATED PARTIALLY THREAD 85MM SUP-611085 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 8.0MM CANNULATED PARTIALLY THREAD 90MM SUP-611090 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 8.0MM CANNULATED PARTIALLY THREAD 95MM SUP-611095 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 8.0MM CANNULATED PARTIALLY THREAD 100MM SUP-611100 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 8.0MM CANNULATED PARTIALLY THREAD 110MM SUP-611110 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 8.0MM CANNULATED PARTIALLY THREAD 115MM SUP-611115 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS 8.0MM CANNULATED PARTIALLY THREAD 120MM SUP-611120 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING WOUND CURITY 3X3IN OIL EMULSION FABRIC STERILE LF NONADHERENT KNIT IMPREGNATE OPEN MESH SUP-6112 CDM 0270 RC outpatient 0.52 0.52 0.52 74 0.38 percent of total billed charges 0.52 93 0.42 percent of total billed charges 0.52 0.52 other OPPS APC 0.52 0.52 other OPPS APC 0.52 27.63 0.14 percent of total billed charges 0.52 0.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Z-MED II BALLOON 28MM X 4CM SUP-611660 CDM 0481 RC outpatient 1713.66 1713.66 1713.66 74 1268.11 percent of total billed charges 1713.66 93 1388.06 percent of total billed charges 1713.66 1713.66 other OPPS APC 1713.66 1713.66 other OPPS APC 1713.66 51 873.97 percent of total billed charges 1713.66 1713.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Z-MED II BALLOON 30MM X 4CM SUP-611661 CDM 0481 RC outpatient 1713.66 1713.66 1713.66 74 1268.11 percent of total billed charges 1713.66 93 1388.06 percent of total billed charges 1713.66 1713.66 other OPPS APC 1713.66 1713.66 other OPPS APC 1713.66 51 873.97 percent of total billed charges 1713.66 1713.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Z-MED BALLOON 33MM X 4CM SUP-611669 CDM 0481 RC outpatient 1681.39 1681.39 1681.39 74 1244.23 percent of total billed charges 1681.39 93 1361.93 percent of total billed charges 1681.39 1681.39 other OPPS APC 1681.39 1681.39 other OPPS APC 1681.39 51 857.51 percent of total billed charges 1681.39 1681.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Z-MED BALLOON 35MM X 4CM SUP-611671 CDM 0481 RC outpatient 1681.39 1681.39 1681.39 74 1244.23 percent of total billed charges 1681.39 93 1361.93 percent of total billed charges 1681.39 1681.39 other OPPS APC 1681.39 1681.39 other OPPS APC 1681.39 51 857.51 percent of total billed charges 1681.39 1681.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAVR Z-MED II BALLOON 20MM X 4CM SUP-611757 CDM 0270 RC outpatient 1242.46 1242.46 1242.46 74 919.42 percent of total billed charges 1242.46 93 1006.39 percent of total billed charges 1242.46 1242.46 other OPPS APC 1242.46 1242.46 other OPPS APC 1242.46 27.63 343.29 percent of total billed charges 1242.46 1242.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION Z-MED II L100 CM L4 CM OD9 FR ODSEC22 MM COAXIAL RADIOPAQUE FLEXIBLE DISTAL TIP DEHP FREE LATEX FREE ACCEPTS .035 IN GUIDEWIRE 12 FR INTRODUCER PERCUTANEOUS TRANSLUMINAL VALVULOPLASTY SUP-611761 CDM outpatient 1645.8 1645.8 1645.8 1645.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Z-MED II BALLOON 23MM X 4CM SUP-611765 CDM 0481 RC outpatient 1075.21 1075.21 1075.21 74 795.66 percent of total billed charges 1075.21 93 870.92 percent of total billed charges 1075.21 1075.21 other OPPS APC 1075.21 1075.21 other OPPS APC 1075.21 51 548.36 percent of total billed charges 1075.21 1075.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW THK1.27 MM L90 MM X W18 MM SAGITTAL STERILE SUP-6118-127-090 CDM 0270 RC outpatient 135.72 135.72 135.72 74 100.43 percent of total billed charges 135.72 93 109.93 percent of total billed charges 135.72 135.72 other OPPS APC 135.72 135.72 other OPPS APC 135.72 27.63 37.5 percent of total billed charges 135.72 135.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAGITTAL SUP-6118-89-75 CDM 0270 RC outpatient 160.19 160.19 160.19 74 118.54 percent of total billed charges 160.19 93 129.75 percent of total billed charges 160.19 160.19 other OPPS APC 160.19 160.19 other OPPS APC 160.19 27.63 44.26 percent of total billed charges 160.19 160.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAVR Z-MED BALLOON 24MM X 4CM SUP-611819 CDM 0481 RC outpatient 1713.66 1713.66 1713.66 74 1268.11 percent of total billed charges 1713.66 93 1388.06 percent of total billed charges 1713.66 1713.66 other OPPS APC 1713.66 1713.66 other OPPS APC 1713.66 51 873.97 percent of total billed charges 1713.66 1713.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAVR Z-MED BALLOON 26MM X 4CM SUP-611820 CDM 0270 RC outpatient 1713.66 1713.66 1713.66 74 1268.11 percent of total billed charges 1713.66 93 1388.06 percent of total billed charges 1713.66 1713.66 other OPPS APC 1713.66 1713.66 other OPPS APC 1713.66 27.63 473.48 percent of total billed charges 1713.66 1713.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING COMPRESSION CAP SM LONG THIGH HIGH NATURAL NYLON LF ANTIEMBOLISM SUP-612 CDM 270009042 LOCAL 0270 RC outpatient 7.62 7.62 7.62 74 5.64 percent of total billed charges 7.62 93 6.17 percent of total billed charges 7.62 7.62 other OPPS APC 7.62 7.62 other OPPS APC 7.62 27.63 2.11 percent of total billed charges 7.62 7.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACUSON ACUNAV ULTRASOUND CATHETER CONNECTOR COVER SUP-612-113 CDM 0270 RC outpatient 20.8 20.8 20.8 74 15.39 percent of total billed charges 20.8 93 16.85 percent of total billed charges 20.8 20.8 other OPPS APC 20.8 20.8 other OPPS APC 20.8 27.63 5.75 percent of total billed charges 20.8 20.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 SOFT XL 10MM X 40CM SUP-612104 CDM 0270 RC outpatient 7787 7787 7787 74 5762.38 percent of total billed charges 7787 93 6307.47 percent of total billed charges 7787 7787 other OPPS APC 7787 7787 other OPPS APC 7787 27.63 2151.55 percent of total billed charges 7787 7787 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 SOFT XL 12MM X 45CM SUP-612124 CDM 0270 RC outpatient 7787 7787 7787 74 5762.38 percent of total billed charges 7787 93 6307.47 percent of total billed charges 7787 7787 other OPPS APC 7787 7787 other OPPS APC 7787 27.63 2151.55 percent of total billed charges 7787 7787 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 SOFT XL 14MM X 50CM SUP-612145 CDM 0270 RC outpatient 7787 7787 7787 74 5762.38 percent of total billed charges 7787 93 6307.47 percent of total billed charges 7787 7787 other OPPS APC 7787 7787 other OPPS APC 7787 27.63 2151.55 percent of total billed charges 7787 7787 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 SOFT XL 16MM X 50CM SUP-612165 CDM 0270 RC outpatient 7540 7540 7540 74 5579.6 percent of total billed charges 7540 93 6107.4 percent of total billed charges 7540 7540 other OPPS APC 7540 7540 other OPPS APC 7540 27.63 2083.3 percent of total billed charges 7540 7540 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 SOFT XL 18MM X 50CM SUP-612185 CDM 0270 RC outpatient 7540 7540 7540 74 5579.6 percent of total billed charges 7540 93 6107.4 percent of total billed charges 7540 7540 other OPPS APC 7540 7540 other OPPS APC 7540 27.63 2083.3 percent of total billed charges 7540 7540 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 SOFT XL 20MM X 50CM SUP-612205 CDM 0270 RC outpatient 7540 7540 7540 74 5579.6 percent of total billed charges 7540 93 6107.4 percent of total billed charges 7540 7540 other OPPS APC 7540 7540 other OPPS APC 7540 27.63 2083.3 percent of total billed charges 7540 7540 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 SOFT XL 6MM X 20CM SUP-612620 CDM 0270 RC outpatient 8255 8255 8255 74 6108.7 percent of total billed charges 8255 93 6686.55 percent of total billed charges 8255 8255 other OPPS APC 8255 8255 other OPPS APC 8255 27.63 2280.86 percent of total billed charges 8255 8255 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 SOFT XL 7MM X 20CM SUP-612720 CDM 0270 RC outpatient 8255 8255 8255 74 6108.7 percent of total billed charges 8255 93 6686.55 percent of total billed charges 8255 8255 other OPPS APC 8255 8255 other OPPS APC 8255 27.63 2280.86 percent of total billed charges 8255 8255 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TARGET 360 SOFT XL 7MM X 20MM SUP-612720 CDM 0270 RC outpatient 9097.4 9097.4 9097.4 74 6732.08 percent of total billed charges 9097.4 93 7368.89 percent of total billed charges 9097.4 9097.4 other OPPS APC 9097.4 9097.4 other OPPS APC 9097.4 27.63 2513.61 percent of total billed charges 9097.4 9097.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 SOFT XL 8MM X 30CM SUP-612830 CDM 0270 RC outpatient 9097.4 9097.4 9097.4 74 6732.08 percent of total billed charges 9097.4 93 7368.89 percent of total billed charges 9097.4 9097.4 other OPPS APC 9097.4 9097.4 other OPPS APC 9097.4 27.63 2513.61 percent of total billed charges 9097.4 9097.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 SOFT XL 9MM X 30CM SUP-612930 CDM 0270 RC outpatient 7540 7540 7540 74 5579.6 percent of total billed charges 7540 93 6107.4 percent of total billed charges 7540 7540 other OPPS APC 7540 7540 other OPPS APC 7540 27.63 2083.3 percent of total billed charges 7540 7540 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENT BONE NORIAN CRS FAST SET 5 ML PUTTY STERILE SUP-613.05.01S CDM 270010031 LOCAL 0270 RC outpatient 3705 3705 3705 74 2741.7 percent of total billed charges 3705 93 3001.05 percent of total billed charges 3705 3705 other OPPS APC 3705 3705 other OPPS APC 3705 27.63 1023.69 percent of total billed charges 3705 3705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 3D 10 X 30CM SUP-615103 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 3D 3 X 6CM SUP-615306 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 3D 4 X 8CM SUP-615408 CDM 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TARGET 3D 4MM X 8MM SUP-615408 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 3D 5 X 10CM SUP-615510 CDM 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 3D 6 X 15CM SUP-615615 CDM 0270 RC outpatient 6019 6019 6019 74 4454.06 percent of total billed charges 6019 93 4875.39 percent of total billed charges 6019 6019 other OPPS APC 6019 6019 other OPPS APC 6019 27.63 1663.05 percent of total billed charges 6019 6019 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 3D 7 X 15CM SUP-615715 CDM 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 3D 8 X 25CM SUP-615825 CDM 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP SPINAL X-CORE 2 0D 40MM 18MM 18MM TITANIUM NS SUP-6185000 CDM 270010020 LOCAL 0270 RC outpatient 5252 5252 5252 74 3886.48 percent of total billed charges 5252 93 4254.12 percent of total billed charges 5252 5252 other OPPS APC 5252 5252 other OPPS APC 5252 27.63 1451.13 percent of total billed charges 5252 5252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDCAP NUVASIVE X-CORE11 8DEG 18MM X 50MM SUP-6185008 CDM 270010020 LOCAL 0270 RC outpatient 5252 5252 5252 74 3886.48 percent of total billed charges 5252 93 4254.12 percent of total billed charges 5252 5252 other OPPS APC 5252 5252 other OPPS APC 5252 27.63 1451.13 percent of total billed charges 5252 5252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET INSTRUMENT GMK 5 SPHERE LEFT KNEE TIBIAL INSERT STERILE LATEX FREE DISPOSABLE SUP-61852 CDM 0272 RC outpatient 192.5 192.5 192.5 192.5 other OPPS APC 192.5 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE GMK SPHERE SPINE PACK STERILE SUP-61854 CDM 0272 RC outpatient 192.5 192.5 192.5 192.5 other OPPS APC 192.5 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS TITANIUM L21 MM SPINE CERVICAL ANTERIOR LOCK TRANSLATIONAL SUP-6190021 CDM 270010020 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS TITANIUM L25 MM SPINE CERVICAL ANTERIOR LOCK TRANSLATIONAL SUP-6190025 CDM 270010020 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS TITANIUM L27.5 MM SPINE CERVICAL ANTERIOR LOCK TRANSLATIONAL SUP-6190027 CDM 270010020 LOCAL 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS TITANIUM L30 MM SPINE CERVICAL ANTERIOR LOCK TRANSLATIONAL SUP-6190030 CDM 270010020 LOCAL 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MEDTRONIC TRANSLATIONAL PLATE ONE LEVEL 32.5MM SUP-6190032 CDM 270010020 LOCAL 0270 RC outpatient 2217.28 2217.28 2217.28 74 1640.79 percent of total billed charges 2217.28 93 1796 percent of total billed charges 2217.28 2217.28 other OPPS APC 2217.28 2217.28 other OPPS APC 2217.28 27.63 612.63 percent of total billed charges 2217.28 2217.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS TITANIUM L37.5 MM SPINE CERVICAL ANTERIOR LOCK TRANSLATIONAL SUP-6190037 CDM 270010020 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS TITANIUM L40 MM SPINE CERVICAL ANTERIOR LOCK TRANSLATIONAL SUP-6190040 CDM 270010020 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS TITANIUM L42.5 MM SPINE CERVICAL ANTERIOR LOCK TRANSLATIONAL SUP-6190042 CDM 270010020 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS TITANIUM L45 MM SPINE CERVICAL ANTERIOR LOCK TRANSLATIONAL SUP-6190045 CDM 270010020 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS TITANIUM L47.5 MM SPINE CERVICAL ANTERIOR LOCK TRANSLATIONAL SUP-6190047 CDM 270010020 LOCAL 0270 RC outpatient 3250 3250 3250 74 2405 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 3250 other OPPS APC 3250 3250 other OPPS APC 3250 27.63 897.98 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS TITANIUM L50 MM SPINE CERVICAL ANTERIOR LOCK TRANSLATIONAL SUP-6190050 CDM 270010020 LOCAL 0270 RC outpatient 2990 2990 2990 74 2212.6 percent of total billed charges 2990 93 2421.9 percent of total billed charges 2990 2990 other OPPS APC 2990 2990 other OPPS APC 2990 27.63 826.14 percent of total billed charges 2990 2990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS TITANIUM L52.5 MM SPINE CERVICAL ANTERIOR LOCK TRANSLATIONAL SUP-6190052 CDM 270010020 LOCAL 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS TITANIUM L55 MM SPINE CERVICAL ANTERIOR LOCK TRANSLATIONAL SUP-6190055 CDM 270010020 LOCAL 0270 RC outpatient 4160 4160 4160 74 3078.4 percent of total billed charges 4160 93 3369.6 percent of total billed charges 4160 4160 other OPPS APC 4160 4160 other OPPS APC 4160 27.63 1149.41 percent of total billed charges 4160 4160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS TITANIUM L57.5 MM SPINE CERVICAL ANTERIOR LOCK TRANSLATIONAL SUP-6190057 CDM 270010020 LOCAL 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS TITANIUM L60 MM SPINE CERVICAL ANTERIOR LOCK TRANSLATIONAL SUP-6190060 CDM 270010020 LOCAL 0270 RC outpatient 4550 4550 4550 74 3367 percent of total billed charges 4550 93 3685.5 percent of total billed charges 4550 4550 other OPPS APC 4550 4550 other OPPS APC 4550 27.63 1257.17 percent of total billed charges 4550 4550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS TITANIUM L62.5 MM SPINE CERVICAL ANTERIOR LOCK TRANSLATIONAL SUP-6190062 CDM 270010020 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS TITANIUM L65 MM SPINE CERVICAL ANTERIOR LOCK TRANSLATIONAL SUP-6190065 CDM 270010020 LOCAL 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS TITANIUM L80 MM SPINE CERVICAL ANTERIOR LOCK TRANSLATIONAL SUP-6190080 CDM 270010020 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS TITANIUM L82.5 MM SPINE CERVICAL ANTERIOR LOCK TRANSLATIONAL SUP-6190082 CDM 270010020 LOCAL 0270 RC outpatient 5590 5590 5590 74 4136.6 percent of total billed charges 5590 93 4527.9 percent of total billed charges 5590 5590 other OPPS APC 5590 5590 other OPPS APC 5590 27.63 1544.52 percent of total billed charges 5590 5590 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENT BONE SIMPLEX P RADIOPAQUE FULL DOSE STERILE SUP-6191-1-010 CDM 0270 RC outpatient 150.8 150.8 150.8 74 111.59 percent of total billed charges 150.8 93 122.15 percent of total billed charges 150.8 150.8 other OPPS APC 150.8 150.8 other OPPS APC 150.8 27.63 41.67 percent of total billed charges 150.8 150.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENT BONE SIMPLEX P SPEEDSET RADIOPAQUE STERILE SUP-6192-1-010 CDM 0270 RC outpatient 150.8 150.8 150.8 74 111.59 percent of total billed charges 150.8 93 122.15 percent of total billed charges 150.8 150.8 other OPPS APC 150.8 150.8 other OPPS APC 150.8 27.63 41.67 percent of total billed charges 150.8 150.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENT BONE SIMPLEX 20ML STERILE 40GM HIGH VISCOSITY SUP-6194-1-010 CDM 0270 RC outpatient 150.8 150.8 150.8 74 111.59 percent of total billed charges 150.8 93 122.15 percent of total billed charges 150.8 150.8 other OPPS APC 150.8 150.8 other OPPS APC 150.8 27.63 41.67 percent of total billed charges 150.8 150.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENT BONE SIMPLEX P TOBRAMYCIN FULL DOSE RADIOPAQUE PREBLEND STERILE SUP-6197-9-001 CDM 0270 RC outpatient 612.3 612.3 612.3 74 453.1 percent of total billed charges 612.3 93 495.96 percent of total billed charges 612.3 612.3 other OPPS APC 612.3 612.3 other OPPS APC 612.3 27.63 169.18 percent of total billed charges 612.3 612.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENT BONE SIMPLEX P TOBRAMYCIN FULL DOSE RADIOPAQUE PREBLEND STERILE SUP-6197-9-010 CDM 0270 RC outpatient 612.3 612.3 612.3 74 453.1 percent of total billed charges 612.3 93 495.96 percent of total billed charges 612.3 612.3 other OPPS APC 612.3 612.3 other OPPS APC 612.3 27.63 169.18 percent of total billed charges 612.3 612.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC ASNIS III TITANIUM LARGE DISPOSABLE 6.5/8 MM CANNULATED SCREW SUP-619904 CDM 0270 RC outpatient 49.4 49.4 49.4 74 36.56 percent of total billed charges 49.4 93 40.01 percent of total billed charges 49.4 49.4 other OPPS APC 49.4 49.4 other OPPS APC 49.4 27.63 13.65 percent of total billed charges 49.4 49.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC ASNIS III TITANIUM 4 MM SCREW SUP-619905 CDM 0270 RC outpatient 49.4 49.4 49.4 74 36.56 percent of total billed charges 49.4 93 40.01 percent of total billed charges 49.4 49.4 other OPPS APC 49.4 49.4 other OPPS APC 49.4 27.63 13.65 percent of total billed charges 49.4 49.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER 4.0MM ANSIS SCREWS SUP-619905S CDM 0270 RC outpatient 70.2 70.2 70.2 74 51.95 percent of total billed charges 70.2 93 56.86 percent of total billed charges 70.2 70.2 other OPPS APC 70.2 70.2 other OPPS APC 70.2 27.63 19.4 percent of total billed charges 70.2 70.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "UNIV TROCAR HANDLE, NO CANNULA" SUP-62-00400 CDM 0270 RC outpatient 2809.64 2809.64 2809.64 74 2079.13 percent of total billed charges 2809.64 93 2275.81 percent of total billed charges 2809.64 2809.64 other OPPS APC 2809.64 2809.64 other OPPS APC 2809.64 27.63 776.3 percent of total billed charges 2809.64 2809.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HANDLE TROCAR UNIVERSAL W/O CANNULA F/62-00400 MANDIBULAR SUP-62-00403 CDM 0270 RC outpatient 641.52 641.52 641.52 74 474.72 percent of total billed charges 641.52 93 519.63 percent of total billed charges 641.52 641.52 other OPPS APC 641.52 641.52 other OPPS APC 641.52 27.63 177.25 percent of total billed charges 641.52 641.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "UCHEEK RETRACTOR, W/LT SOURCE" SUP-62-00414 CDM 0270 RC outpatient 2807.06 2807.06 2807.06 74 2077.22 percent of total billed charges 2807.06 93 2273.72 percent of total billed charges 2807.06 2807.06 other OPPS APC 2807.06 2807.06 other OPPS APC 2807.06 27.63 775.59 percent of total billed charges 2807.06 2807.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMARTLOCK HMMF PLATE BENDER SUP-62-00604 CDM 0270 RC outpatient 4446 4446 4446 74 3290.04 percent of total billed charges 4446 93 3601.26 percent of total billed charges 4446 4446 other OPPS APC 4446 4446 other OPPS APC 4446 27.63 1228.43 percent of total billed charges 4446 4446 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER MAXILLOFACIAL SMARTLOCK HYBRID MMF SUP-62-00605 CDM 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE DRILL LEIBINGER 2MM UNIVERSAL MANDIBULAR TROCAR CENTRIC F/2.3MM INSTRUMENT SUP-62-04230 CDM 0270 RC outpatient 887.64 887.64 887.64 74 656.85 percent of total billed charges 887.64 93 718.99 percent of total billed charges 887.64 887.64 other OPPS APC 887.64 887.64 other OPPS APC 887.64 27.63 245.25 percent of total billed charges 887.64 887.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "UNIV MAND DEPTH GUAGE, BLACK" SUP-62-08430 CDM 0270 RC outpatient 2528.86 2528.86 2528.86 74 1871.36 percent of total billed charges 2528.86 93 2048.38 percent of total billed charges 2528.86 2528.86 other OPPS APC 2528.86 2528.86 other OPPS APC 2528.86 27.63 698.72 percent of total billed charges 2528.86 2528.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENDER SURGICAL UNIVERSAL SELECT PLATE UPPER MIDFACE CRANIOFACIAL 3-PRONG 1/PK SUP-62-12173 CDM 0270 RC outpatient 1061.84 1061.84 1061.84 74 785.76 percent of total billed charges 1061.84 93 860.09 percent of total billed charges 1061.84 1061.84 other OPPS APC 1061.84 1061.84 other OPPS APC 1061.84 27.63 293.39 percent of total billed charges 1061.84 1061.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SCREWDRIVER AXS STANDARD 82MM NON-POWERED F/1.2/1.7MM SCREW SUP-62-12174 CDM 0270 RC outpatient 834.21 834.21 834.21 74 617.32 percent of total billed charges 834.21 93 675.71 percent of total billed charges 834.21 834.21 other OPPS APC 834.21 834.21 other OPPS APC 834.21 27.63 230.49 percent of total billed charges 834.21 834.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BENDER/UPERFC/MIDFACE RT SUP-62-12175 CDM 0270 RC outpatient 3403.4 3403.4 3403.4 74 2518.52 percent of total billed charges 3403.4 93 2756.75 percent of total billed charges 3403.4 3403.4 other OPPS APC 3403.4 3403.4 other OPPS APC 3403.4 27.63 940.36 percent of total billed charges 3403.4 3403.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BENDER/UPERFC/MIDFACE LF SUP-62-12176 CDM 0270 RC outpatient 3405.19 3405.19 3405.19 74 2519.84 percent of total billed charges 3405.19 93 2758.2 percent of total billed charges 3405.19 3405.19 other OPPS APC 3405.19 3405.19 other OPPS APC 3405.19 27.63 940.85 percent of total billed charges 3405.19 3405.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS BONE HOLDING MICRO STANDARD STRAIGHT F/PLATE/SCREW HOLDING SUP-62-18110 CDM 0270 RC outpatient 569.87 569.87 569.87 74 421.7 percent of total billed charges 569.87 93 461.59 percent of total billed charges 569.87 569.87 other OPPS APC 569.87 569.87 other OPPS APC 569.87 27.63 157.46 percent of total billed charges 569.87 569.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER/UPPR/MID FC IN-SITU PLT SUP-62-18330 CDM 0270 RC outpatient 2082.05 2082.05 2082.05 74 1540.72 percent of total billed charges 2082.05 93 1686.46 percent of total billed charges 2082.05 2082.05 other OPPS APC 2082.05 2082.05 other OPPS APC 2082.05 27.63 575.27 percent of total billed charges 2082.05 2082.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "AXS SCREWDRIVER BLADE,MMF,COMPL." SUP-62-20133 CDM 0270 RC outpatient 6403.8 6403.8 6403.8 74 4738.81 percent of total billed charges 6403.8 93 5187.08 percent of total billed charges 6403.8 6403.8 other OPPS APC 6403.8 6403.8 other OPPS APC 6403.8 27.63 1769.37 percent of total billed charges 6403.8 6403.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "AXS SCREWDRIVER BLADE,2.0/2.3MM" SUP-62-20134 CDM 0270 RC outpatient 1648.4 1648.4 1648.4 74 1219.82 percent of total billed charges 1648.4 93 1335.2 percent of total billed charges 1648.4 1648.4 other OPPS APC 1648.4 1648.4 other OPPS APC 1648.4 27.63 455.45 percent of total billed charges 1648.4 1648.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE/WDRVR CRSPN GRASPNG SLV SUP-62-20135 CDM 0270 RC outpatient 2719.42 2719.42 2719.42 74 2012.37 percent of total billed charges 2719.42 93 2202.73 percent of total billed charges 2719.42 2719.42 other OPPS APC 2719.42 2719.42 other OPPS APC 2719.42 27.63 751.38 percent of total billed charges 2719.42 2719.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HANDLE/DRIVER/TAP 1.5/2.0 SUP-62-20285 CDM 0270 RC outpatient 1609.48 1609.48 1609.48 74 1191.02 percent of total billed charges 1609.48 93 1303.68 percent of total billed charges 1609.48 1609.48 other OPPS APC 1609.48 1609.48 other OPPS APC 1609.48 27.63 444.7 percent of total billed charges 1609.48 1609.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HANDLE/DRIVER RATCHET SUP-62-20290 CDM 0270 RC outpatient 3436.76 3436.76 3436.76 74 2543.2 percent of total billed charges 3436.76 93 2783.78 percent of total billed charges 3436.76 3436.76 other OPPS APC 3436.76 3436.76 other OPPS APC 3436.76 27.63 949.58 percent of total billed charges 3436.76 3436.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN BONE 3.2MM F/1.7MM MIDFACE REPOSITIONING FIXATION SUP-62-32440 CDM 0270 RC outpatient 1203.64 1203.64 1203.64 74 890.69 percent of total billed charges 1203.64 93 974.95 percent of total billed charges 1203.64 1203.64 other OPPS APC 1203.64 1203.64 other OPPS APC 1203.64 27.63 332.57 percent of total billed charges 1203.64 1203.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT MICROSENSOR METAL BOLT SUP-62-6638US CDM 0270 RC outpatient 2247.7 2247.7 2247.7 74 1663.3 percent of total billed charges 2247.7 93 1820.64 percent of total billed charges 2247.7 2247.7 other OPPS APC 2247.7 2247.7 other OPPS APC 2247.7 27.63 621.04 percent of total billed charges 2247.7 2247.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT MICROSENSOR VENTRICULAR SUP-62-6653US CDM 0270 RC outpatient 2346.5 2346.5 2346.5 74 1736.41 percent of total billed charges 2346.5 93 1900.67 percent of total billed charges 2346.5 2346.5 other OPPS APC 2346.5 2346.5 other OPPS APC 2346.5 27.63 648.34 percent of total billed charges 2346.5 2346.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING COMPRESSION CAP THIGH LENGTH MEDIUM SHORT SUP-620 CDM 270009042 LOCAL 0270 RC outpatient 7.62 7.62 7.62 74 5.64 percent of total billed charges 7.62 93 6.17 percent of total billed charges 7.62 7.62 other OPPS APC 7.62 7.62 other OPPS APC 7.62 27.63 2.11 percent of total billed charges 7.62 7.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT MICROBIOLOGY TEST PLATELET RICH PLASMA APPLICATOR ACCELERATE SUP-620-00-02 CDM 0270 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 27.63 57.47 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STIMULAN RAPID CURE 10CC SUP-620-010 CDM 0270 RC outpatient 3159 3159 3159 74 2337.66 percent of total billed charges 3159 93 2558.79 percent of total billed charges 3159 3159 other OPPS APC 3159 3159 other OPPS APC 3159 27.63 872.83 percent of total billed charges 3159 3159 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PROCEDURE SUP-620-12-02 CDM 0270 RC outpatient 884 884 884 74 654.16 percent of total billed charges 884 93 716.04 percent of total billed charges 884 884 other OPPS APC 884 884 other OPPS APC 884 27.63 244.25 percent of total billed charges 884 884 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE FEMUR HEAD WITHOUT CARTILAGE SUP-620100 CDM 270010031 LOCAL 0270 RC outpatient 3640 3640 3203.2 74 2370.37 percent of total billed charges 3203.2 93 2594.59 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3203.2 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE FEMUR HEAD WITHOUT CARTILAGE SUP-620100 CDM 270010031 LOCAL 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3203.2 3203.2 other OPPS APC 3203.2 3203.2 other OPPS APC 3203.2 27.63 885.04 percent of total billed charges 3203.2 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER LEAD OD9 FR PEELABLE SPLITTABLE SUP-6209-S5 CDM 0270 RC outpatient 422.5 422.5 422.5 74 312.65 percent of total billed charges 422.5 93 342.23 percent of total billed charges 422.5 422.5 other OPPS APC 422.5 422.5 other OPPS APC 422.5 27.63 116.74 percent of total billed charges 422.5 422.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING COMPRESSION CAP NYLON MEDIUM REGULAR THIGH HIGH ANTIEMBOLISM LATEX FREE NATURAL SUP-621 CDM 270009042 LOCAL 0270 RC outpatient 7.62 7.62 7.62 74 5.64 percent of total billed charges 7.62 93 6.17 percent of total billed charges 7.62 7.62 other OPPS APC 7.62 7.62 other OPPS APC 7.62 27.63 2.11 percent of total billed charges 7.62 7.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH DURAL DUREPAIR BOVINE COLLAGEN MATRIX L2 IN X W2 IN CRANIAL RESORBABLE STERILE DURAPLASTY SUP-62100 CDM 270010012 LOCAL 0270 RC outpatient 1296.13 1296.13 1296.13 74 959.14 percent of total billed charges 1296.13 93 1049.87 percent of total billed charges 1296.13 1296.13 other OPPS APC 1296.13 1296.13 other OPPS APC 1296.13 27.63 358.12 percent of total billed charges 1296.13 1296.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH DURAL DUREPAIR BOVINE COLLAGEN MATRIX L3 IN X W1 IN CRANIAL RESORBABLE STERILE DURAPLASTY SUP-62106 CDM 270010012 LOCAL 0270 RC outpatient 1173.3 1173.3 1173.3 74 868.24 percent of total billed charges 1173.3 93 950.37 percent of total billed charges 1173.3 1173.3 other OPPS APC 1173.3 1173.3 other OPPS APC 1173.3 27.63 324.18 percent of total billed charges 1173.3 1173.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL COCR +0 MM C TAPER OD36 MM HIP NECK SUP-621066 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH DURAL DUREPAIR BOVINE COLLAGEN MATRIX L5 IN X W4 IN CRANIAL RESORBABLE STERILE DURAPLASTY SUP-62110 CDM 0270 RC outpatient 3.42 3.42 3.42 74 2.53 percent of total billed charges 3.42 93 2.77 percent of total billed charges 3.42 3.42 other OPPS APC 3.42 3.42 other OPPS APC 3.42 27.63 0.94 percent of total billed charges 3.42 3.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE UPPERFACE/MIDFACE BENDER /CUTTER RIGHT SUP-6212175 CDM 0270 RC outpatient 2343.12 2343.12 2343.12 74 1733.91 percent of total billed charges 2343.12 93 1897.93 percent of total billed charges 2343.12 2343.12 other OPPS APC 2343.12 2343.12 other OPPS APC 2343.12 27.63 647.4 percent of total billed charges 2343.12 2343.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE MIDFACE/UPPER FACE BENDER LEFT SUP-6212176 CDM 0270 RC outpatient 2212.08 2212.08 2212.08 74 1636.94 percent of total billed charges 2212.08 93 1791.78 percent of total billed charges 2212.08 2212.08 other OPPS APC 2212.08 2212.08 other OPPS APC 2212.08 27.63 611.2 percent of total billed charges 2212.08 2212.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLUG BONE 9-12MM SUP-6215-5-001 CDM 0270 RC outpatient 143 143 143 74 105.82 percent of total billed charges 143 93 115.83 percent of total billed charges 143 143 other OPPS APC 143 143 other OPPS APC 143 27.63 39.51 percent of total billed charges 143 143 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LDS CATHETER ONLY SUP-62186250 CDM 0275 RC outpatient 624 624 624 57 355.68 percent of total billed charges 624 93 505.44 percent of total billed charges 624 624 other OPPS APC 624 624 other OPPS APC 624 51 318.24 percent of total billed charges 624 624 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSTRUMENT SPHERE INSERT I14R-T3/4 SUP-62189 CDM 0272 RC outpatient 192.5 192.5 192.5 192.5 other OPPS APC 192.5 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING COMPRESSION CAP NYLON MEDIUM LONG THIGH HIGH COOL LIGHTWEIGHT DURABLE FLOATING DESIGN LATEX FREE NATURAL SUP-622 CDM 270009042 LOCAL 0270 RC outpatient 7.62 7.62 7.62 74 5.64 percent of total billed charges 7.62 93 6.17 percent of total billed charges 7.62 7.62 other OPPS APC 7.62 7.62 other OPPS APC 7.62 27.63 2.11 percent of total billed charges 7.62 7.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SAW BLADE SAGITTAL SUP-6221-100-090 CDM 0270 RC outpatient 152.44 152.44 152.44 74 112.81 percent of total billed charges 152.44 93 123.48 percent of total billed charges 152.44 152.44 other OPPS APC 152.44 152.44 other OPPS APC 152.44 27.63 42.12 percent of total billed charges 152.44 152.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW L90 MM X W21 MM X H1.19 MM SAGITTAL SUP-6221119090 CDM 0270 RC outpatient 152.44 152.44 152.44 74 112.81 percent of total billed charges 152.44 93 123.48 percent of total billed charges 152.44 152.44 other OPPS APC 152.44 152.44 other OPPS APC 152.44 27.63 42.12 percent of total billed charges 152.44 152.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION GMK SPHERE SMOOTH PACK STERILE SUP-62242 CDM 0272 RC outpatient 192.5 192.5 192.5 192.5 other OPPS APC 192.5 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT O DEG X3 INSERT 28MM SUP-623-00-28A CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D B H5.9 MM ID28 MM HIP SUP-623-00-28B CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D C H6.9 MM ID28 MM HIP SUP-623-00-28C CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT O DEG X3 INSERT 28MM SUP-623-00-28D CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D B H3.9 MM OD46 MM ID32 MM HIP SUP-623-00-32B CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D C H4.9 MM ID32 MM HIP SUP-623-00-32C CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D D H5.9 MM ID32 MM HIP SUP-623-00-32D CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D E H7.9 MM ID32 MM HIP SUP-623-00-32E CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D F H9.9 MM ID32 MM HIP SUP-623-00-32F CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D G H11.4 MM ID32 MM HIP SUP-623-00-32G CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D H H13.2 MM ID32 MM HIP SUP-623-00-32H CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D I H14.7 MM ID32 MM HIP SUP-623-00-32I CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D J H16.7 MM ID32 MM HIP SUP-623-00-32J CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 0 D D H3.9 MM ID36 MM HIP SUP-623-00-36D CDM 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D D H3.9 MM ID36 MM HIP SUP-623-00-36D CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D E H5.9 MM ID36 MM HIP SUP-623-00-36E CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D F H7.9 MM ID36 MM HIP SUP-623-00-36F CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D G H9.4 MM ID36 MM HIP SUP-623-00-36G CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D H H11.2 MM OD66 MM ID36 MM HIP SUP-623-00-36H CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D J H14.7 MM ID36 MM HIP SUP-623-00-36J CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D E H3.8 MM ID40 MM HIP SUP-623-00-40E CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D F H5.8 MM ID40 MM HIP SUP-623-00-40F CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D G H7.4 MM ID40 MM HIP SUP-623-00-40G CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D H H9.1 MM ID40 MM HIP SUP-623-00-40H CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D I H10.6 MM ID40 MM HIP SUP-623-00-40I CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D J H12.6 MM ID40 MM HIP SUP-623-00-40J CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D B F H3.8 MM ID44 MM HIP SUP-623-00-44F CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D G H5.4 MM ID44 MM HIP SUP-623-00-44G CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D H H7.1 MM ID44 MM HIP SUP-623-00-44H CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D I H8.6 MM ID44 MM HIP SUP-623-00-44I CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 0 D J H10.6 MM ID44 MM HIP SUP-623-00-44J CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 10 D C H6.9 MM ID28 MM HIP SUP-623-10-28C CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT 10DEG X3 INSERT 32MM SIZE D SUP-623-10-32D CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 10 D E ID32 MM HIP PRIMARY SUP-623-10-32E CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 10 D F H9.9 MM ID32 MM HIP SUP-623-10-32F CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 10 D H H13.2 MM ID32 MM HIP SUP-623-10-32H CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 10 D E H5.9 MM ID36 MM HIP SUP-623-10-36E CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 10 D F H7.9 MM ID36 MM HIP SUP-623-10-36F CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 10 D G H9.4 MM ID36 MM HIP SUP-623-10-36G CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR X3 10 D H H11.2 MM ID36 MM HIP SUP-623-10-36H CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTAIN SELECT II SUP-6248DEL CDM 0275 RC outpatient 468 468 468 57 266.76 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 51 238.68 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND SILK 0 KS L30 IN BRAID BLACK SUP-624H CDM 0270 RC outpatient 3.82 3.82 3.82 74 2.83 percent of total billed charges 3.82 93 3.09 percent of total billed charges 3.82 3.82 other OPPS APC 3.82 3.82 other OPPS APC 3.82 27.63 1.06 percent of total billed charges 3.82 3.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BATTERY SURGICAL DRIVER PACK QUICKDRIVE SUP-6250113 CDM 0270 RC outpatient 552.92 552.92 552.92 74 409.16 percent of total billed charges 552.92 93 447.87 percent of total billed charges 552.92 552.92 other OPPS APC 552.92 552.92 other OPPS APC 552.92 27.63 152.77 percent of total billed charges 552.92 552.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER ATTAIN COMMAND HYDROPHILIC MB2 EXTEND HOOK CURVE TAPER L19.7 IN L17.7 IN OD9 FR ID7.2 FR 2 BRAID DIAMOND PATTERN SUP-6250V CDM 0275 RC outpatient 437 437 437 57 249.09 percent of total billed charges 437 93 353.97 percent of total billed charges 437 437 other OPPS APC 437 437 other OPPS APC 437 51 222.87 percent of total billed charges 437 437 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM ATTAIN COMMAND SUP-6250VC/6250VS CDM 0275 RC outpatient 1215.5 1215.5 1215.5 57 692.84 percent of total billed charges 1215.5 93 984.56 percent of total billed charges 1215.5 1215.5 other OPPS APC 1215.5 1215.5 other OPPS APC 1215.5 51 619.91 percent of total billed charges 1215.5 1215.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER BRONCHOSCOPE PNEUPAC OD15 MM 2 AXIS SWIVEL FIBER OPTIC O2 STERILE LATEX FREE DISPOSABLE BLUE SUP-625191 CDM 0270 RC outpatient 20.15 20.15 20.15 74 14.91 percent of total billed charges 20.15 93 16.32 percent of total billed charges 20.15 20.15 other OPPS APC 20.15 20.15 other OPPS APC 20.15 27.63 5.57 percent of total billed charges 20.15 20.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STYLET SUP-6254 CDM 0270 RC outpatient 79.04 79.04 79.04 74 58.49 percent of total billed charges 79.04 93 64.02 percent of total billed charges 79.04 79.04 other OPPS APC 79.04 79.04 other OPPS APC 79.04 27.63 21.84 percent of total billed charges 79.04 79.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER STRYKER CEMENTLESS 36MM SIZE C SUP-626-00-36C CDM 270010024 LOCAL 0270 RC outpatient 4517.5 4517.5 4517.5 74 3342.95 percent of total billed charges 4517.5 93 3659.18 percent of total billed charges 4517.5 4517.5 other OPPS APC 4517.5 4517.5 other OPPS APC 4517.5 27.63 1248.19 percent of total billed charges 4517.5 4517.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR D ID38 MM HIP MODULAR 2 MOBILITY SUP-626-00-38D CDM 270010024 LOCAL 0270 RC outpatient 4517.5 4517.5 4517.5 74 3342.95 percent of total billed charges 4517.5 93 3659.18 percent of total billed charges 4517.5 4517.5 other OPPS APC 4517.5 4517.5 other OPPS APC 4517.5 27.63 1248.19 percent of total billed charges 4517.5 4517.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MDM COCR E OD42 MM HIP 2 MOBILITY MODULAR SUP-626-00-42E CDM 270010024 LOCAL 0270 RC outpatient 4517.5 4517.5 4517.5 74 3342.95 percent of total billed charges 4517.5 93 3659.18 percent of total billed charges 4517.5 4517.5 other OPPS APC 4517.5 4517.5 other OPPS APC 4517.5 27.63 1248.19 percent of total billed charges 4517.5 4517.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR COCR F OD46 MM HIP MODULAR DUAL MOBILITY PRIMARY SUP-626-00-46F CDM 270010024 LOCAL 0270 RC outpatient 4517.5 4517.5 4517.5 74 3342.95 percent of total billed charges 4517.5 93 3659.18 percent of total billed charges 4517.5 4517.5 other OPPS APC 4517.5 4517.5 other OPPS APC 4517.5 27.63 1248.19 percent of total billed charges 4517.5 4517.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MDM COCR G OD48 MM HIP 28 MM FEMORAL HEAD SUP-626-00-48G CDM 270010024 LOCAL 0270 RC outpatient 4517.5 4517.5 4517.5 74 3342.95 percent of total billed charges 4517.5 93 3659.18 percent of total billed charges 4517.5 4517.5 other OPPS APC 4517.5 4517.5 other OPPS APC 4517.5 27.63 1248.19 percent of total billed charges 4517.5 4517.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER STRYKER CEMENTLESS 52MM SIZE H SUP-626-00-52H CDM 270010024 LOCAL 0270 RC outpatient 4517.5 4517.5 4517.5 74 3342.95 percent of total billed charges 4517.5 93 3659.18 percent of total billed charges 4517.5 4517.5 other OPPS APC 4517.5 4517.5 other OPPS APC 4517.5 27.63 1248.19 percent of total billed charges 4517.5 4517.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER STRYKER CEMENTLESS 54MM SIZE I SUP-626-00-54I CDM 270010024 LOCAL 0270 RC outpatient 4517.5 4517.5 4517.5 74 3342.95 percent of total billed charges 4517.5 93 3659.18 percent of total billed charges 4517.5 4517.5 other OPPS APC 4517.5 4517.5 other OPPS APC 4517.5 27.63 1248.19 percent of total billed charges 4517.5 4517.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR MDM J 58MM COCR HIP 28MM FEMORAL HEAD SUP-626-00-58J CDM 270010024 LOCAL 0270 RC outpatient 4517.5 4517.5 4517.5 74 3342.95 percent of total billed charges 4517.5 93 3659.18 percent of total billed charges 4517.5 4517.5 other OPPS APC 4517.5 4517.5 other OPPS APC 4517.5 27.63 1248.19 percent of total billed charges 4517.5 4517.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT COCR -3 MM OFFSET TAPER OD26 MM HIP PRIMARY SUP-6260-9-026 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP PRIMARY SUP-6260-9-028 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD32 MM HIP PRIMARY SUP-6260-9-032 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT TRITANIUM COCR -5 MM OFFSET TAPER OD36 MM HIP PRIMARY SUP-6260-9-036 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD40 MM HIP PRIMARY ANATOMIC SUP-6260-9-040 CDM 270010024 LOCAL 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD26 MM HIP PRIMARY SUP-6260-9-126 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT TRITANIUM COCR +0 MM OFFSET TAPER OD28 MM HIP PRIMARY SUP-6260-9-128 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD32 MM HIP PRIMARY SUP-6260-9-132 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD36 MM HIP PRIMARY ANATOMIC SUP-6260-9-136 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD40 MM HIP PRIMARY ANATOMIC SUP-6260-9-140 CDM 270010025 LOCAL 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT COCR +3 MM OFFSET TAPER OD22 MM HIP PRIMARY SUP-6260-9-222 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD26 MM HIP PRIMARY SUP-6260-9-226 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT TRITANIUM COCR +4 MM OFFSET TAPER OD28 MM HIP PRIMARY SUP-6260-9-228 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD32 MM HIP PRIMARY SUP-6260-9-232 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT TRITANIUM COCR +5 MM OFFSET TAPER OD36 MM HIP PRIMARY SUP-6260-9-236 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT COCR +8 MM OFFSET TAPER OD22 MM HIP PRIMARY SUP-6260-9-322 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT COCR +8 MM OFFSET TAPER OD26 MM HIP PRIMARY SUP-6260-9-326 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT COCR +8 MM OFFSET TAPER OD28 MM HIP PRIMARY SUP-6260-9-328 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT COCR +8 MM OFFSET TAPER OD32 MM HIP PRIMARY SUP-6260-9-332 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT TRITANIUM COCR +10 MM OFFSET TAPER OD36 MM HIP PRIMARY SUP-6260-9-336 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT COCR +8 MM OFFSET TAPER OD44 MM HIP PRIMARY ANATOMIC SUP-6260-9-344 CDM 270010024 LOCAL 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT COCR +12 MM OFFSET TAPER OD26 MM HIP PRIMARY SUP-6260-9-426 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT COCR +12 MM OFFSET OD28 MM HIP SUP-6260-9-428 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT COCR +12 MM OFFSET TAPER OD32 MM HIP PRIMARY SUP-6260-9-432 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT COCR +12 MM OFFSET TAPER OD40 MM HIP PRIMARY ANATOMIC SUP-6260-9-440 CDM 270010024 LOCAL 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 LFIT COCR +12 MM OFFSET TAPER OD44 MM HIP PRIMARY ANATOMIC SUP-6260-9-444 CDM 270010024 LOCAL 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PRESSURE MONITOR CODMAN MICROSENSOR METAL SKULL SUP-626638US CDM 0270 RC outpatient 2364.6 2364.6 2364.6 74 1749.8 percent of total billed charges 2364.6 93 1915.33 percent of total billed charges 2364.6 2364.6 other OPPS APC 2364.6 2364.6 other OPPS APC 2364.6 27.63 653.34 percent of total billed charges 2364.6 2364.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PRESSURE MONITOR CODMAN MICROSENSOR VENTRICULAR SUP-626653US CDM 0270 RC outpatient 2272.01 2272.01 2272.01 74 1681.29 percent of total billed charges 2272.01 93 1840.33 percent of total billed charges 2272.01 2272.01 other OPPS APC 2272.01 2272.01 other OPPS APC 2272.01 27.63 627.76 percent of total billed charges 2272.01 2272.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAZ LOCKING MEDIAL COMUM FUSION LEFT LONG SUP-626773S CDM 0270 RC outpatient 4729.92 4729.92 4729.92 74 3500.14 percent of total billed charges 4729.92 93 3831.24 percent of total billed charges 4729.92 4729.92 other OPPS APC 4729.92 4729.92 other OPPS APC 4729.92 27.63 1306.88 percent of total billed charges 4729.92 4729.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX CUBOID LOCKING SUP-626885S CDM 0270 RC outpatient 4539.6 4539.6 4539.6 74 3359.3 percent of total billed charges 4539.6 93 3677.08 percent of total billed charges 4539.6 4539.6 other OPPS APC 4539.6 4539.6 other OPPS APC 4539.6 27.63 1254.29 percent of total billed charges 4539.6 4539.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BODY CONE RESTORATION +0 MM STANDARD OD19 MM HIP MODULAR REVISION SUP-6276-1-019 CDM 270010025 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BODY CONE RESTORATION +0 MM STANDARD OD21 MM HIP MODULAR REVISION BOLT SUP-6276-1-021 CDM 270010024 LOCAL 0270 RC outpatient 9692.28 9692.28 9692.28 74 7172.29 percent of total billed charges 9692.28 93 7850.75 percent of total billed charges 9692.28 9692.28 other OPPS APC 9692.28 9692.28 other OPPS APC 9692.28 27.63 2677.98 percent of total billed charges 9692.28 9692.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BODY CONE RESTORATION +0 MM STANDARD OD23 MM HIP MODULAR REVISION SUP-6276-1-023 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BODY CONE RESTORATION +0 MM STANDARD OD25 MM HIP MODULAR REVISION SUP-6276-1-025 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER STEM MODULAR HIP SIZE 27MM +0 SUP-6276-1-027 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER STEM MODULAR HIP SIZE 29MM +0 # SUP-6276-1-029 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER STEM MODULAR HIP SIZE 31MM +0 SUP-6276-1-031 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BODY CONE RESTORATION +10 MM OD19 MM HIP MODULAR SUP-6276-1-119 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BODY CONE RESTORATION +10 MM OD21 MM HIP MODULAR REVISION SUP-6276-1-121 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BODY CONE RESTORATION +10 MM OD23 MM HIP MODULAR REVISION SUP-6276-1-123 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER STEM MODULAR HIP SIZE 25MM +10 SUP-6276-1-125 CDM 270010024 LOCAL 0270 RC outpatient 9692.28 9692.28 9692.28 74 7172.29 percent of total billed charges 9692.28 93 7850.75 percent of total billed charges 9692.28 9692.28 other OPPS APC 9692.28 9692.28 other OPPS APC 9692.28 27.63 2677.98 percent of total billed charges 9692.28 9692.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER STEM MODULAR HIP SIZE 27MM +10 SUP-6276-1-127 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER STEM MODULAR HIP SIZE 29MM +10 SUP-6276-1-129 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER STEM MODULAR HIP SIZE 31MM +10 SUP-6276-1-131 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BODY CONE RESTORATION +20 MM OD19 MM HIP MODULAR REVISION SUP-6276-1-216 CDM 270010025 LOCAL 0270 RC outpatient 10267.9 10267.9 10267.9 74 7598.26 percent of total billed charges 10267.9 93 8317.02 percent of total billed charges 10267.9 10267.9 other OPPS APC 10267.9 10267.9 other OPPS APC 10267.9 27.63 2837.03 percent of total billed charges 10267.9 10267.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER STEM MODULAR HIP SIZE 19MM + 20 SUP-6276-1-219 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BODY CONE RESTORATION +20 MM OD21 MM HIP MODULAR REVISION SUP-6276-1-221 CDM 270010025 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER STEM MODULAR HIP SIZE 23MM +20 SUP-6276-1-223 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER STEM MODULAR HIP SIZE 25MM +20 SUP-6276-1-225 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER STEM MODULAR HIP SIZE 27MM +20 SUP-6276-1-227 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER STEM MODULAR HIP SIZE 29MM +20 SUP-6276-1-229 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER STEM MODULAR HIP SIZE 31MM +20 SUP-6276-1-231 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER STEM MODULAR HIP SIZE 19MM + 30 SUP-6276-1-319 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BODY CONE RESTORATION +30 MM OD21 MM HIP MODULAR REVISION SUP-6276-1-321 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BODY CONE RESTORATION +30 MM OD23 MM HIP MODULAR REVISION SUP-6276-1-323 CDM 270010024 LOCAL 0270 RC outpatient 9692.28 9692.28 9692.28 74 7172.29 percent of total billed charges 9692.28 93 7850.75 percent of total billed charges 9692.28 9692.28 other OPPS APC 9692.28 9692.28 other OPPS APC 9692.28 27.63 2677.98 percent of total billed charges 9692.28 9692.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER STEM MODULAR HIP SIZE 25MM +30 SUP-6276-1-325 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER STEM MODULAR HIP SIZE 29MM +30 SUP-6276-1-329 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER STEM MODULAR HIP SIZE 31MM +30 SUP-6276-1-331 CDM 270010024 LOCAL 0270 RC outpatient 10151.7 10151.7 10151.7 74 7512.26 percent of total billed charges 10151.7 93 8222.88 percent of total billed charges 10151.7 10151.7 other OPPS APC 10151.7 10151.7 other OPPS APC 10151.7 27.63 2804.91 percent of total billed charges 10151.7 10151.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION HA STRAIGHT CONICAL L155 MM OD14 MM HIP MODULAR SYSTEM SUP-6276-7-014 CDM 270010025 LOCAL 0270 RC outpatient 7273.5 7273.5 7273.5 74 5382.39 percent of total billed charges 7273.5 93 5891.54 percent of total billed charges 7273.5 7273.5 other OPPS APC 7273.5 7273.5 other OPPS APC 7273.5 27.63 2009.67 percent of total billed charges 7273.5 7273.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION HA STRAIGHT CONICAL L155 MM OD15 MM HIP MODULAR SYSTEM SUP-6276-7-015 CDM 270010024 LOCAL 0270 RC outpatient 7273.5 7273.5 7273.5 74 5382.39 percent of total billed charges 7273.5 93 5891.54 percent of total billed charges 7273.5 7273.5 other OPPS APC 7273.5 7273.5 other OPPS APC 7273.5 27.63 2009.67 percent of total billed charges 7273.5 7273.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION HA STRAIGHT CONICAL L155 MM OD16 MM HIP MODULAR SYSTEM SUP-6276-7-016 CDM 270010024 LOCAL 0270 RC outpatient 6943.95 6943.95 6943.95 74 5138.52 percent of total billed charges 6943.95 93 5624.6 percent of total billed charges 6943.95 6943.95 other OPPS APC 6943.95 6943.95 other OPPS APC 6943.95 27.63 1918.61 percent of total billed charges 6943.95 6943.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION HA STRAIGHT CONICAL L155 MM OD17 MM HIP MODULAR SYSTEM SUP-6276-7-017 CDM 270010024 LOCAL 0270 RC outpatient 7273.5 7273.5 7273.5 74 5382.39 percent of total billed charges 7273.5 93 5891.54 percent of total billed charges 7273.5 7273.5 other OPPS APC 7273.5 7273.5 other OPPS APC 7273.5 27.63 2009.67 percent of total billed charges 7273.5 7273.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION HA STRAIGHT CONICAL L155 MM OD18 MM HIP MODULAR SYSTEM SUP-6276-7-018 CDM 270010024 LOCAL 0270 RC outpatient 7273.5 7273.5 7273.5 74 5382.39 percent of total billed charges 7273.5 93 5891.54 percent of total billed charges 7273.5 7273.5 other OPPS APC 7273.5 7273.5 other OPPS APC 7273.5 27.63 2009.67 percent of total billed charges 7273.5 7273.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION HA CONICAL L155 MM OD19 MM DISTAL HIP MODULAR SUP-6276-7-019 CDM 270010024 LOCAL 0270 RC outpatient 6943.95 6943.95 6943.95 74 5138.52 percent of total billed charges 6943.95 93 5624.6 percent of total billed charges 6943.95 6943.95 other OPPS APC 6943.95 6943.95 other OPPS APC 6943.95 27.63 1918.61 percent of total billed charges 6943.95 6943.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION HA STRAIGHT CONICAL L155 MM OD20 MM HIP MODULAR SYSTEM SUP-6276-7-020 CDM 270010024 LOCAL 0270 RC outpatient 7273.5 7273.5 7273.5 74 5382.39 percent of total billed charges 7273.5 93 5891.54 percent of total billed charges 7273.5 7273.5 other OPPS APC 7273.5 7273.5 other OPPS APC 7273.5 27.63 2009.67 percent of total billed charges 7273.5 7273.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL STRYKER RESTORATION MODULAR 22X155MM SUP-6276-7-022 CDM 270010024 LOCAL 0270 RC outpatient 7273.5 7273.5 7273.5 74 5382.39 percent of total billed charges 7273.5 93 5891.54 percent of total billed charges 7273.5 7273.5 other OPPS APC 7273.5 7273.5 other OPPS APC 7273.5 27.63 2009.67 percent of total billed charges 7273.5 7273.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL STRYKER RESTORATION MODULAR 23X155MM SUP-6276-7-023 CDM 270010024 LOCAL 0270 RC outpatient 7273.5 7273.5 7273.5 74 5382.39 percent of total billed charges 7273.5 93 5891.54 percent of total billed charges 7273.5 7273.5 other OPPS APC 7273.5 7273.5 other OPPS APC 7273.5 27.63 2009.67 percent of total billed charges 7273.5 7273.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL STRYKER RESTORATION MODULAR 24X155MM SUP-6276-7-024 CDM 270010024 LOCAL 0270 RC outpatient 7273.5 7273.5 7273.5 74 5382.39 percent of total billed charges 7273.5 93 5891.54 percent of total billed charges 7273.5 7273.5 other OPPS APC 7273.5 7273.5 other OPPS APC 7273.5 27.63 2009.67 percent of total billed charges 7273.5 7273.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL STRYKER RESTORATION MODULAR 25X155MM SUP-6276-7-025 CDM 270010024 LOCAL 0270 RC outpatient 7273.5 7273.5 7273.5 74 5382.39 percent of total billed charges 7273.5 93 5891.54 percent of total billed charges 7273.5 7273.5 other OPPS APC 7273.5 7273.5 other OPPS APC 7273.5 27.63 2009.67 percent of total billed charges 7273.5 7273.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL STRYKER RESTORATION MODULAR 26X155MM SUP-6276-7-026 CDM 270010024 LOCAL 0270 RC outpatient 7273.5 7273.5 7273.5 74 5382.39 percent of total billed charges 7273.5 93 5891.54 percent of total billed charges 7273.5 7273.5 other OPPS APC 7273.5 7273.5 other OPPS APC 7273.5 27.63 2009.67 percent of total billed charges 7273.5 7273.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL STRYKER RESTORATION MODULAR 27X155MM SUP-6276-7-027 CDM 270010024 LOCAL 0270 RC outpatient 7273.5 7273.5 7273.5 74 5382.39 percent of total billed charges 7273.5 93 5891.54 percent of total billed charges 7273.5 7273.5 other OPPS APC 7273.5 7273.5 other OPPS APC 7273.5 27.63 2009.67 percent of total billed charges 7273.5 7273.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL STRYKER RESTORATION MODULAR 28X155MM SUP-6276-7-028 CDM 270010024 LOCAL 0270 RC outpatient 7273.5 7273.5 7273.5 74 5382.39 percent of total billed charges 7273.5 93 5891.54 percent of total billed charges 7273.5 7273.5 other OPPS APC 7273.5 7273.5 other OPPS APC 7273.5 27.63 2009.67 percent of total billed charges 7273.5 7273.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL STRYKER RESTORATION MODULAR 15X195MM SUP-6276-7-115 CDM 270010024 LOCAL 0270 RC outpatient 7702.5 7702.5 7702.5 74 5699.85 percent of total billed charges 7702.5 93 6239.03 percent of total billed charges 7702.5 7702.5 other OPPS APC 7702.5 7702.5 other OPPS APC 7702.5 27.63 2128.2 percent of total billed charges 7702.5 7702.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION HA STRAIGHT CONICAL L195 MM OD16 MM HIP MODULAR SYSTEM SUP-6276-7-116 CDM 270010024 LOCAL 0270 RC outpatient 7702.5 7702.5 7702.5 74 5699.85 percent of total billed charges 7702.5 93 6239.03 percent of total billed charges 7702.5 7702.5 other OPPS APC 7702.5 7702.5 other OPPS APC 7702.5 27.63 2128.2 percent of total billed charges 7702.5 7702.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION PUREFIX TITANIUM STRAIGHT CONICAL L195 MM OD18 MM HIP DISTAL REVISION MODULAR SUP-6276-7-118 CDM 270010024 LOCAL 0270 RC outpatient 7354.62 7354.62 7354.62 74 5442.42 percent of total billed charges 7354.62 93 5957.24 percent of total billed charges 7354.62 7354.62 other OPPS APC 7354.62 7354.62 other OPPS APC 7354.62 27.63 2032.08 percent of total billed charges 7354.62 7354.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION STRAIGHT CONE L195 MM OD20 MM HIP MODULAR SUP-6276-7-120 CDM 270010024 LOCAL 0270 RC outpatient 7702.5 7702.5 7702.5 74 5699.85 percent of total billed charges 7702.5 93 6239.03 percent of total billed charges 7702.5 7702.5 other OPPS APC 7702.5 7702.5 other OPPS APC 7702.5 27.63 2128.2 percent of total billed charges 7702.5 7702.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION PUREFIX TITANIUM STRAIGHT CONICAL L195 MM OD21 MM HIP DISTAL REVISION MODULAR SUP-6276-7-121 CDM 270010024 LOCAL 0270 RC outpatient 7354.62 7354.62 7354.62 74 5442.42 percent of total billed charges 7354.62 93 5957.24 percent of total billed charges 7354.62 7354.62 other OPPS APC 7354.62 7354.62 other OPPS APC 7354.62 27.63 2032.08 percent of total billed charges 7354.62 7354.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION BOWED CONICAL L235 MM OD24 MM DISTAL HIP MODULAR SUP-6276-7-324 CDM 270010024 LOCAL 0270 RC outpatient 8556.6 8556.6 8556.6 74 6331.88 percent of total billed charges 8556.6 93 6930.85 percent of total billed charges 8556.6 8556.6 other OPPS APC 8556.6 8556.6 other OPPS APC 8556.6 27.63 2364.19 percent of total billed charges 8556.6 8556.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL VERTE-STACK CORNERSTONE PSR PEEK-OPTIMA D11 MM W11 MM X H6 MM STRUT STERILE LATEX FREE CERVICAL INTERBODY FUSION SUP-6276006 CDM 270010020 LOCAL 0270 RC outpatient 5191.68 5191.68 5191.68 74 3841.84 percent of total billed charges 5191.68 93 4205.26 percent of total billed charges 5191.68 5191.68 other OPPS APC 5191.68 5191.68 other OPPS APC 5191.68 27.63 1434.46 percent of total billed charges 5191.68 5191.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL VERTE-STACK CORNERSTONE PSR PEEK-OPTIMA D11 MM W11 MM X H6 MM STERILE LATEX FREE CERVICAL INTERBODY FUSION SUP-6276611 CDM 270010020 LOCAL 0270 RC outpatient 2535 2535 2535 74 1875.9 percent of total billed charges 2535 93 2053.35 percent of total billed charges 2535 2535 other OPPS APC 2535 2535 other OPPS APC 2535 27.63 700.42 percent of total billed charges 2535 2535 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL VERTE-STACK CORNERSTONE PSR 11MMX14MM 6MM STERILE LF STRUT SUP-6277006 CDM 270010012 LOCAL 0270 RC outpatient 5191.68 5191.68 5191.68 74 3841.84 percent of total billed charges 5191.68 93 4205.26 percent of total billed charges 5191.68 5191.68 other OPPS APC 5191.68 5191.68 other OPPS APC 5191.68 27.63 1434.46 percent of total billed charges 5191.68 5191.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRUT MEDTRONIC CORNERSTON 25X14X11 SUP-6277025 CDM 270010020 LOCAL 0270 RC outpatient 5191.68 5191.68 5191.68 74 3841.84 percent of total billed charges 5191.68 93 4205.26 percent of total billed charges 5191.68 5191.68 other OPPS APC 5191.68 5191.68 other OPPS APC 5191.68 27.63 1434.46 percent of total billed charges 5191.68 5191.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL VERTE-STACK CORNERSTONE PSR PEEK-OPTIMA D4 MM W11 MM X H14 MM LIF SUP-6277441 CDM 270010012 LOCAL 0270 RC outpatient 2098.2 2098.2 2098.2 74 1552.67 percent of total billed charges 2098.2 93 1699.54 percent of total billed charges 2098.2 2098.2 other OPPS APC 2098.2 2098.2 other OPPS APC 2098.2 27.63 579.73 percent of total billed charges 2098.2 2098.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON 3-0 KS L30 IN MONOFILAMENT BLACK SUP-627H CDM 0270 RC outpatient 4.88 4.88 4.88 74 3.61 percent of total billed charges 4.88 93 3.95 percent of total billed charges 4.88 4.88 other OPPS APC 4.88 4.88 other OPPS APC 4.88 27.63 1.35 percent of total billed charges 4.88 4.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CORNERSTONE PSR PEEK-OPTIMA D11 MM W14 MM X H10 MM LIF LATERAL PORT SUP-6287041 CDM 270010020 LOCAL 0270 RC outpatient 2535 2535 2535 74 1875.9 percent of total billed charges 2535 93 2053.35 percent of total billed charges 2535 2535 other OPPS APC 2535 2535 other OPPS APC 2535 27.63 700.42 percent of total billed charges 2535 2535 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CORNERSTONE PSR PEEK-OPTIMA L14 MM X W11 MM X H12 MM LUMBAR INTERBODY FUSION LATERAL PORT SUP-6287241 CDM 270010020 LOCAL 0270 RC outpatient 2098.2 2098.2 2098.2 74 1552.67 percent of total billed charges 2098.2 93 1699.54 percent of total billed charges 2098.2 2098.2 other OPPS APC 2098.2 2098.2 other OPPS APC 2098.2 27.63 579.73 percent of total billed charges 2098.2 2098.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CORNERSTONE PSR PEEK-OPTIMA D11 MM W14 MM X H13 MM LIF LATERAL PORT SUP-6287341 CDM 270010020 LOCAL 0270 RC outpatient 2098.2 2098.2 2098.2 74 1552.67 percent of total billed charges 2098.2 93 1699.54 percent of total billed charges 2098.2 2098.2 other OPPS APC 2098.2 2098.2 other OPPS APC 2098.2 27.63 579.73 percent of total billed charges 2098.2 2098.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CORNERSTONE PSR PEEK-OPTIMA D11 MM W14 MM X H5 MM LIF LATERAL PORT SUP-6287541 CDM 270010020 LOCAL 0270 RC outpatient 2098.2 2098.2 2098.2 74 1552.67 percent of total billed charges 2098.2 93 1699.54 percent of total billed charges 2098.2 2098.2 other OPPS APC 2098.2 2098.2 other OPPS APC 2098.2 27.63 579.73 percent of total billed charges 2098.2 2098.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CORNERSTONE PSR PEEK-OPTIMA D11 MM W14 MM X H6 MM LIF LATERAL PORT SUP-6287641 CDM 270010020 LOCAL 0270 RC outpatient 2098.2 2098.2 2098.2 74 1552.67 percent of total billed charges 2098.2 93 1699.54 percent of total billed charges 2098.2 2098.2 other OPPS APC 2098.2 2098.2 other OPPS APC 2098.2 27.63 579.73 percent of total billed charges 2098.2 2098.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CORNERSTONE PSR PEEK-OPTIMA L14 MM X W11 MM X H7 MM LATERAL PORT LUMBAR INTERBODY FUSION SUP-6287741 CDM 270010020 LOCAL 0270 RC outpatient 2098.2 2098.2 2098.2 74 1552.67 percent of total billed charges 2098.2 93 1699.54 percent of total billed charges 2098.2 2098.2 other OPPS APC 2098.2 2098.2 other OPPS APC 2098.2 27.63 579.73 percent of total billed charges 2098.2 2098.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CORNERSTONE PSR PEEK-OPTIMA L14 MM X W11 MM X H8 MM LATERAL PORT LUMBAR INTERBODY FUSION SUP-6287841 CDM 270010020 LOCAL 0270 RC outpatient 2098.2 2098.2 2098.2 74 1552.67 percent of total billed charges 2098.2 93 1699.54 percent of total billed charges 2098.2 2098.2 other OPPS APC 2098.2 2098.2 other OPPS APC 2098.2 27.63 579.73 percent of total billed charges 2098.2 2098.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MEDTRONIC CORNERSTONE PSR END CAP 9X14X11MM SUP-6287941 CDM 270010020 LOCAL 0270 RC outpatient 2098.2 2098.2 2098.2 74 1552.67 percent of total billed charges 2098.2 93 1699.54 percent of total billed charges 2098.2 2098.2 other OPPS APC 2098.2 2098.2 other OPPS APC 2098.2 27.63 579.73 percent of total billed charges 2098.2 2098.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRIPPER SURGICAL DISPOSABLE STERILE VEIN 2 CABLE OLIVE HANDLE SUP-63-4031 CDM 0270 RC outpatient 60 60 60 74 44.4 percent of total billed charges 60 93 48.6 percent of total billed charges 60 60 other OPPS APC 60 60 other OPPS APC 60 27.63 16.58 percent of total billed charges 60 60 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING COMPRESSION CAP NYLON LARGE SHORT THIGH HIGH LATEX FREE NATURAL SUP-630 CDM 270009042 LOCAL 0270 RC outpatient 7.62 7.62 7.62 74 5.64 percent of total billed charges 7.62 93 6.17 percent of total billed charges 7.62 7.62 other OPPS APC 7.62 7.62 other OPPS APC 7.62 27.63 2.11 percent of total billed charges 7.62 7.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING COMPRESSION CAP NYLON LARGE REGULAR THIGH HIGH COOL LIGHTWEIGHT DURABLE FLOATING DESIGN LATEX FREE NATURAL SUP-631 CDM 270009042 LOCAL 0270 RC outpatient 7.62 7.62 7.62 74 5.64 percent of total billed charges 7.62 93 6.17 percent of total billed charges 7.62 7.62 other OPPS APC 7.62 7.62 other OPPS APC 7.62 27.63 2.11 percent of total billed charges 7.62 7.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PARTICLES EMBOLIZATION TRUFILL NBCA 1 GM KIT LIQUID SYSTEM SUP-631500 CDM 0270 RC outpatient 13216.7 13216.7 13216.7 74 9780.39 percent of total billed charges 13216.7 93 10705.6 percent of total billed charges 13216.7 13216.7 other OPPS APC 13216.7 13216.7 other OPPS APC 13216.7 27.63 3651.79 percent of total billed charges 13216.7 13216.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING COMPRESSION CAP NYLON LARGE LONG THIGH HIGH COOL LIGHTWEIGHT DURABLE FLOATING DESIGN LATEX FREE NATURAL SUP-632 CDM 270009042 LOCAL 0270 RC outpatient 7.62 7.62 7.62 74 5.64 percent of total billed charges 7.62 93 6.17 percent of total billed charges 7.62 7.62 other OPPS APC 7.62 7.62 other OPPS APC 7.62 27.63 2.11 percent of total billed charges 7.62 7.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE INFLATION/DEFLATION TRUFILL DCS II PLATINUM INDEFLATOR EMBOLISM COIL SUP-635002 CDM 0270 RC outpatient 884.99 884.99 884.99 74 654.89 percent of total billed charges 884.99 93 716.84 percent of total billed charges 884.99 884.99 other OPPS APC 884.99 884.99 other OPPS APC 884.99 27.63 244.52 percent of total billed charges 884.99 884.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE CHROMIC 4-0 FS-2 L27 IN MONOFILAMENT BROWN SUP-635H CDM 0270 RC outpatient 6.73 6.73 6.73 74 4.98 percent of total billed charges 6.73 93 5.45 percent of total billed charges 6.73 6.73 other OPPS APC 6.73 6.73 other OPPS APC 6.73 27.63 1.86 percent of total billed charges 6.73 6.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE CHROMIC 3-0 FS-2 L27 IN MONOFILAMENT BROWN SUP-636H CDM 0270 RC outpatient 6.47 6.47 6.47 74 4.79 percent of total billed charges 6.47 93 5.24 percent of total billed charges 6.47 6.47 other OPPS APC 6.47 6.47 other OPPS APC 6.47 27.63 1.79 percent of total billed charges 6.47 6.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND ANNULOPLASTY CG FUTURE OD26 MM 10 L SUP-638BL26 CDM 0270 RC outpatient 4225 4225 4225 74 3126.5 percent of total billed charges 4225 93 3422.25 percent of total billed charges 4225 4225 other OPPS APC 4225 4225 other OPPS APC 4225 27.63 1167.37 percent of total billed charges 4225 4225 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND ANNULOPLASTY CG FUTURE OD28 MM SUP-638BL28 CDM 0270 RC outpatient 4225 4225 4225 74 3126.5 percent of total billed charges 4225 93 3422.25 percent of total billed charges 4225 4225 other OPPS APC 4225 4225 other OPPS APC 4225 27.63 1167.37 percent of total billed charges 4225 4225 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND ANNULOPLASTY CG FUTURE OD30 MM 10 L SUP-638BL30 CDM 0270 RC outpatient 4225 4225 4225 74 3126.5 percent of total billed charges 4225 93 3422.25 percent of total billed charges 4225 4225 other OPPS APC 4225 4225 other OPPS APC 4225 27.63 1167.37 percent of total billed charges 4225 4225 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND ANNULOPLASTY CG FUTURE OD32 MM SUP-638BL32 CDM 27000000 LOCAL 0270 RC outpatient 4225 4225 4225 74 3126.5 percent of total billed charges 4225 93 3422.25 percent of total billed charges 4225 4225 other OPPS APC 4225 4225 other OPPS APC 4225 27.63 1167.37 percent of total billed charges 4225 4225 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND ANNULOPLASTY CG FUTURE OD34 MM SUP-638BL34 CDM 0270 RC outpatient 4225 4225 4225 74 3126.5 percent of total billed charges 4225 93 3422.25 percent of total billed charges 4225 4225 other OPPS APC 4225 4225 other OPPS APC 4225 27.63 1167.37 percent of total billed charges 4225 4225 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND ANNULOPLASTY CG FUTURE OD36 MM SUP-638BL36 CDM 0270 RC outpatient 4225 4225 4225 74 3126.5 percent of total billed charges 4225 93 3422.25 percent of total billed charges 4225 4225 other OPPS APC 4225 4225 other OPPS APC 4225 27.63 1167.37 percent of total billed charges 4225 4225 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND ANNULOPLASTY CG FUTURE OD38 MM SUP-638BL38 CDM 0270 RC outpatient 4225 4225 4225 74 3126.5 percent of total billed charges 4225 93 3422.25 percent of total billed charges 4225 4225 other OPPS APC 4225 4225 other OPPS APC 4225 27.63 1167.37 percent of total billed charges 4225 4225 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE MATRIGRAFT 200MM FEMORAL SHAFT BISECTED FROZEN SUP-639120 CDM 270010031 LOCAL 0270 RC outpatient 3432 3432 3432 74 2539.68 percent of total billed charges 3432 93 2779.92 percent of total billed charges 3432 3432 other OPPS APC 3432 3432 other OPPS APC 3432 27.63 948.26 percent of total billed charges 3432 3432 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEP/PLATE/BONE LEFT SUP-64-00175 CDM 0270 RC outpatient 1704.01 1704.01 1704.01 74 1260.97 percent of total billed charges 1704.01 93 1380.25 percent of total billed charges 1704.01 1704.01 other OPPS APC 1704.01 1704.01 other OPPS APC 1704.01 27.63 470.82 percent of total billed charges 1704.01 1704.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEP/PLATE/BONE RIGHT SUP-64-00176 CDM 0270 RC outpatient 1704.01 1704.01 1704.01 74 1260.97 percent of total billed charges 1704.01 93 1380.25 percent of total billed charges 1704.01 1704.01 other OPPS APC 1704.01 1704.01 other OPPS APC 1704.01 27.63 470.82 percent of total billed charges 1704.01 1704.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENDER CUTTER/LEFT SUP-64-00242 CDM 0270 RC outpatient 3405.19 3405.19 3405.19 74 2519.84 percent of total billed charges 3405.19 93 2758.2 percent of total billed charges 3405.19 3405.19 other OPPS APC 3405.19 3405.19 other OPPS APC 3405.19 27.63 940.85 percent of total billed charges 3405.19 3405.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENDER CUTTER/RIGHT SUP-64-00243 CDM 0270 RC outpatient 3405.19 3405.19 3405.19 74 2519.84 percent of total billed charges 3405.19 93 2758.2 percent of total billed charges 3405.19 3405.19 other OPPS APC 3405.19 3405.19 other OPPS APC 3405.19 27.63 940.85 percent of total billed charges 3405.19 3405.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON EXPRESS 360 RFA SUP-64082 CDM 0270 RC outpatient 7664.8 7664.8 7664.8 74 5671.95 percent of total billed charges 7664.8 93 6208.49 percent of total billed charges 7664.8 7664.8 other OPPS APC 7664.8 7664.8 other OPPS APC 7664.8 27.63 2117.78 percent of total billed charges 7664.8 7664.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L6 CM OD 3MM COMPLEX FILL SUP-640CF0306 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L8 CM OD 3MM COMPLEX FILL SUP-640CF0308 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L10 CM OD 4MM COMPLEX FILL SUP-640CF0410 CDM 0270 RC outpatient 5956.68 5956.68 5956.68 74 4407.94 percent of total billed charges 5956.68 93 4824.91 percent of total billed charges 5956.68 5956.68 other OPPS APC 5956.68 5956.68 other OPPS APC 5956.68 27.63 1645.83 percent of total billed charges 5956.68 5956.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L12 CM OD 4MM COMPLEX FILL SUP-640CF0412 CDM 0270 RC outpatient 5683.86 5683.86 5683.86 74 4206.06 percent of total billed charges 5683.86 93 4603.93 percent of total billed charges 5683.86 5683.86 other OPPS APC 5683.86 5683.86 other OPPS APC 5683.86 27.63 1570.45 percent of total billed charges 5683.86 5683.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L5 CM OD 5MM COMPLEX FILL SUP-640CF0505 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L10 CM OD 5MM COMPLEX FILL SUP-640CF0510 CDM 0270 RC outpatient 5460 5460 5460 74 4040.4 percent of total billed charges 5460 93 4422.6 percent of total billed charges 5460 5460 other OPPS APC 5460 5460 other OPPS APC 5460 27.63 1508.6 percent of total billed charges 5460 5460 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY .012 IN L15 CM OD 5MM COMPLEX FILL DETACHABLE RANDOM LOOP DESIGN STRETCH RESISTANT SUP-640CF0515 CDM 0270 RC outpatient 5956.68 5956.68 5956.68 74 4407.94 percent of total billed charges 5956.68 93 4824.91 percent of total billed charges 5956.68 5956.68 other OPPS APC 5956.68 5956.68 other OPPS APC 5956.68 27.63 1645.83 percent of total billed charges 5956.68 5956.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L10 CM OD 6MM COMPLEX FILL SUP-640CF0610 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L15 CM OD 6MM COMPLEX FILL SUP-640CF0615 CDM 0270 RC outpatient 5956.68 5956.68 5956.68 74 4407.94 percent of total billed charges 5956.68 93 4824.91 percent of total billed charges 5956.68 5956.68 other OPPS APC 5956.68 5956.68 other OPPS APC 5956.68 27.63 1645.83 percent of total billed charges 5956.68 5956.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L20 CM OD 6MM COMPLEX FILL SUP-640CF0620 CDM 0270 RC outpatient 5683.86 5683.86 5683.86 74 4206.06 percent of total billed charges 5683.86 93 4603.93 percent of total billed charges 5683.86 5683.86 other OPPS APC 5683.86 5683.86 other OPPS APC 5683.86 27.63 1570.45 percent of total billed charges 5683.86 5683.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L15 CM OD 7MM COMPLEX FILL SUP-640CF0715 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L21 CM OD 7MM COMPLEX FILL SUP-640CF0721 CDM 0270 RC outpatient 5460 5460 5460 74 4040.4 percent of total billed charges 5460 93 4422.6 percent of total billed charges 5460 5460 other OPPS APC 5460 5460 other OPPS APC 5460 27.63 1508.6 percent of total billed charges 5460 5460 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L15 CM OD 8MM COMPLEX FILL SUP-640CF0815 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L24 CM OD 8MM COMPLEX FILL SUP-640CF0824 CDM 0270 RC outpatient 5683.86 5683.86 5683.86 74 4206.06 percent of total billed charges 5683.86 93 4603.93 percent of total billed charges 5683.86 5683.86 other OPPS APC 5683.86 5683.86 other OPPS APC 5683.86 27.63 1570.45 percent of total billed charges 5683.86 5683.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L15 CM OD 9MM COMPLEX FILL SUP-640CF0915 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L25 CM OD 9MM COMPLEX FILL SUP-640CF0925 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L30 CM OD 10MM COMPLEX FILL SUP-640CF1030 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L30 CM OD 12MM COMPLEX FILL SUP-640CF1230 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L20 CM OD 6MM COMPLEX FRAME SUP-640CR0620 CDM 0270 RC outpatient 5460 5460 5460 74 4040.4 percent of total billed charges 5460 93 4422.6 percent of total billed charges 5460 5460 other OPPS APC 5460 5460 other OPPS APC 5460 27.63 1508.6 percent of total billed charges 5460 5460 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L25 CM OD 7MM COMPLEX FRAME SUP-640CR0725 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L30 CM OD 8MM COMPLEX FRAME SUP-640CR0830 CDM 0270 RC outpatient 5460 5460 5460 74 4040.4 percent of total billed charges 5460 93 4422.6 percent of total billed charges 5460 5460 other OPPS APC 5460 5460 other OPPS APC 5460 27.63 1508.6 percent of total billed charges 5460 5460 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L30 CM OD 9MM COMPLEX FRAME SUP-640CR0930 CDM 0270 RC outpatient 5460 5460 5460 74 4040.4 percent of total billed charges 5460 93 4422.6 percent of total billed charges 5460 5460 other OPPS APC 5460 5460 other OPPS APC 5460 27.63 1508.6 percent of total billed charges 5460 5460 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L30 CM OD 10MM COMPLEX FRAME SUP-640CR1030 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L20 CM OD 12MM COMPLEX FRAME SUP-640CR1230 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L30 CM OD 14MM COMPLEX FRAME SUP-640CR1430 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L30 CM OD 16MM COMPLEX FRAME SUP-640CR1630 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L30 CM OD 18MM COMPLEX FRAME SUP-640CR1830 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TRUFILL DCS ORBIT GALAXY L30 CM OD 20MM COMPLEX FRAME SUP-640CR2030 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION XTRASOFT L1.5 CM OD 2MMCOMPLEX OCCLUSION GRADE SUP-640CX0201 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION XTRASOFT GALAXY TRUSEEK TRUFILL DCS ORBIT L2 CM OD 2MM ODSEC .012 IN RANDOM LOOP SOFT SUP-640CX0202 CDM 0270 RC outpatient 5460 5460 5460 74 4040.4 percent of total billed charges 5460 93 4422.6 percent of total billed charges 5460 5460 other OPPS APC 5460 5460 other OPPS APC 5460 27.63 1508.6 percent of total billed charges 5460 5460 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION XTRASOFT L3 CM OD 3MM COMPLEX OCCLUSION GRADE SUP-640CX0303 CDM 0270 RC outpatient 5460 5460 5460 74 4040.4 percent of total billed charges 5460 93 4422.6 percent of total billed charges 5460 5460 other OPPS APC 5460 5460 other OPPS APC 5460 27.63 1508.6 percent of total billed charges 5460 5460 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION XTRASOFT L4 CM OD 3MM COMPLEX OCCLUSION GRADE SUP-640CX0304 CDM 0270 RC outpatient 5683.86 5683.86 5683.86 74 4206.06 percent of total billed charges 5683.86 93 4603.93 percent of total billed charges 5683.86 5683.86 other OPPS APC 5683.86 5683.86 other OPPS APC 5683.86 27.63 1570.45 percent of total billed charges 5683.86 5683.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION XTRASOFT L6 CM OD 3MM COMPLEX OCCLUSION GRADE SUP-640CX0306 CDM 0270 RC outpatient 5956.68 5956.68 5956.68 74 4407.94 percent of total billed charges 5956.68 93 4824.91 percent of total billed charges 5956.68 5956.68 other OPPS APC 5956.68 5956.68 other OPPS APC 5956.68 27.63 1645.83 percent of total billed charges 5956.68 5956.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION XTRASOFT L8 CM OD 3MM COMPLEX OCCLUSION GRADE SUP-640CX0308 CDM 0270 RC outpatient 5460 5460 5460 74 4040.4 percent of total billed charges 5460 93 4422.6 percent of total billed charges 5460 5460 other OPPS APC 5460 5460 other OPPS APC 5460 27.63 1508.6 percent of total billed charges 5460 5460 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION XTRASOFT L4 CM OD 4MM COMPLEX OCCLUSION GRADE SUP-640CX0404 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION XTRASOFT L6 CM OD 4MM COMPLEX OCCLUSION GRADE SUP-640CX0406 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION XTRASOFT L8 CM OD 4MM COMPLEX OCCLUSION GRADE SUP-640CX0408 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION XTRASOFT L10 CM OD 4MM COMPLEX OCCLUSION GRADE SUP-640CX0410 CDM 0270 RC outpatient 5956.68 5956.68 5956.68 74 4407.94 percent of total billed charges 5956.68 93 4824.91 percent of total billed charges 5956.68 5956.68 other OPPS APC 5956.68 5956.68 other OPPS APC 5956.68 27.63 1645.83 percent of total billed charges 5956.68 5956.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION XTRASOFT L5 CM OD 2.5MM COMPLEX OCCLUSION GRADE SUP-640CX2505 CDM 0270 RC outpatient 5956.68 5956.68 5956.68 74 4407.94 percent of total billed charges 5956.68 93 4824.91 percent of total billed charges 5956.68 5956.68 other OPPS APC 5956.68 5956.68 other OPPS APC 5956.68 27.63 1645.83 percent of total billed charges 5956.68 5956.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION XTRASOFT L2.5 CM OD 2.5MM COMPLEX OCCLUSION GRADE SUP-640CX2525 CDM 0270 RC outpatient 5527.6 5527.6 5527.6 74 4090.42 percent of total billed charges 5527.6 93 4477.36 percent of total billed charges 5527.6 5527.6 other OPPS APC 5527.6 5527.6 other OPPS APC 5527.6 27.63 1527.28 percent of total billed charges 5527.6 5527.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION XTRASOFT L3.5 CM OD 2.5MM COMPLEX OCCLUSION GRADE SUP-640CX2535 CDM 0270 RC outpatient 5683.86 5683.86 5683.86 74 4206.06 percent of total billed charges 5683.86 93 4603.93 percent of total billed charges 5683.86 5683.86 other OPPS APC 5683.86 5683.86 other OPPS APC 5683.86 27.63 1570.45 percent of total billed charges 5683.86 5683.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION XTRASOFT L5 CM OD 3.5MM COMPLEX OCCLUSION GRADE SUP-640CX3505 CDM 0270 RC outpatient 5683.86 5683.86 5683.86 74 4206.06 percent of total billed charges 5683.86 93 4603.93 percent of total billed charges 5683.86 5683.86 other OPPS APC 5683.86 5683.86 other OPPS APC 5683.86 27.63 1570.45 percent of total billed charges 5683.86 5683.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION XTRASOFT L9 CM OD 3.5MM COMPLEX OCCLUSION GRADE SUP-640CX3509 CDM 0270 RC outpatient 5956.68 5956.68 5956.68 74 4407.94 percent of total billed charges 5956.68 93 4824.91 percent of total billed charges 5956.68 5956.68 other OPPS APC 5956.68 5956.68 other OPPS APC 5956.68 27.63 1645.83 percent of total billed charges 5956.68 5956.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION XTRASOFT L7.5 CM OD 3.5MM COMPLEX OCCLUSION GRADE SUP-640CX3575 CDM 0270 RC outpatient 5683.86 5683.86 5683.86 74 4206.06 percent of total billed charges 5683.86 93 4603.93 percent of total billed charges 5683.86 5683.86 other OPPS APC 5683.86 5683.86 other OPPS APC 5683.86 27.63 1570.45 percent of total billed charges 5683.86 5683.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKING COMPRESSION CAP NYLON XL LONG THIGH HIGH COOL LIGHTWEIGHT DURABLE FLOATING DESIGN LATEX FREE NATURAL SUP-642 CDM 270009042 LOCAL 0270 RC outpatient 7.62 7.62 7.62 74 5.64 percent of total billed charges 7.62 93 6.17 percent of total billed charges 7.62 7.62 other OPPS APC 7.62 7.62 other OPPS APC 7.62 27.63 2.11 percent of total billed charges 7.62 7.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPOSITE DENTAL TPH SPECTRA COMPULES .25 GM LOW VISCOSITY STAIN RESISTANCE REFILL RESTORATIVE A2 SUP-642221 CDM 0270 RC outpatient 21.06 21.06 21.06 74 15.58 percent of total billed charges 21.06 93 17.06 percent of total billed charges 21.06 21.06 other OPPS APC 21.06 21.06 other OPPS APC 21.06 27.63 5.82 percent of total billed charges 21.06 21.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP HUMERAL UNIVERS REVERS NEUTRAL OD39 MM SHOULDER SUTURE STERILE SUP-64260 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING STREAMLINE L3 MM OD.48 MM ATRIUM UNIPOLAR TEMPORARY PURPLE SUP-6492F CDM 0270 RC outpatient 85.59 85.59 85.59 74 63.34 percent of total billed charges 85.59 93 69.33 percent of total billed charges 85.59 85.59 other OPPS APC 85.59 85.59 other OPPS APC 85.59 27.63 23.65 percent of total billed charges 85.59 85.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE TISSUEMEND COLLAGEN MEMBRANE L10 CM X W6 CM PATCH SUP-6495-9-004 CDM 0270 RC outpatient 8219.85 8219.85 8219.85 74 6082.69 percent of total billed charges 8219.85 93 6658.08 percent of total billed charges 8219.85 8219.85 other OPPS APC 8219.85 8219.85 other OPPS APC 8219.85 27.63 2271.14 percent of total billed charges 8219.85 8219.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CREAM ELECTRODE REDUX 114 GM EKG JELLY TUBE NONABRASIVE DEFIBRILLATION SUP-65-04 CDM outpatient 10.27 10.27 10.27 10.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEPARATOR SURGICAL WOODSON STAINLESS STEEL GROOVE L7 IN L.5 IN X W1/8 IN DURA 2 END BLADE PACKER SUP-65-1135 CDM outpatient 223.81 223.81 223.81 223.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL M/L TCP HA 40 MM TAPER STRAIGHT EXTENDED OFFSET L107 MM OD4 MM HIP PRIMARY STERILE SUP-65-7711-004-40 CDM 270010024 LOCAL 0270 RC outpatient 12464.4 12464.4 12464.4 74 9223.66 percent of total billed charges 12464.4 93 10096.2 percent of total billed charges 12464.4 12464.4 other OPPS APC 12464.4 12464.4 other OPPS APC 12464.4 27.63 3443.91 percent of total billed charges 12464.4 12464.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE OPTECURE DEMINERALIZED BONE MATRIX 5 ML POWDER STERILE SUP-650-00-05 CDM 270010031 LOCAL 0270 RC outpatient 2639 2639 2639 74 1952.86 percent of total billed charges 2639 93 2137.59 percent of total billed charges 2639 2639 other OPPS APC 2639 2639 other OPPS APC 2639 27.63 729.16 percent of total billed charges 2639 2639 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE OPTECURE DEMINERALIZED BONE MATRIX 10 ML POWDER STERILE SUP-650-00-10 CDM 270010031 LOCAL 0270 RC outpatient 4199 4199 4199 74 3107.26 percent of total billed charges 4199 93 3401.19 percent of total billed charges 4199 4199 other OPPS APC 4199 4199 other OPPS APC 4199 27.63 1160.18 percent of total billed charges 4199 4199 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL G7 BIOLOX DELTA BIOLOX OPTION OD44 MM HIP SKIRT SUP-650-1059 CDM 270010024 LOCAL 0270 RC outpatient 2522 2522 2522 74 1866.28 percent of total billed charges 2522 93 2042.82 percent of total billed charges 2522 2522 other OPPS APC 2522 2522 other OPPS APC 2522 27.63 696.83 percent of total billed charges 2522 2522 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE CENTERING G7 TITANIUM +6 MM OFFSET TAPER HIP TYPE 1 BIOLOX DELTA BIOLOX OPTION FEMORAL HEAD SUP-650-1068 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT INJECTABLE CONTIGEN BOVINE COLLAGEN 2.5 ML PERIURETHRAL INJECTABLE COLLAGEN BULKING THERAPY TREATMENT SYRINGE ONLY STRESS URINARY INCONTINENCE SUP-651005 CDM 0270 RC outpatient 909.87 909.87 909.87 74 673.3 percent of total billed charges 909.87 93 736.99 percent of total billed charges 909.87 909.87 other OPPS APC 909.87 909.87 other OPPS APC 909.87 27.63 251.4 percent of total billed charges 909.87 909.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL BIOLOX OD28 MM HIP TAPERED SUP-6519-1-028 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL BIOLOX DELTA UNIVERSAL OD32 MM HIP TAPERED SUP-6519-1-032 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL UNIVERSAL OD36 MM HIP ANATOMIC SUP-6519-1-036 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL BIOLOX DELTA CERAMIC +0 UNIVERSAL TAPER OD40 MM HIP SUP-6519-1-040 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL BIOLOX UNIVERSAL OD44 MM HIP TAPERED NONSTERILE SUP-6519-1-044 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE ADAPTER V40 TITANIUM -2.5 MM OFFSET UNIVERSAL TAPER HIP SUP-6519-T-025 CDM 270010024 LOCAL 0270 RC outpatient 462.8 462.8 462.8 74 342.47 percent of total billed charges 462.8 93 374.87 percent of total billed charges 462.8 462.8 other OPPS APC 462.8 462.8 other OPPS APC 462.8 27.63 127.87 percent of total billed charges 462.8 462.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE ADAPTER V40 TITANIUM +0 MM OFFSET UNIVERSAL TAPER HIP SUP-6519-T-100 CDM 270010024 LOCAL 0270 RC outpatient 462.8 462.8 462.8 74 342.47 percent of total billed charges 462.8 93 374.87 percent of total billed charges 462.8 462.8 other OPPS APC 462.8 462.8 other OPPS APC 462.8 27.63 127.87 percent of total billed charges 462.8 462.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE ADAPTER V40 TITANIUM +4 MM OFFSET UNIVERSAL TAPER HIP SUP-6519-T-204 CDM 270010024 LOCAL 0270 RC outpatient 462.8 462.8 462.8 74 342.47 percent of total billed charges 462.8 93 374.87 percent of total billed charges 462.8 462.8 other OPPS APC 462.8 462.8 other OPPS APC 462.8 27.63 127.87 percent of total billed charges 462.8 462.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE OPTECURE CANCELLOUS CORTICAL 2 ML JAR CHIP SUP-652-00-02 CDM 270010031 LOCAL 0270 RC outpatient 1606.8 1606.8 1606.8 74 1189.03 percent of total billed charges 1606.8 93 1301.51 percent of total billed charges 1606.8 1606.8 other OPPS APC 1606.8 1606.8 other OPPS APC 1606.8 27.63 443.96 percent of total billed charges 1606.8 1606.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE OPTECURE CANCELLOUS CORTICAL 5 ML CHIP JAR SUP-652-00-05 CDM 270010031 LOCAL 0270 RC outpatient 3718 3718 3718 74 2751.32 percent of total billed charges 3718 93 3011.58 percent of total billed charges 3718 3718 other OPPS APC 3718 3718 other OPPS APC 3718 27.63 1027.28 percent of total billed charges 3718 3718 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE OPTECURE CANCELLOUS CORTICAL 10 ML CHIP JAR SUP-652-00-10 CDM 270010031 LOCAL 0270 RC outpatient 6211.4 6211.4 6211.4 74 4596.44 percent of total billed charges 6211.4 93 5031.23 percent of total billed charges 6211.4 6211.4 other OPPS APC 6211.4 6211.4 other OPPS APC 6211.4 27.63 1716.21 percent of total billed charges 6211.4 6211.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE OPTECURE CANCELLOUS CORTICAL 20 ML CHIP JAR SUP-652-00-20 CDM 270010031 LOCAL 0270 RC outpatient 10088 10088 10088 74 7465.12 percent of total billed charges 10088 93 8171.28 percent of total billed charges 10088 10088 other OPPS APC 10088 10088 other OPPS APC 10088 27.63 2787.31 percent of total billed charges 10088 10088 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT INJECTABLE TRANSURETHRAL NEEDLE SUP-652200 CDM 0270 RC outpatient 61.1 61.1 61.1 74 45.21 percent of total billed charges 61.1 93 49.49 percent of total billed charges 61.1 61.1 other OPPS APC 61.1 61.1 other OPPS APC 61.1 27.63 16.88 percent of total billed charges 61.1 61.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE DEMINERALIZED BONE MATRIX SHORT L5 CM X W2.5 CM SUP-653050 CDM 270010012 LOCAL 0270 RC outpatient 3993.6 3993.6 3993.6 74 2955.26 percent of total billed charges 3993.6 93 3234.82 percent of total billed charges 3993.6 3993.6 other OPPS APC 3993.6 3993.6 other OPPS APC 3993.6 27.63 1103.43 percent of total billed charges 3993.6 3993.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIO DBM BOAT SINGLE SUP-65305001 CDM 270010012 LOCAL 0270 RC outpatient 3678.92 3678.92 3678.92 74 2722.4 percent of total billed charges 3678.92 93 2979.93 percent of total billed charges 3678.92 3678.92 other OPPS APC 3678.92 3678.92 other OPPS APC 3678.92 27.63 1016.49 percent of total billed charges 3678.92 3678.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE ALLOGRAFT DEMINERALIZED BONE MATRIX 20 ML BIO BOAT SUP-653100 CDM 270010012 LOCAL 0270 RC outpatient 6440.2 6440.2 6440.2 74 4765.75 percent of total billed charges 6440.2 93 5216.56 percent of total billed charges 6440.2 6440.2 other OPPS APC 6440.2 6440.2 other OPPS APC 6440.2 27.63 1779.43 percent of total billed charges 6440.2 6440.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET IRRIGATION L77 IN ID.241 IN BLADDER GRAVITY FLOW LARGE BORE NONVENT PIERCING PIN SIGHT CHAMBER STERILE LATEX FREE CYSTOSCOPY SUP-654401 CDM 0270 RC outpatient 17.7 17.7 17.7 74 13.1 percent of total billed charges 17.7 93 14.34 percent of total billed charges 17.7 17.7 other OPPS APC 17.7 17.7 other OPPS APC 17.7 27.63 4.89 percent of total billed charges 17.7 17.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANISTER SUCTION MEDI-VAC GUARDIAN 90 D 2000 ML LOCK LID OVERFLOW SHUTOFF VALVE POUR SPOUT FILTER LATEX FREE DISPOSABLE SUP-65651-220 CDM 270009176 LOCAL 0270 RC outpatient 3 3 3 74 2.22 percent of total billed charges 3 93 2.43 percent of total billed charges 3 3 other OPPS APC 3 3 other OPPS APC 3 27.63 0.83 percent of total billed charges 3 3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANISTER SUCTION MEDI-VAC GUARDIAN 90D 3000ML DISPOSABLE LF SHUT OFF VALVE POUR SPOUT SUP-65651-230 CDM 270009176 LOCAL 0270 RC outpatient 3 3 3 74 2.22 percent of total billed charges 3 93 2.43 percent of total billed charges 3 3 other OPPS APC 3 3 other OPPS APC 3 27.63 0.83 percent of total billed charges 3 3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANISTER SUCTION MEDI-VAC PLASTIC STANDARD L9 IN ID3/8- IN SPECIMEN CONVERTER SOCK HARDWARE MALE PORT RETAINER NONSTERILE LATEX FREE DISPOSABLE SUP-65652-122 CDM 0270 RC outpatient 3.17 3.17 3.17 74 2.35 percent of total billed charges 3.17 93 2.57 percent of total billed charges 3.17 3.17 other OPPS APC 3.17 3.17 other OPPS APC 3.17 27.63 0.88 percent of total billed charges 3.17 3.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL -4MM OFFSET TAPER 28MM HIP BIOLOX DELTA V40 SUP-6570-0-028 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 BIOLOX DELTA -4 MM OFFSET TAPER OD32 MM HIP SUP-6570-0-032 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 BIOLOX DELTA -5 MM OFFSET TAPER OD36 MM HIP SUP-6570-0-036 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL 0MM OFFSET TAPER 28MM HIP BIOLOX DELTA V40 SUP-6570-0-128 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 BIOLOX DELTA 0 MM OFFSET TAPER OD32 MM HIP SUP-6570-0-132 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 BIOLOX DELTA 0 MM OFFSET TAPER OD36 MM HIP SUP-6570-0-136 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 BIOLOX DELTA +4 MM OFFSET TAPER OD28 MM HIP SUP-6570-0-228 CDM 270010024 LOCAL 0270 RC outpatient 3498.3 3498.3 3498.3 74 2588.74 percent of total billed charges 3498.3 93 2833.62 percent of total billed charges 3498.3 3498.3 other OPPS APC 3498.3 3498.3 other OPPS APC 3498.3 27.63 966.58 percent of total billed charges 3498.3 3498.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 BIOLOX DELTA +4 MM OFFSET TAPER OD32 MM HIP SUP-6570-0-232 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 BIOLOX DELTA +5 MM OFFSET TAPER OD36 MM HIP SUP-6570-0-236 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 BIOLOX DELTA -2.7 MM OFFSET TAPER OD28 MM HIP STERILE SUP-6570-0-328 CDM 270010024 LOCAL 0270 RC outpatient 3498.3 3498.3 3498.3 74 2588.74 percent of total billed charges 3498.3 93 2833.62 percent of total billed charges 3498.3 3498.3 other OPPS APC 3498.3 3498.3 other OPPS APC 3498.3 27.63 966.58 percent of total billed charges 3498.3 3498.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 BIOLOX DELTA -2.5 MM OFFSET TAPER OD36 MM HIP SUP-6570-0-436 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 BIOLOX DELTA +2.5 MM OFFSET TAPER OD36 MM HIP SUP-6570-0-536 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL V40 BIOLOX DELTA +7.5 MM OFFSET TAPER OD36 MM HIP SUP-6570-0-736 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL M/L TIVANIUM TCP HA 38 MM TAPER STRAIGHT STANDARD OFFSET L117 MM OD9 MM HIP PRIMARY STERILE SUP-65771100900 CDM 270010024 LOCAL 0270 RC outpatient 12339.6 12339.6 12339.6 74 9131.3 percent of total billed charges 12339.6 93 9995.08 percent of total billed charges 12339.6 12339.6 other OPPS APC 12339.6 12339.6 other OPPS APC 12339.6 27.63 3409.43 percent of total billed charges 12339.6 12339.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIXOS 4.0X46 SUP-658046 CDM 0270 RC outpatient 1071.98 1071.98 1071.98 74 793.27 percent of total billed charges 1071.98 93 868.3 percent of total billed charges 1071.98 1071.98 other OPPS APC 1071.98 1071.98 other OPPS APC 1071.98 27.63 296.19 percent of total billed charges 1071.98 1071.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING WOUND PRIMAPORE ACRYLIC POLYESTER L8 IN X W4 IN ADHESIVE NONWOVEN HIGH ABSORBENT PAD SOFT BREATHABLE COVER SUP-66000319 CDM 0270 RC outpatient 1.97 1.97 1.97 74 1.46 percent of total billed charges 1.97 93 1.6 percent of total billed charges 1.97 1.97 other OPPS APC 1.97 1.97 other OPPS APC 1.97 27.63 0.54 percent of total billed charges 1.97 1.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM NEGATIVE PRESSURE PICO 7 L20 CM X W10 CM STERILE LATEX FREE DISPOSABLE SUP-66022002 CDM 0270 RC outpatient 214.97 214.97 214.97 74 159.08 percent of total billed charges 214.97 93 174.13 percent of total billed charges 214.97 214.97 other OPPS APC 214.97 214.97 other OPPS APC 214.97 27.63 59.4 percent of total billed charges 214.97 214.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL COROENT 8D LG CONTOUR 25X9X8MM NS LF SUP-6608925 CDM 270010020 LOCAL 0270 RC outpatient 7485.4 7485.4 7485.4 74 5539.2 percent of total billed charges 7485.4 93 6063.17 percent of total billed charges 7485.4 7485.4 other OPPS APC 7485.4 7485.4 other OPPS APC 7485.4 27.63 2068.22 percent of total billed charges 7485.4 7485.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL 3M STERI-DRAPE IOBAN PLASTIC LARGE L129 IN X W100 IN L27 IN X W12 IN 2 ANTIMICROBIAL INCISE FILM ISOLATION POUCH ADHESIVE STRIP STERILE CLEAR SUP-6619 CDM 0270 RC outpatient 52.05 52.05 52.05 74 38.52 percent of total billed charges 52.05 93 42.16 percent of total billed charges 52.05 52.05 other OPPS APC 52.05 52.05 other OPPS APC 52.05 27.63 14.38 percent of total billed charges 52.05 52.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STAND ALONE INTERBODY CAGE 6DEG SUP-6626527 CDM 270010020 LOCAL 0270 RC outpatient 7020 7020 7020 74 5194.8 percent of total billed charges 7020 93 5686.2 percent of total billed charges 7020 7020 other OPPS APC 7020 7020 other OPPS APC 7020 27.63 1939.63 percent of total billed charges 7020 7020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WRENCH PACEMAKER 2 BIDRECTIONAL TORQUE STERILE SUP-6628 CDM 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON MULTIPASS NYLON 4-0 PS-2 L18 IN MONOFILAMENT BLACK SUP-662H CDM 0270 RC outpatient 4.22 4.22 4.22 74 3.12 percent of total billed charges 4.22 93 3.42 percent of total billed charges 4.22 4.22 other OPPS APC 4.22 4.22 other OPPS APC 4.22 27.63 1.17 percent of total billed charges 4.22 4.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 0 D D ECCENTRIC ID32 MM HIP SUP-663-00-32D CDM 270010024 LOCAL 0270 RC outpatient 3894.8 3894.8 3894.8 74 2882.15 percent of total billed charges 3894.8 93 3154.79 percent of total billed charges 3894.8 3894.8 other OPPS APC 3894.8 3894.8 other OPPS APC 3894.8 27.63 1076.13 percent of total billed charges 3894.8 3894.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 0 D E ECCENTRIC ID32 MM HIP SUP-663-00-32E CDM 270010024 LOCAL 0270 RC outpatient 3894.8 3894.8 3894.8 74 2882.15 percent of total billed charges 3894.8 93 3154.79 percent of total billed charges 3894.8 3894.8 other OPPS APC 3894.8 3894.8 other OPPS APC 3894.8 27.63 1076.13 percent of total billed charges 3894.8 3894.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 0 D F ECCENTRIC ID32 MM HIP SUP-663-00-32F CDM 270010024 LOCAL 0270 RC outpatient 3894.8 3894.8 3894.8 74 2882.15 percent of total billed charges 3894.8 93 3154.79 percent of total billed charges 3894.8 3894.8 other OPPS APC 3894.8 3894.8 other OPPS APC 3894.8 27.63 1076.13 percent of total billed charges 3894.8 3894.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 0 D G ECCENTRIC ID32 MM HIP SUP-663-00-32G CDM 270010024 LOCAL 0270 RC outpatient 3894.8 3894.8 3894.8 74 2882.15 percent of total billed charges 3894.8 93 3154.79 percent of total billed charges 3894.8 3894.8 other OPPS APC 3894.8 3894.8 other OPPS APC 3894.8 27.63 1076.13 percent of total billed charges 3894.8 3894.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 0 D H ECCENTRIC ID32 MM HIP SUP-663-00-32H CDM 270010024 LOCAL 0270 RC outpatient 3894.8 3894.8 3894.8 74 2882.15 percent of total billed charges 3894.8 93 3154.79 percent of total billed charges 3894.8 3894.8 other OPPS APC 3894.8 3894.8 other OPPS APC 3894.8 27.63 1076.13 percent of total billed charges 3894.8 3894.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 0 D I ECCENTRIC ID32 MM HIP SUP-663-00-32I CDM 270010024 LOCAL 0270 RC outpatient 3894.8 3894.8 3894.8 74 2882.15 percent of total billed charges 3894.8 93 3154.79 percent of total billed charges 3894.8 3894.8 other OPPS APC 3894.8 3894.8 other OPPS APC 3894.8 27.63 1076.13 percent of total billed charges 3894.8 3894.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 0 D E ECCENTRIC ID36 MM HIP SUP-663-00-36E CDM 270010024 LOCAL 0270 RC outpatient 4161.3 4161.3 4161.3 74 3079.36 percent of total billed charges 4161.3 93 3370.65 percent of total billed charges 4161.3 4161.3 other OPPS APC 4161.3 4161.3 other OPPS APC 4161.3 27.63 1149.77 percent of total billed charges 4161.3 4161.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 0 D F ECCENTRIC ID36 MM HIP SUP-663-00-36F CDM 270010024 LOCAL 0270 RC outpatient 4161.3 4161.3 4161.3 74 3079.36 percent of total billed charges 4161.3 93 3370.65 percent of total billed charges 4161.3 4161.3 other OPPS APC 4161.3 4161.3 other OPPS APC 4161.3 27.63 1149.77 percent of total billed charges 4161.3 4161.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 0 D G ECCENTRIC ID36 MM HIP SUP-663-00-36G CDM 270010024 LOCAL 0270 RC outpatient 4161.3 4161.3 4161.3 74 3079.36 percent of total billed charges 4161.3 93 3370.65 percent of total billed charges 4161.3 4161.3 other OPPS APC 4161.3 4161.3 other OPPS APC 4161.3 27.63 1149.77 percent of total billed charges 4161.3 4161.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 0 D H ECCENTRIC ID36 MM HIP SUP-663-00-36H CDM 270010024 LOCAL 0270 RC outpatient 4161.3 4161.3 4161.3 74 3079.36 percent of total billed charges 4161.3 93 3370.65 percent of total billed charges 4161.3 4161.3 other OPPS APC 4161.3 4161.3 other OPPS APC 4161.3 27.63 1149.77 percent of total billed charges 4161.3 4161.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 0 D I ECCENTRIC ID36 MM HIP SUP-663-00-36I CDM 270010024 LOCAL 0270 RC outpatient 4161.3 4161.3 4161.3 74 3079.36 percent of total billed charges 4161.3 93 3370.65 percent of total billed charges 4161.3 4161.3 other OPPS APC 4161.3 4161.3 other OPPS APC 4161.3 27.63 1149.77 percent of total billed charges 4161.3 4161.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 0 D J ECCENTRIC ID36 MM HIP SUP-663-00-36J CDM 270010024 LOCAL 0270 RC outpatient 4161.3 4161.3 4161.3 74 3079.36 percent of total billed charges 4161.3 93 3370.65 percent of total billed charges 4161.3 4161.3 other OPPS APC 4161.3 4161.3 other OPPS APC 4161.3 27.63 1149.77 percent of total billed charges 4161.3 4161.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 10 D D ECCENTRIC ID32 MM HIP SUP-663-10-32D CDM 270010024 LOCAL 0270 RC outpatient 3864.9 3864.9 3864.9 74 2860.03 percent of total billed charges 3864.9 93 3130.57 percent of total billed charges 3864.9 3864.9 other OPPS APC 3864.9 3864.9 other OPPS APC 3864.9 27.63 1067.87 percent of total billed charges 3864.9 3864.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 10 D E ID32 MM HIP ECCENTRIC SUP-663-10-32E CDM 270010024 LOCAL 0270 RC outpatient 3864.9 3864.9 3864.9 74 2860.03 percent of total billed charges 3864.9 93 3130.57 percent of total billed charges 3864.9 3864.9 other OPPS APC 3864.9 3864.9 other OPPS APC 3864.9 27.63 1067.87 percent of total billed charges 3864.9 3864.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 10 D F ECCENTRIC ID32 MM HIP SUP-663-10-32F CDM 270010024 LOCAL 0270 RC outpatient 3864.9 3864.9 3864.9 74 2860.03 percent of total billed charges 3864.9 93 3130.57 percent of total billed charges 3864.9 3864.9 other OPPS APC 3864.9 3864.9 other OPPS APC 3864.9 27.63 1067.87 percent of total billed charges 3864.9 3864.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 10 D G ECCENTRIC ID32 MM HIP SUP-663-10-32G CDM 270010024 LOCAL 0270 RC outpatient 3864.9 3864.9 3864.9 74 2860.03 percent of total billed charges 3864.9 93 3130.57 percent of total billed charges 3864.9 3864.9 other OPPS APC 3864.9 3864.9 other OPPS APC 3864.9 27.63 1067.87 percent of total billed charges 3864.9 3864.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 10 D H ECCENTRIC ID32 MM HIP SUP-663-10-32H CDM 270010024 LOCAL 0270 RC outpatient 3864.9 3864.9 3864.9 74 2860.03 percent of total billed charges 3864.9 93 3130.57 percent of total billed charges 3864.9 3864.9 other OPPS APC 3864.9 3864.9 other OPPS APC 3864.9 27.63 1067.87 percent of total billed charges 3864.9 3864.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 10 D I ECCENTRIC ID32 MM HIP SUP-663-10-32I CDM 270010024 LOCAL 0270 RC outpatient 3864.9 3864.9 3864.9 74 2860.03 percent of total billed charges 3864.9 93 3130.57 percent of total billed charges 3864.9 3864.9 other OPPS APC 3864.9 3864.9 other OPPS APC 3864.9 27.63 1067.87 percent of total billed charges 3864.9 3864.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 10 D E ECCENTRIC ID36 MM HIP SUP-663-10-36E CDM 270010024 LOCAL 0270 RC outpatient 4128.8 4128.8 4128.8 74 3055.31 percent of total billed charges 4128.8 93 3344.33 percent of total billed charges 4128.8 4128.8 other OPPS APC 4128.8 4128.8 other OPPS APC 4128.8 27.63 1140.79 percent of total billed charges 4128.8 4128.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 10 D F ECCENTRIC ID36 MM HIP SUP-663-10-36F CDM 270010024 LOCAL 0270 RC outpatient 4128.8 4128.8 4128.8 74 3055.31 percent of total billed charges 4128.8 93 3344.33 percent of total billed charges 4128.8 4128.8 other OPPS APC 4128.8 4128.8 other OPPS APC 4128.8 27.63 1140.79 percent of total billed charges 4128.8 4128.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 10 D G ECCENTRIC ID36 MM HIP SUP-663-10-36G CDM 270010024 LOCAL 0270 RC outpatient 4128.8 4128.8 4128.8 74 3055.31 percent of total billed charges 4128.8 93 3344.33 percent of total billed charges 4128.8 4128.8 other OPPS APC 4128.8 4128.8 other OPPS APC 4128.8 27.63 1140.79 percent of total billed charges 4128.8 4128.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 10 D H ECCENTRIC ID36 MM HIP SUP-663-10-36H CDM 270010024 LOCAL 0270 RC outpatient 4128.8 4128.8 4128.8 74 3055.31 percent of total billed charges 4128.8 93 3344.33 percent of total billed charges 4128.8 4128.8 other OPPS APC 4128.8 4128.8 other OPPS APC 4128.8 27.63 1140.79 percent of total billed charges 4128.8 4128.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 10 D I ECCENTRIC ID36 MM HIP SUP-663-10-36I CDM 270010024 LOCAL 0270 RC outpatient 4128.8 4128.8 4128.8 74 3055.31 percent of total billed charges 4128.8 93 3344.33 percent of total billed charges 4128.8 4128.8 other OPPS APC 4128.8 4128.8 other OPPS APC 4128.8 27.63 1140.79 percent of total billed charges 4128.8 4128.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 10 D J ECCENTRIC ID36 MM HIP SUP-663-10-36J CDM 270010024 LOCAL 0270 RC outpatient 4128.8 4128.8 4128.8 74 3055.31 percent of total billed charges 4128.8 93 3344.33 percent of total billed charges 4128.8 4128.8 other OPPS APC 4128.8 4128.8 other OPPS APC 4128.8 27.63 1140.79 percent of total billed charges 4128.8 4128.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON 2-0 FS L18 IN MONOFILAMENT BLACK SUP-664H CDM 0270 RC outpatient 4.62 4.62 4.62 74 3.42 percent of total billed charges 4.62 93 3.74 percent of total billed charges 4.62 4.62 other OPPS APC 4.62 4.62 other OPPS APC 4.62 27.63 1.28 percent of total billed charges 4.62 4.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE TRANSPARENT 3M IOBAN 2 23X17IN FABRIC STERILE INCISE ANTIMICROBIAL SUP-6650EZ CDM 0270 RC outpatient 12.19 12.19 12.19 74 9.02 percent of total billed charges 12.19 93 9.87 percent of total billed charges 12.19 12.19 other OPPS APC 12.19 12.19 other OPPS APC 12.19 27.63 3.37 percent of total billed charges 12.19 12.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE TRANSPARENT 3M IOBAN 2 POLYETHYLENE XL L33 IN X W23 IN 2 ANTIMICROBIAL INCISE FILM IMPREGNATE SUP-6651EZ CDM 0270 RC outpatient 24.46 24.46 24.46 74 18.1 percent of total billed charges 24.46 93 19.81 percent of total billed charges 24.46 24.46 other OPPS APC 24.46 24.46 other OPPS APC 24.46 27.63 6.76 percent of total billed charges 24.46 24.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING TRANSPARENT OPSITE HYDROCELLULAR FOAM L25 CM X W10 CM POSTOPERATIVE VISIBLE BACTERIA PROOF ABSORBENT PAD ADHERENT SUP-66800139 CDM 0270 RC outpatient 13.57 13.57 13.57 74 10.04 percent of total billed charges 13.57 93 10.99 percent of total billed charges 13.57 13.57 other OPPS APC 13.57 13.57 other OPPS APC 13.57 27.63 3.75 percent of total billed charges 13.57 13.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOAM PORT LARGE RENASYS SUP-66800641 CDM 0270 RC outpatient 135.12 135.12 135.12 74 99.99 percent of total billed charges 135.12 93 109.45 percent of total billed charges 135.12 135.12 other OPPS APC 135.12 135.12 other OPPS APC 135.12 27.63 37.33 percent of total billed charges 135.12 135.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIGH OUTPUT FISTULA KIT - RENASYS WOUND VAC SUP-66800932 CDM 0270 RC outpatient 179.4 179.4 179.4 74 132.76 percent of total billed charges 179.4 93 145.31 percent of total billed charges 179.4 179.4 other OPPS APC 179.4 179.4 other OPPS APC 179.4 27.63 49.57 percent of total billed charges 179.4 179.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ETHILON MONO 3-0BLK SUP-669H CDM 0270 RC outpatient 4.32 4.32 4.32 74 3.2 percent of total billed charges 4.32 93 3.5 percent of total billed charges 4.32 4.32 other OPPS APC 4.32 4.32 other OPPS APC 4.32 27.63 1.19 percent of total billed charges 4.32 4.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPONGE SURGICAL UNIQCOT RAYON L1/4 IN X W1/4 IN RADIOPAQUE PATTY STERILE SUP-67-02 CDM outpatient 8.59 8.59 8.59 8.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPONGE SURGICAL UNIQCOT RAYON L1/2 IN X W1/2 IN RADIOPAQUE PATTY STERILE SUP-67-06 CDM 0270 RC outpatient 4.61 4.61 4.61 74 3.41 percent of total billed charges 4.61 93 3.73 percent of total billed charges 4.61 4.61 other OPPS APC 4.61 4.61 other OPPS APC 4.61 27.63 1.27 percent of total billed charges 4.61 4.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPONGE SURGICAL UNIQCOT RAYON THIN L1 1/2 IN X W1/2 IN PATTY STERILE SUP-67-08 CDM outpatient 4.61 4.61 4.61 4.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPONGE SURGICAL UNIQCOT RAYON THIN L3 IN X W1/2 IN PATTY RADIOPAQUE STERILE SUP-67-09 CDM outpatient 4.61 4.61 4.61 4.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS SURGICAL SKLAR HARTMANN ALLIGATOR STAINLESS STEEL L3 1/2 IN EAR SERRATE TIP STRAIGHT JAW ANGLE SHANK NONSTERILE REUSABLE MYRINGOTOMY SUP-67-1035 CDM 0270 RC outpatient 410.28 410.28 410.28 74 303.61 percent of total billed charges 410.28 93 332.33 percent of total billed charges 410.28 410.28 other OPPS APC 410.28 410.28 other OPPS APC 410.28 27.63 113.36 percent of total billed charges 410.28 410.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPONGE SURGICAL UNIQCOT RAYON .55 MM THIN L1 IN X W1 IN LOW ADHESION PROFILE STRONG RADIOPAQUE STERILE SUP-67-12 CDM 0270 RC outpatient 4.61 4.61 4.61 74 3.41 percent of total billed charges 4.61 93 3.73 percent of total billed charges 4.61 4.61 other OPPS APC 4.61 4.61 other OPPS APC 4.61 27.63 1.27 percent of total billed charges 4.61 4.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPONGE SURGICAL UNIQCOT RAYON L3 IN X W1 IN RADIOPAQUE PATTY STERILE SUP-67-13 CDM outpatient 4.61 4.61 4.61 4.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING RDC1 VISTA BRITE TIP 55CM X 6FR SUP-670-210-55 CDM 0481 RC outpatient 145.6 145.6 145.6 74 107.74 percent of total billed charges 145.6 93 117.94 percent of total billed charges 145.6 145.6 other OPPS APC 145.6 145.6 other OPPS APC 145.6 51 74.26 percent of total billed charges 145.6 145.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE BULB DOVER 60 CC PROTECTOR CAP STERILE SUP-67000 CDM 0270 RC outpatient 3.51 3.51 3.51 74 2.6 percent of total billed charges 3.51 93 2.84 percent of total billed charges 3.51 3.51 other OPPS APC 3.51 3.51 other OPPS APC 3.51 27.63 0.97 percent of total billed charges 3.51 3.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN STAINLESS STEEL PTFE NYLON STANDARD JUDKINS LEFT CORONARY 3.5 CURVE L100 CM L.1 IN OD6 FR ID.07 IN HYBRID BRAID MULTISEGMENT RADIOPAQUE BLUE YELLOW SUP-67000200 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F VISTA GUIDE JL 3.5 S/H SUP-67000300 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F VISTA GUIDE JL 4 SUP-67000400 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F VISTA GUIDE JL 4 S/H SUP-67000500 CDM 0481 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 51 58.34 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F VISTA GUIDE JL 4.5 SUP-67000600 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F VISTA GUIDE JL 5 SUP-67000800 CDM 0481 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 51 58.34 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN STAINLESS STEEL NYLON PTFE AMPLATZ LEFT CORONARY 1 CURVE L100 CM L.1 IN OD6 FR ID.07 IN RADIOPAQUE HYBRID BRAID MULTISEGMENT TORQUE CONTROL DISPOSABLE BLUE YELLOW SUP-67003600 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F VISTA GUIDE AL 1 S/H SUP-67003700 CDM 0481 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 51 58.34 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F VISTA GUIDE AL 2 SUP-67004000 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F VISTA GUIDE AL 2 S/H SUP-67004100 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F VISTA GUIDE AL 3 SUP-67004200 CDM 0481 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 51 58.34 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN XBACKUP 3 CURVE 100CM .1IN 6FR .07IN BLUE YELLOW SS NYLON PTFE DISPOSABLE SUP-67005200 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN STAINLESS STEEL PTFE NYLON EXTRA BACKUP 3 CURVE L100 CM L.1 IN OD6 FR ID.07 IN SIDEHOLE RADIOPAQUE HYBRID BRAID MULTISEGMENT BLUE YELLOW SUP-67005300 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN EXTRA BACKUP 3.5 CURVE 100CM .1IN 6FR .07IN BLUE YELLOW SS PTFE NYLON SUP-67005400 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN STAINLESS STEEL PTFE NYLON EXTRA BACKUP 3.5 CURVE L100 CM L.1 IN OD6 FR ID.07 IN PERIPHERAL SIDEHOLE RADIOPAQUE HYBRID BRAID MULTISEGMENT DISPOSABLE BLUE YELLOW SUP-67005500 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN STAINLESS STEEL PTFE NYLON EXTRA BACKUP 4 CURVE L100 CM L.1 IN OD6 FR ID.07 IN RADIOPAQUE HYBRID BRAID MULTISEGMENT TORQUE CONTROL DISPOSABLE BLUE YELLOW SUP-67005600 CDM 0481 RC outpatient 128.7 128.7 128.7 74 95.24 percent of total billed charges 128.7 93 104.25 percent of total billed charges 128.7 128.7 other OPPS APC 128.7 128.7 other OPPS APC 128.7 51 65.64 percent of total billed charges 128.7 128.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN STANDARD EXTRA BACK-UP LEFT ANTERIOR DESCEND CORONARY 3.5 CURVE 100CM .1IN 6 SUP-67006000 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN REGULAR XBLAD4 CURVE 100CM .1IN 6FR .07IN BLUE YELLOW SS NYLON PTFE SUP-67006200 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F VISTA GUIDE JR 3.5 SUP-67008000 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F VISTA GUIDE JR 3.5 S/H SUP-67008100 CDM 0481 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 51 58.34 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN STAINLESS STEEL PTFE NYLON JUDKINS RIGHT 4 CURVE L100 CM L.1 IN OD6 FR ID.07 IN RADIOPAQUE HYBRID BRAID MULTISEGMENT TORQUE CONTROL DISPOSABLE BLUE YELLOW SUP-67008200 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN STAINLESS STEEL PTFE NYLON STANDARD JUDKINS RIGHT CORONARY 4 CURVE L100 CM L.1 IN OD6 FR ID.07 IN 2 SIDEHOLE HYBRID BRAID MULTISEGMENT RADIOPAQUE BLUE YELLOW SUP-67008300 CDM 0481 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 51 58.34 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN STAINLESS STEEL PTFE NYLON AMPLATZ RIGHT 1 CURVE L100 CM L.1 IN OD6 FR ID.07 IN PERIPHERAL RADIOPAQUE HYBRID BRAID MULTISEGMENT TORQUE CONTROL DISPOSABLE BLUE YELLOW SUP-67011000 CDM 0481 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 51 58.34 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F VISTA GUIDE AR 1 S/H SUP-67011100 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN STAINLESS STEEL PTFE NYLON AMPLATZ RIGHT 2 CURVE L100 CM L.1 IN OD6 FR ID.07 IN PERIPHERAL RADIOPAQUE HYBRID BRAID MULTISEGMENT TORQUE CONTROL DISPOSABLE BLUE YELLOW SUP-67011200 CDM 0481 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 51 58.34 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN STAINLESS STEEL PTFE NYLON AMPLATZ RIGHT CORONARY 2 CURVE L100 CM L.1 IN OD6 FR ID.07 IN PERIPHERAL SIDEHOLE RADIOPAQUE HYBRID BRAID MULTISEGMENT DISPOSABLE BLUE YELLOW SUP-67011300 CDM 0481 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 51 58.34 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F VISTA GUIDE XB RCA SUP-67012400 CDM 0481 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 51 58.34 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN STAINLESS STEEL PTFE NYLON LEFT CORONARY BYPASS CURVE L100 CM L.1 IN OD6 FR ID.07 IN PERIPHERAL RADIOPAQUE HYBRID BRAID MULTISEGMENT TORQUE CONTROL DISPOSABLE BLUE YELLOW SUP-67018000 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6FR RCB VISTA GUIDE SUP-67018200 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN STAINLESS STEEL PTFE NYLON REGULAR INTERNAL MAMMARY CURVE L100 CM L.1 IN OD6 FR ID.07 IN HYBRID BRAID MULTISEGMENT RADIOPAQUE BLUE YELLOW SUP-67019000 CDM 0481 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 51 58.34 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE SILVERGLIDE BIPOLAR SUP-6702-000-000 CDM 0270 RC outpatient 12.47 12.47 12.47 74 9.23 percent of total billed charges 12.47 93 10.1 percent of total billed charges 12.47 12.47 other OPPS APC 12.47 12.47 other OPPS APC 12.47 27.63 3.45 percent of total billed charges 12.47 12.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING ENVOY STAINLESS STEEL NYLON POLYURETHANE PTFE MULTIPURPSE C CURVE L 90CM OD 6FR ID .07IN CORONARY NEUROVASCULAR BRAID RADIOPAQUE MULTISEGMENT SUP-67025690 CDM 0270 RC outpatient 1361.52 1361.52 1361.52 74 1007.52 percent of total billed charges 1361.52 93 1102.83 percent of total billed charges 1361.52 1361.52 other OPPS APC 1361.52 1361.52 other OPPS APC 1361.52 27.63 376.19 percent of total billed charges 1361.52 1361.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING ENVOY XB STAINLESS STEEL NYLON POLYURETHANE PTFE MULTIPURPSE D CURVE L 100CM OD 6FR ID .07IN CORONARY NEUROVASCULAR PERIPHERAL BRAID RADIOPAQUE MULTISEGMENT SUP-67025800B CDM 0270 RC outpatient 1100.53 1100.53 1100.53 74 814.39 percent of total billed charges 1100.53 93 891.43 percent of total billed charges 1100.53 1100.53 other OPPS APC 1100.53 1100.53 other OPPS APC 1100.53 27.63 304.08 percent of total billed charges 1100.53 1100.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING ENVOY XB STAINLESS STEEL NYLON POLYURETHANE PTFE EXTRA BACKUP MULTIPURPOSE D CURVE L 90CM OD 6FR ID .07IN CORONARY NEUROVASCULAR PERIPHERAL BRAID RADIOPAQUE MULTISEGMENT SUP-67025890B CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F VISTA GUIDE MPA 1 SUP-67027000 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F VISTA GUIDE MPA 1 S/H SUP-67027100 CDM 0481 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 51 58.34 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F VISTA GUIDE H-STICK SUP-67027800 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F VISTA GUIDE H-STICK S/H SUP-67027900 CDM 0481 RC outpatient 113.1 113.1 113.1 74 83.69 percent of total billed charges 113.1 93 91.61 percent of total billed charges 113.1 113.1 other OPPS APC 113.1 113.1 other OPPS APC 113.1 51 57.68 percent of total billed charges 113.1 113.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING VISTA BRITE TIP TRUELUMEN STAINLESS STEEL PTFE NYLON STRAIGHT CURVE L90 CM L.1 IN OD6 FR ID.07 IN PERIPHERAL RADIOPAQUE HYBRID BRAID MULTISEGMENT TORQUE CONTROL DISPOSABLE BLUE YELLOW SUP-67028090 CDM 0481 RC outpatient 205.66 205.66 205.66 74 152.19 percent of total billed charges 205.66 93 166.58 percent of total billed charges 205.66 205.66 other OPPS APC 205.66 205.66 other OPPS APC 205.66 51 104.89 percent of total billed charges 205.66 205.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE/SLEEVE ORTHOPEDIC DALL-MILES 1.6MM DISPOSABLE STERILE LF SET BEAD SUP-6704-0-420 CDM 0270 RC outpatient 845.52 845.52 845.52 74 625.68 percent of total billed charges 845.52 93 684.87 percent of total billed charges 845.52 845.52 other OPPS APC 845.52 845.52 other OPPS APC 845.52 27.63 233.62 percent of total billed charges 845.52 845.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET DALL-MILES CABLE & SLEEVE USE 17984 SUP-6704-0-420 CDM 270010024 LOCAL 0270 RC outpatient 817.7 817.7 817.7 74 605.1 percent of total billed charges 817.7 93 662.34 percent of total billed charges 817.7 817.7 other OPPS APC 817.7 817.7 other OPPS APC 817.7 27.63 225.93 percent of total billed charges 817.7 817.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE/SLEEVE ORTHOPEDIC DALL-MILES VITALLIUM OD2 MM HIP SET SUP-6704-0-520 CDM 0270 RC outpatient 845.52 845.52 845.52 74 625.68 percent of total billed charges 845.52 93 684.87 percent of total billed charges 845.52 845.52 other OPPS APC 845.52 845.52 other OPPS APC 845.52 27.63 233.62 percent of total billed charges 845.52 845.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRIP CABLE DALL-MILES VITALLIUM 2 MM MEDIUM OD2 MM HIP TROCHANTER SUP-6704-3-080 CDM 0270 RC outpatient 2688.66 2688.66 2688.66 74 1989.61 percent of total billed charges 2688.66 93 2177.81 percent of total billed charges 2688.66 2688.66 other OPPS APC 2688.66 2688.66 other OPPS APC 2688.66 27.63 742.88 percent of total billed charges 2688.66 2688.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DALL-MILES VITALLIUM 2 MM MEDIUM L100 MM HIP TROCHANTERIC 2 CABLE GRIP STERILE SUP-6704-3-081 CDM 0270 RC outpatient 3504.15 3504.15 3504.15 74 2593.07 percent of total billed charges 3504.15 93 2838.36 percent of total billed charges 3504.15 3504.15 other OPPS APC 3504.15 3504.15 other OPPS APC 3504.15 27.63 968.2 percent of total billed charges 3504.15 3504.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DALL-MILES VITALLIUM 2 MM MEDIUM L150 MM HIP TROCHANTER 2 CABLE GRIP SUP-6704-3-082 CDM 0270 RC outpatient 3671.2 3671.2 3671.2 74 2716.69 percent of total billed charges 3671.2 93 2973.67 percent of total billed charges 3671.2 3671.2 other OPPS APC 3671.2 3671.2 other OPPS APC 3671.2 27.63 1014.35 percent of total billed charges 3671.2 3671.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DALL-MILES VITALLIUM 2 MM MEDIUM L200 MM HIP TROCHANTERIC 2 CABLE GRIP STERILE SUP-6704-3-083 CDM 0270 RC outpatient 4180.8 4180.8 4180.8 74 3093.79 percent of total billed charges 4180.8 93 3386.45 percent of total billed charges 4180.8 4180.8 other OPPS APC 4180.8 4180.8 other OPPS APC 4180.8 27.63 1155.16 percent of total billed charges 4180.8 4180.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRIP CABLE DALL-MILES VITALLIUM SMALL OD1.6 MM HIP SUP-6704-5-016 CDM 0270 RC outpatient 1361.36 1361.36 1361.36 74 1007.41 percent of total billed charges 1361.36 93 1102.7 percent of total billed charges 1361.36 1361.36 other OPPS APC 1361.36 1361.36 other OPPS APC 1361.36 27.63 376.14 percent of total billed charges 1361.36 1361.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRIP CABLE DALL-MILES VITALLIUM MEDIUM OD2 MM HIP SUP-6704-6-020 CDM 0270 RC outpatient 1361.36 1361.36 1361.36 74 1007.41 percent of total billed charges 1361.36 93 1102.7 percent of total billed charges 1361.36 1361.36 other OPPS APC 1361.36 1361.36 other OPPS APC 1361.36 27.63 376.14 percent of total billed charges 1361.36 1361.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING ENVOY BRITE TIP HYDROPHILIC MULTIPURPOSE D CURVE L105CM L8CM OD 6FR ID .071IN DISTAL ACCESS SOFT TIP LARGE LUMEN EXTRA BACKUP SUPPORT SUP-67125805DB CDM 0270 RC outpatient 2448.47 2448.47 2448.47 74 1811.87 percent of total billed charges 2448.47 93 1983.26 percent of total billed charges 2448.47 2448.47 other OPPS APC 2448.47 2448.47 other OPPS APC 2448.47 27.63 676.51 percent of total billed charges 2448.47 2448.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING ENVOY STRAIGHT L 95CM OD 6FR DISTAL ACCESS SUP-67126095D CDM 0270 RC outpatient 1829.88 1829.88 1829.88 74 1354.11 percent of total billed charges 1829.88 93 1482.2 percent of total billed charges 1829.88 1829.88 other OPPS APC 1829.88 1829.88 other OPPS APC 1829.88 27.63 505.6 percent of total billed charges 1829.88 1829.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE GAUZE KERLIX LG 4 1/8YDX4.5IN COTTON STERILE LF 6 PLY ABSORBENT SOFT POUCH LINT FREE SUP-6715 CDM 0270 RC outpatient 1.79 1.79 1.79 74 1.32 percent of total billed charges 1.79 93 1.45 percent of total billed charges 1.79 1.79 other OPPS APC 1.79 1.79 other OPPS APC 1.79 27.63 0.49 percent of total billed charges 1.79 1.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT FEMORAL STEM ACCOLADE 132 DEG SIZE 0 SUP-6720-0027 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT FEMORAL STEM ACCOLADE 132 DEG SIZE 1 SUP-6720-0127 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE II V40 PUREFIX TITANIUM PLASMA SPRAY 132 D 2 33 MM OFFSET L99 MM L30 MM HIP SUP-6720-0230 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE 132D 3 TAPER 102MM 30MM STERILE HIP MODULAR SUP-6720-0330 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE 132D 4 TAPER 105MM 35MM STERILE HIP MODULAR SUP-6720-0435 CDM 270010025 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE 132D 5 TAPER 108MM 35MM STERILE HIP MODULAR SUP-6720-0535 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE 132D 6 TAPER 111MM 35MM STERILE HIP MODULAR SUP-6720-0635 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE 132D 7 TAPER 114MM 37MM STERILE HIP MODULAR SUP-6720-0737 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT FEMORAL STEM ACCOLADE 132 DEG SIZE 8 SUP-6720-0837 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT FEMORAL STEM ACCOLADE 132 DEG SIZE 9 49MM SUP-6720-0937 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT FEMORAL STEM ACCOLADE 132 DEG SIZE 10 51MM SUP-6720-1040 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT FEMORAL STEM ACCOLADE 132 DEG SIZE 11 53MM SUP-6720-1140 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER FEMORAL STEM ACCOLADE 127DEG SIZE 0 SUP-6721-0027 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE II V40 PUREFIX TITANIUM 127 D 2 37 MM OFFSET L99 MM L30 MM HIP PRESS FIT SUP-6721-0230 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE 127D 3 TAPER 102MM 30MM STERILE HIP MODULAR SUP-6721-0330 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE 127D 4 TAPER 105MM 35MM STERILE HIP MODULAR SUP-6721-0435 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE 127D 5 TAPER 108MM 35MM STERILE HIP MODULAR SUP-6721-0535 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE 127D 6 TAPER 111MM 35MM STERILE HIP MODULAR SUP-6721-0635 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE 127D 7 TAPER 114MM 37MM STERILE HIP MODULAR SUP-6721-0737 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE 127D 8 TAPER 117MM 37MM STERILE HIP MODULAR SUP-6721-0837 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER FEMORAL STEM ACCOLADE 127DEG SIZE 9 SUP-6721-0937 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ACCOLADE II 10 127D SUP-6721-1040 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STRYKER FEMORAL STEM ACCOLADE 127DEG SIZE 11 SUP-6721-1140 CDM 270010024 LOCAL 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH EPICARDIAL DF-1 "SUP-6721M,S,L" CDM 0275 RC outpatient 2600 2600 2600 57 1482 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "FORCEPS BIPOLAR DISPOSABLE SPETZLER-MALIS 7"" .05 MM TIP" SUP-6760180005 CDM 0270 RC outpatient 1141.92 1141.92 1141.92 74 845.02 percent of total billed charges 1141.92 93 924.96 percent of total billed charges 1141.92 1141.92 other OPPS APC 1141.92 1141.92 other OPPS APC 1141.92 27.63 315.51 percent of total billed charges 1141.92 1141.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "FORCEPS BIPOLAR DISPOSABLE SPETZLER-MALIS 8"" 0.5MM TIP" SUP-676020005 CDM 0270 RC outpatient 1073.8 1073.8 1073.8 74 794.61 percent of total billed charges 1073.8 93 869.78 percent of total billed charges 1073.8 1073.8 other OPPS APC 1073.8 1073.8 other OPPS APC 1073.8 27.63 296.69 percent of total billed charges 1073.8 1073.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET IRRIGATION MALIS BIPOLAR CORD INTEGRATE TUBE ROTARY DISPOSABLE SUP-6790-100-003 CDM 0270 RC outpatient 143.7 143.7 143.7 74 106.34 percent of total billed charges 143.7 93 116.4 percent of total billed charges 143.7 143.7 other OPPS APC 143.7 143.7 other OPPS APC 143.7 27.63 39.7 percent of total billed charges 143.7 143.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE DISP W/IRRIGATION SUP-6790100001 CDM 0270 RC outpatient 138.31 138.31 138.31 74 102.35 percent of total billed charges 138.31 93 112.03 percent of total billed charges 138.31 138.31 other OPPS APC 138.31 138.31 other OPPS APC 138.31 27.63 38.22 percent of total billed charges 138.31 138.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SALINE P4.6 CM MODERATE PROFILE ROUND OD14.1 CM 480-510 ML STYLE 68MP SMOOTH ANTERIOR DIAPHRAGM VALVE STERILE SUP-68-480 CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SECUREMENT STAYFIX SMALL OD5-14 FR DRAIN CATHETER FASTENER FIXATION STERILE LATEX FREE PERCUTANEOUS CATHETER SUP-680ME CDM 0270 RC outpatient 22.75 22.75 22.75 74 16.84 percent of total billed charges 22.75 93 18.43 percent of total billed charges 22.75 22.75 other OPPS APC 22.75 22.75 other OPPS APC 22.75 27.63 6.29 percent of total billed charges 22.75 22.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY PROFILE 3D OD24 MM SUP-680R24 CDM 0270 RC outpatient 4420 4420 4420 74 3270.8 percent of total billed charges 4420 93 3580.2 percent of total billed charges 4420 4420 other OPPS APC 4420 4420 other OPPS APC 4420 27.63 1221.25 percent of total billed charges 4420 4420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY PROFILE 3D OD26 MM SUP-680R26 CDM 0270 RC outpatient 4420 4420 4420 74 3270.8 percent of total billed charges 4420 93 3580.2 percent of total billed charges 4420 4420 other OPPS APC 4420 4420 other OPPS APC 4420 27.63 1221.25 percent of total billed charges 4420 4420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY PROFILE 3D OD28 MM SUP-680R28 CDM 0270 RC outpatient 4420 4420 4420 74 3270.8 percent of total billed charges 4420 93 3580.2 percent of total billed charges 4420 4420 other OPPS APC 4420 4420 other OPPS APC 4420 27.63 1221.25 percent of total billed charges 4420 4420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY PROFILE 3D OD30 MM SUP-680R30 CDM 0270 RC outpatient 4420 4420 4420 74 3270.8 percent of total billed charges 4420 93 3580.2 percent of total billed charges 4420 4420 other OPPS APC 4420 4420 other OPPS APC 4420 27.63 1221.25 percent of total billed charges 4420 4420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY PROFILE 3D OD32 MM SUP-680R32 CDM 0270 RC outpatient 4420 4420 4420 74 3270.8 percent of total billed charges 4420 93 3580.2 percent of total billed charges 4420 4420 other OPPS APC 4420 4420 other OPPS APC 4420 27.63 1221.25 percent of total billed charges 4420 4420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY PROFILE 3D OD34 MM SUP-680R34 CDM 0270 RC outpatient 4420 4420 4420 74 3270.8 percent of total billed charges 4420 93 3580.2 percent of total billed charges 4420 4420 other OPPS APC 4420 4420 other OPPS APC 4420 27.63 1221.25 percent of total billed charges 4420 4420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY PROFILE 3D OD36 MM SUP-680R36 CDM 0270 RC outpatient 4420 4420 4420 74 3270.8 percent of total billed charges 4420 93 3580.2 percent of total billed charges 4420 4420 other OPPS APC 4420 4420 other OPPS APC 4420 27.63 1221.25 percent of total billed charges 4420 4420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY PROFILE 3D OD38 MM SUP-680R38 CDM 0270 RC outpatient 4420 4420 4420 74 3270.8 percent of total billed charges 4420 93 3580.2 percent of total billed charges 4420 4420 other OPPS APC 4420 4420 other OPPS APC 4420 27.63 1221.25 percent of total billed charges 4420 4420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY PROFILE 3D OD40 MM SUP-680R40 CDM 0270 RC outpatient 4420 4420 4420 74 3270.8 percent of total billed charges 4420 93 3580.2 percent of total billed charges 4420 4420 other OPPS APC 4420 4420 other OPPS APC 4420 27.63 1221.25 percent of total billed charges 4420 4420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOOTWEAR PATIENT PEDIATRIC TERRY IN YELLOW SUP-68125-YEL CDM 270009080 LOCAL 0270 RC outpatient 2.5 2.5 2.5 74 1.85 percent of total billed charges 2.5 93 2.03 percent of total billed charges 2.5 2.5 other OPPS APC 2.5 2.5 other OPPS APC 2.5 27.63 0.69 percent of total billed charges 2.5 2.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND SILK 4-0 FS-2 L18 IN BRAID BLACK SUP-683G CDM 0270 RC outpatient 3.92 3.92 3.92 74 2.9 percent of total billed charges 3.92 93 3.18 percent of total billed charges 3.92 3.92 other OPPS APC 3.92 3.92 other OPPS APC 3.92 27.63 1.08 percent of total billed charges 3.92 3.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE DRAINAGE STAYFIX OD12-22 FR FIXATION FASTEN SHOWERCAP PERCUTANEOUS CATHETER SUP-685ME CDM 0270 RC outpatient 22.75 22.75 22.75 74 16.84 percent of total billed charges 22.75 93 18.43 percent of total billed charges 22.75 22.75 other OPPS APC 22.75 22.75 other OPPS APC 22.75 27.63 6.29 percent of total billed charges 22.75 22.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PREMIER TITANIUM L13 MM OD4 MM SPINE CANCELLOUS SELF TAP STERILE SUP-6860013 CDM 270010020 LOCAL 0270 RC outpatient 501.57 501.57 501.57 74 371.16 percent of total billed charges 501.57 93 406.27 percent of total billed charges 501.57 501.57 other OPPS APC 501.57 501.57 other OPPS APC 501.57 27.63 138.58 percent of total billed charges 501.57 501.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PREMIER TITANIUM L14 MM OD4 MM SPINE CERVICAL CANCELLOUS ANTERIOR VARIABLE ANGLE SELF TAP STERILE SUP-6860014 CDM 270010020 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PREMIER TITANIUM L15 MM OD4 MM SPINE CERVICAL CANCELLOUS ANTERIOR VARIABLE ANGLE SELF TAP STERILE SUP-6860015 CDM 270010020 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PREMIER TITANIUM L16 MM OD4 MM SPINE CERVICAL CANCELLOUS ANTERIOR VARIABLE ANGLE SELF TAP STERILE SUP-6860016 CDM 270010020 LOCAL 0270 RC outpatient 535.81 535.81 535.81 74 396.5 percent of total billed charges 535.81 93 434.01 percent of total billed charges 535.81 535.81 other OPPS APC 535.81 535.81 other OPPS APC 535.81 27.63 148.04 percent of total billed charges 535.81 535.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PREMIER TITANIUM L17 MM OD4 MM SPINE CERVICAL CANCELLOUS ANTERIOR VARIABLE ANGLE SELF TAP STERILE SUP-6860017 CDM 270010020 LOCAL 0270 RC outpatient 535.81 535.81 535.81 74 396.5 percent of total billed charges 535.81 93 434.01 percent of total billed charges 535.81 535.81 other OPPS APC 535.81 535.81 other OPPS APC 535.81 27.63 148.04 percent of total billed charges 535.81 535.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PREMIER TITANIUM L18 MM OD4 MM SPINE CERVICAL CANCELLOUS ANTERIOR VARIABLE ANGLE SELF TAP STERILE SUP-6860018 CDM 270010020 LOCAL 0270 RC outpatient 535.81 535.81 535.81 74 396.5 percent of total billed charges 535.81 93 434.01 percent of total billed charges 535.81 535.81 other OPPS APC 535.81 535.81 other OPPS APC 535.81 27.63 148.04 percent of total billed charges 535.81 535.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PREMIER TITANIUM L13 MM OD4.5 MM SPINE CERVICAL CANCELLOUS ANTERIOR VARIABLE ANGLE SELF TAP STERILE SUP-6860053 CDM 270010020 LOCAL 0270 RC outpatient 535.81 535.81 535.81 74 396.5 percent of total billed charges 535.81 93 434.01 percent of total billed charges 535.81 535.81 other OPPS APC 535.81 535.81 other OPPS APC 535.81 27.63 148.04 percent of total billed charges 535.81 535.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PREMIER TITANIUM L15 MM OD4.5 MM SPINE CERVICAL CANCELLOUS ANTERIOR VARIABLE ANGLE SELF TAP STERILE SUP-6860055 CDM 270010020 LOCAL 0270 RC outpatient 501.57 501.57 501.57 74 371.16 percent of total billed charges 501.57 93 406.27 percent of total billed charges 501.57 501.57 other OPPS APC 501.57 501.57 other OPPS APC 501.57 27.63 138.58 percent of total billed charges 501.57 501.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PREMIER TITANIUM L17 MM OD4.5 MM SPINE CERVICAL CANCELLOUS ANTERIOR VARIABLE ANGLE SELF TAP STERILE SUP-6860057 CDM 270010020 LOCAL 0270 RC outpatient 535.81 535.81 535.81 74 396.5 percent of total billed charges 535.81 93 434.01 percent of total billed charges 535.81 535.81 other OPPS APC 535.81 535.81 other OPPS APC 535.81 27.63 148.04 percent of total billed charges 535.81 535.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PREMIER TITANIUM LORDOTIC CURVATURE L23 MM SPINE CERVICAL ANTERIOR PRECOMPRESSION SLIDE WASHER STERILE SUP-6860123 CDM 270010020 LOCAL 0270 RC outpatient 2413.74 2413.74 2413.74 74 1786.17 percent of total billed charges 2413.74 93 1955.13 percent of total billed charges 2413.74 2413.74 other OPPS APC 2413.74 2413.74 other OPPS APC 2413.74 27.63 666.92 percent of total billed charges 2413.74 2413.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PREMIER TITANIUM LORDOTIC CURVATURE L25 MM SPINE CERVICAL ANTERIOR PRECOMPRESSION SLIDE WASHER STERILE SUP-6860125 CDM 270010020 LOCAL 0270 RC outpatient 2413.74 2413.74 2413.74 74 1786.17 percent of total billed charges 2413.74 93 1955.13 percent of total billed charges 2413.74 2413.74 other OPPS APC 2413.74 2413.74 other OPPS APC 2413.74 27.63 666.92 percent of total billed charges 2413.74 2413.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PREMIER TITANIUM LORDOTIC CURVATURE L27.5 MM SPINE CERVICAL ANTERIOR PRECOMPRESSION SLIDE WASHER STERILE SUP-6860127 CDM 270010020 LOCAL 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PREMIER TITANIUM LORDOTIC CURVATURE L30 MM SPINE CERVICAL ANTERIOR PRECOMPRESSION SLIDE WASHER STERILE SUP-6860130 CDM 270010020 LOCAL 0270 RC outpatient 3325.89 3325.89 3325.89 74 2461.16 percent of total billed charges 3325.89 93 2693.97 percent of total billed charges 3325.89 3325.89 other OPPS APC 3325.89 3325.89 other OPPS APC 3325.89 27.63 918.94 percent of total billed charges 3325.89 3325.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PREMIER TITANIUM LORDOTIC CURVATURE L35 MM SPINE CERVICAL ANTERIOR PRECOMPRESSION SLIDE WASHER STERILE SUP-6860135 CDM 270010020 LOCAL 0270 RC outpatient 3590.7 3590.7 3590.7 74 2657.12 percent of total billed charges 3590.7 93 2908.47 percent of total billed charges 3590.7 3590.7 other OPPS APC 3590.7 3590.7 other OPPS APC 3590.7 27.63 992.11 percent of total billed charges 3590.7 3590.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PREMIER TITANIUM LORDOTIC CURVATURE L37.5 MM SPINE CERVICAL ANTERIOR PRECOMPRESSION SLIDE WASHER STERILE SUP-6860137 CDM 270010020 LOCAL 0270 RC outpatient 2450.6 2450.6 2450.6 74 1813.44 percent of total billed charges 2450.6 93 1984.99 percent of total billed charges 2450.6 2450.6 other OPPS APC 2450.6 2450.6 other OPPS APC 2450.6 27.63 677.1 percent of total billed charges 2450.6 2450.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PREMIER TITANIUM LORDOTIC CURVATURE L40 MM SPINE CERVICAL ANTERIOR PRECOMPRESSION SLIDE WASHER STERILE SUP-6860140 CDM 270010020 LOCAL 0270 RC outpatient 2450.6 2450.6 2450.6 74 1813.44 percent of total billed charges 2450.6 93 1984.99 percent of total billed charges 2450.6 2450.6 other OPPS APC 2450.6 2450.6 other OPPS APC 2450.6 27.63 677.1 percent of total billed charges 2450.6 2450.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PREMIER TITANIUM LORDOTIC CURVATURE L42.5 MM SPINE CERVICAL ANTERIOR PRECOMPRESSION SLIDE WASHER STERILE SUP-6860142 CDM 270010020 LOCAL 0270 RC outpatient 2450.6 2450.6 2450.6 74 1813.44 percent of total billed charges 2450.6 93 1984.99 percent of total billed charges 2450.6 2450.6 other OPPS APC 2450.6 2450.6 other OPPS APC 2450.6 27.63 677.1 percent of total billed charges 2450.6 2450.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PREMIER TITANIUM LORDOTIC CURVATURE L45 MM SPINE CERVICAL ANTERIOR PRECOMPRESSION SLIDE WASHER STERILE SUP-6860145 CDM 270010020 LOCAL 0270 RC outpatient 3590.7 3590.7 3590.7 74 2657.12 percent of total billed charges 3590.7 93 2908.47 percent of total billed charges 3590.7 3590.7 other OPPS APC 3590.7 3590.7 other OPPS APC 3590.7 27.63 992.11 percent of total billed charges 3590.7 3590.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PREMIER TITANIUM LORDOTIC CURVATURE L47.5 MM SPINE CERVICAL ANTERIOR PRECOMPRESSION SLIDE WASHER STERILE SUP-6860147 CDM 270010020 LOCAL 0270 RC outpatient 2997.8 2997.8 2997.8 74 2218.37 percent of total billed charges 2997.8 93 2428.22 percent of total billed charges 2997.8 2997.8 other OPPS APC 2997.8 2997.8 other OPPS APC 2997.8 27.63 828.29 percent of total billed charges 2997.8 2997.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PREMIER TITANIUM LORDOTIC CURVATURE L50 MM SPINE CERVICAL ANTERIOR PRECOMPRESSION SLIDE WASHER STERILE SUP-6860150 CDM 270010020 LOCAL 0270 RC outpatient 3590.7 3590.7 3590.7 74 2657.12 percent of total billed charges 3590.7 93 2908.47 percent of total billed charges 3590.7 3590.7 other OPPS APC 3590.7 3590.7 other OPPS APC 3590.7 27.63 992.11 percent of total billed charges 3590.7 3590.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PREMIER TITANIUM LORDOTIC CURVATURE L52.5 MM SPINE CERVICAL ANTERIOR PRECOMPRESSION SLIDE WASHER STERILE SUP-6860152 CDM 270010020 LOCAL 0270 RC outpatient 2578.58 2578.58 2578.58 74 1908.15 percent of total billed charges 2578.58 93 2088.65 percent of total billed charges 2578.58 2578.58 other OPPS APC 2578.58 2578.58 other OPPS APC 2578.58 27.63 712.46 percent of total billed charges 2578.58 2578.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PREMIER TITANIUM LORDOTIC CURVATURE L55 MM SPINE CERVICAL ANTERIOR PRECOMPRESSION SLIDE WASHER STERILE SUP-6860155 CDM 270010020 LOCAL 0270 RC outpatient 2578.58 2578.58 2578.58 74 1908.15 percent of total billed charges 2578.58 93 2088.65 percent of total billed charges 2578.58 2578.58 other OPPS APC 2578.58 2578.58 other OPPS APC 2578.58 27.63 712.46 percent of total billed charges 2578.58 2578.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PREMIER TITANIUM LORDOTIC CURVATURE L57.5 MM SPINE CERVICAL ANTERIOR PRECOMPRESSION SLIDE WASHER STERILE SUP-6860157 CDM 270010020 LOCAL 0270 RC outpatient 3267.47 3267.47 3267.47 74 2417.93 percent of total billed charges 3267.47 93 2646.65 percent of total billed charges 3267.47 3267.47 other OPPS APC 3267.47 3267.47 other OPPS APC 3267.47 27.63 902.8 percent of total billed charges 3267.47 3267.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PREMIER TITANIUM LORDOTIC CURVATURE L60 MM SPINE CERVICAL ANTERIOR PRECOMPRESSION SLIDE WASHER STERILE SUP-6860160 CDM 270010020 LOCAL 0270 RC outpatient 2578.58 2578.58 2578.58 74 1908.15 percent of total billed charges 2578.58 93 2088.65 percent of total billed charges 2578.58 2578.58 other OPPS APC 2578.58 2578.58 other OPPS APC 2578.58 27.63 712.46 percent of total billed charges 2578.58 2578.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PREMIER TITANIUM LORDOTIC CURVATURE L62.5 MM SPINE CERVICAL ANTERIOR PRECOMPRESSION SLIDE WASHER STERILE SUP-6860162 CDM 270010020 LOCAL 0270 RC outpatient 2578.58 2578.58 2578.58 74 1908.15 percent of total billed charges 2578.58 93 2088.65 percent of total billed charges 2578.58 2578.58 other OPPS APC 2578.58 2578.58 other OPPS APC 2578.58 27.63 712.46 percent of total billed charges 2578.58 2578.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PREMIER TITANIUM LORDOTIC CURVATURE L65 MM SPINE CERVICAL ANTERIOR PRECOMPRESSION SLIDE WASHER STERILE SUP-6860165 CDM 270010020 LOCAL 0270 RC outpatient 3268.72 3268.72 3268.72 74 2418.85 percent of total billed charges 3268.72 93 2647.66 percent of total billed charges 3268.72 3268.72 other OPPS APC 3268.72 3268.72 other OPPS APC 3268.72 27.63 903.15 percent of total billed charges 3268.72 3268.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PREMIER TITANIUM LORDOTIC CURVATURE L80 MM SPINE CERVICAL ANTERIOR PRECOMPRESSION SLIDE WASHER STERILE SUP-6860180 CDM 270010020 LOCAL 0270 RC outpatient 3503.14 3503.14 3503.14 74 2592.32 percent of total billed charges 3503.14 93 2837.54 percent of total billed charges 3503.14 3503.14 other OPPS APC 3503.14 3503.14 other OPPS APC 3503.14 27.63 967.92 percent of total billed charges 3503.14 3503.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PREMIER TITANIUM LORDOTIC CURVATURE L90 MM SPINE CERVICAL ANTERIOR PRECOMPRESSION SLIDE WASHER STERILE SUP-6860190 CDM 270010020 LOCAL 0270 RC outpatient 2.6 2.6 2.6 74 1.92 percent of total billed charges 2.6 93 2.11 percent of total billed charges 2.6 2.6 other OPPS APC 2.6 2.6 other OPPS APC 2.6 27.63 0.72 percent of total billed charges 2.6 2.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN HOLDING PREMIER ANTERIOR CERVICAL SPINE PLATE EASY INSERTION TEMPORARY FIXATION STERILE DISPOSABLE ANTERIOR CERVICAL SYSTEM SUP-6860404 CDM 270010020 LOCAL 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL PREMIER 4 MM OD13 MM ANTERIOR CERVICAL TRIFLAT STERILE DISPOSABLE ANTERIOR CERVICAL PLATE SYSTEM SUP-6860443 CDM 270010020 LOCAL 0270 RC outpatient 777.4 777.4 777.4 74 575.28 percent of total billed charges 777.4 93 629.69 percent of total billed charges 777.4 777.4 other OPPS APC 777.4 777.4 other OPPS APC 777.4 27.63 214.8 percent of total billed charges 777.4 777.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL PREMIER TRIFLAT ADJUSTABLE NONSTERILE ANTERIOR CERVICAL PLATE SYSTEM SUP-6860455 CDM 0270 RC outpatient 777.4 777.4 777.4 74 575.28 percent of total billed charges 777.4 93 629.69 percent of total billed charges 777.4 777.4 other OPPS APC 777.4 777.4 other OPPS APC 777.4 27.63 214.8 percent of total billed charges 777.4 777.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MULTIPASS CHROMIC 5-0 P-3 L18 IN MONOFILAMENT BROWN SUP-687G CDM 0270 RC outpatient 14.46 14.46 14.46 74 10.7 percent of total billed charges 14.46 93 11.71 percent of total billed charges 14.46 14.46 other OPPS APC 14.46 14.46 other OPPS APC 14.46 27.63 4 percent of total billed charges 14.46 14.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY IRRIGATION DOVER 60CC 1200CC 500CC STERILE LF LID PISTON SYRINGE ALCOHOL PREP PAD SUP-68800 CDM 0270 RC outpatient 2.67 2.67 2.67 74 1.98 percent of total billed charges 2.67 93 2.16 percent of total billed charges 2.67 2.67 other OPPS APC 2.67 2.67 other OPPS APC 2.67 27.63 0.74 percent of total billed charges 2.67 2.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON 6-0 P-1 L18 IN MONOFILAMENT UNDYED SUP-689G CDM 0270 RC outpatient 11.99 11.99 11.99 74 8.87 percent of total billed charges 11.99 93 9.71 percent of total billed charges 11.99 11.99 other OPPS APC 11.99 11.99 other OPPS APC 11.99 27.63 3.31 percent of total billed charges 11.99 11.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST BIOCELL SALINE P5.9 CM HIGH PROFILE OD12.1 CM 425-455 ML STYLE 68 SMOOTH ROUND SUP-68HP-425 CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER STRYKER ACETABULAR CONSTRAINED 22MM SIZE D SUP-690-00-22D CDM 270010024 LOCAL 0270 RC outpatient 7156.5 7156.5 7156.5 74 5295.81 percent of total billed charges 7156.5 93 5796.77 percent of total billed charges 7156.5 7156.5 other OPPS APC 7156.5 7156.5 other OPPS APC 7156.5 27.63 1977.34 percent of total billed charges 7156.5 7156.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT 10 D E ID22 MM HIP CONSTRAIN SUP-690-10-22E CDM 270010024 LOCAL 0270 RC outpatient 7100.6 7100.6 7100.6 74 5254.44 percent of total billed charges 7100.6 93 5751.49 percent of total billed charges 7100.6 7100.6 other OPPS APC 7100.6 7100.6 other OPPS APC 7100.6 27.63 1961.9 percent of total billed charges 7100.6 7100.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE HEART MITRAL PERICARDIAL CARPENTER 25MM SUP-6900-P25 CDM 0270 RC outpatient 15600 15600 15600 74 11544 percent of total billed charges 15600 93 12636 percent of total billed charges 15600 15600 other OPPS APC 15600 15600 other OPPS APC 15600 27.63 4310.28 percent of total billed charges 15600 15600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE HEART MITRAL PERICARDIAL CARPENTER 27MM SUP-6900-P27 CDM 0270 RC outpatient 15600 15600 15600 74 11544 percent of total billed charges 15600 93 12636 percent of total billed charges 15600 15600 other OPPS APC 15600 15600 other OPPS APC 15600 27.63 4310.28 percent of total billed charges 15600 15600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE HEART MITRAL PERICARDIAL CARPENTER 29MM SUP-6900-P29 CDM 0270 RC outpatient 15600 15600 15600 74 11544 percent of total billed charges 15600 93 12636 percent of total billed charges 15600 15600 other OPPS APC 15600 15600 other OPPS APC 15600 27.63 4310.28 percent of total billed charges 15600 15600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE HEART MITRAL PERIMOUNT CARPENTER 31MM SUP-6900-P31 CDM 0270 RC outpatient 15600 15600 15600 74 11544 percent of total billed charges 15600 93 12636 percent of total billed charges 15600 15600 other OPPS APC 15600 15600 other OPPS APC 15600 27.63 4310.28 percent of total billed charges 15600 15600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL CARPENTIER-EDWARDS PERIMOUNT PLUS ASSORTED PERICARDIAL SUP-6900P CDM 0270 RC outpatient 15600 15600 15600 74 11544 percent of total billed charges 15600 93 12636 percent of total billed charges 15600 15600 other OPPS APC 15600 15600 other OPPS APC 15600 27.63 4310.28 percent of total billed charges 15600 15600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL CARPENTIER-EDWARDS PERIMOUNT PLUS TRICENTRIX PERICARDIAL OD27 MM BIOPROSTHESIS STENTED THERMAFIX HOLDER SUP-6900PTFX27MM CDM 0270 RC outpatient 16380 16380 16380 74 12121.2 percent of total billed charges 16380 93 13267.8 percent of total billed charges 16380 16380 other OPPS APC 16380 16380 other OPPS APC 16380 27.63 4525.79 percent of total billed charges 16380 16380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL COROENT XL 50X18X12MM NS LF SUP-6912850 CDM 270010020 LOCAL 0270 RC outpatient 10667.8 10667.8 10667.8 74 7894.17 percent of total billed charges 10667.8 93 8640.92 percent of total billed charges 10667.8 10667.8 other OPPS APC 10667.8 10667.8 other OPPS APC 10667.8 27.63 2947.51 percent of total billed charges 10667.8 10667.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM GASTRIC LAVAGE VISIGI 3D OD36 FR SELECTION VALVE SHORT HOLE BYPASS SUP-69160 CDM 0270 RC outpatient 683.2 683.2 683.2 74 505.57 percent of total billed charges 683.2 93 553.39 percent of total billed charges 683.2 683.2 other OPPS APC 683.2 683.2 other OPPS APC 683.2 27.63 188.77 percent of total billed charges 683.2 683.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUATTRO SINGLE COIL DF1 6935 SUP-693558 CDM 0270 RC outpatient 8078.2 8078.2 8078.2 74 5977.87 percent of total billed charges 8078.2 93 6543.34 percent of total billed charges 8078.2 8078.2 other OPPS APC 8078.2 8078.2 other OPPS APC 8078.2 27.63 2232.01 percent of total billed charges 8078.2 8078.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING SPRINT QUATTRO SECURE STEROID ELUTING SILICONE HELIX L65 CM OD8.6 FR VENTRICLE 1 COIL ACTIVE FIXATION DEFIBRILLATION TRIPOLAR SUP-693565 CDM 0275 RC outpatient 8078.2 8078.2 8078.2 57 4604.57 percent of total billed charges 8078.2 93 6543.34 percent of total billed charges 8078.2 8078.2 other OPPS APC 8078.2 8078.2 other OPPS APC 8078.2 51 4119.88 percent of total billed charges 8078.2 8078.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING SPRINT QUATTRO SECURE STEROID ELUTING SILICONE HELIX L49 CM OD 8.6 FR VENTRICLE 1 COIL ACTIVE FIXATION DEFIBRILLATION SUP-6935M49 CDM 0275 RC outpatient 8078.2 8078.2 8078.2 57 4604.57 percent of total billed charges 8078.2 93 6543.34 percent of total billed charges 8078.2 8078.2 other OPPS APC 8078.2 8078.2 other OPPS APC 8078.2 51 4119.88 percent of total billed charges 8078.2 8078.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING SPRINT QUATTRO SECURE S L55 CM RIGHT VENTRICLE DF-4 TRIPOLAR SCREW DEFIBRILLATOR SUP-6935M55 CDM 0275 RC outpatient 8078.2 8078.2 8078.2 57 4604.57 percent of total billed charges 8078.2 93 6543.34 percent of total billed charges 8078.2 8078.2 other OPPS APC 8078.2 8078.2 other OPPS APC 8078.2 51 4119.88 percent of total billed charges 8078.2 8078.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING SPRINT QUATTRO SECURE DEXAMETHASONE SODIUM PHOSPHATE STEROID ELUTING L62 CM SUP-6935M62 CDM 0275 RC outpatient 8078.2 8078.2 8078.2 57 4604.57 percent of total billed charges 8078.2 93 6543.34 percent of total billed charges 8078.2 8078.2 other OPPS APC 8078.2 8078.2 other OPPS APC 8078.2 51 4119.88 percent of total billed charges 8078.2 8078.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING SPRINT QUATTRO SECURE S ISOGLIDE STEROID ELUTING SILICONE ETFE L 72 CM OD 8.6 FR VENTRICULAR HELIX ELECTRODE DF-4 CONNECTOR TRIPOLAR DEFIBRILLATION COIL STERILE SUP-6935M72 CDM 0275 RC outpatient 8078.2 8078.2 8078.2 57 4604.57 percent of total billed charges 8078.2 93 6543.34 percent of total billed charges 8078.2 8078.2 other OPPS APC 8078.2 8078.2 other OPPS APC 8078.2 51 4119.88 percent of total billed charges 8078.2 8078.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING SPRINT QUATTRO SECURE S ISOGLIDE STEROID ELUTING SILICONE ETFE L97 CM OD 8.6 FR VENTRICULAR HELIX ELECTRODE DF-4 CONNECTOR TRIPOLAR DEFIBRILLATION COIL STERILE SUP-6935M97 CDM 0275 RC outpatient 8078.2 8078.2 8078.2 57 4604.57 percent of total billed charges 8078.2 93 6543.34 percent of total billed charges 8078.2 8078.2 other OPPS APC 8078.2 8078.2 other OPPS APC 8078.2 51 4119.88 percent of total billed charges 8078.2 8078.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING TRANSVENE SILICONE POLYURETHANE L58 CM OD7.5 FR VENTRICLE CS SVC COIL SUP-6937A-58 CDM 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING TRANSVENE SILICONE POLYURETHANE L65 CM OD7.5 FR VENTRICULAR UNIPOLAR DF-1 CS OR SVC PLACEMENT SUP-6937A-65 CDM 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROTECTOR HOOD SUP-69392 CDM 0270 RC outpatient 45.3 45.3 45.3 74 33.52 percent of total billed charges 45.3 93 36.69 percent of total billed charges 45.3 45.3 other OPPS APC 45.3 45.3 other OPPS APC 45.3 27.63 12.52 percent of total billed charges 45.3 45.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD UNIPOLAR UNITRAX OD38 MM HIP FEMORAL MODULAR EXETER V40 STEM SUP-6942-5-038 CDM 270010024 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD UNIPOLAR UNITRAX OD40 MM HIP FEMORAL MODULAR EXETER V40 STEM SUP-6942-5-040 CDM 270010024 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD UNIPOLAR UNITRAX OD48 MM HIP FEMORAL MODULAR EXETER V40 STEM SUP-6942-5-048 CDM 270010023 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE CENTERING UNITRAX V40 -4 MM HIP UNIPOLAR SUP-6942-6-060 CDM 270010024 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE CENTERING UNITRAX V40 EXETER +0 MM TAPER HIP UNIPOLAR SUP-6942-6-065 CDM 270010024 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE CENTERING UNITRAX V40 EXETER +4 MM TAPER HIP UNIPOLAR SUP-6942-6-070 CDM 270010024 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE CENTERING UNITRAX V40 EXETER +8 MM TAPER HIP UNIPOLAR SUP-6942-6-075 CDM 270010024 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE CENTERING UNITRAX V40 +12 MM HIP UNIPOLAR SUP-6942-6-080 CDM 270010024 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE CENTERING UNITRAX +0 MM C TAPER HIP FEMUR SUP-6942-7-065 CDM 270010024 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE CENTERING V-40 UNITRAX +5 MM C TAPER HIP FEMUR SUP-6942-7-075 CDM 270010024 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE CENTERING V-40 UNITRAX +10 MM C TAPER HIP FEMUR SUP-6942-7-085 CDM 270010024 LOCAL 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON 11.0D SUP-69422 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON IOL 11.0D SUP-69422 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING SPRINT QUATTRO DEFIBRILLATOR SUP-6944 SERIES CDM 0275 RC outpatient 8320 8320 8320 57 4742.4 percent of total billed charges 8320 93 6739.2 percent of total billed charges 8320 8320 other OPPS APC 8320 8320 other OPPS APC 8320 51 4243.2 percent of total billed charges 8320 8320 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD QUATRO SECURE RV SUP-6947 SERIES CDM 0275 RC outpatient 8320 8320 8320 57 4742.4 percent of total billed charges 8320 93 6739.2 percent of total billed charges 8320 8320 other OPPS APC 8320 8320 other OPPS APC 8320 51 4243.2 percent of total billed charges 8320 8320 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SET VERTEX MAX TITANIUM M6 BUTTRESS THREAD SPINE POSTERIOR RECONSTRUCTION SYSTEM SUP-6950315 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEPTUNE FLUID TRAP SUP-69532 CDM 0270 RC outpatient 34 34 34 74 25.16 percent of total billed charges 34 93 27.54 percent of total billed charges 34 34 other OPPS APC 34 34 other OPPS APC 34 27.63 9.39 percent of total billed charges 34 34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL VERTEX MAX L10-24 MM OD2.4 MM NONSTERILE DISPOSABLE GREEN RECONSTRUCTION SYSTEM SUP-6956010 CDM 270010020 LOCAL 0270 RC outpatient 800.8 800.8 800.8 74 592.59 percent of total billed charges 800.8 93 648.65 percent of total billed charges 800.8 800.8 other OPPS APC 800.8 800.8 other OPPS APC 800.8 27.63 221.26 percent of total billed charges 800.8 800.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VERTEX MAX TITANIUM L10 MM OD3.5 MM SPINE THORACIC MULTIAXIAL GREEN SUP-6958710 CDM 270010020 LOCAL 0270 RC outpatient 2897.44 2897.44 2897.44 74 2144.11 percent of total billed charges 2897.44 93 2346.93 percent of total billed charges 2897.44 2897.44 other OPPS APC 2897.44 2897.44 other OPPS APC 2897.44 27.63 800.56 percent of total billed charges 2897.44 2897.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VERTEX MAX TITANIUM L12 MM OD3.5 MM SPINE THORACIC MULTIAXIAL GREEN SUP-6958712 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VERTEX MAX TITANIUM L14 MM OD3.5 MM SPINE THORACIC MULTIAXIAL GREEN SUP-6958714 CDM 270010020 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VERTEX MAX TITANIUM L16 MM OD3.5 MM SPINE THORACIC MULTIAXIAL GREEN SUP-6958716 CDM 270010020 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MEDTRONIC 3.5MM X 20MM SUP-6958720 CDM 270010020 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MEDTRONIC 3.5MM X 22MM SUP-6958722 CDM 270010020 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VERTEX MAX TITANIUM L24 MM OD3.5 MM SPINE THORACIC MULTIAXIAL GREEN SUP-6958724 CDM 270010020 LOCAL 0270 RC outpatient 2897.44 2897.44 2897.44 74 2144.11 percent of total billed charges 2897.44 93 2346.93 percent of total billed charges 2897.44 2897.44 other OPPS APC 2897.44 2897.44 other OPPS APC 2897.44 27.63 800.56 percent of total billed charges 2897.44 2897.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VERTEX MAX TITANIUM PARTIAL THREAD L28 MM OD3.5 MM SPINE THORACIC MULTIAXIAL GREEN SUP-6958728PT CDM 270010020 LOCAL 0270 RC outpatient 3552.64 3552.64 3552.64 74 2628.95 percent of total billed charges 3552.64 93 2877.64 percent of total billed charges 3552.64 3552.64 other OPPS APC 3552.64 3552.64 other OPPS APC 3552.64 27.63 981.59 percent of total billed charges 3552.64 3552.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VERTEX MAX TITANIUM L30 MM OD3.5 MM SPINE THORACIC MULTIAXIALGREEN SUP-6958730 CDM 270010020 LOCAL 0270 RC outpatient 2897.44 2897.44 2897.44 74 2144.11 percent of total billed charges 2897.44 93 2346.93 percent of total billed charges 2897.44 2897.44 other OPPS APC 2897.44 2897.44 other OPPS APC 2897.44 27.63 800.56 percent of total billed charges 2897.44 2897.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VERTEX MAX TITANIUM PARTIAL THREAD L30 MM OD3.5 MM SPINE THORACIC MULTIAXIAL GREEN SUP-6958730PT CDM 270010020 LOCAL 0270 RC outpatient 3108.56 3108.56 3108.56 74 2300.33 percent of total billed charges 3108.56 93 2517.93 percent of total billed charges 3108.56 3108.56 other OPPS APC 3108.56 3108.56 other OPPS APC 3108.56 27.63 858.9 percent of total billed charges 3108.56 3108.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VERTEX MAX TITANIUM L12 MM OD4 MM SPINE MULTIAXIAL SUP-6958812 CDM 270010020 LOCAL 0270 RC outpatient 2897.44 2897.44 2897.44 74 2144.11 percent of total billed charges 2897.44 93 2346.93 percent of total billed charges 2897.44 2897.44 other OPPS APC 2897.44 2897.44 other OPPS APC 2897.44 27.63 800.56 percent of total billed charges 2897.44 2897.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VERTEX MAX TITANIUM L14 MM OD4 MM SPINE THORACIC MULTIAXIAL BLUE SUP-6958814 CDM 270010020 LOCAL 0270 RC outpatient 2897.44 2897.44 2897.44 74 2144.11 percent of total billed charges 2897.44 93 2346.93 percent of total billed charges 2897.44 2897.44 other OPPS APC 2897.44 2897.44 other OPPS APC 2897.44 27.63 800.56 percent of total billed charges 2897.44 2897.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VERTEX MAX TITANIUM L16 MM OD4 MM SPINE THORACIC MULTIAXIAL BLUE SUP-6958816 CDM 270010020 LOCAL 0270 RC outpatient 2897.44 2897.44 2897.44 74 2144.11 percent of total billed charges 2897.44 93 2346.93 percent of total billed charges 2897.44 2897.44 other OPPS APC 2897.44 2897.44 other OPPS APC 2897.44 27.63 800.56 percent of total billed charges 2897.44 2897.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MEDTRONIC 4.0MM X 20MM SUP-6958820 CDM 270010020 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MEDTRONIC 4.0MM X 22MM SUP-6958822 CDM 270010020 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VERTEX MAX TITANIUM L30 MM OD4 MM SPINE THORACIC MULTIAXIAL GOLD SUP-6958830 CDM 270010020 LOCAL 0270 RC outpatient 3311.36 3311.36 3311.36 74 2450.41 percent of total billed charges 3311.36 93 2682.2 percent of total billed charges 3311.36 3311.36 other OPPS APC 3311.36 3311.36 other OPPS APC 3311.36 27.63 914.93 percent of total billed charges 3311.36 3311.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICS IRRIGATION CLIP STERILE SUP-69631 CDM 0272 RC outpatient 323.75 323.75 323.75 74 239.58 percent of total billed charges 323.75 93 262.24 percent of total billed charges 323.75 323.75 other OPPS APC 323.75 323.75 other OPPS APC 323.75 27.63 89.45 percent of total billed charges 323.75 323.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AXIS JACKSON CONTOUR TUBING SET SUP-6977-50 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON MULTIPASS 6-0 P-1 18IN BLACK MONOFILAMENT PLIABILIZE SUP-697G CDM 0270 RC outpatient 9.99 9.99 9.99 74 7.39 percent of total billed charges 9.99 93 8.09 percent of total billed charges 9.99 9.99 other OPPS APC 9.99 9.99 other OPPS APC 9.99 27.63 2.76 percent of total billed charges 9.99 9.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PATIENT PRONEVIEW WING ACP TUBE BILATERAL CHEST PAD HIP THIGH HINGE COVER ARM CRADLE AXIS JACKSON SUP-6980PV CDM 0270 RC outpatient 172.47 172.47 172.47 74 127.63 percent of total billed charges 172.47 93 139.7 percent of total billed charges 172.47 172.47 other OPPS APC 172.47 172.47 other OPPS APC 172.47 27.63 47.65 percent of total billed charges 172.47 172.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL COROENT 10D XL 50X18X10MM NS LF SUP-6981050 CDM 270010020 LOCAL 0270 RC outpatient 10667.8 10667.8 10667.8 74 7894.17 percent of total billed charges 10667.8 93 8640.92 percent of total billed charges 10667.8 10667.8 other OPPS APC 10667.8 10667.8 other OPPS APC 10667.8 27.63 2947.51 percent of total billed charges 10667.8 10667.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT POSITIONING PROAXIS PRONEVIEW SUP-6988A-PV CDM 0270 RC outpatient 188.2 188.2 188.2 74 139.27 percent of total billed charges 188.2 93 152.44 percent of total billed charges 188.2 188.2 other OPPS APC 188.2 188.2 other OPPS APC 188.2 27.63 52 percent of total billed charges 188.2 188.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON MULTIPASS 5-0 P-3 18IN BLACK MONOFILAMENT SUP-698G CDM 0270 RC outpatient 8.81 8.81 8.81 74 6.52 percent of total billed charges 8.81 93 7.14 percent of total billed charges 8.81 8.81 other OPPS APC 8.81 8.81 other OPPS APC 8.81 27.63 2.43 percent of total billed charges 8.81 8.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING SILICONE L58 CM L33 CM OD7.5 FR ODSEC10.5 FR SUBCUTANEOUS DF-1 CONNECTOR UNIPOLAR FLEXIBLE INTRODUCER DEFIBRILLATION SUP-6996SQ58 CDM 0275 RC outpatient 6175 6175 6175 57 3519.75 percent of total billed charges 6175 93 5001.75 percent of total billed charges 6175 6175 other OPPS APC 6175 6175 other OPPS APC 6175 51 3149.25 percent of total billed charges 6175 6175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL TUNNELING STAINLESS STEEL L338 MM OD3.1 MM 6996SQ LEAD SUP-6996T CDM 0270 RC outpatient 437 437 437 74 323.38 percent of total billed charges 437 93 353.97 percent of total billed charges 437 437 other OPPS APC 437 437 other OPPS APC 437 27.63 120.74 percent of total billed charges 437 437 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON MULTIPASS 4-0 P-3 L18 IN MONOFILAMENT BLACK SUP-699G CDM 0270 RC outpatient 9.87 9.87 9.87 74 7.3 percent of total billed charges 9.87 93 7.99 percent of total billed charges 9.87 9.87 other OPPS APC 9.87 9.87 other OPPS APC 9.87 27.63 2.73 percent of total billed charges 9.87 9.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE 6.4MM CUFF LP CANN SHILEY SUP-6DCT CDM 270009133 LOCAL 0270 RC outpatient 36.61 36.61 36.61 74 27.09 percent of total billed charges 36.61 93 29.65 percent of total billed charges 36.61 36.61 other OPPS APC 36.61 36.61 other OPPS APC 36.61 27.63 10.12 percent of total billed charges 36.61 36.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA INNER SHILEY 6 15MM PVC DISPOSABLE STERILE LF SNAP LOCK CONNECTOR TRACHEOSTOMY TUBE SUP-6DIC CDM 0270 RC outpatient 10.18 10.18 10.18 74 7.53 percent of total billed charges 10.18 93 8.25 percent of total billed charges 10.18 10.18 other OPPS APC 10.18 10.18 other OPPS APC 10.18 27.63 2.81 percent of total billed charges 10.18 10.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE GORE-TEX 5-0 30IN 3/8 CIRCLE CV-6/PT-9 DOUBLE-ARM PIERCING POINT WHITE 12/BX 6M06A MONOFILAMENT EPTFE 9MM NONABSORBABLE SUP-6M06A CDM 0270 RC outpatient 115.27 115.27 115.27 74 85.3 percent of total billed charges 115.27 93 93.37 percent of total billed charges 115.27 115.27 other OPPS APC 115.27 115.27 other OPPS APC 115.27 27.63 31.85 percent of total billed charges 115.27 115.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE GORE-TEX CV-6 PT-9 L30 IN 2 ARM MONOFILAMENT WHITE SUP-6M06B CDM 0270 RC outpatient 98.66 98.66 98.66 74 73.01 percent of total billed charges 98.66 93 79.91 percent of total billed charges 98.66 98.66 other OPPS APC 98.66 98.66 other OPPS APC 98.66 27.63 27.26 percent of total billed charges 98.66 98.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE GORE-TEX 5-0 30IN 3/8 CIRCLE CV-6/PT-13 DOUBLE-ARM PIERCING POINT WHITE 12/BX 6M08A MONOFILAMENT EPTFE 13MM NONABSORBABLE SUP-6M08A CDM 0270 RC outpatient 110.28 110.28 110.28 74 81.61 percent of total billed charges 110.28 93 89.33 percent of total billed charges 110.28 110.28 other OPPS APC 110.28 110.28 other OPPS APC 110.28 27.63 30.47 percent of total billed charges 110.28 110.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE GORE-TEX CV-6 PT-13 L30 IN 2 ARM MONOFILAMENT WHITE SUP-6M08B CDM 0270 RC outpatient 95.26 95.26 95.26 74 70.49 percent of total billed charges 95.26 93 77.16 percent of total billed charges 95.26 95.26 other OPPS APC 95.26 95.26 other OPPS APC 95.26 27.63 26.32 percent of total billed charges 95.26 95.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE EPIDURAL TUOHY PLASTIC CURVE L7 IN OD20 GA BLUNT TIP LUER LOCK FIRM CANNULA BUFF HEEL STERILE LATEX FREE DISPOSABLE SUP-7-2150-20 CDM 0270 RC outpatient 28.21 28.21 28.21 74 20.88 percent of total billed charges 28.21 93 22.85 percent of total billed charges 28.21 28.21 other OPPS APC 28.21 28.21 other OPPS APC 28.21 27.63 7.79 percent of total billed charges 28.21 28.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 17G X 7 TOUHY WHITE NEEDLE SUP-7-21501-7 CDM 0270 RC outpatient 39 39 39 74 28.86 percent of total billed charges 39 93 31.59 percent of total billed charges 39 39 other OPPS APC 39 39 other OPPS APC 39 27.63 10.78 percent of total billed charges 39 39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOPTY 18G X 16CM SUP-70-00003 CDM 0272 RC outpatient 110.29 110.29 110.29 74 81.61 percent of total billed charges 110.29 93 89.33 percent of total billed charges 110.29 110.29 other OPPS APC 110.29 110.29 other OPPS APC 110.29 27.63 30.47 percent of total billed charges 110.29 110.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER OPEN END POLLACK 4 FR SUP-70-00006 CDM C1758 HCPCS 0272 RC outpatient 48.05 48.05 48.05 74 35.56 percent of total billed charges 48.05 93 38.92 percent of total billed charges 48.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.05 other OPPS APC 48.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.05 other OPPS APC 48.05 27.63 13.28 percent of total billed charges 48.05 48.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER OPEN END POLLACK 5 FR SUP-70-00007 CDM C1758 HCPCS 0272 RC outpatient 52.34 52.34 52.34 74 38.73 percent of total billed charges 52.34 93 42.4 percent of total billed charges 52.34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52.34 other OPPS APC 52.34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52.34 other OPPS APC 52.34 27.63 14.46 percent of total billed charges 52.34 52.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER OPEN END POLLACK 6 FR SUP-70-00008 CDM C1758 HCPCS 0272 RC outpatient 61.37 61.37 61.37 74 45.41 percent of total billed charges 61.37 93 49.71 percent of total billed charges 61.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 61.37 other OPPS APC 61.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 61.37 other OPPS APC 61.37 27.63 16.96 percent of total billed charges 61.37 61.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER STAMEY SUPRAPUBIC 12 SUP-70-00010 CDM C1729 HCPCS 0272 RC outpatient 181.76 181.76 181.76 74 134.5 percent of total billed charges 181.76 93 147.23 percent of total billed charges 181.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 181.76 other OPPS APC 181.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 181.76 other OPPS APC 181.76 27.63 50.22 percent of total billed charges 181.76 181.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING CONNECTING 14 FR URETER SUP-70-00022 CDM 0272 RC outpatient 70.51 70.51 70.51 74 52.18 percent of total billed charges 70.51 93 57.11 percent of total billed charges 70.51 70.51 other OPPS APC 70.51 70.51 other OPPS APC 70.51 27.63 19.48 percent of total billed charges 70.51 70.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE GUIDE .025 SUP-70-00028 CDM C1769 HCPCS 0272 RC outpatient 58 58 58 74 42.92 percent of total billed charges 58 93 46.98 percent of total billed charges 58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 58 other OPPS APC 58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 58 other OPPS APC 58 27.63 16.03 percent of total billed charges 58 58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE GUIDE .032 SUP-70-00029 CDM C1769 HCPCS 0272 RC outpatient 57.93 57.93 57.93 74 42.87 percent of total billed charges 57.93 93 46.92 percent of total billed charges 57.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 57.93 other OPPS APC 57.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 57.93 other OPPS APC 57.93 27.63 16.01 percent of total billed charges 57.93 57.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMATURIA CATHETER 22FR 30CC 3 SUP-70-00033 CDM C1729 HCPCS 0272 RC outpatient 80.8 80.8 80.8 74 59.79 percent of total billed charges 80.8 93 65.45 percent of total billed charges 80.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 80.8 other OPPS APC 80.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 80.8 other OPPS APC 80.8 27.63 22.33 percent of total billed charges 80.8 80.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNCILL CATHETER 16FR SUP-70-00034 CDM C1729 HCPCS 0272 RC outpatient 48.16 48.16 48.16 74 35.64 percent of total billed charges 48.16 93 39.01 percent of total billed charges 48.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.16 other OPPS APC 48.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.16 other OPPS APC 48.16 27.63 13.31 percent of total billed charges 48.16 48.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE SHORT LOOP 24F SUP-70-00035 CDM 0272 RC outpatient 499.47 499.47 499.47 74 369.61 percent of total billed charges 499.47 93 404.57 percent of total billed charges 499.47 499.47 other OPPS APC 499.47 499.47 other OPPS APC 499.47 27.63 138 percent of total billed charges 499.47 499.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE SHORT LOOP 27F SUP-70-00036 CDM 0272 RC outpatient 420 420 420 74 310.8 percent of total billed charges 420 93 340.2 percent of total billed charges 420 420 other OPPS APC 420 420 other OPPS APC 420 27.63 116.05 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ELECTRODE, VAPOR CUT 0.6MM 24F" SUP-70-00039 CDM 0272 RC outpatient 521.02 521.02 521.02 74 385.55 percent of total billed charges 521.02 93 422.03 percent of total billed charges 521.02 521.02 other OPPS APC 521.02 521.02 other OPPS APC 521.02 27.63 143.96 percent of total billed charges 521.02 521.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ELECTRODE, VAPOR CUT 24FR 2705" SUP-70-00041 CDM 0272 RC outpatient 553.4 553.4 553.4 74 409.52 percent of total billed charges 553.4 93 448.25 percent of total billed charges 553.4 553.4 other OPPS APC 553.4 553.4 other OPPS APC 553.4 27.63 152.9 percent of total billed charges 553.4 553.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ELECTRODE, ROLLERBAR 3MM 24FR" SUP-70-00046 CDM 0272 RC outpatient 400.1 400.1 400.1 74 296.07 percent of total billed charges 400.1 93 324.08 percent of total billed charges 400.1 400.1 other OPPS APC 400.1 400.1 other OPPS APC 400.1 27.63 110.55 percent of total billed charges 400.1 400.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZIPWIRE FLEX STRAIGHT .035 SUP-70-00070 CDM C1769 HCPCS 0272 RC outpatient 146.34 146.34 146.34 74 108.29 percent of total billed charges 146.34 93 118.54 percent of total billed charges 146.34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 146.34 other OPPS APC 146.34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 146.34 other OPPS APC 146.34 27.63 40.43 percent of total billed charges 146.34 146.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZIPWIRE STIFF ANGLED .35 SUP-70-00072 CDM C1769 HCPCS 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZIPWIRE FLEX STRAIGHT .038 SUP-70-00073 CDM C1769 HCPCS 0272 RC outpatient 146.34 146.34 146.34 74 108.29 percent of total billed charges 146.34 93 118.54 percent of total billed charges 146.34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 146.34 other OPPS APC 146.34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 146.34 other OPPS APC 146.34 27.63 40.43 percent of total billed charges 146.34 146.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRASPER 2.6 GRASPIT SUP-70-00089 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON DILATATION CATH UROMAX SUP-70-00095 CDM C1726 HCPCS 0272 RC outpatient 760.38 760.38 760.38 74 562.68 percent of total billed charges 760.38 93 615.91 percent of total billed charges 760.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 760.38 other OPPS APC 760.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 760.38 other OPPS APC 760.38 27.63 210.09 percent of total billed charges 760.38 760.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON DILATATION CATHNEPLHRO SUP-70-00097 CDM C1726 HCPCS 0272 RC outpatient 779.81 779.81 779.81 74 577.06 percent of total billed charges 779.81 93 631.65 percent of total billed charges 779.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 779.81 other OPPS APC 779.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 779.81 other OPPS APC 779.81 27.63 215.46 percent of total billed charges 779.81 779.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "COLD KNIFE, HALF-ROUND 27069L" SUP-70-00102 CDM 0272 RC outpatient 568.38 568.38 568.38 74 420.6 percent of total billed charges 568.38 93 460.39 percent of total billed charges 568.38 568.38 other OPPS APC 568.38 568.38 other OPPS APC 568.38 27.63 157.04 percent of total billed charges 568.38 568.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "COLD KNIFE, DISPOSABLE 27069K" SUP-70-00103 CDM 0272 RC outpatient 662.6 662.6 662.6 74 490.32 percent of total billed charges 662.6 93 536.71 percent of total billed charges 662.6 662.6 other OPPS APC 662.6 662.6 other OPPS APC 662.6 27.63 183.08 percent of total billed charges 662.6 662.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DRAIN BAG, UROLOGICAL CMS958" SUP-70-00105 CDM 0272 RC outpatient 41 41 41 74 30.34 percent of total billed charges 41 93 33.21 percent of total billed charges 41 41 other OPPS APC 41 41 other OPPS APC 41 27.63 11.33 percent of total billed charges 41 41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIRANHA URETEROSCOPIC BIOPSY F SUP-70-00109 CDM 0272 RC outpatient 1039.08 1039.08 1039.08 74 768.92 percent of total billed charges 1039.08 93 841.65 percent of total billed charges 1039.08 1039.08 other OPPS APC 1039.08 1039.08 other OPPS APC 1039.08 27.63 287.1 percent of total billed charges 1039.08 1039.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GUIDEWIRE, J-TIP .032 PTFE" SUP-70-00112 CDM 0272 RC outpatient 60.44 60.44 60.44 74 44.73 percent of total billed charges 60.44 93 48.96 percent of total billed charges 60.44 60.44 other OPPS APC 60.44 60.44 other OPPS APC 60.44 27.63 16.7 percent of total billed charges 60.44 60.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER COUNCIL 20FR SUP-70-00113 CDM 0272 RC outpatient 48.16 48.16 48.16 74 35.64 percent of total billed charges 48.16 93 39.01 percent of total billed charges 48.16 48.16 other OPPS APC 48.16 48.16 other OPPS APC 48.16 27.63 13.31 percent of total billed charges 48.16 48.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER COUNCIL 20FR 5CC SUP-70-00114 CDM C1729 HCPCS 0272 RC outpatient 67.47 67.47 67.47 74 49.93 percent of total billed charges 67.47 93 54.65 percent of total billed charges 67.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 67.47 other OPPS APC 67.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 67.47 other OPPS APC 67.47 27.63 18.64 percent of total billed charges 67.47 67.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PUMPING SYSTEM, SINGLE ACTION" SUP-70-00118 CDM 0272 RC outpatient 185.3 185.3 185.3 74 137.12 percent of total billed charges 185.3 93 150.09 percent of total billed charges 185.3 185.3 other OPPS APC 185.3 185.3 other OPPS APC 185.3 27.63 51.2 percent of total billed charges 185.3 185.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER TUOHY-BURST SUP-70-00119 CDM 0272 RC outpatient 33.33 33.33 33.33 74 24.66 percent of total billed charges 33.33 93 27 percent of total billed charges 33.33 33.33 other OPPS APC 33.33 33.33 other OPPS APC 33.33 27.63 9.21 percent of total billed charges 33.33 33.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "INTRODUCER, PEEL-AWAY 10FR 073" SUP-70-00125 CDM 0272 RC outpatient 196.56 196.56 196.56 74 145.45 percent of total billed charges 196.56 93 159.21 percent of total billed charges 196.56 196.56 other OPPS APC 196.56 196.56 other OPPS APC 196.56 27.63 54.31 percent of total billed charges 196.56 196.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY ALL SILICONE 14 SUP-70-00130 CDM C1729 HCPCS 0272 RC outpatient 3.21 3.21 3.21 74 2.38 percent of total billed charges 3.21 93 2.6 percent of total billed charges 3.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.21 other OPPS APC 3.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.21 other OPPS APC 3.21 27.63 0.89 percent of total billed charges 3.21 3.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY ALL SILICONE 22 SUP-70-00131 CDM C1729 HCPCS 0272 RC outpatient 3.59 3.59 3.59 74 2.66 percent of total billed charges 3.59 93 2.91 percent of total billed charges 3.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.59 other OPPS APC 3.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.59 other OPPS APC 3.59 27.63 0.99 percent of total billed charges 3.59 3.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER FOLEY ALL SILICONE 24 SUP-70-00132 CDM C1729 HCPCS 0272 RC outpatient 3.21 3.21 3.21 74 2.38 percent of total billed charges 3.21 93 2.6 percent of total billed charges 3.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.21 other OPPS APC 3.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.21 other OPPS APC 3.21 27.63 0.89 percent of total billed charges 3.21 3.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE CALCUTRIPT 7FR X 50CM SUP-70-00139 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER TRANSDUCER NEOGUARD SUP-70-00143 CDM 0272 RC outpatient 3.28 3.28 3.28 74 2.43 percent of total billed charges 3.28 93 2.66 percent of total billed charges 3.28 3.28 other OPPS APC 3.28 3.28 other OPPS APC 3.28 27.63 0.91 percent of total billed charges 3.28 3.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER COUNCIL 22FR SUP-70-00148 CDM C1729 HCPCS 0272 RC outpatient 48.16 48.16 48.16 74 35.64 percent of total billed charges 48.16 93 39.01 percent of total billed charges 48.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.16 other OPPS APC 48.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.16 other OPPS APC 48.16 27.63 13.31 percent of total billed charges 48.16 48.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTRACTOR STONE NITINOL SUP-70-00149 CDM 0272 RC outpatient 803.44 803.44 803.44 74 594.55 percent of total billed charges 803.44 93 650.79 percent of total billed charges 803.44 803.44 other OPPS APC 803.44 803.44 other OPPS APC 803.44 27.63 221.99 percent of total billed charges 803.44 803.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE AMPLATZ X-STIFF .038 SUP-70-00150 CDM 0272 RC outpatient 124.8 124.8 124.8 74 92.35 percent of total billed charges 124.8 93 101.09 percent of total billed charges 124.8 124.8 other OPPS APC 124.8 124.8 other OPPS APC 124.8 27.63 34.48 percent of total billed charges 124.8 124.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE AMPLATZ X-STIFF .025 SUP-70-00151 CDM 0272 RC outpatient 85.96 85.96 85.96 74 63.61 percent of total billed charges 85.96 93 69.63 percent of total billed charges 85.96 85.96 other OPPS APC 85.96 85.96 other OPPS APC 85.96 27.63 23.75 percent of total billed charges 85.96 85.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET HEYMAN FOLLOWER SUP-70-00154 CDM 0272 RC outpatient 767.61 767.61 767.61 74 568.03 percent of total billed charges 767.61 93 621.76 percent of total billed charges 767.61 767.61 other OPPS APC 767.61 767.61 other OPPS APC 767.61 27.63 212.09 percent of total billed charges 767.61 767.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT 6FR X24 CONTOUR SOFT SUP-70-00160 CDM C2625 HCPCS 0278 RC outpatient 390.92 390.92 390.92 57 222.82 percent of total billed charges 390.92 93 316.65 percent of total billed charges 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 51 199.37 percent of total billed charges 390.92 390.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT 6FR X26 CONTOUR SOFT SUP-70-00161 CDM C2625 HCPCS 0278 RC outpatient 390.92 390.92 390.92 57 222.82 percent of total billed charges 390.92 93 316.65 percent of total billed charges 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 51 199.37 percent of total billed charges 390.92 390.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT 6FR X28 CONTOUR SOFT SUP-70-00162 CDM C2625 HCPCS 0278 RC outpatient 390.92 390.92 390.92 57 222.82 percent of total billed charges 390.92 93 316.65 percent of total billed charges 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 51 199.37 percent of total billed charges 390.92 390.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT 6FR X 22-30CM CONTOUR SUP-70-00163 CDM C2625 HCPCS 0278 RC outpatient 390.92 390.92 390.92 57 222.82 percent of total billed charges 390.92 93 316.65 percent of total billed charges 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 51 199.37 percent of total billed charges 390.92 390.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT 7FR X24 CONTOUR SOFT SUP-70-00164 CDM C2625 HCPCS 0278 RC outpatient 390.92 390.92 390.92 57 222.82 percent of total billed charges 390.92 93 316.65 percent of total billed charges 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 51 199.37 percent of total billed charges 390.92 390.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT 7FR X26 CONTOUR SOFT SUP-70-00165 CDM C2625 HCPCS 0278 RC outpatient 390.92 390.92 390.92 57 222.82 percent of total billed charges 390.92 93 316.65 percent of total billed charges 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 51 199.37 percent of total billed charges 390.92 390.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT 7FR X28 CONTOUR SOFT SUP-70-00166 CDM C2625 HCPCS 0278 RC outpatient 390.92 390.92 390.92 57 222.82 percent of total billed charges 390.92 93 316.65 percent of total billed charges 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 51 199.37 percent of total billed charges 390.92 390.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTRACTOR 3FR STONE 4W GEMINI PAIR HELIC SUP-70-00169 CDM 0272 RC outpatient 672.81 672.81 672.81 74 497.88 percent of total billed charges 672.81 93 544.98 percent of total billed charges 672.81 672.81 other OPPS APC 672.81 672.81 other OPPS APC 672.81 27.63 185.9 percent of total billed charges 672.81 672.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE .038 AMPLATZ SUP-70-00179 CDM C1769 HCPCS 0272 RC outpatient 102.82 102.82 102.82 74 76.09 percent of total billed charges 102.82 93 83.28 percent of total billed charges 102.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 102.82 other OPPS APC 102.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 102.82 other OPPS APC 102.82 27.63 28.41 percent of total billed charges 102.82 102.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE .038 W/3CM TIP FIXED CORE SUP-70-00181 CDM C1769 HCPCS 0272 RC outpatient 43.04 43.04 43.04 74 31.85 percent of total billed charges 43.04 93 34.86 percent of total billed charges 43.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 43.04 other OPPS APC 43.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 43.04 other OPPS APC 43.04 27.63 11.89 percent of total billed charges 43.04 43.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE .035 FIXED CORE SUP-70-00182 CDM C1769 HCPCS 0272 RC outpatient 43.04 43.04 43.04 74 31.85 percent of total billed charges 43.04 93 34.86 percent of total billed charges 43.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 43.04 other OPPS APC 43.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 43.04 other OPPS APC 43.04 27.63 11.89 percent of total billed charges 43.04 43.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR 8FR SEQUENTIAL SUP-70-00183 CDM 0272 RC outpatient 178 178 178 74 131.72 percent of total billed charges 178 93 144.18 percent of total billed charges 178 178 other OPPS APC 178 178 other OPPS APC 178 27.63 49.18 percent of total billed charges 178 178 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER IMAGER 2 COBRA SUP-70-00185 CDM C1758 HCPCS 0272 RC outpatient 69.99 69.99 69.99 74 51.79 percent of total billed charges 69.99 93 56.69 percent of total billed charges 69.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 69.99 other OPPS APC 69.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 69.99 other OPPS APC 69.99 27.63 19.34 percent of total billed charges 69.99 69.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER 6FR OPEN ENDED SUP-70-00188 CDM C1758 HCPCS 0272 RC outpatient 35.67 35.67 35.67 74 26.4 percent of total billed charges 35.67 93 28.89 percent of total billed charges 35.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35.67 other OPPS APC 35.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35.67 other OPPS APC 35.67 27.63 9.86 percent of total billed charges 35.67 35.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DUAL LUMEN SUP-70-00189 CDM C1758 HCPCS 0272 RC outpatient 241.36 241.36 241.36 74 178.61 percent of total billed charges 241.36 93 195.5 percent of total billed charges 241.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.36 other OPPS APC 241.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.36 other OPPS APC 241.36 27.63 66.69 percent of total billed charges 241.36 241.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR 8FR SUP-70-00191 CDM 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR 6FR SUP-70-00192 CDM 0272 RC outpatient 199.25 199.25 199.25 74 147.45 percent of total billed charges 199.25 93 161.39 percent of total billed charges 199.25 199.25 other OPPS APC 199.25 199.25 other OPPS APC 199.25 27.63 55.05 percent of total billed charges 199.25 199.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXIVA 365 MICRON FIBER (SLIMLINE EZ ) SUP-70-00199 CDM 0272 RC outpatient 921.89 921.89 921.89 74 682.2 percent of total billed charges 921.89 93 746.73 percent of total billed charges 921.89 921.89 other OPPS APC 921.89 921.89 other OPPS APC 921.89 27.63 254.72 percent of total billed charges 921.89 921.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXIVA 550 MICRON FIBER (SLIMLINE EZ ) SUP-70-00200 CDM 0272 RC outpatient 1236.79 1236.79 1236.79 74 915.22 percent of total billed charges 1236.79 93 1001.8 percent of total billed charges 1236.79 1236.79 other OPPS APC 1236.79 1236.79 other OPPS APC 1236.79 27.63 341.73 percent of total billed charges 1236.79 1236.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH ACCESS 28 CM 11-13 FR URETEROSCOPIC SUP-70-00205 CDM 0272 RC outpatient 445.94 445.94 445.94 74 330 percent of total billed charges 445.94 93 361.21 percent of total billed charges 445.94 445.94 other OPPS APC 445.94 445.94 other OPPS APC 445.94 27.63 123.21 percent of total billed charges 445.94 445.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRASPER 2.4FR TRICEPT SUP-70-00206 CDM 0272 RC outpatient 605.05 605.05 605.05 74 447.74 percent of total billed charges 605.05 93 490.09 percent of total billed charges 605.05 605.05 other OPPS APC 605.05 605.05 other OPPS APC 605.05 27.63 167.18 percent of total billed charges 605.05 605.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRAIGHT SENSOR WIRE .035 SUP-70-00207 CDM C1769 HCPCS 0272 RC outpatient 170.3 170.3 170.3 74 126.02 percent of total billed charges 170.3 93 137.94 percent of total billed charges 170.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 170.3 other OPPS APC 170.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 170.3 other OPPS APC 170.3 27.63 47.05 percent of total billed charges 170.3 170.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT PERCUFLEX 4.8FR X 22 SUP-70-00209 CDM C2625 HCPCS 0278 RC outpatient 390.92 390.92 390.92 57 222.82 percent of total billed charges 390.92 93 316.65 percent of total billed charges 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 51 199.37 percent of total billed charges 390.92 390.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT PERCUFLEX 4.8FR X 24 SUP-70-00210 CDM C2625 HCPCS 0278 RC outpatient 390.92 390.92 390.92 57 222.82 percent of total billed charges 390.92 93 316.65 percent of total billed charges 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 51 199.37 percent of total billed charges 390.92 390.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT PERCUFLEX 4.8FR X 26 SUP-70-00211 CDM C2625 HCPCS 0278 RC outpatient 390.92 390.92 390.92 57 222.82 percent of total billed charges 390.92 93 316.65 percent of total billed charges 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 51 199.37 percent of total billed charges 390.92 390.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT PERCUFLEX 4.8FR X 28 SUP-70-00212 CDM C2625 HCPCS 0278 RC outpatient 390.92 390.92 390.92 57 222.82 percent of total billed charges 390.92 93 316.65 percent of total billed charges 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.92 other OPPS APC 390.92 51 199.37 percent of total billed charges 390.92 390.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE 24FR POINTED 27050L SUP-70-00213 CDM 0272 RC outpatient 347.82 347.82 347.82 74 257.39 percent of total billed charges 347.82 93 281.73 percent of total billed charges 347.82 347.82 other OPPS APC 347.82 347.82 other OPPS APC 347.82 27.63 96.1 percent of total billed charges 347.82 347.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT SET BANDER UTETERAL DIV 70CM SUP-70-00214 CDM C2625 HCPCS 0278 RC outpatient 390.55 390.55 390.55 57 222.61 percent of total billed charges 390.55 93 316.35 percent of total billed charges 390.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.55 other OPPS APC 390.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.55 other OPPS APC 390.55 51 199.18 percent of total billed charges 390.55 390.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RANGER IRRIGATION FLUID WARMING SET SUP-70-00215 CDM 0272 RC outpatient 154.36 154.36 154.36 74 114.23 percent of total billed charges 154.36 93 125.03 percent of total billed charges 154.36 154.36 other OPPS APC 154.36 154.36 other OPPS APC 154.36 27.63 42.65 percent of total billed charges 154.36 154.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE STORTZ 4FR INJECTION SUP-70-00219 CDM 0272 RC outpatient 447.06 447.06 447.06 74 330.82 percent of total billed charges 447.06 93 362.12 percent of total billed charges 447.06 447.06 other OPPS APC 447.06 447.06 other OPPS APC 447.06 27.63 123.52 percent of total billed charges 447.06 447.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE 24FR BIPOLAR COAGULATION BALL SUP-70-00220 CDM 0272 RC outpatient 1513.24 1513.24 1513.24 74 1119.8 percent of total billed charges 1513.24 93 1225.72 percent of total billed charges 1513.24 1513.24 other OPPS APC 1513.24 1513.24 other OPPS APC 1513.24 27.63 418.11 percent of total billed charges 1513.24 1513.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 24/26FR BIPOLAR CUTTING LOOP SUP-70-00221 CDM 0272 RC outpatient 1364.27 1364.27 1364.27 74 1009.56 percent of total billed charges 1364.27 93 1105.06 percent of total billed charges 1364.27 1364.27 other OPPS APC 1364.27 1364.27 other OPPS APC 1364.27 27.63 376.95 percent of total billed charges 1364.27 1364.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTING LOOP BIPOLAR LONGITUDINAL SUP-70-00222 CDM 0272 RC outpatient 1220.2 1220.2 1220.2 74 902.95 percent of total billed charges 1220.2 93 988.36 percent of total billed charges 1220.2 1220.2 other OPPS APC 1220.2 1220.2 other OPPS APC 1220.2 27.63 337.14 percent of total billed charges 1220.2 1220.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MALECOT NEPH CATH 7 X 18 SUP-70-00224 CDM C1729 HCPCS 0272 RC outpatient 288.91 288.91 288.91 74 213.79 percent of total billed charges 288.91 93 234.02 percent of total billed charges 288.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 288.91 other OPPS APC 288.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 288.91 other OPPS APC 288.91 27.63 79.83 percent of total billed charges 288.91 288.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MALECOT NEPH CATH 7 X 22 SUP-70-00225 CDM C1729 HCPCS 0272 RC outpatient 294.63 294.63 294.63 74 218.03 percent of total billed charges 294.63 93 238.65 percent of total billed charges 294.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 294.63 other OPPS APC 294.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 294.63 other OPPS APC 294.63 27.63 81.41 percent of total billed charges 294.63 294.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MALECOT NEPH CATH 7 X 24 SUP-70-00226 CDM C1729 HCPCS 0272 RC outpatient 297.36 297.36 297.36 74 220.05 percent of total billed charges 297.36 93 240.86 percent of total billed charges 297.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.36 other OPPS APC 297.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.36 other OPPS APC 297.36 27.63 82.16 percent of total billed charges 297.36 297.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6FR CONTOUR VL SUP-70-00227 CDM C2625 HCPCS 0278 RC outpatient 475.16 475.16 475.16 57 270.84 percent of total billed charges 475.16 93 384.88 percent of total billed charges 475.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 475.16 other OPPS APC 475.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 475.16 other OPPS APC 475.16 51 242.33 percent of total billed charges 475.16 475.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.8FR CONTOUR VL SUP-70-00228 CDM C2625 HCPCS 0278 RC outpatient 475.16 475.16 475.16 57 270.84 percent of total billed charges 475.16 93 384.88 percent of total billed charges 475.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 475.16 other OPPS APC 475.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 475.16 other OPPS APC 475.16 51 242.33 percent of total billed charges 475.16 475.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ESCAPE BASET SUP-70-00232 CDM 0272 RC outpatient 763.09 763.09 763.09 74 564.69 percent of total billed charges 763.09 93 618.1 percent of total billed charges 763.09 763.09 other OPPS APC 763.09 763.09 other OPPS APC 763.09 27.63 210.84 percent of total billed charges 763.09 763.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Y ADAPTER BOX SUP-70-00233 CDM 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 630 other OPPS APC 630 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASKET SEGURA 4 WIRE O TIP 3.0FR 120MM SUP-70-00236 CDM 0272 RC outpatient 618.17 618.17 618.17 74 457.45 percent of total billed charges 618.17 93 500.72 percent of total billed charges 618.17 618.17 other OPPS APC 618.17 618.17 other OPPS APC 618.17 27.63 170.8 percent of total billed charges 618.17 618.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASKET SEGURA 4 WIRE O TIP 4.5FR. 90CM SUP-70-00237 CDM 0272 RC outpatient 629.83 629.83 629.83 74 466.07 percent of total billed charges 629.83 93 510.16 percent of total billed charges 629.83 629.83 other OPPS APC 629.83 629.83 other OPPS APC 629.83 27.63 174.02 percent of total billed charges 629.83 629.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STONE CATCHER W/TUBING SUP-70-00239 CDM 0272 RC outpatient 262.74 262.74 262.74 74 194.43 percent of total billed charges 262.74 93 212.82 percent of total billed charges 262.74 262.74 other OPPS APC 262.74 262.74 other OPPS APC 262.74 27.63 72.6 percent of total billed charges 262.74 262.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLEAR RENAL SHEATH SUP-70-00240 CDM 0272 RC outpatient 198.7 198.7 198.7 74 147.04 percent of total billed charges 198.7 93 160.95 percent of total billed charges 198.7 198.7 other OPPS APC 198.7 198.7 other OPPS APC 198.7 27.63 54.9 percent of total billed charges 198.7 198.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE 24/26 BIPOLAR POINTED SUP-70-00242 CDM 0272 RC outpatient 1220.2 1220.2 1220.2 74 902.95 percent of total billed charges 1220.2 93 988.36 percent of total billed charges 1220.2 1220.2 other OPPS APC 1220.2 1220.2 other OPPS APC 1220.2 27.63 337.14 percent of total billed charges 1220.2 1220.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASKET 2.4FR ZERO TIP SUP-70-00243 CDM 0272 RC outpatient 631.47 631.47 631.47 74 467.29 percent of total billed charges 631.47 93 511.49 percent of total billed charges 631.47 631.47 other OPPS APC 631.47 631.47 other OPPS APC 631.47 27.63 174.48 percent of total billed charges 631.47 631.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONE STAR RETRACTOR STAY 12MM BLUNT SUP-70-00244 CDM 0272 RC outpatient 31.08 31.08 31.08 74 23 percent of total billed charges 31.08 93 25.17 percent of total billed charges 31.08 31.08 other OPPS APC 31.08 31.08 other OPPS APC 31.08 27.63 8.59 percent of total billed charges 31.08 31.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISPOSABLE CORE BIOPSY INSTRUMENT SUP-70-00245 CDM 0272 RC outpatient 186.14 186.14 186.14 74 137.74 percent of total billed charges 186.14 93 150.77 percent of total billed charges 186.14 186.14 other OPPS APC 186.14 186.14 other OPPS APC 186.14 27.63 51.43 percent of total billed charges 186.14 186.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBER FLEXIVA PULSE ID 242 SUP-70-00247 CDM 0272 RC outpatient 1224.17 1224.17 1224.17 74 905.89 percent of total billed charges 1224.17 93 991.58 percent of total billed charges 1224.17 1224.17 other OPPS APC 1224.17 1224.17 other OPPS APC 1224.17 27.63 338.24 percent of total billed charges 1224.17 1224.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBER FLEXIVA PULSE ID 365 SUP-70-00248 CDM 0272 RC outpatient 1016.29 1016.29 1016.29 74 752.05 percent of total billed charges 1016.29 93 823.19 percent of total billed charges 1016.29 1016.29 other OPPS APC 1016.29 1016.29 other OPPS APC 1016.29 27.63 280.8 percent of total billed charges 1016.29 1016.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBER FLEXIVA PULSE ID 550 SUP-70-00249 CDM 0272 RC outpatient 1339.65 1339.65 1339.65 74 991.34 percent of total billed charges 1339.65 93 1085.12 percent of total billed charges 1339.65 1339.65 other OPPS APC 1339.65 1339.65 other OPPS APC 1339.65 27.63 370.15 percent of total billed charges 1339.65 1339.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBER FLEXIVA PULSE ID910 MICRON SUP-70-00250 CDM 0272 RC outpatient 2252 2252 2252 74 1666.48 percent of total billed charges 2252 93 1824.12 percent of total billed charges 2252 2252 other OPPS APC 2252 2252 other OPPS APC 2252 27.63 622.23 percent of total billed charges 2252 2252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OPTILUME DCB AND INFLATION DEVICE 24FR 3CM SUP-70-00251 CDM C1726 HCPCS 0272 RC outpatient 7750 7750 7750 74 5735 percent of total billed charges 7750 93 6277.5 percent of total billed charges 7750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7750 other OPPS APC 7750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7750 other OPPS APC 7750 27.63 2141.33 percent of total billed charges 7750 7750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OPTILUME DCB AND INFLATION DEVICE 24FR 5CM SUP-70-00252 CDM C1726 HCPCS 0272 RC outpatient 7750 7750 7750 74 5735 percent of total billed charges 7750 93 6277.5 percent of total billed charges 7750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7750 other OPPS APC 7750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7750 other OPPS APC 7750 27.63 2141.33 percent of total billed charges 7750 7750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OPTILUME DCB AND INFLATION DEVICE 30FR 3CM SUP-70-00253 CDM C1726 HCPCS 0272 RC outpatient 7750 7750 7750 74 5735 percent of total billed charges 7750 93 6277.5 percent of total billed charges 7750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7750 other OPPS APC 7750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7750 other OPPS APC 7750 27.63 2141.33 percent of total billed charges 7750 7750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OPTILUME DCB AND INFLATION DEVICE 30FR 5CM SUP-70-00254 CDM C1726 HCPCS 0272 RC outpatient 7750 7750 7750 74 5735 percent of total billed charges 7750 93 6277.5 percent of total billed charges 7750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7750 other OPPS APC 7750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7750 other OPPS APC 7750 27.63 2141.33 percent of total billed charges 7750 7750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH ACCESS 36 CM 11-13 FR URETEROSCOPIC SUP-70-00255 CDM outpatient 445.94 445.94 445.94 445.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE MINI MENISCUS BX/6 SUP-70-0075-003 CDM 0270 RC outpatient 122.2 122.2 122.2 74 90.43 percent of total billed charges 122.2 93 98.98 percent of total billed charges 122.2 122.2 other OPPS APC 122.2 122.2 other OPPS APC 122.2 27.63 33.76 percent of total billed charges 122.2 122.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE MINI MENISCUS BX/6 SUP-70-0077-003 CDM 0270 RC outpatient 122.2 122.2 122.2 74 90.43 percent of total billed charges 122.2 93 98.98 percent of total billed charges 122.2 122.2 other OPPS APC 122.2 122.2 other OPPS APC 122.2 27.63 33.76 percent of total billed charges 122.2 122.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNIFE ARTHROSCOPIC SHEATHED MENISCUS SERRATED STRAIGHT 2 SIDE POINT BLACK 3.0MM SUP-70-0077-103 CDM 0270 RC outpatient 122.2 122.2 122.2 74 90.43 percent of total billed charges 122.2 93 98.98 percent of total billed charges 122.2 122.2 other OPPS APC 122.2 122.2 other OPPS APC 122.2 27.63 33.76 percent of total billed charges 122.2 122.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE MINI MENISCUS BX/6 SUP-70-0078-003 CDM 0270 RC outpatient 122.2 122.2 122.2 74 90.43 percent of total billed charges 122.2 93 98.98 percent of total billed charges 122.2 122.2 other OPPS APC 122.2 122.2 other OPPS APC 122.2 27.63 33.76 percent of total billed charges 122.2 122.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNIFE ARTHROSCOPIC SHEATHED MENISCUS SERRATED STRAIGHT 2 SIDED ROUND TAN 3.0MM SUP-70-0078-103 CDM 0270 RC outpatient 122.2 122.2 122.2 74 90.43 percent of total billed charges 122.2 93 98.98 percent of total billed charges 122.2 122.2 other OPPS APC 122.2 122.2 other OPPS APC 122.2 27.63 33.76 percent of total billed charges 122.2 122.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ACU-LOC 2 LUNATE DISTAL VOLAR SUTURE NONSTERILE SUP-70-0334 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ACU-LOC 2 STANDARD L49 MM X W24 MM RADIAL LEFT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW SUP-70-0350 CDM 0270 RC outpatient 2992.6 2992.6 2992.6 74 2214.52 percent of total billed charges 2992.6 93 2424.01 percent of total billed charges 2992.6 2992.6 other OPPS APC 2992.6 2992.6 other OPPS APC 2992.6 27.63 826.86 percent of total billed charges 2992.6 2992.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ACU-LOC 2 STANDARD L51 MM RADIUS LEFT VOLAR DISTAL VARIABLE ANGLE NONSTERILE 2.3 MM SUP-70-0356 CDM 0270 RC outpatient 2992.6 2992.6 2992.6 74 2214.52 percent of total billed charges 2992.6 93 2424.01 percent of total billed charges 2992.6 2992.6 other OPPS APC 2992.6 2992.6 other OPPS APC 2992.6 27.63 826.86 percent of total billed charges 2992.6 2992.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ACU-LOC 2 STANDARD L51 MM X W25 MM RADIUS RIGHT VOLAR DISTAL VARIABLE ANGLE NONSTERILE 2.3 MM SCREW SUP-70-0357 CDM 0270 RC outpatient 2992.6 2992.6 2992.6 74 2214.52 percent of total billed charges 2992.6 93 2424.01 percent of total billed charges 2992.6 2992.6 other OPPS APC 2992.6 2992.6 other OPPS APC 2992.6 27.63 826.86 percent of total billed charges 2992.6 2992.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ACU-LOC 2 NARROW L51 MM X W22 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW SUP-70-0359 CDM 0270 RC outpatient 2992.6 2992.6 2992.6 74 2214.52 percent of total billed charges 2992.6 93 2424.01 percent of total billed charges 2992.6 2992.6 other OPPS APC 2992.6 2992.6 other OPPS APC 2992.6 27.63 826.86 percent of total billed charges 2992.6 2992.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIUS LEFT VOLAR DISTAL VARIABLE ANGLE NONSTERILE 2.3 MM SCREW SUP-70-0360 CDM 0270 RC outpatient 2992.6 2992.6 2992.6 74 2214.52 percent of total billed charges 2992.6 93 2424.01 percent of total billed charges 2992.6 2992.6 other OPPS APC 2992.6 2992.6 other OPPS APC 2992.6 27.63 826.86 percent of total billed charges 2992.6 2992.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ACU-LOC 2 LONG STANDARD L65 MM RADIAL RIGHT VOLAR DISTAL EXTENSION LOW PROFILE NONSTERILE SUP-70-0369 CDM 0270 RC outpatient 2992.6 2992.6 2992.6 74 2214.52 percent of total billed charges 2992.6 93 2424.01 percent of total billed charges 2992.6 2992.6 other OPPS APC 2992.6 2992.6 other OPPS APC 2992.6 27.63 826.86 percent of total billed charges 2992.6 2992.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ACU-LOC 2 LONG NARROW L65 MM LEFT DISTAL VOLAR RADIAL EXTENSION LOW PROFILE STERILE SILVER SUP-70-0370 CDM 0270 RC outpatient 2992.6 2992.6 2992.6 74 2214.52 percent of total billed charges 2992.6 93 2424.01 percent of total billed charges 2992.6 2992.6 other OPPS APC 2992.6 2992.6 other OPPS APC 2992.6 27.63 826.86 percent of total billed charges 2992.6 2992.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ACU-LOC 2 LONG NARROW L65 MM X W21 MM RADIAL LEFT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW SUP-70-0382 CDM 0270 RC outpatient 2992.6 2992.6 2992.6 74 2214.52 percent of total billed charges 2992.6 93 2424.01 percent of total billed charges 2992.6 2992.6 other OPPS APC 2992.6 2992.6 other OPPS APC 2992.6 27.63 826.86 percent of total billed charges 2992.6 2992.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VARIAX TITANIUM T7 L10 MM OD2.7 MM FOOT NONLOCK SELF TAP SCREWDRIVER YELLOW LOCK PLATE SYSTEM SUP-70-27010 CDM 0270 RC outpatient 332.8 332.8 332.8 74 246.27 percent of total billed charges 332.8 93 269.57 percent of total billed charges 332.8 332.8 other OPPS APC 332.8 332.8 other OPPS APC 332.8 27.63 91.95 percent of total billed charges 332.8 332.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STRYKER NON LOCKING 2.7MM X 18MM SUP-70-27018 CDM 0270 RC outpatient 247.52 247.52 247.52 74 183.16 percent of total billed charges 247.52 93 200.49 percent of total billed charges 247.52 247.52 other OPPS APC 247.52 247.52 other OPPS APC 247.52 27.63 68.39 percent of total billed charges 247.52 247.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT II TRITANIUM D OD50 MM HIP SOLID BACK STERILE SUP-700-04-50D CDM 270010024 LOCAL 0270 RC outpatient 4959.63 4959.63 4959.63 74 3670.13 percent of total billed charges 4959.63 93 4017.3 percent of total billed charges 4959.63 4959.63 other OPPS APC 4959.63 4959.63 other OPPS APC 4959.63 27.63 1370.35 percent of total billed charges 4959.63 4959.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT II TRITANIUM E OD52 MM HIP SOLID BACK STERILE SUP-700-04-52E CDM 270010024 LOCAL 0270 RC outpatient 4959.63 4959.63 4959.63 74 3670.13 percent of total billed charges 4959.63 93 4017.3 percent of total billed charges 4959.63 4959.63 other OPPS APC 4959.63 4959.63 other OPPS APC 4959.63 27.63 1370.35 percent of total billed charges 4959.63 4959.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT II TRITANIUM E OD54 MM HIP SOLID BACK STERILE SUP-700-04-54E CDM 270010024 LOCAL 0270 RC outpatient 4959.63 4959.63 4959.63 74 3670.13 percent of total billed charges 4959.63 93 4017.3 percent of total billed charges 4959.63 4959.63 other OPPS APC 4959.63 4959.63 other OPPS APC 4959.63 27.63 1370.35 percent of total billed charges 4959.63 4959.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL STARBURST XL L15 CM L3-5 CM OD6.4 FR 9 ARRAY TROCAR TIP SLIM HANDLE DESIGN EXPANDABLE RADIOFREQUENCY ABLATION STERILE DISPOSABLE SUP-700-101320 CDM 0270 RC outpatient 3965 3965 3965 74 2934.1 percent of total billed charges 3965 93 3211.65 percent of total billed charges 3965 3965 other OPPS APC 3965 3965 other OPPS APC 3965 27.63 1095.53 percent of total billed charges 3965 3965 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE STARBURST XLI ENHANCED WITH THERMOPADS 12CM SUP-700-103027 CDM 0270 RC outpatient 2.6 2.6 2.6 74 1.92 percent of total billed charges 2.6 93 2.11 percent of total billed charges 2.6 2.6 other OPPS APC 2.6 2.6 other OPPS APC 2.6 27.63 0.72 percent of total billed charges 2.6 2.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL STARBURST XL C0-90 D TROCAR BEVEL L15 CM L3.5 CM OD6.4 FR ATTACHED CABLE SLIM HANDLE DESIGN MULTIPOINT TEMPERATURE SMALL MINIMALLY INVASIVE DISPOSABLE SUP-700-103902 CDM 0270 RC outpatient 5530.2 5530.2 5530.2 74 4092.35 percent of total billed charges 5530.2 93 4479.46 percent of total billed charges 5530.2 5530.2 other OPPS APC 5530.2 5530.2 other OPPS APC 5530.2 27.63 1527.99 percent of total billed charges 5530.2 5530.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5FR VASCADE CLOSURE DEVICE SUP-700-500DX-05U CDM 0270 RC outpatient 533 533 533 74 394.42 percent of total billed charges 533 93 431.73 percent of total billed charges 533 533 other OPPS APC 533 533 other OPPS APC 533 27.63 147.27 percent of total billed charges 533 533 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6/7FR VASCADE CLOSURE DEVICE SUP-700-580I-05U CDM 0270 RC outpatient 533 533 533 74 394.42 percent of total billed charges 533 93 431.73 percent of total billed charges 533 533 other OPPS APC 533 533 other OPPS APC 533 27.63 147.27 percent of total billed charges 533 533 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Cleaner XT 6F x 65cm SUP-700009XT CDM 0270 RC outpatient 1547 1547 1547 74 1144.78 percent of total billed charges 1547 93 1253.07 percent of total billed charges 1547 1547 other OPPS APC 1547 1547 other OPPS APC 1547 27.63 427.44 percent of total billed charges 1547 1547 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC 27MM SUP-7000TFX27 CDM 0270 RC outpatient 16380 16380 16380 74 12121.2 percent of total billed charges 16380 93 13267.8 percent of total billed charges 16380 16380 other OPPS APC 16380 16380 other OPPS APC 16380 27.63 4525.79 percent of total billed charges 16380 16380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOPCOCK ANGIOGRAPHY NAMIC 200 PSI 3 WAY ROTATE MALE COLLAR PORT PROTECTOR NONDEHP LATEX FREE SUP-70015002 CDM 0270 RC outpatient 3.86 3.86 3.86 74 2.86 percent of total billed charges 3.86 93 3.13 percent of total billed charges 3.86 3.86 other OPPS APC 3.86 3.86 other OPPS APC 3.86 27.63 1.07 percent of total billed charges 3.86 3.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOPCOCK ANGIOGRAPHY 1050 PSI 3 WAY ROTATE ADAPTER RIGHT PORT SUP-70055009 CDM 0270 RC outpatient 7.43 7.43 7.43 74 5.5 percent of total billed charges 7.43 93 6.02 percent of total billed charges 7.43 7.43 other OPPS APC 7.43 7.43 other OPPS APC 7.43 27.63 2.05 percent of total billed charges 7.43 7.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEETING SILASTIC ALLIEDSIL SILICONE THK.01 IN L8 IN X W6 IN REINFORCE SHORT TERM PERMANENT STERILE SUP-701-10 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON 23.5D SUP-70141 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON IOL 23.5D SUP-70141 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT II TRITANIUM D OD50 MM HIP CLUSTER HOLE STERILE SUP-702-04-50D CDM 270010024 LOCAL 0270 RC outpatient 4959.63 4959.63 4959.63 74 3670.13 percent of total billed charges 4959.63 93 4017.3 percent of total billed charges 4959.63 4959.63 other OPPS APC 4959.63 4959.63 other OPPS APC 4959.63 27.63 1370.35 percent of total billed charges 4959.63 4959.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT II TRITANIUM E OD52 MM HIP CLUSTER HOLE STERILE SUP-702-04-52E CDM 270010024 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT II TRITANIUM E OD54 MM HIP 5 SCREW HOLE CLUSTER STERILE SUP-702-04-54E CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT II TRITANIUM F OD56 MM HIP CLUSTER HOLE STERILE SUP-702-04-56F CDM 270010024 LOCAL 0270 RC outpatient 4959.63 4959.63 4959.63 74 3670.13 percent of total billed charges 4959.63 93 4017.3 percent of total billed charges 4959.63 4959.63 other OPPS APC 4959.63 4959.63 other OPPS APC 4959.63 27.63 1370.35 percent of total billed charges 4959.63 4959.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT II TRITANIUM F OD58 MM HIP 5 SCREW HOLE CLUSTER STERILE SUP-702-04-58F CDM 270010024 LOCAL 0270 RC outpatient 4959.63 4959.63 4959.63 74 3670.13 percent of total billed charges 4959.63 93 4017.3 percent of total billed charges 4959.63 4959.63 other OPPS APC 4959.63 4959.63 other OPPS APC 4959.63 27.63 1370.35 percent of total billed charges 4959.63 4959.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT II TRITANIUM G OD62 MM HIP CLUSTER HOLE STERILE SUP-702-04-62G CDM 270010024 LOCAL 0270 RC outpatient 4959.63 4959.63 4959.63 74 3670.13 percent of total billed charges 4959.63 93 4017.3 percent of total billed charges 4959.63 4959.63 other OPPS APC 4959.63 4959.63 other OPPS APC 4959.63 27.63 1370.35 percent of total billed charges 4959.63 4959.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL STANDARD OD2.7 MM AO FITTING CANNULATED NONSTERILE SUP-702449 CDM 0270 RC outpatient 452.4 452.4 452.4 74 334.78 percent of total billed charges 452.4 93 366.44 percent of total billed charges 452.4 452.4 other OPPS APC 452.4 452.4 other OPPS APC 452.4 27.63 125 percent of total billed charges 452.4 452.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE STRYKER 2.0 FENESTRATED SUP-702453 CDM 0270 RC outpatient 424.32 424.32 424.32 74 314 percent of total billed charges 424.32 93 343.7 percent of total billed charges 424.32 424.32 other OPPS APC 424.32 424.32 other OPPS APC 424.32 27.63 117.24 percent of total billed charges 424.32 424.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC ASNIS III L150 MM OD1.4 MM HIP FEMUR THREAD 4 MM SCREW SUP-702459S CDM 0270 RC outpatient 187.2 187.2 187.2 74 138.53 percent of total billed charges 187.2 93 151.63 percent of total billed charges 187.2 187.2 other OPPS APC 187.2 187.2 other OPPS APC 187.2 27.63 51.72 percent of total billed charges 187.2 187.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC ASNIS III L300 MM L5 MM OD3.2 MM FEMUR HIP STERILE DISPOSABLE 6.5/8 MM SCREW SUP-702462 CDM 0270 RC outpatient 241.8 241.8 241.8 74 178.93 percent of total billed charges 241.8 93 195.86 percent of total billed charges 241.8 241.8 other OPPS APC 241.8 241.8 other OPPS APC 241.8 27.63 66.81 percent of total billed charges 241.8 241.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KWIRE STRYKER 3.2MM SUP-702462 CDM 0270 RC outpatient 117 117 117 74 86.58 percent of total billed charges 117 93 94.77 percent of total billed charges 117 117 other OPPS APC 117 117 other OPPS APC 117 27.63 32.33 percent of total billed charges 117 117 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE GUIDE SMOOTH 3.2 X 300MM SUP-702463 CDM 0270 RC outpatient 117 117 117 74 86.58 percent of total billed charges 117 93 94.77 percent of total billed charges 117 117 other OPPS APC 117 117 other OPPS APC 117 27.63 32.33 percent of total billed charges 117 117 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SWAB ORAL TOOTHETTE GLYCERIN FOAM STICK RIDGE LEMON SUP-702485 CDM outpatient 0.06 0.06 0.06 0.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL ASNIS III LARGE OD4.9 MM CANNULATED AO FIT 6.5 MM SCREW SUP-702601 CDM 0270 RC outpatient 1050.4 1050.4 1050.4 74 777.3 percent of total billed charges 1050.4 93 850.82 percent of total billed charges 1050.4 1050.4 other OPPS APC 1050.4 1050.4 other OPPS APC 1050.4 27.63 290.23 percent of total billed charges 1050.4 1050.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT ASNIS 5.6MM SUP-702611 CDM 0270 RC outpatient 492.96 492.96 492.96 74 364.79 percent of total billed charges 492.96 93 399.3 percent of total billed charges 492.96 492.96 other OPPS APC 492.96 492.96 other OPPS APC 492.96 27.63 136.2 percent of total billed charges 492.96 492.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.2MM X 300MM SUP-702626 CDM 0270 RC outpatient 492.96 492.96 492.96 74 364.79 percent of total billed charges 492.96 93 399.3 percent of total billed charges 492.96 492.96 other OPPS APC 492.96 492.96 other OPPS APC 492.96 27.63 136.2 percent of total billed charges 492.96 492.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE MAGNETOS 1-2 MM 1 CC ALLOGRAFT GRANULE PUTTY GOLD STANDARD SUP-703-029-US CDM 0270 RC outpatient 845 845 845 74 625.3 percent of total billed charges 845 93 684.45 percent of total billed charges 845 845 other OPPS APC 845 845 other OPPS APC 845 27.63 233.47 percent of total billed charges 845 845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE MAGNETOS 5CC EASYPACK PUTTY SUP-703-051-US CDM 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID MAGNETOS EASYPACK 1-2 MM GRANULE 10 CC PUTTY SUP-703-053-US CDM 0270 RC outpatient 7800 7800 7800 74 5772 percent of total billed charges 7800 93 6318 percent of total billed charges 7800 7800 other OPPS APC 7800 7800 other OPPS APC 7800 27.63 2155.14 percent of total billed charges 7800 7800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE MAGNETOS MATRIX .25-1 MM MEDIUM ALLOGRAFT FLEX SUP-703-057-US CDM 0270 RC outpatient 5460 5460 5460 74 4040.4 percent of total billed charges 5460 93 4422.6 percent of total billed charges 5460 5460 other OPPS APC 5460 5460 other OPPS APC 5460 27.63 1508.6 percent of total billed charges 5460 5460 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE MAGNETOS MATRIX .25-1 MM LARGE ALLOGRAFT FLEX SUP-703-058-US CDM 0270 RC outpatient 9100 9100 9100 74 6734 percent of total billed charges 9100 93 7371 percent of total billed charges 9100 9100 other OPPS APC 9100 9100 other OPPS APC 9100 27.63 2514.33 percent of total billed charges 9100 9100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIDENT II L15 MM OD6.5 MM LOW PROFILE HEXAGONAL STERILE SUP-7030-6515 CDM 270010024 LOCAL 0270 RC outpatient 257.4 257.4 257.4 74 190.48 percent of total billed charges 257.4 93 208.49 percent of total billed charges 257.4 257.4 other OPPS APC 257.4 257.4 other OPPS APC 257.4 27.63 71.12 percent of total billed charges 257.4 257.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIDENT II L20 MM OD6.5 MM LOW PROFILE HEXAGONAL STERILE SUP-7030-6520 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ACETABULAR TRIDENT II TRITANIUM 6.5MM X 25MM SCREW HOLE CLUSTER STERILE SUP-7030-6525 CDM 270010024 LOCAL 0270 RC outpatient 257.4 257.4 257.4 74 190.48 percent of total billed charges 257.4 93 208.49 percent of total billed charges 257.4 257.4 other OPPS APC 257.4 257.4 other OPPS APC 257.4 27.63 71.12 percent of total billed charges 257.4 257.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIDENT II L30 MM OD6.5 MM LOW PROFILE HEXAGONAL STERILE SUP-7030-6530 CDM 270010024 LOCAL 0270 RC outpatient 257.4 257.4 257.4 74 190.48 percent of total billed charges 257.4 93 208.49 percent of total billed charges 257.4 257.4 other OPPS APC 257.4 257.4 other OPPS APC 257.4 27.63 71.12 percent of total billed charges 257.4 257.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIDENT II L35 MM OD6.5 MM LOW PROFILE HEXAGONAL STERILE SUP-7030-6535 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIDENT II L40 MM OD6.5 MM LOW PROFILE HEXAGONAL STERILE SUP-7030-6540 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.5MM LOW PROFILE HEX SCREW 45MM SUP-7030-6545 CDM 270010024 LOCAL 0270 RC outpatient 257.4 257.4 257.4 74 190.48 percent of total billed charges 257.4 93 208.49 percent of total billed charges 257.4 257.4 other OPPS APC 257.4 257.4 other OPPS APC 257.4 27.63 71.12 percent of total billed charges 257.4 257.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIDENT II L50 MM OD6.5 MM LOW PROFILE HEXAGONAL STERILE SUP-7030-6550 CDM 270010024 LOCAL 0270 RC outpatient 257.4 257.4 257.4 74 190.48 percent of total billed charges 257.4 93 208.49 percent of total billed charges 257.4 257.4 other OPPS APC 257.4 257.4 other OPPS APC 257.4 27.63 71.12 percent of total billed charges 257.4 257.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEPTUNE FLUID TRAP SUP-703040001 CDM 0270 RC outpatient 19.5 19.5 19.5 74 14.43 percent of total billed charges 19.5 93 15.8 percent of total billed charges 19.5 19.5 other OPPS APC 19.5 19.5 other OPPS APC 19.5 27.63 5.39 percent of total billed charges 19.5 19.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OR STERILE TOWELS 4/PK SUP-704-B CDM 0270 RC outpatient 5.19 5.19 5.19 74 3.84 percent of total billed charges 5.19 93 4.2 percent of total billed charges 5.19 5.19 other OPPS APC 5.19 5.19 other OPPS APC 5.19 27.63 1.43 percent of total billed charges 5.19 5.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAMIC PRECEPTOR DT STANDARD POLE MOUNT KIT TRANSDUCER SUP-70400052 CDM 0270 RC outpatient 65.08 65.08 65.08 74 48.16 percent of total billed charges 65.08 93 52.71 percent of total billed charges 65.08 65.08 other OPPS APC 65.08 65.08 other OPPS APC 65.08 27.63 17.98 percent of total billed charges 65.08 65.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON 18.0D SUP-70486 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON IOL 18.0D SUP-70486 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS LENS GRIESHABER MAXGRIP OD25+ GA MICRO TEXTURE BROAD GRASP SURFACE BLUNT DISTAL END HEAVY MEMBRANE STERILE DISPOSABLE SUP-705.13P CDM 0270 RC outpatient 449.36 449.36 449.36 74 332.53 percent of total billed charges 449.36 93 363.98 percent of total billed charges 449.36 449.36 other OPPS APC 449.36 449.36 other OPPS APC 449.36 27.63 124.16 percent of total billed charges 449.36 449.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS SURGICAL L25 CM END GRASPING TIP POSITIVE SUP-705.43P CDM 0270 RC outpatient 402.87 402.87 402.87 74 298.12 percent of total billed charges 402.87 93 326.32 percent of total billed charges 402.87 402.87 other OPPS APC 402.87 402.87 other OPPS APC 402.87 27.63 111.31 percent of total billed charges 402.87 402.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS OPHTHALMIC GRIESHABER REVOLUTION 25GA DISPOSABLE STERILE RETINAL INTERNAL LIMIT MEMBRANE SUP-705.44 CDM 0270 RC outpatient 395.59 395.59 395.59 74 292.74 percent of total billed charges 395.59 93 320.43 percent of total billed charges 395.59 395.59 other OPPS APC 395.59 395.59 other OPPS APC 395.59 27.63 109.3 percent of total billed charges 395.59 395.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS OPHTHALMIC GRIESHABER REVOLUTION OD25+ GA ILLUMINATOR MULTIPURPOSE END GRASP FINE MEMBRANE STERILE DISPOSABLE SUP-705.44P CDM 0270 RC outpatient 436.25 436.25 436.25 74 322.83 percent of total billed charges 436.25 93 353.36 percent of total billed charges 436.25 436.25 other OPPS APC 436.25 436.25 other OPPS APC 436.25 27.63 120.54 percent of total billed charges 436.25 436.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCISSORS OPHTHALMIC GRIESHABER REVOLUTION 25+ D CURVED TIP SUP-705.52P CDM 0270 RC outpatient 641.29 641.29 641.29 74 474.55 percent of total billed charges 641.29 93 519.44 percent of total billed charges 641.29 641.29 other OPPS APC 641.29 641.29 other OPPS APC 641.29 27.63 177.19 percent of total billed charges 641.29 641.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS SURGICAL SHARKSKIN OD25+ GA ILLUMINATE STERILE DISPOSABLE SUP-705.88P CDM 0270 RC outpatient 464.41 464.41 464.41 74 343.66 percent of total billed charges 464.41 93 376.17 percent of total billed charges 464.41 464.41 other OPPS APC 464.41 464.41 other OPPS APC 464.41 27.63 128.32 percent of total billed charges 464.41 464.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K WIRE 1.4X150 SUP-705233S CDM 0270 RC outpatient 249.34 249.34 249.34 74 184.51 percent of total billed charges 249.34 93 201.97 percent of total billed charges 249.34 249.34 other OPPS APC 249.34 249.34 other OPPS APC 249.34 27.63 68.89 percent of total billed charges 249.34 249.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 3.2 SUP-705235S CDM 0270 RC outpatient 278.46 278.46 278.46 74 206.06 percent of total billed charges 278.46 93 225.55 percent of total billed charges 278.46 278.46 other OPPS APC 278.46 278.46 other OPPS APC 278.46 27.63 76.94 percent of total billed charges 278.46 278.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL CANNULATED 2.7 SUP-705250 CDM 0270 RC outpatient 938.91 938.91 938.91 74 694.79 percent of total billed charges 938.91 93 760.52 percent of total billed charges 938.91 938.91 other OPPS APC 938.91 938.91 other OPPS APC 938.91 27.63 259.42 percent of total billed charges 938.91 938.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK SUP-705260 CDM 0270 RC outpatient 729.82 729.82 729.82 74 540.07 percent of total billed charges 729.82 93 591.15 percent of total billed charges 729.82 729.82 other OPPS APC 729.82 729.82 other OPPS APC 729.82 27.63 201.65 percent of total billed charges 729.82 729.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS SURGICAL GRIESHABER MAXGRIP OD23 GA STERILE DISPOSABLE SUP-706.13 CDM 0270 RC outpatient 435.97 435.97 435.97 74 322.62 percent of total billed charges 435.97 93 353.14 percent of total billed charges 435.97 435.97 other OPPS APC 435.97 435.97 other OPPS APC 435.97 27.63 120.46 percent of total billed charges 435.97 435.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS SURGICAL GRIESHABER REVOLUTION OD23 GA END GRASPING FINE TIP MULTIPURPOSE STERILE DISPOSABLE SUP-706.43 CDM 0270 RC outpatient 391.12 391.12 391.12 74 289.43 percent of total billed charges 391.12 93 316.81 percent of total billed charges 391.12 391.12 other OPPS APC 391.12 391.12 other OPPS APC 391.12 27.63 108.07 percent of total billed charges 391.12 391.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS OPHTHALMIC GRIESHABER REVOLUTION 23GA DISPOSABLE STERILE RETINAL INTERNAL LIMIT MEMBRANE SUP-706.44 CDM 0270 RC outpatient 391.12 391.12 391.12 74 289.43 percent of total billed charges 391.12 93 316.81 percent of total billed charges 391.12 391.12 other OPPS APC 391.12 391.12 other OPPS APC 391.12 27.63 108.07 percent of total billed charges 391.12 391.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCISSORS SURGICAL GRIESHABER OD23 GA OPHTHALMIC CURVED DISPOSABLE SUP-706.52 CDM 0270 RC outpatient 542.33 542.33 542.33 74 401.32 percent of total billed charges 542.33 93 439.29 percent of total billed charges 542.33 542.33 other OPPS APC 542.33 542.33 other OPPS APC 542.33 27.63 149.85 percent of total billed charges 542.33 542.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOME HOLE PLUG SUP-7060-0000 CDM 270010024 LOCAL 0270 RC outpatient 143 143 143 74 105.82 percent of total billed charges 143 93 115.83 percent of total billed charges 143 143 other OPPS APC 143 143 other OPPS APC 143 27.63 39.51 percent of total billed charges 143 143 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIDENT II L35 MM OD6.5 MM LOW PROFILE HEXAGONAL STERILE SUP-7060-6515 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 6.5MM LOW PROFILE 25MM SUP-7060-6525 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLIF NUVASIVE MAS TULIP MODULAR SUP-707000 CDM 270010020 LOCAL 0270 RC outpatient 1755 1755 1755 74 1298.7 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 1755 other OPPS APC 1755 1755 other OPPS APC 1755 27.63 484.91 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW NUVASIVE MAD FIXATION LOCK SUP-7070003 CDM 270010020 LOCAL 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHANK NUVASIVE 5.0MM X 30MM SUP-7075030 CDM 270010020 LOCAL 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSITIONER IMPLANT SPINE PIN PLATE HOLD SUP-7080902 CDM 270010020 LOCAL 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT II TRITANIUM F OD56 MM HIP MULTIHOLE STERILE SUP-709-04-56F CDM 270010024 LOCAL 0270 RC outpatient 7540.65 7540.65 7540.65 74 5580.08 percent of total billed charges 7540.65 93 6107.93 percent of total billed charges 7540.65 7540.65 other OPPS APC 7540.65 7540.65 other OPPS APC 7540.65 27.63 2083.48 percent of total billed charges 7540.65 7540.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT II TRITANIUM F OD58 MM HIP 13 HOLE STERILE SUP-709-04-58F CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHANK NUVASIVE MAS PLIF 5 X 30MM SUP-7095030 CDM 270010020 LOCAL 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHANK NUVASIVE MAS PLIF 5 X 35MM SUP-7095035 CDM 270010020 LOCAL 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TWIST DILL 2.0 SUP-71-00004 CDM 0272 RC outpatient 269.5 269.5 269.5 74 199.43 percent of total billed charges 269.5 93 218.3 percent of total billed charges 269.5 269.5 other OPPS APC 269.5 269.5 other OPPS APC 269.5 27.63 74.46 percent of total billed charges 269.5 269.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LORENZ IMF 2.0 X 5MM SUP-71-00006 CDM C1713 HCPCS 0278 RC outpatient 200.2 200.2 200.2 57 114.11 percent of total billed charges 200.2 93 162.16 percent of total billed charges 200.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200.2 other OPPS APC 200.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200.2 other OPPS APC 200.2 51 102.1 percent of total billed charges 200.2 200.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LORENZ IMF 2.0 X 7MM SUP-71-00007 CDM C1713 HCPCS 0278 RC outpatient 200.2 200.2 200.2 57 114.11 percent of total billed charges 200.2 93 162.16 percent of total billed charges 200.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200.2 other OPPS APC 200.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200.2 other OPPS APC 200.2 51 102.1 percent of total billed charges 200.2 200.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LORENZ IMF 2.0 X 9MM SUP-71-00008 CDM C1713 HCPCS 0278 RC outpatient 190.4 190.4 190.4 57 108.53 percent of total billed charges 190.4 93 154.22 percent of total billed charges 190.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 190.4 other OPPS APC 190.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 190.4 other OPPS APC 190.4 51 97.1 percent of total billed charges 190.4 190.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LORENZ IMF 2.0 X 11MM SUP-71-00009 CDM C1713 HCPCS 0278 RC outpatient 190.4 190.4 190.4 57 108.53 percent of total billed charges 190.4 93 154.22 percent of total billed charges 190.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 190.4 other OPPS APC 190.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 190.4 other OPPS APC 190.4 51 97.1 percent of total billed charges 190.4 190.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE LORENZ 2.0 X-LOCK STD SUP-71-00010 CDM 0272 RC outpatient 448 448 448 74 331.52 percent of total billed charges 448 93 362.88 percent of total billed charges 448 448 other OPPS APC 448 448 other OPPS APC 448 27.63 123.78 percent of total billed charges 448 448 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROLENE MESH 3 X 6 SUP-71-00129 CDM C1781 HCPCS 0278 RC outpatient 206.72 206.72 206.72 57 117.83 percent of total billed charges 206.72 93 167.44 percent of total billed charges 206.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.72 other OPPS APC 206.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.72 other OPPS APC 206.72 51 105.43 percent of total billed charges 206.72 206.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE WAX W31G SUP-71-00132 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ENDOKNOT ETHILON EX10G SUP-71-00177 CDM 0272 RC outpatient 121.72 121.72 121.72 74 90.07 percent of total billed charges 121.72 93 98.59 percent of total billed charges 121.72 121.72 other OPPS APC 121.72 121.72 other OPPS APC 121.72 27.63 33.63 percent of total billed charges 121.72 121.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW HT X-DRIVE 2.0 X 15MM SUP-71-00185 CDM 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUR ROUND 1.5MM SUP-71-00186 CDM 0272 RC outpatient 127 127 127 74 93.98 percent of total billed charges 127 93 102.87 percent of total billed charges 127 127 other OPPS APC 127 127 other OPPS APC 127 27.63 35.09 percent of total billed charges 127 127 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOP 5MM TWIST DRILL SUP-71-00187 CDM 0272 RC outpatient 357 357 357 74 264.18 percent of total billed charges 357 93 289.17 percent of total billed charges 357 357 other OPPS APC 357 357 other OPPS APC 357 27.63 98.64 percent of total billed charges 357 357 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.0 X 5MM IMF SUP-71-00188 CDM C1713 HCPCS 0278 RC outpatient 255.5 255.5 255.5 57 145.64 percent of total billed charges 255.5 93 206.96 percent of total billed charges 255.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 255.5 other OPPS APC 255.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 255.5 other OPPS APC 255.5 51 130.31 percent of total billed charges 255.5 255.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.0 X 7MM IMF SUP-71-00189 CDM C1713 HCPCS 0278 RC outpatient 255.5 255.5 255.5 57 145.64 percent of total billed charges 255.5 93 206.96 percent of total billed charges 255.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 255.5 other OPPS APC 255.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 255.5 other OPPS APC 255.5 51 130.31 percent of total billed charges 255.5 255.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.0 X 9MM IMF SUP-71-00190 CDM C1713 HCPCS 0278 RC outpatient 255.5 255.5 255.5 57 145.64 percent of total billed charges 255.5 93 206.96 percent of total billed charges 255.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 255.5 other OPPS APC 255.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 255.5 other OPPS APC 255.5 51 130.31 percent of total billed charges 255.5 255.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW HT SDX-DR 1.5X4MM SUP-71-00191 CDM C1713 HCPCS 0278 RC outpatient 200 200 200 57 114 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 51 102 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW HT SDX-DR 1.5X5MM SUP-71-00192 CDM C1713 HCPCS 0278 RC outpatient 188 188 188 57 107.16 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 51 95.88 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW HT SDX-DR 1.5X6MM SUP-71-00193 CDM C1713 HCPCS 0278 RC outpatient 188 188 188 57 107.16 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 51 95.88 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW HT SDX-DR 1.5X7MM SUP-71-00194 CDM C1713 HCPCS 0278 RC outpatient 189 189 189 57 107.73 percent of total billed charges 189 93 153.09 percent of total billed charges 189 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 189 other OPPS APC 189 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 189 other OPPS APC 189 51 96.39 percent of total billed charges 189 189 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW HTX-DR 1.5X9MM SUP-71-00195 CDM C1713 HCPCS 0278 RC outpatient 188 188 188 57 107.16 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 51 95.88 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW HTX-DR 1.5X11MM SUP-71-00196 CDM C1713 HCPCS 0278 RC outpatient 188 188 188 57 107.16 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 51 95.88 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW HTX-DR 1.5X13MM SUP-71-00197 CDM C1713 HCPCS 0278 RC outpatient 188 188 188 57 107.16 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 51 95.88 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW HTX-DR 1.5X15MM SUP-71-00198 CDM C1713 HCPCS 0278 RC outpatient 188 188 188 57 107.16 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 51 95.88 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW HTX-DR 1.8X5MM SUP-71-00199 CDM C1713 HCPCS 0278 RC outpatient 188 188 188 57 107.16 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 51 95.88 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW HTX-DR 1.8X7MM SUP-71-00200 CDM C1713 HCPCS 0278 RC outpatient 188 188 188 57 107.16 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 51 95.88 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 1.5 5-HOLE REG Y SUP-71-00201 CDM C1713 HCPCS 0278 RC outpatient 472.5 472.5 472.5 57 269.33 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 51 240.98 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 1.5 6-HOLE REG DBL Y SUP-71-00203 CDM C1713 HCPCS 0278 RC outpatient 542.5 542.5 542.5 57 309.23 percent of total billed charges 542.5 93 439.43 percent of total billed charges 542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.5 other OPPS APC 542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.5 other OPPS APC 542.5 51 276.68 percent of total billed charges 542.5 542.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 1.5 4-HOLE MED ST SUP-71-00204 CDM C1713 HCPCS 0278 RC outpatient 280 280 280 57 159.6 percent of total billed charges 280 93 226.8 percent of total billed charges 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 51 142.8 percent of total billed charges 280 280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 1.5 4-HOLE REG ST SUP-71-00205 CDM C1713 HCPCS 0278 RC outpatient 280 280 280 57 159.6 percent of total billed charges 280 93 226.8 percent of total billed charges 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 51 142.8 percent of total billed charges 280 280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 1.5 2X2-HOLE LFT MED SUP-71-00206 CDM C1713 HCPCS 0278 RC outpatient 455 455 455 57 259.35 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 51 232.05 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 1.5 2X2-HOLE RT MED SUP-71-00207 CDM C1713 HCPCS 0278 RC outpatient 455 455 455 57 259.35 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 51 232.05 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 1.5 5-HOLE LONG Y SUP-71-00208 CDM C1713 HCPCS 0278 RC outpatient 472.5 472.5 472.5 57 269.33 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 51 240.98 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 1.5 3X3-HOLE REG T SUP-71-00209 CDM C1713 HCPCS 0278 RC outpatient 472.5 472.5 472.5 57 269.33 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 51 240.98 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE 2.0MM HTX-LOCK LG SUP-71-00210 CDM C1713 HCPCS 0278 RC outpatient 388.5 388.5 388.5 57 221.45 percent of total billed charges 388.5 93 314.69 percent of total billed charges 388.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 388.5 other OPPS APC 388.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 388.5 other OPPS APC 388.5 51 198.14 percent of total billed charges 388.5 388.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL STP 1.5X105MM SUP-71-00211 CDM C1713 HCPCS 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL TWIST STP 1.5X50MM SUP-71-00212 CDM C1713 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.0 HT SD X-DR X5MM SUP-71-00216 CDM C1713 HCPCS 0278 RC outpatient 176 176 176 57 100.32 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 51 89.76 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.0 HT SD X-DR X7MM SUP-71-00217 CDM C1713 HCPCS 0278 RC outpatient 176 176 176 57 100.32 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 51 89.76 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.0 HT X-DR X9MM SUP-71-00218 CDM C1713 HCPCS 0278 RC outpatient 168 168 168 57 95.76 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 51 85.68 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.0 HT X-DR X11MM SUP-71-00219 CDM C1713 HCPCS 0278 RC outpatient 168 168 168 57 95.76 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 51 85.68 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.0 HT X-DR X17MM SUP-71-00220 CDM C1713 HCPCS 0278 RC outpatient 175.5 175.5 175.5 57 100.04 percent of total billed charges 175.5 93 142.16 percent of total billed charges 175.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 175.5 other OPPS APC 175.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 175.5 other OPPS APC 175.5 51 89.51 percent of total billed charges 175.5 175.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.0 HT X-DR X19MM SUP-71-00221 CDM C1713 HCPCS 0278 RC outpatient 180 180 180 57 102.6 percent of total billed charges 180 93 145.8 percent of total billed charges 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 51 91.8 percent of total billed charges 180 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.3 HT X-DR X5MM SUP-71-00222 CDM C1713 HCPCS 0278 RC outpatient 172 172 172 57 98.04 percent of total billed charges 172 93 139.32 percent of total billed charges 172 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 172 other OPPS APC 172 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 172 other OPPS APC 172 51 87.72 percent of total billed charges 172 172 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.3 HT X-DR X7MM SUP-71-00223 CDM C1713 HCPCS 0278 RC outpatient 172 172 172 57 98.04 percent of total billed charges 172 93 139.32 percent of total billed charges 172 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 172 other OPPS APC 172 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 172 other OPPS APC 172 51 87.72 percent of total billed charges 172 172 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2.0/1.0 6-HOLE REG CVD SUP-71-00225 CDM C1713 HCPCS 0278 RC outpatient 455 455 455 57 259.35 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 51 232.05 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2.0/1.0 2X2-HOLE RT REG SUP-71-00226 CDM C1713 HCPCS 0278 RC outpatient 367.5 367.5 367.5 57 209.48 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 51 187.43 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2.0/1.0 2X2-HOLE LFT REG SUP-71-00227 CDM C1713 HCPCS 0278 RC outpatient 367.5 367.5 367.5 57 209.48 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 51 187.43 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.0 MED ROUND BUR CARBIDE SUP-71-00228 CDM C1713 HCPCS 0272 RC outpatient 45.8 45.8 45.8 74 33.89 percent of total billed charges 45.8 93 37.1 percent of total billed charges 45.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 45.8 other OPPS APC 45.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 45.8 other OPPS APC 45.8 27.63 12.65 percent of total billed charges 45.8 45.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.0 HT X-DR 13MM SUP-71-00229 CDM C1713 HCPCS 0278 RC outpatient 246.43 246.43 246.43 57 140.47 percent of total billed charges 246.43 93 199.61 percent of total billed charges 246.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 246.43 other OPPS APC 246.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 246.43 other OPPS APC 246.43 51 125.68 percent of total billed charges 246.43 246.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE DENTAL 20G (SUTURE WIRE) SUP-71-00230 CDM 0272 RC outpatient 262.26 262.26 262.26 74 194.07 percent of total billed charges 262.26 93 212.43 percent of total billed charges 262.26 262.26 other OPPS APC 262.26 262.26 other OPPS APC 262.26 27.63 72.46 percent of total billed charges 262.26 262.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUR OVAL 4 X 8MM SUP-71-00232 CDM 0272 RC outpatient 90 90 90 74 66.6 percent of total billed charges 90 93 72.9 percent of total billed charges 90 90 other OPPS APC 90 90 other OPPS APC 90 27.63 24.87 percent of total billed charges 90 90 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAP POLYP SPECIMEN QUICK CATCH IN LINE SUCTION H332 SUP-710201 CDM 0270 RC outpatient 6.63 6.63 6.63 74 4.91 percent of total billed charges 6.63 93 5.37 percent of total billed charges 6.63 6.63 other OPPS APC 6.63 6.63 other OPPS APC 6.63 27.63 1.83 percent of total billed charges 6.63 6.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAP SPECIMEN COLLECTION SUCTION PLASTIC 4 CHAMBER SUP-710202 CDM 0270 RC outpatient 28.6 28.6 28.6 74 21.16 percent of total billed charges 28.6 93 23.17 percent of total billed charges 28.6 28.6 other OPPS APC 28.6 28.6 other OPPS APC 28.6 27.63 7.9 percent of total billed charges 28.6 28.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION JET-X MINI 2 PIN BALL JOINT SUP-71062016 CDM 0270 RC outpatient 1783.08 1783.08 1783.08 74 1319.48 percent of total billed charges 1783.08 93 1444.29 percent of total billed charges 1783.08 1783.08 other OPPS APC 1783.08 1783.08 other OPPS APC 1783.08 27.63 492.67 percent of total billed charges 1783.08 1783.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN HALF L15 MM OD3 MM RADIUS DISTAL SUP-71063152 CDM 0270 RC outpatient 449.28 449.28 449.28 74 332.47 percent of total billed charges 449.28 93 363.92 percent of total billed charges 449.28 449.28 other OPPS APC 449.28 449.28 other OPPS APC 449.28 27.63 124.14 percent of total billed charges 449.28 449.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN HALF L20 MM OD3 MM RADIUS DISTAL SUP-71063202 CDM 0270 RC outpatient 449.28 449.28 449.28 74 332.47 percent of total billed charges 449.28 93 363.92 percent of total billed charges 449.28 449.28 other OPPS APC 449.28 449.28 other OPPS APC 449.28 27.63 124.14 percent of total billed charges 449.28 449.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HALF PIN EXTERNAL FIXATION 3MM 20MM THREADED ANKLE FOOT JET-X STAINLESS STEEL TITANIUM NITRIDE NON-STERILE SUP-71063208 CDM 0270 RC outpatient 274.25 274.25 274.25 74 202.95 percent of total billed charges 274.25 93 222.14 percent of total billed charges 274.25 274.25 other OPPS APC 274.25 274.25 other OPPS APC 274.25 27.63 75.78 percent of total billed charges 274.25 274.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION MINI 1.5INL ALUMINUM ANODIZED TITANIUM STAINLESS STEEL METAPHYSEAL DIAPHYSEAL 360DEG ANGLED F/6MM BAR TO 4MM PIN JET-X PVC-FREE STERILE SUP-71064011 CDM 0270 RC outpatient 1492.92 1492.92 1492.92 74 1104.76 percent of total billed charges 1492.92 93 1209.27 percent of total billed charges 1492.92 1492.92 other OPPS APC 1492.92 1492.92 other OPPS APC 1492.92 27.63 412.49 percent of total billed charges 1492.92 1492.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HALF PIN EXTERNAL FIXATION 4MM 20MM THREADED ANKLE FOOT JET-X STAINLESS STEEL TITANIUM NITRIDE NON-STERILE SUP-71064208 CDM 0270 RC outpatient 307.94 307.94 307.94 74 227.88 percent of total billed charges 307.94 93 249.43 percent of total billed charges 307.94 307.94 other OPPS APC 307.94 307.94 other OPPS APC 307.94 27.63 85.08 percent of total billed charges 307.94 307.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAR EXTERNAL FIXATION 6MM MINI 185MM OFFSET ROUND CROSS SECTION DISTAL RADIAL JET-X CARBON FIBER NON-STERILE SUP-71065185 CDM 0270 RC outpatient 296.71 296.71 296.71 74 219.57 percent of total billed charges 296.71 93 240.34 percent of total billed charges 296.71 296.71 other OPPS APC 296.71 296.71 other OPPS APC 296.71 27.63 81.98 percent of total billed charges 296.71 296.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAR EXTERNAL FIXATION L225 MM OD6 MM SUP-71065225 CDM 0270 RC outpatient 393.12 393.12 393.12 74 290.91 percent of total billed charges 393.12 93 318.43 percent of total billed charges 393.12 393.12 other OPPS APC 393.12 393.12 other OPPS APC 393.12 27.63 108.62 percent of total billed charges 393.12 393.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL JET-X MINI OD2 MM RADIUS DISTAL NONSTERILE LATEX FREE DISPOSABLE SUP-71067327 CDM 0270 RC outpatient 802.15 802.15 802.15 74 593.59 percent of total billed charges 802.15 93 649.74 percent of total billed charges 802.15 802.15 other OPPS APC 802.15 802.15 other OPPS APC 802.15 27.63 221.63 percent of total billed charges 802.15 802.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP EXTERNAL FIXATION DISTAL RADIAL FOOT F/6MM BAR 4MM PIN JET-X PVC-FREE STERILE SUP-71067377 CDM 0270 RC outpatient 1141.92 1141.92 1141.92 74 845.02 percent of total billed charges 1141.92 93 924.96 percent of total billed charges 1141.92 1141.92 other OPPS APC 1141.92 1141.92 other OPPS APC 1141.92 27.63 315.51 percent of total billed charges 1141.92 1141.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP SWIVEL MAVERICK 11MM TO 5-6MM SUP-71094020 CDM 0270 RC outpatient 3308.5 3308.5 3308.5 74 2448.29 percent of total billed charges 3308.5 93 2679.89 percent of total billed charges 3308.5 3308.5 other OPPS APC 3308.5 3308.5 other OPPS APC 3308.5 27.63 914.14 percent of total billed charges 3308.5 3308.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP MULTI-PIN MAVERICK 45MM SUP-71094045 CDM 0270 RC outpatient 2281.5 2281.5 2281.5 74 1688.31 percent of total billed charges 2281.5 93 1848.02 percent of total billed charges 2281.5 2281.5 other OPPS APC 2281.5 2281.5 other OPPS APC 2281.5 27.63 630.38 percent of total billed charges 2281.5 2281.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAVERICK MULTI PIN CLAMP 75MM SUP-71094075 CDM 0270 RC outpatient 2574 2574 2574 74 1904.76 percent of total billed charges 2574 93 2084.94 percent of total billed charges 2574 2574 other OPPS APC 2574 2574 other OPPS APC 2574 27.63 711.2 percent of total billed charges 2574 2574 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTACHMENT SWIVEL MAVERICK SUP-71094111 CDM 0270 RC outpatient 2574 2574 2574 74 1904.76 percent of total billed charges 2574 93 2084.94 percent of total billed charges 2574 2574 other OPPS APC 2574 2574 other OPPS APC 2574 27.63 711.2 percent of total billed charges 2574 2574 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL LONG MAVERICK 4.0 MM SUP-71094140 CDM 0270 RC outpatient 1397.5 1397.5 1397.5 74 1034.15 percent of total billed charges 1397.5 93 1131.98 percent of total billed charges 1397.5 1397.5 other OPPS APC 1397.5 1397.5 other OPPS APC 1397.5 27.63 386.13 percent of total billed charges 1397.5 1397.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL MAVERICK 4.5MM LONG SUP-71094145 CDM 0270 RC outpatient 1397.5 1397.5 1397.5 74 1034.15 percent of total billed charges 1397.5 93 1131.98 percent of total billed charges 1397.5 1397.5 other OPPS APC 1397.5 1397.5 other OPPS APC 1397.5 27.63 386.13 percent of total billed charges 1397.5 1397.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAR MAVERICK 11MM X 250MM SUP-71094250 CDM 0270 RC outpatient 1249.3 1249.3 1249.3 74 924.48 percent of total billed charges 1249.3 93 1011.93 percent of total billed charges 1249.3 1249.3 other OPPS APC 1249.3 1249.3 other OPPS APC 1249.3 27.63 345.18 percent of total billed charges 1249.3 1249.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAR EXTERNAL FIXATION 11MM 300MM MAVERICK SUP-71094300 CDM 0270 RC outpatient 1397.5 1397.5 1397.5 74 1034.15 percent of total billed charges 1397.5 93 1131.98 percent of total billed charges 1397.5 1397.5 other OPPS APC 1397.5 1397.5 other OPPS APC 1397.5 27.63 386.13 percent of total billed charges 1397.5 1397.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAR MAVERICK 11MM X 350MM SUP-71094350 CDM 0270 RC outpatient 1397.5 1397.5 1397.5 74 1034.15 percent of total billed charges 1397.5 93 1131.98 percent of total billed charges 1397.5 1397.5 other OPPS APC 1397.5 1397.5 other OPPS APC 1397.5 27.63 386.13 percent of total billed charges 1397.5 1397.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAR EXTERNAL FIXATION 11 MM 400MM MAVERICK SUP-71094400 CDM 0270 RC outpatient 1397.5 1397.5 1397.5 74 1034.15 percent of total billed charges 1397.5 93 1131.98 percent of total billed charges 1397.5 1397.5 other OPPS APC 1397.5 1397.5 other OPPS APC 1397.5 27.63 386.13 percent of total billed charges 1397.5 1397.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HALF-PIN MAVERICK 5MM X 200MM X 45MM SUP-71094545 CDM 0270 RC outpatient 625.3 625.3 625.3 74 462.72 percent of total billed charges 625.3 93 506.49 percent of total billed charges 625.3 625.3 other OPPS APC 625.3 625.3 other OPPS APC 625.3 27.63 172.77 percent of total billed charges 625.3 625.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN HALF MAVERICK L200 MM L65 MM OD5 MM NONSTERILE SUP-71094565 CDM 0270 RC outpatient 625.3 625.3 625.3 74 462.72 percent of total billed charges 625.3 93 506.49 percent of total billed charges 625.3 625.3 other OPPS APC 625.3 625.3 other OPPS APC 625.3 27.63 172.77 percent of total billed charges 625.3 625.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN EXTERNAL FIXATION 5MM 275MM TRANSFIXING MAVERICK SUP-71094575 CDM 0270 RC outpatient 698.1 698.1 698.1 74 516.59 percent of total billed charges 698.1 93 565.46 percent of total billed charges 698.1 698.1 other OPPS APC 698.1 698.1 other OPPS APC 698.1 27.63 192.89 percent of total billed charges 698.1 698.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HALF PIN EXTERNAL FIXATION 5MM 250MM 85MM MAVERICK SUP-71094585 CDM 0270 RC outpatient 625.3 625.3 625.3 74 462.72 percent of total billed charges 625.3 93 506.49 percent of total billed charges 625.3 625.3 other OPPS APC 625.3 625.3 other OPPS APC 625.3 27.63 172.77 percent of total billed charges 625.3 625.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HALF PIN MAVERICK L 200MM 6MM 55MM SUP-71094655 CDM 0270 RC outpatient 625.3 625.3 625.3 74 462.72 percent of total billed charges 625.3 93 506.49 percent of total billed charges 625.3 625.3 other OPPS APC 625.3 625.3 other OPPS APC 625.3 27.63 172.77 percent of total billed charges 625.3 625.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HALF PIN MAVERICK 6 MM X 250MM X 95MM SUP-71094695 CDM 0270 RC outpatient 625.3 625.3 625.3 74 462.72 percent of total billed charges 625.3 93 506.49 percent of total billed charges 625.3 625.3 other OPPS APC 625.3 625.3 other OPPS APC 625.3 27.63 172.77 percent of total billed charges 625.3 625.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS LENS GRIESHABER REVOLUTION DSP OD27+ GA ILLUMINATOR END GRASP MULTIPURPOSE STERILE DISPOSABLE FINE MEMBRANE SUP-711.44 CDM 0270 RC outpatient 408.95 408.95 408.95 74 302.62 percent of total billed charges 408.95 93 331.25 percent of total billed charges 408.95 408.95 other OPPS APC 408.95 408.95 other OPPS APC 408.95 27.63 112.99 percent of total billed charges 408.95 408.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP SPINAL X-CORE 2 22MM 18MM TITANIUM NS LOCK SUP-7110003 CDM 270010020 LOCAL 0270 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 27.63 57.47 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION VLP L 150 MM OD 1.1 MM FOOT DRILL TIP STERILE LATEX FREE SUP-71101413 CDM 0270 RC outpatient 113.88 113.88 113.88 74 84.27 percent of total billed charges 113.88 93 92.24 percent of total billed charges 113.88 113.88 other OPPS APC 113.88 113.88 other OPPS APC 113.88 27.63 31.47 percent of total billed charges 113.88 113.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION VLP FOOT 2MM 150MM KIRSCHNER VARIABLE ANGLE DRILL TIP COBALT CHROMIUM TROCHANTERIC SUP-71101501 CDM 0270 RC outpatient 683.28 683.28 683.28 74 505.63 percent of total billed charges 683.28 93 553.46 percent of total billed charges 683.28 683.28 other OPPS APC 683.28 683.28 other OPPS APC 683.28 27.63 188.79 percent of total billed charges 683.28 683.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER COCR FLUTE L150MM OD 1.6MM DRILL TIP SUP-71101502 CDM 0270 RC outpatient 113.88 113.88 113.88 74 84.27 percent of total billed charges 113.88 93 92.24 percent of total billed charges 113.88 113.88 other OPPS APC 113.88 113.88 other OPPS APC 113.88 27.63 31.47 percent of total billed charges 113.88 113.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC ROUND SUP-71101690S CDM 0270 RC outpatient 161.93 161.93 161.93 74 119.83 percent of total billed charges 161.93 93 131.16 percent of total billed charges 161.93 161.93 other OPPS APC 161.93 161.93 other OPPS APC 161.93 27.63 44.74 percent of total billed charges 161.93 161.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SMALL 3MM 12MM CANNULATED PARTIALLY THREADED SELF-DRILLING/TAPPING STAINLESS STEEL REVERSE CUTTING FLUTE DRILL TIP GUIDEWIRE STERILE SUP-71103212 CDM 0270 RC outpatient 543.92 543.92 543.92 74 402.5 percent of total billed charges 543.92 93 440.58 percent of total billed charges 543.92 543.92 other OPPS APC 543.92 543.92 other OPPS APC 543.92 27.63 150.29 percent of total billed charges 543.92 543.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SMALL 3MM 16MM CANNULATED PARTIALLY THREADED SELF-DRILLING/TAPPING STAINLESS STEEL REVERSE CUTTING FLUTE DRILL TIP GUIDEWIRE NON-STERILE SUP-71103216 CDM 0270 RC outpatient 543.92 543.92 543.92 74 402.5 percent of total billed charges 543.92 93 440.58 percent of total billed charges 543.92 543.92 other OPPS APC 543.92 543.92 other OPPS APC 543.92 27.63 150.29 percent of total billed charges 543.92 543.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SMALL 3MM 22MM CANNULATED PARTIALLY THREADED SELF-DRILLING/TAPPING STAINLESS STEEL REVERSE CUTTING FLUTE DRILL TIP GUIDEWIRE STERILE SUP-71103222S CDM 0270 RC outpatient 543.92 543.92 543.92 74 402.5 percent of total billed charges 543.92 93 440.58 percent of total billed charges 543.92 543.92 other OPPS APC 543.92 543.92 other OPPS APC 543.92 27.63 150.29 percent of total billed charges 543.92 543.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE SMALL 3MM 30MM CANNULATED PARTIALLY THREADED SELF-DRILLING/TAPPING STAINLESS STEEL REVERSE CUTTING FLUTE DRILL TIP GUIDEWIRE SUP-71103230S CDM 0270 RC outpatient 543.92 543.92 543.92 74 402.5 percent of total billed charges 543.92 93 440.58 percent of total billed charges 543.92 543.92 other OPPS APC 543.92 543.92 other OPPS APC 543.92 27.63 150.29 percent of total billed charges 543.92 543.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L 24 MM OD 3 MM SMALL BONE CANNULATED HEADLESS SELF DRILLING SELF TAPPING SUP-71103324S CDM 0270 RC outpatient 667.42 667.42 667.42 74 493.89 percent of total billed charges 667.42 93 540.61 percent of total billed charges 667.42 667.42 other OPPS APC 667.42 667.42 other OPPS APC 667.42 27.63 184.41 percent of total billed charges 667.42 667.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE QUICKFIX STAINLESS STEEL L 26 MM OD 3 MM METACARPAL TARSAL CANNULATED COMPRESSION HEADLESS STERILE SUP-71103326S CDM 0270 RC outpatient 667.42 667.42 667.42 74 493.89 percent of total billed charges 667.42 93 540.61 percent of total billed charges 667.42 667.42 other OPPS APC 667.42 667.42 other OPPS APC 667.42 27.63 184.41 percent of total billed charges 667.42 667.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 32 MM OD 3 MM CANNULATED HEADLESS SUP-71103332 CDM 0270 RC outpatient 667.42 667.42 667.42 74 493.89 percent of total billed charges 667.42 93 540.61 percent of total billed charges 667.42 667.42 other OPPS APC 667.42 667.42 other OPPS APC 667.42 27.63 184.41 percent of total billed charges 667.42 667.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 38 MM OD 3 MM CANNULATED HEADLESS SUP-71103338 CDM 0270 RC outpatient 667.42 667.42 667.42 74 493.89 percent of total billed charges 667.42 93 540.61 percent of total billed charges 667.42 667.42 other OPPS APC 667.42 667.42 other OPPS APC 667.42 27.63 184.41 percent of total billed charges 667.42 667.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 38MM OD 3MM CANNULATED HEADLESS SUP-71103338S CDM 0270 RC outpatient 667.42 667.42 667.42 74 493.89 percent of total billed charges 667.42 93 540.61 percent of total billed charges 667.42 667.42 other OPPS APC 667.42 667.42 other OPPS APC 667.42 27.63 184.41 percent of total billed charges 667.42 667.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 40 MM OD 3 MM CANNULATED HEADLESS SUP-71103340 CDM 0270 RC outpatient 667.42 667.42 667.42 74 493.89 percent of total billed charges 667.42 93 540.61 percent of total billed charges 667.42 667.42 other OPPS APC 667.42 667.42 other OPPS APC 667.42 27.63 184.41 percent of total billed charges 667.42 667.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 40 MM OD 3MM CANNULATED HEADLESS STERILE SUP-71103340S CDM 0270 RC outpatient 667.42 667.42 667.42 74 493.89 percent of total billed charges 667.42 93 540.61 percent of total billed charges 667.42 667.42 other OPPS APC 667.42 667.42 other OPPS APC 667.42 27.63 184.41 percent of total billed charges 667.42 667.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LARGE 6.5MM 45MM CANNULATED FULLY THREADED SELF DRILLING/TAPPING STAINLESS STEEL HEX DRIVE REVERSE CUTTING FLUTE STERILE SUP-71106245 CDM 0270 RC outpatient 534.46 534.46 534.46 74 395.5 percent of total billed charges 534.46 93 432.91 percent of total billed charges 534.46 534.46 other OPPS APC 534.46 534.46 other OPPS APC 534.46 27.63 147.67 percent of total billed charges 534.46 534.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LARGE 6.5MM 55MM CANNULATED FULLY THREADED SELF DRILLING/TAPPING STAINLESS STEEL HEX DRIVE REVERSE CUTTING FLUTE STERILE SUP-71106255 CDM 0270 RC outpatient 534.46 534.46 534.46 74 395.5 percent of total billed charges 534.46 93 432.91 percent of total billed charges 534.46 534.46 other OPPS APC 534.46 534.46 other OPPS APC 534.46 27.63 147.67 percent of total billed charges 534.46 534.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L 60 MM OD 6.5 MM LONG BONE SMALL BONE CANNULATED STERILE SUP-71106260S CDM 0270 RC outpatient 534.46 534.46 534.46 74 395.5 percent of total billed charges 534.46 93 432.91 percent of total billed charges 534.46 534.46 other OPPS APC 534.46 534.46 other OPPS APC 534.46 27.63 147.67 percent of total billed charges 534.46 534.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LARGE 6.5MM 70MM CANNULATED FULLY THREADED SELF DRILLING/TAPPING STAINLESS STEEL HEX DRIVE REVERSE CUTTING FLUTE STERILE SUP-71106270 CDM 0270 RC outpatient 534.46 534.46 534.46 74 395.5 percent of total billed charges 534.46 93 432.91 percent of total billed charges 534.46 534.46 other OPPS APC 534.46 534.46 other OPPS APC 534.46 27.63 147.67 percent of total billed charges 534.46 534.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L 150 MM OD 6.5MM LONG BONE SMALL BONE CANNULATED STERILE SUP-71106350S CDM 0270 RC outpatient 620.57 620.57 620.57 74 459.22 percent of total billed charges 620.57 93 502.66 percent of total billed charges 620.57 620.57 other OPPS APC 620.57 620.57 other OPPS APC 620.57 27.63 171.46 percent of total billed charges 620.57 620.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L 155 MM OD 6.5 MM LONG BONE SMALL BONE CANNULATED STERILE SUP-71106355S CDM 0270 RC outpatient 620.57 620.57 620.57 74 459.22 percent of total billed charges 620.57 93 502.66 percent of total billed charges 620.57 620.57 other OPPS APC 620.57 620.57 other OPPS APC 620.57 27.63 171.46 percent of total billed charges 620.57 620.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 40 MM L 22 MM OD 6.5 MM LONG BONE SMALL BONE CANNUALTED STERILE SUP-71106540S CDM 0270 RC outpatient 534.46 534.46 534.46 74 395.5 percent of total billed charges 534.46 93 432.91 percent of total billed charges 534.46 534.46 other OPPS APC 534.46 534.46 other OPPS APC 534.46 27.63 147.67 percent of total billed charges 534.46 534.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL PARTIAL THREAD L 80 MM L 22 MM OD 6.5 MM CANNUALTED STERILE SUP-71106580S CDM 0270 RC outpatient 534.46 534.46 534.46 74 395.5 percent of total billed charges 534.46 93 432.91 percent of total billed charges 534.46 534.46 other OPPS APC 534.46 534.46 other OPPS APC 534.46 27.63 147.67 percent of total billed charges 534.46 534.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 85MM L 22MM OD 6.5MM LONG BONE SMALL BONE CANNULATED STERILE SUP-71106585S CDM 0270 RC outpatient 534.46 534.46 534.46 74 395.5 percent of total billed charges 534.46 93 432.91 percent of total billed charges 534.46 534.46 other OPPS APC 534.46 534.46 other OPPS APC 534.46 27.63 147.67 percent of total billed charges 534.46 534.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LARGE 6.5MM 75MM CANNUALTED 46MML PARTIALLY THREADED SELF DRILLING/TAPPING STAINLESS STEEL HEX DRIVE REVERSE CUTTING FLUTE NON-STERILE SUP-71106775 CDM 0270 RC outpatient 534.46 534.46 534.46 74 395.5 percent of total billed charges 534.46 93 432.91 percent of total billed charges 534.46 534.46 other OPPS APC 534.46 534.46 other OPPS APC 534.46 27.63 147.67 percent of total billed charges 534.46 534.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 80 MM L 46 MM OD 6.5 MM LONG BONE SMALL BONE CANNULATED STERILE SUP-71106780S CDM 0270 RC outpatient 534.46 534.46 534.46 74 395.5 percent of total billed charges 534.46 93 432.91 percent of total billed charges 534.46 534.46 other OPPS APC 534.46 534.46 other OPPS APC 534.46 27.63 147.67 percent of total billed charges 534.46 534.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LARGE 6.5MM 55MM CANNULATED 22MML PARTIALLY THREADED SELF DRILLING TAPPING TITANIUM HEX DRIVE REVERSE CUTTING FLUTE SUP-71107555 CDM 0270 RC outpatient 665.5 665.5 665.5 74 492.47 percent of total billed charges 665.5 93 539.06 percent of total billed charges 665.5 665.5 other OPPS APC 665.5 665.5 other OPPS APC 665.5 27.63 183.88 percent of total billed charges 665.5 665.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L 65MM OD 8 MM LONG BONE SMALL BONE CANNULATED STERILE SUP-71108265S CDM 0270 RC outpatient 546.62 546.62 546.62 74 404.5 percent of total billed charges 546.62 93 442.76 percent of total billed charges 546.62 546.62 other OPPS APC 546.62 546.62 other OPPS APC 546.62 27.63 151.03 percent of total billed charges 546.62 546.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L 70 MM OD 8MM LONG BONE SMALL BONE CANNUALTED STERILE SUP-71108270S CDM 0270 RC outpatient 546.62 546.62 546.62 74 404.5 percent of total billed charges 546.62 93 442.76 percent of total billed charges 546.62 546.62 other OPPS APC 546.62 546.62 other OPPS APC 546.62 27.63 151.03 percent of total billed charges 546.62 546.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L 75MM OD 8 MM LONG BONE SMALL BONE CANNULATED STERILE SUP-71108275S CDM 0270 RC outpatient 546.62 546.62 546.62 74 404.5 percent of total billed charges 546.62 93 442.76 percent of total billed charges 546.62 546.62 other OPPS APC 546.62 546.62 other OPPS APC 546.62 27.63 151.03 percent of total billed charges 546.62 546.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LARGE 8MM 95MM CANNULATED FULLY THREADED SELF-DRILLING/TAPPING STAINLESS STEEL HEX DRIVE REVERSE CUTTING FLUTE SUP-71108295 CDM 0270 RC outpatient 546.62 546.62 546.62 74 404.5 percent of total billed charges 546.62 93 442.76 percent of total billed charges 546.62 546.62 other OPPS APC 546.62 546.62 other OPPS APC 546.62 27.63 151.03 percent of total billed charges 546.62 546.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L 145MM OD 8 MM LONG BONE SMALL BONE CANNULATED STERILE SUP-71108345S CDM 0270 RC outpatient 626.18 626.18 626.18 74 463.37 percent of total billed charges 626.18 93 507.21 percent of total billed charges 626.18 626.18 other OPPS APC 626.18 626.18 other OPPS APC 626.18 27.63 173.01 percent of total billed charges 626.18 626.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L 150 MM OD 8 MM LONG BONE SMALL BONE CANNULATED STERILE SUP-71108350S CDM 0270 RC outpatient 626.18 626.18 626.18 74 463.37 percent of total billed charges 626.18 93 507.21 percent of total billed charges 626.18 626.18 other OPPS APC 626.18 626.18 other OPPS APC 626.18 27.63 173.01 percent of total billed charges 626.18 626.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LARGE 8MM 160MM CANNULATED FULLY THREADED SELF DRILLING TAPPING STAINLESS STEEL HEX DRIVE REVERSE CUTTING FLUTE SUP-71108360 CDM 0270 RC outpatient 626.18 626.18 626.18 74 463.37 percent of total billed charges 626.18 93 507.21 percent of total billed charges 626.18 626.18 other OPPS APC 626.18 626.18 other OPPS APC 626.18 27.63 173.01 percent of total billed charges 626.18 626.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LARGE 8MM 85MM CANNULATED 22MM L PARTIALLY THREADED SELF-DRILLING/TAPPING STAINLESS STEEL HEX DRIVE REVERSE CUTTING FLUTE SUP-71108585 CDM 0270 RC outpatient 546.62 546.62 546.62 74 404.5 percent of total billed charges 546.62 93 442.76 percent of total billed charges 546.62 546.62 other OPPS APC 546.62 546.62 other OPPS APC 546.62 27.63 151.03 percent of total billed charges 546.62 546.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LARGE 8MM 95MM CANNULATED 22MM L PARTIALLY THREADED SELF-DRILLING/TAPPING STAINLESS STEEL HEX DRIVE REVERSE CUTTING FLUTE SUP-71108595 CDM 0270 RC outpatient 546.62 546.62 546.62 74 404.5 percent of total billed charges 546.62 93 442.76 percent of total billed charges 546.62 546.62 other OPPS APC 546.62 546.62 other OPPS APC 546.62 27.63 151.03 percent of total billed charges 546.62 546.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LARGE 8MM 90MM CANNULATED 46MML PARTIALLY THREADED SELF DRILLING TAPPING STAINLESS STEEL HEX DRIVE REVERSE CUTTING FLUTE SUP-71108790 CDM 0270 RC outpatient 546.62 546.62 546.62 74 404.5 percent of total billed charges 546.62 93 442.76 percent of total billed charges 546.62 546.62 other OPPS APC 546.62 546.62 other OPPS APC 546.62 27.63 151.03 percent of total billed charges 546.62 546.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L145 MM OD8 MM CANNULATED FULLY THREADED SUP-71109345S CDM 0270 RC outpatient 630.86 630.86 630.86 74 466.84 percent of total billed charges 630.86 93 511 percent of total billed charges 630.86 630.86 other OPPS APC 630.86 630.86 other OPPS APC 630.86 27.63 174.31 percent of total billed charges 630.86 630.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE PIN ORTHOPEDIC L 300MM OD 1.9 MM THREAD STERILE 5.5 MM CANNUALTED SCREW SUP-71110400 CDM 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL OD 4 MM CANNULATED STERILE SUP-71119007 CDM 0270 RC outpatient 1154.4 1154.4 1154.4 74 854.26 percent of total billed charges 1154.4 93 935.06 percent of total billed charges 1154.4 1154.4 other OPPS APC 1154.4 1154.4 other OPPS APC 1154.4 27.63 318.96 percent of total billed charges 1154.4 1154.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC STAINLESS STEEL THK 1 MM OD 8 MM ID 4 MM STERILE SUP-71120006 CDM 0270 RC outpatient 96.36 96.36 96.36 74 71.31 percent of total billed charges 96.36 93 78.05 percent of total billed charges 96.36 96.36 other OPPS APC 96.36 96.36 other OPPS APC 96.36 27.63 26.62 percent of total billed charges 96.36 96.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 80 MM L 32 MM OD 5.5 MM ORTHOPEDIC CANNUALTED STERILE SUP-71124080 CDM 0270 RC outpatient 734.24 734.24 734.24 74 543.34 percent of total billed charges 734.24 93 594.73 percent of total billed charges 734.24 734.24 other OPPS APC 734.24 734.24 other OPPS APC 734.24 27.63 202.87 percent of total billed charges 734.24 734.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 85 MM L 32 MM OD 5.5 MM ORTHOPEDIC CANNULATED STERILE SUP-71124085 CDM 0270 RC outpatient 734.24 734.24 734.24 74 543.34 percent of total billed charges 734.24 93 594.73 percent of total billed charges 734.24 734.24 other OPPS APC 734.24 734.24 other OPPS APC 734.24 27.63 202.87 percent of total billed charges 734.24 734.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 5.5MM 120MM CANNUALTED 32MML THREADED SELF DRILLING TAPPING STAINLESS STEEL REVERSE CUTTING FLUTE SUP-71124120 CDM 0270 RC outpatient 734.24 734.24 734.24 74 543.34 percent of total billed charges 734.24 93 594.73 percent of total billed charges 734.24 734.24 other OPPS APC 734.24 734.24 other OPPS APC 734.24 27.63 202.87 percent of total billed charges 734.24 734.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 32 MM L 16 MM OD 5.5 MM ORTHOPEDIC CANNULATED STERILE SUP-71125032 CDM 0270 RC outpatient 734.24 734.24 734.24 74 543.34 percent of total billed charges 734.24 93 594.73 percent of total billed charges 734.24 734.24 other OPPS APC 734.24 734.24 other OPPS APC 734.24 27.63 202.87 percent of total billed charges 734.24 734.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 40 MM L 16 MM OD 7 MM CANNULATED SUP-71127040 CDM 0270 RC outpatient 415.35 415.35 415.35 74 307.36 percent of total billed charges 415.35 93 336.43 percent of total billed charges 415.35 415.35 other OPPS APC 415.35 415.35 other OPPS APC 415.35 27.63 114.76 percent of total billed charges 415.35 415.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 45 MM L 16 MM OD 7MM CANNULATED STERILE SUP-71127045 CDM 0270 RC outpatient 415.35 415.35 415.35 74 307.36 percent of total billed charges 415.35 93 336.43 percent of total billed charges 415.35 415.35 other OPPS APC 415.35 415.35 other OPPS APC 415.35 27.63 114.76 percent of total billed charges 415.35 415.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 80 MM L 16 MM OD 7MM CORTICAL CANNULATED STERILE SUP-71127080 CDM 0270 RC outpatient 415.35 415.35 415.35 74 307.36 percent of total billed charges 415.35 93 336.43 percent of total billed charges 415.35 415.35 other OPPS APC 415.35 415.35 other OPPS APC 415.35 27.63 114.76 percent of total billed charges 415.35 415.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 70 MM L 32 MM OD 7 MM CORTICAL CANNULATED STERILE SUP-71128070 CDM 0270 RC outpatient 415.35 415.35 415.35 74 307.36 percent of total billed charges 415.35 93 336.43 percent of total billed charges 415.35 415.35 other OPPS APC 415.35 415.35 other OPPS APC 415.35 27.63 114.76 percent of total billed charges 415.35 415.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 95 MM L 32MM OD 7 MM CANNULATED SUP-71128095 CDM 0270 RC outpatient 415.35 415.35 415.35 74 307.36 percent of total billed charges 415.35 93 336.43 percent of total billed charges 415.35 415.35 other OPPS APC 415.35 415.35 other OPPS APC 415.35 27.63 114.76 percent of total billed charges 415.35 415.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 115 MM L 32 MM OD 7 MM CANNUALTED SUP-71128115 CDM 0270 RC outpatient 415.35 415.35 415.35 74 307.36 percent of total billed charges 415.35 93 336.43 percent of total billed charges 415.35 415.35 other OPPS APC 415.35 415.35 other OPPS APC 415.35 27.63 114.76 percent of total billed charges 415.35 415.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LARGE 7MM 125MM CANNULATED 32 MM L PARTIALLY THREADED SELF-DRILLING/TAPPING STAINLESS STEEL HEX DRIVE REVERSE CUTTING FLUTE SUP-71128125 CDM 0270 RC outpatient 415.35 415.35 415.35 74 307.36 percent of total billed charges 415.35 93 336.43 percent of total billed charges 415.35 415.35 other OPPS APC 415.35 415.35 other OPPS APC 415.35 27.63 114.76 percent of total billed charges 415.35 415.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LARGE 7MM 60MM CANNULATED FULLY THREADED SELF DRILLING TAPPING STAINLESS STEEL HEX DRIVE REVERSE CUTTING FLUTE SUP-71129060 CDM 0270 RC outpatient 598.1 598.1 598.1 74 442.59 percent of total billed charges 598.1 93 484.46 percent of total billed charges 598.1 598.1 other OPPS APC 598.1 598.1 other OPPS APC 598.1 27.63 165.26 percent of total billed charges 598.1 598.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L 75 MM OD 7 MM ORTHOPEDIC STERILE SUP-71129075 CDM 0270 RC outpatient 598.1 598.1 598.1 74 442.59 percent of total billed charges 598.1 93 484.46 percent of total billed charges 598.1 598.1 other OPPS APC 598.1 598.1 other OPPS APC 598.1 27.63 165.26 percent of total billed charges 598.1 598.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L 80 MM OD 7 MM ORTHOPEDIC CANNULATED STERILE SUP-71129080 CDM 0270 RC outpatient 598.1 598.1 598.1 74 442.59 percent of total billed charges 598.1 93 484.46 percent of total billed charges 598.1 598.1 other OPPS APC 598.1 598.1 other OPPS APC 598.1 27.63 165.26 percent of total billed charges 598.1 598.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LARGE 7MM 85MM CANNULATED FULLY THREADED SELF DRILLING TAPPING STAINLESS STEEL HEX DRIVE REVERSE CUTTING FLUTE SUP-71129085 CDM 0270 RC outpatient 598.1 598.1 598.1 74 442.59 percent of total billed charges 598.1 93 484.46 percent of total billed charges 598.1 598.1 other OPPS APC 598.1 598.1 other OPPS APC 598.1 27.63 165.26 percent of total billed charges 598.1 598.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL FULL THREAD L 95MM OD 7 MM ORTHOPEDIC CANNULATED STERILE SUP-71129095 CDM 0270 RC outpatient 598.1 598.1 598.1 74 442.59 percent of total billed charges 598.1 93 484.46 percent of total billed charges 598.1 598.1 other OPPS APC 598.1 598.1 other OPPS APC 598.1 27.63 165.26 percent of total billed charges 598.1 598.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL EVOS OD1.8MM RADIUS DISTAL AO QUICK CONNECT STERILE DISPOSABLE SUP-71158092 CDM 0270 RC outpatient 553.28 553.28 553.28 74 409.43 percent of total billed charges 553.28 93 448.16 percent of total billed charges 553.28 553.28 other OPPS APC 553.28 553.28 other OPPS APC 553.28 27.63 152.87 percent of total billed charges 553.28 553.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS TITANIUM STANDARD L 56 MM RADIUS LEFT DISTAL VOLAR 4 HOLE STERILE LATEX FREE SUP-71158104 CDM 0270 RC outpatient 2100.8 2100.8 2100.8 74 1554.59 percent of total billed charges 2100.8 93 1701.65 percent of total billed charges 2100.8 2100.8 other OPPS APC 2100.8 2100.8 other OPPS APC 2100.8 27.63 580.45 percent of total billed charges 2100.8 2100.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 81MM HOLEX5 NON-STERILE STANDARD LEFT DISTAL VOLAR RADIAL TITANIUM SUP-71158105 CDM 0270 RC outpatient 3161.6 3161.6 3161.6 74 2339.58 percent of total billed charges 3161.6 93 2560.9 percent of total billed charges 3161.6 3161.6 other OPPS APC 3161.6 3161.6 other OPPS APC 3161.6 27.63 873.55 percent of total billed charges 3161.6 3161.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 48MM 3-HOLE TITANIUM STANDARD RIGHT DISTAL VOLAR RADIAL STERILE SUP-71158203 CDM 0270 RC outpatient 1887.6 1887.6 1887.6 74 1396.82 percent of total billed charges 1887.6 93 1528.96 percent of total billed charges 1887.6 1887.6 other OPPS APC 1887.6 1887.6 other OPPS APC 1887.6 27.63 521.54 percent of total billed charges 1887.6 1887.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 105MM HOLE X7 STERILE STANDARD RIGHT DISTAL VOLAR RADIAL TITANIUM SUP-71158207 CDM 0270 RC outpatient 3250 3250 3250 74 2405 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 3250 other OPPS APC 3250 3250 other OPPS APC 3250 27.63 897.98 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL L 150MM OD 1.25MM TROCAR POINT STERILE SUP-71161012 CDM 0270 RC outpatient 517.14 517.14 517.14 74 382.68 percent of total billed charges 517.14 93 418.88 percent of total billed charges 517.14 517.14 other OPPS APC 517.14 517.14 other OPPS APC 517.14 27.63 142.89 percent of total billed charges 517.14 517.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION L 100 MM OD 1.4 MM TROCAR TIP SUP-71161014 CDM 0270 RC outpatient 85.8 85.8 85.8 74 63.49 percent of total billed charges 85.8 93 69.5 percent of total billed charges 85.8 85.8 other OPPS APC 85.8 85.8 other OPPS APC 85.8 27.63 23.71 percent of total billed charges 85.8 85.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL L 150MM OD 1.6MM TROCAR POINT STERILE SUP-71161016 CDM 0270 RC outpatient 66.3 66.3 66.3 74 49.06 percent of total billed charges 66.3 93 53.7 percent of total billed charges 66.3 66.3 other OPPS APC 66.3 66.3 other OPPS APC 66.3 27.63 18.32 percent of total billed charges 66.3 66.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL L 150MM OD 2MM TROCAR POINT STERILE SUP-71161020 CDM 0270 RC outpatient 66.3 66.3 66.3 74 49.06 percent of total billed charges 66.3 93 53.7 percent of total billed charges 66.3 66.3 other OPPS APC 66.3 66.3 other OPPS APC 66.3 27.63 18.32 percent of total billed charges 66.3 66.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOOK BONE TC-100 SHARP NONSTERILE LATEX FREE DISPOSABLE SUP-71170043 CDM 0270 RC outpatient 569.97 569.97 569.97 74 421.78 percent of total billed charges 569.97 93 461.68 percent of total billed charges 569.97 569.97 other OPPS APC 569.97 569.97 other OPPS APC 569.97 27.63 157.48 percent of total billed charges 569.97 569.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS SURGICAL REDUCTION POINT BROAD SUP-71173377 CDM 0270 RC outpatient 1834.76 1834.76 1834.76 74 1357.72 percent of total billed charges 1834.76 93 1486.16 percent of total billed charges 1834.76 1834.76 other OPPS APC 1834.76 1834.76 other OPPS APC 1834.76 27.63 506.94 percent of total billed charges 1834.76 1834.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL PERI-LOC OD 3.5MM TARGETER SUP-71173402 CDM 0270 RC outpatient 304.2 304.2 304.2 74 225.11 percent of total billed charges 304.2 93 246.4 percent of total billed charges 304.2 304.2 other OPPS APC 304.2 304.2 other OPPS APC 304.2 27.63 84.05 percent of total billed charges 304.2 304.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION PERI-LOC STAINLESS STEEL L 40MM OD 3.5MM TRIAL TARGETER SUP-71173408 CDM 0270 RC outpatient 452.92 452.92 452.92 74 335.16 percent of total billed charges 452.92 93 366.87 percent of total billed charges 452.92 452.92 other OPPS APC 452.92 452.92 other OPPS APC 452.92 27.63 125.14 percent of total billed charges 452.92 452.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL PERI-LOC SHORT OD 3.5 MM QUICK CONNECT STERILE LATEX FREE DISPOSABLE SUP-71173504 CDM 0270 RC outpatient 325.16 325.16 325.16 74 240.62 percent of total billed charges 325.16 93 263.38 percent of total billed charges 325.16 325.16 other OPPS APC 325.16 325.16 other OPPS APC 325.16 27.63 89.84 percent of total billed charges 325.16 325.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL PERI-LOC L 220 MM OD 3.5 MM AO QUICK CONNECT CALIBRATED STERILE DISPOSABLE SUP-71173505 CDM 0270 RC outpatient 366.39 366.39 366.39 74 271.13 percent of total billed charges 366.39 93 296.78 percent of total billed charges 366.39 366.39 other OPPS APC 366.39 366.39 other OPPS APC 366.39 27.63 101.23 percent of total billed charges 366.39 366.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL PERI-LOC OD 4.5 MM AO QUICK CONNECT CALIBRATE DISPOSABLE SUP-71173506 CDM 0270 RC outpatient 366.39 366.39 366.39 74 271.13 percent of total billed charges 366.39 93 296.78 percent of total billed charges 366.39 366.39 other OPPS APC 366.39 366.39 other OPPS APC 366.39 27.63 101.23 percent of total billed charges 366.39 366.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL PERI-LOC OD 4.5 MM QUICK CONNECT CANNULATED STERILE DISPOSABLE SUP-71173508 CDM 0270 RC outpatient 1230.32 1230.32 1230.32 74 910.44 percent of total billed charges 1230.32 93 996.56 percent of total billed charges 1230.32 1230.32 other OPPS APC 1230.32 1230.32 other OPPS APC 1230.32 27.63 339.94 percent of total billed charges 1230.32 1230.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HANDLE SCREWDRIVER PERI-LOC LARGE FRAGMENT SUP-71173547 CDM 0270 RC outpatient 1959.59 1959.59 1959.59 74 1450.1 percent of total billed charges 1959.59 93 1587.27 percent of total billed charges 1959.59 1959.59 other OPPS APC 1959.59 1959.59 other OPPS APC 1959.59 27.63 541.43 percent of total billed charges 1959.59 1959.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L 155 MM OD 2.7MM CANNULATED DISPOSABLE SUP-71173581 CDM 0270 RC outpatient 901.68 901.68 901.68 74 667.24 percent of total billed charges 901.68 93 730.36 percent of total billed charges 901.68 901.68 other OPPS APC 901.68 901.68 other OPPS APC 901.68 27.63 249.13 percent of total billed charges 901.68 901.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL VLP L 130 MM OD 2MM SUP-71173801 CDM 0270 RC outpatient 218.4 218.4 218.4 74 161.62 percent of total billed charges 218.4 93 176.9 percent of total billed charges 218.4 218.4 other OPPS APC 218.4 218.4 other OPPS APC 218.4 27.63 60.34 percent of total billed charges 218.4 218.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL L 130 MM OD 2.7 MM SUP-71173803 CDM 0270 RC outpatient 218.4 218.4 218.4 74 161.62 percent of total billed charges 218.4 93 176.9 percent of total billed charges 218.4 218.4 other OPPS APC 218.4 218.4 other OPPS APC 218.4 27.63 60.34 percent of total billed charges 218.4 218.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOS OD 1.5MM AO QUICK CONNECT DISPOSABLE SUP-71174901 CDM 0270 RC outpatient 190.94 190.94 190.94 74 141.3 percent of total billed charges 190.94 93 154.66 percent of total billed charges 190.94 190.94 other OPPS APC 190.94 190.94 other OPPS APC 190.94 27.63 52.76 percent of total billed charges 190.94 190.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOS MINI OD 2MM AO QUICK CONNECT COUPLING DISPOSABLE SUP-71174902 CDM 0270 RC outpatient 190.94 190.94 190.94 74 141.3 percent of total billed charges 190.94 93 154.66 percent of total billed charges 190.94 190.94 other OPPS APC 190.94 190.94 other OPPS APC 190.94 27.63 52.76 percent of total billed charges 190.94 190.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN BONE FIXATION EVOS 1.5MM 20MM PROVISIONAL AO QUICK-CONNECT OVER STAINLESS STEEL SUP-71174904 CDM 0270 RC outpatient 357.76 357.76 357.76 74 264.74 percent of total billed charges 357.76 93 289.79 percent of total billed charges 357.76 357.76 other OPPS APC 357.76 357.76 other OPPS APC 357.76 27.63 98.85 percent of total billed charges 357.76 357.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOSO SHORT OD1.8MM AO QUICK CONNECT DISPOSABLE SUP-71174905 CDM 0270 RC outpatient 224.64 224.64 224.64 74 166.23 percent of total billed charges 224.64 93 181.96 percent of total billed charges 224.64 224.64 other OPPS APC 224.64 224.64 other OPPS APC 224.64 27.63 62.07 percent of total billed charges 224.64 224.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOS LONG OD1.8MM AO QUICK CONNECT DISPOSABLE SUP-71174906 CDM 0270 RC outpatient 274.56 274.56 274.56 74 203.17 percent of total billed charges 274.56 93 222.39 percent of total billed charges 274.56 274.56 other OPPS APC 274.56 274.56 other OPPS APC 274.56 27.63 75.86 percent of total billed charges 274.56 274.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOS OD 2.4MM AO QUICK CONNECT DISPOSABLE SUP-71174907 CDM 0270 RC outpatient 190.94 190.94 190.94 74 141.3 percent of total billed charges 190.94 93 154.66 percent of total billed charges 190.94 190.94 other OPPS APC 190.94 190.94 other OPPS APC 190.94 27.63 52.76 percent of total billed charges 190.94 190.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN BONE FIXATION EVOS 1.8MM 30MM PROVISIONAL AO QUICK-CONNECT OVER STAINLESS STEEL SUP-71174909 CDM 0270 RC outpatient 357.76 357.76 357.76 74 264.74 percent of total billed charges 357.76 93 289.79 percent of total billed charges 357.76 357.76 other OPPS APC 357.76 357.76 other OPPS APC 357.76 27.63 98.85 percent of total billed charges 357.76 357.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOS SHORT OD 2MM AO QUICK CONNECT DISPOSABLE SUP-71174910 CDM 0270 RC outpatient 190.94 190.94 190.94 74 141.3 percent of total billed charges 190.94 93 154.66 percent of total billed charges 190.94 190.94 other OPPS APC 190.94 190.94 other OPPS APC 190.94 27.63 52.76 percent of total billed charges 190.94 190.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOS LONG OD 2MM AO QUICK CONNECT DISPOSABLE SUP-71174911 CDM 0270 RC outpatient 274.56 274.56 274.56 74 203.17 percent of total billed charges 274.56 93 222.39 percent of total billed charges 274.56 274.56 other OPPS APC 274.56 274.56 other OPPS APC 274.56 27.63 75.86 percent of total billed charges 274.56 274.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOS OD 2.7MM AO QUICK CONNECT DISPOSABLE SUP-71174912 CDM 0270 RC outpatient 190.94 190.94 190.94 74 141.3 percent of total billed charges 190.94 93 154.66 percent of total billed charges 190.94 190.94 other OPPS APC 190.94 190.94 other OPPS APC 190.94 27.63 52.76 percent of total billed charges 190.94 190.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN BONE FIXATION EVOS 2MM 30MM PROVISIONAL AO QUICK-CONNECT OVER STAINLESS STEEL SUP-71174914 CDM 0270 RC outpatient 357.76 357.76 357.76 74 264.74 percent of total billed charges 357.76 93 289.79 percent of total billed charges 357.76 357.76 other OPPS APC 357.76 357.76 other OPPS APC 357.76 27.63 98.85 percent of total billed charges 357.76 357.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOS SMALL LONG OD 2MM AO QUICK CONNECT STERILE LATEX FREE REUSABLE SUP-71175020 CDM 0270 RC outpatient 201.55 201.55 201.55 74 149.15 percent of total billed charges 201.55 93 163.26 percent of total billed charges 201.55 201.55 other OPPS APC 201.55 201.55 other OPPS APC 201.55 27.63 55.69 percent of total billed charges 201.55 201.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOS SMALL SHORT OD 2MM AO QUICK CONNECT DISPOSABLE SUP-71175021 CDM 0270 RC outpatient 201.55 201.55 201.55 74 149.15 percent of total billed charges 201.55 93 163.26 percent of total billed charges 201.55 201.55 other OPPS APC 201.55 201.55 other OPPS APC 201.55 27.63 55.69 percent of total billed charges 201.55 201.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOS SMALL LONG OD 2.5MM AO QUICK CONNECT STERILE LATEX FREE REUSABLE SUP-71175022 CDM 0270 RC outpatient 201.55 201.55 201.55 74 149.15 percent of total billed charges 201.55 93 163.26 percent of total billed charges 201.55 201.55 other OPPS APC 201.55 201.55 other OPPS APC 201.55 27.63 55.69 percent of total billed charges 201.55 201.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOS SMALL SHORT OD2.5MM AO QUICK CONNECT DISPOSABLE SUP-71175023 CDM 0270 RC outpatient 201.55 201.55 201.55 74 149.15 percent of total billed charges 201.55 93 163.26 percent of total billed charges 201.55 201.55 other OPPS APC 201.55 201.55 other OPPS APC 201.55 27.63 55.69 percent of total billed charges 201.55 201.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOS SMALL LONG OD 2.7 MM AO QUICK CONNECT OVER STERILE LATEX FREE DISPOSABLE SUP-71175024 CDM 0270 RC outpatient 201.55 201.55 201.55 74 149.15 percent of total billed charges 201.55 93 163.26 percent of total billed charges 201.55 201.55 other OPPS APC 201.55 201.55 other OPPS APC 201.55 27.63 55.69 percent of total billed charges 201.55 201.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOS SMALL SHORT OD 2.7MM AO QUICK CONNECT OVER STERILE LATEX FREE DISPOSABLE SUP-71175025 CDM 0270 RC outpatient 201.55 201.55 201.55 74 149.15 percent of total billed charges 201.55 93 163.26 percent of total billed charges 201.55 201.55 other OPPS APC 201.55 201.55 other OPPS APC 201.55 27.63 55.69 percent of total billed charges 201.55 201.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOS SMALL SHORT OD 3.5 MM AO QUICK CONNECT OVER STERILE LATEX FREE DISPOSABLE SUP-71175027 CDM 0270 RC outpatient 201.55 201.55 201.55 74 149.15 percent of total billed charges 201.55 93 163.26 percent of total billed charges 201.55 201.55 other OPPS APC 201.55 201.55 other OPPS APC 201.55 27.63 55.69 percent of total billed charges 201.55 201.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE DRILL EVOS OD 2.5 MM FIX VARIABLE ANGLE SUP-71175042 CDM 0270 RC outpatient 2723.76 2723.76 2723.76 74 2015.58 percent of total billed charges 2723.76 93 2206.25 percent of total billed charges 2723.76 2723.76 other OPPS APC 2723.76 2723.76 other OPPS APC 2723.76 27.63 752.57 percent of total billed charges 2723.76 2723.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE DRILL EVOS OD 2.5MM SNAP IN SERRATE SUP-71175047 CDM 0270 RC outpatient 1364.4 1364.4 1364.4 74 1009.66 percent of total billed charges 1364.4 93 1105.16 percent of total billed charges 1364.4 1364.4 other OPPS APC 1364.4 1364.4 other OPPS APC 1364.4 27.63 376.98 percent of total billed charges 1364.4 1364.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE DRILL EVOS OD 2.5 MM SNAP IN SUP-71175050 CDM 0270 RC outpatient 1124.81 1124.81 1124.81 74 832.36 percent of total billed charges 1124.81 93 911.1 percent of total billed charges 1124.81 1124.81 other OPPS APC 1124.81 1124.81 other OPPS APC 1124.81 27.63 310.79 percent of total billed charges 1124.81 1124.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE DRILL EVOS OD 3.5MM SNAP IN SERRATE SUP-71175051 CDM 0270 RC outpatient 1364.4 1364.4 1364.4 74 1009.66 percent of total billed charges 1364.4 93 1105.16 percent of total billed charges 1364.4 1364.4 other OPPS APC 1364.4 1364.4 other OPPS APC 1364.4 27.63 376.98 percent of total billed charges 1364.4 1364.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE DRILL EVOS OD 2.5 MM LOCK SUP-71175056 CDM 0270 RC outpatient 802 802 802 74 593.48 percent of total billed charges 802 93 649.62 percent of total billed charges 802 802 other OPPS APC 802 802 other OPPS APC 802 27.63 221.59 percent of total billed charges 802 802 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HANDLE INSTRUMENT EVOS MODULAR SUP-71175065 CDM 0270 RC outpatient 3694.73 3694.73 3694.73 74 2734.1 percent of total billed charges 3694.73 93 2992.73 percent of total billed charges 3694.73 3694.73 other OPPS APC 3694.73 3694.73 other OPPS APC 3694.73 27.63 1020.85 percent of total billed charges 3694.73 3694.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GAUGE DEPTH EVOS SMALL LONG 3.5 MM SCREW SUP-71175068 CDM 0270 RC outpatient 2340.42 2340.42 2340.42 74 1731.91 percent of total billed charges 2340.42 93 1895.74 percent of total billed charges 2340.42 2340.42 other OPPS APC 2340.42 2340.42 other OPPS APC 2340.42 27.63 646.66 percent of total billed charges 2340.42 2340.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GAUGE DEPTH EVOS SMALL SHORT 3.5 MM SCREW SUP-71175069 CDM 0270 RC outpatient 2247.1 2247.1 2247.1 74 1662.85 percent of total billed charges 2247.1 93 1820.15 percent of total billed charges 2247.1 2247.1 other OPPS APC 2247.1 2247.1 other OPPS APC 2247.1 27.63 620.87 percent of total billed charges 2247.1 2247.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHAFT SCREWDRIVER SHORT HEXAGON OD 2.5MM SUP-71175073 CDM 0270 RC outpatient 549.8 549.8 549.8 74 406.85 percent of total billed charges 549.8 93 445.34 percent of total billed charges 549.8 549.8 other OPPS APC 549.8 549.8 other OPPS APC 549.8 27.63 151.91 percent of total billed charges 549.8 549.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION EVO L 14 MM OD 2 MM PROVISIONAL STERILE SUP-71175090 CDM 0270 RC outpatient 307.84 307.84 307.84 74 227.8 percent of total billed charges 307.84 93 249.35 percent of total billed charges 307.84 307.84 other OPPS APC 307.84 307.84 other OPPS APC 307.84 27.63 85.06 percent of total billed charges 307.84 307.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION EVOS L 14 MM OD 2.5 MM PROVISIONAL STERILE SUP-71175093 CDM 0270 RC outpatient 191.88 191.88 191.88 74 141.99 percent of total billed charges 191.88 93 155.42 percent of total billed charges 191.88 191.88 other OPPS APC 191.88 191.88 other OPPS APC 191.88 27.63 53.02 percent of total billed charges 191.88 191.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION EVOS L 25MM OD 2.5MM PROVISIONAL STERILE SUP-71175094 CDM 0270 RC outpatient 421.2 421.2 421.2 74 311.69 percent of total billed charges 421.2 93 341.17 percent of total billed charges 421.2 421.2 other OPPS APC 421.2 421.2 other OPPS APC 421.2 27.63 116.38 percent of total billed charges 421.2 421.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION EVOS L 40 MM OD 2.5 MM PROVISIONAL STERILE SUP-71175095 CDM 0270 RC outpatient 229.84 229.84 229.84 74 170.08 percent of total billed charges 229.84 93 186.17 percent of total billed charges 229.84 229.84 other OPPS APC 229.84 229.84 other OPPS APC 229.84 27.63 63.5 percent of total billed charges 229.84 229.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRIVER LINEAR SHAFT HEXAGON 2.5 MM SUP-71175098 CDM 0270 RC outpatient 1202.99 1202.99 1202.99 74 890.21 percent of total billed charges 1202.99 93 974.42 percent of total billed charges 1202.99 1202.99 other OPPS APC 1202.99 1202.99 other OPPS APC 1202.99 27.63 332.39 percent of total billed charges 1202.99 1202.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER EVOS L 225MM OD 2 MM TROCAR TIP SUP-71175600 CDM 0270 RC outpatient 577.2 577.2 577.2 74 427.13 percent of total billed charges 577.2 93 467.53 percent of total billed charges 577.2 577.2 other OPPS APC 577.2 577.2 other OPPS APC 577.2 27.63 159.48 percent of total billed charges 577.2 577.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NUT ORTHOPEDIC OD 3.5 MM COMPRESSION NONSTERILE LATEX FREE SUP-71175605 CDM 0270 RC outpatient 183.3 183.3 183.3 74 135.64 percent of total billed charges 183.3 93 148.47 percent of total billed charges 183.3 183.3 other OPPS APC 183.3 183.3 other OPPS APC 183.3 27.63 50.65 percent of total billed charges 183.3 183.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOS LARGE SHORT OD 3.7MM AO QUICK CONNECTOR STERILE LATEX FREE DISPOSABLE SUP-71175618 CDM 0270 RC outpatient 665.6 665.6 665.6 74 492.54 percent of total billed charges 665.6 93 539.14 percent of total billed charges 665.6 665.6 other OPPS APC 665.6 665.6 other OPPS APC 665.6 27.63 183.91 percent of total billed charges 665.6 665.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOS LARGE LONG OD 3.7MM AO QUICK CONNECTOR STERILE LATEX FREE DISPOSABLE SUP-71175619 CDM 0270 RC outpatient 842.4 842.4 842.4 74 623.38 percent of total billed charges 842.4 93 682.34 percent of total billed charges 842.4 842.4 other OPPS APC 842.4 842.4 other OPPS APC 842.4 27.63 232.76 percent of total billed charges 842.4 842.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOS LARGE OD 4.5MM AO QUICK CONNECT OVER STERILE LATEX FREE DISPOSABLE SUP-71175626 CDM 0270 RC outpatient 481 481 481 74 355.94 percent of total billed charges 481 93 389.61 percent of total billed charges 481 481 other OPPS APC 481 481 other OPPS APC 481 27.63 132.9 percent of total billed charges 481 481 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOS 3.7MM/5.5MM STEP LARGE W/AO QUICK CONNECT SUP-71175646 CDM 0270 RC outpatient 1002.3 1002.3 1002.3 74 741.7 percent of total billed charges 1002.3 93 811.86 percent of total billed charges 1002.3 1002.3 other OPPS APC 1002.3 1002.3 other OPPS APC 1002.3 27.63 276.94 percent of total billed charges 1002.3 1002.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PUSH EVOS LARGE 5.5 MM SUP-71175648 CDM 0270 RC outpatient 351.65 351.65 351.65 74 260.22 percent of total billed charges 351.65 93 284.84 percent of total billed charges 351.65 351.65 other OPPS APC 351.65 351.65 other OPPS APC 351.65 27.63 97.16 percent of total billed charges 351.65 351.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STERILE LATEX FREE 4.5MM CABLE SUP-71175652 CDM 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STERILE LATEX FREE 3.5MM CABLE SUP-71175680 CDM 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL OD 2MM CANNULATED QUICK CONNECT SUP-71177110 CDM 0270 RC outpatient 714.48 714.48 714.48 74 528.72 percent of total billed charges 714.48 93 578.73 percent of total billed charges 714.48 714.48 other OPPS APC 714.48 714.48 other OPPS APC 714.48 27.63 197.41 percent of total billed charges 714.48 714.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE PIN ORTHOPEDIC L 358MM OD 3.2MM THREAD SUP-71177123 CDM 0270 RC outpatient 123.55 123.55 123.55 74 91.43 percent of total billed charges 123.55 93 100.08 percent of total billed charges 123.55 123.55 other OPPS APC 123.55 123.55 other OPPS APC 123.55 27.63 34.14 percent of total billed charges 123.55 123.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL OD 5 MM CANNULATED SUP-71177134 CDM 0270 RC outpatient 1118.26 1118.26 1118.26 74 827.51 percent of total billed charges 1118.26 93 905.79 percent of total billed charges 1118.26 1118.26 other OPPS APC 1118.26 1118.26 other OPPS APC 1118.26 27.63 308.98 percent of total billed charges 1118.26 1118.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL OD 5.5 MM CANNULATED 8 MM SCREW SUP-71177135 CDM 0270 RC outpatient 1118.26 1118.26 1118.26 74 827.51 percent of total billed charges 1118.26 93 905.79 percent of total billed charges 1118.26 1118.26 other OPPS APC 1118.26 1118.26 other OPPS APC 1118.26 27.63 308.98 percent of total billed charges 1118.26 1118.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE DRILL PIN MULTIPARALLEL ATTACHMENT SUP-71177152 CDM 0270 RC outpatient 8437 8437 8437 74 6243.38 percent of total billed charges 8437 93 6833.97 percent of total billed charges 8437 8437 other OPPS APC 8437 8437 other OPPS APC 8437 27.63 2331.14 percent of total billed charges 8437 8437 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE PIN ORTHOPEDIC L300 MM OD 3.2MM THREAD SUP-71177201 CDM 0270 RC outpatient 133.04 133.04 133.04 74 98.45 percent of total billed charges 133.04 93 107.76 percent of total billed charges 133.04 133.04 other OPPS APC 133.04 133.04 other OPPS APC 133.04 27.63 36.76 percent of total billed charges 133.04 133.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L 300MM OD 3.2 MM QUICK COUPLING SUP-71177202 CDM 0270 RC outpatient 436.7 436.7 436.7 74 323.16 percent of total billed charges 436.7 93 353.73 percent of total billed charges 436.7 436.7 other OPPS APC 436.7 436.7 other OPPS APC 436.7 27.63 120.66 percent of total billed charges 436.7 436.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER EVOS L 350 MM OD 2 MM TROCAR TIP SUP-71177719 CDM 0270 RC outpatient 200.2 200.2 200.2 74 148.15 percent of total billed charges 200.2 93 162.16 percent of total billed charges 200.2 200.2 other OPPS APC 200.2 200.2 other OPPS APC 200.2 27.63 55.32 percent of total billed charges 200.2 200.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION EVOS LARGE L 14 MM OD 3.5 MM PROVISIONAL TARGETER STERILE LATEX DISPOSABLE SUP-71177725 CDM 0270 RC outpatient 1162.2 1162.2 1162.2 74 860.03 percent of total billed charges 1162.2 93 941.38 percent of total billed charges 1162.2 1162.2 other OPPS APC 1162.2 1162.2 other OPPS APC 1162.2 27.63 321.12 percent of total billed charges 1162.2 1162.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION EVOS LARGE L 40 MM OD 3.5 MM PROVISIONAL TARGETER STERILE LATEX DISPOSABLE SUP-71177726 CDM 0270 RC outpatient 1240.2 1240.2 1240.2 74 917.75 percent of total billed charges 1240.2 93 1004.56 percent of total billed charges 1240.2 1240.2 other OPPS APC 1240.2 1240.2 other OPPS APC 1240.2 27.63 342.67 percent of total billed charges 1240.2 1240.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION EVOS LARGE L 60 MM OD 3.5 MM PROVISIONAL TARGETER STERILE LATEX FREE DISPOSABLE SUP-71177728 CDM 0270 RC outpatient 421.2 421.2 421.2 74 311.69 percent of total billed charges 421.2 93 341.17 percent of total billed charges 421.2 421.2 other OPPS APC 421.2 421.2 other OPPS APC 421.2 27.63 116.38 percent of total billed charges 421.2 421.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAP SURGICAL EVOS LARGE OD 4.5MM TARGETER STERILE LATEX FREE DIPOSABLE SUP-71177731 CDM 0270 RC outpatient 522.6 522.6 522.6 74 386.72 percent of total billed charges 522.6 93 423.31 percent of total billed charges 522.6 522.6 other OPPS APC 522.6 522.6 other OPPS APC 522.6 27.63 144.39 percent of total billed charges 522.6 522.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOS LARGE OD 3.7MM AO QUICK CONNECTOR TARGETER STERILE LATEX FREE DISPOSABLE SUP-71177735 CDM 0270 RC outpatient 1090.7 1090.7 1090.7 74 807.12 percent of total billed charges 1090.7 93 883.47 percent of total billed charges 1090.7 1090.7 other OPPS APC 1090.7 1090.7 other OPPS APC 1090.7 27.63 301.36 percent of total billed charges 1090.7 1090.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL EVOS LARGE OD 4.5 MM TARGETER AO QUICK OVER STERILE LATEX FREE DISPOSABLE SUP-71177737 CDM 0270 RC outpatient 581.1 581.1 581.1 74 430.01 percent of total billed charges 581.1 93 470.69 percent of total billed charges 581.1 581.1 other OPPS APC 581.1 581.1 other OPPS APC 581.1 27.63 160.56 percent of total billed charges 581.1 581.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOS LARGE OD 4.5 MM TARGETER AO QUICK OVER CANNUALTE STERILE LAXTEX FREE DISPOSABLE SUP-71177740 CDM 0270 RC outpatient 763.75 763.75 763.75 74 565.18 percent of total billed charges 763.75 93 618.64 percent of total billed charges 763.75 763.75 other OPPS APC 763.75 763.75 other OPPS APC 763.75 27.63 211.02 percent of total billed charges 763.75 763.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL EVOS LARGE OD 3.7 MM CORTICAL AO QUICK OVER CANNULATE STERILE LATEX FREE DISPOSABLE SUP-71177749 CDM 0270 RC outpatient 1566.5 1566.5 1566.5 74 1159.21 percent of total billed charges 1566.5 93 1268.87 percent of total billed charges 1566.5 1566.5 other OPPS APC 1566.5 1566.5 other OPPS APC 1566.5 27.63 432.82 percent of total billed charges 1566.5 1566.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL SURGICAL EVOS LARGE OD 2.5 MM TARGETER AO QUICK STERILE LATEX FREE DISPOSABLE SUP-71177752 CDM 0270 RC outpatient 581.1 581.1 581.1 74 430.01 percent of total billed charges 581.1 93 470.69 percent of total billed charges 581.1 581.1 other OPPS APC 581.1 581.1 other OPPS APC 581.1 27.63 160.56 percent of total billed charges 581.1 581.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL EVOS LARGE OD 4.5 MM TARGETER AO QUICK STERILE LATEX FREE DISPOSABLE SUP-71177765 CDM 0270 RC outpatient 1162.2 1162.2 1162.2 74 860.03 percent of total billed charges 1162.2 93 941.38 percent of total billed charges 1162.2 1162.2 other OPPS APC 1162.2 1162.2 other OPPS APC 1162.2 27.63 321.12 percent of total billed charges 1162.2 1162.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD COCR 90MM CURVED SUP-7119.7070 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING DURATA STEROID ELUTING L60 CM OD7 FR ENDOCARDIUM 2 COIL SUP-7120/60 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING DURATA STEROID ELUTING L65 CM OD7 FR ENDOCARDIUM 2 COIL SUP-7120/65 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SELF DRILLING 16MM SUP-7120416 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD DEFIBRILLATOR DURATA L52 CM L17 CM OD7 FR 2 COIL DF-4 SUP-7120Q/52 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD DURATA SJ4 SINGLE SHOCK L58 SUP-7120Q/58 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING DURATA STEROID ELUTING L65 CM OD7 FR ENDOCARDIUM 2 COIL DF-4 SUP-7120Q/65 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING DURATA OPTIM L60 CM OD7 FR ENDOCARDIUM 2 COIL SUP-7121/60 CDM 0275 RC outpatient 7540 7540 7540 57 4297.8 percent of total billed charges 7540 93 6107.4 percent of total billed charges 7540 7540 other OPPS APC 7540 7540 other OPPS APC 7540 51 3845.4 percent of total billed charges 7540 7540 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD DEFIBRILLATOR DURATA 21 CM SPACE L65 CM OD7 FR 2 COIL SUP-7121/65 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON 20.0D SUP-71215 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON IOL 20.0D SUP-71215 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING DURATA SJ4 21 CM SPACE L52 CM OD7 FR ENDOCARDIUM 2 COIL SUP-7121Q/52 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING DURATA SJ4 21 CM SPACE L58 CM OD7 FR ENDOCARDIUM 2 COIL SUP-7121Q/58 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING DURATA SJ4 21 CM SPACE L65 CM OD7 FR ENDOCARDIUM 2 COIL SUP-7121Q/65 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD ICD 7122 DURATA DF1 SUP-7122 CDM 0275 RC outpatient 8093.8 8093.8 8093.8 57 4613.47 percent of total billed charges 8093.8 93 6555.98 percent of total billed charges 8093.8 8093.8 other OPPS APC 8093.8 8093.8 other OPPS APC 8093.8 51 4127.84 percent of total billed charges 8093.8 8093.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD ICD DURATA OPTIM L60 CM OD7 FR 1 COIL DF1 SUP-7122/60 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING DURATA STEROID ELUTING OPTIM L65 CM OD7 FR ENDOCARDIUM 1 COIL SUP-7122/65 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD HUMERAL SIMPLICITI H19 MM OD52 MM SHOULDER SOFT TISSUE BALANCE STERILE LATEX FREE SUP-7122875 CDM 270010030 LOCAL 0270 RC outpatient 8546.2 8546.2 8546.2 74 6324.19 percent of total billed charges 8546.2 93 6922.42 percent of total billed charges 8546.2 8546.2 other OPPS APC 8546.2 8546.2 other OPPS APC 8546.2 27.63 2361.32 percent of total billed charges 8546.2 8546.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD HUMERAL SIMPLICITI H18 MM OD40 MM SHOULDER SOFT TISSUE BALANCE STERILE LATEX FREE SUP-7122878 CDM 270010020 LOCAL 0270 RC outpatient 8546.2 8546.2 8546.2 74 6324.19 percent of total billed charges 8546.2 93 6922.42 percent of total billed charges 8546.2 8546.2 other OPPS APC 8546.2 8546.2 other OPPS APC 8546.2 27.63 2361.32 percent of total billed charges 8546.2 8546.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING DURATA SJ4 STEROID ELUTING OPTIM L52 CM OD7 FR ENDOCARDIUM 1 COIL SUP-7122Q/52 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING DURATA SJ4 STEROID ELUTING SILICONE 11 MM SPACING L58 CM OD6.8 FR ENDOCARDIUM 1 COIL SUP-7122Q/58 CDM 0275 RC outpatient 7020 7020 7020 57 4001.4 percent of total billed charges 7020 93 5686.2 percent of total billed charges 7020 7020 other OPPS APC 7020 7020 other OPPS APC 7020 51 3580.2 percent of total billed charges 7020 7020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING DURATA SJ4 STEROID ELUTING SILICONE 11 MM SPACING L65 CM OD6.8 FR ENDOCARDIUM SUP-7122Q/65 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING DURATA STEROID ELUTING SILICONE 17 MM SPACING L60 CM OD6.8 FR ENDOCARDIUM 2 COIL SUP-7130/60 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL ECHELON COCR +4 MM 12/14 OD28 MM HIP TAPER NECK PRIMARY ASTM F799 SUP-71302804 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL ECHELON COCR -3 MM 12/14 OD36 MM HIP SUP-71303603 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL ECHELON COCR +8 MM 12/14 OD36 MM HIP SUP-71303608 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING DURATA STEROID ELUTING SILICONE 21 MM SPACING L65 CM OD6.8 FR ENDOCARDIUM 2 COIL SUP-7131/65 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE REFLECTION R3 CONTOUR L15 MM OD6.5 MM HIP ACETABULAR SPHERICAL HEAD SUP-71332515 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ACETABULAR REFLECTION R3 CONTOUR L20 MM OD6.5 MM HIP CANCELLOUS SPHERICAL HEAD SUP-71332520 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE REFLECTION R3 CONTOUR L25 MM OD6.5 MM HIP ACETABULAR CANCELLOUS SPHERICAL HEAD SUP-71332525 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR R3 XLPE 0 D OD52 MM ID36 MM HIP SUP-71332752 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR R3 XLPE 0 D OD56 MM ID36 MM HIP STERILE SUP-71332756 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR REFLECTION XLPE 20 D G OD58-60 MM ID36 MM HIP SUP-71333346 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR REFLECTION XLPE 0 D +4 MM F OD54-56 MM ID36 MM HIP LATERALIZED SUP-71333495 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR R3 POLY STANDARD OD52 MM HIP 3 HOLE SUP-71335552 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR R3 STANDARD OD56 MM HIP 3 HOLE SUP-71335556 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CREW ACETABULAR REFLECTION UNIVERSAL FULL THREAD L20 MM OD6.5 MM HIP CANCELLOUS SUP-71336520 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ACETABULAR REFLECTION UNIVERSAL FULL THREAD L25 MM OD6.5 MM HIP CANCELLOUS SELF TAP SUP-71336525 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL OXINIUM +0 MM 12/14 TAPER OD36 MM HIP SUP-71343600 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL ECHELON OXINIUM -3 MM 12/14 TAPER OD36 MM HIP REVISION SUP-71343603 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL OXINIUM +4 MM 12/14 TAPER OD36 MM HIP SUP-71343604 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR 56MM 3 HOLE SUP-7135556 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ANTHOLOGY HA POROUS PLUS 131 D 5 STANDARD OFFSET L108 MM HIP PRIMARY STERILE SUP-71357005 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL HYDROXYAPATITE POROUS PLUS 3 HIGH OFFSET HIP SUP-71357103 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ANTHOLOGY HA POROUS PLUS 131 D 7 HIGH OFFSET L112 MM HIP PRIMARY STERILE SUP-71357107 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON 15.0D SUP-71424 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON IOL 15.0D SUP-71424 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP SPINAL X-CORE 2 TITANIUM NS LOCK SCREW SUP-7162000 CDM 270010020 LOCAL 0270 RC outpatient 834.6 834.6 834.6 74 617.6 percent of total billed charges 834.6 93 676.03 percent of total billed charges 834.6 834.6 other OPPS APC 834.6 834.6 other OPPS APC 834.6 27.63 230.6 percent of total billed charges 834.6 834.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL TRIGEN LONG OD4 MM PILOT STERILE DISPOSABLE SUP-71631110 CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL TRIGEN SHORT OD 3.2MM PILOT STERILE SUP-71631112 CDM 0270 RC outpatient 189.1 189.1 189.1 74 139.93 percent of total billed charges 189.1 93 153.17 percent of total billed charges 189.1 189.1 other OPPS APC 189.1 189.1 other OPPS APC 189.1 27.63 52.25 percent of total billed charges 189.1 189.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL TRIGEN SHORT OD4 MM PILOT STERILE DISPOSABLE SUP-71631117 CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL TRIGEN LONG OD 4 MM AO PILOT STERILE DISPOSABLE SUP-71631121 CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL TRIGEN SHORT L 161MM OD 4MM TROCHANTER FEMUR AO PILOT STERILE DISPOSABLE SUP-71631123 CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE ROD ORTHOPEDIC TRIGEN L1000 MM OD3 MM INTRAMEDULLARY BALL TIP STERILE DISPOSABLE 8.5 MM FEMORAL ANTEGRADE NAIL SYSTEM SUP-71631126 CDM 0270 RC outpatient 391.46 391.46 391.46 74 289.68 percent of total billed charges 391.46 93 317.08 percent of total billed charges 391.46 391.46 other OPPS APC 391.46 391.46 other OPPS APC 391.46 27.63 108.16 percent of total billed charges 391.46 391.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIGEN DISPOSABLE EXTRACTOR SUP-71631320 CDM 0270 RC outpatient 540.07 540.07 540.07 74 399.65 percent of total billed charges 540.07 93 437.46 percent of total billed charges 540.07 540.07 other OPPS APC 540.07 540.07 other OPPS APC 540.07 27.63 149.22 percent of total billed charges 540.07 540.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE PIN ORTHOPEDIC TRIGEN META-TAN L 343MM OD 3.2MM SUP-71631436 CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE ROD ORTHOPEDIC TRIGEN STAINLESS STEEL BALL L 1000MM OD 3MM BALL TIP STERILE DISPOSABLE SUP-71631626 CDM 0270 RC outpatient 267.8 267.8 267.8 74 198.17 percent of total billed charges 267.8 93 216.92 percent of total billed charges 267.8 267.8 other OPPS APC 267.8 267.8 other OPPS APC 267.8 27.63 73.99 percent of total billed charges 267.8 267.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP END TRIGEN TITANIUM 0 MM SET DISPOSABLE INTERNAL HEX INTRAMEDULLARY NAIL SUP-71634000 CDM 0270 RC outpatient 482.98 482.98 482.98 74 357.41 percent of total billed charges 482.98 93 391.21 percent of total billed charges 482.98 482.98 other OPPS APC 482.98 482.98 other OPPS APC 482.98 27.63 133.45 percent of total billed charges 482.98 482.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP END TRIGEN TITANIUM OD 20MM INTERNAL HEX INTRAMEDULLARY NAIL SUP-71634020 CDM 0270 RC outpatient 482.98 482.98 482.98 74 357.41 percent of total billed charges 482.98 93 391.21 percent of total billed charges 482.98 482.98 other OPPS APC 482.98 482.98 other OPPS APC 482.98 27.63 133.45 percent of total billed charges 482.98 482.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 30CM OD 9MM RIGHT SUP-71640530 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 32CM OD 9MM RIGHT SUP-71640532 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 34CM OD 9MM RIGHT SUP-71640534 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 36CM OD 9MM RIGHT SUP-71640536 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 38CM OD 9MM RIGHT SUP-71640538 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 40CM OD 9MM RIGHT SUP-71640540 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 42CM OD 9MM RIGHT SUP-71640542 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 44CM OD 9MM RIGHT SUP-71640544 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 30CM OD 10MM RIGHT SUP-71640630 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 32CM OD 10MM RIGHT SUP-71640632 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 34CM OD 10MM RIGHT SUP-71640634 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 36CM OD 10MM RIGHT SUP-71640636 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 38CM OD 10MM RIGHT SUP-71640638 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 40CM OD 10MM RIGHT SUP-71640640 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 42CM OD 10MM RIGHT SUP-71640642 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 44CM OD 10MM RIGHT SUP-71640644 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 30CM OD 11.5MM RIGHT SUP-71640730 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 32CM OD 11.5MM RIGHT SUP-71640732 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 34CM OD 11.5MM RIGHT SUP-71640734 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 36CM OD 11.5MM RIGHT SUP-71640736 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 38CM OD 11.5MM RIGHT SUP-71640738 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 40CM OD 11.5MM RIGHT SUP-71640740 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 42CM OD 11.5MM RIGHT SUP-71640742 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET SCREW BONE TRIGEN META-TAN 100/95MM COMPRESSION LAG INTEGRATED TROCHANTERIC SUP-71642600 CDM 0270 RC outpatient 2149.68 2149.68 2149.68 74 1590.76 percent of total billed charges 2149.68 93 1741.24 percent of total billed charges 2149.68 2149.68 other OPPS APC 2149.68 2149.68 other OPPS APC 2149.68 27.63 593.96 percent of total billed charges 2149.68 2149.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KTI TRAUMA FIXATION META-TAN L 80MM L 75MMINTEGRATE LAG COMPRESSION SCREW TROCHANTERIC ANTEGRADE NAIL SUP-71642680 CDM 0270 RC outpatient 2149.68 2149.68 2149.68 74 1590.76 percent of total billed charges 2149.68 93 1741.24 percent of total billed charges 2149.68 2149.68 other OPPS APC 2149.68 2149.68 other OPPS APC 2149.68 27.63 593.96 percent of total billed charges 2149.68 2149.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE META-TANL L35 MM FEMUR COMPRESSION SUP-71642935 CDM 0270 RC outpatient 946.69 946.69 946.69 74 700.55 percent of total billed charges 946.69 93 766.82 percent of total billed charges 946.69 946.69 other OPPS APC 946.69 946.69 other OPPS APC 946.69 27.63 261.57 percent of total billed charges 946.69 946.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 25 MM OD 5 MM FEMUR LOW PROFILE INTERNAL HEX TRIGEN INTRAMEDULLARY NAIL SYSTEM SUP-71645025 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN L 27.5 MM OD 5 MM TIBIAL INTERNAL CAPTURE SUP-71645027 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN L 30 MM OD 5 MM TIBIAL INTERNAL CAPTURE SUP-71645030 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 32.5 MM OD 5 MM FEMUR LOW PROFILE INTERNAL HEX TRIGEN INTRAMEDULLARY NAIL SYSTEM SUP-71645032 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN L 35MM OD 5MM TIBIAL INTERNAL CAPTURE SUP-71645035 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 37.5MM OD 5MM FEMUR LOW PROFILE INTERAL HEX SUP-71645037 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN L 40 MM OD 5 MM TIBIAL INTERNAL CAPTURE SUP-71645040 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 42.5 MM OD 5 MM CAPTURE LOCK INTERNAL HEX SUP-71645042 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 45MM OD 5 MM CAPTURE LOCK INTERNAL HEX SUP-71645045 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 47.5 MM OD 5 MM FEMUR LOW PROFILE INTERNAL HEX TRIGEN INTRAMEDULLARY NAIL SYSTEM SUP-71645047 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN META-NAIL L50 MM OD 5 MM INTERNAL CAPTURE GOLD SUP-71645050 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 52.5 MM OD 5 MM FEMUR LOW PROFILE INTERNAL HEX TRIGEN INTRAMEDULLARY NAIL SYSTEM SUP-71645052 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 55 MM OD 5 MM LOW PROFILE INTERNAL HEX SUP-71645055 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 57 MM OD 5 MM FEMUR LOW PROFILE INTERNAL HEX TRIGEN INTRAMEDULLARY NAIL SYSTEM SUP-71645057 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 60 MM OD 5 MM INTERNAL HEX LOW PROFILE SUP-71645060 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN L 62.5 MM OD 5 MM FEMUR LOW PROFILE SUP-71645062 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 65 MM OD 5 MM FEMUR LOW PROFILE INTERNAL HEX TRIGEN INTRAMEDULLARY NAIL SYSTEM SUP-71645065 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 67 MM OD 5 MM FEMUR LOW PROFILE INTERNAL HEX TRIGEN INTRAMEDULLARY NAIL SYSTEM SUP-71645067 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 70 MM OD 5MM LOW PROFILE INTERNAL HEX SUP-71645070 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 75 MM OD 5 MM LOW PROFILE INTERNAL HEX SUP-71645075 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN META-NAIL L 77.5 MM OD 5 MM INTERNAL CAPTURE GOLD SUP-71645077 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L95 MM OD 5 MM FEMUR LOW PROFILE INTERNAL HEX TRIGEN INTRAMEDULLARY NAIL SYSTEM SUP-71645095 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN TITANIUM ADULT 130 D L 30 CM OD 8.5 MM TROCHANTERIC LEFT ANTEGRADE LIME SUP-71645130 CDM 0270 RC outpatient 4296.24 4296.24 4296.24 74 3179.22 percent of total billed charges 4296.24 93 3479.95 percent of total billed charges 4296.24 4296.24 other OPPS APC 4296.24 4296.24 other OPPS APC 4296.24 27.63 1187.05 percent of total billed charges 4296.24 4296.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN ADULT L 32 CM OD 8.5 MM TROCHANTERIC LEFT ANTEGRADE STERILE LATEX FREE SUP-71645132 CDM 0270 RC outpatient 4296.24 4296.24 4296.24 74 3179.22 percent of total billed charges 4296.24 93 3479.95 percent of total billed charges 4296.24 4296.24 other OPPS APC 4296.24 4296.24 other OPPS APC 4296.24 27.63 1187.05 percent of total billed charges 4296.24 4296.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN ADULT 130 D L 26 CM OD 8.5MM TROCHANTERIC LEFT ANTEGRADE STERILE LATEX FREE LIME SUP-71645134 CDM 0270 RC outpatient 4296.24 4296.24 4296.24 74 3179.22 percent of total billed charges 4296.24 93 3479.95 percent of total billed charges 4296.24 4296.24 other OPPS APC 4296.24 4296.24 other OPPS APC 4296.24 27.63 1187.05 percent of total billed charges 4296.24 4296.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN TITANIUM ADULT 130 D L 36 CM OD 8.5 MM TROCHANTERIC LEFT ANTEGRADE LIME SUP-71645136 CDM 0270 RC outpatient 4296.24 4296.24 4296.24 74 3179.22 percent of total billed charges 4296.24 93 3479.95 percent of total billed charges 4296.24 4296.24 other OPPS APC 4296.24 4296.24 other OPPS APC 4296.24 27.63 1187.05 percent of total billed charges 4296.24 4296.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8.5 X 38 LEFT SUP-71645138 CDM 0270 RC outpatient 4296.24 4296.24 4296.24 74 3179.22 percent of total billed charges 4296.24 93 3479.95 percent of total billed charges 4296.24 4296.24 other OPPS APC 4296.24 4296.24 other OPPS APC 4296.24 27.63 1187.05 percent of total billed charges 4296.24 4296.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN TITANIUM ADULT 130 D L 40 CM OD 8.5 MM TROCHANTERIC LEFT ANTEGRADE LIME SUP-71645140 CDM 0270 RC outpatient 4296.24 4296.24 4296.24 74 3179.22 percent of total billed charges 4296.24 93 3479.95 percent of total billed charges 4296.24 4296.24 other OPPS APC 4296.24 4296.24 other OPPS APC 4296.24 27.63 1187.05 percent of total billed charges 4296.24 4296.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN L 22.5 MM OD 4.5 MM LOW PROFILE SUP-71645422 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN L 25 MM OD 4.5 MM LOW PROFILE SUP-71645425 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN L 27.5 MM OD 4.5 MM LOW PROFILE INTRAMEDULLARY NAILING SYSTEM SUP-71645427 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN L 30 MM OD 4.5 MM LOW PROFILE SUP-71645430 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN L 32.5 MM OD 4.5 MM LOW PROFILE STERILE LATEX FREE SUP-71645432 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN L 35 MM OD 4.5 MM FEMUR LOW PROFILE SUP-71645435 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN L 37.5 MM OD 4.5 MM LOW PROFILE STERILE LATEX FREE SUP-71645437 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN L 40 MM OD 4.5 MM LOW PROFILE STERILE SUP-71645440 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 42.5 MM OD 4.5 MM FEMUR LOW PROFILE INTERNAL CAPTURE TRIGEN INTRAMEDULLARY NAIL SYSTEM SUP-71645442 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIGEN L-P SCREW 4.5MM X 45MM SUP-71645445 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN L 47.5 MM OD 4.5 MM LOW PROFILE INTRAMEDULLARY NAILING SYSTEM SUP-71645447 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN 4.5MM 50MM LOW-PROFILE CAPTURED TITANIUM HEX DRIVE SUP-71645450 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN L 52.5 MM OD 4.5 MM LOW PROFILE SUP-71645452 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN L 60 MM OD 4.5 MM LOW PROFILE STERILE LATEX FREE SUP-71645460 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN 130 D L 26 CM OD 8.5 MM TROCHANTERIC RIGHT ANTEGRADE STERILE LATEX FREE LIME ADOLESCENT SUP-71646126 CDM 0270 RC outpatient 4296.24 4296.24 4296.24 74 3179.22 percent of total billed charges 4296.24 93 3479.95 percent of total billed charges 4296.24 4296.24 other OPPS APC 4296.24 4296.24 other OPPS APC 4296.24 27.63 1187.05 percent of total billed charges 4296.24 4296.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN 130 D L 28 CM OD 8.5 MM TROCHANTERIC RIGHT ANTEGRADE STERILE LATEX FREE LIME ADOLESCENT SUP-71646128 CDM 0270 RC outpatient 4296.24 4296.24 4296.24 74 3179.22 percent of total billed charges 4296.24 93 3479.95 percent of total billed charges 4296.24 4296.24 other OPPS APC 4296.24 4296.24 other OPPS APC 4296.24 27.63 1187.05 percent of total billed charges 4296.24 4296.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN 130 D L 30 CM OD 8.5 MM TROCHANTERIC RIGHT ANTEGRADE STERILE LATEX FREE ROSE ADOLESCENT SUP-71646130 CDM 0270 RC outpatient 4296.24 4296.24 4296.24 74 3179.22 percent of total billed charges 4296.24 93 3479.95 percent of total billed charges 4296.24 4296.24 other OPPS APC 4296.24 4296.24 other OPPS APC 4296.24 27.63 1187.05 percent of total billed charges 4296.24 4296.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN 130 D L 32 CM OD 8.5 MM TROCHANTERIC RIGHT ANTEGRADE STERILE LATEX FREE ADOLESCENT SUP-71646132 CDM 0270 RC outpatient 4296.24 4296.24 4296.24 74 3179.22 percent of total billed charges 4296.24 93 3479.95 percent of total billed charges 4296.24 4296.24 other OPPS APC 4296.24 4296.24 other OPPS APC 4296.24 27.63 1187.05 percent of total billed charges 4296.24 4296.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN 130 D L 34 CM OD 8.5 MM TROCHANTERIC RIGHT ANTEGRADE STERILE LATEX FREE ADOLESCENT SUP-71646134 CDM 0270 RC outpatient 4296.24 4296.24 4296.24 74 3179.22 percent of total billed charges 4296.24 93 3479.95 percent of total billed charges 4296.24 4296.24 other OPPS APC 4296.24 4296.24 other OPPS APC 4296.24 27.63 1187.05 percent of total billed charges 4296.24 4296.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8.5 X 36 RIGHT SUP-71646136 CDM 0270 RC outpatient 4296.24 4296.24 4296.24 74 3179.22 percent of total billed charges 4296.24 93 3479.95 percent of total billed charges 4296.24 4296.24 other OPPS APC 4296.24 4296.24 other OPPS APC 4296.24 27.63 1187.05 percent of total billed charges 4296.24 4296.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8.5 X 38 RIGHT SUP-71646138 CDM 0270 RC outpatient 4296.24 4296.24 4296.24 74 3179.22 percent of total billed charges 4296.24 93 3479.95 percent of total billed charges 4296.24 4296.24 other OPPS APC 4296.24 4296.24 other OPPS APC 4296.24 27.63 1187.05 percent of total billed charges 4296.24 4296.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8.5 X 40 RIGHT SUP-71646140 CDM 0270 RC outpatient 4296.24 4296.24 4296.24 74 3179.22 percent of total billed charges 4296.24 93 3479.95 percent of total billed charges 4296.24 4296.24 other OPPS APC 4296.24 4296.24 other OPPS APC 4296.24 27.63 1187.05 percent of total billed charges 4296.24 4296.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN TITANIUM 130 D L 40 CM OD 10MM LEFT TROCHANTERIC ANTEGRADE SUP-71647240 CDM 0270 RC outpatient 4642.56 4642.56 4642.56 74 3435.49 percent of total billed charges 4642.56 93 3760.47 percent of total billed charges 4642.56 4642.56 other OPPS APC 4642.56 4642.56 other OPPS APC 4642.56 27.63 1282.74 percent of total billed charges 4642.56 4642.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 30CM OD 9MM LEFT SUP-71649530 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 32CM OD 9MM LEFT SUP-71649532 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 34CM OD 9MM LEFT SUP-71649534 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 36CM OD 9MM LEFT SUP-71649536 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 38CM OD 9MM LEFT SUP-71649538 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 40CM OD 9MM LEFT SUP-71649540 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 42CM OD 9MM LEFT SUP-71649542 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 44CM OD 9MM LEFT SUP-71649544 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 30CM OD 10MM LEFT SUP-71649630 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 32CM OD 10MM LEFT SUP-71649632 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 34CM OD 10MM LEFT SUP-71649634 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 36CM OD 10MM LEFT SUP-71649636 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 38CM OD 10MM LEFT SUP-71649638 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 40CM OD 10MM LEFT SUP-71649640 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 42CM OD 10MM LEFT SUP-71649642 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 44CM OD 10MM LEFT SUP-71649644 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 30CM OD 11.5MM LEFT SUP-71649730 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 32CM OD 11.5MM LEFT SUP-71649732 CDM 27000000 LOCAL 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 34CM OD 11.5MM LEFT SUP-71649734 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 36CM OD 11.5MM LEFT SUP-71649736 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 38CM OD 11.5MM LEFT SUP-71649738 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 40CM OD 11.5MM LEFT SUP-71649740 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 42CM OD 11.5MM LEFT SUP-71649742 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY META-TAN L 44CM OD 11.5MM LEFT SUP-71649744 CDM 0270 RC outpatient 5959.85 5959.85 5959.85 74 4410.29 percent of total billed charges 5959.85 93 4827.48 percent of total billed charges 5959.85 5959.85 other OPPS APC 5959.85 5959.85 other OPPS APC 5959.85 27.63 1646.71 percent of total billed charges 5959.85 5959.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN META-NAIL TITANIUM L 32 CM OD 10 MM FEMORAL RETROGRADE GOLD SUP-71653032 CDM 0270 RC outpatient 3356.08 3356.08 3356.08 74 2483.5 percent of total billed charges 3356.08 93 2718.42 percent of total billed charges 3356.08 3356.08 other OPPS APC 3356.08 3356.08 other OPPS APC 3356.08 27.63 927.28 percent of total billed charges 3356.08 3356.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN META 10MM 340MM CANNULATED LOCKING RETROGRADE MULTI-PLANAR DISTAL FEMORAL TITANIUM ALLOY GOLD STERILE SUP-71653034 CDM 0270 RC outpatient 3356.08 3356.08 3356.08 74 2483.5 percent of total billed charges 3356.08 93 2718.42 percent of total billed charges 3356.08 3356.08 other OPPS APC 3356.08 3356.08 other OPPS APC 3356.08 27.63 927.28 percent of total billed charges 3356.08 3356.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL FEMORAL RETRO 10 X 36 SUP-71653036 CDM 0270 RC outpatient 3356.08 3356.08 3356.08 74 2483.5 percent of total billed charges 3356.08 93 2718.42 percent of total billed charges 3356.08 3356.08 other OPPS APC 3356.08 3356.08 other OPPS APC 3356.08 27.63 927.28 percent of total billed charges 3356.08 3356.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN META 10MM 380MM CANNULATED LOCKING RETROGRADE MULTI-PLANAR DISTAL FEMORAL TITANIUM ALLOY GOLD STERILE SUP-71653038 CDM 0270 RC outpatient 3356.08 3356.08 3356.08 74 2483.5 percent of total billed charges 3356.08 93 2718.42 percent of total billed charges 3356.08 3356.08 other OPPS APC 3356.08 3356.08 other OPPS APC 3356.08 27.63 927.28 percent of total billed charges 3356.08 3356.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN META-NAIL TITANIUM L 36 CM OD 11.5 MM FEMUR RETROGRADE ROUND CROSS SECTION GOLD SUP-71653236 CDM 0270 RC outpatient 3356.08 3356.08 3356.08 74 2483.5 percent of total billed charges 3356.08 93 2718.42 percent of total billed charges 3356.08 3356.08 other OPPS APC 3356.08 3356.08 other OPPS APC 3356.08 27.63 927.28 percent of total billed charges 3356.08 3356.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN META 11.5MM 420MM CANNULATED LOCKING RETROGRADE MULTI-PLANAR DISTAL FEMORAL TITANIUM ALLOY GOLD STERILE SUP-71653242 CDM 0270 RC outpatient 3356.08 3356.08 3356.08 74 2483.5 percent of total billed charges 3356.08 93 2718.42 percent of total billed charges 3356.08 3356.08 other OPPS APC 3356.08 3356.08 other OPPS APC 3356.08 27.63 927.28 percent of total billed charges 3356.08 3356.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN META-NAIL TITANIUM L 38 CM OD 13 MM FEMORAL RETROGRADE GOLD SUP-71653438 CDM 0270 RC outpatient 3356.08 3356.08 3356.08 74 2483.5 percent of total billed charges 3356.08 93 2718.42 percent of total billed charges 3356.08 3356.08 other OPPS APC 3356.08 3356.08 other OPPS APC 3356.08 27.63 927.28 percent of total billed charges 3356.08 3356.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL COMPRESSION DRIVER SUP-71654528 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 8.5MM X 24CM SUP-71655024 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 8.5MM X 26CM SUP-71655026 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 8.5MM X 28CM SUP-71655028 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 8.5MM X 30CM SUP-71655030 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 8.5MM X 32CM SUP-71655032 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 8.5MM X 33CM SUP-71655033 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 8.5MM X 34CM SUP-71655034 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 8.5MM X 35CM SUP-71655035 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 8.5MM X 36CM SUP-71655036 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 8.5MM X 37CM SUP-71655037 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 8.5MM X 38CM SUP-71655038 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN L 39 CM OD 8.5MM TIBIAL SUP-71655039 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 10MM X 28CM SUP-71655128 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 10MM X 30CM SUP-71655130 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 10MM X 32CM SUP-71655132 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 10MM X 34CM SUP-71655134 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 10MM X 35CM SUP-71655135 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 10MM X 36CM SUP-71655136 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 10MM X 37CM SUP-71655137 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 10MM X 38CM SUP-71655138 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 10MM X 39CM SUP-71655139 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 10MM X 40CM SUP-71655140 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 11.5MM X 30CM SUP-71655230 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 11.5MM X 32CM SUP-71655232 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 11.5MM X 34CM SUP-71655234 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 11.5MM X 35CM SUP-71655235 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 11.5MM X 36CM SUP-71655236 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 11.5MM X 37CM SUP-71655237 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 11.5MM X 38CM SUP-71655238 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 11.5MM X 39CM SUP-71655239 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL TIBIAL 11.5MM X 40CM SUP-71655240 CDM 0270 RC outpatient 4212 4212 4212 74 3116.88 percent of total billed charges 4212 93 3411.72 percent of total billed charges 4212 4212 other OPPS APC 4212 4212 other OPPS APC 4212 27.63 1163.78 percent of total billed charges 4212 4212 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. META-NAIL NAIL CAP 0MM SUP-71656000 CDM 0270 RC outpatient 423.07 423.07 423.07 74 313.07 percent of total billed charges 423.07 93 342.69 percent of total billed charges 423.07 423.07 other OPPS APC 423.07 423.07 other OPPS APC 423.07 27.63 116.89 percent of total billed charges 423.07 423.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 30 MM COMPRESSION SUP-71672030 CDM 0270 RC outpatient 740.79 740.79 740.79 74 548.18 percent of total billed charges 740.79 93 600.04 percent of total billed charges 740.79 740.79 other OPPS APC 740.79 740.79 other OPPS APC 740.79 27.63 204.68 percent of total billed charges 740.79 740.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN 11.5MM X 18CM 125DEG SUP-71675202 CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN 13MM X 18CM 125DEG SUP-71675203 CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN 11.5MM X 20CM 125DEG SUP-71675205 CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN 13MM X 20CM 125DEG SUP-71675206 CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN 11.5MM X 18CM 130DEG SUP-71675208 CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN 13MM X 18CM 130DEG SUP-71675209 CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN 11.5MM X 20CM 130DEG SUP-71675211 CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN 13MM X 20CM 130DEG SUP-71675212 CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY INTERTAN TITANIUM 125 D L 44 CM OD 10 MM RIGHT TROCHANTERIC ROSE SUP-71675232 CDM 0270 RC outpatient 4994.6 4994.6 4994.6 74 3696 percent of total billed charges 4994.6 93 4045.63 percent of total billed charges 4994.6 4994.6 other OPPS APC 4994.6 4994.6 other OPPS APC 4994.6 27.63 1380.01 percent of total billed charges 4994.6 4994.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN 10MM X 18CM 125DEG SUP-71675383 CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN 10MM X 18CM 130DEG SUP-71675384 CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN 10MM X 20CM 125DEG SUP-71675385 CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN 10MM X 20CM 130DEG SUP-71675386 CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN INTERTAN 10MM 320MM 130DEG ANGLED CANNULATED INTERLOCKING ANTEGRADE LEFT INTERTROCHANTERIC CLOTHESPIN LIME SUP-71675508 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN INTERTAN 130 D L 34 CM OD 10 MM LEFT TROCHANTER SUP-71675510 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY INTERTAN TRIGEN 130 D L 36 CM OD 10 MM FEMUR LEFT STERILE LATEX FREE SUP-71675512 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY INTERTAN 130 D L 38 CM OD 10 MM LEFT TROCHANTER SUP-71675514 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY INTERTAN 125 D L 40 CM OD 10MM LEFT TROCHANTER SUP-71675515 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY INTERTAN 130 D L 40 CM OD 10 MM LEFT TROCHANTER SUP-71675516 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY INTERTAN 125D L 42 CM OD 10 MM LEFT TROCHANTER SUP-71675517 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY 130 D L 42 CM OD 10 MM LEFT TROCHANTER SUP-71675518 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN INTERTAN 130 D L 44 CM OD 10 MM LEFT TROCHANTER SUP-71675520 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN RIGHT 10MM X 32 125DEG SUP-71675529 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN RIGHT 10MM X 34 125DEG SUP-71675531 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY INTERTAN 130D L 34 CM OD 10 MM RIGHT TROCHANTER SUP-71675532 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN RIGHT 10MM X 36 125DEG SUP-71675533 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY INTERTAN 130 D L 36 CM OD 10 MM RIGHT TROCHANTER SUP-71675534 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN RIGHT 10MM X 38 125DEG SUP-71675535 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY INTERTAN 130 D L 38 CM OD 10 MM TROCHANTER RIGHT SUP-71675536 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN RIGHT 10MM X 40 125DEG SUP-71675537 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY INTERTAN 130 D L 40 CM OD 10 MM RIGHT TROCHANTER SUP-71675538 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN RIGHT 10MM X 42 125DEG SUP-71675539 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY INTERTAN 130 D L 42 CM OD 10 MM RIGHT TROCHANTER SUP-71675540 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY INTERTAN 130 D L 44 CM OD 10 MM RIGHT TROCHANTER SUP-71675542 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN 1.5 11.5 MM X 38CM 130 D LT SUP-71676579 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN INTERTAN 11.5MM 380MM 130DEG ANGLED CANNULATED INTERLOCKING ANTEGRADE RIGHT INTERTROCHANTERIC TITANIUM CLOTHESPIN ROSE 1.5M BOW SUP-71676580 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY INTERTAN 130 D 1.5MM L 40 CM OD 11.5 MM LEFT SUP-71676581 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY TRIGEN INTERTAN 11.5MM 400MM 130DEG ANGLED CANNULATED INTERLOCKING ANTEGRADE RIGHT INTERTROCHANTERIC TITANIUM ALLOY CLOTHESPIN ROSE 1.5M BOW SUP-71676582 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY INTERTAN 130 D 1.5MM L 42CM OD 11.5 MM LEFT SUP-71676583 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY INTERTAN 130D 1.5MM L 44 CM OD 11.5MM LEFT SUP-71676585 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY INTERTAN 130 D 1.5 MM L 44 CM L 11.5 MM RIGHT SUP-71676586 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN RIGHT 13MM X 32 130DEG SUP-71676618 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN RIGHT 13MM X 34 130DEG SUP-71676620 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN RIGHT 13MM X 36 130DEG SUP-71676622 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN RIGHT 13MM X 38 130DEG SUP-71676624 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN RIGHT 13MM X 40 130DEG SUP-71676626 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN RIGHT 13MM X 42 130DEG SUP-71676628 CDM 0270 RC outpatient 4745 4745 4745 74 3511.3 percent of total billed charges 4745 93 3843.45 percent of total billed charges 4745 4745 other OPPS APC 4745 4745 other OPPS APC 4745 27.63 1311.04 percent of total billed charges 4745 4745 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN LAG/COMP KIT 75/70 SUP-71677075 CDM 0270 RC outpatient 1600.04 1600.04 1600.04 74 1184.03 percent of total billed charges 1600.04 93 1296.03 percent of total billed charges 1600.04 1600.04 other OPPS APC 1600.04 1600.04 other OPPS APC 1600.04 27.63 442.09 percent of total billed charges 1600.04 1600.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN LAG/COMP KIT 80/75 SUP-71677080 CDM 0270 RC outpatient 1600.04 1600.04 1600.04 74 1184.03 percent of total billed charges 1600.04 93 1296.03 percent of total billed charges 1600.04 1600.04 other OPPS APC 1600.04 1600.04 other OPPS APC 1600.04 27.63 442.09 percent of total billed charges 1600.04 1600.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN LAG/COMP KIT 85/80 SUP-71677085 CDM 0270 RC outpatient 1600.04 1600.04 1600.04 74 1184.03 percent of total billed charges 1600.04 93 1296.03 percent of total billed charges 1600.04 1600.04 other OPPS APC 1600.04 1600.04 other OPPS APC 1600.04 27.63 442.09 percent of total billed charges 1600.04 1600.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN LAG/COMP KIT 90/85 SUP-71677090 CDM 0270 RC outpatient 1600.04 1600.04 1600.04 74 1184.03 percent of total billed charges 1600.04 93 1296.03 percent of total billed charges 1600.04 1600.04 other OPPS APC 1600.04 1600.04 other OPPS APC 1600.04 27.63 442.09 percent of total billed charges 1600.04 1600.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT SCREW INTERTAN L 95MM L 90MM OD 11.5 ODSEC 7MM TROCHANTERIC LAG COMPRESSION INTEGRATE INTERLOCK SUP-71677095 CDM 0270 RC outpatient 1600.04 1600.04 1600.04 74 1184.03 percent of total billed charges 1600.04 93 1296.03 percent of total billed charges 1600.04 1600.04 other OPPS APC 1600.04 1600.04 other OPPS APC 1600.04 27.63 442.09 percent of total billed charges 1600.04 1600.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN LAG/COMP KIT 100/95 SUP-71677100 CDM 0270 RC outpatient 1600.04 1600.04 1600.04 74 1184.03 percent of total billed charges 1600.04 93 1296.03 percent of total billed charges 1600.04 1600.04 other OPPS APC 1600.04 1600.04 other OPPS APC 1600.04 27.63 442.09 percent of total billed charges 1600.04 1600.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN LAG/COMP KIT 105/100 SUP-71677105 CDM 0270 RC outpatient 1600.04 1600.04 1600.04 74 1184.03 percent of total billed charges 1600.04 93 1296.03 percent of total billed charges 1600.04 1600.04 other OPPS APC 1600.04 1600.04 other OPPS APC 1600.04 27.63 442.09 percent of total billed charges 1600.04 1600.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN LAG/COMP KIT 110/105 SUP-71677110 CDM 0270 RC outpatient 1600.04 1600.04 1600.04 74 1184.03 percent of total billed charges 1600.04 93 1296.03 percent of total billed charges 1600.04 1600.04 other OPPS APC 1600.04 1600.04 other OPPS APC 1600.04 27.63 442.09 percent of total billed charges 1600.04 1600.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN LAG/COMP KIT 115/110 SUP-71677115 CDM 0270 RC outpatient 1600.04 1600.04 1600.04 74 1184.03 percent of total billed charges 1600.04 93 1296.03 percent of total billed charges 1600.04 1600.04 other OPPS APC 1600.04 1600.04 other OPPS APC 1600.04 27.63 442.09 percent of total billed charges 1600.04 1600.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN LAG/COMP KIT 120/115 SUP-71677120 CDM 0270 RC outpatient 1600.04 1600.04 1600.04 74 1184.03 percent of total billed charges 1600.04 93 1296.03 percent of total billed charges 1600.04 1600.04 other OPPS APC 1600.04 1600.04 other OPPS APC 1600.04 27.63 442.09 percent of total billed charges 1600.04 1600.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN LAG/COMP KIT 125/120 SUP-71677125 CDM 0270 RC outpatient 1600.04 1600.04 1600.04 74 1184.03 percent of total billed charges 1600.04 93 1296.03 percent of total billed charges 1600.04 1600.04 other OPPS APC 1600.04 1600.04 other OPPS APC 1600.04 27.63 442.09 percent of total billed charges 1600.04 1600.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN INTERTAN 11MM 100MM LAG TITANIUM SUBTROCHANTERIC SUP-71678010 CDM 0270 RC outpatient 1290.64 1290.64 1290.64 74 955.07 percent of total billed charges 1290.64 93 1045.42 percent of total billed charges 1290.64 1290.64 other OPPS APC 1290.64 1290.64 other OPPS APC 1290.64 27.63 356.6 percent of total billed charges 1290.64 1290.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN SUBTROCH 100MM SUP-716780100 CDM 0270 RC outpatient 1290.64 1290.64 1290.64 74 955.07 percent of total billed charges 1290.64 93 1045.42 percent of total billed charges 1290.64 1290.64 other OPPS APC 1290.64 1290.64 other OPPS APC 1290.64 27.63 356.6 percent of total billed charges 1290.64 1290.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN SUBTROCH 105MM SUP-716780105 CDM 0270 RC outpatient 1290.64 1290.64 1290.64 74 955.07 percent of total billed charges 1290.64 93 1045.42 percent of total billed charges 1290.64 1290.64 other OPPS APC 1290.64 1290.64 other OPPS APC 1290.64 27.63 356.6 percent of total billed charges 1290.64 1290.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN SUBTROCH 110MM SUP-716780110 CDM 0270 RC outpatient 1290.64 1290.64 1290.64 74 955.07 percent of total billed charges 1290.64 93 1045.42 percent of total billed charges 1290.64 1290.64 other OPPS APC 1290.64 1290.64 other OPPS APC 1290.64 27.63 356.6 percent of total billed charges 1290.64 1290.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN SUBTROCH 70MM SUP-71678070 CDM 0270 RC outpatient 1290.64 1290.64 1290.64 74 955.07 percent of total billed charges 1290.64 93 1045.42 percent of total billed charges 1290.64 1290.64 other OPPS APC 1290.64 1290.64 other OPPS APC 1290.64 27.63 356.6 percent of total billed charges 1290.64 1290.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN SUBTROCH 75MM SUP-71678075 CDM 0270 RC outpatient 1290.64 1290.64 1290.64 74 955.07 percent of total billed charges 1290.64 93 1045.42 percent of total billed charges 1290.64 1290.64 other OPPS APC 1290.64 1290.64 other OPPS APC 1290.64 27.63 356.6 percent of total billed charges 1290.64 1290.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN SUBTROCH 80MM SUP-71678080 CDM 0270 RC outpatient 1290.64 1290.64 1290.64 74 955.07 percent of total billed charges 1290.64 93 1045.42 percent of total billed charges 1290.64 1290.64 other OPPS APC 1290.64 1290.64 other OPPS APC 1290.64 27.63 356.6 percent of total billed charges 1290.64 1290.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN SUBTROCH 85MM SUP-71678085 CDM 0270 RC outpatient 1290.64 1290.64 1290.64 74 955.07 percent of total billed charges 1290.64 93 1045.42 percent of total billed charges 1290.64 1290.64 other OPPS APC 1290.64 1290.64 other OPPS APC 1290.64 27.63 356.6 percent of total billed charges 1290.64 1290.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN SUBTROCH 90MM SUP-71678090 CDM 0270 RC outpatient 1290.64 1290.64 1290.64 74 955.07 percent of total billed charges 1290.64 93 1045.42 percent of total billed charges 1290.64 1290.64 other OPPS APC 1290.64 1290.64 other OPPS APC 1290.64 27.63 356.6 percent of total billed charges 1290.64 1290.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN SUBTROCH 95MM SUP-71678095 CDM 0270 RC outpatient 1290.64 1290.64 1290.64 74 955.07 percent of total billed charges 1290.64 93 1045.42 percent of total billed charges 1290.64 1290.64 other OPPS APC 1290.64 1290.64 other OPPS APC 1290.64 27.63 356.6 percent of total billed charges 1290.64 1290.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD DEFIBRILLATOR DURATA L65 CM L17 CM OD7 FR 2 COIL DF1 SUP-7170/65 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING DURATA SJ4 L58 CM L17 CM OD7 FR ENDOCARDIUM 2 COIL SUP-7170Q/58 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING DURATA SJ4 L65 CM L17 CM OD7 FR ENDOCARDIUM 2 COIL SUP-7170Q/65 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD DEFIBRILLATOR DURATA L65 CM L21 CM OD7 FR 2 COIL DF1 SUP-7171/65 CDM 0275 RC outpatient 7540 7540 7540 57 4297.8 percent of total billed charges 7540 93 6107.4 percent of total billed charges 7540 7540 other OPPS APC 7540 7540 other OPPS APC 7540 51 3845.4 percent of total billed charges 7540 7540 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING DURATA SJ4 L58 CM L21 CM OD7 FR ENDOCARDIUM 2 COIL SUP-7171Q/58 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING DURATA SJ4 L65 CM L21 CM OD7 FR ENDOCARDIUM 2 COIL SUP-7171Q/65 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE ROD ORTHOPEDIC TRIGEN L 600 MM OD 2 MM HUMERUS BALL TIP GRADUATE DISPOSABLE INTERAMEDULLARY NAIL SUP-71751146 CDM 0270 RC outpatient 413.71 413.71 413.71 74 306.15 percent of total billed charges 413.71 93 335.11 percent of total billed charges 413.71 413.71 other OPPS APC 413.71 413.71 other OPPS APC 413.71 27.63 114.31 percent of total billed charges 413.71 413.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL TRIGEN LONG OD 3.2MM GRADUATED BRAD POINT STERILE DISPOSABLE INTRAMEDULLARY NAIL SUP-71751149 CDM 0270 RC outpatient 581.26 581.26 581.26 74 430.13 percent of total billed charges 581.26 93 470.82 percent of total billed charges 581.26 581.26 other OPPS APC 581.26 581.26 other OPPS APC 581.26 27.63 160.6 percent of total billed charges 581.26 581.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN TITANIUM L 22MM OD 4MM HUMERUS CORTICAL SELF TAP INTRAMEDULLARY NAIL SYSTEM SUP-71754022 CDM 0270 RC outpatient 413.71 413.71 413.71 74 306.15 percent of total billed charges 413.71 93 335.11 percent of total billed charges 413.71 413.71 other OPPS APC 413.71 413.71 other OPPS APC 413.71 27.63 114.31 percent of total billed charges 413.71 413.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN TITANIUM L 24 MM OD 4 MM HUMERUS CORTICAL SELF TAP INTRAMEDULLARY NAIL SYSTEM SUP-71754024 CDM 0270 RC outpatient 413.71 413.71 413.71 74 306.15 percent of total billed charges 413.71 93 335.11 percent of total billed charges 413.71 413.71 other OPPS APC 413.71 413.71 other OPPS APC 413.71 27.63 114.31 percent of total billed charges 413.71 413.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L 46 MM OD 5 MM CANCELLOUS SELF TAP SUP-71755046 CDM 0270 RC outpatient 500.76 500.76 500.76 74 370.56 percent of total billed charges 500.76 93 405.62 percent of total billed charges 500.76 500.76 other OPPS APC 500.76 500.76 other OPPS APC 500.76 27.63 138.36 percent of total billed charges 500.76 500.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRIGEN TITANIUM L 48MM OD 5MM HUMERUS CANCELLOUS SELF TAP INTRAMEDULLARY NAIL SYSTEM SUP-71755048 CDM 0270 RC outpatient 500.76 500.76 500.76 74 370.56 percent of total billed charges 500.76 93 405.62 percent of total billed charges 500.76 500.76 other OPPS APC 500.76 500.76 other OPPS APC 500.76 27.63 138.36 percent of total billed charges 500.76 500.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PERI-LOC L 193 MM FEMUR LEFT DISTAL LATERAL 8 HOLE LOCK 4.5 MM SCREW SUP-71800008 CDM 0270 RC outpatient 4025.58 4025.58 4025.58 74 2978.93 percent of total billed charges 4025.58 93 3260.72 percent of total billed charges 4025.58 4025.58 other OPPS APC 4025.58 4025.58 other OPPS APC 4025.58 27.63 1112.27 percent of total billed charges 4025.58 4025.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PERI-LOC STAINLESS STEEL 18 MM SPACE L 286 MM X W 36 MM X H3.6MMW17.6 MM X H4.8MM FEMUR LEFT DISTAL LATERAL 13 HOLE LOCK BEVEL TIP RADIOLUCENT TARGETER STERILE 4.5MM SCREW LARGE FRAGMENT SET SUP-71800013 CDM 0270 RC outpatient 4285.84 4285.84 4285.84 74 3171.52 percent of total billed charges 4285.84 93 3471.53 percent of total billed charges 4285.84 4285.84 other OPPS APC 4285.84 4285.84 other OPPS APC 4285.84 27.63 1184.18 percent of total billed charges 4285.84 4285.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PERI-LOC STAINLESS STEEL 18 MM SPACE L 342 MM X W 36 MM X H 3.6 MM W 17.6 MM X H4.8 MM FEMUR LEFT DISTAL LATERAL 16 HOLE LOCK BEVEL TIP RADIOLUCENT TARGETER STERILE 4.5 MM SCREW LARGE FRAGMENT SET SUP-71800016 CDM 0270 RC outpatient 4366.96 4366.96 4366.96 74 3231.55 percent of total billed charges 4366.96 93 3537.24 percent of total billed charges 4366.96 4366.96 other OPPS APC 4366.96 4366.96 other OPPS APC 4366.96 27.63 1206.59 percent of total billed charges 4366.96 4366.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PERI-LOC STAINLESS STEEL L 18MM SPACE L 342MM X W 36MM X H 3.6MM W 17.6MM X H 4.8MMFEMUR RIGHT DISTAL LATERAL 16 HOLE LOCK BEVEL TIP RADIOLUCENT TARGETER STERILE SUP-71800116 CDM 0270 RC outpatient 4366.96 4366.96 4366.96 74 3231.55 percent of total billed charges 4366.96 93 3537.24 percent of total billed charges 4366.96 4366.96 other OPPS APC 4366.96 4366.96 other OPPS APC 4366.96 27.63 1206.59 percent of total billed charges 4366.96 4366.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL X-CORE II VBR TITANIUM L18 MM X H28-41 MM EXPANDABLE SUP-7180041 CDM 270010020 LOCAL 0270 RC outpatient 21517.6 21517.6 21517.6 74 15923 percent of total billed charges 21517.6 93 17429.3 percent of total billed charges 21517.6 21517.6 other OPPS APC 21517.6 21517.6 other OPPS APC 21517.6 27.63 5945.31 percent of total billed charges 21517.6 21517.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PERI-LOC L 342 MM FEMUR LEFT DISTAL LATERAL 16 HOLE LOCK STERILE 4.5MM SCREW SUP-71820016S CDM 0270 RC outpatient 5012.36 5012.36 5012.36 74 3709.15 percent of total billed charges 5012.36 93 4060.01 percent of total billed charges 5012.36 5012.36 other OPPS APC 5012.36 5012.36 other OPPS APC 5012.36 27.63 1384.92 percent of total billed charges 5012.36 5012.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 15D L30 MM OD 3.5MM CORTEX SELF TAP LOW PROFILE HEAD 2.7MM DRILL BIT SUP-71821330 CDM 0270 RC outpatient 52.13 52.13 52.13 74 38.58 percent of total billed charges 52.13 93 42.23 percent of total billed charges 52.13 52.13 other OPPS APC 52.13 52.13 other OPPS APC 52.13 27.63 14.4 percent of total billed charges 52.13 52.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC VLP 5MM 24MM LOCKING FULLY THREADED STANDARD CORTICAL STAINLESS STEEL HEX RECESS HEAD 150DEG ANGLED COARSE PITCH F/OSTEOPENIA SUP-71822024 CDM 0270 RC outpatient 147.89 147.89 147.89 74 109.44 percent of total billed charges 147.89 93 119.79 percent of total billed charges 147.89 147.89 other OPPS APC 147.89 147.89 other OPPS APC 147.89 27.63 40.86 percent of total billed charges 147.89 147.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC VLP 5MM 26MM LOCKING FULLY THREADED STANDARD CORTICAL STAINLESS STEEL HEX RECESS HEAD 15DEG ANGLED COARSE PITCH F/OSTEOPENIA SUP-71822026 CDM 0270 RC outpatient 147.89 147.89 147.89 74 109.44 percent of total billed charges 147.89 93 119.79 percent of total billed charges 147.89 147.89 other OPPS APC 147.89 147.89 other OPPS APC 147.89 27.63 40.86 percent of total billed charges 147.89 147.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC VLP 5MM 28MM LOCKING FULLY THREADED STANDARD CORTICAL STAINLESS STEEL HEX RECESS HEAD 15DEG ANGLED COARSE PITCH F/OSTEOPENIA SUP-71822028 CDM 0270 RC outpatient 147.89 147.89 147.89 74 109.44 percent of total billed charges 147.89 93 119.79 percent of total billed charges 147.89 147.89 other OPPS APC 147.89 147.89 other OPPS APC 147.89 27.63 40.86 percent of total billed charges 147.89 147.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC VLP 5MM 30MM LOCKING FULLY THREADED STANDARD CORTICAL STAINLESS STEEL HEX RECESS HEAD 15DEG ANGLED COARSE PITCH F/OSTEOPENIA SUP-71822030 CDM 0270 RC outpatient 147.89 147.89 147.89 74 109.44 percent of total billed charges 147.89 93 119.79 percent of total billed charges 147.89 147.89 other OPPS APC 147.89 147.89 other OPPS APC 147.89 27.63 40.86 percent of total billed charges 147.89 147.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI LOCK VLP FULL THREAD L 34MM OD 5MM OSTEOPENIA SUP-71822034 CDM 0270 RC outpatient 147.89 147.89 147.89 74 109.44 percent of total billed charges 147.89 93 119.79 percent of total billed charges 147.89 147.89 other OPPS APC 147.89 147.89 other OPPS APC 147.89 27.63 40.86 percent of total billed charges 147.89 147.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI LOCK VLP FULL THREAD L 36MM OD 5MM OSTEOPENIA SUP-71822036 CDM 0270 RC outpatient 147.89 147.89 147.89 74 109.44 percent of total billed charges 147.89 93 119.79 percent of total billed charges 147.89 147.89 other OPPS APC 147.89 147.89 other OPPS APC 147.89 27.63 40.86 percent of total billed charges 147.89 147.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 18 MM OD 2.7 MM CORTEX SELF TAP SUP-71823018 CDM 0270 RC outpatient 58.21 58.21 58.21 74 43.08 percent of total billed charges 58.21 93 47.15 percent of total billed charges 58.21 58.21 other OPPS APC 58.21 58.21 other OPPS APC 58.21 27.63 16.08 percent of total billed charges 58.21 58.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 22 MM OD 2.7 MM CORTEX SELF TAP SUP-71823022 CDM 0270 RC outpatient 58.21 58.21 58.21 74 43.08 percent of total billed charges 58.21 93 47.15 percent of total billed charges 58.21 58.21 other OPPS APC 58.21 58.21 other OPPS APC 58.21 27.63 16.08 percent of total billed charges 58.21 58.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 26 MM OD 2.7 MM CORTEX SELF TAP SUP-71823026 CDM 0270 RC outpatient 58.21 58.21 58.21 74 43.08 percent of total billed charges 58.21 93 47.15 percent of total billed charges 58.21 58.21 other OPPS APC 58.21 58.21 other OPPS APC 58.21 27.63 16.08 percent of total billed charges 58.21 58.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L30 MM OD2.7 MM CORTEX SELF TAP SUP-71823030 CDM 0270 RC outpatient 58.21 58.21 58.21 74 43.08 percent of total billed charges 58.21 93 47.15 percent of total billed charges 58.21 58.21 other OPPS APC 58.21 58.21 other OPPS APC 58.21 27.63 16.08 percent of total billed charges 58.21 58.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 32 MM OD 2.7MM CORTEX SELF TAP SUP-71823032 CDM 0270 RC outpatient 58.21 58.21 58.21 74 43.08 percent of total billed charges 58.21 93 47.15 percent of total billed charges 58.21 58.21 other OPPS APC 58.21 58.21 other OPPS APC 58.21 27.63 16.08 percent of total billed charges 58.21 58.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC L 30 MM OD 4.5MM CORTEX SELF TAP LOW PROFILE NONSTERILE LATEX FREE DISPOSABLE SUP-71826030 CDM 0270 RC outpatient 43.89 43.89 43.89 74 32.48 percent of total billed charges 43.89 93 35.55 percent of total billed charges 43.89 43.89 other OPPS APC 43.89 43.89 other OPPS APC 43.89 27.63 12.13 percent of total billed charges 43.89 43.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC STAINLESS STEEL L 42 MM OD 4.5 MM CORTEX SELF TAP LOW PROFILE SUP-71826042 CDM 0270 RC outpatient 43.89 43.89 43.89 74 32.48 percent of total billed charges 43.89 93 35.55 percent of total billed charges 43.89 43.89 other OPPS APC 43.89 43.89 other OPPS APC 43.89 27.63 12.13 percent of total billed charges 43.89 43.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 12 MM OD 4.5 MM LOCK BLUNT TIP SUP-71827012 CDM 0270 RC outpatient 290.97 290.97 290.97 74 215.32 percent of total billed charges 290.97 93 235.69 percent of total billed charges 290.97 290.97 other OPPS APC 290.97 290.97 other OPPS APC 290.97 27.63 80.4 percent of total billed charges 290.97 290.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 36 MM OD 4.5 MM CORTEX SELF TAP LOCK SUP-71827036 CDM 0270 RC outpatient 290.97 290.97 290.97 74 215.32 percent of total billed charges 290.97 93 235.69 percent of total billed charges 290.97 290.97 other OPPS APC 290.97 290.97 other OPPS APC 290.97 27.63 80.4 percent of total billed charges 290.97 290.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 50 MM OD 4.5 MM CORTEX SELF TAP LOCK SUP-71827050 CDM 0270 RC outpatient 290.97 290.97 290.97 74 215.32 percent of total billed charges 290.97 93 235.69 percent of total billed charges 290.97 290.97 other OPPS APC 290.97 290.97 other OPPS APC 290.97 27.63 80.4 percent of total billed charges 290.97 290.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC STAINLESS STEEL L 78 MM OD 4.5 MM CORTEX SELF TAP LOCK LOW PROFILE SUP-71827068 CDM 0270 RC outpatient 290.97 290.97 290.97 74 215.32 percent of total billed charges 290.97 93 235.69 percent of total billed charges 290.97 290.97 other OPPS APC 290.97 290.97 other OPPS APC 290.97 27.63 80.4 percent of total billed charges 290.97 290.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 70 MM OD 4.5 MM CORTEX SELF TAP LOCK SUP-71827070 CDM 0270 RC outpatient 290.97 290.97 290.97 74 215.32 percent of total billed charges 290.97 93 235.69 percent of total billed charges 290.97 290.97 other OPPS APC 290.97 290.97 other OPPS APC 290.97 27.63 80.4 percent of total billed charges 290.97 290.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 72MM OD 4.5 MM CORTEX SELF TAP LOCK SUP-71827072 CDM 0270 RC outpatient 290.97 290.97 290.97 74 215.32 percent of total billed charges 290.97 93 235.69 percent of total billed charges 290.97 290.97 other OPPS APC 290.97 290.97 other OPPS APC 290.97 27.63 80.4 percent of total billed charges 290.97 290.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 80 MM OD 5.7 MM CANNULATED LOCK SUP-71828080 CDM 0270 RC outpatient 679.38 679.38 679.38 74 502.74 percent of total billed charges 679.38 93 550.3 percent of total billed charges 679.38 679.38 other OPPS APC 679.38 679.38 other OPPS APC 679.38 27.63 187.71 percent of total billed charges 679.38 679.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD L 75 MM OD 6.5 MM CANCELLOUS LOW PROFILE NONSTERILE SUP-71828175 CDM 0270 RC outpatient 66.79 66.79 66.79 74 49.42 percent of total billed charges 66.79 93 54.1 percent of total billed charges 66.79 66.79 other OPPS APC 66.79 66.79 other OPPS APC 66.79 27.63 18.45 percent of total billed charges 66.79 66.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY INTERTAN 130 D L 24 MM OD 10 MM STERILE SUP-71934480 CDM 0270 RC outpatient 4247.62 4247.62 4247.62 74 3143.24 percent of total billed charges 4247.62 93 3440.57 percent of total billed charges 4247.62 4247.62 other OPPS APC 4247.62 4247.62 other OPPS APC 4247.62 27.63 1173.62 percent of total billed charges 4247.62 4247.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERTAN 11.5MM X 24CM 125D SUP-71934481 CDM 0270 RC outpatient 4247.62 4247.62 4247.62 74 3143.24 percent of total billed charges 4247.62 93 3440.57 percent of total billed charges 4247.62 4247.62 other OPPS APC 4247.62 4247.62 other OPPS APC 4247.62 27.63 1173.62 percent of total billed charges 4247.62 4247.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL ANTHOLOGY POROUS PLUS HA 9 HIGH OFFSET HIP STERILE SUP-71935581 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT BUCKLING SCLERAL SLEEVE SILICONE STYLE 72 SUP-72 CDM 0270 RC outpatient 150.8 150.8 150.8 74 111.59 percent of total billed charges 150.8 93 122.15 percent of total billed charges 150.8 150.8 other OPPS APC 150.8 150.8 other OPPS APC 150.8 27.63 41.67 percent of total billed charges 150.8 150.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARON SINUS PK SUP-72-00001 CDM 0272 RC outpatient 131.2 131.2 131.2 74 97.09 percent of total billed charges 131.2 93 106.27 percent of total billed charges 131.2 131.2 other OPPS APC 131.2 131.2 other OPPS APC 131.2 27.63 36.25 percent of total billed charges 131.2 131.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADES ADENOTOME SZ 2 SUP-72-00003 CDM 0272 RC outpatient 76.76 76.76 76.76 74 56.8 percent of total billed charges 76.76 93 62.18 percent of total billed charges 76.76 76.76 other OPPS APC 76.76 76.76 other OPPS APC 76.76 27.63 21.21 percent of total billed charges 76.76 76.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSTRA-MAG DISP BLANKET SUP-72-00010 CDM 0272 RC outpatient 23.06 23.06 23.06 74 17.06 percent of total billed charges 23.06 93 18.68 percent of total billed charges 23.06 23.06 other OPPS APC 23.06 23.06 other OPPS APC 23.06 27.63 6.37 percent of total billed charges 23.06 23.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINTS SILICONE NASAL SUP-72-00017 CDM 0272 RC outpatient 163.1 163.1 163.1 74 120.69 percent of total billed charges 163.1 93 132.11 percent of total billed charges 163.1 163.1 other OPPS APC 163.1 163.1 other OPPS APC 163.1 27.63 45.06 percent of total billed charges 163.1 163.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUCTION CAUTERIZER-ENT SUP-72-00018 CDM 0272 RC outpatient 25.76 25.76 25.76 74 19.06 percent of total billed charges 25.76 93 20.87 percent of total billed charges 25.76 25.76 other OPPS APC 25.76 25.76 other OPPS APC 25.76 27.63 7.12 percent of total billed charges 25.76 25.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TEFLON CAUTERY TIP (12/BX) SUP-72-00019 CDM 0272 RC outpatient 3.33 3.33 3.33 74 2.46 percent of total billed charges 3.33 93 2.7 percent of total billed charges 3.33 3.33 other OPPS APC 3.33 3.33 other OPPS APC 3.33 27.63 0.92 percent of total billed charges 3.33 3.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBES SOILEAU DOUBLE SUP-72-00020 CDM 0272 RC outpatient 503.3 503.3 503.3 74 372.44 percent of total billed charges 503.3 93 407.67 percent of total billed charges 503.3 503.3 other OPPS APC 503.3 503.3 other OPPS APC 503.3 27.63 139.06 percent of total billed charges 503.3 503.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GOODE TUBES SUP-72-00021 CDM 0272 RC outpatient 58.82 58.82 58.82 74 43.53 percent of total billed charges 58.82 93 47.64 percent of total billed charges 58.82 58.82 other OPPS APC 58.82 58.82 other OPPS APC 58.82 27.63 16.25 percent of total billed charges 58.82 58.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DONALDSON TUBE SUP-72-00022 CDM 0272 RC outpatient 47.03 47.03 47.03 74 34.8 percent of total billed charges 47.03 93 38.09 percent of total billed charges 47.03 47.03 other OPPS APC 47.03 47.03 other OPPS APC 47.03 27.63 12.99 percent of total billed charges 47.03 47.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBES SOILEAU SINGLE SUP-72-00023 CDM 0272 RC outpatient 212.46 212.46 212.46 74 157.22 percent of total billed charges 212.46 93 172.09 percent of total billed charges 212.46 212.46 other OPPS APC 212.46 212.46 other OPPS APC 212.46 27.63 58.7 percent of total billed charges 212.46 212.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SURGIFLO (FLOSEAL) SUP-72-00030 CDM 0272 RC outpatient 634.48 634.48 634.48 74 469.52 percent of total billed charges 634.48 93 513.93 percent of total billed charges 634.48 634.48 other OPPS APC 634.48 634.48 other OPPS APC 634.48 27.63 175.31 percent of total billed charges 634.48 634.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CPT TONSIL PACK SUP-72-00031 CDM 0272 RC outpatient 153.41 153.41 153.41 74 113.52 percent of total billed charges 153.41 93 124.26 percent of total billed charges 153.41 153.41 other OPPS APC 153.41 153.41 other OPPS APC 153.41 27.63 42.39 percent of total billed charges 153.41 153.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK CPT NASAL-SMR SUP-72-00032 CDM 0272 RC outpatient 190.17 190.17 190.17 74 140.73 percent of total billed charges 190.17 93 154.04 percent of total billed charges 190.17 190.17 other OPPS APC 190.17 190.17 other OPPS APC 190.17 27.63 52.54 percent of total billed charges 190.17 190.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CPT MYRINGOTOMY PACK SUP-72-00033 CDM 0272 RC outpatient 88.06 88.06 88.06 74 65.16 percent of total billed charges 88.06 93 71.33 percent of total billed charges 88.06 88.06 other OPPS APC 88.06 88.06 other OPPS APC 88.06 27.63 24.33 percent of total billed charges 88.06 88.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAPARELLA VENT TUBES SUP-72-00034 CDM 0272 RC outpatient 180 180 180 74 133.2 percent of total billed charges 180 93 145.8 percent of total billed charges 180 180 other OPPS APC 180 180 other OPPS APC 180 27.63 49.73 percent of total billed charges 180 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIVERSAL FACIAL BAND SUP-72-00050 CDM 0272 RC outpatient 55.64 55.64 55.64 74 41.17 percent of total billed charges 55.64 93 45.07 percent of total billed charges 55.64 55.64 other OPPS APC 55.64 55.64 other OPPS APC 55.64 27.63 15.37 percent of total billed charges 55.64 55.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NASOPORE 4CM SUP-72-00052 CDM 0272 RC outpatient 454.9 454.9 454.9 74 336.63 percent of total billed charges 454.9 93 368.47 percent of total billed charges 454.9 454.9 other OPPS APC 454.9 454.9 other OPPS APC 454.9 27.63 125.69 percent of total billed charges 454.9 454.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NASOPORE 8CM SUP-72-00053 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBES TYMPANOPLASTY U SUP-72-00055 CDM 0272 RC outpatient 95 95 95 74 70.3 percent of total billed charges 95 93 76.95 percent of total billed charges 95 95 other OPPS APC 95 95 other OPPS APC 95 27.63 26.25 percent of total billed charges 95 95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EENT PRECISION CUTTER SUP-72-00056 CDM 0272 RC outpatient 418.22 418.22 418.22 74 309.48 percent of total billed charges 418.22 93 338.76 percent of total billed charges 418.22 418.22 other OPPS APC 418.22 418.22 other OPPS APC 418.22 27.63 115.55 percent of total billed charges 418.22 418.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XPRESS LOPROFILE ENT DILATION SYSTEM SUP-72-00057 CDM 0272 RC outpatient 4844.1 4844.1 4844.1 74 3584.63 percent of total billed charges 4844.1 93 3923.72 percent of total billed charges 4844.1 4844.1 other OPPS APC 4844.1 4844.1 other OPPS APC 4844.1 27.63 1338.42 percent of total billed charges 4844.1 4844.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISSOLVABLE DRESSING SINU-KNIT SUP-72-00060 CDM 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TOUMA T-TYPE SUP-72-00061 CDM 0272 RC outpatient 172.67 172.67 172.67 74 127.78 percent of total billed charges 172.67 93 139.86 percent of total billed charges 172.67 172.67 other OPPS APC 172.67 172.67 other OPPS APC 172.67 27.63 47.71 percent of total billed charges 172.67 172.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOYLE NASAL SEPTAL SPLINT SUP-72-00062 CDM 0272 RC outpatient 283.5 283.5 283.5 74 209.79 percent of total billed charges 283.5 93 229.64 percent of total billed charges 283.5 283.5 other OPPS APC 283.5 283.5 other OPPS APC 283.5 27.63 78.33 percent of total billed charges 283.5 283.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLEARVISION TUBING SET (FESS ) SUP-72-00063 CDM 0272 RC outpatient 116.48 116.48 116.48 74 86.2 percent of total billed charges 116.48 93 94.35 percent of total billed charges 116.48 116.48 other OPPS APC 116.48 116.48 other OPPS APC 116.48 27.63 32.18 percent of total billed charges 116.48 116.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISPOSABLE SUCTION NEEDLE 20GA SUP-72-00064 CDM 0272 RC outpatient 22.56 22.56 22.56 74 16.69 percent of total billed charges 22.56 93 18.27 percent of total billed charges 22.56 22.56 other OPPS APC 22.56 22.56 other OPPS APC 22.56 27.63 6.23 percent of total billed charges 22.56 22.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENT PRECISION CUTTER 2.5MM AGGRESSIVE SUP-72-00065 CDM 0272 RC outpatient 474.47 474.47 474.47 74 351.11 percent of total billed charges 474.47 93 384.32 percent of total billed charges 474.47 474.47 other OPPS APC 474.47 474.47 other OPPS APC 474.47 27.63 131.1 percent of total billed charges 474.47 474.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NASAL PACKING MEROCEL 8CM WITHOUT STRING SUP-72-00067 CDM 0272 RC outpatient 89.2 89.2 89.2 74 66.01 percent of total billed charges 89.2 93 72.25 percent of total billed charges 89.2 89.2 other OPPS APC 89.2 89.2 other OPPS APC 89.2 27.63 24.65 percent of total billed charges 89.2 89.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NERVEANA ET TUBE SIZE 6 COBRA 3-PLATE SUP-72-00068 CDM 0272 RC outpatient 1020 1020 1020 74 754.8 percent of total billed charges 1020 93 826.2 percent of total billed charges 1020 1020 other OPPS APC 1020 1020 other OPPS APC 1020 27.63 281.83 percent of total billed charges 1020 1020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NERVEANA ET TUBE SIZE 7 COBRA 3-PLATE SUP-72-00069 CDM 0272 RC outpatient 1020 1020 1020 74 754.8 percent of total billed charges 1020 93 826.2 percent of total billed charges 1020 1020 other OPPS APC 1020 1020 other OPPS APC 1020 27.63 281.83 percent of total billed charges 1020 1020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NERVEANA ET TUBE SIZE 8 COBRA 3-PLATE SUP-72-00070 CDM 0272 RC outpatient 1020 1020 1020 74 754.8 percent of total billed charges 1020 93 826.2 percent of total billed charges 1020 1020 other OPPS APC 1020 1020 other OPPS APC 1020 27.63 281.83 percent of total billed charges 1020 1020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NERVEANA MASTODON FACIAL NERVE MONITORING KIT SUP-72-00071 CDM 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 630 other OPPS APC 630 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAUTERY NEEDLE TIP 1IN WITH EXTENDED INSULATION SUP-72-00073 CDM 0272 RC outpatient 3.69 3.69 3.69 74 2.73 percent of total billed charges 3.69 93 2.99 percent of total billed charges 3.69 3.69 other OPPS APC 3.69 3.69 other OPPS APC 3.69 27.63 1.02 percent of total billed charges 3.69 3.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAUTERY TIP 1IN WITH EXTENDED INSULATION SUP-72-00074 CDM 0272 RC outpatient 3.45 3.45 3.45 74 2.55 percent of total billed charges 3.45 93 2.79 percent of total billed charges 3.45 3.45 other OPPS APC 3.45 3.45 other OPPS APC 3.45 27.63 0.95 percent of total billed charges 3.45 3.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HARMONIC SHEARS FOCUS 9CM SUP-72-00075 CDM 0272 RC outpatient 1343.96 1343.96 1343.96 74 994.53 percent of total billed charges 1343.96 93 1088.61 percent of total billed charges 1343.96 1343.96 other OPPS APC 1343.96 1343.96 other OPPS APC 1343.96 27.63 371.34 percent of total billed charges 1343.96 1343.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO BHX IMPLANT 4MM ABUTMENT 14 SUP-72-00076 CDM L8690 CPT 0278 RC outpatient 8021.25 8021.25 8021.25 57 4572.11 percent of total billed charges 8021.25 93 6497.21 percent of total billed charges 8021.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8021.25 other OPPS APC 8021.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8021.25 other OPPS APC 8021.25 51 4090.84 percent of total billed charges 8021.25 8021.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOUND PROCESSOR PONTO 5 MINI CHESTNUT BROWN SUP-72-00079 CDM L8690 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOUND PROCESSOR PONTO 5 MINI TERRACOTTA SUP-72-00080 CDM L8690 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOUND PROCESSOR PONTO 5 MINI STEEL GREY SUP-72-00081 CDM L8690 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOUND PROCESSOR PONTO 5 MINI SILVER (C044) SUP-72-00082 CDM L8690 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECT CLIP SUP-72-00083 CDM outpatient 696.5 696.5 696.5 696.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FACIAL NERVE MONITORING KIT 4 CHANNEL EMG NERVEANA SUP-72-00084 CDM 0272 RC outpatient 665 665 665 74 492.1 percent of total billed charges 665 93 538.65 percent of total billed charges 665 665 other OPPS APC 665 665 other OPPS APC 665 27.63 183.74 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOUND PROCESSOR PONTO 5 SUPERPOWER SILVER SUP-72-00085 CDM L8690 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BATTERY BIOMET THINFLAP PLATING SYSTEM SUP-72-1010 CDM 0270 RC outpatient 254.8 254.8 254.8 74 188.55 percent of total billed charges 254.8 93 206.39 percent of total billed charges 254.8 254.8 other OPPS APC 254.8 254.8 other OPPS APC 254.8 27.63 70.4 percent of total billed charges 254.8 254.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNIFE OPHTHALMIC KERATOME ANGLED FULL HANDLE SHARPOINT BEVELED UP 3MM SUP-72-2961 CDM 0270 RC outpatient 25.42 25.42 25.42 74 18.81 percent of total billed charges 25.42 93 20.59 percent of total billed charges 25.42 25.42 other OPPS APC 25.42 25.42 other OPPS APC 25.42 27.63 7.02 percent of total billed charges 25.42 25.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS VISION ELITE TITANIUM L19 MM SPINE CERVICAL ANTERIOR SUP-7200019 CDM 270010020 LOCAL 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS VISION ELITE TITANIUM L35 MM SPINE CERVICAL ANTERIOR SUP-7200035 CDM 270010020 LOCAL 0270 RC outpatient 2990 2990 2990 74 2212.6 percent of total billed charges 2990 93 2421.9 percent of total billed charges 2990 2990 other OPPS APC 2990 2990 other OPPS APC 2990 27.63 826.14 percent of total billed charges 2990 2990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS VISION ELITE TITANIUM L37.5 MM SPINE CERVICAL ANTERIOR SUP-7200037 CDM 270010020 LOCAL 0270 RC outpatient 2990 2990 2990 74 2212.6 percent of total billed charges 2990 93 2421.9 percent of total billed charges 2990 2990 other OPPS APC 2990 2990 other OPPS APC 2990 27.63 826.14 percent of total billed charges 2990 2990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS VISION ELITE TITANIUM L40 MM SPINE CERVICAL ANTERIOR SUP-7200040 CDM 270010020 LOCAL 0270 RC outpatient 3250 3250 3250 74 2405 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 3250 other OPPS APC 3250 3250 other OPPS APC 3250 27.63 897.98 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS VISION ELITE 55MM SPINE CERVICAL ANTERIOR LEVEL 3 SUP-7200055 CDM 270010020 LOCAL 0270 RC outpatient 4160 4160 4160 74 3078.4 percent of total billed charges 4160 93 3369.6 percent of total billed charges 4160 4160 other OPPS APC 4160 4160 other OPPS APC 4160 27.63 1149.41 percent of total billed charges 4160 4160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS VISION ELITE TITANIUM L57.5 MM SPINE CERVICAL ANTERIOR SUP-7200057 CDM 270010020 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS VISION ELITE TITANIUM L60 MM SPINE CERVICAL ANTERIOR SUP-7200060 CDM 270010020 LOCAL 0270 RC outpatient 4550 4550 4550 74 3367 percent of total billed charges 4550 93 3685.5 percent of total billed charges 4550 4550 other OPPS APC 4550 4550 other OPPS APC 4550 27.63 1257.17 percent of total billed charges 4550 4550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS VISION ELITE TITANIUM L62.5 MM SPINE CERVICAL ANTERIOR SUP-7200062 CDM 270010020 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS VISION ELITE 50MM SPINE CERVICAL ANTERIOR LEVEL 3 SUP-7200150 CDM 270010020 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLING SUBURETHRAL ADVANCE POLYPROPYLENE MALE KIT SUP-720088-01 CDM 0270 RC outpatient 17810 17810 17810 74 13179.4 percent of total billed charges 17810 93 14426.1 percent of total billed charges 17810 17810 other OPPS APC 17810 17810 other OPPS APC 17810 27.63 4920.9 percent of total billed charges 17810 17810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA ARTHROSCOPIC L70 MM ID5.5 MM CONICAL TIP THREADED OBTURATOR WITHOUT HOLE SET STERILE LATEX FREE DISPOSABLE ORANGE SUP-7204895 CDM 0270 RC outpatient 77.12 77.12 77.12 74 57.07 percent of total billed charges 77.12 93 62.47 percent of total billed charges 77.12 77.12 other OPPS APC 77.12 77.12 other OPPS APC 77.12 27.63 21.31 percent of total billed charges 77.12 77.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING INSUFFLATION L10 FT 40 L LUER LOCK HIGH FLOW HEATED PATIENT KIT STERILE DISPOSABLE SUP-7205861 CDM 0270 RC outpatient 47.09 47.09 47.09 74 34.85 percent of total billed charges 47.09 93 38.14 percent of total billed charges 47.09 47.09 other OPPS APC 47.09 47.09 other OPPS APC 47.09 27.63 13.01 percent of total billed charges 47.09 47.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ARTHROSCOPIC ACUFEX LONG L10 IN OD2.4 MM PCL CALIBRATED NO EYELET STERILE DISPOSABLE SUP-7207284 CDM 0270 RC outpatient 388.05 388.05 388.05 74 287.16 percent of total billed charges 388.05 93 314.32 percent of total billed charges 388.05 388.05 other OPPS APC 388.05 388.05 other OPPS APC 388.05 27.63 107.22 percent of total billed charges 388.05 388.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL ENDOBUTTON CL OD4.5 MM CANNULATED ENDOSCOPIC SUP-7207315 CDM 0270 RC outpatient 365.56 365.56 365.56 74 270.51 percent of total billed charges 365.56 93 296.1 percent of total billed charges 365.56 365.56 other OPPS APC 365.56 365.56 other OPPS APC 365.56 27.63 101 percent of total billed charges 365.56 365.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOBUTTON FIXATION SYSTEM CLOSED LOOP WITH SUTURE 35MM SUP-7207326 CDM 0270 RC outpatient 609.73 609.73 609.73 74 451.2 percent of total billed charges 609.73 93 493.88 percent of total billed charges 609.73 609.73 other OPPS APC 609.73 609.73 other OPPS APC 609.73 27.63 168.47 percent of total billed charges 609.73 609.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOBUTTON FIXATION SYSTEM CLOSED LOOP WITH SUTURE 45MM SUP-7207328 CDM 0270 RC outpatient 609.73 609.73 609.73 74 451.2 percent of total billed charges 609.73 93 493.88 percent of total billed charges 609.73 609.73 other OPPS APC 609.73 609.73 other OPPS APC 609.73 27.63 168.47 percent of total billed charges 609.73 609.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CANNULATED BIORCI 1.5MM CANNULATION STERILE 7 X 25MM SUP-7207554 CDM 0270 RC outpatient 344.76 344.76 344.76 74 255.12 percent of total billed charges 344.76 93 279.26 percent of total billed charges 344.76 344.76 other OPPS APC 344.76 344.76 other OPPS APC 344.76 27.63 95.26 percent of total billed charges 344.76 344.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CANNULATED BIORCI 1.5MM CANNULATION STERILE 8 X 25MM SUP-7207560 CDM 0270 RC outpatient 344.76 344.76 344.76 74 255.12 percent of total billed charges 344.76 93 279.26 percent of total billed charges 344.76 344.76 other OPPS APC 344.76 344.76 other OPPS APC 344.76 27.63 95.26 percent of total billed charges 344.76 344.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CANNULATED BIORCI 1.5MM CANNULATION STERILE 9 X 25MM SUP-7207563 CDM 0270 RC outpatient 344.76 344.76 344.76 74 255.12 percent of total billed charges 344.76 93 279.26 percent of total billed charges 344.76 344.76 other OPPS APC 344.76 344.76 other OPPS APC 344.76 27.63 95.26 percent of total billed charges 344.76 344.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CANNULATED BIORCI 1.5MM CANNULATION STERILE 9 X 35MM SUP-7207565 CDM 0270 RC outpatient 344.76 344.76 344.76 74 255.12 percent of total billed charges 344.76 93 279.26 percent of total billed charges 344.76 344.76 other OPPS APC 344.76 344.76 other OPPS APC 344.76 27.63 95.26 percent of total billed charges 344.76 344.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC ACUFEX OD17 MM ACL PCL SPIKE STERILE TIBIAL ANCHOR SUP-7207725 CDM 0270 RC outpatient 351 351 351 74 259.74 percent of total billed charges 351 93 284.31 percent of total billed charges 351 351 other OPPS APC 351 351 other OPPS APC 351 27.63 96.98 percent of total billed charges 351 351 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE FASTFIX ST SUP-7207876 CDM 0270 RC outpatient 380.25 380.25 380.25 74 281.39 percent of total billed charges 380.25 93 308 percent of total billed charges 380.25 380.25 other OPPS APC 380.25 380.25 other OPPS APC 380.25 27.63 105.06 percent of total billed charges 380.25 380.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE MEDTRONIC ELITE 47.5MM SUP-7208147 CDM 270010020 LOCAL 0270 RC outpatient 4160 4160 4160 74 3078.4 percent of total billed charges 4160 93 3369.6 percent of total billed charges 4160 4160 other OPPS APC 4160 4160 other OPPS APC 4160 27.63 1149.41 percent of total billed charges 4160 4160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER SUTURE MENISCAL KNOT PUSHER FAST FIX DELIVERY SYSTEM SUP-7209084 CDM 0270 RC outpatient 267.62 267.62 267.62 74 198.04 percent of total billed charges 267.62 93 216.77 percent of total billed charges 267.62 267.62 other OPPS APC 267.62 267.62 other OPPS APC 267.62 27.63 73.94 percent of total billed charges 267.62 267.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE FAST FIX ABSORBABLE CURVED MENISCAL REPAIR DELIVERY SYSTEM SUP-7209399 CDM 0270 RC outpatient 767.68 767.68 767.68 74 568.08 percent of total billed charges 767.68 93 621.82 percent of total billed charges 767.68 767.68 other OPPS APC 767.68 767.68 other OPPS APC 767.68 27.63 212.11 percent of total billed charges 767.68 767.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET SUTURE MENDER II MENISCAL STERILE DISPOSABLE SUP-7209485 CDM 0270 RC outpatient 382.2 382.2 382.2 74 282.83 percent of total billed charges 382.2 93 309.58 percent of total billed charges 382.2 382.2 other OPPS APC 382.2 382.2 other OPPS APC 382.2 27.63 105.6 percent of total billed charges 382.2 382.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORCELLATOR SURGICAL TRUCLEAR ROTARY DISPOSABLE HYSTEROSCOPY SUP-7209509 CDM 0270 RC outpatient 1474.2 1474.2 1474.2 74 1090.91 percent of total billed charges 1474.2 93 1194.1 percent of total billed charges 1474.2 1474.2 other OPPS APC 1474.2 1474.2 other OPPS APC 1474.2 27.63 407.32 percent of total billed charges 1474.2 1474.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EFLEX TAC-S PROBE EA SUP-7209637 CDM 0270 RC outpatient 1307.54 1307.54 1307.54 74 967.58 percent of total billed charges 1307.54 93 1059.11 percent of total billed charges 1307.54 1307.54 other OPPS APC 1307.54 1307.54 other OPPS APC 1307.54 27.63 361.27 percent of total billed charges 1307.54 1307.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EFLEX CHISEL PROBE EA SUP-7209663 CDM 0270 RC outpatient 1234.22 1234.22 1234.22 74 913.32 percent of total billed charges 1234.22 93 999.72 percent of total billed charges 1234.22 1234.22 other OPPS APC 1234.22 1234.22 other OPPS APC 1234.22 27.63 341.01 percent of total billed charges 1234.22 1234.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INFLOW TUBING FOR FLUID MANAGEMENT SYSTEM SUP-7209822 CDM outpatient 401.54 401.54 401.54 401.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE PUSHER KNOT SUTURE ARTHROSCOPY MENISCAL FAST FIX CURVED SUP-7210076 CDM 0270 RC outpatient 274.35 274.35 274.35 74 203.02 percent of total billed charges 274.35 93 222.22 percent of total billed charges 274.35 274.35 other OPPS APC 274.35 274.35 other OPPS APC 274.35 27.63 75.8 percent of total billed charges 274.35 274.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK POSITIONING T-MAX GEL FACE SUP-7210556 CDM 0270 RC outpatient 8.01 8.01 8.01 74 5.93 percent of total billed charges 8.01 93 6.49 percent of total billed charges 8.01 8.01 other OPPS APC 8.01 8.01 other OPPS APC 8.01 27.63 2.21 percent of total billed charges 8.01 8.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK POSITIONING T-MAX GEL FACE SUP-7210559 CDM 0270 RC outpatient 8.01 8.01 8.01 74 5.93 percent of total billed charges 8.01 93 6.49 percent of total billed charges 8.01 8.01 other OPPS APC 8.01 8.01 other OPPS APC 8.01 27.63 2.21 percent of total billed charges 8.01 8.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLEARFIL SEABOND 3270KA SUP-7210575 CDM 27000000 LOCAL 0270 RC outpatient 592.77 592.77 592.77 74 438.65 percent of total billed charges 592.77 93 480.14 percent of total billed charges 592.77 592.77 other OPPS APC 592.77 592.77 other OPPS APC 592.77 27.63 163.78 percent of total billed charges 592.77 592.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE TWINFIX ULTRABRAID TITANIUM 2 OD3.5 MM NEEDLE STERILE SUP-7210707 CDM 0270 RC outpatient 790.14 790.14 790.14 74 584.7 percent of total billed charges 790.14 93 640.01 percent of total billed charges 790.14 790.14 other OPPS APC 790.14 790.14 other OPPS APC 790.14 27.63 218.32 percent of total billed charges 790.14 790.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOBUTTON 20MM SUP-72200147 CDM 0270 RC outpatient 816.4 816.4 816.4 74 604.14 percent of total billed charges 816.4 93 661.28 percent of total billed charges 816.4 816.4 other OPPS APC 816.4 816.4 other OPPS APC 816.4 27.63 225.57 percent of total billed charges 816.4 816.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOBUTTON 25MM SUP-72200148 CDM 0270 RC outpatient 783.33 783.33 783.33 74 579.66 percent of total billed charges 783.33 93 634.5 percent of total billed charges 783.33 783.33 other OPPS APC 783.33 783.33 other OPPS APC 783.33 27.63 216.43 percent of total billed charges 783.33 783.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOBUTTON 30MM SUP-72200149 CDM 0270 RC outpatient 882.93 882.93 882.93 74 653.37 percent of total billed charges 882.93 93 715.17 percent of total billed charges 882.93 882.93 other OPPS APC 882.93 882.93 other OPPS APC 882.93 27.63 243.95 percent of total billed charges 882.93 882.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOBUTTON 35MM SUP-72200150 CDM 0270 RC outpatient 857.22 857.22 857.22 74 634.34 percent of total billed charges 857.22 93 694.35 percent of total billed charges 857.22 857.22 other OPPS APC 857.22 857.22 other OPPS APC 857.22 27.63 236.85 percent of total billed charges 857.22 857.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOBUTTON 40MM SUP-72200151 CDM 0270 RC outpatient 816.4 816.4 816.4 74 604.14 percent of total billed charges 816.4 93 661.28 percent of total billed charges 816.4 816.4 other OPPS APC 816.4 816.4 other OPPS APC 816.4 27.63 225.57 percent of total billed charges 816.4 816.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOBUTTON 45MM SUP-72200152 CDM 0270 RC outpatient 857.22 857.22 857.22 74 634.34 percent of total billed charges 857.22 93 694.35 percent of total billed charges 857.22 857.22 other OPPS APC 857.22 857.22 other OPPS APC 857.22 27.63 236.85 percent of total billed charges 857.22 857.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOBUTTON 50MM SUP-72200153 CDM 0270 RC outpatient 857.22 857.22 857.22 74 634.34 percent of total billed charges 857.22 93 694.35 percent of total billed charges 857.22 857.22 other OPPS APC 857.22 857.22 other OPPS APC 857.22 27.63 236.85 percent of total billed charges 857.22 857.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT POSITIONING COBAN S SHOULDER STABILIZATION ARM DRAPE HOOK SUSPENSION STERILE LATEX FREE DISPOSABLE ARTHROSCOPY SUP-72200195 CDM 0270 RC outpatient 242.63 242.63 242.63 74 179.55 percent of total billed charges 242.63 93 196.53 percent of total billed charges 242.63 242.63 other OPPS APC 242.63 242.63 other OPPS APC 242.63 27.63 67.04 percent of total billed charges 242.63 242.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE TWINFIX ULTRABRAID TITANIUM 2 OD3.5 MM PRELOADED STERILE SUP-72200752 CDM 0270 RC outpatient 728 728 728 74 538.72 percent of total billed charges 728 93 589.68 percent of total billed charges 728 728 other OPPS APC 728 728 other OPPS APC 728 27.63 201.15 percent of total billed charges 728 728 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIORPTR ANCHOR EA SUP-72200801 CDM 0270 RC outpatient 741 741 741 74 548.34 percent of total billed charges 741 93 600.21 percent of total billed charges 741 741 other OPPS APC 741 741 other OPPS APC 741 27.63 204.74 percent of total billed charges 741 741 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLUG BONE GRAFT SYSTEM TRUFIT KIT GREEN 5MM SUP-72200923 CDM 0270 RC outpatient 1352 1352 1352 74 1000.48 percent of total billed charges 1352 93 1095.12 percent of total billed charges 1352 1352 other OPPS APC 1352 1352 other OPPS APC 1352 27.63 373.56 percent of total billed charges 1352 1352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLUG BONE GRAFT SYSTEM TRUFIT KIT RED 7MM SUP-72200925 CDM 0270 RC outpatient 1352 1352 1352 74 1000.48 percent of total billed charges 1352 93 1095.12 percent of total billed charges 1352 1352 other OPPS APC 1352 1352 other OPPS APC 1352 27.63 373.56 percent of total billed charges 1352 1352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLUG BONE GRAFT SYSTEM TRUFIT KIT BLUE 9MM SUP-72200927 CDM 0270 RC outpatient 1352 1352 1352 74 1000.48 percent of total billed charges 1352 93 1095.12 percent of total billed charges 1352 1352 other OPPS APC 1352 1352 other OPPS APC 1352 27.63 373.56 percent of total billed charges 1352 1352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE DRILL BONE DISPOSABLE TRUKOR RED 7MM SUP-72200938 CDM 0270 RC outpatient 555.75 555.75 555.75 74 411.26 percent of total billed charges 555.75 93 450.16 percent of total billed charges 555.75 555.75 other OPPS APC 555.75 555.75 other OPPS APC 555.75 27.63 153.55 percent of total billed charges 555.75 555.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE DRILL BONE DISPOSABLE TRUKOR BLUE 9MM SUP-72200939 CDM 0270 RC outpatient 572.42 572.42 572.42 74 423.59 percent of total billed charges 572.42 93 463.66 percent of total billed charges 572.42 572.42 other OPPS APC 572.42 572.42 other OPPS APC 572.42 27.63 158.16 percent of total billed charges 572.42 572.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FAST FX AB SUP-72201493 CDM 0270 RC outpatient 891.8 891.8 891.8 74 659.93 percent of total billed charges 891.8 93 722.36 percent of total billed charges 891.8 891.8 other OPPS APC 891.8 891.8 other OPPS APC 891.8 27.63 246.4 percent of total billed charges 891.8 891.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRV. NEEDLE SUP-72201494 CDM 0270 RC outpatient 861.67 861.67 861.67 74 637.64 percent of total billed charges 861.67 93 697.95 percent of total billed charges 861.67 861.67 other OPPS APC 861.67 861.67 other OPPS APC 861.67 27.63 238.08 percent of total billed charges 861.67 861.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE DELIVERY SYSTEM ULTRA FAST FIX AB ASSEMBLY REVERSE CURVED SUP-72201495 CDM 0270 RC outpatient 861.67 861.67 861.67 74 637.64 percent of total billed charges 861.67 93 697.95 percent of total billed charges 861.67 861.67 other OPPS APC 861.67 861.67 other OPPS APC 861.67 27.63 238.08 percent of total billed charges 861.67 861.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PUSHER KNOT ULTRA FAST-FIX STRAIGHT SUTURE CUTTER STERILE DISPOSABLE MENISCAL REPAIR SYSTEM SUP-72201537 CDM 0270 RC outpatient 326.4 326.4 326.4 74 241.54 percent of total billed charges 326.4 93 264.38 percent of total billed charges 326.4 326.4 other OPPS APC 326.4 326.4 other OPPS APC 326.4 27.63 90.18 percent of total billed charges 326.4 326.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAD POSITIONING FERKEL FOAM THIGH DISPOSABLE SUP-72201813 CDM 0270 RC outpatient 231.92 231.92 231.92 74 171.62 percent of total billed charges 231.92 93 187.86 percent of total billed charges 231.92 231.92 other OPPS APC 231.92 231.92 other OPPS APC 231.92 27.63 64.08 percent of total billed charges 231.92 231.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOFT TISSUE MINI BLADE SUP-72202536 CDM 0270 RC outpatient 1667.98 1667.98 1667.98 74 1234.31 percent of total billed charges 1667.98 93 1351.06 percent of total billed charges 1667.98 1667.98 other OPPS APC 1667.98 1667.98 other OPPS APC 1667.98 27.63 460.86 percent of total billed charges 1667.98 1667.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DENSE TISSUE PLUS BLADE SUP-72203012 CDM 0270 RC outpatient 2454.27 2454.27 2454.27 74 1816.16 percent of total billed charges 2454.27 93 1987.96 percent of total billed charges 2454.27 2454.27 other OPPS APC 2454.27 2454.27 other OPPS APC 2454.27 27.63 678.11 percent of total billed charges 2454.27 2454.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACUFEX ACCESS POSITIONING KIT SUP-72205102 CDM 0270 RC outpatient 412.33 412.33 412.33 74 305.12 percent of total billed charges 412.33 93 333.99 percent of total billed charges 412.33 412.33 other OPPS APC 412.33 412.33 other OPPS APC 412.33 27.63 113.93 percent of total billed charges 412.33 412.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACUFEX ACCESS ADV POSITIONING KIT SUP-72205104 CDM 0270 RC outpatient 466.57 466.57 466.57 74 345.26 percent of total billed charges 466.57 93 377.92 percent of total billed charges 466.57 466.57 other OPPS APC 466.57 466.57 other OPPS APC 466.57 27.63 128.91 percent of total billed charges 466.57 466.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SET CD HORIZON LEGACY PEEK SPINE EXTERNAL HEXAGONAL HEAD STERILE 8.5 MM ROD SUP-7220850 CDM 270010020 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDEN 0 DEG INSERT 36MM SUP-723-00-36D CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ACETABULAR TRIDENT X3 0 D E ID36 MM STERILE LATEX FREE SUP-723-00-36E CDM 270010024 LOCAL 0270 RC outpatient 3581.37 3581.37 3581.37 74 2650.21 percent of total billed charges 3581.37 93 2900.91 percent of total billed charges 3581.37 3581.37 other OPPS APC 3581.37 3581.37 other OPPS APC 3581.37 27.63 989.53 percent of total billed charges 3581.37 3581.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT 0 X3 INSERT 36MM ID SUP-723-00-36F CDM 270010024 LOCAL 0270 RC outpatient 3581.37 3581.37 3581.37 74 2650.21 percent of total billed charges 3581.37 93 2900.91 percent of total billed charges 3581.37 3581.37 other OPPS APC 3581.37 3581.37 other OPPS APC 3581.37 27.63 989.53 percent of total billed charges 3581.37 3581.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCISSORS OPHTHALMIC GRIESHABER OD23 GA VERTICAL ADVANCE TIP DISPOSABLE MPS SUP-723.26 CDM 0270 RC outpatient 451.33 451.33 451.33 74 333.98 percent of total billed charges 451.33 93 365.58 percent of total billed charges 451.33 451.33 other OPPS APC 451.33 451.33 other OPPS APC 451.33 27.63 124.7 percent of total billed charges 451.33 451.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VACUUM EXTRACTION JADA HEMORRHAGE CONTROL BLUE SEAL VALVE KIT GREEN BOX SUP-72303 CDM outpatient 3237.5 3237.5 3237.5 3237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON 21.0D SUP-72374 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON IOL 21.0D SUP-72374 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS ACRYSOF IQ IOL 14.0D SUP-72375 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT AMS 700 ACCESSORY SUP-72401850 CDM 270010002 LOCAL 0270 RC outpatient 2236 2236 2236 74 1654.64 percent of total billed charges 2236 93 1811.16 percent of total billed charges 2236 2236 other OPPS APC 2236 2236 other OPPS APC 2236 27.63 617.81 percent of total billed charges 2236 2236 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 6MM SELF-TAPPING VARIABLE ANGLE CORTICAL STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72402006 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 L 7 MM OD 2 MM ODSEC 3 MM CORTEX SELF RETAINING SCREWDRIVER SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402007 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 8 MM OD 2 MM CORTICAL STERILE SUP-72402008 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 L9 MM OD 2 MM ODSEC 3MM CORTEX SELF RETAINING SCREWDRIVER SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402009 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 10MM OD 2MM CORTICAL STERILE SUP-72402010 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 11MM OD 2MM CORTICAL STERILE SUP-72402011 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS T6 L 12 MM OD 2 MM ODSEC 3 MM CORTEX SELF TAP STERILE MINI PLATE SYSTEM SUP-72402012 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS T6 L 13MM OD 2 MM ODSEC 3 MM CORTEX SELF TAP MINI PLATE SYSTEM SUP-72402013 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 14 MM OD 2 MM CORTICAL STERILE SUP-72402014 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI T6 L 15MM OD 2MM ODSEC 3MM CORTEX SELF TAP STERILE SUP-72402015 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 L 16 MM OD 2 MM ODSEC 3 MM CORTEX SELF RETAINING SCREWDRIVER SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402016 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 L 17 MM OD 2 MM CORTEX SELF RATAINING SCREWDRIVER SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402017 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS T6 L 18 MM OD 2MM ODSEC 3 MM CORTEX SELF TAP MINI PLATE SYSTEM SUP-72402018 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 L 19 MM OD 2 MM OD SEC 3 MM CORTEX SELF RETAINING SCREWDRIVER SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402019 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 20 MM OD 2 MM CORTICAL STERILE SUP-72402020 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 L 21 MM OD 2 MM CORTEX SELF RETAINING SCREWDRIVER SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402021 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 L 22MMOD 2 MM ODSEC 3 MM CORTEX SELF RETAINING SCREWDRIVER SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402022 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 L 23 MM OD 2MM ODSEC 3MM CORTEX SELF RETAINING SCREWDRIVER SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402023 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 24 MM OD 2.4 MM CORTICAL STERILE SUP-72402024 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS T6 L 26 MM OD 2 MM CORTEX SELF TAP STERILE LATEX FREE SUP-72402026 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 28MM SELF-TAPPING VARIABLE ANGLE CORTICAL STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM SUP-72402028 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 30MM SELF-TAPPING VARIABLE ANGLE CORTICAL STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72402030 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 32MM SELF-TAPPING VARIABLE ANGLE CORTICAL STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM SUP-72402032 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 34MM SELF-TAPPING VARIABLE ANGLE CORTICAL STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM SUP-72402034 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 36MM SELF-TAPPING VARIABLE ANGLE CORTICAL STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM SUP-72402036 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 38MM SELF-TAPPING VARIABLE ANGLE CORTICAL STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM SUP-72402038 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 40MM SELF-TAPPING VARIABLE ANGLE CORTICAL STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM SUP-72402040 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE OD 3.5 MM T7 L 6MM OD 2.4 MM ODSEC 3.8MM CORTEX SELF RETAINING SCREWDRIVER SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402406 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI STAINLESS STEEL T7 L 7MM OD 2.4MM CORTEX STERILE SUP-72402407 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE OD 3.5 MM T7 L 8 MM OD 2.4 MM ODSEC 3.8 MM CORTEX SELF RETAINING SCREWDRIVER SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402408 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI STAINLESS STEEL T7 L 9MM OD 2.4MM CORTEX STERILE SUP-72402409 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS T7 L 10MM CORTEX SELF TAP STERILE SUP-72402410 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS T7 L 11MM CORTEX SELF TAP STERILE SUP-72402411 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI T7 L 12 MM OD 2.4MM ODSEC3.8MM LONG BONE SMALL BONE CORTEX SELF TAP DRIVER STERILE SUP-72402412 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI T7 L 13 MM OD 2.4MM ODSEC 3.8MM LONG BONE SMALL BONE CORTEX SELF TAP DRIVER STERILE SUP-72402413 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI T7 L 14 MM OD 2.4MM ODSEC3.8MM LONG BONE SMALL BONE CORTEX SELF TAP DRIVER STERILE SUP-72402414 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI T7 L 15 MM OD 2.4MM ODSEC3.8MM LONG BONE SMALL BONE CORTEX SELF TAP DRIVER STERILE SUP-72402415 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI T7 L 16 MM OD 2.4MM ODSEC3.8MM LONG BONE SMALL BONE CORTEX SELF TAP DRIVER STERILE SUP-72402416 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE OD 3.5 MM T7 L 17MM OD 2.4MM CORTEX SELF RETAINING SCREWDRIVER SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402417 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE OD 3.5 MM T7 L 18MM OD 2.4MM CORTEX SELF RETAINING SCREWDRIVER SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402418 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE OD 3.5 MM T7 L 19 MM OD 2.4 MM ODSEC 3.8MM CORTEX SELF RETAINING SCREWDRIVER SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402419 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 20 MM OD 2.4 MM CORITCAL STERILE SUP-72402420 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI T7 L 21 MM OD 2.4 MM CORTEX SELF TAP STERILE SUP-72402421 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI T7 L 22 MM OD 2.4 MM CORTEX SELF TAP STERILE SUP-72402422 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI T7 L23MM OD 2.4 MM CORTEX SELF TAP STERILE SUP-72402423 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 24 MM OD 2.4 MM CORTICAL STERILE SUP-72402424 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS STAINLESS STEEL L 26 MM OD 2.4 MM WRIST CORTEX CADDY STERILE SUP-72402426 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 28 MM OD 2.4 MM CORTICAL STERILE SUP-72402428 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI T7 L30 MM OD 2.4 MNM CORTEX SELF TAP STERILE SUP-72402430 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI T7 L 32 MM OD 2.4 MM CORTEX SELF TAP STERILE SUP-72402432 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 34 MM OD 2.4 MM CORTICAL STERILE SUP-72402434 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 36 MM OD 2.4 MM CORTICAL STERILE SUP-72402436 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2.4MM 38MM SELF TAPPING VARIABLE ANGLE CORTICAL STAINLESS STEEL T7 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72402438 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS T7 L 40 MM OD 2.4 MM CORTEX SELF TAP SUP-72402440 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI T7 L42 MM OD2.4 MM CORTEX SELF TAP STERILE SUP-72402442 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 44 MM OD 2.4 MM CORTICAL STERILE SUP-72402444 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 46 MM OD 2.4 MM CORTICAL STERILE SUP-72402446 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2.4MM 48MM SELF-TAPPING VARIBALE ANGLE CORTICAL STAINLESS STEEL T7 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72402448 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 50 MM OD 2.4 MM CORTICAL STERILE SUP-72402450 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE OD 3.5 MM T7 L 55 MM OD 2.4 MM ODSEC 3.8MM CORTEX SELF RETAINING SCREWDRIVER SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402455 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 60 MM OD 2.4 MM CORTICAL STERILE SUP-72402460 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE OD 3.5 MM T7 L 65 MM OD 2.4MM ODSEC 3.8MM CORTEX SELF RETAINING SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402465 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE OD 3.5 MM T7 L 70 MM OD 2.4 MM OD SEC 3.8MM CORTEX SELF RETAINING SCREWDRIVER SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402470 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE OD 3.5 MM T7 L 75MM OD 2.4 MM ODSEC 3.8MM CORTEX SELF-RETAINING SCREWDRIVER SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402475 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE OD 3.5MM T7 L 80 MM OD 2.4MM ODSEC 3.8MM CORTEX SELF RETAINING SCREWDRIVER SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402480 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2.7MM 6MM SELF-TAPPING VARIABLE ANGLE CORTICAL STAINLESS STEEL T8 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72402706 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2.7MM 7MM SELF-TAPPING VARIABLE ANGLE CORTICAL STAINLESS STEEL T8 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72402707 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS T8 L 8 MM OD 2.7 MM CORTEX SELF TAP MINI PLATE SYSTEM SUP-72402708 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2.7MM X 9.0MM SUP-72402709 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 10MM OD 2.7 MM CORTEX SELF TAP MINI SYSTEM SUP-72402710 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 11MM OD 2.7 MM CORTEX SELF TAP MINI SYSTEM SUP-72402711 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 12MM OD 2.7 MM CORTEX SELF TAP MINI SYSTEM SUP-72402712 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 13MM OD 2.7MM M CORTEX SELF TAP SUP-72402713 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 14MM OD 2.7 MM CORTEX SELF TAP MINI SYSTEM SUP-72402714 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 15MM OD 2.7MM CORTEX SELF TAP SUP-72402715 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 16 MM OD 2.7 MM CORTICAL STERILE SUP-72402716 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS T8 L 17 MM OD 2.7 MM CORTEX SELF TAP NONSTERILE MINI PLATE SYSTEM SUP-72402717 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 18MM OD 2.7MM CORTEX SELF TAP SUP-72402718 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE OD2MM L 19 MM OD 2.7MM CORTEX SELF TAP EVOS SUP-72402719 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 20 MM OD 2.7 MM CORTEX SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402720 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L21 MM OD 2.7 MM CORTEX SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402721 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 22MM OD 2.7MM CORTICAL STERILE SUP-72402722 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L23 MM OD 2.7 MM CORTEX SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402723 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 24 MM OD 2.7 MM CORTICAL STERILE SUP-72402724 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STELL L 26 MM OD 2.7 MM CORTICAL STERILE SUP-72402726 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 28 MM OD 2.7 MM CORTICAL STERILE SUP-72402728 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 30 MM OD 2.7 MM CORTICAL STERILE SUP-72402730 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 32MM OD 2.7MM CORTICAL STERILE SUP-72402732 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 34MM OD 2.7MM CORTICAL STERILE SUP-72402734 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 36 MM OD 2.7 MM CORTICAL STERILE SUP-72402736 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 38MM OD 2.7MM CORTICAL STERILE SUP-72402738 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 40 MM OD 2.7 MM CORTICAL STERILE SUP-72402740 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 42 MM OD 2.7 MM CORTEX STERILE SUP-72402742 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 44 MM OD 2.7MM CORTICAL STERILE SUP-72402744 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 46 MM ID 2.7 MM CORTICAL STERILE SUP-72402746 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 48 MM OD 2.7 MM CORTEX SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402748 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 50 MM OD 2.7 MM CORTICAL STERILE SUP-72402750 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 55MM CORTEX OD 2.7MM SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402755 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 60 MM OD 2.7 MM CORTEX SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402760 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 65MM OD 2.7MM CORTEX SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402765 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 70MM OD 2.7MM CORTICAL STERILE SUP-72402770 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI T8 L75 MM OD 2.7 MM LONG BONE SMALL BONE CORTEX SELF TAP SUP-72402775 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 80MM OD 2.7MM CORTEX SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72402780 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 6 MM OD 3.5MM CORTEX SELF TAP STERILE SUP-72403506 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 3.5MM 8MM SELF TAPPING CORTICAL STAINLESS STEEL F/MINI PLATING SYSTEM NON-STERILE SUP-72403508 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 10MM OD 3.5MM CORTEX STERILE SUP-72403510 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 11MM OD 3.5MM CORTEX SELF TAP STERILE SUP-72403511 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L12 MM OD 3.5 MM CORTEX SELF TAP SUP-72403512 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 13MM OD 3.5MM CORTEX STERILE SUP-72403513 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 14MM OD 3.5MM CORTEX SELF TAP STERILE SUP-72403514 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 15MM OD 3.5MM CORTEX SELF TAP STERILE SUP-72403515 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 16MM OD 3.5MM CORTEX SELF TAP STERILE SUP-72403516 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 17 MM OD 3.5 MM CORTEX SELF TAP STERILE SUP-72403517 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 18 MM OD 3.5MM CORTEX SELF TAP STERILE SUP-72403518 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 19MM OD 3.5MM CORTEX SELF TAP STERILE SUP-72403519 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 20MM OD 3.5MM CORTEX SELF TAP STERILE SUP-72403520 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 22MM OD 3.5MM CORTEX SELF TAP STERILE SUP-72403522 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 24 MM OD 3.5 MM CORTEX SELF TAP STERILE SUP-72403524 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 26 MM OD 3.5 MM CORTEX SELF TAP STERILE SUP-72403526 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 28 MM OD 3.5 MM CORTEX SELF TAP STERILE SUP-72403528 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 30 MM OD 3.5 MM CORTEX SELF TAP STERILE SUP-72403530 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 32 MM OD 3.5 MM CORTEX SELF TAP STERILE SUP-72403532 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 34 MM OD 3.5 MM CORTEX SELF TAP STERILE SUP-72403534 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 36 MM OD 3.5 MM CORTEX SELF TAP STERILE SUP-72403536 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 38 MM OD 3.5 MM CORTEX SELF TAP STERILE SUP-72403538 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 40 MM OD 3.5 MM CORTEX SELF TAP STERILE SUP-72403540 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L42 MM OD3.5 MM CORTEX SELF TAP STERILE SUP-72403542 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 44MM OD 3.5MM CORTEX SELF TAP STERILE SUP-72403544 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 46 MM OD 3.5 MM CORTEX SELF TAP STERILE SUP-72403546 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 48 MM OD 3.5 MM CORTEX SELF TAP STERILE SUP-72403548 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 50 MM OD 3.5 MM CORTEX SELF TAP STERILE SUP-72403550 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 55MM OD 3.5MM CORTEX SELF-TAP STERILE SUP-72403555 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L60 MM OD3.5 MM CORTEX SELF TAP STERILE SUP-72403560 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L65 MM OD3.5 MM CORTEX SELF TAP STERILE SUP-72403565 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 70 MM OD 3.5MM CORTEX SELF TAP STERILE SUP-72403570 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 75MM OD 3.5MM CORTEX SELF TAP STERILE SUP-72403575 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 80 MM OD 3.5 M CORTEX SELF TAP STERILE SUP-72403580 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L85 MM OD3.5 MM CORTEX SELF TAP STERILE SUP-72403585 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 90 MM OD 3.5 MM CORTEX SELF TAP STERILE SUP-72403590 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 120 MM OD 3.5 MM CORTEX SELF TAP STERILE SUP-72403620 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 135MM OD 3.5MM CORTEX SELF TAP STERILE SUP-72403635 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 150 MM OD 3.5 MM CORTEX SELF TAP STERILE SUP-72403650 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLING MONARC SUP-72403830 CDM 0270 RC outpatient 3543.8 3543.8 3543.8 74 2622.41 percent of total billed charges 3543.8 93 2870.48 percent of total billed charges 3543.8 3543.8 other OPPS APC 3543.8 3543.8 other OPPS APC 3543.8 27.63 979.15 percent of total billed charges 3543.8 3543.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH INTERPRO Y SUP-72404000 CDM 0270 RC outpatient 2366 2366 2366 74 1750.84 percent of total billed charges 2366 93 1916.46 percent of total billed charges 2366 2366 other OPPS APC 2366 2366 other OPPS APC 2366 27.63 653.73 percent of total billed charges 2366 2366 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG BONE FIXATION EVOS 1.8MM 14MM T7 DRIVE RECESS LOCKING STAINLESS STEEL STERILE SUP-72411814 CDM 0270 RC outpatient 244.4 244.4 244.4 74 180.86 percent of total billed charges 244.4 93 197.96 percent of total billed charges 244.4 244.4 other OPPS APC 244.4 244.4 other OPPS APC 244.4 27.63 67.53 percent of total billed charges 244.4 244.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG BONE FIXATION EVOS 1.8MM 16MM T7 DRIVE RECESS LOCKING STAINLESS STEEL STERILE SUP-72411816 CDM 0270 RC outpatient 244.4 244.4 244.4 74 180.86 percent of total billed charges 244.4 93 197.96 percent of total billed charges 244.4 244.4 other OPPS APC 244.4 244.4 other OPPS APC 244.4 27.63 67.53 percent of total billed charges 244.4 244.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG BONE FIXATION EVOS 1.8MM 20MM T7 DRIVE RECESS LOCKING STAINLESS STEEL STERILE SUP-72411820 CDM 0270 RC outpatient 244.4 244.4 244.4 74 180.86 percent of total billed charges 244.4 93 197.96 percent of total billed charges 244.4 244.4 other OPPS APC 244.4 244.4 other OPPS APC 244.4 27.63 67.53 percent of total billed charges 244.4 244.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 6MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72412006 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 L 7MM OD 2MM ODSEC 3.3MM SMALL BONE LONG BONE LOCK SELF RETAINING SCREWDRIVER SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72412007 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 8 MM OD 2 MM LOCK STERILE SUP-72412008 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T6 L 9 MM OD 2MM ODSEC 3.3MM SMALL BONE LONG BONE LOCK SELF RETAINING SCREWDRIVER SELF TAP FLAT HEAD STERILE EVOS MINI SUP-72412009 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 10 MM OD 2 MM LOCK STERILE SUP-72412010 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL 11MM OD 2 MM LOCK STERILE SUP-72412011 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 12 MM OD 2 MM LOCK STERILE SUP-72412012 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI T6 L 13 MM OD 2 MM ODSEC 3.3 MM LONG BONE SMALL BONE LOCK STERILE SUP-72412013 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI T6 L 14 MM OD 2 MM ODSEC 3.3 MM LONG BONE SMALL BONE LOCK STERILE SUP-72412014 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 15MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72412015 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 16MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72412016 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 17MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM SUP-72412017 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 18MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM SUP-72412018 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 19MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM SUP-72412019 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 20MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72412020 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 22MM OD 2 MM LOCK STERILE SUP-72412022 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 23MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T6 STARDRIVE RECESS SELF_RETAINING COUNTERSINK F/MINI PLATING SYSTEM SUP-72412023 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 24MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72412024 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 26MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72412026 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 28MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM SUP-72412028 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 30MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM SUP-72412030 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 32MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM SUP-72412032 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 34MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM SUP-72412034 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 36MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM SUP-72412036 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 38MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72412038 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2MM 40MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T6 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM SUP-72412040 CDM 0270 RC outpatient 255.84 255.84 255.84 74 189.32 percent of total billed charges 255.84 93 207.23 percent of total billed charges 255.84 255.84 other OPPS APC 255.84 255.84 other OPPS APC 255.84 27.63 70.69 percent of total billed charges 255.84 255.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI STAINLESS STEEL T 7 L 6MM OD 2.4MM OD SEC 3.8MM LONG BONE SMALL BONE LOCK STERILE SUP-72412406 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI STAINLESS STEEL T7 L 7 MM OD 2.4MM ODSEC 3.8MM LONG BONE SMALL BONE LOCK STERILE SUP-72412407 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 8 MM OD 2.4 MM LOCK STERLE SUP-72412408 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI STAINLESS STEEL T7 L 9MM OD 2.4MM ODSEC 3.8MM LONG BONE SMALL BONE LOCK STERILE SUP-72412409 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS T7 L 10 MM OD 2.4 MM SELF-TAP LOCK STERILE SUP-72412410 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI STAINLESS STEEL T7 L 11MM OD 2.4MM ODSEC 3.8MM LONG BONE SMALL BONE LOCK STERILE SUP-72412411 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVOS 2.4MM X 12MM LOCKING SCREW T7 SELF EVOS SUP-72412412 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI T7 L13MM OD 2.4 MM LONG BONE SMALL BONE LOCK DRIVER STERILE SUP-72412413 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS T7 L 14MM OD2.4MM ODSEC 3.8MM LONG BONE SMALL BONE LOCK STERILE SUP-72412414 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI STAINLESS STEEL T7 L 15MM OD 2.4MM ODSEC 3.8MM LONG BONE SMALL BONE LOCK STERILE SUP-72412415 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS T7 L 16MM OD2.4MM ODSEC 3.8MM LONG BONE SMALL BONE LOCK STERILE SUP-72412416 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI STAINLESS STEEL T7 L 17 MM OD 2.4 MM ODSEC 3.8MM LONG BONE SMALL BONE LOCK STERILE SUP-72412417 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI T7 L18 MM OD 2.4 MM ODSEC 3.8 MM LONG BONE SMALL BONE LOCK DRIVER STERILE SUP-72412418 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI STAINLESS STEEL T7L 19 MM OD 2.4 MM OD SEC 3.8MM LONG BONE SMALL BONE LOCK STERILE SUP-72412419 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI T7 L20 MM OD 2.4 MM ODSEC 3.8 MM LONG BONE SMALL BONE LOCK DRIVER STERILE SUP-72412420 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI STAINLESS STEEL T7 L 21 MM OD 2.4 MM ODSEC 3.8 MM LONG BONE SMALL BONE LOCK STERILE SUP-72412421 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI STAINLESS STEEL T7 L 22MM OD 2.4MM ODSEC 3.8MM LONG BONE SMALL BONE LOCK STERILE SUP-72412422 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2.4MM 23MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T7 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72412423 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS T7 L 24MM OD 2.4 MM SELF TAP LOCK SUP-72412424 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI STAINLESS STEEL T7 L 26 MM OD 2.4 MM ODSEC 3.8MM LONG BONE SMALL BONE LOCK STERILE SUP-72412426 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI STAINLESS STEEL T7 L 28 MM OD 2.4 MM ODSEC 3.8 MM LONG BONE SMALL BONE LOCK STERILE SUP-72412428 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI STAINLESS STEEL T7 L 30 MM OD 2.4 MM OD SEC 3.8 MMLONG BONE SMALL BONE LOCK STERILE SUP-72412430 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS T7 L 32 MM OD 2.4 MM SELF TAP LOCK SUP-72412432 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI STAINLESS STEEL T7 L 34 MM OD 2.4 MM ODSEC 3.8MM LONG BONE SMALL BONE LOCK STERILE SUP-72412434 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS MINI T7 L36 MM OD2.4 MM ODSEC3.8 MM LONG BONE SMALL BONE LOCK STERILE SUP-72412436 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2.4MM 38MM LOCKING SELF TAPPING VARIABLE ANGLE STAINLESS STEEL T7 STARDRIVE RECESS SELF RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72412438 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS T7 L 40MM OD 2.4 MM SELF TAP LOCK SUP-72412440 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2.4MM 42MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T7 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72412442 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2.4MM 44MM LOCKING SELF TAPPING VARIABLE ANGLE STAINLESS STEEL T7 STARDRIVE RECESS SELF RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72412444 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS T7 L46 MM OD2.4 MM SELF TAP LOCK SUP-72412446 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS T7 L 50MM OD 2.4 MM SELF TAP LOCK SUP-72412450 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2.4MM 55MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T7 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72412455 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS T7 L 60MM OD 2.4 MM SELF TAP LOCK SUP-72412460 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2.4MM 65MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T7 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM SUP-72412465 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2.4MM 70MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T7 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM SUP-72412470 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2.4MM 75MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T7 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM SUP-72412475 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2.4MM 80MM LOCKING SELF-TAPPING VARIABLE ANGLE STAINLESS STEEL T7 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM SUP-72412480 CDM 0270 RC outpatient 263.12 263.12 263.12 74 194.71 percent of total billed charges 263.12 93 213.13 percent of total billed charges 263.12 263.12 other OPPS APC 263.12 263.12 other OPPS APC 263.12 27.63 72.7 percent of total billed charges 263.12 263.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 6 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412706 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 7 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412707 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L8 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412708 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 9 MMOD 2.7 MM SELF TAP LOCK STERILE SUP-72412709 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 10 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412710 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 11 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412711 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 12 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412712 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 13 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412713 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L14 MM OD 2.7 MM L 14MM SELF TAP LOCK STERILE SUP-72412714 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 15 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412715 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 16 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412716 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2.7MM 17MM LOCKING SELF TAPPING VARIBALE ANGLE CORTICAL STAINLESS STEEL T8 STARDRIVE RECESS SELF RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72412717 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 18 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412718 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 19 MM OD 2.7MM SELF TAP LOCK STERILE SUP-72412719 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 20 MM OD 2.7MM SELF TAP LOCK STERILE SUP-72412720 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 22 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412722 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 24 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412724 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 26 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412726 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 28 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412728 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 30 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412730 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 32 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412732 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 34 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412734 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L36 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412736 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 38 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412738 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 40 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412740 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2.7MM 42MM LOCKING SELF-TAPPING VARIABLE ANGLE CORTICAL STAINLESS STEEL T8 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72412742 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 44MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412744 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L46 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412746 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 48 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412748 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 50 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412750 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 55bMM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412755 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 60 MM OD 2.7 MM SELF TAP LOCK STERILE SUP-72412760 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2.7MM 65MM LOCKING SELF TAPPING VARIABLE ANGLE CORTICAL STAINLESS STEEL T8 STARDRIVE RECESS SELF_RETAINING COUNTERSINK F/MINI PLATING SUP-72412765 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2.7MM 70MM LOCKING SELF TAPPING VARIABLE ANGLE CORTICAL STAINLESS STEEL T8 STARDRIVE RECESS SELF RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72412770 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2.7MM 75MM LOCKING SELF-TAPPING VARIABLE ANGLE CORTICAL STAINLESS STEEL T8 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72412775 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 2.7MM 80MM LOCKING SELF-TAPPING VARIABLE ANGLE CORTICAL STAINLESS STEEL T8 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72412780 CDM 0270 RC outpatient 228.96 228.96 228.96 74 169.43 percent of total billed charges 228.96 93 185.46 percent of total billed charges 228.96 228.96 other OPPS APC 228.96 228.96 other OPPS APC 228.96 27.63 63.26 percent of total billed charges 228.96 228.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 10 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413510 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 11 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413511 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 12 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413512 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 13 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413513 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 14 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413514 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 15 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413515 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 16 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413516 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 17 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413517 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 18 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413518 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 3.5MM 19MM LOCKING SELF TAPPING VARIABLE ANGLE CORTICAL STAINLESS STEEL T8 STARDRIVE RECESS SELF RETAINING COUNTERSINK F/MINI PLATING SYSTEM STERILE SUP-72413519 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 20 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413520 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 22 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413522 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 24 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413524 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 26 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413526 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 28 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413528 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 30 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413530 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 32 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413532 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 34 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413534 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 36 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413536 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 38 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413538 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 40 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413540 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 42 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413542 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 44 MM OD 3.5 MM LOCKING SCREW SELF TAP STERILE SUP-72413544 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 46 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413546 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 48 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413548 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 50 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413550 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 5 5MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413555 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 60 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413560 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L65 MM OD3.5 MM SELF TAP LOCK STERILE SUP-72413565 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 70 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413570 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 75 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413575 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 80 MM OD 3.5 MM SELF TAP LOCK STERILE SUP-72413580 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SPHERX II PREBENT 35MM SUP-7242035 CDM 270010020 LOCAL 0270 RC outpatient 1549.6 1549.6 1549.6 74 1146.7 percent of total billed charges 1549.6 93 1255.18 percent of total billed charges 1549.6 1549.6 other OPPS APC 1549.6 1549.6 other OPPS APC 1549.6 27.63 428.15 percent of total billed charges 1549.6 1549.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SPHERX II PREBENT 40MM SUP-7242040 CDM 270010020 LOCAL 0270 RC outpatient 1549.6 1549.6 1549.6 74 1146.7 percent of total billed charges 1549.6 93 1255.18 percent of total billed charges 1549.6 1549.6 other OPPS APC 1549.6 1549.6 other OPPS APC 1549.6 27.63 428.15 percent of total billed charges 1549.6 1549.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 FULL THREAD L 14MM OD 4 MM SELF RETAINING TAP EVOS MINI OSTEOPENIA SUP-72424014 CDM 0270 RC outpatient 167.44 167.44 167.44 74 123.91 percent of total billed charges 167.44 93 135.63 percent of total billed charges 167.44 167.44 other OPPS APC 167.44 167.44 other OPPS APC 167.44 27.63 46.26 percent of total billed charges 167.44 167.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 FULL THREAD L 28 MM OD 4 MM SELF RETAINING TAP EVOS MINI OSTEOPENIA SUP-72424028 CDM 0270 RC outpatient 167.44 167.44 167.44 74 123.91 percent of total billed charges 167.44 93 135.63 percent of total billed charges 167.44 167.44 other OPPS APC 167.44 167.44 other OPPS APC 167.44 27.63 46.26 percent of total billed charges 167.44 167.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 4MM 32MM FULLY THREADED CORTICAL STAINLESS STEEL T8 STARDRIVE RECESS SELF RETAINING COUNTERSINK F/OSTEOPENIA SUP-72424032 CDM 0270 RC outpatient 167.44 167.44 167.44 74 123.91 percent of total billed charges 167.44 93 135.63 percent of total billed charges 167.44 167.44 other OPPS APC 167.44 167.44 other OPPS APC 167.44 27.63 46.26 percent of total billed charges 167.44 167.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 4MM 36MM FULLY THREADED CORTICAL STAINLESS STEEL T8 STARDRIVE RECESS SELF RETAINING COUNTERSINK F/OSTEOPENIA SUP-72424036 CDM 0270 RC outpatient 167.44 167.44 167.44 74 123.91 percent of total billed charges 167.44 93 135.63 percent of total billed charges 167.44 167.44 other OPPS APC 167.44 167.44 other OPPS APC 167.44 27.63 46.26 percent of total billed charges 167.44 167.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 4MM 40MM FULLY THREADED CORTICAL STAINLESS STEEL T8 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/OSTEOPENIA SUP-72424040 CDM 0270 RC outpatient 167.44 167.44 167.44 74 123.91 percent of total billed charges 167.44 93 135.63 percent of total billed charges 167.44 167.44 other OPPS APC 167.44 167.44 other OPPS APC 167.44 27.63 46.26 percent of total billed charges 167.44 167.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 4MM 50MM FULLY THREADED CORTICAL STAINLESS STEEL T8 STARDRIVE RECESS SELF RETAINING COUNTERSINK F/OSTEOPENIA SUP-72424050 CDM 0270 RC outpatient 167.44 167.44 167.44 74 123.91 percent of total billed charges 167.44 93 135.63 percent of total billed charges 167.44 167.44 other OPPS APC 167.44 167.44 other OPPS APC 167.44 27.63 46.26 percent of total billed charges 167.44 167.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L 10 MM OD 4.7MM STERILE OSTEOPENIA SUP-72424710 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L 12MM OD 4.7MM STERILE OSTEOPENIA SUP-72424712 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L 14MM OD 4.7MM STERILE OSTEOPENIA SUP-72424714 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L 16 MM OD 4.7MM STERILE OSTEOPENIA SUP-72424716 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L 18MM OD 4.7MM STERILE OSTEOPENIA SUP-72424718 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 4.7MM 20 MM FULLY THREADED CORTICAL STAINLESS STEEL T8 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/OSTOPENIA SUP-72424720 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 4.7MM 22MM FULLY THREADED CORTICAL STAINLESS STEEL T8 STARDRIVE RECESS SELF RETAINING COUNTERSINK F/OSTEOPENIA SUP-72424722 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L 24 MM OD 4.7MM STERILE OSTEOPENIA SUP-72424724 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L 26MM OD 4.7MM STERILE OSTEOPENIA SUP-72424726 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L 28 MM OD 4.7 MM STERILE OSTEOPENIA SUP-72424728 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L 30 MM OD 4.7MM STERILE OSTEOPENIA SUP-72424730 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L 32 MM OD 4.7 MM STERILE OSTEOPENIA SUP-72424732 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L 34 MM OD 4.7 MM STERILE OSTEOPENIA SUP-72424734 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L 36 MM OD 4.7 MM STERILE OSTEOPENIA SUP-72424736 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L 38 MM OD 4.7MM STERILE OSTEOPENIA SUP-72424738 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L 40 MM OD 4.7 MM STERILE OSTEOPENIA SUP-72424740 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L 42 MM OD 4.7MM STERILE OSTEOPENIA SUP-72424742 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L 44 MM OD 4.7MM STERILE OSTEOPENIA SUP-72424744 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L46 MM OD4.7 MM STERILE OSTEOPENIA SUP-72424746 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L 50 MM OD 4.7 MM STERILE OSTEOPENIA SUP-72424750 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L 55 MM OD 4.7 MM STERILE OSTEOPENIA SUP-72424755 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L 65 MM OD 4.7 MM STERILE OSTEOPENIA SUP-72424765 CDM 0270 RC outpatient 186.16 186.16 186.16 74 137.76 percent of total billed charges 186.16 93 150.79 percent of total billed charges 186.16 186.16 other OPPS APC 186.16 186.16 other OPPS APC 186.16 27.63 51.44 percent of total billed charges 186.16 186.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L 70 MM OD 4.7MM STERILE OSTEOPENIA SUP-72424770 CDM 0270 RC outpatient 186.16 186.16 186.16 74 137.76 percent of total billed charges 186.16 93 150.79 percent of total billed charges 186.16 186.16 other OPPS APC 186.16 186.16 other OPPS APC 186.16 27.63 51.44 percent of total billed charges 186.16 186.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS FULL THREAD L 75 MM OD 4.7 MM STERILE OSTEOPENIA SUP-72424775 CDM 0270 RC outpatient 186.16 186.16 186.16 74 137.76 percent of total billed charges 186.16 93 150.79 percent of total billed charges 186.16 186.16 other OPPS APC 186.16 186.16 other OPPS APC 186.16 27.63 51.44 percent of total billed charges 186.16 186.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD L 55 MM OD 4 MM SELF-RETAINING EVOS MINI OSTEOPENIA SUP-72434055 CDM 0270 RC outpatient 198.64 198.64 198.64 74 146.99 percent of total billed charges 198.64 93 160.9 percent of total billed charges 198.64 198.64 other OPPS APC 198.64 198.64 other OPPS APC 198.64 27.63 54.88 percent of total billed charges 198.64 198.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS PARTIAL THREAD L 38 MM OD 4.7 MM STERILE OSTEOPENIA SUP-72434738 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS PARTIAL THREAD L44 MM OD 4.7 MM STERILE OSTEOPENIA SUP-72434744 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS PARTIAL THREAD L 46 MM OD 4.7 MM STERILE OSTEOPENIA SUP-72434746 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS PARTIAL THREAD L 60 MM OD 4.7 MM STERILE OSTEOPENIA SUP-72434760 CDM 0270 RC outpatient 160.16 160.16 160.16 74 118.52 percent of total billed charges 160.16 93 129.73 percent of total billed charges 160.16 160.16 other OPPS APC 160.16 160.16 other OPPS APC 160.16 27.63 44.25 percent of total billed charges 160.16 160.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PARTIAL THREAD L 70 MM OD 4.7 MM STERILE OSTEOPENIA SUP-72434770 CDM 0270 RC outpatient 186.16 186.16 186.16 74 137.76 percent of total billed charges 186.16 93 150.79 percent of total billed charges 186.16 186.16 other OPPS APC 186.16 186.16 other OPPS APC 186.16 27.63 51.44 percent of total billed charges 186.16 186.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS PARTIAL THREAD L 75MM OD 4.7 MM STERILE OSTEOPENIA SUP-72434775 CDM 0270 RC outpatient 186.16 186.16 186.16 74 137.76 percent of total billed charges 186.16 93 150.79 percent of total billed charges 186.16 186.16 other OPPS APC 186.16 186.16 other OPPS APC 186.16 27.63 51.44 percent of total billed charges 186.16 186.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 4.7MM 80MM PARTIALLY THREADED CORTICAL STAINLESS STEEL T8 STARDRIVE RECESS SELF-RETAINING COUNTERSINK F/OSTEOPENIA STERILE SUP-72434780 CDM 0270 RC outpatient 184.6 184.6 184.6 74 136.6 percent of total billed charges 184.6 93 149.53 percent of total billed charges 184.6 184.6 other OPPS APC 184.6 184.6 other OPPS APC 184.6 27.63 51 percent of total billed charges 184.6 184.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 8 MM SPACE L 32 MM X W 8 MM X H 3.2 MM 4 HOLE LOCK RECONSTRUCTION STERILE 2.7MM SCREW SUP-72440104 CDM 0270 RC outpatient 1227.2 1227.2 1227.2 74 908.13 percent of total billed charges 1227.2 93 994.03 percent of total billed charges 1227.2 1227.2 other OPPS APC 1227.2 1227.2 other OPPS APC 1227.2 27.63 339.08 percent of total billed charges 1227.2 1227.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 7.5MM SPACE L46 MM X W6 M X H 3.2MM HOLE LOCK COMPRESSION STERILE 2.7MM SCREW SUP-72440206 CDM 0270 RC outpatient 764.66 764.66 764.66 74 565.85 percent of total billed charges 764.66 93 619.37 percent of total billed charges 764.66 764.66 other OPPS APC 764.66 764.66 other OPPS APC 764.66 27.63 211.28 percent of total billed charges 764.66 764.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 7.5MM SPACE L61 MM X W8 M X H 3.2MM HOLE LOCK COMPRESSION STERILE 2.7MM SCREW SUP-72440208 CDM 0270 RC outpatient 764.66 764.66 764.66 74 565.85 percent of total billed charges 764.66 93 619.37 percent of total billed charges 764.66 764.66 other OPPS APC 764.66 764.66 other OPPS APC 764.66 27.63 211.28 percent of total billed charges 764.66 764.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 7.5 MM SPACE L76 MM X W 8 MM X H 3.2 MM 10 HOLE LOCK COMPRESSION STERILE 2.7 MM SCREW SUP-72440210 CDM 0270 RC outpatient 764.66 764.66 764.66 74 565.85 percent of total billed charges 764.66 93 619.37 percent of total billed charges 764.66 764.66 other OPPS APC 764.66 764.66 other OPPS APC 764.66 27.63 211.28 percent of total billed charges 764.66 764.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLAT BONE EVOS STAINLESS STEEL 12 MM SPACE 1/3 TUBULAR L 22MM X W9.5MM X H 1.5MM 2-HOLE LOCK STERILE 3.5MM SCREW SUP-72440502 CDM 0270 RC outpatient 459.68 459.68 459.68 74 340.16 percent of total billed charges 459.68 93 372.34 percent of total billed charges 459.68 459.68 other OPPS APC 459.68 459.68 other OPPS APC 459.68 27.63 127.01 percent of total billed charges 459.68 459.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 46MM F/3.5MM SCREW HOLE X4 LOCKING 1/3 TUBULAR STAINLESS STEEL SUP-72440504 CDM 0270 RC outpatient 532.17 532.17 532.17 74 393.81 percent of total billed charges 532.17 93 431.06 percent of total billed charges 532.17 532.17 other OPPS APC 532.17 532.17 other OPPS APC 532.17 27.63 147.04 percent of total billed charges 532.17 532.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 12MM SPACE 1/3 TUBULAR L 70MM X W 9.5MM X H 1.5MM 6 HOLE LOCK STERILE 3.5MM SCREW SUP-72440506 CDM 0270 RC outpatient 532.17 532.17 532.17 74 393.81 percent of total billed charges 532.17 93 431.06 percent of total billed charges 532.17 532.17 other OPPS APC 532.17 532.17 other OPPS APC 532.17 27.63 147.04 percent of total billed charges 532.17 532.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 12 MM SPACE 1/3 TUBULAR L 82 MM X W 9.5MM X H 1.5MM 7 HOLE LOCK STERILE 3.5 MM SCREW SUP-72440507 CDM 0270 RC outpatient 532.17 532.17 532.17 74 393.81 percent of total billed charges 532.17 93 431.06 percent of total billed charges 532.17 532.17 other OPPS APC 532.17 532.17 other OPPS APC 532.17 27.63 147.04 percent of total billed charges 532.17 532.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 12 MM SPACE 1/3 TUBULAR L 94 MM X W 9.5 MM X H 1.5 MM 8 HOLE LOCK STERILE 3.5 MM SCREW SUP-72440508 CDM 0270 RC outpatient 532.17 532.17 532.17 74 393.81 percent of total billed charges 532.17 93 431.06 percent of total billed charges 532.17 532.17 other OPPS APC 532.17 532.17 other OPPS APC 532.17 27.63 147.04 percent of total billed charges 532.17 532.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 12MM SPACE 1/3 TUBULAR L 118MM X W 9.5MM X H 1.5MM 10 HOLE LOCK STERILE 3.5MM SCREW SUP-72440510 CDM 0270 RC outpatient 532.17 532.17 532.17 74 393.81 percent of total billed charges 532.17 93 431.06 percent of total billed charges 532.17 532.17 other OPPS APC 532.17 532.17 other OPPS APC 532.17 27.63 147.04 percent of total billed charges 532.17 532.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11.5 MM SPACE L 81 MM X W 10.7 MM X H 3.4MM 7 HOLE LOCK COMPRESSION STERILE 3.5MM SCREW SUP-72440707 CDM 0270 RC outpatient 861.12 861.12 861.12 74 637.23 percent of total billed charges 861.12 93 697.51 percent of total billed charges 861.12 861.12 other OPPS APC 861.12 861.12 other OPPS APC 861.12 27.63 237.93 percent of total billed charges 861.12 861.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11.5MM SPACE L93 MM X W 10.7 MM X H 3.4 MM 8 HOLE LOCK COMPRESSION STERILE 3.5 MM SCREW SUP-72440708 CDM 0270 RC outpatient 964.08 964.08 964.08 74 713.42 percent of total billed charges 964.08 93 780.9 percent of total billed charges 964.08 964.08 other OPPS APC 964.08 964.08 other OPPS APC 964.08 27.63 266.38 percent of total billed charges 964.08 964.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11.5 MM SPACE L 116 MM X W 10.7 MM X H 3.4MM 10 HOLE LOCK COMPRESSION STERILE 3.5 MM SCREW SUP-72440710 CDM 0270 RC outpatient 1019.2 1019.2 1019.2 74 754.21 percent of total billed charges 1019.2 93 825.55 percent of total billed charges 1019.2 1019.2 other OPPS APC 1019.2 1019.2 other OPPS APC 1019.2 27.63 281.6 percent of total billed charges 1019.2 1019.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11.5 MM SPACE L 139 MM X W 10.7 MM X H 3.4 MM 12 HOLE LOCK COMPRESSION STERILE 3.5 MM SCREW SUP-72440712 CDM 0270 RC outpatient 1133.6 1133.6 1133.6 74 838.86 percent of total billed charges 1133.6 93 918.22 percent of total billed charges 1133.6 1133.6 other OPPS APC 1133.6 1133.6 other OPPS APC 1133.6 27.63 313.21 percent of total billed charges 1133.6 1133.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL 11.5 MM SPACE L 162 MM X W 10.7 MM X H 3.4 MM 14 HOLE LOCK COMPRESSION STERILE 3.5 MM SCREW SUP-72440714 CDM 0270 RC outpatient 1747.2 1747.2 1747.2 74 1292.93 percent of total billed charges 1747.2 93 1415.23 percent of total billed charges 1747.2 1747.2 other OPPS APC 1747.2 1747.2 other OPPS APC 1747.2 27.63 482.75 percent of total billed charges 1747.2 1747.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 12 MM SPACE 1/3 TUBULAR L70MM X W 9 MM H 1.1 MM 6 HOLE STERILE 3.5 MM SCREW SUP-72440806 CDM 0270 RC outpatient 224.64 224.64 224.64 74 166.23 percent of total billed charges 224.64 93 181.96 percent of total billed charges 224.64 224.64 other OPPS APC 224.64 224.64 other OPPS APC 224.64 27.63 62.07 percent of total billed charges 224.64 224.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 82MM 7-HOLE 1/3 TUBULAR STAINLESS STEEL F/3.5MM SCREW STERILE SUP-72440807 CDM 0270 RC outpatient 211.12 211.12 211.12 74 156.23 percent of total billed charges 211.12 93 171.01 percent of total billed charges 211.12 211.12 other OPPS APC 211.12 211.12 other OPPS APC 211.12 27.63 58.33 percent of total billed charges 211.12 211.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 12 MM SPACE 1/3 TUBULAR L 94 MM X H 1.1 MM 8 HOLE STERILE 3.5 MM SCREW SUP-72440808 CDM 0270 RC outpatient 230.88 230.88 230.88 74 170.85 percent of total billed charges 230.88 93 187.01 percent of total billed charges 230.88 230.88 other OPPS APC 230.88 230.88 other OPPS APC 230.88 27.63 63.79 percent of total billed charges 230.88 230.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 MM SPACE L 110 MM X W 10.2 MM X H 2.8MM 10 HOLE RECONSTRUCTION STERILE 3.5MM SCREW SUP-72440910 CDM 0270 RC outpatient 1159.6 1159.6 1159.6 74 858.1 percent of total billed charges 1159.6 93 939.28 percent of total billed charges 1159.6 1159.6 other OPPS APC 1159.6 1159.6 other OPPS APC 1159.6 27.63 320.4 percent of total billed charges 1159.6 1159.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 12.5 MM SPACE L 77 MM X W 10.7MM X H 3.4MM 6 HOLE COMPRESSION STERILE 3.5MM SCREW SUP-72441006 CDM 0270 RC outpatient 421.2 421.2 421.2 74 311.69 percent of total billed charges 421.2 93 341.17 percent of total billed charges 421.2 421.2 other OPPS APC 421.2 421.2 other OPPS APC 421.2 27.63 116.38 percent of total billed charges 421.2 421.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 12.5 MM SPACE L 90 MM X W 10.7MM X H 3.4MM 7 HOLE COMPRESSION STERILE 3.5MM SCREW SUP-72441007 CDM 0270 RC outpatient 684.32 684.32 684.32 74 506.4 percent of total billed charges 684.32 93 554.3 percent of total billed charges 684.32 684.32 other OPPS APC 684.32 684.32 other OPPS APC 684.32 27.63 189.08 percent of total billed charges 684.32 684.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 12.5MM SPACE L 102 MM X W 10.7 MM X H 3.4MM 8 HOLE COMPRESSION STERILE 3.5 MM SCREW SUP-72441008 CDM 0270 RC outpatient 459.68 459.68 459.68 74 340.16 percent of total billed charges 459.68 93 372.34 percent of total billed charges 459.68 459.68 other OPPS APC 459.68 459.68 other OPPS APC 459.68 27.63 127.01 percent of total billed charges 459.68 459.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 12.5 MM SPACE L 127 MM X W 10.7 MM X H 3.4 MM 10 HOLE COMPRESSION STERILE 3.5 MM SCREW SUP-72441010 CDM 0270 RC outpatient 478.4 478.4 478.4 74 354.02 percent of total billed charges 478.4 93 387.5 percent of total billed charges 478.4 478.4 other OPPS APC 478.4 478.4 other OPPS APC 478.4 27.63 132.18 percent of total billed charges 478.4 478.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 12.5 MM SPACE L 177 MM X W 10.7 MM X H 3.4MM 14 HOLE COMPRESSION STERILE 3.5MM SCREW SUP-72441014 CDM 0270 RC outpatient 1008.8 1008.8 1008.8 74 746.51 percent of total billed charges 1008.8 93 817.13 percent of total billed charges 1008.8 1008.8 other OPPS APC 1008.8 1008.8 other OPPS APC 1008.8 27.63 278.73 percent of total billed charges 1008.8 1008.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 36MM 2/6-HOLE T-SHAPED STAINLESS STEEL F/2MM SCREW NON-STERILE SUP-72442050N CDM 0270 RC outpatient 1279.2 1279.2 1279.2 74 946.61 percent of total billed charges 1279.2 93 1036.15 percent of total billed charges 1279.2 1279.2 other OPPS APC 1279.2 1279.2 other OPPS APC 1279.2 27.63 353.44 percent of total billed charges 1279.2 1279.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 46MM F/2MM SCREW HOLEX2/8 NON-STERILE T-SHAPED STAINLESS STEEL SUP-72442052N CDM 0270 RC outpatient 1279.2 1279.2 1279.2 74 946.61 percent of total billed charges 1279.2 93 1036.15 percent of total billed charges 1279.2 1279.2 other OPPS APC 1279.2 1279.2 other OPPS APC 1279.2 27.63 353.44 percent of total billed charges 1279.2 1279.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 31MM F/2MM SCREW HOLEX3/5 NON-STERILE T-SHAPED STAINLESS STEEL SUP-72442054N CDM 0270 RC outpatient 1279.2 1279.2 1279.2 74 946.61 percent of total billed charges 1279.2 93 1036.15 percent of total billed charges 1279.2 1279.2 other OPPS APC 1279.2 1279.2 other OPPS APC 1279.2 27.63 353.44 percent of total billed charges 1279.2 1279.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 51MM F/2MM SCREW HOLEX3/9 NON-STERILE T-SHAPED STAINLESS STEEL SUP-72442056N CDM 0270 RC outpatient 1279.2 1279.2 1279.2 74 946.61 percent of total billed charges 1279.2 93 1036.15 percent of total billed charges 1279.2 1279.2 other OPPS APC 1279.2 1279.2 other OPPS APC 1279.2 27.63 353.44 percent of total billed charges 1279.2 1279.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 21MM HOLEX4 STAINLESS STEEL FLEXIBLE F/2MM SCREW NON-STERILE SUP-72442058N CDM 0270 RC outpatient 1331.2 1331.2 1331.2 74 985.09 percent of total billed charges 1331.2 93 1078.27 percent of total billed charges 1331.2 1331.2 other OPPS APC 1331.2 1331.2 other OPPS APC 1331.2 27.63 367.81 percent of total billed charges 1331.2 1331.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 6 HOLE FLEX 2 MM SCREW SUP-72442060 CDM 0270 RC outpatient 1331.2 1331.2 1331.2 74 985.09 percent of total billed charges 1331.2 93 1078.27 percent of total billed charges 1331.2 1331.2 other OPPS APC 1331.2 1331.2 other OPPS APC 1331.2 27.63 367.81 percent of total billed charges 1331.2 1331.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 8 HOLE FLEX 2 MM SCREW SUP-72442062 CDM 0270 RC outpatient 1331.2 1331.2 1331.2 74 985.09 percent of total billed charges 1331.2 93 1078.27 percent of total billed charges 1331.2 1331.2 other OPPS APC 1331.2 1331.2 other OPPS APC 1331.2 27.63 367.81 percent of total billed charges 1331.2 1331.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 10 HOLE FLEX 2 MM SCREW SUP-72442064 CDM 0270 RC outpatient 1331.2 1331.2 1331.2 74 985.09 percent of total billed charges 1331.2 93 1078.27 percent of total billed charges 1331.2 1331.2 other OPPS APC 1331.2 1331.2 other OPPS APC 1331.2 27.63 367.81 percent of total billed charges 1331.2 1331.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 20 HOLE FLEX 2 MM SCREW SUP-72442066 CDM 0270 RC outpatient 1331.2 1331.2 1331.2 74 985.09 percent of total billed charges 1331.2 93 1078.27 percent of total billed charges 1331.2 1331.2 other OPPS APC 1331.2 1331.2 other OPPS APC 1331.2 27.63 367.81 percent of total billed charges 1331.2 1331.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 21MM F/2MM SCREW HOLE X4 STRENGTH STAINLESS STEEL SUP-72442068 CDM 0270 RC outpatient 1331.2 1331.2 1331.2 74 985.09 percent of total billed charges 1331.2 93 1078.27 percent of total billed charges 1331.2 1331.2 other OPPS APC 1331.2 1331.2 other OPPS APC 1331.2 27.63 367.81 percent of total billed charges 1331.2 1331.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 6 HOLE STRENGTH 2 MM SCREW SUP-72442070 CDM 0270 RC outpatient 1331.2 1331.2 1331.2 74 985.09 percent of total billed charges 1331.2 93 1078.27 percent of total billed charges 1331.2 1331.2 other OPPS APC 1331.2 1331.2 other OPPS APC 1331.2 27.63 367.81 percent of total billed charges 1331.2 1331.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 41MM HOLEX8 STAINLESS STEEL STRENGTH F/2MM SCREW NON-STERILE SUP-72442072N CDM 0270 RC outpatient 1331.2 1331.2 1331.2 74 985.09 percent of total billed charges 1331.2 93 1078.27 percent of total billed charges 1331.2 1331.2 other OPPS APC 1331.2 1331.2 other OPPS APC 1331.2 27.63 367.81 percent of total billed charges 1331.2 1331.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 28MM F/2MM SCREW HOLEX5 NON-STERILE STRAIGHT TINE STAINLESS STEEL SUP-72442078N CDM 0270 RC outpatient 1580.8 1580.8 1580.8 74 1169.79 percent of total billed charges 1580.8 93 1280.45 percent of total billed charges 1580.8 1580.8 other OPPS APC 1580.8 1580.8 other OPPS APC 1580.8 27.63 436.78 percent of total billed charges 1580.8 1580.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 38MM F/2MM SCREW HOLEX7 NON-STERILE STRAIGHT TINE STAINLESS STEEL SUP-72442080N CDM 0270 RC outpatient 1580.8 1580.8 1580.8 74 1169.79 percent of total billed charges 1580.8 93 1280.45 percent of total billed charges 1580.8 1580.8 other OPPS APC 1580.8 1580.8 other OPPS APC 1580.8 27.63 436.78 percent of total billed charges 1580.8 1580.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC EVOS 3.5 MM SCREW SUP-72442135 CDM 0270 RC outpatient 87.1 87.1 87.1 74 64.45 percent of total billed charges 87.1 93 70.55 percent of total billed charges 87.1 87.1 other OPPS APC 87.1 87.1 other OPPS APC 87.1 27.63 24.07 percent of total billed charges 87.1 87.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 43MM F/2.4MM SCREW HOLEX2/6 NON-STERILE T-SHAPED STAINLESS STEEL SUP-72442450N CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS T 2 HOLE HEAD 8 HOLE SHAFT 2.4MM SCREW SUP-72442452 CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 37MM F/2.4MM SCREW HOLEX3/5 NON-STERILE T-SHAPED STAINLESS STEEL SUP-72442454N CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 61MM F/2.4MM SCREW HOLEX3/9 NON-STERILE T-SHAPED STAINLESS STEEL SUP-72442456N CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 25MM HOLEX4 STAINLESS STEEL FLEXIBLE F/2.4MM SCREW NON-STERILE SUP-72442458N CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 37MM HOLEX6 STAINLESS STEEL FLEXIBLE F/2.4MM SCREW NON-STERILE SUP-72442460N CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 10 HOLE FLEX 2.4MM SCREW SUP-72442464 CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 20 HOLE FLEX 2.4 MM SCREW SUP-72442466 CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 25MM F/2.4MM SCREW HOLEX4 NON-STERILE STRENGTH STAINLESS STEEL SUP-72442468N CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 6 HOLE STRENGTH 2.4 MM SCREW SUP-72442470 CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 8 HOLE STRENGTH 2.4 MM SCREW SUP-72442472 CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 10 HOLE STRENGTH 2.4MM SCREW SUP-72442474 CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 20 HOLE STRENGTH 2.4 MM SCREW SUP-72442476 CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 34MM HOLEX5 STRAIGHT TINE STAINLESS STEEL F/2.4MM SCREW STERILE SUP-72442478 CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 34MM F/2.4MM SCREW HOLEX5 NON-STERILE STRAIGHT TINE STAINLESS STEEL SUP-72442478N CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STRAIGHT 7 HOLE TINE 2.4 MM SCREW SUP-72442480 CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 47MM F/2.4MM SCREW HOLEX5 STERILE Y-SHAPED STAINLESS STEEL SUP-72442482 CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 47MM HOLEX5/5 Y-SHAPED STAINLESS STEEL F/2.4MM SCREW NON-STERILE SUP-72442482N CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 59MM F/2.4MM SCREW HOLEX7 NON-STERILE Y-SHAPED STAINLESS STEEL SUP-72442484N CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS Y 5 HOLE SHAFT TINE 2.4 MM SCREW SUP-72442486 CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS Y7 HOLE TINE STERILE 2.4MM SCREW SUP-72442488 CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS TRIANGLE 6 HOLE 2.4 MM SCREW SUP-72442490 CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS TRIANGLE 8 HOLE 2.4MM SCREW SUP-72442492 CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 18MM X 24MM F/2.4MM SCREW NON-STERILE TRAPEZOID STAINLESS STEEL SUP-72442494N CDM 0270 RC outpatient 1418.82 1418.82 1418.82 74 1049.93 percent of total billed charges 1418.82 93 1149.24 percent of total billed charges 1418.82 1418.82 other OPPS APC 1418.82 1418.82 other OPPS APC 1418.82 27.63 392.02 percent of total billed charges 1418.82 1418.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 42MM 3/5-HOLE T-SHAPED STAINLESS STEEL F/2.7MM SCREW NON-STERILE SUP-72442720N CDM 0270 RC outpatient 1794 1794 1794 74 1327.56 percent of total billed charges 1794 93 1453.14 percent of total billed charges 1794 1794 other OPPS APC 1794 1794 other OPPS APC 1794 27.63 495.68 percent of total billed charges 1794 1794 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS T 3 HOLE HEAD 9 HOLE SHAFT 2.7 MM SCREW SUP-72442722 CDM 0270 RC outpatient 1794 1794 1794 74 1327.56 percent of total billed charges 1794 93 1453.14 percent of total billed charges 1794 1794 other OPPS APC 1794 1794 other OPPS APC 1794 27.63 495.68 percent of total billed charges 1794 1794 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 28MM HOLEX4 STAINLESS STEEL FLEXIBLE F/2.7MM SCREW NON-STERILE SUP-72442724N CDM 0270 RC outpatient 1835.6 1835.6 1835.6 74 1358.34 percent of total billed charges 1835.6 93 1486.84 percent of total billed charges 1835.6 1835.6 other OPPS APC 1835.6 1835.6 other OPPS APC 1835.6 27.63 507.18 percent of total billed charges 1835.6 1835.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 42MM HOLEX6 STAINLESS STEEL FLEXIBLE F/2.7MM SCREW NON-STERILE SUP-72442726N CDM 0270 RC outpatient 1835.6 1835.6 1835.6 74 1358.34 percent of total billed charges 1835.6 93 1486.84 percent of total billed charges 1835.6 1835.6 other OPPS APC 1835.6 1835.6 other OPPS APC 1835.6 27.63 507.18 percent of total billed charges 1835.6 1835.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 56MM HOLEX8 STAINLESS STEEL FLEXIBLE F/2.7MM SCREW NON-STERILE SUP-72442728N CDM 0270 RC outpatient 1835.6 1835.6 1835.6 74 1358.34 percent of total billed charges 1835.6 93 1486.84 percent of total billed charges 1835.6 1835.6 other OPPS APC 1835.6 1835.6 other OPPS APC 1835.6 27.63 507.18 percent of total billed charges 1835.6 1835.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 10 HOLE FLEX 2.7 MM SCREW SUP-72442760 CDM 0270 RC outpatient 1835.6 1835.6 1835.6 74 1358.34 percent of total billed charges 1835.6 93 1486.84 percent of total billed charges 1835.6 1835.6 other OPPS APC 1835.6 1835.6 other OPPS APC 1835.6 27.63 507.18 percent of total billed charges 1835.6 1835.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 20 HOLE FLEX 2.7MM SCREW SUP-72442762 CDM 0270 RC outpatient 1835.6 1835.6 1835.6 74 1358.34 percent of total billed charges 1835.6 93 1486.84 percent of total billed charges 1835.6 1835.6 other OPPS APC 1835.6 1835.6 other OPPS APC 1835.6 27.63 507.18 percent of total billed charges 1835.6 1835.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 28MM F/2.7MM SCREW HOLEX4 NON-STERILE STRENGTH STAINLESS STEEL SUP-72442764N CDM 0270 RC outpatient 1835.6 1835.6 1835.6 74 1358.34 percent of total billed charges 1835.6 93 1486.84 percent of total billed charges 1835.6 1835.6 other OPPS APC 1835.6 1835.6 other OPPS APC 1835.6 27.63 507.18 percent of total billed charges 1835.6 1835.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 42MM HOLE X6 STAINLESS STEEL STRENGTH F/2.7 SCREW STERILE SUP-72442766 CDM 0270 RC outpatient 1835.6 1835.6 1835.6 74 1358.34 percent of total billed charges 1835.6 93 1486.84 percent of total billed charges 1835.6 1835.6 other OPPS APC 1835.6 1835.6 other OPPS APC 1835.6 27.63 507.18 percent of total billed charges 1835.6 1835.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 8 HOLE STRENGTH 2.7MM SCREW SUP-72442768 CDM 0270 RC outpatient 1835.6 1835.6 1835.6 74 1358.34 percent of total billed charges 1835.6 93 1486.84 percent of total billed charges 1835.6 1835.6 other OPPS APC 1835.6 1835.6 other OPPS APC 1835.6 27.63 507.18 percent of total billed charges 1835.6 1835.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 10 HOLE STRENGTH 2.7 MM SCREW SUP-72442770 CDM 0270 RC outpatient 1835.6 1835.6 1835.6 74 1358.34 percent of total billed charges 1835.6 93 1486.84 percent of total billed charges 1835.6 1835.6 other OPPS APC 1835.6 1835.6 other OPPS APC 1835.6 27.63 507.18 percent of total billed charges 1835.6 1835.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 140MM F/2.7MM SCREW HOLEX20 NON-STERILE STRENGTH STAINLESS STEEL SUP-72442772N CDM 0270 RC outpatient 1835.6 1835.6 1835.6 74 1358.34 percent of total billed charges 1835.6 93 1486.84 percent of total billed charges 1835.6 1835.6 other OPPS APC 1835.6 1835.6 other OPPS APC 1835.6 27.63 507.18 percent of total billed charges 1835.6 1835.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 38MM F/2.7MM SCREW HOLEX5 NON-STERILE STRAIGHT TINE STAINLESS STEEL SUP-72442774N CDM 0270 RC outpatient 1929.2 1929.2 1929.2 74 1427.61 percent of total billed charges 1929.2 93 1562.65 percent of total billed charges 1929.2 1929.2 other OPPS APC 1929.2 1929.2 other OPPS APC 1929.2 27.63 533.04 percent of total billed charges 1929.2 1929.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 52MM F/2.7MM SCREW HOLEX7 NON-STERILE STRAIGHT TINE STAINLESS STEEL SUP-72442776N CDM 0270 RC outpatient 1929.2 1929.2 1929.2 74 1427.61 percent of total billed charges 1929.2 93 1562.65 percent of total billed charges 1929.2 1929.2 other OPPS APC 1929.2 1929.2 other OPPS APC 1929.2 27.63 533.04 percent of total billed charges 1929.2 1929.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS Y 5 HOLE 2.7 MM SCREW SUP-72442778 CDM 0270 RC outpatient 2022.8 2022.8 2022.8 74 1496.87 percent of total billed charges 2022.8 93 1638.47 percent of total billed charges 2022.8 2022.8 other OPPS APC 2022.8 2022.8 other OPPS APC 2022.8 27.63 558.9 percent of total billed charges 2022.8 2022.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS Y 7 HOLE 2.7 MM SCREW SUP-72442780 CDM 0270 RC outpatient 2022.8 2022.8 2022.8 74 1496.87 percent of total billed charges 2022.8 93 1638.47 percent of total billed charges 2022.8 2022.8 other OPPS APC 2022.8 2022.8 other OPPS APC 2022.8 27.63 558.9 percent of total billed charges 2022.8 2022.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 52MM F/2.7MM SCREW HOLEX5 NON-STERILE Y-TINE STAINLESS STEEL SUP-72442782N CDM 0270 RC outpatient 2298.4 2298.4 2298.4 74 1700.82 percent of total billed charges 2298.4 93 1861.7 percent of total billed charges 2298.4 2298.4 other OPPS APC 2298.4 2298.4 other OPPS APC 2298.4 27.63 635.05 percent of total billed charges 2298.4 2298.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS Y 7 HOLE SHAFT TINE STERILE LATEX FREE 2.7MM SCREW SUP-72442784 CDM 0270 RC outpatient 2298.4 2298.4 2298.4 74 1700.82 percent of total billed charges 2298.4 93 1861.7 percent of total billed charges 2298.4 2298.4 other OPPS APC 2298.4 2298.4 other OPPS APC 2298.4 27.63 635.05 percent of total billed charges 2298.4 2298.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 6 HOLE TRIANGLE 2.7MM SCREW SUP-72442786 CDM 0270 RC outpatient 2022.8 2022.8 2022.8 74 1496.87 percent of total billed charges 2022.8 93 1638.47 percent of total billed charges 2022.8 2022.8 other OPPS APC 2022.8 2022.8 other OPPS APC 2022.8 27.63 558.9 percent of total billed charges 2022.8 2022.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 8 HOLE TRIANGLE 2.7 MM SCREW SUP-72442788 CDM 0270 RC outpatient 2022.8 2022.8 2022.8 74 1496.87 percent of total billed charges 2022.8 93 1638.47 percent of total billed charges 2022.8 2022.8 other OPPS APC 2022.8 2022.8 other OPPS APC 2022.8 27.63 558.9 percent of total billed charges 2022.8 2022.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS L 70 MM LEFT PROXIMAL LATERAL 4 HOLE PARTIAL ARTICULAR 3.5 MM SCREW SUP-72453104 CDM 0270 RC outpatient 2719.6 2719.6 2719.6 74 2012.5 percent of total billed charges 2719.6 93 2202.88 percent of total billed charges 2719.6 2719.6 other OPPS APC 2719.6 2719.6 other OPPS APC 2719.6 27.63 751.43 percent of total billed charges 2719.6 2719.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 MM SPACE L &) MM X W 11.2 MM X H 2 MM W 31.9 MM X H 1.8MM TIBIAL RIGHT PROXIMAL LATERAL 4 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5MM SCREW SUP-72453204 CDM 0270 RC outpatient 2719.6 2719.6 2719.6 74 2012.5 percent of total billed charges 2719.6 93 2202.88 percent of total billed charges 2719.6 2719.6 other OPPS APC 2719.6 2719.6 other OPPS APC 2719.6 27.63 751.43 percent of total billed charges 2719.6 2719.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 91MM F/3.5MM SCREW HOLE X6 STERILE RIGHT LATERAL PROXIMAL TIBIAL STAINLESS STEEL SUP-72453206 CDM 0270 RC outpatient 2823.6 2823.6 2823.6 74 2089.46 percent of total billed charges 2823.6 93 2287.12 percent of total billed charges 2823.6 2823.6 other OPPS APC 2823.6 2823.6 other OPPS APC 2823.6 27.63 780.16 percent of total billed charges 2823.6 2823.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 103MM F/3.5MM SCREW HOLE X7 STERILE LEFT POSTEROMEDIAL PROXIMAL TIBIAL T-SHAPED STAINLESS STEEL SUP-72453307 CDM 0270 RC outpatient 2823.6 2823.6 2823.6 74 2089.46 percent of total billed charges 2823.6 93 2287.12 percent of total billed charges 2823.6 2823.6 other OPPS APC 2823.6 2823.6 other OPPS APC 2823.6 27.63 780.16 percent of total billed charges 2823.6 2823.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11MM SPACE T L71MM X H 2 MM W 32.5 MM X H 2 MM TIIAL RIGHT PROXIMAL POSTEROMEDIAL $ HOLE VARIABLE ANGLE LOCK LOW PROFILE PARTIAL ARTICULAR STERILE SUP-72453404 CDM 0270 RC outpatient 2719.6 2719.6 2719.6 74 2012.5 percent of total billed charges 2719.6 93 2202.88 percent of total billed charges 2719.6 2719.6 other OPPS APC 2719.6 2719.6 other OPPS APC 2719.6 27.63 751.43 percent of total billed charges 2719.6 2719.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11MM SPACE T L 103 MM X W 10.9 MMX H 2MM W32.5MM X H 2 MM TIBIAL RIGHT PROXIMAL POSTEROMEDIAL 7 HOLE VARIABLE ANGLE LOCK LOW PROFILE PARTIAL ARTICULAR STERILE 3.5MM SCREW SUP-72453407 CDM 0270 RC outpatient 2823.6 2823.6 2823.6 74 2089.46 percent of total billed charges 2823.6 93 2287.12 percent of total billed charges 2823.6 2823.6 other OPPS APC 2823.6 2823.6 other OPPS APC 2823.6 27.63 780.16 percent of total billed charges 2823.6 2823.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 78MM F/3.5MM SCREW HOLE X5 STERILE LEFT POSTEROMEDIAL PROXMAL TIBIAL I-SHAPED STAINLESS STEEL SUP-72453505 CDM 0270 RC outpatient 2719.6 2719.6 2719.6 74 2012.5 percent of total billed charges 2719.6 93 2202.88 percent of total billed charges 2719.6 2719.6 other OPPS APC 2719.6 2719.6 other OPPS APC 2719.6 27.63 751.43 percent of total billed charges 2719.6 2719.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11MM SPACE I L 78 MM X W 10.9MM X H 2MM W 21.8 MM X H 1.8MM TIBIAL RIGHT PROXIMAL POSTEROMEDIAL 5 HOLE VARIABLE ANGLE LOCK LOW PROFILE PARTIAL ARTICULAR STERILE 3.5 MM SCREW SUP-72453605 CDM 0270 RC outpatient 2719.6 2719.6 2719.6 74 2012.5 percent of total billed charges 2719.6 93 2202.88 percent of total billed charges 2719.6 2719.6 other OPPS APC 2719.6 2719.6 other OPPS APC 2719.6 27.63 751.43 percent of total billed charges 2719.6 2719.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 MM SPACE I L 111MM X W 10.9MM X H 2 MM W 21.8MM X H 1.8MM TIBIAL RIGHT PROXIMAL POSTEROMEDIAL 8 HOLE VARIABLE ANGLE LOCK LOW PROFILE PARTIAL ARTICULAR STERILE 3.5 MM SCREW SUP-72453608 CDM 0270 RC outpatient 2823.6 2823.6 2823.6 74 2089.46 percent of total billed charges 2823.6 93 2287.12 percent of total billed charges 2823.6 2823.6 other OPPS APC 2823.6 2823.6 other OPPS APC 2823.6 27.63 780.16 percent of total billed charges 2823.6 2823.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11MM SPACE L 64MM X W 12.2MM X H 2MM W17.4MM X H1.7MM TIBIAL RIGHT DISTAL MEDIAL 3 HOLE VARIABLE ANGLE LOCK LOW PROFILE PARTIAL ARTICULAR STERILE 2.7/3.5 MM SCREW SUP-72454003 CDM 0270 RC outpatient 2719.6 2719.6 2719.6 74 2012.5 percent of total billed charges 2719.6 93 2202.88 percent of total billed charges 2719.6 2719.6 other OPPS APC 2719.6 2719.6 other OPPS APC 2719.6 27.63 751.43 percent of total billed charges 2719.6 2719.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 MM SPACE L 130 MM X W 12.2 MM X H 2MM W 17.4 MM X H 1.7 MM TIBIAL RIGHT DISTAL MEDIAL 9 HOLE VARIABLE ANGLE LOCK LOW PROFILE PARTIAL ARTICULAR STERILE 2.7/3.5 MM SCREW SUP-72454009 CDM 0270 RC outpatient 2984.8 2984.8 2984.8 74 2208.75 percent of total billed charges 2984.8 93 2417.69 percent of total billed charges 2984.8 2984.8 other OPPS APC 2984.8 2984.8 other OPPS APC 2984.8 27.63 824.7 percent of total billed charges 2984.8 2984.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 MM SPACE L 120 MM X W 11.2 MM X H 2 MM W 34.4 MM X H 1.7MM TIBIAL LEFT DISTAL ANTEROLATERAL 9 HOLE VARIABLE ANGLE LOCK LOW PROFILE PARTIAL ARTICULAR STERILE 2.7/3.5 MM SCREW SUP-72454309 CDM 0270 RC outpatient 2823.6 2823.6 2823.6 74 2089.46 percent of total billed charges 2823.6 93 2287.12 percent of total billed charges 2823.6 2823.6 other OPPS APC 2823.6 2823.6 other OPPS APC 2823.6 27.63 780.16 percent of total billed charges 2823.6 2823.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL !! MM SPACE L 87 MM X W 11.2 MM X H 2 MM W 34.4 MM X H1.7 MM TIBIAL RIGHT DISTAL ANTEROLATERAL 6 HOLE VARIABLE ANGLE LOCK LOW PROFILE PARTIAL ARTICULAR STERILE 2.7/3.5 MM SCREW SUP-72454406 CDM 0270 RC outpatient 2719.6 2719.6 2719.6 74 2012.5 percent of total billed charges 2719.6 93 2202.88 percent of total billed charges 2719.6 2719.6 other OPPS APC 2719.6 2719.6 other OPPS APC 2719.6 27.63 751.43 percent of total billed charges 2719.6 2719.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL 11MM SPACE L 63MM X W 10.9MM X H 1.5MM W 19MM X H 1.5MM TIBIAL RIGHT DISTAL POSTERIOR 3 HOLE VARIABLE ANGLE LOCK LOW PROFILE PARTIAL ARTICULAR STERILE 3.5MM SCREW SUP-72454603 CDM 0270 RC outpatient 1742 1742 1742 74 1289.08 percent of total billed charges 1742 93 1411.02 percent of total billed charges 1742 1742 other OPPS APC 1742 1742 other OPPS APC 1742 27.63 481.31 percent of total billed charges 1742 1742 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 91MM F/3.5MM SCREW HOLE X6 LEFT LATERAL PROXIMAL TIBIAL STAINLESS STEEL SUP-72463106 CDM 0270 RC outpatient 4378.4 4378.4 4378.4 74 3240.02 percent of total billed charges 4378.4 93 3546.5 percent of total billed charges 4378.4 4378.4 other OPPS APC 4378.4 4378.4 other OPPS APC 4378.4 27.63 1209.75 percent of total billed charges 4378.4 4378.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11MM SPACE STANDARD L 200MM X W 11.5MM X H 3.6MM X W 32.3 MM X H 1.9MM TIBIAL LEFT PROXIMAL LATERAL 16 HOLE CARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5 MM SCREW SUP-72463116 CDM 0270 RC outpatient 4763.2 4763.2 4763.2 74 3524.77 percent of total billed charges 4763.2 93 3858.19 percent of total billed charges 4763.2 4763.2 other OPPS APC 4763.2 4763.2 other OPPS APC 4763.2 27.63 1316.07 percent of total billed charges 4763.2 4763.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11MM SPACE STANDARD L221 MM X W 11.5 MM X H 3.6MM W32.3 MM X H 1.9 MM TIBIAL LEFT PROXIMAL LATERAL 18 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5 MM SCREW SUP-72463118 CDM 0270 RC outpatient 4872.4 4872.4 4872.4 74 3605.58 percent of total billed charges 4872.4 93 3946.64 percent of total billed charges 4872.4 4872.4 other OPPS APC 4872.4 4872.4 other OPPS APC 4872.4 27.63 1346.24 percent of total billed charges 4872.4 4872.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11MM SPACE STANDARD L 70 MM X W 11.5 MM X H 3.6MM W32.3 MM X H 1.9 MM TIBIAL RIGHT PROXIMAL LATERAL 4 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5 MM SCREW SUP-72463204 CDM 0270 RC outpatient 4321.2 4321.2 4321.2 74 3197.69 percent of total billed charges 4321.2 93 3500.17 percent of total billed charges 4321.2 4321.2 other OPPS APC 4321.2 4321.2 other OPPS APC 4321.2 27.63 1193.95 percent of total billed charges 4321.2 4321.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 MM SPACE STANDARD L91 MM X W11.5 MM X H3.6 MM W32.3 MM X H1.9 MM TIBIAL RIGHT PROXIMAL LATERAL 6 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5 MM SCREW SUP-72463206 CDM 0270 RC outpatient 4378.4 4378.4 4378.4 74 3240.02 percent of total billed charges 4378.4 93 3546.5 percent of total billed charges 4378.4 4378.4 other OPPS APC 4378.4 4378.4 other OPPS APC 4378.4 27.63 1209.75 percent of total billed charges 4378.4 4378.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 MM SPACE STANDARD L 113 MM X W 11.5MM X H 3.6MM W32.3MM X H 1.9MM TIBIAL RIGHT PROXIMAL LATERAL8 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5MM SCREW SUP-72463208 CDM 0270 RC outpatient 4425.2 4425.2 4425.2 74 3274.65 percent of total billed charges 4425.2 93 3584.41 percent of total billed charges 4425.2 4425.2 other OPPS APC 4425.2 4425.2 other OPPS APC 4425.2 27.63 1222.68 percent of total billed charges 4425.2 4425.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11MM SPACE STANDARD L 134 MM X W 11.5MM X H 3.6MM W 32.3 MM X H 1.9MM TIBIAL RIGHT PROXIMAL LATERAL 10 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5 MM SCREW SUP-72463210 CDM 0270 RC outpatient 4477.2 4477.2 4477.2 74 3313.13 percent of total billed charges 4477.2 93 3626.53 percent of total billed charges 4477.2 4477.2 other OPPS APC 4477.2 4477.2 other OPPS APC 4477.2 27.63 1237.05 percent of total billed charges 4477.2 4477.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 MM SPACE STANDARD L 167 MM X W 11.5 MM X H 3.6MM W 32.3 MM X H1.9MM TIBIAL RIGHT PROXIMAL LATERAL 13 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5MM SCREW SUP-72463213 CDM 0270 RC outpatient 4534.4 4534.4 4534.4 74 3355.46 percent of total billed charges 4534.4 93 3672.86 percent of total billed charges 4534.4 4534.4 other OPPS APC 4534.4 4534.4 other OPPS APC 4534.4 27.63 1252.85 percent of total billed charges 4534.4 4534.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 104MM F/3.5MM SCREW HOLE X7 LEFT POSTEROMEDIAL PROXIMAL TIBIAL T-SHAPED STAINLESS STEEL SUP-72463307 CDM 0270 RC outpatient 3416.4 3416.4 3416.4 74 2528.14 percent of total billed charges 3416.4 93 2767.28 percent of total billed charges 3416.4 3416.4 other OPPS APC 3416.4 3416.4 other OPPS APC 3416.4 27.63 943.95 percent of total billed charges 3416.4 3416.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 SPACE STANDARD T L104 MM X W11.4 MM X H3.4 MM W32.5 MM X H2 MM TIBIAL RIGHT PROXIMAL POSTEROMEDIAL 7 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5 MM SCREW SUP-72463407 CDM 0270 RC outpatient 3416.4 3416.4 3416.4 74 2528.14 percent of total billed charges 3416.4 93 2767.28 percent of total billed charges 3416.4 3416.4 other OPPS APC 3416.4 3416.4 other OPPS APC 3416.4 27.63 943.95 percent of total billed charges 3416.4 3416.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 SPACE STANDARD L 138 MM X W 10.9MM X H 3.4MM X W 25 MM X H 2.5 MM TIBIAL LEFT PROXIMAL MEDIAL 10 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5 MM SCREW SUP-72463710 CDM 0270 RC outpatient 3588 3588 3588 74 2655.12 percent of total billed charges 3588 93 2906.28 percent of total billed charges 3588 3588 other OPPS APC 3588 3588 other OPPS APC 3588 27.63 991.36 percent of total billed charges 3588 3588 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 SPACE STANDARD L201MM X W 10.9MM X H3.4MM W25MMX H2.5MM TIBIAL LEFT PROXIMAL MEDIAL 16 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5 MM SCREW SUP-72463716 CDM 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 SPACE STANDARD L 117MM X W 10.9MM X H 3.4MM W 25MM TIBIAL RIGHT PROXIMAL MEDIAL 8 HOLE VARAIBLE ANGLE LOCK LOW PROFILE STERILE 3.5MM SCREW SUP-72463808 CDM 0270 RC outpatient 3478.8 3478.8 3478.8 74 2574.31 percent of total billed charges 3478.8 93 2817.83 percent of total billed charges 3478.8 3478.8 other OPPS APC 3478.8 3478.8 other OPPS APC 3478.8 27.63 961.19 percent of total billed charges 3478.8 3478.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINlESS STEEL 11 SPACE STANDARD L 201 MM X W 10.9 MM X H 3.4 MM W 25 MM X H 2.5MM TIBIAL RIGHT PROXIMAL MEDIAL 16 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5 MM SCREW SUP-72463816 CDM 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 130MM F/2.7//3.5MM SCREW HOLE X9 LEFT MEDIAL DISTAL TIBIAL STAINLESS STEEL SUP-72463909 CDM 0270 RC outpatient 4945.2 4945.2 4945.2 74 3659.45 percent of total billed charges 4945.2 93 4005.61 percent of total billed charges 4945.2 4945.2 other OPPS APC 4945.2 4945.2 other OPPS APC 4945.2 27.63 1366.36 percent of total billed charges 4945.2 4945.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11MM SPACE STANDARD L 228MM X W 11.4MM X H3.4MM W 18.8MM X H 2.7MM TIBIAL LEFT DISTAL MEDIAL 18 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 2.7/3.5 MM SCREW SUP-72463918 CDM 0270 RC outpatient 5361.2 5361.2 5361.2 74 3967.29 percent of total billed charges 5361.2 93 4342.57 percent of total billed charges 5361.2 5361.2 other OPPS APC 5361.2 5361.2 other OPPS APC 5361.2 27.63 1481.3 percent of total billed charges 5361.2 5361.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 130MM F/2.7/3.5MM SCREW HOLEX9 STERILE RIGHT MEDIAL DISTAL TIBIAL STAINLESS STEEL SUP-72464009 CDM 0270 RC outpatient 4945.2 4945.2 4945.2 74 3659.45 percent of total billed charges 4945.2 93 4005.61 percent of total billed charges 4945.2 4945.2 other OPPS APC 4945.2 4945.2 other OPPS APC 4945.2 27.63 1366.36 percent of total billed charges 4945.2 4945.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 MM SPACE STANDARD L 195 MM X W 11.4 MM X H 3.4 MM W 18.8 MM X H 2.7 TIBIAL RIGHT DISTAL MEDIAL 15 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 2.7/3.5 MM SCREW SUP-72464015 CDM 0270 RC outpatient 5127.2 5127.2 5127.2 74 3794.13 percent of total billed charges 5127.2 93 4153.03 percent of total billed charges 5127.2 5127.2 other OPPS APC 5127.2 5127.2 other OPPS APC 5127.2 27.63 1416.65 percent of total billed charges 5127.2 5127.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 MM SPACE L59 MM X W10 MM X H2 MM W16.3 MM X H1.7 MM FIBULA LEFT DISTAL LATERAL 3 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5 MM SCREW SUP-72464903 CDM 0270 RC outpatient 1595.62 1595.62 1595.62 74 1180.76 percent of total billed charges 1595.62 93 1292.45 percent of total billed charges 1595.62 1595.62 other OPPS APC 1595.62 1595.62 other OPPS APC 1595.62 27.63 440.87 percent of total billed charges 1595.62 1595.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 MM SPACE L103 MM X W10 MM X H2 MM W16.3 MM X H1.7 MM FIBULA RIGHT DISTAL LATERAL 7 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5 MM SCREW SUP-72465007 CDM 0270 RC outpatient 1595.62 1595.62 1595.62 74 1180.76 percent of total billed charges 1595.62 93 1292.45 percent of total billed charges 1595.62 1595.62 other OPPS APC 1595.62 1595.62 other OPPS APC 1595.62 27.63 440.87 percent of total billed charges 1595.62 1595.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11MM SPACE L 147MM X W 10MM X H 2 MM W16.3MM X H 1.7MM FIBULA RIGHT DISTAL LATERAL 11 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5 MM SCREW SUP-72465011 CDM 0270 RC outpatient 1595.62 1595.62 1595.62 74 1180.76 percent of total billed charges 1595.62 93 1292.45 percent of total billed charges 1595.62 1595.62 other OPPS APC 1595.62 1595.62 other OPPS APC 1595.62 27.63 440.87 percent of total billed charges 1595.62 1595.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 81MM 5-HOLE STAINLESS STEEL LEFT LATERAL DISTAL FIBULA F/2.7/3.5MM SCREW STERILE SUP-72465105 CDM 0270 RC outpatient 1595.62 1595.62 1595.62 74 1180.76 percent of total billed charges 1595.62 93 1292.45 percent of total billed charges 1595.62 1595.62 other OPPS APC 1595.62 1595.62 other OPPS APC 1595.62 27.63 440.87 percent of total billed charges 1595.62 1595.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 MM SPACE L 103 MM X W 10 MM X H 2 MM W 16.3 MM X H 1.7MM FIBULA LEFT DISTAL LATERAL 7 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 2.7/3.5 MM SCREW SUP-72465107 CDM 0270 RC outpatient 1595.62 1595.62 1595.62 74 1180.76 percent of total billed charges 1595.62 93 1292.45 percent of total billed charges 1595.62 1595.62 other OPPS APC 1595.62 1595.62 other OPPS APC 1595.62 27.63 440.87 percent of total billed charges 1595.62 1595.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11MM SPACE L 125 MM X W 10 MM X H 2 MM W 16.3 MM X H 1.7MM FIBULA LEFT DISTAL LATERAL 9 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 2.7/3.5 MM SCREW SUP-72465109 CDM 0270 RC outpatient 1595.62 1595.62 1595.62 74 1180.76 percent of total billed charges 1595.62 93 1292.45 percent of total billed charges 1595.62 1595.62 other OPPS APC 1595.62 1595.62 other OPPS APC 1595.62 27.63 440.87 percent of total billed charges 1595.62 1595.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 MM SPACE L 81 MM X W 10 MM X H 2 MM W 16.3 MM X H 1.7MM FIBULA RIGHT DISTAL LATERAL 5 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 2.7/3.5 MM SCREW SUP-72465205 CDM 0270 RC outpatient 1595.62 1595.62 1595.62 74 1180.76 percent of total billed charges 1595.62 93 1292.45 percent of total billed charges 1595.62 1595.62 other OPPS APC 1595.62 1595.62 other OPPS APC 1595.62 27.63 440.87 percent of total billed charges 1595.62 1595.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11MM SPACE L 103 MM X W 10 MM X H 2 MM W 16.3 MM X H 1.7MM FIBULA RIGHT DISTAL LATERAL 7 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 2.7/3.5 MM SCREW SUP-72465207 CDM 0270 RC outpatient 1595.62 1595.62 1595.62 74 1180.76 percent of total billed charges 1595.62 93 1292.45 percent of total billed charges 1595.62 1595.62 other OPPS APC 1595.62 1595.62 other OPPS APC 1595.62 27.63 440.87 percent of total billed charges 1595.62 1595.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11MM SPACE L 93 MM X W 10 MM X H 2 MM W 8 MM X H 1.8 MM FIBULA LEFT DISTAL POSTEROLATERAL 5 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 2.7/3.5 MM SCREW SUP-72465305 CDM 0270 RC outpatient 1595.62 1595.62 1595.62 74 1180.76 percent of total billed charges 1595.62 93 1292.45 percent of total billed charges 1595.62 1595.62 other OPPS APC 1595.62 1595.62 other OPPS APC 1595.62 27.63 440.87 percent of total billed charges 1595.62 1595.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11MM SPACE L 137 MM X W 10 MM X H 2 MM W8 MM X H 1.8MM FIBULA LEFT DISTAL POSTEROLATERAL 9 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 2.7/3.5 MM SCREW SUP-72465309 CDM 0270 RC outpatient 1595.62 1595.62 1595.62 74 1180.76 percent of total billed charges 1595.62 93 1292.45 percent of total billed charges 1595.62 1595.62 other OPPS APC 1595.62 1595.62 other OPPS APC 1595.62 27.63 440.87 percent of total billed charges 1595.62 1595.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 93MM F/2.7/3.5MM SCREW HOLE X5 RIGHT POSTEROLATERAL DISTAL FIBULA STAINLESS STEEL SUP-72465405 CDM 0270 RC outpatient 1595.62 1595.62 1595.62 74 1180.76 percent of total billed charges 1595.62 93 1292.45 percent of total billed charges 1595.62 1595.62 other OPPS APC 1595.62 1595.62 other OPPS APC 1595.62 27.63 440.87 percent of total billed charges 1595.62 1595.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 115MM F/2.7/3.5MM SCREW HOLE X7 RIGHT POSTEROLATERAL DISTAL FIBULA STAINLESS STEEL SUP-72465407 CDM 0270 RC outpatient 1595.62 1595.62 1595.62 74 1180.76 percent of total billed charges 1595.62 93 1292.45 percent of total billed charges 1595.62 1595.62 other OPPS APC 1595.62 1595.62 other OPPS APC 1595.62 27.63 440.87 percent of total billed charges 1595.62 1595.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL L 80 MM HUMERUS LEFT DISTAL MEDIAL 3 HOLE VARIABLE ANGLE LOCK LOW PROFILE 2.7/3.5MM SCREW SUP-72465503 CDM 0270 RC outpatient 2756 2756 2756 74 2039.44 percent of total billed charges 2756 93 2232.36 percent of total billed charges 2756 2756 other OPPS APC 2756 2756 other OPPS APC 2756 27.63 761.48 percent of total billed charges 2756 2756 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 102MM F/2.7/3.5MM SCREW HOLE X5 LEFT MEDIAL DISTAL HUMERAL STAINLESS STEEL SUP-72465505 CDM 0270 RC outpatient 3068 3068 3068 74 2270.32 percent of total billed charges 3068 93 2485.08 percent of total billed charges 3068 3068 other OPPS APC 3068 3068 other OPPS APC 3068 27.63 847.69 percent of total billed charges 3068 3068 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL L 80 MM HUMERUS RIGHT DISTAL MEDIAL 3 HOLE VARIABLE ANGLE LOCK LOW PROFILE 2.7/3.5 MM SCREW SUP-72465603 CDM 0270 RC outpatient 2756 2756 2756 74 2039.44 percent of total billed charges 2756 93 2232.36 percent of total billed charges 2756 2756 other OPPS APC 2756 2756 other OPPS APC 2756 27.63 761.48 percent of total billed charges 2756 2756 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL L 130 MM HUMERUS LEFT DISTAL MEDIAL 7 HOLE VARIABLE ANGLE LOCK LOW PROFILE EXTEND 2.7/3.5 MM SCREW SUP-72465707 CDM 0270 RC outpatient 3068 3068 3068 74 2270.32 percent of total billed charges 3068 93 2485.08 percent of total billed charges 3068 3068 other OPPS APC 3068 3068 other OPPS APC 3068 27.63 847.69 percent of total billed charges 3068 3068 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 130MM HOLE X7 STAINLESS STEEL RIGHT MEDIAL DISTAL HUMERAL F/2.7/3.5 MM SCREW STERILE SUP-72465807 CDM 0270 RC outpatient 3068 3068 3068 74 2270.32 percent of total billed charges 3068 93 2485.08 percent of total billed charges 3068 3068 other OPPS APC 3068 3068 other OPPS APC 3068 27.63 847.69 percent of total billed charges 3068 3068 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL L 85 MM HUMERUS LEFT DISTAL POSTEROLATERAL 6 HOLE LOW PROFILE VARIABLE ANGLE LOCK 2.7/3.5 MM SCREW SUP-72466106 CDM 0270 RC outpatient 2834 2834 2834 74 2097.16 percent of total billed charges 2834 93 2295.54 percent of total billed charges 2834 2834 other OPPS APC 2834 2834 other OPPS APC 2834 27.63 783.03 percent of total billed charges 2834 2834 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL L 129 MM HUMERUS LEFT DISTAL POSTEROLATERAL 10 HOLE LOW PROFILE VARIABLE ANGLE LOCK 2.7/3.5 MM SCREW SUP-72466110 CDM 0270 RC outpatient 3369.6 3369.6 3369.6 74 2493.5 percent of total billed charges 3369.6 93 2729.38 percent of total billed charges 3369.6 3369.6 other OPPS APC 3369.6 3369.6 other OPPS APC 3369.6 27.63 931.02 percent of total billed charges 3369.6 3369.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL L 85 MM HUMERUS RIGHT DISTAL POSTEROLATERAL 6 HOLE LOW PROFILE VARIABLE ANGLE LOCK 2.7/3.5 MM SCREW SUP-72466206 CDM 0270 RC outpatient 2834 2834 2834 74 2097.16 percent of total billed charges 2834 93 2295.54 percent of total billed charges 2834 2834 other OPPS APC 2834 2834 other OPPS APC 2834 27.63 783.03 percent of total billed charges 2834 2834 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS L 114 MM OLECRANON LEFT 7 HOLE TINE 2.7/3.5 MM SCREW SUP-72466307 CDM 0270 RC outpatient 2598.96 2598.96 2598.96 74 1923.23 percent of total billed charges 2598.96 93 2105.16 percent of total billed charges 2598.96 2598.96 other OPPS APC 2598.96 2598.96 other OPPS APC 2598.96 27.63 718.09 percent of total billed charges 2598.96 2598.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL L 61 MM OLECRANON LEFT 3 HOLE LOW PROFILE VARIABLE ANGLE LOCK STERILE 2.7/3.5 MM SCREW SUP-72466503 CDM 0270 RC outpatient 2598.96 2598.96 2598.96 74 1923.23 percent of total billed charges 2598.96 93 2105.16 percent of total billed charges 2598.96 2598.96 other OPPS APC 2598.96 2598.96 other OPPS APC 2598.96 27.63 718.09 percent of total billed charges 2598.96 2598.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL L 83 MM OLECRANON LEFT 5 HOLE LOW PROFILE VARIABLE ANGLE LOCK STERILE 2.7/3.5 MM SCREW SUP-72466505 CDM 0270 RC outpatient 2598.96 2598.96 2598.96 74 1923.23 percent of total billed charges 2598.96 93 2105.16 percent of total billed charges 2598.96 2598.96 other OPPS APC 2598.96 2598.96 other OPPS APC 2598.96 27.63 718.09 percent of total billed charges 2598.96 2598.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 61MM HOLEX3 STAINLESS STEEL RIGHT OLECRANON F/2.7/3.5MM SCREW STERILE SUP-72466603 CDM 0270 RC outpatient 2598.96 2598.96 2598.96 74 1923.23 percent of total billed charges 2598.96 93 2105.16 percent of total billed charges 2598.96 2598.96 other OPPS APC 2598.96 2598.96 other OPPS APC 2598.96 27.63 718.09 percent of total billed charges 2598.96 2598.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL L 83 MM OLECRANON RIGHT 5 HOLE LOW PROFILE VARIABLE ANGLE LOCK STERILE 2.7/3.5 MM SCREW SUP-72466605 CDM 0270 RC outpatient 2598.96 2598.96 2598.96 74 1923.23 percent of total billed charges 2598.96 93 2105.16 percent of total billed charges 2598.96 2598.96 other OPPS APC 2598.96 2598.96 other OPPS APC 2598.96 27.63 718.09 percent of total billed charges 2598.96 2598.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 62MM HOLE X5 STERILE GREATER TUBEROSITY STAINLESS STEEL SUP-72466705 CDM 0270 RC outpatient 2262 2262 2262 74 1673.88 percent of total billed charges 2262 93 1832.22 percent of total billed charges 2262 2262 other OPPS APC 2262 2262 other OPPS APC 2262 27.63 624.99 percent of total billed charges 2262 2262 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11MM SPACE STRAIGHT L 92 MM X W 12 MM X H 3MM HUMERUS PROXIMAL 3 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5MM SCREW SUP-72466903 CDM 0270 RC outpatient 2903.94 2903.94 2903.94 74 2148.92 percent of total billed charges 2903.94 93 2352.19 percent of total billed charges 2903.94 2903.94 other OPPS APC 2903.94 2903.94 other OPPS APC 2903.94 27.63 802.36 percent of total billed charges 2903.94 2903.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11MM SPACE STRAIGHT L 114 MM X W 12MMX H 3 MM HUMERUS PROXIMAL 5 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5 MM SCREW SUP-72466905 CDM 0270 RC outpatient 2903.94 2903.94 2903.94 74 2148.92 percent of total billed charges 2903.94 93 2352.19 percent of total billed charges 2903.94 2903.94 other OPPS APC 2903.94 2903.94 other OPPS APC 2903.94 27.63 802.36 percent of total billed charges 2903.94 2903.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 MM SPACE CURVE L 92 MM X W 12 MM X H 3MM HUMERUS LEFT PROXIMAL 4 HOLE VARIBALE ANGLE LOCK LOW PROFILE STERILE 3.5 MM SCREW SUP-72467104 CDM 0270 RC outpatient 2903.94 2903.94 2903.94 74 2148.92 percent of total billed charges 2903.94 93 2352.19 percent of total billed charges 2903.94 2903.94 other OPPS APC 2903.94 2903.94 other OPPS APC 2903.94 27.63 802.36 percent of total billed charges 2903.94 2903.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 MM SPACE CURVE L 114 MM X W 12 MM X H 3MM HUMERUS LEFT PROXIMAL 4 HOLE VARIBALE ANGLE LOCK LOW PROFILE STERILE 3.5 MM SCREW SUP-72467106 CDM 0270 RC outpatient 2903.94 2903.94 2903.94 74 2148.92 percent of total billed charges 2903.94 93 2352.19 percent of total billed charges 2903.94 2903.94 other OPPS APC 2903.94 2903.94 other OPPS APC 2903.94 27.63 802.36 percent of total billed charges 2903.94 2903.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 MM SPACE CURVE L 147 MM X W 12 MM X H 3MM HUMERUS LEFT PROXIMAL 9 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5 MM SCREW SUP-72467109 CDM 0270 RC outpatient 2903.94 2903.94 2903.94 74 2148.92 percent of total billed charges 2903.94 93 2352.19 percent of total billed charges 2903.94 2903.94 other OPPS APC 2903.94 2903.94 other OPPS APC 2903.94 27.63 802.36 percent of total billed charges 2903.94 2903.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11MM SPACE CURVE L 180 MM X W 12 MM X H 3 MM HUMERUS LEFT PROXIMAL 12 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5 MM SCREW SUP-72467112 CDM 0270 RC outpatient 2903.94 2903.94 2903.94 74 2148.92 percent of total billed charges 2903.94 93 2352.19 percent of total billed charges 2903.94 2903.94 other OPPS APC 2903.94 2903.94 other OPPS APC 2903.94 27.63 802.36 percent of total billed charges 2903.94 2903.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11MM SPACE CURVE L 213MM X W 12MM X H 3MM HUMERUS LEFT PROXIMAL 15 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5MM SCREW SUP-72467115 CDM 0270 RC outpatient 2903.94 2903.94 2903.94 74 2148.92 percent of total billed charges 2903.94 93 2352.19 percent of total billed charges 2903.94 2903.94 other OPPS APC 2903.94 2903.94 other OPPS APC 2903.94 27.63 802.36 percent of total billed charges 2903.94 2903.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11MM SPACE CURVE L 92 MM X W 12MM X H 3MM HUMERUS RIGHT PROXIMAL 4 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5MM SCREW SUP-72467204 CDM 0270 RC outpatient 2903.94 2903.94 2903.94 74 2148.92 percent of total billed charges 2903.94 93 2352.19 percent of total billed charges 2903.94 2903.94 other OPPS APC 2903.94 2903.94 other OPPS APC 2903.94 27.63 802.36 percent of total billed charges 2903.94 2903.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 MM SPACE CURVE L114 MM X W12 MM X H3 MM HUMERUS RIGHT PROXIMAL 6 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5 MM SCREW SUP-72467206 CDM 0270 RC outpatient 2903.94 2903.94 2903.94 74 2148.92 percent of total billed charges 2903.94 93 2352.19 percent of total billed charges 2903.94 2903.94 other OPPS APC 2903.94 2903.94 other OPPS APC 2903.94 27.63 802.36 percent of total billed charges 2903.94 2903.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 MM SPACE CURVE L 147 MM X W 12MM X H 3MM HUMERUS RIGHT PROXIMAL 9 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5MM SCREW SUP-72467209 CDM 0270 RC outpatient 2903.94 2903.94 2903.94 74 2148.92 percent of total billed charges 2903.94 93 2352.19 percent of total billed charges 2903.94 2903.94 other OPPS APC 2903.94 2903.94 other OPPS APC 2903.94 27.63 802.36 percent of total billed charges 2903.94 2903.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 MM SPACE CURVE L 180 MM X W 12 MM X H 3 MM HUMERUS RIGHT PROXIMAL 12 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5 MM SCREW SUP-72467212 CDM 0270 RC outpatient 2903.94 2903.94 2903.94 74 2148.92 percent of total billed charges 2903.94 93 2352.19 percent of total billed charges 2903.94 2903.94 other OPPS APC 2903.94 2903.94 other OPPS APC 2903.94 27.63 802.36 percent of total billed charges 2903.94 2903.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL 11 MM SPACE CURVE L 213 MM X W 12 MM X H 3MM HUMERUS RIGHT PROXIMAL 15 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 3.5 MM SCREW SUP-72467215 CDM 0270 RC outpatient 2903.94 2903.94 2903.94 74 2148.92 percent of total billed charges 2903.94 93 2352.19 percent of total billed charges 2903.94 2903.94 other OPPS APC 2903.94 2903.94 other OPPS APC 2903.94 27.63 802.36 percent of total billed charges 2903.94 2903.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11MM SPACE L 89 MM X W 10.5 MM X H 3 MM H 2.5 MM CLAVICALE RIGHT DISTAL SUPERIOR 5 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 2.7/3.5 MM SCREW SUP-72467405 CDM 0270 RC outpatient 1939.6 1939.6 1939.6 74 1435.3 percent of total billed charges 1939.6 93 1571.08 percent of total billed charges 1939.6 1939.6 other OPPS APC 1939.6 1939.6 other OPPS APC 1939.6 27.63 535.91 percent of total billed charges 1939.6 1939.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 11 MM SPACE L 86 MM X W10.5MM X H 3MM CLAVICLE LEFT DISTAL INFERIOR 3 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 2.7/3.5 MM SCREW SUP-72467703 CDM 0270 RC outpatient 1939.6 1939.6 1939.6 74 1435.3 percent of total billed charges 1939.6 93 1571.08 percent of total billed charges 1939.6 1939.6 other OPPS APC 1939.6 1939.6 other OPPS APC 1939.6 27.63 535.91 percent of total billed charges 1939.6 1939.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STANDARD L 48 MM RADIAL LEFT DISTAL VOLAR 3 HOLE STERILE SUP-72468103 CDM 0270 RC outpatient 1785.68 1785.68 1785.68 74 1321.4 percent of total billed charges 1785.68 93 1446.4 percent of total billed charges 1785.68 1785.68 other OPPS APC 1785.68 1785.68 other OPPS APC 1785.68 27.63 493.38 percent of total billed charges 1785.68 1785.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STANDARD L 56 MM RADIAL LEFT DISTAL VOLAR 4 HOLE STERILE SUP-72468104 CDM 0270 RC outpatient 1785.68 1785.68 1785.68 74 1321.4 percent of total billed charges 1785.68 93 1446.4 percent of total billed charges 1785.68 1785.68 other OPPS APC 1785.68 1785.68 other OPPS APC 1785.68 27.63 493.38 percent of total billed charges 1785.68 1785.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STANDARD L 100 MM RADIAL LEFT DISTAL VOLAR 7 HOLE STERILE SUP-72468107 CDM 0270 RC outpatient 1785.68 1785.68 1785.68 74 1321.4 percent of total billed charges 1785.68 93 1446.4 percent of total billed charges 1785.68 1785.68 other OPPS APC 1785.68 1785.68 other OPPS APC 1785.68 27.63 493.38 percent of total billed charges 1785.68 1785.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STANDARD L 48 MM RADIAL RIGHT DISTAL VOLAR 3 HOLE STERILE SUP-72468203 CDM 0270 RC outpatient 1785.68 1785.68 1785.68 74 1321.4 percent of total billed charges 1785.68 93 1446.4 percent of total billed charges 1785.68 1785.68 other OPPS APC 1785.68 1785.68 other OPPS APC 1785.68 27.63 493.38 percent of total billed charges 1785.68 1785.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STANDARD L 56 MM RADIAL RIGHT DISTAL VOLAR 4 HOLE STERILE SUP-72468204 CDM 0270 RC outpatient 1785.68 1785.68 1785.68 74 1321.4 percent of total billed charges 1785.68 93 1446.4 percent of total billed charges 1785.68 1785.68 other OPPS APC 1785.68 1785.68 other OPPS APC 1785.68 27.63 493.38 percent of total billed charges 1785.68 1785.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STANDARD L 76 MM RADIAL RIGHT DISTAL VOLAR 5 HOLE STERILE SUP-72468205 CDM 0270 RC outpatient 1785.68 1785.68 1785.68 74 1321.4 percent of total billed charges 1785.68 93 1446.4 percent of total billed charges 1785.68 1785.68 other OPPS APC 1785.68 1785.68 other OPPS APC 1785.68 27.63 493.38 percent of total billed charges 1785.68 1785.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STANDARD L 100MM RADIAL RIGHT DISTAL VOLAR 7 HOLE STERILE SUP-72468207 CDM 0270 RC outpatient 1785.68 1785.68 1785.68 74 1321.4 percent of total billed charges 1785.68 93 1446.4 percent of total billed charges 1785.68 1785.68 other OPPS APC 1785.68 1785.68 other OPPS APC 1785.68 27.63 493.38 percent of total billed charges 1785.68 1785.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 138MM HOLEX10 NON-STERILE STANDARD RIGHT DISTAL VOLAR RADIAL STAINLESS STEEL SUP-72468210 CDM 0270 RC outpatient 1785.68 1785.68 1785.68 74 1321.4 percent of total billed charges 1785.68 93 1446.4 percent of total billed charges 1785.68 1785.68 other OPPS APC 1785.68 1785.68 other OPPS APC 1785.68 27.63 493.38 percent of total billed charges 1785.68 1785.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS WIDE L 48 MM RADIAL LEFT DISTAL VOLAR 3 HOLE STERILE SUP-72468303 CDM 0270 RC outpatient 1785.68 1785.68 1785.68 74 1321.4 percent of total billed charges 1785.68 93 1446.4 percent of total billed charges 1785.68 1785.68 other OPPS APC 1785.68 1785.68 other OPPS APC 1785.68 27.63 493.38 percent of total billed charges 1785.68 1785.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS WIDE L 56 MM RADIAL LEFT DISTAL VOLAR 4 HOLE STERILE SUP-72468304 CDM 0270 RC outpatient 1785.68 1785.68 1785.68 74 1321.4 percent of total billed charges 1785.68 93 1446.4 percent of total billed charges 1785.68 1785.68 other OPPS APC 1785.68 1785.68 other OPPS APC 1785.68 27.63 493.38 percent of total billed charges 1785.68 1785.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS WIDE L 48 MM RADIAL RIGHT DISTAL VOLAR 3 HOLE STERILE SUP-72468403 CDM 0270 RC outpatient 1785.68 1785.68 1785.68 74 1321.4 percent of total billed charges 1785.68 93 1446.4 percent of total billed charges 1785.68 1785.68 other OPPS APC 1785.68 1785.68 other OPPS APC 1785.68 27.63 493.38 percent of total billed charges 1785.68 1785.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS WIDE L 56MM RADIAL RIGHT DISTAL VOLAR 4 HOLE STERILE SUP-72468404 CDM 0270 RC outpatient 1785.68 1785.68 1785.68 74 1321.4 percent of total billed charges 1785.68 93 1446.4 percent of total billed charges 1785.68 1785.68 other OPPS APC 1785.68 1785.68 other OPPS APC 1785.68 27.63 493.38 percent of total billed charges 1785.68 1785.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS L 98MM X H 8MM RADIAL STERILE LATEX FREE SUP-72468608 CDM 0270 RC outpatient 1487.2 1487.2 1487.2 74 1100.53 percent of total billed charges 1487.2 93 1204.63 percent of total billed charges 1487.2 1487.2 other OPPS APC 1487.2 1487.2 other OPPS APC 1487.2 27.63 410.91 percent of total billed charges 1487.2 1487.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 7 MM SPACE L 81 MM X W 8.5MM X H 2.4MM CLAVICLE RIGHT DISTAL INFERIOR 3 HOLE LOCK VARIABLE ANGLE LOCK LOW PROFILE STERILE 2.7MM SCREW SUP-72468803 CDM 0270 RC outpatient 1580.8 1580.8 1580.8 74 1169.79 percent of total billed charges 1580.8 93 1280.45 percent of total billed charges 1580.8 1580.8 other OPPS APC 1580.8 1580.8 other OPPS APC 1580.8 27.63 436.78 percent of total billed charges 1580.8 1580.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 7 MM SPACE L 109 MM X W 8.5 MM X H 2.4MM CLAVICLE RIGHT DISTAL INFERIOR 7 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 2.7 MM SCREW SUP-72468807 CDM 0270 RC outpatient 1622.4 1622.4 1622.4 74 1200.58 percent of total billed charges 1622.4 93 1314.14 percent of total billed charges 1622.4 1622.4 other OPPS APC 1622.4 1622.4 other OPPS APC 1622.4 27.63 448.27 percent of total billed charges 1622.4 1622.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL 7 MM SPACE L 87 MM X W 8 MM X H 2.4 MM CLAVICLE MEDIAL SUPERIOR 13 HOLE VARIABLE ANGLE LOCK LOW PROFILE STERILE 2.7 MM SCREW SUP-72468913 CDM 0270 RC outpatient 1658.8 1658.8 1658.8 74 1227.51 percent of total billed charges 1658.8 93 1343.63 percent of total billed charges 1658.8 1658.8 other OPPS APC 1658.8 1658.8 other OPPS APC 1658.8 27.63 458.33 percent of total billed charges 1658.8 1658.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL L 151MM HUMERUS LEFT DISTAL POSTEROLATERAL 12 HOLE LOW PROFILE VARIABLE ANGLE LOCK EXTRA ARTICULAR 2.7/3.5 MM SCREW SUP-72469112 CDM 0270 RC outpatient 3723.2 3723.2 3723.2 74 2755.17 percent of total billed charges 3723.2 93 3015.79 percent of total billed charges 3723.2 3723.2 other OPPS APC 3723.2 3723.2 other OPPS APC 3723.2 27.63 1028.72 percent of total billed charges 3723.2 3723.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL L 195MM HUMERUS LEFT DISTAL POSTEROLATERAL 16 HOLE LOW PROFILE VARIABLE ANGLE LOCK EXTRA ARTICULAR 2.7/3.5MM SCREW SUP-72469116 CDM 0270 RC outpatient 3790.8 3790.8 3790.8 74 2805.19 percent of total billed charges 3790.8 93 3070.55 percent of total billed charges 3790.8 3790.8 other OPPS APC 3790.8 3790.8 other OPPS APC 3790.8 27.63 1047.4 percent of total billed charges 3790.8 3790.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS STAINLESS STEEL L 151 MM HUMERUS RIGHT DISTAL POSTEROLATERAL 12 HOLE LOW PROFILE VARIABLE ANGLE LOCK EXTRA ARTICULAR 2.7/3.5 MM SCREW SUP-72469212 CDM 0270 RC outpatient 3723.2 3723.2 3723.2 74 2755.17 percent of total billed charges 3723.2 93 3015.79 percent of total billed charges 3723.2 3723.2 other OPPS APC 3723.2 3723.2 other OPPS APC 3723.2 27.63 1028.72 percent of total billed charges 3723.2 3723.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 195MM F/2.7/3.5MM SCREW HOLEX16 STERILE RIGHT POSTEROLATERAL DISTAL HUMERAL STAINLESS STEEL SUP-72469216 CDM 0270 RC outpatient 3790.8 3790.8 3790.8 74 2805.19 percent of total billed charges 3790.8 93 3070.55 percent of total billed charges 3790.8 3790.8 other OPPS APC 3790.8 3790.8 other OPPS APC 3790.8 27.63 1047.4 percent of total billed charges 3790.8 3790.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 108MM 10-HOLE 3.5MM RIGHT SUPERIOR MIDSHAFT CLAVICLE STERILE SUP-72469610 CDM 0270 RC outpatient 1898 1898 1898 74 1404.52 percent of total billed charges 1898 93 1537.38 percent of total billed charges 1898 1898 other OPPS APC 1898 1898 other OPPS APC 1898 27.63 524.42 percent of total billed charges 1898 1898 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS SMALL L93 MM CLAVICLE RIGHT SUPERIOR 14 HOLE MIDSHAFT 2.7MM SCREW SUP-72469814 CDM 0270 RC outpatient 1627.6 1627.6 1627.6 74 1204.42 percent of total billed charges 1627.6 93 1318.36 percent of total billed charges 1627.6 1627.6 other OPPS APC 1627.6 1627.6 other OPPS APC 1627.6 27.63 449.71 percent of total billed charges 1627.6 1627.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 99MM HOLE X8 F/2.7MM SCREW MIDSHAFT INFERIOR CLAVICLE STAINLESS STEEL SUP-72469908 CDM 0270 RC outpatient 1835.6 1835.6 1835.6 74 1358.34 percent of total billed charges 1835.6 93 1486.84 percent of total billed charges 1835.6 1835.6 other OPPS APC 1835.6 1835.6 other OPPS APC 1835.6 27.63 507.18 percent of total billed charges 1835.6 1835.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV INJECTION 0.9% NACL 6% HETASTARCH 500ML SUP-724803 CDM 0270 RC outpatient 30.17 30.17 30.17 74 22.33 percent of total billed charges 30.17 93 24.44 percent of total billed charges 30.17 30.17 other OPPS APC 30.17 30.17 other OPPS APC 30.17 27.63 8.34 percent of total billed charges 30.17 30.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE CHROMIC 4-0 J-1 L18 IN MONOFILAMENT SUP-724G CDM 0270 RC outpatient 7.23 7.23 7.23 74 5.35 percent of total billed charges 7.23 93 5.86 percent of total billed charges 7.23 7.23 other OPPS APC 7.23 7.23 other OPPS APC 7.23 27.63 2 percent of total billed charges 7.23 7.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HANDPIECE VITREORETINAL CONSTELLATION PNEUMATIC LIGHT WEIGHT ERGONOMIC HANDLE STERILE DISPOSABLE SUP-725.03 CDM 0270 RC outpatient 292.27 292.27 292.27 74 216.28 percent of total billed charges 292.27 93 236.74 percent of total billed charges 292.27 292.27 other OPPS APC 292.27 292.27 other OPPS APC 292.27 27.63 80.75 percent of total billed charges 292.27 292.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 20 MM OD 4.5 MM CORTEX SELF TAP STERILE LATEX FREE SUP-72504520 CDM 0270 RC outpatient 99.32 99.32 99.32 74 73.5 percent of total billed charges 99.32 93 80.45 percent of total billed charges 99.32 99.32 other OPPS APC 99.32 99.32 other OPPS APC 99.32 27.63 27.44 percent of total billed charges 99.32 99.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 22 MM OD 4.5 MM CORTEX SELF TAP STERILE LATEX FREE SUP-72504522 CDM 0270 RC outpatient 99.32 99.32 99.32 74 73.5 percent of total billed charges 99.32 93 80.45 percent of total billed charges 99.32 99.32 other OPPS APC 99.32 99.32 other OPPS APC 99.32 27.63 27.44 percent of total billed charges 99.32 99.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 24 MM OD 4.5 MM CORTEX SELF TAP STERILE LATEX FREE SUP-72504524 CDM 0270 RC outpatient 99.32 99.32 99.32 74 73.5 percent of total billed charges 99.32 93 80.45 percent of total billed charges 99.32 99.32 other OPPS APC 99.32 99.32 other OPPS APC 99.32 27.63 27.44 percent of total billed charges 99.32 99.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 26 MM OD 4.5 MM CORTEX SELF TAP STERILE LATEX FREE SUP-72504526 CDM 0270 RC outpatient 99.32 99.32 99.32 74 73.5 percent of total billed charges 99.32 93 80.45 percent of total billed charges 99.32 99.32 other OPPS APC 99.32 99.32 other OPPS APC 99.32 27.63 27.44 percent of total billed charges 99.32 99.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 28 MM OD 4.5 MM CORTEX SELF TAP STERILE LATEX FREE SUP-72504528 CDM 0270 RC outpatient 99.32 99.32 99.32 74 73.5 percent of total billed charges 99.32 93 80.45 percent of total billed charges 99.32 99.32 other OPPS APC 99.32 99.32 other OPPS APC 99.32 27.63 27.44 percent of total billed charges 99.32 99.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 30 MM OD 4.5 MM CORTEX SELF TAP STERILE LATEX FREE SUP-72504530 CDM 0270 RC outpatient 99.32 99.32 99.32 74 73.5 percent of total billed charges 99.32 93 80.45 percent of total billed charges 99.32 99.32 other OPPS APC 99.32 99.32 other OPPS APC 99.32 27.63 27.44 percent of total billed charges 99.32 99.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 32 MM OD 4.5 MM CORTEX SELF TAP STERILE LATEX FREE SUP-72504532 CDM 0270 RC outpatient 99.32 99.32 99.32 74 73.5 percent of total billed charges 99.32 93 80.45 percent of total billed charges 99.32 99.32 other OPPS APC 99.32 99.32 other OPPS APC 99.32 27.63 27.44 percent of total billed charges 99.32 99.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L34 MM OD4.5 MM CORTEX SELF TAP STERILE LATEX FREE SUP-72504534 CDM 0270 RC outpatient 99.32 99.32 99.32 74 73.5 percent of total billed charges 99.32 93 80.45 percent of total billed charges 99.32 99.32 other OPPS APC 99.32 99.32 other OPPS APC 99.32 27.63 27.44 percent of total billed charges 99.32 99.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L36 MM OD4.5 MM CORTEX SELF TAP STERILE LATEX FREE SUP-72504536 CDM 0270 RC outpatient 99.32 99.32 99.32 74 73.5 percent of total billed charges 99.32 93 80.45 percent of total billed charges 99.32 99.32 other OPPS APC 99.32 99.32 other OPPS APC 99.32 27.63 27.44 percent of total billed charges 99.32 99.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 38MM OD 4.5 MM CORTEX SELF TAP STERILE LATEX FREE SUP-72504538 CDM 0270 RC outpatient 99.32 99.32 99.32 74 73.5 percent of total billed charges 99.32 93 80.45 percent of total billed charges 99.32 99.32 other OPPS APC 99.32 99.32 other OPPS APC 99.32 27.63 27.44 percent of total billed charges 99.32 99.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 4.5MM 40MM SELF-TAPPING CORTICAL TITANIUM ALLOY SUP-72504540 CDM 0270 RC outpatient 99.32 99.32 99.32 74 73.5 percent of total billed charges 99.32 93 80.45 percent of total billed charges 99.32 99.32 other OPPS APC 99.32 99.32 other OPPS APC 99.32 27.63 27.44 percent of total billed charges 99.32 99.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 42 MM OD 4.5MM CORTEX SELF TAP STERILE LATEX FREE SUP-72504542 CDM 0270 RC outpatient 99.32 99.32 99.32 74 73.5 percent of total billed charges 99.32 93 80.45 percent of total billed charges 99.32 99.32 other OPPS APC 99.32 99.32 other OPPS APC 99.32 27.63 27.44 percent of total billed charges 99.32 99.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 44 MM OD 4.5 MM CORTEX SELF TAP STERILE LATEX FREE SUP-72504544 CDM 0270 RC outpatient 99.32 99.32 99.32 74 73.5 percent of total billed charges 99.32 93 80.45 percent of total billed charges 99.32 99.32 other OPPS APC 99.32 99.32 other OPPS APC 99.32 27.63 27.44 percent of total billed charges 99.32 99.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EVOS CTX S-T 4.5MM X 58MM SUP-72504558 CDM 0270 RC outpatient 99.32 99.32 99.32 74 73.5 percent of total billed charges 99.32 93 80.45 percent of total billed charges 99.32 99.32 other OPPS APC 99.32 99.32 other OPPS APC 99.32 27.63 27.44 percent of total billed charges 99.32 99.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 4.5MM 60MM SELF-TAPPING CORTICAL TITANIUM ALLOY STERILE SUP-72504560 CDM 0270 RC outpatient 99.32 99.32 99.32 74 73.5 percent of total billed charges 99.32 93 80.45 percent of total billed charges 99.32 99.32 other OPPS APC 99.32 99.32 other OPPS APC 99.32 27.63 27.44 percent of total billed charges 99.32 99.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 4.5MM 66MM SELF-TAPPING CORTICAL TITANIUM ALLOY NON-STERILE SUP-72504566 CDM 0270 RC outpatient 99.32 99.32 99.32 74 73.5 percent of total billed charges 99.32 93 80.45 percent of total billed charges 99.32 99.32 other OPPS APC 99.32 99.32 other OPPS APC 99.32 27.63 27.44 percent of total billed charges 99.32 99.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EVOS 4.5MM X 68MM CTX S-T SUP-72504568 CDM 0270 RC outpatient 99.32 99.32 99.32 74 73.5 percent of total billed charges 99.32 93 80.45 percent of total billed charges 99.32 99.32 other OPPS APC 99.32 99.32 other OPPS APC 99.32 27.63 27.44 percent of total billed charges 99.32 99.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EVOS 4.5 X 72 MM CTX S-T SUP-72504572 CDM 0270 RC outpatient 99.32 99.32 99.32 74 73.5 percent of total billed charges 99.32 93 80.45 percent of total billed charges 99.32 99.32 other OPPS APC 99.32 99.32 other OPPS APC 99.32 27.63 27.44 percent of total billed charges 99.32 99.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 4.5MM 74MM SELF-TAPPING CORTICAL TITANIUM ALLOY STERILE SUP-72504574 CDM 0270 RC outpatient 99.32 99.32 99.32 74 73.5 percent of total billed charges 99.32 93 80.45 percent of total billed charges 99.32 99.32 other OPPS APC 99.32 99.32 other OPPS APC 99.32 27.63 27.44 percent of total billed charges 99.32 99.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L76MM OD 4.5 MM CORTEX SELF TAP STERILE LATEX FREE SUP-72504576 CDM 0270 RC outpatient 99.32 99.32 99.32 74 73.5 percent of total billed charges 99.32 93 80.45 percent of total billed charges 99.32 99.32 other OPPS APC 99.32 99.32 other OPPS APC 99.32 27.63 27.44 percent of total billed charges 99.32 99.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 4.5MM 80MM SELF-TAPPING CORTICAL TITANIUM ALLOY STERILE SUP-72504580 CDM 0270 RC outpatient 110.5 110.5 110.5 74 81.77 percent of total billed charges 110.5 93 89.51 percent of total billed charges 110.5 110.5 other OPPS APC 110.5 110.5 other OPPS APC 110.5 27.63 30.53 percent of total billed charges 110.5 110.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE TISSUE REMOVAL AVETA HYSTEROSCOPE CORAL STERILE LATEX FREE DISPOSABLE SUP-72505 CDM 0270 RC outpatient 668.5 668.5 668.5 74 494.69 percent of total billed charges 668.5 93 541.49 percent of total billed charges 668.5 668.5 other OPPS APC 668.5 668.5 other OPPS APC 668.5 27.63 184.71 percent of total billed charges 668.5 668.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT MICROINTRODUCER VASCULAR VSI 5FR W/0.018IN 40CM TG SOFT TIP NT MANDREL GW REG DIL 21GA 7CM ECHO NDL SUP-7250V CDM 0270 RC outpatient 47.84 47.84 47.84 47.84 other OPPS APC 47.84 47.84 other OPPS APC 47.84 27.63 13.22 percent of total billed charges 47.84 47.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE TISSUE REMOVAL AVETA HYSTEROSCOPE PEARL STERILE LATEX FREE DISPOSABLE SUP-72510 CDM 0270 RC outpatient 668.5 668.5 668.5 74 494.69 percent of total billed charges 668.5 93 541.49 percent of total billed charges 668.5 668.5 other OPPS APC 668.5 668.5 other OPPS APC 668.5 27.63 184.71 percent of total billed charges 668.5 668.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE TISSUE REMOVAL AVETA OD2.9 MM RESECT SMOL STERILE LATEX FREE DISPOSABLE SUP-72511 CDM 0270 RC outpatient 1350 1350 1350 74 999 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 1350 other OPPS APC 1350 1350 other OPPS APC 1350 27.63 373.01 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE TISSUE REMOVAL AVETA OD2.9 MM RESECT FLEX STERILE LATEX FREE DISPOSABLE SUP-72512 CDM 0270 RC outpatient 2250 2250 2250 74 1665 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 2250 other OPPS APC 2250 2250 other OPPS APC 2250 27.63 621.68 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE TISSUE REMOVAL AVETA OD3.9 MM RESECT STERILE DISPOSABLE SUP-72513 CDM 0270 RC outpatient 2400 2400 2400 74 1776 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 2400 other OPPS APC 2400 2400 other OPPS APC 2400 27.63 663.12 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EVOS BLT TIP LCK 4.5MM X 8 MM SUP-72514408 CDM 0270 RC outpatient 1120.6 1120.6 1120.6 74 829.24 percent of total billed charges 1120.6 93 907.69 percent of total billed charges 1120.6 1120.6 other OPPS APC 1120.6 1120.6 other OPPS APC 1120.6 27.63 309.62 percent of total billed charges 1120.6 1120.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EVOS BLT TIP LCK SCR 4.5MM X 10MM SUP-72514410 CDM 0270 RC outpatient 1120.6 1120.6 1120.6 74 829.24 percent of total billed charges 1120.6 93 907.69 percent of total billed charges 1120.6 1120.6 other OPPS APC 1120.6 1120.6 other OPPS APC 1120.6 27.63 309.62 percent of total billed charges 1120.6 1120.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EVOS BLT TIP LCK 4.5MM X 12MM SUP-72514412 CDM 0270 RC outpatient 1120.6 1120.6 1120.6 74 829.24 percent of total billed charges 1120.6 93 907.69 percent of total billed charges 1120.6 1120.6 other OPPS APC 1120.6 1120.6 other OPPS APC 1120.6 27.63 309.62 percent of total billed charges 1120.6 1120.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EVOS BLT TIP LCK 4.5MM X 14MM SUP-72514414 CDM 0270 RC outpatient 1120.6 1120.6 1120.6 74 829.24 percent of total billed charges 1120.6 93 907.69 percent of total billed charges 1120.6 1120.6 other OPPS APC 1120.6 1120.6 other OPPS APC 1120.6 27.63 309.62 percent of total billed charges 1120.6 1120.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING EVOS 4.5MM X 20 MM S-T SUP-72514520 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING EVOS L 22MM 4.5MM S-T SUP-72514522 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 4.5MM 24MM LOCKING SELF-TAPPING TITANIUM ALLOY STERILE SUP-72514524 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 4.5MM 26MM LOCKING SELF-TAPPING TITANIUM ALLOY STERILE SUP-72514526 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EVOS LOCKING 4.5MM X 30MM STERILE SUP-72514530 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 4.5MM 32MM LOCKING SELF-TAPPING TITANIUM ALLOY STERILE SUP-72514532 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 34 MM OD 4.5MM SELF TAP LOCK STERILE LATEX FREE SUP-72514534 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L36 MM OD 4.5 MM SELF TAP LOCK STERILE LATEX FREE SUP-72514536 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 4.5MM 38MM LOCKING SELF-TAPPING TITANIUM ALLOY STERILE SUP-72514538 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING EVOS L 40MM 4.5 MM S-T SUP-72514540 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L42 MM OD 4.5 MM SELF TAP LOCK STERILE LATEX FREE SUP-72514542 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 4.5MM 44MM LOCKING SELF-TAPPING TITANIUM ALLOY STERILE SUP-72514544 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING EVOS 4.5 MM X 50 MM S-T SUP-72514550 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EVOS LOCKING 4.5MM X 52MM STERILE SUP-72514552 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 4.5MM 54MM LOCKING SELF-TAPPING TITANIUM ALLOY STERILE SUP-72514554 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5 LOCKING SCREW 58MM SUP-72514558 CDM 0270 RC outpatient 642.2 642.2 642.2 74 475.23 percent of total billed charges 642.2 93 520.18 percent of total billed charges 642.2 642.2 other OPPS APC 642.2 642.2 other OPPS APC 642.2 27.63 177.44 percent of total billed charges 642.2 642.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EVOS LOCKING 4.5MM X 60MM STERILE SUP-72514560 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 4.5MM 62MM LOCKING SELF-TAPPING TITANIUM ALLOY NON-STERILE SUP-72514562 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING EVOS L 64MM 4.5MM S-T SUP-72514564 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING EVOS 4.5MM X 66MM S-T SUP-72514566 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 4.5MM 68MM LOCKING SELF-TAPPING TITANIUM ALLOY STERILE SUP-72514568 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 4.5MM 70MM LOCKING SELF-TAPPING TITANIUM ALLOY STERILE SUP-72514570 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EVOS LOCKING 4.5MM X 72MM STERILE SUP-72514572 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EVOS LOCKING 4.5MM X 74MM STERILE SUP-72514574 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EVOS LOCKING 4.5MM X 76MM STERILE SUP-72514576 CDM 0270 RC outpatient 640.9 640.9 640.9 74 474.27 percent of total billed charges 640.9 93 519.13 percent of total billed charges 640.9 640.9 other OPPS APC 640.9 640.9 other OPPS APC 640.9 27.63 177.08 percent of total billed charges 640.9 640.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS L 80 MM OD 4.5MM SELF TAP LOCK STERILE LATEX FREE SUP-72514580 CDM 0270 RC outpatient 721.5 721.5 721.5 74 533.91 percent of total billed charges 721.5 93 584.42 percent of total billed charges 721.5 721.5 other OPPS APC 721.5 721.5 other OPPS APC 721.5 27.63 199.35 percent of total billed charges 721.5 721.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING EVOS 4.5MM X 85MM S-T SUP-72514585 CDM 0270 RC outpatient 721.5 721.5 721.5 74 533.91 percent of total billed charges 721.5 93 584.42 percent of total billed charges 721.5 721.5 other OPPS APC 721.5 721.5 other OPPS APC 721.5 27.63 199.35 percent of total billed charges 721.5 721.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCR FT EVOS HIGGH TORQUE 6.7MM X 30MM SUP-72526730 CDM 0270 RC outpatient 721.5 721.5 721.5 74 533.91 percent of total billed charges 721.5 93 584.42 percent of total billed charges 721.5 721.5 other OPPS APC 721.5 721.5 other OPPS APC 721.5 27.63 199.35 percent of total billed charges 721.5 721.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCR FT EVOS HIGGH TORQUE 6.7MM X 34MM SUP-72526734 CDM 0270 RC outpatient 721.5 721.5 721.5 74 533.91 percent of total billed charges 721.5 93 584.42 percent of total billed charges 721.5 721.5 other OPPS APC 721.5 721.5 other OPPS APC 721.5 27.63 199.35 percent of total billed charges 721.5 721.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 6.7MM 36MM FULLY THREADED TITANIUM ALLOY HIGH TORQUE SUP-72526736 CDM 0270 RC outpatient 721.5 721.5 721.5 74 533.91 percent of total billed charges 721.5 93 584.42 percent of total billed charges 721.5 721.5 other OPPS APC 721.5 721.5 other OPPS APC 721.5 27.63 199.35 percent of total billed charges 721.5 721.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE HIGH TORQUE EVOS L 40MM 6.7MM SUP-72526740 CDM 0270 RC outpatient 721.5 721.5 721.5 74 533.91 percent of total billed charges 721.5 93 584.42 percent of total billed charges 721.5 721.5 other OPPS APC 721.5 721.5 other OPPS APC 721.5 27.63 199.35 percent of total billed charges 721.5 721.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 6.7MM 65MM FULLY THREADED TITANIUM ALLOY HIGH TORQUE SUP-72526765 CDM 0270 RC outpatient 721.5 721.5 721.5 74 533.91 percent of total billed charges 721.5 93 584.42 percent of total billed charges 721.5 721.5 other OPPS APC 721.5 721.5 other OPPS APC 721.5 27.63 199.35 percent of total billed charges 721.5 721.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 6.7MM 70MM FULLY THREADED TITANIUM ALLOY HIGH TORQUE STERILE SUP-72526770 CDM 0270 RC outpatient 721.5 721.5 721.5 74 533.91 percent of total billed charges 721.5 93 584.42 percent of total billed charges 721.5 721.5 other OPPS APC 721.5 721.5 other OPPS APC 721.5 27.63 199.35 percent of total billed charges 721.5 721.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE HIGH TORQUE EVOS L 75MM 6.7MM SUP-72526775 CDM 0270 RC outpatient 721.5 721.5 721.5 74 533.91 percent of total billed charges 721.5 93 584.42 percent of total billed charges 721.5 721.5 other OPPS APC 721.5 721.5 other OPPS APC 721.5 27.63 199.35 percent of total billed charges 721.5 721.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 6.7MM 90MM FULLY THREADED TITANIUM ALLOY HIGH TORQUE STERILE SUP-72526790 CDM 0270 RC outpatient 800.8 800.8 800.8 74 592.59 percent of total billed charges 800.8 93 648.65 percent of total billed charges 800.8 800.8 other OPPS APC 800.8 800.8 other OPPS APC 800.8 27.63 221.26 percent of total billed charges 800.8 800.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EVOS LOCKING CANNULATED 5.7MM X 30MM SUP-72535730 CDM 0270 RC outpatient 881.4 881.4 881.4 74 652.24 percent of total billed charges 881.4 93 713.93 percent of total billed charges 881.4 881.4 other OPPS APC 881.4 881.4 other OPPS APC 881.4 27.63 243.53 percent of total billed charges 881.4 881.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 5.7MM 32MM CANNULATED LOCKING TITANIUM ALLOY STERILE SUP-72535732 CDM 0270 RC outpatient 881.4 881.4 881.4 74 652.24 percent of total billed charges 881.4 93 713.93 percent of total billed charges 881.4 881.4 other OPPS APC 881.4 881.4 other OPPS APC 881.4 27.63 243.53 percent of total billed charges 881.4 881.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EVOS LOCKING CANNULATED 5.7MM X 40MM SUP-72535740 CDM 0270 RC outpatient 881.4 881.4 881.4 74 652.24 percent of total billed charges 881.4 93 713.93 percent of total billed charges 881.4 881.4 other OPPS APC 881.4 881.4 other OPPS APC 881.4 27.63 243.53 percent of total billed charges 881.4 881.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 5.7MM 60MM CANNULATED LOCKING TITANIUM ALLOY STERILE SUP-72535760 CDM 0270 RC outpatient 881.4 881.4 881.4 74 652.24 percent of total billed charges 881.4 93 713.93 percent of total billed charges 881.4 881.4 other OPPS APC 881.4 881.4 other OPPS APC 881.4 27.63 243.53 percent of total billed charges 881.4 881.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EVOS LOCKING CANNULATED 5.7MM X 65MM SUP-72535765 CDM 0270 RC outpatient 881.4 881.4 881.4 74 652.24 percent of total billed charges 881.4 93 713.93 percent of total billed charges 881.4 881.4 other OPPS APC 881.4 881.4 other OPPS APC 881.4 27.63 243.53 percent of total billed charges 881.4 881.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EVOS LOCKING CANNULATED 5.7MM X 70MM SUP-72535770 CDM 0270 RC outpatient 881.4 881.4 881.4 74 652.24 percent of total billed charges 881.4 93 713.93 percent of total billed charges 881.4 881.4 other OPPS APC 881.4 881.4 other OPPS APC 881.4 27.63 243.53 percent of total billed charges 881.4 881.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EVOS LOCKING CANNUALTED 5.7MM X 75MM SUP-72535775 CDM 0270 RC outpatient 881.4 881.4 881.4 74 652.24 percent of total billed charges 881.4 93 713.93 percent of total billed charges 881.4 881.4 other OPPS APC 881.4 881.4 other OPPS APC 881.4 27.63 243.53 percent of total billed charges 881.4 881.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EVOS LOCKING CANNUALTED 5.7MM X 80MM SUP-72535780 CDM 0270 RC outpatient 881.4 881.4 881.4 74 652.24 percent of total billed charges 881.4 93 713.93 percent of total billed charges 881.4 881.4 other OPPS APC 881.4 881.4 other OPPS APC 881.4 27.63 243.53 percent of total billed charges 881.4 881.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE EVOS 4.5MM NRW NON-LOCKING COMP 9 HOLE 167MM SUP-72561009 CDM 0270 RC outpatient 1280.5 1280.5 1280.5 74 947.57 percent of total billed charges 1280.5 93 1037.21 percent of total billed charges 1280.5 1280.5 other OPPS APC 1280.5 1280.5 other OPPS APC 1280.5 27.63 353.8 percent of total billed charges 1280.5 1280.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 299MM 18-HOLE BOWED LOCKING COMPRESSION TITANIUM ALLOY F/4.5MM SCREW STERILE SUP-72564018 CDM 0270 RC outpatient 3854.5 3854.5 3854.5 74 2852.33 percent of total billed charges 3854.5 93 3122.15 percent of total billed charges 3854.5 3854.5 other OPPS APC 3854.5 3854.5 other OPPS APC 3854.5 27.63 1065 percent of total billed charges 3854.5 3854.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 196MM 11-HOLE TITANIUM ALLOY RIGHT PROXIMAL HUMERUS F/4.5MM SCREW SUP-72571211 CDM 0270 RC outpatient 7852 7852 7852 74 5810.48 percent of total billed charges 7852 93 6360.12 percent of total billed charges 7852 7852 other OPPS APC 7852 7852 other OPPS APC 7852 27.63 2169.51 percent of total billed charges 7852 7852 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS L 115 MM FEMUR LEFT DISTAL MEDIAL 5 HOLE STERILE LATEX FREE 3.4 MM SCREW SUP-72573102 CDM 0270 RC outpatient 5889 5889 5889 74 4357.86 percent of total billed charges 5889 93 4770.09 percent of total billed charges 5889 5889 other OPPS APC 5889 5889 other OPPS APC 5889 27.63 1627.13 percent of total billed charges 5889 5889 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS L 115 MM FEMUR RIGHT DISTAL MEDIAL 5 HOLE STERILE LATEX FREE 3.4 MM SCREW SUP-72573202 CDM 0270 RC outpatient 5889 5889 5889 74 4357.86 percent of total billed charges 5889 93 4770.09 percent of total billed charges 5889 5889 other OPPS APC 5889 5889 other OPPS APC 5889 27.63 1627.13 percent of total billed charges 5889 5889 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS 209MM 11-HOLE TITANIUM ALLOY LEFT LATERAL PROXIMAL TIBIA F/4.5MM SCREW STERILE SUP-72575111 CDM 0270 RC outpatient 7696 7696 7696 74 5695.04 percent of total billed charges 7696 93 6233.76 percent of total billed charges 7696 7696 other OPPS APC 7696 7696 other OPPS APC 7696 27.63 2126.4 percent of total billed charges 7696 7696 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE STAINLESS STEEL EVOS WITH CRIMP SUP-72580000 CDM 0270 RC outpatient 1605.5 1605.5 1605.5 74 1188.07 percent of total billed charges 1605.5 93 1300.46 percent of total billed charges 1605.5 1605.5 other OPPS APC 1605.5 1605.5 other OPPS APC 1605.5 27.63 443.6 percent of total billed charges 1605.5 1605.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS L 147MM 4 HOLE UTILITY STERILE LATEX FREE 3.5MM/4.5MM SCREW SUP-72581004 CDM 0270 RC outpatient 12090 12090 12090 74 8946.6 percent of total billed charges 12090 93 9792.9 percent of total billed charges 12090 12090 other OPPS APC 12090 12090 other OPPS APC 12090 27.63 3340.47 percent of total billed charges 12090 12090 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS L 297 MM FEMUR LEFT DISTAL 14 HOLE STERILE LATEX FREE 3.5/4.5 MM SCREW PERIPROSTHETIC SUP-72585114 CDM 0270 RC outpatient 14488.5 14488.5 14488.5 74 10721.5 percent of total billed charges 14488.5 93 11735.7 percent of total billed charges 14488.5 14488.5 other OPPS APC 14488.5 14488.5 other OPPS APC 14488.5 27.63 4003.17 percent of total billed charges 14488.5 14488.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS L 333MM FEMUR LEFT DISTAL 16 HOLE 3.5/4.5 MM SCREW PERIPROSTHETIC SUP-72585116 CDM 0270 RC outpatient 14891.5 14891.5 14891.5 74 11019.7 percent of total billed charges 14891.5 93 12062.1 percent of total billed charges 14891.5 14891.5 other OPPS APC 14891.5 14891.5 other OPPS APC 14891.5 27.63 4114.52 percent of total billed charges 14891.5 14891.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVOS 3.5/4.5 PP DIS FEM PL R 14H 297MM SUP-72585214 CDM 0270 RC outpatient 14488.5 14488.5 14488.5 74 10721.5 percent of total billed charges 14488.5 93 11735.7 percent of total billed charges 14488.5 14488.5 other OPPS APC 14488.5 14488.5 other OPPS APC 14488.5 27.63 4003.17 percent of total billed charges 14488.5 14488.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE EVOS L 333MM FEMUR RIGHT DISTAL 16 HOLE 3.5/4.5 MM PERIPROSTHETIC SUP-72585216 CDM 0270 RC outpatient 14891.5 14891.5 14891.5 74 11019.7 percent of total billed charges 14891.5 93 12062.1 percent of total billed charges 14891.5 14891.5 other OPPS APC 14891.5 14891.5 other OPPS APC 14891.5 27.63 4114.52 percent of total billed charges 14891.5 14891.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON 15.0D SUP-72670 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON IOL 15.0D SUP-72670 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE VLP LARGE L62 MM X W33.5 MM X H1.27 MM FOOT RIGHT CALCANEUS STERILE 2.7 MM SCREW PERCUTANEOUS SUP-72821021S CDM 0270 RC outpatient 2756 2756 2756 74 2039.44 percent of total billed charges 2756 93 2232.36 percent of total billed charges 2756 2756 other OPPS APC 2756 2756 other OPPS APC 2756 27.63 761.48 percent of total billed charges 2756 2756 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE VLP MEDIUM L 57.7 MM X W 33.5MM X H 1.27 MM FOOT LEFT CALCANEUS STERILE 2.7MM SCREW PERCUTANEOUS SUP-72821036S CDM 0270 RC outpatient 2631.2 2631.2 2631.2 74 1947.09 percent of total billed charges 2631.2 93 2131.27 percent of total billed charges 2631.2 2631.2 other OPPS APC 2631.2 2631.2 other OPPS APC 2631.2 27.63 727 percent of total billed charges 2631.2 2631.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 16 MM OD 2.7 MM CORTICAL SELF TAP LOCK SUP-72823116 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 18 MM OF 2.7 MM FOREFOOT MIDFOOT CORTEX SELF TAP LOCK LOW PROFILE HEXAGONAL NONSTERILE PERI-LOC VLP SUP-72823118 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L22 MM OD 2.7 MM CORTICAL SELF TAP LOCK SUP-72823122 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 24 MM OD 2.7 MM CORTICAL SELF TAP LOCK SUP-72823124 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 26 MM OD 2.7MM CORTICAL SELF TAP LOCK SUP-72823126 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL L 28MM OD 2.7 MM CORTICAL SELF TAP LOCK SUP-72823128 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD L 26 MM OD 4 MM CORTICAL OSTEOPENIA SUP-72823226 CDM 0270 RC outpatient 162.24 162.24 162.24 74 120.06 percent of total billed charges 162.24 93 131.41 percent of total billed charges 162.24 162.24 other OPPS APC 162.24 162.24 other OPPS APC 162.24 27.63 44.83 percent of total billed charges 162.24 162.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD L 28 MM OD 4 MM COTRICAL OSTEOPENIA SUP-72823228 CDM 0270 RC outpatient 162.24 162.24 162.24 74 120.06 percent of total billed charges 162.24 93 131.41 percent of total billed charges 162.24 162.24 other OPPS APC 162.24 162.24 other OPPS APC 162.24 27.63 44.83 percent of total billed charges 162.24 162.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD L 30 MM OD 4 MM ODSEC 4.9MM FOOT LOW PROFILE HEXAGONAL NONSTERILE PERI-LOC VLP OSTEOPENIA SUP-72823230 CDM 0270 RC outpatient 162.24 162.24 162.24 74 120.06 percent of total billed charges 162.24 93 131.41 percent of total billed charges 162.24 162.24 other OPPS APC 162.24 162.24 other OPPS APC 162.24 27.63 44.83 percent of total billed charges 162.24 162.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD L32 MM OD4 MM CORTICAL OSTEOPENIA SUP-72823232 CDM 0270 RC outpatient 162.24 162.24 162.24 74 120.06 percent of total billed charges 162.24 93 131.41 percent of total billed charges 162.24 162.24 other OPPS APC 162.24 162.24 other OPPS APC 162.24 27.63 44.83 percent of total billed charges 162.24 162.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD L34 MM OD4 MM CORTICAL OSTEOPENIA SUP-72823234 CDM 0270 RC outpatient 162.24 162.24 162.24 74 120.06 percent of total billed charges 162.24 93 131.41 percent of total billed charges 162.24 162.24 other OPPS APC 162.24 162.24 other OPPS APC 162.24 27.63 44.83 percent of total billed charges 162.24 162.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 26 MM OD 4 MM OD SEC 4.9 MM FOOT LOCK LOW PROFILE HEAD PERI-LOC VLP OSTEOPENIA SUP-72823426 CDM 0270 RC outpatient 465.92 465.92 465.92 74 344.78 percent of total billed charges 465.92 93 377.4 percent of total billed charges 465.92 465.92 other OPPS APC 465.92 465.92 other OPPS APC 465.92 27.63 128.73 percent of total billed charges 465.92 465.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 28 MM OD 4 MM OD SEC 4.9 MM FOOT LOCK LOW PROFILE HEAD PERI-LOC VLP OSTEOPENIA SUP-72823428 CDM 0270 RC outpatient 465.92 465.92 465.92 74 344.78 percent of total billed charges 465.92 93 377.4 percent of total billed charges 465.92 465.92 other OPPS APC 465.92 465.92 other OPPS APC 465.92 27.63 128.73 percent of total billed charges 465.92 465.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L30 MM OD4 MM CORTICAL LOCK OSTEOPENIA SUP-72823430 CDM 0270 RC outpatient 465.92 465.92 465.92 74 344.78 percent of total billed charges 465.92 93 377.4 percent of total billed charges 465.92 465.92 other OPPS APC 465.92 465.92 other OPPS APC 465.92 27.63 128.73 percent of total billed charges 465.92 465.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L32 MM OD4 MM CORTICAL LOCK OSTEOPENIA SUP-72823432 CDM 0270 RC outpatient 465.92 465.92 465.92 74 344.78 percent of total billed charges 465.92 93 377.4 percent of total billed charges 465.92 465.92 other OPPS APC 465.92 465.92 other OPPS APC 465.92 27.63 128.73 percent of total billed charges 465.92 465.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L 34 MM OD 4 MM OD SEC 4.9 MM FOOT LOCK LOW PROFILE HEAD PERI-LOC VLP OSTEOPENIA SUP-72823434 CDM 0270 RC outpatient 465.92 465.92 465.92 74 344.78 percent of total billed charges 465.92 93 377.4 percent of total billed charges 465.92 465.92 other OPPS APC 465.92 465.92 other OPPS APC 465.92 27.63 128.73 percent of total billed charges 465.92 465.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE FULL THREAD L 36 MM OD 4 MM CORTICAL LOCK OSTEOPENIA SUP-72823436 CDM 0270 RC outpatient 465.92 465.92 465.92 74 344.78 percent of total billed charges 465.92 93 377.4 percent of total billed charges 465.92 465.92 other OPPS APC 465.92 465.92 other OPPS APC 465.92 27.63 128.73 percent of total billed charges 465.92 465.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP 15D 2.5 MM L28 MM X H 3.3MM OD 5MM ODSEC 5.4MM MIDFOOT HINDFOOT LOCKING LOW PROFILE HEAD HEXAGONAL RECESS DRIVE OSTEOPENIA SUP-72823528 CDM 0270 RC outpatient 465.92 465.92 465.92 74 344.78 percent of total billed charges 465.92 93 377.4 percent of total billed charges 465.92 465.92 other OPPS APC 465.92 465.92 other OPPS APC 465.92 27.63 128.73 percent of total billed charges 465.92 465.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP 15D 2.5 MM L30 MM X H 3.3MM OD 5MM ODSEC 5.4MM MIDFOOT HINDFOOT LOCKING LOW PROFILE HEAD HEXAGONAL RECESS DRIVE OSTEOPENIA SUP-72823530 CDM 0270 RC outpatient 465.92 465.92 465.92 74 344.78 percent of total billed charges 465.92 93 377.4 percent of total billed charges 465.92 465.92 other OPPS APC 465.92 465.92 other OPPS APC 465.92 27.63 128.73 percent of total billed charges 465.92 465.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP 15D 2.5 MM L32 MM X H 3.3MM OD 5MM ODSEC 5.4MM MIDFOOT HINDFOOT LOCKING LOW PROFILE HEAD HEXAGONAL RECESS DRIVE OSTEOPENIA SUP-72823532 CDM 0270 RC outpatient 465.92 465.92 465.92 74 344.78 percent of total billed charges 465.92 93 377.4 percent of total billed charges 465.92 465.92 other OPPS APC 465.92 465.92 other OPPS APC 465.92 27.63 128.73 percent of total billed charges 465.92 465.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP 5MM 34MM LOCKING STAINLESS STEEL HEX RECESS 15 DEG ANGLED MID/HINDFOOT F/OSTEOPENIA STERILE SUP-72823534 CDM 0270 RC outpatient 465.92 465.92 465.92 74 344.78 percent of total billed charges 465.92 93 377.4 percent of total billed charges 465.92 465.92 other OPPS APC 465.92 465.92 other OPPS APC 465.92 27.63 128.73 percent of total billed charges 465.92 465.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP 15D 2.5 MM L36 MM X H 3.3MM OD 5MM ODSEC 5.4MM MIDFOOT HINDFOOT LOCKING LOW PROFILE HEAD HEXAGONAL RECESS DRIVE OSTEOPENIA SUP-72823536 CDM 0270 RC outpatient 465.92 465.92 465.92 74 344.78 percent of total billed charges 465.92 93 377.4 percent of total billed charges 465.92 465.92 other OPPS APC 465.92 465.92 other OPPS APC 465.92 27.63 128.73 percent of total billed charges 465.92 465.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE VLP STAINLESS STEEL 8 MM SPACE 1/4 TUBULAR L 55.8 MM X W 8 MM X H 1.5 MM FOOT 7 HOLE STERILE 2.7 MM SCREW SUP-72824010S CDM 0270 RC outpatient 1060.8 1060.8 1060.8 74 784.99 percent of total billed charges 1060.8 93 859.25 percent of total billed charges 1060.8 1060.8 other OPPS APC 1060.8 1060.8 other OPPS APC 1060.8 27.63 293.1 percent of total billed charges 1060.8 1060.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE VLP STAINLESS STEEL LARGE L 67.7 MM X W 36.2 MM X H 1.27 MM FOOT L CALCANEOUS STERILE 3.5MM SCREW SUP-72824030S CDM 0270 RC outpatient 2293.2 2293.2 2293.2 74 1696.97 percent of total billed charges 2293.2 93 1857.49 percent of total billed charges 2293.2 2293.2 other OPPS APC 2293.2 2293.2 other OPPS APC 2293.2 27.63 633.61 percent of total billed charges 2293.2 2293.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PERI-LOC VLP 36.2MM X 67.7MM F/3.5MM SCREW 1.27MM THK STERILE VARIABLE ANGLE LOCKING RIGHT CALCANEAL COUNTOURED LARGE STAINLESS STEEL SUP-72824031 CDM 0270 RC outpatient 2293.2 2293.2 2293.2 74 1696.97 percent of total billed charges 2293.2 93 1857.49 percent of total billed charges 2293.2 2293.2 other OPPS APC 2293.2 2293.2 other OPPS APC 2293.2 27.63 633.61 percent of total billed charges 2293.2 2293.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SPHERX II PREBENT 25MM 5.5MM TITANIUM SUP-7292025 CDM 270010020 LOCAL 0270 RC outpatient 1053 1053 1053 74 779.22 percent of total billed charges 1053 93 852.93 percent of total billed charges 1053 1053 other OPPS APC 1053 1053 other OPPS APC 1053 27.63 290.94 percent of total billed charges 1053 1053 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON 22.5D SUP-72993 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON IOL 22.5D SUP-72993 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE MICRO #7515 SUP-73-00001 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE MINI #6900 SUP-73-00003 CDM 0272 RC outpatient 22.64 22.64 22.64 74 16.75 percent of total billed charges 22.64 93 18.34 percent of total billed charges 22.64 22.64 other OPPS APC 22.64 22.64 other OPPS APC 22.64 27.63 6.26 percent of total billed charges 22.64 22.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EYE CAUTERY SUP-73-00006 CDM 0272 RC outpatient 39.74 39.74 39.74 74 29.41 percent of total billed charges 39.74 93 32.19 percent of total billed charges 39.74 39.74 other OPPS APC 39.74 39.74 other OPPS APC 39.74 27.63 10.98 percent of total billed charges 39.74 39.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WECK-CEL STICKS SUP-73-00018 CDM 0272 RC outpatient 2.55 2.55 2.55 74 1.89 percent of total billed charges 2.55 93 2.07 percent of total billed charges 2.55 2.55 other OPPS APC 2.55 2.55 other OPPS APC 2.55 27.63 0.7 percent of total billed charges 2.55 2.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYPERFLEX TRACH TUBE SZ-6 SUP-73-00040 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYPERFLEX TRACH TUBE SZ-7 SUP-73-00041 CDM 0272 RC outpatient 685.55 685.55 685.55 74 507.31 percent of total billed charges 685.55 93 555.3 percent of total billed charges 685.55 685.55 other OPPS APC 685.55 685.55 other OPPS APC 685.55 27.63 189.42 percent of total billed charges 685.55 685.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYPERFLEX TRACH TUBE SZ-8 SUP-73-00042 CDM 0272 RC outpatient 675.55 675.55 675.55 74 499.91 percent of total billed charges 675.55 93 547.2 percent of total billed charges 675.55 675.55 other OPPS APC 675.55 675.55 other OPPS APC 675.55 27.63 186.65 percent of total billed charges 675.55 675.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE BEAVER 6700 SUP-73-00043 CDM 0272 RC outpatient 1.71 1.71 1.71 74 1.27 percent of total billed charges 1.71 93 1.39 percent of total billed charges 1.71 1.71 other OPPS APC 1.71 1.71 other OPPS APC 1.71 27.63 0.47 percent of total billed charges 1.71 1.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK EYE DR MUNRO SUP-73-00044 CDM 0272 RC outpatient 127.42 127.42 127.42 74 94.29 percent of total billed charges 127.42 93 103.21 percent of total billed charges 127.42 127.42 other OPPS APC 127.42 127.42 other OPPS APC 127.42 27.63 35.21 percent of total billed charges 127.42 127.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BETADINE SOLUTION 5% SUP-73-00045 CDM 0272 RC outpatient 41 41 41 74 30.34 percent of total billed charges 41 93 33.21 percent of total billed charges 41 41 other OPPS APC 41 41 other OPPS APC 41 27.63 11.33 percent of total billed charges 41 41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDRODISSECTOR-FLATTENED ANGLED 8 X 25 SUP-73-00047 CDM 0272 RC outpatient 3.59 3.59 3.59 74 2.66 percent of total billed charges 3.59 93 2.91 percent of total billed charges 3.59 3.59 other OPPS APC 3.59 3.59 other OPPS APC 3.59 27.63 0.99 percent of total billed charges 3.59 3.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CYSTOTOME FORMED PEARCE 25G SUP-73-00048 CDM 0272 RC outpatient 2.88 2.88 2.88 74 2.13 percent of total billed charges 2.88 93 2.33 percent of total billed charges 2.88 2.88 other OPPS APC 2.88 2.88 other OPPS APC 2.88 27.63 0.8 percent of total billed charges 2.88 2.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHANG FLAT TIP ANGLED 90 27G SUP-73-00049 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VICRYL 8-0 J974G SUP-73-00051 CDM 0272 RC outpatient 57.75 57.75 57.75 74 42.74 percent of total billed charges 57.75 93 46.78 percent of total billed charges 57.75 57.75 other OPPS APC 57.75 57.75 other OPPS APC 57.75 27.63 15.96 percent of total billed charges 57.75 57.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VICRYL 9-0 TAPER V402G SUP-73-00054 CDM 0272 RC outpatient 63.41 63.41 63.41 74 46.92 percent of total billed charges 63.41 93 51.36 percent of total billed charges 63.41 63.41 other OPPS APC 63.41 63.41 other OPPS APC 63.41 27.63 17.52 percent of total billed charges 63.41 63.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VICRYL 8-0 TAPER J401G SUP-73-00055 CDM 0272 RC outpatient 52.92 52.92 52.92 74 39.16 percent of total billed charges 52.92 93 42.87 percent of total billed charges 52.92 52.92 other OPPS APC 52.92 52.92 other OPPS APC 52.92 27.63 14.62 percent of total billed charges 52.92 52.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISP 20G VITRECTOMY CUTTER & SLEEVE SUP-73-00057 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IRIS RETRACTORS SUP-73-00059 CDM 0272 RC outpatient 344.75 344.75 344.75 74 255.12 percent of total billed charges 344.75 93 279.25 percent of total billed charges 344.75 344.75 other OPPS APC 344.75 344.75 other OPPS APC 344.75 27.63 95.25 percent of total billed charges 344.75 344.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VISION BLUE SUP-73-00067 CDM 0272 RC outpatient 280.35 280.35 280.35 74 207.46 percent of total billed charges 280.35 93 227.08 percent of total billed charges 280.35 280.35 other OPPS APC 280.35 280.35 other OPPS APC 280.35 27.63 77.46 percent of total billed charges 280.35 280.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AHMED GLAUCOMA VALVE SUP-73-00069 CDM C1783 HCPCS 0278 RC outpatient 1725 1725 1725 57 983.25 percent of total billed charges 1725 93 1397.25 percent of total billed charges 1725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1725 other OPPS APC 1725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1725 other OPPS APC 1725 51 879.75 percent of total billed charges 1725 1725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUTOPLAST PATCH SUP-73-00070 CDM C1783 HCPCS 0278 RC outpatient 810 810 810 57 461.7 percent of total billed charges 810 93 656.1 percent of total billed charges 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 51 413.1 percent of total billed charges 810 810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE 10-0 NYLON DOUBLE ARM SUP-73-00071 CDM 0272 RC outpatient 81.67 81.67 81.67 74 60.44 percent of total billed charges 81.67 93 66.15 percent of total billed charges 81.67 81.67 other OPPS APC 81.67 81.67 other OPPS APC 81.67 27.63 22.57 percent of total billed charges 81.67 81.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUSION OP071 SUP-73-00072 CDM 0272 RC outpatient 188.38 188.38 188.38 74 139.4 percent of total billed charges 188.38 93 152.59 percent of total billed charges 188.38 188.38 other OPPS APC 188.38 188.38 other OPPS APC 188.38 27.63 52.05 percent of total billed charges 188.38 188.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MALYUGIN RING 6.25MM SUP-73-00073 CDM 0272 RC outpatient 510.42 510.42 510.42 74 377.71 percent of total billed charges 510.42 93 413.44 percent of total billed charges 510.42 510.42 other OPPS APC 510.42 510.42 other OPPS APC 510.42 27.63 141.03 percent of total billed charges 510.42 510.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MALYUGIN RING 7.0MM SUP-73-00074 CDM 0272 RC outpatient 495.83 495.83 495.83 74 366.91 percent of total billed charges 495.83 93 401.62 percent of total billed charges 495.83 495.83 other OPPS APC 495.83 495.83 other OPPS APC 495.83 27.63 137 percent of total billed charges 495.83 495.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAMINAR PHACO TIP& INFUSION SLEEVE SUP-73-00076 CDM 0272 RC outpatient 210 210 210 74 155.4 percent of total billed charges 210 93 170.1 percent of total billed charges 210 210 other OPPS APC 210 210 other OPPS APC 210 27.63 58.02 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAPSULAR TENSION RING 12MM SUP-73-00078 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAPSULAR TENSION RING 13MM SUP-73-00079 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ISTENT INJECT SUP-73-00081 CDM C1783 HCPCS 0278 RC outpatient 5687.5 5687.5 5687.5 57 3241.88 percent of total billed charges 5687.5 93 4606.88 percent of total billed charges 5687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5687.5 other OPPS APC 5687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5687.5 other OPPS APC 5687.5 51 2900.63 percent of total billed charges 5687.5 5687.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STERNALOCK BLU STRAIGHT STERNUM 8 HOLE SUP-73-1952 CDM 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STERNALOCK BLU L8 MM OD2.4 MM STERNUM CANCELLOUS SELF DRILL LOCK GOLD PRIMARY CLOSURE SYSTEM SUP-73-2408 CDM 0270 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 27.63 21.55 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 2.4MM 10MM STERNALOCK BLU STERNUM CANCELLOUS SELF DRILL LOCK GOLD PRIMARY SUP-73-2410 CDM 0270 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 27.63 21.55 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STERNALOCK BLU L12 MM OD2.4 MM STERNUM CANCELLOUS SELF DRILL LOCK GOLD PRIMARY CLOSURE SYSTEM SUP-73-2412 CDM 0270 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 27.63 21.55 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STERNALOCK BLU L14 MM OD2.4 MM STERNUM CANCELLOUS SELF DRILL LOCK GOLD PRIMARY CLOSURE SYSTEM SUP-73-2414 CDM 0270 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 27.63 21.55 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STERNALOCK BLU L16 MM OD2.4 MM STERNUM CANCELLOUS SELF DRILL LOCK GOLD PRIMARY CLOSURE SYSTEM SUP-73-2416 CDM 0270 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 27.63 21.55 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STERNALOCK BLU L18 MM OD2.4 MM STERNUM CANCELLOUS SELF DRILL LOCK GOLD PRIMARY CLOSURE SYSTEM SUP-73-2418 CDM 0270 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 27.63 21.55 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STERNALOCK BLU L20 MM OD2.4 MM STERNUM CANCELLOUS SELF DRILL LOCK GOLD PRIMARY CLOSURE SYSTEM SUP-73-2420 CDM 0270 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 27.63 21.55 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STERNALOCK BLU SQUARE STERNUM 4 HOLE 2 SIDE LOW PROFILE SUP-73-2622 CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STERNALOCK BLU STERNUM 8 HOLE SUP-73-2623 CDM 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STERNALOCK BLU NARROW STERNUM 12 HOLE 2.4 MM SCREW SUP-73-2632 CDM 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STERNALOCK BLU WIDE STERNUM 12 HOLE 2.4 MM SCREW SUP-73-2634 CDM 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STERNALOCK BLU STRAIGHT STERNUM 4 HOLE 2.4 MM SCREW SUP-73-2636 CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STERNALOCK BLU 100D L STERNUM 4 HOLE 2 SIDE LOW PROFILE SUP-73-2643 CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STERNALOCK BLU STERNUM JL SUP-73-2645 CDM 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STERNALOCK BLU L8 MM OD2.7 MM STERNUM CANCELLOUS SELF DRILL LOCK MAGENTA PRIMARY CLOSURE SYSTEM SUP-73-2708 CDM 0270 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 27.63 21.55 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STERNALOCK BLU L10 MM OD2.7 MM STERNUM CANCELLOUS SELF DRILL LOCK MAGENTA PRIMARY CLOSURE SYSTEM SUP-73-2710 CDM 0270 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 27.63 21.55 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STERNALOCK BLU L12 MM OD2.7 MM STERNUM CANCELLOUS SELF DRILL LOCK MAGENTA PRIMARY CLOSURE SYSTEM SUP-73-2712 CDM 0270 RC outpatient 123.06 123.06 123.06 74 91.06 percent of total billed charges 123.06 93 99.68 percent of total billed charges 123.06 123.06 other OPPS APC 123.06 123.06 other OPPS APC 123.06 27.63 34 percent of total billed charges 123.06 123.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STERNALOCK BLU L14 MM OD2.7 MM STERNUM CANCELLOUS SELF DRILL LOCK MAGENTA PRIMARY CLOSURE SYSTEM SUP-73-2714 CDM 0270 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 27.63 21.55 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STERNALOCK BLU L16 MM OD2.7 MM STERNUM CANCELLOUS SELF DRILL LOCK MAGENTA PRIMARY CLOSURE SYSTEM SUP-73-2716 CDM 0270 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 27.63 21.55 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STERNALOCK BLU L18 MM OD2.7 MM STERNUM CANCELLOUS SELF DRILL LOCK MAGENTA PRIMARY CLOSURE SYSTEM SUP-73-2718 CDM 0270 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 27.63 21.55 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STERNALOCK BLU L20 MM OD2.7 MM STERNUM CANCELLOUS SELF DRILL LOCK MAGENTA PRIMARY CLOSURE SYSTEM SUP-73-2720 CDM 0270 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 27.63 21.55 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL CARPENTIER-EDWARDS PERIMOUNT MAGNA OD25 MM HEART BIOPROSTHESIS EASE SUP-7300TFX25MM CDM 0270 RC outpatient 16380 16380 16380 74 12121.2 percent of total billed charges 16380 93 13267.8 percent of total billed charges 16380 16380 other OPPS APC 16380 16380 other OPPS APC 16380 27.63 4525.79 percent of total billed charges 16380 16380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL CARPENTIER-EDWARDS PERIMOUNT MAGNA OD27 MM HEART BIOPROSTHESIS SUP-7300TFX27 CDM 0270 RC outpatient 16380 16380 16380 74 12121.2 percent of total billed charges 16380 93 13267.8 percent of total billed charges 16380 16380 other OPPS APC 16380 16380 other OPPS APC 16380 27.63 4525.79 percent of total billed charges 16380 16380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL CARPENTIER-EDWARDS PERIMOUNT MAGNA PERICARDIAL OD29 MM HEART EASE SUP-7300TFX29 CDM 0270 RC outpatient 16900 16900 16900 74 12506 percent of total billed charges 16900 93 13689 percent of total billed charges 16900 16900 other OPPS APC 16900 16900 other OPPS APC 16900 27.63 4669.47 percent of total billed charges 16900 16900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL CARPENTIER-EDWARDS PERIMOUNT MAGNA OD31 MM HEART BIOPROSTHESIS EASE SUP-7300TFX31 CDM 0270 RC outpatient 16900 16900 16900 74 12506 percent of total billed charges 16900 93 13689 percent of total billed charges 16900 16900 other OPPS APC 16900 16900 other OPPS APC 16900 27.63 4669.47 percent of total billed charges 16900 16900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL 33MM CARPENTIER-EDWARDS PERIMOUNT MAGNA HEART PERICARDIAL EASE SUP-7300TFX33MM CDM 0270 RC outpatient 16900 16900 16900 74 12506 percent of total billed charges 16900 93 13689 percent of total billed charges 16900 16900 other OPPS APC 16900 16900 other OPPS APC 16900 27.63 4669.47 percent of total billed charges 16900 16900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VSI .018 GUIDEWIRE SUP-7301 CDM 0481 RC outpatient 58.5 58.5 58.5 74 43.29 percent of total billed charges 58.5 93 47.39 percent of total billed charges 58.5 58.5 other OPPS APC 58.5 58.5 other OPPS APC 58.5 51 29.84 percent of total billed charges 58.5 58.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL LUBRI-SIL IC 24FR 30CC BACTI-GUARD SILICONE HYDROGEL DISPOSABLE STERILE LF 3 WAY FOLEY BALLOON SUP-73024SI CDM outpatient 34.06 34.06 34.06 34.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPONGE GAUZE KERLIX WOVEN COTTON MEDIUM L6 3/4 IN X W6 IN LINT FREE SUPER ABSORBENT STERILE LATEX FREE SUP-7310 CDM 0270 RC outpatient 0.27 0.27 0.27 74 0.2 percent of total billed charges 0.27 93 0.22 percent of total billed charges 0.27 0.27 other OPPS APC 0.27 0.27 other OPPS APC 0.27 27.63 0.07 percent of total billed charges 0.27 0.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPONGE SURGICAL VISTEC 4X4IN BLUE WHITE GAUZE STERILE LF 16 PLY RADIOPAQUE LOW LINT BAND SUP-7317 CDM 0270 RC outpatient 0.13 0.13 0.13 74 0.1 percent of total billed charges 0.13 93 0.11 percent of total billed charges 0.13 0.13 other OPPS APC 0.13 0.13 other OPPS APC 0.13 27.63 0.04 percent of total billed charges 0.13 0.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HANDLE LIGHT HALOGEN 6V L3 FT RECTUM CORD LATEX FREE DISPOSABLE ANOSCOPE SIGMOIDOSCOPE SUP-73211 CDM 0270 RC outpatient 214.81 214.81 214.81 74 158.96 percent of total billed charges 214.81 93 174 percent of total billed charges 214.81 214.81 other OPPS APC 214.81 214.81 other OPPS APC 214.81 27.63 59.35 percent of total billed charges 214.81 214.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PORT IMPLANTABLE INFUSION VACCESS CT 6FR TITANIUM POLYURETHANE POWER INJECTABLE LOW PROFILE SILICONE FILL SUTURE PLUG SUP-7360000 CDM 0270 RC outpatient 481 481 481 74 355.94 percent of total billed charges 481 93 389.61 percent of total billed charges 481 481 other OPPS APC 481 481 other OPPS APC 481 27.63 132.9 percent of total billed charges 481 481 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE PLASTER SPECIALIST PLASTER OF PARIS L3 YD X W2 IN EXTRA FAST SET SMOOTH FINISH MOISTURE RESISTANT LOW EXOTHERM LATEX FREE SUP-7362 CDM 0270 RC outpatient 1.85 1.85 1.85 74 1.37 percent of total billed charges 1.85 93 1.5 percent of total billed charges 1.85 1.85 other OPPS APC 1.85 1.85 other OPPS APC 1.85 27.63 0.51 percent of total billed charges 1.85 1.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE PLASTER SPECIALIST PLASTER OF PARIS L3 YD X W3 IN EXTRA FAST SET SMOOTH FINISH MOISTURE RESISTANT LOW EXOTHERM LATEX FREE SUP-7363 CDM 270009228 LOCAL 0270 RC outpatient 4.97 4.97 4.97 74 3.68 percent of total billed charges 4.97 93 4.03 percent of total billed charges 4.97 4.97 other OPPS APC 4.97 4.97 other OPPS APC 4.97 27.63 1.37 percent of total billed charges 4.97 4.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE PLASTER SPECIALIST PLASTER OF PARIS L5 YD X W4 IN EXTRA FAST SET SMOOTH FINISH MOISTURE RESISTANT LOW EXOTHERM LATEX FREE SUP-7367 CDM 0270 RC outpatient 3.28 3.28 3.28 74 2.43 percent of total billed charges 3.28 93 2.66 percent of total billed charges 3.28 3.28 other OPPS APC 3.28 3.28 other OPPS APC 3.28 27.63 0.91 percent of total billed charges 3.28 3.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE PLASTER SPECIALIST PLASTER OF PARIS L5 YD X W6 IN EXTRA FAST SET SMOOTH FINISH MOISTURE RESISTANT LOW EXOTHERM LATEX FREE SUP-7368 CDM 0270 RC outpatient 4.32 4.32 4.32 74 3.2 percent of total billed charges 4.32 93 3.5 percent of total billed charges 4.32 4.32 other OPPS APC 4.32 4.32 other OPPS APC 4.32 27.63 1.19 percent of total billed charges 4.32 4.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE PLASTER SPECIALIST PLASTER OF PARIS L5 YD X W5 IN EXTRA FAST SET SMOOTH FINISH MOISTURE RESISTANT LOW EXOTHERM LATEX FREE SUP-7369 CDM 0270 RC outpatient 3.93 3.93 3.93 74 2.91 percent of total billed charges 3.93 93 3.18 percent of total billed charges 3.93 3.93 other OPPS APC 3.93 3.93 other OPPS APC 3.93 27.63 1.09 percent of total billed charges 3.93 3.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE PLASTER SPECIALIST PLASTER OF PARIS L3 YD X W3 IN FAST SET SMOOTH FINISH MOISTURE RESISTANT LOW EXOTHERM LATEX FREE SUP-7373 CDM 270009040 LOCAL 0270 RC outpatient 3.42 3.42 3.42 74 2.53 percent of total billed charges 3.42 93 2.77 percent of total billed charges 3.42 3.42 other OPPS APC 3.42 3.42 other OPPS APC 3.42 27.63 0.94 percent of total billed charges 3.42 3.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC T25 L30MM OD 4.5MM CORTEX SELF TAP LOCK SUP-73826030 CDM 0270 RC outpatient 63.28 63.28 63.28 74 46.83 percent of total billed charges 63.28 93 51.26 percent of total billed charges 63.28 63.28 other OPPS APC 63.28 63.28 other OPPS APC 63.28 27.63 17.48 percent of total billed charges 63.28 63.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC t 25 L 32 MM OD 4.5 MM CORTEX SELF TAP NONSTERILE SUP-73826032 CDM 0270 RC outpatient 63.28 63.28 63.28 74 46.83 percent of total billed charges 63.28 93 51.26 percent of total billed charges 63.28 63.28 other OPPS APC 63.28 63.28 other OPPS APC 63.28 27.63 17.48 percent of total billed charges 63.28 63.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC T25 L 34 MM OD 4.5 MM CORTEX SELF-TAP SUP-73826034 CDM 0270 RC outpatient 63.28 63.28 63.28 74 46.83 percent of total billed charges 63.28 93 51.26 percent of total billed charges 63.28 63.28 other OPPS APC 63.28 63.28 other OPPS APC 63.28 27.63 17.48 percent of total billed charges 63.28 63.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC T25 L 36 MM OD 4.5 CORTEX SELF-TAP SUP-73826036 CDM 0270 RC outpatient 63.28 63.28 63.28 74 46.83 percent of total billed charges 63.28 93 51.26 percent of total billed charges 63.28 63.28 other OPPS APC 63.28 63.28 other OPPS APC 63.28 27.63 17.48 percent of total billed charges 63.28 63.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC T25 L42MM OD 4.5MM CORTEX SELF TAP LOCK SUP-73826042 CDM 0270 RC outpatient 63.28 63.28 63.28 74 46.83 percent of total billed charges 63.28 93 51.26 percent of total billed charges 63.28 63.28 other OPPS APC 63.28 63.28 other OPPS APC 63.28 27.63 17.48 percent of total billed charges 63.28 63.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOCT25 L 48 MM OD 4.5 MM CORTEX SELF TAP SUP-73826048 CDM 0270 RC outpatient 63.28 63.28 63.28 74 46.83 percent of total billed charges 63.28 93 51.26 percent of total billed charges 63.28 63.28 other OPPS APC 63.28 63.28 other OPPS APC 63.28 27.63 17.48 percent of total billed charges 63.28 63.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC STAINLESS STEEL T25 L90MM OD 4.5MM CORTEX SELF TAP SUP-73826090 CDM 0270 RC outpatient 114.92 114.92 114.92 74 85.04 percent of total billed charges 114.92 93 93.09 percent of total billed charges 114.92 114.92 other OPPS APC 114.92 114.92 other OPPS APC 114.92 27.63 31.75 percent of total billed charges 114.92 114.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC T25 L 10 MM OD 4.5 MM BLUNT TIP SUP-73827010 CDM 0270 RC outpatient 386.67 386.67 386.67 74 286.14 percent of total billed charges 386.67 93 313.2 percent of total billed charges 386.67 386.67 other OPPS APC 386.67 386.67 other OPPS APC 386.67 27.63 106.84 percent of total billed charges 386.67 386.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC T25 L20MM OD 4.5MM SELF TAP LOCK SUP-73827020 CDM 0270 RC outpatient 386.67 386.67 386.67 74 286.14 percent of total billed charges 386.67 93 313.2 percent of total billed charges 386.67 386.67 other OPPS APC 386.67 386.67 other OPPS APC 386.67 27.63 106.84 percent of total billed charges 386.67 386.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC T25 L 26 MM OD 4.5 MM SELf-TAP LOCK SUP-73827026 CDM 0270 RC outpatient 386.67 386.67 386.67 74 286.14 percent of total billed charges 386.67 93 313.2 percent of total billed charges 386.67 386.67 other OPPS APC 386.67 386.67 other OPPS APC 386.67 27.63 106.84 percent of total billed charges 386.67 386.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC T25 L30MM OD 4.5MM SELF TAP LOCK SUP-73827030 CDM 0270 RC outpatient 386.67 386.67 386.67 74 286.14 percent of total billed charges 386.67 93 313.2 percent of total billed charges 386.67 386.67 other OPPS APC 386.67 386.67 other OPPS APC 386.67 27.63 106.84 percent of total billed charges 386.67 386.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC T25 L32MM OD 4.5MM SELF TAP LOCK SUP-73827032 CDM 0270 RC outpatient 386.67 386.67 386.67 74 286.14 percent of total billed charges 386.67 93 313.2 percent of total billed charges 386.67 386.67 other OPPS APC 386.67 386.67 other OPPS APC 386.67 27.63 106.84 percent of total billed charges 386.67 386.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC T25 L34MM OD 4.5MM SELF TAP LOCK SUP-73827034 CDM 0270 RC outpatient 386.67 386.67 386.67 74 286.14 percent of total billed charges 386.67 93 313.2 percent of total billed charges 386.67 386.67 other OPPS APC 386.67 386.67 other OPPS APC 386.67 27.63 106.84 percent of total billed charges 386.67 386.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC T25 L 36 MM OD 4.5 MM SELF TAP LOCK SUP-73827036 CDM 0270 RC outpatient 386.67 386.67 386.67 74 286.14 percent of total billed charges 386.67 93 313.2 percent of total billed charges 386.67 386.67 other OPPS APC 386.67 386.67 other OPPS APC 386.67 27.63 106.84 percent of total billed charges 386.67 386.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC T25 L66MM OD 4.5MM SELF TAP LOCK SUP-73827066 CDM 0270 RC outpatient 386.67 386.67 386.67 74 286.14 percent of total billed charges 386.67 93 313.2 percent of total billed charges 386.67 386.67 other OPPS APC 386.67 386.67 other OPPS APC 386.67 27.63 106.84 percent of total billed charges 386.67 386.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC T25 L70MM OD 4.5MM SELF TAP LOCK SUP-73827070 CDM 0270 RC outpatient 386.67 386.67 386.67 74 286.14 percent of total billed charges 386.67 93 313.2 percent of total billed charges 386.67 386.67 other OPPS APC 386.67 386.67 other OPPS APC 386.67 27.63 106.84 percent of total billed charges 386.67 386.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI LOC t 25 L 72 MM OD 4.5 MM SELF TAP LOCK SUP-73827072 CDM 0270 RC outpatient 386.67 386.67 386.67 74 286.14 percent of total billed charges 386.67 93 313.2 percent of total billed charges 386.67 386.67 other OPPS APC 386.67 386.67 other OPPS APC 386.67 27.63 106.84 percent of total billed charges 386.67 386.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC T20 CUT FLUTE L76 MM OD 4.5 MM ODSEC 3.5MM CORTICAL SELF TAP LOCK 3 LEAD THREAD 3 FLUTE SUP-73827076 CDM 0270 RC outpatient 386.67 386.67 386.67 74 286.14 percent of total billed charges 386.67 93 313.2 percent of total billed charges 386.67 386.67 other OPPS APC 386.67 386.67 other OPPS APC 386.67 27.63 106.84 percent of total billed charges 386.67 386.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC T25 L 78 MM OD 4.5 MM SELF TAP LOCK SUP-73827078 CDM 0270 RC outpatient 386.67 386.67 386.67 74 286.14 percent of total billed charges 386.67 93 313.2 percent of total billed charges 386.67 386.67 other OPPS APC 386.67 386.67 other OPPS APC 386.67 27.63 106.84 percent of total billed charges 386.67 386.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC T25 L80MM OD 4.5MM SELF TAP LOCK SUP-73827080 CDM 0270 RC outpatient 386.67 386.67 386.67 74 286.14 percent of total billed charges 386.67 93 313.2 percent of total billed charges 386.67 386.67 other OPPS APC 386.67 386.67 other OPPS APC 386.67 27.63 106.84 percent of total billed charges 386.67 386.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC T25 L85MM OD 4.5MM SELF TAP LOCK SUP-73827085 CDM 0270 RC outpatient 386.67 386.67 386.67 74 286.14 percent of total billed charges 386.67 93 313.2 percent of total billed charges 386.67 386.67 other OPPS APC 386.67 386.67 other OPPS APC 386.67 27.63 106.84 percent of total billed charges 386.67 386.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC T25 PARTIAL THREAD L 75MM OD 6.5 MM CANCELLOUS SUP-73828175 CDM 0270 RC outpatient 97.34 97.34 97.34 74 72.03 percent of total billed charges 97.34 93 78.85 percent of total billed charges 97.34 97.34 other OPPS APC 97.34 97.34 other OPPS APC 97.34 27.63 26.9 percent of total billed charges 97.34 97.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE PERI-LOC T25 PARTIAL THREAD L 80 MM OD 6.5 MM CANCELLOUS SUP-73828180 CDM 0270 RC outpatient 97.34 97.34 97.34 74 72.03 percent of total billed charges 97.34 93 78.85 percent of total billed charges 97.34 97.34 other OPPS APC 97.34 97.34 other OPPS APC 97.34 27.63 26.9 percent of total billed charges 97.34 97.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPECTRE STRAIGHT TIP GUIDEWIRE 190CM SUP-7386 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT CAST SPECIALIST PLASTER OF PARIS L15 IN X W3 IN EXTRA FAST SET SMOOTH FINISH MOISTURE RESISTANT LOW EXOTHERM LATEX FREE SUP-7390 CDM outpatient 0.42 0.42 0.42 0.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT CAST SPECIALIST PLASTER OF PARIS L15 IN X W4 IN EXTRA FAST SET SMOOTH FINISH MOISTURE RESISTANT LOW EXOTHERM LATEX FREE SUP-7391 CDM 0270 RC outpatient 0.36 0.36 0.36 74 0.27 percent of total billed charges 0.36 93 0.29 percent of total billed charges 0.36 0.36 other OPPS APC 0.36 0.36 other OPPS APC 0.36 27.63 0.1 percent of total billed charges 0.36 0.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT CAST SPECIALIST PLASTER OF PARIS L30 IN X W5 IN EXTRA FAST SET SMOOTH FINISH MOISTURE RESISTANT LOW EXOTHERM LATEX FREE SUP-7392 CDM 0270 RC outpatient 0.78 0.78 0.78 74 0.58 percent of total billed charges 0.78 93 0.63 percent of total billed charges 0.78 0.78 other OPPS APC 0.78 0.78 other OPPS APC 0.78 27.63 0.22 percent of total billed charges 0.78 0.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAMINECTOMY PATTIE 1/2 X 1 SUP-74-00005 CDM 0272 RC outpatient 62.8 62.8 62.8 74 46.47 percent of total billed charges 62.8 93 50.87 percent of total billed charges 62.8 62.8 other OPPS APC 62.8 62.8 other OPPS APC 62.8 27.63 17.35 percent of total billed charges 62.8 62.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAMINECTOMY PATTIE 3/4 X 3/4 SUP-74-00007 CDM 0272 RC outpatient 27.22 27.22 27.22 74 20.14 percent of total billed charges 27.22 93 22.05 percent of total billed charges 27.22 27.22 other OPPS APC 27.22 27.22 other OPPS APC 27.22 27.63 7.52 percent of total billed charges 27.22 27.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAVACUATOR TUBE SZ 36 FR FOR R SUP-74-00017 CDM 0272 RC outpatient 38.6 38.6 38.6 74 28.56 percent of total billed charges 38.6 93 31.27 percent of total billed charges 38.6 38.6 other OPPS APC 38.6 38.6 other OPPS APC 38.6 27.63 10.67 percent of total billed charges 38.6 38.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE DERMATOME SUP-74-00018 CDM 0272 RC outpatient 154 154 154 74 113.96 percent of total billed charges 154 93 124.74 percent of total billed charges 154 154 other OPPS APC 154 154 other OPPS APC 154 27.63 42.55 percent of total billed charges 154 154 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DERMACARRIER SUP-74-00021 CDM 0272 RC outpatient 167.6 167.6 167.6 74 124.02 percent of total billed charges 167.6 93 135.76 percent of total billed charges 167.6 167.6 other OPPS APC 167.6 167.6 other OPPS APC 167.6 27.63 46.31 percent of total billed charges 167.6 167.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAINS MINI SYNDER 10 X 20 SUP-74-00022 CDM 0272 RC outpatient 47.17 47.17 47.17 74 34.91 percent of total billed charges 47.17 93 38.21 percent of total billed charges 47.17 47.17 other OPPS APC 47.17 47.17 other OPPS APC 47.17 27.63 13.03 percent of total billed charges 47.17 47.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAINS THORACIC 32 FR SUP-74-00028 CDM 0272 RC outpatient 40.68 40.68 40.68 74 30.1 percent of total billed charges 40.68 93 32.95 percent of total billed charges 40.68 40.68 other OPPS APC 40.68 40.68 other OPPS APC 40.68 27.63 11.24 percent of total billed charges 40.68 40.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAINS THORACIC 36 FR SUP-74-00029 CDM 0272 RC outpatient 4 4 4 74 2.96 percent of total billed charges 4 93 3.24 percent of total billed charges 4 4 other OPPS APC 4 4 other OPPS APC 4 27.63 1.11 percent of total billed charges 4 4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUFFS SURGICAL SUP-74-00031 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ISOLATION BAGS (3M) 10/EA SUP-74-00032 CDM 0272 RC outpatient 2.79 2.79 2.79 74 2.06 percent of total billed charges 2.79 93 2.26 percent of total billed charges 2.79 2.79 other OPPS APC 2.79 2.79 other OPPS APC 2.79 27.63 0.77 percent of total billed charges 2.79 2.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONE STAR RETRACTOR STAYS-5MM SUP-74-00033 CDM 0272 RC outpatient 121.15 121.15 121.15 74 89.65 percent of total billed charges 121.15 93 98.13 percent of total billed charges 121.15 121.15 other OPPS APC 121.15 121.15 other OPPS APC 121.15 27.63 33.47 percent of total billed charges 121.15 121.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONE STAR RECTAL RETRACTOR 3/B SUP-74-00034 CDM 0272 RC outpatient 222.62 222.62 222.62 74 164.74 percent of total billed charges 222.62 93 180.32 percent of total billed charges 222.62 222.62 other OPPS APC 222.62 222.62 other OPPS APC 222.62 27.63 61.51 percent of total billed charges 222.62 222.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FISH LG VISCERA RETAINER SUP-74-00046 CDM 0272 RC outpatient 160 160 160 74 118.4 percent of total billed charges 160 93 129.6 percent of total billed charges 160 160 other OPPS APC 160 160 other OPPS APC 160 27.63 44.21 percent of total billed charges 160 160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3/16 PERROTA DRAIN SUP-74-00050 CDM 0272 RC outpatient 72.38 72.38 72.38 74 53.56 percent of total billed charges 72.38 93 58.63 percent of total billed charges 72.38 72.38 other OPPS APC 72.38 72.38 other OPPS APC 72.38 27.63 20 percent of total billed charges 72.38 72.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BULB ONLY FOR HEMAVAC'S SUP-74-00051 CDM 0272 RC outpatient 2.6 2.6 2.6 74 1.92 percent of total billed charges 2.6 93 2.11 percent of total billed charges 2.6 2.6 other OPPS APC 2.6 2.6 other OPPS APC 2.6 27.63 0.72 percent of total billed charges 2.6 2.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHOLANGIOCATH (5/KITS) ARROW SUP-74-00054 CDM 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 385 other OPPS APC 385 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHOLANGIOGRAPHY CANNULA UNIT R SUP-74-00055 CDM 0272 RC outpatient 130.9 130.9 130.9 74 96.87 percent of total billed charges 130.9 93 106.03 percent of total billed charges 130.9 130.9 other OPPS APC 130.9 130.9 other OPPS APC 130.9 27.63 36.17 percent of total billed charges 130.9 130.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SKIN STAPLER 35W ROTATOR SUP-74-00061 CDM 0272 RC outpatient 70.7 70.7 70.7 74 52.32 percent of total billed charges 70.7 93 57.27 percent of total billed charges 70.7 70.7 other OPPS APC 70.7 70.7 other OPPS APC 70.7 27.63 19.53 percent of total billed charges 70.7 70.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD PROXIMATE TX 30MM BLUE SUP-74-00063 CDM 0272 RC outpatient 144.36 144.36 144.36 74 106.83 percent of total billed charges 144.36 93 116.93 percent of total billed charges 144.36 144.36 other OPPS APC 144.36 144.36 other OPPS APC 144.36 27.63 39.89 percent of total billed charges 144.36 144.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER 60MM SUP-74-00068 CDM 0272 RC outpatient 274.84 274.84 274.84 74 203.38 percent of total billed charges 274.84 93 222.62 percent of total billed charges 274.84 274.84 other OPPS APC 274.84 274.84 other OPPS APC 274.84 27.63 75.94 percent of total billed charges 274.84 274.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XR60 RELOAD SUP-74-00071 CDM 0272 RC outpatient 157.04 157.04 157.04 74 116.21 percent of total billed charges 157.04 93 127.2 percent of total billed charges 157.04 157.04 other OPPS APC 157.04 157.04 other OPPS APC 157.04 27.63 43.39 percent of total billed charges 157.04 157.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TCR10 RELOAD SUP-74-00073 CDM 0272 RC outpatient 156.86 156.86 156.86 74 116.08 percent of total billed charges 156.86 93 127.06 percent of total billed charges 156.86 156.86 other OPPS APC 156.86 156.86 other OPPS APC 156.86 27.63 43.34 percent of total billed charges 156.86 156.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRUCUT 4 IN. SUP-74-00076 CDM 0272 RC outpatient 60.79 60.79 60.79 74 44.98 percent of total billed charges 60.79 93 49.24 percent of total billed charges 60.79 60.79 other OPPS APC 60.79 60.79 other OPPS APC 60.79 27.63 16.8 percent of total billed charges 60.79 60.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAUT PERITONEAL INTRADUCER CAT SUP-74-00079 CDM 0272 RC outpatient 82.36 82.36 82.36 74 60.95 percent of total billed charges 82.36 93 66.71 percent of total billed charges 82.36 82.36 other OPPS APC 82.36 82.36 other OPPS APC 82.36 27.63 22.76 percent of total billed charges 82.36 82.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ESMARK 4 SUP-74-00082 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ESMARK 6 SUP-74-00083 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRYKER PULSA-VAC SYSTEM SUP-74-00089 CDM 0272 RC outpatient 119.9 119.9 119.9 74 88.73 percent of total billed charges 119.9 93 97.12 percent of total billed charges 119.9 119.9 other OPPS APC 119.9 119.9 other OPPS APC 119.9 27.63 33.13 percent of total billed charges 119.9 119.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "12 "" A.T.S. DISP CUFF W/SLEEVE" SUP-74-00092 CDM 0272 RC outpatient 89.79 89.79 89.79 74 66.44 percent of total billed charges 89.79 93 72.73 percent of total billed charges 89.79 89.79 other OPPS APC 89.79 89.79 other OPPS APC 89.79 27.63 24.81 percent of total billed charges 89.79 89.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHIELD SPLASH SPRAY TIP SUP-74-00107 CDM 0272 RC outpatient 30.19 30.19 30.19 74 22.34 percent of total billed charges 30.19 93 24.45 percent of total billed charges 30.19 30.19 other OPPS APC 30.19 30.19 other OPPS APC 30.19 27.63 8.34 percent of total billed charges 30.19 30.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHIELD SPLASH TIP W/SOFT CONE SUP-74-00108 CDM 0272 RC outpatient 48.1 48.1 48.1 74 35.59 percent of total billed charges 48.1 93 38.96 percent of total billed charges 48.1 48.1 other OPPS APC 48.1 48.1 other OPPS APC 48.1 27.63 13.29 percent of total billed charges 48.1 48.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEXTRUS FIXED LENGTH ACES RETRACTOR-MED SUP-74-00115 CDM 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER CONTOUR SUP-74-00118 CDM 0272 RC outpatient 1511.5 1511.5 1511.5 74 1118.51 percent of total billed charges 1511.5 93 1224.32 percent of total billed charges 1511.5 1511.5 other OPPS APC 1511.5 1511.5 other OPPS APC 1511.5 27.63 417.63 percent of total billed charges 1511.5 1511.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER RELOAD CONTOUR GREEN SUP-74-00119 CDM 0272 RC outpatient 858.94 858.94 858.94 74 635.62 percent of total billed charges 858.94 93 695.74 percent of total billed charges 858.94 858.94 other OPPS APC 858.94 858.94 other OPPS APC 858.94 27.63 237.33 percent of total billed charges 858.94 858.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER PROXIMATE PPH SUP-74-00120 CDM 0272 RC outpatient 1192.59 1192.59 1192.59 74 882.52 percent of total billed charges 1192.59 93 966 percent of total billed charges 1192.59 1192.59 other OPPS APC 1192.59 1192.59 other OPPS APC 1192.59 27.63 329.51 percent of total billed charges 1192.59 1192.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVACUATION PLUME AWAY SMOKE SUP-74-00121 CDM 0272 RC outpatient 86 86 86 74 63.64 percent of total billed charges 86 93 69.66 percent of total billed charges 86 86 other OPPS APC 86 86 other OPPS APC 86 27.63 23.76 percent of total billed charges 86 86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRANSOBTURATOR KIT SUP-74-00128 CDM C1781 HCPCS 0278 RC outpatient 3962.5 3962.5 3962.5 57 2258.63 percent of total billed charges 3962.5 93 3209.63 percent of total billed charges 3962.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3962.5 other OPPS APC 3962.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3962.5 other OPPS APC 3962.5 51 2020.88 percent of total billed charges 3962.5 3962.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CT CLOSURE SYSTEM STD SUP-74-00133 CDM 0272 RC outpatient 551.12 551.12 551.12 74 407.83 percent of total billed charges 551.12 93 446.41 percent of total billed charges 551.12 551.12 other OPPS APC 551.12 551.12 other OPPS APC 551.12 27.63 152.27 percent of total billed charges 551.12 551.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CT CLOSURE SYSTEM XL SUP-74-00134 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSTRUMENT WIPES SUP-74-00137 CDM 0272 RC outpatient 2.25 2.25 2.25 74 1.67 percent of total billed charges 2.25 93 1.82 percent of total billed charges 2.25 2.25 other OPPS APC 2.25 2.25 other OPPS APC 2.25 27.63 0.62 percent of total billed charges 2.25 2.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR C-SECTION ALEXIS LG SUP-74-00138 CDM 0272 RC outpatient 192.5 192.5 192.5 74 142.45 percent of total billed charges 192.5 93 155.93 percent of total billed charges 192.5 192.5 other OPPS APC 192.5 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GROUNDING PAD (LEEP) SUP-74-00149 CDM 0272 RC outpatient 2.59 2.59 2.59 74 1.92 percent of total billed charges 2.59 93 2.1 percent of total billed charges 2.59 2.59 other OPPS APC 2.59 2.59 other OPPS APC 2.59 27.63 0.72 percent of total billed charges 2.59 2.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ETHIBOND 0 CX45D SUP-74-00151 CDM 0272 RC outpatient 49.01 49.01 49.01 74 36.27 percent of total billed charges 49.01 93 39.7 percent of total billed charges 49.01 49.01 other OPPS APC 49.01 49.01 other OPPS APC 49.01 27.63 13.54 percent of total billed charges 49.01 49.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE SILK 3-0 C013D SUP-74-00164 CDM 0272 RC outpatient 31.99 31.99 31.99 74 23.67 percent of total billed charges 31.99 93 25.91 percent of total billed charges 31.99 31.99 other OPPS APC 31.99 31.99 other OPPS APC 31.99 27.63 8.84 percent of total billed charges 31.99 31.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE PROLENE 2-0 8833H SUP-74-00178 CDM 0272 RC outpatient 3.31 3.31 3.31 74 2.45 percent of total billed charges 3.31 93 2.68 percent of total billed charges 3.31 3.31 other OPPS APC 3.31 3.31 other OPPS APC 3.31 27.63 0.91 percent of total billed charges 3.31 3.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WRAP SHOULDER W/COLD PACKS SUP-74-00179 CDM 0272 RC outpatient 72 72 72 74 53.28 percent of total billed charges 72 93 58.32 percent of total billed charges 72 72 other OPPS APC 72 72 other OPPS APC 72 27.63 19.89 percent of total billed charges 72 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE PROLENE 6-0 8610H SUP-74-00184 CDM 0272 RC outpatient 65.52 65.52 65.52 74 48.48 percent of total billed charges 65.52 93 53.07 percent of total billed charges 65.52 65.52 other OPPS APC 65.52 65.52 other OPPS APC 65.52 27.63 18.1 percent of total billed charges 65.52 65.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELETROSURG PENCIL FOR FOOT SWITCH SUP-74-00194 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE COUNTER DOUBLE FOAM SUP-74-00201 CDM 0272 RC outpatient 1.59 1.59 1.59 74 1.18 percent of total billed charges 1.59 93 1.29 percent of total billed charges 1.59 1.59 other OPPS APC 1.59 1.59 other OPPS APC 1.59 27.63 0.44 percent of total billed charges 1.59 1.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG 1L PRESSURE INFUSER 1000CC LF SUP-74-00205 CDM 0272 RC outpatient 27.88 27.88 27.88 74 20.63 percent of total billed charges 27.88 93 22.58 percent of total billed charges 27.88 27.88 other OPPS APC 27.88 27.88 other OPPS APC 27.88 27.63 7.7 percent of total billed charges 27.88 27.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE 30 CUTTING LOOP 22FR SUP-74-00211 CDM 0272 RC outpatient 643.58 643.58 643.58 74 476.25 percent of total billed charges 643.58 93 521.3 percent of total billed charges 643.58 643.58 other OPPS APC 643.58 643.58 other OPPS APC 643.58 27.63 177.82 percent of total billed charges 643.58 643.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ACHIEVE BIOPSY 16G X 11 SUP-74-00213 CDM 0272 RC outpatient 153.45 153.45 153.45 74 113.55 percent of total billed charges 153.45 93 124.29 percent of total billed charges 153.45 153.45 other OPPS APC 153.45 153.45 other OPPS APC 153.45 27.63 42.4 percent of total billed charges 153.45 153.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ACHIEVE BIOPSY 16G X 20 SUP-74-00214 CDM 0272 RC outpatient 156.31 156.31 156.31 74 115.67 percent of total billed charges 156.31 93 126.61 percent of total billed charges 156.31 156.31 other OPPS APC 156.31 156.31 other OPPS APC 156.31 27.63 43.19 percent of total billed charges 156.31 156.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ACHIEVE BIOPSY 18G X20 SUP-74-00215 CDM 0272 RC outpatient 162.62 162.62 162.62 74 120.34 percent of total billed charges 162.62 93 131.72 percent of total billed charges 162.62 162.62 other OPPS APC 162.62 162.62 other OPPS APC 162.62 27.63 44.93 percent of total billed charges 162.62 162.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN ABRAMSON TRIPLE LUMEN SUMP SUP-74-00216 CDM 0272 RC outpatient 122.84 122.84 122.84 74 90.9 percent of total billed charges 122.84 93 99.5 percent of total billed charges 122.84 122.84 other OPPS APC 122.84 122.84 other OPPS APC 122.84 27.63 33.94 percent of total billed charges 122.84 122.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "RECY 12"" A.T.S DISP CUFF W/O SLEEVE" SUP-74-00220 CDM 0272 RC outpatient 36.08 36.08 36.08 74 26.7 percent of total billed charges 36.08 93 29.22 percent of total billed charges 36.08 36.08 other OPPS APC 36.08 36.08 other OPPS APC 36.08 27.63 9.97 percent of total billed charges 36.08 36.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TOURNIQUET 18"" A.T.S DISP CUFF W/O SLEEVE" SUP-74-00221 CDM 0272 RC outpatient 36.08 36.08 36.08 74 26.7 percent of total billed charges 36.08 93 29.22 percent of total billed charges 36.08 36.08 other OPPS APC 36.08 36.08 other OPPS APC 36.08 27.63 9.97 percent of total billed charges 36.08 36.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "34"" A.T.S DISP CUFF W/O SLEEVE" SUP-74-00222 CDM 0272 RC outpatient 36.08 36.08 36.08 74 26.7 percent of total billed charges 36.08 93 29.22 percent of total billed charges 36.08 36.08 other OPPS APC 36.08 36.08 other OPPS APC 36.08 27.63 9.97 percent of total billed charges 36.08 36.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NASAL DRESSING HOLDER SUP-74-00224 CDM 0272 RC outpatient 3.69 3.69 3.69 74 2.73 percent of total billed charges 3.69 93 2.99 percent of total billed charges 3.69 3.69 other OPPS APC 3.69 3.69 other OPPS APC 3.69 27.63 1.02 percent of total billed charges 3.69 3.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POLY ORTHO BUTTON SUP-74-00228 CDM 0272 RC outpatient 2.04 2.04 2.04 74 1.51 percent of total billed charges 2.04 93 1.65 percent of total billed charges 2.04 2.04 other OPPS APC 2.04 2.04 other OPPS APC 2.04 27.63 0.56 percent of total billed charges 2.04 2.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4-0 FIBER LOOP SUP-74-00229 CDM 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 200 other OPPS APC 200 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERWIRE 5 AR-7211 SUP-74-00230 CDM 0272 RC outpatient 160 160 160 74 118.4 percent of total billed charges 160 93 129.6 percent of total billed charges 160 160 other OPPS APC 160 160 other OPPS APC 160 27.63 44.21 percent of total billed charges 160 160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ACHIEVE BIOPSY 14G X 15 SUP-74-00231 CDM 0272 RC outpatient 174.68 174.68 174.68 74 129.26 percent of total billed charges 174.68 93 141.49 percent of total billed charges 174.68 174.68 other OPPS APC 174.68 174.68 other OPPS APC 174.68 27.63 48.26 percent of total billed charges 174.68 174.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ENDOLOOP PDSII EZ10G SUP-74-00233 CDM 0272 RC outpatient 138.08 138.08 138.08 74 102.18 percent of total billed charges 138.08 93 111.84 percent of total billed charges 138.08 138.08 other OPPS APC 138.08 138.08 other OPPS APC 138.08 27.63 38.15 percent of total billed charges 138.08 138.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ETHIBOND 5 MB66G SUP-74-00234 CDM 0272 RC outpatient 57.13 57.13 57.13 74 42.28 percent of total billed charges 57.13 93 46.28 percent of total billed charges 57.13 57.13 other OPPS APC 57.13 57.13 other OPPS APC 57.13 27.63 15.79 percent of total billed charges 57.13 57.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ETHIBOND 5 MB47G SUP-74-00235 CDM 0272 RC outpatient 69.63 69.63 69.63 74 51.53 percent of total billed charges 69.63 93 56.4 percent of total billed charges 69.63 69.63 other OPPS APC 69.63 69.63 other OPPS APC 69.63 27.63 19.24 percent of total billed charges 69.63 69.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ETHIBOND 2 MX69G SUP-74-00236 CDM 0272 RC outpatient 56.59 56.59 56.59 74 41.88 percent of total billed charges 56.59 93 45.84 percent of total billed charges 56.59 56.59 other OPPS APC 56.59 56.59 other OPPS APC 56.59 27.63 15.64 percent of total billed charges 56.59 56.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERWIRE 2 AR-7200 BX/12 SUP-74-00243 CDM C1713 HCPCS 0278 RC outpatient 88 88 88 57 50.16 percent of total billed charges 88 93 71.28 percent of total billed charges 88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 88 other OPPS APC 88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 88 other OPPS APC 88 51 44.88 percent of total billed charges 88 88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERWIRE 2 AR-7201 BX/12 SUP-74-00244 CDM 0272 RC outpatient 140 140 140 74 103.6 percent of total billed charges 140 93 113.4 percent of total billed charges 140 140 other OPPS APC 140 140 other OPPS APC 140 27.63 38.68 percent of total billed charges 140 140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERWIRE 2 AR-7206 BX/12 SUP-74-00245 CDM C1713 HCPCS 0278 RC outpatient 88 88 88 57 50.16 percent of total billed charges 88 93 71.28 percent of total billed charges 88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 88 other OPPS APC 88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 88 other OPPS APC 88 51 44.88 percent of total billed charges 88 88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERWIRE 2-0 AR-7220 BX12 SUP-74-00246 CDM C1713 HCPCS 0278 RC outpatient 88 88 88 57 50.16 percent of total billed charges 88 93 71.28 percent of total billed charges 88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 88 other OPPS APC 88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 88 other OPPS APC 88 51 44.88 percent of total billed charges 88 88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE MAYO 1/2 CIRCLE #5 SUP-74-00247 CDM 0272 RC outpatient 23.82 23.82 23.82 74 17.63 percent of total billed charges 23.82 93 19.29 percent of total billed charges 23.82 23.82 other OPPS APC 23.82 23.82 other OPPS APC 23.82 27.63 6.58 percent of total billed charges 23.82 23.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE SILK 3-0 M3T SUP-74-00297 CDM 0272 RC outpatient 26.2 26.2 26.2 74 19.39 percent of total billed charges 26.2 93 21.22 percent of total billed charges 26.2 26.2 other OPPS APC 26.2 26.2 other OPPS APC 26.2 27.63 7.24 percent of total billed charges 26.2 26.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VLOC 180 VLOCA006L SUP-74-00305 CDM 0272 RC outpatient 428.82 428.82 428.82 74 317.33 percent of total billed charges 428.82 93 347.34 percent of total billed charges 428.82 428.82 other OPPS APC 428.82 428.82 other OPPS APC 428.82 27.63 118.48 percent of total billed charges 428.82 428.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VICRYL 2-0 J443H SUP-74-00319 CDM 0272 RC outpatient 1.85 1.85 1.85 74 1.37 percent of total billed charges 1.85 93 1.5 percent of total billed charges 1.85 1.85 other OPPS APC 1.85 1.85 other OPPS APC 1.85 27.63 0.51 percent of total billed charges 1.85 1.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN ROUND SILICONE HUBLESS 19FR SUP-74-00349 CDM 0272 RC outpatient 258.92 258.92 258.92 74 191.6 percent of total billed charges 258.92 93 209.73 percent of total billed charges 258.92 258.92 other OPPS APC 258.92 258.92 other OPPS APC 258.92 27.63 71.54 percent of total billed charges 258.92 258.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ENDOSTITCH 0 48IN VIOLET SUP-74-00361 CDM 0272 RC outpatient 233.84 233.84 233.84 74 173.04 percent of total billed charges 233.84 93 189.41 percent of total billed charges 233.84 233.84 other OPPS APC 233.84 233.84 other OPPS APC 233.84 27.63 64.61 percent of total billed charges 233.84 233.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ENDOSTITCH 0 48IN GREEN (ORANGE) SUP-74-00362 CDM 0272 RC outpatient 252.89 252.89 252.89 74 187.14 percent of total billed charges 252.89 93 204.84 percent of total billed charges 252.89 252.89 other OPPS APC 252.89 252.89 other OPPS APC 252.89 27.63 69.87 percent of total billed charges 252.89 252.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "RECY 24"" A.T.S DISP CUFF W/O SLEEVE" SUP-74-00370 CDM 0272 RC outpatient 36.08 36.08 36.08 74 26.7 percent of total billed charges 36.08 93 29.22 percent of total billed charges 36.08 36.08 other OPPS APC 36.08 36.08 other OPPS APC 36.08 27.63 9.97 percent of total billed charges 36.08 36.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VLOC 90 VLOCM0124 SUP-74-00371 CDM 0272 RC outpatient 89.45 89.45 89.45 74 66.19 percent of total billed charges 89.45 93 72.45 percent of total billed charges 89.45 89.45 other OPPS APC 89.45 89.45 other OPPS APC 89.45 27.63 24.72 percent of total billed charges 89.45 89.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SUTURE MONOCRYL 3/0 27"" Y416H" SUP-74-00373 CDM 0272 RC outpatient 1.94 1.94 1.94 74 1.44 percent of total billed charges 1.94 93 1.57 percent of total billed charges 1.94 1.94 other OPPS APC 1.94 1.94 other OPPS APC 1.94 27.63 0.54 percent of total billed charges 1.94 1.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VTI SURGICAL DOPPLER SUP-74-00375 CDM 0272 RC outpatient 503.13 503.13 503.13 74 372.32 percent of total billed charges 503.13 93 407.54 percent of total billed charges 503.13 503.13 other OPPS APC 503.13 503.13 other OPPS APC 503.13 27.63 139.01 percent of total billed charges 503.13 503.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VESSEL CLUDE SUP-74-00377 CDM 0272 RC outpatient 44.8 44.8 44.8 74 33.15 percent of total billed charges 44.8 93 36.29 percent of total billed charges 44.8 44.8 other OPPS APC 44.8 44.8 other OPPS APC 44.8 27.63 12.38 percent of total billed charges 44.8 44.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOPOUCH CATCH SPECIMEN 15MM SUP-74-00380 CDM 0272 RC outpatient 920 920 920 74 680.8 percent of total billed charges 920 93 745.2 percent of total billed charges 920 920 other OPPS APC 920 920 other OPPS APC 920 27.63 254.2 percent of total billed charges 920 920 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE **USE 95-04482** SUP-74-00385 CDM 0272 RC outpatient 3.88 3.88 3.88 74 2.87 percent of total billed charges 3.88 93 3.14 percent of total billed charges 3.88 3.88 other OPPS APC 3.88 3.88 other OPPS APC 3.88 27.63 1.07 percent of total billed charges 3.88 3.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY EDLICH TUBE 34FR SUP-74-00387 CDM 0272 RC outpatient 32.76 32.76 32.76 74 24.24 percent of total billed charges 32.76 93 26.54 percent of total billed charges 32.76 32.76 other OPPS APC 32.76 32.76 other OPPS APC 32.76 27.63 9.05 percent of total billed charges 32.76 32.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR WOUND PROTECTOR ALEXIS SMALL SUP-74-00388 CDM 0272 RC outpatient 144 144 144 74 106.56 percent of total billed charges 144 93 116.64 percent of total billed charges 144 144 other OPPS APC 144 144 other OPPS APC 144 27.63 39.79 percent of total billed charges 144 144 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER ECHELON 60MM SUP-74-00389 CDM 0272 RC outpatient 1167.04 1167.04 1167.04 74 863.61 percent of total billed charges 1167.04 93 945.3 percent of total billed charges 1167.04 1167.04 other OPPS APC 1167.04 1167.04 other OPPS APC 1167.04 27.63 322.45 percent of total billed charges 1167.04 1167.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD ECHELON 60MM WHITE SUP-74-00390 CDM 0272 RC outpatient 648.35 648.35 648.35 74 479.78 percent of total billed charges 648.35 93 525.16 percent of total billed charges 648.35 648.35 other OPPS APC 648.35 648.35 other OPPS APC 648.35 27.63 179.14 percent of total billed charges 648.35 648.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD ECHELON 60MM BLUE SUP-74-00391 CDM 0272 RC outpatient 614.46 614.46 614.46 74 454.7 percent of total billed charges 614.46 93 497.71 percent of total billed charges 614.46 614.46 other OPPS APC 614.46 614.46 other OPPS APC 614.46 27.63 169.78 percent of total billed charges 614.46 614.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD ECHELON 60MM GREEN SUP-74-00393 CDM 0272 RC outpatient 654.84 654.84 654.84 74 484.58 percent of total billed charges 654.84 93 530.42 percent of total billed charges 654.84 654.84 other OPPS APC 654.84 654.84 other OPPS APC 654.84 27.63 180.93 percent of total billed charges 654.84 654.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD ECHELON 60MM BLACK SUP-74-00394 CDM 0272 RC outpatient 614.46 614.46 614.46 74 454.7 percent of total billed charges 614.46 93 497.71 percent of total billed charges 614.46 614.46 other OPPS APC 614.46 614.46 other OPPS APC 614.46 27.63 169.78 percent of total billed charges 614.46 614.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE LINE SEAMGUARD SUP-74-00395 CDM 0272 RC outpatient 583.33 583.33 583.33 74 431.66 percent of total billed charges 583.33 93 472.5 percent of total billed charges 583.33 583.33 other OPPS APC 583.33 583.33 other OPPS APC 583.33 27.63 161.17 percent of total billed charges 583.33 583.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAUTERY TIP 0014 SUP-74-00398 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SELF- SEALING CAP HYSTEROSCOPE SUP-74-00401 CDM 0272 RC outpatient 55.97 55.97 55.97 74 41.42 percent of total billed charges 55.97 93 45.34 percent of total billed charges 55.97 55.97 other OPPS APC 55.97 55.97 other OPPS APC 55.97 27.63 15.46 percent of total billed charges 55.97 55.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER ECHELON STANDARD SUP-74-00402 CDM 0272 RC outpatient 1178.71 1178.71 1178.71 74 872.25 percent of total billed charges 1178.71 93 954.76 percent of total billed charges 1178.71 1178.71 other OPPS APC 1178.71 1178.71 other OPPS APC 1178.71 27.63 325.68 percent of total billed charges 1178.71 1178.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER EEA CIRCULAR SUP-74-00406 CDM 0272 RC outpatient 1603.13 1603.13 1603.13 74 1186.32 percent of total billed charges 1603.13 93 1298.54 percent of total billed charges 1603.13 1603.13 other OPPS APC 1603.13 1603.13 other OPPS APC 1603.13 27.63 442.94 percent of total billed charges 1603.13 1603.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER EEA CIRCULAR XLONG SUP-74-00407 CDM 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER HANDLE GIA 4 SUP-74-00408 CDM 0272 RC outpatient 1207.07 1207.07 1207.07 74 893.23 percent of total billed charges 1207.07 93 977.73 percent of total billed charges 1207.07 1207.07 other OPPS APC 1207.07 1207.07 other OPPS APC 1207.07 27.63 333.51 percent of total billed charges 1207.07 1207.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD GIA 60MM MED THICK SUP-74-00409 CDM 0272 RC outpatient 1480.77 1480.77 1480.77 74 1095.77 percent of total billed charges 1480.77 93 1199.42 percent of total billed charges 1480.77 1480.77 other OPPS APC 1480.77 1480.77 other OPPS APC 1480.77 27.63 409.14 percent of total billed charges 1480.77 1480.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD GIA 60MM VASC MED THICK SUP-74-00410 CDM 0272 RC outpatient 1503.38 1503.38 1503.38 74 1112.5 percent of total billed charges 1503.38 93 1217.74 percent of total billed charges 1503.38 1503.38 other OPPS APC 1503.38 1503.38 other OPPS APC 1503.38 27.63 415.38 percent of total billed charges 1503.38 1503.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD GIA 45MM VASC XTRA THIN SUP-74-00411 CDM 0272 RC outpatient 1700.27 1700.27 1700.27 74 1258.2 percent of total billed charges 1700.27 93 1377.22 percent of total billed charges 1700.27 1700.27 other OPPS APC 1700.27 1700.27 other OPPS APC 1700.27 27.63 469.78 percent of total billed charges 1700.27 1700.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD RADIAL MED THICK SUP-74-00412 CDM 0272 RC outpatient 1988.72 1988.72 1988.72 74 1471.65 percent of total billed charges 1988.72 93 1610.86 percent of total billed charges 1988.72 1988.72 other OPPS APC 1988.72 1988.72 other OPPS APC 1988.72 27.63 549.48 percent of total billed charges 1988.72 1988.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD GIA 45 SUP-74-00413 CDM 0272 RC outpatient 1486.84 1486.84 1486.84 74 1100.26 percent of total billed charges 1486.84 93 1204.34 percent of total billed charges 1486.84 1486.84 other OPPS APC 1486.84 1486.84 other OPPS APC 1486.84 27.63 410.81 percent of total billed charges 1486.84 1486.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AQUILEX INFLOW /OUTFLOW TUBE SET SUP-74-00414 CDM 0272 RC outpatient 424.55 424.55 424.55 74 314.17 percent of total billed charges 424.55 93 343.89 percent of total billed charges 424.55 424.55 other OPPS APC 424.55 424.55 other OPPS APC 424.55 27.63 117.3 percent of total billed charges 424.55 424.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE FEEDING J MIC 12FR SUP-74-00415 CDM 0272 RC outpatient 467.85 467.85 467.85 74 346.21 percent of total billed charges 467.85 93 378.96 percent of total billed charges 467.85 467.85 other OPPS APC 467.85 467.85 other OPPS APC 467.85 27.63 129.27 percent of total billed charges 467.85 467.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVICEL FLEXIBLE TIP SUP-74-00418 CDM 0272 RC outpatient 103.73 103.73 103.73 74 76.76 percent of total billed charges 103.73 93 84.02 percent of total billed charges 103.73 103.73 other OPPS APC 103.73 103.73 other OPPS APC 103.73 27.63 28.66 percent of total billed charges 103.73 103.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE PROLENE 788G SUP-74-00419 CDM 0272 RC outpatient 75.05 75.05 75.05 74 55.54 percent of total billed charges 75.05 93 60.79 percent of total billed charges 75.05 75.05 other OPPS APC 75.05 75.05 other OPPS APC 75.05 27.63 20.74 percent of total billed charges 75.05 75.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDO APPLICATOR FOR SURGIFLO SUP-74-00420 CDM 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DERMABOND PRINEO 22CM SUP-74-00421 CDM 0272 RC outpatient 293.77 293.77 293.77 74 217.39 percent of total billed charges 293.77 93 237.95 percent of total billed charges 293.77 293.77 other OPPS APC 293.77 293.77 other OPPS APC 293.77 27.63 81.17 percent of total billed charges 293.77 293.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE STRATAFIX PDS CT-1 45CM SUP-74-00422 CDM 0272 RC outpatient 129.79 129.79 129.79 74 96.04 percent of total billed charges 129.79 93 105.13 percent of total billed charges 129.79 129.79 other OPPS APC 129.79 129.79 other OPPS APC 129.79 27.63 35.86 percent of total billed charges 129.79 129.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "18"" A.T.S DISP CUFF W/ SLEEVE" SUP-74-00424 CDM 0272 RC outpatient 1.18 1.18 1.18 74 0.87 percent of total billed charges 1.18 93 0.96 percent of total billed charges 1.18 1.18 other OPPS APC 1.18 1.18 other OPPS APC 1.18 27.63 0.33 percent of total billed charges 1.18 1.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "24"" A.T.S DISP CUFF W/ SLEEVE" SUP-74-00425 CDM 0272 RC outpatient 47.24 47.24 47.24 74 34.96 percent of total billed charges 47.24 93 38.26 percent of total billed charges 47.24 47.24 other OPPS APC 47.24 47.24 other OPPS APC 47.24 27.63 13.05 percent of total billed charges 47.24 47.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "34"" A.T.S DISP CUFF W/SLEEVE" SUP-74-00426 CDM 0272 RC outpatient 47.24 47.24 47.24 74 34.96 percent of total billed charges 47.24 93 38.26 percent of total billed charges 47.24 47.24 other OPPS APC 47.24 47.24 other OPPS APC 47.24 27.63 13.05 percent of total billed charges 47.24 47.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "RECY 42"" A.T.S DISP CUFF W/ SLEEVE" SUP-74-00427 CDM 0272 RC outpatient 1.24 1.24 1.24 74 0.92 percent of total billed charges 1.24 93 1 percent of total billed charges 1.24 1.24 other OPPS APC 1.24 1.24 other OPPS APC 1.24 27.63 0.34 percent of total billed charges 1.24 1.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "12"" A.T.S DISP CUFF W/ SLEEVE" SUP-74-00428 CDM 0272 RC outpatient 95.84 95.84 95.84 74 70.92 percent of total billed charges 95.84 93 77.63 percent of total billed charges 95.84 95.84 other OPPS APC 95.84 95.84 other OPPS APC 95.84 27.63 26.48 percent of total billed charges 95.84 95.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER URETHRAL CATHETER SUP-74-00431 CDM 0272 RC outpatient 1 1 1 74 0.74 percent of total billed charges 1 93 0.81 percent of total billed charges 1 1 other OPPS APC 1 1 other OPPS APC 1 27.63 0.28 percent of total billed charges 1 1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKINETTE IMPERVIOUS 10 IN. SUP-74-00434 CDM 0272 RC outpatient 3.16 3.16 3.16 74 2.34 percent of total billed charges 3.16 93 2.56 percent of total billed charges 3.16 3.16 other OPPS APC 3.16 3.16 other OPPS APC 3.16 27.63 0.87 percent of total billed charges 3.16 3.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE CRANIOTOMY SUP-74-00439 CDM 0272 RC outpatient 99.21 99.21 99.21 74 73.42 percent of total billed charges 99.21 93 80.36 percent of total billed charges 99.21 99.21 other OPPS APC 99.21 99.21 other OPPS APC 99.21 27.63 27.41 percent of total billed charges 99.21 99.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING SIGMOID 18 FR. SUP-74-00441 CDM 0272 RC outpatient 1.51 1.51 1.51 74 1.12 percent of total billed charges 1.51 93 1.22 percent of total billed charges 1.51 1.51 other OPPS APC 1.51 1.51 other OPPS APC 1.51 27.63 0.42 percent of total billed charges 1.51 1.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VLOC 1 GS-21 VLOCN0327 SUP-74-00443 CDM 0272 RC outpatient 129.07 129.07 129.07 74 95.51 percent of total billed charges 129.07 93 104.55 percent of total billed charges 129.07 129.07 other OPPS APC 129.07 129.07 other OPPS APC 129.07 27.63 35.66 percent of total billed charges 129.07 129.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE STRATAFIX CTX 36CM SUP-74-00444 CDM 0272 RC outpatient 115.94 115.94 115.94 74 85.8 percent of total billed charges 115.94 93 93.91 percent of total billed charges 115.94 115.94 other OPPS APC 115.94 115.94 other OPPS APC 115.94 27.63 32.03 percent of total billed charges 115.94 115.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE STRATAFIX MONOCRYL 4-0 70CM SUP-74-00445 CDM 0272 RC outpatient 82.58 82.58 82.58 74 61.11 percent of total billed charges 82.58 93 66.89 percent of total billed charges 82.58 82.58 other OPPS APC 82.58 82.58 other OPPS APC 82.58 27.63 22.82 percent of total billed charges 82.58 82.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VLOC PBT 0 GS-21 VLOCN0306 SUP-74-00447 CDM 0272 RC outpatient 86.5 86.5 86.5 74 64.01 percent of total billed charges 86.5 93 70.07 percent of total billed charges 86.5 86.5 other OPPS APC 86.5 86.5 other OPPS APC 86.5 27.63 23.9 percent of total billed charges 86.5 86.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "30"" A.T.S. DISP CUFF W/SLEEVE" SUP-74-00448 CDM 0272 RC outpatient 47.24 47.24 47.24 74 34.96 percent of total billed charges 47.24 93 38.26 percent of total billed charges 47.24 47.24 other OPPS APC 47.24 47.24 other OPPS APC 47.24 27.63 13.05 percent of total billed charges 47.24 47.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VLOC 180 GS21 0 VLOCL0346 SUP-74-00450 CDM 0272 RC outpatient 98.39 98.39 98.39 74 72.81 percent of total billed charges 98.39 93 79.7 percent of total billed charges 98.39 98.39 other OPPS APC 98.39 98.39 other OPPS APC 98.39 27.63 27.19 percent of total billed charges 98.39 98.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP RADIAL SPRAY IM HI-CAP SUP-74-00453 CDM 0272 RC outpatient 28.8 28.8 28.8 74 21.31 percent of total billed charges 28.8 93 23.33 percent of total billed charges 28.8 28.8 other OPPS APC 28.8 28.8 other OPPS APC 28.8 27.63 7.96 percent of total billed charges 28.8 28.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DERMABOND PRINEO 42CM SUP-74-00454 CDM 0272 RC outpatient 381.89 381.89 381.89 74 282.6 percent of total billed charges 381.89 93 309.33 percent of total billed charges 381.89 381.89 other OPPS APC 381.89 381.89 other OPPS APC 381.89 27.63 105.52 percent of total billed charges 381.89 381.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMOOTH BITE SHAVER BLADE 3.5 SUP-74-00455 CDM 0272 RC outpatient 320.02 320.02 320.02 74 236.81 percent of total billed charges 320.02 93 259.22 percent of total billed charges 320.02 320.02 other OPPS APC 320.02 320.02 other OPPS APC 320.02 27.63 88.42 percent of total billed charges 320.02 320.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SKIN CLOSURE ZIP 24CM SUP-74-00456 CDM 0272 RC outpatient 492.38 492.38 492.38 74 364.36 percent of total billed charges 492.38 93 398.83 percent of total billed charges 492.38 492.38 other OPPS APC 492.38 492.38 other OPPS APC 492.38 27.63 136.04 percent of total billed charges 492.38 492.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN JP 15FR ROUND WITH END PERFORATION SUP-74-00457 CDM 0272 RC outpatient 21.56 21.56 21.56 74 15.95 percent of total billed charges 21.56 93 17.46 percent of total billed charges 21.56 21.56 other OPPS APC 21.56 21.56 other OPPS APC 21.56 27.63 5.96 percent of total billed charges 21.56 21.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAUTERY TIP ULTRACLEAN 4 INCH SUP-74-00459 CDM 0272 RC outpatient 3.23 3.23 3.23 74 2.39 percent of total billed charges 3.23 93 2.62 percent of total billed charges 3.23 3.23 other OPPS APC 3.23 3.23 other OPPS APC 3.23 27.63 0.89 percent of total billed charges 3.23 3.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTROSURGICAL PENCIL PLUMEPEN ULTRA SMOKE EVAC SUP-74-00467 CDM 0272 RC outpatient 134.1 134.1 134.1 134.1 other OPPS APC 134.1 134.1 other OPPS APC 134.1 27.63 37.05 percent of total billed charges 134.1 134.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTROSURGICAL PENCIL PLUMEPEN PRO SMOKE EVAC SUP-74-00468 CDM 0272 RC outpatient 122.09 122.09 122.09 122.09 other OPPS APC 122.09 122.09 other OPPS APC 122.09 27.63 33.73 percent of total billed charges 122.09 122.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE PLAIN GUT 4-0 SC-1 1824H SUP-74-00470 CDM 0272 RC outpatient 2.79 2.79 2.79 2.79 other OPPS APC 2.79 2.79 other OPPS APC 2.79 27.63 0.77 percent of total billed charges 2.79 2.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRAIGHT CRESANT KNIFE SUP-74-1000 CDM 0270 RC outpatient 27.73 27.73 27.73 74 20.52 percent of total billed charges 27.73 93 22.46 percent of total billed charges 27.73 27.73 other OPPS APC 27.73 27.73 other OPPS APC 27.73 27.63 7.66 percent of total billed charges 27.73 27.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNIFE CRESCENT SUP-74-1010 CDM 0270 RC outpatient 28.6 28.6 28.6 74 21.16 percent of total billed charges 28.6 93 23.17 percent of total billed charges 28.6 28.6 other OPPS APC 28.6 28.6 other OPPS APC 28.6 27.63 7.9 percent of total billed charges 28.6 28.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON 25.0D SUP-74147 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON IOL 25.0D SUP-74147 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL ACETABULAR TRIDENT II PSL HA D OD48 MM HIP CLUSTER HOLE STERILE SUP-742-11-48D CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP MINI-MOD TITANIUM T4 L 8MM OD 1.5MM CORTEX SELF TAP SUP-74401508 CDM 0270 RC outpatient 160.68 160.68 160.68 74 118.9 percent of total billed charges 160.68 93 130.15 percent of total billed charges 160.68 160.68 other OPPS APC 160.68 160.68 other OPPS APC 160.68 27.63 44.4 percent of total billed charges 160.68 160.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP MINI-MOD TITANIUM T4 L 9MM OD 1.5MM CORTEX SELF TAP SUP-74401509 CDM 0270 RC outpatient 160.68 160.68 160.68 74 118.9 percent of total billed charges 160.68 93 130.15 percent of total billed charges 160.68 160.68 other OPPS APC 160.68 160.68 other OPPS APC 160.68 27.63 44.4 percent of total billed charges 160.68 160.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP MINI-MOD TITANIUM T4 L 12MM OD 1.5MM CORTEX SELF TAP SUP-74401512 CDM 0270 RC outpatient 160.68 160.68 160.68 74 118.9 percent of total billed charges 160.68 93 130.15 percent of total billed charges 160.68 160.68 other OPPS APC 160.68 160.68 other OPPS APC 160.68 27.63 44.4 percent of total billed charges 160.68 160.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 6 MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402406 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 7 MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402407 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 8 MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402408 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM L 10 MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402410 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L11 MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402411 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIAUM L 12 MM OD 2.4MM FOOT CORTICAL SELF TAP SUP-74402412 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 13 MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402413 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L !$ MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402414 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 16 MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402416 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP MINI-MOD 2.4 MM 18MM SELF-TAPPING CORTICAL TITANIUM T7 STARDRIVE SUP-74402418 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM L 20 MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402420 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 22MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402422 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 24MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402424 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 26MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402426 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 28 MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402428 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 30 MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402430 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP MINI-MOD TITANIUM T7 L 32 MM OD 2.4 MM CORTEX SELF TAP STERILE LATEX FREE SUP-74402432 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 34 MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402434 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 36MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402436 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 38 MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402438 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 40MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402440 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 42 MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402442 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 46 MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402446 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 48MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402448 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 55MM OD 2.4 MM FOOT CORTICAL SELF TAP SUP-74402455 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP MINI-MOD TITANIUM T4 L 8MM OD 1.5MM LOCK SELF TAP SUP-74411508 CDM 0270 RC outpatient 335.4 335.4 335.4 74 248.2 percent of total billed charges 335.4 93 271.67 percent of total billed charges 335.4 335.4 other OPPS APC 335.4 335.4 other OPPS APC 335.4 27.63 92.67 percent of total billed charges 335.4 335.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 6 MM OD 2.4 MM FOOT LOCK SELF TAP SUP-74412406 CDM 0270 RC outpatient 354.12 354.12 354.12 74 262.05 percent of total billed charges 354.12 93 286.84 percent of total billed charges 354.12 354.12 other OPPS APC 354.12 354.12 other OPPS APC 354.12 27.63 97.84 percent of total billed charges 354.12 354.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L7 MM OD 2.4 MM FOOT LOCK SELF TAP SUP-74412407 CDM 0270 RC outpatient 354.12 354.12 354.12 74 262.05 percent of total billed charges 354.12 93 286.84 percent of total billed charges 354.12 354.12 other OPPS APC 354.12 354.12 other OPPS APC 354.12 27.63 97.84 percent of total billed charges 354.12 354.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 8 MM OD 2.4 MM FOOT LOCK SELF TAP SUP-74412408 CDM 0270 RC outpatient 354.12 354.12 354.12 74 262.05 percent of total billed charges 354.12 93 286.84 percent of total billed charges 354.12 354.12 other OPPS APC 354.12 354.12 other OPPS APC 354.12 27.63 97.84 percent of total billed charges 354.12 354.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 10 MM OD 2.4 MM FOOT LOCK SELF TAP SUP-74412410 CDM 0270 RC outpatient 354.12 354.12 354.12 74 262.05 percent of total billed charges 354.12 93 286.84 percent of total billed charges 354.12 354.12 other OPPS APC 354.12 354.12 other OPPS APC 354.12 27.63 97.84 percent of total billed charges 354.12 354.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM L 11 MM OD 2.4 MM FOOT LOCK SELF TAP SUP-74412411 CDM 0270 RC outpatient 354.12 354.12 354.12 74 262.05 percent of total billed charges 354.12 93 286.84 percent of total billed charges 354.12 354.12 other OPPS APC 354.12 354.12 other OPPS APC 354.12 27.63 97.84 percent of total billed charges 354.12 354.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 12 MM OD 2.4 MM FOOT LOCK SELF TAP SUP-74412412 CDM 0270 RC outpatient 354.12 354.12 354.12 74 262.05 percent of total billed charges 354.12 93 286.84 percent of total billed charges 354.12 354.12 other OPPS APC 354.12 354.12 other OPPS APC 354.12 27.63 97.84 percent of total billed charges 354.12 354.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM L 13 MM OD 2.4 MM FOOT LOCK SELF TAP T7 DRIVER SUP-74412413 CDM 0270 RC outpatient 354.12 354.12 354.12 74 262.05 percent of total billed charges 354.12 93 286.84 percent of total billed charges 354.12 354.12 other OPPS APC 354.12 354.12 other OPPS APC 354.12 27.63 97.84 percent of total billed charges 354.12 354.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM L 14 MM OD 2.4 MM FOOT LOCK SELF TAP T7 DRIVER SUP-74412414 CDM 0270 RC outpatient 354.12 354.12 354.12 74 262.05 percent of total billed charges 354.12 93 286.84 percent of total billed charges 354.12 354.12 other OPPS APC 354.12 354.12 other OPPS APC 354.12 27.63 97.84 percent of total billed charges 354.12 354.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 15 MM OD 2.4 MM FOOT LOCK SELF TAP SUP-74412415 CDM 0270 RC outpatient 354.12 354.12 354.12 74 262.05 percent of total billed charges 354.12 93 286.84 percent of total billed charges 354.12 354.12 other OPPS APC 354.12 354.12 other OPPS APC 354.12 27.63 97.84 percent of total billed charges 354.12 354.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 16 MM OD 2.4 MM FOOT LOCK SELF TAP SUP-74412416 CDM 0270 RC outpatient 354.12 354.12 354.12 74 262.05 percent of total billed charges 354.12 93 286.84 percent of total billed charges 354.12 354.12 other OPPS APC 354.12 354.12 other OPPS APC 354.12 27.63 97.84 percent of total billed charges 354.12 354.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP MINI-MOD 2.4MM 17MM LOCKING SELF_TAPPING TITANIUM T7 STARDRIVE SUP-74412417 CDM 0270 RC outpatient 354.12 354.12 354.12 74 262.05 percent of total billed charges 354.12 93 286.84 percent of total billed charges 354.12 354.12 other OPPS APC 354.12 354.12 other OPPS APC 354.12 27.63 97.84 percent of total billed charges 354.12 354.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP MINI-MOD 2.4MM 18MM LOCKING SELF-TAPPING TITANIUM t7 STARDRIVE SUP-74412418 CDM 0270 RC outpatient 354.12 354.12 354.12 74 262.05 percent of total billed charges 354.12 93 286.84 percent of total billed charges 354.12 354.12 other OPPS APC 354.12 354.12 other OPPS APC 354.12 27.63 97.84 percent of total billed charges 354.12 354.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 19MM OD 2.4 MM FOOT LOCK SELF TAP SUP-74412419 CDM 0270 RC outpatient 354.12 354.12 354.12 74 262.05 percent of total billed charges 354.12 93 286.84 percent of total billed charges 354.12 354.12 other OPPS APC 354.12 354.12 other OPPS APC 354.12 27.63 97.84 percent of total billed charges 354.12 354.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM L 20 MM OD 2.4MM FOOT LOCK SELF TAP SUP-74412420 CDM 0270 RC outpatient 354.12 354.12 354.12 74 262.05 percent of total billed charges 354.12 93 286.84 percent of total billed charges 354.12 354.12 other OPPS APC 354.12 354.12 other OPPS APC 354.12 27.63 97.84 percent of total billed charges 354.12 354.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP MINI-MOD 2.4MM 22MM LOCKING SELF-TAPPING TITANIUM T7 STARDRIVE SUP-74412422 CDM 0270 RC outpatient 354.12 354.12 354.12 74 262.05 percent of total billed charges 354.12 93 286.84 percent of total billed charges 354.12 354.12 other OPPS APC 354.12 354.12 other OPPS APC 354.12 27.63 97.84 percent of total billed charges 354.12 354.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 38MM OD 2.4 MM FOOT LOCK SELF TAP SUP-74412438 CDM 0270 RC outpatient 354.12 354.12 354.12 74 262.05 percent of total billed charges 354.12 93 286.84 percent of total billed charges 354.12 354.12 other OPPS APC 354.12 354.12 other OPPS APC 354.12 27.63 97.84 percent of total billed charges 354.12 354.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE VLP TITANIUM T7 L 44M OD 2.4 MM FOOT LOCK SELF TAP SUP-74412444 CDM 0270 RC outpatient 354.12 354.12 354.12 74 262.05 percent of total billed charges 354.12 93 286.84 percent of total billed charges 354.12 354.12 other OPPS APC 354.12 354.12 other OPPS APC 354.12 27.63 97.84 percent of total billed charges 354.12 354.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE VLP MINI-MOD TITANIUM STRAIGHT H 1MM 6 HOLE 1.5MM SCREW MINI FRAGMENT SUP-74441522 CDM 0270 RC outpatient 1366.56 1366.56 1366.56 74 1011.25 percent of total billed charges 1366.56 93 1106.91 percent of total billed charges 1366.56 1366.56 other OPPS APC 1366.56 1366.56 other OPPS APC 1366.56 27.63 377.58 percent of total billed charges 1366.56 1366.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE VLP MINI MOD Y H 1.25MM 8 HOLE 2.4 MM SCREW MINI FRAGMENT SUP-74442412 CDM 0270 RC outpatient 2886 2886 2886 74 2135.64 percent of total billed charges 2886 93 2337.66 percent of total billed charges 2886 2886 other OPPS APC 2886 2886 other OPPS APC 2886 27.63 797.4 percent of total billed charges 2886 2886 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE VLP MINI-MOD F/2.4MM SCREW HOLEX2/6 T-SHAPED TITANIUM SUP-74442414 CDM 0270 RC outpatient 1677 1677 1677 74 1240.98 percent of total billed charges 1677 93 1358.37 percent of total billed charges 1677 1677 other OPPS APC 1677 1677 other OPPS APC 1677 27.63 463.36 percent of total billed charges 1677 1677 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE VLP MINI-MOD TITANIUM STRAIGHT H1.25MM 6 HOLE 2.4 MM SCREW MINI FRAGMENT SUP-74442422 CDM 0270 RC outpatient 1441.44 1441.44 1441.44 74 1066.67 percent of total billed charges 1441.44 93 1167.57 percent of total billed charges 1441.44 1441.44 other OPPS APC 1441.44 1441.44 other OPPS APC 1441.44 27.63 398.27 percent of total billed charges 1441.44 1441.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE VLP MINI-MOD TITANIUM 12 X 3 HOLE MESH 2.4MM SCREW MINI FRAGMENT SUP-74442428 CDM 0270 RC outpatient 3611.4 3611.4 3611.4 74 2672.44 percent of total billed charges 3611.4 93 2925.23 percent of total billed charges 3611.4 3611.4 other OPPS APC 3611.4 3611.4 other OPPS APC 3611.4 27.63 997.83 percent of total billed charges 3611.4 3611.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE VLP MINI-MOD TITANIUM STOUT H 1.6 MM 8 HOLE 2.4 MM SCREW MINI FRAGMENT SUP-74442432 CDM 0270 RC outpatient 2168.4 2168.4 2168.4 74 1604.62 percent of total billed charges 2168.4 93 1756.4 percent of total billed charges 2168.4 2168.4 other OPPS APC 2168.4 2168.4 other OPPS APC 2168.4 27.63 599.13 percent of total billed charges 2168.4 2168.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE VLP MINI-MOD TITANIUM STOUT H 1.6 MM 12 HOLE 2.4 MM SCREW MINI FRAGMENT SUP-74442434 CDM 0270 RC outpatient 2652 2652 2652 74 1962.48 percent of total billed charges 2652 93 2148.12 percent of total billed charges 2652 2652 other OPPS APC 2652 2652 other OPPS APC 2652 27.63 732.75 percent of total billed charges 2652 2652 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL VLP MINI-MOD OD 1.1 MM MINI QC SUP-74461500 CDM 0270 RC outpatient 402.48 402.48 402.48 74 297.84 percent of total billed charges 402.48 93 326.01 percent of total billed charges 402.48 402.48 other OPPS APC 402.48 402.48 other OPPS APC 402.48 27.63 111.21 percent of total billed charges 402.48 402.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL VLP MINI-MOD SHORT L 122 MM OD 1.8MM SUP-74462402 CDM 0270 RC outpatient 365.04 365.04 365.04 74 270.13 percent of total billed charges 365.04 93 295.68 percent of total billed charges 365.04 365.04 other OPPS APC 365.04 365.04 other OPPS APC 365.04 27.63 100.86 percent of total billed charges 365.04 365.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL VLP MINI-MOD LONG L 1.8MM AO QUICK COUPLING STERILE LATEX FREE DISPOSABLE SUP-74462404 CDM 0270 RC outpatient 419.64 419.64 419.64 74 310.53 percent of total billed charges 419.64 93 339.91 percent of total billed charges 419.64 419.64 other OPPS APC 419.64 419.64 other OPPS APC 419.64 27.63 115.95 percent of total billed charges 419.64 419.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL VLP MINI-MOD OD 2.4 MM AO QUICK COUPLING OVER SUP-74462410 CDM 0270 RC outpatient 365.04 365.04 365.04 74 270.13 percent of total billed charges 365.04 93 295.68 percent of total billed charges 365.04 365.04 other OPPS APC 365.04 365.04 other OPPS APC 365.04 27.63 100.86 percent of total billed charges 365.04 365.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE 4-0 CHROMIC SUP-744G CDM 0270 RC outpatient 15.72 15.72 15.72 74 11.63 percent of total billed charges 15.72 93 12.73 percent of total billed charges 15.72 15.72 other OPPS APC 15.72 15.72 other OPPS APC 15.72 27.63 4.34 percent of total billed charges 15.72 15.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE VASCULAR POLYMER STANDARD L45 CM OD1-1.5 MM BULB FLEXIBLE SHAFT EXTRA SUPPLE STERILE DISPOSABLE SUP-7451015ES CDM 0270 RC outpatient 283.6 283.6 283.6 74 209.86 percent of total billed charges 283.6 93 229.72 percent of total billed charges 283.6 283.6 other OPPS APC 283.6 283.6 other OPPS APC 283.6 27.63 78.36 percent of total billed charges 283.6 283.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE VASCULAR GLOBAL L45 CM OD1.5-2 MM BULB SUP-7451520ES CDM 0270 RC outpatient 262.23 262.23 262.23 74 194.05 percent of total billed charges 262.23 93 212.41 percent of total billed charges 262.23 262.23 other OPPS APC 262.23 262.23 other OPPS APC 262.23 27.63 72.45 percent of total billed charges 262.23 262.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PORT IMPLANTABLE INFUSION VACCESS CT 6FR POWER INJECTABLE SUP-7460000 CDM 0270 RC outpatient 481 481 481 74 355.94 percent of total billed charges 481 93 389.61 percent of total billed charges 481 481 other OPPS APC 481 481 other OPPS APC 481 27.63 132.9 percent of total billed charges 481 481 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH SAFESHEATH II OD9.5 FR HEMOSTASIS VALVE SIDEPORT SUP-7464 CDM 0481 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 51 66.3 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ARTERIAL LINE 110CM 8FR PULMONARY 7 LUMEN CONTINUOUS CARDIAC OUTPUT SUP-746HF8 CDM 0270 RC outpatient 518.02 518.02 518.02 74 383.33 percent of total billed charges 518.02 93 419.6 percent of total billed charges 518.02 518.02 other OPPS APC 518.02 518.02 other OPPS APC 518.02 27.63 143.13 percent of total billed charges 518.02 518.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR VSI TRU-TORQUE L180 CM OD.035 IN STRAIGHT FLEXIBLE FLOPPY TIP SUP-7473 CDM 0481 RC outpatient 189.8 189.8 189.8 189.8 other OPPS APC 189.8 189.8 other OPPS APC 189.8 51 96.8 percent of total billed charges 189.8 189.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VSI TRU-TORQUE STRAIGHT TIP GUIDEWIRE 180CM SUP-7473 CDM 0481 RC outpatient 189.8 189.8 189.8 74 140.45 percent of total billed charges 189.8 93 153.74 percent of total billed charges 189.8 189.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GW VSI TRU-TORQUE WIRE 260CM SUP-7474 CDM 0481 RC outpatient 202.8 202.8 202.8 74 150.07 percent of total billed charges 202.8 93 164.27 percent of total billed charges 202.8 202.8 other OPPS APC 202.8 202.8 other OPPS APC 202.8 51 103.43 percent of total billed charges 202.8 202.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE ORTHOPEDIC PERI-LOC STAINLESS STEEL SHORT SADDLE SUP-74800601 CDM 0270 RC outpatient 458.64 458.64 458.64 74 339.39 percent of total billed charges 458.64 93 371.5 percent of total billed charges 458.64 458.64 other OPPS APC 458.64 458.64 other OPPS APC 458.64 27.63 126.72 percent of total billed charges 458.64 458.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PORT IMPLANTABLE INFUSION VACCESS CT OD9.6 FR POWER INJECTABLE SUP-7496000 CDM 0270 RC outpatient 481 481 481 74 355.94 percent of total billed charges 481 93 389.61 percent of total billed charges 481 481 other OPPS APC 481 481 other OPPS APC 481 27.63 132.9 percent of total billed charges 481 481 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FELT SUP-75-00002 CDM 0272 RC outpatient 346.5 346.5 346.5 74 256.41 percent of total billed charges 346.5 93 280.67 percent of total billed charges 346.5 346.5 other OPPS APC 346.5 346.5 other OPPS APC 346.5 27.63 95.74 percent of total billed charges 346.5 346.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT 3DMAX LIGHT SUP-75-00062 CDM C1781 HCPCS 0278 RC outpatient 975 975 975 57 555.75 percent of total billed charges 975 93 789.75 percent of total billed charges 975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 975 other OPPS APC 975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 975 other OPPS APC 975 51 497.25 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PROGRIP LT 12X8 (TEM1208GL) SUP-75-00064 CDM C1781 HCPCS 0278 RC outpatient 1231.95 1231.95 1231.95 57 702.21 percent of total billed charges 1231.95 93 997.88 percent of total billed charges 1231.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1231.95 other OPPS APC 1231.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1231.95 other OPPS APC 1231.95 51 628.29 percent of total billed charges 1231.95 1231.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PROGRIP RT 12X8 (TEM1208GR) SUP-75-00065 CDM C1781 HCPCS 0278 RC outpatient 1231.95 1231.95 1231.95 57 702.21 percent of total billed charges 1231.95 93 997.88 percent of total billed charges 1231.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1231.95 other OPPS APC 1231.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1231.95 other OPPS APC 1231.95 51 628.29 percent of total billed charges 1231.95 1231.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PROGRIP LT 14X9 ( TEM1409GL) SUP-75-00066 CDM C1781 HCPCS 0278 RC outpatient 1231.71 1231.71 1231.71 57 702.07 percent of total billed charges 1231.71 93 997.69 percent of total billed charges 1231.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1231.71 other OPPS APC 1231.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1231.71 other OPPS APC 1231.71 51 628.17 percent of total billed charges 1231.71 1231.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PROGRIP RT 14X9 ( TEM1409GR) SUP-75-00067 CDM C1781 HCPCS 0278 RC outpatient 1375.2 1375.2 1375.2 57 783.86 percent of total billed charges 1375.2 93 1113.91 percent of total billed charges 1375.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1375.2 other OPPS APC 1375.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1375.2 other OPPS APC 1375.2 51 701.35 percent of total billed charges 1375.2 1375.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PROGRIP RECT 15X9 ( TEM1509G) SUP-75-00068 CDM C1781 HCPCS 0278 RC outpatient 1159.47 1159.47 1159.47 57 660.9 percent of total billed charges 1159.47 93 939.17 percent of total billed charges 1159.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1159.47 other OPPS APC 1159.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1159.47 other OPPS APC 1159.47 51 591.33 percent of total billed charges 1159.47 1159.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VENTRIO ST HERNIA 13.8 X 17.8 SUP-75-00082 CDM C1781 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VENTRIO ST HERNIA 15.5 X 25.7 SUP-75-00083 CDM C1781 HCPCS 0278 RC outpatient 4402.75 4402.75 4402.75 57 2509.57 percent of total billed charges 4402.75 93 3566.23 percent of total billed charges 4402.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4402.75 other OPPS APC 4402.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4402.75 other OPPS APC 4402.75 51 2245.4 percent of total billed charges 4402.75 4402.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VENTRIO ST HERNIA 19.6 X 24.6 SUP-75-00084 CDM C1781 HCPCS 0278 RC outpatient 3889 3889 3889 57 2216.73 percent of total billed charges 3889 93 3150.09 percent of total billed charges 3889 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3889 other OPPS APC 3889 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3889 other OPPS APC 3889 51 1983.39 percent of total billed charges 3889 3889 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VENTRIO ST HERNIA 22.1 X 27.1 SUP-75-00085 CDM C1781 HCPCS 0278 RC outpatient 4591.5 4591.5 4591.5 57 2617.16 percent of total billed charges 4591.5 93 3719.12 percent of total billed charges 4591.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4591.5 other OPPS APC 4591.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4591.5 other OPPS APC 4591.5 51 2341.67 percent of total billed charges 4591.5 4591.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VENTRIO ST HERNIA 27.4 X 34.9 SUP-75-00086 CDM C1781 HCPCS 0278 RC outpatient 5524.75 5524.75 5524.75 57 3149.11 percent of total billed charges 5524.75 93 4475.05 percent of total billed charges 5524.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5524.75 other OPPS APC 5524.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5524.75 other OPPS APC 5524.75 51 2817.62 percent of total billed charges 5524.75 5524.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VENTRALIGHT 6X8 ELIPSE (5954680) SUP-75-00087 CDM C1781 HCPCS 0278 RC outpatient 2259.4 2259.4 2259.4 57 1287.86 percent of total billed charges 2259.4 93 1830.11 percent of total billed charges 2259.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2259.4 other OPPS APC 2259.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2259.4 other OPPS APC 2259.4 51 1152.29 percent of total billed charges 2259.4 2259.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VENTRALIGHT ST 10 X 13 (5954113) SUP-75-00088 CDM C1781 HCPCS 0278 RC outpatient 4006.41 4006.41 4006.41 57 2283.65 percent of total billed charges 4006.41 93 3245.19 percent of total billed charges 4006.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4006.41 other OPPS APC 4006.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4006.41 other OPPS APC 4006.41 51 2043.27 percent of total billed charges 4006.41 4006.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VENTRALIGHT ST 7X9 (5954790) SUP-75-00089 CDM C1781 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VENTRALIGHT ST 8X10 (5954810) SUP-75-00090 CDM C1781 HCPCS 0278 RC outpatient 3015.63 3015.63 3015.63 57 1718.91 percent of total billed charges 3015.63 93 2442.66 percent of total billed charges 3015.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3015.63 other OPPS APC 3015.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3015.63 other OPPS APC 3015.63 51 1537.97 percent of total billed charges 3015.63 3015.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VENTRALEX ST HERNIA PATCH SM SUP-75-00091 CDM C1781 HCPCS 0278 RC outpatient 1140 1140 1140 57 649.8 percent of total billed charges 1140 93 923.4 percent of total billed charges 1140 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1140 other OPPS APC 1140 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1140 other OPPS APC 1140 51 581.4 percent of total billed charges 1140 1140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VENTRALEX ST HERNIA PATCH 6.4/2.5 SUP-75-00092 CDM C1781 HCPCS 0278 RC outpatient 1435.2 1435.2 1435.2 57 818.06 percent of total billed charges 1435.2 93 1162.51 percent of total billed charges 1435.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1435.2 other OPPS APC 1435.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1435.2 other OPPS APC 1435.2 51 731.95 percent of total billed charges 1435.2 1435.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VENTRALEX ST HERNIA PATCH 8/3.2 LG SUP-75-00093 CDM C1781 HCPCS 0278 RC outpatient 1856.4 1856.4 1856.4 57 1058.15 percent of total billed charges 1856.4 93 1503.68 percent of total billed charges 1856.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1856.4 other OPPS APC 1856.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1856.4 other OPPS APC 1856.4 51 946.76 percent of total billed charges 1856.4 1856.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VENTRALIGHT 6X10 OVAL (5954610) SUP-75-00094 CDM C1781 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VENTRIO ST MED OVAL 11X14 5950040 SUP-75-00095 CDM C1781 HCPCS 0278 RC outpatient 2709.6 2709.6 2709.6 57 1544.47 percent of total billed charges 2709.6 93 2194.78 percent of total billed charges 2709.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2709.6 other OPPS APC 2709.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2709.6 other OPPS APC 2709.6 51 1381.9 percent of total billed charges 2709.6 2709.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VENTRIO ST LG CIRCLE 11.4 (5950020 SUP-75-00096 CDM C1781 HCPCS 0278 RC outpatient 2026.5 2026.5 2026.5 57 1155.11 percent of total billed charges 2026.5 93 1641.47 percent of total billed charges 2026.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2026.5 other OPPS APC 2026.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2026.5 other OPPS APC 2026.5 51 1033.52 percent of total billed charges 2026.5 2026.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BIODESIGN 2 X 3 ENT SUP-75-00097 CDM C1763 HCPCS 0278 RC outpatient 855 855 855 57 487.35 percent of total billed charges 855 93 692.55 percent of total billed charges 855 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 855 other OPPS APC 855 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 855 other OPPS APC 855 51 436.05 percent of total billed charges 855 855 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BIODESIGN 4 X 7 ENT SUP-75-00098 CDM C1763 HCPCS 0278 RC outpatient 1575 1575 1575 57 897.75 percent of total billed charges 1575 93 1275.75 percent of total billed charges 1575 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1575 other OPPS APC 1575 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1575 other OPPS APC 1575 51 803.25 percent of total billed charges 1575 1575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VENTRALIGHT 4X6 ELIPSE (5954460) SUP-75-00099 CDM C1781 HCPCS 0278 RC outpatient 1189.8 1189.8 1189.8 57 678.19 percent of total billed charges 1189.8 93 963.74 percent of total billed charges 1189.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1189.8 other OPPS APC 1189.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1189.8 other OPPS APC 1189.8 51 606.8 percent of total billed charges 1189.8 1189.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SURGICEL 2 X 3 (1953S) SUP-75-00101 CDM 0272 RC outpatient 154.06 154.06 154.06 74 114 percent of total billed charges 154.06 93 124.79 percent of total billed charges 154.06 154.06 other OPPS APC 154.06 154.06 other OPPS APC 154.06 27.63 42.57 percent of total billed charges 154.06 154.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SURGICEL 4X8 (1952S) SUP-75-00102 CDM 0272 RC outpatient 242.68 242.68 242.68 74 179.58 percent of total billed charges 242.68 93 196.57 percent of total billed charges 242.68 242.68 other OPPS APC 242.68 242.68 other OPPS APC 242.68 27.63 67.05 percent of total billed charges 242.68 242.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FISTULA PLUG (G53614) SUP-75-00106 CDM C1763 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH PARIETX 14.5 X 11 35MM SUP-75-00113 CDM C1781 HCPCS 0278 RC outpatient 1439.28 1439.28 1439.28 57 820.39 percent of total billed charges 1439.28 93 1165.82 percent of total billed charges 1439.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1439.28 other OPPS APC 1439.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1439.28 other OPPS APC 1439.28 51 734.03 percent of total billed charges 1439.28 1439.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH PARIETX 15 X 15 50MM SUP-75-00114 CDM C1781 HCPCS 0278 RC outpatient 1776.78 1776.78 1776.78 57 1012.76 percent of total billed charges 1776.78 93 1439.19 percent of total billed charges 1776.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1776.78 other OPPS APC 1776.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1776.78 other OPPS APC 1776.78 51 906.16 percent of total billed charges 1776.78 1776.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STIMUBLAST 255CC SUP-75-00118 CDM C1713 HCPCS 0278 RC outpatient 1320 1320 1320 57 752.4 percent of total billed charges 1320 93 1069.2 percent of total billed charges 1320 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1320 other OPPS APC 1320 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1320 other OPPS APC 1320 51 673.2 percent of total billed charges 1320 1320 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE PUTTY 2.5CC SUP-75-00124 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ILLIAC CREST WEDGE PICWS SUP-75-00125 CDM C1762 HCPCS 0278 RC outpatient 2828.91 2828.91 2828.91 57 1612.48 percent of total billed charges 2828.91 93 2291.42 percent of total billed charges 2828.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2828.91 other OPPS APC 2828.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2828.91 other OPPS APC 2828.91 51 1442.74 percent of total billed charges 2828.91 2828.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT HEMASHIELD PATCH (M00202019579PO) SUP-75-00126 CDM C1768 HCPCS 0278 RC outpatient 387.62 387.62 387.62 57 220.94 percent of total billed charges 387.62 93 313.97 percent of total billed charges 387.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 387.62 other OPPS APC 387.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 387.62 other OPPS APC 387.62 51 197.69 percent of total billed charges 387.62 387.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT DBX / DBM PUTTY 1CC SUP-75-00129 CDM C1713 HCPCS 0278 RC outpatient 560.21 560.21 560.21 57 319.32 percent of total billed charges 560.21 93 453.77 percent of total billed charges 560.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 560.21 other OPPS APC 560.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 560.21 other OPPS APC 560.21 51 285.71 percent of total billed charges 560.21 560.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VITOSS 10CC SUP-75-00138 CDM C1713 HCPCS 0278 RC outpatient 2625 2625 2625 57 1496.25 percent of total billed charges 2625 93 2126.25 percent of total billed charges 2625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2625 other OPPS APC 2625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2625 other OPPS APC 2625 51 1338.75 percent of total billed charges 2625 2625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR STD 6MMX40CM SUP-75-00139 CDM C1768 HCPCS 0278 RC outpatient 1635 1635 1635 57 931.95 percent of total billed charges 1635 93 1324.35 percent of total billed charges 1635 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1635 other OPPS APC 1635 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1635 other OPPS APC 1635 51 833.85 percent of total billed charges 1635 1635 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT 3DMAX MED RIGHT (0115320) SUP-75-00144 CDM C1781 HCPCS 0278 RC outpatient 548.8 548.8 548.8 57 312.82 percent of total billed charges 548.8 93 444.53 percent of total billed charges 548.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 548.8 other OPPS APC 548.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 548.8 other OPPS APC 548.8 51 279.89 percent of total billed charges 548.8 548.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT 3DMAX LG RIGHT (0115321) SUP-75-00145 CDM C1781 HCPCS 0278 RC outpatient 600.25 600.25 600.25 57 342.14 percent of total billed charges 600.25 93 486.2 percent of total billed charges 600.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 600.25 other OPPS APC 600.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 600.25 other OPPS APC 600.25 51 306.13 percent of total billed charges 600.25 600.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT DBM PUTTY 5CC (3102-1005) SUP-75-00146 CDM C1713 HCPCS 0278 RC outpatient 1395 1395 1395 57 795.15 percent of total billed charges 1395 93 1129.95 percent of total billed charges 1395 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1395 other OPPS APC 1395 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1395 other OPPS APC 1395 51 711.45 percent of total billed charges 1395 1395 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTEGRAFT 6X40 (AG740) SUP-75-00147 CDM C1768 HCPCS 0278 RC outpatient 5322.5 5322.5 5322.5 57 3033.83 percent of total billed charges 5322.5 93 4311.23 percent of total billed charges 5322.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5322.5 other OPPS APC 5322.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5322.5 other OPPS APC 5322.5 51 2714.48 percent of total billed charges 5322.5 5322.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VENTRALIGHT ST 4X5 (5954450) SUP-75-00148 CDM C1781 HCPCS 0278 RC outpatient 1410.9 1410.9 1410.9 57 804.21 percent of total billed charges 1410.9 93 1142.83 percent of total billed charges 1410.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1410.9 other OPPS APC 1410.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1410.9 other OPPS APC 1410.9 51 719.56 percent of total billed charges 1410.9 1410.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VENTRALIGHT ST 6 CIRCLE (5954600) SUP-75-00149 CDM C1781 HCPCS 0278 RC outpatient 1856.7 1856.7 1856.7 57 1058.32 percent of total billed charges 1856.7 93 1503.93 percent of total billed charges 1856.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1856.7 other OPPS APC 1856.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1856.7 other OPPS APC 1856.7 51 946.92 percent of total billed charges 1856.7 1856.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT HERNIA 6 X 6 (0112720) SUP-75-00150 CDM C1781 HCPCS 0278 RC outpatient 188 188 188 57 107.16 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 51 95.88 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT HERNIA 10 X 14 (0112660) SUP-75-00152 CDM C1781 HCPCS 0278 RC outpatient 322 322 322 57 183.54 percent of total billed charges 322 93 260.82 percent of total billed charges 322 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 322 other OPPS APC 322 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 322 other OPPS APC 322 51 164.22 percent of total billed charges 322 322 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ECHO2 10 X 15CM (4 X 6IN) (5991015) SUP-75-00154 CDM C1781 HCPCS 0278 RC outpatient 1827.6 1827.6 1827.6 57 1041.73 percent of total billed charges 1827.6 93 1480.36 percent of total billed charges 1827.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1827.6 other OPPS APC 1827.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1827.6 other OPPS APC 1827.6 51 932.08 percent of total billed charges 1827.6 1827.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ECHO2 15 X 25 (5991525) SUP-75-00157 CDM C1781 HCPCS 0278 RC outpatient 3568 3568 3568 57 2033.76 percent of total billed charges 3568 93 2890.08 percent of total billed charges 3568 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3568 other OPPS APC 3568 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3568 other OPPS APC 3568 51 1819.68 percent of total billed charges 3568 3568 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ECHO2 CIRCLE 7 x 9 IN (5991823) SUP-75-00158 CDM outpatient 3756.75 3756.75 3756.75 3756.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PHASIX 10 X 15 COATED (1201015) SUP-75-00164 CDM C1781 HCPCS 0278 RC outpatient 9196 9196 9196 57 5241.72 percent of total billed charges 9196 93 7448.76 percent of total billed charges 9196 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9196 other OPPS APC 9196 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9196 other OPPS APC 9196 51 4689.96 percent of total billed charges 9196 9196 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PHASIX 15 X 20 COATED (1201520) SUP-75-00165 CDM C1781 HCPCS 0278 RC outpatient 15840 15840 15840 57 9028.8 percent of total billed charges 15840 93 12830.4 percent of total billed charges 15840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15840 other OPPS APC 15840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15840 other OPPS APC 15840 51 8078.4 percent of total billed charges 15840 15840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VENTRIO SM OVAL (5950030) SUP-75-00169 CDM C1781 HCPCS 0278 RC outpatient 1836.6 1836.6 1836.6 57 1046.86 percent of total billed charges 1836.6 93 1487.65 percent of total billed charges 1836.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1836.6 other OPPS APC 1836.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1836.6 other OPPS APC 1836.6 51 936.67 percent of total billed charges 1836.6 1836.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PCO VENTRAL PATCH 4C ( PCO4VP SUP-75-00171 CDM C1781 HCPCS 0278 RC outpatient 1047.28 1047.28 1047.28 57 596.95 percent of total billed charges 1047.28 93 848.3 percent of total billed charges 1047.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1047.28 other OPPS APC 1047.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1047.28 other OPPS APC 1047.28 51 534.11 percent of total billed charges 1047.28 1047.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PCO VENTRAL PATCH 6C ( PCO6VP ) SUP-75-00172 CDM C1781 HCPCS 0278 RC outpatient 1837.59 1837.59 1837.59 57 1047.43 percent of total billed charges 1837.59 93 1488.45 percent of total billed charges 1837.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1837.59 other OPPS APC 1837.59 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1837.59 other OPPS APC 1837.59 51 937.17 percent of total billed charges 1837.59 1837.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PCO VENTRAL PATCH 8C ( PCO8VP ) SUP-75-00173 CDM C1781 HCPCS 0278 RC outpatient 2360.34 2360.34 2360.34 57 1345.39 percent of total billed charges 2360.34 93 1911.88 percent of total billed charges 2360.34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2360.34 other OPPS APC 2360.34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2360.34 other OPPS APC 2360.34 51 1203.77 percent of total billed charges 2360.34 2360.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PROLAYER UNMESHED 4X8CM 3102-2648 SUP-75-00175 CDM Q4100 HCPCS 0636 RC outpatient 3272.73 3272.73 3272.73 74 2421.82 percent of total billed charges 3272.73 93 2650.91 percent of total billed charges 3272.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3272.73 other OPPS APC 3272.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3272.73 other OPPS APC 3272.73 24.86 813.6 percent of total billed charges 3272.73 3272.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PROLAYER MESHED 5X5CM 3102-2555 SUP-75-00176 CDM Q4100 HCPCS 0636 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 24.86 745.8 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FELT PLEDGET 4.8 X 9.5MM SUP-75-00179 CDM 0272 RC outpatient 507.5 507.5 507.5 74 375.55 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 507.5 other OPPS APC 507.5 507.5 other OPPS APC 507.5 27.63 140.22 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ARTHROFLEX 403 25X30X1.0MM SUP-75-00180 CDM outpatient 3000 3000 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SYNECOR IP 10 X 15CM OVAL SUP-75-00181 CDM C1781 HCPCS 0278 RC outpatient 2241 2241 2241 57 1277.37 percent of total billed charges 2241 93 1815.21 percent of total billed charges 2241 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2241 other OPPS APC 2241 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2241 other OPPS APC 2241 51 1142.91 percent of total billed charges 2241 2241 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SYNECOR IP 15 X 20CM OVAL SUP-75-00182 CDM C1781 HCPCS 0278 RC outpatient 3732.5 3732.5 3732.5 57 2127.53 percent of total billed charges 3732.5 93 3023.33 percent of total billed charges 3732.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3732.5 other OPPS APC 3732.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3732.5 other OPPS APC 3732.5 51 1903.58 percent of total billed charges 3732.5 3732.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PERFIX PLUG MEDIUM SUP-75-00183 CDM C1781 HCPCS 0278 RC outpatient 491.72 491.72 491.72 57 280.28 percent of total billed charges 491.72 93 398.29 percent of total billed charges 491.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 491.72 other OPPS APC 491.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 491.72 other OPPS APC 491.72 51 250.78 percent of total billed charges 491.72 491.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PERFIX PLUG LARGE SUP-75-00184 CDM C1781 HCPCS 0278 RC outpatient 859.32 859.32 859.32 57 489.81 percent of total billed charges 859.32 93 696.05 percent of total billed charges 859.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 859.32 other OPPS APC 859.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 859.32 other OPPS APC 859.32 51 438.25 percent of total billed charges 859.32 859.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHCLOTH SHEILD DIMETHICONE 3 PACK SUP-7503 CDM 0270 RC outpatient 2.64 2.64 2.64 74 1.95 percent of total billed charges 2.64 93 2.14 percent of total billed charges 2.64 2.64 other OPPS APC 2.64 2.64 other OPPS APC 2.64 27.63 0.73 percent of total billed charges 2.64 2.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC PERFORMA PEBAX POLYCARBONATE NYLON STRAIGHT PIGTAIL CURVE L110 CM OD6 FR CARDIAC 5 SIDEHOLE RADIOPAQUE BRAID STERILE ACCEPTS .038 IN GUIDEWIRE SUP-7509-11 CDM 0481 RC outpatient 23.53 23.53 23.53 74 17.41 percent of total billed charges 23.53 93 19.06 percent of total billed charges 23.53 23.53 other OPPS APC 23.53 23.53 other OPPS APC 23.53 51 12 percent of total billed charges 23.53 23.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC PERFORMA PEBAX POLYCARBONATE NYLON 145 D PIGTAIL CURVE L110 CM OD6 FR PERIPHERAL CARDIAC 5 SIDEHOLE RADIOPAQUE BRAID STERILE ACCEPTS .038 IN GUIDEWIRE SUP-7509-23 CDM 0481 RC outpatient 24.93 24.93 24.93 74 18.45 percent of total billed charges 24.93 93 20.19 percent of total billed charges 24.93 24.93 other OPPS APC 24.93 24.93 other OPPS APC 24.93 51 12.71 percent of total billed charges 24.93 24.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CEMENTING VITREBOND GLASS IONOMER 5.5 ML 9 GM LIGHT CURE LINER DENTAL WATER BASE SUP-7510 CDM outpatient 1305.17 1305.17 1305.17 1305.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE INFUSE RHBMP-2 BOVINE COLLAGEN XS 1.4 ML SPINE ALLOGRAPH ABSORBABLE SPONGE SYRINGE NEEDLE STERILE LUMBAR TAPER FUSION DEVICE SUP-7510100_73551 CDM 270010020 LOCAL 0270 RC outpatient 5865.6 5865.6 5865.6 74 4340.54 percent of total billed charges 5865.6 93 4751.14 percent of total billed charges 5865.6 5865.6 other OPPS APC 5865.6 5865.6 other OPPS APC 5865.6 27.63 1620.67 percent of total billed charges 5865.6 5865.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE INFUSE BOVINE COLLAGEN RHBMP-2 SMALL L23 MM OD14 MM 2.8 ML SPINE ABSORBABLE SPONGE STERILE WATER SYRINGE NEEDLE LUMBAR TAPERED FUSION DEVICE SUP-7510200 CDM 270010022 LOCAL 0270 RC outpatient 11653.2 11653.2 11653.2 74 8623.37 percent of total billed charges 11653.2 93 9439.09 percent of total billed charges 11653.2 11653.2 other OPPS APC 11653.2 11653.2 other OPPS APC 11653.2 27.63 3219.78 percent of total billed charges 11653.2 11653.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE INFUSE RHBMP-2 BOVINE COLLAGEN SMALL L23 MM OD14 MM 2.8 ML SPINE ABSORBABLE SPONGE SYRINGE NEEDLE STERILE LUMBAR TAPER FUSION DEVICE SUP-7510200_73552 CDM 0270 RC outpatient 11206 11206 11206 74 8292.44 percent of total billed charges 11206 93 9076.86 percent of total billed charges 11206 11206 other OPPS APC 11206 11206 other OPPS APC 11206 27.63 3096.22 percent of total billed charges 11206 11206 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE INFUSE BOVINE COLLAGEN RHBMP-2 MEDIUM L2 IN X W1 IN OD20 GA 5.6 ML 8.4 MG VIAL ABSORBABLE COLLAGEN SPONGE WATER SYRINGE NEEDLE STERILE LUMBAR TAPERED FUSION DEVICE SUP-7510400 CDM 270010031 LOCAL 0270 RC outpatient 13780 13780 13780 74 10197.2 percent of total billed charges 13780 93 11161.8 percent of total billed charges 13780 13780 other OPPS APC 13780 13780 other OPPS APC 13780 27.63 3807.41 percent of total billed charges 13780 13780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE INFUSE BOVINE COLLAGEN RHBMP-2 LARGE L26 MM OD18 MM 8 ML SPINE ABSORBABLE SPONGE STERILE WATER SYRINGE NEEDLE LUMBAR TAPERED FUSION DEVICE SUP-7510600 CDM 270010031 LOCAL 0270 RC outpatient 14060.8 14060.8 14060.8 74 10405 percent of total billed charges 14060.8 93 11389.3 percent of total billed charges 14060.8 14060.8 other OPPS APC 14060.8 14060.8 other OPPS APC 14060.8 27.63 3885 percent of total billed charges 14060.8 14060.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE INFUSE BOVINE COLLAGEN RHBMP-2 LARGE II L26 MM OD18 MM 8 ML SPINE ABSORBABLE SPONGE STERILE WATER SYRINGE NEEDLE LUMBAR TAPERED FUSION DEVICE SUP-7510800 CDM 270010031 LOCAL 0270 RC outpatient 14060.8 14060.8 14060.8 74 10405 percent of total billed charges 14060.8 93 11389.3 percent of total billed charges 14060.8 14060.8 other OPPS APC 14060.8 14060.8 other OPPS APC 14060.8 27.63 3885 percent of total billed charges 14060.8 14060.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL ECLIPSE NATURAL RUBBER 8 L299 MM X W103 MM POWDER FREE MICRO ROUGHEN SURFACE BEAD CUFF NONPYROGENIC STERILE LATEX STRAW CURVE FINGER SUP-75280 CDM 0270 RC outpatient 2.02 2.02 2.02 74 1.49 percent of total billed charges 2.02 93 1.64 percent of total billed charges 2.02 2.02 other OPPS APC 2.02 2.02 other OPPS APC 2.02 27.63 0.56 percent of total billed charges 2.02 2.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL ECLIPSE NATURAL RUBBER 8.5 ROUGH SURFACE BEAD CUFF STERILE LATEX STRAW CURVE FINGER MICRO SUP-75285 CDM 0270 RC outpatient 1.19 1.19 1.19 74 0.88 percent of total billed charges 1.19 93 0.96 percent of total billed charges 1.19 1.19 other OPPS APC 1.19 1.19 other OPPS APC 1.19 27.63 0.33 percent of total billed charges 1.19 1.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 3.5MM 13MM LOCKING SELF-TAPPING CORTEX T15 SHAPED SUP-75403513 CDM 0270 RC outpatient 60.79 60.79 60.79 74 44.98 percent of total billed charges 60.79 93 49.24 percent of total billed charges 60.79 60.79 other OPPS APC 60.79 60.79 other OPPS APC 60.79 27.63 16.8 percent of total billed charges 60.79 60.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 3.5MM 14MM LOCKING SELF-TAPPING CORTEX T15 SHAPED SUP-75403514 CDM 0270 RC outpatient 60.79 60.79 60.79 74 44.98 percent of total billed charges 60.79 93 49.24 percent of total billed charges 60.79 60.79 other OPPS APC 60.79 60.79 other OPPS APC 60.79 27.63 16.8 percent of total billed charges 60.79 60.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE EVOS 3.5MM 15MM LOCKING SELF-TAPPING CORTEX T15 SHAPED SUP-75403515 CDM 0270 RC outpatient 60.79 60.79 60.79 74 44.98 percent of total billed charges 60.79 93 49.24 percent of total billed charges 60.79 60.79 other OPPS APC 60.79 60.79 other OPPS APC 60.79 27.63 16.8 percent of total billed charges 60.79 60.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING ADHESIVE KENDALL TELFA 8X4IN POLYESTER COTTON STERILE LF ISLAND ABSORBENT NONADHERENT FILM NONWOVEN SUP-7541 CDM 0270 RC outpatient 1.89 1.89 1.89 74 1.4 percent of total billed charges 1.89 93 1.53 percent of total billed charges 1.89 1.89 other OPPS APC 1.89 1.89 other OPPS APC 1.89 27.63 0.52 percent of total billed charges 1.89 1.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SET CD HORIZON SEXTANT II STAINLESS STEEL SPINE PEDICLE BREAKOFF ROD INSERTION SUP-7570955 CDM 270010020 LOCAL 0270 RC outpatient 243.36 243.36 243.36 74 180.09 percent of total billed charges 243.36 93 197.12 percent of total billed charges 243.36 243.36 other OPPS APC 243.36 243.36 other OPPS APC 243.36 27.63 67.24 percent of total billed charges 243.36 243.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL LONGITUDE CD HORIZON TITANIUM STRAIGHT L70 MM OD5.5 MM SUP-7571070 CDM 270010020 LOCAL 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL LONGITUDE CD HORIZON TITANIUM STRAIGHT L80 MM OD5.5 MM SUP-7571080 CDM 270010020 LOCAL 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEGACY CD HORIZON TITANIUM L50 MM OD5.5 MM SPINE PEDICLE MULTIAXIAL CANNULATED 5.5 MM ROD SUP-7575550 CDM 270010020 LOCAL 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEGACY CD HORIZON TITANIUM L50 MM OD6.5 MM SPINE PEDICLE MULTIAXIAL CANNULATED 5.5 MM ROD SUP-7576550 CDM 270010020 LOCAL 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY BIVONA AIRE-CUF HYPERFLEX SILICONE ADULT L100 MM OD9.2 MM ID6.0 MM FIX NECK FLANGE WIRE REINFORCE CLIP IN OBTURATOR FLEXIBLE STERILE LATEX FREE SUP-75FHXL60 CDM 0270 RC outpatient 335.24 335.24 335.24 74 248.08 percent of total billed charges 335.24 93 271.54 percent of total billed charges 335.24 335.24 other OPPS APC 335.24 335.24 other OPPS APC 335.24 27.63 92.63 percent of total billed charges 335.24 335.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BIVONA AIRE-CUF HYPERFLEX SILICONE ADULT XLENGTH L110 MM OD10.6 MM ID7.0 MM FIX NECK FLANGE MID RANGE CLIP IN OBTURATOR HOLLOW TIP STERILE LATEX FREE SUP-75FHXL70 CDM 0270 RC outpatient 320.66 320.66 320.66 74 237.29 percent of total billed charges 320.66 93 259.73 percent of total billed charges 320.66 320.66 other OPPS APC 320.66 320.66 other OPPS APC 320.66 27.63 88.6 percent of total billed charges 320.66 320.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY PORTEX BIVONA AIRE-CUF HYPERFLEX SILICONE 8 MM L120 MM OD11.7 MM ID8.0 MM FIX NECK FLANGE WIRE REINFORCE CLIP IN OBTURATOR FLEXIBLE STERILE LATEX FREE SUP-75FHXL80 CDM outpatient 285.25 285.25 285.25 285.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY BIVONA AIRE-CUF HYPERFLEX SILICONE XLENGTH L130 MM OD12.9 MM ID9.0 MM CLIP IN OBTURATOR WIRE REINFORCEMENT MID RANGE TWILL TIE STERILE LATEX FREE SUP-75FHXL90 CDM outpatient 326.48 326.48 326.48 326.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACHEOSTOMY BIVONA AIRE-CUF HYPERFLEX PORTEX SILICONE ADULT L130 MM OD11.7 MM ID8.0 MM ADJUSTABLE NECK FLANGE CLIP IN OBTURATOR HOLLOW TIP TIE STERILE LATEX FREE SUP-75HA80 CDM outpatient 503.44 503.44 503.44 503.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP APPLIER LAPAROSCOPIC 10MM SUP-76-00005 CDM 0272 RC outpatient 268.53 268.53 268.53 74 198.71 percent of total billed charges 268.53 93 217.51 percent of total billed charges 268.53 268.53 other OPPS APC 268.53 268.53 other OPPS APC 268.53 27.63 74.19 percent of total billed charges 268.53 268.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CLIP APPLIER, LARGE OPEN" SUP-76-00006 CDM 0272 RC outpatient 179.76 179.76 179.76 74 133.02 percent of total billed charges 179.76 93 145.61 percent of total billed charges 179.76 179.76 other OPPS APC 179.76 179.76 other OPPS APC 179.76 27.63 49.67 percent of total billed charges 179.76 179.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CORSON PROBE /ASSY STRYKEFLOW 2W/TIP SUP-76-00007 CDM 0272 RC outpatient 251.48 251.48 251.48 74 186.1 percent of total billed charges 251.48 93 203.7 percent of total billed charges 251.48 251.48 other OPPS APC 251.48 251.48 other OPPS APC 251.48 27.63 69.48 percent of total billed charges 251.48 251.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DETACHABLE SCISSORS SUP-76-00008 CDM 0272 RC outpatient 963.51 963.51 963.51 74 713 percent of total billed charges 963.51 93 780.44 percent of total billed charges 963.51 963.51 other OPPS APC 963.51 963.51 other OPPS APC 963.51 27.63 266.22 percent of total billed charges 963.51 963.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EEA 25MM SUP-76-00011 CDM 0272 RC outpatient 1254.57 1254.57 1254.57 74 928.38 percent of total billed charges 1254.57 93 1016.2 percent of total billed charges 1254.57 1254.57 other OPPS APC 1254.57 1254.57 other OPPS APC 1254.57 27.63 346.64 percent of total billed charges 1254.57 1254.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EEA 29MM SUP-76-00012 CDM 0272 RC outpatient 1267.12 1267.12 1267.12 74 937.67 percent of total billed charges 1267.12 93 1026.37 percent of total billed charges 1267.12 1267.12 other OPPS APC 1267.12 1267.12 other OPPS APC 1267.12 27.63 350.11 percent of total billed charges 1267.12 1267.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EEA 31MM SUP-76-00013 CDM 0272 RC outpatient 1267.12 1267.12 1267.12 74 937.67 percent of total billed charges 1267.12 93 1026.37 percent of total billed charges 1267.12 1267.12 other OPPS APC 1267.12 1267.12 other OPPS APC 1267.12 27.63 350.11 percent of total billed charges 1267.12 1267.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FREDS SUP-76-00014 CDM 0272 RC outpatient 3.93 3.93 3.93 74 2.91 percent of total billed charges 3.93 93 3.18 percent of total billed charges 3.93 3.93 other OPPS APC 3.93 3.93 other OPPS APC 3.93 27.63 1.09 percent of total billed charges 3.93 3.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GIA75 SUP-76-00021 CDM 0272 RC outpatient 433.8 433.8 433.8 74 321.01 percent of total billed charges 433.8 93 351.38 percent of total billed charges 433.8 433.8 other OPPS APC 433.8 433.8 other OPPS APC 433.8 27.63 119.86 percent of total billed charges 433.8 433.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GIA75 RELOAD SUP-76-00022 CDM 0272 RC outpatient 231.34 231.34 231.34 74 171.19 percent of total billed charges 231.34 93 187.39 percent of total billed charges 231.34 231.34 other OPPS APC 231.34 231.34 other OPPS APC 231.34 27.63 63.92 percent of total billed charges 231.34 231.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PURSTRING SUP-76-00028 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TACKER SUP-76-00035 CDM 0272 RC outpatient 2030.91 2030.91 2030.91 74 1502.87 percent of total billed charges 2030.91 93 1645.04 percent of total billed charges 2030.91 2030.91 other OPPS APC 2030.91 2030.91 other OPPS APC 2030.91 27.63 561.14 percent of total billed charges 2030.91 2030.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR 8MM SUP-76-00048 CDM 0272 RC outpatient 99.48 99.48 99.48 74 73.62 percent of total billed charges 99.48 93 80.58 percent of total billed charges 99.48 99.48 other OPPS APC 99.48 99.48 other OPPS APC 99.48 27.63 27.49 percent of total billed charges 99.48 99.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERRIS NEEDLE 120MM SUP-76-00051 CDM 0272 RC outpatient 51.92 51.92 51.92 74 38.42 percent of total billed charges 51.92 93 42.06 percent of total billed charges 51.92 51.92 other OPPS APC 51.92 51.92 other OPPS APC 51.92 27.63 14.35 percent of total billed charges 51.92 51.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERRIS NEEDLE 150MM SUP-76-00052 CDM 0272 RC outpatient 52.68 52.68 52.68 74 38.98 percent of total billed charges 52.68 93 42.67 percent of total billed charges 52.68 52.68 other OPPS APC 52.68 52.68 other OPPS APC 52.68 27.63 14.56 percent of total billed charges 52.68 52.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCALPEL HARMONIC SHORT SUP-76-00053 CDM 0272 RC outpatient 1350.98 1350.98 1350.98 74 999.73 percent of total billed charges 1350.98 93 1094.29 percent of total billed charges 1350.98 1350.98 other OPPS APC 1350.98 1350.98 other OPPS APC 1350.98 27.63 373.28 percent of total billed charges 1350.98 1350.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON TROCAR BLUNT TIP 12MM SUP-76-00057 CDM 0272 RC outpatient 749.11 749.11 749.11 74 554.34 percent of total billed charges 749.11 93 606.78 percent of total billed charges 749.11 749.11 other OPPS APC 749.11 749.11 other OPPS APC 749.11 27.63 206.98 percent of total billed charges 749.11 749.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOCUTTER RELOAD SUP-76-00060 CDM 0272 RC outpatient 405.22 405.22 405.22 74 299.86 percent of total billed charges 405.22 93 328.23 percent of total billed charges 405.22 405.22 other OPPS APC 405.22 405.22 other OPPS APC 405.22 27.63 111.96 percent of total billed charges 405.22 405.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTICULATING GIA 45-4.1 RELOAD SUP-76-00063 CDM 0272 RC outpatient 387.88 387.88 387.88 74 287.03 percent of total billed charges 387.88 93 314.18 percent of total billed charges 387.88 387.88 other OPPS APC 387.88 387.88 other OPPS APC 387.88 27.63 107.17 percent of total billed charges 387.88 387.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. L HOOKS=CORSON PROBE ATTACHMEN SUP-76-00064 CDM 0272 RC outpatient 174.72 174.72 174.72 74 129.29 percent of total billed charges 174.72 93 141.52 percent of total billed charges 174.72 174.72 other OPPS APC 174.72 174.72 other OPPS APC 174.72 27.63 48.28 percent of total billed charges 174.72 174.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 45MM STAPLER VASCULAR RELOADS SUP-76-00071 CDM 0272 RC outpatient 409.27 409.27 409.27 74 302.86 percent of total billed charges 409.27 93 331.51 percent of total billed charges 409.27 409.27 other OPPS APC 409.27 409.27 other OPPS APC 409.27 27.63 113.08 percent of total billed charges 409.27 409.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOSTITCH DEVICE SUP-76-00073 CDM 0272 RC outpatient 1298.96 1298.96 1298.96 74 961.23 percent of total billed charges 1298.96 93 1052.16 percent of total billed charges 1298.96 1298.96 other OPPS APC 1298.96 1298.96 other OPPS APC 1298.96 27.63 358.9 percent of total billed charges 1298.96 1298.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK GENERAL LAP ABDMONIAL SUP-76-00077 CDM 0272 RC outpatient 476.34 476.34 476.34 74 352.49 percent of total billed charges 476.34 93 385.84 percent of total billed charges 476.34 476.34 other OPPS APC 476.34 476.34 other OPPS APC 476.34 27.63 131.61 percent of total billed charges 476.34 476.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CPT LAP CHOLE PACK SUP-76-00078 CDM 0272 RC outpatient 486.59 486.59 486.59 74 360.08 percent of total billed charges 486.59 93 394.14 percent of total billed charges 486.59 486.59 other OPPS APC 486.59 486.59 other OPPS APC 486.59 27.63 134.44 percent of total billed charges 486.59 486.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CATHETER, THERMOCHOICE III (T" SUP-76-00079 CDM 0272 RC outpatient 2411.89 2411.89 2411.89 74 1784.8 percent of total billed charges 2411.89 93 1953.63 percent of total billed charges 2411.89 2411.89 other OPPS APC 2411.89 2411.89 other OPPS APC 2411.89 27.63 666.41 percent of total billed charges 2411.89 2411.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP APPLIER MEDIUM OPEN SUP-76-00101 CDM 0272 RC outpatient 184.88 184.88 184.88 74 136.81 percent of total billed charges 184.88 93 149.75 percent of total billed charges 184.88 184.88 other OPPS APC 184.88 184.88 other OPPS APC 184.88 27.63 51.08 percent of total billed charges 184.88 184.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER LINEAR FLEX ARTIC 45MM SUP-76-00104 CDM 0272 RC outpatient 701.61 701.61 701.61 74 519.19 percent of total billed charges 701.61 93 568.3 percent of total billed charges 701.61 701.61 other OPPS APC 701.61 701.61 other OPPS APC 701.61 27.63 193.85 percent of total billed charges 701.61 701.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP APPLIER 5MM LAPAROSCOPIC SUP-76-00107 CDM 0272 RC outpatient 470.26 470.26 470.26 74 347.99 percent of total billed charges 470.26 93 380.91 percent of total billed charges 470.26 470.26 other OPPS APC 470.26 470.26 other OPPS APC 470.26 27.63 129.93 percent of total billed charges 470.26 470.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR 5MM DILATING TIP 100MM SUP-76-00108 CDM 0272 RC outpatient 99.48 99.48 99.48 74 73.62 percent of total billed charges 99.48 93 80.58 percent of total billed charges 99.48 99.48 other OPPS APC 99.48 99.48 other OPPS APC 99.48 27.63 27.49 percent of total billed charges 99.48 99.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA 5MM STABILITY SLEEVE SUP-76-00111 CDM 0272 RC outpatient 69.2 69.2 69.2 74 51.21 percent of total billed charges 69.2 93 56.05 percent of total billed charges 69.2 69.2 other OPPS APC 69.2 69.2 other OPPS APC 69.2 27.63 19.12 percent of total billed charges 69.2 69.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR 12MM OPTIVIEW DILATING TIP 100MM SUP-76-00113 CDM 0272 RC outpatient 99.48 99.48 99.48 74 73.62 percent of total billed charges 99.48 93 80.58 percent of total billed charges 99.48 99.48 other OPPS APC 99.48 99.48 other OPPS APC 99.48 27.63 27.49 percent of total billed charges 99.48 99.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR 12MM OPTIVIEW BLUNT TIP 100MM SUP-76-00116 CDM 0272 RC outpatient 99.48 99.48 99.48 74 73.62 percent of total billed charges 99.48 93 80.58 percent of total billed charges 99.48 99.48 other OPPS APC 99.48 99.48 other OPPS APC 99.48 27.63 27.49 percent of total billed charges 99.48 99.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA 12M STABILITY SLEEVE SUP-76-00117 CDM 0272 RC outpatient 69.2 69.2 69.2 74 51.21 percent of total billed charges 69.2 93 56.05 percent of total billed charges 69.2 69.2 other OPPS APC 69.2 69.2 other OPPS APC 69.2 27.63 19.12 percent of total billed charges 69.2 69.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCALPEL HARMONIC LONG SUP-76-00118 CDM 0272 RC outpatient 2109.84 2109.84 2109.84 74 1561.28 percent of total billed charges 2109.84 93 1708.97 percent of total billed charges 2109.84 2109.84 other OPPS APC 2109.84 2109.84 other OPPS APC 2109.84 27.63 582.95 percent of total billed charges 2109.84 2109.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRIEVER ENDOPOUCH SUP-76-00119 CDM 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ABSORBATACK SHORT 20 SUP-76-00126 CDM 0272 RC outpatient 2029.77 2029.77 2029.77 74 1502.03 percent of total billed charges 2029.77 93 1644.11 percent of total billed charges 2029.77 2029.77 other OPPS APC 2029.77 2029.77 other OPPS APC 2029.77 27.63 560.83 percent of total billed charges 2029.77 2029.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SORBAFIX 30-SHOT TACKER SUP-76-00127 CDM 0272 RC outpatient 2325 2325 2325 74 1720.5 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 2325 other OPPS APC 2325 2325 other OPPS APC 2325 27.63 642.4 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FALLER TUNNELING TROCAR SUP-76-00129 CDM 0272 RC outpatient 465.26 465.26 465.26 74 344.29 percent of total billed charges 465.26 93 376.86 percent of total billed charges 465.26 465.26 other OPPS APC 465.26 465.26 other OPPS APC 465.26 27.63 128.55 percent of total billed charges 465.26 465.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PERITONEAL SWAN NECK CURL SUP-76-00131 CDM C1750 HCPCS 0278 RC outpatient 495.29 495.29 495.29 57 282.32 percent of total billed charges 495.29 93 401.18 percent of total billed charges 495.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 495.29 other OPPS APC 495.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 495.29 other OPPS APC 495.29 51 252.6 percent of total billed charges 495.29 495.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KII BALLOON BLUNT TIP SYSTEM SUP-76-00133 CDM 0272 RC outpatient 420 420 420 74 310.8 percent of total billed charges 420 93 340.2 percent of total billed charges 420 420 other OPPS APC 420 420 other OPPS APC 420 27.63 116.05 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDO RETRACTOR 10MM SUP-76-00134 CDM 0272 RC outpatient 982.75 982.75 982.75 74 727.24 percent of total billed charges 982.75 93 796.03 percent of total billed charges 982.75 982.75 other OPPS APC 982.75 982.75 other OPPS APC 982.75 27.63 271.53 percent of total billed charges 982.75 982.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEP HALO CUTTING SUP-76-00135 CDM 0272 RC outpatient 1725.02 1725.02 1725.02 74 1276.51 percent of total billed charges 1725.02 93 1397.27 percent of total billed charges 1725.02 1725.02 other OPPS APC 1725.02 1725.02 other OPPS APC 1725.02 27.63 476.62 percent of total billed charges 1725.02 1725.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLASMA J-HOOK SUP-76-00136 CDM 0272 RC outpatient 1098.04 1098.04 1098.04 74 812.55 percent of total billed charges 1098.04 93 889.41 percent of total billed charges 1098.04 1098.04 other OPPS APC 1098.04 1098.04 other OPPS APC 1098.04 27.63 303.39 percent of total billed charges 1098.04 1098.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RECY TROCAR 12MM OPTIVIEW DILATG TIP 100 SUP-76-00140 CDM 0272 RC outpatient 88.28 88.28 88.28 74 65.33 percent of total billed charges 88.28 93 71.51 percent of total billed charges 88.28 88.28 other OPPS APC 88.28 88.28 other OPPS APC 88.28 27.63 24.39 percent of total billed charges 88.28 88.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER STRAIGHTENING STYLET 61CM SUP-76-00146 CDM 0272 RC outpatient 342.2 342.2 342.2 74 253.23 percent of total billed charges 342.2 93 277.18 percent of total billed charges 342.2 342.2 other OPPS APC 342.2 342.2 other OPPS APC 342.2 27.63 94.55 percent of total billed charges 342.2 342.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SORBAFIX 15-SHOT TACKER SUP-76-00148 CDM 0272 RC outpatient 1500 1500 1500 74 1110 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 1500 other OPPS APC 1500 1500 other OPPS APC 1500 27.63 414.45 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PRESTERNAL PERITONEAL DIALYSIS SUP-76-00153 CDM C1750 HCPCS 0278 RC outpatient 1194 1194 1194 57 680.58 percent of total billed charges 1194 93 967.14 percent of total billed charges 1194 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1194 other OPPS APC 1194 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1194 other OPPS APC 1194 51 608.94 percent of total billed charges 1194 1194 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER LOCKING TITANIUM SUP-76-00154 CDM 0272 RC outpatient 982.23 982.23 982.23 74 726.85 percent of total billed charges 982.23 93 795.61 percent of total billed charges 982.23 982.23 other OPPS APC 982.23 982.23 other OPPS APC 982.23 27.63 271.39 percent of total billed charges 982.23 982.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUNNELER SHEATH BLUE BULLET SUP-76-00156 CDM 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP APPLIER LAPAROSCOPIC LARGE SUP-76-00157 CDM 0272 RC outpatient 275.71 275.71 275.71 74 204.03 percent of total billed charges 275.71 93 223.33 percent of total billed charges 275.71 275.71 other OPPS APC 275.71 275.71 other OPPS APC 275.71 27.63 76.18 percent of total billed charges 275.71 275.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIGASURE BLUNT HAND PIECE 5MM SUP-76-00161 CDM 0272 RC outpatient 2742.56 2742.56 2742.56 74 2029.49 percent of total billed charges 2742.56 93 2221.47 percent of total billed charges 2742.56 2742.56 other OPPS APC 2742.56 2742.56 other OPPS APC 2742.56 27.63 757.77 percent of total billed charges 2742.56 2742.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THUNDERBEAT 5MM SUP-76-00163 CDM 0272 RC outpatient 1440 1440 1440 74 1065.6 percent of total billed charges 1440 93 1166.4 percent of total billed charges 1440 1440 other OPPS APC 1440 1440 other OPPS APC 1440 27.63 397.87 percent of total billed charges 1440 1440 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELTACK 3 X 10 SUP-76-00164 CDM 0272 RC outpatient 2693.07 2693.07 2693.07 74 1992.87 percent of total billed charges 2693.07 93 2181.39 percent of total billed charges 2693.07 2693.07 other OPPS APC 2693.07 2693.07 other OPPS APC 2693.07 27.63 744.1 percent of total billed charges 2693.07 2693.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELTACK 10R SUP-76-00165 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELTACK 5R SUP-76-00166 CDM 0272 RC outpatient 282.98 282.98 282.98 74 209.41 percent of total billed charges 282.98 93 229.21 percent of total billed charges 282.98 282.98 other OPPS APC 282.98 282.98 other OPPS APC 282.98 27.63 78.19 percent of total billed charges 282.98 282.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON DISSECTION ROUND KIDNEY SUP-76-00167 CDM 0272 RC outpatient 1197.84 1197.84 1197.84 74 886.4 percent of total billed charges 1197.84 93 970.25 percent of total billed charges 1197.84 1197.84 other OPPS APC 1197.84 1197.84 other OPPS APC 1197.84 27.63 330.96 percent of total billed charges 1197.84 1197.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDO SUCTION/IRRIGATION W/TUBING STRYKER SUP-76-00170 CDM 0272 RC outpatient 198.95 198.95 198.95 74 147.22 percent of total billed charges 198.95 93 161.15 percent of total billed charges 198.95 198.95 other OPPS APC 198.95 198.95 other OPPS APC 198.95 27.63 54.97 percent of total billed charges 198.95 198.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENSEALX1 LARGE JAW TISSUE SUP-76-00171 CDM 0272 RC outpatient 1609.24 1609.24 1609.24 74 1190.84 percent of total billed charges 1609.24 93 1303.48 percent of total billed charges 1609.24 1609.24 other OPPS APC 1609.24 1609.24 other OPPS APC 1609.24 27.63 444.63 percent of total billed charges 1609.24 1609.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THUNDERBEAT OPEN FINE JAW SUP-76-00172 CDM 0272 RC outpatient 1493.57 1493.57 1493.57 74 1105.24 percent of total billed charges 1493.57 93 1209.79 percent of total billed charges 1493.57 1493.57 other OPPS APC 1493.57 1493.57 other OPPS APC 1493.57 27.63 412.67 percent of total billed charges 1493.57 1493.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPYGLASS DISCOVER T/A CATH/SCOPE SUP-76-00174 CDM 0272 RC outpatient 7081.25 7081.25 7081.25 7081.25 other OPPS APC 7081.25 7081.25 other OPPS APC 7081.25 27.63 1956.55 percent of total billed charges 7081.25 7081.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER IOC SPYGLASS DISCOVER 5FR 65CM SUP-76-00175 CDM 0272 RC outpatient 507.5 507.5 507.5 507.5 other OPPS APC 507.5 507.5 other OPPS APC 507.5 27.63 140.22 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASKET RETRIEVAL 12MM SPYGLASS DISCOVER SUP-76-00176 CDM 0272 RC outpatient 720 720 720 720 other OPPS APC 720 720 other OPPS APC 720 27.63 198.94 percent of total billed charges 720 720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH SUPER CBDE 12FR 25CM SPYGLASS DISCOVER SUP-76-00177 CDM 0272 RC outpatient 156 156 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUBSTITUTE BONE GRAFT GAMMA-BSM 5CC CALCIUM PHOSPHATE STERILE PUTTY KIT SUP-76-6005 CDM 270010031 LOCAL 0270 RC outpatient 5850 5850 5850 74 4329 percent of total billed charges 5850 93 4738.5 percent of total billed charges 5850 5850 other OPPS APC 5850 5850 other OPPS APC 5850 27.63 1616.36 percent of total billed charges 5850 5850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUBSTITUTE BONE GRAFT GAMMA-BSM 10CC CALCIUM PHOSPHATE STERILE PUTTY KIT SUP-76-6010 CDM 270010031 LOCAL 0270 RC outpatient 8580 8580 8580 74 6349.2 percent of total billed charges 8580 93 6949.8 percent of total billed charges 8580 8580 other OPPS APC 8580 8580 other OPPS APC 8580 27.63 2370.65 percent of total billed charges 8580 8580 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEOS 2.7MM 14MM NON-LOCKING SUP-7620-2714 CDM 0270 RC outpatient 530.4 530.4 530.4 74 392.5 percent of total billed charges 530.4 93 429.62 percent of total billed charges 530.4 530.4 other OPPS APC 530.4 530.4 other OPPS APC 530.4 27.63 146.55 percent of total billed charges 530.4 530.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEOS 2.7MM 16MM NON-LOCKING SUP-7620-2716 CDM 0270 RC outpatient 530.4 530.4 530.4 74 392.5 percent of total billed charges 530.4 93 429.62 percent of total billed charges 530.4 530.4 other OPPS APC 530.4 530.4 other OPPS APC 530.4 27.63 146.55 percent of total billed charges 530.4 530.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEOS 2.7MM 18MM NON-LOCKING SUP-7620-2718 CDM 0270 RC outpatient 530.4 530.4 530.4 74 392.5 percent of total billed charges 530.4 93 429.62 percent of total billed charges 530.4 530.4 other OPPS APC 530.4 530.4 other OPPS APC 530.4 27.63 146.55 percent of total billed charges 530.4 530.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW NON-LOCKING LEOS 3.5MM 18MM SUP-76203518 CDM 0270 RC outpatient 608.4 608.4 608.4 74 450.22 percent of total billed charges 608.4 93 492.8 percent of total billed charges 608.4 608.4 other OPPS APC 608.4 608.4 other OPPS APC 608.4 27.63 168.1 percent of total billed charges 608.4 608.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW NON-LOCKING LEOS 3.5MM 20MM SUP-76203520 CDM 0270 RC outpatient 608.4 608.4 608.4 74 450.22 percent of total billed charges 608.4 93 492.8 percent of total billed charges 608.4 608.4 other OPPS APC 608.4 608.4 other OPPS APC 608.4 27.63 168.1 percent of total billed charges 608.4 608.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEOS 2.7MM 14MM NON-LOCKING SUP-7621-2714 CDM 0270 RC outpatient 717.6 717.6 717.6 74 531.02 percent of total billed charges 717.6 93 581.26 percent of total billed charges 717.6 717.6 other OPPS APC 717.6 717.6 other OPPS APC 717.6 27.63 198.27 percent of total billed charges 717.6 717.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEOS 3.5MM 16MM NON-LOCKING SUP-7621-3516 CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEOS 3.5MM 18MM NON-LOCKING SUP-7621-3518 CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEOS 3.5MM 24MM LOCKING VARIABLE ANGLE SUP-7621-3524 CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING LEOS 3.5MM 18MM SUP-76213518 CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING LEOS 3.5MM 26MM SUP-76213526 CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING LEOS 3.5MM 40MM SUP-76213540 CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEOS SMALL 0DEG LEFT METATARSOPHALANGEAL SUP-7622-1000 CDM 0270 RC outpatient 5616 5616 5616 74 4155.84 percent of total billed charges 5616 93 4548.96 percent of total billed charges 5616 5616 other OPPS APC 5616 5616 other OPPS APC 5616 27.63 1551.7 percent of total billed charges 5616 5616 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SM 0 DEGREE RT LEOS MTP SUP-76221002 CDM 0270 RC outpatient 5616 5616 5616 74 4155.84 percent of total billed charges 5616 93 4548.96 percent of total billed charges 5616 5616 other OPPS APC 5616 5616 other OPPS APC 5616 27.63 1551.7 percent of total billed charges 5616 5616 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION LEOS 1.6MM KIRSCHNER SMOOTH SUP-7624-2016 CDM 0270 RC outpatient 187.2 187.2 187.2 74 138.53 percent of total billed charges 187.2 93 151.63 percent of total billed charges 187.2 187.2 other OPPS APC 187.2 187.2 other OPPS APC 187.2 27.63 51.72 percent of total billed charges 187.2 187.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION LEOS 2MM KIRSCHNER SUP-7624-2020 CDM 0270 RC outpatient 234 234 234 74 173.16 percent of total billed charges 234 93 189.54 percent of total billed charges 234 234 other OPPS APC 234 234 other OPPS APC 234 27.63 64.65 percent of total billed charges 234 234 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LEOS 10MM TACK SUP-7624-2210 CDM 0270 RC outpatient 374.4 374.4 374.4 74 277.06 percent of total billed charges 374.4 93 303.26 percent of total billed charges 374.4 374.4 other OPPS APC 374.4 374.4 other OPPS APC 374.4 27.63 103.45 percent of total billed charges 374.4 374.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEOS O2.0 DRILL SUP-7624-2920 CDM 0270 RC outpatient 639.6 639.6 639.6 74 473.3 percent of total billed charges 639.6 93 518.08 percent of total billed charges 639.6 639.6 other OPPS APC 639.6 639.6 other OPPS APC 639.6 27.63 176.72 percent of total billed charges 639.6 639.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEOS O2.4 DRILL SUP-7624-2924 CDM 0270 RC outpatient 639.6 639.6 639.6 74 473.3 percent of total billed charges 639.6 93 518.08 percent of total billed charges 639.6 639.6 other OPPS APC 639.6 639.6 other OPPS APC 639.6 27.63 176.72 percent of total billed charges 639.6 639.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE TACK LEOS 20MM SUP-76242220 CDM 0270 RC outpatient 374.4 374.4 374.4 74 277.06 percent of total billed charges 374.4 93 303.26 percent of total billed charges 374.4 374.4 other OPPS APC 374.4 374.4 other OPPS APC 374.4 27.63 103.45 percent of total billed charges 374.4 374.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SUBCHONDRAL LEOS 2MM SUP-76242820 CDM 0270 RC outpatient 514.8 514.8 514.8 74 380.95 percent of total billed charges 514.8 93 416.99 percent of total billed charges 514.8 514.8 other OPPS APC 514.8 514.8 other OPPS APC 514.8 27.63 142.24 percent of total billed charges 514.8 514.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL LEOS 2.4 SUP-76242924 CDM 0270 RC outpatient 639.6 639.6 639.6 74 473.3 percent of total billed charges 639.6 93 518.08 percent of total billed charges 639.6 639.6 other OPPS APC 639.6 639.6 other OPPS APC 639.6 27.63 176.72 percent of total billed charges 639.6 639.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACKING WOUND CURITY COTTON L15 FT X W1/2 IN STRIP PLAIN LATEX FREE DISPOSABLE SUP-7632 CDM 270009022 LOCAL 0270 RC outpatient 5 5 5 74 3.7 percent of total billed charges 5 93 4.05 percent of total billed charges 5 5 other OPPS APC 5 5 other OPPS APC 5 27.63 1.38 percent of total billed charges 5 5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACKING WOUND CURITY COTTON GAUZE L5 YD X W1 IN STRIP SELVAGE EDGE PLAIN MESH STERILE LATEX FREE DISPOSABLE SUP-7633 CDM 270009022 LOCAL 0270 RC outpatient 5 5 5 74 3.7 percent of total billed charges 5 93 4.05 percent of total billed charges 5 5 other OPPS APC 5 5 other OPPS APC 5 27.63 1.38 percent of total billed charges 5 5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACKING WOUND CURITY COTTON GAUZE L5 YD X W2 IN STRIP SELVAGE EDGE PLAIN MESH STERILE LATEX FREE DISPOSABLE SUP-7634 CDM 270009022 LOCAL 0270 RC outpatient 5 5 5 74 3.7 percent of total billed charges 5 93 4.05 percent of total billed charges 5 5 other OPPS APC 5 5 other OPPS APC 5 27.63 1.38 percent of total billed charges 5 5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SET LEGACY CD HORIZON TITANIUM SPINE BREAK OFF 6.35 MM ROD SUP-7640020 CDM 270010020 LOCAL 0270 RC outpatient 283.5 283.5 283.5 74 209.79 percent of total billed charges 283.5 93 229.64 percent of total billed charges 283.5 283.5 other OPPS APC 283.5 283.5 other OPPS APC 283.5 27.63 78.33 percent of total billed charges 283.5 283.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEGACY CD HORIZON TITANIUM FLUTE L40 MM OD6.5 MM SPINE G4 TECHNOLOGY MULTIAXIAL SELF TAP LOCK MECHANISM STERILE 6.35 MM ROD SUP-76446540 CDM 270010020 LOCAL 0270 RC outpatient 2335.89 2335.89 2335.89 74 1728.56 percent of total billed charges 2335.89 93 1892.07 percent of total billed charges 2335.89 2335.89 other OPPS APC 2335.89 2335.89 other OPPS APC 2335.89 27.63 645.41 percent of total billed charges 2335.89 2335.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEGACY CD HORIZON TITANIUM FLUTE L45 MM OD6.5 MM SPINE G4 TECHNOLOGY MULTIAXIAL SELF TAP LOCK MECHANISM STERILE 6.35 MM ROD SUP-76446545 CDM 270010020 LOCAL 0270 RC outpatient 2335.89 2335.89 2335.89 74 1728.56 percent of total billed charges 2335.89 93 1892.07 percent of total billed charges 2335.89 2335.89 other OPPS APC 2335.89 2335.89 other OPPS APC 2335.89 27.63 645.41 percent of total billed charges 2335.89 2335.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEGACY CD HORIZON TITANIUM FLUTE L50 MM OD6.5 MM SPINE G4 TECHNOLOGY MULTIAXIAL SELF TAP LOCK MECHANISM STERILE 6.35 MM ROD SUP-76446550 CDM 270010020 LOCAL 0270 RC outpatient 2335.89 2335.89 2335.89 74 1728.56 percent of total billed charges 2335.89 93 1892.07 percent of total billed charges 2335.89 2335.89 other OPPS APC 2335.89 2335.89 other OPPS APC 2335.89 27.63 645.41 percent of total billed charges 2335.89 2335.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KA FEMORAL S5+ INSTRUMENT SET SUP-76527 CDM 0272 RC outpatient 192.5 192.5 192.5 192.5 other OPPS APC 192.5 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING WOUND TELFA AMD PHMB L4 IN X W3 IN NONADHERENT ANTIMICROBIAL STRIP STERILE LATEX FREE SUP-7662 CDM 0270 RC outpatient 0.4 0.4 0.4 74 0.3 percent of total billed charges 0.4 93 0.32 percent of total billed charges 0.4 0.4 other OPPS APC 0.4 0.4 other OPPS APC 0.4 27.63 0.11 percent of total billed charges 0.4 0.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILSHIE CLIP SUP-77-00008 CDM 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 385 other OPPS APC 385 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MONSELS SUP-77-00011 CDM 0272 RC outpatient 54.18 54.18 54.18 74 40.09 percent of total billed charges 54.18 93 43.89 percent of total billed charges 54.18 54.18 other OPPS APC 54.18 54.18 other OPPS APC 54.18 27.63 14.97 percent of total billed charges 54.18 54.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CPT,LAPARASCOPIC TUBAL LIG PAC" SUP-77-00015 CDM 0272 RC outpatient 346.33 346.33 346.33 74 256.28 percent of total billed charges 346.33 93 280.53 percent of total billed charges 346.33 346.33 other OPPS APC 346.33 346.33 other OPPS APC 346.33 27.63 95.69 percent of total billed charges 346.33 346.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE C-LETZ CONIZATION 11 SUP-77-00017 CDM 0272 RC outpatient 91.52 91.52 91.52 74 67.72 percent of total billed charges 91.52 93 74.13 percent of total billed charges 91.52 91.52 other OPPS APC 91.52 91.52 other OPPS APC 91.52 27.63 25.29 percent of total billed charges 91.52 91.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ELECTRODE, CTZ CONIZATION 20X1" SUP-77-00018 CDM 0272 RC outpatient 64.4 64.4 64.4 74 47.66 percent of total billed charges 64.4 93 52.16 percent of total billed charges 64.4 64.4 other OPPS APC 64.4 64.4 other OPPS APC 64.4 27.63 17.79 percent of total billed charges 64.4 64.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ELECTRODE, C-LETZ CONIZATION 2" SUP-77-00019 CDM 0272 RC outpatient 62.4 62.4 62.4 74 46.18 percent of total billed charges 62.4 93 50.54 percent of total billed charges 62.4 62.4 other OPPS APC 62.4 62.4 other OPPS APC 62.4 27.63 17.24 percent of total billed charges 62.4 62.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ELECTRODE, C-LETZ CONIZATION 1" SUP-77-00020 CDM 0272 RC outpatient 64.4 64.4 64.4 74 47.66 percent of total billed charges 64.4 93 52.16 percent of total billed charges 64.4 64.4 other OPPS APC 64.4 64.4 other OPPS APC 64.4 27.63 17.79 percent of total billed charges 64.4 64.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ELECTRODE, C-LETZ CONIZATION 5" SUP-77-00021 CDM 0272 RC outpatient 64.4 64.4 64.4 74 47.66 percent of total billed charges 64.4 93 52.16 percent of total billed charges 64.4 64.4 other OPPS APC 64.4 64.4 other OPPS APC 64.4 27.63 17.79 percent of total billed charges 64.4 64.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT NOVASURE ADVANCED SUP-77-00029 CDM 0272 RC outpatient 3100 3100 3100 74 2294 percent of total billed charges 3100 93 2511 percent of total billed charges 3100 3100 other OPPS APC 3100 3100 other OPPS APC 3100 27.63 856.53 percent of total billed charges 3100 3100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MANIPULATOR UTERINE CLEARVIEW SUP-77-00030 CDM 0272 RC outpatient 265.13 265.13 265.13 74 196.2 percent of total billed charges 265.13 93 214.76 percent of total billed charges 265.13 265.13 other OPPS APC 265.13 265.13 other OPPS APC 265.13 27.63 73.26 percent of total billed charges 265.13 265.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ESSURE SUP-77-00031 CDM 0272 RC outpatient 4625 4625 4625 74 3422.5 percent of total billed charges 4625 93 3746.25 percent of total billed charges 4625 4625 other OPPS APC 4625 4625 other OPPS APC 4625 27.63 1277.89 percent of total billed charges 4625 4625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COBLATION WAND EIC-5872 SUP-77-00032 CDM 0272 RC outpatient 969.93 969.93 969.93 74 717.75 percent of total billed charges 969.93 93 785.64 percent of total billed charges 969.93 969.93 other OPPS APC 969.93 969.93 other OPPS APC 969.93 27.63 267.99 percent of total billed charges 969.93 969.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COBLATION WAND HP EIC-5874 SUP-77-00033 CDM 0272 RC outpatient 816.12 816.12 816.12 74 603.93 percent of total billed charges 816.12 93 661.06 percent of total billed charges 816.12 816.12 other OPPS APC 816.12 816.12 other OPPS APC 816.12 27.63 225.49 percent of total billed charges 816.12 816.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COBLATION WAND PTR EIC-4835 SUP-77-00034 CDM 0272 RC outpatient 912.36 912.36 912.36 74 675.15 percent of total billed charges 912.36 93 739.01 percent of total billed charges 912.36 912.36 other OPPS APC 912.36 912.36 other OPPS APC 912.36 27.63 252.09 percent of total billed charges 912.36 912.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COBLATION WAND PROCISE XP SUP-77-00035 CDM 0272 RC outpatient 972.96 972.96 972.96 74 719.99 percent of total billed charges 972.96 93 788.1 percent of total billed charges 972.96 972.96 other OPPS APC 972.96 972.96 other OPPS APC 972.96 27.63 268.83 percent of total billed charges 972.96 972.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XCISE MORECELLATOR SUP-77-00037 CDM C1782 HCPCS 0272 RC outpatient 2139 2139 2139 74 1582.86 percent of total billed charges 2139 93 1732.59 percent of total billed charges 2139 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2139 other OPPS APC 2139 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2139 other OPPS APC 2139 27.63 591.01 percent of total billed charges 2139 2139 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEPRAFILM 3X5 SUP-77-00041 CDM C1765 HCPCS 0272 RC outpatient 420 420 420 74 310.8 percent of total billed charges 420 93 340.2 percent of total billed charges 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 27.63 116.05 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEPRAFILM 5X6 SUP-77-00042 CDM C1765 HCPCS 0272 RC outpatient 691.25 691.25 691.25 74 511.53 percent of total billed charges 691.25 93 559.91 percent of total billed charges 691.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 691.25 other OPPS APC 691.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 691.25 other OPPS APC 691.25 27.63 190.99 percent of total billed charges 691.25 691.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONE STAR RETRACTOR GYN KIT SUP-77-00045 CDM 0272 RC outpatient 420.4 420.4 420.4 74 311.1 percent of total billed charges 420.4 93 340.52 percent of total billed charges 420.4 420.4 other OPPS APC 420.4 420.4 other OPPS APC 420.4 27.63 116.16 percent of total billed charges 420.4 420.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAKRI BALLOON SUP-77-00047 CDM 0272 RC outpatient 1031.4 1031.4 1031.4 74 763.24 percent of total billed charges 1031.4 93 835.43 percent of total billed charges 1031.4 1031.4 other OPPS APC 1031.4 1031.4 other OPPS APC 1031.4 27.63 284.98 percent of total billed charges 1031.4 1031.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WILLSCHER VAS REAPPROXIMATOR SET SUP-77-00048 CDM 0272 RC outpatient 199.33 199.33 199.33 74 147.5 percent of total billed charges 199.33 93 161.46 percent of total billed charges 199.33 199.33 other OPPS APC 199.33 199.33 other OPPS APC 199.33 27.63 55.07 percent of total billed charges 199.33 199.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MACROPLASTIQUE IMPLANT SUP-77-00049 CDM L8606 HCPCS 0278 RC outpatient 2121 2121 2121 57 1208.97 percent of total billed charges 2121 93 1718.01 percent of total billed charges 2121 2121 other OPPS APC 2121 2121 other OPPS APC 2121 51 1081.71 percent of total billed charges 2121 2121 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UROPLASTY ENDOSCOPIC NEEDLE SUP-77-00050 CDM 0272 RC outpatient 164 164 164 74 121.36 percent of total billed charges 164 93 132.84 percent of total billed charges 164 164 other OPPS APC 164 164 other OPPS APC 164 27.63 45.31 percent of total billed charges 164 164 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WAND COBLATION TURBINATOR SUP-77-00052 CDM 0272 RC outpatient 950.64 950.64 950.64 74 703.47 percent of total billed charges 950.64 93 770.02 percent of total billed charges 950.64 950.64 other OPPS APC 950.64 950.64 other OPPS APC 950.64 27.63 262.66 percent of total billed charges 950.64 950.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALS ROD LENS SCOPE SUP-77-00053 CDM 0272 RC outpatient 40 40 40 74 29.6 percent of total billed charges 40 93 32.4 percent of total billed charges 40 40 other OPPS APC 40 40 other OPPS APC 40 27.63 11.05 percent of total billed charges 40 40 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MYOSURE LITE SUP-77-00054 CDM C1782 HCPCS 0272 RC outpatient 2124 2124 2124 74 1571.76 percent of total billed charges 2124 93 1720.44 percent of total billed charges 2124 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2124 other OPPS APC 2124 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2124 other OPPS APC 2124 27.63 586.86 percent of total billed charges 2124 2124 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MYOSURE SUP-77-00055 CDM C1782 HCPCS 0272 RC outpatient 2825 2825 2825 74 2090.5 percent of total billed charges 2825 93 2288.25 percent of total billed charges 2825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2825 other OPPS APC 2825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2825 other OPPS APC 2825 27.63 780.55 percent of total billed charges 2825 2825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCOPE LITHOVUE SUP-77-00057 CDM 0272 RC outpatient 3750 3750 3750 74 2775 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 3750 other OPPS APC 3750 3750 other OPPS APC 3750 27.63 1036.13 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING ASPIRATION AXS UNIVERSAL L300 CM OD8 MM STERILE LATEX FREE DISPOSABLE SUP-77.0193 CDM 0270 RC outpatient 821.6 821.6 821.6 74 607.98 percent of total billed charges 821.6 93 665.5 percent of total billed charges 821.6 821.6 other OPPS APC 821.6 821.6 other OPPS APC 821.6 27.63 227.01 percent of total billed charges 821.6 821.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT SUCTION AXS UNIVERSAL LINER NONSTERILE LATEX FREE DISPOSABLE SUP-77.0194 CDM 0270 RC outpatient 71.93 71.93 71.93 74 53.23 percent of total billed charges 71.93 93 58.26 percent of total billed charges 71.93 71.93 other OPPS APC 71.93 71.93 other OPPS APC 71.93 27.63 19.87 percent of total billed charges 71.93 71.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE 6.0 PLAIN SUP-770G CDM 0270 RC outpatient 35.09 35.09 35.09 74 25.97 percent of total billed charges 35.09 93 28.42 percent of total billed charges 35.09 35.09 other OPPS APC 35.09 35.09 other OPPS APC 35.09 27.63 9.7 percent of total billed charges 35.09 35.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ZEVO TITANIUM L13 MM OD3.5 MM SPINE CERVICAL ANTERIOR VARIABLE SELF DRILL SUP-7713513 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ZEVO TITANIUM L15 MM OD3.5 MM SPINE CERVICAL ANTERIOR VARIABLE SELF DRILL SUP-7713515 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ZEVO TITANIUM L17 MM OD3.5 MM SPINE CERVICAL ANTERIOR VARIABLE SELF DRILL SUP-7713517 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MEDTRONIC 3.5MM X 15MM SUP-7723515 CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ZEVO TITANIUM L13 MM OD4 MM SPINE CERVICAL ANTERIOR VARIABLE SELF TAP SUP-7724013 CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ZEVO TITANIUM L15 MM OD4 MM SPINE CERVICAL ANTERIOR VARIABLE SELF TAP SUP-7724015 CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY CATHETERIZATION BARD NATURAL RUBBER OD15 FR 1000 ML 2 LEVEL INTERMITTENT PREATTACH COLLECTION BAG DRAPE STERILE LATEX DISPOSABLE RED SUP-772414 CDM 270009005 LOCAL 0270 RC outpatient 2.95 2.95 2.95 74 2.18 percent of total billed charges 2.95 93 2.39 percent of total billed charges 2.95 2.95 other OPPS APC 2.95 2.95 other OPPS APC 2.95 27.63 0.82 percent of total billed charges 2.95 2.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA SUBRETINAL SUP-7725 CDM 0270 RC outpatient 20.8 20.8 20.8 74 15.39 percent of total billed charges 20.8 93 16.85 percent of total billed charges 20.8 20.8 other OPPS APC 20.8 20.8 other OPPS APC 20.8 27.63 5.75 percent of total billed charges 20.8 20.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD INGEVITY 32 CM FOR ACCOLADE MRI DEVICES SUP-7731/32 CDM 0275 RC outpatient 1131 1131 1131 57 644.67 percent of total billed charges 1131 93 916.11 percent of total billed charges 1131 1131 other OPPS APC 1131 1131 other OPPS APC 1131 51 576.81 percent of total billed charges 1131 1131 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD INGEVITY 35 CM FOR ACCOLADE MRI DEVICES SUP-7731/35 CDM 0275 RC outpatient 1131 1131 1131 57 644.67 percent of total billed charges 1131 93 916.11 percent of total billed charges 1131 1131 other OPPS APC 1131 1131 other OPPS APC 1131 51 576.81 percent of total billed charges 1131 1131 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD INGEVITY 36 CM FOR ACCOLADE MRI DEVICES SUP-7731/36 CDM 0275 RC outpatient 1131 1131 1131 57 644.67 percent of total billed charges 1131 93 916.11 percent of total billed charges 1131 1131 other OPPS APC 1131 1131 other OPPS APC 1131 51 576.81 percent of total billed charges 1131 1131 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON SABRELOC 5-0 S-24 18IN BLACK 2 ARM MONOFILAMENT SUP-7731G CDM 0270 RC outpatient 30.67 30.67 30.67 74 22.7 percent of total billed charges 30.67 93 24.84 percent of total billed charges 30.67 30.67 other OPPS APC 30.67 30.67 other OPPS APC 30.67 27.63 8.47 percent of total billed charges 30.67 30.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEODORANT OSTOMY M9 2 OZ PUMP SPRAY BOTTLE ROOM NEUTRALIZE NONSTERILE LATEX FREE UNSCENTED SUP-7732 CDM 0270 RC outpatient 1.64 1.64 1.64 74 1.21 percent of total billed charges 1.64 93 1.33 percent of total billed charges 1.64 1.64 other OPPS APC 1.64 1.64 other OPPS APC 1.64 27.63 0.45 percent of total billed charges 1.64 1.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD INGEVITY 45 CM FOR ACCOLADE MRI DEVICES SUP-7740/45 CDM 0275 RC outpatient 1040 1040 1040 57 592.8 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD 7741 INGEVITY 52 CM FOR ACCOLADE MRI DEVICES SUP-7741/52 CDM 0275 RC outpatient 1040 1040 1040 57 592.8 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD INGEVITY 59 CM FOR ACCOLADE MRI DEVICES SUP-7742/59 CDM 0275 RC outpatient 1040 1040 1040 57 592.8 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD MEDTRONIC 240MM SUP-7750015 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER STERILIZATION CONTAINER STAINLESS STEEL L7.5 IN PAPER NONSTERILE DISPOSABLE SUP-775200 CDM 0270 RC outpatient 0.31 0.31 0.31 74 0.23 percent of total billed charges 0.31 93 0.25 percent of total billed charges 0.31 0.31 other OPPS APC 0.31 0.31 other OPPS APC 0.31 27.63 0.09 percent of total billed charges 0.31 0.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL VERTEX SELECT L25 MM OD3.5 MM PRECUT SUP-7753725 CDM 270010020 LOCAL 0270 RC outpatient 1092 1092 1092 74 808.08 percent of total billed charges 1092 93 884.52 percent of total billed charges 1092 1092 other OPPS APC 1092 1092 other OPPS APC 1092 27.63 301.72 percent of total billed charges 1092 1092 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD MEDTRONIC 30MM SUP-7753730 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL VERTEX L40 MM OD3.5 MM PRECUT SUP-7753740 CDM 270010020 LOCAL 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL VERTEX SELECT L60 MM OD3.5 MM PRECUT SUP-7753760 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CCM PLUS L70 MM OD3.5 MM PRECUT SUP-7753770 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL 80MM 3.5MM CCM PLUS PRECUT SUP-7753780 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CCM PLUS L90 MM OD3.5 MM PRECUT SUP-7753890 CDM 270010020 LOCAL 0270 RC outpatient 1092 1092 1092 74 808.08 percent of total billed charges 1092 93 884.52 percent of total billed charges 1092 1092 other OPPS APC 1092 1092 other OPPS APC 1092 27.63 301.72 percent of total billed charges 1092 1092 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL VERTEX OD2.4 MM RECONSTRUCTION SET SUP-7756010 CDM 270010020 LOCAL 0270 RC outpatient 800.8 800.8 800.8 74 592.59 percent of total billed charges 800.8 93 648.65 percent of total billed charges 800.8 800.8 other OPPS APC 800.8 800.8 other OPPS APC 800.8 27.63 221.26 percent of total billed charges 800.8 800.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR LATERAL 10MM SUP-7756064 CDM 270010020 LOCAL 0270 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 27.63 341.23 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON MICROPOINT 10-0 TG160-6 6IN BLACK 2 ARM MONOFILAMENT SUP-7757G CDM 0270 RC outpatient 43.58 43.58 43.58 74 32.25 percent of total billed charges 43.58 93 35.3 percent of total billed charges 43.58 43.58 other OPPS APC 43.58 43.58 other OPPS APC 43.58 27.63 12.04 percent of total billed charges 43.58 43.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON MICROPOINT 9-0 TG160-6 L12 IN 2 ARM MONOFILAMENT BLACK SUP-7760G CDM 0270 RC outpatient 44.18 44.18 44.18 74 32.69 percent of total billed charges 44.18 93 35.79 percent of total billed charges 44.18 44.18 other OPPS APC 44.18 44.18 other OPPS APC 44.18 27.63 12.21 percent of total billed charges 44.18 44.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 10-0 CS160-6 L12 IN 2 ARM MONOFILAMENT BLUE SUP-7761G CDM 0270 RC outpatient 52.24 52.24 52.24 74 38.66 percent of total billed charges 52.24 93 42.31 percent of total billed charges 52.24 52.24 other OPPS APC 52.24 52.24 other OPPS APC 52.24 27.63 14.43 percent of total billed charges 52.24 52.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRIDGE LOOP OSTOMY STERILE SUP-7767 CDM 0270 RC outpatient 1.03 1.03 1.03 74 0.76 percent of total billed charges 1.03 93 0.83 percent of total billed charges 1.03 1.03 other OPPS APC 1.03 1.03 other OPPS APC 1.03 27.63 0.28 percent of total billed charges 1.03 1.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN 3M UL-1 SUP-777-0661 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 2 CUSPID FIRST PRIMARY MOLAR UPPER LEFT PREFABRICATE PRETRIM BELL CRIMP SUP-777-0793 CDM 0270 RC outpatient 23.39 23.39 23.39 74 17.31 percent of total billed charges 23.39 93 18.95 percent of total billed charges 23.39 23.39 other OPPS APC 23.39 23.39 other OPPS APC 23.39 27.63 6.46 percent of total billed charges 23.39 23.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 2 CUSPID FIRST PERMANENT MOLAR UPPER RIGHT PREFABRICATE PRECRIMP PRETRIM DUPLICATE ANATOMY SUP-777-1176 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL 7 CONTOUR CUSPID UPPER RIGHT FIRST PERMANENT MOLAR PRETRIM BELL CRIMP SUP-777-1220 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 3 CUSPID FIRST PERMANENT MOLAR LOWER LEFT PREFABRICATE PRETRIM CRIMP BELL SUP-777-1685 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 4 FIRST PERMANENT MOLAR UPPER RIGHT PREFABRICATE PRETRIM CRIMP SUP-777-1948 CDM 0270 RC outpatient 23.39 23.39 23.39 74 17.31 percent of total billed charges 23.39 93 18.95 percent of total billed charges 23.39 23.39 other OPPS APC 23.39 23.39 other OPPS APC 23.39 27.63 6.46 percent of total billed charges 23.39 23.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 2 CUSPID SECOND PRIMARY MOLAR LOWER LEFT PREFABRICATE PRETRIM BELL CRIMP SUP-777-1992 CDM 0270 RC outpatient 26.77 26.77 26.77 74 19.81 percent of total billed charges 26.77 93 21.68 percent of total billed charges 26.77 26.77 other OPPS APC 26.77 26.77 other OPPS APC 26.77 27.63 7.4 percent of total billed charges 26.77 26.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 7 CUSPID FIRST PERMANENT MOLAR UPPER LEFT PREFABRICATE PRETRIM CRIMP BELL SUP-777-2134 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 2 CUSPID SECOND PRIMARY MOLAR LOWER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-777-2221 CDM 0270 RC outpatient 26.77 26.77 26.77 74 19.81 percent of total billed charges 26.77 93 21.68 percent of total billed charges 26.77 26.77 other OPPS APC 26.77 26.77 other OPPS APC 26.77 27.63 7.4 percent of total billed charges 26.77 26.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 3 CUSPID FIRST PERMANENT MOLAR LOWER RIGHT PREFABRICATE PRETRIM CRIMP BELL SUP-777-2398 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL 7 CUSPID CONTOUR FIRST PERMANENT MOLAR LOWER RIGHT PREFABRICATE PRETRIM SUP-777-2522 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 3 CUSPID FIRST PRIMARY MOLAR UPPER LEFT PREFABRICATE PRETRIM BELL CRIMP SUP-777-2527 CDM 0270 RC outpatient 23.39 23.39 23.39 74 17.31 percent of total billed charges 23.39 93 18.95 percent of total billed charges 23.39 23.39 other OPPS APC 23.39 23.39 other OPPS APC 23.39 27.63 6.46 percent of total billed charges 23.39 23.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL 6 CUSPID LOWER LEFT FIRST PERMANENT MOLAR PREFABRICATE PRETRIM CRIMP BELL SUP-777-2705 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN 3M UR-1 SUP-777-2720 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE PLASTIC PEDIATRIC 2 CONTOUR PRIMARY ANTERIOR UPPER RIGHT CENTRAL STRIP AUTOMATIC PREFABRICATE TRANSPARENT SUP-777-3039 CDM 0270 RC outpatient 31.09 31.09 31.09 74 23.01 percent of total billed charges 31.09 93 25.18 percent of total billed charges 31.09 31.09 other OPPS APC 31.09 31.09 other OPPS APC 31.09 27.63 8.59 percent of total billed charges 31.09 31.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 3 CUSPID FIRST PERMANENT MOLAR UPPER RIGHT PREFABRICATE PRECRIMP PRETRIM DUPLICATE ANATOMY SUP-777-3748 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 2 CUSPID FIRST PERMANENT MOLAR LOWER RIGHT PREFABRICATE PRECRIMP PRETRIM DUPLICATE ANATOMY SUP-777-3889 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 6 FIRST PERMANENT MOLAR LOWER RIGHT PREFABRICATE PRETRIM CRIMP SUP-777-3928 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE PLASTIC PEDIATRIC 4 THIN CONTOUR PRIMARY ANTERIOR UPPER RIGHT CENTRAL STRIP FORM AUTOMATIC INTERPROXIMAL WALL PREFABRICATE TRANSPARENT SUP-777-3944 CDM 0270 RC outpatient 19.75 19.75 19.75 74 14.62 percent of total billed charges 19.75 93 16 percent of total billed charges 19.75 19.75 other OPPS APC 19.75 19.75 other OPPS APC 19.75 27.63 5.46 percent of total billed charges 19.75 19.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 5 FIRST PERMANENT MOLAR LOWER RIGHT PREFABRICATE PRETRIM CRIMP SUP-777-4369 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 2 CUSPID FIRST PRIMARY MOLAR LOWER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-777-4911 CDM outpatient 26.77 26.77 26.77 26.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC D-UR-2 CUSPID FIRST PRIMARY MOLAR UPPER LEFT PREFABRICATE PRETRIM BELL CRIMP REPLACEMENT SUP-777-5159 CDM 0270 RC outpatient 23.39 23.39 23.39 74 17.31 percent of total billed charges 23.39 93 18.95 percent of total billed charges 23.39 23.39 other OPPS APC 23.39 23.39 other OPPS APC 23.39 27.63 6.46 percent of total billed charges 23.39 23.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 5 FIRST PERMANENT MOLAR UPPER LEFT PREFABRICATE PRETRIM CRIMP SUP-777-5315 CDM 0270 RC outpatient 17.05 17.05 17.05 74 12.62 percent of total billed charges 17.05 93 13.81 percent of total billed charges 17.05 17.05 other OPPS APC 17.05 17.05 other OPPS APC 17.05 27.63 4.71 percent of total billed charges 17.05 17.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 4 CUSPID FIRST PERMANENT MOLAR LOWER LEFT PREFABRICATE PRECRIMP PRETRIM DUPLICATE ANATOMY SUP-777-5371 CDM 0270 RC outpatient 23.39 23.39 23.39 74 17.31 percent of total billed charges 23.39 93 18.95 percent of total billed charges 23.39 23.39 other OPPS APC 23.39 23.39 other OPPS APC 23.39 27.63 6.46 percent of total billed charges 23.39 23.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 3 CUSPID FIRST PERMANENT MOLAR UPPER LEFT PREFABRICATE PRECRIMP PRETRIM DUPLICATE ANATOMY SUP-777-5628 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 3 CUSPID FIRST PRIMARY MOLAR LOWER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-777-5656 CDM outpatient 26.77 26.77 26.77 26.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 5 FIRST PERMANENT MOLAR UPPER RIGHT PREFABRICATE PRETRIM CRIMP SUP-777-6209 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE PLASTIC PEDIATRIC 2 CONTOUR PRIMARY ANTERIOR UPPER LEFT CENTRAL STRIP THIN INTERPROXIMAL WALL PREFABRICATE TRANSPARENT PEDODONTIC SUP-777-6339 CDM 0270 RC outpatient 19.75 19.75 19.75 74 14.62 percent of total billed charges 19.75 93 16 percent of total billed charges 19.75 19.75 other OPPS APC 19.75 19.75 other OPPS APC 19.75 27.63 5.46 percent of total billed charges 19.75 19.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 2 CUSPID FIRST PERMANENT MOLAR LOWER LEFT PREFABRICATE PRECRIMP PRETRIM DUPLICATE ANATOMY SUP-777-6802 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 6 CUSPID FIRST PERMANENT MOLAR UPPER LEFT PREFABRICATE PRECRIMP PRETRIM DUPLICATE ANATOMY SUP-777-6943 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL 5 CUSPID LOWER LEFT FIRST PERMANENT MOLAR PREFABRICATE PRETRIM CRIMP BELL SUP-777-7122 CDM 0270 RC outpatient 23.39 23.39 23.39 74 17.31 percent of total billed charges 23.39 93 18.95 percent of total billed charges 23.39 23.39 other OPPS APC 23.39 23.39 other OPPS APC 23.39 27.63 6.46 percent of total billed charges 23.39 23.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE PLASTIC PEDIATRIC 4 CONTOUR PRIMARY ANTERIOR UPPER LEFT CENTRAL STRIP AUTOMATIC PREFABRICATE TRANSPARENT SUP-777-7523 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL 6 FIRST PERMANENT MOLAR LOWER RIGHT PREFABRICATE PRETRIM CRIMP BELL SUP-777-7644 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE PLASTIC 1 CONTOUR PRIMARY ANTERIOR UPPER LEFT LATERAL TRANSPARENT STRIP PREFABRICATE THIN INTERPROXIMAL WALL SUP-777-7656 CDM 0270 RC outpatient 19.75 19.75 19.75 74 14.62 percent of total billed charges 19.75 93 16 percent of total billed charges 19.75 19.75 other OPPS APC 19.75 19.75 other OPPS APC 19.75 27.63 5.46 percent of total billed charges 19.75 19.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM 3M ESPE PLASTIC 42 CONTOUR PRIMARY ANTERIOR UPPER LEFT LATERAL TRANSPARENT STRIP PREFABRICATE THIN INTERPROXIMAL WALL SUP-777-7815 CDM 0270 RC outpatient 20.59 20.59 20.59 74 15.24 percent of total billed charges 20.59 93 16.68 percent of total billed charges 20.59 20.59 other OPPS APC 20.59 20.59 other OPPS APC 20.59 27.63 5.69 percent of total billed charges 20.59 20.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 7 CUSPID SECOND PRIMARY MOLAR LOWER LEFT PREFABRICATE PRETRIM BELL CRIMP SUP-777-7892 CDM 0270 RC outpatient 23.39 23.39 23.39 74 17.31 percent of total billed charges 23.39 93 18.95 percent of total billed charges 23.39 23.39 other OPPS APC 23.39 23.39 other OPPS APC 23.39 27.63 6.46 percent of total billed charges 23.39 23.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL ESPE STAINLESS STEEL PEDIATRIC 4 FIRST PERMANENT MOLAR UPPER LEFT PREFABRICATED PRETRIMMED CRIMPED SUP-777-7941 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 2 CUSPID FIRST PERMANENT MOLAR UPPER LEFT PREFABRICATE PRECRIMP PRETRIM DUPLICATE ANATOMY SUP-777-8039 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE PLASTIC 1 CONTOUR PRIMARY ANTERIOR UPPER RIGHT LATERAL TRANSPARENT STRIP PREFABRICATE THIN INTERPROXIMAL WALL CLEAR PEDODONTIC SUP-777-8296 CDM 0270 RC outpatient 19.75 19.75 19.75 74 14.62 percent of total billed charges 19.75 93 16 percent of total billed charges 19.75 19.75 other OPPS APC 19.75 19.75 other OPPS APC 19.75 27.63 5.46 percent of total billed charges 19.75 19.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE PLASTIC PEDIATRIC 2 THIN CONTOUR PRIMARY ANTERIOR UPPER RIGHT LATERAL STRIP FORM AUTOMATIC INTERPROXIMAL WALL PREFABRICATE TRANSPARENT SUP-777-8520 CDM 0270 RC outpatient 19.75 19.75 19.75 74 14.62 percent of total billed charges 19.75 93 16 percent of total billed charges 19.75 19.75 other OPPS APC 19.75 19.75 other OPPS APC 19.75 27.63 5.46 percent of total billed charges 19.75 19.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 2 CUSPID FIRST PRIMARY MOLAR LOWER LEFT PREFABRICATE PRETRIM BELL CRIMP SUP-777-8601 CDM 0270 RC outpatient 23.39 23.39 23.39 74 17.31 percent of total billed charges 23.39 93 18.95 percent of total billed charges 23.39 23.39 other OPPS APC 23.39 23.39 other OPPS APC 23.39 27.63 6.46 percent of total billed charges 23.39 23.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 7 FIRST PERMANENT MOLAR LOWER LEFT PREFABRICATE PRETRIM CRIMP SUP-777-8622 CDM 0270 RC outpatient 23.39 23.39 23.39 74 17.31 percent of total billed charges 23.39 93 18.95 percent of total billed charges 23.39 23.39 other OPPS APC 23.39 23.39 other OPPS APC 23.39 27.63 6.46 percent of total billed charges 23.39 23.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN 3M UR-4 SUP-777-8797 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 7 CUSPID SECOND PRIMARY MOLAR LOWER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-777-9526 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL 6 CONTOUR CUSPID UPPER RIGHT FIRST PERMANENT MOLAR PRETRIM BELL CRIMP SUP-777-9793 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK DENTAL RELYX AUTOMIX GLASS IONOMER 3-8.5 GM 36 MIX TIP LUTE PLUS RESIN MODIFY SUP-7770454 CDM 27000000 LOCAL 0270 RC outpatient 298.12 298.12 298.12 74 220.61 percent of total billed charges 298.12 93 241.48 percent of total billed charges 298.12 298.12 other OPPS APC 298.12 298.12 other OPPS APC 298.12 27.63 82.37 percent of total billed charges 298.12 298.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 7 CUSPID SECOND PRIMARY MOLAR UPPER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-7776009 CDM 0270 RC outpatient 26.77 26.77 26.77 74 19.81 percent of total billed charges 26.77 93 21.68 percent of total billed charges 26.77 26.77 other OPPS APC 26.77 26.77 other OPPS APC 26.77 27.63 7.4 percent of total billed charges 26.77 26.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PULMONARY ARTERY SWAN-GANZ CCO VIP 110CM 7.5FR HEPARIN POLYMER PULMONARY SUP-777F8 CDM 0481 RC outpatient 864.94 864.94 864.94 74 640.06 percent of total billed charges 864.94 93 700.6 percent of total billed charges 864.94 864.94 other OPPS APC 864.94 864.94 other OPPS APC 864.94 51 441.12 percent of total billed charges 864.94 864.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK SPHERX PPS OD5.5 MM SPINE SUP-7782001 CDM 270010020 LOCAL 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TULIP SPINE 5.5 MM ROD SUP-7782004 CDM 270010020 LOCAL 0270 RC outpatient 1755 1755 1755 74 1298.7 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 1755 other OPPS APC 1755 1755 other OPPS APC 1755 27.63 484.91 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR ROD DOMINO TITANIUM CL5.5 CURVE SPINE CLOSED SUP-779125555 CDM 270010020 LOCAL 0270 RC outpatient 3569.28 3569.28 3569.28 74 2641.27 percent of total billed charges 3569.28 93 2891.12 percent of total billed charges 3569.28 3569.28 other OPPS APC 3569.28 3569.28 other OPPS APC 3569.28 27.63 986.19 percent of total billed charges 3569.28 3569.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR ROD DOMINO TITANIUM SD5.5 CURVE SPINE SOLID SUP-779145555 CDM 270010020 LOCAL 0270 RC outpatient 2920.32 2920.32 2920.32 74 2161.04 percent of total billed charges 2920.32 93 2365.46 percent of total billed charges 2920.32 2920.32 other OPPS APC 2920.32 2920.32 other OPPS APC 2920.32 27.63 806.88 percent of total billed charges 2920.32 2920.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR ROD DOMINO TITANIUM CL5.5 SD6.35 CURVE SPINE OPEN CLOSE SOLID SUP-779146555 CDM 270010020 LOCAL 0270 RC outpatient 4056 4056 4056 74 3001.44 percent of total billed charges 4056 93 3285.36 percent of total billed charges 4056 4056 other OPPS APC 4056 4056 other OPPS APC 4056 27.63 1120.67 percent of total billed charges 4056 4056 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SET STANDARD 32 THREAD OD.25 IN SPINE CAP SUP-779170005 CDM 270010020 LOCAL 0270 RC outpatient 457.6 457.6 457.6 74 338.62 percent of total billed charges 457.6 93 370.66 percent of total billed charges 457.6 457.6 other OPPS APC 457.6 457.6 other OPPS APC 457.6 27.63 126.43 percent of total billed charges 457.6 457.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIRSHNER WIRE .045 SUP-78-00104 CDM C1713 HCPCS 0278 RC outpatient 20 20 20 57 11.4 percent of total billed charges 20 93 16.2 percent of total billed charges 20 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20 other OPPS APC 20 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20 other OPPS APC 20 51 10.2 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLAIN STEINMAN PIN 3/16 SUP-78-00121 CDM C1713 HCPCS 0278 RC outpatient 45.47 45.47 45.47 57 25.92 percent of total billed charges 45.47 93 36.83 percent of total billed charges 45.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 45.47 other OPPS APC 45.47 45.47 other OPPS APC 45.47 51 23.19 percent of total billed charges 45.47 45.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THREADED STEINMAN PIN 1/8 SUP-78-00136 CDM C1713 HCPCS 0278 RC outpatient 29.01 29.01 29.01 57 16.54 percent of total billed charges 29.01 93 23.5 percent of total billed charges 29.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.01 other OPPS APC 29.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.01 other OPPS APC 29.01 51 14.8 percent of total billed charges 29.01 29.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THREADED STEINMAN PIN 3/16 SUP-78-00137 CDM C1713 HCPCS 0278 RC outpatient 29.01 29.01 29.01 57 16.54 percent of total billed charges 29.01 93 23.5 percent of total billed charges 29.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.01 other OPPS APC 29.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.01 other OPPS APC 29.01 51 14.8 percent of total billed charges 29.01 29.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THREADED STEINMAN PIN 3/32 SUP-78-00138 CDM C1713 HCPCS 0278 RC outpatient 29.01 29.01 29.01 57 16.54 percent of total billed charges 29.01 93 23.5 percent of total billed charges 29.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.01 other OPPS APC 29.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.01 other OPPS APC 29.01 51 14.8 percent of total billed charges 29.01 29.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THREADED STEINMAN PIN 5/64 SUP-78-00139 CDM C1713 HCPCS 0278 RC outpatient 76.63 76.63 76.63 57 43.68 percent of total billed charges 76.63 93 62.07 percent of total billed charges 76.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 76.63 other OPPS APC 76.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 76.63 other OPPS APC 76.63 51 39.08 percent of total billed charges 76.63 76.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THREADED STEINMAN PIN 7/64 SUP-78-00140 CDM C1713 HCPCS 0278 RC outpatient 29.01 29.01 29.01 57 16.54 percent of total billed charges 29.01 93 23.5 percent of total billed charges 29.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.01 other OPPS APC 29.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 29.01 other OPPS APC 29.01 51 14.8 percent of total billed charges 29.01 29.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TWIST DRILL 1/8 SUP-78-00141 CDM 0272 RC outpatient 49.49 49.49 49.49 74 36.62 percent of total billed charges 49.49 93 40.09 percent of total billed charges 49.49 49.49 other OPPS APC 49.49 49.49 other OPPS APC 49.49 27.63 13.67 percent of total billed charges 49.49 49.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TWIST DRILL 3/32 3.2 X 12.7 SUP-78-00143 CDM 0272 RC outpatient 127.98 127.98 127.98 74 94.71 percent of total billed charges 127.98 93 103.66 percent of total billed charges 127.98 127.98 other OPPS APC 127.98 127.98 other OPPS APC 127.98 27.63 35.36 percent of total billed charges 127.98 127.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE MICRO RECIP 220 SUP-78-00174 CDM 0272 RC outpatient 22.58 22.58 22.58 74 16.71 percent of total billed charges 22.58 93 18.29 percent of total billed charges 22.58 22.58 other OPPS APC 22.58 22.58 other OPPS APC 22.58 27.63 6.24 percent of total billed charges 22.58 22.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE OSC 253 SUP-78-00177 CDM 0272 RC outpatient 95.96 95.96 95.96 74 71.01 percent of total billed charges 95.96 93 77.73 percent of total billed charges 95.96 95.96 other OPPS APC 95.96 95.96 other OPPS APC 95.96 27.63 26.51 percent of total billed charges 95.96 95.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAG 138 SUP-78-00180 CDM 0272 RC outpatient 53.28 53.28 53.28 74 39.43 percent of total billed charges 53.28 93 43.16 percent of total billed charges 53.28 53.28 other OPPS APC 53.28 53.28 other OPPS APC 53.28 27.63 14.72 percent of total billed charges 53.28 53.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAG 139 SUP-78-00181 CDM 0272 RC outpatient 53.28 53.28 53.28 74 39.43 percent of total billed charges 53.28 93 43.16 percent of total billed charges 53.28 53.28 other OPPS APC 53.28 53.28 other OPPS APC 53.28 27.63 14.72 percent of total billed charges 53.28 53.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WILSON FRAME KIT SUP-78-00198 CDM 0272 RC outpatient 154.02 154.02 154.02 74 113.97 percent of total billed charges 154.02 93 124.76 percent of total billed charges 154.02 154.02 other OPPS APC 154.02 154.02 other OPPS APC 154.02 27.63 42.56 percent of total billed charges 154.02 154.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PINEAPPLE FLAME BUR SUP-78-00200 CDM 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 168 other OPPS APC 168 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PINEAPPLE OVAL MEDIUM BUR SUP-78-00203 CDM 0272 RC outpatient 60.3 60.3 60.3 74 44.62 percent of total billed charges 60.3 93 48.84 percent of total billed charges 60.3 60.3 other OPPS APC 60.3 60.3 other OPPS APC 60.3 27.63 16.66 percent of total billed charges 60.3 60.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSCILLATING SAW BLADE# 5023-26 SUP-78-00204 CDM 0272 RC outpatient 88.41 88.41 88.41 74 65.42 percent of total billed charges 88.41 93 71.61 percent of total billed charges 88.41 88.41 other OPPS APC 88.41 88.41 other OPPS APC 88.41 27.63 24.43 percent of total billed charges 88.41 88.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSCILLATING SAW BLADE 5023-164 SUP-78-00206 CDM 0272 RC outpatient 69.17 69.17 69.17 74 51.19 percent of total billed charges 69.17 93 56.03 percent of total billed charges 69.17 69.17 other OPPS APC 69.17 69.17 other OPPS APC 69.17 27.63 19.11 percent of total billed charges 69.17 69.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE RETRIEVER SUP-78-00258 CDM 0272 RC outpatient 187.04 187.04 187.04 74 138.41 percent of total billed charges 187.04 93 151.5 percent of total billed charges 187.04 187.04 other OPPS APC 187.04 187.04 other OPPS APC 187.04 27.63 51.68 percent of total billed charges 187.04 187.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANKLE DISTRACTOR FOOT STRAP SUP-78-00259 CDM 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE STERNUM SUP-78-00311 CDM 0272 RC outpatient 88 88 88 74 65.12 percent of total billed charges 88 93 71.28 percent of total billed charges 88 88 other OPPS APC 88 88 other OPPS APC 88 27.63 24.31 percent of total billed charges 88 88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUTOTRANSFUSION SYSTEM SUP-78-00316 CDM 0272 RC outpatient 672.07 672.07 672.07 74 497.33 percent of total billed charges 672.07 93 544.38 percent of total billed charges 672.07 672.07 other OPPS APC 672.07 672.07 other OPPS APC 672.07 27.63 185.69 percent of total billed charges 672.07 672.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENT PALACOS R SUP-78-00319 CDM C1713 HCPCS 0278 RC outpatient 188 188 188 57 107.16 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 51 95.88 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPACT MIXING SYSTEM CEMENT SUP-78-00321 CDM 0272 RC outpatient 345.45 345.45 345.45 74 255.63 percent of total billed charges 345.45 93 279.81 percent of total billed charges 345.45 345.45 other OPPS APC 345.45 345.45 other OPPS APC 345.45 27.63 95.45 percent of total billed charges 345.45 345.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENT BONE PALACOS R +G SUP-78-00325 CDM C1713 HCPCS 0278 RC outpatient 581.88 581.88 581.88 57 331.67 percent of total billed charges 581.88 93 471.32 percent of total billed charges 581.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 581.88 other OPPS APC 581.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 581.88 other OPPS APC 581.88 51 296.76 percent of total billed charges 581.88 581.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPACT MIXING SYSTEM SUP-78-00326 CDM 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 262.5 other OPPS APC 262.5 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUIK-USE FEMORAL BONE CEMENT PREP KIT SUP-78-00327 CDM 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 472.5 other OPPS APC 472.5 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SURG SIMPLEX P BONE CEMENT SUP-78-00328 CDM C1713 HCPCS 0278 RC outpatient 192.5 192.5 192.5 57 109.73 percent of total billed charges 192.5 93 155.93 percent of total billed charges 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 51 98.18 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIMPLEX P W/TOBRAMYCIN SUP-78-00329 CDM C1713 HCPCS 0278 RC outpatient 706.5 706.5 706.5 57 402.71 percent of total billed charges 706.5 93 572.27 percent of total billed charges 706.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 706.5 other OPPS APC 706.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 706.5 other OPPS APC 706.5 51 360.32 percent of total billed charges 706.5 706.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISP CEMENT SCULPS SUP-78-00330 CDM 0272 RC outpatient 66.54 66.54 66.54 74 49.24 percent of total billed charges 66.54 93 53.9 percent of total billed charges 66.54 66.54 other OPPS APC 66.54 66.54 other OPPS APC 66.54 27.63 18.39 percent of total billed charges 66.54 66.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENT PALACOS LV+G SUP-78-00331 CDM C1713 HCPCS 0278 RC outpatient 581.88 581.88 581.88 57 331.67 percent of total billed charges 581.88 93 471.32 percent of total billed charges 581.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 581.88 other OPPS APC 581.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 581.88 other OPPS APC 581.88 51 296.76 percent of total billed charges 581.88 581.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSC BLADE 19.5 X 90X 1.27MM SUP-78-00337 CDM 0272 RC outpatient 158.68 158.68 158.68 74 117.42 percent of total billed charges 158.68 93 128.53 percent of total billed charges 158.68 158.68 other OPPS APC 158.68 158.68 other OPPS APC 158.68 27.63 43.84 percent of total billed charges 158.68 158.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRECISION BLADE 19.5 SUP-78-00342 CDM 0272 RC outpatient 1407 1407 1407 74 1041.18 percent of total billed charges 1407 93 1139.67 percent of total billed charges 1407 1407 other OPPS APC 1407 1407 other OPPS APC 1407 27.63 388.75 percent of total billed charges 1407 1407 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 5/64 2.0MM SUP-78-00343 CDM 0272 RC outpatient 128.8 128.8 128.8 74 95.31 percent of total billed charges 128.8 93 104.33 percent of total billed charges 128.8 128.8 other OPPS APC 128.8 128.8 other OPPS APC 128.8 27.63 35.59 percent of total billed charges 128.8 128.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE PREPARATION KIT BIO-PREP SUP-78-00344 CDM 0272 RC outpatient 328.18 328.18 328.18 74 242.85 percent of total billed charges 328.18 93 265.83 percent of total billed charges 328.18 328.18 other OPPS APC 328.18 328.18 other OPPS APC 328.18 27.63 90.68 percent of total billed charges 328.18 328.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADVANCED CEMENT MIXING BOWL SUP-78-00345 CDM 0272 RC outpatient 265.94 265.94 265.94 74 196.8 percent of total billed charges 265.94 93 215.41 percent of total billed charges 265.94 265.94 other OPPS APC 265.94 265.94 other OPPS APC 265.94 27.63 73.48 percent of total billed charges 265.94 265.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WRAP KNEE W/COLD PACK SUP-78-00346 CDM 0271 RC outpatient 78.4 78.4 78.4 74 58.02 percent of total billed charges 78.4 93 63.5 percent of total billed charges 78.4 78.4 other OPPS APC 78.4 78.4 other OPPS APC 78.4 27.63 21.66 percent of total billed charges 78.4 78.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TWIN LOOP FLEX DRILL KNOTILLUS SUP-78-00347 CDM 0272 RC outpatient 551.92 551.92 551.92 74 408.42 percent of total billed charges 551.92 93 447.06 percent of total billed charges 551.92 551.92 other OPPS APC 551.92 551.92 other OPPS APC 551.92 27.63 152.5 percent of total billed charges 551.92 551.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRUISE 90-S SUP-78-00348 CDM 0272 RC outpatient 662.38 662.38 662.38 74 490.16 percent of total billed charges 662.38 93 536.53 percent of total billed charges 662.38 662.38 other OPPS APC 662.38 662.38 other OPPS APC 662.38 27.63 183.02 percent of total billed charges 662.38 662.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE C-ARMOR SUP-78-00349 CDM 0272 RC outpatient 177.76 177.76 177.76 74 131.54 percent of total billed charges 177.76 93 143.99 percent of total billed charges 177.76 177.76 other OPPS APC 177.76 177.76 other OPPS APC 177.76 27.63 49.12 percent of total billed charges 177.76 177.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SAW BLADE 12.5 X 7.6 SUP-78-00350 CDM 0272 RC outpatient 190 190 190 74 140.6 percent of total billed charges 190 93 153.9 percent of total billed charges 190 190 other OPPS APC 190 190 other OPPS APC 190 27.63 52.5 percent of total billed charges 190 190 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENT R HV SIMPLEX SUP-78-00353 CDM C1713 HCPCS 0278 RC outpatient 227.5 227.5 227.5 57 129.68 percent of total billed charges 227.5 93 184.28 percent of total billed charges 227.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 227.5 other OPPS APC 227.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 227.5 other OPPS APC 227.5 51 116.03 percent of total billed charges 227.5 227.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE 6 FLEXMASTER SUP-78-00355 CDM 0272 RC outpatient 23.23 23.23 23.23 74 17.19 percent of total billed charges 23.23 93 18.82 percent of total billed charges 23.23 23.23 other OPPS APC 23.23 23.23 other OPPS APC 23.23 27.63 6.42 percent of total billed charges 23.23 23.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE 4 FLEXMASTER SUP-78-00356 CDM 0272 RC outpatient 46.05 46.05 46.05 74 34.08 percent of total billed charges 46.05 93 37.3 percent of total billed charges 46.05 46.05 other OPPS APC 46.05 46.05 other OPPS APC 46.05 27.63 12.72 percent of total billed charges 46.05 46.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW OSC 25 SUP-78-00357 CDM 0272 RC outpatient 388.5 388.5 388.5 74 287.49 percent of total billed charges 388.5 93 314.69 percent of total billed charges 388.5 388.5 other OPPS APC 388.5 388.5 other OPPS APC 388.5 27.63 107.34 percent of total billed charges 388.5 388.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW OSC 13 SUP-78-00358 CDM 0272 RC outpatient 365.25 365.25 365.25 74 270.29 percent of total billed charges 365.25 93 295.85 percent of total billed charges 365.25 365.25 other OPPS APC 365.25 365.25 other OPPS APC 365.25 27.63 100.92 percent of total billed charges 365.25 365.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAGITTAL 90 X 12.7 X 1.19 SUP-78-00359 CDM 0272 RC outpatient 193.13 193.13 193.13 74 142.92 percent of total billed charges 193.13 93 156.44 percent of total billed charges 193.13 193.13 other OPPS APC 193.13 193.13 other OPPS APC 193.13 27.63 53.36 percent of total billed charges 193.13 193.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SAW BLADE SAGITTAL 90L X 25MM X 1.19MM 6125-119-090 SUP-78-00360 CDM 0272 RC outpatient 193.13 193.13 193.13 74 142.92 percent of total billed charges 193.13 93 156.44 percent of total billed charges 193.13 193.13 other OPPS APC 193.13 193.13 other OPPS APC 193.13 27.63 53.36 percent of total billed charges 193.13 193.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REPIC SAW BLADE 277-96-277 SUP-78-00361 CDM 0272 RC outpatient 98.32 98.32 98.32 74 72.76 percent of total billed charges 98.32 93 79.64 percent of total billed charges 98.32 98.32 other OPPS APC 98.32 98.32 other OPPS APC 98.32 27.63 27.17 percent of total billed charges 98.32 98.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW RECIP 70 X 12.5 X .8MM SUP-78-00365 CDM 0272 RC outpatient 120 120 120 74 88.8 percent of total billed charges 120 93 97.2 percent of total billed charges 120 120 other OPPS APC 120 120 other OPPS APC 120 27.63 33.16 percent of total billed charges 120 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW SAG 85 X 21 X .9MM SUP-78-00366 CDM 0272 RC outpatient 188.66 188.66 188.66 74 139.61 percent of total billed charges 188.66 93 152.81 percent of total billed charges 188.66 188.66 other OPPS APC 188.66 188.66 other OPPS APC 188.66 27.63 52.13 percent of total billed charges 188.66 188.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW SAG HEAVY DUTY SUP-78-00367 CDM 0272 RC outpatient 94.12 94.12 94.12 74 69.65 percent of total billed charges 94.12 93 76.24 percent of total billed charges 94.12 94.12 other OPPS APC 94.12 94.12 other OPPS APC 94.12 27.63 26.01 percent of total billed charges 94.12 94.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW SAG SYSTEM 2000MT SUP-78-00368 CDM 0272 RC outpatient 193.98 193.98 193.98 74 143.55 percent of total billed charges 193.98 93 157.12 percent of total billed charges 193.98 193.98 other OPPS APC 193.98 193.98 other OPPS APC 193.98 27.63 53.6 percent of total billed charges 193.98 193.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GPS KIT SUP-78-00373 CDM 0272 RC outpatient 1350 1350 1350 74 999 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 1350 other OPPS APC 1350 1350 other OPPS APC 1350 27.63 373.01 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK ANTERIOR HIP SUP-78-00375 CDM 0272 RC outpatient 1217.55 1217.55 1217.55 74 900.99 percent of total billed charges 1217.55 93 986.22 percent of total billed charges 1217.55 1217.55 other OPPS APC 1217.55 1217.55 other OPPS APC 1217.55 27.63 336.41 percent of total billed charges 1217.55 1217.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE RETRIEVER HEWSON SUP-78-00394 CDM 0272 RC outpatient 264.6 264.6 264.6 74 195.8 percent of total billed charges 264.6 93 214.33 percent of total billed charges 264.6 264.6 other OPPS APC 264.6 264.6 other OPPS APC 264.6 27.63 73.11 percent of total billed charges 264.6 264.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEINMAN PIN PLAIN 4.0 5/32 SUP-78-00397 CDM C1713 HCPCS 0278 RC outpatient 34.53 34.53 34.53 57 19.68 percent of total billed charges 34.53 93 27.97 percent of total billed charges 34.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.53 other OPPS APC 34.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34.53 other OPPS APC 34.53 51 17.61 percent of total billed charges 34.53 34.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRIPPER - KINETEC SUP-78-00398 CDM 0272 RC outpatient 481.25 481.25 481.25 74 356.13 percent of total billed charges 481.25 93 389.81 percent of total billed charges 481.25 481.25 other OPPS APC 481.25 481.25 other OPPS APC 481.25 27.63 132.97 percent of total billed charges 481.25 481.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRECISION BLADE UNI (6720127090) SUP-78-00399 CDM 0272 RC outpatient 637 637 637 74 471.38 percent of total billed charges 637 93 515.97 percent of total billed charges 637 637 other OPPS APC 637 637 other OPPS APC 637 27.63 176 percent of total billed charges 637 637 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO STANDARD BLADE (116170) SUP-78-00400 CDM 0272 RC outpatient 915 915 915 74 677.1 percent of total billed charges 915 93 741.15 percent of total billed charges 915 915 other OPPS APC 915 915 other OPPS APC 915 27.63 252.81 percent of total billed charges 915 915 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO NARROW BLADE (116171) SUP-78-00401 CDM 0272 RC outpatient 915 915 915 74 677.1 percent of total billed charges 915 93 741.15 percent of total billed charges 915 915 other OPPS APC 915 915 other OPPS APC 915 27.63 252.81 percent of total billed charges 915 915 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO BONE PIN-4MM X 140MM-STERILE SUP-78-00402 CDM 0272 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO VIZADISC KNEE PROCED TRACKING KIT SUP-78-00403 CDM 0272 RC outpatient 614.25 614.25 614.25 74 454.55 percent of total billed charges 614.25 93 497.54 percent of total billed charges 614.25 614.25 other OPPS APC 614.25 614.25 other OPPS APC 614.25 27.63 169.72 percent of total billed charges 614.25 614.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO FEM /TIBIAL CH/POINT KIT -(STERILE) SUP-78-00404 CDM 0272 RC outpatient 271.25 271.25 271.25 74 200.73 percent of total billed charges 271.25 93 219.71 percent of total billed charges 271.25 271.25 other OPPS APC 271.25 271.25 other OPPS APC 271.25 27.63 74.95 percent of total billed charges 271.25 271.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO STRYKER LEG POSITIONER DISP KIT SUP-78-00405 CDM 0272 RC outpatient 116 116 116 74 85.84 percent of total billed charges 116 93 93.96 percent of total billed charges 116 116 other OPPS APC 116 116 other OPPS APC 116 27.63 32.05 percent of total billed charges 116 116 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO MICS IRRIGATION TUBING SUP-78-00406 CDM 0272 RC outpatient 323.75 323.75 323.75 74 239.58 percent of total billed charges 323.75 93 262.24 percent of total billed charges 323.75 323.75 other OPPS APC 323.75 323.75 other OPPS APC 323.75 27.63 89.45 percent of total billed charges 323.75 323.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO SILICONE RETRACTOR CORD SUP-78-00407 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO MICS IRRIGATION CLIP SUP-78-00408 CDM 0272 RC outpatient 323.75 323.75 323.75 74 239.58 percent of total billed charges 323.75 93 262.24 percent of total billed charges 323.75 323.75 other OPPS APC 323.75 323.75 other OPPS APC 323.75 27.63 89.45 percent of total billed charges 323.75 323.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO MICS BURR SUP-78-00409 CDM 0272 RC outpatient 208.25 208.25 208.25 74 154.11 percent of total billed charges 208.25 93 168.68 percent of total billed charges 208.25 208.25 other OPPS APC 208.25 208.25 other OPPS APC 208.25 27.63 57.54 percent of total billed charges 208.25 208.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO RIO-« DRAPE KIT-ONE PIECE W/POCKETS SUP-78-00410 CDM 0272 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO BONE PIN-4MM X 110MM-STERILE 2 PACK SUP-78-00411 CDM 0272 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO STRYKER LEG POSITIONER DISP KIT SUP-78-00412 CDM 0272 RC outpatient 116 116 116 74 85.84 percent of total billed charges 116 93 93.96 percent of total billed charges 116 116 other OPPS APC 116 116 other OPPS APC 116 27.63 32.05 percent of total billed charges 116 116 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO VISADISC HIP SUP-78-00413 CDM 0272 RC outpatient 614.25 614.25 614.25 74 454.55 percent of total billed charges 614.25 93 497.54 percent of total billed charges 614.25 614.25 other OPPS APC 614.25 614.25 other OPPS APC 614.25 27.63 169.72 percent of total billed charges 614.25 614.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO CHECKPOINT 3.5 HEX IMPACTION SUP-78-00414 CDM 0272 RC outpatient 315 315 315 74 233.1 percent of total billed charges 315 93 255.15 percent of total billed charges 315 315 other OPPS APC 315 315 other OPPS APC 315 27.63 87.03 percent of total billed charges 315 315 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO BONE PIN 170MM SUP-78-00415 CDM 0272 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO TIBIAL CHECKPOINT SUP-78-00416 CDM 0272 RC outpatient 164 164 164 74 121.36 percent of total billed charges 164 93 132.84 percent of total billed charges 164 164 other OPPS APC 164 164 other OPPS APC 164 27.63 45.31 percent of total billed charges 164 164 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EASY CLIP COMP STAPLE 12X15X13 SUP-78-00417 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUADLINK IMPLANT SYSTEM 8MM SUP-78-00418 CDM C1713 HCPCS 0278 RC outpatient 5437.5 5437.5 5437.5 57 3099.38 percent of total billed charges 5437.5 93 4404.38 percent of total billed charges 5437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5437.5 other OPPS APC 5437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5437.5 other OPPS APC 5437.5 51 2773.13 percent of total billed charges 5437.5 5437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALIPERS SET SUP-78-00419 CDM 0272 RC outpatient 192.5 192.5 192.5 74 142.45 percent of total billed charges 192.5 93 155.93 percent of total billed charges 192.5 192.5 other OPPS APC 192.5 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA INSTRUMENT SET SUP-78-00420 CDM 0272 RC outpatient 192.5 192.5 192.5 74 142.45 percent of total billed charges 192.5 93 155.93 percent of total billed charges 192.5 192.5 other OPPS APC 192.5 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EFFICIENCY RT SZ I5-T5 INSERT SET SUP-78-00421 CDM 0272 RC outpatient 192.5 192.5 192.5 74 142.45 percent of total billed charges 192.5 93 155.93 percent of total billed charges 192.5 192.5 other OPPS APC 192.5 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CORRECTION GUIDE INSTRUMENT SET SUP-78-00422 CDM 0272 RC outpatient 192.5 192.5 192.5 74 142.45 percent of total billed charges 192.5 93 155.93 percent of total billed charges 192.5 192.5 other OPPS APC 192.5 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPHERE INSERT INSTRUMENT SET I6R-T6 SUP-78-00423 CDM 0272 RC outpatient 192.5 192.5 192.5 74 142.45 percent of total billed charges 192.5 93 155.93 percent of total billed charges 192.5 192.5 other OPPS APC 192.5 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KA FEMORAL S7 INSTRUMENT SET SUP-78-00424 CDM 0272 RC outpatient 192.5 192.5 192.5 74 142.45 percent of total billed charges 192.5 93 155.93 percent of total billed charges 192.5 192.5 other OPPS APC 192.5 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON TS FEMUR SZ1 LEFT SUP-78-00425 CDM C1776 HCPCS 0278 RC outpatient 12280.8 12280.8 12280.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.8 other OPPS APC 12280.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.8 other OPPS APC 12280.8 51 6263.21 percent of total billed charges 12280.8 12280.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON FEMORAL DISTAL AUGMENT 5MM SIZE 1 LEFT SUP-78-00426 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON INSERT PS #7 12MM SUP-78-00477 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KA FEMORAL S2 INSTRUMENT SET SUP-78-00478 CDM 0272 RC outpatient 192.5 192.5 192.5 192.5 other OPPS APC 192.5 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING OSTOMY BAG ADAPT FLEXTEND M FLAT BENT W4.5 MM OD2 IN STING FREE STRETCH MOLD SKIN BARRIER LATEX FREE SUP-7805 CDM 0270 RC outpatient 1.48 1.48 1.48 74 1.1 percent of total billed charges 1.48 93 1.2 percent of total billed charges 1.48 1.48 other OPPS APC 1.48 1.48 other OPPS APC 1.48 27.63 0.41 percent of total billed charges 1.48 1.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VASCULAR SOLUTIONS 2.75 IN. SMART NEEDLE SUP-78050 CDM 0481 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VASCULAR SOLUTIONS 3.5 IN. SMART NEEDLE SUP-78060 CDM 0481 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND MICROPOINT SILK 6-0 G-1 L18 IN 2 ARM BRAID BLACK SUP-780G CDM outpatient 27.8 27.8 27.8 27.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT IMPLANT MED PEEK NS CRANIAL CUSTOM SUTURE DRAINAGE HOLE COMPLEX SUP-7810020 CDM 270010013 LOCAL 0270 RC outpatient 27950 27950 27950 74 20683 percent of total billed charges 27950 93 22639.5 percent of total billed charges 27950 27950 other OPPS APC 27950 27950 other OPPS APC 27950 27.63 7722.59 percent of total billed charges 27950 27950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT CRANIAL PEEK LARGE KIT CUSTOMIZE SUP-7810030 CDM 0270 RC outpatient 33220.2 33220.2 33220.2 74 24583 percent of total billed charges 33220.2 93 26908.4 percent of total billed charges 33220.2 33220.2 other OPPS APC 33220.2 33220.2 other OPPS APC 33220.2 27.63 9178.74 percent of total billed charges 33220.2 33220.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING SHORT JUDKINS RIGHT 6 CURVE OD8 FR ID.089 IN SIDEHOLE SUP-783080 CDM 270010020 LOCAL 0270 RC outpatient 1378 1378 1378 74 1019.72 percent of total billed charges 1378 93 1116.18 percent of total billed charges 1378 1378 other OPPS APC 1378 1378 other OPPS APC 1378 27.63 380.74 percent of total billed charges 1378 1378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACKING WOUND CURITY IODOFORM COTTON GAUZE L5 YD X W1/4 IN STRIP STERILE LATEX FREE DISPOSABLE SUP-7831 CDM 270009022 LOCAL 0270 RC outpatient 5 5 5 74 3.7 percent of total billed charges 5 93 4.05 percent of total billed charges 5 5 other OPPS APC 5 5 other OPPS APC 5 27.63 1.38 percent of total billed charges 5 5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACKING WOUND CURITY IODOFORM COTTON MESH GAUZE L5 YD X W1/2 IN STRIP SUP-7832 CDM 270009022 LOCAL 0270 RC outpatient 5 5 5 74 3.7 percent of total billed charges 5 93 4.05 percent of total billed charges 5 5 other OPPS APC 5 5 other OPPS APC 5 27.63 1.38 percent of total billed charges 5 5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACKING WOUND CURITY IODOFORM COTTON GAUZE L5 YD X W1 IN STRIP MESH STERILE LATEX FREE DISPOSABLE SUP-7833 CDM 270009022 LOCAL 0270 RC outpatient 5 5 5 74 3.7 percent of total billed charges 5 93 4.05 percent of total billed charges 5 5 other OPPS APC 5 5 other OPPS APC 5 27.63 1.38 percent of total billed charges 5 5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACKING WOUND CURITY IODOFORM COTTON GAUZE L5 YD X W2 IN STRIP FINE MESH SUP-7834 CDM 270009022 LOCAL 0270 RC outpatient 5 5 5 74 3.7 percent of total billed charges 5 93 4.05 percent of total billed charges 5 5 other OPPS APC 5 5 other OPPS APC 5 27.63 1.38 percent of total billed charges 5 5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD INGEVITY PLUS PACING 45CM SUP-7840/45 CDM 0275 RC outpatient 1040 1040 1040 57 592.8 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD INGEVITY PLUS PACING 52CM SUP-7841/52 CDM 0275 RC outpatient 1040 1040 1040 57 592.8 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD 7842 INGEVITY PLUS PACING 59CM _59857_ SUP-7842/59 CDM 0275 RC outpatient 1040 1040 1040 57 592.8 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL COROENT XL 50X18X8MM NS LF SUP-7860850 CDM 270010020 LOCAL 0270 RC outpatient 12152.4 12152.4 12152.4 74 8992.78 percent of total billed charges 12152.4 93 9843.44 percent of total billed charges 12152.4 12152.4 other OPPS APC 12152.4 12152.4 other OPPS APC 12152.4 27.63 3357.71 percent of total billed charges 12152.4 12152.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL PEEK-OPTIMA L30 MM OD6.35 MM PEDICLE SUP-7893030 CDM 270010020 LOCAL 0270 RC outpatient 1378 1378 1378 74 1019.72 percent of total billed charges 1378 93 1116.18 percent of total billed charges 1378 1378 other OPPS APC 1378 1378 other OPPS APC 1378 27.63 380.74 percent of total billed charges 1378 1378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL LEGACY CD HORIZON PEEK-OPTIMA L35 MM OD6.35 MM PEDICLE SUP-7893035 CDM 270010020 LOCAL 0270 RC outpatient 1378 1378 1378 74 1019.72 percent of total billed charges 1378 93 1116.18 percent of total billed charges 1378 1378 other OPPS APC 1378 1378 other OPPS APC 1378 27.63 380.74 percent of total billed charges 1378 1378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL LEGACY CD HORIZON PEEK-OPTIMA L40 MM OD6.35 MM PEDICLE SUP-7893040 CDM 270010020 LOCAL 0270 RC outpatient 1378 1378 1378 74 1019.72 percent of total billed charges 1378 93 1116.18 percent of total billed charges 1378 1378 other OPPS APC 1378 1378 other OPPS APC 1378 27.63 380.74 percent of total billed charges 1378 1378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL PEEK-OPTIMA L45 MM SUP-7893045 CDM 270010020 LOCAL 0270 RC outpatient 1378 1378 1378 74 1019.72 percent of total billed charges 1378 93 1116.18 percent of total billed charges 1378 1378 other OPPS APC 1378 1378 other OPPS APC 1378 27.63 380.74 percent of total billed charges 1378 1378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL PEEK-OPTIMA L50 MM OD6.35 MM PEDICLE SUP-7893050 CDM 270010020 LOCAL 0270 RC outpatient 1378 1378 1378 74 1019.72 percent of total billed charges 1378 93 1116.18 percent of total billed charges 1378 1378 other OPPS APC 1378 1378 other OPPS APC 1378 27.63 380.74 percent of total billed charges 1378 1378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL LEGACY CD HORIZON PEEK-OPTIMA L60 MM OD6.35 MM PEDICLE SUP-7893060 CDM 270010020 LOCAL 0270 RC outpatient 1378 1378 1378 74 1019.72 percent of total billed charges 1378 93 1116.18 percent of total billed charges 1378 1378 other OPPS APC 1378 1378 other OPPS APC 1378 27.63 380.74 percent of total billed charges 1378 1378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL LEGACY CD HORIZON PEEK-OPTIMA L70 MM OD6.35 MM PEDICLE SUP-7893070 CDM 270010020 LOCAL 0270 RC outpatient 1378 1378 1378 74 1019.72 percent of total billed charges 1378 93 1116.18 percent of total billed charges 1378 1378 other OPPS APC 1378 1378 other OPPS APC 1378 27.63 380.74 percent of total billed charges 1378 1378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CD HORIZON LEGACY PEEK TITANIUM L75 MM OD6.35 MM PEDICLE SUP-7893075 CDM 270010020 LOCAL 0270 RC outpatient 1378 1378 1378 74 1019.72 percent of total billed charges 1378 93 1116.18 percent of total billed charges 1378 1378 other OPPS APC 1378 1378 other OPPS APC 1378 27.63 380.74 percent of total billed charges 1378 1378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL 80MM 6.35MM PEEK-OPTIMA PEDICLE SUP-7893080 CDM 270010020 LOCAL 0270 RC outpatient 1378 1378 1378 74 1019.72 percent of total billed charges 1378 93 1116.18 percent of total billed charges 1378 1378 other OPPS APC 1378 1378 other OPPS APC 1378 27.63 380.74 percent of total billed charges 1378 1378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL 90MM 6.35MM PEEK-OPTIMA PEDICLE SUP-7893090 CDM 270010020 LOCAL 0270 RC outpatient 1378 1378 1378 74 1019.72 percent of total billed charges 1378 93 1116.18 percent of total billed charges 1378 1378 other OPPS APC 1378 1378 other OPPS APC 1378 27.63 380.74 percent of total billed charges 1378 1378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL PREBENT 100MM 6.35MM PEEK-OPTIMA SUP-7893100 CDM 270010020 LOCAL 0270 RC outpatient 1378 1378 1378 74 1019.72 percent of total billed charges 1378 93 1116.18 percent of total billed charges 1378 1378 other OPPS APC 1378 1378 other OPPS APC 1378 27.63 380.74 percent of total billed charges 1378 1378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MEDTRONIC SCREW 5.5MM X 50MM SUP-7895550 CDM 270010020 LOCAL 0270 RC outpatient 3536 3536 3536 74 2616.64 percent of total billed charges 3536 93 2864.16 percent of total billed charges 3536 3536 other OPPS APC 3536 3536 other OPPS APC 3536 27.63 977 percent of total billed charges 3536 3536 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEGACY CD HORIZON PEEK L35 MM OD6.5 MM SPINE PEDICLE MULTIAXIAL STERILE 5.5 MM ROD SUP-7896535 CDM 270010020 LOCAL 0270 RC outpatient 3536 3536 3536 74 2616.64 percent of total billed charges 3536 93 2864.16 percent of total billed charges 3536 3536 other OPPS APC 3536 3536 other OPPS APC 3536 27.63 977 percent of total billed charges 3536 3536 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEGACY CD HORIZON PEEK L40 MM OD6.5 MM SPINE PEDICLE MULTIAXIAL STERILE 5.5 MM ROD SUP-7896540 CDM 270010020 LOCAL 0270 RC outpatient 3536 3536 3536 74 2616.64 percent of total billed charges 3536 93 2864.16 percent of total billed charges 3536 3536 other OPPS APC 3536 3536 other OPPS APC 3536 27.63 977 percent of total billed charges 3536 3536 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEGACY CD HORIZON PEEK L45 MM OD6.5 MM SPINE PEDICLE MULTIAXIAL STERILE 5.5 MM ROD SUP-7896545 CDM 270010020 LOCAL 0270 RC outpatient 3536 3536 3536 74 2616.64 percent of total billed charges 3536 93 2864.16 percent of total billed charges 3536 3536 other OPPS APC 3536 3536 other OPPS APC 3536 27.63 977 percent of total billed charges 3536 3536 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEGACY CD HORIZON PEEK L50 MM OD6.5 MM SPINE PEDICLE MULTIAXIAL STERILE 5.5 MM ROD SUP-7896550 CDM 270010020 LOCAL 0270 RC outpatient 3536 3536 3536 74 2616.64 percent of total billed charges 3536 93 2864.16 percent of total billed charges 3536 3536 other OPPS APC 3536 3536 other OPPS APC 3536 27.63 977 percent of total billed charges 3536 3536 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEGACY CD HORIZON PEEK L55 MM OD6.5 MM SPINE PEDICLE MULTIAXIAL STERILE 5.5 MM ROD SUP-7896555 CDM 270010020 LOCAL 0270 RC outpatient 3536 3536 3536 74 2616.64 percent of total billed charges 3536 93 2864.16 percent of total billed charges 3536 3536 other OPPS APC 3536 3536 other OPPS APC 3536 27.63 977 percent of total billed charges 3536 3536 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEGACY CD HORIZON PEEK L60 MM OD6.5 MM SPINE PEDICLE MULTIAXIAL STERILE 5.5 MM ROD SUP-7896560 CDM 270010020 LOCAL 0270 RC outpatient 3536 3536 3536 74 2616.64 percent of total billed charges 3536 93 2864.16 percent of total billed charges 3536 3536 other OPPS APC 3536 3536 other OPPS APC 3536 27.63 977 percent of total billed charges 3536 3536 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEGACY CD HORIZON PEEK L30 MM OD7.5 MM SPINE PEDICLE MULTIAXIAL STERILE 5.5 MM ROD SUP-7897530 CDM 270010020 LOCAL 0270 RC outpatient 3744 3744 3744 74 2770.56 percent of total billed charges 3744 93 3032.64 percent of total billed charges 3744 3744 other OPPS APC 3744 3744 other OPPS APC 3744 27.63 1034.47 percent of total billed charges 3744 3744 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEGACY CD HORIZON PEEK L40 MM OD7.5 MM SPINE PEDICLE MULTIAXIAL STERILE 5.5 MM ROD SUP-7897540 CDM 270010020 LOCAL 0270 RC outpatient 3744 3744 3744 74 2770.56 percent of total billed charges 3744 93 3032.64 percent of total billed charges 3744 3744 other OPPS APC 3744 3744 other OPPS APC 3744 27.63 1034.47 percent of total billed charges 3744 3744 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEGACY CD HORIZON PEEK L45 MM OD7.5 MM SPINE PEDICLE MULTIAXIAL STERILE 5.5 MM ROD SUP-7897545 CDM 270010020 LOCAL 0270 RC outpatient 3744 3744 3744 74 2770.56 percent of total billed charges 3744 93 3032.64 percent of total billed charges 3744 3744 other OPPS APC 3744 3744 other OPPS APC 3744 27.63 1034.47 percent of total billed charges 3744 3744 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LEGACY CD HORIZON PEEK L55 MM OD7.5 MM SPINE PEDICLE MULTIAXIAL STERILE 5.5 MM ROD SUP-7897555 CDM 270010020 LOCAL 0270 RC outpatient 3744 3744 3744 74 2770.56 percent of total billed charges 3744 93 3032.64 percent of total billed charges 3744 3744 other OPPS APC 3744 3744 other OPPS APC 3744 27.63 1034.47 percent of total billed charges 3744 3744 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MEDTRONIC SCREW 7.5MM X 60MM SUP-7897560 CDM 270010020 LOCAL 0270 RC outpatient 3536 3536 3536 74 2616.64 percent of total billed charges 3536 93 2864.16 percent of total billed charges 3536 3536 other OPPS APC 3536 3536 other OPPS APC 3536 27.63 977 percent of total billed charges 3536 3536 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MEDTRONIC 8.5MM X 45MM SUP-7898545 CDM 270010020 LOCAL 0270 RC outpatient 3536 3536 3536 74 2616.64 percent of total billed charges 3536 93 2864.16 percent of total billed charges 3536 3536 other OPPS APC 3536 3536 other OPPS APC 3536 27.63 977 percent of total billed charges 3536 3536 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILOK CANNULA 8MM X 75MM SUP-79-00001 CDM 0272 RC outpatient 93.31 93.31 93.31 74 69.05 percent of total billed charges 93.31 93 75.58 percent of total billed charges 93.31 93.31 other OPPS APC 93.31 93.31 other OPPS APC 93.31 27.63 25.78 percent of total billed charges 93.31 93.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILOK CANNULA 6.5MM X 75MM SUP-79-00002 CDM 0272 RC outpatient 77.19 77.19 77.19 74 57.12 percent of total billed charges 77.19 93 62.52 percent of total billed charges 77.19 77.19 other OPPS APC 77.19 77.19 other OPPS APC 77.19 27.63 21.33 percent of total billed charges 77.19 77.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE LASSO 45DEG CVD R SUP-79-00006 CDM 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 490 other OPPS APC 490 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE LOOP SD NITINOL SUP-79-00007 CDM 0272 RC outpatient 112 112 112 74 82.88 percent of total billed charges 112 93 90.72 percent of total billed charges 112 112 other OPPS APC 112 112 other OPPS APC 112 27.63 30.95 percent of total billed charges 112 112 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA TWIST 8.25MM X 7CM SUP-79-00009 CDM 0272 RC outpatient 100 100 100 74 74 percent of total billed charges 100 93 81 percent of total billed charges 100 100 other OPPS APC 100 100 other OPPS APC 100 27.63 27.63 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE CUTTER 4MM X 13CM BX/5 SUP-79-00016 CDM 0272 RC outpatient 148 148 148 74 109.52 percent of total billed charges 148 93 119.88 percent of total billed charges 148 148 other OPPS APC 148 148 other OPPS APC 148 27.63 40.89 percent of total billed charges 148 148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCORPION NEEDLE SUP-79-00027 CDM 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 490 other OPPS APC 490 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SCORPION MICROFIRE W/SUTUREMITT SUP-79-00029 CDM 0272 RC outpatient 595 595 595 74 440.3 percent of total billed charges 595 93 481.95 percent of total billed charges 595 595 other OPPS APC 595 595 other OPPS APC 595 27.63 164.4 percent of total billed charges 595 595 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE LASSO SD 90 STRAIGHT SUP-79-00031 CDM 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 490 other OPPS APC 490 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERTAPE 2MM BX/6 SUP-79-00038 CDM 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 200 other OPPS APC 200 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIGERTAPE 2MM BX/6 SUP-79-00039 CDM 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 200 other OPPS APC 200 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR OVAL XLONG SUP-79-00044 CDM 0272 RC outpatient 81.6 81.6 81.6 74 60.38 percent of total billed charges 81.6 93 66.1 percent of total billed charges 81.6 81.6 other OPPS APC 81.6 81.6 other OPPS APC 81.6 27.63 22.55 percent of total billed charges 81.6 81.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOMCAT 4.0MM SUP-79-00050 CDM 0272 RC outpatient 172 172 172 74 127.28 percent of total billed charges 172 93 139.32 percent of total billed charges 172 172 other OPPS APC 172 172 other OPPS APC 172 27.63 47.52 percent of total billed charges 172 172 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOMCAT 5.5MM SUP-79-00051 CDM 0272 RC outpatient 172 172 172 74 127.28 percent of total billed charges 172 93 139.32 percent of total billed charges 172 172 other OPPS APC 172 172 other OPPS APC 172 27.63 47.52 percent of total billed charges 172 172 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARREL BURR 5.5MM SUP-79-00052 CDM 0272 RC outpatient 172 172 172 74 127.28 percent of total billed charges 172 93 139.32 percent of total billed charges 172 172 other OPPS APC 172 172 other OPPS APC 172 27.63 47.52 percent of total billed charges 172 172 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARREL BURR 4.0MM SUP-79-00053 CDM 0272 RC outpatient 246.25 246.25 246.25 74 182.23 percent of total billed charges 246.25 93 199.46 percent of total billed charges 246.25 246.25 other OPPS APC 246.25 246.25 other OPPS APC 246.25 27.63 68.04 percent of total billed charges 246.25 246.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESECTOR 4.0MM SUP-79-00054 CDM 0272 RC outpatient 233.12 233.12 233.12 74 172.51 percent of total billed charges 233.12 93 188.83 percent of total billed charges 233.12 233.12 other OPPS APC 233.12 233.12 other OPPS APC 233.12 27.63 64.41 percent of total billed charges 233.12 233.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE 4.0MM ANGLED ADD PLUS SUP-79-00056 CDM 0272 RC outpatient 172 172 172 74 127.28 percent of total billed charges 172 93 139.32 percent of total billed charges 172 172 other OPPS APC 172 172 other OPPS APC 172 27.63 47.52 percent of total billed charges 172 172 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE 4.0MM AGGRESSIVE PLUS SUP-79-00057 CDM 0272 RC outpatient 213.17 213.17 213.17 74 157.75 percent of total billed charges 213.17 93 172.67 percent of total billed charges 213.17 213.17 other OPPS APC 213.17 213.17 other OPPS APC 213.17 27.63 58.9 percent of total billed charges 213.17 213.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RECY RESECTOR 4.0MM SUP-79-00058 CDM 0272 RC outpatient 88.88 88.88 88.88 74 65.77 percent of total billed charges 88.88 93 71.99 percent of total billed charges 88.88 88.88 other OPPS APC 88.88 88.88 other OPPS APC 88.88 27.63 24.56 percent of total billed charges 88.88 88.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RECY TOMCAT 4.0MM SUP-79-00059 CDM 0272 RC outpatient 88.88 88.88 88.88 74 65.77 percent of total billed charges 88.88 93 71.99 percent of total billed charges 88.88 88.88 other OPPS APC 88.88 88.88 other OPPS APC 88.88 27.63 24.56 percent of total billed charges 88.88 88.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RECY TOMCAT 5.5MM SUP-79-00060 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RECY BARREL BUR 4.0MM SUP-79-00061 CDM 0272 RC outpatient 86.12 86.12 86.12 74 63.73 percent of total billed charges 86.12 93 69.76 percent of total billed charges 86.12 86.12 other OPPS APC 86.12 86.12 other OPPS APC 86.12 27.63 23.79 percent of total billed charges 86.12 86.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RECY BARREL BUR 5.5MM SUP-79-00062 CDM 0272 RC outpatient 86.12 86.12 86.12 74 63.73 percent of total billed charges 86.12 93 69.76 percent of total billed charges 86.12 86.12 other OPPS APC 86.12 86.12 other OPPS APC 86.12 27.63 23.79 percent of total billed charges 86.12 86.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRACE TROM ADVANCE COOL KNEE SUP-79-00068 CDM L1832 HCPCS 0272 RC outpatient 295.68 295.68 295.68 74 218.8 percent of total billed charges 295.68 93 239.5 percent of total billed charges 778.08 778.08 fee schedule 778.08 778.08 fee schedule 295.68 27.63 81.7 percent of total billed charges 295.68 778.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR ROUND 4.0 SUP-79-00069 CDM 0272 RC outpatient 246.25 246.25 246.25 74 182.23 percent of total billed charges 246.25 93 199.46 percent of total billed charges 246.25 246.25 other OPPS APC 246.25 246.25 other OPPS APC 246.25 27.63 68.04 percent of total billed charges 246.25 246.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRACE TROM ADVANCE COOL KNEE XL SUP-79-00070 CDM L1832 HCPCS 0271 RC outpatient 380.7 380.7 380.7 74 281.72 percent of total billed charges 380.7 93 308.37 percent of total billed charges 778.08 778.08 fee schedule 778.08 778.08 fee schedule 380.7 27.63 105.19 percent of total billed charges 380.7 778.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTHREX LABRAL TAPE SUP-79-00073 CDM 0272 RC outpatient 245 245 245 74 181.3 percent of total billed charges 245 93 198.45 percent of total billed charges 245 245 other OPPS APC 245 245 other OPPS APC 245 27.63 67.69 percent of total billed charges 245 245 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESECTOR FORMULA 3.5MM SUP-79-00074 CDM 0272 RC outpatient 148 148 148 74 109.52 percent of total billed charges 148 93 119.88 percent of total billed charges 148 148 other OPPS APC 148 148 other OPPS APC 148 27.63 40.89 percent of total billed charges 148 148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOMCAT 3.5 SUP-79-00075 CDM 0272 RC outpatient 148 148 148 74 109.52 percent of total billed charges 148 93 119.88 percent of total billed charges 148 148 other OPPS APC 148 148 other OPPS APC 148 27.63 40.89 percent of total billed charges 148 148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICONIX 2.3 DRILL BX/5 SUP-79-00078 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICONIX 2 BX/5 SUP-79-00079 CDM 0272 RC outpatient 1050 1050 1050 74 777 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 1050 other OPPS APC 1050 1050 other OPPS APC 1050 27.63 290.12 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REELX ANCHOR 4.5 SUP-79-00080 CDM 0272 RC outpatient 1033.53 1033.53 1033.53 74 764.81 percent of total billed charges 1033.53 93 837.16 percent of total billed charges 1033.53 1033.53 other OPPS APC 1033.53 1033.53 other OPPS APC 1033.53 27.63 285.56 percent of total billed charges 1033.53 1033.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOF NEEDLE SUP-79-00081 CDM 0272 RC outpatient 408.7 408.7 408.7 74 302.44 percent of total billed charges 408.7 93 331.05 percent of total billed charges 408.7 408.7 other OPPS APC 408.7 408.7 other OPPS APC 408.7 27.63 112.92 percent of total billed charges 408.7 408.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE DELIVERY SYSTM FAST-FIX 360 STRT SUP-79-00082 CDM 0272 RC outpatient 1466.52 1466.52 1466.52 74 1085.22 percent of total billed charges 1466.52 93 1187.88 percent of total billed charges 1466.52 1466.52 other OPPS APC 1466.52 1466.52 other OPPS APC 1466.52 27.63 405.2 percent of total billed charges 1466.52 1466.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE DELIVERY SYSTM FAST-FIX 360 CURVD SUP-79-00083 CDM 0272 RC outpatient 1466.52 1466.52 1466.52 74 1085.22 percent of total billed charges 1466.52 93 1187.88 percent of total billed charges 1466.52 1466.52 other OPPS APC 1466.52 1466.52 other OPPS APC 1466.52 27.63 405.2 percent of total billed charges 1466.52 1466.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE PASSER FIRSTPASS STANDARD SUP-79-00087 CDM 0272 RC outpatient 649.74 649.74 649.74 74 480.81 percent of total billed charges 649.74 93 526.29 percent of total billed charges 649.74 649.74 other OPPS APC 649.74 649.74 other OPPS APC 649.74 27.63 179.52 percent of total billed charges 649.74 649.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE 5.5MM HEALICOIL BLK SUP-79-00088 CDM C1713 HCPCS 0278 RC outpatient 1118.07 1118.07 1118.07 57 637.3 percent of total billed charges 1118.07 93 905.64 percent of total billed charges 1118.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1118.07 other OPPS APC 1118.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1118.07 other OPPS APC 1118.07 51 570.22 percent of total billed charges 1118.07 1118.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE 5.5MM HEALICOIL BLUE SUP-79-00089 CDM C1713 HCPCS 0278 RC outpatient 1120 1120 1120 57 638.4 percent of total billed charges 1120 93 907.2 percent of total billed charges 1120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1120 other OPPS APC 1120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1120 other OPPS APC 1120 51 571.2 percent of total billed charges 1120 1120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR KNOTLESS 5.5MM S-ULTRA SUP-79-00090 CDM C1713 HCPCS 0278 RC outpatient 1170 1170 1170 57 666.9 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1170 other OPPS APC 1170 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR KNOTLESS 6.5MM S-ULTRA SUP-79-00091 CDM C1713 HCPCS 0278 RC outpatient 1125 1125 1125 57 641.25 percent of total billed charges 1125 93 911.25 percent of total billed charges 1125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1125 other OPPS APC 1125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1125 other OPPS APC 1125 51 573.75 percent of total billed charges 1125 1125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE 2.8MM Q-FIX SUP-79-00092 CDM C1713 HCPCS 0278 RC outpatient 1252.32 1252.32 1252.32 57 713.82 percent of total billed charges 1252.32 93 1014.38 percent of total billed charges 1252.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1252.32 other OPPS APC 1252.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1252.32 other OPPS APC 1252.32 51 638.68 percent of total billed charges 1252.32 1252.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT SHOULDER Q-FIX 2.8MM SUP-79-00093 CDM C1713 HCPCS 0278 RC outpatient 765 765 765 57 436.05 percent of total billed charges 765 93 619.65 percent of total billed charges 765 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 765 other OPPS APC 765 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 765 other OPPS APC 765 51 390.15 percent of total billed charges 765 765 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING OUTFLOW W/ REDEUCE 10 EA SUP-79-00094 CDM 0272 RC outpatient 210 210 210 74 155.4 percent of total billed charges 210 93 170.1 percent of total billed charges 210 210 other OPPS APC 210 210 other OPPS APC 210 27.63 58.02 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 1.8MM KNOTLESS HIP FIBERTAK SUP-79-00095 CDM 0272 RC outpatient 507.5 507.5 507.5 74 375.55 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 507.5 other OPPS APC 507.5 507.5 other OPPS APC 507.5 27.63 140.22 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISPOSABLES KIT FOR FIBERTAK STRAIGHT SUP-79-00096 CDM 0272 RC outpatient 612.5 612.5 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLINGSHOT 70 UP SUTURE PASSER SUP-79-00097 CDM 0272 RC outpatient 1133.28 1133.28 1133.28 1133.28 other OPPS APC 1133.28 1133.28 other OPPS APC 1133.28 27.63 313.13 percent of total billed charges 1133.28 1133.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE MANAGER NANOPASS REACH LEFT 45 DEGREE SUP-79-00098 CDM 0272 RC outpatient 1034.64 1034.64 1034.64 1034.64 other OPPS APC 1034.64 1034.64 other OPPS APC 1034.64 27.63 285.87 percent of total billed charges 1034.64 1034.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE MANAGER NANOPASS REACH RIGHT 45 DEGREE SUP-79-00099 CDM 0272 RC outpatient 1034.64 1034.64 1034.64 1034.64 other OPPS APC 1034.64 1034.64 other OPPS APC 1034.64 27.63 285.87 percent of total billed charges 1034.64 1034.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAUTERY I STAT WHITE DISPOSABLE SUP-79-4100 CDM 0270 RC outpatient 190.14 190.14 190.14 74 140.7 percent of total billed charges 190.14 93 154.01 percent of total billed charges 190.14 190.14 other OPPS APC 190.14 190.14 other OPPS APC 190.14 27.63 52.54 percent of total billed charges 190.14 190.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENT BONE HYDROSET CALCIUM PHOSPHATE 5 ML INJECTABLE BIOCOMPATIBLE OSTEOCONDUCTIVE STERILE SUP-79-43905 CDM 0270 RC outpatient 3870.52 3870.52 3870.52 74 2864.18 percent of total billed charges 3870.52 93 3135.12 percent of total billed charges 3870.52 3870.52 other OPPS APC 3870.52 3870.52 other OPPS APC 3870.52 27.63 1069.42 percent of total billed charges 3870.52 3870.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENT BONE HYDROSET CALCIUM PHOSPHATE 10 CC INJECTABLE OSTEOCONDUCTIVE STERILE LATEX FREE VOID FILLER SUP-79-43910 CDM 0270 RC outpatient 7437.09 7437.09 7437.09 74 5503.45 percent of total billed charges 7437.09 93 6024.04 percent of total billed charges 7437.09 7437.09 other OPPS APC 7437.09 7437.09 other OPPS APC 7437.09 27.63 2054.87 percent of total billed charges 7437.09 7437.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT ORTHOPEDIC PROCARE LG FROG CONTOUR 3.75X3IN BLUE ALUMINUM FOAM LF FINGER PHALANX PAD SUP-79-71967 CDM 0270 RC outpatient 2 2 2 74 1.48 percent of total billed charges 2 93 1.62 percent of total billed charges 2 2 other OPPS APC 2 2 other OPPS APC 2 27.63 0.55 percent of total billed charges 2 2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BINDER ABDOMINAL PROCARE XL 12IN 62-74IN FLANNEL COTTON 4 PANEL ELASTIC CONTACT CLOSURE SUP-79-89220 CDM 270009158 LOCAL 0270 RC outpatient 18.59 18.59 18.59 74 13.76 percent of total billed charges 18.59 93 15.06 percent of total billed charges 18.59 18.59 other OPPS APC 18.59 18.59 other OPPS APC 18.59 27.63 5.14 percent of total billed charges 18.59 18.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLING ARM PROCARE HOOK AND LOOP CLOSURE UNIVERSAL SUP-79-92070 CDM outpatient 7.7 7.7 7.7 7.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SET TOURNIQUET VASCULAR 6"" TUBE QUICK TIE CAP W/TUBEX2 WIRE SNAREX1 BRONZE TOURNIKWIK MERCURY FREE" SUP-79010 CDM 270010028 LOCAL 0270 RC outpatient 20.36 20.36 20.36 74 15.07 percent of total billed charges 20.36 93 16.49 percent of total billed charges 20.36 20.36 other OPPS APC 20.36 20.36 other OPPS APC 20.36 27.63 5.63 percent of total billed charges 20.36 20.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION INJECTION VIAFLEX 1L 20 MEQ POTASSIUM CHLORIDE 5% DEXTROSE 0.45% SODIUM CHLORIDE LF SUP-790209 CDM 0270 RC outpatient 5.36 5.36 5.36 74 3.97 percent of total billed charges 5.36 93 4.34 percent of total billed charges 5.36 5.36 other OPPS APC 5.36 5.36 other OPPS APC 5.36 27.63 1.48 percent of total billed charges 5.36 5.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POWDER OSTOMY KARAYA 2.5 OZ PUFF BOTTLE SKIN BARRIER STICKY GEL SUP-7905 CDM 0270 RC outpatient 6.08 6.08 6.08 74 4.5 percent of total billed charges 6.08 93 4.92 percent of total billed charges 6.08 6.08 other OPPS APC 6.08 6.08 other OPPS APC 6.08 27.63 1.68 percent of total billed charges 6.08 6.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POWDER OSTOMY ADAPT STOMAHESIVE 1 OZ PUFF BOTTLE ADHERENCE BARRIER VIEW WINDOW NONSTERILE LATEX FREE SUP-7906 CDM 0270 RC outpatient 2.05 2.05 2.05 74 1.52 percent of total billed charges 2.05 93 1.66 percent of total billed charges 2.05 2.05 other OPPS APC 2.05 2.05 other OPPS APC 2.05 27.63 0.57 percent of total billed charges 2.05 2.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MICROPOINT CHROMIC 6-0 G-1 L18 IN 2 ARM MONOFILAMENT BROWN SUP-790G CDM 0270 RC outpatient 37.02 37.02 37.02 74 27.39 percent of total billed charges 37.02 93 29.99 percent of total billed charges 37.02 37.02 other OPPS APC 37.02 37.02 other OPPS APC 37.02 27.63 10.23 percent of total billed charges 37.02 37.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MICROPOINT 5-0 G-3 18IN BROWN CHROMIC 2 ARM MONOFILAMENT SUP-792G CDM 0270 RC outpatient 36.44 36.44 36.44 74 26.97 percent of total billed charges 36.44 93 29.52 percent of total billed charges 36.44 36.44 other OPPS APC 36.44 36.44 other OPPS APC 36.44 27.63 10.07 percent of total billed charges 36.44 36.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PASTE OSTOMY ADAPT ALCOHOL 2.1 OZ SQUEEZE TUBE CAP SKIN BARRIER LATEX FREE RED SUP-79300 CDM 0270 RC outpatient 2.83 2.83 2.83 74 2.09 percent of total billed charges 2.83 93 2.29 percent of total billed charges 2.83 2.83 other OPPS APC 2.83 2.83 other OPPS APC 2.83 27.63 0.78 percent of total billed charges 2.83 2.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEAL OSTOMY EAKIN COHESIVE HYDROCOLLOID PECTIN SMALL DONUT OD 2 IN ABSORBENT ADHESIVE SLIN BARRIER RING LATEX FREE SUP-79402 CDM 0270 RC outpatient 0.72 0.72 0.72 74 0.53 percent of total billed charges 0.72 93 0.58 percent of total billed charges 0.72 0.72 other OPPS APC 0.72 0.72 other OPPS APC 0.72 27.63 0.2 percent of total billed charges 0.72 0.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLEDGET CARDIOVASCULAR BARD THK1.65MM RECTANGLE 3/16X3/8IN PTFE STERILE FELT SUP-7963 CDM 0270 RC outpatient 29.12 29.12 29.12 74 21.55 percent of total billed charges 29.12 93 23.59 percent of total billed charges 29.12 29.12 other OPPS APC 29.12 29.12 other OPPS APC 29.12 27.63 8.05 percent of total billed charges 29.12 29.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION IV IRRIGATION SODIUM CHLORIDE 0.9% PLASTIC BAG 1000ML SUP-797205 CDM 270009181 LOCAL 0270 RC outpatient 30 30 30 74 22.2 percent of total billed charges 30 93 24.3 percent of total billed charges 30 30 other OPPS APC 30 30 other OPPS APC 30 27.63 8.29 percent of total billed charges 30 30 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAPER RECORDING MEDI-TRACE L97 FT X W1.97 IN 1 CHANNEL EKG THERMAL CHART PHILIPS 40477A SUP-7G30725389 CDM outpatient 2.7 2.7 2.7 2.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE GORE-TEX 6-0 24IN 3/8 CIRCLE CV-7/TTC-13 DOUBLE-ARM TAPER POINT WHITE 12/BX 7K06A MONOFILAMENT EPTFE 13MM NONABSORBABLE SUP-7K06A CDM 0270 RC outpatient 96.42 96.42 96.42 74 71.35 percent of total billed charges 96.42 93 78.1 percent of total billed charges 96.42 96.42 other OPPS APC 96.42 96.42 other OPPS APC 96.42 27.63 26.64 percent of total billed charges 96.42 96.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE GORE-TEX CV-7 TTC-13 24IN 2 ARM MONOFILAMENT WHITE NONABSORBABLE SUP-7K06B CDM 0270 RC outpatient 251.12 251.12 251.12 74 185.83 percent of total billed charges 251.12 93 203.41 percent of total billed charges 251.12 251.12 other OPPS APC 251.12 251.12 other OPPS APC 251.12 27.63 69.38 percent of total billed charges 251.12 251.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE GORE-TEX CV-7 PT-13 L24 IN 2 ARM MONOFILAMENT WHITE SUP-7K08A CDM 0270 RC outpatient 105.08 105.08 105.08 74 77.76 percent of total billed charges 105.08 93 85.11 percent of total billed charges 105.08 105.08 other OPPS APC 105.08 105.08 other OPPS APC 105.08 27.63 29.03 percent of total billed charges 105.08 105.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE SUP-7M02A CDM 0270 RC outpatient 99.23 99.23 99.23 74 73.43 percent of total billed charges 99.23 93 80.38 percent of total billed charges 99.23 99.23 other OPPS APC 99.23 99.23 other OPPS APC 99.23 27.63 27.42 percent of total billed charges 99.23 99.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE GORE-TEX 6-0 30IN 3/8 CIRCLE CV-7/PT-13 DOUBLE-ARM PIERCING POINT WHITE 12/BX 7M08A MONOFILAMENT EPTFE 13MM NONABSORBABLE SUP-7M08A CDM 0270 RC outpatient 112.88 112.88 112.88 74 83.53 percent of total billed charges 112.88 93 91.43 percent of total billed charges 112.88 112.88 other OPPS APC 112.88 112.88 other OPPS APC 112.88 27.63 31.19 percent of total billed charges 112.88 112.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER OSPREY EAGLE I SUP-8-07 CDM 270010020 LOCAL 0270 RC outpatient 3185 3185 3185 74 2356.9 percent of total billed charges 3185 93 2579.85 percent of total billed charges 3185 3185 other OPPS APC 3185 3185 other OPPS APC 3185 27.63 880.02 percent of total billed charges 3185 3185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA TWIST-IN 7MMX7CM SUP-80-00002 CDM 0272 RC outpatient 100 100 100 74 74 percent of total billed charges 100 93 81 percent of total billed charges 100 100 other OPPS APC 100 100 other OPPS APC 100 27.63 27.63 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNOTILUS IMPLANT LOOP 25MM SUP-80-00015 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNOTILUS ANCHOR 3.5MM SUP-80-00016 CDM C1713 HCPCS 0278 RC outpatient 793.31 793.31 793.31 57 452.19 percent of total billed charges 793.31 93 642.58 percent of total billed charges 793.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 793.31 other OPPS APC 793.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 793.31 other OPPS APC 793.31 51 404.59 percent of total billed charges 793.31 793.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5.5MM REELX STT ANCHOR SUP-80-00018 CDM C1713 HCPCS 0278 RC outpatient 1151.73 1151.73 1151.73 57 656.49 percent of total billed charges 1151.73 93 932.9 percent of total billed charges 1151.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1151.73 other OPPS APC 1151.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1151.73 other OPPS APC 1151.73 51 587.38 percent of total billed charges 1151.73 1151.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MINI BIO-PUSHLOCK 2.5M (BX/5) SUP-80-00020 CDM C1713 HCPCS 0278 RC outpatient 1275 1275 1275 57 726.75 percent of total billed charges 1275 93 1032.75 percent of total billed charges 1275 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1275 other OPPS APC 1275 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1275 other OPPS APC 1275 51 650.25 percent of total billed charges 1275 1275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISPOSABLE KIT FOR MINI SUTURETAK SUP-80-00022 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT FOR 3.5MM PUSHLOCK SUP-80-00027 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT FOR 2.9MM PUSHLOCK SUP-80-00030 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRYKER 5.5MM PEEK ZIP ANCHOR PK/5 SUP-80-00037 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 11M X28 INTERFERENCE SUP-80-00038 CDM C1713 HCPCS 0278 RC outpatient 807 807 807 57 459.99 percent of total billed charges 807 93 653.67 percent of total billed charges 807 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 807 other OPPS APC 807 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 807 other OPPS APC 807 51 411.57 percent of total billed charges 807 807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 9M X23 INTERFERENCE SUP-80-00039 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 7M X23 INTERFERENCE SUP-80-00040 CDM C1713 HCPCS 0278 RC outpatient 747.28 747.28 747.28 57 425.95 percent of total billed charges 747.28 93 605.3 percent of total billed charges 747.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 747.28 other OPPS APC 747.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 747.28 other OPPS APC 747.28 51 381.11 percent of total billed charges 747.28 747.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 20M GLOCK SUP-80-00041 CDM C1713 HCPCS 0278 RC outpatient 936 936 936 57 533.52 percent of total billed charges 936 93 758.16 percent of total billed charges 936 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 936 other OPPS APC 936 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 936 other OPPS APC 936 51 477.36 percent of total billed charges 936 936 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3MM S-300QD SUP-80-00043 CDM 0272 RC outpatient 774 774 774 74 572.76 percent of total billed charges 774 93 626.94 percent of total billed charges 774 774 other OPPS APC 774 774 other OPPS APC 774 27.63 213.86 percent of total billed charges 774 774 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOCOMPOSITE SWIVEL SP SELF PUNCHING SUP-80-00046 CDM C1713 HCPCS 0278 RC outpatient 1260 1260 1260 57 718.2 percent of total billed charges 1260 93 1020.6 percent of total billed charges 1260 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1260 other OPPS APC 1260 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1260 other OPPS APC 1260 51 642.6 percent of total billed charges 1260 1260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOGRAFT COTTON WEDGE 6X24X14 SUP-80-00047 CDM C1713 HCPCS 0278 RC outpatient 4125 4125 4125 57 2351.25 percent of total billed charges 4125 93 3341.25 percent of total billed charges 4125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4125 other OPPS APC 4125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4125 other OPPS APC 4125 51 2103.75 percent of total billed charges 4125 4125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ANCHOR SHORT 2.9MM SUP-80-00051 CDM C1713 HCPCS 0278 RC outpatient 1200 1200 1200 57 684 percent of total billed charges 1200 93 972 percent of total billed charges 1200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1200 other OPPS APC 1200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1200 other OPPS APC 1200 51 612 percent of total billed charges 1200 1200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SHORT PUSHLOCK 2.9MM SUP-80-00052 CDM 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 367.5 other OPPS APC 367.5 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE DOWEL REVISION KIT 10MM SUP-80-00053 CDM 0272 RC outpatient 1470 1470 1470 74 1087.8 percent of total billed charges 1470 93 1190.7 percent of total billed charges 1470 1470 other OPPS APC 1470 1470 other OPPS APC 1470 27.63 406.16 percent of total billed charges 1470 1470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TIGHTROPE II ABS, IMPLANT" SUP-80-00054 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACUTRAK 2 MINI DRILL LONG SUP-80-0100 CDM 0270 RC outpatient 865.8 865.8 865.8 74 640.69 percent of total billed charges 865.8 93 701.3 percent of total billed charges 865.8 865.8 other OPPS APC 865.8 865.8 other OPPS APC 865.8 27.63 239.22 percent of total billed charges 865.8 865.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL SURGIBIT OD2 MM QUICK COUPLER NONSTERILE SUP-80-0318 CDM 0270 RC outpatient 340.6 340.6 340.6 74 252.04 percent of total billed charges 340.6 93 275.89 percent of total billed charges 340.6 340.6 other OPPS APC 340.6 340.6 other OPPS APC 340.6 27.63 94.11 percent of total billed charges 340.6 340.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL OD2.8 MM QUICK RELEASE 3.5 MM SCREW SUP-80-0387 CDM 0270 RC outpatient 369.2 369.2 369.2 74 273.21 percent of total billed charges 369.2 93 299.05 percent of total billed charges 369.2 369.2 other OPPS APC 369.2 369.2 other OPPS APC 369.2 27.63 102.01 percent of total billed charges 369.2 369.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTRODUCER GLIDESHEATH SLENDER .021IN 35MM 10CM 45CM 5FR 21GA SS HYDROPHILIC DISPOSABLE STERILE NEEDLE DILATOR SUP-80-1050 CDM 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTRODUCER GLIDESHEATH SLENDER .021IN 35MM 10CM 45CM 6FR 21GA SS HYDROPHILIC DISPOSABLE STERILE NEEDLE DILATOR SUP-80-1060 CDM 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPONGE SURGICAL CODMAN L6 IN X W3.5 IN STERILE DISPOSABLE SUP-80-1457 CDM outpatient 39.62 39.62 39.62 39.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL ACUTRAK 2 MICRO LONG EXTEND SUP-80-1522 CDM 0270 RC outpatient 863.2 863.2 863.2 74 638.77 percent of total billed charges 863.2 93 699.19 percent of total billed charges 863.2 863.2 other OPPS APC 863.2 863.2 other OPPS APC 863.2 27.63 238.5 percent of total billed charges 863.2 863.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC ACUTRAK 2 L6 IN OD.035 IN 1 TROCAR NONSTERILE SUP-80-1524 CDM 0270 RC outpatient 49.4 49.4 49.4 74 36.56 percent of total billed charges 49.4 93 40.01 percent of total billed charges 49.4 49.4 other OPPS APC 49.4 49.4 other OPPS APC 49.4 27.63 13.65 percent of total billed charges 49.4 49.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC ACUTRAK 2 L6 IN OD.035 IN 2 TROCAR NONSTERILE SUP-80-1525 CDM 0270 RC outpatient 52 52 52 74 38.48 percent of total billed charges 52 93 42.12 percent of total billed charges 52 52 other OPPS APC 52 52 other OPPS APC 52 27.63 14.37 percent of total billed charges 52 52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIGATOR HEMORRHOID STAINLESS STEEL 30 D ANGLE UP SUCTION NONSTERILE LATEX FREE REUSABLE SUP-80-1970 CDM 0270 RC outpatient 977.63 977.63 977.63 74 723.45 percent of total billed charges 977.63 93 791.88 percent of total billed charges 977.63 977.63 other OPPS APC 977.63 977.63 other OPPS APC 977.63 27.63 270.12 percent of total billed charges 977.63 977.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CLOSURE VASCADE MVP ID 6-12 FR VENOUS SUP-800-612C-10U CDM 0270 RC outpatient 1352 1352 1352 74 1000.48 percent of total billed charges 1352 93 1095.12 percent of total billed charges 1352 1352 other OPPS APC 1352 1352 other OPPS APC 1352 27.63 373.56 percent of total billed charges 1352 1352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT BIOPSY CARTICEL TRANSPORT CYLINDER CARTILAGE SUP-80001 CDM 0270 RC outpatient 1287 1287 1287 74 952.38 percent of total billed charges 1287 93 1042.47 percent of total billed charges 1287 1287 other OPPS APC 1287 1287 other OPPS APC 1287 27.63 355.6 percent of total billed charges 1287 1287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PUTTY STIMUBLAST DBM 10CC SUP-80038010 CDM 270010031 LOCAL 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCATHETER 14 TREVO XP PROVUE +PRO 3 X 20MM SUP-80051 CDM 0270 RC outpatient 21707.4 21707.4 21707.4 74 16063.5 percent of total billed charges 21707.4 93 17583 percent of total billed charges 21707.4 21707.4 other OPPS APC 21707.4 21707.4 other OPPS APC 21707.4 27.63 5997.75 percent of total billed charges 21707.4 21707.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCATHETER 18 TREVO XP PROVUE +PRO 4 X 20MM SUP-80052 CDM 0270 RC outpatient 22347 22347 22347 74 16536.8 percent of total billed charges 22347 93 18101.1 percent of total billed charges 22347 22347 other OPPS APC 22347 22347 other OPPS APC 22347 27.63 6174.48 percent of total billed charges 22347 22347 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE FIBULA SHAFT L8 CM X W14-18 MM ALLOGRAFT FREEZE DRIED PRETREATE SUP-800740 CDM 270010031 LOCAL 0270 RC outpatient 2264.6 2264.6 2264.6 74 1675.8 percent of total billed charges 2264.6 93 1834.33 percent of total billed charges 2264.6 2264.6 other OPPS APC 2264.6 2264.6 other OPPS APC 2264.6 27.63 625.71 percent of total billed charges 2264.6 2264.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE PVC STRAIGHT L22 IN OD20 FR THORACIC 4 EYELET RADIOPAQUE TAPER CONNECTOR TIP STERILE LATEX FREE SUP-8020 CDM 0270 RC outpatient 18.69 18.69 18.69 74 13.83 percent of total billed charges 18.69 93 15.14 percent of total billed charges 18.69 18.69 other OPPS APC 18.69 18.69 other OPPS APC 18.69 27.63 5.16 percent of total billed charges 18.69 18.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLEARWAY INFUSION CATHETER 1.5 X 20 SUP-80208 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STIRRUP ORTHOPEDIC AIRFORM GRAY WHITE ADULT ANKLE INFLATABLE AIR BLADDER FLEX EDGE ADJUST HEEL STRAP SUP-80250 CDM 0270 RC outpatient 25.3 25.3 25.3 74 18.72 percent of total billed charges 25.3 93 20.49 percent of total billed charges 25.3 25.3 other OPPS APC 25.3 25.3 other OPPS APC 25.3 27.63 6.99 percent of total billed charges 25.3 25.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID STIMUBLAST CANCELLOUS DEMINERALIZED BONE MATRIX 10 ML PUTTY REVERSE PHASE MEDIUM SUP-80338010 CDM 270010031 LOCAL 0270 RC outpatient 3367 3367 3367 74 2491.58 percent of total billed charges 3367 93 2727.27 percent of total billed charges 3367 3367 other OPPS APC 3367 3367 other OPPS APC 3367 27.63 930.3 percent of total billed charges 3367 3367 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT VOCAL CORD PROLARYN SODIUM CARBOXYMETHYLCELLULOSE 1 ML KIT INJECTABLE SYRINGE 2 NEEDLE RESORBABLE STERILE LATEX FREE TEMPORARY SUP-8044M0 CDM 0270 RC outpatient 1768 1768 1768 74 1308.32 percent of total billed charges 1768 93 1432.08 percent of total billed charges 1768 1768 other OPPS APC 1768 1768 other OPPS APC 1768 27.63 488.5 percent of total billed charges 1768 1768 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE OPHTHALMIC ASB HOCKEY STICK SHARP ALL AROUND SUP-8065005701 CDM 0270 RC outpatient 44.02 44.02 44.02 74 32.57 percent of total billed charges 44.02 93 35.66 percent of total billed charges 44.02 44.02 other OPPS APC 44.02 44.02 other OPPS APC 44.02 27.63 12.16 percent of total billed charges 44.02 44.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MANIPULATOR SURGICAL ACCURUS INFINITECH 1 MM OD20 GA ODSEC28 GA TISSUE 3 FUNCTION ILLUMINATION ASPIRATION COAGULATION STERILE DISPOSABLE SUP-8065020100 CDM 0270 RC outpatient 425.18 425.18 425.18 74 314.63 percent of total billed charges 425.18 93 344.4 percent of total billed charges 425.18 425.18 other OPPS APC 425.18 425.18 other OPPS APC 425.18 27.63 117.48 percent of total billed charges 425.18 425.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE OPTHALMIC SUP-8065102320 CDM 0270 RC outpatient 34.71 34.71 34.71 74 25.69 percent of total billed charges 34.71 93 28.12 percent of total billed charges 34.71 34.71 other OPPS APC 34.71 34.71 other OPPS APC 34.71 27.63 9.59 percent of total billed charges 34.71 34.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL EYE-PAK 254X165CM 13X10CM BLUE FABRIC DISPOSABLE STERILE LF FULL BODY 2 FLUID CATCH BAG NOSE BRIDGE SUP-8065103020 CDM 0270 RC outpatient 55.25 55.25 55.25 74 40.89 percent of total billed charges 55.25 93 44.75 percent of total billed charges 55.25 55.25 other OPPS APC 55.25 55.25 other OPPS APC 55.25 27.63 15.27 percent of total billed charges 55.25 55.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE OPHTHALMIC INCISE FLUID POUCH ROUND PLASTIC 40 X 48IN SUP-8065104020 CDM 0270 RC outpatient 27.51 27.51 27.51 74 20.36 percent of total billed charges 27.51 93 22.28 percent of total billed charges 27.51 27.51 other OPPS APC 27.51 27.51 other OPPS APC 27.51 27.63 7.6 percent of total billed charges 27.51 27.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA OPHTHALMIC SILICONE OD23 GA SOFT TIP DISPOSABLE SUP-8065149523 CDM 0270 RC outpatient 56.84 56.84 56.84 74 42.06 percent of total billed charges 56.84 93 46.04 percent of total billed charges 56.84 56.84 other OPPS APC 56.84 56.84 other OPPS APC 56.84 27.63 15.7 percent of total billed charges 56.84 56.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA OPHTHALMIC SILICONE OD25 GA SOFT TIP DISPOSABLE SUP-8065149525 CDM 0270 RC outpatient 62.4 62.4 62.4 74 46.18 percent of total billed charges 62.4 93 50.54 percent of total billed charges 62.4 62.4 other OPPS APC 62.4 62.4 other OPPS APC 62.4 27.63 17.24 percent of total billed charges 62.4 62.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA OPHTHALMIC SHORT OD23 GA SOFT TIP STERILE DISPOSABLE SUP-8065149527 CDM 0270 RC outpatient 55.8 55.8 55.8 74 41.29 percent of total billed charges 55.8 93 45.2 percent of total billed charges 55.8 55.8 other OPPS APC 55.8 55.8 other OPPS APC 55.8 27.63 15.42 percent of total billed charges 55.8 55.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA OPHTHALMIC GRIESHABER OD27+ GA ODSEC.8 MM SOFT TIP STERILE DISPOSABLE SUP-8065149529 CDM 0270 RC outpatient 65.08 65.08 65.08 74 48.16 percent of total billed charges 65.08 93 52.71 percent of total billed charges 65.08 65.08 other OPPS APC 65.08 65.08 other OPPS APC 65.08 27.63 17.98 percent of total billed charges 65.08 65.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA OPHTHALMIC GRIESHABER SHORT OD25 GA ODSEC.8 MM SOFT TIP STERILE DISPOSABLE SUP-8065149530 CDM 0270 RC outpatient 55.8 55.8 55.8 74 41.29 percent of total billed charges 55.8 93 45.2 percent of total billed charges 55.8 55.8 other OPPS APC 55.8 55.8 other OPPS APC 55.8 27.63 15.42 percent of total billed charges 55.8 55.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE POLYPROPOLENE NEEDLE:AUM-5 SIZE:10-0 LENGTH:12IN SUP-8065304901 CDM 0270 RC outpatient 173.16 173.16 173.16 74 128.14 percent of total billed charges 173.16 93 140.26 percent of total billed charges 173.16 173.16 other OPPS APC 173.16 173.16 other OPPS APC 173.16 27.63 47.84 percent of total billed charges 173.16 173.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA OPHTHALMIC ANGLED L4 MM OD27 GA ANTERIOR CHAMBER IRRIGATION STERILE DISPOSABLE SUP-8065420120 CDM 0270 RC outpatient 17.99 17.99 17.99 74 13.31 percent of total billed charges 17.99 93 14.57 percent of total billed charges 17.99 17.99 other OPPS APC 17.99 17.99 other OPPS APC 17.99 27.63 4.97 percent of total billed charges 17.99 17.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POLISHER LENS TERRY SQUEEGEE SILICONE OD27 GA CAPSULE TIP STERILE DISPOSABLE SUP-8065428220 CDM 0270 RC outpatient 18.72 18.72 18.72 74 13.85 percent of total billed charges 18.72 93 15.16 percent of total billed charges 18.72 18.72 other OPPS APC 18.72 18.72 other OPPS APC 18.72 27.63 5.17 percent of total billed charges 18.72 18.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION OPHTHALMIC SILIKON 1000 8.5ML POLYDIMETHYLSILOXANE STERILE LF OIL SUP-8065601187 CDM 0270 RC outpatient 1178.76 1178.76 1178.76 74 872.28 percent of total billed charges 1178.76 93 954.8 percent of total billed charges 1178.76 1178.76 other OPPS APC 1178.76 1178.76 other OPPS APC 1178.76 27.63 325.69 percent of total billed charges 1178.76 1178.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP PHACOEMULSIFICATION 1.1MM ABS 45D ROUND FLARE STERILE DISPOSABLE SUP-8065740807 CDM 270009056 LOCAL 0270 RC outpatient 72 72 72 74 53.28 percent of total billed charges 72 93 58.32 percent of total billed charges 72 72 other OPPS APC 72 72 other OPPS APC 72 27.63 19.89 percent of total billed charges 72 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK VITRECTOMY ACCURUS TOTAL PLUS PROBE 2500 SUP-8065741017 CDM 270009186 LOCAL 0270 RC outpatient 328.8 328.8 328.8 74 243.31 percent of total billed charges 328.8 93 266.33 percent of total billed charges 328.8 328.8 other OPPS APC 328.8 328.8 other OPPS APC 328.8 27.63 90.85 percent of total billed charges 328.8 328.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK VITRECTOMY ACCURUS OD25 GA PROBE LIGHT PIPE SUP-8065750220 CDM 0270 RC outpatient 1297.4 1297.4 1297.4 74 960.08 percent of total billed charges 1297.4 93 1050.89 percent of total billed charges 1297.4 1297.4 other OPPS APC 1297.4 1297.4 other OPPS APC 1297.4 27.63 358.47 percent of total billed charges 1297.4 1297.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ILLUMINATOR OPHTHALMIC ACCURUS WIDE ANGLE OD20 GA PROBE WIDE ANGLE PERIPHERAL VISUALIZATION NONRFID STERILE DISPOSABLE SAPPHIRE SUP-8065750425 CDM 0270 RC outpatient 182 182 182 74 134.68 percent of total billed charges 182 93 147.42 percent of total billed charges 182 182 other OPPS APC 182 182 other OPPS APC 182 27.63 50.29 percent of total billed charges 182 182 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PHACOEMULSIFICATION INTREPID MICROSMOOTH OD.9 MM ULTRA INFUSION SLEEVE IRRIGATION ASPIRATION MICRO COAXIAL SYSTEM SUP-8065750517 CDM 0270 RC outpatient 79.64 79.64 79.64 74 58.93 percent of total billed charges 79.64 93 64.51 percent of total billed charges 79.64 79.64 other OPPS APC 79.64 79.64 other OPPS APC 79.64 27.63 22 percent of total billed charges 79.64 79.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ILLUMINATOR OPHTHALMIC OD23 GA ENDO PROBE SUP-8065750802 CDM 0270 RC outpatient 165.33 165.33 165.33 74 122.34 percent of total billed charges 165.33 93 133.92 percent of total billed charges 165.33 165.33 other OPPS APC 165.33 165.33 other OPPS APC 165.33 27.63 45.68 percent of total billed charges 165.33 165.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK VITRECTOMY ACCURUS TOTAL PLUS OD23 GA LATEX FREE SUP-8065750828 CDM 0270 RC outpatient 1265.37 1265.37 1265.37 74 936.37 percent of total billed charges 1265.37 93 1024.95 percent of total billed charges 1265.37 1265.37 other OPPS APC 1265.37 1265.37 other OPPS APC 1265.37 27.63 349.62 percent of total billed charges 1265.37 1265.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLUG OPHTHALMIC ACCURUS OD23 GA SET SUP-8065750837 CDM 0270 RC outpatient 156.47 156.47 156.47 74 115.79 percent of total billed charges 156.47 93 126.74 percent of total billed charges 156.47 156.47 other OPPS APC 156.47 156.47 other OPPS APC 156.47 27.63 43.23 percent of total billed charges 156.47 156.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP PHACOEMULSIFICATION KELMAN ABS 30 D MINI FLARED SUP-8065750852 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET VITRECTOMY INFUSION ACCESS NGVS SUP-8065750914 CDM 0270 RC outpatient 162.66 162.66 162.66 74 120.37 percent of total billed charges 162.66 93 131.75 percent of total billed charges 162.66 162.66 other OPPS APC 162.66 162.66 other OPPS APC 162.66 27.63 44.94 percent of total billed charges 162.66 162.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING ASPIRATION CONSTELLATION OPHTHALMIC AUXILLARY SUP-8065750917 CDM 0270 RC outpatient 153.45 153.45 153.45 74 113.55 percent of total billed charges 153.45 93 124.29 percent of total billed charges 153.45 153.45 other OPPS APC 153.45 153.45 other OPPS APC 153.45 27.63 42.4 percent of total billed charges 153.45 153.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE VITRECTOMY TOTAL PLUS CONSTELLATION 5000 CPM OD20 GA SUP-8065750948 CDM 0270 RC outpatient 572 572 572 74 423.28 percent of total billed charges 572 93 463.32 percent of total billed charges 572 572 other OPPS APC 572 572 other OPPS APC 572 27.63 158.04 percent of total billed charges 572 572 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE VITRECTOMY ULTRAVIT CONSTELLATION 5000 CPM OD23 GA LATEX FREE SUP-8065750949 CDM 0270 RC outpatient 756.39 756.39 756.39 74 559.73 percent of total billed charges 756.39 93 612.68 percent of total billed charges 756.39 756.39 other OPPS APC 756.39 756.39 other OPPS APC 756.39 27.63 208.99 percent of total billed charges 756.39 756.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK VITRECTOMY CONSTELLATION ENGAUGE RUBBER OD25 GA OD20 GA ODSEC23 GA 10 CC VISCUOUS FLUID CONTROL SYRINGE NEEDLE CANNULA STERILE LATEX FREE DISPOSABLE VFC SUP-8065750957 CDM 0270 RC outpatient 182.83 182.83 182.83 74 135.29 percent of total billed charges 182.83 93 148.09 percent of total billed charges 182.83 182.83 other OPPS APC 182.83 182.83 other OPPS APC 182.83 27.63 50.52 percent of total billed charges 182.83 182.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK VITRECTOMY CONSTELLATION OD20 GA PROBE FRAGMENTATION HANDPIECE LIGHTWEIGHT LATEX FREE SUP-8065750958 CDM 0270 RC outpatient 226.46 226.46 226.46 74 167.58 percent of total billed charges 226.46 93 183.43 percent of total billed charges 226.46 226.46 other OPPS APC 226.46 226.46 other OPPS APC 226.46 27.63 62.57 percent of total billed charges 226.46 226.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK VITRECTOMY CONSTELLATION ENGAUGE V-LOCITY C3F8 SF6 GAS FILL SYRINGE RFID AUTOMATIC PURGE STERILE LATEX FREE DISPOSABLE SUP-8065751014 CDM 0270 RC outpatient 182.83 182.83 182.83 74 135.29 percent of total billed charges 182.83 93 148.09 percent of total billed charges 182.83 182.83 other OPPS APC 182.83 182.83 other OPPS APC 182.83 27.63 50.52 percent of total billed charges 182.83 182.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK PHACOEMULSIFICATION INTREPID 30 D OD.9 MM ULTRA SUP-8065751039 CDM 0270 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK VITRECTOMY CONSTELLATION TOTAL PLUS 5000 CPM OD23 GA 20 CC 3 WAY STOPCOCK PROBE STRAIGHT ENDOILLUMINATOR AUTO INFUSION VALVE LATEX FREE SUP-8065751058 CDM 0270 RC outpatient 1510 1510 1510 74 1117.4 percent of total billed charges 1510 93 1223.1 percent of total billed charges 1510 1510 other OPPS APC 1510 1510 other OPPS APC 1510 27.63 417.21 percent of total billed charges 1510 1510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK VITRECTOMY TOTAL PLUS CONSTELLATION 5000 CPM STRAIGHT 20GA LF PROBE ENDOILLUMINATOR SUP-8065751063 CDM 0270 RC outpatient 1469.23 1469.23 1469.23 74 1087.23 percent of total billed charges 1469.23 93 1190.08 percent of total billed charges 1469.23 1469.23 other OPPS APC 1469.23 1469.23 other OPPS APC 1469.23 27.63 405.95 percent of total billed charges 1469.23 1469.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE LASER PUREPOINT NITINOL 40 D L6 MM OD23 GA RETINA RFID FLEXIBLE NITINOL TIP EASY INSERTION ANGLED STERILE DISPOSABLE SUP-8065751113 CDM 0270 RC outpatient 495.82 495.82 495.82 74 366.91 percent of total billed charges 495.82 93 401.61 percent of total billed charges 495.82 495.82 other OPPS APC 495.82 495.82 other OPPS APC 495.82 27.63 137 percent of total billed charges 495.82 495.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE LASER PUREPOINT 40 D L6 MM OD25 GA RETINA RFID FLEXIBLE NITINOL TIP EASY INSERTION ANGLED STERILE LATEX FREE DISPOSABLE SUP-8065751114 CDM 0270 RC outpatient 495.82 495.82 495.82 74 366.91 percent of total billed charges 495.82 93 401.61 percent of total billed charges 495.82 495.82 other OPPS APC 495.82 495.82 other OPPS APC 495.82 27.63 137 percent of total billed charges 495.82 495.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ILLUMINATOR OPHTHALMIC ACCURUS PROBE WIDE ANGLE STERILE DISPOSABLE SAPPHIRE SUP-8065751183 CDM 0270 RC outpatient 182 182 182 74 134.68 percent of total billed charges 182 93 147.42 percent of total billed charges 182 182 other OPPS APC 182 182 other OPPS APC 182 27.63 50.29 percent of total billed charges 182 182 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK ANT BIT 23G SUP-8065751196 CDM 0270 RC outpatient 584.22 584.22 584.22 74 432.32 percent of total billed charges 584.22 93 473.22 percent of total billed charges 584.22 584.22 other OPPS APC 584.22 584.22 other OPPS APC 584.22 27.63 161.42 percent of total billed charges 584.22 584.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE VITRECTOMY ULTRAVIT 5000 CPM OD25+ GA LATEX FREE SUP-8065751438 CDM 0270 RC outpatient 585 585 585 74 432.9 percent of total billed charges 585 93 473.85 percent of total billed charges 585 585 other OPPS APC 585 585 other OPPS APC 585 27.63 161.64 percent of total billed charges 585 585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE VITRECTOMY CONSTELLATION OD25+ GA TROCAR PLUG SET SUP-8065751443 CDM 0270 RC outpatient 139.44 139.44 139.44 74 103.19 percent of total billed charges 139.44 93 112.95 percent of total billed charges 139.44 139.44 other OPPS APC 139.44 139.44 other OPPS APC 139.44 27.63 38.53 percent of total billed charges 139.44 139.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE VITRECTOMY CONSTELLATION OD23 GA EDGEPLUS TROCAR CANNULA SET SUP-8065751446 CDM 0270 RC outpatient 126.36 126.36 126.36 74 93.51 percent of total billed charges 126.36 93 102.35 percent of total billed charges 126.36 126.36 other OPPS APC 126.36 126.36 other OPPS APC 126.36 27.63 34.91 percent of total billed charges 126.36 126.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET OPHTHALMIC EDGEPLUS OD25 GA TROCAR/CANNULA SUP-8065751448 CDM 0270 RC outpatient 105.3 105.3 105.3 74 77.92 percent of total billed charges 105.3 93 85.29 percent of total billed charges 105.3 105.3 other OPPS APC 105.3 105.3 other OPPS APC 105.3 27.63 29.09 percent of total billed charges 105.3 105.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA OPHTHALMIC OD25 GA CHANDELIER STERILE SUP-8065751577 CDM 0270 RC outpatient 445.64 445.64 445.64 74 329.77 percent of total billed charges 445.64 93 360.97 percent of total billed charges 445.64 445.64 other OPPS APC 445.64 445.64 other OPPS APC 445.64 27.63 123.13 percent of total billed charges 445.64 445.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE VITRECTOMY EDGEPLUS 4 MM OD23 GA 1 COUNT VALVED ENTRY SYSTEM STAND ALONE SUP-8065751585 CDM 0270 RC outpatient 136.63 136.63 136.63 74 101.11 percent of total billed charges 136.63 93 110.67 percent of total billed charges 136.63 136.63 other OPPS APC 136.63 136.63 other OPPS APC 136.63 27.63 37.75 percent of total billed charges 136.63 136.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE VITRECTOMY EDGEPLUS 4 MM OD25 GA 1 COUNT VALVED ENTRY SYSTEM STAND ALONE LOCKING MECHANISM CANNULA SUP-8065751586 CDM 0270 RC outpatient 130.16 130.16 130.16 74 96.32 percent of total billed charges 130.16 93 105.43 percent of total billed charges 130.16 130.16 other OPPS APC 130.16 130.16 other OPPS APC 130.16 27.63 35.96 percent of total billed charges 130.16 130.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE LASER PUREPOINT NITINOL PLASTIC GLASS 78 D L2 IN OD23 GA ILLUMINATION CURVE TIP LARGE TACTILE INDICATOR RFID X2 LATEX FREE SUP-8065751592 CDM 0270 RC outpatient 723.03 723.03 723.03 74 535.04 percent of total billed charges 723.03 93 585.65 percent of total billed charges 723.03 723.03 other OPPS APC 723.03 723.03 other OPPS APC 723.03 27.63 199.77 percent of total billed charges 723.03 723.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE LASER ENGAUGE VEKTOR OD25 GA ARTICULATE ILLUMINATE STERILE LATEX FREE DISPOSABLE SUP-8065751593 CDM 0270 RC outpatient 619.79 619.79 619.79 74 458.64 percent of total billed charges 619.79 93 502.03 percent of total billed charges 619.79 619.79 other OPPS APC 619.79 619.79 other OPPS APC 619.79 27.63 171.25 percent of total billed charges 619.79 619.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE LASER PUREPOINT NITINOL 40 D BEND L6 MM OD27+ GA FLEXIBLE EASY INSERTION RFID STERILE DISPOSABLE CONSTELLATION VISION SYSTEM SUP-8065751709 CDM 0270 RC outpatient 571.66 571.66 571.66 74 423.03 percent of total billed charges 571.66 93 463.04 percent of total billed charges 571.66 571.66 other OPPS APC 571.66 571.66 other OPPS APC 571.66 27.63 157.95 percent of total billed charges 571.66 571.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM VITRECTOMY EDGEPLUS 6 MM OD25 GA 1 COUNT VALVED ENTRY LOCKING MECHANISM CANNULA LOW FRICTION SUP-8065751782 CDM 0270 RC outpatient 130.16 130.16 130.16 74 96.32 percent of total billed charges 130.16 93 105.43 percent of total billed charges 130.16 130.16 other OPPS APC 130.16 130.16 other OPPS APC 130.16 27.63 35.96 percent of total billed charges 130.16 130.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM VITRECTOMY EDGEPLUS SILICONE 6 MM OD23 GA 1 COUNT VALVE ENTRY LOCK MECHANISM CANNULA SUP-8065751800 CDM 0270 RC outpatient 174.33 174.33 174.33 74 129 percent of total billed charges 174.33 93 141.21 percent of total billed charges 174.33 174.33 other OPPS APC 174.33 174.33 other OPPS APC 174.33 27.63 48.17 percent of total billed charges 174.33 174.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE VITRECTOMY TOTAL PLUS CONSTELLATION 5000 CPM OD23 GA EDGEPLUS VALVED CANNULA STRAIGHT ENDOILLUMINATOR SUP-8065751900 CDM 0270 RC outpatient 1486.29 1486.29 1486.29 74 1099.85 percent of total billed charges 1486.29 93 1203.89 percent of total billed charges 1486.29 1486.29 other OPPS APC 1486.29 1486.29 other OPPS APC 1486.29 27.63 410.66 percent of total billed charges 1486.29 1486.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK VITRECTOMY TOTAL PLUS CONSTELLATION 5000 CPM OD25+ GA STRAIGHT ENDOILLUMINATOR EDGEPLUS VALVED ENTRY SYSTEM SUP-8065751902 CDM 0270 RC outpatient 1510 1510 1510 74 1117.4 percent of total billed charges 1510 93 1223.1 percent of total billed charges 1510 1510 other OPPS APC 1510 1510 other OPPS APC 1510 27.63 417.21 percent of total billed charges 1510 1510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK VITRECTOMY TOTAL PLUS CONSTELLATION 7500 CPM OD27 GA STRAIGHT ENDOILLUMINATOR VALVED CANNULA SUP-8065752062 CDM 0270 RC outpatient 1772.16 1772.16 1772.16 74 1311.4 percent of total billed charges 1772.16 93 1435.45 percent of total billed charges 1772.16 1772.16 other OPPS APC 1772.16 1772.16 other OPPS APC 1772.16 27.63 489.65 percent of total billed charges 1772.16 1772.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA INFUSION CONSTELLATION OD25 GA ENHANCE PRIMING TRAY SUP-8065752151 CDM 0270 RC outpatient 198.59 198.59 198.59 74 146.96 percent of total billed charges 198.59 93 160.86 percent of total billed charges 198.59 198.59 other OPPS APC 198.59 198.59 other OPPS APC 198.59 27.63 54.87 percent of total billed charges 198.59 198.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTERS25G STAND ALONE SUP-8065752415 CDM 0270 RC outpatient 538.28 538.28 538.28 74 398.33 percent of total billed charges 538.28 93 436.01 percent of total billed charges 538.28 538.28 other OPPS APC 538.28 538.28 other OPPS APC 538.28 27.63 148.73 percent of total billed charges 538.28 538.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE VITRECTOMY TOTAL PLUS CONSTELLATION 5000 CPM OD23 GA EDGEPLUS VALVED CANNULA STRAIGHT ENDOILLUMINATOR SUP-8065752435 CDM 0270 RC outpatient 1669.85 1669.85 1669.85 74 1235.69 percent of total billed charges 1669.85 93 1352.58 percent of total billed charges 1669.85 1669.85 other OPPS APC 1669.85 1669.85 other OPPS APC 1669.85 27.63 461.38 percent of total billed charges 1669.85 1669.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER 25G TOTAL PLUS PACK W/10K SUP-8065752437 CDM 0270 RC outpatient 1641.67 1641.67 1641.67 74 1214.84 percent of total billed charges 1641.67 93 1329.75 percent of total billed charges 1641.67 1641.67 other OPPS APC 1641.67 1641.67 other OPPS APC 1641.67 27.63 453.59 percent of total billed charges 1641.67 1641.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK VITRECTOMY TOTAL PLUS HYPERVIT 20000 CPM OD25 GA BEVEL SUP-8065753106 CDM 0270 RC outpatient 1656.25 1656.25 1656.25 74 1225.63 percent of total billed charges 1656.25 93 1341.56 percent of total billed charges 1656.25 1656.25 other OPPS APC 1656.25 1656.25 other OPPS APC 1656.25 27.63 457.62 percent of total billed charges 1656.25 1656.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP PHACOEMULSIFICATION ABS MICROTIP 30 D STRAIGHT ROUND OD.9 MM FACO SUP-8065790020 CDM 270009056 LOCAL 0270 RC outpatient 72 72 72 74 53.28 percent of total billed charges 72 93 58.32 percent of total billed charges 72 72 other OPPS APC 72 72 other OPPS APC 72 27.63 19.89 percent of total billed charges 72 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP PHACOEMULSIFICATION 45 D ROUND SUP-8065790021 CDM 270009056 LOCAL 0270 RC outpatient 72 72 72 74 53.28 percent of total billed charges 72 93 58.32 percent of total billed charges 72 72 other OPPS APC 72 72 other OPPS APC 72 27.63 19.89 percent of total billed charges 72 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP PHACOEMULSIFICATION ABS KELMAN 45 D OD.9 MM EYE CATARACT CUSTOM TRAY STERILE DISPOSABLE SUP-8065790023 CDM 270009056 LOCAL 0270 RC outpatient 72 72 72 74 53.28 percent of total billed charges 72 93 58.32 percent of total billed charges 72 72 other OPPS APC 72 72 other OPPS APC 72 27.63 19.89 percent of total billed charges 72 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET TUBING VGFI OD23 GA VENT LATEX FREE DISPOSABLE SUP-8065808002 CDM 270009187 LOCAL 0270 RC outpatient 48 48 48 74 35.52 percent of total billed charges 48 93 38.88 percent of total billed charges 48 48 other OPPS APC 48 48 other OPPS APC 48 27.63 13.26 percent of total billed charges 48 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBEROPTIC LIGHT GUIDE 20G SUP-8065812001 CDM outpatient 132.83 132.83 132.83 132.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA OPHTHALMIC OD4 MM INFUSION STERILE DISPOSABLE SUP-8065820101 CDM 0270 RC outpatient 67.6 67.6 67.6 74 50.02 percent of total billed charges 67.6 93 54.76 percent of total billed charges 67.6 67.6 other OPPS APC 67.6 67.6 other OPPS APC 67.6 27.63 18.68 percent of total billed charges 67.6 67.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE VITRECTOMY ULTRAVIT 25+ 20000 CPM OD27 MM CONSTELLATION VISION SYSTEM SUP-8065830026 CDM 0270 RC outpatient 567.63 567.63 567.63 74 420.05 percent of total billed charges 567.63 93 459.78 percent of total billed charges 567.63 567.63 other OPPS APC 567.63 567.63 other OPPS APC 567.63 27.63 156.84 percent of total billed charges 567.63 567.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE VITRECTOMY ULTRAVIT 27+ 20000 CPM OD27 MM CONSTELLATION VISION SYSTEM SUP-8065830027 CDM 0270 RC outpatient 663 663 663 74 490.62 percent of total billed charges 663 93 537.03 percent of total billed charges 663 663 other OPPS APC 663 663 other OPPS APC 663 27.63 183.19 percent of total billed charges 663 663 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT VITRECTOMY PERFLUORON PERFLUORO-N-OCTANE 7 ML PROCEDURAL LIQUID PURIFY LATEX FREE SUP-8065900164 CDM 0270 RC outpatient 1465.49 1465.49 1465.49 74 1084.46 percent of total billed charges 1465.49 93 1187.05 percent of total billed charges 1465.49 1465.49 other OPPS APC 1465.49 1465.49 other OPPS APC 1465.49 27.63 404.91 percent of total billed charges 1465.49 1465.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE OPHTHALMIC GRIESHABER DSP OD25 GA MVR DISPOSABLE SUP-8065912501 CDM 0270 RC outpatient 117.34 117.34 117.34 74 86.83 percent of total billed charges 117.34 93 95.05 percent of total billed charges 117.34 117.34 other OPPS APC 117.34 117.34 other OPPS APC 117.34 27.63 32.42 percent of total billed charges 117.34 117.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNIFE OPHTHALMIC ALCON A-OK 15 D STANDARD W1.52 MM BLADE FULL HANDLE DISPOSABLE SUP-8065921501 CDM 0270 RC outpatient 36.24 36.24 36.24 74 26.82 percent of total billed charges 36.24 93 29.35 percent of total billed charges 36.24 36.24 other OPPS APC 36.24 36.24 other OPPS APC 36.24 27.63 10.01 percent of total billed charges 36.24 36.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNIFE OPHTHALMIC CLEARCUT ANGLE FULL W1 MM 2 BEVEL SIDEPORT SATIN FINISH STERILE LATEX DISPOSABLE FLUORESCENT PINK SUP-8065921540 CDM 0270 RC outpatient 44.82 44.82 44.82 74 33.17 percent of total billed charges 44.82 93 36.3 percent of total billed charges 44.82 44.82 other OPPS APC 44.82 44.82 other OPPS APC 44.82 27.63 12.38 percent of total billed charges 44.82 44.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNIFE OPHTHALMIC A-OK 30 D W1.85 MM FULL HANDLE ANGLE BLADE STERILE DISPOSABLE SUP-8065923001 CDM 0270 RC outpatient 36.24 36.24 36.24 74 26.82 percent of total billed charges 36.24 93 29.35 percent of total billed charges 36.24 36.24 other OPPS APC 36.24 36.24 other OPPS APC 36.24 27.63 10.01 percent of total billed charges 36.24 36.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNIFE OPHTHALMIC INTREPID ANGLE 2 BEVEL W2.4 MM MICRO COAXIAL SLIT STERILE DISPOSABLE SUP-8065982465 CDM 0270 RC outpatient 137.77 137.77 137.77 74 101.95 percent of total billed charges 137.77 93 111.59 percent of total billed charges 137.77 137.77 other OPPS APC 137.77 137.77 other OPPS APC 137.77 27.63 38.07 percent of total billed charges 137.77 137.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNIFE SURGICAL CLEARCUT HP2 W2.8 MM CUT ANGLED SLIT STERILE DISPOSABLE CLEAR HP2DB SUP-8065982865 CDM 0270 RC outpatient 127.4 127.4 127.4 74 94.28 percent of total billed charges 127.4 93 103.19 percent of total billed charges 127.4 127.4 other OPPS APC 127.4 127.4 other OPPS APC 127.4 27.63 35.2 percent of total billed charges 127.4 127.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNIFE OPHTHALMIC CLEARCUT SATINSLIT ANGLE W3.2 MM SLIT STERILE DISPOSABLE SUP-8065993245 CDM 0270 RC outpatient 87.98 87.98 87.98 74 65.11 percent of total billed charges 87.98 93 71.26 percent of total billed charges 87.98 87.98 other OPPS APC 87.98 87.98 other OPPS APC 87.98 27.63 24.31 percent of total billed charges 87.98 87.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNIFE EYE 3.5MM SUP-8065993561 CDM 0270 RC outpatient 357.79 357.79 357.79 74 264.76 percent of total billed charges 357.79 93 289.81 percent of total billed charges 357.79 357.79 other OPPS APC 357.79 357.79 other OPPS APC 357.79 27.63 98.86 percent of total billed charges 357.79 357.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASEPTIC TRANSFER SYSTEM - DRAIN-PERROTTA SUP-81-00001 CDM 0272 RC outpatient 44.85 44.85 44.85 74 33.19 percent of total billed charges 44.85 93 36.33 percent of total billed charges 44.85 44.85 other OPPS APC 44.85 44.85 other OPPS APC 44.85 27.63 12.39 percent of total billed charges 44.85 44.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIPOSUCTION KITS SUP-81-00002 CDM 0272 RC outpatient 192.06 192.06 192.06 74 142.12 percent of total billed charges 192.06 93 155.57 percent of total billed charges 192.06 192.06 other OPPS APC 192.06 192.06 other OPPS APC 192.06 27.63 53.07 percent of total billed charges 192.06 192.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CURETTE 12MM CURVED CANNULA SUP-81-00005 CDM 0272 RC outpatient 21.81 21.81 21.81 74 16.14 percent of total billed charges 21.81 93 17.67 percent of total billed charges 21.81 21.81 other OPPS APC 21.81 21.81 other OPPS APC 21.81 27.63 6.03 percent of total billed charges 21.81 21.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CURETTE 10MM CURVED CANNULA SUP-81-00006 CDM 0272 RC outpatient 20.2 20.2 20.2 74 14.95 percent of total billed charges 20.2 93 16.36 percent of total billed charges 20.2 20.2 other OPPS APC 20.2 20.2 other OPPS APC 20.2 27.63 5.58 percent of total billed charges 20.2 20.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER DISPOSABLE SUP-81-00012 CDM 0271 RC outpatient 27.36 27.36 27.36 74 20.25 percent of total billed charges 27.36 93 22.16 percent of total billed charges 27.36 27.36 other OPPS APC 27.36 27.36 other OPPS APC 27.36 27.63 7.56 percent of total billed charges 27.36 27.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADVANTAGE FIT SUP-81-00015 CDM C1781 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VCARE PLUS MED 34MM CERVICAL CUP SUP-81-00016 CDM 0272 RC outpatient 249.2 249.2 249.2 74 184.41 percent of total billed charges 249.2 93 201.85 percent of total billed charges 249.2 249.2 other OPPS APC 249.2 249.2 other OPPS APC 249.2 27.63 68.85 percent of total billed charges 249.2 249.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VCARE PLUS LG 37MM CERVICAL CUP SUP-81-00017 CDM 0272 RC outpatient 249.2 249.2 249.2 74 184.41 percent of total billed charges 249.2 93 201.85 percent of total billed charges 249.2 249.2 other OPPS APC 249.2 249.2 other OPPS APC 249.2 27.63 68.85 percent of total billed charges 249.2 249.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VCARE PLUS SM 32MM CERVICAL CUP SUP-81-00018 CDM 0272 RC outpatient 249.2 249.2 249.2 74 184.41 percent of total billed charges 249.2 93 201.85 percent of total billed charges 249.2 249.2 other OPPS APC 249.2 249.2 other OPPS APC 249.2 27.63 68.85 percent of total billed charges 249.2 249.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE NASOPHARYNGEAL 9FR SUP-81-025409 CDM 0270 RC outpatient 4.1 4.1 4.1 74 3.03 percent of total billed charges 4.1 93 3.32 percent of total billed charges 4.1 4.1 other OPPS APC 4.1 4.1 other OPPS APC 4.1 27.63 1.13 percent of total billed charges 4.1 4.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE TEMPERATURE STAINLESS STEEL SMALL DIAMETER L18 MM OD21 GA MYOCARDIAL LATEX SAFE TINY NEEDLE HUB PYROGEN FREE STERILE LATEX FREE DISPOSABLE YSI 400 SUP-81-030418 CDM 0270 RC outpatient 30.36 30.36 30.36 74 22.47 percent of total billed charges 30.36 93 24.59 percent of total billed charges 30.36 30.36 other OPPS APC 30.36 30.36 other OPPS APC 30.36 27.63 8.39 percent of total billed charges 30.36 30.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH GYNECOLOGICAL GYNECARE TVT MECHANICAL CUT RETROPUBIC SYSTEM SUP-810041B CDM 0270 RC outpatient 3200.6 3200.6 3200.6 74 2368.44 percent of total billed charges 3200.6 93 2592.49 percent of total billed charges 3200.6 3200.6 other OPPS APC 3200.6 3200.6 other OPPS APC 3200.6 27.63 884.33 percent of total billed charges 3200.6 3200.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLING URETHRAL GYNECARE TVT 18X.5IN PROLENE SS PLASTIC STERILE FEMALE MIDURETHRAL SYSTEM TRANSOBTURATOR STRESS URINARY SUP-810081L CDM 0270 RC outpatient 3588 3588 3588 74 2655.12 percent of total billed charges 3588 93 2906.28 percent of total billed charges 3588 3588 other OPPS APC 3588 3588 other OPPS APC 3588 27.63 991.36 percent of total billed charges 3588 3588 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE CERVICAL ONE LEVEL 12MM SUP-810112 CDM 270010020 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SEAPINE CERVICAL 3 LEVEL 45MM SUP-810345 CDM 270010020 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE MULTI-SPAN CROSSLINK CD HORIZON TITANIUM LOW PROFILE L1.75-2.15 IN SPINE STERILE 6.35 MM ROD SUP-811-422 CDM 270010020 LOCAL 0270 RC outpatient 2482.17 2482.17 2482.17 74 1836.81 percent of total billed charges 2482.17 93 2010.56 percent of total billed charges 2482.17 2482.17 other OPPS APC 2482.17 2482.17 other OPPS APC 2482.17 27.63 685.82 percent of total billed charges 2482.17 2482.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SEASPINE FIXED 4.0MM X 14MM SUP-811114 CDM 270010020 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SEASPINE VARIABLE 4.0MM X 14MM SUP-811214 CDM 270010020 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SEASPINE FIXED 4.3MM X 14MM SUP-811714 CDM 270010020 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE CHROMIC 2-0 CT-1 L27 IN MONOFILAMENT BROWN SUP-811H CDM 0270 RC outpatient 6.91 6.91 6.91 74 5.11 percent of total billed charges 6.91 93 5.6 percent of total billed charges 6.91 6.91 other OPPS APC 6.91 6.91 other OPPS APC 6.91 27.63 1.91 percent of total billed charges 6.91 6.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WARMING GOWN XL BAIR HUGGAR FLEX SUP-81203 CDM 0270 RC outpatient 40.57 40.57 40.57 74 30.02 percent of total billed charges 40.57 93 32.86 percent of total billed charges 40.57 40.57 other OPPS APC 40.57 40.57 other OPPS APC 40.57 27.63 11.21 percent of total billed charges 40.57 40.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE CHROMIC 0 CT-1 L27 IN MONOFILAMENT BROWN SUP-812H CDM 0270 RC outpatient 7.11 7.11 7.11 74 5.26 percent of total billed charges 7.11 93 5.76 percent of total billed charges 7.11 7.11 other OPPS APC 7.11 7.11 other OPPS APC 7.11 27.63 1.96 percent of total billed charges 7.11 7.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE CHROMIC 1 CT-1 L27 IN MONOFILAMENT SUP-813H CDM 0270 RC outpatient 7.39 7.39 7.39 74 5.47 percent of total billed charges 7.39 93 5.99 percent of total billed charges 7.39 7.39 other OPPS APC 7.39 7.39 other OPPS APC 7.39 27.63 2.04 percent of total billed charges 7.39 7.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUTTON GASTROSTOMY MIC-KEY SECUR-LOK 2CM 20FR 5ML SILICONE DISPOSABLE STERILE LF ENTERAL RADIOPAQUE LOW PROFILE TAPER SUP-8140-20-2.0 CDM 0270 RC outpatient 239.3 239.3 239.3 74 177.08 percent of total billed charges 239.3 93 193.83 percent of total billed charges 239.3 239.3 other OPPS APC 239.3 239.3 other OPPS APC 239.3 27.63 66.12 percent of total billed charges 239.3 239.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUTTON GASTROSTOMY MIC-KEY SECUR-LOK 2.5CM 20FR 5ML SILICONE DISPOSABLE STERILE LF ENTERAL RADIOPAQUE LOW PROFILE TAPER SUP-8140-20-2.5 CDM 0270 RC outpatient 239.3 239.3 239.3 74 177.08 percent of total billed charges 239.3 93 193.83 percent of total billed charges 239.3 239.3 other OPPS APC 239.3 239.3 other OPPS APC 239.3 27.63 66.12 percent of total billed charges 239.3 239.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUTTON GASTROSTOMY MIC-KEY SECUR-LOK 3CM 20FR 5ML SILICONE DISPOSABLE STERILE LF ENTERAL RADIOPAQUE LOW PROFILE TAPER SUP-8140-20-3.0 CDM 0270 RC outpatient 239.3 239.3 239.3 74 177.08 percent of total billed charges 239.3 93 193.83 percent of total billed charges 239.3 239.3 other OPPS APC 239.3 239.3 other OPPS APC 239.3 27.63 66.12 percent of total billed charges 239.3 239.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT GASTROSTOMY MIC-KEY SECUR-LOK TAPER 3.5CM 20FR 5ML SILICONE STERILE ENTERAL FEEDING TUBE RADIOPAQUE LOW PROFILE DEHP SUP-8140-20-3.5 CDM 0270 RC outpatient 239.3 239.3 239.3 74 177.08 percent of total billed charges 239.3 93 193.83 percent of total billed charges 239.3 239.3 other OPPS APC 239.3 239.3 other OPPS APC 239.3 27.63 66.12 percent of total billed charges 239.3 239.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUTTON GASTROSTOMY MIC-KEY SECUR-LOK 4CM 20FR 5ML SILICONE DISPOSABLE STERILE LF ENTERAL RADIOPAQUE LOW PROFILE TAPER SUP-8140-20-4.0 CDM 0270 RC outpatient 239.3 239.3 239.3 74 177.08 percent of total billed charges 239.3 93 193.83 percent of total billed charges 239.3 239.3 other OPPS APC 239.3 239.3 other OPPS APC 239.3 27.63 66.12 percent of total billed charges 239.3 239.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUTTON GASTROSTOMY MIC-KEY SECUR-LOK 2.5CM 24FR 5ML SILICONE DISPOSABLE STERILE LF ENTERAL RADIOPAQUE LOW PROFILE TAPER SUP-8140-24-2.5 CDM 0270 RC outpatient 239.3 239.3 239.3 74 177.08 percent of total billed charges 239.3 93 193.83 percent of total billed charges 239.3 239.3 other OPPS APC 239.3 239.3 other OPPS APC 239.3 27.63 66.12 percent of total billed charges 239.3 239.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DRESSING CHANGE SUP-81429 CDM 270009216 LOCAL 0270 RC outpatient 8.26 8.26 8.26 74 6.11 percent of total billed charges 8.26 93 6.69 percent of total billed charges 8.26 8.26 other OPPS APC 8.26 8.26 other OPPS APC 8.26 27.63 2.28 percent of total billed charges 8.26 8.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CENTRAL LINE DRESSING 2 SUP-81430 CDM 270009216 LOCAL 0270 RC outpatient 26.65 26.65 26.65 74 19.72 percent of total billed charges 26.65 93 21.59 percent of total billed charges 26.65 26.65 other OPPS APC 26.65 26.65 other OPPS APC 26.65 27.63 7.36 percent of total billed charges 26.65 26.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5 X 14MM LOCKING SUP-82-03255 CDM C1713 HCPCS 0278 RC outpatient 434.91 434.91 434.91 57 247.9 percent of total billed charges 434.91 93 352.28 percent of total billed charges 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 51 221.8 percent of total billed charges 434.91 434.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5 X 34MM SUP-82-03256 CDM C1713 HCPCS 0278 RC outpatient 434.91 434.91 434.91 57 247.9 percent of total billed charges 434.91 93 352.28 percent of total billed charges 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 51 221.8 percent of total billed charges 434.91 434.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5 X 48MM CORTEX TI SUP-82-03257 CDM C1713 HCPCS 0278 RC outpatient 110.96 110.96 110.96 57 63.25 percent of total billed charges 110.96 93 89.88 percent of total billed charges 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 51 56.59 percent of total billed charges 110.96 110.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5 X 48MM LOCKING SUP-82-03258 CDM C1713 HCPCS 0278 RC outpatient 434.91 434.91 434.91 57 247.9 percent of total billed charges 434.91 93 352.28 percent of total billed charges 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 51 221.8 percent of total billed charges 434.91 434.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5 X 16MM PERIPROSTHETIC LOCKING SUP-82-03259 CDM C1713 HCPCS 0278 RC outpatient 504.07 504.07 504.07 57 287.32 percent of total billed charges 504.07 93 408.3 percent of total billed charges 504.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 504.07 other OPPS APC 504.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 504.07 other OPPS APC 504.07 51 257.08 percent of total billed charges 504.07 504.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 6 X 70MM CANCELLOUS FULL THREAD SUP-82-03260 CDM C1713 HCPCS 0278 RC outpatient 124.64 124.64 124.64 57 71.04 percent of total billed charges 124.64 93 100.96 percent of total billed charges 124.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 124.64 other OPPS APC 124.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 124.64 other OPPS APC 124.64 51 63.57 percent of total billed charges 124.64 124.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 6 X 90MM CANCELLOUS FULL THREAD SUP-82-03261 CDM C1713 HCPCS 0278 RC outpatient 124.64 124.64 124.64 57 71.04 percent of total billed charges 124.64 93 100.96 percent of total billed charges 124.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 124.64 other OPPS APC 124.64 124.64 other OPPS APC 124.64 51 63.57 percent of total billed charges 124.64 124.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CORTICAL OPENER DIA 3.5MM AO FITTING SUP-82-03262 CDM 0272 RC outpatient 387.45 387.45 387.45 74 286.71 percent of total billed charges 387.45 93 313.83 percent of total billed charges 387.45 387.45 other OPPS APC 387.45 387.45 other OPPS APC 387.45 27.63 107.05 percent of total billed charges 387.45 387.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 14 HOLE L 188MM LOCKING COMPRESSION SUP-82-03263 CDM C1713 HCPCS 0278 RC outpatient 2790.72 2790.72 2790.72 57 1590.71 percent of total billed charges 2790.72 93 2260.48 percent of total billed charges 2790.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2790.72 other OPPS APC 2790.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2790.72 other OPPS APC 2790.72 51 1423.27 percent of total billed charges 2790.72 2790.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5 X 70MM CANNULATED FULLY THREADED ASNIS SUP-82-03264 CDM C1713 HCPCS 0278 RC outpatient 521.92 521.92 521.92 57 297.49 percent of total billed charges 521.92 93 422.76 percent of total billed charges 521.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 521.92 other OPPS APC 521.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 521.92 other OPPS APC 521.92 51 266.18 percent of total billed charges 521.92 521.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 X 40MM HEADLESS SUP-82-03265 CDM C1713 HCPCS 0278 RC outpatient 1186.08 1186.08 1186.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1186.08 other OPPS APC 1186.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1186.08 other OPPS APC 1186.08 51 604.9 percent of total billed charges 1186.08 1186.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.1MM CANNULATED SUP-82-03266 CDM 0272 RC outpatient 778.5 778.5 778.5 778.5 other OPPS APC 778.5 778.5 other OPPS APC 778.5 27.63 215.1 percent of total billed charges 778.5 778.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KWIRE 3.0MM NON THREADED SUP-82-03267 CDM 0272 RC outpatient 3 3 3 3 other OPPS APC 3 3 other OPPS APC 3 27.63 0.83 percent of total billed charges 3 3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 16MM LOCKING ANCHORAGE SUP-82-03268 CDM C1713 HCPCS 0278 RC outpatient 641.76 641.76 641.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 641.76 other OPPS APC 641.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 641.76 other OPPS APC 641.76 51 327.3 percent of total billed charges 641.76 641.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION ANCHORAGE SUP-82-03269 CDM 0272 RC outpatient 472.5 472.5 472.5 472.5 other OPPS APC 472.5 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 18MM ANCHORAGE STANDARD SUP-82-03270 CDM C1713 HCPCS 0278 RC outpatient 443.52 443.52 443.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 443.52 other OPPS APC 443.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 443.52 other OPPS APC 443.52 51 226.2 percent of total billed charges 443.52 443.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 16MM LOCKING ANCHORAGE SUP-82-03271 CDM C1713 HCPCS 0278 RC outpatient 641.76 641.76 641.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 641.76 other OPPS APC 641.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 641.76 other OPPS APC 641.76 51 327.3 percent of total billed charges 641.76 641.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 20MM ANCHORAGE STANDARD SUP-82-03272 CDM C1713 HCPCS 0278 RC outpatient 435.12 435.12 435.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 435.12 other OPPS APC 435.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 435.12 other OPPS APC 435.12 51 221.91 percent of total billed charges 435.12 435.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 12MM LOCKING ANCHORAGE SUP-82-03273 CDM C1713 HCPCS 0278 RC outpatient 641.76 641.76 641.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 641.76 other OPPS APC 641.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 641.76 other OPPS APC 641.76 51 327.3 percent of total billed charges 641.76 641.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 6 X 70MM CANCELLOUS TI SUP-82-03274 CDM C1713 HCPCS 0278 RC outpatient 124.64 124.64 124.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 124.64 other OPPS APC 124.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 124.64 other OPPS APC 124.64 51 63.57 percent of total billed charges 124.64 124.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 6 X 75MM CANCELLOUS TI SUP-82-03275 CDM C1713 HCPCS 0278 RC outpatient 124.64 124.64 124.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 124.64 other OPPS APC 124.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 124.64 other OPPS APC 124.64 51 63.57 percent of total billed charges 124.64 124.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 12 HOLE FEMORAL DISTAL LATERAL RIGHT SUP-82-03276 CDM C1713 HCPCS 0278 RC outpatient 3994.75 3994.75 3994.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3994.75 other OPPS APC 3994.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3994.75 other OPPS APC 3994.75 51 2037.32 percent of total billed charges 3994.75 3994.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 6.5 X 75MM ASNIS III STAINLESS STEEL CANNULATED SUP-82-03277 CDM C1713 HCPCS 0278 RC outpatient 618.24 618.24 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 51 315.3 percent of total billed charges 618.24 618.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 4.2 X 260 AO SUP-82-03278 CDM 0272 RC outpatient 380.1 380.1 380.1 380.1 other OPPS APC 380.1 380.1 other OPPS APC 380.1 27.63 105.02 percent of total billed charges 380.1 380.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL PROXIMAL HUMERAL 8 X 150MM CANNULATED LEFT SUP-82-03279 CDM C1713 HCPCS 0278 RC outpatient 3072.75 3072.75 3072.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3072.75 other OPPS APC 3072.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3072.75 other OPPS APC 3072.75 51 1567.1 percent of total billed charges 3072.75 3072.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACCU-FLO 3 WAY PLASTIC CONNECTOR SUP-82-1520 CDM 0270 RC outpatient 771.73 771.73 771.73 74 571.08 percent of total billed charges 771.73 93 625.1 percent of total billed charges 771.73 771.73 other OPPS APC 771.73 771.73 other OPPS APC 771.73 27.63 213.23 percent of total billed charges 771.73 771.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE EDS II SILICONE L46 CM OD1.65 MM ID.76 MM LUMBAR LUER LOCK CONNECTOR TUOHY NEEDLE KIT STERILE LATEX FREE DISPOSABLE SUP-82-1706 CDM 270009132 LOCAL 0270 RC outpatient 153.6 153.6 153.6 74 113.66 percent of total billed charges 153.6 93 124.42 percent of total billed charges 153.6 153.6 other OPPS APC 153.6 153.6 other OPPS APC 153.6 27.63 42.44 percent of total billed charges 153.6 153.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION PREP BETADINE 10% PVP IODINE 4 OZ FLIPTOP CAP SUP-82-255 CDM 0270 RC outpatient 2.8 2.8 2.8 74 2.07 percent of total billed charges 2.8 93 2.27 percent of total billed charges 2.8 2.8 other OPPS APC 2.8 2.8 other OPPS APC 2.8 27.63 0.77 percent of total billed charges 2.8 2.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE COMPRESSION ESMARK L4 YD X W6 IN STERILE LATEX FREE BLUE SUP-820-3612 CDM 0270 RC outpatient 18.89 18.89 18.89 74 13.98 percent of total billed charges 18.89 93 15.3 percent of total billed charges 18.89 18.89 other OPPS APC 18.89 18.89 other OPPS APC 18.89 27.63 5.22 percent of total billed charges 18.89 18.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING PRESSURE SAFEGUARD L24 CM HEMOSTASIS SUP-82000 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE CASTING 3M SCOTCHCAST PLUS FIBERGLASS FABRIC POLYURETHANE RESIN POROUS L4 YD X W2 IN LIGHTWEIGHT STRONG STRETCH WATER ACTIVATE LATEX FREE WHITE SUP-82002 CDM 0270 RC outpatient 5.05 5.05 5.05 74 3.74 percent of total billed charges 5.05 93 4.09 percent of total billed charges 5.05 5.05 other OPPS APC 5.05 5.05 other OPPS APC 5.05 27.63 1.4 percent of total billed charges 5.05 5.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE CASTING 3M SCOTCHCAST PLUS 4YDX3IN WHITE FIBERGLASS FABRIC POLYURETHANE RESIN LF STRETCH WATER ACTIVATE SUP-82003 CDM 0270 RC outpatient 6.1 6.1 6.1 74 4.51 percent of total billed charges 6.1 93 4.94 percent of total billed charges 6.1 6.1 other OPPS APC 6.1 6.1 other OPPS APC 6.1 27.63 1.69 percent of total billed charges 6.1 6.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE CASTING 3M SCOTCHCAST PLUS 4YDX5IN WHITE FIBERGLASS FABRIC POLYURETHANE RESIN LF STRETCH WATER ACTIVATE SUP-82005 CDM outpatient 9.88 9.88 9.88 9.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS XACT TAPERED 7-9 FRENCH X 40MM SUP-82086-01 CDM 0270 RC outpatient 5343 5343 5343 74 3953.82 percent of total billed charges 5343 93 4327.83 percent of total billed charges 5343 5343 other OPPS APC 5343 5343 other OPPS APC 5343 27.63 1476.27 percent of total billed charges 5343 5343 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS XACT TAPERED 7-9 FRENCH X 30MM SUP-82087-01 CDM 0270 RC outpatient 5343 5343 5343 74 3953.82 percent of total billed charges 5343 93 4327.83 percent of total billed charges 5343 5343 other OPPS APC 5343 5343 other OPPS APC 5343 27.63 1476.27 percent of total billed charges 5343 5343 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR XACT NITINOL TAPER L40 MM OD8-6 MM SUP-82090-01 CDM 0270 RC outpatient 5343 5343 5343 74 3953.82 percent of total billed charges 5343 93 4327.83 percent of total billed charges 5343 5343 other OPPS APC 5343 5343 other OPPS APC 5343 27.63 1476.27 percent of total billed charges 5343 5343 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS XACT TAPERED 6-8 FRENCH X 30MM SUP-82091-01 CDM 0270 RC outpatient 5343 5343 5343 74 3953.82 percent of total billed charges 5343 93 4327.83 percent of total billed charges 5343 5343 other OPPS APC 5343 5343 other OPPS APC 5343 27.63 1476.27 percent of total billed charges 5343 5343 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS XACT STRAIGHT 8.0 X 30MM SUP-82092-01 CDM 0270 RC outpatient 5343 5343 5343 74 3953.82 percent of total billed charges 5343 93 4327.83 percent of total billed charges 5343 5343 other OPPS APC 5343 5343 other OPPS APC 5343 27.63 1476.27 percent of total billed charges 5343 5343 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR XACT NITINOL STRAIGHT L20MM OD 8MM CAROTID ARTERY SELF EXPAND CLOSED CELL FLARE END ACCEPTS 8 FR GUIDE 6 FR SHEATH SUP-82093-01 CDM 0270 RC outpatient 5343 5343 5343 74 3953.82 percent of total billed charges 5343 93 4327.83 percent of total billed charges 5343 5343 other OPPS APC 5343 5343 other OPPS APC 5343 27.63 1476.27 percent of total billed charges 5343 5343 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS XACT STRAIGHT 7.0 X 30MM SUP-82094-01 CDM 0270 RC outpatient 5343 5343 5343 74 3953.82 percent of total billed charges 5343 93 4327.83 percent of total billed charges 5343 5343 other OPPS APC 5343 5343 other OPPS APC 5343 27.63 1476.27 percent of total billed charges 5343 5343 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR XACT NITINOL STRAIGHT L20MM OD 7MM CAROTID ARTERY SELF EXPAND CLOSED CELL FLARE END ACCEPTS 8 FR GUIDE 6 FR SHEATH SUP-82095-01 CDM 0270 RC outpatient 5343 5343 5343 74 3953.82 percent of total billed charges 5343 93 4327.83 percent of total billed charges 5343 5343 other OPPS APC 5343 5343 other OPPS APC 5343 27.63 1476.27 percent of total billed charges 5343 5343 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR XACT NITINOL TAPER L 40 MM OD 8-10MM CAROTID ARTERY SELF EXPAND CLOSED CELL FLARE END FREESTYLE ACCEPTS 8 FR GUIDE 6 FR SHEATH SUP-82096-01 CDM 0270 RC outpatient 5343 5343 5343 74 3953.82 percent of total billed charges 5343 93 4327.83 percent of total billed charges 5343 5343 other OPPS APC 5343 5343 other OPPS APC 5343 27.63 1476.27 percent of total billed charges 5343 5343 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR XACT NITINOL TAPER L30 MM OD 8-10 MM CAROTID ARTERY SELF EXPAND CLOSED CELL FLARE END FREESTYLE ACCEPTS 8 FR GUIDE 6 FR SHEATH SUP-82097-01 CDM 0270 RC outpatient 5343 5343 5343 74 3953.82 percent of total billed charges 5343 93 4327.83 percent of total billed charges 5343 5343 other OPPS APC 5343 5343 other OPPS APC 5343 27.63 1476.27 percent of total billed charges 5343 5343 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING BIOLOGICAL OASIS ULTRA PORCINE SUBMUCOSA L10 CM X W7 CM 3 LAYER MATRIX MESH SUP-8213-0000-09 CDM 0270 RC outpatient 11033.8 11033.8 11033.8 74 8164.98 percent of total billed charges 11033.8 93 8937.34 percent of total billed charges 11033.8 11033.8 other OPPS APC 11033.8 11033.8 other OPPS APC 11033.8 27.63 3048.63 percent of total billed charges 11033.8 11033.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING BIOLOGICAL OASIS ULTRA PORCINE SUBMUCOSA L20 CM X W7 CM 3 LAYER MATRIX MESH SUP-8213-0000-11 CDM 0270 RC outpatient 4413.5 4413.5 4413.5 74 3265.99 percent of total billed charges 4413.5 93 3574.94 percent of total billed charges 4413.5 4413.5 other OPPS APC 4413.5 4413.5 other OPPS APC 4413.5 27.63 1219.45 percent of total billed charges 4413.5 4413.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PASSER SURGICAL UNI-SHUNT ADULT XL L65 CM PERITONEUM CATHETER MALLEABLE STERILE LATEX FREE DISPSABLE HYDROCEPHALUS SHUNT SYSTEM SUP-821517 CDM 0270 RC outpatient 374.81 374.81 374.81 74 277.36 percent of total billed charges 374.81 93 303.6 percent of total billed charges 374.81 374.81 other OPPS APC 374.81 374.81 other OPPS APC 374.81 27.63 103.56 percent of total billed charges 374.81 374.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUARDIAN HEMOSTASIS VALVE SUP-8216 CDM 0481 RC outpatient 96.2 96.2 96.2 74 71.19 percent of total billed charges 96.2 93 77.92 percent of total billed charges 96.2 96.2 other OPPS APC 96.2 96.2 other OPPS APC 96.2 51 49.06 percent of total billed charges 96.2 96.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHUNT NEUROSURGICAL HOLTER RICKHAM STAINLESS STEEL LARGE L15 CM OD9.5 MM CSF VENTRICULAR CATHETER BURR HOLE STRAIGHT STYLET STERILE SUP-821623 CDM 0270 RC outpatient 1280.19 1280.19 1280.19 74 947.34 percent of total billed charges 1280.19 93 1036.95 percent of total billed charges 1280.19 1280.19 other OPPS APC 1280.19 1280.19 other OPPS APC 1280.19 27.63 353.72 percent of total billed charges 1280.19 1280.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER VENTRICULAR HOLTER BARIUM STRAIGHT L15 CM OD3.1 MM ID1.5 MM STYLET STERILE SUP-821650 CDM 0270 RC outpatient 492.36 492.36 492.36 74 364.35 percent of total billed charges 492.36 93 398.81 percent of total billed charges 492.36 492.36 other OPPS APC 492.36 492.36 other OPPS APC 492.36 27.63 136.04 percent of total billed charges 492.36 492.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DIALYSIS BARIUM L90 CM PERITONEUM TYPE A SUP-821682 CDM 0270 RC outpatient 666.64 666.64 666.64 74 493.31 percent of total billed charges 666.64 93 539.98 percent of total billed charges 666.64 666.64 other OPPS APC 666.64 666.64 other OPPS APC 666.64 27.63 184.19 percent of total billed charges 666.64 666.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE EDS II SILICONE L35 CM CSF VENTRICULAR STRAIGHT STYLET CURVED TROCAR LUER LOCK CONNECTOR SET STERILE LATEX FREE DISPOSABLE SUP-821705 CDM 0270 RC outpatient 429.78 429.78 429.78 74 318.04 percent of total billed charges 429.78 93 348.12 percent of total billed charges 429.78 429.78 other OPPS APC 429.78 429.78 other OPPS APC 429.78 27.63 118.75 percent of total billed charges 429.78 429.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM DRAINAGE EDS III CSF VENTRICULAR CATHETER STERILE LATEX FREE DISPOSABLE SUP-821730 CDM 270009132 LOCAL 0270 RC outpatient 153.6 153.6 153.6 74 113.66 percent of total billed charges 153.6 93 124.42 percent of total billed charges 153.6 153.6 other OPPS APC 153.6 153.6 other OPPS APC 153.6 27.63 42.44 percent of total billed charges 153.6 153.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG EXTERNAL DRAINAGE EDS 3 700 ML CSF COLLECTION SUP-821732 CDM 0270 RC outpatient 102.22 102.22 102.22 74 75.64 percent of total billed charges 102.22 93 82.8 percent of total billed charges 102.22 102.22 other OPPS APC 102.22 102.22 other OPPS APC 102.22 27.63 28.24 percent of total billed charges 102.22 102.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE NERVE STIMULATOR NIM-RESPONSE STANDARD OD.33 MM PRASS MONOPOLAR FLUSH TIP SLIMLINE HANDLE STERILE SUP-8225103 CDM 0270 RC outpatient 443.04 443.04 443.04 74 327.85 percent of total billed charges 443.04 93 358.86 percent of total billed charges 443.04 443.04 other OPPS APC 443.04 443.04 other OPPS APC 443.04 27.63 122.41 percent of total billed charges 443.04 443.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE SHUNT HAKIM PRECISION 100 MM HP VENTRICULAR MEDIUM HIGH PRESSURE CYLINDRICAL FIXED STRAIGHT CONNECTOR SUP-823085 CDM 0270 RC outpatient 4383.6 4383.6 4383.6 74 3243.86 percent of total billed charges 4383.6 93 3550.72 percent of total billed charges 4383.6 4383.6 other OPPS APC 4383.6 4383.6 other OPPS APC 4383.6 27.63 1211.19 percent of total billed charges 4383.6 4383.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON 2 TP-1 L60 IN MONOFILAMENT BLACK SUP-825G CDM 0270 RC outpatient 9.42 9.42 9.42 74 6.97 percent of total billed charges 9.42 93 7.63 percent of total billed charges 9.42 9.42 other OPPS APC 9.42 9.42 other OPPS APC 9.42 27.63 2.6 percent of total billed charges 9.42 9.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL CRANIAL 5.8MM SUP-826608 CDM 0270 RC outpatient 176.98 176.98 176.98 74 130.97 percent of total billed charges 176.98 93 143.35 percent of total billed charges 176.98 176.98 other OPPS APC 176.98 176.98 other OPPS APC 176.98 27.63 48.9 percent of total billed charges 176.98 176.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SET TSRH-3D TITANIUM L32 MM OD6.35 MM SPINE BREAKOFF LOCK 2 HEX HEAD SUP-8281246 CDM 270010020 LOCAL 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE SHUNT CODMAN CERTAS PLUS SIPHONGUARD IN-LINE PROGRAMMABLE SUP-828804PL CDM 0270 RC outpatient 14913.5 14913.5 14913.5 74 11036 percent of total billed charges 14913.5 93 12079.9 percent of total billed charges 14913.5 14913.5 other OPPS APC 14913.5 14913.5 other OPPS APC 14913.5 27.63 4120.6 percent of total billed charges 14913.5 14913.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CODMAN CERTAS PLUS PROGRAMMABLE VALVE SUP-828814PL CDM 0270 RC outpatient 14910.1 14910.1 14910.1 74 11033.4 percent of total billed charges 14910.1 93 12077.2 percent of total billed charges 14910.1 14910.1 other OPPS APC 14910.1 14910.1 other OPPS APC 14910.1 27.63 4119.65 percent of total billed charges 14910.1 14910.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR BALL EMM TUNGSTEN SUP-82960.3730 CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR BALL 3MM DIAMOND SUP-82960.3930 CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR BALL 4MM DIAMOND SUP-82960.3940 CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER MEDIASTINAL 34 FR SUP-83-00003 CDM 0272 RC outpatient 61.76 61.76 61.76 74 45.7 percent of total billed charges 61.76 93 50.03 percent of total billed charges 61.76 61.76 other OPPS APC 61.76 61.76 other OPPS APC 61.76 27.63 17.06 percent of total billed charges 61.76 61.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RAY PORTS MUSCLE BX CLAMPS 12M SUP-83-00005 CDM 0272 RC outpatient 32.07 32.07 32.07 74 23.73 percent of total billed charges 32.07 93 25.98 percent of total billed charges 32.07 32.07 other OPPS APC 32.07 32.07 other OPPS APC 32.07 27.63 8.86 percent of total billed charges 32.07 32.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIGHT ANGLED CHEST TUBES SZ 32 SUP-83-00008 CDM 0272 RC outpatient 23.64 23.64 23.64 74 17.49 percent of total billed charges 23.64 93 19.15 percent of total billed charges 23.64 23.64 other OPPS APC 23.64 23.64 other OPPS APC 23.64 27.63 6.53 percent of total billed charges 23.64 23.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIGHT ANGLED CHEST TUBES SZ 36 SUP-83-00009 CDM 0272 RC outpatient 26.71 26.71 26.71 74 19.77 percent of total billed charges 26.71 93 21.64 percent of total billed charges 26.71 26.71 other OPPS APC 26.71 26.71 other OPPS APC 26.71 27.63 7.38 percent of total billed charges 26.71 26.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOGARTY EMBOLECTOMY CATH 2 FR SUP-83-00012 CDM C1757 HCPCS 0272 RC outpatient 235.06 235.06 235.06 74 173.94 percent of total billed charges 235.06 93 190.4 percent of total billed charges 235.06 235.06 other OPPS APC 235.06 235.06 other OPPS APC 235.06 27.63 64.95 percent of total billed charges 235.06 235.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOGARTY EMBOLECTOMY CATH 3 FR SUP-83-00013 CDM C1757 HCPCS 0272 RC outpatient 149.96 149.96 149.96 74 110.97 percent of total billed charges 149.96 93 121.47 percent of total billed charges 149.96 149.96 other OPPS APC 149.96 149.96 other OPPS APC 149.96 27.63 41.43 percent of total billed charges 149.96 149.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOGARTY EMBOLECTOMY CATH 4 FR SUP-83-00014 CDM C1757 HCPCS 0272 RC outpatient 149.96 149.96 149.96 74 110.97 percent of total billed charges 149.96 93 121.47 percent of total billed charges 149.96 149.96 other OPPS APC 149.96 149.96 other OPPS APC 149.96 27.63 41.43 percent of total billed charges 149.96 149.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOGARTY EMBOLECTOMY CATH 5 FR SUP-83-00015 CDM C1757 HCPCS 0272 RC outpatient 146.52 146.52 146.52 74 108.42 percent of total billed charges 146.52 93 118.68 percent of total billed charges 146.52 146.52 other OPPS APC 146.52 146.52 other OPPS APC 146.52 27.63 40.48 percent of total billed charges 146.52 146.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOGARTY EMBOLECTOMY CATH 6 FR SUP-83-00016 CDM C1757 HCPCS 0272 RC outpatient 149.96 149.96 149.96 74 110.97 percent of total billed charges 149.96 93 121.47 percent of total billed charges 149.96 149.96 other OPPS APC 149.96 149.96 other OPPS APC 149.96 27.63 41.43 percent of total billed charges 149.96 149.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOGARTY IRRIGATION CATH 4 FR SUP-83-00017 CDM C1757 HCPCS 0272 RC outpatient 210 210 210 74 155.4 percent of total billed charges 210 93 170.1 percent of total billed charges 210 210 other OPPS APC 210 210 other OPPS APC 210 27.63 58.02 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOGARTY IRRIGATION CATH 6 FR SUP-83-00018 CDM C1757 HCPCS 0272 RC outpatient 60.68 60.68 60.68 74 44.9 percent of total billed charges 60.68 93 49.15 percent of total billed charges 60.68 60.68 other OPPS APC 60.68 60.68 other OPPS APC 60.68 27.63 16.77 percent of total billed charges 60.68 60.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THORACIC 32FR SUP-83-00044 CDM 0272 RC outpatient 3.83 3.83 3.83 74 2.83 percent of total billed charges 3.83 93 3.1 percent of total billed charges 3.83 3.83 other OPPS APC 3.83 3.83 other OPPS APC 3.83 27.63 1.06 percent of total billed charges 3.83 3.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SNARE VASCULAR MICRO ELITE .014 IN L180 CM OD4 MM HELICAL LOOP DESIGN RADIOPAQUE SUP-8301 CDM 0270 RC outpatient 5564 5564 5564 74 4117.36 percent of total billed charges 5564 93 4506.84 percent of total billed charges 5564 5564 other OPPS APC 5564 5564 other OPPS APC 5564 27.63 1537.33 percent of total billed charges 5564 5564 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICRO ELITE SNARE 7MM SUP-8302 CDM 0270 RC outpatient 5252 5252 5252 74 3886.48 percent of total billed charges 5252 93 4254.12 percent of total billed charges 5252 5252 other OPPS APC 5252 5252 other OPPS APC 5252 27.63 1451.13 percent of total billed charges 5252 5252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAT OPERATING ROOM SURGISAFE L40 IN X W28 IN HIGH ABSORBENT FLUID BARRIER BACKING NONSTERILE LATEX FREE GREEN SUP-83030 CDM 0270 RC outpatient 11.8 11.8 11.8 74 8.73 percent of total billed charges 11.8 93 9.56 percent of total billed charges 11.8 11.8 other OPPS APC 11.8 11.8 other OPPS APC 11.8 27.63 3.26 percent of total billed charges 11.8 11.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 6-0 BV-1 L24 IN 2 ARM MONOFILAMENT BLUE SUP-8305H CDM 0270 RC outpatient 42.12 42.12 42.12 74 31.17 percent of total billed charges 42.12 93 34.12 percent of total billed charges 42.12 42.12 other OPPS APC 42.12 42.12 other OPPS APC 42.12 27.63 11.64 percent of total billed charges 42.12 42.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE VISI-BLACK 6-0 C-1 L30 IN 2 ARM MONOFILAMENT BLUE SUP-8307H CDM outpatient 37.87 37.87 37.87 37.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PULMONARY ARTERY SWAN-GANZ VIP STANDARD L110 CM OD7.5 FR 5 LUMEN THERMODILUTION VOLUMETRIC LATEX SUP-831F75P CDM 270009129 LOCAL 0270 RC outpatient 353.6 353.6 353.6 74 261.66 percent of total billed charges 353.6 93 286.42 percent of total billed charges 353.6 353.6 other OPPS APC 353.6 353.6 other OPPS APC 353.6 27.63 97.7 percent of total billed charges 353.6 353.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE POLYPROPYLENE 5-0 C-1 L36 IN 2 ARM MONOFILAMENT BLUE SUP-8321H CDM 0270 RC outpatient 38.26 38.26 38.26 74 28.31 percent of total billed charges 38.26 93 30.99 percent of total billed charges 38.26 38.26 other OPPS APC 38.26 38.26 other OPPS APC 38.26 27.63 10.57 percent of total billed charges 38.26 38.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SET SCREW, TSRH 3DX FLUSH BREAK" SUP-8351500 CDM 270010020 LOCAL 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR ROD TSRH TITANIUM SMALL SPINE 3DX SUP-8351520 CDM 270010020 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR ROD TSRH TITANIUM MEDIUM SPINE 3DX SUP-8351521 CDM 270010020 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR ROD TSRH TITANIUM LARGE SPINE 3DX SUP-8351522 CDM 270010020 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR ROD TSRH 90 D OFFSET 3DX SUP-8351523 CDM 270010020 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE L45 MM OD4.5 MM SPINE SUP-83545459 CDM 270010020 LOCAL 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L50 MM OD4.5 MM SPINE SUP-83545509 CDM 270010020 LOCAL 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L30 MM OD5.5 MM SPINE SUP-83555309 CDM 270010020 LOCAL 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L35 MM OD5.5 MM SPINE SUP-83555359 CDM 270010020 LOCAL 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L40 MM OD5.5 MM SPINE SUP-83555409 CDM 270010020 LOCAL 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH THINLINE OSTEOGRIP L45 MM OD5.5 MM SPINE SUP-83555459 CDM 270010020 LOCAL 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L50 MM OD5.5 MM SPINE SUP-83555509 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L55 MM OD5.5 MM SPINE SUP-83555559 CDM 270010020 LOCAL 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L30 MM OD6.5 MM SPINE PEDICLE SUP-83565309 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L35 MM OD6.5 MM SPINE SUP-83565359 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L40 MM OD6.5 MM SPINE SUP-83565409 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L45 MM OD6.5 MM SPINE SUP-83565459 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L50 MM OD6.5 MM SPINE SUP-83565509 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L55 MM OD6.5 MM SPINE SUP-83565559 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L60 MM OD6.5 MM SPINE SUP-83565609 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L30 MM OD7.5 MM SPINE SUP-83575309 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP TITANIUM L35 MM OD7.5 MM SPINE RECONSTRUCTION SUP-83575359 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE L40 MM OD7.5 MM SPINE SUP-83575409 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L45 MM OD7.5 MM SPINE PEDICLE SUP-83575459 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L50 MM OD7.5 MM SPINE SUP-83575509 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L55 MM OD7.5 MM SPINE SUP-83575559 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L60 MM OD7.5 MM SPINE SUP-83575609 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE L35 MM OD8.5 MM SPINE SUP-83585359 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L45 MM OD8.5 MM SPINE SUP-83585459 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L50 MM OD8.5 MM SPINE SUP-83585509 CDM 270010020 LOCAL 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH OSTEOGRIP THINLINE TITANIUM L55 MM OD8.5 MM SPINE SUP-83585559 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL SILO TSRH-3D TITANIUM PRECUT L25 MM OD5.5 MM PEDICLE SUP-837-125 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL TSRH-3D TITANIUM STANDARD STRAIGHT L25 CM OD6.35 MM PRECUT SUP-837-135 CDM 270010020 LOCAL 0270 RC outpatient 743.6 743.6 743.6 74 550.26 percent of total billed charges 743.6 93 602.32 percent of total billed charges 743.6 743.6 other OPPS APC 743.6 743.6 other OPPS APC 743.6 27.63 205.46 percent of total billed charges 743.6 743.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL TSRH-3D TITANIUM L30 MM OD5.5 MM PEDICLE PRECUT CONTOURED SUP-8370030 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL TSRH-3D TITANIUM CONTOUR PREBENT PRECUT L3.5 CM OD5.5 MM PEDICLE SUP-8370035 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL TSRH-3D CONTOUR PREBENT 40MM 5.5MM TITANIUM PEDICLE PRECUT SUP-8370040 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL TSRH-3D TITANIUM CONTOUR PREBENT PRECUT L4.5 CM OD5.5 MM PEDICLE SUP-8370045 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL TSRH-3D TITANIUM STANDARD L5 CM OD5.5 MM PEDICLE PRECUT CONTOURED SUP-8370050 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL TSRH-3D TITANIUM CONTOUR PREBENT PRECUT L60 MM OD5.5 MM PEDICLE SUP-8370060 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL TSRH-3D TITANIUM L7 CM OD5.5 MM PEDICLE BENT PRECUT SUP-8370070 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL TSRH-3D TITANIUM CONTOUR PREBENT PRECUT L80 MM OD5.5 MM PEDICLE SUP-8370080 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL TSRH-3D CONTOUR PREBENT 9CM 5.5MM TITANIUM PEDICLE PRECUT SUP-8370090 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL TSRH-3D TITANIUM CONTOUR PREBENT PRECUT L100 MM OD5.5 MM PEDICLE SUP-8370100 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL TSRH-3D TITANIUM CONTOUR PREBENT PRECUT L3.5 CM OD6.35 MM PEDICLE SUP-8371035 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL TSRH-3D TITANIUM L40 MM OD6.35 MM PREBENT PRECUT SUP-8371040 CDM 270010020 LOCAL 0270 RC outpatient 597.58 597.58 597.58 74 442.21 percent of total billed charges 597.58 93 484.04 percent of total billed charges 597.58 597.58 other OPPS APC 597.58 597.58 other OPPS APC 597.58 27.63 165.11 percent of total billed charges 597.58 597.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL TSRH-3D TITANIUM L50 MM OD6.35 MM PREBENT PRECUT SUP-8371050 CDM 270010020 LOCAL 0270 RC outpatient 597.58 597.58 597.58 74 442.21 percent of total billed charges 597.58 93 484.04 percent of total billed charges 597.58 597.58 other OPPS APC 597.58 597.58 other OPPS APC 597.58 27.63 165.11 percent of total billed charges 597.58 597.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL TSRH-3D TITANIUM CONTOUR BENT L60 MM OD6.35 MM INSERT PRECUT SUP-8371060 CDM 270010020 LOCAL 0270 RC outpatient 585.62 585.62 585.62 74 433.36 percent of total billed charges 585.62 93 474.35 percent of total billed charges 585.62 585.62 other OPPS APC 585.62 585.62 other OPPS APC 585.62 27.63 161.81 percent of total billed charges 585.62 585.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL 70MM 6.35MM TSRH-3D CONTOUR PREBENT PRECUT PEDICLE TITANIUM SUP-8371070 CDM 270010020 LOCAL 0270 RC outpatient 597.58 597.58 597.58 74 442.21 percent of total billed charges 597.58 93 484.04 percent of total billed charges 597.58 597.58 other OPPS APC 597.58 597.58 other OPPS APC 597.58 27.63 165.11 percent of total billed charges 597.58 597.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL TITANIUM L80 MM OD6.35 MM PREBENT PRECUT SUP-8371080 CDM 270010020 LOCAL 0270 RC outpatient 597.58 597.58 597.58 74 442.21 percent of total billed charges 597.58 93 484.04 percent of total billed charges 597.58 597.58 other OPPS APC 597.58 597.58 other OPPS APC 597.58 27.63 165.11 percent of total billed charges 597.58 597.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL TSRH-2D CONTOUR BENT L9 CM OD6.35 MM PRECUT SUP-8371090 CDM 270010020 LOCAL 0270 RC outpatient 597.58 597.58 597.58 74 442.21 percent of total billed charges 597.58 93 484.04 percent of total billed charges 597.58 597.58 other OPPS APC 597.58 597.58 other OPPS APC 597.58 27.63 165.11 percent of total billed charges 597.58 597.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL TITANIUM L100 MM OD6.35 MM PREBENT PRECUT SUP-8371100 CDM 270010020 LOCAL 0270 RC outpatient 597.58 597.58 597.58 74 442.21 percent of total billed charges 597.58 93 484.04 percent of total billed charges 597.58 597.58 other OPPS APC 597.58 597.58 other OPPS APC 597.58 27.63 165.11 percent of total billed charges 597.58 597.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH-3D TITANIUM SHORT POST L30 MM OD5.5 MM SPINE PEDICLE POSTERIOR SUP-8372530 CDM 270010020 LOCAL 0270 RC outpatient 890.34 890.34 890.34 74 658.85 percent of total billed charges 890.34 93 721.18 percent of total billed charges 890.34 890.34 other OPPS APC 890.34 890.34 other OPPS APC 890.34 27.63 246 percent of total billed charges 890.34 890.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH-3D TITANIUM SHORT POST L35 MM OD5.5 MM SPINE PEDICLE POSTERIOR SUP-8372535 CDM 270010020 LOCAL 0270 RC outpatient 890.34 890.34 890.34 74 658.85 percent of total billed charges 890.34 93 721.18 percent of total billed charges 890.34 890.34 other OPPS APC 890.34 890.34 other OPPS APC 890.34 27.63 246 percent of total billed charges 890.34 890.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH-3D TITANIUM SHORT POST L40 MM OD5.5 MM SPINE PEDICLE POSTERIOR SUP-8372540 CDM 270010020 LOCAL 0270 RC outpatient 778.75 778.75 778.75 74 576.28 percent of total billed charges 778.75 93 630.79 percent of total billed charges 778.75 778.75 other OPPS APC 778.75 778.75 other OPPS APC 778.75 27.63 215.17 percent of total billed charges 778.75 778.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH-3D TITANIUM SHORT POST L45 MM OD5.5 MM SPINE PEDICLE POSTERIOR SUP-8372545 CDM 270010020 LOCAL 0270 RC outpatient 778.75 778.75 778.75 74 576.28 percent of total billed charges 778.75 93 630.79 percent of total billed charges 778.75 778.75 other OPPS APC 778.75 778.75 other OPPS APC 778.75 27.63 215.17 percent of total billed charges 778.75 778.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH-3D TITANIUM SHORT POST L55 MM OD5.5 MM SPINE PEDICLE POSTERIOR SUP-8372555 CDM 270010020 LOCAL 0270 RC outpatient 890.34 890.34 890.34 74 658.85 percent of total billed charges 890.34 93 721.18 percent of total billed charges 890.34 890.34 other OPPS APC 890.34 890.34 other OPPS APC 890.34 27.63 246 percent of total billed charges 890.34 890.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH-3D TITANIUM SHORT POST L30 MM OD6.5 MM SPINE PEDICLE POSTERIOR SUP-8372630 CDM 270010020 LOCAL 0270 RC outpatient 778.75 778.75 778.75 74 576.28 percent of total billed charges 778.75 93 630.79 percent of total billed charges 778.75 778.75 other OPPS APC 778.75 778.75 other OPPS APC 778.75 27.63 215.17 percent of total billed charges 778.75 778.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH-3D TITANIUM SHORT POST L35 MM OD6.5 MM SPINE PEDICLE POSTERIOR SUP-8372635 CDM 270010020 LOCAL 0270 RC outpatient 778.75 778.75 778.75 74 576.28 percent of total billed charges 778.75 93 630.79 percent of total billed charges 778.75 778.75 other OPPS APC 778.75 778.75 other OPPS APC 778.75 27.63 215.17 percent of total billed charges 778.75 778.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH-3D TITANIUM SHORT POST L40 MM OD6.5 MM SPINE PEDICLE POSTERIOR SUP-8372640 CDM 270010020 LOCAL 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH-3D TITANIUM SHORT POST L45 MM OD6.5 MM SPINE PEDICLE POSTERIOR SUP-8372645 CDM 270010020 LOCAL 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH-3D TITANIUM SHORT POST L50 MM OD6.5 MM SPINE PEDICLE POSTERIOR SUP-8372650 CDM 270010020 LOCAL 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH-3D TITANIUM SHORT POST L55 MM OD6.5 MM SPINE PEDICLE POSTERIOR SUP-8372655 CDM 270010020 LOCAL 0270 RC outpatient 778.78 778.78 778.78 74 576.3 percent of total billed charges 778.78 93 630.81 percent of total billed charges 778.78 778.78 other OPPS APC 778.78 778.78 other OPPS APC 778.78 27.63 215.18 percent of total billed charges 778.78 778.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH-3D TITANIUM SHORT POST L35 MM OD7.5 MM SPINE PEDICLE POSTERIOR SUP-8372735 CDM 270010020 LOCAL 0270 RC outpatient 890.34 890.34 890.34 74 658.85 percent of total billed charges 890.34 93 721.18 percent of total billed charges 890.34 890.34 other OPPS APC 890.34 890.34 other OPPS APC 890.34 27.63 246 percent of total billed charges 890.34 890.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH-3D TITANIUM SHORT L40 MM OD7.5 MM SPINE PEDICLE POSTERIOR SUP-8372740 CDM 270010020 LOCAL 0270 RC outpatient 778.75 778.75 778.75 74 576.28 percent of total billed charges 778.75 93 630.79 percent of total billed charges 778.75 778.75 other OPPS APC 778.75 778.75 other OPPS APC 778.75 27.63 215.17 percent of total billed charges 778.75 778.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TSRH-3D TITANIUM SHORT POST L45 MM OD7.5 MM SPINE PEDICLE POSTERIOR SUP-8372745 CDM 270010020 LOCAL 0270 RC outpatient 778.75 778.75 778.75 74 576.28 percent of total billed charges 778.75 93 630.79 percent of total billed charges 778.75 778.75 other OPPS APC 778.75 778.75 other OPPS APC 778.75 27.63 215.17 percent of total billed charges 778.75 778.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR ROD TSRH-3D TITANIUM LARGE OD5.5 MM SPINE PEDICLE POSTERIOR OPEN OFFSET SUP-8379122 CDM 270010020 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR ROD TSRH-3D TITANIUM SMALL OD6.35 MM SPINE CLOSED OFFSET SUP-8379140 CDM 270010020 LOCAL 0270 RC outpatient 1675.13 1675.13 1675.13 74 1239.6 percent of total billed charges 1675.13 93 1356.86 percent of total billed charges 1675.13 1675.13 other OPPS APC 1675.13 1675.13 other OPPS APC 1675.13 27.63 462.84 percent of total billed charges 1675.13 1675.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR ROD TSRH-3D TITANIUM MEDIUM OD6.35 MM SPINE PEDICLE POSTERIOR CLOSED OFFSET SUP-8379141 CDM 270010020 LOCAL 0270 RC outpatient 1703.91 1703.91 1703.91 74 1260.89 percent of total billed charges 1703.91 93 1380.17 percent of total billed charges 1703.91 1703.91 other OPPS APC 1703.91 1703.91 other OPPS APC 1703.91 27.63 470.79 percent of total billed charges 1703.91 1703.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR ROD TSRH-3D TITANIUM LARGE OD6.35 MM SPINE PEDICLE POSTERIOR CLOSED OFFSET SUP-8379142 CDM 270010020 LOCAL 0270 RC outpatient 1703.91 1703.91 1703.91 74 1260.89 percent of total billed charges 1703.91 93 1380.17 percent of total billed charges 1703.91 1703.91 other OPPS APC 1703.91 1703.91 other OPPS APC 1703.91 27.63 470.79 percent of total billed charges 1703.91 1703.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 23 MAXILLARY UPPER SPACE MAINTAINER SEAMLESS ATTACH TUBE MALLEABLE SUP-8385-131 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 23.5 UPPER MAXILLARY SPACE MAINTAINER STRONG SEAMLESS MALLEABLE SUP-8385-132 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 24 MAXILLARY UPPER SPACE MAINTAINER SEAMLESS ATTACH TUBE MALLEABLE SUP-8385-133 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 24.5 UPPER MAXILLARY SPACE MAINTAINER STRONG SEAMLESS MALLEABLE SUP-8385-134 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 25 UPPER MAXILLA SPACE MAINTAINER CHAIRSIDE SEAMLESS MALLEABLE ATTACHED TUBE SUP-8385-135 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 25.5 UPPER MAXILLARY SPACE MAINTAINER STRONG SEAMLESS MALLEABLE SUP-8385-136 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 26 UPPER MAXILLA SPACE MAINTAINER CHAIRSIDE SEAMLESS MALLEABLE ATTACHED TUBE SUP-8385-137 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 26.5 UPPER MAXILLARY SPACE MAINTAINER STRONG SEAMLESS MALLEABLE SUP-8385-138 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 27 UPPER MAXILLA SPACE MAINTAINER CHAIRSIDE SEAMLESS MALLEABLE ATTACHED TUBE SUP-8385-139 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 27 1/2 MAXILLARY UPPER SPACE MAINTAINER SEAMLESS MALLEABLE SUP-8385-140 CDM 0270 RC outpatient 22.62 22.62 22.62 74 16.74 percent of total billed charges 22.62 93 18.32 percent of total billed charges 22.62 22.62 other OPPS APC 22.62 22.62 other OPPS APC 22.62 27.63 6.25 percent of total billed charges 22.62 22.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 28 UPPER MAXILLA SPACE MAINTAINER CHAIRSIDE SEAMLESS MALLEABLE ATTACHED TUBE SUP-8385-141 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 28 1/2 MAXILLARY UPPER SPACE MAINTAINER SEAMLESS MALLEABLE SUP-8385-143 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 29 UPPER MAXILLA SPACE MAINTAINER CHAIRSIDE SEAMLESS MALLEABLE ATTACHED TUBE SUP-8385-145 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 29 1/2 MAXILLARY UPPER SPACE MAINTAINER SEAMLESS MALLEABLE SUP-8385-147 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 30 UPPER MAXILLARY SPACE MAINTAINER CHAIRSIDE ATTACH TUBE RED SUP-8385-149 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 30 1/2 UPPER SPACE MAINTAINER SEAMLESS MALLEABLE SUP-8385-151 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 31 UPPER MAXILLARY SPACE MAINTAINER CHAIRSIDE ATTACH TUBE RED SUP-8385-153 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 31.5 UPPER MAXILLARY SPACE MAINTAINER STRONG SEAMLESS MALLEABLE SUP-8385-155 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 32 UPPER MAXILLARY SPACE MAINTAINER CHAIRSIDE ATTACH TUBE RED SUP-8385-157 CDM 0270 RC outpatient 20.15 20.15 20.15 74 14.91 percent of total billed charges 20.15 93 16.32 percent of total billed charges 20.15 20.15 other OPPS APC 20.15 20.15 other OPPS APC 20.15 27.63 5.57 percent of total billed charges 20.15 20.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 32 1/2 UPPER MAXILLARY SPACE MAINTAINER SEAMLESS MALLEABLE SUP-8385-159 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 33 UPPER MAXILLARY SPACE MAINTAINER CHAIRSIDE ATTACH TUBE RED SUP-8385-161 CDM 0270 RC outpatient 19.37 19.37 19.37 74 14.33 percent of total billed charges 19.37 93 15.69 percent of total billed charges 19.37 19.37 other OPPS APC 19.37 19.37 other OPPS APC 19.37 27.63 5.35 percent of total billed charges 19.37 19.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 34 UPPER MAXILLA SPACE MAINTAINER CHAIRSIDE SEAMLESS MALLEABLE ATTACHED TUBE SUP-8385-165 CDM 0270 RC outpatient 20.15 20.15 20.15 74 14.91 percent of total billed charges 20.15 93 16.32 percent of total billed charges 20.15 20.15 other OPPS APC 20.15 20.15 other OPPS APC 20.15 27.63 5.57 percent of total billed charges 20.15 20.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 34.5 UPPER MAXILLA SPACE MAINTAINER CHAIRSIDE SEAMLESS MALLEABLE ATTACHED TUBE SUP-8385-167 CDM 0270 RC outpatient 19.37 19.37 19.37 74 14.33 percent of total billed charges 19.37 93 15.69 percent of total billed charges 19.37 19.37 other OPPS APC 19.37 19.37 other OPPS APC 19.37 27.63 5.35 percent of total billed charges 19.37 19.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 35 UPPER MAXILLARY SPACE MAINTAINER CHAIRSIDE ATTACH TUBE RED SUP-8385-169 CDM 0270 RC outpatient 20.15 20.15 20.15 74 14.91 percent of total billed charges 20.15 93 16.32 percent of total billed charges 20.15 20.15 other OPPS APC 20.15 20.15 other OPPS APC 20.15 27.63 5.57 percent of total billed charges 20.15 20.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 35 1/2 UPPER MAXILLARY SPACE MAINTAINER CHAIRSIDE ATTACH TUBE RED SUP-8385-171 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 36 UPPER MAXILLARY SPACE MAINTAINER CHAIRSIDE ATTACH TUBE RED SUP-8385-173 CDM 0270 RC outpatient 19.11 19.11 19.11 74 14.14 percent of total billed charges 19.11 93 15.48 percent of total billed charges 19.11 19.11 other OPPS APC 19.11 19.11 other OPPS APC 19.11 27.63 5.28 percent of total billed charges 19.11 19.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 36 1/2 MAXILLARY CHAIRSIDE SPACE MAINTAINER ATTACH TUBE RED SUP-8385-175 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 37 UPPER MAXILLARY SPACE MAINTAINER CHAIRSIDE ATTACH TUBE RED SUP-8385-177 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 37 1/2 UPPER MAXILLARY SPACE MAINTAINER CHAIRSIDE ATTACH TUBE RED SUP-8385-179 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 38 UPPER MAXILLARY SPACE MAINTAINER CHAIRSIDE ATTACH TUBE SEAMLESS SUP-8385-181 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR 38 UPPER MAXILLARY SPACE MAINTAINER CHAIRSIDE SUP-8385-183 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 39 UPPER MAXILLARY SPACE MAINTAINER CHAIRSIDE ATTACH TUBE RED SUP-8385-185 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 39.5 MAXILLARY ORTHODONTIC SPACE MAINTAINER ATTACHED TUBE SUP-8385-187 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 40 UPPER MAXILLARY SPACE MAINTAINER CHAIRSIDE ATTACH TUBE RED SUP-8385-189 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 40.5 UPPER MAXILLARY SPACE MAINTAINER STRONG SEAMLESS MALLEABLE SUP-8385-191 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 41 UPPER MAXILLARY SPACE MAINTAINER CHAIRSIDE ATTACH TUBE RED SUP-8385-193 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 41.5 UPPER MAXILLARY SPACE MAINTAINER STRONG SEAMLESS MALLEABLE SUP-8385-195 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 42 UPPER MAXILLARY SPACE MAINTAINER STRONG SEAMLESS MALLEABLE SUP-8385-197 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 23 LOWER MANDIBLE SPACE MAINTAINER CHAIRSIDE SEAMLESS MALLEABLE ATTACH TUBE SUP-8385-231 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 23 1/2 MAXILLARY LOWER SPACE MAINTAINER SEAMLESS MALLEABLE SUP-8385-232 CDM 0270 RC outpatient 22.62 22.62 22.62 74 16.74 percent of total billed charges 22.62 93 18.32 percent of total billed charges 22.62 22.62 other OPPS APC 22.62 22.62 other OPPS APC 22.62 27.63 6.25 percent of total billed charges 22.62 22.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 24 LOWER MANDIBLE SPACE MAINTAINER CHAIRSIDE SEAMLESS MALLEABLE ATTACHED TUBE SUP-8385-233 CDM 0270 RC outpatient 20.15 20.15 20.15 74 14.91 percent of total billed charges 20.15 93 16.32 percent of total billed charges 20.15 20.15 other OPPS APC 20.15 20.15 other OPPS APC 20.15 27.63 5.57 percent of total billed charges 20.15 20.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 24.5 LOWER MAXILLARY SPACE MAINTAINER STRONG SEAMLESS MALLEABLE SUP-8385-234 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 25 LOWER MANDIBLE SPACE MAINTAINER CHAIRSIDE SEAMLESS MALLEABLE ATTACHED TUBE SUP-8385-235 CDM 0270 RC outpatient 20.15 20.15 20.15 74 14.91 percent of total billed charges 20.15 93 16.32 percent of total billed charges 20.15 20.15 other OPPS APC 20.15 20.15 other OPPS APC 20.15 27.63 5.57 percent of total billed charges 20.15 20.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 25 1/2 MAXILLARY LOWER SPACE MAINTAINER SEAMLESS MALLEABLE SUP-8385-236 CDM 0270 RC outpatient 20.15 20.15 20.15 74 14.91 percent of total billed charges 20.15 93 16.32 percent of total billed charges 20.15 20.15 other OPPS APC 20.15 20.15 other OPPS APC 20.15 27.63 5.57 percent of total billed charges 20.15 20.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 26 LOWER MANDIBLE SPACE MAINTAINER CHAIRSIDE SEAMLESS MALLEABLE ATTACHED TUBE SUP-8385-237 CDM 0270 RC outpatient 20.15 20.15 20.15 74 14.91 percent of total billed charges 20.15 93 16.32 percent of total billed charges 20.15 20.15 other OPPS APC 20.15 20.15 other OPPS APC 20.15 27.63 5.57 percent of total billed charges 20.15 20.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 26 1/2 MAXILLARY LOWER SPACE MAINTAINER SEAMLESS MALLEABLE SUP-8385-238 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 27 LOWER MANDIBLE SPACE MAINTAINER CHAIRSIDE SEAMLESS MALLEABLE ATTACHED TUBE SUP-8385-239 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 27 1/2 MAXILLARY LOWER SPACE MAINTAINER SEAMLESS MALLEABLE SUP-8385-240 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 28 LOWER MANDIBULAR SPACE MAINTAINER ATTACHED TUBE WIDE WIRE STRONG SEAMLESS SUP-8385-241 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 28 1/2 LOWER SPACE MAINTAINER SEAMLESS MALLEABLE SUP-8385-243 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 29 LOWER MANDIBLE SPACE MAINTAINER CHAIRSIDE SEAMLESS MALLEABLE ATTACH TUBE SUP-8385-245 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 29 1/2 LOWER SPACE MAINTAINER SEAMLESS MALLEABLE SUP-8385-247 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 30 LOWER MANDIBULAR SPACE MAINTAINER CHAIRSIDE ATTACH TUBE BLACK SUP-8385-249 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 30 1/2 LOWER MAXILLARY SPACE MAINTAINER SUP-8385-251 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 31 LOWER MANDIBULAR SPACE MAINTAINER CHAIRSIDE ATTACH TUBE BLACK SUP-8385-253 CDM 0270 RC outpatient 20.15 20.15 20.15 74 14.91 percent of total billed charges 20.15 93 16.32 percent of total billed charges 20.15 20.15 other OPPS APC 20.15 20.15 other OPPS APC 20.15 27.63 5.57 percent of total billed charges 20.15 20.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 31.5 LOWER MAXILLARY SPACE MAINTAINER STRONG SEAMLESS MALLEABLE SUP-8385-255 CDM 0270 RC outpatient 19.63 19.63 19.63 74 14.53 percent of total billed charges 19.63 93 15.9 percent of total billed charges 19.63 19.63 other OPPS APC 19.63 19.63 other OPPS APC 19.63 27.63 5.42 percent of total billed charges 19.63 19.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 32 LOWER MANDIBULAR SPACE MAINTAINER CHAIRSIDE ATTACH TUBE BLACK SUP-8385-257 CDM 0270 RC outpatient 19.37 19.37 19.37 74 14.33 percent of total billed charges 19.37 93 15.69 percent of total billed charges 19.37 19.37 other OPPS APC 19.37 19.37 other OPPS APC 19.37 27.63 5.35 percent of total billed charges 19.37 19.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 32 1/2 LOWER MAXILLARY SPACE MAINTAINER SEAMLESS MALLEABLE SUP-8385-259 CDM 0270 RC outpatient 19.37 19.37 19.37 74 14.33 percent of total billed charges 19.37 93 15.69 percent of total billed charges 19.37 19.37 other OPPS APC 19.37 19.37 other OPPS APC 19.37 27.63 5.35 percent of total billed charges 19.37 19.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 33 LOWER MANDIBULAR SPACE MAINTAINER CHAIRSIDE ATTACH TUBE BLACK SUP-8385-261 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 33 1/2 MANDIBLE CHAIRSIDE SPACE MAINTAINER ATTACH TUBE BLACK SUP-8385-263 CDM 0270 RC outpatient 19.63 19.63 19.63 74 14.53 percent of total billed charges 19.63 93 15.9 percent of total billed charges 19.63 19.63 other OPPS APC 19.63 19.63 other OPPS APC 19.63 27.63 5.42 percent of total billed charges 19.63 19.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 34 LOWER MANDIBULAR SPACE MAINTAINER CHAIRSIDE ATTACH TUBE BLACK SUP-8385-265 CDM 0270 RC outpatient 19.63 19.63 19.63 74 14.53 percent of total billed charges 19.63 93 15.9 percent of total billed charges 19.63 19.63 other OPPS APC 19.63 19.63 other OPPS APC 19.63 27.63 5.42 percent of total billed charges 19.63 19.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 34.5 LOWER MANDIBULAR SPACE MAINTAINER ATTACHED TUBE WIDE WIRE STRONG SEAMLESS SUP-8385-267 CDM 0270 RC outpatient 19.37 19.37 19.37 74 14.33 percent of total billed charges 19.37 93 15.69 percent of total billed charges 19.37 19.37 other OPPS APC 19.37 19.37 other OPPS APC 19.37 27.63 5.35 percent of total billed charges 19.37 19.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 35 LOWER MANDIBULAR SPACE MAINTAINER CHAIRSIDE ATTACH TUBE BLACK SUP-8385-269 CDM 0270 RC outpatient 19.63 19.63 19.63 74 14.53 percent of total billed charges 19.63 93 15.9 percent of total billed charges 19.63 19.63 other OPPS APC 19.63 19.63 other OPPS APC 19.63 27.63 5.42 percent of total billed charges 19.63 19.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 35.5 LOWER MANDIBULAR SPACE MAINTAINER ATTACHED TUBE WIDE WIRE STRONG SEAMLESS SUP-8385-271 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 36 LOWER MANDIBULAR SPACE MAINTAINER CHAIRSIDE ATTACH TUBE BLACK SUP-8385-273 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 36 1/2 LOWER MANDIBULAR SPACE MAINTAINER CHAIRSIDE ATTACH TUBE BLACK SUP-8385-275 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 37 1/2 MANDIBLE CHAIRSIDE SPACE MAINTAINER ATTACH TUBE BLACK SUP-8385-279 CDM 0270 RC outpatient 18.72 18.72 18.72 74 13.85 percent of total billed charges 18.72 93 15.16 percent of total billed charges 18.72 18.72 other OPPS APC 18.72 18.72 other OPPS APC 18.72 27.63 5.17 percent of total billed charges 18.72 18.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 38 1/2 LOWER MANDIBULAR SPACE MAINTAINER CHAIRSIDE ATTACH TUBE BLACK SUP-8385-283 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 39 LOWER MANDIBULAR SPACE MAINTAINER CHAIRSIDE ATTACH TUBE BLACK SUP-8385-285 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 39 1/2 LOWER MANDIBULAR SPACE MAINTAINER CHAIRSIDE ATTACH TUBE BLACK SUP-8385-287 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 40 LOWER MANDIBULAR SPACE MAINTAINER CHAIRSIDE ATTACH TUBE BLACK SUP-8385-289 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 40.5 LOWER MAXILLARY SPACE MAINTAINER STRONG SEAMLESS MALLEABLE SUP-8385-291 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 41 LOWER MANDIBULAR SPACE MAINTAINER CHAIRSIDE ATTACH TUBE BLACK SUP-8385-293 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 41.5 LOWER MAXILLARY SPACE MAINTAINER STRONG SEAMLESS MALLEABLE SUP-8385-295 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND MOLAR STAINLESS STEEL 42 LOWER MAXILLARY SPACE MAINTAINER STRONG SEAMLESS MALLEABLE SUP-8385-297 CDM 0270 RC outpatient 18.07 18.07 18.07 74 13.37 percent of total billed charges 18.07 93 14.64 percent of total billed charges 18.07 18.07 other OPPS APC 18.07 18.07 other OPPS APC 18.07 27.63 4.99 percent of total billed charges 18.07 18.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOTRAC BLADE SUP-84-00001 CDM 0272 RC outpatient 1000.5 1000.5 1000.5 74 740.37 percent of total billed charges 1000.5 93 810.41 percent of total billed charges 1000.5 1000.5 other OPPS APC 1000.5 1000.5 other OPPS APC 1000.5 27.63 276.44 percent of total billed charges 1000.5 1000.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORTHOSORB PINS SUP-84-00002 CDM C1713 HCPCS 0278 RC outpatient 508.06 508.06 508.06 57 289.59 percent of total billed charges 508.06 93 411.53 percent of total billed charges 508.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 508.06 other OPPS APC 508.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 508.06 other OPPS APC 508.06 51 259.11 percent of total billed charges 508.06 508.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GII QUICKANCHOR (MITEK) SUP-84-00005 CDM C1713 HCPCS 0278 RC outpatient 1276.54 1276.54 1276.54 57 727.63 percent of total billed charges 1276.54 93 1034 percent of total billed charges 1276.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1276.54 other OPPS APC 1276.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1276.54 other OPPS APC 1276.54 51 651.04 percent of total billed charges 1276.54 1276.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPER QUICKANCHOR (MITEK) SUP-84-00006 CDM C1713 HCPCS 0278 RC outpatient 1394.57 1394.57 1394.57 57 794.9 percent of total billed charges 1394.57 93 1129.6 percent of total billed charges 1394.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1394.57 other OPPS APC 1394.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1394.57 other OPPS APC 1394.57 51 711.23 percent of total billed charges 1394.57 1394.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DR LEMON'S K WIRES .045 SUP-84-00007 CDM C1713 HCPCS 0278 RC outpatient 25.39 25.39 25.39 57 14.47 percent of total billed charges 25.39 93 20.57 percent of total billed charges 25.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 25.39 other OPPS APC 25.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 25.39 other OPPS APC 25.39 51 12.95 percent of total billed charges 25.39 25.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DR LEMON'S K WIRES .062 SUP-84-00008 CDM C1713 HCPCS 0278 RC outpatient 25.14 25.14 25.14 57 14.33 percent of total billed charges 25.14 93 20.36 percent of total billed charges 25.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 25.14 other OPPS APC 25.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 25.14 other OPPS APC 25.14 51 12.82 percent of total billed charges 25.14 25.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PETITE WOUND DRAINAGE KIT,7FR." SUP-84-00009 CDM 0272 RC outpatient 117.2 117.2 117.2 74 86.73 percent of total billed charges 117.2 93 94.93 percent of total billed charges 117.2 117.2 other OPPS APC 117.2 117.2 other OPPS APC 117.2 27.63 32.38 percent of total billed charges 117.2 117.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RASP MICRORECIPRICATING LARGE CROSSCUT SUP-84-00011 CDM 0272 RC outpatient 215.11 215.11 215.11 74 159.18 percent of total billed charges 215.11 93 174.24 percent of total billed charges 215.11 215.11 other OPPS APC 215.11 215.11 other OPPS APC 215.11 27.63 59.43 percent of total billed charges 215.11 215.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MINI SHANNON BURRS SUP-84-00012 CDM 0272 RC outpatient 80.9 80.9 80.9 74 59.87 percent of total billed charges 80.9 93 65.53 percent of total billed charges 80.9 80.9 other OPPS APC 80.9 80.9 other OPPS APC 80.9 27.63 22.35 percent of total billed charges 80.9 80.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CPT,PODIATRY PACK" SUP-84-00020 CDM 0272 RC outpatient 194.71 194.71 194.71 74 144.09 percent of total billed charges 194.71 93 157.72 percent of total billed charges 194.71 194.71 other OPPS APC 194.71 194.71 other OPPS APC 194.71 27.63 53.8 percent of total billed charges 194.71 194.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 2.5MM SUP-84-00021 CDM 0272 RC outpatient 774 774 774 74 572.76 percent of total billed charges 774 93 626.94 percent of total billed charges 774 774 other OPPS APC 774 774 other OPPS APC 774 27.63 213.86 percent of total billed charges 774 774 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSSTAPLE 18 X18 X 15 X 2MM SUP-84-00035 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICRO SAG BLADE FINE 5EA SUP-84-00038 CDM 0272 RC outpatient 28.96 28.96 28.96 74 21.43 percent of total billed charges 28.96 93 23.46 percent of total billed charges 28.96 28.96 other OPPS APC 28.96 28.96 other OPPS APC 28.96 27.63 8 percent of total billed charges 28.96 28.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RASP INTRAMEDULLARY SMALL MICRORECIP SUP-84-00040 CDM 0272 RC outpatient 576.17 576.17 576.17 74 426.37 percent of total billed charges 576.17 93 466.7 percent of total billed charges 576.17 576.17 other OPPS APC 576.17 576.17 other OPPS APC 576.17 27.63 159.2 percent of total billed charges 576.17 576.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RASP INTRAMEDULLARY LARGE MICRORECIP SUP-84-00041 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAPIPLASTY SYSTEM 4 SUP-84-00043 CDM C1713 HCPCS 0278 RC outpatient 10462 10462 10462 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10462 other OPPS APC 10462 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10462 other OPPS APC 10462 51 5335.62 percent of total billed charges 10462 10462 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPEEDPLATE LAPIPLASTY SUP-84-00044 CDM C1713 HCPCS 0278 RC outpatient 7500 7500 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 51 3825 percent of total billed charges 7500 7500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION ORTHOSORB L40 MM OD1.3 MM 1 KIT SUP-84-1052 CDM 0270 RC outpatient 1921.4 1921.4 1921.4 74 1421.84 percent of total billed charges 1921.4 93 1556.33 percent of total billed charges 1921.4 1921.4 other OPPS APC 1921.4 1921.4 other OPPS APC 1921.4 27.63 530.88 percent of total billed charges 1921.4 1921.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT BONE GRAFT OSTEOSET 25ML CALCIUM SULFATE RESORBABLE BEAD SUP-8400-0311 CDM 0270 RC outpatient 5779.8 5779.8 5779.8 74 4277.05 percent of total billed charges 5779.8 93 4681.64 percent of total billed charges 5779.8 5779.8 other OPPS APC 5779.8 5779.8 other OPPS APC 5779.8 27.63 1596.96 percent of total billed charges 5779.8 5779.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SNARE VASCULAR EXPRO ELITE .035IN 150CM 15MM HELICAL LOOP RADIOPAQUE SUP-8402 CDM 0270 RC outpatient 1037.4 1037.4 1037.4 74 767.68 percent of total billed charges 1037.4 93 840.29 percent of total billed charges 1037.4 1037.4 other OPPS APC 1037.4 1037.4 other OPPS APC 1037.4 27.63 286.63 percent of total billed charges 1037.4 1037.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SNARE VASCULAR EXPRO ELITE .035 IN L150 CM OD25 MM HELICAL LOOP RADIOPAQUE SUP-8403 CDM 0270 RC outpatient 1287 1287 1287 74 952.38 percent of total billed charges 1287 93 1042.47 percent of total billed charges 1287 1287 other OPPS APC 1287 1287 other OPPS APC 1287 27.63 355.6 percent of total billed charges 1287 1287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SNARE VASCULAR EXPRO ELITE .035 IN L150 CM OD35 MM HELICAL LOOP RADIOPAQUE SUP-8404 CDM 0270 RC outpatient 1196 1196 1196 74 885.04 percent of total billed charges 1196 93 968.76 percent of total billed charges 1196 1196 other OPPS APC 1196 1196 other OPPS APC 1196 27.63 330.45 percent of total billed charges 1196 1196 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL LG 22-24FR DISPOSABLE STERILE ROLLER BALL RESECTOSCOPE SUP-8423.0205 CDM 0270 RC outpatient 298.52 298.52 298.52 74 220.9 percent of total billed charges 298.52 93 241.8 percent of total billed charges 298.52 298.52 other OPPS APC 298.52 298.52 other OPPS APC 298.52 27.63 82.48 percent of total billed charges 298.52 298.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL OD22-24 FR KNIFE SUP-8423.1905 CDM 0270 RC outpatient 229.55 229.55 229.55 74 169.87 percent of total billed charges 229.55 93 185.94 percent of total billed charges 229.55 229.55 other OPPS APC 229.55 229.55 other OPPS APC 229.55 27.63 63.42 percent of total billed charges 229.55 229.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 2-0 CT-1 L30 IN MONOFILAMENT BLUE SUP-8423H CDM 0270 RC outpatient 6.09 6.09 6.09 74 4.51 percent of total billed charges 6.09 93 4.93 percent of total billed charges 6.09 6.09 other OPPS APC 6.09 6.09 other OPPS APC 6.09 27.63 1.68 percent of total billed charges 6.09 6.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL OD24 FR LOOP WIRE STERILE SUP-8424.1410 CDM 0270 RC outpatient 163.1 163.1 163.1 74 120.69 percent of total billed charges 163.1 93 132.11 percent of total billed charges 163.1 163.1 other OPPS APC 163.1 163.1 other OPPS APC 163.1 27.63 45.06 percent of total billed charges 163.1 163.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL PEDIATRIC OD26 FR ODSEC.4 MM CUTTING LOOP WIRE STERILE SUP-8426.1420 CDM 0270 RC outpatient 163.1 163.1 163.1 74 120.69 percent of total billed charges 163.1 93 132.11 percent of total billed charges 163.1 163.1 other OPPS APC 163.1 163.1 other OPPS APC 163.1 27.63 45.06 percent of total billed charges 163.1 163.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE POLYPROPYLENE 0 CT L30 IN MONOFILAMENT BLUE SUP-8434H CDM 0270 RC outpatient 6.04 6.04 6.04 74 4.47 percent of total billed charges 6.04 93 4.89 percent of total billed charges 6.04 6.04 other OPPS APC 6.04 6.04 other OPPS APC 6.04 27.63 1.67 percent of total billed charges 6.04 6.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PLAIN 0 CT-1 L27 IN MONOFILAMENT SUP-844H CDM 0270 RC outpatient 7.11 7.11 7.11 74 5.26 percent of total billed charges 7.11 93 5.76 percent of total billed charges 7.11 7.11 other OPPS APC 7.11 7.11 other OPPS APC 7.11 27.63 1.96 percent of total billed charges 7.11 7.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER SHOE CRITICAL ZONE UNIVERSAL NONSTERILE LATEX FREE SUP-8451 CDM outpatient 180.88 180.88 180.88 180.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 1 CTX L30 IN MONOFILAMENT BLUE SUP-8455H CDM 0270 RC outpatient 5.7 5.7 5.7 74 4.22 percent of total billed charges 5.7 93 4.62 percent of total billed charges 5.7 5.7 other OPPS APC 5.7 5.7 other OPPS APC 5.7 27.63 1.57 percent of total billed charges 5.7 5.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT C-SECTION SUP-85-00000 CDM 0272 RC outpatient 464.42 464.42 464.42 74 343.67 percent of total billed charges 464.42 93 376.18 percent of total billed charges 464.42 464.42 other OPPS APC 464.42 464.42 other OPPS APC 464.42 27.63 128.32 percent of total billed charges 464.42 464.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CYSTO SUP-85-00001 CDM 0272 RC outpatient 149.04 149.04 149.04 74 110.29 percent of total billed charges 149.04 93 120.72 percent of total billed charges 149.04 149.04 other OPPS APC 149.04 149.04 other OPPS APC 149.04 27.63 41.18 percent of total billed charges 149.04 149.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT GYN LAP SUP-85-00002 CDM 0272 RC outpatient 404.94 404.94 404.94 74 299.66 percent of total billed charges 404.94 93 328 percent of total billed charges 404.94 404.94 other OPPS APC 404.94 404.94 other OPPS APC 404.94 27.63 111.88 percent of total billed charges 404.94 404.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT TOTAL KNEE SUP-85-00003 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT TOTAL HIP SUP-85-00004 CDM 0272 RC outpatient 895.83 895.83 895.83 74 662.91 percent of total billed charges 895.83 93 725.62 percent of total billed charges 895.83 895.83 other OPPS APC 895.83 895.83 other OPPS APC 895.83 27.63 247.52 percent of total billed charges 895.83 895.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK KNEE ARTHROSCOPY SUP-85-00006 CDM 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT KNEE PACK DR PETRERA SUP-85-00007 CDM 0272 RC outpatient 420.7 420.7 420.7 74 311.32 percent of total billed charges 420.7 93 340.77 percent of total billed charges 420.7 420.7 other OPPS APC 420.7 420.7 other OPPS APC 420.7 27.63 116.24 percent of total billed charges 420.7 420.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT LAP GASTRIC SURGERY SUP-85-00008 CDM 0272 RC outpatient 548.66 548.66 548.66 74 406.01 percent of total billed charges 548.66 93 444.41 percent of total billed charges 548.66 548.66 other OPPS APC 548.66 548.66 other OPPS APC 548.66 27.63 151.59 percent of total billed charges 548.66 548.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CARDIAC CATH SUP-85-00010 CDM outpatient 20 20 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SPINAL SHORELINE ASC 6MM HOLEX2 ANTERIOR SUP-85-0506 CDM 270010020 LOCAL 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SPINAL SHORELINE 5MM 3-HOLE STANDALONE ANTERIOR CERVICAL SUP-85-0605 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SPINAL SHORELINE 6MM 3-HOLE STANDALONE ANTERIOR CERVICAL SUP-85-0606 CDM 270010020 LOCAL 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "5MM, LOCKING COVER" SUP-85-2105 CDM 270010020 LOCAL 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "6MM, LOCKING COVER" SUP-85-2106 CDM 270010020 LOCAL 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SPINAL SHORELINE ACS 3.5MM 14MM SELF-DRILLING VARIABLE ANGLE TITANIUM ANTERIOR CERVICAL SUP-85-3214 CDM 270010020 LOCAL 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT MAINTENANCE VERIFYNOW 13 CLEAN DEVICE 1 REPLACEMENT FAN FILTER PREVENTIVE SUP-85062 CDM 0270 RC outpatient 18.29 18.29 18.29 74 13.53 percent of total billed charges 18.29 93 14.81 percent of total billed charges 18.29 18.29 other OPPS APC 18.29 18.29 other OPPS APC 18.29 27.63 5.05 percent of total billed charges 18.29 18.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE L24 MM X W24 MM X H.5 MM ORBITAL FLOOR RAPID REABSORBABLE STERILE TRANSPARENT 1.5 MM SCREW SUP-851.540.01S CDM 270010014 LOCAL 0270 RC outpatient 2512.85 2512.85 2512.85 74 1859.51 percent of total billed charges 2512.85 93 2035.41 percent of total billed charges 2512.85 2512.85 other OPPS APC 2512.85 2512.85 other OPPS APC 2512.85 27.63 694.3 percent of total billed charges 2512.85 2512.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVER SURGICAL DERMA PRENE ULTRA NEOPRENE POLYURETHANE 8 L11.6 IN CHEMOTHERAPY POWDER FREE SMOOTH BEAD CUFF STERILE LATEX FREE DARK GREEN SUP-8516 CDM 0270 RC outpatient 3.46 3.46 3.46 74 2.56 percent of total billed charges 3.46 93 2.8 percent of total billed charges 3.46 3.46 other OPPS APC 3.46 3.46 other OPPS APC 3.46 27.63 0.96 percent of total billed charges 3.46 3.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 4-0 SH L36 IN 2 ARM MONOFILAMENT BLUE SUP-8521H CDM 0270 RC outpatient 14.21 14.21 14.21 74 10.52 percent of total billed charges 14.21 93 11.51 percent of total billed charges 14.21 14.21 other OPPS APC 14.21 14.21 other OPPS APC 14.21 27.63 3.93 percent of total billed charges 14.21 14.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 3-0 SH L36 IN 2 ARM MONOFILAMENT BLUE SUP-8522H CDM 0270 RC outpatient 14.06 14.06 14.06 74 10.4 percent of total billed charges 14.06 93 11.39 percent of total billed charges 14.06 14.06 other OPPS APC 14.06 14.06 other OPPS APC 14.06 27.63 3.88 percent of total billed charges 14.06 14.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 2-0 SH L36 IN 2 ARM MONOFILAMENT BLUE SUP-8523H CDM 0270 RC outpatient 13.83 13.83 13.83 74 10.23 percent of total billed charges 13.83 93 11.2 percent of total billed charges 13.83 13.83 other OPPS APC 13.83 13.83 other OPPS APC 13.83 27.63 3.82 percent of total billed charges 13.83 13.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CENTERPIECE TITANIUM PRECONTOUR L10 MM SPINE MULTIPLE HOLE OPEN DOOR PRECUT KICKSTAND COLOR CODED SUP-853-010 CDM 270010020 LOCAL 0270 RC outpatient 1723.8 1723.8 1723.8 74 1275.61 percent of total billed charges 1723.8 93 1396.28 percent of total billed charges 1723.8 1723.8 other OPPS APC 1723.8 1723.8 other OPPS APC 1723.8 27.63 476.29 percent of total billed charges 1723.8 1723.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CENTERPIECE TITANIUM PRECONTOUR L12 MM SPINE MULTIPLE HOLE OPEN DOOR PRECUT KICKSTAND COLOR CODED SUP-853-012 CDM 270010020 LOCAL 0270 RC outpatient 1723.8 1723.8 1723.8 74 1275.61 percent of total billed charges 1723.8 93 1396.28 percent of total billed charges 1723.8 1723.8 other OPPS APC 1723.8 1723.8 other OPPS APC 1723.8 27.63 476.29 percent of total billed charges 1723.8 1723.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CENTERPIECE TITANIUM PRECONTOUR L10 MM SPINE GRAFT PRECUT COLOR CODED SUP-853-410 CDM 270010020 LOCAL 0270 RC outpatient 1723.8 1723.8 1723.8 74 1275.61 percent of total billed charges 1723.8 93 1396.28 percent of total billed charges 1723.8 1723.8 other OPPS APC 1723.8 1723.8 other OPPS APC 1723.8 27.63 476.29 percent of total billed charges 1723.8 1723.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CENTERPIECE TITANIUM PRECONTOUR L12 MM SPINE GRAFT PRECUT COLOR CODED SUP-853-412 CDM 270010020 LOCAL 0270 RC outpatient 1723.8 1723.8 1723.8 74 1275.61 percent of total billed charges 1723.8 93 1396.28 percent of total billed charges 1723.8 1723.8 other OPPS APC 1723.8 1723.8 other OPPS APC 1723.8 27.63 476.29 percent of total billed charges 1723.8 1723.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CENTERPIECE TITANIUM L5 MM OD2.6 MM SPINE SELF TAPPING STAB GRAB COLOR CODED LAMINOPLASTY SUP-853-465 CDM 270010020 LOCAL 0270 RC outpatient 270.4 270.4 270.4 74 200.1 percent of total billed charges 270.4 93 219.02 percent of total billed charges 270.4 270.4 other OPPS APC 270.4 270.4 other OPPS APC 270.4 27.63 74.71 percent of total billed charges 270.4 270.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CENTERPIECE TITANIUM L7 MM OD2.6 MM SPINE SELF TAP STAB GRAB COLOR CODED LAMINOPLASTY SUP-853-467 CDM 270010020 LOCAL 0270 RC outpatient 270.4 270.4 270.4 74 200.1 percent of total billed charges 270.4 93 219.02 percent of total billed charges 270.4 270.4 other OPPS APC 270.4 270.4 other OPPS APC 270.4 27.63 74.71 percent of total billed charges 270.4 270.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL CENTERPIECE TITANIUM L5.5 MM OD1.9 MM TRIFLAT STOP STERILE DISPOSABLE SUP-8530605 CDM 270010020 LOCAL 0270 RC outpatient 551.2 551.2 551.2 74 407.89 percent of total billed charges 551.2 93 446.47 percent of total billed charges 551.2 551.2 other OPPS APC 551.2 551.2 other OPPS APC 551.2 27.63 152.3 percent of total billed charges 551.2 551.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POUCH DRAINAGE PREMIER FLEXTEND LOCK N ROLL COMFORTWEAR POROUS FLAT L12 IN OD2 1/2 IN 1 PIECE CUT TO FIT TAPE LATEX FREE ULTRA CLEAR SUP-8531 CDM 270009218 LOCAL 0270 RC outpatient 2.2 2.2 2.2 74 1.63 percent of total billed charges 2.2 93 1.78 percent of total billed charges 2.2 2.2 other OPPS APC 2.2 2.2 other OPPS APC 2.2 27.63 0.61 percent of total billed charges 2.2 2.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SANOTEX ENVIRONMENTAL SURFACE WIPER 10X12 60 WIPES PER ROLL SUP-85340 CDM outpatient 13 13 13 13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRUT CENTERPIECE 12MM SUP-853910 CDM 270010031 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CENTERPIECE CORTICAL H12 MM SPINE FREEZE DRIED STRUT ALLOGRAFT PLATE FIXATION SYSTEM SUP-853912 CDM 270010031 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL ICAST STAINLESS STEEL PTFE L38 MM L120 CM OD6 MM ODSEC7 FR COVER CATHETER INTRODUCER STERILE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-85412 CDM 0270 RC outpatient 6695 6695 6695 74 4954.3 percent of total billed charges 6695 93 5422.95 percent of total billed charges 6695 6695 other OPPS APC 6695 6695 other OPPS APC 6695 27.63 1849.83 percent of total billed charges 6695 6695 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL ICAST STAINLESS STEEL PTFE L38 MM L120 CM OD7 MM ODSEC7 FR COVER CATHETER INTRODUCER STERILE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-85414 CDM 0270 RC outpatient 6695 6695 6695 74 4954.3 percent of total billed charges 6695 93 5422.95 percent of total billed charges 6695 6695 other OPPS APC 6695 6695 other OPPS APC 6695 27.63 1849.83 percent of total billed charges 6695 6695 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL ICAST STAINLESS STEEL PTFE L59 MM L120 CM OD7 MM ODSEC7 FR COVER CATHETER INTRODUCER STERILE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-85415 CDM 0270 RC outpatient 7215 7215 7215 74 5339.1 percent of total billed charges 7215 93 5844.15 percent of total billed charges 7215 7215 other OPPS APC 7215 7215 other OPPS APC 7215 27.63 1993.5 percent of total billed charges 7215 7215 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL ICAST STAINLESS STEEL PTFE L38 MM L120 CM OD8 MM ODSEC7 FR COVER CATHETER INTRODUCER STERILE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-85416 CDM 0270 RC outpatient 6360.25 6360.25 6360.25 74 4706.59 percent of total billed charges 6360.25 93 5151.8 percent of total billed charges 6360.25 6360.25 other OPPS APC 6360.25 6360.25 other OPPS APC 6360.25 27.63 1757.34 percent of total billed charges 6360.25 6360.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL ICAST PTFE .035 IN L59 MM L120 CM OD8 MM OD7 FR COVERED CATHETER INTRODUCER SUP-85417 CDM 0270 RC outpatient 6998.55 6998.55 6998.55 74 5178.93 percent of total billed charges 6998.55 93 5668.83 percent of total billed charges 6998.55 6998.55 other OPPS APC 6998.55 6998.55 other OPPS APC 6998.55 27.63 1933.7 percent of total billed charges 6998.55 6998.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL ICAST .035IN 22MM 80CM 6MM 6FR SS PTFE DISPOSABLE STERILE COVERED BALLOON EXPANDABLE SUP-85443 CDM 0270 RC outpatient 6342.83 6342.83 6342.83 74 4693.69 percent of total billed charges 6342.83 93 5137.69 percent of total billed charges 6342.83 6342.83 other OPPS APC 6342.83 6342.83 other OPPS APC 6342.83 27.63 1752.52 percent of total billed charges 6342.83 6342.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL ICAST PTFE L16 MM L120 CM OD6 MM ID6 FR COVER ULTRA LOW CROSS PROFILE POWER CRIMP ACCEPTS .035 IN GUIDEWIRE SUP-85452 CDM 0270 RC outpatient 5681 5681 5681 74 4203.94 percent of total billed charges 5681 93 4601.61 percent of total billed charges 5681 5681 other OPPS APC 5681 5681 other OPPS APC 5681 27.63 1569.66 percent of total billed charges 5681 5681 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL ICAST STAINLESS STEEL PTFE L22 MM L120 CM OD6 MM ODSEC6 FR COVER CATHETER INTRODUCER STERILE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-85453 CDM 0270 RC outpatient 6539 6539 6539 74 4838.86 percent of total billed charges 6539 93 5296.59 percent of total billed charges 6539 6539 other OPPS APC 6539 6539 other OPPS APC 6539 27.63 1806.73 percent of total billed charges 6539 6539 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INFUSION PUMP SYNCHROMED .22 UM OD22 GA REFILL NEEDLE FENESTRATED DRAPE FILTER STERILE SUP-8551 CDM 0270 RC outpatient 72.8 72.8 72.8 74 53.87 percent of total billed charges 72.8 93 58.97 percent of total billed charges 72.8 72.8 other OPPS APC 72.8 72.8 other OPPS APC 72.8 27.63 20.11 percent of total billed charges 72.8 72.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 4-0 RB-1 L36 IN 2 ARM MONOFILAMENT BLUE SUP-8557H CDM 0270 RC outpatient 14.08 14.08 14.08 74 10.42 percent of total billed charges 14.08 93 11.4 percent of total billed charges 14.08 14.08 other OPPS APC 14.08 14.08 other OPPS APC 14.08 27.63 3.89 percent of total billed charges 14.08 14.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 3-0 RB-1 L36 IN 2 ARM MONOFILAMENT BLUE SUP-8558H CDM 0270 RC outpatient 14.07 14.07 14.07 74 10.41 percent of total billed charges 14.07 93 11.4 percent of total billed charges 14.07 14.07 other OPPS APC 14.07 14.07 other OPPS APC 14.07 27.63 3.89 percent of total billed charges 14.07 14.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STIMULATOR NERVE VARI-STIM III STANDARD SUBDERMIS HANDHELD LOCATOR SUP-8562010 CDM outpatient 114.92 114.92 114.92 114.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET TUBING COOL POINT L2.6 MR 2 WAY COMMUNICATION IRRIGATION PUMP CATHETER SUP-85785 CDM 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTRATHECAL PUMP REPAIR DRUG DELIVERY SYSTEM SUP-8590-9 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VOLCANO EAGLE EYE PLATINUM IVUS CATHETER SUP-85900P CDM 0481 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 51 961.35 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PASSER SURGICAL ON-Q PAINBUSTER L38 CM CATHETER SUP-8591-38 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER FOR TENOLOCK ANCHOR SUP-8593 CDM 0270 RC outpatient 341.46 341.46 341.46 74 252.68 percent of total billed charges 341.46 93 276.58 percent of total billed charges 341.46 341.46 other OPPS APC 341.46 341.46 other OPPS APC 341.46 27.63 94.35 percent of total billed charges 341.46 341.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 4.5MM CANNULATED SUP-86-00084 CDM 0272 RC outpatient 644 644 644 74 476.56 percent of total billed charges 644 93 521.64 percent of total billed charges 644 644 other OPPS APC 644 644 other OPPS APC 644 27.63 177.94 percent of total billed charges 644 644 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER LOW PROFILE 11MM SUP-86-00090 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM SIGMA 1.5/2/2.5/3 L30 MM OD13 MM KNEE TIBIAL CEMENTED SUP-86-6401 CDM 270010025 LOCAL 0270 RC outpatient 2457 2457 2457 74 1818.18 percent of total billed charges 2457 93 1990.17 percent of total billed charges 2457 2457 other OPPS APC 2457 2457 other OPPS APC 2457 27.63 678.87 percent of total billed charges 2457 2457 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM SIGMA 2/2.5/3 L60 MM OD13 MM KNEE TIBIA CEMENTED SUP-86-6402 CDM 270010025 LOCAL 0270 RC outpatient 2045.16 2045.16 2045.16 74 1513.42 percent of total billed charges 2045.16 93 1656.58 percent of total billed charges 2045.16 2045.16 other OPPS APC 2045.16 2045.16 other OPPS APC 2045.16 27.63 565.08 percent of total billed charges 2045.16 2045.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION STEM PFC SIGMA 4 5 6 L30 MM OD15 MM KNEE TIBIA CEMENTED SUP-86-6403 CDM 270010025 LOCAL 0270 RC outpatient 2510.04 2510.04 2510.04 74 1857.43 percent of total billed charges 2510.04 93 2033.13 percent of total billed charges 2510.04 2510.04 other OPPS APC 2510.04 2510.04 other OPPS APC 2510.04 27.63 693.52 percent of total billed charges 2510.04 2510.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL UNIVERSAL FLUTE L75 MM OD12 MM KNEE PRESS FIT SUP-86-7412 CDM 270010024 LOCAL 0270 RC outpatient 3876.6 3876.6 3876.6 74 2868.68 percent of total billed charges 3876.6 93 3140.05 percent of total billed charges 3876.6 3876.6 other OPPS APC 3876.6 3876.6 other OPPS APC 3876.6 27.63 1071.1 percent of total billed charges 3876.6 3876.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL UNIVERSAL FLUTE L75 MM OD14 MM KNEE PRESS FIT SUP-86-7414 CDM 270010025 LOCAL 0270 RC outpatient 3876.6 3876.6 3876.6 74 2868.68 percent of total billed charges 3876.6 93 3140.05 percent of total billed charges 3876.6 3876.6 other OPPS APC 3876.6 3876.6 other OPPS APC 3876.6 27.63 1071.1 percent of total billed charges 3876.6 3876.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL UNIVERSAL FLUTE L75 MM OD16 MM KNEE PRESS FIT SUP-86-7416 CDM 270010025 LOCAL 0270 RC outpatient 3876.6 3876.6 3876.6 74 2868.68 percent of total billed charges 3876.6 93 3140.05 percent of total billed charges 3876.6 3876.6 other OPPS APC 3876.6 3876.6 other OPPS APC 3876.6 27.63 1071.1 percent of total billed charges 3876.6 3876.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL UNIVERSAL FLUTE 75MM 18MM KNEE PRESS FIT SUP-86-7418 CDM 270010025 LOCAL 0270 RC outpatient 3876.6 3876.6 3876.6 74 2868.68 percent of total billed charges 3876.6 93 3140.05 percent of total billed charges 3876.6 3876.6 other OPPS APC 3876.6 3876.6 other OPPS APC 3876.6 27.63 1071.1 percent of total billed charges 3876.6 3876.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL UNIVERSAL FLUTE L115 MM OD14 MM KNEE PRESS FIT SUP-86-7428 CDM 270010025 LOCAL 0270 RC outpatient 3876.6 3876.6 3876.6 74 2868.68 percent of total billed charges 3876.6 93 3140.05 percent of total billed charges 3876.6 3876.6 other OPPS APC 3876.6 3876.6 other OPPS APC 3876.6 27.63 1071.1 percent of total billed charges 3876.6 3876.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL UNIVERSAL FLUTE L115 MM OD16 MM KNEE PRESS FIT SUP-86-7430 CDM 270010025 LOCAL 0270 RC outpatient 3876.6 3876.6 3876.6 74 2868.68 percent of total billed charges 3876.6 93 3140.05 percent of total billed charges 3876.6 3876.6 other OPPS APC 3876.6 3876.6 other OPPS APC 3876.6 27.63 1071.1 percent of total billed charges 3876.6 3876.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL UNIVERSAL FLUTE L150 MM OD20 MM KNEE PRESS FIT SUP-86-7447 CDM 270010025 LOCAL 0270 RC outpatient 3876.6 3876.6 3876.6 74 2868.68 percent of total billed charges 3876.6 93 3140.05 percent of total billed charges 3876.6 3876.6 other OPPS APC 3876.6 3876.6 other OPPS APC 3876.6 27.63 1071.1 percent of total billed charges 3876.6 3876.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE GRAFTJACKET ACELLULAR DERMAL MATRIX STANDARD L10 CM X W5 CM X H1 MM REGENERATIVE NONMESHED SUP-8600 CDM 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDOTRACHEAL MALLINCKRODT LO-PRO PVC ID4.0 MM NASAL ORAL CUFF TRANSLUCENT MURPHY EYE STERILE LATEX FREE DISPOSABLE WHITE SUP-86045 CDM outpatient 3.73 3.73 3.73 3.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDOTRACHEAL SHILEY LO-PRO 5.5MM WHITE DISPOSABLE STERILE LF NASAL ORAL CUFF MURPHY EYE RADIOPAQUE CATHETER SUP-86048 CDM outpatient 3.42 3.42 3.42 3.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDOTRACHEAL SHILEY LO-PRO 6MM WHITE DISPOSABLE STERILE LF NASAL ORAL CUFF MURPHY EYE RADIOPAQUE CATHETER SUP-86049 CDM outpatient 3.42 3.42 3.42 3.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDOTRACHEAL SHILEY LO-PRO 6.5MM WHITE DISPOSABLE STERILE LF NASAL ORAL CUFF MURPHY EYE RADIOPAQUE CATHETER SUP-86050 CDM outpatient 3.42 3.42 3.42 3.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDOTRACHEAL SHILEY LO-PRO 7MM WHITE DISPOSABLE STERILE LF NASAL ORAL CUFF MURPHY EYE RADIOPAQUE CATHETER SUP-86051 CDM outpatient 3.42 3.42 3.42 3.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDOTRACHEAL MALLINCKRODT LO-PRO 7.5MM WHITE PVC DISPOSABLE STERILE NASAL ORAL CUFF TRANSLUCENT MURPHY EYE SUP-86052 CDM 0270 RC outpatient 3.42 3.42 3.42 74 2.53 percent of total billed charges 3.42 93 2.77 percent of total billed charges 3.42 3.42 other OPPS APC 3.42 3.42 other OPPS APC 3.42 27.63 0.94 percent of total billed charges 3.42 3.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDOTRACHEAL MALLINCKRODT LO-PRO PVC ID8.0 MM NASAL ORAL CUFF TRANSLUCENT MURPHY EYE STERILE LATEX FREE DISPOSABLE WHITE SUP-86053 CDM 0270 RC outpatient 3.42 3.42 3.42 74 2.53 percent of total billed charges 3.42 93 2.77 percent of total billed charges 3.42 3.42 other OPPS APC 3.42 3.42 other OPPS APC 3.42 27.63 0.94 percent of total billed charges 3.42 3.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDOTRACHEAL MALLINCKRODT LO-PRO PVC ID8.5 MM NASAL ORAL CUFF TRANSLUCENT MURPHY EYE STERILE LATEX FREE DISPOSABLE WHITE SUP-86054 CDM outpatient 3.42 3.42 3.42 3.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDOTRACHEAL SHILEY LO-PRO 9MM CLEAR PVC DISPOSABLE STERILE LF NASAL ORAL CUFF MURPHY TIP RADIOPAQUE PRECUT SUP-86055 CDM outpatient 3.42 3.42 3.42 3.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE ALLOMATRIX C CANCELLOUS SMALL 10 ML PUTTY MOLDABLE SUP-860C-1000 CDM 270010031 LOCAL 0270 RC outpatient 3424.2 3424.2 3424.2 74 2533.91 percent of total billed charges 3424.2 93 2773.6 percent of total billed charges 3424.2 3424.2 other OPPS APC 3424.2 3424.2 other OPPS APC 3424.2 27.63 946.11 percent of total billed charges 3424.2 3424.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE ALLOMATRIX C 5CC CANCELLOUS ALLOGRAFT PUTTY MOLDABLE SUP-860C0500 CDM 270010031 LOCAL 0270 RC outpatient 2490.8 2490.8 2490.8 74 1843.19 percent of total billed charges 2490.8 93 2017.55 percent of total billed charges 2490.8 2490.8 other OPPS APC 2490.8 2490.8 other OPPS APC 2490.8 27.63 688.21 percent of total billed charges 2490.8 2490.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 3-0 KS L30 IN MONOFILAMENT BLUE SUP-8622H CDM 0270 RC outpatient 7.73 7.73 7.73 74 5.72 percent of total billed charges 7.73 93 6.26 percent of total billed charges 7.73 7.73 other OPPS APC 7.73 7.73 other OPPS APC 7.73 27.63 2.14 percent of total billed charges 7.73 7.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE MONOPOLAR OD24.5 FR ODSEC26 FR HOOK BIPOLAR SUP-862309 CDM 0270 RC outpatient 854.15 854.15 854.15 74 632.07 percent of total billed charges 854.15 93 691.86 percent of total billed charges 854.15 854.15 other OPPS APC 854.15 854.15 other OPPS APC 854.15 27.63 236 percent of total billed charges 854.15 854.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDOTRACHEAL SHILEY 4.5MM DISPOSABLE STERILE LF PEDIATRIC NASAL ORAL UNCUFF MURPHY EYE SUP-86237 CDM outpatient 2.57 2.57 2.57 2.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDOTRACHEAL SHILEY 5MM DISPOSABLE STERILE LF PEDIATRIC NASAL ORAL UNCUFF MURPHY EYE SUP-86238 CDM outpatient 2.32 2.32 2.32 2.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID 6.5MM NASAL ORAL UNCUFF MAGILL CURVE MURPHY EYE DEHP FREE STERILE LATEX FREE SUP-86241 CDM outpatient 2.32 2.32 2.32 2.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION PREP 3M DURAPREP 26ML 74% ISOPROPYL ALCOHOL 0.7% IODINE POVACRYLEX STERILE SKIN COATED SELF CONTAIN APPLICATOR SUP-8630 CDM 0270 RC outpatient 9.59 9.59 9.59 74 7.1 percent of total billed charges 9.59 93 7.77 percent of total billed charges 9.59 9.59 other OPPS APC 9.59 9.59 other OPPS APC 9.59 27.63 2.65 percent of total billed charges 9.59 9.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION PREP 3M DURAPREP 74% ISOPROPYL ALCOHOL 0.7% IODINE POVACRYLEX 6 ML SKIN 1 COAT SELF CONTAIN APPLICATOR STERILE PREOPERATIVE SUP-8635 CDM 270009184 LOCAL 0270 RC outpatient 2.96 2.96 2.96 74 2.19 percent of total billed charges 2.96 93 2.4 percent of total billed charges 2.96 2.96 other OPPS APC 2.96 2.96 other OPPS APC 2.96 27.63 0.82 percent of total billed charges 2.96 2.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PUMP INTRATHECAL SYNCHROMED II TITANIUM THK.78 IN C20 ML H.78 IN 20 ML RESERVOIR FILTER MESH POUCH PROGRAMMABLE NONSTERILE SUP-8637-20 CDM 0270 RC outpatient 29120 29120 29120 74 21548.8 percent of total billed charges 29120 93 23587.2 percent of total billed charges 29120 29120 other OPPS APC 29120 29120 other OPPS APC 29120 27.63 8045.86 percent of total billed charges 29120 29120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PUMP INTRATHECAL SYNCHROMED II TITANIUM THK1 IN .22 UM H1 IN OD3.4 IN 40 ML 6.2-7.6 OZ PROGRAMMABLE RADIOPAQUE IDENTIFIER BACTERIAL RETENTIVE FILTER SILICONE SEPTUM STERILE SUP-8637-40 CDM 0270 RC outpatient 29120 29120 29120 74 21548.8 percent of total billed charges 29120 93 23587.2 percent of total billed charges 29120 29120 other OPPS APC 29120 29120 other OPPS APC 29120 27.63 8045.86 percent of total billed charges 29120 29120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE MULTIPASS 3-0 PS-1 L18 IN MONOFILAMENT BLUE SUP-8663G CDM 0270 RC outpatient 12.56 12.56 12.56 74 9.29 percent of total billed charges 12.56 93 10.17 percent of total billed charges 12.56 12.56 other OPPS APC 12.56 12.56 other OPPS APC 12.56 27.63 3.47 percent of total billed charges 12.56 12.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE AUGMENTATION ALLOPURE EVANS ALLOTRUE BICORTICAL L20 MM X W22 MM X H10 MM H5.5 MM FOOT ANKLE ALLOGRAFT SUP-86661000 CDM 270010031 LOCAL 0270 RC outpatient 9269 9269 9269 74 6859.06 percent of total billed charges 9269 93 7507.89 percent of total billed charges 9269 9269 other OPPS APC 9269 9269 other OPPS APC 9269 27.63 2561.02 percent of total billed charges 9269 9269 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE AUGMENTATION EVANS ALLOPURE PLUS L20 MM X W22 MM X H12 MM CORTICOCANCELLOUS BONE ALLOGRAFT STERILE OSTEOTOMY SUP-86661200 CDM 270010031 LOCAL 0270 RC outpatient 9269 9269 9269 74 6859.06 percent of total billed charges 9269 93 7507.89 percent of total billed charges 9269 9269 other OPPS APC 9269 9269 other OPPS APC 9269 27.63 2561.02 percent of total billed charges 9269 9269 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ULTRASOUND VISIONS PV 3.4FR 135CM TAPERED TIP OTW PERIPHERAL GLYDX PLATINUM HYDROPHILIC F/IVUS IMAGING NON-RADIOLUCENT 0.018IN GW SUP-86700 CDM 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC SEXTANT TITANIUM SPINE BLUNT INSTRUMENT DISPOSABLE ROD INSERTION SYSTEM SUP-8670001 CDM 270010020 LOCAL 0270 RC outpatient 239.2 239.2 239.2 74 177.01 percent of total billed charges 239.2 93 193.75 percent of total billed charges 239.2 239.2 other OPPS APC 239.2 239.2 other OPPS APC 239.2 27.63 66.09 percent of total billed charges 239.2 239.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC CD HORIZON TITANIUM SPINE SHARP DISPOSABLE ROD INSERTION SYSTEM SUP-8670002 CDM 270010020 LOCAL 0270 RC outpatient 239.2 239.2 239.2 74 177.01 percent of total billed charges 239.2 93 193.75 percent of total billed charges 239.2 239.2 other OPPS APC 239.2 239.2 other OPPS APC 239.2 27.63 66.09 percent of total billed charges 239.2 239.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CD HORIZON SEXTANT STANDARD CONTOUR PREBENT 50MM 5.5MM TITANIUM PRECUT SUP-8672050 CDM 270010020 LOCAL 0270 RC outpatient 742.56 742.56 742.56 74 549.49 percent of total billed charges 742.56 93 601.47 percent of total billed charges 742.56 742.56 other OPPS APC 742.56 742.56 other OPPS APC 742.56 27.63 205.17 percent of total billed charges 742.56 742.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE MULTIPASS 4-0 PS-2 18IN BLUE MONOFILAMENT SUP-8682G CDM 0270 RC outpatient 13.35 13.35 13.35 74 9.88 percent of total billed charges 13.35 93 10.81 percent of total billed charges 13.35 13.35 other OPPS APC 13.35 13.35 other OPPS APC 13.35 27.63 3.69 percent of total billed charges 13.35 13.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 3-0 FS-1 L18 IN MONOFILAMENT BLUE SUP-8684G CDM 0270 RC outpatient 7.67 7.67 7.67 74 5.68 percent of total billed charges 7.67 93 6.21 percent of total billed charges 7.67 7.67 other OPPS APC 7.67 7.67 other OPPS APC 7.67 27.63 2.12 percent of total billed charges 7.67 7.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 2-0 FS L18 IN MONOFILAMENT BLUE SUP-8685H CDM 0270 RC outpatient 6.43 6.43 6.43 74 4.76 percent of total billed charges 6.43 93 5.21 percent of total billed charges 6.43 6.43 other OPPS APC 6.43 6.43 other OPPS APC 6.43 27.63 1.78 percent of total billed charges 6.43 6.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE MULTIPASS 3-0 PS-2 18IN BLUE MONOFILAMENT SUP-8687H CDM 0270 RC outpatient 13.22 13.22 13.22 74 9.78 percent of total billed charges 13.22 93 10.71 percent of total billed charges 13.22 13.22 other OPPS APC 13.22 13.22 other OPPS APC 13.22 27.63 3.65 percent of total billed charges 13.22 13.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL COCR L500 MM OD5.5 MM SUP-8690024 CDM 270010020 LOCAL 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CD HORIZON LEGACY TITANIUM L210 MM OD5.5 MM SPINE MULTIAXIAL 5.5 MM LINED ROD SUP-869021 CDM 270010020 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 0 FSLX L30 IN MONOFILAMENT BLUE SUP-8690H CDM 0270 RC outpatient 7.87 7.87 7.87 74 5.82 percent of total billed charges 7.87 93 6.37 percent of total billed charges 7.87 7.87 other OPPS APC 7.87 7.87 other OPPS APC 7.87 27.63 2.17 percent of total billed charges 7.87 7.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE MULTIPASS 6-0 P-3 18IN BLUE MONOFILAMENT SUP-8695G CDM 0270 RC outpatient 14.67 14.67 14.67 74 10.86 percent of total billed charges 14.67 93 11.88 percent of total billed charges 14.67 14.67 other OPPS APC 14.67 14.67 other OPPS APC 14.67 27.63 4.05 percent of total billed charges 14.67 14.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE PROLENE 7-0 P-1 18IN MONOFILAMENT BLUE NONABSORBABLE SUP-8696G CDM 0270 RC outpatient 14.02 14.02 14.02 74 10.37 percent of total billed charges 14.02 93 11.36 percent of total billed charges 14.02 14.02 other OPPS APC 14.02 14.02 other OPPS APC 14.02 27.63 3.87 percent of total billed charges 14.02 14.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 6-0 P-1 L18 IN MONOFILAMENT BLUE SUP-8697G CDM 0270 RC outpatient 14.58 14.58 14.58 74 10.79 percent of total billed charges 14.58 93 11.81 percent of total billed charges 14.58 14.58 other OPPS APC 14.58 14.58 other OPPS APC 14.58 27.63 4.03 percent of total billed charges 14.58 14.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE MULTIPASS 5-0 P-3 18IN BLUE MONOFILAMENT SUP-8698G CDM 0270 RC outpatient 11.8 11.8 11.8 74 8.73 percent of total billed charges 11.8 93 9.56 percent of total billed charges 11.8 11.8 other OPPS APC 11.8 11.8 other OPPS APC 11.8 27.63 3.26 percent of total billed charges 11.8 11.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE MULTIPASS 4-0 P-3 18IN BLUE MONOFILAMENT SUP-8699G CDM 0270 RC outpatient 13.6 13.6 13.6 74 10.06 percent of total billed charges 13.6 93 11.02 percent of total billed charges 13.6 13.6 other OPPS APC 13.6 13.6 other OPPS APC 13.6 27.63 3.76 percent of total billed charges 13.6 13.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 7-0 BV-1 L30 IN 2 ARM MONOFILAMENT BLUE SUP-8703H CDM 0270 RC outpatient 44.06 44.06 44.06 74 32.6 percent of total billed charges 44.06 93 35.69 percent of total billed charges 44.06 44.06 other OPPS APC 44.06 44.06 other OPPS APC 44.06 27.63 12.17 percent of total billed charges 44.06 44.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 6-0 C-1 L30 IN 2 ARM MONOFILAMENT BLUE SUP-8706H CDM 0270 RC outpatient 37.61 37.61 37.61 74 27.83 percent of total billed charges 37.61 93 30.46 percent of total billed charges 37.61 37.61 other OPPS APC 37.61 37.61 other OPPS APC 37.61 27.63 10.39 percent of total billed charges 37.61 37.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 6-0 BV-1 L30 IN 2 ARM MONOFILAMENT BLUE SUP-8709H CDM 0270 RC outpatient 42.59 42.59 42.59 74 31.52 percent of total billed charges 42.59 93 34.5 percent of total billed charges 42.59 42.59 other OPPS APC 42.59 42.59 other OPPS APC 42.59 27.63 11.77 percent of total billed charges 42.59 42.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 5-0 C-1 L36 IN 2 ARM MONOFILAMENT BLUE SUP-8720H CDM 0270 RC outpatient 33.95 33.95 33.95 74 25.12 percent of total billed charges 33.95 93 27.5 percent of total billed charges 33.95 33.95 other OPPS APC 33.95 33.95 other OPPS APC 33.95 27.63 9.38 percent of total billed charges 33.95 33.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 5-0 C-1 L36 IN 2 ARM MONOFILAMENT BLUE SUP-8720ZH CDM 0270 RC outpatient 35.47 35.47 35.47 74 26.25 percent of total billed charges 35.47 93 28.73 percent of total billed charges 35.47 35.47 other OPPS APC 35.47 35.47 other OPPS APC 35.47 27.63 9.8 percent of total billed charges 35.47 35.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE MULTIPASS 8-0 BV130-5 24IN BLUE 2 ARM MONOFILAMENT SUP-8732H CDM 0270 RC outpatient 62 62 62 74 45.88 percent of total billed charges 62 93 50.22 percent of total billed charges 62 62 other OPPS APC 62 62 other OPPS APC 62 27.63 17.13 percent of total billed charges 62 62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE PROLENE 7/0 24IN BV175-6 SUP-8735H CDM 0270 RC outpatient 62 62 62 74 45.88 percent of total billed charges 62 93 50.22 percent of total billed charges 62 62 other OPPS APC 62 62 other OPPS APC 62 27.63 17.13 percent of total billed charges 62 62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER SURGICAL CORNERSTONE SR D11 MM OD5 MM DISPOSABLE MIDAS G8 SUP-874-405 CDM 0270 RC outpatient 460.2 460.2 460.2 74 340.55 percent of total billed charges 460.2 93 372.76 percent of total billed charges 460.2 460.2 other OPPS APC 460.2 460.2 other OPPS APC 460.2 27.63 127.15 percent of total billed charges 460.2 460.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER SURGICAL CORNERSTONE SR D11 MM OD5 MM DISPOSABLE BM SUP-874-425 CDM 0270 RC outpatient 741 741 741 74 548.34 percent of total billed charges 741 93 600.21 percent of total billed charges 741 741 other OPPS APC 741 741 other OPPS APC 741 27.63 204.74 percent of total billed charges 741 741 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER POWER SPINAL CORNERSTONE SR F BLACK MAX DIAMOND 8 X 11MM SUP-874-428 CDM 0270 RC outpatient 673.4 673.4 673.4 74 498.32 percent of total billed charges 673.4 93 545.45 percent of total billed charges 673.4 673.4 other OPPS APC 673.4 673.4 other OPPS APC 673.4 27.63 186.06 percent of total billed charges 673.4 673.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER SURGICAL CORNERSTONE SR D11 MM L14 MM OD5 MM DISPOSABLE ML SUP-874-455 CDM 270010020 LOCAL 0270 RC outpatient 522.5 522.5 522.5 74 386.65 percent of total billed charges 522.5 93 423.23 percent of total billed charges 522.5 522.5 other OPPS APC 522.5 522.5 other OPPS APC 522.5 27.63 144.37 percent of total billed charges 522.5 522.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER SURGICAL CORNERSTONE SR D11 MM L14 MM OD6 MM DISPOSABLE ML SUP-874-456 CDM 270010020 LOCAL 0270 RC outpatient 816.4 816.4 816.4 74 604.14 percent of total billed charges 816.4 93 661.28 percent of total billed charges 816.4 816.4 other OPPS APC 816.4 816.4 other OPPS APC 816.4 27.63 225.57 percent of total billed charges 816.4 816.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER SURGICAL CORNERSTONE SR D11 MM L14 MM OD7 MM DISPOSABLE ML SUP-874-457 CDM 270010020 LOCAL 0270 RC outpatient 653.12 653.12 653.12 74 483.31 percent of total billed charges 653.12 93 529.03 percent of total billed charges 653.12 653.12 other OPPS APC 653.12 653.12 other OPPS APC 653.12 27.63 180.46 percent of total billed charges 653.12 653.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER SURGICAL CORNERSTONE SR D11 MM L14 MM OD8 MM DISPOSABLE ML SUP-874-458 CDM 270010020 LOCAL 0270 RC outpatient 816.4 816.4 816.4 74 604.14 percent of total billed charges 816.4 93 661.28 percent of total billed charges 816.4 816.4 other OPPS APC 816.4 816.4 other OPPS APC 816.4 27.63 225.57 percent of total billed charges 816.4 816.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS TITANIUM LOW PROFILE L23 MM SPINE CERVICAL ANTERIOR LOCK STERILE SUP-876-123 CDM 270010020 LOCAL 0270 RC outpatient 2444.47 2444.47 2444.47 74 1808.91 percent of total billed charges 2444.47 93 1980.02 percent of total billed charges 2444.47 2444.47 other OPPS APC 2444.47 2444.47 other OPPS APC 2444.47 27.63 675.41 percent of total billed charges 2444.47 2444.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE CERVICAL ANTERIOR ATLANTIS 30MM SUP-876-130 CDM 270010020 LOCAL 0270 RC outpatient 3250 3250 3250 74 2405 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 3250 other OPPS APC 3250 3250 other OPPS APC 3250 27.63 897.98 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS TITANIUM LOW PROFILE L42.5 MM SPINE CERVICAL ANTERIOR LOCK STERILE SUP-876-142 CDM 270010020 LOCAL 0270 RC outpatient 2.6 2.6 2.6 74 1.92 percent of total billed charges 2.6 93 2.11 percent of total billed charges 2.6 2.6 other OPPS APC 2.6 2.6 other OPPS APC 2.6 27.63 0.72 percent of total billed charges 2.6 2.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS TITANIUM L67.5 MM SPINE CERVICAL ANTERIOR LOCK LOW PROFILE STERILE SUP-876-167 CDM 270010020 LOCAL 0270 RC outpatient 6112.65 6112.65 6112.65 74 4523.36 percent of total billed charges 6112.65 93 4951.25 percent of total billed charges 6112.65 6112.65 other OPPS APC 6112.65 6112.65 other OPPS APC 6112.65 27.63 1688.93 percent of total billed charges 6112.65 6112.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN HOLDING ATLANTIS TITANIUM SPINE CERVICAL ANTERIOR PLATE STERILE SUP-876-404 CDM 270010020 LOCAL 0270 RC outpatient 335.4 335.4 335.4 74 248.2 percent of total billed charges 335.4 93 271.67 percent of total billed charges 335.4 335.4 other OPPS APC 335.4 335.4 other OPPS APC 335.4 27.63 92.67 percent of total billed charges 335.4 335.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL ATLANTIS OD13 MM SPINE TRI FLAT STERILE DISPOSABLE SUP-876-443 CDM 270010020 LOCAL 0270 RC outpatient 790.4 790.4 790.4 74 584.9 percent of total billed charges 790.4 93 640.22 percent of total billed charges 790.4 790.4 other OPPS APC 790.4 790.4 other OPPS APC 790.4 27.63 218.39 percent of total billed charges 790.4 790.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L13 MM OD4 MM SPINE CERVICAL CANCELLOUS ANTERIOR FIX ANGLE SELF TAP STERILE GRAY SUP-876-713 CDM 270010020 LOCAL 0270 RC outpatient 562.48 562.48 562.48 74 416.24 percent of total billed charges 562.48 93 455.61 percent of total billed charges 562.48 562.48 other OPPS APC 562.48 562.48 other OPPS APC 562.48 27.63 155.41 percent of total billed charges 562.48 562.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L15 MM OD4 MM SPINE CERVICAL CANCELLOUS ANTERIOR FIX ANGLE SELF TAP STERILE GRAY SUP-876-715 CDM 270010013 LOCAL 0270 RC outpatient 562.48 562.48 562.48 74 416.24 percent of total billed charges 562.48 93 455.61 percent of total billed charges 562.48 562.48 other OPPS APC 562.48 562.48 other OPPS APC 562.48 27.63 155.41 percent of total billed charges 562.48 562.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L16 MM OD4 MM SPINE CERVICAL CANCELLOUS ANTERIOR FIX ANGLE SELF TAP STERILE GRAY SUP-876-716 CDM 270010020 LOCAL 0270 RC outpatient 562.48 562.48 562.48 74 416.24 percent of total billed charges 562.48 93 455.61 percent of total billed charges 562.48 562.48 other OPPS APC 562.48 562.48 other OPPS APC 562.48 27.63 155.41 percent of total billed charges 562.48 562.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L17 MM OD4 MM SPINE CERVICAL CANCELLOUS ANTERIOR FIX ANGLE SELF TAP STERILE GRAY SUP-876-717 CDM 270010020 LOCAL 0270 RC outpatient 562.48 562.48 562.48 74 416.24 percent of total billed charges 562.48 93 455.61 percent of total billed charges 562.48 562.48 other OPPS APC 562.48 562.48 other OPPS APC 562.48 27.63 155.41 percent of total billed charges 562.48 562.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L16 MM OD4 MM SPINE CERVICAL CANCELLOUS ANTERIOR VARIABLE ANGLE SELF TAP STERILE GREEN SUP-876-816 CDM 270010020 LOCAL 0270 RC outpatient 562.48 562.48 562.48 74 416.24 percent of total billed charges 562.48 93 455.61 percent of total billed charges 562.48 562.48 other OPPS APC 562.48 562.48 other OPPS APC 562.48 27.63 155.41 percent of total billed charges 562.48 562.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ATLANTIS TITANIUM L17 MM OD4 MM SPINE CERVICAL CANCELLOUS ANTERIOR VARIABLE ANGLE SELF TAP STERILE GREEN SUP-876-817 CDM 270010020 LOCAL 0270 RC outpatient 562.48 562.48 562.48 74 416.24 percent of total billed charges 562.48 93 455.61 percent of total billed charges 562.48 562.48 other OPPS APC 562.48 562.48 other OPPS APC 562.48 27.63 155.41 percent of total billed charges 562.48 562.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INTRATHECAL ASCENDA SILICONE L114 CM L86 CM OD4 FR ID.5 MM 2 PIECE CONNECTOR PIN FLEXIBLE CLOSE TIP STERILE DISPOSABLE SUP-8780 CDM 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ZEPHIR TITANIUM L13 MM OD3.5 MM SPINE CERVICAL CANCELLOUS ANTERIOR SELF TAP STERILE SUP-8792113 CDM 270010020 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ZEPHIR TITANIUM L13 MM OD4 MM SPINE CERVICAL CANCELLOUS ANTERIOR VARIABLE ANGLE SELF TAP STERILE SUP-8792713 CDM 270010020 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MEDTRONIC 3.5MM X 15MM SUP-8792815 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ZEPHIR TITANIUM SMALL L13 MM OD4 MM SPINE CERVICAL CANCELLOUS ANTERIOR VARIABLE ANGLE SELF DRILL STERILE SUP-8792913 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ZEPHIR TITANIUM SMALL L15 MM OD4 MM SPINE CERVICAL CANCELLOUS ANTERIOR VARIABLE ANGLE SELF DRILL STERILE SUP-8792915 CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION ZEPHIR SPINE CERVICAL ANTERIOR PREFIXATION DISPOSABLE SUP-8796003 CDM 270010020 LOCAL 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL ZEPHIR L11 MM OD2 MM SPINE TRIFLAT STERILE SUP-8796909 CDM 270010020 LOCAL 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ZEPHIR TITANIUM L22.5 MM SPINE CERVICAL ANTERIOR INTEGRATE LOCK MECHANISM NONSTERILE SUP-8799022 CDM 270010020 LOCAL 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ZEPHIR TITANIUM L40 MM SPINE CERVICAL ANTERIOR INTEGRATE LOCK MECHANISM SUP-8799140 CDM 270010020 LOCAL 0270 RC outpatient 2990 2990 2990 74 2212.6 percent of total billed charges 2990 93 2421.9 percent of total billed charges 2990 2990 other OPPS APC 2990 2990 other OPPS APC 2990 27.63 826.14 percent of total billed charges 2990 2990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ZEPHIR TITANIUM L52.5 MM SPINE CERVICAL ANTERIOR INTEGRATE LOCK MECHANISM SUP-8799152 CDM 270010020 LOCAL 0270 RC outpatient 4160 4160 4160 74 3078.4 percent of total billed charges 4160 93 3369.6 percent of total billed charges 4160 4160 other OPPS APC 4160 4160 other OPPS APC 4160 27.63 1149.41 percent of total billed charges 4160 4160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE MEDTRONIC ZEPHIR 57.5MM SUP-8799157 CDM 270010020 LOCAL 0270 RC outpatient 4550 4550 4550 74 3367 percent of total billed charges 4550 93 3685.5 percent of total billed charges 4550 4550 other OPPS APC 4550 4550 other OPPS APC 4550 27.63 1257.17 percent of total billed charges 4550 4550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY STERLIZATION SPHERES SUP-8801075 CDM 0270 RC outpatient 190.81 190.81 190.81 74 141.2 percent of total billed charges 190.81 93 154.56 percent of total billed charges 190.81 190.81 other OPPS APC 190.81 190.81 other OPPS APC 190.81 27.63 52.72 percent of total billed charges 190.81 190.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL ORTHO LOWER EXTREMITY SUP-88041 CDM 0270 RC outpatient 58.1 58.1 58.1 74 42.99 percent of total billed charges 58.1 93 47.06 percent of total billed charges 58.1 58.1 other OPPS APC 58.1 58.1 other OPPS APC 58.1 27.63 16.05 percent of total billed charges 58.1 58.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING OSTOMY BAG ADAPT CERARING CERAMIDE 2 IN W 4.5 MM FLEXTEND M LATEX FREE DISPOSABLE SUP-8805 CDM 0270 RC outpatient 1.48 1.48 1.48 74 1.1 percent of total billed charges 1.48 93 1.2 percent of total billed charges 1.48 1.48 other OPPS APC 1.48 1.48 other OPPS APC 1.48 27.63 0.41 percent of total billed charges 1.48 1.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 6-0 BV-1 L24 IN 2 ARM MONOFILAMENT BLUE SUP-8805H CDM 0270 RC outpatient 42.59 42.59 42.59 74 31.52 percent of total billed charges 42.59 93 34.5 percent of total billed charges 42.59 42.59 other OPPS APC 42.59 42.59 other OPPS APC 42.59 27.63 11.77 percent of total billed charges 42.59 42.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PERITONEAL DIALYSIS TENCKHOFF BETA-CAP ARGYLE SILICONE L42 CM OD15 FR 2 CUFF CLAMP ADAPTER RADIOPAQUE SUP-8810888003 CDM 270009028 LOCAL 0270 RC outpatient 49.8 49.8 49.8 74 36.85 percent of total billed charges 49.8 93 40.34 percent of total billed charges 49.8 49.8 other OPPS APC 49.8 49.8 other OPPS APC 49.8 27.63 13.76 percent of total billed charges 49.8 49.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8817791002 TUNNELING DEVICE KIT SUP-8817791002 CDM 0270 RC outpatient 408.64 408.64 408.64 74 302.39 percent of total billed charges 408.64 93 331 percent of total billed charges 408.64 408.64 other OPPS APC 408.64 408.64 other OPPS APC 408.64 27.63 112.91 percent of total billed charges 408.64 408.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 3-0 MH L36 IN 2 ARM MONOFILAMENT BLUE SUP-8842H CDM 0270 RC outpatient 13.75 13.75 13.75 74 10.18 percent of total billed charges 13.75 93 11.14 percent of total billed charges 13.75 13.75 other OPPS APC 13.75 13.75 other OPPS APC 13.75 27.63 3.8 percent of total billed charges 13.75 13.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 1 XLH 60IN BLUE MONOFILAMENT SUP-8845G CDM 0270 RC outpatient 9.09 9.09 9.09 74 6.73 percent of total billed charges 9.09 93 7.36 percent of total billed charges 9.09 9.09 other OPPS APC 9.09 9.09 other OPPS APC 9.09 27.63 2.51 percent of total billed charges 9.09 9.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE 0 CT-2 27IN BROWN CHROMIC MONOFILAMENT SUP-884H CDM 0270 RC outpatient 7.11 7.11 7.11 74 5.26 percent of total billed charges 7.11 93 5.76 percent of total billed charges 7.11 7.11 other OPPS APC 7.11 7.11 other OPPS APC 7.11 27.63 1.96 percent of total billed charges 7.11 7.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 2-0 MH L48 IN 2 ARM MONOFILAMENT BLUE SUP-8853H CDM 0270 RC outpatient 13.58 13.58 13.58 74 10.05 percent of total billed charges 13.58 93 11 percent of total billed charges 13.58 13.58 other OPPS APC 13.58 13.58 other OPPS APC 13.58 27.63 3.75 percent of total billed charges 13.58 13.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE CHROMIC 1 CT-2 L27 IN MONOFILAMENT SUP-885H CDM 0270 RC outpatient 6.94 6.94 6.94 74 5.14 percent of total billed charges 6.94 93 5.62 percent of total billed charges 6.94 6.94 other OPPS APC 6.94 6.94 other OPPS APC 6.94 27.63 1.92 percent of total billed charges 6.94 6.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 4-0 BB L24 IN 2 ARM MONOFILAMENT BLUE SUP-8861H CDM 0270 RC outpatient 14.52 14.52 14.52 74 10.74 percent of total billed charges 14.52 93 11.76 percent of total billed charges 14.52 14.52 other OPPS APC 14.52 14.52 other OPPS APC 14.52 27.63 4.01 percent of total billed charges 14.52 14.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL LAP BAND PENINSULA REGIONAL MEDICAL CENTER SUP-88750-013 CDM 0270 RC outpatient 320.09 320.09 320.09 74 236.87 percent of total billed charges 320.09 93 259.27 percent of total billed charges 320.09 320.09 other OPPS APC 320.09 320.09 other OPPS APC 320.09 27.63 88.44 percent of total billed charges 320.09 320.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING PETROLATUM VASELINE GAUZE L72 IN X W1/2 IN NONADHERENT FINE MESH NONTOXIC NONIRRITATE STERILE WHITE SUP-8884421600 CDM 0270 RC outpatient 2.68 2.68 2.68 74 1.98 percent of total billed charges 2.68 93 2.17 percent of total billed charges 2.68 2.68 other OPPS APC 2.68 2.68 other OPPS APC 2.68 27.63 0.74 percent of total billed charges 2.68 2.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING PETROLATUM VASELINE CISION 18X3IN WHITE GAUZE STERILE LF ABSORBENT NONADHERENT FINE MESH NONTOXIC SUP-8884424600 CDM 0270 RC outpatient 2.18 2.18 2.18 74 1.61 percent of total billed charges 2.18 93 1.77 percent of total billed charges 2.18 2.18 other OPPS APC 2.18 2.18 other OPPS APC 2.18 27.63 0.6 percent of total billed charges 2.18 2.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING PETROLATUM VASELINE CISION 8X1IN WHITE GAUZE STERILE LF NONADHERENT FINE MESH NONTOXIC ABSORBENT SUP-8884427601 CDM 0270 RC outpatient 1.7 1.7 1.7 74 1.26 percent of total billed charges 1.7 93 1.38 percent of total billed charges 1.7 1.7 other OPPS APC 1.7 1.7 other OPPS APC 1.7 27.63 0.47 percent of total billed charges 1.7 1.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING PETROLATUM XEROFORM 3% BISMUTH TRIBROMOPHENATE GAUZE L8 IN X W1 IN NONADHERENT OCCLUSIVE BACTERIOSTATIC LOW PROFILE STERILE LATEX FREE SUP-8884433301 CDM 0270 RC outpatient 1.39 1.39 1.39 74 1.03 percent of total billed charges 1.39 93 1.13 percent of total billed charges 1.39 1.39 other OPPS APC 1.39 1.39 other OPPS APC 1.39 27.63 0.38 percent of total billed charges 1.39 1.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING PETROLATUM XEROFORM 3% BISMUTH TRIBROMOPHENATE GAUZE L9 IN X W5 IN NONADHERENT BACTERIOSTATIC STRIP LOW PROFILE STERILE SUP-8884433605 CDM 0270 RC outpatient 1.12 1.12 1.12 74 0.83 percent of total billed charges 1.12 93 0.91 percent of total billed charges 1.12 1.12 other OPPS APC 1.12 1.12 other OPPS APC 1.12 27.63 0.31 percent of total billed charges 1.12 1.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE GASTROSTOMY KANGAROO 16FR 20ML SILICONE Y PORT GRADUATE SHAFT ROUND TIP OPEN DISTAL END SUP-8884720163 CDM 0270 RC outpatient 18.75 18.75 18.75 74 13.88 percent of total billed charges 18.75 93 15.19 percent of total billed charges 18.75 18.75 other OPPS APC 18.75 18.75 other OPPS APC 18.75 27.63 5.18 percent of total billed charges 18.75 18.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE GASTROSTOMY KANGAROO LONG TERM FEEDING 16FR 20ML BALLOON ENTERAL ROUND FLUSH TIP/SKIN DISC RAISED FEET ENFIT Y-PORT PURPLE SILICONE LATEX-FREE DEHP-FREE STERILE 5/CA SUP-8884720163E CDM 0270 RC outpatient 40.36 40.36 40.36 74 29.87 percent of total billed charges 40.36 93 32.69 percent of total billed charges 40.36 40.36 other OPPS APC 40.36 40.36 other OPPS APC 40.36 27.63 11.15 percent of total billed charges 40.36 40.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE GASTROSTOMY KANGAROO 18FR 20ML SILICONE Y PORT GRADUATE SHAFT ROUND TIP OPEN DISTAL END SUP-8884720189 CDM 0270 RC outpatient 40.95 40.95 40.95 74 30.3 percent of total billed charges 40.95 93 33.17 percent of total billed charges 40.95 40.95 other OPPS APC 40.95 40.95 other OPPS APC 40.95 27.63 11.31 percent of total billed charges 40.95 40.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE GASTROSTOMY KANGAROO LONG TERM FEEDING 18FR 20ML BALLOON ENTERAL ROUND FLUSH TIP/SKIN DISC RAISED FEET ENFIT Y-PORT PURPLE SILICONE LATEX-FREE DEHP-FREE STERILE 5/CA SUP-8884720189E CDM 0270 RC outpatient 40.36 40.36 40.36 74 29.87 percent of total billed charges 40.36 93 32.69 percent of total billed charges 40.36 40.36 other OPPS APC 40.36 40.36 other OPPS APC 40.36 27.63 11.15 percent of total billed charges 40.36 40.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE GASTROSTOMY KANGAROO LONG TERM FEEDING 20FR 20ML BALLOON ENTERAL ROUND FLUSH TIP/SKIN DISC RAISED FEET ENFIT Y-PORT PURPLE SILICONE LATEX-FREE DEHP-FREE STERILE 5/CA SUP-8884720205E CDM 270009103 LOCAL 0270 RC outpatient 40.36 40.36 40.36 74 29.87 percent of total billed charges 40.36 93 32.69 percent of total billed charges 40.36 40.36 other OPPS APC 40.36 40.36 other OPPS APC 40.36 27.63 11.15 percent of total billed charges 40.36 40.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE NASOGASTRIC KANGAROO ENTRIFLEX FEEDING 8FR 43IN ADULT ENTERAL 3GM WEIGHTED ENFIT RIGID 2-PORT STYLET STANDARD TIP PURPLE POLYURETHANE LATEX-FREE DEHP-FREE MRI CONDITIONAL NON-RADIOLUCENT NON-STERILE 10/CA SUP-8884720858E CDM 270009048 LOCAL 0270 RC outpatient 22.42 22.42 22.42 74 16.59 percent of total billed charges 22.42 93 18.16 percent of total billed charges 22.42 22.42 other OPPS APC 22.42 22.42 other OPPS APC 22.42 27.63 6.19 percent of total billed charges 22.42 22.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE NASOGASTRIC KANGAROO 43IN 10FR PURPLE POLYURETHANE 5GM Y PORT WEIGHT TIP STYLET SUP-8884721088 CDM 270009048 LOCAL 0270 RC outpatient 21 21 21 74 15.54 percent of total billed charges 21 93 17.01 percent of total billed charges 21 21 other OPPS APC 21 21 other OPPS APC 21 27.63 5.8 percent of total billed charges 21 21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE NASOGASTRIC KANGAROO ENTRIFLEX FEEDING 10FR 43IN ADULT ENTERAL 5GM WEIGHTED ENFIT RIGID 2-PORT STYLET STANDARD TIP PURPLE POLYURETHANE LATEX-FREE DEHP-FREE MRI CONDITIONAL NON-RADIOLUCENT NON-STERILE 10/CA SUP-8884721088E CDM 270009048 LOCAL 0270 RC outpatient 22.42 22.42 22.42 74 16.59 percent of total billed charges 22.42 93 18.16 percent of total billed charges 22.42 22.42 other OPPS APC 22.42 22.42 other OPPS APC 22.42 27.63 6.19 percent of total billed charges 22.42 22.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE TI-CRON CARDIOPOINT 2-0 CV-305 L36 IN 2 ARM BRAID 10 STRAND COATED VLUE WHITE SUP-88862981-56 CDM 0270 RC outpatient 327.89 327.89 327.89 74 242.64 percent of total billed charges 327.89 93 265.59 percent of total billed charges 327.89 327.89 other OPPS APC 327.89 327.89 other OPPS APC 327.89 27.63 90.6 percent of total billed charges 327.89 327.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE TI-CRON CARDIOPOINT 2-0CV-331 L30IN 2 ARM BRAID 8 STRAND COATED BLUE WHITE SUP-88863083-56 CDM 0270 RC outpatient 251.37 251.37 251.37 74 186.01 percent of total billed charges 251.37 93 203.61 percent of total billed charges 251.37 251.37 other OPPS APC 251.37 251.37 other OPPS APC 251.37 27.63 69.45 percent of total billed charges 251.37 251.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE TI-CRON CARDIOPOINT 2-0 CV-316 L 30 IN 2 ARM BRAID 10 STRAND COATED BLUE WHITE SUP-88863324-56 CDM 0270 RC outpatient 766.22 766.22 766.22 74 567 percent of total billed charges 766.22 93 620.64 percent of total billed charges 766.22 766.22 other OPPS APC 766.22 766.22 other OPPS APC 766.22 27.63 211.71 percent of total billed charges 766.22 766.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOLSTER SUTURE PLASTIC L1 3/4 IN OD3/16 IN RETENTION STERILE LATEX FREE SUP-8886863112 CDM outpatient 24.66 24.66 24.66 24.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL DOVER BESPAK SILICONE NONPOROUS OD10 FR 3 ML 2 WAY FOLEY REINFORCE TIP LATEX FREE SUP-8887603101 CDM 0270 RC outpatient 13.59 13.59 13.59 74 10.06 percent of total billed charges 13.59 93 11.01 percent of total billed charges 13.59 13.59 other OPPS APC 13.59 13.59 other OPPS APC 13.59 27.63 3.75 percent of total billed charges 13.59 13.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL DOVER SILICONE NONPOROUS L16 IN OD12 FR 5 ML 2 WAY FOLEY REINFORCE TIP LATEX FREE SUP-8887605122 CDM 0270 RC outpatient 18.25 18.25 18.25 74 13.51 percent of total billed charges 18.25 93 14.78 percent of total billed charges 18.25 18.25 other OPPS APC 18.25 18.25 other OPPS APC 18.25 27.63 5.04 percent of total billed charges 18.25 18.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL DOVER SILICONE L16 IN OD14 FR 5 CC 2 WAY FOLEY COLOR CODED INFLATION VALVE REINFORCE TIP LATEX FREE SUP-8887605148 CDM 270009003 LOCAL 0270 RC outpatient 4.9 4.9 4.9 74 3.63 percent of total billed charges 4.9 93 3.97 percent of total billed charges 4.9 4.9 other OPPS APC 4.9 4.9 other OPPS APC 4.9 27.63 1.35 percent of total billed charges 4.9 4.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL DOVER SILICONE NONPOROUS L16 IN OD16 FR 5 CC 2 WAY FOLEY COLOR CODED INFLATION VALVE REINFORCE TIP LATEX FREE SUP-8887605163 CDM 0270 RC outpatient 9.22 9.22 9.22 74 6.82 percent of total billed charges 9.22 93 7.47 percent of total billed charges 9.22 9.22 other OPPS APC 9.22 9.22 other OPPS APC 9.22 27.63 2.55 percent of total billed charges 9.22 9.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL DOVER SILICONE NONPOROUS L16 IN OD18 FR 5 CC 2 WAY FOLEY COLOR CODED INFLATION VALVE REINFORCE TIP LATEX FREE SUP-8887605189 CDM 270009136 LOCAL 0270 RC outpatient 6.47 6.47 6.47 74 4.79 percent of total billed charges 6.47 93 5.24 percent of total billed charges 6.47 6.47 other OPPS APC 6.47 6.47 other OPPS APC 6.47 27.63 1.79 percent of total billed charges 6.47 6.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL DOVER SILICONE L16 IN OD20 FR 5 CC 2 WAY FOLEY COLOR CODED INFLATION VALVE REINFORCE TIP LATEX FREE SUP-8887605205 CDM 270009136 LOCAL 0270 RC outpatient 6.47 6.47 6.47 74 4.79 percent of total billed charges 6.47 93 5.24 percent of total billed charges 6.47 6.47 other OPPS APC 6.47 6.47 other OPPS APC 6.47 27.63 1.79 percent of total billed charges 6.47 6.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY CATHETER ARGYLE SWAN NECK CURL L122.3 CM OD15 FR PRESTERNAL CUFF STERILE LATEX FREE DISPOSABLE SUP-8888111132 CDM 0270 RC outpatient 1034.8 1034.8 1034.8 74 765.75 percent of total billed charges 1034.8 93 838.19 percent of total billed charges 1034.8 1034.8 other OPPS APC 1034.8 1034.8 other OPPS APC 1034.8 27.63 285.92 percent of total billed charges 1034.8 1034.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK CATHETER 36CM 19FR PALINDROME TAL VENATRAC VASCULAR 2 STYLET 2 TISSUE DILATOR SUP-8888119364 CDM 0270 RC outpatient 754 754 754 74 557.96 percent of total billed charges 754 93 610.74 percent of total billed charges 754 754 other OPPS APC 754 754 other OPPS APC 754 27.63 208.33 percent of total billed charges 754 754 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER CENTRAL VENOUS 36CM 19FR HEPARIN TAL PALINDROME EMERALD SPORTPACK VENATRAC SUP-8888119365 CDM 0270 RC outpatient 754 754 754 74 557.96 percent of total billed charges 754 93 610.74 percent of total billed charges 754 754 other OPPS APC 754 754 other OPPS APC 754 27.63 208.33 percent of total billed charges 754 754 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER CENTRAL VENOUS TAL PALINDROME EMERALD HEPARIN L36 CM OD19 FR SPORTPACK VENATRAC SUP-8888119365P CDM 0270 RC outpatient 644.94 644.94 644.94 74 477.26 percent of total billed charges 644.94 93 522.4 percent of total billed charges 644.94 644.94 other OPPS APC 644.94 644.94 other OPPS APC 644.94 27.63 178.2 percent of total billed charges 644.94 644.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK CATHETER 40CM 12FR PALINDROME TAL VENATRAC VASCULAR 2 LUMEN 2 SEAL CAP INSERTION SUP-8888123404 CDM 0270 RC outpatient 754 754 754 74 557.96 percent of total billed charges 754 93 610.74 percent of total billed charges 754 754 other OPPS APC 754 754 other OPPS APC 754 27.63 208.33 percent of total billed charges 754 754 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK CATHETER PALINDROME TAL VENATRAC L40 CM L23 CM OD12 FR VASCULAR 2 LUMEN 2 SEAL CAP INSERTION STYLET TISSUE DILATOR STERILE LATEX FREE SUP-8888123404P CDM 0270 RC outpatient 669.5 669.5 669.5 74 495.43 percent of total billed charges 669.5 93 542.3 percent of total billed charges 669.5 669.5 other OPPS APC 669.5 669.5 other OPPS APC 669.5 27.63 184.98 percent of total billed charges 669.5 669.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER CENTRAL VENOUS TAL PALINDROME EMERALD HEPARIN L40 CM OD23 FR SPORTPACK VENATRAC SUP-8888123405P CDM 0270 RC outpatient 644.94 644.94 644.94 74 477.26 percent of total billed charges 644.94 93 522.4 percent of total billed charges 644.94 644.94 other OPPS APC 644.94 644.94 other OPPS APC 644.94 27.63 178.2 percent of total billed charges 644.94 644.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK CATHETER 45CM 12FR PALINDROME TAL VENATRAC VASCULAR 2 LUMEN 2 SEAL CAP INSERTION SUP-8888128454 CDM 0270 RC outpatient 754 754 754 74 557.96 percent of total billed charges 754 93 610.74 percent of total billed charges 754 754 other OPPS APC 754 754 other OPPS APC 754 27.63 208.33 percent of total billed charges 754 754 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK CATHETER PALINDROME TAL VENATRAC L45 CM L28 CM OD12 FR VASCULAR 2 LUMEN 2 SEAL CAP INSERTION STYLET TISSUE DILATOR STERILE LATEX FREE SUP-8888128454P CDM 0270 RC outpatient 496.68 496.68 496.68 74 367.54 percent of total billed charges 496.68 93 402.31 percent of total billed charges 496.68 496.68 other OPPS APC 496.68 496.68 other OPPS APC 496.68 27.63 137.23 percent of total billed charges 496.68 496.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK CATHETER PALINDROME VENATRAC H-HEPARIN STRAIGHT L45 CM L28 CM OD14.5 FR ODSEC12 FR 2.1 ML OTW INSERTION STYLET SPORTPACK TISSUE DILATOR SEAL CAP STERILE SUP-8888128455P CDM 0270 RC outpatient 644.94 644.94 644.94 74 477.26 percent of total billed charges 644.94 93 522.4 percent of total billed charges 644.94 644.94 other OPPS APC 644.94 644.94 other OPPS APC 644.94 27.63 178.2 percent of total billed charges 644.94 644.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER HEMODIALYSIS PALINDROME VENATRAC L50 CM OD33 FR SPORTPACK SUP-8888133504P CDM 0270 RC outpatient 496.68 496.68 496.68 74 367.54 percent of total billed charges 496.68 93 402.31 percent of total billed charges 496.68 496.68 other OPPS APC 496.68 496.68 other OPPS APC 496.68 27.63 137.23 percent of total billed charges 496.68 496.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT 13.5FR X 16CM MAHURKAR SUP-8888135162 CDM 0270 RC outpatient 1522.46 1522.46 1522.46 74 1126.62 percent of total billed charges 1522.46 93 1233.19 percent of total billed charges 1522.46 1522.46 other OPPS APC 1522.46 1522.46 other OPPS APC 1522.46 27.63 420.66 percent of total billed charges 1522.46 1522.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER MAHURKAR L16 CM OD13.5 FR 2 LUMEN HIGH FLOW PRECURVE EXTENSION HEMODIALYSIS SUP-8888135163 CDM 0270 RC outpatient 193.05 193.05 193.05 74 142.86 percent of total billed charges 193.05 93 156.37 percent of total billed charges 193.05 193.05 other OPPS APC 193.05 193.05 other OPPS APC 193.05 27.63 53.34 percent of total billed charges 193.05 193.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT 13.5FR X 16CM MAHURKAR SUP-8888135168 CDM 0270 RC outpatient 1522.46 1522.46 1522.46 74 1126.62 percent of total billed charges 1522.46 93 1233.19 percent of total billed charges 1522.46 1522.46 other OPPS APC 1522.46 1522.46 other OPPS APC 1522.46 27.63 420.66 percent of total billed charges 1522.46 1522.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER MAHURKAR QPLUS POLYURETHANE L19.5 CM OD13.5 FR STRAIGHT EXTENSION STERILE HEMODIALYSIS SUP-8888135191 CDM 0270 RC outpatient 193.05 193.05 193.05 74 142.86 percent of total billed charges 193.05 93 156.37 percent of total billed charges 193.05 193.05 other OPPS APC 193.05 193.05 other OPPS APC 193.05 27.63 53.34 percent of total billed charges 193.05 193.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER MAHURKAR POLYURETHANE .038 IN STRAIGHT J L19.5 CM L70 CM OD13.5 FR 1.7 ML 2 LUMEN HIGH FLOW CURVE EXTENSION GUIDEWIRE STERILE HEMODIALYSIS SUP-8888135192 CDM 0270 RC outpatient 199.85 199.85 199.85 74 147.89 percent of total billed charges 199.85 93 161.88 percent of total billed charges 199.85 199.85 other OPPS APC 199.85 199.85 other OPPS APC 199.85 27.63 55.22 percent of total billed charges 199.85 199.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT 13.5FR X 24CM MAHURKAR SUP-8888135241 CDM 0270 RC outpatient 193.05 193.05 193.05 74 142.86 percent of total billed charges 193.05 93 156.37 percent of total billed charges 193.05 193.05 other OPPS APC 193.05 193.05 other OPPS APC 193.05 27.63 53.34 percent of total billed charges 193.05 193.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY CATHETER MAHURKAR L24 CM OD13.5 FR 2 LUMEN HIGH FLOW STRAIGHT EXTENSION STERILE HEMODIALYSIS SUP-8888135247 CDM 270009212 LOCAL 0270 RC outpatient 186 186 186 74 137.64 percent of total billed charges 186 93 150.66 percent of total billed charges 186 186 other OPPS APC 186 186 other OPPS APC 186 27.63 51.39 percent of total billed charges 186 186 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER PALINDROME L19 CM OD 14.5 FR TWO LUMEN LATEX FREE SUP-8888145014P CDM 0270 RC outpatient 694.98 694.98 694.98 74 514.29 percent of total billed charges 694.98 93 562.93 percent of total billed charges 694.98 694.98 other OPPS APC 694.98 694.98 other OPPS APC 694.98 27.63 192.02 percent of total billed charges 694.98 694.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER HEMODIALYSIS PALINDROME TAL VENATRAC CARBOTHANE SYMMETRIC L72 CM L55 CM OD14.5 FR 3.1 ML KIT 2 LUMEN SEAL CAP SUP-8888145018P CDM 0270 RC outpatient 694.98 694.98 694.98 74 514.29 percent of total billed charges 694.98 93 562.93 percent of total billed charges 694.98 694.98 other OPPS APC 694.98 694.98 other OPPS APC 694.98 27.63 192.02 percent of total billed charges 694.98 694.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER MAHURKAR ELITE L20 CM OD13.5 FR STRAIGHT EXTENSION SUP-8888211220 CDM 0270 RC outpatient 141.89 141.89 141.89 74 105 percent of total billed charges 141.89 93 114.93 percent of total billed charges 141.89 141.89 other OPPS APC 141.89 141.89 other OPPS APC 141.89 27.63 39.2 percent of total billed charges 141.89 141.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAHURKAR 20CM SUP-8888211220 CDM 0270 RC outpatient 141.89 141.89 141.89 74 105 percent of total billed charges 141.89 93 114.93 percent of total billed charges 141.89 141.89 other OPPS APC 141.89 141.89 other OPPS APC 141.89 27.63 39.2 percent of total billed charges 141.89 141.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER MAHURKAR ELITE L24 CM OD13.5 FR STRAIGHT EXTENSION SUP-8888211224 CDM 0270 RC outpatient 193.05 193.05 193.05 74 142.86 percent of total billed charges 193.05 93 156.37 percent of total billed charges 193.05 193.05 other OPPS APC 193.05 193.05 other OPPS APC 193.05 27.63 53.34 percent of total billed charges 193.05 193.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L24 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS SUP-8888211424 CDM 270009212 LOCAL 0270 RC outpatient 281.32 281.32 281.32 74 208.18 percent of total billed charges 281.32 93 227.87 percent of total billed charges 281.32 281.32 other OPPS APC 281.32 281.32 other OPPS APC 281.32 27.63 77.73 percent of total billed charges 281.32 281.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER MAHURKAR ELITE POLYURETHANE LARGE L16 CM OD13.5 FR 2 LUMEN HIGH FLOW ATRAUMATIC TIP CURVE EXTENSION GREEN HEMODIALYSIS SUP-8888212216 CDM 0270 RC outpatient 141.89 141.89 141.89 74 105 percent of total billed charges 141.89 93 114.93 percent of total billed charges 141.89 141.89 other OPPS APC 141.89 141.89 other OPPS APC 141.89 27.63 39.2 percent of total billed charges 141.89 141.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW ATRAUMATIC TIP CURVE EXTENSION GREEN HEMODIALYSIS SUP-8888212220 CDM 0270 RC outpatient 193.05 193.05 193.05 74 142.86 percent of total billed charges 193.05 93 156.37 percent of total billed charges 193.05 193.05 other OPPS APC 193.05 193.05 other OPPS APC 193.05 27.63 53.34 percent of total billed charges 193.05 193.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY CATHETER HD MAHURKAR ELITE ACUTE PASS 13.5 FR DIAMETER 16 CM 450 ML/MIN CURVED EXTENSION SYMMETRIC TIP SUP-8888212416 CDM 0270 RC outpatient 445.33 445.33 445.33 74 329.54 percent of total billed charges 445.33 93 360.72 percent of total billed charges 445.33 445.33 other OPPS APC 445.33 445.33 other OPPS APC 445.33 27.63 123.04 percent of total billed charges 445.33 445.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER MAHURKAR ELITE POLYURETHANE LARGE L16 CM OD13.5 FR 2 LUMEN HIGH FLOW ATRAUMATIC TIP CURVE EXTENSION GREEN HEMODIALYSIS SUP-8888213216 CDM 0270 RC outpatient 141.89 141.89 141.89 74 105 percent of total billed charges 141.89 93 114.93 percent of total billed charges 141.89 141.89 other OPPS APC 141.89 141.89 other OPPS APC 141.89 27.63 39.2 percent of total billed charges 141.89 141.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE NASOGASTRIC SALEM SUMP PVC L36IN OD 10 FR INTEGRAL FUNNEL CONNECTOR 2 LUMEN 5 IN 1 ADAPTER STERILE LATEX FREE SUP-8888264911 CDM 0270 RC outpatient 2.7 2.7 2.7 74 2 percent of total billed charges 2.7 93 2.19 percent of total billed charges 2.7 2.7 other OPPS APC 2.7 2.7 other OPPS APC 2.7 27.63 0.75 percent of total billed charges 2.7 2.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE NASOGASTRIC SALEM SUMP PVC L 48 IN OD 12 FR INTEGRAL FUNNEL CONNECTOR 2 LUMEN 5 IN 1 ADAPTER STERILE LATEX FREE SUP-8888264929 CDM 0270 RC outpatient 2.7 2.7 2.7 74 2 percent of total billed charges 2.7 93 2.19 percent of total billed charges 2.7 2.7 other OPPS APC 2.7 2.7 other OPPS APC 2.7 27.63 0.75 percent of total billed charges 2.7 2.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE NASOGASTRIC SALEM SUMP PVC L 48 IN OD 14 FR INTEGRAL FUNNEL CONNECTOR 2 LUMEN 5 IN 1 ADAPTER STERILE LATEX FREE SUP-8888264945 CDM 0270 RC outpatient 2.7 2.7 2.7 74 2 percent of total billed charges 2.7 93 2.19 percent of total billed charges 2.7 2.7 other OPPS APC 2.7 2.7 other OPPS APC 2.7 27.63 0.75 percent of total billed charges 2.7 2.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE NASOGASTRIC SALEM SUMP 14FR 48IN STOMACH FUNNEL END 2-LUMEN ENFIT 5-IN-1 ADAPTER SENTINEL EYE PVC LATEX-FREE DEHP-FREE PVC NON-RADIOLUCENT STERILE 50/CA SUP-8888264945E CDM 0270 RC outpatient 5.39 5.39 5.39 74 3.99 percent of total billed charges 5.39 93 4.37 percent of total billed charges 5.39 5.39 other OPPS APC 5.39 5.39 other OPPS APC 5.39 27.63 1.49 percent of total billed charges 5.39 5.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE NASOGASTRIC SALEM SUMP PVC L 48 IN OD 16 FR INTEGRAL CONNECTOR 2 LUMEN 5 IN 1 ADAPTER STERILE LATEX FREE SUP-8888264960 CDM 0270 RC outpatient 2.7 2.7 2.7 74 2 percent of total billed charges 2.7 93 2.19 percent of total billed charges 2.7 2.7 other OPPS APC 2.7 2.7 other OPPS APC 2.7 27.63 0.75 percent of total billed charges 2.7 2.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE NASOGASTRIC SALEM SUMP SENTINEL LINE SENTINEL EYE 48IN 18FR PVC STERILE STOMACH 2 LUMEN DEHP FREE 5IN 1 ADAPTER SUP-8888264986 CDM 0270 RC outpatient 2.7 2.7 2.7 74 2 percent of total billed charges 2.7 93 2.19 percent of total billed charges 2.7 2.7 other OPPS APC 2.7 2.7 other OPPS APC 2.7 27.63 0.75 percent of total billed charges 2.7 2.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE NASOGASTRIC SALEM SUMP 18FR 48IN STOMACH FUNNEL END 2-LUMEN ENFIT 5-IN-1 ADAPTER SENTINEL EYE PVC LATEX-FREE DEHP-FREE PVC NON-RADIOLUCENT STERILE 50/CA SUP-8888264986E CDM 0270 RC outpatient 5.39 5.39 5.39 74 3.99 percent of total billed charges 5.39 93 4.37 percent of total billed charges 5.39 5.39 other OPPS APC 5.39 5.39 other OPPS APC 5.39 27.63 1.49 percent of total billed charges 5.39 5.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE FEEDING TUBE SALEM SUMP PVC ANTIREFLUX STERILE LATEX FREE SUP-8888266197 CDM 0270 RC outpatient 10.03 10.03 10.03 74 7.42 percent of total billed charges 10.03 93 8.12 percent of total billed charges 10.03 10.03 other OPPS APC 10.03 10.03 other OPPS APC 10.03 27.63 2.77 percent of total billed charges 10.03 10.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING SUCTION ARGYLE PVC L1 1/2 FT OD3/16 IN FEMALE MALE MOLD CONNECTOR MINIMAL COIL MEMORY STERILE LATEX FREE CLEAR SUP-8888301507 CDM 0270 RC outpatient 1.05 1.05 1.05 74 0.78 percent of total billed charges 1.05 93 0.85 percent of total billed charges 1.05 1.05 other OPPS APC 1.05 1.05 other OPPS APC 1.05 27.63 0.29 percent of total billed charges 1.05 1.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PERITONEAL ARGYLE SWAN NECK CURL CATH 180D 62.5CM 15FR SILICONE STERILE LATEX LEFT 2 CUFF RADIOPAQUE PREFORM SUP-8888413807 CDM 0270 RC outpatient 371.62 371.62 371.62 74 275 percent of total billed charges 371.62 93 301.01 percent of total billed charges 371.62 371.62 other OPPS APC 371.62 371.62 other OPPS APC 371.62 27.63 102.68 percent of total billed charges 371.62 371.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PERITONEAL ARGYLE SWAN NECK CURL CATH 180D 62.5CM 15FR SILICONE STERILE LF ADULT PERITONEAL RIGHT 2 CUFF 2 DISC SUP-8888413815 CDM 0270 RC outpatient 345.62 345.62 345.62 74 255.76 percent of total billed charges 345.62 93 279.95 percent of total billed charges 345.62 345.62 other OPPS APC 345.62 345.62 other OPPS APC 345.62 27.63 95.49 percent of total billed charges 345.62 345.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR DIALYSIS ARGYLE TITANIUM PERITONEAL 2 PART LUER ADAPTER STERILE LATEX FREE SUP-8888415604 CDM 0270 RC outpatient 321.75 321.75 321.75 74 238.1 percent of total billed charges 321.75 93 260.62 percent of total billed charges 321.75 321.75 other OPPS APC 321.75 321.75 other OPPS APC 321.75 27.63 88.9 percent of total billed charges 321.75 321.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR SURGICAL ARGYLE L18 3/4 CM FALLER TUNNEL STERILE LATEX FREE PERITONEAL DIALYSIS SUP-8888415679 CDM 0270 RC outpatient 345.62 345.62 345.62 74 255.76 percent of total billed charges 345.62 93 279.95 percent of total billed charges 345.62 345.62 other OPPS APC 345.62 345.62 other OPPS APC 345.62 27.63 95.49 percent of total billed charges 345.62 345.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL DOVER ROB-NEL PVC L14 IN OD8 FR ROUND TIP 2 STAGGER EYE INTEGRAL TAPER FUNNEL END STERILE LATEX FREE SUP-8888492017 CDM 0270 RC outpatient 0.81 0.81 0.81 74 0.6 percent of total billed charges 0.81 93 0.66 percent of total billed charges 0.81 0.81 other OPPS APC 0.81 0.81 other OPPS APC 0.81 27.63 0.22 percent of total billed charges 0.81 0.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL DOVER ROB-NEL DEHP PVC L16 IN OD10 FR 2 STAGGER EYE SMOOTH ROUND TIP TAPER FUNNEL END RADIOPAQUE STERILE LATEX FREE SUP-8888492025 CDM 0270 RC outpatient 0.98 0.98 0.98 74 0.73 percent of total billed charges 0.98 93 0.79 percent of total billed charges 0.98 0.98 other OPPS APC 0.98 0.98 other OPPS APC 0.98 27.63 0.27 percent of total billed charges 0.98 0.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL DOVER ROBNEL THERMOSENSITIVE PVC STERILE LATEX FREE 12FR X 16IN SUP-8888492033 CDM outpatient 0.88 0.88 0.88 0.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL DOVER ROB-NEL DEHP PVC L14 IN OD14 FR 2 STAGGER EYE SMOOTH ROUND TIP TAPER FUNNEL END RADIOPAQUE STERILE LATEX FREE SUP-8888492041 CDM 0270 RC outpatient 0.88 0.88 0.88 74 0.65 percent of total billed charges 0.88 93 0.71 percent of total billed charges 0.88 0.88 other OPPS APC 0.88 0.88 other OPPS APC 0.88 27.63 0.24 percent of total billed charges 0.88 0.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL DOVER ROB-NEL 16IN 16FR PVC DISPOSABLE STERILE LF 2 STAGGER EYE SMOOTH ROUND TIP TAPER FUNNEL END SUP-8888492058 CDM 0270 RC outpatient 0.88 0.88 0.88 74 0.65 percent of total billed charges 0.88 93 0.71 percent of total billed charges 0.88 0.88 other OPPS APC 0.88 0.88 other OPPS APC 0.88 27.63 0.24 percent of total billed charges 0.88 0.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE SUCTION ARGYLE YANKAUER VINYL L25 CM OD22 FR SET LARGE TIP NO VACUUM CONTROL INNER LUMEN LATEX FREE DISPOSABLE SUP-8888502005 CDM 0270 RC outpatient 1.55 1.55 1.55 74 1.15 percent of total billed charges 1.55 93 1.26 percent of total billed charges 1.55 1.55 other OPPS APC 1.55 1.55 other OPPS APC 1.55 27.63 0.43 percent of total billed charges 1.55 1.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING DRAINAGE ARGYLE PENROSE RUBBER FLAT L12 IN X W5/8 IN OD3/8 IN RADIOPAQUE STERILE LATEX DISPOSABLE SUP-8888513408 CDM 0270 RC outpatient 1.77 1.77 1.77 74 1.31 percent of total billed charges 1.77 93 1.43 percent of total billed charges 1.77 1.77 other OPPS APC 1.77 1.77 other OPPS APC 1.77 27.63 0.49 percent of total billed charges 1.77 1.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING DRAINAGE ARGYLE PENROSE RUBBER L30 CM OD16 MM THORACIC RADIOPAQUE STERILE LATEX DISPOSABLE SUP-8888513804 CDM 0270 RC outpatient 1.77 1.77 1.77 74 1.31 percent of total billed charges 1.77 93 1.43 percent of total billed charges 1.77 1.77 other OPPS APC 1.77 1.77 other OPPS APC 1.77 27.63 0.49 percent of total billed charges 1.77 1.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE ARGYLE SENTINEL LINE SENTINEL EYE ALUMINUM PVC L15 3/4 IN OD20 FR THORACIC SHARP TROCAR TIP INTEGRAL FUNNEL END THERMOSENSITIVE DEPTH MARK STERILE LATEX FREE DISPOSABLE CLEAR CLOSED CHEST TUBE THORACOSTOMY SUP-8888561043 CDM 0270 RC outpatient 47.5 47.5 47.5 74 35.15 percent of total billed charges 47.5 93 38.48 percent of total billed charges 47.5 47.5 other OPPS APC 47.5 47.5 other OPPS APC 47.5 27.63 13.12 percent of total billed charges 47.5 47.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE ARGYLE SENTINEL LINE SENTINEL EYE ALUMINUM PVC L15 3/4 IN OD28 FR THORACIC SHARP TROCAR TIP RADIOPAQUE NUMERIC DEPTH MARK INTEGRAL FUNNEL END STERILE LATEX FREE DISPOSABLE CLEAR CLOSED CHEST TUBE THORACOSTOMY SUP-8888561068 CDM 0270 RC outpatient 51.3 51.3 51.3 74 37.96 percent of total billed charges 51.3 93 41.55 percent of total billed charges 51.3 51.3 other OPPS APC 51.3 51.3 other OPPS APC 51.3 27.63 14.17 percent of total billed charges 51.3 51.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE ARGYLE SENTINEL LINE SENTINEL EYE PVC STRAIGHT L20 IN OD20 FR THORACIC SMOOTH SIDE EYE RADIOPAQUE OPEN DISTAL TIP BEVEL CONNECTOR END STERILE LATEX FREE DISPOSABLE CLEAR SUP-8888570523 CDM 270009136 LOCAL 0270 RC outpatient 6.47 6.47 6.47 74 4.79 percent of total billed charges 6.47 93 5.24 percent of total billed charges 6.47 6.47 other OPPS APC 6.47 6.47 other OPPS APC 6.47 27.63 1.79 percent of total billed charges 6.47 6.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE ARGYLE STRAIGHT 20IN 24FR CLEAR PVC DISPOSABLE STERILE THORACIC SMOOTH SIDE EYE RADIOPAQUE OPEN DISTAL SUP-8888570531 CDM 270009136 LOCAL 0270 RC outpatient 6.47 6.47 6.47 74 4.79 percent of total billed charges 6.47 93 5.24 percent of total billed charges 6.47 6.47 other OPPS APC 6.47 6.47 other OPPS APC 6.47 27.63 1.79 percent of total billed charges 6.47 6.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE ARGYLE SENTINEL LINE SENTINEL EYE STRAIGHT 20IN 28FR CLEAR PVC DISPOSABLE STERILE LF THORACIC SMOOTH SUP-8888570549 CDM 270009136 LOCAL 0270 RC outpatient 6.47 6.47 6.47 74 4.79 percent of total billed charges 6.47 93 5.24 percent of total billed charges 6.47 6.47 other OPPS APC 6.47 6.47 other OPPS APC 6.47 27.63 1.79 percent of total billed charges 6.47 6.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE ARGYLE SENTINEL LINE SENTINEL EYE STRAIGHT 20IN 32FR CLEAR PVC DISPOSABLE STERILE LF THORACIC SMOOTH SUP-8888570556 CDM 270009136 LOCAL 0270 RC outpatient 6.47 6.47 6.47 74 4.79 percent of total billed charges 6.47 93 5.24 percent of total billed charges 6.47 6.47 other OPPS APC 6.47 6.47 other OPPS APC 6.47 27.63 1.79 percent of total billed charges 6.47 6.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE ARGYLE SENTINEL LINE SENTINEL EYE PVC STRAIGHT L20 IN OD36 FR THORACIC 6 SIDE EYE BEVEL CONNECTOR END DEPTH MARK RADIOPAQUE STERILE LATEX FREE DISPOSABLE CLEAR SUP-8888570564 CDM 270009136 LOCAL 0270 RC outpatient 6.47 6.47 6.47 74 4.79 percent of total billed charges 6.47 93 5.24 percent of total billed charges 6.47 6.47 other OPPS APC 6.47 6.47 other OPPS APC 6.47 27.63 1.79 percent of total billed charges 6.47 6.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ARGYLE CAROTID SUP-8888577775 CDM 0270 RC outpatient 123.12 123.12 123.12 74 91.11 percent of total billed charges 123.12 93 99.73 percent of total billed charges 123.12 123.12 other OPPS APC 123.12 123.12 other OPPS APC 123.12 27.63 34.02 percent of total billed charges 123.12 123.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY GASTRIC LAVAGE MONOJECT ARGYLE EDLICH PVC LARGE L36 IN OD34 FR 140 CC 4 EYE CLOSED END GRADUATED SYRINGE TRANSPARENT STERILE LATEX FREE SUP-8888750018 CDM 0270 RC outpatient 15.83 15.83 15.83 74 11.71 percent of total billed charges 15.83 93 12.82 percent of total billed charges 15.83 15.83 other OPPS APC 15.83 15.83 other OPPS APC 15.83 27.63 4.37 percent of total billed charges 15.83 15.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE EQUIPMENT L78 IN X W54 IN C ARM ELASTIC OPEN FLUOROSCAN SUP-8888M CDM 0270 RC outpatient 27.65 27.65 27.65 74 20.46 percent of total billed charges 27.65 93 22.4 percent of total billed charges 27.65 27.65 other OPPS APC 27.65 27.65 other OPPS APC 27.65 27.63 7.64 percent of total billed charges 27.65 27.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ULTRASOUND VISIONS PV GLYDX .035 IN L90 CM L100 CM OD8.5 FR INTRAVASCULAR LARGE VESSEL OTW RADIOPAQUE MARKER DIGITAL IMAGING GUIDEWIRE STERILE DISPOSABLE SUP-88901 CDM 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE DEFIBRILLATOR ONESTEP CODE-READY PEDIATRIC RESUSCITATION COMPLETE SPEED PACK CONNECTOR R SERIES SUP-8900-0215-40 CDM 0270 RC outpatient 156.92 156.92 156.92 74 116.12 percent of total billed charges 156.92 93 127.11 percent of total billed charges 156.92 156.92 other OPPS APC 131.82 131.82 other OPPS APC 131.82 27.63 36.42 percent of total billed charges 131.82 156.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE DEFIBRILLATOR ONESTEP CODE-READY PEDIATRIC RESUSCITATION COMPLETE SPEED PACK CONNECTOR R SERIES SUP-8900-0215-40 CDM 0270 RC outpatient 156.92 156.92 131.82 74 97.55 percent of total billed charges 131.82 93 106.77 percent of total billed charges 131.82 131.82 other OPPS APC 156.92 156.92 other OPPS APC 156.92 27.63 43.36 percent of total billed charges 131.82 156.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL CONTROL PLUS L172 IN X W100 IN BEACH CHAIR ATTACHABLE FLUID COLLECTION POUCH SUCTION PORT STERILE SHOULDER ARTHROSCOPY SUP-89066 CDM 0270 RC outpatient 81.98 81.98 81.98 74 60.67 percent of total billed charges 81.98 93 66.4 percent of total billed charges 81.98 81.98 other OPPS APC 81.98 81.98 other OPPS APC 81.98 27.63 22.65 percent of total billed charges 81.98 81.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR OMNIWIRE NITINOL STRAIGHT L185 CM PRESSURE SUP-89185 CDM 0481 RC outpatient 1716 1716 1716 74 1269.84 percent of total billed charges 1716 93 1389.96 percent of total billed charges 1716 1716 other OPPS APC 1716 1716 other OPPS APC 1716 51 875.16 percent of total billed charges 1716 1716 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE GUIDING OMNIWIRE NITINOL J L185 CM PRESSURE SOLID PROXIMAL CORE WORKSHORE CONDUCTIVE BAND IFR IFR COREGISTRATION SUP-89185J CDM 0481 RC outpatient 1755 1755 1755 74 1298.7 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 1755 other OPPS APC 1755 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL CONTROL PLUS STANDARD L124 IN X W112 IN W30 IN FLUID COLLECTION POUCH HOOK LOOP TUBE ARMBOARD COVER LOW LINT STERILE LAPAROSCOPY SUP-89219 CDM 0270 RC outpatient 60.56 60.56 60.56 74 44.81 percent of total billed charges 60.56 93 49.05 percent of total billed charges 60.56 60.56 other OPPS APC 60.56 60.56 other OPPS APC 60.56 27.63 16.73 percent of total billed charges 60.56 60.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SOFT TISSUE ENDURAGEN PORCINE DERMAL COLLAGEN FLAT L4 CM X W1 CM X H1 CM MOIST TOUGH FLEXIBLE SHEET STERILE OFF WHITE SUP-89223 CDM 0270 RC outpatient 897 897 897 74 663.78 percent of total billed charges 897 93 726.57 percent of total billed charges 897 897 other OPPS APC 897 897 other OPPS APC 897 27.63 247.84 percent of total billed charges 897 897 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POUCH OSTOMY PREMIER LOCK N ROLL CERAPLUS CERAMIDE PLASTIC FLAT L 12 IN OD 2 IN OD 2.5 IN 1 PIECE CUT TO FIT TAPE BORDER LATEX FREE ULTRA CLEAR SUP-8931 CDM 270009218 LOCAL 0270 RC outpatient 1.26 1.26 1.26 74 0.93 percent of total billed charges 1.26 93 1.02 percent of total billed charges 1.26 1.26 other OPPS APC 1.26 1.26 other OPPS APC 1.26 27.63 0.35 percent of total billed charges 1.26 1.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE PROLENE BLUE DOUBLE ARMED MONOFILAMENT NEEDLE:V-5 SIZE:4-0 LENGTH:36IN SUP-8935H CDM 0270 RC outpatient 17.26 17.26 17.26 74 12.77 percent of total billed charges 17.26 93 13.98 percent of total billed charges 17.26 17.26 other OPPS APC 17.26 17.26 other OPPS APC 17.26 27.63 4.77 percent of total billed charges 17.26 17.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL CVARTS CONTROL PLUS SMS L38 IN W84 IN L100 IN X W60 IN L76 IN X W60 IN HEAVY DUTY REINFORCEMENT STERILE LATEX UNIVERSAL SYSTEM SUP-89454 CDM 0270 RC outpatient 110.23 110.23 110.23 74 81.57 percent of total billed charges 110.23 93 89.29 percent of total billed charges 110.23 110.23 other OPPS APC 110.23 110.23 other OPPS APC 110.23 27.63 30.46 percent of total billed charges 110.23 110.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL CONTROL PLUS L124 IN X W76 IN OD3.5 IN 2 ADHESIVE FENESTRATION FEMORAL ANGIOGRAPHY REINFORCEMENT STERILE LATEX FREE SUP-89704 CDM outpatient 19.93 19.93 19.93 19.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRANSDUCER ULTRASOUND REFINITY INTRAVASCULAR ROTATIONAL SHORT TIP STERILE LATEX FREE DISPOSABLE SUP-89900 CDM 0481 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 51 961.35 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTAINER SHARPS SHARPSAFETY LARGE VOLUME 18 GL ADJUSTABLE SLIDE HINGE LID SEAL GASKET NESTABLE CARRY HANDLE RED SUP-8991 CDM 0270 RC outpatient 39.58 39.58 39.58 74 29.29 percent of total billed charges 39.58 93 32.06 percent of total billed charges 39.58 39.58 other OPPS APC 39.58 39.58 other OPPS APC 39.58 27.63 10.94 percent of total billed charges 39.58 39.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CRTD MOMENTUM IS1 DF4 SUP-8CM1/2 CDM 0275 RC outpatient 40330 40330 40330 57 22988.1 percent of total billed charges 40330 93 32667.3 percent of total billed charges 40330 40330 other OPPS APC 40330 40330 other OPPS APC 40330 51 20568.3 percent of total billed charges 40330 40330 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CRTD MOMENTUM IS1 DF1 SUP-8CMA/B CDM 0275 RC outpatient 40330 40330 40330 57 22988.1 percent of total billed charges 40330 93 32667.3 percent of total billed charges 40330 40330 other OPPS APC 40330 40330 other OPPS APC 40330 51 20568.3 percent of total billed charges 40330 40330 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD DYNAGEN MINI VR DF4 SINGLE CHAMBER SYSTEM 1 LEAD SUP-8D02/A CDM 0275 RC outpatient 34200 34200 34200 57 19494 percent of total billed charges 34200 93 27702 percent of total billed charges 34200 34200 other OPPS APC 34200 34200 other OPPS APC 34200 51 17442 percent of total billed charges 34200 34200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD DYNAGEN MINI VR SINGLE CHAMBER SYSTEM 1 LEAD SUP-8D12/A CDM 0275 RC outpatient 34200 34200 34200 57 19494 percent of total billed charges 34200 93 27702 percent of total billed charges 34200 34200 other OPPS APC 34200 34200 other OPPS APC 34200 51 17442 percent of total billed charges 34200 34200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD DYNAGEN MINI DR DF4 DUAL CHAMBER SYSTEM 2 LEAD SUP-8D22/A CDM 0275 RC outpatient 35304 35304 35304 57 20123.3 percent of total billed charges 35304 93 28596.2 percent of total billed charges 35304 35304 other OPPS APC 35304 35304 other OPPS APC 35304 51 18005 percent of total billed charges 35304 35304 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD DYNAGEN MINI DR DF4 DUAL CHAMBER SYSTEM 1 LEAD SUP-8D23/B CDM 0275 RC outpatient 35304 35304 35304 57 20123.3 percent of total billed charges 35304 93 28596.2 percent of total billed charges 35304 35304 other OPPS APC 35304 35304 other OPPS APC 35304 51 18005 percent of total billed charges 35304 35304 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD DYNAGEN MINI DR DUAL CHAMBER SYSTEM 2 LEAD SUP-8D32/A CDM 0275 RC outpatient 35304 35304 35304 57 20123.3 percent of total billed charges 35304 93 28596.2 percent of total billed charges 35304 35304 other OPPS APC 35304 35304 other OPPS APC 35304 51 18005 percent of total billed charges 35304 35304 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD DYNAGEN MINI DR DUAL CHAMBER SYSTEM 1 LEAD SUP-8D33/B CDM 0275 RC outpatient 35304 35304 35304 57 20123.3 percent of total billed charges 35304 93 28596.2 percent of total billed charges 35304 35304 other OPPS APC 35304 35304 other OPPS APC 35304 51 18005 percent of total billed charges 35304 35304 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD DYNAGEN EL VR DF4 SINGLE CHAMBER SYSTEM 1 LEAD SUP-8D42/A CDM 0275 RC outpatient 21520 21520 21520 57 12266.4 percent of total billed charges 21520 93 17431.2 percent of total billed charges 21520 21520 other OPPS APC 21520 21520 other OPPS APC 21520 51 10975.2 percent of total billed charges 21520 21520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD DYNAGEN EL VR SINGLE CHAMBER SYSTEM 1 LEAD SUP-8D52/A CDM 0275 RC outpatient 20144 20144 20144 57 11482.1 percent of total billed charges 20144 93 16316.6 percent of total billed charges 20144 20144 other OPPS APC 20144 20144 other OPPS APC 20144 51 10273.4 percent of total billed charges 20144 20144 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD DYNAGEN EL DR DF4 DUAL CHAMBER SYSTEM 2 LEADS SUP-8D62/A CDM 0275 RC outpatient 35140 35140 35140 57 20029.8 percent of total billed charges 35140 93 28463.4 percent of total billed charges 35140 35140 other OPPS APC 35140 35140 other OPPS APC 35140 51 17921.4 percent of total billed charges 35140 35140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD DYNAGEN EL DR DF4 DUAL CHAMBER SYSTEM 1 LEAD SUP-8D63/B CDM 0275 RC outpatient 35304 35304 35304 57 20123.3 percent of total billed charges 35304 93 28596.2 percent of total billed charges 35304 35304 other OPPS APC 35304 35304 other OPPS APC 35304 51 18005 percent of total billed charges 35304 35304 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD DYNAGEN EL DR DUAL CHAMBER SYSTEM 2 LEAD SUP-8D72/A CDM 0275 RC outpatient 21093 21093 21093 57 12023 percent of total billed charges 21093 93 17085.3 percent of total billed charges 21093 21093 other OPPS APC 21093 21093 other OPPS APC 21093 51 10757.4 percent of total billed charges 21093 21093 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD DYNAGEN EL DR DUAL CHAMBER SYSTEM 1 LEAD SUP-8D73/B CDM 0275 RC outpatient 35304 35304 35304 57 20123.3 percent of total billed charges 35304 93 28596.2 percent of total billed charges 35304 35304 other OPPS APC 35304 35304 other OPPS APC 35304 51 18005 percent of total billed charges 35304 35304 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT-D DYNAGEN DF4 SYSTEM SUP-8D8C/D CDM 0275 RC outpatient 39330 39330 39330 57 22418.1 percent of total billed charges 39330 93 31857.3 percent of total billed charges 39330 39330 other OPPS APC 39330 39330 other OPPS APC 39330 51 20058.3 percent of total billed charges 39330 39330 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT-D DYNAGEN SYSTEM SUP-8D9C/D CDM 0275 RC outpatient 39330 39330 39330 57 22418.1 percent of total billed charges 39330 93 31857.3 percent of total billed charges 39330 39330 other OPPS APC 39330 39330 other OPPS APC 39330 51 20058.3 percent of total billed charges 39330 39330 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT-D DYNAGEN X4 SYSTEM SUP-8DAC/D CDM 0275 RC outpatient 41050 41050 41050 57 23398.5 percent of total billed charges 41050 93 33250.5 percent of total billed charges 41050 41050 other OPPS APC 41050 41050 other OPPS APC 41050 51 20935.5 percent of total billed charges 41050 41050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT-D DYNAGEN X4 DF4 SYSTEM SUP-8DBC/D CDM 0275 RC outpatient 42598 42598 42598 57 24280.9 percent of total billed charges 42598 93 34504.4 percent of total billed charges 42598 42598 other OPPS APC 42598 42598 other OPPS APC 42598 51 21725 percent of total billed charges 42598 42598 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT-D DYNAGEN LV-1 SYSTEM SUP-8DCC/D CDM 0275 RC outpatient 39330 39330 39330 57 22418.1 percent of total billed charges 39330 93 31857.3 percent of total billed charges 39330 39330 other OPPS APC 39330 39330 other OPPS APC 39330 51 20058.3 percent of total billed charges 39330 39330 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE 7.6MM CUFF LP CANN SHILEY SUP-8DCT CDM 270009133 LOCAL 0270 RC outpatient 36.61 36.61 36.61 74 27.09 percent of total billed charges 36.61 93 29.65 percent of total billed charges 36.61 36.61 other OPPS APC 36.61 36.61 other OPPS APC 36.61 27.63 10.12 percent of total billed charges 36.61 36.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA INNER SHILEY 8 79MM 7.6MM PVC DISPOSABLE STERILE LF SNAP LOCK CONNECTOR LOW PRESSURE SUP-8DIC CDM 270009134 LOCAL 0270 RC outpatient 4.63 4.63 4.63 74 3.43 percent of total billed charges 4.63 93 3.75 percent of total billed charges 4.63 4.63 other OPPS APC 4.63 4.63 other OPPS APC 4.63 27.63 1.28 percent of total billed charges 4.63 4.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER ACCOLADE DR SYSTEM DUAL CHAMBER SUP-8H32 CDM 0275 RC outpatient 8811 8811 8811 57 5022.27 percent of total billed charges 8811 93 7136.91 percent of total billed charges 8811 8811 other OPPS APC 8811 8811 other OPPS APC 8811 51 4493.61 percent of total billed charges 8811 8811 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER ACCOLADE DR 1 LEAD DUAL CHAMBER SYSTEM SUP-8H33 CDM 0275 RC outpatient 9900 9900 9900 57 5643 percent of total billed charges 9900 93 8019 percent of total billed charges 9900 9900 other OPPS APC 9900 9900 other OPPS APC 9900 51 5049 percent of total billed charges 9900 9900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER ACCOLADE SR SINGLE CHAMBER SYSTEM SUP-8H42 CDM 0275 RC outpatient 8113.5 8113.5 8113.5 57 4624.7 percent of total billed charges 8113.5 93 6571.94 percent of total billed charges 8113.5 8113.5 other OPPS APC 8113.5 8113.5 other OPPS APC 8113.5 51 4137.89 percent of total billed charges 8113.5 8113.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER ACCOLADE L321 DR EL DUAL CHAMBER 2 LEAD SYSTEM SUP-8H52 CDM 0275 RC outpatient 8811 8811 8811 57 5022.27 percent of total billed charges 8811 93 7136.91 percent of total billed charges 8811 8811 other OPPS APC 8811 8811 other OPPS APC 8811 51 4493.61 percent of total billed charges 8811 8811 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER L321 ACCOLADE DR EL 1 LEAD SYSTEM DUAL CHAMBER SUP-8H53 CDM 0275 RC outpatient 9900 9900 9900 57 5643 percent of total billed charges 9900 93 8019 percent of total billed charges 9900 9900 other OPPS APC 9900 9900 other OPPS APC 9900 51 5049 percent of total billed charges 9900 9900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE GORE-TEX CV-8 TTC-9 L18 IN 2 ARM MONOFILAMENT WHITE SUP-8J02A CDM 0270 RC outpatient 104.22 104.22 104.22 74 77.12 percent of total billed charges 104.22 93 84.42 percent of total billed charges 104.22 104.22 other OPPS APC 104.22 104.22 other OPPS APC 104.22 27.63 28.8 percent of total billed charges 104.22 104.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE GORE-TEX CV-8 TTC-9 L24 IN 2 ARM MONOFILAMENT WHITE SUP-8K02A CDM 0270 RC outpatient 100.53 100.53 100.53 74 74.39 percent of total billed charges 100.53 93 81.43 percent of total billed charges 100.53 100.53 other OPPS APC 100.53 100.53 other OPPS APC 100.53 27.63 27.78 percent of total billed charges 100.53 100.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MIDAS REX LEGEND TAPER FLUTE L8 CM L6.4 MM OD1.1 MM SUP-8TA11_57642 CDM 0270 RC outpatient 359.66 359.66 359.66 74 266.15 percent of total billed charges 359.66 93 291.32 percent of total billed charges 359.66 359.66 other OPPS APC 359.66 359.66 other OPPS APC 359.66 27.63 99.37 percent of total billed charges 359.66 359.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL TWIST MIDAS REX LEGEND L8 CM L4 MM OD1 MM STOP STERILE SUP-8TD104 CDM 270010028 LOCAL 0270 RC outpatient 359.66 359.66 359.66 74 266.15 percent of total billed charges 359.66 93 291.32 percent of total billed charges 359.66 359.66 other OPPS APC 359.66 359.66 other OPPS APC 359.66 27.63 99.37 percent of total billed charges 359.66 359.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD D121 MOMENTUM EL DR DF1 SYSTEM SUP-8TMA CDM 0275 RC outpatient 33993 33993 33993 57 19376 percent of total billed charges 33993 93 27534.3 percent of total billed charges 33993 33993 other OPPS APC 33993 33993 other OPPS APC 33993 51 17336.4 percent of total billed charges 33993 33993 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM ICD MOMENTUM EL VR DF1 SUP-8TMC CDM 0275 RC outpatient 21144 21144 21144 57 12052.1 percent of total billed charges 21144 93 17126.6 percent of total billed charges 21144 21144 other OPPS APC 21144 21144 other OPPS APC 21144 51 10783.4 percent of total billed charges 21144 21144 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD D233 VIGILANT EL DR DF 4 2 LEAD SYSTEM SUP-8TV1 CDM 0275 RC outpatient 36140 36140 36140 57 20599.8 percent of total billed charges 36140 93 29273.4 percent of total billed charges 36140 36140 other OPPS APC 36140 36140 other OPPS APC 36140 51 18431.4 percent of total billed charges 36140 36140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR D232 VIGILANT EL VR DF4 1 LEAD SYSTEM SUP-8TV3 CDM 0275 RC outpatient 34420 34420 34420 57 19619.4 percent of total billed charges 34420 93 27880.2 percent of total billed charges 34420 34420 other OPPS APC 34420 34420 other OPPS APC 34420 51 17554.2 percent of total billed charges 34420 34420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT-P VALITUDE X4 SYSTEM SUP-8V4G/J/H CDM 0275 RC outpatient 14210 14210 14210 57 8099.7 percent of total billed charges 14210 93 11510.1 percent of total billed charges 14210 14210 other OPPS APC 14210 14210 other OPPS APC 14210 51 7247.1 percent of total billed charges 14210 14210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT-P VALITUDE IS-1 SYSTEM SUP-8V5G/J/H CDM 0275 RC outpatient 14210 14210 14210 57 8099.7 percent of total billed charges 14210 93 11510.1 percent of total billed charges 14210 14210 other OPPS APC 14210 14210 other OPPS APC 14210 51 7247.1 percent of total billed charges 14210 14210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CRTD MOMENTUM X4 DF1 SUP-8XM1/2 CDM 0275 RC outpatient 42050 42050 42050 57 23968.5 percent of total billed charges 42050 93 34060.5 percent of total billed charges 42050 42050 other OPPS APC 42050 42050 other OPPS APC 42050 51 21445.5 percent of total billed charges 42050 42050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CRTD VIGILANT MRI X4 DF1 SUP-8XV1/2 CDM 0275 RC outpatient 43598 43598 43598 57 24850.9 percent of total billed charges 43598 93 35314.4 percent of total billed charges 43598 43598 other OPPS APC 43598 43598 other OPPS APC 43598 51 22235 percent of total billed charges 43598 43598 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CORTICAL CANCELLOUS H7 MM CERVICAL SPINE SERIES CII SUP-9-07 CDM 270010020 LOCAL 0270 RC outpatient 3575 3575 3575 74 2645.5 percent of total billed charges 3575 93 2895.75 percent of total billed charges 3575 3575 other OPPS APC 3575 3575 other OPPS APC 3575 27.63 987.77 percent of total billed charges 3575 3575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CORTICAL CANCELLOUS H9 MM CERVICAL SPINE SERIES CII SUP-9-09 CDM 270010020 LOCAL 0270 RC outpatient 3575 3575 3575 74 2645.5 percent of total billed charges 3575 93 2895.75 percent of total billed charges 3575 3575 other OPPS APC 3575 3575 other OPPS APC 3575 27.63 987.77 percent of total billed charges 3575 3575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE LITHOTRIPTER AUTOLITH SUP-9-202-3751-DS CDM 27000000 LOCAL 0270 RC outpatient 1115.4 1115.4 1115.4 74 825.4 percent of total billed charges 1115.4 93 903.47 percent of total billed charges 1115.4 1115.4 other OPPS APC 1115.4 1115.4 other OPPS APC 1115.4 27.63 308.19 percent of total billed charges 1115.4 1115.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLUG CARDIOVASCULAR AMPLATZER NITINOL L7MM L100CM OD8MM TYPE II DELIVERY SYSTEM OPTIMAL EMBOLIZATION SELF EXPANDABLE MULTILAYER MESH LOBE STERILE LATEX FREE DISPOSABLE SUP-9-AVP2-008 CDM 0270 RC outpatient 2314 2314 2314 74 1712.36 percent of total billed charges 2314 93 1874.34 percent of total billed charges 2314 2314 other OPPS APC 2314 2314 other OPPS APC 2314 27.63 639.36 percent of total billed charges 2314 2314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLUG CARDIOVASCULAR AMPLATZER NITINOL L7MM L100CM OD10MM TYPE II DELIVERY SYSTEM OPTIMAL EMBOLIZATION SELF EXPANDABLE MULTILAYER MESH LOBE STERILE LATEX FREE DISPOSABLE SUP-9-AVP2-010 CDM 0270 RC outpatient 2314 2314 2314 74 1712.36 percent of total billed charges 2314 93 1874.34 percent of total billed charges 2314 2314 other OPPS APC 2314 2314 other OPPS APC 2314 27.63 639.36 percent of total billed charges 2314 2314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLUG CARDIOVASCULAR AMPLATZER NITINOL L9MM L100CM OD12MM TYPE II DELIVERY SYSTEM OPTIMAL EMBOLIZATION SELF EXPANDABLE MULTILAYER MESH LOBE STERILE LATEX FREE DISPOSABLE SUP-9-AVP2-012 CDM 0270 RC outpatient 2314 2314 2314 74 1712.36 percent of total billed charges 2314 93 1874.34 percent of total billed charges 2314 2314 other OPPS APC 2314 2314 other OPPS APC 2314 27.63 639.36 percent of total billed charges 2314 2314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACUPAC X 2.5 CC SUP-90-1X400002 CDM 0270 RC outpatient 2990 2990 2990 74 2212.6 percent of total billed charges 2990 93 2421.9 percent of total billed charges 2990 2990 other OPPS APC 2990 2990 other OPPS APC 2990 27.63 826.14 percent of total billed charges 2990 2990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION HALO90 BARRX 90 D L160 CM L20 MM X W13 MM OD4 MM ESOPHAGEAL BIPOLAR ELECTRODE BALLOON FOCAL DISPOSABLE SUP-90-9100 CDM 0270 RC outpatient 5462.6 5462.6 5462.6 74 4042.32 percent of total billed charges 5462.6 93 4424.71 percent of total billed charges 5462.6 5462.6 other OPPS APC 5462.6 5462.6 other OPPS APC 5462.6 27.63 1509.32 percent of total billed charges 5462.6 5462.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION HALO90 BARRX ULTRA LONG L160 CM L40 MM X W13 MM OD4 MM BIPOLAR ELECTRODE STREAMLINE PROFILE SHAFT DISPOSABLE SUP-90-9200 CDM 0270 RC outpatient 6926.4 6926.4 6926.4 74 5125.54 percent of total billed charges 6926.4 93 5610.38 percent of total billed charges 6926.4 6926.4 other OPPS APC 6926.4 6926.4 other OPPS APC 6926.4 27.63 1913.76 percent of total billed charges 6926.4 6926.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION HALO60 BARRX 90 D L160 CM L15 MM X W10 MM OD4 MM ESOPHAGEAL BIPOLAR ELECTRODE BALLOON FOCAL DISPOSABLE SUP-90-9300 CDM 0270 RC outpatient 4713.8 4713.8 4713.8 74 3488.21 percent of total billed charges 4713.8 93 3818.18 percent of total billed charges 4713.8 4713.8 other OPPS APC 4713.8 4713.8 other OPPS APC 4713.8 27.63 1302.42 percent of total billed charges 4713.8 4713.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOGRAFT HUMAN TISSUE 2.5CC FROZEN CANCELLOUS BONE STERILE SUP-90-D1040002 CDM 0270 RC outpatient 2990 2990 2990 74 2212.6 percent of total billed charges 2990 93 2421.9 percent of total billed charges 2990 2990 other OPPS APC 2990 2990 other OPPS APC 2990 27.63 826.14 percent of total billed charges 2990 2990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOGRAFT HUMAN TISSUE 10CC FROZEN CANCELLOUS SUP-90-D1040010 CDM 0270 RC outpatient 11960 11960 11960 74 8850.4 percent of total billed charges 11960 93 9687.6 percent of total billed charges 11960 11960 other OPPS APC 11960 11960 other OPPS APC 11960 27.63 3304.55 percent of total billed charges 11960 11960 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCIUM HYDROXITE SUP-900-3663 CDM 27000000 LOCAL 0270 RC outpatient 98.77 98.77 98.77 74 73.09 percent of total billed charges 98.77 93 80 percent of total billed charges 98.77 98.77 other OPPS APC 98.77 98.77 other OPPS APC 98.77 27.63 27.29 percent of total billed charges 98.77 98.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIAMOND BURR SUP-900-7231 CDM 27000000 LOCAL 0270 RC outpatient 3.16 3.16 3.16 74 2.34 percent of total billed charges 3.16 93 2.56 percent of total billed charges 3.16 3.16 other OPPS APC 3.16 3.16 other OPPS APC 3.16 27.63 0.87 percent of total billed charges 3.16 3.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIAMOND BURR SUP-900-7278 CDM 27000000 LOCAL 0270 RC outpatient 2.73 2.73 2.73 74 2.02 percent of total billed charges 2.73 93 2.21 percent of total billed charges 2.73 2.73 other OPPS APC 2.73 2.73 other OPPS APC 2.73 27.63 0.75 percent of total billed charges 2.73 2.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC COBALT L150 MM OD1.25 MM NONTHREAD NONSTERILE SUP-900.721 CDM 270010022 LOCAL 0270 RC outpatient 156.91 156.91 156.91 74 116.11 percent of total billed charges 156.91 93 127.1 percent of total billed charges 156.91 156.91 other OPPS APC 156.91 156.91 other OPPS APC 156.91 27.63 43.35 percent of total billed charges 156.91 156.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC L150 MM OD1.25 MM THREAD NONSTERILE 3.5 MM CANNULATED SCREW SUP-900.722 CDM 270010022 LOCAL 0270 RC outpatient 61.15 61.15 61.15 74 45.25 percent of total billed charges 61.15 93 49.53 percent of total billed charges 61.15 61.15 other OPPS APC 61.15 61.15 other OPPS APC 61.15 27.63 16.9 percent of total billed charges 61.15 61.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC LCP DHHS SPADE L230 MM OD2.5 MM THREAD NONSTERILE SUP-900.723 CDM 270010022 LOCAL 0270 RC outpatient 130.13 130.13 130.13 74 96.3 percent of total billed charges 130.13 93 105.41 percent of total billed charges 130.13 130.13 other OPPS APC 130.13 130.13 other OPPS APC 130.13 27.63 35.95 percent of total billed charges 130.13 130.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC L450 MM L300 MM OD2.8 MM TROCAR POINT THREADED CALIBRATED NONSTERILE 6.5/7.3 CANNULATED SCREW SYSTEM SUP-900.726 CDM 270010022 LOCAL 0270 RC outpatient 161.62 161.62 161.62 74 119.6 percent of total billed charges 161.62 93 130.91 percent of total billed charges 161.62 161.62 other OPPS APC 161.62 161.62 other OPPS APC 161.62 27.63 44.66 percent of total billed charges 161.62 161.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DECANTER FLUID L9 IN BAG LATEX SUP-9001 CDM 0270 RC outpatient 4.11 4.11 4.11 74 3.04 percent of total billed charges 4.11 93 3.33 percent of total billed charges 4.11 4.11 other OPPS APC 4.11 4.11 other OPPS APC 4.11 27.63 1.14 percent of total billed charges 4.11 4.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER PROBE SITE-RITE L48 IN PREGEL LATEX FREE SUP-9001C0197 CDM 0270 RC outpatient 39.81 39.81 39.81 74 29.46 percent of total billed charges 39.81 93 32.25 percent of total billed charges 39.81 39.81 other OPPS APC 39.81 39.81 other OPPS APC 39.81 27.63 11 percent of total billed charges 39.81 39.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMOBILIZER ORTHOPEDIC MUSLIN MEDIUM UNIVERSAL L16 1/2 IN X W8 IN SHOULDER WAIST STRAP ADJUSTABLE BUCKLE CLOSURE CLOSED POUCH THUMB LOOP NONSTERILE LATEX FREE SUP-9003-03 CDM 270009112 LOCAL 0270 RC outpatient 5.63 5.63 5.63 74 4.17 percent of total billed charges 5.63 93 4.56 percent of total billed charges 5.63 5.63 other OPPS APC 5.63 5.63 other OPPS APC 5.63 27.63 1.56 percent of total billed charges 5.63 5.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMOBILIZER ORTHOPEDIC MUSLIN LARGE UNIVERSAL L19 1/2 IN X W9 IN SHOULDER WAIST STRAP ADJUSTABLE BUCKLE CLOSURE CLOSED POUCH THUMB LOOP NONSTERILE LATEX FREE SUP-9003-04 CDM 270009112 LOCAL 0270 RC outpatient 5.63 5.63 5.63 74 4.17 percent of total billed charges 5.63 93 4.56 percent of total billed charges 5.63 5.63 other OPPS APC 5.63 5.63 other OPPS APC 5.63 27.63 1.56 percent of total billed charges 5.63 5.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE PROCEDURE ACQCROSS QX 61CM TRANSSEPTAL BRAIDED STEERABLE W/0.032IN 180CM J-TIP GW EGM ADAPTER CABLE ES DIL 61CM AGILIS NXT SUP-900300_72396 CDM 0481 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 51 795.6 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE PROCEDURE ACQCROSS QX 71CM TRANSSEPTAL BRAIDED STEERABLE W/0.032IN 180CM J-TIP GW EGM ADAPTER CABLE ES DIL 71CM AGILIS NXT SUP-900301_72397 CDM 0481 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 51 795.6 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE PROCEDURE ACQCROSS QX 63CM TRANSSEPTAL BRAIDED STEERABLE W/0.032IN 180CM J-TIP GW EGM ADAPTER CABLE ES DIL 63CM SL1 SUP-900302_72398 CDM 0481 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 51 795.6 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE PROCEDURE ACQCROSS QX 71CM TRANSSEPTAL BRAIDED STEERABLE W/0.032IN 180CM J-TIP GW EGM ADAPTER CABLE ES DIL 71CM CARTO VIZIGO SUP-900303_72399 CDM 0481 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 51 795.6 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE PROCEDURE ACQCROSS QX 65CM TRANSSEPTAL BRAIDED STEERABLE W/0.032IN 180CM J-TIP GW EGM ADAPTER CABLE ES DIL 65CM FLEXCATH ADVANCE SUP-900304_72400 CDM 0481 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 51 795.6 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE PROCEDURE ACQCROSS QX 70CM TRANSSEPTAL BRAIDED STEERABLE W/0.032IN 180CM J-TIP GW EGM ADAPTER CABLE ES DIL 70CM ACUTUS MEDICAL ACQGUIDE MAX SUP-900305_72401 CDM 0481 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 51 795.6 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE PROCEDURE ACQCROSS 63CM TRANSSEPTAL MH STEERABLE W/0.032IN 180CM J-TIP GW DIL EGM ADAPTER CABLE ES SUP-900306_72402 CDM 0481 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 51 795.6 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE PROCEDURE ACQCROSS 81CM TRANSSEPTAL MH STEERABLE W/0.032IN 180CM J-TIP GW DIL EGM ADAPTER CABLE ES SUP-900307_72403 CDM 0481 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 51 795.6 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE PROCEDURE ACQCROSS 75CM TRANSSEPTAL WT STEERABLE W/0.032IN 180CM J-TIP GW DIL EGM ADAPTER CABLE ES SUP-900308_72404 CDM 0481 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 51 795.6 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE PROCEDURE ACQCROSS 81CM TRANSSEPTAL SL1 STEERABLE W/0.032IN 180CM J-TIP GW DIL EGM ADAPTER CABLE ES SUP-900309_72405 CDM 0481 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 51 795.6 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR DENTAL CARBIDE 12 12 BLADE FRICTION GRIP TRIMMING FINISHING 7613 SUP-9004370 CDM 0270 RC outpatient 19.75 19.75 19.75 74 14.62 percent of total billed charges 19.75 93 16 percent of total billed charges 19.75 19.75 other OPPS APC 19.75 19.75 other OPPS APC 19.75 27.63 5.46 percent of total billed charges 19.75 19.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAXIMA DIAMOND BUR FRICTION GRIP SUP-9007227 CDM 0270 RC outpatient 31.61 31.61 31.61 74 23.39 percent of total billed charges 31.61 93 25.6 percent of total billed charges 31.61 31.61 other OPPS APC 31.61 31.61 other OPPS APC 31.61 27.63 8.73 percent of total billed charges 31.61 31.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPONGE GAUZE VERSALON POLYESTER RAYON L2 IN X W2 IN 4 PLY ABSORBENT NONWOVEN LINT FREE NONSTERILE LATEX FREE DISPOSABLE SUP-9022 CDM 0270 RC outpatient 0.01 0.01 0.01 74 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 0.01 other OPPS APC 0.01 0.01 other OPPS APC 0.01 Service paid by percent of billed. 0.01 other OP Med Supplies 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY CATHETERIZATION BARDEX 18FR 350ML SILVER HYDROGEL LATEX FOLEY URINE METER SUP-903018 CDM 270009006 LOCAL 0270 RC outpatient 12.49 12.49 12.49 74 9.24 percent of total billed charges 12.49 93 10.12 percent of total billed charges 12.49 12.49 other OPPS APC 12.49 12.49 other OPPS APC 12.49 27.63 3.45 percent of total billed charges 12.49 12.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE BRACHYTHERAPY MAMMOSITE BREAST CAVITY EVALUATION TARGET SUP-9031 CDM 0270 RC outpatient 387.4 387.4 387.4 74 286.68 percent of total billed charges 387.4 93 313.79 percent of total billed charges 387.4 387.4 other OPPS APC 387.4 387.4 other OPPS APC 387.4 27.63 107.04 percent of total billed charges 387.4 387.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON ULTIMA NYLON 66 8-0 CS175-8 L12 IN 2 ARM MONOFILAMENT BLACK SUP-9038G CDM 0270 RC outpatient 41.71 41.71 41.71 74 30.87 percent of total billed charges 41.71 93 33.79 percent of total billed charges 41.71 41.71 other OPPS APC 41.71 41.71 other OPPS APC 41.71 27.63 11.52 percent of total billed charges 41.71 41.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 1 PRIMARY CENTRAL INCISOR UPPER LEFT PREFABRICATED PRETRIMMED THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907001 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 3 PRIMARY ANTERIOR UPPER LEFT CENTRAL PREFABRICATE PRETRIM THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907003 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 4 PRIMARY CENTRAL INCISOR UPPER LEFT PREFABRICATE PRETRIM THICK OCCLUSAL PARALLEL WALL SUP-907004 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 5 PRIMARY ANTERIOR UPPER LEFT CENTRAL PREFABRICATE PRETRIM THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907005 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 6 PRIMARY CENTRAL INCISOR UPPER LEFT PREFABRICATE PRETRIM THICK OCCLUSAL PARALLEL WALL SUP-907006 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 1 PRIMARY ANTERIOR UPPER LEFT CENTRAL PREFABRICATE PRETRIM THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907011 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 2 PRIMARY CENTRAL INCISOR UPPER RIGHT PREFABRICATED PRETRIMMED THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907012 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 3 PRIMARY ANTERIOR UPPER RIGHT CENTRAL PREFABRICATE PRETRIM THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907013 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 4 PRIMARY ANTERIOR UPPER LEFT CENTRAL PREFABRICATE PRETRIM THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907014 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 5 PRIMARY ANTERIOR UPPER RIGHT CENTRAL PREFABRICATE PRETRIM THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907015 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 6 PRIMARY CENTRAL INCISOR UPPER RIGHT PREFABRICATED PRETRIMMED THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907016 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 1 PRIMARY ANTERIOR UPPER LEFT LATERAL PREFABRICATE PRETRIM THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907021 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 2 PRIMARY LATERAL INCISOR UPPER LEFT PREFABRICATED PRETRIMMED THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907022 CDM 0270 RC outpatient 16.79 16.79 16.79 74 12.42 percent of total billed charges 16.79 93 13.6 percent of total billed charges 16.79 16.79 other OPPS APC 16.79 16.79 other OPPS APC 16.79 27.63 4.64 percent of total billed charges 16.79 16.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 3 UPPER LEFT LATERAL PRIMARY ANTERIOR PREFABRICATE PRETRIM THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907023 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 4 PRIMARY ANTERIOR UPPER LEFT LATERAL PREFABRICATE PRETRIM THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907024 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN ANTERIOR LATERALS SUP-907026 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 1 PRIMARY ANTERIOR UPPER RIGHT LATERAL PREFABRICATE PRETRIM THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907031 CDM 0270 RC outpatient 16.79 16.79 16.79 74 12.42 percent of total billed charges 16.79 93 13.6 percent of total billed charges 16.79 16.79 other OPPS APC 16.79 16.79 other OPPS APC 16.79 27.63 4.64 percent of total billed charges 16.79 16.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 2 PRIMARY LATERAL INCISOR UPPER RIGHT PREFABRICATED PRETRIMMED THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907032 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 3 PRIMARY ANTERIOR UPPER RIGHT LATERAL PREFABRICATE PRETRIM THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907033 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 4 PRIMARY LATERAL INCISOR UPPER RIGHT PREFABRICATED PRETRIMMED THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907034 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 5 PRIMARY LATERAL INCISOR UPPER RIGHT PREFABRICATED PRETRIMMED THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907035 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 6 PRIMARY LATERAL INCISOR UPPER RIGHT PREFABRICATED PRETRIMMED THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907036 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 1 PARALLEL WALL CUSPID PRIMARY ANTERIOR PREFABRICATE PRETRIM SUP-907041 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 2 PRIMARY ANTERIOR UPPER CUSPID PREFABRICATE PRETRIM THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907042 CDM 0270 RC outpatient 16.79 16.79 16.79 74 12.42 percent of total billed charges 16.79 93 13.6 percent of total billed charges 16.79 16.79 other OPPS APC 16.79 16.79 other OPPS APC 16.79 27.63 4.64 percent of total billed charges 16.79 16.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 3 PRIMARY CUSPID UPPER PREFABRICATE PRETRIM THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907043 CDM 0270 RC outpatient 20.99 20.99 20.99 74 15.53 percent of total billed charges 20.99 93 17 percent of total billed charges 20.99 20.99 other OPPS APC 20.99 20.99 other OPPS APC 20.99 27.63 5.8 percent of total billed charges 20.99 20.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 4 PRIMARY ANTERIOR UPPER CUSPID PREFABRICATE PRETRIM THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907044 CDM 0270 RC outpatient 17.47 17.47 17.47 74 12.93 percent of total billed charges 17.47 93 14.15 percent of total billed charges 17.47 17.47 other OPPS APC 17.47 17.47 other OPPS APC 17.47 27.63 4.83 percent of total billed charges 17.47 17.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 5 PARALLEL WALL CUSPID PRIMARY ANTERIOR PREFABRICATE PRETRIM SUP-907045 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 6 BICUSPID PRIMARY ANTERIOR PREFABRICATE PRETRIM SUP-907046 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 1 PARALLEL WALL PRIMARY CUSPID LOWER PREFABRICATE PRETRIM SUP-907051 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 2 PRIMARY ANTERIOR LOWER CUSPID PREFABRICATE PRETRIM THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907052 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 3 PRIMARY ANTERIOR LOWER CUSPID PREFABRICATE PRETRIM THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907053 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 4 CONTOUR LOWER CUSPID PRIMARY ANTERIOR PARALLEL WALL PRETRIM THICK OCCLUSAL SURFACE SHALLOW ANATOMY SUP-907054 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 5 ANTERIOR PRIMARY LOWER CUSPID PREFABRICATE PRETRIM THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907055 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M UNITEK STAINLESS STEEL PEDIATRIC 6 PRIMARY ANTERIOR LOWER CUSPID PREFABRICATE PRETRIM THICK OCCLUSAL SURFACE PARALLEL WALL SUP-907056 CDM 0270 RC outpatient 20.74 20.74 20.74 74 15.35 percent of total billed charges 20.74 93 16.8 percent of total billed charges 20.74 20.74 other OPPS APC 20.74 20.74 other OPPS APC 20.74 27.63 5.73 percent of total billed charges 20.74 20.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKINETTE ORTHOPEDIC SPECIALIST COTTON L25 YD X W4 IN 1 PLY KNIT STRETCHABLE HIGH ABSORBENT NONSTERILE LATEX FREE SUP-9074 CDM outpatient 42.19 42.19 42.19 42.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE HEMO-SEAL ULTIMA 10-0 CTC-6L L4 IN 2 ARM MONOFILAMENT BLUE SUP-9091G CDM 0270 RC outpatient 62.22 62.22 62.22 74 46.04 percent of total billed charges 62.22 93 50.4 percent of total billed charges 62.22 62.22 other OPPS APC 62.22 62.22 other OPPS APC 62.22 27.63 17.19 percent of total billed charges 62.22 62.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STERILETRAC TITANIUM L5 MM OD1.8 MM MIDFACE SELF TAP EMERGENCY HIGH TORQUE CROSS DRIVE MAGENTA 1.5 MM LORENZ PLATE SYSTEM SUP-91-1805 CDM 0270 RC outpatient 161.2 161.2 161.2 74 119.29 percent of total billed charges 161.2 93 130.57 percent of total billed charges 161.2 161.2 other OPPS APC 161.2 161.2 other OPPS APC 161.2 27.63 44.54 percent of total billed charges 161.2 161.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SELF DRILLING 1.5MM 3.5MM SUP-91-6103 CDM 0270 RC outpatient 161.2 161.2 161.2 74 119.29 percent of total billed charges 161.2 93 130.57 percent of total billed charges 161.2 161.2 other OPPS APC 161.2 161.2 other OPPS APC 161.2 27.63 44.54 percent of total billed charges 161.2 161.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SELF DRILLING 1.5MM 4MM SUP-91-6104 CDM 0270 RC outpatient 161.2 161.2 161.2 74 119.29 percent of total billed charges 161.2 93 130.57 percent of total billed charges 161.2 161.2 other OPPS APC 161.2 161.2 other OPPS APC 161.2 27.63 44.54 percent of total billed charges 161.2 161.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TRAUMAONE LORENZ TITANIUM L5 MM OD1.5 MM MIDFACE SELF DRILL HIGH TORQUE CROSS DRIVE GREEN SUP-91-6105 CDM 0270 RC outpatient 161.2 161.2 161.2 74 119.29 percent of total billed charges 161.2 93 130.57 percent of total billed charges 161.2 161.2 other OPPS APC 161.2 161.2 other OPPS APC 161.2 27.63 44.54 percent of total billed charges 161.2 161.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE THINFLAP L3.5 MM OD1.5 MM CRANIOMAXILLOFACIAL SELF DRILL CROSS DRIVE SUP-91-6703 CDM 0270 RC outpatient 126.75 126.75 126.75 74 93.8 percent of total billed charges 126.75 93 102.67 percent of total billed charges 126.75 126.75 other OPPS APC 126.75 126.75 other OPPS APC 126.75 27.63 35.02 percent of total billed charges 126.75 126.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE THINFLAP L4 MM OD1.5 MM CRANIOMAXILLOFACIAL SELF DRILL CROSS DRIVE SUP-91-6704 CDM 0270 RC outpatient 161.2 161.2 161.2 74 119.29 percent of total billed charges 161.2 93 130.57 percent of total billed charges 161.2 161.2 other OPPS APC 161.2 161.2 other OPPS APC 161.2 27.63 44.54 percent of total billed charges 161.2 161.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STERILETRAC THINFLAP LORENZ TITANIUM L3.5 MM OD1.8 MM CRANIOMAXILLOFACIAL EMERGENCY CROSS DRIVE SUP-91-6903 CDM 0270 RC outpatient 161.2 161.2 161.2 74 119.29 percent of total billed charges 161.2 93 130.57 percent of total billed charges 161.2 161.2 other OPPS APC 161.2 161.2 other OPPS APC 161.2 27.63 44.54 percent of total billed charges 161.2 161.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STERILETRAC THINFLAP LORENZ TITANIUM L4 MM OD1.8 MM CRANIOMAXILLOFACIAL EMERGENCY CROSS DRIVE SUP-91-6904 CDM 0270 RC outpatient 161.2 161.2 161.2 74 119.29 percent of total billed charges 161.2 93 130.57 percent of total billed charges 161.2 161.2 other OPPS APC 161.2 161.2 other OPPS APC 161.2 27.63 44.54 percent of total billed charges 161.2 161.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BATTERY ALKALINE PREMIERPRO PLASTIC 1.5 V 9V MERCURY FREE CADMIUM FREE 4 SHRINK WRAP PERFORATE CLEAR GREEN SUP-9101 CDM outpatient 1.51 1.51 1.51 1.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BATTERY ALKALINE PREMIERPRO PLASTIC 1.5V AA MERCURY FREE CADMIUM FREE 4 SHRINK WRAP PERFORATE CLEAR GREEN LR6 SUP-9102 CDM 0270 RC outpatient 0.33 0.33 0.33 74 0.24 percent of total billed charges 0.33 93 0.27 percent of total billed charges 0.33 0.33 other OPPS APC 0.33 0.33 other OPPS APC 0.33 27.63 0.09 percent of total billed charges 0.33 0.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BATTERYL ALKALINE PREMIERPRO PLASTIC 1.5 V AAA MERCURY FREE CADMIUM FREE 4 SHRINK WRAP PERFORATE CLEAR GREEN SUP-9103 CDM outpatient 0.3 0.3 0.3 0.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BATTERY ALKALINE PREMIERPRO PLASTIC 1.5V C MERCURY FREE CADMIUM FREE 4 SHRINK WRAP PERFORATE CLEAR GREEN SUP-9104 CDM outpatient 0.96 0.96 0.96 0.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BATTERY ALKALINE PREMIERPRO PLASTIC 1.5V D MERCURY FREE CADMIUM FREE 4 SHRINK WRAP PERFORATE CLEAR GREEN LR6 SUP-9105 CDM outpatient 1.44 1.44 1.44 1.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER VENTRICULAR ANTIMICROBIAL SUP-91101 CDM 0270 RC outpatient 1268.46 1268.46 1268.46 74 938.66 percent of total billed charges 1268.46 93 1027.45 percent of total billed charges 1268.46 1268.46 other OPPS APC 1268.46 1268.46 other OPPS APC 1268.46 27.63 350.48 percent of total billed charges 1268.46 1268.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL TWIST 1.2MM STOP 4MM SUP-9112504 CDM 0270 RC outpatient 458.64 458.64 458.64 74 339.39 percent of total billed charges 458.64 93 371.5 percent of total billed charges 458.64 458.64 other OPPS APC 458.64 458.64 other OPPS APC 458.64 27.63 126.72 percent of total billed charges 458.64 458.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT ORTHOPEDIC PLASTALUME PLASTIC FOAM CIRCLE L4.25 IN FINGER BASE PAD NONSTERILE LATEX FREE BLUE WHITE SUP-9119-06 CDM 0270 RC outpatient 2.23 2.23 2.23 74 1.65 percent of total billed charges 2.23 93 1.81 percent of total billed charges 2.23 2.23 other OPPS APC 2.23 2.23 other OPPS APC 2.23 27.63 0.62 percent of total billed charges 2.23 2.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT ORTHOPEDIC PLASTALUME 6.25IN BLUE WHITE ALUMINUM PLASTIC FINGER CIRCULAR BASE PAD SUP-9119-08 CDM outpatient 2.46 2.46 2.46 2.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRIEVER ENDOSCOPIC TREVO NXT PROVUE L32 MM OD3 MM TREVO TRAK 21 MICROCATHETER STERILE LATEX FREE DISPOSABLE SUP-91312 CDM 27000000 LOCAL 0270 RC outpatient 21450 21450 21450 74 15873 percent of total billed charges 21450 93 17374.5 percent of total billed charges 21450 21450 other OPPS APC 21450 21450 other OPPS APC 21450 27.63 5926.64 percent of total billed charges 21450 21450 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRIEVER ENDOSCOPIC TREVO NXT PROVUE L41 MM OD4 MM TREVO TRAK 21 MICROCATHETER STERILE LATEX FREE DISPOSABLE SUP-91314 CDM 27000000 LOCAL 0270 RC outpatient 23912.2 23912.2 23912.2 74 17695 percent of total billed charges 23912.2 93 19368.9 percent of total billed charges 23912.2 23912.2 other OPPS APC 23912.2 23912.2 other OPPS APC 23912.2 27.63 6606.94 percent of total billed charges 23912.2 23912.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRIEVER ENDOSCOPIC TREVO NXT PROVUE L37 MM OD6 MM TREVO TRAK 21 MICROCATHETER STERILE LATEX FREE DISPOSABLE SUP-91315 CDM 27000000 LOCAL 0270 RC outpatient 23912.2 23912.2 23912.2 74 17695 percent of total billed charges 23912.2 93 19368.9 percent of total billed charges 23912.2 23912.2 other OPPS APC 23912.2 23912.2 other OPPS APC 23912.2 27.63 6606.94 percent of total billed charges 23912.2 23912.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAD UNIPOLAR ELECTROSURGICAL GROUNDING 15 IN LARGE NONSPLIT PRECORD PLATE PLUG CMAC SUP-9135-LP CDM 0275 RC outpatient 11.63 11.63 11.63 57 6.63 percent of total billed charges 11.63 93 9.42 percent of total billed charges 11.63 11.63 other OPPS APC 11.63 11.63 other OPPS APC 11.63 51 5.93 percent of total billed charges 11.63 11.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADPATER ANGIOGRAPHY NAMIC OPTION 125 200 PSI 3/8 IN 24 THREAD ID .125 IN STERILE SUP-91400025 CDM 0270 RC outpatient 59.76 59.76 59.76 74 44.22 percent of total billed charges 59.76 93 48.41 percent of total billed charges 59.76 59.76 other OPPS APC 59.76 59.76 other OPPS APC 59.76 27.63 16.51 percent of total billed charges 59.76 59.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER ANGIOGRAPHY NAMIC OPTION 125 200 PSI 3/8 IN 24 THREAD ID .125 IN ID SEC .1 IN 3 STERILE SUP-91400035 CDM 0270 RC outpatient 3.27 3.27 3.27 74 2.42 percent of total billed charges 3.27 93 2.65 percent of total billed charges 3.27 3.27 other OPPS APC 3.27 3.27 other OPPS APC 3.27 27.63 0.9 percent of total billed charges 3.27 3.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE PLASTIC PEDIATRIC 3 CONTOUR PRIMARY ANTERIOR UPPER LEFT CENTRAL STRIP AUTOMATIC PREFABRICATE TRANSPARENT SUP-914003 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN FORM 3M ESPE PLASTIC 3 CONTOUR PRIMARY ANTERIOR UPPER RIGHT CENTRAL TRANSPARENT STRIP PREFABRICATE THIN INTERPROXIMAL WALL SUP-914013 CDM 0270 RC outpatient 19.75 19.75 19.75 74 14.62 percent of total billed charges 19.75 93 16 percent of total billed charges 19.75 19.75 other OPPS APC 19.75 19.75 other OPPS APC 19.75 27.63 5.46 percent of total billed charges 19.75 19.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE PLASTIC PEDIATRIC 3 PRIMARY ANTERIOR UPPER LEFT LATERAL STRIP FORM AUTOMATIC CONTOUR THIN INTERPROXIMAL WALL TRANSPARENT SUP-914023 CDM 0270 RC outpatient 19.75 19.75 19.75 74 14.62 percent of total billed charges 19.75 93 16 percent of total billed charges 19.75 19.75 other OPPS APC 19.75 19.75 other OPPS APC 19.75 27.63 5.46 percent of total billed charges 19.75 19.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN 4 THIN CONTOUR PRIMARY ANTERIOR UPPER LEFT LATERAL PLASTIC 3M ESPE STRIP FORM SUP-914024 CDM 0270 RC outpatient 21.49 21.49 21.49 74 15.9 percent of total billed charges 21.49 93 17.41 percent of total billed charges 21.49 21.49 other OPPS APC 21.49 21.49 other OPPS APC 21.49 27.63 5.94 percent of total billed charges 21.49 21.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE PLASTIC PEDIATRIC 3 PRIMARY ANTERIOR UPPER RIGHT LATERAL STRIP AUTOMATIC RESTORATIVE THIN INTERPROXIMAL WALL TRANSPARENT SUP-914033 CDM 0270 RC outpatient 19.75 19.75 19.75 74 14.62 percent of total billed charges 19.75 93 16 percent of total billed charges 19.75 19.75 other OPPS APC 19.75 19.75 other OPPS APC 19.75 27.63 5.46 percent of total billed charges 19.75 19.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CARTICEL TRANSPLANT ACCESS PENINSULA REGIONAL MEDICAL CENTER SUP-914879-009 CDM 0270 RC outpatient 228.74 228.74 228.74 74 169.27 percent of total billed charges 228.74 93 185.28 percent of total billed charges 228.74 228.74 other OPPS APC 228.74 228.74 other OPPS APC 228.74 27.63 63.2 percent of total billed charges 228.74 228.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK THERAPEUTIC LACTOSORB AIR ACTIVATE HEAT SOURCE SUP-915-2055 CDM 0270 RC outpatient 403 403 403 74 298.22 percent of total billed charges 403 93 326.43 percent of total billed charges 403 403 other OPPS APC 403 403 other OPPS APC 403 27.63 111.35 percent of total billed charges 403 403 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE CHROMIC 1 CT L36 IN MONOFILAMENT SUP-915H CDM 0270 RC outpatient 7.83 7.83 7.83 74 5.79 percent of total billed charges 7.83 93 6.34 percent of total billed charges 7.83 7.83 other OPPS APC 7.83 7.83 other OPPS APC 7.83 27.63 2.16 percent of total billed charges 7.83 7.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER CARDIOVASCULAR AUST L40 CM EXTENDED HOOK SITE SELECTIVE PACING SUP-9182 CDM 0270 RC outpatient 1287 1287 1287 74 952.38 percent of total billed charges 1287 93 1042.47 percent of total billed charges 1287 1287 other OPPS APC 1287 1287 other OPPS APC 1287 27.63 355.6 percent of total billed charges 1287 1287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND CIRC STYLE 240 2.5 MM SUP-92-02 CDM 0270 RC outpatient 44.2 44.2 44.2 74 32.71 percent of total billed charges 44.2 93 35.8 percent of total billed charges 44.2 44.2 other OPPS APC 44.2 44.2 other OPPS APC 44.2 27.63 12.21 percent of total billed charges 44.2 44.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 4-HOLE 7.7MM BAR PRE-BENT TITANIUM F/MINI PLATING LEFT CRANIOFACIAL SUP-92-055506 CDM 0270 RC outpatient 869.02 869.02 869.02 74 643.07 percent of total billed charges 869.02 93 703.91 percent of total billed charges 869.02 869.02 other OPPS APC 869.02 869.02 other OPPS APC 869.02 27.63 240.11 percent of total billed charges 869.02 869.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "FORK/PLATE HOLDING, 18CM" SUP-92-08130 CDM 0270 RC outpatient 2048.8 2048.8 2048.8 74 1516.11 percent of total billed charges 2048.8 93 1659.53 percent of total billed charges 2048.8 2048.8 other OPPS APC 2048.8 2048.8 other OPPS APC 2048.8 27.63 566.08 percent of total billed charges 2048.8 2048.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PLT/MINI 4 HOLE, 1.5MM" SUP-92-10504 CDM 0270 RC outpatient 1589.74 1589.74 1589.74 74 1176.41 percent of total billed charges 1589.74 93 1287.69 percent of total billed charges 1589.74 1589.74 other OPPS APC 1589.74 1589.74 other OPPS APC 1589.74 27.63 439.25 percent of total billed charges 1589.74 1589.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PLT/MINI 4 HOLE W/ BAR,1.5MM" SUP-92-10505 CDM 0270 RC outpatient 1775.8 1775.8 1775.8 74 1314.09 percent of total billed charges 1775.8 93 1438.4 percent of total billed charges 1775.8 1775.8 other OPPS APC 1775.8 1775.8 other OPPS APC 1775.8 27.63 490.65 percent of total billed charges 1775.8 1775.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PLT/MINI 6 HOLE,1.5MM" SUP-92-10506 CDM 0270 RC outpatient 2099.19 2099.19 2099.19 74 1553.4 percent of total billed charges 2099.19 93 1700.34 percent of total billed charges 2099.19 2099.19 other OPPS APC 2099.19 2099.19 other OPPS APC 2099.19 27.63 580.01 percent of total billed charges 2099.19 2099.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "3D PLATE/5X2 CNDSD,1.5 PROFILE" SUP-92-10562 CDM 0270 RC outpatient 1951.07 1951.07 1951.07 74 1443.79 percent of total billed charges 1951.07 93 1580.37 percent of total billed charges 1951.07 1951.07 other OPPS APC 1951.07 1951.07 other OPPS APC 1951.07 27.63 539.08 percent of total billed charges 1951.07 1951.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL TWIST 1.6MM 35MM WORKING 90MM THREADED 115MM COLOR MARK SUP-92-16135 CDM 0270 RC outpatient 721.63 721.63 721.63 74 534.01 percent of total billed charges 721.63 93 584.52 percent of total billed charges 721.63 721.63 other OPPS APC 721.63 721.63 other OPPS APC 721.63 27.63 199.39 percent of total billed charges 721.63 721.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIRE SCLERAL SILICONE CONVEX OD6 MM ODSEC2.5 MM STYLE 286 SUP-92-22 CDM 0270 RC outpatient 68.64 68.64 68.64 74 50.79 percent of total billed charges 68.64 93 55.6 percent of total billed charges 68.64 68.64 other OPPS APC 68.64 68.64 other OPPS APC 68.64 27.63 18.97 percent of total billed charges 68.64 68.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE SCLERAL SILICONE ROUND STYLE 72 BUCKLING SUP-92-30 CDM 0270 RC outpatient 30.16 30.16 30.16 74 22.32 percent of total billed charges 30.16 93 24.43 percent of total billed charges 30.16 30.16 other OPPS APC 30.16 30.16 other OPPS APC 30.16 27.63 8.33 percent of total billed charges 30.16 30.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE HOLEX4 7.7MM BAR PRE-BEND TITANIUM F/MINI PLATING RIGHT CRANIOMAXILLOFACIAL SUP-92-55505 CDM 0270 RC outpatient 868.97 868.97 868.97 74 643.04 percent of total billed charges 868.97 93 703.87 percent of total billed charges 868.97 868.97 other OPPS APC 868.97 868.97 other OPPS APC 868.97 27.63 240.1 percent of total billed charges 868.97 868.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 4-HOLE 7.7MM BAR PRE-BENT TITANIUM F/MINI PLATING LEFT CRANIOFACIAL SUP-92-55506 CDM 0270 RC outpatient 869.02 869.02 869.02 74 643.07 percent of total billed charges 869.02 93 703.91 percent of total billed charges 869.02 869.02 other OPPS APC 869.02 869.02 other OPPS APC 869.02 27.63 240.11 percent of total billed charges 869.02 869.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3D 5 HOLE MINI PLT W. TAB SUP-92-55521 CDM 0270 RC outpatient 2329.6 2329.6 2329.6 74 1723.9 percent of total billed charges 2329.6 93 1886.98 percent of total billed charges 2329.6 2329.6 other OPPS APC 2329.6 2329.6 other OPPS APC 2329.6 27.63 643.67 percent of total billed charges 2329.6 2329.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE HOLEX6X2 3D CURVED CRANIOMAXILLOFACIAL SUP-92-55562 CDM 0270 RC outpatient 1323.66 1323.66 1323.66 74 979.51 percent of total billed charges 1323.66 93 1072.16 percent of total billed charges 1323.66 1323.66 other OPPS APC 1323.66 1323.66 other OPPS APC 1323.66 27.63 365.73 percent of total billed charges 1323.66 1323.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PLT/TRAPEZE,2X2HOLES,MP" SUP-92-55563 CDM 0270 RC outpatient 1324.05 1324.05 1324.05 74 979.8 percent of total billed charges 1324.05 93 1072.48 percent of total billed charges 1324.05 1324.05 other OPPS APC 1324.05 1324.05 other OPPS APC 1324.05 27.63 365.84 percent of total billed charges 1324.05 1324.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3D 6 HOLE MINI PLT W. TAB SUP-92-55621 CDM 0270 RC outpatient 2329.6 2329.6 2329.6 74 1723.9 percent of total billed charges 2329.6 93 1886.98 percent of total billed charges 2329.6 2329.6 other OPPS APC 2329.6 2329.6 other OPPS APC 2329.6 27.63 643.67 percent of total billed charges 2329.6 2329.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PLT/PRIMARY HEMI 2.0MM,RIGHT" SUP-92-55920 CDM 0270 RC outpatient 5353.43 5353.43 5353.43 74 3961.54 percent of total billed charges 5353.43 93 4336.28 percent of total billed charges 5353.43 5353.43 other OPPS APC 5353.43 5353.43 other OPPS APC 5353.43 27.63 1479.15 percent of total billed charges 5353.43 5353.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PLT/PRIMARY HEMI 2.0MM,LEFT" SUP-92-55922 CDM 0270 RC outpatient 5353.43 5353.43 5353.43 74 3961.54 percent of total billed charges 5353.43 93 4336.28 percent of total billed charges 5353.43 5353.43 other OPPS APC 5353.43 5353.43 other OPPS APC 5353.43 27.63 1479.15 percent of total billed charges 5353.43 5353.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION SURGICAL SCRUB 3M AVAGARD 16OZ 61% ETHYL ALCOHOL 1% CHLORHEXIDINE GLUCONATE ANTISEPTIC MOISTURIZER WEDGE BOTTLE SUP-9200 CDM outpatient 75.26 75.26 75.26 75.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LOW PROFILE CRANIUM 2 HOLE TAP SUP-9203210 CDM 0270 RC outpatient 322.79 322.79 322.79 74 238.86 percent of total billed charges 322.79 93 261.46 percent of total billed charges 322.79 322.79 other OPPS APC 322.79 322.79 other OPPS APC 322.79 27.63 89.19 percent of total billed charges 322.79 322.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER BURR HOLE OD10 MM CRANIUM LOW PROFILE 3 MM SCREW SUP-9203510 CDM 0270 RC outpatient 1011.4 1011.4 1011.4 74 748.44 percent of total billed charges 1011.4 93 819.23 percent of total billed charges 1011.4 1011.4 other OPPS APC 1011.4 1011.4 other OPPS APC 1011.4 27.63 279.45 percent of total billed charges 1011.4 1011.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER BURR HOLE LOW PROFILE OD14 MM CRANIUM 3 MM SCREW SUP-9203514 CDM 0270 RC outpatient 604.79 604.79 604.79 74 447.54 percent of total billed charges 604.79 93 489.88 percent of total billed charges 604.79 604.79 other OPPS APC 604.79 604.79 other OPPS APC 604.79 27.63 167.1 percent of total billed charges 604.79 604.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 2Y MICRO LOW PROFILE L8 MM CRANIUM 6 HOLE BAR SUP-9203608 CDM 0270 RC outpatient 1066 1066 1066 74 788.84 percent of total billed charges 1066 93 863.46 percent of total billed charges 1066 1066 other OPPS APC 1066 1066 other OPPS APC 1066 27.63 294.54 percent of total billed charges 1066 1066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 4 HOLE PROFILE SUP-9203804 CDM 0270 RC outpatient 438.31 438.31 438.31 74 324.35 percent of total billed charges 438.31 93 355.03 percent of total billed charges 438.31 438.31 other OPPS APC 438.31 438.31 other OPPS APC 438.31 27.63 121.11 percent of total billed charges 438.31 438.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRIP SCLERAL SILICONE L125 MM X W3.5 MM X H.75 MM STYLE 41 SUP-9209 CDM 0270 RC outpatient 47.32 47.32 47.32 74 35.02 percent of total billed charges 47.32 93 38.33 percent of total billed charges 47.32 47.32 other OPPS APC 47.32 47.32 other OPPS APC 47.32 27.63 13.07 percent of total billed charges 47.32 47.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE RETINAL SILICONE ROUND L30 MM OD2.1 MM ODSEC1 MM BAND SECURE SUP-9213 CDM 0270 RC outpatient 30.16 30.16 30.16 74 22.32 percent of total billed charges 30.16 93 24.43 percent of total billed charges 30.16 30.16 other OPPS APC 30.16 30.16 other OPPS APC 30.16 27.63 8.33 percent of total billed charges 30.16 30.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L4 MM OD1.5 MM CRANIOMAXILLOFACIAL SELF DRILLING CROSS PIN SUP-9215304 CDM 0270 RC outpatient 62.92 62.92 62.92 74 46.56 percent of total billed charges 62.92 93 50.97 percent of total billed charges 62.92 62.92 other OPPS APC 62.92 62.92 other OPPS APC 62.92 27.63 17.38 percent of total billed charges 62.92 62.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 4MM 1.5MM CRANIOMAXILLOFACIAL TITANIUM SELF DRILL SUP-9215904 CDM 0270 RC outpatient 191.2 191.2 191.2 74 141.49 percent of total billed charges 191.2 93 154.87 percent of total billed charges 191.2 191.2 other OPPS APC 191.2 191.2 other OPPS APC 191.2 27.63 52.83 percent of total billed charges 191.2 191.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TITANIUM 5MM 1.5MM CRANIOMAXILLOFACIAL SELF DRILL BONE SUP-9215905 CDM 0270 RC outpatient 191.2 191.2 191.2 74 141.49 percent of total billed charges 191.2 93 154.87 percent of total billed charges 191.2 191.2 other OPPS APC 191.2 191.2 other OPPS APC 191.2 27.63 52.83 percent of total billed charges 191.2 191.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE CHROMIC 3-0 CT-1 L36 IN MONOFILAMENT BROWN SUP-922H CDM 0270 RC outpatient 7.65 7.65 7.65 74 5.66 percent of total billed charges 7.65 93 6.2 percent of total billed charges 7.65 7.65 other OPPS APC 7.65 7.65 other OPPS APC 7.65 27.63 2.11 percent of total billed charges 7.65 7.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNIFE OPHTHALMIC A-OK 30 D W1.85 MM FULL HANDLE STERILE DISPOSABLE SUP-923001 CDM 0270 RC outpatient 27.3 27.3 27.3 74 20.2 percent of total billed charges 27.3 93 22.11 percent of total billed charges 27.3 27.3 other OPPS APC 27.3 27.3 other OPPS APC 27.3 27.63 7.54 percent of total billed charges 27.3 27.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POUCH STERILIZATION DUALPEEL PAPER L9 IN X W3.5 IN 2 INDICATOR SELF SEAL CENTRAL SUPPLY BLUE SUP-92309 CDM 270010030 LOCAL 0270 RC outpatient 0.08 0.08 0.08 74 0.06 percent of total billed charges 0.08 93 0.06 percent of total billed charges 0.08 0.08 other OPPS APC 0.08 0.08 other OPPS APC 0.08 27.63 0.02 percent of total billed charges 0.08 0.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THERMODIL SUP-93-132-F5 CDM 270009129 LOCAL 0270 RC outpatient 54 54 54 74 39.96 percent of total billed charges 54 93 43.74 percent of total billed charges 54 54 other OPPS APC 54 54 other OPPS APC 54 27.63 14.92 percent of total billed charges 54 54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR PREP CHLORAPREP FREPP ENTURIA 70% ISOPROPYL ALCOHOL 2% CHLORHEXIDINE GLUCONATE 1.5 ML 1 STEP AMPULE DRIP RESISTANT STERILE LATEX FREE DISPOSABLE SUP-930299 CDM 270009040 LOCAL 0270 RC outpatient 1.65 1.65 1.65 74 1.22 percent of total billed charges 1.65 93 1.34 percent of total billed charges 1.65 1.65 other OPPS APC 1.65 1.65 other OPPS APC 1.65 27.63 0.46 percent of total billed charges 1.65 1.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCATHETER 18 TREVO XP PROVUE +PRO 4 X 30MM SUP-93067 CDM 0270 RC outpatient 21707.4 21707.4 21707.4 74 16063.5 percent of total billed charges 21707.4 93 17583 percent of total billed charges 21707.4 21707.4 other OPPS APC 21707.4 21707.4 other OPPS APC 21707.4 27.63 5997.75 percent of total billed charges 21707.4 21707.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCATHETER TREVO XP PROVUE +XT27 6 X 25MM SUP-93068 CDM 0270 RC outpatient 22347 22347 22347 74 16536.8 percent of total billed charges 22347 93 18101.1 percent of total billed charges 22347 22347 other OPPS APC 22347 22347 other OPPS APC 22347 27.63 6174.48 percent of total billed charges 22347 22347 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR PREP CHLORAPREP HI-LITE ORANGE 70% ISOPROPYL ALCOHOL 2% CHLORHEXIDINE GLUCONATE 10.5 ML ANTIMICROBIAL 1 STEP DEHP FREE STERILE LATEX FREE DISPOSABLE SUP-930715 CDM 270009040 LOCAL 0270 RC outpatient 9.44 9.44 9.44 74 6.99 percent of total billed charges 9.44 93 7.65 percent of total billed charges 9.44 9.44 other OPPS APC 9.44 9.44 other OPPS APC 9.44 27.63 2.61 percent of total billed charges 9.44 9.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR PREP CHLORAPREP HI-LITE ORANGE 70% ISOPROPYL ALCOHOL 2% CHLORHEXIDINE GLUCONATE 26 ML ANTIMICROBIAL 1 STEP DEHP FREE STERILE LATEX FREE DISPOSABLE SUP-930815 CDM 0270 RC outpatient 16.28 16.28 16.28 74 12.05 percent of total billed charges 16.28 93 13.19 percent of total billed charges 16.28 16.28 other OPPS APC 16.28 16.28 other OPPS APC 16.28 27.63 4.5 percent of total billed charges 16.28 16.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DISTIAL ANTIMICROBIAL SUP-93092 CDM 0270 RC outpatient 1256.4 1256.4 1256.4 74 929.74 percent of total billed charges 1256.4 93 1017.68 percent of total billed charges 1256.4 1256.4 other OPPS APC 1256.4 1256.4 other OPPS APC 1256.4 27.63 347.14 percent of total billed charges 1256.4 1256.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOLDER LEG ALIMED ALUMINUM POLYPROPYLENE SPIRAL W3 IN OD11 IN ID7 IN LEG IMMOBILIZER LATEX FREE DISPOSABLE WHITE SUP-931961 CDM outpatient 65.65 65.65 65.65 65.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AGENT HEMOSTATIC FLOSEAL 5ML GELATIN MATRIX HUMAN THROMBIN CALCIUM CHLORIDE SURGICAL KIT SUP-934057 CDM 0270 RC outpatient 467.74 467.74 467.74 74 346.13 percent of total billed charges 467.74 93 378.87 percent of total billed charges 467.74 467.74 other OPPS APC 467.74 467.74 other OPPS APC 467.74 27.63 129.24 percent of total billed charges 467.74 467.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALANT ADHESIVE COSEAL 4ML PEG DISPOSABLE STERILE LF SUP-934071 CDM 0270 RC outpatient 1706.38 1706.38 1706.38 74 1262.72 percent of total billed charges 1706.38 93 1382.17 percent of total billed charges 1706.38 1706.38 other OPPS APC 1706.38 1706.38 other OPPS APC 1706.38 27.63 471.47 percent of total billed charges 1706.38 1706.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALANT ADHESIVE COSEAL 8ML PEG DISPOSABLE STERILE LF SUP-934072 CDM 0270 RC outpatient 2641.34 2641.34 2641.34 74 1954.59 percent of total billed charges 2641.34 93 2139.49 percent of total billed charges 2641.34 2641.34 other OPPS APC 2641.34 2641.34 other OPPS APC 2641.34 27.63 729.8 percent of total billed charges 2641.34 2641.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOCKET OPERATING ROOM CLARK STAINLESS STEEL STANDARD W2.75 IN X H7/8 IN W3/8 IN X H1 1/8 IN OD11/16 IN 2 LB SUP-936673 CDM outpatient 516.85 516.85 516.85 516.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WRAP THERAPEUTIC ACTIVEWRAP PLUSH SMALL MEDIUM OD16- IN LEG KNEE THERMAL SUPPORT GEL PACK POST OPERATIVE NONSTERILE LATEX FREE SUP-9373-04 CDM 0270 RC outpatient 90.09 90.09 90.09 74 66.67 percent of total billed charges 90.09 93 72.97 percent of total billed charges 90.09 90.09 other OPPS APC 90.09 90.09 other OPPS APC 90.09 27.63 24.89 percent of total billed charges 90.09 90.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WRAP THERAPEUTIC ACTIVEWRAP PLUSH LARGE XL OD16+ IN LEG KNEE THERMAL SUPPORT GEL PACK POST OPERATIVE NONSTERILE LATEX FREE SUP-9373-05 CDM 0270 RC outpatient 92.87 92.87 92.87 74 68.72 percent of total billed charges 92.87 93 75.22 percent of total billed charges 92.87 92.87 other OPPS APC 92.87 92.87 other OPPS APC 92.87 27.63 25.66 percent of total billed charges 92.87 92.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WRAP SHOULDER FOAM WITH 4 COLD PACK SUP-9381-00 CDM 270009124 LOCAL 0270 RC outpatient 57.23 57.23 57.23 74 42.35 percent of total billed charges 57.23 93 46.36 percent of total billed charges 57.23 57.23 other OPPS APC 57.23 57.23 other OPPS APC 57.23 27.63 15.81 percent of total billed charges 57.23 57.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WRAP THERAPEUTIC FOAM L25.5 IN X W14 IN KNEE 4 COLD PACK ADJUSTABLE PAD SUP-9383-10 CDM 270009123 LOCAL 0270 RC outpatient 26.81 26.81 26.81 74 19.84 percent of total billed charges 26.81 93 21.72 percent of total billed charges 26.81 26.81 other OPPS APC 26.81 26.81 other OPPS APC 26.81 27.63 7.41 percent of total billed charges 26.81 26.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRUT SPINAL CENTERPIECE L19 MM X W19 MM T2 ALTITUDE 19A SUP-9391919 CDM 270010020 LOCAL 0270 RC outpatient 13260 13260 13260 74 9812.4 percent of total billed charges 13260 93 10740.6 percent of total billed charges 13260 13260 other OPPS APC 13260 13260 other OPPS APC 13260 27.63 3663.74 percent of total billed charges 13260 13260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CRESCENT PEEK-OPTIMA L30 MM X H11 MM SUP-9393011 CDM 270010020 LOCAL 0270 RC outpatient 8119.33 8119.33 8119.33 74 6008.3 percent of total billed charges 8119.33 93 6576.66 percent of total billed charges 8119.33 8119.33 other OPPS APC 8119.33 8119.33 other OPPS APC 8119.33 27.63 2243.37 percent of total billed charges 8119.33 8119.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELEVIEW 10ML SUBMUCOSAL INJECTABLE SUP-94-00183 CDM 0272 RC outpatient 292.6 292.6 292.6 74 216.52 percent of total billed charges 292.6 93 237.01 percent of total billed charges 292.6 292.6 other OPPS APC 292.6 292.6 other OPPS APC 292.6 27.63 80.85 percent of total billed charges 292.6 292.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRIVER SURGICAL ARROW ONCONTROL POWER SUP-9401 CDM 0270 RC outpatient 1755 1755 1755 74 1298.7 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 1755 other OPPS APC 1755 1755 other OPPS APC 1755 27.63 484.91 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP SPINAL 4 D OD19 MM LATEX FREE SUP-9401904 CDM 270010020 LOCAL 0270 RC outpatient 858 858 858 74 634.92 percent of total billed charges 858 93 694.98 percent of total billed charges 858 858 other OPPS APC 858 858 other OPPS APC 858 27.63 237.07 percent of total billed charges 858 858 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY BIOPSY ARROW ONCONTROL L102 MM SUP-9408-VC-006 CDM 0270 RC outpatient 430.3 430.3 430.3 74 318.42 percent of total billed charges 430.3 93 348.54 percent of total billed charges 430.3 430.3 other OPPS APC 430.3 430.3 other OPPS APC 430.3 27.63 118.89 percent of total billed charges 430.3 430.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY BIOPSY ARROW ONCONTROL L152 MM SUP-9411-VC-006 CDM 0270 RC outpatient 430.3 430.3 430.3 74 318.42 percent of total billed charges 430.3 93 348.54 percent of total billed charges 430.3 430.3 other OPPS APC 430.3 430.3 other OPPS APC 430.3 27.63 118.89 percent of total billed charges 430.3 430.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP CORD DOUBLE-GRIP PLASTIC DISPOSABLE STERILE LF NEONATE UMBILICAL HINGE GUARD SERRATE JAW SUP-9423 CDM 0270 RC outpatient 6.97 6.97 6.97 74 5.16 percent of total billed charges 6.97 93 5.65 percent of total billed charges 6.97 6.97 other OPPS APC 6.97 6.97 other OPPS APC 6.97 27.63 1.93 percent of total billed charges 6.97 6.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TWIST DRILL AO 1.9 X 108MM SUP-95-00001 CDM 0272 RC outpatient 369.25 369.25 369.25 74 273.25 percent of total billed charges 369.25 93 299.09 percent of total billed charges 369.25 369.25 other OPPS APC 369.25 369.25 other OPPS APC 369.25 27.63 102.02 percent of total billed charges 369.25 369.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GREEN PIN GUARDS SUP-95-00009 CDM 0272 RC outpatient 1.83 1.83 1.83 74 1.35 percent of total billed charges 1.83 93 1.48 percent of total billed charges 1.83 1.83 other OPPS APC 1.83 1.83 other OPPS APC 1.83 27.63 0.51 percent of total billed charges 1.83 1.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLING SAM MEDIUM 32-50 SUP-95-00078 CDM 0271 RC outpatient 240.91 240.91 240.91 74 178.27 percent of total billed charges 240.91 93 195.14 percent of total billed charges 240.91 240.91 other OPPS APC 240.91 240.91 other OPPS APC 240.91 27.63 66.56 percent of total billed charges 240.91 240.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLING SAM LARGE 36-60 SUP-95-00079 CDM 0271 RC outpatient 240.91 240.91 240.91 74 178.27 percent of total billed charges 240.91 93 195.14 percent of total billed charges 240.91 240.91 other OPPS APC 240.91 240.91 other OPPS APC 240.91 27.63 66.56 percent of total billed charges 240.91 240.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLING SAM SMALL 27-47 SUP-95-00080 CDM 0271 RC outpatient 302.09 302.09 302.09 74 223.55 percent of total billed charges 302.09 93 244.69 percent of total billed charges 302.09 302.09 other OPPS APC 302.09 302.09 other OPPS APC 302.09 27.63 83.47 percent of total billed charges 302.09 302.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE DARCO POST OP MAN LG SUP-95-00190 CDM L3260 HCPCS 0271 RC outpatient 32.8 32.8 32.8 74 24.27 percent of total billed charges 32.8 93 26.57 percent of total billed charges 32.8 32.8 other OPPS APC 32.8 32.8 other OPPS APC 32.8 27.63 9.06 percent of total billed charges 32.8 32.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE DARCO POST OP MAN MED SUP-95-00191 CDM L3260 HCPCS 0271 RC outpatient 32.8 32.8 32.8 74 24.27 percent of total billed charges 32.8 93 26.57 percent of total billed charges 32.8 32.8 other OPPS APC 32.8 32.8 other OPPS APC 32.8 27.63 9.06 percent of total billed charges 32.8 32.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE DARCO POST OP WMS MED SUP-95-00192 CDM L3260 HCPCS 0271 RC outpatient 32.8 32.8 32.8 74 24.27 percent of total billed charges 32.8 93 26.57 percent of total billed charges 32.8 32.8 other OPPS APC 32.8 32.8 other OPPS APC 32.8 27.63 9.06 percent of total billed charges 32.8 32.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE DARCO POST OP WMS LG SUP-95-00193 CDM L3260 HCPCS 0271 RC outpatient 32.8 32.8 32.8 74 24.27 percent of total billed charges 32.8 93 26.57 percent of total billed charges 32.8 32.8 other OPPS APC 32.8 32.8 other OPPS APC 32.8 27.63 9.06 percent of total billed charges 32.8 32.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHEST TUBE KIT 14FR THAL-QUICK SUP-95-00195 CDM 0272 RC outpatient 529.17 529.17 529.17 74 391.59 percent of total billed charges 529.17 93 428.63 percent of total billed charges 529.17 529.17 other OPPS APC 529.17 529.17 other OPPS APC 529.17 27.63 146.21 percent of total billed charges 529.17 529.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMBI TUBE 41FR SUP-95-00196 CDM 0272 RC outpatient 622.16 622.16 622.16 74 460.4 percent of total billed charges 622.16 93 503.95 percent of total billed charges 622.16 622.16 other OPPS APC 622.16 622.16 other OPPS APC 622.16 27.63 171.9 percent of total billed charges 622.16 622.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT HIGH FLOW MAC SHEATH INTRODUCER SUP-95-00199 CDM 0272 RC outpatient 416.71 416.71 416.71 74 308.37 percent of total billed charges 416.71 93 337.54 percent of total billed charges 416.71 416.71 other OPPS APC 416.71 416.71 other OPPS APC 416.71 27.63 115.14 percent of total billed charges 416.71 416.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIDERITE RIGID STYLET SUP-95-00200 CDM 0272 RC outpatient 1029 1029 1029 74 761.46 percent of total billed charges 1029 93 833.49 percent of total billed charges 1029 1029 other OPPS APC 1029 1029 other OPPS APC 1029 27.63 284.31 percent of total billed charges 1029 1029 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONRAY 100ML SUP-95-00216 CDM 0271 RC outpatient 1192.5 1192.5 1192.5 74 882.45 percent of total billed charges 1192.5 93 965.93 percent of total billed charges 1192.5 1192.5 other OPPS APC 1192.5 1192.5 other OPPS APC 1192.5 27.63 329.49 percent of total billed charges 1192.5 1192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DARCO MED-SURG SHOE MAN MED SUP-95-00230 CDM L3260 HCPCS 0271 RC outpatient 66.8 66.8 66.8 74 49.43 percent of total billed charges 66.8 93 54.11 percent of total billed charges 66.8 66.8 other OPPS APC 66.8 66.8 other OPPS APC 66.8 27.63 18.46 percent of total billed charges 66.8 66.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE COVER 26W X 62L X 61H SUP-95-00232 CDM 0272 RC outpatient 595 595 595 74 440.3 percent of total billed charges 595 93 481.95 percent of total billed charges 595 595 other OPPS APC 595 595 other OPPS APC 595 27.63 164.4 percent of total billed charges 595 595 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SPRING WIRE J .025"" X 35CM" SUP-95-00242 CDM C1769 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TRAY JAMSHIDI BONE MRW W/DISP 4"" NDLE" SUP-95-00260 CDM 0272 RC outpatient 935.37 935.37 935.37 74 692.17 percent of total billed charges 935.37 93 757.65 percent of total billed charges 935.37 935.37 other OPPS APC 935.37 935.37 other OPPS APC 935.37 27.63 258.44 percent of total billed charges 935.37 935.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TUBING ARTERIAL PRESSURE 24""" SUP-95-00279 CDM 0272 RC outpatient 1.59 1.59 1.59 74 1.18 percent of total billed charges 1.59 93 1.29 percent of total billed charges 1.59 1.59 other OPPS APC 1.59 1.59 other OPPS APC 1.59 27.63 0.44 percent of total billed charges 1.59 1.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DURA CLIPS 11MM SUP-95-00332 CDM 0272 RC outpatient 517.65 517.65 517.65 74 383.06 percent of total billed charges 517.65 93 419.3 percent of total billed charges 517.65 517.65 other OPPS APC 517.65 517.65 other OPPS APC 517.65 27.63 143.03 percent of total billed charges 517.65 517.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT THERASKIN 6CM 1 X 1 SUP-95-00345 CDM Q4121 HCPCS 0636 RC outpatient 2625 2625 53.63 53.63 fee schedule 2625 93 2126.25 percent of total billed charges 2625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2625 other OPPS APC 2625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2625 other OPPS APC 2625 24.86 652.58 percent of total billed charges 53.63 2625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING ENDO FLUSH SUP-95-00346 CDM 0272 RC outpatient 579.53 579.53 579.53 74 428.85 percent of total billed charges 579.53 93 469.42 percent of total billed charges 579.53 579.53 other OPPS APC 579.53 579.53 other OPPS APC 579.53 27.63 160.12 percent of total billed charges 579.53 579.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VITALSTIM LEADWIRE SUP-95-00352 CDM 0272 RC outpatient 137.36 137.36 137.36 74 101.65 percent of total billed charges 137.36 93 111.26 percent of total billed charges 137.36 137.36 other OPPS APC 137.36 137.36 other OPPS APC 137.36 27.63 37.95 percent of total billed charges 137.36 137.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON PYLORIC COLONIC 12MM SUP-95-00359 CDM C1726 HCPCS 0272 RC outpatient 273 273 273 74 202.02 percent of total billed charges 273 93 221.13 percent of total billed charges 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 273 27.63 75.43 percent of total billed charges 273 273 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON PYLORIC COLONIC 15MM SUP-95-00360 CDM C1726 HCPCS 0272 RC outpatient 273 273 273 74 202.02 percent of total billed charges 273 93 221.13 percent of total billed charges 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 273 27.63 75.43 percent of total billed charges 273 273 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON PYLORIC COLONIC 18MM SUP-95-00361 CDM C1726 HCPCS 0272 RC outpatient 273 273 273 74 202.02 percent of total billed charges 273 93 221.13 percent of total billed charges 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 273 27.63 75.43 percent of total billed charges 273 273 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEP DISP 6.5 HARTMANN ALLIGATOR SUP-95-00397 CDM 0272 RC outpatient 2147.4 2147.4 2147.4 74 1589.08 percent of total billed charges 2147.4 93 1739.39 percent of total billed charges 2147.4 2147.4 other OPPS APC 2147.4 2147.4 other OPPS APC 2147.4 27.63 593.33 percent of total billed charges 2147.4 2147.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT COLONIC WALLFLEX 22/27MM SUP-95-00455 CDM C2625 HCPCS 0278 RC outpatient 6562.5 6562.5 6562.5 57 3740.63 percent of total billed charges 6562.5 93 5315.63 percent of total billed charges 6562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6562.5 other OPPS APC 6562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6562.5 other OPPS APC 6562.5 51 3346.88 percent of total billed charges 6562.5 6562.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT DUODENAL WALLFLEX 22/27MM SUP-95-00456 CDM C2625 HCPCS 0278 RC outpatient 9240 9240 9240 57 5266.8 percent of total billed charges 9240 93 7484.4 percent of total billed charges 9240 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9240 other OPPS APC 9240 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9240 other OPPS APC 9240 51 4712.4 percent of total billed charges 9240 9240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "COVER CART 24""X60""X68"" BLUE" SUP-95-00466 CDM 0271 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE COVER 24W X 48L X 60H SUP-95-00481 CDM 0271 RC outpatient 364.14 364.14 364.14 74 269.46 percent of total billed charges 364.14 93 294.95 percent of total billed charges 364.14 364.14 other OPPS APC 364.14 364.14 other OPPS APC 364.14 27.63 100.61 percent of total billed charges 364.14 364.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASC WALLSTENT 500CM X 035 SUP-95-00483 CDM 0272 RC outpatient 1860 1860 1860 74 1376.4 percent of total billed charges 1860 93 1506.6 percent of total billed charges 1860 1860 other OPPS APC 1860 1860 other OPPS APC 1860 27.63 513.92 percent of total billed charges 1860 1860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER EQUIPMENT SUP-95-00488 CDM 0271 RC outpatient 369.25 369.25 369.25 74 273.25 percent of total billed charges 369.25 93 299.09 percent of total billed charges 369.25 369.25 other OPPS APC 369.25 369.25 other OPPS APC 369.25 27.63 102.02 percent of total billed charges 369.25 369.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER CART 64X27X67 SUP-95-00489 CDM 0271 RC outpatient 366.87 366.87 366.87 74 271.48 percent of total billed charges 366.87 93 297.16 percent of total billed charges 366.87 366.87 other OPPS APC 366.87 366.87 other OPPS APC 366.87 27.63 101.37 percent of total billed charges 366.87 366.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STICKERS - FENTANYL SUP-95-00490 CDM 0271 RC outpatient 41.28 41.28 41.28 74 30.55 percent of total billed charges 41.28 93 33.44 percent of total billed charges 41.28 41.28 other OPPS APC 41.28 41.28 other OPPS APC 41.28 27.63 11.41 percent of total billed charges 41.28 41.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STICKERS - VERSED SUP-95-00491 CDM 0271 RC outpatient 41.28 41.28 41.28 74 30.55 percent of total billed charges 41.28 93 33.44 percent of total billed charges 41.28 41.28 other OPPS APC 41.28 41.28 other OPPS APC 41.28 27.63 11.41 percent of total billed charges 41.28 41.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STICKERS - BENEDRYL SUP-95-00492 CDM 0271 RC outpatient 37.88 37.88 37.88 74 28.03 percent of total billed charges 37.88 93 30.68 percent of total billed charges 37.88 37.88 other OPPS APC 37.88 37.88 other OPPS APC 37.88 27.63 10.47 percent of total billed charges 37.88 37.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE 8G SUP-95-00530 CDM 0272 RC outpatient 2597.07 2597.07 2597.07 74 1921.83 percent of total billed charges 2597.07 93 2103.63 percent of total billed charges 2597.07 2597.07 other OPPS APC 2597.07 2597.07 other OPPS APC 2597.07 27.63 717.57 percent of total billed charges 2597.07 2597.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VACUUM SET SUP-95-00531 CDM 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BIOPSY SITE ID, 11G" SUP-95-00532 CDM outpatient 1692.9 1692.9 1692.9 1692.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE WANG BIOPSY 21G SUP-95-00561 CDM 0272 RC outpatient 194.92 194.92 194.92 74 144.24 percent of total billed charges 194.92 93 157.89 percent of total billed charges 194.92 194.92 other OPPS APC 194.92 194.92 other OPPS APC 194.92 27.63 53.86 percent of total billed charges 194.92 194.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRIMATRIX MASHED 3X3CM SUP-95-00562 CDM Q4110 HCPCS 0636 RC outpatient 2250 2250 48.93 48.93 fee schedule 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 24.86 559.35 percent of total billed charges 48.93 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE TALON II MEN'S BLACK SUP-95-00566 CDM L3260 HCPCS 0271 RC outpatient 119.92 119.92 119.92 74 88.74 percent of total billed charges 119.92 93 97.14 percent of total billed charges 119.92 119.92 other OPPS APC 119.92 119.92 other OPPS APC 119.92 27.63 33.13 percent of total billed charges 119.92 119.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. J-SPLINT 4X20FT PLASTER SUP-95-00572 CDM 0271 RC outpatient 171.96 171.96 171.96 74 127.25 percent of total billed charges 171.96 93 139.29 percent of total billed charges 171.96 171.96 other OPPS APC 171.96 171.96 other OPPS APC 171.96 27.63 47.51 percent of total billed charges 171.96 171.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT FINGER STACK SZ 1 SUP-95-00577 CDM 0271 RC outpatient 25.44 25.44 25.44 74 18.83 percent of total billed charges 25.44 93 20.61 percent of total billed charges 25.44 25.44 other OPPS APC 25.44 25.44 other OPPS APC 25.44 27.63 7.03 percent of total billed charges 25.44 25.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT FINGER STACK SZ 2 SUP-95-00578 CDM 0271 RC outpatient 25.44 25.44 25.44 74 18.83 percent of total billed charges 25.44 93 20.61 percent of total billed charges 25.44 25.44 other OPPS APC 25.44 25.44 other OPPS APC 25.44 27.63 7.03 percent of total billed charges 25.44 25.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT FINGER STACK SZ 3 SUP-95-00579 CDM 0271 RC outpatient 25.44 25.44 25.44 74 18.83 percent of total billed charges 25.44 93 20.61 percent of total billed charges 25.44 25.44 other OPPS APC 25.44 25.44 other OPPS APC 25.44 27.63 7.03 percent of total billed charges 25.44 25.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT FINGER STACK SZ 4 SUP-95-00580 CDM 0271 RC outpatient 25.44 25.44 25.44 74 18.83 percent of total billed charges 25.44 93 20.61 percent of total billed charges 25.44 25.44 other OPPS APC 25.44 25.44 other OPPS APC 25.44 27.63 7.03 percent of total billed charges 25.44 25.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SET EZ IO 15MM PEDIATRIC SUP-95-00585 CDM outpatient 402.5 402.5 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPPORT WRIST RIGHT SMALL SUP-95-00602 CDM L3906 HCPCS 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPPORT WRIST RIGHT MED SUP-95-00603 CDM L3906 HCPCS 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPPORT WRIST RIGHT LARGE SUP-95-00604 CDM L3906 HCPCS 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPPORT WRIST RIGHT XL SUP-95-00605 CDM L3906 HCPCS 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPPORT WRIST LEFT XS SUP-95-00606 CDM L3906 HCPCS 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPPORT WRIST LEFT SMALL SUP-95-00607 CDM L3906 HCPCS 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPPORT WRIST LEFT MED SUP-95-00608 CDM L3906 HCPCS 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPPORT WRIST LEFT LARGE SUP-95-00609 CDM L3906 HCPCS 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPPORT WRIST LEFT XL SUP-95-00610 CDM L3906 HCPCS 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT COLLES RIGHT SMALL SUP-95-00616 CDM A4570 HCPCS 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT COLLES ALUM/FOAM LEFT SMALL SUP-95-00620 CDM A4570 HCPCS 0272 RC outpatient 45.4 45.4 45.4 74 33.6 percent of total billed charges 45.4 93 36.77 percent of total billed charges 45.4 45.4 other OPPS APC 45.4 45.4 other OPPS APC 45.4 27.63 12.54 percent of total billed charges 45.4 45.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT COLLES ALUM/FOAM LEFT MEDIUM SUP-95-00621 CDM A4570 HCPCS 0272 RC outpatient 45.4 45.4 45.4 74 33.6 percent of total billed charges 45.4 93 36.77 percent of total billed charges 45.4 45.4 other OPPS APC 45.4 45.4 other OPPS APC 45.4 27.63 12.54 percent of total billed charges 45.4 45.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT COLLES ALUM/FOAM LFT LARGE SUP-95-00622 CDM A4570 HCPCS 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT COLLES ALUM/FOAM RIGHT SMALL SUP-95-00623 CDM A4570 HCPCS 0272 RC outpatient 45.4 45.4 45.4 74 33.6 percent of total billed charges 45.4 93 36.77 percent of total billed charges 45.4 45.4 other OPPS APC 45.4 45.4 other OPPS APC 45.4 27.63 12.54 percent of total billed charges 45.4 45.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT COLLES ALUM/FOAM RIGHT MEDIUM SUP-95-00624 CDM A4570 HCPCS 0272 RC outpatient 45.4 45.4 45.4 74 33.6 percent of total billed charges 45.4 93 36.77 percent of total billed charges 45.4 45.4 other OPPS APC 45.4 45.4 other OPPS APC 45.4 27.63 12.54 percent of total billed charges 45.4 45.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT COLLES ALUM/FOAM RT LARGE SUP-95-00625 CDM A4570 HCPCS 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SPROTTE SPINAL 22G X 4 3/4 SUP-95-00647 CDM 0272 RC outpatient 620.76 620.76 620.76 74 459.36 percent of total billed charges 620.76 93 502.82 percent of total billed charges 620.76 620.76 other OPPS APC 620.76 620.76 other OPPS APC 620.76 27.63 171.52 percent of total billed charges 620.76 620.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VISIPAQUE 320 100CC V045 SUP-95-00648 CDM Q9967 CPT 0255 RC outpatient 251.2 251.2 0.15 0.15 fee schedule 251.2 93 203.47 percent of total billed charges 251.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 251.2 other OPPS APC 251.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 251.2 other OPPS APC 251.2 24.86 62.45 percent of total billed charges 0.15 251.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG TUBE 22FR REPLACEMENT ENDOVIVE STANDARD STRAIGHT SUP-95-00686 CDM B4087 HCPCS 0278 RC outpatient 316.61 316.61 316.61 57 180.47 percent of total billed charges 316.61 93 256.45 percent of total billed charges 316.61 316.61 other OPPS APC 316.61 316.61 other OPPS APC 316.61 51 161.47 percent of total billed charges 316.61 316.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG TUBE 20FR REPLACEMENT ENDOVIVE STANDARD STRAIGHT SUP-95-00687 CDM B4087 HCPCS 0278 RC outpatient 316.62 316.62 316.62 57 180.47 percent of total billed charges 316.62 93 256.46 percent of total billed charges 316.62 316.62 other OPPS APC 316.62 316.62 other OPPS APC 316.62 51 161.48 percent of total billed charges 316.62 316.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "WANG NEEDLE, 20G" SUP-95-00697 CDM 0272 RC outpatient 348.6 348.6 348.6 74 257.96 percent of total billed charges 348.6 93 282.37 percent of total billed charges 348.6 348.6 other OPPS APC 348.6 348.6 other OPPS APC 348.6 27.63 96.32 percent of total billed charges 348.6 348.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 12X20CATH KIT LG BORE MULTI-LUMEN NU0125 SUP-95-00701 CDM 0272 RC outpatient 381.5 381.5 381.5 74 282.31 percent of total billed charges 381.5 93 309.02 percent of total billed charges 381.5 381.5 other OPPS APC 381.5 381.5 other OPPS APC 381.5 27.63 105.41 percent of total billed charges 381.5 381.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. YUEH CENTESIS DTVN 5.0-19-10.0 SUP-95-00721 CDM 0272 RC outpatient 75.2 75.2 75.2 74 55.65 percent of total billed charges 75.2 93 60.91 percent of total billed charges 75.2 75.2 other OPPS APC 75.2 75.2 other OPPS APC 75.2 27.63 20.78 percent of total billed charges 75.2 75.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AHA CORE INSTRUCTOR COURSE SUP-95-00727 CDM C1894 HCPCS 0272 RC outpatient 100 100 100 74 74 percent of total billed charges 100 93 81 percent of total billed charges 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 27.63 27.63 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LARGE COLOSTOMY FLANGE SUP-95-00762 CDM outpatient 3.55 3.55 3.55 3.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BRUSH, PEG" SUP-95-00791 CDM 0272 RC outpatient 21.4 21.4 21.4 74 15.84 percent of total billed charges 21.4 93 17.33 percent of total billed charges 21.4 21.4 other OPPS APC 21.4 21.4 other OPPS APC 21.4 27.63 5.91 percent of total billed charges 21.4 21.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLAR HEMOSTASIS PROBE SUP-95-00792 CDM 0272 RC outpatient 553.35 553.35 553.35 74 409.48 percent of total billed charges 553.35 93 448.21 percent of total billed charges 553.35 553.35 other OPPS APC 553.35 553.35 other OPPS APC 553.35 27.63 152.89 percent of total billed charges 553.35 553.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MINI OVAL SNARE BX/10EA SUP-95-00793 CDM 0272 RC outpatient 107.2 107.2 107.2 74 79.33 percent of total billed charges 107.2 93 86.83 percent of total billed charges 107.2 107.2 other OPPS APC 107.2 107.2 other OPPS APC 107.2 27.63 29.62 percent of total billed charges 107.2 107.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IRRIGATION VALVE BIOSHIELD SUP-95-00795 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG TUBE 18FR REPLACEMENT ENDOVIVE STANDARD STRAIGHT SUP-95-00796 CDM B4087 HCPCS 0278 RC outpatient 316.61 316.61 316.61 57 180.47 percent of total billed charges 316.61 93 256.45 percent of total billed charges 316.61 316.61 other OPPS APC 316.61 316.61 other OPPS APC 316.61 51 161.47 percent of total billed charges 316.61 316.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG TUBE 24FR REPLACEMENT ENDOVIVE STANDARD STRAIGHT SUP-95-00797 CDM B4087 HCPCS 0278 RC outpatient 316.61 316.61 316.61 57 180.47 percent of total billed charges 316.61 93 256.45 percent of total billed charges 316.61 316.61 other OPPS APC 316.61 316.61 other OPPS APC 316.61 51 161.47 percent of total billed charges 316.61 316.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG TUBE ENFIT MAGNA PORT 26FR SUP-95-00798 CDM B4087 HCPCS 0278 RC outpatient 88.34 88.34 88.34 57 50.35 percent of total billed charges 88.34 93 71.56 percent of total billed charges 88.34 88.34 other OPPS APC 88.34 88.34 other OPPS APC 88.34 51 45.05 percent of total billed charges 88.34 88.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TUBING, A-LINE PRESSURE" SUP-95-00800 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON INFLATOR SUP-95-00802 CDM 0272 RC outpatient 32.4 32.4 32.4 74 23.98 percent of total billed charges 32.4 93 26.24 percent of total billed charges 32.4 32.4 other OPPS APC 32.4 32.4 other OPPS APC 32.4 27.63 8.95 percent of total billed charges 32.4 32.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BALLOON, 12-15MM, 8CM" SUP-95-00807 CDM C1726 HCPCS 0272 RC outpatient 1002 1002 1002 74 741.48 percent of total billed charges 1002 93 811.62 percent of total billed charges 1002 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1002 other OPPS APC 1002 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1002 other OPPS APC 1002 27.63 276.85 percent of total billed charges 1002 1002 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "RESOLUTION CLIP, 23 5CM" SUP-95-00809 CDM 0272 RC outpatient 685.65 685.65 685.65 74 507.38 percent of total billed charges 685.65 93 555.38 percent of total billed charges 685.65 685.65 other OPPS APC 685.65 685.65 other OPPS APC 685.65 27.63 189.45 percent of total billed charges 685.65 685.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "FORCEPS, DISPOSABLE TRIPOD" SUP-95-00810 CDM 0272 RC outpatient 234.1 234.1 234.1 74 173.23 percent of total billed charges 234.1 93 189.62 percent of total billed charges 234.1 234.1 other OPPS APC 234.1 234.1 other OPPS APC 234.1 27.63 64.68 percent of total billed charges 234.1 234.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTH NET RETRIEVER SUP-95-00811 CDM 0272 RC outpatient 322 322 322 74 238.28 percent of total billed charges 322 93 260.82 percent of total billed charges 322 322 other OPPS APC 322 322 other OPPS APC 322 27.63 88.97 percent of total billed charges 322 322 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARR-LOCKE INJECTION NEEDLE 25G SUP-95-00812 CDM 0272 RC outpatient 140 140 140 74 103.6 percent of total billed charges 140 93 113.4 percent of total billed charges 140 140 other OPPS APC 140 140 other OPPS APC 140 27.63 38.68 percent of total billed charges 140 140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "FORCEPS, BIOPSY DISPOSABLE" SUP-95-00813 CDM 0272 RC outpatient 37.25 37.25 37.25 74 27.57 percent of total billed charges 37.25 93 30.17 percent of total billed charges 37.25 37.25 other OPPS APC 37.25 37.25 other OPPS APC 37.25 27.63 10.29 percent of total billed charges 37.25 37.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "FORCEPS, HOT BIOPSY" SUP-95-00814 CDM 0272 RC outpatient 71 71 71 74 52.54 percent of total billed charges 71 93 57.51 percent of total billed charges 71 71 other OPPS APC 71 71 other OPPS APC 71 27.63 19.62 percent of total billed charges 71 71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE PRECISION GLIDE 23G X 1 SUP-95-00819 CDM 0272 RC outpatient 3.15 3.15 3.15 74 2.33 percent of total billed charges 3.15 93 2.55 percent of total billed charges 3.15 3.15 other OPPS APC 3.15 3.15 other OPPS APC 3.15 27.63 0.87 percent of total billed charges 3.15 3.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GUIDEWIRE, LONG LINEAR" SUP-95-00823 CDM C1769 HCPCS 0272 RC outpatient 441 441 441 74 326.34 percent of total billed charges 441 93 357.21 percent of total billed charges 441 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 441 other OPPS APC 441 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 441 other OPPS APC 441 27.63 121.85 percent of total billed charges 441 441 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPHINCTEROTOME SUP-95-00824 CDM 0272 RC outpatient 508.48 508.48 508.48 74 376.28 percent of total billed charges 508.48 93 411.87 percent of total billed charges 508.48 508.48 other OPPS APC 508.48 508.48 other OPPS APC 508.48 27.63 140.49 percent of total billed charges 508.48 508.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BALLOON, ERCP" SUP-95-00825 CDM C1726 HCPCS 0272 RC outpatient 440.23 440.23 440.23 74 325.77 percent of total billed charges 440.23 93 356.59 percent of total billed charges 440.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 440.23 other OPPS APC 440.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 440.23 other OPPS APC 440.23 27.63 121.64 percent of total billed charges 440.23 440.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRONCH SUCTION BUTTON SUP-95-00826 CDM 0272 RC outpatient 56.55 56.55 56.55 74 41.85 percent of total billed charges 56.55 93 45.81 percent of total billed charges 56.55 56.55 other OPPS APC 56.55 56.55 other OPPS APC 56.55 27.63 15.62 percent of total billed charges 56.55 56.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "WANG NEEDLE, 19G" SUP-95-00827 CDM 0272 RC outpatient 348.6 348.6 348.6 74 257.96 percent of total billed charges 348.6 93 282.37 percent of total billed charges 348.6 348.6 other OPPS APC 348.6 348.6 other OPPS APC 348.6 27.63 96.32 percent of total billed charges 348.6 348.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SYRINGE, INTEGRATED INFLATION SYSTEM" SUP-95-00828 CDM 0272 RC outpatient 167.2 167.2 167.2 74 123.73 percent of total billed charges 167.2 93 135.43 percent of total billed charges 167.2 167.2 other OPPS APC 167.2 167.2 other OPPS APC 167.2 27.63 46.2 percent of total billed charges 167.2 167.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SAF-T INTIMA 22G SUP-95-00829 CDM outpatient 267.68 267.68 267.68 267.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CYTOLOGY BRUSH SUP-95-00830 CDM 0272 RC outpatient 423.5 423.5 423.5 74 313.39 percent of total billed charges 423.5 93 343.04 percent of total billed charges 423.5 423.5 other OPPS APC 423.5 423.5 other OPPS APC 423.5 27.63 117.01 percent of total billed charges 423.5 423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESOLUTION CLIP SUP-95-00831 CDM 0272 RC outpatient 929.28 929.28 929.28 74 687.67 percent of total billed charges 929.28 93 752.72 percent of total billed charges 929.28 929.28 other OPPS APC 929.28 929.28 other OPPS APC 929.28 27.63 256.76 percent of total billed charges 929.28 929.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PULL G-TUBE PEG KIT, 20FR" SUP-95-00832 CDM B4087 HCPCS 0278 RC outpatient 592.25 592.25 592.25 57 337.58 percent of total billed charges 592.25 93 479.72 percent of total billed charges 592.25 592.25 other OPPS APC 592.25 592.25 other OPPS APC 592.25 51 302.05 percent of total billed charges 592.25 592.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEEDLE, DISPOSABLE INJECTION" SUP-95-00839 CDM 0272 RC outpatient 118 118 118 74 87.32 percent of total billed charges 118 93 95.58 percent of total billed charges 118 118 other OPPS APC 118 118 other OPPS APC 118 27.63 32.6 percent of total billed charges 118 118 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPOT SUP-95-00840 CDM 0272 RC outpatient 144 144 144 74 106.56 percent of total billed charges 144 93 116.64 percent of total billed charges 144 144 other OPPS APC 144 144 other OPPS APC 144 27.63 39.79 percent of total billed charges 144 144 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "FORCEPS, DISPOSABLE BIOPSY ALLGTR JAW" SUP-95-00927 CDM 0272 RC outpatient 110.47 110.47 110.47 74 81.75 percent of total billed charges 110.47 93 89.48 percent of total billed charges 110.47 110.47 other OPPS APC 110.47 110.47 other OPPS APC 110.47 27.63 30.52 percent of total billed charges 110.47 110.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER FIBEROPTIC SWIVEL STERILE SUP-95-00932 CDM 0272 RC outpatient 30.54 30.54 30.54 74 22.6 percent of total billed charges 30.54 93 24.74 percent of total billed charges 30.54 30.54 other OPPS APC 30.54 30.54 other OPPS APC 30.54 27.63 8.44 percent of total billed charges 30.54 30.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MONOPTY (22M) 20G X 10CM USSUP SUP-95-00939 CDM 0272 RC outpatient 1305 1305 1305 74 965.7 percent of total billed charges 1305 93 1057.05 percent of total billed charges 1305 1305 other OPPS APC 1305 1305 other OPPS APC 1305 27.63 360.57 percent of total billed charges 1305 1305 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MONOPTY (22M) 20G X 16CM USSUP SUP-95-00940 CDM 0272 RC outpatient 1135.14 1135.14 1135.14 74 840 percent of total billed charges 1135.14 93 919.46 percent of total billed charges 1135.14 1135.14 other OPPS APC 1135.14 1135.14 other OPPS APC 1135.14 27.63 313.64 percent of total billed charges 1135.14 1135.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MONOPTY (22M) 18G X 10CM USSUP SUP-95-00942 CDM 0272 RC outpatient 1110.3 1110.3 1110.3 74 821.62 percent of total billed charges 1110.3 93 899.34 percent of total billed charges 1110.3 1110.3 other OPPS APC 1110.3 1110.3 other OPPS APC 1110.3 27.63 306.78 percent of total billed charges 1110.3 1110.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MONOPTY (22M) 18G X 16CM USSUP SUP-95-00943 CDM 0272 RC outpatient 1112.43 1112.43 1112.43 74 823.2 percent of total billed charges 1112.43 93 901.07 percent of total billed charges 1112.43 1112.43 other OPPS APC 1112.43 1112.43 other OPPS APC 1112.43 27.63 307.36 percent of total billed charges 1112.43 1112.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MONOPTY (22M) 18G X 20CM SUP-95-00944 CDM outpatient 574 574 574 574 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TRUEGUIDE (17,8CM) 20G X 20CM" SUP-95-00945 CDM outpatient 287 287 287 287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOUGIE ENDO TUBE STERILE 15FR 70CM SUP-95-00954 CDM 0272 RC outpatient 27.88 27.88 27.88 74 20.63 percent of total billed charges 27.88 93 22.58 percent of total billed charges 27.88 27.88 other OPPS APC 27.88 27.88 other OPPS APC 27.88 27.63 7.7 percent of total billed charges 27.88 27.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY PERC INTRO BLUE RHINO G2 SZ 8.5 SUP-95-00956 CDM outpatient 1304.61 1304.61 1304.61 1304.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY PERC INTRO BLUE RHINO G2 SZ 7.5 SUP-95-00957 CDM outpatient 1304.61 1304.61 1304.61 1304.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPRING WIRE .018 X 25CM (A-LINE) SUP-95-00959 CDM C1769 HCPCS 0272 RC outpatient 619.5 619.5 619.5 74 458.43 percent of total billed charges 619.5 93 501.8 percent of total billed charges 619.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 619.5 other OPPS APC 619.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 619.5 other OPPS APC 619.5 27.63 171.17 percent of total billed charges 619.5 619.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SPRING WIRE .032"" X 60CM (C-LINE)" SUP-95-00970 CDM C1769 HCPCS 0272 RC outpatient 39.65 39.65 39.65 74 29.34 percent of total billed charges 39.65 93 32.12 percent of total billed charges 39.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.65 other OPPS APC 39.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.65 other OPPS APC 39.65 27.63 10.96 percent of total billed charges 39.65 39.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - SWAN GANZ 7.5FR PACEPORT SUP-95-00972 CDM 0272 RC outpatient 195.72 195.72 195.72 74 144.83 percent of total billed charges 195.72 93 158.53 percent of total billed charges 195.72 195.72 other OPPS APC 195.72 195.72 other OPPS APC 195.72 27.63 54.08 percent of total billed charges 195.72 195.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BALLOON, 18-20MM" SUP-95-00984 CDM C1726 HCPCS 0272 RC outpatient 765 765 765 74 566.1 percent of total billed charges 765 93 619.65 percent of total billed charges 765 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 765 other OPPS APC 765 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 765 other OPPS APC 765 27.63 211.37 percent of total billed charges 765 765 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ACHIEVE BIOPSY 14GX11CM USSUP SUP-95-00990 CDM 0272 RC outpatient 172 172 172 74 127.28 percent of total billed charges 172 93 139.32 percent of total billed charges 172 172 other OPPS APC 172 172 other OPPS APC 172 27.63 47.52 percent of total billed charges 172 172 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ACHIEVE BIOPSY 16GX11CM SUP-95-00991 CDM 0272 RC outpatient 172 172 172 74 127.28 percent of total billed charges 172 93 139.32 percent of total billed charges 172 172 other OPPS APC 172 172 other OPPS APC 172 27.63 47.52 percent of total billed charges 172 172 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THORACENTESIS SET SUP-95-00992 CDM 0272 RC outpatient 697.38 697.38 697.38 74 516.06 percent of total billed charges 697.38 93 564.88 percent of total billed charges 697.38 697.38 other OPPS APC 697.38 697.38 other OPPS APC 697.38 27.63 192.69 percent of total billed charges 697.38 697.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BRUSH, DISPOSABLE CYTOLOGY" SUP-95-01006 CDM 0272 RC outpatient 51.17 51.17 51.17 74 37.87 percent of total billed charges 51.17 93 41.45 percent of total billed charges 51.17 51.17 other OPPS APC 51.17 51.17 other OPPS APC 51.17 27.63 14.14 percent of total billed charges 51.17 51.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "FORCEPS, 3 NAIL GRASPING" SUP-95-01007 CDM outpatient 700 700 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BASKET, 4 WIRE SPIRAL" SUP-95-01008 CDM outpatient 700 700 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BASKET, 3 WIRE SPIRAL" SUP-95-01009 CDM outpatient 684.88 684.88 684.88 684.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 7X9 STENT (ERCP) SUP-95-01011 CDM C2617 HCPCS 0278 RC outpatient 159.2 159.2 159.2 57 90.74 percent of total billed charges 159.2 93 128.95 percent of total billed charges 159.2 159.2 other OPPS APC 159.2 159.2 other OPPS APC 159.2 51 81.19 percent of total billed charges 159.2 159.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 7X7 STENT (ERCP) SUP-95-01012 CDM C2617 HCPCS 0278 RC outpatient 159.2 159.2 159.2 57 90.74 percent of total billed charges 159.2 93 128.95 percent of total billed charges 159.2 159.2 other OPPS APC 159.2 159.2 other OPPS APC 159.2 51 81.19 percent of total billed charges 159.2 159.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 7FR STENT INTRODUCER (ERCP) SUP-95-01013 CDM C1894 HCPCS 0278 RC outpatient 205.28 205.28 205.28 57 117.01 percent of total billed charges 205.28 93 166.28 percent of total billed charges 205.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 205.28 other OPPS APC 205.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 205.28 other OPPS APC 205.28 51 104.69 percent of total billed charges 205.28 205.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 25MM SNARE SUP-95-01014 CDM 0272 RC outpatient 405.65 405.65 405.65 74 300.18 percent of total billed charges 405.65 93 328.58 percent of total billed charges 405.65 405.65 other OPPS APC 405.65 405.65 other OPPS APC 405.65 27.63 112.08 percent of total billed charges 405.65 405.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 15MM SNARE SUP-95-01015 CDM 0272 RC outpatient 367.71 367.71 367.71 74 272.11 percent of total billed charges 367.71 93 297.85 percent of total billed charges 367.71 367.71 other OPPS APC 367.71 367.71 other OPPS APC 367.71 27.63 101.6 percent of total billed charges 367.71 367.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG TUBE 16FR REPLACEMENT ENDOVIVE STANDARD STRAIGHT SUP-95-01073 CDM B4087 HCPCS 0278 RC outpatient 316.61 316.61 316.61 57 180.47 percent of total billed charges 316.61 93 256.45 percent of total billed charges 316.61 316.61 other OPPS APC 316.61 316.61 other OPPS APC 316.61 51 161.47 percent of total billed charges 316.61 316.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UMBILICUP SUP-95-01126 CDM 0272 RC outpatient 336.14 336.14 336.14 74 248.74 percent of total billed charges 336.14 93 272.27 percent of total billed charges 336.14 336.14 other OPPS APC 336.14 336.14 other OPPS APC 336.14 27.63 92.88 percent of total billed charges 336.14 336.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "COVER, EYE GUARD DISPOSABLE" SUP-95-01154 CDM 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ANESTHESIA EPIDURAL TUOHY SUP-95-01155 CDM 0272 RC outpatient 160.76 160.76 160.76 74 118.96 percent of total billed charges 160.76 93 130.22 percent of total billed charges 160.76 160.76 other OPPS APC 160.76 160.76 other OPPS APC 160.76 27.63 44.42 percent of total billed charges 160.76 160.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEEDLE, SPINAL 25GX1 1/2" SUP-95-01200 CDM 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BACTOSHIELD 4% 4OZ SUP-95-01202 CDM 0272 RC outpatient 2.37 2.37 2.37 74 1.75 percent of total billed charges 2.37 93 1.92 percent of total billed charges 2.37 2.37 other OPPS APC 2.37 2.37 other OPPS APC 2.37 27.63 0.65 percent of total billed charges 2.37 2.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLANKET UNDERBODY HUGGER SUP-95-01211 CDM 0272 RC outpatient 415.98 415.98 415.98 74 307.83 percent of total billed charges 415.98 93 336.94 percent of total billed charges 415.98 415.98 other OPPS APC 415.98 415.98 other OPPS APC 415.98 27.63 114.94 percent of total billed charges 415.98 415.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LUMEN DOUBLE SIZE 35 SUP-95-01212 CDM 0272 RC outpatient 284.59 284.59 284.59 74 210.6 percent of total billed charges 284.59 93 230.52 percent of total billed charges 284.59 284.59 other OPPS APC 284.59 284.59 other OPPS APC 284.59 27.63 78.63 percent of total billed charges 284.59 284.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LUMEN DOUBLE SIZE 39 SUP-95-01213 CDM 0272 RC outpatient 300.27 300.27 300.27 74 222.2 percent of total billed charges 300.27 93 243.22 percent of total billed charges 300.27 300.27 other OPPS APC 300.27 300.27 other OPPS APC 300.27 27.63 82.96 percent of total billed charges 300.27 300.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LUMEN DOUBLE SIZE 37 SUP-95-01214 CDM 0272 RC outpatient 308.07 308.07 308.07 74 227.97 percent of total billed charges 308.07 93 249.54 percent of total billed charges 308.07 308.07 other OPPS APC 308.07 308.07 other OPPS APC 308.07 27.63 85.12 percent of total billed charges 308.07 308.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BIOPSY SITE ID, 2 BREAST" SUP-95-01219 CDM outpatient 1692.9 1692.9 1692.9 1692.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VACUUM CANNISTER SUP-95-01221 CDM 0272 RC outpatient 317.98 317.98 317.98 74 235.31 percent of total billed charges 317.98 93 257.56 percent of total billed charges 317.98 317.98 other OPPS APC 317.98 317.98 other OPPS APC 317.98 27.63 87.86 percent of total billed charges 317.98 317.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BIOPSY DRAPE, NON STERILE DISP" SUP-95-01222 CDM 0272 RC outpatient 1346.64 1346.64 1346.64 74 996.51 percent of total billed charges 1346.64 93 1090.78 percent of total billed charges 1346.64 1346.64 other OPPS APC 1346.64 1346.64 other OPPS APC 1346.64 27.63 372.08 percent of total billed charges 1346.64 1346.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PORT-A-CATH SINGLE 8FR UNASSM 1MM SUP-95-01300 CDM 0272 RC outpatient 802.47 802.47 802.47 74 593.83 percent of total billed charges 802.47 93 650 percent of total billed charges 802.47 802.47 other OPPS APC 802.47 802.47 other OPPS APC 802.47 27.63 221.72 percent of total billed charges 802.47 802.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PORT-A-CATH SINGLE PREASSM 1MM SUP-95-01301 CDM 0272 RC outpatient 835.23 835.23 835.23 74 618.07 percent of total billed charges 835.23 93 676.54 percent of total billed charges 835.23 835.23 other OPPS APC 835.23 835.23 other OPPS APC 835.23 27.63 230.77 percent of total billed charges 835.23 835.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BARTHOLIN GLAND CH10 5CC SUP-95-01317 CDM C1729 HCPCS 0278 RC outpatient 86.84 86.84 86.84 57 49.5 percent of total billed charges 86.84 93 70.34 percent of total billed charges 86.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 86.84 other OPPS APC 86.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 86.84 other OPPS APC 86.84 51 44.29 percent of total billed charges 86.84 86.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRUSH BRONCH CYTOLOGY-10EA SUP-95-01321 CDM 0272 RC outpatient 63.84 63.84 63.84 74 47.24 percent of total billed charges 63.84 93 51.71 percent of total billed charges 63.84 63.84 other OPPS APC 63.84 63.84 other OPPS APC 63.84 27.63 17.64 percent of total billed charges 63.84 63.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE TEMNO COAXIAL 22GX20 CTSUP USSUP SUP-95-01325 CDM 0272 RC outpatient 915.99 915.99 915.99 74 677.83 percent of total billed charges 915.99 93 741.95 percent of total billed charges 915.99 915.99 other OPPS APC 915.99 915.99 other OPPS APC 915.99 27.63 253.09 percent of total billed charges 915.99 915.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE TEMNO COAXIAL BS 22GX15 CTSUP SUP-95-01326 CDM 0272 RC outpatient 915.96 915.96 915.96 74 677.81 percent of total billed charges 915.96 93 741.93 percent of total billed charges 915.96 915.96 other OPPS APC 915.96 915.96 other OPPS APC 915.96 27.63 253.08 percent of total billed charges 915.96 915.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE TEMNO COAXIAL 18GX20 CTSUP USSUP SUP-95-01327 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE TEMNO COAXIAL 18GX15 CTSUP USSUP SUP-95-01328 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE TEMNO COAXIAL 20GX15 CTSUP USSUP SUP-95-01329 CDM 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 168 other OPPS APC 168 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE TEMNO COAXIAL 20GX20 CTSUP USSUP SUP-95-01330 CDM 0272 RC outpatient 755.01 755.01 755.01 74 558.71 percent of total billed charges 755.01 93 611.56 percent of total billed charges 755.01 755.01 other OPPS APC 755.01 755.01 other OPPS APC 755.01 27.63 208.61 percent of total billed charges 755.01 755.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TEMNO EVOLUT COAX 18GX11 CTSUP USSUP SUP-95-01331 CDM 0272 RC outpatient 180 180 180 74 133.2 percent of total billed charges 180 93 145.8 percent of total billed charges 180 180 other OPPS APC 180 180 other OPPS APC 180 27.63 49.73 percent of total billed charges 180 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TEMNO EVOLUT COAX 16GX20 CTSUP USSUP SUP-95-01332 CDM 0272 RC outpatient 701.04 701.04 701.04 74 518.77 percent of total billed charges 701.04 93 567.84 percent of total billed charges 701.04 701.04 other OPPS APC 701.04 701.04 other OPPS APC 701.04 27.63 193.7 percent of total billed charges 701.04 701.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TEMNO EVOLUT COAX 20GX11 CTSUP USSUP SUP-95-01336 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEEDLE, ACHIEVE BIOPSY 18G X 15CM USSUP" SUP-95-01337 CDM 0272 RC outpatient 172 172 172 74 127.28 percent of total billed charges 172 93 139.32 percent of total billed charges 172 172 other OPPS APC 172 172 other OPPS APC 172 27.63 47.52 percent of total billed charges 172 172 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAINAGE CATH - 8.5F MULTIPURPOSE CTSUP SUP-95-01342 CDM C1729 HCPCS 0272 RC outpatient 258.72 258.72 258.72 74 191.45 percent of total billed charges 258.72 93 209.56 percent of total billed charges 258.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 258.72 other OPPS APC 258.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 258.72 other OPPS APC 258.72 27.63 71.48 percent of total billed charges 258.72 258.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAINAGE CATHETER - 6.3F DAWSON CTSUP SUP-95-01343 CDM C1729 HCPCS 0272 RC outpatient 241.64 241.64 241.64 74 178.81 percent of total billed charges 241.64 93 195.73 percent of total billed charges 241.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.64 other OPPS APC 241.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.64 other OPPS APC 241.64 27.63 66.77 percent of total billed charges 241.64 241.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAINAGE CATH - 10.2F MULTIPURPOSE CTSUP SUP-95-01344 CDM C1729 HCPCS 0272 RC outpatient 258.72 258.72 258.72 74 191.45 percent of total billed charges 258.72 93 209.56 percent of total billed charges 258.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 258.72 other OPPS APC 258.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 258.72 other OPPS APC 258.72 27.63 71.48 percent of total billed charges 258.72 258.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SWAN TUBING 10/CS SUP-95-01355 CDM outpatient 58.71 58.71 58.71 58.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE TEMNO BIOPSY 20G X 9 USSUP SUP-95-01364 CDM 0272 RC outpatient 537.29 537.29 537.29 74 397.59 percent of total billed charges 537.29 93 435.2 percent of total billed charges 537.29 537.29 other OPPS APC 537.29 537.29 other OPPS APC 537.29 27.63 148.45 percent of total billed charges 537.29 537.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING - DRAINAGE CONNECTING TUBE SUP-95-01367 CDM 0272 RC outpatient 772.5 772.5 772.5 74 571.65 percent of total billed charges 772.5 93 625.73 percent of total billed charges 772.5 772.5 other OPPS APC 772.5 772.5 other OPPS APC 772.5 27.63 213.44 percent of total billed charges 772.5 772.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INVRAD PICC 4F SUP-95-01377 CDM C1751 HCPCS 0272 RC outpatient 268.45 268.45 268.45 74 198.65 percent of total billed charges 268.45 93 217.44 percent of total billed charges 268.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 268.45 other OPPS APC 268.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 268.45 other OPPS APC 268.45 27.63 74.17 percent of total billed charges 268.45 268.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INVRAD PICC 5F POWER SUP-95-01385 CDM C1751 HCPCS 0272 RC outpatient 314.97 314.97 314.97 74 233.08 percent of total billed charges 314.97 93 255.13 percent of total billed charges 314.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 314.97 other OPPS APC 314.97 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 314.97 other OPPS APC 314.97 27.63 87.03 percent of total billed charges 314.97 314.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INVRAD MEDIPORT REGULAR SUP-95-01388 CDM C1788 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPER SHOE II WOMENS MED SUP-95-01405 CDM 0271 RC outpatient 26.08 26.08 26.08 74 19.3 percent of total billed charges 26.08 93 21.12 percent of total billed charges 26.08 26.08 other OPPS APC 26.08 26.08 other OPPS APC 26.08 27.63 7.21 percent of total billed charges 26.08 26.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPER SHOE II WOMENS LG SUP-95-01406 CDM 0271 RC outpatient 25.56 25.56 25.56 74 18.91 percent of total billed charges 25.56 93 20.7 percent of total billed charges 25.56 25.56 other OPPS APC 25.56 25.56 other OPPS APC 25.56 27.63 7.06 percent of total billed charges 25.56 25.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPER SHOE II MENS SM SUP-95-01407 CDM 0271 RC outpatient 27.36 27.36 27.36 74 20.25 percent of total billed charges 27.36 93 22.16 percent of total billed charges 27.36 27.36 other OPPS APC 27.36 27.36 other OPPS APC 27.36 27.63 7.56 percent of total billed charges 27.36 27.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPER SHOE II MENS MED SUP-95-01408 CDM 0271 RC outpatient 25.56 25.56 25.56 74 18.91 percent of total billed charges 25.56 93 20.7 percent of total billed charges 25.56 25.56 other OPPS APC 25.56 25.56 other OPPS APC 25.56 27.63 7.06 percent of total billed charges 25.56 25.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTRAST - ISOVUE 370 100CC SUP-95-01426 CDM Q9967 CPT 0255 RC outpatient 351.47 351.47 0.15 0.15 fee schedule 351.47 93 284.69 percent of total billed charges 351.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 351.47 other OPPS APC 351.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 351.47 other OPPS APC 351.47 24.86 87.38 percent of total billed charges 0.15 351.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 12X16 CATH KIT LG BORE MULTILUMEN NU0123 SUP-95-01441 CDM 0272 RC outpatient 312.71 312.71 312.71 74 231.41 percent of total billed charges 312.71 93 253.3 percent of total billed charges 312.71 312.71 other OPPS APC 312.71 312.71 other OPPS APC 312.71 27.63 86.4 percent of total billed charges 312.71 312.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SPINAL WHITACRE 22G X 3.5 SUP-95-01459 CDM 0272 RC outpatient 165.36 165.36 165.36 74 122.37 percent of total billed charges 165.36 93 133.94 percent of total billed charges 165.36 165.36 other OPPS APC 165.36 165.36 other OPPS APC 165.36 27.63 45.69 percent of total billed charges 165.36 165.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INVRAD LOW PROFILE MEDIPORT SUP-95-01460 CDM C1788 HCPCS 0278 RC outpatient 747.69 747.69 747.69 57 426.18 percent of total billed charges 747.69 93 605.63 percent of total billed charges 747.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 747.69 other OPPS APC 747.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 747.69 other OPPS APC 747.69 27.63 206.59 percent of total billed charges 747.69 747.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING - DRAINAGE DEPOT SUP-95-01487 CDM 0272 RC outpatient 38.04 38.04 38.04 74 28.15 percent of total billed charges 38.04 93 30.81 percent of total billed charges 38.04 38.04 other OPPS APC 38.04 38.04 other OPPS APC 38.04 27.63 10.51 percent of total billed charges 38.04 38.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAINAGE CATH 8F FLEXIM APD INVRAD CTSUP SUP-95-01489 CDM C1729 HCPCS 0272 RC outpatient 276.5 276.5 276.5 74 204.61 percent of total billed charges 276.5 93 223.97 percent of total billed charges 276.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 276.5 other OPPS APC 276.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 276.5 other OPPS APC 276.5 27.63 76.4 percent of total billed charges 276.5 276.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRISMA MATRIX 28CM 2 4.34SQ IN SUP-95-01490 CDM 0272 RC outpatient 283.12 283.12 283.12 74 209.51 percent of total billed charges 283.12 93 229.33 percent of total billed charges 283.12 283.12 other OPPS APC 283.12 283.12 other OPPS APC 283.12 27.63 78.23 percent of total billed charges 283.12 283.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIG 60 INFLATION DEVICE SUP-95-01504 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER 28 PALINDROME RUBY SUP-95-01506 CDM C1750 HCPCS 0278 RC outpatient 1207.65 1207.65 1207.65 57 688.36 percent of total billed charges 1207.65 93 978.2 percent of total billed charges 1207.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1207.65 other OPPS APC 1207.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1207.65 other OPPS APC 1207.65 51 615.9 percent of total billed charges 1207.65 1207.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEEDLE, ACHIEVE BIOPSY 20GX15CM USSUP" SUP-95-01527 CDM 0272 RC outpatient 172 172 172 74 127.28 percent of total billed charges 172 93 139.32 percent of total billed charges 172 172 other OPPS APC 172 172 other OPPS APC 172 27.63 47.52 percent of total billed charges 172 172 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING MEPILEX BORDER FLEX 4X4 SUP-95-01532 CDM 0272 RC outpatient 2.46 2.46 2.46 74 1.82 percent of total billed charges 2.46 93 1.99 percent of total billed charges 2.46 2.46 other OPPS APC 2.46 2.46 other OPPS APC 2.46 27.63 0.68 percent of total billed charges 2.46 2.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ANGIOGRAPHIC 18G X 3.5 SUP-95-01541 CDM 0272 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMBI TUBE 37FR SUP-95-01543 CDM 0272 RC outpatient 559.79 559.79 559.79 74 414.24 percent of total billed charges 559.79 93 453.43 percent of total billed charges 559.79 559.79 other OPPS APC 559.79 559.79 other OPPS APC 559.79 27.63 154.67 percent of total billed charges 559.79 559.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT - HYBRID DIALYSIS 6 X 5 X 50 SUP-95-01592 CDM C1768 HCPCS 0278 RC outpatient 6277.5 6277.5 6277.5 57 3578.18 percent of total billed charges 6277.5 93 5084.78 percent of total billed charges 6277.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6277.5 other OPPS APC 6277.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6277.5 other OPPS APC 6277.5 51 3201.53 percent of total billed charges 6277.5 6277.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAINAGE CATH - 6.3F FLEXIMA APD CTSUP SUP-95-01626 CDM C1729 HCPCS 0278 RC outpatient 276.5 276.5 276.5 57 157.61 percent of total billed charges 276.5 93 223.97 percent of total billed charges 276.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 276.5 other OPPS APC 276.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 276.5 other OPPS APC 276.5 51 141.02 percent of total billed charges 276.5 276.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAINAGE CATH - 10F FLEXIMA APD CTSUP SUP-95-01627 CDM C1729 HCPCS 0278 RC outpatient 276.5 276.5 276.5 57 157.61 percent of total billed charges 276.5 93 223.97 percent of total billed charges 276.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 276.5 other OPPS APC 276.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 276.5 other OPPS APC 276.5 51 141.02 percent of total billed charges 276.5 276.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ESOPHAGEL/RECTAL TEMP PROBE SUP-95-01643 CDM 0272 RC outpatient 400.09 400.09 400.09 74 296.07 percent of total billed charges 400.09 93 324.07 percent of total billed charges 400.09 400.09 other OPPS APC 400.09 400.09 other OPPS APC 400.09 27.63 110.54 percent of total billed charges 400.09 400.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHEST TUBE KIT 16F SUP-95-01647 CDM 0272 RC outpatient 470.54 470.54 470.54 74 348.2 percent of total billed charges 470.54 93 381.14 percent of total billed charges 470.54 470.54 other OPPS APC 470.54 470.54 other OPPS APC 470.54 27.63 130.01 percent of total billed charges 470.54 470.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHEST TUBE KIT 20F SUP-95-01648 CDM 0272 RC outpatient 470.54 470.54 470.54 74 348.2 percent of total billed charges 470.54 93 381.14 percent of total billed charges 470.54 470.54 other OPPS APC 470.54 470.54 other OPPS APC 470.54 27.63 130.01 percent of total billed charges 470.54 470.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHEST TUBE KIT 24FR THAL-QUICK SUP-95-01649 CDM 0272 RC outpatient 683.55 683.55 683.55 74 505.83 percent of total billed charges 683.55 93 553.68 percent of total billed charges 683.55 683.55 other OPPS APC 683.55 683.55 other OPPS APC 683.55 27.63 188.86 percent of total billed charges 683.55 683.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THORACIC 24FR RT ANGLE SUP-95-01651 CDM 0272 RC outpatient 205.1 205.1 205.1 74 151.77 percent of total billed charges 205.1 93 166.13 percent of total billed charges 205.1 205.1 other OPPS APC 205.1 205.1 other OPPS APC 205.1 27.63 56.67 percent of total billed charges 205.1 205.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THORACIC 20FR RT ANGLE SUP-95-01652 CDM 0272 RC outpatient 205.1 205.1 205.1 74 151.77 percent of total billed charges 205.1 93 166.13 percent of total billed charges 205.1 205.1 other OPPS APC 205.1 205.1 other OPPS APC 205.1 27.63 56.67 percent of total billed charges 205.1 205.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE TEMNO 20G X 6 CM CTSUP USSUP SUP-95-01653 CDM 0272 RC outpatient 112 112 112 74 82.88 percent of total billed charges 112 93 90.72 percent of total billed charges 112 112 other OPPS APC 112 112 other OPPS APC 112 27.63 30.95 percent of total billed charges 112 112 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HERCULES BALLOON HBDW 8-9-10 SUP-95-01659 CDM outpatient 783.75 783.75 783.75 783.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HERCULES BALLOON HBDW-12-13.5-15 SUP-95-01660 CDM outpatient 783.75 783.75 783.75 783.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DREAMWIRE .35 450CM SUP-95-01661 CDM 0272 RC outpatient 1096.2 1096.2 1096.2 74 811.19 percent of total billed charges 1096.2 93 887.92 percent of total billed charges 1096.2 1096.2 other OPPS APC 1096.2 1096.2 other OPPS APC 1096.2 27.63 302.88 percent of total billed charges 1096.2 1096.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADVANCE CAPSULE SUP-95-01665 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAINAGE CATHETER - 10F BILIARY CTSUP SUP-95-01667 CDM C1729 HCPCS 0272 RC outpatient 255.5 255.5 255.5 74 189.07 percent of total billed charges 255.5 93 206.96 percent of total billed charges 255.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 255.5 other OPPS APC 255.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 255.5 other OPPS APC 255.5 27.63 70.59 percent of total billed charges 255.5 255.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HYPODERMIC 30G X 1/2 SUP-95-01674 CDM 0272 RC outpatient 26.76 26.76 26.76 74 19.8 percent of total billed charges 26.76 93 21.68 percent of total billed charges 26.76 26.76 other OPPS APC 26.76 26.76 other OPPS APC 26.76 27.63 7.39 percent of total billed charges 26.76 26.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SPINAL WHITACRE 25G X 3.5 SUP-95-01675 CDM 0272 RC outpatient 164.12 164.12 164.12 74 121.45 percent of total billed charges 164.12 93 132.94 percent of total billed charges 164.12 164.12 other OPPS APC 164.12 164.12 other OPPS APC 164.12 27.63 45.35 percent of total billed charges 164.12 164.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IV CATHETER DIFFUSICS - 22G SUP-95-01678 CDM 0272 RC outpatient 428.58 428.58 428.58 74 317.15 percent of total billed charges 428.58 93 347.15 percent of total billed charges 428.58 428.58 other OPPS APC 428.58 428.58 other OPPS APC 428.58 27.63 118.42 percent of total billed charges 428.58 428.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IV CATHETER DIFFUSICS - 20G SUP-95-01679 CDM 0272 RC outpatient 1469.4 1469.4 1469.4 74 1087.36 percent of total billed charges 1469.4 93 1190.21 percent of total billed charges 1469.4 1469.4 other OPPS APC 1469.4 1469.4 other OPPS APC 1469.4 27.63 406 percent of total billed charges 1469.4 1469.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GONIOMETER 12 STANDARD SUP-95-01685 CDM 0272 RC outpatient 49.12 49.12 49.12 74 36.35 percent of total billed charges 49.12 93 39.79 percent of total billed charges 49.12 49.12 other OPPS APC 49.12 49.12 other OPPS APC 49.12 27.63 13.57 percent of total billed charges 49.12 49.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUCTION VALVE DISPOSABLE SUP-95-01688 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOPSY PUNCH 3MM DISPOSABLE SUP-95-01703 CDM 0272 RC outpatient 1.73 1.73 1.73 74 1.28 percent of total billed charges 1.73 93 1.4 percent of total billed charges 1.73 1.73 other OPPS APC 1.73 1.73 other OPPS APC 1.73 27.63 0.48 percent of total billed charges 1.73 1.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORTHOSIS HAND WRIST LEFT SUP-95-01704 CDM 0272 RC outpatient 70.72 70.72 70.72 74 52.33 percent of total billed charges 70.72 93 57.28 percent of total billed charges 70.72 70.72 other OPPS APC 70.72 70.72 other OPPS APC 70.72 27.63 19.54 percent of total billed charges 70.72 70.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORTHOSIS HAND WRIST RIGHT SUP-95-01705 CDM 0272 RC outpatient 70.72 70.72 70.72 74 52.33 percent of total billed charges 70.72 93 57.28 percent of total billed charges 70.72 70.72 other OPPS APC 70.72 70.72 other OPPS APC 70.72 27.63 19.54 percent of total billed charges 70.72 70.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEPHROURETERAL STENT PIGTAIL 8FX22CM SUP-95-01720 CDM C1877 HCPCS 0278 RC outpatient 363.37 363.37 363.37 57 207.12 percent of total billed charges 363.37 93 294.33 percent of total billed charges 363.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 363.37 other OPPS APC 363.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 363.37 other OPPS APC 363.37 51 185.32 percent of total billed charges 363.37 363.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEPHROURETERAL STENT PIGTAIL 8FX24CM SUP-95-01721 CDM C1877 HCPCS 0278 RC outpatient 363.37 363.37 363.37 57 207.12 percent of total billed charges 363.37 93 294.33 percent of total billed charges 363.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 363.37 other OPPS APC 363.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 363.37 other OPPS APC 363.37 51 185.32 percent of total billed charges 363.37 363.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEPHROURETERAL STENT PIGTAIL 8FX26CM SUP-95-01722 CDM C1877 HCPCS 0278 RC outpatient 363.37 363.37 363.37 57 207.12 percent of total billed charges 363.37 93 294.33 percent of total billed charges 363.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 363.37 other OPPS APC 363.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 363.37 other OPPS APC 363.37 51 185.32 percent of total billed charges 363.37 363.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WRAP COBAN 1X5 SUP-95-01726 CDM 0272 RC outpatient 31.72 31.72 31.72 74 23.47 percent of total billed charges 31.72 93 25.69 percent of total billed charges 31.72 31.72 other OPPS APC 31.72 31.72 other OPPS APC 31.72 27.63 8.76 percent of total billed charges 31.72 31.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WRAP COBAN 2X5 SUP-95-01727 CDM 0272 RC outpatient 1.06 1.06 1.06 74 0.78 percent of total billed charges 1.06 93 0.86 percent of total billed charges 1.06 1.06 other OPPS APC 1.06 1.06 other OPPS APC 1.06 27.63 0.29 percent of total billed charges 1.06 1.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING LEVEL 1 INFUSER SUP-95-01730 CDM 0272 RC outpatient 1719.24 1719.24 1719.24 74 1272.24 percent of total billed charges 1719.24 93 1392.58 percent of total billed charges 1719.24 1719.24 other OPPS APC 1719.24 1719.24 other OPPS APC 1719.24 27.63 475.03 percent of total billed charges 1719.24 1719.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DELUXE SHOULDER IMMOB UNIV SUP-95-01731 CDM 0272 RC outpatient 30.6 30.6 30.6 74 22.64 percent of total billed charges 30.6 93 24.79 percent of total billed charges 30.6 30.6 other OPPS APC 30.6 30.6 other OPPS APC 30.6 27.63 8.45 percent of total billed charges 30.6 30.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATH PERCUTANEOUS NEPHROSTOMY W/LOOP SUP-95-01736 CDM C1729 HCPCS 0278 RC outpatient 315.88 315.88 315.88 57 180.05 percent of total billed charges 315.88 93 255.86 percent of total billed charges 315.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 315.88 other OPPS APC 315.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 315.88 other OPPS APC 315.88 51 161.1 percent of total billed charges 315.88 315.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SET EZ IO YELLOW 15G SUP-95-01738 CDM 0272 RC outpatient 478.1 478.1 478.1 74 353.79 percent of total billed charges 478.1 93 387.26 percent of total billed charges 478.1 478.1 other OPPS APC 478.1 478.1 other OPPS APC 478.1 27.63 132.1 percent of total billed charges 478.1 478.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPIRAL FLEX TRACH 8FR CUFFED SUP-95-01741 CDM 0272 RC outpatient 122.58 122.58 122.58 74 90.71 percent of total billed charges 122.58 93 99.29 percent of total billed charges 122.58 122.58 other OPPS APC 122.58 122.58 other OPPS APC 122.58 27.63 33.87 percent of total billed charges 122.58 122.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXCHANGER TRACH TUBE 4.8 SUP-95-01743 CDM 0272 RC outpatient 24.62 24.62 24.62 74 18.22 percent of total billed charges 24.62 93 19.94 percent of total billed charges 24.62 24.62 other OPPS APC 24.62 24.62 other OPPS APC 24.62 27.63 6.8 percent of total billed charges 24.62 24.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE BRACHIAL ANGIOGRAPHY SUP-95-01744 CDM 0272 RC outpatient 252.25 252.25 252.25 74 186.67 percent of total billed charges 252.25 93 204.32 percent of total billed charges 252.25 252.25 other OPPS APC 252.25 252.25 other OPPS APC 252.25 27.63 69.7 percent of total billed charges 252.25 252.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PLEURX BULB 500ML SUP-95-01746 CDM 0272 RC outpatient 217 217 217 217 other OPPS APC 217 217 other OPPS APC 217 27.63 59.96 percent of total billed charges 217 217 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLEURX BULB KIT SUP-95-01746 CDM 0272 RC outpatient 217 217 217 74 160.58 percent of total billed charges 217 93 175.77 percent of total billed charges 217 217 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PLEURX CATHETER SUP-95-01747 CDM C1729 HCPCS 0278 RC outpatient 2028 2028 2028 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2028 other OPPS APC 2028 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2028 other OPPS APC 2028 51 1034.28 percent of total billed charges 2028 2028 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLEURX CATHETER KIT SUP-95-01747 CDM C1729 HCPCS 0278 RC outpatient 2028 2028 2028 57 1155.96 percent of total billed charges 2028 93 1642.68 percent of total billed charges 2028 2028 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE TRACH ORAL RAE 4.5MM CUFFED SUP-95-01766 CDM 0272 RC outpatient 166.44 166.44 166.44 74 123.17 percent of total billed charges 166.44 93 134.82 percent of total billed charges 166.44 166.44 other OPPS APC 166.44 166.44 other OPPS APC 166.44 27.63 45.99 percent of total billed charges 166.44 166.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - BENTSON .035 145CM STRAIGHT SUP-95-01773 CDM C1769 HCPCS 0272 RC outpatient 56 56 56 74 41.44 percent of total billed charges 56 93 45.36 percent of total billed charges 56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56 other OPPS APC 56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56 other OPPS APC 56 27.63 15.47 percent of total billed charges 56 56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GLIDEWIRE .035X150CM ANGLED SUP-95-01774 CDM C1769 HCPCS 0272 RC outpatient 116 116 116 74 85.84 percent of total billed charges 116 93 93.96 percent of total billed charges 116 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 116 other OPPS APC 116 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 116 other OPPS APC 116 27.63 32.05 percent of total billed charges 116 116 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING CATHETER CONNECTION 30CM SUP-95-01775 CDM 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 750 other OPPS APC 750 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACCUSTICK II .038 J-TIP .018 NIT INVRAD SUP-95-01779 CDM 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 297.5 other OPPS APC 297.5 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT EDGE 180 SUP-95-01783 CDM 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIDESCOPE COVER #2 COBALT RANGER GLV2 SUP-95-01784 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VISIGLIDE .025 X 450 STRAIGHT SUP-95-01785 CDM C1769 HCPCS 0272 RC outpatient 551.25 551.25 551.25 74 407.93 percent of total billed charges 551.25 93 446.51 percent of total billed charges 551.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.25 other OPPS APC 551.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.25 other OPPS APC 551.25 27.63 152.31 percent of total billed charges 551.25 551.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VISIGLIDE .025 X 450 ANGLED SUP-95-01786 CDM C1769 HCPCS 0272 RC outpatient 551.25 551.25 551.25 74 407.93 percent of total billed charges 551.25 93 446.51 percent of total billed charges 551.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.25 other OPPS APC 551.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.25 other OPPS APC 551.25 27.63 152.31 percent of total billed charges 551.25 551.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONE-STEP CENTESIS NEEDLE 5F X 7CM SUP-95-01795 CDM 0272 RC outpatient 74.84 74.84 74.84 74 55.38 percent of total billed charges 74.84 93 60.62 percent of total billed charges 74.84 74.84 other OPPS APC 74.84 74.84 other OPPS APC 74.84 27.63 20.68 percent of total billed charges 74.84 74.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE 0 VICRYL PLUS VCPJ207 SUP-95-01796 CDM 0272 RC outpatient 2.21 2.21 2.21 74 1.64 percent of total billed charges 2.21 93 1.79 percent of total billed charges 2.21 2.21 other OPPS APC 2.21 2.21 other OPPS APC 2.21 27.63 0.61 percent of total billed charges 2.21 2.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY 14FR SUP-95-01813 CDM 0272 RC outpatient 54.88 54.88 54.88 74 40.61 percent of total billed charges 54.88 93 44.45 percent of total billed charges 54.88 54.88 other OPPS APC 54.88 54.88 other OPPS APC 54.88 27.63 15.16 percent of total billed charges 54.88 54.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NASAL TRUMPET 18FR SUP-95-01814 CDM 0272 RC outpatient 54.88 54.88 54.88 74 40.61 percent of total billed charges 54.88 93 44.45 percent of total billed charges 54.88 54.88 other OPPS APC 54.88 54.88 other OPPS APC 54.88 27.63 15.16 percent of total billed charges 54.88 54.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY 20FR SUP-95-01815 CDM 0272 RC outpatient 54.88 54.88 54.88 74 40.61 percent of total billed charges 54.88 93 44.45 percent of total billed charges 54.88 54.88 other OPPS APC 54.88 54.88 other OPPS APC 54.88 27.63 15.16 percent of total billed charges 54.88 54.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY 22FR SUP-95-01816 CDM 0272 RC outpatient 54.88 54.88 54.88 74 40.61 percent of total billed charges 54.88 93 44.45 percent of total billed charges 54.88 54.88 other OPPS APC 54.88 54.88 other OPPS APC 54.88 27.63 15.16 percent of total billed charges 54.88 54.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NASAL TRUMPET 26FR SUP-95-01817 CDM 0272 RC outpatient 54.88 54.88 54.88 74 40.61 percent of total billed charges 54.88 93 44.45 percent of total billed charges 54.88 54.88 other OPPS APC 54.88 54.88 other OPPS APC 54.88 27.63 15.16 percent of total billed charges 54.88 54.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY 30FR SUP-95-01818 CDM 0272 RC outpatient 54.88 54.88 54.88 74 40.61 percent of total billed charges 54.88 93 44.45 percent of total billed charges 54.88 54.88 other OPPS APC 54.88 54.88 other OPPS APC 54.88 27.63 15.16 percent of total billed charges 54.88 54.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SUCTION 12FR SUP-95-01819 CDM 0272 RC outpatient 54.88 54.88 54.88 74 40.61 percent of total billed charges 54.88 93 44.45 percent of total billed charges 54.88 54.88 other OPPS APC 54.88 54.88 other OPPS APC 54.88 27.63 15.16 percent of total billed charges 54.88 54.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDO CUFFED 6.5MM MURPHY SUP-95-01820 CDM 0272 RC outpatient 94.84 94.84 94.84 74 70.18 percent of total billed charges 94.84 93 76.82 percent of total billed charges 94.84 94.84 other OPPS APC 94.84 94.84 other OPPS APC 94.84 27.63 26.2 percent of total billed charges 94.84 94.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDO UNCUFFED 5.5MM MURPHY SUP-95-01821 CDM 0272 RC outpatient 55.52 55.52 55.52 74 41.08 percent of total billed charges 55.52 93 44.97 percent of total billed charges 55.52 55.52 other OPPS APC 55.52 55.52 other OPPS APC 55.52 27.63 15.34 percent of total billed charges 55.52 55.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STYLET INTUBATING SZ 10 SUP-95-01826 CDM 0272 RC outpatient 1.87 1.87 1.87 74 1.38 percent of total billed charges 1.87 93 1.51 percent of total billed charges 1.87 1.87 other OPPS APC 1.87 1.87 other OPPS APC 1.87 27.63 0.52 percent of total billed charges 1.87 1.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING ST 3.5MM X 24MM SUP-95-01827 CDM C1713 HCPCS 0278 RC outpatient 472.89 472.89 472.89 57 269.55 percent of total billed charges 472.89 93 383.04 percent of total billed charges 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 51 241.17 percent of total billed charges 472.89 472.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 6 HOLE 69MM LCP TUBULAR SUP-95-01828 CDM C1713 HCPCS 0278 RC outpatient 633.96 633.96 633.96 57 361.36 percent of total billed charges 633.96 93 513.51 percent of total billed charges 633.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 633.96 other OPPS APC 633.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 633.96 other OPPS APC 633.96 51 323.32 percent of total billed charges 633.96 633.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT 23 X 105 SUP-95-01834 CDM 0272 RC outpatient 7080.63 7080.63 7080.63 74 5239.67 percent of total billed charges 7080.63 93 5735.31 percent of total billed charges 7080.63 7080.63 other OPPS APC 7080.63 7080.63 other OPPS APC 7080.63 27.63 1956.38 percent of total billed charges 7080.63 7080.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT 23 X 125 SUP-95-01835 CDM 0272 RC outpatient 6312.5 6312.5 6312.5 74 4671.25 percent of total billed charges 6312.5 93 5113.13 percent of total billed charges 6312.5 6312.5 other OPPS APC 6312.5 6312.5 other OPPS APC 6312.5 27.63 1744.14 percent of total billed charges 6312.5 6312.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH ENDO TUBE 3.5 CUFFED SUP-95-01853 CDM 0272 RC outpatient 55.2 55.2 55.2 74 40.85 percent of total billed charges 55.2 93 44.71 percent of total billed charges 55.2 55.2 other OPPS APC 55.2 55.2 other OPPS APC 55.2 27.63 15.25 percent of total billed charges 55.2 55.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH ENDO TUBE 4.5 CUFFED SUP-95-01854 CDM 0272 RC outpatient 55.2 55.2 55.2 74 40.85 percent of total billed charges 55.2 93 44.71 percent of total billed charges 55.2 55.2 other OPPS APC 55.2 55.2 other OPPS APC 55.2 27.63 15.25 percent of total billed charges 55.2 55.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH ENDO TUBE 5.5 CUFFED SUP-95-01855 CDM 0272 RC outpatient 55.2 55.2 55.2 74 40.85 percent of total billed charges 55.2 93 44.71 percent of total billed charges 55.2 55.2 other OPPS APC 55.2 55.2 other OPPS APC 55.2 27.63 15.25 percent of total billed charges 55.2 55.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN LONG THREAD 4MM X 34MM SUP-95-01861 CDM C1713 HCPCS 0278 RC outpatient 676.76 676.76 676.76 57 385.75 percent of total billed charges 676.76 93 548.18 percent of total billed charges 676.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 676.76 other OPPS APC 676.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 676.76 other OPPS APC 676.76 51 345.15 percent of total billed charges 676.76 676.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE 3MHZ SUP-95-01862 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.2 3 FLUTED NP100MM N/S SUP-95-01865 CDM 0272 RC outpatient 782.34 782.34 782.34 74 578.93 percent of total billed charges 782.34 93 633.7 percent of total billed charges 782.34 782.34 other OPPS APC 782.34 782.34 other OPPS APC 782.34 27.63 216.16 percent of total billed charges 782.34 782.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.2 3 FLUTED NP145MM N/S SUP-95-01866 CDM 0272 RC outpatient 650.48 650.48 650.48 74 481.36 percent of total billed charges 650.48 93 526.89 percent of total billed charges 650.48 650.48 other OPPS APC 650.48 650.48 other OPPS APC 650.48 27.63 179.73 percent of total billed charges 650.48 650.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING IV SITE SM SUP-95-01891 CDM 0272 RC outpatient 556.5 556.5 556.5 74 411.81 percent of total billed charges 556.5 93 450.77 percent of total billed charges 556.5 556.5 other OPPS APC 556.5 556.5 other OPPS APC 556.5 27.63 153.76 percent of total billed charges 556.5 556.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INTRODUCER 18G X 2.5 SUP-95-01944 CDM 0272 RC outpatient 610.44 610.44 610.44 74 451.73 percent of total billed charges 610.44 93 494.46 percent of total billed charges 610.44 610.44 other OPPS APC 610.44 610.44 other OPPS APC 610.44 27.63 168.66 percent of total billed charges 610.44 610.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING MELGISORB ALGINATE 4X4 SUP-95-01963 CDM 0272 RC outpatient 22.57 22.57 22.57 74 16.7 percent of total billed charges 22.57 93 18.28 percent of total billed charges 22.57 22.57 other OPPS APC 22.57 22.57 other OPPS APC 22.57 27.63 6.24 percent of total billed charges 22.57 22.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAGEN PURACOL PLUS 2X2 SUP-95-01973 CDM 0272 RC outpatient 217 217 217 74 160.58 percent of total billed charges 217 93 175.77 percent of total billed charges 217 217 other OPPS APC 217 217 other OPPS APC 217 27.63 59.96 percent of total billed charges 217 217 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINTING TUBE SUP-95-01975 CDM 0272 RC outpatient 892.98 892.98 892.98 74 660.81 percent of total billed charges 892.98 93 723.31 percent of total billed charges 892.98 892.98 other OPPS APC 892.98 892.98 other OPPS APC 892.98 27.63 246.73 percent of total billed charges 892.98 892.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPIFIX 1.5MM SQ CM. SUP-95-01979 CDM Q4131 HCPCS 0636 RC outpatient 954 954 954 74 705.96 percent of total billed charges 954 93 772.74 percent of total billed charges 954 954 other OPPS APC 954 954 other OPPS APC 954 24.86 237.16 percent of total billed charges 954 954 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER 10FR 2WAY 5ML SUP-95-01980 CDM C1729 HCPCS 0272 RC outpatient 145.68 145.68 145.68 74 107.8 percent of total billed charges 145.68 93 118 percent of total billed charges 145.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.68 other OPPS APC 145.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.68 other OPPS APC 145.68 27.63 40.25 percent of total billed charges 145.68 145.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ET TUBE SPIRAL-FLEX 7MM SUP-95-02001 CDM 0272 RC outpatient 112.7 112.7 112.7 74 83.4 percent of total billed charges 112.7 93 91.29 percent of total billed charges 112.7 112.7 other OPPS APC 112.7 112.7 other OPPS APC 112.7 27.63 31.14 percent of total billed charges 112.7 112.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ET TUBE SPIRAL-FLEX 6MM SUP-95-02002 CDM 0272 RC outpatient 112.7 112.7 112.7 74 83.4 percent of total billed charges 112.7 93 91.29 percent of total billed charges 112.7 112.7 other OPPS APC 112.7 112.7 other OPPS APC 112.7 27.63 31.14 percent of total billed charges 112.7 112.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOVAC SUCTION DEVICE SUP-95-02004 CDM 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 437.5 other OPPS APC 437.5 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLD SNARE EXACTO SUP-95-02005 CDM 0272 RC outpatient 48 48 48 74 35.52 percent of total billed charges 48 93 38.88 percent of total billed charges 48 48 other OPPS APC 48 48 other OPPS APC 48 27.63 13.26 percent of total billed charges 48 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 15MM OVAL ARGON SNARE PROBE SUP-95-02007 CDM 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH ENDO TUBE 6.5 CUFFED SUP-95-02084 CDM 0272 RC outpatient 55.2 55.2 55.2 74 40.85 percent of total billed charges 55.2 93 44.71 percent of total billed charges 55.2 55.2 other OPPS APC 55.2 55.2 other OPPS APC 55.2 27.63 15.25 percent of total billed charges 55.2 55.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE MOSS GASTRO 18FR SUP-95-02101 CDM B4087 HCPCS 0278 RC outpatient 1536.87 1536.87 1536.87 57 876.02 percent of total billed charges 1536.87 93 1244.86 percent of total billed charges 1536.87 1536.87 other OPPS APC 1536.87 1536.87 other OPPS APC 1536.87 51 783.8 percent of total billed charges 1536.87 1536.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE MOSS G 20FR SUP-95-02102 CDM B4087 HCPCS 0278 RC outpatient 148.58 148.58 148.58 57 84.69 percent of total billed charges 148.58 93 120.35 percent of total billed charges 148.58 148.58 other OPPS APC 148.58 148.58 other OPPS APC 148.58 51 75.78 percent of total billed charges 148.58 148.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE MOSS G 24FR SUP-95-02103 CDM B4087 HCPCS 0278 RC outpatient 148.58 148.58 148.58 57 84.69 percent of total billed charges 148.58 93 120.35 percent of total billed charges 148.58 148.58 other OPPS APC 148.58 148.58 other OPPS APC 148.58 51 75.78 percent of total billed charges 148.58 148.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE J-G 22FR 45 IN SUP-95-02104 CDM B4087 HCPCS 0278 RC outpatient 937.5 937.5 937.5 57 534.38 percent of total billed charges 937.5 93 759.38 percent of total billed charges 937.5 937.5 other OPPS APC 937.5 937.5 other OPPS APC 937.5 51 478.13 percent of total billed charges 937.5 937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE OVERSHOE MEN LARGE SUP-95-02125 CDM L3260 HCPCS 0271 RC outpatient 79.96 79.96 79.96 74 59.17 percent of total billed charges 79.96 93 64.77 percent of total billed charges 79.96 79.96 other OPPS APC 79.96 79.96 other OPPS APC 79.96 27.63 22.09 percent of total billed charges 79.96 79.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE OVERSHOE MEN X-LARGE SUP-95-02126 CDM L3260 HCPCS 0271 RC outpatient 79.96 79.96 79.96 74 59.17 percent of total billed charges 79.96 93 64.77 percent of total billed charges 79.96 79.96 other OPPS APC 79.96 79.96 other OPPS APC 79.96 27.63 22.09 percent of total billed charges 79.96 79.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING OPTIFOAM ADH AG+ 4 X 4 SUP-95-02131 CDM 0272 RC outpatient 243.81 243.81 243.81 74 180.42 percent of total billed charges 243.81 93 197.49 percent of total billed charges 243.81 243.81 other OPPS APC 243.81 243.81 other OPPS APC 243.81 27.63 67.36 percent of total billed charges 243.81 243.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING DRAINAGE SET - 25CM INVRAD SUP-95-02132 CDM 0272 RC outpatient 166.36 166.36 166.36 74 123.11 percent of total billed charges 166.36 93 134.75 percent of total billed charges 166.36 166.36 other OPPS APC 166.36 166.36 other OPPS APC 166.36 27.63 45.97 percent of total billed charges 166.36 166.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SAFETY GLIDE 23X1 SUP-95-02136 CDM 0272 RC outpatient 43.9 43.9 43.9 74 32.49 percent of total billed charges 43.9 93 35.56 percent of total billed charges 43.9 43.9 other OPPS APC 43.9 43.9 other OPPS APC 43.9 27.63 12.13 percent of total billed charges 43.9 43.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.5MM 110MM SUP-95-02139 CDM 0272 RC outpatient 278.78 278.78 278.78 74 206.3 percent of total billed charges 278.78 93 225.81 percent of total billed charges 278.78 278.78 other OPPS APC 278.78 278.78 other OPPS APC 278.78 27.63 77.03 percent of total billed charges 278.78 278.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.8MM 165MM SUP-95-02140 CDM 0272 RC outpatient 346.92 346.92 346.92 74 256.72 percent of total billed charges 346.92 93 281.01 percent of total billed charges 346.92 346.92 other OPPS APC 346.92 346.92 other OPPS APC 346.92 27.63 95.85 percent of total billed charges 346.92 346.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 4.0MM 3FLUTE 195MM SUP-95-02145 CDM 0272 RC outpatient 572.32 572.32 572.32 74 423.52 percent of total billed charges 572.32 93 463.58 percent of total billed charges 572.32 572.32 other OPPS APC 572.32 572.32 other OPPS APC 572.32 27.63 158.13 percent of total billed charges 572.32 572.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5MM CORTEX F THREAD 16MM SUP-95-02147 CDM C1713 HCPCS 0278 RC outpatient 106.2 106.2 106.2 57 60.53 percent of total billed charges 106.2 93 86.02 percent of total billed charges 106.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.2 other OPPS APC 106.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.2 other OPPS APC 106.2 51 54.16 percent of total billed charges 106.2 106.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM CANN F THREAD 50MM SUP-95-02149 CDM C1713 HCPCS 0278 RC outpatient 79.88 79.88 79.88 57 45.53 percent of total billed charges 79.88 93 64.7 percent of total billed charges 79.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 79.88 other OPPS APC 79.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 79.88 other OPPS APC 79.88 51 40.74 percent of total billed charges 79.88 79.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAMMOTOME ELITE 13G PROBE SUP-95-02159 CDM 0272 RC outpatient 406.46 406.46 406.46 74 300.78 percent of total billed charges 406.46 93 329.23 percent of total billed charges 406.46 406.46 other OPPS APC 406.46 406.46 other OPPS APC 406.46 27.63 112.3 percent of total billed charges 406.46 406.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING MELGISORB AG 1.2 X 18 SUP-95-02165 CDM 0272 RC outpatient 267.19 267.19 267.19 74 197.72 percent of total billed charges 267.19 93 216.42 percent of total billed charges 267.19 267.19 other OPPS APC 267.19 267.19 other OPPS APC 267.19 27.63 73.82 percent of total billed charges 267.19 267.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPEEDBAND SUPERVIEW SUPER 7 SUP-95-02172 CDM 0272 RC outpatient 1275.53 1275.53 1275.53 74 943.89 percent of total billed charges 1275.53 93 1033.18 percent of total billed charges 1275.53 1275.53 other OPPS APC 1275.53 1275.53 other OPPS APC 1275.53 27.63 352.43 percent of total billed charges 1275.53 1275.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APLIGRAF SUP-95-02177 CDM Q4101 HCPCS 0636 RC outpatient 3187.5 3187.5 34.73 34.73 fee schedule 3187.5 93 2581.88 percent of total billed charges 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 24.86 792.41 percent of total billed charges 34.73 3187.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT GRAFIX PRIME 1.5CM X 2CM SUP-95-02183 CDM Q4133 HCPCS 0636 RC outpatient 2235 2235 166 166 fee schedule 2235 93 1810.35 percent of total billed charges 2235 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2235 other OPPS APC 2235 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2235 other OPPS APC 2235 24.86 555.62 percent of total billed charges 166 2235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT THERASKIN 13CM 1 X 2 SUP-95-02207 CDM Q4121 HCPCS 0636 RC outpatient 2925 2925 53.63 53.63 fee schedule 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 24.86 727.16 percent of total billed charges 53.63 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT THERASKIN 39CM 2 X 3 SUP-95-02208 CDM Q4121 HCPCS 0636 RC outpatient 3187.5 3187.5 53.63 53.63 fee schedule 3187.5 93 2581.88 percent of total billed charges 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 24.86 792.41 percent of total billed charges 53.63 3187.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING OPTIFOAM AG SILVER 4X4 NONADH SUP-95-02215 CDM 0272 RC outpatient 23.18 23.18 23.18 74 17.15 percent of total billed charges 23.18 93 18.78 percent of total billed charges 23.18 23.18 other OPPS APC 23.18 23.18 other OPPS APC 23.18 27.63 6.4 percent of total billed charges 23.18 23.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPIFIX 18MM DISK SHEET SUP-95-02235 CDM Q4186 HCPCS 0636 RC outpatient 2235 2235 169.88 169.88 fee schedule 2235 93 1810.35 percent of total billed charges 2235 2235 other OPPS APC 2235 2235 other OPPS APC 2235 24.86 555.62 percent of total billed charges 169.88 2235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIDESCOPE COVER #1 COBALT RANGER GLV1 SUP-95-02261 CDM 0272 RC outpatient 81.93 81.93 81.93 74 60.63 percent of total billed charges 81.93 93 66.36 percent of total billed charges 81.93 81.93 other OPPS APC 81.93 81.93 other OPPS APC 81.93 27.63 22.64 percent of total billed charges 81.93 81.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "FORCEPS, BIOPSY DISPOSABLE JUMBO" SUP-95-02308 CDM 0272 RC outpatient 52.86 52.86 52.86 74 39.12 percent of total billed charges 52.86 93 42.82 percent of total billed charges 52.86 52.86 other OPPS APC 52.86 52.86 other OPPS APC 52.86 27.63 14.61 percent of total billed charges 52.86 52.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRAVO SUP-95-02309 CDM 0272 RC outpatient 913.8 913.8 913.8 74 676.21 percent of total billed charges 913.8 93 740.18 percent of total billed charges 913.8 913.8 other OPPS APC 913.8 913.8 other OPPS APC 913.8 27.63 252.48 percent of total billed charges 913.8 913.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX SELF TAP 3.5MM X 20MM SUP-95-02325 CDM C1713 HCPCS 0278 RC outpatient 106.2 106.2 106.2 57 60.53 percent of total billed charges 106.2 93 86.02 percent of total billed charges 106.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.2 other OPPS APC 106.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.2 other OPPS APC 106.2 51 54.16 percent of total billed charges 106.2 106.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LMA SIZE 1.5 SUP-95-02348 CDM 0272 RC outpatient 24.8 24.8 24.8 74 18.35 percent of total billed charges 24.8 93 20.09 percent of total billed charges 24.8 24.8 other OPPS APC 24.8 24.8 other OPPS APC 24.8 27.63 6.85 percent of total billed charges 24.8 24.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LMA SIZE 1 SUP-95-02349 CDM 0272 RC outpatient 46.98 46.98 46.98 74 34.77 percent of total billed charges 46.98 93 38.05 percent of total billed charges 46.98 46.98 other OPPS APC 46.98 46.98 other OPPS APC 46.98 27.63 12.98 percent of total billed charges 46.98 46.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LMA SIZE 2.5 SUP-95-02350 CDM 0272 RC outpatient 45.48 45.48 45.48 74 33.66 percent of total billed charges 45.48 93 36.84 percent of total billed charges 45.48 45.48 other OPPS APC 45.48 45.48 other OPPS APC 45.48 27.63 12.57 percent of total billed charges 45.48 45.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIWI OMNICUP PALM PUMP SUP-95-02352 CDM 0272 RC outpatient 115.58 115.58 115.58 74 85.53 percent of total billed charges 115.58 93 93.62 percent of total billed charges 115.58 115.58 other OPPS APC 115.58 115.58 other OPPS APC 115.58 27.63 31.93 percent of total billed charges 115.58 115.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ESOPH WALLFLEX 18/23-25MMX1 0CM SUP-95-02355 CDM C1876 HCPCS 0278 RC outpatient 6562.5 6562.5 6562.5 57 3740.63 percent of total billed charges 6562.5 93 5315.63 percent of total billed charges 6562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6562.5 other OPPS APC 6562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6562.5 other OPPS APC 6562.5 51 3346.88 percent of total billed charges 6562.5 6562.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ESOPH WALLFLEX 18/23-25MMX1 2CM SUP-95-02356 CDM C1876 HCPCS 0278 RC outpatient 6562.5 6562.5 6562.5 57 3740.63 percent of total billed charges 6562.5 93 5315.63 percent of total billed charges 6562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6562.5 other OPPS APC 6562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6562.5 other OPPS APC 6562.5 51 3346.88 percent of total billed charges 6562.5 6562.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ESOPH WALLFLEX 18/23MM X1 03MM SUP-95-02357 CDM C1876 HCPCS 0278 RC outpatient 6312.5 6312.5 6312.5 57 3598.13 percent of total billed charges 6312.5 93 5113.13 percent of total billed charges 6312.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6312.5 other OPPS APC 6312.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6312.5 other OPPS APC 6312.5 51 3219.38 percent of total billed charges 6312.5 6312.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE GUIDE-JAG 038/260CM SUP-95-02358 CDM C1769 HCPCS 0278 RC outpatient 498.75 498.75 498.75 57 284.29 percent of total billed charges 498.75 93 403.99 percent of total billed charges 498.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 498.75 other OPPS APC 498.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 498.75 other OPPS APC 498.75 51 254.36 percent of total billed charges 498.75 498.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRUSH CYTOLOGY COLON SUP-95-02360 CDM 0272 RC outpatient 47 47 47 74 34.78 percent of total billed charges 47 93 38.07 percent of total billed charges 47 47 other OPPS APC 47 47 other OPPS APC 47 27.63 12.99 percent of total billed charges 47 47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAINAGE CATH - 12F FLEXIMA APD CTSUP SUP-95-02392 CDM C1729 HCPCS 0272 RC outpatient 272.69 272.69 272.69 74 201.79 percent of total billed charges 272.69 93 220.88 percent of total billed charges 272.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 272.69 other OPPS APC 272.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 272.69 other OPPS APC 272.69 27.63 75.34 percent of total billed charges 272.69 272.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAINAGE CATH - 14F FLEXIMA APD CTSUP SUP-95-02393 CDM C1729 HCPCS 0272 RC outpatient 272.69 272.69 272.69 74 201.79 percent of total billed charges 272.69 93 220.88 percent of total billed charges 272.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 272.69 other OPPS APC 272.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 272.69 other OPPS APC 272.69 27.63 75.34 percent of total billed charges 272.69 272.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BIOPSY SITE IDENTIFIER, 14G CERAMIC" SUP-95-02405 CDM A4648 CPT 0278 RC outpatient 326.48 326.48 326.48 57 186.09 percent of total billed charges 326.48 93 264.45 percent of total billed charges 326.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 326.48 other OPPS APC 326.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 326.48 other OPPS APC 326.48 51 166.5 percent of total billed charges 326.48 326.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - COONS 0.035 180CM SUP-95-02418 CDM C2625 HCPCS 0272 RC outpatient 81 81 81 74 59.94 percent of total billed charges 81 93 65.61 percent of total billed charges 81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 81 other OPPS APC 81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 81 other OPPS APC 81 27.63 22.38 percent of total billed charges 81 81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.5MM X 110MM SUP-95-02452 CDM 0272 RC outpatient 297.36 297.36 297.36 74 220.05 percent of total billed charges 297.36 93 240.86 percent of total billed charges 297.36 297.36 other OPPS APC 297.36 297.36 other OPPS APC 297.36 27.63 82.16 percent of total billed charges 297.36 297.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM LOCKING SLF TAP 4 SUP-95-02453 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN LONG THREAD 4MM X 38MM SUP-95-02454 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDO LOOP SUP-95-02503 CDM 0272 RC outpatient 1386.75 1386.75 1386.75 74 1026.2 percent of total billed charges 1386.75 93 1123.27 percent of total billed charges 1386.75 1386.75 other OPPS APC 1386.75 1386.75 other OPPS APC 1386.75 27.63 383.16 percent of total billed charges 1386.75 1386.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING ST 3.5 MM X 10MM SUP-95-02515 CDM C1713 HCPCS 0278 RC outpatient 431.38 431.38 431.38 57 245.89 percent of total billed charges 431.38 93 349.42 percent of total billed charges 431.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 431.38 other OPPS APC 431.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 431.38 other OPPS APC 431.38 51 220 percent of total billed charges 431.38 431.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 3.5 X 40MM SUP-95-02523 CDM C1713 HCPCS 0278 RC outpatient 91.2 91.2 91.2 57 51.98 percent of total billed charges 91.2 93 73.87 percent of total billed charges 91.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 91.2 other OPPS APC 91.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 91.2 other OPPS APC 91.2 51 46.51 percent of total billed charges 91.2 91.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INVRAD MEDIPORT CLEARVUE 8FR SUP-95-02529 CDM C1788 HCPCS 0278 RC outpatient 1239 1239 1239 57 706.23 percent of total billed charges 1239 93 1003.59 percent of total billed charges 1239 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1239 other OPPS APC 1239 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1239 other OPPS APC 1239 27.63 342.34 percent of total billed charges 1239 1239 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER SEAL CAP SUP-95-02561 CDM 0272 RC outpatient 180 180 180 74 133.2 percent of total billed charges 180 93 145.8 percent of total billed charges 180 180 other OPPS APC 180 180 other OPPS APC 180 27.63 49.73 percent of total billed charges 180 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SD 190 KIT SUP-95-02562 CDM 0272 RC outpatient 3048.7 3048.7 3048.7 74 2256.04 percent of total billed charges 3048.7 93 2469.45 percent of total billed charges 3048.7 3048.7 other OPPS APC 3048.7 3048.7 other OPPS APC 3048.7 27.63 842.36 percent of total billed charges 3048.7 3048.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PURAPLY AM COM 2X2 SUP-95-02569 CDM Q4196 HCPCS 0636 RC outpatient 1776 1776 116.75 116.75 fee schedule 1776 93 1438.56 percent of total billed charges 1776 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1776 other OPPS APC 1776 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1776 other OPPS APC 1776 24.86 441.51 percent of total billed charges 116.75 1776 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BILLIARY STENT 10-5 SUP-95-02575 CDM C1874 HCPCS 0278 RC outpatient 350 350 350 57 199.5 percent of total billed charges 350 93 283.5 percent of total billed charges 350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 350 other OPPS APC 350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 350 other OPPS APC 350 51 178.5 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LMA SIZE 5 FASTRACH SUP-95-02579 CDM 0272 RC outpatient 283.5 283.5 283.5 74 209.79 percent of total billed charges 283.5 93 229.64 percent of total billed charges 283.5 283.5 other OPPS APC 283.5 283.5 other OPPS APC 283.5 27.63 78.33 percent of total billed charges 283.5 283.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LMA SIZE 4 FASTRACH SUP-95-02580 CDM 0272 RC outpatient 283.5 283.5 283.5 74 209.79 percent of total billed charges 283.5 93 229.64 percent of total billed charges 283.5 283.5 other OPPS APC 283.5 283.5 other OPPS APC 283.5 27.63 78.33 percent of total billed charges 283.5 283.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LUMEN DOUBLE SIZE 28 SUP-95-02584 CDM 0272 RC outpatient 206.54 206.54 206.54 74 152.84 percent of total billed charges 206.54 93 167.3 percent of total billed charges 206.54 206.54 other OPPS APC 206.54 206.54 other OPPS APC 206.54 27.63 57.07 percent of total billed charges 206.54 206.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PURAPLYE AM-COM 6X9 SUP-95-02594 CDM Q4196 HCPCS 0636 RC outpatient 9600 9600 116.75 116.75 fee schedule 9600 93 7776 percent of total billed charges 9600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9600 other OPPS APC 9600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9600 other OPPS APC 9600 24.86 2386.56 percent of total billed charges 116.75 9600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE JEJUNAL FEEDING 24FR SUP-95-02598 CDM 0272 RC outpatient 427 427 427 74 315.98 percent of total billed charges 427 93 345.87 percent of total billed charges 427 427 other OPPS APC 427 427 other OPPS APC 427 27.63 117.98 percent of total billed charges 427 427 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM LOCKING SLF TAP 5 SUP-95-02616 CDM C1713 HCPCS 0278 RC outpatient 487.66 487.66 487.66 57 277.97 percent of total billed charges 487.66 93 395 percent of total billed charges 487.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 487.66 other OPPS APC 487.66 487.66 other OPPS APC 487.66 51 248.71 percent of total billed charges 487.66 487.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LCP RECON 3.5 MM 7 HOLES SUP-95-02617 CDM C1713 HCPCS 0278 RC outpatient 1802.04 1802.04 1802.04 57 1027.16 percent of total billed charges 1802.04 93 1459.65 percent of total billed charges 1802.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1802.04 other OPPS APC 1802.04 1802.04 other OPPS APC 1802.04 51 919.04 percent of total billed charges 1802.04 1802.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER EYE GUARD DISPOSABLE SUP-95-02636 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRIMATRIX MASHED 2X2CM SUP-95-02652 CDM Q4110 HCPCS 0636 RC outpatient 2094 2094 48.93 48.93 fee schedule 2094 93 1696.14 percent of total billed charges 2094 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2094 other OPPS APC 2094 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2094 other OPPS APC 2094 24.86 520.57 percent of total billed charges 48.93 2094 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INVRAD GLIDEPATH DIALYSIS 19CM SUP-95-02661 CDM C1750 HCPCS 0278 RC outpatient 1221 1221 1221 57 695.97 percent of total billed charges 1221 93 989.01 percent of total billed charges 1221 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1221 other OPPS APC 1221 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1221 other OPPS APC 1221 51 622.71 percent of total billed charges 1221 1221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INVRAD GLIDEPATH DIALYSIS 23CM SUP-95-02662 CDM C1750 HCPCS 0278 RC outpatient 1221 1221 1221 57 695.97 percent of total billed charges 1221 93 989.01 percent of total billed charges 1221 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1221 other OPPS APC 1221 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1221 other OPPS APC 1221 51 622.71 percent of total billed charges 1221 1221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INVRAD GLIDEPATH DIALYSIS 27CM SUP-95-02663 CDM C1750 HCPCS 0278 RC outpatient 1221 1221 1221 57 695.97 percent of total billed charges 1221 93 989.01 percent of total billed charges 1221 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1221 other OPPS APC 1221 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1221 other OPPS APC 1221 51 622.71 percent of total billed charges 1221 1221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INVRAD GLIDEPATH DIALYSIS 31CM SUP-95-02664 CDM C1750 HCPCS 0278 RC outpatient 5087.5 5087.5 5087.5 57 2899.88 percent of total billed charges 5087.5 93 4120.88 percent of total billed charges 5087.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5087.5 other OPPS APC 5087.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5087.5 other OPPS APC 5087.5 51 2594.63 percent of total billed charges 5087.5 5087.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INVRAD GLIDEPATH DIALYSIS 35CM SUP-95-02665 CDM C1750 HCPCS 0278 RC outpatient 5087.5 5087.5 5087.5 57 2899.88 percent of total billed charges 5087.5 93 4120.88 percent of total billed charges 5087.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5087.5 other OPPS APC 5087.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5087.5 other OPPS APC 5087.5 51 2594.63 percent of total billed charges 5087.5 5087.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INVRAD GLIDEPATH DIALYSIS 42CM SUP-95-02666 CDM C1750 HCPCS 0278 RC outpatient 5087.5 5087.5 5087.5 57 2899.88 percent of total billed charges 5087.5 93 4120.88 percent of total billed charges 5087.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5087.5 other OPPS APC 5087.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5087.5 other OPPS APC 5087.5 51 2594.63 percent of total billed charges 5087.5 5087.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INVRAD GLIDEPATH DIALYSIS 50CM SUP-95-02667 CDM C1750 HCPCS 0278 RC outpatient 5087.5 5087.5 5087.5 57 2899.88 percent of total billed charges 5087.5 93 4120.88 percent of total billed charges 5087.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5087.5 other OPPS APC 5087.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5087.5 other OPPS APC 5087.5 51 2594.63 percent of total billed charges 5087.5 5087.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ESOPH WALLFLEX 18/23 X 153MM SUP-95-02690 CDM C1874 HCPCS 0278 RC outpatient 6312.5 6312.5 6312.5 57 3598.13 percent of total billed charges 6312.5 93 5113.13 percent of total billed charges 6312.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6312.5 other OPPS APC 6312.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6312.5 other OPPS APC 6312.5 51 3219.38 percent of total billed charges 6312.5 6312.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRIMATRIX 14MM DISC SUP-95-02700 CDM Q4110 HCPCS 0636 RC outpatient 1350 1350 48.93 48.93 fee schedule 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 24.86 335.61 percent of total billed charges 48.93 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLOSTOMY ONE PIECE CUT TO FIT SUP-95-02701 CDM 0271 RC outpatient 25.44 25.44 25.44 74 18.83 percent of total billed charges 25.44 93 20.61 percent of total billed charges 25.44 25.44 other OPPS APC 25.44 25.44 other OPPS APC 25.44 27.63 7.03 percent of total billed charges 25.44 25.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSTOMY MEDICAL ADHESIVE SUP-95-02702 CDM 0271 RC outpatient 27.76 27.76 27.76 74 20.54 percent of total billed charges 27.76 93 22.49 percent of total billed charges 27.76 27.76 other OPPS APC 27.76 27.76 other OPPS APC 27.76 27.63 7.67 percent of total billed charges 27.76 27.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REPLACEMENT VACUUM CANISTER 800CC SUP-95-02755 CDM 0272 RC outpatient 32.12 32.12 32.12 74 23.77 percent of total billed charges 32.12 93 26.02 percent of total billed charges 32.12 32.12 other OPPS APC 32.12 32.12 other OPPS APC 32.12 27.63 8.87 percent of total billed charges 32.12 32.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE GUIDE 8G MAMMOTOME FORK SHAPE SUP-95-02756 CDM 0272 RC outpatient 454.23 454.23 454.23 74 336.13 percent of total billed charges 454.23 93 367.93 percent of total billed charges 454.23 454.23 other OPPS APC 454.23 454.23 other OPPS APC 454.23 27.63 125.5 percent of total billed charges 454.23 454.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE ST 8G 9CM MAMMOTOME REVOLVE SUP-95-02760 CDM 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE ST 8G 12CM MAMMOTOME REVOLVE SUP-95-02761 CDM 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE ST 10G 9CM MAMMOTOME REVOLVE SUP-95-02762 CDM 0272 RC outpatient 2833.11 2833.11 2833.11 74 2096.5 percent of total billed charges 2833.11 93 2294.82 percent of total billed charges 2833.11 2833.11 other OPPS APC 2833.11 2833.11 other OPPS APC 2833.11 27.63 782.79 percent of total billed charges 2833.11 2833.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE ST 10G 12CM MAMMOTOME REVOLVE SUP-95-02763 CDM 0272 RC outpatient 661.06 661.06 661.06 74 489.18 percent of total billed charges 661.06 93 535.46 percent of total billed charges 661.06 661.06 other OPPS APC 661.06 661.06 other OPPS APC 661.06 27.63 182.65 percent of total billed charges 661.06 661.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BIOPSY SITE INDENTIFIER 8G ""BOWTIE""" SUP-95-02764 CDM outpatient 2884.29 2884.29 2884.29 2884.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BIOPSY SITE IDENTIFIER 8G ""V"" SHAPE" SUP-95-02765 CDM outpatient 1916.46 1916.46 1916.46 1916.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MAMMOMARK 8G ""TRIPLE TWIST"" SHAPE" SUP-95-02766 CDM outpatient 1916.46 1916.46 1916.46 1916.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BIOPSY SITE INDENTIFIER 10G ""BOWTIE""" SUP-95-02767 CDM outpatient 1916.46 1916.46 1916.46 1916.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BIOPSY SITE INDENTIFIER 10G ""V"" SHAPE" SUP-95-02768 CDM outpatient 1916.46 1916.46 1916.46 1916.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MAMMOMARK 10G ""TRIPLE TWIST"" SHAPE" SUP-95-02769 CDM outpatient 1916.46 1916.46 1916.46 1916.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THE ECOSUCTIONER SUP-95-02772 CDM 0271 RC outpatient 241.5 241.5 241.5 74 178.71 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 241.5 other OPPS APC 241.5 241.5 other OPPS APC 241.5 27.63 66.73 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE GUIDED BALLON (COLON) 10MM SUP-95-02787 CDM C1726 HCPCS 0272 RC outpatient 720 720 720 74 532.8 percent of total billed charges 720 93 583.2 percent of total billed charges 720 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 720 other OPPS APC 720 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 720 other OPPS APC 720 27.63 198.94 percent of total billed charges 720 720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE GUIDED BALLON (COLON) 12MM SUP-95-02788 CDM C1726 HCPCS 0272 RC outpatient 720 720 720 74 532.8 percent of total billed charges 720 93 583.2 percent of total billed charges 720 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 720 other OPPS APC 720 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 720 other OPPS APC 720 27.63 198.94 percent of total billed charges 720 720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAPTIVATOR EMR DEVICE SUP-95-02792 CDM C1726 HCPCS 0272 RC outpatient 1590 1590 1590 74 1176.6 percent of total billed charges 1590 93 1287.9 percent of total billed charges 1590 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1590 other OPPS APC 1590 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1590 other OPPS APC 1590 27.63 439.32 percent of total billed charges 1590 1590 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON DILATOR 6-7-8 SUP-95-02796 CDM C1726 HCPCS 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON DILATOR 8-9-10 SUP-95-02797 CDM C1726 HCPCS 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON DILATOR 10-11-12 SUP-95-02798 CDM C1726 HCPCS 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON DILATOR 12-13.5-15 SUP-95-02799 CDM C1726 HCPCS 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOMAXX 23X10 ESOPHAGEAL SUP-95-02801 CDM C1874 HCPCS 0278 RC outpatient 6500 6500 6500 57 3705 percent of total billed charges 6500 93 5265 percent of total billed charges 6500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6500 other OPPS APC 6500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6500 other OPPS APC 6500 51 3315 percent of total billed charges 6500 6500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLAIN STEINMAN PIN 3/32 SUP-95-02815 CDM C1713 HCPCS 0278 RC outpatient 27.53 27.53 27.53 57 15.69 percent of total billed charges 27.53 93 22.3 percent of total billed charges 27.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.53 other OPPS APC 27.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 27.53 other OPPS APC 27.53 51 14.04 percent of total billed charges 27.53 27.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE 6 FLEXMASTER SUP-95-02818 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON DILATOR 15-18 SUP-95-02819 CDM C1726 HCPCS 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON DILATOR 18-20 SUP-95-02820 CDM C1726 HCPCS 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DRILL BIT, 7/64MM" SUP-95-02821 CDM 0272 RC outpatient 676.2 676.2 676.2 74 500.39 percent of total billed charges 676.2 93 547.72 percent of total billed charges 676.2 676.2 other OPPS APC 676.2 676.2 other OPPS APC 676.2 27.63 186.83 percent of total billed charges 676.2 676.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIRSHNER WIRE .045 SUP-95-02822 CDM C1713 HCPCS 0278 RC outpatient 31.64 31.64 31.64 57 18.03 percent of total billed charges 31.64 93 25.63 percent of total billed charges 31.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 31.64 other OPPS APC 31.64 31.64 other OPPS APC 31.64 51 16.14 percent of total billed charges 31.64 31.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TWIST DRILL 3/32 3.2 X 12.7 SUP-95-02827 CDM 0272 RC outpatient 128.8 128.8 128.8 74 95.31 percent of total billed charges 128.8 93 104.33 percent of total billed charges 128.8 128.8 other OPPS APC 128.8 128.8 other OPPS APC 128.8 27.63 35.59 percent of total billed charges 128.8 128.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.5 SUP-95-02841 CDM 0272 RC outpatient 128.8 128.8 128.8 74 95.31 percent of total billed charges 128.8 93 104.33 percent of total billed charges 128.8 128.8 other OPPS APC 128.8 128.8 other OPPS APC 128.8 27.63 35.59 percent of total billed charges 128.8 128.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5 UNIVERSAL DRILL GUIDE SUP-95-02844 CDM 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING O2 EXTENSION SUP-95-02863 CDM 0272 RC outpatient 166.8 166.8 166.8 74 123.43 percent of total billed charges 166.8 93 135.11 percent of total billed charges 166.8 166.8 other OPPS APC 166.8 166.8 other OPPS APC 166.8 27.63 46.09 percent of total billed charges 166.8 166.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SPINAL 25 X 3.5 PENCIL POINT SUP-95-02867 CDM 0272 RC outpatient 550.34 550.34 550.34 74 407.25 percent of total billed charges 550.34 93 445.78 percent of total billed charges 550.34 550.34 other OPPS APC 550.34 550.34 other OPPS APC 550.34 27.63 152.06 percent of total billed charges 550.34 550.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINKS 2.7 SUP-95-02875 CDM 0272 RC outpatient 1434 1434 1434 74 1061.16 percent of total billed charges 1434 93 1161.54 percent of total billed charges 1434 1434 other OPPS APC 1434 1434 other OPPS APC 1434 27.63 396.21 percent of total billed charges 1434 1434 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENOUS ABLATION LASER KIT (ANGIODYNAM) SUP-95-02889 CDM 0272 RC outpatient 1080 1080 1080 74 799.2 percent of total billed charges 1080 93 874.8 percent of total billed charges 1080 1080 other OPPS APC 1080 1080 other OPPS APC 1080 27.63 298.4 percent of total billed charges 1080 1080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOPSY NEEDLE - CHIBA 18G X 15CM CTSUP SUP-95-02891 CDM 0272 RC outpatient 41.52 41.52 41.52 74 30.72 percent of total billed charges 41.52 93 33.63 percent of total billed charges 41.52 41.52 other OPPS APC 41.52 41.52 other OPPS APC 41.52 27.63 11.47 percent of total billed charges 41.52 41.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOPSY NEEDLE - CHIBA 18G X 10CM CTSUP SUP-95-02892 CDM 0272 RC outpatient 41.52 41.52 41.52 74 30.72 percent of total billed charges 41.52 93 33.63 percent of total billed charges 41.52 41.52 other OPPS APC 41.52 41.52 other OPPS APC 41.52 27.63 11.47 percent of total billed charges 41.52 41.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE SPIKED 8MM X 20MM SUP-95-02899 CDM C1713 HCPCS 0278 RC outpatient 276.5 276.5 276.5 57 157.61 percent of total billed charges 276.5 93 223.97 percent of total billed charges 276.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 276.5 other OPPS APC 276.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 276.5 other OPPS APC 276.5 51 141.02 percent of total billed charges 276.5 276.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHEST TUBE KIT 12FR THAL-QUICK SUP-95-02900 CDM 0272 RC outpatient 529.17 529.17 529.17 74 391.59 percent of total billed charges 529.17 93 428.63 percent of total billed charges 529.17 529.17 other OPPS APC 529.17 529.17 other OPPS APC 529.17 27.63 146.21 percent of total billed charges 529.17 529.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CENTRAL LINE KIT - PEDIATRIC TWO LUMEN SUP-95-02904 CDM 0272 RC outpatient 793.35 793.35 793.35 74 587.08 percent of total billed charges 793.35 93 642.61 percent of total billed charges 793.35 793.35 other OPPS APC 793.35 793.35 other OPPS APC 793.35 27.63 219.2 percent of total billed charges 793.35 793.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WORD CATHETER BARTHOLIN SET SUP-95-02905 CDM C1729 HCPCS 0278 RC outpatient 83.32 83.32 83.32 57 47.49 percent of total billed charges 83.32 93 67.49 percent of total billed charges 83.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 83.32 other OPPS APC 83.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 83.32 other OPPS APC 83.32 51 42.49 percent of total billed charges 83.32 83.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE SUCTION FRAZIER 8FR SUP-95-02939 CDM 0272 RC outpatient 177.2 177.2 177.2 74 131.13 percent of total billed charges 177.2 93 143.53 percent of total billed charges 177.2 177.2 other OPPS APC 177.2 177.2 other OPPS APC 177.2 27.63 48.96 percent of total billed charges 177.2 177.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE SUCTION FRAZIER 7FR SUP-95-02940 CDM 0272 RC outpatient 175.84 175.84 175.84 74 130.12 percent of total billed charges 175.84 93 142.43 percent of total billed charges 175.84 175.84 other OPPS APC 175.84 175.84 other OPPS APC 175.84 27.63 48.58 percent of total billed charges 175.84 175.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIAGON UNIVERSAL POINTER SHELL SUP-95-02954 CDM 0272 RC outpatient 6375 6375 6375 74 4717.5 percent of total billed charges 6375 93 5163.75 percent of total billed charges 6375 6375 other OPPS APC 6375 6375 other OPPS APC 6375 27.63 1761.41 percent of total billed charges 6375 6375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXTUBE 4 MM SUP-95-02955 CDM 0272 RC outpatient 6375 6375 6375 74 4717.5 percent of total billed charges 6375 93 5163.75 percent of total billed charges 6375 6375 other OPPS APC 6375 6375 other OPPS APC 6375 27.63 1761.41 percent of total billed charges 6375 6375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLAIN STEINMAN PIN 5/64 SUP-95-02958 CDM C1713 HCPCS 0278 RC outpatient 24 24 24 57 13.68 percent of total billed charges 24 93 19.44 percent of total billed charges 24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24 other OPPS APC 24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24 other OPPS APC 24 51 12.24 percent of total billed charges 24 24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATH IV INTROCAN 18 X 1.75 SUP-95-02976 CDM 0272 RC outpatient 306.15 306.15 306.15 74 226.55 percent of total billed charges 306.15 93 247.98 percent of total billed charges 306.15 306.15 other OPPS APC 306.15 306.15 other OPPS APC 306.15 27.63 84.59 percent of total billed charges 306.15 306.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATH IV INTROCAN 20 X 1.75 SUP-95-02977 CDM 0272 RC outpatient 306.15 306.15 306.15 74 226.55 percent of total billed charges 306.15 93 247.98 percent of total billed charges 306.15 306.15 other OPPS APC 306.15 306.15 other OPPS APC 306.15 27.63 84.59 percent of total billed charges 306.15 306.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING MEPILEX FOAM 4X4 SUP-95-02978 CDM 0272 RC outpatient 59.8 59.8 59.8 74 44.25 percent of total billed charges 59.8 93 48.44 percent of total billed charges 59.8 59.8 other OPPS APC 59.8 59.8 other OPPS APC 59.8 27.63 16.52 percent of total billed charges 59.8 59.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONRAY 50ML SUP-95-02986 CDM 0272 RC outpatient 66.15 66.15 66.15 74 48.95 percent of total billed charges 66.15 93 53.58 percent of total billed charges 66.15 66.15 other OPPS APC 66.15 66.15 other OPPS APC 66.15 27.63 18.28 percent of total billed charges 66.15 66.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR LIGHTED RADIALUX SUP-95-02993 CDM 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 705 other OPPS APC 705 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ENDOSTITCH 0 48IN GREEN (ORANGE) SUP-95-02998 CDM 0272 RC outpatient 576.24 576.24 576.24 74 426.42 percent of total billed charges 576.24 93 466.75 percent of total billed charges 576.24 576.24 other OPPS APC 576.24 576.24 other OPPS APC 576.24 27.63 159.22 percent of total billed charges 576.24 576.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT DUODENAL WALLFLEX SUP-95-03002 CDM C1876 HCPCS 0278 RC outpatient 9240 9240 9240 57 5266.8 percent of total billed charges 9240 93 7484.4 percent of total billed charges 9240 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9240 other OPPS APC 9240 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9240 other OPPS APC 9240 51 4712.4 percent of total billed charges 9240 9240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL ASNIS CANN 2MM AO COUPLING 1.7MM SUP-95-03056 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT CANN 2.7MM TWIST W/ AO F SUP-95-03059 CDM 0272 RC outpatient 928.5 928.5 928.5 74 687.09 percent of total billed charges 928.5 93 752.09 percent of total billed charges 928.5 928.5 other OPPS APC 928.5 928.5 other OPPS APC 928.5 27.63 256.54 percent of total billed charges 928.5 928.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KWIRE SMOOTH 1.4 X150MM SUP-95-03060 CDM C1713 HCPCS 0278 RC outpatient 554.75 554.75 554.75 57 316.21 percent of total billed charges 554.75 93 449.35 percent of total billed charges 554.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 554.75 other OPPS APC 554.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 554.75 other OPPS APC 554.75 51 282.92 percent of total billed charges 554.75 554.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE ASNIS 3MM 1.2MM X 100MM SUP-95-03063 CDM C1713 HCPCS 0278 RC outpatient 148 148 148 57 84.36 percent of total billed charges 148 93 119.88 percent of total billed charges 148 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 148 other OPPS APC 148 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 148 other OPPS APC 148 51 75.48 percent of total billed charges 148 148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OLIVE K WIRE SUP-95-03068 CDM C1713 HCPCS 0278 RC outpatient 252 252 252 57 143.64 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 51 128.52 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNIFE SICKLE SUP-95-03089 CDM 0272 RC outpatient 347.59 347.59 347.59 74 257.22 percent of total billed charges 347.59 93 281.55 percent of total billed charges 347.59 347.59 other OPPS APC 347.59 347.59 other OPPS APC 347.59 27.63 96.04 percent of total billed charges 347.59 347.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOMAXX 23X150 ESOPHAGEAL SUP-95-03093 CDM C1876 HCPCS 0278 RC outpatient 6500 6500 6500 57 3705 percent of total billed charges 6500 93 5265 percent of total billed charges 6500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6500 other OPPS APC 6500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6500 other OPPS APC 6500 51 3315 percent of total billed charges 6500 6500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLAR PROBE 10FR SUP-95-03094 CDM 0272 RC outpatient 428.75 428.75 428.75 74 317.28 percent of total billed charges 428.75 93 347.29 percent of total billed charges 428.75 428.75 other OPPS APC 428.75 428.75 other OPPS APC 428.75 27.63 118.46 percent of total billed charges 428.75 428.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL ASNIS 3MM CANN 2.1MM AO COUP SUP-95-03113 CDM 0272 RC outpatient 690.27 690.27 690.27 74 510.8 percent of total billed charges 690.27 93 559.12 percent of total billed charges 690.27 690.27 other OPPS APC 690.27 690.27 other OPPS APC 690.27 27.63 190.72 percent of total billed charges 690.27 690.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL ASNIS 3MM CANN 2.1MM AO COUP SUP-95-03114 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT SET 4.0 CANN 2.7MM SUP-95-03116 CDM 0272 RC outpatient 1237.5 1237.5 1237.5 74 915.75 percent of total billed charges 1237.5 93 1002.38 percent of total billed charges 1237.5 1237.5 other OPPS APC 1237.5 1237.5 other OPPS APC 1237.5 27.63 341.92 percent of total billed charges 1237.5 1237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA SET 3.0MM FENESTRATED SUP-95-03123 CDM 0272 RC outpatient 3362.5 3362.5 3362.5 74 2488.25 percent of total billed charges 3362.5 93 2723.63 percent of total billed charges 3362.5 3362.5 other OPPS APC 3362.5 3362.5 other OPPS APC 3362.5 27.63 929.06 percent of total billed charges 3362.5 3362.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIXATION PIN HEADED 7/8 1.75 SUP-95-03129 CDM C1713 HCPCS 0278 RC outpatient 210 210 210 57 119.7 percent of total billed charges 210 93 170.1 percent of total billed charges 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 51 107.1 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIXATION PIN HEADED 7/8 1 SUP-95-03130 CDM C1713 HCPCS 0278 RC outpatient 210 210 210 57 119.7 percent of total billed charges 210 93 170.1 percent of total billed charges 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 51 107.1 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIM SMALL HEADED CUPPED TIP SUP-95-03131 CDM C1713 HCPCS 0278 RC outpatient 644 644 644 57 367.08 percent of total billed charges 644 93 521.64 percent of total billed charges 644 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 644 other OPPS APC 644 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 644 other OPPS APC 644 51 328.44 percent of total billed charges 644 644 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORAL RAE W/TAPERGUARD 8.0 SUP-95-03132 CDM 0272 RC outpatient 189.36 189.36 189.36 74 140.13 percent of total billed charges 189.36 93 153.38 percent of total billed charges 189.36 189.36 other OPPS APC 189.36 189.36 other OPPS APC 189.36 27.63 52.32 percent of total billed charges 189.36 189.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.3 SUP-95-03133 CDM 0272 RC outpatient 300.48 300.48 300.48 74 222.36 percent of total billed charges 300.48 93 243.39 percent of total billed charges 300.48 300.48 other OPPS APC 300.48 300.48 other OPPS APC 300.48 27.63 83.02 percent of total billed charges 300.48 300.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT SET BANDER UTETERAL DIV 90CM SUP-95-03142 CDM C2625 HCPCS 0278 RC outpatient 635.04 635.04 635.04 57 361.97 percent of total billed charges 635.04 93 514.38 percent of total billed charges 635.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 635.04 other OPPS APC 635.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 635.04 other OPPS APC 635.04 51 323.87 percent of total billed charges 635.04 635.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ACHIEVE BIOPSY 16G X 20 SUP-95-03146 CDM 0272 RC outpatient 172.09 172.09 172.09 74 127.35 percent of total billed charges 172.09 93 139.39 percent of total billed charges 172.09 172.09 other OPPS APC 172.09 172.09 other OPPS APC 172.09 27.63 47.55 percent of total billed charges 172.09 172.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTRESSE 7/8 TUBING SUP-95-03149 CDM 0272 RC outpatient 35.6 35.6 35.6 74 26.34 percent of total billed charges 35.6 93 28.84 percent of total billed charges 35.6 35.6 other OPPS APC 35.6 35.6 other OPPS APC 35.6 27.63 9.84 percent of total billed charges 35.6 35.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT LOCKING SHORT ?4.3X216MM SUP-95-03150 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPERMAT ORTHO SUP-95-03151 CDM 0271 RC outpatient 35.83 35.83 35.83 74 26.51 percent of total billed charges 35.83 93 29.02 percent of total billed charges 35.83 35.83 other OPPS APC 35.83 35.83 other OPPS APC 35.83 27.63 9.9 percent of total billed charges 35.83 35.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.8MM X 102MM AO FITTING SUP-95-03153 CDM 0272 RC outpatient 392.32 392.32 392.32 74 290.32 percent of total billed charges 392.32 93 317.78 percent of total billed charges 392.32 392.32 other OPPS APC 392.32 392.32 other OPPS APC 392.32 27.63 108.4 percent of total billed charges 392.32 392.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 2MM X 102MM WL50MM AO-SHAFT SUP-95-03154 CDM 0272 RC outpatient 357.84 357.84 357.84 74 264.8 percent of total billed charges 357.84 93 289.85 percent of total billed charges 357.84 357.84 other OPPS APC 357.84 357.84 other OPPS APC 357.84 27.63 98.87 percent of total billed charges 357.84 357.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPRAPUBIC CATHETER INSERTIONS SUP-95-03169 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALING CAPS SUP-95-03173 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K WIRE 2.3X150MM SUP-95-03180 CDM C1713 HCPCS 0278 RC outpatient 80 80 80 57 45.6 percent of total billed charges 80 93 64.8 percent of total billed charges 80 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 80 other OPPS APC 80 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 80 other OPPS APC 80 51 40.8 percent of total billed charges 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIRSHNER WIRE .035 SUP-95-03201 CDM C1713 HCPCS 0278 RC outpatient 0.81 0.81 0.81 57 0.46 percent of total billed charges 0.81 93 0.66 percent of total billed charges 0.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.81 other OPPS APC 0.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.81 other OPPS APC 0.81 51 0.41 percent of total billed charges 0.81 0.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT GRAFIX PRIME 1.6CM X 2CM SUP-95-03213 CDM Q4133 HCPCS 0636 RC outpatient 1485 1485 166 166 fee schedule 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 24.86 369.17 percent of total billed charges 166 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER S.J FULL RADIUS SUP-95-03215 CDM outpatient 222.18 222.18 222.18 222.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 1.8MM W/DEPTH 110MM SUP-95-03217 CDM 0272 RC outpatient 572.01 572.01 572.01 74 423.29 percent of total billed charges 572.01 93 463.33 percent of total billed charges 572.01 572.01 other OPPS APC 572.01 572.01 other OPPS APC 572.01 27.63 158.05 percent of total billed charges 572.01 572.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHORT PIN SUP-95-03219 CDM 0272 RC outpatient 210 210 210 74 155.4 percent of total billed charges 210 93 170.1 percent of total billed charges 210 210 other OPPS APC 210 210 other OPPS APC 210 27.63 58.02 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 1.1 X 150MM DOUBLE ENDED TROCAR TIP SMOOTH SUP-95-03235 CDM 0272 RC outpatient 80 80 80 74 59.2 percent of total billed charges 80 93 64.8 percent of total billed charges 80 80 other OPPS APC 80 80 other OPPS APC 80 27.63 22.1 percent of total billed charges 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYMMETRIC PATELLA 29MMX8MM SUP-95-03236 CDM C1776 HCPCS 0278 RC outpatient 463.93 463.93 463.93 57 264.44 percent of total billed charges 463.93 93 375.78 percent of total billed charges 463.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 463.93 other OPPS APC 463.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 463.93 other OPPS APC 463.93 51 236.6 percent of total billed charges 463.93 463.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERC INSERT KIT 2.9MM P-LCK SUP-95-03237 CDM C1713 HCPCS 0278 RC outpatient 945 945 945 57 538.65 percent of total billed charges 945 93 765.45 percent of total billed charges 945 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 945 other OPPS APC 945 945 other OPPS APC 945 51 481.95 percent of total billed charges 945 945 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PINK PIN GUARDS SUP-95-03239 CDM 0272 RC outpatient 96 96 96 74 71.04 percent of total billed charges 96 93 77.76 percent of total billed charges 96 96 other OPPS APC 96 96 other OPPS APC 96 27.63 26.52 percent of total billed charges 96 96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT BIOCARTILAGE SMALL JOINT SUP-95-03240 CDM 0272 RC outpatient 735 735 735 74 543.9 percent of total billed charges 735 93 595.35 percent of total billed charges 735 735 other OPPS APC 735 735 other OPPS APC 735 27.63 203.08 percent of total billed charges 735 735 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACP KIT SERIES SUP-95-03241 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 4.2 X 300MM AO SUP-95-03244 CDM 0272 RC outpatient 395.85 395.85 395.85 74 292.93 percent of total billed charges 395.85 93 320.64 percent of total billed charges 395.85 395.85 other OPPS APC 395.85 395.85 other OPPS APC 395.85 27.63 109.37 percent of total billed charges 395.85 395.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMALL JOINT BLADE 2.5 SUP-95-03255 CDM 0272 RC outpatient 222.18 222.18 222.18 74 164.41 percent of total billed charges 222.18 93 179.97 percent of total billed charges 222.18 222.18 other OPPS APC 222.18 222.18 other OPPS APC 222.18 27.63 61.39 percent of total billed charges 222.18 222.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE BIO TAK DISPOSABLES KIT SUP-95-03260 CDM 0272 RC outpatient 560 560 560 74 414.4 percent of total billed charges 560 93 453.6 percent of total billed charges 560 560 other OPPS APC 560 560 other OPPS APC 560 27.63 154.73 percent of total billed charges 560 560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN 5MM FEMORAL POSTERIOR SZ C/D SUP-95-03264 CDM C1713 HCPCS 0278 RC outpatient 532 532 532 57 303.24 percent of total billed charges 532 93 430.92 percent of total billed charges 532 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532 other OPPS APC 532 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532 other OPPS APC 532 51 271.32 percent of total billed charges 532 532 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN 5MM FEMORAL POSTERIOR SZ G SUP-95-03265 CDM C1776 HCPCS 0278 RC outpatient 532 532 532 57 303.24 percent of total billed charges 532 93 430.92 percent of total billed charges 532 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532 other OPPS APC 532 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532 other OPPS APC 532 51 271.32 percent of total billed charges 532 532 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SYSTEM PARS SUTURE KIT SUP-95-03267 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LMA 1.5 SUP-95-03270 CDM 0272 RC outpatient 26.72 26.72 26.72 74 19.77 percent of total billed charges 26.72 93 21.64 percent of total billed charges 26.72 26.72 other OPPS APC 26.72 26.72 other OPPS APC 26.72 27.63 7.38 percent of total billed charges 26.72 26.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 1.8 SUP-95-03304 CDM 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 577.5 other OPPS APC 577.5 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 2.2 SUP-95-03305 CDM 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 577.5 other OPPS APC 577.5 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POST OP SHOE MALE SM SUP-95-03321 CDM L3260 HCPCS 0272 RC outpatient 3.88 3.88 3.88 74 2.87 percent of total billed charges 3.88 93 3.14 percent of total billed charges 3.88 3.88 other OPPS APC 3.88 3.88 other OPPS APC 3.88 27.63 1.07 percent of total billed charges 3.88 3.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE POST OP MENS XLG SUP-95-03324 CDM L3260 HCPCS 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ECLIPSE 25G X 1 SUP-95-03329 CDM 0272 RC outpatient 62.96 62.96 62.96 74 46.59 percent of total billed charges 62.96 93 51 percent of total billed charges 62.96 62.96 other OPPS APC 62.96 62.96 other OPPS APC 62.96 27.63 17.4 percent of total billed charges 62.96 62.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OLIVE K WIRE 1.6 X8 SUP-95-03339 CDM C1713 HCPCS 0278 RC outpatient 308 308 308 57 175.56 percent of total billed charges 308 93 249.48 percent of total billed charges 308 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 308 other OPPS APC 308 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 308 other OPPS APC 308 51 157.08 percent of total billed charges 308 308 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE DRILL TIP 2.5 SUP-95-03342 CDM 0272 RC outpatient 225.44 225.44 225.44 74 166.83 percent of total billed charges 225.44 93 182.61 percent of total billed charges 225.44 225.44 other OPPS APC 225.44 225.44 other OPPS APC 225.44 27.63 62.29 percent of total billed charges 225.44 225.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNNULAD DRILL 5.0 SUP-95-03343 CDM 0272 RC outpatient 1827 1827 1827 74 1351.98 percent of total billed charges 1827 93 1479.87 percent of total billed charges 1827 1827 other OPPS APC 1827 1827 other OPPS APC 1827 27.63 504.8 percent of total billed charges 1827 1827 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR CATHETER 8FR SUP-95-03350 CDM C1729 HCPCS 0272 RC outpatient 793.23 793.23 793.23 74 586.99 percent of total billed charges 793.23 93 642.52 percent of total billed charges 793.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 793.23 other OPPS APC 793.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 793.23 other OPPS APC 793.23 27.63 219.17 percent of total billed charges 793.23 793.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR CATHETER 10FR SUP-95-03351 CDM C1729 HCPCS 0272 RC outpatient 793.23 793.23 793.23 74 586.99 percent of total billed charges 793.23 93 642.52 percent of total billed charges 793.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 793.23 other OPPS APC 793.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 793.23 other OPPS APC 793.23 27.63 219.17 percent of total billed charges 793.23 793.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WRAP SHOULDER W/COLD PACKS 4 SUP-95-03368 CDM 0271 RC outpatient 80.68 80.68 80.68 74 59.7 percent of total billed charges 80.68 93 65.35 percent of total billed charges 80.68 80.68 other OPPS APC 80.68 80.68 other OPPS APC 80.68 27.63 22.29 percent of total billed charges 80.68 80.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ANCHOR BIOCOMPOSITE KNOTLESS SUP-95-03378 CDM C1713 HCPCS 0278 RC outpatient 1266 1266 1266 57 721.62 percent of total billed charges 1266 93 1025.46 percent of total billed charges 1266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1266 other OPPS APC 1266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1266 other OPPS APC 1266 51 645.66 percent of total billed charges 1266 1266 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLAIN STEINMAN PIN 3/16 SUP-95-03380 CDM C1713 HCPCS 0278 RC outpatient 55.44 55.44 55.44 57 31.6 percent of total billed charges 55.44 93 44.91 percent of total billed charges 55.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.44 other OPPS APC 55.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.44 other OPPS APC 55.44 51 28.27 percent of total billed charges 55.44 55.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLAIN STEINMAN PIN 7/64 SUP-95-03381 CDM C1713 HCPCS 0278 RC outpatient 33.04 33.04 33.04 57 18.83 percent of total billed charges 33.04 93 26.76 percent of total billed charges 33.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 33.04 other OPPS APC 33.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 33.04 other OPPS APC 33.04 51 16.85 percent of total billed charges 33.04 33.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 5/64 2.0MM 2318-20-06 SUP-95-03388 CDM 0272 RC outpatient 82.74 82.74 82.74 74 61.23 percent of total billed charges 82.74 93 67.02 percent of total billed charges 82.74 82.74 other OPPS APC 82.74 82.74 other OPPS APC 82.74 27.63 22.86 percent of total billed charges 82.74 82.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOPSY NEEDLE - CHIBA 20G X 10CM CTSUP SUP-95-03394 CDM 0272 RC outpatient 41.52 41.52 41.52 74 30.72 percent of total billed charges 41.52 93 33.63 percent of total billed charges 41.52 41.52 other OPPS APC 41.52 41.52 other OPPS APC 41.52 27.63 11.47 percent of total billed charges 41.52 41.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOPSY NEEDLE - CHIBA 20G X 15CM CTSUP SUP-95-03395 CDM 0272 RC outpatient 41.52 41.52 41.52 74 30.72 percent of total billed charges 41.52 93 33.63 percent of total billed charges 41.52 41.52 other OPPS APC 41.52 41.52 other OPPS APC 41.52 27.63 11.47 percent of total billed charges 41.52 41.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOPSY NEEDLE - CHIBA 20G X 20CM CTSUP SUP-95-03396 CDM 0272 RC outpatient 152 152 152 74 112.48 percent of total billed charges 152 93 123.12 percent of total billed charges 152 152 other OPPS APC 152 152 other OPPS APC 152 27.63 42 percent of total billed charges 152 152 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOPSY NEEDLE - CHIBA 22G X 10CM CTSUP SUP-95-03397 CDM 0272 RC outpatient 41.52 41.52 41.52 74 30.72 percent of total billed charges 41.52 93 33.63 percent of total billed charges 41.52 41.52 other OPPS APC 41.52 41.52 other OPPS APC 41.52 27.63 11.47 percent of total billed charges 41.52 41.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOPSY NEEDLE - CHIBA 22G X 15CM CTSUP SUP-95-03398 CDM 0272 RC outpatient 41.52 41.52 41.52 74 30.72 percent of total billed charges 41.52 93 33.63 percent of total billed charges 41.52 41.52 other OPPS APC 41.52 41.52 other OPPS APC 41.52 27.63 11.47 percent of total billed charges 41.52 41.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOPSY NEEDLE - CHIBA 22G X 20CM CTSUP SUP-95-03399 CDM 0272 RC outpatient 152 152 152 74 112.48 percent of total billed charges 152 93 123.12 percent of total billed charges 152 152 other OPPS APC 152 152 other OPPS APC 152 27.63 42 percent of total billed charges 152 152 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K WIRE 2.3X150MM SUP-95-03401 CDM C1713 HCPCS 0278 RC outpatient 84 84 84 57 47.88 percent of total billed charges 84 93 68.04 percent of total billed charges 84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84 other OPPS APC 84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84 other OPPS APC 84 51 42.84 percent of total billed charges 84 84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE THREADED 1.25MM X 150MM SUP-95-03415 CDM C1713 HCPCS 0278 RC outpatient 112 112 112 57 63.84 percent of total billed charges 112 93 90.72 percent of total billed charges 112 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112 other OPPS APC 112 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112 other OPPS APC 112 51 57.12 percent of total billed charges 112 112 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VENTRALIGHT ST MESH (5992533) SUP-95-03416 CDM C1781 HCPCS 0278 RC outpatient 4550 4550 4550 57 2593.5 percent of total billed charges 4550 93 3685.5 percent of total billed charges 4550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4550 other OPPS APC 4550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4550 other OPPS APC 4550 51 2320.5 percent of total billed charges 4550 4550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL GUIDE OVAL COMP HOLES SUP-95-03417 CDM 0272 RC outpatient 1887.84 1887.84 1887.84 74 1397 percent of total billed charges 1887.84 93 1529.15 percent of total billed charges 1887.84 1887.84 other OPPS APC 1887.84 1887.84 other OPPS APC 1887.84 27.63 521.61 percent of total billed charges 1887.84 1887.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "OVER DRILL, 2.0 X 110 MM, CANN" SUP-95-03420 CDM 0272 RC outpatient 595 595 595 74 440.3 percent of total billed charges 595 93 481.95 percent of total billed charges 595 595 other OPPS APC 595 595 other OPPS APC 595 27.63 164.4 percent of total billed charges 595 595 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING OPTIFOAM 4X4 NONADH SUP-95-03421 CDM 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ABRASION HOODED BUR SUP-95-03424 CDM 0272 RC outpatient 922.77 922.77 922.77 74 682.85 percent of total billed charges 922.77 93 747.44 percent of total billed charges 922.77 922.77 other OPPS APC 922.77 922.77 other OPPS APC 922.77 27.63 254.96 percent of total billed charges 922.77 922.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLOTTED CANNULA SUP-95-03425 CDM outpatient 1379.1 1379.1 1379.1 1379.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.1MM CANNULATED SUP-95-03430 CDM 0272 RC outpatient 350 350 350 74 259 percent of total billed charges 350 93 283.5 percent of total billed charges 350 350 other OPPS APC 350 350 other OPPS APC 350 27.63 96.71 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 4.6 SUP-95-03431 CDM 0272 RC outpatient 691.25 691.25 691.25 74 511.53 percent of total billed charges 691.25 93 559.91 percent of total billed charges 691.25 691.25 other OPPS APC 691.25 691.25 other OPPS APC 691.25 27.63 190.99 percent of total billed charges 691.25 691.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DENTAL WIRE 18G SUP-95-03436 CDM C1713 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE DUAL TROCAR 1.35MM BX/6 SUP-95-03442 CDM 0272 RC outpatient 164 164 164 74 121.36 percent of total billed charges 164 93 132.84 percent of total billed charges 164 164 other OPPS APC 164 164 other OPPS APC 164 27.63 45.31 percent of total billed charges 164 164 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT CANNULATED 2.6MM SUP-95-03443 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERTAPE 17'W/STR NDL SUP-95-03444 CDM outpatient 682.5 682.5 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPIDURAL NEEDLE 17G X 3.5 PERIFIX TUOHY SUP-95-03449 CDM 0272 RC outpatient 598.36 598.36 598.36 74 442.79 percent of total billed charges 598.36 93 484.67 percent of total billed charges 598.36 598.36 other OPPS APC 598.36 598.36 other OPPS APC 598.36 27.63 165.33 percent of total billed charges 598.36 598.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPIDURAL CATH 19G PERIFIX SPRINGWOUND SUP-95-03450 CDM 0272 RC outpatient 710.73 710.73 710.73 74 525.94 percent of total billed charges 710.73 93 575.69 percent of total billed charges 710.73 710.73 other OPPS APC 710.73 710.73 other OPPS APC 710.73 27.63 196.37 percent of total billed charges 710.73 710.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.3 40MM SUP-95-03458 CDM 0272 RC outpatient 282.98 282.98 282.98 74 209.41 percent of total billed charges 282.98 93 229.21 percent of total billed charges 282.98 282.98 other OPPS APC 282.98 282.98 other OPPS APC 282.98 27.63 78.19 percent of total billed charges 282.98 282.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.3X60MM SUP-95-03459 CDM 0272 RC outpatient 282.98 282.98 282.98 74 209.41 percent of total billed charges 282.98 93 229.21 percent of total billed charges 282.98 282.98 other OPPS APC 282.98 282.98 other OPPS APC 282.98 27.63 78.19 percent of total billed charges 282.98 282.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO STANDARD BLADE (116170) SUP-95-03460 CDM 0272 RC outpatient 855 855 855 74 632.7 percent of total billed charges 855 93 692.55 percent of total billed charges 855 855 other OPPS APC 855 855 other OPPS APC 855 27.63 236.24 percent of total billed charges 855 855 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO NARROW BLADE (116171) SUP-95-03461 CDM 0272 RC outpatient 855 855 855 74 632.7 percent of total billed charges 855 93 692.55 percent of total billed charges 855 855 other OPPS APC 855 855 other OPPS APC 855 27.63 236.24 percent of total billed charges 855 855 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K WIRE W/17MM STOP SUP-95-03466 CDM C1713 HCPCS 0278 RC outpatient 130 130 130 57 74.1 percent of total billed charges 130 93 105.3 percent of total billed charges 130 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130 other OPPS APC 130 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130 other OPPS APC 130 51 66.3 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SECUREMENT 16/17G LOCKIT PLUS SUP-95-03472 CDM 0272 RC outpatient 445.8 445.8 445.8 74 329.89 percent of total billed charges 445.8 93 361.1 percent of total billed charges 445.8 445.8 other OPPS APC 445.8 445.8 other OPPS APC 445.8 27.63 123.17 percent of total billed charges 445.8 445.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO RIO? DRAPE KIT-ONE PIECE W/POCKETS SUP-95-03477 CDM 0272 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO BONE PIN-4MM X 110MM-STERILE 2 PACK SUP-95-03478 CDM 0272 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO BONE PIN-4MM X 140MM-STERILE 2 PACK SUP-95-03479 CDM 0272 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO VIZADISC KNEE PROCED TRACKING KIT SUP-95-03480 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO FEM /TIBIAL CH/POINT KIT -(STERILE) SUP-95-03481 CDM 0272 RC outpatient 271.25 271.25 271.25 74 200.73 percent of total billed charges 271.25 93 219.71 percent of total billed charges 271.25 271.25 other OPPS APC 271.25 271.25 other OPPS APC 271.25 27.63 74.95 percent of total billed charges 271.25 271.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO STRYKER LEG POSITIONER DISP KIT SUP-95-03482 CDM 0272 RC outpatient 120 120 120 74 88.8 percent of total billed charges 120 93 97.2 percent of total billed charges 120 120 other OPPS APC 120 120 other OPPS APC 120 27.63 33.16 percent of total billed charges 120 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO MICS IRRIGATION CLIP SUP-95-03485 CDM 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 192 other OPPS APC 192 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAKO MICS BURR SUP-95-03486 CDM 0272 RC outpatient 208.25 208.25 208.25 74 154.11 percent of total billed charges 208.25 93 168.68 percent of total billed charges 208.25 208.25 other OPPS APC 208.25 208.25 other OPPS APC 208.25 27.63 57.54 percent of total billed charges 208.25 208.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSISEPX6X2.0 SUP-95-03493 CDM 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 490 other OPPS APC 490 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACHALASIA BALLON 30MM SUP-95-03495 CDM C1726 HCPCS 0272 RC outpatient 757.5 757.5 757.5 74 560.55 percent of total billed charges 757.5 93 613.58 percent of total billed charges 757.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 757.5 other OPPS APC 757.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 757.5 other OPPS APC 757.5 27.63 209.3 percent of total billed charges 757.5 757.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACHALASIA BALLON 35MM SUP-95-03496 CDM C1726 HCPCS 0272 RC outpatient 757.5 757.5 757.5 74 560.55 percent of total billed charges 757.5 93 613.58 percent of total billed charges 757.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 757.5 other OPPS APC 757.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 757.5 other OPPS APC 757.5 27.63 209.3 percent of total billed charges 757.5 757.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "K-WIRE, DOUBLE ENDED TROCAR TIP, 1.40MM" SUP-95-03507 CDM C1713 HCPCS 0272 RC outpatient 160 160 160 74 118.4 percent of total billed charges 160 93 129.6 percent of total billed charges 160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160 other OPPS APC 160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160 other OPPS APC 160 27.63 44.21 percent of total billed charges 160 160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DRILL, 2.75MM, CANNULATED" SUP-95-03508 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "K-WIRE, DOUBLE ENDED TROCAR TIP, 1.40MM" SUP-95-03509 CDM C1713 HCPCS 0272 RC outpatient 160 160 160 74 118.4 percent of total billed charges 160 93 129.6 percent of total billed charges 160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160 other OPPS APC 160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160 other OPPS APC 160 27.63 44.21 percent of total billed charges 160 160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 2MM W/STOP-FOR T10 SC HEAD SUP-95-03516 CDM C1713 HCPCS 0278 RC outpatient 323.75 323.75 323.75 57 184.54 percent of total billed charges 323.75 93 262.24 percent of total billed charges 323.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 323.75 other OPPS APC 323.75 323.75 other OPPS APC 323.75 51 165.11 percent of total billed charges 323.75 323.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SPEEDGUIDE DRILL AO, DIA 2.0MM (L = 30MM" SUP-95-03517 CDM 0272 RC outpatient 631.68 631.68 631.68 74 467.44 percent of total billed charges 631.68 93 511.66 percent of total billed charges 631.68 631.68 other OPPS APC 631.68 631.68 other OPPS APC 631.68 27.63 174.53 percent of total billed charges 631.68 631.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING OASIS TRI-LAYER 3 X 3.5CM SUP-95-03520 CDM Q4102 HCPCS 0278 RC outpatient 2382.39 2382.39 2382.39 57 1357.96 percent of total billed charges 2382.39 93 1929.74 percent of total billed charges 2382.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2382.39 other OPPS APC 2382.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2382.39 other OPPS APC 2382.39 51 1215.02 percent of total billed charges 2382.39 2382.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMOSPRAY 7FR SUP-95-03534 CDM 0272 RC outpatient 3750 3750 3750 74 2775 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 3750 other OPPS APC 3750 3750 other OPPS APC 3750 27.63 1036.13 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIAGON DBL SUPPORT CABLE SUP-95-03536 CDM 0272 RC outpatient 2850 2850 2850 74 2109 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 2850 other OPPS APC 2850 2850 other OPPS APC 2850 27.63 787.46 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXPOINTER 1.5MM SUP-95-03537 CDM 0272 RC outpatient 6375 6375 6375 74 4717.5 percent of total billed charges 6375 93 5163.75 percent of total billed charges 6375 6375 other OPPS APC 6375 6375 other OPPS APC 6375 27.63 1761.41 percent of total billed charges 6375 6375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STIENT EVOLTION COLONIC SUP-95-03541 CDM C2625 HCPCS 0278 RC outpatient 5005 5005 5005 57 2852.85 percent of total billed charges 5005 93 4054.05 percent of total billed charges 5005 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5005 other OPPS APC 5005 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5005 other OPPS APC 5005 51 2552.55 percent of total billed charges 5005 5005 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIS FEMORAL NAVIGATION STYLUS. SUP-95-03543 CDM outpatient 958.65 958.65 958.65 958.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREWDRIVER HEX HEAD ATTACHMENT SUP-95-03544 CDM outpatient 1596.96 1596.96 1596.96 1596.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRECISION BLADE 19.5 SUB SUP-95-03545 CDM 0272 RC outpatient 777 777 777 74 574.98 percent of total billed charges 777 93 629.37 percent of total billed charges 777 777 other OPPS APC 777 777 other OPPS APC 777 27.63 214.69 percent of total billed charges 777 777 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE SUCTION 3FR BARON SUP-95-03546 CDM 0272 RC outpatient 180.96 180.96 180.96 74 133.91 percent of total billed charges 180.96 93 146.58 percent of total billed charges 180.96 180.96 other OPPS APC 180.96 180.96 other OPPS APC 180.96 27.63 50 percent of total billed charges 180.96 180.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DRILL BIT, AO DIA 2.0MM X 135MM, SCALED" SUP-95-03572 CDM 0272 RC outpatient 549.5 549.5 549.5 74 406.63 percent of total billed charges 549.5 93 445.1 percent of total billed charges 549.5 549.5 other OPPS APC 549.5 549.5 other OPPS APC 549.5 27.63 151.83 percent of total billed charges 549.5 549.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ESOPHAGEAL STENT TAEWOONG SUP-95-03578 CDM C2625 HCPCS 0272 RC outpatient 6445 6445 6445 74 4769.3 percent of total billed charges 6445 93 5220.45 percent of total billed charges 6445 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6445 other OPPS APC 6445 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6445 other OPPS APC 6445 27.63 1780.75 percent of total billed charges 6445 6445 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE 2.0MM X 150MM SUP-95-03595 CDM C1713 HCPCS 0278 RC outpatient 302.75 302.75 302.75 57 172.57 percent of total billed charges 302.75 93 245.23 percent of total billed charges 302.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 302.75 other OPPS APC 302.75 302.75 other OPPS APC 302.75 51 154.4 percent of total billed charges 302.75 302.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL CANNULATED 3.5MM AO FITTING SUP-95-03596 CDM 0272 RC outpatient 668.64 668.64 668.64 74 494.79 percent of total billed charges 668.64 93 541.6 percent of total billed charges 668.64 668.64 other OPPS APC 668.64 668.64 other OPPS APC 668.64 27.63 184.75 percent of total billed charges 668.64 668.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT CANNULATED 4.3MM SUP-95-03608 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 2.4MMX170MM SUP-95-03609 CDM 0272 RC outpatient 60 60 60 74 44.4 percent of total billed charges 60 93 48.6 percent of total billed charges 60 60 other OPPS APC 60 60 other OPPS APC 60 27.63 16.58 percent of total billed charges 60 60 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING OASIS ULTRA TRI-LAYER 7 X 10CM SUP-95-03619 CDM Q4102 HCPCS 0636 RC outpatient 8386.76 8386.76 14.64 14.64 fee schedule 8386.76 93 6793.28 percent of total billed charges 8386.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8386.76 other OPPS APC 8386.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8386.76 other OPPS APC 8386.76 24.86 2084.95 percent of total billed charges 14.64 8386.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADED NAIL 1/1/2 SUP-95-03623 CDM C1713 HCPCS 0278 RC outpatient 298.38 298.38 298.38 57 170.08 percent of total billed charges 298.38 93 241.69 percent of total billed charges 298.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 298.38 other OPPS APC 298.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 298.38 other OPPS APC 298.38 51 152.17 percent of total billed charges 298.38 298.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE HEEL OFF LOADING SUP-95-03632 CDM 0271 RC outpatient 141 141 141 74 104.34 percent of total billed charges 141 93 114.21 percent of total billed charges 141 141 other OPPS APC 141 141 other OPPS APC 141 27.63 38.96 percent of total billed charges 141 141 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DRILL BIT, AO DIA 2.4MM X 122MM, SCALED" SUP-95-03633 CDM 0272 RC outpatient 490.56 490.56 490.56 74 363.01 percent of total billed charges 490.56 93 397.35 percent of total billed charges 490.56 490.56 other OPPS APC 490.56 490.56 other OPPS APC 490.56 27.63 135.54 percent of total billed charges 490.56 490.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VICRYL 4-0 J214H SUP-95-03643 CDM 0272 RC outpatient 1.44 1.44 1.44 74 1.07 percent of total billed charges 1.44 93 1.17 percent of total billed charges 1.44 1.44 other OPPS APC 1.44 1.44 other OPPS APC 1.44 27.63 0.4 percent of total billed charges 1.44 1.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THORACIC ANGLED 28FR SUP-95-03653 CDM 0272 RC outpatient 24.32 24.32 24.32 74 18 percent of total billed charges 24.32 93 19.7 percent of total billed charges 24.32 24.32 other OPPS APC 24.32 24.32 other OPPS APC 24.32 27.63 6.72 percent of total billed charges 24.32 24.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHORT SMOOTH PIN W/SMALL HEAD SUP-95-03657 CDM C1713 HCPCS 0278 RC outpatient 644 644 644 57 367.08 percent of total billed charges 644 93 521.64 percent of total billed charges 644 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 644 other OPPS APC 644 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 644 other OPPS APC 644 51 328.44 percent of total billed charges 644 644 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHORT THREADED PIN LONG INSERT SHAFT SUP-95-03658 CDM C1713 HCPCS 0278 RC outpatient 644 644 644 57 367.08 percent of total billed charges 644 93 521.64 percent of total billed charges 644 644 other OPPS APC 644 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 644 other OPPS APC 644 51 328.44 percent of total billed charges 644 644 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.7 SUP-95-03682 CDM 0272 RC outpatient 668.64 668.64 668.64 74 494.79 percent of total billed charges 668.64 93 541.6 percent of total billed charges 668.64 668.64 other OPPS APC 668.64 668.64 other OPPS APC 668.64 27.63 184.75 percent of total billed charges 668.64 668.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE MCGRATH BLADE SIZE 1 SUP-95-03687 CDM 0272 RC outpatient 1500 1500 1500 74 1110 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 1500 other OPPS APC 1500 1500 other OPPS APC 1500 27.63 414.45 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE MCGRATH BLADE SIZE 2 SUP-95-03688 CDM 0272 RC outpatient 1500 1500 1500 74 1110 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 1500 other OPPS APC 1500 1500 other OPPS APC 1500 27.63 414.45 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCGRATH XBLADE SIZE 3 SUP-95-03689 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALIBRATED DRILL 4.3MM SUP-95-03693 CDM 0272 RC outpatient 507.5 507.5 507.5 74 375.55 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 507.5 other OPPS APC 507.5 507.5 other OPPS APC 507.5 27.63 140.22 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED DRILL 7MMX200MM SUP-95-03694 CDM 0272 RC outpatient 315 315 315 74 233.1 percent of total billed charges 315 93 255.15 percent of total billed charges 315 315 other OPPS APC 315 315 other OPPS APC 315 27.63 87.03 percent of total billed charges 315 315 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL CANNULATED 4.0 SUP-95-03695 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROFILE DRILL MICRO CMP FT SUP-95-03696 CDM C1713 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROFILE DRILL STANDARD CMP FT SUP-95-03697 CDM 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT COMP FT CALBRATED SUP-95-03698 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 1.2 SUP-95-03699 CDM C1713 HCPCS 0278 RC outpatient 126 126 126 57 71.82 percent of total billed charges 126 93 102.06 percent of total billed charges 126 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 126 other OPPS APC 126 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 126 other OPPS APC 126 51 64.26 percent of total billed charges 126 126 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE BALL TIPPED 2.5X800 SUP-95-03710 CDM 0272 RC outpatient 574.56 574.56 574.56 74 425.17 percent of total billed charges 574.56 93 465.39 percent of total billed charges 574.56 574.56 other OPPS APC 574.56 574.56 other OPPS APC 574.56 27.63 158.75 percent of total billed charges 574.56 574.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE BALL TIPPED 2.2X800 SUP-95-03711 CDM 0272 RC outpatient 559.44 559.44 559.44 74 413.99 percent of total billed charges 559.44 93 453.15 percent of total billed charges 559.44 559.44 other OPPS APC 559.44 559.44 other OPPS APC 559.44 27.63 154.57 percent of total billed charges 559.44 559.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.0MM 140MM SUP-95-03713 CDM 0272 RC outpatient 572.01 572.01 572.01 74 423.29 percent of total billed charges 572.01 93 463.33 percent of total billed charges 572.01 572.01 other OPPS APC 572.01 572.01 other OPPS APC 572.01 27.63 158.05 percent of total billed charges 572.01 572.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT THREE 5.0MM 356MM/126MM SUP-95-03715 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT THREE 4.2MM 330MM/100MM SUP-95-03716 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K WIRE DOUBLE ENDED 1.4X150MM SUP-95-03717 CDM C1713 HCPCS 0278 RC outpatient 160 160 160 57 91.2 percent of total billed charges 160 93 129.6 percent of total billed charges 160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160 other OPPS APC 160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160 other OPPS APC 160 51 81.6 percent of total billed charges 160 160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DRILL, CANNULATED, POLYAXIAL LOCKING SCR" SUP-95-03718 CDM 0272 RC outpatient 283.5 283.5 283.5 74 209.79 percent of total billed charges 283.5 93 229.64 percent of total billed charges 283.5 283.5 other OPPS APC 283.5 283.5 other OPPS APC 283.5 27.63 78.33 percent of total billed charges 283.5 283.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CALIBRATED DRILL BIT, 3.0MM" SUP-95-03728 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DRILL BIT, 4.5MM" SUP-95-03729 CDM 0272 RC outpatient 276.5 276.5 276.5 74 204.61 percent of total billed charges 276.5 93 223.97 percent of total billed charges 276.5 276.5 other OPPS APC 276.5 276.5 other OPPS APC 276.5 27.63 76.4 percent of total billed charges 276.5 276.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLES 8GAX10CM SUP-95-03730 CDM outpatient 214.2 214.2 214.2 214.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DRILL A.O 3,5X130MM" SUP-95-03734 CDM 0272 RC outpatient 581.28 581.28 581.28 74 430.15 percent of total billed charges 581.28 93 470.84 percent of total billed charges 581.28 581.28 other OPPS APC 581.28 581.28 other OPPS APC 581.28 27.63 160.61 percent of total billed charges 581.28 581.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE W/ WASHER 7.8X3X285 SUP-95-03735 CDM C1713 HCPCS 0278 RC outpatient 581.28 581.28 581.28 57 331.33 percent of total billed charges 581.28 93 470.84 percent of total billed charges 581.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 581.28 other OPPS APC 581.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 581.28 other OPPS APC 581.28 51 296.45 percent of total billed charges 581.28 581.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DRILL A.O 3,5X230MM" SUP-95-03736 CDM 0272 RC outpatient 581.28 581.28 581.28 74 430.15 percent of total billed charges 581.28 93 470.84 percent of total billed charges 581.28 581.28 other OPPS APC 581.28 581.28 other OPPS APC 581.28 27.63 160.61 percent of total billed charges 581.28 581.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL AO 4.2X260MM SUP-95-03738 CDM 0272 RC outpatient 539 539 539 74 398.86 percent of total billed charges 539 93 436.59 percent of total billed charges 539 539 other OPPS APC 539 539 other OPPS APC 539 27.63 148.93 percent of total billed charges 539 539 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY EPIDURAL CONT SUP-95-03749 CDM 0272 RC outpatient 699.13 699.13 699.13 74 517.36 percent of total billed charges 699.13 93 566.3 percent of total billed charges 699.13 699.13 other OPPS APC 699.13 699.13 other OPPS APC 699.13 27.63 193.17 percent of total billed charges 699.13 699.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.3 SUP-95-03750 CDM 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 192 other OPPS APC 192 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUFF PROXIMAL 8.00MM CUFFED SUP-95-03753 CDM 0272 RC outpatient 281.4 281.4 281.4 74 208.24 percent of total billed charges 281.4 93 227.93 percent of total billed charges 281.4 281.4 other OPPS APC 281.4 281.4 other OPPS APC 281.4 27.63 77.75 percent of total billed charges 281.4 281.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE NASAL JEJUNAL FEEDING 8FR SUP-95-03780 CDM 0272 RC outpatient 395.5 395.5 395.5 74 292.67 percent of total billed charges 395.5 93 320.36 percent of total billed charges 395.5 395.5 other OPPS APC 395.5 395.5 other OPPS APC 395.5 27.63 109.28 percent of total billed charges 395.5 395.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL SMOOTH SUP-95-03813 CDM 0272 RC outpatient 1050 1050 1050 74 777 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 1050 other OPPS APC 1050 1050 other OPPS APC 1050 27.63 290.12 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILLBIT 1.3 SUP-95-03830 CDM 0272 RC outpatient 464.63 464.63 464.63 74 343.83 percent of total billed charges 464.63 93 376.35 percent of total billed charges 464.63 464.63 other OPPS APC 464.63 464.63 other OPPS APC 464.63 27.63 128.38 percent of total billed charges 464.63 464.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILLBIT 1.6 SUP-95-03831 CDM 0272 RC outpatient 464.63 464.63 464.63 74 343.83 percent of total billed charges 464.63 93 376.35 percent of total billed charges 464.63 464.63 other OPPS APC 464.63 464.63 other OPPS APC 464.63 27.63 128.38 percent of total billed charges 464.63 464.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE VIZISHOT 19G SUP-95-03847 CDM 0272 RC outpatient 924 924 924 74 683.76 percent of total billed charges 924 93 748.44 percent of total billed charges 924 924 other OPPS APC 924 924 other OPPS APC 924 27.63 255.3 percent of total billed charges 924 924 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OBTURATOR 3MM SUP-95-03857 CDM 0272 RC outpatient 647.92 647.92 647.92 74 479.46 percent of total billed charges 647.92 93 524.82 percent of total billed charges 647.92 647.92 other OPPS APC 647.92 647.92 other OPPS APC 647.92 27.63 179.02 percent of total billed charges 647.92 647.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA OUTFLOW 3MM SUP-95-03858 CDM 0272 RC outpatient 1329.12 1329.12 1329.12 74 983.55 percent of total billed charges 1329.12 93 1076.59 percent of total billed charges 1329.12 1329.12 other OPPS APC 1329.12 1329.12 other OPPS APC 1329.12 27.63 367.24 percent of total billed charges 1329.12 1329.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STIENT EVOLTION COLONIC SUP-95-03861 CDM C2625 HCPCS 0278 RC outpatient 5005 5005 5005 57 2852.85 percent of total billed charges 5005 93 4054.05 percent of total billed charges 5005 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5005 other OPPS APC 5005 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5005 other OPPS APC 5005 51 2552.55 percent of total billed charges 5005 5005 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPIKE TRANSOFIX TRANSFER VENTED DOUBLE SUP-95-03863 CDM 0272 RC outpatient 1.43 1.43 1.43 74 1.06 percent of total billed charges 1.43 93 1.16 percent of total billed charges 1.43 1.43 other OPPS APC 1.43 1.43 other OPPS APC 1.43 27.63 0.4 percent of total billed charges 1.43 1.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GONIOMETER STANDARD SUP-95-03889 CDM 0272 RC outpatient 63.16 63.16 63.16 74 46.74 percent of total billed charges 63.16 93 51.16 percent of total billed charges 63.16 63.16 other OPPS APC 63.16 63.16 other OPPS APC 63.16 27.63 17.45 percent of total billed charges 63.16 63.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VARI-STIM III SUP-95-03914 CDM 0272 RC outpatient 298.2 298.2 298.2 74 220.67 percent of total billed charges 298.2 93 241.54 percent of total billed charges 298.2 298.2 other OPPS APC 298.2 298.2 other OPPS APC 298.2 27.63 82.39 percent of total billed charges 298.2 298.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPRING -WIRE GUIDE SUP-95-03930 CDM 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 825 other OPPS APC 825 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE PROLENE 2-0 8423H SUP-95-03931 CDM 0272 RC outpatient 2.22 2.22 2.22 74 1.64 percent of total billed charges 2.22 93 1.8 percent of total billed charges 2.22 2.22 other OPPS APC 2.22 2.22 other OPPS APC 2.22 27.63 0.61 percent of total billed charges 2.22 2.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE SMOOTH 2.3 FLOURO BAND SUP-95-03940 CDM C1713 HCPCS 0278 RC outpatient 280 280 280 57 159.6 percent of total billed charges 280 93 226.8 percent of total billed charges 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 51 142.8 percent of total billed charges 280 280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE 2.0MMX240MM SUP-95-03941 CDM 0272 RC outpatient 129.8 129.8 129.8 74 96.05 percent of total billed charges 129.8 93 105.14 percent of total billed charges 129.8 129.8 other OPPS APC 129.8 129.8 other OPPS APC 129.8 27.63 35.86 percent of total billed charges 129.8 129.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED DRILL BIT 4.5MM SUP-95-03942 CDM 0272 RC outpatient 1018.05 1018.05 1018.05 74 753.36 percent of total billed charges 1018.05 93 824.62 percent of total billed charges 1018.05 1018.05 other OPPS APC 1018.05 1018.05 other OPPS APC 1018.05 27.63 281.29 percent of total billed charges 1018.05 1018.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP T25 STRDRV OMM EXHUMERAJ NAIL SUP-95-03943 CDM C1713 HCPCS 0278 RC outpatient 462 462 462 57 263.34 percent of total billed charges 462 93 374.22 percent of total billed charges 462 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 462 other OPPS APC 462 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 462 other OPPS APC 462 51 235.62 percent of total billed charges 462 462 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE PROLENE 2-0 8523H SUP-95-03962 CDM 0272 RC outpatient 21.27 21.27 21.27 74 15.74 percent of total billed charges 21.27 93 17.23 percent of total billed charges 21.27 21.27 other OPPS APC 21.27 21.27 other OPPS APC 21.27 27.63 5.88 percent of total billed charges 21.27 21.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRIMATRIX FENESTRATED 4X4 SUP-95-03970 CDM Q4110 HCPCS 0636 RC outpatient 2850.39 2850.39 48.93 48.93 fee schedule 2850.39 93 2308.82 percent of total billed charges 2850.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850.39 other OPPS APC 2850.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850.39 other OPPS APC 2850.39 24.86 708.61 percent of total billed charges 48.93 2850.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXRACTION SYSTEM CONTAINED ALEXIS SUP-95-03972 CDM 0272 RC outpatient 1125 1125 1125 74 832.5 percent of total billed charges 1125 93 911.25 percent of total billed charges 1125 1125 other OPPS APC 1125 1125 other OPPS APC 1125 27.63 310.84 percent of total billed charges 1125 1125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE DISTAL LATERAL FIBULA 6 HOLE SUP-95-03981 CDM C1713 HCPCS 0278 RC outpatient 1324.98 1324.98 1324.98 57 755.24 percent of total billed charges 1324.98 93 1073.23 percent of total billed charges 1324.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1324.98 other OPPS APC 1324.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1324.98 other OPPS APC 1324.98 51 675.74 percent of total billed charges 1324.98 1324.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CS INSERT SZ4 16MM SUP-95-04004 CDM C1776 HCPCS 0278 RC outpatient 313.78 313.78 313.78 57 178.85 percent of total billed charges 313.78 93 254.16 percent of total billed charges 313.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.78 other OPPS APC 313.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.78 other OPPS APC 313.78 51 160.03 percent of total billed charges 313.78 313.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CS INSERT SZ4 19MM SUP-95-04005 CDM C1776 HCPCS 0278 RC outpatient 313.78 313.78 313.78 57 178.85 percent of total billed charges 313.78 93 254.16 percent of total billed charges 313.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.78 other OPPS APC 313.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.78 other OPPS APC 313.78 51 160.03 percent of total billed charges 313.78 313.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP 5 HOLE PIN SUP-95-04006 CDM C1713 HCPCS 0278 RC outpatient 1616.4 1616.4 1616.4 57 921.35 percent of total billed charges 1616.4 93 1309.28 percent of total billed charges 1616.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1616.4 other OPPS APC 1616.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1616.4 other OPPS APC 1616.4 51 824.36 percent of total billed charges 1616.4 1616.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE WW/LENGTH MARKINGS 1.143MM SUP-95-04007 CDM C1713 HCPCS 0278 RC outpatient 705 705 705 57 401.85 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 51 359.55 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CS INSERT SZ3 9MM SUP-95-04008 CDM C1776 HCPCS 0278 RC outpatient 313.78 313.78 313.78 57 178.85 percent of total billed charges 313.78 93 254.16 percent of total billed charges 313.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.78 other OPPS APC 313.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.78 other OPPS APC 313.78 51 160.03 percent of total billed charges 313.78 313.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TWIST DRILL 9/64 SUP-95-04010 CDM outpatient 308.74 308.74 308.74 308.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.3X25MM SUP-95-04011 CDM 0272 RC outpatient 448 448 448 74 331.52 percent of total billed charges 448 93 362.88 percent of total billed charges 448 448 other OPPS APC 448 448 other OPPS APC 448 27.63 123.78 percent of total billed charges 448 448 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SKIN STAPLER 35W ROTATOR SUP-95-04023 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL SPACER 5MM SUP-95-04024 CDM C1776 HCPCS 0278 RC outpatient 762.3 762.3 762.3 57 434.51 percent of total billed charges 762.3 93 617.46 percent of total billed charges 762.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 762.3 other OPPS APC 762.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 762.3 other OPPS APC 762.3 51 388.77 percent of total billed charges 762.3 762.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL SPACER 15MM SUP-95-04025 CDM C1776 HCPCS 0278 RC outpatient 828.3 828.3 828.3 57 472.13 percent of total billed charges 828.3 93 670.92 percent of total billed charges 828.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 828.3 other OPPS APC 828.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 828.3 other OPPS APC 828.3 51 422.43 percent of total billed charges 828.3 828.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PADDLE TIP TROCAR SUP-95-04026 CDM outpatient 1104.48 1104.48 1104.48 1104.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOD HALF PIN 4X120 40 CONT THR SUP-95-04030 CDM C1713 HCPCS 0278 RC outpatient 379.68 379.68 379.68 57 216.42 percent of total billed charges 379.68 93 307.54 percent of total billed charges 379.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 379.68 other OPPS APC 379.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 379.68 other OPPS APC 379.68 51 193.64 percent of total billed charges 379.68 379.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHUCK FOR PINS HOFFMANN SUP-95-04031 CDM 0272 RC outpatient 1434.24 1434.24 1434.24 74 1061.34 percent of total billed charges 1434.24 93 1161.73 percent of total billed charges 1434.24 1434.24 other OPPS APC 1434.24 1434.24 other OPPS APC 1434.24 27.63 396.28 percent of total billed charges 1434.24 1434.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SELF-DRILLING HALF PIN APEX SUP-95-04032 CDM C1713 HCPCS 0278 RC outpatient 492.24 492.24 492.24 57 280.58 percent of total billed charges 492.24 93 398.71 percent of total billed charges 492.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 492.24 other OPPS APC 492.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 492.24 other OPPS APC 492.24 51 251.04 percent of total billed charges 492.24 492.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SELF-DRILLING HALF PIN APEX 3/5 120X20 SUP-95-04033 CDM C1713 HCPCS 0278 RC outpatient 492.24 492.24 492.24 57 280.58 percent of total billed charges 492.24 93 398.71 percent of total billed charges 492.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 492.24 other OPPS APC 492.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 492.24 other OPPS APC 492.24 51 251.04 percent of total billed charges 492.24 492.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INJECTOR FORCE MAX 3MM SUP-95-04037 CDM 0272 RC outpatient 102 102 102 74 75.48 percent of total billed charges 102 93 82.62 percent of total billed charges 102 102 other OPPS APC 102 102 other OPPS APC 102 27.63 28.18 percent of total billed charges 102 102 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRIMATRIX MASHED 5X5CM SUP-95-04038 CDM Q4110 HCPCS 0636 RC outpatient 3000 3000 48.93 48.93 fee schedule 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 24.86 745.8 percent of total billed charges 48.93 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALL POLY PATELLA DRLL W/STOP SUP-95-04039 CDM outpatient 808.5 808.5 808.5 808.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE MONOCRYL 3-0 Y936H SUP-95-04044 CDM 0272 RC outpatient 22.52 22.52 22.52 74 16.66 percent of total billed charges 22.52 93 18.24 percent of total billed charges 22.52 22.52 other OPPS APC 22.52 22.52 other OPPS APC 22.52 27.63 6.22 percent of total billed charges 22.52 22.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEM/TIB NAIL REAMING ROD W BAL SUP-95-04057 CDM 0272 RC outpatient 596.68 596.68 596.68 74 441.54 percent of total billed charges 596.68 93 483.31 percent of total billed charges 596.68 596.68 other OPPS APC 596.68 596.68 other OPPS APC 596.68 27.63 164.86 percent of total billed charges 596.68 596.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL LONG CANNUATED 4.6X340MM SUP-95-04058 CDM 0272 RC outpatient 280 280 280 74 207.2 percent of total billed charges 280 93 226.8 percent of total billed charges 280 280 other OPPS APC 280 280 other OPPS APC 280 27.63 77.36 percent of total billed charges 280 280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL STANDARD CANNUATED 4.6X250MM SUP-95-04059 CDM 0272 RC outpatient 1042.5 1042.5 1042.5 74 771.45 percent of total billed charges 1042.5 93 844.43 percent of total billed charges 1042.5 1042.5 other OPPS APC 1042.5 1042.5 other OPPS APC 1042.5 27.63 288.04 percent of total billed charges 1042.5 1042.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL GUIDE 1.8 SUP-95-04063 CDM 0272 RC outpatient 1506.84 1506.84 1506.84 74 1115.06 percent of total billed charges 1506.84 93 1220.54 percent of total billed charges 1506.84 1506.84 other OPPS APC 1506.84 1506.84 other OPPS APC 1506.84 27.63 416.34 percent of total billed charges 1506.84 1506.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 14FR NEPHROSTOMY TUBE SUP-95-04066 CDM C1729 HCPCS 0272 RC outpatient 343.49 343.49 343.49 74 254.18 percent of total billed charges 343.49 93 278.23 percent of total billed charges 343.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 343.49 other OPPS APC 343.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 343.49 other OPPS APC 343.49 27.63 94.91 percent of total billed charges 343.49 343.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED 6.5MM 4.9 DIA TWIST DRILL SUP-95-04068 CDM 0272 RC outpatient 810.9 810.9 810.9 74 600.07 percent of total billed charges 810.9 93 656.83 percent of total billed charges 810.9 810.9 other OPPS APC 810.9 810.9 other OPPS APC 810.9 27.63 224.05 percent of total billed charges 810.9 810.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIRSCHNER WIRE W/15MM SUP-95-04070 CDM C1713 HCPCS 0278 RC outpatient 630.28 630.28 630.28 57 359.26 percent of total billed charges 630.28 93 510.53 percent of total billed charges 630.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630.28 other OPPS APC 630.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630.28 other OPPS APC 630.28 51 321.44 percent of total billed charges 630.28 630.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.2MM/L145MM SUP-95-04075 CDM 0272 RC outpatient 532.7 532.7 532.7 74 394.2 percent of total billed charges 532.7 93 431.49 percent of total billed charges 532.7 532.7 other OPPS APC 532.7 532.7 other OPPS APC 532.7 27.63 147.19 percent of total billed charges 532.7 532.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED DRILL 6.5MM LG AO FITTING SUP-95-04076 CDM 0272 RC outpatient 1352.16 1352.16 1352.16 74 1000.6 percent of total billed charges 1352.16 93 1095.25 percent of total billed charges 1352.16 1352.16 other OPPS APC 1352.16 1352.16 other OPPS APC 1352.16 27.63 373.6 percent of total billed charges 1352.16 1352.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OMEGA PLUS 2.8MM THREADED TIP GUIDE PIN SUP-95-04077 CDM C1713 HCPCS 0272 RC outpatient 178.56 178.56 178.56 74 132.13 percent of total billed charges 178.56 93 144.63 percent of total billed charges 178.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 178.56 other OPPS APC 178.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 178.56 other OPPS APC 178.56 27.63 49.34 percent of total billed charges 178.56 178.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON (FOR ULTRASONIC ENDOSCOPE) SUP-95-04085 CDM C1726 HCPCS 0272 RC outpatient 112.4 112.4 112.4 74 83.18 percent of total billed charges 112.4 93 91.04 percent of total billed charges 112.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.4 other OPPS APC 112.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.4 other OPPS APC 112.4 27.63 31.06 percent of total billed charges 112.4 112.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SINGLE USE ASPIRATION NEEDLE 21G SUP-95-04086 CDM 0272 RC outpatient 1650 1650 1650 74 1221 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 1650 other OPPS APC 1650 1650 other OPPS APC 1650 27.63 455.9 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CURETTE 7MM CURVED CANNULA SUP-95-04090 CDM 0272 RC outpatient 147 147 147 74 108.78 percent of total billed charges 147 93 119.07 percent of total billed charges 147 147 other OPPS APC 147 147 other OPPS APC 147 27.63 40.62 percent of total billed charges 147 147 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CURETTE 8MM CURVED CANNULA SUP-95-04091 CDM 0272 RC outpatient 21.81 21.81 21.81 74 16.14 percent of total billed charges 21.81 93 17.67 percent of total billed charges 21.81 21.81 other OPPS APC 21.81 21.81 other OPPS APC 21.81 27.63 6.03 percent of total billed charges 21.81 21.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAKRI BALLOON SUP-95-04101 CDM 0272 RC outpatient 747 747 747 74 552.78 percent of total billed charges 747 93 605.07 percent of total billed charges 747 747 other OPPS APC 747 747 other OPPS APC 747 27.63 206.4 percent of total billed charges 747 747 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METAL-BACKED PATELLA DRILL W/STOP SUP-95-04103 CDM C1776 HCPCS 0278 RC outpatient 866.25 866.25 866.25 57 493.76 percent of total billed charges 866.25 93 701.66 percent of total billed charges 866.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 866.25 other OPPS APC 866.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 866.25 other OPPS APC 866.25 51 441.79 percent of total billed charges 866.25 866.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERTAK RC DISPOSABLES KIT SUP-95-04112 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.5MM CANNULATED SUP-95-04113 CDM outpatient 612.5 612.5 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUTOLOGOUS TISSUE COLLECTOR SUP-95-04114 CDM 0272 RC outpatient 1650 1650 1650 74 1221 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 1650 other OPPS APC 1650 1650 other OPPS APC 1650 27.63 455.9 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IRRISEPT SUP-95-04115 CDM 0272 RC outpatient 229.78 229.78 229.78 74 170.04 percent of total billed charges 229.78 93 186.12 percent of total billed charges 229.78 229.78 other OPPS APC 229.78 229.78 other OPPS APC 229.78 27.63 63.49 percent of total billed charges 229.78 229.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANN 3.5MM DIA. TWIST DRILL SUP-95-04117 CDM 0272 RC outpatient 813.6 813.6 813.6 74 602.06 percent of total billed charges 813.6 93 659.02 percent of total billed charges 813.6 813.6 other OPPS APC 813.6 813.6 other OPPS APC 813.6 27.63 224.8 percent of total billed charges 813.6 813.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CS INSERT SZ4 5MM SUP-95-04140 CDM C1776 HCPCS 0278 RC outpatient 313.78 313.78 313.78 57 178.85 percent of total billed charges 313.78 93 254.16 percent of total billed charges 313.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.78 other OPPS APC 313.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.78 other OPPS APC 313.78 51 160.03 percent of total billed charges 313.78 313.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER STRAIGHT HANDLE SUP-95-04143 CDM outpatient 2364.45 2364.45 2364.45 2364.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 12X20CATH KIT LG BORE MULTI-LUMEN X1A SUP-95-04144 CDM 0272 RC outpatient 1340.19 1340.19 1340.19 74 991.74 percent of total billed charges 1340.19 93 1085.55 percent of total billed charges 1340.19 1340.19 other OPPS APC 1340.19 1340.19 other OPPS APC 1340.19 27.63 370.29 percent of total billed charges 1340.19 1340.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PESSARY DOUNT 2-3/4IN #3 SUP-95-04145 CDM A4562 HCPCS 0272 RC outpatient 217 217 217 74 160.58 percent of total billed charges 217 93 175.77 percent of total billed charges 217 217 other OPPS APC 217 217 other OPPS APC 217 27.63 59.96 percent of total billed charges 217 217 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PESSARY DOUNT 3IN #4 SUP-95-04146 CDM A4562 HCPCS 0272 RC outpatient 217 217 217 74 160.58 percent of total billed charges 217 93 175.77 percent of total billed charges 217 217 other OPPS APC 217 217 other OPPS APC 217 27.63 59.96 percent of total billed charges 217 217 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PESSARY DOUNT 3-1/4IN #5 SUP-95-04147 CDM A4562 HCPCS 0272 RC outpatient 217 217 217 74 160.58 percent of total billed charges 217 93 175.77 percent of total billed charges 217 217 other OPPS APC 217 217 other OPPS APC 217 27.63 59.96 percent of total billed charges 217 217 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PESSARY DOUNT 3-1/2IN #6 SUP-95-04148 CDM A4562 HCPCS 0272 RC outpatient 217 217 217 74 160.58 percent of total billed charges 217 93 175.77 percent of total billed charges 217 217 other OPPS APC 217 217 other OPPS APC 217 27.63 59.96 percent of total billed charges 217 217 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLON DILATION GUIDED WIRE 3STAGE 8/10 SUP-95-04159 CDM C1726 HCPCS 0272 RC outpatient 665 665 665 74 492.1 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 27.63 183.74 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLON DILATION GUIDED WIRE 3STAGE 10/12 SUP-95-04160 CDM C1726 HCPCS 0272 RC outpatient 665 665 665 74 492.1 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 27.63 183.74 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEP STONE GRASPING 5FR X 60CM SUP-95-04162 CDM 0272 RC outpatient 2324.79 2324.79 2324.79 74 1720.34 percent of total billed charges 2324.79 93 1883.08 percent of total billed charges 2324.79 2324.79 other OPPS APC 2324.79 2324.79 other OPPS APC 2324.79 27.63 642.34 percent of total billed charges 2324.79 2324.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIDESCOPE COVER LOPRO S1 SUP-95-04163 CDM 0272 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIDESCOPE COVER LOPRO S2 SUP-95-04164 CDM 0272 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE BALLOON SUP-95-04171 CDM C1726 HCPCS 0272 RC outpatient 665 665 665 74 492.1 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 27.63 183.74 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DRILL BIT, 1.5MM (.059)" SUP-95-04173 CDM 0272 RC outpatient 676.2 676.2 676.2 74 500.39 percent of total billed charges 676.2 93 547.72 percent of total billed charges 676.2 676.2 other OPPS APC 676.2 676.2 other OPPS APC 676.2 27.63 186.83 percent of total billed charges 676.2 676.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT AO 4.2 X 180MM SUP-95-04181 CDM 0272 RC outpatient 601.44 601.44 601.44 74 445.07 percent of total billed charges 601.44 93 487.17 percent of total billed charges 601.44 601.44 other OPPS APC 601.44 601.44 other OPPS APC 601.44 27.63 166.18 percent of total billed charges 601.44 601.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHORAGE 1.2MM X 70MM GUIDE WIRE SUP-95-04183 CDM C1713 HCPCS 0278 RC outpatient 126.72 126.72 126.72 57 72.23 percent of total billed charges 126.72 93 102.64 percent of total billed charges 126.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 126.72 other OPPS APC 126.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 126.72 other OPPS APC 126.72 51 64.63 percent of total billed charges 126.72 126.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHORAGE 1.6MM X 100MM GUIDE WIRE SUP-95-04184 CDM C1713 HCPCS 0278 RC outpatient 126.72 126.72 126.72 57 72.23 percent of total billed charges 126.72 93 102.64 percent of total billed charges 126.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 126.72 other OPPS APC 126.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 126.72 other OPPS APC 126.72 51 64.63 percent of total billed charges 126.72 126.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALIBRATED REAMER 2.0 MM X 110 MM SUP-95-04185 CDM 0272 RC outpatient 567.84 567.84 567.84 74 420.2 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 567.84 other OPPS APC 567.84 567.84 other OPPS APC 567.84 27.63 156.89 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT SUP-95-04189 CDM outpatient 654.5 654.5 654.5 654.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT SUP-95-04190 CDM outpatient 654.5 654.5 654.5 654.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LARGE BONE OSCILLATING SAW BLADE SUP-95-04191 CDM 0272 RC outpatient 196 196 196 74 145.04 percent of total billed charges 196 93 158.76 percent of total billed charges 196 196 other OPPS APC 196 196 other OPPS APC 196 27.63 54.15 percent of total billed charges 196 196 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLEMASTER 3MMX 26G SUP-95-04194 CDM 0272 RC outpatient 729.12 729.12 729.12 74 539.55 percent of total billed charges 729.12 93 590.59 percent of total billed charges 729.12 729.12 other OPPS APC 729.12 729.12 other OPPS APC 729.12 27.63 201.46 percent of total billed charges 729.12 729.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DUAL KNIFE J LOWER LENGTH SUP-95-04195 CDM 0272 RC outpatient 2763 2763 2763 74 2044.62 percent of total billed charges 2763 93 2238.03 percent of total billed charges 2763 2763 other OPPS APC 2763 2763 other OPPS APC 2763 27.63 763.42 percent of total billed charges 2763 2763 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACCESSORY PORT TUBE W/ SALINE SPIKE SUP-95-04196 CDM 0272 RC outpatient 1050 1050 1050 74 777 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 1050 other OPPS APC 1050 1050 other OPPS APC 1050 27.63 290.12 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "KNIFE NANO, 230CM" SUP-95-04197 CDM 0272 RC outpatient 1736.43 1736.43 1736.43 74 1284.96 percent of total billed charges 1736.43 93 1406.51 percent of total billed charges 1736.43 1736.43 other OPPS APC 1736.43 1736.43 other OPPS APC 1736.43 27.63 479.78 percent of total billed charges 1736.43 1736.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COAGRASPER - MONOPOLAR HEMO SUP-95-04198 CDM 0272 RC outpatient 741.93 741.93 741.93 74 549.03 percent of total billed charges 741.93 93 600.96 percent of total billed charges 741.93 741.93 other OPPS APC 741.93 741.93 other OPPS APC 741.93 27.63 205 percent of total billed charges 741.93 741.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE PROLENE 3-0 8842H SUP-95-04201 CDM 0272 RC outpatient 22.08 22.08 22.08 74 16.34 percent of total billed charges 22.08 93 17.88 percent of total billed charges 22.08 22.08 other OPPS APC 22.08 22.08 other OPPS APC 22.08 27.63 6.1 percent of total billed charges 22.08 22.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE 60CC LL COVIDIEN SUP-95-04202 CDM 0272 RC outpatient 59.88 59.88 59.88 74 44.31 percent of total billed charges 59.88 93 48.5 percent of total billed charges 59.88 59.88 other OPPS APC 59.88 59.88 other OPPS APC 59.88 27.63 16.54 percent of total billed charges 59.88 59.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SB-KNIFE JR 2.30 SUP-95-04205 CDM 0272 RC outpatient 2652 2652 2652 74 1962.48 percent of total billed charges 2652 93 2148.12 percent of total billed charges 2652 2652 other OPPS APC 2652 2652 other OPPS APC 2652 27.63 732.75 percent of total billed charges 2652 2652 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OVERSTITCH ENDO SUTURING SYSTEM SUP-95-04207 CDM 0272 RC outpatient 7992.5 7992.5 7992.5 74 5914.45 percent of total billed charges 7992.5 93 6473.93 percent of total billed charges 7992.5 7992.5 other OPPS APC 7992.5 7992.5 other OPPS APC 7992.5 27.63 2208.33 percent of total billed charges 7992.5 7992.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE OVERSTITCH 2-0 POLYPROPYLENE SUP-95-04208 CDM 0272 RC outpatient 366.49 366.49 366.49 74 271.2 percent of total billed charges 366.49 93 296.86 percent of total billed charges 366.49 366.49 other OPPS APC 366.49 366.49 other OPPS APC 366.49 27.63 101.26 percent of total billed charges 366.49 366.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE OVERSTITCH 2-0 POLYDIOXANONE ABSORBABLE SUP-95-04209 CDM 0272 RC outpatient 303.63 303.63 303.63 74 224.69 percent of total billed charges 303.63 93 245.94 percent of total billed charges 303.63 303.63 other OPPS APC 303.63 303.63 other OPPS APC 303.63 27.63 83.89 percent of total billed charges 303.63 303.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE OVERSTITCH CINCH SUP-95-04210 CDM 0272 RC outpatient 1701 1701 1701 74 1258.74 percent of total billed charges 1701 93 1377.81 percent of total billed charges 1701 1701 other OPPS APC 1701 1701 other OPPS APC 1701 27.63 469.99 percent of total billed charges 1701 1701 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OVERSTITCH TISSUE HELIX SUP-95-04211 CDM 0272 RC outpatient 3445 3445 3445 74 2549.3 percent of total billed charges 3445 93 2790.45 percent of total billed charges 3445 3445 other OPPS APC 3445 3445 other OPPS APC 3445 27.63 951.85 percent of total billed charges 3445 3445 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OVERTUBE ENDO ACCESS SYSTEM SUP-95-04212 CDM 0272 RC outpatient 1785 1785 1785 74 1320.9 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 27.63 493.2 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENSIZOR ENDO SCISSOR 235CM SUP-95-04213 CDM 0272 RC outpatient 2871 2871 2871 74 2124.54 percent of total billed charges 2871 93 2325.51 percent of total billed charges 2871 2871 other OPPS APC 2871 2871 other OPPS APC 2871 27.63 793.26 percent of total billed charges 2871 2871 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANISTERS PREVENA 45ML SUP-95-04225 CDM 0272 RC outpatient 97.39 97.39 97.39 74 72.07 percent of total billed charges 97.39 93 78.89 percent of total billed charges 97.39 97.39 other OPPS APC 97.39 97.39 other OPPS APC 97.39 27.63 26.91 percent of total billed charges 97.39 97.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LMA GASTRO AIRWAY SIZE 3 SUP-95-04226 CDM 0272 RC outpatient 140 140 140 74 103.6 percent of total billed charges 140 93 113.4 percent of total billed charges 140 140 other OPPS APC 140 140 other OPPS APC 140 27.63 38.68 percent of total billed charges 140 140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LMA GASTRO AIRWAY SIZE 4 SUP-95-04227 CDM 0272 RC outpatient 140 140 140 74 103.6 percent of total billed charges 140 93 113.4 percent of total billed charges 140 140 other OPPS APC 140 140 other OPPS APC 140 27.63 38.68 percent of total billed charges 140 140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LMA GASTRO AIRWAY SIZE 5 SUP-95-04228 CDM 0272 RC outpatient 140 140 140 74 103.6 percent of total billed charges 140 93 113.4 percent of total billed charges 140 140 other OPPS APC 140 140 other OPPS APC 140 27.63 38.68 percent of total billed charges 140 140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING OASIS ULTRA TRI-LAYER 3 X 7CM SUP-95-04237 CDM Q4102 HCPCS 0636 RC outpatient 857.67 857.67 14.64 14.64 fee schedule 857.67 93 694.71 percent of total billed charges 857.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 857.67 other OPPS APC 857.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 857.67 other OPPS APC 857.67 24.86 213.22 percent of total billed charges 14.64 857.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT COMPLETE OPENING SUP-95-04252 CDM 0272 RC outpatient 4125 4125 4125 74 3052.5 percent of total billed charges 4125 93 3341.25 percent of total billed charges 4125 4125 other OPPS APC 4125 4125 other OPPS APC 4125 27.63 1139.74 percent of total billed charges 4125 4125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 4.3MM X 413MM SUP-95-04253 CDM 0272 RC outpatient 1305 1305 1305 74 965.7 percent of total billed charges 1305 93 1057.05 percent of total billed charges 1305 1305 other OPPS APC 1305 1305 other OPPS APC 1305 27.63 360.57 percent of total billed charges 1305 1305 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAG SAW SUP-95-04255 CDM 0272 RC outpatient 205.21 205.21 205.21 74 151.86 percent of total billed charges 205.21 93 166.22 percent of total billed charges 205.21 205.21 other OPPS APC 205.21 205.21 other OPPS APC 205.21 27.63 56.7 percent of total billed charges 205.21 205.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DISPOSABLE INSTRUMENT SUP-95-04275 CDM 0272 RC outpatient 885 885 885 74 654.9 percent of total billed charges 885 93 716.85 percent of total billed charges 885 885 other OPPS APC 885 885 other OPPS APC 885 27.63 244.53 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NASAL MUCOSAL ATOMIZATION (MAD) SUP-95-04279 CDM 0272 RC outpatient 554.72 554.72 554.72 74 410.49 percent of total billed charges 554.72 93 449.32 percent of total billed charges 554.72 554.72 other OPPS APC 554.72 554.72 other OPPS APC 554.72 27.63 153.27 percent of total billed charges 554.72 554.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK ASNIS 3MM CANN 3.8MM AO COUP SUP-95-04283 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAG SAW SYSTEM 6 SUP-95-04287 CDM 0272 RC outpatient 193.13 193.13 193.13 74 142.92 percent of total billed charges 193.13 93 156.44 percent of total billed charges 193.13 193.13 other OPPS APC 193.13 193.13 other OPPS APC 193.13 27.63 53.36 percent of total billed charges 193.13 193.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAG SAW 20.7 X .88 X .85 SUP-95-04288 CDM 0272 RC outpatient 123.6 123.6 123.6 74 91.46 percent of total billed charges 123.6 93 100.12 percent of total billed charges 123.6 123.6 other OPPS APC 123.6 123.6 other OPPS APC 123.6 27.63 34.15 percent of total billed charges 123.6 123.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER ACETABULAR 51MM SUP-95-04293 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER ECHELON ARTICULATING 45 X 340 SUP-95-04294 CDM 0272 RC outpatient 871.86 871.86 871.86 74 645.18 percent of total billed charges 871.86 93 706.21 percent of total billed charges 871.86 871.86 other OPPS APC 871.86 871.86 other OPPS APC 871.86 27.63 240.89 percent of total billed charges 871.86 871.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN ABRAMSON TRIPLE LUMEN SUMP SUP-95-04301 CDM 0272 RC outpatient 121.04 121.04 121.04 74 89.57 percent of total billed charges 121.04 93 98.04 percent of total billed charges 121.04 121.04 other OPPS APC 121.04 121.04 other OPPS APC 121.04 27.63 33.44 percent of total billed charges 121.04 121.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POOLE SUCTION 5MM SUP-95-04306 CDM 0272 RC outpatient 353.43 353.43 353.43 74 261.54 percent of total billed charges 353.43 93 286.28 percent of total billed charges 353.43 353.43 other OPPS APC 353.43 353.43 other OPPS APC 353.43 27.63 97.65 percent of total billed charges 353.43 353.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIX COMPRES 7HOLE X 91MM LCKNG SUP-95-04311 CDM C1713 HCPCS 0278 RC outpatient 1321.32 1321.32 1321.32 57 753.15 percent of total billed charges 1321.32 93 1070.27 percent of total billed charges 1321.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1321.32 other OPPS APC 1321.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1321.32 other OPPS APC 1321.32 51 673.87 percent of total billed charges 1321.32 1321.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNIFE ANGLED TAPERED CRESCENT SUP-95-04313 CDM 0272 RC outpatient 53.33 53.33 53.33 74 39.46 percent of total billed charges 53.33 93 43.2 percent of total billed charges 53.33 53.33 other OPPS APC 53.33 53.33 other OPPS APC 53.33 27.63 14.74 percent of total billed charges 53.33 53.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYPERFLEX TRACH TUBE SZ-6 SUP-95-04339 CDM 0272 RC outpatient 665.56 665.56 665.56 74 492.51 percent of total billed charges 665.56 93 539.1 percent of total billed charges 665.56 665.56 other OPPS APC 665.56 665.56 other OPPS APC 665.56 27.63 183.89 percent of total billed charges 665.56 665.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING TEGADERM HYDROCOLLOID 4X4 SUP-95-04349 CDM 0272 RC outpatient 29.72 29.72 29.72 74 21.99 percent of total billed charges 29.72 93 24.07 percent of total billed charges 29.72 29.72 other OPPS APC 29.72 29.72 other OPPS APC 29.72 27.63 8.21 percent of total billed charges 29.72 29.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 12X16 CATH KIT LG BORE MULTILUMEN (SUB) SUP-95-04351 CDM 0272 RC outpatient 321.3 321.3 321.3 74 237.76 percent of total billed charges 321.3 93 260.25 percent of total billed charges 321.3 321.3 other OPPS APC 321.3 321.3 other OPPS APC 321.3 27.63 88.78 percent of total billed charges 321.3 321.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OATS KIT 6MM SUP-95-04416 CDM C1713 HCPCS 0278 RC outpatient 1950 1950 1950 57 1111.5 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 51 994.5 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLING OBTRYX II HALO SUP-95-04458 CDM C1781 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INVRAD GUIDEWIRE - .018X80CM SUP-95-04468 CDM C1769 HCPCS 0272 RC outpatient 116.8 116.8 116.8 74 86.43 percent of total billed charges 116.8 93 94.61 percent of total billed charges 116.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 116.8 other OPPS APC 116.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 116.8 other OPPS APC 116.8 27.63 32.27 percent of total billed charges 116.8 116.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE CHROMIC 0 47T SUP-95-04469 CDM 0272 RC outpatient 35.8 35.8 35.8 74 26.49 percent of total billed charges 35.8 93 29 percent of total billed charges 35.8 35.8 other OPPS APC 35.8 35.8 other OPPS APC 35.8 27.63 9.89 percent of total billed charges 35.8 35.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VICRYL 3-0 VIOLET J104T SUP-95-04477 CDM 0272 RC outpatient 28.88 28.88 28.88 74 21.37 percent of total billed charges 28.88 93 23.39 percent of total billed charges 28.88 28.88 other OPPS APC 28.88 28.88 other OPPS APC 28.88 27.63 7.98 percent of total billed charges 28.88 28.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT QC 2.8 X 165 SUP-95-04478 CDM 0272 RC outpatient 817.38 817.38 817.38 74 604.86 percent of total billed charges 817.38 93 662.08 percent of total billed charges 817.38 817.38 other OPPS APC 817.38 817.38 other OPPS APC 817.38 27.63 225.84 percent of total billed charges 817.38 817.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 2MM 0.8 X 100 SUP-95-04500 CDM C1713 HCPCS 0278 RC outpatient 148 148 148 57 84.36 percent of total billed charges 148 93 119.88 percent of total billed charges 148 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 148 other OPPS APC 148 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 148 other OPPS APC 148 51 75.48 percent of total billed charges 148 148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 4.0 X 25MM SUP-95-04501 CDM 0272 RC outpatient 465.5 465.5 465.5 74 344.47 percent of total billed charges 465.5 93 377.06 percent of total billed charges 465.5 465.5 other OPPS APC 465.5 465.5 other OPPS APC 465.5 27.63 128.62 percent of total billed charges 465.5 465.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED TAP 2MM SUP-95-04502 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMOCLIP INSTINCT-10 PLUS SUP-95-04519 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILLBIT 2.0 SUP-95-04532 CDM 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 825 other OPPS APC 825 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER 10X15X13 SUP-95-04533 CDM C1713 HCPCS 0278 RC outpatient 2994 2994 2994 57 1706.58 percent of total billed charges 2994 93 2425.14 percent of total billed charges 2994 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2994 other OPPS APC 2994 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2994 other OPPS APC 2994 51 1526.94 percent of total billed charges 2994 2994 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER 12X15X13 SUP-95-04534 CDM C1713 HCPCS 0278 RC outpatient 4875 4875 4875 57 2778.75 percent of total billed charges 4875 93 3948.75 percent of total billed charges 4875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4875 other OPPS APC 4875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4875 other OPPS APC 4875 51 2486.25 percent of total billed charges 4875 4875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PASSPORT BALLOON 12FR X 4CM SUP-95-04535 CDM C1726 HCPCS 0272 RC outpatient 871.77 871.77 871.77 74 645.11 percent of total billed charges 871.77 93 706.13 percent of total billed charges 871.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 871.77 other OPPS APC 871.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 871.77 other OPPS APC 871.77 27.63 240.87 percent of total billed charges 871.77 871.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER 10X10X10 SUP-95-04536 CDM C1713 HCPCS 0278 RC outpatient 4875 4875 4875 57 2778.75 percent of total billed charges 4875 93 3948.75 percent of total billed charges 4875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4875 other OPPS APC 4875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4875 other OPPS APC 4875 51 2486.25 percent of total billed charges 4875 4875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 16F PEEL-AWAY SUP-95-04538 CDM 0272 RC outpatient 420 420 420 74 310.8 percent of total billed charges 420 93 340.2 percent of total billed charges 420 420 other OPPS APC 420 420 other OPPS APC 420 27.63 116.05 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 18F PEEL-AWAY SUP-95-04539 CDM 0272 RC outpatient 420 420 420 74 310.8 percent of total billed charges 420 93 340.2 percent of total billed charges 420 420 other OPPS APC 420 420 other OPPS APC 420 27.63 116.05 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 1.4 LG150 SUP-95-04540 CDM C1713 HCPCS 0278 RC outpatient 132 132 132 57 75.24 percent of total billed charges 132 93 106.92 percent of total billed charges 132 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 132 other OPPS APC 132 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 132 other OPPS APC 132 51 67.32 percent of total billed charges 132 132 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 1.0 X LG150 SUP-95-04541 CDM C1713 HCPCS 0278 RC outpatient 66 66 66 57 37.62 percent of total billed charges 66 93 53.46 percent of total billed charges 66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 66 other OPPS APC 66 66 other OPPS APC 66 51 33.66 percent of total billed charges 66 66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REDUCTION WIRE PCA 3MM SUP-95-04542 CDM 0272 RC outpatient 536.9 536.9 536.9 74 397.31 percent of total billed charges 536.9 93 434.89 percent of total billed charges 536.9 536.9 other OPPS APC 536.9 536.9 other OPPS APC 536.9 27.63 148.35 percent of total billed charges 536.9 536.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REDUCTION WIRE PCA 5MM SUP-95-04543 CDM 0272 RC outpatient 536.9 536.9 536.9 74 397.31 percent of total billed charges 536.9 93 434.89 percent of total billed charges 536.9 536.9 other OPPS APC 536.9 536.9 other OPPS APC 536.9 27.63 148.35 percent of total billed charges 536.9 536.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE SURGICAL BURR LG 13 SUP-95-04544 CDM 0272 RC outpatient 1162.2 1162.2 1162.2 74 860.03 percent of total billed charges 1162.2 93 941.38 percent of total billed charges 1162.2 1162.2 other OPPS APC 1162.2 1162.2 other OPPS APC 1162.2 27.63 321.12 percent of total billed charges 1162.2 1162.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHANNON LONGA SURGICAL BURR LG 22 SUP-95-04545 CDM 0272 RC outpatient 1006.2 1006.2 1006.2 74 744.59 percent of total billed charges 1006.2 93 815.02 percent of total billed charges 1006.2 1006.2 other OPPS APC 1006.2 1006.2 other OPPS APC 1006.2 27.63 278.01 percent of total billed charges 1006.2 1006.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHANNON RECTA SURGICAL BURR LG 12 SUP-95-04546 CDM 0272 RC outpatient 1006.2 1006.2 1006.2 74 744.59 percent of total billed charges 1006.2 93 815.02 percent of total billed charges 1006.2 1006.2 other OPPS APC 1006.2 1006.2 other OPPS APC 1006.2 27.63 278.01 percent of total billed charges 1006.2 1006.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER QUICK STEP 2.0 SUP-95-04547 CDM 0272 RC outpatient 693 693 693 74 512.82 percent of total billed charges 693 93 561.33 percent of total billed charges 693 693 other OPPS APC 693 693 other OPPS APC 693 27.63 191.48 percent of total billed charges 693 693 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER QUICK STEP 3.0 SUP-95-04548 CDM 0272 RC outpatient 693 693 693 74 512.82 percent of total billed charges 693 93 561.33 percent of total billed charges 693 693 other OPPS APC 693 693 other OPPS APC 693 27.63 191.48 percent of total billed charges 693 693 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OLIVE WIRES SUP-95-04549 CDM C1713 HCPCS 0278 RC outpatient 554.4 554.4 554.4 57 316.01 percent of total billed charges 554.4 93 449.06 percent of total billed charges 554.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 554.4 other OPPS APC 554.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 554.4 other OPPS APC 554.4 51 282.74 percent of total billed charges 554.4 554.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT AIRLOCK 02 SUP-95-04550 CDM 0272 RC outpatient 441 441 441 74 326.34 percent of total billed charges 441 93 357.21 percent of total billed charges 441 441 other OPPS APC 441 441 other OPPS APC 441 27.63 121.85 percent of total billed charges 441 441 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ASPIRATION VISI SHOT 21G SUP-95-04609 CDM 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 385 other OPPS APC 385 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON EBUS SUP-95-04610 CDM C1726 HCPCS 0272 RC outpatient 133.08 133.08 133.08 74 98.48 percent of total billed charges 133.08 93 107.79 percent of total billed charges 133.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 133.08 other OPPS APC 133.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 133.08 other OPPS APC 133.08 27.63 36.77 percent of total billed charges 133.08 133.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 2.8 X 200MM SUP-95-04635 CDM 0272 RC outpatient 1 1 1 74 0.74 percent of total billed charges 1 93 0.81 percent of total billed charges 1 1 other OPPS APC 1 1 other OPPS APC 1 27.63 0.28 percent of total billed charges 1 1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5.0 X 100MM SUP-95-04636 CDM C1713 HCPCS 0278 RC outpatient 1 1 1 57 0.57 percent of total billed charges 1 93 0.81 percent of total billed charges 1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1 other OPPS APC 1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1 other OPPS APC 1 51 0.51 percent of total billed charges 1 1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0 X 34MM SUP-95-04637 CDM C1713 HCPCS 0278 RC outpatient 1 1 1 57 0.57 percent of total billed charges 1 93 0.81 percent of total billed charges 1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1 other OPPS APC 1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1 other OPPS APC 1 51 0.51 percent of total billed charges 1 1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0 X 42MM SUP-95-04638 CDM C1713 HCPCS 0278 RC outpatient 1 1 1 57 0.57 percent of total billed charges 1 93 0.81 percent of total billed charges 1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1 other OPPS APC 1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1 other OPPS APC 1 51 0.51 percent of total billed charges 1 1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP INTERUTERINE RUMI II LAVENDAR SUP-95-04643 CDM outpatient 206.93 206.93 206.93 206.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP INTERUTERINE RUMI II BLUE SUP-95-04644 CDM 0272 RC outpatient 206.93 206.93 206.93 74 153.13 percent of total billed charges 206.93 93 167.61 percent of total billed charges 206.93 206.93 other OPPS APC 206.93 206.93 other OPPS APC 206.93 27.63 57.17 percent of total billed charges 206.93 206.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP INTERUTERINE RUMI II GREEN SUP-95-04645 CDM 0272 RC outpatient 206.93 206.93 206.93 74 153.13 percent of total billed charges 206.93 93 167.61 percent of total billed charges 206.93 206.93 other OPPS APC 206.93 206.93 other OPPS APC 206.93 27.63 57.17 percent of total billed charges 206.93 206.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KOH-EFFICIENT 3.0 RUMI II SUP-95-04646 CDM 0272 RC outpatient 423.85 423.85 423.85 74 313.65 percent of total billed charges 423.85 93 343.32 percent of total billed charges 423.85 423.85 other OPPS APC 423.85 423.85 other OPPS APC 423.85 27.63 117.11 percent of total billed charges 423.85 423.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KOH-EFFICIENT 3.5 RUMI II SUP-95-04647 CDM 0272 RC outpatient 424.55 424.55 424.55 74 314.17 percent of total billed charges 424.55 93 343.89 percent of total billed charges 424.55 424.55 other OPPS APC 424.55 424.55 other OPPS APC 424.55 27.63 117.3 percent of total billed charges 424.55 424.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 3.5MM PROFILE BEVELED FT SUP-95-04653 CDM C1713 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIS STERILE BUMP PACK SUP-95-04677 CDM 0272 RC outpatient 2013 2013 2013 74 1489.62 percent of total billed charges 2013 93 1630.53 percent of total billed charges 2013 2013 other OPPS APC 2013 2013 other OPPS APC 2013 27.63 556.19 percent of total billed charges 2013 2013 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOUND PROCESSOR PONTO 5 MINI CHESTNUT BROWN SUP-95-04678 CDM L8690 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MINI MONOKA SUP-95-04680 CDM 0272 RC outpatient 245 245 245 74 181.3 percent of total billed charges 245 93 198.45 percent of total billed charges 245 245 other OPPS APC 245 245 other OPPS APC 245 27.63 67.69 percent of total billed charges 245 245 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.6MM SUP-95-04681 CDM 0272 RC outpatient 420 420 420 74 310.8 percent of total billed charges 420 93 340.2 percent of total billed charges 420 420 other OPPS APC 420 420 other OPPS APC 420 27.63 116.05 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILUMEN ENDOLUMENAL INTERVENTIONAL PLATFORM 103CM SUP-95-04683 CDM 0272 RC outpatient 3750 3750 3750 74 2775 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 3750 other OPPS APC 3750 3750 other OPPS APC 3750 27.63 1036.13 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLS AIMING GUIDES SUP-95-04707 CDM 0272 RC outpatient 148 148 148 74 109.52 percent of total billed charges 148 93 119.88 percent of total billed charges 148 148 other OPPS APC 148 148 other OPPS APC 148 27.63 40.89 percent of total billed charges 148 148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 2.0 CANNULATED POLYAXIAL SUP-95-04708 CDM 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 297.5 other OPPS APC 297.5 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT CANNULATED 1.7MM SUP-95-04712 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE 3.2 X 230MM UNTHREADED SUP-95-04713 CDM 0272 RC outpatient 302.75 302.75 302.75 74 224.04 percent of total billed charges 302.75 93 245.23 percent of total billed charges 302.75 302.75 other OPPS APC 302.75 302.75 other OPPS APC 302.75 27.63 83.65 percent of total billed charges 302.75 302.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 4.9MM CANNULATED LARGE AO SUP-95-04714 CDM 0272 RC outpatient 672 672 672 74 497.28 percent of total billed charges 672 93 544.32 percent of total billed charges 672 672 other OPPS APC 672 672 other OPPS APC 672 27.63 185.67 percent of total billed charges 672 672 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK 7.0MM CANNULATED LARGE AO SUP-95-04715 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSTRUMENT PACK EASYFUSE SUP-95-04717 CDM 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK 2.8MM CANNULATED DART FIRE COMPRESSION SCREW SUP-95-04718 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 0.9 X 150MM BLUNT/TROCAR SUP-95-04719 CDM 0272 RC outpatient 738 738 738 74 546.12 percent of total billed charges 738 93 597.78 percent of total billed charges 738 738 other OPPS APC 738 738 other OPPS APC 738 27.63 203.91 percent of total billed charges 738 738 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2 X 30MM SUP-95-04720 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN STEINMANN 3 X 150MM CENTRAL THREAD SUP-95-04721 CDM C1713 HCPCS 0278 RC outpatient 455 455 455 57 259.35 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 51 232.05 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WRENCH PIN 4.5 X 120MM SUP-95-04722 CDM 0272 RC outpatient 225.23 225.23 225.23 74 166.67 percent of total billed charges 225.23 93 182.44 percent of total billed charges 225.23 225.23 other OPPS APC 225.23 225.23 other OPPS APC 225.23 27.63 62.23 percent of total billed charges 225.23 225.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE 1.1 DOUPLE TIP NITINOL 2 ZONE DYNANITE SUP-95-04725 CDM C1713 HCPCS 0278 RC outpatient 486.5 486.5 486.5 57 277.31 percent of total billed charges 486.5 93 394.07 percent of total billed charges 486.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 486.5 other OPPS APC 486.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 486.5 other OPPS APC 486.5 51 248.12 percent of total billed charges 486.5 486.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CF DELIVERY DEV CAPS BRAVO SUP-95-04729 CDM 0272 RC outpatient 988.8 988.8 988.8 74 731.71 percent of total billed charges 988.8 93 800.93 percent of total billed charges 988.8 988.8 other OPPS APC 988.8 988.8 other OPPS APC 988.8 27.63 273.21 percent of total billed charges 988.8 988.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DISPOSABLES DX KNOTLESS FIBERTAK SUP-95-04730 CDM 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 825 other OPPS APC 825 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR CARTILAGE SUP-95-04734 CDM 0272 RC outpatient 1173 1173 1173 74 868.02 percent of total billed charges 1173 93 950.13 percent of total billed charges 1173 1173 other OPPS APC 1173 1173 other OPPS APC 1173 27.63 324.1 percent of total billed charges 1173 1173 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR CARTILAGE 3 X 12 SUP-95-04735 CDM 0272 RC outpatient 1173 1173 1173 74 868.02 percent of total billed charges 1173 93 950.13 percent of total billed charges 1173 1173 other OPPS APC 1173 1173 other OPPS APC 1173 27.63 324.1 percent of total billed charges 1173 1173 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR ARTHRODESIS CARTILAGE SUP-95-04736 CDM 0272 RC outpatient 1173 1173 1173 74 868.02 percent of total billed charges 1173 93 950.13 percent of total billed charges 1173 1173 other OPPS APC 1173 1173 other OPPS APC 1173 27.63 324.1 percent of total billed charges 1173 1173 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE 3.2 X 230 THREADED SUP-95-04737 CDM 0272 RC outpatient 330.75 330.75 330.75 74 244.76 percent of total billed charges 330.75 93 267.91 percent of total billed charges 330.75 330.75 other OPPS APC 330.75 330.75 other OPPS APC 330.75 27.63 91.39 percent of total billed charges 330.75 330.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CS INSERT SZ 3 13MM SUP-95-04744 CDM C1776 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CS INSERT SZ 2 9MM SUP-95-04745 CDM C1776 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CS INSERT SZ 4 9MM SUP-95-04747 CDM C1776 HCPCS 0278 RC outpatient 399 399 399 57 227.43 percent of total billed charges 399 93 323.19 percent of total billed charges 399 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 399 other OPPS APC 399 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 399 other OPPS APC 399 51 203.49 percent of total billed charges 399 399 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOOK 4MM X 300MM SUP-95-04749 CDM 0272 RC outpatient 1401 1401 1401 74 1036.74 percent of total billed charges 1401 93 1134.81 percent of total billed charges 1401 1401 other OPPS APC 1401 1401 other OPPS APC 1401 27.63 387.1 percent of total billed charges 1401 1401 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END MILL HRIS CANN 12.7 X 330MM SUP-95-04750 CDM 0272 RC outpatient 1755 1755 1755 74 1298.7 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 1755 other OPPS APC 1755 1755 other OPPS APC 1755 27.63 484.91 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HRIS INVERTED V TIP .25X120 SUP-95-04751 CDM 0272 RC outpatient 861 861 861 74 637.14 percent of total billed charges 861 93 697.41 percent of total billed charges 861 861 other OPPS APC 861 861 other OPPS APC 861 27.63 237.89 percent of total billed charges 861 861 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR AIRSEAL 5/100MM PORT SUP-95-04753 CDM 0272 RC outpatient 437.34 437.34 437.34 74 323.63 percent of total billed charges 437.34 93 354.25 percent of total billed charges 437.34 437.34 other OPPS APC 437.34 437.34 other OPPS APC 437.34 27.63 120.84 percent of total billed charges 437.34 437.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR AIRSEAL 8/10MM PORT SUP-95-04754 CDM 0272 RC outpatient 450.83 450.83 450.83 74 333.61 percent of total billed charges 450.83 93 365.17 percent of total billed charges 450.83 450.83 other OPPS APC 450.83 450.83 other OPPS APC 450.83 27.63 124.56 percent of total billed charges 450.83 450.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR AIRSEAL 12/100MM LPI PORT SUP-95-04755 CDM 0272 RC outpatient 462.39 462.39 462.39 74 342.17 percent of total billed charges 462.39 93 374.54 percent of total billed charges 462.39 462.39 other OPPS APC 462.39 462.39 other OPPS APC 462.39 27.63 127.76 percent of total billed charges 462.39 462.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRSEAL 8MM CANNULA CAP AND OB SUP-95-04756 CDM 0272 RC outpatient 502.25 502.25 502.25 74 371.67 percent of total billed charges 502.25 93 406.82 percent of total billed charges 502.25 502.25 other OPPS APC 502.25 502.25 other OPPS APC 502.25 27.63 138.77 percent of total billed charges 502.25 502.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRSEAL ROBOTIC XI LONG SUP-95-04757 CDM 0272 RC outpatient 502.25 502.25 502.25 74 371.67 percent of total billed charges 502.25 93 406.82 percent of total billed charges 502.25 502.25 other OPPS APC 502.25 502.25 other OPPS APC 502.25 27.63 138.77 percent of total billed charges 502.25 502.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSUFFLATION TUBING TRI LUMEN FILTERED AIRSEAL TUBE SET SUP-95-04758 CDM 0272 RC outpatient 465.13 465.13 465.13 74 344.2 percent of total billed charges 465.13 93 376.76 percent of total billed charges 465.13 465.13 other OPPS APC 465.13 465.13 other OPPS APC 465.13 27.63 128.52 percent of total billed charges 465.13 465.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSUFFLATION TUBING DAVINCI AIRSEAL BIFURCATED FILTERED SUP-95-04759 CDM 0272 RC outpatient 502.25 502.25 502.25 74 371.67 percent of total billed charges 502.25 93 406.82 percent of total billed charges 502.25 502.25 other OPPS APC 502.25 502.25 other OPPS APC 502.25 27.63 138.77 percent of total billed charges 502.25 502.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSUFFLATION TUBING SMOKE EVAC FILTERED SUP-95-04760 CDM 0272 RC outpatient 1993.86 1993.86 1993.86 74 1475.46 percent of total billed charges 1993.86 93 1615.03 percent of total billed charges 1993.86 1993.86 other OPPS APC 1993.86 1993.86 other OPPS APC 1993.86 27.63 550.9 percent of total billed charges 1993.86 1993.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 1.4 X 100MM SINGLE ENDED TROCAR TIP SMOOTH SUP-95-04761 CDM 0272 RC outpatient 80 80 80 74 59.2 percent of total billed charges 80 93 64.8 percent of total billed charges 80 80 other OPPS APC 80 80 other OPPS APC 80 27.63 22.1 percent of total billed charges 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.5MM SUP-95-04762 CDM 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 297.5 other OPPS APC 297.5 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE THREADED W/ TROCAR TIP 1.35MM SUP-95-04763 CDM 0272 RC outpatient 80 80 80 74 59.2 percent of total billed charges 80 93 64.8 percent of total billed charges 80 80 other OPPS APC 80 80 other OPPS APC 80 27.63 22.1 percent of total billed charges 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 5.0MM CANNULATED SUP-95-04767 CDM 0272 RC outpatient 1587.3 1587.3 1587.3 74 1174.6 percent of total billed charges 1587.3 93 1285.71 percent of total billed charges 1587.3 1587.3 other OPPS APC 1587.3 1587.3 other OPPS APC 1587.3 27.63 438.57 percent of total billed charges 1587.3 1587.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OLIVE WIRE 1.4MM THREADED SUP-95-04768 CDM 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 297.5 other OPPS APC 297.5 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER AO CANNULATED 4.0MM SUP-95-04772 CDM 0272 RC outpatient 679.84 679.84 679.84 74 503.08 percent of total billed charges 679.84 93 550.67 percent of total billed charges 679.84 679.84 other OPPS APC 679.84 679.84 other OPPS APC 679.84 27.63 187.84 percent of total billed charges 679.84 679.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR 4 X 16MM SCULPTING CYLINDER SUP-95-04777 CDM 0272 RC outpatient 1173 1173 1173 74 868.02 percent of total billed charges 1173 93 950.13 percent of total billed charges 1173 1173 other OPPS APC 1173 1173 other OPPS APC 1173 27.63 324.1 percent of total billed charges 1173 1173 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.2MM PERIPHERAL SCREW SUP-95-04778 CDM 0272 RC outpatient 336 336 336 74 248.64 percent of total billed charges 336 93 272.16 percent of total billed charges 336 336 other OPPS APC 336 336 other OPPS APC 336 27.63 92.84 percent of total billed charges 336 336 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.2MM CANNULATED SUP-95-04780 CDM 0272 RC outpatient 474.6 474.6 474.6 74 351.2 percent of total billed charges 474.6 93 384.43 percent of total billed charges 474.6 474.6 other OPPS APC 474.6 474.6 other OPPS APC 474.6 27.63 131.13 percent of total billed charges 474.6 474.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2 X 24MM SUP-95-04781 CDM 0272 RC outpatient 474.6 474.6 474.6 74 351.2 percent of total billed charges 474.6 93 384.43 percent of total billed charges 474.6 474.6 other OPPS APC 474.6 474.6 other OPPS APC 474.6 27.63 131.13 percent of total billed charges 474.6 474.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BRA SMALL PINK ELIZABETH SURGICAL 30-33""" SUP-95-04785 CDM 0272 RC outpatient 128 128 128 74 94.72 percent of total billed charges 128 93 103.68 percent of total billed charges 128 128 other OPPS APC 128 128 other OPPS APC 128 27.63 35.37 percent of total billed charges 128 128 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BRA MEDIUM PINK ELIZABETH SURGICAL 33-36""" SUP-95-04786 CDM 0272 RC outpatient 128 128 128 74 94.72 percent of total billed charges 128 93 103.68 percent of total billed charges 128 128 other OPPS APC 128 128 other OPPS APC 128 27.63 35.37 percent of total billed charges 128 128 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BRA LARGE PINK ELIZABETH SURGICAL 36-39""" SUP-95-04787 CDM 0272 RC outpatient 128 128 128 74 94.72 percent of total billed charges 128 93 103.68 percent of total billed charges 128 128 other OPPS APC 128 128 other OPPS APC 128 27.63 35.37 percent of total billed charges 128 128 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BRA XLARGE PINK ELIZABETH SURGICAL 39-42""" SUP-95-04788 CDM 0272 RC outpatient 128 128 128 74 94.72 percent of total billed charges 128 93 103.68 percent of total billed charges 128 128 other OPPS APC 128 128 other OPPS APC 128 27.63 35.37 percent of total billed charges 128 128 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BRA 2XL PINK ELIZABETH SURGICAL 42-45""" SUP-95-04789 CDM 0272 RC outpatient 128 128 128 74 94.72 percent of total billed charges 128 93 103.68 percent of total billed charges 128 128 other OPPS APC 128 128 other OPPS APC 128 27.63 35.37 percent of total billed charges 128 128 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BRA 3XL PINK ELIZABETH SURGICAL 45-48""" SUP-95-04790 CDM 0272 RC outpatient 128 128 128 74 94.72 percent of total billed charges 128 93 103.68 percent of total billed charges 128 128 other OPPS APC 128 128 other OPPS APC 128 27.63 35.37 percent of total billed charges 128 128 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 1.3MM QUICKFIX SUP-95-04791 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.5MM SUP-95-04792 CDM 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 825 other OPPS APC 825 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE 2 X 200MM UNTHREADED SUP-95-04793 CDM 0272 RC outpatient 295.75 295.75 295.75 74 218.86 percent of total billed charges 295.75 93 239.56 percent of total billed charges 295.75 295.75 other OPPS APC 295.75 295.75 other OPPS APC 295.75 27.63 81.72 percent of total billed charges 295.75 295.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VLOC 2-0 18 GREEN VLOCL0625 SUP-95-04797 CDM 0272 RC outpatient 94.67 94.67 94.67 74 70.06 percent of total billed charges 94.67 93 76.68 percent of total billed charges 94.67 94.67 other OPPS APC 94.67 94.67 other OPPS APC 94.67 27.63 26.16 percent of total billed charges 94.67 94.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3 X 200MM CANNULATED WITH CALIBRATIONS AO SUP-95-04798 CDM 0272 RC outpatient 698.25 698.25 698.25 74 516.71 percent of total billed charges 698.25 93 565.58 percent of total billed charges 698.25 698.25 other OPPS APC 698.25 698.25 other OPPS APC 698.25 27.63 192.93 percent of total billed charges 698.25 698.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAP 4MM CANNULATED WITH CALIBRATIONS AO SUP-95-04799 CDM 0272 RC outpatient 418.88 418.88 418.88 74 309.97 percent of total billed charges 418.88 93 339.29 percent of total billed charges 418.88 418.88 other OPPS APC 418.88 418.88 other OPPS APC 418.88 27.63 115.74 percent of total billed charges 418.88 418.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE KEITH STRAIGHT TRIPOINT SZ3 SUP-95-04805 CDM 0272 RC outpatient 3.6 3.6 3.6 74 2.66 percent of total billed charges 3.6 93 2.92 percent of total billed charges 3.6 3.6 other OPPS APC 3.6 3.6 other OPPS APC 3.6 27.63 0.99 percent of total billed charges 3.6 3.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE NARROW SAW SUP-95-04816 CDM 0272 RC outpatient 729 729 729 74 539.46 percent of total billed charges 729 93 590.49 percent of total billed charges 729 729 other OPPS APC 729 729 other OPPS APC 729 27.63 201.42 percent of total billed charges 729 729 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KWIRE 1.4 SUP-95-04817 CDM C1713 HCPCS 0278 RC outpatient 188 188 188 57 107.16 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 51 95.88 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN STEINMANN 2.4 SUP-95-04818 CDM C1713 HCPCS 0278 RC outpatient 180 180 180 57 102.6 percent of total billed charges 180 93 145.8 percent of total billed charges 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 51 91.8 percent of total billed charges 180 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE WIDE SAW SUP-95-04819 CDM 0272 RC outpatient 729 729 729 74 539.46 percent of total billed charges 729 93 590.49 percent of total billed charges 729 729 other OPPS APC 729 729 other OPPS APC 729 27.63 201.42 percent of total billed charges 729 729 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT THERASKIN 3CM .50 X .50 SUP-95-04825 CDM outpatient 2685 2685 2685 2685 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT THERASKIN 26CM 2 X 2 SUP-95-04826 CDM outpatient 3187.5 3187.5 3187.5 3187.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT THERASKIN 116CM 3 X 6 SUP-95-04827 CDM outpatient 8987.5 8987.5 8987.5 8987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. J-HOOK E-Z CLEAN 33CM SUP-95-04846 CDM 0272 RC outpatient 152.5 152.5 152.5 74 112.85 percent of total billed charges 152.5 93 123.53 percent of total billed charges 152.5 152.5 other OPPS APC 152.5 152.5 other OPPS APC 152.5 27.63 42.14 percent of total billed charges 152.5 152.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SCORPION KNEE SUP-95-04854 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOPSY BASIN PACK CATSUP SUP-95-04859 CDM 0272 RC outpatient 243.32 243.32 243.32 74 180.06 percent of total billed charges 243.32 93 197.09 percent of total billed charges 243.32 243.32 other OPPS APC 243.32 243.32 other OPPS APC 243.32 27.63 67.23 percent of total billed charges 243.32 243.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASCOPE BRONCH SLIM SINGLE USE SUP-95-04863 CDM 0272 RC outpatient 765 765 765 74 566.1 percent of total billed charges 765 93 619.65 percent of total billed charges 765 765 other OPPS APC 765 765 other OPPS APC 765 27.63 211.37 percent of total billed charges 765 765 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASCOPE BRONCH REGULAR SUP-95-04864 CDM 0272 RC outpatient 793.5 793.5 793.5 74 587.19 percent of total billed charges 793.5 93 642.74 percent of total billed charges 793.5 793.5 other OPPS APC 793.5 793.5 other OPPS APC 793.5 27.63 219.24 percent of total billed charges 793.5 793.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOUND PROCESSOR PONTO 4 SG GRAY SUP-95-04865 CDM L8614 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VICRYL TIE 2-0 J911T SUP-95-04871 CDM outpatient 53.44 53.44 53.44 53.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP ACCS VISTASEAL 45CM LAP AIRLESS SPRA SUP-95-04872 CDM 0272 RC outpatient 227.45 227.45 227.45 74 168.31 percent of total billed charges 227.45 93 184.23 percent of total billed charges 227.45 227.45 other OPPS APC 227.45 227.45 other OPPS APC 227.45 27.63 62.84 percent of total billed charges 227.45 227.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REDUCER 12-8MM DAVINCI SUP-95-04875 CDM 0272 RC outpatient 105.33 105.33 105.33 74 77.94 percent of total billed charges 105.33 93 85.32 percent of total billed charges 105.33 105.33 other OPPS APC 105.33 105.33 other OPPS APC 105.33 27.63 29.1 percent of total billed charges 105.33 105.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER CANNULA SEAL 12MM DAVINCI SUP-95-04876 CDM 0272 RC outpatient 84 84 84 74 62.16 percent of total billed charges 84 93 68.04 percent of total billed charges 84 84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA SEAL 5MM-8MM DAVINCI SUP-95-04877 CDM 0272 RC outpatient 75.6 75.6 75.6 74 55.94 percent of total billed charges 75.6 93 61.24 percent of total billed charges 75.6 75.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR 15MM ENDOPATH EXCEL BLADELESS B15LT SUP-95-04878 CDM 0272 RC outpatient 173.04 173.04 173.04 74 128.05 percent of total billed charges 173.04 93 140.16 percent of total billed charges 173.04 173.04 other OPPS APC 173.04 173.04 other OPPS APC 173.04 27.63 47.81 percent of total billed charges 173.04 173.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY CENTRAL LINE 3 LUMEN 7FR X 16CM SUP-95-04879 CDM 0272 RC outpatient 481.6 481.6 481.6 74 356.38 percent of total billed charges 481.6 93 390.1 percent of total billed charges 481.6 481.6 other OPPS APC 481.6 481.6 other OPPS APC 481.6 27.63 133.07 percent of total billed charges 481.6 481.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM TISSUE RETRIEVAL SUP-95-04881 CDM 0272 RC outpatient 535.97 535.97 535.97 74 396.62 percent of total billed charges 535.97 93 434.14 percent of total billed charges 535.97 535.97 other OPPS APC 535.97 535.97 other OPPS APC 535.97 27.63 148.09 percent of total billed charges 535.97 535.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER SUREFORM 60 SUP-95-04883 CDM 0272 RC outpatient 1669.5 1669.5 1669.5 74 1235.43 percent of total billed charges 1669.5 93 1352.3 percent of total billed charges 1669.5 1669.5 other OPPS APC 1669.5 1669.5 other OPPS APC 1669.5 27.63 461.28 percent of total billed charges 1669.5 1669.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD SUREFORM 45 2.5 WHITE SUP-95-04884 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD ENDOWRIST 30 4.3 GREEN SUP-95-04888 CDM 0272 RC outpatient 627.96 627.96 627.96 74 464.69 percent of total billed charges 627.96 93 508.65 percent of total billed charges 627.96 627.96 other OPPS APC 627.96 627.96 other OPPS APC 627.96 27.63 173.51 percent of total billed charges 627.96 627.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOWRIST STAPLER SHEATH DAVINCI SUP-95-04894 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOWRIST SUCTION IRRIG DAVINCI SUP-95-04895 CDM 0272 RC outpatient 835 835 835 74 617.9 percent of total billed charges 835 93 676.35 percent of total billed charges 835 835 other OPPS APC 835 835 other OPPS APC 835 27.63 230.71 percent of total billed charges 835 835 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD ENDOWRIST 30 4.3 WHITE SUP-95-04903 CDM 0272 RC outpatient 627.96 627.96 627.96 74 464.69 percent of total billed charges 627.96 93 508.65 percent of total billed charges 627.96 627.96 other OPPS APC 627.96 627.96 other OPPS APC 627.96 27.63 173.51 percent of total billed charges 627.96 627.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD ENDOWRIST 45 GREEN DAVINCI SUP-95-04911 CDM 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 630 other OPPS APC 630 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD ENDOWRIST 45 WHITE DAVINCI SUP-95-04912 CDM 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 630 other OPPS APC 630 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERICARDIOCENTESIS (CHEST TUBE) TRAY SUP-95-04919 CDM C1769 HCPCS 0272 RC outpatient 653.8 653.8 653.8 74 483.81 percent of total billed charges 653.8 93 529.58 percent of total billed charges 653.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 653.8 other OPPS APC 653.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 653.8 other OPPS APC 653.8 27.63 180.64 percent of total billed charges 653.8 653.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3X13MM QUICKFIX TITANIUM SUP-95-0492 CDM C1713 HCPCS 0278 RC outpatient 720 720 720 57 410.4 percent of total billed charges 720 93 583.2 percent of total billed charges 720 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 720 other OPPS APC 720 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 720 other OPPS APC 720 51 367.2 percent of total billed charges 720 720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE TROCLEAN TROCAR CLEANING SUP-95-04926 CDM 0272 RC outpatient 73.67 73.67 73.67 74 54.52 percent of total billed charges 73.67 93 59.67 percent of total billed charges 73.67 73.67 other OPPS APC 73.67 73.67 other OPPS APC 73.67 27.63 20.36 percent of total billed charges 73.67 73.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP WECK HEMOLOK MED/LG SUP-95-04928 CDM 0272 RC outpatient 125.04 125.04 125.04 74 92.53 percent of total billed charges 125.04 93 101.28 percent of total billed charges 125.04 125.04 other OPPS APC 125.04 125.04 other OPPS APC 125.04 27.63 34.55 percent of total billed charges 125.04 125.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP WECK HEMOLOK LG SUP-95-04929 CDM 0272 RC outpatient 123.22 123.22 123.22 74 91.18 percent of total billed charges 123.22 93 99.81 percent of total billed charges 123.22 123.22 other OPPS APC 123.22 123.22 other OPPS APC 123.22 27.63 34.05 percent of total billed charges 123.22 123.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP WECK HORIZON SM/WIDE SUP-95-04930 CDM 0272 RC outpatient 2.19 2.19 2.19 74 1.62 percent of total billed charges 2.19 93 1.77 percent of total billed charges 2.19 2.19 other OPPS APC 2.19 2.19 other OPPS APC 2.19 27.63 0.61 percent of total billed charges 2.19 2.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER SUREFORM 45 SUP-95-04935 CDM 0272 RC outpatient 1449 1449 1449 74 1072.26 percent of total billed charges 1449 93 1173.69 percent of total billed charges 1449 1449 other OPPS APC 1449 1449 other OPPS APC 1449 27.63 400.36 percent of total billed charges 1449 1449 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD SUREFORM 60 WHITE SUP-95-04936 CDM 0272 RC outpatient 724.5 724.5 724.5 74 536.13 percent of total billed charges 724.5 93 586.85 percent of total billed charges 724.5 724.5 other OPPS APC 724.5 724.5 other OPPS APC 724.5 27.63 200.18 percent of total billed charges 724.5 724.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD SUREFORM 60 BLUE SUP-95-04937 CDM 0272 RC outpatient 724.5 724.5 724.5 74 536.13 percent of total billed charges 724.5 93 586.85 percent of total billed charges 724.5 724.5 other OPPS APC 724.5 724.5 other OPPS APC 724.5 27.63 200.18 percent of total billed charges 724.5 724.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD SUREFORM 60 GREEN SUP-95-04938 CDM 0272 RC outpatient 724.5 724.5 724.5 74 536.13 percent of total billed charges 724.5 93 586.85 percent of total billed charges 724.5 724.5 other OPPS APC 724.5 724.5 other OPPS APC 724.5 27.63 200.18 percent of total billed charges 724.5 724.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD SUREFORM 60 BLACK SUP-95-04939 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD SUREFORM 45 BLUE SUP-95-04940 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD SUREFORM 45 GREEN SUP-95-04941 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VESSEL SEALER EXTEND DAVINCI SUP-95-04942 CDM 0272 RC outpatient 1969 1969 1969 74 1457.06 percent of total billed charges 1969 93 1594.89 percent of total billed charges 1969 1969 other OPPS APC 1969 1969 other OPPS APC 1969 27.63 544.03 percent of total billed charges 1969 1969 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VLOC 180 GS-21 2-0 VLOCL0305 SUP-95-04948 CDM 0272 RC outpatient 136.34 136.34 136.34 74 100.89 percent of total billed charges 136.34 93 110.44 percent of total billed charges 136.34 136.34 other OPPS APC 136.34 136.34 other OPPS APC 136.34 27.63 37.67 percent of total billed charges 136.34 136.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VLOC PBT V-20 2-0 VLOCN0605 SUP-95-04949 CDM 0272 RC outpatient 94.67 94.67 94.67 74 70.06 percent of total billed charges 94.67 93 76.68 percent of total billed charges 94.67 94.67 other OPPS APC 94.67 94.67 other OPPS APC 94.67 27.63 26.16 percent of total billed charges 94.67 94.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VLOC 180 V-20 2-0 VLOCL0615 SUP-95-04950 CDM 0272 RC outpatient 94.67 94.67 94.67 74 70.06 percent of total billed charges 94.67 93 76.68 percent of total billed charges 94.67 94.67 other OPPS APC 94.67 94.67 other OPPS APC 94.67 27.63 26.16 percent of total billed charges 94.67 94.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VLOC CV-23 3-0 VLOCL0804 SUP-95-04951 CDM 0272 RC outpatient 94.67 94.67 94.67 74 70.06 percent of total billed charges 94.67 93 76.68 percent of total billed charges 94.67 94.67 other OPPS APC 94.67 94.67 other OPPS APC 94.67 27.63 26.16 percent of total billed charges 94.67 94.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VLOC PBT V-20 3-0 VLOCN0604 SUP-95-04952 CDM 0272 RC outpatient 134.37 134.37 134.37 74 99.43 percent of total billed charges 134.37 93 108.84 percent of total billed charges 134.37 134.37 other OPPS APC 134.37 134.37 other OPPS APC 134.37 27.63 37.13 percent of total billed charges 134.37 134.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE STRATAFIX CT-1 60CM SUP-95-04953 CDM 0272 RC outpatient 129.79 129.79 129.79 74 96.04 percent of total billed charges 129.79 93 105.13 percent of total billed charges 129.79 129.79 other OPPS APC 129.79 129.79 other OPPS APC 129.79 27.63 35.86 percent of total billed charges 129.79 129.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FMT LOWER DELIVERY SUP-95-04955 CDM 0272 RC outpatient 4237.5 4237.5 4237.5 74 3135.75 percent of total billed charges 4237.5 93 3432.38 percent of total billed charges 4237.5 4237.5 other OPPS APC 4237.5 4237.5 other OPPS APC 4237.5 27.63 1170.82 percent of total billed charges 4237.5 4237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OVAL BURR ARTHROSOPIC 5.5MM SUP-95-04956 CDM 0272 RC outpatient 148 148 148 74 109.52 percent of total billed charges 148 93 119.88 percent of total billed charges 148 148 other OPPS APC 148 148 other OPPS APC 148 27.63 40.89 percent of total billed charges 148 148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ABLATOR ARTHROSCOPIC APOLLORF MP50 SUP-95-04957 CDM 0272 RC outpatient 556.5 556.5 556.5 74 411.81 percent of total billed charges 556.5 93 450.77 percent of total billed charges 556.5 556.5 other OPPS APC 556.5 556.5 other OPPS APC 556.5 27.63 153.76 percent of total billed charges 556.5 556.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE FEEDING J MIC 18FR SUP-95-04958 CDM B4087 HCPCS 0278 RC outpatient 459.2 459.2 459.2 57 261.74 percent of total billed charges 459.2 93 371.95 percent of total billed charges 459.2 459.2 other OPPS APC 459.2 459.2 other OPPS APC 459.2 51 234.19 percent of total billed charges 459.2 459.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARDIO CONNECTOR 1:1 SUP-95-04960 CDM 0272 RC outpatient 50.37 50.37 50.37 74 37.27 percent of total billed charges 50.37 93 40.8 percent of total billed charges 50.37 50.37 other OPPS APC 50.37 50.37 other OPPS APC 50.37 27.63 13.92 percent of total billed charges 50.37 50.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUICKPASS TENDON SHUTTLE SMALL SUP-95-04961 CDM 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 297.5 other OPPS APC 297.5 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VRT AI INFUSION PACK VERITAS ADVANCED SUP-95-04965 CDM 0272 RC outpatient 152 152 152 74 112.48 percent of total billed charges 152 93 123.12 percent of total billed charges 152 152 other OPPS APC 152 152 other OPPS APC 152 27.63 42 percent of total billed charges 152 152 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMARK T3 BIOPSY MARKER - ULTRASOUND SUP-95-04976 CDM C1819 HCPCS 0278 RC outpatient 340.04 340.04 340.04 57 193.82 percent of total billed charges 340.04 93 275.43 percent of total billed charges 340.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 340.04 other OPPS APC 340.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 340.04 other OPPS APC 340.04 51 173.42 percent of total billed charges 340.04 340.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMARK T4 BIOPSY MARKER - ULTRASOUND SUP-95-04977 CDM C1819 HCPCS 0278 RC outpatient 323.85 323.85 323.85 57 184.59 percent of total billed charges 323.85 93 262.32 percent of total billed charges 323.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 323.85 other OPPS APC 323.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 323.85 other OPPS APC 323.85 51 165.16 percent of total billed charges 323.85 323.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMARK T4 BIOPSY MARKER - STEREO SUP-95-04978 CDM C1819 HCPCS 0278 RC outpatient 323.85 323.85 323.85 57 184.59 percent of total billed charges 323.85 93 262.32 percent of total billed charges 323.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 323.85 other OPPS APC 323.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 323.85 other OPPS APC 323.85 51 165.16 percent of total billed charges 323.85 323.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMARK T3 BIOPSY MARKER - STEREO SUP-95-04979 CDM C1819 HCPCS 0278 RC outpatient 323.85 323.85 323.85 57 184.59 percent of total billed charges 323.85 93 262.32 percent of total billed charges 323.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 323.85 other OPPS APC 323.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 323.85 other OPPS APC 323.85 51 165.16 percent of total billed charges 323.85 323.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CYSTOSCOPE SINGLE USE SUP-95-04980 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IOBAN 23 X 17 SUP-95-04991 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INVRAD LOW PROFILE POWER MEDIPORT SUP-95-05012 CDM C1788 HCPCS 0278 RC outpatient 1613.46 1613.46 1613.46 57 919.67 percent of total billed charges 1613.46 93 1306.9 percent of total billed charges 1613.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1613.46 other OPPS APC 1613.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1613.46 other OPPS APC 1613.46 27.63 445.8 percent of total billed charges 1613.46 1613.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OBTURATOR BLADELESS 8MM LONG SUP-95-05036 CDM 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 630 other OPPS APC 630 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 12F SUP-95-05050 CDM 0272 RC outpatient 33.32 33.32 33.32 74 24.66 percent of total billed charges 33.32 93 26.99 percent of total billed charges 33.32 33.32 other OPPS APC 33.32 33.32 other OPPS APC 33.32 27.63 9.21 percent of total billed charges 33.32 33.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE 1.6MM BEVELED FT SUP-95-05055 CDM 0272 RC outpatient 196 196 196 74 145.04 percent of total billed charges 196 93 158.76 percent of total billed charges 196 196 other OPPS APC 196 196 other OPPS APC 196 27.63 54.15 percent of total billed charges 196 196 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE 1.6X150MM CAPITAL FRAG SUP-95-05056 CDM 0272 RC outpatient 196 196 196 74 145.04 percent of total billed charges 196 93 158.76 percent of total billed charges 196 196 other OPPS APC 196 196 other OPPS APC 196 27.63 54.15 percent of total billed charges 196 196 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT CANNULATED 3.6MM SUP-95-05057 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL PROFILE 4MM BEVELED FT SUP-95-05058 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR WOUND PROTECTOR ALEXIS XXS SUP-95-05061 CDM 0272 RC outpatient 144 144 144 74 106.56 percent of total billed charges 144 93 116.64 percent of total billed charges 144 144 other OPPS APC 144 144 other OPPS APC 144 27.63 39.79 percent of total billed charges 144 144 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GELPOINT MINI SUP-95-05062 CDM 0272 RC outpatient 2250 2250 2250 74 1665 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 2250 other OPPS APC 2250 2250 other OPPS APC 2250 27.63 621.68 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE MARROW BIOPSY NEEDLE - 102MM SUP-95-05070 CDM 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE MARROW BIOPSY NEEDLE - 152MM SUP-95-05071 CDM 0272 RC outpatient 553.58 553.58 553.58 74 409.65 percent of total billed charges 553.58 93 448.4 percent of total billed charges 553.58 553.58 other OPPS APC 553.58 553.58 other OPPS APC 553.58 27.63 152.95 percent of total billed charges 553.58 553.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE 1.4MM BEVELED FT SUP-95-05074 CDM 0272 RC outpatient 196 196 196 74 145.04 percent of total billed charges 196 93 158.76 percent of total billed charges 196 196 other OPPS APC 196 196 other OPPS APC 196 27.63 54.15 percent of total billed charges 196 196 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT CANNULATED 2.9MM SUP-95-05075 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ENDOSTITCH SILK 0 170003 SUP-95-05078 CDM 0272 RC outpatient 231.53 231.53 231.53 74 171.33 percent of total billed charges 231.53 93 187.54 percent of total billed charges 231.53 231.53 other OPPS APC 231.53 231.53 other OPPS APC 231.53 27.63 63.97 percent of total billed charges 231.53 231.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ENDOSTITCH SILK 2-0 170004 SUP-95-05079 CDM 0272 RC outpatient 231.53 231.53 231.53 74 171.33 percent of total billed charges 231.53 93 187.54 percent of total billed charges 231.53 231.53 other OPPS APC 231.53 231.53 other OPPS APC 231.53 27.63 63.97 percent of total billed charges 231.53 231.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ENDOSTITCH POLYSORB 2-0 170053 SUP-95-05080 CDM 0272 RC outpatient 231.53 231.53 231.53 74 171.33 percent of total billed charges 231.53 93 187.54 percent of total billed charges 231.53 231.53 other OPPS APC 231.53 231.53 other OPPS APC 231.53 27.63 63.97 percent of total billed charges 231.53 231.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ENDOSTITCH VLOC 2-0 VLOCA208L SUP-95-05081 CDM 0272 RC outpatient 424.48 424.48 424.48 74 314.12 percent of total billed charges 424.48 93 343.83 percent of total billed charges 424.48 424.48 other OPPS APC 424.48 424.48 other OPPS APC 424.48 27.63 117.28 percent of total billed charges 424.48 424.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EEA 23MM SUP-95-05084 CDM outpatient 1200.87 1200.87 1200.87 1200.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT LOCKING MED 4.3MM X 296MM SUP-95-05085 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMARK T1 BIOPSY MARKER - ULTRASOUND SUP-95-05087 CDM C1819 HCPCS 0278 RC outpatient 323.85 323.85 323.85 57 184.59 percent of total billed charges 323.85 93 262.32 percent of total billed charges 323.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 323.85 other OPPS APC 323.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 323.85 other OPPS APC 323.85 51 165.16 percent of total billed charges 323.85 323.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SAW BLADE SAGITTAL 90L X 18MM X 1.27MM SUP-95-05091 CDM 0272 RC outpatient 234.61 234.61 234.61 74 173.61 percent of total billed charges 234.61 93 190.03 percent of total billed charges 234.61 234.61 other OPPS APC 234.61 234.61 other OPPS APC 234.61 27.63 64.82 percent of total billed charges 234.61 234.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SAW BLADE DUAL CUT 90L X 25MM SUP-95-05092 CDM 0272 RC outpatient 229.22 229.22 229.22 74 169.62 percent of total billed charges 229.22 93 185.67 percent of total billed charges 229.22 229.22 other OPPS APC 229.22 229.22 other OPPS APC 229.22 27.63 63.33 percent of total billed charges 229.22 229.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KWIRE 0.8 X 100MM SUP-95-05099 CDM 0272 RC outpatient 66.16 66.16 66.16 74 48.96 percent of total billed charges 66.16 93 53.59 percent of total billed charges 66.16 66.16 other OPPS APC 66.16 66.16 other OPPS APC 66.16 27.63 18.28 percent of total billed charges 66.16 66.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL CAN TWIST 2.2 SUP-95-05100 CDM 0272 RC outpatient 546.7 546.7 546.7 74 404.56 percent of total billed charges 546.7 93 442.83 percent of total billed charges 546.7 546.7 other OPPS APC 546.7 546.7 other OPPS APC 546.7 27.63 151.05 percent of total billed charges 546.7 546.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ENDOSTITCH VLOC 90 3-0 VLOCM0224 SUP-95-05107 CDM outpatient 186.84 186.84 186.84 186.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR SPACEMAKER PROACCESS DISSECTOR SUP-95-05108 CDM 0272 RC outpatient 2637.62 2637.62 2637.62 74 1951.84 percent of total billed charges 2637.62 93 2136.47 percent of total billed charges 2637.62 2637.62 other OPPS APC 2637.62 2637.62 other OPPS APC 2637.62 27.63 728.77 percent of total billed charges 2637.62 2637.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT DEPTH MARK QC 2.0 X 110MM SUP-95-05111 CDM outpatient 421.26 421.26 421.26 421.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE TROCAR TIP 1.1MM X 150MM SUP-95-05112 CDM 0272 RC outpatient 273 273 273 74 202.02 percent of total billed charges 273 93 221.13 percent of total billed charges 273 273 other OPPS APC 273 273 other OPPS APC 273 27.63 75.43 percent of total billed charges 273 273 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOUND PROCESSOR PONTO 4 SG BROWN SUP-95-05113 CDM L8614 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE COAGULATION 3FR 110CM SUP-95-05118 CDM 0272 RC outpatient 306.25 306.25 306.25 74 226.63 percent of total billed charges 306.25 93 248.06 percent of total billed charges 306.25 306.25 other OPPS APC 306.25 306.25 other OPPS APC 306.25 27.63 84.62 percent of total billed charges 306.25 306.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VLOC 180 3-0 VLOCL0644 SUP-95-05119 CDM 0272 RC outpatient 143.15 143.15 143.15 74 105.93 percent of total billed charges 143.15 93 115.95 percent of total billed charges 143.15 143.15 other OPPS APC 143.15 143.15 other OPPS APC 143.15 27.63 39.55 percent of total billed charges 143.15 143.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER AIRWAY EXCHANGE 11FR 100CM SUP-95-05120 CDM 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 437.5 other OPPS APC 437.5 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THORACIC STRT 5 EYE 20FR SIL SUP-95-05121 CDM C1729 HCPCS 0278 RC outpatient 44.44 44.44 44.44 57 25.33 percent of total billed charges 44.44 93 36 percent of total billed charges 44.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.44 other OPPS APC 44.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 44.44 other OPPS APC 44.44 51 22.66 percent of total billed charges 44.44 44.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLAIN STEINMAN PIN 5/32 SUP-95-05122 CDM C1713 HCPCS 0278 RC outpatient 20.52 20.52 20.52 57 11.7 percent of total billed charges 20.52 93 16.62 percent of total billed charges 20.52 20.52 other OPPS APC 20.52 20.52 other OPPS APC 20.52 51 10.47 percent of total billed charges 20.52 20.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIR MATT DISPOSABLE SINGLE 39' SUP-95-05129 CDM 0272 RC outpatient 196 196 196 74 145.04 percent of total billed charges 196 93 158.76 percent of total billed charges 196 196 other OPPS APC 196 196 other OPPS APC 196 27.63 54.15 percent of total billed charges 196 196 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THORACIC STRGT 24FR 20IN 6 EYE SUP-95-05135 CDM C1729 HCPCS 0278 RC outpatient 363.3 363.3 363.3 57 207.08 percent of total billed charges 363.3 93 294.27 percent of total billed charges 363.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 363.3 other OPPS APC 363.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 363.3 other OPPS APC 363.3 51 185.28 percent of total billed charges 363.3 363.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 0.9 X 150MM BLUNT TROCAR SUP-95-05139 CDM 0272 RC outpatient 136 136 136 74 100.64 percent of total billed charges 136 93 110.16 percent of total billed charges 136 136 other OPPS APC 136 136 other OPPS APC 136 27.63 37.58 percent of total billed charges 136 136 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEPTH GUAGE MICA 150MM SUP-95-05140 CDM 0272 RC outpatient 469 469 469 74 347.06 percent of total billed charges 469 93 379.89 percent of total billed charges 469 469 other OPPS APC 469 469 other OPPS APC 469 27.63 129.58 percent of total billed charges 469 469 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SKIN CLOSURE ZIP 4 SUP-95-05142 CDM 0272 RC outpatient 179.23 179.23 179.23 74 132.63 percent of total billed charges 179.23 93 145.18 percent of total billed charges 179.23 179.23 other OPPS APC 179.23 179.23 other OPPS APC 179.23 27.63 49.52 percent of total billed charges 179.23 179.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBNG PACK PHACO WHITESTAR SIGNATURE PRO DUAL PUMP SUP-95-05143 CDM 0272 RC outpatient 152 152 152 74 112.48 percent of total billed charges 152 93 123.12 percent of total billed charges 152 152 other OPPS APC 152 152 other OPPS APC 152 27.63 42 percent of total billed charges 152 152 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.0 X 150MM SUP-95-05146 CDM 0272 RC outpatient 623 623 623 74 461.02 percent of total billed charges 623 93 504.63 percent of total billed charges 623 623 other OPPS APC 623 623 other OPPS APC 623 27.63 172.13 percent of total billed charges 623 623 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.5MM CALIBRATED SUP-95-05149 CDM 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 297.5 other OPPS APC 297.5 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 1.6MM SUP-95-05150 CDM 0272 RC outpatient 420 420 420 74 310.8 percent of total billed charges 420 93 340.2 percent of total billed charges 420 420 other OPPS APC 420 420 other OPPS APC 420 27.63 116.05 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.0MM SUP-95-05151 CDM 0272 RC outpatient 420 420 420 74 310.8 percent of total billed charges 420 93 340.2 percent of total billed charges 420 420 other OPPS APC 420 420 other OPPS APC 420 27.63 116.05 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEIWRE 1.2MM SUP-95-05152 CDM 0272 RC outpatient 88 88 88 74 65.12 percent of total billed charges 88 93 71.28 percent of total billed charges 88 88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEIWRE 1.2MM PK/6 SUP-95-05152 CDM 0272 RC outpatient 88 88 88 88 other OPPS APC 88 88 other OPPS APC 88 27.63 24.31 percent of total billed charges 88 88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR BLADELESS VERSAONE 15MM LONG SUP-95-05158 CDM 0272 RC outpatient 2979.72 2979.72 2979.72 74 2204.99 percent of total billed charges 2979.72 93 2413.57 percent of total billed charges 2979.72 2979.72 other OPPS APC 2979.72 2979.72 other OPPS APC 2979.72 27.63 823.3 percent of total billed charges 2979.72 2979.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILUMEN ENDOLUMENAL INTERVENTIONAL PLATFORM 130CM LENGTH SUP-95-05160 CDM 0272 RC outpatient 3750 3750 3750 74 2775 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 3750 other OPPS APC 3750 3750 other OPPS APC 3750 27.63 1036.13 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.5MM CANNULATED SUP-95-05183 CDM 0272 RC outpatient 238 238 238 74 176.12 percent of total billed charges 238 93 192.78 percent of total billed charges 238 238 other OPPS APC 238 238 other OPPS APC 238 27.63 65.76 percent of total billed charges 238 238 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 1.7MM SUP-95-05184 CDM 0272 RC outpatient 276.5 276.5 276.5 74 204.61 percent of total billed charges 276.5 93 223.97 percent of total billed charges 276.5 276.5 other OPPS APC 276.5 276.5 other OPPS APC 276.5 27.63 76.4 percent of total billed charges 276.5 276.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER LOW PROFILE 11MM SUP-95-05185 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SYSTEM FIBULOCK SUP-95-05186 CDM 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 2100 other OPPS APC 2100 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.5MM FIBULOCK SUP-95-05187 CDM 0272 RC outpatient 332.5 332.5 332.5 74 246.05 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 332.5 other OPPS APC 332.5 332.5 other OPPS APC 332.5 27.63 91.87 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAP AO 2.7MM SUP-95-05189 CDM 0272 RC outpatient 924 924 924 74 683.76 percent of total billed charges 924 93 748.44 percent of total billed charges 924 924 other OPPS APC 924 924 other OPPS APC 924 27.63 255.3 percent of total billed charges 924 924 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL AO 2 X 140MM SOLID MEASURING LONG SUP-95-05190 CDM 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 0.9 X 150MM DOUBLE ENDED TROCAR TIP SMOOTH SUP-95-05191 CDM 0272 RC outpatient 80 80 80 74 59.2 percent of total billed charges 80 93 64.8 percent of total billed charges 80 80 other OPPS APC 80 80 other OPPS APC 80 27.63 22.1 percent of total billed charges 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPECIMEN RETRIEVAL BAG 5MM SUP-95-05192 CDM 0272 RC outpatient 150.34 150.34 150.34 74 111.25 percent of total billed charges 150.34 93 121.78 percent of total billed charges 150.34 150.34 other OPPS APC 150.34 150.34 other OPPS APC 150.34 27.63 41.54 percent of total billed charges 150.34 150.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPECIMEN RETRIEVAL BAG 10MM 240ML SUP-95-05193 CDM 0272 RC outpatient 121.96 121.96 121.96 74 90.25 percent of total billed charges 121.96 93 98.79 percent of total billed charges 121.96 121.96 other OPPS APC 121.96 121.96 other OPPS APC 121.96 27.63 33.7 percent of total billed charges 121.96 121.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW COMPRESSION T2 ANKLE SUP-95-05194 CDM C1713 HCPCS 0278 RC outpatient 407.4 407.4 407.4 57 232.22 percent of total billed charges 407.4 93 329.99 percent of total billed charges 407.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 407.4 other OPPS APC 407.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 407.4 other OPPS APC 407.4 51 207.77 percent of total billed charges 407.4 407.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.2 X 60MM MICA CANNULATED SUP-95-05195 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 1.7MM CANNULATED SUP-95-05196 CDM 0272 RC outpatient 350 350 350 74 259 percent of total billed charges 350 93 283.5 percent of total billed charges 350 350 other OPPS APC 350 350 other OPPS APC 350 27.63 96.71 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK 4MM CANNULATED AO SUP-95-05200 CDM 0272 RC outpatient 985.5 985.5 985.5 74 729.27 percent of total billed charges 985.5 93 798.26 percent of total billed charges 985.5 985.5 other OPPS APC 985.5 985.5 other OPPS APC 985.5 27.63 272.29 percent of total billed charges 985.5 985.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 4.5MM CANNULATED SUP-95-05201 CDM 0272 RC outpatient 644 644 644 74 476.56 percent of total billed charges 644 93 521.64 percent of total billed charges 644 644 other OPPS APC 644 644 other OPPS APC 644 27.63 177.94 percent of total billed charges 644 644 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 4MM CANNULATED SUP-95-05202 CDM 0272 RC outpatient 644 644 644 74 476.56 percent of total billed charges 644 93 521.64 percent of total billed charges 644 644 other OPPS APC 644 644 other OPPS APC 644 27.63 177.94 percent of total billed charges 644 644 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESECTING DEVICE 2.9MM AVETA SMOL DISPOSABLE SUP-95-05247 CDM 0272 RC outpatient 1350 1350 1350 74 999 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 1350 other OPPS APC 1350 1350 other OPPS APC 1350 27.63 373.01 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESECTING DEVICE 2.9MM AVETA FLEX DISPOSABLE SUP-95-05248 CDM 0272 RC outpatient 2250 2250 2250 74 1665 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 2250 other OPPS APC 2250 2250 other OPPS APC 2250 27.63 621.68 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESECTING DEVICE 3.9MM AVETA WAVE+ DISPOSABLE SUP-95-05249 CDM 0272 RC outpatient 2400 2400 2400 74 1776 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 2400 other OPPS APC 2400 2400 other OPPS APC 2400 27.63 663.12 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER Y-PORT PEG 20FR SUP-95-05256 CDM 0271 RC outpatient 23.72 23.72 23.72 74 17.55 percent of total billed charges 23.72 93 19.21 percent of total billed charges 23.72 23.72 other OPPS APC 23.72 23.72 other OPPS APC 23.72 27.63 6.55 percent of total billed charges 23.72 23.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR C-SECTION ALEXIS XLG SUP-95-05258 CDM 0272 RC outpatient 241.5 241.5 241.5 74 178.71 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 241.5 other OPPS APC 241.5 241.5 other OPPS APC 241.5 27.63 66.73 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE MONOCRYL 3-0 KS Y523H SUP-95-05259 CDM 0272 RC outpatient 3.14 3.14 3.14 74 2.32 percent of total billed charges 3.14 93 2.54 percent of total billed charges 3.14 3.14 other OPPS APC 3.14 3.14 other OPPS APC 3.14 27.63 0.87 percent of total billed charges 3.14 3.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE MONOCRYL 1 CTX Y399H SUP-95-05260 CDM 0272 RC outpatient 2.31 2.31 2.31 74 1.71 percent of total billed charges 2.31 93 1.87 percent of total billed charges 2.31 2.31 other OPPS APC 2.31 2.31 other OPPS APC 2.31 27.63 0.64 percent of total billed charges 2.31 2.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT OVITEX LPR 12 X 12CM SUP-95-05269 CDM C1781 HCPCS 0278 RC outpatient 4835.5 4835.5 4835.5 57 2756.24 percent of total billed charges 4835.5 93 3916.76 percent of total billed charges 4835.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4835.5 other OPPS APC 4835.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4835.5 other OPPS APC 4835.5 51 2466.11 percent of total billed charges 4835.5 4835.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BETA CAP ADAPTER SUP-95-05271 CDM 0272 RC outpatient 3.67 3.67 3.67 74 2.72 percent of total billed charges 3.67 93 2.97 percent of total billed charges 3.67 3.67 other OPPS APC 3.67 3.67 other OPPS APC 3.67 27.63 1.01 percent of total billed charges 3.67 3.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG TUBE 14FR REPLACEMENT ENDOVIVE STANDARD STRAIGHT SUP-95-05272 CDM B4087 HCPCS 0278 RC outpatient 316.61 316.61 316.61 57 180.47 percent of total billed charges 316.61 93 256.45 percent of total billed charges 316.61 316.61 other OPPS APC 316.61 316.61 other OPPS APC 316.61 51 161.47 percent of total billed charges 316.61 316.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG TUBE 12FR REPLACEMENT ENDOVIVE STANDARD STRAIGHT SUP-95-05273 CDM B4087 HCPCS 0278 RC outpatient 316.61 316.61 316.61 57 180.47 percent of total billed charges 316.61 93 256.45 percent of total billed charges 316.61 316.61 other OPPS APC 316.61 316.61 other OPPS APC 316.61 51 161.47 percent of total billed charges 316.61 316.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK 5MM CANNULATED AO FITTING SUP-95-05275 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OATS DISPOSABLE KIT 12MM SINGLE USE SUP-95-05276 CDM 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 2100 other OPPS APC 2100 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE SILK 3-0 SH K832H SUP-95-05278 CDM 0272 RC outpatient 1.15 1.15 1.15 74 0.85 percent of total billed charges 1.15 93 0.93 percent of total billed charges 1.15 1.15 other OPPS APC 1.15 1.15 other OPPS APC 1.15 27.63 0.32 percent of total billed charges 1.15 1.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VLOC 180 3-0 V-20 6IN VLOCL0604 SUP-95-05279 CDM 0272 RC outpatient 83.31 83.31 83.31 74 61.65 percent of total billed charges 83.31 93 67.48 percent of total billed charges 83.31 83.31 other OPPS APC 83.31 83.31 other OPPS APC 83.31 27.63 23.02 percent of total billed charges 83.31 83.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BINDER ABDOMINAL12"", 62""-74""" SUP-95-05280 CDM 0272 RC outpatient 35.64 35.64 35.64 74 26.37 percent of total billed charges 35.64 93 28.87 percent of total billed charges 35.64 35.64 other OPPS APC 35.64 35.64 other OPPS APC 35.64 27.63 9.85 percent of total billed charges 35.64 35.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SUTURE PLAIN GUT 2-0 XLH 27"" 53T" SUP-95-05281 CDM 0272 RC outpatient 24.78 24.78 24.78 74 18.34 percent of total billed charges 24.78 93 20.07 percent of total billed charges 24.78 24.78 other OPPS APC 24.78 24.78 other OPPS APC 24.78 27.63 6.85 percent of total billed charges 24.78 24.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER BETA-CAP ARGYLE SUP-95-05282 CDM 0272 RC outpatient 2.68 2.68 2.68 74 1.98 percent of total billed charges 2.68 93 2.17 percent of total billed charges 2.68 2.68 other OPPS APC 2.68 2.68 other OPPS APC 2.68 27.63 0.74 percent of total billed charges 2.68 2.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAD KIT HIP DISTRACTION SYSTEM DISPOSABLE SUP-95-05283 CDM 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 750 other OPPS APC 750 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTLESS KIT HIP DISTRACTION SYSTEM DISPOSABLE SUP-95-05284 CDM 0272 RC outpatient 1185 1185 1185 74 876.9 percent of total billed charges 1185 93 959.85 percent of total billed charges 1185 1185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTLESS KIT HIP DISTRACTION SYSTEM DISPOSABLE BX/5 SUP-95-05284 CDM 0272 RC outpatient 1185 1185 1185 1185 other OPPS APC 1185 1185 other OPPS APC 1185 27.63 327.42 percent of total billed charges 1185 1185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DISPOSABLE MASTER HIP ARTHROSCOPY SUP-95-05285 CDM 0272 RC outpatient 1350 1350 1350 1350 other OPPS APC 1350 1350 other OPPS APC 1350 27.63 373.01 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DISPOSABLE W/ BLADE HIP ARTHROSCOPY SUP-95-05285 CDM 0272 RC outpatient 1350 1350 1350 74 999 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DISPOSABLE HIP 2.9MM PUSHLOCK SUP-95-05286 CDM 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 825 other OPPS APC 825 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DISPOSABLE CURVED KNOTLESS HIP FIBERTAK SUP-95-05287 CDM 0272 RC outpatient 885 885 885 74 654.9 percent of total billed charges 885 93 716.85 percent of total billed charges 885 885 other OPPS APC 885 885 other OPPS APC 885 27.63 244.53 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DISPOSABLE STRAIGHT KNOTLESS HIP FIBERTAK SUP-95-05288 CDM 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 825 other OPPS APC 825 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DISPOSABLE 3.0MM KNOTLESS SUTURETAK SUP-95-05289 CDM 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 825 other OPPS APC 825 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA TRIM IT CUSTOM HIP SUP-95-05290 CDM 0272 RC outpatient 227.5 227.5 227.5 74 168.35 percent of total billed charges 227.5 93 184.28 percent of total billed charges 227.5 227.5 other OPPS APC 227.5 227.5 other OPPS APC 227.5 27.63 62.86 percent of total billed charges 227.5 227.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SCORPION HIP LENGTH SUP-95-05291 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHAVER ARTHROSCOPY TORPEDO HIP LENGTH 4.2MM X 19CM SUP-95-05292 CDM 0272 RC outpatient 353.5 353.5 353.5 74 261.59 percent of total billed charges 353.5 93 286.34 percent of total billed charges 353.5 353.5 other OPPS APC 353.5 353.5 other OPPS APC 353.5 27.63 97.67 percent of total billed charges 353.5 353.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DISPOSABLES FIBERTAK CURVED SUP-95-05295 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DISPOSABLES FIBERTAK STRAIGHT SUP-95-05296 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SUTURE MONOCRYL 2-0 36"" SH UNDYED Y417H" SUP-95-05298 CDM 0272 RC outpatient 1.84 1.84 1.84 74 1.36 percent of total billed charges 1.84 93 1.49 percent of total billed charges 1.84 1.84 other OPPS APC 1.84 1.84 other OPPS APC 1.84 27.63 0.51 percent of total billed charges 1.84 1.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TENSIONER/CUTTER SUTURE KNEE SUP-95-05299 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZONE NAVIGATOR SUP-95-05302 CDM 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 750 other OPPS APC 750 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA ANTERIOR ZONE NAVIGATOR SUP-95-05303 CDM 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA MID/POST LEFT ZONE NAVIGATOR SUP-95-05304 CDM 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA MID/POST RIGHT ZONE NAVIGATOR SUP-95-05305 CDM 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRENGUARD 450 PROCEDURE PACK SUP-95-05317 CDM 0272 RC outpatient 313.25 313.25 313.25 74 231.81 percent of total billed charges 313.25 93 253.73 percent of total billed charges 313.25 313.25 other OPPS APC 313.25 313.25 other OPPS APC 313.25 27.63 86.55 percent of total billed charges 313.25 313.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIMANO BEACH CHAIR KIT/6 SUP-95-05322 CDM 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 262.5 other OPPS APC 262.5 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UTERINE MANIPULATOR ADVINCULA DELINEATOR 2.5CM SUP-95-05330 CDM 0272 RC outpatient 824.23 824.23 824.23 74 609.93 percent of total billed charges 824.23 93 667.63 percent of total billed charges 824.23 824.23 other OPPS APC 824.23 824.23 other OPPS APC 824.23 27.63 227.73 percent of total billed charges 824.23 824.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UTERINE MANIPULATOR ADVINCULA DELINEATOR 3.0CM SUP-95-05331 CDM 0272 RC outpatient 824.23 824.23 824.23 74 609.93 percent of total billed charges 824.23 93 667.63 percent of total billed charges 824.23 824.23 other OPPS APC 824.23 824.23 other OPPS APC 824.23 27.63 227.73 percent of total billed charges 824.23 824.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UTERINE MANIPULATOR ADVINCULA DELINEATOR 3.5CM SUP-95-05332 CDM 0272 RC outpatient 824.23 824.23 824.23 74 609.93 percent of total billed charges 824.23 93 667.63 percent of total billed charges 824.23 824.23 other OPPS APC 824.23 824.23 other OPPS APC 824.23 27.63 227.73 percent of total billed charges 824.23 824.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UTERINE MANIPULATOR ADVINCULA DELINEATOR 4.0CM SUP-95-05333 CDM 0272 RC outpatient 824.23 824.23 824.23 74 609.93 percent of total billed charges 824.23 93 667.63 percent of total billed charges 824.23 824.23 other OPPS APC 824.23 824.23 other OPPS APC 824.23 27.63 227.73 percent of total billed charges 824.23 824.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "STRAP STIRRUP DISPOSABLE 19 X 3.5"" SLIP RING" SUP-95-05335 CDM 0272 RC outpatient 20.93 20.93 20.93 74 15.49 percent of total billed charges 20.93 93 16.95 percent of total billed charges 20.93 20.93 other OPPS APC 20.93 20.93 other OPPS APC 20.93 27.63 5.78 percent of total billed charges 20.93 20.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA PASSPORT BUTTON 8MM ID X 3CM SUP-95-05347 CDM 0272 RC outpatient 128 128 128 74 94.72 percent of total billed charges 128 93 103.68 percent of total billed charges 128 128 other OPPS APC 128 128 other OPPS APC 128 27.63 35.37 percent of total billed charges 128 128 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA PASSPORT BUTTON 8MM ID X 4CM SUP-95-05348 CDM 0272 RC outpatient 128 128 128 74 94.72 percent of total billed charges 128 93 103.68 percent of total billed charges 128 128 other OPPS APC 128 128 other OPPS APC 128 27.63 35.37 percent of total billed charges 128 128 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA PASSPORT BUTTON 10MM ID X 3CM SUP-95-05349 CDM 0272 RC outpatient 128 128 128 74 94.72 percent of total billed charges 128 93 103.68 percent of total billed charges 128 128 other OPPS APC 128 128 other OPPS APC 128 27.63 35.37 percent of total billed charges 128 128 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA GEMINI SR8 8.25MM X 9CM BX/5 SUP-95-05350 CDM 0272 RC outpatient 128 128 128 74 94.72 percent of total billed charges 128 93 103.68 percent of total billed charges 128 128 other OPPS APC 128 128 other OPPS APC 128 27.63 35.37 percent of total billed charges 128 128 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE PIN 2.0MM TARGETING MICA SUP-95-05351 CDM 0272 RC outpatient 234.5 234.5 234.5 74 173.53 percent of total billed charges 234.5 93 189.95 percent of total billed charges 234.5 234.5 other OPPS APC 234.5 234.5 other OPPS APC 234.5 27.63 64.79 percent of total billed charges 234.5 234.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SWITCHING STICK 2.6MM X 305MM SUP-95-05352 CDM 0272 RC outpatient 280 280 280 74 207.2 percent of total billed charges 280 93 226.8 percent of total billed charges 280 280 other OPPS APC 280 280 other OPPS APC 280 27.63 77.36 percent of total billed charges 280 280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK 5.5MM HEADED SUP-95-05353 CDM 0272 RC outpatient 499.1 499.1 499.1 74 369.33 percent of total billed charges 499.1 93 404.27 percent of total billed charges 499.1 499.1 other OPPS APC 499.1 499.1 other OPPS APC 499.1 27.63 137.9 percent of total billed charges 499.1 499.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 3.8 X 180MM CANNULATED 3/16IN CONNECTION SUP-95-05354 CDM 0272 RC outpatient 350 350 350 74 259 percent of total billed charges 350 93 283.5 percent of total billed charges 350 350 other OPPS APC 350 350 other OPPS APC 350 27.63 96.71 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL AND PASSING WIRE CANNULATED 2.4MM SUP-95-05356 CDM 0272 RC outpatient 885 885 885 74 654.9 percent of total billed charges 885 93 716.85 percent of total billed charges 885 885 other OPPS APC 885 885 other OPPS APC 885 27.63 244.53 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE CAPSULOTOMY WITH HANDLE DISPOSABLE SUP-95-05357 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE CAPSULOTOMY CURVED WITH HANDLE DISPOSABLE SUP-95-05358 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE PASSER HIP SWIFTSTITCH SUP-95-05359 CDM 0272 RC outpatient 720 720 720 74 532.8 percent of total billed charges 720 93 583.2 percent of total billed charges 720 720 other OPPS APC 720 720 other OPPS APC 720 27.63 198.94 percent of total billed charges 720 720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE PASSER CAPSULESTITCH SUP-95-05360 CDM 0272 RC outpatient 885 885 885 74 654.9 percent of total billed charges 885 93 716.85 percent of total billed charges 885 885 other OPPS APC 885 885 other OPPS APC 885 27.63 244.53 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 1.6MM FOR FIBERTAK SUP-95-05361 CDM 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 367.5 other OPPS APC 367.5 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 1.8MM FOR FIBERTAK SUP-95-05362 CDM 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 367.5 other OPPS APC 367.5 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHAVER ARTHROSCOPY TORPEDO CURVED HIP LENGTH 4.2MM X 19CM SUP-95-05363 CDM 0272 RC outpatient 353.5 353.5 353.5 74 261.59 percent of total billed charges 353.5 93 286.34 percent of total billed charges 353.5 353.5 other OPPS APC 353.5 353.5 other OPPS APC 353.5 27.63 97.67 percent of total billed charges 353.5 353.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR ROUND HIP LENGTH RETRACT 8 FLUTE 5MM X 18CM SUP-95-05364 CDM 0272 RC outpatient 353.5 353.5 353.5 74 261.59 percent of total billed charges 353.5 93 286.34 percent of total billed charges 353.5 353.5 other OPPS APC 353.5 353.5 other OPPS APC 353.5 27.63 97.67 percent of total billed charges 353.5 353.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE CUTTER HIP LENGTH 4.2MM X 19CM SUP-95-05365 CDM 0272 RC outpatient 269.5 269.5 269.5 74 199.43 percent of total billed charges 269.5 93 218.3 percent of total billed charges 269.5 269.5 other OPPS APC 269.5 269.5 other OPPS APC 269.5 27.63 74.46 percent of total billed charges 269.5 269.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE CUTTER CURVED HIP LENGTH 4.2MM X 19CM SUP-95-05366 CDM 0272 RC outpatient 269.5 269.5 269.5 74 199.43 percent of total billed charges 269.5 93 218.3 percent of total billed charges 269.5 269.5 other OPPS APC 269.5 269.5 other OPPS APC 269.5 27.63 74.46 percent of total billed charges 269.5 269.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLINGSHOT 70 UP CAPSULE RESTORATION SUP-95-05367 CDM 0272 RC outpatient 1133.28 1133.28 1133.28 74 838.63 percent of total billed charges 1133.28 93 917.96 percent of total billed charges 1133.28 1133.28 other OPPS APC 1133.28 1133.28 other OPPS APC 1133.28 27.63 313.13 percent of total billed charges 1133.28 1133.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE MANAGER NANOPASS REACH LEFT 45 DEGREE SUP-95-05368 CDM 0272 RC outpatient 1034.64 1034.64 1034.64 74 765.63 percent of total billed charges 1034.64 93 838.06 percent of total billed charges 1034.64 1034.64 other OPPS APC 1034.64 1034.64 other OPPS APC 1034.64 27.63 285.87 percent of total billed charges 1034.64 1034.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE MANAGER NANOPASS REACH RIGHT 45 DEGREE SUP-95-05369 CDM 0272 RC outpatient 1034.64 1034.64 1034.64 74 765.63 percent of total billed charges 1034.64 93 838.06 percent of total billed charges 1034.64 1034.64 other OPPS APC 1034.64 1034.64 other OPPS APC 1034.64 27.63 285.87 percent of total billed charges 1034.64 1034.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 1.8MM FLEXIBLE HIP FLUTED FTAK SUP-95-05370 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 1.9MM FLEXIBLE HIP FLUTED FTAK SUP-95-05371 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK 3MM HEADLESS SUP-95-05372 CDM 0272 RC outpatient 499.1 499.1 499.1 74 369.33 percent of total billed charges 499.1 93 404.27 percent of total billed charges 499.1 499.1 other OPPS APC 499.1 499.1 other OPPS APC 499.1 27.63 137.9 percent of total billed charges 499.1 499.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE ROD BALL TIPPED 3 X 550MM PHANTOM SUP-95-05374 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN GUIDE DRILL 3 X 320MM PRECISION PHANTOM SUP-95-05375 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 3.8 X 250MM SOLID TROCAR TIP SUP-95-05376 CDM 0272 RC outpatient 350 350 350 74 259 percent of total billed charges 350 93 283.5 percent of total billed charges 350 350 other OPPS APC 350 350 other OPPS APC 350 27.63 96.71 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 2.3 X 300MM SINGLE ENDED TROCAR TIP SUP-95-05377 CDM 0272 RC outpatient 80 80 80 74 59.2 percent of total billed charges 80 93 64.8 percent of total billed charges 80 80 other OPPS APC 80 80 other OPPS APC 80 27.63 22.1 percent of total billed charges 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK CANNULATED HEADLESS SUP-95-05378 CDM 0272 RC outpatient 1530.75 1530.75 1530.75 74 1132.76 percent of total billed charges 1530.75 93 1239.91 percent of total billed charges 1530.75 1530.75 other OPPS APC 1530.75 1530.75 other OPPS APC 1530.75 27.63 422.95 percent of total billed charges 1530.75 1530.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRIVER CANNULATED T8 SUP-95-05379 CDM 0272 RC outpatient 1963.65 1963.65 1963.65 74 1453.1 percent of total billed charges 1963.65 93 1590.56 percent of total billed charges 1963.65 1963.65 other OPPS APC 1963.65 1963.65 other OPPS APC 1963.65 27.63 542.56 percent of total billed charges 1963.65 1963.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR OVAL 15MM DIA 5MM SUP-95-05380 CDM 0272 RC outpatient 1050 1050 1050 74 777 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 1050 other OPPS APC 1050 1050 other OPPS APC 1050 27.63 290.12 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL FLEXIBLE 1.8MM FIBERTAK SUP-95-05381 CDM 0272 RC outpatient 422.63 422.63 422.63 74 312.75 percent of total billed charges 422.63 93 342.33 percent of total billed charges 422.63 422.63 other OPPS APC 422.63 422.63 other OPPS APC 422.63 27.63 116.77 percent of total billed charges 422.63 422.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SCORPION HD (PK/5) SUP-95-05387 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE PROLENE 0 CT-1 30IN 8424H SUP-95-05389 CDM 0272 RC outpatient 2.19 2.19 2.19 74 1.62 percent of total billed charges 2.19 93 1.77 percent of total billed charges 2.19 2.19 other OPPS APC 2.19 2.19 other OPPS APC 2.19 27.63 0.61 percent of total billed charges 2.19 2.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GOLDLINE FOOT CONTROL PENCIL SUP-95-05390 CDM 0272 RC outpatient 2.58 2.58 2.58 74 1.91 percent of total billed charges 2.58 93 2.09 percent of total billed charges 2.58 2.58 other OPPS APC 2.58 2.58 other OPPS APC 2.58 27.63 0.71 percent of total billed charges 2.58 2.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Z GUIDE WIRE 1.5 X 50 SUP-95-05393 CDM 0272 RC outpatient 350 350 350 74 259 percent of total billed charges 350 93 283.5 percent of total billed charges 350 350 other OPPS APC 350 350 other OPPS APC 350 27.63 96.71 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SAW BLADE LAPIPLASTY 40 X 11MM SUP-95-05394 CDM 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 200 other OPPS APC 200 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSTRUMENT SPEEDRELEASE GUIDED RELEASE SUP-95-05395 CDM 0272 RC outpatient 1494 1494 1494 74 1105.56 percent of total billed charges 1494 93 1210.14 percent of total billed charges 1494 1494 other OPPS APC 1494 1494 other OPPS APC 1494 27.63 412.79 percent of total billed charges 1494 1494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.6MM LISFRANC CHARLOTTE F&A SYSTEM SUP-95-05396 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE TROCAR 1.6 X 150MM SINGLE SUP-95-05397 CDM 0272 RC outpatient 136 136 136 74 100.64 percent of total billed charges 136 93 110.16 percent of total billed charges 136 136 other OPPS APC 136 136 other OPPS APC 136 27.63 37.58 percent of total billed charges 136 136 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOCLOT HEMOSTATIC SYSTEM 3G SUP-95-05400 CDM 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE KIT STERNUM DOUBLE WIRE STAINLESS STEEL SUP-95-05403 CDM 0272 RC outpatient 344.75 344.75 344.75 74 255.12 percent of total billed charges 344.75 93 279.25 percent of total billed charges 344.75 344.75 other OPPS APC 344.75 344.75 other OPPS APC 344.75 27.63 95.25 percent of total billed charges 344.75 344.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE KIT STERNUM SINGLE WIRE STAINLESS STEEL SUP-95-05404 CDM 0272 RC outpatient 783 783 783 74 579.42 percent of total billed charges 783 93 634.23 percent of total billed charges 783 783 other OPPS APC 783 783 other OPPS APC 783 27.63 216.34 percent of total billed charges 783 783 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.7MM SUP-95-05406 CDM 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE TENDON STRIPPER 10MM SUP-95-05408 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER LOW PROFILE SUP-95-05409 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE PIN 2.5 X 220MM PERFORM+ SUP-95-05410 CDM 0272 RC outpatient 318.5 318.5 318.5 74 235.69 percent of total billed charges 318.5 93 257.99 percent of total billed charges 318.5 318.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEPIN ORTHOPEDIC AEQUALIS REVERSED II PERFORM+ 2.5MM 220MM STERILE SINGLE-USE SUP-95-05410 CDM 0272 RC outpatient 318.5 318.5 318.5 318.5 other OPPS APC 318.5 318.5 other OPPS APC 318.5 27.63 88 percent of total billed charges 318.5 318.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BIO 4 1CC SUP-95-05411 CDM C1734 HCPCS 0278 RC outpatient 877.5 877.5 877.5 57 500.18 percent of total billed charges 877.5 93 710.78 percent of total billed charges 877.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 877.5 other OPPS APC 877.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 877.5 other OPPS APC 877.5 51 447.53 percent of total billed charges 877.5 877.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TWITCHVIEW ADULT ELECTRODE ARRAY SUP-95-05412 CDM 0272 RC outpatient 100 100 100 74 74 percent of total billed charges 100 93 81 percent of total billed charges 100 100 other OPPS APC 100 100 other OPPS APC 100 27.63 27.63 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TWITCHVIEW MEDIUM ELECTRODE ARRAY SUP-95-05413 CDM 0272 RC outpatient 100 100 100 74 74 percent of total billed charges 100 93 81 percent of total billed charges 100 100 other OPPS APC 100 100 other OPPS APC 100 27.63 27.63 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE STRATAFIX MONOCRYL 4-0 18IN SUP-95-05414 CDM 0272 RC outpatient 115.54 115.54 115.54 74 85.5 percent of total billed charges 115.54 93 93.59 percent of total billed charges 115.54 115.54 other OPPS APC 115.54 115.54 other OPPS APC 115.54 27.63 31.92 percent of total billed charges 115.54 115.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE STRATAFIX MONOCRYL 2-0 18IN SUP-95-05415 CDM 0272 RC outpatient 115.54 115.54 115.54 74 85.5 percent of total billed charges 115.54 93 93.59 percent of total billed charges 115.54 115.54 other OPPS APC 115.54 115.54 other OPPS APC 115.54 27.63 31.92 percent of total billed charges 115.54 115.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VISIGI 3D 40FR FOR SLEEVE SUP-95-05419 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE OLECRANON 4 HOLE RIGHT SUP-95-05421 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING ONLY PREVENA 13CM PEEL AND PLACE SUP-95-05423 CDM 0272 RC outpatient 911.55 911.55 911.55 74 674.55 percent of total billed charges 911.55 93 738.36 percent of total billed charges 911.55 911.55 other OPPS APC 911.55 911.55 other OPPS APC 911.55 27.63 251.86 percent of total billed charges 911.55 911.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PREVENA 20CM PEEL AND PLACE KIT SUP-95-05424 CDM 0272 RC outpatient 1529.55 1529.55 1529.55 74 1131.87 percent of total billed charges 1529.55 93 1238.94 percent of total billed charges 1529.55 1529.55 other OPPS APC 1529.55 1529.55 other OPPS APC 1529.55 27.63 422.61 percent of total billed charges 1529.55 1529.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PREVENA 13CM PEEL AND PLACE KIT SUP-95-05425 CDM 0272 RC outpatient 1529.55 1529.55 1529.55 74 1131.87 percent of total billed charges 1529.55 93 1238.94 percent of total billed charges 1529.55 1529.55 other OPPS APC 1529.55 1529.55 other OPPS APC 1529.55 27.63 422.61 percent of total billed charges 1529.55 1529.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PREVENA CUSTOMIZABLE SYSTEM KIT SUP-95-05426 CDM outpatient 2008.5 2008.5 2008.5 2008.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL CANNULATED 4.6 X 220MM SUP-95-05433 CDM 0272 RC outpatient 350 350 350 74 259 percent of total billed charges 350 93 283.5 percent of total billed charges 350 350 other OPPS APC 350 350 other OPPS APC 350 27.63 96.71 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL CANNULATED AO 3.5 X 160MM SUP-95-05434 CDM 0272 RC outpatient 350 350 350 74 259 percent of total billed charges 350 93 283.5 percent of total billed charges 350 350 other OPPS APC 350 350 other OPPS APC 350 27.63 96.71 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOUND PROCESSOR PONTO 5 MINI TERRACOTTA SUP-95-05437 CDM L8690 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE STRATAFIX MONOCRYL BIDIRECTIONAL 2-0 CT-1 SXMP2B401 SUP-95-05438 CDM 0272 RC outpatient 118.63 118.63 118.63 74 87.79 percent of total billed charges 118.63 93 96.09 percent of total billed charges 118.63 118.63 other OPPS APC 118.63 118.63 other OPPS APC 118.63 27.63 32.78 percent of total billed charges 118.63 118.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALER BIPOLAR AQUAMANTYS 2.3 SUP-95-05439 CDM 0272 RC outpatient 1615.95 1615.95 1615.95 74 1195.8 percent of total billed charges 1615.95 93 1308.92 percent of total billed charges 1615.95 1615.95 other OPPS APC 1615.95 1615.95 other OPPS APC 1615.95 27.63 446.49 percent of total billed charges 1615.95 1615.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GASTROSTOMY FEEDING TUBE KIT WITH BALLOON LOW PROFILE MIC KEY 16FR 2.0CM STOMA LENGTH SUP-95-05440 CDM outpatient 331.87 331.87 331.87 331.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNEE KIT TRIMANO SUP-95-05442 CDM 0272 RC outpatient 160 160 160 74 118.4 percent of total billed charges 160 93 129.6 percent of total billed charges 160 160 other OPPS APC 160 160 other OPPS APC 160 27.63 44.21 percent of total billed charges 160 160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER CANNULATED 3.2MM AO QC FLEX THREAD SUP-95-05444 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2 X 175MM AO QC FLEX THREAD SUP-95-05445 CDM 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 437.5 other OPPS APC 437.5 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER CANNULATED 4.2MM SUP-95-05446 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE 1.6MM FLEX THREAD SUP-95-05447 CDM 0272 RC outpatient 100 100 100 74 74 percent of total billed charges 100 93 81 percent of total billed charges 100 100 other OPPS APC 100 100 other OPPS APC 100 27.63 27.63 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER CANNULATED 5.2MM AO QC FLEX THREAD SUP-95-05448 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE FREE 1/2 CIRCLE SIZE 5 REVERSE CUT SUP-95-05471 CDM 0272 RC outpatient 39.79 39.79 39.79 74 29.44 percent of total billed charges 39.79 93 32.23 percent of total billed charges 39.79 39.79 other OPPS APC 39.79 39.79 other OPPS APC 39.79 27.63 10.99 percent of total billed charges 39.79 39.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE PROLENE 10-0 TG140-8 12IN SUP-95-05472 CDM 0272 RC outpatient 60.21 60.21 60.21 74 44.56 percent of total billed charges 60.21 93 48.77 percent of total billed charges 60.21 60.21 other OPPS APC 60.21 60.21 other OPPS APC 60.21 27.63 16.64 percent of total billed charges 60.21 60.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ETHILON 10-0 TG140-8 12IN SUP-95-05473 CDM 0272 RC outpatient 47.87 47.87 47.87 74 35.42 percent of total billed charges 47.87 93 38.77 percent of total billed charges 47.87 47.87 other OPPS APC 47.87 47.87 other OPPS APC 47.87 27.63 13.23 percent of total billed charges 47.87 47.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERTAK KNEE DISPOSABLE KIT SUP-95-05475 CDM 0272 RC outpatient 735 735 735 74 543.9 percent of total billed charges 735 93 595.35 percent of total billed charges 735 735 other OPPS APC 735 735 other OPPS APC 735 27.63 203.08 percent of total billed charges 735 735 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE CHROMIC 1 CTX 36IN 905H SUP-95-05481 CDM 0272 RC outpatient 3.04 3.04 3.04 74 2.25 percent of total billed charges 3.04 93 2.46 percent of total billed charges 3.04 3.04 other OPPS APC 3.04 3.04 other OPPS APC 3.04 27.63 0.84 percent of total billed charges 3.04 3.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREWDRIVER SHAFT SUP-95-05483 CDM 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 750 other OPPS APC 750 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREDRIVER SHAFT T8 SUP-95-05484 CDM 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 750 other OPPS APC 750 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT MIC-KEY GASTRO W/BALLOON 24 FR 2CM SUP-95-05485 CDM B4087 HCPCS 0272 RC outpatient 328.58 328.58 328.58 74 243.15 percent of total billed charges 328.58 93 266.15 percent of total billed charges 328.58 328.58 other OPPS APC 328.58 328.58 other OPPS APC 328.58 27.63 90.79 percent of total billed charges 328.58 328.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT MICK-KEY GASTRO W/BALLOON 20FR 2CM SUP-95-05486 CDM B4087 HCPCS 0272 RC outpatient 328.58 328.58 328.58 74 243.15 percent of total billed charges 328.58 93 266.15 percent of total billed charges 328.58 328.58 other OPPS APC 328.58 328.58 other OPPS APC 328.58 27.63 90.79 percent of total billed charges 328.58 328.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEINMAN PIN 1/8 PLAIN 3.2MM SUP-95-05487 CDM C1713 HCPCS 0278 RC outpatient 3.69 3.69 3.69 57 2.1 percent of total billed charges 3.69 93 2.99 percent of total billed charges 3.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.69 other OPPS APC 3.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3.69 other OPPS APC 3.69 51 1.88 percent of total billed charges 3.69 3.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOUND PROCESSOR PONTO 5 MINI STEEL GREY SUP-95-05490 CDM L8690 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL AO SCALED 2 X 105MM SUP-95-05492 CDM 0272 RC outpatient 593.46 593.46 593.46 74 439.16 percent of total billed charges 593.46 93 480.7 percent of total billed charges 593.46 593.46 other OPPS APC 593.46 593.46 other OPPS APC 593.46 27.63 163.97 percent of total billed charges 593.46 593.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.5MM SUP-95-05493 CDM 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 437.5 other OPPS APC 437.5 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE 1.1 X 22MM FRACTURE FINGER SUP-95-05502 CDM C1713 HCPCS 0272 RC outpatient 100 100 100 74 74 percent of total billed charges 100 93 81 percent of total billed charges 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 27.63 27.63 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TORPEDO 4MM CURVED SUP-95-05504 CDM 0272 RC outpatient 353.5 353.5 353.5 74 261.59 percent of total billed charges 353.5 93 286.34 percent of total billed charges 353.5 353.5 other OPPS APC 353.5 353.5 other OPPS APC 353.5 27.63 97.67 percent of total billed charges 353.5 353.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOCLOT HEMOSTATIC SYSTEM 5GM SUP-95-05513 CDM 0272 RC outpatient 3750 3750 3750 74 2775 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 3750 other OPPS APC 3750 3750 other OPPS APC 3750 27.63 1036.13 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 4MM CANNULATED SUP-95-05528 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL METAL CUTTER MR8 9CM 1.6MM DIAMETER SUP-95-05529 CDM 0272 RC outpatient 801.27 801.27 801.27 74 592.94 percent of total billed charges 801.27 93 649.03 percent of total billed charges 801.27 801.27 other OPPS APC 801.27 801.27 other OPPS APC 801.27 27.63 221.39 percent of total billed charges 801.27 801.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL METAL CUTTER MR8 9CM 3MM DIAMETER CARBIDE SUP-95-05530 CDM 0272 RC outpatient 801.27 801.27 801.27 74 592.94 percent of total billed charges 801.27 93 649.03 percent of total billed charges 801.27 801.27 other OPPS APC 801.27 801.27 other OPPS APC 801.27 27.63 221.39 percent of total billed charges 801.27 801.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL METAL CUTTER 14CM 3MM DIAMETER CARBIDE SUP-95-05531 CDM 0272 RC outpatient 801.27 801.27 801.27 74 592.94 percent of total billed charges 801.27 93 649.03 percent of total billed charges 801.27 801.27 other OPPS APC 801.27 801.27 other OPPS APC 801.27 27.63 221.39 percent of total billed charges 801.27 801.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL METAL CUTTER MR8 9CM DIA WHEEL 25.4 DIAMETER SUP-95-05532 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY FLEXISION 19G WITH SYRINGE AND STOPCOCK SUP-95-05542 CDM 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 750 other OPPS APC 750 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY FLEXISION 21G WITH SYRINGE AND STOPCOCK SUP-95-05543 CDM 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 750 other OPPS APC 750 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY FLEXISION 23G WITH SYRINGE AND STOPCOCK SUP-95-05544 CDM 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 750 other OPPS APC 750 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE 1.5 PERIPHERAL VISION IF 1000 SUP-95-05547 CDM 0272 RC outpatient 4750 4750 4750 74 3515 percent of total billed charges 4750 93 3847.5 percent of total billed charges 4750 4750 other OPPS APC 4750 4750 other OPPS APC 4750 27.63 1312.43 percent of total billed charges 4750 4750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SWIVEL CONNECTOR ION SUP-95-05550 CDM 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER PROBE AND ADAPTER SUCTION ION VISION SUP-95-05552 CDM 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 200 other OPPS APC 200 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE BAG ION VISION SUP-95-05553 CDM 0272 RC outpatient 88 88 88 74 65.12 percent of total billed charges 88 93 71.28 percent of total billed charges 88 88 other OPPS APC 88 88 other OPPS APC 88 27.63 24.31 percent of total billed charges 88 88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEX DRIVER SET SCREW 2MM SUP-95-05561 CDM 0272 RC outpatient 238 238 238 74 176.12 percent of total billed charges 238 93 192.78 percent of total billed charges 238 238 other OPPS APC 238 238 other OPPS APC 238 27.63 65.76 percent of total billed charges 238 238 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER BLADE PATELLA SIZE 41 SUP-95-05562 CDM 0272 RC outpatient 350 350 350 74 259 percent of total billed charges 350 93 283.5 percent of total billed charges 350 350 other OPPS APC 350 350 other OPPS APC 350 27.63 96.71 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OVERDRILL 3.5 DIA FOR LAGGING SCREWS SUP-95-05564 CDM 0272 RC outpatient 368.04 368.04 368.04 74 272.35 percent of total billed charges 368.04 93 298.11 percent of total billed charges 368.04 368.04 other OPPS APC 368.04 368.04 other OPPS APC 368.04 27.63 101.69 percent of total billed charges 368.04 368.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.6 X 220MM AO SUP-95-05565 CDM 0272 RC outpatient 266 266 266 74 196.84 percent of total billed charges 266 93 215.46 percent of total billed charges 266 266 other OPPS APC 266 266 other OPPS APC 266 27.63 73.5 percent of total billed charges 266 266 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HANDLE CANNULATED AO MICA SCREW SYSTEM SUP-95-05566 CDM 0272 RC outpatient 266 266 266 74 196.84 percent of total billed charges 266 93 215.46 percent of total billed charges 266 266 other OPPS APC 266 266 other OPPS APC 266 27.63 73.5 percent of total billed charges 266 266 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEPTH GUAGE MICA 150MM SUP-95-05567 CDM 0272 RC outpatient 469 469 469 74 347.06 percent of total billed charges 469 93 379.89 percent of total billed charges 469 469 other OPPS APC 469 469 other OPPS APC 469 27.63 129.58 percent of total billed charges 469 469 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3X60MM MICA CANNULATED SUP-95-05568 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 0.9 X 150MM BLUNT TROCAR SUP-95-05569 CDM 0272 RC outpatient 136 136 136 74 100.64 percent of total billed charges 136 93 110.16 percent of total billed charges 136 136 other OPPS APC 136 136 other OPPS APC 136 27.63 37.58 percent of total billed charges 136 136 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICA HEX DRIVER 2.5 SUP-95-05570 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICA HEX DRIVER 2.0 SUP-95-05571 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 1.4 X 150MM BLUNT TROCAR SUP-95-05572 CDM 0272 RC outpatient 136 136 136 74 100.64 percent of total billed charges 136 93 110.16 percent of total billed charges 136 136 other OPPS APC 136 136 other OPPS APC 136 27.63 37.58 percent of total billed charges 136 136 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIS STERILE INSTRUMENT PACK SUP-95-05573 CDM 0272 RC outpatient 840 840 840 74 621.6 percent of total billed charges 840 93 680.4 percent of total billed charges 840 840 other OPPS APC 840 840 other OPPS APC 840 27.63 232.09 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SURGICAL IRRIGATION TUBE SUP-95-05574 CDM 0272 RC outpatient 266 266 266 74 196.84 percent of total billed charges 266 93 215.46 percent of total billed charges 266 266 other OPPS APC 266 266 other OPPS APC 266 27.63 73.5 percent of total billed charges 266 266 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAILOR'S BUNION BROACH SET PROSTEP SUP-95-05575 CDM 0272 RC outpatient 1173 1173 1173 74 868.02 percent of total billed charges 1173 93 950.13 percent of total billed charges 1173 1173 other OPPS APC 1173 1173 other OPPS APC 1173 27.63 324.1 percent of total billed charges 1173 1173 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICA BURR 2 X 20MM SUP-95-05576 CDM 0272 RC outpatient 1173 1173 1173 74 868.02 percent of total billed charges 1173 93 950.13 percent of total billed charges 1173 1173 other OPPS APC 1173 1173 other OPPS APC 1173 27.63 324.1 percent of total billed charges 1173 1173 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICA BURR 2 X 12MM SUP-95-05577 CDM 0272 RC outpatient 1173 1173 1173 74 868.02 percent of total billed charges 1173 93 950.13 percent of total billed charges 1173 1173 other OPPS APC 1173 1173 other OPPS APC 1173 27.63 324.1 percent of total billed charges 1173 1173 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT CANNULATED 2.0MM SUP-95-05580 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT CANNULATED 3.0MM SUP-95-05581 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TARGET GUIDE PACK SUP-95-05582 CDM 0272 RC outpatient 708 708 708 74 523.92 percent of total billed charges 708 93 573.48 percent of total billed charges 708 708 other OPPS APC 708 708 other OPPS APC 708 27.63 195.62 percent of total billed charges 708 708 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 0.9 X 102MM PHALINX HAMMERTOE SUP-95-05583 CDM 0272 RC outpatient 136 136 136 74 100.64 percent of total billed charges 136 93 110.16 percent of total billed charges 136 136 other OPPS APC 136 136 other OPPS APC 136 27.63 37.58 percent of total billed charges 136 136 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 2.2MM CANNULATED PHALINX HAMMERTOE SUP-95-05584 CDM 0272 RC outpatient 738 738 738 74 546.12 percent of total billed charges 738 93 597.78 percent of total billed charges 738 738 other OPPS APC 738 738 other OPPS APC 738 27.63 203.91 percent of total billed charges 738 738 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 2.2 PHALINX HAMMERTOE SUP-95-05585 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEPTH GUAGE MICA 150MM SUP-95-05586 CDM 0272 RC outpatient 939 939 939 74 694.86 percent of total billed charges 939 93 760.59 percent of total billed charges 939 939 other OPPS APC 939 939 other OPPS APC 939 27.63 259.45 percent of total billed charges 939 939 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLARIFIX SUP-95-05587 CDM 0272 RC outpatient 4805.75 4805.75 4805.75 74 3556.26 percent of total billed charges 4805.75 93 3892.66 percent of total billed charges 4805.75 4805.75 other OPPS APC 4805.75 4805.75 other OPPS APC 4805.75 27.63 1327.83 percent of total billed charges 4805.75 4805.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMARK T1 BIOPSY MARKER - STEREO SUP-95-05588 CDM C1819 HCPCS 0278 RC outpatient 323.85 323.85 323.85 57 184.59 percent of total billed charges 323.85 93 262.32 percent of total billed charges 323.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 323.85 other OPPS APC 323.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 323.85 other OPPS APC 323.85 51 165.16 percent of total billed charges 323.85 323.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHAMBER REPL TISSUE 8G MGMT SYSTEM SUP-95-05589 CDM 0272 RC outpatient 210.85 210.85 210.85 74 156.03 percent of total billed charges 210.85 93 170.79 percent of total billed charges 210.85 210.85 other OPPS APC 210.85 210.85 other OPPS APC 210.85 27.63 58.26 percent of total billed charges 210.85 210.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE SINGLE ENDED TROCAR TIP SMOOTH 2.0 X 200MM SUP-95-05592 CDM C1713 HCPCS 0278 RC outpatient 80 80 80 57 45.6 percent of total billed charges 80 93 64.8 percent of total billed charges 80 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 80 other OPPS APC 80 80 other OPPS APC 80 51 40.8 percent of total billed charges 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 1.4 X 150MM SINGLE ENDED TROCAR TIP SMOOTH SUP-95-05593 CDM outpatient 80 80 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN SCHANZ 5.0MM AO CONNECT SUP-95-05594 CDM 0272 RC outpatient 341.25 341.25 341.25 74 252.53 percent of total billed charges 341.25 93 276.41 percent of total billed charges 341.25 341.25 other OPPS APC 341.25 341.25 other OPPS APC 341.25 27.63 94.29 percent of total billed charges 341.25 341.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 1.4 X 150MM TREADED SUP-95-05595 CDM 0272 RC outpatient 80 80 80 74 59.2 percent of total billed charges 80 93 64.8 percent of total billed charges 80 80 other OPPS APC 80 80 other OPPS APC 80 27.63 22.1 percent of total billed charges 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEDINOL PHENOL EZ SWAB PK/30 SWABS SUP-95-05599 CDM 0272 RC outpatient 31.06 31.06 31.06 74 22.98 percent of total billed charges 31.06 93 25.16 percent of total billed charges 31.06 31.06 other OPPS APC 31.06 31.06 other OPPS APC 31.06 27.63 8.58 percent of total billed charges 31.06 31.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APDYNE PHENOL APPLICATOR KIT MULTIPLE DOSE SUP-95-05600 CDM 0272 RC outpatient 158.61 158.61 158.61 74 117.37 percent of total billed charges 158.61 93 128.47 percent of total billed charges 158.61 158.61 other OPPS APC 158.61 158.61 other OPPS APC 158.61 27.63 43.82 percent of total billed charges 158.61 158.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASCOPE 5 BRONCHOSCOPE HD 4.2/2.2 SUP-95-05603 CDM C1601 CPT outpatient 987 987 987 74 730.38 percent of total billed charges 987 93 799.47 percent of total billed charges 987 987 other OPPS APC 987 987 other OPPS APC 987 987 other OP Med Supplies 987 987 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASCOPE 5 BRONCHOSCOPE 2.7/1.2 SUP-95-05604 CDM C1601 CPT outpatient 987 987 987 74 730.38 percent of total billed charges 987 93 799.47 percent of total billed charges 987 987 other OPPS APC 987 987 other OPPS APC 987 987 other OP Med Supplies 987 987 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICA BURR 2 X 8MM SUP-95-05619 CDM 0272 RC outpatient 1173 1173 1173 74 868.02 percent of total billed charges 1173 93 950.13 percent of total billed charges 1173 1173 other OPPS APC 1173 1173 other OPPS APC 1173 27.63 324.1 percent of total billed charges 1173 1173 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR WEDGE MICA 3.1 X 13MM SUP-95-05620 CDM 0272 RC outpatient 1173 1173 1173 74 868.02 percent of total billed charges 1173 93 950.13 percent of total billed charges 1173 1173 other OPPS APC 1173 1173 other OPPS APC 1173 27.63 324.1 percent of total billed charges 1173 1173 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEDIPORT - CLEARVUE 8FR SUP-95-05673 CDM C1788 HCPCS 0278 RC outpatient 714 714 714 57 406.98 percent of total billed charges 714 93 578.34 percent of total billed charges 714 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 714 other OPPS APC 714 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 714 other OPPS APC 714 27.63 197.28 percent of total billed charges 714 714 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEDIPORT - CLEARVUE LOW PROFILE SLIM PORT SUP-95-05674 CDM C1788 HCPCS 0278 RC outpatient 714 714 714 57 406.98 percent of total billed charges 714 93 578.34 percent of total billed charges 714 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 714 other OPPS APC 714 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 714 other OPPS APC 714 27.63 197.28 percent of total billed charges 714 714 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOOK 6 X 250MM SUP-95-05700 CDM 0272 RC outpatient 1503 1503 1503 74 1112.22 percent of total billed charges 1503 93 1217.43 percent of total billed charges 1503 1503 other OPPS APC 1503 1503 other OPPS APC 1503 27.63 415.28 percent of total billed charges 1503 1503 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS BIOPSY BRONCHOSCOPE CAPTURA DISPOSABLE SUP-95-05704 CDM 0272 RC outpatient 135.6 135.6 135.6 74 100.34 percent of total billed charges 135.6 93 109.84 percent of total billed charges 135.6 135.6 other OPPS APC 135.6 135.6 other OPPS APC 135.6 27.63 37.47 percent of total billed charges 135.6 135.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE FIAPC W/ FILTER 3000 A SUP-95-05709 CDM 0272 RC outpatient 772.5 772.5 772.5 74 571.65 percent of total billed charges 772.5 93 625.73 percent of total billed charges 772.5 772.5 other OPPS APC 772.5 772.5 other OPPS APC 772.5 27.63 213.44 percent of total billed charges 772.5 772.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE FIAPC W/ FILTER 2200 C SUP-95-05710 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON DILATOR WIREGUIDED 6-7-8 ELATION SUP-95-05720 CDM C1726 HCPCS 0272 RC outpatient 700 700 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAW II PLATE TACK SUP-95-05851 CDM 0272 RC outpatient 300.3 300.3 300.3 74 222.22 percent of total billed charges 300.3 93 243.24 percent of total billed charges 300.3 300.3 other OPPS APC 300.3 300.3 other OPPS APC 300.3 27.63 82.97 percent of total billed charges 300.3 300.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE MTP FUSION 10DG LT ORTHOLOC 3DI SUP-95-05852 CDM C1713 HCPCS 0278 RC outpatient 3100.5 3100.5 3100.5 57 1767.29 percent of total billed charges 3100.5 93 2511.41 percent of total billed charges 3100.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3100.5 other OPPS APC 3100.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3100.5 other OPPS APC 3100.5 51 1581.26 percent of total billed charges 3100.5 3100.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE PASSER W/ BRAIDED LOOP SUP-95-06000 CDM 0272 RC outpatient 691.25 691.25 691.25 74 511.53 percent of total billed charges 691.25 93 559.91 percent of total billed charges 691.25 691.25 other OPPS APC 691.25 691.25 other OPPS APC 691.25 27.63 190.99 percent of total billed charges 691.25 691.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - BERENSTEIN 4F X 35 SUP-95-06008 CDM 0272 RC outpatient 49.28 49.28 49.28 74 36.47 percent of total billed charges 49.28 93 39.92 percent of total billed charges 49.28 49.28 other OPPS APC 49.28 49.28 other OPPS APC 49.28 27.63 13.62 percent of total billed charges 49.28 49.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - BERENSTEIN 4F X 65 SUP-95-06009 CDM 0272 RC outpatient 44 44 44 74 32.56 percent of total billed charges 44 93 35.64 percent of total billed charges 44 44 other OPPS APC 44 44 other OPPS APC 44 27.63 12.16 percent of total billed charges 44 44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE ULTRASOUND 8G MAMMOTOME REVOLVE SUP-95-06010 CDM 0272 RC outpatient 801.38 801.38 801.38 74 593.02 percent of total billed charges 801.38 93 649.12 percent of total billed charges 801.38 801.38 other OPPS APC 801.38 801.38 other OPPS APC 801.38 27.63 221.42 percent of total billed charges 801.38 801.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE ULTRASOUND 10G MAMMOTOME REVOLVE SUP-95-06011 CDM 0272 RC outpatient 728.65 728.65 728.65 74 539.2 percent of total billed charges 728.65 93 590.21 percent of total billed charges 728.65 728.65 other OPPS APC 728.65 728.65 other OPPS APC 728.65 27.63 201.33 percent of total billed charges 728.65 728.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER TUBING ADAPTER SUP-95-06012 CDM 27000000 LOCAL 0270 RC outpatient 43.6 43.6 43.6 74 32.26 percent of total billed charges 43.6 93 35.32 percent of total billed charges 43.6 43.6 other OPPS APC 43.6 43.6 other OPPS APC 43.6 27.63 12.05 percent of total billed charges 43.6 43.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOPSY NEEDLE - CHIBA 18G X 20CM CTSUP SUP-95-06018 CDM 0272 RC outpatient 45.96 45.96 45.96 74 34.01 percent of total billed charges 45.96 93 37.23 percent of total billed charges 45.96 45.96 other OPPS APC 45.96 45.96 other OPPS APC 45.96 27.63 12.7 percent of total billed charges 45.96 45.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GLIDEWIRE - 0.035"" X 150CM ANGLED STIFF" SUP-95-06019 CDM C1769 HCPCS 0272 RC outpatient 180.6 180.6 180.6 74 133.64 percent of total billed charges 180.6 93 146.29 percent of total billed charges 180.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180.6 other OPPS APC 180.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180.6 other OPPS APC 180.6 27.63 49.9 percent of total billed charges 180.6 180.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHEST DRAIN ACCESSORY STANDARD ADULT CONNECTOR SUP-95-06020 CDM 0272 RC outpatient 26.1 26.1 26.1 74 19.31 percent of total billed charges 26.1 93 21.14 percent of total billed charges 26.1 26.1 other OPPS APC 26.1 26.1 other OPPS APC 26.1 27.63 7.21 percent of total billed charges 26.1 26.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHEST DRAIN ACCESSORY STEP-DOWN CONNECTOR SUP-95-06021 CDM 0272 RC outpatient 58.15 58.15 58.15 74 43.03 percent of total billed charges 58.15 93 47.1 percent of total billed charges 58.15 58.15 other OPPS APC 58.15 58.15 other OPPS APC 58.15 27.63 16.07 percent of total billed charges 58.15 58.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROMARK T5 BIOPSY MARKER - ULTRASOUND SUP-95-06022 CDM C1819 HCPCS 0278 RC outpatient 378.9 378.9 378.9 57 215.97 percent of total billed charges 378.9 93 306.91 percent of total billed charges 378.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378.9 other OPPS APC 378.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378.9 other OPPS APC 378.9 51 193.24 percent of total billed charges 378.9 378.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PALINDROME DIALYSIS 14.5FR X 19CM SUP-95-06046 CDM C1750 HCPCS 0278 RC outpatient 696.61 696.61 696.61 57 397.07 percent of total billed charges 696.61 93 564.25 percent of total billed charges 696.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 696.61 other OPPS APC 696.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 696.61 other OPPS APC 696.61 51 355.27 percent of total billed charges 696.61 696.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PALINDROME DIALYSIS 14.5FR X 23CM SUP-95-06047 CDM C1750 HCPCS 0278 RC outpatient 696.61 696.61 696.61 57 397.07 percent of total billed charges 696.61 93 564.25 percent of total billed charges 696.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 696.61 other OPPS APC 696.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 696.61 other OPPS APC 696.61 51 355.27 percent of total billed charges 696.61 696.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PALINDROME DIALYSIS 14.5FR X 28CM SUP-95-06048 CDM C1750 HCPCS 0278 RC outpatient 696.61 696.61 696.61 57 397.07 percent of total billed charges 696.61 93 564.25 percent of total billed charges 696.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 696.61 other OPPS APC 696.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 696.61 other OPPS APC 696.61 51 355.27 percent of total billed charges 696.61 696.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PALINDROME DIALYSIS 14.5FR X 33CM SUP-95-06049 CDM C1750 HCPCS 0278 RC outpatient 696.61 696.61 696.61 57 397.07 percent of total billed charges 696.61 93 564.25 percent of total billed charges 696.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 696.61 other OPPS APC 696.61 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 696.61 other OPPS APC 696.61 51 355.27 percent of total billed charges 696.61 696.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PALINDROME DIALYSIS 14.5FR X 44CM SUP-95-06050 CDM C1750 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PALINDROME DIALYSIS 14.5FR X 55CM SUP-95-06051 CDM C1750 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAHURKAR TEMPORARY DIALYSIS 12.5FR X 16CM SUP-95-06052 CDM C1751 HCPCS 0272 RC outpatient 233.81 233.81 233.81 74 173.02 percent of total billed charges 233.81 93 189.39 percent of total billed charges 233.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 233.81 other OPPS APC 233.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 233.81 other OPPS APC 233.81 27.63 64.6 percent of total billed charges 233.81 233.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAHURKAR TEMPORARY DIALYSIS 12.5FR X 20CM SUP-95-06053 CDM C1751 HCPCS 0272 RC outpatient 233.81 233.81 233.81 74 173.02 percent of total billed charges 233.81 93 189.39 percent of total billed charges 233.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 233.81 other OPPS APC 233.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 233.81 other OPPS APC 233.81 27.63 64.6 percent of total billed charges 233.81 233.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAHURKAR DUAL LUMEN TEMPORARY DIALYSIS 12FR X 20CM SUP-95-06054 CDM C1751 HCPCS 0272 RC outpatient 233.8 233.8 233.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 233.8 other OPPS APC 233.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 233.8 other OPPS APC 233.8 27.63 64.6 percent of total billed charges 233.8 233.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PILLCAM PATENCY CAPSULE SUP-95-23324 CDM 0272 RC outpatient 128 128 128 74 94.72 percent of total billed charges 128 93 103.68 percent of total billed charges 128 128 other OPPS APC 128 128 other OPPS APC 128 27.63 35.37 percent of total billed charges 128 128 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER SUP-95-23325 CDM 0272 RC outpatient 276.5 276.5 276.5 74 204.61 percent of total billed charges 276.5 93 223.97 percent of total billed charges 276.5 276.5 other OPPS APC 276.5 276.5 other OPPS APC 276.5 27.63 76.4 percent of total billed charges 276.5 276.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 90 EDGE KIT SUP-95-23326 CDM 0272 RC outpatient 3048.7 3048.7 3048.7 74 2256.04 percent of total billed charges 3048.7 93 2469.45 percent of total billed charges 3048.7 3048.7 other OPPS APC 3048.7 3048.7 other OPPS APC 3048.7 27.63 842.36 percent of total billed charges 3048.7 3048.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COTTON LUNG STENT SET CLSB-7-7 SUP-95-23332 CDM C2625 HCPCS 0278 RC outpatient 350 350 350 57 199.5 percent of total billed charges 350 93 283.5 percent of total billed charges 350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 350 other OPPS APC 350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 350 other OPPS APC 350 51 178.5 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COTTON LUNG STENT SET (CLBS-7-9) SUP-95-23333 CDM C2625 HCPCS 0278 RC outpatient 350 350 350 57 199.5 percent of total billed charges 350 93 283.5 percent of total billed charges 350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 350 other OPPS APC 350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 350 other OPPS APC 350 51 178.5 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COTTON LUNG STENT SET (CLBS-10-7 SUP-95-23334 CDM C2625 HCPCS 0278 RC outpatient 350 350 350 57 199.5 percent of total billed charges 350 93 283.5 percent of total billed charges 350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 350 other OPPS APC 350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 350 other OPPS APC 350 51 178.5 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALING CAP (LATEX FREE) SUP-95-23337 CDM 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 176 other OPPS APC 176 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.3MMX230CM BEAMER ARGON PROBE (10/CS) SUP-95-23350 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPER D BIOPSY FORCEP SUP-95-23363 CDM 0272 RC outpatient 354.9 354.9 354.9 74 262.63 percent of total billed charges 354.9 93 287.47 percent of total billed charges 354.9 354.9 other OPPS APC 354.9 354.9 other OPPS APC 354.9 27.63 98.06 percent of total billed charges 354.9 354.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPER D 21G ASPIRATION NEEDLE SUP-95-23364 CDM 0272 RC outpatient 516.6 516.6 516.6 74 382.28 percent of total billed charges 516.6 93 418.45 percent of total billed charges 516.6 516.6 other OPPS APC 516.6 516.6 other OPPS APC 516.6 27.63 142.74 percent of total billed charges 516.6 516.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPER D 19G ASPIRATION NEEDLE SUP-95-23365 CDM 0272 RC outpatient 1617.36 1617.36 1617.36 74 1196.85 percent of total billed charges 1617.36 93 1310.06 percent of total billed charges 1617.36 1617.36 other OPPS APC 1617.36 1617.36 other OPPS APC 1617.36 27.63 446.88 percent of total billed charges 1617.36 1617.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EDGE ADAPTER FOR 180 KIT SUP-95-23366 CDM 0272 RC outpatient 237.65 237.65 237.65 74 175.86 percent of total billed charges 237.65 93 192.5 percent of total billed charges 237.65 237.65 other OPPS APC 237.65 237.65 other OPPS APC 237.65 27.63 65.66 percent of total billed charges 237.65 237.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPER D CYTOLOGY BRUSH NEEDLE TIPPED SUP-95-23396 CDM 0272 RC outpatient 2077.11 2077.11 2077.11 74 1537.06 percent of total billed charges 2077.11 93 1682.46 percent of total billed charges 2077.11 2077.11 other OPPS APC 2077.11 2077.11 other OPPS APC 2077.11 27.63 573.91 percent of total billed charges 2077.11 2077.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPER D CORE BX SYSTEM SUP-95-23397 CDM 0272 RC outpatient 1050 1050 1050 74 777 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 1050 other OPPS APC 1050 1050 other OPPS APC 1050 27.63 290.12 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALING CAP SUP-95-23415 CDM 0272 RC outpatient 196.88 196.88 196.88 74 145.69 percent of total billed charges 196.88 93 159.47 percent of total billed charges 196.88 196.88 other OPPS APC 196.88 196.88 other OPPS APC 196.88 27.63 54.4 percent of total billed charges 196.88 196.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BD SAFETY GLIDE 27G X 5/8 NEEDLE SUP-95-23420 CDM 0272 RC outpatient 44.64 44.64 44.64 74 33.03 percent of total billed charges 44.64 93 36.16 percent of total billed charges 44.64 44.64 other OPPS APC 44.64 44.64 other OPPS APC 44.64 27.63 12.33 percent of total billed charges 44.64 44.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRIMATRIX FENESTRATED AG 4 X 4 SUP-95-23463 CDM Q4110 HCPCS 0636 RC outpatient 3950 3950 48.93 48.93 fee schedule 3950 93 3199.5 percent of total billed charges 3950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3950 other OPPS APC 3950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3950 other OPPS APC 3950 24.86 981.97 percent of total billed charges 48.93 3950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RT.NARROW EXTRA SHORT VOLAR PLATE SUP-95-23468 CDM C1713 HCPCS 0278 RC outpatient 2965.56 2965.56 2965.56 57 1690.37 percent of total billed charges 2965.56 93 2402.1 percent of total billed charges 2965.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2965.56 other OPPS APC 2965.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2965.56 other OPPS APC 2965.56 51 1512.44 percent of total billed charges 2965.56 2965.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 18 MM DISC MESHED SUP-95-23476 CDM Q4110 HCPCS 0636 RC outpatient 1824 1824 48.93 48.93 fee schedule 1824 93 1477.44 percent of total billed charges 1824 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1824 other OPPS APC 1824 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1824 other OPPS APC 1824 24.86 453.45 percent of total billed charges 48.93 1824 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON APPLICATOR SUP-95-23479 CDM 0272 RC outpatient 321.37 321.37 321.37 74 237.81 percent of total billed charges 321.37 93 260.31 percent of total billed charges 321.37 321.37 other OPPS APC 321.37 321.37 other OPPS APC 321.37 27.63 88.79 percent of total billed charges 321.37 321.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 4.0 SUP-95-23516 CDM 0272 RC outpatient 859.68 859.68 859.68 74 636.16 percent of total billed charges 859.68 93 696.34 percent of total billed charges 859.68 859.68 other OPPS APC 859.68 859.68 other OPPS APC 859.68 27.63 237.53 percent of total billed charges 859.68 859.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "OSTOMY ADAPT BELT,LARGE" SUP-95-23583 CDM A4396 HCPCS 0271 RC outpatient 69.12 69.12 69.12 74 51.15 percent of total billed charges 69.12 93 55.99 percent of total billed charges 69.12 69.12 other OPPS APC 69.12 69.12 other OPPS APC 69.12 27.63 19.1 percent of total billed charges 69.12 69.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SKIN STAPLER X35 PMR35 SUP-95-23584 CDM 0272 RC outpatient 111.12 111.12 111.12 74 82.23 percent of total billed charges 111.12 93 90.01 percent of total billed charges 111.12 111.12 other OPPS APC 111.12 111.12 other OPPS APC 111.12 27.63 30.7 percent of total billed charges 111.12 111.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7MM CAN DRILL BIT SUP-95-23601 CDM 0272 RC outpatient 780.48 780.48 780.48 74 577.56 percent of total billed charges 780.48 93 632.19 percent of total billed charges 780.48 780.48 other OPPS APC 780.48 780.48 other OPPS APC 780.48 27.63 215.65 percent of total billed charges 780.48 780.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. J-HOOK TIPS SUP-95-23607 CDM 0272 RC outpatient 215.11 215.11 215.11 74 159.18 percent of total billed charges 215.11 93 174.24 percent of total billed charges 215.11 215.11 other OPPS APC 215.11 215.11 other OPPS APC 215.11 27.63 59.43 percent of total billed charges 215.11 215.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SINGLE USE SKIN STAPLER 35W SUP-95-23608 CDM 0272 RC outpatient 345.85 345.85 345.85 74 255.93 percent of total billed charges 345.85 93 280.14 percent of total billed charges 345.85 345.85 other OPPS APC 345.85 345.85 other OPPS APC 345.85 27.63 95.56 percent of total billed charges 345.85 345.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE DOUBLE END TROCAR TIP 1.6X150MM SUP-95-23635 CDM C1713 HCPCS 0278 RC outpatient 84 84 84 57 47.88 percent of total billed charges 84 93 68.04 percent of total billed charges 84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84 other OPPS APC 84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84 other OPPS APC 84 51 42.84 percent of total billed charges 84 84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 3.5MM CANNULATED(PATENT PENDING) SUP-95-23636 CDM 0272 RC outpatient 542.5 542.5 542.5 74 401.45 percent of total billed charges 542.5 93 439.43 percent of total billed charges 542.5 542.5 other OPPS APC 542.5 542.5 other OPPS APC 542.5 27.63 149.89 percent of total billed charges 542.5 542.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.6MM DIA MAX 168MM LENGTH SUP-95-23679 CDM 0272 RC outpatient 1757.61 1757.61 1757.61 74 1300.63 percent of total billed charges 1757.61 93 1423.66 percent of total billed charges 1757.61 1757.61 other OPPS APC 1757.61 1757.61 other OPPS APC 1757.61 27.63 485.63 percent of total billed charges 1757.61 1757.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THREADED STEINMAN PIN 3/32 SUP-95-23680 CDM C1713 HCPCS 0278 RC outpatient 174.04 174.04 174.04 57 99.2 percent of total billed charges 174.04 93 140.97 percent of total billed charges 174.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.04 other OPPS APC 174.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174.04 other OPPS APC 174.04 51 88.76 percent of total billed charges 174.04 174.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLEMASTER 5MM X 25G LOWER SUP-95-23731 CDM 0272 RC outpatient 152 152 152 74 112.48 percent of total billed charges 152 93 123.12 percent of total billed charges 152 152 other OPPS APC 152 152 other OPPS APC 152 27.63 42 percent of total billed charges 152 152 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOOK KNIFE J LOWER LENGTH SUP-95-23732 CDM 0272 RC outpatient 1833 1833 1833 74 1356.42 percent of total billed charges 1833 93 1484.73 percent of total billed charges 1833 1833 other OPPS APC 1833 1833 other OPPS APC 1833 27.63 506.46 percent of total billed charges 1833 1833 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THORACIC CATHETER 12FR PVC SUP-95-23742 CDM C1729 HCPCS 0278 RC outpatient 207.06 207.06 207.06 57 118.02 percent of total billed charges 207.06 93 167.72 percent of total billed charges 207.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 207.06 other OPPS APC 207.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 207.06 other OPPS APC 207.06 51 105.6 percent of total billed charges 207.06 207.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THORACIC CATHETER 20FR PVC SUP-95-23743 CDM C1729 HCPCS 0278 RC outpatient 28.76 28.76 28.76 57 16.39 percent of total billed charges 28.76 93 23.3 percent of total billed charges 28.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28.76 other OPPS APC 28.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28.76 other OPPS APC 28.76 51 14.67 percent of total billed charges 28.76 28.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THORACIC CATHETER 24FR PVC SUP-95-23744 CDM C1729 HCPCS 0278 RC outpatient 28.4 28.4 28.4 57 16.19 percent of total billed charges 28.4 93 23 percent of total billed charges 28.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28.4 other OPPS APC 28.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28.4 other OPPS APC 28.4 51 14.48 percent of total billed charges 28.4 28.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLOW 20-PULL-S 20FR PEG KIT SUP-95-23746 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OBURATOR BLADELESS 8MM DAVINCI SUP-95-23849 CDM 0272 RC outpatient 126 126 126 74 93.24 percent of total billed charges 126 93 102.06 percent of total billed charges 126 126 other OPPS APC 126 126 other OPPS APC 126 27.63 34.81 percent of total billed charges 126 126 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENSURE TM NAV SUP-95-23860 CDM 0272 RC outpatient 3737.5 3737.5 3737.5 74 2765.75 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 3737.5 other OPPS APC 3737.5 3737.5 other OPPS APC 3737.5 27.63 1032.67 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INFLATION DEVICE SUP-95-23861 CDM 0272 RC outpatient 210 210 210 74 155.4 percent of total billed charges 210 93 170.1 percent of total billed charges 210 210 other OPPS APC 210 210 other OPPS APC 210 27.63 58.02 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTOUR INJECTION 6 X 26 SUP-95-23862 CDM C2617 HCPCS 0278 RC outpatient 470.47 470.47 470.47 57 268.17 percent of total billed charges 470.47 93 381.08 percent of total billed charges 470.47 470.47 other OPPS APC 470.47 470.47 other OPPS APC 470.47 51 239.94 percent of total billed charges 470.47 470.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTOUR VL INJECTION STENT 7F 22-30CM SUP-95-23863 CDM C2617 HCPCS 0278 RC outpatient 470.47 470.47 470.47 57 268.17 percent of total billed charges 470.47 93 381.08 percent of total billed charges 470.47 470.47 other OPPS APC 470.47 470.47 other OPPS APC 470.47 51 239.94 percent of total billed charges 470.47 470.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRETCH VL FLEXIMA 4.8 23-30CM SUP-95-23864 CDM C2617 HCPCS 0278 RC outpatient 417.59 417.59 417.59 57 238.03 percent of total billed charges 417.59 93 338.25 percent of total billed charges 417.59 417.59 other OPPS APC 417.59 417.59 other OPPS APC 417.59 51 212.97 percent of total billed charges 417.59 417.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ASPIRATION VISI SHOT 22G SUP-95-23884 CDM 0272 RC outpatient 1067.64 1067.64 1067.64 74 790.05 percent of total billed charges 1067.64 93 864.79 percent of total billed charges 1067.64 1067.64 other OPPS APC 1067.64 1067.64 other OPPS APC 1067.64 27.63 294.99 percent of total billed charges 1067.64 1067.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INJECTABLE STENT KWART 6FR SUP-95-23909 CDM C2625 HCPCS 0278 RC outpatient 437.5 437.5 437.5 57 249.38 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 51 223.13 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 6.5 X 55MM HEADLESS THD SUP-95-23922 CDM C1713 HCPCS 0278 RC outpatient 2398.5 2398.5 2398.5 57 1367.15 percent of total billed charges 2398.5 93 1942.79 percent of total billed charges 2398.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2398.5 other OPPS APC 2398.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2398.5 other OPPS APC 2398.5 51 1223.24 percent of total billed charges 2398.5 2398.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 6.5 X 60MM HEADLESS THD SUP-95-23923 CDM C1713 HCPCS 0278 RC outpatient 2398.5 2398.5 2398.5 57 1367.15 percent of total billed charges 2398.5 93 1942.79 percent of total billed charges 2398.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2398.5 other OPPS APC 2398.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2398.5 other OPPS APC 2398.5 51 1223.24 percent of total billed charges 2398.5 2398.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AI TUBING PHACO PACK SUP-95-23937 CDM 0272 RC outpatient 152 152 152 74 112.48 percent of total billed charges 152 93 123.12 percent of total billed charges 152 152 other OPPS APC 152 152 other OPPS APC 152 27.63 42 percent of total billed charges 152 152 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE ORTHOPEDIC ACTION METAL GEL L28 IN OD2 IN POLE STIRRUP HOOK PAD LATEX FREE UROLOGY GYN SUP-95-839 CDM outpatient 580.06 580.06 580.06 580.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER VENTRICULAR ANTIMOCROBIAL SUP-95001 CDM 0270 RC outpatient 2301.1 2301.1 2301.1 74 1702.81 percent of total billed charges 2301.1 93 1863.89 percent of total billed charges 2301.1 2301.1 other OPPS APC 2301.1 2301.1 other OPPS APC 2301.1 27.63 635.79 percent of total billed charges 2301.1 2301.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MANIFOLD IV Q2 MULTIPORT L10IN 6 PORT CHECK VALVE LUER LATEX FREE SUP-9520 CDM 0270 RC outpatient 30.68 30.68 30.68 74 22.7 percent of total billed charges 30.68 93 24.85 percent of total billed charges 30.68 30.68 other OPPS APC 30.68 30.68 other OPPS APC 30.68 27.63 8.48 percent of total billed charges 30.68 30.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REVEAL DX SUP-9528 CDM 0275 RC outpatient 8580 8580 8580 57 4890.6 percent of total billed charges 8580 93 6949.8 percent of total billed charges 8580 8580 other OPPS APC 8580 8580 other OPPS APC 8580 51 4375.8 percent of total billed charges 8580 8580 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING COMPRESSION KENDALL SCD KENDALL SCD EXPRESS L7 FT SET SLEEVE SUP-9528 CDM 0270 RC outpatient 64.22 64.22 64.22 74 47.52 percent of total billed charges 64.22 93 52.02 percent of total billed charges 64.22 64.22 other OPPS APC 64.22 64.22 other OPPS APC 64.22 27.63 17.74 percent of total billed charges 64.22 64.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE COMPRESSION MED KNEE LENGTH KENDALL SCD EXPRESS ADJUSTABLE CIRCUMFERENTIAL SUP-9529 CDM 0270 RC outpatient 33.86 33.86 33.86 74 25.06 percent of total billed charges 33.86 93 27.43 percent of total billed charges 33.86 33.86 other OPPS APC 33.86 33.86 other OPPS APC 33.86 27.63 9.36 percent of total billed charges 33.86 33.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CARDIAC MONITOR REVEAL XT TITANIUM SILICONE POLYURETHANE D8 MM 3.6V 256HZ SMALL W19 MM X H62 MM 9 ML 15 GM INSERTABLE IMPLANTABLE 2 ELECTRODE SUP-9529 CDM 0270 RC outpatient 9607 9607 9607 74 7109.18 percent of total billed charges 9607 93 7781.67 percent of total billed charges 9607 9607 other OPPS APC 9607 9607 other OPPS APC 9607 27.63 2654.41 percent of total billed charges 9607 9607 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE COMPRESSION KENDALL SCD EXPRESS MEDIUM KNEE LENGTH OD21- IN ADJUSTABLE CIRCUMFERENTIAL BLADDER STREAMLINE CONNECTOR NONSTERILE LATEX FREE DISPOSABLE SUP-9529B CDM 0270 RC outpatient 33.86 33.86 33.86 74 25.06 percent of total billed charges 33.86 93 27.43 percent of total billed charges 33.86 33.86 other OPPS APC 33.86 33.86 other OPPS APC 33.86 27.63 9.36 percent of total billed charges 33.86 33.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE COMPRESSION KENDALL SCD KAMBIA MEDIUM THIGH LENGTH OD28- IN TEAR AWAY DISPOSABLE SUP-9530T CDM 270009043 LOCAL 0270 RC outpatient 44.36 44.36 44.36 74 32.83 percent of total billed charges 44.36 93 35.93 percent of total billed charges 44.36 44.36 other OPPS APC 44.36 44.36 other OPPS APC 44.36 27.63 12.26 percent of total billed charges 44.36 44.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PH MONITORING VERSAFLEX Z ZNIS+8R 6FR DISPOSABLE 8 RING SUP-955907 CDM 0270 RC outpatient 298.22 298.22 298.22 74 220.68 percent of total billed charges 298.22 93 241.56 percent of total billed charges 298.22 298.22 other OPPS APC 298.22 298.22 other OPPS APC 298.22 27.63 82.4 percent of total billed charges 298.22 298.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL PKS PLASMA J-HOOK HOOK L33 CM OD5 MM RAPID HEMOSTATIC CUT COAGULATION CORD UNIQUE TIP STERILE DISPOSABLE SUP-956010PC CDM 0270 RC outpatient 1263.6 1263.6 1263.6 74 935.06 percent of total billed charges 1263.6 93 1023.52 percent of total billed charges 1263.6 1263.6 other OPPS APC 1263.6 1263.6 other OPPS APC 1263.6 27.63 349.13 percent of total billed charges 1263.6 1263.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL PFC SIGMA TC3 3 65X61MM STERILE KNEE LEFT CEMENTED CRUCIATE STABILIZE SUP-96-0082 CDM 270010025 LOCAL 0270 RC outpatient 14745.1 14745.1 14745.1 74 10911.4 percent of total billed charges 14745.1 93 11943.5 percent of total billed charges 14745.1 14745.1 other OPPS APC 14745.1 14745.1 other OPPS APC 14745.1 27.63 4074.08 percent of total billed charges 14745.1 14745.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL PFC SIGMA TC3 4 71X65MM STERILE KNEE LEFT CEMENTED CRUCIATE RETAINING SUP-96-0083 CDM 270010025 LOCAL 0270 RC outpatient 14745.1 14745.1 14745.1 74 10911.4 percent of total billed charges 14745.1 93 11943.5 percent of total billed charges 14745.1 14745.1 other OPPS APC 14745.1 14745.1 other OPPS APC 14745.1 27.63 4074.08 percent of total billed charges 14745.1 14745.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL PFC SIGMA TC3 3 65X61MM STERILE KNEE RIGHT CEMENTED CRUCIATE STABILIZE SUP-96-0088 CDM 270010025 LOCAL 0270 RC outpatient 14745.1 14745.1 14745.1 74 10911.4 percent of total billed charges 14745.1 93 11943.5 percent of total billed charges 14745.1 14745.1 other OPPS APC 14745.1 14745.1 other OPPS APC 14745.1 27.63 4074.08 percent of total billed charges 14745.1 14745.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL PFC SIGMA TC3 4 71X65MM STERILE KNEE RIGHT CEMENTED CRUCIATE STABILIZE SUP-96-0089 CDM 270010025 LOCAL 0270 RC outpatient 14745.1 14745.1 14745.1 74 10911.4 percent of total billed charges 14745.1 93 11943.5 percent of total billed charges 14745.1 14745.1 other OPPS APC 14745.1 14745.1 other OPPS APC 14745.1 27.63 4074.08 percent of total billed charges 14745.1 14745.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER FEMORAL SIGMA NEUTRAL KNEE BOLT SUP-96-0783 CDM 270010025 LOCAL 0270 RC outpatient 594.36 594.36 594.36 74 439.83 percent of total billed charges 594.36 93 481.43 percent of total billed charges 594.36 594.36 other OPPS APC 594.36 594.36 other OPPS APC 594.36 27.63 164.22 percent of total billed charges 594.36 594.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER FEMORAL PFC SIGMA +2/-2 OFFSET STERILE KNEE BOLT SUP-96-0784 CDM 270010025 LOCAL 0270 RC outpatient 772.2 772.2 772.2 74 571.43 percent of total billed charges 772.2 93 625.48 percent of total billed charges 772.2 772.2 other OPPS APC 772.2 772.2 other OPPS APC 772.2 27.63 213.36 percent of total billed charges 772.2 772.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT FEMORAL PFC SIGMA TC3 3 4MM TITANIUM STERILE KNEE LEFT CEMENTED SUP-96-0860 CDM 270010025 LOCAL 0270 RC outpatient 2528.76 2528.76 2528.76 74 1871.28 percent of total billed charges 2528.76 93 2048.3 percent of total billed charges 2528.76 2528.76 other OPPS APC 2528.76 2528.76 other OPPS APC 2528.76 27.63 698.7 percent of total billed charges 2528.76 2528.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT FEMORAL PFC SIGMA TC3 3 4MM TITANIUM STERILE KNEE RIGHT CEMENTED SUP-96-0861 CDM 270010025 LOCAL 0270 RC outpatient 2528.76 2528.76 2528.76 74 1871.28 percent of total billed charges 2528.76 93 2048.3 percent of total billed charges 2528.76 2528.76 other OPPS APC 2528.76 2528.76 other OPPS APC 2528.76 27.63 698.7 percent of total billed charges 2528.76 2528.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT FEMORAL PFC SIGMA TC3 3 8MM TITANIUM STERILE KNEE RIGHT CEMENTED SUP-96-0863 CDM 270010025 LOCAL 0270 RC outpatient 2528.76 2528.76 2528.76 74 1871.28 percent of total billed charges 2528.76 93 2048.3 percent of total billed charges 2528.76 2528.76 other OPPS APC 2528.76 2528.76 other OPPS APC 2528.76 27.63 698.7 percent of total billed charges 2528.76 2528.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT FEMORAL PFC SIGMA TC3 3 4MM TITANIUM STERILE KNEE POSTERIOR COMBO CEMENTED SUP-96-0866 CDM 270010025 LOCAL 0270 RC outpatient 2528.76 2528.76 2528.76 74 1871.28 percent of total billed charges 2528.76 93 2048.3 percent of total billed charges 2528.76 2528.76 other OPPS APC 2528.76 2528.76 other OPPS APC 2528.76 27.63 698.7 percent of total billed charges 2528.76 2528.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT FEMORAL PFC SIGMA TC3 3 8MM TITANIUM STERILE KNEE POSTERIOR COMBO CEMENTED SUP-96-0868 CDM 270010025 LOCAL 0270 RC outpatient 2528.76 2528.76 2528.76 74 1871.28 percent of total billed charges 2528.76 93 2048.3 percent of total billed charges 2528.76 2528.76 other OPPS APC 2528.76 2528.76 other OPPS APC 2528.76 27.63 698.7 percent of total billed charges 2528.76 2528.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT FEMORAL PFC SIGMA TC3 4 4MM TITANIUM STERILE KNEE LEFT CEMENTED SUP-96-0880 CDM 270010025 LOCAL 0270 RC outpatient 2528.76 2528.76 2528.76 74 1871.28 percent of total billed charges 2528.76 93 2048.3 percent of total billed charges 2528.76 2528.76 other OPPS APC 2528.76 2528.76 other OPPS APC 2528.76 27.63 698.7 percent of total billed charges 2528.76 2528.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT FEMORAL PFC SIGMA TC3 4 8MM TITANIUM STERILE KNEE RIGHT CEMENTED SUP-96-0883 CDM 270010025 LOCAL 0270 RC outpatient 2528.76 2528.76 2528.76 74 1871.28 percent of total billed charges 2528.76 93 2048.3 percent of total billed charges 2528.76 2528.76 other OPPS APC 2528.76 2528.76 other OPPS APC 2528.76 27.63 698.7 percent of total billed charges 2528.76 2528.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT FEMORAL PFC SIGMA TC3 4 8MM TITANIUM STERILE KNEE POSTERIOR COMBO CEMENTED SUP-96-0888 CDM 270010025 LOCAL 0270 RC outpatient 2528.76 2528.76 2528.76 74 1871.28 percent of total billed charges 2528.76 93 2048.3 percent of total billed charges 2528.76 2528.76 other OPPS APC 2528.76 2528.76 other OPPS APC 2528.76 27.63 698.7 percent of total billed charges 2528.76 2528.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT FEMORAL PFC SIGMA TC3 TITANIUM 6 H16 MM KNEE RIGHT COMBO STERILE SUP-96-0892 CDM 270010025 LOCAL 0270 RC outpatient 2528.76 2528.76 2528.76 74 1871.28 percent of total billed charges 2528.76 93 2048.3 percent of total billed charges 2528.76 2528.76 other OPPS APC 2528.76 2528.76 other OPPS APC 2528.76 27.63 698.7 percent of total billed charges 2528.76 2528.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PUNCH BIOPSY TRU-PUNCH STAINLESS STEEL PLASTIC STRAIGHT OD4 MM DERMAL RAZOR TIP RIBBED HOLLOW HANDLE STERILE LATEX FREE DISPOSABLE SUP-96-1115 CDM 0270 RC outpatient 3.13 3.13 3.13 74 2.32 percent of total billed charges 3.13 93 2.54 percent of total billed charges 3.13 3.13 other OPPS APC 3.13 3.13 other OPPS APC 3.13 27.63 0.86 percent of total billed charges 3.13 3.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY MINI INST SUP-96-1300A CDM 0270 RC outpatient 46.8 46.8 46.8 74 34.63 percent of total billed charges 46.8 93 37.91 percent of total billed charges 46.8 46.8 other OPPS APC 46.8 46.8 other OPPS APC 46.8 27.63 12.93 percent of total billed charges 46.8 46.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL PFC SIGMA 3 10MM GVF STERILE KNEE ROTATE PLATFORM STABILIZE SUP-96-2131 CDM 270010025 LOCAL 0270 RC outpatient 4243.2 4243.2 4243.2 74 3139.97 percent of total billed charges 4243.2 93 3436.99 percent of total billed charges 4243.2 4243.2 other OPPS APC 4243.2 4243.2 other OPPS APC 4243.2 27.63 1172.4 percent of total billed charges 4243.2 4243.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL PFC SIGMA 4 12.5MM GVF STERILE KNEE ROTATE PLATFORM STABILIZE SUP-96-2142 CDM 270010025 LOCAL 0270 RC outpatient 4243.2 4243.2 4243.2 74 3139.97 percent of total billed charges 4243.2 93 3436.99 percent of total billed charges 4243.2 4243.2 other OPPS APC 4243.2 4243.2 other OPPS APC 4243.2 27.63 1172.4 percent of total billed charges 4243.2 4243.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL PFC SIGMA GVF 4 H17.5 MM KNEE ROTATE PLATFORM STABILIZE SUP-96-2144 CDM 270010025 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL SIGMA TC3 3 12.5MM GVF UHMWPE STERILE KNEE ROTATE PLATFORM SUP-96-2342 CDM 270010025 LOCAL 0270 RC outpatient 6619.08 6619.08 6619.08 74 4898.12 percent of total billed charges 6619.08 93 5361.45 percent of total billed charges 6619.08 6619.08 other OPPS APC 6619.08 6619.08 other OPPS APC 6619.08 27.63 1828.85 percent of total billed charges 6619.08 6619.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL SIGMA TC3 3 15MM GVF UHMWPE STERILE KNEE ROTATE PLATFORM SUP-96-2343 CDM 270010025 LOCAL 0270 RC outpatient 6619.08 6619.08 6619.08 74 4898.12 percent of total billed charges 6619.08 93 5361.45 percent of total billed charges 6619.08 6619.08 other OPPS APC 6619.08 6619.08 other OPPS APC 6619.08 27.63 1828.85 percent of total billed charges 6619.08 6619.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL SIGMA TC3 4 20MM GVF UHMWPE STERILE KNEE ROTATE PLATFORM SUP-96-2355 CDM 270010025 LOCAL 0270 RC outpatient 6619.08 6619.08 6619.08 74 4898.12 percent of total billed charges 6619.08 93 5361.45 percent of total billed charges 6619.08 6619.08 other OPPS APC 6619.08 6619.08 other OPPS APC 6619.08 27.63 1828.85 percent of total billed charges 6619.08 6619.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL SIGMA TC3 4 25MM GVF UHMWPE STERILE KNEE ROTATE PLATFORM SUP-96-2357 CDM 270010025 LOCAL 0270 RC outpatient 6619.08 6619.08 6619.08 74 4898.12 percent of total billed charges 6619.08 93 5361.45 percent of total billed charges 6619.08 6619.08 other OPPS APC 6619.08 6619.08 other OPPS APC 6619.08 27.63 1828.85 percent of total billed charges 6619.08 6619.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIA ALL POLY STABILIZED SIZE 2.5 15MM SUP-96-2633 CDM 270010025 LOCAL 0270 RC outpatient 4453.8 4453.8 4453.8 74 3295.81 percent of total billed charges 4453.8 93 3607.58 percent of total billed charges 4453.8 4453.8 other OPPS APC 4453.8 4453.8 other OPPS APC 4453.8 27.63 1230.58 percent of total billed charges 4453.8 4453.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL PFC SIGMA 2 10MM UHMWPE STERILE KNEE FIX BEARING STABILIZE PLUS SUP-96-2710 CDM 270010025 LOCAL 0270 RC outpatient 4950.4 4950.4 4950.4 74 3663.3 percent of total billed charges 4950.4 93 4009.82 percent of total billed charges 4950.4 4950.4 other OPPS APC 4950.4 4950.4 other OPPS APC 4950.4 27.63 1367.8 percent of total billed charges 4950.4 4950.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL PFC SIGMA 5 10MM UHMWPE STERILE KNEE FIX BEARING STABILIZE PLUS SUP-96-2750 CDM 270010025 LOCAL 0270 RC outpatient 1216.8 1216.8 1216.8 74 900.43 percent of total billed charges 1216.8 93 985.61 percent of total billed charges 1216.8 1216.8 other OPPS APC 1216.8 1216.8 other OPPS APC 1216.8 27.63 336.2 percent of total billed charges 1216.8 1216.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC EDWARDS SAPIEN 3 COMMANDER OD 29MM DELIVERY SYSTEM SUP-9600CM29A CDM 0270 RC outpatient 51300 51300 51300 74 37962 percent of total billed charges 51300 93 41553 percent of total billed charges 51300 51300 other OPPS APC 51300 51300 other OPPS APC 51300 27.63 14174.2 percent of total billed charges 51300 51300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKINETTE ORTHOPEDIC COTTON WAX STANDARD L48 IN X W6 IN 2 PLY EXTENSIVE LINE PULL TAB STERILE LATEX FREE OFF WHITE SUP-9606-48 CDM 0270 RC outpatient 12.92 12.92 12.92 74 9.56 percent of total billed charges 12.92 93 10.47 percent of total billed charges 12.92 12.92 other OPPS APC 12.92 12.92 other OPPS APC 12.92 27.63 3.57 percent of total billed charges 12.92 12.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MORCELLATOR BIPOLAR PKS PLASMASORD SUP-962000PK CDM 0270 RC outpatient 1838.2 1838.2 1838.2 74 1360.27 percent of total billed charges 1838.2 93 1488.94 percent of total billed charges 1838.2 1838.2 other OPPS APC 1838.2 1838.2 other OPPS APC 1838.2 27.63 507.89 percent of total billed charges 1838.2 1838.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL ORTRON 90 ELITE PLUS +3MM 9/10 TAPER 32MM STERILE HIP MODULAR SUP-9627-35-000 CDM 270010024 LOCAL 0270 RC outpatient 2004.6 2004.6 2004.6 74 1483.4 percent of total billed charges 2004.6 93 1623.73 percent of total billed charges 2004.6 2004.6 other OPPS APC 2004.6 2004.6 other OPPS APC 2004.6 27.63 553.87 percent of total billed charges 2004.6 2004.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE PROTECTIVE GRAFCO COTTON LARGE LINER KNIT LIGHTWEIGHT NONSTERILE LATEX FREE WHITE SUP-9666 CDM outpatient 6.91 6.91 6.91 6.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL LEGACY CD HORIZON TITANIUM PRECUT PREBENT L40 MM OD6.35 MM STERILE SUP-9690040 CDM 270010020 LOCAL 0270 RC outpatient 649.95 649.95 649.95 74 480.96 percent of total billed charges 649.95 93 526.46 percent of total billed charges 649.95 649.95 other OPPS APC 649.95 649.95 other OPPS APC 649.95 27.63 179.58 percent of total billed charges 649.95 649.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CD HORIZON PREBENT 50MM 6.35MM TITANIUM PRECUT CENTRAL POST SUP-9690050 CDM 270010020 LOCAL 0270 RC outpatient 582.71 582.71 582.71 74 431.21 percent of total billed charges 582.71 93 472 percent of total billed charges 582.71 582.71 other OPPS APC 582.71 582.71 other OPPS APC 582.71 27.63 161 percent of total billed charges 582.71 582.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL LEGACY CD HORIZON TITANIUM PRECUT PREBENT L60 CM OD6.35 MM STERILE SUP-9690060 CDM 270010020 LOCAL 0270 RC outpatient 649.95 649.95 649.95 74 480.96 percent of total billed charges 649.95 93 526.46 percent of total billed charges 649.95 649.95 other OPPS APC 649.95 649.95 other OPPS APC 649.95 27.63 179.58 percent of total billed charges 649.95 649.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CD HORIZON PREBENT 70MM 6.35MM TITANIUM PRECUT CENTRAL POST SUP-9690070 CDM 270010020 LOCAL 0270 RC outpatient 649.95 649.95 649.95 74 480.96 percent of total billed charges 649.95 93 526.46 percent of total billed charges 649.95 649.95 other OPPS APC 649.95 649.95 other OPPS APC 649.95 27.63 179.58 percent of total billed charges 649.95 649.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD SPINAL CD HORIZON TITANIUM PREBENT L100 MM OD6.35 MM SUP-9690100 CDM 270010020 LOCAL 0270 RC outpatient 649.95 649.95 649.95 74 480.96 percent of total billed charges 649.95 93 526.46 percent of total billed charges 649.95 649.95 other OPPS APC 649.95 649.95 other OPPS APC 649.95 27.63 179.58 percent of total billed charges 649.95 649.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40M -4.0D SUP-97- CDM outpatient 612.5 612.5 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL 4.5MM 20MM SUP-97-00001 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL 4.5MM 22MM SUP-97-00002 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL 4.5MM 24 MM SUP-97-00003 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL 4.5MM 26MM SUP-97-00004 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL 4.5MM 28MM SUP-97-00005 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL 4.5MM 30MM SUP-97-00006 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL 4.5MM 32MM SUP-97-00007 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL 4.5MM 34MM SUP-97-00008 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL 4.5MM 36MM SUP-97-00009 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL 4.5MM 40MM SUP-97-00010 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL 4.5MM 38MM SUP-97-00011 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 24MM 8.0X110MM SUP-97-00012 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 24MM 8.0X105MM SUP-97-00013 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 24MM 8.0X100MM SUP-97-00014 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 24MM 8.0X95MM SUP-97-00015 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 24MM 8.0X90MM SUP-97-00016 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 24MM 8.0X85MM SUP-97-00017 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 24MM 8.0X80MM SUP-97-00018 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 24MM 8.0X75MM SUP-97-00019 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 24MM 8.0X50MM SUP-97-00020 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 24MM 8.0X55MM SUP-97-00021 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 24MM 8.0X60MM SUP-97-00022 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 24MM 8.0X65MM SUP-97-00023 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 24MM 8.0X70MM SUP-97-00024 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 24MM 8.0X45MM SUP-97-00025 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 24MM 8.0X40MM SUP-97-00026 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG CORTICAL 4.5MM 44MM SUP-97-00027 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG CORTICAL 4.5MM 42MM SUP-97-00028 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG CORTICAL 4.5MM 40MM SUP-97-00029 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG CORTICAL 4.5MM 38MM SUP-97-00030 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG CORTICAL 4.5MM 36MM SUP-97-00031 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG CORTICAL 4.5MM 34MM SUP-97-00032 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG CORTICAL 4.5MM 32MM SUP-97-00033 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG CORTICAL 4.5MM 30MM SUP-97-00034 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL 4.5MM 70MM SUP-97-00035 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL 4.5MM 65MM SUP-97-00036 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL 4.5MM 60MM SUP-97-00037 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL 4.5MM 55MM SUP-97-00038 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL 4.5MM 50MM SUP-97-00039 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL 4.5MM 48MM SUP-97-00040 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL 4.5MM 46MM SUP-97-00041 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL 4.5MM 44MM SUP-97-00042 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL 4.5MM 42MM SUP-97-00043 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 40MM 110X6.5 SUP-97-00044 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 40MM 6.5X105MM SUP-97-00045 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 40MM 6.5X100MM SUP-97-00046 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 40MM 6.5X95MM SUP-97-00047 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 40MM 6.5X90MM SUP-97-00048 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 40MM 6.5X85MM SUP-97-00050 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 40MM 6.5X80MM SUP-97-00051 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 40MM 6.5X75MM SUP-97-00052 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 40MM 6.5X70MM SUP-97-00053 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 40MM 6.5X65MM SUP-97-00054 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 40MM 6.5X60MM SUP-97-00055 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 40MM 6.5X55MM SUP-97-00056 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 40MM 6.5X50MM SUP-97-00057 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 40MM 6.5X45MM SUP-97-00058 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 40MM 6.5X40MM SUP-97-00059 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 22MM 6.5X120MM SUP-97-00060 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 22MM 6.5X115MM SUP-97-00061 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 22MM 6.5X110MM SUP-97-00062 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 22MM 6.5X105MM SUP-97-00063 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 22MM 6.5X100MM SUP-97-00064 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 22MM 6.5X95MM SUP-97-00065 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 22MM 6.5X90MM SUP-97-00066 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 22MM 6.5X85MM SUP-97-00067 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 22MM 6.5X80MM SUP-97-00068 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 22MM 6.5X75MM SUP-97-00069 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 22MM 6.5X70MM SUP-97-00070 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 22MM 6.5X65MM SUP-97-00071 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 22MM 6.5X60MM SUP-97-00072 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 22MM 6.5X55MM SUP-97-00073 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 22MM 6.5X50MM SUP-97-00074 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 22MM 6.5X45MM SUP-97-00075 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 22MM 6.5X40MM SUP-97-00076 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 22MM 6.5X30MM SUP-97-00077 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 22MM 6.5X35MM SUP-97-00078 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG TH 22MM 6.5X25MM SUP-97-00079 CDM C1713 HCPCS 0278 RC outpatient 840 840 840 57 478.8 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 51 428.4 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEINMAN PIN 2MMX9 SUP-97-00080 CDM C1713 HCPCS 0278 RC outpatient 385 385 385 57 219.45 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 51 196.35 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 5.5MM SUP-97-00081 CDM 0272 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 5.0MM SUP-97-00082 CDM 0272 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.8MM SUP-97-00083 CDM 0272 RC outpatient 315 315 315 74 233.1 percent of total billed charges 315 93 255.15 percent of total billed charges 315 315 other OPPS APC 315 315 other OPPS APC 315 27.63 87.03 percent of total billed charges 315 315 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER 8.0MM SUP-97-00084 CDM 0272 RC outpatient 160 160 160 74 118.4 percent of total billed charges 160 93 129.6 percent of total billed charges 160 160 other OPPS APC 160 160 other OPPS APC 160 27.63 44.21 percent of total billed charges 160 160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER 6.5MM SUP-97-00085 CDM 0272 RC outpatient 120 120 120 74 88.8 percent of total billed charges 120 93 97.2 percent of total billed charges 120 120 other OPPS APC 120 120 other OPPS APC 120 27.63 33.16 percent of total billed charges 120 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.8MM SUP-97-00086 CDM 0272 RC outpatient 1020 1020 1020 74 754.8 percent of total billed charges 1020 93 826.2 percent of total billed charges 1020 1020 other OPPS APC 1020 1020 other OPPS APC 1020 27.63 281.83 percent of total billed charges 1020 1020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GUIDE PIN 3.2MMX9""" SUP-97-00087 CDM 0272 RC outpatient 120 120 120 74 88.8 percent of total billed charges 120 93 97.2 percent of total billed charges 120 120 other OPPS APC 120 120 other OPPS APC 120 27.63 33.16 percent of total billed charges 120 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "STYLET, 5 FR" SUP-97-00088 CDM 0272 RC outpatient 137.6 137.6 137.6 74 101.82 percent of total billed charges 137.6 93 111.46 percent of total billed charges 137.6 137.6 other OPPS APC 137.6 137.6 other OPPS APC 137.6 27.63 38.02 percent of total billed charges 137.6 137.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "STYLET, 3FR" SUP-97-00089 CDM 0272 RC outpatient 138 138 138 74 102.12 percent of total billed charges 138 93 111.78 percent of total billed charges 138 138 other OPPS APC 138 138 other OPPS APC 138 27.63 38.13 percent of total billed charges 138 138 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE SCREW 6.5X15 SELF-TAP SUP-97-00094 CDM C1776 HCPCS 0278 RC outpatient 336 336 336 57 191.52 percent of total billed charges 336 93 272.16 percent of total billed charges 336 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336 other OPPS APC 336 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336 other OPPS APC 336 51 171.36 percent of total billed charges 336 336 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK C02 TRI-ANIM SUP-97-00106 CDM 0272 RC outpatient 351.51 351.51 351.51 74 260.12 percent of total billed charges 351.51 93 284.72 percent of total billed charges 351.51 351.51 other OPPS APC 351.51 351.51 other OPPS APC 351.51 27.63 97.12 percent of total billed charges 351.51 351.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO SYSTEM STAGE ONE W/9MM SUP-97-00107 CDM L8690 HCPCS 0272 RC outpatient 9192.5 9192.5 9192.5 74 6802.45 percent of total billed charges 9192.5 93 7445.93 percent of total billed charges 9192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9192.5 other OPPS APC 9192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9192.5 other OPPS APC 9192.5 27.63 2539.89 percent of total billed charges 9192.5 9192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO PRO LEFT BLACK SUP-97-00108 CDM L8690 HCPCS 0272 RC outpatient 9500 9500 9500 74 7030 percent of total billed charges 9500 93 7695 percent of total billed charges 9500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9500 other OPPS APC 9500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9500 other OPPS APC 9500 27.63 2624.85 percent of total billed charges 9500 9500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO PRO RIGHT SUP-97-00109 CDM L8690 HCPCS 0272 RC outpatient 9750 9750 9750 74 7215 percent of total billed charges 9750 93 7897.5 percent of total billed charges 9750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9750 other OPPS APC 9750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9750 other OPPS APC 9750 27.63 2693.93 percent of total billed charges 9750 9750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO PRO LEFT SUP-97-00110 CDM L8690 HCPCS 0272 RC outpatient 9750 9750 9750 74 7215 percent of total billed charges 9750 93 7897.5 percent of total billed charges 9750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9750 other OPPS APC 9750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9750 other OPPS APC 9750 27.63 2693.93 percent of total billed charges 9750 9750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERMACOL 10X10X1 SUP-97-00116 CDM C9364 HCPCS 0278 RC outpatient 5764.68 5764.68 5764.68 57 3285.87 percent of total billed charges 5764.68 93 4669.39 percent of total billed charges 5764.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5764.68 other OPPS APC 5764.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5764.68 other OPPS APC 5764.68 51 2939.99 percent of total billed charges 5764.68 5764.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER RESPIRAGARD II SUP-97-00122 CDM 0272 RC outpatient 0.79 0.79 0.79 74 0.58 percent of total billed charges 0.79 93 0.64 percent of total billed charges 0.79 0.79 other OPPS APC 0.79 0.79 other OPPS APC 0.79 27.63 0.22 percent of total billed charges 0.79 0.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALISTRAP 1.5X30 (OR/XRAY) SUP-97-00127 CDM 0271 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG EMESIS 6.5X15 1.35ML SUP-97-00132 CDM 0271 RC outpatient 321.3 321.3 321.3 74 237.76 percent of total billed charges 321.3 93 260.25 percent of total billed charges 321.3 321.3 other OPPS APC 321.3 321.3 other OPPS APC 321.3 27.63 88.78 percent of total billed charges 321.3 321.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLANKET LITHOTOMY UNDERBODY SUP-97-00134 CDM 0272 RC outpatient 76.46 76.46 76.46 74 56.58 percent of total billed charges 76.46 93 61.93 percent of total billed charges 76.46 76.46 other OPPS APC 76.46 76.46 other OPPS APC 76.46 27.63 21.13 percent of total billed charges 76.46 76.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE HAND LOCKING T WIDE 8 HOLE PROFYLE SUP-97-00138 CDM outpatient 1686.36 1686.36 1686.36 1686.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CROSSPIN LOCKING 2.3 X 15MM SUP-97-00139 CDM C1713 HCPCS 0278 RC outpatient 318.99 318.99 318.99 57 181.82 percent of total billed charges 318.99 93 258.38 percent of total billed charges 318.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 318.99 other OPPS APC 318.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 318.99 other OPPS APC 318.99 51 162.68 percent of total billed charges 318.99 318.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW HEADLESS COMPRESSION 5.0 X 60MM SUP-97-00140 CDM C1713 HCPCS 0278 RC outpatient 1221.36 1221.36 1221.36 57 696.18 percent of total billed charges 1221.36 93 989.3 percent of total billed charges 1221.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1221.36 other OPPS APC 1221.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1221.36 other OPPS APC 1221.36 51 622.89 percent of total billed charges 1221.36 1221.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW HEADLESS COMPRESSION 5.0 X 46MM SUP-97-00141 CDM C1713 HCPCS 0278 RC outpatient 1221.36 1221.36 1221.36 57 696.18 percent of total billed charges 1221.36 93 989.3 percent of total billed charges 1221.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1221.36 other OPPS APC 1221.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1221.36 other OPPS APC 1221.36 51 622.89 percent of total billed charges 1221.36 1221.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SUP MIDSHAFT DECREASED CURVE 8 HOLE LEFT SUP-97-00142 CDM C1713 HCPCS 0278 RC outpatient 3199.3 3199.3 3199.3 57 1823.6 percent of total billed charges 3199.3 93 2591.43 percent of total billed charges 3199.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3199.3 other OPPS APC 3199.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3199.3 other OPPS APC 3199.3 51 1631.64 percent of total billed charges 3199.3 3199.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 34MM SUP-97-00143 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 44MM SUP-97-00144 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 46MM SUP-97-00145 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SUTURE 5-0 18"" MONOCRYL PLUS P-3 UD" SUP-97-00146 CDM 0272 RC outpatient 196.88 196.88 196.88 74 145.69 percent of total billed charges 196.88 93 159.47 percent of total billed charges 196.88 196.88 other OPPS APC 196.88 196.88 other OPPS APC 196.88 27.63 54.4 percent of total billed charges 196.88 196.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROFYLE HAND LOCK 3D 4X2 HOLE SUP-97-00147 CDM C1713 HCPCS 0278 RC outpatient 1686.36 1686.36 1686.36 57 961.23 percent of total billed charges 1686.36 93 1365.95 percent of total billed charges 1686.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1686.36 other OPPS APC 1686.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1686.36 other OPPS APC 1686.36 51 860.04 percent of total billed charges 1686.36 1686.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING VARIAX 1.7 X 7MM SUP-97-00148 CDM C1713 HCPCS 0278 RC outpatient 317.52 317.52 317.52 57 180.99 percent of total billed charges 317.52 93 257.19 percent of total billed charges 317.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 317.52 other OPPS APC 317.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 317.52 other OPPS APC 317.52 51 161.94 percent of total billed charges 317.52 317.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE SILK 2-0 CR/CT-2 8-18 BLK BR SUP-97-00155 CDM 0272 RC outpatient 315.88 315.88 315.88 74 233.75 percent of total billed charges 315.88 93 255.86 percent of total billed charges 315.88 315.88 other OPPS APC 315.88 315.88 other OPPS APC 315.88 27.63 87.28 percent of total billed charges 315.88 315.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALDERA WINGS - #CAL-WI SUP-97-00159 CDM 0272 RC outpatient 332.5 332.5 332.5 74 246.05 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 332.5 other OPPS APC 332.5 332.5 other OPPS APC 332.5 27.63 91.87 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ACUVANCE PLUS 22G SUP-97-00164 CDM 0272 RC outpatient 304.29 304.29 304.29 74 225.17 percent of total billed charges 304.29 93 246.47 percent of total billed charges 304.29 304.29 other OPPS APC 304.29 304.29 other OPPS APC 304.29 27.63 84.08 percent of total billed charges 304.29 304.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ACUVANCE PLUS 18G SUP-97-00166 CDM 0272 RC outpatient 1601.34 1601.34 1601.34 74 1184.99 percent of total billed charges 1601.34 93 1297.09 percent of total billed charges 1601.34 1601.34 other OPPS APC 1601.34 1601.34 other OPPS APC 1601.34 27.63 442.45 percent of total billed charges 1601.34 1601.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SPINAL WHITACRE 25G X 4.69 SUP-97-00171 CDM 0272 RC outpatient 51.5 51.5 51.5 74 38.11 percent of total billed charges 51.5 93 41.72 percent of total billed charges 51.5 51.5 other OPPS APC 51.5 51.5 other OPPS APC 51.5 27.63 14.23 percent of total billed charges 51.5 51.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANESTHESIA EXTENSION SET 180IN SUP-97-00183 CDM 0272 RC outpatient 234.43 234.43 234.43 74 173.48 percent of total billed charges 234.43 93 189.89 percent of total billed charges 234.43 234.43 other OPPS APC 234.43 234.43 other OPPS APC 234.43 27.63 64.77 percent of total billed charges 234.43 234.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT DUAL MESH PLUS 26X34 SUP-97-00188 CDM C1781 HCPCS 0278 RC outpatient 7040 7040 7040 57 4012.8 percent of total billed charges 7040 93 5702.4 percent of total billed charges 7040 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7040 other OPPS APC 7040 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7040 other OPPS APC 7040 51 3590.4 percent of total billed charges 7040 7040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT DUAL MESH PLUS 18X24 SUP-97-00189 CDM C1781 HCPCS 0278 RC outpatient 4255 4255 4255 57 2425.35 percent of total billed charges 4255 93 3446.55 percent of total billed charges 4255 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4255 other OPPS APC 4255 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4255 other OPPS APC 4255 51 2170.05 percent of total billed charges 4255 4255 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT DUAL MESH PLUS 20X30 SUP-97-00190 CDM C1781 HCPCS 0278 RC outpatient 5570 5570 5570 57 3174.9 percent of total billed charges 5570 93 4511.7 percent of total billed charges 5570 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5570 other OPPS APC 5570 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5570 other OPPS APC 5570 51 2840.7 percent of total billed charges 5570 5570 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT DUAL MESH PLUS 8 X 12 SUP-97-00191 CDM C1781 HCPCS 0278 RC outpatient 1770 1770 1770 57 1008.9 percent of total billed charges 1770 93 1433.7 percent of total billed charges 1770 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1770 other OPPS APC 1770 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1770 other OPPS APC 1770 51 902.7 percent of total billed charges 1770 1770 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT DUAL MESH PLUS 15X19 SUP-97-00192 CDM C1781 HCPCS 0278 RC outpatient 3100 3100 3100 57 1767 percent of total billed charges 3100 93 2511 percent of total billed charges 3100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3100 other OPPS APC 3100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3100 other OPPS APC 3100 51 1581 percent of total billed charges 3100 3100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT DUAL MESH PLUS 10X15 SUP-97-00193 CDM C1781 HCPCS 0278 RC outpatient 2004 2004 2004 57 1142.28 percent of total billed charges 2004 93 1623.24 percent of total billed charges 2004 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2004 other OPPS APC 2004 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2004 other OPPS APC 2004 51 1022.04 percent of total billed charges 2004 2004 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYNTHES SAW BLADE 68MM SUP-97-00194 CDM 0272 RC outpatient 273.07 273.07 273.07 74 202.07 percent of total billed charges 273.07 93 221.19 percent of total billed charges 273.07 273.07 other OPPS APC 273.07 273.07 other OPPS APC 273.07 27.63 75.45 percent of total billed charges 273.07 273.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 4.5 52MM SUP-97-001964 CDM C1713 HCPCS 0278 RC outpatient 95.08 95.08 95.08 57 54.2 percent of total billed charges 95.08 93 77.01 percent of total billed charges 95.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 95.08 other OPPS APC 95.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 95.08 other OPPS APC 95.08 51 48.49 percent of total billed charges 95.08 95.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE TIP CAPS SUP-97-00197 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY 30FR 7.5MM SUP-97-00198 CDM 0272 RC outpatient 162.6 162.6 162.6 74 120.32 percent of total billed charges 162.6 93 131.71 percent of total billed charges 162.6 162.6 other OPPS APC 162.6 162.6 other OPPS APC 162.6 27.63 44.93 percent of total billed charges 162.6 162.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY 26FR 6.5MM SUP-97-00199 CDM 0272 RC outpatient 69.28 69.28 69.28 74 51.27 percent of total billed charges 69.28 93 56.12 percent of total billed charges 69.28 69.28 other OPPS APC 69.28 69.28 other OPPS APC 69.28 27.63 19.14 percent of total billed charges 69.28 69.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SODA SORB SUP-97-00200 CDM 0271 RC outpatient 311.12 311.12 311.12 74 230.23 percent of total billed charges 311.12 93 252.01 percent of total billed charges 311.12 311.12 other OPPS APC 311.12 311.12 other OPPS APC 311.12 27.63 85.96 percent of total billed charges 311.12 311.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR STRAIGHT WALL SUP-97-00204 CDM C1768 HCPCS 0272 RC outpatient 1674 1674 1674 74 1238.76 percent of total billed charges 1674 93 1355.94 percent of total billed charges 1674 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1674 other OPPS APC 1674 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1674 other OPPS APC 1674 27.63 462.53 percent of total billed charges 1674 1674 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PROPATEN 6X70 SUP-97-00205 CDM C1768 HCPCS 0272 RC outpatient 5907.5 5907.5 5907.5 74 4371.55 percent of total billed charges 5907.5 93 4785.08 percent of total billed charges 5907.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5907.5 other OPPS APC 5907.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5907.5 other OPPS APC 5907.5 27.63 1632.24 percent of total billed charges 5907.5 5907.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ACUVANCE PLUS 20G SUP-97-00207 CDM 0272 RC outpatient 1043.31 1043.31 1043.31 74 772.05 percent of total billed charges 1043.31 93 845.08 percent of total billed charges 1043.31 1043.31 other OPPS APC 1043.31 1043.31 other OPPS APC 1043.31 27.63 288.27 percent of total billed charges 1043.31 1043.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENTRALIGHT ST 4X6 SUP-97-00212 CDM C1781 HCPCS 0278 RC outpatient 2209.14 2209.14 2209.14 57 1259.21 percent of total billed charges 2209.14 93 1789.4 percent of total billed charges 2209.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2209.14 other OPPS APC 2209.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2209.14 other OPPS APC 2209.14 51 1126.66 percent of total billed charges 2209.14 2209.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENTRALIGHT ST 7X9 SUP-97-00213 CDM C1781 HCPCS 0278 RC outpatient 3775.95 3775.95 3775.95 57 2152.29 percent of total billed charges 3775.95 93 3058.52 percent of total billed charges 3775.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3775.95 other OPPS APC 3775.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3775.95 other OPPS APC 3775.95 51 1925.73 percent of total billed charges 3775.95 3775.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENTRALIGHT ST 4.5 CIRCLE SUP-97-00215 CDM C1781 HCPCS 0278 RC outpatient 2625 2625 2625 57 1496.25 percent of total billed charges 2625 93 2126.25 percent of total billed charges 2625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2625 other OPPS APC 2625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2625 other OPPS APC 2625 51 1338.75 percent of total billed charges 2625 2625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENTRALIGHT ST 6X10 MIDLINE SUP-97-00216 CDM C1781 HCPCS 0278 RC outpatient 3462.5 3462.5 3462.5 57 1973.63 percent of total billed charges 3462.5 93 2804.63 percent of total billed charges 3462.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3462.5 other OPPS APC 3462.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3462.5 other OPPS APC 3462.5 51 1765.88 percent of total billed charges 3462.5 3462.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENTRALIGHT ST 6X8 ELLIPSE SUP-97-00217 CDM C1781 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENTRALIGHT ST 8X10 ELLIPSE SUP-97-00218 CDM C1781 HCPCS 0278 RC outpatient 4958.45 4958.45 4958.45 57 2826.32 percent of total billed charges 4958.45 93 4016.34 percent of total billed charges 4958.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4958.45 other OPPS APC 4958.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4958.45 other OPPS APC 4958.45 51 2528.81 percent of total billed charges 4958.45 4958.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENTRALIGHT ST 10 X 13 ELLIPSE SUP-97-00219 CDM C1781 HCPCS 0278 RC outpatient 6288.75 6288.75 6288.75 57 3584.59 percent of total billed charges 6288.75 93 5093.89 percent of total billed charges 6288.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6288.75 other OPPS APC 6288.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6288.75 other OPPS APC 6288.75 51 3207.26 percent of total billed charges 6288.75 6288.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENTRALIGHT ST 12X14 RECTANGLE SUP-97-00220 CDM C1781 HCPCS 0278 RC outpatient 6000 6000 6000 57 3420 percent of total billed charges 6000 93 4860 percent of total billed charges 6000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6000 other OPPS APC 6000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6000 other OPPS APC 6000 51 3060 percent of total billed charges 6000 6000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENTRALEX ST SM CIRCLE W/STRAP SUP-97-00221 CDM C1781 HCPCS 0278 RC outpatient 1838.25 1838.25 1838.25 57 1047.8 percent of total billed charges 1838.25 93 1488.98 percent of total billed charges 1838.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1838.25 other OPPS APC 1838.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1838.25 other OPPS APC 1838.25 51 937.51 percent of total billed charges 1838.25 1838.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENTRALEX ST MED CIRCLE W/STRAP SUP-97-00222 CDM C1781 HCPCS 0278 RC outpatient 2199.45 2199.45 2199.45 57 1253.69 percent of total billed charges 2199.45 93 1781.55 percent of total billed charges 2199.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2199.45 other OPPS APC 2199.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2199.45 other OPPS APC 2199.45 51 1121.72 percent of total billed charges 2199.45 2199.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENTRALEX ST LG CIRCLE W/STRAP SUP-97-00223 CDM C1781 HCPCS 0278 RC outpatient 2499.39 2499.39 2499.39 57 1424.65 percent of total billed charges 2499.39 93 2024.51 percent of total billed charges 2499.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2499.39 other OPPS APC 2499.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2499.39 other OPPS APC 2499.39 51 1274.69 percent of total billed charges 2499.39 2499.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTHREX 5.5MM EXCALIBUR SUP-97-00230 CDM 0272 RC outpatient 148 148 148 74 109.52 percent of total billed charges 148 93 119.88 percent of total billed charges 148 148 other OPPS APC 148 148 other OPPS APC 148 27.63 40.89 percent of total billed charges 148 148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENTRIO ST SM CIRCLE 7.6 SUP-97-00232 CDM C1781 HCPCS 0278 RC outpatient 1950 1950 1950 57 1111.5 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 51 994.5 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENTRIO ST LG CIRCLE 11.4 SUP-97-00233 CDM C1781 HCPCS 0278 RC outpatient 2730 2730 2730 57 1556.1 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2730 other OPPS APC 2730 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2730 other OPPS APC 2730 51 1392.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENTRIO ST MED OVAL 11 X 14 SUP-97-00235 CDM C1781 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENTRIO ST LG OVAL SUP-97-00236 CDM C1781 HCPCS 0278 RC outpatient 4031.25 4031.25 4031.25 57 2297.81 percent of total billed charges 4031.25 93 3265.31 percent of total billed charges 4031.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4031.25 other OPPS APC 4031.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4031.25 other OPPS APC 4031.25 51 2055.94 percent of total billed charges 4031.25 4031.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIDLINE 15.5 X 25.7 SUP-97-00237 CDM C1781 HCPCS 0278 RC outpatient 6503.75 6503.75 6503.75 57 3707.14 percent of total billed charges 6503.75 93 5268.04 percent of total billed charges 6503.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6503.75 other OPPS APC 6503.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6503.75 other OPPS APC 6503.75 51 3316.91 percent of total billed charges 6503.75 6503.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENTRIO ST XLG OVAL 19.6 X 24.6 SUP-97-00238 CDM C1781 HCPCS 0278 RC outpatient 5442.2 5442.2 5442.2 57 3102.05 percent of total billed charges 5442.2 93 4408.18 percent of total billed charges 5442.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5442.2 other OPPS APC 5442.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5442.2 other OPPS APC 5442.2 51 2775.52 percent of total billed charges 5442.2 5442.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENTRIO ST XLG OVAL 22.1 X 27.1 SUP-97-00239 CDM C1781 HCPCS 0278 RC outpatient 6517.2 6517.2 6517.2 57 3714.8 percent of total billed charges 6517.2 93 5278.93 percent of total billed charges 6517.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6517.2 other OPPS APC 6517.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6517.2 other OPPS APC 6517.2 51 3323.77 percent of total billed charges 6517.2 6517.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENTRIO ST XLG OVAL 27.4 X 34.9 SUP-97-00240 CDM C1781 HCPCS 0278 RC outpatient 8062.5 8062.5 8062.5 57 4595.63 percent of total billed charges 8062.5 93 6530.63 percent of total billed charges 8062.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8062.5 other OPPS APC 8062.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8062.5 other OPPS APC 8062.5 51 4111.88 percent of total billed charges 8062.5 8062.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZIMMER TOTAL KNEE PERSONA CEM SUP-97-00245 CDM C1887 HCPCS 0272 RC outpatient 13600 13600 13600 74 10064 percent of total billed charges 13600 93 11016 percent of total billed charges 13600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13600 other OPPS APC 13600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13600 other OPPS APC 13600 27.63 3757.68 percent of total billed charges 13600 13600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE STIMUPLEX 20G X 6 SUP-97-00246 CDM 0272 RC outpatient 42.6 42.6 42.6 74 31.52 percent of total billed charges 42.6 93 34.51 percent of total billed charges 42.6 42.6 other OPPS APC 42.6 42.6 other OPPS APC 42.6 27.63 11.77 percent of total billed charges 42.6 42.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROPATEN GRAFT SUP-97-00256 CDM C1768 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CORE/HUMMER DISP CASSETTE PK/10 SUP-97-00257 CDM 0272 RC outpatient 212.94 212.94 212.94 74 157.58 percent of total billed charges 212.94 93 172.48 percent of total billed charges 212.94 212.94 other OPPS APC 212.94 212.94 other OPPS APC 212.94 27.63 58.84 percent of total billed charges 212.94 212.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MACROPLASTIQUE ASC TRAINING KIT SUP-97-00259 CDM 0272 RC outpatient 1485 1485 1485 74 1098.9 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 1485 other OPPS APC 1485 1485 other OPPS APC 1485 27.63 410.31 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERCEED SUP-97-00260 CDM C1765 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE HARMONIC CURVED 32CM SUP-97-00265 CDM 0272 RC outpatient 510.41 510.41 510.41 74 377.7 percent of total billed charges 510.41 93 413.43 percent of total billed charges 510.41 510.41 other OPPS APC 510.41 510.41 other OPPS APC 510.41 27.63 141.03 percent of total billed charges 510.41 510.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOTH PROTECTOR SUP-97-00266 CDM 0271 RC outpatient 35.64 35.64 35.64 74 26.37 percent of total billed charges 35.64 93 28.87 percent of total billed charges 35.64 35.64 other OPPS APC 35.64 35.64 other OPPS APC 35.64 27.63 9.85 percent of total billed charges 35.64 35.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR ALEXIS LARGE SUP-97-00268 CDM 0272 RC outpatient 217 217 217 74 160.58 percent of total billed charges 217 93 175.77 percent of total billed charges 217 217 other OPPS APC 217 217 other OPPS APC 217 27.63 59.96 percent of total billed charges 217 217 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE WEISS 17G X 5 SUP-97-00272 CDM 0272 RC outpatient 258.65 258.65 258.65 74 191.4 percent of total billed charges 258.65 93 209.51 percent of total billed charges 258.65 258.65 other OPPS APC 258.65 258.65 other OPPS APC 258.65 27.63 71.46 percent of total billed charges 258.65 258.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SPINAL INTRODUCER 20G X 1 1/4 SUP-97-00273 CDM 0272 RC outpatient 65.04 65.04 65.04 74 48.13 percent of total billed charges 65.04 93 52.68 percent of total billed charges 65.04 65.04 other OPPS APC 65.04 65.04 other OPPS APC 65.04 27.63 17.97 percent of total billed charges 65.04 65.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLING ARM DELUXE XLG SUP-97-00274 CDM 0271 RC outpatient 2.42 2.42 2.42 74 1.79 percent of total billed charges 2.42 93 1.96 percent of total billed charges 2.42 2.42 other OPPS APC 2.42 2.42 other OPPS APC 2.42 27.63 0.67 percent of total billed charges 2.42 2.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROSET 10CC SUP-97-00284 CDM C1713 HCPCS 0278 RC outpatient 6924 6924 6924 57 3946.68 percent of total billed charges 6924 93 5608.44 percent of total billed charges 6924 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6924 other OPPS APC 6924 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6924 other OPPS APC 6924 51 3531.24 percent of total billed charges 6924 6924 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VITOSS 10CC SUP-97-00285 CDM C1713 HCPCS 0278 RC outpatient 2625 2625 2625 57 1496.25 percent of total billed charges 2625 93 2126.25 percent of total billed charges 2625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2625 other OPPS APC 2625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2625 other OPPS APC 2625 51 1338.75 percent of total billed charges 2625 2625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ORO TRACHEAL INJECTOR SUP-97-00287 CDM 0272 RC outpatient 408.52 408.52 408.52 74 302.3 percent of total billed charges 408.52 93 330.9 percent of total billed charges 408.52 408.52 other OPPS APC 408.52 408.52 other OPPS APC 408.52 27.63 112.87 percent of total billed charges 408.52 408.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING TITANIUM 3.5MM 30MM SUP-97-002875 CDM C1713 HCPCS 0278 RC outpatient 297.5 297.5 297.5 57 169.58 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 51 151.73 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZIMMER TOTAL HIP SUP-97-00288 CDM C1776 HCPCS 0278 RC outpatient 12400 12400 12400 57 7068 percent of total billed charges 12400 93 10044 percent of total billed charges 12400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12400 other OPPS APC 12400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12400 other OPPS APC 12400 51 6324 percent of total billed charges 12400 12400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANTERIOR TIBIALS TENDON SUP-97-00290 CDM C1762 HCPCS 0278 RC outpatient 5417.5 5417.5 5417.5 57 3087.98 percent of total billed charges 5417.5 93 4388.18 percent of total billed charges 5417.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5417.5 other OPPS APC 5417.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5417.5 other OPPS APC 5417.5 51 2762.93 percent of total billed charges 5417.5 5417.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACHILLES TENDON SUP-97-00291 CDM C1762 HCPCS 0278 RC outpatient 3120 3120 3120 57 1778.4 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3120 other OPPS APC 3120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3120 other OPPS APC 3120 51 1591.2 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOTAL KNEE SUP-97-00292 CDM C1776 HCPCS 0278 RC outpatient 9800 9800 9800 57 5586 percent of total billed charges 9800 93 7938 percent of total billed charges 9800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9800 other OPPS APC 9800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9800 other OPPS APC 9800 51 4998 percent of total billed charges 9800 9800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE STIMUPLEX 22G X 2 SUP-97-00295 CDM 0272 RC outpatient 29.14 29.14 29.14 74 21.56 percent of total billed charges 29.14 93 23.6 percent of total billed charges 29.14 29.14 other OPPS APC 29.14 29.14 other OPPS APC 29.14 27.63 8.05 percent of total billed charges 29.14 29.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EYESHIELD SAFEVIEW GLASSES SUP-97-00296 CDM 0271 RC outpatient 1.19 1.19 1.19 74 0.88 percent of total billed charges 1.19 93 0.96 percent of total billed charges 1.19 1.19 other OPPS APC 1.19 1.19 other OPPS APC 1.19 27.63 0.33 percent of total billed charges 1.19 1.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFIX PRIME CELLULAR MATRIX 2X2 SUP-97-00298 CDM Q4133 HCPCS 0636 RC outpatient 3000 3000 166 166 fee schedule 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 24.86 745.8 percent of total billed charges 166 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFIX PRIME CELLULAR MATRIX 5X5 SUP-97-00299 CDM Q4133 HCPCS 0636 RC outpatient 6625 6625 166 166 fee schedule 6625 93 5366.25 percent of total billed charges 6625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6625 other OPPS APC 6625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6625 other OPPS APC 6625 24.86 1646.98 percent of total billed charges 166 6625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFIX CORE CELLULAR MATRIX 5X5 SUP-97-00300 CDM Q4133 HCPCS 0636 RC outpatient 6625 6625 166 166 fee schedule 6625 93 5366.25 percent of total billed charges 6625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6625 other OPPS APC 6625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6625 other OPPS APC 6625 24.86 1646.98 percent of total billed charges 166 6625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIFUSION ENTCEPS SUP-97-00302 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE STIM ULTRA 22G X 50MM 2IN SUP-97-00304 CDM 0272 RC outpatient 43.41 43.41 43.41 74 32.12 percent of total billed charges 43.41 93 35.16 percent of total billed charges 43.41 43.41 other OPPS APC 43.41 43.41 other OPPS APC 43.41 27.63 11.99 percent of total billed charges 43.41 43.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROLARYN + PLUS VOICE INJECTABLE IMPLANT SUP-97-00306 CDM C1878 HCPCS 0278 RC outpatient 1875 1875 1875 57 1068.75 percent of total billed charges 1875 93 1518.75 percent of total billed charges 1875 1875 other OPPS APC 1875 1875 other OPPS APC 1875 51 956.25 percent of total billed charges 1875 1875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 MM LOCKING IM NAIL 3 SUP-97-00310 CDM C1713 HCPCS 0278 RC outpatient 748.38 748.38 748.38 57 426.58 percent of total billed charges 748.38 93 606.19 percent of total billed charges 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 51 381.67 percent of total billed charges 748.38 748.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 MM LOCKING IM NAIL 3 SUP-97-00311 CDM C1713 HCPCS 0278 RC outpatient 748.38 748.38 748.38 57 426.58 percent of total billed charges 748.38 93 606.19 percent of total billed charges 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 51 381.67 percent of total billed charges 748.38 748.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 MM LOCKING IM NAIL 3 SUP-97-00312 CDM C1713 HCPCS 0278 RC outpatient 748.38 748.38 748.38 57 426.58 percent of total billed charges 748.38 93 606.19 percent of total billed charges 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 51 381.67 percent of total billed charges 748.38 748.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 MM LOCKING IM NAIL 4 SUP-97-00313 CDM C1713 HCPCS 0278 RC outpatient 748.38 748.38 748.38 57 426.58 percent of total billed charges 748.38 93 606.19 percent of total billed charges 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 51 381.67 percent of total billed charges 748.38 748.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 3 SUP-97-00314 CDM C1713 HCPCS 0278 RC outpatient 1152 1152 1152 57 656.64 percent of total billed charges 1152 93 933.12 percent of total billed charges 1152 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1152 other OPPS APC 1152 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1152 other OPPS APC 1152 51 587.52 percent of total billed charges 1152 1152 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 4 SUP-97-00315 CDM C1713 HCPCS 0278 RC outpatient 726.57 726.57 726.57 57 414.14 percent of total billed charges 726.57 93 588.52 percent of total billed charges 726.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 726.57 other OPPS APC 726.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 726.57 other OPPS APC 726.57 51 370.55 percent of total billed charges 726.57 726.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE 11 MM HELICAL 120 MM SUP-97-00316 CDM C1713 HCPCS 0278 RC outpatient 2157.51 2157.51 2157.51 57 1229.78 percent of total billed charges 2157.51 93 1747.58 percent of total billed charges 2157.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2157.51 other OPPS APC 2157.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2157.51 other OPPS APC 2157.51 51 1100.33 percent of total billed charges 2157.51 2157.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TIBIAL CANN 10MM X 345MM SUP-97-00317 CDM C1713 HCPCS 0278 RC outpatient 4561.35 4561.35 4561.35 57 2599.97 percent of total billed charges 4561.35 93 3694.69 percent of total billed charges 4561.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4561.35 other OPPS APC 4561.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4561.35 other OPPS APC 4561.35 51 2326.29 percent of total billed charges 4561.35 4561.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TIBIAL CANN 10MM X 390MM SUP-97-00318 CDM C1713 HCPCS 0278 RC outpatient 4561.35 4561.35 4561.35 57 2599.97 percent of total billed charges 4561.35 93 3694.69 percent of total billed charges 4561.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4561.35 other OPPS APC 4561.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4561.35 other OPPS APC 4561.35 51 2326.29 percent of total billed charges 4561.35 4561.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TIBIAL CANN 9MM X 360MM SUP-97-00319 CDM C1713 HCPCS 0278 RC outpatient 4561.35 4561.35 4561.35 57 2599.97 percent of total billed charges 4561.35 93 3694.69 percent of total billed charges 4561.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4561.35 other OPPS APC 4561.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4561.35 other OPPS APC 4561.35 51 2326.29 percent of total billed charges 4561.35 4561.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TIVIAL CANN 8MM 285 SUP-97-00320 CDM C1713 HCPCS 0278 RC outpatient 4561.35 4561.35 4561.35 57 2599.97 percent of total billed charges 4561.35 93 3694.69 percent of total billed charges 4561.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4561.35 other OPPS APC 4561.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4561.35 other OPPS APC 4561.35 51 2326.29 percent of total billed charges 4561.35 4561.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL NAIL DRILL BIT 4.0MM 3 SUP-97-00321 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER SUP-97-00322 CDM C1713 HCPCS 0278 RC outpatient 108.56 108.56 108.56 57 61.88 percent of total billed charges 108.56 93 87.93 percent of total billed charges 108.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 108.56 other OPPS APC 108.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 108.56 other OPPS APC 108.56 51 55.37 percent of total billed charges 108.56 108.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE 11MM HELICAL 105MM SUP-97-00323 CDM C1713 HCPCS 0278 RC outpatient 2157.51 2157.51 2157.51 57 1229.78 percent of total billed charges 2157.51 93 1747.58 percent of total billed charges 2157.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2157.51 other OPPS APC 2157.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2157.51 other OPPS APC 2157.51 51 1100.33 percent of total billed charges 2157.51 2157.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 5 STERILE SUP-97-00324 CDM C1713 HCPCS 0278 RC outpatient 1152 1152 1152 57 656.64 percent of total billed charges 1152 93 933.12 percent of total billed charges 1152 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1152 other OPPS APC 1152 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1152 other OPPS APC 1152 51 587.52 percent of total billed charges 1152 1152 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 5 SUP-97-00325 CDM C1713 HCPCS 0278 RC outpatient 748.38 748.38 748.38 57 426.58 percent of total billed charges 748.38 93 606.19 percent of total billed charges 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 51 381.67 percent of total billed charges 748.38 748.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANN TROCH FIX 10MM 130 SUP-97-00326 CDM C1713 HCPCS 0278 RC outpatient 5940.8 5940.8 5940.8 57 3386.26 percent of total billed charges 5940.8 93 4812.05 percent of total billed charges 5940.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5940.8 other OPPS APC 5940.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5940.8 other OPPS APC 5940.8 51 3029.81 percent of total billed charges 5940.8 5940.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 4.2 3 FLUTED NEEDLE 145MM SUP-97-00327 CDM 0272 RC outpatient 720.39 720.39 720.39 74 533.09 percent of total billed charges 720.39 93 583.52 percent of total billed charges 720.39 720.39 other OPPS APC 720.39 720.39 other OPPS APC 720.39 27.63 199.04 percent of total billed charges 720.39 720.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE 3.2MM X 400MM SUP-97-00328 CDM 0272 RC outpatient 371.7 371.7 371.7 74 275.06 percent of total billed charges 371.7 93 301.08 percent of total billed charges 371.7 371.7 other OPPS APC 371.7 371.7 other OPPS APC 371.7 27.63 102.7 percent of total billed charges 371.7 371.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE 11MM HELICAL 90MM SUP-97-00329 CDM C1713 HCPCS 0278 RC outpatient 2157.51 2157.51 2157.51 57 1229.78 percent of total billed charges 2157.51 93 1747.58 percent of total billed charges 2157.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2157.51 other OPPS APC 2157.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2157.51 other OPPS APC 2157.51 51 1100.33 percent of total billed charges 2157.51 2157.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 44MM SUP-97-00330 CDM C1713 HCPCS 0278 RC outpatient 843.18 843.18 843.18 57 480.61 percent of total billed charges 843.18 93 682.98 percent of total billed charges 843.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 843.18 other OPPS APC 843.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 843.18 other OPPS APC 843.18 51 430.02 percent of total billed charges 843.18 843.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANN TROCH FIX 11MM 130 400 SUP-97-00331 CDM C1713 HCPCS 0278 RC outpatient 4805.33 4805.33 4805.33 57 2739.04 percent of total billed charges 4805.33 93 3892.32 percent of total billed charges 4805.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4805.33 other OPPS APC 4805.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4805.33 other OPPS APC 4805.33 51 2450.72 percent of total billed charges 4805.33 4805.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANN TROCH FIX 10MM 130 400 SUP-97-00332 CDM C1713 HCPCS 0278 RC outpatient 5272.78 5272.78 5272.78 57 3005.48 percent of total billed charges 5272.78 93 4270.95 percent of total billed charges 5272.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5272.78 other OPPS APC 5272.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5272.78 other OPPS APC 5272.78 51 2689.12 percent of total billed charges 5272.78 5272.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE 11MM HELICAL 95MM SUP-97-00333 CDM C1713 HCPCS 0278 RC outpatient 2157.51 2157.51 2157.51 57 1229.78 percent of total billed charges 2157.51 93 1747.58 percent of total billed charges 2157.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2157.51 other OPPS APC 2157.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2157.51 other OPPS APC 2157.51 51 1100.33 percent of total billed charges 2157.51 2157.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 46MM SUP-97-00334 CDM C1713 HCPCS 0278 RC outpatient 770.82 770.82 770.82 57 439.37 percent of total billed charges 770.82 93 624.36 percent of total billed charges 770.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 770.82 other OPPS APC 770.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 770.82 other OPPS APC 770.82 51 393.12 percent of total billed charges 770.82 770.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TISSUEMEND SUP-97-00335 CDM C1763 HCPCS 0278 RC outpatient 8787.5 8787.5 8787.5 57 5008.88 percent of total billed charges 8787.5 93 7117.88 percent of total billed charges 8787.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8787.5 other OPPS APC 8787.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8787.5 other OPPS APC 8787.5 51 4481.63 percent of total billed charges 8787.5 8787.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYNTHES SAW BLADE 70/1.27MM SUP-97-00336 CDM 0272 RC outpatient 353.5 353.5 353.5 74 261.59 percent of total billed charges 353.5 93 286.34 percent of total billed charges 353.5 353.5 other OPPS APC 353.5 353.5 other OPPS APC 353.5 27.63 97.67 percent of total billed charges 353.5 353.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 MM LOCKING IM NAIL 5 SUP-97-00337 CDM C1713 HCPCS 0278 RC outpatient 843.18 843.18 843.18 57 480.61 percent of total billed charges 843.18 93 682.98 percent of total billed charges 843.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 843.18 other OPPS APC 843.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 843.18 other OPPS APC 843.18 51 430.02 percent of total billed charges 843.18 843.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANN TROCH FIX 11MM 130 380 R SUP-97-00338 CDM C1713 HCPCS 0278 RC outpatient 4805.33 4805.33 4805.33 57 2739.04 percent of total billed charges 4805.33 93 3892.32 percent of total billed charges 4805.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4805.33 other OPPS APC 4805.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4805.33 other OPPS APC 4805.33 51 2450.72 percent of total billed charges 4805.33 4805.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.5MM 3FLUTE 110MM SUP-97-00340 CDM 0272 RC outpatient 281.75 281.75 281.75 74 208.5 percent of total billed charges 281.75 93 228.22 percent of total billed charges 281.75 281.75 other OPPS APC 281.75 281.75 other OPPS APC 281.75 27.63 77.85 percent of total billed charges 281.75 281.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATH PED 8FR FOLEY 3CC 2WAY SUP-97-00347 CDM C1729 HCPCS 0272 RC outpatient 22.12 22.12 22.12 74 16.37 percent of total billed charges 22.12 93 17.92 percent of total billed charges 22.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.12 other OPPS APC 22.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 22.12 other OPPS APC 22.12 27.63 6.11 percent of total billed charges 22.12 22.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATH PED 10FR FOLEY 3CC 2WAY SUP-97-00348 CDM C1729 HCPCS 0272 RC outpatient 26.56 26.56 26.56 74 19.65 percent of total billed charges 26.56 93 21.51 percent of total billed charges 26.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 26.56 other OPPS APC 26.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 26.56 other OPPS APC 26.56 27.63 7.34 percent of total billed charges 26.56 26.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY NASOPHARYNGEAL 34FR 8.5MM SUP-97-00349 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 3 SUP-97-00350 CDM C1713 HCPCS 0278 RC outpatient 868.56 868.56 868.56 57 495.08 percent of total billed charges 868.56 93 703.53 percent of total billed charges 868.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 868.56 other OPPS APC 868.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 868.56 other OPPS APC 868.56 51 442.97 percent of total billed charges 868.56 868.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANN TROCH FIX 11MM 130 340 SUP-97-00351 CDM C1713 HCPCS 0278 RC outpatient 5745.75 5745.75 5745.75 57 3275.08 percent of total billed charges 5745.75 93 4654.06 percent of total billed charges 5745.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5745.75 other OPPS APC 5745.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5745.75 other OPPS APC 5745.75 51 2930.33 percent of total billed charges 5745.75 5745.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD REAMING 2.5 X 950MM SUP-97-00352 CDM 0272 RC outpatient 523.25 523.25 523.25 74 387.21 percent of total billed charges 523.25 93 423.83 percent of total billed charges 523.25 523.25 other OPPS APC 523.25 523.25 other OPPS APC 523.25 27.63 144.57 percent of total billed charges 523.25 523.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5.0 78MM SUP-97-00353 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ARTICULAR SURFACE E,F 17MM LCCK" SUP-97-00354 CDM C1776 HCPCS 0278 RC outpatient 4257 4257 4257 57 2426.49 percent of total billed charges 4257 93 3448.17 percent of total billed charges 4257 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4257 other OPPS APC 4257 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4257 other OPPS APC 4257 51 2171.07 percent of total billed charges 4257 4257 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 1 SUP-97-00355 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5.0 X 70MM IM NAIL SUP-97-00356 CDM C1713 HCPCS 0278 RC outpatient 727.47 727.47 727.47 57 414.66 percent of total billed charges 727.47 93 589.25 percent of total billed charges 727.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 727.47 other OPPS APC 727.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 727.47 other OPPS APC 727.47 51 371.01 percent of total billed charges 727.47 727.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL SUP-97-00357 CDM C1713 HCPCS 0278 RC outpatient 748.38 748.38 748.38 57 426.58 percent of total billed charges 748.38 93 606.19 percent of total billed charges 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 51 381.67 percent of total billed charges 748.38 748.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 8 SUP-97-00358 CDM C1713 HCPCS 0278 RC outpatient 770.82 770.82 770.82 57 439.37 percent of total billed charges 770.82 93 624.36 percent of total billed charges 770.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 770.82 other OPPS APC 770.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 770.82 other OPPS APC 770.82 51 393.12 percent of total billed charges 770.82 770.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 7 SUP-97-00359 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD REAMING 2.5 X 850MM SUP-97-00360 CDM 0272 RC outpatient 627.8 627.8 627.8 74 464.57 percent of total billed charges 627.8 93 508.52 percent of total billed charges 627.8 627.8 other OPPS APC 627.8 627.8 other OPPS APC 627.8 27.63 173.46 percent of total billed charges 627.8 627.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE THREADED 2.8MM SUP-97-00361 CDM 0272 RC outpatient 172 172 172 74 127.28 percent of total billed charges 172 93 139.32 percent of total billed charges 172 172 other OPPS APC 172 172 other OPPS APC 172 27.63 47.52 percent of total billed charges 172 172 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SAW BLADE 25MM 95/1.25MM SUP-97-00362 CDM 0272 RC outpatient 371 371 371 74 274.54 percent of total billed charges 371 93 300.51 percent of total billed charges 371 371 other OPPS APC 371 371 other OPPS APC 371 27.63 102.51 percent of total billed charges 371 371 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 4.2 3 FLUTED NP145MM N/S SUP-97-00363 CDM 0272 RC outpatient 650.48 650.48 650.48 74 481.36 percent of total billed charges 650.48 93 526.89 percent of total billed charges 650.48 650.48 other OPPS APC 650.48 650.48 other OPPS APC 650.48 27.63 179.73 percent of total billed charges 650.48 650.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SYSTEM DRILL PIN BX/5EA SUP-97-00364 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASPIRATOR KIT SUP-97-00365 CDM 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CERCLAGE POSITIONING PIN 4.5MM SUP-97-00368 CDM C1713 HCPCS 0278 RC outpatient 710.64 710.64 710.64 57 405.06 percent of total billed charges 710.64 93 575.62 percent of total billed charges 710.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 710.64 other OPPS APC 710.64 710.64 other OPPS APC 710.64 51 362.43 percent of total billed charges 710.64 710.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PUNCH BIOPSY 6MM DISPOSABLE SUP-97-00373 CDM 0272 RC outpatient 1.48 1.48 1.48 74 1.1 percent of total billed charges 1.48 93 1.2 percent of total billed charges 1.48 1.48 other OPPS APC 1.48 1.48 other OPPS APC 1.48 27.63 0.41 percent of total billed charges 1.48 1.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER 13MM SUP-97-00378 CDM C1713 HCPCS 0278 RC outpatient 120.36 120.36 120.36 57 68.61 percent of total billed charges 120.36 93 97.49 percent of total billed charges 120.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 120.36 other OPPS APC 120.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 120.36 other OPPS APC 120.36 51 61.38 percent of total billed charges 120.36 120.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW THREADED 7.3MM X 32MM X 95MM SUP-97-00379 CDM C1713 HCPCS 0278 RC outpatient 886.83 886.83 886.83 57 505.49 percent of total billed charges 886.83 93 718.33 percent of total billed charges 886.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 886.83 other OPPS APC 886.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 886.83 other OPPS APC 886.83 51 452.28 percent of total billed charges 886.83 886.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DERMACLOSE SUP-97-00380 CDM 0272 RC outpatient 2997 2997 2997 74 2217.78 percent of total billed charges 2997 93 2427.57 percent of total billed charges 2997 2997 other OPPS APC 2997 2997 other OPPS APC 2997 27.63 828.07 percent of total billed charges 2997 2997 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CORD BUGBY MONOPOLAR 4MM PLUG SUP-97-00383 CDM 0272 RC outpatient 590.63 590.63 590.63 74 437.07 percent of total billed charges 590.63 93 478.41 percent of total billed charges 590.63 590.63 other OPPS APC 590.63 590.63 other OPPS APC 590.63 27.63 163.19 percent of total billed charges 590.63 590.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 7.3MM CANNULATED 16MM THEAD 95MM SUP-97-00384 CDM C1713 HCPCS 0278 RC outpatient 733.5 733.5 733.5 57 418.1 percent of total billed charges 733.5 93 594.14 percent of total billed charges 733.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 733.5 other OPPS APC 733.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 733.5 other OPPS APC 733.5 51 374.09 percent of total billed charges 733.5 733.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8FR CLEAN CATH SUP-97-00386 CDM 0272 RC outpatient 1 1 1 74 0.74 percent of total billed charges 1 93 0.81 percent of total billed charges 1 1 other OPPS APC 1 1 other OPPS APC 1 27.63 0.28 percent of total billed charges 1 1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANN TROCH FIX 11MM 130 360 SUP-97-00387 CDM C1713 HCPCS 0278 RC outpatient 4805.33 4805.33 4805.33 57 2739.04 percent of total billed charges 4805.33 93 3892.32 percent of total billed charges 4805.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4805.33 other OPPS APC 4805.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4805.33 other OPPS APC 4805.33 51 2450.72 percent of total billed charges 4805.33 4805.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT DBM PUTTY 5CC (3102-1005) SUP-97-00388 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEM GEL SUP-97-00389 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIGASURE RETRACTABLE L-HOOK LAPAROSCOPIC SEALER/DIVIDER 37CM SUP-97-00390 CDM 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZIMMER HIP PARTIAL SUP-97-00392 CDM C1776 HCPCS 0278 RC outpatient 8400 8400 8400 57 4788 percent of total billed charges 8400 93 6804 percent of total billed charges 8400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8400 other OPPS APC 8400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8400 other OPPS APC 8400 51 4284 percent of total billed charges 8400 8400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TISSUE RETENTION SYSTEM SUP-97-00393 CDM 0272 RC outpatient 234.5 234.5 234.5 74 173.53 percent of total billed charges 234.5 93 189.95 percent of total billed charges 234.5 234.5 other OPPS APC 234.5 234.5 other OPPS APC 234.5 27.63 64.79 percent of total billed charges 234.5 234.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT 9MM W/ABUTMENT SUP-97-00394 CDM L8670 HCPCS 0278 RC outpatient 5047.5 5047.5 5047.5 57 2877.08 percent of total billed charges 5047.5 93 4088.48 percent of total billed charges 5047.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5047.5 other OPPS APC 5047.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5047.5 other OPPS APC 5047.5 51 2574.23 percent of total billed charges 5047.5 5047.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIDE IMPLANT 4MM W/ABUTMENT9MM SUP-97-00395 CDM L8670 HCPCS 0278 RC outpatient 7962.5 7962.5 7962.5 57 4538.63 percent of total billed charges 7962.5 93 6449.63 percent of total billed charges 7962.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7962.5 other OPPS APC 7962.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7962.5 other OPPS APC 7962.5 51 4060.88 percent of total billed charges 7962.5 7962.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO AFTER CASE KIT SUP-97-00396 CDM 0272 RC outpatient 51.68 51.68 51.68 74 38.24 percent of total billed charges 51.68 93 41.86 percent of total billed charges 51.68 51.68 other OPPS APC 51.68 51.68 other OPPS APC 51.68 27.63 14.28 percent of total billed charges 51.68 51.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE DRILL3/4MM SUP-97-00397 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIDE COUNTERSINK 3MM SUP-97-00398 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOPSY PUNCH 4MM SUP-97-00399 CDM 0272 RC outpatient 1.73 1.73 1.73 74 1.28 percent of total billed charges 1.73 93 1.4 percent of total billed charges 1.73 1.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOPSY PUNCH 4MM DISPOSABLE SUP-97-00399 CDM 0272 RC outpatient 1.73 1.73 1.73 1.73 other OPPS APC 1.73 1.73 other OPPS APC 1.73 27.63 0.48 percent of total billed charges 1.73 1.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEALING CAP SUP-97-00400 CDM 0272 RC outpatient 60.8 60.8 60.8 74 44.99 percent of total billed charges 60.8 93 49.25 percent of total billed charges 60.8 60.8 other OPPS APC 60.8 60.8 other OPPS APC 60.8 27.63 16.8 percent of total billed charges 60.8 60.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLEVYN WOUND CARE SUP-97-00401 CDM 0272 RC outpatient 31.92 31.92 31.92 74 23.62 percent of total billed charges 31.92 93 25.86 percent of total billed charges 31.92 31.92 other OPPS APC 31.92 31.92 other OPPS APC 31.92 27.63 8.82 percent of total billed charges 31.92 31.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO PLUS POWER SUP-97-00402 CDM L8679 HCPCS 0272 RC outpatient 8990 8990 8990 74 6652.6 percent of total billed charges 8990 93 7281.9 percent of total billed charges 8990 8990 other OPPS APC 8990 8990 other OPPS APC 8990 27.63 2483.94 percent of total billed charges 8990 8990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO STEAMER BLACK SUP-97-00403 CDM L8679 HCPCS 0272 RC outpatient 339.5 339.5 339.5 74 251.23 percent of total billed charges 339.5 93 275 percent of total billed charges 339.5 339.5 other OPPS APC 339.5 339.5 other OPPS APC 339.5 27.63 93.8 percent of total billed charges 339.5 339.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.7MM CABLEW/ CRIMP SUP-97-00404 CDM C1713 HCPCS 0278 RC outpatient 1900.68 1900.68 1900.68 57 1083.39 percent of total billed charges 1900.68 93 1539.55 percent of total billed charges 1900.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1900.68 other OPPS APC 1900.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1900.68 other OPPS APC 1900.68 51 969.35 percent of total billed charges 1900.68 1900.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.7MM COCR CABLEW/ TI CRIMP SUP-97-00405 CDM C1713 HCPCS 0278 RC outpatient 1688.58 1688.58 1688.58 57 962.49 percent of total billed charges 1688.58 93 1367.75 percent of total billed charges 1688.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1688.58 other OPPS APC 1688.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1688.58 other OPPS APC 1688.58 51 861.18 percent of total billed charges 1688.58 1688.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOTAL HIP SUP-97-00406 CDM C1776 HCPCS 0278 RC outpatient 13900 13900 13900 57 7923 percent of total billed charges 13900 93 11259 percent of total billed charges 13900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13900 other OPPS APC 13900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 13900 other OPPS APC 13900 51 7089 percent of total billed charges 13900 13900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP POSITIONER SUP-97-00410 CDM 0272 RC outpatient 1149.6 1149.6 1149.6 74 850.7 percent of total billed charges 1149.6 93 931.18 percent of total billed charges 1149.6 1149.6 other OPPS APC 1149.6 1149.6 other OPPS APC 1149.6 27.63 317.63 percent of total billed charges 1149.6 1149.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANN TROCH FIX 11MM LEFT 130 380 R SUP-97-00414 CDM C1713 HCPCS 0278 RC outpatient 4805.33 4805.33 4805.33 57 2739.04 percent of total billed charges 4805.33 93 3892.32 percent of total billed charges 4805.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4805.33 other OPPS APC 4805.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4805.33 other OPPS APC 4805.33 51 2450.72 percent of total billed charges 4805.33 4805.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTACHMENT 45DEG X 20G SILCONE SLV TIP SUP-97-00415 CDM 0272 RC outpatient 1650 1650 1650 74 1221 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 1650 other OPPS APC 1650 1650 other OPPS APC 1650 27.63 455.9 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TIBIA 10MM CANN EX 375 MM SUP-97-00425 CDM C1713 HCPCS 0278 RC outpatient 4700 4700 4700 57 2679 percent of total billed charges 4700 93 3807 percent of total billed charges 4700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4700 other OPPS APC 4700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4700 other OPPS APC 4700 51 2397 percent of total billed charges 4700 4700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HELICAL BLADE SUP-97-00426 CDM C1713 HCPCS 0278 RC outpatient 2157.51 2157.51 2157.51 57 1229.78 percent of total billed charges 2157.51 93 1747.58 percent of total billed charges 2157.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2157.51 other OPPS APC 2157.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2157.51 other OPPS APC 2157.51 51 1100.33 percent of total billed charges 2157.51 2157.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 12.0MM OUTER PROTECTION SLEEVE SUP-97-00427 CDM C1713 HCPCS 0278 RC outpatient 354.2 354.2 354.2 57 201.89 percent of total billed charges 354.2 93 286.9 percent of total billed charges 354.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 354.2 other OPPS APC 354.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 354.2 other OPPS APC 354.2 51 180.64 percent of total billed charges 354.2 354.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TROCH SUP-97-00428 CDM C1713 HCPCS 0278 RC outpatient 4805.33 4805.33 4805.33 57 2739.04 percent of total billed charges 4805.33 93 3892.32 percent of total billed charges 4805.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4805.33 other OPPS APC 4805.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4805.33 other OPPS APC 4805.33 51 2450.72 percent of total billed charges 4805.33 4805.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DBX PUTTY 1CC SUP-97-00476 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DBX PUTTY 2.5CC SUP-97-00477 CDM C1713 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LCP TUBULAR 8 HOLE 93 MM SUP-97-00479 CDM C1713 HCPCS 0278 RC outpatient 683.52 683.52 683.52 57 389.61 percent of total billed charges 683.52 93 553.65 percent of total billed charges 683.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 683.52 other OPPS APC 683.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 683.52 other OPPS APC 683.52 51 348.6 percent of total billed charges 683.52 683.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN LONG THREAD 4MM X 50MM SUP-97-00480 CDM C1713 HCPCS 0278 RC outpatient 659.75 659.75 659.75 57 376.06 percent of total billed charges 659.75 93 534.4 percent of total billed charges 659.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 659.75 other OPPS APC 659.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 659.75 other OPPS APC 659.75 51 336.47 percent of total billed charges 659.75 659.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTEGRA MESHED BILAYER WOUND MATRIX 4X5 SUP-97-00481 CDM Q4104 HCPCS 0636 RC outpatient 8507.2 8507.2 55.89 55.89 fee schedule 8507.2 93 6890.83 percent of total billed charges 8507.2 8507.2 other OPPS APC 8507.2 8507.2 other OPPS APC 8507.2 24.86 2114.89 percent of total billed charges 55.89 8507.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TIBIA 9MM CANN EX 330 MM SUP-97-00571 CDM C1713 HCPCS 0278 RC outpatient 3930.53 3930.53 3930.53 57 2240.4 percent of total billed charges 3930.53 93 3183.73 percent of total billed charges 3930.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3930.53 other OPPS APC 3930.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3930.53 other OPPS APC 3930.53 51 2004.57 percent of total billed charges 3930.53 3930.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENCORE HYOID & TONGUE SUSPENSION SYS SUP-97-00573 CDM C1713 HCPCS 0278 RC outpatient 6100 6100 6100 57 3477 percent of total billed charges 6100 93 4941 percent of total billed charges 6100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6100 other OPPS APC 6100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6100 other OPPS APC 6100 51 3111 percent of total billed charges 6100 6100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REVOLUTION SUTURE PASSER SUP-97-00574 CDM 0272 RC outpatient 720 720 720 74 532.8 percent of total billed charges 720 93 583.2 percent of total billed charges 720 720 other OPPS APC 720 720 other OPPS APC 720 27.63 198.94 percent of total billed charges 720 720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACHILLES TEN- BONE BLOCK-ZORC SUP-97-00590 CDM C1762 HCPCS 0278 RC outpatient 7175.35 7175.35 7175.35 57 4089.95 percent of total billed charges 7175.35 93 5812.03 percent of total billed charges 7175.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7175.35 other OPPS APC 7175.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7175.35 other OPPS APC 7175.35 51 3659.43 percent of total billed charges 7175.35 7175.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LMA SZ 4 SUPREME SUP-97-00591 CDM 0272 RC outpatient 49.4 49.4 49.4 74 36.56 percent of total billed charges 49.4 93 40.01 percent of total billed charges 49.4 49.4 other OPPS APC 49.4 49.4 other OPPS APC 49.4 27.63 13.65 percent of total billed charges 49.4 49.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LMA SZ 5 SUPREME SUP-97-00592 CDM 0272 RC outpatient 49.4 49.4 49.4 74 36.56 percent of total billed charges 49.4 93 40.01 percent of total billed charges 49.4 49.4 other OPPS APC 49.4 49.4 other OPPS APC 49.4 27.63 13.65 percent of total billed charges 49.4 49.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ACUSEAL VASCULAR 6MM X 40CM SUP-97-00593 CDM C1768 HCPCS 0278 RC outpatient 3265 3265 3265 57 1861.05 percent of total billed charges 3265 93 2644.65 percent of total billed charges 3265 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3265 other OPPS APC 3265 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3265 other OPPS APC 3265 51 1665.15 percent of total billed charges 3265 3265 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TISSUE EXPANDERS 400CC SUP-97-00594 CDM L8699 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 3875 other OPPS APC 3875 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANCELLOUS SCREW 4.0X20MM SUP-97-00597 CDM C1713 HCPCS 0278 RC outpatient 107.16 107.16 107.16 57 61.08 percent of total billed charges 107.16 93 86.8 percent of total billed charges 107.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 107.16 other OPPS APC 107.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 107.16 other OPPS APC 107.16 51 54.65 percent of total billed charges 107.16 107.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANCELLOUS SCREW 3.5X14MM SUP-97-00598 CDM C1713 HCPCS 0278 RC outpatient 77.56 77.56 77.56 57 44.21 percent of total billed charges 77.56 93 62.82 percent of total billed charges 77.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 77.56 other OPPS APC 77.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 77.56 other OPPS APC 77.56 51 39.56 percent of total billed charges 77.56 77.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR WLGORE SUP-97-00600 CDM C1768 HCPCS 0278 RC outpatient 3595 3595 3595 57 2049.15 percent of total billed charges 3595 93 2911.95 percent of total billed charges 3595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3595 other OPPS APC 3595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3595 other OPPS APC 3595 51 1833.45 percent of total billed charges 3595 3595 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOOD STRYKER PEEL AWAY FACE SHIELD SUP-97-00603 CDM 0272 RC outpatient 160.38 160.38 160.38 74 118.68 percent of total billed charges 160.38 93 129.91 percent of total billed charges 160.38 160.38 other OPPS APC 160.38 160.38 other OPPS APC 160.38 27.63 44.31 percent of total billed charges 160.38 160.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE TIP IRRIGATION EXLONG 5MM SUP-97-00610 CDM 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 490 other OPPS APC 490 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE TIP IRRIGATION 33CM SUP-97-00611 CDM 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 437.5 other OPPS APC 437.5 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 3 SUP-97-00621 CDM C1713 HCPCS 0278 RC outpatient 1152 1152 1152 57 656.64 percent of total billed charges 1152 93 933.12 percent of total billed charges 1152 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1152 other OPPS APC 1152 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1152 other OPPS APC 1152 51 587.52 percent of total billed charges 1152 1152 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANN TROCH 10MM/130DEG SUP-97-00626 CDM C1713 HCPCS 0278 RC outpatient 3651.08 3651.08 3651.08 57 2081.12 percent of total billed charges 3651.08 93 2957.37 percent of total billed charges 3651.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3651.08 other OPPS APC 3651.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3651.08 other OPPS APC 3651.08 51 1862.05 percent of total billed charges 3651.08 3651.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANN TROCH 10MM/130DEG SUP-97-00627 CDM C1713 HCPCS 0278 RC outpatient 3760.6 3760.6 3760.6 57 2143.54 percent of total billed charges 3760.6 93 3046.09 percent of total billed charges 3760.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3760.6 other OPPS APC 3760.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3760.6 other OPPS APC 3760.6 51 1917.91 percent of total billed charges 3760.6 3760.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 4.0 SUP-97-00636 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 95 SUP-97-00642 CDM C1713 HCPCS 0278 RC outpatient 770.82 770.82 770.82 57 439.37 percent of total billed charges 770.82 93 624.36 percent of total billed charges 770.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 770.82 other OPPS APC 770.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 770.82 other OPPS APC 770.82 51 393.12 percent of total billed charges 770.82 770.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE 11MM HELICAL 80MM SUP-97-00643 CDM C1713 HCPCS 0278 RC outpatient 2504.16 2504.16 2504.16 57 1427.37 percent of total billed charges 2504.16 93 2028.37 percent of total billed charges 2504.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2504.16 other OPPS APC 2504.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2504.16 other OPPS APC 2504.16 51 1277.12 percent of total billed charges 2504.16 2504.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANCELLOUS CHIPS 30 SUP-97-00644 CDM C1713 HCPCS 0278 RC outpatient 1782 1782 1782 57 1015.74 percent of total billed charges 1782 93 1443.42 percent of total billed charges 1782 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1782 other OPPS APC 1782 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1782 other OPPS APC 1782 51 908.82 percent of total billed charges 1782 1782 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 2.0 SUP-97-00646 CDM C1713 HCPCS 0278 RC outpatient 140.12 140.12 140.12 57 79.87 percent of total billed charges 140.12 93 113.5 percent of total billed charges 140.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 140.12 other OPPS APC 140.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 140.12 other OPPS APC 140.12 51 71.46 percent of total billed charges 140.12 140.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE LABEL LIDOCAINE SUP-97-00652 CDM 0271 RC outpatient 1.73 1.73 1.73 74 1.28 percent of total billed charges 1.73 93 1.4 percent of total billed charges 1.73 1.73 other OPPS APC 1.73 1.73 other OPPS APC 1.73 27.63 0.48 percent of total billed charges 1.73 1.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE LABEL FENTANYL SUP-97-00653 CDM 0271 RC outpatient 2.89 2.89 2.89 74 2.14 percent of total billed charges 2.89 93 2.34 percent of total billed charges 2.89 2.89 other OPPS APC 2.89 2.89 other OPPS APC 2.89 27.63 0.8 percent of total billed charges 2.89 2.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE LABEL ROBINUL SUP-97-00654 CDM 0271 RC outpatient 2.54 2.54 2.54 74 1.88 percent of total billed charges 2.54 93 2.06 percent of total billed charges 2.54 2.54 other OPPS APC 2.54 2.54 other OPPS APC 2.54 27.63 0.7 percent of total billed charges 2.54 2.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE LABEL ATROPINE SUP-97-00655 CDM 0271 RC outpatient 2.03 2.03 2.03 74 1.5 percent of total billed charges 2.03 93 1.64 percent of total billed charges 2.03 2.03 other OPPS APC 2.03 2.03 other OPPS APC 2.03 27.63 0.56 percent of total billed charges 2.03 2.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE LABEL INAPSINE SUP-97-00656 CDM 0271 RC outpatient 2.2 2.2 2.2 74 1.63 percent of total billed charges 2.2 93 1.78 percent of total billed charges 2.2 2.2 other OPPS APC 2.2 2.2 other OPPS APC 2.2 27.63 0.61 percent of total billed charges 2.2 2.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE LABEL MIDAZOLAM SUP-97-00657 CDM 0271 RC outpatient 2.03 2.03 2.03 74 1.5 percent of total billed charges 2.03 93 1.64 percent of total billed charges 2.03 2.03 other OPPS APC 2.03 2.03 other OPPS APC 2.03 27.63 0.56 percent of total billed charges 2.03 2.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE LABEL DIPRIVAN SUP-97-00658 CDM 0271 RC outpatient 2.3 2.3 2.3 74 1.7 percent of total billed charges 2.3 93 1.86 percent of total billed charges 2.3 2.3 other OPPS APC 2.3 2.3 other OPPS APC 2.3 27.63 0.64 percent of total billed charges 2.3 2.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE LABEL NEOSTIGMINE SUP-97-00659 CDM 0271 RC outpatient 2.03 2.03 2.03 74 1.5 percent of total billed charges 2.03 93 1.64 percent of total billed charges 2.03 2.03 other OPPS APC 2.03 2.03 other OPPS APC 2.03 27.63 0.56 percent of total billed charges 2.03 2.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE LABEL WHITE 1 CORE 1/2X500 SUP-97-00660 CDM 0271 RC outpatient 2.2 2.2 2.2 74 1.63 percent of total billed charges 2.2 93 1.78 percent of total billed charges 2.2 2.2 other OPPS APC 2.2 2.2 other OPPS APC 2.2 27.63 0.61 percent of total billed charges 2.2 2.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE LABEL ONDANSETRON SUP-97-00661 CDM 0271 RC outpatient 2.2 2.2 2.2 74 1.63 percent of total billed charges 2.2 93 1.78 percent of total billed charges 2.2 2.2 other OPPS APC 2.2 2.2 other OPPS APC 2.2 27.63 0.61 percent of total billed charges 2.2 2.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GPS PINS SUP-97-00682 CDM 0272 RC outpatient 227.5 227.5 227.5 74 168.35 percent of total billed charges 227.5 93 184.28 percent of total billed charges 227.5 227.5 other OPPS APC 227.5 227.5 other OPPS APC 227.5 27.63 62.86 percent of total billed charges 227.5 227.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDO TRACH 4.5 CUFFED SUP-97-00687 CDM 0272 RC outpatient 2.29 2.29 2.29 74 1.69 percent of total billed charges 2.29 93 1.85 percent of total billed charges 2.29 2.29 other OPPS APC 2.29 2.29 other OPPS APC 2.29 27.63 0.63 percent of total billed charges 2.29 2.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE ENDO TRACH 6.5 NASAL CUFF SUP-97-00688 CDM 0272 RC outpatient 157.64 157.64 157.64 74 116.65 percent of total billed charges 157.64 93 127.69 percent of total billed charges 157.64 157.64 other OPPS APC 157.64 157.64 other OPPS APC 157.64 27.63 43.56 percent of total billed charges 157.64 157.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SURGICAL SNOW 1 X 2 SMALL SUP-97-00689 CDM 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SURGICAL SNOW 4 X 4 LG SUP-97-00690 CDM 0272 RC outpatient 420.65 420.65 420.65 74 311.28 percent of total billed charges 420.65 93 340.73 percent of total billed charges 420.65 420.65 other OPPS APC 420.65 420.65 other OPPS APC 420.65 27.63 116.23 percent of total billed charges 420.65 420.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMISPHERICAL CLUSTER HOLE SHELL SUP-97-00691 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POLYETHYLENE INSERT SUP-97-00692 CDM C1776 HCPCS 0278 RC outpatient 3125 3125 3125 57 1781.25 percent of total billed charges 3125 93 2531.25 percent of total billed charges 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 51 1593.75 percent of total billed charges 3125 3125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANCELELLOUS BONE SCREW SUP-97-00693 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANGLE HIP STEM SUP-97-00694 CDM C1776 HCPCS 0278 RC outpatient 7500 7500 7500 57 4275 percent of total billed charges 7500 93 6075 percent of total billed charges 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 51 3825 percent of total billed charges 7500 7500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD SUP-97-00695 CDM C1776 HCPCS 0278 RC outpatient 2250 2250 2250 57 1282.5 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 51 1147.5 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL COMPONENT POSTERIOR SUP-97-00696 CDM C1776 HCPCS 0278 RC outpatient 9888.75 9888.75 9888.75 57 5636.59 percent of total billed charges 9888.75 93 8009.89 percent of total billed charges 9888.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9888.75 other OPPS APC 9888.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9888.75 other OPPS APC 9888.75 51 5043.26 percent of total billed charges 9888.75 9888.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL SUP-97-00697 CDM C1776 HCPCS 0278 RC outpatient 4896.4 4896.4 4896.4 57 2790.95 percent of total billed charges 4896.4 93 3966.08 percent of total billed charges 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 51 2497.16 percent of total billed charges 4896.4 4896.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT SUP-97-00698 CDM C1776 HCPCS 0278 RC outpatient 3419.25 3419.25 3419.25 57 1948.97 percent of total billed charges 3419.25 93 2769.59 percent of total billed charges 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 51 1743.82 percent of total billed charges 3419.25 3419.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA SUP-97-00699 CDM C1776 HCPCS 0278 RC outpatient 1979.64 1979.64 1979.64 57 1128.39 percent of total billed charges 1979.64 93 1603.51 percent of total billed charges 1979.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1979.64 other OPPS APC 1979.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1979.64 other OPPS APC 1979.64 51 1009.62 percent of total billed charges 1979.64 1979.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOLDING PINS SUP-97-00700 CDM 0272 RC outpatient 586.25 586.25 586.25 74 433.83 percent of total billed charges 586.25 93 474.86 percent of total billed charges 586.25 586.25 other OPPS APC 586.25 586.25 other OPPS APC 586.25 27.63 161.98 percent of total billed charges 586.25 586.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING ST 3.5MM X 12MM SUP-97-00715 CDM C1713 HCPCS 0278 RC outpatient 472.89 472.89 472.89 57 269.55 percent of total billed charges 472.89 93 383.04 percent of total billed charges 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 51 241.17 percent of total billed charges 472.89 472.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR SUP-97-00716 CDM C1776 HCPCS 0278 RC outpatient 9665.23 9665.23 9665.23 57 5509.18 percent of total billed charges 9665.23 93 7828.84 percent of total billed charges 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 51 4929.27 percent of total billed charges 9665.23 9665.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 5MM SUP-97-00734 CDM 0272 RC outpatient 1221 1221 1221 74 903.54 percent of total billed charges 1221 93 989.01 percent of total billed charges 1221 1221 other OPPS APC 1221 1221 other OPPS APC 1221 27.63 337.36 percent of total billed charges 1221 1221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LCP TUBULAR 10 HOLE 117 SUP-97-00736 CDM C1713 HCPCS 0278 RC outpatient 927 927 927 57 528.39 percent of total billed charges 927 93 750.87 percent of total billed charges 927 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 927 other OPPS APC 927 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 927 other OPPS APC 927 51 472.77 percent of total billed charges 927 927 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE STIM ULTRA 20G X 4IN SUP-97-00742 CDM 0272 RC outpatient 972.42 972.42 972.42 74 719.59 percent of total billed charges 972.42 93 787.66 percent of total billed charges 972.42 972.42 other OPPS APC 972.42 972.42 other OPPS APC 972.42 27.63 268.68 percent of total billed charges 972.42 972.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 14.5MM OUTER PROTECTION SLEEVE SUP-97-00743 CDM 0272 RC outpatient 379.89 379.89 379.89 74 281.12 percent of total billed charges 379.89 93 307.71 percent of total billed charges 379.89 379.89 other OPPS APC 379.89 379.89 other OPPS APC 379.89 27.63 104.96 percent of total billed charges 379.89 379.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCALPEL HARMONIC 36CM HANDPIECE SUP-97-00745 CDM 0272 RC outpatient 2685 2685 2685 74 1986.9 percent of total billed charges 2685 93 2174.85 percent of total billed charges 2685 2685 other OPPS APC 2685 2685 other OPPS APC 2685 27.63 741.87 percent of total billed charges 2685 2685 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW THREAD 16MMX85MM SUP-97-00750 CDM C1713 HCPCS 0278 RC outpatient 733.5 733.5 733.5 57 418.1 percent of total billed charges 733.5 93 594.14 percent of total billed charges 733.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 733.5 other OPPS APC 733.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 733.5 other OPPS APC 733.5 51 374.09 percent of total billed charges 733.5 733.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY LMA SIZE 2.5 SUP-97-00751 CDM 0272 RC outpatient 279.48 279.48 279.48 74 206.82 percent of total billed charges 279.48 93 226.38 percent of total billed charges 279.48 279.48 other OPPS APC 279.48 279.48 other OPPS APC 279.48 27.63 77.22 percent of total billed charges 279.48 279.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNUULATED SCREW 16MMX90MM SUP-97-00752 CDM C1713 HCPCS 0278 RC outpatient 733.5 733.5 733.5 57 418.1 percent of total billed charges 733.5 93 594.14 percent of total billed charges 733.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 733.5 other OPPS APC 733.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 733.5 other OPPS APC 733.5 51 374.09 percent of total billed charges 733.5 733.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING SUP-97-00753 CDM C1713 HCPCS 0278 RC outpatient 748.38 748.38 748.38 57 426.58 percent of total billed charges 748.38 93 606.19 percent of total billed charges 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 51 381.67 percent of total billed charges 748.38 748.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN LONG THREAD 4MM X 44MM SUP-97-00757 CDM C1713 HCPCS 0278 RC outpatient 659.75 659.75 659.75 57 376.06 percent of total billed charges 659.75 93 534.4 percent of total billed charges 659.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 659.75 other OPPS APC 659.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 659.75 other OPPS APC 659.75 51 336.47 percent of total billed charges 659.75 659.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING SCREW 5.0MM SUP-97-00759 CDM C1713 HCPCS 0278 RC outpatient 1152 1152 1152 57 656.64 percent of total billed charges 1152 93 933.12 percent of total billed charges 1152 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1152 other OPPS APC 1152 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1152 other OPPS APC 1152 51 587.52 percent of total billed charges 1152 1152 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZIMMER KNEE PERSONA PS SUP-97-00767 CDM C1776 HCPCS 0278 RC outpatient 16000 16000 16000 57 9120 percent of total billed charges 16000 93 12960 percent of total billed charges 16000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16000 other OPPS APC 16000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16000 other OPPS APC 16000 51 8160 percent of total billed charges 16000 16000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 2 SUP-97-00768 CDM C1713 HCPCS 0278 RC outpatient 726.57 726.57 726.57 57 414.14 percent of total billed charges 726.57 93 588.52 percent of total billed charges 726.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 726.57 other OPPS APC 726.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 726.57 other OPPS APC 726.57 51 370.55 percent of total billed charges 726.57 726.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 2 SUP-97-00769 CDM C1713 HCPCS 0278 RC outpatient 726.57 726.57 726.57 57 414.14 percent of total billed charges 726.57 93 588.52 percent of total billed charges 726.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 726.57 other OPPS APC 726.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 726.57 other OPPS APC 726.57 51 370.55 percent of total billed charges 726.57 726.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 3 SUP-97-00770 CDM C1713 HCPCS 0278 RC outpatient 726.57 726.57 726.57 57 414.14 percent of total billed charges 726.57 93 588.52 percent of total billed charges 726.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 726.57 other OPPS APC 726.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 726.57 other OPPS APC 726.57 51 370.55 percent of total billed charges 726.57 726.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5.0 X 32MM IM NAIL SUP-97-00771 CDM C1713 HCPCS 0278 RC outpatient 727.47 727.47 727.47 57 414.66 percent of total billed charges 727.47 93 589.25 percent of total billed charges 727.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 727.47 other OPPS APC 727.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 727.47 other OPPS APC 727.47 51 371.01 percent of total billed charges 727.47 727.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 6 SUP-97-00772 CDM C1713 HCPCS 0278 RC outpatient 748.38 748.38 748.38 57 426.58 percent of total billed charges 748.38 93 606.19 percent of total billed charges 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 51 381.67 percent of total billed charges 748.38 748.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 6 SUP-97-00773 CDM C1713 HCPCS 0278 RC outpatient 748.38 748.38 748.38 57 426.58 percent of total billed charges 748.38 93 606.19 percent of total billed charges 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 51 381.67 percent of total billed charges 748.38 748.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOOD SOLUTION SET Y-TUBE LARGE ANES SUP-97-00777 CDM 0272 RC outpatient 779.73 779.73 779.73 74 577 percent of total billed charges 779.73 93 631.58 percent of total billed charges 779.73 779.73 other OPPS APC 779.73 779.73 other OPPS APC 779.73 27.63 215.44 percent of total billed charges 779.73 779.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOWRAP GRAFT DS 4X8 SUP-97-00778 CDM Q4150 HCPCS 0636 RC outpatient 7450 7450 88.06 88.06 fee schedule 7450 93 6034.5 percent of total billed charges 7450 7450 other OPPS APC 7450 7450 other OPPS APC 7450 24.86 1852.07 percent of total billed charges 88.06 7450 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SPROTTE CANNULA SUP-97-00779 CDM 0272 RC outpatient 328.65 328.65 328.65 74 243.2 percent of total billed charges 328.65 93 266.21 percent of total billed charges 328.65 328.65 other OPPS APC 328.65 328.65 other OPPS APC 328.65 27.63 90.81 percent of total billed charges 328.65 328.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACHILLES SPEED BRIDGE SUP-97-00781 CDM C1713 HCPCS 0278 RC outpatient 4350 4350 4350 57 2479.5 percent of total billed charges 4350 93 3523.5 percent of total billed charges 4350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4350 other OPPS APC 4350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4350 other OPPS APC 4350 51 2218.5 percent of total billed charges 4350 4350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HELICAL BLADE SUP-97-00783 CDM C1713 HCPCS 0278 RC outpatient 2094.66 2094.66 2094.66 57 1193.96 percent of total billed charges 2094.66 93 1696.67 percent of total billed charges 2094.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2094.66 other OPPS APC 2094.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2094.66 other OPPS APC 2094.66 51 1068.28 percent of total billed charges 2094.66 2094.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUR ROUND DIAMOND 6.0MM SUP-97-00786 CDM 0272 RC outpatient 369.08 369.08 369.08 74 273.12 percent of total billed charges 369.08 93 298.95 percent of total billed charges 369.08 369.08 other OPPS APC 369.08 369.08 other OPPS APC 369.08 27.63 101.98 percent of total billed charges 369.08 369.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW THREADED 7.3MM X 32MM X 80MM SUP-97-00787 CDM C1713 HCPCS 0278 RC outpatient 835.92 835.92 835.92 57 476.47 percent of total billed charges 835.92 93 677.1 percent of total billed charges 835.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 835.92 other OPPS APC 835.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 835.92 other OPPS APC 835.92 51 426.32 percent of total billed charges 835.92 835.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN PART THREAD 7.3 16MM/50MM SUP-97-00788 CDM C1713 HCPCS 0278 RC outpatient 835.92 835.92 835.92 57 476.47 percent of total billed charges 835.92 93 677.1 percent of total billed charges 835.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 835.92 other OPPS APC 835.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 835.92 other OPPS APC 835.92 51 426.32 percent of total billed charges 835.92 835.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN PART THREAD 7.3MM X 16MM SUP-97-00789 CDM C1713 HCPCS 0278 RC outpatient 835.92 835.92 835.92 57 476.47 percent of total billed charges 835.92 93 677.1 percent of total billed charges 835.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 835.92 other OPPS APC 835.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 835.92 other OPPS APC 835.92 51 426.32 percent of total billed charges 835.92 835.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EYE PROTECTOR SUP-97-00792 CDM 0272 RC outpatient 406.35 406.35 406.35 74 300.7 percent of total billed charges 406.35 93 329.14 percent of total billed charges 406.35 406.35 other OPPS APC 406.35 406.35 other OPPS APC 406.35 27.63 112.27 percent of total billed charges 406.35 406.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON SPACEMAKER KIDNEY SUP-97-00793 CDM outpatient 4185.93 4185.93 4185.93 4185.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN SHRT THREAD 4MM X 42MM SUP-97-00794 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN SHRT THREAD 4MM X 44MM SUP-97-00795 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REELX ANCHOR 4.5 SUP-97-00797 CDM C1713 HCPCS 0278 RC outpatient 1033.53 1033.53 1033.53 57 589.11 percent of total billed charges 1033.53 93 837.16 percent of total billed charges 1033.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1033.53 other OPPS APC 1033.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1033.53 other OPPS APC 1033.53 51 527.1 percent of total billed charges 1033.53 1033.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE 3.0 SUP-97-00798 CDM C1713 HCPCS 0278 RC outpatient 564.73 564.73 564.73 57 321.9 percent of total billed charges 564.73 93 457.43 percent of total billed charges 564.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 564.73 other OPPS APC 564.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 564.73 other OPPS APC 564.73 51 288.01 percent of total billed charges 564.73 564.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOPYELOTOMY STENT 24 SUP-97-00799 CDM outpatient 665.35 665.35 665.35 665.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOPYELOTOMY STENT 26 SUP-97-00800 CDM outpatient 665.35 665.35 665.35 665.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOPYELOTOMY STENT 28 SUP-97-00801 CDM outpatient 665.35 665.35 665.35 665.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 4.2 330MM SUP-97-00804 CDM 0272 RC outpatient 782.34 782.34 782.34 74 578.93 percent of total billed charges 782.34 93 633.7 percent of total billed charges 782.34 782.34 other OPPS APC 782.34 782.34 other OPPS APC 782.34 27.63 216.16 percent of total billed charges 782.34 782.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALCANEUS WEDGE SUP-97-00805 CDM C1762 HCPCS 0278 RC outpatient 1295.7 1295.7 1295.7 57 738.55 percent of total billed charges 1295.7 93 1049.52 percent of total billed charges 1295.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1295.7 other OPPS APC 1295.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1295.7 other OPPS APC 1295.7 51 660.81 percent of total billed charges 1295.7 1295.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ILLIAC CREST WEDGE 20MM SUP-97-00806 CDM C1762 HCPCS 0278 RC outpatient 2373 2373 2373 57 1352.61 percent of total billed charges 2373 93 1922.13 percent of total billed charges 2373 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2373 other OPPS APC 2373 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2373 other OPPS APC 2373 51 1210.23 percent of total billed charges 2373 2373 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. URETERAL CATHETER ADAPTOR SUP-97-00807 CDM 0272 RC outpatient 86.67 86.67 86.67 74 64.14 percent of total billed charges 86.67 93 70.2 percent of total billed charges 86.67 86.67 other OPPS APC 86.67 86.67 other OPPS APC 86.67 27.63 23.95 percent of total billed charges 86.67 86.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BIO 4 5CC (3102-2105) SUP-97-00810 CDM C1734 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BIO 4 2.5CC (3102-2102) SUP-97-00811 CDM C1762 HCPCS 0278 RC outpatient 2231.25 2231.25 2231.25 57 1271.81 percent of total billed charges 2231.25 93 1807.31 percent of total billed charges 2231.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2231.25 other OPPS APC 2231.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2231.25 other OPPS APC 2231.25 51 1137.94 percent of total billed charges 2231.25 2231.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATOMIZATION DEVICE-DISPOSABLE SUP-97-00812 CDM 0272 RC outpatient 39.61 39.61 39.61 74 29.31 percent of total billed charges 39.61 93 32.08 percent of total billed charges 39.61 39.61 other OPPS APC 39.61 39.61 other OPPS APC 39.61 27.63 10.94 percent of total billed charges 39.61 39.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ABUTMENT 12 MM SUP-97-00813 CDM L8670 HCPCS 0278 RC outpatient 4743.75 4743.75 4743.75 57 2703.94 percent of total billed charges 4743.75 93 3842.44 percent of total billed charges 4743.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4743.75 other OPPS APC 4743.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4743.75 other OPPS APC 4743.75 51 2419.31 percent of total billed charges 4743.75 4743.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENSEAL LAP 5MM TISSUE SEALER SUP-97-00824 CDM 0272 RC outpatient 1795.62 1795.62 1795.62 74 1328.76 percent of total billed charges 1795.62 93 1454.45 percent of total billed charges 1795.62 1795.62 other OPPS APC 1795.62 1795.62 other OPPS APC 1795.62 27.63 496.13 percent of total billed charges 1795.62 1795.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TI CANN RETRO/ANT FEM 11MM X 380MM SUP-97-00828 CDM C1713 HCPCS 0278 RC outpatient 4487.4 4487.4 4487.4 57 2557.82 percent of total billed charges 4487.4 93 3634.79 percent of total billed charges 4487.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4487.4 other OPPS APC 4487.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4487.4 other OPPS APC 4487.4 51 2288.57 percent of total billed charges 4487.4 4487.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TI END CAP T40 FEMORAL NAIL0MM SUP-97-00829 CDM C1713 HCPCS 0278 RC outpatient 710.82 710.82 710.82 57 405.17 percent of total billed charges 710.82 93 575.76 percent of total billed charges 710.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 710.82 other OPPS APC 710.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 710.82 other OPPS APC 710.82 51 362.52 percent of total billed charges 710.82 710.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE 3.2 SUP-97-00830 CDM 0272 RC outpatient 367.92 367.92 367.92 74 272.26 percent of total billed charges 367.92 93 298.02 percent of total billed charges 367.92 367.92 other OPPS APC 367.92 367.92 other OPPS APC 367.92 27.63 101.66 percent of total billed charges 367.92 367.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOMEY SYRINGE SUP-97-00831 CDM 0272 RC outpatient 776.25 776.25 776.25 74 574.43 percent of total billed charges 776.25 93 628.76 percent of total billed charges 776.25 776.25 other OPPS APC 776.25 776.25 other OPPS APC 776.25 27.63 214.48 percent of total billed charges 776.25 776.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 6 SUP-97-00832 CDM C1713 HCPCS 0278 RC outpatient 663.39 663.39 663.39 57 378.13 percent of total billed charges 663.39 93 537.35 percent of total billed charges 663.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 663.39 other OPPS APC 663.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 663.39 other OPPS APC 663.39 51 338.33 percent of total billed charges 663.39 663.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 7 SUP-97-00833 CDM C1713 HCPCS 0278 RC outpatient 1152 1152 1152 57 656.64 percent of total billed charges 1152 93 933.12 percent of total billed charges 1152 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1152 other OPPS APC 1152 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1152 other OPPS APC 1152 51 587.52 percent of total billed charges 1152 1152 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 X 85MM LOCKING IM NAIL 8 SUP-97-00834 CDM C1713 HCPCS 0278 RC outpatient 727.47 727.47 727.47 57 414.66 percent of total billed charges 727.47 93 589.25 percent of total billed charges 727.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 727.47 other OPPS APC 727.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 727.47 other OPPS APC 727.47 51 371.01 percent of total billed charges 727.47 727.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 MM LOCKING IM NAIL 3 SUP-97-00835 CDM C1713 HCPCS 0278 RC outpatient 663.39 663.39 663.39 57 378.13 percent of total billed charges 663.39 93 537.35 percent of total billed charges 663.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 663.39 other OPPS APC 663.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 663.39 other OPPS APC 663.39 51 338.33 percent of total billed charges 663.39 663.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5 X 90MM FEMORAL IM NAIL SUP-97-00836 CDM C1713 HCPCS 0278 RC outpatient 727.47 727.47 727.47 57 414.66 percent of total billed charges 727.47 93 589.25 percent of total billed charges 727.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 727.47 other OPPS APC 727.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 727.47 other OPPS APC 727.47 51 371.01 percent of total billed charges 727.47 727.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 MM LOCKING IM NAIL 4 SUP-97-00837 CDM C1713 HCPCS 0278 RC outpatient 663.39 663.39 663.39 57 378.13 percent of total billed charges 663.39 93 537.35 percent of total billed charges 663.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 663.39 other OPPS APC 663.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 663.39 other OPPS APC 663.39 51 338.33 percent of total billed charges 663.39 663.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING TI 4.0 58MM SUP-97-00838 CDM C1713 HCPCS 0278 RC outpatient 727.47 727.47 727.47 57 414.66 percent of total billed charges 727.47 93 589.25 percent of total billed charges 727.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 727.47 other OPPS APC 727.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 727.47 other OPPS APC 727.47 51 371.01 percent of total billed charges 727.47 727.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 MM LOCKING IM NAIL 8 SUP-97-00839 CDM C1713 HCPCS 0278 RC outpatient 748.38 748.38 748.38 57 426.58 percent of total billed charges 748.38 93 606.19 percent of total billed charges 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 51 381.67 percent of total billed charges 748.38 748.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACHILLES TENDON GRAFT10MM SUP-97-00841 CDM C1762 HCPCS 0278 RC outpatient 8000 8000 8000 57 4560 percent of total billed charges 8000 93 6480 percent of total billed charges 8000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8000 other OPPS APC 8000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8000 other OPPS APC 8000 51 4080 percent of total billed charges 8000 8000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANISTER KIT SUP-97-00848 CDM 0271 RC outpatient 1050 1050 1050 74 777 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 1050 other OPPS APC 1050 1050 other OPPS APC 1050 27.63 290.12 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AQUILEX FLUID CONTROL SYSTEM SUP-97-00850 CDM 0272 RC outpatient 19000 19000 19000 74 14060 percent of total billed charges 19000 93 15390 percent of total billed charges 19000 19000 other OPPS APC 19000 19000 other OPPS APC 19000 27.63 5249.7 percent of total billed charges 19000 19000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT JACKET SUP-97-00851 CDM Q4107 HCPCS 0636 RC outpatient 7572 7572 7572 74 5603.28 percent of total billed charges 7572 93 6133.32 percent of total billed charges 7572 7572 other OPPS APC 7572 7572 other OPPS APC 7572 24.86 1882.4 percent of total billed charges 7572 7572 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANN DRILL BIT 60.MM SUP-97-00853 CDM 0272 RC outpatient 1812.84 1812.84 1812.84 74 1341.5 percent of total billed charges 1812.84 93 1468.4 percent of total billed charges 1812.84 1812.84 other OPPS APC 1812.84 1812.84 other OPPS APC 1812.84 27.63 500.89 percent of total billed charges 1812.84 1812.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW THEAD 7.3MM 16MM 80MM SUP-97-00854 CDM C1713 HCPCS 0278 RC outpatient 733.5 733.5 733.5 57 418.1 percent of total billed charges 733.5 93 594.14 percent of total billed charges 733.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 733.5 other OPPS APC 733.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 733.5 other OPPS APC 733.5 51 374.09 percent of total billed charges 733.5 733.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SWITCHING STICK SUP-97-00855 CDM outpatient 525 525 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASPIRATION ASSEMBLY SUP-97-00856 CDM 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 262.5 other OPPS APC 262.5 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLOOD FILTER SUP-97-00857 CDM 0272 RC outpatient 140 140 140 74 103.6 percent of total billed charges 140 93 113.4 percent of total billed charges 140 140 other OPPS APC 140 140 other OPPS APC 140 27.63 38.68 percent of total billed charges 140 140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIDE IMPLANT 4MM W/ABUTMENT12MM SUP-97-00858 CDM L8670 HCPCS 0278 RC outpatient 7962.5 7962.5 7962.5 57 4538.63 percent of total billed charges 7962.5 93 6449.63 percent of total billed charges 7962.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7962.5 other OPPS APC 7962.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7962.5 other OPPS APC 7962.5 51 4060.88 percent of total billed charges 7962.5 7962.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIDE PORT KNIFE 1.0MM SUP-97-00859 CDM 0272 RC outpatient 33.33 33.33 33.33 74 24.66 percent of total billed charges 33.33 93 27 percent of total billed charges 33.33 33.33 other OPPS APC 33.33 33.33 other OPPS APC 33.33 27.63 9.21 percent of total billed charges 33.33 33.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLIT KNIFE SINGLE BEVEL 2.4 SUP-97-00860 CDM 0272 RC outpatient 40 40 40 74 29.6 percent of total billed charges 40 93 32.4 percent of total billed charges 40 40 other OPPS APC 40 40 other OPPS APC 40 27.63 11.05 percent of total billed charges 40 40 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMOKE EVACUATOR TUBING SUP-97-00866 CDM 0271 RC outpatient 560 560 560 74 414.4 percent of total billed charges 560 93 453.6 percent of total billed charges 560 560 other OPPS APC 560 560 other OPPS APC 560 27.63 154.73 percent of total billed charges 560 560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE 11MM HELICAL 110MM SUP-97-00872 CDM C1713 HCPCS 0278 RC outpatient 2222.25 2222.25 2222.25 57 1266.68 percent of total billed charges 2222.25 93 1800.02 percent of total billed charges 2222.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2222.25 other OPPS APC 2222.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2222.25 other OPPS APC 2222.25 51 1133.35 percent of total billed charges 2222.25 2222.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE 11MM HELICAL 115MM SUP-97-00873 CDM C1713 HCPCS 0278 RC outpatient 2094.66 2094.66 2094.66 57 1193.96 percent of total billed charges 2094.66 93 1696.67 percent of total billed charges 2094.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2094.66 other OPPS APC 2094.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2094.66 other OPPS APC 2094.66 51 1068.28 percent of total billed charges 2094.66 2094.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA REAMER BLADE SUP-97-00874 CDM 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLAR COMPOENT SUP-97-00879 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSI KNEE ZUK SUP-97-00882 CDM C1776 HCPCS 0278 RC outpatient 11011 11011 11011 57 6276.27 percent of total billed charges 11011 93 8918.91 percent of total billed charges 11011 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11011 other OPPS APC 11011 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11011 other OPPS APC 11011 51 5615.61 percent of total billed charges 11011 11011 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA PEG DRILL GUIDE SIZE 26 SUP-97-00884 CDM 0272 RC outpatient 1050 1050 1050 74 777 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 1050 other OPPS APC 1050 1050 other OPPS APC 1050 27.63 290.12 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM LOCKING SLF TAP 3 SUP-97-00894 CDM C1713 HCPCS 0278 RC outpatient 473.45 473.45 473.45 57 269.87 percent of total billed charges 473.45 93 383.49 percent of total billed charges 473.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 473.45 other OPPS APC 473.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 473.45 other OPPS APC 473.45 51 241.46 percent of total billed charges 473.45 473.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANTERIOR CHAMBER INJ CANN 27G ANG PK/10 SUP-97-00896 CDM 0272 RC outpatient 2.05 2.05 2.05 74 1.52 percent of total billed charges 2.05 93 1.66 percent of total billed charges 2.05 2.05 other OPPS APC 2.05 2.05 other OPPS APC 2.05 27.63 0.57 percent of total billed charges 2.05 2.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER CEMENTLESS SUP-97-00897 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TROCH FIXATION 11MM/130 SUP-97-00898 CDM C1713 HCPCS 0278 RC outpatient 4805.33 4805.33 4805.33 57 2739.04 percent of total billed charges 4805.33 93 3892.32 percent of total billed charges 4805.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4805.33 other OPPS APC 4805.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4805.33 other OPPS APC 4805.33 51 2450.72 percent of total billed charges 4805.33 4805.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE SUP-97-00899 CDM C1713 HCPCS 0278 RC outpatient 1053 1053 1053 57 600.21 percent of total billed charges 1053 93 852.93 percent of total billed charges 1053 1053 other OPPS APC 1053 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1053 other OPPS APC 1053 51 537.03 percent of total billed charges 1053 1053 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEADED CABLE AND SLEEVE SET SUP-97-00900 CDM C1713 HCPCS 0278 RC outpatient 1309.5 1309.5 1309.5 57 746.42 percent of total billed charges 1309.5 93 1060.7 percent of total billed charges 1309.5 1309.5 other OPPS APC 1309.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1309.5 other OPPS APC 1309.5 51 667.85 percent of total billed charges 1309.5 1309.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SWANSON FLEXIBLE HINGE TOE IMPLANT 4S SUP-97-00904 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERCNCIRCLE NITINOL TIPLESS STONE EXT SUP-97-00907 CDM outpatient 453.6 453.6 453.6 453.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERCUTANEOUS ACCESS NEEDLE 18GA X 20CM SUP-97-00908 CDM 0272 RC outpatient 124.08 124.08 124.08 74 91.82 percent of total billed charges 124.08 93 100.5 percent of total billed charges 124.08 124.08 other OPPS APC 124.08 124.08 other OPPS APC 124.08 27.63 34.28 percent of total billed charges 124.08 124.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLEARVISION II LENS IRRIGATION SYS SET SUP-97-00912 CDM 0272 RC outpatient 9948.76 9948.76 9948.76 74 7362.08 percent of total billed charges 9948.76 93 8058.5 percent of total billed charges 9948.76 9948.76 other OPPS APC 9948.76 9948.76 other OPPS APC 9948.76 27.63 2748.84 percent of total billed charges 9948.76 9948.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5 SELF TAPPING SUP-97-00913 CDM C1713 HCPCS 0278 RC outpatient 92.32 92.32 92.32 57 52.62 percent of total billed charges 92.32 93 74.78 percent of total billed charges 92.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.32 other OPPS APC 92.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.32 other OPPS APC 92.32 51 47.08 percent of total billed charges 92.32 92.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.5 SELF TAPPING SUP-97-00914 CDM C1713 HCPCS 0278 RC outpatient 140.92 140.92 140.92 57 80.32 percent of total billed charges 140.92 93 114.15 percent of total billed charges 140.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 140.92 other OPPS APC 140.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 140.92 other OPPS APC 140.92 51 71.87 percent of total billed charges 140.92 140.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5.0 SELF TAPPING 36MM SUP-97-00915 CDM C1713 HCPCS 0278 RC outpatient 569.42 569.42 569.42 57 324.57 percent of total billed charges 569.42 93 461.23 percent of total billed charges 569.42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 569.42 other OPPS APC 569.42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 569.42 other OPPS APC 569.42 51 290.4 percent of total billed charges 569.42 569.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5.0 SELF TAPPING 38MM SUP-97-00916 CDM C1713 HCPCS 0278 RC outpatient 569.42 569.42 569.42 57 324.57 percent of total billed charges 569.42 93 461.23 percent of total billed charges 569.42 569.42 other OPPS APC 569.42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 569.42 other OPPS APC 569.42 51 290.4 percent of total billed charges 569.42 569.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0MM SELF TAPPING SUP-97-00917 CDM C1713 HCPCS 0278 RC outpatient 552.83 552.83 552.83 57 315.11 percent of total billed charges 552.83 93 447.79 percent of total billed charges 552.83 552.83 other OPPS APC 552.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 552.83 other OPPS APC 552.83 51 281.94 percent of total billed charges 552.83 552.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5.0 SELF TAPPING SUP-97-00918 CDM C1713 HCPCS 0278 RC outpatient 552.83 552.83 552.83 57 315.11 percent of total billed charges 552.83 93 447.79 percent of total billed charges 552.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 552.83 other OPPS APC 552.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 552.83 other OPPS APC 552.83 51 281.94 percent of total billed charges 552.83 552.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.0 MM CORTEX SLF TAP 10 SUP-97-00919 CDM C1713 HCPCS 0278 RC outpatient 145.96 145.96 145.96 57 83.2 percent of total billed charges 145.96 93 118.23 percent of total billed charges 145.96 145.96 other OPPS APC 145.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.96 other OPPS APC 145.96 51 74.44 percent of total billed charges 145.96 145.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.0 MM CORTEX SLF TAP 10 SUP-97-00920 CDM C1713 HCPCS 0278 RC outpatient 145.96 145.96 145.96 57 83.2 percent of total billed charges 145.96 93 118.23 percent of total billed charges 145.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.96 other OPPS APC 145.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.96 other OPPS APC 145.96 51 74.44 percent of total billed charges 145.96 145.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE STEEL 6 4X8IN SUP-97-00922 CDM C1713 HCPCS 0278 RC outpatient 401.21 401.21 401.21 57 228.69 percent of total billed charges 401.21 93 324.98 percent of total billed charges 401.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 401.21 other OPPS APC 401.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 401.21 other OPPS APC 401.21 51 204.62 percent of total billed charges 401.21 401.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASKET ZERO TIP 1.9 FR SUP-97-00925 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM/36MM SUP-97-00926 CDM C1713 HCPCS 0278 RC outpatient 92.32 92.32 92.32 57 52.62 percent of total billed charges 92.32 93 74.78 percent of total billed charges 92.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.32 other OPPS APC 92.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.32 other OPPS APC 92.32 51 47.08 percent of total billed charges 92.32 92.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LARGE TESTICUAR IMPLANT SUP-97-00928 CDM 0272 RC outpatient 4500 4500 4500 74 3330 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 4500 other OPPS APC 4500 4500 other OPPS APC 4500 27.63 1243.35 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEDIUM TESTICUAR IMPLANT SUP-97-00929 CDM 0272 RC outpatient 4500 4500 4500 74 3330 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 4500 other OPPS APC 4500 4500 other OPPS APC 4500 27.63 1243.35 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THUNDERBEAT TRANSDUCER SUP-97-00932 CDM outpatient 4625 4625 4625 4625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW THREADED 7.3MM X 32MM X 90MM SUP-97-00933 CDM C1713 HCPCS 0278 RC outpatient 886.83 886.83 886.83 57 505.49 percent of total billed charges 886.83 93 718.33 percent of total billed charges 886.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 886.83 other OPPS APC 886.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 886.83 other OPPS APC 886.83 51 452.28 percent of total billed charges 886.83 886.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT EYE SUP-97-00945 CDM C1783 HCPCS 0278 RC outpatient 5437.5 5437.5 5437.5 57 3099.38 percent of total billed charges 5437.5 93 4404.38 percent of total billed charges 5437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5437.5 other OPPS APC 5437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5437.5 other OPPS APC 5437.5 51 2773.13 percent of total billed charges 5437.5 5437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW THREAD BONE 7.3MM SUP-97-00948 CDM C1713 HCPCS 0278 RC outpatient 886.83 886.83 886.83 57 505.49 percent of total billed charges 886.83 93 718.33 percent of total billed charges 886.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 886.83 other OPPS APC 886.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 886.83 other OPPS APC 886.83 51 452.28 percent of total billed charges 886.83 886.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.0 CORTEX SUP-97-00949 CDM C1713 HCPCS 0278 RC outpatient 145.96 145.96 145.96 57 83.2 percent of total billed charges 145.96 93 118.23 percent of total billed charges 145.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.96 other OPPS APC 145.96 145.96 other OPPS APC 145.96 51 74.44 percent of total billed charges 145.96 145.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 1.5MM SUP-97-00950 CDM 0272 RC outpatient 281.75 281.75 281.75 74 208.5 percent of total billed charges 281.75 93 228.22 percent of total billed charges 281.75 281.75 other OPPS APC 281.75 281.75 other OPPS APC 281.75 27.63 77.85 percent of total billed charges 281.75 281.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LCP 4.5 MM CRVD BROAD 12 SUP-97-00951 CDM C1713 HCPCS 0278 RC outpatient 2315.79 2315.79 2315.79 57 1320 percent of total billed charges 2315.79 93 1875.79 percent of total billed charges 2315.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2315.79 other OPPS APC 2315.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2315.79 other OPPS APC 2315.79 51 1181.05 percent of total billed charges 2315.79 2315.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE STRAIGHT 4HOLE 2MM SUP-97-00952 CDM C1713 HCPCS 0278 RC outpatient 229.64 229.64 229.64 57 130.89 percent of total billed charges 229.64 93 186.01 percent of total billed charges 229.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 229.64 other OPPS APC 229.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 229.64 other OPPS APC 229.64 51 117.12 percent of total billed charges 229.64 229.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE LABEL DECARON SUP-97-00965 CDM 0271 RC outpatient 2.03 2.03 2.03 74 1.5 percent of total billed charges 2.03 93 1.64 percent of total billed charges 2.03 2.03 other OPPS APC 2.03 2.03 other OPPS APC 2.03 27.63 0.56 percent of total billed charges 2.03 2.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TISSUE EXPANDERS 500CC SUP-97-00966 CDM L8699 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 3875 other OPPS APC 3875 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLODERM 6X16 SUP-97-00967 CDM Q4116 HCPCS 0636 RC outpatient 7775 7775 7775 74 5753.5 percent of total billed charges 7775 93 6297.75 percent of total billed charges 7775 7775 other OPPS APC 7775 7775 other OPPS APC 7775 24.86 1932.87 percent of total billed charges 7775 7775 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STIMUBLAST 255CC SUP-97-00968 CDM C1713 HCPCS 0278 RC outpatient 1320 1320 1320 57 752.4 percent of total billed charges 1320 93 1069.2 percent of total billed charges 1320 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1320 other OPPS APC 1320 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1320 other OPPS APC 1320 51 673.2 percent of total billed charges 1320 1320 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BIO 4 10CC (3102-2110) SUP-97-00971 CDM C1734 HCPCS 0278 RC outpatient 7360 7360 7360 57 4195.2 percent of total billed charges 7360 93 5961.6 percent of total billed charges 7360 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7360 other OPPS APC 7360 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7360 other OPPS APC 7360 51 3753.6 percent of total billed charges 7360 7360 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT SUP-97-00972 CDM C1776 HCPCS 0278 RC outpatient 3144.3 3144.3 3144.3 57 1792.25 percent of total billed charges 3144.3 93 2546.88 percent of total billed charges 3144.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3144.3 other OPPS APC 3144.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3144.3 other OPPS APC 3144.3 51 1603.59 percent of total billed charges 3144.3 3144.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN 7.3 16MM/110MM SUP-97-00973 CDM C1713 HCPCS 0278 RC outpatient 835.92 835.92 835.92 57 476.47 percent of total billed charges 835.92 93 677.1 percent of total billed charges 835.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 835.92 other OPPS APC 835.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 835.92 other OPPS APC 835.92 51 426.32 percent of total billed charges 835.92 835.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING ST 3.5 MM X 26MM SUP-97-00977 CDM C1713 HCPCS 0278 RC outpatient 472.89 472.89 472.89 57 269.55 percent of total billed charges 472.89 93 383.04 percent of total billed charges 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 51 241.17 percent of total billed charges 472.89 472.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMART TOE II SUP-97-00980 CDM C1713 HCPCS 0278 RC outpatient 2960.16 2960.16 2960.16 57 1687.29 percent of total billed charges 2960.16 93 2397.73 percent of total billed charges 2960.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2960.16 other OPPS APC 2960.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2960.16 other OPPS APC 2960.16 51 1509.68 percent of total billed charges 2960.16 2960.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING ST 3.5MM X 20MM SUP-97-00983 CDM C1713 HCPCS 0278 RC outpatient 472.89 472.89 472.89 57 269.55 percent of total billed charges 472.89 93 383.04 percent of total billed charges 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 51 241.17 percent of total billed charges 472.89 472.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING ST 3.5MM X 14MM SUP-97-00984 CDM C1713 HCPCS 0278 RC outpatient 472.89 472.89 472.89 57 269.55 percent of total billed charges 472.89 93 383.04 percent of total billed charges 472.89 472.89 other OPPS APC 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 51 241.17 percent of total billed charges 472.89 472.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING ST 3.5MM X 18MM SUP-97-00985 CDM C1713 HCPCS 0278 RC outpatient 472.89 472.89 472.89 57 269.55 percent of total billed charges 472.89 93 383.04 percent of total billed charges 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 51 241.17 percent of total billed charges 472.89 472.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING ST 3.5MM X 16MM SUP-97-00986 CDM C1713 HCPCS 0278 RC outpatient 472.89 472.89 472.89 57 269.55 percent of total billed charges 472.89 93 383.04 percent of total billed charges 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 51 241.17 percent of total billed charges 472.89 472.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN THREAD 4.0MM/16MM SUP-97-00987 CDM C1713 HCPCS 0278 RC outpatient 75.32 75.32 75.32 57 42.93 percent of total billed charges 75.32 93 61.01 percent of total billed charges 75.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 75.32 other OPPS APC 75.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 75.32 other OPPS APC 75.32 51 38.41 percent of total billed charges 75.32 75.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE GUIDE NON-THREAD 1.25MM/150MM SUP-97-00988 CDM C1713 HCPCS 0278 RC outpatient 124.32 124.32 124.32 57 70.86 percent of total billed charges 124.32 93 100.7 percent of total billed charges 124.32 124.32 other OPPS APC 124.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 124.32 other OPPS APC 124.32 51 63.4 percent of total billed charges 124.32 124.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHAMPION SLINGSHOT 70 UP SUP-97-00989 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER PATELLA STERILE KNEE 38MM SUP-97-00990 CDM 0272 RC outpatient 768 768 768 74 568.32 percent of total billed charges 768 93 622.08 percent of total billed charges 768 768 other OPPS APC 768 768 other OPPS APC 768 27.63 212.2 percent of total billed charges 768 768 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTERIOR STABLIZER FEMORAL LEFT SUP-97-00991 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTERIOR STABLIZER FEMORAL RIGHT SUP-97-00992 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIVERSAL TIBUAL BASEPLATE TOTAL KNEE SUP-97-00993 CDM C1776 HCPCS 0278 RC outpatient 3125 3125 3125 57 1781.25 percent of total billed charges 3125 93 2531.25 percent of total billed charges 3125 3125 other OPPS APC 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 51 1593.75 percent of total billed charges 3125 3125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASYMMETRIC PATELLA 9MM X3 SUP-97-00994 CDM C1776 HCPCS 0278 RC outpatient 810 810 810 57 461.7 percent of total billed charges 810 93 656.1 percent of total billed charges 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 51 413.1 percent of total billed charges 810 810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BEARING INSERT-PS 9MM SUP-97-00995 CDM C1713 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK ANGLE HIP STEM SUP-97-00996 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K WIRE 1.0 SUP-97-00999 CDM C1713 HCPCS 0278 RC outpatient 334.53 334.53 334.53 57 190.68 percent of total billed charges 334.53 93 270.97 percent of total billed charges 334.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 334.53 other OPPS APC 334.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 334.53 other OPPS APC 334.53 51 170.61 percent of total billed charges 334.53 334.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFIX PRIME 2CM X 3CM SUP-97-01000 CDM Q4133 HCPCS 0636 RC outpatient 3000 3000 166 166 fee schedule 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 24.86 745.8 percent of total billed charges 166 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR PS 5/LT SUP-97-01001 CDM C1776 HCPCS 0278 RC outpatient 9665.23 9665.23 9665.23 57 5509.18 percent of total billed charges 9665.23 93 7828.84 percent of total billed charges 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 51 4929.27 percent of total billed charges 9665.23 9665.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIA FIT 5F/4T SUP-97-01002 CDM C1776 HCPCS 0278 RC outpatient 4896.4 4896.4 4896.4 57 2790.95 percent of total billed charges 4896.4 93 3966.08 percent of total billed charges 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 51 2497.16 percent of total billed charges 4896.4 4896.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSL INSERT 5X9MM SUP-97-01003 CDM C1776 HCPCS 0278 RC outpatient 3419.25 3419.25 3419.25 57 1948.97 percent of total billed charges 3419.25 93 2769.59 percent of total billed charges 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 51 1743.82 percent of total billed charges 3419.25 3419.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL FEMORAL RIGHT 12X340 SUP-97-01004 CDM C1713 HCPCS 0278 RC outpatient 3595.2 3595.2 3595.2 57 2049.26 percent of total billed charges 3595.2 93 2912.11 percent of total billed charges 3595.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3595.2 other OPPS APC 3595.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3595.2 other OPPS APC 3595.2 51 1833.55 percent of total billed charges 3595.2 3595.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZUK CEM UNI TIB & STD POLY SUP-97-01005 CDM C1776 HCPCS 0278 RC outpatient 10000 10000 10000 57 5700 percent of total billed charges 10000 93 8100 percent of total billed charges 10000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10000 other OPPS APC 10000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10000 other OPPS APC 10000 51 5100 percent of total billed charges 10000 10000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIB BASE SZ 6 RM/LL SUP-97-01007 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTICULAR SURFACE SZ 6 8MM SUP-97-01008 CDM C1776 HCPCS 0278 RC outpatient 1668 1668 1668 57 950.76 percent of total billed charges 1668 93 1351.08 percent of total billed charges 1668 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1668 other OPPS APC 1668 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1668 other OPPS APC 1668 51 850.68 percent of total billed charges 1668 1668 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZUK PSI GUIDE SUP-97-01009 CDM 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZUK PSI GUIDE SUP-97-01010 CDM 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MIS HEADED 33MM SUP-97-01011 CDM C1713 HCPCS 0278 RC outpatient 250.25 250.25 250.25 57 142.64 percent of total billed charges 250.25 93 202.7 percent of total billed charges 250.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 250.25 other OPPS APC 250.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 250.25 other OPPS APC 250.25 51 127.63 percent of total billed charges 250.25 250.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MIS HEADED 48MM SUP-97-01012 CDM C1713 HCPCS 0278 RC outpatient 306.25 306.25 306.25 57 174.56 percent of total billed charges 306.25 93 248.06 percent of total billed charges 306.25 306.25 other OPPS APC 306.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 306.25 other OPPS APC 306.25 51 156.19 percent of total billed charges 306.25 306.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY ARTICULAR SURFACE INSERTER TIP SUP-97-01013 CDM C1776 HCPCS 0278 RC outpatient 318.5 318.5 318.5 57 181.55 percent of total billed charges 318.5 93 257.99 percent of total billed charges 318.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 318.5 other OPPS APC 318.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 318.5 other OPPS APC 318.5 51 162.44 percent of total billed charges 318.5 318.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTICULAR SURFACE SZ 3 8MM SUP-97-01016 CDM C1776 HCPCS 0278 RC outpatient 1668 1668 1668 57 950.76 percent of total billed charges 1668 93 1351.08 percent of total billed charges 1668 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1668 other OPPS APC 1668 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1668 other OPPS APC 1668 51 850.68 percent of total billed charges 1668 1668 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTICULAR SURFACE SZ 2 8MM SUP-97-01018 CDM C1776 HCPCS 0278 RC outpatient 1668 1668 1668 57 950.76 percent of total billed charges 1668 93 1351.08 percent of total billed charges 1668 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1668 other OPPS APC 1668 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1668 other OPPS APC 1668 51 850.68 percent of total billed charges 1668 1668 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIB BASE SZ 2 RM/LL SUP-97-01019 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PSN 2.5MM FEMALE 25MM SUP-97-01020 CDM C1713 HCPCS 0278 RC outpatient 813 813 813 57 463.41 percent of total billed charges 813 93 658.53 percent of total billed charges 813 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 813 other OPPS APC 813 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 813 other OPPS APC 813 51 414.63 percent of total billed charges 813 813 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERSONA CEM FEM TIB VE SURF/XLPE PAT SUP-97-01021 CDM C1776 HCPCS 0278 RC outpatient 14400 14400 14400 57 8208 percent of total billed charges 14400 93 11664 percent of total billed charges 14400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14400 other OPPS APC 14400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14400 other OPPS APC 14400 51 7344 percent of total billed charges 14400 14400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSN FEM PS CMT CCR STD SZ11 L SUP-97-01024 CDM C1776 HCPCS 0278 RC outpatient 8560 8560 8560 57 4879.2 percent of total billed charges 8560 93 6933.6 percent of total billed charges 8560 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8560 other OPPS APC 8560 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8560 other OPPS APC 8560 51 4365.6 percent of total billed charges 8560 8560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLANEXGEN PROLONG ALL POLY 32MM SUP-97-01026 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MODULAR STEM CEMENTED SIGMA SUP-97-01030 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL ADAPTER SIGMA SUP-97-01031 CDM C1776 HCPCS 0278 RC outpatient 7382 7382 7382 57 4207.74 percent of total billed charges 7382 93 5979.42 percent of total billed charges 7382 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7382 other OPPS APC 7382 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7382 other OPPS APC 7382 51 3764.82 percent of total billed charges 7382 7382 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL ADAPTER BOLT SIGMA SUP-97-01032 CDM C1776 HCPCS 0278 RC outpatient 973.8 973.8 973.8 57 555.07 percent of total billed charges 973.8 93 788.78 percent of total billed charges 973.8 973.8 other OPPS APC 973.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 973.8 other OPPS APC 973.8 51 496.64 percent of total billed charges 973.8 973.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIVERSAL STEM FLUTED SUP-97-01033 CDM C1776 HCPCS 0278 RC outpatient 5120 5120 5120 57 2918.4 percent of total billed charges 5120 93 4147.2 percent of total billed charges 5120 5120 other OPPS APC 5120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5120 other OPPS APC 5120 51 2611.2 percent of total billed charges 5120 5120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENTED FIXED BEARING TKR SIGMA (CAP) SUP-97-01034 CDM C1776 HCPCS 0278 RC outpatient 11500 11500 11500 57 6555 percent of total billed charges 11500 93 9315 percent of total billed charges 11500 11500 other OPPS APC 11500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11500 other OPPS APC 11500 51 5865 percent of total billed charges 11500 11500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACH ESOPH AIRWAY 41FR XRAY SUP-97-01035 CDM 0272 RC outpatient 539 539 539 74 398.86 percent of total billed charges 539 93 436.59 percent of total billed charges 539 539 other OPPS APC 539 539 other OPPS APC 539 27.63 148.93 percent of total billed charges 539 539 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ET TUBE PREFORMED UNCUFF TRACH TUBE ORAL SUP-97-01036 CDM 0272 RC outpatient 111.2 111.2 111.2 74 82.29 percent of total billed charges 111.2 93 90.07 percent of total billed charges 111.2 111.2 other OPPS APC 111.2 111.2 other OPPS APC 111.2 27.63 30.72 percent of total billed charges 111.2 111.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 25.5D TECNIS EYHANCE SUP-97-01037 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 16.0D TECNIS EYHANCE SUP-97-01038 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 17.5D TECNIS EYHANCE SUP-97-01039 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLID DRILL 1.7MM SUP-97-01042 CDM 0272 RC outpatient 226.52 226.52 226.52 74 167.62 percent of total billed charges 226.52 93 183.48 percent of total billed charges 226.52 226.52 other OPPS APC 226.52 226.52 other OPPS APC 226.52 27.63 62.59 percent of total billed charges 226.52 226.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYMBOTEX 15*10 SUP-97-01047 CDM C1781 HCPCS 0278 RC outpatient 1406.43 1406.43 1406.43 57 801.67 percent of total billed charges 1406.43 93 1139.21 percent of total billed charges 1406.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1406.43 other OPPS APC 1406.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1406.43 other OPPS APC 1406.43 51 717.28 percent of total billed charges 1406.43 1406.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIGMA FEMORAL SIZE 3 LM/RL SUP-97-01048 CDM C1776 HCPCS 0278 RC outpatient 6646.5 6646.5 6646.5 57 3788.51 percent of total billed charges 6646.5 93 5383.67 percent of total billed charges 6646.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6646.5 other OPPS APC 6646.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6646.5 other OPPS APC 6646.5 51 3389.72 percent of total billed charges 6646.5 6646.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIGMA TIB SIZE 3 UNI-FIXED SUP-97-01049 CDM C1776 HCPCS 0278 RC outpatient 4035 4035 4035 57 2299.95 percent of total billed charges 4035 93 3268.35 percent of total billed charges 4035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4035 other OPPS APC 4035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4035 other OPPS APC 4035 51 2057.85 percent of total billed charges 4035 4035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIGMA TIBIAL SZ 3 9MM SUP-97-01050 CDM C1776 HCPCS 0278 RC outpatient 2907 2907 2907 57 1656.99 percent of total billed charges 2907 93 2354.67 percent of total billed charges 2907 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2907 other OPPS APC 2907 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2907 other OPPS APC 2907 51 1482.57 percent of total billed charges 2907 2907 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIGMA FEM SIZE 2.5 LFT SUP-97-01051 CDM C1776 HCPCS 0278 RC outpatient 8329.5 8329.5 8329.5 57 4747.82 percent of total billed charges 8329.5 93 6746.9 percent of total billed charges 8329.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8329.5 other OPPS APC 8329.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8329.5 other OPPS APC 8329.5 51 4248.05 percent of total billed charges 8329.5 8329.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM 115MM X 12MM SUP-97-01052 CDM C1776 HCPCS 0278 RC outpatient 5120 5120 5120 57 2918.4 percent of total billed charges 5120 93 4147.2 percent of total billed charges 5120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5120 other OPPS APC 5120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5120 other OPPS APC 5120 51 2611.2 percent of total billed charges 5120 5120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIGMA TIBIAL MOD COCR 3 SUP-97-01053 CDM C1776 HCPCS 0278 RC outpatient 6238.5 6238.5 6238.5 57 3555.95 percent of total billed charges 6238.5 93 5053.19 percent of total billed charges 6238.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6238.5 other OPPS APC 6238.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6238.5 other OPPS APC 6238.5 51 3181.64 percent of total billed charges 6238.5 6238.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA ROUND DOME 35MM SUP-97-01054 CDM C1776 HCPCS 0278 RC outpatient 1693.2 1693.2 1693.2 57 965.12 percent of total billed charges 1693.2 93 1371.49 percent of total billed charges 1693.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1693.2 other OPPS APC 1693.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1693.2 other OPPS APC 1693.2 51 863.53 percent of total billed charges 1693.2 1693.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIGMA TIBIAL SIZE 3 12.5MM SUP-97-01055 CDM C1776 HCPCS 0278 RC outpatient 7132 7132 7132 57 4065.24 percent of total billed charges 7132 93 5776.92 percent of total billed charges 7132 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7132 other OPPS APC 7132 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7132 other OPPS APC 7132 51 3637.32 percent of total billed charges 7132 7132 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR PS 3./RT SUP-97-01056 CDM C1776 HCPCS 0278 RC outpatient 9665.23 9665.23 9665.23 57 5509.18 percent of total billed charges 9665.23 93 7828.84 percent of total billed charges 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 51 4929.27 percent of total billed charges 9665.23 9665.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSL INSERT 3X9MM SUP-97-01057 CDM C1776 HCPCS 0278 RC outpatient 3419.25 3419.25 3419.25 57 1948.97 percent of total billed charges 3419.25 93 2769.59 percent of total billed charges 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 51 1743.82 percent of total billed charges 3419.25 3419.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK ART SURF EF 7-10/BLUE 10MM SUP-97-01058 CDM C1776 HCPCS 0278 RC outpatient 5212.5 5212.5 5212.5 57 2971.13 percent of total billed charges 5212.5 93 4222.13 percent of total billed charges 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 51 2658.38 percent of total billed charges 5212.5 5212.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN PC STEMMED TIBIAL PLATE SZ 7 SUP-97-01059 CDM C1776 HCPCS 0278 RC outpatient 3610 3610 3610 57 2057.7 percent of total billed charges 3610 93 2924.1 percent of total billed charges 3610 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3610 other OPPS APC 3610 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3610 other OPPS APC 3610 51 1841.1 percent of total billed charges 3610 3610 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK FEMORAL SZ E-LT SUP-97-01060 CDM C1776 HCPCS 0278 RC outpatient 12600 12600 12600 57 7182 percent of total billed charges 12600 93 10206 percent of total billed charges 12600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12600 other OPPS APC 12600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12600 other OPPS APC 12600 51 6426 percent of total billed charges 12600 12600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSN STR HYB ST 14X30+M SUP-97-01061 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD SUP-97-01062 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMISPHERICAL CLUSTER HOLE SHELL SUP-97-01063 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 12.5D TECNIS EYHANCE SUP-97-01064 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NASAL SEPTAL BUTTON SUP-97-01065 CDM outpatient 507.5 507.5 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO PLUS POWER RIGHT MOCCA SUP-97-01066 CDM L8614 HCPCS 0272 RC outpatient 8990 8990 8990 74 6652.6 percent of total billed charges 8990 93 7281.9 percent of total billed charges 8990 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8990 other OPPS APC 8990 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8990 other OPPS APC 8990 27.63 2483.94 percent of total billed charges 8990 8990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMART TOE ST0-15 SUP-97-01067 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STIMULAN PASTE BEADS SUP-97-01068 CDM C1713 HCPCS 0278 RC outpatient 4587.5 4587.5 4587.5 57 2614.88 percent of total billed charges 4587.5 93 3715.88 percent of total billed charges 4587.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4587.5 other OPPS APC 4587.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4587.5 other OPPS APC 4587.5 51 2339.63 percent of total billed charges 4587.5 4587.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT PSC 3.5X13MIN SUP-97-01069 CDM C1713 HCPCS 0278 RC outpatient 3419.25 3419.25 3419.25 57 1948.97 percent of total billed charges 3419.25 93 2769.59 percent of total billed charges 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 51 1743.82 percent of total billed charges 3419.25 3419.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAPER HOLDER PINK SUP-97-01070 CDM 0271 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TIBIA 8MM CANN EX 360 MM SUP-97-01071 CDM C1713 HCPCS 0278 RC outpatient 3930.53 3930.53 3930.53 57 2240.4 percent of total billed charges 3930.53 93 3183.73 percent of total billed charges 3930.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3930.53 other OPPS APC 3930.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3930.53 other OPPS APC 3930.53 51 2004.57 percent of total billed charges 3930.53 3930.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TIBIA 10MM CANN EX 330 MM SUP-97-01072 CDM C1713 HCPCS 0278 RC outpatient 4048.45 4048.45 4048.45 57 2307.62 percent of total billed charges 4048.45 93 3279.24 percent of total billed charges 4048.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4048.45 other OPPS APC 4048.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4048.45 other OPPS APC 4048.45 51 2064.71 percent of total billed charges 4048.45 4048.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 15.0D TECNIS EYHANCE SUP-97-01074 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS14.0D SUP-97-01075 CDM C1780 HCPCS 0278 RC outpatient 595 595 595 57 339.15 percent of total billed charges 595 93 481.95 percent of total billed charges 595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 595 other OPPS APC 595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 595 other OPPS APC 595 51 303.45 percent of total billed charges 595 595 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENTED HIP STEM SIZE4 SUP-97-01076 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL SPACER SUP-97-01077 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD SUP-97-01078 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER PATELLA STERILE KNEE 36MM SUP-97-01079 CDM 0272 RC outpatient 672 672 672 74 497.28 percent of total billed charges 672 93 544.32 percent of total billed charges 672 672 other OPPS APC 672 672 other OPPS APC 672 27.63 185.67 percent of total billed charges 672 672 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTERIOR STABLIZER FEMORAL LEFT SUP-97-01080 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIVERSAL TIBUAL BASEPLATE TOTAL KNEE SUP-97-01081 CDM C1776 HCPCS 0278 RC outpatient 3125 3125 3125 57 1781.25 percent of total billed charges 3125 93 2531.25 percent of total billed charges 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 51 1593.75 percent of total billed charges 3125 3125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BEARING INSERT-PS 9MM SUP-97-01082 CDM C1713 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 21.0D SUP-97-01084 CDM C1780 HCPCS 0278 RC outpatient 381.5 381.5 381.5 57 217.46 percent of total billed charges 381.5 93 309.02 percent of total billed charges 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 51 194.57 percent of total billed charges 381.5 381.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 23.5D SUP-97-01085 CDM C1780 HCPCS 0278 RC outpatient 381.5 381.5 381.5 57 217.46 percent of total billed charges 381.5 93 309.02 percent of total billed charges 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 51 194.57 percent of total billed charges 381.5 381.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 20.5D SUP-97-01086 CDM C1780 HCPCS 0278 RC outpatient 402.5 402.5 402.5 57 229.43 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 51 205.28 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANN TROCH FIX 10MM 130 340 SUP-97-01090 CDM C1713 HCPCS 0278 RC outpatient 5121.7 5121.7 5121.7 57 2919.37 percent of total billed charges 5121.7 93 4148.58 percent of total billed charges 5121.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5121.7 other OPPS APC 5121.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5121.7 other OPPS APC 5121.7 51 2612.07 percent of total billed charges 5121.7 5121.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 20.5D TECNIS EYHANCE SUP-97-01094 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BREAST IMPLANTS 470CC(MF-410470) SUP-97-01098 CDM L8600 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 3250 other OPPS APC 3250 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BREAST IMPLANTS 525CC (MF-410525) SUP-97-01099 CDM L8600 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 3250 other OPPS APC 3250 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TISSUE EXPANDERS 650CC SUP-97-01100 CDM L8699 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 3750 other OPPS APC 3750 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD SUP-97-01102 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLAR COMPONENT SUP-97-01103 CDM C1776 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 10MM CANNULATED SUP-97-01104 CDM outpatient 837 837 837 837 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER LOW PROFILE 10MM SUP-97-01105 CDM 0272 RC outpatient 837 837 837 74 619.38 percent of total billed charges 837 93 677.97 percent of total billed charges 837 837 other OPPS APC 837 837 other OPPS APC 837 27.63 231.26 percent of total billed charges 837 837 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 23.5D SUP-97-01106 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 14.5D TECNIS EYHANCE SUP-97-01108 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 23.5D TECNIS EYHANCE SUP-97-01109 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 22.0D SUP-97-01110 CDM C1780 HCPCS 0278 RC outpatient 402.5 402.5 402.5 57 229.43 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 51 205.28 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 8.0D TECNIS EYHANCE SUP-97-01113 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EASY RED TAG SUP-97-01115 CDM 0271 RC outpatient 308.35 308.35 308.35 74 228.18 percent of total billed charges 308.35 93 249.76 percent of total billed charges 308.35 308.35 other OPPS APC 308.35 308.35 other OPPS APC 308.35 27.63 85.2 percent of total billed charges 308.35 308.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR SIZE 2 NMC SUP-97-01116 CDM C1776 HCPCS 0278 RC outpatient 9518.44 9518.44 9518.44 57 5425.51 percent of total billed charges 9518.44 93 7709.94 percent of total billed charges 9518.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9518.44 other OPPS APC 9518.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9518.44 other OPPS APC 9518.44 51 4854.4 percent of total billed charges 9518.44 9518.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT CC 2X9 MM SUP-97-01117 CDM C1776 HCPCS 0278 RC outpatient 3859.88 3859.88 3859.88 57 2200.13 percent of total billed charges 3859.88 93 3126.5 percent of total billed charges 3859.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3859.88 other OPPS APC 3859.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3859.88 other OPPS APC 3859.88 51 1968.54 percent of total billed charges 3859.88 3859.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION 12MMX11MM SUP-97-01118 CDM C1776 HCPCS 0278 RC outpatient 2974.5 2974.5 2974.5 57 1695.47 percent of total billed charges 2974.5 93 2409.35 percent of total billed charges 2974.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2974.5 other OPPS APC 2974.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2974.5 other OPPS APC 2974.5 51 1517 percent of total billed charges 2974.5 2974.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL STEM SCREW SUP-97-01119 CDM C1776 HCPCS 0278 RC outpatient 197.4 197.4 197.4 57 112.52 percent of total billed charges 197.4 93 159.89 percent of total billed charges 197.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 197.4 other OPPS APC 197.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 197.4 other OPPS APC 197.4 51 100.67 percent of total billed charges 197.4 197.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSN ASF CPS 14MM VE R 6-9 EF SUP-97-01120 CDM C1776 HCPCS 0278 RC outpatient 5625 5625 5625 57 3206.25 percent of total billed charges 5625 93 4556.25 percent of total billed charges 5625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5625 other OPPS APC 5625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5625 other OPPS APC 5625 51 2868.75 percent of total billed charges 5625 5625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR PS 4RT SUP-97-01121 CDM C1776 HCPCS 0278 RC outpatient 9665.23 9665.23 9665.23 57 5509.18 percent of total billed charges 9665.23 93 7828.84 percent of total billed charges 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 51 4929.27 percent of total billed charges 9665.23 9665.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIA FIT 4F/4T SUP-97-01122 CDM C1776 HCPCS 0278 RC outpatient 4896.4 4896.4 4896.4 57 2790.95 percent of total billed charges 4896.4 93 3966.08 percent of total billed charges 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 51 2497.16 percent of total billed charges 4896.4 4896.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT PS 4X11MM SUP-97-01123 CDM C1776 HCPCS 0278 RC outpatient 3144.3 3144.3 3144.3 57 1792.25 percent of total billed charges 3144.3 93 2546.88 percent of total billed charges 3144.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3144.3 other OPPS APC 3144.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3144.3 other OPPS APC 3144.3 51 1603.59 percent of total billed charges 3144.3 3144.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR PS 2.5RT SUP-97-01124 CDM C1776 HCPCS 0278 RC outpatient 9665.23 9665.23 9665.23 57 5509.18 percent of total billed charges 9665.23 93 7828.84 percent of total billed charges 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 51 4929.27 percent of total billed charges 9665.23 9665.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIA FIT 2.5F/1.5T SUP-97-01125 CDM C1776 HCPCS 0278 RC outpatient 4896.4 4896.4 4896.4 57 2790.95 percent of total billed charges 4896.4 93 3966.08 percent of total billed charges 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 51 2497.16 percent of total billed charges 4896.4 4896.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT PS 2.5X9MM SUP-97-01126 CDM C1776 HCPCS 0278 RC outpatient 3144.3 3144.3 3144.3 57 1792.25 percent of total billed charges 3144.3 93 2546.88 percent of total billed charges 3144.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3144.3 other OPPS APC 3144.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3144.3 other OPPS APC 3144.3 51 1603.59 percent of total billed charges 3144.3 3144.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD SUP-97-01127 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETABULAR DOME HOLE PLUG SUP-97-01128 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMISPHERICAL CLUSTER HOLE SHELL SUP-97-01129 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 11.0D TECNIS EYHANCE SUP-97-01130 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 18.5D SUP-97-01131 CDM C1780 HCPCS 0278 RC outpatient 402.5 402.5 402.5 57 229.43 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 51 205.28 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED LARGE DRILL BIT 11MM SUP-97-01133 CDM 0272 RC outpatient 1646.91 1646.91 1646.91 74 1218.71 percent of total billed charges 1646.91 93 1334 percent of total billed charges 1646.91 1646.91 other OPPS APC 1646.91 1646.91 other OPPS APC 1646.91 27.63 455.04 percent of total billed charges 1646.91 1646.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANN TROCH 10MM/380DEG SUP-97-01136 CDM C1713 HCPCS 0278 RC outpatient 5272.78 5272.78 5272.78 57 3005.48 percent of total billed charges 5272.78 93 4270.95 percent of total billed charges 5272.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5272.78 other OPPS APC 5272.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5272.78 other OPPS APC 5272.78 51 2689.12 percent of total billed charges 5272.78 5272.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS ZCT400 SUP-97-01139 CDM C1780 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILLBIT 2.0MM SUP-97-01140 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3 HOLE DLB COMP PLATE 20MM SUP-97-01141 CDM C1713 HCPCS 0278 RC outpatient 4270 4270 4270 57 2433.9 percent of total billed charges 4270 93 3458.7 percent of total billed charges 4270 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4270 other OPPS APC 4270 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4270 other OPPS APC 4270 51 2177.7 percent of total billed charges 4270 4270 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4 HOLE DLB COMP PLATE 20MM SUP-97-01142 CDM C1713 HCPCS 0278 RC outpatient 4270 4270 4270 57 2433.9 percent of total billed charges 4270 93 3458.7 percent of total billed charges 4270 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4270 other OPPS APC 4270 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4270 other OPPS APC 4270 51 2177.7 percent of total billed charges 4270 4270 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCRW4.0 STD 26MM LGTH SUP-97-01143 CDM C1713 HCPCS 0278 RC outpatient 1266 1266 1266 57 721.62 percent of total billed charges 1266 93 1025.46 percent of total billed charges 1266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1266 other OPPS APC 1266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1266 other OPPS APC 1266 51 645.66 percent of total billed charges 1266 1266 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO PRO SCRW3.5X 18MM SUP-97-01144 CDM C1713 HCPCS 0278 RC outpatient 301 301 301 57 171.57 percent of total billed charges 301 93 243.81 percent of total billed charges 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 51 153.51 percent of total billed charges 301 301 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO PRO SCRW3.5X 18MM SUP-97-01145 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PRO SCRWT16.7X 85MMCANN18MM SUP-97-01146 CDM C1713 HCPCS 0278 RC outpatient 750 750 750 57 427.5 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 51 382.5 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER 13MM TITAHIUM SUP-97-01147 CDM C1713 HCPCS 0278 RC outpatient 402.5 402.5 402.5 57 229.43 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 51 205.28 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERSONA CEM FEM TIB VE SURF/XLPE PAT SUP-97-01148 CDM C1776 HCPCS 0278 RC outpatient 16000 16000 16000 57 9120 percent of total billed charges 16000 93 12960 percent of total billed charges 16000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16000 other OPPS APC 16000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16000 other OPPS APC 16000 51 8160 percent of total billed charges 16000 16000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERSONA CEM FEM TB VE SURF/XLPE PAT SUP-97-01149 CDM C1776 HCPCS 0278 RC outpatient 14400 14400 14400 57 8208 percent of total billed charges 14400 93 11664 percent of total billed charges 14400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14400 other OPPS APC 14400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14400 other OPPS APC 14400 51 7344 percent of total billed charges 14400 14400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DVR ANATOMIC NARW SHORT LEFT SUP-97-01151 CDM C1713 HCPCS 0278 RC outpatient 1650.57 1650.57 1650.57 57 940.82 percent of total billed charges 1650.57 93 1336.96 percent of total billed charges 1650.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650.57 other OPPS APC 1650.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650.57 other OPPS APC 1650.57 51 841.79 percent of total billed charges 1650.57 1650.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE SS 1.6X127MM NS SUP-97-01152 CDM C1713 HCPCS 0278 RC outpatient 58.52 58.52 58.52 57 33.36 percent of total billed charges 58.52 93 47.4 percent of total billed charges 58.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 58.52 other OPPS APC 58.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 58.52 other OPPS APC 58.52 51 29.85 percent of total billed charges 58.52 58.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG DRIVER FAST 2.0MM SUP-97-01153 CDM 0272 RC outpatient 155.24 155.24 155.24 74 114.88 percent of total billed charges 155.24 93 125.74 percent of total billed charges 155.24 155.24 other OPPS APC 155.24 155.24 other OPPS APC 155.24 27.63 42.89 percent of total billed charges 155.24 155.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT FAST 2.0MM SUP-97-01154 CDM 0272 RC outpatient 246.72 246.72 246.72 74 182.57 percent of total billed charges 246.72 93 199.84 percent of total billed charges 246.72 246.72 other OPPS APC 246.72 246.72 other OPPS APC 246.72 27.63 68.17 percent of total billed charges 246.72 246.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT FAST 2.5MM NS SUP-97-01155 CDM 0272 RC outpatient 246.72 246.72 246.72 74 182.57 percent of total billed charges 246.72 93 199.84 percent of total billed charges 246.72 246.72 other OPPS APC 246.72 246.72 other OPPS APC 246.72 27.63 68.17 percent of total billed charges 246.72 246.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL 3.5X12MM SUP-97-01156 CDM C1713 HCPCS 0278 RC outpatient 207.48 207.48 207.48 57 118.26 percent of total billed charges 207.48 93 168.06 percent of total billed charges 207.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 207.48 other OPPS APC 207.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 207.48 other OPPS APC 207.48 51 105.81 percent of total billed charges 207.48 207.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG PARTIAL THEARD 2.5X18MM SUP-97-01157 CDM C1713 HCPCS 0278 RC outpatient 207.48 207.48 207.48 57 118.26 percent of total billed charges 207.48 93 168.06 percent of total billed charges 207.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 207.48 other OPPS APC 207.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 207.48 other OPPS APC 207.48 51 105.81 percent of total billed charges 207.48 207.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG PARTIAL THEARD 2.5X20MM SUP-97-01158 CDM C1713 HCPCS 0278 RC outpatient 207.48 207.48 207.48 57 118.26 percent of total billed charges 207.48 93 168.06 percent of total billed charges 207.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 207.48 other OPPS APC 207.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 207.48 other OPPS APC 207.48 51 105.81 percent of total billed charges 207.48 207.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG PARTIAL THEARD 2.5X22MM SUP-97-01159 CDM C1713 HCPCS 0278 RC outpatient 207.48 207.48 207.48 57 118.26 percent of total billed charges 207.48 93 168.06 percent of total billed charges 207.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 207.48 other OPPS APC 207.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 207.48 other OPPS APC 207.48 51 105.81 percent of total billed charges 207.48 207.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG PARTIAL THEARD 2.5X24MM SUP-97-01160 CDM C1713 HCPCS 0278 RC outpatient 207.48 207.48 207.48 57 118.26 percent of total billed charges 207.48 93 168.06 percent of total billed charges 207.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 207.48 other OPPS APC 207.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 207.48 other OPPS APC 207.48 51 105.81 percent of total billed charges 207.48 207.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STANDARD STEM SIZE 10 SUP-97-01161 CDM C1776 HCPCS 0278 RC outpatient 6090 6090 6090 57 3471.3 percent of total billed charges 6090 93 4932.9 percent of total billed charges 6090 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6090 other OPPS APC 6090 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6090 other OPPS APC 6090 51 3105.9 percent of total billed charges 6090 6090 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KEELED GLENOID PREMIERON SIZE 44 SUP-97-01162 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADANTAGE HUMERAL HEAD SUP-97-01163 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POLYETHYLENE INSERT SUP-97-01164 CDM C1776 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED SCREWDRIVER SUP-97-01165 CDM 0272 RC outpatient 602 602 602 74 445.48 percent of total billed charges 602 93 487.62 percent of total billed charges 602 602 other OPPS APC 602 602 other OPPS APC 602 27.63 166.33 percent of total billed charges 602 602 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 10.0D TECNIS EYHANCE SUP-97-01166 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4MM VA-LCP 2-CLMN DSTLRADIUS PL 6H HD SUP-97-01168 CDM C1713 HCPCS 0278 RC outpatient 2494.5 2494.5 2494.5 57 1421.87 percent of total billed charges 2494.5 93 2020.55 percent of total billed charges 2494.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2494.5 other OPPS APC 2494.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2494.5 other OPPS APC 2494.5 51 1272.2 percent of total billed charges 2494.5 2494.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.6MM COMPRESSION WIRE 15MM THREAD SUP-97-01169 CDM C1713 HCPCS 0278 RC outpatient 188 188 188 57 107.16 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 51 95.88 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 LOCKING 14MM SUP-97-01170 CDM C1713 HCPCS 0278 RC outpatient 532.77 532.77 532.77 57 303.68 percent of total billed charges 532.77 93 431.54 percent of total billed charges 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 51 271.71 percent of total billed charges 532.77 532.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX SLF TAPPING 2.7MM 22M SUP-97-01171 CDM C1713 HCPCS 0278 RC outpatient 145.96 145.96 145.96 57 83.2 percent of total billed charges 145.96 93 118.23 percent of total billed charges 145.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.96 other OPPS APC 145.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.96 other OPPS APC 145.96 51 74.44 percent of total billed charges 145.96 145.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TI CANN HUMERAL FEMORAL EX/200MM STERIL SUP-97-01172 CDM C1713 HCPCS 0278 RC outpatient 5287.38 5287.38 5287.38 57 3013.81 percent of total billed charges 5287.38 93 4282.78 percent of total billed charges 5287.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5287.38 other OPPS APC 5287.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5287.38 other OPPS APC 5287.38 51 2696.56 percent of total billed charges 5287.38 5287.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.2MM THREE FLUTED DRILL QC 330MM/100MM SUP-97-01173 CDM 0272 RC outpatient 823.35 823.35 823.35 74 609.28 percent of total billed charges 823.35 93 666.91 percent of total billed charges 823.35 823.35 other OPPS APC 823.35 823.35 other OPPS APC 823.35 27.63 227.49 percent of total billed charges 823.35 823.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.2MM THREE FLUTED DRILL QC 145MM SUP-97-01174 CDM 0272 RC outpatient 728.34 728.34 728.34 74 538.97 percent of total billed charges 728.34 93 589.96 percent of total billed charges 728.34 728.34 other OPPS APC 728.34 728.34 other OPPS APC 728.34 27.63 201.24 percent of total billed charges 728.34 728.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0MM LOCKING SCREW W/T 25STARDRIVE 26 SUP-97-01175 CDM C1713 HCPCS 0278 RC outpatient 748.38 748.38 748.38 57 426.58 percent of total billed charges 748.38 93 606.19 percent of total billed charges 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 51 381.67 percent of total billed charges 748.38 748.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR SIZE 4 NMC SUP-97-01176 CDM C1776 HCPCS 0278 RC outpatient 10126 10126 10126 57 5771.82 percent of total billed charges 10126 93 8202.06 percent of total billed charges 10126 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10126 other OPPS APC 10126 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10126 other OPPS APC 10126 51 5164.26 percent of total billed charges 10126 10126 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT CC 4X15 MM SUP-97-01177 CDM C1776 HCPCS 0278 RC outpatient 3859.88 3859.88 3859.88 57 2200.13 percent of total billed charges 3859.88 93 3126.5 percent of total billed charges 3859.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3859.88 other OPPS APC 3859.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3859.88 other OPPS APC 3859.88 51 1968.54 percent of total billed charges 3859.88 3859.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSL INSERT 5X11MM SUP-97-01178 CDM C1776 HCPCS 0278 RC outpatient 3419.25 3419.25 3419.25 57 1948.97 percent of total billed charges 3419.25 93 2769.59 percent of total billed charges 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 51 1743.82 percent of total billed charges 3419.25 3419.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE LABEL MORPHINE SUP-97-01179 CDM 0271 RC outpatient 2.2 2.2 2.2 74 1.63 percent of total billed charges 2.2 93 1.78 percent of total billed charges 2.2 2.2 other OPPS APC 2.2 2.2 other OPPS APC 2.2 27.63 0.61 percent of total billed charges 2.2 2.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE LABEL ZEMURON SUP-97-01180 CDM 0271 RC outpatient 1.84 1.84 1.84 74 1.36 percent of total billed charges 1.84 93 1.49 percent of total billed charges 1.84 1.84 other OPPS APC 1.84 1.84 other OPPS APC 1.84 27.63 0.51 percent of total billed charges 1.84 1.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL 10MM/130DEG TROCH FIXATION LEFT SUP-97-01181 CDM C1713 HCPCS 0278 RC outpatient 5272.78 5272.78 5272.78 57 3005.48 percent of total billed charges 5272.78 93 4270.95 percent of total billed charges 5272.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5272.78 other OPPS APC 5272.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5272.78 other OPPS APC 5272.78 51 2689.12 percent of total billed charges 5272.78 5272.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL AUGMENT HALF BLOCK SUP-97-01183 CDM C1776 HCPCS 0278 RC outpatient 2966.4 2966.4 2966.4 57 1690.85 percent of total billed charges 2966.4 93 2402.78 percent of total billed charges 2966.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2966.4 other OPPS APC 2966.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2966.4 other OPPS APC 2966.4 51 1512.86 percent of total billed charges 2966.4 2966.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTED STEM SUP-97-01184 CDM C1776 HCPCS 0278 RC outpatient 4110 4110 4110 57 2342.7 percent of total billed charges 4110 93 3329.1 percent of total billed charges 4110 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4110 other OPPS APC 4110 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4110 other OPPS APC 4110 51 2096.1 percent of total billed charges 4110 4110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOTAL STABLIZER FEMORAL COMPONENT SUP-97-01185 CDM C1776 HCPCS 0278 RC outpatient 12280.8 12280.8 12280.8 57 7000.06 percent of total billed charges 12280.8 93 9947.45 percent of total billed charges 12280.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.8 other OPPS APC 12280.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.8 other OPPS APC 12280.8 51 6263.21 percent of total billed charges 12280.8 12280.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTED STEM SUP-97-01186 CDM C1776 HCPCS 0278 RC outpatient 3041 3041 3041 57 1733.37 percent of total billed charges 3041 93 2463.21 percent of total billed charges 3041 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3041 other OPPS APC 3041 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3041 other OPPS APC 3041 51 1550.91 percent of total billed charges 3041 3041 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL AUGMENT HALF BLOCK SUP-97-01187 CDM C1776 HCPCS 0278 RC outpatient 2966.4 2966.4 2966.4 57 1690.85 percent of total billed charges 2966.4 93 2402.78 percent of total billed charges 2966.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2966.4 other OPPS APC 2966.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2966.4 other OPPS APC 2966.4 51 1512.86 percent of total billed charges 2966.4 2966.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS ZCT 150 19.0D SUP-97-01188 CDM C1780 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SWEAT BAND FOR STRYKER HOOD SUP-97-01191 CDM 0271 RC outpatient 204.12 204.12 204.12 74 151.05 percent of total billed charges 204.12 93 165.34 percent of total billed charges 204.12 204.12 other OPPS APC 204.12 204.12 other OPPS APC 204.12 27.63 56.4 percent of total billed charges 204.12 204.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE KETORALAC SUP-97-01192 CDM 0271 RC outpatient 31.8 31.8 31.8 74 23.53 percent of total billed charges 31.8 93 25.76 percent of total billed charges 31.8 31.8 other OPPS APC 31.8 31.8 other OPPS APC 31.8 27.63 8.79 percent of total billed charges 31.8 31.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PURAPLY AM 2X4 SUP-97-01193 CDM Q4196 HCPCS 0636 RC outpatient 2688 2688 116.75 116.75 fee schedule 2688 93 2177.28 percent of total billed charges 2688 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2688 other OPPS APC 2688 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2688 other OPPS APC 2688 24.86 668.24 percent of total billed charges 116.75 2688 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PURAPLY AM 5X5 SUP-97-01194 CDM Q4196 HCPCS 0636 RC outpatient 7000 7000 116.75 116.75 fee schedule 7000 93 5670 percent of total billed charges 7000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7000 other OPPS APC 7000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7000 other OPPS APC 7000 24.86 1740.2 percent of total billed charges 116.75 7000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSL INSERT 2X9MM SUP-97-01196 CDM C1776 HCPCS 0278 RC outpatient 3419.25 3419.25 3419.25 57 1948.97 percent of total billed charges 3419.25 93 2769.59 percent of total billed charges 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 51 1743.82 percent of total billed charges 3419.25 3419.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE BALL TIP 3 X 1000 SUP-97-01197 CDM 0272 RC outpatient 418.95 418.95 418.95 74 310.02 percent of total billed charges 418.95 93 339.35 percent of total billed charges 418.95 418.95 other OPPS APC 418.95 418.95 other OPPS APC 418.95 27.63 115.76 percent of total billed charges 418.95 418.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 35MM SUP-97-01198 CDM C1713 HCPCS 0278 RC outpatient 394.8 394.8 394.8 57 225.04 percent of total billed charges 394.8 93 319.79 percent of total billed charges 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 51 201.35 percent of total billed charges 394.8 394.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL AO SUP-97-01199 CDM 0272 RC outpatient 603.12 603.12 603.12 74 446.31 percent of total billed charges 603.12 93 488.53 percent of total billed charges 603.12 603.12 other OPPS APC 603.12 603.12 other OPPS APC 603.12 27.63 166.64 percent of total billed charges 603.12 603.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 47.5MM SUP-97-01200 CDM C1713 HCPCS 0278 RC outpatient 394.8 394.8 394.8 57 225.04 percent of total billed charges 394.8 93 319.79 percent of total billed charges 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 51 201.35 percent of total billed charges 394.8 394.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POLYETHYLENE INSERT SUP-97-01201 CDM C1776 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD SUP-97-01202 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERSYS PRESS FIT LD/FX SZ 15X140MM SUP-97-01203 CDM C1776 HCPCS 0278 RC outpatient 4275 4275 4275 57 2436.75 percent of total billed charges 4275 93 3462.75 percent of total billed charges 4275 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4275 other OPPS APC 4275 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4275 other OPPS APC 4275 51 2180.25 percent of total billed charges 4275 4275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL NAIL SUP-97-01204 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T-2 HUMERUS SYSTEM SUP-97-01205 CDM C1713 HCPCS 0278 RC outpatient 645.12 645.12 645.12 57 367.72 percent of total billed charges 645.12 93 522.55 percent of total billed charges 645.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 645.12 other OPPS APC 645.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 645.12 other OPPS APC 645.12 51 329.01 percent of total billed charges 645.12 645.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE SMOOTH TIPPED SUP-97-01206 CDM 0272 RC outpatient 578.27 578.27 578.27 74 427.92 percent of total billed charges 578.27 93 468.4 percent of total billed charges 578.27 578.27 other OPPS APC 578.27 578.27 other OPPS APC 578.27 27.63 159.78 percent of total billed charges 578.27 578.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER SHAFT 450MM SUP-97-01208 CDM 0272 RC outpatient 632.1 632.1 632.1 74 467.75 percent of total billed charges 632.1 93 512 percent of total billed charges 632.1 632.1 other OPPS APC 632.1 632.1 other OPPS APC 632.1 27.63 174.65 percent of total billed charges 632.1 632.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD SUP-97-01209 CDM C1776 HCPCS 0278 RC outpatient 3595.2 3595.2 3595.2 57 2049.26 percent of total billed charges 3595.2 93 2912.11 percent of total billed charges 3595.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3595.2 other OPPS APC 3595.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3595.2 other OPPS APC 3595.2 51 1833.55 percent of total billed charges 3595.2 3595.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 45MM SUP-97-01210 CDM C1713 HCPCS 0278 RC outpatient 394.8 394.8 394.8 57 225.04 percent of total billed charges 394.8 93 319.79 percent of total billed charges 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 51 201.35 percent of total billed charges 394.8 394.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 42MM SUP-97-01211 CDM C1713 HCPCS 0278 RC outpatient 394.8 394.8 394.8 57 225.04 percent of total billed charges 394.8 93 319.79 percent of total billed charges 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 51 201.35 percent of total billed charges 394.8 394.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMISPHERICAL CLUSTER HOLE SHELL SUP-97-01212 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN 7.3 16MM/100MM SUP-97-01213 CDM C1713 HCPCS 0278 RC outpatient 861 861 861 57 490.77 percent of total billed charges 861 93 697.41 percent of total billed charges 861 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 861 other OPPS APC 861 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 861 other OPPS APC 861 51 439.11 percent of total billed charges 861 861 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCHANZ SCREW 4.0 SUP-97-01214 CDM C1713 HCPCS 0278 RC outpatient 308.7 308.7 308.7 57 175.96 percent of total billed charges 308.7 93 250.05 percent of total billed charges 308.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 308.7 other OPPS APC 308.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 308.7 other OPPS APC 308.7 51 157.44 percent of total billed charges 308.7 308.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBON ROD 100MM 4MM SUP-97-01215 CDM C1713 HCPCS 0278 RC outpatient 183.56 183.56 183.56 57 104.63 percent of total billed charges 183.56 93 148.68 percent of total billed charges 183.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 183.56 other OPPS APC 183.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 183.56 other OPPS APC 183.56 51 93.62 percent of total billed charges 183.56 183.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBON ROD 120MM 4MM SUP-97-01216 CDM C1713 HCPCS 0278 RC outpatient 168 168 168 57 95.76 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 51 85.68 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KEELED GLENOID PREMIERON SIZE 40 SUP-97-01218 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK ANGLE HIP STEM SUP-97-01219 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5MM CORTEX SELF TAPPING 26MM SUP-97-01220 CDM C1713 HCPCS 0278 RC outpatient 94.28 94.28 94.28 57 53.74 percent of total billed charges 94.28 93 76.37 percent of total billed charges 94.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 94.28 other OPPS APC 94.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 94.28 other OPPS APC 94.28 51 48.08 percent of total billed charges 94.28 94.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5MM CORTEX SELF TAPPING 14MM SUP-97-01221 CDM C1713 HCPCS 0278 RC outpatient 106.2 106.2 106.2 57 60.53 percent of total billed charges 106.2 93 86.02 percent of total billed charges 106.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.2 other OPPS APC 106.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.2 other OPPS APC 106.2 51 54.16 percent of total billed charges 106.2 106.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE WRIST FUSION 8 HOLES SUP-97-01222 CDM C1713 HCPCS 0278 RC outpatient 3016 3016 3016 57 1719.12 percent of total billed charges 3016 93 2442.96 percent of total billed charges 3016 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3016 other OPPS APC 3016 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3016 other OPPS APC 3016 51 1538.16 percent of total billed charges 3016 3016 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIA FIT 3F/2T SUP-97-01223 CDM C1776 HCPCS 0278 RC outpatient 4896.4 4896.4 4896.4 57 2790.95 percent of total billed charges 4896.4 93 3966.08 percent of total billed charges 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 51 2497.16 percent of total billed charges 4896.4 4896.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CORTEX SCREWSELF 2.7MM 12MM SUP-97-01224 CDM C1713 HCPCS 0278 RC outpatient 145.96 145.96 145.96 57 83.2 percent of total billed charges 145.96 93 118.23 percent of total billed charges 145.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.96 other OPPS APC 145.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.96 other OPPS APC 145.96 51 74.44 percent of total billed charges 145.96 145.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT SIZE 8 SUP-97-01225 CDM C1776 HCPCS 0278 RC outpatient 7800 7800 7800 57 4446 percent of total billed charges 7800 93 6318 percent of total billed charges 7800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7800 other OPPS APC 7800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7800 other OPPS APC 7800 51 3978 percent of total billed charges 7800 7800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CORTEX SCREWSELF 2.7MM 18MM SUP-97-01226 CDM C1713 HCPCS 0278 RC outpatient 145.96 145.96 145.96 57 83.2 percent of total billed charges 145.96 93 118.23 percent of total billed charges 145.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.96 other OPPS APC 145.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.96 other OPPS APC 145.96 51 74.44 percent of total billed charges 145.96 145.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CORTEX SCREWSELF TAPPING 2.7 18MM SUP-97-01227 CDM C1713 HCPCS 0278 RC outpatient 145.96 145.96 145.96 57 83.2 percent of total billed charges 145.96 93 118.23 percent of total billed charges 145.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.96 other OPPS APC 145.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.96 other OPPS APC 145.96 51 74.44 percent of total billed charges 145.96 145.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA NEXGEN PROLONG ALL POLY 38MM SUP-97-01235 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN PC STEMMED TIBIAL PLATE SZ6 SUP-97-01236 CDM C1776 HCPCS 0278 RC outpatient 5287.5 5287.5 5287.5 57 3013.88 percent of total billed charges 5287.5 93 4282.88 percent of total billed charges 5287.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5287.5 other OPPS APC 5287.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5287.5 other OPPS APC 5287.5 51 2696.63 percent of total billed charges 5287.5 5287.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK FEMORAL SZ G-RT SUP-97-01237 CDM C1776 HCPCS 0278 RC outpatient 15375 15375 15375 57 8763.75 percent of total billed charges 15375 93 12453.8 percent of total billed charges 15375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15375 other OPPS APC 15375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15375 other OPPS APC 15375 51 7841.25 percent of total billed charges 15375 15375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK ART SURF G 5-6/ GREEN 12MM SUP-97-01238 CDM C1776 HCPCS 0278 RC outpatient 6687.5 6687.5 6687.5 57 3811.88 percent of total billed charges 6687.5 93 5416.88 percent of total billed charges 6687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6687.5 other OPPS APC 6687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6687.5 other OPPS APC 6687.5 51 3410.63 percent of total billed charges 6687.5 6687.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR PS 2.5 LT SUP-97-01239 CDM C1776 HCPCS 0278 RC outpatient 9665.23 9665.23 9665.23 57 5509.18 percent of total billed charges 9665.23 93 7828.84 percent of total billed charges 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 51 4929.27 percent of total billed charges 9665.23 9665.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIA FIT 2.5F/2T SUP-97-01240 CDM C1776 HCPCS 0278 RC outpatient 4896.4 4896.4 4896.4 57 2790.95 percent of total billed charges 4896.4 93 3966.08 percent of total billed charges 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 51 2497.16 percent of total billed charges 4896.4 4896.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSL INSERT 9X2.5MM SUP-97-01241 CDM C1776 HCPCS 0278 RC outpatient 3419.25 3419.25 3419.25 57 1948.97 percent of total billed charges 3419.25 93 2769.59 percent of total billed charges 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 51 1743.82 percent of total billed charges 3419.25 3419.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR PS 3.5 LT SUP-97-01242 CDM C1776 HCPCS 0278 RC outpatient 9665.23 9665.23 9665.23 57 5509.18 percent of total billed charges 9665.23 93 7828.84 percent of total billed charges 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 51 4929.27 percent of total billed charges 9665.23 9665.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSL INSERT 3.5X11MM SUP-97-01243 CDM C1776 HCPCS 0278 RC outpatient 3419.25 3419.25 3419.25 57 1948.97 percent of total billed charges 3419.25 93 2769.59 percent of total billed charges 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 51 1743.82 percent of total billed charges 3419.25 3419.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. XEROGEL SUP-97-01244 CDM 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 750 other OPPS APC 750 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZIMMER BLUE CLIPS SUP-97-01245 CDM 0272 RC outpatient 196.35 196.35 196.35 74 145.3 percent of total billed charges 196.35 93 159.04 percent of total billed charges 196.35 196.35 other OPPS APC 196.35 196.35 other OPPS APC 196.35 27.63 54.25 percent of total billed charges 196.35 196.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS ZCT 225 19.5D SUP-97-01248 CDM C1780 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL SZ E RM/LL SUP-97-01250 CDM C1776 HCPCS 0278 RC outpatient 5360 5360 5360 57 3055.2 percent of total billed charges 5360 93 4341.6 percent of total billed charges 5360 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5360 other OPPS APC 5360 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5360 other OPPS APC 5360 51 2733.6 percent of total billed charges 5360 5360 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 LOCKING 30MM SUP-97-01251 CDM C1713 HCPCS 0278 RC outpatient 532.77 532.77 532.77 57 303.68 percent of total billed charges 532.77 93 431.54 percent of total billed charges 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 51 271.71 percent of total billed charges 532.77 532.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX SLF TPN W/ STAR DRV 2.7 22M SUP-97-01252 CDM C1713 HCPCS 0278 RC outpatient 170.2 170.2 170.2 57 97.01 percent of total billed charges 170.2 93 137.86 percent of total billed charges 170.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 170.2 other OPPS APC 170.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 170.2 other OPPS APC 170.2 51 86.8 percent of total billed charges 170.2 170.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4MM VA-LCP 2-CLMN DSTLRADIUS PL7H SUP-97-01253 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERLOOP #2 W/FIBERLOOP/TAG SUP-97-01254 CDM 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 437.5 other OPPS APC 437.5 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMART TOE SUP-97-01255 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHORT THREADED PIN /SHORT INSERTER SUP-97-01256 CDM C1713 HCPCS 0278 RC outpatient 227.5 227.5 227.5 57 129.68 percent of total billed charges 227.5 93 184.28 percent of total billed charges 227.5 227.5 other OPPS APC 227.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 227.5 other OPPS APC 227.5 51 116.03 percent of total billed charges 227.5 227.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANCELELLOUS BONE SCREW SUP-97-01257 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK ANGLE HIP STEM SUP-97-01258 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEADED CABLE AND SLEEVE SET SUP-97-01259 CDM C1713 HCPCS 0278 RC outpatient 975.6 975.6 975.6 57 556.09 percent of total billed charges 975.6 93 790.24 percent of total billed charges 975.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 975.6 other OPPS APC 975.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 975.6 other OPPS APC 975.6 51 497.56 percent of total billed charges 975.6 975.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU150 17.0D SUP-97-01261 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GII PS INSERT SZ 3-4 9MM SUP-97-01263 CDM C1776 HCPCS 0278 RC outpatient 6537.5 6537.5 6537.5 57 3726.38 percent of total billed charges 6537.5 93 5295.38 percent of total billed charges 6537.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6537.5 other OPPS APC 6537.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6537.5 other OPPS APC 6537.5 51 3334.13 percent of total billed charges 6537.5 6537.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STERI-STRIP 1/2 X 3 3M SUP-97-01264 CDM 0272 RC outpatient 100.08 100.08 100.08 74 74.06 percent of total billed charges 100.08 93 81.06 percent of total billed charges 100.08 100.08 other OPPS APC 100.08 100.08 other OPPS APC 100.08 27.63 27.65 percent of total billed charges 100.08 100.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRAVIX 2X4CM SUP-97-01266 CDM Q4133 HCPCS 0636 RC outpatient 4275 4275 166 166 fee schedule 4275 93 3462.75 percent of total billed charges 4275 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4275 other OPPS APC 4275 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4275 other OPPS APC 4275 24.86 1062.77 percent of total billed charges 166 4275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO PLUS POWER SUP-97-01267 CDM L8614 HCPCS 0272 RC outpatient 8990 8990 8990 74 6652.6 percent of total billed charges 8990 93 7281.9 percent of total billed charges 8990 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8990 other OPPS APC 8990 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8990 other OPPS APC 8990 27.63 2483.94 percent of total billed charges 8990 8990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BREAST IMPLANTS 390CC (LF-410390) SUP-97-01268 CDM L8600 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 3250 other OPPS APC 3250 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BREAST IMPLANTS 440CC (LF-410440) SUP-97-01269 CDM L8600 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 3250 other OPPS APC 3250 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLAR COMPONENT SUP-97-01270 CDM C1776 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS SA60WF 20.5D SUP-97-01273 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 20.0D ACRYSOF SUP-97-01275 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 6 HOLE HEAD 5 HOLE SHAFT SUP-97-01278 CDM C1713 HCPCS 0278 RC outpatient 3630.9 3630.9 3630.9 57 2069.61 percent of total billed charges 3630.9 93 2941.03 percent of total billed charges 3630.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3630.9 other OPPS APC 3630.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3630.9 other OPPS APC 3630.9 51 1851.76 percent of total billed charges 3630.9 3630.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN LONG THREAD 4MM X 46MM SUP-97-01279 CDM C1713 HCPCS 0278 RC outpatient 659.75 659.75 659.75 57 376.06 percent of total billed charges 659.75 93 534.4 percent of total billed charges 659.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 659.75 other OPPS APC 659.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 659.75 other OPPS APC 659.75 51 336.47 percent of total billed charges 659.75 659.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CORTEX SCREW 3.5 X 12MM SUP-97-01280 CDM C1713 HCPCS 0278 RC outpatient 106.2 106.2 106.2 57 60.53 percent of total billed charges 106.2 93 86.02 percent of total billed charges 106.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.2 other OPPS APC 106.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.2 other OPPS APC 106.2 51 54.16 percent of total billed charges 106.2 106.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 3.5 X 45MM SUP-97-01281 CDM C1713 HCPCS 0278 RC outpatient 94.28 94.28 94.28 57 53.74 percent of total billed charges 94.28 93 76.37 percent of total billed charges 94.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 94.28 other OPPS APC 94.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 94.28 other OPPS APC 94.28 51 48.08 percent of total billed charges 94.28 94.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KWIRE 2.5 SUP-97-01282 CDM C1713 HCPCS 0278 RC outpatient 150.16 150.16 150.16 57 85.59 percent of total billed charges 150.16 93 121.63 percent of total billed charges 150.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 150.16 other OPPS APC 150.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 150.16 other OPPS APC 150.16 51 76.58 percent of total billed charges 150.16 150.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP 4MM 2.5MM SUP-97-01283 CDM C1713 HCPCS 0278 RC outpatient 995.4 995.4 995.4 57 567.38 percent of total billed charges 995.4 93 806.27 percent of total billed charges 995.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 995.4 other OPPS APC 995.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 995.4 other OPPS APC 995.4 51 507.65 percent of total billed charges 995.4 995.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP 4MM 4MM SUP-97-01284 CDM C1713 HCPCS 0278 RC outpatient 995.4 995.4 995.4 57 567.38 percent of total billed charges 995.4 93 806.27 percent of total billed charges 995.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 995.4 other OPPS APC 995.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 995.4 other OPPS APC 995.4 51 507.65 percent of total billed charges 995.4 995.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK ANGLE HIP STEM SUP-97-01285 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIA FIT SUP-97-01286 CDM C1776 HCPCS 0278 RC outpatient 4896.4 4896.4 4896.4 57 2790.95 percent of total billed charges 4896.4 93 3966.08 percent of total billed charges 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 51 2497.16 percent of total billed charges 4896.4 4896.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TECNIS LENS 450 19..5D SUP-97-01289 CDM C1780 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSL INSERT 3.5X9MM SUP-97-01290 CDM C1776 HCPCS 0278 RC outpatient 3419.25 3419.25 3419.25 57 1948.97 percent of total billed charges 3419.25 93 2769.59 percent of total billed charges 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 51 1743.82 percent of total billed charges 3419.25 3419.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIGMA TIBIAL SZ 2 8MM SUP-97-01291 CDM C1776 HCPCS 0278 RC outpatient 2907 2907 2907 57 1656.99 percent of total billed charges 2907 93 2354.67 percent of total billed charges 2907 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2907 other OPPS APC 2907 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2907 other OPPS APC 2907 51 1482.57 percent of total billed charges 2907 2907 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIGMA TIB SIZE 2 UNI-FIXED SUP-97-01292 CDM C1776 HCPCS 0278 RC outpatient 4035 4035 4035 57 2299.95 percent of total billed charges 4035 93 3268.35 percent of total billed charges 4035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4035 other OPPS APC 4035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4035 other OPPS APC 4035 51 2057.85 percent of total billed charges 4035 4035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIGMA FEMORAL SIZE 2 LM/RL SUP-97-01293 CDM C1776 HCPCS 0278 RC outpatient 6646.5 6646.5 6646.5 57 3788.51 percent of total billed charges 6646.5 93 5383.67 percent of total billed charges 6646.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6646.5 other OPPS APC 6646.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6646.5 other OPPS APC 6646.5 51 3389.72 percent of total billed charges 6646.5 6646.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 28.5D TECNIS EYHANCE SUP-97-01294 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING FULLY THREADED 5.0 X 60MM SUP-97-01295 CDM C1713 HCPCS 0278 RC outpatient 394.8 394.8 394.8 57 225.04 percent of total billed charges 394.8 93 319.79 percent of total billed charges 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 51 201.35 percent of total billed charges 394.8 394.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 65MM SUP-97-01296 CDM C1713 HCPCS 0278 RC outpatient 394.8 394.8 394.8 57 225.04 percent of total billed charges 394.8 93 319.79 percent of total billed charges 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 51 201.35 percent of total billed charges 394.8 394.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL NAIL 12 X 300MM T2 STANDARD SUP-97-01297 CDM C1713 HCPCS 0278 RC outpatient 2734.2 2734.2 2734.2 57 1558.49 percent of total billed charges 2734.2 93 2214.7 percent of total billed charges 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 51 1394.44 percent of total billed charges 2734.2 2734.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZCT400 LENS 32.0D SUP-97-01300 CDM C1780 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER NPHSTM 25CM 8FR SUP-97-01301 CDM C1729 HCPCS 0278 RC outpatient 278.39 278.39 278.39 57 158.68 percent of total billed charges 278.39 93 225.5 percent of total billed charges 278.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 278.39 other OPPS APC 278.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 278.39 other OPPS APC 278.39 51 141.98 percent of total billed charges 278.39 278.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TISSUE EXPANDERS 600CC SUP-97-01303 CDM L8699 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 3875 other OPPS APC 3875 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN SHRT THREAD 4MM X 48MM SUP-97-01304 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TIBIA 8MM CANN EX 315 MM SUP-97-01305 CDM C1713 HCPCS 0278 RC outpatient 4048.45 4048.45 4048.45 57 2307.62 percent of total billed charges 4048.45 93 3279.24 percent of total billed charges 4048.45 4048.45 other OPPS APC 4048.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4048.45 other OPPS APC 4048.45 51 2064.71 percent of total billed charges 4048.45 4048.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 MM LOCKING IM NAIL 4 SUP-97-01306 CDM C1713 HCPCS 0278 RC outpatient 748.38 748.38 748.38 57 426.58 percent of total billed charges 748.38 93 606.19 percent of total billed charges 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 51 381.67 percent of total billed charges 748.38 748.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANATOMIC PROXIMAL BODY SUP-97-01307 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POROCOAT STANDARD STEM SUP-97-01308 CDM C1776 HCPCS 0278 RC outpatient 4821.25 4821.25 4821.25 57 2748.11 percent of total billed charges 4821.25 93 3905.21 percent of total billed charges 4821.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4821.25 other OPPS APC 4821.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4821.25 other OPPS APC 4821.25 51 2458.84 percent of total billed charges 4821.25 4821.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ECCENTRIC HUMERAL HEAD SUP-97-01309 CDM C1776 HCPCS 0278 RC outpatient 3045 3045 3045 57 1735.65 percent of total billed charges 3045 93 2466.45 percent of total billed charges 3045 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3045 other OPPS APC 3045 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3045 other OPPS APC 3045 51 1552.95 percent of total billed charges 3045 3045 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.7MM 100MM SUP-97-01310 CDM 0272 RC outpatient 299.43 299.43 299.43 74 221.58 percent of total billed charges 299.43 93 242.54 percent of total billed charges 299.43 299.43 other OPPS APC 299.43 299.43 other OPPS APC 299.43 27.63 82.73 percent of total billed charges 299.43 299.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4MM VA-LCP 2-CLMN DSTLRADIUS PL7H 2H SUP-97-01311 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4MM VA-LCP 2-CLMN DSTLRADIUS PL7H 3H SUP-97-01312 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SMALL FRAGMENT 4.0 CANCELLOUS SUP-97-01313 CDM C1713 HCPCS 0278 RC outpatient 77.56 77.56 77.56 57 44.21 percent of total billed charges 77.56 93 62.82 percent of total billed charges 77.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 77.56 other OPPS APC 77.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 77.56 other OPPS APC 77.56 51 39.56 percent of total billed charges 77.56 77.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4MM VA-LCP 2-CLMN DSTLRADIUS PL6H SUP-97-01314 CDM C1713 HCPCS 0278 RC outpatient 2398.5 2398.5 2398.5 57 1367.15 percent of total billed charges 2398.5 93 1942.79 percent of total billed charges 2398.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2398.5 other OPPS APC 2398.5 2398.5 other OPPS APC 2398.5 51 1223.24 percent of total billed charges 2398.5 2398.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE HOLLOW REAMER SPARE SUP-97-01315 CDM C1713 HCPCS 0278 RC outpatient 868.77 868.77 868.77 57 495.2 percent of total billed charges 868.77 93 703.7 percent of total billed charges 868.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 868.77 other OPPS APC 868.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 868.77 other OPPS APC 868.77 51 443.07 percent of total billed charges 868.77 868.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTERIOR STABIZED CEMENTED SUP-97-01316 CDM C1776 HCPCS 0278 RC outpatient 8329.5 8329.5 8329.5 57 4747.82 percent of total billed charges 8329.5 93 6746.9 percent of total billed charges 8329.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8329.5 other OPPS APC 8329.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8329.5 other OPPS APC 8329.5 51 4248.05 percent of total billed charges 8329.5 8329.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIVERSAL STEM FLUTED SUP-97-01317 CDM C1776 HCPCS 0278 RC outpatient 4233 4233 4233 57 2412.81 percent of total billed charges 4233 93 3428.73 percent of total billed charges 4233 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4233 other OPPS APC 4233 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4233 other OPPS APC 4233 51 2158.83 percent of total billed charges 4233 4233 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTERIOR AUGMENT COMBO SUP-97-01318 CDM C1776 HCPCS 0278 RC outpatient 3438 3438 3438 57 1959.66 percent of total billed charges 3438 93 2784.78 percent of total billed charges 3438 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3438 other OPPS APC 3438 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3438 other OPPS APC 3438 51 1753.38 percent of total billed charges 3438 3438 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THIN OSTEOTOME BLADE 8MMX5 SUP-97-01319 CDM 0272 RC outpatient 948 948 948 74 701.52 percent of total billed charges 948 93 767.88 percent of total billed charges 948 948 other OPPS APC 948 948 other OPPS APC 948 27.63 261.93 percent of total billed charges 948 948 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL AUGMENT SUP-97-01320 CDM C1776 HCPCS 0278 RC outpatient 3438 3438 3438 57 1959.66 percent of total billed charges 3438 93 2784.78 percent of total billed charges 3438 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3438 other OPPS APC 3438 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3438 other OPPS APC 3438 51 1753.38 percent of total billed charges 3438 3438 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL TRAY FIXED BEADING SUP-97-01321 CDM C1776 HCPCS 0278 RC outpatient 6057 6057 6057 57 3452.49 percent of total billed charges 6057 93 4906.17 percent of total billed charges 6057 6057 other OPPS APC 6057 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6057 other OPPS APC 6057 51 3089.07 percent of total billed charges 6057 6057 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THIN OSTEOTOME BLADE 10MMX3 SUP-97-01322 CDM 0272 RC outpatient 948 948 948 74 701.52 percent of total billed charges 948 93 767.88 percent of total billed charges 948 948 other OPPS APC 948 948 other OPPS APC 948 27.63 261.93 percent of total billed charges 948 948 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT FIXED BEADING SUP-97-01323 CDM C1776 HCPCS 0278 RC outpatient 7132 7132 7132 57 4065.24 percent of total billed charges 7132 93 5776.92 percent of total billed charges 7132 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7132 other OPPS APC 7132 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7132 other OPPS APC 7132 51 3637.32 percent of total billed charges 7132 7132 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL AUGMENT SUP-97-01324 CDM C1776 HCPCS 0278 RC outpatient 3438 3438 3438 57 1959.66 percent of total billed charges 3438 93 2784.78 percent of total billed charges 3438 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3438 other OPPS APC 3438 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3438 other OPPS APC 3438 51 1753.38 percent of total billed charges 3438 3438 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HUMERAL STEM W/ POROCOAT SUP-97-01327 CDM C1776 HCPCS 0278 RC outpatient 6090 6090 6090 57 3471.3 percent of total billed charges 6090 93 4932.9 percent of total billed charges 6090 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6090 other OPPS APC 6090 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6090 other OPPS APC 6090 51 3105.9 percent of total billed charges 6090 6090 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADANTAGE HUMERAL HEAD SUP-97-01328 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KEELED GLENOID PREMIERON SIZE 40 SUP-97-01329 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMISPHERICAL SOLID BACK SHELL SUP-97-01330 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD SUP-97-01331 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT AO 4.2 X 180MM SUP-97-01332 CDM 0272 RC outpatient 407.4 407.4 407.4 74 301.48 percent of total billed charges 407.4 93 329.99 percent of total billed charges 407.4 407.4 other OPPS APC 407.4 407.4 other OPPS APC 407.4 27.63 112.56 percent of total billed charges 407.4 407.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL SUPRACONDYLAR SUP-97-01333 CDM C1713 HCPCS 0278 RC outpatient 3631.2 3631.2 3631.2 57 2069.78 percent of total billed charges 3631.2 93 2941.27 percent of total billed charges 3631.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3631.2 other OPPS APC 3631.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3631.2 other OPPS APC 3631.2 51 1851.91 percent of total billed charges 3631.2 3631.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 70MM SUP-97-01334 CDM C1713 HCPCS 0278 RC outpatient 470.4 470.4 470.4 57 268.13 percent of total billed charges 470.4 93 381.02 percent of total billed charges 470.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 470.4 other OPPS APC 470.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 470.4 other OPPS APC 470.4 51 239.9 percent of total billed charges 470.4 470.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING FULLY THREADED 5.0 X 32.5MM SUP-97-01335 CDM C1713 HCPCS 0278 RC outpatient 394.8 394.8 394.8 57 225.04 percent of total billed charges 394.8 93 319.79 percent of total billed charges 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 51 201.35 percent of total billed charges 394.8 394.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 18MM NON LOCKING SUP-97-01336 CDM C1713 HCPCS 0278 RC outpatient 264.6 264.6 264.6 57 150.82 percent of total billed charges 264.6 93 214.33 percent of total billed charges 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 51 134.95 percent of total billed charges 264.6 264.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 12MM NON LOCKING SUP-97-01337 CDM C1713 HCPCS 0278 RC outpatient 264.6 264.6 264.6 57 150.82 percent of total billed charges 264.6 93 214.33 percent of total billed charges 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 51 134.95 percent of total billed charges 264.6 264.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 2.6MM X 122MM WL70MM AO-SHAFT SUP-97-01338 CDM 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 490 other OPPS APC 490 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL LATERAL FIBULA PLATE 3HOLE SUP-97-01339 CDM C1713 HCPCS 0278 RC outpatient 1276.02 1276.02 1276.02 57 727.33 percent of total billed charges 1276.02 93 1033.58 percent of total billed charges 1276.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1276.02 other OPPS APC 1276.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1276.02 other OPPS APC 1276.02 51 650.77 percent of total billed charges 1276.02 1276.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 12MM LOCKING SUP-97-01340 CDM C1713 HCPCS 0278 RC outpatient 523.32 523.32 523.32 57 298.29 percent of total billed charges 523.32 93 423.89 percent of total billed charges 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 51 266.89 percent of total billed charges 523.32 523.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 14MM LOCKING SUP-97-01341 CDM C1713 HCPCS 0278 RC outpatient 523.32 523.32 523.32 57 298.29 percent of total billed charges 523.32 93 423.89 percent of total billed charges 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 51 266.89 percent of total billed charges 523.32 523.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 16MM LOCKING SUP-97-01342 CDM C1713 HCPCS 0278 RC outpatient 523.32 523.32 523.32 57 298.29 percent of total billed charges 523.32 93 423.89 percent of total billed charges 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 51 266.89 percent of total billed charges 523.32 523.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM PERIPROS LOCKING SUP-97-01345 CDM C1713 HCPCS 0278 RC outpatient 870.9 870.9 870.9 57 496.41 percent of total billed charges 870.9 93 705.43 percent of total billed charges 870.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870.9 other OPPS APC 870.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870.9 other OPPS APC 870.9 51 444.16 percent of total billed charges 870.9 870.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANN TROCH FIX 11MM 130 420 SUP-97-01346 CDM C1713 HCPCS 0278 RC outpatient 4949.48 4949.48 4949.48 57 2821.2 percent of total billed charges 4949.48 93 4009.08 percent of total billed charges 4949.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4949.48 other OPPS APC 4949.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4949.48 other OPPS APC 4949.48 51 2524.23 percent of total billed charges 4949.48 4949.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 3.5 X 30MM SUP-97-01347 CDM C1713 HCPCS 0278 RC outpatient 106.2 106.2 106.2 57 60.53 percent of total billed charges 106.2 93 86.02 percent of total billed charges 106.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.2 other OPPS APC 106.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.2 other OPPS APC 106.2 51 54.16 percent of total billed charges 106.2 106.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 3.5 X 38MM SUP-97-01348 CDM C1713 HCPCS 0278 RC outpatient 94.28 94.28 94.28 57 53.74 percent of total billed charges 94.28 93 76.37 percent of total billed charges 94.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 94.28 other OPPS APC 94.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 94.28 other OPPS APC 94.28 51 48.08 percent of total billed charges 94.28 94.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PT 4.0X 70 SUP-97-01352 CDM C1713 HCPCS 0278 RC outpatient 165 165 165 57 94.05 percent of total billed charges 165 93 133.65 percent of total billed charges 165 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165 other OPPS APC 165 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165 other OPPS APC 165 51 84.15 percent of total billed charges 165 165 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX NON LOCKING 3.5MM X 30MM SUP-97-01353 CDM C1713 HCPCS 0278 RC outpatient 97.28 97.28 97.28 57 55.45 percent of total billed charges 97.28 93 78.8 percent of total billed charges 97.28 97.28 other OPPS APC 97.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.28 other OPPS APC 97.28 51 49.61 percent of total billed charges 97.28 97.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.1 X 328 SUP-97-01354 CDM 0272 RC outpatient 587.09 587.09 587.09 74 434.45 percent of total billed charges 587.09 93 475.54 percent of total billed charges 587.09 587.09 other OPPS APC 587.09 587.09 other OPPS APC 587.09 27.63 162.21 percent of total billed charges 587.09 587.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 60MM SUP-97-01355 CDM C1713 HCPCS 0278 RC outpatient 412.3 412.3 412.3 57 235.01 percent of total billed charges 412.3 93 333.96 percent of total billed charges 412.3 412.3 other OPPS APC 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 51 210.27 percent of total billed charges 412.3 412.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW FT 4.0X70 SUP-97-01356 CDM C1713 HCPCS 0278 RC outpatient 106.4 106.4 106.4 57 60.65 percent of total billed charges 106.4 93 86.18 percent of total billed charges 106.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.4 other OPPS APC 106.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.4 other OPPS APC 106.4 51 54.26 percent of total billed charges 106.4 106.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 85MM SUP-97-01357 CDM C1713 HCPCS 0278 RC outpatient 412.3 412.3 412.3 57 235.01 percent of total billed charges 412.3 93 333.96 percent of total billed charges 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 51 210.27 percent of total billed charges 412.3 412.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW FT 4.0X55 SUP-97-01358 CDM C1713 HCPCS 0278 RC outpatient 165 165 165 57 94.05 percent of total billed charges 165 93 133.65 percent of total billed charges 165 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165 other OPPS APC 165 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165 other OPPS APC 165 51 84.15 percent of total billed charges 165 165 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 28MM SUP-97-01359 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 30MM SUP-97-01360 CDM C1713 HCPCS 0278 RC outpatient 412.3 412.3 412.3 57 235.01 percent of total billed charges 412.3 93 333.96 percent of total billed charges 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 51 210.27 percent of total billed charges 412.3 412.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 80MM SUP-97-01361 CDM C1713 HCPCS 0278 RC outpatient 412.3 412.3 412.3 57 235.01 percent of total billed charges 412.3 93 333.96 percent of total billed charges 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 51 210.27 percent of total billed charges 412.3 412.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE TIBIAL PROXIMAL LATERAL 8 HOLE LEFT SUP-97-01362 CDM C1713 HCPCS 0278 RC outpatient 3178.7 3178.7 3178.7 57 1811.86 percent of total billed charges 3178.7 93 2574.75 percent of total billed charges 3178.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3178.7 other OPPS APC 3178.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3178.7 other OPPS APC 3178.7 51 1621.14 percent of total billed charges 3178.7 3178.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE FIXATION SUP-97-01363 CDM C1713 HCPCS 0278 RC outpatient 341.25 341.25 341.25 57 194.51 percent of total billed charges 341.25 93 276.41 percent of total billed charges 341.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 341.25 other OPPS APC 341.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 341.25 other OPPS APC 341.25 51 174.04 percent of total billed charges 341.25 341.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL NAIL 10 X 360MM T2 STANDARD SUP-97-01364 CDM C1713 HCPCS 0278 RC outpatient 2734.2 2734.2 2734.2 57 1558.49 percent of total billed charges 2734.2 93 2214.7 percent of total billed charges 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 2734.2 other OPPS APC 2734.2 51 1394.44 percent of total billed charges 2734.2 2734.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE HOLDER SUP-97-01365 CDM 0272 RC outpatient 2367 2367 2367 74 1751.58 percent of total billed charges 2367 93 1917.27 percent of total billed charges 2367 2367 other OPPS APC 2367 2367 other OPPS APC 2367 27.63 654 percent of total billed charges 2367 2367 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK ANGLE HIP STEM SUP-97-01366 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZCT400 LENS 32.5D SUP-97-01367 CDM C1780 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR PS 4/LT SUP-97-01368 CDM C1776 HCPCS 0278 RC outpatient 9665.23 9665.23 9665.23 57 5509.18 percent of total billed charges 9665.23 93 7828.84 percent of total billed charges 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 51 4929.27 percent of total billed charges 9665.23 9665.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIA FIT 4F/3T SUP-97-01369 CDM C1776 HCPCS 0278 RC outpatient 5522.5 5522.5 5522.5 57 3147.83 percent of total billed charges 5522.5 93 4473.23 percent of total billed charges 5522.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5522.5 other OPPS APC 5522.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5522.5 other OPPS APC 5522.5 51 2816.48 percent of total billed charges 5522.5 5522.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSL INSERT 4X9MM SUP-97-01370 CDM C1776 HCPCS 0278 RC outpatient 3419.25 3419.25 3419.25 57 1948.97 percent of total billed charges 3419.25 93 2769.59 percent of total billed charges 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 51 1743.82 percent of total billed charges 3419.25 3419.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN TIBIAL AUGMENT BLOCK 5MM SIZE 4 SUP-97-01371 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEXGEN LPS FLEX FIXED PROLONG EF3-4,17M" SUP-97-01372 CDM C1776 HCPCS 0278 RC outpatient 4106.25 4106.25 4106.25 57 2340.56 percent of total billed charges 4106.25 93 3326.06 percent of total billed charges 4106.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4106.25 other OPPS APC 4106.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4106.25 other OPPS APC 4106.25 51 2094.19 percent of total billed charges 4106.25 4106.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER BLADEPATELLA W/ PILOT HOLE SZ35 SUP-97-01373 CDM 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK ART SURF EF 3-4/YELLOW 14MM SUP-97-01374 CDM C1776 HCPCS 0278 RC outpatient 5212.5 5212.5 5212.5 57 2971.13 percent of total billed charges 5212.5 93 4222.13 percent of total billed charges 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 51 2658.38 percent of total billed charges 5212.5 5212.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVARREST PATCH 4 X 2 SUP-97-01375 CDM 0272 RC outpatient 2325 2325 2325 74 1720.5 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 2325 other OPPS APC 2325 2325 other OPPS APC 2325 27.63 642.4 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 12.0D TECNIS EYHANCE SUP-97-01381 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 11.5D TECNIS EYHANCE SUP-97-01382 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN SHRT THREAD 4MM X 38MM SUP-97-01383 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN SHRT THREAD 4MM X 42MM SUP-97-01384 CDM C1713 HCPCS 0278 RC outpatient 659.75 659.75 659.75 57 376.06 percent of total billed charges 659.75 93 534.4 percent of total billed charges 659.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 659.75 other OPPS APC 659.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 659.75 other OPPS APC 659.75 51 336.47 percent of total billed charges 659.75 659.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK ANGLE HIP STEM SZ 6 SUP-97-01385 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD SUP-97-01386 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK ANGLE HIP STEM SUP-97-01387 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK FACE DISPOSABLE SUP-97-01389 CDM 0271 RC outpatient 134.36 134.36 134.36 74 99.43 percent of total billed charges 134.36 93 108.83 percent of total billed charges 134.36 134.36 other OPPS APC 134.36 134.36 other OPPS APC 134.36 27.63 37.12 percent of total billed charges 134.36 134.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SWITCH DRAPE TENET 7633 SUP-97-01390 CDM 0272 RC outpatient 151.2 151.2 151.2 74 111.89 percent of total billed charges 151.2 93 122.47 percent of total billed charges 151.2 151.2 other OPPS APC 151.2 151.2 other OPPS APC 151.2 27.63 41.78 percent of total billed charges 151.2 151.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTERIOR STABLIZER FEMORAL LEFT SUP-97-01394 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIVERSAL TIBUAL BASEPLATE TOTAL KNEE SUP-97-01395 CDM C1776 HCPCS 0278 RC outpatient 3125 3125 3125 57 1781.25 percent of total billed charges 3125 93 2531.25 percent of total billed charges 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 51 1593.75 percent of total billed charges 3125 3125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYMMETRIC PATELLA 10MM X35 SUP-97-01396 CDM C1776 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BEARING INSERT-PS 16MM SUP-97-01397 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BEARING INSERT-PS 11MM SUP-97-01398 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMART TOE SUP-97-01399 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMART TOE SUP-97-01400 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK ART SURF G 7-10/BLUE 10MM SUP-97-01401 CDM C1776 HCPCS 0278 RC outpatient 5212.5 5212.5 5212.5 57 2971.13 percent of total billed charges 5212.5 93 4222.13 percent of total billed charges 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 51 2658.38 percent of total billed charges 5212.5 5212.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 LOCKING 24MM SUP-97-01404 CDM C1713 HCPCS 0278 RC outpatient 532.77 532.77 532.77 57 303.68 percent of total billed charges 532.77 93 431.54 percent of total billed charges 532.77 532.77 other OPPS APC 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 51 271.71 percent of total billed charges 532.77 532.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUPPIES FLUID DIAMOND SUP-97-01405 CDM 0271 RC outpatient 72 72 72 74 53.28 percent of total billed charges 72 93 58.32 percent of total billed charges 72 72 other OPPS APC 72 72 other OPPS APC 72 27.63 19.89 percent of total billed charges 72 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD SUP-97-01411 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLAR COMPONENT SUP-97-01412 CDM C1776 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMISPHERICAL SOLID BACK SHELL SUP-97-01413 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER CEMENTLESS SUP-97-01414 CDM C1776 HCPCS 0278 RC outpatient 2325 2325 2325 57 1325.25 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 51 1185.75 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD SUP-97-01415 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT FOR MDM LINER SUP-97-01416 CDM C1776 HCPCS 0278 RC outpatient 2325 2325 2325 57 1325.25 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 51 1185.75 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 18.5D TECNIS EYHANCE SUP-97-01417 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT PERCUFLEX 4.8FR X 20 SUP-97-01422 CDM C2625 HCPCS 0272 RC outpatient 370.06 370.06 370.06 74 273.84 percent of total billed charges 370.06 93 299.75 percent of total billed charges 370.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 370.06 other OPPS APC 370.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 370.06 other OPPS APC 370.06 27.63 102.25 percent of total billed charges 370.06 370.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 3.5 X 50MM SUP-97-01427 CDM C1713 HCPCS 0278 RC outpatient 83.4 83.4 83.4 57 47.54 percent of total billed charges 83.4 93 67.55 percent of total billed charges 83.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 83.4 other OPPS APC 83.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 83.4 other OPPS APC 83.4 51 42.53 percent of total billed charges 83.4 83.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 26.5D TECNIS EYHANCE SUP-97-01428 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 1.9MM WL50MM AO-SHAFT SUP-97-01429 CDM 0272 RC outpatient 381.64 381.64 381.64 74 282.41 percent of total billed charges 381.64 93 309.13 percent of total billed charges 381.64 381.64 other OPPS APC 381.64 381.64 other OPPS APC 381.64 27.63 105.45 percent of total billed charges 381.64 381.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 2.6MM WL50MM AO-SHAFT SUP-97-01430 CDM 0272 RC outpatient 381.64 381.64 381.64 74 282.41 percent of total billed charges 381.64 93 309.13 percent of total billed charges 381.64 381.64 other OPPS APC 381.64 381.64 other OPPS APC 381.64 27.63 105.45 percent of total billed charges 381.64 381.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE, T10, 2.7X12MM" SUP-97-01431 CDM C1713 HCPCS 0278 RC outpatient 236.6 236.6 236.6 57 134.86 percent of total billed charges 236.6 93 191.65 percent of total billed charges 236.6 236.6 other OPPS APC 236.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.6 other OPPS APC 236.6 51 120.67 percent of total billed charges 236.6 236.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE TROCAR POINT 2MM X 150MM PK/10 SUP-97-01432 CDM C1713 HCPCS 0278 RC outpatient 58.8 58.8 58.8 57 33.52 percent of total billed charges 58.8 93 47.63 percent of total billed charges 58.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 58.8 other OPPS APC 58.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 58.8 other OPPS APC 58.8 51 29.99 percent of total billed charges 58.8 58.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE, T10, 2.7X16MM" SUP-97-01433 CDM C1713 HCPCS 0278 RC outpatient 236.6 236.6 236.6 57 134.86 percent of total billed charges 236.6 93 191.65 percent of total billed charges 236.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.6 other OPPS APC 236.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.6 other OPPS APC 236.6 51 120.67 percent of total billed charges 236.6 236.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE, T10, 2.7X14MM" SUP-97-01434 CDM C1713 HCPCS 0278 RC outpatient 236.6 236.6 236.6 57 134.86 percent of total billed charges 236.6 93 191.65 percent of total billed charges 236.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.6 other OPPS APC 236.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.6 other OPPS APC 236.6 51 120.67 percent of total billed charges 236.6 236.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE, T10, 2.7X10MM" SUP-97-01435 CDM C1713 HCPCS 0278 RC outpatient 236.6 236.6 236.6 57 134.86 percent of total billed charges 236.6 93 191.65 percent of total billed charges 236.6 236.6 other OPPS APC 236.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.6 other OPPS APC 236.6 51 120.67 percent of total billed charges 236.6 236.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW LOCKING, T10, 2.7X10MM" SUP-97-01436 CDM C1713 HCPCS 0278 RC outpatient 455 455 455 57 259.35 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 51 232.05 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAVICAL 7 HOLE / LEFT SUP-97-01437 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK ANGLE HIP STEM SUP-97-01438 CDM C1776 HCPCS 0278 RC outpatient 7500 7500 7500 57 4275 percent of total billed charges 7500 93 6075 percent of total billed charges 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 51 3825 percent of total billed charges 7500 7500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMISPHERICAL CLUSTER HOLE SHELL SUP-97-01439 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR PS 6/LT SUP-97-01441 CDM C1776 HCPCS 0278 RC outpatient 9665.23 9665.23 9665.23 57 5509.18 percent of total billed charges 9665.23 93 7828.84 percent of total billed charges 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 51 4929.27 percent of total billed charges 9665.23 9665.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIA FIT 6F/5T SUP-97-01442 CDM C1776 HCPCS 0278 RC outpatient 4896.4 4896.4 4896.4 57 2790.95 percent of total billed charges 4896.4 93 3966.08 percent of total billed charges 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 51 2497.16 percent of total billed charges 4896.4 4896.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSL INSERT 6X11MM SUP-97-01443 CDM C1776 HCPCS 0278 RC outpatient 3419.25 3419.25 3419.25 57 1948.97 percent of total billed charges 3419.25 93 2769.59 percent of total billed charges 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 51 1743.82 percent of total billed charges 3419.25 3419.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THIN OSTEOTOME BLADE 8MMX3 SUP-97-01444 CDM 0272 RC outpatient 948 948 948 74 701.52 percent of total billed charges 948 93 767.88 percent of total billed charges 948 948 other OPPS APC 948 948 other OPPS APC 948 27.63 261.93 percent of total billed charges 948 948 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING CORTSCREW 2.7X18MM SUP-97-01447 CDM C1713 HCPCS 0278 RC outpatient 1068 1068 1068 57 608.76 percent of total billed charges 1068 93 865.08 percent of total billed charges 1068 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1068 other OPPS APC 1068 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1068 other OPPS APC 1068 51 544.68 percent of total billed charges 1068 1068 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING CORTSCREW 2.7X20MM SUP-97-01448 CDM C1713 HCPCS 0278 RC outpatient 1068 1068 1068 57 608.76 percent of total billed charges 1068 93 865.08 percent of total billed charges 1068 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1068 other OPPS APC 1068 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1068 other OPPS APC 1068 51 544.68 percent of total billed charges 1068 1068 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING CORTSCREW MM SUP-97-01449 CDM C1713 HCPCS 0278 RC outpatient 1068 1068 1068 57 608.76 percent of total billed charges 1068 93 865.08 percent of total billed charges 1068 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1068 other OPPS APC 1068 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1068 other OPPS APC 1068 51 544.68 percent of total billed charges 1068 1068 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN LONG THREAD 4MM X 42MM SUP-97-01450 CDM C1713 HCPCS 0278 RC outpatient 676.76 676.76 676.76 57 385.75 percent of total billed charges 676.76 93 548.18 percent of total billed charges 676.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 676.76 other OPPS APC 676.76 676.76 other OPPS APC 676.76 51 345.15 percent of total billed charges 676.76 676.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAW II 3 HOLE T PLATE 25MM SUP-97-01451 CDM C1713 HCPCS 0278 RC outpatient 6287.5 6287.5 6287.5 57 3583.88 percent of total billed charges 6287.5 93 5092.88 percent of total billed charges 6287.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6287.5 other OPPS APC 6287.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6287.5 other OPPS APC 6287.5 51 3206.63 percent of total billed charges 6287.5 6287.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAW II 3 DRILL BIT 2.0MM SUP-97-01452 CDM outpatient 795 795 795 795 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REF XLPE 36 0DEG 58-60 SZ G SUP-97-01453 CDM C1776 HCPCS 0278 RC outpatient 8570 8570 8570 57 4884.9 percent of total billed charges 8570 93 6941.7 percent of total billed charges 8570 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8570 other OPPS APC 8570 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8570 other OPPS APC 8570 51 4370.7 percent of total billed charges 8570 8570 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REF XLPE 36 20DEG 58-60 G SUP-97-01454 CDM C1776 HCPCS 0278 RC outpatient 8570 8570 8570 57 4884.9 percent of total billed charges 8570 93 6941.7 percent of total billed charges 8570 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8570 other OPPS APC 8570 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8570 other OPPS APC 8570 51 4370.7 percent of total billed charges 8570 8570 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OXINIUM FEM HD 12/14 36MM+0 SUP-97-01455 CDM C1776 HCPCS 0278 RC outpatient 9825 9825 9825 57 5600.25 percent of total billed charges 9825 93 7958.25 percent of total billed charges 9825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9825 other OPPS APC 9825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9825 other OPPS APC 9825 51 5010.75 percent of total billed charges 9825 9825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIS HEADED SCREW 48MM SUP-97-01456 CDM C1776 HCPCS 0278 RC outpatient 306.25 306.25 306.25 57 174.56 percent of total billed charges 306.25 93 248.06 percent of total billed charges 306.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 306.25 other OPPS APC 306.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 306.25 other OPPS APC 306.25 51 156.19 percent of total billed charges 306.25 306.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TENO SCREWBIO COMP 4.75X15 SUP-97-01457 CDM C1713 HCPCS 0278 RC outpatient 1035 1035 1035 57 589.95 percent of total billed charges 1035 93 838.35 percent of total billed charges 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 51 527.85 percent of total billed charges 1035 1035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIS INSTR KIT FOR TENO SCREW SUP-97-01458 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBALANCE UKA TIBIAL BEARING SZ 4 8MM SUP-97-01459 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBALANCE UKA TIBIAL TRAY S Z 4RT SUP-97-01460 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBALANCE UKA FEM CEMENTED SIZ 6R SUP-97-01461 CDM C1776 HCPCS 0278 RC outpatient 7500 7500 7500 57 4275 percent of total billed charges 7500 93 6075 percent of total billed charges 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 51 3825 percent of total billed charges 7500 7500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTR ANCH MINI BC S-TAK 2.4X8.5MM SUP-97-01463 CDM C1713 HCPCS 0278 RC outpatient 1395 1395 1395 57 795.15 percent of total billed charges 1395 93 1129.95 percent of total billed charges 1395 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1395 other OPPS APC 1395 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1395 other OPPS APC 1395 51 711.45 percent of total billed charges 1395 1395 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUICKFIX SCREW 2X12MM SUP-97-01464 CDM C1713 HCPCS 0278 RC outpatient 720 720 720 57 410.4 percent of total billed charges 720 93 583.2 percent of total billed charges 720 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 720 other OPPS APC 720 720 other OPPS APC 720 51 367.2 percent of total billed charges 720 720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. G-WIRE W/TRCR TIP0.045X5.91 SUP-97-01465 CDM C1713 HCPCS 0278 RC outpatient 60 60 60 57 34.2 percent of total billed charges 60 93 48.6 percent of total billed charges 60 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 60 other OPPS APC 60 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 60 other OPPS APC 60 51 30.6 percent of total billed charges 60 60 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANN TROCH FIX 11MM RIGHT 130 420 SUP-97-01467 CDM C1713 HCPCS 0278 RC outpatient 4949.48 4949.48 4949.48 57 2821.2 percent of total billed charges 4949.48 93 4009.08 percent of total billed charges 4949.48 4949.48 other OPPS APC 4949.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4949.48 other OPPS APC 4949.48 51 2524.23 percent of total billed charges 4949.48 4949.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 5 SUP-97-01468 CDM C1713 HCPCS 0278 RC outpatient 770.82 770.82 770.82 57 439.37 percent of total billed charges 770.82 93 624.36 percent of total billed charges 770.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 770.82 other OPPS APC 770.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 770.82 other OPPS APC 770.82 51 393.12 percent of total billed charges 770.82 770.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 MM LOCKING IM NAIL 4 SUP-97-01469 CDM C1713 HCPCS 0278 RC outpatient 748.38 748.38 748.38 57 426.58 percent of total billed charges 748.38 93 606.19 percent of total billed charges 748.38 748.38 other OPPS APC 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 51 381.67 percent of total billed charges 748.38 748.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 MM LOCKING IM NAIL 5 SUP-97-01470 CDM C1713 HCPCS 0278 RC outpatient 748.38 748.38 748.38 57 426.58 percent of total billed charges 748.38 93 606.19 percent of total billed charges 748.38 748.38 other OPPS APC 748.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.38 other OPPS APC 748.38 51 381.67 percent of total billed charges 748.38 748.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TI END CAP FOR TIBIAL-EX T40 STRDR SUP-97-01471 CDM C1713 HCPCS 0278 RC outpatient 866.01 866.01 866.01 57 493.63 percent of total billed charges 866.01 93 701.47 percent of total billed charges 866.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 866.01 other OPPS APC 866.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 866.01 other OPPS APC 866.01 51 441.67 percent of total billed charges 866.01 866.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANN TROCH FIX 10MM 130 360 SUP-97-01472 CDM C1713 HCPCS 0278 RC outpatient 5272.78 5272.78 5272.78 57 3005.48 percent of total billed charges 5272.78 93 4270.95 percent of total billed charges 5272.78 5272.78 other OPPS APC 5272.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5272.78 other OPPS APC 5272.78 51 2689.12 percent of total billed charges 5272.78 5272.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANN TROCH FIX 10MM 130 400 SUP-97-01473 CDM C1713 HCPCS 0278 RC outpatient 5272.78 5272.78 5272.78 57 3005.48 percent of total billed charges 5272.78 93 4270.95 percent of total billed charges 5272.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5272.78 other OPPS APC 5272.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5272.78 other OPPS APC 5272.78 51 2689.12 percent of total billed charges 5272.78 5272.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TECNIS LENS 17.5D SUP-97-01475 CDM C1780 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD SUP-97-01476 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POLYETHYLENE INSERT SUP-97-01477 CDM C1776 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BEARING INSERT-PS 11MM SUP-97-01478 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL F 1.2MM SCREW WL 22MM AO QUICK SUP-97-01479 CDM C1713 HCPCS 0278 RC outpatient 359.31 359.31 359.31 57 204.81 percent of total billed charges 359.31 93 291.04 percent of total billed charges 359.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 359.31 other OPPS APC 359.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 359.31 other OPPS APC 359.31 51 183.25 percent of total billed charges 359.31 359.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TWIST DRILL 1.9 DIA AO SUP-97-01480 CDM 0272 RC outpatient 372.75 372.75 372.75 74 275.84 percent of total billed charges 372.75 93 301.93 percent of total billed charges 372.75 372.75 other OPPS APC 372.75 372.75 other OPPS APC 372.75 27.63 102.99 percent of total billed charges 372.75 372.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TWIST DRILL 1.4MM DIA AO SUP-97-01481 CDM 0272 RC outpatient 372.75 372.75 372.75 74 275.84 percent of total billed charges 372.75 93 301.93 percent of total billed charges 372.75 372.75 other OPPS APC 372.75 372.75 other OPPS APC 372.75 27.63 102.99 percent of total billed charges 372.75 372.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1.2 X 12MM CROSSPIN LEFT SUP-97-01482 CDM C1713 HCPCS 0278 RC outpatient 236.6 236.6 236.6 57 134.86 percent of total billed charges 236.6 93 191.65 percent of total billed charges 236.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.6 other OPPS APC 236.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.6 other OPPS APC 236.6 51 120.67 percent of total billed charges 236.6 236.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NON LOK CRSSPIN ST 2.3 X 11MM SUP-97-01483 CDM C1713 HCPCS 0278 RC outpatient 236.6 236.6 236.6 57 134.86 percent of total billed charges 236.6 93 191.65 percent of total billed charges 236.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.6 other OPPS APC 236.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.6 other OPPS APC 236.6 51 120.67 percent of total billed charges 236.6 236.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NON LOK CRSSPIN ST 2.3 X 13MM SUP-97-01484 CDM C1713 HCPCS 0278 RC outpatient 263.13 263.13 263.13 57 149.98 percent of total billed charges 263.13 93 213.14 percent of total billed charges 263.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 263.13 other OPPS APC 263.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 263.13 other OPPS APC 263.13 51 134.2 percent of total billed charges 263.13 263.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 2.3 X 14MM CROSSPIN ST SUP-97-01485 CDM C1713 HCPCS 0278 RC outpatient 236.6 236.6 236.6 57 134.86 percent of total billed charges 236.6 93 191.65 percent of total billed charges 236.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.6 other OPPS APC 236.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.6 other OPPS APC 236.6 51 120.67 percent of total billed charges 236.6 236.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NON LOK CRSSPIN ST 2.3 X 15MM SUP-97-01486 CDM C1713 HCPCS 0278 RC outpatient 236.6 236.6 236.6 57 134.86 percent of total billed charges 236.6 93 191.65 percent of total billed charges 236.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.6 other OPPS APC 236.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.6 other OPPS APC 236.6 51 120.67 percent of total billed charges 236.6 236.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NON LOK CRSSPIN ST 2.3 X 12MM SUP-97-01487 CDM C1713 HCPCS 0278 RC outpatient 263.13 263.13 263.13 57 149.98 percent of total billed charges 263.13 93 213.14 percent of total billed charges 263.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 263.13 other OPPS APC 263.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 263.13 other OPPS APC 263.13 51 134.2 percent of total billed charges 263.13 263.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1.2 X 9MM CROSSPIN LEFT SUP-97-01488 CDM C1713 HCPCS 0278 RC outpatient 236.6 236.6 236.6 57 134.86 percent of total billed charges 236.6 93 191.65 percent of total billed charges 236.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.6 other OPPS APC 236.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.6 other OPPS APC 236.6 51 120.67 percent of total billed charges 236.6 236.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1.2 X 10MM CROSSPIN LEFT SUP-97-01489 CDM C1713 HCPCS 0278 RC outpatient 236.6 236.6 236.6 57 134.86 percent of total billed charges 236.6 93 191.65 percent of total billed charges 236.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.6 other OPPS APC 236.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.6 other OPPS APC 236.6 51 120.67 percent of total billed charges 236.6 236.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Z-PLATE PROFYL/M 2.3M HAND LCK NRW 13H SUP-97-01490 CDM C1713 HCPCS 0278 RC outpatient 1053 1053 1053 57 600.21 percent of total billed charges 1053 93 852.93 percent of total billed charges 1053 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1053 other OPPS APC 1053 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1053 other OPPS APC 1053 51 537.03 percent of total billed charges 1053 1053 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCKG CRSSPIN ST 2.3 X 13MM SUP-97-01491 CDM C1713 HCPCS 0278 RC outpatient 273 273 273 57 155.61 percent of total billed charges 273 93 221.13 percent of total billed charges 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 273 51 139.23 percent of total billed charges 273 273 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROFYLE/M 2.3 HND LCK STRGT 16H SUP-97-01492 CDM C1713 HCPCS 0278 RC outpatient 1053 1053 1053 57 600.21 percent of total billed charges 1053 93 852.93 percent of total billed charges 1053 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1053 other OPPS APC 1053 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1053 other OPPS APC 1053 51 537.03 percent of total billed charges 1053 1053 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASKUMM SPRAY BUBBLE GUM SUP-97-01496 CDM 0271 RC outpatient 488.25 488.25 488.25 74 361.31 percent of total billed charges 488.25 93 395.48 percent of total billed charges 488.25 488.25 other OPPS APC 488.25 488.25 other OPPS APC 488.25 27.63 134.9 percent of total billed charges 488.25 488.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LO-PRO TMSS 3.5 X 28MM CORT SUP-97-01498 CDM C1713 HCPCS 0278 RC outpatient 140 140 140 57 79.8 percent of total billed charges 140 93 113.4 percent of total billed charges 140 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 140 other OPPS APC 140 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 140 other OPPS APC 140 51 71.4 percent of total billed charges 140 140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LO-PRO LOCK SS 3.5 X 28MM SUP-97-01501 CDM C1713 HCPCS 0278 RC outpatient 402.5 402.5 402.5 57 229.43 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 51 205.28 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LO-PRO LOCK SS 3.5 X 30MM SUP-97-01502 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LO-PRO LOCK SS 3.5 X 34MM SUP-97-01503 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LO-PRO LOCK SS 4.0X 30MM CANCL SUP-97-01504 CDM C1713 HCPCS 0278 RC outpatient 200 200 200 57 114 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 51 102 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LO-PRO T 4.5 X 38MM CANN PT THD SUP-97-01505 CDM C1713 HCPCS 0278 RC outpatient 750 750 750 57 427.5 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 51 382.5 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LO-PRO T 16.7 X 80MM CANN 18 THD SUP-97-01506 CDM C1713 HCPCS 0278 RC outpatient 1074 1074 1074 57 612.18 percent of total billed charges 1074 93 869.94 percent of total billed charges 1074 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1074 other OPPS APC 1074 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1074 other OPPS APC 1074 51 547.74 percent of total billed charges 1074 1074 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE G W/TRCR TIP .094X8 SUP-97-01507 CDM 0272 RC outpatient 60 60 60 74 44.4 percent of total billed charges 60 93 48.6 percent of total billed charges 60 60 other OPPS APC 60 60 other OPPS APC 60 27.63 16.58 percent of total billed charges 60 60 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE G W/TRCR THRDED TIP .062 SUP-97-01508 CDM 0272 RC outpatient 126 126 126 74 93.24 percent of total billed charges 126 93 102.06 percent of total billed charges 126 126 other OPPS APC 126 126 other OPPS APC 126 27.63 34.81 percent of total billed charges 126 126 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZCT 225 22..0D SUP-97-01510 CDM C1840 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENTED HIP STEM SIZE4 SUP-97-01511 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT ROTATING PLATFORM SUP-97-01512 CDM C1776 HCPCS 0278 RC outpatient 5568 5568 5568 57 3173.76 percent of total billed charges 5568 93 4510.08 percent of total billed charges 5568 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5568 other OPPS APC 5568 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5568 other OPPS APC 5568 51 2839.68 percent of total billed charges 5568 5568 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROLINE SCISSOR REUSABLE SUP-97-01516 CDM 0272 RC outpatient 945 945 945 74 699.3 percent of total billed charges 945 93 765.45 percent of total billed charges 945 945 other OPPS APC 945 945 other OPPS APC 945 27.63 261.1 percent of total billed charges 945 945 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZCT300 LENS 17.0D SUP-97-01517 CDM C1780 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 16.0D SUP-97-01521 CDM C1780 HCPCS 0278 RC outpatient 402.5 402.5 402.5 57 229.43 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 51 205.28 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEX DRILL SUP-97-01522 CDM outpatient 1202.64 1202.64 1202.64 1202.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS ZKBOO 22.0D SUP-97-01523 CDM C1780 HCPCS 0278 RC outpatient 2685 2685 2685 57 1530.45 percent of total billed charges 2685 93 2174.85 percent of total billed charges 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 51 1369.35 percent of total billed charges 2685 2685 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLASH SHIELD SET SUP-97-01524 CDM 0272 RC outpatient 539 539 539 74 398.86 percent of total billed charges 539 93 436.59 percent of total billed charges 539 539 other OPPS APC 539 539 other OPPS APC 539 27.63 148.93 percent of total billed charges 539 539 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4MM VA-LCP 2-CLMN DSTLRADIUS PL 6H HD SUP-97-01525 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4MM 2.7MM VA- LOCK MESH PLATE 5/12HOL SUP-97-01526 CDM C1713 HCPCS 0278 RC outpatient 4409.28 4409.28 4409.28 57 2513.29 percent of total billed charges 4409.28 93 3571.52 percent of total billed charges 4409.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4409.28 other OPPS APC 4409.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4409.28 other OPPS APC 4409.28 51 2248.73 percent of total billed charges 4409.28 4409.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TI CANN RETRO/ANTE FEMORAL 10X360MM SUP-97-01531 CDM C1713 HCPCS 0278 RC outpatient 4807.03 4807.03 4807.03 57 2740.01 percent of total billed charges 4807.03 93 3893.69 percent of total billed charges 4807.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4807.03 other OPPS APC 4807.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4807.03 other OPPS APC 4807.03 51 2451.59 percent of total billed charges 4807.03 4807.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE STIMUPLEX 22G X 3 1/8 SUP-97-01535 CDM 0272 RC outpatient 852.63 852.63 852.63 74 630.95 percent of total billed charges 852.63 93 690.63 percent of total billed charges 852.63 852.63 other OPPS APC 852.63 852.63 other OPPS APC 852.63 27.63 235.58 percent of total billed charges 852.63 852.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZCT 600 9.5D SUP-97-01536 CDM C1840 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZCT 225 24.00 SUP-97-01537 CDM C1840 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.2MM SUP-97-01540 CDM 0272 RC outpatient 277.41 277.41 277.41 74 205.28 percent of total billed charges 277.41 93 224.7 percent of total billed charges 277.41 277.41 other OPPS APC 277.41 277.41 other OPPS APC 277.41 27.63 76.65 percent of total billed charges 277.41 277.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 4.3MM SUP-97-01541 CDM 0272 RC outpatient 478.91 478.91 478.91 74 354.39 percent of total billed charges 478.91 93 387.92 percent of total billed charges 478.91 478.91 other OPPS APC 478.91 478.91 other OPPS APC 478.91 27.63 132.32 percent of total billed charges 478.91 478.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE THREADED SUP-97-01542 CDM C1713 HCPCS 0278 RC outpatient 168.52 168.52 168.52 57 96.06 percent of total billed charges 168.52 93 136.5 percent of total billed charges 168.52 168.52 other OPPS APC 168.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168.52 other OPPS APC 168.52 51 85.95 percent of total billed charges 168.52 168.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSL INSERT 4X13MM SUP-97-01543 CDM C1776 HCPCS 0278 RC outpatient 3856.25 3856.25 3856.25 57 2198.06 percent of total billed charges 3856.25 93 3123.56 percent of total billed charges 3856.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3856.25 other OPPS APC 3856.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3856.25 other OPPS APC 3856.25 51 1966.69 percent of total billed charges 3856.25 3856.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEARING POSTERIOR STABILIZED 6MM SUP-97-01544 CDM C1776 HCPCS 0278 RC outpatient 8035 8035 8035 57 4579.95 percent of total billed charges 8035 93 6508.35 percent of total billed charges 8035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8035 other OPPS APC 8035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8035 other OPPS APC 8035 51 4097.85 percent of total billed charges 8035 8035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 22.0D ACRYSOF IQ ASPHERIC SUP-97-01546 CDM C1780 HCPCS 0278 RC outpatient 1282.5 1282.5 1282.5 57 731.03 percent of total billed charges 1282.5 93 1038.83 percent of total billed charges 1282.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1282.5 other OPPS APC 1282.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1282.5 other OPPS APC 1282.5 51 654.08 percent of total billed charges 1282.5 1282.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS ZKBOO 21.0D SUP-97-01549 CDM C1780 HCPCS 0278 RC outpatient 2685 2685 2685 57 1530.45 percent of total billed charges 2685 93 2174.85 percent of total billed charges 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 51 1369.35 percent of total billed charges 2685 2685 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK ART SURF EF 7-10/ BLUE 17MM SUP-97-01552 CDM C1776 HCPCS 0278 RC outpatient 5212.5 5212.5 5212.5 57 2971.13 percent of total billed charges 5212.5 93 4222.13 percent of total billed charges 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 51 2658.38 percent of total billed charges 5212.5 5212.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.5MM SUP-97-01553 CDM 0272 RC outpatient 276.5 276.5 276.5 74 204.61 percent of total billed charges 276.5 93 223.97 percent of total billed charges 276.5 276.5 other OPPS APC 276.5 276.5 other OPPS APC 276.5 27.63 76.4 percent of total billed charges 276.5 276.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO PRO SCRW3.5X 14MM SUP-97-01554 CDM C1713 HCPCS 0278 RC outpatient 200 200 200 57 114 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 51 102 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO PRO SCRW3.5X 16MM SUP-97-01555 CDM C1713 HCPCS 0278 RC outpatient 301 301 301 57 171.57 percent of total billed charges 301 93 243.81 percent of total billed charges 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 51 153.51 percent of total billed charges 301 301 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.5 SUP-97-01556 CDM 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 297.5 other OPPS APC 297.5 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING THIRD TUBULAR PLATE SS SUP-97-01557 CDM C1713 HCPCS 0278 RC outpatient 1029 1029 1029 57 586.53 percent of total billed charges 1029 93 833.49 percent of total billed charges 1029 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1029 other OPPS APC 1029 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1029 other OPPS APC 1029 51 524.79 percent of total billed charges 1029 1029 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK 3.5/ 4.0MM SUP-97-01558 CDM outpatient 700 700 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GULDE WIRE TROCAR TIP DIA 1.35MM SUP-97-01559 CDM C1713 HCPCS 0278 RC outpatient 60 60 60 57 34.2 percent of total billed charges 60 93 48.6 percent of total billed charges 60 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 60 other OPPS APC 60 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 60 other OPPS APC 60 51 30.6 percent of total billed charges 60 60 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 12MM CORTICAL LOW PROFILE TITANIUM SUP-97-01560 CDM C1713 HCPCS 0278 RC outpatient 385 385 385 57 219.45 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 51 196.35 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 14MM CORTICAL LOW PROFILE TITANIUM SUP-97-01561 CDM C1713 HCPCS 0278 RC outpatient 385 385 385 57 219.45 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 51 196.35 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PRO SCRWT 3.0MMX SUP-97-01562 CDM C1713 HCPCS 0278 RC outpatient 553 553 553 57 315.21 percent of total billed charges 553 93 447.93 percent of total billed charges 553 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 553 other OPPS APC 553 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 553 other OPPS APC 553 51 282.03 percent of total billed charges 553 553 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 22MM CORTICAL LOW PROFILE TITANIUM SUP-97-01563 CDM C1713 HCPCS 0278 RC outpatient 553 553 553 57 315.21 percent of total billed charges 553 93 447.93 percent of total billed charges 553 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 553 other OPPS APC 553 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 553 other OPPS APC 553 51 282.03 percent of total billed charges 553 553 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 24MM CORTICAL LOW PROFILE TITANIUM SUP-97-01564 CDM C1713 HCPCS 0278 RC outpatient 385 385 385 57 219.45 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 51 196.35 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.0MM SUP-97-01565 CDM 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 297.5 other OPPS APC 297.5 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO- PRO STR MTP PLTSTDTI SUP-97-01566 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK 3.0MM SUP-97-01567 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 4.2MM 3 FLUTED QC 330MM/100MM SUP-97-01568 CDM 0272 RC outpatient 823.35 823.35 823.35 74 609.28 percent of total billed charges 823.35 93 666.91 percent of total billed charges 823.35 823.35 other OPPS APC 823.35 823.35 other OPPS APC 823.35 27.63 227.49 percent of total billed charges 823.35 823.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BEARING INSERT PS SUP-97-01571 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER PATELLA STERILE KNEE 42MM SUP-97-01572 CDM 0272 RC outpatient 768 768 768 74 568.32 percent of total billed charges 768 93 622.08 percent of total billed charges 768 768 other OPPS APC 768 768 other OPPS APC 768 27.63 212.2 percent of total billed charges 768 768 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTERIOR STABLILZED FEMORAL SUP-97-01573 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO AFTER CARE KIT SUP-97-01574 CDM 0272 RC outpatient 64 64 64 74 47.36 percent of total billed charges 64 93 51.84 percent of total billed charges 64 64 other OPPS APC 64 64 other OPPS APC 64 27.63 17.68 percent of total billed charges 64 64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MPS SURGERY KIT SUP-97-01575 CDM 0272 RC outpatient 1531.8 1531.8 1531.8 74 1133.53 percent of total billed charges 1531.8 93 1240.76 percent of total billed charges 1531.8 1531.8 other OPPS APC 1531.8 1531.8 other OPPS APC 1531.8 27.63 423.24 percent of total billed charges 1531.8 1531.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO BHX IMPLANT 3MM ABUTMENT 9 SUP-97-01576 CDM L8614 HCPCS 0278 RC outpatient 8021.25 8021.25 8021.25 57 4572.11 percent of total billed charges 8021.25 93 6497.21 percent of total billed charges 8021.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8021.25 other OPPS APC 8021.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8021.25 other OPPS APC 8021.25 51 4090.84 percent of total billed charges 8021.25 8021.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO BHX IMPLANT 4MM ABUTMENT 9 SUP-97-01577 CDM L8614 HCPCS 0278 RC outpatient 8021.25 8021.25 8021.25 57 4572.11 percent of total billed charges 8021.25 93 6497.21 percent of total billed charges 8021.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8021.25 other OPPS APC 8021.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8021.25 other OPPS APC 8021.25 51 4090.84 percent of total billed charges 8021.25 8021.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO BHX IMPLANT 4MM ABUTMENT 12 SUP-97-01578 CDM L8614 HCPCS 0278 RC outpatient 8021.25 8021.25 8021.25 57 4572.11 percent of total billed charges 8021.25 93 6497.21 percent of total billed charges 8021.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8021.25 other OPPS APC 8021.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8021.25 other OPPS APC 8021.25 51 4090.84 percent of total billed charges 8021.25 8021.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOPSY PUNCH 5MM SUP-97-01579 CDM 0272 RC outpatient 1.7 1.7 1.7 74 1.26 percent of total billed charges 1.7 93 1.38 percent of total billed charges 1.7 1.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOPSY PUNCH 5MM DISPOSABLE SUP-97-01579 CDM 0272 RC outpatient 1.7 1.7 1.7 1.7 other OPPS APC 1.7 1.7 other OPPS APC 1.7 27.63 0.47 percent of total billed charges 1.7 1.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO3 POWER RIGHT MOCCA BROWN SUP-97-01580 CDM L8614 HCPCS 0272 RC outpatient 8136 8136 8136 74 6020.64 percent of total billed charges 8136 93 6590.16 percent of total billed charges 8136 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8136 other OPPS APC 8136 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8136 other OPPS APC 8136 27.63 2247.98 percent of total billed charges 8136 8136 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZCT 600 11.5D SUP-97-01582 CDM C1840 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEDIAL PLATE SUP-97-01583 CDM C1713 HCPCS 0278 RC outpatient 4771.88 4771.88 4771.88 57 2719.97 percent of total billed charges 4771.88 93 3865.22 percent of total billed charges 4771.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4771.88 other OPPS APC 4771.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4771.88 other OPPS APC 4771.88 51 2433.66 percent of total billed charges 4771.88 4771.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.5 SUP-97-01584 CDM 0272 RC outpatient 450.73 450.73 450.73 74 333.54 percent of total billed charges 450.73 93 365.09 percent of total billed charges 450.73 450.73 other OPPS APC 450.73 450.73 other OPPS APC 450.73 27.63 124.54 percent of total billed charges 450.73 450.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX NON LOCKING 3.5MM X 50MM SUP-97-01585 CDM C1713 HCPCS 0278 RC outpatient 117 117 117 57 66.69 percent of total billed charges 117 93 94.77 percent of total billed charges 117 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 117 other OPPS APC 117 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 117 other OPPS APC 117 51 59.67 percent of total billed charges 117 117 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.1 X 216MM SUP-97-01586 CDM 0272 RC outpatient 529.2 529.2 529.2 74 391.61 percent of total billed charges 529.2 93 428.65 percent of total billed charges 529.2 529.2 other OPPS APC 529.2 529.2 other OPPS APC 529.2 27.63 146.22 percent of total billed charges 529.2 529.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 32MM CANCELLOUS SUP-97-01587 CDM C1713 HCPCS 0278 RC outpatient 145.6 145.6 145.6 57 82.99 percent of total billed charges 145.6 93 117.94 percent of total billed charges 145.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.6 other OPPS APC 145.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.6 other OPPS APC 145.6 51 74.26 percent of total billed charges 145.6 145.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX NON LOCKING 3.5MM X 32MM SUP-97-01588 CDM C1713 HCPCS 0278 RC outpatient 97.28 97.28 97.28 57 55.45 percent of total billed charges 97.28 93 78.8 percent of total billed charges 97.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.28 other OPPS APC 97.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.28 other OPPS APC 97.28 51 49.61 percent of total billed charges 97.28 97.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4MM X 50MM SUP-97-01589 CDM C1713 HCPCS 0278 RC outpatient 412.3 412.3 412.3 57 235.01 percent of total billed charges 412.3 93 333.96 percent of total billed charges 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 51 210.27 percent of total billed charges 412.3 412.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 40MM SUP-97-01590 CDM C1713 HCPCS 0278 RC outpatient 412.3 412.3 412.3 57 235.01 percent of total billed charges 412.3 93 333.96 percent of total billed charges 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 51 210.27 percent of total billed charges 412.3 412.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE TIBIAL 6HOLE LEFT DISTAL MEDIAL SUP-97-01591 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX NON LOCKING 3.5MM X 38MM SUP-97-01592 CDM C1713 HCPCS 0278 RC outpatient 134.4 134.4 134.4 57 76.61 percent of total billed charges 134.4 93 108.86 percent of total billed charges 134.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.4 other OPPS APC 134.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.4 other OPPS APC 134.4 51 68.54 percent of total billed charges 134.4 134.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 1/3 TUBE 12 HOLE SS SUP-97-01593 CDM C1713 HCPCS 0278 RC outpatient 242.06 242.06 242.06 57 137.97 percent of total billed charges 242.06 93 196.07 percent of total billed charges 242.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 242.06 other OPPS APC 242.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 242.06 other OPPS APC 242.06 51 123.45 percent of total billed charges 242.06 242.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANCELLOUS4.0X20 SUP-97-01594 CDM C1713 HCPCS 0278 RC outpatient 81.12 81.12 81.12 57 46.24 percent of total billed charges 81.12 93 65.71 percent of total billed charges 81.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 81.12 other OPPS APC 81.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 81.12 other OPPS APC 81.12 51 41.37 percent of total billed charges 81.12 81.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 42MM CANCELLOUS SUP-97-01595 CDM C1713 HCPCS 0278 RC outpatient 106.4 106.4 106.4 57 60.65 percent of total billed charges 106.4 93 86.18 percent of total billed charges 106.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.4 other OPPS APC 106.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.4 other OPPS APC 106.4 51 54.26 percent of total billed charges 106.4 106.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL ST 3.5 X 12MM SUP-97-01596 CDM C1713 HCPCS 0278 RC outpatient 77.16 77.16 77.16 57 43.98 percent of total billed charges 77.16 93 62.5 percent of total billed charges 77.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 77.16 other OPPS APC 77.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 77.16 other OPPS APC 77.16 51 39.35 percent of total billed charges 77.16 77.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANCELLOUS 4.0X24 SUP-97-01597 CDM C1713 HCPCS 0278 RC outpatient 81.12 81.12 81.12 57 46.24 percent of total billed charges 81.12 93 65.71 percent of total billed charges 81.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 81.12 other OPPS APC 81.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 81.12 other OPPS APC 81.12 51 41.37 percent of total billed charges 81.12 81.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANCELLOUS 4.0X16 SUP-97-01598 CDM C1713 HCPCS 0278 RC outpatient 81.12 81.12 81.12 57 46.24 percent of total billed charges 81.12 93 65.71 percent of total billed charges 81.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 81.12 other OPPS APC 81.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 81.12 other OPPS APC 81.12 51 41.37 percent of total billed charges 81.12 81.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL ST 3.5 X 14 SUP-97-01599 CDM C1713 HCPCS 0278 RC outpatient 93.6 93.6 93.6 57 53.35 percent of total billed charges 93.6 93 75.82 percent of total billed charges 93.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 93.6 other OPPS APC 93.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 93.6 other OPPS APC 93.6 51 47.74 percent of total billed charges 93.6 93.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS SA60WF SUP-97-01600 CDM C1780 HCPCS 0278 RC outpatient 1282.5 1282.5 1282.5 57 731.03 percent of total billed charges 1282.5 93 1038.83 percent of total billed charges 1282.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1282.5 other OPPS APC 1282.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1282.5 other OPPS APC 1282.5 51 654.08 percent of total billed charges 1282.5 1282.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OPTEFORM FROZEN DISC 90CC SUP-97-01603 CDM C1762 HCPCS 0278 RC outpatient 10680 10680 10680 57 6087.6 percent of total billed charges 10680 93 8650.8 percent of total billed charges 10680 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10680 other OPPS APC 10680 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10680 other OPPS APC 10680 51 5446.8 percent of total billed charges 10680 10680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SEMI TUBLAR SUP-97-01606 CDM C1713 HCPCS 0278 RC outpatient 397.08 397.08 397.08 57 226.34 percent of total billed charges 397.08 93 321.63 percent of total billed charges 397.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 397.08 other OPPS APC 397.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 397.08 other OPPS APC 397.08 51 202.51 percent of total billed charges 397.08 397.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 CORTEX SUP-97-01607 CDM C1713 HCPCS 0278 RC outpatient 177 177 177 57 100.89 percent of total billed charges 177 93 143.37 percent of total billed charges 177 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 177 other OPPS APC 177 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 177 other OPPS APC 177 51 90.27 percent of total billed charges 177 177 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7MM 5MM/14MM SUP-97-01608 CDM C1713 HCPCS 0278 RC outpatient 177 177 177 57 100.89 percent of total billed charges 177 93 143.37 percent of total billed charges 177 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 177 other OPPS APC 177 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 177 other OPPS APC 177 51 90.27 percent of total billed charges 177 177 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7MM 5MM/16MM SUP-97-01609 CDM C1713 HCPCS 0278 RC outpatient 177 177 177 57 100.89 percent of total billed charges 177 93 143.37 percent of total billed charges 177 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 177 other OPPS APC 177 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 177 other OPPS APC 177 51 90.27 percent of total billed charges 177 177 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7MM 5MM/20MM SUP-97-01610 CDM C1713 HCPCS 0278 RC outpatient 177 177 177 57 100.89 percent of total billed charges 177 93 143.37 percent of total billed charges 177 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 177 other OPPS APC 177 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 177 other OPPS APC 177 51 90.27 percent of total billed charges 177 177 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 LOCKING 28MM SUP-97-01611 CDM C1713 HCPCS 0278 RC outpatient 532.77 532.77 532.77 57 303.68 percent of total billed charges 532.77 93 431.54 percent of total billed charges 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 51 271.71 percent of total billed charges 532.77 532.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK ANGLE HIP STEM SUP-97-01612 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTERIOR STABLILZED FEMORAL SUP-97-01613 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE 2.8 THEADED DRILL SUP-97-01616 CDM 0272 RC outpatient 408.8 408.8 408.8 74 302.51 percent of total billed charges 408.8 93 331.13 percent of total billed charges 408.8 408.8 other OPPS APC 408.8 408.8 other OPPS APC 408.8 27.63 112.95 percent of total billed charges 408.8 408.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE GEMINUS VOLAR DISTAL 3 HOLE RT SUP-97-01617 CDM C1713 HCPCS 0278 RC outpatient 1974 1974 1974 57 1125.18 percent of total billed charges 1974 93 1598.94 percent of total billed charges 1974 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1974 other OPPS APC 1974 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1974 other OPPS APC 1974 51 1006.74 percent of total billed charges 1974 1974 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG HIGH COMPRESSION 2.7MM X 18MM SUP-97-01618 CDM C1713 HCPCS 0278 RC outpatient 206.5 206.5 206.5 57 117.71 percent of total billed charges 206.5 93 167.27 percent of total billed charges 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 51 105.32 percent of total billed charges 206.5 206.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG THREADED LOCKING 2.3MM X 18MM SUP-97-01619 CDM C1713 HCPCS 0278 RC outpatient 252 252 252 57 143.64 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 51 128.52 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG THREADED LOCKING 2.3MM X 20MM SUP-97-01620 CDM C1713 HCPCS 0278 RC outpatient 252 252 252 57 143.64 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 51 128.52 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG THREADED LOCKING 2.7MM X 20MM SUP-97-01621 CDM C1713 HCPCS 0278 RC outpatient 206.5 206.5 206.5 57 117.71 percent of total billed charges 206.5 93 167.27 percent of total billed charges 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 51 105.32 percent of total billed charges 206.5 206.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW POLYAXIAL LOC CANN 2.5MM X 18MM SUP-97-01622 CDM C1713 HCPCS 0278 RC outpatient 332.5 332.5 332.5 57 189.53 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 51 169.58 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL NON-LOC 3.5MM X 11MM SUP-97-01623 CDM C1713 HCPCS 0278 RC outpatient 252 252 252 57 143.64 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 51 128.52 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL NON-LOC 3.5MM X 12MM SUP-97-01624 CDM C1713 HCPCS 0278 RC outpatient 252 252 252 57 143.64 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 51 128.52 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE STANDARD TIP 9MM X 152MM SUP-97-01625 CDM C1713 HCPCS 0278 RC outpatient 84 84 84 57 47.88 percent of total billed charges 84 93 68.04 percent of total billed charges 84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84 other OPPS APC 84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84 other OPPS APC 84 51 42.84 percent of total billed charges 84 84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE STANDARD TIP 1.5MM X 127MM SUP-97-01626 CDM C1713 HCPCS 0278 RC outpatient 84 84 84 57 47.88 percent of total billed charges 84 93 68.04 percent of total billed charges 84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84 other OPPS APC 84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84 other OPPS APC 84 51 42.84 percent of total billed charges 84 84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SOLID SIDE CUTTING 2MM X 40MM SUP-97-01627 CDM 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 297.5 other OPPS APC 297.5 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SOLID SIDE CUTTING 2.5MM X 40MM SUP-97-01628 CDM 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 297.5 other OPPS APC 297.5 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT TRI POST SIZE 4 10MM SUP-97-01629 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE PINNING SYSTEM SUP-97-01630 CDM 0272 RC outpatient 990 990 990 74 732.6 percent of total billed charges 990 93 801.9 percent of total billed charges 990 990 other OPPS APC 990 990 other OPPS APC 990 27.63 273.54 percent of total billed charges 990 990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 CORTEX 20MM SUP-97-01631 CDM C1713 HCPCS 0278 RC outpatient 165.2 165.2 165.2 57 94.16 percent of total billed charges 165.2 93 133.81 percent of total billed charges 165.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165.2 other OPPS APC 165.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165.2 other OPPS APC 165.2 51 84.25 percent of total billed charges 165.2 165.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 CORTEX 28MM SUP-97-01632 CDM C1713 HCPCS 0278 RC outpatient 170.2 170.2 170.2 57 97.01 percent of total billed charges 170.2 93 137.86 percent of total billed charges 170.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 170.2 other OPPS APC 170.2 170.2 other OPPS APC 170.2 51 86.8 percent of total billed charges 170.2 170.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION 14MMX40MM SUP-97-01633 CDM C1776 HCPCS 0278 RC outpatient 2974.5 2974.5 2974.5 57 1695.47 percent of total billed charges 2974.5 93 2409.35 percent of total billed charges 2974.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2974.5 other OPPS APC 2974.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2974.5 other OPPS APC 2974.5 51 1517 percent of total billed charges 2974.5 2974.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WARMER DRAPE SUP-97-01634 CDM outpatient 164 164 164 164 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR SIZE 3 NMC SUP-97-01635 CDM C1776 HCPCS 0278 RC outpatient 9518.44 9518.44 9518.44 57 5425.51 percent of total billed charges 9518.44 93 7709.94 percent of total billed charges 9518.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9518.44 other OPPS APC 9518.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9518.44 other OPPS APC 9518.44 51 4854.4 percent of total billed charges 9518.44 9518.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT CC 3X9 MM SUP-97-01636 CDM C1776 HCPCS 0278 RC outpatient 3859.88 3859.88 3859.88 57 2200.13 percent of total billed charges 3859.88 93 3126.5 percent of total billed charges 3859.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3859.88 other OPPS APC 3859.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3859.88 other OPPS APC 3859.88 51 1968.54 percent of total billed charges 3859.88 3859.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZCT300 LENS 23.0D SUP-97-01637 CDM C1780 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW ASNIS MICRO,CANN 3.0MMX16/4MM" SUP-97-01638 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS MICRO 2MM LENGTH 16/7MM SUP-97-01639 CDM C1713 HCPCS 0278 RC outpatient 514.5 514.5 514.5 57 293.27 percent of total billed charges 514.5 93 416.75 percent of total billed charges 514.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 514.5 other OPPS APC 514.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 514.5 other OPPS APC 514.5 51 262.4 percent of total billed charges 514.5 514.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMART TOE II SUP-97-01640 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANCELELLOUS BONE SCREW SUP-97-01641 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMISPHERICAL SOLID BACK SHELL SUP-97-01642 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EASY CLIP MONCRTCL FIXN DEVICE 12X10X10 SUP-97-01643 CDM C1713 HCPCS 0278 RC outpatient 2463.24 2463.24 2463.24 57 1404.05 percent of total billed charges 2463.24 93 1995.22 percent of total billed charges 2463.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2463.24 other OPPS APC 2463.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2463.24 other OPPS APC 2463.24 51 1256.25 percent of total billed charges 2463.24 2463.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBAL UKA TIBIAL TRAY S Z 4LT SUP-97-01644 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBAL UKA FEM CEMENTED SZ 4 L MEDIAL SUP-97-01645 CDM C1776 HCPCS 0278 RC outpatient 7500 7500 7500 57 4275 percent of total billed charges 7500 93 6075 percent of total billed charges 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 51 3825 percent of total billed charges 7500 7500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 28.0D TECNIS EYHANCE SUP-97-01646 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 23.0D SUP-97-01647 CDM C1780 HCPCS 0278 RC outpatient 381.5 381.5 381.5 57 217.46 percent of total billed charges 381.5 93 309.02 percent of total billed charges 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 51 194.57 percent of total billed charges 381.5 381.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK ART SURF EF 5-6/GREEN 12MM SUP-97-01655 CDM C1776 HCPCS 0278 RC outpatient 5212.5 5212.5 5212.5 57 2971.13 percent of total billed charges 5212.5 93 4222.13 percent of total billed charges 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 51 2658.38 percent of total billed charges 5212.5 5212.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIGMA TIBIAL SZ 3 9-7MM SUP-97-01656 CDM C1776 HCPCS 0278 RC outpatient 2907 2907 2907 57 1656.99 percent of total billed charges 2907 93 2354.67 percent of total billed charges 2907 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2907 other OPPS APC 2907 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2907 other OPPS APC 2907 51 1482.57 percent of total billed charges 2907 2907 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLAR COMPONENT SUP-97-01658 CDM C1776 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIVERSAL TIBUAL BASEPLATE TOTAL KNEE 7 SUP-97-01659 CDM C1776 HCPCS 0278 RC outpatient 3125 3125 3125 57 1781.25 percent of total billed charges 3125 93 2531.25 percent of total billed charges 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 51 1593.75 percent of total billed charges 3125 3125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BEARING INSERT-PS7 9MM SUP-97-01660 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETROGRADE INTUBATION SET SUP-97-01661 CDM 0272 RC outpatient 498.37 498.37 498.37 74 368.79 percent of total billed charges 498.37 93 403.68 percent of total billed charges 498.37 498.37 other OPPS APC 498.37 498.37 other OPPS APC 498.37 27.63 137.7 percent of total billed charges 498.37 498.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAP 3 DBM / 2X5CC SUP-97-01663 CDM C1713 HCPCS 0278 RC outpatient 5857.5 5857.5 5857.5 57 3338.78 percent of total billed charges 5857.5 93 4744.58 percent of total billed charges 5857.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5857.5 other OPPS APC 5857.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5857.5 other OPPS APC 5857.5 51 2987.33 percent of total billed charges 5857.5 5857.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2MM CALIBRATED REAMER SUP-97-01664 CDM 0272 RC outpatient 446.88 446.88 446.88 74 330.69 percent of total billed charges 446.88 93 361.97 percent of total billed charges 446.88 446.88 other OPPS APC 446.88 446.88 other OPPS APC 446.88 27.63 123.47 percent of total billed charges 446.88 446.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL STOP SUP-97-01665 CDM 0272 RC outpatient 906 906 906 74 670.44 percent of total billed charges 906 93 733.86 percent of total billed charges 906 906 other OPPS APC 906 906 other OPPS APC 906 27.63 250.33 percent of total billed charges 906 906 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. .86 GULDE WIRE TROCAR TIP SUP-97-01666 CDM 0272 RC outpatient 88 88 88 74 65.12 percent of total billed charges 88 93 71.28 percent of total billed charges 88 88 other OPPS APC 88 88 other OPPS APC 88 27.63 24.31 percent of total billed charges 88 88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. .86 GULDE WIRE TROCAR THEADED SUP-97-01667 CDM 0272 RC outpatient 104 104 104 74 76.96 percent of total billed charges 104 93 84.24 percent of total billed charges 104 104 other OPPS APC 104 104 other OPPS APC 104 27.63 28.74 percent of total billed charges 104 104 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.2M.M DRILL BIT CMP FT CALIBRATED SUP-97-01668 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO- PRO SCRW TMSS 3.5X24MMCRT SUP-97-01669 CDM C1713 HCPCS 0278 RC outpatient 200 200 200 57 114 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 51 102 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO- PRO LOCK SCRW 3.5X24MMCRT SUP-97-01670 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO- PRO LOCK SCRW 3.5X26MMCRT SUP-97-01671 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO- PRO SCRWSS 4.0X42MM SHT THD SUP-97-01672 CDM C1713 HCPCS 0278 RC outpatient 200 200 200 57 114 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 51 102 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE TROCAR TIP 1.35MM SUP-97-01673 CDM 0272 RC outpatient 80 80 80 74 59.2 percent of total billed charges 80 93 64.8 percent of total billed charges 80 80 other OPPS APC 80 80 other OPPS APC 80 27.63 22.1 percent of total billed charges 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PRO SCRWT16.7X 90MM CANN 18MMTHD SUP-97-01675 CDM C1713 HCPCS 0278 RC outpatient 1074 1074 1074 57 612.18 percent of total billed charges 1074 93 869.94 percent of total billed charges 1074 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1074 other OPPS APC 1074 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1074 other OPPS APC 1074 51 547.74 percent of total billed charges 1074 1074 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO BHX IMPLANT 4MM ABUTMENT 1 SUP-97-01680 CDM L8614 HCPCS 0278 RC outpatient 8021.25 8021.25 8021.25 57 4572.11 percent of total billed charges 8021.25 93 6497.21 percent of total billed charges 8021.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8021.25 other OPPS APC 8021.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8021.25 other OPPS APC 8021.25 51 4090.84 percent of total billed charges 8021.25 8021.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUATTRO KNOTLESS ANCHOR 4.5 SUP-97-01683 CDM C1713 HCPCS 0278 RC outpatient 1197 1197 1197 57 682.29 percent of total billed charges 1197 93 969.57 percent of total billed charges 1197 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1197 other OPPS APC 1197 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1197 other OPPS APC 1197 51 610.47 percent of total billed charges 1197 1197 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO- PRO SCRWSS 4.0X38MM CANN SHT SUP-97-01684 CDM C1713 HCPCS 0278 RC outpatient 708 708 708 57 403.56 percent of total billed charges 708 93 573.48 percent of total billed charges 708 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 708 other OPPS APC 708 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 708 other OPPS APC 708 51 361.08 percent of total billed charges 708 708 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE GUIDE W/TRCR THRDED TIP 8 SUP-97-01685 CDM 0272 RC outpatient 120 120 120 74 88.8 percent of total billed charges 120 93 97.2 percent of total billed charges 120 120 other OPPS APC 120 120 other OPPS APC 120 27.63 33.16 percent of total billed charges 120 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7MM 16MM SUP-97-01686 CDM C1713 HCPCS 0278 RC outpatient 461.37 461.37 461.37 57 262.98 percent of total billed charges 461.37 93 373.71 percent of total billed charges 461.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 461.37 other OPPS APC 461.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 461.37 other OPPS APC 461.37 51 235.3 percent of total billed charges 461.37 461.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7MM/35MM DIST AFIBULA PLATE 5H/LEFT SUP-97-01687 CDM C1713 HCPCS 0278 RC outpatient 2104.95 2104.95 2104.95 57 1199.82 percent of total billed charges 2104.95 93 1705.01 percent of total billed charges 2104.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2104.95 other OPPS APC 2104.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2104.95 other OPPS APC 2104.95 51 1073.52 percent of total billed charges 2104.95 2104.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 14MM LOCKING T8 SUP-97-01688 CDM C1713 HCPCS 0278 RC outpatient 443.98 443.98 443.98 57 253.07 percent of total billed charges 443.98 93 359.62 percent of total billed charges 443.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 443.98 other OPPS APC 443.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 443.98 other OPPS APC 443.98 51 226.43 percent of total billed charges 443.98 443.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 18MM LOCKING SELF TAPPING SUP-97-01689 CDM C1713 HCPCS 0278 RC outpatient 443.98 443.98 443.98 57 253.07 percent of total billed charges 443.98 93 359.62 percent of total billed charges 443.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 443.98 other OPPS APC 443.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 443.98 other OPPS APC 443.98 51 226.43 percent of total billed charges 443.98 443.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7MM 22MM SUP-97-01690 CDM C1713 HCPCS 0278 RC outpatient 443.98 443.98 443.98 57 253.07 percent of total billed charges 443.98 93 359.62 percent of total billed charges 443.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 443.98 other OPPS APC 443.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 443.98 other OPPS APC 443.98 51 226.43 percent of total billed charges 443.98 443.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7MM 10MM SUP-97-01691 CDM C1713 HCPCS 0278 RC outpatient 443.98 443.98 443.98 57 253.07 percent of total billed charges 443.98 93 359.62 percent of total billed charges 443.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 443.98 other OPPS APC 443.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 443.98 other OPPS APC 443.98 51 226.43 percent of total billed charges 443.98 443.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2.7MM/3 5MM DIST AFIBULA 6H/LEFT SUP-97-01692 CDM C1713 HCPCS 0278 RC outpatient 2300.16 2300.16 2300.16 57 1311.09 percent of total billed charges 2300.16 93 1863.13 percent of total billed charges 2300.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2300.16 other OPPS APC 2300.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2300.16 other OPPS APC 2300.16 51 1173.08 percent of total billed charges 2300.16 2300.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZXT 225 LEN 17.5 SUP-97-01693 CDM C1840 HCPCS 0278 RC outpatient 2953.5 2953.5 2953.5 57 1683.5 percent of total billed charges 2953.5 93 2392.34 percent of total billed charges 2953.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2953.5 other OPPS APC 2953.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2953.5 other OPPS APC 2953.5 51 1506.29 percent of total billed charges 2953.5 2953.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 23.0D ACRYSOF SINGLE PIECE IOL SUP-97-01694 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 22.0D SUP-97-01695 CDM C1780 HCPCS 0278 RC outpatient 1251.15 1251.15 1251.15 57 713.16 percent of total billed charges 1251.15 93 1013.43 percent of total billed charges 1251.15 1251.15 other OPPS APC 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 51 638.09 percent of total billed charges 1251.15 1251.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIVERSAL STEM FLUTED SUP-97-01696 CDM C1776 HCPCS 0278 RC outpatient 5376 5376 5376 57 3064.32 percent of total billed charges 5376 93 4354.56 percent of total billed charges 5376 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5376 other OPPS APC 5376 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5376 other OPPS APC 5376 51 2741.76 percent of total billed charges 5376 5376 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM LCP CLAVICLE PLATE 8/HLEFT 115MM SUP-97-01697 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LYNC SIZE M, 0 DEGREE" SUP-97-01698 CDM C1713 HCPCS 0278 RC outpatient 2849.85 2849.85 2849.85 57 1624.41 percent of total billed charges 2849.85 93 2308.38 percent of total billed charges 2849.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2849.85 other OPPS APC 2849.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2849.85 other OPPS APC 2849.85 51 1453.42 percent of total billed charges 2849.85 2849.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LYNC SIZE M, 10 DEGREE" SUP-97-01699 CDM C1713 HCPCS 0278 RC outpatient 2849.85 2849.85 2849.85 57 1624.41 percent of total billed charges 2849.85 93 2308.38 percent of total billed charges 2849.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2849.85 other OPPS APC 2849.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2849.85 other OPPS APC 2849.85 51 1453.42 percent of total billed charges 2849.85 2849.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT LYNC 2.3MM SUP-97-01700 CDM 0272 RC outpatient 402.5 402.5 402.5 74 297.85 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 402.5 other OPPS APC 402.5 402.5 other OPPS APC 402.5 27.63 111.21 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZXT 300 LENS 18.0 SUP-97-01701 CDM C1780 HCPCS 0278 RC outpatient 2955 2955 2955 57 1684.35 percent of total billed charges 2955 93 2393.55 percent of total billed charges 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 51 1507.05 percent of total billed charges 2955 2955 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN SHRT THREAD 4MM X 34MM SUP-97-01707 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN SHRT THREAD 4MM X 36MM SUP-97-01708 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBAL UKA FEM CEMENTED SZ 45L MEDIAL SUP-97-01710 CDM C1776 HCPCS 0278 RC outpatient 7500 7500 7500 57 4275 percent of total billed charges 7500 93 6075 percent of total billed charges 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 51 3825 percent of total billed charges 7500 7500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 52.5MM SUP-97-01711 CDM C1713 HCPCS 0278 RC outpatient 394.8 394.8 394.8 57 225.04 percent of total billed charges 394.8 93 319.79 percent of total billed charges 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 51 201.35 percent of total billed charges 394.8 394.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL NAIL 12 X 390MM T2 STANDARD SUP-97-01712 CDM C1713 HCPCS 0278 RC outpatient 2734.2 2734.2 2734.2 57 1558.49 percent of total billed charges 2734.2 93 2214.7 percent of total billed charges 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 51 1394.44 percent of total billed charges 2734.2 2734.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP 15MM SUP-97-01713 CDM C1713 HCPCS 0278 RC outpatient 389.55 389.55 389.55 57 222.04 percent of total billed charges 389.55 93 315.54 percent of total billed charges 389.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 389.55 other OPPS APC 389.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 389.55 other OPPS APC 389.55 51 198.67 percent of total billed charges 389.55 389.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K- WIRE 0.10MM L100MM TIP TROCAR SUP-97-01714 CDM 0272 RC outpatient 94.08 94.08 94.08 74 69.62 percent of total billed charges 94.08 93 76.2 percent of total billed charges 94.08 94.08 other OPPS APC 94.08 94.08 other OPPS APC 94.08 27.63 25.99 percent of total billed charges 94.08 94.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN SHRT THREAD 4MM X 50MM SUP-97-01715 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADES MAC SIZE 4 SUP-97-01723 CDM 0272 RC outpatient 583.1 583.1 583.1 74 431.49 percent of total billed charges 583.1 93 472.31 percent of total billed charges 583.1 583.1 other OPPS APC 583.1 583.1 other OPPS APC 583.1 27.63 161.11 percent of total billed charges 583.1 583.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADES MILLER SIZE3 SUP-97-01724 CDM 0272 RC outpatient 583.1 583.1 583.1 74 431.49 percent of total billed charges 583.1 93 472.31 percent of total billed charges 583.1 583.1 other OPPS APC 583.1 583.1 other OPPS APC 583.1 27.63 161.11 percent of total billed charges 583.1 583.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADES MILLER SIZE2 SUP-97-01725 CDM 0272 RC outpatient 583.1 583.1 583.1 74 431.49 percent of total billed charges 583.1 93 472.31 percent of total billed charges 583.1 583.1 other OPPS APC 583.1 583.1 other OPPS APC 583.1 27.63 161.11 percent of total billed charges 583.1 583.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADES MAC SIZE 3 SUP-97-01729 CDM 0272 RC outpatient 583.1 583.1 583.1 74 431.49 percent of total billed charges 583.1 93 472.31 percent of total billed charges 583.1 583.1 other OPPS APC 583.1 583.1 other OPPS APC 583.1 27.63 161.11 percent of total billed charges 583.1 583.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLAR COMPONENT SUP-97-01730 CDM C1776 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 29.0D TECNIS EYHANCE SUP-97-01732 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL RADIUS PLATE WIDE GEMI 4 HOLE LT SUP-97-01733 CDM C1713 HCPCS 0278 RC outpatient 1611 1611 1611 57 918.27 percent of total billed charges 1611 93 1304.91 percent of total billed charges 1611 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1611 other OPPS APC 1611 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1611 other OPPS APC 1611 51 821.61 percent of total billed charges 1611 1611 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THREADED PEG NON LOCKING 2.7X14MM SUP-97-01734 CDM C1713 HCPCS 0278 RC outpatient 206.5 206.5 206.5 57 117.71 percent of total billed charges 206.5 93 167.27 percent of total billed charges 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 51 105.32 percent of total billed charges 206.5 206.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW POLYAXIAL LOC CANN 2.5MM X 14MM SUP-97-01735 CDM C1713 HCPCS 0278 RC outpatient 332.5 332.5 332.5 57 189.53 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 51 169.58 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW POLYAXIAL LOC CANN 2.5MM X 22MM SUP-97-01736 CDM C1713 HCPCS 0278 RC outpatient 332.5 332.5 332.5 57 189.53 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 51 169.58 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW POLYAXIAL LOC CANN 2.5MM X 24MM SUP-97-01737 CDM C1713 HCPCS 0278 RC outpatient 332.5 332.5 332.5 57 189.53 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 51 169.58 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW POLYAXIAL LOC CANN 2.5MM X 26MM SUP-97-01738 CDM C1713 HCPCS 0278 RC outpatient 332.5 332.5 332.5 57 189.53 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 51 169.58 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL NON LOC 3.5MMX14MM SUP-97-01739 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL NON LOC 3.5MMX15MM SUP-97-01740 CDM C1713 HCPCS 0278 RC outpatient 252 252 252 57 143.64 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 51 128.52 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI LAG 10.5 X 85MM SUP-97-01741 CDM C1713 HCPCS 0278 RC outpatient 1215.36 1215.36 1215.36 57 692.76 percent of total billed charges 1215.36 93 984.44 percent of total billed charges 1215.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1215.36 other OPPS APC 1215.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1215.36 other OPPS APC 1215.36 51 619.83 percent of total billed charges 1215.36 1215.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL GAMMA3 S LEFT 10 X 360MM X125 SUP-97-01742 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 3.2 X 450MM SUP-97-01743 CDM C1713 HCPCS 0278 RC outpatient 273 273 273 57 155.61 percent of total billed charges 273 93 221.13 percent of total billed charges 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 273 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 273 other OPPS APC 273 51 139.23 percent of total billed charges 273 273 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZXT 375LENS 22.50 SUP-97-01744 CDM C1780 HCPCS 0278 RC outpatient 2955 2955 2955 57 1684.35 percent of total billed charges 2955 93 2393.55 percent of total billed charges 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 51 1507.05 percent of total billed charges 2955 2955 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX PROFILE LOW 2.4X18MM SUP-97-01746 CDM C1713 HCPCS 0278 RC outpatient 385 385 385 57 219.45 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 385 other OPPS APC 385 51 196.35 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX PROFILE LOW 2.4X16MM SUP-97-01747 CDM C1713 HCPCS 0278 RC outpatient 490 490 490 57 279.3 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 51 249.9 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE TROCAR TIP CR TIP .045 SUP-97-01748 CDM C1713 HCPCS 0278 RC outpatient 60 60 60 57 34.2 percent of total billed charges 60 93 48.6 percent of total billed charges 60 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 60 other OPPS APC 60 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 60 other OPPS APC 60 51 30.6 percent of total billed charges 60 60 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 16MM CORTICAL LOW PROFILE TITANIUM SUP-97-01750 CDM C1713 HCPCS 0278 RC outpatient 385 385 385 57 219.45 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 51 196.35 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE T-PLATE 2.4MM 5 HOLE SUP-97-01751 CDM C1713 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAIR HUGGER / LOWER BODY BLANKET SUP-97-01754 CDM 0271 RC outpatient 30.55 30.55 30.55 74 22.61 percent of total billed charges 30.55 93 24.75 percent of total billed charges 30.55 30.55 other OPPS APC 30.55 30.55 other OPPS APC 30.55 27.63 8.44 percent of total billed charges 30.55 30.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOGRAFT BTB 10/10 SUP-97-01757 CDM C1762 HCPCS 0272 RC outpatient 9000 9000 9000 74 6660 percent of total billed charges 9000 93 7290 percent of total billed charges 9000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9000 other OPPS APC 9000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9000 other OPPS APC 9000 27.63 2486.7 percent of total billed charges 9000 9000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4MM VA-LCP 2-CLMN DSTLRADIUS 7HD/5H SUP-97-01758 CDM C1713 HCPCS 0272 RC outpatient 4322.5 4322.5 4322.5 74 3198.65 percent of total billed charges 4322.5 93 3501.23 percent of total billed charges 4322.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4322.5 other OPPS APC 4322.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4322.5 other OPPS APC 4322.5 27.63 1194.31 percent of total billed charges 4322.5 4322.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD SUP-97-01767 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.0 DRILLBIT SUP-97-01768 CDM 0272 RC outpatient 446.88 446.88 446.88 74 330.69 percent of total billed charges 446.88 93 361.97 percent of total billed charges 446.88 446.88 other OPPS APC 446.88 446.88 other OPPS APC 446.88 27.63 123.47 percent of total billed charges 446.88 446.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZXT 375LENS 22.0 SUP-97-01778 CDM C1780 HCPCS 0278 RC outpatient 2955 2955 2955 57 1684.35 percent of total billed charges 2955 93 2393.55 percent of total billed charges 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 51 1507.05 percent of total billed charges 2955 2955 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4 HOLE DLB COMP PLATE 20MM SUP-97-01782 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO- PRO SCRWSS 4.0X40MM CANN SHT SUP-97-01783 CDM C1713 HCPCS 0278 RC outpatient 708 708 708 57 403.56 percent of total billed charges 708 93 573.48 percent of total billed charges 708 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 708 other OPPS APC 708 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 708 other OPPS APC 708 51 361.08 percent of total billed charges 708 708 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 30MM LO PROFILE CANNULATED LONG THREAD SS SUP-97-01784 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PRO SCRWT16.7X 50MMCANN18MM SUP-97-01785 CDM C1713 HCPCS 0278 RC outpatient 750 750 750 57 427.5 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 51 382.5 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIGMA FEMORAL SIZE 3 LM/RL SUP-97-01786 CDM C1776 HCPCS 0278 RC outpatient 6646.5 6646.5 6646.5 57 3788.51 percent of total billed charges 6646.5 93 5383.67 percent of total billed charges 6646.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6646.5 other OPPS APC 6646.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6646.5 other OPPS APC 6646.5 51 3389.72 percent of total billed charges 6646.5 6646.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIGMA TIB SIZE 4 UNI-FIXED SUP-97-01787 CDM C1776 HCPCS 0278 RC outpatient 4035 4035 4035 57 2299.95 percent of total billed charges 4035 93 3268.35 percent of total billed charges 4035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4035 other OPPS APC 4035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4035 other OPPS APC 4035 51 2057.85 percent of total billed charges 4035 4035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIGMA TIBIAL SZ 4RM/LL 8MM SUP-97-01788 CDM C1776 HCPCS 0278 RC outpatient 2907 2907 2907 57 1656.99 percent of total billed charges 2907 93 2354.67 percent of total billed charges 2907 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2907 other OPPS APC 2907 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2907 other OPPS APC 2907 51 1482.57 percent of total billed charges 2907 2907 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIGMA TIBIAL SZ 2RM/LL 7MM SUP-97-01789 CDM C1776 HCPCS 0278 RC outpatient 2907 2907 2907 57 1656.99 percent of total billed charges 2907 93 2354.67 percent of total billed charges 2907 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2907 other OPPS APC 2907 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2907 other OPPS APC 2907 51 1482.57 percent of total billed charges 2907 2907 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 7 HOLE STRAIGHT 1/3 TUBULAR SUP-97-01790 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX STRAIGHT 5 HOLE SUP-97-01791 CDM C1713 HCPCS 0278 RC outpatient 929.76 929.76 929.76 57 529.96 percent of total billed charges 929.76 93 753.11 percent of total billed charges 929.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 929.76 other OPPS APC 929.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 929.76 other OPPS APC 929.76 51 474.18 percent of total billed charges 929.76 929.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 22.0D IQ ASPHERIC NATURAL SUP-97-01793 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANN TROCH FIX 10MM 130 360 SUP-97-01794 CDM C1713 HCPCS 0278 RC outpatient 5272.78 5272.78 5272.78 57 3005.48 percent of total billed charges 5272.78 93 4270.95 percent of total billed charges 5272.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5272.78 other OPPS APC 5272.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5272.78 other OPPS APC 5272.78 51 2689.12 percent of total billed charges 5272.78 5272.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIB BASE SZ 3 RM/LL SUP-97-01795 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL SIZE C RM/LL SUP-97-01796 CDM C1776 HCPCS 0278 RC outpatient 5360 5360 5360 57 3055.2 percent of total billed charges 5360 93 4341.6 percent of total billed charges 5360 5360 other OPPS APC 5360 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5360 other OPPS APC 5360 51 2733.6 percent of total billed charges 5360 5360 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 27.5D TECNIS EYHANCE SUP-97-01797 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYMMETRIC PATELLA 9MM X31 SUP-97-01799 CDM C1776 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENTED STEM SUP-97-01800 CDM C1776 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELIMINATOR HOLE PS SUP-97-01805 CDM C1776 HCPCS 0278 RC outpatient 192.5 192.5 192.5 57 109.73 percent of total billed charges 192.5 93 155.93 percent of total billed charges 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 51 98.18 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT SUP-97-01806 CDM C1776 HCPCS 0278 RC outpatient 3144.3 3144.3 3144.3 57 1792.25 percent of total billed charges 3144.3 93 2546.88 percent of total billed charges 3144.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3144.3 other OPPS APC 3144.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3144.3 other OPPS APC 3144.3 51 1603.59 percent of total billed charges 3144.3 3144.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANCELELLOUS BONE SCREW SUP-97-01807 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONSTRAINED ACETABULAR INSERT SUP-97-01808 CDM C1776 HCPCS 0278 RC outpatient 7112 7112 7112 57 4053.84 percent of total billed charges 7112 93 5760.72 percent of total billed charges 7112 7112 other OPPS APC 7112 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7112 other OPPS APC 7112 51 3627.12 percent of total billed charges 7112 7112 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD SUP-97-01809 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETABULAR LINER SUP-97-01815 CDM C1776 HCPCS 0278 RC outpatient 4369.5 4369.5 4369.5 57 2490.62 percent of total billed charges 4369.5 93 3539.3 percent of total billed charges 4369.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4369.5 other OPPS APC 4369.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4369.5 other OPPS APC 4369.5 51 2228.45 percent of total billed charges 4369.5 4369.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD SUP-97-01816 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 6 HOLE STRAIGHT 1/3 TUBULAR B&R SUP-97-01817 CDM C1713 HCPCS 0278 RC outpatient 929.76 929.76 929.76 57 529.96 percent of total billed charges 929.76 93 753.11 percent of total billed charges 929.76 929.76 other OPPS APC 929.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 929.76 other OPPS APC 929.76 51 474.18 percent of total billed charges 929.76 929.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZXR00 LENS 24.5 SUP-97-01818 CDM C1780 HCPCS 0278 RC outpatient 2685 2685 2685 57 1530.45 percent of total billed charges 2685 93 2174.85 percent of total billed charges 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 51 1369.35 percent of total billed charges 2685 2685 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 15.5 SUP-97-01819 CDM C1780 HCPCS 0278 RC outpatient 1251 1251 1251 57 713.07 percent of total billed charges 1251 93 1013.31 percent of total billed charges 1251 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251 other OPPS APC 1251 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251 other OPPS APC 1251 51 638.01 percent of total billed charges 1251 1251 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 7.3MM CANNULATED 16MM THEAD 75MM SUP-97-01821 CDM C1713 HCPCS 0278 RC outpatient 733.5 733.5 733.5 57 418.1 percent of total billed charges 733.5 93 594.14 percent of total billed charges 733.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 733.5 other OPPS APC 733.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 733.5 other OPPS APC 733.5 51 374.09 percent of total billed charges 733.5 733.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO3 POWER LEFT CHOMA BEIGE SUP-97-01822 CDM L8614 HCPCS 0278 RC outpatient 8136 8136 8136 57 4637.52 percent of total billed charges 8136 93 6590.16 percent of total billed charges 8136 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8136 other OPPS APC 8136 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8136 other OPPS APC 8136 51 4149.36 percent of total billed charges 8136 8136 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO3 POWER RIGHT CHOMA BEIGE SUP-97-01823 CDM L8614 HCPCS 0278 RC outpatient 8136 8136 8136 57 4637.52 percent of total billed charges 8136 93 6590.16 percent of total billed charges 8136 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8136 other OPPS APC 8136 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8136 other OPPS APC 8136 51 4149.36 percent of total billed charges 8136 8136 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT 9MM W/ABUTMENT BILATERAL SUP-97-01824 CDM L8614 HCPCS 0278 RC outpatient 9625 9625 9625 57 5486.25 percent of total billed charges 9625 93 7796.25 percent of total billed charges 9625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9625 other OPPS APC 9625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9625 other OPPS APC 9625 51 4908.75 percent of total billed charges 9625 9625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MPS BACK-UP SURGARY KIT SUP-97-01825 CDM 0272 RC outpatient 720 720 720 74 532.8 percent of total billed charges 720 93 583.2 percent of total billed charges 720 720 other OPPS APC 720 720 other OPPS APC 720 27.63 198.94 percent of total billed charges 720 720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORAL RAE W/TAPERGUARD 7.0 SUP-97-01827 CDM 0272 RC outpatient 159.76 159.76 159.76 74 118.22 percent of total billed charges 159.76 93 129.41 percent of total billed charges 159.76 159.76 other OPPS APC 159.76 159.76 other OPPS APC 159.76 27.63 44.14 percent of total billed charges 159.76 159.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT PSC 3X15MM TIBIAL SUP-97-01828 CDM C1776 HCPCS 0278 RC outpatient 3419.25 3419.25 3419.25 57 1948.97 percent of total billed charges 3419.25 93 2769.59 percent of total billed charges 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 51 1743.82 percent of total billed charges 3419.25 3419.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE K 1.6 150MM SUP-97-01830 CDM C1713 HCPCS 0278 RC outpatient 76.31 76.31 76.31 57 43.5 percent of total billed charges 76.31 93 61.81 percent of total billed charges 76.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 76.31 other OPPS APC 76.31 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 76.31 other OPPS APC 76.31 51 38.92 percent of total billed charges 76.31 76.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE K 2.0 150MM SUP-97-01831 CDM C1713 HCPCS 0278 RC outpatient 39.18 39.18 39.18 57 22.33 percent of total billed charges 39.18 93 31.74 percent of total billed charges 39.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.18 other OPPS APC 39.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.18 other OPPS APC 39.18 51 19.98 percent of total billed charges 39.18 39.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE REAMER HOLLOW N/S SUP-97-01832 CDM 0272 RC outpatient 843.48 843.48 843.48 74 624.18 percent of total billed charges 843.48 93 683.22 percent of total billed charges 843.48 843.48 other OPPS APC 843.48 843.48 other OPPS APC 843.48 27.63 233.05 percent of total billed charges 843.48 843.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA NEXGEN PROLONG ALL POLY 41MM SUP-97-01837 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN PC STEMMED TIBIAL PLATE SZ 8 SUP-97-01838 CDM C1776 HCPCS 0278 RC outpatient 3610 3610 3610 57 2057.7 percent of total billed charges 3610 93 2924.1 percent of total billed charges 3610 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3610 other OPPS APC 3610 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3610 other OPPS APC 3610 51 1841.1 percent of total billed charges 3610 3610 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT 10X4CM EPIXL SUP-97-01842 CDM Q4131 HCPCS 0636 RC outpatient 9237.5 9237.5 9237.5 74 6835.75 percent of total billed charges 9237.5 93 7482.38 percent of total billed charges 9237.5 9237.5 other OPPS APC 9237.5 9237.5 other OPPS APC 9237.5 24.86 2296.44 percent of total billed charges 9237.5 9237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS TITANIUM CANN 3.0X2.0 SUP-97-01843 CDM C1713 HCPCS 0278 RC outpatient 514.5 514.5 514.5 57 293.27 percent of total billed charges 514.5 93 416.75 percent of total billed charges 514.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 514.5 other OPPS APC 514.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 514.5 other OPPS APC 514.5 51 262.4 percent of total billed charges 514.5 514.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STERIS PAPER ROLL SUP-97-01844 CDM 0271 RC outpatient 28.08 28.08 28.08 74 20.78 percent of total billed charges 28.08 93 22.74 percent of total billed charges 28.08 28.08 other OPPS APC 28.08 28.08 other OPPS APC 28.08 27.63 7.76 percent of total billed charges 28.08 28.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN LONG THREAD 4MM X 36MM SUP-97-01845 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.8 165MM SUP-97-01846 CDM 0272 RC outpatient 350.42 350.42 350.42 74 259.31 percent of total billed charges 350.42 93 283.84 percent of total billed charges 350.42 350.42 other OPPS APC 350.42 350.42 other OPPS APC 350.42 27.63 96.82 percent of total billed charges 350.42 350.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZXT 150 LENS 24.5 SUP-97-01849 CDM C1780 HCPCS 0278 RC outpatient 2955 2955 2955 57 1684.35 percent of total billed charges 2955 93 2393.55 percent of total billed charges 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 51 1507.05 percent of total billed charges 2955 2955 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 20.5D ACRYSOF IQ ASPHERIC NATURAL SUP-97-01850 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPEED TITAN IMLANT SUP-97-01852 CDM C1713 HCPCS 0278 RC outpatient 4750 4750 4750 57 2707.5 percent of total billed charges 4750 93 3847.5 percent of total billed charges 4750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4750 other OPPS APC 4750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4750 other OPPS APC 4750 51 2422.5 percent of total billed charges 4750 4750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL KIT CONLLNUOUS COMPESSION IMPLANT SUP-97-01853 CDM C1713 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT FIXED BEARING SUP-97-01855 CDM C1776 HCPCS 0278 RC outpatient 7132 7132 7132 57 4065.24 percent of total billed charges 7132 93 5776.92 percent of total billed charges 7132 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7132 other OPPS APC 7132 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7132 other OPPS APC 7132 51 3637.32 percent of total billed charges 7132 7132 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTERIOR AUGMENT COMBO SUP-97-01856 CDM C1776 HCPCS 0278 RC outpatient 3438 3438 3438 57 1959.66 percent of total billed charges 3438 93 2784.78 percent of total billed charges 3438 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3438 other OPPS APC 3438 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3438 other OPPS APC 3438 51 1753.38 percent of total billed charges 3438 3438 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL TRAY FIXED BEARING SUP-97-01857 CDM C1776 HCPCS 0278 RC outpatient 8696 8696 8696 57 4956.72 percent of total billed charges 8696 93 7043.76 percent of total billed charges 8696 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8696 other OPPS APC 8696 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8696 other OPPS APC 8696 51 4434.96 percent of total billed charges 8696 8696 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL POSTERIOR STABILIZED CEMMENTED SUP-97-01858 CDM C1776 HCPCS 0278 RC outpatient 8329.5 8329.5 8329.5 57 4747.82 percent of total billed charges 8329.5 93 6746.9 percent of total billed charges 8329.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8329.5 other OPPS APC 8329.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8329.5 other OPPS APC 8329.5 51 4248.05 percent of total billed charges 8329.5 8329.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THIN OSTEOTOME BLADE 8MMX3 SUP-97-01859 CDM 0272 RC outpatient 996 996 996 74 737.04 percent of total billed charges 996 93 806.76 percent of total billed charges 996 996 other OPPS APC 996 996 other OPPS APC 996 27.63 275.19 percent of total billed charges 996 996 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HUMERAL CUP 32MM, 4MM" SUP-97-01860 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIVERSAL STEM FLUTED SUP-97-01861 CDM C1776 HCPCS 0278 RC outpatient 5376 5376 5376 57 3064.32 percent of total billed charges 5376 93 4354.56 percent of total billed charges 5376 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5376 other OPPS APC 5376 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5376 other OPPS APC 5376 51 2741.76 percent of total billed charges 5376 5376 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL AUGMENT COMBO SUP-97-01862 CDM C1776 HCPCS 0278 RC outpatient 3438 3438 3438 57 1959.66 percent of total billed charges 3438 93 2784.78 percent of total billed charges 3438 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3438 other OPPS APC 3438 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3438 other OPPS APC 3438 51 1753.38 percent of total billed charges 3438 3438 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOF NEEDLE SUP-97-01863 CDM 0272 RC outpatient 408.7 408.7 408.7 74 302.44 percent of total billed charges 408.7 93 331.05 percent of total billed charges 408.7 408.7 other OPPS APC 408.7 408.7 other OPPS APC 408.7 27.63 112.92 percent of total billed charges 408.7 408.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.1 SUP-97-01865 CDM 0272 RC outpatient 245 245 245 74 181.3 percent of total billed charges 245 93 198.45 percent of total billed charges 245 245 other OPPS APC 245 245 other OPPS APC 245 27.63 67.69 percent of total billed charges 245 245 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PILOT WIRE SUP-97-01866 CDM outpatient 162.4 162.4 162.4 162.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLENOID BASEPLATE SUP-97-01867 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CENTER SCREW SUP-97-01868 CDM C1713 HCPCS 0278 RC outpatient 100 100 100 57 57 percent of total billed charges 100 93 81 percent of total billed charges 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 51 51 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERIPHERAL SCREW SUP-97-01869 CDM C1713 HCPCS 0278 RC outpatient 100 100 100 57 57 percent of total billed charges 100 93 81 percent of total billed charges 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 51 51 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERIPHERAL SCREW 4.5 SUP-97-01870 CDM C1713 HCPCS 0278 RC outpatient 100 100 100 57 57 percent of total billed charges 100 93 81 percent of total billed charges 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 51 51 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERIPHERAL SCREW 4.5 32MM SUP-97-01871 CDM C1713 HCPCS 0278 RC outpatient 100 100 100 57 57 percent of total billed charges 100 93 81 percent of total billed charges 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 51 51 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONCENTRIC GLENOSPHERE 32MM SUP-97-01872 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MODULAR HUMERAL STEM SUP-97-01873 CDM C1776 HCPCS 0278 RC outpatient 7500 7500 7500 57 4275 percent of total billed charges 7500 93 6075 percent of total billed charges 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 51 3825 percent of total billed charges 7500 7500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HUMERAL INSERT SUP-97-01874 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING ST 3.5MM X 22MM SUP-97-01875 CDM C1713 HCPCS 0278 RC outpatient 472.89 472.89 472.89 57 269.55 percent of total billed charges 472.89 93 383.04 percent of total billed charges 472.89 472.89 other OPPS APC 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 51 241.17 percent of total billed charges 472.89 472.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PUMP IRRIGATION SUP-97-01876 CDM 0272 RC outpatient 3250 3250 3250 74 2405 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 3250 other OPPS APC 3250 3250 other OPPS APC 3250 27.63 897.98 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZXT 225 LEN 14.0 SUP-97-01877 CDM C1840 HCPCS 0278 RC outpatient 2953.5 2953.5 2953.5 57 1683.5 percent of total billed charges 2953.5 93 2392.34 percent of total billed charges 2953.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2953.5 other OPPS APC 2953.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2953.5 other OPPS APC 2953.5 51 1506.29 percent of total billed charges 2953.5 2953.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 24.0D ACRYSOF IQ ASPHERIC NATURAL SUP-97-01878 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINERS FOR MOUTH GAG - ADULT SUP-97-01882 CDM 0271 RC outpatient 23 23 23 74 17.02 percent of total billed charges 23 93 18.63 percent of total billed charges 23 23 other OPPS APC 23 23 other OPPS APC 23 27.63 6.35 percent of total billed charges 23 23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACHILLES TENDON GRAFT11MM BONE BLOCK SUP-97-01884 CDM C1762 HCPCS 0278 RC outpatient 8000 8000 8000 57 4560 percent of total billed charges 8000 93 6480 percent of total billed charges 8000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8000 other OPPS APC 8000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8000 other OPPS APC 8000 51 4080 percent of total billed charges 8000 8000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLAR COMPONENT SUP-97-01885 CDM C1776 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMISPHERICAL SHELL SUP-97-01886 CDM C1776 HCPCS 0278 RC outpatient 7319 7319 7319 57 4171.83 percent of total billed charges 7319 93 5928.39 percent of total billed charges 7319 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7319 other OPPS APC 7319 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7319 other OPPS APC 7319 51 3732.69 percent of total billed charges 7319 7319 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW GAP PLATE SUP-97-01887 CDM C1776 HCPCS 0278 RC outpatient 429.8 429.8 429.8 57 244.99 percent of total billed charges 429.8 93 348.14 percent of total billed charges 429.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 429.8 other OPPS APC 429.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 429.8 other OPPS APC 429.8 51 219.2 percent of total billed charges 429.8 429.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTERIOR STABLIZER FEMORAL RIGHT SUP-97-01888 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRILOGY ACET SHELL 58MM SUP-97-01890 CDM C1776 HCPCS 0278 RC outpatient 4143.75 4143.75 4143.75 57 2361.94 percent of total billed charges 4143.75 93 3356.44 percent of total billed charges 4143.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4143.75 other OPPS APC 4143.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4143.75 other OPPS APC 4143.75 51 2113.31 percent of total billed charges 4143.75 4143.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD 12/14COCR SUP-97-01891 CDM C1776 HCPCS 0278 RC outpatient 2992.5 2992.5 2992.5 57 1705.73 percent of total billed charges 2992.5 93 2423.93 percent of total billed charges 2992.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2992.5 other OPPS APC 2992.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2992.5 other OPPS APC 2992.5 51 1526.18 percent of total billed charges 2992.5 2992.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MODULAR CUP 10 DEGREE LINER 58X36 SUP-97-01892 CDM C1776 HCPCS 0278 RC outpatient 4031.25 4031.25 4031.25 57 2297.81 percent of total billed charges 4031.25 93 3265.31 percent of total billed charges 4031.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4031.25 other OPPS APC 4031.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4031.25 other OPPS APC 4031.25 51 2055.94 percent of total billed charges 4031.25 4031.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIS HEADED SCREW 33MM SUP-97-01895 CDM C1713 HCPCS 0278 RC outpatient 250.25 250.25 250.25 57 142.64 percent of total billed charges 250.25 93 202.7 percent of total billed charges 250.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 250.25 other OPPS APC 250.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 250.25 other OPPS APC 250.25 51 127.63 percent of total billed charges 250.25 250.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER LOW PROFILE SUP-97-01896 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERLOOP #2 BLUE SUP-97-01897 CDM 0272 RC outpatient 378 378 378 74 279.72 percent of total billed charges 378 93 306.18 percent of total billed charges 378 378 other OPPS APC 378 378 other OPPS APC 378 27.63 104.44 percent of total billed charges 378 378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHAVER FORMULA 180 SUP-97-01898 CDM 0272 RC outpatient 3750 3750 3750 74 2775 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 3750 other OPPS APC 3750 3750 other OPPS APC 3750 27.63 1036.13 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT TENOLOK TENODESIS 50MM SUP-97-01899 CDM 0272 RC outpatient 1406.16 1406.16 1406.16 74 1040.56 percent of total billed charges 1406.16 93 1138.99 percent of total billed charges 1406.16 1406.16 other OPPS APC 1406.16 1406.16 other OPPS APC 1406.16 27.63 388.52 percent of total billed charges 1406.16 1406.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EASY CLIP MONCRTCL FIXN DEVICE 10X10X10 SUP-97-01900 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE GRAD BLACK 3.5MM TIP SUP-97-01901 CDM 0272 RC outpatient 350 350 350 74 259 percent of total billed charges 350 93 283.5 percent of total billed charges 350 350 other OPPS APC 350 350 other OPPS APC 350 27.63 96.71 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BEARING INSERT-PS 13MM SUP-97-01918 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT MIRROR 48X9MM SUP-97-01922 CDM C1776 HCPCS 0278 RC outpatient 1740 1740 1740 57 991.8 percent of total billed charges 1740 93 1409.4 percent of total billed charges 1740 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1740 other OPPS APC 1740 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1740 other OPPS APC 1740 51 887.4 percent of total billed charges 1740 1740 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL TWO POST MIRROR 50MM SUP-97-01923 CDM C1776 HCPCS 0278 RC outpatient 4725 4725 4725 57 2693.25 percent of total billed charges 4725 93 3827.25 percent of total billed charges 4725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4725 other OPPS APC 4725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4725 other OPPS APC 4725 51 2409.75 percent of total billed charges 4725 4725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BASEPLATE SUP-97-01924 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER SUP-97-01925 CDM 0272 RC outpatient 1185 1185 1185 74 876.9 percent of total billed charges 1185 93 959.85 percent of total billed charges 1185 1185 other OPPS APC 1185 1185 other OPPS APC 1185 27.63 327.42 percent of total billed charges 1185 1185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT SCW 3X11MM SUP-97-01926 CDM C1713 HCPCS 0278 RC outpatient 3859.88 3859.88 3859.88 57 2200.13 percent of total billed charges 3859.88 93 3126.5 percent of total billed charges 3859.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3859.88 other OPPS APC 3859.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3859.88 other OPPS APC 3859.88 51 1968.54 percent of total billed charges 3859.88 3859.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMISPHERICAL CLUSTER HOLE SHELL SUP-97-01927 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMISPHERICAL CLUSTER HOLE SHELL SUP-97-01928 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7MM VA-LCP 2-LATERAL DISTALFIBULAR SUP-97-01929 CDM C1713 HCPCS 0278 RC outpatient 2953.41 2953.41 2953.41 57 1683.44 percent of total billed charges 2953.41 93 2392.26 percent of total billed charges 2953.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2953.41 other OPPS APC 2953.41 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2953.41 other OPPS APC 2953.41 51 1506.24 percent of total billed charges 2953.41 2953.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 1.1MM SUP-97-01930 CDM 0272 RC outpatient 281.75 281.75 281.75 74 208.5 percent of total billed charges 281.75 93 228.22 percent of total billed charges 281.75 281.75 other OPPS APC 281.75 281.75 other OPPS APC 281.75 27.63 77.85 percent of total billed charges 281.75 281.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM CRTX SCREWLOW PROF HDSELF DRIVE14M SUP-97-01931 CDM C1713 HCPCS 0278 RC outpatient 141.72 141.72 141.72 57 80.78 percent of total billed charges 141.72 93 114.79 percent of total billed charges 141.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 141.72 other OPPS APC 141.72 141.72 other OPPS APC 141.72 51 72.28 percent of total billed charges 141.72 141.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM CRTX SCREWLOW PROF HDSELF DRIVE40M SUP-97-01932 CDM C1713 HCPCS 0278 RC outpatient 160.2 160.2 160.2 57 91.31 percent of total billed charges 160.2 93 129.76 percent of total billed charges 160.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.2 other OPPS APC 160.2 160.2 other OPPS APC 160.2 51 81.7 percent of total billed charges 160.2 160.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.0 DRILL SUP-97-01933 CDM 0272 RC outpatient 287.74 287.74 287.74 74 212.93 percent of total billed charges 287.74 93 233.07 percent of total billed charges 287.74 287.74 other OPPS APC 287.74 287.74 other OPPS APC 287.74 27.63 79.5 percent of total billed charges 287.74 287.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZXT 300 LEN 14.0 SUP-97-01934 CDM C1840 HCPCS 0278 RC outpatient 2953.5 2953.5 2953.5 57 1683.5 percent of total billed charges 2953.5 93 2392.34 percent of total billed charges 2953.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2953.5 other OPPS APC 2953.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2953.5 other OPPS APC 2953.5 51 1506.29 percent of total billed charges 2953.5 2953.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL COMPONENT SIZE 4 SUP-97-01935 CDM C1776 HCPCS 0278 RC outpatient 6000 6000 6000 57 3420 percent of total billed charges 6000 93 4860 percent of total billed charges 6000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6000 other OPPS APC 6000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6000 other OPPS APC 6000 51 3060 percent of total billed charges 6000 6000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BASEPATE SIZE 3 SUP-97-01936 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT RMLLLSIZE 3 SUP-97-01937 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL COMPONENT SIZE 4 SUP-97-01938 CDM C1776 HCPCS 0278 RC outpatient 6000 6000 6000 57 3420 percent of total billed charges 6000 93 4860 percent of total billed charges 6000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6000 other OPPS APC 6000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6000 other OPPS APC 6000 51 3060 percent of total billed charges 6000 6000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BASEPATE SIZE 3 SUP-97-01939 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT LM/RLSIZE 3 SUP-97-01940 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MDM HEAD SUPPORITER SUP-97-01941 CDM C1776 HCPCS 0278 RC outpatient 531.3 531.3 531.3 57 302.84 percent of total billed charges 531.3 93 430.35 percent of total billed charges 531.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 531.3 other OPPS APC 531.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 531.3 other OPPS APC 531.3 51 270.96 percent of total billed charges 531.3 531.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZXT 150LENS 20.5 SUP-97-01942 CDM C1780 HCPCS 0278 RC outpatient 2955 2955 2955 57 1684.35 percent of total billed charges 2955 93 2393.55 percent of total billed charges 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 51 1507.05 percent of total billed charges 2955 2955 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYMFONY ZXT 300LENS 14.0 SUP-97-01943 CDM C1840 HCPCS 0278 RC outpatient 2955 2955 2955 57 1684.35 percent of total billed charges 2955 93 2393.55 percent of total billed charges 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 51 1507.05 percent of total billed charges 2955 2955 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5.0 SELF TAPPING 34MM SUP-97-01945 CDM C1713 HCPCS 0278 RC outpatient 569.42 569.42 569.42 57 324.57 percent of total billed charges 569.42 93 461.23 percent of total billed charges 569.42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 569.42 other OPPS APC 569.42 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 569.42 other OPPS APC 569.42 51 290.4 percent of total billed charges 569.42 569.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA 4.5MM 2 EACH IN PK SUP-97-01946 CDM 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 825 other OPPS APC 825 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OBTURATOR BLUNT 4.5 SUP-97-01947 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA INFFOW ADAPTOR SUP-97-01948 CDM 0272 RC outpatient 220.5 220.5 220.5 74 163.17 percent of total billed charges 220.5 93 178.61 percent of total billed charges 220.5 220.5 other OPPS APC 220.5 220.5 other OPPS APC 220.5 27.63 60.92 percent of total billed charges 220.5 220.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA 5.5MM 2 EACH IN PK SUP-97-01949 CDM 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 825 other OPPS APC 825 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OBTURATOR BLUNT 5.5 SUP-97-01950 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA INFLOE W/STOPCOCK SUP-97-01951 CDM 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 750 other OPPS APC 750 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK ART SURF EF 5-6/YELLOW 10MM SUP-97-01952 CDM C1776 HCPCS 0278 RC outpatient 5212.5 5212.5 5212.5 57 2971.13 percent of total billed charges 5212.5 93 4222.13 percent of total billed charges 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 51 2658.38 percent of total billed charges 5212.5 5212.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2.7MM VA-LCP 2-LATERAL DSTL FIBULAR 7 HOLES SUP-97-01953 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7MM METASEAL SCR SLF TPNWT8 14MM SUP-97-01954 CDM C1713 HCPCS 0278 RC outpatient 195.88 195.88 195.88 57 111.65 percent of total billed charges 195.88 93 158.66 percent of total billed charges 195.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 195.88 other OPPS APC 195.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 195.88 other OPPS APC 195.88 51 99.9 percent of total billed charges 195.88 195.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7MM METAPHYSEAL SCR SLF TPNWT8 16MM SUP-97-01955 CDM C1713 HCPCS 0278 RC outpatient 180.08 180.08 180.08 57 102.65 percent of total billed charges 180.08 93 145.86 percent of total billed charges 180.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180.08 other OPPS APC 180.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180.08 other OPPS APC 180.08 51 91.84 percent of total billed charges 180.08 180.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7MM METAPHYSEAL SLF TPNWT8 18MM SUP-97-01956 CDM C1713 HCPCS 0278 RC outpatient 195.88 195.88 195.88 57 111.65 percent of total billed charges 195.88 93 158.66 percent of total billed charges 195.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 195.88 other OPPS APC 195.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 195.88 other OPPS APC 195.88 51 99.9 percent of total billed charges 195.88 195.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM CRTX SCREWLOW PROF HDSELF DRIVE16M SUP-97-01957 CDM C1713 HCPCS 0278 RC outpatient 165 165 165 57 94.05 percent of total billed charges 165 93 133.65 percent of total billed charges 165 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165 other OPPS APC 165 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165 other OPPS APC 165 51 84.15 percent of total billed charges 165 165 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM CRTX SCREWLOW PROF HDSELF DRIVE60M SUP-97-01958 CDM C1713 HCPCS 0278 RC outpatient 160.2 160.2 160.2 57 91.31 percent of total billed charges 160.2 93 129.76 percent of total billed charges 160.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.2 other OPPS APC 160.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160.2 other OPPS APC 160.2 51 81.7 percent of total billed charges 160.2 160.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.5MM QC/GOLD 180MM SUP-97-01959 CDM 0272 RC outpatient 313.88 313.88 313.88 74 232.27 percent of total billed charges 313.88 93 254.24 percent of total billed charges 313.88 313.88 other OPPS APC 313.88 313.88 other OPPS APC 313.88 27.63 86.73 percent of total billed charges 313.88 313.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE TUBULAR 1/3 7 HOLE SUP-97-01960 CDM C1713 HCPCS 0278 RC outpatient 644.28 644.28 644.28 57 367.24 percent of total billed charges 644.28 93 521.87 percent of total billed charges 644.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 644.28 other OPPS APC 644.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 644.28 other OPPS APC 644.28 51 328.58 percent of total billed charges 644.28 644.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 9 HOLE STRAIGHT 1/3 TUBULAR B&R SUP-97-01961 CDM C1713 HCPCS 0278 RC outpatient 1292.85 1292.85 1292.85 57 736.92 percent of total billed charges 1292.85 93 1047.21 percent of total billed charges 1292.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1292.85 other OPPS APC 1292.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1292.85 other OPPS APC 1292.85 51 659.35 percent of total billed charges 1292.85 1292.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 4.5 56MM SUP-97-01965 CDM C1713 HCPCS 0278 RC outpatient 95.08 95.08 95.08 57 54.2 percent of total billed charges 95.08 93 77.01 percent of total billed charges 95.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 95.08 other OPPS APC 95.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 95.08 other OPPS APC 95.08 51 48.49 percent of total billed charges 95.08 95.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOFT HEALING CAP SUP-97-01966 CDM 0272 RC outpatient 60.8 60.8 60.8 74 44.99 percent of total billed charges 60.8 93 49.25 percent of total billed charges 60.8 60.8 other OPPS APC 60.8 60.8 other OPPS APC 60.8 27.63 16.8 percent of total billed charges 60.8 60.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK ANGLE HIP STEM SUP-97-01968 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT PSC 2.5X11MM SUP-97-01969 CDM C1776 HCPCS 0278 RC outpatient 3419.25 3419.25 3419.25 57 1948.97 percent of total billed charges 3419.25 93 2769.59 percent of total billed charges 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 51 1743.82 percent of total billed charges 3419.25 3419.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPEED HAND & WRIST DRILL KIT SUP-97-01970 CDM 0272 RC outpatient 1445.85 1445.85 1445.85 74 1069.93 percent of total billed charges 1445.85 93 1171.14 percent of total billed charges 1445.85 1445.85 other OPPS APC 1445.85 1445.85 other OPPS APC 1445.85 27.63 399.49 percent of total billed charges 1445.85 1445.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPEED COMPRESSION IMPLANT KIT 13X12MM SUP-97-01971 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HUMERAL INSERT 3/36 SUP-97-01974 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIVERS REVERS SPACER 36+15MM SUP-97-01975 CDM C1776 HCPCS 0278 RC outpatient 1470 1470 1470 57 837.9 percent of total billed charges 1470 93 1190.7 percent of total billed charges 1470 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1470 other OPPS APC 1470 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1470 other OPPS APC 1470 51 749.7 percent of total billed charges 1470 1470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BEARING INSERT-PS 7SZ 11MM SUP-97-01976 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 9.0D TECNIS EYHANCE SUP-97-01978 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZXT300 21.0D SUP-97-01979 CDM C1840 HCPCS 0278 RC outpatient 2955 2955 2955 57 1684.35 percent of total billed charges 2955 93 2393.55 percent of total billed charges 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 51 1507.05 percent of total billed charges 2955 2955 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS ZXR00 20.5D SUP-97-01980 CDM C1780 HCPCS 0278 RC outpatient 2955 2955 2955 57 1684.35 percent of total billed charges 2955 93 2393.55 percent of total billed charges 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 51 1507.05 percent of total billed charges 2955 2955 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCE FIBER SUTURE SIZE 3-4-C SUP-97-01981 CDM outpatient 172 172 172 172 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZXT 225 LEN 15.5 SUP-97-01983 CDM C1840 HCPCS 0278 RC outpatient 2953.5 2953.5 2953.5 57 1683.5 percent of total billed charges 2953.5 93 2392.34 percent of total billed charges 2953.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2953.5 other OPPS APC 2953.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2953.5 other OPPS APC 2953.5 51 1506.29 percent of total billed charges 2953.5 2953.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPIKED WASHER 13.5MM/6.5 SUP-97-01984 CDM C1713 HCPCS 0278 RC outpatient 470.12 470.12 470.12 57 267.97 percent of total billed charges 470.12 93 380.8 percent of total billed charges 470.12 470.12 other OPPS APC 470.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 470.12 other OPPS APC 470.12 51 239.76 percent of total billed charges 470.12 470.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLUSTER ACETABULAR SHELL SUP-97-01985 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL CEMENT SPACER SUP-97-01986 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 9.5TI MULTILOC PROX HUMERANAIL T/CANN 16 SUP-97-01987 CDM C1776 HCPCS 0278 RC outpatient 5243.58 5243.58 5243.58 57 2988.84 percent of total billed charges 5243.58 93 4247.3 percent of total billed charges 5243.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5243.58 other OPPS APC 5243.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5243.58 other OPPS APC 5243.58 51 2674.23 percent of total billed charges 5243.58 5243.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5 MMTIMULTILOC SCREWLENGTH 44 STERILE SUP-97-01988 CDM C1776 HCPCS 0278 RC outpatient 993.66 993.66 993.66 57 566.39 percent of total billed charges 993.66 93 804.86 percent of total billed charges 993.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 993.66 other OPPS APC 993.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 993.66 other OPPS APC 993.66 51 506.77 percent of total billed charges 993.66 993.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5 MMTIMULTILOC SCREWLENGTH 48 STERILE SUP-97-01989 CDM C1776 HCPCS 0278 RC outpatient 993.66 993.66 993.66 57 566.39 percent of total billed charges 993.66 93 804.86 percent of total billed charges 993.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 993.66 other OPPS APC 993.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 993.66 other OPPS APC 993.66 51 506.77 percent of total billed charges 993.66 993.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 11.5MM HOLLOW DRILL BIT 9.5MM MULTILOC SUP-97-01990 CDM 0272 RC outpatient 1108.77 1108.77 1108.77 74 820.49 percent of total billed charges 1108.77 93 898.1 percent of total billed charges 1108.77 1108.77 other OPPS APC 1108.77 1108.77 other OPPS APC 1108.77 27.63 306.35 percent of total billed charges 1108.77 1108.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.8MM THREE FULTED DRILL BIT SUP-97-01991 CDM 0272 RC outpatient 863.49 863.49 863.49 74 638.98 percent of total billed charges 863.49 93 699.43 percent of total billed charges 863.49 863.49 other OPPS APC 863.49 863.49 other OPPS APC 863.49 27.63 238.58 percent of total billed charges 863.49 863.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.5MM DRILL BIT /CONICAL WSTOSTERILE SUP-97-01992 CDM 0272 RC outpatient 1216.41 1216.41 1216.41 74 900.14 percent of total billed charges 1216.41 93 985.29 percent of total billed charges 1216.41 1216.41 other OPPS APC 1216.41 1216.41 other OPPS APC 1216.41 27.63 336.09 percent of total billed charges 1216.41 1216.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.5MM GUIDE ROD W/STOPTROCAR TIP 230MM SUP-97-01993 CDM 0272 RC outpatient 268.66 268.66 268.66 74 198.81 percent of total billed charges 268.66 93 217.61 percent of total billed charges 268.66 268.66 other OPPS APC 268.66 268.66 other OPPS APC 268.66 27.63 74.23 percent of total billed charges 268.66 268.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOSPA TIBIAL INSERT CR 5/14MM SUP-97-01994 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SURGIMEND PRS SUP-97-01995 CDM C8358 HCPCS 0278 RC outpatient 9511.25 9511.25 9511.25 57 5421.41 percent of total billed charges 9511.25 93 7704.11 percent of total billed charges 9511.25 9511.25 other OPPS APC 9511.25 9511.25 other OPPS APC 9511.25 51 4850.74 percent of total billed charges 9511.25 9511.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL AUGMENT HALF BLOCK SIZE 3 5MM SUP-97-01996 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL AUGMENT HALF BLOCK SIZE 3 5MM SUP-97-01997 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL DISTAL AUGMENT LT SIZE4 5MM SUP-97-01998 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL DISTAL AUGMENT LT SIZE4 5MM SUP-97-01999 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K WIRE 1.6 SUP-97-02001 CDM C1713 HCPCS 0278 RC outpatient 39.18 39.18 39.18 57 22.33 percent of total billed charges 39.18 93 31.74 percent of total billed charges 39.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.18 other OPPS APC 39.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.18 other OPPS APC 39.18 51 19.98 percent of total billed charges 39.18 39.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR PS 2/LT SUP-97-02004 CDM C1776 HCPCS 0278 RC outpatient 9665.23 9665.23 9665.23 57 5509.18 percent of total billed charges 9665.23 93 7828.84 percent of total billed charges 9665.23 9665.23 other OPPS APC 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 51 4929.27 percent of total billed charges 9665.23 9665.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL 2F/IT SUP-97-02005 CDM C1776 HCPCS 0278 RC outpatient 4896.4 4896.4 4896.4 57 2790.95 percent of total billed charges 4896.4 93 3966.08 percent of total billed charges 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 51 2497.16 percent of total billed charges 4896.4 4896.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT PSC 2X11MM SUP-97-02006 CDM C1776 HCPCS 0278 RC outpatient 3419.25 3419.25 3419.25 57 1948.97 percent of total billed charges 3419.25 93 2769.59 percent of total billed charges 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 51 1743.82 percent of total billed charges 3419.25 3419.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA 29MM SUP-97-02007 CDM C1776 HCPCS 0278 RC outpatient 1979.64 1979.64 1979.64 57 1128.39 percent of total billed charges 1979.64 93 1603.51 percent of total billed charges 1979.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1979.64 other OPPS APC 1979.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1979.64 other OPPS APC 1979.64 51 1009.62 percent of total billed charges 1979.64 1979.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR PS 5/LT SUP-97-02008 CDM C1776 HCPCS 0278 RC outpatient 9665.23 9665.23 9665.23 57 5509.18 percent of total billed charges 9665.23 93 7828.84 percent of total billed charges 9665.23 9665.23 other OPPS APC 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 51 4929.27 percent of total billed charges 9665.23 9665.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL 2F/IT SUP-97-02009 CDM C1776 HCPCS 0278 RC outpatient 5522.5 5522.5 5522.5 57 3147.83 percent of total billed charges 5522.5 93 4473.23 percent of total billed charges 5522.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5522.5 other OPPS APC 5522.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5522.5 other OPPS APC 5522.5 51 2816.48 percent of total billed charges 5522.5 5522.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT PSC 5X9MM SUP-97-02010 CDM C1776 HCPCS 0278 RC outpatient 3144.3 3144.3 3144.3 57 1792.25 percent of total billed charges 3144.3 93 2546.88 percent of total billed charges 3144.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3144.3 other OPPS APC 3144.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3144.3 other OPPS APC 3144.3 51 1603.59 percent of total billed charges 3144.3 3144.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA 38MM SUP-97-02011 CDM C1776 HCPCS 0278 RC outpatient 1979.64 1979.64 1979.64 57 1128.39 percent of total billed charges 1979.64 93 1603.51 percent of total billed charges 1979.64 1979.64 other OPPS APC 1979.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1979.64 other OPPS APC 1979.64 51 1009.62 percent of total billed charges 1979.64 1979.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 19.5D TECNIS EYHANCE SUP-97-02013 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 18.0D TECNIS EYHANCE SUP-97-02014 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 20.5D SUP-97-02015 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 21.0D TECNIS EYHANCE SUP-97-02016 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 22.0D TECNIS EYHANCE SUP-97-02017 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 22.5D TECNIS EYHANCE SUP-97-02018 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTERIOR STABLIZER FEMORAL LEFT SUP-97-02019 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASYMMETRIC PATELLA 10MM SUP-97-02020 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIVERSAL TIBUAL BASEPLATE TOTAL KNEE SUP-97-02021 CDM C1776 HCPCS 0278 RC outpatient 3125 3125 3125 57 1781.25 percent of total billed charges 3125 93 2531.25 percent of total billed charges 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 51 1593.75 percent of total billed charges 3125 3125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BEARING INSERT-PS 11MM SUP-97-02022 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BB-TAK SUP-97-02023 CDM 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 200 other OPPS APC 200 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2 HOLE DLB COMP PLATE SUP-97-02024 CDM C1713 HCPCS 0278 RC outpatient 3197.5 3197.5 3197.5 57 1822.58 percent of total billed charges 3197.5 93 2589.98 percent of total billed charges 3197.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3197.5 other OPPS APC 3197.5 3197.5 other OPPS APC 3197.5 51 1630.73 percent of total billed charges 3197.5 3197.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4 HOLE DLB COMP PLATE SUP-97-02025 CDM C1713 HCPCS 0278 RC outpatient 4270 4270 4270 57 2433.9 percent of total billed charges 4270 93 3458.7 percent of total billed charges 4270 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4270 other OPPS APC 4270 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4270 other OPPS APC 4270 51 2177.7 percent of total billed charges 4270 4270 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE TROCAR TIP .45IN SUP-97-02026 CDM C1713 HCPCS 0278 RC outpatient 88 88 88 57 50.16 percent of total billed charges 88 93 71.28 percent of total billed charges 88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 88 other OPPS APC 88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 88 other OPPS APC 88 51 44.88 percent of total billed charges 88 88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCRW 4.0 SUP-97-02027 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO PRO SCRW3.5X 20MM SUP-97-02028 CDM C1713 HCPCS 0278 RC outpatient 140 140 140 57 79.8 percent of total billed charges 140 93 113.4 percent of total billed charges 140 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 140 other OPPS APC 140 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 140 other OPPS APC 140 51 71.4 percent of total billed charges 140 140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO PRO SCRW3.5X 22MM SUP-97-02029 CDM C1713 HCPCS 0278 RC outpatient 140 140 140 57 79.8 percent of total billed charges 140 93 113.4 percent of total billed charges 140 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 140 other OPPS APC 140 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 140 other OPPS APC 140 51 71.4 percent of total billed charges 140 140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO PRO SCRW3.5X 26MM SUP-97-02030 CDM C1713 HCPCS 0278 RC outpatient 200 200 200 57 114 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 51 102 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO PRO SCRW3.5X 20MM SUP-97-02031 CDM C1713 HCPCS 0278 RC outpatient 402.5 402.5 402.5 57 229.43 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 51 205.28 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. .062 GUIDE WIRE TROCAR TIP SUP-97-02032 CDM C1713 HCPCS 0278 RC outpatient 60 60 60 57 34.2 percent of total billed charges 60 93 48.6 percent of total billed charges 60 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 60 other OPPS APC 60 60 other OPPS APC 60 51 30.6 percent of total billed charges 60 60 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT CALIBRATED 2.0 SUP-97-02033 CDM 0272 RC outpatient 332.5 332.5 332.5 74 246.05 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 332.5 other OPPS APC 332.5 332.5 other OPPS APC 332.5 27.63 91.87 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.5 DRILL BIT CALIBRATED SUP-97-02034 CDM 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 297.5 other OPPS APC 297.5 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PRO SCRWT16.7X 75MMCANN18MM SUP-97-02035 CDM C1713 HCPCS 0278 RC outpatient 1074 1074 1074 57 612.18 percent of total billed charges 1074 93 869.94 percent of total billed charges 1074 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1074 other OPPS APC 1074 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1074 other OPPS APC 1074 51 547.74 percent of total billed charges 1074 1074 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. G-WIRE W/TRCR TIPNON- THREDED12 SUP-97-02036 CDM outpatient 88 88 88 88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 21.5D SUP-97-02037 CDM C1780 HCPCS 0278 RC outpatient 402.5 402.5 402.5 57 229.43 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 51 205.28 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHAMPION SLINGSHOT 45LEFT SUP-97-02038 CDM outpatient 612.5 612.5 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHAMPION SLINGSHOT 45RIGHT SUP-97-02039 CDM outpatient 507.5 507.5 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRIVER 2MM SCREW HEX SET SUP-97-02040 CDM 0272 RC outpatient 238 238 238 74 176.12 percent of total billed charges 238 93 192.78 percent of total billed charges 238 238 other OPPS APC 238 238 other OPPS APC 238 27.63 65.76 percent of total billed charges 238 238 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER BLADEPATELLA W/ PILOT HOLE SZ38 SUP-97-02041 CDM 0272 RC outpatient 306.25 306.25 306.25 74 226.63 percent of total billed charges 306.25 93 248.06 percent of total billed charges 306.25 306.25 other OPPS APC 306.25 306.25 other OPPS APC 306.25 27.63 84.62 percent of total billed charges 306.25 306.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK FEMORAL SZ F-LT SUP-97-02042 CDM C1776 HCPCS 0278 RC outpatient 12600 12600 12600 57 7182 percent of total billed charges 12600 93 10206 percent of total billed charges 12600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12600 other OPPS APC 12600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12600 other OPPS APC 12600 51 6426 percent of total billed charges 12600 12600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN PC STEMMED TIBIAL PLATE SZ5 SUP-97-02043 CDM C1776 HCPCS 0278 RC outpatient 5468.75 5468.75 5468.75 57 3117.19 percent of total billed charges 5468.75 93 4429.69 percent of total billed charges 5468.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5468.75 other OPPS APC 5468.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5468.75 other OPPS APC 5468.75 51 2789.06 percent of total billed charges 5468.75 5468.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK ART SURF EF 5-6/GREEN 10MM SUP-97-02044 CDM C1776 HCPCS 0278 RC outpatient 5212.5 5212.5 5212.5 57 2971.13 percent of total billed charges 5212.5 93 4222.13 percent of total billed charges 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 51 2658.38 percent of total billed charges 5212.5 5212.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN PROLONG ALL-POLY PATELLA 35MM SUP-97-02045 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN STRAIGHT STEM EXT 15MM X 30MM SUP-97-02046 CDM C1776 HCPCS 0278 RC outpatient 3484.38 3484.38 3484.38 57 1986.1 percent of total billed charges 3484.38 93 2822.35 percent of total billed charges 3484.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3484.38 other OPPS APC 3484.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3484.38 other OPPS APC 3484.38 51 1777.03 percent of total billed charges 3484.38 3484.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 18.5D SUP-97-02048 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 19.0D TECNIS EYHANCE SUP-97-02049 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE BALL SUP-97-02050 CDM 0272 RC outpatient 591.36 591.36 591.36 74 437.61 percent of total billed charges 591.36 93 479 percent of total billed charges 591.36 591.36 other OPPS APC 591.36 591.36 other OPPS APC 591.36 27.63 163.39 percent of total billed charges 591.36 591.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 03X285 SUP-97-02051 CDM C1713 HCPCS 0278 RC outpatient 262.5 262.5 262.5 57 149.63 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 51 133.88 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL AO SUP-97-02052 CDM 0272 RC outpatient 380.1 380.1 380.1 74 281.27 percent of total billed charges 380.1 93 307.88 percent of total billed charges 380.1 380.1 other OPPS APC 380.1 380.1 other OPPS APC 380.1 27.63 105.02 percent of total billed charges 380.1 380.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL NAIL 12 x 330MM T2 STANDARD SUP-97-02053 CDM C1713 HCPCS 0278 RC outpatient 2734.2 2734.2 2734.2 57 1558.49 percent of total billed charges 2734.2 93 2214.7 percent of total billed charges 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 51 1394.44 percent of total billed charges 2734.2 2734.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 55MM SUP-97-02054 CDM C1713 HCPCS 0278 RC outpatient 394.8 394.8 394.8 57 225.04 percent of total billed charges 394.8 93 319.79 percent of total billed charges 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 51 201.35 percent of total billed charges 394.8 394.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL AO SUP-97-02055 CDM 0272 RC outpatient 380.1 380.1 380.1 74 281.27 percent of total billed charges 380.1 93 307.88 percent of total billed charges 380.1 380.1 other OPPS APC 380.1 380.1 other OPPS APC 380.1 27.63 105.02 percent of total billed charges 380.1 380.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMI FEMORAL SHAFT166.202MM SUP-97-02056 CDM C1762 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 37.5MM SUP-97-02057 CDM C1713 HCPCS 0278 RC outpatient 394.8 394.8 394.8 57 225.04 percent of total billed charges 394.8 93 319.79 percent of total billed charges 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 51 201.35 percent of total billed charges 394.8 394.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 40MM SUP-97-02058 CDM C1713 HCPCS 0278 RC outpatient 394.8 394.8 394.8 57 225.04 percent of total billed charges 394.8 93 319.79 percent of total billed charges 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 51 201.35 percent of total billed charges 394.8 394.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 50MM SUP-97-02059 CDM C1713 HCPCS 0278 RC outpatient 394.8 394.8 394.8 57 225.04 percent of total billed charges 394.8 93 319.79 percent of total billed charges 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 51 201.35 percent of total billed charges 394.8 394.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE ASNIS 3MM 1.2MM X 100MM STERLIE SUP-97-02060 CDM C1713 HCPCS 0278 RC outpatient 122.88 122.88 122.88 57 70.04 percent of total billed charges 122.88 93 99.53 percent of total billed charges 122.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 122.88 other OPPS APC 122.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 122.88 other OPPS APC 122.88 51 62.67 percent of total billed charges 122.88 122.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMART TOE II SUP-97-02061 CDM C1713 HCPCS 0278 RC outpatient 2608.2 2608.2 2608.2 57 1486.67 percent of total billed charges 2608.2 93 2112.64 percent of total billed charges 2608.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2608.2 other OPPS APC 2608.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2608.2 other OPPS APC 2608.2 51 1330.18 percent of total billed charges 2608.2 2608.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW ASNIS MICRO,CANN 3.0MMX18/5MM" SUP-97-02062 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS MICRO 2MM LENGTH 18/5MM SUP-97-02063 CDM C1713 HCPCS 0278 RC outpatient 514.5 514.5 514.5 57 293.27 percent of total billed charges 514.5 93 416.75 percent of total billed charges 514.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 514.5 other OPPS APC 514.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 514.5 other OPPS APC 514.5 51 262.4 percent of total billed charges 514.5 514.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS MICRO 2MM LENGTH 12/5MM SUP-97-02064 CDM C1713 HCPCS 0278 RC outpatient 514.5 514.5 514.5 57 293.27 percent of total billed charges 514.5 93 416.75 percent of total billed charges 514.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 514.5 other OPPS APC 514.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 514.5 other OPPS APC 514.5 51 262.4 percent of total billed charges 514.5 514.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK ASNIS 2MM CANN 2.8MM COUP SUP-97-02065 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK ASNIS 3MM CANN 3.8MM AO COUP SUP-97-02066 CDM 0272 RC outpatient 751.29 751.29 751.29 74 555.95 percent of total billed charges 751.29 93 608.54 percent of total billed charges 751.29 751.29 other OPPS APC 751.29 751.29 other OPPS APC 751.29 27.63 207.58 percent of total billed charges 751.29 751.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE ASNIS 2MM 0.8 X 100 SUP-97-02067 CDM C1713 HCPCS 0278 RC outpatient 122.88 122.88 122.88 57 70.04 percent of total billed charges 122.88 93 99.53 percent of total billed charges 122.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 122.88 other OPPS APC 122.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 122.88 other OPPS APC 122.88 51 62.67 percent of total billed charges 122.88 122.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMISPHERICAL CLUSTER HOLE SHELL SUP-97-02068 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD SUP-97-02069 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POLYETHYLENE INSERT SUP-97-02070 CDM C1776 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POLYETHYLENE INSERT SUP-97-02071 CDM C1776 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK ANGLE HIP STEM SUP-97-02072 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANCELELLOUS BONE SCREW SUP-97-02073 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANCELELLOUS BONE SCREW SUP-97-02074 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANCELELLOUS BONE SCREW SUP-97-02075 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERSITOMIC STERILE PIN PACK SUP-97-02076 CDM 0272 RC outpatient 855 855 855 74 632.7 percent of total billed charges 855 93 692.55 percent of total billed charges 855 855 other OPPS APC 855 855 other OPPS APC 855 27.63 236.24 percent of total billed charges 855 855 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCE FIBER SIZE #5 SUP-97-02077 CDM 0272 RC outpatient 127.84 127.84 127.84 74 94.6 percent of total billed charges 127.84 93 103.55 percent of total billed charges 127.84 127.84 other OPPS APC 127.84 127.84 other OPPS APC 127.84 27.63 35.32 percent of total billed charges 127.84 127.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ACUVANCE PLUS 16X2G SUP-97-02078 CDM 0272 RC outpatient 1058.4 1058.4 1058.4 74 783.22 percent of total billed charges 1058.4 93 857.3 percent of total billed charges 1058.4 1058.4 other OPPS APC 1058.4 1058.4 other OPPS APC 1058.4 27.63 292.44 percent of total billed charges 1058.4 1058.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MALYUGIN RING MANIPULATOR SUP-97-02079 CDM outpatient 346.5 346.5 346.5 346.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTERIOR TIBIALIS TENDON SUP-97-02082 CDM C1762 HCPCS 0278 RC outpatient 6500 6500 6500 57 3705 percent of total billed charges 6500 93 5265 percent of total billed charges 6500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6500 other OPPS APC 6500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6500 other OPPS APC 6500 51 3315 percent of total billed charges 6500 6500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 23.0D TECNIS EYHANCE SUP-97-02084 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 16.5D TECNIS EYHANCE SUP-97-02085 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 20.0D TECNIS EYHANCE SUP-97-02086 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER CEMENTLESS SUP-97-02087 CDM C1776 HCPCS 0278 RC outpatient 2325 2325 2325 57 1325.25 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 51 1185.75 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESTORATION INSERT SUP-97-02088 CDM C1776 HCPCS 0278 RC outpatient 2325 2325 2325 57 1325.25 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 51 1185.75 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK ANGLE HIP STEM SUP-97-02089 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD SUP-97-02090 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TI CANN RETRO/ANT FEM 11MM X 200MM SUP-97-02093 CDM C1713 HCPCS 0278 RC outpatient 4487.4 4487.4 4487.4 57 2557.82 percent of total billed charges 4487.4 93 3634.79 percent of total billed charges 4487.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4487.4 other OPPS APC 4487.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4487.4 other OPPS APC 4487.4 51 2288.57 percent of total billed charges 4487.4 4487.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TI CANN RETRO/ANT FEM 11MM X 240MM SUP-97-02094 CDM C1713 HCPCS 0278 RC outpatient 4487.4 4487.4 4487.4 57 2557.82 percent of total billed charges 4487.4 93 3634.79 percent of total billed charges 4487.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4487.4 other OPPS APC 4487.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4487.4 other OPPS APC 4487.4 51 2288.57 percent of total billed charges 4487.4 4487.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TI END CAP TROCHANTERIC FIXATION SUP-97-02097 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANN TROCH FIX 10MM 130 400 SUP-97-02098 CDM C1713 HCPCS 0278 RC outpatient 4805.33 4805.33 4805.33 57 2739.04 percent of total billed charges 4805.33 93 3892.32 percent of total billed charges 4805.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4805.33 other OPPS APC 4805.33 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4805.33 other OPPS APC 4805.33 51 2450.72 percent of total billed charges 4805.33 4805.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG OMEGA PLUS 75MM SUP-97-02099 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 18.0D SUP-97-02100 CDM C1780 HCPCS 0278 RC outpatient 381.5 381.5 381.5 57 217.46 percent of total billed charges 381.5 93 309.02 percent of total billed charges 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 51 194.57 percent of total billed charges 381.5 381.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE SUP-97-02101 CDM 0272 RC outpatient 144 144 144 74 106.56 percent of total billed charges 144 93 116.64 percent of total billed charges 144 144 other OPPS APC 144 144 other OPPS APC 144 27.63 39.79 percent of total billed charges 144 144 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 12 HOLE OMEGA 10 PLATE SUP-97-02102 CDM C1713 HCPCS 0278 RC outpatient 2360.16 2360.16 2360.16 57 1345.29 percent of total billed charges 2360.16 93 1911.73 percent of total billed charges 2360.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2360.16 other OPPS APC 2360.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2360.16 other OPPS APC 2360.16 51 1203.68 percent of total billed charges 2360.16 2360.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL ST 4.5 X 36MM SUP-97-02103 CDM C1713 HCPCS 0278 RC outpatient 101.92 101.92 101.92 57 58.09 percent of total billed charges 101.92 93 82.56 percent of total billed charges 101.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 101.92 other OPPS APC 101.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 101.92 other OPPS APC 101.92 51 51.98 percent of total billed charges 101.92 101.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL ST 4.5 X 32MM SUP-97-02104 CDM C1713 HCPCS 0278 RC outpatient 101.92 101.92 101.92 57 58.09 percent of total billed charges 101.92 93 82.56 percent of total billed charges 101.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 101.92 other OPPS APC 101.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 101.92 other OPPS APC 101.92 51 51.98 percent of total billed charges 101.92 101.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.6 DRILL SUP-97-02105 CDM 0272 RC outpatient 330.96 330.96 330.96 74 244.91 percent of total billed charges 330.96 93 268.08 percent of total billed charges 330.96 330.96 other OPPS APC 330.96 330.96 other OPPS APC 330.96 27.63 91.44 percent of total billed charges 330.96 330.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL ST 4.5 X 38MM SUP-97-02106 CDM C1713 HCPCS 0278 RC outpatient 114.4 114.4 114.4 57 65.21 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 114.4 other OPPS APC 114.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 114.4 other OPPS APC 114.4 51 58.34 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMART TOE II SUP-97-02107 CDM C1713 HCPCS 0278 RC outpatient 2608.2 2608.2 2608.2 57 1486.67 percent of total billed charges 2608.2 93 2112.64 percent of total billed charges 2608.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2608.2 other OPPS APC 2608.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2608.2 other OPPS APC 2608.2 51 1330.18 percent of total billed charges 2608.2 2608.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 19.0D SUP-97-02110 CDM C1780 HCPCS 0278 RC outpatient 402.5 402.5 402.5 57 229.43 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 51 205.28 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 17.5 SUP-97-02112 CDM C1780 HCPCS 0278 RC outpatient 1282.5 1282.5 1282.5 57 731.03 percent of total billed charges 1282.5 93 1038.83 percent of total billed charges 1282.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1282.5 other OPPS APC 1282.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1282.5 other OPPS APC 1282.5 51 654.08 percent of total billed charges 1282.5 1282.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 17.0 SUP-97-02113 CDM C1780 HCPCS 0278 RC outpatient 926.25 926.25 926.25 57 527.96 percent of total billed charges 926.25 93 750.26 percent of total billed charges 926.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 926.25 other OPPS APC 926.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 926.25 other OPPS APC 926.25 51 472.39 percent of total billed charges 926.25 926.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BIOSTEON 6MM X 23MM SUP-97-02114 CDM C1713 HCPCS 0278 RC outpatient 799.11 799.11 799.11 57 455.49 percent of total billed charges 799.11 93 647.28 percent of total billed charges 799.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 799.11 other OPPS APC 799.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 799.11 other OPPS APC 799.11 51 407.55 percent of total billed charges 799.11 799.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BIOSTEON 8MM X 23MM SUP-97-02115 CDM C1713 HCPCS 0278 RC outpatient 799.11 799.11 799.11 57 455.49 percent of total billed charges 799.11 93 647.28 percent of total billed charges 799.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 799.11 other OPPS APC 799.11 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 799.11 other OPPS APC 799.11 51 407.55 percent of total billed charges 799.11 799.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE #2 BRAID 1/2 CURCLE K-POINT SUP-97-02116 CDM 0272 RC outpatient 113.64 113.64 113.64 74 84.09 percent of total billed charges 113.64 93 92.05 percent of total billed charges 113.64 113.64 other OPPS APC 113.64 113.64 other OPPS APC 113.64 27.63 31.4 percent of total billed charges 113.64 113.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER 9.5MM FLIP II SUP-97-02117 CDM 0272 RC outpatient 975 975 975 74 721.5 percent of total billed charges 975 93 789.75 percent of total billed charges 975 975 other OPPS APC 975 975 other OPPS APC 975 27.63 269.39 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERFSCRW S/ DISP SHTH BIO-COMP 7X23 SUP-97-02118 CDM C1713 HCPCS 0278 RC outpatient 705 705 705 57 401.85 percent of total billed charges 705 93 571.05 percent of total billed charges 705 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 51 359.55 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERFSCRW W/DISP SHTH BIO-COMP 9X23 SUP-97-02119 CDM C1713 HCPCS 0278 RC outpatient 1008 1008 1008 57 574.56 percent of total billed charges 1008 93 816.48 percent of total billed charges 1008 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1008 other OPPS APC 1008 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1008 other OPPS APC 1008 51 514.08 percent of total billed charges 1008 1008 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISPS KITTRANS-TIB ACL W/P SAWBLD SUP-97-02120 CDM C1713 HCPCS 0278 RC outpatient 116 116 116 57 66.12 percent of total billed charges 116 93 93.96 percent of total billed charges 116 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 116 other OPPS APC 116 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 116 other OPPS APC 116 51 59.16 percent of total billed charges 116 116 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERWIRE #2 FIBERSTICK SUP-97-02121 CDM C1713 HCPCS 0278 RC outpatient 200 200 200 57 114 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 51 102 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERLOOP #2 BLUE SUP-97-02122 CDM 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 200 other OPPS APC 200 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR PS 5/LT SUP-97-02123 CDM C1776 HCPCS 0278 RC outpatient 9665.23 9665.23 9665.23 57 5509.18 percent of total billed charges 9665.23 93 7828.84 percent of total billed charges 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 51 4929.27 percent of total billed charges 9665.23 9665.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSL INSERT 5X9MM SUP-97-02124 CDM C1713 HCPCS 0278 RC outpatient 3419.25 3419.25 3419.25 57 1948.97 percent of total billed charges 3419.25 93 2769.59 percent of total billed charges 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 51 1743.82 percent of total billed charges 3419.25 3419.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TISSUE EXPANDERS SUP-97-02125 CDM L8699 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 3250 other OPPS APC 3250 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TISSUE EXPANDERS SUP-97-02126 CDM L8699 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 3250 other OPPS APC 3250 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7MM CORTEX SUP-97-02128 CDM C1713 HCPCS 0278 RC outpatient 165.2 165.2 165.2 57 94.16 percent of total billed charges 165.2 93 133.81 percent of total billed charges 165.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165.2 other OPPS APC 165.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165.2 other OPPS APC 165.2 51 84.25 percent of total billed charges 165.2 165.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4MM VA-LCP 2-CLMN DSTLRADIUS PL SUP-97-02130 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 LOCKING 12MM SUP-97-02131 CDM C1713 HCPCS 0278 RC outpatient 532.77 532.77 532.77 57 303.68 percent of total billed charges 532.77 93 431.54 percent of total billed charges 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 51 271.71 percent of total billed charges 532.77 532.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 LOCKING 22MM SUP-97-02132 CDM C1713 HCPCS 0278 RC outpatient 532.77 532.77 532.77 57 303.68 percent of total billed charges 532.77 93 431.54 percent of total billed charges 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 51 271.71 percent of total billed charges 532.77 532.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 LOCKING 20MM SUP-97-02133 CDM C1713 HCPCS 0278 RC outpatient 532.77 532.77 532.77 57 303.68 percent of total billed charges 532.77 93 431.54 percent of total billed charges 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 51 271.71 percent of total billed charges 532.77 532.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 LOCKING 18MM SUP-97-02134 CDM C1713 HCPCS 0278 RC outpatient 532.77 532.77 532.77 57 303.68 percent of total billed charges 532.77 93 431.54 percent of total billed charges 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 51 271.71 percent of total billed charges 532.77 532.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER CEMENTLESS SUP-97-02135 CDM C1776 HCPCS 0278 RC outpatient 2325 2325 2325 57 1325.25 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 51 1185.75 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESTORATION INSERT SUP-97-02136 CDM C1776 HCPCS 0278 RC outpatient 2325 2325 2325 57 1325.25 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 51 1185.75 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD SUP-97-02137 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR PS 3/LT SUP-97-02138 CDM C1776 HCPCS 0278 RC outpatient 9665.23 9665.23 9665.23 57 5509.18 percent of total billed charges 9665.23 93 7828.84 percent of total billed charges 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 51 4929.27 percent of total billed charges 9665.23 9665.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIA FIT 3F/3T SUP-97-02139 CDM C1776 HCPCS 0278 RC outpatient 4896.4 4896.4 4896.4 57 2790.95 percent of total billed charges 4896.4 93 3966.08 percent of total billed charges 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 51 2497.16 percent of total billed charges 4896.4 4896.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSL INSERT 3X11MM SUP-97-02140 CDM C1776 HCPCS 0278 RC outpatient 3419.25 3419.25 3419.25 57 1948.97 percent of total billed charges 3419.25 93 2769.59 percent of total billed charges 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 51 1743.82 percent of total billed charges 3419.25 3419.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA 32MM SUP-97-02141 CDM C1776 HCPCS 0278 RC outpatient 1979.64 1979.64 1979.64 57 1128.39 percent of total billed charges 1979.64 93 1603.51 percent of total billed charges 1979.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1979.64 other OPPS APC 1979.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1979.64 other OPPS APC 1979.64 51 1009.62 percent of total billed charges 1979.64 1979.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSL INSERT 5X13MM SUP-97-02143 CDM C1776 HCPCS 0278 RC outpatient 3144.3 3144.3 3144.3 57 1792.25 percent of total billed charges 3144.3 93 2546.88 percent of total billed charges 3144.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3144.3 other OPPS APC 3144.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3144.3 other OPPS APC 3144.3 51 1603.59 percent of total billed charges 3144.3 3144.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO PLUS POWER SUP-97-02145 CDM L8614 HCPCS 0272 RC outpatient 8990 8990 8990 74 6652.6 percent of total billed charges 8990 93 7281.9 percent of total billed charges 8990 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8990 other OPPS APC 8990 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8990 other OPPS APC 8990 27.63 2483.94 percent of total billed charges 8990 8990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LCP ADAPTION 2.7MM 12 HOLE SUP-97-02146 CDM C1713 HCPCS 0278 RC outpatient 1479.87 1479.87 1479.87 57 843.53 percent of total billed charges 1479.87 93 1198.69 percent of total billed charges 1479.87 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1479.87 other OPPS APC 1479.87 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1479.87 other OPPS APC 1479.87 51 754.73 percent of total billed charges 1479.87 1479.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEPHROMAX BALLOON KIT SUP-97-02147 CDM C1726 HCPCS 0272 RC outpatient 775.53 775.53 775.53 74 573.89 percent of total billed charges 775.53 93 628.18 percent of total billed charges 775.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 775.53 other OPPS APC 775.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 775.53 other OPPS APC 775.53 27.63 214.28 percent of total billed charges 775.53 775.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX SLF TPN W/ STAR DRV 2.7 18M SUP-97-02148 CDM C1713 HCPCS 0278 RC outpatient 170.2 170.2 170.2 57 97.01 percent of total billed charges 170.2 93 137.86 percent of total billed charges 170.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 170.2 other OPPS APC 170.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 170.2 other OPPS APC 170.2 51 86.8 percent of total billed charges 170.2 170.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX SLF TPN W/ STAR DRV 2.7 12M SUP-97-02150 CDM C1713 HCPCS 0278 RC outpatient 170.2 170.2 170.2 57 97.01 percent of total billed charges 170.2 93 137.86 percent of total billed charges 170.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 170.2 other OPPS APC 170.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 170.2 other OPPS APC 170.2 51 86.8 percent of total billed charges 170.2 170.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERFSCRW W/DISP SHTH BIO-COMP 8X23 SUP-97-02155 CDM C1713 HCPCS 0278 RC outpatient 1008 1008 1008 57 574.56 percent of total billed charges 1008 93 816.48 percent of total billed charges 1008 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1008 other OPPS APC 1008 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1008 other OPPS APC 1008 51 514.08 percent of total billed charges 1008 1008 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K WIRE 1.25 PK/10 SUP-97-02156 CDM C1713 HCPCS 0278 RC outpatient 39.18 39.18 39.18 57 22.33 percent of total billed charges 39.18 93 31.74 percent of total billed charges 39.18 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.18 other OPPS APC 39.18 39.18 other OPPS APC 39.18 51 19.98 percent of total billed charges 39.18 39.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.0MM SUP-97-02157 CDM 0272 RC outpatient 297.85 297.85 297.85 74 220.41 percent of total billed charges 297.85 93 241.26 percent of total billed charges 297.85 297.85 other OPPS APC 297.85 297.85 other OPPS APC 297.85 27.63 82.3 percent of total billed charges 297.85 297.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 31.5D SUP-97-02165 CDM C1780 HCPCS 0278 RC outpatient 595 595 595 57 339.15 percent of total billed charges 595 93 481.95 percent of total billed charges 595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 595 other OPPS APC 595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 595 other OPPS APC 595 51 303.45 percent of total billed charges 595 595 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK ANGLE HIP STEM SUP-97-02166 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD SUP-97-02167 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLAR COMPONENT SUP-97-02168 CDM C1776 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK ANGLE HIP STEM SUP-97-02169 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK ANGLE HIP STEM SUP-97-02170 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMISPHERICAL CLUSTER HOLE SHELL SUP-97-02171 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMISPHERICAL CLUSTER HOLE SHELL SUP-97-02172 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR PS 2/RT SUP-97-02173 CDM C1776 HCPCS 0278 RC outpatient 9665.23 9665.23 9665.23 57 5509.18 percent of total billed charges 9665.23 93 7828.84 percent of total billed charges 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 51 4929.27 percent of total billed charges 9665.23 9665.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIA FIT 2F/2T SUP-97-02174 CDM C1776 HCPCS 0278 RC outpatient 4896.4 4896.4 4896.4 57 2790.95 percent of total billed charges 4896.4 93 3966.08 percent of total billed charges 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 51 2497.16 percent of total billed charges 4896.4 4896.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT PSC 2X13MM SUP-97-02175 CDM C1776 HCPCS 0278 RC outpatient 3419.25 3419.25 3419.25 57 1948.97 percent of total billed charges 3419.25 93 2769.59 percent of total billed charges 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 51 1743.82 percent of total billed charges 3419.25 3419.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 LOCKING 26MM SUP-97-02176 CDM C1713 HCPCS 0278 RC outpatient 532.77 532.77 532.77 57 303.68 percent of total billed charges 532.77 93 431.54 percent of total billed charges 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 51 271.71 percent of total billed charges 532.77 532.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7MM CORTEX 16MM SUP-97-02177 CDM C1713 HCPCS 0278 RC outpatient 165.2 165.2 165.2 57 94.16 percent of total billed charges 165.2 93 133.81 percent of total billed charges 165.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165.2 other OPPS APC 165.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165.2 other OPPS APC 165.2 51 84.25 percent of total billed charges 165.2 165.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4MM VA-LCP 2-CLMN DSTLRADIUS PL6H SUP-97-02178 CDM C1713 HCPCS 0278 RC outpatient 2494.5 2494.5 2494.5 57 1421.87 percent of total billed charges 2494.5 93 2020.55 percent of total billed charges 2494.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2494.5 other OPPS APC 2494.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2494.5 other OPPS APC 2494.5 51 1272.2 percent of total billed charges 2494.5 2494.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 LOCKING 16MM SUP-97-02179 CDM C1713 HCPCS 0278 RC outpatient 532.77 532.77 532.77 57 303.68 percent of total billed charges 532.77 93 431.54 percent of total billed charges 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 51 271.71 percent of total billed charges 532.77 532.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 21.5D TECNIS EYHANCE SUP-97-02180 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS TECNIS MONOFOCAL 24.0D SUP-97-02181 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 25.5D SUP-97-02182 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 17.0D TECNIS EYHANCE SUP-97-02183 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 24.5D TECNIS EYHANCE SUP-97-02184 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 21.5D TECNIS SUP-97-02185 CDM C1780 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK ANGLE HIP STEM SUP-97-02186 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 13.5D TECNIS EYHANCE SUP-97-02187 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS TECNIS MONOFOCAL 25.0D SUP-97-02188 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 33.5D SUP-97-02189 CDM C1780 HCPCS 0278 RC outpatient 595 595 595 57 339.15 percent of total billed charges 595 93 481.95 percent of total billed charges 595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 595 other OPPS APC 595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 595 other OPPS APC 595 51 303.45 percent of total billed charges 595 595 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 17.0D SUP-97-02191 CDM C1780 HCPCS 0278 RC outpatient 381.5 381.5 381.5 57 217.46 percent of total billed charges 381.5 93 309.02 percent of total billed charges 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 51 194.57 percent of total billed charges 381.5 381.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR PS 3.5/RT SUP-97-02193 CDM C1776 HCPCS 0278 RC outpatient 9665.23 9665.23 9665.23 57 5509.18 percent of total billed charges 9665.23 93 7828.84 percent of total billed charges 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 51 4929.27 percent of total billed charges 9665.23 9665.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIA FIT3.5/3.5 SUP-97-02194 CDM C1776 HCPCS 0278 RC outpatient 4896.4 4896.4 4896.4 57 2790.95 percent of total billed charges 4896.4 93 3966.08 percent of total billed charges 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 51 2497.16 percent of total billed charges 4896.4 4896.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PS INSERT 3.5X9MM SUP-97-02195 CDM C1776 HCPCS 0278 RC outpatient 3144.3 3144.3 3144.3 57 1792.25 percent of total billed charges 3144.3 93 2546.88 percent of total billed charges 3144.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3144.3 other OPPS APC 3144.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3144.3 other OPPS APC 3144.3 51 1603.59 percent of total billed charges 3144.3 3144.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA 35MM SUP-97-02196 CDM C1776 HCPCS 0278 RC outpatient 2232 2232 2232 57 1272.24 percent of total billed charges 2232 93 1807.92 percent of total billed charges 2232 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2232 other OPPS APC 2232 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2232 other OPPS APC 2232 51 1138.32 percent of total billed charges 2232 2232 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER PATELLA STERILE KNEE 46MM SUP-97-02197 CDM 0272 RC outpatient 768 768 768 74 568.32 percent of total billed charges 768 93 622.08 percent of total billed charges 768 768 other OPPS APC 768 768 other OPPS APC 768 27.63 212.2 percent of total billed charges 768 768 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASYMMETRIC PATELLA 10MM X35 SUP-97-02198 CDM C1776 HCPCS 0278 RC outpatient 810 810 810 57 461.7 percent of total billed charges 810 93 656.1 percent of total billed charges 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 51 413.1 percent of total billed charges 810 810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BEARING INSERT-PS 9MMX5 SUP-97-02199 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER BLADE PATELLA W/ PILOT HOLE SZ41 SUP-97-02200 CDM 0272 RC outpatient 350 350 350 74 259 percent of total billed charges 350 93 283.5 percent of total billed charges 350 350 other OPPS APC 350 350 other OPPS APC 350 27.63 96.71 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK FEMORAL SZ F-RT SUP-97-02201 CDM C1776 HCPCS 0278 RC outpatient 12600 12600 12600 57 7182 percent of total billed charges 12600 93 10206 percent of total billed charges 12600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12600 other OPPS APC 12600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12600 other OPPS APC 12600 51 6426 percent of total billed charges 12600 12600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN PC STEMMED TIBIAL PLATE SZ5 SUP-97-02202 CDM C1776 HCPCS 0278 RC outpatient 3562.5 3562.5 3562.5 57 2030.63 percent of total billed charges 3562.5 93 2885.63 percent of total billed charges 3562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3562.5 other OPPS APC 3562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3562.5 other OPPS APC 3562.5 51 1816.88 percent of total billed charges 3562.5 3562.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK ART SURF EF 5-6/YELLOW 10MM SUP-97-02203 CDM C1776 HCPCS 0278 RC outpatient 6687.5 6687.5 6687.5 57 3811.88 percent of total billed charges 6687.5 93 5416.88 percent of total billed charges 6687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6687.5 other OPPS APC 6687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6687.5 other OPPS APC 6687.5 51 3410.63 percent of total billed charges 6687.5 6687.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER BLADEPATELLA W/ PILOT HOLE SZ46 SUP-97-02204 CDM 0272 RC outpatient 503.13 503.13 503.13 74 372.32 percent of total billed charges 503.13 93 407.54 percent of total billed charges 503.13 503.13 other OPPS APC 503.13 503.13 other OPPS APC 503.13 27.63 139.01 percent of total billed charges 503.13 503.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA ALL POLY VE 38MM SUP-97-02205 CDM C1776 HCPCS 0278 RC outpatient 2172 2172 2172 57 1238.04 percent of total billed charges 2172 93 1759.32 percent of total billed charges 2172 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2172 other OPPS APC 2172 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2172 other OPPS APC 2172 51 1107.72 percent of total billed charges 2172 2172 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 19.5D SUP-97-02209 CDM C1780 HCPCS 0278 RC outpatient 926.25 926.25 926.25 57 527.96 percent of total billed charges 926.25 93 750.26 percent of total billed charges 926.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 926.25 other OPPS APC 926.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 926.25 other OPPS APC 926.25 51 472.39 percent of total billed charges 926.25 926.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAP 3 DBM / STEM CELLS 5CC SUP-97-02210 CDM C1762 HCPCS 0278 RC outpatient 5857.5 5857.5 5857.5 57 3338.78 percent of total billed charges 5857.5 93 4744.58 percent of total billed charges 5857.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5857.5 other OPPS APC 5857.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5857.5 other OPPS APC 5857.5 51 2987.33 percent of total billed charges 5857.5 5857.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAIR HUGGER / UPPER BODY SUP-97-02219 CDM 0271 RC outpatient 25.52 25.52 25.52 74 18.88 percent of total billed charges 25.52 93 20.67 percent of total billed charges 25.52 25.52 other OPPS APC 25.52 25.52 other OPPS APC 25.52 27.63 7.05 percent of total billed charges 25.52 25.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 2.0 150MM MINI FRAG CANN SUP-97-02235 CDM 0272 RC outpatient 1446.24 1446.24 1446.24 74 1070.22 percent of total billed charges 1446.24 93 1171.45 percent of total billed charges 1446.24 1446.24 other OPPS APC 1446.24 1446.24 other OPPS APC 1446.24 27.63 399.6 percent of total billed charges 1446.24 1446.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI ST CORT CANN 3.O 14MM SELF TAP SUP-97-02236 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI ST CORT CANN 3.O 16MM SELF TAP SUP-97-02237 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI LT CANN LCK 3.O 15MM N/S SUP-97-02238 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI LT CANN LCK 3.O 16MM N/S SUP-97-02239 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX F THREAD 3.5MM X 18MM SUP-97-02240 CDM C1713 HCPCS 0278 RC outpatient 106.2 106.2 106.2 57 60.53 percent of total billed charges 106.2 93 86.02 percent of total billed charges 106.2 106.2 other OPPS APC 106.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.2 other OPPS APC 106.2 51 54.16 percent of total billed charges 106.2 106.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI LT CANN LCK 3.O 28MM N/S SUP-97-022400 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET TBG BEAMER IRR PUMP SUP-97-02241 CDM 0272 RC outpatient 60 60 60 74 44.4 percent of total billed charges 60 93 48.6 percent of total billed charges 60 60 other OPPS APC 60 60 other OPPS APC 60 27.63 16.58 percent of total billed charges 60 60 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTED STEM SUP-97-02242 CDM C1776 HCPCS 0278 RC outpatient 3008.5 3008.5 3008.5 57 1714.85 percent of total billed charges 3008.5 93 2436.89 percent of total billed charges 3008.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3008.5 other OPPS APC 3008.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3008.5 other OPPS APC 3008.5 51 1534.34 percent of total billed charges 3008.5 3008.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL POSTERIOR AUGMENT SIZE 4 5MM SUP-97-02243 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OFFSET ADAPTER SUP-97-02244 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOTAL STABILLZER TIBIAL INSERT 3 13MM SUP-97-02245 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE GEMINUS VOLAR DISTAL 3 HOLE LT SUP-97-02246 CDM C1713 HCPCS 0278 RC outpatient 1974 1974 1974 57 1125.18 percent of total billed charges 1974 93 1598.94 percent of total billed charges 1974 1974 other OPPS APC 1974 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1974 other OPPS APC 1974 51 1006.74 percent of total billed charges 1974 1974 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL NON-LOC 3.5MM X 10MM SUP-97-02247 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG THREADED LOCKING 2.3MM X 21MM SUP-97-02248 CDM C1713 HCPCS 0278 RC outpatient 252 252 252 57 143.64 percent of total billed charges 252 93 204.12 percent of total billed charges 252 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 51 128.52 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG THREADED LOCKING 2.3MM X 22MM SUP-97-02249 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOOK 10 X 250MM SUP-97-02251 CDM 0272 RC outpatient 2266.5 2266.5 2266.5 74 1677.21 percent of total billed charges 2266.5 93 1835.87 percent of total billed charges 2266.5 2266.5 other OPPS APC 2266.5 2266.5 other OPPS APC 2266.5 27.63 626.23 percent of total billed charges 2266.5 2266.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAY REV INST SYS CVD OSTEOTOME SUP-97-02252 CDM 0272 RC outpatient 928.5 928.5 928.5 74 687.09 percent of total billed charges 928.5 93 752.09 percent of total billed charges 928.5 928.5 other OPPS APC 928.5 928.5 other OPPS APC 928.5 27.63 256.54 percent of total billed charges 928.5 928.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAY REV INST SYS FLEXIIBLE OSTEOTOME SUP-97-02253 CDM 0272 RC outpatient 1081.5 1081.5 1081.5 74 800.31 percent of total billed charges 1081.5 93 876.02 percent of total billed charges 1081.5 1081.5 other OPPS APC 1081.5 1081.5 other OPPS APC 1081.5 27.63 298.82 percent of total billed charges 1081.5 1081.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX PROFILE LOW 2.4X12MM SUP-97-02254 CDM C1713 HCPCS 0278 RC outpatient 385 385 385 57 219.45 percent of total billed charges 385 93 311.85 percent of total billed charges 385 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 51 196.35 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING PROFILE LOW 2.4X12MM SUP-97-02255 CDM C1713 HCPCS 0278 RC outpatient 626.5 626.5 626.5 57 357.11 percent of total billed charges 626.5 93 507.47 percent of total billed charges 626.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 626.5 other OPPS APC 626.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 626.5 other OPPS APC 626.5 51 319.52 percent of total billed charges 626.5 626.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING PROFILE LOW 2.4X14MM SUP-97-02256 CDM C1713 HCPCS 0278 RC outpatient 437.5 437.5 437.5 57 249.38 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 51 223.13 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO-PRO STR PLT 2.4 MM6 HOLE SUP-97-02257 CDM C1713 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACERS 9MM NARROW BLOCK SUP-97-02258 CDM C1776 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACERS 11MM NARROW BLOCK SUP-97-02259 CDM C1776 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACERS 13MM NARROW BLOCK SUP-97-02260 CDM C1776 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACERS 15MM NARROW BLOCK SUP-97-02261 CDM C1776 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT SOLID SUP-97-02262 CDM 0272 RC outpatient 464.63 464.63 464.63 74 343.83 percent of total billed charges 464.63 93 376.35 percent of total billed charges 464.63 464.63 other OPPS APC 464.63 464.63 other OPPS APC 464.63 27.63 128.38 percent of total billed charges 464.63 464.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD 4.0 X36 SUP-97-02263 CDM C1713 HCPCS 0278 RC outpatient 451.5 451.5 451.5 57 257.36 percent of total billed charges 451.5 93 365.72 percent of total billed charges 451.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 451.5 other OPPS APC 451.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 451.5 other OPPS APC 451.5 51 230.27 percent of total billed charges 451.5 451.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TWIST LONG THREAD 2.0X12 SUP-97-02264 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TWIST LONG THREAD 2.0X12 SUP-97-02265 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8 TRIAL BASEPLATE SUP-97-02266 CDM C1776 HCPCS 0278 RC outpatient 345.8 345.8 345.8 57 197.11 percent of total billed charges 345.8 93 280.1 percent of total billed charges 345.8 345.8 other OPPS APC 345.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 345.8 other OPPS APC 345.8 51 176.36 percent of total billed charges 345.8 345.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASYMMETRIC PATELLA 40 SUP-97-02267 CDM C1776 HCPCS 0278 RC outpatient 506.1 506.1 506.1 57 288.48 percent of total billed charges 506.1 93 409.94 percent of total billed charges 506.1 506.1 other OPPS APC 506.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 506.1 other OPPS APC 506.1 51 258.11 percent of total billed charges 506.1 506.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOTAL STABILLZER TIBIAL INSERT 4 13MM SUP-97-02270 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING ABTHERA SUP-97-02271 CDM E2402 HCPCS 0272 RC outpatient 1420.56 1420.56 1420.56 74 1051.21 percent of total billed charges 1420.56 93 1150.65 percent of total billed charges 1420.56 1420.56 other OPPS APC 1420.56 1420.56 other OPPS APC 1420.56 27.63 392.5 percent of total billed charges 1420.56 1420.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TWIST DRILL 2.5X26 MM SUP-97-02272 CDM 0272 RC outpatient 271.43 271.43 271.43 74 200.86 percent of total billed charges 271.43 93 219.86 percent of total billed charges 271.43 271.43 other OPPS APC 271.43 271.43 other OPPS APC 271.43 27.63 75 percent of total billed charges 271.43 271.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK 1.2MM SCREW 53MM SUP-97-02273 CDM 0272 RC outpatient 353.68 353.68 353.68 74 261.72 percent of total billed charges 353.68 93 286.48 percent of total billed charges 353.68 353.68 other OPPS APC 353.68 353.68 other OPPS APC 353.68 27.63 97.72 percent of total billed charges 353.68 353.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 27.0D TECNIS EYHANCE SUP-97-02274 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL DISTAL FIXATION PEG SUP-97-02276 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZXR00 LENS 19.0D SUP-97-02277 CDM C1780 HCPCS 0278 RC outpatient 2685 2685 2685 57 1530.45 percent of total billed charges 2685 93 2174.85 percent of total billed charges 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 51 1369.35 percent of total billed charges 2685 2685 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 13.0D TECNIS EYHANCE SUP-97-02286 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTERIOR STABLIZER FEMORAL RIGHT SUP-97-02287 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AWL TAPERED 3 .8MM DISPOSABLE SUP-97-02288 CDM outpatient 158.08 158.08 158.08 158.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISP FIRSTPASS STR PASSR SELF SUP-97-02289 CDM 0272 RC outpatient 595 595 595 74 440.3 percent of total billed charges 595 93 481.95 percent of total billed charges 595 595 other OPPS APC 595 595 other OPPS APC 595 27.63 164.4 percent of total billed charges 595 595 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MULTIFIX S PEEK 5.5MM SUP-97-02290 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEALICOIL PK 5.5MMW/UB-2BL UTP SUP-97-02291 CDM C1713 HCPCS 0278 RC outpatient 1035 1035 1035 57 589.95 percent of total billed charges 1035 93 838.35 percent of total billed charges 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 51 527.85 percent of total billed charges 1035 1035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEALICOIL PK 5.5MMW/UB-2BL CBR SUP-97-02292 CDM C1713 HCPCS 0278 RC outpatient 990 990 990 57 564.3 percent of total billed charges 990 93 801.9 percent of total billed charges 990 990 other OPPS APC 990 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 990 other OPPS APC 990 51 504.9 percent of total billed charges 990 990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISPOSABLE KIT FOR1.8MM SHOULDER Q SUP-97-02293 CDM 0272 RC outpatient 747 747 747 74 552.78 percent of total billed charges 747 93 605.07 percent of total billed charges 747 747 other OPPS APC 747 747 other OPPS APC 747 27.63 206.4 percent of total billed charges 747 747 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ANCHOR 1.8MM Q-FIX SUP-97-02294 CDM C1713 HCPCS 0278 RC outpatient 1230 1230 1230 57 701.1 percent of total billed charges 1230 93 996.3 percent of total billed charges 1230 1230 other OPPS APC 1230 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1230 other OPPS APC 1230 51 627.3 percent of total billed charges 1230 1230 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 16.5 SUP-97-02295 CDM C1780 HCPCS 0278 RC outpatient 1251.15 1251.15 1251.15 57 713.16 percent of total billed charges 1251.15 93 1013.43 percent of total billed charges 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 51 638.09 percent of total billed charges 1251.15 1251.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 17.5D SUP-97-02296 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNICONDYAR METAL BACKED SUP-97-02299 CDM C1776 HCPCS 0278 RC outpatient 6646.5 6646.5 6646.5 57 3788.51 percent of total billed charges 6646.5 93 5383.67 percent of total billed charges 6646.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6646.5 other OPPS APC 6646.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6646.5 other OPPS APC 6646.5 51 3389.72 percent of total billed charges 6646.5 6646.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNICONDYAR METAL BACKED SUP-97-02300 CDM C1776 HCPCS 0278 RC outpatient 2907 2907 2907 57 1656.99 percent of total billed charges 2907 93 2354.67 percent of total billed charges 2907 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2907 other OPPS APC 2907 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2907 other OPPS APC 2907 51 1482.57 percent of total billed charges 2907 2907 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSC TIBIAL INSERT 3X13MM SUP-97-02301 CDM C1776 HCPCS 0278 RC outpatient 3417.5 3417.5 3417.5 57 1947.98 percent of total billed charges 3417.5 93 2768.18 percent of total billed charges 3417.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3417.5 other OPPS APC 3417.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3417.5 other OPPS APC 3417.5 51 1742.93 percent of total billed charges 3417.5 3417.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN STRAIGHT STEM EXT 15MMX75MM SUP-97-02303 CDM C1776 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AWL TAPERED 3 .8MM DISPOSABLE SUP-97-02306 CDM 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 200 other OPPS APC 200 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MULTIFIX S PEEK 5.5MM SUP-97-02307 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEALICOIL PK 4.5MMW/ ULTRA TAPE CBRD SUP-97-02308 CDM C1713 HCPCS 0278 RC outpatient 1035 1035 1035 57 589.95 percent of total billed charges 1035 93 838.35 percent of total billed charges 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 51 527.85 percent of total billed charges 1035 1035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPIFIX 11MM SUP-97-02311 CDM Q4186 HCPCS 0636 RC outpatient 19991 19991 169.88 169.88 fee schedule 19991 93 16192.7 percent of total billed charges 19991 19991 other OPPS APC 19991 19991 other OPPS APC 19991 24.86 4969.76 percent of total billed charges 169.88 19991 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZXT 225 LEN 19.0 SUP-97-02312 CDM C1840 HCPCS 0278 RC outpatient 2953.5 2953.5 2953.5 57 1683.5 percent of total billed charges 2953.5 93 2392.34 percent of total billed charges 2953.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2953.5 other OPPS APC 2953.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2953.5 other OPPS APC 2953.5 51 1506.29 percent of total billed charges 2953.5 2953.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL KIT TI TROCHANTERIC 11 X 180 X 125 SUP-97-02313 CDM C1713 HCPCS 0278 RC outpatient 2618.1 2618.1 2618.1 57 1492.32 percent of total billed charges 2618.1 93 2120.66 percent of total billed charges 2618.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2618.1 other OPPS APC 2618.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2618.1 other OPPS APC 2618.1 51 1335.23 percent of total billed charges 2618.1 2618.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI LAG 10.5 X 95MM SUP-97-02314 CDM C1713 HCPCS 0278 RC outpatient 991.8 991.8 991.8 57 565.33 percent of total billed charges 991.8 93 803.36 percent of total billed charges 991.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 991.8 other OPPS APC 991.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 991.8 other OPPS APC 991.8 51 505.82 percent of total billed charges 991.8 991.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS ZXR00 22.0D SUP-97-02316 CDM C1780 HCPCS 0278 RC outpatient 2685 2685 2685 57 1530.45 percent of total billed charges 2685 93 2174.85 percent of total billed charges 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 51 1369.35 percent of total billed charges 2685 2685 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. METALON MARATHON POLY SUP-97-02317 CDM C1776 HCPCS 0278 RC outpatient 12400 12400 12400 57 7068 percent of total billed charges 12400 93 10044 percent of total billed charges 12400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12400 other OPPS APC 12400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12400 other OPPS APC 12400 51 6324 percent of total billed charges 12400 12400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.5 HEADLESS COMRESSIONSCREW W/32MM SUP-97-02318 CDM C1713 HCPCS 0278 RC outpatient 1239.3 1239.3 1239.3 57 706.4 percent of total billed charges 1239.3 93 1003.83 percent of total billed charges 1239.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1239.3 other OPPS APC 1239.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1239.3 other OPPS APC 1239.3 51 632.04 percent of total billed charges 1239.3 1239.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE 2.8 MMM W/ FLUTRS 300MM/150MM SUP-97-02319 CDM 0272 RC outpatient 406.04 406.04 406.04 74 300.47 percent of total billed charges 406.04 93 328.89 percent of total billed charges 406.04 406.04 other OPPS APC 406.04 406.04 other OPPS APC 406.04 27.63 112.19 percent of total billed charges 406.04 406.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEALICOIL RG SA 5.5MMW/2UB-BL CBRD SUP-97-02323 CDM C1713 HCPCS 0278 RC outpatient 1020 1020 1020 57 581.4 percent of total billed charges 1020 93 826.2 percent of total billed charges 1020 1020 other OPPS APC 1020 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1020 other OPPS APC 1020 51 520.2 percent of total billed charges 1020 1020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISPOSABLE KIT FOR2.8MM SHOULDER Q-FIX SUP-97-02324 CDM 0272 RC outpatient 747 747 747 74 552.78 percent of total billed charges 747 93 605.07 percent of total billed charges 747 747 other OPPS APC 747 747 other OPPS APC 747 27.63 206.4 percent of total billed charges 747 747 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ANCHOR 2.8MM Q-FIX SUP-97-02325 CDM C1713 HCPCS 0278 RC outpatient 1230 1230 1230 57 701.1 percent of total billed charges 1230 93 996.3 percent of total billed charges 1230 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1230 other OPPS APC 1230 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1230 other OPPS APC 1230 51 627.3 percent of total billed charges 1230 1230 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK ART SURF EF 3-4/YELLOW 23MM SUP-97-02326 CDM C1776 HCPCS 0278 RC outpatient 5212.5 5212.5 5212.5 57 2971.13 percent of total billed charges 5212.5 93 4222.13 percent of total billed charges 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 51 2658.38 percent of total billed charges 5212.5 5212.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK FEMORAL SZ E-LT SUP-97-02327 CDM C1776 HCPCS 0278 RC outpatient 12600 12600 12600 57 7182 percent of total billed charges 12600 93 10206 percent of total billed charges 12600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12600 other OPPS APC 12600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12600 other OPPS APC 12600 51 6426 percent of total billed charges 12600 12600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN PC STEMMED TIBIAL PLATE SZ3 SUP-97-02328 CDM C1776 HCPCS 0278 RC outpatient 3800 3800 3800 57 2166 percent of total billed charges 3800 93 3078 percent of total billed charges 3800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3800 other OPPS APC 3800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3800 other OPPS APC 3800 51 1938 percent of total billed charges 3800 3800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN STRAIGHT STEM EXT 15MM DIA SUP-97-02329 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTERIOR STABLIZER FEMORAL 8 RIGHT SUP-97-02330 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIVERSAL TIBUAL BASEPLATE TOTAL KNEE 8 SUP-97-02331 CDM C1776 HCPCS 0278 RC outpatient 3125 3125 3125 57 1781.25 percent of total billed charges 3125 93 2531.25 percent of total billed charges 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 51 1593.75 percent of total billed charges 3125 3125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BEARING INSERT-PS7 9MM SUP-97-02332 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BEARING INSERT-PS 6SZ 11MM SUP-97-02333 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LCP PROX HUMERUS 3.5 MM SUP-97-02336 CDM C1713 HCPCS 0278 RC outpatient 4367.53 4367.53 4367.53 57 2489.49 percent of total billed charges 4367.53 93 3537.7 percent of total billed charges 4367.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4367.53 other OPPS APC 4367.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4367.53 other OPPS APC 4367.53 51 2227.44 percent of total billed charges 4367.53 4367.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING SELF TAPPING 3.5 X 36MM SUP-97-02337 CDM C1713 HCPCS 0278 RC outpatient 472.89 472.89 472.89 57 269.55 percent of total billed charges 472.89 93 383.04 percent of total billed charges 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 51 241.17 percent of total billed charges 472.89 472.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STIMUBLAST SUP-97-02338 CDM C1713 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT EPICORD 3CMX5CM SUP-97-02339 CDM Q4187 HCPCS 0636 RC outpatient 8025 8025 277.05 277.05 fee schedule 8025 93 6500.25 percent of total billed charges 8025 8025 other OPPS APC 8025 8025 other OPPS APC 8025 24.86 1995.02 percent of total billed charges 277.05 8025 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 21.D SUP-97-02341 CDM C1780 HCPCS 0278 RC outpatient 1251.15 1251.15 1251.15 57 713.16 percent of total billed charges 1251.15 93 1013.43 percent of total billed charges 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 51 638.09 percent of total billed charges 1251.15 1251.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TISSUE EXPANDERS SUP-97-02348 CDM L8699 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 3250 other OPPS APC 3250 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TISSUE EXPANDERS SUP-97-02349 CDM L8699 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 3250 other OPPS APC 3250 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LO-PRO TMSS 3.5 X 30MM CORT SUP-97-02350 CDM C1713 HCPCS 0278 RC outpatient 140 140 140 57 79.8 percent of total billed charges 140 93 113.4 percent of total billed charges 140 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 140 other OPPS APC 140 140 other OPPS APC 140 51 71.4 percent of total billed charges 140 140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K WIRE 2.3X 150MM SUP-97-02351 CDM C1713 HCPCS 0278 RC outpatient 72 72 72 57 41.04 percent of total billed charges 72 93 58.32 percent of total billed charges 72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 72 other OPPS APC 72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 72 other OPPS APC 72 51 36.72 percent of total billed charges 72 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEDIUM HEANS LEFT PLATE SUP-97-02352 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING SCREW 3.5X20 SUP-97-02353 CDM C1713 HCPCS 0278 RC outpatient 488.25 488.25 488.25 57 278.3 percent of total billed charges 488.25 93 395.48 percent of total billed charges 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 51 249.01 percent of total billed charges 488.25 488.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON LOCKING SCREW 3.5X20 SUP-97-02354 CDM C1713 HCPCS 0278 RC outpatient 378 378 378 57 215.46 percent of total billed charges 378 93 306.18 percent of total billed charges 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 51 192.78 percent of total billed charges 378 378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K WIRE SMOOTH OLIVE SUP-97-02355 CDM C1713 HCPCS 0278 RC outpatient 252 252 252 57 143.64 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 51 128.52 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVANS OSTEOTOMY SUP-97-02356 CDM C1762 HCPCS 0278 RC outpatient 5000 5000 5000 57 2850 percent of total billed charges 5000 93 4050 percent of total billed charges 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 51 2550 percent of total billed charges 5000 5000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK ANGLE HIP STEM SUP-97-02357 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN LONG THREAD 4MM X 40MM SUP-97-02359 CDM C1713 HCPCS 0278 RC outpatient 659.75 659.75 659.75 57 376.06 percent of total billed charges 659.75 93 534.4 percent of total billed charges 659.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 659.75 other OPPS APC 659.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 659.75 other OPPS APC 659.75 51 336.47 percent of total billed charges 659.75 659.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS ZXR00 22.5D SUP-97-02361 CDM C1780 HCPCS 0278 RC outpatient 2685 2685 2685 57 1530.45 percent of total billed charges 2685 93 2174.85 percent of total billed charges 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 51 1369.35 percent of total billed charges 2685 2685 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 16.5 SUP-97-02363 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 16.0 SUP-97-02364 CDM C1780 HCPCS 0278 RC outpatient 1251.15 1251.15 1251.15 57 713.16 percent of total billed charges 1251.15 93 1013.43 percent of total billed charges 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 51 638.09 percent of total billed charges 1251.15 1251.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT1.7MM AO SUP-97-02365 CDM 0272 RC outpatient 276.5 276.5 276.5 74 204.61 percent of total billed charges 276.5 93 223.97 percent of total billed charges 276.5 276.5 other OPPS APC 276.5 276.5 other OPPS APC 276.5 27.63 76.4 percent of total billed charges 276.5 276.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE SCREW 2.4X14MM CORTEX SUP-97-02366 CDM C1713 HCPCS 0278 RC outpatient 385 385 385 57 219.45 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 51 196.35 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE SCREW 2.4X24MM CORTEX SUP-97-02367 CDM C1713 HCPCS 0278 RC outpatient 385 385 385 57 219.45 percent of total billed charges 385 93 311.85 percent of total billed charges 385 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 51 196.35 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VAL 2.4X14MM SUP-97-02368 CDM C1713 HCPCS 0278 RC outpatient 490 490 490 57 279.3 percent of total billed charges 490 93 396.9 percent of total billed charges 490 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 51 249.9 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VAL 2.4X18MM SUP-97-02369 CDM C1713 HCPCS 0278 RC outpatient 490 490 490 57 279.3 percent of total billed charges 490 93 396.9 percent of total billed charges 490 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 51 249.9 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE .045 X 5.91 SUP-97-02370 CDM 0272 RC outpatient 28 28 28 74 20.72 percent of total billed charges 28 93 22.68 percent of total billed charges 28 28 other OPPS APC 28 28 other OPPS APC 28 27.63 7.74 percent of total billed charges 28 28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIVERSAL 5 TH METARSAL HOOK PLATE SUP-97-02371 CDM C1713 HCPCS 0278 RC outpatient 2775 2775 2775 57 1581.75 percent of total billed charges 2775 93 2247.75 percent of total billed charges 2775 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2775 other OPPS APC 2775 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2775 other OPPS APC 2775 51 1415.25 percent of total billed charges 2775 2775 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZXR00 LENS 23.0 SUP-97-02376 CDM C1780 HCPCS 0278 RC outpatient 2685 2685 2685 57 1530.45 percent of total billed charges 2685 93 2174.85 percent of total billed charges 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 51 1369.35 percent of total billed charges 2685 2685 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT COUNTER SINK SUP-97-02377 CDM 0272 RC outpatient 589.51 589.51 589.51 74 436.24 percent of total billed charges 589.51 93 477.5 percent of total billed charges 589.51 589.51 other OPPS APC 589.51 589.51 other OPPS APC 589.51 27.63 162.88 percent of total billed charges 589.51 589.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K WIRE 1.2X150MM SUP-97-02379 CDM C1713 HCPCS 0278 RC outpatient 80 80 80 57 45.6 percent of total billed charges 80 93 64.8 percent of total billed charges 80 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 80 other OPPS APC 80 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 80 other OPPS APC 80 51 40.8 percent of total billed charges 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS COUNTERSINK SUP-97-02380 CDM 0272 RC outpatient 516.25 516.25 516.25 74 382.03 percent of total billed charges 516.25 93 418.16 percent of total billed charges 516.25 516.25 other OPPS APC 516.25 516.25 other OPPS APC 516.25 27.63 142.64 percent of total billed charges 516.25 516.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD HEADLESS 4.0X36 SUP-97-02381 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 18MM LOCKING GORILLA R3CON SUP-97-02382 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW NONLOCKING 3.5X18 SUP-97-02383 CDM C1713 HCPCS 0278 RC outpatient 437.5 437.5 437.5 57 249.38 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 51 223.13 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE R STANDARD LAPIDUS SUP-97-02384 CDM C1713 HCPCS 0278 RC outpatient 3362.5 3362.5 3362.5 57 1916.63 percent of total billed charges 3362.5 93 2723.63 percent of total billed charges 3362.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3362.5 other OPPS APC 3362.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3362.5 other OPPS APC 3362.5 51 1714.88 percent of total billed charges 3362.5 3362.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K WIRE 0.9X150MM SUP-97-02385 CDM 0272 RC outpatient 80 80 80 74 59.2 percent of total billed charges 80 93 64.8 percent of total billed charges 80 80 other OPPS APC 80 80 other OPPS APC 80 27.63 22.1 percent of total billed charges 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD HEADLESS 2.0X22 SUP-97-02386 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPIFIX 3X4MM SUP-97-02387 CDM Q4186 HCPCS 0636 RC outpatient 5948.75 5948.75 169.88 169.88 fee schedule 5948.75 93 4818.49 percent of total billed charges 5948.75 5948.75 other OPPS APC 5948.75 5948.75 other OPPS APC 5948.75 24.86 1478.86 percent of total billed charges 169.88 5948.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORAL RAE W/TAPERGUARD 5.5 SUP-97-02388 CDM 0272 RC outpatient 159.76 159.76 159.76 74 118.22 percent of total billed charges 159.76 93 129.41 percent of total billed charges 159.76 159.76 other OPPS APC 159.76 159.76 other OPPS APC 159.76 27.63 44.14 percent of total billed charges 159.76 159.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORAL RAE W/TAPERGUARD 6.0 SUP-97-02389 CDM 0272 RC outpatient 166.44 166.44 166.44 74 123.17 percent of total billed charges 166.44 93 134.82 percent of total billed charges 166.44 166.44 other OPPS APC 166.44 166.44 other OPPS APC 166.44 27.63 45.99 percent of total billed charges 166.44 166.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 24.5D SUP-97-02390 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 17.0D SUP-97-02391 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 17.0D SUP-97-02392 CDM C1780 HCPCS 0278 RC outpatient 1251 1251 1251 57 713.07 percent of total billed charges 1251 93 1013.31 percent of total billed charges 1251 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251 other OPPS APC 1251 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251 other OPPS APC 1251 51 638.01 percent of total billed charges 1251 1251 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 23.D SUP-97-02393 CDM C1780 HCPCS 0278 RC outpatient 1251 1251 1251 57 713.07 percent of total billed charges 1251 93 1013.31 percent of total billed charges 1251 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251 other OPPS APC 1251 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251 other OPPS APC 1251 51 638.01 percent of total billed charges 1251 1251 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZCT 150 21.5 SUP-97-02394 CDM C1840 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS TITANIUM CANN 5.0X50MM SUP-97-02396 CDM C1713 HCPCS 0278 RC outpatient 497 497 497 57 283.29 percent of total billed charges 497 93 402.57 percent of total billed charges 497 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 497 other OPPS APC 497 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 497 other OPPS APC 497 51 253.47 percent of total billed charges 497 497 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX NON LOCKING 3.5MM X 70MM SUP-97-02399 CDM C1713 HCPCS 0278 RC outpatient 97.28 97.28 97.28 57 55.45 percent of total billed charges 97.28 93 78.8 percent of total billed charges 97.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.28 other OPPS APC 97.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.28 other OPPS APC 97.28 51 49.61 percent of total billed charges 97.28 97.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX NON LOCKING 3.5MM X 75MM SUP-97-02400 CDM C1713 HCPCS 0278 RC outpatient 97.28 97.28 97.28 57 55.45 percent of total billed charges 97.28 93 78.8 percent of total billed charges 97.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.28 other OPPS APC 97.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.28 other OPPS APC 97.28 51 49.61 percent of total billed charges 97.28 97.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 75MM SUP-97-02401 CDM C1713 HCPCS 0278 RC outpatient 412.3 412.3 412.3 57 235.01 percent of total billed charges 412.3 93 333.96 percent of total billed charges 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 51 210.27 percent of total billed charges 412.3 412.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.5 X 216MM SUP-97-02402 CDM 0272 RC outpatient 537.6 537.6 537.6 74 397.82 percent of total billed charges 537.6 93 435.46 percent of total billed charges 537.6 537.6 other OPPS APC 537.6 537.6 other OPPS APC 537.6 27.63 148.54 percent of total billed charges 537.6 537.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROXIMAL LATERAL 2 HOLE RT SUP-97-02403 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX NON LOCKING 3.5MM X 40MM SUP-97-02404 CDM C1713 HCPCS 0278 RC outpatient 97.28 97.28 97.28 57 55.45 percent of total billed charges 97.28 93 78.8 percent of total billed charges 97.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.28 other OPPS APC 97.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.28 other OPPS APC 97.28 51 49.61 percent of total billed charges 97.28 97.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE CROSS KNOTLESS 4.75 SUP-97-02405 CDM C1713 HCPCS 0278 RC outpatient 1110 1110 1110 57 632.7 percent of total billed charges 1110 93 899.1 percent of total billed charges 1110 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1110 other OPPS APC 1110 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1110 other OPPS APC 1110 51 566.1 percent of total billed charges 1110 1110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE CROSS KNOTLESS 5.5 SUP-97-02406 CDM C1713 HCPCS 0278 RC outpatient 1110 1110 1110 57 632.7 percent of total billed charges 1110 93 899.1 percent of total billed charges 1110 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1110 other OPPS APC 1110 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1110 other OPPS APC 1110 51 566.1 percent of total billed charges 1110 1110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLSUTURE NEEDLE YKNOT ANCHOR SUP-97-02407 CDM C1713 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILLBIT NEEDLE YKNOT RC DISPOSABLE SUP-97-02408 CDM outpatient 259 259 259 259 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BEARING INSERT-PS 13MM SUP-97-02409 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT 7X7 EPIXL SUP-97-02410 CDM Q4186 HCPCS 0636 RC outpatient 9870 9870 169.88 169.88 fee schedule 9870 93 7994.7 percent of total billed charges 9870 9870 other OPPS APC 9870 9870 other OPPS APC 9870 24.86 2453.68 percent of total billed charges 169.88 9870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 18.5D SUP-97-02412 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON IOL 23.5D SUP-97-02413 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 22.5D SUP-97-02414 CDM C1780 HCPCS 0278 RC outpatient 1251.15 1251.15 1251.15 57 713.16 percent of total billed charges 1251.15 93 1013.43 percent of total billed charges 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 51 638.09 percent of total billed charges 1251.15 1251.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IM ROD 5/16 SUP-97-02415 CDM C1776 HCPCS 0278 RC outpatient 1521 1521 1521 57 866.97 percent of total billed charges 1521 93 1232.01 percent of total billed charges 1521 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1521 other OPPS APC 1521 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1521 other OPPS APC 1521 51 775.71 percent of total billed charges 1521 1521 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS PIN 3 SUP-97-02416 CDM C1713 HCPCS 0278 RC outpatient 865.8 865.8 865.8 57 493.51 percent of total billed charges 865.8 93 701.3 percent of total billed charges 865.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 865.8 other OPPS APC 865.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 865.8 other OPPS APC 865.8 51 441.56 percent of total billed charges 865.8 865.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HEADED NAIL PIM 1-1/2""" SUP-97-02417 CDM C1776 HCPCS 0278 RC outpatient 298.38 298.38 298.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 298.38 other OPPS APC 298.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 298.38 other OPPS APC 298.38 51 152.17 percent of total billed charges 298.38 298.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADED NAIL PIM 1/1/2 SUP-97-02417 CDM C1776 HCPCS 0278 RC outpatient 298.38 298.38 298.38 57 170.08 percent of total billed charges 298.38 93 241.69 percent of total billed charges 298.38 298.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADED NAIL PIM 3/4 SUP-97-02418 CDM C1713 HCPCS 0278 RC outpatient 213.68 213.68 213.68 57 121.8 percent of total billed charges 213.68 93 173.08 percent of total billed charges 213.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 213.68 other OPPS APC 213.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 213.68 other OPPS APC 213.68 51 108.98 percent of total billed charges 213.68 213.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT PSC 3X13MM SUP-97-02420 CDM C1776 HCPCS 0278 RC outpatient 3419.25 3419.25 3419.25 57 1948.97 percent of total billed charges 3419.25 93 2769.59 percent of total billed charges 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3419.25 other OPPS APC 3419.25 51 1743.82 percent of total billed charges 3419.25 3419.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BIOCOMPOSTE INTER-FERENCE 10X23 SUP-97-02423 CDM C1713 HCPCS 0278 RC outpatient 1008 1008 1008 57 574.56 percent of total billed charges 1008 93 816.48 percent of total billed charges 1008 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1008 other OPPS APC 1008 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1008 other OPPS APC 1008 51 514.08 percent of total billed charges 1008 1008 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACUTE AC REPAIR KIT SUP-97-02424 CDM 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL CANN TROCH FIX 10MM 130 SUP-97-02426 CDM C1713 HCPCS 0278 RC outpatient 5430.95 5430.95 5430.95 57 3095.64 percent of total billed charges 5430.95 93 4399.07 percent of total billed charges 5430.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5430.95 other OPPS APC 5430.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5430.95 other OPPS APC 5430.95 51 2769.78 percent of total billed charges 5430.95 5430.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZCT 225 23.00 SUP-97-02427 CDM C1840 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOTAL STABILLZER TIBIAL INSERT 3 11MM SUP-97-02428 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADES MAC SIZE 2 SUP-97-02429 CDM 0272 RC outpatient 583.1 583.1 583.1 74 431.49 percent of total billed charges 583.1 93 472.31 percent of total billed charges 583.1 583.1 other OPPS APC 583.1 583.1 other OPPS APC 583.1 27.63 161.11 percent of total billed charges 583.1 583.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADES MAC SIZE 1 SUP-97-02430 CDM 0272 RC outpatient 583.1 583.1 583.1 74 431.49 percent of total billed charges 583.1 93 472.31 percent of total billed charges 583.1 583.1 other OPPS APC 583.1 583.1 other OPPS APC 583.1 27.63 161.11 percent of total billed charges 583.1 583.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADES MILLER SIZE1 SUP-97-02431 CDM 0272 RC outpatient 583.1 583.1 583.1 74 431.49 percent of total billed charges 583.1 93 472.31 percent of total billed charges 583.1 583.1 other OPPS APC 583.1 583.1 other OPPS APC 583.1 27.63 161.11 percent of total billed charges 583.1 583.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SWANSON BASIL THUMB SUP-97-02439 CDM C1776 HCPCS 0278 RC outpatient 6155 6155 6155 57 3508.35 percent of total billed charges 6155 93 4985.55 percent of total billed charges 6155 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6155 other OPPS APC 6155 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6155 other OPPS APC 6155 51 3139.05 percent of total billed charges 6155 6155 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROSTOP PLUS GUIDE WIRE SUP-97-02440 CDM 0272 RC outpatient 332.5 332.5 332.5 74 246.05 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 332.5 other OPPS APC 332.5 332.5 other OPPS APC 332.5 27.63 91.87 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROSTOP SUBTALAR SUP-97-02441 CDM 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNOTLESS AC REPAIR SYSTEM SUP-97-02443 CDM 0272 RC outpatient 4277.5 4277.5 4277.5 74 3165.35 percent of total billed charges 4277.5 93 3464.78 percent of total billed charges 4277.5 4277.5 other OPPS APC 4277.5 4277.5 other OPPS APC 4277.5 27.63 1181.87 percent of total billed charges 4277.5 4277.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIGERSTICK #2 TIGERWIRE SUP-97-02444 CDM C1713 HCPCS 0278 RC outpatient 200 200 200 57 114 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 51 102 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CANNULATED DRILL BIT FIXOS +ÿ2.7MM, AO" SUP-97-02445 CDM 0272 RC outpatient 780.48 780.48 780.48 74 577.56 percent of total billed charges 780.48 93 632.19 percent of total billed charges 780.48 780.48 other OPPS APC 780.48 780.48 other OPPS APC 780.48 27.63 215.65 percent of total billed charges 780.48 780.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 10HOLE STRAIGHT 1/3 TUBULAR B&R SUP-97-02446 CDM C1713 HCPCS 0278 RC outpatient 975 975 975 57 555.75 percent of total billed charges 975 93 789.75 percent of total billed charges 975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 975 other OPPS APC 975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 975 other OPPS APC 975 51 497.25 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD SUP-97-02447 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE FULLY THREADED 1.6MM X 200MM SUP-97-02448 CDM C1713 HCPCS 0278 RC outpatient 188 188 188 57 107.16 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 51 95.88 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEINMANN PIN SMOOTH 2.5MM X 100MM SUP-97-02449 CDM C1713 HCPCS 0278 RC outpatient 105.6 105.6 105.6 57 60.19 percent of total billed charges 105.6 93 85.54 percent of total billed charges 105.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 105.6 other OPPS APC 105.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 105.6 other OPPS APC 105.6 51 53.86 percent of total billed charges 105.6 105.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE SMOOTH 1.4MM X 100MM SUP-97-02450 CDM C1713 HCPCS 0278 RC outpatient 55.68 55.68 55.68 57 31.74 percent of total billed charges 55.68 93 45.1 percent of total billed charges 55.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.68 other OPPS APC 55.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 55.68 other OPPS APC 55.68 51 28.4 percent of total billed charges 55.68 55.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 14MM NON LOCKING SUP-97-02451 CDM C1713 HCPCS 0278 RC outpatient 264.6 264.6 264.6 57 150.82 percent of total billed charges 264.6 93 214.33 percent of total billed charges 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 51 134.95 percent of total billed charges 264.6 264.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZCT300 LENS 22.5D SUP-97-02452 CDM C1780 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 22MM NON LOCKING SUP-97-02453 CDM C1713 HCPCS 0278 RC outpatient 264.6 264.6 264.6 57 150.82 percent of total billed charges 264.6 93 214.33 percent of total billed charges 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 51 134.95 percent of total billed charges 264.6 264.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 28MM NON LOCKING SUP-97-02454 CDM C1713 HCPCS 0278 RC outpatient 264.6 264.6 264.6 57 150.82 percent of total billed charges 264.6 93 214.33 percent of total billed charges 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 51 134.95 percent of total billed charges 264.6 264.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SUTURE ANCHOR, BIOCOMPOSITE" SUP-97-02455 CDM C1713 HCPCS 0278 RC outpatient 975 975 975 57 555.75 percent of total billed charges 975 93 789.75 percent of total billed charges 975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 975 other OPPS APC 975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 975 other OPPS APC 975 51 497.25 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSTRUMENT KIT DISPOSABLES SUP-97-02456 CDM outpatient 507.5 507.5 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 25.0D SUP-97-02457 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HELICAL BLADE 95MM TFNA SUP-97-02460 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TI CANN TFNA 10MM/130DEG SUP-97-02461 CDM C1713 HCPCS 0278 RC outpatient 6041.6 6041.6 6041.6 57 3443.71 percent of total billed charges 6041.6 93 4893.7 percent of total billed charges 6041.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6041.6 other OPPS APC 6041.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6041.6 other OPPS APC 6041.6 51 3081.22 percent of total billed charges 6041.6 6041.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG THREADED LOCKING 2.3MM X 19MM SUP-97-02462 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL LOCKING 3.5MMX11MM SUP-97-02463 CDM C1713 HCPCS 0278 RC outpatient 206.5 206.5 206.5 57 117.71 percent of total billed charges 206.5 93 167.27 percent of total billed charges 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 51 105.32 percent of total billed charges 206.5 206.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE GEMINUS VOLAR DISTAL RADI3 HOLE LT SUP-97-02464 CDM C1713 HCPCS 0278 RC outpatient 1881 1881 1881 57 1072.17 percent of total billed charges 1881 93 1523.61 percent of total billed charges 1881 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1881 other OPPS APC 1881 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1881 other OPPS APC 1881 51 959.31 percent of total billed charges 1881 1881 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLUSTER ACETABULAR SHELL SUP-97-02465 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANCELLOUS CHIPS 15CC SUP-97-02467 CDM C1762 HCPCS 0278 RC outpatient 1083 1083 1083 57 617.31 percent of total billed charges 1083 93 877.23 percent of total billed charges 1083 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1083 other OPPS APC 1083 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1083 other OPPS APC 1083 51 552.33 percent of total billed charges 1083 1083 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E +2.5 SUP-97-02468 CDM C1780 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DENTAL WIRE 24G SUP-97-02471 CDM C1713 HCPCS 0278 RC outpatient 546 546 546 57 311.22 percent of total billed charges 546 93 442.26 percent of total billed charges 546 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 546 other OPPS APC 546 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 546 other OPPS APC 546 51 278.46 percent of total billed charges 546 546 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DENTAL WIRE 22G SUP-97-02472 CDM C1713 HCPCS 0278 RC outpatient 317.35 317.35 317.35 57 180.89 percent of total billed charges 317.35 93 257.05 percent of total billed charges 317.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 317.35 other OPPS APC 317.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 317.35 other OPPS APC 317.35 51 161.85 percent of total billed charges 317.35 317.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT 5X6 XL-5560 SUP-97-02477 CDM Q4186 HCPCS 0636 RC outpatient 7977.5 7977.5 169.88 169.88 fee schedule 7977.5 93 6461.78 percent of total billed charges 7977.5 7977.5 other OPPS APC 7977.5 7977.5 other OPPS APC 7977.5 24.86 1983.21 percent of total billed charges 169.88 7977.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT SUP-97-02480 CDM 0272 RC outpatient 2493 2493 2493 74 1844.82 percent of total billed charges 2493 93 2019.33 percent of total billed charges 2493 2493 other OPPS APC 2493 2493 other OPPS APC 2493 27.63 688.82 percent of total billed charges 2493 2493 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG HIGH COMPRESSION 2.7MM X 19MM SUP-97-02483 CDM C1713 HCPCS 0278 RC outpatient 206.5 206.5 206.5 57 117.71 percent of total billed charges 206.5 93 167.27 percent of total billed charges 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 51 105.32 percent of total billed charges 206.5 206.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG HIGH COMPRESSION 2.7MM X 20MM SUP-97-02484 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG THREADED LOCKING 2.3MM X 19MM SUP-97-02485 CDM C1713 HCPCS 0278 RC outpatient 252 252 252 57 143.64 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 51 128.52 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLAR COMPONENT SUP-97-02487 CDM C1776 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORAL RAE W/ TAPERGUARD 6.5 SUP-97-02488 CDM 0272 RC outpatient 159.76 159.76 159.76 74 118.22 percent of total billed charges 159.76 93 129.41 percent of total billed charges 159.76 159.76 other OPPS APC 159.76 159.76 other OPPS APC 159.76 27.63 44.14 percent of total billed charges 159.76 159.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 26.0D SUP-97-02489 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HELICAL BLADE 105MM TFNA SUP-97-02490 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILLBIT 2.4 SUP-97-02491 CDM 0272 RC outpatient 350 350 350 74 259 percent of total billed charges 350 93 283.5 percent of total billed charges 350 350 other OPPS APC 350 350 other OPPS APC 350 27.63 96.71 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2 HOLE LOCKING 20MM SUP-97-02492 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 15.5D TECNIS EYHANCE SUP-97-02493 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAVENDER PIN GUARDS SUP-97-02498 CDM 0272 RC outpatient 84.4 84.4 84.4 74 62.46 percent of total billed charges 84.4 93 68.36 percent of total billed charges 84.4 84.4 other OPPS APC 84.4 84.4 other OPPS APC 84.4 27.63 23.32 percent of total billed charges 84.4 84.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TI CANN RETRO/ANT FEM 10MM X 380MM SUP-97-02500 CDM C1713 HCPCS 0278 RC outpatient 4760.68 4760.68 4760.68 57 2713.59 percent of total billed charges 4760.68 93 3856.15 percent of total billed charges 4760.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4760.68 other OPPS APC 4760.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4760.68 other OPPS APC 4760.68 51 2427.95 percent of total billed charges 4760.68 4760.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 300MM CANNULATED 13.0MM SUP-97-02501 CDM C1713 HCPCS 0278 RC outpatient 1974.72 1974.72 1974.72 57 1125.59 percent of total billed charges 1974.72 93 1599.52 percent of total billed charges 1974.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1974.72 other OPPS APC 1974.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1974.72 other OPPS APC 1974.72 51 1007.11 percent of total billed charges 1974.72 1974.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS COUNTERSINK SUP-97-02502 CDM 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD HEADED 4.0X38 SUP-97-02503 CDM C1713 HCPCS 0278 RC outpatient 451.5 451.5 451.5 57 257.36 percent of total billed charges 451.5 93 365.72 percent of total billed charges 451.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 451.5 other OPPS APC 451.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 451.5 other OPPS APC 451.5 51 230.27 percent of total billed charges 451.5 451.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT LYNC 2.0MM SUP-97-02504 CDM 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 437.5 other OPPS APC 437.5 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPRESSIVE STAPLE SUP-97-02505 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GEMNUS VOLAR DISTALRADIUS PLATE SUP-97-02506 CDM C1713 HCPCS 0278 RC outpatient 1611 1611 1611 57 918.27 percent of total billed charges 1611 93 1304.91 percent of total billed charges 1611 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1611 other OPPS APC 1611 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1611 other OPPS APC 1611 51 821.61 percent of total billed charges 1611 1611 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG THREADED LOCKING 2.3MM X 24MM SUP-97-02507 CDM C1713 HCPCS 0278 RC outpatient 206.5 206.5 206.5 57 117.71 percent of total billed charges 206.5 93 167.27 percent of total billed charges 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 51 105.32 percent of total billed charges 206.5 206.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG THREADED LOCKING 2.3MM X 26MM SUP-97-02508 CDM C1713 HCPCS 0278 RC outpatient 206.5 206.5 206.5 57 117.71 percent of total billed charges 206.5 93 167.27 percent of total billed charges 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 51 105.32 percent of total billed charges 206.5 206.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL LOCKING 3.5MMX16MM SUP-97-02509 CDM C1713 HCPCS 0278 RC outpatient 206.5 206.5 206.5 57 117.71 percent of total billed charges 206.5 93 167.27 percent of total billed charges 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 51 105.32 percent of total billed charges 206.5 206.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRIVER AO CONN SQUARE TIP 20MM SUP-97-02510 CDM 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 297.5 other OPPS APC 297.5 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BERKELEY SAFETOUCH COLLECT BTL LG SUP-97-02511 CDM 0271 RC outpatient 27.6 27.6 27.6 74 20.42 percent of total billed charges 27.6 93 22.36 percent of total billed charges 27.6 27.6 other OPPS APC 27.6 27.6 other OPPS APC 27.6 27.63 7.63 percent of total billed charges 27.6 27.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 2.0D SUP-97-02512 CDM C1780 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMISPHERICAL SOLID BACK SHELL SUP-97-02514 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTERIOR STABLIZER FEMORAL LEFT SUP-97-02515 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BEARING INSERT-PS7 16MM SUP-97-02516 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TISSUE EXPANDERS SUP-97-02517 CDM L8699 HCPCS 0278 RC outpatient 2835 2835 2835 57 1615.95 percent of total billed charges 2835 93 2296.35 percent of total billed charges 2835 2835 other OPPS APC 2835 2835 other OPPS APC 2835 51 1445.85 percent of total billed charges 2835 2835 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TISSUE EXPANDERS SUP-97-02518 CDM L8699 HCPCS 0278 RC outpatient 2835 2835 2835 57 1615.95 percent of total billed charges 2835 93 2296.35 percent of total billed charges 2835 2835 other OPPS APC 2835 2835 other OPPS APC 2835 51 1445.85 percent of total billed charges 2835 2835 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIGMA FEM SIZE 6 RIGHT SUP-97-02523 CDM C1776 HCPCS 0278 RC outpatient 8329.5 8329.5 8329.5 57 4747.82 percent of total billed charges 8329.5 93 6746.9 percent of total billed charges 8329.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8329.5 other OPPS APC 8329.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8329.5 other OPPS APC 8329.5 51 4248.05 percent of total billed charges 8329.5 8329.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MODULAR PLUS TIBIAL HEM WEDGE SUP-97-02524 CDM C1776 HCPCS 0278 RC outpatient 5536 5536 5536 57 3155.52 percent of total billed charges 5536 93 4484.16 percent of total billed charges 5536 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5536 other OPPS APC 5536 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5536 other OPPS APC 5536 51 2823.36 percent of total billed charges 5536 5536 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEARING MODULAR PLUS SIZE 4 SUP-97-02525 CDM C1776 HCPCS 0278 RC outpatient 8859.2 8859.2 8859.2 57 5049.74 percent of total billed charges 8859.2 93 7175.95 percent of total billed charges 8859.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8859.2 other OPPS APC 8859.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8859.2 other OPPS APC 8859.2 51 4518.19 percent of total billed charges 8859.2 8859.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT FIXED BEADING SUP-97-02526 CDM C1776 HCPCS 0278 RC outpatient 4647 4647 4647 57 2648.79 percent of total billed charges 4647 93 3764.07 percent of total billed charges 4647 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4647 other OPPS APC 4647 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4647 other OPPS APC 4647 51 2369.97 percent of total billed charges 4647 4647 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA ROUND DOME 35MM SUP-97-02527 CDM C1776 HCPCS 0278 RC outpatient 2358 2358 2358 57 1344.06 percent of total billed charges 2358 93 1909.98 percent of total billed charges 2358 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2358 other OPPS APC 2358 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2358 other OPPS APC 2358 51 1202.58 percent of total billed charges 2358 2358 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BN 4MM 45MM SS F-T CANC NS SM SUP-97-02528 CDM C1713 HCPCS 0278 RC outpatient 87.32 87.32 87.32 57 49.77 percent of total billed charges 87.32 93 70.73 percent of total billed charges 87.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 87.32 other OPPS APC 87.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 87.32 other OPPS APC 87.32 51 44.53 percent of total billed charges 87.32 87.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZCT525 LENS 19.5 SUP-97-02529 CDM C1780 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZXT225 LENS 12.5 SUP-97-02530 CDM C1780 HCPCS 0278 RC outpatient 2953.5 2953.5 2953.5 57 1683.5 percent of total billed charges 2953.5 93 2392.34 percent of total billed charges 2953.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2953.5 other OPPS APC 2953.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2953.5 other OPPS APC 2953.5 51 1506.29 percent of total billed charges 2953.5 2953.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMISPHERICAL SHELL SUP-97-02532 CDM C1776 HCPCS 0278 RC outpatient 7319 7319 7319 57 4171.83 percent of total billed charges 7319 93 5928.39 percent of total billed charges 7319 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7319 other OPPS APC 7319 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7319 other OPPS APC 7319 51 3732.69 percent of total billed charges 7319 7319 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW GAP PLATE SUP-97-02533 CDM C1776 HCPCS 0278 RC outpatient 429.8 429.8 429.8 57 244.99 percent of total billed charges 429.8 93 348.14 percent of total billed charges 429.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 429.8 other OPPS APC 429.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 429.8 other OPPS APC 429.8 51 219.2 percent of total billed charges 429.8 429.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMISPHERICAL SHELL 62 SUP-97-02534 CDM C1776 HCPCS 0278 RC outpatient 7319 7319 7319 57 4171.83 percent of total billed charges 7319 93 5928.39 percent of total billed charges 7319 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7319 other OPPS APC 7319 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7319 other OPPS APC 7319 51 3732.69 percent of total billed charges 7319 7319 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POLYETHYLENE INSERT SUP-97-02535 CDM C1776 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK ANGLE HIP STEM SUP-97-02536 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMISPHERICAL CLUSTER HOLE SHELL SUP-97-02537 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LUER LOCK TUBE CONNECTOR W/STOPCOCK SUP-97-02538 CDM 0272 RC outpatient 399.35 399.35 399.35 74 295.52 percent of total billed charges 399.35 93 323.47 percent of total billed charges 399.35 399.35 other OPPS APC 399.35 399.35 other OPPS APC 399.35 27.63 110.34 percent of total billed charges 399.35 399.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4MM VA LCP 2 COL DSTL RAD P6HH/3RT KIT SUP-97-02539 CDM C1713 HCPCS 0278 RC outpatient 7695 7695 7695 57 4386.15 percent of total billed charges 7695 93 6232.95 percent of total billed charges 7695 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7695 other OPPS APC 7695 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7695 other OPPS APC 7695 51 3924.45 percent of total billed charges 7695 7695 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4MM VA LOCKING SCREW STARDRIVE 26MM SUP-97-02540 CDM C1713 HCPCS 0278 RC outpatient 719.28 719.28 719.28 57 409.99 percent of total billed charges 719.28 93 582.62 percent of total billed charges 719.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 719.28 other OPPS APC 719.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 719.28 other OPPS APC 719.28 51 366.83 percent of total billed charges 719.28 719.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4MM VA LCP 2 COL DSTL RAD PTEMPLATES SUP-97-02541 CDM C1713 HCPCS 0278 RC outpatient 729 729 729 57 415.53 percent of total billed charges 729 93 590.49 percent of total billed charges 729 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 729 other OPPS APC 729 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 729 other OPPS APC 729 51 371.79 percent of total billed charges 729 729 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STANDERD HUMERAL HEAD SUP-97-02542 CDM C1713 HCPCS 0278 RC outpatient 7225 7225 7225 57 4118.25 percent of total billed charges 7225 93 5852.25 percent of total billed charges 7225 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7225 other OPPS APC 7225 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7225 other OPPS APC 7225 51 3684.75 percent of total billed charges 7225 7225 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENTED STEM 12MM SUP-97-02543 CDM C1776 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYMMETRIC PATELLA 11MM XA38 SUP-97-02544 CDM C1713 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BEARING INSERT-PS 13MM SUP-97-02545 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL ASNIS CANN 2MM AO COUPLING 1.7MM SUP-97-02546 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS MICRO 2MM LENGTH 16/7MM SUP-97-02547 CDM C1713 HCPCS 0278 RC outpatient 514.5 514.5 514.5 57 293.27 percent of total billed charges 514.5 93 416.75 percent of total billed charges 514.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 514.5 other OPPS APC 514.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 514.5 other OPPS APC 514.5 51 262.4 percent of total billed charges 514.5 514.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK 2.7/3.5MM SUP-97-02549 CDM 0272 RC outpatient 416.12 416.12 416.12 74 307.93 percent of total billed charges 416.12 93 337.06 percent of total billed charges 416.12 416.12 other OPPS APC 416.12 416.12 other OPPS APC 416.12 27.63 114.97 percent of total billed charges 416.12 416.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TISSUE EXPANDERS 700CC SUP-97-02553 CDM L8699 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 3875 other OPPS APC 3875 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX NON LOCKING 3.5MM X 26MM SUP-97-02554 CDM C1713 HCPCS 0278 RC outpatient 135.24 135.24 135.24 57 77.09 percent of total billed charges 135.24 93 109.54 percent of total billed charges 135.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 135.24 other OPPS APC 135.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 135.24 other OPPS APC 135.24 51 68.97 percent of total billed charges 135.24 135.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 36MM SUP-97-02555 CDM C1713 HCPCS 0278 RC outpatient 640.5 640.5 640.5 57 365.09 percent of total billed charges 640.5 93 518.81 percent of total billed charges 640.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 640.5 other OPPS APC 640.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 640.5 other OPPS APC 640.5 51 326.66 percent of total billed charges 640.5 640.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 34MM SUP-97-02556 CDM C1713 HCPCS 0278 RC outpatient 640.5 640.5 640.5 57 365.09 percent of total billed charges 640.5 93 518.81 percent of total billed charges 640.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 640.5 other OPPS APC 640.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 640.5 other OPPS APC 640.5 51 326.66 percent of total billed charges 640.5 640.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4 X 46MM SUP-97-02557 CDM C1713 HCPCS 0278 RC outpatient 412.3 412.3 412.3 57 235.01 percent of total billed charges 412.3 93 333.96 percent of total billed charges 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 51 210.27 percent of total billed charges 412.3 412.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 24MM SUP-97-02558 CDM C1713 HCPCS 0278 RC outpatient 412.3 412.3 412.3 57 235.01 percent of total billed charges 412.3 93 333.96 percent of total billed charges 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 51 210.27 percent of total billed charges 412.3 412.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0 X 55MM SUP-97-02559 CDM C1713 HCPCS 0278 RC outpatient 412.3 412.3 412.3 57 235.01 percent of total billed charges 412.3 93 333.96 percent of total billed charges 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 51 210.27 percent of total billed charges 412.3 412.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX NON LOCKING 3.5MM X 20MM SUP-97-02560 CDM C1713 HCPCS 0278 RC outpatient 97.28 97.28 97.28 57 55.45 percent of total billed charges 97.28 93 78.8 percent of total billed charges 97.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.28 other OPPS APC 97.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.28 other OPPS APC 97.28 51 49.61 percent of total billed charges 97.28 97.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 22MM SUP-97-02561 CDM C1713 HCPCS 0278 RC outpatient 412.3 412.3 412.3 57 235.01 percent of total billed charges 412.3 93 333.96 percent of total billed charges 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 51 210.27 percent of total billed charges 412.3 412.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 44MM SUP-97-02562 CDM C1713 HCPCS 0278 RC outpatient 412.3 412.3 412.3 57 235.01 percent of total billed charges 412.3 93 333.96 percent of total billed charges 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 51 210.27 percent of total billed charges 412.3 412.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX NON LOCKING 3.5MM X 24MM SUP-97-02563 CDM C1713 HCPCS 0278 RC outpatient 135.24 135.24 135.24 57 77.09 percent of total billed charges 135.24 93 109.54 percent of total billed charges 135.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 135.24 other OPPS APC 135.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 135.24 other OPPS APC 135.24 51 68.97 percent of total billed charges 135.24 135.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT SZ 1RM/LL 7MM SUP-97-02564 CDM C1776 HCPCS 0278 RC outpatient 2907 2907 2907 57 1656.99 percent of total billed charges 2907 93 2354.67 percent of total billed charges 2907 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2907 other OPPS APC 2907 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2907 other OPPS APC 2907 51 1482.57 percent of total billed charges 2907 2907 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIB SIZE 21UNI- SUP-97-02565 CDM C1776 HCPCS 0278 RC outpatient 4035 4035 4035 57 2299.95 percent of total billed charges 4035 93 3268.35 percent of total billed charges 4035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4035 other OPPS APC 4035 4035 other OPPS APC 4035 51 2057.85 percent of total billed charges 4035 4035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIGMA FEMORAL SIZE 1 LM/RL SUP-97-02566 CDM C1776 HCPCS 0278 RC outpatient 6646.5 6646.5 6646.5 57 3788.51 percent of total billed charges 6646.5 93 5383.67 percent of total billed charges 6646.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6646.5 other OPPS APC 6646.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6646.5 other OPPS APC 6646.5 51 3389.72 percent of total billed charges 6646.5 6646.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 7.5D TECNIS EYHANCE SUP-97-02569 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZCT 600 21.5D SUP-97-02570 CDM C1840 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROGRIP MESH 16X12 SUP-97-02571 CDM C1781 HCPCS 0278 RC outpatient 1433.04 1433.04 1433.04 57 816.83 percent of total billed charges 1433.04 93 1160.76 percent of total billed charges 1433.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1433.04 other OPPS APC 1433.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1433.04 other OPPS APC 1433.04 51 730.85 percent of total billed charges 1433.04 1433.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INMPLANT SYSTEM CPR MINI SCORPION SUP-97-02572 CDM 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUICKFIX SCREW 2X13MM SUP-97-02573 CDM C1713 HCPCS 0278 RC outpatient 720 720 720 57 410.4 percent of total billed charges 720 93 583.2 percent of total billed charges 720 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 720 other OPPS APC 720 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 720 other OPPS APC 720 51 367.2 percent of total billed charges 720 720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK ART SURF G 7-10/ BLUE 12MM SUP-97-02574 CDM C1776 HCPCS 0278 RC outpatient 6687.5 6687.5 6687.5 57 3811.88 percent of total billed charges 6687.5 93 5416.88 percent of total billed charges 6687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6687.5 other OPPS APC 6687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6687.5 other OPPS APC 6687.5 51 3410.63 percent of total billed charges 6687.5 6687.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL TWO POST MIRROR 42MM SUP-97-02575 CDM C1776 HCPCS 0278 RC outpatient 4725 4725 4725 57 2693.25 percent of total billed charges 4725 93 3827.25 percent of total billed charges 4725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4725 other OPPS APC 4725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4725 other OPPS APC 4725 51 2409.75 percent of total billed charges 4725 4725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT MIRROR 48X8MM SUP-97-02576 CDM C1776 HCPCS 0278 RC outpatient 1740 1740 1740 57 991.8 percent of total billed charges 1740 93 1409.4 percent of total billed charges 1740 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1740 other OPPS APC 1740 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1740 other OPPS APC 1740 51 887.4 percent of total billed charges 1740 1740 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT FOR MDM LINER 36 38C SUP-97-02577 CDM C1776 HCPCS 0278 RC outpatient 2325 2325 2325 57 1325.25 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 51 1185.75 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMISPHERICAL CLUSTER HOLE SHELL SUP-97-02578 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER CEMENTLESS 36MM C SUP-97-02579 CDM C1776 HCPCS 0278 RC outpatient 2325 2325 2325 57 1325.25 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 51 1185.75 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TI CANN TFNA 11MM/130DEG 380MM SUP-97-02580 CDM C1713 HCPCS 0278 RC outpatient 6711.35 6711.35 6711.35 57 3825.47 percent of total billed charges 6711.35 93 5436.19 percent of total billed charges 6711.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6711.35 other OPPS APC 6711.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6711.35 other OPPS APC 6711.35 51 3422.79 percent of total billed charges 6711.35 6711.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HELICAL BLADE 90MM TFNA SUP-97-02581 CDM C1713 HCPCS 0278 RC outpatient 2745.57 2745.57 2745.57 57 1564.97 percent of total billed charges 2745.57 93 2223.91 percent of total billed charges 2745.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2745.57 other OPPS APC 2745.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2745.57 other OPPS APC 2745.57 51 1400.24 percent of total billed charges 2745.57 2745.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK ART SURF EF 3/4/YELLOW 17MM SUP-97-02582 CDM C1776 HCPCS 0278 RC outpatient 5212.5 5212.5 5212.5 57 2971.13 percent of total billed charges 5212.5 93 4222.13 percent of total billed charges 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 51 2658.38 percent of total billed charges 5212.5 5212.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK FEMORAL SIZE D RT SUP-97-02583 CDM C1776 HCPCS 0278 RC outpatient 12600 12600 12600 57 7182 percent of total billed charges 12600 93 10206 percent of total billed charges 12600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12600 other OPPS APC 12600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12600 other OPPS APC 12600 51 6426 percent of total billed charges 12600 12600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER PILOTED HEADED 7.5 MM SUP-97-02584 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SWVLK TENE BIO COMP 8X19.5 MM SUP-97-02585 CDM C1713 HCPCS 0278 RC outpatient 1305 1305 1305 57 743.85 percent of total billed charges 1305 93 1057.05 percent of total billed charges 1305 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1305 other OPPS APC 1305 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1305 other OPPS APC 1305 51 665.55 percent of total billed charges 1305 1305 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BEARING INSERT-PS 16MM SUP-97-02586 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOOP EAR 5.2 BILLEAU MED 7IN SURG 7.7MM SUP-97-02587 CDM 0271 RC outpatient 113.52 113.52 113.52 74 84 percent of total billed charges 113.52 93 91.95 percent of total billed charges 113.52 113.52 other OPPS APC 113.52 113.52 other OPPS APC 113.52 27.63 31.37 percent of total billed charges 113.52 113.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE ADENTOME SHAMBAUGH 9 1/8IN SUP-97-02588 CDM 0272 RC outpatient 755.28 755.28 755.28 74 558.91 percent of total billed charges 755.28 93 611.78 percent of total billed charges 755.28 755.28 other OPPS APC 755.28 755.28 other OPPS APC 755.28 27.63 208.68 percent of total billed charges 755.28 755.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER 6.5 CANN TI 3MM N/S SUP-97-02589 CDM C1713 HCPCS 0278 RC outpatient 134.08 134.08 134.08 57 76.43 percent of total billed charges 134.08 93 108.6 percent of total billed charges 134.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.08 other OPPS APC 134.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.08 other OPPS APC 134.08 51 68.38 percent of total billed charges 134.08 134.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE 1.1MM 150MM THRD CANN N/S SUP-97-02590 CDM C1713 HCPCS 0278 RC outpatient 135.76 135.76 135.76 57 77.38 percent of total billed charges 135.76 93 109.97 percent of total billed charges 135.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 135.76 other OPPS APC 135.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 135.76 other OPPS APC 135.76 51 69.24 percent of total billed charges 135.76 135.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HANDLE SCREWDRIVER CUNTERSINK N/S SUP-97-02591 CDM 0272 RC outpatient 1118.85 1118.85 1118.85 74 827.95 percent of total billed charges 1118.85 93 906.27 percent of total billed charges 1118.85 1118.85 other OPPS APC 1118.85 1118.85 other OPPS APC 1118.85 27.63 309.14 percent of total billed charges 1118.85 1118.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K WIRE 1.1X150MM SUP-97-02595 CDM 0272 RC outpatient 80 80 80 74 59.2 percent of total billed charges 80 93 64.8 percent of total billed charges 80 80 other OPPS APC 80 80 other OPPS APC 80 27.63 22.1 percent of total billed charges 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK HEADED 2.0 SUP-97-02596 CDM 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK HEADED 3.0 SUP-97-02597 CDM 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD HEADED 2.0X16 SUP-97-02598 CDM C1713 HCPCS 0278 RC outpatient 647.5 647.5 647.5 57 369.08 percent of total billed charges 647.5 93 524.48 percent of total billed charges 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 51 330.23 percent of total billed charges 647.5 647.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD HEADED 3.0X16 SUP-97-02599 CDM C1713 HCPCS 0278 RC outpatient 647.5 647.5 647.5 57 369.08 percent of total billed charges 647.5 93 524.48 percent of total billed charges 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 51 330.23 percent of total billed charges 647.5 647.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILLBIT 1.7 SUP-97-02600 CDM 0272 RC outpatient 595 595 595 74 440.3 percent of total billed charges 595 93 481.95 percent of total billed charges 595 595 other OPPS APC 595 595 other OPPS APC 595 27.63 164.4 percent of total billed charges 595 595 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO3 POWER LEFT MOCCA BROWN SUP-97-02601 CDM L8614 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ABUTMENT 14 MM SUP-97-02602 CDM L8614 HCPCS 0278 RC outpatient 4743.75 4743.75 4743.75 57 2703.94 percent of total billed charges 4743.75 93 3842.44 percent of total billed charges 4743.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4743.75 other OPPS APC 4743.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4743.75 other OPPS APC 4743.75 51 2419.31 percent of total billed charges 4743.75 4743.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO3 SUPER POWER RIGHT DIAMOND BLACK SUP-97-02603 CDM L8614 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLUSTER ACETABULAR SHELL SZ 58MM SUP-97-02604 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT 1.5 11MM SUP-97-02608 CDM C1776 HCPCS 0278 RC outpatient 3144.3 3144.3 3144.3 57 1792.25 percent of total billed charges 3144.3 93 2546.88 percent of total billed charges 3144.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3144.3 other OPPS APC 3144.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3144.3 other OPPS APC 3144.3 51 1603.59 percent of total billed charges 3144.3 3144.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL TRAY 1.5F 1.5T SUP-97-02609 CDM C1776 HCPCS 0278 RC outpatient 4896.4 4896.4 4896.4 57 2790.95 percent of total billed charges 4896.4 93 3966.08 percent of total billed charges 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4896.4 other OPPS APC 4896.4 51 2497.16 percent of total billed charges 4896.4 4896.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL COMPONENT POSTERIOR SUP-97-02610 CDM C1776 HCPCS 0278 RC outpatient 9665.23 9665.23 9665.23 57 5509.18 percent of total billed charges 9665.23 93 7828.84 percent of total billed charges 9665.23 9665.23 other OPPS APC 9665.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665.23 other OPPS APC 9665.23 51 4929.27 percent of total billed charges 9665.23 9665.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZCT 600 20.0D SUP-97-02611 CDM C1840 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE K 400MM 3.2MM SUP-97-02614 CDM C1713 HCPCS 0278 RC outpatient 502.43 502.43 502.43 57 286.39 percent of total billed charges 502.43 93 406.97 percent of total billed charges 502.43 502.43 other OPPS APC 502.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 502.43 other OPPS APC 502.43 51 256.24 percent of total billed charges 502.43 502.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL T2 IM TI 11MM 420MM STERILE SUP-97-02615 CDM C1713 HCPCS 0278 RC outpatient 4866.63 4866.63 4866.63 57 2773.98 percent of total billed charges 4866.63 93 3941.97 percent of total billed charges 4866.63 4866.63 other OPPS APC 4866.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4866.63 other OPPS APC 4866.63 51 2481.98 percent of total billed charges 4866.63 4866.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG 6.5MM 105MM T2 IM FEM CANN SUP-97-02616 CDM C1713 HCPCS 0278 RC outpatient 716.76 716.76 716.76 57 408.55 percent of total billed charges 716.76 93 580.58 percent of total billed charges 716.76 716.76 other OPPS APC 716.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 716.76 other OPPS APC 716.76 51 365.55 percent of total billed charges 716.76 716.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZXT225 22.0D SUP-97-02617 CDM C1840 HCPCS 0278 RC outpatient 2953.5 2953.5 2953.5 57 1683.5 percent of total billed charges 2953.5 93 2392.34 percent of total billed charges 2953.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2953.5 other OPPS APC 2953.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2953.5 other OPPS APC 2953.5 51 1506.29 percent of total billed charges 2953.5 2953.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG 6.5MM 90MM T2 IM FEM CANN SUP-97-02618 CDM C1713 HCPCS 0278 RC outpatient 716.76 716.76 716.76 57 408.55 percent of total billed charges 716.76 93 580.58 percent of total billed charges 716.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 716.76 other OPPS APC 716.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 716.76 other OPPS APC 716.76 51 365.55 percent of total billed charges 716.76 716.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNOTLESS T-ROPE SYN DESMOSIS SUP-97-02619 CDM C1713 HCPCS 0278 RC outpatient 3145 3145 3145 57 1792.65 percent of total billed charges 3145 93 2547.45 percent of total billed charges 3145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3145 other OPPS APC 3145 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3145 other OPPS APC 3145 51 1603.95 percent of total billed charges 3145 3145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER OSTEONICS UNIV DISTAL 11MM SUP-97-02620 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIVERSAL HEAD BIPOLAR COMPONENT SUP-97-02621 CDM C1776 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE 1.8MM ASPIRATING SUP-97-02622 CDM 0272 RC outpatient 422.8 422.8 422.8 74 312.87 percent of total billed charges 422.8 93 342.47 percent of total billed charges 422.8 422.8 other OPPS APC 422.8 422.8 other OPPS APC 422.8 27.63 116.82 percent of total billed charges 422.8 422.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONG THREAD BREAK-OFF SCREW SUP-97-02623 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELASTIC FUSION SYSTEM 12X12X12 SUP-97-02624 CDM C1713 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN FULL BLOCK TIBIAL AUGMENT 10MM SUP-97-02625 CDM C1776 HCPCS 0278 RC outpatient 3468.75 3468.75 3468.75 57 1977.19 percent of total billed charges 3468.75 93 2809.69 percent of total billed charges 3468.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3468.75 other OPPS APC 3468.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3468.75 other OPPS APC 3468.75 51 1769.06 percent of total billed charges 3468.75 3468.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK ART SURF EF 5-6/GREEN 17MM SUP-97-02626 CDM C1776 HCPCS 0278 RC outpatient 5212.5 5212.5 5212.5 57 2971.13 percent of total billed charges 5212.5 93 4222.13 percent of total billed charges 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 51 2658.38 percent of total billed charges 5212.5 5212.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK FEMORAL SZ D-LT SUP-97-02627 CDM C1776 HCPCS 0278 RC outpatient 12600 12600 12600 57 7182 percent of total billed charges 12600 93 10206 percent of total billed charges 12600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12600 other OPPS APC 12600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12600 other OPPS APC 12600 51 6426 percent of total billed charges 12600 12600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEXGEN LPS FLEX FIXED PROLONG EF1-2,17M" SUP-97-02628 CDM C1776 HCPCS 0278 RC outpatient 4106.25 4106.25 4106.25 57 2340.56 percent of total billed charges 4106.25 93 3326.06 percent of total billed charges 4106.25 4106.25 other OPPS APC 4106.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4106.25 other OPPS APC 4106.25 51 2094.19 percent of total billed charges 4106.25 4106.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 8 HOLE 1/3 TUBULAR SUP-97-02632 CDM C1713 HCPCS 0278 RC outpatient 895.05 895.05 895.05 57 510.18 percent of total billed charges 895.05 93 724.99 percent of total billed charges 895.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 895.05 other OPPS APC 895.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 895.05 other OPPS APC 895.05 51 456.48 percent of total billed charges 895.05 895.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED DRILL BIT 4.0MM SUP-97-02633 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW THREADED 7.3MM X 85MM SUP-97-02636 CDM C1713 HCPCS 0278 RC outpatient 761.64 761.64 761.64 57 434.13 percent of total billed charges 761.64 93 616.93 percent of total billed charges 761.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 761.64 other OPPS APC 761.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 761.64 other OPPS APC 761.64 51 388.44 percent of total billed charges 761.64 761.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFIX CORE 3X4 CM SUP-97-02638 CDM Q4132 HCPCS 0636 RC outpatient 3137.5 3137.5 326.18 326.18 fee schedule 3137.5 93 2541.38 percent of total billed charges 3137.5 3137.5 other OPPS APC 3137.5 3137.5 other OPPS APC 3137.5 24.86 779.98 percent of total billed charges 326.18 3137.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ORAL RAE W/TAPERGUARD 5.0 SUP-97-02639 CDM 0272 RC outpatient 159.76 159.76 159.76 74 118.22 percent of total billed charges 159.76 93 129.41 percent of total billed charges 159.76 159.76 other OPPS APC 159.76 159.76 other OPPS APC 159.76 27.63 44.14 percent of total billed charges 159.76 159.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK FEMORAL SZ F-RT SUP-97-02643 CDM C1776 HCPCS 0278 RC outpatient 12600 12600 12600 57 7182 percent of total billed charges 12600 93 10206 percent of total billed charges 12600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12600 other OPPS APC 12600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12600 other OPPS APC 12600 51 6426 percent of total billed charges 12600 12600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT MIRROR 48X SUP-97-02644 CDM C1776 HCPCS 0278 RC outpatient 1740 1740 1740 57 991.8 percent of total billed charges 1740 93 1409.4 percent of total billed charges 1740 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1740 other OPPS APC 1740 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1740 other OPPS APC 1740 51 887.4 percent of total billed charges 1740 1740 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BASEPLATE SUP-97-02645 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELASTIC FUSION SYSTEM 18X18X18 SUP-97-02646 CDM C1713 HCPCS 0278 RC outpatient 3187.5 3187.5 3187.5 57 1816.88 percent of total billed charges 3187.5 93 2581.88 percent of total billed charges 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 51 1625.63 percent of total billed charges 3187.5 3187.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE MNPLR 33CM 5MM OUTER SUP-97-02648 CDM C1713 HCPCS 0278 RC outpatient 343.39 343.39 343.39 57 195.73 percent of total billed charges 343.39 93 278.15 percent of total billed charges 343.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 343.39 other OPPS APC 343.39 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 343.39 other OPPS APC 343.39 51 175.13 percent of total billed charges 343.39 343.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOTAL KNEE SUP-97-02649 CDM C1776 HCPCS 0278 RC outpatient 9800 9800 9800 57 5586 percent of total billed charges 9800 93 7938 percent of total billed charges 9800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9800 other OPPS APC 9800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9800 other OPPS APC 9800 51 4998 percent of total billed charges 9800 9800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOTAL HIP METAL SUP-97-02650 CDM C1776 HCPCS 0278 RC outpatient 9750 9750 9750 57 5557.5 percent of total billed charges 9750 93 7897.5 percent of total billed charges 9750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9750 other OPPS APC 9750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9750 other OPPS APC 9750 51 4972.5 percent of total billed charges 9750 9750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOTAL HIP CERAMIC SUP-97-02651 CDM C1776 HCPCS 0278 RC outpatient 10800 10800 10800 57 6156 percent of total billed charges 10800 93 8748 percent of total billed charges 10800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10800 other OPPS APC 10800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10800 other OPPS APC 10800 51 5508 percent of total billed charges 10800 10800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIPOLAR/ BIPOLAR HIP SUP-97-02652 CDM C1776 HCPCS 0278 RC outpatient 9500 9500 9500 57 5415 percent of total billed charges 9500 93 7695 percent of total billed charges 9500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9500 other OPPS APC 9500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9500 other OPPS APC 9500 51 4845 percent of total billed charges 9500 9500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNI KNEE SUP-97-02653 CDM C1776 HCPCS 0278 RC outpatient 8500 8500 8500 57 4845 percent of total billed charges 8500 93 6885 percent of total billed charges 8500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8500 other OPPS APC 8500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8500 other OPPS APC 8500 51 4335 percent of total billed charges 8500 8500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. URETE CATH FLEXI OPEN TIP NON-PORTED EYE SUP-97-02654 CDM C1729 HCPCS 0272 RC outpatient 337.82 337.82 337.82 74 249.99 percent of total billed charges 337.82 93 273.63 percent of total billed charges 337.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 337.82 other OPPS APC 337.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 337.82 other OPPS APC 337.82 27.63 93.34 percent of total billed charges 337.82 337.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. URETE CATH FLEXI OPEN TIP NON-PORTED EYE SUP-97-02655 CDM C1729 HCPCS 0272 RC outpatient 337.82 337.82 337.82 74 249.99 percent of total billed charges 337.82 93 273.63 percent of total billed charges 337.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 337.82 other OPPS APC 337.82 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 337.82 other OPPS APC 337.82 27.63 93.34 percent of total billed charges 337.82 337.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.0X 234 K-WIRE SUP-97-02656 CDM C1713 HCPCS 0278 RC outpatient 190.3 190.3 190.3 57 108.47 percent of total billed charges 190.3 93 154.14 percent of total billed charges 190.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 190.3 other OPPS APC 190.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 190.3 other OPPS APC 190.3 51 97.05 percent of total billed charges 190.3 190.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4 HOLE PMT RIGHT SUP-97-02657 CDM C1713 HCPCS 0278 RC outpatient 5210.58 5210.58 5210.58 57 2970.03 percent of total billed charges 5210.58 93 4220.57 percent of total billed charges 5210.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5210.58 other OPPS APC 5210.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5210.58 other OPPS APC 5210.58 51 2657.4 percent of total billed charges 5210.58 5210.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 38MM CANCELLOUS SUP-97-02658 CDM C1713 HCPCS 0278 RC outpatient 190.76 190.76 190.76 57 108.73 percent of total billed charges 190.76 93 154.52 percent of total billed charges 190.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 190.76 other OPPS APC 190.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 190.76 other OPPS APC 190.76 51 97.29 percent of total billed charges 190.76 190.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 38MM SUP-97-02659 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX NON LOCKING 3.5MM X 28MM SUP-97-02660 CDM C1713 HCPCS 0278 RC outpatient 135.24 135.24 135.24 57 77.09 percent of total billed charges 135.24 93 109.54 percent of total billed charges 135.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 135.24 other OPPS APC 135.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 135.24 other OPPS APC 135.24 51 68.97 percent of total billed charges 135.24 135.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 70MM SUP-97-02661 CDM C1713 HCPCS 0278 RC outpatient 412.3 412.3 412.3 57 235.01 percent of total billed charges 412.3 93 333.96 percent of total billed charges 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 51 210.27 percent of total billed charges 412.3 412.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 65MM SUP-97-02662 CDM C1713 HCPCS 0278 RC outpatient 412.3 412.3 412.3 57 235.01 percent of total billed charges 412.3 93 333.96 percent of total billed charges 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 51 210.27 percent of total billed charges 412.3 412.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 32MM SUP-97-02663 CDM C1713 HCPCS 0278 RC outpatient 412.3 412.3 412.3 57 235.01 percent of total billed charges 412.3 93 333.96 percent of total billed charges 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 51 210.27 percent of total billed charges 412.3 412.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCRES 4 X 65MM CANCELLOUS SUP-97-02664 CDM C1713 HCPCS 0278 RC outpatient 106.4 106.4 106.4 57 60.65 percent of total billed charges 106.4 93 86.18 percent of total billed charges 106.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.4 other OPPS APC 106.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.4 other OPPS APC 106.4 51 54.26 percent of total billed charges 106.4 106.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT CALIBRATED 3.1 X 285MM AO SUP-97-02665 CDM 0272 RC outpatient 433.65 433.65 433.65 74 320.9 percent of total billed charges 433.65 93 351.26 percent of total billed charges 433.65 433.65 other OPPS APC 433.65 433.65 other OPPS APC 433.65 27.63 119.82 percent of total billed charges 433.65 433.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT CALIBRATED 2.5 X 285MM AO SUP-97-02666 CDM 0272 RC outpatient 636.76 636.76 636.76 74 471.2 percent of total billed charges 636.76 93 515.78 percent of total billed charges 636.76 636.76 other OPPS APC 636.76 636.76 other OPPS APC 636.76 27.63 175.94 percent of total billed charges 636.76 636.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 10 HOLE R PLT PLATE SUP-97-02667 CDM C1713 HCPCS 0278 RC outpatient 5542.3 5542.3 5542.3 57 3159.11 percent of total billed charges 5542.3 93 4489.26 percent of total billed charges 5542.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5542.3 other OPPS APC 5542.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5542.3 other OPPS APC 5542.3 51 2826.57 percent of total billed charges 5542.3 5542.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K WIRE 1.6X150MM SUP-97-02668 CDM C1713 HCPCS 0278 RC outpatient 84 84 84 57 47.88 percent of total billed charges 84 93 68.04 percent of total billed charges 84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84 other OPPS APC 84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84 other OPPS APC 84 51 42.84 percent of total billed charges 84 84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD HEADLESS 5.5X50 SUP-97-02669 CDM C1713 HCPCS 0278 RC outpatient 825 825 825 57 470.25 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 51 420.75 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS COUNTERSINK SUP-97-02670 CDM 0272 RC outpatient 516.25 516.25 516.25 74 382.03 percent of total billed charges 516.25 93 418.16 percent of total billed charges 516.25 516.25 other OPPS APC 516.25 516.25 other OPPS APC 516.25 27.63 142.64 percent of total billed charges 516.25 516.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEX TUBING 1/4 TUBING SUP-97-02674 CDM 0271 RC outpatient 33.37 33.37 33.37 74 24.69 percent of total billed charges 33.37 93 27.03 percent of total billed charges 33.37 33.37 other OPPS APC 33.37 33.37 other OPPS APC 33.37 27.63 9.22 percent of total billed charges 33.37 33.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA FEMORAL JOINT SUP-97-02675 CDM C1776 HCPCS 0278 RC outpatient 8250 8250 8250 57 4702.5 percent of total billed charges 8250 93 6682.5 percent of total billed charges 8250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8250 other OPPS APC 8250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8250 other OPPS APC 8250 51 4207.5 percent of total billed charges 8250 8250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PARIETEX 15 X 15 SUP-97-02682 CDM C1781 HCPCS 0278 RC outpatient 732.9 732.9 732.9 57 417.75 percent of total billed charges 732.9 93 593.65 percent of total billed charges 732.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 732.9 other OPPS APC 732.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 732.9 other OPPS APC 732.9 51 373.78 percent of total billed charges 732.9 732.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PARIETEX RECT 20 X 15CM SUP-97-02683 CDM C1781 HCPCS 0278 RC outpatient 887.88 887.88 887.88 57 506.09 percent of total billed charges 887.88 93 719.18 percent of total billed charges 887.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 887.88 other OPPS APC 887.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 887.88 other OPPS APC 887.88 51 452.82 percent of total billed charges 887.88 887.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PARIETEX 30 X 15 SUP-97-02684 CDM C1781 HCPCS 0278 RC outpatient 1236.69 1236.69 1236.69 57 704.91 percent of total billed charges 1236.69 93 1001.72 percent of total billed charges 1236.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1236.69 other OPPS APC 1236.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1236.69 other OPPS APC 1236.69 51 630.71 percent of total billed charges 1236.69 1236.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PP MACRO 30X30CM SUP-97-02685 CDM C1781 HCPCS 0278 RC outpatient 285.29 285.29 285.29 57 162.62 percent of total billed charges 285.29 93 231.08 percent of total billed charges 285.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 285.29 other OPPS APC 285.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 285.29 other OPPS APC 285.29 51 145.5 percent of total billed charges 285.29 285.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PP MACRO 20X20CM SUP-97-02686 CDM C1781 HCPCS 0278 RC outpatient 276.12 276.12 276.12 57 157.39 percent of total billed charges 276.12 93 223.66 percent of total billed charges 276.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 276.12 other OPPS APC 276.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 276.12 other OPPS APC 276.12 51 140.82 percent of total billed charges 276.12 276.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 6 HOLE 3.5MM SUP-97-02695 CDM C1713 HCPCS 0278 RC outpatient 1072.44 1072.44 1072.44 57 611.29 percent of total billed charges 1072.44 93 868.68 percent of total billed charges 1072.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1072.44 other OPPS APC 1072.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1072.44 other OPPS APC 1072.44 51 546.94 percent of total billed charges 1072.44 1072.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TI CANN RETRO/ANT FEM 10MM X 400MM SUP-97-02696 CDM C1713 HCPCS 0278 RC outpatient 4760.68 4760.68 4760.68 57 2713.59 percent of total billed charges 4760.68 93 3856.15 percent of total billed charges 4760.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4760.68 other OPPS APC 4760.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4760.68 other OPPS APC 4760.68 51 2427.95 percent of total billed charges 4760.68 4760.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 13MM FLEXIBLE CANNULATED LG SUP-97-02697 CDM 0272 RC outpatient 2412.99 2412.99 2412.99 74 1785.61 percent of total billed charges 2412.99 93 1954.52 percent of total billed charges 2412.99 2412.99 other OPPS APC 2412.99 2412.99 other OPPS APC 2412.99 27.63 666.71 percent of total billed charges 2412.99 2412.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3MM X 14MM HEADLESS SHORT THREAD SUP-97-02698 CDM C1713 HCPCS 0278 RC outpatient 1175.55 1175.55 1175.55 57 670.06 percent of total billed charges 1175.55 93 952.2 percent of total billed charges 1175.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1175.55 other OPPS APC 1175.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1175.55 other OPPS APC 1175.55 51 599.53 percent of total billed charges 1175.55 1175.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE 1.1MM X 150MM NON-THREADED SUP-97-02699 CDM C1713 HCPCS 0278 RC outpatient 128.88 128.88 128.88 57 73.46 percent of total billed charges 128.88 93 104.39 percent of total billed charges 128.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 128.88 other OPPS APC 128.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 128.88 other OPPS APC 128.88 51 65.73 percent of total billed charges 128.88 128.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELASTIC FUSION SYSTEM 10X10X10 SUP-97-02700 CDM C1713 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LYNC SIZE S, 10 DEGREE" SUP-97-02701 CDM C1713 HCPCS 0278 RC outpatient 2849.85 2849.85 2849.85 57 1624.41 percent of total billed charges 2849.85 93 2308.38 percent of total billed charges 2849.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2849.85 other OPPS APC 2849.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2849.85 other OPPS APC 2849.85 51 1453.42 percent of total billed charges 2849.85 2849.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD 3.0 X18 SUP-97-02702 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD 2.0 X 24 SUP-97-02703 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL NAIL 10 X 345MM T2 STANDARD SUP-97-02704 CDM C1713 HCPCS 0278 RC outpatient 2734.2 2734.2 2734.2 57 1558.49 percent of total billed charges 2734.2 93 2214.7 percent of total billed charges 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 51 1394.44 percent of total billed charges 2734.2 2734.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAPER HOLDER BLUE SUP-97-02705 CDM 0271 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ENDOSTITCH VLOCA008L SUP-97-02707 CDM 0272 RC outpatient 274.73 274.73 274.73 74 203.3 percent of total billed charges 274.73 93 222.53 percent of total billed charges 274.73 274.73 other OPPS APC 274.73 274.73 other OPPS APC 274.73 27.63 75.91 percent of total billed charges 274.73 274.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 16.5 SUP-97-02708 CDM C1780 HCPCS 0278 RC outpatient 437.5 437.5 437.5 57 249.38 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 51 223.13 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK TRIAL 35MM 127DEG SUP-97-02709 CDM C1776 HCPCS 0278 RC outpatient 1465.2 1465.2 1465.2 57 835.16 percent of total billed charges 1465.2 93 1186.81 percent of total billed charges 1465.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1465.2 other OPPS APC 1465.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1465.2 other OPPS APC 1465.2 51 747.25 percent of total billed charges 1465.2 1465.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLO FEMORAL JOINT SYSTEM SUP-97-02710 CDM C1776 HCPCS 0278 RC outpatient 477.75 477.75 477.75 57 272.32 percent of total billed charges 477.75 93 386.98 percent of total billed charges 477.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 477.75 other OPPS APC 477.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 477.75 other OPPS APC 477.75 51 243.65 percent of total billed charges 477.75 477.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLO FEMORAL PARTIAL KNEE CAP SUP-97-02711 CDM C1776 HCPCS 0278 RC outpatient 8400 8400 8400 57 4788 percent of total billed charges 8400 93 6804 percent of total billed charges 8400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8400 other OPPS APC 8400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8400 other OPPS APC 8400 51 4284 percent of total billed charges 8400 8400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT CC 4X13 MM SUP-97-02712 CDM C1776 HCPCS 0278 RC outpatient 4106.25 4106.25 4106.25 57 2340.56 percent of total billed charges 4106.25 93 3326.06 percent of total billed charges 4106.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4106.25 other OPPS APC 4106.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4106.25 other OPPS APC 4106.25 51 2094.19 percent of total billed charges 4106.25 4106.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR SIZE 5 NMC SUP-97-02713 CDM C1776 HCPCS 0278 RC outpatient 10126 10126 10126 57 5771.82 percent of total billed charges 10126 93 8202.06 percent of total billed charges 10126 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10126 other OPPS APC 10126 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10126 other OPPS APC 10126 51 5164.26 percent of total billed charges 10126 10126 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT CC 5X9 MM SUP-97-02714 CDM C1776 HCPCS 0278 RC outpatient 4106.25 4106.25 4106.25 57 2340.56 percent of total billed charges 4106.25 93 3326.06 percent of total billed charges 4106.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4106.25 other OPPS APC 4106.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4106.25 other OPPS APC 4106.25 51 2094.19 percent of total billed charges 4106.25 4106.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION STRAIGHT - NEXGEN SUP-97-02715 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA REAMING SYSTEM 48MM SUP-97-02716 CDM 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL HALF BLOCK AUGMENT - NEXGEN SUP-97-02717 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEGACY KNEE-CONSTR 10MM (LCCK) - NEXGEN SUP-97-02718 CDM C1776 HCPCS 0278 RC outpatient 5212.5 5212.5 5212.5 57 2971.13 percent of total billed charges 5212.5 93 4222.13 percent of total billed charges 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 51 2658.38 percent of total billed charges 5212.5 5212.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA REAMING SYSTEM 38MM SUP-97-02719 CDM 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEGACY KNEE-CONSTR 17MM (LCCK) - NEXGEN SUP-97-02720 CDM C1776 HCPCS 0278 RC outpatient 5212.5 5212.5 5212.5 57 2971.13 percent of total billed charges 5212.5 93 4222.13 percent of total billed charges 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5212.5 other OPPS APC 5212.5 51 2658.38 percent of total billed charges 5212.5 5212.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION OFFSET 14MM - NEXGEN SUP-97-02721 CDM C1776 HCPCS 0278 RC outpatient 3918.75 3918.75 3918.75 57 2233.69 percent of total billed charges 3918.75 93 3174.19 percent of total billed charges 3918.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3918.75 other OPPS APC 3918.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3918.75 other OPPS APC 3918.75 51 1998.56 percent of total billed charges 3918.75 3918.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILLBIT 1.3 SUP-97-02722 CDM 0272 RC outpatient 464.63 464.63 464.63 74 343.83 percent of total billed charges 464.63 93 376.35 percent of total billed charges 464.63 464.63 other OPPS APC 464.63 464.63 other OPPS APC 464.63 27.63 128.38 percent of total billed charges 464.63 464.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE 1.3 SMOOTH OLIVE SUP-97-02723 CDM 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 252 other OPPS APC 252 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW NONLOCKING 2.5 X 14 SUP-97-02724 CDM C1713 HCPCS 0278 RC outpatient 378 378 378 57 215.46 percent of total billed charges 378 93 306.18 percent of total billed charges 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 51 192.78 percent of total billed charges 378 378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.5 X 12 SUP-97-02725 CDM C1713 HCPCS 0278 RC outpatient 488.25 488.25 488.25 57 278.3 percent of total billed charges 488.25 93 395.48 percent of total billed charges 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 51 249.01 percent of total billed charges 488.25 488.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 6 HOLE STRAIGHT SUP-97-02726 CDM C1713 HCPCS 0278 RC outpatient 2242.5 2242.5 2242.5 57 1278.23 percent of total billed charges 2242.5 93 1816.43 percent of total billed charges 2242.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2242.5 other OPPS APC 2242.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2242.5 other OPPS APC 2242.5 51 1143.68 percent of total billed charges 2242.5 2242.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION SUP-97-02727 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SURGIMEND PRS SUP-97-02728 CDM C8358 HCPCS 0278 RC outpatient 13800 13800 13800 57 7866 percent of total billed charges 13800 93 11178 percent of total billed charges 13800 13800 other OPPS APC 13800 13800 other OPPS APC 13800 51 7038 percent of total billed charges 13800 13800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OBTURATOR CANNULATED STRYKER SUP-97-02729 CDM outpatient 700 700 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BREAST IMPLANTS 650CC (45-650) SUP-97-02735 CDM L8600 HCPCS 0278 RC outpatient 2475 2475 2475 57 1410.75 percent of total billed charges 2475 93 2004.75 percent of total billed charges 2475 2475 other OPPS APC 2475 2475 other OPPS APC 2475 51 1262.25 percent of total billed charges 2475 2475 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BREAST SIZER 650CC SUP-97-02736 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENFLEX EXP PS INSERT SUP-97-02737 CDM C1776 HCPCS 0278 RC outpatient 4695 4695 4695 57 2676.15 percent of total billed charges 4695 93 3802.95 percent of total billed charges 4695 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4695 other OPPS APC 4695 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4695 other OPPS APC 4695 51 2394.45 percent of total billed charges 4695 4695 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA NEXGEN PROLONG ALL POLY 35MM SUP-97-02751 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA NEXGEN PROLONG ALL POLY 32MM SUP-97-02752 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER BLADEPATELLA W/ PILOT HOLE SZ41 SUP-97-02753 CDM 0272 RC outpatient 503.13 503.13 503.13 74 372.32 percent of total billed charges 503.13 93 407.54 percent of total billed charges 503.13 503.13 other OPPS APC 503.13 503.13 other OPPS APC 503.13 27.63 139.01 percent of total billed charges 503.13 503.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIRSHNER WIRE .062 SUP-97-02755 CDM C1713 HCPCS 0278 RC outpatient 20 20 20 57 11.4 percent of total billed charges 20 93 16.2 percent of total billed charges 20 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20 other OPPS APC 20 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20 other OPPS APC 20 51 10.2 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTERIOR AUGMENT COMBO SZ3 4MM SUP-97-02756 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTERIOR STABIZED CEMENTED SUP-97-02757 CDM C1776 HCPCS 0278 RC outpatient 8580 8580 8580 57 4890.6 percent of total billed charges 8580 93 6949.8 percent of total billed charges 8580 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8580 other OPPS APC 8580 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8580 other OPPS APC 8580 51 4375.8 percent of total billed charges 8580 8580 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT FIXED BEADING SUP-97-02758 CDM C1776 HCPCS 0278 RC outpatient 4786.5 4786.5 4786.5 57 2728.31 percent of total billed charges 4786.5 93 3877.07 percent of total billed charges 4786.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4786.5 other OPPS APC 4786.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4786.5 other OPPS APC 4786.5 51 2441.12 percent of total billed charges 4786.5 4786.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SYMBOTEX SKIRT 15 X 10CM SUP-97-02759 CDM C1781 HCPCS 0278 RC outpatient 1452.21 1452.21 1452.21 57 827.76 percent of total billed charges 1452.21 93 1176.29 percent of total billed charges 1452.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1452.21 other OPPS APC 1452.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1452.21 other OPPS APC 1452.21 51 740.63 percent of total billed charges 1452.21 1452.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT 2.4MM VA LCP-COL DSTL RAD P6HH/3HS SUP-97-02760 CDM 0272 RC outpatient 7695 7695 7695 74 5694.3 percent of total billed charges 7695 93 6232.95 percent of total billed charges 7695 7695 other OPPS APC 7695 7695 other OPPS APC 7695 27.63 2126.13 percent of total billed charges 7695 7695 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4MM VA LCK 18MM STARDRIVE SUP-97-02761 CDM C1713 HCPCS 0278 RC outpatient 719.28 719.28 719.28 57 409.99 percent of total billed charges 719.28 93 582.62 percent of total billed charges 719.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 719.28 other OPPS APC 719.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 719.28 other OPPS APC 719.28 51 366.83 percent of total billed charges 719.28 719.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4MM VA LCK 20MM STARDRIVE SUP-97-02762 CDM C1713 HCPCS 0278 RC outpatient 719.28 719.28 719.28 57 409.99 percent of total billed charges 719.28 93 582.62 percent of total billed charges 719.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 719.28 other OPPS APC 719.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 719.28 other OPPS APC 719.28 51 366.83 percent of total billed charges 719.28 719.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL 10MM/130 DEG TI CANN TFNA360MM RT SUP-97-02763 CDM C1713 HCPCS 0278 RC outpatient 6041.6 6041.6 6041.6 57 3443.71 percent of total billed charges 6041.6 93 4893.7 percent of total billed charges 6041.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6041.6 other OPPS APC 6041.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6041.6 other OPPS APC 6041.6 51 3081.22 percent of total billed charges 6041.6 6041.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TI END CAP FOR TFNA0MM EXTN SUP-97-02764 CDM C1713 HCPCS 0278 RC outpatient 2745.57 2745.57 2745.57 57 1564.97 percent of total billed charges 2745.57 93 2223.91 percent of total billed charges 2745.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2745.57 other OPPS APC 2745.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2745.57 other OPPS APC 2745.57 51 1400.24 percent of total billed charges 2745.57 2745.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEALICOIL RG DILATOR 4.75MM DISPOSABLE SUP-97-02765 CDM C1713 HCPCS 0278 RC outpatient 682.5 682.5 682.5 57 389.03 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 51 348.08 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD HEADED 2.0X14 SUP-97-02766 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD HEADED 3.0X14 SUP-97-02767 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 3.5 X 110MM GOLD SUP-97-02768 CDM C1713 HCPCS 0278 RC outpatient 463.16 463.16 463.16 57 264 percent of total billed charges 463.16 93 375.16 percent of total billed charges 463.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 463.16 other OPPS APC 463.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 463.16 other OPPS APC 463.16 51 236.21 percent of total billed charges 463.16 463.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 3.5 X 28MM SUP-97-02769 CDM C1713 HCPCS 0278 RC outpatient 97.12 97.12 97.12 57 55.36 percent of total billed charges 97.12 93 78.67 percent of total billed charges 97.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.12 other OPPS APC 97.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.12 other OPPS APC 97.12 51 49.53 percent of total billed charges 97.12 97.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPIFIX 2X3MM SUP-97-02770 CDM Q4186 HCPCS 0636 RC outpatient 3000 3000 169.88 169.88 fee schedule 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 24.86 745.8 percent of total billed charges 169.88 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPIFIX 2X2MM (GS-5220) SUP-97-02773 CDM Q4186 HCPCS 0636 RC outpatient 3000 3000 169.88 169.88 fee schedule 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 24.86 745.8 percent of total billed charges 169.88 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 19.0D SUP-97-02775 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DUAL MOBILITY TOTAL HIP SUP-97-02778 CDM C1776 HCPCS 0278 RC outpatient 12000 12000 12000 57 6840 percent of total billed charges 12000 93 9720 percent of total billed charges 12000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12000 other OPPS APC 12000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12000 other OPPS APC 12000 51 6120 percent of total billed charges 12000 12000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REUNION REVERSE TOTAL SHOULDER SUP-97-02779 CDM C1776 HCPCS 0278 RC outpatient 16600 16600 16600 57 9462 percent of total billed charges 16600 93 13446 percent of total billed charges 16600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16600 other OPPS APC 16600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16600 other OPPS APC 16600 51 8466 percent of total billed charges 16600 16600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UKA TIBIAL BEARING SIZE 2 8MM VIT -E SUP-97-02796 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMNIOFILL 250CC SUP-97-02797 CDM outpatient 1725 1725 1725 1725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD HEADLESS 2.0X19 SUP-97-02801 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD HEADLESS 2.0X18 SUP-97-02802 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD HEADLESS 2.0X16 SUP-97-02803 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSDISTAL BICEPS BC SUP-97-02804 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIRABO CUP 58MM SUP-97-02805 CDM C1776 HCPCS 0278 RC outpatient 4050 4050 4050 57 2308.5 percent of total billed charges 4050 93 3280.5 percent of total billed charges 4050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4050 other OPPS APC 4050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4050 other OPPS APC 4050 51 2065.5 percent of total billed charges 4050 4050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX BONE SCREW 25MM SUP-97-02806 CDM C1713 HCPCS 0278 RC outpatient 403.2 403.2 403.2 57 229.82 percent of total billed charges 403.2 93 326.59 percent of total billed charges 403.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 403.2 other OPPS APC 403.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 403.2 other OPPS APC 403.2 51 205.63 percent of total billed charges 403.2 403.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIRABO PE LINER 33NN HEAD SUP-97-02807 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX BONE SCRE 20MM SUP-97-02808 CDM C1713 HCPCS 0278 RC outpatient 403.2 403.2 403.2 57 229.82 percent of total billed charges 403.2 93 326.59 percent of total billed charges 403.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 403.2 other OPPS APC 403.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 403.2 other OPPS APC 403.2 51 205.63 percent of total billed charges 403.2 403.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZCT 225 18.5 SUP-97-02809 CDM C1840 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 9.5D SUP-97-02810 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 9.0 SUP-97-02811 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM CRTX SCREWLOW PROF SUP-97-02812 CDM C1713 HCPCS 0278 RC outpatient 141.72 141.72 141.72 57 80.78 percent of total billed charges 141.72 93 114.79 percent of total billed charges 141.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 141.72 other OPPS APC 141.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 141.72 other OPPS APC 141.72 51 72.28 percent of total billed charges 141.72 141.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 20MM CORTEX HD LOW PROFILE SELF TAPPING STARDRIVE SUP-97-02813 CDM C1713 HCPCS 0278 RC outpatient 165 165 165 57 94.05 percent of total billed charges 165 93 133.65 percent of total billed charges 165 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165 other OPPS APC 165 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165 other OPPS APC 165 51 84.15 percent of total billed charges 165 165 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 LOCKING 10MM SUP-97-02814 CDM C1713 HCPCS 0278 RC outpatient 532.77 532.77 532.77 57 303.68 percent of total billed charges 532.77 93 431.54 percent of total billed charges 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 51 271.71 percent of total billed charges 532.77 532.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K WIRE NITIROL1.6X150MM SUP-97-02815 CDM C1713 HCPCS 0278 RC outpatient 358.75 358.75 358.75 57 204.49 percent of total billed charges 358.75 93 290.59 percent of total billed charges 358.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 358.75 other OPPS APC 358.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 358.75 other OPPS APC 358.75 51 182.96 percent of total billed charges 358.75 358.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED SCREW 4.5X48 SUP-97-02816 CDM C1713 HCPCS 0278 RC outpatient 1762.5 1762.5 1762.5 57 1004.63 percent of total billed charges 1762.5 93 1427.63 percent of total billed charges 1762.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1762.5 other OPPS APC 1762.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1762.5 other OPPS APC 1762.5 51 898.88 percent of total billed charges 1762.5 1762.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILLBIT 3.2 SUP-97-02817 CDM 0272 RC outpatient 656.32 656.32 656.32 74 485.68 percent of total billed charges 656.32 93 531.62 percent of total billed charges 656.32 656.32 other OPPS APC 656.32 656.32 other OPPS APC 656.32 27.63 181.34 percent of total billed charges 656.32 656.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED SCREW 4.0X45 SUP-97-02818 CDM C1713 HCPCS 0278 RC outpatient 656.32 656.32 656.32 57 374.1 percent of total billed charges 656.32 93 531.62 percent of total billed charges 656.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 656.32 other OPPS APC 656.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 656.32 other OPPS APC 656.32 51 334.72 percent of total billed charges 656.32 656.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MTP PLATE LEFT 5 DEGREE MED SUP-97-02819 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILLBIT 2.0 SOLID SUP-97-02820 CDM 0272 RC outpatient 350 350 350 74 259 percent of total billed charges 350 93 283.5 percent of total billed charges 350 350 other OPPS APC 350 350 other OPPS APC 350 27.63 96.71 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW THREAD SHORT 3.5X34 SUP-97-02821 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW THREAD SHORT 3.5X28 SUP-97-02823 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OLIVE WIRE SMOOTH 1.4 SUP-97-02824 CDM 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 297.5 other OPPS APC 297.5 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7X16 SUP-97-02825 CDM C1713 HCPCS 0278 RC outpatient 488.25 488.25 488.25 57 278.3 percent of total billed charges 488.25 93 395.48 percent of total billed charges 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 51 249.01 percent of total billed charges 488.25 488.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5MM VARIABLE ANGLE LOCKING 18MM SUP-97-02826 CDM C1713 HCPCS 0278 RC outpatient 519.19 519.19 519.19 57 295.94 percent of total billed charges 519.19 93 420.54 percent of total billed charges 519.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 519.19 other OPPS APC 519.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 519.19 other OPPS APC 519.19 51 264.79 percent of total billed charges 519.19 519.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 3.5MM LCP SUP CLAVICLE SUP-97-02827 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL 10MM/130 DEG TI CANN RIGHT STERILE SUP-97-02828 CDM C1713 HCPCS 0278 RC outpatient 6041.6 6041.6 6041.6 57 3443.71 percent of total billed charges 6041.6 93 4893.7 percent of total billed charges 6041.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6041.6 other OPPS APC 6041.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6041.6 other OPPS APC 6041.6 51 3081.22 percent of total billed charges 6041.6 6041.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 16MM CANN FLEXIBLE SUP-97-02829 CDM 0272 RC outpatient 2869.32 2869.32 2869.32 74 2123.3 percent of total billed charges 2869.32 93 2324.15 percent of total billed charges 2869.32 2869.32 other OPPS APC 2869.32 2869.32 other OPPS APC 2869.32 27.63 792.79 percent of total billed charges 2869.32 2869.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 6MM/9MM CANN STEPPED SUP-97-02830 CDM 0272 RC outpatient 1923.18 1923.18 1923.18 74 1423.15 percent of total billed charges 1923.18 93 1557.78 percent of total billed charges 1923.18 1923.18 other OPPS APC 1923.18 1923.18 other OPPS APC 1923.18 27.63 531.37 percent of total billed charges 1923.18 1923.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SEMI T 5.0 230 SUP-97-02831 CDM C1762 HCPCS 0278 RC outpatient 3327.75 3327.75 3327.75 57 1896.82 percent of total billed charges 3327.75 93 2695.48 percent of total billed charges 3327.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3327.75 other OPPS APC 3327.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3327.75 other OPPS APC 3327.75 51 1697.15 percent of total billed charges 3327.75 3327.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SEMI T 9.5 SUP-97-02832 CDM C1762 HCPCS 0278 RC outpatient 3042 3042 3042 57 1733.94 percent of total billed charges 3042 93 2464.02 percent of total billed charges 3042 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3042 other OPPS APC 3042 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3042 other OPPS APC 3042 51 1551.42 percent of total billed charges 3042 3042 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACUTE AC JOINT KIT SUP-97-02833 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOG BONE BUTTON SUP-97-02834 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TENODESIS SCREW 5.5X15MM SUP-97-02835 CDM C1713 HCPCS 0278 RC outpatient 945 945 945 57 538.65 percent of total billed charges 945 93 765.45 percent of total billed charges 945 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 945 other OPPS APC 945 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 945 other OPPS APC 945 51 481.95 percent of total billed charges 945 945 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPADE TIP PIN 4MM SUP-97-02836 CDM 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 437.5 other OPPS APC 437.5 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIGHTROPE RT SUP-97-02837 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTRACTION BOLT 3.5/4.0MM SUP-97-02838 CDM C1713 HCPCS 0278 RC outpatient 390.99 390.99 390.99 57 222.86 percent of total billed charges 390.99 93 316.7 percent of total billed charges 390.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.99 other OPPS APC 390.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.99 other OPPS APC 390.99 51 199.4 percent of total billed charges 390.99 390.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.6MM X 122MM AO FITTING SUP-97-02839 CDM C1713 HCPCS 0278 RC outpatient 391.76 391.76 391.76 57 223.3 percent of total billed charges 391.76 93 317.33 percent of total billed charges 391.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 391.76 other OPPS APC 391.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 391.76 other OPPS APC 391.76 51 199.8 percent of total billed charges 391.76 391.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 20MM NON LOCKING SUP-97-02840 CDM C1713 HCPCS 0278 RC outpatient 264.6 264.6 264.6 57 150.82 percent of total billed charges 264.6 93 214.33 percent of total billed charges 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 51 134.95 percent of total billed charges 264.6 264.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 20MM SUP-97-02841 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE COMPRESSION HOLE 14 SUP-97-02842 CDM C1713 HCPCS 0278 RC outpatient 5777.5 5777.5 5777.5 57 3293.18 percent of total billed charges 5777.5 93 4679.78 percent of total billed charges 5777.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5777.5 other OPPS APC 5777.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5777.5 other OPPS APC 5777.5 51 2946.53 percent of total billed charges 5777.5 5777.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOGRAFT TRINITY ELITE SM SUP-97-02843 CDM C1762 HCPCS 0278 RC outpatient 2196 2196 2196 57 1251.72 percent of total billed charges 2196 93 1778.76 percent of total billed charges 2196 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2196 other OPPS APC 2196 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2196 other OPPS APC 2196 51 1119.96 percent of total billed charges 2196 2196 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 7.0D SUP-97-02844 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 7.0D SUP-97-02845 CDM C1780 HCPCS 0278 RC outpatient 1251 1251 1251 57 713.07 percent of total billed charges 1251 93 1013.31 percent of total billed charges 1251 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251 other OPPS APC 1251 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251 other OPPS APC 1251 51 638.01 percent of total billed charges 1251 1251 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIPOLAR/ BIPOLAR HIP SUP-97-02846 CDM C1776 HCPCS 0278 RC outpatient 7500 7500 7500 57 4275 percent of total billed charges 7500 93 6075 percent of total billed charges 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 51 3825 percent of total billed charges 7500 7500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRANSFICTION PIN SUP-97-02847 CDM C1713 HCPCS 0278 RC outpatient 485.52 485.52 485.52 57 276.75 percent of total billed charges 485.52 93 393.27 percent of total billed charges 485.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 485.52 other OPPS APC 485.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 485.52 other OPPS APC 485.52 51 247.62 percent of total billed charges 485.52 485.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SELF DRILLING/SELF TAPPING SUP-97-02848 CDM outpatient 485.52 485.52 485.52 485.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD HEADED 4.0X32 SUP-97-02849 CDM C1713 HCPCS 0278 RC outpatient 451.5 451.5 451.5 57 257.36 percent of total billed charges 451.5 93 365.72 percent of total billed charges 451.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 451.5 other OPPS APC 451.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 451.5 other OPPS APC 451.5 51 230.27 percent of total billed charges 451.5 451.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD HEADED 4.0X30 SUP-97-02850 CDM C1713 HCPCS 0278 RC outpatient 451.5 451.5 451.5 57 257.36 percent of total billed charges 451.5 93 365.72 percent of total billed charges 451.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 451.5 other OPPS APC 451.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 451.5 other OPPS APC 451.5 51 230.27 percent of total billed charges 451.5 451.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD HEADED 3.5X26 SUP-97-02851 CDM C1713 HCPCS 0278 RC outpatient 647.5 647.5 647.5 57 369.08 percent of total billed charges 647.5 93 524.48 percent of total billed charges 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 51 330.23 percent of total billed charges 647.5 647.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING SCREW 3.5X14 SUP-97-02853 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 12MM LOCKING R3CON SUP-97-02854 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON LOCKING SCREW 3.5X16 SUP-97-02855 CDM C1713 HCPCS 0278 RC outpatient 437.5 437.5 437.5 57 249.38 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 51 223.13 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMOOTH PEG LOCKING 2.0MMX20 SUP-97-02856 CDM C1713 HCPCS 0278 RC outpatient 206.5 206.5 206.5 57 117.71 percent of total billed charges 206.5 93 167.27 percent of total billed charges 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 51 105.32 percent of total billed charges 206.5 206.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG THREADED LOCKING 2.3MM X 28MM SUP-97-02857 CDM C1713 HCPCS 0278 RC outpatient 206.5 206.5 206.5 57 117.71 percent of total billed charges 206.5 93 167.27 percent of total billed charges 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 51 105.32 percent of total billed charges 206.5 206.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL NON LOC 3.5MMX13MM SUP-97-02858 CDM C1713 HCPCS 0278 RC outpatient 252 252 252 57 143.64 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 51 128.52 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL NON LOC 3.5MMX16MM SUP-97-02859 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG THREADED LOCKING 2.3MM X 23MM SUP-97-02860 CDM C1713 HCPCS 0278 RC outpatient 206.5 206.5 206.5 57 117.71 percent of total billed charges 206.5 93 167.27 percent of total billed charges 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 206.5 other OPPS APC 206.5 51 105.32 percent of total billed charges 206.5 206.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 14.0D SUP-97-02861 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 26.5D SUP-97-02862 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 21.5D SUP-97-02863 CDM C1780 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT TISSUE EXPANDER 430CC (133FX- 12-T SUP-97-02864 CDM L8699 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 3875 other OPPS APC 3875 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 26.0 SUP-97-02865 CDM C1780 HCPCS 0278 RC outpatient 1251.15 1251.15 1251.15 57 713.16 percent of total billed charges 1251.15 93 1013.43 percent of total billed charges 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 51 638.09 percent of total billed charges 1251.15 1251.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZXT 150 LENS 21.0 SUP-97-02866 CDM C1780 HCPCS 0278 RC outpatient 2952 2952 2952 57 1682.64 percent of total billed charges 2952 93 2391.12 percent of total billed charges 2952 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2952 other OPPS APC 2952 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2952 other OPPS APC 2952 51 1505.52 percent of total billed charges 2952 2952 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BB-TAK THREADED SUP-97-02868 CDM 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 297.5 other OPPS APC 297.5 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.5MM SUP-97-02869 CDM 0272 RC outpatient 395.5 395.5 395.5 74 292.67 percent of total billed charges 395.5 93 320.36 percent of total billed charges 395.5 395.5 other OPPS APC 395.5 395.5 other OPPS APC 395.5 27.63 109.28 percent of total billed charges 395.5 395.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIPLE PLAY DEVICE 4.0MM SUP-97-02870 CDM outpatient 3000 3000 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOCKFIX SCRWTICANN SUP-97-02871 CDM C1713 HCPCS 0278 RC outpatient 708 708 708 57 403.56 percent of total billed charges 708 93 573.48 percent of total billed charges 708 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 708 other OPPS APC 708 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 708 other OPPS APC 708 51 361.08 percent of total billed charges 708 708 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER 7.0 MMTI SUP-97-02872 CDM C1713 HCPCS 0278 RC outpatient 200 200 200 57 114 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 51 102 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO- PRO SCRWTI 3.5MMX 28MM SUP-97-02873 CDM C1713 HCPCS 0278 RC outpatient 210 210 210 57 119.7 percent of total billed charges 210 93 170.1 percent of total billed charges 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 51 107.1 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING SCREW TITANIUM 3.5MM 16MM SUP-97-02874 CDM C1713 HCPCS 0278 RC outpatient 297.5 297.5 297.5 57 169.58 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 51 151.73 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING SCREW TITANIUM 3.5MM 40MM SUP-97-02876 CDM C1713 HCPCS 0278 RC outpatient 427 427 427 57 243.39 percent of total billed charges 427 93 345.87 percent of total billed charges 427 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 427 other OPPS APC 427 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 427 other OPPS APC 427 51 217.77 percent of total billed charges 427 427 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING SCREW TITANIUM 3.5MM 42MM SUP-97-02877 CDM C1713 HCPCS 0278 RC outpatient 427 427 427 57 243.39 percent of total billed charges 427 93 345.87 percent of total billed charges 427 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 427 other OPPS APC 427 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 427 other OPPS APC 427 51 217.77 percent of total billed charges 427 427 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLLP MEDIAL COLUMN PLT 3.5 MM SMFT SUP-97-02878 CDM C1713 HCPCS 0278 RC outpatient 5340 5340 5340 57 3043.8 percent of total billed charges 5340 93 4325.4 percent of total billed charges 5340 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5340 other OPPS APC 5340 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5340 other OPPS APC 5340 51 2723.4 percent of total billed charges 5340 5340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BITE BREAK-OFF SCREW, 3/4 THD, 2.0X12" SUP-97-02880 CDM C1713 HCPCS 0278 RC outpatient 816.9 816.9 816.9 57 465.63 percent of total billed charges 816.9 93 661.69 percent of total billed charges 816.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 816.9 other OPPS APC 816.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 816.9 other OPPS APC 816.9 51 416.62 percent of total billed charges 816.9 816.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BITE BREAK-OFF SCREW, 3/4 THD, 2.0 X 11" SUP-97-02881 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LISFRANC, OBLIQUE L, 3-HOLE PLATE, RIGHT" SUP-97-02882 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE TROCAR TIP SMOOTH 2.0 X 150 MM SUP-97-02883 CDM 0272 RC outpatient 80 80 80 74 59.2 percent of total billed charges 80 93 64.8 percent of total billed charges 80 80 other OPPS APC 80 80 other OPPS APC 80 27.63 22.1 percent of total billed charges 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DRILL, 2.6 X 130 MM, CANNULATED, AO" SUP-97-02884 CDM 0272 RC outpatient 350 350 350 74 259 percent of total billed charges 350 93 283.5 percent of total billed charges 350 350 other OPPS APC 350 350 other OPPS APC 350 27.63 96.71 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CANNULATED, SHORT THREAD SCREW, HEADED," SUP-97-02885 CDM C1713 HCPCS 0278 RC outpatient 451.5 451.5 451.5 57 257.36 percent of total billed charges 451.5 93 365.72 percent of total billed charges 451.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 451.5 other OPPS APC 451.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 451.5 other OPPS APC 451.5 51 230.27 percent of total billed charges 451.5 451.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON LOCKING SCREW 3.5X12 SUP-97-02886 CDM C1713 HCPCS 0278 RC outpatient 378 378 378 57 215.46 percent of total billed charges 378 93 306.18 percent of total billed charges 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 51 192.78 percent of total billed charges 378 378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 14MM NON LOCKING R3CON SUP-97-02887 CDM C1713 HCPCS 0278 RC outpatient 437.5 437.5 437.5 57 249.38 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 51 223.13 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON LOCKING SCREW 4.2X22 SUP-97-02888 CDM C1713 HCPCS 0278 RC outpatient 386.4 386.4 386.4 57 220.25 percent of total billed charges 386.4 93 312.98 percent of total billed charges 386.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 386.4 other OPPS APC 386.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 386.4 other OPPS APC 386.4 51 197.06 percent of total billed charges 386.4 386.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING SCREW 3.5X20 SUP-97-02889 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CANNULATED, SHORT THREAD SCREW, HEADLES" SUP-97-02890 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 22 NON LOCKING R3CON SUP-97-02891 CDM C1713 HCPCS 0278 RC outpatient 437.5 437.5 437.5 57 249.38 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 51 223.13 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "STRAIGHT PLATE, 8 HOLE" SUP-97-02892 CDM C1713 HCPCS 0278 RC outpatient 2242.5 2242.5 2242.5 57 1278.23 percent of total billed charges 2242.5 93 1816.43 percent of total billed charges 2242.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2242.5 other OPPS APC 2242.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2242.5 other OPPS APC 2242.5 51 1143.68 percent of total billed charges 2242.5 2242.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 4.6 X 300MM SOLID TROCAR TIP SUP-97-02893 CDM 0272 RC outpatient 350 350 350 74 259 percent of total billed charges 350 93 283.5 percent of total billed charges 350 350 other OPPS APC 350 350 other OPPS APC 350 27.63 96.71 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON LOCKING SCREW 2.5X16 SUP-97-02894 CDM C1713 HCPCS 0278 RC outpatient 488.25 488.25 488.25 57 278.3 percent of total billed charges 488.25 93 395.48 percent of total billed charges 488.25 488.25 other OPPS APC 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 51 249.01 percent of total billed charges 488.25 488.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON LOCKING SCREW 2.0X14 SUP-97-02895 CDM C1713 HCPCS 0278 RC outpatient 378 378 378 57 215.46 percent of total billed charges 378 93 306.18 percent of total billed charges 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 51 192.78 percent of total billed charges 378 378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON LOCKING SCREW 2.5X16 SUP-97-02896 CDM C1713 HCPCS 0278 RC outpatient 378 378 378 57 215.46 percent of total billed charges 378 93 306.18 percent of total billed charges 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 51 192.78 percent of total billed charges 378 378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON LOCKING SCREW 2.0X16 SUP-97-02897 CDM C1713 HCPCS 0278 RC outpatient 378 378 378 57 215.46 percent of total billed charges 378 93 306.18 percent of total billed charges 378 378 other OPPS APC 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 51 192.78 percent of total billed charges 378 378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING SCREW 2.0X12 SUP-97-02898 CDM C1713 HCPCS 0278 RC outpatient 488.25 488.25 488.25 57 278.3 percent of total billed charges 488.25 93 395.48 percent of total billed charges 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 51 249.01 percent of total billed charges 488.25 488.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANCELLOUS BONE SCREW 50MM SUP-97-02899 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TRILOCK OLECRANON PLATE,10 HOLE, R" SUP-97-02901 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TRILOCK OLECRANON PLATE,10 HOLE, L" SUP-97-02902 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TWIST DRILL 2.35X151 SUP-97-02903 CDM C1713 HCPCS 0278 RC outpatient 223.27 223.27 223.27 57 127.26 percent of total billed charges 223.27 93 180.85 percent of total billed charges 223.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 223.27 other OPPS APC 223.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 223.27 other OPPS APC 223.27 51 113.87 percent of total billed charges 223.27 223.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.8 X 14MM CORTICAL SUP-97-02904 CDM C1713 HCPCS 0278 RC outpatient 142.6 142.6 142.6 57 81.28 percent of total billed charges 142.6 93 115.51 percent of total billed charges 142.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 142.6 other OPPS APC 142.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 142.6 other OPPS APC 142.6 51 72.73 percent of total billed charges 142.6 142.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.8 CORTICAL 16MM SUP-97-02905 CDM C1713 HCPCS 0278 RC outpatient 142.6 142.6 142.6 57 81.28 percent of total billed charges 142.6 93 115.51 percent of total billed charges 142.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 142.6 other OPPS APC 142.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 142.6 other OPPS APC 142.6 51 72.73 percent of total billed charges 142.6 142.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.8 CORTICAL 18MM SUP-97-02906 CDM C1713 HCPCS 0278 RC outpatient 432.32 432.32 432.32 57 246.42 percent of total billed charges 432.32 93 350.18 percent of total billed charges 432.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.32 other OPPS APC 432.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.32 other OPPS APC 432.32 51 220.48 percent of total billed charges 432.32 432.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.8 CORTICAL 22MM SUP-97-02907 CDM C1713 HCPCS 0278 RC outpatient 432.32 432.32 432.32 57 246.42 percent of total billed charges 432.32 93 350.18 percent of total billed charges 432.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.32 other OPPS APC 432.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.32 other OPPS APC 432.32 51 220.48 percent of total billed charges 432.32 432.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.8 CORTICAL 26MM SUP-97-02908 CDM C1713 HCPCS 0278 RC outpatient 356.48 356.48 356.48 57 203.19 percent of total billed charges 356.48 93 288.75 percent of total billed charges 356.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 356.48 other OPPS APC 356.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 356.48 other OPPS APC 356.48 51 181.8 percent of total billed charges 356.48 356.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.8 CORTICAL 26MM SUP-97-02909 CDM C1713 HCPCS 0278 RC outpatient 356.48 356.48 356.48 57 203.19 percent of total billed charges 356.48 93 288.75 percent of total billed charges 356.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 356.48 other OPPS APC 356.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 356.48 other OPPS APC 356.48 51 181.8 percent of total billed charges 356.48 356.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.8 CORTICAL 30MM SUP-97-02910 CDM C1713 HCPCS 0278 RC outpatient 142.6 142.6 142.6 57 81.28 percent of total billed charges 142.6 93 115.51 percent of total billed charges 142.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 142.6 other OPPS APC 142.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 142.6 other OPPS APC 142.6 51 72.73 percent of total billed charges 142.6 142.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.8 TRILOCK SCREW 14MM SUP-97-02912 CDM C1713 HCPCS 0278 RC outpatient 636.3 636.3 636.3 57 362.69 percent of total billed charges 636.3 93 515.4 percent of total billed charges 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 51 324.51 percent of total billed charges 636.3 636.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.8 TRILOCK SCREW 16MM SUP-97-02913 CDM C1713 HCPCS 0278 RC outpatient 576.98 576.98 576.98 57 328.88 percent of total billed charges 576.98 93 467.35 percent of total billed charges 576.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.98 other OPPS APC 576.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.98 other OPPS APC 576.98 51 294.26 percent of total billed charges 576.98 576.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.8 TRILOCK SCREW 18MM SUP-97-02914 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.8 TRILOCK SCREW 20MM SUP-97-02915 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.8 TRILOCK SCREW 24MM SUP-97-02916 CDM C1713 HCPCS 0278 RC outpatient 576.98 576.98 576.98 57 328.88 percent of total billed charges 576.98 93 467.35 percent of total billed charges 576.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.98 other OPPS APC 576.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.98 other OPPS APC 576.98 51 294.26 percent of total billed charges 576.98 576.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KWIRE 1.6X 150MM SUP-97-02917 CDM C1713 HCPCS 0278 RC outpatient 136 136 136 57 77.52 percent of total billed charges 136 93 110.16 percent of total billed charges 136 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 136 other OPPS APC 136 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 136 other OPPS APC 136 51 69.36 percent of total billed charges 136 136 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 9.5 SUP-97-02919 CDM C1780 HCPCS 0278 RC outpatient 1251.15 1251.15 1251.15 57 713.16 percent of total billed charges 1251.15 93 1013.43 percent of total billed charges 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 51 638.09 percent of total billed charges 1251.15 1251.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI PRESS FIT STEM 22 X 150MM SUP-97-02920 CDM C1776 HCPCS 0278 RC outpatient 3041 3041 3041 57 1733.37 percent of total billed charges 3041 93 2463.21 percent of total billed charges 3041 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3041 other OPPS APC 3041 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3041 other OPPS APC 3041 51 1550.91 percent of total billed charges 3041 3041 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI LM/RL TIB AUG SZ7 5MM SUP-97-02921 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI PRESS FIT STEM 16X150MM SUP-97-02923 CDM C1776 HCPCS 0278 RC outpatient 3041 3041 3041 57 1733.37 percent of total billed charges 3041 93 2463.21 percent of total billed charges 3041 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3041 other OPPS APC 3041 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3041 other OPPS APC 3041 51 1550.91 percent of total billed charges 3041 3041 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI IS FEMUR SZ7 LEFT SUP-97-02924 CDM C1776 HCPCS 0278 RC outpatient 12280.8 12280.8 12280.8 57 7000.06 percent of total billed charges 12280.8 93 9947.45 percent of total billed charges 12280.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.8 other OPPS APC 12280.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.8 other OPPS APC 12280.8 51 6263.21 percent of total billed charges 12280.8 12280.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI POST AUGMEMT SZ7 10MM SUP-97-02925 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON FEM DISTAL AUG15MM SZ7 LEFT SUP-97-02926 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON FEM DISTAL AUG15MM SZ7 RIGHT SUP-97-02927 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON FEM DISTAL AUG 5MM SZ7 RIGHT SUP-97-02928 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON FEM DISTAL AUG 5MM SZ7 LEFT SUP-97-02929 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIMLEX P WITH TOBRAMYCIN SUP-97-02930 CDM C1713 HCPCS 0278 RC outpatient 825 825 825 57 470.25 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 51 420.75 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI LM/RL TIB AUG SZ7 SMM SUP-97-02931 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL NAIL 9 X 285MM SUP-97-02933 CDM C1713 HCPCS 0278 RC outpatient 2734.2 2734.2 2734.2 57 1558.49 percent of total billed charges 2734.2 93 2214.7 percent of total billed charges 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 51 1394.44 percent of total billed charges 2734.2 2734.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP 10MM SUP-97-02934 CDM C1713 HCPCS 0278 RC outpatient 389.55 389.55 389.55 57 222.04 percent of total billed charges 389.55 93 315.54 percent of total billed charges 389.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 389.55 other OPPS APC 389.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 389.55 other OPPS APC 389.55 51 198.67 percent of total billed charges 389.55 389.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIO COMP INTERFERENCE SCREW 9X28 SUP-97-02935 CDM C1713 HCPCS 0278 RC outpatient 1008 1008 1008 57 574.56 percent of total billed charges 1008 93 816.48 percent of total billed charges 1008 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1008 other OPPS APC 1008 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1008 other OPPS APC 1008 51 514.08 percent of total billed charges 1008 1008 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTBRACE LGMNT REPR AUGMNT KIT SUP-97-02936 CDM C1713 HCPCS 0278 RC outpatient 3482.5 3482.5 3482.5 57 1985.03 percent of total billed charges 3482.5 93 2820.83 percent of total billed charges 3482.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3482.5 other OPPS APC 3482.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3482.5 other OPPS APC 3482.5 51 1776.08 percent of total billed charges 3482.5 3482.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNITRAX MODULAR ENDO HEAD SUP-97-02937 CDM C1776 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNITRAX V40 TAPER SLEEVE +8MM SUP-97-02938 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K WIRE SUP-97-02939 CDM C1713 HCPCS 0278 RC outpatient 80 80 80 57 45.6 percent of total billed charges 80 93 64.8 percent of total billed charges 80 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 80 other OPPS APC 80 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 80 other OPPS APC 80 51 40.8 percent of total billed charges 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K WIRE 1.4 SUP-97-02940 CDM C1713 HCPCS 0278 RC outpatient 160 160 160 57 91.2 percent of total billed charges 160 93 129.6 percent of total billed charges 160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160 other OPPS APC 160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160 other OPPS APC 160 51 81.6 percent of total billed charges 160 160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 4MM FOR 4.5MM ANCHOR SUP-97-02941 CDM 0272 RC outpatient 551.25 551.25 551.25 74 407.93 percent of total billed charges 551.25 93 446.51 percent of total billed charges 551.25 551.25 other OPPS APC 551.25 551.25 other OPPS APC 551.25 27.63 152.31 percent of total billed charges 551.25 551.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEALICOIL RG SA 4.75MMW/1UB-BL CBRD SUP-97-02942 CDM C1713 HCPCS 0278 RC outpatient 1065 1065 1065 57 607.05 percent of total billed charges 1065 93 862.65 percent of total billed charges 1065 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1065 other OPPS APC 1065 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1065 other OPPS APC 1065 51 543.15 percent of total billed charges 1065 1065 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 25.5D SUP-97-02943 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 25.5D SUP-97-02944 CDM C1780 HCPCS 0278 RC outpatient 1251.15 1251.15 1251.15 57 713.16 percent of total billed charges 1251.15 93 1013.43 percent of total billed charges 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 51 638.09 percent of total billed charges 1251.15 1251.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40M -1.0D SUP-97-02945 CDM C1780 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AEQUALIS REVERSE 11 THREADED POST SUP-97-02946 CDM C1776 HCPCS 0278 RC outpatient 16600 16600 16600 57 9462 percent of total billed charges 16600 93 13446 percent of total billed charges 16600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16600 other OPPS APC 16600 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16600 other OPPS APC 16600 51 8466 percent of total billed charges 16600 16600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 10.0D SUP-97-02947 CDM C1780 HCPCS 0278 RC outpatient 1251.15 1251.15 1251.15 57 713.16 percent of total billed charges 1251.15 93 1013.43 percent of total billed charges 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 51 638.09 percent of total billed charges 1251.15 1251.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 19.5D SUP-97-02948 CDM C1780 HCPCS 0278 RC outpatient 2955 2955 2955 57 1684.35 percent of total billed charges 2955 93 2393.55 percent of total billed charges 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 51 1507.05 percent of total billed charges 2955 2955 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELASTIC FUSION SYSTEM 15X15X15 SUP-97-02950 CDM C1713 HCPCS 0278 RC outpatient 3187.5 3187.5 3187.5 57 1816.88 percent of total billed charges 3187.5 93 2581.88 percent of total billed charges 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 51 1625.63 percent of total billed charges 3187.5 3187.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K WIRE 0.9 SUP-97-02951 CDM C1713 HCPCS 0278 RC outpatient 72 72 72 57 41.04 percent of total billed charges 72 93 58.32 percent of total billed charges 72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 72 other OPPS APC 72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 72 other OPPS APC 72 51 36.72 percent of total billed charges 72 72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD 2.0 X 20 SUP-97-02952 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONG THREAD BREAK-OFF SCREW SUP-97-02953 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONG THREAD SNAP OFF SCREW 2.0X20 SUP-97-02954 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERWIRE #2 FIBERSNARE FIBERWIRE 26 SUP-97-02955 CDM 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIRABO PE LINER 38NN HEAD SUP-97-02956 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELASTIC FUSION SYSTEM 18MMX14MMX14MM SUP-97-02957 CDM C1713 HCPCS 0278 RC outpatient 3187.5 3187.5 3187.5 57 1816.88 percent of total billed charges 3187.5 93 2581.88 percent of total billed charges 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 51 1625.63 percent of total billed charges 3187.5 3187.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOTOCLIP18MMX14MM SUP-97-02958 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40M +0.5D SUP-97-02959 CDM C1780 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E +5.0 SUP-97-02960 CDM C1780 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANCELELLOUS BONE SCREW SUP-97-02961 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HRIS FLEXIBLE OSTEO 12X120MM SUP-97-02962 CDM 0272 RC outpatient 1081.5 1081.5 1081.5 74 800.31 percent of total billed charges 1081.5 93 876.02 percent of total billed charges 1081.5 1081.5 other OPPS APC 1081.5 1081.5 other OPPS APC 1081.5 27.63 298.82 percent of total billed charges 1081.5 1081.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PS ALL POLYETHYLENE TIBA COMPONENT 8X16M SUP-97-02963 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRILOGY LONGEVITY CONSTRAINED 58X30 SUP-97-02964 CDM C1776 HCPCS 0278 RC outpatient 9328.13 9328.13 9328.13 57 5317.03 percent of total billed charges 9328.13 93 7555.79 percent of total billed charges 9328.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9328.13 other OPPS APC 9328.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9328.13 other OPPS APC 9328.13 51 4757.35 percent of total billed charges 9328.13 9328.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD HEADED 4.0X36 SUP-97-02965 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO3 SUPERPOWER RIGHT WHITE SILVER SUP-97-02966 CDM L8614 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTRACTION BOLT 2.7 SUP-97-02967 CDM C1713 HCPCS 0278 RC outpatient 345.21 345.21 345.21 57 196.77 percent of total billed charges 345.21 93 279.62 percent of total billed charges 345.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 345.21 other OPPS APC 345.21 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 345.21 other OPPS APC 345.21 51 176.06 percent of total billed charges 345.21 345.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL NAIL 10 X 405MM T2 STANDARD SUP-97-02968 CDM C1713 HCPCS 0278 RC outpatient 2734.2 2734.2 2734.2 57 1558.49 percent of total billed charges 2734.2 93 2214.7 percent of total billed charges 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 51 1394.44 percent of total billed charges 2734.2 2734.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP 5MM SUP-97-02969 CDM C1713 HCPCS 0278 RC outpatient 593.78 593.78 593.78 57 338.45 percent of total billed charges 593.78 93 480.96 percent of total billed charges 593.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 593.78 other OPPS APC 593.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 593.78 other OPPS APC 593.78 51 302.83 percent of total billed charges 593.78 593.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BREAST INPLANT (SRM-310CC) SUP-97-02970 CDM L8600 HCPCS 0278 RC outpatient 2835 2835 2835 57 1615.95 percent of total billed charges 2835 93 2296.35 percent of total billed charges 2835 2835 other OPPS APC 2835 2835 other OPPS APC 2835 51 1445.85 percent of total billed charges 2835 2835 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTICUL/EZE BIOLOX DELTA TS HEAD SUP-97-02971 CDM C1776 HCPCS 0278 RC outpatient 6423 6423 6423 57 3661.11 percent of total billed charges 6423 93 5202.63 percent of total billed charges 6423 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6423 other OPPS APC 6423 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6423 other OPPS APC 6423 51 3275.73 percent of total billed charges 6423 6423 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX BONE SCREW 30MM SUP-97-02972 CDM C1713 HCPCS 0278 RC outpatient 403.2 403.2 403.2 57 229.82 percent of total billed charges 403.2 93 326.59 percent of total billed charges 403.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 403.2 other OPPS APC 403.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 403.2 other OPPS APC 403.2 51 205.63 percent of total billed charges 403.2 403.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX BONE SCREW 32MM SUP-97-02973 CDM C1713 HCPCS 0278 RC outpatient 403.2 403.2 403.2 57 229.82 percent of total billed charges 403.2 93 326.59 percent of total billed charges 403.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 403.2 other OPPS APC 403.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 403.2 other OPPS APC 403.2 51 205.63 percent of total billed charges 403.2 403.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX BONE SCREW 20MM SUP-97-02974 CDM C1713 HCPCS 0278 RC outpatient 403.2 403.2 403.2 57 229.82 percent of total billed charges 403.2 93 326.59 percent of total billed charges 403.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 403.2 other OPPS APC 403.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 403.2 other OPPS APC 403.2 51 205.63 percent of total billed charges 403.2 403.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIRABO CUP 52MM SUP-97-02975 CDM C1776 HCPCS 0278 RC outpatient 3500 3500 3500 57 1995 percent of total billed charges 3500 93 2835 percent of total billed charges 3500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3500 other OPPS APC 3500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3500 other OPPS APC 3500 51 1785 percent of total billed charges 3500 3500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIRABO PE LINER 33MM HEAD SUP-97-02976 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HINGE ELBOW FIXTOR SUP-97-02977 CDM C1776 HCPCS 0278 RC outpatient 6562.5 6562.5 6562.5 57 3740.63 percent of total billed charges 6562.5 93 5315.63 percent of total billed charges 6562.5 6562.5 other OPPS APC 6562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6562.5 other OPPS APC 6562.5 51 3346.88 percent of total billed charges 6562.5 6562.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM VA-LCP PROX TIBIA PLATE BEND SUP-97-02978 CDM C1713 HCPCS 0278 RC outpatient 3849.75 3849.75 3849.75 57 2194.36 percent of total billed charges 3849.75 93 3118.3 percent of total billed charges 3849.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3849.75 other OPPS APC 3849.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3849.75 other OPPS APC 3849.75 51 1963.37 percent of total billed charges 3849.75 3849.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM VARIBLE ANGLE LOCKING SCREW 85MM SUP-97-02979 CDM C1713 HCPCS 0278 RC outpatient 768 768 768 57 437.76 percent of total billed charges 768 93 622.08 percent of total billed charges 768 768 other OPPS APC 768 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 768 other OPPS APC 768 51 391.68 percent of total billed charges 768 768 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM VARIBLE ANGLE LOCKING SCREW 95MM SUP-97-02980 CDM C1713 HCPCS 0278 RC outpatient 768 768 768 57 437.76 percent of total billed charges 768 93 622.08 percent of total billed charges 768 768 other OPPS APC 768 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 768 other OPPS APC 768 51 391.68 percent of total billed charges 768 768 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM VARIBLE ANGLE LOCKING SCREW 58MM SUP-97-02981 CDM C1713 HCPCS 0278 RC outpatient 768 768 768 57 437.76 percent of total billed charges 768 93 622.08 percent of total billed charges 768 768 other OPPS APC 768 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 768 other OPPS APC 768 51 391.68 percent of total billed charges 768 768 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM VARIBLE ANGLE LOCKING SCREW 30MM SUP-97-02982 CDM C1713 HCPCS 0278 RC outpatient 768 768 768 57 437.76 percent of total billed charges 768 93 622.08 percent of total billed charges 768 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 768 other OPPS APC 768 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 768 other OPPS APC 768 51 391.68 percent of total billed charges 768 768 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM VARIBLE ANGLE LOCKING SCREW 80MM SUP-97-02983 CDM C1713 HCPCS 0278 RC outpatient 768 768 768 57 437.76 percent of total billed charges 768 93 622.08 percent of total billed charges 768 768 other OPPS APC 768 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 768 other OPPS APC 768 51 391.68 percent of total billed charges 768 768 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.8MM CALIBRATED DRILL BIT 250MM/95MM SUP-97-02984 CDM 0272 RC outpatient 501.8 501.8 501.8 74 371.33 percent of total billed charges 501.8 93 406.46 percent of total billed charges 501.8 501.8 other OPPS APC 501.8 501.8 other OPPS APC 501.8 27.63 138.65 percent of total billed charges 501.8 501.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIRABO PE LINER 32MM HEAD SUP-97-02985 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX BONE SCREW 15MM SUP-97-02986 CDM C1713 HCPCS 0278 RC outpatient 403.2 403.2 403.2 57 229.82 percent of total billed charges 403.2 93 326.59 percent of total billed charges 403.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 403.2 other OPPS APC 403.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 403.2 other OPPS APC 403.2 51 205.63 percent of total billed charges 403.2 403.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBALANCE UKA TIBIAL TRAY S Z 1RT SUP-97-02987 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBALANCE UKA FEM CEMENTED SIZ 4R SUP-97-02988 CDM C1776 HCPCS 0278 RC outpatient 7500 7500 7500 57 4275 percent of total billed charges 7500 93 6075 percent of total billed charges 7500 7500 other OPPS APC 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 51 3825 percent of total billed charges 7500 7500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UKA TIBIAL BEARING SIZE 1 8MM VIT -E SUP-97-02989 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 20.D SUP-97-02991 CDM C1780 HCPCS 0278 RC outpatient 381.5 381.5 381.5 57 217.46 percent of total billed charges 381.5 93 309.02 percent of total billed charges 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 51 194.57 percent of total billed charges 381.5 381.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZCT 600 23.0D SUP-97-02992 CDM C1840 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZXR00 LENS 22.5 SUP-97-02993 CDM C1780 HCPCS 0278 RC outpatient 2685 2685 2685 57 1530.45 percent of total billed charges 2685 93 2174.85 percent of total billed charges 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 51 1369.35 percent of total billed charges 2685 2685 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 4.2 X 230MM AP SMALL SUP-97-02994 CDM 0272 RC outpatient 408.45 408.45 408.45 74 302.25 percent of total billed charges 408.45 93 330.84 percent of total billed charges 408.45 408.45 other OPPS APC 408.45 408.45 other OPPS APC 408.45 27.63 112.85 percent of total billed charges 408.45 408.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONG NAIL KIT R1/5 TI RT 11 X380MM X 125 SUP-97-02995 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNITE HEAD 52X15 ECC SUP-97-02996 CDM C1776 HCPCS 0278 RC outpatient 3355 3355 3355 57 1912.35 percent of total billed charges 3355 93 2717.55 percent of total billed charges 3355 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3355 other OPPS APC 3355 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3355 other OPPS APC 3355 51 1711.05 percent of total billed charges 3355 3355 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNITE ANT BODY 135 SZ 14 SUP-97-02997 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROSSLINK FIN GLENOID 52 SUP-97-02998 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNITE SRD STEM SZ 14 SUP-97-02999 CDM C1776 HCPCS 0278 RC outpatient 5120 5120 5120 57 2918.4 percent of total billed charges 5120 93 4147.2 percent of total billed charges 5120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5120 other OPPS APC 5120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5120 other OPPS APC 5120 51 2611.2 percent of total billed charges 5120 5120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX M STEM LATERA OFFSET NUMBER 1 SUP-97-03000 CDM C1776 HCPCS 0278 RC outpatient 6000 6000 6000 57 3420 percent of total billed charges 6000 93 4860 percent of total billed charges 6000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6000 other OPPS APC 6000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6000 other OPPS APC 6000 51 3060 percent of total billed charges 6000 6000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX DELTA HEAD 36MM-SHORT SUP-97-03001 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HELICAL BLADE 90MM TFNA SUP-97-03002 CDM C1713 HCPCS 0278 RC outpatient 2272.68 2272.68 2272.68 57 1295.43 percent of total billed charges 2272.68 93 1840.87 percent of total billed charges 2272.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2272.68 other OPPS APC 2272.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2272.68 other OPPS APC 2272.68 51 1159.07 percent of total billed charges 2272.68 2272.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TI CANN TFNA 10MM/130DEG SUP-97-03003 CDM C1713 HCPCS 0278 RC outpatient 6041.6 6041.6 6041.6 57 3443.71 percent of total billed charges 6041.6 93 4893.7 percent of total billed charges 6041.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6041.6 other OPPS APC 6041.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6041.6 other OPPS APC 6041.6 51 3081.22 percent of total billed charges 6041.6 6041.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LG EX-FIX COMBINATION CLAMMR -CONDITIONA SUP-97-03004 CDM C1713 HCPCS 0278 RC outpatient 3005 3005 3005 57 1712.85 percent of total billed charges 3005 93 2434.05 percent of total billed charges 3005 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3005 other OPPS APC 3005 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3005 other OPPS APC 3005 51 1532.55 percent of total billed charges 3005 3005 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LG EX-FIX 11MMCRBN FBR RO100 -CONDITIONA SUP-97-03005 CDM C1713 HCPCS 0278 RC outpatient 1239 1239 1239 57 706.23 percent of total billed charges 1239 93 1003.59 percent of total billed charges 1239 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1239 other OPPS APC 1239 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1239 other OPPS APC 1239 51 631.89 percent of total billed charges 1239 1239 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LG EX-FIX 11MMCRBN FBR RO150 -CONDITIONA SUP-97-03006 CDM C1713 HCPCS 0278 RC outpatient 1239 1239 1239 57 706.23 percent of total billed charges 1239 93 1003.59 percent of total billed charges 1239 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1239 other OPPS APC 1239 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1239 other OPPS APC 1239 51 631.89 percent of total billed charges 1239 1239 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LG EX-FIX 11MMCRBN FBR RO250 -CONDITIONA SUP-97-03007 CDM C1713 HCPCS 0278 RC outpatient 1329 1329 1329 57 757.53 percent of total billed charges 1329 93 1076.49 percent of total billed charges 1329 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1329 other OPPS APC 1329 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1329 other OPPS APC 1329 51 677.79 percent of total billed charges 1329 1329 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5/0MMSELF DRILLING SCHANZSCREW 60MM THRD SUP-97-03008 CDM C1713 HCPCS 0278 RC outpatient 963 963 963 57 548.91 percent of total billed charges 963 93 780.03 percent of total billed charges 963 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 963 other OPPS APC 963 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 963 other OPPS APC 963 51 491.13 percent of total billed charges 963 963 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5MM DRILL BIT /QC 195MM SUP-97-03009 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5.0MM X 32MM SUP-97-03010 CDM C1713 HCPCS 0278 RC outpatient 595 595 595 57 339.15 percent of total billed charges 595 93 481.95 percent of total billed charges 595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 595 other OPPS APC 595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 595 other OPPS APC 595 51 303.45 percent of total billed charges 595 595 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CORTEX SCREW 4.5 30MM SUP-97-03011 CDM C1713 HCPCS 0278 RC outpatient 152.32 152.32 152.32 57 86.82 percent of total billed charges 152.32 93 123.38 percent of total billed charges 152.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.32 other OPPS APC 152.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.32 other OPPS APC 152.32 51 77.68 percent of total billed charges 152.32 152.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CORTEX SCREW 4.5 32MM SUP-97-03012 CDM C1713 HCPCS 0278 RC outpatient 156.08 156.08 156.08 57 88.97 percent of total billed charges 156.08 93 126.42 percent of total billed charges 156.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 156.08 other OPPS APC 156.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 156.08 other OPPS APC 156.08 51 79.6 percent of total billed charges 156.08 156.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5.0MM COMPRESSION BOARD 245MM SUP-97-03013 CDM C1713 HCPCS 0278 RC outpatient 156.08 156.08 156.08 57 88.97 percent of total billed charges 156.08 93 126.42 percent of total billed charges 156.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 156.08 other OPPS APC 156.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 156.08 other OPPS APC 156.08 51 79.6 percent of total billed charges 156.08 156.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETENSION SCREW SUP-97-03014 CDM C1713 HCPCS 0278 RC outpatient 873.93 873.93 873.93 57 498.14 percent of total billed charges 873.93 93 707.88 percent of total billed charges 873.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 873.93 other OPPS APC 873.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 873.93 other OPPS APC 873.93 51 445.7 percent of total billed charges 873.93 873.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER BLADE PATELLA W/ PILOT HOLE SZ38 SUP-97-03017 CDM 0272 RC outpatient 350 350 350 74 259 percent of total billed charges 350 93 283.5 percent of total billed charges 350 350 other OPPS APC 350 350 other OPPS APC 350 27.63 96.71 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMNIOFIX 4CMX4CM SUP-97-03018 CDM outpatient 3737.5 3737.5 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STRAVIX MESHED 3 X 6CM (PS60036) SUP-97-03019 CDM Q4133 HCPCS 0636 RC outpatient 6638.75 6638.75 166 166 fee schedule 6638.75 93 5377.39 percent of total billed charges 6638.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6638.75 other OPPS APC 6638.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6638.75 other OPPS APC 6638.75 24.86 1650.39 percent of total billed charges 166 6638.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 3.0 SUP-97-03020 CDM C1780 HCPCS 0278 RC outpatient 381.5 381.5 381.5 57 217.46 percent of total billed charges 381.5 93 309.02 percent of total billed charges 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 51 194.57 percent of total billed charges 381.5 381.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 40MM THREAD 6.5MM X 100MM SUP-97-03021 CDM C1713 HCPCS 0278 RC outpatient 618.24 618.24 618.24 57 352.4 percent of total billed charges 618.24 93 500.77 percent of total billed charges 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 51 315.3 percent of total billed charges 618.24 618.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 40MM THREAD 6.5MM X 90MM SUP-97-03022 CDM C1713 HCPCS 0278 RC outpatient 618.24 618.24 618.24 57 352.4 percent of total billed charges 618.24 93 500.77 percent of total billed charges 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 51 315.3 percent of total billed charges 618.24 618.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN FULL THRD 4.0 X 26MM SUP-97-03023 CDM C1713 HCPCS 0278 RC outpatient 476 476 476 57 271.32 percent of total billed charges 476 93 385.56 percent of total billed charges 476 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 476 other OPPS APC 476 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 476 other OPPS APC 476 51 242.76 percent of total billed charges 476 476 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU150 25.0D SUP-97-03024 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU225 16.0D SUP-97-03025 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI CANN COMP HEADLESS 3.5MM X 26MM SUP-97-03026 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI CANN COMP HEADLESS 3.5MM X 38MM SUP-97-03027 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE OLECRANON LEFT 4 HOLE SUP-97-03028 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING VAR ANGLE 2.7MM X 32MM SUP-97-03029 CDM C1713 HCPCS 0278 RC outpatient 532.77 532.77 532.77 57 303.68 percent of total billed charges 532.77 93 431.54 percent of total billed charges 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 51 271.71 percent of total billed charges 532.77 532.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING VAR ANGLE 2.7MM X 34MM SUP-97-03030 CDM C1713 HCPCS 0278 RC outpatient 532.77 532.77 532.77 57 303.68 percent of total billed charges 532.77 93 431.54 percent of total billed charges 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 51 271.71 percent of total billed charges 532.77 532.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU300 18.0D SUP-97-03031 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS TECNIS MONOFOCAL 22.5D SUP-97-03032 CDM V2787 CPT 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU150 22.0D SUP-97-03033 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU150 12.5D SUP-97-03034 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU225 12.0D SUP-97-03035 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU225 19.5D SUP-97-03036 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU225 13.0D SUP-97-03037 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON IOL 19.0D SUP-97-03038 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU225 20.0D SUP-97-03039 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 8.5D TECNIS EYHANCE SUP-97-03040 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP 8MM SUP-97-03053 CDM C1713 HCPCS 0278 RC outpatient 389.55 389.55 389.55 57 222.04 percent of total billed charges 389.55 93 315.54 percent of total billed charges 389.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 389.55 other OPPS APC 389.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 389.55 other OPPS APC 389.55 51 198.67 percent of total billed charges 389.55 389.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL NAIL 12 X 345MM T2 STANDARD SUP-97-03054 CDM C1713 HCPCS 0278 RC outpatient 2734.2 2734.2 2734.2 57 1558.49 percent of total billed charges 2734.2 93 2214.7 percent of total billed charges 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 51 1394.44 percent of total billed charges 2734.2 2734.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5.0MM X 30MM SUP-97-03055 CDM C1713 HCPCS 0278 RC outpatient 591.92 591.92 591.92 57 337.39 percent of total billed charges 591.92 93 479.46 percent of total billed charges 591.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 591.92 other OPPS APC 591.92 591.92 other OPPS APC 591.92 51 301.88 percent of total billed charges 591.92 591.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANCELLOUS FULL THRD 6MM X 30MM SUP-97-03056 CDM C1713 HCPCS 0278 RC outpatient 171.36 171.36 171.36 57 97.68 percent of total billed charges 171.36 93 138.8 percent of total billed charges 171.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 171.36 other OPPS APC 171.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 171.36 other OPPS APC 171.36 51 87.39 percent of total billed charges 171.36 171.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING PERIPROSTHETIC 5MM X 8MM SUP-97-03057 CDM C1713 HCPCS 0278 RC outpatient 688.56 688.56 688.56 57 392.48 percent of total billed charges 688.56 93 557.73 percent of total billed charges 688.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 688.56 other OPPS APC 688.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 688.56 other OPPS APC 688.56 51 351.17 percent of total billed charges 688.56 688.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING PERIPROSTHETIC 5MM X 10MM SUP-97-03058 CDM C1713 HCPCS 0278 RC outpatient 688.56 688.56 688.56 57 392.48 percent of total billed charges 688.56 93 557.73 percent of total billed charges 688.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 688.56 other OPPS APC 688.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 688.56 other OPPS APC 688.56 51 351.17 percent of total billed charges 688.56 688.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE DYNANITE NITI W/INST 15MM X15MM SUP-97-03059 CDM C1713 HCPCS 0278 RC outpatient 5737.5 5737.5 5737.5 57 3270.38 percent of total billed charges 5737.5 93 4647.38 percent of total billed charges 5737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5737.5 other OPPS APC 5737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5737.5 other OPPS APC 5737.5 51 2926.13 percent of total billed charges 5737.5 5737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3MM X 12MM HEADLESS SHORT THREAD SUP-97-03060 CDM C1713 HCPCS 0278 RC outpatient 1827 1827 1827 57 1041.39 percent of total billed charges 1827 93 1479.87 percent of total billed charges 1827 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1827 other OPPS APC 1827 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1827 other OPPS APC 1827 51 931.77 percent of total billed charges 1827 1827 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 3 HOLE RIGHT DISTAL HUMERUS 3.5MM SUP-97-03061 CDM C1713 HCPCS 0278 RC outpatient 3635 3635 3635 57 2071.95 percent of total billed charges 3635 93 2944.35 percent of total billed charges 3635 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3635 other OPPS APC 3635 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3635 other OPPS APC 3635 51 1853.85 percent of total billed charges 3635 3635 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 X 50MM MICA PROSTEP SUP-97-03062 CDM C1713 HCPCS 0278 RC outpatient 1428 1428 1428 57 813.96 percent of total billed charges 1428 93 1156.68 percent of total billed charges 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 51 728.28 percent of total billed charges 1428 1428 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE STRIKE 8.0X250MM SUP-97-03063 CDM C1713 HCPCS 0278 RC outpatient 2111.91 2111.91 2111.91 57 1203.79 percent of total billed charges 2111.91 93 1710.65 percent of total billed charges 2111.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2111.91 other OPPS APC 2111.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2111.91 other OPPS APC 2111.91 51 1077.07 percent of total billed charges 2111.91 2111.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL KIT TI TROCHANTERIC 11 X 180 X 130 SUP-97-03064 CDM C1713 HCPCS 0278 RC outpatient 2618.1 2618.1 2618.1 57 1492.32 percent of total billed charges 2618.1 93 2120.66 percent of total billed charges 2618.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2618.1 other OPPS APC 2618.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2618.1 other OPPS APC 2618.1 51 1335.23 percent of total billed charges 2618.1 2618.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE GEMINUS DISTAL RAD 3 HOLE RT SUP-97-03065 CDM C1713 HCPCS 0278 RC outpatient 1881 1881 1881 57 1072.17 percent of total billed charges 1881 93 1523.61 percent of total billed charges 1881 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1881 other OPPS APC 1881 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1881 other OPPS APC 1881 51 959.31 percent of total billed charges 1881 1881 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL LOCKING 3.5MMX12MM SUP-97-03066 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX COMPRES NARROW STRT 8H X102 SUP-97-03067 CDM C1713 HCPCS 0278 RC outpatient 1939.08 1939.08 1939.08 57 1105.28 percent of total billed charges 1939.08 93 1570.65 percent of total billed charges 1939.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1939.08 other OPPS APC 1939.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1939.08 other OPPS APC 1939.08 51 988.93 percent of total billed charges 1939.08 1939.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 14MM SUP-97-03068 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MODULAR RADIAL STEM W/SCREW 8X28 SUP-97-03069 CDM C1713 HCPCS 0278 RC outpatient 5350 5350 5350 57 3049.5 percent of total billed charges 5350 93 4333.5 percent of total billed charges 5350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5350 other OPPS APC 5350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5350 other OPPS APC 5350 51 2728.5 percent of total billed charges 5350 5350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MODULAR RADIAL STEM W/SCREW 18X24 SUP-97-03070 CDM C1713 HCPCS 0278 RC outpatient 5350 5350 5350 57 3049.5 percent of total billed charges 5350 93 4333.5 percent of total billed charges 5350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5350 other OPPS APC 5350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5350 other OPPS APC 5350 51 2728.5 percent of total billed charges 5350 5350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 50MM SUP-97-03071 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SNAP OFF 2.7MM X 14MM SUP-97-03072 CDM C1713 HCPCS 0278 RC outpatient 1186.08 1186.08 1186.08 57 676.07 percent of total billed charges 1186.08 93 960.72 percent of total billed charges 1186.08 1186.08 other OPPS APC 1186.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1186.08 other OPPS APC 1186.08 51 604.9 percent of total billed charges 1186.08 1186.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 30.0D TECNIS EYHANCE SUP-97-03073 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS SENSAR ACRYLIC AR40M -2.5D SUP-97-03074 CDM C1780 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON 8.0D SUP-97-03075 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON IOL 8.0D SUP-97-03075 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SNAP OFF 2.7MM X 16MM SUP-97-03076 CDM C1713 HCPCS 0278 RC outpatient 1186.08 1186.08 1186.08 57 676.07 percent of total billed charges 1186.08 93 960.72 percent of total billed charges 1186.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1186.08 other OPPS APC 1186.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1186.08 other OPPS APC 1186.08 51 604.9 percent of total billed charges 1186.08 1186.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 10.5D TECNIS ASPHERIC SUP-97-03077 CDM C1780 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 29.5D TECNIS EYHANCE SUP-97-03078 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON 13.5D SUP-97-03079 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON IOL 13.5D SUP-97-03079 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON 19.5D SUP-97-03080 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON IOL 19.5D SUP-97-03080 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU225 18.5D SUP-97-03081 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 3.0D SUP-97-03082 CDM C1780 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU375 16.5D SUP-97-03083 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU375 15.5D SUP-97-03084 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU150 21.0D SUP-97-03085 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU150 19.5D SUP-97-03086 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW COMPRESSION CANN 4.0MM X 40MM HEADLESS SUP-97-03087 CDM C1713 HCPCS 0278 RC outpatient 1167.6 1167.6 1167.6 57 665.53 percent of total billed charges 1167.6 93 945.76 percent of total billed charges 1167.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1167.6 other OPPS APC 1167.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1167.6 other OPPS APC 1167.6 51 595.48 percent of total billed charges 1167.6 1167.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN COMP HEADLESS 3.0MM X 26MM SUP-97-03088 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU375 19.0D SUP-97-03089 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 6.5D ACRYLIC ASPHERIC SUP-97-03090 CDM V2787 CPT 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 507.5 other OPPS APC 507.5 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU300 15.5D SUP-97-03091 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU150 20.0D SUP-97-03093 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU150 18.5D SUP-97-03094 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 30.5D TECNIS EYHANCE SUP-97-03095 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU150 23.5D SUP-97-03096 CDM C1780 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU300 20.0D SUP-97-03097 CDM C1780 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIVERSAL STEM FLUTED 75MM X12MM SUP-97-03122 CDM C1713 HCPCS 0278 RC outpatient 5536.5 5536.5 5536.5 57 3155.81 percent of total billed charges 5536.5 93 4484.57 percent of total billed charges 5536.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5536.5 other OPPS APC 5536.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5536.5 other OPPS APC 5536.5 51 2823.62 percent of total billed charges 5536.5 5536.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN LONG THREAD 4MM X 32MM SUP-97-03125 CDM C1713 HCPCS 0278 RC outpatient 676.76 676.76 676.76 57 385.75 percent of total billed charges 676.76 93 548.18 percent of total billed charges 676.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 676.76 other OPPS APC 676.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 676.76 other OPPS APC 676.76 51 345.15 percent of total billed charges 676.76 676.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO BHX IMPLANT 3MM ABUTMENT 6 SUP-97-03127 CDM L8614 HCPCS 0278 RC outpatient 8021.25 8021.25 8021.25 57 4572.11 percent of total billed charges 8021.25 93 6497.21 percent of total billed charges 8021.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8021.25 other OPPS APC 8021.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8021.25 other OPPS APC 8021.25 51 4090.84 percent of total billed charges 8021.25 8021.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TITAN 3-D WEDGE SMALL 8 X 17MM SUP-97-03129 CDM C1713 HCPCS 0278 RC outpatient 4687.5 4687.5 4687.5 57 2671.88 percent of total billed charges 4687.5 93 3796.88 percent of total billed charges 4687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4687.5 other OPPS APC 4687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4687.5 other OPPS APC 4687.5 51 2390.63 percent of total billed charges 4687.5 4687.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FULL THEAD SCREW 3.5X30 SUP-97-03130 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT CANN 2.3 X 120MM SUP-97-03131 CDM 0272 RC outpatient 350 350 350 74 259 percent of total billed charges 350 93 283.5 percent of total billed charges 350 350 other OPPS APC 350 350 other OPPS APC 350 27.63 96.71 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COTTON WEDGE 8MM SUP-97-03132 CDM C1762 HCPCS 0278 RC outpatient 3940.63 3940.63 3940.63 57 2246.16 percent of total billed charges 3940.63 93 3191.91 percent of total billed charges 3940.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3940.63 other OPPS APC 3940.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3940.63 other OPPS APC 3940.63 51 2009.72 percent of total billed charges 3940.63 3940.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE NASAL JEJUNAL TIGER 2 14FR 153CM SUP-97-03133 CDM 0272 RC outpatient 741 741 741 74 548.34 percent of total billed charges 741 93 600.21 percent of total billed charges 741 741 other OPPS APC 741 741 other OPPS APC 741 27.63 204.74 percent of total billed charges 741 741 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL LATERAL FIBULA PLATE 4 HOLE SUP-97-03134 CDM C1713 HCPCS 0278 RC outpatient 1276.02 1276.02 1276.02 57 727.33 percent of total billed charges 1276.02 93 1033.58 percent of total billed charges 1276.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1276.02 other OPPS APC 1276.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1276.02 other OPPS APC 1276.02 51 650.77 percent of total billed charges 1276.02 1276.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX M STEM LATERA OFFSET NUMBER 8 SUP-97-03135 CDM C1776 HCPCS 0278 RC outpatient 6000 6000 6000 57 3420 percent of total billed charges 6000 93 4860 percent of total billed charges 6000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6000 other OPPS APC 6000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6000 other OPPS APC 6000 51 3060 percent of total billed charges 6000 6000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX DELTA HEAD 36MM-LONG SUP-97-03136 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING SELF TAPPING 3.5 X 32MM SUP-97-03137 CDM C1713 HCPCS 0278 RC outpatient 472.89 472.89 472.89 57 269.55 percent of total billed charges 472.89 93 383.04 percent of total billed charges 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 51 241.17 percent of total billed charges 472.89 472.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI LM/RL TIB AUG SZ2 5MM SUP-97-03138 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM LCP LOW BEND MED PLATE 14H/LT239 SUP-97-03139 CDM C1713 HCPCS 0278 RC outpatient 6780 6780 6780 57 3864.6 percent of total billed charges 6780 93 5491.8 percent of total billed charges 6780 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6780 other OPPS APC 6780 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6780 other OPPS APC 6780 51 3457.8 percent of total billed charges 6780 6780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL 10MM/130 DEG TI CANN LEFT STERILE SUP-97-03140 CDM C1713 HCPCS 0278 RC outpatient 6041.6 6041.6 6041.6 57 3443.71 percent of total billed charges 6041.6 93 4893.7 percent of total billed charges 6041.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6041.6 other OPPS APC 6041.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6041.6 other OPPS APC 6041.6 51 3081.22 percent of total billed charges 6041.6 6041.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HELICAL BLADE 100MM TFNA SUP-97-03141 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COTTON WEDGE 7MM SUP-97-03142 CDM C1762 HCPCS 0278 RC outpatient 3940.63 3940.63 3940.63 57 2246.16 percent of total billed charges 3940.63 93 3191.91 percent of total billed charges 3940.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3940.63 other OPPS APC 3940.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3940.63 other OPPS APC 3940.63 51 2009.72 percent of total billed charges 3940.63 3940.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TITAN 3-D WEDGE 10MM SUP-97-03143 CDM C1713 HCPCS 0278 RC outpatient 5078.13 5078.13 5078.13 57 2894.53 percent of total billed charges 5078.13 93 4113.29 percent of total billed charges 5078.13 5078.13 other OPPS APC 5078.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5078.13 other OPPS APC 5078.13 51 2589.85 percent of total billed charges 5078.13 5078.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TRAY INSERT,FEMUR,PATELLA" SUP-97-03144 CDM C1762 HCPCS 0278 RC outpatient 3372.5 3372.5 3372.5 57 1922.33 percent of total billed charges 3372.5 93 2731.73 percent of total billed charges 3372.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3372.5 other OPPS APC 3372.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3372.5 other OPPS APC 3372.5 51 1719.98 percent of total billed charges 3372.5 3372.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMNIOFILL 100MG SUP-97-03145 CDM outpatient 855 855 855 855 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE HOLLOW REAMER SPARE SUP-97-03146 CDM C1713 HCPCS 0278 RC outpatient 1605 1605 1605 57 914.85 percent of total billed charges 1605 93 1300.05 percent of total billed charges 1605 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1605 other OPPS APC 1605 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1605 other OPPS APC 1605 51 818.55 percent of total billed charges 1605 1605 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 85MM SUP-97-03147 CDM C1713 HCPCS 0278 RC outpatient 605.89 605.89 605.89 57 345.36 percent of total billed charges 605.89 93 490.77 percent of total billed charges 605.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 605.89 other OPPS APC 605.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 605.89 other OPPS APC 605.89 51 309 percent of total billed charges 605.89 605.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL NAIL 10 X 375MM T2 STANDARD SUP-97-03148 CDM C1713 HCPCS 0278 RC outpatient 2734.2 2734.2 2734.2 57 1558.49 percent of total billed charges 2734.2 93 2214.7 percent of total billed charges 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 51 1394.44 percent of total billed charges 2734.2 2734.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX M STEM LATERA OFFSET NUMBER 3 SUP-97-03149 CDM C1776 HCPCS 0278 RC outpatient 6000 6000 6000 57 3420 percent of total billed charges 6000 93 4860 percent of total billed charges 6000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6000 other OPPS APC 6000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6000 other OPPS APC 6000 51 3060 percent of total billed charges 6000 6000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX DELTA HEAD 36MM SUP-97-03150 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX DELTA HEAD 36MM SUP-97-03151 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX M STEM LATERA OFFSET NUMBER 9 SUP-97-03152 CDM C1776 HCPCS 0278 RC outpatient 6000 6000 6000 57 3420 percent of total billed charges 6000 93 4860 percent of total billed charges 6000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6000 other OPPS APC 6000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6000 other OPPS APC 6000 51 3060 percent of total billed charges 6000 6000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 32.0D SUP-97-03153 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 70MM NON LOCKING SUP-97-03154 CDM C1713 HCPCS 0278 RC outpatient 264.6 264.6 264.6 57 150.82 percent of total billed charges 264.6 93 214.33 percent of total billed charges 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 51 134.95 percent of total billed charges 264.6 264.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOREFOOT IB IMPLANT SUP-97-03156 CDM C1713 HCPCS 0278 RC outpatient 4982.5 4982.5 4982.5 57 2840.03 percent of total billed charges 4982.5 93 4035.83 percent of total billed charges 4982.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4982.5 other OPPS APC 4982.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4982.5 other OPPS APC 4982.5 51 2541.08 percent of total billed charges 4982.5 4982.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QCKFIX SCRWTI CANN SUP-97-03157 CDM C1713 HCPCS 0278 RC outpatient 490 490 490 57 279.3 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 51 249.9 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW QCKFIX TI CANN PT3 SUP-97-03158 CDM C1713 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW QCKFIX TI CANN PT3 SUP-97-03159 CDM C1713 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GULDEWIRE .086 W/LASER LINE SS SUP-97-03160 CDM 0272 RC outpatient 60 60 60 74 44.4 percent of total billed charges 60 93 48.6 percent of total billed charges 60 60 other OPPS APC 60 60 other OPPS APC 60 27.63 16.58 percent of total billed charges 60 60 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE 0.86MM W/LASER LINE THRD. SS SUP-97-03161 CDM 0272 RC outpatient 80 80 80 74 59.2 percent of total billed charges 80 93 64.8 percent of total billed charges 80 80 other OPPS APC 80 80 other OPPS APC 80 27.63 22.1 percent of total billed charges 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK 3.0MM CANNULATED SUP-97-03162 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE SCREW 2.4X24MM CORTEX SUP-97-03163 CDM C1713 HCPCS 0278 RC outpatient 437.5 437.5 437.5 57 249.38 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 51 223.13 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOSYNC EVANS WEDGE18X18X10 SUP-97-03165 CDM C1713 HCPCS 0278 RC outpatient 5487.5 5487.5 5487.5 57 3127.88 percent of total billed charges 5487.5 93 4444.88 percent of total billed charges 5487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5487.5 other OPPS APC 5487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5487.5 other OPPS APC 5487.5 51 2798.63 percent of total billed charges 5487.5 5487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOSYNC EVANS WEDGE18X18X12 SUP-97-03166 CDM C1713 HCPCS 0278 RC outpatient 5487.5 5487.5 5487.5 57 3127.88 percent of total billed charges 5487.5 93 4444.88 percent of total billed charges 5487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5487.5 other OPPS APC 5487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5487.5 other OPPS APC 5487.5 51 2798.63 percent of total billed charges 5487.5 5487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOSYNC ANATOMIC COTTON WEDGE SUP-97-03167 CDM C1713 HCPCS 0278 RC outpatient 4987.5 4987.5 4987.5 57 2842.88 percent of total billed charges 4987.5 93 4039.88 percent of total billed charges 4987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4987.5 other OPPS APC 4987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4987.5 other OPPS APC 4987.5 51 2543.63 percent of total billed charges 4987.5 4987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2 HOLE DLB COMP PLATE 20MM SUP-97-03168 CDM C1713 HCPCS 0278 RC outpatient 2685 2685 2685 57 1530.45 percent of total billed charges 2685 93 2174.85 percent of total billed charges 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 51 1369.35 percent of total billed charges 2685 2685 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCRW 4.0X32MM SUP-97-03169 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO PRO LOCK SCRW3.5X 16MM SUP-97-03170 CDM C1713 HCPCS 0278 RC outpatient 402.5 402.5 402.5 57 229.43 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 51 205.28 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO PRO LOCK SCRW3.5X 14MM SUP-97-03171 CDM C1713 HCPCS 0278 RC outpatient 297.5 297.5 297.5 57 169.58 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 51 151.73 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE LAPIDUS PLATE SUP-97-03172 CDM C1713 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE DYNANITE NITI W/INST 18MM X18MM SUP-97-03173 CDM C1713 HCPCS 0278 RC outpatient 5737.5 5737.5 5737.5 57 3270.38 percent of total billed charges 5737.5 93 4647.38 percent of total billed charges 5737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5737.5 other OPPS APC 5737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5737.5 other OPPS APC 5737.5 51 2926.13 percent of total billed charges 5737.5 5737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE DYNANITE NITI W/INST 20MM X 20MM SUP-97-03174 CDM C1713 HCPCS 0278 RC outpatient 5737.5 5737.5 5737.5 57 3270.38 percent of total billed charges 5737.5 93 4647.38 percent of total billed charges 5737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5737.5 other OPPS APC 5737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5737.5 other OPPS APC 5737.5 51 2926.13 percent of total billed charges 5737.5 5737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED DRILL BIT 3.0MM SUP-97-03175 CDM C1713 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PRO SCREW 4.5X60MM CANN PT THD SUP-97-03176 CDM C1713 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED LONG DRILL BIT 4MM SUP-97-03178 CDM outpatient 810 810 810 810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PRO SCREW 6.7X90MM SUP-97-03179 CDM C1713 HCPCS 0278 RC outpatient 750 750 750 57 427.5 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 51 382.5 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HELICAL FENESTRATED BLADE 90MM TFNA SUP-97-03180 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZCT 300 11.5D SUP-97-03181 CDM C1840 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THREADED GUIDE WIRE 1.4X1.5MM SUP-97-03182 CDM 0272 RC outpatient 274.75 274.75 274.75 74 203.32 percent of total billed charges 274.75 93 222.55 percent of total billed charges 274.75 274.75 other OPPS APC 274.75 274.75 other OPPS APC 274.75 27.63 75.91 percent of total billed charges 274.75 274.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN TI 4.0X50MM SUP-97-03183 CDM C1713 HCPCS 0278 RC outpatient 396.48 396.48 396.48 57 225.99 percent of total billed charges 396.48 93 321.15 percent of total billed charges 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 51 202.2 percent of total billed charges 396.48 396.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OVERDRILL AO 3.5MM X 122MM SUP-97-03184 CDM 0272 RC outpatient 549.5 549.5 549.5 74 406.63 percent of total billed charges 549.5 93 445.1 percent of total billed charges 549.5 549.5 other OPPS APC 549.5 549.5 other OPPS APC 549.5 27.63 151.83 percent of total billed charges 549.5 549.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 10MM SUP-97-03185 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 12MM SUP-97-03186 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 14MM SUP-97-03187 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 16MM SUP-97-03188 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 18MM SUP-97-03189 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 10MM SUP-97-03190 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 48MM SUP-97-03191 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER T8 & T10 SCREWS 2.4MM / 2.7MM / 3 SUP-97-03192 CDM C1713 HCPCS 0278 RC outpatient 154.96 154.96 154.96 57 88.33 percent of total billed charges 154.96 93 125.52 percent of total billed charges 154.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 154.96 other OPPS APC 154.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 154.96 other OPPS APC 154.96 51 79.03 percent of total billed charges 154.96 154.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE SCREW T10 FULL THREAD 2.7MM / L8MM SUP-97-03193 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K WIRE 1.6 X 150MM SUP-97-03194 CDM 0272 RC outpatient 36 36 36 74 26.64 percent of total billed charges 36 93 29.16 percent of total billed charges 36 36 other OPPS APC 36 36 other OPPS APC 36 27.63 9.95 percent of total billed charges 36 36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K WIRE 1.25 X 150MM SUP-97-03195 CDM C1713 HCPCS 0278 RC outpatient 36 36 36 57 20.52 percent of total billed charges 36 93 29.16 percent of total billed charges 36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36 other OPPS APC 36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36 other OPPS APC 36 51 18.36 percent of total billed charges 36 36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN SHRT THREAD 4MM X 46MM SUP-97-03196 CDM C1713 HCPCS 0278 RC outpatient 659.75 659.75 659.75 57 376.06 percent of total billed charges 659.75 93 534.4 percent of total billed charges 659.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 659.75 other OPPS APC 659.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 659.75 other OPPS APC 659.75 51 336.47 percent of total billed charges 659.75 659.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SLEEVE 2.7 SUP-97-03197 CDM 0272 RC outpatient 777 777 777 74 574.98 percent of total billed charges 777 93 629.37 percent of total billed charges 777 777 other OPPS APC 777 777 other OPPS APC 777 27.63 214.69 percent of total billed charges 777 777 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 30.0D SUP-97-03198 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 30.0 SUP-97-03199 CDM C1780 HCPCS 0278 RC outpatient 1251.15 1251.15 1251.15 57 713.16 percent of total billed charges 1251.15 93 1013.43 percent of total billed charges 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 51 638.09 percent of total billed charges 1251.15 1251.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS ZKBOO 22.5D SUP-97-03200 CDM C1780 HCPCS 0278 RC outpatient 2685 2685 2685 57 1530.45 percent of total billed charges 2685 93 2174.85 percent of total billed charges 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 51 1369.35 percent of total billed charges 2685 2685 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 25MM SUP-97-03201 CDM C1713 HCPCS 0278 RC outpatient 2077.29 2077.29 2077.29 57 1184.06 percent of total billed charges 2077.29 93 1682.6 percent of total billed charges 2077.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2077.29 other OPPS APC 2077.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2077.29 other OPPS APC 2077.29 51 1059.42 percent of total billed charges 2077.29 2077.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 3 SUP-97-03202 CDM C1713 HCPCS 0278 RC outpatient 867 867 867 57 494.19 percent of total billed charges 867 93 702.27 percent of total billed charges 867 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 867 other OPPS APC 867 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 867 other OPPS APC 867 51 442.17 percent of total billed charges 867 867 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 3 SUP-97-03203 CDM C1713 HCPCS 0278 RC outpatient 656.67 656.67 656.67 57 374.3 percent of total billed charges 656.67 93 531.9 percent of total billed charges 656.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 656.67 other OPPS APC 656.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 656.67 other OPPS APC 656.67 51 334.9 percent of total billed charges 656.67 656.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 3 SUP-97-03204 CDM C1713 HCPCS 0278 RC outpatient 604.45 604.45 604.45 57 344.54 percent of total billed charges 604.45 93 489.6 percent of total billed charges 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 51 308.27 percent of total billed charges 604.45 604.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 4 SUP-97-03205 CDM C1713 HCPCS 0278 RC outpatient 656.67 656.67 656.67 57 374.3 percent of total billed charges 656.67 93 531.9 percent of total billed charges 656.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 656.67 other OPPS APC 656.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 656.67 other OPPS APC 656.67 51 334.9 percent of total billed charges 656.67 656.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING SUP-97-03206 CDM C1713 HCPCS 0278 RC outpatient 656.67 656.67 656.67 57 374.3 percent of total billed charges 656.67 93 531.9 percent of total billed charges 656.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 656.67 other OPPS APC 656.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 656.67 other OPPS APC 656.67 51 334.9 percent of total billed charges 656.67 656.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 44MM SUP-97-03207 CDM C1713 HCPCS 0278 RC outpatient 656.67 656.67 656.67 57 374.3 percent of total billed charges 656.67 93 531.9 percent of total billed charges 656.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 656.67 other OPPS APC 656.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 656.67 other OPPS APC 656.67 51 334.9 percent of total billed charges 656.67 656.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PT 8MM X 90 SUP-97-03208 CDM C1713 HCPCS 0278 RC outpatient 743.01 743.01 743.01 57 423.52 percent of total billed charges 743.01 93 601.84 percent of total billed charges 743.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 743.01 other OPPS APC 743.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 743.01 other OPPS APC 743.01 51 378.94 percent of total billed charges 743.01 743.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PT 8MM X 95 SUP-97-03209 CDM C1713 HCPCS 0278 RC outpatient 743.01 743.01 743.01 57 423.52 percent of total billed charges 743.01 93 601.84 percent of total billed charges 743.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 743.01 other OPPS APC 743.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 743.01 other OPPS APC 743.01 51 378.94 percent of total billed charges 743.01 743.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PT 8MM X 100 SUP-97-03210 CDM C1713 HCPCS 0278 RC outpatient 743.01 743.01 743.01 57 423.52 percent of total billed charges 743.01 93 601.84 percent of total billed charges 743.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 743.01 other OPPS APC 743.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 743.01 other OPPS APC 743.01 51 378.94 percent of total billed charges 743.01 743.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE THREADED ASNIS III 3.2 X 300M SUP-97-03211 CDM 0272 RC outpatient 120 120 120 74 88.8 percent of total billed charges 120 93 97.2 percent of total billed charges 120 120 other OPPS APC 120 120 other OPPS APC 120 27.63 33.16 percent of total billed charges 120 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT LOCKING SHORT ?4.3X216MM SUP-97-03213 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT LOCKING SHORT 3.2X216MM SUP-97-03214 CDM 0272 RC outpatient 537.6 537.6 537.6 74 397.82 percent of total billed charges 537.6 93 435.46 percent of total billed charges 537.6 537.6 other OPPS APC 537.6 537.6 other OPPS APC 537.6 27.63 148.54 percent of total billed charges 537.6 537.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5 X 44MM CORTEX SUP-97-03215 CDM C1713 HCPCS 0278 RC outpatient 110.96 110.96 110.96 57 63.25 percent of total billed charges 110.96 93 89.88 percent of total billed charges 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 51 56.59 percent of total billed charges 110.96 110.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5MM CORTEX TI SCREW 4.5MM / L36MM SUP-97-03216 CDM C1713 HCPCS 0278 RC outpatient 110.96 110.96 110.96 57 63.25 percent of total billed charges 110.96 93 89.88 percent of total billed charges 110.96 110.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX TI 4.5MM / L36MM SUP-97-03216 CDM C1713 HCPCS 0278 RC outpatient 110.96 110.96 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 51 56.59 percent of total billed charges 110.96 110.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5.0MM X 28MM SUP-97-03217 CDM C1713 HCPCS 0278 RC outpatient 591.92 591.92 591.92 57 337.39 percent of total billed charges 591.92 93 479.46 percent of total billed charges 591.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 591.92 other OPPS APC 591.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 591.92 other OPPS APC 591.92 51 301.88 percent of total billed charges 591.92 591.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DRILL BIT, AO DIA 2.0MM X 135MM, SCALED" SUP-97-03218 CDM 0272 RC outpatient 549.5 549.5 549.5 74 406.63 percent of total billed charges 549.5 93 445.1 percent of total billed charges 549.5 549.5 other OPPS APC 549.5 549.5 other OPPS APC 549.5 27.63 151.83 percent of total billed charges 549.5 549.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DRILL BIT, AO DIA 2.6MM X 135MM, SCALED" SUP-97-03219 CDM 0272 RC outpatient 549.5 549.5 549.5 74 406.63 percent of total billed charges 549.5 93 445.1 percent of total billed charges 549.5 549.5 other OPPS APC 549.5 549.5 other OPPS APC 549.5 27.63 151.83 percent of total billed charges 549.5 549.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 8MM SUP-97-03220 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 42MM SUP-97-03221 CDM C1713 HCPCS 0278 RC outpatient 313.25 313.25 313.25 57 178.55 percent of total billed charges 313.25 93 253.73 percent of total billed charges 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 51 159.76 percent of total billed charges 313.25 313.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OVERDRILL AO 2.7MM X 122MM SUP-97-03222 CDM 0272 RC outpatient 472.01 472.01 472.01 74 349.29 percent of total billed charges 472.01 93 382.33 percent of total billed charges 472.01 472.01 other OPPS APC 472.01 472.01 other OPPS APC 472.01 27.63 130.42 percent of total billed charges 472.01 472.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.0 TAP CANCELLOUS SUP-97-03223 CDM 0272 RC outpatient 1189.2 1189.2 1189.2 74 880.01 percent of total billed charges 1189.2 93 963.25 percent of total billed charges 1189.2 1189.2 other OPPS APC 1189.2 1189.2 other OPPS APC 1189.2 27.63 328.58 percent of total billed charges 1189.2 1189.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 6 X 40MM CANCELLOUS FULL THREAD SUP-97-03224 CDM C1713 HCPCS 0278 RC outpatient 124.64 124.64 124.64 57 71.04 percent of total billed charges 124.64 93 100.96 percent of total billed charges 124.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 124.64 other OPPS APC 124.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 124.64 other OPPS APC 124.64 51 63.57 percent of total billed charges 124.64 124.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DOUBLE DRILL GUIDE 2.5MM (COMPR/NUETR) SUP-97-03225 CDM 0272 RC outpatient 34.52 34.52 34.52 74 25.54 percent of total billed charges 34.52 93 27.96 percent of total billed charges 34.52 34.52 other OPPS APC 34.52 34.52 other OPPS APC 34.52 27.63 9.54 percent of total billed charges 34.52 34.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PARIETENE DS RND 12CM X 1 SUP-97-03226 CDM C1781 HCPCS 0278 RC outpatient 1090.68 1090.68 1090.68 57 621.69 percent of total billed charges 1090.68 93 883.45 percent of total billed charges 1090.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1090.68 other OPPS APC 1090.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1090.68 other OPPS APC 1090.68 51 556.25 percent of total billed charges 1090.68 1090.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE SCREWS SUP-97-03227 CDM C1713 HCPCS 0278 RC outpatient 100 100 100 57 57 percent of total billed charges 100 93 81 percent of total billed charges 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 51 51 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERIPHERAL SCREW 4.5X16MM SUP-97-03228 CDM C1713 HCPCS 0278 RC outpatient 100 100 100 57 57 percent of total billed charges 100 93 81 percent of total billed charges 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 51 51 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERSY CEM/REV/CALCAR 15MMX180MM SUP-97-03229 CDM C1776 HCPCS 0278 RC outpatient 11312.5 11312.5 11312.5 57 6448.13 percent of total billed charges 11312.5 93 9163.13 percent of total billed charges 11312.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11312.5 other OPPS APC 11312.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11312.5 other OPPS APC 11312.5 51 5769.38 percent of total billed charges 11312.5 11312.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERSY CEM/REV/CALCAR BUILD UP 13/15X20 SUP-97-03230 CDM C1776 HCPCS 0278 RC outpatient 1443.75 1443.75 1443.75 57 822.94 percent of total billed charges 1443.75 93 1169.44 percent of total billed charges 1443.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1443.75 other OPPS APC 1443.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1443.75 other OPPS APC 1443.75 51 736.31 percent of total billed charges 1443.75 1443.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CORCR FEMORAL HEAD 28MM +3.5 SUP-97-03231 CDM C1776 HCPCS 0278 RC outpatient 1956 1956 1956 57 1114.92 percent of total billed charges 1956 93 1584.36 percent of total billed charges 1956 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1956 other OPPS APC 1956 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1956 other OPPS APC 1956 51 997.56 percent of total billed charges 1956 1956 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLARD LINER 47/48/49MM ODX28MM SUP-97-03232 CDM C1776 HCPCS 0278 RC outpatient 1312.5 1312.5 1312.5 57 748.13 percent of total billed charges 1312.5 93 1063.13 percent of total billed charges 1312.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1312.5 other OPPS APC 1312.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1312.5 other OPPS APC 1312.5 51 669.38 percent of total billed charges 1312.5 1312.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLARD SHELL 49MM SUP-97-03233 CDM C1776 HCPCS 0278 RC outpatient 2193.75 2193.75 2193.75 57 1250.44 percent of total billed charges 2193.75 93 1776.94 percent of total billed charges 2193.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2193.75 other OPPS APC 2193.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2193.75 other OPPS APC 2193.75 51 1118.81 percent of total billed charges 2193.75 2193.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK FEMORAL SZ E-RT SUP-97-03234 CDM C1776 HCPCS 0278 RC outpatient 15375 15375 15375 57 8763.75 percent of total billed charges 15375 93 12453.8 percent of total billed charges 15375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15375 other OPPS APC 15375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15375 other OPPS APC 15375 51 7841.25 percent of total billed charges 15375 15375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK ART SURF EF 3-4 STR YELLOW SUP-97-03235 CDM C1776 HCPCS 0278 RC outpatient 6687.5 6687.5 6687.5 57 3811.88 percent of total billed charges 6687.5 93 5416.88 percent of total billed charges 6687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6687.5 other OPPS APC 6687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6687.5 other OPPS APC 6687.5 51 3410.63 percent of total billed charges 6687.5 6687.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LG PIN CLAMP 4 POSITION SUP-97-03236 CDM C1713 HCPCS 0278 RC outpatient 1604.58 1604.58 1604.58 57 914.61 percent of total billed charges 1604.58 93 1299.71 percent of total billed charges 1604.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1604.58 other OPPS APC 1604.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1604.58 other OPPS APC 1604.58 51 818.34 percent of total billed charges 1604.58 1604.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCHANZ SCREW 5.0MM X175MM SUP-97-03238 CDM C1713 HCPCS 0278 RC outpatient 963 963 963 57 548.91 percent of total billed charges 963 93 780.03 percent of total billed charges 963 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 963 other OPPS APC 963 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 963 other OPPS APC 963 51 491.13 percent of total billed charges 963 963 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS TECNIS MONOFOCAL 8.5D SUP-97-03239 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 8.D SUP-97-03240 CDM C1780 HCPCS 0278 RC outpatient 381.5 381.5 381.5 57 217.46 percent of total billed charges 381.5 93 309.02 percent of total billed charges 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 51 194.57 percent of total billed charges 381.5 381.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 15.0 SUP-97-03241 CDM C1780 HCPCS 0278 RC outpatient 1251 1251 1251 57 713.07 percent of total billed charges 1251 93 1013.31 percent of total billed charges 1251 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251 other OPPS APC 1251 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251 other OPPS APC 1251 51 638.01 percent of total billed charges 1251 1251 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4MM VA-LCP 2-CLMN DSTLRADIUS PL7H SUP-97-03242 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI IS FEMUR SZ6 LEFT SUP-97-03243 CDM C1776 HCPCS 0278 RC outpatient 12280.8 12280.8 12280.8 57 7000.06 percent of total billed charges 12280.8 93 9947.45 percent of total billed charges 12280.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.8 other OPPS APC 12280.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.8 other OPPS APC 12280.8 51 6263.21 percent of total billed charges 12280.8 12280.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI POST AUGMENT SZ6.5 SUP-97-03244 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI PRESS FIT STEM 20X100MM SUP-97-03245 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI RM/LL TIB AUG SZ7 5MM SUP-97-03246 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OFFSET ADAPTER SUP-97-03247 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NO.7 TRIATHLON TS PLUS TIBIAL INSERT 13MM SUP-97-03248 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO3 POWER LEFT LEFT STEEL GREY SUP-97-03249 CDM L8614 HCPCS 0278 RC outpatient 8352 8352 8352 57 4760.64 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 51 4259.52 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI IS FEMUR SZ7 RIGHT SUP-97-03250 CDM C1776 HCPCS 0278 RC outpatient 12280.8 12280.8 12280.8 57 7000.06 percent of total billed charges 12280.8 93 9947.45 percent of total billed charges 12280.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.8 other OPPS APC 12280.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.8 other OPPS APC 12280.8 51 6263.21 percent of total billed charges 12280.8 12280.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI PRESS FIT STEM 16MMX 100MM SUP-97-03251 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER TI ASNIS III 4.0MM SUP-97-03252 CDM C1713 HCPCS 0278 RC outpatient 74.24 74.24 74.24 57 42.32 percent of total billed charges 74.24 93 60.13 percent of total billed charges 74.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 74.24 other OPPS APC 74.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 74.24 other OPPS APC 74.24 51 37.86 percent of total billed charges 74.24 74.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN TI 4.0X55MM SUP-97-03253 CDM C1713 HCPCS 0278 RC outpatient 396.48 396.48 396.48 57 225.99 percent of total billed charges 396.48 93 321.15 percent of total billed charges 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 51 202.2 percent of total billed charges 396.48 396.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TENO SCREWBIO BIOCOMPOSITE 4X10MM SUP-97-03254 CDM C1713 HCPCS 0278 RC outpatient 1035 1035 1035 57 589.95 percent of total billed charges 1035 93 838.35 percent of total billed charges 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 51 527.85 percent of total billed charges 1035 1035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TENO SCREWBIO BIOCOMPOSITE 5.5X15MM SUP-97-03255 CDM C1713 HCPCS 0278 RC outpatient 1035 1035 1035 57 589.95 percent of total billed charges 1035 93 838.35 percent of total billed charges 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 51 527.85 percent of total billed charges 1035 1035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TENO SCREWBIO BIOCOMPOSITE 6.25X15MM SUP-97-03256 CDM C1713 HCPCS 0278 RC outpatient 1035 1035 1035 57 589.95 percent of total billed charges 1035 93 838.35 percent of total billed charges 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 51 527.85 percent of total billed charges 1035 1035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE 5.5MM HEALICOIL BLUE SUP-97-03257 CDM C1713 HCPCS 0278 RC outpatient 1065 1065 1065 57 607.05 percent of total billed charges 1065 93 862.65 percent of total billed charges 1065 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1065 other OPPS APC 1065 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1065 other OPPS APC 1065 51 543.15 percent of total billed charges 1065 1065 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FULL THEAD SCREW 3.5X32 SUP-97-03258 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COTTON WEDGE 6MM SUP-97-03259 CDM C1713 HCPCS 0278 RC outpatient 3940.63 3940.63 3940.63 57 2246.16 percent of total billed charges 3940.63 93 3191.91 percent of total billed charges 3940.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3940.63 other OPPS APC 3940.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3940.63 other OPPS APC 3940.63 51 2009.72 percent of total billed charges 3940.63 3940.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VIBONE CELLULAR BONE GRAFT 2CC SUP-97-03260 CDM C1762 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SWANSON FLEXSPAN FLEXIBLE HINGE TOE 3S SUP-97-03261 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL QUICK CONNECT SUP-97-03262 CDM 0272 RC outpatient 1035 1035 1035 74 765.9 percent of total billed charges 1035 93 838.35 percent of total billed charges 1035 1035 other OPPS APC 1035 1035 other OPPS APC 1035 27.63 285.97 percent of total billed charges 1035 1035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW HEADESS COMPRESSION 2.5X20MM SUP-97-03263 CDM C1713 HCPCS 0278 RC outpatient 2385 2385 2385 57 1359.45 percent of total billed charges 2385 93 1931.85 percent of total billed charges 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 51 1216.35 percent of total billed charges 2385 2385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 0.9MM X 152MM SUP-97-03264 CDM C1713 HCPCS 0278 RC outpatient 128 128 128 57 72.96 percent of total billed charges 128 93 103.68 percent of total billed charges 128 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 128 other OPPS APC 128 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 128 other OPPS APC 128 51 65.28 percent of total billed charges 128 128 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL QUICK CONNECT SUP-97-03265 CDM 0272 RC outpatient 1035 1035 1035 74 765.9 percent of total billed charges 1035 93 838.35 percent of total billed charges 1035 1035 other OPPS APC 1035 1035 other OPPS APC 1035 27.63 285.97 percent of total billed charges 1035 1035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL COUNTERSINK 2.7MM SUP-97-03266 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROXIMAL ULIN PLATE SUP-97-03267 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MUITI THREAD LOCKING 3.5X16MM SUP-97-03268 CDM C1713 HCPCS 0278 RC outpatient 479.5 479.5 479.5 57 273.32 percent of total billed charges 479.5 93 388.4 percent of total billed charges 479.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 479.5 other OPPS APC 479.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 479.5 other OPPS APC 479.5 51 244.55 percent of total billed charges 479.5 479.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MUITI THREAD LOCKING 3.5X22MM SUP-97-03269 CDM C1713 HCPCS 0278 RC outpatient 479.5 479.5 479.5 57 273.32 percent of total billed charges 479.5 93 388.4 percent of total billed charges 479.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 479.5 other OPPS APC 479.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 479.5 other OPPS APC 479.5 51 244.55 percent of total billed charges 479.5 479.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MUITI THREAD LOCKING 3.5X12MM SUP-97-03270 CDM C1713 HCPCS 0278 RC outpatient 479.5 479.5 479.5 57 273.32 percent of total billed charges 479.5 93 388.4 percent of total billed charges 479.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 479.5 other OPPS APC 479.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 479.5 other OPPS APC 479.5 51 244.55 percent of total billed charges 479.5 479.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MUITI THREAD LOCKING 3.5X14MM SUP-97-03271 CDM C1713 HCPCS 0278 RC outpatient 479.5 479.5 479.5 57 273.32 percent of total billed charges 479.5 93 388.4 percent of total billed charges 479.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 479.5 other OPPS APC 479.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 479.5 other OPPS APC 479.5 51 244.55 percent of total billed charges 479.5 479.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MUITI THREAD LOCKING 3.5X16MM SUP-97-03272 CDM C1713 HCPCS 0278 RC outpatient 479.5 479.5 479.5 57 273.32 percent of total billed charges 479.5 93 388.4 percent of total billed charges 479.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 479.5 other OPPS APC 479.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 479.5 other OPPS APC 479.5 51 244.55 percent of total billed charges 479.5 479.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MUITI THREAD LOCKING 3.5X16MM SUP-97-03273 CDM C1713 HCPCS 0278 RC outpatient 479.5 479.5 479.5 57 273.32 percent of total billed charges 479.5 93 388.4 percent of total billed charges 479.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 479.5 other OPPS APC 479.5 479.5 other OPPS APC 479.5 51 244.55 percent of total billed charges 479.5 479.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE STANDARD TIP 2.0MM X 152MM SUP-97-03274 CDM C1713 HCPCS 0278 RC outpatient 108 108 108 57 61.56 percent of total billed charges 108 93 87.48 percent of total billed charges 108 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 108 other OPPS APC 108 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 108 other OPPS APC 108 51 55.08 percent of total billed charges 108 108 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 2.7MMX80MM SUP-97-03275 CDM 0272 RC outpatient 329 329 329 74 243.46 percent of total billed charges 329 93 266.49 percent of total billed charges 329 329 other OPPS APC 329 329 other OPPS APC 329 27.63 90.9 percent of total billed charges 329 329 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 2.7MMX40MM SUP-97-03276 CDM 0272 RC outpatient 329 329 329 74 243.46 percent of total billed charges 329 93 266.49 percent of total billed charges 329 329 other OPPS APC 329 329 other OPPS APC 329 27.63 90.9 percent of total billed charges 329 329 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW POLYAXIAL NON LOC 3.5MM X 18MM SUP-97-03278 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALIGN RADIAL HEAD &LOCK SCREW SUP-97-03279 CDM C1776 HCPCS 0278 RC outpatient 4112.5 4112.5 4112.5 57 2344.13 percent of total billed charges 4112.5 93 3331.13 percent of total billed charges 4112.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4112.5 other OPPS APC 4112.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4112.5 other OPPS APC 4112.5 51 2097.38 percent of total billed charges 4112.5 4112.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALIGN RADIAL STEM SUP-97-03280 CDM C1776 HCPCS 0278 RC outpatient 5750 5750 5750 57 3277.5 percent of total billed charges 5750 93 4657.5 percent of total billed charges 5750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5750 other OPPS APC 5750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5750 other OPPS APC 5750 51 2932.5 percent of total billed charges 5750 5750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL GAMMA3 R1.5TI LEFT11X360MMX125 SUP-97-03281 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DERMALGRAFT SUP-97-03282 CDM Q4125 HCPCS 0636 RC outpatient 5305 5305 5305 74 3925.7 percent of total billed charges 5305 93 4297.05 percent of total billed charges 5305 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5305 other OPPS APC 5305 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5305 other OPPS APC 5305 24.86 1318.82 percent of total billed charges 5305 5305 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 25.0D SUP-97-03283 CDM C1780 HCPCS 0278 RC outpatient 381.5 381.5 381.5 57 217.46 percent of total billed charges 381.5 93 309.02 percent of total billed charges 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 51 194.57 percent of total billed charges 381.5 381.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE DISTAL PSTER LATERAL 6H/RT SUP-97-03284 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE DISTAL MEDICAL HUMERUS 6H SUP-97-03285 CDM C1713 HCPCS 0278 RC outpatient 2803.5 2803.5 2803.5 57 1598 percent of total billed charges 2803.5 93 2270.84 percent of total billed charges 2803.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2803.5 other OPPS APC 2803.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2803.5 other OPPS APC 2803.5 51 1429.79 percent of total billed charges 2803.5 2803.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OVERDRILL AO 2.7MM X 122MM NEW SUP-97-03286 CDM 0272 RC outpatient 549.5 549.5 549.5 74 406.63 percent of total billed charges 549.5 93 445.1 percent of total billed charges 549.5 549.5 other OPPS APC 549.5 549.5 other OPPS APC 549.5 27.63 151.83 percent of total billed charges 549.5 549.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 20MM SUP-97-03287 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 22MM SUP-97-03288 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 24MM SUP-97-03289 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 30MM SUP-97-03290 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 60MM SUP-97-03291 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SUPERIOR LATERAL 7H/LT 122MM SUP-97-03292 CDM C1713 HCPCS 0278 RC outpatient 3590.6 3590.6 3590.6 57 2046.64 percent of total billed charges 3590.6 93 2908.39 percent of total billed charges 3590.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3590.6 other OPPS APC 3590.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3590.6 other OPPS APC 3590.6 51 1831.21 percent of total billed charges 3590.6 3590.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SUPERIOR LATERAL 3 HOLE LEFT 74MM SUP-97-03293 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SUPERIOR LATERAL 7H/RT122MM SUP-97-03294 CDM C1713 HCPCS 0278 RC outpatient 3153.75 3153.75 3153.75 57 1797.64 percent of total billed charges 3153.75 93 2554.54 percent of total billed charges 3153.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3153.75 other OPPS APC 3153.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3153.75 other OPPS APC 3153.75 51 1608.41 percent of total billed charges 3153.75 3153.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS MICRO 2MM LENGTH 18/5MM SUP-97-03295 CDM C1713 HCPCS 0278 RC outpatient 599.76 599.76 599.76 57 341.86 percent of total billed charges 599.76 93 485.81 percent of total billed charges 599.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 599.76 other OPPS APC 599.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 599.76 other OPPS APC 599.76 51 305.88 percent of total billed charges 599.76 599.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW ASNIS MICRO,CANN 3.0MMX16/4MM" SUP-97-03296 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI LAG 10.5 X 100MM SUP-97-03299 CDM C1713 HCPCS 0278 RC outpatient 991.8 991.8 991.8 57 565.33 percent of total billed charges 991.8 93 803.36 percent of total billed charges 991.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 991.8 other OPPS APC 991.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 991.8 other OPPS APC 991.8 51 505.82 percent of total billed charges 991.8 991.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN 4 X 40MM TI SUP-97-03300 CDM C1713 HCPCS 0278 RC outpatient 396.48 396.48 396.48 57 225.99 percent of total billed charges 396.48 93 321.15 percent of total billed charges 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 51 202.2 percent of total billed charges 396.48 396.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL NAIL 10 X 285MM T2 STANDARD SUP-97-03301 CDM C1713 HCPCS 0278 RC outpatient 2734.2 2734.2 2734.2 57 1558.49 percent of total billed charges 2734.2 93 2214.7 percent of total billed charges 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 51 1394.44 percent of total billed charges 2734.2 2734.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 30MM SUP-97-03302 CDM C1713 HCPCS 0278 RC outpatient 605.85 605.85 605.85 57 345.33 percent of total billed charges 605.85 93 490.74 percent of total billed charges 605.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 605.85 other OPPS APC 605.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 605.85 other OPPS APC 605.85 51 308.98 percent of total billed charges 605.85 605.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 75MM SUP-97-03303 CDM C1713 HCPCS 0278 RC outpatient 605.85 605.85 605.85 57 345.33 percent of total billed charges 605.85 93 490.74 percent of total billed charges 605.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 605.85 other OPPS APC 605.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 605.85 other OPPS APC 605.85 51 308.98 percent of total billed charges 605.85 605.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TISSUE EXPANDERS SUP-97-03304 CDM C1789 HCPCS 0278 RC outpatient 2835 2835 2835 57 1615.95 percent of total billed charges 2835 93 2296.35 percent of total billed charges 2835 2835 other OPPS APC 2835 2835 other OPPS APC 2835 51 1445.85 percent of total billed charges 2835 2835 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7X16 SUP-97-03305 CDM C1713 HCPCS 0278 RC outpatient 488.25 488.25 488.25 57 278.3 percent of total billed charges 488.25 93 395.48 percent of total billed charges 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 51 249.01 percent of total billed charges 488.25 488.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 20MM NON LOCKING SUP-97-03306 CDM C1713 HCPCS 0278 RC outpatient 437.5 437.5 437.5 57 249.38 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 51 223.13 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "STRAIGHT PLATE, 3 HOLE" SUP-97-03307 CDM C1713 HCPCS 0278 RC outpatient 3237.5 3237.5 3237.5 57 1845.38 percent of total billed charges 3237.5 93 2622.38 percent of total billed charges 3237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3237.5 other OPPS APC 3237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3237.5 other OPPS APC 3237.5 51 1651.13 percent of total billed charges 3237.5 3237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "STRAIGHT PLATE, 4 HOLE COMPRESSION" SUP-97-03308 CDM C1713 HCPCS 0278 RC outpatient 3456.25 3456.25 3456.25 57 1970.06 percent of total billed charges 3456.25 93 2799.56 percent of total billed charges 3456.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3456.25 other OPPS APC 3456.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3456.25 other OPPS APC 3456.25 51 1762.69 percent of total billed charges 3456.25 3456.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RTS IMPLANT SIZE 1-4 SUP-97-03309 CDM C1776 HCPCS 0278 RC outpatient 350 350 350 57 199.5 percent of total billed charges 350 93 283.5 percent of total billed charges 350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 350 other OPPS APC 350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 350 other OPPS APC 350 51 178.5 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RTS FLEX 1ST MPJ IMPLANT W/GROM SZ2 SUP-97-03311 CDM C1776 HCPCS 0278 RC outpatient 3500 3500 3500 57 1995 percent of total billed charges 3500 93 2835 percent of total billed charges 3500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3500 other OPPS APC 3500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3500 other OPPS APC 3500 51 1785 percent of total billed charges 3500 3500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 22MM SUP-97-03312 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 26MM SUP-97-03313 CDM C1713 HCPCS 0278 RC outpatient 313.25 313.25 313.25 57 178.55 percent of total billed charges 313.25 93 253.73 percent of total billed charges 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 51 159.76 percent of total billed charges 313.25 313.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 28MM SUP-97-03314 CDM C1713 HCPCS 0278 RC outpatient 313.25 313.25 313.25 57 178.55 percent of total billed charges 313.25 93 253.73 percent of total billed charges 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 51 159.76 percent of total billed charges 313.25 313.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 30MM SUP-97-03315 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISPS KITTRANS-TIB ACL W/P SAW BLD BX/5 SUP-97-03316 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERNALBRACE LIGAMENT SUP-97-03317 CDM C1713 HCPCS 0278 RC outpatient 3840 3840 3840 57 2188.8 percent of total billed charges 3840 93 3110.4 percent of total billed charges 3840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3840 other OPPS APC 3840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3840 other OPPS APC 3840 51 1958.4 percent of total billed charges 3840 3840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE DYNANITE NITI W/INST 15MM X 12MM SUP-97-03318 CDM C1713 HCPCS 0278 RC outpatient 4737.5 4737.5 4737.5 57 2700.38 percent of total billed charges 4737.5 93 3837.38 percent of total billed charges 4737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4737.5 other OPPS APC 4737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4737.5 other OPPS APC 4737.5 51 2416.13 percent of total billed charges 4737.5 4737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRAMEDULLARY DEGREE SUP-97-03319 CDM C1713 HCPCS 0278 RC outpatient 2849.85 2849.85 2849.85 57 1624.41 percent of total billed charges 2849.85 93 2308.38 percent of total billed charges 2849.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2849.85 other OPPS APC 2849.85 2849.85 other OPPS APC 2849.85 51 1453.42 percent of total billed charges 2849.85 2849.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANTERIOR TIBIALS TENDON 9MM SUP-97-03320 CDM C1762 HCPCS 0278 RC outpatient 5750 5750 5750 57 3277.5 percent of total billed charges 5750 93 4657.5 percent of total billed charges 5750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5750 other OPPS APC 5750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5750 other OPPS APC 5750 51 2932.5 percent of total billed charges 5750 5750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 7.3MM CANNULATED 16MM THEAD 65MM SUP-97-03321 CDM C1713 HCPCS 0278 RC outpatient 733.5 733.5 733.5 57 418.1 percent of total billed charges 733.5 93 594.14 percent of total billed charges 733.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 733.5 other OPPS APC 733.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 733.5 other OPPS APC 733.5 51 374.09 percent of total billed charges 733.5 733.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LPS FLEX FIXED PROLONG EF5-6.20M SUP-97-03322 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 46MM SUP-97-03323 CDM C1713 HCPCS 0278 RC outpatient 602.25 602.25 602.25 57 343.28 percent of total billed charges 602.25 93 487.82 percent of total billed charges 602.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 602.25 other OPPS APC 602.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 602.25 other OPPS APC 602.25 51 307.15 percent of total billed charges 602.25 602.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING SCREW 5.0MM SUP-97-03324 CDM C1713 HCPCS 0278 RC outpatient 656.67 656.67 656.67 57 374.3 percent of total billed charges 656.67 93 531.9 percent of total billed charges 656.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 656.67 other OPPS APC 656.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 656.67 other OPPS APC 656.67 51 334.9 percent of total billed charges 656.67 656.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0MM LOCKING SCREW 26MM SUP-97-03325 CDM C1713 HCPCS 0278 RC outpatient 891 891 891 57 507.87 percent of total billed charges 891 93 721.71 percent of total billed charges 891 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 891 other OPPS APC 891 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 891 other OPPS APC 891 51 454.41 percent of total billed charges 891 891 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0MM LOCKING SCREW 32MM SUP-97-03326 CDM C1713 HCPCS 0278 RC outpatient 891 891 891 57 507.87 percent of total billed charges 891 93 721.71 percent of total billed charges 891 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 891 other OPPS APC 891 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 891 other OPPS APC 891 51 454.41 percent of total billed charges 891 891 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0MM LOCKING SCREW 36MM SUP-97-03327 CDM C1713 HCPCS 0278 RC outpatient 604.45 604.45 604.45 57 344.54 percent of total billed charges 604.45 93 489.6 percent of total billed charges 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 51 308.27 percent of total billed charges 604.45 604.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW THREADED 7.3MM X 32MM X 75MM SUP-97-03328 CDM C1713 HCPCS 0278 RC outpatient 1371 1371 1371 57 781.47 percent of total billed charges 1371 93 1110.51 percent of total billed charges 1371 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1371 other OPPS APC 1371 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1371 other OPPS APC 1371 51 699.21 percent of total billed charges 1371 1371 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TIBIA 8MM CANN EX 300 MM SUP-97-03329 CDM C1713 HCPCS 0278 RC outpatient 6585 6585 6585 57 3753.45 percent of total billed charges 6585 93 5333.85 percent of total billed charges 6585 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6585 other OPPS APC 6585 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6585 other OPPS APC 6585 51 3358.35 percent of total billed charges 6585 6585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM LCP CLAVICLE PLATE 8/H RIGHT 115MM SUP-97-03330 CDM C1713 HCPCS 0278 RC outpatient 4537.5 4537.5 4537.5 57 2586.38 percent of total billed charges 4537.5 93 3675.38 percent of total billed charges 4537.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4537.5 other OPPS APC 4537.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4537.5 other OPPS APC 4537.5 51 2314.13 percent of total billed charges 4537.5 4537.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HELICAL FENESTRATED BLADE 105MM TFNA SUP-97-03331 CDM C1713 HCPCS 0278 RC outpatient 2272.68 2272.68 2272.68 57 1295.43 percent of total billed charges 2272.68 93 1840.87 percent of total billed charges 2272.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2272.68 other OPPS APC 2272.68 2272.68 other OPPS APC 2272.68 51 1159.07 percent of total billed charges 2272.68 2272.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TI CANN TFNA 10MM/130DEG 170MM SUP-97-03332 CDM C1713 HCPCS 0278 RC outpatient 4172.78 4172.78 4172.78 57 2378.48 percent of total billed charges 4172.78 93 3379.95 percent of total billed charges 4172.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4172.78 other OPPS APC 4172.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4172.78 other OPPS APC 4172.78 51 2128.12 percent of total billed charges 4172.78 4172.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HELICAL FENESTRATED BLADE 100MM TFNA SUP-97-03333 CDM C1713 HCPCS 0278 RC outpatient 2272.68 2272.68 2272.68 57 1295.43 percent of total billed charges 2272.68 93 1840.87 percent of total billed charges 2272.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2272.68 other OPPS APC 2272.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2272.68 other OPPS APC 2272.68 51 1159.07 percent of total billed charges 2272.68 2272.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GULDE WIRE TROCAR TIP CR TIP .045 SUP-97-03334 CDM 0272 RC outpatient 80 80 80 74 59.2 percent of total billed charges 80 93 64.8 percent of total billed charges 80 80 other OPPS APC 80 80 other OPPS APC 80 27.63 22.1 percent of total billed charges 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP 12MM +5 T2 NAIL SUP-97-03335 CDM C1713 HCPCS 0278 RC outpatient 456.75 456.75 456.75 57 260.35 percent of total billed charges 456.75 93 369.97 percent of total billed charges 456.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 456.75 other OPPS APC 456.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 456.75 other OPPS APC 456.75 51 232.94 percent of total billed charges 456.75 456.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANKLE ARTHRODESIS NAIL RIGHT SUP-97-03336 CDM C1713 HCPCS 0278 RC outpatient 5404.2 5404.2 5404.2 57 3080.39 percent of total billed charges 5404.2 93 4377.4 percent of total billed charges 5404.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5404.2 other OPPS APC 5404.2 5404.2 other OPPS APC 5404.2 51 2756.14 percent of total billed charges 5404.2 5404.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING SCREW PARTIALLY THREADED SUP-97-03337 CDM C1713 HCPCS 0278 RC outpatient 656.08 656.08 656.08 57 373.97 percent of total billed charges 656.08 93 531.42 percent of total billed charges 656.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 656.08 other OPPS APC 656.08 656.08 other OPPS APC 656.08 51 334.6 percent of total billed charges 656.08 656.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRAVIX 3X6CM (PS60008) SUP-97-03339 CDM Q4133 HCPCS 0636 RC outpatient 6682.5 6682.5 166 166 fee schedule 6682.5 93 5412.83 percent of total billed charges 6682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6682.5 other OPPS APC 6682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6682.5 other OPPS APC 6682.5 24.86 1661.27 percent of total billed charges 166 6682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT DBM PUTTY 10CC (3102-1010) SUP-97-03340 CDM C1713 HCPCS 0278 RC outpatient 2340 2340 2340 57 1333.8 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2340 other OPPS APC 2340 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2340 other OPPS APC 2340 51 1193.4 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5.0MM X 36MM SUP-97-03341 CDM C1713 HCPCS 0278 RC outpatient 434.91 434.91 434.91 57 247.9 percent of total billed charges 434.91 93 352.28 percent of total billed charges 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 51 221.8 percent of total billed charges 434.91 434.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE PRESSFIT STR STEM 14X110MM SUP-97-03342 CDM C1776 HCPCS 0278 RC outpatient 4492.5 4492.5 4492.5 57 2560.73 percent of total billed charges 4492.5 93 3638.93 percent of total billed charges 4492.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4492.5 other OPPS APC 4492.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4492.5 other OPPS APC 4492.5 51 2291.18 percent of total billed charges 4492.5 4492.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE REV TIB BASE FB SZ5 CEM SUP-97-03343 CDM C1776 HCPCS 0278 RC outpatient 8850 8850 8850 57 5044.5 percent of total billed charges 8850 93 7168.5 percent of total billed charges 8850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8850 other OPPS APC 8850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8850 other OPPS APC 8850 51 4513.5 percent of total billed charges 8850 8850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE REV AUG LM RL SZ5/6 10MM SUP-97-03344 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE PS FB INSRT SZ510MM SUP-97-03345 CDM C1776 HCPCS 0278 RC outpatient 4820 4820 4820 57 2747.4 percent of total billed charges 4820 93 3904.2 percent of total billed charges 4820 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4820 other OPPS APC 4820 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4820 other OPPS APC 4820 51 2458.2 percent of total billed charges 4820 4820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL SUPRACONDYLAR 12X170MM SUP-97-03346 CDM C1713 HCPCS 0278 RC outpatient 4044.7 4044.7 4044.7 57 2305.48 percent of total billed charges 4044.7 93 3276.21 percent of total billed charges 4044.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4044.7 other OPPS APC 4044.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4044.7 other OPPS APC 4044.7 51 2062.8 percent of total billed charges 4044.7 4044.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 80MM SUP-97-03347 CDM C1713 HCPCS 0278 RC outpatient 539 539 539 57 307.23 percent of total billed charges 539 93 436.59 percent of total billed charges 539 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 539 other OPPS APC 539 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 539 other OPPS APC 539 51 274.89 percent of total billed charges 539 539 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3D PLATE LFT SUP-97-03348 CDM C1713 HCPCS 0278 RC outpatient 2397.27 2397.27 2397.27 57 1366.44 percent of total billed charges 2397.27 93 1941.79 percent of total billed charges 2397.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2397.27 other OPPS APC 2397.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2397.27 other OPPS APC 2397.27 51 1222.61 percent of total billed charges 2397.27 2397.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3D PLATE RT SUP-97-03349 CDM C1713 HCPCS 0278 RC outpatient 2397.27 2397.27 2397.27 57 1366.44 percent of total billed charges 2397.27 93 1941.79 percent of total billed charges 2397.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2397.27 other OPPS APC 2397.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2397.27 other OPPS APC 2397.27 51 1222.61 percent of total billed charges 2397.27 2397.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. H-PLATE MED SUP-97-03350 CDM C1713 HCPCS 0278 RC outpatient 2246.55 2246.55 2246.55 57 1280.53 percent of total billed charges 2246.55 93 1819.71 percent of total billed charges 2246.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2246.55 other OPPS APC 2246.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2246.55 other OPPS APC 2246.55 51 1145.74 percent of total billed charges 2246.55 2246.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL LATERAL FIBULA PLATE 5 HOLE SUP-97-03351 CDM C1713 HCPCS 0278 RC outpatient 1276.02 1276.02 1276.02 57 727.33 percent of total billed charges 1276.02 93 1033.58 percent of total billed charges 1276.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1276.02 other OPPS APC 1276.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1276.02 other OPPS APC 1276.02 51 650.77 percent of total billed charges 1276.02 1276.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER FOR 2.7MM SCREW SUP-97-03352 CDM C1713 HCPCS 0278 RC outpatient 214.62 214.62 214.62 57 122.33 percent of total billed charges 214.62 93 173.84 percent of total billed charges 214.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 214.62 other OPPS APC 214.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 214.62 other OPPS APC 214.62 51 109.46 percent of total billed charges 214.62 214.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 10MM NON LOCKING SUP-97-03353 CDM C1713 HCPCS 0278 RC outpatient 264.6 264.6 264.6 57 150.82 percent of total billed charges 264.6 93 214.33 percent of total billed charges 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 51 134.95 percent of total billed charges 264.6 264.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 26MM NON LOCKING SUP-97-03354 CDM C1713 HCPCS 0278 RC outpatient 264.6 264.6 264.6 57 150.82 percent of total billed charges 264.6 93 214.33 percent of total billed charges 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 51 134.95 percent of total billed charges 264.6 264.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 10MM LOCKING SUP-97-03356 CDM C1713 HCPCS 0278 RC outpatient 523.32 523.32 523.32 57 298.29 percent of total billed charges 523.32 93 423.89 percent of total billed charges 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 51 266.89 percent of total billed charges 523.32 523.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 14MM LOCKING SUP-97-03357 CDM C1713 HCPCS 0278 RC outpatient 523.32 523.32 523.32 57 298.29 percent of total billed charges 523.32 93 423.89 percent of total billed charges 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 51 266.89 percent of total billed charges 523.32 523.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 36MM LOCKING SUP-97-03358 CDM C1713 HCPCS 0278 RC outpatient 523.32 523.32 523.32 57 298.29 percent of total billed charges 523.32 93 423.89 percent of total billed charges 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 51 266.89 percent of total billed charges 523.32 523.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 40MM LOCKING SUP-97-03359 CDM C1713 HCPCS 0278 RC outpatient 523.32 523.32 523.32 57 298.29 percent of total billed charges 523.32 93 423.89 percent of total billed charges 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 51 266.89 percent of total billed charges 523.32 523.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 50MM LOCKING SUP-97-03360 CDM C1713 HCPCS 0278 RC outpatient 523.32 523.32 523.32 57 298.29 percent of total billed charges 523.32 93 423.89 percent of total billed charges 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 51 266.89 percent of total billed charges 523.32 523.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL GAMMA3 S LEFT 10 X 380MM X125 SUP-97-03361 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW THREADED 7.3MM X 32MM X 60MM SUP-97-03362 CDM C1713 HCPCS 0278 RC outpatient 761.64 761.64 761.64 57 434.13 percent of total billed charges 761.64 93 616.93 percent of total billed charges 761.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 761.64 other OPPS APC 761.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 761.64 other OPPS APC 761.64 51 388.44 percent of total billed charges 761.64 761.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE INCREASED SUPERIOR 8H/LFT SUP-97-03363 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNOTLESS T-ROPE SYN DESMOSIS SUP-97-03364 CDM C1713 HCPCS 0278 RC outpatient 3737.5 3737.5 3737.5 57 2130.38 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 3737.5 other OPPS APC 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 51 1906.13 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONG NAIL KIT R1/5 TI RT 11 X440MM X 125 SUP-97-03366 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI LAG 10.5 X 105MM SUP-97-03367 CDM C1713 HCPCS 0278 RC outpatient 991.8 991.8 991.8 57 565.33 percent of total billed charges 991.8 93 803.36 percent of total billed charges 991.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 991.8 other OPPS APC 991.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 991.8 other OPPS APC 991.8 51 505.82 percent of total billed charges 991.8 991.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MRS 13X127 FEM STEM W/O BODY SUP-97-03368 CDM C1776 HCPCS 0278 RC outpatient 6124 6124 6124 57 3490.68 percent of total billed charges 6124 93 4960.44 percent of total billed charges 6124 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6124 other OPPS APC 6124 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6124 other OPPS APC 6124 51 3123.24 percent of total billed charges 6124 6124 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MRH TIBIAL BASEPLATE S1 SUP-97-03369 CDM C1776 HCPCS 0278 RC outpatient 7257 7257 7257 57 4136.49 percent of total billed charges 7257 93 5878.17 percent of total billed charges 7257 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7257 other OPPS APC 7257 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7257 other OPPS APC 7257 51 3701.07 percent of total billed charges 7257 7257 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COCR PRESSFIT STEM 13MMX80MM SUP-97-03370 CDM C1776 HCPCS 0278 RC outpatient 2433.6 2433.6 2433.6 57 1387.15 percent of total billed charges 2433.6 93 1971.22 percent of total billed charges 2433.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2433.6 other OPPS APC 2433.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2433.6 other OPPS APC 2433.6 51 1241.14 percent of total billed charges 2433.6 2433.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HRHK TB ROT COM XS/SM/ MED SUP-97-03371 CDM C1776 HCPCS 0278 RC outpatient 6648.13 6648.13 6648.13 57 3789.43 percent of total billed charges 6648.13 93 5384.99 percent of total billed charges 6648.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6648.13 other OPPS APC 6648.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6648.13 other OPPS APC 6648.13 51 3390.55 percent of total billed charges 6648.13 6648.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STD RT DIST FEM 65MM GMRS SUP-97-03372 CDM C1776 HCPCS 0278 RC outpatient 12536 12536 12536 57 7145.52 percent of total billed charges 12536 93 10154.2 percent of total billed charges 12536 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12536 other OPPS APC 12536 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12536 other OPPS APC 12536 51 6393.36 percent of total billed charges 12536 12536 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HRHK AXLE SUP-97-03373 CDM C1776 HCPCS 0278 RC outpatient 2698.8 2698.8 2698.8 57 1538.32 percent of total billed charges 2698.8 93 2186.03 percent of total billed charges 2698.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2698.8 other OPPS APC 2698.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2698.8 other OPPS APC 2698.8 51 1376.39 percent of total billed charges 2698.8 2698.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUSHING SM DISTAL FEM GMRS SUP-97-03374 CDM C1776 HCPCS 0278 RC outpatient 811.2 811.2 811.2 57 462.38 percent of total billed charges 811.2 93 657.07 percent of total billed charges 811.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 811.2 other OPPS APC 811.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 811.2 other OPPS APC 811.2 51 413.71 percent of total billed charges 811.2 811.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HRHK TIB INS 10MM XS/S S1/S2 SUP-97-03375 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HRHK TIBIAL SLEEVE SUP-97-03376 CDM C1776 HCPCS 0278 RC outpatient 1386 1386 1386 57 790.02 percent of total billed charges 1386 93 1122.66 percent of total billed charges 1386 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1386 other OPPS APC 1386 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1386 other OPPS APC 1386 51 706.86 percent of total billed charges 1386 1386 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HRHK BUMPER INSERT SUP-97-03377 CDM C1776 HCPCS 0278 RC outpatient 1618.8 1618.8 1618.8 57 922.72 percent of total billed charges 1618.8 93 1311.23 percent of total billed charges 1618.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1618.8 other OPPS APC 1618.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1618.8 other OPPS APC 1618.8 51 825.59 percent of total billed charges 1618.8 1618.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CENTER SCREW 28MM SUP-97-03378 CDM C1776 HCPCS 0278 RC outpatient 837 837 837 57 477.09 percent of total billed charges 837 93 677.97 percent of total billed charges 837 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 837 other OPPS APC 837 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 837 other OPPS APC 837 51 426.87 percent of total billed charges 837 837 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONCENTNC GLENOSPHERE 36MMX2 SUP-97-03379 CDM C1776 HCPCS 0278 RC outpatient 3481.25 3481.25 3481.25 57 1984.31 percent of total billed charges 3481.25 93 2819.81 percent of total billed charges 3481.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3481.25 other OPPS APC 3481.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3481.25 other OPPS APC 3481.25 51 1775.44 percent of total billed charges 3481.25 3481.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 6.0D TECNIS EYHANCE SUP-97-03380 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STIKE PLATE SUP-97-03381 CDM C1776 HCPCS 0278 RC outpatient 649.29 649.29 649.29 57 370.1 percent of total billed charges 649.29 93 525.92 percent of total billed charges 649.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 649.29 other OPPS APC 649.29 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 649.29 other OPPS APC 649.29 51 331.14 percent of total billed charges 649.29 649.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOCOMPOSITE IMPLANT SYSTEM MPFL KIT SUP-97-03382 CDM C1713 HCPCS 0278 RC outpatient 3717.5 3717.5 3717.5 57 2118.98 percent of total billed charges 3717.5 93 3011.18 percent of total billed charges 3717.5 3717.5 other OPPS APC 3717.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3717.5 other OPPS APC 3717.5 51 1895.93 percent of total billed charges 3717.5 3717.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 410HOLE SUP-97-03383 CDM C1713 HCPCS 0278 RC outpatient 7137.5 7137.5 7137.5 57 4068.38 percent of total billed charges 7137.5 93 5781.38 percent of total billed charges 7137.5 7137.5 other OPPS APC 7137.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7137.5 other OPPS APC 7137.5 51 3640.13 percent of total billed charges 7137.5 7137.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5MM CORTEX TI SCREW +ÿ4.5MM / 22MM SUP-97-03384 CDM C1713 HCPCS 0278 RC outpatient 152.32 152.32 152.32 57 86.82 percent of total billed charges 152.32 93 123.38 percent of total billed charges 152.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.32 other OPPS APC 152.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.32 other OPPS APC 152.32 51 77.68 percent of total billed charges 152.32 152.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5MM CORTEX TI SCREW +ÿ4.5MM / 24MM SUP-97-03385 CDM C1713 HCPCS 0278 RC outpatient 152.32 152.32 152.32 57 86.82 percent of total billed charges 152.32 93 123.38 percent of total billed charges 152.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.32 other OPPS APC 152.32 152.32 other OPPS APC 152.32 51 77.68 percent of total billed charges 152.32 152.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5MM CORTEX TI SCREW ?4.5MM / 26MM SUP-97-03386 CDM C1713 HCPCS 0278 RC outpatient 153.32 153.32 153.32 57 87.39 percent of total billed charges 153.32 93 124.19 percent of total billed charges 153.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 153.32 other OPPS APC 153.32 153.32 other OPPS APC 153.32 51 78.19 percent of total billed charges 153.32 153.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5MM CORTEX TI SCREW ?4.5MM / 28MM SUP-97-03387 CDM C1713 HCPCS 0278 RC outpatient 153.32 153.32 153.32 57 87.39 percent of total billed charges 153.32 93 124.19 percent of total billed charges 153.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 153.32 other OPPS APC 153.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 153.32 other OPPS APC 153.32 51 78.19 percent of total billed charges 153.32 153.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX NON LOCKING 3.5MM X 22MM SUP-97-03388 CDM C1713 HCPCS 0278 RC outpatient 133.76 133.76 133.76 57 76.24 percent of total billed charges 133.76 93 108.35 percent of total billed charges 133.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 133.76 other OPPS APC 133.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 133.76 other OPPS APC 133.76 51 68.22 percent of total billed charges 133.76 133.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T7 2.7 X 34MM SUP-97-03389 CDM C1713 HCPCS 0278 RC outpatient 475.06 475.06 475.06 57 270.78 percent of total billed charges 475.06 93 384.8 percent of total billed charges 475.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 475.06 other OPPS APC 475.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 475.06 other OPPS APC 475.06 51 242.28 percent of total billed charges 475.06 475.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONG NAIL KIT SUP-97-03390 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEG SCREW TI SUP-97-03391 CDM C1713 HCPCS 0278 RC outpatient 991.8 991.8 991.8 57 565.33 percent of total billed charges 991.8 93 803.36 percent of total billed charges 991.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 991.8 other OPPS APC 991.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 991.8 other OPPS APC 991.8 51 505.82 percent of total billed charges 991.8 991.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER OSTEONICS UNIV DISTAL 11MM SUP-97-03392 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MINI MONOKA STENT SUP-97-03393 CDM C1783 HCPCS 0278 RC outpatient 665 665 665 57 379.05 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 51 339.15 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOFMAN3 CONNECTING ROD 11 X 400MM SUP-97-03394 CDM C1713 HCPCS 0278 RC outpatient 1077.3 1077.3 1077.3 57 614.06 percent of total billed charges 1077.3 93 872.61 percent of total billed charges 1077.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1077.3 other OPPS APC 1077.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1077.3 other OPPS APC 1077.3 51 549.42 percent of total billed charges 1077.3 1077.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MRI SEMI CIRCULAR CURVED ROD 8 X 174 SUP-97-03395 CDM C1713 HCPCS 0278 RC outpatient 710.4 710.4 710.4 57 404.93 percent of total billed charges 710.4 93 575.42 percent of total billed charges 710.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 710.4 other OPPS APC 710.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 710.4 other OPPS APC 710.4 51 362.3 percent of total billed charges 710.4 710.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL GRAY PT 4MM X 200MM SUP-97-03396 CDM C1713 HCPCS 0278 RC outpatient 324.24 324.24 324.24 57 184.82 percent of total billed charges 324.24 93 262.63 percent of total billed charges 324.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 324.24 other OPPS APC 324.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 324.24 other OPPS APC 324.24 51 165.36 percent of total billed charges 324.24 324.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5X180 APEX S/D HALF PIN 50 TH SUP-97-03397 CDM C1713 HCPCS 0278 RC outpatient 468.72 468.72 468.72 57 267.17 percent of total billed charges 468.72 93 379.66 percent of total billed charges 468.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 468.72 other OPPS APC 468.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 468.72 other OPPS APC 468.72 51 239.05 percent of total billed charges 468.72 468.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5X150 APEX S/D HALF PIN 40 TH SUP-97-03398 CDM C1713 HCPCS 0278 RC outpatient 321.3 321.3 321.3 57 183.14 percent of total billed charges 321.3 93 260.25 percent of total billed charges 321.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 321.3 other OPPS APC 321.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 321.3 other OPPS APC 321.3 51 163.86 percent of total billed charges 321.3 321.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POST HOFMAN3 ANGLD 90DEG 11MM SUP-97-03399 CDM C1713 HCPCS 0278 RC outpatient 533.16 533.16 533.16 57 303.9 percent of total billed charges 533.16 93 431.86 percent of total billed charges 533.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 533.16 other OPPS APC 533.16 533.16 other OPPS APC 533.16 51 271.91 percent of total billed charges 533.16 533.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POST HOFMAN3 ANGLD 30DEG 11MM SUP-97-03400 CDM C1713 HCPCS 0278 RC outpatient 330.4 330.4 330.4 57 188.33 percent of total billed charges 330.4 93 267.62 percent of total billed charges 330.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 330.4 other OPPS APC 330.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 330.4 other OPPS APC 330.4 51 168.5 percent of total billed charges 330.4 330.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP HII MRI 10 HOLE PIN SUP-97-03401 CDM C1713 HCPCS 0278 RC outpatient 2373.72 2373.72 2373.72 57 1353.02 percent of total billed charges 2373.72 93 1922.71 percent of total billed charges 2373.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2373.72 other OPPS APC 2373.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2373.72 other OPPS APC 2373.72 51 1210.6 percent of total billed charges 2373.72 2373.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOFMAN3 CONNECTING ROD 11 X 450MM SUP-97-03402 CDM C1713 HCPCS 0278 RC outpatient 1077.3 1077.3 1077.3 57 614.06 percent of total billed charges 1077.3 93 872.61 percent of total billed charges 1077.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1077.3 other OPPS APC 1077.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1077.3 other OPPS APC 1077.3 51 549.42 percent of total billed charges 1077.3 1077.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOFMAN3 CONNECTING ROD 11 X 350MM SUP-97-03403 CDM C1713 HCPCS 0278 RC outpatient 818.4 818.4 818.4 57 466.49 percent of total billed charges 818.4 93 662.9 percent of total billed charges 818.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 818.4 other OPPS APC 818.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 818.4 other OPPS APC 818.4 51 417.38 percent of total billed charges 818.4 818.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CPLING INV HFMN3 PIN TO ROD 4/5/6 5/8/11 SUP-97-03404 CDM C1713 HCPCS 0278 RC outpatient 1785.75 1785.75 1785.75 57 1017.88 percent of total billed charges 1785.75 93 1446.46 percent of total billed charges 1785.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785.75 other OPPS APC 1785.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785.75 other OPPS APC 1785.75 51 910.73 percent of total billed charges 1785.75 1785.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUPLING HOFMAN3 PIN TO ROD 4/5/6 5/8/11 SUP-97-03405 CDM C1713 HCPCS 0278 RC outpatient 1436.4 1436.4 1436.4 57 818.75 percent of total billed charges 1436.4 93 1163.48 percent of total billed charges 1436.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1436.4 other OPPS APC 1436.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1436.4 other OPPS APC 1436.4 51 732.56 percent of total billed charges 1436.4 1436.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUPLING HOFMAN3 ROD TO ROD DIA 5/8/11MM SUP-97-03406 CDM C1713 HCPCS 0278 RC outpatient 1568.4 1568.4 1568.4 57 893.99 percent of total billed charges 1568.4 93 1270.4 percent of total billed charges 1568.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1568.4 other OPPS APC 1568.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1568.4 other OPPS APC 1568.4 51 799.88 percent of total billed charges 1568.4 1568.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOFFMANN3 5 HOLE PIN CLAMP 1 POST STRAIG SUP-97-03407 CDM C1713 HCPCS 0278 RC outpatient 1991.04 1991.04 1991.04 57 1134.89 percent of total billed charges 1991.04 93 1612.74 percent of total billed charges 1991.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1991.04 other OPPS APC 1991.04 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1991.04 other OPPS APC 1991.04 51 1015.43 percent of total billed charges 1991.04 1991.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TENO SWIVELOCK BIOCOMP 4.75X15 SUP-97-03408 CDM C1713 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUICKFIX SCREW CANN 4.0X40MM SUP-97-03409 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VIBONE CELLULAR BONE GRAFT 5CC SUP-97-03410 CDM C1713 HCPCS 0278 RC outpatient 6250 6250 6250 57 3562.5 percent of total billed charges 6250 93 5062.5 percent of total billed charges 6250 6250 other OPPS APC 6250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6250 other OPPS APC 6250 51 3187.5 percent of total billed charges 6250 6250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD HEADED 4.0X34 SUP-97-03411 CDM C1713 HCPCS 0278 RC outpatient 451.5 451.5 451.5 57 257.36 percent of total billed charges 451.5 93 365.72 percent of total billed charges 451.5 451.5 other OPPS APC 451.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 451.5 other OPPS APC 451.5 51 230.27 percent of total billed charges 451.5 451.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7X14 SUP-97-03412 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING SCREW 3.5X36 SUP-97-03413 CDM C1713 HCPCS 0278 RC outpatient 488.25 488.25 488.25 57 278.3 percent of total billed charges 488.25 93 395.48 percent of total billed charges 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 51 249.01 percent of total billed charges 488.25 488.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING SCREW 3.5X28 SUP-97-03414 CDM C1713 HCPCS 0278 RC outpatient 488.25 488.25 488.25 57 278.3 percent of total billed charges 488.25 93 395.48 percent of total billed charges 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 51 249.01 percent of total billed charges 488.25 488.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING SCREW 3.5X32 SUP-97-03415 CDM C1713 HCPCS 0278 RC outpatient 488.25 488.25 488.25 57 278.3 percent of total billed charges 488.25 93 395.48 percent of total billed charges 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 51 249.01 percent of total billed charges 488.25 488.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE FENESTRATION PERFORATOR SUP-97-03416 CDM 0272 RC outpatient 464.63 464.63 464.63 74 343.83 percent of total billed charges 464.63 93 376.35 percent of total billed charges 464.63 464.63 other OPPS APC 464.63 464.63 other OPPS APC 464.63 27.63 128.38 percent of total billed charges 464.63 464.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HEVANS? PLATE, MEDIUM, LEFT, 20MM" SUP-97-03417 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE L STANDARD LAPIDUS SUP-97-03419 CDM C1713 HCPCS 0278 RC outpatient 3243.75 3243.75 3243.75 57 1848.94 percent of total billed charges 3243.75 93 2627.44 percent of total billed charges 3243.75 3243.75 other OPPS APC 3243.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3243.75 other OPPS APC 3243.75 51 1654.31 percent of total billed charges 3243.75 3243.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LAPIDUS WEDGE, 8MM" SUP-97-03420 CDM C1713 HCPCS 0278 RC outpatient 5390.63 5390.63 5390.63 57 3072.66 percent of total billed charges 5390.63 93 4366.41 percent of total billed charges 5390.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5390.63 other OPPS APC 5390.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5390.63 other OPPS APC 5390.63 51 2749.22 percent of total billed charges 5390.63 5390.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI LAG 10.5 X 110MM SUP-97-03421 CDM C1713 HCPCS 0278 RC outpatient 1354.32 1354.32 1354.32 57 771.96 percent of total billed charges 1354.32 93 1097 percent of total billed charges 1354.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1354.32 other OPPS APC 1354.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1354.32 other OPPS APC 1354.32 51 690.7 percent of total billed charges 1354.32 1354.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIVERSAL HEAD BIPOLAR COMPONENT SUP-97-03423 CDM C1776 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. V40 COCR LFIT HEAD 36MM SUP-97-03424 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG PARTIAL THEARD 2.5X22MM SUP-97-03425 CDM C1762 HCPCS 0278 RC outpatient 420 420 420 57 239.4 percent of total billed charges 420 93 340.2 percent of total billed charges 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 51 214.2 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK FEMORAL SZ F-LT SUP-97-03426 CDM C1776 HCPCS 0278 RC outpatient 9499 9499 9499 57 5414.43 percent of total billed charges 9499 93 7694.19 percent of total billed charges 9499 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9499 other OPPS APC 9499 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9499 other OPPS APC 9499 51 4844.49 percent of total billed charges 9499 9499 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN STRAIGHT STEM EXT 16MM X 30MM SUP-97-03427 CDM C1776 HCPCS 0278 RC outpatient 3484.38 3484.38 3484.38 57 1986.1 percent of total billed charges 3484.38 93 2822.35 percent of total billed charges 3484.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3484.38 other OPPS APC 3484.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3484.38 other OPPS APC 3484.38 51 1777.03 percent of total billed charges 3484.38 3484.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK ART SURF EF 3-4 STR YELLOW SUP-97-03428 CDM C1776 HCPCS 0278 RC outpatient 6687.5 6687.5 6687.5 57 3811.88 percent of total billed charges 6687.5 93 5416.88 percent of total billed charges 6687.5 6687.5 other OPPS APC 6687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6687.5 other OPPS APC 6687.5 51 3410.63 percent of total billed charges 6687.5 6687.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK FEMORAL SZ F-RT SUP-97-03429 CDM C1776 HCPCS 0278 RC outpatient 9770.4 9770.4 9770.4 57 5569.13 percent of total billed charges 9770.4 93 7914.02 percent of total billed charges 9770.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9770.4 other OPPS APC 9770.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9770.4 other OPPS APC 9770.4 51 4982.9 percent of total billed charges 9770.4 9770.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TITAN 3-D WEDGE 12MM SUP-97-03431 CDM C1713 HCPCS 0278 RC outpatient 5078.13 5078.13 5078.13 57 2894.53 percent of total billed charges 5078.13 93 4113.29 percent of total billed charges 5078.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5078.13 other OPPS APC 5078.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5078.13 other OPPS APC 5078.13 51 2589.85 percent of total billed charges 5078.13 5078.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK HEADLESS 3.5MM SUP-97-03432 CDM 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG THREADED LOCKING 2.3MM X 12MM SUP-97-03433 CDM C1713 HCPCS 0278 RC outpatient 252 252 252 57 143.64 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 252 other OPPS APC 252 51 128.52 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG THREADED LOCKING 2.3MM X 16MM SUP-97-03434 CDM C1713 HCPCS 0278 RC outpatient 252 252 252 57 143.64 percent of total billed charges 252 93 204.12 percent of total billed charges 252 252 other OPPS APC 252 252 other OPPS APC 252 51 128.52 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL LOCKING 3.5MMX10MM SUP-97-03435 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL LOCKING 3.5MMX12MM SUP-97-03436 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HELICAL BLADE 95MM TFNA SUP-97-03437 CDM C1713 HCPCS 0278 RC outpatient 2272.68 2272.68 2272.68 57 1295.43 percent of total billed charges 2272.68 93 1840.87 percent of total billed charges 2272.68 2272.68 other OPPS APC 2272.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2272.68 other OPPS APC 2272.68 51 1159.07 percent of total billed charges 2272.68 2272.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM LCP LOW BEND MED PLATE 110H/LT239 SUP-97-03438 CDM C1713 HCPCS 0278 RC outpatient 6622.5 6622.5 6622.5 57 3774.83 percent of total billed charges 6622.5 93 5364.23 percent of total billed charges 6622.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6622.5 other OPPS APC 6622.5 6622.5 other OPPS APC 6622.5 51 3377.48 percent of total billed charges 6622.5 6622.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL 10MM/130 DEG TI CANN TFNA340MM RT SUP-97-03439 CDM C1713 HCPCS 0278 RC outpatient 9570 9570 9570 57 5454.9 percent of total billed charges 9570 93 7751.7 percent of total billed charges 9570 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9570 other OPPS APC 9570 9570 other OPPS APC 9570 51 4880.7 percent of total billed charges 9570 9570 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM LCP CLAVICLE PLATE 6/HLEFT 85MM SUP-97-03440 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4 MM CORTEX SLF T8 18MM SUP-97-03441 CDM C1713 HCPCS 0278 RC outpatient 332.5 332.5 332.5 57 189.53 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 332.5 other OPPS APC 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 51 169.58 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7MM3.5MMVA-LCP 2-ANTERDISTAL PL6 HOL SUP-97-03442 CDM C1713 HCPCS 0278 RC outpatient 7185 7185 7185 57 4095.45 percent of total billed charges 7185 93 5819.85 percent of total billed charges 7185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7185 other OPPS APC 7185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7185 other OPPS APC 7185 51 3664.35 percent of total billed charges 7185 7185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7MMVA LCK SCREW T8/52MM SUP-97-03443 CDM C1713 HCPCS 0278 RC outpatient 723 723 723 57 412.11 percent of total billed charges 723 93 585.63 percent of total billed charges 723 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 723 other OPPS APC 723 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 723 other OPPS APC 723 51 368.73 percent of total billed charges 723 723 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 LOCKING 40MM SUP-97-03444 CDM C1713 HCPCS 0278 RC outpatient 532.77 532.77 532.77 57 303.68 percent of total billed charges 532.77 93 431.54 percent of total billed charges 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 51 271.71 percent of total billed charges 532.77 532.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM VARIBLE ANGLE LOCKING SCREW 38MM SUP-97-03445 CDM C1713 HCPCS 0278 RC outpatient 768 768 768 57 437.76 percent of total billed charges 768 93 622.08 percent of total billed charges 768 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 768 other OPPS APC 768 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 768 other OPPS APC 768 51 391.68 percent of total billed charges 768 768 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM CRTX SCREWLOW PROF 30MM SUP-97-03446 CDM C1713 HCPCS 0278 RC outpatient 213.5 213.5 213.5 57 121.7 percent of total billed charges 213.5 93 172.94 percent of total billed charges 213.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 213.5 other OPPS APC 213.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 213.5 other OPPS APC 213.5 51 108.89 percent of total billed charges 213.5 213.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 LOCKING 38MM SUP-97-03447 CDM C1713 HCPCS 0278 RC outpatient 532.77 532.77 532.77 57 303.68 percent of total billed charges 532.77 93 431.54 percent of total billed charges 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 51 271.71 percent of total billed charges 532.77 532.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM CRTX SCREWLOW PROF28MM SUP-97-03448 CDM C1713 HCPCS 0278 RC outpatient 213.5 213.5 213.5 57 121.7 percent of total billed charges 213.5 93 172.94 percent of total billed charges 213.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 213.5 other OPPS APC 213.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 213.5 other OPPS APC 213.5 51 108.89 percent of total billed charges 213.5 213.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 42MM LOCKING VA SUP-97-03449 CDM C1713 HCPCS 0278 RC outpatient 532.77 532.77 532.77 57 303.68 percent of total billed charges 532.77 93 431.54 percent of total billed charges 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 532.77 other OPPS APC 532.77 51 271.71 percent of total billed charges 532.77 532.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM CRTX SCREWLOW PROF HDSE DRIVE42M SUP-97-03450 CDM C1713 HCPCS 0278 RC outpatient 213.5 213.5 213.5 57 121.7 percent of total billed charges 213.5 93 172.94 percent of total billed charges 213.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 213.5 other OPPS APC 213.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 213.5 other OPPS APC 213.5 51 108.89 percent of total billed charges 213.5 213.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM VARIBLE ANGLE LOCKING SCREW 48MM SUP-97-03451 CDM C1713 HCPCS 0278 RC outpatient 768 768 768 57 437.76 percent of total billed charges 768 93 622.08 percent of total billed charges 768 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 768 other OPPS APC 768 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 768 other OPPS APC 768 51 391.68 percent of total billed charges 768 768 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSN ASF PS 10MM VE L 6-9 EF SUP-97-03452 CDM C1776 HCPCS 0278 RC outpatient 4370 4370 4370 57 2490.9 percent of total billed charges 4370 93 3539.7 percent of total billed charges 4370 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4370 other OPPS APC 4370 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4370 other OPPS APC 4370 51 2228.7 percent of total billed charges 4370 4370 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HEVANS? PLATE, MEDIUM, LEFT," SUP-97-03454 CDM C1713 HCPCS 0278 RC outpatient 3243.75 3243.75 3243.75 57 1848.94 percent of total billed charges 3243.75 93 2627.44 percent of total billed charges 3243.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3243.75 other OPPS APC 3243.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3243.75 other OPPS APC 3243.75 51 1654.31 percent of total billed charges 3243.75 3243.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHORT SCREW 3.5X40 SUP-97-03455 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD HEADED 2.0X13 SUP-97-03456 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH COMPOSITE 25X20 SUP-97-03457 CDM C1713 HCPCS 0278 RC outpatient 4264.23 4264.23 4264.23 57 2430.61 percent of total billed charges 4264.23 93 3454.03 percent of total billed charges 4264.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4264.23 other OPPS APC 4264.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4264.23 other OPPS APC 4264.23 51 2174.76 percent of total billed charges 4264.23 4264.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LAPIDUS WEDGE, 10MM" SUP-97-03458 CDM C1713 HCPCS 0278 RC outpatient 5390.63 5390.63 5390.63 57 3072.66 percent of total billed charges 5390.63 93 4366.41 percent of total billed charges 5390.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5390.63 other OPPS APC 5390.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5390.63 other OPPS APC 5390.63 51 2749.22 percent of total billed charges 5390.63 5390.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLARD SHELL 49MM SUP-97-03459 CDM C1776 HCPCS 0278 RC outpatient 1566 1566 1566 57 892.62 percent of total billed charges 1566 93 1268.46 percent of total billed charges 1566 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1566 other OPPS APC 1566 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1566 other OPPS APC 1566 51 798.66 percent of total billed charges 1566 1566 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CORCR FEMORAL HEAD 28MM 12/14 SUP-97-03460 CDM C1776 HCPCS 0278 RC outpatient 1852.5 1852.5 1852.5 57 1055.93 percent of total billed charges 1852.5 93 1500.53 percent of total billed charges 1852.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1852.5 other OPPS APC 1852.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1852.5 other OPPS APC 1852.5 51 944.78 percent of total billed charges 1852.5 1852.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIO CARTILAGE SUP-97-03461 CDM C1762 HCPCS 0278 RC outpatient 2940 2940 2940 57 1675.8 percent of total billed charges 2940 93 2381.4 percent of total billed charges 2940 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2940 other OPPS APC 2940 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2940 other OPPS APC 2940 51 1499.4 percent of total billed charges 2940 2940 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 MM LOCKING 45MM SUP-97-03462 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 12MM SUP-97-03463 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TI CANN TFNA 10MM/130DEG 420 SUP-97-03464 CDM C1713 HCPCS 0278 RC outpatient 6041.6 6041.6 6041.6 57 3443.71 percent of total billed charges 6041.6 93 4893.7 percent of total billed charges 6041.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6041.6 other OPPS APC 6041.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6041.6 other OPPS APC 6041.6 51 3081.22 percent of total billed charges 6041.6 6041.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T2 FEMORAL NAIL R1500 9MMX380MM SUP-97-03465 CDM C1713 HCPCS 0278 RC outpatient 3938.23 3938.23 3938.23 57 2244.79 percent of total billed charges 3938.23 93 3189.97 percent of total billed charges 3938.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3938.23 other OPPS APC 3938.23 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3938.23 other OPPS APC 3938.23 51 2008.5 percent of total billed charges 3938.23 3938.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN FLUTED STEM EXT 14MM X 175MM SUP-97-03466 CDM C1776 HCPCS 0278 RC outpatient 3328.13 3328.13 3328.13 57 1897.03 percent of total billed charges 3328.13 93 2695.79 percent of total billed charges 3328.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3328.13 other OPPS APC 3328.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3328.13 other OPPS APC 3328.13 51 1697.35 percent of total billed charges 3328.13 3328.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN A/P WEDGED PRCT TIBIAL PLATE SZ5 SUP-97-03467 CDM C1776 HCPCS 0278 RC outpatient 4248 4248 4248 57 2421.36 percent of total billed charges 4248 93 3440.88 percent of total billed charges 4248 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4248 other OPPS APC 4248 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4248 other OPPS APC 4248 51 2166.48 percent of total billed charges 4248 4248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LCCK 0D SZ5 5MM 36X31 CPL SUP-97-03468 CDM C1778 HCPCS 0278 RC outpatient 12037.5 12037.5 12037.5 57 6861.38 percent of total billed charges 12037.5 93 9750.38 percent of total billed charges 12037.5 12037.5 other OPPS APC 12037.5 12037.5 other OPPS APC 12037.5 51 6139.13 percent of total billed charges 12037.5 12037.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN FLUTED STEM EXT 11MM X 175MM SUP-97-03469 CDM C1776 HCPCS 0278 RC outpatient 3328.13 3328.13 3328.13 57 1897.03 percent of total billed charges 3328.13 93 2695.79 percent of total billed charges 3328.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3328.13 other OPPS APC 3328.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3328.13 other OPPS APC 3328.13 51 1697.35 percent of total billed charges 3328.13 3328.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK ART SURF EF 5/6 GREEN 10MM SUP-97-03470 CDM C1776 HCPCS 0278 RC outpatient 6687.5 6687.5 6687.5 57 3811.88 percent of total billed charges 6687.5 93 5416.88 percent of total billed charges 6687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6687.5 other OPPS APC 6687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6687.5 other OPPS APC 6687.5 51 3410.63 percent of total billed charges 6687.5 6687.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE NITINOL COMPRESSION 15WX12L SUP-97-03471 CDM C1713 HCPCS 0278 RC outpatient 3737.5 3737.5 3737.5 57 2130.38 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 3737.5 other OPPS APC 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 51 1906.13 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PROFILE DRILL, 5.0 LARGE COMPRESSION FT" SUP-97-03472 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCRW 5.0LGX40MM SUP-97-03473 CDM C1713 HCPCS 0278 RC outpatient 1425 1425 1425 57 812.25 percent of total billed charges 1425 93 1154.25 percent of total billed charges 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 51 726.75 percent of total billed charges 1425 1425 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GULDEWIRE W/TRCR TIP 062.X25 SUP-97-03474 CDM 0272 RC outpatient 60 60 60 74 44.4 percent of total billed charges 60 93 48.6 percent of total billed charges 60 60 other OPPS APC 60 60 other OPPS APC 60 27.63 16.58 percent of total billed charges 60 60 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO3 SUPERPOWER RIGHT STEEL GREY SUP-97-03475 CDM L8614 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBALANCE UKA TIBIAL TRAY S Z 2RT SUP-97-03476 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBALANCE UKA FEM CEMENTED SIZ 3R SUP-97-03477 CDM C1776 HCPCS 0278 RC outpatient 7500 7500 7500 57 4275 percent of total billed charges 7500 93 6075 percent of total billed charges 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 51 3825 percent of total billed charges 7500 7500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO3 POWER DIAMOND BLACK LEFT SUP-97-03478 CDM L8614 HCPCS 0278 RC outpatient 8352 8352 8352 57 4760.64 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 51 4259.52 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO3 POWER MOCCA BROWN RIGHT SUP-97-03479 CDM L8614 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO3 POWER CHROMA BEIGE LEFT SUP-97-03480 CDM L8614 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO3 POWER CHROMA BEIGE RIGHT SUP-97-03481 CDM L8614 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO3 POWER WHITE SILVER LEFT SUP-97-03482 CDM L8614 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO3 POWER PURE WHITE LEFT SUP-97-03483 CDM L8614 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO3 POWER PURE WHITE RIGHT SUP-97-03484 CDM L8614 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACHILLES SPEED BRIDGE SUP-97-03485 CDM C1713 HCPCS 0278 RC outpatient 2925 2925 2925 57 1667.25 percent of total billed charges 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 51 1491.75 percent of total billed charges 2925 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ANCH BIO COM S TAK SUP-97-03486 CDM C1713 HCPCS 0278 RC outpatient 1374 1374 1374 57 783.18 percent of total billed charges 1374 93 1112.94 percent of total billed charges 1374 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1374 other OPPS APC 1374 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1374 other OPPS APC 1374 51 700.74 percent of total billed charges 1374 1374 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS TECNIS MONOFOCAL 7.0D SUP-97-03487 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX NON LOCKING 3.5MM X 65MM SUP-97-03488 CDM C1713 HCPCS 0278 RC outpatient 97.28 97.28 97.28 57 55.45 percent of total billed charges 97.28 93 78.8 percent of total billed charges 97.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.28 other OPPS APC 97.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.28 other OPPS APC 97.28 51 49.61 percent of total billed charges 97.28 97.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 6 HOLE HEAD 3 HOLE SHAFT SUP-97-03489 CDM C1713 HCPCS 0278 RC outpatient 6175 6175 6175 57 3519.75 percent of total billed charges 6175 93 5001.75 percent of total billed charges 6175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6175 other OPPS APC 6175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6175 other OPPS APC 6175 51 3149.25 percent of total billed charges 6175 6175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 6.5 SUP-97-03490 CDM C1780 HCPCS 0278 RC outpatient 381.5 381.5 381.5 57 217.46 percent of total billed charges 381.5 93 309.02 percent of total billed charges 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 51 194.57 percent of total billed charges 381.5 381.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXIBLE REAMER 10MM SUP-97-03491 CDM outpatient 1500 1500 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT 6X10CM EPIXL SUP-97-03492 CDM Q4186 HCPCS 0636 RC outpatient 9190 9190 169.88 169.88 fee schedule 9190 93 7443.9 percent of total billed charges 9190 9190 other OPPS APC 9190 9190 other OPPS APC 9190 24.86 2284.63 percent of total billed charges 169.88 9190 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMNIOFILL 1000MG SUP-97-03493 CDM outpatient 5625 5625 5625 5625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANTERIOR TIBIALS TENDON 8MM 30CM SUP-97-03494 CDM C1762 HCPCS 0278 RC outpatient 5750 5750 5750 57 3277.5 percent of total billed charges 5750 93 4657.5 percent of total billed charges 5750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5750 other OPPS APC 5750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5750 other OPPS APC 5750 51 2932.5 percent of total billed charges 5750 5750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW THREADED 7.3MM X 32MM X 55MM SUP-97-03495 CDM C1713 HCPCS 0278 RC outpatient 1371 1371 1371 57 781.47 percent of total billed charges 1371 93 1110.51 percent of total billed charges 1371 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1371 other OPPS APC 1371 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1371 other OPPS APC 1371 51 699.21 percent of total billed charges 1371 1371 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRAMEDULLARY IMPLANT SUP-97-03498 CDM C1713 HCPCS 0278 RC outpatient 2849.85 2849.85 2849.85 57 1624.41 percent of total billed charges 2849.85 93 2308.38 percent of total billed charges 2849.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2849.85 other OPPS APC 2849.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2849.85 other OPPS APC 2849.85 51 1453.42 percent of total billed charges 2849.85 2849.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG HIGH COMPRESSION 2.7MM X 22MM SUP-97-03499 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG HIGH COMPRESSION 2.7MM X 22MM SUP-97-03500 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 241.5 other OPPS APC 241.5 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 3.5 X 60MM SUP-97-03501 CDM C1713 HCPCS 0278 RC outpatient 94.28 94.28 94.28 57 53.74 percent of total billed charges 94.28 93 76.37 percent of total billed charges 94.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 94.28 other OPPS APC 94.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 94.28 other OPPS APC 94.28 51 48.08 percent of total billed charges 94.28 94.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 21.5D SUP-97-03502 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ARTHROCELL, 5.0CC" SUP-97-03503 CDM C1762 HCPCS 0278 RC outpatient 8750 8750 8750 57 4987.5 percent of total billed charges 8750 93 7087.5 percent of total billed charges 8750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8750 other OPPS APC 8750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8750 other OPPS APC 8750 51 4462.5 percent of total billed charges 8750 8750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBALANCE UKA TIBIAL TRAY S Z 2RL SUP-97-03504 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRAMEDULLARY IMPLANT SZ RLG SUP-97-03505 CDM C1776 HCPCS 0278 RC outpatient 2849.85 2849.85 2849.85 57 1624.41 percent of total billed charges 2849.85 93 2308.38 percent of total billed charges 2849.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2849.85 other OPPS APC 2849.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2849.85 other OPPS APC 2849.85 51 1453.42 percent of total billed charges 2849.85 2849.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD HEADED 2.0X12 SUP-97-03506 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BTB TIGHTROPE ARTHREX SUP-97-03507 CDM C1713 HCPCS 0278 RC outpatient 1275 1275 1275 57 726.75 percent of total billed charges 1275 93 1032.75 percent of total billed charges 1275 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1275 other OPPS APC 1275 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1275 other OPPS APC 1275 51 650.25 percent of total billed charges 1275 1275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 10 MM FLIP CUTTER II ARTHREX SUP-97-03508 CDM outpatient 975 975 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 10.5 MM FLIP CUTTER II ARTHREX SUP-97-03509 CDM outpatient 975 975 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN SHRT THREAD 4MM X 52MM SUP-97-03510 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM CANN LOCKING 35 M SUP-97-03511 CDM C1713 HCPCS 0278 RC outpatient 996 996 996 57 567.72 percent of total billed charges 996 93 806.76 percent of total billed charges 996 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 996 other OPPS APC 996 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 996 other OPPS APC 996 51 507.96 percent of total billed charges 996 996 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM CANN LOCKING 55 M SUP-97-03512 CDM C1713 HCPCS 0278 RC outpatient 996 996 996 57 567.72 percent of total billed charges 996 93 806.76 percent of total billed charges 996 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 996 other OPPS APC 996 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 996 other OPPS APC 996 51 507.96 percent of total billed charges 996 996 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM CANN LOCKING 55 M SUP-97-03513 CDM C1713 HCPCS 0278 RC outpatient 996 996 996 57 567.72 percent of total billed charges 996 93 806.76 percent of total billed charges 996 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 996 other OPPS APC 996 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 996 other OPPS APC 996 51 507.96 percent of total billed charges 996 996 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 7.3 MM CANN CONICAL PT 7 SUP-97-03514 CDM C1713 HCPCS 0278 RC outpatient 1320 1320 1320 57 752.4 percent of total billed charges 1320 93 1069.2 percent of total billed charges 1320 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1320 other OPPS APC 1320 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1320 other OPPS APC 1320 51 673.2 percent of total billed charges 1320 1320 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SCORPION MICROFIRE W/SUTUREMITT SUP-97-03515 CDM 0272 RC outpatient 729 729 729 74 539.46 percent of total billed charges 729 93 590.49 percent of total billed charges 729 729 other OPPS APC 729 729 other OPPS APC 729 27.63 201.42 percent of total billed charges 729 729 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIA PLATE LAT 6 HOLE SUP-97-03516 CDM C1713 HCPCS 0278 RC outpatient 3482.5 3482.5 3482.5 57 1985.03 percent of total billed charges 3482.5 93 2820.83 percent of total billed charges 3482.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3482.5 other OPPS APC 3482.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3482.5 other OPPS APC 3482.5 51 1776.08 percent of total billed charges 3482.5 3482.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON LOCKING SCREW 3.5X32 SUP-97-03517 CDM C1713 HCPCS 0278 RC outpatient 378 378 378 57 215.46 percent of total billed charges 378 93 306.18 percent of total billed charges 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 51 192.78 percent of total billed charges 378 378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON LOCKING SCREW 3.5X28 SUP-97-03518 CDM C1713 HCPCS 0278 RC outpatient 378 378 378 57 215.46 percent of total billed charges 378 93 306.18 percent of total billed charges 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 51 192.78 percent of total billed charges 378 378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON LOCKING SCREW 3.5X26 SUP-97-03519 CDM C1713 HCPCS 0278 RC outpatient 378 378 378 57 215.46 percent of total billed charges 378 93 306.18 percent of total billed charges 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 51 192.78 percent of total billed charges 378 378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON LOCKING SCREW 3.5X40 SUP-97-03520 CDM C1713 HCPCS 0278 RC outpatient 378 378 378 57 215.46 percent of total billed charges 378 93 306.18 percent of total billed charges 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 51 192.78 percent of total billed charges 378 378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON LOCKING SCREW 3.5X42 SUP-97-03521 CDM C1713 HCPCS 0278 RC outpatient 378 378 378 57 215.46 percent of total billed charges 378 93 306.18 percent of total billed charges 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 51 192.78 percent of total billed charges 378 378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON LOCKING SCREW 3.5X44 SUP-97-03522 CDM C1713 HCPCS 0278 RC outpatient 378 378 378 57 215.46 percent of total billed charges 378 93 306.18 percent of total billed charges 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 51 192.78 percent of total billed charges 378 378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 20MM CORTICAL LOW PROFILE TITANIUM SUP-97-03523 CDM C1713 HCPCS 0278 RC outpatient 385 385 385 57 219.45 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 51 196.35 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 28MM CORTICAL LOW PROFILE TITANIUM SUP-97-03524 CDM C1713 HCPCS 0278 RC outpatient 385 385 385 57 219.45 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 51 196.35 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 16 SUP-97-03525 CDM C1713 HCPCS 0278 RC outpatient 385 385 385 57 219.45 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 385 other OPPS APC 385 51 196.35 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 20MM SUP-97-03527 CDM C1713 HCPCS 0278 RC outpatient 385 385 385 57 219.45 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 51 196.35 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 24MM SUP-97-03528 CDM C1713 HCPCS 0278 RC outpatient 385 385 385 57 219.45 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 51 196.35 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DORSAL MIDFOOT FUSION PLATE 3MM LG SUP-97-03529 CDM C1713 HCPCS 0278 RC outpatient 3737.5 3737.5 3737.5 57 2130.38 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 51 1906.13 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK CANNUL 4.0 SUP-97-03530 CDM 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-LESS T ROPE W/DRV SYN REPR SS SUP-97-03531 CDM C1713 HCPCS 0278 RC outpatient 3737.5 3737.5 3737.5 57 2130.38 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 51 1906.13 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW NUT 5.0 SUP-97-03532 CDM C1713 HCPCS 0278 RC outpatient 822 822 822 57 468.54 percent of total billed charges 822 93 665.82 percent of total billed charges 822 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 822 other OPPS APC 822 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 822 other OPPS APC 822 51 419.22 percent of total billed charges 822 822 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLODERM 16CMX20CM (1518320P) SUP-97-03533 CDM Q4116 HCPCS 0636 RC outpatient 20902.7 20902.7 20902.7 74 15468 percent of total billed charges 20902.7 93 16931.2 percent of total billed charges 20902.7 20902.7 other OPPS APC 20902.7 20902.7 other OPPS APC 20902.7 24.86 5196.41 percent of total billed charges 20902.7 20902.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTHROFLEX 301 SUP-97-03534 CDM Q4125 HCPCS 0636 RC outpatient 9965 9965 9965 74 7374.1 percent of total billed charges 9965 93 8071.65 percent of total billed charges 9965 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9965 other OPPS APC 9965 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9965 other OPPS APC 9965 24.86 2477.3 percent of total billed charges 9965 9965 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 12.5D SUP-97-03535 CDM C1780 HCPCS 0278 RC outpatient 381.5 381.5 381.5 57 217.46 percent of total billed charges 381.5 93 309.02 percent of total billed charges 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 51 194.57 percent of total billed charges 381.5 381.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 15.5D SUP-97-03536 CDM C1780 HCPCS 0278 RC outpatient 402.5 402.5 402.5 57 229.43 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 51 205.28 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 25.0D SUP-97-03537 CDM C1780 HCPCS 0278 RC outpatient 1251.15 1251.15 1251.15 57 713.16 percent of total billed charges 1251.15 93 1013.43 percent of total billed charges 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 51 638.09 percent of total billed charges 1251.15 1251.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 9.5D TECNIS EYHANCE SUP-97-03538 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL 10MM/130 DEG TI CANN TFNA320MM RT SUP-97-03539 CDM C1713 HCPCS 0278 RC outpatient 6124.8 6124.8 6124.8 57 3491.14 percent of total billed charges 6124.8 93 4961.09 percent of total billed charges 6124.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6124.8 other OPPS APC 6124.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6124.8 other OPPS APC 6124.8 51 3123.65 percent of total billed charges 6124.8 6124.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL 10MM/130 DEG TI CANN TFNA420MM LT SUP-97-03540 CDM C1713 HCPCS 0278 RC outpatient 6124.8 6124.8 6124.8 57 3491.14 percent of total billed charges 6124.8 93 4961.09 percent of total billed charges 6124.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6124.8 other OPPS APC 6124.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6124.8 other OPPS APC 6124.8 51 3123.65 percent of total billed charges 6124.8 6124.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE 5.5MM HEALICOIL BLK SUP-97-03541 CDM C1713 HCPCS 0278 RC outpatient 1107.6 1107.6 1107.6 57 631.33 percent of total billed charges 1107.6 93 897.16 percent of total billed charges 1107.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1107.6 other OPPS APC 1107.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1107.6 other OPPS APC 1107.6 51 564.88 percent of total billed charges 1107.6 1107.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR KNOTLESS 5.5MM S-ULTRA SUP-97-03542 CDM C1713 HCPCS 0278 RC outpatient 1125 1125 1125 57 641.25 percent of total billed charges 1125 93 911.25 percent of total billed charges 1125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1125 other OPPS APC 1125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1125 other OPPS APC 1125 51 573.75 percent of total billed charges 1125 1125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT MESH 3X3.5 SUP-97-03543 CDM C1781 HCPCS 0278 RC outpatient 4107.5 4107.5 4107.5 57 2341.28 percent of total billed charges 4107.5 93 3327.08 percent of total billed charges 4107.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4107.5 other OPPS APC 4107.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4107.5 other OPPS APC 4107.5 51 2094.83 percent of total billed charges 4107.5 4107.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER BLADE PATELLA W/ PILOT HOLE SZ51 SUP-97-03544 CDM 0272 RC outpatient 503.13 503.13 503.13 74 372.32 percent of total billed charges 503.13 93 407.54 percent of total billed charges 503.13 503.13 other OPPS APC 503.13 503.13 other OPPS APC 503.13 27.63 139.01 percent of total billed charges 503.13 503.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 5 SUP-97-03545 CDM C1713 HCPCS 0278 RC outpatient 604.45 604.45 604.45 57 344.54 percent of total billed charges 604.45 93 489.6 percent of total billed charges 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 51 308.27 percent of total billed charges 604.45 604.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL SUP-97-03546 CDM C1713 HCPCS 0278 RC outpatient 604.45 604.45 604.45 57 344.54 percent of total billed charges 604.45 93 489.6 percent of total billed charges 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 51 308.27 percent of total billed charges 604.45 604.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROSET 10CC SUP-97-03547 CDM C1713 HCPCS 0278 RC outpatient 6768.5 6768.5 6768.5 57 3858.05 percent of total billed charges 6768.5 93 5482.49 percent of total billed charges 6768.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6768.5 other OPPS APC 6768.5 6768.5 other OPPS APC 6768.5 51 3451.94 percent of total billed charges 6768.5 6768.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIGHTROPE ABS BUTTON 14MM SUP-97-03548 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ABS TIGHTROPE INPLANT ARTHREX SUP-97-03549 CDM C1713 HCPCS 0278 RC outpatient 789 789 789 57 449.73 percent of total billed charges 789 93 639.09 percent of total billed charges 789 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 789 other OPPS APC 789 789 other OPPS APC 789 51 402.39 percent of total billed charges 789 789 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE TENDON STRIPPER 10MM SUP-97-03550 CDM 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 750 other OPPS APC 750 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA BUTTON PASSPORT 10MM ID X 4CM SUP-97-03551 CDM 0272 RC outpatient 128 128 128 74 94.72 percent of total billed charges 128 93 103.68 percent of total billed charges 128 128 other OPPS APC 128 128 other OPPS APC 128 27.63 35.37 percent of total billed charges 128 128 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACHILLES SPEED BRIDGE IMPLANT SYS W/JUMP SUP-97-03552 CDM C1713 HCPCS 0278 RC outpatient 4987.5 4987.5 4987.5 57 2842.88 percent of total billed charges 4987.5 93 4039.88 percent of total billed charges 4987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4987.5 other OPPS APC 4987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4987.5 other OPPS APC 4987.5 51 2543.63 percent of total billed charges 4987.5 4987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE DYNANITE NITI 18MM X 18MM SUP-97-03553 CDM C1713 HCPCS 0278 RC outpatient 4737.5 4737.5 4737.5 57 2700.38 percent of total billed charges 4737.5 93 3837.38 percent of total billed charges 4737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4737.5 other OPPS APC 4737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4737.5 other OPPS APC 4737.5 51 2416.13 percent of total billed charges 4737.5 4737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 MM LOW PROFILE CANNUL SUP-97-03554 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 6.7X7 LOW PROFILE CANNUL18MM SUP-97-03555 CDM C1713 HCPCS 0278 RC outpatient 750 750 750 57 427.5 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 51 382.5 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE DYNANITE NITI 20MM X 20MM SUP-97-03556 CDM C1713 HCPCS 0278 RC outpatient 4737.5 4737.5 4737.5 57 2700.38 percent of total billed charges 4737.5 93 3837.38 percent of total billed charges 4737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4737.5 other OPPS APC 4737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4737.5 other OPPS APC 4737.5 51 2416.13 percent of total billed charges 4737.5 4737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE DYNANITE NITI W/INST 18MM X 18MM SUP-97-03557 CDM C1713 HCPCS 0278 RC outpatient 5737.5 5737.5 5737.5 57 3270.38 percent of total billed charges 5737.5 93 4647.38 percent of total billed charges 5737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5737.5 other OPPS APC 5737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5737.5 other OPPS APC 5737.5 51 2926.13 percent of total billed charges 5737.5 5737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANKLE ARTHRODESIS NAIL RIGHT SUP-97-03558 CDM C1713 HCPCS 0278 RC outpatient 4845.5 4845.5 4845.5 57 2761.94 percent of total billed charges 4845.5 93 3924.86 percent of total billed charges 4845.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4845.5 other OPPS APC 4845.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4845.5 other OPPS APC 4845.5 51 2471.21 percent of total billed charges 4845.5 4845.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL AO SUP-97-03559 CDM 0272 RC outpatient 561.12 561.12 561.12 74 415.23 percent of total billed charges 561.12 93 454.51 percent of total billed charges 561.12 561.12 other OPPS APC 561.12 561.12 other OPPS APC 561.12 27.63 155.04 percent of total billed charges 561.12 561.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T2 SCN SYSTENM END CAP SUP-97-03560 CDM C1713 HCPCS 0278 RC outpatient 406.35 406.35 406.35 57 231.62 percent of total billed charges 406.35 93 329.14 percent of total billed charges 406.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 406.35 other OPPS APC 406.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 406.35 other OPPS APC 406.35 51 207.24 percent of total billed charges 406.35 406.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE DYNANITE NITI 15MM X 15MM SUP-97-03561 CDM C1713 HCPCS 0278 RC outpatient 4737.5 4737.5 4737.5 57 2700.38 percent of total billed charges 4737.5 93 3837.38 percent of total billed charges 4737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4737.5 other OPPS APC 4737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4737.5 other OPPS APC 4737.5 51 2416.13 percent of total billed charges 4737.5 4737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX NON LOCKING 3.5MM X 36MM SUP-97-03562 CDM C1713 HCPCS 0278 RC outpatient 97.28 97.28 97.28 57 55.45 percent of total billed charges 97.28 93 78.8 percent of total billed charges 97.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.28 other OPPS APC 97.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.28 other OPPS APC 97.28 51 49.61 percent of total billed charges 97.28 97.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TI CANN TFNA 10MM/130DEG SUP-97-03563 CDM C1713 HCPCS 0278 RC outpatient 6248.55 6248.55 6248.55 57 3561.67 percent of total billed charges 6248.55 93 5061.33 percent of total billed charges 6248.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6248.55 other OPPS APC 6248.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6248.55 other OPPS APC 6248.55 51 3186.76 percent of total billed charges 6248.55 6248.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SELF DRILL CORTICAL 80 X 40 (30THEAD) SUP-97-03564 CDM 0272 RC outpatient 396.38 396.38 396.38 74 293.32 percent of total billed charges 396.38 93 321.07 percent of total billed charges 396.38 396.38 other OPPS APC 396.38 396.38 other OPPS APC 396.38 27.63 109.52 percent of total billed charges 396.38 396.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SELF DRILLING CORTICAL 80 X 40 (30THEAD SUP-97-03565 CDM 0272 RC outpatient 396.38 396.38 396.38 74 293.32 percent of total billed charges 396.38 93 321.07 percent of total billed charges 396.38 396.38 other OPPS APC 396.38 396.38 other OPPS APC 396.38 27.63 109.52 percent of total billed charges 396.38 396.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SELF DRIL CORTICAL PIN 03.0 X 80 X 40 SUP-97-03566 CDM 0272 RC outpatient 396.38 396.38 396.38 74 293.32 percent of total billed charges 396.38 93 321.07 percent of total billed charges 396.38 396.38 other OPPS APC 396.38 396.38 other OPPS APC 396.38 27.63 109.52 percent of total billed charges 396.38 396.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4MM 2.7MM VA- LCP MTP FUSION 5 DEG/RT SUP-97-03567 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.6MM COMPRESSION WIRE 10MM THREAD SUP-97-03568 CDM C1713 HCPCS 0278 RC outpatient 180.08 180.08 180.08 57 102.65 percent of total billed charges 180.08 93 145.86 percent of total billed charges 180.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180.08 other OPPS APC 180.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180.08 other OPPS APC 180.08 51 91.84 percent of total billed charges 180.08 180.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.6MM COMPRESSION WIRE 25MM THREAD SUP-97-03569 CDM C1713 HCPCS 0278 RC outpatient 180.08 180.08 180.08 57 102.65 percent of total billed charges 180.08 93 145.86 percent of total billed charges 180.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180.08 other OPPS APC 180.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180.08 other OPPS APC 180.08 51 91.84 percent of total billed charges 180.08 180.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4MM VA LCK 12MM SCREWDRIVE SUP-97-03570 CDM C1713 HCPCS 0278 RC outpatient 432.25 432.25 432.25 57 246.38 percent of total billed charges 432.25 93 350.12 percent of total billed charges 432.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.25 other OPPS APC 432.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.25 other OPPS APC 432.25 51 220.45 percent of total billed charges 432.25 432.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4MM VA LCK 16MM SCREWDRIVE SUP-97-03571 CDM C1713 HCPCS 0278 RC outpatient 432.25 432.25 432.25 57 246.38 percent of total billed charges 432.25 93 350.12 percent of total billed charges 432.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.25 other OPPS APC 432.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.25 other OPPS APC 432.25 51 220.45 percent of total billed charges 432.25 432.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4MM VA LCK 20MM SCREWDRIVE SUP-97-03572 CDM C1713 HCPCS 0278 RC outpatient 432.25 432.25 432.25 57 246.38 percent of total billed charges 432.25 93 350.12 percent of total billed charges 432.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.25 other OPPS APC 432.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.25 other OPPS APC 432.25 51 220.45 percent of total billed charges 432.25 432.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HAMMERLOCK 2 DRILL KIT W/ 2.1 DRILL BIT SUP-97-03573 CDM 0272 RC outpatient 810 810 810 74 599.4 percent of total billed charges 810 93 656.1 percent of total billed charges 810 810 other OPPS APC 810 810 other OPPS APC 810 27.63 223.8 percent of total billed charges 810 810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HAMMERLOCK 2 IMPLANT KIT 12X5MM 10DEG SUP-97-03574 CDM C1713 HCPCS 0278 RC outpatient 810 810 810 57 461.7 percent of total billed charges 810 93 656.1 percent of total billed charges 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 51 413.1 percent of total billed charges 810 810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HAMMERLOCK 2 IMPLANT KIT 12X5MM 0DEG SUP-97-03575 CDM C1713 HCPCS 0278 RC outpatient 810 810 810 57 461.7 percent of total billed charges 810 93 656.1 percent of total billed charges 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 810 other OPPS APC 810 51 413.1 percent of total billed charges 810 810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HAMMERLOCK 2 IMPLANT KIT 15X5MM 10DEG SUP-97-03576 CDM C1713 HCPCS 0278 RC outpatient 810 810 810 57 461.7 percent of total billed charges 810 93 656.1 percent of total billed charges 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 51 413.1 percent of total billed charges 810 810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.6MM KIRSCHNER WIRE TROCAPIONT 150MM SUP-97-03577 CDM C1713 HCPCS 0278 RC outpatient 359.07 359.07 359.07 57 204.67 percent of total billed charges 359.07 93 290.85 percent of total billed charges 359.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 359.07 other OPPS APC 359.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 359.07 other OPPS APC 359.07 51 183.13 percent of total billed charges 359.07 359.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAUMACEM INJECTABLEBONE CEMENT SUP-97-03578 CDM C1713 HCPCS 0278 RC outpatient 1382.4 1382.4 1382.4 57 787.97 percent of total billed charges 1382.4 93 1119.74 percent of total billed charges 1382.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1382.4 other OPPS APC 1382.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1382.4 other OPPS APC 1382.4 51 705.02 percent of total billed charges 1382.4 1382.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAUMACEM INJECTION CANNULA FOR TFNA SUP-97-03579 CDM 0272 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT TRAUMACEM SYRINGE SUP-97-03580 CDM 0272 RC outpatient 537.6 537.6 537.6 74 397.82 percent of total billed charges 537.6 93 435.46 percent of total billed charges 537.6 537.6 other OPPS APC 537.6 537.6 other OPPS APC 537.6 27.63 148.54 percent of total billed charges 537.6 537.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MINI RAIL 55MM SUP-97-03581 CDM C1713 HCPCS 0278 RC outpatient 5298.75 5298.75 5298.75 57 3020.29 percent of total billed charges 5298.75 93 4291.99 percent of total billed charges 5298.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5298.75 other OPPS APC 5298.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5298.75 other OPPS APC 5298.75 51 2702.36 percent of total billed charges 5298.75 5298.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALTIPLY 4CMX7CM SUP-97-03582 CDM Q4235 HCPCS 0636 RC outpatient 8125 8125 188.52 188.52 fee schedule 8125 93 6581.25 percent of total billed charges 8125 8125 other OPPS APC 8125 8125 other OPPS APC 8125 24.86 2019.88 percent of total billed charges 188.52 8125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 7 X 55MM CANNULATED MEDIUM THREAD HEADLESS MONSTER SUP-97-03583 CDM C1713 HCPCS 0278 RC outpatient 1787.1 1787.1 1787.1 57 1018.65 percent of total billed charges 1787.1 93 1447.55 percent of total billed charges 1787.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1787.1 other OPPS APC 1787.1 1787.1 other OPPS APC 1787.1 51 911.42 percent of total billed charges 1787.1 1787.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS COUNTERSINK 7.0 SUP-97-03584 CDM 0272 RC outpatient 691.25 691.25 691.25 74 511.53 percent of total billed charges 691.25 93 559.91 percent of total billed charges 691.25 691.25 other OPPS APC 691.25 691.25 other OPPS APC 691.25 27.63 190.99 percent of total billed charges 691.25 691.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TITAN 3-D WEDGE 8MM SUP-97-03585 CDM C1713 HCPCS 0278 RC outpatient 4834.38 4834.38 4834.38 57 2755.6 percent of total billed charges 4834.38 93 3915.85 percent of total billed charges 4834.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4834.38 other OPPS APC 4834.38 4834.38 other OPPS APC 4834.38 51 2465.53 percent of total billed charges 4834.38 4834.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD 2.0X14MM SUP-97-03586 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 7 X 20MM BC IF VENTED SUP-97-03587 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANCELLOUS 70 THR 5X250 APEX SUP-97-03589 CDM C1713 HCPCS 0278 RC outpatient 468.72 468.72 468.72 57 267.17 percent of total billed charges 468.72 93 379.66 percent of total billed charges 468.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 468.72 other OPPS APC 468.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 468.72 other OPPS APC 468.72 51 239.05 percent of total billed charges 468.72 468.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SELF-DRILLING HALF PIN APEX DIA 3/5MM X SUP-97-03590 CDM C1713 HCPCS 0278 RC outpatient 468.72 468.72 468.72 57 267.17 percent of total billed charges 468.72 93 379.66 percent of total billed charges 468.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 468.72 other OPPS APC 468.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 468.72 other OPPS APC 468.72 51 239.05 percent of total billed charges 468.72 468.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEMI-CIRCULAR CURVED ROD HOFFMANN3 +11X2 SUP-97-03591 CDM C1713 HCPCS 0278 RC outpatient 1318.8 1318.8 1318.8 57 751.72 percent of total billed charges 1318.8 93 1068.23 percent of total billed charges 1318.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1318.8 other OPPS APC 1318.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1318.8 other OPPS APC 1318.8 51 672.59 percent of total billed charges 1318.8 1318.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOFMAN3 CONNECTING ROD 11 X 150MM SUP-97-03592 CDM C1713 HCPCS 0278 RC outpatient 778.8 778.8 778.8 57 443.92 percent of total billed charges 778.8 93 630.83 percent of total billed charges 778.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 778.8 other OPPS APC 778.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 778.8 other OPPS APC 778.8 51 397.19 percent of total billed charges 778.8 778.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOFFMANN3 5 HOLE PIN CLAMP 2 POSTS 30 SUP-97-03593 CDM C1713 HCPCS 0278 RC outpatient 1785.6 1785.6 1785.6 57 1017.79 percent of total billed charges 1785.6 93 1446.34 percent of total billed charges 1785.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785.6 other OPPS APC 1785.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785.6 other OPPS APC 1785.6 51 910.66 percent of total billed charges 1785.6 1785.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THREADED GUIDE WIRE 1.4X1.5MM SUP-97-03594 CDM C1713 HCPCS 0278 RC outpatient 245.28 245.28 245.28 57 139.81 percent of total billed charges 245.28 93 198.68 percent of total billed charges 245.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 245.28 other OPPS APC 245.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 245.28 other OPPS APC 245.28 51 125.09 percent of total billed charges 245.28 245.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASNIS III SS WASHER 4.0MM SUP-97-03595 CDM C1713 HCPCS 0278 RC outpatient 96 96 96 57 54.72 percent of total billed charges 96 93 77.76 percent of total billed charges 96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 96 other OPPS APC 96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 96 other OPPS APC 96 51 48.96 percent of total billed charges 96 96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASNIS III SS CANNULATED SCR 4X55MM SUP-97-03596 CDM C1713 HCPCS 0278 RC outpatient 542.64 542.64 542.64 57 309.3 percent of total billed charges 542.64 93 439.54 percent of total billed charges 542.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.64 other OPPS APC 542.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.64 other OPPS APC 542.64 51 276.75 percent of total billed charges 542.64 542.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APEX TRANSFIX 4X250 PIN 5X50THR SUP-97-03597 CDM C1713 HCPCS 0278 RC outpatient 298.2 298.2 298.2 57 169.97 percent of total billed charges 298.2 93 241.54 percent of total billed charges 298.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 298.2 other OPPS APC 298.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 298.2 other OPPS APC 298.2 51 152.08 percent of total billed charges 298.2 298.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOTAL SHOULDER SUP-97-03598 CDM C1776 HCPCS 0278 RC outpatient 9800 9800 9800 57 5586 percent of total billed charges 9800 93 7938 percent of total billed charges 9800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9800 other OPPS APC 9800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9800 other OPPS APC 9800 51 4998 percent of total billed charges 9800 9800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOBAL UNITE ECC HEAD 40X15 SUP-97-03599 CDM C1776 HCPCS 0278 RC outpatient 3045 3045 3045 57 1735.65 percent of total billed charges 3045 93 2466.45 percent of total billed charges 3045 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3045 other OPPS APC 3045 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3045 other OPPS APC 3045 51 1552.95 percent of total billed charges 3045 3045 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOSYNC EVANS WEDGE20X20X6.5 SUP-97-03600 CDM C1713 HCPCS 0278 RC outpatient 5487.5 5487.5 5487.5 57 3127.88 percent of total billed charges 5487.5 93 4444.88 percent of total billed charges 5487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5487.5 other OPPS APC 5487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5487.5 other OPPS APC 5487.5 51 2798.63 percent of total billed charges 5487.5 5487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOSYNC EVANS WEDGE 18MMX18MMX8MM SUP-97-03601 CDM C1713 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PRO SCREW 6.7X40MM SUP-97-03602 CDM C1713 HCPCS 0278 RC outpatient 750 750 750 57 427.5 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 51 382.5 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REVISON CEM TIB TRAYSZ2 SUP-97-03603 CDM C1776 HCPCS 0278 RC outpatient 10659.6 10659.6 10659.6 57 6075.97 percent of total billed charges 10659.6 93 8634.28 percent of total billed charges 10659.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10659.6 other OPPS APC 10659.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10659.6 other OPPS APC 10659.6 51 5436.4 percent of total billed charges 10659.6 10659.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNI KNEE SUP-97-03604 CDM C1776 HCPCS 0278 RC outpatient 8750 8750 8750 57 4987.5 percent of total billed charges 8750 93 7087.5 percent of total billed charges 8750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8750 other OPPS APC 8750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8750 other OPPS APC 8750 51 4462.5 percent of total billed charges 8750 8750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE MBT STEP SZ 2 10MM SUP-97-03605 CDM C1776 HCPCS 0278 RC outpatient 5218.5 5218.5 5218.5 57 2974.55 percent of total billed charges 5218.5 93 4226.99 percent of total billed charges 5218.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5218.5 other OPPS APC 5218.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5218.5 other OPPS APC 5218.5 51 2661.44 percent of total billed charges 5218.5 5218.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT TC3 RP S2 15.0 SUP-97-03606 CDM C1776 HCPCS 0278 RC outpatient 7507.5 7507.5 7507.5 57 4279.28 percent of total billed charges 7507.5 93 6081.08 percent of total billed charges 7507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7507.5 other OPPS APC 7507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7507.5 other OPPS APC 7507.5 51 3828.83 percent of total billed charges 7507.5 7507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THIN OSTEOTOME 12MMX3IN SUP-97-03607 CDM 0272 RC outpatient 697.2 697.2 697.2 74 515.93 percent of total billed charges 697.2 93 564.73 percent of total billed charges 697.2 697.2 other OPPS APC 697.2 697.2 other OPPS APC 697.2 27.63 192.64 percent of total billed charges 697.2 697.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAP FOR 3.5MM SCREWS AO 70MM SUP-97-03608 CDM 0272 RC outpatient 421.68 421.68 421.68 74 312.04 percent of total billed charges 421.68 93 341.56 percent of total billed charges 421.68 421.68 other OPPS APC 421.68 421.68 other OPPS APC 421.68 27.63 116.51 percent of total billed charges 421.68 421.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAP FOR 2.7MM SCREWS AO 50MM SUP-97-03609 CDM outpatient 357.84 357.84 357.84 357.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL LOCKING 3.5MMX15MM SUP-97-03610 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL NON LOCKING 3.5MMX9MM SUP-97-03611 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG HIGH COMPRESSION 2.7MM X 21MM SUP-97-03612 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. A.I.M ING GUIDES SUP-97-03613 CDM 0272 RC outpatient 140 140 140 74 103.6 percent of total billed charges 140 93 113.4 percent of total billed charges 140 140 other OPPS APC 140 140 other OPPS APC 140 27.63 38.68 percent of total billed charges 140 140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CANN, FULL THREAD SCREW, HEADED, 2.0X22" SUP-97-03614 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T7 2.7 X 8MM NON LOCKING SUP-97-03616 CDM C1713 HCPCS 0278 RC outpatient 238.14 238.14 238.14 57 135.74 percent of total billed charges 238.14 93 192.89 percent of total billed charges 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 51 121.45 percent of total billed charges 238.14 238.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CANN, FULL THREAD SCREW, HEADED, 2.0X12" SUP-97-03617 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CANN, FULL THREAD SCREW, HEADED, 2.0X10" SUP-97-03618 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN 7.3 16MM/115MM SUP-97-03619 CDM C1713 HCPCS 0278 RC outpatient 776.64 776.64 776.64 57 442.68 percent of total billed charges 776.64 93 629.08 percent of total billed charges 776.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 776.64 other OPPS APC 776.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 776.64 other OPPS APC 776.64 51 396.09 percent of total billed charges 776.64 776.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN 7.3 16MM/105MM SUP-97-03620 CDM C1713 HCPCS 0278 RC outpatient 761.64 761.64 761.64 57 434.13 percent of total billed charges 761.64 93 616.93 percent of total billed charges 761.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 761.64 other OPPS APC 761.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 761.64 other OPPS APC 761.64 51 388.44 percent of total billed charges 761.64 761.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW THREADED 7.3MM X 32MM X 105MM SUP-97-03621 CDM C1713 HCPCS 0278 RC outpatient 761.64 761.64 761.64 57 434.13 percent of total billed charges 761.64 93 616.93 percent of total billed charges 761.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 761.64 other OPPS APC 761.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 761.64 other OPPS APC 761.64 51 388.44 percent of total billed charges 761.64 761.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROX LAT HUM 3 HOLE LFT X 86MM SUP-97-03622 CDM C1713 HCPCS 0278 RC outpatient 4221 4221 4221 57 2405.97 percent of total billed charges 4221 93 3419.01 percent of total billed charges 4221 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4221 other OPPS APC 4221 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4221 other OPPS APC 4221 51 2152.71 percent of total billed charges 4221 4221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROX LAT HUM 4 HOLE LFT X 99MM SUP-97-03623 CDM C1713 HCPCS 0278 RC outpatient 4221 4221 4221 57 2405.97 percent of total billed charges 4221 93 3419.01 percent of total billed charges 4221 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4221 other OPPS APC 4221 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4221 other OPPS APC 4221 51 2152.71 percent of total billed charges 4221 4221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMNIOFILL 500MG SUP-97-03624 CDM 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD HEADLESS 3.0X16 SUP-97-03625 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THRED 7.0X76 SUP-97-03626 CDM C1713 HCPCS 0278 RC outpatient 2525.25 2525.25 2525.25 57 1439.39 percent of total billed charges 2525.25 93 2045.45 percent of total billed charges 2525.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2525.25 other OPPS APC 2525.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2525.25 other OPPS APC 2525.25 51 1287.88 percent of total billed charges 2525.25 2525.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE 12MM SUP-97-03627 CDM C1713 HCPCS 0278 RC outpatient 6843.75 6843.75 6843.75 57 3900.94 percent of total billed charges 6843.75 93 5543.44 percent of total billed charges 6843.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6843.75 other OPPS APC 6843.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6843.75 other OPPS APC 6843.75 51 3490.31 percent of total billed charges 6843.75 6843.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEPT GAUGE EXTENTION SUP-97-03628 CDM C1713 HCPCS 0278 RC outpatient 2049.03 2049.03 2049.03 57 1167.95 percent of total billed charges 2049.03 93 1659.71 percent of total billed charges 2049.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2049.03 other OPPS APC 2049.03 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2049.03 other OPPS APC 2049.03 51 1045.01 percent of total billed charges 2049.03 2049.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CONDYLE 05X55MM SUP-97-03629 CDM C1713 HCPCS 0278 RC outpatient 659.51 659.51 659.51 57 375.92 percent of total billed charges 659.51 93 534.2 percent of total billed charges 659.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 659.51 other OPPS APC 659.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 659.51 other OPPS APC 659.51 51 336.35 percent of total billed charges 659.51 659.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 1.8X3.10MM SUP-97-03630 CDM C1713 HCPCS 0278 RC outpatient 379.68 379.68 379.68 57 216.42 percent of total billed charges 379.68 93 307.54 percent of total billed charges 379.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 379.68 other OPPS APC 379.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 379.68 other OPPS APC 379.68 51 193.64 percent of total billed charges 379.68 379.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CONDYLE NUT SUP-97-03631 CDM C1713 HCPCS 0278 RC outpatient 586.74 586.74 586.74 57 334.44 percent of total billed charges 586.74 93 475.26 percent of total billed charges 586.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 586.74 other OPPS APC 586.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 586.74 other OPPS APC 586.74 51 299.24 percent of total billed charges 586.74 586.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CONDYLE 05X65MM SUP-97-03632 CDM C1713 HCPCS 0278 RC outpatient 586.74 586.74 586.74 57 334.44 percent of total billed charges 586.74 93 475.26 percent of total billed charges 586.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 586.74 other OPPS APC 586.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 586.74 other OPPS APC 586.74 51 299.24 percent of total billed charges 586.74 586.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CONDYLE 05X70MM SUP-97-03633 CDM C1713 HCPCS 0278 RC outpatient 659.51 659.51 659.51 57 375.92 percent of total billed charges 659.51 93 534.2 percent of total billed charges 659.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 659.51 other OPPS APC 659.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 659.51 other OPPS APC 659.51 51 336.35 percent of total billed charges 659.51 659.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CONDYLE 05X50MM SUP-97-03634 CDM C1713 HCPCS 0278 RC outpatient 659.51 659.51 659.51 57 375.92 percent of total billed charges 659.51 93 534.2 percent of total billed charges 659.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 659.51 other OPPS APC 659.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 659.51 other OPPS APC 659.51 51 336.35 percent of total billed charges 659.51 659.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STERILE YELLOW MONOTUBE KIT2 SUP-97-03635 CDM C1713 HCPCS 0278 RC outpatient 3255.65 3255.65 3255.65 57 1855.72 percent of total billed charges 3255.65 93 2637.08 percent of total billed charges 3255.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3255.65 other OPPS APC 3255.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3255.65 other OPPS APC 3255.65 51 1660.38 percent of total billed charges 3255.65 3255.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX M STEM LATERA OFFSET NUMBER 4 SUP-97-03636 CDM C1776 HCPCS 0278 RC outpatient 6000 6000 6000 57 3420 percent of total billed charges 6000 93 4860 percent of total billed charges 6000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6000 other OPPS APC 6000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6000 other OPPS APC 6000 51 3060 percent of total billed charges 6000 6000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO- PRO SCRWS CANN BLUNT4.0X24MM SUP-97-03637 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO- PRO SCRWS CANN BLUNT4.0X28MM SUP-97-03638 CDM C1713 HCPCS 0278 RC outpatient 708 708 708 57 403.56 percent of total billed charges 708 93 573.48 percent of total billed charges 708 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 708 other OPPS APC 708 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 708 other OPPS APC 708 51 361.08 percent of total billed charges 708 708 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO- PRO SCRWS CANN BLUNT4.0X34MM SUP-97-03639 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOTAL STABILIZED TIBIAL INSERT 1 13MM SUP-97-03640 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 24.0D SUP-97-03641 CDM C1780 HCPCS 0278 RC outpatient 402.5 402.5 402.5 57 229.43 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 51 205.28 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN PART THREAD 7.3MM X 16MM SUP-97-03642 CDM C1713 HCPCS 0278 RC outpatient 761.64 761.64 761.64 57 434.13 percent of total billed charges 761.64 93 616.93 percent of total billed charges 761.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 761.64 other OPPS APC 761.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 761.64 other OPPS APC 761.64 51 388.44 percent of total billed charges 761.64 761.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONG NAIL KIT R1/5 TI LFT 11X320MM X125 SUP-97-03643 CDM C1713 HCPCS 0278 RC outpatient 3302 3302 3302 57 1882.14 percent of total billed charges 3302 93 2674.62 percent of total billed charges 3302 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3302 other OPPS APC 3302 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3302 other OPPS APC 3302 51 1684.02 percent of total billed charges 3302 3302 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL GAMMA3 S LEFT 10 X 320MM X125 SUP-97-03644 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL GAMMA 3 S RT 10 X 420MM X 125 SUP-97-03645 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANCELLOUS BONE 4MM X 110MM SUP-97-03646 CDM C1713 HCPCS 0278 RC outpatient 397.81 397.81 397.81 57 226.75 percent of total billed charges 397.81 93 322.23 percent of total billed charges 397.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 397.81 other OPPS APC 397.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 397.81 other OPPS APC 397.81 51 202.88 percent of total billed charges 397.81 397.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTEGRA MESHED BILAYER WOUND MATRIX 2X2 SUP-97-03647 CDM Q4104 HCPCS 0636 RC outpatient 6098 6098 55.89 55.89 fee schedule 6098 93 4939.38 percent of total billed charges 6098 6098 other OPPS APC 6098 6098 other OPPS APC 6098 24.86 1515.96 percent of total billed charges 55.89 6098 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRES SMOOTH 3.2MM SUP-97-03648 CDM C1713 HCPCS 0278 RC outpatient 433.83 433.83 433.83 57 247.28 percent of total billed charges 433.83 93 351.4 percent of total billed charges 433.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 433.83 other OPPS APC 433.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 433.83 other OPPS APC 433.83 51 221.25 percent of total billed charges 433.83 433.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BITE BREAK-OFF SCREW, 1/2 THD, 2.0 X 11" SUP-97-03649 CDM C1713 HCPCS 0278 RC outpatient 870 870 870 57 495.9 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 51 443.7 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE T LCP 4.5 MM 8 HOLES 147 SUP-97-03650 CDM C1713 HCPCS 0278 RC outpatient 2428.02 2428.02 2428.02 57 1383.97 percent of total billed charges 2428.02 93 1966.7 percent of total billed charges 2428.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2428.02 other OPPS APC 2428.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2428.02 other OPPS APC 2428.02 51 1238.29 percent of total billed charges 2428.02 2428.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LCP 4.5 MM PROX TIBIA 4 SUP-97-03651 CDM C1713 HCPCS 0278 RC outpatient 2325.6 2325.6 2325.6 57 1325.59 percent of total billed charges 2325.6 93 1883.74 percent of total billed charges 2325.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325.6 other OPPS APC 2325.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325.6 other OPPS APC 2325.6 51 1186.06 percent of total billed charges 2325.6 2325.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA PASSPORT BUTTON 12MM ID X 5CM SUP-97-03652 CDM 0272 RC outpatient 210 210 210 74 155.4 percent of total billed charges 210 93 170.1 percent of total billed charges 210 210 other OPPS APC 210 210 other OPPS APC 210 27.63 58.02 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE LOOP SD NITINOL SUP-97-03653 CDM C1713 HCPCS 0278 RC outpatient 160 160 160 57 91.2 percent of total billed charges 160 93 129.6 percent of total billed charges 160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160 other OPPS APC 160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160 other OPPS APC 160 51 81.6 percent of total billed charges 160 160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. A.I.M ING GUIDES SUP-97-03654 CDM 0272 RC outpatient 92 92 92 74 68.08 percent of total billed charges 92 93 74.52 percent of total billed charges 92 92 other OPPS APC 92 92 other OPPS APC 92 27.63 25.42 percent of total billed charges 92 92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRIVER AO CONN SQUARE TIP 10MM SUP-97-03655 CDM 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 297.5 other OPPS APC 297.5 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRIVER AO CONN POLAXIAL LOCKING SC SUP-97-03656 CDM 0272 RC outpatient 287 287 287 74 212.38 percent of total billed charges 287 93 232.47 percent of total billed charges 287 287 other OPPS APC 287 287 other OPPS APC 287 27.63 79.3 percent of total billed charges 287 287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 5 SUP-97-03657 CDM C1713 HCPCS 0278 RC outpatient 656.67 656.67 656.67 57 374.3 percent of total billed charges 656.67 93 531.9 percent of total billed charges 656.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 656.67 other OPPS APC 656.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 656.67 other OPPS APC 656.67 51 334.9 percent of total billed charges 656.67 656.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL NAIL LEFT SUP-97-03658 CDM C1713 HCPCS 0278 RC outpatient 5506.43 5506.43 5506.43 57 3138.67 percent of total billed charges 5506.43 93 4460.21 percent of total billed charges 5506.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5506.43 other OPPS APC 5506.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5506.43 other OPPS APC 5506.43 51 2808.28 percent of total billed charges 5506.43 5506.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACHILLES TENDON SUP-97-03659 CDM C1762 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 10 TI CANN RETRO/ANTEGRA FEM NAIL360MM SUP-97-03660 CDM C1713 HCPCS 0278 RC outpatient 3955.88 3955.88 3955.88 57 2254.85 percent of total billed charges 3955.88 93 3204.26 percent of total billed charges 3955.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3955.88 other OPPS APC 3955.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3955.88 other OPPS APC 3955.88 51 2017.5 percent of total billed charges 3955.88 3955.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TROCH FOR THE GAMMA 3 SUP-97-03661 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT HEMASHIELD PATCH (95224) SUP-97-03662 CDM C1781 HCPCS 0278 RC outpatient 2021.22 2021.22 2021.22 57 1152.1 percent of total billed charges 2021.22 93 1637.19 percent of total billed charges 2021.22 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2021.22 other OPPS APC 2021.22 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2021.22 other OPPS APC 2021.22 51 1030.82 percent of total billed charges 2021.22 2021.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT HEMASHIELD PATCH (85168) SUP-97-03663 CDM C1781 HCPCS 0278 RC outpatient 2888.55 2888.55 2888.55 57 1646.47 percent of total billed charges 2888.55 93 2339.73 percent of total billed charges 2888.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2888.55 other OPPS APC 2888.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2888.55 other OPPS APC 2888.55 51 1473.16 percent of total billed charges 2888.55 2888.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REST MOD CONICAL DISTAL STEM 15MMX155MM SUP-97-03667 CDM C1776 HCPCS 0278 RC outpatient 7228 7228 7228 57 4119.96 percent of total billed charges 7228 93 5854.68 percent of total billed charges 7228 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7228 other OPPS APC 7228 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7228 other OPPS APC 7228 51 3686.28 percent of total billed charges 7228 7228 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REST MOD PROX CONE BODY 21MM+10 SUP-97-03668 CDM C1776 HCPCS 0278 RC outpatient 8068.8 8068.8 8068.8 57 4599.22 percent of total billed charges 8068.8 93 6535.73 percent of total billed charges 8068.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8068.8 other OPPS APC 8068.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8068.8 other OPPS APC 8068.8 51 4115.09 percent of total billed charges 8068.8 8068.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX NON LOCKING 3.5MM X 46MM SUP-97-03670 CDM C1713 HCPCS 0278 RC outpatient 134.4 134.4 134.4 57 76.61 percent of total billed charges 134.4 93 108.86 percent of total billed charges 134.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.4 other OPPS APC 134.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.4 other OPPS APC 134.4 51 68.54 percent of total billed charges 134.4 134.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX NON LOCKING 3.5MM X 80MM SUP-97-03671 CDM C1713 HCPCS 0278 RC outpatient 134.4 134.4 134.4 57 76.61 percent of total billed charges 134.4 93 108.86 percent of total billed charges 134.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.4 other OPPS APC 134.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.4 other OPPS APC 134.4 51 68.54 percent of total billed charges 134.4 134.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROX MED TIB 6 HOLE LEFT SUP-97-03672 CDM C1713 HCPCS 0278 RC outpatient 3816.4 3816.4 3816.4 57 2175.35 percent of total billed charges 3816.4 93 3091.28 percent of total billed charges 3816.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3816.4 other OPPS APC 3816.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3816.4 other OPPS APC 3816.4 51 1946.36 percent of total billed charges 3816.4 3816.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT HEMAGARD KNITTED VAS (HGK0018-40) SUP-97-03674 CDM C1781 HCPCS 0278 RC outpatient 1953 1953 1953 57 1113.21 percent of total billed charges 1953 93 1581.93 percent of total billed charges 1953 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1953 other OPPS APC 1953 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1953 other OPPS APC 1953 51 996.03 percent of total billed charges 1953 1953 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "HAMMER TUBE SYSTEM 2.75MM, 0? CANNULATED" SUP-97-03675 CDM C1713 HCPCS 0278 RC outpatient 2849.85 2849.85 2849.85 57 1624.41 percent of total billed charges 2849.85 93 2308.38 percent of total billed charges 2849.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2849.85 other OPPS APC 2849.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2849.85 other OPPS APC 2849.85 51 1453.42 percent of total billed charges 2849.85 2849.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING SCREW PARTIALLY THREADED SUP-97-03676 CDM C1713 HCPCS 0278 RC outpatient 656.08 656.08 656.08 57 373.97 percent of total billed charges 656.08 93 531.42 percent of total billed charges 656.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 656.08 other OPPS APC 656.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 656.08 other OPPS APC 656.08 51 334.6 percent of total billed charges 656.08 656.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HELICAL BLADE 80MM TFNA SUP-97-03677 CDM C1713 HCPCS 0278 RC outpatient 2272.68 2272.68 2272.68 57 1295.43 percent of total billed charges 2272.68 93 1840.87 percent of total billed charges 2272.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2272.68 other OPPS APC 2272.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2272.68 other OPPS APC 2272.68 51 1159.07 percent of total billed charges 2272.68 2272.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 36MM CANNULATED TI SUP-97-03678 CDM C1713 HCPCS 0278 RC outpatient 396.48 396.48 396.48 57 225.99 percent of total billed charges 396.48 93 321.15 percent of total billed charges 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 51 202.2 percent of total billed charges 396.48 396.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN TI 4.0X48MM SUP-97-03679 CDM C1713 HCPCS 0278 RC outpatient 542.64 542.64 542.64 57 309.3 percent of total billed charges 542.64 93 439.54 percent of total billed charges 542.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.64 other OPPS APC 542.64 542.64 other OPPS APC 542.64 51 276.75 percent of total billed charges 542.64 542.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN TI 4.0X60MM SUP-97-03680 CDM C1713 HCPCS 0278 RC outpatient 542.64 542.64 542.64 57 309.3 percent of total billed charges 542.64 93 439.54 percent of total billed charges 542.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.64 other OPPS APC 542.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.64 other OPPS APC 542.64 51 276.75 percent of total billed charges 542.64 542.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 16MM SUP-97-03681 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA NEXGEN PROLONG ALL POLY 38MM SUP-97-03682 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK ART SURF EF 5/6 GREEN 23MM SUP-97-03683 CDM C1776 HCPCS 0278 RC outpatient 6687.5 6687.5 6687.5 57 3811.88 percent of total billed charges 6687.5 93 5416.88 percent of total billed charges 6687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6687.5 other OPPS APC 6687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6687.5 other OPPS APC 6687.5 51 3410.63 percent of total billed charges 6687.5 6687.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER BLADE PATELLA W/ PILOT HOLE SZ46 SUP-97-03684 CDM 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 262.5 other OPPS APC 262.5 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 8MM SUP-97-03685 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 18MM SUP-97-03686 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 20MM SUP-97-03687 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 44MM SUP-97-03688 CDM C1713 HCPCS 0278 RC outpatient 313.25 313.25 313.25 57 178.55 percent of total billed charges 313.25 93 253.73 percent of total billed charges 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 51 159.76 percent of total billed charges 313.25 313.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 46MM SUP-97-03689 CDM C1713 HCPCS 0278 RC outpatient 313.25 313.25 313.25 57 178.55 percent of total billed charges 313.25 93 253.73 percent of total billed charges 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 51 159.76 percent of total billed charges 313.25 313.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE SCREW T10 FULL THREAD 2.7MM / L16MM SUP-97-03690 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALIGNMENT ROD SUP-97-03691 CDM C1713 HCPCS 0278 RC outpatient 1004.85 1004.85 1004.85 57 572.76 percent of total billed charges 1004.85 93 813.93 percent of total billed charges 1004.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1004.85 other OPPS APC 1004.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1004.85 other OPPS APC 1004.85 51 512.47 percent of total billed charges 1004.85 1004.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIMING ARM LOCKING DEVICE SUP-97-03694 CDM 0272 RC outpatient 2269.44 2269.44 2269.44 74 1679.39 percent of total billed charges 2269.44 93 1838.25 percent of total billed charges 2269.44 2269.44 other OPPS APC 2269.44 2269.44 other OPPS APC 2269.44 27.63 627.05 percent of total billed charges 2269.44 2269.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 3 SUP-97-03695 CDM C1713 HCPCS 0278 RC outpatient 604.45 604.45 604.45 57 344.54 percent of total billed charges 604.45 93 489.6 percent of total billed charges 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 51 308.27 percent of total billed charges 604.45 604.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 8 SUP-97-03696 CDM C1713 HCPCS 0278 RC outpatient 604.45 604.45 604.45 57 344.54 percent of total billed charges 604.45 93 489.6 percent of total billed charges 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 51 308.27 percent of total billed charges 604.45 604.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 7 SUP-97-03697 CDM C1713 HCPCS 0278 RC outpatient 604.45 604.45 604.45 57 344.54 percent of total billed charges 604.45 93 489.6 percent of total billed charges 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 51 308.27 percent of total billed charges 604.45 604.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI LAG 10.5 X 75MM SUP-97-03698 CDM C1713 HCPCS 0278 RC outpatient 1354.32 1354.32 1354.32 57 771.96 percent of total billed charges 1354.32 93 1097 percent of total billed charges 1354.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1354.32 other OPPS APC 1354.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1354.32 other OPPS APC 1354.32 51 690.7 percent of total billed charges 1354.32 1354.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 95MM SUP-97-03699 CDM C1713 HCPCS 0278 RC outpatient 394.8 394.8 394.8 57 225.04 percent of total billed charges 394.8 93 319.79 percent of total billed charges 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 51 201.35 percent of total billed charges 394.8 394.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX COMPRES NARROW STR 6H X 78 SUP-97-03700 CDM C1713 HCPCS 0278 RC outpatient 1321.32 1321.32 1321.32 57 753.15 percent of total billed charges 1321.32 93 1070.27 percent of total billed charges 1321.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1321.32 other OPPS APC 1321.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1321.32 other OPPS APC 1321.32 51 673.87 percent of total billed charges 1321.32 1321.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 7.3MM CANNULATED LOCKING SCREW 95MM SUP-97-03701 CDM C1713 HCPCS 0278 RC outpatient 861.27 861.27 861.27 57 490.92 percent of total billed charges 861.27 93 697.63 percent of total billed charges 861.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 861.27 other OPPS APC 861.27 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 861.27 other OPPS APC 861.27 51 439.25 percent of total billed charges 861.27 861.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TITAN 3-D WEDGE 7MM SUP-97-03703 CDM C1713 HCPCS 0278 RC outpatient 3793.13 3793.13 3793.13 57 2162.08 percent of total billed charges 3793.13 93 3072.44 percent of total billed charges 3793.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3793.13 other OPPS APC 3793.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3793.13 other OPPS APC 3793.13 51 1934.5 percent of total billed charges 3793.13 3793.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "K-WIRE, SINGLE ENDED TRO TIP, THR 1.6" SUP-97-03704 CDM C1713 HCPCS 0278 RC outpatient 80 80 80 57 45.6 percent of total billed charges 80 93 64.8 percent of total billed charges 80 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 80 other OPPS APC 80 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 80 other OPPS APC 80 51 40.8 percent of total billed charges 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0 SCHANTZ PIN SUP-97-03705 CDM C1713 HCPCS 0278 RC outpatient 647.5 647.5 647.5 57 369.08 percent of total billed charges 647.5 93 524.48 percent of total billed charges 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 51 330.23 percent of total billed charges 647.5 647.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.0SCHANTZ PIN SUP-97-03706 CDM C1713 HCPCS 0278 RC outpatient 647.5 647.5 647.5 57 369.08 percent of total billed charges 647.5 93 524.48 percent of total billed charges 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 51 330.23 percent of total billed charges 647.5 647.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON LOCKING SCREW 3.5X30 SUP-97-03707 CDM C1713 HCPCS 0278 RC outpatient 420 420 420 57 239.4 percent of total billed charges 420 93 340.2 percent of total billed charges 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 51 214.2 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON LOCKING SCREW 3.5X50 SUP-97-03708 CDM C1713 HCPCS 0278 RC outpatient 378 378 378 57 215.46 percent of total billed charges 378 93 306.18 percent of total billed charges 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 378 other OPPS APC 378 51 192.78 percent of total billed charges 378 378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CALCANEAL FRACTURE PLATE, RIGHT, MEDIUM" SUP-97-03709 CDM C1713 HCPCS 0278 RC outpatient 4078.13 4078.13 4078.13 57 2324.53 percent of total billed charges 4078.13 93 3303.29 percent of total billed charges 4078.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4078.13 other OPPS APC 4078.13 4078.13 other OPPS APC 4078.13 51 2079.85 percent of total billed charges 4078.13 4078.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7X30 SUP-97-03710 CDM C1713 HCPCS 0278 RC outpatient 488.25 488.25 488.25 57 278.3 percent of total billed charges 488.25 93 395.48 percent of total billed charges 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 51 249.01 percent of total billed charges 488.25 488.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7X32 SUP-97-03711 CDM C1713 HCPCS 0278 RC outpatient 488.25 488.25 488.25 57 278.3 percent of total billed charges 488.25 93 395.48 percent of total billed charges 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 51 249.01 percent of total billed charges 488.25 488.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING SCREW 3.5X38 SUP-97-03712 CDM C1713 HCPCS 0278 RC outpatient 488.25 488.25 488.25 57 278.3 percent of total billed charges 488.25 93 395.48 percent of total billed charges 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 51 249.01 percent of total billed charges 488.25 488.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING SCREW 3.5X42 SUP-97-03713 CDM C1713 HCPCS 0278 RC outpatient 488.25 488.25 488.25 57 278.3 percent of total billed charges 488.25 93 395.48 percent of total billed charges 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 51 249.01 percent of total billed charges 488.25 488.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP 0 SUP-97-03714 CDM C1713 HCPCS 0278 RC outpatient 566.72 566.72 566.72 57 323.03 percent of total billed charges 566.72 93 459.04 percent of total billed charges 566.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 566.72 other OPPS APC 566.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 566.72 other OPPS APC 566.72 51 289.03 percent of total billed charges 566.72 566.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP 5 SUP-97-03715 CDM C1713 HCPCS 0278 RC outpatient 566.72 566.72 566.72 57 323.03 percent of total billed charges 566.72 93 459.04 percent of total billed charges 566.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 566.72 other OPPS APC 566.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 566.72 other OPPS APC 566.72 51 289.03 percent of total billed charges 566.72 566.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP 10 SUP-97-03716 CDM C1713 HCPCS 0278 RC outpatient 566.72 566.72 566.72 57 323.03 percent of total billed charges 566.72 93 459.04 percent of total billed charges 566.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 566.72 other OPPS APC 566.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 566.72 other OPPS APC 566.72 51 289.03 percent of total billed charges 566.72 566.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REST MOD PROX CONE BODY 19MM + 0MM SUP-97-03717 CDM C1776 HCPCS 0278 RC outpatient 8068.8 8068.8 8068.8 57 4599.22 percent of total billed charges 8068.8 93 6535.73 percent of total billed charges 8068.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8068.8 other OPPS APC 8068.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8068.8 other OPPS APC 8068.8 51 4115.09 percent of total billed charges 8068.8 8068.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REST MOD PROX CONE BODY 20MM X 195MM SUP-97-03718 CDM C1776 HCPCS 0278 RC outpatient 7655 7655 7655 57 4363.35 percent of total billed charges 7655 93 6200.55 percent of total billed charges 7655 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7655 other OPPS APC 7655 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7655 other OPPS APC 7655 51 3904.05 percent of total billed charges 7655 7655 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANKLE FUSION PLATE LATERAL SUP-97-03719 CDM C1713 HCPCS 0278 RC outpatient 5437.5 5437.5 5437.5 57 3099.38 percent of total billed charges 5437.5 93 4404.38 percent of total billed charges 5437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5437.5 other OPPS APC 5437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5437.5 other OPPS APC 5437.5 51 2773.13 percent of total billed charges 5437.5 5437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NORIAN DRILL ABLE INJECT 3CC SUP-97-03720 CDM C1713 HCPCS 0278 RC outpatient 2559.6 2559.6 2559.6 57 1458.97 percent of total billed charges 2559.6 93 2073.28 percent of total billed charges 2559.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2559.6 other OPPS APC 2559.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2559.6 other OPPS APC 2559.6 51 1305.4 percent of total billed charges 2559.6 2559.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NORIAN DRILL ABLE INJECT 5CC SUP-97-03721 CDM C1713 HCPCS 0278 RC outpatient 3501 3501 3501 57 1995.57 percent of total billed charges 3501 93 2835.81 percent of total billed charges 3501 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3501 other OPPS APC 3501 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3501 other OPPS APC 3501 51 1785.51 percent of total billed charges 3501 3501 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NON LOK CRSSPIN ST 2.3 X 10MM SUP-97-03722 CDM C1713 HCPCS 0278 RC outpatient 245.49 245.49 245.49 57 139.93 percent of total billed charges 245.49 93 198.85 percent of total billed charges 245.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 245.49 other OPPS APC 245.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 245.49 other OPPS APC 245.49 51 125.2 percent of total billed charges 245.49 245.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NON LOK CRSSPIN ST 2.3 X 16MM SUP-97-03723 CDM C1713 HCPCS 0278 RC outpatient 245.49 245.49 245.49 57 139.93 percent of total billed charges 245.49 93 198.85 percent of total billed charges 245.49 245.49 other OPPS APC 245.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 245.49 other OPPS APC 245.49 51 125.2 percent of total billed charges 245.49 245.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCKG CRSSPIN ST 2.3 X 8MM SUP-97-03724 CDM C1713 HCPCS 0278 RC outpatient 318.99 318.99 318.99 57 181.82 percent of total billed charges 318.99 93 258.38 percent of total billed charges 318.99 318.99 other OPPS APC 318.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 318.99 other OPPS APC 318.99 51 162.68 percent of total billed charges 318.99 318.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCKG CRSSPIN ST 2.3 X 10MM SUP-97-03725 CDM C1713 HCPCS 0278 RC outpatient 318.99 318.99 318.99 57 181.82 percent of total billed charges 318.99 93 258.38 percent of total billed charges 318.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 318.99 other OPPS APC 318.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 318.99 other OPPS APC 318.99 51 162.68 percent of total billed charges 318.99 318.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCKG CRSSPIN ST 2.3 X 12MM SUP-97-03726 CDM C1713 HCPCS 0278 RC outpatient 296.94 296.94 296.94 57 169.26 percent of total billed charges 296.94 93 240.52 percent of total billed charges 296.94 296.94 other OPPS APC 296.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 296.94 other OPPS APC 296.94 51 151.44 percent of total billed charges 296.94 296.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCKG CRSSPIN ST 2.3 X 14MM SUP-97-03727 CDM C1713 HCPCS 0278 RC outpatient 296.94 296.94 296.94 57 169.26 percent of total billed charges 296.94 93 240.52 percent of total billed charges 296.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 296.94 other OPPS APC 296.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 296.94 other OPPS APC 296.94 51 151.44 percent of total billed charges 296.94 296.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE TUBULAR 1/3 4 HOLES SUP-97-03730 CDM C1713 HCPCS 0278 RC outpatient 929.76 929.76 929.76 57 529.96 percent of total billed charges 929.76 93 753.11 percent of total billed charges 929.76 929.76 other OPPS APC 929.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 929.76 other OPPS APC 929.76 51 474.18 percent of total billed charges 929.76 929.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2-0FL 26 W/MOND PNT ST NDL SUP-97-03731 CDM 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 200 other OPPS APC 200 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NARROW COMPRESSION 8 HOLE 5.0 SUP-97-03732 CDM C1713 HCPCS 0278 RC outpatient 7137.5 7137.5 7137.5 57 4068.38 percent of total billed charges 7137.5 93 5781.38 percent of total billed charges 7137.5 7137.5 other OPPS APC 7137.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7137.5 other OPPS APC 7137.5 51 3640.13 percent of total billed charges 7137.5 7137.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5.0MM X 20MM SUP-97-03733 CDM C1713 HCPCS 0278 RC outpatient 591.92 591.92 591.92 57 337.39 percent of total billed charges 591.92 93 479.46 percent of total billed charges 591.92 591.92 other OPPS APC 591.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 591.92 other OPPS APC 591.92 51 301.88 percent of total billed charges 591.92 591.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HUMERAL HEAD STB OFFSET ASCEND 48X20 SUP-97-03734 CDM C1776 HCPCS 0278 RC outpatient 5955 5955 5955 57 3394.35 percent of total billed charges 5955 93 4823.55 percent of total billed charges 5955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5955 other OPPS APC 5955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5955 other OPPS APC 5955 51 3037.05 percent of total billed charges 5955 5955 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HUMERAL STEM STANDARD ASCEND 4A PTC SUP-97-03735 CDM C1776 HCPCS 0278 RC outpatient 7662.5 7662.5 7662.5 57 4367.63 percent of total billed charges 7662.5 93 6206.63 percent of total billed charges 7662.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7662.5 other OPPS APC 7662.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7662.5 other OPPS APC 7662.5 51 3907.88 percent of total billed charges 7662.5 7662.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALIGNMENT PIN L 200 2.5MM SUP-97-03736 CDM 0272 RC outpatient 336 336 336 74 248.64 percent of total billed charges 336 93 272.16 percent of total billed charges 336 336 other OPPS APC 336 336 other OPPS APC 336 27.63 92.84 percent of total billed charges 336 336 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AEQUALIS PERFORM GLENOID KEELED M301 SUP-97-03737 CDM C1776 HCPCS 0278 RC outpatient 4310 4310 4310 57 2456.7 percent of total billed charges 4310 93 3491.1 percent of total billed charges 4310 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4310 other OPPS APC 4310 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4310 other OPPS APC 4310 51 2198.1 percent of total billed charges 4310 4310 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4MM VA LCK 18MM SCREWDRIVE SUP-97-03738 CDM C1713 HCPCS 0278 RC outpatient 432.25 432.25 432.25 57 246.38 percent of total billed charges 432.25 93 350.12 percent of total billed charges 432.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.25 other OPPS APC 432.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.25 other OPPS APC 432.25 51 220.45 percent of total billed charges 432.25 432.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4MM VA LCK 22MM SCREWDRIVE SUP-97-03739 CDM C1713 HCPCS 0278 RC outpatient 432.25 432.25 432.25 57 246.38 percent of total billed charges 432.25 93 350.12 percent of total billed charges 432.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.25 other OPPS APC 432.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.25 other OPPS APC 432.25 51 220.45 percent of total billed charges 432.25 432.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX SELF TAPPING 2.4 X 14MM SUP-97-03740 CDM C1713 HCPCS 0278 RC outpatient 210.63 210.63 210.63 57 120.06 percent of total billed charges 210.63 93 170.61 percent of total billed charges 210.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210.63 other OPPS APC 210.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210.63 other OPPS APC 210.63 51 107.42 percent of total billed charges 210.63 210.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MATRIX DERMAL ACELLUAR SUP-97-03741 CDM Q4100 HCPCS 0636 RC outpatient 5992 5992 5992 74 4434.08 percent of total billed charges 5992 93 4853.52 percent of total billed charges 5992 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5992 other OPPS APC 5992 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5992 other OPPS APC 5992 24.86 1489.61 percent of total billed charges 5992 5992 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TI END CAP T25 STRDRV HINDFOOT ARTHRO SUP-97-03742 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ANCHOR BIO CORKSCREW 5.5X15MM SUP-97-03743 CDM C1713 HCPCS 0278 RC outpatient 855 855 855 57 487.35 percent of total billed charges 855 93 692.55 percent of total billed charges 855 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 855 other OPPS APC 855 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 855 other OPPS APC 855 51 436.05 percent of total billed charges 855 855 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTR ANCH PEEK SWVLKC 4.75X19.1MM SUP-97-03744 CDM C1713 HCPCS 0278 RC outpatient 1125 1125 1125 57 641.25 percent of total billed charges 1125 93 911.25 percent of total billed charges 1125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1125 other OPPS APC 1125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1125 other OPPS APC 1125 51 573.75 percent of total billed charges 1125 1125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN STRAIGHT STEM EXT 18MM X 145MM SUP-97-03745 CDM C1776 HCPCS 0278 RC outpatient 2570.4 2570.4 2570.4 57 1465.13 percent of total billed charges 2570.4 93 2082.02 percent of total billed charges 2570.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2570.4 other OPPS APC 2570.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2570.4 other OPPS APC 2570.4 51 1310.9 percent of total billed charges 2570.4 2570.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN DISTAL PRECOAT AGMT SIZE F 5MM SUP-97-03746 CDM C1776 HCPCS 0278 RC outpatient 3109.38 3109.38 3109.38 57 1772.35 percent of total billed charges 3109.38 93 2518.6 percent of total billed charges 3109.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3109.38 other OPPS APC 3109.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3109.38 other OPPS APC 3109.38 51 1585.78 percent of total billed charges 3109.38 3109.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN PRECOAT POSTERIOR SIZE F 10MM SUP-97-03747 CDM C1776 HCPCS 0278 RC outpatient 3109.38 3109.38 3109.38 57 1772.35 percent of total billed charges 3109.38 93 2518.6 percent of total billed charges 3109.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3109.38 other OPPS APC 3109.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3109.38 other OPPS APC 3109.38 51 1585.78 percent of total billed charges 3109.38 3109.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN PRECOAT POSTERIOR SIZE F 5MM SUP-97-03748 CDM C1776 HCPCS 0278 RC outpatient 2289.6 2289.6 2289.6 57 1305.07 percent of total billed charges 2289.6 93 1854.58 percent of total billed charges 2289.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2289.6 other OPPS APC 2289.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2289.6 other OPPS APC 2289.6 51 1167.7 percent of total billed charges 2289.6 2289.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PT 6.5MM X 50 (20MM) SUP-97-03749 CDM C1713 HCPCS 0278 RC outpatient 740.16 740.16 740.16 57 421.89 percent of total billed charges 740.16 93 599.53 percent of total billed charges 740.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 740.16 other OPPS APC 740.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 740.16 other OPPS APC 740.16 51 377.48 percent of total billed charges 740.16 740.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI LM/RL TIBIAL AUGMENT SIZE 4 5MM SUP-97-03750 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI RM/LL TIBIAL AUGMENT SIZE 4 5MM SUP-97-03751 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TI SLEEVE FOR ALUMINA HEAD SUP-97-03752 CDM C1776 HCPCS 0278 RC outpatient 658.35 658.35 658.35 57 375.26 percent of total billed charges 658.35 93 533.26 percent of total billed charges 658.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 658.35 other OPPS APC 658.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 658.35 other OPPS APC 658.35 51 335.76 percent of total billed charges 658.35 658.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. C- TAPER BIOLOX DELTA HEAD 28MM/+2.5 SUP-97-03753 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONG NAIL KIT R1/5 TI RT 11 X320MM X 125 SUP-97-03754 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ANCHOR SWIVELOCK C 4.75 X 19.1 SUP-97-03756 CDM C1713 HCPCS 0278 RC outpatient 1200 1200 1200 57 684 percent of total billed charges 1200 93 972 percent of total billed charges 1200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1200 other OPPS APC 1200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1200 other OPPS APC 1200 51 612 percent of total billed charges 1200 1200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL NAIL 11 X 330MM T2 STANDARD SUP-97-03757 CDM C1713 HCPCS 0278 RC outpatient 2734.2 2734.2 2734.2 57 1558.49 percent of total billed charges 2734.2 93 2214.7 percent of total billed charges 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 51 1394.44 percent of total billed charges 2734.2 2734.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL NAIL 11 X 330MM T2 STANDARD SUP-97-03758 CDM C1713 HCPCS 0278 RC outpatient 2734.2 2734.2 2734.2 57 1558.49 percent of total billed charges 2734.2 93 2214.7 percent of total billed charges 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 51 1394.44 percent of total billed charges 2734.2 2734.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX SELF TAP 3.5MM X 24MM SUP-97-03759 CDM C1713 HCPCS 0278 RC outpatient 106.2 106.2 106.2 57 60.53 percent of total billed charges 106.2 93 86.02 percent of total billed charges 106.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.2 other OPPS APC 106.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.2 other OPPS APC 106.2 51 54.16 percent of total billed charges 106.2 106.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 3.5 10 HOLE 137MM LCP SUP-97-03760 CDM C1713 HCPCS 0278 RC outpatient 1173.51 1173.51 1173.51 57 668.9 percent of total billed charges 1173.51 93 950.54 percent of total billed charges 1173.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1173.51 other OPPS APC 1173.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1173.51 other OPPS APC 1173.51 51 598.49 percent of total billed charges 1173.51 1173.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN 4 X 42MM TI SUP-97-03761 CDM C1713 HCPCS 0278 RC outpatient 396.48 396.48 396.48 57 225.99 percent of total billed charges 396.48 93 321.15 percent of total billed charges 396.48 396.48 other OPPS APC 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 51 202.2 percent of total billed charges 396.48 396.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LT ARTHRODESIS ANKLE SUP-97-03762 CDM C1713 HCPCS 0278 RC outpatient 4845 4845 4845 57 2761.65 percent of total billed charges 4845 93 3924.45 percent of total billed charges 4845 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4845 other OPPS APC 4845 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4845 other OPPS APC 4845 51 2470.95 percent of total billed charges 4845 4845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 17.5D SUP-97-03763 CDM C1780 HCPCS 0278 RC outpatient 381.5 381.5 381.5 57 217.46 percent of total billed charges 381.5 93 309.02 percent of total billed charges 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 51 194.57 percent of total billed charges 381.5 381.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEN 12.5 (SND1T4) SUP-97-03764 CDM C1840 HCPCS 0278 RC outpatient 2687.85 2687.85 2687.85 57 1532.07 percent of total billed charges 2687.85 93 2177.16 percent of total billed charges 2687.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2687.85 other OPPS APC 2687.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2687.85 other OPPS APC 2687.85 51 1370.8 percent of total billed charges 2687.85 2687.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING SELF TAPPING 3.5 X 34MM SUP-97-03765 CDM C1713 HCPCS 0278 RC outpatient 472.89 472.89 472.89 57 269.55 percent of total billed charges 472.89 93 383.04 percent of total billed charges 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 51 241.17 percent of total billed charges 472.89 472.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONG NAIL KIT RT 3530-1380S SUP-97-03766 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2.7MM XXL VOLAR DR NARROW RI SUP-97-03767 CDM C1713 HCPCS 0278 RC outpatient 3931.25 3931.25 3931.25 57 2240.81 percent of total billed charges 3931.25 93 3184.31 percent of total billed charges 3931.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3931.25 other OPPS APC 3931.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3931.25 other OPPS APC 3931.25 51 2004.94 percent of total billed charges 3931.25 3931.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SUPERIOR LATERAL 3H/RT SUP-97-03768 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 30MM NON LOCKING SUP-97-03769 CDM C1713 HCPCS 0278 RC outpatient 264.6 264.6 264.6 57 150.82 percent of total billed charges 264.6 93 214.33 percent of total billed charges 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 51 134.95 percent of total billed charges 264.6 264.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 32MM NON LOCKING SUP-97-03770 CDM C1713 HCPCS 0278 RC outpatient 264.6 264.6 264.6 57 150.82 percent of total billed charges 264.6 93 214.33 percent of total billed charges 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 51 134.95 percent of total billed charges 264.6 264.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 34MM NON LOCKING SUP-97-03771 CDM C1713 HCPCS 0278 RC outpatient 264.6 264.6 264.6 57 150.82 percent of total billed charges 264.6 93 214.33 percent of total billed charges 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 51 134.95 percent of total billed charges 264.6 264.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 30MM LOCKING SUP-97-03772 CDM C1713 HCPCS 0278 RC outpatient 523.32 523.32 523.32 57 298.29 percent of total billed charges 523.32 93 423.89 percent of total billed charges 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 51 266.89 percent of total billed charges 523.32 523.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 32MM LOCKING SUP-97-03773 CDM C1713 HCPCS 0278 RC outpatient 523.32 523.32 523.32 57 298.29 percent of total billed charges 523.32 93 423.89 percent of total billed charges 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 51 266.89 percent of total billed charges 523.32 523.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 34MM LOCKING SUP-97-03774 CDM C1713 HCPCS 0278 RC outpatient 523.32 523.32 523.32 57 298.29 percent of total billed charges 523.32 93 423.89 percent of total billed charges 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 51 266.89 percent of total billed charges 523.32 523.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW LOCKING, T10, 3.5X12MM" SUP-97-03775 CDM C1713 HCPCS 0278 RC outpatient 475.02 475.02 475.02 57 270.76 percent of total billed charges 475.02 93 384.77 percent of total billed charges 475.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 475.02 other OPPS APC 475.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 475.02 other OPPS APC 475.02 51 242.26 percent of total billed charges 475.02 475.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 FULL THREAD 2.7MM X12MM NON LOCKING SUP-97-03776 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T10 FULL THREAD 2.7MM X 10MM SUP-97-03777 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS SNDIT3 12.5 SUP-97-03778 CDM C1780 HCPCS 0278 RC outpatient 2685 2685 2685 57 1530.45 percent of total billed charges 2685 93 2174.85 percent of total billed charges 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 51 1369.35 percent of total billed charges 2685 2685 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE, T10, 3.5X12MM" SUP-97-03779 CDM C1713 HCPCS 0278 RC outpatient 233.73 233.73 233.73 57 133.23 percent of total billed charges 233.73 93 189.32 percent of total billed charges 233.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 233.73 other OPPS APC 233.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 233.73 other OPPS APC 233.73 51 119.2 percent of total billed charges 233.73 233.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYMMETRIC PATELLA 29MMX8MM SUP-97-03780 CDM C1776 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LAPIDUS, GRAFT SPAN MEDIUM, FOR 10-12MM" SUP-97-03781 CDM C1713 HCPCS 0278 RC outpatient 4865.63 4865.63 4865.63 57 2773.41 percent of total billed charges 4865.63 93 3941.16 percent of total billed charges 4865.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4865.63 other OPPS APC 4865.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4865.63 other OPPS APC 4865.63 51 2481.47 percent of total billed charges 4865.63 4865.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CANNULATED, SHORT THREAD SCREW, HEADED," SUP-97-03782 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRAMEDULLARY IMPLANT SUP-97-03783 CDM C1713 HCPCS 0278 RC outpatient 2849.85 2849.85 2849.85 57 1624.41 percent of total billed charges 2849.85 93 2308.38 percent of total billed charges 2849.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2849.85 other OPPS APC 2849.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2849.85 other OPPS APC 2849.85 51 1453.42 percent of total billed charges 2849.85 2849.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONG NAIL KIT R1/5 TI LFT 11X340MM X125 SUP-97-03784 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5 X 65MM HEADLESS COMPRESSION SUP-97-03785 CDM C1713 HCPCS 0278 RC outpatient 1048.14 1048.14 1048.14 57 597.44 percent of total billed charges 1048.14 93 848.99 percent of total billed charges 1048.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1048.14 other OPPS APC 1048.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1048.14 other OPPS APC 1048.14 51 534.55 percent of total billed charges 1048.14 1048.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5 X 85MM HEADLESS COMPRESSION SUP-97-03786 CDM C1713 HCPCS 0278 RC outpatient 1048.14 1048.14 1048.14 57 597.44 percent of total billed charges 1048.14 93 848.99 percent of total billed charges 1048.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1048.14 other OPPS APC 1048.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1048.14 other OPPS APC 1048.14 51 534.55 percent of total billed charges 1048.14 1048.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 2.4MMX170MM SUP-97-03787 CDM C1713 HCPCS 0278 RC outpatient 1725 1725 1725 57 983.25 percent of total billed charges 1725 93 1397.25 percent of total billed charges 1725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1725 other OPPS APC 1725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1725 other OPPS APC 1725 51 879.75 percent of total billed charges 1725 1725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5.0MM X 26MM SUP-97-03788 CDM C1713 HCPCS 0278 RC outpatient 591.92 591.92 591.92 57 337.39 percent of total billed charges 591.92 93 479.46 percent of total billed charges 591.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 591.92 other OPPS APC 591.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 591.92 other OPPS APC 591.92 51 301.88 percent of total billed charges 591.92 591.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE PLUG SUP-97-03789 CDM C1713 HCPCS 0278 RC outpatient 413.63 413.63 413.63 57 235.77 percent of total billed charges 413.63 93 335.04 percent of total billed charges 413.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 413.63 other OPPS APC 413.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 413.63 other OPPS APC 413.63 51 210.95 percent of total billed charges 413.63 413.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG THREADED LOCKING 2.3MM X 14MM SUP-97-03790 CDM C1713 HCPCS 0278 RC outpatient 252 252 252 57 143.64 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 51 128.52 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG THREADED LOCKING 2.3MM X 17MM SUP-97-03791 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEUROMEND SUP-97-03792 CDM C9361 HCPCS 0278 RC outpatient 5272.5 5272.5 5272.5 57 3005.33 percent of total billed charges 5272.5 93 4270.73 percent of total billed charges 5272.5 5272.5 other OPPS APC 5272.5 5272.5 other OPPS APC 5272.5 51 2688.98 percent of total billed charges 5272.5 5272.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PINNACLE GRIPTION ACETABULAR SHELL 48 SUP-97-03793 CDM C1776 HCPCS 0278 RC outpatient 7051.5 7051.5 7051.5 57 4019.36 percent of total billed charges 7051.5 93 5711.72 percent of total billed charges 7051.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7051.5 other OPPS APC 7051.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7051.5 other OPPS APC 7051.5 51 3596.27 percent of total billed charges 7051.5 7051.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALTRX NEUT 32IDX48OD SUP-97-03794 CDM C1776 HCPCS 0278 RC outpatient 3645 3645 3645 57 2077.65 percent of total billed charges 3645 93 2952.45 percent of total billed charges 3645 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3645 other OPPS APC 3645 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3645 other OPPS APC 3645 51 1858.95 percent of total billed charges 3645 3645 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PINN CANN BONE SCREW SUP-97-03795 CDM C1776 HCPCS 0278 RC outpatient 407.4 407.4 407.4 57 232.22 percent of total billed charges 407.4 93 329.99 percent of total billed charges 407.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 407.4 other OPPS APC 407.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 407.4 other OPPS APC 407.4 51 207.77 percent of total billed charges 407.4 407.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTICUL/EZE BALL 32+5 BR SUP-97-03796 CDM C1776 HCPCS 0278 RC outpatient 2291.4 2291.4 2291.4 57 1306.1 percent of total billed charges 2291.4 93 1856.03 percent of total billed charges 2291.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2291.4 other OPPS APC 2291.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2291.4 other OPPS APC 2291.4 51 1168.61 percent of total billed charges 2291.4 2291.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBULA SEGMENT 101-150MM SUP-97-03797 CDM C1776 HCPCS 0278 RC outpatient 1466.25 1466.25 1466.25 57 835.76 percent of total billed charges 1466.25 93 1187.66 percent of total billed charges 1466.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1466.25 other OPPS APC 1466.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1466.25 other OPPS APC 1466.25 51 747.79 percent of total billed charges 1466.25 1466.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL AUGMENT HALF BLOCK SUP-97-03798 CDM C1776 HCPCS 0278 RC outpatient 2964 2964 2964 57 1689.48 percent of total billed charges 2964 93 2400.84 percent of total billed charges 2964 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2964 other OPPS APC 2964 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2964 other OPPS APC 2964 51 1511.64 percent of total billed charges 2964 2964 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL DISTAL AUGMENT RT SUP-97-03799 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOTAL STABILIZER FEMORAL COMPONENT SUP-97-03800 CDM C1776 HCPCS 0278 RC outpatient 12570.8 12570.8 12570.8 57 7165.36 percent of total billed charges 12570.8 93 10182.4 percent of total billed charges 12570.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12570.8 other OPPS APC 12570.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12570.8 other OPPS APC 12570.8 51 6411.11 percent of total billed charges 12570.8 12570.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL AUGMENT HALF BLOCK SUP-97-03801 CDM C1776 HCPCS 0278 RC outpatient 2964 2964 2964 57 1689.48 percent of total billed charges 2964 93 2400.84 percent of total billed charges 2964 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2964 other OPPS APC 2964 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2964 other OPPS APC 2964 51 1511.64 percent of total billed charges 2964 2964 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOTAL STABILIZER TIBIAL INSERT SUP-97-03802 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LCP 12 HOLES SUP-97-03803 CDM C1713 HCPCS 0278 RC outpatient 1060.2 1060.2 1060.2 57 604.31 percent of total billed charges 1060.2 93 858.76 percent of total billed charges 1060.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1060.2 other OPPS APC 1060.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1060.2 other OPPS APC 1060.2 51 540.7 percent of total billed charges 1060.2 1060.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 NON LCKNG 2.7MM X 22MM SUP-97-03804 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE NARROW LEFT 8 HOLES EXTRA SHORT SUP-97-03805 CDM C1713 HCPCS 0278 RC outpatient 2965.56 2965.56 2965.56 57 1690.37 percent of total billed charges 2965.56 93 2402.1 percent of total billed charges 2965.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2965.56 other OPPS APC 2965.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2965.56 other OPPS APC 2965.56 51 1512.44 percent of total billed charges 2965.56 2965.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOOT RING LONG 180 SUP-97-03806 CDM C1713 HCPCS 0278 RC outpatient 4060 4060 4060 57 2314.2 percent of total billed charges 4060 93 3288.6 percent of total billed charges 4060 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4060 other OPPS APC 4060 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4060 other OPPS APC 4060 51 2070.6 percent of total billed charges 4060 4060 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CIRCULAR RING 180 SUP-97-03807 CDM C1713 HCPCS 0278 RC outpatient 3178 3178 3178 57 1811.46 percent of total billed charges 3178 93 2574.18 percent of total billed charges 3178 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3178 other OPPS APC 3178 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3178 other OPPS APC 3178 51 1620.78 percent of total billed charges 3178 3178 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOOT ARCH 180 SUP-97-03808 CDM C1713 HCPCS 0278 RC outpatient 3530.8 3530.8 3530.8 57 2012.56 percent of total billed charges 3530.8 93 2859.95 percent of total billed charges 3530.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3530.8 other OPPS APC 3530.8 3530.8 other OPPS APC 3530.8 51 1800.71 percent of total billed charges 3530.8 3530.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THREADED ROD 200MM SUP-97-03809 CDM C1713 HCPCS 0278 RC outpatient 188 188 188 57 107.16 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 51 95.88 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THREADED ROD 60MM SUP-97-03810 CDM C1713 HCPCS 0278 RC outpatient 183.68 183.68 183.68 57 104.7 percent of total billed charges 183.68 93 148.78 percent of total billed charges 183.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 183.68 other OPPS APC 183.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 183.68 other OPPS APC 183.68 51 93.68 percent of total billed charges 183.68 183.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MG NUT LONG SUP-97-03811 CDM C1713 HCPCS 0278 RC outpatient 62.72 62.72 62.72 57 35.75 percent of total billed charges 62.72 93 50.8 percent of total billed charges 62.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.72 other OPPS APC 62.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.72 other OPPS APC 62.72 51 31.99 percent of total billed charges 62.72 62.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MG NUT SHORT SUP-97-03812 CDM C1713 HCPCS 0278 RC outpatient 60.48 60.48 60.48 57 34.47 percent of total billed charges 60.48 93 48.99 percent of total billed charges 60.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 60.48 other OPPS APC 60.48 60.48 other OPPS APC 60.48 51 30.84 percent of total billed charges 60.48 60.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TEESCOPE MEDIUM SUP-97-03813 CDM C1713 HCPCS 0278 RC outpatient 3221.4 3221.4 3221.4 57 1836.2 percent of total billed charges 3221.4 93 2609.33 percent of total billed charges 3221.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3221.4 other OPPS APC 3221.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3221.4 other OPPS APC 3221.4 51 1642.91 percent of total billed charges 3221.4 3221.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.8 SMOOTH WIRE SUP-97-03814 CDM C1713 HCPCS 0278 RC outpatient 237.16 237.16 237.16 57 135.18 percent of total billed charges 237.16 93 192.1 percent of total billed charges 237.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 237.16 other OPPS APC 237.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 237.16 other OPPS APC 237.16 51 120.95 percent of total billed charges 237.16 237.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE BOLT (SHORT) SUP-97-03815 CDM C1713 HCPCS 0278 RC outpatient 264.6 264.6 264.6 57 150.82 percent of total billed charges 264.6 93 214.33 percent of total billed charges 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 264.6 other OPPS APC 264.6 51 134.95 percent of total billed charges 264.6 264.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MB NUT (LONG) SUP-97-03816 CDM C1713 HCPCS 0278 RC outpatient 89.6 89.6 89.6 57 51.07 percent of total billed charges 89.6 93 72.58 percent of total billed charges 89.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 89.6 other OPPS APC 89.6 89.6 other OPPS APC 89.6 51 45.7 percent of total billed charges 89.6 89.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.5 WIRW OLIVE STOP SUP-97-03817 CDM C1713 HCPCS 0278 RC outpatient 288.12 288.12 288.12 57 164.23 percent of total billed charges 288.12 93 233.38 percent of total billed charges 288.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 288.12 other OPPS APC 288.12 288.12 other OPPS APC 288.12 51 146.94 percent of total billed charges 288.12 288.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.5 SMOOTH WIRE SUP-97-03818 CDM C1713 HCPCS 0278 RC outpatient 204.96 204.96 204.96 57 116.83 percent of total billed charges 204.96 93 166.02 percent of total billed charges 204.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 204.96 other OPPS APC 204.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 204.96 other OPPS APC 204.96 51 104.53 percent of total billed charges 204.96 204.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE BOLT OFFSET ADAPTER SUP-97-03819 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIVETAC JOINT SUP-97-03820 CDM C1713 HCPCS 0278 RC outpatient 925.68 925.68 925.68 57 527.64 percent of total billed charges 925.68 93 749.8 percent of total billed charges 925.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 925.68 other OPPS APC 925.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 925.68 other OPPS APC 925.68 51 472.1 percent of total billed charges 925.68 925.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HINGLE BOLT MEDIUM SUP-97-03821 CDM C1713 HCPCS 0278 RC outpatient 241.08 241.08 241.08 57 137.42 percent of total billed charges 241.08 93 195.27 percent of total billed charges 241.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.08 other OPPS APC 241.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.08 other OPPS APC 241.08 51 122.95 percent of total billed charges 241.08 241.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE BOLT MEDIUM SUP-97-03822 CDM C1713 HCPCS 0278 RC outpatient 264.6 264.6 264.6 57 150.82 percent of total billed charges 264.6 93 214.33 percent of total billed charges 264.6 264.6 other OPPS APC 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 51 134.95 percent of total billed charges 264.6 264.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE BOLT LONG SUP-97-03823 CDM C1713 HCPCS 0278 RC outpatient 264.6 264.6 264.6 57 150.82 percent of total billed charges 264.6 93 214.33 percent of total billed charges 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 51 134.95 percent of total billed charges 264.6 264.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LARGE ROCHER SHOE (LONG) SUP-97-03824 CDM 0272 RC outpatient 3302.6 3302.6 3302.6 74 2443.92 percent of total billed charges 3302.6 93 2675.11 percent of total billed charges 3302.6 3302.6 other OPPS APC 3302.6 3302.6 other OPPS APC 3302.6 27.63 912.51 percent of total billed charges 3302.6 3302.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL GAMMA3 S LEFT 10 X 340MM X125 SUP-97-03825 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL GAMMA3 S LEFT 10 X 400MM X125 SUP-97-03826 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL 10 X 420MM X 125 LEFT GAMMA LONG SUP-97-03827 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL GAMMA 3 S RT 10 X 340MM X 125 SUP-97-03828 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL GAMMA 3 S RT 10 X 400MM X 125 SUP-97-03829 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 4MM X 26MM SUP-97-03830 CDM C1713 HCPCS 0278 RC outpatient 594.34 594.34 594.34 57 338.77 percent of total billed charges 594.34 93 481.42 percent of total billed charges 594.34 594.34 other OPPS APC 594.34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 594.34 other OPPS APC 594.34 51 303.11 percent of total billed charges 594.34 594.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 4MM X 36MM SUP-97-03831 CDM C1713 HCPCS 0278 RC outpatient 404.25 404.25 404.25 57 230.42 percent of total billed charges 404.25 93 327.44 percent of total billed charges 404.25 404.25 other OPPS APC 404.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 404.25 other OPPS APC 404.25 51 206.17 percent of total billed charges 404.25 404.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 4MM X 50MM SUP-97-03832 CDM C1713 HCPCS 0278 RC outpatient 594.34 594.34 594.34 57 338.77 percent of total billed charges 594.34 93 481.42 percent of total billed charges 594.34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 594.34 other OPPS APC 594.34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 594.34 other OPPS APC 594.34 51 303.11 percent of total billed charges 594.34 594.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 27.5MM SUP-97-03834 CDM C1713 HCPCS 0278 RC outpatient 604.98 604.98 604.98 57 344.84 percent of total billed charges 604.98 93 490.03 percent of total billed charges 604.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.98 other OPPS APC 604.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.98 other OPPS APC 604.98 51 308.54 percent of total billed charges 604.98 604.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 90MM SUP-97-03835 CDM C1713 HCPCS 0278 RC outpatient 394.8 394.8 394.8 57 225.04 percent of total billed charges 394.8 93 319.79 percent of total billed charges 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 51 201.35 percent of total billed charges 394.8 394.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 100MM SUP-97-03836 CDM C1713 HCPCS 0278 RC outpatient 604.98 604.98 604.98 57 344.84 percent of total billed charges 604.98 93 490.03 percent of total billed charges 604.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.98 other OPPS APC 604.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.98 other OPPS APC 604.98 51 308.54 percent of total billed charges 604.98 604.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 115MM SUP-97-03837 CDM C1713 HCPCS 0278 RC outpatient 539 539 539 57 307.23 percent of total billed charges 539 93 436.59 percent of total billed charges 539 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 539 other OPPS APC 539 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 539 other OPPS APC 539 51 274.89 percent of total billed charges 539 539 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 104MM SUP-97-03838 CDM C1713 HCPCS 0278 RC outpatient 604.98 604.98 604.98 57 344.84 percent of total billed charges 604.98 93 490.03 percent of total billed charges 604.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.98 other OPPS APC 604.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.98 other OPPS APC 604.98 51 308.54 percent of total billed charges 604.98 604.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 110MM SUP-97-03839 CDM C1713 HCPCS 0278 RC outpatient 604.98 604.98 604.98 57 344.84 percent of total billed charges 604.98 93 490.03 percent of total billed charges 604.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.98 other OPPS APC 604.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.98 other OPPS APC 604.98 51 308.54 percent of total billed charges 604.98 604.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 5MM X 120MM SUP-97-03840 CDM C1713 HCPCS 0278 RC outpatient 539 539 539 57 307.23 percent of total billed charges 539 93 436.59 percent of total billed charges 539 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 539 other OPPS APC 539 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 539 other OPPS APC 539 51 274.89 percent of total billed charges 539 539 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TI CANN TFNA 11MM/130DEG 380MM LT SUP-97-03841 CDM C1713 HCPCS 0278 RC outpatient 6124.8 6124.8 6124.8 57 3491.14 percent of total billed charges 6124.8 93 4961.09 percent of total billed charges 6124.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6124.8 other OPPS APC 6124.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6124.8 other OPPS APC 6124.8 51 3123.65 percent of total billed charges 6124.8 6124.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN LONG THREAD 4MM X 54MM SUP-97-03842 CDM C1713 HCPCS 0278 RC outpatient 1056 1056 1056 57 601.92 percent of total billed charges 1056 93 855.36 percent of total billed charges 1056 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1056 other OPPS APC 1056 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1056 other OPPS APC 1056 51 538.56 percent of total billed charges 1056 1056 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LONG GAMMA RIGHT 11 X 400MM X 130DEGREE SUP-97-03843 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LISFRANC, DUAL RAY, 2ND & 3RD TMT PLATE" SUP-97-03844 CDM C1713 HCPCS 0278 RC outpatient 5700 5700 5700 57 3249 percent of total billed charges 5700 93 4617 percent of total billed charges 5700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5700 other OPPS APC 5700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5700 other OPPS APC 5700 51 2907 percent of total billed charges 5700 5700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON LOCKING SCREW 3.5X20 SUP-97-03845 CDM C1713 HCPCS 0278 RC outpatient 437.5 437.5 437.5 57 249.38 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 51 223.13 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NON-LOCKING PLATE SCREW, 2.7 X 18MM" SUP-97-03846 CDM C1713 HCPCS 0278 RC outpatient 420 420 420 57 239.4 percent of total billed charges 420 93 340.2 percent of total billed charges 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 51 214.2 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NON-LOCKING PLATE SCREW, 2.7 X 19MM" SUP-97-03847 CDM C1713 HCPCS 0278 RC outpatient 378 378 378 57 215.46 percent of total billed charges 378 93 306.18 percent of total billed charges 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 51 192.78 percent of total billed charges 378 378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LOCKING PLATE SCREW, 2.7 X 26MM" SUP-97-03848 CDM C1713 HCPCS 0278 RC outpatient 488.25 488.25 488.25 57 278.3 percent of total billed charges 488.25 93 395.48 percent of total billed charges 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 51 249.01 percent of total billed charges 488.25 488.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LOCKING PLATE SCREW, 2.7 X 24MM" SUP-97-03849 CDM C1713 HCPCS 0278 RC outpatient 488.25 488.25 488.25 57 278.3 percent of total billed charges 488.25 93 395.48 percent of total billed charges 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 51 249.01 percent of total billed charges 488.25 488.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI PRESS FIT STEM 18MMX 100MM SUP-97-03850 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 42MM SUP-97-03851 CDM C1713 HCPCS 0278 RC outpatient 412.3 412.3 412.3 57 235.01 percent of total billed charges 412.3 93 333.96 percent of total billed charges 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 51 210.27 percent of total billed charges 412.3 412.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN FULL THREAD 4.0 X 44MM SUP-97-03852 CDM C1713 HCPCS 0278 RC outpatient 106.4 106.4 106.4 57 60.65 percent of total billed charges 106.4 93 86.18 percent of total billed charges 106.4 106.4 other OPPS APC 106.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.4 other OPPS APC 106.4 51 54.26 percent of total billed charges 106.4 106.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN FULL THREAD 4.0 X 48MM SUP-97-03853 CDM C1713 HCPCS 0278 RC outpatient 106.4 106.4 106.4 57 60.65 percent of total billed charges 106.4 93 86.18 percent of total billed charges 106.4 106.4 other OPPS APC 106.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.4 other OPPS APC 106.4 51 54.26 percent of total billed charges 106.4 106.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CS INSERT SZ6 9MM SUP-97-03854 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI LAG 10.5 X 80MM SUP-97-03855 CDM C1713 HCPCS 0278 RC outpatient 1482.57 1482.57 1482.57 57 845.06 percent of total billed charges 1482.57 93 1200.88 percent of total billed charges 1482.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1482.57 other OPPS APC 1482.57 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1482.57 other OPPS APC 1482.57 51 756.11 percent of total billed charges 1482.57 1482.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROX LAT HUM 8 HOLE RT X 151MM SUP-97-03856 CDM C1713 HCPCS 0278 RC outpatient 4870.6 4870.6 4870.6 57 2776.24 percent of total billed charges 4870.6 93 3945.19 percent of total billed charges 4870.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4870.6 other OPPS APC 4870.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4870.6 other OPPS APC 4870.6 51 2484.01 percent of total billed charges 4870.6 4870.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER BLADEPATELLA W/ PILOT HOLE SZ51 SUP-97-03857 CDM 0272 RC outpatient 503.13 503.13 503.13 74 372.32 percent of total billed charges 503.13 93 407.54 percent of total billed charges 503.13 503.13 other OPPS APC 503.13 503.13 other OPPS APC 503.13 27.63 139.01 percent of total billed charges 503.13 503.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEAD TIP GD WIRE 2.6MMX80CM SUP-97-03859 CDM 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 297.5 other OPPS APC 297.5 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OFFSET END CAP 12X0MM SUP-97-03860 CDM C1713 HCPCS 0278 RC outpatient 490 490 490 57 279.3 percent of total billed charges 490 93 396.9 percent of total billed charges 490 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 51 249.9 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANKLE LOCKING NAIL 11X210MM SUP-97-03861 CDM C1713 HCPCS 0278 RC outpatient 6050 6050 6050 57 3448.5 percent of total billed charges 6050 93 4900.5 percent of total billed charges 6050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6050 other OPPS APC 6050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6050 other OPPS APC 6050 51 3085.5 percent of total billed charges 6050 6050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TI-DBLE LEAD CORT 5.0X40MM SCR SUP-97-03862 CDM C1713 HCPCS 0278 RC outpatient 665 665 665 57 379.05 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 51 339.15 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TI-DBLE LEAD CORT 5.0X28MM SCR SUP-97-03863 CDM C1713 HCPCS 0278 RC outpatient 665 665 665 57 379.05 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 51 339.15 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TI-DBLE LEAD CORT 5.0X75MM SCR SUP-97-03864 CDM C1713 HCPCS 0278 RC outpatient 665 665 665 57 379.05 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 51 339.15 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TI-DBLE LEAD CORT 5.0X7100MM SCR SUP-97-03865 CDM C1713 HCPCS 0278 RC outpatient 665 665 665 57 379.05 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 51 339.15 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE W/TROCAR 3.2X320 SUP-97-03866 CDM C1713 HCPCS 0278 RC outpatient 315 315 315 57 179.55 percent of total billed charges 315 93 255.15 percent of total billed charges 315 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 315 other OPPS APC 315 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 315 other OPPS APC 315 51 160.65 percent of total billed charges 315 315 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE TAP CANNULATED 4.5MM SUP-97-03867 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE TAP CANNULATED 5.5MM SUP-97-03868 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GD WIRE W TROCAR TIP SUP-97-03869 CDM C1713 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO PRO SCRW PT THD 5.5NNX 55MM SUP-97-03870 CDM C1713 HCPCS 0278 RC outpatient 2385 2385 2385 57 1359.45 percent of total billed charges 2385 93 1931.85 percent of total billed charges 2385 2385 other OPPS APC 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 51 1216.35 percent of total billed charges 2385 2385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE SCREW 2.4X22MM CORTEX SUP-97-03871 CDM C1713 HCPCS 0278 RC outpatient 437.5 437.5 437.5 57 249.38 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 51 223.13 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCREW 2.5 MICRO 24MM SUP-97-03872 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCREW 2.5 MICRO 30MM SUP-97-03873 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCREW 4.0 STD 40MM SUP-97-03874 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO- PRO SCRWTI 3.5MMX 26MM SUP-97-03875 CDM C1713 HCPCS 0278 RC outpatient 301 301 301 57 171.57 percent of total billed charges 301 93 243.81 percent of total billed charges 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 51 153.51 percent of total billed charges 301 301 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING SCREW TITANIUM 3.5MM 22MM SUP-97-03876 CDM C1713 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LISFRANC MEDIUM LEFT TI SUP-97-03877 CDM C1713 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON LOCKING SCREW 2.0X9 SUP-97-03878 CDM C1713 HCPCS 0278 RC outpatient 378 378 378 57 215.46 percent of total billed charges 378 93 306.18 percent of total billed charges 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 51 192.78 percent of total billed charges 378 378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON LOCKING SCREW 2.010 SUP-97-03879 CDM C1713 HCPCS 0278 RC outpatient 378 378 378 57 215.46 percent of total billed charges 378 93 306.18 percent of total billed charges 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 51 192.78 percent of total billed charges 378 378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING SCREW 2.0X10 SUP-97-03880 CDM C1713 HCPCS 0278 RC outpatient 488.25 488.25 488.25 57 278.3 percent of total billed charges 488.25 93 395.48 percent of total billed charges 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 488.25 other OPPS APC 488.25 51 249.01 percent of total billed charges 488.25 488.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON LOCKING SCREW 2.0X08 SUP-97-03881 CDM C1713 HCPCS 0278 RC outpatient 378 378 378 57 215.46 percent of total billed charges 378 93 306.18 percent of total billed charges 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 378 other OPPS APC 378 51 192.78 percent of total billed charges 378 378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE ZIGZAG 11 HOLE SUP-97-03882 CDM C1713 HCPCS 0278 RC outpatient 3178.13 3178.13 3178.13 57 1811.53 percent of total billed charges 3178.13 93 2574.29 percent of total billed charges 3178.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3178.13 other OPPS APC 3178.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3178.13 other OPPS APC 3178.13 51 1620.85 percent of total billed charges 3178.13 3178.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COCR MOD HEAD STD 36MM SUP-97-03883 CDM C1776 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPOLY 36MMRINGLC LNR HW SZ 24 SUP-97-03884 CDM C1776 HCPCS 0278 RC outpatient 4450 4450 4450 57 2536.5 percent of total billed charges 4450 93 3604.5 percent of total billed charges 4450 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4450 other OPPS APC 4450 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4450 other OPPS APC 4450 51 2269.5 percent of total billed charges 4450 4450 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPOLY 36MMRINGLC LNR HW SZ 24 SUP-97-03885 CDM C1776 HCPCS 0278 RC outpatient 5250 5250 5250 57 2992.5 percent of total billed charges 5250 93 4252.5 percent of total billed charges 5250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5250 other OPPS APC 5250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5250 other OPPS APC 5250 51 2677.5 percent of total billed charges 5250 5250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 MM LOCKING IM NAIL 5 SUP-97-03886 CDM C1713 HCPCS 0278 RC outpatient 604.45 604.45 604.45 57 344.54 percent of total billed charges 604.45 93 489.6 percent of total billed charges 604.45 604.45 other OPPS APC 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 51 308.27 percent of total billed charges 604.45 604.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PURAPLY AM -COM 1.6 SUP-97-03887 CDM Q4195 HCPCS 0636 RC outpatient 1350 1350 1350 74 999 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 1350 other OPPS APC 1350 1350 other OPPS APC 1350 24.86 335.61 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANTERIOR TIBIALS TENDON 9MM SUP-97-03889 CDM C1762 HCPCS 0278 RC outpatient 5750 5750 5750 57 3277.5 percent of total billed charges 5750 93 4657.5 percent of total billed charges 5750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5750 other OPPS APC 5750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5750 other OPPS APC 5750 51 2932.5 percent of total billed charges 5750 5750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL AO 4.2X260MM SUP-97-03890 CDM 0272 RC outpatient 3776.3 3776.3 3776.3 74 2794.46 percent of total billed charges 3776.3 93 3058.8 percent of total billed charges 3776.3 3776.3 other OPPS APC 3776.3 3776.3 other OPPS APC 3776.3 27.63 1043.39 percent of total billed charges 3776.3 3776.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ANKLE TALUS LEFT SUP-97-03891 CDM C1762 HCPCS 0278 RC outpatient 8220 8220 8220 57 4685.4 percent of total billed charges 8220 93 6658.2 percent of total billed charges 8220 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8220 other OPPS APC 8220 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8220 other OPPS APC 8220 51 4192.2 percent of total billed charges 8220 8220 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN THREAD 4.0MM/40MM SUP-97-03892 CDM C1713 HCPCS 0278 RC outpatient 139.48 139.48 139.48 57 79.5 percent of total billed charges 139.48 93 112.98 percent of total billed charges 139.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 139.48 other OPPS APC 139.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 139.48 other OPPS APC 139.48 51 71.13 percent of total billed charges 139.48 139.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX M STEM NUMBER 5 SUP-97-03893 CDM C1776 HCPCS 0278 RC outpatient 6000 6000 6000 57 3420 percent of total billed charges 6000 93 4860 percent of total billed charges 6000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6000 other OPPS APC 6000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6000 other OPPS APC 6000 51 3060 percent of total billed charges 6000 6000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "T-SPLITTER, 8 MM X 250 MM" SUP-97-03894 CDM C1776 HCPCS 0278 RC outpatient 2494.5 2494.5 2494.5 57 1421.87 percent of total billed charges 2494.5 93 2020.55 percent of total billed charges 2494.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2494.5 other OPPS APC 2494.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2494.5 other OPPS APC 2494.5 51 1272.2 percent of total billed charges 2494.5 2494.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON SYM CONE AUGMENT SIZE D SUP-97-03895 CDM C1776 HCPCS 0278 RC outpatient 8021.2 8021.2 8021.2 57 4572.08 percent of total billed charges 8021.2 93 6497.17 percent of total billed charges 8021.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8021.2 other OPPS APC 8021.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8021.2 other OPPS APC 8021.2 51 4090.81 percent of total billed charges 8021.2 8021.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NO.6 TRIATHLON TS PLUS TIBIAL INSERT 13MM SUP-97-03896 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2 HOLE 1/3 TUBULAR L23MM SUP-97-03897 CDM C1713 HCPCS 0278 RC outpatient 862.68 862.68 862.68 57 491.73 percent of total billed charges 862.68 93 698.77 percent of total billed charges 862.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 862.68 other OPPS APC 862.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 862.68 other OPPS APC 862.68 51 439.97 percent of total billed charges 862.68 862.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 20MM LOCKING SUP-97-03898 CDM C1713 HCPCS 0278 RC outpatient 523.32 523.32 523.32 57 298.29 percent of total billed charges 523.32 93 423.89 percent of total billed charges 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 51 266.89 percent of total billed charges 523.32 523.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 3 HOLE HOOK LCP 3.5MM SUP-97-03901 CDM C1713 HCPCS 0278 RC outpatient 1874.16 1874.16 1874.16 57 1068.27 percent of total billed charges 1874.16 93 1518.07 percent of total billed charges 1874.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1874.16 other OPPS APC 1874.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1874.16 other OPPS APC 1874.16 51 955.82 percent of total billed charges 1874.16 1874.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SPIRAL TI 60MM RETRO FEMORAL NAIL SUP-97-03902 CDM C1713 HCPCS 0278 RC outpatient 1522.95 1522.95 1522.95 57 868.08 percent of total billed charges 1522.95 93 1233.59 percent of total billed charges 1522.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1522.95 other OPPS APC 1522.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1522.95 other OPPS APC 1522.95 51 776.7 percent of total billed charges 1522.95 1522.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING TI 5.0MM W/25 STARDIVER 26 SUP-97-03903 CDM C1713 HCPCS 0278 RC outpatient 602.25 602.25 602.25 57 343.28 percent of total billed charges 602.25 93 487.82 percent of total billed charges 602.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 602.25 other OPPS APC 602.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 602.25 other OPPS APC 602.25 51 307.15 percent of total billed charges 602.25 602.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTHRODESIS HINDFOOT TI 10MM CANN NAIL SUP-97-03904 CDM C1713 HCPCS 0278 RC outpatient 3845.88 3845.88 3845.88 57 2192.15 percent of total billed charges 3845.88 93 3115.16 percent of total billed charges 3845.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3845.88 other OPPS APC 3845.88 3845.88 other OPPS APC 3845.88 51 1961.4 percent of total billed charges 3845.88 3845.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD 3.0X12 SUP-97-03905 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW, POLYAXIAL LOCKING, 2.5MM X 16MM" SUP-97-03906 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI PRESS FIT STEM 14MMX 100MM SUP-97-03907 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN TIBIAL AUGMENT 10MM SIZE 5 SUP-97-03908 CDM C1776 HCPCS 0278 RC outpatient 3109.38 3109.38 3109.38 57 1772.35 percent of total billed charges 3109.38 93 2518.6 percent of total billed charges 3109.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3109.38 other OPPS APC 3109.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3109.38 other OPPS APC 3109.38 51 1585.78 percent of total billed charges 3109.38 3109.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSN ASF CPS 10MM VE R 6-9 EF SUP-97-03909 CDM C1776 HCPCS 0278 RC outpatient 6250 6250 6250 57 3562.5 percent of total billed charges 6250 93 5062.5 percent of total billed charges 6250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6250 other OPPS APC 6250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6250 other OPPS APC 6250 51 3187.5 percent of total billed charges 6250 6250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL TRIATHLON INSERT-PSX3 SUP-97-03910 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE CONDYLAP CURVED4.5MM6HOLE 159MM SUP-97-03911 CDM C1713 HCPCS 0278 RC outpatient 4261.55 4261.55 4261.55 57 2429.08 percent of total billed charges 4261.55 93 3451.86 percent of total billed charges 4261.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4261.55 other OPPS APC 4261.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4261.55 other OPPS APC 4261.55 51 2173.39 percent of total billed charges 4261.55 4261.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING ANGLE VARIBLE 5.0MMX36MM SUP-97-03912 CDM C1713 HCPCS 0278 RC outpatient 627.69 627.69 627.69 57 357.78 percent of total billed charges 627.69 93 508.43 percent of total billed charges 627.69 627.69 other OPPS APC 627.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 627.69 other OPPS APC 627.69 51 320.12 percent of total billed charges 627.69 627.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING ANGLE VARIBLE 5.0MMX40MM SUP-97-03913 CDM C1713 HCPCS 0278 RC outpatient 627.69 627.69 627.69 57 357.78 percent of total billed charges 627.69 93 508.43 percent of total billed charges 627.69 627.69 other OPPS APC 627.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 627.69 other OPPS APC 627.69 51 320.12 percent of total billed charges 627.69 627.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING ANGLE VARIBLE 5.0MMX42MM SUP-97-03914 CDM C1713 HCPCS 0278 RC outpatient 627.69 627.69 627.69 57 357.78 percent of total billed charges 627.69 93 508.43 percent of total billed charges 627.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 627.69 other OPPS APC 627.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 627.69 other OPPS APC 627.69 51 320.12 percent of total billed charges 627.69 627.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING ANGLE VARIBLE 5.0MMX55MM SUP-97-03915 CDM C1713 HCPCS 0278 RC outpatient 627.69 627.69 627.69 57 357.78 percent of total billed charges 627.69 93 508.43 percent of total billed charges 627.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 627.69 other OPPS APC 627.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 627.69 other OPPS APC 627.69 51 320.12 percent of total billed charges 627.69 627.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING ANGLE VARIBLE 5.0MMX65MM SUP-97-03916 CDM C1713 HCPCS 0278 RC outpatient 627.69 627.69 627.69 57 357.78 percent of total billed charges 627.69 93 508.43 percent of total billed charges 627.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 627.69 other OPPS APC 627.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 627.69 other OPPS APC 627.69 51 320.12 percent of total billed charges 627.69 627.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING ANGLE VARIBLE 5.0MMX70MM SUP-97-03917 CDM C1713 HCPCS 0278 RC outpatient 627.69 627.69 627.69 57 357.78 percent of total billed charges 627.69 93 508.43 percent of total billed charges 627.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 627.69 other OPPS APC 627.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 627.69 other OPPS APC 627.69 51 320.12 percent of total billed charges 627.69 627.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING ANGLE VARIBLE 5.0MMX80MM SUP-97-03918 CDM C1713 HCPCS 0278 RC outpatient 627.69 627.69 627.69 57 357.78 percent of total billed charges 627.69 93 508.43 percent of total billed charges 627.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 627.69 other OPPS APC 627.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 627.69 other OPPS APC 627.69 51 320.12 percent of total billed charges 627.69 627.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING CANNULATED 5.0MMX65MM SUP-97-03919 CDM C1713 HCPCS 0278 RC outpatient 730.62 730.62 730.62 57 416.45 percent of total billed charges 730.62 93 591.8 percent of total billed charges 730.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 730.62 other OPPS APC 730.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 730.62 other OPPS APC 730.62 51 372.62 percent of total billed charges 730.62 730.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING CANNULATED 5.0MMX75MM SUP-97-03920 CDM C1713 HCPCS 0278 RC outpatient 730.62 730.62 730.62 57 416.45 percent of total billed charges 730.62 93 591.8 percent of total billed charges 730.62 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 730.62 other OPPS APC 730.62 730.62 other OPPS APC 730.62 51 372.62 percent of total billed charges 730.62 730.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LOW PROFILE SCREW, TI, 4.5 X 26MM" SUP-97-03921 CDM C1713 HCPCS 0278 RC outpatient 262.5 262.5 262.5 57 149.63 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 51 133.88 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LOW PROFILE SCREW, TI, 4.5 X 32MM" SUP-97-03922 CDM C1713 HCPCS 0278 RC outpatient 262.5 262.5 262.5 57 149.63 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 51 133.88 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LOW PROFILE SCREW, TI, 4.5 X 36MM" SUP-97-03923 CDM C1713 HCPCS 0278 RC outpatient 262.5 262.5 262.5 57 149.63 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 51 133.88 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LOW PROFILE SCREW, TI, 4.5 X 38MM" SUP-97-03924 CDM C1713 HCPCS 0278 RC outpatient 262.5 262.5 262.5 57 149.63 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 51 133.88 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LOW PROFILE SCREW, TI, 4.5 X 40MM" SUP-97-03925 CDM C1713 HCPCS 0278 RC outpatient 262.5 262.5 262.5 57 149.63 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 51 133.88 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LOW PROFILE SCREW, TI, 4.5 X 45MM" SUP-97-03926 CDM C1713 HCPCS 0278 RC outpatient 262.5 262.5 262.5 57 149.63 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 51 133.88 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO-PRO LOCK SCRW TI 4.5X26MM SUP-97-03927 CDM C1713 HCPCS 0278 RC outpatient 682.5 682.5 682.5 57 389.03 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 51 348.08 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO-PRO LOCK SCRW TI 4.5X34MM SUP-97-03928 CDM C1713 HCPCS 0278 RC outpatient 682.5 682.5 682.5 57 389.03 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 51 348.08 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO-PRO LOCK SCRW TI 4.5X38MM SUP-97-03929 CDM C1713 HCPCS 0278 RC outpatient 682.5 682.5 682.5 57 389.03 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 51 348.08 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS COMP SCREW 6.5XX100MM CANN SUP-97-03930 CDM C1713 HCPCS 0278 RC outpatient 1725 1725 1725 57 983.25 percent of total billed charges 1725 93 1397.25 percent of total billed charges 1725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1725 other OPPS APC 1725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1725 other OPPS APC 1725 51 879.75 percent of total billed charges 1725 1725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO-PRO LOCK SCRW TI 4.5X40MM SUP-97-03931 CDM C1713 HCPCS 0278 RC outpatient 682.5 682.5 682.5 57 389.03 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 51 348.08 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LARGE BB-TAK SUP-97-03932 CDM C1713 HCPCS 0278 RC outpatient 472.5 472.5 472.5 57 269.33 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 51 240.98 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 3.5MM X 124MM 9 HOLE SUP-97-03933 CDM C1713 HCPCS 0278 RC outpatient 1139.88 1139.88 1139.88 57 649.73 percent of total billed charges 1139.88 93 923.3 percent of total billed charges 1139.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1139.88 other OPPS APC 1139.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1139.88 other OPPS APC 1139.88 51 581.34 percent of total billed charges 1139.88 1139.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN BLOCK TIBIAL AUGMENT 10MM SZ 7 SUP-97-03935 CDM C1776 HCPCS 0278 RC outpatient 4031.25 4031.25 4031.25 57 2297.81 percent of total billed charges 4031.25 93 3265.31 percent of total billed charges 4031.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4031.25 other OPPS APC 4031.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4031.25 other OPPS APC 4031.25 51 2055.94 percent of total billed charges 4031.25 4031.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN OFFSET STEM EXT 13MM X 145MM SUP-97-03936 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK ART SURF EF 7-10 STR BLUE SUP-97-03937 CDM C1776 HCPCS 0278 RC outpatient 6687.5 6687.5 6687.5 57 3811.88 percent of total billed charges 6687.5 93 5416.88 percent of total billed charges 6687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6687.5 other OPPS APC 6687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6687.5 other OPPS APC 6687.5 51 3410.63 percent of total billed charges 6687.5 6687.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HELICAL BLADE 85MM TFNA SUP-97-03939 CDM C1713 HCPCS 0278 RC outpatient 2272.68 2272.68 2272.68 57 1295.43 percent of total billed charges 2272.68 93 1840.87 percent of total billed charges 2272.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2272.68 other OPPS APC 2272.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2272.68 other OPPS APC 2272.68 51 1159.07 percent of total billed charges 2272.68 2272.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN LONG THREAD 4MM X 52MM SUP-97-03940 CDM C1713 HCPCS 0278 RC outpatient 676.76 676.76 676.76 57 385.75 percent of total billed charges 676.76 93 548.18 percent of total billed charges 676.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 676.76 other OPPS APC 676.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 676.76 other OPPS APC 676.76 51 345.15 percent of total billed charges 676.76 676.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TROCANTERIC GAMMA 3 10 X 170MM X 130 DEGREE SUP-97-03941 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL GAMMA 3 S RT 10 X 360MM X 125 SUP-97-03942 CDM C1713 HCPCS 0278 RC outpatient 4747.6 4747.6 4747.6 57 2706.13 percent of total billed charges 4747.6 93 3845.56 percent of total billed charges 4747.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4747.6 other OPPS APC 4747.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4747.6 other OPPS APC 4747.6 51 2421.28 percent of total billed charges 4747.6 4747.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LONG KIT R1 5 TI LEFT11X440MMX130 SUP-97-03943 CDM C1713 HCPCS 0278 RC outpatient 4747.6 4747.6 4747.6 57 2706.13 percent of total billed charges 4747.6 93 3845.56 percent of total billed charges 4747.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4747.6 other OPPS APC 4747.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4747.6 other OPPS APC 4747.6 51 2421.28 percent of total billed charges 4747.6 4747.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HRIS FLEXIBLE OSTEO 8X80MM SUP-97-03944 CDM 0272 RC outpatient 1081.5 1081.5 1081.5 74 800.31 percent of total billed charges 1081.5 93 876.02 percent of total billed charges 1081.5 1081.5 other OPPS APC 1081.5 1081.5 other OPPS APC 1081.5 27.63 298.82 percent of total billed charges 1081.5 1081.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NITINOL PILOT WIRE SUP-97-03945 CDM 0272 RC outpatient 120 120 120 74 88.8 percent of total billed charges 120 93 97.2 percent of total billed charges 120 120 other OPPS APC 120 120 other OPPS APC 120 27.63 33.16 percent of total billed charges 120 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERIPHERAL SCREW 4.5MMX28MM SUP-97-03946 CDM C1713 HCPCS 0278 RC outpatient 100 100 100 57 57 percent of total billed charges 100 93 81 percent of total billed charges 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 51 51 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HUMERAL FRACTURE STEM 10MMX123MM SUP-97-03947 CDM C1713 HCPCS 0278 RC outpatient 7500 7500 7500 57 4275 percent of total billed charges 7500 93 6075 percent of total billed charges 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 51 3825 percent of total billed charges 7500 7500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL HUMERAL 09X270MM SUP-97-03948 CDM C1713 HCPCS 0278 RC outpatient 3184.35 3184.35 3184.35 57 1815.08 percent of total billed charges 3184.35 93 2579.32 percent of total billed charges 3184.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3184.35 other OPPS APC 3184.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3184.35 other OPPS APC 3184.35 51 1624.02 percent of total billed charges 3184.35 3184.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW F/T LOCKING 4MM X 40MM SUP-97-03949 CDM C1713 HCPCS 0278 RC outpatient 571.55 571.55 571.55 57 325.78 percent of total billed charges 571.55 93 462.96 percent of total billed charges 571.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 571.55 other OPPS APC 571.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 571.55 other OPPS APC 571.55 51 291.49 percent of total billed charges 571.55 571.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDCAP 6MMX10MM SUP-97-03950 CDM C1713 HCPCS 0278 RC outpatient 534.52 534.52 534.52 57 304.68 percent of total billed charges 534.52 93 432.96 percent of total billed charges 534.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 534.52 other OPPS APC 534.52 534.52 other OPPS APC 534.52 51 272.61 percent of total billed charges 534.52 534.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI LAG 10.5 X 115MM SUP-97-03951 CDM C1713 HCPCS 0278 RC outpatient 1354.32 1354.32 1354.32 57 771.96 percent of total billed charges 1354.32 93 1097 percent of total billed charges 1354.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1354.32 other OPPS APC 1354.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1354.32 other OPPS APC 1354.32 51 690.7 percent of total billed charges 1354.32 1354.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI ST CORT CANN 3.O 22MM SELF TAP SUP-97-03952 CDM C1713 HCPCS 0278 RC outpatient 684.5 684.5 684.5 57 390.17 percent of total billed charges 684.5 93 554.45 percent of total billed charges 684.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 684.5 other OPPS APC 684.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 684.5 other OPPS APC 684.5 51 349.1 percent of total billed charges 684.5 684.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONGEVITY ELEVATED LINER II 36X52 SUP-97-03953 CDM C1776 HCPCS 0278 RC outpatient 4093.75 4093.75 4093.75 57 2333.44 percent of total billed charges 4093.75 93 3315.94 percent of total billed charges 4093.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4093.75 other OPPS APC 4093.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4093.75 other OPPS APC 4093.75 51 2087.81 percent of total billed charges 4093.75 4093.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW GAP PLATE SUP-97-03954 CDM C1776 HCPCS 0278 RC outpatient 429.8 429.8 429.8 57 244.99 percent of total billed charges 429.8 93 348.14 percent of total billed charges 429.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 429.8 other OPPS APC 429.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 429.8 other OPPS APC 429.8 51 219.2 percent of total billed charges 429.8 429.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW GAP PLATE SUP-97-03955 CDM C1776 HCPCS 0278 RC outpatient 429.8 429.8 429.8 57 244.99 percent of total billed charges 429.8 93 348.14 percent of total billed charges 429.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 429.8 other OPPS APC 429.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 429.8 other OPPS APC 429.8 51 219.2 percent of total billed charges 429.8 429.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW GAP PLATE SUP-97-03956 CDM C1776 HCPCS 0278 RC outpatient 429.8 429.8 429.8 57 244.99 percent of total billed charges 429.8 93 348.14 percent of total billed charges 429.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 429.8 other OPPS APC 429.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 429.8 other OPPS APC 429.8 51 219.2 percent of total billed charges 429.8 429.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REST MOD CONICAL DISTAL STEM 18MMX155MM SUP-97-03957 CDM C1776 HCPCS 0278 RC outpatient 7228 7228 7228 57 4119.96 percent of total billed charges 7228 93 5854.68 percent of total billed charges 7228 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7228 other OPPS APC 7228 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7228 other OPPS APC 7228 51 3686.28 percent of total billed charges 7228 7228 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING SCREW 3.5X22 SUP-97-03958 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING SCREW 3.5X24 SUP-97-03959 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 26MM LOCKING SUP-97-03960 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON-LOCKING SCREW 3.5X26 SUP-97-03961 CDM C1713 HCPCS 0278 RC outpatient 420 420 420 57 239.4 percent of total billed charges 420 93 340.2 percent of total billed charges 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 51 214.2 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON-LOCKING SCREW 3.5X24 SUP-97-03962 CDM C1713 HCPCS 0278 RC outpatient 437.5 437.5 437.5 57 249.38 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 51 223.13 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LISFRAN RIGHT SM 1&2TMT DUAL RAY SUP-97-03963 CDM C1713 HCPCS 0278 RC outpatient 5700 5700 5700 57 3249 percent of total billed charges 5700 93 4617 percent of total billed charges 5700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5700 other OPPS APC 5700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5700 other OPPS APC 5700 51 2907 percent of total billed charges 5700 5700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RREST MOD CONICAL DISTAL STEM15MMX155MM SUP-97-03964 CDM C1776 HCPCS 0278 RC outpatient 7228 7228 7228 57 4119.96 percent of total billed charges 7228 93 5854.68 percent of total billed charges 7228 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7228 other OPPS APC 7228 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7228 other OPPS APC 7228 51 3686.28 percent of total billed charges 7228 7228 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T10 2.7X12MM SUP-97-03966 CDM C1713 HCPCS 0278 RC outpatient 452.76 452.76 452.76 57 258.07 percent of total billed charges 452.76 93 366.74 percent of total billed charges 452.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 452.76 other OPPS APC 452.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 452.76 other OPPS APC 452.76 51 230.91 percent of total billed charges 452.76 452.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW LOCKING, T10, 2.7X14MM" SUP-97-03967 CDM C1713 HCPCS 0278 RC outpatient 452.76 452.76 452.76 57 258.07 percent of total billed charges 452.76 93 366.74 percent of total billed charges 452.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 452.76 other OPPS APC 452.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 452.76 other OPPS APC 452.76 51 230.91 percent of total billed charges 452.76 452.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW LOCKING, T10, 2.7X16MM" SUP-97-03968 CDM C1713 HCPCS 0278 RC outpatient 452.76 452.76 452.76 57 258.07 percent of total billed charges 452.76 93 366.74 percent of total billed charges 452.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 452.76 other OPPS APC 452.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 452.76 other OPPS APC 452.76 51 230.91 percent of total billed charges 452.76 452.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE, T10, 3.5X14MM" SUP-97-03969 CDM C1713 HCPCS 0278 RC outpatient 233.73 233.73 233.73 57 133.23 percent of total billed charges 233.73 93 189.32 percent of total billed charges 233.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 233.73 other OPPS APC 233.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 233.73 other OPPS APC 233.73 51 119.2 percent of total billed charges 233.73 233.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW BONE, T10, 3.5X14MM" SUP-97-03970 CDM C1713 HCPCS 0278 RC outpatient 233.73 233.73 233.73 57 133.23 percent of total billed charges 233.73 93 189.32 percent of total billed charges 233.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 233.73 other OPPS APC 233.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 233.73 other OPPS APC 233.73 51 119.2 percent of total billed charges 233.73 233.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLAR COMPONENT SUP-97-03971 CDM C1776 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REST MOD CONICAL DISTAL STEM 19X15MM SUP-97-03972 CDM C1776 HCPCS 0278 RC outpatient 7228 7228 7228 57 4119.96 percent of total billed charges 7228 93 5854.68 percent of total billed charges 7228 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7228 other OPPS APC 7228 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7228 other OPPS APC 7228 51 3686.28 percent of total billed charges 7228 7228 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED HUMERAL NAIL 7MM EX/260MM SUP-97-03973 CDM C1713 HCPCS 0278 RC outpatient 4112.63 4112.63 4112.63 57 2344.2 percent of total billed charges 4112.63 93 3331.23 percent of total billed charges 4112.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4112.63 other OPPS APC 4112.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4112.63 other OPPS APC 4112.63 51 2097.44 percent of total billed charges 4112.63 4112.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP T25 STRDRV OMM EXHUMERAJ NAIL SUP-97-03975 CDM C1713 HCPCS 0278 RC outpatient 462 462 462 57 263.34 percent of total billed charges 462 93 374.22 percent of total billed charges 462 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 462 other OPPS APC 462 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 462 other OPPS APC 462 51 235.62 percent of total billed charges 462 462 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0MM LOCKING SCREW 22MM SUP-97-03976 CDM C1713 HCPCS 0278 RC outpatient 604.45 604.45 604.45 57 344.54 percent of total billed charges 604.45 93 489.6 percent of total billed charges 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 51 308.27 percent of total billed charges 604.45 604.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0MM LOCKING SCREW 22MM SUP-97-03977 CDM C1713 HCPCS 0278 RC outpatient 604.45 604.45 604.45 57 344.54 percent of total billed charges 604.45 93 489.6 percent of total billed charges 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 51 308.27 percent of total billed charges 604.45 604.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOTOCLIP IMPLANT KIT SUP-97-03978 CDM C1713 HCPCS 0278 RC outpatient 3187.5 3187.5 3187.5 57 1816.88 percent of total billed charges 3187.5 93 2581.88 percent of total billed charges 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 51 1625.63 percent of total billed charges 3187.5 3187.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOTOCLIP SUPER ELASTIC IMPLANT 20MMX20 SUP-97-03979 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SWVLK TENE BIO COMP 7X19.5 MM SUP-97-03980 CDM C1713 HCPCS 0278 RC outpatient 1866 1866 1866 57 1063.62 percent of total billed charges 1866 93 1511.46 percent of total billed charges 1866 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1866 other OPPS APC 1866 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1866 other OPPS APC 1866 51 951.66 percent of total billed charges 1866 1866 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERC INSERT KIT 3.0MM KNOTLESS ST SUP-97-03981 CDM 0272 RC outpatient 1065 1065 1065 74 788.1 percent of total billed charges 1065 93 862.65 percent of total billed charges 1065 1065 other OPPS APC 1065 1065 other OPPS APC 1065 27.63 294.26 percent of total billed charges 1065 1065 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.9MM KNOTLESS CORKSCREW PEEK SUP-97-03982 CDM C1713 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LONG THREAD HEADLESS 4.0X46 SUP-97-03983 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIO COMPOSITE SWIVEL CLD 5.5X19.1MM SUP-97-03984 CDM C1713 HCPCS 0278 RC outpatient 1716 1716 1716 57 978.12 percent of total billed charges 1716 93 1389.96 percent of total billed charges 1716 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1716 other OPPS APC 1716 1716 other OPPS APC 1716 51 875.16 percent of total billed charges 1716 1716 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD HEADLESS 7.0X84 SUP-97-03985 CDM C1713 HCPCS 0278 RC outpatient 1942.5 1942.5 1942.5 57 1107.23 percent of total billed charges 1942.5 93 1573.43 percent of total billed charges 1942.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1942.5 other OPPS APC 1942.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1942.5 other OPPS APC 1942.5 51 990.68 percent of total billed charges 1942.5 1942.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHORT THREAD HEADLESS 7.0X84 SUP-97-03986 CDM C1713 HCPCS 0278 RC outpatient 1942.5 1942.5 1942.5 57 1107.23 percent of total billed charges 1942.5 93 1573.43 percent of total billed charges 1942.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1942.5 other OPPS APC 1942.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1942.5 other OPPS APC 1942.5 51 990.68 percent of total billed charges 1942.5 1942.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 MM LOCKING 38MM FOR NAIL SUP-97-03987 CDM C1713 HCPCS 0278 RC outpatient 602 602 602 57 343.14 percent of total billed charges 602 93 487.62 percent of total billed charges 602 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 602 other OPPS APC 602 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 602 other OPPS APC 602 51 307.02 percent of total billed charges 602 602 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 MM LOCKING 30MM FOR NAIL SUP-97-03988 CDM C1713 HCPCS 0278 RC outpatient 602 602 602 57 343.14 percent of total billed charges 602 93 487.62 percent of total billed charges 602 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 602 other OPPS APC 602 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 602 other OPPS APC 602 51 307.02 percent of total billed charges 602 602 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 MMX 46 LOCKING IM NAIL 4 SUP-97-03989 CDM C1713 HCPCS 0278 RC outpatient 604.45 604.45 604.45 57 344.54 percent of total billed charges 604.45 93 489.6 percent of total billed charges 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 51 308.27 percent of total billed charges 604.45 604.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG HIGH COMPRESSION 2.7MM X 24MM SUP-97-03990 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG HIGH COMPRESSION 2.7MM X 26MM SUP-97-03991 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROFYLE/S T 90A REG 7H SUP-97-03992 CDM C1713 HCPCS 0278 RC outpatient 715.5 715.5 715.5 57 407.84 percent of total billed charges 715.5 93 579.56 percent of total billed charges 715.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 715.5 other OPPS APC 715.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 715.5 other OPPS APC 715.5 51 364.91 percent of total billed charges 715.5 715.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX MC5 LOCKING 5 HOLE RIGHT 2.3MM SUP-97-03993 CDM C1713 HCPCS 0278 RC outpatient 1686.36 1686.36 1686.36 57 961.23 percent of total billed charges 1686.36 93 1365.95 percent of total billed charges 1686.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1686.36 other OPPS APC 1686.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1686.36 other OPPS APC 1686.36 51 860.04 percent of total billed charges 1686.36 1686.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NON LOK CRSSPIN ST 2.3 X 6MM SUP-97-03994 CDM C1713 HCPCS 0278 RC outpatient 245.49 245.49 245.49 57 139.93 percent of total billed charges 245.49 93 198.85 percent of total billed charges 245.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 245.49 other OPPS APC 245.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 245.49 other OPPS APC 245.49 51 125.2 percent of total billed charges 245.49 245.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCKG CRSSPIN ST 2.3 X 6MM SUP-97-03995 CDM C1713 HCPCS 0278 RC outpatient 318.99 318.99 318.99 57 181.82 percent of total billed charges 318.99 93 258.38 percent of total billed charges 318.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 318.99 other OPPS APC 318.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 318.99 other OPPS APC 318.99 51 162.68 percent of total billed charges 318.99 318.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAT DISTAL FIBULA PLATE 4H/ RT 2.7X3.5MM SUP-97-03996 CDM C1713 HCPCS 0278 RC outpatient 1843.38 1843.38 1843.38 57 1050.73 percent of total billed charges 1843.38 93 1493.14 percent of total billed charges 1843.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1843.38 other OPPS APC 1843.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1843.38 other OPPS APC 1843.38 51 940.12 percent of total billed charges 1843.38 1843.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LCP POSTLAT DISTAL FIBULA PLATE 5H/ SUP-97-03997 CDM C1713 HCPCS 0278 RC outpatient 1932.3 1932.3 1932.3 57 1101.41 percent of total billed charges 1932.3 93 1565.16 percent of total billed charges 1932.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1932.3 other OPPS APC 1932.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1932.3 other OPPS APC 1932.3 51 985.47 percent of total billed charges 1932.3 1932.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 26MM SUP-97-03998 CDM C1713 HCPCS 0278 RC outpatient 412.3 412.3 412.3 57 235.01 percent of total billed charges 412.3 93 333.96 percent of total billed charges 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 51 210.27 percent of total billed charges 412.3 412.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LCP RECON 3.5 MM 8 HOLES SUP-97-04000 CDM C1713 HCPCS 0278 RC outpatient 1583.46 1583.46 1583.46 57 902.57 percent of total billed charges 1583.46 93 1282.6 percent of total billed charges 1583.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1583.46 other OPPS APC 1583.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1583.46 other OPPS APC 1583.46 51 807.56 percent of total billed charges 1583.46 1583.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LCP RECON 3.5 MM 10 HOLES SUP-97-04001 CDM C1713 HCPCS 0278 RC outpatient 1641.6 1641.6 1641.6 57 935.71 percent of total billed charges 1641.6 93 1329.7 percent of total billed charges 1641.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1641.6 other OPPS APC 1641.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1641.6 other OPPS APC 1641.6 51 837.22 percent of total billed charges 1641.6 1641.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NO.4 TRIATHLON TS PLUS TIBIAL INSERT X3 SUP-97-04002 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LCP RECON 3.5 MM 6 HOLES SUP-97-04004 CDM C1713 HCPCS 0278 RC outpatient 1446.66 1446.66 1446.66 57 824.6 percent of total billed charges 1446.66 93 1171.79 percent of total billed charges 1446.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1446.66 other OPPS APC 1446.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1446.66 other OPPS APC 1446.66 51 737.8 percent of total billed charges 1446.66 1446.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROFYLE/S 3-D 4X2 HOLE SUP-97-04005 CDM C1713 HCPCS 0278 RC outpatient 1000.35 1000.35 1000.35 57 570.2 percent of total billed charges 1000.35 93 810.28 percent of total billed charges 1000.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1000.35 other OPPS APC 1000.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1000.35 other OPPS APC 1000.35 51 510.18 percent of total billed charges 1000.35 1000.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1.7 X 6MM CROSSPIN ST SUP-97-04006 CDM C1713 HCPCS 0278 RC outpatient 244.02 244.02 244.02 57 139.09 percent of total billed charges 244.02 93 197.66 percent of total billed charges 244.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 244.02 other OPPS APC 244.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 244.02 other OPPS APC 244.02 51 124.45 percent of total billed charges 244.02 244.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1.7 X 7MM CROSSPIN ST SUP-97-04007 CDM C1713 HCPCS 0278 RC outpatient 244.02 244.02 244.02 57 139.09 percent of total billed charges 244.02 93 197.66 percent of total billed charges 244.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 244.02 other OPPS APC 244.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 244.02 other OPPS APC 244.02 51 124.45 percent of total billed charges 244.02 244.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1.7 X 8MM CROSSPIN ST SUP-97-04008 CDM C1713 HCPCS 0278 RC outpatient 261.66 261.66 261.66 57 149.15 percent of total billed charges 261.66 93 211.94 percent of total billed charges 261.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 261.66 other OPPS APC 261.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 261.66 other OPPS APC 261.66 51 133.45 percent of total billed charges 261.66 261.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1.4 X 3MM CROSSPIN LEFT SUP-97-04009 CDM C1713 HCPCS 0278 RC outpatient 244.02 244.02 244.02 57 139.09 percent of total billed charges 244.02 93 197.66 percent of total billed charges 244.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 244.02 other OPPS APC 244.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 244.02 other OPPS APC 244.02 51 124.45 percent of total billed charges 244.02 244.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN SHRT THREAD 4MM X 32MM SUP-97-04010 CDM C1713 HCPCS 0278 RC outpatient 676.76 676.76 676.76 57 385.75 percent of total billed charges 676.76 93 548.18 percent of total billed charges 676.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 676.76 other OPPS APC 676.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 676.76 other OPPS APC 676.76 51 345.15 percent of total billed charges 676.76 676.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL LATERAL FIBULA PLATE 9 HOLE SUP-97-04011 CDM C1713 HCPCS 0278 RC outpatient 1439.7 1439.7 1439.7 57 820.63 percent of total billed charges 1439.7 93 1166.16 percent of total billed charges 1439.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1439.7 other OPPS APC 1439.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1439.7 other OPPS APC 1439.7 51 734.25 percent of total billed charges 1439.7 1439.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5X200 APEX S/D HALF PIN 50 TH SUP-97-04012 CDM C1713 HCPCS 0278 RC outpatient 468.72 468.72 468.72 57 267.17 percent of total billed charges 468.72 93 379.66 percent of total billed charges 468.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 468.72 other OPPS APC 468.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 468.72 other OPPS APC 468.72 51 239.05 percent of total billed charges 468.72 468.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. E1 VNGD PS TIB BRG 71/75X14 SUP-97-04013 CDM C1776 HCPCS 0278 RC outpatient 6640.63 6640.63 6640.63 57 3785.16 percent of total billed charges 6640.63 93 5378.91 percent of total billed charges 6640.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6640.63 other OPPS APC 6640.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6640.63 other OPPS APC 6640.63 51 3386.72 percent of total billed charges 6640.63 6640.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOMET TIBIAL LOCKING BAR SUP-97-04014 CDM C1776 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI SET 8 X 17.5MM SUP-97-04017 CDM C1713 HCPCS 0278 RC outpatient 679.07 679.07 679.07 57 387.07 percent of total billed charges 679.07 93 550.05 percent of total billed charges 679.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 679.07 other OPPS APC 679.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 679.07 other OPPS APC 679.07 51 346.33 percent of total billed charges 679.07 679.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T2 LONG PROXIMAL NAIL LEFT 260MM SUP-97-04018 CDM C1713 HCPCS 0278 RC outpatient 3776.3 3776.3 3776.3 57 2152.49 percent of total billed charges 3776.3 93 3058.8 percent of total billed charges 3776.3 3776.3 other OPPS APC 3776.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3776.3 other OPPS APC 3776.3 51 1925.91 percent of total billed charges 3776.3 3776.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T2 PROXIMAL STANDARD END CAP SUP-97-04019 CDM C1713 HCPCS 0278 RC outpatient 515.9 515.9 515.9 57 294.06 percent of total billed charges 515.9 93 417.88 percent of total billed charges 515.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 515.9 other OPPS APC 515.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 515.9 other OPPS APC 515.9 51 263.11 percent of total billed charges 515.9 515.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T2 F/T LOCKING SCREW 4MM X 20MM SUP-97-04020 CDM C1713 HCPCS 0278 RC outpatient 536.2 536.2 536.2 57 305.63 percent of total billed charges 536.2 93 434.32 percent of total billed charges 536.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 536.2 other OPPS APC 536.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 536.2 other OPPS APC 536.2 51 273.46 percent of total billed charges 536.2 536.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T2 F/T LOCKING SCREW 4MM X 22MM SUP-97-04021 CDM C1713 HCPCS 0278 RC outpatient 546.7 546.7 546.7 57 311.62 percent of total billed charges 546.7 93 442.83 percent of total billed charges 546.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 546.7 other OPPS APC 546.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 546.7 other OPPS APC 546.7 51 278.82 percent of total billed charges 546.7 546.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CONTINUUM CLUSTER-HOLE SHELL,52II" SUP-97-04022 CDM C1776 HCPCS 0278 RC outpatient 5828.13 5828.13 5828.13 57 3322.03 percent of total billed charges 5828.13 93 4720.79 percent of total billed charges 5828.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5828.13 other OPPS APC 5828.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5828.13 other OPPS APC 5828.13 51 2972.35 percent of total billed charges 5828.13 5828.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BONE,SCREW 6.5X15 SELF-TAP" SUP-97-04023 CDM C1776 HCPCS 0278 RC outpatient 332.5 332.5 332.5 57 189.53 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 51 169.58 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE SCREW 6.5X25 SELF-TAP SUP-97-04024 CDM C1776 HCPCS 0278 RC outpatient 332.5 332.5 332.5 57 189.53 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 51 169.58 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARCOS 16X150MM SPL TPR DIST SUP-97-04025 CDM C1776 HCPCS 0278 RC outpatient 9718.75 9718.75 9718.75 57 5539.69 percent of total billed charges 9718.75 93 7872.19 percent of total billed charges 9718.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9718.75 other OPPS APC 9718.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9718.75 other OPPS APC 9718.75 51 4956.56 percent of total billed charges 9718.75 9718.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARCOS CON SZ A STD 50MM SUP-97-04026 CDM C1776 HCPCS 0278 RC outpatient 12880 12880 12880 57 7341.6 percent of total billed charges 12880 93 10432.8 percent of total billed charges 12880 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12880 other OPPS APC 12880 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12880 other OPPS APC 12880 51 6568.8 percent of total billed charges 12880 12880 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARCOS CON SZ A HI 50MM SUP-97-04027 CDM C1776 HCPCS 0278 RC outpatient 15087.5 15087.5 15087.5 57 8599.88 percent of total billed charges 15087.5 93 12220.9 percent of total billed charges 15087.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15087.5 other OPPS APC 15087.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15087.5 other OPPS APC 15087.5 51 7694.63 percent of total billed charges 15087.5 15087.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 36MM COCR MOD HD-6MM SUP-97-04028 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VOLAR SMRTLCK STD LEFT SUP-97-04029 CDM C1713 HCPCS 0278 RC outpatient 2730 2730 2730 57 1556.1 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2730 other OPPS APC 2730 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2730 other OPPS APC 2730 51 1392.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSN ASF CPS 14MM VE L 6-9EF SUP-97-04030 CDM C1776 HCPCS 0278 RC outpatient 6250 6250 6250 57 3562.5 percent of total billed charges 6250 93 5062.5 percent of total billed charges 6250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6250 other OPPS APC 6250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6250 other OPPS APC 6250 51 3187.5 percent of total billed charges 6250 6250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONUNTERSINK FOR 4.3MM HCS SUP-97-04032 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONUNTERSINK FOR 6.5MM HCS SUP-97-04033 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 1.35X170MM SUP-97-04034 CDM 0272 RC outpatient 80 80 80 74 59.2 percent of total billed charges 80 93 64.8 percent of total billed charges 80 80 other OPPS APC 80 80 other OPPS APC 80 27.63 22.1 percent of total billed charges 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS COMPRES SCRW 4.3X38MM SUP-97-04035 CDM C1713 HCPCS 0278 RC outpatient 1125 1125 1125 57 641.25 percent of total billed charges 1125 93 911.25 percent of total billed charges 1125 1125 other OPPS APC 1125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1125 other OPPS APC 1125 51 573.75 percent of total billed charges 1125 1125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS COMPRES SCRW 4.3X42MM SUP-97-04036 CDM C1713 HCPCS 0278 RC outpatient 1125 1125 1125 57 641.25 percent of total billed charges 1125 93 911.25 percent of total billed charges 1125 1125 other OPPS APC 1125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1125 other OPPS APC 1125 51 573.75 percent of total billed charges 1125 1125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS COMPRES SCRW 4.3X70MM SUP-97-04037 CDM C1713 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPER NITI STAPLE W/INSTRS 18X18L SUP-97-04038 CDM C1713 HCPCS 0278 RC outpatient 6237.5 6237.5 6237.5 57 3555.38 percent of total billed charges 6237.5 93 5052.38 percent of total billed charges 6237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6237.5 other OPPS APC 6237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6237.5 other OPPS APC 6237.5 51 3181.13 percent of total billed charges 6237.5 6237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPER NITI STAPLE W/INSTRS 20X20L SUP-97-04039 CDM C1713 HCPCS 0278 RC outpatient 6237.5 6237.5 6237.5 57 3555.38 percent of total billed charges 6237.5 93 5052.38 percent of total billed charges 6237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6237.5 other OPPS APC 6237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6237.5 other OPPS APC 6237.5 51 3181.13 percent of total billed charges 6237.5 6237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 18MM LOCKING SUP-97-04040 CDM C1713 HCPCS 0278 RC outpatient 523.32 523.32 523.32 57 298.29 percent of total billed charges 523.32 93 423.89 percent of total billed charges 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 51 266.89 percent of total billed charges 523.32 523.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE PSFB INSRT SZ 8 6MM LEFT SUP-97-04041 CDM C1776 HCPCS 0278 RC outpatient 4821 4821 4821 57 2747.97 percent of total billed charges 4821 93 3905.01 percent of total billed charges 4821 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4821 other OPPS APC 4821 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4821 other OPPS APC 4821 51 2458.71 percent of total billed charges 4821 4821 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LCKNG 2.7MM X 22MM SUP-97-04043 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LCKNG 2.7MM X 24MM SUP-97-04044 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION 11 MM X 30 MM SUP-97-04045 CDM C1776 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI TS BASEPLATE SIZE 2 SUP-97-04046 CDM C1776 HCPCS 0278 RC outpatient 3125 3125 3125 57 1781.25 percent of total billed charges 3125 93 2531.25 percent of total billed charges 3125 3125 other OPPS APC 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 51 1593.75 percent of total billed charges 3125 3125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI RM/LL TIB AUG SZ2 5MM SUP-97-04047 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI TS FEMUR SZ3 LEFT SUP-97-04048 CDM C1776 HCPCS 0278 RC outpatient 12570.8 12570.8 12570.8 57 7165.36 percent of total billed charges 12570.8 93 10182.4 percent of total billed charges 12570.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12570.8 other OPPS APC 12570.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12570.8 other OPPS APC 12570.8 51 6411.11 percent of total billed charges 12570.8 12570.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI POST AUGMENT SZ3 5MM SUP-97-04049 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NO 2.TRIATHLON TS PLUS TIBIAL X3 POLY11M SUP-97-04050 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS X3 TIBAL INSERT SUP-97-04051 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASNIS III CANNULATED DRILL 5.6MM LG AO SUP-97-04052 CDM 0272 RC outpatient 810.9 810.9 810.9 74 600.07 percent of total billed charges 810.9 93 656.83 percent of total billed charges 810.9 810.9 other OPPS APC 810.9 810.9 other OPPS APC 810.9 27.63 224.05 percent of total billed charges 810.9 810.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASNIS III CANNULATED SCR 8.0X80MM SUP-97-04053 CDM C1713 HCPCS 0278 RC outpatient 740.16 740.16 740.16 57 421.89 percent of total billed charges 740.16 93 599.53 percent of total billed charges 740.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 740.16 other OPPS APC 740.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 740.16 other OPPS APC 740.16 51 377.48 percent of total billed charges 740.16 740.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASNIS III SS CANNULATED SCR 8.0X85MM SUP-97-04054 CDM C1713 HCPCS 0278 RC outpatient 618.24 618.24 618.24 57 352.4 percent of total billed charges 618.24 93 500.77 percent of total billed charges 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 51 315.3 percent of total billed charges 618.24 618.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T2 10MM RIGID REAMER SUP-97-04055 CDM C1713 HCPCS 0278 RC outpatient 1709.28 1709.28 1709.28 57 974.29 percent of total billed charges 1709.28 93 1384.52 percent of total billed charges 1709.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1709.28 other OPPS APC 1709.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1709.28 other OPPS APC 1709.28 51 871.73 percent of total billed charges 1709.28 1709.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT OSTEOCHONDRAL CORE FRESH SUP-97-04056 CDM C1762 HCPCS 0278 RC outpatient 6237.5 6237.5 6237.5 57 3555.38 percent of total billed charges 6237.5 93 5052.38 percent of total billed charges 6237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6237.5 other OPPS APC 6237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6237.5 other OPPS APC 6237.5 51 3181.13 percent of total billed charges 6237.5 6237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 9.5MM PROX HUMERAL NAIL 160MM STER SUP-97-04057 CDM C1713 HCPCS 0278 RC outpatient 5118 5118 5118 57 2917.26 percent of total billed charges 5118 93 4145.58 percent of total billed charges 5118 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5118 other OPPS APC 5118 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5118 other OPPS APC 5118 51 2610.18 percent of total billed charges 5118 5118 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5MM MULTILOC SCREW 32MM SUP-97-04058 CDM C1713 HCPCS 0278 RC outpatient 811.8 811.8 811.8 57 462.73 percent of total billed charges 811.8 93 657.56 percent of total billed charges 811.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 811.8 other OPPS APC 811.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 811.8 other OPPS APC 811.8 51 414.02 percent of total billed charges 811.8 811.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5MM TI MULTILOC SCREW 42MM SUP-97-04059 CDM C1713 HCPCS 0278 RC outpatient 811.8 811.8 811.8 57 462.73 percent of total billed charges 811.8 93 657.56 percent of total billed charges 811.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 811.8 other OPPS APC 811.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 811.8 other OPPS APC 811.8 51 414.02 percent of total billed charges 811.8 811.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5MM TI MULTILOC SCREW 44MM SUP-97-04060 CDM C1713 HCPCS 0278 RC outpatient 811.8 811.8 811.8 57 462.73 percent of total billed charges 811.8 93 657.56 percent of total billed charges 811.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 811.8 other OPPS APC 811.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 811.8 other OPPS APC 811.8 51 414.02 percent of total billed charges 811.8 811.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0MM TI LOCKING SCREW T25 26MM NAILS SUP-97-04061 CDM C1713 HCPCS 0278 RC outpatient 604.45 604.45 604.45 57 344.54 percent of total billed charges 604.45 93 489.6 percent of total billed charges 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 51 308.27 percent of total billed charges 604.45 604.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 11.5MM HOLLOW DRILL BIT 9.5MM PROX NAIL SUP-97-04062 CDM C1713 HCPCS 0278 RC outpatient 836.91 836.91 836.91 57 477.04 percent of total billed charges 836.91 93 677.9 percent of total billed charges 836.91 836.91 other OPPS APC 836.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 836.91 other OPPS APC 836.91 51 426.82 percent of total billed charges 836.91 836.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.8MM THREE FLUTED DRILL BIT 270MM SUP-97-04063 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.5MM DRILL BIT/CONICAL W/STOP SUP-97-04064 CDM 0272 RC outpatient 932.1 932.1 932.1 74 689.75 percent of total billed charges 932.1 93 755 percent of total billed charges 932.1 932.1 other OPPS APC 932.1 932.1 other OPPS APC 932.1 27.63 257.54 percent of total billed charges 932.1 932.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.5MM GUIDE ROD W/STOPTROCAR TIP 230MM SUP-97-04065 CDM 0272 RC outpatient 160.8 160.8 160.8 74 118.99 percent of total billed charges 160.8 93 130.25 percent of total billed charges 160.8 160.8 other OPPS APC 160.8 160.8 other OPPS APC 160.8 27.63 44.43 percent of total billed charges 160.8 160.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.5MM KIRSCHNER WIRE W/TROCAR PT 285MM SUP-97-04066 CDM 0272 RC outpatient 379.72 379.72 379.72 74 280.99 percent of total billed charges 379.72 93 307.57 percent of total billed charges 379.72 379.72 other OPPS APC 379.72 379.72 other OPPS APC 379.72 27.63 104.92 percent of total billed charges 379.72 379.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OATS OSTEOCHONDRAL AUTOGRAFT10MM SUP-97-04067 CDM C1762 HCPCS 0278 RC outpatient 1560 1560 1560 57 889.2 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1560 other OPPS APC 1560 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1560 other OPPS APC 1560 51 795.6 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OATS OSTEOCHONDRAL SM JOINT 10MM SUP-97-04068 CDM C1762 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANGEL SYSTEM W/ ASPIRATION ACDA SUP-97-04069 CDM C1713 HCPCS 0278 RC outpatient 2940 2940 2940 57 1675.8 percent of total billed charges 2940 93 2381.4 percent of total billed charges 2940 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2940 other OPPS APC 2940 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2940 other OPPS APC 2940 51 1499.4 percent of total billed charges 2940 2940 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOSURGE KIT 15X40X3MM SUP-97-04070 CDM C1713 HCPCS 0278 RC outpatient 3625 3625 3625 57 2066.25 percent of total billed charges 3625 93 2936.25 percent of total billed charges 3625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3625 other OPPS APC 3625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3625 other OPPS APC 3625 51 1848.75 percent of total billed charges 3625 3625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T2 HUMERAL NAIL 8MMX250MM SUP-97-04071 CDM C1713 HCPCS 0278 RC outpatient 3045.9 3045.9 3045.9 57 1736.16 percent of total billed charges 3045.9 93 2467.18 percent of total billed charges 3045.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3045.9 other OPPS APC 3045.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3045.9 other OPPS APC 3045.9 51 1553.41 percent of total billed charges 3045.9 3045.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T2 F/T LOCKING SCREW 4MMX32MM SUP-97-04072 CDM C1713 HCPCS 0278 RC outpatient 546.7 546.7 546.7 57 311.62 percent of total billed charges 546.7 93 442.83 percent of total billed charges 546.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 546.7 other OPPS APC 546.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 546.7 other OPPS APC 546.7 51 278.82 percent of total billed charges 546.7 546.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T2 F/T LOCKING SCREW 4MMX24MM SUP-97-04073 CDM C1713 HCPCS 0278 RC outpatient 546.7 546.7 546.7 57 311.62 percent of total billed charges 546.7 93 442.83 percent of total billed charges 546.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 546.7 other OPPS APC 546.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 546.7 other OPPS APC 546.7 51 278.82 percent of total billed charges 546.7 546.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T2 F/T LOCKING SCREW 4MMX28MM SUP-97-04074 CDM C1713 HCPCS 0278 RC outpatient 546.7 546.7 546.7 57 311.62 percent of total billed charges 546.7 93 442.83 percent of total billed charges 546.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 546.7 other OPPS APC 546.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 546.7 other OPPS APC 546.7 51 278.82 percent of total billed charges 546.7 546.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRITANIUM ASYMMETRIC METALPATELLA A29X9 SUP-97-04075 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NO.4 TRIATHLON TS PLUS TIBAL INSERTX3 9MM SUP-97-04076 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING IM NAIL 7 5X62 SUP-97-04077 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING 58MM SUP-97-04078 CDM C1713 HCPCS 0278 RC outpatient 604.45 604.45 604.45 57 344.54 percent of total billed charges 604.45 93 489.6 percent of total billed charges 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 51 308.27 percent of total billed charges 604.45 604.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0 MM LOCKING 62MM SUP-97-04079 CDM C1713 HCPCS 0278 RC outpatient 604.45 604.45 604.45 57 344.54 percent of total billed charges 604.45 93 489.6 percent of total billed charges 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 51 308.27 percent of total billed charges 604.45 604.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8MM TI HUMERAL NAIL RIGHT CANN 160MM-STE SUP-97-04081 CDM C1713 HCPCS 0278 RC outpatient 5118 5118 5118 57 2917.26 percent of total billed charges 5118 93 4145.58 percent of total billed charges 5118 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5118 other OPPS APC 5118 5118 other OPPS APC 5118 51 2610.18 percent of total billed charges 5118 5118 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5MM TI SCREW 36MM-STERILE SUP-97-04082 CDM C1713 HCPCS 0278 RC outpatient 964.8 964.8 964.8 57 549.94 percent of total billed charges 964.8 93 781.49 percent of total billed charges 964.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 964.8 other OPPS APC 964.8 964.8 other OPPS APC 964.8 51 492.05 percent of total billed charges 964.8 964.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5MM TI SCREW 38MM-STERILE SUP-97-04083 CDM C1713 HCPCS 0278 RC outpatient 964.8 964.8 964.8 57 549.94 percent of total billed charges 964.8 93 781.49 percent of total billed charges 964.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 964.8 other OPPS APC 964.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 964.8 other OPPS APC 964.8 51 492.05 percent of total billed charges 964.8 964.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5MM TI SCREW 40MM-STERILE SUP-97-04084 CDM C1713 HCPCS 0278 RC outpatient 964.8 964.8 964.8 57 549.94 percent of total billed charges 964.8 93 781.49 percent of total billed charges 964.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 964.8 other OPPS APC 964.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 964.8 other OPPS APC 964.8 51 492.05 percent of total billed charges 964.8 964.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7MM 8MM SUP-97-04086 CDM C1713 HCPCS 0278 RC outpatient 443.98 443.98 443.98 57 253.07 percent of total billed charges 443.98 93 359.62 percent of total billed charges 443.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 443.98 other OPPS APC 443.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 443.98 other OPPS APC 443.98 51 226.43 percent of total billed charges 443.98 443.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 55MM FULL THREAD CANCELLOUS SUP-97-04089 CDM C1713 HCPCS 0278 RC outpatient 145.6 145.6 145.6 57 82.99 percent of total billed charges 145.6 93 117.94 percent of total billed charges 145.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.6 other OPPS APC 145.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.6 other OPPS APC 145.6 51 74.26 percent of total billed charges 145.6 145.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAP CANCELLOUS 6.0 X 295MM SUP-97-04090 CDM C1713 HCPCS 0278 RC outpatient 556.08 556.08 556.08 57 316.97 percent of total billed charges 556.08 93 450.42 percent of total billed charges 556.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 556.08 other OPPS APC 556.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 556.08 other OPPS APC 556.08 51 283.6 percent of total billed charges 556.08 556.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VOLAR NARROW LEFT LONG SUP-97-04091 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VOLAR SMRTLCK STD RIGHT SUP-97-04092 CDM C1713 HCPCS 0278 RC outpatient 2775.24 2775.24 2775.24 57 1581.89 percent of total billed charges 2775.24 93 2247.94 percent of total billed charges 2775.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2775.24 other OPPS APC 2775.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2775.24 other OPPS APC 2775.24 51 1415.37 percent of total billed charges 2775.24 2775.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING PEG T8 2.0MM / L16MM SUP-97-04093 CDM C1713 HCPCS 0278 RC outpatient 516.25 516.25 516.25 57 294.26 percent of total billed charges 516.25 93 418.16 percent of total billed charges 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 516.25 other OPPS APC 516.25 51 263.29 percent of total billed charges 516.25 516.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING PEG T8 2.0MM / L18MM SUP-97-04094 CDM C1713 HCPCS 0278 RC outpatient 516.25 516.25 516.25 57 294.26 percent of total billed charges 516.25 93 418.16 percent of total billed charges 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 51 263.29 percent of total billed charges 516.25 516.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING PEG T8 2.0MM / L20MM SUP-97-04095 CDM C1713 HCPCS 0278 RC outpatient 516.25 516.25 516.25 57 294.26 percent of total billed charges 516.25 93 418.16 percent of total billed charges 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 51 263.29 percent of total billed charges 516.25 516.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 NON LCKNG 2.7MM X 26MM SUP-97-04096 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5.0MM TI LOCKING SCREW W/T25 X56MM SUP-97-04097 CDM C1713 HCPCS 0278 RC outpatient 604.45 604.45 604.45 57 344.54 percent of total billed charges 604.45 93 489.6 percent of total billed charges 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 604.45 other OPPS APC 604.45 51 308.27 percent of total billed charges 604.45 604.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 7.3 CANNULATED SCREW 16MM THREAD/55MM SUP-97-04098 CDM C1713 HCPCS 0278 RC outpatient 761.64 761.64 761.64 57 434.13 percent of total billed charges 761.64 93 616.93 percent of total billed charges 761.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 761.64 other OPPS APC 761.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 761.64 other OPPS APC 761.64 51 388.44 percent of total billed charges 761.64 761.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7MM/3.5MM LCP POSTLAT DISTAL FIBULA PL SUP-97-04099 CDM C1713 HCPCS 0278 RC outpatient 1904.94 1904.94 1904.94 57 1085.82 percent of total billed charges 1904.94 93 1543 percent of total billed charges 1904.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1904.94 other OPPS APC 1904.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1904.94 other OPPS APC 1904.94 51 971.52 percent of total billed charges 1904.94 1904.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM CLAVICLE PLATE 7H/LT/110MM SUP-97-04100 CDM C1713 HCPCS 0278 RC outpatient 2749.68 2749.68 2749.68 57 1567.32 percent of total billed charges 2749.68 93 2227.24 percent of total billed charges 2749.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2749.68 other OPPS APC 2749.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2749.68 other OPPS APC 2749.68 51 1402.34 percent of total billed charges 2749.68 2749.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE TFNA FENESTRATED HELICAL 120MM SUP-97-04101 CDM C1713 HCPCS 0278 RC outpatient 2304 2304 2304 57 1313.28 percent of total billed charges 2304 93 1866.24 percent of total billed charges 2304 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2304 other OPPS APC 2304 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2304 other OPPS APC 2304 51 1175.04 percent of total billed charges 2304 2304 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEXGEN LCCK SURF,EF 5-6/GREEN,17MM" SUP-97-04102 CDM C1776 HCPCS 0278 RC outpatient 6687.5 6687.5 6687.5 57 3811.88 percent of total billed charges 6687.5 93 5416.88 percent of total billed charges 6687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6687.5 other OPPS APC 6687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6687.5 other OPPS APC 6687.5 51 3410.63 percent of total billed charges 6687.5 6687.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4MM RADIUS PL 7H HD/5H SHAFT/RIGHT SUP-97-04103 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SPHERE WIRE, THREADED, 2.0MM X 72MM" SUP-97-04104 CDM outpatient 411.25 411.25 411.25 411.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GORILLA GRIP? PLATE, 2.0MM THICKNESS, RI" SUP-97-04105 CDM C1713 HCPCS 0278 RC outpatient 6116.25 6116.25 6116.25 57 3486.26 percent of total billed charges 6116.25 93 4954.16 percent of total billed charges 6116.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6116.25 other OPPS APC 6116.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6116.25 other OPPS APC 6116.25 51 3119.29 percent of total billed charges 6116.25 6116.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 16MM LOCKING SUP-97-04106 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CANNU, SHORT THREAD SCREW, HEADLES 7X70" SUP-97-04107 CDM C1713 HCPCS 0278 RC outpatient 1942.5 1942.5 1942.5 57 1107.23 percent of total billed charges 1942.5 93 1573.43 percent of total billed charges 1942.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1942.5 other OPPS APC 1942.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1942.5 other OPPS APC 1942.5 51 990.68 percent of total billed charges 1942.5 1942.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CANN, SHORT THREAD SCREW, HEADLES 7X72" SUP-97-04108 CDM C1713 HCPCS 0278 RC outpatient 1942.5 1942.5 1942.5 57 1107.23 percent of total billed charges 1942.5 93 1573.43 percent of total billed charges 1942.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1942.5 other OPPS APC 1942.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1942.5 other OPPS APC 1942.5 51 990.68 percent of total billed charges 1942.5 1942.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS COUNTERSINK 7.0 SUP-97-04109 CDM 0272 RC outpatient 691.25 691.25 691.25 74 511.53 percent of total billed charges 691.25 93 559.91 percent of total billed charges 691.25 691.25 other OPPS APC 691.25 691.25 other OPPS APC 691.25 27.63 190.99 percent of total billed charges 691.25 691.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI CEMENTED STEM 9MM X 100MM SUP-97-04110 CDM C1776 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN SCR 6.5X90MM SUP-97-04111 CDM C1713 HCPCS 0278 RC outpatient 618.24 618.24 618.24 57 352.4 percent of total billed charges 618.24 93 500.77 percent of total billed charges 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 51 315.3 percent of total billed charges 618.24 618.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0MM SCHANZ SCREW SPADE POINT 80MM SUP-97-04112 CDM C1713 HCPCS 0278 RC outpatient 1216.8 1216.8 1216.8 57 693.58 percent of total billed charges 1216.8 93 985.61 percent of total billed charges 1216.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1216.8 other OPPS APC 1216.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1216.8 other OPPS APC 1216.8 51 620.57 percent of total billed charges 1216.8 1216.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROTECTIVE CAPS FOR 4.0MM BARS & RODS SUP-97-04113 CDM C1713 HCPCS 0278 RC outpatient 216.3 216.3 216.3 57 123.29 percent of total billed charges 216.3 93 175.2 percent of total billed charges 216.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 216.3 other OPPS APC 216.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 216.3 other OPPS APC 216.3 51 110.31 percent of total billed charges 216.3 216.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SHORT BARREL HIP PLATE 130DEG, 4 HOLES" SUP-97-04114 CDM C1713 HCPCS 0278 RC outpatient 1194.6 1194.6 1194.6 57 680.92 percent of total billed charges 1194.6 93 967.63 percent of total billed charges 1194.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1194.6 other OPPS APC 1194.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1194.6 other OPPS APC 1194.6 51 609.25 percent of total billed charges 1194.6 1194.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPRESSION SCREW SUP-97-04115 CDM C1713 HCPCS 0278 RC outpatient 224.84 224.84 224.84 57 128.16 percent of total billed charges 224.84 93 182.12 percent of total billed charges 224.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 224.84 other OPPS APC 224.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 224.84 other OPPS APC 224.84 51 114.67 percent of total billed charges 224.84 224.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OMEGA PLUS LAG SCREW 90MM SUP-97-04116 CDM C1713 HCPCS 0278 RC outpatient 769.56 769.56 769.56 57 438.65 percent of total billed charges 769.56 93 623.34 percent of total billed charges 769.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 769.56 other OPPS APC 769.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 769.56 other OPPS APC 769.56 51 392.48 percent of total billed charges 769.56 769.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5MM TI MULTILOC SCREW 42MM-STERILE SUP-97-04117 CDM C1713 HCPCS 0278 RC outpatient 964.8 964.8 964.8 57 549.94 percent of total billed charges 964.8 93 781.49 percent of total billed charges 964.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 964.8 other OPPS APC 964.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 964.8 other OPPS APC 964.8 51 492.05 percent of total billed charges 964.8 964.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0MM TI LOCKING SCREW W/T25 24MM F/M SUP-97-04118 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0MM TI LOCKING SCREW W/T25 STARDRIVE 2 SUP-97-04119 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOTOBAND MAX 4 HOLE 15MM SUP-97-04120 CDM C1713 HCPCS 0278 RC outpatient 7487.5 7487.5 7487.5 57 4267.88 percent of total billed charges 7487.5 93 6064.88 percent of total billed charges 7487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7487.5 other OPPS APC 7487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7487.5 other OPPS APC 7487.5 51 3818.63 percent of total billed charges 7487.5 7487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "IMPLANT KIT, DYNAFORCE HIMAX, 15 X 15 X" SUP-97-04121 CDM C1713 HCPCS 0278 RC outpatient 3187.5 3187.5 3187.5 57 1816.88 percent of total billed charges 3187.5 93 2581.88 percent of total billed charges 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 51 1625.63 percent of total billed charges 3187.5 3187.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOTOBAND CP - LOCKING SCREWS -3.0MM X 22 SUP-97-04122 CDM C1713 HCPCS 0278 RC outpatient 930 930 930 57 530.1 percent of total billed charges 930 93 753.3 percent of total billed charges 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 51 474.3 percent of total billed charges 930 930 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOTOBAND CP - LOCKING SCREWS -3.0MM X 18 SUP-97-04123 CDM C1713 HCPCS 0278 RC outpatient 930 930 930 57 530.1 percent of total billed charges 930 93 753.3 percent of total billed charges 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 51 474.3 percent of total billed charges 930 930 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOTOBAND CP - NON-LOCKING SCREWS -3.5MM SUP-97-04124 CDM C1713 HCPCS 0278 RC outpatient 930 930 930 57 530.1 percent of total billed charges 930 93 753.3 percent of total billed charges 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 51 474.3 percent of total billed charges 930 930 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NON LOK CRSSPIN ST 2.3 X 9MM SUP-97-04125 CDM C1713 HCPCS 0278 RC outpatient 263.13 263.13 263.13 57 149.98 percent of total billed charges 263.13 93 213.14 percent of total billed charges 263.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 263.13 other OPPS APC 263.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 263.13 other OPPS APC 263.13 51 134.2 percent of total billed charges 263.13 263.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCKG CRSSPIN ST 2.3 X 9MM SUP-97-04126 CDM C1713 HCPCS 0278 RC outpatient 318.99 318.99 318.99 57 181.82 percent of total billed charges 318.99 93 258.38 percent of total billed charges 318.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 318.99 other OPPS APC 318.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 318.99 other OPPS APC 318.99 51 162.68 percent of total billed charges 318.99 318.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T7 FULL THREAD 2.7MM X 14MM NON LOCKING SUP-97-04127 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE SCREW T10 FULL THREAD 2.7MM / L18MM SUP-97-04128 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE SCREW T8 FULL THREAD 2.4MM / L10MM SUP-97-04129 CDM C1713 HCPCS 0278 RC outpatient 301 301 301 57 171.57 percent of total billed charges 301 93 243.81 percent of total billed charges 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 51 153.51 percent of total billed charges 301 301 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE SCREW T8 FULL THREAD 2.4MM / L16MM SUP-97-04130 CDM C1713 HCPCS 0278 RC outpatient 301 301 301 57 171.57 percent of total billed charges 301 93 243.81 percent of total billed charges 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 51 153.51 percent of total billed charges 301 301 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE SCREW T8 FULL THREAD 2.4MM / L20MM SUP-97-04131 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LCKNG 2.7MM X 12MM SUP-97-04132 CDM C1713 HCPCS 0278 RC outpatient 516.25 516.25 516.25 57 294.26 percent of total billed charges 516.25 93 418.16 percent of total billed charges 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 51 263.29 percent of total billed charges 516.25 516.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LCKNG 2.7MM X 14MM SUP-97-04133 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LCKNG 2.7MM X 18MM SUP-97-04134 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LCKNG 2.7MM X 20MM SUP-97-04135 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 NON LCKNG 2.7MM X 12MM SUP-97-04136 CDM C1713 HCPCS 0278 RC outpatient 301 301 301 57 171.57 percent of total billed charges 301 93 243.81 percent of total billed charges 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 51 153.51 percent of total billed charges 301 301 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 NON LCKNG 2.7MM X 14MM SUP-97-04137 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 NON LCKNG 2.7MM X 18MM SUP-97-04138 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 NON LCKNG 2.7MM X 20MM SUP-97-04139 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCK SCREW T10 FULL THREAD 2.7MM / L12 SUP-97-04140 CDM C1713 HCPCS 0278 RC outpatient 575.75 575.75 575.75 57 328.18 percent of total billed charges 575.75 93 466.36 percent of total billed charges 575.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 575.75 other OPPS APC 575.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 575.75 other OPPS APC 575.75 51 293.63 percent of total billed charges 575.75 575.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE SCREW T10 FULL THREAD 2.7MM / L20MM SUP-97-04141 CDM C1713 HCPCS 0278 RC outpatient 313.25 313.25 313.25 57 178.55 percent of total billed charges 313.25 93 253.73 percent of total billed charges 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 51 159.76 percent of total billed charges 313.25 313.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 NON LCKNG 2.7MM X 16MM SUP-97-04142 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBON ROD 100MM 4MM SUP-97-04143 CDM C1713 HCPCS 0278 RC outpatient 201.6 201.6 201.6 57 114.91 percent of total billed charges 201.6 93 163.3 percent of total billed charges 201.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 201.6 other OPPS APC 201.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 201.6 other OPPS APC 201.6 51 102.82 percent of total billed charges 201.6 201.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPEEDBRIDGE KIT WITH SCORPION NEEDLE SUP-97-04144 CDM C1713 HCPCS 0278 RC outpatient 4775 4775 4775 57 2721.75 percent of total billed charges 4775 93 3867.75 percent of total billed charges 4775 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4775 other OPPS APC 4775 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4775 other OPPS APC 4775 51 2435.25 percent of total billed charges 4775 4775 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "KNOTLESS FIBERTAK? ANCHOR," SUP-97-04145 CDM C1713 HCPCS 0278 RC outpatient 5625 5625 5625 57 3206.25 percent of total billed charges 5625 93 4556.25 percent of total billed charges 5625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5625 other OPPS APC 5625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5625 other OPPS APC 5625 51 2868.75 percent of total billed charges 5625 5625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNOTLESS FIBERTAK DISPOSABLE KIT SUP-97-04146 CDM C1713 HCPCS 0278 RC outpatient 682.5 682.5 682.5 57 389.03 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 51 348.08 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL PEEK KNOTLESS CORKSCREW ANCHOR SUP-97-04147 CDM C1713 HCPCS 0278 RC outpatient 367.5 367.5 367.5 57 209.48 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 51 187.43 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA PASSPORT 12 MM ID X 3 CM SUP-97-04148 CDM 0272 RC outpatient 210 210 210 74 155.4 percent of total billed charges 210 93 170.1 percent of total billed charges 210 210 other OPPS APC 210 210 other OPPS APC 210 27.63 58.02 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA PASSPORT 12 MM ID X 4 CM SUP-97-04149 CDM 0272 RC outpatient 210 210 210 74 155.4 percent of total billed charges 210 93 170.1 percent of total billed charges 210 210 other OPPS APC 210 210 other OPPS APC 210 27.63 58.02 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROFYLE/XS T-BEVL NRW RT SUP-97-04150 CDM C1713 HCPCS 0278 RC outpatient 715.5 715.5 715.5 57 407.84 percent of total billed charges 715.5 93 579.56 percent of total billed charges 715.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 715.5 other OPPS APC 715.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 715.5 other OPPS APC 715.5 51 364.91 percent of total billed charges 715.5 715.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Y-PLATE PROFYL/M 2.3M HAND LCK NRW 7H SUP-97-04151 CDM C1713 HCPCS 0278 RC outpatient 1468.5 1468.5 1468.5 57 837.05 percent of total billed charges 1468.5 93 1189.49 percent of total billed charges 1468.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1468.5 other OPPS APC 1468.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1468.5 other OPPS APC 1468.5 51 748.94 percent of total billed charges 1468.5 1468.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPRACONDYLAR NAIL T2 SUP-97-04153 CDM C1713 HCPCS 0278 RC outpatient 4044.7 4044.7 4044.7 57 2305.48 percent of total billed charges 4044.7 93 3276.21 percent of total billed charges 4044.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4044.7 other OPPS APC 4044.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4044.7 other OPPS APC 4044.7 51 2062.8 percent of total billed charges 4044.7 4044.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERTAX RC DR LBRLTAPE WHITE TT/BL/BLK SUP-97-04154 CDM C1713 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURETAPE FIBERLINK 1.3MM WH/BL BX/12 SUP-97-04155 CDM C1713 HCPCS 0278 RC outpatient 297.5 297.5 297.5 57 169.58 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 51 151.73 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 50MM QUICKFIX TI CANNULATED ST CANCELLOUS SUP-97-04156 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 8X20MM BC IF VENTED SUP-97-04157 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASEPLATE SIZE 5 TRIATHLON TRITANIUM SUP-97-04158 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASYMMETRIC METAL BACK PATELLA A32X10 SUP-97-04159 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASCEND REVERSE SHOULDER SUP-97-04160 CDM C1776 HCPCS 0278 RC outpatient 17000 17000 17000 57 9690 percent of total billed charges 17000 93 13770 percent of total billed charges 17000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17000 other OPPS APC 17000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17000 other OPPS APC 17000 51 8670 percent of total billed charges 17000 17000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS III TI CANN 5.0MM X 75MM SUP-97-04161 CDM C1713 HCPCS 0278 RC outpatient 596.4 596.4 596.4 57 339.95 percent of total billed charges 596.4 93 483.08 percent of total billed charges 596.4 596.4 other OPPS APC 596.4 596.4 other OPPS APC 596.4 51 304.16 percent of total billed charges 596.4 596.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED SCREW +5.0X42MM SUP-97-04162 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNTHREADED GUIDE WIRE 3.2MM X 230MM SUP-97-04163 CDM C1713 HCPCS 0278 RC outpatient 252 252 252 57 143.64 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 51 128.52 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED DRILL 4.9MM LG.AO FITTING SUP-97-04164 CDM 0272 RC outpatient 783.36 783.36 783.36 74 579.69 percent of total billed charges 783.36 93 634.52 percent of total billed charges 783.36 783.36 other OPPS APC 783.36 783.36 other OPPS APC 783.36 27.63 216.44 percent of total billed charges 783.36 783.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD. COMPRESS SCREW 7.0/L50MM SHORT THR SUP-97-04165 CDM C1713 HCPCS 0278 RC outpatient 1675.08 1675.08 1675.08 57 954.8 percent of total billed charges 1675.08 93 1356.81 percent of total billed charges 1675.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1675.08 other OPPS APC 1675.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1675.08 other OPPS APC 1675.08 51 854.29 percent of total billed charges 1675.08 1675.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEDIAL PLATE SUP-97-04166 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T2 CONDYLE SCREW 5MMX80MM SUP-97-04167 CDM C1713 HCPCS 0278 RC outpatient 586.74 586.74 586.74 57 334.44 percent of total billed charges 586.74 93 475.26 percent of total billed charges 586.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 586.74 other OPPS APC 586.74 586.74 other OPPS APC 586.74 51 299.24 percent of total billed charges 586.74 586.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T2 CONDYLE SCREW 5MMX50MM SUP-97-04168 CDM C1713 HCPCS 0278 RC outpatient 586.74 586.74 586.74 57 334.44 percent of total billed charges 586.74 93 475.26 percent of total billed charges 586.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 586.74 other OPPS APC 586.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 586.74 other OPPS APC 586.74 51 299.24 percent of total billed charges 586.74 586.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T2 CONDYLE SCREW 5MMX45MM SUP-97-04169 CDM C1713 HCPCS 0278 RC outpatient 586.74 586.74 586.74 57 334.44 percent of total billed charges 586.74 93 475.26 percent of total billed charges 586.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 586.74 other OPPS APC 586.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 586.74 other OPPS APC 586.74 51 299.24 percent of total billed charges 586.74 586.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING TI 5.0X60MM SUP-97-04170 CDM C1713 HCPCS 0278 RC outpatient 656.67 656.67 656.67 57 374.3 percent of total billed charges 656.67 93 531.9 percent of total billed charges 656.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 656.67 other OPPS APC 656.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 656.67 other OPPS APC 656.67 51 334.9 percent of total billed charges 656.67 656.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NO.4 TRIATHLON PLUS TIBAL INSERT X3 16MM SUP-97-04171 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED SCREW +5.0X40MM SUP-97-04172 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4 X 14MM SUP-97-04173 CDM C1713 HCPCS 0278 RC outpatient 412.3 412.3 412.3 57 235.01 percent of total billed charges 412.3 93 333.96 percent of total billed charges 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 51 210.27 percent of total billed charges 412.3 412.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 16MM SUP-97-04174 CDM C1713 HCPCS 0278 RC outpatient 412.3 412.3 412.3 57 235.01 percent of total billed charges 412.3 93 333.96 percent of total billed charges 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 51 210.27 percent of total billed charges 412.3 412.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI IS FEMUR SZ5 RIGHT SUP-97-04175 CDM C1713 HCPCS 0278 RC outpatient 12570.4 12570.4 12570.4 57 7165.13 percent of total billed charges 12570.4 93 10182 percent of total billed charges 12570.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12570.4 other OPPS APC 12570.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12570.4 other OPPS APC 12570.4 51 6410.9 percent of total billed charges 12570.4 12570.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI CEMENTED STEM 15MM X 100MM SUP-97-04176 CDM C1776 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL NAIL 10 X 330MM T2 STANDARD SUP-97-04177 CDM C1713 HCPCS 0278 RC outpatient 2734.2 2734.2 2734.2 57 1558.49 percent of total billed charges 2734.2 93 2214.7 percent of total billed charges 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 51 1394.44 percent of total billed charges 2734.2 2734.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 9 HOLE STRAIGHT 1/3 TUBULAR B&R SUP-97-04178 CDM C1713 HCPCS 0278 RC outpatient 1248 1248 1248 57 711.36 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1248 other OPPS APC 1248 1248 other OPPS APC 1248 51 636.48 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THREADED ROD LENGTH 150MM SUP-97-04179 CDM C1713 HCPCS 0278 RC outpatient 188 188 188 57 107.16 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 51 95.88 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HALF HINGE SUP-97-04180 CDM C1713 HCPCS 0278 RC outpatient 433.16 433.16 433.16 57 246.9 percent of total billed charges 433.16 93 350.86 percent of total billed charges 433.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 433.16 other OPPS APC 433.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 433.16 other OPPS APC 433.16 51 220.91 percent of total billed charges 433.16 433.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTION BOLT SUP-97-04181 CDM C1713 HCPCS 0278 RC outpatient 62.72 62.72 62.72 57 35.75 percent of total billed charges 62.72 93 50.8 percent of total billed charges 62.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.72 other OPPS APC 62.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 62.72 other OPPS APC 62.72 51 31.99 percent of total billed charges 62.72 62.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE W/OLIVE DIA 1.8X450MM SUP-97-04182 CDM 0272 RC outpatient 288.12 288.12 288.12 74 213.21 percent of total billed charges 288.12 93 233.38 percent of total billed charges 288.12 288.12 other OPPS APC 288.12 288.12 other OPPS APC 288.12 27.63 79.61 percent of total billed charges 288.12 288.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TELESCOPE STRUT SHORT 119.161MM SUP-97-04183 CDM C1713 HCPCS 0278 RC outpatient 3221.4 3221.4 3221.4 57 1836.2 percent of total billed charges 3221.4 93 2609.33 percent of total billed charges 3221.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3221.4 other OPPS APC 3221.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3221.4 other OPPS APC 3221.4 51 1642.91 percent of total billed charges 3221.4 3221.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE BOLT ADAPTER SHORT SUP-97-04184 CDM C1713 HCPCS 0278 RC outpatient 3221.4 3221.4 3221.4 57 1836.2 percent of total billed charges 3221.4 93 2609.33 percent of total billed charges 3221.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3221.4 other OPPS APC 3221.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3221.4 other OPPS APC 3221.4 51 1642.91 percent of total billed charges 3221.4 3221.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POST SHORT LENGHT 44MM SUP-97-04185 CDM C1713 HCPCS 0278 RC outpatient 288.12 288.12 288.12 57 164.23 percent of total billed charges 288.12 93 233.38 percent of total billed charges 288.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 288.12 other OPPS APC 288.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 288.12 other OPPS APC 288.12 51 146.94 percent of total billed charges 288.12 288.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEDIUM ROCKER SHE LONG SUP-97-04186 CDM C1713 HCPCS 0278 RC outpatient 288.12 288.12 288.12 57 164.23 percent of total billed charges 288.12 93 233.38 percent of total billed charges 288.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 288.12 other OPPS APC 288.12 288.12 other OPPS APC 288.12 51 146.94 percent of total billed charges 288.12 288.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIXOS MV SCREW 4.0X46MM SUP-97-04187 CDM C1713 HCPCS 0278 RC outpatient 1007.64 1007.64 1007.64 57 574.35 percent of total billed charges 1007.64 93 816.19 percent of total billed charges 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 51 513.9 percent of total billed charges 1007.64 1007.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENFLEX EXP PS INSERT SUP-97-04188 CDM C1776 HCPCS 0278 RC outpatient 4750 4750 4750 57 2707.5 percent of total billed charges 4750 93 3847.5 percent of total billed charges 4750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4750 other OPPS APC 4750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4750 other OPPS APC 4750 51 2422.5 percent of total billed charges 4750 4750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED CONNECTING SCREW SUP-97-04189 CDM C1713 HCPCS 0278 RC outpatient 2042.88 2042.88 2042.88 57 1164.44 percent of total billed charges 2042.88 93 1654.73 percent of total billed charges 2042.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2042.88 other OPPS APC 2042.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2042.88 other OPPS APC 2042.88 51 1041.87 percent of total billed charges 2042.88 2042.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. *DNO* SPEEDBRIDGE KIT W/SCORPION NEEDLE SUP-97-04190 CDM C1713 HCPCS 0278 RC outpatient 4350 4350 4350 57 2479.5 percent of total billed charges 4350 93 3523.5 percent of total billed charges 4350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4350 other OPPS APC 4350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4350 other OPPS APC 4350 51 2218.5 percent of total billed charges 4350 4350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP 4.0MMX4.0MM SUP-97-04191 CDM C1713 HCPCS 0278 RC outpatient 995.4 995.4 995.4 57 567.38 percent of total billed charges 995.4 93 806.27 percent of total billed charges 995.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 995.4 other OPPS APC 995.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 995.4 other OPPS APC 995.4 51 507.65 percent of total billed charges 995.4 995.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 40MM SUP-97-04192 CDM C1713 HCPCS 0278 RC outpatient 313.25 313.25 313.25 57 178.55 percent of total billed charges 313.25 93 253.73 percent of total billed charges 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 51 159.76 percent of total billed charges 313.25 313.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL 7MM TI LEFT/CANN/225MM STERILE SUP-97-04193 CDM C1713 HCPCS 0278 RC outpatient 5332.5 5332.5 5332.5 57 3039.53 percent of total billed charges 5332.5 93 4319.33 percent of total billed charges 5332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5332.5 other OPPS APC 5332.5 5332.5 other OPPS APC 5332.5 51 2719.58 percent of total billed charges 5332.5 5332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.5MM REAMING ROD 650MM-STERILE SUP-97-04198 CDM 0272 RC outpatient 421.05 421.05 421.05 74 311.58 percent of total billed charges 421.05 93 341.05 percent of total billed charges 421.05 421.05 other OPPS APC 421.05 421.05 other OPPS APC 421.05 27.63 116.34 percent of total billed charges 421.05 421.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOWRAP GRAFT DS 4X4 SUP-97-04199 CDM Q4150 HCPCS 0636 RC outpatient 5062.5 5062.5 88.06 88.06 fee schedule 5062.5 93 4100.63 percent of total billed charges 5062.5 5062.5 other OPPS APC 5062.5 5062.5 other OPPS APC 5062.5 24.86 1258.54 percent of total billed charges 88.06 5062.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW FULL THRD CANN 4.0 X 44MM SUP-97-04200 CDM C1713 HCPCS 0278 RC outpatient 396.48 396.48 396.48 57 225.99 percent of total billed charges 396.48 93 321.15 percent of total billed charges 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 51 202.2 percent of total billed charges 396.48 396.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW FULL THRD CANN 4.0 X 46MM SUP-97-04201 CDM C1713 HCPCS 0278 RC outpatient 396.48 396.48 396.48 57 225.99 percent of total billed charges 396.48 93 321.15 percent of total billed charges 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 396.48 other OPPS APC 396.48 51 202.2 percent of total billed charges 396.48 396.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW FULL THREAD CANNULATED 4.0 X 48MM SUP-97-04202 CDM C1713 HCPCS 0278 RC outpatient 396.48 396.48 396.48 57 225.99 percent of total billed charges 396.48 93 321.15 percent of total billed charges 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 51 202.2 percent of total billed charges 396.48 396.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW FULL THRD CANN 4.0 X 50MM SUP-97-04203 CDM C1713 HCPCS 0278 RC outpatient 396.48 396.48 396.48 57 225.99 percent of total billed charges 396.48 93 321.15 percent of total billed charges 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 51 202.2 percent of total billed charges 396.48 396.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHORAGE MTP CP PLATE LEFT SUP-97-04204 CDM C1713 HCPCS 0278 RC outpatient 3495.6 3495.6 3495.6 57 1992.49 percent of total billed charges 3495.6 93 2831.44 percent of total billed charges 3495.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3495.6 other OPPS APC 3495.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3495.6 other OPPS APC 3495.6 51 1782.76 percent of total billed charges 3495.6 3495.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3MM X 22MM NON LOCKING SUP-97-04205 CDM C1713 HCPCS 0278 RC outpatient 413 413 413 57 235.41 percent of total billed charges 413 93 334.53 percent of total billed charges 413 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 413 other OPPS APC 413 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 413 other OPPS APC 413 51 210.63 percent of total billed charges 413 413 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ANCHORAGE LOCKING 3 X 10MM SUP-97-04206 CDM C1713 HCPCS 0278 RC outpatient 610.75 610.75 610.75 57 348.13 percent of total billed charges 610.75 93 494.71 percent of total billed charges 610.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 610.75 other OPPS APC 610.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 610.75 other OPPS APC 610.75 51 311.48 percent of total billed charges 610.75 610.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ANCHORAGE LOCKING 3 X 12MM SUP-97-04207 CDM C1713 HCPCS 0278 RC outpatient 610.75 610.75 610.75 57 348.13 percent of total billed charges 610.75 93 494.71 percent of total billed charges 610.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 610.75 other OPPS APC 610.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 610.75 other OPPS APC 610.75 51 311.48 percent of total billed charges 610.75 610.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ANCHORAGE LOCKING 3 X 14MM SUP-97-04208 CDM C1713 HCPCS 0278 RC outpatient 610.75 610.75 610.75 57 348.13 percent of total billed charges 610.75 93 494.71 percent of total billed charges 610.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 610.75 other OPPS APC 610.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 610.75 other OPPS APC 610.75 51 311.48 percent of total billed charges 610.75 610.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ANCHORAGE LOCKING 3 X 14MM SUP-97-04209 CDM C1713 HCPCS 0278 RC outpatient 610.75 610.75 610.75 57 348.13 percent of total billed charges 610.75 93 494.71 percent of total billed charges 610.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 610.75 other OPPS APC 610.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 610.75 other OPPS APC 610.75 51 311.48 percent of total billed charges 610.75 610.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONG NAIL KIT R1/5 TI RT 11 X420MM X 125 SUP-97-04210 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VARIAX DRILL GUIDE 2.0MM COMPRESSION SUP-97-04215 CDM 0272 RC outpatient 621.6 621.6 621.6 74 459.98 percent of total billed charges 621.6 93 503.5 percent of total billed charges 621.6 621.6 other OPPS APC 621.6 621.6 other OPPS APC 621.6 27.63 171.75 percent of total billed charges 621.6 621.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE DECREASED - 6 HOLE BRIDGE / RIGHT SUP-97-04216 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE SCREW T10 FULL THREAD 2.7MM / L24MM SUP-97-04217 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PT 6.5MM X 75MM SUP-97-04218 CDM C1713 HCPCS 0278 RC outpatient 738.48 738.48 738.48 57 420.93 percent of total billed charges 738.48 93 598.17 percent of total billed charges 738.48 738.48 other OPPS APC 738.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 738.48 other OPPS APC 738.48 51 376.62 percent of total billed charges 738.48 738.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG HIGH COMPRESSION 2.7MM X16MM SUP-97-04219 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG LOCKING THREADED 2.3MM X 10MM SUP-97-04220 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOULDER HEMI SUP-97-04221 CDM C1776 HCPCS 0278 RC outpatient 8400 8400 8400 57 4788 percent of total billed charges 8400 93 6804 percent of total billed charges 8400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8400 other OPPS APC 8400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8400 other OPPS APC 8400 51 4284 percent of total billed charges 8400 8400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASNIS III SS CANN SCR 6.5X80MM SUP-97-04222 CDM C1713 HCPCS 0278 RC outpatient 740.16 740.16 740.16 57 421.89 percent of total billed charges 740.16 93 599.53 percent of total billed charges 740.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 740.16 other OPPS APC 740.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 740.16 other OPPS APC 740.16 51 377.48 percent of total billed charges 740.16 740.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS III SS CANN 6.5 X 85MM SUP-97-04223 CDM C1713 HCPCS 0278 RC outpatient 618.24 618.24 618.24 57 352.4 percent of total billed charges 618.24 93 500.77 percent of total billed charges 618.24 618.24 other OPPS APC 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 51 315.3 percent of total billed charges 618.24 618.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIMING BLOCK SET SCREW M6X0.75 SUP-97-04224 CDM C1713 HCPCS 0278 RC outpatient 172.8 172.8 172.8 57 98.5 percent of total billed charges 172.8 93 139.97 percent of total billed charges 172.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 172.8 other OPPS APC 172.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 172.8 other OPPS APC 172.8 51 88.13 percent of total billed charges 172.8 172.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROXIMAL LATERAL 14 HOLE RIGHT SUP-97-04225 CDM C1713 HCPCS 0278 RC outpatient 3054.25 3054.25 3054.25 57 1740.92 percent of total billed charges 3054.25 93 2473.94 percent of total billed charges 3054.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3054.25 other OPPS APC 3054.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3054.25 other OPPS APC 3054.25 51 1557.67 percent of total billed charges 3054.25 3054.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL NAIL RT 12X440MM SUP-97-04226 CDM C1713 HCPCS 0278 RC outpatient 3967.7 3967.7 3967.7 57 2261.59 percent of total billed charges 3967.7 93 3213.84 percent of total billed charges 3967.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3967.7 other OPPS APC 3967.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3967.7 other OPPS APC 3967.7 51 2023.53 percent of total billed charges 3967.7 3967.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP T2 GTN SUP-97-04227 CDM C1713 HCPCS 0278 RC outpatient 505.12 505.12 505.12 57 287.92 percent of total billed charges 505.12 93 409.15 percent of total billed charges 505.12 505.12 other OPPS APC 505.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 505.12 other OPPS APC 505.12 51 257.61 percent of total billed charges 505.12 505.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ANCHOR SWIVELOCK 6.25X19.1MM SUP-97-04228 CDM C1713 HCPCS 0278 RC outpatient 1230 1230 1230 57 701.1 percent of total billed charges 1230 93 996.3 percent of total billed charges 1230 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1230 other OPPS APC 1230 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1230 other OPPS APC 1230 51 627.3 percent of total billed charges 1230 1230 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 10 X 20MM BC IF VENTED SUP-97-04229 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 885 other OPPS APC 885 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 10 X 30MM BC IF VENTED SUP-97-04230 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 11 X 30MM BC IF VENTED SUP-97-04231 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE SCREW TITANIUM 3.5X24MM SUP-97-04232 CDM C1713 HCPCS 0278 RC outpatient 210 210 210 57 119.7 percent of total billed charges 210 93 170.1 percent of total billed charges 210 210 other OPPS APC 210 210 other OPPS APC 210 51 107.1 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE SCREW TITANIUM 3.5X30MM SUP-97-04233 CDM C1713 HCPCS 0278 RC outpatient 210 210 210 57 119.7 percent of total billed charges 210 93 170.1 percent of total billed charges 210 210 other OPPS APC 210 210 other OPPS APC 210 51 107.1 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE SCREW TITANIUM 3.5X38MM SUP-97-04234 CDM C1713 HCPCS 0278 RC outpatient 210 210 210 57 119.7 percent of total billed charges 210 93 170.1 percent of total billed charges 210 210 other OPPS APC 210 210 other OPPS APC 210 51 107.1 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE SCREW LOCKING 3.5X28MM SUP-97-04235 CDM C1713 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE SCREW LOCKING 3.5X34MM SUP-97-04236 CDM C1713 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE SCREW LOCKING 3.5X36MM SUP-97-04237 CDM C1713 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CALC FX PERC LONG ANTERIOR PROCESS R SUP-97-04238 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANTERIOR TIBIALS TENDON 9MM SUP-97-04239 CDM C1762 HCPCS 0278 RC outpatient 5750 5750 5750 57 3277.5 percent of total billed charges 5750 93 4657.5 percent of total billed charges 5750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5750 other OPPS APC 5750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5750 other OPPS APC 5750 51 2932.5 percent of total billed charges 5750 5750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5X14MM CORTEX SELF TAP SCREW SUP-97-04240 CDM C1713 HCPCS 0278 RC outpatient 84.16 84.16 84.16 57 47.97 percent of total billed charges 84.16 93 68.17 percent of total billed charges 84.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84.16 other OPPS APC 84.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84.16 other OPPS APC 84.16 51 42.92 percent of total billed charges 84.16 84.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NO.6 TRIATHLON TS PLUS INSERT X3 POLY 22M SUP-97-04241 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANNULATED TI 4.0 X 38MM SUP-97-04242 CDM C1713 HCPCS 0278 RC outpatient 542.64 542.64 542.64 57 309.3 percent of total billed charges 542.64 93 439.54 percent of total billed charges 542.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.64 other OPPS APC 542.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.64 other OPPS APC 542.64 51 276.75 percent of total billed charges 542.64 542.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. P.F.C.*TIB STM EXT 4/5/6 30MM SUP-97-04245 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSN ASF CPS 16MM VE R 6-9EF SUP-97-04246 CDM C1776 HCPCS 0278 RC outpatient 6250 6250 6250 57 3562.5 percent of total billed charges 6250 93 5062.5 percent of total billed charges 6250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6250 other OPPS APC 6250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6250 other OPPS APC 6250 51 3187.5 percent of total billed charges 6250 6250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSN ASF CPS 16MM VE L 6-9EF SUP-97-04247 CDM C1776 HCPCS 0278 RC outpatient 6250 6250 6250 57 3562.5 percent of total billed charges 6250 93 5062.5 percent of total billed charges 6250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6250 other OPPS APC 6250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6250 other OPPS APC 6250 51 3187.5 percent of total billed charges 6250 6250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SP2 PAT PLANER BLDE/CTR DRL MD SUP-97-04248 CDM C1776 HCPCS 0278 RC outpatient 693 693 693 57 395.01 percent of total billed charges 693 93 561.33 percent of total billed charges 693 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 693 other OPPS APC 693 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 693 other OPPS APC 693 51 353.43 percent of total billed charges 693 693 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HP STRL THREADED PINS HEADED SUP-97-04249 CDM C1776 HCPCS 0278 RC outpatient 1542 1542 1542 57 878.94 percent of total billed charges 1542 93 1249.02 percent of total billed charges 1542 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1542 other OPPS APC 1542 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1542 other OPPS APC 1542 51 786.42 percent of total billed charges 1542 1542 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS COMPRESSION SCREW 7.0/L85MM SUP-97-04250 CDM C1713 HCPCS 0278 RC outpatient 1675.08 1675.08 1675.08 57 954.8 percent of total billed charges 1675.08 93 1356.81 percent of total billed charges 1675.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1675.08 other OPPS APC 1675.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1675.08 other OPPS APC 1675.08 51 854.29 percent of total billed charges 1675.08 1675.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL NAIL A/R R1500 SUP-97-04251 CDM C1713 HCPCS 0278 RC outpatient 3544.2 3544.2 3544.2 57 2020.19 percent of total billed charges 3544.2 93 2870.8 percent of total billed charges 3544.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3544.2 other OPPS APC 3544.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3544.2 other OPPS APC 3544.2 51 1807.54 percent of total billed charges 3544.2 3544.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PARS SUTURE IMPLANT KIT W/SUTURE TAPE SUP-97-04252 CDM C1713 HCPCS 0278 RC outpatient 3737.5 3737.5 3737.5 57 2130.38 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 51 1906.13 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ACHILLIES 23CM SUP-97-04253 CDM C1762 HCPCS 0278 RC outpatient 5500 5500 5500 57 3135 percent of total billed charges 5500 93 4455 percent of total billed charges 5500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5500 other OPPS APC 5500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5500 other OPPS APC 5500 51 2805 percent of total billed charges 5500 5500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ANTIROTATION 95MM SUP-97-04254 CDM C1713 HCPCS 0278 RC outpatient 801 801 801 57 456.57 percent of total billed charges 801 93 648.81 percent of total billed charges 801 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 801 other OPPS APC 801 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 801 other OPPS APC 801 51 408.51 percent of total billed charges 801 801 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOLT FOR FEMORAL NECK 95MM SUP-97-04255 CDM C1713 HCPCS 0278 RC outpatient 1188 1188 1188 57 677.16 percent of total billed charges 1188 93 962.28 percent of total billed charges 1188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1188 other OPPS APC 1188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1188 other OPPS APC 1188 51 605.88 percent of total billed charges 1188 1188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE FEMORAL NECK SYSTEMS 2 HOLE SUP-97-04256 CDM C1713 HCPCS 0278 RC outpatient 2403 2403 2403 57 1369.71 percent of total billed charges 2403 93 1946.43 percent of total billed charges 2403 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2403 other OPPS APC 2403 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2403 other OPPS APC 2403 51 1225.53 percent of total billed charges 2403 2403 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI LOCKING 48MM X 5MM SUP-97-04257 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOLT FOR FEMORAL NECK SYSTEM 80MM SUP-97-04258 CDM C1713 HCPCS 0278 RC outpatient 1188 1188 1188 57 677.16 percent of total billed charges 1188 93 962.28 percent of total billed charges 1188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1188 other OPPS APC 1188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1188 other OPPS APC 1188 51 605.88 percent of total billed charges 1188 1188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ANTIROTATION 80MM SUP-97-04259 CDM C1713 HCPCS 0278 RC outpatient 801 801 801 57 456.57 percent of total billed charges 801 93 648.81 percent of total billed charges 801 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 801 other OPPS APC 801 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 801 other OPPS APC 801 51 408.51 percent of total billed charges 801 801 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE FEMORAL NECK SYSTEM 1 HOLE SUP-97-04260 CDM C1713 HCPCS 0278 RC outpatient 2403 2403 2403 57 1369.71 percent of total billed charges 2403 93 1946.43 percent of total billed charges 2403 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2403 other OPPS APC 2403 2403 other OPPS APC 2403 51 1225.53 percent of total billed charges 2403 2403 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW COMPR FT 4.0MM X 42MM SUP-97-04261 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW COMPR FT 4.0MM X 44MM SUP-97-04262 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TI CANN TFNA 11MM/130DEG 170MM SUP-97-04263 CDM C1713 HCPCS 0278 RC outpatient 4172.78 4172.78 4172.78 57 2378.48 percent of total billed charges 4172.78 93 3379.95 percent of total billed charges 4172.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4172.78 other OPPS APC 4172.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4172.78 other OPPS APC 4172.78 51 2128.12 percent of total billed charges 4172.78 4172.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENFLEX2 KNEE THREE PEG PATELLA SUP-97-04264 CDM C1713 HCPCS 0278 RC outpatient 2170.5 2170.5 2170.5 57 1237.19 percent of total billed charges 2170.5 93 1758.11 percent of total billed charges 2170.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2170.5 other OPPS APC 2170.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2170.5 other OPPS APC 2170.5 51 1106.96 percent of total billed charges 2170.5 2170.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "INTERNAL BRACE KIT,W/CC FT & JUMP START" SUP-97-04266 CDM C1713 HCPCS 0278 RC outpatient 3737.5 3737.5 3737.5 57 2130.38 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 51 1906.13 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "2-0 FIBERWIRE LOOP 60""W/DIA.NEEDLE 48MM" SUP-97-04267 CDM C1713 HCPCS 0278 RC outpatient 200 200 200 57 114 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 51 102 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LOW PRO SCREW,TI,6.7 X 45MM" SUP-97-04268 CDM C1713 HCPCS 0278 RC outpatient 750 750 750 57 427.5 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 750 other OPPS APC 750 51 382.5 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LOW PRO SCREW,TI,6.7 X 50MM" SUP-97-04269 CDM C1713 HCPCS 0278 RC outpatient 750 750 750 57 427.5 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 750 other OPPS APC 750 51 382.5 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.0X40 MM L KING SUP-97-04270 CDM C1713 HCPCS 0278 RC outpatient 604.45 604.45 604.45 57 344.54 percent of total billed charges 604.45 93 489.6 percent of total billed charges 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 604.45 other OPPS APC 604.45 51 308.27 percent of total billed charges 604.45 604.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON FEM DISTAL 5MM-SIZE 2 RIGHT SUP-97-04271 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENFLEX2 KNEE THREE PEG PATELLA SUP-97-04272 CDM C1776 HCPCS 0278 RC outpatient 2170.5 2170.5 2170.5 57 1237.19 percent of total billed charges 2170.5 93 1758.11 percent of total billed charges 2170.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2170.5 other OPPS APC 2170.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2170.5 other OPPS APC 2170.5 51 1106.96 percent of total billed charges 2170.5 2170.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PS X3 TIBIAL INSERT SUP-97-04273 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL X3 BEARING INSERT PS SZ4 11MM SUP-97-04274 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NO.3 TS PLUS TIBIAL INSERT X3 POLY 9MM SUP-97-04275 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERTAK DX SUTURE ANCHOR W/1.3MM FIBER SUP-97-04276 CDM C1713 HCPCS 0278 RC outpatient 1395 1395 1395 57 795.15 percent of total billed charges 1395 93 1129.95 percent of total billed charges 1395 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1395 other OPPS APC 1395 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1395 other OPPS APC 1395 51 711.45 percent of total billed charges 1395 1395 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "DISPOSABLES KIT,FOR DX FIBERTAK" SUP-97-04277 CDM C1713 HCPCS 0278 RC outpatient 825 825 825 57 470.25 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 51 420.75 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK SUP-97-04278 CDM 0272 RC outpatient 1082.88 1082.88 1082.88 74 801.33 percent of total billed charges 1082.88 93 877.13 percent of total billed charges 1082.88 1082.88 other OPPS APC 1082.88 1082.88 other OPPS APC 1082.88 27.63 299.2 percent of total billed charges 1082.88 1082.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX LOCKING 3.5MM X 36MM SUP-97-04279 CDM C1713 HCPCS 0278 RC outpatient 143.36 143.36 143.36 57 81.72 percent of total billed charges 143.36 93 116.12 percent of total billed charges 143.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 143.36 other OPPS APC 143.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 143.36 other OPPS APC 143.36 51 73.11 percent of total billed charges 143.36 143.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX LOCKING 4.0MM X 40MM SUP-97-04280 CDM C1713 HCPCS 0278 RC outpatient 143.36 143.36 143.36 57 81.72 percent of total billed charges 143.36 93 116.12 percent of total billed charges 143.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 143.36 other OPPS APC 143.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 143.36 other OPPS APC 143.36 51 73.11 percent of total billed charges 143.36 143.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED SCREW COUPLING HEX 2.5 SUP-97-04282 CDM C1713 HCPCS 0278 RC outpatient 732.96 732.96 732.96 57 417.79 percent of total billed charges 732.96 93 593.7 percent of total billed charges 732.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 732.96 other OPPS APC 732.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 732.96 other OPPS APC 732.96 51 373.81 percent of total billed charges 732.96 732.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0X46MM PART.THD.CAN.SCREW SUP-97-04283 CDM C1713 HCPCS 0278 RC outpatient 396.48 396.48 396.48 57 225.99 percent of total billed charges 396.48 93 321.15 percent of total billed charges 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 51 202.2 percent of total billed charges 396.48 396.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BROAD PLATE SUP-97-04284 CDM C1713 HCPCS 0278 RC outpatient 4090.8 4090.8 4090.8 57 2331.76 percent of total billed charges 4090.8 93 3313.55 percent of total billed charges 4090.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4090.8 other OPPS APC 4090.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4090.8 other OPPS APC 4090.8 51 2086.31 percent of total billed charges 4090.8 4090.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 36MM COCR MOD HD +6MM SUP-97-04285 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARCOS CAL SZ B +0 HI 60MM SUP-97-04286 CDM C1776 HCPCS 0278 RC outpatient 15087.5 15087.5 15087.5 57 8599.88 percent of total billed charges 15087.5 93 12220.9 percent of total billed charges 15087.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15087.5 other OPPS APC 15087.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15087.5 other OPPS APC 15087.5 51 7694.63 percent of total billed charges 15087.5 15087.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARCOS 17X150MM SPL TPR DIST SUP-97-04287 CDM C1776 HCPCS 0278 RC outpatient 9718.75 9718.75 9718.75 57 5539.69 percent of total billed charges 9718.75 93 7872.19 percent of total billed charges 9718.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9718.75 other OPPS APC 9718.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9718.75 other OPPS APC 9718.75 51 4956.56 percent of total billed charges 9718.75 9718.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTINUUM CLUSTER-HOLE SHELL 56KK SUP-97-04288 CDM C1776 HCPCS 0278 RC outpatient 5828.13 5828.13 5828.13 57 3322.03 percent of total billed charges 5828.13 93 4720.79 percent of total billed charges 5828.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5828.13 other OPPS APC 5828.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5828.13 other OPPS APC 5828.13 51 2972.35 percent of total billed charges 5828.13 5828.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTINUUM VIVACIT-E ELEV.LINER KK 36X56 SUP-97-04289 CDM C1776 HCPCS 0278 RC outpatient 5359.38 5359.38 5359.38 57 3054.85 percent of total billed charges 5359.38 93 4341.1 percent of total billed charges 5359.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5359.38 other OPPS APC 5359.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5359.38 other OPPS APC 5359.38 51 2733.28 percent of total billed charges 5359.38 5359.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE SCREW 6.5 X 30 SELF-TAP SUP-97-04290 CDM C1776 HCPCS 0278 RC outpatient 503.13 503.13 503.13 57 286.78 percent of total billed charges 503.13 93 407.54 percent of total billed charges 503.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 503.13 other OPPS APC 503.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 503.13 other OPPS APC 503.13 51 256.6 percent of total billed charges 503.13 503.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T2 SHAFT SCREW 5MM X 50MM SUP-97-04291 CDM C1776 HCPCS 0278 RC outpatient 583.66 583.66 583.66 57 332.69 percent of total billed charges 583.66 93 472.76 percent of total billed charges 583.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 583.66 other OPPS APC 583.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 583.66 other OPPS APC 583.66 51 297.67 percent of total billed charges 583.66 583.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON CS INS SIZE 2 9MM SUP-97-04293 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSN ASF CPS 20MM VE L6-9EF SUP-97-04294 CDM C1776 HCPCS 0278 RC outpatient 4370 4370 4370 57 2490.9 percent of total billed charges 4370 93 3539.7 percent of total billed charges 4370 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4370 other OPPS APC 4370 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4370 other OPPS APC 4370 51 2228.7 percent of total billed charges 4370 4370 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TIBIA 8MM CANN EX 330 MM SUP-97-04295 CDM C1713 HCPCS 0278 RC outpatient 3930.53 3930.53 3930.53 57 2240.4 percent of total billed charges 3930.53 93 3183.73 percent of total billed charges 3930.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3930.53 other OPPS APC 3930.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3930.53 other OPPS APC 3930.53 51 2004.57 percent of total billed charges 3930.53 3930.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANCELLOUS SCREW 4.0 X 26MM SUP-97-04296 CDM C1713 HCPCS 0278 RC outpatient 68.64 68.64 68.64 57 39.12 percent of total billed charges 68.64 93 55.6 percent of total billed charges 68.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 68.64 other OPPS APC 68.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 68.64 other OPPS APC 68.64 51 35.01 percent of total billed charges 68.64 68.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENFLEX2 KNEE FEMUR PS LEFT SUP-97-04297 CDM C1776 HCPCS 0278 RC outpatient 4000 4000 4000 57 2280 percent of total billed charges 4000 93 3240 percent of total billed charges 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 51 2040 percent of total billed charges 4000 4000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENTED TIBAL TRAY SZ4 TIB SZ 4 FEM SUP-97-04298 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENFLEX2 KNEE EXP PS INSERT SUP-97-04299 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PINNACLE 300 ACET CUP 48 MM SUP-97-04301 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUMMIT POR TAPER SZ3 STD OFF SUP-97-04302 CDM C1776 HCPCS 0278 RC outpatient 5000 5000 5000 57 2850 percent of total billed charges 5000 93 4050 percent of total billed charges 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 51 2550 percent of total billed charges 5000 5000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DELTA CER HEAD 12/14 32MM +9 SUP-97-04303 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON ASYMMETRIC X3 PATELLA SUP-97-04304 CDM C1776 HCPCS 0278 RC outpatient 810 810 810 57 461.7 percent of total billed charges 810 93 656.1 percent of total billed charges 810 810 other OPPS APC 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 51 413.1 percent of total billed charges 810 810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIT.ASYM.METAL BACKED PATAELLA A35X10 SUP-97-04305 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS FEM COMP-BEADED W/PA SUP-97-04306 CDM C1776 HCPCS 0278 RC outpatient 3125 3125 3125 57 1781.25 percent of total billed charges 3125 93 2531.25 percent of total billed charges 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 51 1593.75 percent of total billed charges 3125 3125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI.TRITANIUM BASEPLATE SIZE 6 SUP-97-04307 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS X3 TIBAL INSERT SUP-97-04308 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX MIRABO CUP 50MM-B SUP-97-04309 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX BONE SCREW 25MM SUP-97-04310 CDM C1776 HCPCS 0278 RC outpatient 238 238 238 57 135.66 percent of total billed charges 238 93 192.78 percent of total billed charges 238 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238 other OPPS APC 238 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238 other OPPS APC 238 51 121.38 percent of total billed charges 238 238 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIRABO PE LINER 32/39 STANDARD C SUP-97-04311 CDM C1776 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX M STEM NO.1 SUP-97-04312 CDM C1776 HCPCS 0278 RC outpatient 5000 5000 5000 57 2850 percent of total billed charges 5000 93 4050 percent of total billed charges 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 51 2550 percent of total billed charges 5000 5000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX DELTA HEAD 32MM MEDIUM SUP-97-04313 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS X3 TIBAL INSERT SUP-97-04315 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOWASHER 10 X 14X 2.0MM SUP-97-04316 CDM Q4125 HCPCS 0636 RC outpatient 1776 1776 1776 74 1314.24 percent of total billed charges 1776 93 1438.56 percent of total billed charges 1776 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1776 other OPPS APC 1776 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1776 other OPPS APC 1776 24.86 441.51 percent of total billed charges 1776 1776 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONG NAIL KIT R1/5 TI LFT 11X420MM SUP-97-04317 CDM C1713 HCPCS 0278 RC outpatient 4747.6 4747.6 4747.6 57 2706.13 percent of total billed charges 4747.6 93 3845.56 percent of total billed charges 4747.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4747.6 other OPPS APC 4747.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4747.6 other OPPS APC 4747.6 51 2421.28 percent of total billed charges 4747.6 4747.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DLT TS CER HD 12/14 32MM +1 SUP-97-04322 CDM C1776 HCPCS 0278 RC outpatient 6196.25 6196.25 6196.25 57 3531.86 percent of total billed charges 6196.25 93 5018.96 percent of total billed charges 6196.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6196.25 other OPPS APC 6196.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6196.25 other OPPS APC 6196.25 51 3160.09 percent of total billed charges 6196.25 6196.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED COUNTERSINK SUP-97-04323 CDM 0272 RC outpatient 851.04 851.04 851.04 74 629.77 percent of total billed charges 851.04 93 689.34 percent of total billed charges 851.04 851.04 other OPPS APC 851.04 851.04 other OPPS APC 851.04 27.63 235.14 percent of total billed charges 851.04 851.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENFLEX2 KNEE FEMUR PS RT SUP-97-04324 CDM C1776 HCPCS 0278 RC outpatient 4000 4000 4000 57 2280 percent of total billed charges 4000 93 3240 percent of total billed charges 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 51 2040 percent of total billed charges 4000 4000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENTED TIBAL SZ3TIB SZ 3 FEM SUP-97-04325 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENFLEX2 KNEE EXP PS INSERT SUP-97-04326 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POLYAXIAL LOCKING PLATE LEFT(T8) SUP-97-04327 CDM C1713 HCPCS 0278 RC outpatient 5488 5488 5488 57 3128.16 percent of total billed charges 5488 93 4445.28 percent of total billed charges 5488 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5488 other OPPS APC 5488 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5488 other OPPS APC 5488 51 2798.88 percent of total billed charges 5488 5488 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CP LAG SCREW+3.6MM L30MM(T8) SUP-97-04328 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT TIBIAL INSERT FIXED BEARING CURVED PLUS SIZE 2 15MM SUP-97-0433 CDM 270010024 LOCAL 0270 RC outpatient 4977.96 4977.96 4977.96 74 3683.69 percent of total billed charges 4977.96 93 4032.15 percent of total billed charges 4977.96 4977.96 other OPPS APC 4977.96 4977.96 other OPPS APC 4977.96 27.63 1375.41 percent of total billed charges 4977.96 4977.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EASYCUP FIXATION DEVICE 15X12X12 SUP-97-04330 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRITANIUM ASYMMETRIC PATELLA A38X11 SUP-97-04331 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS FEM COMPONENT BEADED W/PA SUP-97-04332 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM CEMENTED SUP-97-04333 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURETAPE 1.3MM W/TAILS WHITE/BLUE SUP-97-04334 CDM C1713 HCPCS 0278 RC outpatient 140 140 140 57 79.8 percent of total billed charges 140 93 113.4 percent of total billed charges 140 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 140 other OPPS APC 140 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 140 other OPPS APC 140 51 71.4 percent of total billed charges 140 140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISP KIT FOR DX SWIVELOCK SL 3.5X8.5MM SUP-97-04335 CDM C1713 HCPCS 0278 RC outpatient 825 825 825 57 470.25 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 51 420.75 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DX SWIVELOCK SL 3.5X8.5MM W/FORK EYELET SUP-97-04336 CDM C1713 HCPCS 0278 RC outpatient 1275 1275 1275 57 726.75 percent of total billed charges 1275 93 1032.75 percent of total billed charges 1275 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1275 other OPPS APC 1275 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1275 other OPPS APC 1275 51 650.25 percent of total billed charges 1275 1275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENFLEX KNEE FEMUR PS LEFT SUP-97-04337 CDM C1776 HCPCS 0278 RC outpatient 4000 4000 4000 57 2280 percent of total billed charges 4000 93 3240 percent of total billed charges 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 51 2040 percent of total billed charges 4000 4000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 16.5D SUP-97-04338 CDM C1780 HCPCS 0278 RC outpatient 402.5 402.5 402.5 57 229.43 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 51 205.28 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS X3 TIBAL INSERT SUP-97-04339 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAN.TAP 4.0 MM SUP-97-04340 CDM C1713 HCPCS 0278 RC outpatient 559.44 559.44 559.44 57 318.88 percent of total billed charges 559.44 93 453.15 percent of total billed charges 559.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 559.44 other OPPS APC 559.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 559.44 other OPPS APC 559.44 51 285.31 percent of total billed charges 559.44 559.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0 X 30MM PART THD SCREW SUP-97-04341 CDM C1713 HCPCS 0278 RC outpatient 396.48 396.48 396.48 57 225.99 percent of total billed charges 396.48 93 321.15 percent of total billed charges 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 51 202.2 percent of total billed charges 396.48 396.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0 X 70 MM PART THD SCREW SUP-97-04342 CDM C1713 HCPCS 0278 RC outpatient 542.64 542.64 542.64 57 309.3 percent of total billed charges 542.64 93 439.54 percent of total billed charges 542.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.64 other OPPS APC 542.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.64 other OPPS APC 542.64 51 276.75 percent of total billed charges 542.64 542.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW FULL THRD CANN 4.0 X 42MM SUP-97-04343 CDM C1713 HCPCS 0278 RC outpatient 542.64 542.64 542.64 57 309.3 percent of total billed charges 542.64 93 439.54 percent of total billed charges 542.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.64 other OPPS APC 542.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.64 other OPPS APC 542.64 51 276.75 percent of total billed charges 542.64 542.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JOYSTICH FOR SCREW HOLES SUP-97-04344 CDM C9364 HCPCS 0278 RC outpatient 1198.08 1198.08 1198.08 57 682.91 percent of total billed charges 1198.08 93 970.44 percent of total billed charges 1198.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1198.08 other OPPS APC 1198.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1198.08 other OPPS APC 1198.08 51 611.02 percent of total billed charges 1198.08 1198.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPEED GUIDE FOR 2.7 SCREW SUP-97-04345 CDM 0272 RC outpatient 1025.28 1025.28 1025.28 74 758.71 percent of total billed charges 1025.28 93 830.48 percent of total billed charges 1025.28 1025.28 other OPPS APC 1025.28 1025.28 other OPPS APC 1025.28 27.63 283.28 percent of total billed charges 1025.28 1025.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK FEMORAL-LM-RL-SZ 3 SUP-97-04346 CDM C1776 HCPCS 0278 RC outpatient 3562.5 3562.5 3562.5 57 2030.63 percent of total billed charges 3562.5 93 2885.63 percent of total billed charges 3562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3562.5 other OPPS APC 3562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3562.5 other OPPS APC 3562.5 51 1816.88 percent of total billed charges 3562.5 3562.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBAL BASEPLATE-LM/RL-SZ 3 SUP-97-04347 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBAL ONLAY INSERT-SZ 3-8MM SUP-97-04348 CDM C1776 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATH PS FEM COMP-BEADED W/PA SUP-97-04349 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIA TRITANIUM BASEPLATE SIZE 8 SUP-97-04350 CDM C1776 HCPCS 0278 RC outpatient 3700 3700 3700 57 2109 percent of total billed charges 3700 93 2997 percent of total billed charges 3700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3700 other OPPS APC 3700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3700 other OPPS APC 3700 51 1887 percent of total billed charges 3700 3700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIA TRITANIUM BASEPLATE SIZE 3 SUP-97-04351 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIA PS FEM COMPONENT BEADED W/PA SUP-97-04352 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIA CR FEM COMPONENT BEADED W/PA SUP-97-04353 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIA CS INS SIZE3 11MM SUP-97-04354 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT II TRITANIUM CLUSTERHOLE 60G SUP-97-04355 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.5MM LOW PROFILE HEX SCREW 25MM SUP-97-04356 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT II TRITANIUM CLUSERHOLE 52E SUP-97-04357 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT II TRITANIUM CLUSTERHOLE 54E SUP-97-04358 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASYMMETRIC PATELLA 29X9 CEMENTED SUP-97-04359 CDM C1776 HCPCS 0278 RC outpatient 810 810 810 57 461.7 percent of total billed charges 810 93 656.1 percent of total billed charges 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 51 413.1 percent of total billed charges 810 810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSC17361- ATTUNE FB CEMENTED SUP-97-04360 CDM C1776 HCPCS 0278 RC outpatient 9000 9000 9000 57 5130 percent of total billed charges 9000 93 7290 percent of total billed charges 9000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9000 other OPPS APC 9000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9000 other OPPS APC 9000 51 4590 percent of total billed charges 9000 9000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS X3 TIBAL INSERT SUP-97-04361 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON TRITANIUM BASEPLATE SIZE 4 SUP-97-04362 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS X3 TIBAL INSERT SUP-97-04363 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTINUUM CLUSTER-HOLE SHELL 50 HH SUP-97-04364 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTINUUM VIVACIT-E ELE.LINER HH32X50 SUP-97-04365 CDM C1776 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOLOX DELTA FEM HEAD 32MM +7MM SUP-97-04366 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERSYS FM MC CLR 12X140MM STD BODY EXT SUP-97-04367 CDM C1776 HCPCS 0278 RC outpatient 5000 5000 5000 57 2850 percent of total billed charges 5000 93 4050 percent of total billed charges 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 51 2550 percent of total billed charges 5000 5000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON ASYMMETRIC X3 PATELLA SUP-97-04368 CDM C1776 HCPCS 0278 RC outpatient 810 810 810 57 461.7 percent of total billed charges 810 93 656.1 percent of total billed charges 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 51 413.1 percent of total billed charges 810 810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS X3 TIBAL INSERT SUP-97-04369 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON ASYMMETRIC X3 PATELLA SUP-97-04370 CDM C1776 HCPCS 0278 RC outpatient 810 810 810 57 461.7 percent of total billed charges 810 93 656.1 percent of total billed charges 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 810 other OPPS APC 810 51 413.1 percent of total billed charges 810 810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS X3 TIBAL INSERT SUP-97-04371 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMPONENET BEAD W/PA SUP-97-04372 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON TRITANIUM BASEPLATE SIZE 2 SUP-97-04373 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON CS INS SIZE3 9MM SUP-97-04374 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS FEM COMPONET BEAD W/PA SUP-97-04375 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON TRITANIUM BASEPLATE SIZE 7 SUP-97-04376 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS FEM COMPONENT BEAD W/PA SUP-97-04377 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIANIUM ASY.METAL BACK PATELLA A40X11 SUP-97-04378 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS X3 TIBAL INSERT SUP-97-04379 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THREADED GUIRE WIRE W/TROCAR 1.35MM SUP-97-04380 CDM 0272 RC outpatient 80 80 80 74 59.2 percent of total billed charges 80 93 64.8 percent of total billed charges 80 80 other OPPS APC 80 80 other OPPS APC 80 27.63 22.1 percent of total billed charges 80 80 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUICKFIX SCREW TI CANN ST4.0X42MM SUP-97-04381 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE SCREW TITANIUM 3.5MMX22MM SUP-97-04382 CDM C1713 HCPCS 0278 RC outpatient 210 210 210 57 119.7 percent of total billed charges 210 93 170.1 percent of total billed charges 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 51 107.1 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE SCREW TITANIUM 3.5MM X42MM SUP-97-04383 CDM C1713 HCPCS 0278 RC outpatient 210 210 210 57 119.7 percent of total billed charges 210 93 170.1 percent of total billed charges 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 51 107.1 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE LOCKING SCREW TIT 3.5MMX20MM SUP-97-04384 CDM C1713 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE SCREW TIT 4.5NN X 50MM CANNU SUP-97-04385 CDM C1713 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.2 X 5MM STANDARD PLATE ST. 4 HOLE SUP-97-04386 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING CROSSPIN ST 2.3 X 13MM SUP-97-04387 CDM C1713 HCPCS 0278 RC outpatient 318.99 318.99 318.99 57 181.82 percent of total billed charges 318.99 93 258.38 percent of total billed charges 318.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 318.99 other OPPS APC 318.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 318.99 other OPPS APC 318.99 51 162.68 percent of total billed charges 318.99 318.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCKG CRSSPIN ST 2.3 X 11MM SUP-97-04388 CDM C1713 HCPCS 0278 RC outpatient 296.94 296.94 296.94 57 169.26 percent of total billed charges 296.94 93 240.52 percent of total billed charges 296.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 296.94 other OPPS APC 296.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 296.94 other OPPS APC 296.94 51 151.44 percent of total billed charges 296.94 296.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.3 M COMP.PLATE RT 6 HOLES SUP-97-04389 CDM C1713 HCPCS 0278 RC outpatient 945 945 945 57 538.65 percent of total billed charges 945 93 765.45 percent of total billed charges 945 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 945 other OPPS APC 945 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 945 other OPPS APC 945 51 481.95 percent of total billed charges 945 945 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.6 MM SPEED GUIDE DRILL SUP-97-04390 CDM 0272 RC outpatient 631.68 631.68 631.68 74 467.44 percent of total billed charges 631.68 93 511.66 percent of total billed charges 631.68 631.68 other OPPS APC 631.68 631.68 other OPPS APC 631.68 27.63 174.53 percent of total billed charges 631.68 631.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LCKNG 2.7MM X 16MM SUP-97-04391 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7 X 28MM T8 FULL THREAD SUP-97-04392 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 NON LCKNG 2.7MM X 24MM SUP-97-04393 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VOLAR SMRTLCK STD LEFT LONG SUP-97-04394 CDM C1713 HCPCS 0278 RC outpatient 2815.5 2815.5 2815.5 57 1604.84 percent of total billed charges 2815.5 93 2280.56 percent of total billed charges 2815.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2815.5 other OPPS APC 2815.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2815.5 other OPPS APC 2815.5 51 1435.91 percent of total billed charges 2815.5 2815.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DELTA CER HEAD 12/14 36MM+5 SUP-97-04395 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALTRX NEUT 36IDX52OD SUP-97-04396 CDM C1776 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUMMIT POR TAPER SZ6 STD OFF SUP-97-04397 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PINNACLE 300 ACET CUP 52MM SUP-97-04398 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERSYS FM MC CLR 12X140MM STD BODY NECK SUP-97-04399 CDM C1776 HCPCS 0278 RC outpatient 8150 8150 8150 57 4645.5 percent of total billed charges 8150 93 6601.5 percent of total billed charges 8150 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8150 other OPPS APC 8150 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8150 other OPPS APC 8150 51 4156.5 percent of total billed charges 8150 8150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 12/14 COCR FEMORAL HEAD 22MM+0 SUP-97-04400 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLAR LINER 42/43 OD X 22MM ID SUP-97-04401 CDM C1776 HCPCS 0278 RC outpatient 855 855 855 57 487.35 percent of total billed charges 855 93 692.55 percent of total billed charges 855 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 855 other OPPS APC 855 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 855 other OPPS APC 855 51 436.05 percent of total billed charges 855 855 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLAR SHELL 43MM OD SUP-97-04402 CDM C1776 HCPCS 0278 RC outpatient 1567.5 1567.5 1567.5 57 893.48 percent of total billed charges 1567.5 93 1269.68 percent of total billed charges 1567.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1567.5 other OPPS APC 1567.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1567.5 other OPPS APC 1567.5 51 799.43 percent of total billed charges 1567.5 1567.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 NON LCKNG 2.7MM X 28MM SUP-97-04403 CDM C1713 HCPCS 0278 RC outpatient 301 301 301 57 171.57 percent of total billed charges 301 93 243.81 percent of total billed charges 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 51 153.51 percent of total billed charges 301 301 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LCKNG 2.7MM X 26MM SUP-97-04404 CDM C1713 HCPCS 0278 RC outpatient 516.25 516.25 516.25 57 294.26 percent of total billed charges 516.25 93 418.16 percent of total billed charges 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 51 263.29 percent of total billed charges 516.25 516.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HELICAL FENESTRATED BLADE 75MM TFNA SUP-97-04405 CDM C1713 HCPCS 0278 RC outpatient 2304 2304 2304 57 1313.28 percent of total billed charges 2304 93 1866.24 percent of total billed charges 2304 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2304 other OPPS APC 2304 2304 other OPPS APC 2304 51 1175.04 percent of total billed charges 2304 2304 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 1.6 X 200 MM SUP-97-04406 CDM C1713 HCPCS 0278 RC outpatient 160 160 160 57 91.2 percent of total billed charges 160 93 129.6 percent of total billed charges 160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160 other OPPS APC 160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160 other OPPS APC 160 51 81.6 percent of total billed charges 160 160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO-PRO SCREW CANN BLUNT TIP 4X30 MM SUP-97-04407 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO-PRO SCREW CANN BLUNT TIP 4 X 32 MM SUP-97-04408 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5MM TI MULTILOC SCREW LENGTH 29MM SUP-97-04409 CDM C1713 HCPCS 0278 RC outpatient 811.8 811.8 811.8 57 462.73 percent of total billed charges 811.8 93 657.56 percent of total billed charges 811.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 811.8 other OPPS APC 811.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 811.8 other OPPS APC 811.8 51 414.02 percent of total billed charges 811.8 811.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5MM TI MULTILOC SCREW LENGTH 28MM SUP-97-04410 CDM C1713 HCPCS 0278 RC outpatient 811.8 811.8 811.8 57 462.73 percent of total billed charges 811.8 93 657.56 percent of total billed charges 811.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 811.8 other OPPS APC 811.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 811.8 other OPPS APC 811.8 51 414.02 percent of total billed charges 811.8 811.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. .91 MM KWIRE SUP-97-04411 CDM C1713 HCPCS 0278 RC outpatient 82.56 82.56 82.56 57 47.06 percent of total billed charges 82.56 93 66.87 percent of total billed charges 82.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 82.56 other OPPS APC 82.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 82.56 other OPPS APC 82.56 51 42.11 percent of total billed charges 82.56 82.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 16MM SUP-97-04412 CDM C1713 HCPCS 0278 RC outpatient 747.36 747.36 747.36 57 426 percent of total billed charges 747.36 93 605.36 percent of total billed charges 747.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 747.36 other OPPS APC 747.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 747.36 other OPPS APC 747.36 51 381.15 percent of total billed charges 747.36 747.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4 X 14 MM LKNG SUP-97-04413 CDM C1713 HCPCS 0278 RC outpatient 432.25 432.25 432.25 57 246.38 percent of total billed charges 432.25 93 350.12 percent of total billed charges 432.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.25 other OPPS APC 432.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.25 other OPPS APC 432.25 51 220.45 percent of total billed charges 432.25 432.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4 X 24 MM LKNG SUP-97-04414 CDM C1713 HCPCS 0278 RC outpatient 467.53 467.53 467.53 57 266.49 percent of total billed charges 467.53 93 378.7 percent of total billed charges 467.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 467.53 other OPPS APC 467.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 467.53 other OPPS APC 467.53 51 238.44 percent of total billed charges 467.53 467.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4 X 14MM LOCKING SCREW SUP-97-04415 CDM C1713 HCPCS 0278 RC outpatient 516.25 516.25 516.25 57 294.26 percent of total billed charges 516.25 93 418.16 percent of total billed charges 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 516.25 other OPPS APC 516.25 51 263.29 percent of total billed charges 516.25 516.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4 X 18MM LOCKING SCREW SUP-97-04416 CDM C1713 HCPCS 0278 RC outpatient 516.25 516.25 516.25 57 294.26 percent of total billed charges 516.25 93 418.16 percent of total billed charges 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 51 263.29 percent of total billed charges 516.25 516.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4 X 12MM LOCKING SCREW SUP-97-04417 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4 X 14MM LOCKING SCREW SUP-97-04418 CDM C1713 HCPCS 0278 RC outpatient 301 301 301 57 171.57 percent of total billed charges 301 93 243.81 percent of total billed charges 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 51 153.51 percent of total billed charges 301 301 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBON FIBER VEC. CONNECTING 11X350MM SUP-97-04419 CDM C1713 HCPCS 0278 RC outpatient 1011.36 1011.36 1011.36 57 576.48 percent of total billed charges 1011.36 93 819.2 percent of total billed charges 1011.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1011.36 other OPPS APC 1011.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1011.36 other OPPS APC 1011.36 51 515.79 percent of total billed charges 1011.36 1011.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN-SELF DRILLING 5 X250MM SUP-97-04420 CDM C1713 HCPCS 0278 RC outpatient 468.72 468.72 468.72 57 267.17 percent of total billed charges 468.72 93 379.66 percent of total billed charges 468.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 468.72 other OPPS APC 468.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 468.72 other OPPS APC 468.72 51 239.05 percent of total billed charges 468.72 468.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T10 FULL THREAD 2.7MM X 8MM SUP-97-04422 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POST LATERAL LEFT 6HOLE 2.7/3.5 PLATE SUP-97-04423 CDM C1713 HCPCS 0278 RC outpatient 1961.37 1961.37 1961.37 57 1117.98 percent of total billed charges 1961.37 93 1588.71 percent of total billed charges 1961.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1961.37 other OPPS APC 1961.37 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1961.37 other OPPS APC 1961.37 51 1000.3 percent of total billed charges 1961.37 1961.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN LONG THREAD 4MM X 58MM SUP-97-04424 CDM C1713 HCPCS 0278 RC outpatient 676.76 676.76 676.76 57 385.75 percent of total billed charges 676.76 93 548.18 percent of total billed charges 676.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 676.76 other OPPS APC 676.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 676.76 other OPPS APC 676.76 51 345.15 percent of total billed charges 676.76 676.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONG NAIL KIT 11 X 420MM X 130 SUP-97-04425 CDM C1713 HCPCS 0278 RC outpatient 4747.6 4747.6 4747.6 57 2706.13 percent of total billed charges 4747.6 93 3845.56 percent of total billed charges 4747.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4747.6 other OPPS APC 4747.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4747.6 other OPPS APC 4747.6 51 2421.28 percent of total billed charges 4747.6 4747.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHORAGE LISFRANC PLATING MED.LS SUP-97-04426 CDM C1713 HCPCS 0278 RC outpatient 3067.5 3067.5 3067.5 57 1748.48 percent of total billed charges 3067.5 93 2484.68 percent of total billed charges 3067.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3067.5 other OPPS APC 3067.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3067.5 other OPPS APC 3067.5 51 1564.43 percent of total billed charges 3067.5 3067.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHORAGE 2.0MM X 110MM CALI.REAMER SUP-97-04427 CDM C1713 HCPCS 0278 RC outpatient 567.84 567.84 567.84 57 323.67 percent of total billed charges 567.84 93 459.95 percent of total billed charges 567.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 567.84 other OPPS APC 567.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 567.84 other OPPS APC 567.84 51 289.6 percent of total billed charges 567.84 567.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHORAGE LOCKING SCREW 3.5MM X 24MM SUP-97-04428 CDM C1713 HCPCS 0278 RC outpatient 598.5 598.5 598.5 57 341.15 percent of total billed charges 598.5 93 484.79 percent of total billed charges 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 51 305.24 percent of total billed charges 598.5 598.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHORAGE STANDARD SCREW 3MM X 24MM SUP-97-04429 CDM C1713 HCPCS 0278 RC outpatient 413 413 413 57 235.41 percent of total billed charges 413 93 334.53 percent of total billed charges 413 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 413 other OPPS APC 413 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 413 other OPPS APC 413 51 210.63 percent of total billed charges 413 413 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHORAGE LOCKING SCREW 3MM X 20MM SUP-97-04430 CDM C1713 HCPCS 0278 RC outpatient 610.75 610.75 610.75 57 348.13 percent of total billed charges 610.75 93 494.71 percent of total billed charges 610.75 610.75 other OPPS APC 610.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 610.75 other OPPS APC 610.75 51 311.48 percent of total billed charges 610.75 610.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHORAGE FIXATION PIN SUP-97-04431 CDM C1713 HCPCS 0278 RC outpatient 414.96 414.96 414.96 57 236.53 percent of total billed charges 414.96 93 336.12 percent of total billed charges 414.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 414.96 other OPPS APC 414.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 414.96 other OPPS APC 414.96 51 211.63 percent of total billed charges 414.96 414.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHORAGE LOCKING SCREW 3MM X 18MM SUP-97-04432 CDM C1713 HCPCS 0278 RC outpatient 610.75 610.75 610.75 57 348.13 percent of total billed charges 610.75 93 494.71 percent of total billed charges 610.75 610.75 other OPPS APC 610.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 610.75 other OPPS APC 610.75 51 311.48 percent of total billed charges 610.75 610.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POLYAXIAL LOCKING 2.5MM X 16MM SCREW SUP-97-04433 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CORTICAL NON-LOCKING 3.5MM X 22MM TI SUP-97-04434 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE RIGHT 8 HOLE SUP-97-04435 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL POSTORIOR PLATE 10 HOLES RT. SUP-97-04436 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISTAL POSTORIOR PLATE 12 HOLES RT. SUP-97-04437 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OLECRANON PLATE 10 HOLES LT 161MM SUP-97-04438 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OLECRANON PLATE 10 HOLES LT 184MM SUP-97-04439 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTHROFLEX 101 SUP-97-04440 CDM Q4125 HCPCS 0636 RC outpatient 7065 7065 7065 74 5228.1 percent of total billed charges 7065 93 5722.65 percent of total billed charges 7065 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7065 other OPPS APC 7065 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7065 other OPPS APC 7065 24.86 1756.36 percent of total billed charges 7065 7065 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HELICAL FENESTRATED BLADE 100MM TFNA SUP-97-04441 CDM C1713 HCPCS 0278 RC outpatient 2094.72 2094.72 2094.72 57 1193.99 percent of total billed charges 2094.72 93 1696.72 percent of total billed charges 2094.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2094.72 other OPPS APC 2094.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2094.72 other OPPS APC 2094.72 51 1068.31 percent of total billed charges 2094.72 2094.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE DISTAL LATERAL FIBULA 8 HOLE SUP-97-04442 CDM C1713 HCPCS 0278 RC outpatient 1438.2 1438.2 1438.2 57 819.77 percent of total billed charges 1438.2 93 1164.94 percent of total billed charges 1438.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1438.2 other OPPS APC 1438.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1438.2 other OPPS APC 1438.2 51 733.48 percent of total billed charges 1438.2 1438.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBAL NAIL 12 X 375MM T2 STANDARD SUP-97-04446 CDM C1713 HCPCS 0278 RC outpatient 2734.2 2734.2 2734.2 57 1558.49 percent of total billed charges 2734.2 93 2214.7 percent of total billed charges 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 51 1394.44 percent of total billed charges 2734.2 2734.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING SCREW 5MM X 57.5MM SUP-97-04447 CDM C1713 HCPCS 0278 RC outpatient 539 539 539 57 307.23 percent of total billed charges 539 93 436.59 percent of total billed charges 539 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 539 other OPPS APC 539 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 539 other OPPS APC 539 51 274.89 percent of total billed charges 539 539 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T SHAPE LOCKING 6 HOLE X 23 MM PLATE SUP-97-04448 CDM C1713 HCPCS 0278 RC outpatient 1087.5 1087.5 1087.5 57 619.88 percent of total billed charges 1087.5 93 880.88 percent of total billed charges 1087.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1087.5 other OPPS APC 1087.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1087.5 other OPPS APC 1087.5 51 554.63 percent of total billed charges 1087.5 1087.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING CROSSPIN 2.3 X 14MM SUP-97-04449 CDM C1713 HCPCS 0278 RC outpatient 318.99 318.99 318.99 57 181.82 percent of total billed charges 318.99 93 258.38 percent of total billed charges 318.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 318.99 other OPPS APC 318.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 318.99 other OPPS APC 318.99 51 162.68 percent of total billed charges 318.99 318.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.0 DRILL BIT SUP-97-04450 CDM 0272 RC outpatient 313.88 313.88 313.88 74 232.27 percent of total billed charges 313.88 93 254.24 percent of total billed charges 313.88 313.88 other OPPS APC 313.88 313.88 other OPPS APC 313.88 27.63 86.73 percent of total billed charges 313.88 313.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOSYNC PURE SUP-97-04455 CDM C1762 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LKNG SCREW 4.0 X 48MM SUP-97-04456 CDM C1713 HCPCS 0278 RC outpatient 604.45 604.45 604.45 57 344.54 percent of total billed charges 604.45 93 489.6 percent of total billed charges 604.45 604.45 other OPPS APC 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 51 308.27 percent of total billed charges 604.45 604.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR 12.0 MM SUP-97-04457 CDM 0272 RC outpatient 1085.7 1085.7 1085.7 74 803.42 percent of total billed charges 1085.7 93 879.42 percent of total billed charges 1085.7 1085.7 other OPPS APC 1085.7 1085.7 other OPPS APC 1085.7 27.63 299.98 percent of total billed charges 1085.7 1085.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 24.5 SUP-97-04458 CDM C1780 HCPCS 0278 RC outpatient 381.5 381.5 381.5 57 217.46 percent of total billed charges 381.5 93 309.02 percent of total billed charges 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 51 194.57 percent of total billed charges 381.5 381.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. C-TAPER TRIAL HEAD 22MM STD. SUP-97-04460 CDM C1776 HCPCS 0278 RC outpatient 686 686 686 57 391.02 percent of total billed charges 686 93 555.66 percent of total billed charges 686 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 686 other OPPS APC 686 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 686 other OPPS APC 686 51 349.86 percent of total billed charges 686 686 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TIBIA 8MM CANN EX 345 MM SUP-97-04464 CDM C1713 HCPCS 0278 RC outpatient 6585 6585 6585 57 3753.45 percent of total billed charges 6585 93 5333.85 percent of total billed charges 6585 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6585 other OPPS APC 6585 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6585 other OPPS APC 6585 51 3358.35 percent of total billed charges 6585 6585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOSURGE KIT 5CC SUP-97-04470 CDM C1713 HCPCS 0278 RC outpatient 4375 4375 4375 57 2493.75 percent of total billed charges 4375 93 3543.75 percent of total billed charges 4375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4375 other OPPS APC 4375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4375 other OPPS APC 4375 51 2231.25 percent of total billed charges 4375 4375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.0 X 20MM SCREW SUP-97-04472 CDM C1713 HCPCS 0278 RC outpatient 747.36 747.36 747.36 57 426 percent of total billed charges 747.36 93 605.36 percent of total billed charges 747.36 747.36 other OPPS APC 747.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 747.36 other OPPS APC 747.36 51 381.15 percent of total billed charges 747.36 747.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT II CLUSTERHOLE 56F SUP-97-04473 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT II CLUSTERHOLE 58F SUP-97-04474 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT II CLUSTERHOLE 50D SUP-97-04475 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS FEM COMP-BEADED W/PA SUP-97-04476 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS FEM COMP-BEADED W/PA SUP-97-04477 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACCOLADE C CS 127 NK SUP-97-04478 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACCOLADE DISTAL SPACER SUP-97-04479 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACCOLADE C CS 132 NK SUP-97-04480 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACCOLADE DISTAL SPACER SUP-97-04481 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. V40 BIOLOX DELTA HEAD 28MM/-2.7 SUP-97-04482 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMPONENT CEMENTED SUP-97-04483 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMPONENT BEAD.W/PA SUP-97-04484 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REST MOD CONICAL DISTAL STEM 17MMX155MM SUP-97-04485 CDM C1776 HCPCS 0278 RC outpatient 7228 7228 7228 57 4119.96 percent of total billed charges 7228 93 5854.68 percent of total billed charges 7228 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7228 other OPPS APC 7228 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7228 other OPPS APC 7228 51 3686.28 percent of total billed charges 7228 7228 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. H1.A11.1056 MIRABO CUP 54MM SUP-97-04486 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 12/14 COCR FEMORAL HEAD 22MM +3 SUP-97-04487 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLAR SHELL 42MM OD SUP-97-04488 CDM C1776 HCPCS 0278 RC outpatient 1567.5 1567.5 1567.5 57 893.48 percent of total billed charges 1567.5 93 1269.68 percent of total billed charges 1567.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1567.5 other OPPS APC 1567.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1567.5 other OPPS APC 1567.5 51 799.43 percent of total billed charges 1567.5 1567.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT CANNULATED 3.0MM SUP-97-04489 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS COMPRES SCREW 4.3 X 48MM SUP-97-04490 CDM C1713 HCPCS 0278 RC outpatient 1125 1125 1125 57 641.25 percent of total billed charges 1125 93 911.25 percent of total billed charges 1125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1125 other OPPS APC 1125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1125 other OPPS APC 1125 51 573.75 percent of total billed charges 1125 1125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROF SCREW SS4.0X45MM CANN SHT THREA SUP-97-04491 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFSCREW SS4.0X50MM CANN SHT THREAD SUP-97-04492 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACCOLADE DISTAL SPACER SUP-97-04493 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX BONE SCREW 20MM SUP-97-04494 CDM C1776 HCPCS 0278 RC outpatient 238 238 238 57 135.66 percent of total billed charges 238 93 192.78 percent of total billed charges 238 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238 other OPPS APC 238 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238 other OPPS APC 238 51 121.38 percent of total billed charges 238 238 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX M STEM LATER OFFSET #6 SUP-97-04495 CDM C1776 HCPCS 0278 RC outpatient 5000 5000 5000 57 2850 percent of total billed charges 5000 93 4050 percent of total billed charges 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 51 2550 percent of total billed charges 5000 5000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUCTION TUBE 3MM SHORT CURVE SUP-97-04496 CDM C9364 HCPCS 0278 RC outpatient 392.46 392.46 392.46 57 223.7 percent of total billed charges 392.46 93 317.89 percent of total billed charges 392.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.46 other OPPS APC 392.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.46 other OPPS APC 392.46 51 200.15 percent of total billed charges 392.46 392.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.6MM KNOTLESS FIBERTAK ANCHOR SUP-97-04501 CDM C1713 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPERMX NITI STAPLE W/INSTRS 18W X 15L SUP-97-04502 CDM C1713 HCPCS 0278 RC outpatient 6237.5 6237.5 6237.5 57 3555.38 percent of total billed charges 6237.5 93 5052.38 percent of total billed charges 6237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6237.5 other OPPS APC 6237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6237.5 other OPPS APC 6237.5 51 3181.13 percent of total billed charges 6237.5 6237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPERMX NITI STAPLE W/INSTRS 25W X 20L SUP-97-04503 CDM C1713 HCPCS 0278 RC outpatient 6237.5 6237.5 6237.5 57 3555.38 percent of total billed charges 6237.5 93 5052.38 percent of total billed charges 6237.5 6237.5 other OPPS APC 6237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6237.5 other OPPS APC 6237.5 51 3181.13 percent of total billed charges 6237.5 6237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SP FBRTAK DR LBRLTPE WH/BLK TT W/G/BLK SUP-97-04504 CDM C1713 HCPCS 0278 RC outpatient 1425 1425 1425 57 812.25 percent of total billed charges 1425 93 1154.25 percent of total billed charges 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 51 726.75 percent of total billed charges 1425 1425 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.0 X 24MM HEADED CANN.SHORT THREAD SUP-97-04505 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ANCH BIO SWIVELOCK 3.5 X 14.8MM SUP-97-04506 CDM C1713 HCPCS 0278 RC outpatient 1200 1200 1200 57 684 percent of total billed charges 1200 93 972 percent of total billed charges 1200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1200 other OPPS APC 1200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1200 other OPPS APC 1200 51 612 percent of total billed charges 1200 1200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACL TIGHTROPE W/FIBERTAG SUP-97-04507 CDM C1713 HCPCS 0278 RC outpatient 1575 1575 1575 57 897.75 percent of total billed charges 1575 93 1275.75 percent of total billed charges 1575 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1575 other OPPS APC 1575 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1575 other OPPS APC 1575 51 803.25 percent of total billed charges 1575 1575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACL TIGHTROPE W/FIBERTAG ABS SUP-97-04508 CDM C1713 HCPCS 0278 RC outpatient 1005 1005 1005 57 572.85 percent of total billed charges 1005 93 814.05 percent of total billed charges 1005 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1005 other OPPS APC 1005 1005 other OPPS APC 1005 51 512.55 percent of total billed charges 1005 1005 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PORTAL SKID SUP-97-04509 CDM 0272 RC outpatient 180 180 180 74 133.2 percent of total billed charges 180 93 145.8 percent of total billed charges 180 180 other OPPS APC 180 180 other OPPS APC 180 27.63 49.73 percent of total billed charges 180 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERSTITCH IMPLANT CURVED SUP-97-04510 CDM C1713 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPERMX NITI STAPLE W/INSTRS 20W X 15L SUP-97-04511 CDM C1713 HCPCS 0278 RC outpatient 6237.5 6237.5 6237.5 57 3555.38 percent of total billed charges 6237.5 93 5052.38 percent of total billed charges 6237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6237.5 other OPPS APC 6237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6237.5 other OPPS APC 6237.5 51 3181.13 percent of total billed charges 6237.5 6237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 14MM LOW PROFILE VA LOK TI SUP-97-04512 CDM C1713 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOW PROFILE VA LOK 3.0 X 16.00MM T SUP-97-04513 CDM C1713 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 65MM SUP-97-04514 CDM C1713 HCPCS 0278 RC outpatient 313.25 313.25 313.25 57 178.55 percent of total billed charges 313.25 93 253.73 percent of total billed charges 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 51 159.76 percent of total billed charges 313.25 313.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4/2.7MM X30 SPEED GUIDE SUP-97-04515 CDM 0272 RC outpatient 1025.28 1025.28 1025.28 74 758.71 percent of total billed charges 1025.28 93 830.48 percent of total billed charges 1025.28 1025.28 other OPPS APC 1025.28 1025.28 other OPPS APC 1025.28 27.63 283.28 percent of total billed charges 1025.28 1025.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CONICAL EXTRACTION SUP-97-04516 CDM C1713 HCPCS 0278 RC outpatient 434.91 434.91 434.91 57 247.9 percent of total billed charges 434.91 93 352.28 percent of total billed charges 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 51 221.8 percent of total billed charges 434.91 434.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI PS FEM COMPONET BEADED W/PA SUP-97-04517 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE LKG SCREW 3.5 MM X 24 MM SUP-97-04518 CDM C1713 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LISFRANC PLATE LARGE RIGHT TI SUP-97-04520 CDM C1713 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUMMIT POR TAPER SZ7 STD OFF SUP-97-04521 CDM C1776 HCPCS 0278 RC outpatient 5000 5000 5000 57 2850 percent of total billed charges 5000 93 4050 percent of total billed charges 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 51 2550 percent of total billed charges 5000 5000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DELTA CER HEAD 12/14 36MM +8.5 SUP-97-04522 CDM C1776 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GII PS HIGH FLEXON INSERT W/JRNY 7-8 9MM SUP-97-04523 CDM C1776 HCPCS 0278 RC outpatient 5081.25 5081.25 5081.25 57 2896.31 percent of total billed charges 5081.25 93 4115.81 percent of total billed charges 5081.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5081.25 other OPPS APC 5081.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5081.25 other OPPS APC 5081.25 51 2591.44 percent of total billed charges 5081.25 5081.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STIMULAN RAPID CURE SUP-97-04524 CDM C1713 HCPCS 0278 RC outpatient 9737.5 9737.5 9737.5 57 5550.38 percent of total billed charges 9737.5 93 7887.38 percent of total billed charges 9737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9737.5 other OPPS APC 9737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9737.5 other OPPS APC 9737.5 51 4966.13 percent of total billed charges 9737.5 9737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 21.0D SUP-97-04525 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 20.5 SUP-97-04526 CDM C1780 HCPCS 0278 RC outpatient 1317 1317 1317 57 750.69 percent of total billed charges 1317 93 1066.77 percent of total billed charges 1317 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1317 other OPPS APC 1317 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1317 other OPPS APC 1317 51 671.67 percent of total billed charges 1317 1317 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS X3 TIBIAL INSERT SUP-97-04527 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN LONG THREAD 4MM X 48MM SUP-97-04528 CDM C1713 HCPCS 0278 RC outpatient 676.76 676.76 676.76 57 385.75 percent of total billed charges 676.76 93 548.18 percent of total billed charges 676.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 676.76 other OPPS APC 676.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 676.76 other OPPS APC 676.76 51 345.15 percent of total billed charges 676.76 676.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5 X 28MM SELF TP SCREW SUP-97-04529 CDM C1713 HCPCS 0278 RC outpatient 431.38 431.38 431.38 57 245.89 percent of total billed charges 431.38 93 349.42 percent of total billed charges 431.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 431.38 other OPPS APC 431.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 431.38 other OPPS APC 431.38 51 220 percent of total billed charges 431.38 431.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING SELF TAPPING 3.5 X 38MM SUP-97-04530 CDM C1713 HCPCS 0278 RC outpatient 472.89 472.89 472.89 57 269.55 percent of total billed charges 472.89 93 383.04 percent of total billed charges 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 51 241.17 percent of total billed charges 472.89 472.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 14 HOLE 3.5 X 189 MM SUP-97-04531 CDM C1713 HCPCS 0278 RC outpatient 1754.46 1754.46 1754.46 57 1000.04 percent of total billed charges 1754.46 93 1421.11 percent of total billed charges 1754.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1754.46 other OPPS APC 1754.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1754.46 other OPPS APC 1754.46 51 894.77 percent of total billed charges 1754.46 1754.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.4 CAN DRILL BIT SUP-97-04534 CDM 0272 RC outpatient 614.88 614.88 614.88 74 455.01 percent of total billed charges 614.88 93 498.05 percent of total billed charges 614.88 614.88 other OPPS APC 614.88 614.88 other OPPS APC 614.88 27.63 169.89 percent of total billed charges 614.88 614.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS X3 TIBAL INSERT SUP-97-04536 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS X3 TIBIAL INSERT SUP-97-04537 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4 X 26MM LKNG SCREW SUP-97-04538 CDM C1713 HCPCS 0278 RC outpatient 516.25 516.25 516.25 57 294.26 percent of total billed charges 516.25 93 418.16 percent of total billed charges 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 516.25 other OPPS APC 516.25 51 263.29 percent of total billed charges 516.25 516.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 12 X 380 FEMORAL NAIL SUP-97-04539 CDM C1713 HCPCS 0278 RC outpatient 3544.2 3544.2 3544.2 57 2020.19 percent of total billed charges 3544.2 93 2870.8 percent of total billed charges 3544.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3544.2 other OPPS APC 3544.2 3544.2 other OPPS APC 3544.2 51 1807.54 percent of total billed charges 3544.2 3544.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VOLAR SMRTLCK NARROW LEFT SHORT SUP-97-04540 CDM C1714 HCPCS 0278 RC outpatient 2437.5 2437.5 2437.5 57 1389.38 percent of total billed charges 2437.5 93 1974.38 percent of total billed charges 2437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2437.5 other OPPS APC 2437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2437.5 other OPPS APC 2437.5 51 1243.13 percent of total billed charges 2437.5 2437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NON LOK CRSSPIN ST 2.3 X 18MM SUP-97-04541 CDM C1715 HCPCS 0278 RC outpatient 245.49 245.49 245.49 57 139.93 percent of total billed charges 245.49 93 198.85 percent of total billed charges 245.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 245.49 other OPPS APC 245.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 245.49 other OPPS APC 245.49 51 125.2 percent of total billed charges 245.49 245.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCKG CRSSPIN ST 2.3 X 16MM SUP-97-04542 CDM C1716 HCPCS 0278 RC outpatient 296.94 296.94 296.94 57 169.26 percent of total billed charges 296.94 93 240.52 percent of total billed charges 296.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 270.91 other OPPS APC 296.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 270.91 other OPPS APC 296.94 51 151.44 percent of total billed charges 296.94 296.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LCKG CRSSPIN ST 2.3 X 18MM SUP-97-04543 CDM C1717 HCPCS 0278 RC outpatient 296.94 296.94 296.94 57 169.26 percent of total billed charges 296.94 93 240.52 percent of total billed charges 296.94 296.94 other OPPS APC 296.94 296.94 other OPPS APC 296.94 51 151.44 percent of total billed charges 296.94 296.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ALLO SYNC PURE,5.0 CC" SUP-97-04544 CDM C1762 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE PS FB INSERT SZ 7 5MM SUP-97-04545 CDM C1776 HCPCS 0278 RC outpatient 3361 3361 3361 57 1915.77 percent of total billed charges 3361 93 2722.41 percent of total billed charges 3361 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3361 other OPPS APC 3361 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3361 other OPPS APC 3361 51 1714.11 percent of total billed charges 3361 3361 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONT.LONGEVITY ELEV.LINER HH 32 X 50 SUP-97-04547 CDM C1776 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERSYS FM MC CLR 13X140MM STD BODY SUP-97-04548 CDM C1776 HCPCS 0278 RC outpatient 5000 5000 5000 57 2850 percent of total billed charges 5000 93 4050 percent of total billed charges 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 51 2550 percent of total billed charges 5000 5000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIGH COMPRESSION LKNG PEG 2.7MM X 23MM SUP-97-04549 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NO.7 TRIATHLON TS PLUS TIBIAL INSERT 13MM POLY SUP-97-04550 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIA. PS X3 TIBIAL INSERT SUP-97-04551 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIA. CS INSERT #2 11MM SUP-97-04552 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UHR BIPOLAR 28 X 56MM SUP-97-04553 CDM C1776 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI CANN COMPRESSION 3.5MM X 28MM SUP-97-04554 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI CANN COMPRESSION 3.5MM X 40MM SUP-97-04555 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN COMP HEADLESS 4.0MM X 32MM SUP-97-04556 CDM C1713 HCPCS 0278 RC outpatient 1314 1314 1314 57 748.98 percent of total billed charges 1314 93 1064.34 percent of total billed charges 1314 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1314 other OPPS APC 1314 1314 other OPPS APC 1314 51 670.14 percent of total billed charges 1314 1314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM LCP LOW BEND PLATE RT/187MM-STER SUP-97-04557 CDM C1713 HCPCS 0278 RC outpatient 3774.83 3774.83 3774.83 57 2151.65 percent of total billed charges 3774.83 93 3057.61 percent of total billed charges 3774.83 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3774.83 other OPPS APC 3774.83 3774.83 other OPPS APC 3774.83 51 1925.16 percent of total billed charges 3774.83 3774.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM LCP LOW BEND PLATE 8H/RT/161MM SUP-97-04558 CDM C1713 HCPCS 0278 RC outpatient 3395.78 3395.78 3395.78 57 1935.59 percent of total billed charges 3395.78 93 2750.58 percent of total billed charges 3395.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3395.78 other OPPS APC 3395.78 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3395.78 other OPPS APC 3395.78 51 1731.85 percent of total billed charges 3395.78 3395.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE TROCAR TIP 1.4MM X150MM SUP-97-04559 CDM 0272 RC outpatient 316.23 316.23 316.23 74 234.01 percent of total billed charges 316.23 93 256.15 percent of total billed charges 316.23 316.23 other OPPS APC 316.23 316.23 other OPPS APC 316.23 27.63 87.37 percent of total billed charges 316.23 316.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.7MM CANN SUP-97-04560 CDM 0272 RC outpatient 1608.75 1608.75 1608.75 74 1190.48 percent of total billed charges 1608.75 93 1303.09 percent of total billed charges 1608.75 1608.75 other OPPS APC 1608.75 1608.75 other OPPS APC 1608.75 27.63 444.5 percent of total billed charges 1608.75 1608.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANN COUNTERSINK 3.5MM/4.0MM SUP-97-04561 CDM 0272 RC outpatient 1375.2 1375.2 1375.2 74 1017.65 percent of total billed charges 1375.2 93 1113.91 percent of total billed charges 1375.2 1375.2 other OPPS APC 1375.2 1375.2 other OPPS APC 1375.2 27.63 379.97 percent of total billed charges 1375.2 1375.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI CANN COMPRESSION 4.0MM X 36MM SUP-97-04562 CDM C1713 HCPCS 0278 RC outpatient 1314 1314 1314 57 748.98 percent of total billed charges 1314 93 1064.34 percent of total billed charges 1314 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1314 other OPPS APC 1314 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1314 other OPPS APC 1314 51 670.14 percent of total billed charges 1314 1314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOSYNC EVANS WEDGE20MM X20MM X6.5MM SUP-97-04563 CDM C1762 HCPCS 0278 RC outpatient 4000 4000 4000 57 2280 percent of total billed charges 4000 93 3240 percent of total billed charges 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 51 2040 percent of total billed charges 4000 4000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS COMPRES SCREW 4.3 X 46MM SUP-97-04564 CDM C1713 HCPCS 0278 RC outpatient 1125 1125 1125 57 641.25 percent of total billed charges 1125 93 911.25 percent of total billed charges 1125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1125 other OPPS APC 1125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1125 other OPPS APC 1125 51 573.75 percent of total billed charges 1125 1125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE SCREW 6.7MM X 45MM TITANIUM SUP-97-04565 CDM C1713 HCPCS 0278 RC outpatient 750 750 750 57 427.5 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 51 382.5 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANN.COUNTERSINK 6.7MM SUP-97-04566 CDM 0272 RC outpatient 900 900 900 74 666 percent of total billed charges 900 93 729 percent of total billed charges 900 900 other OPPS APC 900 900 other OPPS APC 900 27.63 248.67 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT II TRIT.CLUSTERHOLE 48D SUP-97-04567 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5.0MM X 22MM SUP-97-04568 CDM C1713 HCPCS 0278 RC outpatient 434.91 434.91 434.91 57 247.9 percent of total billed charges 434.91 93 352.28 percent of total billed charges 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 51 221.8 percent of total billed charges 434.91 434.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5.0MM X 24MM SUP-97-04569 CDM C1713 HCPCS 0278 RC outpatient 434.91 434.91 434.91 57 247.9 percent of total billed charges 434.91 93 352.28 percent of total billed charges 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 51 221.8 percent of total billed charges 434.91 434.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.5 X 20 COMP.CAN.SCREW SUP-97-04570 CDM C1713 HCPCS 0278 RC outpatient 1007.64 1007.64 1007.64 57 574.35 percent of total billed charges 1007.64 93 816.19 percent of total billed charges 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 51 513.9 percent of total billed charges 1007.64 1007.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.5 X 24 COMP. CAN. SCREW SUP-97-04571 CDM C1713 HCPCS 0278 RC outpatient 1007.64 1007.64 1007.64 57 574.35 percent of total billed charges 1007.64 93 816.19 percent of total billed charges 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 51 513.9 percent of total billed charges 1007.64 1007.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.0 X 11MM TWIST OFF SCREW SUP-97-04572 CDM C1713 HCPCS 0278 RC outpatient 1007.64 1007.64 1007.64 57 574.35 percent of total billed charges 1007.64 93 816.19 percent of total billed charges 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 51 513.9 percent of total billed charges 1007.64 1007.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.0 X 12MM TWIST OFF SCREW SUP-97-04573 CDM C1713 HCPCS 0278 RC outpatient 1186.08 1186.08 1186.08 57 676.07 percent of total billed charges 1186.08 93 960.72 percent of total billed charges 1186.08 1186.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TWIST OFF 2.0 X 12MM SUP-97-04573 CDM C1713 HCPCS 0278 RC outpatient 1186.08 1186.08 1186.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1186.08 other OPPS APC 1186.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1186.08 other OPPS APC 1186.08 51 604.9 percent of total billed charges 1186.08 1186.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.0 X 14MM TWIST OFF SCREW SUP-97-04574 CDM C1713 HCPCS 0278 RC outpatient 1007.64 1007.64 1007.64 57 574.35 percent of total billed charges 1007.64 93 816.19 percent of total billed charges 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 51 513.9 percent of total billed charges 1007.64 1007.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REUNION TSA HUMERAL STEM 12MM SUP-97-04575 CDM C1762 HCPCS 0278 RC outpatient 7500 7500 7500 57 4275 percent of total billed charges 7500 93 6075 percent of total billed charges 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 51 3825 percent of total billed charges 7500 7500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COM.BEADED W/PA SUP-97-04576 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON CS INS SIZE 3 11MM SUP-97-04577 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.5MM LOW PROFILE HEX SCREW 20MM SUP-97-04578 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOTAL STABIZER + TRIBAL INSERT SUP-97-04579 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX MIRABO CUP 56MM-D SUP-97-04580 CDM C1762 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PINNACLE 300 ACET CUP 54MM SUP-97-04581 CDM C1762 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALTRX NEUT 36IDX64OD SUP-97-04582 CDM C1762 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PINNACLE 300 ACET CUP 56MM SUP-97-04583 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALTRX NEUT 36IDX58OD SUP-97-04584 CDM C1762 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THREADED PEG LOCKING 2.3MM X 24MM SUP-97-04585 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE SCREW TI-3.5MM X 46MM SUP-97-04586 CDM C1713 HCPCS 0278 RC outpatient 210 210 210 57 119.7 percent of total billed charges 210 93 170.1 percent of total billed charges 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 51 107.1 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING DISTAL FIBULA PLATE TI RIGHT 5H SUP-97-04587 CDM C1713 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERSYS FM MC CLR 16X160MM LM STD NECK SUP-97-04588 CDM C1776 HCPCS 0278 RC outpatient 5000 5000 5000 57 2850 percent of total billed charges 5000 93 4050 percent of total billed charges 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 51 2550 percent of total billed charges 5000 5000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLAR SHELL 51MM OD SUP-97-04589 CDM C1776 HCPCS 0278 RC outpatient 1567.5 1567.5 1567.5 57 893.48 percent of total billed charges 1567.5 93 1269.68 percent of total billed charges 1567.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1567.5 other OPPS APC 1567.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1567.5 other OPPS APC 1567.5 51 799.43 percent of total billed charges 1567.5 1567.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLAR LINER 50/51/52MM OD X 28MM ID SUP-97-04590 CDM C1776 HCPCS 0278 RC outpatient 855 855 855 57 487.35 percent of total billed charges 855 93 692.55 percent of total billed charges 855 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 855 other OPPS APC 855 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 855 other OPPS APC 855 51 436.05 percent of total billed charges 855 855 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLAR SHELL 50MM OD SUP-97-04591 CDM C1776 HCPCS 0278 RC outpatient 1567.5 1567.5 1567.5 57 893.48 percent of total billed charges 1567.5 93 1269.68 percent of total billed charges 1567.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1567.5 other OPPS APC 1567.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1567.5 other OPPS APC 1567.5 51 799.43 percent of total billed charges 1567.5 1567.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PONTO 4 SILVER SUP-97-04592 CDM L8614 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM X 20MM VANNULATED COMP. SCREW SUP-97-04594 CDM C1713 HCPCS 0278 RC outpatient 1007.64 1007.64 1007.64 57 574.35 percent of total billed charges 1007.64 93 816.19 percent of total billed charges 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 51 513.9 percent of total billed charges 1007.64 1007.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM X 24MM CANNULATED COMP. SCREW SUP-97-04595 CDM C1714 HCPCS 0278 RC outpatient 1007.64 1007.64 1007.64 57 574.35 percent of total billed charges 1007.64 93 816.19 percent of total billed charges 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 51 513.9 percent of total billed charges 1007.64 1007.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUTOFIX COMPR SCREW MOD T7 DR 2.0 X 22MM SUP-97-04596 CDM C1715 HCPCS 0278 RC outpatient 747.36 747.36 747.36 57 426 percent of total billed charges 747.36 93 605.36 percent of total billed charges 747.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 747.36 other OPPS APC 747.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 747.36 other OPPS APC 747.36 51 381.15 percent of total billed charges 747.36 747.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SP FIBERTAK DR LBRLTPE WHITE & TT BL/BLK SUP-97-04597 CDM C1716 HCPCS 0278 RC outpatient 1425 1425 1425 57 812.25 percent of total billed charges 1425 93 1154.25 percent of total billed charges 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 270.91 other OPPS APC 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 270.91 other OPPS APC 1425 51 726.75 percent of total billed charges 1425 1425 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN SHRT THREAD 4MM X 28MM SUP-97-04599 CDM C1718 HCPCS 0278 RC outpatient 676.76 676.76 676.76 57 385.75 percent of total billed charges 676.76 93 548.18 percent of total billed charges 676.76 676.76 other OPPS APC 676.76 676.76 other OPPS APC 676.76 51 345.15 percent of total billed charges 676.76 676.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7 X 20MM SUP-97-04600 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAPIDUS 5MM STEP PLATE LEFT SUP-97-04601 CDM C1720 HCPCS 0278 RC outpatient 4288.75 4288.75 4288.75 57 2444.59 percent of total billed charges 4288.75 93 3473.89 percent of total billed charges 4288.75 4288.75 other OPPS APC 4288.75 4288.75 other OPPS APC 4288.75 51 2187.26 percent of total billed charges 4288.75 4288.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM MONSTER HEADLESS SUP-97-04602 CDM C1713 HCPCS 0278 RC outpatient 542.5 542.5 542.5 57 309.23 percent of total billed charges 542.5 93 439.43 percent of total billed charges 542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.5 other OPPS APC 542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.5 other OPPS APC 542.5 51 276.68 percent of total billed charges 542.5 542.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAPIDUS 3-HOLE STANDARD SUP-97-04603 CDM C1722 HCPCS 0278 RC outpatient 4288.75 4288.75 4288.75 57 2444.59 percent of total billed charges 4288.75 93 3473.89 percent of total billed charges 4288.75 4288.75 other OPPS APC 4288.75 4288.75 other OPPS APC 4288.75 51 2187.26 percent of total billed charges 4288.75 4288.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW R3ON 2.7 X 24MM SUP-97-04604 CDM C1723 HCPCS 0278 RC outpatient 420 420 420 57 239.4 percent of total billed charges 420 93 340.2 percent of total billed charges 420 420 other OPPS APC 420 420 other OPPS APC 420 51 214.2 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW R3ON 4.2 X 18MM SUP-97-04605 CDM C1713 HCPCS 0278 RC outpatient 437.5 437.5 437.5 57 249.38 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 51 223.13 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI MONSTER 4.0 X 30MM SUP-97-04606 CDM C1714 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN SHRT THREAD 4MM X 30MM SUP-97-04607 CDM C1715 HCPCS 0278 RC outpatient 676.76 676.76 676.76 57 385.75 percent of total billed charges 676.76 93 548.18 percent of total billed charges 676.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 676.76 other OPPS APC 676.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 676.76 other OPPS APC 676.76 51 345.15 percent of total billed charges 676.76 676.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW ASNIS MICRO,CANN 3.0MMX16/4MM" SUP-97-04608 CDM C1716 HCPCS 0278 RC outpatient 599.55 599.55 599.55 57 341.74 percent of total billed charges 599.55 93 485.64 percent of total billed charges 599.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 270.91 other OPPS APC 599.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 270.91 other OPPS APC 599.55 51 305.77 percent of total billed charges 599.55 599.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.0 X 12MM MICRO ASNIS CAN.SCREW SUP-97-04609 CDM C1717 HCPCS 0278 RC outpatient 599.76 599.76 599.76 57 341.86 percent of total billed charges 599.76 93 485.81 percent of total billed charges 599.76 599.76 other OPPS APC 599.76 599.76 other OPPS APC 599.76 51 305.88 percent of total billed charges 599.76 599.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW COMPRESSION CANN 4.0 X 22MM SUP-97-04610 CDM C1718 HCPCS 0278 RC outpatient 1001.16 1001.16 1001.16 57 570.66 percent of total billed charges 1001.16 93 810.94 percent of total billed charges 1001.16 1001.16 other OPPS APC 1001.16 1001.16 other OPPS APC 1001.16 51 510.59 percent of total billed charges 1001.16 1001.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW COMPRESSION CANN 4.0 X 26MM SUP-97-04611 CDM C1719 HCPCS 0278 RC outpatient 1001.16 1001.16 1001.16 57 570.66 percent of total billed charges 1001.16 93 810.94 percent of total billed charges 1001.16 1001.16 other OPPS APC 1001.16 1001.16 other OPPS APC 1001.16 51 510.59 percent of total billed charges 1001.16 1001.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIGHTROPE BUTTON 11MM SUP-97-04612 CDM C1713 HCPCS 0278 RC outpatient 825 825 825 57 470.25 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 51 420.75 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BTB TIGHTROPE SUP-97-04613 CDM C1721 HCPCS 0278 RC outpatient 1335 1335 1335 57 760.95 percent of total billed charges 1335 93 1081.35 percent of total billed charges 1335 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1335 other OPPS APC 1335 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1335 other OPPS APC 1335 51 680.85 percent of total billed charges 1335 1335 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLIPCUTTER 3 SUP-97-04614 CDM 0272 RC outpatient 1245 1245 1245 74 921.3 percent of total billed charges 1245 93 1008.45 percent of total billed charges 1245 1245 other OPPS APC 1245 1245 other OPPS APC 1245 27.63 343.99 percent of total billed charges 1245 1245 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACL BACKUP SUP-97-04615 CDM C1713 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFTLINK PRE-SUTURED TENDON SUP-97-04616 CDM C1762 HCPCS 0278 RC outpatient 8220 8220 8220 57 4685.4 percent of total billed charges 8220 93 6658.2 percent of total billed charges 8220 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8220 other OPPS APC 8220 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8220 other OPPS APC 8220 51 4192.2 percent of total billed charges 8220 8220 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONG NAIL 11X 400X125 SUP-97-04617 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TI CANN TFNA 11X 340 X 130 SUP-97-04618 CDM C1713 HCPCS 0278 RC outpatient 6711.35 6711.35 6711.35 57 3825.47 percent of total billed charges 6711.35 93 5436.19 percent of total billed charges 6711.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6711.35 other OPPS APC 6711.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6711.35 other OPPS APC 6711.35 51 3422.79 percent of total billed charges 6711.35 6711.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ABS TIGHTROPE INPLANT OPEN SUP-97-04619 CDM C1713 HCPCS 0278 RC outpatient 679 679 679 57 387.03 percent of total billed charges 679 93 549.99 percent of total billed charges 679 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 679 other OPPS APC 679 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 679 other OPPS APC 679 51 346.29 percent of total billed charges 679 679 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5.0MM X 32MM LKNG SCREW SUP-97-04620 CDM C1713 HCPCS 0278 RC outpatient 604.45 604.45 604.45 57 344.54 percent of total billed charges 604.45 93 489.6 percent of total billed charges 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 51 308.27 percent of total billed charges 604.45 604.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE 3.2 X 13MM SUP-97-04621 CDM C1713 HCPCS 0278 RC outpatient 745.8 745.8 745.8 57 425.11 percent of total billed charges 745.8 93 604.1 percent of total billed charges 745.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 745.8 other OPPS APC 745.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 745.8 other OPPS APC 745.8 51 380.36 percent of total billed charges 745.8 745.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS COMPRES SCREW 4.3 X 50MM SUP-97-04622 CDM C1713 HCPCS 0278 RC outpatient 1125 1125 1125 57 641.25 percent of total billed charges 1125 93 911.25 percent of total billed charges 1125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1125 other OPPS APC 1125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1125 other OPPS APC 1125 51 573.75 percent of total billed charges 1125 1125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. #2 FIBERLOOP BLUE W/CURVED NEEDLES SUP-97-04623 CDM 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 200 other OPPS APC 200 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.5MM LOW PROFILE HEX SCREW 30MM SUP-97-04624 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS FEM CEMENTED SUP-97-04625 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS FEM CEMENTED SUP-97-04626 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HRIS OSTEO STR .25X120MM SUP-97-04627 CDM 0272 RC outpatient 700.5 700.5 700.5 74 518.37 percent of total billed charges 700.5 93 567.41 percent of total billed charges 700.5 700.5 other OPPS APC 700.5 700.5 other OPPS APC 700.5 27.63 193.55 percent of total billed charges 700.5 700.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PS ALL-POLY TIBIA SIZE 2 11MM SUP-97-04628 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0 X 44MM CAN. PORT THD SCREW SUP-97-04629 CDM C1713 HCPCS 0278 RC outpatient 396.48 396.48 396.48 57 225.99 percent of total billed charges 396.48 93 321.15 percent of total billed charges 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 51 202.2 percent of total billed charges 396.48 396.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS X3 TIBAL INSERT SUP-97-04631 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NO.4 TRIATHLON TS PLUS TIBAL X3 POLY 13MM SUP-97-04632 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.0MM ASNIS MICRO CANN SCREW 36/7MM SUP-97-04633 CDM C1713 HCPCS 0278 RC outpatient 599.76 599.76 599.76 57 341.86 percent of total billed charges 599.76 93 485.81 percent of total billed charges 599.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 599.76 other OPPS APC 599.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 599.76 other OPPS APC 599.76 51 305.88 percent of total billed charges 599.76 599.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.0MM ASNIS MICRO CANN SCREW 28/6MM SUP-97-04634 CDM C1713 HCPCS 0278 RC outpatient 599.76 599.76 599.76 57 341.86 percent of total billed charges 599.76 93 485.81 percent of total billed charges 599.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 599.76 other OPPS APC 599.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 599.76 other OPPS APC 599.76 51 305.88 percent of total billed charges 599.76 599.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULATED COMPR. SCREW +4.0MM/L38NN SUP-97-04635 CDM C1713 HCPCS 0278 RC outpatient 3244.5 3244.5 3244.5 57 1849.37 percent of total billed charges 3244.5 93 2628.05 percent of total billed charges 3244.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3244.5 other OPPS APC 3244.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3244.5 other OPPS APC 3244.5 51 1654.7 percent of total billed charges 3244.5 3244.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE DYNANITE NITI W/INST 9MM X 7MM SUP-97-04636 CDM C1713 HCPCS 0278 RC outpatient 3737.5 3737.5 3737.5 57 2130.38 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 51 1906.13 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUICKFIX SCREW TI CANN PT 2.4X12MM SUP-97-04637 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUICKFIX SCREW TI CANN PT 2.4X14MM SUP-97-04638 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUICKFIX SCREW TI CANN PT 2.4X16MM SUP-97-04639 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 9 X 20MM BC IF VENTED SUP-97-04640 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 12 X 30MM BC IF VENTED SUP-97-04641 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 10.5D TECNIS EYHANCE SUP-97-04645 CDM C1780 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 19.0 SUP-97-04646 CDM C1780 HCPCS 0278 RC outpatient 437.5 437.5 437.5 57 249.38 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 51 223.13 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN PT 4 X 34MM SUP-97-04647 CDM C1713 HCPCS 0278 RC outpatient 542.64 542.64 542.64 57 309.3 percent of total billed charges 542.64 93 439.54 percent of total billed charges 542.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.64 other OPPS APC 542.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.64 other OPPS APC 542.64 51 276.75 percent of total billed charges 542.64 542.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROX LAT HUM 10 HOLE RT X 176MM SUP-97-04648 CDM C1713 HCPCS 0278 RC outpatient 4870.6 4870.6 4870.6 57 2776.24 percent of total billed charges 4870.6 93 3945.19 percent of total billed charges 4870.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4870.6 other OPPS APC 4870.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4870.6 other OPPS APC 4870.6 51 2484.01 percent of total billed charges 4870.6 4870.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER AO CANNULATED 3.7 X 1 SUP-97-04649 CDM C1713 HCPCS 0278 RC outpatient 1848.96 1848.96 1848.96 57 1053.91 percent of total billed charges 1848.96 93 1497.66 percent of total billed charges 1848.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1848.96 other OPPS APC 1848.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1848.96 other OPPS APC 1848.96 51 942.97 percent of total billed charges 1848.96 1848.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW COMPRESSION CANN 4.0 X 24MM SUP-97-04650 CDM C1713 HCPCS 0278 RC outpatient 1001.16 1001.16 1001.16 57 570.66 percent of total billed charges 1001.16 93 810.94 percent of total billed charges 1001.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1001.16 other OPPS APC 1001.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1001.16 other OPPS APC 1001.16 51 510.59 percent of total billed charges 1001.16 1001.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW COMPRESSION CANN 4.0 X 28MM SUP-97-04651 CDM C1713 HCPCS 0278 RC outpatient 1001.16 1001.16 1001.16 57 570.66 percent of total billed charges 1001.16 93 810.94 percent of total billed charges 1001.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1001.16 other OPPS APC 1001.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1001.16 other OPPS APC 1001.16 51 510.59 percent of total billed charges 1001.16 1001.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT W/STOP SUP-97-04652 CDM 0272 RC outpatient 268.8 268.8 268.8 74 198.91 percent of total billed charges 268.8 93 217.73 percent of total billed charges 268.8 268.8 other OPPS APC 268.8 268.8 other OPPS APC 268.8 27.63 74.27 percent of total billed charges 268.8 268.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUAGE SUP-97-04653 CDM 0272 RC outpatient 250.32 250.32 250.32 74 185.24 percent of total billed charges 250.32 93 202.76 percent of total billed charges 250.32 250.32 other OPPS APC 250.32 250.32 other OPPS APC 250.32 27.63 69.16 percent of total billed charges 250.32 250.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 34.0 SUP-97-04654 CDM C1780 HCPCS 0278 RC outpatient 469 469 469 57 267.33 percent of total billed charges 469 93 379.89 percent of total billed charges 469 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 469 other OPPS APC 469 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 469 other OPPS APC 469 51 239.19 percent of total billed charges 469 469 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACP KIT SERIES 2 SUP-97-04655 CDM 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 750 other OPPS APC 750 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIM-IT DRILL PIN 1.5MM BX/5EA SUP-97-04656 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACTIVAPIN 2.0 X 70MM SUP-97-04658 CDM C1713 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40MN -2.0D SUP-97-04659 CDM C1780 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW NEXIS COMP 4MM X 46MM SUP-97-04660 CDM C1713 HCPCS 0278 RC outpatient 1674.75 1674.75 1674.75 57 954.61 percent of total billed charges 1674.75 93 1356.55 percent of total billed charges 1674.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1674.75 other OPPS APC 1674.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1674.75 other OPPS APC 1674.75 51 854.12 percent of total billed charges 1674.75 1674.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW NEXIS COMP 4MM X 30MM SUP-97-04661 CDM C1713 HCPCS 0278 RC outpatient 1674.75 1674.75 1674.75 57 954.61 percent of total billed charges 1674.75 93 1356.55 percent of total billed charges 1674.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1674.75 other OPPS APC 1674.75 1674.75 other OPPS APC 1674.75 51 854.12 percent of total billed charges 1674.75 1674.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXIS PECA 3MM X 20MM SUP-97-04662 CDM C1713 HCPCS 0278 RC outpatient 1506.6 1506.6 1506.6 57 858.76 percent of total billed charges 1506.6 93 1220.35 percent of total billed charges 1506.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1506.6 other OPPS APC 1506.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1506.6 other OPPS APC 1506.6 51 768.37 percent of total billed charges 1506.6 1506.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW AIRLOCK NON LOCKING 3MM X 14MM SUP-97-04663 CDM C1713 HCPCS 0278 RC outpatient 278.25 278.25 278.25 57 158.6 percent of total billed charges 278.25 93 225.38 percent of total billed charges 278.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 278.25 other OPPS APC 278.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 278.25 other OPPS APC 278.25 51 141.91 percent of total billed charges 278.25 278.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW AIRLOCK LOCKING 3MM X 12MM SUP-97-04664 CDM C1713 HCPCS 0278 RC outpatient 664.13 664.13 664.13 57 378.55 percent of total billed charges 664.13 93 537.95 percent of total billed charges 664.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 664.13 other OPPS APC 664.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 664.13 other OPPS APC 664.13 51 338.71 percent of total billed charges 664.13 664.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRLOCK PLATE 6 HOLES SUP-97-04665 CDM C1713 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW AIRLOCK NON-LOCKING 3MM X 12MM SUP-97-04666 CDM C1713 HCPCS 0278 RC outpatient 278.25 278.25 278.25 57 158.6 percent of total billed charges 278.25 93 225.38 percent of total billed charges 278.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 278.25 other OPPS APC 278.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 278.25 other OPPS APC 278.25 51 141.91 percent of total billed charges 278.25 278.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW NEXIS COMP 4MM X 34MM SUP-97-04667 CDM C1713 HCPCS 0278 RC outpatient 1674.75 1674.75 1674.75 57 954.61 percent of total billed charges 1674.75 93 1356.55 percent of total billed charges 1674.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1674.75 other OPPS APC 1674.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1674.75 other OPPS APC 1674.75 51 854.12 percent of total billed charges 1674.75 1674.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW NEXIS COMP 4MM X 48MM SUP-97-04668 CDM C1713 HCPCS 0278 RC outpatient 1674.75 1674.75 1674.75 57 954.61 percent of total billed charges 1674.75 93 1356.55 percent of total billed charges 1674.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1674.75 other OPPS APC 1674.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1674.75 other OPPS APC 1674.75 51 854.12 percent of total billed charges 1674.75 1674.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXIS PECA 3MM X 22MM SUP-97-04669 CDM C1713 HCPCS 0278 RC outpatient 1506.6 1506.6 1506.6 57 858.76 percent of total billed charges 1506.6 93 1220.35 percent of total billed charges 1506.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1506.6 other OPPS APC 1506.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1506.6 other OPPS APC 1506.6 51 768.37 percent of total billed charges 1506.6 1506.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40MN 0.0 DIRECT PURCHASE SUP-97-04670 CDM C1780 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTEGRA MESHED BILAYER WOUND MATRIX 4X10 SUP-97-04671 CDM Q4104 HCPCS 0636 RC outpatient 8507.2 8507.2 55.89 55.89 fee schedule 8507.2 93 6890.83 percent of total billed charges 8507.2 8507.2 other OPPS APC 8507.2 8507.2 other OPPS APC 8507.2 24.86 2114.89 percent of total billed charges 55.89 8507.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS MN60AC 24.5D SUP-97-04672 CDM C1780 HCPCS 0278 RC outpatient 1251.15 1251.15 1251.15 57 713.16 percent of total billed charges 1251.15 93 1013.43 percent of total billed charges 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1251.15 other OPPS APC 1251.15 51 638.09 percent of total billed charges 1251.15 1251.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FHL TENDON TRANSFER KIT SUP-97-04673 CDM C1713 HCPCS 0278 RC outpatient 3737.5 3737.5 3737.5 57 2130.38 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 51 1906.13 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT POSTERIOR TIBIALIS TENDON 7.5 X 230 SUP-97-04674 CDM C9364 HCPCS 0278 RC outpatient 5260.2 5260.2 5260.2 57 2998.31 percent of total billed charges 5260.2 93 4260.76 percent of total billed charges 5260.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5260.2 other OPPS APC 5260.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5260.2 other OPPS APC 5260.2 51 2682.7 percent of total billed charges 5260.2 5260.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 26.5D SUP-97-04676 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE 2.8MM X 350MM SUP-97-04677 CDM C9364 HCPCS 0278 RC outpatient 323.4 323.4 323.4 57 184.34 percent of total billed charges 323.4 93 261.95 percent of total billed charges 323.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 323.4 other OPPS APC 323.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 323.4 other OPPS APC 323.4 51 164.93 percent of total billed charges 323.4 323.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TI CANN RETRO/ANT FEM 12MM X 380MM SUP-97-04678 CDM C9364 HCPCS 0278 RC outpatient 4487.4 4487.4 4487.4 57 2557.82 percent of total billed charges 4487.4 93 3634.79 percent of total billed charges 4487.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4487.4 other OPPS APC 4487.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4487.4 other OPPS APC 4487.4 51 2288.57 percent of total billed charges 4487.4 4487.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRILOCK OLECRANON PLATE RT.TI6.7H SUP-97-04679 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRILOCK OLECRANON PLATE LT T1 6.7H SUP-97-04680 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.8 CORTICAL SCREW 75MM HD7 1/PKG SUP-97-04681 CDM C1713 HCPCS 0278 RC outpatient 392.7 392.7 392.7 57 223.84 percent of total billed charges 392.7 93 318.09 percent of total billed charges 392.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.7 other OPPS APC 392.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.7 other OPPS APC 392.7 51 200.28 percent of total billed charges 392.7 392.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.8 TRILOCK SCREW 10MM HD7 1/PKG SUP-97-04682 CDM C9364 HCPCS 0278 RC outpatient 636.3 636.3 636.3 57 362.69 percent of total billed charges 636.3 93 515.4 percent of total billed charges 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 51 324.51 percent of total billed charges 636.3 636.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.8 TRILOCK SCREW 12MM HD7 1/PKG SUP-97-04683 CDM C9364 HCPCS 0278 RC outpatient 636.3 636.3 636.3 57 362.69 percent of total billed charges 636.3 93 515.4 percent of total billed charges 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 51 324.51 percent of total billed charges 636.3 636.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.75MM BC KNOTLESS SWIVELOCK SUP-97-04684 CDM C1713 HCPCS 0278 RC outpatient 1380 1380 1380 57 786.6 percent of total billed charges 1380 93 1117.8 percent of total billed charges 1380 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1380 other OPPS APC 1380 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1380 other OPPS APC 1380 51 703.8 percent of total billed charges 1380 1380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LARGE THREADED PIN SUP-97-04686 CDM C9364 HCPCS 0278 RC outpatient 644 644 644 57 367.08 percent of total billed charges 644 93 521.64 percent of total billed charges 644 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 644 other OPPS APC 644 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 644 other OPPS APC 644 51 328.44 percent of total billed charges 644 644 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MEDIAL PLATE SUP-97-04687 CDM C9364 HCPCS 0278 RC outpatient 463.68 463.68 463.68 57 264.3 percent of total billed charges 463.68 93 375.58 percent of total billed charges 463.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 463.68 other OPPS APC 463.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 463.68 other OPPS APC 463.68 51 236.48 percent of total billed charges 463.68 463.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSTEONICS UNIV.DISTAL SPACER SUP-97-04688 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HRHK TIBIAL SLEEVE SUP-97-04689 CDM C1776 HCPCS 0278 RC outpatient 1354.8 1354.8 1354.8 57 772.24 percent of total billed charges 1354.8 93 1097.39 percent of total billed charges 1354.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1354.8 other OPPS APC 1354.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1354.8 other OPPS APC 1354.8 51 690.95 percent of total billed charges 1354.8 1354.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HRHK TIB ROT COMP XS/SM/MED SUP-97-04690 CDM C1776 HCPCS 0278 RC outpatient 6495 6495 6495 57 3702.15 percent of total billed charges 6495 93 5260.95 percent of total billed charges 6495 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6495 other OPPS APC 6495 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6495 other OPPS APC 6495 51 3312.45 percent of total billed charges 6495 6495 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HRHK FEMORAL BUSHING SUP-97-04691 CDM C1776 HCPCS 0278 RC outpatient 789.6 789.6 789.6 57 450.07 percent of total billed charges 789.6 93 639.58 percent of total billed charges 789.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 789.6 other OPPS APC 789.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 789.6 other OPPS APC 789.6 51 402.7 percent of total billed charges 789.6 789.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.5MM X 95MM 20 THD SCREW SUP-97-04692 CDM C1713 HCPCS 0278 RC outpatient 618.24 618.24 618.24 57 352.4 percent of total billed charges 618.24 93 500.77 percent of total billed charges 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 51 315.3 percent of total billed charges 618.24 618.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRILOCK OLECRANON PI STRAIGHT TL6.7M SUP-97-04694 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TWIST DRILL 02.35MM X 50MM L101MM AD SUP-97-04695 CDM C9364 HCPCS 0278 RC outpatient 590.52 590.52 590.52 57 336.6 percent of total billed charges 590.52 93 478.32 percent of total billed charges 590.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 590.52 other OPPS APC 590.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 590.52 other OPPS APC 590.52 51 301.17 percent of total billed charges 590.52 590.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.8 CORTICAL 20MM SUP-97-04696 CDM C1713 HCPCS 0278 RC outpatient 432.32 432.32 432.32 57 246.42 percent of total billed charges 432.32 93 350.18 percent of total billed charges 432.32 432.32 other OPPS APC 432.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.32 other OPPS APC 432.32 51 220.48 percent of total billed charges 432.32 432.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.8 CORTICAL 24MM SUP-97-04697 CDM C1713 HCPCS 0278 RC outpatient 392.7 392.7 392.7 57 223.84 percent of total billed charges 392.7 93 318.09 percent of total billed charges 392.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.7 other OPPS APC 392.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.7 other OPPS APC 392.7 51 200.28 percent of total billed charges 392.7 392.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.8 TRILOCK SCREW 22MM SUP-97-04698 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LONG GAMMA 11 X 360MM RT SUP-97-04703 CDM C9364 HCPCS 0278 RC outpatient 4747.6 4747.6 4747.6 57 2706.13 percent of total billed charges 4747.6 93 3845.56 percent of total billed charges 4747.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4747.6 other OPPS APC 4747.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4747.6 other OPPS APC 4747.6 51 2421.28 percent of total billed charges 4747.6 4747.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SELF PRESSURIZING GLENOID SZ 48 SUP-97-04704 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MODULAR HUMERAL STEM SZ 13 SUP-97-04705 CDM C9364 HCPCS 0278 RC outpatient 7500 7500 7500 57 4275 percent of total billed charges 7500 93 6075 percent of total billed charges 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 51 3825 percent of total billed charges 7500 7500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SINGLE RADIUS HUMERAL HEAD SZ48 SUP-97-04706 CDM C1776 HCPCS 0278 RC outpatient 2460 2460 2460 57 1402.2 percent of total billed charges 2460 93 1992.6 percent of total billed charges 2460 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2460 other OPPS APC 2460 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2460 other OPPS APC 2460 51 1254.6 percent of total billed charges 2460 2460 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MONSTER BITE SCREW 2.0X12MM SHORT THREAD SUP-97-04707 CDM C9364 HCPCS 0278 RC outpatient 816.9 816.9 816.9 57 465.63 percent of total billed charges 816.9 93 661.69 percent of total billed charges 816.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 816.9 other OPPS APC 816.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 816.9 other OPPS APC 816.9 51 416.62 percent of total billed charges 816.9 816.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON CS INS SZ 2 16MM SUP-97-04708 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REGULAR FLUTED STEM 15X80 MM SUP-97-04709 CDM C1776 HCPCS 0278 RC outpatient 2977.2 2977.2 2977.2 57 1697 percent of total billed charges 2977.2 93 2411.53 percent of total billed charges 2977.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2977.2 other OPPS APC 2977.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2977.2 other OPPS APC 2977.2 51 1518.37 percent of total billed charges 2977.2 2977.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REGULAR FLUTED STEM 13X80 MM SUP-97-04710 CDM C1776 HCPCS 0278 RC outpatient 2977.2 2977.2 2977.2 57 1697 percent of total billed charges 2977.2 93 2411.53 percent of total billed charges 2977.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2977.2 other OPPS APC 2977.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2977.2 other OPPS APC 2977.2 51 1518.37 percent of total billed charges 2977.2 2977.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MRH TIBIAL BASEPLATE L2 SUP-97-04711 CDM C9364 HCPCS 0278 RC outpatient 5960 5960 5960 57 3397.2 percent of total billed charges 5960 93 4827.6 percent of total billed charges 5960 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5960 other OPPS APC 5960 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5960 other OPPS APC 5960 51 3039.6 percent of total billed charges 5960 5960 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HRHK TIB INS 200MM M/L M2/L2 SUP-97-04712 CDM C9364 HCPCS 0278 RC outpatient 2493.6 2493.6 2493.6 57 1421.35 percent of total billed charges 2493.6 93 2019.82 percent of total billed charges 2493.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2493.6 other OPPS APC 2493.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2493.6 other OPPS APC 2493.6 51 1271.74 percent of total billed charges 2493.6 2493.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOW ROT HNG KNEE FEM SM RT SUP-97-04713 CDM C1776 HCPCS 0278 RC outpatient 9477.6 9477.6 9477.6 57 5402.23 percent of total billed charges 9477.6 93 7676.86 percent of total billed charges 9477.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9477.6 other OPPS APC 9477.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9477.6 other OPPS APC 9477.6 51 4833.58 percent of total billed charges 9477.6 9477.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROXIMAL MED TIB 5 HOLE/L84MM LFT SUP-97-04714 CDM C9364 HCPCS 0278 RC outpatient 3700.2 3700.2 3700.2 57 2109.11 percent of total billed charges 3700.2 93 2997.16 percent of total billed charges 3700.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3700.2 other OPPS APC 3700.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3700.2 other OPPS APC 3700.2 51 1887.1 percent of total billed charges 3700.2 3700.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX NON LOCKING 3.5MM X 48MM SUP-97-04715 CDM C9364 HCPCS 0278 RC outpatient 134.4 134.4 134.4 57 76.61 percent of total billed charges 134.4 93 108.86 percent of total billed charges 134.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.4 other OPPS APC 134.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.4 other OPPS APC 134.4 51 68.54 percent of total billed charges 134.4 134.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.0MM ASNIS MICRO SOLID DRILL2.1MM AO SUP-97-04716 CDM C9364 HCPCS 0278 RC outpatient 243.6 243.6 243.6 57 138.85 percent of total billed charges 243.6 93 197.32 percent of total billed charges 243.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 243.6 other OPPS APC 243.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 243.6 other OPPS APC 243.6 51 124.24 percent of total billed charges 243.6 243.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERTAPE 54IN 2MM(BLUE)#2FIBERWIRE 8IN SUP-97-04719 CDM C9364 HCPCS 0278 RC outpatient 367.5 367.5 367.5 57 209.48 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 51 187.43 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOSURGE KIT 2.5CC SUP-97-04720 CDM C9364 HCPCS 0278 RC outpatient 3500 3500 3500 57 1995 percent of total billed charges 3500 93 2835 percent of total billed charges 3500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3500 other OPPS APC 3500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3500 other OPPS APC 3500 51 1785 percent of total billed charges 3500 3500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0 3.0MM X 80MM SHANZ SCREW SUP-97-04722 CDM C1713 HCPCS 0278 RC outpatient 308.7 308.7 308.7 57 175.96 percent of total billed charges 308.7 93 250.05 percent of total billed charges 308.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 308.7 other OPPS APC 308.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 308.7 other OPPS APC 308.7 51 157.44 percent of total billed charges 308.7 308.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T2 LONG PROXIMAL NAIL LFT.280MM HUMERAL SUP-97-04723 CDM C9364 HCPCS 0278 RC outpatient 3776.3 3776.3 3776.3 57 2152.49 percent of total billed charges 3776.3 93 3058.8 percent of total billed charges 3776.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3776.3 other OPPS APC 3776.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3776.3 other OPPS APC 3776.3 51 1925.91 percent of total billed charges 3776.3 3776.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTINUUM MULTIHOLE SHELL 54 JJ SUP-97-04724 CDM C9364 HCPCS 0278 RC outpatient 5080 5080 5080 57 2895.6 percent of total billed charges 5080 93 4114.8 percent of total billed charges 5080 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5080 other OPPS APC 5080 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5080 other OPPS APC 5080 51 2590.8 percent of total billed charges 5080 5080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTINUUM LONGEVITY ELEV LINER JJ36X54 SUP-97-04725 CDM C9364 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOLOX DENTA FEM EAD 36MM 3.5MM SUP-97-04726 CDM C9364 HCPCS 0278 RC outpatient 3430 3430 3430 57 1955.1 percent of total billed charges 3430 93 2778.3 percent of total billed charges 3430 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3430 other OPPS APC 3430 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3430 other OPPS APC 3430 51 1749.3 percent of total billed charges 3430 3430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERNALBRACE LISFRANC REPAIR KIT SUP-97-04727 CDM C9364 HCPCS 0278 RC outpatient 3737.5 3737.5 3737.5 57 2130.38 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 51 1906.13 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPL SYS CMC MINI T-ROPE 1.1MM SUP-97-04728 CDM C1713 HCPCS 0278 RC outpatient 2685 2685 2685 57 1530.45 percent of total billed charges 2685 93 2174.85 percent of total billed charges 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 51 1369.35 percent of total billed charges 2685 2685 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANCELLOUS FULL THRD 6MM X 60MM SUP-97-04729 CDM C1713 HCPCS 0278 RC outpatient 170.24 170.24 170.24 57 97.04 percent of total billed charges 170.24 93 137.89 percent of total billed charges 170.24 170.24 other OPPS APC 170.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 170.24 other OPPS APC 170.24 51 86.82 percent of total billed charges 170.24 170.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANCELLOUS FULL THRD 6MM X 65MM SUP-97-04730 CDM C1713 HCPCS 0278 RC outpatient 170.24 170.24 170.24 57 97.04 percent of total billed charges 170.24 93 137.89 percent of total billed charges 170.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 170.24 other OPPS APC 170.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 170.24 other OPPS APC 170.24 51 86.82 percent of total billed charges 170.24 170.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANCELLOUS FULL THRD 6MM X 85MM SUP-97-04731 CDM C1713 HCPCS 0278 RC outpatient 170.24 170.24 170.24 57 97.04 percent of total billed charges 170.24 93 137.89 percent of total billed charges 170.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 170.24 other OPPS APC 170.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 170.24 other OPPS APC 170.24 51 86.82 percent of total billed charges 170.24 170.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 4.5MM X 16MM SUP-97-04732 CDM C1713 HCPCS 0278 RC outpatient 152.32 152.32 152.32 57 86.82 percent of total billed charges 152.32 93 123.38 percent of total billed charges 152.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.32 other OPPS APC 152.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.32 other OPPS APC 152.32 51 77.68 percent of total billed charges 152.32 152.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 4.5MM X 46MM SUP-97-04733 CDM C1713 HCPCS 0278 RC outpatient 152.32 152.32 152.32 57 86.82 percent of total billed charges 152.32 93 123.38 percent of total billed charges 152.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.32 other OPPS APC 152.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.32 other OPPS APC 152.32 51 77.68 percent of total billed charges 152.32 152.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 4.5MM X 48MM SUP-97-04734 CDM C1713 HCPCS 0278 RC outpatient 152.32 152.32 152.32 57 86.82 percent of total billed charges 152.32 93 123.38 percent of total billed charges 152.32 152.32 other OPPS APC 152.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.32 other OPPS APC 152.32 51 77.68 percent of total billed charges 152.32 152.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 4.5MM X 75MM SUP-97-04735 CDM C1713 HCPCS 0278 RC outpatient 152.32 152.32 152.32 57 86.82 percent of total billed charges 152.32 93 123.38 percent of total billed charges 152.32 152.32 other OPPS APC 152.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.32 other OPPS APC 152.32 51 77.68 percent of total billed charges 152.32 152.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 16 HOLE LEFT FEM DIS LAT SUP-97-04737 CDM C1713 HCPCS 0278 RC outpatient 5607 5607 5607 57 3195.99 percent of total billed charges 5607 93 4541.67 percent of total billed charges 5607 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5607 other OPPS APC 5607 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5607 other OPPS APC 5607 51 2859.57 percent of total billed charges 5607 5607 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.2 X 315 MM SUP-97-04738 CDM 0272 RC outpatient 430.5 430.5 430.5 74 318.57 percent of total billed charges 430.5 93 348.71 percent of total billed charges 430.5 430.5 other OPPS APC 430.5 430.5 other OPPS APC 430.5 27.63 118.95 percent of total billed charges 430.5 430.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 4.3 X 315 MM SUP-97-04739 CDM 0272 RC outpatient 658.56 658.56 658.56 74 487.33 percent of total billed charges 658.56 93 533.43 percent of total billed charges 658.56 658.56 other OPPS APC 658.56 658.56 other OPPS APC 658.56 27.63 181.96 percent of total billed charges 658.56 658.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL NAIL 13 X 345MM T2 STANDARD SUP-97-04743 CDM C1713 HCPCS 0278 RC outpatient 2734.2 2734.2 2734.2 57 1558.49 percent of total billed charges 2734.2 93 2214.7 percent of total billed charges 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 51 1394.44 percent of total billed charges 2734.2 2734.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JMF HOOK PLATE COMP.5 HOLE RIGHT SUP-97-04744 CDM C9364 HCPCS 0278 RC outpatient 3990 3990 3990 57 2274.3 percent of total billed charges 3990 93 3231.9 percent of total billed charges 3990 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3990 other OPPS APC 3990 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3990 other OPPS APC 3990 51 2034.9 percent of total billed charges 3990 3990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BG NON-LOCKING SCREW 2.5 X 26MM SUP-97-04745 CDM C9364 HCPCS 0278 RC outpatient 588 588 588 57 335.16 percent of total billed charges 588 93 476.28 percent of total billed charges 588 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 588 other OPPS APC 588 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 588 other OPPS APC 588 51 299.88 percent of total billed charges 588 588 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BG NON-LOCKING SCREW 2.5 X 12MM SUP-97-04746 CDM C9364 HCPCS 0278 RC outpatient 588 588 588 57 335.16 percent of total billed charges 588 93 476.28 percent of total billed charges 588 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 588 other OPPS APC 588 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 588 other OPPS APC 588 51 299.88 percent of total billed charges 588 588 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 12/14 COCR FEMORAL HEAD 28MM -3.5 SUP-97-04747 CDM C9364 HCPCS 0278 RC outpatient 1956 1956 1956 57 1114.92 percent of total billed charges 1956 93 1584.36 percent of total billed charges 1956 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1956 other OPPS APC 1956 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1956 other OPPS APC 1956 51 997.56 percent of total billed charges 1956 1956 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERSYS FM MC CLR 15X160MM STD BODY STD N SUP-97-04748 CDM C9364 HCPCS 0278 RC outpatient 8150 8150 8150 57 4645.5 percent of total billed charges 8150 93 6601.5 percent of total billed charges 8150 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8150 other OPPS APC 8150 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8150 other OPPS APC 8150 51 4156.5 percent of total billed charges 8150 8150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS X3 TIBIAL INSERT SUP-97-04749 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NO.3 TRIATHLON TS PLUS TIBIAL INSERT 9M SUP-97-04750 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE TM SS3.5X35MM CORTICAL SUP-97-04751 CDM C9364 HCPCS 0278 RC outpatient 140 140 140 57 79.8 percent of total billed charges 140 93 113.4 percent of total billed charges 140 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 140 other OPPS APC 140 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 140 other OPPS APC 140 51 71.4 percent of total billed charges 140 140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROF SCREW SS4.0X60MM CANN SHT THREA SUP-97-04752 CDM C9364 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING MEDIAL HOOK PLATE SS 5H SUP-97-04753 CDM C9364 HCPCS 0278 RC outpatient 2475 2475 2475 57 1410.75 percent of total billed charges 2475 93 2004.75 percent of total billed charges 2475 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2475 other OPPS APC 2475 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2475 other OPPS APC 2475 51 1262.25 percent of total billed charges 2475 2475 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5 X 36MM CORTEX SCREW SUP-97-04755 CDM C1713 HCPCS 0278 RC outpatient 83.4 83.4 83.4 57 47.54 percent of total billed charges 83.4 93 67.55 percent of total billed charges 83.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 83.4 other OPPS APC 83.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 83.4 other OPPS APC 83.4 51 42.53 percent of total billed charges 83.4 83.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FHL INPLANT SYSTEM 6.25MM SUP-97-04756 CDM C9364 HCPCS 0278 RC outpatient 3737.5 3737.5 3737.5 57 2130.38 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 51 1906.13 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBIAL ONLAY INSERT SZ 5-9MM SUP-97-04757 CDM C1776 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK FEMORAL-LM-RL-SZ 5 SUP-97-04758 CDM C1776 HCPCS 0278 RC outpatient 3562.5 3562.5 3562.5 57 2030.63 percent of total billed charges 3562.5 93 2885.63 percent of total billed charges 3562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3562.5 other OPPS APC 3562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3562.5 other OPPS APC 3562.5 51 1816.88 percent of total billed charges 3562.5 3562.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBIAL BASEPLATE-LM/RL-SZ 5 SUP-97-04759 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TFN LONG 10MM DISTAL STERILE SUP-97-04760 CDM C1713 HCPCS 0278 RC outpatient 6124.8 6124.8 6124.8 57 3491.14 percent of total billed charges 6124.8 93 4961.09 percent of total billed charges 6124.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6124.8 other OPPS APC 6124.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6124.8 other OPPS APC 6124.8 51 3123.65 percent of total billed charges 6124.8 6124.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 24MM SUP-97-04763 CDM C1713 HCPCS 0278 RC outpatient 313.25 313.25 313.25 57 178.55 percent of total billed charges 313.25 93 253.73 percent of total billed charges 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 51 159.76 percent of total billed charges 313.25 313.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.5MM CENTER SCREW 24MM SUP-97-04765 CDM C9364 HCPCS 0278 RC outpatient 100 100 100 57 57 percent of total billed charges 100 93 81 percent of total billed charges 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 51 51 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 HUMERAL INSERT 32MM X 6MM STANDARD SUP-97-04766 CDM C9364 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.2 X 340MM DRILL BIT SUP-97-04767 CDM 0272 RC outpatient 561.12 561.12 561.12 74 415.23 percent of total billed charges 561.12 93 454.51 percent of total billed charges 561.12 561.12 other OPPS APC 561.12 561.12 other OPPS APC 561.12 27.63 155.04 percent of total billed charges 561.12 561.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS FEM COMPONENT BEADED/W PA SUP-97-04771 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0 X 60MM CAN COMP SCREW SUP-97-04773 CDM C1713 HCPCS 0278 RC outpatient 1007.64 1007.64 1007.64 57 574.35 percent of total billed charges 1007.64 93 816.19 percent of total billed charges 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 51 513.9 percent of total billed charges 1007.64 1007.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS COMP SCREW 4.0 X48MM FIXOS SUP-97-04774 CDM C1713 HCPCS 0278 RC outpatient 1001.16 1001.16 1001.16 57 570.66 percent of total billed charges 1001.16 93 810.94 percent of total billed charges 1001.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1001.16 other OPPS APC 1001.16 1001.16 other OPPS APC 1001.16 51 510.59 percent of total billed charges 1001.16 1001.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM TI CANN COMPRESSION SUP-97-04776 CDM C1713 HCPCS 0278 RC outpatient 1314 1314 1314 57 748.98 percent of total billed charges 1314 93 1064.34 percent of total billed charges 1314 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1314 other OPPS APC 1314 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1314 other OPPS APC 1314 51 670.14 percent of total billed charges 1314 1314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM TI CANN COMPRESSION SUP-97-04777 CDM C1713 HCPCS 0278 RC outpatient 1314 1314 1314 57 748.98 percent of total billed charges 1314 93 1064.34 percent of total billed charges 1314 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1314 other OPPS APC 1314 1314 other OPPS APC 1314 51 670.14 percent of total billed charges 1314 1314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM TI CANN COMPRESSION SUP-97-04778 CDM C1713 HCPCS 0278 RC outpatient 1314 1314 1314 57 748.98 percent of total billed charges 1314 93 1064.34 percent of total billed charges 1314 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1314 other OPPS APC 1314 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1314 other OPPS APC 1314 51 670.14 percent of total billed charges 1314 1314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5MM TI CANN COMPRESSION SUP-97-04779 CDM C1713 HCPCS 0278 RC outpatient 1314 1314 1314 57 748.98 percent of total billed charges 1314 93 1064.34 percent of total billed charges 1314 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1314 other OPPS APC 1314 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1314 other OPPS APC 1314 51 670.14 percent of total billed charges 1314 1314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.6MM GUIDE WIRE/220MM LENGTH SUP-97-04780 CDM 0272 RC outpatient 343.53 343.53 343.53 74 254.21 percent of total billed charges 343.53 93 278.26 percent of total billed charges 343.53 343.53 other OPPS APC 343.53 343.53 other OPPS APC 343.53 27.63 94.92 percent of total billed charges 343.53 343.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MONSTER 5.5X44MMHEDLESS SHRT THRED SUP-97-04781 CDM C9364 HCPCS 0278 RC outpatient 1669.5 1669.5 1669.5 57 951.62 percent of total billed charges 1669.5 93 1352.3 percent of total billed charges 1669.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1669.5 other OPPS APC 1669.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1669.5 other OPPS APC 1669.5 51 851.45 percent of total billed charges 1669.5 1669.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 7.0X44MM HEADLESS CANN SHORT THREAD SUP-97-04782 CDM C9364 HCPCS 0278 RC outpatient 1942.5 1942.5 1942.5 57 1107.23 percent of total billed charges 1942.5 93 1573.43 percent of total billed charges 1942.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1942.5 other OPPS APC 1942.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1942.5 other OPPS APC 1942.5 51 990.68 percent of total billed charges 1942.5 1942.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK 5.5 HEADLESS SUP-97-04783 CDM 0272 RC outpatient 691.25 691.25 691.25 74 511.53 percent of total billed charges 691.25 93 559.91 percent of total billed charges 691.25 691.25 other OPPS APC 691.25 691.25 other OPPS APC 691.25 27.63 190.99 percent of total billed charges 691.25 691.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 3.5X160MM CANN AO SUP-97-04784 CDM 0272 RC outpatient 542.5 542.5 542.5 74 401.45 percent of total billed charges 542.5 93 439.43 percent of total billed charges 542.5 542.5 other OPPS APC 542.5 542.5 other OPPS APC 542.5 27.63 149.89 percent of total billed charges 542.5 542.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT HEMISPHERICAL MULTI SUP-97-04785 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REUNION TSA X3 PEGGED GLENOID SIZE 44 SUP-97-04786 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REUNION S PRESS-FIT HUMERAL 15MM L99MM SUP-97-04787 CDM C9364 HCPCS 0278 RC outpatient 7500 7500 7500 57 4275 percent of total billed charges 7500 93 6075 percent of total billed charges 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 51 3825 percent of total billed charges 7500 7500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REUNION TSA SR STD. HUMERAL HEAD44X19 SUP-97-04788 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS FEM COMPOENT CEMENTED SUP-97-04789 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS X3 TIBIAL INSERT SUP-97-04790 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CER OPTION TYPE 1 TPR SLEVE +3 SUP-97-04791 CDM C9364 HCPCS 0278 RC outpatient 616 616 616 57 351.12 percent of total billed charges 616 93 498.96 percent of total billed charges 616 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 616 other OPPS APC 616 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 616 other OPPS APC 616 51 314.16 percent of total billed charges 616 616 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CER BIOLOXD OPTION HD 36MM SUP-97-04792 CDM C9364 HCPCS 0278 RC outpatient 3928.75 3928.75 3928.75 57 2239.39 percent of total billed charges 3928.75 93 3182.29 percent of total billed charges 3928.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3928.75 other OPPS APC 3928.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3928.75 other OPPS APC 3928.75 51 2003.66 percent of total billed charges 3928.75 3928.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. E-POLY 36MM +3 MAXROM LNR SZ23 SUP-97-04793 CDM C9364 HCPCS 0278 RC outpatient 3560 3560 3560 57 2029.2 percent of total billed charges 3560 93 2883.6 percent of total billed charges 3560 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3560 other OPPS APC 3560 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3560 other OPPS APC 3560 51 1815.6 percent of total billed charges 3560 3560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VLOC 180 VLOCA004L SUP-97-04794 CDM C9364 HCPCS 0278 RC outpatient 359.85 359.85 359.85 57 205.11 percent of total billed charges 359.85 93 291.48 percent of total billed charges 359.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 359.85 other OPPS APC 359.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 359.85 other OPPS APC 359.85 51 183.52 percent of total billed charges 359.85 359.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE CRS FB TIB BASE SZ6 CEM SUP-97-04795 CDM C1776 HCPCS 0278 RC outpatient 6879 6879 6879 57 3921.03 percent of total billed charges 6879 93 5571.99 percent of total billed charges 6879 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6879 other OPPS APC 6879 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6879 other OPPS APC 6879 51 3508.29 percent of total billed charges 6879 6879 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE REV CEM STEM 14 X 50MM SUP-97-04796 CDM C9364 HCPCS 0278 RC outpatient 2580 2580 2580 57 1470.6 percent of total billed charges 2580 93 2089.8 percent of total billed charges 2580 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2580 other OPPS APC 2580 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2580 other OPPS APC 2580 51 1315.8 percent of total billed charges 2580 2580 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE PS FEM RT SZ 6 CEM SUP-97-04798 CDM C9364 HCPCS 0278 RC outpatient 7324 7324 7324 57 4174.68 percent of total billed charges 7324 93 5932.44 percent of total billed charges 7324 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7324 other OPPS APC 7324 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7324 other OPPS APC 7324 51 3735.24 percent of total billed charges 7324 7324 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE PS FEM INSRT SZ 6 8MM SUP-97-04799 CDM C1776 HCPCS 0278 RC outpatient 3361 3361 3361 57 1915.77 percent of total billed charges 3361 93 2722.41 percent of total billed charges 3361 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3361 other OPPS APC 3361 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3361 other OPPS APC 3361 51 1714.11 percent of total billed charges 3361 3361 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ANCHOR CORKSCREW 3.5 SUP-97-04800 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RT.PLATE CP SUP-97-04810 CDM C1713 HCPCS 0278 RC outpatient 3240 3240 3240 57 1846.8 percent of total billed charges 3240 93 2624.4 percent of total billed charges 3240 3240 other OPPS APC 3240 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3240 other OPPS APC 3240 51 1652.4 percent of total billed charges 3240 3240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RT. PLATE STEP O SUP-97-04811 CDM C1713 HCPCS 0278 RC outpatient 3067.5 3067.5 3067.5 57 1748.48 percent of total billed charges 3067.5 93 2484.68 percent of total billed charges 3067.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3067.5 other OPPS APC 3067.5 3067.5 other OPPS APC 3067.5 51 1564.43 percent of total billed charges 3067.5 3067.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LISFRANC DUAL RAY 2ND&3RD TMT PLATE R/S SUP-97-04820 CDM C9364 HCPCS 0278 RC outpatient 5320 5320 5320 57 3032.4 percent of total billed charges 5320 93 4309.2 percent of total billed charges 5320 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5320 other OPPS APC 5320 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5320 other OPPS APC 5320 51 2713.2 percent of total billed charges 5320 5320 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS COMPRES SCREW 4.3X44MM SUP-97-04821 CDM C9364 HCPCS 0278 RC outpatient 1125 1125 1125 57 641.25 percent of total billed charges 1125 93 911.25 percent of total billed charges 1125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1125 other OPPS APC 1125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1125 other OPPS APC 1125 51 573.75 percent of total billed charges 1125 1125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS COMPRES SCREW 6.5X45MM SHT THD SUP-97-04822 CDM C9364 HCPCS 0278 RC outpatient 1725 1725 1725 57 983.25 percent of total billed charges 1725 93 1397.25 percent of total billed charges 1725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1725 other OPPS APC 1725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1725 other OPPS APC 1725 51 879.75 percent of total billed charges 1725 1725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NO.6 TRIATHLON TS PLUS TIBIAL INSERT X3 POLY11 SUP-97-04823 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T2 PROXIMAL HUMERAL +4MM END CAP SUP-97-04824 CDM C9364 HCPCS 0278 RC outpatient 515.9 515.9 515.9 57 294.06 percent of total billed charges 515.9 93 417.88 percent of total billed charges 515.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 515.9 other OPPS APC 515.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 515.9 other OPPS APC 515.9 51 263.11 percent of total billed charges 515.9 515.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRL BIT 3.2MM CANN LONG SUP-97-04825 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCRW 5.0 LG 44MM LGTH SUP-97-04826 CDM C9364 HCPCS 0278 RC outpatient 1425 1425 1425 57 812.25 percent of total billed charges 1425 93 1154.25 percent of total billed charges 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 51 726.75 percent of total billed charges 1425 1425 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCRW 5.0LG 46MM LGTH SUP-97-04827 CDM C9364 HCPCS 0278 RC outpatient 1425 1425 1425 57 812.25 percent of total billed charges 1425 93 1154.25 percent of total billed charges 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 51 726.75 percent of total billed charges 1425 1425 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LCP WRIST FUSION STRAIGHT PLATE SUP-97-04828 CDM C1713 HCPCS 0278 RC outpatient 4585.78 4585.78 4585.78 57 2613.89 percent of total billed charges 4585.78 93 3714.48 percent of total billed charges 4585.78 4585.78 other OPPS APC 4585.78 4585.78 other OPPS APC 4585.78 51 2338.75 percent of total billed charges 4585.78 4585.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7MM LKG SCREW SLFTPING T8 12MM SUP-97-04829 CDM C9364 HCPCS 0278 RC outpatient 408.14 408.14 408.14 57 232.64 percent of total billed charges 408.14 93 330.59 percent of total billed charges 408.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 408.14 other OPPS APC 408.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 408.14 other OPPS APC 408.14 51 208.15 percent of total billed charges 408.14 408.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POLY BUTTON WHITE 1/2 SUP-97-04830 CDM C9364 HCPCS 0278 RC outpatient 1.93 1.93 1.93 57 1.1 percent of total billed charges 1.93 93 1.56 percent of total billed charges 1.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.93 other OPPS APC 1.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1.93 other OPPS APC 1.93 51 0.98 percent of total billed charges 1.93 1.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 15.5D SUP-97-04831 CDM C1780 HCPCS 0278 RC outpatient 381.5 381.5 381.5 57 217.46 percent of total billed charges 381.5 93 309.02 percent of total billed charges 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 51 194.57 percent of total billed charges 381.5 381.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR CONICAL 13MM DIAM 2.9MM SUP-97-04832 CDM 0272 RC outpatient 1050 1050 1050 74 777 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 1050 other OPPS APC 1050 1050 other OPPS APC 1050 27.63 290.12 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR STRAIGHT 13MM DIA. 2.9MM SUP-97-04833 CDM 0272 RC outpatient 1050 1050 1050 74 777 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 1050 other OPPS APC 1050 1050 other OPPS APC 1050 27.63 290.12 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI CMP FT 30MM SUP-97-04834 CDM C9364 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW COMP FT 3.5 MINI 38MM SUP-97-04835 CDM C9364 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.2MM DRILL BIT CMP FT CALIBRATED SUP-97-04836 CDM C9364 HCPCS 0278 RC outpatient 682.5 682.5 682.5 57 389.03 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 51 348.08 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEFT STEP 1 PLATE SUP-97-04839 CDM C1713 HCPCS 0278 RC outpatient 3308.4 3308.4 3308.4 57 1885.79 percent of total billed charges 3308.4 93 2679.8 percent of total billed charges 3308.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3308.4 other OPPS APC 3308.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3308.4 other OPPS APC 3308.4 51 1687.28 percent of total billed charges 3308.4 3308.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. V2 5 HOLE LEFT PLATE SUP-97-04840 CDM C1713 HCPCS 0278 RC outpatient 3308.4 3308.4 3308.4 57 1885.79 percent of total billed charges 3308.4 93 2679.8 percent of total billed charges 3308.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3308.4 other OPPS APC 3308.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3308.4 other OPPS APC 3308.4 51 1687.28 percent of total billed charges 3308.4 3308.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.0 X 10 MM NON LKNG SCREW SUP-97-04841 CDM C1713 HCPCS 0278 RC outpatient 413 413 413 57 235.41 percent of total billed charges 413 93 334.53 percent of total billed charges 413 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 413 other OPPS APC 413 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 413 other OPPS APC 413 51 210.63 percent of total billed charges 413 413 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.0 X 14 MM NON LKNG SCREW SUP-97-04842 CDM C1713 HCPCS 0278 RC outpatient 421.75 421.75 421.75 57 240.4 percent of total billed charges 421.75 93 341.62 percent of total billed charges 421.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 421.75 other OPPS APC 421.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 421.75 other OPPS APC 421.75 51 215.09 percent of total billed charges 421.75 421.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X PLATE LAPIDUS TEMPLATE SUP-97-04843 CDM C1713 HCPCS 0278 RC outpatient 1052.64 1052.64 1052.64 57 600 percent of total billed charges 1052.64 93 852.64 percent of total billed charges 1052.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1052.64 other OPPS APC 1052.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1052.64 other OPPS APC 1052.64 51 536.85 percent of total billed charges 1052.64 1052.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 55MM SUP-97-04848 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 7 HOLE DIST FIB PLATE SUP-97-04849 CDM C1713 HCPCS 0278 RC outpatient 1438.2 1438.2 1438.2 57 819.77 percent of total billed charges 1438.2 93 1164.94 percent of total billed charges 1438.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1438.2 other OPPS APC 1438.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1438.2 other OPPS APC 1438.2 51 733.48 percent of total billed charges 1438.2 1438.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REUNION RFX LONG HUMERAL FRAC.STEM 10MM SUP-97-04850 CDM C1713 HCPCS 0278 RC outpatient 7500 7500 7500 57 4275 percent of total billed charges 7500 93 6075 percent of total billed charges 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 51 3825 percent of total billed charges 7500 7500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HUMERAL CUP 32MM DIA X 10MM THK SUP-97-04851 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP1133 PRIMARY SHOULDER REV/INVERSE SUP-97-04852 CDM C1776 HCPCS 0278 RC outpatient 17000 17000 17000 57 9690 percent of total billed charges 17000 93 13770 percent of total billed charges 17000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17000 other OPPS APC 17000 17000 other OPPS APC 17000 51 8670 percent of total billed charges 17000 17000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NO.5 TRIATHLON TS PLUS TIBAL INSERT X3 1 SUP-97-04853 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI CMP FT 26MM SUP-97-04854 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROFILE DRILL MINI CMP FT SUP-97-04855 CDM 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS COMPRES SCREW 6.5X80MM SHT THD SUP-97-04856 CDM C1713 HCPCS 0278 RC outpatient 1725 1725 1725 57 983.25 percent of total billed charges 1725 93 1397.25 percent of total billed charges 1725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1725 other OPPS APC 1725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1725 other OPPS APC 1725 51 879.75 percent of total billed charges 1725 1725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS COMPRES SCREW 6.5X85MM SHT THD SUP-97-04857 CDM C1713 HCPCS 0278 RC outpatient 1725 1725 1725 57 983.25 percent of total billed charges 1725 93 1397.25 percent of total billed charges 1725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1725 other OPPS APC 1725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1725 other OPPS APC 1725 51 879.75 percent of total billed charges 1725 1725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOP DRILL SUP-97-04864 CDM 0272 RC outpatient 2079 2079 2079 74 1538.46 percent of total billed charges 2079 93 1683.99 percent of total billed charges 2079 2079 other OPPS APC 2079 2079 other OPPS APC 2079 27.63 574.43 percent of total billed charges 2079 2079 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSN ASF PS 12MM VE L 6-9 EF SUP-97-04865 CDM C1776 HCPCS 0278 RC outpatient 3670 3670 3670 57 2091.9 percent of total billed charges 3670 93 2972.7 percent of total billed charges 3670 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3670 other OPPS APC 3670 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3670 other OPPS APC 3670 51 1871.7 percent of total billed charges 3670 3670 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CER BIOLOXD OPTION HD 32MM SUP-97-04866 CDM C1776 HCPCS 0278 RC outpatient 3902.5 3902.5 3902.5 57 2224.43 percent of total billed charges 3902.5 93 3161.03 percent of total billed charges 3902.5 3902.5 other OPPS APC 3902.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3902.5 other OPPS APC 3902.5 51 1990.28 percent of total billed charges 3902.5 3902.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. E-POLY 32MM 3 HIWALL LNR SZ22 SUP-97-04867 CDM C1776 HCPCS 0278 RC outpatient 3560 3560 3560 57 2029.2 percent of total billed charges 3560 93 2883.6 percent of total billed charges 3560 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3560 other OPPS APC 3560 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3560 other OPPS APC 3560 51 1815.6 percent of total billed charges 3560 3560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4 X 18 MM NON LKNG SCREW SUP-97-04871 CDM C1713 HCPCS 0278 RC outpatient 301 301 301 57 171.57 percent of total billed charges 301 93 243.81 percent of total billed charges 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 51 153.51 percent of total billed charges 301 301 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBIAL BASEPLATE RM/LL SZ4 SUP-97-04872 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBIAL ONLAY INSERT SZ4-8MM SUP-97-04873 CDM C1776 HCPCS 0278 RC outpatient 2280 2280 2280 57 1299.6 percent of total billed charges 2280 93 1846.8 percent of total billed charges 2280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2280 other OPPS APC 2280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2280 other OPPS APC 2280 51 1162.8 percent of total billed charges 2280 2280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK FEMORAL RM-LL SZ4 SUP-97-04874 CDM C1776 HCPCS 0278 RC outpatient 3562.5 3562.5 3562.5 57 2030.63 percent of total billed charges 3562.5 93 2885.63 percent of total billed charges 3562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3562.5 other OPPS APC 3562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3562.5 other OPPS APC 3562.5 51 1816.88 percent of total billed charges 3562.5 3562.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLIM STRAIGHT PLATE 7 HOLES (T8) SUP-97-04878 CDM C1713 HCPCS 0278 RC outpatient 2218.05 2218.05 2218.05 57 1264.29 percent of total billed charges 2218.05 93 1796.62 percent of total billed charges 2218.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2218.05 other OPPS APC 2218.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2218.05 other OPPS APC 2218.05 51 1131.21 percent of total billed charges 2218.05 2218.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUICKFIX SCREW TI CANN PT 2.4X18MM SUP-97-04880 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK 2.0/2.4MM CANNULATED SUP-97-04881 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5MM PERIPHERAL SCREW 36MM SUP-97-04882 CDM C1713 HCPCS 0278 RC outpatient 100 100 100 57 57 percent of total billed charges 100 93 81 percent of total billed charges 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 51 51 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RTS FLEX 1ST MPJ IMPLANT W/GRMTS SZ 2 SUP-97-04883 CDM C1776 HCPCS 0278 RC outpatient 2991 2991 2991 57 1704.87 percent of total billed charges 2991 93 2422.71 percent of total billed charges 2991 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2991 other OPPS APC 2991 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2991 other OPPS APC 2991 51 1525.41 percent of total billed charges 2991 2991 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTHROFLEX 201 SUP-97-04884 CDM Q4125 HCPCS 0636 RC outpatient 9484.43 9484.43 9484.43 74 7018.48 percent of total billed charges 9484.43 93 7682.39 percent of total billed charges 9484.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9484.43 other OPPS APC 9484.43 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9484.43 other OPPS APC 9484.43 24.86 2357.83 percent of total billed charges 9484.43 9484.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7MM VA-LCP LAT.DIS FIBULA PLATE3H LEFT SUP-97-04885 CDM C1713 HCPCS 0278 RC outpatient 2209.8 2209.8 2209.8 57 1259.59 percent of total billed charges 2209.8 93 1789.94 percent of total billed charges 2209.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2209.8 other OPPS APC 2209.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2209.8 other OPPS APC 2209.8 51 1127 percent of total billed charges 2209.8 2209.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE DYNANITE NITI W/INST 20MM X 15MM SUP-97-04886 CDM C1713 HCPCS 0278 RC outpatient 5737.5 5737.5 5737.5 57 3270.38 percent of total billed charges 5737.5 93 4647.38 percent of total billed charges 5737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5737.5 other OPPS APC 5737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5737.5 other OPPS APC 5737.5 51 2926.13 percent of total billed charges 5737.5 5737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40E 13.5D SUP-97-04889 CDM C1780 HCPCS 0278 RC outpatient 381.5 381.5 381.5 57 217.46 percent of total billed charges 381.5 93 309.02 percent of total billed charges 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 51 194.57 percent of total billed charges 381.5 381.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VOLAR SMRTLCK NARROW RT SHORT SUP-97-04891 CDM C1713 HCPCS 0278 RC outpatient 2775.24 2775.24 2775.24 57 1581.89 percent of total billed charges 2775.24 93 2247.94 percent of total billed charges 2775.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2775.24 other OPPS APC 2775.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2775.24 other OPPS APC 2775.24 51 1415.37 percent of total billed charges 2775.24 2775.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3HOLE LT LAT DIST POS PLATER SUP-97-04892 CDM C1713 HCPCS 0278 RC outpatient 2542.5 2542.5 2542.5 57 1449.23 percent of total billed charges 2542.5 93 2059.43 percent of total billed charges 2542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2542.5 other OPPS APC 2542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2542.5 other OPPS APC 2542.5 51 1296.68 percent of total billed charges 2542.5 2542.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4HOLE DIST MED HUM PLATE SUP-97-04893 CDM C1713 HCPCS 0278 RC outpatient 2803.5 2803.5 2803.5 57 1598 percent of total billed charges 2803.5 93 2270.84 percent of total billed charges 2803.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2803.5 other OPPS APC 2803.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2803.5 other OPPS APC 2803.5 51 1429.79 percent of total billed charges 2803.5 2803.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3HOLE LT OLECRANON PLATE SUP-97-04894 CDM C1713 HCPCS 0278 RC outpatient 2542.5 2542.5 2542.5 57 1449.23 percent of total billed charges 2542.5 93 2059.43 percent of total billed charges 2542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2542.5 other OPPS APC 2542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2542.5 other OPPS APC 2542.5 51 1296.68 percent of total billed charges 2542.5 2542.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 0.9MM X 70MM K-WIRE SUP-97-04895 CDM C1713 HCPCS 0278 RC outpatient 148 148 148 57 84.36 percent of total billed charges 148 93 119.88 percent of total billed charges 148 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 148 other OPPS APC 148 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 148 other OPPS APC 148 51 75.48 percent of total billed charges 148 148 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5X14MM CAN COMP SCREW SUP-97-04896 CDM C1713 HCPCS 0278 RC outpatient 1007.64 1007.64 1007.64 57 574.35 percent of total billed charges 1007.64 93 816.19 percent of total billed charges 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 51 513.9 percent of total billed charges 1007.64 1007.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5 X 16MM CAN COMP SCREW SUP-97-04897 CDM C1713 HCPCS 0278 RC outpatient 1007.64 1007.64 1007.64 57 574.35 percent of total billed charges 1007.64 93 816.19 percent of total billed charges 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 51 513.9 percent of total billed charges 1007.64 1007.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5X18MM CAN COMP SCREW SUP-97-04898 CDM C1713 HCPCS 0278 RC outpatient 1007.64 1007.64 1007.64 57 574.35 percent of total billed charges 1007.64 93 816.19 percent of total billed charges 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 51 513.9 percent of total billed charges 1007.64 1007.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INBONE REMOVER SUP-97-04900 CDM C1776 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT INFINITY EVERLAST VIT-E HXLPE SUP-97-04901 CDM C1776 HCPCS 0278 RC outpatient 5928.75 5928.75 5928.75 57 3379.39 percent of total billed charges 5928.75 93 4802.29 percent of total billed charges 5928.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5928.75 other OPPS APC 5928.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5928.75 other OPPS APC 5928.75 51 3023.66 percent of total billed charges 5928.75 5928.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALIGNMENT GUIDE PROPHECY INIFINITY SUP-97-04902 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL INIFINITY ADAPTIS SUP-97-04903 CDM C1776 HCPCS 0278 RC outpatient 16246.5 16246.5 16246.5 57 9260.51 percent of total billed charges 16246.5 93 13159.7 percent of total billed charges 16246.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16246.5 other OPPS APC 16246.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16246.5 other OPPS APC 16246.5 51 8285.72 percent of total billed charges 16246.5 16246.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INFINITY ADAPTIS TALAR DOME FLAT CUT SUP-97-04904 CDM C1776 HCPCS 0278 RC outpatient 17810 17810 17810 57 10151.7 percent of total billed charges 17810 93 14426.1 percent of total billed charges 17810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17810 other OPPS APC 17810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17810 other OPPS APC 17810 51 9083.1 percent of total billed charges 17810 17810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI MONSTER 4.0X28MM HEADED LONG SUP-97-04905 CDM C1713 HCPCS 0278 RC outpatient 691.25 691.25 691.25 57 394.01 percent of total billed charges 691.25 93 559.91 percent of total billed charges 691.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 691.25 other OPPS APC 691.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 691.25 other OPPS APC 691.25 51 352.54 percent of total billed charges 691.25 691.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TI CANN TFNA 11MM/130DEG 360MM SUP-97-04906 CDM C1713 HCPCS 0278 RC outpatient 6711.35 6711.35 6711.35 57 3825.47 percent of total billed charges 6711.35 93 5436.19 percent of total billed charges 6711.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6711.35 other OPPS APC 6711.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6711.35 other OPPS APC 6711.35 51 3422.79 percent of total billed charges 6711.35 6711.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON INSERT PS #5 10MM SUP-97-04907 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR STR. 19.5MM DIAM. 2.0 MM SUP-97-04908 CDM 0272 RC outpatient 1050 1050 1050 74 777 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 1050 other OPPS APC 1050 1050 other OPPS APC 1050 27.63 290.12 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AR-200 IRRIGATION TUBING SET SUP-97-04909 CDM 0272 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE SCREW T10 NON LCKNG 3.5MM X 60MM SUP-97-04910 CDM C1713 HCPCS 0278 RC outpatient 313.25 313.25 313.25 57 178.55 percent of total billed charges 313.25 93 253.73 percent of total billed charges 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 51 159.76 percent of total billed charges 313.25 313.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 26MM SUP-97-04911 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 NON LCKNG 2.7MM X 10MM SUP-97-04912 CDM C1713 HCPCS 0278 RC outpatient 301 301 301 57 171.57 percent of total billed charges 301 93 243.81 percent of total billed charges 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 51 153.51 percent of total billed charges 301 301 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LCKNG 2.7MM X 10MM SUP-97-04913 CDM C1713 HCPCS 0278 RC outpatient 516.25 516.25 516.25 57 294.26 percent of total billed charges 516.25 93 418.16 percent of total billed charges 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 51 263.29 percent of total billed charges 516.25 516.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX COMPRES BRD CRVD 20 HOLES SUP-97-04914 CDM C1713 HCPCS 0278 RC outpatient 2829 2829 2829 57 1612.53 percent of total billed charges 2829 93 2291.49 percent of total billed charges 2829 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2829 other OPPS APC 2829 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2829 other OPPS APC 2829 51 1442.79 percent of total billed charges 2829 2829 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON INSERT PS#4 12MM SUP-97-04915 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4HOLE DIST MED 4 HOLE PLATE SUP-97-04917 CDM C1713 HCPCS 0278 RC outpatient 2803.5 2803.5 2803.5 57 1598 percent of total billed charges 2803.5 93 2270.84 percent of total billed charges 2803.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2803.5 other OPPS APC 2803.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2803.5 other OPPS APC 2803.5 51 1429.79 percent of total billed charges 2803.5 2803.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON INSERT PS#8 10MM SUP-97-04918 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX COMPRES 7 HOLE X 90 LCKNG SUP-97-04919 CDM C1713 HCPCS 0278 RC outpatient 1321.32 1321.32 1321.32 57 753.15 percent of total billed charges 1321.32 93 1070.27 percent of total billed charges 1321.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1321.32 other OPPS APC 1321.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1321.32 other OPPS APC 1321.32 51 673.87 percent of total billed charges 1321.32 1321.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NORIAN DRILLABLE INJECT 10CC-STERILE SUP-97-04920 CDM C1713 HCPCS 0278 RC outpatient 6880.5 6880.5 6880.5 57 3921.89 percent of total billed charges 6880.5 93 5573.21 percent of total billed charges 6880.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6880.5 other OPPS APC 6880.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6880.5 other OPPS APC 6880.5 51 3509.06 percent of total billed charges 6880.5 6880.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.2 SUP-97-04921 CDM 0272 RC outpatient 468.72 468.72 468.72 74 346.85 percent of total billed charges 468.72 93 379.66 percent of total billed charges 468.72 468.72 other OPPS APC 468.72 468.72 other OPPS APC 468.72 27.63 129.51 percent of total billed charges 468.72 468.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER SUP-97-04922 CDM C1713 HCPCS 0278 RC outpatient 104.96 104.96 104.96 57 59.83 percent of total billed charges 104.96 93 85.02 percent of total billed charges 104.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 104.96 other OPPS APC 104.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 104.96 other OPPS APC 104.96 51 53.53 percent of total billed charges 104.96 104.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 40MM SUP-97-04923 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7 X 44 MM LKNG SCREW SUP-97-04924 CDM C1713 HCPCS 0278 RC outpatient 575.75 575.75 575.75 57 328.18 percent of total billed charges 575.75 93 466.36 percent of total billed charges 575.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 575.75 other OPPS APC 575.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 575.75 other OPPS APC 575.75 51 293.63 percent of total billed charges 575.75 575.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7 X 46MM LKNG SCREW SUP-97-04925 CDM C1713 HCPCS 0278 RC outpatient 575.75 575.75 575.75 57 328.18 percent of total billed charges 575.75 93 466.36 percent of total billed charges 575.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 575.75 other OPPS APC 575.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 575.75 other OPPS APC 575.75 51 293.63 percent of total billed charges 575.75 575.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7 X 50MM LKNG SCREW SUP-97-04926 CDM C1713 HCPCS 0278 RC outpatient 575.75 575.75 575.75 57 328.18 percent of total billed charges 575.75 93 466.36 percent of total billed charges 575.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 575.75 other OPPS APC 575.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 575.75 other OPPS APC 575.75 51 293.63 percent of total billed charges 575.75 575.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7X50MM NON LKNG SCREW SUP-97-04927 CDM C1713 HCPCS 0278 RC outpatient 313.25 313.25 313.25 57 178.55 percent of total billed charges 313.25 93 253.73 percent of total billed charges 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 51 159.76 percent of total billed charges 313.25 313.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7X55MM NON LKNG SCREW SUP-97-04928 CDM C1713 HCPCS 0278 RC outpatient 313.25 313.25 313.25 57 178.55 percent of total billed charges 313.25 93 253.73 percent of total billed charges 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 51 159.76 percent of total billed charges 313.25 313.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7X60MM NON LKNG SCREW SUP-97-04929 CDM C1713 HCPCS 0278 RC outpatient 313.25 313.25 313.25 57 178.55 percent of total billed charges 313.25 93 253.73 percent of total billed charges 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 51 159.76 percent of total billed charges 313.25 313.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4 HOLE LT DIS LAT HUM PLATE SUP-97-04930 CDM C1713 HCPCS 0278 RC outpatient 2803.5 2803.5 2803.5 57 1598 percent of total billed charges 2803.5 93 2270.84 percent of total billed charges 2803.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2803.5 other OPPS APC 2803.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2803.5 other OPPS APC 2803.5 51 1429.79 percent of total billed charges 2803.5 2803.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMPONENT-CEMENTED SUP-97-04933 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL GAMMA LONG LEFT 11 X 380MM X 125 SUP-97-04934 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NARROW HEADS 4 HOLE SHAFT LEFT SUP-97-04935 CDM C1713 HCPCS 0278 RC outpatient 1881 1881 1881 57 1072.17 percent of total billed charges 1881 93 1523.61 percent of total billed charges 1881 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1881 other OPPS APC 1881 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1881 other OPPS APC 1881 51 959.31 percent of total billed charges 1881 1881 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANCELLOUS CHIPS 5CC SUP-97-04936 CDM C1762 HCPCS 0278 RC outpatient 375.06 375.06 375.06 57 213.78 percent of total billed charges 375.06 93 303.8 percent of total billed charges 375.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 375.06 other OPPS APC 375.06 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 375.06 other OPPS APC 375.06 51 191.28 percent of total billed charges 375.06 375.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 10.5MM CAN. REAMER HEAD SUP-97-04937 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 7 HOLE RT 88MM PLATE SUP-97-04938 CDM C1713 HCPCS 0278 RC outpatient 2761.5 2761.5 2761.5 57 1574.06 percent of total billed charges 2761.5 93 2236.82 percent of total billed charges 2761.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2761.5 other OPPS APC 2761.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2761.5 other OPPS APC 2761.5 51 1408.37 percent of total billed charges 2761.5 2761.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7 X 55MM LKNG. SCREW SUP-97-04939 CDM C1713 HCPCS 0278 RC outpatient 575.75 575.75 575.75 57 328.18 percent of total billed charges 575.75 93 466.36 percent of total billed charges 575.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 575.75 other OPPS APC 575.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 575.75 other OPPS APC 575.75 51 293.63 percent of total billed charges 575.75 575.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7 X 60 MM LKNG. SCREW SUP-97-04940 CDM C1713 HCPCS 0278 RC outpatient 575.75 575.75 575.75 57 328.18 percent of total billed charges 575.75 93 466.36 percent of total billed charges 575.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 575.75 other OPPS APC 575.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 575.75 other OPPS APC 575.75 51 293.63 percent of total billed charges 575.75 575.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE DYNAMITE NITI W/INSTRS 13WX15\12L SUP-97-04942 CDM C1713 HCPCS 0278 RC outpatient 4737.5 4737.5 4737.5 57 2700.38 percent of total billed charges 4737.5 93 3837.38 percent of total billed charges 4737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4737.5 other OPPS APC 4737.5 4737.5 other OPPS APC 4737.5 51 2416.13 percent of total billed charges 4737.5 4737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLAR SHELL 54MM OD SUP-97-04943 CDM C1776 HCPCS 0278 RC outpatient 1440 1440 1440 57 820.8 percent of total billed charges 1440 93 1166.4 percent of total billed charges 1440 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1440 other OPPS APC 1440 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1440 other OPPS APC 1440 51 734.4 percent of total billed charges 1440 1440 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIPOLAR LINER 53/54/55MM OD X 28MM ID SUP-97-04944 CDM C1776 HCPCS 0278 RC outpatient 864 864 864 57 492.48 percent of total billed charges 864 93 699.84 percent of total billed charges 864 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 864 other OPPS APC 864 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 864 other OPPS APC 864 51 440.64 percent of total billed charges 864 864 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 28MM DIA COCR MOD HD +3MM NK SUP-97-04945 CDM C1776 HCPCS 0278 RC outpatient 1992 1992 1992 57 1135.44 percent of total billed charges 1992 93 1613.52 percent of total billed charges 1992 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1992 other OPPS APC 1992 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1992 other OPPS APC 1992 51 1015.92 percent of total billed charges 1992 1992 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARCOS 12X175MM BRCH BODY STD SUP-97-04946 CDM C1776 HCPCS 0278 RC outpatient 9890 9890 9890 57 5637.3 percent of total billed charges 9890 93 8010.9 percent of total billed charges 9890 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9890 other OPPS APC 9890 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9890 other OPPS APC 9890 51 5043.9 percent of total billed charges 9890 9890 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VAR ANG LOCKING 3.5 X 26MM SUP-97-04947 CDM C1713 HCPCS 0278 RC outpatient 623.35 623.35 623.35 57 355.31 percent of total billed charges 623.35 93 504.91 percent of total billed charges 623.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 623.35 other OPPS APC 623.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 623.35 other OPPS APC 623.35 51 317.91 percent of total billed charges 623.35 623.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VAR ANG LOCKING 3.5 X 65MM SUP-97-04948 CDM C1713 HCPCS 0278 RC outpatient 519.19 519.19 519.19 57 295.94 percent of total billed charges 519.19 93 420.54 percent of total billed charges 519.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 519.19 other OPPS APC 519.19 519.19 other OPPS APC 519.19 51 264.79 percent of total billed charges 519.19 519.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROCESSOR PONTO 4 DIAMOND BLACK SUP-97-04949 CDM L8614 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE TRILOCK OLECRANON TENSION 2.8 SUP-97-04950 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL 2.8 X 60MM HD7 SUP-97-04951 CDM C1713 HCPCS 0278 RC outpatient 392.7 392.7 392.7 57 223.84 percent of total billed charges 392.7 93 318.09 percent of total billed charges 392.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.7 other OPPS APC 392.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.7 other OPPS APC 392.7 51 200.28 percent of total billed charges 392.7 392.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL 2.8 X 65MM HD7 SUP-97-04952 CDM C1713 HCPCS 0278 RC outpatient 392.7 392.7 392.7 57 223.84 percent of total billed charges 392.7 93 318.09 percent of total billed charges 392.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.7 other OPPS APC 392.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392.7 other OPPS APC 392.7 51 200.28 percent of total billed charges 392.7 392.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT MCK TIBIAL ONLAY SZ2-8MM SUP-97-04953 CDM C1776 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5.5 OPERATIVE W/HOLE CANNULATED SUP-97-04954 CDM C1713 HCPCS 0278 RC outpatient 825 825 825 57 470.25 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 51 420.75 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMPONENT-CEMENTED SUP-97-04955 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRISTHLON CS INS SIZE 7 9MM SUP-97-04956 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON CS INS SIZE6 11MM SUP-97-04957 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SELF DRILLING CORTICAL PIN 03.0X60X15 MM SUP-97-04959 CDM 0272 RC outpatient 396.38 396.38 396.38 74 293.32 percent of total billed charges 396.38 93 321.07 percent of total billed charges 396.38 396.38 other OPPS APC 396.38 396.38 other OPPS APC 396.38 27.63 109.52 percent of total billed charges 396.38 396.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR STRAIGHT 13MM DIAM. 2.0 MM SUP-97-04960 CDM 0272 RC outpatient 1050 1050 1050 74 777 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 1050 other OPPS APC 1050 1050 other OPPS APC 1050 27.63 290.12 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCREW 4.0 STD 32MM LGTH SUP-97-04961 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SYSTEM CPR VIPER SUP-97-04963 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE DYNANITE NITI W/INST 9MM X 10MM SUP-97-04964 CDM C1713 HCPCS 0278 RC outpatient 3737.5 3737.5 3737.5 57 2130.38 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 51 1906.13 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI CMP FT 34MM SUP-97-04965 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUICK FIX SCREW TITANIUM 2 MM X 11 MM SUP-97-04966 CDM C1713 HCPCS 0278 RC outpatient 720 720 720 57 410.4 percent of total billed charges 720 93 583.2 percent of total billed charges 720 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 720 other OPPS APC 720 720 other OPPS APC 720 51 367.2 percent of total billed charges 720 720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE DYNANITE NITI W/INST 13MM X 10MM SUP-97-04967 CDM C1713 HCPCS 0278 RC outpatient 4737.5 4737.5 4737.5 57 2700.38 percent of total billed charges 4737.5 93 3837.38 percent of total billed charges 4737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4737.5 other OPPS APC 4737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4737.5 other OPPS APC 4737.5 51 2416.13 percent of total billed charges 4737.5 4737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LONG GAMMA 11 X 440MM SUP-97-04968 CDM C1713 HCPCS 0278 RC outpatient 4747.6 4747.6 4747.6 57 2706.13 percent of total billed charges 4747.6 93 3845.56 percent of total billed charges 4747.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4747.6 other OPPS APC 4747.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4747.6 other OPPS APC 4747.6 51 2421.28 percent of total billed charges 4747.6 4747.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT AMNION THIN 4CM X 6CM SUP-97-04969 CDM C1762 HCPCS 0278 RC outpatient 7562.5 7562.5 7562.5 57 4310.63 percent of total billed charges 7562.5 93 6125.63 percent of total billed charges 7562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7562.5 other OPPS APC 7562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7562.5 other OPPS APC 7562.5 51 3856.88 percent of total billed charges 7562.5 7562.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT AMNION THIN 3CM X 3CM SUP-97-04971 CDM C1762 HCPCS 0278 RC outpatient 3937.5 3937.5 3937.5 57 2244.38 percent of total billed charges 3937.5 93 3189.38 percent of total billed charges 3937.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3937.5 other OPPS APC 3937.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3937.5 other OPPS APC 3937.5 51 2008.13 percent of total billed charges 3937.5 3937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 31.0D SUP-97-04972 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP10102 SHOULDER REVERSE/INVERSE SUP-97-04973 CDM C1776 HCPCS 0278 RC outpatient 14500 14500 14500 57 8265 percent of total billed charges 14500 93 11745 percent of total billed charges 14500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14500 other OPPS APC 14500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 14500 other OPPS APC 14500 51 7395 percent of total billed charges 14500 14500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANN TI LONG THREAD 3.0MM X 38MM SUP-97-04975 CDM C1713 HCPCS 0278 RC outpatient 684.5 684.5 684.5 57 390.17 percent of total billed charges 684.5 93 554.45 percent of total billed charges 684.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 684.5 other OPPS APC 684.5 684.5 other OPPS APC 684.5 51 349.1 percent of total billed charges 684.5 684.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANN TI LONG THREAD 3.0MM X 40MM SUP-97-04976 CDM C1713 HCPCS 0278 RC outpatient 684.5 684.5 684.5 57 390.17 percent of total billed charges 684.5 93 554.45 percent of total billed charges 684.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 684.5 other OPPS APC 684.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 684.5 other OPPS APC 684.5 51 349.1 percent of total billed charges 684.5 684.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN COMP HEADLESS 4.5MM X 38MM SUP-97-04977 CDM C1713 HCPCS 0278 RC outpatient 1314 1314 1314 57 748.98 percent of total billed charges 1314 93 1064.34 percent of total billed charges 1314 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1314 other OPPS APC 1314 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1314 other OPPS APC 1314 51 670.14 percent of total billed charges 1314 1314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6HOLE HARD 4 HOLE SHAFT 2 COL.2.4MM SUP-97-04979 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SCHANZ SPADE POINT 4.0 MM X 100MM SUP-97-04980 CDM C1713 HCPCS 0278 RC outpatient 308.7 308.7 308.7 57 175.96 percent of total billed charges 308.7 93 250.05 percent of total billed charges 308.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 308.7 other OPPS APC 308.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 308.7 other OPPS APC 308.7 51 157.44 percent of total billed charges 308.7 308.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LATERA SYSTEM 1 PACK SUP-97-04981 CDM L8699 HCPCS 0278 RC outpatient 4125 4125 4125 57 2351.25 percent of total billed charges 4125 93 3341.25 percent of total billed charges 4125 4125 other OPPS APC 4125 4125 other OPPS APC 4125 51 2103.75 percent of total billed charges 4125 4125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40MN -10.0D SUP-97-04982 CDM C1780 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBIAL BASEPLATE LM/RL-SZ 4 SUP-97-04983 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBIAL ONLAY INSERT SZ 4-8 MM SUP-97-04984 CDM C1776 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMPONENT CEMENTED SUP-97-04985 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIMPLEX P SPEEDSET FULL DOSE SUP-97-04986 CDM C1713 HCPCS 0278 RC outpatient 192.5 192.5 192.5 57 109.73 percent of total billed charges 192.5 93 155.93 percent of total billed charges 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 51 98.18 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANGEL PRP PROCESSING KIT SUP-97-04987 CDM 0272 RC outpatient 975 975 975 74 721.5 percent of total billed charges 975 93 789.75 percent of total billed charges 975 975 other OPPS APC 975 975 other OPPS APC 975 27.63 269.39 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE TIBIAL BASE RP SZ5 CEM SUP-97-04989 CDM C1776 HCPCS 0278 RC outpatient 5144 5144 5144 57 2932.08 percent of total billed charges 5144 93 4166.64 percent of total billed charges 5144 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5144 other OPPS APC 5144 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5144 other OPPS APC 5144 51 2623.44 percent of total billed charges 5144 5144 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE CR FEM RT SZ6 CEM SUP-97-04990 CDM C1776 HCPCS 0278 RC outpatient 7324 7324 7324 57 4174.68 percent of total billed charges 7324 93 5932.44 percent of total billed charges 7324 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7324 other OPPS APC 7324 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7324 other OPPS APC 7324 51 3735.24 percent of total billed charges 7324 7324 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE MEDIAL DOME PAT 32MM SUP-97-04991 CDM C1776 HCPCS 0278 RC outpatient 1939.2 1939.2 1939.2 57 1105.34 percent of total billed charges 1939.2 93 1570.75 percent of total billed charges 1939.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1939.2 other OPPS APC 1939.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1939.2 other OPPS APC 1939.2 51 988.99 percent of total billed charges 1939.2 1939.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIA PIN GUIDE SET USE W/ RT HYBRID SUP-97-04992 CDM 0272 RC outpatient 1500 1500 1500 74 1110 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 1500 other OPPS APC 1500 1500 other OPPS APC 1500 27.63 414.45 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE CR RP INSRT SZ 6 5MM SUP-97-04993 CDM C1776 HCPCS 0278 RC outpatient 3920 3920 3920 57 2234.4 percent of total billed charges 3920 93 3175.2 percent of total billed charges 3920 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3920 other OPPS APC 3920 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3920 other OPPS APC 3920 51 1999.2 percent of total billed charges 3920 3920 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 28MM SUP-97-04995 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 32MM SUP-97-04996 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T SHAPE LKNG 10 HOLE NARROW PLATE SUP-97-04998 CDM C1713 HCPCS 0278 RC outpatient 1321.65 1321.65 1321.65 57 753.34 percent of total billed charges 1321.65 93 1070.54 percent of total billed charges 1321.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1321.65 other OPPS APC 1321.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1321.65 other OPPS APC 1321.65 51 674.04 percent of total billed charges 1321.65 1321.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.7 X 13MM LKNG SCREW SUP-97-04999 CDM C1713 HCPCS 0278 RC outpatient 295.47 295.47 295.47 57 168.42 percent of total billed charges 295.47 93 239.33 percent of total billed charges 295.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 295.47 other OPPS APC 295.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 295.47 other OPPS APC 295.47 51 150.69 percent of total billed charges 295.47 295.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.7 X 15MM LKNG SCREW SUP-97-05000 CDM C1713 HCPCS 0278 RC outpatient 295.47 295.47 295.47 57 168.42 percent of total billed charges 295.47 93 239.33 percent of total billed charges 295.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 295.47 other OPPS APC 295.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 295.47 other OPPS APC 295.47 51 150.69 percent of total billed charges 295.47 295.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.5 X 5 MM LKNG SCREW SUP-97-05001 CDM C1713 HCPCS 0278 RC outpatient 295.47 295.47 295.47 57 168.42 percent of total billed charges 295.47 93 239.33 percent of total billed charges 295.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 295.47 other OPPS APC 295.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 295.47 other OPPS APC 295.47 51 150.69 percent of total billed charges 295.47 295.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.7 X 9MM LKNG SCREW SUP-97-05002 CDM C1713 HCPCS 0278 RC outpatient 295.47 295.47 295.47 57 168.42 percent of total billed charges 295.47 93 239.33 percent of total billed charges 295.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 295.47 other OPPS APC 295.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 295.47 other OPPS APC 295.47 51 150.69 percent of total billed charges 295.47 295.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.2 X 8MM NON LKNG SCREW SUP-97-05003 CDM C1713 HCPCS 0278 RC outpatient 244.02 244.02 244.02 57 139.09 percent of total billed charges 244.02 93 197.66 percent of total billed charges 244.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 244.02 other OPPS APC 244.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 244.02 other OPPS APC 244.02 51 124.45 percent of total billed charges 244.02 244.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1.7 X 10MM CROSSPIN ST SUP-97-05004 CDM C1713 HCPCS 0278 RC outpatient 261.66 261.66 261.66 57 149.15 percent of total billed charges 261.66 93 211.94 percent of total billed charges 261.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 261.66 other OPPS APC 261.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 261.66 other OPPS APC 261.66 51 133.45 percent of total billed charges 261.66 261.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX COMPRES NRW STRGHT 10 HOLE SUP-97-05005 CDM C1713 HCPCS 0278 RC outpatient 1171.5 1171.5 1171.5 57 667.76 percent of total billed charges 1171.5 93 948.92 percent of total billed charges 1171.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1171.5 other OPPS APC 1171.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1171.5 other OPPS APC 1171.5 51 597.47 percent of total billed charges 1171.5 1171.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNEE PRIMARY ATTUNE RP CEMENTED SUP-97-05006 CDM C1776 HCPCS 0278 RC outpatient 7125 7125 7125 57 4061.25 percent of total billed charges 7125 93 5771.25 percent of total billed charges 7125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7125 other OPPS APC 7125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7125 other OPPS APC 7125 51 3633.75 percent of total billed charges 7125 7125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT 0# X3 INSERT 36MM F SUP-97-05007 CDM C1776 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.0 DRILL BIT SUP-97-05008 CDM 0272 RC outpatient 999 999 999 74 739.26 percent of total billed charges 999 93 809.19 percent of total billed charges 999 999 other OPPS APC 999 999 other OPPS APC 999 27.63 276.02 percent of total billed charges 999 999 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 20 X 16 X16 STAPLE IMPLANT SUP-97-05009 CDM C1713 HCPCS 0278 RC outpatient 5000 5000 5000 57 2850 percent of total billed charges 5000 93 4050 percent of total billed charges 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 5000 other OPPS APC 5000 51 2550 percent of total billed charges 5000 5000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON SYM CONE AUGMENT SIZE A SUP-97-05010 CDM C1776 HCPCS 0278 RC outpatient 9795 9795 9795 57 5583.15 percent of total billed charges 9795 93 7933.95 percent of total billed charges 9795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9795 other OPPS APC 9795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9795 other OPPS APC 9795 51 4995.45 percent of total billed charges 9795 9795 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CEMENTED STEM 15MM X 50MM SUP-97-05011 CDM C1776 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON FEM. DISTAL AUG.5MM SZ3 LEFT SUP-97-05012 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NO.3 TRIATHLON TS PLUS INSERT X3 POLY 16M SUP-97-05013 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBAL BASEPLATE-LM/RL SZ6 SUP-97-05014 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMPONENT CEMENTED SUP-97-05015 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMOR FT SCRW 5.0 LG 75MM LGTH SUP-97-05016 CDM C1713 HCPCS 0278 RC outpatient 1425 1425 1425 57 812.25 percent of total billed charges 1425 93 1154.25 percent of total billed charges 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 51 726.75 percent of total billed charges 1425 1425 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCRW 5.0 LG 80MM LGTH SUP-97-05017 CDM C1713 HCPCS 0278 RC outpatient 1425 1425 1425 57 812.25 percent of total billed charges 1425 93 1154.25 percent of total billed charges 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 51 726.75 percent of total billed charges 1425 1425 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK 3.5 HEADLESS SUP-97-05018 CDM 0272 RC outpatient 542.5 542.5 542.5 74 401.45 percent of total billed charges 542.5 93 439.43 percent of total billed charges 542.5 542.5 other OPPS APC 542.5 542.5 other OPPS APC 542.5 27.63 149.89 percent of total billed charges 542.5 542.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI MONSTER HDLESS SHORT 3.5X30MM SUP-97-05019 CDM C1713 HCPCS 0278 RC outpatient 871.5 871.5 871.5 57 496.76 percent of total billed charges 871.5 93 705.92 percent of total billed charges 871.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 871.5 other OPPS APC 871.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 871.5 other OPPS APC 871.5 51 444.47 percent of total billed charges 871.5 871.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT 0 DEG INSERT 36MM D SUP-97-05020 CDM C1776 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS AR40M -4.0D SUP-97-05021 CDM C1780 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW FULL THRD CANN 4.0 X 36MM SUP-97-05022 CDM C1713 HCPCS 0278 RC outpatient 476 476 476 57 271.32 percent of total billed charges 476 93 385.56 percent of total billed charges 476 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 476 other OPPS APC 476 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 476 other OPPS APC 476 51 242.76 percent of total billed charges 476 476 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW FULL THRD CANN 4.0 X 38MM SUP-97-05023 CDM C1713 HCPCS 0278 RC outpatient 542.64 542.64 542.64 57 309.3 percent of total billed charges 542.64 93 439.54 percent of total billed charges 542.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.64 other OPPS APC 542.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.64 other OPPS APC 542.64 51 276.75 percent of total billed charges 542.64 542.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.2 X 70MM 20MM THD SCREW SUP-97-05024 CDM C1713 HCPCS 0278 RC outpatient 740.16 740.16 740.16 57 421.89 percent of total billed charges 740.16 93 599.53 percent of total billed charges 740.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 740.16 other OPPS APC 740.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 740.16 other OPPS APC 740.16 51 377.48 percent of total billed charges 740.16 740.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SUP-97-05025 CDM C1776 HCPCS 0278 RC outpatient 2754 2754 2754 57 1569.78 percent of total billed charges 2754 93 2230.74 percent of total billed charges 2754 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2754 other OPPS APC 2754 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2754 other OPPS APC 2754 51 1404.54 percent of total billed charges 2754 2754 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 36MM X 12MM SUP-97-05026 CDM C1776 HCPCS 0278 RC outpatient 3880 3880 3880 57 2211.6 percent of total billed charges 3880 93 3142.8 percent of total billed charges 3880 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3880 other OPPS APC 3880 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3880 other OPPS APC 3880 51 1978.8 percent of total billed charges 3880 3880 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK PATELLOFEMORAL L-SZ 3 SUP-97-05027 CDM C1776 HCPCS 0278 RC outpatient 5250 5250 5250 57 2992.5 percent of total billed charges 5250 93 4252.5 percent of total billed charges 5250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5250 other OPPS APC 5250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5250 other OPPS APC 5250 51 2677.5 percent of total billed charges 5250 5250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UHR BIPOLAR 28 X 49 MM SUP-97-05028 CDM C1776 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.5MM LOW PROFILE HEX SCREW 45MM SUP-97-05029 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT II TRIT MULTIHOLE ACETAB. SHELL SUP-97-05030 CDM C1776 HCPCS 0278 RC outpatient 7848 7848 7848 57 4473.36 percent of total billed charges 7848 93 6356.88 percent of total billed charges 7848 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7848 other OPPS APC 7848 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7848 other OPPS APC 7848 51 4002.48 percent of total billed charges 7848 7848 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRL BIT 5.0MM CANN. SUP-97-05031 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRFL DRL 7.0MM CMPR FT SUP-97-05032 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCREW 7.0 XL 65MM LGTH SUP-97-05033 CDM C1713 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GD WIRE 2.4 MM X 9.25IN SUP-97-05034 CDM 0272 RC outpatient 60 60 60 74 44.4 percent of total billed charges 60 93 48.6 percent of total billed charges 60 60 other OPPS APC 60 60 other OPPS APC 60 27.63 16.58 percent of total billed charges 60 60 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 28MM COCR MOD HD +6MM NO SKIRT SUP-97-05035 CDM C1776 HCPCS 0278 RC outpatient 1992 1992 1992 57 1135.44 percent of total billed charges 1992 93 1613.52 percent of total billed charges 1992 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1992 other OPPS APC 1992 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1992 other OPPS APC 1992 51 1015.92 percent of total billed charges 1992 1992 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.2 X 18MM NON LKG SCREW SUP-97-05036 CDM C1713 HCPCS 0278 RC outpatient 244.02 244.02 244.02 57 139.09 percent of total billed charges 244.02 93 197.66 percent of total billed charges 244.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 244.02 other OPPS APC 244.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 244.02 other OPPS APC 244.02 51 124.45 percent of total billed charges 244.02 244.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.2 X 20MM NON LKG SCREW SUP-97-05037 CDM C1713 HCPCS 0278 RC outpatient 244.02 244.02 244.02 57 139.09 percent of total billed charges 244.02 93 197.66 percent of total billed charges 244.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 244.02 other OPPS APC 244.02 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 244.02 other OPPS APC 244.02 51 124.45 percent of total billed charges 244.02 244.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 2.4 X 8MM STAR DRIVE SUP-97-05038 CDM C1713 HCPCS 0278 RC outpatient 193.73 193.73 193.73 57 110.43 percent of total billed charges 193.73 93 156.92 percent of total billed charges 193.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.73 other OPPS APC 193.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.73 other OPPS APC 193.73 51 98.8 percent of total billed charges 193.73 193.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4 X 26MM LKNG SCREW SUP-97-05039 CDM C1713 HCPCS 0278 RC outpatient 432.25 432.25 432.25 57 246.38 percent of total billed charges 432.25 93 350.12 percent of total billed charges 432.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.25 other OPPS APC 432.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.25 other OPPS APC 432.25 51 220.45 percent of total billed charges 432.25 432.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ILLIAC CREST WEDGE 18MM SUP-97-05040 CDM outpatient 1912.29 1912.29 1912.29 1912.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMI HIP SUP-97-05042 CDM C1776 HCPCS 0278 RC outpatient 5000 5000 5000 57 2850 percent of total billed charges 5000 93 4050 percent of total billed charges 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 51 2550 percent of total billed charges 5000 5000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. V40 COCR LFIT HEAD 22.2MM/+8 SUP-97-05044 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE DYNANITE NIT W/INST 11MM X 15\12M SUP-97-05046 CDM C1713 HCPCS 0278 RC outpatient 3737.5 3737.5 3737.5 57 2130.38 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 51 1906.13 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERSTITCH IMPLANT REVERSE CURVE SUP-97-05047 CDM C1713 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERSTITCH IMPLANT 24DEG CURVE SUP-97-05048 CDM C1713 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERSTITCH IMPLANT STRAIGHT SUP-97-05049 CDM C1713 HCPCS 0278 RC outpatient 1485 1485 1485 57 846.45 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERSTITCH IMPLANT STRAIGHT 1.5 SUP-97-05049 CDM C1713 HCPCS 0278 RC outpatient 1485 1485 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1485 other OPPS APC 1485 51 757.35 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HRIS OFFSET GOUGE 6.4 X 180MM SUP-97-05051 CDM 0272 RC outpatient 1516.5 1516.5 1516.5 74 1122.21 percent of total billed charges 1516.5 93 1228.37 percent of total billed charges 1516.5 1516.5 other OPPS APC 1516.5 1516.5 other OPPS APC 1516.5 27.63 419.01 percent of total billed charges 1516.5 1516.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HRIS 1/2 ROUND GOUGE 6MM X 250MM SUP-97-05052 CDM 0272 RC outpatient 1470 1470 1470 74 1087.8 percent of total billed charges 1470 93 1190.7 percent of total billed charges 1470 1470 other OPPS APC 1470 1470 other OPPS APC 1470 27.63 406.16 percent of total billed charges 1470 1470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HRIS FLEXIBLE OSTEO 12 X 93MM SUP-97-05053 CDM 0272 RC outpatient 1081.5 1081.5 1081.5 74 800.31 percent of total billed charges 1081.5 93 876.02 percent of total billed charges 1081.5 1081.5 other OPPS APC 1081.5 1081.5 other OPPS APC 1081.5 27.63 298.82 percent of total billed charges 1081.5 1081.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOW PROFILE HEX 6.5 X 40MM SUP-97-05054 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HRIS T SPLITTER 125MM SUP-97-05055 CDM 0272 RC outpatient 2088 2088 2088 74 1545.12 percent of total billed charges 2088 93 1691.28 percent of total billed charges 2088 2088 other OPPS APC 2088 2088 other OPPS APC 2088 27.63 576.91 percent of total billed charges 2088 2088 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HRIS CANN END MILL 9.5 X 330MM SUP-97-05056 CDM 0272 RC outpatient 1755 1755 1755 74 1298.7 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 1755 other OPPS APC 1755 1755 other OPPS APC 1755 27.63 484.91 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NRS 13MM X 127MM FEMORAL STEM SUP-97-05057 CDM C1776 HCPCS 0278 RC outpatient 8454 8454 8454 57 4818.78 percent of total billed charges 8454 93 6847.74 percent of total billed charges 8454 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8454 other OPPS APC 8454 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8454 other OPPS APC 8454 51 4311.54 percent of total billed charges 8454 8454 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STANDARD PROXIMAL TIBIAL GMRS SUP-97-05058 CDM C1776 HCPCS 0278 RC outpatient 12624 12624 12624 57 7195.68 percent of total billed charges 12624 93 10225.4 percent of total billed charges 12624 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12624 other OPPS APC 12624 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12624 other OPPS APC 12624 51 6438.24 percent of total billed charges 12624 12624 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "MRS 9,, TIBIAL STEM W/OUT BODY" SUP-97-05059 CDM C1776 HCPCS 0278 RC outpatient 6065 6065 6065 57 3457.05 percent of total billed charges 6065 93 4912.65 percent of total billed charges 6065 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6065 other OPPS APC 6065 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6065 other OPPS APC 6065 51 3093.15 percent of total billed charges 6065 6065 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HRHK TIB INS 20MM XS/S S1/S2 SUP-97-05060 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMPONENT CEMENTED SUP-97-05061 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0 X 44MM LKNG SCREW SUP-97-05062 CDM C1713 HCPCS 0278 RC outpatient 604.45 604.45 604.45 57 344.54 percent of total billed charges 604.45 93 489.6 percent of total billed charges 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.45 other OPPS APC 604.45 51 308.27 percent of total billed charges 604.45 604.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SYSTM MPFL FASTTHREAD SUP-97-05064 CDM C1713 HCPCS 0278 RC outpatient 4987.5 4987.5 4987.5 57 2842.88 percent of total billed charges 4987.5 93 4039.88 percent of total billed charges 4987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4987.5 other OPPS APC 4987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4987.5 other OPPS APC 4987.5 51 2543.63 percent of total billed charges 4987.5 4987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REPAIR KIT BIOCOMPOSITE MENISCAL ROOT SUP-97-05065 CDM C1713 HCPCS 0278 RC outpatient 4250 4250 4250 57 2422.5 percent of total billed charges 4250 93 3442.5 percent of total billed charges 4250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4250 other OPPS APC 4250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4250 other OPPS APC 4250 51 2167.5 percent of total billed charges 4250 4250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT #0 X3 INSERT 36MM E SUP-97-05066 CDM C1776 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.0 X 15 MICO CAN SCREW SUP-97-05067 CDM C1713 HCPCS 0278 RC outpatient 599.76 599.76 599.76 57 341.86 percent of total billed charges 599.76 93 485.81 percent of total billed charges 599.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 599.76 other OPPS APC 599.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 599.76 other OPPS APC 599.76 51 305.88 percent of total billed charges 599.76 599.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.3 DRIVER BLADE CROSS PIN SUP-97-05068 CDM 0272 RC outpatient 547.68 547.68 547.68 74 405.28 percent of total billed charges 547.68 93 443.62 percent of total billed charges 547.68 547.68 other OPPS APC 547.68 547.68 other OPPS APC 547.68 27.63 151.32 percent of total billed charges 547.68 547.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.2 MM COUNTERSINK SUP-97-05069 CDM 0272 RC outpatient 435.12 435.12 435.12 74 321.99 percent of total billed charges 435.12 93 352.45 percent of total billed charges 435.12 435.12 other OPPS APC 435.12 435.12 other OPPS APC 435.12 27.63 120.22 percent of total billed charges 435.12 435.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DYNANITE PIP-BENT 14MM W/INSTR SUP-97-05072 CDM C1713 HCPCS 0278 RC outpatient 2460 2460 2460 57 1402.2 percent of total billed charges 2460 93 1992.6 percent of total billed charges 2460 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2460 other OPPS APC 2460 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2460 other OPPS APC 2460 51 1254.6 percent of total billed charges 2460 2460 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE DYNANITE NITI W/INST 11MM X 10MM SUP-97-05073 CDM C1713 HCPCS 0278 RC outpatient 3737.5 3737.5 3737.5 57 2130.38 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 51 1906.13 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCREW 4.0 STD 36MM LGTH SUP-97-05074 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICRO CMT FT 34MM SUP-97-05075 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCREW 4.0 STD 34MM LGTH SUP-97-05076 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON INSERT PS#6 10MM SUP-97-05077 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T2 LONG PROXIMAL HUMERAL NAIL LF.300MM SUP-97-05078 CDM C1713 HCPCS 0278 RC outpatient 3776.3 3776.3 3776.3 57 2152.49 percent of total billed charges 3776.3 93 3058.8 percent of total billed charges 3776.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3776.3 other OPPS APC 3776.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3776.3 other OPPS APC 3776.3 51 1925.91 percent of total billed charges 3776.3 3776.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T2 F/T LKNG SCREW 4MM X 30MM SUP-97-05079 CDM C1713 HCPCS 0278 RC outpatient 546.7 546.7 546.7 57 311.62 percent of total billed charges 546.7 93 442.83 percent of total billed charges 546.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 546.7 other OPPS APC 546.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 546.7 other OPPS APC 546.7 51 278.82 percent of total billed charges 546.7 546.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO-PRO SCREW CANN BLUNT TIP 4 X 26MM SUP-97-05081 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.5 DRILL BIT SUP-97-05082 CDM 0272 RC outpatient 542.5 542.5 542.5 74 401.45 percent of total billed charges 542.5 93 439.43 percent of total billed charges 542.5 542.5 other OPPS APC 542.5 542.5 other OPPS APC 542.5 27.63 149.89 percent of total billed charges 542.5 542.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7 X 22 NON LOCKING SCREW SUP-97-05086 CDM C1713 HCPCS 0278 RC outpatient 420 420 420 57 239.4 percent of total billed charges 420 93 340.2 percent of total billed charges 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 51 214.2 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7 X 15 NONLOCKING SCREW SUP-97-05087 CDM C1713 HCPCS 0278 RC outpatient 420 420 420 57 239.4 percent of total billed charges 420 93 340.2 percent of total billed charges 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 51 214.2 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.0 CANNUL. DRILL SUP-97-05088 CDM 0272 RC outpatient 542.5 542.5 542.5 74 401.45 percent of total billed charges 542.5 93 439.43 percent of total billed charges 542.5 542.5 other OPPS APC 542.5 542.5 other OPPS APC 542.5 27.63 149.89 percent of total billed charges 542.5 542.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI PRESS-FIT STEM 17MM X 100MM SUP-97-05092 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LONG GAMMA 11 X 420MM 130DEG SUP-97-05093 CDM C1713 HCPCS 0278 RC outpatient 4747.6 4747.6 4747.6 57 2706.13 percent of total billed charges 4747.6 93 3845.56 percent of total billed charges 4747.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4747.6 other OPPS APC 4747.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4747.6 other OPPS APC 4747.6 51 2421.28 percent of total billed charges 4747.6 4747.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 95MM SUP-97-05095 CDM C1713 HCPCS 0278 RC outpatient 560.56 560.56 560.56 57 319.52 percent of total billed charges 560.56 93 454.05 percent of total billed charges 560.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 560.56 other OPPS APC 560.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 560.56 other OPPS APC 560.56 51 285.89 percent of total billed charges 560.56 560.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI CMP FT 32MM SUP-97-05100 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE DOUBLE ENDED TROCAR .045IN SUP-97-05101 CDM 0272 RC outpatient 120 120 120 74 88.8 percent of total billed charges 120 93 97.2 percent of total billed charges 120 120 other OPPS APC 120 120 other OPPS APC 120 27.63 33.16 percent of total billed charges 120 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0 X 35MM FULL THD SCREW SUP-97-05104 CDM C1713 HCPCS 0278 RC outpatient 87.32 87.32 87.32 57 49.77 percent of total billed charges 87.32 93 70.73 percent of total billed charges 87.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 87.32 other OPPS APC 87.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 87.32 other OPPS APC 87.32 51 44.53 percent of total billed charges 87.32 87.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON SYMMETRIC X3 PATELLA SUP-97-05108 CDM C1776 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON INSERT PS#3 10MM SUP-97-05109 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI TS BASEPLATE SIZE 1 SUP-97-05110 CDM C1776 HCPCS 0278 RC outpatient 3125 3125 3125 57 1781.25 percent of total billed charges 3125 93 2531.25 percent of total billed charges 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 51 1593.75 percent of total billed charges 3125 3125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI MONSTER HD SHRT THRED3.5X20MM SUP-97-05114 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI MONSTER HD SHRT THRED3.5X38MM SUP-97-05115 CDM C1713 HCPCS 0278 RC outpatient 871.5 871.5 871.5 57 496.76 percent of total billed charges 871.5 93 705.92 percent of total billed charges 871.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 871.5 other OPPS APC 871.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 871.5 other OPPS APC 871.5 51 444.47 percent of total billed charges 871.5 871.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR CONICAL 12 MM DIA.2.2 MM SUP-97-05116 CDM 0272 RC outpatient 1050 1050 1050 74 777 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 1050 other OPPS APC 1050 1050 other OPPS APC 1050 27.63 290.12 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI CMP FT 28MM SUP-97-05117 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCREW 4.0 STD 26MM LGTH SUP-97-05118 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRIVER PEG SUP-97-05120 CDM 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 297.5 other OPPS APC 297.5 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE PS FB INSRT SZ 6 10MM SUP-97-05121 CDM C1776 HCPCS 0278 RC outpatient 3361 3361 3361 57 1915.77 percent of total billed charges 3361 93 2722.41 percent of total billed charges 3361 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3361 other OPPS APC 3361 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3361 other OPPS APC 3361 51 1714.11 percent of total billed charges 3361 3361 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON INSERT PS #6 14MM SUP-97-05122 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MDM COCR LINER 48MM G SUP-97-05123 CDM C1776 HCPCS 0278 RC outpatient 2325 2325 2325 57 1325.25 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 51 1185.75 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESTORATION ADN X3 INSERT 28MM/OD54MM SUP-97-05124 CDM C1776 HCPCS 0278 RC outpatient 2325 2325 2325 57 1325.25 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 51 1185.75 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON CS INS SIZE2 13MM SUP-97-05125 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7 X 10MM NON LKG SCREW SUP-97-05128 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.5MM CALIB DRILL BIT SUP-97-05131 CDM 0272 RC outpatient 443.1 443.1 443.1 74 327.89 percent of total billed charges 443.1 93 358.91 percent of total billed charges 443.1 443.1 other OPPS APC 443.1 443.1 other OPPS APC 443.1 27.63 122.43 percent of total billed charges 443.1 443.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIGHT 3.5 10H 177MM PLATE SUP-97-05132 CDM C1713 HCPCS 0278 RC outpatient 4479.05 4479.05 4479.05 57 2553.06 percent of total billed charges 4479.05 93 3628.03 percent of total billed charges 4479.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4479.05 other OPPS APC 4479.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4479.05 other OPPS APC 4479.05 51 2284.32 percent of total billed charges 4479.05 4479.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5 X 28MM LOCK SCREW SUP-97-05133 CDM C1713 HCPCS 0278 RC outpatient 519.19 519.19 519.19 57 295.94 percent of total billed charges 519.19 93 420.54 percent of total billed charges 519.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 519.19 other OPPS APC 519.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 519.19 other OPPS APC 519.19 51 264.79 percent of total billed charges 519.19 519.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5 X 32MM LOCK SCREW SUP-97-05134 CDM C1713 HCPCS 0278 RC outpatient 519.19 519.19 519.19 57 295.94 percent of total billed charges 519.19 93 420.54 percent of total billed charges 519.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 519.19 other OPPS APC 519.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 519.19 other OPPS APC 519.19 51 264.79 percent of total billed charges 519.19 519.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5 X 50MM LOCK SCREW SUP-97-05135 CDM C1713 HCPCS 0278 RC outpatient 519.19 519.19 519.19 57 295.94 percent of total billed charges 519.19 93 420.54 percent of total billed charges 519.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 519.19 other OPPS APC 519.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 519.19 other OPPS APC 519.19 51 264.79 percent of total billed charges 519.19 519.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5 X 54MM LOCK SCREW SUP-97-05136 CDM C1713 HCPCS 0278 RC outpatient 519.19 519.19 519.19 57 295.94 percent of total billed charges 519.19 93 420.54 percent of total billed charges 519.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 519.19 other OPPS APC 519.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 519.19 other OPPS APC 519.19 51 264.79 percent of total billed charges 519.19 519.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5 X 75MM LOCK SCREW SUP-97-05137 CDM C1713 HCPCS 0278 RC outpatient 623.35 623.35 623.35 57 355.31 percent of total billed charges 623.35 93 504.91 percent of total billed charges 623.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 623.35 other OPPS APC 623.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 623.35 other OPPS APC 623.35 51 317.91 percent of total billed charges 623.35 623.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCREW 7.0 XL 80MM LGTH SUP-97-05139 CDM C1713 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7MM XXL VOLAR DR PLATE NARROW LE 11HOL SUP-97-05140 CDM C1713 HCPCS 0278 RC outpatient 3931.25 3931.25 3931.25 57 2240.81 percent of total billed charges 3931.25 93 3184.31 percent of total billed charges 3931.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3931.25 other OPPS APC 3931.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3931.25 other OPPS APC 3931.25 51 2004.94 percent of total billed charges 3931.25 3931.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCREW 4.0STD 46MM LENGTH SUP-97-05142 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT 3.0 CC SUP-97-05143 CDM C1734 HCPCS 0278 RC outpatient 6750 6750 6750 57 3847.5 percent of total billed charges 6750 93 5467.5 percent of total billed charges 6750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6750 other OPPS APC 6750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6750 other OPPS APC 6750 51 3442.5 percent of total billed charges 6750 6750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN SHRT THREAD 4MM X 60MM SUP-97-05144 CDM C1713 HCPCS 0278 RC outpatient 676.76 676.76 676.76 57 385.75 percent of total billed charges 676.76 93 548.18 percent of total billed charges 676.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 676.76 other OPPS APC 676.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 676.76 other OPPS APC 676.76 51 345.15 percent of total billed charges 676.76 676.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN SHRT THREAD 4MM X 64MM SUP-97-05145 CDM C1713 HCPCS 0278 RC outpatient 676.76 676.76 676.76 57 385.75 percent of total billed charges 676.76 93 548.18 percent of total billed charges 676.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 676.76 other OPPS APC 676.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 676.76 other OPPS APC 676.76 51 345.15 percent of total billed charges 676.76 676.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 LCKNG 2.7MM X 8MM SUP-97-05148 CDM C1713 HCPCS 0278 RC outpatient 516.25 516.25 516.25 57 294.26 percent of total billed charges 516.25 93 418.16 percent of total billed charges 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 51 263.29 percent of total billed charges 516.25 516.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL KIT SUP-97-05153 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T8 NON LCKNG 2.7MM X 8MM SUP-97-05154 CDM C1713 HCPCS 0278 RC outpatient 301 301 301 57 171.57 percent of total billed charges 301 93 243.81 percent of total billed charges 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 51 153.51 percent of total billed charges 301 301 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM LCP CLAVICLE PLATE 7 HOLE LFT 100M SUP-97-05156 CDM C1713 HCPCS 0278 RC outpatient 2749.68 2749.68 2749.68 57 1567.32 percent of total billed charges 2749.68 93 2227.24 percent of total billed charges 2749.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2749.68 other OPPS APC 2749.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2749.68 other OPPS APC 2749.68 51 1402.34 percent of total billed charges 2749.68 2749.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK 5.0MM HEADLESS SUP-97-05157 CDM 0272 RC outpatient 691.25 691.25 691.25 74 511.53 percent of total billed charges 691.25 93 559.91 percent of total billed charges 691.25 691.25 other OPPS APC 691.25 691.25 other OPPS APC 691.25 27.63 190.99 percent of total billed charges 691.25 691.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 3.3 X 200MM 3/16 SQ CONNECTION SUP-97-05164 CDM 0272 RC outpatient 1042.5 1042.5 1042.5 74 771.45 percent of total billed charges 1042.5 93 844.43 percent of total billed charges 1042.5 1042.5 other OPPS APC 1042.5 1042.5 other OPPS APC 1042.5 27.63 288.04 percent of total billed charges 1042.5 1042.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 3.5X200MM 3/16 SQ CONNECTION SUP-97-05165 CDM 0272 RC outpatient 1042.5 1042.5 1042.5 74 771.45 percent of total billed charges 1042.5 93 844.43 percent of total billed charges 1042.5 1042.5 other OPPS APC 1042.5 1042.5 other OPPS APC 1042.5 27.63 288.04 percent of total billed charges 1042.5 1042.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DYNANITE PIP STR 14MM W/INSTR SUP-97-05168 CDM C1713 HCPCS 0278 RC outpatient 3737.5 3737.5 3737.5 57 2130.38 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 51 1906.13 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCREW 4.0 STD 28MM LGTH SUP-97-05169 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT II TRITANIUM CLUSTERHOLE 44B SUP-97-05172 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT 0 DEG X3 INSERT 32MM ID SUP-97-05173 CDM C1776 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. V40 BIOLOX DELTA HEAD 32MM/-4 SUP-97-05174 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCREW 7.0XL 50MM LGTH SUP-97-05178 CDM C1713 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMPONENT-CEMENTED SUP-97-05180 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL BEARING INSERT CS TRIATHLON SUP-97-05181 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNOTLESS SPEEDBRIDGE KIT SUP-97-05183 CDM C1713 HCPCS 0278 RC outpatient 5375 5375 5375 57 3063.75 percent of total billed charges 5375 93 4353.75 percent of total billed charges 5375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5375 other OPPS APC 5375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5375 other OPPS APC 5375 51 2741.25 percent of total billed charges 5375 5375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS FEM COMPONENT BEADED W/PA SUP-97-05190 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON INSERT PS #2 10MM SUP-97-05191 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4 X 16MM LKNG SCREW SUP-97-05192 CDM C1713 HCPCS 0278 RC outpatient 516.25 516.25 516.25 57 294.26 percent of total billed charges 516.25 93 418.16 percent of total billed charges 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 51 263.29 percent of total billed charges 516.25 516.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4 X 20MM LKNG SCREW SUP-97-05193 CDM C1713 HCPCS 0278 RC outpatient 516.25 516.25 516.25 57 294.26 percent of total billed charges 516.25 93 418.16 percent of total billed charges 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 51 263.29 percent of total billed charges 516.25 516.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.4 X 22MM LKNG SCREW SUP-97-05194 CDM C1713 HCPCS 0278 RC outpatient 516.25 516.25 516.25 57 294.26 percent of total billed charges 516.25 93 418.16 percent of total billed charges 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 516.25 other OPPS APC 516.25 51 263.29 percent of total billed charges 516.25 516.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON INSERT PS #4 10MM SUP-97-05195 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON SYMMETRIC X3 PATELLA SUP-97-05197 CDM C1776 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS X3 TIBIAL INSERT SUP-97-05198 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 20.5D SUP-97-05199 CDM C1780 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3X10 CS INSERT SUP-97-05202 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS X3 TIBAL INSERT SUP-97-05206 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.3 LT 6. HOLE L SHAPED SUP-97-05207 CDM C1713 HCPCS 0278 RC outpatient 1249.56 1249.56 1249.56 57 712.25 percent of total billed charges 1249.56 93 1012.14 percent of total billed charges 1249.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1249.56 other OPPS APC 1249.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1249.56 other OPPS APC 1249.56 51 637.28 percent of total billed charges 1249.56 1249.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE NON LOK CRSSPIN ST 2.3 X 8MM SUP-97-05208 CDM C1713 HCPCS 0278 RC outpatient 263.13 263.13 263.13 57 149.98 percent of total billed charges 263.13 93 213.14 percent of total billed charges 263.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 263.13 other OPPS APC 263.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 263.13 other OPPS APC 263.13 51 134.2 percent of total billed charges 263.13 263.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REST MOD CONICAL DISTAL STEM 22MM X 155M SUP-97-05209 CDM C1776 HCPCS 0278 RC outpatient 7228 7228 7228 57 4119.96 percent of total billed charges 7228 93 5854.68 percent of total billed charges 7228 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7228 other OPPS APC 7228 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7228 other OPPS APC 7228 51 3686.28 percent of total billed charges 7228 7228 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCREW 4.0 STD 22MM LGTH SUP-97-05210 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7 X 46 MM VAR. ANG.LKNG SCREW SUP-97-05216 CDM C1713 HCPCS 0278 RC outpatient 490.77 490.77 490.77 57 279.74 percent of total billed charges 490.77 93 397.52 percent of total billed charges 490.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490.77 other OPPS APC 490.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490.77 other OPPS APC 490.77 51 250.29 percent of total billed charges 490.77 490.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 12MM META SUP-97-05217 CDM C1713 HCPCS 0278 RC outpatient 195.88 195.88 195.88 57 111.65 percent of total billed charges 195.88 93 158.66 percent of total billed charges 195.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 195.88 other OPPS APC 195.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 195.88 other OPPS APC 195.88 51 99.9 percent of total billed charges 195.88 195.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXIBLE HINGE TOE IMPLANT W/GROMT.#5S SUP-97-05221 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5MM CRTX SCREW/LOW S.TAP.STAR 48MM SUP-97-05222 CDM C1713 HCPCS 0278 RC outpatient 141.72 141.72 141.72 57 80.78 percent of total billed charges 141.72 93 114.79 percent of total billed charges 141.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 141.72 other OPPS APC 141.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 141.72 other OPPS APC 141.72 51 72.28 percent of total billed charges 141.72 141.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMPONENT-CEMENTED SUP-97-05223 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4 X 12MM CS POLY SUP-97-05224 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5 X 12MM SCREW LKNG SUP-97-05227 CDM C1713 HCPCS 0278 RC outpatient 623.35 623.35 623.35 57 355.31 percent of total billed charges 623.35 93 504.91 percent of total billed charges 623.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 623.35 other OPPS APC 623.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 623.35 other OPPS APC 623.35 51 317.91 percent of total billed charges 623.35 623.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5 X 14 MM SCREW LKNG SUP-97-05228 CDM C1713 HCPCS 0278 RC outpatient 519.19 519.19 519.19 57 295.94 percent of total billed charges 519.19 93 420.54 percent of total billed charges 519.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 519.19 other OPPS APC 519.19 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 519.19 other OPPS APC 519.19 51 264.79 percent of total billed charges 519.19 519.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.5 X 16MM SCREW LKNG SUP-97-05229 CDM C1713 HCPCS 0278 RC outpatient 623.35 623.35 623.35 57 355.31 percent of total billed charges 623.35 93 504.91 percent of total billed charges 623.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 623.35 other OPPS APC 623.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 623.35 other OPPS APC 623.35 51 317.91 percent of total billed charges 623.35 623.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2 X 10MM CS LINER SUP-97-05230 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPERMX NITI STAPLE W/INSTRS 15W X 15L SUP-97-05231 CDM C1713 HCPCS 0278 RC outpatient 6237.5 6237.5 6237.5 57 3555.38 percent of total billed charges 6237.5 93 5052.38 percent of total billed charges 6237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6237.5 other OPPS APC 6237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6237.5 other OPPS APC 6237.5 51 3181.13 percent of total billed charges 6237.5 6237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ABLATOR 50DEGREE APOLLO RF H50 SUP-97-05234 CDM 0272 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4MM SPADE TIP DRILL SUP-97-05235 CDM 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 437.5 other OPPS APC 437.5 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DYNANITE PIP - BENT 12MM - W/INSTR SUP-97-05239 CDM C1713 HCPCS 0278 RC outpatient 3737.5 3737.5 3737.5 57 2130.38 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 51 1906.13 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUICKFIX SCREW TI CANN. PT 2.0 X 16MM SUP-97-05240 CDM C1713 HCPCS 0278 RC outpatient 490 490 490 57 279.3 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 51 249.9 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI CMP FT 16MM SUP-97-05241 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUICKFIX SCREW TI CANN. PT 2.0 X 14MM SUP-97-05243 CDM C1713 HCPCS 0278 RC outpatient 490 490 490 57 279.3 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 51 249.9 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICRO CMP FT 13MM SUP-97-05244 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE FENESTRATION PERFORATOR SUP-97-05246 CDM 0272 RC outpatient 350 350 350 74 259 percent of total billed charges 350 93 283.5 percent of total billed charges 350 350 other OPPS APC 350 350 other OPPS APC 350 27.63 96.71 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 2.8 X 160MM SOLID LONG AO SUP-97-05249 CDM 0272 RC outpatient 542.5 542.5 542.5 74 401.45 percent of total billed charges 542.5 93 439.43 percent of total billed charges 542.5 542.5 other OPPS APC 542.5 542.5 other OPPS APC 542.5 27.63 149.89 percent of total billed charges 542.5 542.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK 7.0MM MONSTER SCREW HEADED SUP-97-05255 CDM C1713 HCPCS 0278 RC outpatient 691.25 691.25 691.25 57 394.01 percent of total billed charges 691.25 93 559.91 percent of total billed charges 691.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 691.25 other OPPS APC 691.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 691.25 other OPPS APC 691.25 51 352.54 percent of total billed charges 691.25 691.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. R3CON NON-LNG PLATE SCREW 4.2X30MM SUP-97-05258 CDM C1713 HCPCS 0278 RC outpatient 437.5 437.5 437.5 57 249.38 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 51 223.13 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.5 X 28MM MICRO COMPRESSION FT SUP-97-05262 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS COMPRES SCRW 4.3 X 55MM SUP-97-05263 CDM C1713 HCPCS 0278 RC outpatient 1125 1125 1125 57 641.25 percent of total billed charges 1125 93 911.25 percent of total billed charges 1125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1125 other OPPS APC 1125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1125 other OPPS APC 1125 51 573.75 percent of total billed charges 1125 1125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCRW 7.0 XL 90MM LGTH SUP-97-05264 CDM C1713 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCRW 7.0 XL 95MM LGTH SUP-97-05265 CDM C1713 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.0MM DRILL BIT QC 140MM SUP-97-05267 CDM 0272 RC outpatient 642.6 642.6 642.6 74 475.52 percent of total billed charges 642.6 93 520.51 percent of total billed charges 642.6 642.6 other OPPS APC 642.6 642.6 other OPPS APC 642.6 27.63 177.55 percent of total billed charges 642.6 642.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACCOLADE CS 127 NK SUP-97-05269 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5.0MM X 38MM SUP-97-05271 CDM C1713 HCPCS 0278 RC outpatient 434.91 434.91 434.91 57 247.9 percent of total billed charges 434.91 93 352.28 percent of total billed charges 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 51 221.8 percent of total billed charges 434.91 434.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5.0MM X 40MM SUP-97-05272 CDM C1713 HCPCS 0278 RC outpatient 434.91 434.91 434.91 57 247.9 percent of total billed charges 434.91 93 352.28 percent of total billed charges 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 51 221.8 percent of total billed charges 434.91 434.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 14 HOLE RIGHT FEM DIS LAT SUP-97-05273 CDM C1713 HCPCS 0278 RC outpatient 5492.2 5492.2 5492.2 57 3130.55 percent of total billed charges 5492.2 93 4448.68 percent of total billed charges 5492.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5492.2 other OPPS APC 5492.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5492.2 other OPPS APC 5492.2 51 2801.02 percent of total billed charges 5492.2 5492.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 16 HOLE RIGHT FEM DIST LAT SUP-97-05274 CDM C1713 HCPCS 0278 RC outpatient 5607 5607 5607 57 3195.99 percent of total billed charges 5607 93 4541.67 percent of total billed charges 5607 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5607 other OPPS APC 5607 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5607 other OPPS APC 5607 51 2859.57 percent of total billed charges 5607 5607 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIAATHLON INSERT PS#6 12MM SUP-97-05275 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMPONENT BEADED W/PA SUP-97-05277 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T10 FULL THREAD 2.7MM X 14MM SUP-97-05280 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T10 FULL THREAD 2.7MM X 16MM SUP-97-05281 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T10 FULL THREAD 2.7MM X 18MM SUP-97-05282 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 46MM LOCKING SUP-97-05283 CDM C1713 HCPCS 0278 RC outpatient 523.32 523.32 523.32 57 298.29 percent of total billed charges 523.32 93 423.89 percent of total billed charges 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 523.32 other OPPS APC 523.32 51 266.89 percent of total billed charges 523.32 523.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T10 3.5 X 46MM NON LOCKING SUP-97-05284 CDM C1713 HCPCS 0278 RC outpatient 264.6 264.6 264.6 57 150.82 percent of total billed charges 264.6 93 214.33 percent of total billed charges 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 264.6 other OPPS APC 264.6 51 134.95 percent of total billed charges 264.6 264.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE DYNANITE NITI 9MM X 10MM SUP-97-05285 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE DYNANITE NITI 11MM X 10MM SUP-97-05286 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE DYNANITE NITI 11MM X 15/12MM SUP-97-05287 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE DYNANITE NITI 13MM X 10MM SUP-97-05289 CDM C1713 HCPCS 0278 RC outpatient 3737.5 3737.5 3737.5 57 2130.38 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 51 1906.13 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE DYNANITE NITI 13MM X 15/12MM SUP-97-05290 CDM C1713 HCPCS 0278 RC outpatient 3737.5 3737.5 3737.5 57 2130.38 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 51 1906.13 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REUNION TSA SR 4MM OFFSET HUM HEAD44X22 SUP-97-05291 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REST MOD PROX CONE BODY 19MM +20 SUP-97-05293 CDM C1776 HCPCS 0278 RC outpatient 8068.8 8068.8 8068.8 57 4599.22 percent of total billed charges 8068.8 93 6535.73 percent of total billed charges 8068.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8068.8 other OPPS APC 8068.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8068.8 other OPPS APC 8068.8 51 4115.09 percent of total billed charges 8068.8 8068.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUICKFIX SCREW TI CANN PT 2.4 X 20MM SUP-97-05299 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MRS 15MM X 127MM FEMORAL STEM SUP-97-05300 CDM C1776 HCPCS 0278 RC outpatient 8454 8454 8454 57 4818.78 percent of total billed charges 8454 93 6847.74 percent of total billed charges 8454 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8454 other OPPS APC 8454 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8454 other OPPS APC 8454 51 4311.54 percent of total billed charges 8454 8454 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MRS 11MM X 127MM FEMORAL STEM SUP-97-05301 CDM C1776 HCPCS 0278 RC outpatient 6943 6943 6943 57 3957.51 percent of total billed charges 6943 93 5623.83 percent of total billed charges 6943 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6943 other OPPS APC 6943 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6943 other OPPS APC 6943 51 3540.93 percent of total billed charges 6943 6943 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STD LT DIST FEM 65MM GMRS SUP-97-05302 CDM C1776 HCPCS 0278 RC outpatient 12536 12536 12536 57 7145.52 percent of total billed charges 12536 93 10154.2 percent of total billed charges 12536 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12536 other OPPS APC 12536 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12536 other OPPS APC 12536 51 6393.36 percent of total billed charges 12536 12536 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MRH/GMRS DISTAL FEMUR POLY PACK SUP-97-05303 CDM C1776 HCPCS 0278 RC outpatient 3549 3549 3549 57 2022.93 percent of total billed charges 3549 93 2874.69 percent of total billed charges 3549 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3549 other OPPS APC 3549 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3549 other OPPS APC 3549 51 1809.99 percent of total billed charges 3549 3549 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HRHK TIB INS 20MM M/L M2/L2 SUP-97-05304 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT 0# X3 INSERT 36MM ID SUP-97-05305 CDM C1776 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIZE 5 X 10MM CS TIBIAL BEARING INSERT SUP-97-05306 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANN. LAG SCREW 2.3MM X 18MM SUP-97-05307 CDM C1713 HCPCS 0278 RC outpatient 402.5 402.5 402.5 57 229.43 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 51 205.28 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DYNANITE PIP-STR 12MM W/INSTR SUP-97-05310 CDM C1713 HCPCS 0278 RC outpatient 3737.5 3737.5 3737.5 57 2130.38 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 51 1906.13 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIGHTROPE XP BUTTRESS PLATE SUP-97-05311 CDM C1713 HCPCS 0278 RC outpatient 9987.5 9987.5 9987.5 57 5692.88 percent of total billed charges 9987.5 93 8089.88 percent of total billed charges 9987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9987.5 other OPPS APC 9987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9987.5 other OPPS APC 9987.5 51 5093.63 percent of total billed charges 9987.5 9987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERTAPE CERCLAGE W/O NEEDLE SUP-97-05312 CDM C1713 HCPCS 0278 RC outpatient 5937.5 5937.5 5937.5 57 3384.38 percent of total billed charges 5937.5 93 4809.38 percent of total billed charges 5937.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5937.5 other OPPS APC 5937.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5937.5 other OPPS APC 5937.5 51 3028.13 percent of total billed charges 5937.5 5937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMPONENT-CEMENTED SUP-97-05313 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUICKFIX SCREW TI CANN PT 2.0X26MM SUP-97-05315 CDM C1713 HCPCS 0278 RC outpatient 490 490 490 57 279.3 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 51 249.9 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUICKFIX SCREW TI CANN PT 2.0X30MM SUP-97-05316 CDM C1713 HCPCS 0278 RC outpatient 490 490 490 57 279.3 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 51 249.9 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOSYNC EVANS WEDGE 20X20X10MM SUP-97-05317 CDM C1713 HCPCS 0278 RC outpatient 5487.5 5487.5 5487.5 57 3127.88 percent of total billed charges 5487.5 93 4444.88 percent of total billed charges 5487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5487.5 other OPPS APC 5487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5487.5 other OPPS APC 5487.5 51 2798.63 percent of total billed charges 5487.5 5487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUICKFIX SCREW TI CANN PT 2.4X24MM SUP-97-05318 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VAL KREULOCK TI 3.0X12 SUP-97-05319 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VAL KREULOCK TI 3.0X14 SUP-97-05320 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VAL KREULOCK TI 3.0X16 SUP-97-05321 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VAL KREULOCK TI 3.0X18 SUP-97-05322 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE SCREW TITAN.3.5MM X 14MM SUP-97-05323 CDM C1713 HCPCS 0278 RC outpatient 210 210 210 57 119.7 percent of total billed charges 210 93 170.1 percent of total billed charges 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 51 107.1 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KREULOCK SCREW TI 3.5X12 SUP-97-05325 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING DISTAL FIBULA PLATE TI LEFT 5H SUP-97-05327 CDM C1713 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0 X 60MM CAN. BONE SCREW SUP-97-05329 CDM C1713 HCPCS 0278 RC outpatient 87.32 87.32 87.32 57 49.77 percent of total billed charges 87.32 93 70.73 percent of total billed charges 87.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 87.32 other OPPS APC 87.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 87.32 other OPPS APC 87.32 51 44.53 percent of total billed charges 87.32 87.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ABLATOR ASPIRATING APOLLO RF i90 SUP-97-05330 CDM 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 705 other OPPS APC 705 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT 3DMAX MID LEFT LARGE SUP-97-05334 CDM C1781 HCPCS 0278 RC outpatient 705 705 705 57 401.85 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 51 359.55 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MRS 13MM TIBAL STEM SUP-97-05337 CDM C1776 HCPCS 0278 RC outpatient 8376 8376 8376 57 4774.32 percent of total billed charges 8376 93 6784.56 percent of total billed charges 8376 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8376 other OPPS APC 8376 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8376 other OPPS APC 8376 51 4271.76 percent of total billed charges 8376 8376 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MRS 15X127 FEM STEM W/O BODY SUP-97-05338 CDM C1776 HCPCS 0278 RC outpatient 6124 6124 6124 57 3490.68 percent of total billed charges 6124 93 4960.44 percent of total billed charges 6124 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6124 other OPPS APC 6124 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6124 other OPPS APC 6124 51 3123.24 percent of total billed charges 6124 6124 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMPONENT BEADED W/PA SUP-97-05339 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIZE 10 ACCOLADE II 127 DEG SUP-97-05340 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSTEONICS UNIV DISTAL SPACER SUP-97-05341 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACCOLADE C CS 132 NK SUP-97-05342 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMPONENT BEADED W/PA SUP-97-05349 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 10MM X 320MM LEFT TFNA STERILE SUP-97-05350 CDM C1713 HCPCS 0278 RC outpatient 6124.8 6124.8 6124.8 57 3491.14 percent of total billed charges 6124.8 93 4961.09 percent of total billed charges 6124.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6124.8 other OPPS APC 6124.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6124.8 other OPPS APC 6124.8 51 3123.65 percent of total billed charges 6124.8 6124.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 10MM X 340MM RIGHT TFNA STERILE SUP-97-05351 CDM C1713 HCPCS 0278 RC outpatient 6041.6 6041.6 6041.6 57 3443.71 percent of total billed charges 6041.6 93 4893.7 percent of total billed charges 6041.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6041.6 other OPPS APC 6041.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6041.6 other OPPS APC 6041.6 51 3081.22 percent of total billed charges 6041.6 6041.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE STRATAFIX PDS CT-1 30CM SUP-97-05352 CDM 0272 RC outpatient 129.79 129.79 129.79 74 96.04 percent of total billed charges 129.79 93 105.13 percent of total billed charges 129.79 129.79 other OPPS APC 129.79 129.79 other OPPS APC 129.79 27.63 35.86 percent of total billed charges 129.79 129.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 39.0 SUP-97-05355 CDM C1780 HCPCS 0278 RC outpatient 469 469 469 57 267.33 percent of total billed charges 469 93 379.89 percent of total billed charges 469 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 469 other OPPS APC 469 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 469 other OPPS APC 469 51 239.19 percent of total billed charges 469 469 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RIGHT 2.7MM 3 HOLE PLATE SUP-97-05356 CDM C1713 HCPCS 0278 RC outpatient 2209.8 2209.8 2209.8 57 1259.59 percent of total billed charges 2209.8 93 1789.94 percent of total billed charges 2209.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2209.8 other OPPS APC 2209.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2209.8 other OPPS APC 2209.8 51 1127 percent of total billed charges 2209.8 2209.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONG NAIL GAMMA 11X360MM RIGHT SUP-97-05358 CDM C1713 HCPCS 0278 RC outpatient 4867.8 4867.8 4867.8 57 2774.65 percent of total billed charges 4867.8 93 3942.92 percent of total billed charges 4867.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4867.8 other OPPS APC 4867.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4867.8 other OPPS APC 4867.8 51 2482.58 percent of total billed charges 4867.8 4867.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONG NAIL KIT 11 X 360MM X 130 LEFT SUP-97-05360 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT 3DMAX MID LEFT MEDIUM SUP-97-05362 CDM C1781 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT 3DMAX MID RIGHT LARGE SUP-97-05363 CDM C1781 HCPCS 0278 RC outpatient 705 705 705 57 401.85 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 51 359.55 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT 3DMAX MID RIGHT MEDIUM SUP-97-05364 CDM C1781 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCRW 2.5 MICRO 36MM LGTH SUP-97-05367 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW COMPR FT 3.5 MINI 40MM SUP-97-05368 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PHACO IRRIGATION SLEEVE SUP-97-05370 CDM 0272 RC outpatient 40 40 40 74 29.6 percent of total billed charges 40 93 32.4 percent of total billed charges 40 40 other OPPS APC 40 40 other OPPS APC 40 27.63 11.05 percent of total billed charges 40 40 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TORPEDO 4.0MM SUP-97-05373 CDM 0272 RC outpatient 353.5 353.5 353.5 74 261.59 percent of total billed charges 353.5 93 286.34 percent of total billed charges 353.5 353.5 other OPPS APC 353.5 353.5 other OPPS APC 353.5 27.63 97.67 percent of total billed charges 353.5 353.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXCALIBUR 4MM X 13CM SUP-97-05374 CDM 0272 RC outpatient 206.5 206.5 206.5 74 152.81 percent of total billed charges 206.5 93 167.27 percent of total billed charges 206.5 206.5 other OPPS APC 206.5 206.5 other OPPS APC 206.5 27.63 57.06 percent of total billed charges 206.5 206.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TORPEDO 5.0MM SUP-97-05377 CDM 0272 RC outpatient 353.5 353.5 353.5 74 261.59 percent of total billed charges 353.5 93 286.34 percent of total billed charges 353.5 353.5 other OPPS APC 353.5 353.5 other OPPS APC 353.5 27.63 97.67 percent of total billed charges 353.5 353.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISSECTOR 3.0MM BX5 SUP-97-05378 CDM 0272 RC outpatient 231 231 231 74 170.94 percent of total billed charges 231 93 187.11 percent of total billed charges 231 231 other OPPS APC 231 231 other OPPS APC 231 27.63 63.83 percent of total billed charges 231 231 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX NON LOCKING 3.5MM X 60MM SUP-97-05381 CDM C1713 HCPCS 0278 RC outpatient 134.4 134.4 134.4 57 76.61 percent of total billed charges 134.4 93 108.86 percent of total billed charges 134.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.4 other OPPS APC 134.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 134.4 other OPPS APC 134.4 51 68.54 percent of total billed charges 134.4 134.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4.0MM X 90MM SUP-97-05383 CDM C1713 HCPCS 0278 RC outpatient 560.56 560.56 560.56 57 319.52 percent of total billed charges 560.56 93 454.05 percent of total billed charges 560.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 560.56 other OPPS APC 560.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 560.56 other OPPS APC 560.56 51 285.89 percent of total billed charges 560.56 560.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROX LAT TIB 6 HOLE RT SUP-97-05384 CDM C1713 HCPCS 0278 RC outpatient 4235 4235 4235 57 2413.95 percent of total billed charges 4235 93 3430.35 percent of total billed charges 4235 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4235 other OPPS APC 4235 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4235 other OPPS APC 4235 51 2159.85 percent of total billed charges 4235 4235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRAVIX 2 X 2 CM SUP-97-05385 CDM Q4133 HCPCS 0636 RC outpatient 2656.5 2656.5 166 166 fee schedule 2656.5 93 2151.77 percent of total billed charges 2656.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2656.5 other OPPS APC 2656.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2656.5 other OPPS APC 2656.5 24.86 660.41 percent of total billed charges 166 2656.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REUNION TSA SR 4MM OFFSET HUMERAL 48X18 SUP-97-05386 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAVITY SYNCHFIX SUP-97-05398 CDM C1713 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSN ASF CPS 12MM VE R 6-9EF SUP-97-05399 CDM C1776 HCPCS 0278 RC outpatient 4370 4370 4370 57 2490.9 percent of total billed charges 4370 93 3539.7 percent of total billed charges 4370 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4370 other OPPS APC 4370 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4370 other OPPS APC 4370 51 2228.7 percent of total billed charges 4370 4370 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBIAL ONLAY INSERT-SZ 5-10 MM SUP-97-05400 CDM C1776 HCPCS 0278 RC outpatient 2280 2280 2280 57 1299.6 percent of total billed charges 2280 93 1846.8 percent of total billed charges 2280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2280 other OPPS APC 2280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2280 other OPPS APC 2280 51 1162.8 percent of total billed charges 2280 2280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3 X 14MM CS POLY SUP-97-05401 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI PRESS-FIT STEM 12X150MM SUP-97-05402 CDM C1776 HCPCS 0278 RC outpatient 3041 3041 3041 57 1733.37 percent of total billed charges 3041 93 2463.21 percent of total billed charges 3041 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3041 other OPPS APC 3041 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3041 other OPPS APC 3041 51 1550.91 percent of total billed charges 3041 3041 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMPONENT BEADED W/PA SUP-97-05403 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT II TRIT MULTI ACET SHELL 60MM G SUP-97-05404 CDM C1776 HCPCS 0278 RC outpatient 7848 7848 7848 57 4473.36 percent of total billed charges 7848 93 6356.88 percent of total billed charges 7848 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7848 other OPPS APC 7848 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7848 other OPPS APC 7848 51 4002.48 percent of total billed charges 7848 7848 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NO 3 TRIATHLON TS PLUS INSERT X3 POLY11M SUP-97-05405 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCRW 7.0 XL 75MM LGTH SUP-97-05410 CDM C1713 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.8 TRILOCK SCREW 10MM HD7 1/ PKG SUP-97-05417 CDM C1713 HCPCS 0278 RC outpatient 636.3 636.3 636.3 57 362.69 percent of total billed charges 636.3 93 515.4 percent of total billed charges 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 51 324.51 percent of total billed charges 636.3 636.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MARKER BIOZORB 2 X 2CM SUP-97-05418 CDM C9728 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1412.81 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1412.81 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MARKER BIOZORB 2 X 3CM SUP-97-05419 CDM C9728 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1412.81 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1412.81 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MARKER BIOZORB 3 X 3CM SUP-97-05420 CDM C9728 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1412.81 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1412.81 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MARKER BIOZORB LP 2 X 2 X 1CM SUP-97-05421 CDM C9728 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1412.81 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1412.81 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MARKER BIOZORB LP 2 X 3 X 1CM SUP-97-05422 CDM C9728 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1412.81 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1412.81 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MARKER BIOZORB 3 X 3 X 1CM SUP-97-05423 CDM C9728 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1412.81 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1412.81 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON INSERT PS#7 10MM SUP-97-05430 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROLAYER XENOGRAFT 4CM X 7CM SUP-97-05436 CDM Q4100 HCPCS 0636 RC outpatient 3863.63 3863.63 3863.63 74 2859.09 percent of total billed charges 3863.63 93 3129.54 percent of total billed charges 3863.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3863.63 other OPPS APC 3863.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3863.63 other OPPS APC 3863.63 24.86 960.5 percent of total billed charges 3863.63 3863.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROLAYER XENOGRAFT 5CM X 10CM SUP-97-05437 CDM Q4100 HCPCS 0636 RC outpatient 4659.1 4659.1 4659.1 74 3447.73 percent of total billed charges 4659.1 93 3773.87 percent of total billed charges 4659.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4659.1 other OPPS APC 4659.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4659.1 other OPPS APC 4659.1 24.86 1158.25 percent of total billed charges 4659.1 4659.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD LINEAR CUTTER BLUE SUP-97-05438 CDM 0272 RC outpatient 568.26 568.26 568.26 74 420.51 percent of total billed charges 568.26 93 460.29 percent of total billed charges 568.26 568.26 other OPPS APC 568.26 568.26 other OPPS APC 568.26 27.63 157.01 percent of total billed charges 568.26 568.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD LINEAR CUTTER WHITE SUP-97-05440 CDM 0272 RC outpatient 568.26 568.26 568.26 74 420.51 percent of total billed charges 568.26 93 460.29 percent of total billed charges 568.26 568.26 other OPPS APC 568.26 568.26 other OPPS APC 568.26 27.63 157.01 percent of total billed charges 568.26 568.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPERMX COMP STAPLE 20 X 20 SUP-97-05441 CDM C1713 HCPCS 0278 RC outpatient 5237.5 5237.5 5237.5 57 2985.38 percent of total billed charges 5237.5 93 4242.38 percent of total billed charges 5237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5237.5 other OPPS APC 5237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5237.5 other OPPS APC 5237.5 51 2671.13 percent of total billed charges 5237.5 5237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPERMX COMP STAPLE 18 X 18 SUP-97-05442 CDM C1713 HCPCS 0278 RC outpatient 5237.5 5237.5 5237.5 57 2985.38 percent of total billed charges 5237.5 93 4242.38 percent of total billed charges 5237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5237.5 other OPPS APC 5237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5237.5 other OPPS APC 5237.5 51 2671.13 percent of total billed charges 5237.5 5237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPERMX COMP STAPLE 25 X 20 SUP-97-05443 CDM C1713 HCPCS 0278 RC outpatient 5237.5 5237.5 5237.5 57 2985.38 percent of total billed charges 5237.5 93 4242.38 percent of total billed charges 5237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5237.5 other OPPS APC 5237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5237.5 other OPPS APC 5237.5 51 2671.13 percent of total billed charges 5237.5 5237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENTRALIGHT ST W/ECHO 4.5 CIRCLE SUP-97-05449 CDM C1781 HCPCS 0278 RC outpatient 1890 1890 1890 57 1077.3 percent of total billed charges 1890 93 1530.9 percent of total billed charges 1890 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1890 other OPPS APC 1890 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1890 other OPPS APC 1890 51 963.9 percent of total billed charges 1890 1890 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VENTRALIGHT ST W/ECHO 4X6 SUP-97-05450 CDM C1781 HCPCS 0278 RC outpatient 1693.5 1693.5 1693.5 57 965.3 percent of total billed charges 1693.5 93 1371.74 percent of total billed charges 1693.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1693.5 other OPPS APC 1693.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1693.5 other OPPS APC 1693.5 51 863.69 percent of total billed charges 1693.5 1693.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS 38.0 SUP-97-05453 CDM C1780 HCPCS 0278 RC outpatient 469 469 469 57 267.33 percent of total billed charges 469 93 379.89 percent of total billed charges 469 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 469 other OPPS APC 469 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 469 other OPPS APC 469 51 239.19 percent of total billed charges 469 469 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8.0 X 105MM CAN SCREW SUP-97-05456 CDM C1713 HCPCS 0278 RC outpatient 618.24 618.24 618.24 57 352.4 percent of total billed charges 618.24 93 500.77 percent of total billed charges 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 51 315.3 percent of total billed charges 618.24 618.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL FIBULA LEFT 3.8 X 130MM SUP-97-05457 CDM C1713 HCPCS 0278 RC outpatient 7487.5 7487.5 7487.5 57 4267.88 percent of total billed charges 7487.5 93 6064.88 percent of total billed charges 7487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7487.5 other OPPS APC 7487.5 7487.5 other OPPS APC 7487.5 51 3818.63 percent of total billed charges 7487.5 7487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBIAL ONLAY INSERT SZ 6-10MM SUP-97-05460 CDM C1776 HCPCS 0278 RC outpatient 2280 2280 2280 57 1299.6 percent of total billed charges 2280 93 1846.8 percent of total billed charges 2280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2280 other OPPS APC 2280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2280 other OPPS APC 2280 51 1162.8 percent of total billed charges 2280 2280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI PRESS FIT STEM 10MM X 100MM SUP-97-05461 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VAL KREULOCK TI 3.0 X 20 SUP-97-05469 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR VISTA SEAL DUAL SUP-97-05472 CDM 0272 RC outpatient 502.11 502.11 502.11 74 371.56 percent of total billed charges 502.11 93 406.71 percent of total billed charges 502.11 502.11 other OPPS APC 502.11 502.11 other OPPS APC 502.11 27.63 138.73 percent of total billed charges 502.11 502.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3X8 TENODESIS SUP-97-05473 CDM C1713 HCPCS 0278 RC outpatient 1215 1215 1215 57 692.55 percent of total billed charges 1215 93 984.15 percent of total billed charges 1215 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1215 other OPPS APC 1215 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1215 other OPPS APC 1215 51 619.65 percent of total billed charges 1215 1215 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DISPOSABLE 3X8 TENODESIS SUP-97-05474 CDM 0272 RC outpatient 2655 2655 2655 74 1964.7 percent of total billed charges 2655 93 2150.55 percent of total billed charges 2655 2655 other OPPS APC 2655 2655 other OPPS APC 2655 27.63 733.58 percent of total billed charges 2655 2655 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE LASSO MICRO SUP-97-05475 CDM 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 2100 other OPPS APC 2100 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERWIRE O AR-7250 SUP-97-05476 CDM 0272 RC outpatient 792 792 792 74 586.08 percent of total billed charges 792 93 641.52 percent of total billed charges 792 792 other OPPS APC 792 792 other OPPS APC 792 27.63 218.83 percent of total billed charges 792 792 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UHR BIPOLAR 28 X 48MM SUP-97-05486 CDM C1776 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VLOC 90 3-0 P-12 VLOCM0134 SUP-97-05489 CDM 0272 RC outpatient 195.64 195.64 195.64 74 144.77 percent of total billed charges 195.64 93 158.47 percent of total billed charges 195.64 195.64 other OPPS APC 195.64 195.64 other OPPS APC 195.64 27.63 54.06 percent of total billed charges 195.64 195.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL NAIL 10 X 315MM T2 STANDARD SUP-97-05491 CDM C1713 HCPCS 0278 RC outpatient 2734.2 2734.2 2734.2 57 1558.49 percent of total billed charges 2734.2 93 2214.7 percent of total billed charges 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 51 1394.44 percent of total billed charges 2734.2 2734.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLAKE CARDIO CONNECTOR 2:1 SUP-97-05497 CDM 0272 RC outpatient 793.32 793.32 793.32 74 587.06 percent of total billed charges 793.32 93 642.59 percent of total billed charges 793.32 793.32 other OPPS APC 793.32 793.32 other OPPS APC 793.32 27.63 219.19 percent of total billed charges 793.32 793.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLAKE CARDIO CONNECTOR 3:1 SUP-97-05498 CDM 0272 RC outpatient 793.32 793.32 793.32 74 587.06 percent of total billed charges 793.32 93 642.59 percent of total billed charges 793.32 793.32 other OPPS APC 793.32 793.32 other OPPS APC 793.32 27.63 219.19 percent of total billed charges 793.32 793.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW QCKFIX TI CANN. PT 3.0X20MM SUP-97-05499 CDM C1713 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOW PROFILE VA LKG 3.0X26.0MM TI SUP-97-05503 CDM C1713 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOW PROFILE VA LKG 3.0X32.0MM TI SUP-97-05504 CDM C1713 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.0MM CANN SUP-97-05506 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI MONSTER CANN HD 3.5 X 22MM SUP-97-05510 CDM C1713 HCPCS 0278 RC outpatient 647.5 647.5 647.5 57 369.08 percent of total billed charges 647.5 93 524.48 percent of total billed charges 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 51 330.23 percent of total billed charges 647.5 647.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI MONSTER CANN HD 3.5 X 34MM SUP-97-05511 CDM C1713 HCPCS 0278 RC outpatient 647.5 647.5 647.5 57 369.08 percent of total billed charges 647.5 93 524.48 percent of total billed charges 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 51 330.23 percent of total billed charges 647.5 647.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOW PROFILE VA LKG 3.0X12 MM TI SUP-97-05513 CDM C1713 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOW PROFILE VA LKG 3.0X18 MM TI SUP-97-05514 CDM C1713 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING TITANIUM 3.5MM X 12MM SUP-97-05515 CDM C1713 HCPCS 0278 RC outpatient 297.5 297.5 297.5 57 169.58 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 51 151.73 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REST MOD PROX CONE BODY 21MM + 0MM SUP-97-05517 CDM C1776 HCPCS 0278 RC outpatient 8068.8 8068.8 8068.8 57 4599.22 percent of total billed charges 8068.8 93 6535.73 percent of total billed charges 8068.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8068.8 other OPPS APC 8068.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8068.8 other OPPS APC 8068.8 51 4115.09 percent of total billed charges 8068.8 8068.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROX LAT HUM 5 HOLE LFT X 112MM SUP-97-05518 CDM C1713 HCPCS 0278 RC outpatient 4221 4221 4221 57 2405.97 percent of total billed charges 4221 93 3419.01 percent of total billed charges 4221 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4221 other OPPS APC 4221 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4221 other OPPS APC 4221 51 2152.71 percent of total billed charges 4221 4221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSN ASFB CPS 20MM VE L 6-9CD SUP-97-05519 CDM C1776 HCPCS 0278 RC outpatient 4370 4370 4370 57 2490.9 percent of total billed charges 4370 93 3539.7 percent of total billed charges 4370 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4370 other OPPS APC 4370 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4370 other OPPS APC 4370 51 2228.7 percent of total billed charges 4370 4370 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7 X 14 NONLOCKING SCREW SUP-97-05520 CDM C1713 HCPCS 0278 RC outpatient 420 420 420 57 239.4 percent of total billed charges 420 93 340.2 percent of total billed charges 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 51 214.2 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MTP PLATE 0 DEGREE SHORT RIGHT SUP-97-05521 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERTAK DX SUTURE ANCHOR W/0.9MM ST SUP-97-05522 CDM C1713 HCPCS 0278 RC outpatient 1575 1575 1575 57 897.75 percent of total billed charges 1575 93 1275.75 percent of total billed charges 1575 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1575 other OPPS APC 1575 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1575 other OPPS APC 1575 51 803.25 percent of total billed charges 1575 1575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCRW 2.5 MICRO 26MM LGTH SUP-97-05523 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BEVELED 4.0X28MM SUP-97-05524 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BEVELED 4.0X40MM SUP-97-05525 CDM C1713 HCPCS 0278 RC outpatient 1950 1950 1950 57 1111.5 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 51 994.5 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPR FT SCRW 2.5 MICRO 32MM LGTH SUP-97-05526 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BEVELED 4.0X50MM SUP-97-05528 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW QCKFIX TI CANN. PT 3.0X26MM SUP-97-05530 CDM C1713 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW QCKFIX TI CANN. PT 3.0X30MM SUP-97-05531 CDM C1713 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW QCKFIX CANN 4.0X40MM SUP-97-05532 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BEVELED 4.0X36MM SUP-97-05533 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BEVELED 4.0X42MM SUP-97-05534 CDM C1713 HCPCS 0278 RC outpatient 1950 1950 1950 57 1111.5 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 51 994.5 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BEVELED 3.5X32MM SUP-97-05535 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW QUICKFIX 2X14MM SUP-97-05536 CDM C1713 HCPCS 0278 RC outpatient 720 720 720 57 410.4 percent of total billed charges 720 93 583.2 percent of total billed charges 720 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 720 other OPPS APC 720 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 720 other OPPS APC 720 51 367.2 percent of total billed charges 720 720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA ALL POLY VE 32MM SUP-97-05537 CDM C1776 HCPCS 0278 RC outpatient 2172 2172 2172 57 1238.04 percent of total billed charges 2172 93 1759.32 percent of total billed charges 2172 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2172 other OPPS APC 2172 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2172 other OPPS APC 2172 51 1107.72 percent of total billed charges 2172 2172 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA ALL POLY VE 32MM SUP-97-05537A CDM C1776 HCPCS 0278 RC outpatient 2172 2172 2172 57 1238.04 percent of total billed charges 2172 93 1759.32 percent of total billed charges 2172 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2172 other OPPS APC 2172 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2172 other OPPS APC 2172 51 1107.72 percent of total billed charges 2172 2172 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI CMP FT 18MM SUP-97-05538 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KNOTLESS FIBERTAK ANCHOR 2.6 BLUE/BLACK SUP-97-05539 CDM C1713 HCPCS 0278 RC outpatient 1590 1590 1590 57 906.3 percent of total billed charges 1590 93 1287.9 percent of total billed charges 1590 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1590 other OPPS APC 1590 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1590 other OPPS APC 1590 51 810.9 percent of total billed charges 1590 1590 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TI TIBIAL CANN EX-PROX 8MM X 300MM SUP-97-05540 CDM C1713 HCPCS 0278 RC outpatient 4579.25 4579.25 4579.25 57 2610.17 percent of total billed charges 4579.25 93 3709.19 percent of total billed charges 4579.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4579.25 other OPPS APC 4579.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4579.25 other OPPS APC 4579.25 51 2335.42 percent of total billed charges 4579.25 4579.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BEVELED 4.0 X 34MM SUP-97-05541 CDM C1713 HCPCS 0278 RC outpatient 1950 1950 1950 57 1111.5 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 51 994.5 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALTRX NEUT 36IDX54OD SUP-97-05542 CDM C1776 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANCELLOUS FULL THRD 6MM X 75MM SUP-97-05543 CDM C1713 HCPCS 0278 RC outpatient 124.64 124.64 124.64 57 71.04 percent of total billed charges 124.64 93 100.96 percent of total billed charges 124.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 124.64 other OPPS APC 124.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 124.64 other OPPS APC 124.64 51 63.57 percent of total billed charges 124.64 124.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 4.5MM X 14MM SUP-97-05544 CDM C1713 HCPCS 0278 RC outpatient 152.32 152.32 152.32 57 86.82 percent of total billed charges 152.32 93 123.38 percent of total billed charges 152.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.32 other OPPS APC 152.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.32 other OPPS APC 152.32 51 77.68 percent of total billed charges 152.32 152.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5.0MM X 80MM SUP-97-05545 CDM C1713 HCPCS 0278 RC outpatient 595.81 595.81 595.81 57 339.61 percent of total billed charges 595.81 93 482.61 percent of total billed charges 595.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 595.81 other OPPS APC 595.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 595.81 other OPPS APC 595.81 51 303.86 percent of total billed charges 595.81 595.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5.0MM X 90MM SUP-97-05546 CDM C1713 HCPCS 0278 RC outpatient 595.81 595.81 595.81 57 339.61 percent of total billed charges 595.81 93 482.61 percent of total billed charges 595.81 595.81 other OPPS APC 595.81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 595.81 other OPPS APC 595.81 51 303.86 percent of total billed charges 595.81 595.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 6 HOLE RIGHT FEM DIS LAT SUP-97-05547 CDM C1713 HCPCS 0278 RC outpatient 5607.13 5607.13 5607.13 57 3196.06 percent of total billed charges 5607.13 93 4541.78 percent of total billed charges 5607.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5607.13 other OPPS APC 5607.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5607.13 other OPPS APC 5607.13 51 2859.64 percent of total billed charges 5607.13 5607.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BEVELED 4.0 X 38MM SUP-97-05548 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BEVELED 4.0 X 48MM SUP-97-05549 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 4.5MM X 34MM SUP-97-05550 CDM C1713 HCPCS 0278 RC outpatient 152.32 152.32 152.32 57 86.82 percent of total billed charges 152.32 93 123.38 percent of total billed charges 152.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.32 other OPPS APC 152.32 152.32 other OPPS APC 152.32 51 77.68 percent of total billed charges 152.32 152.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 4.5MM X 42MM SUP-97-05551 CDM C1713 HCPCS 0278 RC outpatient 152.32 152.32 152.32 57 86.82 percent of total billed charges 152.32 93 123.38 percent of total billed charges 152.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.32 other OPPS APC 152.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152.32 other OPPS APC 152.32 51 77.68 percent of total billed charges 152.32 152.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROX LAT HUM 12 HOLE LFT X 202MM SUP-97-05552 CDM C1713 HCPCS 0278 RC outpatient 3164.45 3164.45 3164.45 57 1803.74 percent of total billed charges 3164.45 93 2563.2 percent of total billed charges 3164.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3164.45 other OPPS APC 3164.45 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3164.45 other OPPS APC 3164.45 51 1613.87 percent of total billed charges 3164.45 3164.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROX LAT HUM 4 HOLE RT X 99MM SUP-97-05553 CDM C1713 HCPCS 0278 RC outpatient 4870.6 4870.6 4870.6 57 2776.24 percent of total billed charges 4870.6 93 3945.19 percent of total billed charges 4870.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4870.6 other OPPS APC 4870.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4870.6 other OPPS APC 4870.6 51 2484.01 percent of total billed charges 4870.6 4870.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX COMPRES 7HOLE X 90MM LCKING SUP-97-05554 CDM C1713 HCPCS 0278 RC outpatient 1321.32 1321.32 1321.32 57 753.15 percent of total billed charges 1321.32 93 1070.27 percent of total billed charges 1321.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1321.32 other OPPS APC 1321.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1321.32 other OPPS APC 1321.32 51 673.87 percent of total billed charges 1321.32 1321.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.2X16 CAN COMP SUP-97-05555 CDM C1713 HCPCS 0278 RC outpatient 614.46 614.46 614.46 57 350.24 percent of total billed charges 614.46 93 497.71 percent of total billed charges 614.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 614.46 other OPPS APC 614.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 614.46 other OPPS APC 614.46 51 313.37 percent of total billed charges 614.46 614.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.2X18 CAN COMP SUP-97-05556 CDM C1713 HCPCS 0278 RC outpatient 614.46 614.46 614.46 57 350.24 percent of total billed charges 614.46 93 497.71 percent of total billed charges 614.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 614.46 other OPPS APC 614.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 614.46 other OPPS APC 614.46 51 313.37 percent of total billed charges 614.46 614.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BEVELED 4.0X32MM SUP-97-05557 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN COMP HEADLESS 3.0MM X 34MM SUP-97-05558 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN COMP HEADLESS 3.0MM X 40MM SUP-97-05559 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LT CANN COMP HEADLESS 3.0MM X 30MM SUP-97-05560 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LT CANN COMP HEADLESS 4.0MM X 30MM SUP-97-05561 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LT CANN COMP HEADLESS 4.0MM X 40MM SUP-97-05562 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LT CANN COMP HEADLESS 3.5MM X 42MM SUP-97-05563 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS MICRO CANN 3.0MM X 13/4MM SUP-97-05564 CDM C1716 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 270.91 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 270.91 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LT CANN COMP HEADLESS 3.5MM X 46MM SUP-97-05565 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LT CANN COMP HEADLESS 3.5MM X 50MM SUP-97-05566 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN COMP HEADLESS 3.5MM X 32MM SUP-97-05567 CDM C1713 HCPCS 0278 RC outpatient 1314 1314 1314 57 748.98 percent of total billed charges 1314 93 1064.34 percent of total billed charges 1314 1314 other OPPS APC 1314 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1314 other OPPS APC 1314 51 670.14 percent of total billed charges 1314 1314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER SHAFT 240MM SUP-97-05568 CDM 0272 RC outpatient 632.1 632.1 632.1 74 467.75 percent of total billed charges 632.1 93 512 percent of total billed charges 632.1 632.1 other OPPS APC 632.1 632.1 other OPPS APC 632.1 27.63 174.65 percent of total billed charges 632.1 632.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 0.6 X 70MM TROCAR PT SUP-97-05569 CDM C1713 HCPCS 0278 RC outpatient 33.98 33.98 33.98 57 19.37 percent of total billed charges 33.98 93 27.52 percent of total billed charges 33.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 33.98 other OPPS APC 33.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 33.98 other OPPS APC 33.98 51 17.33 percent of total billed charges 33.98 33.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CENTRAL THREADED POST 6.5X30MM SUP-97-05570 CDM C1776 HCPCS 0278 RC outpatient 1272 1272 1272 57 725.04 percent of total billed charges 1272 93 1030.32 percent of total billed charges 1272 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1272 other OPPS APC 1272 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1272 other OPPS APC 1272 51 648.72 percent of total billed charges 1272 1272 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI IS FEMUR SZ5 LEFT SUP-97-05571 CDM C1776 HCPCS 0278 RC outpatient 12280.8 12280.8 12280.8 57 7000.06 percent of total billed charges 12280.8 93 9947.45 percent of total billed charges 12280.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.8 other OPPS APC 12280.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.8 other OPPS APC 12280.8 51 6263.21 percent of total billed charges 12280.8 12280.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI PRESS-FIT STEM 19X150MM SUP-97-05572 CDM C1776 HCPCS 0278 RC outpatient 3041 3041 3041 57 1733.37 percent of total billed charges 3041 93 2463.21 percent of total billed charges 3041 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3041 other OPPS APC 3041 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3041 other OPPS APC 3041 51 1550.91 percent of total billed charges 3041 3041 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI PRESS-FIT STEM 18X150MM SUP-97-05573 CDM C1776 HCPCS 0278 RC outpatient 3041 3041 3041 57 1733.37 percent of total billed charges 3041 93 2463.21 percent of total billed charges 3041 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3041 other OPPS APC 3041 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3041 other OPPS APC 3041 51 1550.91 percent of total billed charges 3041 3041 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEEK INTERFERENCE SCREW SUP-97-05574 CDM C1713 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE SINGLE END SMOOTH 1.6 X 200MM SUP-97-05575 CDM C1713 HCPCS 0278 RC outpatient 280 280 280 57 159.6 percent of total billed charges 280 93 226.8 percent of total billed charges 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 51 142.8 percent of total billed charges 280 280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONG NAIL KIT 11 X 400MM X 130 SUP-97-05576 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAILOR'S BUNION IMPLANT SMALL SUP-97-05577 CDM C1713 HCPCS 0278 RC outpatient 3377.5 3377.5 3377.5 57 1925.18 percent of total billed charges 3377.5 93 2735.78 percent of total billed charges 3377.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3377.5 other OPPS APC 3377.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3377.5 other OPPS APC 3377.5 51 1722.53 percent of total billed charges 3377.5 3377.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAILOR'S BUNION IMPLANT MEDIUM SUP-97-05578 CDM C1713 HCPCS 0278 RC outpatient 3377.5 3377.5 3377.5 57 1925.18 percent of total billed charges 3377.5 93 2735.78 percent of total billed charges 3377.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3377.5 other OPPS APC 3377.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3377.5 other OPPS APC 3377.5 51 1722.53 percent of total billed charges 3377.5 3377.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAILOR'S BUNION IMPLANT LARGE SUP-97-05579 CDM C1713 HCPCS 0278 RC outpatient 3377.5 3377.5 3377.5 57 1925.18 percent of total billed charges 3377.5 93 2735.78 percent of total billed charges 3377.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3377.5 other OPPS APC 3377.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3377.5 other OPPS APC 3377.5 51 1722.53 percent of total billed charges 3377.5 3377.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 X 28MM MICA PROSTEP SUP-97-05580 CDM C1713 HCPCS 0278 RC outpatient 1428 1428 1428 57 813.96 percent of total billed charges 1428 93 1156.68 percent of total billed charges 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 51 728.28 percent of total billed charges 1428 1428 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 X 38MM MICA PROSTEP SUP-97-05581 CDM C1713 HCPCS 0278 RC outpatient 1428 1428 1428 57 813.96 percent of total billed charges 1428 93 1156.68 percent of total billed charges 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 1428 other OPPS APC 1428 51 728.28 percent of total billed charges 1428 1428 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 X 44MM MICA PROSTEP SUP-97-05582 CDM C1713 HCPCS 0278 RC outpatient 1428 1428 1428 57 813.96 percent of total billed charges 1428 93 1156.68 percent of total billed charges 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 51 728.28 percent of total billed charges 1428 1428 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONG NAIL KIT R1/5 TI LFT 15X420MM X125 SUP-97-05583 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 X 50MM MICA PROSTEP SUP-97-05584 CDM C1713 HCPCS 0278 RC outpatient 1428 1428 1428 57 813.96 percent of total billed charges 1428 93 1156.68 percent of total billed charges 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 51 728.28 percent of total billed charges 1428 1428 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 X 34MM MICA PROSTEP SUP-97-05585 CDM C1713 HCPCS 0278 RC outpatient 1428 1428 1428 57 813.96 percent of total billed charges 1428 93 1156.68 percent of total billed charges 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 51 728.28 percent of total billed charges 1428 1428 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 X 32MM MICA PROSTEP SUP-97-05586 CDM C1713 HCPCS 0278 RC outpatient 1428 1428 1428 57 813.96 percent of total billed charges 1428 93 1156.68 percent of total billed charges 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 51 728.28 percent of total billed charges 1428 1428 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LOCKING PLATE SCREW, 2.7 X 12MM" SUP-97-05587 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "LOCKING PLATE SCREW, 2.7 X 15MM" SUP-97-05588 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MTP PLATE 5 DEGREE SHORT RIGHT SUP-97-05589 CDM C1713 HCPCS 0278 RC outpatient 3237.5 3237.5 3237.5 57 1845.38 percent of total billed charges 3237.5 93 2622.38 percent of total billed charges 3237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3237.5 other OPPS APC 3237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3237.5 other OPPS APC 3237.5 51 1651.13 percent of total billed charges 3237.5 3237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONG NAIL KIT R1/5 TI LFT 13X440MM SUP-97-05590 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T2 HUMERAL NAIL 8MMX300MM SUP-97-05591 CDM C1713 HCPCS 0278 RC outpatient 2702.7 2702.7 2702.7 57 1540.54 percent of total billed charges 2702.7 93 2189.19 percent of total billed charges 2702.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2702.7 other OPPS APC 2702.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2702.7 other OPPS APC 2702.7 51 1378.38 percent of total billed charges 2702.7 2702.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. T2 HUMERAL NAIL 8MMX280MM SUP-97-05592 CDM C1713 HCPCS 0278 RC outpatient 2702.7 2702.7 2702.7 57 1540.54 percent of total billed charges 2702.7 93 2189.19 percent of total billed charges 2702.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2702.7 other OPPS APC 2702.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2702.7 other OPPS APC 2702.7 51 1378.38 percent of total billed charges 2702.7 2702.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VITOSS 5CC SUP-97-05596 CDM C1713 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 HUMERAL INSERT 36 X 4MM CONSTRAINED SUP-97-05598 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL SYM CONE AUGMENT SIZE E SUP-97-05609 CDM C1776 HCPCS 0278 RC outpatient 9795 9795 9795 57 5583.15 percent of total billed charges 9795 93 7933.95 percent of total billed charges 9795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9795 other OPPS APC 9795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9795 other OPPS APC 9795 51 4995.45 percent of total billed charges 9795 9795 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTED STEM TRIATHLON 17 X 150MM TS SUP-97-05610 CDM C1776 HCPCS 0278 RC outpatient 3041 3041 3041 57 1733.37 percent of total billed charges 3041 93 2463.21 percent of total billed charges 3041 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3041 other OPPS APC 3041 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3041 other OPPS APC 3041 51 1550.91 percent of total billed charges 3041 3041 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLUTED STEM TRIATHLON 20 X 150MM TS SUP-97-05611 CDM C1776 HCPCS 0278 RC outpatient 3041 3041 3041 57 1733.37 percent of total billed charges 3041 93 2463.21 percent of total billed charges 3041 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3041 other OPPS APC 3041 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3041 other OPPS APC 3041 51 1550.91 percent of total billed charges 3041 3041 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL COMPONENT TS SIZE 5 RIGHT SUP-97-05612 CDM C1776 HCPCS 0278 RC outpatient 12280.8 12280.8 12280.8 57 7000.06 percent of total billed charges 12280.8 93 9947.45 percent of total billed charges 12280.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.8 other OPPS APC 12280.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.8 other OPPS APC 12280.8 51 6263.21 percent of total billed charges 12280.8 12280.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 16MM LOW PROFILE CORTEX SUP-97-05616 CDM C1713 HCPCS 0278 RC outpatient 180 180 180 57 102.6 percent of total billed charges 180 93 145.8 percent of total billed charges 180 180 other OPPS APC 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 51 91.8 percent of total billed charges 180 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 22MM LOW PROFILE CORTEX SUP-97-05617 CDM C1713 HCPCS 0278 RC outpatient 180 180 180 57 102.6 percent of total billed charges 180 93 145.8 percent of total billed charges 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 51 91.8 percent of total billed charges 180 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL FIBULA LEFT 3.0 X 130MM SUP-97-05618 CDM C1713 HCPCS 0278 RC outpatient 7487.5 7487.5 7487.5 57 4267.88 percent of total billed charges 7487.5 93 6064.88 percent of total billed charges 7487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7487.5 other OPPS APC 7487.5 7487.5 other OPPS APC 7487.5 51 3818.63 percent of total billed charges 7487.5 7487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOUND PROCESSOR PONTO 5 MINI SILVER (C044) SUP-97-05619 CDM L8690 HCPCS 0272 RC outpatient 8352 8352 8352 74 6180.48 percent of total billed charges 8352 93 6765.12 percent of total billed charges 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8352 other OPPS APC 8352 27.63 2307.66 percent of total billed charges 8352 8352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PRESS FIT STEM 15 X 150MM SUP-97-05620 CDM C1776 HCPCS 0278 RC outpatient 3041 3041 3041 57 1733.37 percent of total billed charges 3041 93 2463.21 percent of total billed charges 3041 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3041 other OPPS APC 3041 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3041 other OPPS APC 3041 51 1550.91 percent of total billed charges 3041 3041 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PRESS FIT STEM 11 X 150MM SUP-97-05621 CDM C1776 HCPCS 0278 RC outpatient 3041 3041 3041 57 1733.37 percent of total billed charges 3041 93 2463.21 percent of total billed charges 3041 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3041 other OPPS APC 3041 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3041 other OPPS APC 3041 51 1550.91 percent of total billed charges 3041 3041 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR TRIATHLON TS SIZE 3 RIGHT SUP-97-05622 CDM C1776 HCPCS 0278 RC outpatient 12280.8 12280.8 12280.8 57 7000.06 percent of total billed charges 12280.8 93 9947.45 percent of total billed charges 12280.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.8 other OPPS APC 12280.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.8 other OPPS APC 12280.8 51 6263.21 percent of total billed charges 12280.8 12280.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL AUGMENT SIZE 2 10MM LM/RL TRIATHLON SUP-97-05623 CDM C1776 HCPCS 0278 RC outpatient 2966.4 2966.4 2966.4 57 1690.85 percent of total billed charges 2966.4 93 2402.78 percent of total billed charges 2966.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2966.4 other OPPS APC 2966.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2966.4 other OPPS APC 2966.4 51 1512.86 percent of total billed charges 2966.4 2966.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL AUGMENT SIZE 2 10MM RM/LL TRIATHLON SUP-97-05624 CDM C1776 HCPCS 0278 RC outpatient 2966.4 2966.4 2966.4 57 1690.85 percent of total billed charges 2966.4 93 2402.78 percent of total billed charges 2966.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2966.4 other OPPS APC 2966.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2966.4 other OPPS APC 2966.4 51 1512.86 percent of total billed charges 2966.4 2966.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL DISTAL AUGMENT 10MM SIZE 3 RIGHT TRIATHLON SUP-97-05625 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT X3 POLY 11MM TRIATHLON TS SUP-97-05626 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTERIOR AUGMENT SIZE 3 10MM TRIATHLON SUP-97-05627 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL RESTORATION ANATOMIC SIZE 56 LEFT SUP-97-05628 CDM C1776 HCPCS 0278 RC outpatient 9081 9081 9081 57 5176.17 percent of total billed charges 9081 93 7355.61 percent of total billed charges 9081 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9081 other OPPS APC 9081 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9081 other OPPS APC 9081 51 4631.31 percent of total billed charges 9081 9081 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTENSION PIECE 60MM GMRS SUP-97-05629 CDM C1776 HCPCS 0278 RC outpatient 6631 6631 6631 57 3779.67 percent of total billed charges 6631 93 5371.11 percent of total billed charges 6631 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6631 other OPPS APC 6631 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6631 other OPPS APC 6631 51 3381.81 percent of total billed charges 6631 6631 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCHANTERIC PROXIMAL FEMUR NEUTRAL GMRS SUP-97-05630 CDM C1776 HCPCS 0278 RC outpatient 8779.2 8779.2 8779.2 57 5004.14 percent of total billed charges 8779.2 93 7111.15 percent of total billed charges 8779.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8779.2 other OPPS APC 8779.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8779.2 other OPPS APC 8779.2 51 4477.39 percent of total billed charges 8779.2 8779.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 10MM SINGLE USE OATS DISPOSABLE KIT SUP-97-05631 CDM 0272 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OATS PLUG 10MM FRESH GRAFT SUP-97-05632 CDM C1762 HCPCS 0278 RC outpatient 5937.5 5937.5 5937.5 57 3384.38 percent of total billed charges 5937.5 93 4809.38 percent of total billed charges 5937.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5937.5 other OPPS APC 5937.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5937.5 other OPPS APC 5937.5 51 3028.13 percent of total billed charges 5937.5 5937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANNULATED FULL THREAD 4 X 40MM SUP-97-05633 CDM C1713 HCPCS 0278 RC outpatient 396.48 396.48 396.48 57 225.99 percent of total billed charges 396.48 93 321.15 percent of total billed charges 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 396.48 other OPPS APC 396.48 51 202.2 percent of total billed charges 396.48 396.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE STRATAFIX SPIRAL PDS PLUS VIOLET 2-0 6IN SUP-97-05634 CDM 0272 RC outpatient 125.29 125.29 125.29 74 92.71 percent of total billed charges 125.29 93 101.48 percent of total billed charges 125.29 125.29 other OPPS APC 125.29 125.29 other OPPS APC 125.29 27.63 34.62 percent of total billed charges 125.29 125.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BEVELED 4 X 30MM SUP-97-05635 CDM C1713 HCPCS 0278 RC outpatient 1950 1950 1950 57 1111.5 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 1950 other OPPS APC 1950 51 994.5 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 5 HOLE STRAIGHT COMPRESSION SUP-97-05636 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 32MM HEADLESS SHORT THREAD CANNULATED MINI MONSTER SUP-97-05637 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT AO 4.2 X 250MM SUP-97-05638 CDM 0272 RC outpatient 385.35 385.35 385.35 74 285.16 percent of total billed charges 385.35 93 312.13 percent of total billed charges 385.35 385.35 other OPPS APC 385.35 385.35 other OPPS APC 385.35 27.63 106.47 percent of total billed charges 385.35 385.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL ARTHRODESIS T2 ANKLE RIGHT 12 X 200MM SUP-97-05639 CDM C1713 HCPCS 0278 RC outpatient 3615.75 3615.75 3615.75 57 2060.98 percent of total billed charges 3615.75 93 2928.76 percent of total billed charges 3615.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3615.75 other OPPS APC 3615.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3615.75 other OPPS APC 3615.75 51 1844.03 percent of total billed charges 3615.75 3615.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SHAFT T2 5 X 45MM SUP-97-05640 CDM C1713 HCPCS 0278 RC outpatient 427.35 427.35 427.35 57 243.59 percent of total billed charges 427.35 93 346.15 percent of total billed charges 427.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 427.35 other OPPS APC 427.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 427.35 other OPPS APC 427.35 51 217.95 percent of total billed charges 427.35 427.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 52MM MICA PROSTEP SUP-97-05641 CDM C1713 HCPCS 0278 RC outpatient 1428 1428 1428 57 813.96 percent of total billed charges 1428 93 1156.68 percent of total billed charges 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 51 728.28 percent of total billed charges 1428 1428 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 30MM MICA PROSTEP SUP-97-05642 CDM C1713 HCPCS 0278 RC outpatient 1428 1428 1428 57 813.96 percent of total billed charges 1428 93 1156.68 percent of total billed charges 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 51 728.28 percent of total billed charges 1428 1428 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL FIBULA RIGHT 3.0 X 130MM SUP-97-05643 CDM C1713 HCPCS 0278 RC outpatient 7487.5 7487.5 7487.5 57 4267.88 percent of total billed charges 7487.5 93 6064.88 percent of total billed charges 7487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7487.5 other OPPS APC 7487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7487.5 other OPPS APC 7487.5 51 3818.63 percent of total billed charges 7487.5 7487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARBON ROD MONOTUBE SUP-97-05644 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN CLAMP GREY AND GOLD 15MM SUP-97-05645 CDM C1713 HCPCS 0278 RC outpatient 1237.5 1237.5 1237.5 57 705.38 percent of total billed charges 1237.5 93 1002.38 percent of total billed charges 1237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1237.5 other OPPS APC 1237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1237.5 other OPPS APC 1237.5 51 631.13 percent of total billed charges 1237.5 1237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 6.5 X 105MM CANNULATED SUP-97-05646 CDM C1713 HCPCS 0278 RC outpatient 618.24 618.24 618.24 57 352.4 percent of total billed charges 618.24 93 500.77 percent of total billed charges 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 51 315.3 percent of total billed charges 618.24 618.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE SCREW INSERTION SUP-97-05647 CDM 0272 RC outpatient 484.96 484.96 484.96 74 358.87 percent of total billed charges 484.96 93 392.82 percent of total billed charges 484.96 484.96 other OPPS APC 484.96 484.96 other OPPS APC 484.96 27.63 133.99 percent of total billed charges 484.96 484.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH PERI-GUARD 10 X 16CM BOVINE PERICARDIUM SUP-97-05648 CDM C1768 HCPCS 0278 RC outpatient 2631.3 2631.3 2631.3 57 1499.84 percent of total billed charges 2631.3 93 2131.35 percent of total billed charges 2631.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2631.3 other OPPS APC 2631.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2631.3 other OPPS APC 2631.3 51 1341.96 percent of total billed charges 2631.3 2631.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 30MM BEVELED FULL THREAD SUP-97-05649 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BEVELED 4 X 46MM SUP-97-05650 CDM C1713 HCPCS 0278 RC outpatient 1950 1950 1950 57 1111.5 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 51 994.5 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BEVELED 3.5 X 36MM SUP-97-05651 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BEVELED 4 X 44MM SUP-97-05652 CDM C1713 HCPCS 0278 RC outpatient 1950 1950 1950 57 1111.5 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 51 994.5 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL LONG GAMMA 10 X 400MM X 125DEG SUP-97-05653 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 20MM BEVELED FT SUP-97-05654 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 22MM BEVELED FT SUP-97-05655 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 2146.5 other OPPS APC 2146.5 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 24MM BEVELED FT SUP-97-05656 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 26MM BEVELED FT SUP-97-05657 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 28MM BEVELED FT SUP-97-05658 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 34MM BEVELED FT SUP-97-05659 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 38MM BEVELED FT SUP-97-05660 CDM C1713 HCPCS 0278 RC outpatient 1950 1950 1950 57 1111.5 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 51 994.5 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 40MM BEVELED FT SUP-97-05661 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 44MM BEVELED FT SUP-97-05663 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 46MM BEVELED FT SUP-97-05664 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 48MM BEVELED FT SUP-97-05665 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 50MM BEVELED FT SUP-97-05666 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 52MM BEVELED FT SUP-97-05667 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 54MM BEVELED FT SUP-97-05668 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 56MM BEVELED FT SUP-97-05669 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 58MM BEVELED FT SUP-97-05670 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 60MM BEVELED FT SUP-97-05671 CDM C1713 HCPCS 0278 RC outpatient 1950 1950 1950 57 1111.5 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 51 994.5 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.5 X 14MM MICRO COMPRESSION FT SUP-97-05672 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.5 X 16MM MICRO COMPRESSION FT SUP-97-05673 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.5 X 18MM MICRO COMPRESSION FT SUP-97-05674 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.5 X 20MM MICRO COMPRESSION FT SUP-97-05675 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.5 X 22MM MICRO COMPRESSION FT SUP-97-05676 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.5 X 24MM MICRO COMPRESSION FT SUP-97-05677 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.5 X 38MM MICRO COMPRESSION FT SUP-97-05678 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 20MM BELVELED FT SUP-97-05679 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL FIBULA RIGHT 3.8 X 130MM SUP-97-05680 CDM C1713 HCPCS 0278 RC outpatient 7487.5 7487.5 7487.5 57 4267.88 percent of total billed charges 7487.5 93 6064.88 percent of total billed charges 7487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7487.5 other OPPS APC 7487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7487.5 other OPPS APC 7487.5 51 3818.63 percent of total billed charges 7487.5 7487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 22MM BEVELED FT SUP-97-05681 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 24MM BEVELED FT SUP-97-05682 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 26MM BEVELED FT SUP-97-05683 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 54MM BEVELED FT SUP-97-05684 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 56MM BEVELED FT SUP-97-05685 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 58MM BEVELED FT SUP-97-05686 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 60MM BEVELED FT SUP-97-05687 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7 X 26MM T8 FULL THREAD SUP-97-05688 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7 X 30MM T8 LOCKING SUP-97-05689 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7 X 32MM T8 FULL THREAD SUP-97-05690 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7 X 34MM T8 FULL THREAD SUP-97-05691 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7 X 36MM T8 FULL THREAD SUP-97-05692 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7 X 38MM T8 FULL THREAD SUP-97-05693 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7 X 40MM T8 FULL THREAD SUP-97-05694 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7 X 45MM T8 FULL THREAD SUP-97-05695 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7 X 50MM T8 FULL THREAD SUP-97-05696 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 28MM T8 FULL THREAD SUP-97-05697 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 30MM T8 FULL THREAD SUP-97-05698 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 32MM T8 FULL THREAD SUP-97-05699 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 34MM T8 FULL THREAD SUP-97-05700 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 36MM T8 FULL THREAD SUP-97-05701 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 38MM T8 FULL THREAD SUP-97-05702 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 40MM T8 FULL THREAD SUP-97-05703 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 45MM T8 FULL THREAD SUP-97-05704 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 50MM T8 FULL THREAD SUP-97-05705 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7 X 38MM T10 FULL THREAD SUP-97-05706 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7 X 40MM T10 FULL THREAD SUP-97-05707 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7 X 42MM T10 FULL THREAD SUP-97-05708 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7 X 48MM T10 FULL THREAD SUP-97-05709 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7 X 65MM T10 FULL THREAD SUP-97-05710 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7 X 70MM T10 FULL THREAD SUP-97-05711 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 X 46MM PROSTEP MICA SUP-97-05712 CDM C1713 HCPCS 0278 RC outpatient 1428 1428 1428 57 813.96 percent of total billed charges 1428 93 1156.68 percent of total billed charges 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 51 728.28 percent of total billed charges 1428 1428 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 12MM R3CON LOCKING SUP-97-05713 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 16MM R3CON NON LOCKING SUP-97-05714 CDM C1713 HCPCS 0278 RC outpatient 437.5 437.5 437.5 57 249.38 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 51 223.13 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 10.5 X 80MM LAG TI SUP-97-05715 CDM C1713 HCPCS 0278 RC outpatient 991.8 991.8 991.8 57 565.33 percent of total billed charges 991.8 93 803.36 percent of total billed charges 991.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 991.8 other OPPS APC 991.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 991.8 other OPPS APC 991.8 51 505.82 percent of total billed charges 991.8 991.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT 15 X 20CM (6 X 8IN) VENTRALIGHT W/ ECHO SUP-97-05716 CDM C1781 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCRWE 1.7 X 22MM VARIAX NON LOCKING SUP-97-05717 CDM C1713 HCPCS 0278 RC outpatient 261.66 261.66 261.66 57 149.15 percent of total billed charges 261.66 93 211.94 percent of total billed charges 261.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 261.66 other OPPS APC 261.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 261.66 other OPPS APC 261.66 51 133.45 percent of total billed charges 261.66 261.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 3 HOLE STRAIGHT VARIAX SUP-97-05718 CDM C1713 HCPCS 0278 RC outpatient 862.68 862.68 862.68 57 491.73 percent of total billed charges 862.68 93 698.77 percent of total billed charges 862.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 862.68 other OPPS APC 862.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 862.68 other OPPS APC 862.68 51 439.97 percent of total billed charges 862.68 862.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING SELF TAPPING 3.5 X 30MM STARDRIVE RECESS SUP-97-05719 CDM C1713 HCPCS 0278 RC outpatient 472.89 472.89 472.89 57 269.55 percent of total billed charges 472.89 93 383.04 percent of total billed charges 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 51 241.17 percent of total billed charges 472.89 472.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 44MM TI CANNULATED COMPRESSION HEADLESS SUP-97-05720 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL COMPONENT SIZE 7 16MM PS ALL POLY SUP-97-05722 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.5 X 14MM POLYAXIAL LOCKING SUP-97-05723 CDM C1713 HCPCS 0278 RC outpatient 409.5 409.5 409.5 57 233.42 percent of total billed charges 409.5 93 331.7 percent of total billed charges 409.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 409.5 other OPPS APC 409.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 409.5 other OPPS APC 409.5 51 208.85 percent of total billed charges 409.5 409.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTHROFLEX 40 X 70 X 1.0MM SUP-97-05724 CDM outpatient 6368.13 6368.13 6368.13 6368.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTHROFLEX 30 X 40 X 0.5MM SUP-97-05725 CDM outpatient 3202.5 3202.5 3202.5 3202.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 12MM CORTEX LO PRO TM SS SUP-97-05726 CDM C1713 HCPCS 0278 RC outpatient 180 180 180 57 102.6 percent of total billed charges 180 93 145.8 percent of total billed charges 180 180 other OPPS APC 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 51 91.8 percent of total billed charges 180 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 14MM CORTEX LO PRO TM SS SUP-97-05727 CDM C1713 HCPCS 0278 RC outpatient 180 180 180 57 102.6 percent of total billed charges 180 93 145.8 percent of total billed charges 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 51 91.8 percent of total billed charges 180 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 18MM CORTEX LO PRO TM SS SUP-97-05728 CDM C1713 HCPCS 0278 RC outpatient 180 180 180 57 102.6 percent of total billed charges 180 93 145.8 percent of total billed charges 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 51 91.8 percent of total billed charges 180 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 20MM CORTEX LO PRO TM SS SUP-97-05729 CDM C1713 HCPCS 0278 RC outpatient 180 180 180 57 102.6 percent of total billed charges 180 93 145.8 percent of total billed charges 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 51 91.8 percent of total billed charges 180 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 24MM CORTEX LO PRO TM SS SUP-97-05730 CDM C1713 HCPCS 0278 RC outpatient 180 180 180 57 102.6 percent of total billed charges 180 93 145.8 percent of total billed charges 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 51 91.8 percent of total billed charges 180 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 40MM CANNULATED SHORT THREAD LOW PROFILE SS SUP-97-05731 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 42MM CANNULATED SHORT THREAD LOW PROFILE SS SUP-97-05732 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 44MM CANNULATED SHORT THREAD LOW PROFILE SS SUP-97-05733 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 46MM CANNULATED SHORT THREAD LOW PROFILE SS SUP-97-05734 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 48MM CANNULATED SHORT THREAD LOW PROFILE SS SUP-97-05735 CDM C1713 HCPCS 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 50MM CANNULATED SHORT THREAD LOW PROFILE SS SUP-97-05736 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 55MM CANNULATED SHORT THREAD LOW PROFILE SS SUP-97-05737 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOFFMAN 3 POST STRAIGHT DIA 11MM SUP-97-05738 CDM C1713 HCPCS 0278 RC outpatient 401.8 401.8 401.8 57 229.03 percent of total billed charges 401.8 93 325.46 percent of total billed charges 401.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 401.8 other OPPS APC 401.8 401.8 other OPPS APC 401.8 51 204.92 percent of total billed charges 401.8 401.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 5 HOLES LEFT CURVED SUP-97-05739 CDM C1713 HCPCS 0278 RC outpatient 2006.16 2006.16 2006.16 57 1143.51 percent of total billed charges 2006.16 93 1624.99 percent of total billed charges 2006.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2006.16 other OPPS APC 2006.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2006.16 other OPPS APC 2006.16 51 1023.14 percent of total billed charges 2006.16 2006.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATED BROAD STRAIGHT MEDIUM SUP-97-05740 CDM C1713 HCPCS 0278 RC outpatient 1946.88 1946.88 1946.88 57 1109.72 percent of total billed charges 1946.88 93 1576.97 percent of total billed charges 1946.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1946.88 other OPPS APC 1946.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1946.88 other OPPS APC 1946.88 51 992.91 percent of total billed charges 1946.88 1946.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 7 X 65MM HEADLESS COMPRESSION SHORT THREAD SUP-97-05741 CDM C1713 HCPCS 0278 RC outpatient 1970.64 1970.64 1970.64 57 1123.26 percent of total billed charges 1970.64 93 1596.22 percent of total billed charges 1970.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1970.64 other OPPS APC 1970.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1970.64 other OPPS APC 1970.64 51 1005.03 percent of total billed charges 1970.64 1970.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 7 X 60MM HEADLESS COMPRESSION SHORT THREAD SUP-97-05742 CDM 0272 RC outpatient 1970.64 1970.64 1970.64 74 1458.27 percent of total billed charges 1970.64 93 1596.22 percent of total billed charges 1970.64 1970.64 other OPPS APC 1970.64 1970.64 other OPPS APC 1970.64 27.63 544.49 percent of total billed charges 1970.64 1970.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT LGN XLPE PS SIZE 3-4 9MM SUP-97-05743 CDM C1776 HCPCS 0278 RC outpatient 4367.63 4367.63 4367.63 57 2489.55 percent of total billed charges 4367.63 93 3537.78 percent of total billed charges 4367.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4367.63 other OPPS APC 4367.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4367.63 other OPPS APC 4367.63 51 2227.49 percent of total billed charges 4367.63 4367.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE 4-LEG EASYFUSE MTP L NITINOL SUP-97-05744 CDM C1713 HCPCS 0278 RC outpatient 7500 7500 7500 57 4275 percent of total billed charges 7500 93 6075 percent of total billed charges 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 51 3825 percent of total billed charges 7500 7500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 5 HOLE 2.3MM M VARIAX LOCKING ROTATION SUP-97-05746 CDM C1713 HCPCS 0278 RC outpatient 1686.36 1686.36 1686.36 57 961.23 percent of total billed charges 1686.36 93 1365.95 percent of total billed charges 1686.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1686.36 other OPPS APC 1686.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1686.36 other OPPS APC 1686.36 51 860.04 percent of total billed charges 1686.36 1686.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM DISTAL CONICAL 21 X 155MM REST MOD SUP-97-05747 CDM C1776 HCPCS 0278 RC outpatient 5935 5935 5935 57 3382.95 percent of total billed charges 5935 93 4807.35 percent of total billed charges 5935 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5935 other OPPS APC 5935 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5935 other OPPS APC 5935 51 3026.85 percent of total billed charges 5935 5935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT SIZE 8 8MM ATTUNE PS FB SUP-97-05748 CDM C1776 HCPCS 0278 RC outpatient 2430 2430 2430 57 1385.1 percent of total billed charges 2430 93 1968.3 percent of total billed charges 2430 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2430 other OPPS APC 2430 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2430 other OPPS APC 2430 51 1239.3 percent of total billed charges 2430 2430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TI LAG 10.5 X 115MM SUP-97-05749 CDM C1713 HCPCS 0278 RC outpatient 991.8 991.8 991.8 57 565.33 percent of total billed charges 991.8 93 803.36 percent of total billed charges 991.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 991.8 other OPPS APC 991.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 991.8 other OPPS APC 991.8 51 505.82 percent of total billed charges 991.8 991.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERFYL 1.5ML FLOWABLE SUP-97-05750 CDM Q4171 CPT 0278 RC outpatient 5225 5225 5225 57 2978.25 percent of total billed charges 5225 93 4232.25 percent of total billed charges 5225 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5225 other OPPS APC 5225 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5225 other OPPS APC 5225 51 2664.75 percent of total billed charges 5225 5225 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE BIOSYNC EVANS 18 X 18 X 10MM SUP-97-05751 CDM C1713 HCPCS 0278 RC outpatient 5487.5 5487.5 5487.5 57 3127.88 percent of total billed charges 5487.5 93 4444.88 percent of total billed charges 5487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5487.5 other OPPS APC 5487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5487.5 other OPPS APC 5487.5 51 2798.63 percent of total billed charges 5487.5 5487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW COMPRE FT 7.0 X 55MM SUP-97-05752 CDM C1713 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL TFNA 11MM/130DEG X 380MM RIGHT SUP-97-05753 CDM C1713 HCPCS 0278 RC outpatient 6041.6 6041.6 6041.6 57 3443.71 percent of total billed charges 6041.6 93 4893.7 percent of total billed charges 6041.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6041.6 other OPPS APC 6041.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6041.6 other OPPS APC 6041.6 51 3081.22 percent of total billed charges 6041.6 6041.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL LOCKING 3.5MMX13MM SUP-97-05754 CDM C1713 HCPCS 0278 RC outpatient 252 252 252 57 143.64 percent of total billed charges 252 93 204.12 percent of total billed charges 252 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 51 128.52 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FLUTED TRIATHLON 11MM 100MM TS SUP-97-05755 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT X3 SIZE 3X12 SUP-97-05756 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALTRX NEUT 36IDX56OD SUP-97-05757 CDM C1776 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS X3 TIBIAL INSERT SUP-97-05758 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 38MM MICA PROSTEP SUP-97-05759 CDM C1713 HCPCS 0278 RC outpatient 1908 1908 1908 57 1087.56 percent of total billed charges 1908 93 1545.48 percent of total billed charges 1908 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1908 other OPPS APC 1908 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1908 other OPPS APC 1908 51 973.08 percent of total billed charges 1908 1908 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE 15 X 15 EASYFUSE SUP-97-05760 CDM C1713 HCPCS 0278 RC outpatient 6250 6250 6250 57 3562.5 percent of total billed charges 6250 93 5062.5 percent of total billed charges 6250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6250 other OPPS APC 6250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6250 other OPPS APC 6250 51 3187.5 percent of total billed charges 6250 6250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DX FIBERTAK SUTURE ANCHOR #2 MIS W/ NEEDLE SUP-97-05761 CDM C1713 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTERNAL BRACE KIT W/ CC FT AND JUMPSTART SUP-97-05762 CDM C1713 HCPCS 0278 RC outpatient 3737.5 3737.5 3737.5 57 2130.38 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 51 1906.13 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 3 HOLE SHAFT LEFT SUP-97-05763 CDM C1713 HCPCS 0278 RC outpatient 1974 1974 1974 57 1125.18 percent of total billed charges 1974 93 1598.94 percent of total billed charges 1974 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1974 other OPPS APC 1974 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1974 other OPPS APC 1974 51 1006.74 percent of total billed charges 1974 1974 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 32MM CANNULATED FULLY THREADED SUP-97-05764 CDM C1713 HCPCS 0278 RC outpatient 476 476 476 57 271.32 percent of total billed charges 476 93 385.56 percent of total billed charges 476 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 476 other OPPS APC 476 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 476 other OPPS APC 476 51 242.76 percent of total billed charges 476 476 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 34MM CANNULATED FULLY THREADED SUP-97-05765 CDM C1713 HCPCS 0278 RC outpatient 476 476 476 57 271.32 percent of total billed charges 476 93 385.56 percent of total billed charges 476 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 476 other OPPS APC 476 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 476 other OPPS APC 476 51 242.76 percent of total billed charges 476 476 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE HUMERAL PROXIMAL LATERAL 8 HOLE LEFT SUP-97-05766 CDM C1713 HCPCS 0278 RC outpatient 3650.85 3650.85 3650.85 57 2080.98 percent of total billed charges 3650.85 93 2957.19 percent of total billed charges 3650.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3650.85 other OPPS APC 3650.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3650.85 other OPPS APC 3650.85 51 1861.93 percent of total billed charges 3650.85 3650.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SUPERIOR LATERAL 4 HOLE RIGHT 86MM SUP-97-05767 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE 18 X 15 EASYFUSE SUP-97-05768 CDM C1713 HCPCS 0278 RC outpatient 6250 6250 6250 57 3562.5 percent of total billed charges 6250 93 5062.5 percent of total billed charges 6250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6250 other OPPS APC 6250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6250 other OPPS APC 6250 51 3187.5 percent of total billed charges 6250 6250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE 20 X 20 EASYFUSE SUP-97-05769 CDM C1713 HCPCS 0278 RC outpatient 7000 7000 7000 57 3990 percent of total billed charges 7000 93 5670 percent of total billed charges 7000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7000 other OPPS APC 7000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7000 other OPPS APC 7000 51 3570 percent of total billed charges 7000 7000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE 20 X 15 EASYFUSE SUP-97-05770 CDM C1713 HCPCS 0278 RC outpatient 7000 7000 7000 57 3990 percent of total billed charges 7000 93 5670 percent of total billed charges 7000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7000 other OPPS APC 7000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7000 other OPPS APC 7000 51 3570 percent of total billed charges 7000 7000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 7.0 X 70MM HEADLESS COMPRESSION SUP-97-05771 CDM C1713 HCPCS 0278 RC outpatient 1970.64 1970.64 1970.64 57 1123.26 percent of total billed charges 1970.64 93 1596.22 percent of total billed charges 1970.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1970.64 other OPPS APC 1970.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1970.64 other OPPS APC 1970.64 51 1005.03 percent of total billed charges 1970.64 1970.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 7.0 X 75MM HEADLESS COMPRESSION SUP-97-05772 CDM C1713 HCPCS 0278 RC outpatient 1970.64 1970.64 1970.64 57 1123.26 percent of total billed charges 1970.64 93 1596.22 percent of total billed charges 1970.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1970.64 other OPPS APC 1970.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1970.64 other OPPS APC 1970.64 51 1005.03 percent of total billed charges 1970.64 1970.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX LCKNG 4.5MM X 38MM SUP-97-05778 CDM C1713 HCPCS 0278 RC outpatient 110.96 110.96 110.96 57 63.25 percent of total billed charges 110.96 93 89.88 percent of total billed charges 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 51 56.59 percent of total billed charges 110.96 110.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX LCKNG 4.5MM X 40MM SUP-97-05779 CDM C1713 HCPCS 0278 RC outpatient 110.96 110.96 110.96 57 63.25 percent of total billed charges 110.96 93 89.88 percent of total billed charges 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 51 56.59 percent of total billed charges 110.96 110.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LCKNG PERIPROSTHETIC 12MM SUP-97-05780 CDM C1713 HCPCS 0278 RC outpatient 504.07 504.07 504.07 57 287.32 percent of total billed charges 504.07 93 408.3 percent of total billed charges 504.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 504.07 other OPPS APC 504.07 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 504.07 other OPPS APC 504.07 51 257.08 percent of total billed charges 504.07 504.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW COUNTERSINK CANN AO 3.8MM X 80MM SUP-97-05781 CDM outpatient 700 700 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 38MM QUICKFIX TI CANNULATED ST SUP-97-05782 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 24MM QUICKFIX CANNULATED ST SUP-97-05783 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 26MM QUICKFIX CANNULATED ST SUP-97-05784 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5 X 32MM COMPRESSION FT SUP-97-05785 CDM C1713 HCPCS 0278 RC outpatient 1425 1425 1425 57 812.25 percent of total billed charges 1425 93 1154.25 percent of total billed charges 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 51 726.75 percent of total billed charges 1425 1425 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTICULAR SURFACE GH 7-10 10MM NEXGEN LPS FLEX FIXEX PROLONG SUP-97-05786 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 40MM T2 FT LOCKING SUP-97-05787 CDM C1713 HCPCS 0278 RC outpatient 401.1 401.1 401.1 57 228.63 percent of total billed charges 401.1 93 324.89 percent of total billed charges 401.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 401.1 other OPPS APC 401.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 401.1 other OPPS APC 401.1 51 204.56 percent of total billed charges 401.1 401.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 24MM T2 FT LOCKING SUP-97-05788 CDM C1713 HCPCS 0278 RC outpatient 401.1 401.1 401.1 57 228.63 percent of total billed charges 401.1 93 324.89 percent of total billed charges 401.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 401.1 other OPPS APC 401.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 401.1 other OPPS APC 401.1 51 204.56 percent of total billed charges 401.1 401.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 18 HOLE LEFT DISTAL LATERAL FEMUR SUP-97-05789 CDM C1713 HCPCS 0278 RC outpatient 4332.95 4332.95 4332.95 57 2469.78 percent of total billed charges 4332.95 93 3509.69 percent of total billed charges 4332.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4332.95 other OPPS APC 4332.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4332.95 other OPPS APC 4332.95 51 2209.8 percent of total billed charges 4332.95 4332.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLENOID BASEPLATE 28MM REUNION RSA SUP-97-05790 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HUMERAL INSERT 32 X 4MM X3 STANDARD SUP-97-05791 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONE AUGMENT TRIATHLON SYM SIZE B SUP-97-05792 CDM C1776 HCPCS 0278 RC outpatient 9795 9795 9795 57 5583.15 percent of total billed charges 9795 93 7933.95 percent of total billed charges 9795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9795 other OPPS APC 9795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9795 other OPPS APC 9795 51 4995.45 percent of total billed charges 9795 9795 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONE AUGMENT TRIATHLON TRITANIUM CENTRAL 1&2 RIGHT SUP-97-05793 CDM C1776 HCPCS 0278 RC outpatient 8924 8924 8924 57 5086.68 percent of total billed charges 8924 93 7228.44 percent of total billed charges 8924 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8924 other OPPS APC 8924 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8924 other OPPS APC 8924 51 4551.24 percent of total billed charges 8924 8924 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI PRESS FIT STEM 12MM X 100MM SUP-97-05794 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT X3 POLY 16MM TRIATHLON TS PLUS SUP-97-05795 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE 18 X 20 EASYFUSE SUP-97-05797 CDM C1713 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE 25 X 20 EASYFUSE SUP-97-05798 CDM C1713 HCPCS 0278 RC outpatient 5067.5 5067.5 5067.5 57 2888.48 percent of total billed charges 5067.5 93 4104.68 percent of total billed charges 5067.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5067.5 other OPPS APC 5067.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5067.5 other OPPS APC 5067.5 51 2584.43 percent of total billed charges 5067.5 5067.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 7 X 80MM HEADLESS COMPRESSION ST SUP-97-05799 CDM C1713 HCPCS 0278 RC outpatient 1970.64 1970.64 1970.64 57 1123.26 percent of total billed charges 1970.64 93 1596.22 percent of total billed charges 1970.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1970.64 other OPPS APC 1970.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1970.64 other OPPS APC 1970.64 51 1005.03 percent of total billed charges 1970.64 1970.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 7 X 85MM HEADLESS COMPRESSION SHORT THREAD SUP-97-05800 CDM C1713 HCPCS 0278 RC outpatient 1970.64 1970.64 1970.64 57 1123.26 percent of total billed charges 1970.64 93 1596.22 percent of total billed charges 1970.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1970.64 other OPPS APC 1970.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1970.64 other OPPS APC 1970.64 51 1005.03 percent of total billed charges 1970.64 1970.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNITRAX MODULAR ENDO HEAD 58MM SUP-97-05801 CDM C1776 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNITRAX V40 TAPER SLEEVE +0MM (STD) SUP-97-05802 CDM C1713 HCPCS 0278 RC outpatient 659.4 659.4 659.4 57 375.86 percent of total billed charges 659.4 93 534.11 percent of total billed charges 659.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 659.4 other OPPS APC 659.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 659.4 other OPPS APC 659.4 51 336.29 percent of total billed charges 659.4 659.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICA FIRST MET TRANSLATOR SUP-97-05804 CDM 0272 RC outpatient 479.5 479.5 479.5 74 354.83 percent of total billed charges 479.5 93 388.4 percent of total billed charges 479.5 479.5 other OPPS APC 479.5 479.5 other OPPS APC 479.5 27.63 132.49 percent of total billed charges 479.5 479.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK ART SURF EF 5-6/GREEN 17MM SUP-97-05805 CDM C1776 HCPCS 0278 RC outpatient 4257 4257 4257 57 2426.49 percent of total billed charges 4257 93 3448.17 percent of total billed charges 4257 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4257 other OPPS APC 4257 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4257 other OPPS APC 4257 51 2171.07 percent of total billed charges 4257 4257 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI PRESS FIT STEM 19 X 100MM SUP-97-05807 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 X 22MM HYBRID VAL KREULOCK SUP-97-05808 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 X 14MM HYBRID VAL KREULOCK SUP-97-05809 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 X 16MM HYBRID VAL KREULOCK SUP-97-05810 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 X 18MM HYBRID VAL KREULOCK SUP-97-05811 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 X 24MM HYBRID VAL KREULOCK SUP-97-05812 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 3MM SMALL DORSAL MIDFOOT FUSION SUP-97-05813 CDM C1713 HCPCS 0278 RC outpatient 3737.5 3737.5 3737.5 57 2130.38 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 51 1906.13 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL COMPONENT SIZE 6 16MM SUP-97-05814 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIGMA XKL CVC PLUS INSERT 3 8MM SUP-97-05815 CDM C1776 HCPCS 0278 RC outpatient 4171.25 4171.25 4171.25 57 2377.61 percent of total billed charges 4171.25 93 3378.71 percent of total billed charges 4171.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4171.25 other OPPS APC 4171.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4171.25 other OPPS APC 4171.25 51 2127.34 percent of total billed charges 4171.25 4171.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 26MM T10 FULL THREAD SUP-97-05816 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 28MM T10 FULL THREAD SUP-97-05817 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 30MM T10 FULL THREAD SUP-97-05818 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 32MM T10 FULL THREAD SUP-97-05819 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 34MM T10 FULL THREAD SUP-97-05820 CDM outpatient 349.44 349.44 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 36MM T10 FULL THREAD SUP-97-05821 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 38MM T10 FULL THREAD SUP-97-05822 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 40MM T10 FULL THREAD SUP-97-05823 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 42MM T10 FULL THREAD SUP-97-05824 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 44MM T10 FULL THREAD SUP-97-05825 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 46MM T10 FULL THREAD SUP-97-05826 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 48MM T10 FULL THREAD SUP-97-05827 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 65MM T10 FULL THREAD SUP-97-05828 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 70MM T10 FULL THREAD SUP-97-05829 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 6.5 X 60MM HEADLESS COMPRESSION SHORT THREAD SUP-97-05830 CDM C1713 HCPCS 0278 RC outpatient 2398.5 2398.5 2398.5 57 1367.15 percent of total billed charges 2398.5 93 1942.79 percent of total billed charges 2398.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2398.5 other OPPS APC 2398.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2398.5 other OPPS APC 2398.5 51 1223.24 percent of total billed charges 2398.5 2398.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 6.5 X 70MM HEADLESS COMPRESSION SHORT THREAD SUP-97-05831 CDM C1713 HCPCS 0278 RC outpatient 2398.5 2398.5 2398.5 57 1367.15 percent of total billed charges 2398.5 93 1942.79 percent of total billed charges 2398.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2398.5 other OPPS APC 2398.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2398.5 other OPPS APC 2398.5 51 1223.24 percent of total billed charges 2398.5 2398.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMART TOE IMPLANT 15MM ANGLED SUP-97-05832 CDM C1713 HCPCS 0278 RC outpatient 2960.16 2960.16 2960.16 57 1687.29 percent of total billed charges 2960.16 93 2397.73 percent of total billed charges 2960.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2960.16 other OPPS APC 2960.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2960.16 other OPPS APC 2960.16 51 1509.68 percent of total billed charges 2960.16 2960.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 X 36MM CANNULATED HEADLESS SHORT THREAD MINI MONSTER SUP-97-05833 CDM C1713 HCPCS 0278 RC outpatient 720 720 720 57 410.4 percent of total billed charges 720 93 583.2 percent of total billed charges 720 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 720 other OPPS APC 720 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 720 other OPPS APC 720 51 367.2 percent of total billed charges 720 720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 X 48MM CANNULATED HEADLESS SHORT THREAD MINI MONSTER SUP-97-05834 CDM C1713 HCPCS 0278 RC outpatient 720 720 720 57 410.4 percent of total billed charges 720 93 583.2 percent of total billed charges 720 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 720 other OPPS APC 720 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 720 other OPPS APC 720 51 367.2 percent of total billed charges 720 720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 X 20MM HEADED CANNULATED SHORT THREAD SUP-97-05835 CDM C1713 HCPCS 0278 RC outpatient 647.5 647.5 647.5 57 369.08 percent of total billed charges 647.5 93 524.48 percent of total billed charges 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 51 330.23 percent of total billed charges 647.5 647.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE DR ANATOMICAL VOLAR INTERMEDIATE RIGHT SHORT SUP-97-05836 CDM C1713 HCPCS 0278 RC outpatient 2965.56 2965.56 2965.56 57 1690.37 percent of total billed charges 2965.56 93 2402.1 percent of total billed charges 2965.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2965.56 other OPPS APC 2965.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2965.56 other OPPS APC 2965.56 51 1512.44 percent of total billed charges 2965.56 2965.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 7.3 X 125MM CANNULATED 16MM THREAD SUP-97-05837 CDM C1713 HCPCS 0278 RC outpatient 733.5 733.5 733.5 57 418.1 percent of total billed charges 733.5 93 594.14 percent of total billed charges 733.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 733.5 other OPPS APC 733.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 733.5 other OPPS APC 733.5 51 374.09 percent of total billed charges 733.5 733.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP TIBIAL NAIL SIZE 5 SUP-97-05838 CDM C1713 HCPCS 0278 RC outpatient 725.7 725.7 725.7 57 413.65 percent of total billed charges 725.7 93 587.82 percent of total billed charges 725.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 725.7 other OPPS APC 725.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 725.7 other OPPS APC 725.7 51 370.11 percent of total billed charges 725.7 725.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL NAIL A/R R1500 11 X 320MM SUP-97-05839 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5 X 80MM LOCKING FULLY THREADED SUP-97-05840 CDM C1713 HCPCS 0278 RC outpatient 394.8 394.8 394.8 57 225.04 percent of total billed charges 394.8 93 319.79 percent of total billed charges 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 51 201.35 percent of total billed charges 394.8 394.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 12MM CANNULATED FULLY THREADED SUP-97-05841 CDM C1713 HCPCS 0278 RC outpatient 476 476 476 57 271.32 percent of total billed charges 476 93 385.56 percent of total billed charges 476 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 476 other OPPS APC 476 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 476 other OPPS APC 476 51 242.76 percent of total billed charges 476 476 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 30MM CANNULATED FULLY THREADED SUP-97-05842 CDM C1713 HCPCS 0278 RC outpatient 476 476 476 57 271.32 percent of total billed charges 476 93 385.56 percent of total billed charges 476 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 476 other OPPS APC 476 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 476 other OPPS APC 476 51 242.76 percent of total billed charges 476 476 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM 41 X 111MM HIGH OFFSET SUP-97-05843 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM SIZE 9 INSIGNIA COLLARD SUP-97-05844 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 26MM CORTICAL LOW PROFILE TITANIUM SUP-97-05845 CDM C1713 HCPCS 0278 RC outpatient 385 385 385 57 219.45 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 51 196.35 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL PLATE SIZE 7 NEXGEN PRECOAT STEMMED SUP-97-05846 CDM C1776 HCPCS 0278 RC outpatient 3610 3610 3610 57 2057.7 percent of total billed charges 3610 93 2924.1 percent of total billed charges 3610 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3610 other OPPS APC 3610 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3610 other OPPS APC 3610 51 1841.1 percent of total billed charges 3610 3610 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXTENSION 20 DIA X 145MM NEXTGEN STRAIGHT SUP-97-05847 CDM C1776 HCPCS 0278 RC outpatient 2570.4 2570.4 2570.4 57 1465.13 percent of total billed charges 2570.4 93 2082.02 percent of total billed charges 2570.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2570.4 other OPPS APC 2570.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2570.4 other OPPS APC 2570.4 51 1310.9 percent of total billed charges 2570.4 2570.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK FEMORAL SIZE G-LT SUP-97-05848 CDM C1776 HCPCS 0278 RC outpatient 9770.4 9770.4 9770.4 57 5569.13 percent of total billed charges 9770.4 93 7914.02 percent of total billed charges 9770.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9770.4 other OPPS APC 9770.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9770.4 other OPPS APC 9770.4 51 4982.9 percent of total billed charges 9770.4 9770.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN LCCK ARTICULAR SURFACE G 7-10/BLUE 17MM SUP-97-05849 CDM C1776 HCPCS 0278 RC outpatient 4257 4257 4257 57 2426.49 percent of total billed charges 4257 93 3448.17 percent of total billed charges 4257 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4257 other OPPS APC 4257 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4257 other OPPS APC 4257 51 2171.07 percent of total billed charges 4257 4257 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA ALL POLY VE 41MM DIA SUP-97-05850 CDM C1713 HCPCS 0278 RC outpatient 2172 2172 2172 57 1238.04 percent of total billed charges 2172 93 1759.32 percent of total billed charges 2172 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2172 other OPPS APC 2172 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2172 other OPPS APC 2172 51 1107.72 percent of total billed charges 2172 2172 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 40MM HEADLESS SUP-97-05851 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 16MM CORTICAL SCREW SUP-97-05852 CDM C1713 HCPCS 0278 RC outpatient 323.4 323.4 323.4 57 184.34 percent of total billed charges 323.4 93 261.95 percent of total billed charges 323.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 323.4 other OPPS APC 323.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 323.4 other OPPS APC 323.4 51 164.93 percent of total billed charges 323.4 323.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 18MM LOCKING LG HD SUP-97-05853 CDM C1713 HCPCS 0278 RC outpatient 636.3 636.3 636.3 57 362.69 percent of total billed charges 636.3 93 515.4 percent of total billed charges 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 51 324.51 percent of total billed charges 636.3 636.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 12MM LOCKING LG HD SUP-97-05854 CDM C1713 HCPCS 0278 RC outpatient 636.3 636.3 636.3 57 362.69 percent of total billed charges 636.3 93 515.4 percent of total billed charges 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 51 324.51 percent of total billed charges 636.3 636.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 12MM CORTICAL LOW PROFILE SUP-97-05855 CDM C1713 HCPCS 0278 RC outpatient 323.4 323.4 323.4 57 184.34 percent of total billed charges 323.4 93 261.95 percent of total billed charges 323.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 323.4 other OPPS APC 323.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 323.4 other OPPS APC 323.4 51 164.93 percent of total billed charges 323.4 323.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCRW 3.5 X 14MM LOCKING SUP-97-05856 CDM C1713 HCPCS 0278 RC outpatient 636.3 636.3 636.3 57 362.69 percent of total billed charges 636.3 93 515.4 percent of total billed charges 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 51 324.51 percent of total billed charges 636.3 636.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 10MM LOCKING LG HD SUP-97-05857 CDM C1713 HCPCS 0278 RC outpatient 636.3 636.3 636.3 57 362.69 percent of total billed charges 636.3 93 515.4 percent of total billed charges 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 51 324.51 percent of total billed charges 636.3 636.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 18MM LOCKING SUP-97-05858 CDM C1713 HCPCS 0278 RC outpatient 636.3 636.3 636.3 57 362.69 percent of total billed charges 636.3 93 515.4 percent of total billed charges 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 51 324.51 percent of total billed charges 636.3 636.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 50MM CANNULATED COMPRESSION HEADLESS LONG THREAD SUP-97-05859 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 14MM QUICKFIX TI CANC SUP-97-05860 CDM C1713 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN 2.4 X 12MM SNAP-OFF FT SUP-97-05861 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 8 X 30MM BC IF VENTED SUP-97-05862 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE 15X15X15 SUP-97-05863 CDM C1713 HCPCS 0278 RC outpatient 4875 4875 4875 57 2778.75 percent of total billed charges 4875 93 3948.75 percent of total billed charges 4875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4875 other OPPS APC 4875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4875 other OPPS APC 4875 51 2486.25 percent of total billed charges 4875 4875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE 20X16X16 SUP-97-05864 CDM C1713 HCPCS 0278 RC outpatient 5000 5000 5000 57 2850 percent of total billed charges 5000 93 4050 percent of total billed charges 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 51 2550 percent of total billed charges 5000 5000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL NAIL 12 X 315MM T2 STANDARD SUP-97-05865 CDM C1713 HCPCS 0278 RC outpatient 2734.2 2734.2 2734.2 57 1558.49 percent of total billed charges 2734.2 93 2214.7 percent of total billed charges 2734.2 2734.2 other OPPS APC 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 51 1394.44 percent of total billed charges 2734.2 2734.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 18MM CORTEX TI SUP-97-05866 CDM C1713 HCPCS 0278 RC outpatient 97.28 97.28 97.28 57 55.45 percent of total billed charges 97.28 93 78.8 percent of total billed charges 97.28 97.28 other OPPS APC 97.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.28 other OPPS APC 97.28 51 49.61 percent of total billed charges 97.28 97.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 30MM CANCELLOUS TI SUP-97-05867 CDM C1713 HCPCS 0278 RC outpatient 106.4 106.4 106.4 57 60.65 percent of total billed charges 106.4 93 86.18 percent of total billed charges 106.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.4 other OPPS APC 106.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.4 other OPPS APC 106.4 51 54.26 percent of total billed charges 106.4 106.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INFINITY ADAPTIS TIB SIZE 1 SUP-97-05868 CDM C1776 HCPCS 0278 RC outpatient 8050 8050 8050 57 4588.5 percent of total billed charges 8050 93 6520.5 percent of total billed charges 8050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8050 other OPPS APC 8050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8050 other OPPS APC 8050 51 4105.5 percent of total billed charges 8050 8050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INFINITY EVERLAST SIZE 2 6MM SUP-97-05869 CDM C1776 HCPCS 0278 RC outpatient 3975 3975 3975 57 2265.75 percent of total billed charges 3975 93 3219.75 percent of total billed charges 3975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3975 other OPPS APC 3975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3975 other OPPS APC 3975 51 2027.25 percent of total billed charges 3975 3975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAILOR'S BUNION IMPLANT SMALL SUP-97-05870 CDM C1713 HCPCS 0278 RC outpatient 5552.5 5552.5 5552.5 57 3164.93 percent of total billed charges 5552.5 93 4497.53 percent of total billed charges 5552.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5552.5 other OPPS APC 5552.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5552.5 other OPPS APC 5552.5 51 2831.78 percent of total billed charges 5552.5 5552.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT OVITEX 1S 6 X 10 SUP-97-05871 CDM C1781 HCPCS 0278 RC outpatient 2916 2916 2916 57 1662.12 percent of total billed charges 2916 93 2361.96 percent of total billed charges 2916 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2916 other OPPS APC 2916 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2916 other OPPS APC 2916 51 1487.16 percent of total billed charges 2916 2916 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 36MM MICA SUP-97-05872 CDM C1713 HCPCS 0278 RC outpatient 1908 1908 1908 57 1087.56 percent of total billed charges 1908 93 1545.48 percent of total billed charges 1908 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1908 other OPPS APC 1908 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1908 other OPPS APC 1908 51 973.08 percent of total billed charges 1908 1908 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTICULAR SURFACE 7-10/BLUE 12MM NEXGEN SUP-97-05873 CDM C1776 HCPCS 0278 RC outpatient 2568 2568 2568 57 1463.76 percent of total billed charges 2568 93 2080.08 percent of total billed charges 2568 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2568 other OPPS APC 2568 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2568 other OPPS APC 2568 51 1309.68 percent of total billed charges 2568 2568 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL FIBULA LEFT 3.0 X 180MM SUP-97-05874 CDM C1713 HCPCS 0278 RC outpatient 7487.5 7487.5 7487.5 57 4267.88 percent of total billed charges 7487.5 93 6064.88 percent of total billed charges 7487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7487.5 other OPPS APC 7487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7487.5 other OPPS APC 7487.5 51 3818.63 percent of total billed charges 7487.5 7487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER FOR 4 - 8MM SCREW SUP-97-05875 CDM C1713 HCPCS 0278 RC outpatient 188 188 188 57 107.16 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 51 95.88 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 50MM CANNULATED COMPRESSION SUP-97-05876 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT 32MM 0 DEGREE TRIDENT X3 SUP-97-05877 CDM C1776 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD 32MM/+8 V40 COCR LFIT SUP-97-05878 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONE AUGMENT ASYMETRIC SIZE D RM/LL TRIATHLON SUP-97-05879 CDM C1776 HCPCS 0278 RC outpatient 8380.8 8380.8 8380.8 57 4777.06 percent of total billed charges 8380.8 93 6788.45 percent of total billed charges 8380.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8380.8 other OPPS APC 8380.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8380.8 other OPPS APC 8380.8 51 4274.21 percent of total billed charges 8380.8 8380.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL AUGMENT SIZE 7 10MM RM/LL TRIATHLON SUP-97-05880 CDM C1776 HCPCS 0278 RC outpatient 2966.4 2966.4 2966.4 57 1690.85 percent of total billed charges 2966.4 93 2402.78 percent of total billed charges 2966.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2966.4 other OPPS APC 2966.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2966.4 other OPPS APC 2966.4 51 1512.86 percent of total billed charges 2966.4 2966.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMART TOE DIP IMPLANT 13MM SUP-97-05881 CDM C1713 HCPCS 0278 RC outpatient 2960.16 2960.16 2960.16 57 1687.29 percent of total billed charges 2960.16 93 2397.73 percent of total billed charges 2960.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2960.16 other OPPS APC 2960.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2960.16 other OPPS APC 2960.16 51 1509.68 percent of total billed charges 2960.16 2960.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AMNION THIN 3X4 SUP-97-05882 CDM C1762 HCPCS 0278 RC outpatient 7000 7000 7000 57 3990 percent of total billed charges 7000 93 5670 percent of total billed charges 7000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7000 other OPPS APC 7000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7000 other OPPS APC 7000 51 3570 percent of total billed charges 7000 7000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JUMPSTART 4X4 ANTIMICROBIAL DRESSING SUP-97-05883 CDM 0272 RC outpatient 100 100 100 74 74 percent of total billed charges 100 93 81 percent of total billed charges 100 100 other OPPS APC 100 100 other OPPS APC 100 27.63 27.63 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENERGEL WOUND HYDROGEL SUP-97-05884 CDM 0272 RC outpatient 20 20 20 74 14.8 percent of total billed charges 20 93 16.2 percent of total billed charges 20 20 other OPPS APC 20 20 other OPPS APC 20 27.63 5.53 percent of total billed charges 20 20 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 20MM LOW PROFILE VA LOK TI SUP-97-05885 CDM C1713 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 22MM LOW PROFILE VA LOK TI SUP-97-05886 CDM C1713 HCPCS 0278 RC outpatient 612.5 612.5 612.5 57 349.13 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 51 312.38 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERLOOP 2-0 WITH NEEDLE SUP-97-05887 CDM C1713 HCPCS 0278 RC outpatient 200 200 200 57 114 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 51 102 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.8 X 34MM CORTICAL SUP-97-05888 CDM C1713 HCPCS 0278 RC outpatient 142.6 142.6 142.6 57 81.28 percent of total billed charges 142.6 93 115.51 percent of total billed charges 142.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 142.6 other OPPS APC 142.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 142.6 other OPPS APC 142.6 51 72.73 percent of total billed charges 142.6 142.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.8 X 26MM TRILOCK SUP-97-05889 CDM C1713 HCPCS 0278 RC outpatient 334.64 334.64 334.64 57 190.74 percent of total billed charges 334.64 93 271.06 percent of total billed charges 334.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 334.64 other OPPS APC 334.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 334.64 other OPPS APC 334.64 51 170.67 percent of total billed charges 334.64 334.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.8 X 28MM TRILOCK SUP-97-05890 CDM C1713 HCPCS 0278 RC outpatient 334.64 334.64 334.64 57 190.74 percent of total billed charges 334.64 93 271.06 percent of total billed charges 334.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 334.64 other OPPS APC 334.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 334.64 other OPPS APC 334.64 51 170.67 percent of total billed charges 334.64 334.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUADLINK IMPLANT SYSTEM 9MM SUP-97-05891 CDM C1713 HCPCS 0278 RC outpatient 5437.5 5437.5 5437.5 57 3099.38 percent of total billed charges 5437.5 93 4404.38 percent of total billed charges 5437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5437.5 other OPPS APC 5437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5437.5 other OPPS APC 5437.5 51 2773.13 percent of total billed charges 5437.5 5437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUADLINK IMPLANT SYSTEM 10MM SUP-97-05892 CDM C1713 HCPCS 0278 RC outpatient 5437.5 5437.5 5437.5 57 3099.38 percent of total billed charges 5437.5 93 4404.38 percent of total billed charges 5437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5437.5 other OPPS APC 5437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5437.5 other OPPS APC 5437.5 51 2773.13 percent of total billed charges 5437.5 5437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUADLINK IMPLANT SYSTEM 11MM SUP-97-05893 CDM C1713 HCPCS 0278 RC outpatient 5437.5 5437.5 5437.5 57 3099.38 percent of total billed charges 5437.5 93 4404.38 percent of total billed charges 5437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5437.5 other OPPS APC 5437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5437.5 other OPPS APC 5437.5 51 2773.13 percent of total billed charges 5437.5 5437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 30MM FULLY THREADED CANCELLOUS SUP-97-05894 CDM C1713 HCPCS 0278 RC outpatient 106.4 106.4 106.4 57 60.65 percent of total billed charges 106.4 93 86.18 percent of total billed charges 106.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.4 other OPPS APC 106.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.4 other OPPS APC 106.4 51 54.26 percent of total billed charges 106.4 106.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 42MM CANNULATED SHORT THREAD MINI-MONSTER SUP-97-05895 CDM C1713 HCPCS 0278 RC outpatient 647.5 647.5 647.5 57 369.08 percent of total billed charges 647.5 93 524.48 percent of total billed charges 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 51 330.23 percent of total billed charges 647.5 647.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 4HOLE RIGHT OLECRANON SUP-97-05896 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T7 2.7 X 10MM NON LOCKING SUP-97-05897 CDM C1713 HCPCS 0278 RC outpatient 238.14 238.14 238.14 57 135.74 percent of total billed charges 238.14 93 192.89 percent of total billed charges 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 51 121.45 percent of total billed charges 238.14 238.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T7 2.7 X 16MM NON LOCKING SUP-97-05900 CDM C1713 HCPCS 0278 RC outpatient 238.14 238.14 238.14 57 135.74 percent of total billed charges 238.14 93 192.89 percent of total billed charges 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 51 121.45 percent of total billed charges 238.14 238.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T7 2.7 X 18MM NON LOCKING SUP-97-05901 CDM C1713 HCPCS 0278 RC outpatient 238.14 238.14 238.14 57 135.74 percent of total billed charges 238.14 93 192.89 percent of total billed charges 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 51 121.45 percent of total billed charges 238.14 238.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T7 2.7 X 20MM NON LOCKING SUP-97-05902 CDM C1713 HCPCS 0278 RC outpatient 238.14 238.14 238.14 57 135.74 percent of total billed charges 238.14 93 192.89 percent of total billed charges 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 51 121.45 percent of total billed charges 238.14 238.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T7 2.7 X 22MM NON LOCKING SUP-97-05903 CDM C1713 HCPCS 0278 RC outpatient 238.14 238.14 238.14 57 135.74 percent of total billed charges 238.14 93 192.89 percent of total billed charges 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 51 121.45 percent of total billed charges 238.14 238.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T7 2.7 X 24MM NON LOCKING SUP-97-05904 CDM C1713 HCPCS 0278 RC outpatient 238.14 238.14 238.14 57 135.74 percent of total billed charges 238.14 93 192.89 percent of total billed charges 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 51 121.45 percent of total billed charges 238.14 238.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T7 2.7 X 26MM NON LOCKING SUP-97-05905 CDM C1713 HCPCS 0278 RC outpatient 238.14 238.14 238.14 57 135.74 percent of total billed charges 238.14 93 192.89 percent of total billed charges 238.14 238.14 other OPPS APC 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 51 121.45 percent of total billed charges 238.14 238.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T7 2.7 X 28MM NON LOCKING SUP-97-05906 CDM C1713 HCPCS 0278 RC outpatient 238.14 238.14 238.14 57 135.74 percent of total billed charges 238.14 93 192.89 percent of total billed charges 238.14 238.14 other OPPS APC 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 51 121.45 percent of total billed charges 238.14 238.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T7 2.7 X 30MM NON LOCKING SUP-97-05907 CDM C1713 HCPCS 0278 RC outpatient 238.14 238.14 238.14 57 135.74 percent of total billed charges 238.14 93 192.89 percent of total billed charges 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 51 121.45 percent of total billed charges 238.14 238.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T7 2.7 X 32MM NON LOCKING SUP-97-05908 CDM C1713 HCPCS 0278 RC outpatient 238.14 238.14 238.14 57 135.74 percent of total billed charges 238.14 93 192.89 percent of total billed charges 238.14 238.14 other OPPS APC 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 51 121.45 percent of total billed charges 238.14 238.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T7 2.7 X 34MM NON LOCKING SUP-97-05909 CDM C1713 HCPCS 0278 RC outpatient 238.14 238.14 238.14 57 135.74 percent of total billed charges 238.14 93 192.89 percent of total billed charges 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 51 121.45 percent of total billed charges 238.14 238.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T7 2.7 X 36MM NON LOCKING SUP-97-05910 CDM C1713 HCPCS 0278 RC outpatient 238.14 238.14 238.14 57 135.74 percent of total billed charges 238.14 93 192.89 percent of total billed charges 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 51 121.45 percent of total billed charges 238.14 238.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T7 2.7 X 38MM NON LOCKING SUP-97-05911 CDM C1713 HCPCS 0278 RC outpatient 238.14 238.14 238.14 57 135.74 percent of total billed charges 238.14 93 192.89 percent of total billed charges 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 51 121.45 percent of total billed charges 238.14 238.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T7 2.7 X 40MM NON LOCKING SUP-97-05912 CDM C1713 HCPCS 0278 RC outpatient 238.14 238.14 238.14 57 135.74 percent of total billed charges 238.14 93 192.89 percent of total billed charges 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 51 121.45 percent of total billed charges 238.14 238.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T7 2.7 X 45MM NON LOCKING SUP-97-05913 CDM C1713 HCPCS 0278 RC outpatient 238.14 238.14 238.14 57 135.74 percent of total billed charges 238.14 93 192.89 percent of total billed charges 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 51 121.45 percent of total billed charges 238.14 238.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T7 2.7 X 50MM NON LOCKING SUP-97-05914 CDM C1713 HCPCS 0278 RC outpatient 238.14 238.14 238.14 57 135.74 percent of total billed charges 238.14 93 192.89 percent of total billed charges 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238.14 other OPPS APC 238.14 51 121.45 percent of total billed charges 238.14 238.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.5 X 30MM PINNACLE CANCELLOUS SUP-97-05915 CDM C1776 HCPCS 0278 RC outpatient 238 238 238 57 135.66 percent of total billed charges 238 93 192.78 percent of total billed charges 238 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238 other OPPS APC 238 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238 other OPPS APC 238 51 121.38 percent of total billed charges 238 238 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 12/14 ARTICUL 40MM M SPEC+8.5 SUP-97-05916 CDM C1776 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT OVITEX LPR 12 X 18CM SUP-97-05917 CDM C1781 HCPCS 0278 RC outpatient 7253.25 7253.25 7253.25 57 4134.35 percent of total billed charges 7253.25 93 5875.13 percent of total billed charges 7253.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7253.25 other OPPS APC 7253.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7253.25 other OPPS APC 7253.25 51 3699.16 percent of total billed charges 7253.25 7253.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EASY CLIP MONCRTCL FIXN DEVICE 8X8X8 SUP-97-05918 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM EXT 12 X 145MM NEXGEN SUP-97-05919 CDM C1776 HCPCS 0278 RC outpatient 2570.4 2570.4 2570.4 57 1465.13 percent of total billed charges 2570.4 93 2082.02 percent of total billed charges 2570.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2570.4 other OPPS APC 2570.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2570.4 other OPPS APC 2570.4 51 1310.9 percent of total billed charges 2570.4 2570.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTICULAR SURFACE G7-10/BLUE 14MM NEXGEN SUP-97-05920 CDM C1713 HCPCS 0278 RC outpatient 4257 4257 4257 57 2426.49 percent of total billed charges 4257 93 3448.17 percent of total billed charges 4257 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4257 other OPPS APC 4257 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4257 other OPPS APC 4257 51 2171.07 percent of total billed charges 4257 4257 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5 X 26MM CANNULATED ASNIS SUP-97-05921 CDM C1713 HCPCS 0278 RC outpatient 521.92 521.92 521.92 57 297.49 percent of total billed charges 521.92 93 422.76 percent of total billed charges 521.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 521.92 other OPPS APC 521.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 521.92 other OPPS APC 521.92 51 266.18 percent of total billed charges 521.92 521.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL NAIL 10 X 390MM T2 STANDARD SUP-97-05922 CDM C1713 HCPCS 0278 RC outpatient 2734.2 2734.2 2734.2 57 1558.49 percent of total billed charges 2734.2 93 2214.7 percent of total billed charges 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 51 1394.44 percent of total billed charges 2734.2 2734.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HALF PIN 3 X 110MM 25MM THREAD APEX SUP-97-05923 CDM C1713 HCPCS 0278 RC outpatient 313.25 313.25 313.25 57 178.55 percent of total billed charges 313.25 93 253.73 percent of total billed charges 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 313.25 other OPPS APC 313.25 51 159.76 percent of total billed charges 313.25 313.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5 X 65MM HEADLESS COMPRESSION SUP-97-05924 CDM C1713 HCPCS 0278 RC outpatient 1221.36 1221.36 1221.36 57 696.18 percent of total billed charges 1221.36 93 989.3 percent of total billed charges 1221.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1221.36 other OPPS APC 1221.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1221.36 other OPPS APC 1221.36 51 622.89 percent of total billed charges 1221.36 1221.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTICULAR SURFACE EF 5-6 12MM NEXGEN LPS-FLEX FIXED SUP-97-05925 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT 22.5MM SZ4 PFC SIGMA STAB+ SUP-97-05926 CDM C1776 HCPCS 0278 RC outpatient 5277.5 5277.5 5277.5 57 3008.18 percent of total billed charges 5277.5 93 4274.78 percent of total billed charges 5277.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5277.5 other OPPS APC 5277.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5277.5 other OPPS APC 5277.5 51 2691.53 percent of total billed charges 5277.5 5277.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT 4 22.5MM SIGMA STAB XLK SUP-97-05927 CDM C1776 HCPCS 0278 RC outpatient 4171.25 4171.25 4171.25 57 2377.61 percent of total billed charges 4171.25 93 3378.71 percent of total billed charges 4171.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4171.25 other OPPS APC 4171.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4171.25 other OPPS APC 4171.25 51 2127.34 percent of total billed charges 4171.25 4171.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE AND SLEEVE SET 2.0MM SUP-97-05928 CDM C1713 HCPCS 0278 RC outpatient 910.8 910.8 910.8 57 519.16 percent of total billed charges 910.8 93 737.75 percent of total billed charges 910.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 910.8 other OPPS APC 910.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 910.8 other OPPS APC 910.8 51 464.51 percent of total billed charges 910.8 910.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM 19 X 195MM REST MOD CONICAL DISTAL SUP-97-05929 CDM C1776 HCPCS 0278 RC outpatient 7655 7655 7655 57 4363.35 percent of total billed charges 7655 93 6200.55 percent of total billed charges 7655 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7655 other OPPS APC 7655 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7655 other OPPS APC 7655 51 3904.05 percent of total billed charges 7655 7655 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTICULAR INSERT SIZE 3-4 LT 13MM JRNY II BCS SUP-97-05930 CDM C1776 HCPCS 0278 RC outpatient 5137.13 5137.13 5137.13 57 2928.16 percent of total billed charges 5137.13 93 4161.08 percent of total billed charges 5137.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5137.13 other OPPS APC 5137.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5137.13 other OPPS APC 5137.13 51 2619.94 percent of total billed charges 5137.13 5137.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETABULAR SHELL MULTIHOLE TRIDENT II TRITANIUM SIZE 48MM D SUP-97-05931 CDM C1776 HCPCS 0278 RC outpatient 7848 7848 7848 57 4473.36 percent of total billed charges 7848 93 6356.88 percent of total billed charges 7848 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7848 other OPPS APC 7848 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7848 other OPPS APC 7848 51 4002.48 percent of total billed charges 7848 7848 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM SIZE 2 NK 36MM STM 99MM HIGH OFFSET INSIGNIA SUP-97-05932 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 70MM LOCKING VA SUP-97-05933 CDM C1713 HCPCS 0278 RC outpatient 623.35 623.35 623.35 57 355.31 percent of total billed charges 623.35 93 504.91 percent of total billed charges 623.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 623.35 other OPPS APC 623.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 623.35 other OPPS APC 623.35 51 317.91 percent of total billed charges 623.35 623.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ANCHOR 2.9 X 12.5MM HIP BIO COMP PUSH LOCK SUP-97-05934 CDM C1713 HCPCS 0278 RC outpatient 1260 1260 1260 57 718.2 percent of total billed charges 1260 93 1020.6 percent of total billed charges 1260 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1260 other OPPS APC 1260 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1260 other OPPS APC 1260 51 642.6 percent of total billed charges 1260 1260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERTAK 1.8 SELF BUNCHING KL HIP SUP-97-05935 CDM C1713 HCPCS 0278 RC outpatient 1425 1425 1425 57 812.25 percent of total billed charges 1425 93 1154.25 percent of total billed charges 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 51 726.75 percent of total billed charges 1425 1425 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ANCHOR PEEK S-TAK KNOTLESS HIP SUP-97-05936 CDM C1713 HCPCS 0278 RC outpatient 1215 1215 1215 57 692.55 percent of total billed charges 1215 93 984.15 percent of total billed charges 1215 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1215 other OPPS APC 1215 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1215 other OPPS APC 1215 51 619.65 percent of total billed charges 1215 1215 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT OVITEX LPR 15CM CIRCLE SUP-97-05937 CDM C1781 HCPCS 0278 RC outpatient 7554.88 7554.88 7554.88 57 4306.28 percent of total billed charges 7554.88 93 6119.45 percent of total billed charges 7554.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7554.88 other OPPS APC 7554.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7554.88 other OPPS APC 7554.88 51 3852.99 percent of total billed charges 7554.88 7554.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT LOOPLOC SUP-97-05938 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LAPIDUS LEFT STEP 0MM SUP-97-05940 CDM C1713 HCPCS 0278 RC outpatient 3308.4 3308.4 3308.4 57 1885.79 percent of total billed charges 3308.4 93 2679.8 percent of total billed charges 3308.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3308.4 other OPPS APC 3308.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3308.4 other OPPS APC 3308.4 51 1687.28 percent of total billed charges 3308.4 3308.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROXIMAL MEDIAL TIBIA RT 8 HOLE SUP-97-05941 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR KNOTLESS 1.8 FIBERTAK SHOULDER SUP-97-05942 CDM C1713 HCPCS 0278 RC outpatient 1386 1386 1386 57 790.02 percent of total billed charges 1386 93 1122.66 percent of total billed charges 1386 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1386 other OPPS APC 1386 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1386 other OPPS APC 1386 51 706.86 percent of total billed charges 1386 1386 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR KNOTLESS FIBERTAK RC WH/BLK FT & BLUE #2 SUP-97-05943 CDM C1713 HCPCS 0278 RC outpatient 1590 1590 1590 57 906.3 percent of total billed charges 1590 93 1287.9 percent of total billed charges 1590 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1590 other OPPS APC 1590 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1590 other OPPS APC 1590 51 810.9 percent of total billed charges 1590 1590 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURETAPE 2-0 MENISCUS REPAIR NEEDLES SUP-97-05944 CDM 0272 RC outpatient 402.5 402.5 402.5 74 297.85 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 402.5 other OPPS APC 402.5 402.5 other OPPS APC 402.5 27.63 111.21 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE WIDE HEAD 4 HOLE SHAFT LEFT SUP-97-05945 CDM C1713 HCPCS 0278 RC outpatient 1974 1974 1974 57 1125.18 percent of total billed charges 1974 93 1598.94 percent of total billed charges 1974 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1974 other OPPS APC 1974 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1974 other OPPS APC 1974 51 1006.74 percent of total billed charges 1974 1974 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL HUMERAL 7 X 220MM SUP-97-05946 CDM C1713 HCPCS 0278 RC outpatient 2702.7 2702.7 2702.7 57 1540.54 percent of total billed charges 2702.7 93 2189.19 percent of total billed charges 2702.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2702.7 other OPPS APC 2702.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2702.7 other OPPS APC 2702.7 51 1378.38 percent of total billed charges 2702.7 2702.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT OVITEX 1S 16 X 20CM SUP-97-05947 CDM C1781 HCPCS 0278 RC outpatient 10368 10368 10368 57 5909.76 percent of total billed charges 10368 93 8398.08 percent of total billed charges 10368 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10368 other OPPS APC 10368 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 10368 other OPPS APC 10368 51 5287.68 percent of total billed charges 10368 10368 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD 32MM/+4 V40 BIOLOX SUP-97-05948 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 22MM LP CORTICAL MTPTI SUP-97-05949 CDM C1713 HCPCS 0278 RC outpatient 437.5 437.5 437.5 57 249.38 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 51 223.13 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BB TAK MTP SUP-97-05950 CDM C1713 HCPCS 0278 RC outpatient 200 200 200 57 114 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 51 102 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 12MM LP CORTICAL MTP TI SUP-97-05951 CDM C1713 HCPCS 0278 RC outpatient 437.5 437.5 437.5 57 249.38 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 51 223.13 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE STD 0 - 0 RIGHT MAXFORCE MTP SUP-97-05952 CDM C1713 HCPCS 0278 RC outpatient 4987.5 4987.5 4987.5 57 2842.88 percent of total billed charges 4987.5 93 4039.88 percent of total billed charges 4987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4987.5 other OPPS APC 4987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4987.5 other OPPS APC 4987.5 51 2543.63 percent of total billed charges 4987.5 4987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALTRX NEUT 32IDX50OD SUP-97-05953 CDM C1776 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD 12/14 TAPER 28MM DIA +10.5 MM NECK LENGTH SUP-97-05954 CDM C1713 HCPCS 0278 RC outpatient 1956 1956 1956 57 1114.92 percent of total billed charges 1956 93 1584.36 percent of total billed charges 1956 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1956 other OPPS APC 1956 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1956 other OPPS APC 1956 51 997.56 percent of total billed charges 1956 1956 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETABULAR SHELL 54MM E MULTIHOLE TRIDENT II TRITANIUM SUP-97-05955 CDM C1776 HCPCS 0278 RC outpatient 7848 7848 7848 57 4473.36 percent of total billed charges 7848 93 6356.88 percent of total billed charges 7848 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7848 other OPPS APC 7848 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7848 other OPPS APC 7848 51 4002.48 percent of total billed charges 7848 7848 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM STANDARD OFFSET SZ 3 NK 32.5MM STM 101MM SUP-97-05956 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 3.5MM 8 HOLE LEFT LCP SUPERIOR CLAVICLE SUP-97-05957 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSN ASF CPS 14MM VE R 6-9GH SUP-97-05958 CDM C1776 HCPCS 0278 RC outpatient 4370 4370 4370 57 2490.9 percent of total billed charges 4370 93 3539.7 percent of total billed charges 4370 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4370 other OPPS APC 4370 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4370 other OPPS APC 4370 51 2228.7 percent of total billed charges 4370 4370 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 3.5 LEFT VA LCP TIBIAL 6H 117MM SUP-97-05959 CDM C1713 HCPCS 0278 RC outpatient 4519.13 4519.13 4519.13 57 2575.9 percent of total billed charges 4519.13 93 3660.5 percent of total billed charges 4519.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4519.13 other OPPS APC 4519.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4519.13 other OPPS APC 4519.13 51 2304.76 percent of total billed charges 4519.13 4519.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5 X 38MM CANNULATED FULLY THREADED ASNIS SUP-97-05960 CDM C1713 HCPCS 0278 RC outpatient 521.92 521.92 521.92 57 297.49 percent of total billed charges 521.92 93 422.76 percent of total billed charges 521.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 521.92 other OPPS APC 521.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 521.92 other OPPS APC 521.92 51 266.18 percent of total billed charges 521.92 521.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 9 HOLE COMPRESSION VARIAX BROAD CURVED SUP-97-05961 CDM C1713 HCPCS 0278 RC outpatient 1939.08 1939.08 1939.08 57 1105.28 percent of total billed charges 1939.08 93 1570.65 percent of total billed charges 1939.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1939.08 other OPPS APC 1939.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1939.08 other OPPS APC 1939.08 51 988.93 percent of total billed charges 1939.08 1939.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VICRYL 2 TIES 54IN J618H SUP-97-05963 CDM 0272 RC outpatient 2.26 2.26 2.26 74 1.67 percent of total billed charges 2.26 93 1.83 percent of total billed charges 2.26 2.26 other OPPS APC 2.26 2.26 other OPPS APC 2.26 27.63 0.62 percent of total billed charges 2.26 2.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE DACRON 1/8 X 30IN TIES SUP-97-05964 CDM 0272 RC outpatient 42.37 42.37 42.37 74 31.35 percent of total billed charges 42.37 93 34.32 percent of total billed charges 42.37 42.37 other OPPS APC 42.37 42.37 other OPPS APC 42.37 27.63 11.71 percent of total billed charges 42.37 42.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSN ASF CPS 16MM VE R 10-12 GH SUP-97-05965 CDM C1776 HCPCS 0278 RC outpatient 4370 4370 4370 57 2490.9 percent of total billed charges 4370 93 3539.7 percent of total billed charges 4370 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4370 other OPPS APC 4370 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4370 other OPPS APC 4370 51 2228.7 percent of total billed charges 4370 4370 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INFINITY ADAPTIS TIB SIZE 4 SUP-97-05966 CDM C1776 HCPCS 0278 RC outpatient 11066 11066 11066 57 6307.62 percent of total billed charges 11066 93 8963.46 percent of total billed charges 11066 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11066 other OPPS APC 11066 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11066 other OPPS APC 11066 51 5643.66 percent of total billed charges 11066 11066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INFINITY ADAPTIS FLATCUT TALDOME SIZE 3 SUP-97-05967 CDM C1776 HCPCS 0278 RC outpatient 9540 9540 9540 57 5437.8 percent of total billed charges 9540 93 7727.4 percent of total billed charges 9540 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9540 other OPPS APC 9540 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9540 other OPPS APC 9540 51 4865.4 percent of total billed charges 9540 9540 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INFINITY EVERLAST SIZE 3+ 7MM SUP-97-05968 CDM C1776 HCPCS 0278 RC outpatient 3975 3975 3975 57 2265.75 percent of total billed charges 3975 93 3219.75 percent of total billed charges 3975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3975 other OPPS APC 3975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3975 other OPPS APC 3975 51 2027.25 percent of total billed charges 3975 3975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE PS FB INSRT SZ 6 5MM SUP-97-05970 CDM C1776 HCPCS 0278 RC outpatient 2430 2430 2430 57 1385.1 percent of total billed charges 2430 93 1968.3 percent of total billed charges 2430 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2430 other OPPS APC 2430 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2430 other OPPS APC 2430 51 1239.3 percent of total billed charges 2430 2430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANCELLOUS FULL THRD 6MM X 80MM SUP-97-05990 CDM C1713 HCPCS 0278 RC outpatient 124.64 124.64 124.64 57 71.04 percent of total billed charges 124.64 93 100.96 percent of total billed charges 124.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 124.64 other OPPS APC 124.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 124.64 other OPPS APC 124.64 51 63.57 percent of total billed charges 124.64 124.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANCELLOUS 4.0 X 24MM SUP-97-05991 CDM C1713 HCPCS 0278 RC outpatient 87.32 87.32 87.32 57 49.77 percent of total billed charges 87.32 93 70.73 percent of total billed charges 87.32 87.32 other OPPS APC 87.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 87.32 other OPPS APC 87.32 51 44.53 percent of total billed charges 87.32 87.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PROLAYER 4 X 4 THIN SUP-97-05992 CDM Q4100 HCPCS 0636 RC outpatient 3863.63 3863.63 3863.63 74 2859.09 percent of total billed charges 3863.63 93 3129.54 percent of total billed charges 3863.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3863.63 other OPPS APC 3863.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3863.63 other OPPS APC 3863.63 24.86 960.5 percent of total billed charges 3863.63 3863.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PROLAYER 4 X 4 THICK SUP-97-05993 CDM Q4100 HCPCS 0636 RC outpatient 3863.63 3863.63 3863.63 74 2859.09 percent of total billed charges 3863.63 93 3129.54 percent of total billed charges 3863.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3863.63 other OPPS APC 3863.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3863.63 other OPPS APC 3863.63 24.86 960.5 percent of total billed charges 3863.63 3863.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX TI 4.5MM X 42MM SUP-97-05994 CDM C1713 HCPCS 0278 RC outpatient 110.96 110.96 110.96 57 63.25 percent of total billed charges 110.96 93 89.88 percent of total billed charges 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 51 56.59 percent of total billed charges 110.96 110.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX TI 4.5MM X 46MM SUP-97-05995 CDM C1713 HCPCS 0278 RC outpatient 110.96 110.96 110.96 57 63.25 percent of total billed charges 110.96 93 89.88 percent of total billed charges 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 51 56.59 percent of total billed charges 110.96 110.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX TI 4.5MM X 65MM SUP-97-05996 CDM C1713 HCPCS 0278 RC outpatient 110.96 110.96 110.96 57 63.25 percent of total billed charges 110.96 93 89.88 percent of total billed charges 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 51 56.59 percent of total billed charges 110.96 110.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX TI 4.5MM X 75MM SUP-97-05997 CDM C1713 HCPCS 0278 RC outpatient 110.96 110.96 110.96 57 63.25 percent of total billed charges 110.96 93 89.88 percent of total billed charges 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 51 56.59 percent of total billed charges 110.96 110.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX TI 4.5MM X 80MM SUP-97-05998 CDM C1713 HCPCS 0278 RC outpatient 110.96 110.96 110.96 57 63.25 percent of total billed charges 110.96 93 89.88 percent of total billed charges 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 51 56.59 percent of total billed charges 110.96 110.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5.0MM X 75MM SUP-97-05999 CDM C1713 HCPCS 0278 RC outpatient 434.91 434.91 434.91 57 247.9 percent of total billed charges 434.91 93 352.28 percent of total billed charges 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 51 221.8 percent of total billed charges 434.91 434.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYMMETRIC PATELLA X3 S33X9MM SUP-97-06000 CDM C1776 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 32MM SUP-97-06001 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 34MM SUP-97-06002 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 642.46 other OPPS APC 642.46 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 36MM SUP-97-06003 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 38MM SUP-97-06004 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 42MM SUP-97-06005 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 44MM SUP-97-06006 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 46MM SUP-97-06007 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 48MM SUP-97-06008 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 50MM SUP-97-06009 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 55MM SUP-97-06010 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 65MM SUP-97-06011 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCK T10 FULL THRD 3.5MM X 70MM SUP-97-06012 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 36MM SUP-97-06013 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 38MM SUP-97-06014 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 65MM SUP-97-06015 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE T10 NON LCKNG 3.5MM X 70MM SUP-97-06016 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T10 FULL THREAD 2.7MM X 20MM SUP-97-06017 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T10 FULL THREAD 2.7MM X 22MM SUP-97-06018 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T10 FULL THREAD 2.7MM X 24MM SUP-97-06019 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T10 FULL THREAD 2.7MM X 26MM SUP-97-06020 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T10 FULL THREAD 2.7MM X 28MM SUP-97-06021 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T10 FULL THREAD 2.7MM X 30MM SUP-97-06022 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T10 FULL THREAD 2.7MM X 32MM SUP-97-06023 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T10 FULL THREAD 2.7MM X 34MM SUP-97-06024 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 642.46 other OPPS APC 642.46 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T10 FULL THREAD 2.7MM X 36MM SUP-97-06025 CDM C1713 HCPCS 0278 RC outpatient 642.46 642.46 642.46 57 366.2 percent of total billed charges 642.46 93 520.39 percent of total billed charges 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 642.46 other OPPS APC 642.46 51 327.65 percent of total billed charges 642.46 642.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 3.5MM X 26MM SUP-97-06026 CDM C1713 HCPCS 0278 RC outpatient 106.2 106.2 106.2 57 60.53 percent of total billed charges 106.2 93 86.02 percent of total billed charges 106.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.2 other OPPS APC 106.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.2 other OPPS APC 106.2 51 54.16 percent of total billed charges 106.2 106.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SUP MIDSHAFT DECREASED CURVATURE 10 HOLE RIGHT SUP-97-06027 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VOLAR DISTAL RADIUS STD 4 HOLE RIGHT SUP-97-06028 CDM C1713 HCPCS 0278 RC outpatient 1881 1881 1881 57 1072.17 percent of total billed charges 1881 93 1523.61 percent of total billed charges 1881 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1881 other OPPS APC 1881 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1881 other OPPS APC 1881 51 959.31 percent of total billed charges 1881 1881 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG THREADED LOCKING 2.3MM X 24MM SUP-97-06029 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VLOCL2105 2-0 GREEN GS-22 SUP-97-06030 CDM 0272 RC outpatient 83.14 83.14 83.14 74 61.52 percent of total billed charges 83.14 93 67.34 percent of total billed charges 83.14 83.14 other OPPS APC 83.14 83.14 other OPPS APC 83.14 27.63 22.97 percent of total billed charges 83.14 83.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 X 42MM MICA PROSTEP SUP-97-06031 CDM C1713 HCPCS 0278 RC outpatient 1428 1428 1428 57 813.96 percent of total billed charges 1428 93 1156.68 percent of total billed charges 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 51 728.28 percent of total billed charges 1428 1428 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 X 26MM PROSTEP MICA SUP-97-06032 CDM C1713 HCPCS 0278 RC outpatient 1428 1428 1428 57 813.96 percent of total billed charges 1428 93 1156.68 percent of total billed charges 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 51 728.28 percent of total billed charges 1428 1428 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL COMPONENT UNI SIZE 3 LM/RL SUP-97-06033 CDM C1776 HCPCS 0278 RC outpatient 5965 5965 5965 57 3400.05 percent of total billed charges 5965 93 4831.65 percent of total billed charges 5965 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5965 other OPPS APC 5965 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5965 other OPPS APC 5965 51 3042.15 percent of total billed charges 5965 5965 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL TRAY UNI SIZE 3 LM/RL SUP-97-06034 CDM C1776 HCPCS 0278 RC outpatient 3622.5 3622.5 3622.5 57 2064.83 percent of total billed charges 3622.5 93 2934.23 percent of total billed charges 3622.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3622.5 other OPPS APC 3622.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3622.5 other OPPS APC 3622.5 51 1847.48 percent of total billed charges 3622.5 3622.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT UNI SIZE 3 10MM LM/RL SUP-97-06035 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VARIAX LOCKING 1.7 X 8MM SUP-97-06036 CDM C1713 HCPCS 0278 RC outpatient 317.52 317.52 317.52 57 180.99 percent of total billed charges 317.52 93 257.19 percent of total billed charges 317.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 317.52 other OPPS APC 317.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 317.52 other OPPS APC 317.52 51 161.94 percent of total billed charges 317.52 317.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROFYLE 7 HOLE Y NARROW 1.7MM SUP-97-06037 CDM C1713 HCPCS 0278 RC outpatient 719.55 719.55 719.55 57 410.14 percent of total billed charges 719.55 93 582.84 percent of total billed charges 719.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 719.55 other OPPS APC 719.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 719.55 other OPPS APC 719.55 51 366.97 percent of total billed charges 719.55 719.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SYSTEM SPEEDBRIDGE HIP 4.75MM SUP-97-06038 CDM C1713 HCPCS 0278 RC outpatient 6237.5 6237.5 6237.5 57 3555.38 percent of total billed charges 6237.5 93 5052.38 percent of total billed charges 6237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6237.5 other OPPS APC 6237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6237.5 other OPPS APC 6237.5 51 3181.13 percent of total billed charges 6237.5 6237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE T LCP RIGHT ANGLE 4 HOLE HEAD/4 HOLE SHAFT 3.5 X 56MM SUP-97-06039 CDM C1713 HCPCS 0278 RC outpatient 1047.84 1047.84 1047.84 57 597.27 percent of total billed charges 1047.84 93 848.75 percent of total billed charges 1047.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1047.84 other OPPS APC 1047.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1047.84 other OPPS APC 1047.84 51 534.4 percent of total billed charges 1047.84 1047.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANCELLOUS FULL THREAD 4.0 X 30MM SUP-97-06040 CDM C1713 HCPCS 0278 RC outpatient 87.32 87.32 87.32 57 49.77 percent of total billed charges 87.32 93 70.73 percent of total billed charges 87.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 87.32 other OPPS APC 87.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 87.32 other OPPS APC 87.32 51 44.53 percent of total billed charges 87.32 87.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING SELF TAPPING 3.5 X 60MM SUP-97-06041 CDM C1713 HCPCS 0278 RC outpatient 472.89 472.89 472.89 57 269.55 percent of total billed charges 472.89 93 383.04 percent of total billed charges 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.89 other OPPS APC 472.89 51 241.17 percent of total billed charges 472.89 472.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REST MOD PROXIMAL CONE BODY 19MM +10 SUP-97-06043 CDM C1776 HCPCS 0278 RC outpatient 8068.8 8068.8 8068.8 57 4599.22 percent of total billed charges 8068.8 93 6535.73 percent of total billed charges 8068.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8068.8 other OPPS APC 8068.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8068.8 other OPPS APC 8068.8 51 4115.09 percent of total billed charges 8068.8 8068.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESTORATION ADM X3 INS SUP-97-06044 CDM C1776 HCPCS 0278 RC outpatient 2325 2325 2325 57 1325.25 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 51 1185.75 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT TRIATHLON X3 TOTAL STABILIZER #6 9MM SUP-97-06045 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW HEX LOW PROFILE 6.5 X 50MM SUP-97-06046 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REST MOD CONICAL DISTAL STEM 20 X 155MM SUP-97-06047 CDM C1776 HCPCS 0278 RC outpatient 7228 7228 7228 57 4119.96 percent of total billed charges 7228 93 5854.68 percent of total billed charges 7228 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7228 other OPPS APC 7228 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7228 other OPPS APC 7228 51 3686.28 percent of total billed charges 7228 7228 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESTORATION ADM X3 INS 28/52 SUP-97-06048 CDM C1776 HCPCS 0278 RC outpatient 2325 2325 2325 57 1325.25 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 51 1185.75 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 X 40MM MICA PROSTEP SUP-97-06049 CDM C1713 HCPCS 0278 RC outpatient 1428 1428 1428 57 813.96 percent of total billed charges 1428 93 1156.68 percent of total billed charges 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 51 728.28 percent of total billed charges 1428 1428 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL LOCKING 3.5MM X 10MM SUP-97-06050 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE STANDARD HEADS 7 HOLE SHAFT LEFT SUP-97-06051 CDM C1713 HCPCS 0278 RC outpatient 2070 2070 2070 57 1179.9 percent of total billed charges 2070 93 1676.7 percent of total billed charges 2070 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2070 other OPPS APC 2070 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2070 other OPPS APC 2070 51 1055.7 percent of total billed charges 2070 2070 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG SMOOTH LOCKING 2.0 X 17MM SUP-97-06052 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG THREADED LOCKING 2.3 X 10MM SUP-97-06053 CDM C1713 HCPCS 0278 RC outpatient 241.5 241.5 241.5 57 137.66 percent of total billed charges 241.5 93 195.62 percent of total billed charges 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 241.5 other OPPS APC 241.5 51 123.17 percent of total billed charges 241.5 241.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BROAD Y 4 HOLE SUP-97-06054 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESTORATION ADM X3 INS 28/48 SUP-97-06055 CDM C1776 HCPCS 0278 RC outpatient 2325 2325 2325 57 1325.25 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 51 1185.75 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE COMPRESSION SUPERMX SUP-97-06056 CDM C1713 HCPCS 0278 RC outpatient 5237.5 5237.5 5237.5 57 2985.38 percent of total billed charges 5237.5 93 4242.38 percent of total billed charges 5237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5237.5 other OPPS APC 5237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5237.5 other OPPS APC 5237.5 51 2671.13 percent of total billed charges 5237.5 5237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW COMPR FT 3.5 MINI 46MM SUP-97-06057 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW COMPR FT 7.0 X 40MM SUP-97-06058 CDM C1713 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T8 FULL THREAD 2.4 X 8MM SUP-97-06059 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T8 FULL THREAD 2.4 X 10MM SUP-97-06060 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T8 FULL THREAD 2.4 X 12MM SUP-97-06061 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T8 FULL THREAD 2.4 X 24MM SUP-97-06062 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T8 FULL THREAD 2.4 X 26MM SUP-97-06063 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T8 FULL THREAD 2.4 X 28MM SUP-97-06064 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T8 FULL THREAD 2.4 X 30MM SUP-97-06065 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T8 FULL THREAD 2.4 X 32MM SUP-97-06066 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T8 FULL THREAD 2.4 X 34MM SUP-97-06067 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T8 FULL THREAD 2.4 X 36MM SUP-97-06068 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING T8 FULL THREAD 2.4 X 38MM SUP-97-06069 CDM C1713 HCPCS 0278 RC outpatient 576.94 576.94 576.94 57 328.86 percent of total billed charges 576.94 93 467.32 percent of total billed charges 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 576.94 other OPPS APC 576.94 51 294.24 percent of total billed charges 576.94 576.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T8 FULL THREAD 2.4 X 10MM SUP-97-06070 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T8 FULL THREAD 2.4 X 22MM SUP-97-06071 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T8 FULL THREAD 2.4 X 24MM SUP-97-06072 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T8 FULL THREAD 2.4 X 26MM SUP-97-06073 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T8 FULL THREAD 2.4 X 28MM SUP-97-06074 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T8 FULL THREAD 2.4 X 30MM SUP-97-06075 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T8 FULL THREAD 2.4 X 32MM SUP-97-06076 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T8 FULL THREAD 2.4 X 34MM SUP-97-06077 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T8 FULL THREAD 2.4 X 36MM SUP-97-06078 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T8 FULL THREAD 2.4 X 38MM SUP-97-06079 CDM C1713 HCPCS 0278 RC outpatient 336.7 336.7 336.7 57 191.92 percent of total billed charges 336.7 93 272.73 percent of total billed charges 336.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 336.7 other OPPS APC 336.7 336.7 other OPPS APC 336.7 51 171.72 percent of total billed charges 336.7 336.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 20MM THREAD 6.5 X 120MM SUP-97-06080 CDM C1713 HCPCS 0278 RC outpatient 618.24 618.24 618.24 57 352.4 percent of total billed charges 618.24 93 500.77 percent of total billed charges 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 51 315.3 percent of total billed charges 618.24 618.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANCELLOUS PARTIALLY THREADED 4.0 X 42MM SUP-97-06081 CDM C1713 HCPCS 0278 RC outpatient 106.4 106.4 106.4 57 60.65 percent of total billed charges 106.4 93 86.18 percent of total billed charges 106.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.4 other OPPS APC 106.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.4 other OPPS APC 106.4 51 54.26 percent of total billed charges 106.4 106.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANCELLOUS PARTIALLY TRHEADED 4.0 X 46MM SUP-97-06082 CDM C1713 HCPCS 0278 RC outpatient 106.4 106.4 106.4 57 60.65 percent of total billed charges 106.4 93 86.18 percent of total billed charges 106.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.4 other OPPS APC 106.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.4 other OPPS APC 106.4 51 54.26 percent of total billed charges 106.4 106.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5.0 X 55MM SUP-97-06083 CDM C1713 HCPCS 0278 RC outpatient 434.91 434.91 434.91 57 247.9 percent of total billed charges 434.91 93 352.28 percent of total billed charges 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 51 221.8 percent of total billed charges 434.91 434.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5.0 X 60MM SUP-97-06084 CDM C1713 HCPCS 0278 RC outpatient 434.91 434.91 434.91 57 247.9 percent of total billed charges 434.91 93 352.28 percent of total billed charges 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 51 221.8 percent of total billed charges 434.91 434.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5.0 X 70MM SUP-97-06085 CDM C1713 HCPCS 0278 RC outpatient 434.91 434.91 434.91 57 247.9 percent of total billed charges 434.91 93 352.28 percent of total billed charges 434.91 434.91 other OPPS APC 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 51 221.8 percent of total billed charges 434.91 434.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 4.5 X 34MM SUP-97-06086 CDM C1713 HCPCS 0278 RC outpatient 110.96 110.96 110.96 57 63.25 percent of total billed charges 110.96 93 89.88 percent of total billed charges 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 51 56.59 percent of total billed charges 110.96 110.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VARIAX NON LOCKING 2.3 X 22MM SUP-97-06087 CDM C1713 HCPCS 0278 RC outpatient 263.13 263.13 263.13 57 149.98 percent of total billed charges 263.13 93 213.14 percent of total billed charges 263.13 263.13 other OPPS APC 263.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 263.13 other OPPS APC 263.13 51 134.2 percent of total billed charges 263.13 263.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX SELF TAPPING 2.4 X 16MM SUP-97-06088 CDM C1713 HCPCS 0278 RC outpatient 210.63 210.63 210.63 57 120.06 percent of total billed charges 210.63 93 170.61 percent of total billed charges 210.63 210.63 other OPPS APC 210.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210.63 other OPPS APC 210.63 51 107.42 percent of total billed charges 210.63 210.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCRW LOCKING STARDRIVE 2.4 X 10MM SUP-97-06089 CDM C1713 HCPCS 0278 RC outpatient 432.25 432.25 432.25 57 246.38 percent of total billed charges 432.25 93 350.12 percent of total billed charges 432.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.25 other OPPS APC 432.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 432.25 other OPPS APC 432.25 51 220.45 percent of total billed charges 432.25 432.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS CANNULATED 8 X 130MM SUP-97-06090 CDM C1713 HCPCS 0278 RC outpatient 618.24 618.24 618.24 57 352.4 percent of total billed charges 618.24 93 500.77 percent of total billed charges 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 51 315.3 percent of total billed charges 618.24 618.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS CANNULATED 6.5 X 130MM SUP-97-06091 CDM C1713 HCPCS 0278 RC outpatient 618.24 618.24 618.24 57 352.4 percent of total billed charges 618.24 93 500.77 percent of total billed charges 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 51 315.3 percent of total billed charges 618.24 618.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ASNIS CANNULATED 6.5 X 110MM SUP-97-06092 CDM C1713 HCPCS 0278 RC outpatient 618.24 618.24 618.24 57 352.4 percent of total billed charges 618.24 93 500.77 percent of total billed charges 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 618.24 other OPPS APC 618.24 51 315.3 percent of total billed charges 618.24 618.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 4 X 18MM SUP-97-06093 CDM C1713 HCPCS 0278 RC outpatient 412.3 412.3 412.3 57 235.01 percent of total billed charges 412.3 93 333.96 percent of total billed charges 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 412.3 other OPPS APC 412.3 51 210.27 percent of total billed charges 412.3 412.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE K-WIRE 2.0MM SUP-97-06094 CDM C1713 HCPCS 0278 RC outpatient 588 588 588 57 335.16 percent of total billed charges 588 93 476.28 percent of total billed charges 588 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 588 other OPPS APC 588 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 588 other OPPS APC 588 51 299.88 percent of total billed charges 588 588 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN CLAMP 4 POSITION LARGE SUP-97-06095 CDM C1713 HCPCS 0278 RC outpatient 1335 1335 1335 57 760.95 percent of total billed charges 1335 93 1081.35 percent of total billed charges 1335 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1335 other OPPS APC 1335 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1335 other OPPS APC 1335 51 680.85 percent of total billed charges 1335 1335 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POST OUTRIGGER 30DEG 11MM SUP-97-06096 CDM C1713 HCPCS 0278 RC outpatient 423.5 423.5 423.5 57 241.4 percent of total billed charges 423.5 93 343.04 percent of total billed charges 423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 423.5 other OPPS APC 423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 423.5 other OPPS APC 423.5 51 215.99 percent of total billed charges 423.5 423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SCHANZ SELF DRILLING 60MM THREAD 5 X 175MM SUP-97-06097 CDM C1713 HCPCS 0278 RC outpatient 600.25 600.25 600.25 57 342.14 percent of total billed charges 600.25 93 486.2 percent of total billed charges 600.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 600.25 other OPPS APC 600.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 600.25 other OPPS APC 600.25 51 306.13 percent of total billed charges 600.25 600.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROXIMAL OLECRANON RIGHT 2 HOLE SUP-97-06098 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TENDON QUADLINK PRESUTURED CONSTRUCT SUP-97-06099 CDM C1762 HCPCS 0278 RC outpatient 6565 6565 6565 57 3742.05 percent of total billed charges 6565 93 5317.65 percent of total billed charges 6565 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6565 other OPPS APC 6565 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6565 other OPPS APC 6565 51 3348.15 percent of total billed charges 6565 6565 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANNULATED COMPRESSION HEADLESS 4 X 46MM SUP-97-06100 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3 X 60MM MICA CANNULATED SUP-97-06101 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MICA PROSTEP 3 X 32MM SUP-97-06102 CDM C1713 HCPCS 0278 RC outpatient 1428 1428 1428 57 813.96 percent of total billed charges 1428 93 1156.68 percent of total billed charges 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 51 728.28 percent of total billed charges 1428 1428 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MICA PROSTEP 3 X 34MM SUP-97-06103 CDM C1713 HCPCS 0278 RC outpatient 1428 1428 1428 57 813.96 percent of total billed charges 1428 93 1156.68 percent of total billed charges 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 51 728.28 percent of total billed charges 1428 1428 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE CLAVICLE FRACTURE CENTRAL THIRD LEFT SUP-97-06104 CDM C1713 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOW PROFILE TM 3.5 X 18MM CORTICAL SUP-97-06105 CDM C1713 HCPCS 0278 RC outpatient 140 140 140 57 79.8 percent of total billed charges 140 93 113.4 percent of total billed charges 140 140 other OPPS APC 140 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 140 other OPPS APC 140 51 71.4 percent of total billed charges 140 140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOW PROFILE TM 3.5 X 20MM SUP-97-06106 CDM C1713 HCPCS 0278 RC outpatient 140 140 140 57 79.8 percent of total billed charges 140 93 113.4 percent of total billed charges 140 140 other OPPS APC 140 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 140 other OPPS APC 140 51 71.4 percent of total billed charges 140 140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOW PROFILE TM 3.5 X 22MM CORTICAL SUP-97-06107 CDM C1713 HCPCS 0278 RC outpatient 140 140 140 57 79.8 percent of total billed charges 140 93 113.4 percent of total billed charges 140 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 140 other OPPS APC 140 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 140 other OPPS APC 140 51 71.4 percent of total billed charges 140 140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOW PROFILE TM 3.5 X 26MM CORTICAL SUP-97-06108 CDM C1713 HCPCS 0278 RC outpatient 140 140 140 57 79.8 percent of total billed charges 140 93 113.4 percent of total billed charges 140 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 140 other OPPS APC 140 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 140 other OPPS APC 140 51 71.4 percent of total billed charges 140 140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOW PROFILE 3.5 X 22MM LOCKING SUP-97-06109 CDM C1713 HCPCS 0278 RC outpatient 402.5 402.5 402.5 57 229.43 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 51 205.28 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOW PROFILE 3.5 X 24MM LOCKING SUP-97-06110 CDM C1713 HCPCS 0278 RC outpatient 402.5 402.5 402.5 57 229.43 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 51 205.28 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX NON LOCKING 3.5 X 38MM SUP-97-06111 CDM C1713 HCPCS 0278 RC outpatient 97.28 97.28 97.28 57 55.45 percent of total billed charges 97.28 93 78.8 percent of total billed charges 97.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.28 other OPPS APC 97.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.28 other OPPS APC 97.28 51 49.61 percent of total billed charges 97.28 97.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE TIBIAL DISTAL MEDIAL 4 HOLE LEFT SUP-97-06112 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX 12 HOLE 1/3 TUBULAR SUP-97-06113 CDM C1713 HCPCS 0278 RC outpatient 1248 1248 1248 57 711.36 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1248 other OPPS APC 1248 1248 other OPPS APC 1248 51 636.48 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX COMPRESSION STRAIGHT 6 HOLE BROAD 79MM SUP-97-06114 CDM C1713 HCPCS 0278 RC outpatient 1321.32 1321.32 1321.32 57 753.15 percent of total billed charges 1321.32 93 1070.27 percent of total billed charges 1321.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1321.32 other OPPS APC 1321.32 1321.32 other OPPS APC 1321.32 51 673.87 percent of total billed charges 1321.32 1321.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOFFMANN3 PIN TO ROD COUPLING INVERTED 4/5/6MM 5/8/11MM SUP-97-06115 CDM C1713 HCPCS 0278 RC outpatient 1568.4 1568.4 1568.4 57 893.99 percent of total billed charges 1568.4 93 1270.4 percent of total billed charges 1568.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1568.4 other OPPS APC 1568.4 1568.4 other OPPS APC 1568.4 51 799.88 percent of total billed charges 1568.4 1568.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HALF PIN SELF DRILLING HYBRID 3/5 X 20 X 120MM SUP-97-06116 CDM C1713 HCPCS 0278 RC outpatient 337.05 337.05 337.05 57 192.12 percent of total billed charges 337.05 93 273.01 percent of total billed charges 337.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 337.05 other OPPS APC 337.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 337.05 other OPPS APC 337.05 51 171.9 percent of total billed charges 337.05 337.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HALF PIN SELF DRILLING HYBRID 4/5 X 40 X 150MM SUP-97-06117 CDM C1713 HCPCS 0278 RC outpatient 337.05 337.05 337.05 57 192.12 percent of total billed charges 337.05 93 273.01 percent of total billed charges 337.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 337.05 other OPPS APC 337.05 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 337.05 other OPPS APC 337.05 51 171.9 percent of total billed charges 337.05 337.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOFFMANN3 CONNECTING ROD 11 X 250MM SUP-97-06118 CDM C1713 HCPCS 0278 RC outpatient 798 798 798 57 454.86 percent of total billed charges 798 93 646.38 percent of total billed charges 798 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 798 other OPPS APC 798 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 798 other OPPS APC 798 51 406.98 percent of total billed charges 798 798 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOFFMAN3 CONNECTING ROD 11 X 450MM SUP-97-06119 CDM C1713 HCPCS 0278 RC outpatient 938.4 938.4 938.4 57 534.89 percent of total billed charges 938.4 93 760.1 percent of total billed charges 938.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 938.4 other OPPS APC 938.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 938.4 other OPPS APC 938.4 51 478.58 percent of total billed charges 938.4 938.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX SELF TAPPING 2.4 X 20MM SUP-97-06120 CDM C1713 HCPCS 0278 RC outpatient 210.63 210.63 210.63 57 120.06 percent of total billed charges 210.63 93 170.61 percent of total billed charges 210.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210.63 other OPPS APC 210.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210.63 other OPPS APC 210.63 51 107.42 percent of total billed charges 210.63 210.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL NAIL 12 X 375MM T2 STANDARD SUP-97-06121 CDM C1713 HCPCS 0278 RC outpatient 2734.2 2734.2 2734.2 57 1558.49 percent of total billed charges 2734.2 93 2214.7 percent of total billed charges 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 51 1394.44 percent of total billed charges 2734.2 2734.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING FULLY THREADED 5 X 70MM SUP-97-06122 CDM C1713 HCPCS 0278 RC outpatient 394.8 394.8 394.8 57 225.04 percent of total billed charges 394.8 93 319.79 percent of total billed charges 394.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 394.8 other OPPS APC 394.8 394.8 other OPPS APC 394.8 51 201.35 percent of total billed charges 394.8 394.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACETABULAR SHELL MULTIHOLE TRIDENT II TRITANIUM SIZE 50MM D SUP-97-06123 CDM C1776 HCPCS 0278 RC outpatient 7847.5 7847.5 7847.5 57 4473.08 percent of total billed charges 7847.5 93 6356.48 percent of total billed charges 7847.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7847.5 other OPPS APC 7847.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7847.5 other OPPS APC 7847.5 51 4002.23 percent of total billed charges 7847.5 7847.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM STANDARD OFFSET INSIGNIA SIZE 2 SUP-97-06124 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT X3 TRIATHLON CA #3 16MM SUP-97-06125 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT FEMORAL DISTAL 5MM SIZE 4 LEFT SUP-97-06126 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT TRIPOST SIZE 4 5MM SUP-97-06127 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM TRI PRESS-FIT 15 X 100MM SUP-97-06128 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI TS FEMUR SIZE 4 LEFT SUP-97-06129 CDM C1776 HCPCS 0278 RC outpatient 12280.8 12280.8 12280.8 57 7000.06 percent of total billed charges 12280.8 93 9947.45 percent of total billed charges 12280.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.8 other OPPS APC 12280.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.8 other OPPS APC 12280.8 51 6263.21 percent of total billed charges 12280.8 12280.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VENTRALIGHT W/ ECHO 2 15CM SUP-97-06130 CDM C1781 HCPCS 0278 RC outpatient 2822.1 2822.1 2822.1 57 1608.6 percent of total billed charges 2822.1 93 2285.9 percent of total billed charges 2822.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2822.1 other OPPS APC 2822.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2822.1 other OPPS APC 2822.1 51 1439.27 percent of total billed charges 2822.1 2822.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOULDER INSERT 36 X 9MM SUP-97-06131 CDM C1776 HCPCS 0278 RC outpatient 3880 3880 3880 57 2211.6 percent of total billed charges 3880 93 3142.8 percent of total billed charges 3880 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3880 other OPPS APC 3880 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3880 other OPPS APC 3880 51 1978.8 percent of total billed charges 3880 3880 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERSYS FM MC CLR 18 X 160MM LM BODY STD NECK SUP-97-06132 CDM C1776 HCPCS 0278 RC outpatient 8150 8150 8150 57 4645.5 percent of total billed charges 8150 93 6601.5 percent of total billed charges 8150 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8150 other OPPS APC 8150 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8150 other OPPS APC 8150 51 4156.5 percent of total billed charges 8150 8150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOLOX DELTA FEM HEAD 36MM -3.5MM SUP-97-06133 CDM C1776 HCPCS 0278 RC outpatient 3430 3430 3430 57 1955.1 percent of total billed charges 3430 93 2778.3 percent of total billed charges 3430 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3430 other OPPS APC 3430 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3430 other OPPS APC 3430 51 1749.3 percent of total billed charges 3430 3430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOW PROFILE HEX 6.5 X 15MM SUP-97-06134 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT X3 ELEVATED RIM 36MM ID SUP-97-06135 CDM C1776 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW QUICKFIX TITANIUM 2 X 10MM SUP-97-06136 CDM C1713 HCPCS 0278 RC outpatient 720 720 720 57 410.4 percent of total billed charges 720 93 583.2 percent of total billed charges 720 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 720 other OPPS APC 720 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 720 other OPPS APC 720 51 367.2 percent of total billed charges 720 720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MICA PROSTEP 4.0 X 48MM SUP-97-06137 CDM C1713 HCPCS 0278 RC outpatient 1428 1428 1428 57 813.96 percent of total billed charges 1428 93 1156.68 percent of total billed charges 1428 1428 other OPPS APC 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 51 728.28 percent of total billed charges 1428 1428 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW HV PROSTEP 3.0 X 24MM SUP-97-06138 CDM C1713 HCPCS 0278 RC outpatient 1428 1428 1428 57 813.96 percent of total billed charges 1428 93 1156.68 percent of total billed charges 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1428 other OPPS APC 1428 51 728.28 percent of total billed charges 1428 1428 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT EXTRA SMALL CANNULATED PHALINX HAMMERTOE SUP-97-06139 CDM C1713 HCPCS 0278 RC outpatient 816 816 816 57 465.12 percent of total billed charges 816 93 660.96 percent of total billed charges 816 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 816 other OPPS APC 816 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 816 other OPPS APC 816 51 416.16 percent of total billed charges 816 816 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BEVELED FT 4.0 X 52MM SUP-97-06140 CDM C1713 HCPCS 0278 RC outpatient 2146.5 2146.5 2146.5 57 1223.51 percent of total billed charges 2146.5 93 1738.67 percent of total billed charges 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2146.5 other OPPS APC 2146.5 51 1094.72 percent of total billed charges 2146.5 2146.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SCREW, CONICAL EXTRACTION" SUP-97-06142 CDM C1713 HCPCS 0278 RC outpatient 1362 1362 1362 57 776.34 percent of total billed charges 1362 93 1103.22 percent of total billed charges 1362 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1362 other OPPS APC 1362 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1362 other OPPS APC 1362 51 694.62 percent of total billed charges 1362 1362 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD - ZORC SUP-97-06143 CDM C1762 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANNULATED COMPRESSION 4.0 X 54MM SUP-97-06144 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE DYNANITE COMPRESSION 2 HOLE STRAIGHT 30MM SUP-97-06145 CDM C1713 HCPCS 0278 RC outpatient 6237.5 6237.5 6237.5 57 3555.38 percent of total billed charges 6237.5 93 5052.38 percent of total billed charges 6237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6237.5 other OPPS APC 6237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6237.5 other OPPS APC 6237.5 51 3181.13 percent of total billed charges 6237.5 6237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANTERIOR TT PLATE LONG RIGHT SUP-97-06146 CDM C1713 HCPCS 0278 RC outpatient 4937.5 4937.5 4937.5 57 2814.38 percent of total billed charges 4937.5 93 3999.38 percent of total billed charges 4937.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4937.5 other OPPS APC 4937.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4937.5 other OPPS APC 4937.5 51 2518.13 percent of total billed charges 4937.5 4937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW NONLOCKING R3CON 4.2 X 28MM SUP-97-06147 CDM C1713 HCPCS 0278 RC outpatient 472.5 472.5 472.5 57 269.33 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 51 240.98 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCING R3CON 4.2 X 28MM SUP-97-06148 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW NON LOCKING SILVERBACK 5.2 X 28MM SUP-97-06149 CDM C1713 HCPCS 0278 RC outpatient 542.5 542.5 542.5 57 309.23 percent of total billed charges 542.5 93 439.43 percent of total billed charges 542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.5 other OPPS APC 542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.5 other OPPS APC 542.5 51 276.68 percent of total billed charges 542.5 542.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 4.6MM SUP-97-06150 CDM C1713 HCPCS 0278 RC outpatient 350 350 350 57 199.5 percent of total billed charges 350 93 283.5 percent of total billed charges 350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 350 other OPPS APC 350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 350 other OPPS APC 350 51 178.5 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK HEADLESS 7.0 SUP-97-06151 CDM 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MONSTER CANNULATED LONG THREAD HEADLESS 7.0 X 86MM SUP-97-06152 CDM C1713 HCPCS 0278 RC outpatient 1950 1950 1950 57 1111.5 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 51 994.5 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SILVERBACK NON LOCKING 5.2 X 48MM SUP-97-06153 CDM C1713 HCPCS 0278 RC outpatient 542.5 542.5 542.5 57 309.23 percent of total billed charges 542.5 93 439.43 percent of total billed charges 542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.5 other OPPS APC 542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.5 other OPPS APC 542.5 51 276.68 percent of total billed charges 542.5 542.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SILVERBACK LOCKING 5.2 X 22M SUP-97-06154 CDM C1713 HCPCS 0278 RC outpatient 682.5 682.5 682.5 57 389.03 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 51 348.08 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SHAFT 2.7MM CS2 RIGHT SUP-97-06155 CDM C1713 HCPCS 0278 RC outpatient 4067.8 4067.8 4067.8 57 2318.65 percent of total billed charges 4067.8 93 3294.92 percent of total billed charges 4067.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4067.8 other OPPS APC 4067.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4067.8 other OPPS APC 4067.8 51 2074.58 percent of total billed charges 4067.8 4067.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SELF TAPPING T8 STARDRIVE RECESS 2.7 X 16MM SUP-97-06156 CDM C1713 HCPCS 0278 RC outpatient 165.2 165.2 165.2 57 94.16 percent of total billed charges 165.2 93 133.81 percent of total billed charges 165.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165.2 other OPPS APC 165.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 165.2 other OPPS APC 165.2 51 84.25 percent of total billed charges 165.2 165.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOW PROFILE TITANIUM 3.5 X 38MM SUP-97-06158 CDM C1713 HCPCS 0278 RC outpatient 210 210 210 57 119.7 percent of total billed charges 210 93 170.1 percent of total billed charges 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 51 107.1 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW KREULOCK 3.5 X 16 SUP-97-06159 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LOCKING THIRD TUBULAR TI 8H SUP-97-06160 CDM C1713 HCPCS 0278 RC outpatient 795 795 795 57 453.15 percent of total billed charges 795 93 643.95 percent of total billed charges 795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 795 other OPPS APC 795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 795 other OPPS APC 795 51 405.45 percent of total billed charges 795 795 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE CRS FB TIBIAL BASE SIZE 7 CEM SUP-97-06161 CDM C1776 HCPCS 0278 RC outpatient 8598.75 8598.75 8598.75 57 4901.29 percent of total billed charges 8598.75 93 6964.99 percent of total billed charges 8598.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8598.75 other OPPS APC 8598.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8598.75 other OPPS APC 8598.75 51 4385.36 percent of total billed charges 8598.75 8598.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE REV OFFSET STM ADAPTER 2MM SUP-97-06162 CDM C1776 HCPCS 0278 RC outpatient 2956.5 2956.5 2956.5 57 1685.21 percent of total billed charges 2956.5 93 2394.77 percent of total billed charges 2956.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2956.5 other OPPS APC 2956.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2956.5 other OPPS APC 2956.5 51 1507.82 percent of total billed charges 2956.5 2956.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE TIBIAL AUGMENT RM/LL SIZE 7/8 10MM SUP-97-06163 CDM C1776 HCPCS 0278 RC outpatient 3611.25 3611.25 3611.25 57 2058.41 percent of total billed charges 3611.25 93 2925.11 percent of total billed charges 3611.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3611.25 other OPPS APC 3611.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3611.25 other OPPS APC 3611.25 51 1841.74 percent of total billed charges 3611.25 3611.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE PRESSFIT STR STEM 12 X 110MM SUP-97-06164 CDM C1776 HCPCS 0278 RC outpatient 4246.25 4246.25 4246.25 57 2420.36 percent of total billed charges 4246.25 93 3439.46 percent of total billed charges 4246.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4246.25 other OPPS APC 4246.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4246.25 other OPPS APC 4246.25 51 2165.59 percent of total billed charges 4246.25 4246.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTUNE PS FB INSERT SIZE 6 7MM SUP-97-06165 CDM C1776 HCPCS 0278 RC outpatient 2430 2430 2430 57 1385.1 percent of total billed charges 2430 93 1968.3 percent of total billed charges 2430 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2430 other OPPS APC 2430 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2430 other OPPS APC 2430 51 1239.3 percent of total billed charges 2430 2430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 36MM MINI MONSTER CANNULATED FULL THREAD HEADED SUP-97-06167 CDM C1713 HCPCS 0278 RC outpatient 647.5 647.5 647.5 57 369.08 percent of total billed charges 647.5 93 524.48 percent of total billed charges 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 51 330.23 percent of total billed charges 647.5 647.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SINUS TARSI SUPPORT RIGHT LARGE SUP-97-06168 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW R3CON LOCING 3.5 X 22MM SUP-97-06169 CDM C1713 HCPCS 0278 RC outpatient 437.5 437.5 437.5 57 249.38 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 51 223.13 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 34MM R3CON NON LOCKING SUP-97-06170 CDM C1713 HCPCS 0278 RC outpatient 437.5 437.5 437.5 57 249.38 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 437.5 other OPPS APC 437.5 51 223.13 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 28MM R3CON LOCKING SUP-97-06171 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 36MM R3CON LOCKING SUP-97-06172 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 36MM R3CON NON-LOCKING SUP-97-06173 CDM C1713 HCPCS 0278 RC outpatient 437.5 437.5 437.5 57 249.38 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 51 223.13 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROXIMAL TIBIA SMALL B END 3.5 X 87MM 4 HOLE SUP-97-06174 CDM C1713 HCPCS 0278 RC outpatient 4470.38 4470.38 4470.38 57 2548.12 percent of total billed charges 4470.38 93 3621.01 percent of total billed charges 4470.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4470.38 other OPPS APC 4470.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4470.38 other OPPS APC 4470.38 51 2279.89 percent of total billed charges 4470.38 4470.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 60MM LOCKING VARIABLE ANGLE SUP-97-06175 CDM C1713 HCPCS 0278 RC outpatient 623.35 623.35 623.35 57 355.31 percent of total billed charges 623.35 93 504.91 percent of total billed charges 623.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 623.35 other OPPS APC 623.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 623.35 other OPPS APC 623.35 51 317.91 percent of total billed charges 623.35 623.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW REMOVAL BLADE 1.2 DENTAL SUP-97-06176 CDM 0272 RC outpatient 392 392 392 74 290.08 percent of total billed charges 392 93 317.52 percent of total billed charges 392 392 other OPPS APC 392 392 other OPPS APC 392 27.63 108.31 percent of total billed charges 392 392 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROFYLE HAND LOCK 3-D 1.7 S 3 X 2 HOLE SUP-97-06177 CDM C1713 HCPCS 0278 RC outpatient 1686.36 1686.36 1686.36 57 961.23 percent of total billed charges 1686.36 93 1365.95 percent of total billed charges 1686.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1686.36 other OPPS APC 1686.36 1686.36 other OPPS APC 1686.36 51 860.04 percent of total billed charges 1686.36 1686.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 1.7 X 6MM LOCKING VARIAX SUP-97-06178 CDM C1713 HCPCS 0278 RC outpatient 317.52 317.52 317.52 57 180.99 percent of total billed charges 317.52 93 257.19 percent of total billed charges 317.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 317.52 other OPPS APC 317.52 317.52 other OPPS APC 317.52 51 161.94 percent of total billed charges 317.52 317.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.3 X 11MM LOCKING VARIAX SUP-97-06179 CDM C1713 HCPCS 0278 RC outpatient 318.99 318.99 318.99 57 181.82 percent of total billed charges 318.99 93 258.38 percent of total billed charges 318.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 318.99 other OPPS APC 318.99 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 318.99 other OPPS APC 318.99 51 162.68 percent of total billed charges 318.99 318.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 1.7 X 6MM NON LOCKING VARIAX SUP-97-06180 CDM C1713 HCPCS 0278 RC outpatient 261.66 261.66 261.66 57 149.15 percent of total billed charges 261.66 93 211.94 percent of total billed charges 261.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 261.66 other OPPS APC 261.66 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 261.66 other OPPS APC 261.66 51 133.45 percent of total billed charges 261.66 261.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE VARIAX COMPRESSION STRAIGHT BROAD 8 HOLE 103MM SUP-97-06181 CDM C1713 HCPCS 0278 RC outpatient 1939.08 1939.08 1939.08 57 1105.28 percent of total billed charges 1939.08 93 1570.65 percent of total billed charges 1939.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1939.08 other OPPS APC 1939.08 1939.08 other OPPS APC 1939.08 51 988.93 percent of total billed charges 1939.08 1939.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.5 X 55MM TI CANNULATED COMPRESSION SUP-97-06182 CDM C1713 HCPCS 0278 RC outpatient 2398.5 2398.5 2398.5 57 1367.15 percent of total billed charges 2398.5 93 1942.79 percent of total billed charges 2398.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2398.5 other OPPS APC 2398.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2398.5 other OPPS APC 2398.5 51 1223.24 percent of total billed charges 2398.5 2398.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.5 X 65MM TI CANNULATED COMPRESSION SUP-97-06183 CDM outpatient 2398.5 2398.5 2398.5 2398.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REVISION STEM CORAIL STD 10 SUP-97-06184 CDM C1776 HCPCS 0278 RC outpatient 16732 16732 16732 57 9537.24 percent of total billed charges 16732 93 13552.9 percent of total billed charges 16732 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16732 other OPPS APC 16732 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16732 other OPPS APC 16732 51 8533.32 percent of total billed charges 16732 16732 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD DELTA CERAMIC 12/14 32MM +1 SUP-97-06185 CDM C1776 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EASY CLIP BICORTICAL FIXATION DEVICE 10X15X13 SUP-97-06186 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER G7 VITAMIN E HIGH WALL 40MM G SUP-97-06187 CDM C1776 HCPCS 0278 RC outpatient 3560 3560 3560 57 2029.2 percent of total billed charges 3560 93 2883.6 percent of total billed charges 3560 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3560 other OPPS APC 3560 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3560 other OPPS APC 3560 51 1815.6 percent of total billed charges 3560 3560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REST MOD PROXIMAL CONE BODY 23MM +0MM STD SUP-97-06188 CDM C1776 HCPCS 0278 RC outpatient 8068.8 8068.8 8068.8 57 4599.22 percent of total billed charges 8068.8 93 6535.73 percent of total billed charges 8068.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8068.8 other OPPS APC 8068.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8068.8 other OPPS APC 8068.8 51 4115.09 percent of total billed charges 8068.8 8068.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD BIOLOX DELTA UNIVERSAL TAPER ANATOMIC SIZE 40 +0MM SUP-97-06189 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIVERSAL V40 +4MM ADAPTER SLEEVE SUP-97-06190 CDM C1776 HCPCS 0278 RC outpatient 1 1 1 57 0.57 percent of total billed charges 1 93 0.81 percent of total billed charges 1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1 other OPPS APC 1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1 other OPPS APC 1 51 0.51 percent of total billed charges 1 1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE MTP 0DEGREE MEDIUM RIGHT SUP-97-06191 CDM C1713 HCPCS 0278 RC outpatient 3237.5 3237.5 3237.5 57 1845.38 percent of total billed charges 3237.5 93 2622.38 percent of total billed charges 3237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3237.5 other OPPS APC 3237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3237.5 other OPPS APC 3237.5 51 1651.13 percent of total billed charges 3237.5 3237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 X 26MM HEADED CANNULATED SHORT THREAD SUP-97-06192 CDM C1713 HCPCS 0278 RC outpatient 647.5 647.5 647.5 57 369.08 percent of total billed charges 647.5 93 524.48 percent of total billed charges 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 51 330.23 percent of total billed charges 647.5 647.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 X 26MM CANNULATED FULL THREAD SUP-97-06193 CDM C1713 HCPCS 0278 RC outpatient 647.5 647.5 647.5 57 369.08 percent of total billed charges 647.5 93 524.48 percent of total billed charges 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 647.5 other OPPS APC 647.5 51 330.23 percent of total billed charges 647.5 647.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 13MM LOCKING SUP-97-06194 CDM C1713 HCPCS 0278 RC outpatient 630 630 630 57 359.1 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 51 321.3 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4 X 22MM LOW PROFILE VA LOCKING SUP-97-06195 CDM C1713 HCPCS 0278 RC outpatient 490 490 490 57 279.3 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 51 249.9 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4 X 24MM LOW PROFILE VA LOCKING SUP-97-06196 CDM C1713 HCPCS 0278 RC outpatient 490 490 490 57 279.3 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 51 249.9 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 14MM LOW PROFILE CORTICAL SUP-97-06197 CDM C1713 HCPCS 0278 RC outpatient 210 210 210 57 119.7 percent of total billed charges 210 93 170.1 percent of total billed charges 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 51 107.1 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 16MM LOW PROFILE CORTICAL SUP-97-06198 CDM C1713 HCPCS 0278 RC outpatient 210 210 210 57 119.7 percent of total billed charges 210 93 170.1 percent of total billed charges 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 51 107.1 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4 X 26MM LOW PROFILE CORTEX SUP-97-06199 CDM C1713 HCPCS 0278 RC outpatient 385 385 385 57 219.45 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 51 196.35 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4 X 26 LOW PROFILE VA CORTEX SUP-97-06200 CDM C1713 HCPCS 0278 RC outpatient 490 490 490 57 279.3 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 51 249.9 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LEFT 3HOLE VOLAR DISTAL RADIUS SUP-97-06201 CDM C1713 HCPCS 0278 RC outpatient 2385 2385 2385 57 1359.45 percent of total billed charges 2385 93 1931.85 percent of total billed charges 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 51 1216.35 percent of total billed charges 2385 2385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX 3.5 X 32MM SUP-97-06202 CDM C1713 HCPCS 0278 RC outpatient 106.2 106.2 106.2 57 60.53 percent of total billed charges 106.2 93 86.02 percent of total billed charges 106.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.2 other OPPS APC 106.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.2 other OPPS APC 106.2 51 54.16 percent of total billed charges 106.2 106.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SYSTEM INTERNALBRACE KNEE LIGAMENT SUP-97-06203 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE CALCANEUS MESH SMALL SUP-97-06204 CDM C1713 HCPCS 0278 RC outpatient 2474.16 2474.16 2474.16 57 1410.27 percent of total billed charges 2474.16 93 2004.07 percent of total billed charges 2474.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2474.16 other OPPS APC 2474.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2474.16 other OPPS APC 2474.16 51 1261.82 percent of total billed charges 2474.16 2474.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE FRAGMENT DISTAL ULNA SUP-97-06205 CDM C1713 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT #0S FLEXIBLE HINGE TOE W/ GROMMETS SUP-97-06206 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.5 X 48MM PRECISION CANNULATED SHORT THREAD BLUNT TIP SUP-97-06207 CDM C1713 HCPCS 0278 RC outpatient 1875 1875 1875 57 1068.75 percent of total billed charges 1875 93 1518.75 percent of total billed charges 1875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1875 other OPPS APC 1875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1875 other OPPS APC 1875 51 956.25 percent of total billed charges 1875 1875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SYSTEM FIBERTAK BUTTON SUP-97-06208 CDM C1713 HCPCS 0278 RC outpatient 2367 2367 2367 57 1349.19 percent of total billed charges 2367 93 1917.27 percent of total billed charges 2367 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2367 other OPPS APC 2367 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2367 other OPPS APC 2367 51 1207.17 percent of total billed charges 2367 2367 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE EVANS LARGE 6 X 19MM TITAN 3D SUP-97-06209 CDM C1713 HCPCS 0278 RC outpatient 3984.38 3984.38 3984.38 57 2271.1 percent of total billed charges 3984.38 93 3227.35 percent of total billed charges 3984.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3984.38 other OPPS APC 3984.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3984.38 other OPPS APC 3984.38 51 2032.03 percent of total billed charges 3984.38 3984.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 0 DEGREE MEDIUM LEFT MTP SUP-97-06210 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 36MM HEADLESSS SHORT THREAD MINI MONSTER SUP-97-06211 CDM C1713 HCPCS 0278 RC outpatient 668.15 668.15 668.15 57 380.85 percent of total billed charges 668.15 93 541.2 percent of total billed charges 668.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 668.15 other OPPS APC 668.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 668.15 other OPPS APC 668.15 51 340.76 percent of total billed charges 668.15 668.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3 X 42MM HEADLESS CANNULATED SHORT THREAD MINI MONSTER SUP-97-06212 CDM C1713 HCPCS 0278 RC outpatient 668.15 668.15 668.15 57 380.85 percent of total billed charges 668.15 93 541.2 percent of total billed charges 668.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 668.15 other OPPS APC 668.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 668.15 other OPPS APC 668.15 51 340.76 percent of total billed charges 668.15 668.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT 9MM POLY TRIATHLON TS PLUS SUP-97-06213 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE ARTHROCELL PLUS 2.5CC SUP-97-06215 CDM C1762 HCPCS 0278 RC outpatient 3895 3895 3895 57 2220.15 percent of total billed charges 3895 93 3154.95 percent of total billed charges 3895 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3895 other OPPS APC 3895 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3895 other OPPS APC 3895 51 1986.45 percent of total billed charges 3895 3895 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3MM PHANTOM HINDFOOT NAIL COMPRESSION SUP-97-06216 CDM C1713 HCPCS 0278 RC outpatient 915 915 915 57 521.55 percent of total billed charges 915 93 741.15 percent of total billed charges 915 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 915 other OPPS APC 915 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 915 other OPPS APC 915 51 466.65 percent of total billed charges 915 915 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL 10 X 200MM LEFT PHANTOM TTC SUP-97-06217 CDM C1713 HCPCS 0278 RC outpatient 8375 8375 8375 57 4773.75 percent of total billed charges 8375 93 6783.75 percent of total billed charges 8375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8375 other OPPS APC 8375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8375 other OPPS APC 8375 51 4271.25 percent of total billed charges 8375 8375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG 7.2 X 70MM THREADED PHANTOM HINDFOOT NAIL SUP-97-06218 CDM C1713 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG 7.2 X 80MM THREADED PHANTOM HINDFOOT NAIL SUP-97-06219 CDM C1713 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG 5 X 24MM THREADED PHANTOM HINDFOOT NAIL SUP-97-06220 CDM C1713 HCPCS 0278 RC outpatient 990 990 990 57 564.3 percent of total billed charges 990 93 801.9 percent of total billed charges 990 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 990 other OPPS APC 990 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 990 other OPPS APC 990 51 504.9 percent of total billed charges 990 990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG 5 X 28MM THREADED PHANTOM HINDFOOT NAIL SUP-97-06221 CDM C1713 HCPCS 0278 RC outpatient 990 990 990 57 564.3 percent of total billed charges 990 93 801.9 percent of total billed charges 990 990 other OPPS APC 990 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 990 other OPPS APC 990 51 504.9 percent of total billed charges 990 990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG 5 X 36MM THREADED PHANTOM HINDFOOT NAIL SUP-97-06222 CDM C1713 HCPCS 0278 RC outpatient 990 990 990 57 564.3 percent of total billed charges 990 93 801.9 percent of total billed charges 990 990 other OPPS APC 990 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 990 other OPPS APC 990 51 504.9 percent of total billed charges 990 990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG 5 X 32MM THREADED PHANTOM HINDFOOT NAIL SUP-97-06223 CDM C1713 HCPCS 0278 RC outpatient 990 990 990 57 564.3 percent of total billed charges 990 93 801.9 percent of total billed charges 990 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 990 other OPPS APC 990 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 990 other OPPS APC 990 51 504.9 percent of total billed charges 990 990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP LONG PHANTOM HINDFOOT NAIL SHOULDERED SUP-97-06224 CDM C1713 HCPCS 0278 RC outpatient 915 915 915 57 521.55 percent of total billed charges 915 93 741.15 percent of total billed charges 915 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 915 other OPPS APC 915 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 915 other OPPS APC 915 51 466.65 percent of total billed charges 915 915 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESTORATION ADM X3 INS 28/54 SUP-97-06225 CDM C1776 HCPCS 0278 RC outpatient 2325 2325 2325 57 1325.25 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 51 1185.75 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4 X 30MM TI CANNULATED PARTIALLY THREADED QUICKFIX SUP-97-06226 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT FEMORAL DISTAL 10MM SIZE 4 RIGHT TRIATHLON SUP-97-06227 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRATAFIX PDS 0 CT-1 30CM VIOLET SUP-97-06228 CDM 0272 RC outpatient 161.83 161.83 161.83 74 119.75 percent of total billed charges 161.83 93 131.08 percent of total billed charges 161.83 161.83 other OPPS APC 161.83 161.83 other OPPS APC 161.83 27.63 44.71 percent of total billed charges 161.83 161.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT SIZE 2 8MM SIGMA STAB XLK SUP-97-06229 CDM C1776 HCPCS 0278 RC outpatient 4171.25 4171.25 4171.25 57 2377.61 percent of total billed charges 4171.25 93 3378.71 percent of total billed charges 4171.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4171.25 other OPPS APC 4171.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4171.25 other OPPS APC 4171.25 51 2127.34 percent of total billed charges 4171.25 4171.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONESYNC BIOACTIVE MATRIX PUTTY 10CC SUP-97-06230 CDM C1713 HCPCS 0278 RC outpatient 4000 4000 4000 57 2280 percent of total billed charges 4000 93 3240 percent of total billed charges 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 51 2040 percent of total billed charges 4000 4000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERTAK WITH NEEDLES HYBRID KNEE SUP-97-06231 CDM C1713 HCPCS 0278 RC outpatient 1575 1575 1575 57 897.75 percent of total billed charges 1575 93 1275.75 percent of total billed charges 1575 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1575 other OPPS APC 1575 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1575 other OPPS APC 1575 51 803.25 percent of total billed charges 1575 1575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELTOK CLEAR-FLO NASAL AIRWAY & NASAL SPLINTS SUP-97-06232 CDM C1763 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5 X 55 HEADLESS COMPRESSION SUP-97-06233 CDM C1713 HCPCS 0278 RC outpatient 1221.36 1221.36 1221.36 57 696.18 percent of total billed charges 1221.36 93 989.3 percent of total billed charges 1221.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1221.36 other OPPS APC 1221.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1221.36 other OPPS APC 1221.36 51 622.89 percent of total billed charges 1221.36 1221.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT OVITEX 1S 10 X 20CM SUP-97-06234 CDM C1781 HCPCS 0278 RC outpatient 8100 8100 8100 57 4617 percent of total billed charges 8100 93 6561 percent of total billed charges 8100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8100 other OPPS APC 8100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8100 other OPPS APC 8100 51 4131 percent of total billed charges 8100 8100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 1.6 X 100 THREADED TIP 10/PK SUP-97-06235 CDM C1713 HCPCS 0278 RC outpatient 188 188 188 57 107.16 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 51 95.88 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASEPLATE PRIMARY TIBIAL TRIATHLON SIZE 7 SUP-97-06236 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOCARTILAGE 0.75CC SUP-97-06237 CDM C1762 HCPCS 0278 RC outpatient 2250 2250 2250 57 1282.5 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 51 1147.5 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE 7 X 30MM SUP-97-06238 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 46MM CANCELLOUS FULL THREAD SUP-97-06239 CDM C1713 HCPCS 0278 RC outpatient 106.4 106.4 106.4 57 60.65 percent of total billed charges 106.4 93 86.18 percent of total billed charges 106.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.4 other OPPS APC 106.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 106.4 other OPPS APC 106.4 51 54.26 percent of total billed charges 106.4 106.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Z STAPLE 10/11MM SUP-97-06240 CDM C1713 HCPCS 0278 RC outpatient 2970 2970 2970 57 1692.9 percent of total billed charges 2970 93 2405.7 percent of total billed charges 2970 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2970 other OPPS APC 2970 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2970 other OPPS APC 2970 51 1514.7 percent of total billed charges 2970 2970 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7MM LAPIPLASTY SUP-97-06241 CDM C1713 HCPCS 0278 RC outpatient 1875 1875 1875 57 1068.75 percent of total billed charges 1875 93 1518.75 percent of total billed charges 1875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1875 other OPPS APC 1875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1875 other OPPS APC 1875 51 956.25 percent of total billed charges 1875 1875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7MM LAPIPLASTY SUP-97-06242 CDM C1713 HCPCS 0278 RC outpatient 1875 1875 1875 57 1068.75 percent of total billed charges 1875 93 1518.75 percent of total billed charges 1875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1875 other OPPS APC 1875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1875 other OPPS APC 1875 51 956.25 percent of total billed charges 1875 1875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 FULLY THREADED LAPIPLASTY SUP-97-06243 CDM C1713 HCPCS 0278 RC outpatient 2157 2157 2157 57 1229.49 percent of total billed charges 2157 93 1747.17 percent of total billed charges 2157 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2157 other OPPS APC 2157 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2157 other OPPS APC 2157 51 1100.07 percent of total billed charges 2157 2157 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LAPIPLASTY SELECT KIT SUP-97-06244 CDM C1713 HCPCS 0278 RC outpatient 5562.5 5562.5 5562.5 57 3170.63 percent of total billed charges 5562.5 93 4505.63 percent of total billed charges 5562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5562.5 other OPPS APC 5562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5562.5 other OPPS APC 5562.5 51 2836.88 percent of total billed charges 5562.5 5562.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LISFRANC 3.7 X 40MM CHARLOTTE F&A SUP-97-06245 CDM C1713 HCPCS 0278 RC outpatient 3072.5 3072.5 3072.5 57 1751.33 percent of total billed charges 3072.5 93 2488.73 percent of total billed charges 3072.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3072.5 other OPPS APC 3072.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3072.5 other OPPS APC 3072.5 51 1566.98 percent of total billed charges 3072.5 3072.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL NAIL 11 X 360MM T2 STANDARD SUP-97-06246 CDM C1713 HCPCS 0278 RC outpatient 2734.2 2734.2 2734.2 57 1558.49 percent of total billed charges 2734.2 93 2214.7 percent of total billed charges 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2734.2 other OPPS APC 2734.2 51 1394.44 percent of total billed charges 2734.2 2734.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4 X 30MM LOW PROFILE CORTEX SUP-97-06247 CDM C1713 HCPCS 0278 RC outpatient 385 385 385 57 219.45 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 51 196.35 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4 X 14MM VAL KREULOCK TI SUP-97-06248 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LONG RIGHT 5TH METATARSAL HOOK SUP-97-06249 CDM C1713 HCPCS 0278 RC outpatient 3187.5 3187.5 3187.5 57 1816.88 percent of total billed charges 3187.5 93 2581.88 percent of total billed charges 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 51 1625.63 percent of total billed charges 3187.5 3187.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4 X 12MM VAL KREULOCK TI SUP-97-06250 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4 X 16MM VAL KREULOCK TI SUP-97-06251 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INFINITY EVERLAST SIZE 4+ 9MM SUP-97-06252 CDM C1776 HCPCS 0278 RC outpatient 3975 3975 3975 57 2265.75 percent of total billed charges 3975 93 3219.75 percent of total billed charges 3975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3975 other OPPS APC 3975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3975 other OPPS APC 3975 51 2027.25 percent of total billed charges 3975 3975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INFINITY ADAPTIS FLATCUT TALAR DOME SIZE 4 SUP-97-06253 CDM C1776 HCPCS 0278 RC outpatient 9540 9540 9540 57 5437.8 percent of total billed charges 9540 93 7727.4 percent of total billed charges 9540 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9540 other OPPS APC 9540 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9540 other OPPS APC 9540 51 4865.4 percent of total billed charges 9540 9540 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INFINITY ADAPTIS TIB SZ 5 SUP-97-06254 CDM C1776 HCPCS 0278 RC outpatient 11066 11066 11066 57 6307.62 percent of total billed charges 11066 93 8963.46 percent of total billed charges 11066 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11066 other OPPS APC 11066 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11066 other OPPS APC 11066 51 5643.66 percent of total billed charges 11066 11066 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 14MM LOW PROFILE CORTICAL SUP-97-06255 CDM C1713 HCPCS 0278 RC outpatient 646.8 646.8 646.8 57 368.68 percent of total billed charges 646.8 93 523.91 percent of total billed charges 646.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 646.8 other OPPS APC 646.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 646.8 other OPPS APC 646.8 51 329.87 percent of total billed charges 646.8 646.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 14MM LOCKING LG HD SUP-97-06256 CDM C1713 HCPCS 0278 RC outpatient 636.3 636.3 636.3 57 362.69 percent of total billed charges 636.3 93 515.4 percent of total billed charges 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 51 324.51 percent of total billed charges 636.3 636.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 16MM LOCKING LG HD SUP-97-06257 CDM C1713 HCPCS 0278 RC outpatient 636.3 636.3 636.3 57 362.69 percent of total billed charges 636.3 93 515.4 percent of total billed charges 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 636.3 other OPPS APC 636.3 51 324.51 percent of total billed charges 636.3 636.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE MTP FUSION MEDIUM 5DEG LT ORTHOLOC 3DI SUP-97-06258 CDM C1713 HCPCS 0278 RC outpatient 3100.5 3100.5 3100.5 57 1767.29 percent of total billed charges 3100.5 93 2511.41 percent of total billed charges 3100.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3100.5 other OPPS APC 3100.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3100.5 other OPPS APC 3100.5 51 1581.26 percent of total billed charges 3100.5 3100.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPER POST 7 X 13MM LG MTP SUP-97-06259 CDM C1713 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTICULAR COMPONENT 12MM 1.5 X 2MM MTP SUP-97-06260 CDM C1713 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HUMERAL CUP 2MM THICKNESS 36MM REUNION RSA SUP-97-06261 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENOSPHERE +3 36MM CANNULATED COCR LATERALIZED SUP-97-06262 CDM C1776 HCPCS 0278 RC outpatient 9337.5 9337.5 9337.5 57 5322.38 percent of total billed charges 9337.5 93 7563.38 percent of total billed charges 9337.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9337.5 other OPPS APC 9337.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9337.5 other OPPS APC 9337.5 51 4762.13 percent of total billed charges 9337.5 9337.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PERIPHERAL 14MM SUP-97-06263 CDM C1776 HCPCS 0278 RC outpatient 441 441 441 57 251.37 percent of total billed charges 441 93 357.21 percent of total billed charges 441 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 441 other OPPS APC 441 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 441 other OPPS APC 441 51 224.91 percent of total billed charges 441 441 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE AEQUALIS PERFORM 5MM 18MM REVERSED PERIPHERAL CORTICAL METAL POLYMER NON-STERILE SUP-97-06264 CDM C1776 HCPCS 0278 RC outpatient 441 441 441 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 441 other OPPS APC 441 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 441 other OPPS APC 441 51 224.91 percent of total billed charges 441 441 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PERIPHERAL 18MM SUP-97-06264 CDM C1776 HCPCS 0278 RC outpatient 441 441 441 57 251.37 percent of total billed charges 441 93 357.21 percent of total billed charges 441 441 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PERIPHERAL 26MM SUP-97-06265 CDM C1776 HCPCS 0278 RC outpatient 441 441 441 57 251.37 percent of total billed charges 441 93 357.21 percent of total billed charges 441 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 441 other OPPS APC 441 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 441 other OPPS APC 441 51 224.91 percent of total billed charges 441 441 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PERIPHERAL 30MM SUP-97-06266 CDM C1776 HCPCS 0278 RC outpatient 441 441 441 57 251.37 percent of total billed charges 441 93 357.21 percent of total billed charges 441 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 441 other OPPS APC 441 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 441 other OPPS APC 441 51 224.91 percent of total billed charges 441 441 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASEPLATE STANDARD 25MM SUP-97-06267 CDM C1776 HCPCS 0278 RC outpatient 3177.5 3177.5 3177.5 57 1811.18 percent of total billed charges 3177.5 93 2573.78 percent of total billed charges 3177.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3177.5 other OPPS APC 3177.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3177.5 other OPPS APC 3177.5 51 1620.53 percent of total billed charges 3177.5 3177.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT OVITEX 1S 10 X 12CM SUP-97-06268 CDM C1781 HCPCS 0278 RC outpatient 4860 4860 4860 57 2770.2 percent of total billed charges 4860 93 3936.6 percent of total billed charges 4860 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4860 other OPPS APC 4860 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4860 other OPPS APC 4860 51 2478.6 percent of total billed charges 4860 4860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL DISTAL AUGMENT 10MM SIZE 5 RIGHT TRIATHLON SUP-97-06269 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POST AUGMENT SIZE 5 5MM TRIALTHLON SUP-97-06270 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL DISTAL AUGMENT 10MM SIZE 7 RIGHT SUP-97-06271 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSTERIOR AUGMENT TRIATHLON SIZE 7 5MM SUP-97-06272 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASSEMBLY SCREW 0MM SUP-97-06273 CDM C1776 HCPCS 0278 RC outpatient 2319 2319 2319 57 1321.83 percent of total billed charges 2319 93 1878.39 percent of total billed charges 2319 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2319 other OPPS APC 2319 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2319 other OPPS APC 2319 51 1182.69 percent of total billed charges 2319 2319 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCKING CAP SUP-97-06274 CDM C1776 HCPCS 0278 RC outpatient 1083 1083 1083 57 617.31 percent of total billed charges 1083 93 877.23 percent of total billed charges 1083 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1083 other OPPS APC 1083 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1083 other OPPS APC 1083 51 552.33 percent of total billed charges 1083 1083 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROXIMAL BODY 13MM SUP-97-06275 CDM C1776 HCPCS 0278 RC outpatient 9665 9665 9665 57 5509.05 percent of total billed charges 9665 93 7828.65 percent of total billed charges 9665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665 other OPPS APC 9665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9665 other OPPS APC 9665 51 4929.15 percent of total billed charges 9665 9665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PTC PARTIALLY COATED DISTAL STEM 13 X 90MM SUP-97-06276 CDM C1776 HCPCS 0278 RC outpatient 8700 8700 8700 57 4959 percent of total billed charges 8700 93 7047 percent of total billed charges 8700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8700 other OPPS APC 8700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8700 other OPPS APC 8700 51 4437 percent of total billed charges 8700 8700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT HUMERAL 36 DIA REVISION REVERSED 6/12.5 SUP-97-06277 CDM C1776 HCPCS 0278 RC outpatient 2643 2643 2643 57 1506.51 percent of total billed charges 2643 93 2140.83 percent of total billed charges 2643 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2643 other OPPS APC 2643 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2643 other OPPS APC 2643 51 1347.93 percent of total billed charges 2643 2643 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CENTERED REVERSED TRAY +0 SUP-97-06278 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POST PRESS FIT 15MM SUP-97-06279 CDM C1776 HCPCS 0278 RC outpatient 1272 1272 1272 57 725.04 percent of total billed charges 1272 93 1030.32 percent of total billed charges 1272 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1272 other OPPS APC 1272 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1272 other OPPS APC 1272 51 648.72 percent of total billed charges 1272 1272 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLENOSPHERE STANDARD 36MM SUP-97-06280 CDM C1776 HCPCS 0278 RC outpatient 5970 5970 5970 57 3402.9 percent of total billed charges 5970 93 4835.7 percent of total billed charges 5970 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5970 other OPPS APC 5970 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5970 other OPPS APC 5970 51 3044.7 percent of total billed charges 5970 5970 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PERIPHERAL 34MM SUP-97-06281 CDM C1776 HCPCS 0278 RC outpatient 441 441 441 57 251.37 percent of total billed charges 441 93 357.21 percent of total billed charges 441 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 441 other OPPS APC 441 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 441 other OPPS APC 441 51 224.91 percent of total billed charges 441 441 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASEPLATE FULL WEDGE AUGMENT 15DEG 25MM SUP-97-06282 CDM C1776 HCPCS 0278 RC outpatient 5220 5220 5220 57 2975.4 percent of total billed charges 5220 93 4228.2 percent of total billed charges 5220 5220 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASEPLATE GLENOID FIXATION AEQUALIS PERFORM 25MM 15DEG ANGLED REVERSE FULL WEDGE SHOULDER SUP-97-06282 CDM C1776 HCPCS 0278 RC outpatient 5220 5220 5220 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5220 other OPPS APC 5220 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5220 other OPPS APC 5220 51 2662.2 percent of total billed charges 5220 5220 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARCOMXL 36MM RLC LNR MROM SZ24 SUP-97-06283 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RNGLC REPLC LOCKING RING SZ24 SUP-97-06284 CDM C1776 HCPCS 0278 RC outpatient 308 308 308 57 175.56 percent of total billed charges 308 93 249.48 percent of total billed charges 308 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 308 other OPPS APC 308 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 308 other OPPS APC 308 51 157.08 percent of total billed charges 308 308 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SOLID HEADLESS FULL THREAD 5.5 X 70MM JOUST BEAM SUP-97-06285 CDM C1713 HCPCS 0278 RC outpatient 2845.8 2845.8 2845.8 57 1622.11 percent of total billed charges 2845.8 93 2305.1 percent of total billed charges 2845.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2845.8 other OPPS APC 2845.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2845.8 other OPPS APC 2845.8 51 1451.36 percent of total billed charges 2845.8 2845.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SOLID HEADLESS FULL THREAD 5 X 120MM JOUST BEAM SUP-97-06286 CDM C1713 HCPCS 0278 RC outpatient 2845.8 2845.8 2845.8 57 1622.11 percent of total billed charges 2845.8 93 2305.1 percent of total billed charges 2845.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2845.8 other OPPS APC 2845.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2845.8 other OPPS APC 2845.8 51 1451.36 percent of total billed charges 2845.8 2845.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SOLID HEADLESS FULL THREAD 5.5 X 120MM JOUST BEAM SUP-97-06287 CDM C1713 HCPCS 0278 RC outpatient 2845.8 2845.8 2845.8 57 1622.11 percent of total billed charges 2845.8 93 2305.1 percent of total billed charges 2845.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2845.8 other OPPS APC 2845.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2845.8 other OPPS APC 2845.8 51 1451.36 percent of total billed charges 2845.8 2845.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW SOLID HEADLESS FULL THREAD 7.2 X 115MM JOUST BEAM SUP-97-06288 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANNULATED SHORT THREAD HEADLESS 5.5 X 65MM MONSTER SUP-97-06289 CDM C1713 HCPCS 0278 RC outpatient 940.95 940.95 940.95 57 536.34 percent of total billed charges 940.95 93 762.17 percent of total billed charges 940.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 940.95 other OPPS APC 940.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 940.95 other OPPS APC 940.95 51 479.88 percent of total billed charges 940.95 940.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE ASSEMBLE STRAIGHT 20X20X20MM GREAT WHITE SUP-97-06290 CDM C1713 HCPCS 0278 RC outpatient 3499.88 3499.88 3499.88 57 1994.93 percent of total billed charges 3499.88 93 2834.9 percent of total billed charges 3499.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3499.88 other OPPS APC 3499.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3499.88 other OPPS APC 3499.88 51 1784.94 percent of total billed charges 3499.88 3499.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.5 X 22MM CANNULATED COMPRESSION HEADLESS SUP-97-06291 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.5 X 26MM CANNULATED COMPRESSION HEADLESS SUP-97-06292 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 50MM CANNULATED COMPRESSION HEADLESS SHORT THREAD SUP-97-06293 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 36MM CANNULATED COMPRESSION HEADLESS SUP-97-06294 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.5 X 32MM CANNULATED COMPRESSION HEADLESS SUP-97-06295 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU150 24.5D SUP-97-06296 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT FLEXIGRAFT CONNECT PRESUTURED TENDON SUP-97-06297 CDM C1762 HCPCS 0278 RC outpatient 3208.55 3208.55 3208.55 57 1828.87 percent of total billed charges 3208.55 93 2598.93 percent of total billed charges 3208.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3208.55 other OPPS APC 3208.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3208.55 other OPPS APC 3208.55 51 1636.36 percent of total billed charges 3208.55 3208.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU150 19.0D SUP-97-06298 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU150 21.5D SUP-97-06299 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU300 21.0D SUP-97-06300 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU225 24.0D SUP-97-06301 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBULA NAIL 4.5 X 130MM FLEX THREAD SUP-97-06302 CDM C1713 HCPCS 0278 RC outpatient 7250 7250 7250 57 4132.5 percent of total billed charges 7250 93 5872.5 percent of total billed charges 7250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7250 other OPPS APC 7250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7250 other OPPS APC 7250 51 3697.5 percent of total billed charges 7250 7250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7 X 16MM ZERO PROFILE FLEX THREAD SUP-97-06303 CDM C1713 HCPCS 0278 RC outpatient 200 200 200 57 114 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 51 102 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7 X 18MM ZERO PROFILE FLEX THREAD SUP-97-06304 CDM C1713 HCPCS 0278 RC outpatient 200 200 200 57 114 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 51 102 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBULA NAIL 5.5 X 130MM FLEX THREAD SUP-97-06305 CDM C1713 HCPCS 0278 RC outpatient 7250 7250 7250 57 4132.5 percent of total billed charges 7250 93 5872.5 percent of total billed charges 7250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7250 other OPPS APC 7250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7250 other OPPS APC 7250 51 3697.5 percent of total billed charges 7250 7250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7 X 14MM ZERO THREAD FLEX THREAD SUP-97-06306 CDM C1713 HCPCS 0278 RC outpatient 200 200 200 57 114 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 51 102 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT 3DMAX MID EXTRA LARGE LEFT SUP-97-06307 CDM C1781 HCPCS 0278 RC outpatient 774.3 774.3 774.3 57 441.35 percent of total billed charges 774.3 93 627.18 percent of total billed charges 774.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 774.3 other OPPS APC 774.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 774.3 other OPPS APC 774.3 51 394.89 percent of total billed charges 774.3 774.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT 3DMAX MID EXTRA LARGE RIGHT SUP-97-06308 CDM C1781 HCPCS 0278 RC outpatient 774.3 774.3 774.3 57 441.35 percent of total billed charges 774.3 93 627.18 percent of total billed charges 774.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 774.3 other OPPS APC 774.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 774.3 other OPPS APC 774.3 51 394.89 percent of total billed charges 774.3 774.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 16MM LOW PROFILE TITANIUM SUP-97-06309 CDM C1713 HCPCS 0278 RC outpatient 210 210 210 57 119.7 percent of total billed charges 210 93 170.1 percent of total billed charges 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 51 107.1 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 36MM QUICKFIC CANNULATED ST CANCELLOUS SUP-97-06310 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE HOOK LATERAL SUP-97-06311 CDM C1713 HCPCS 0278 RC outpatient 2775 2775 2775 57 1581.75 percent of total billed charges 2775 93 2247.75 percent of total billed charges 2775 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2775 other OPPS APC 2775 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2775 other OPPS APC 2775 51 1415.25 percent of total billed charges 2775 2775 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE 1.6 DOUBLE TIP 2 ZONE DYNANITE SUP-97-06312 CDM C1713 HCPCS 0278 RC outpatient 486.5 486.5 486.5 57 277.31 percent of total billed charges 486.5 93 394.07 percent of total billed charges 486.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 486.5 other OPPS APC 486.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 486.5 other OPPS APC 486.5 51 248.12 percent of total billed charges 486.5 486.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPEEDPLATE LAPIPLASTY QUAD COMPRESSION IMPLANT SUP-97-06313 CDM C1713 HCPCS 0278 RC outpatient 7250 7250 7250 57 4132.5 percent of total billed charges 7250 93 5872.5 percent of total billed charges 7250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7250 other OPPS APC 7250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7250 other OPPS APC 7250 51 3697.5 percent of total billed charges 7250 7250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPEEDPLATE 18X14MM RAPID COMPRESSION IMPLANT SUP-97-06314 CDM C1713 HCPCS 0278 RC outpatient 6750 6750 6750 57 3847.5 percent of total billed charges 6750 93 5467.5 percent of total billed charges 6750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6750 other OPPS APC 6750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6750 other OPPS APC 6750 51 3442.5 percent of total billed charges 6750 6750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPEEDPLATE 18X17MM RAPID COMPRESSION IMPLANT SUP-97-06315 CDM C1713 HCPCS 0278 RC outpatient 6750 6750 6750 57 3847.5 percent of total billed charges 6750 93 5467.5 percent of total billed charges 6750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6750 other OPPS APC 6750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6750 other OPPS APC 6750 51 3442.5 percent of total billed charges 6750 6750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM INSIGNIA COLLARED STANDARD 0 SUP-97-06316 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM INSIGNIA COLLARED STANDARD 1 SUP-97-06317 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM INSIGNIA COLLARED STANDARD 4 SUP-97-06318 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM INSIGNIA COLLARED STANDARD 5 SUP-97-06319 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM INSIGNIA COLLARED STANDARD 6 SUP-97-06320 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM INSIGNIA COLLARED STANDARD 7 SUP-97-06321 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM INSIGNIA COLLARED STANDARD 8 SUP-97-06322 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM INSIGNIA COLLARED STANDARD 9 SUP-97-06323 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM INSIGNIA COLLARED STANDARD 10 SUP-97-06324 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM INSIGNIA COLLARED STANDARD 11 SUP-97-06325 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM INSIGNIA COLLARED HIGH 0 SUP-97-06326 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM INSIGNIA COLLARED HIGH 1 SUP-97-06327 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM INSIGNIA COLLARED HIGH 3 SUP-97-06328 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM INSIGNIA COLLARED HIGH 4 SUP-97-06329 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM INSIGNIA COLLARED HIGH 5 SUP-97-06330 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM INSIGNIA COLLARED HIGH 6 SUP-97-06331 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM INSIGNIA COLLARED HIGH 7 SUP-97-06332 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM INSIGNIA COLLARED HIGH 10 SUP-97-06333 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HIP STEM INSIGNIA COLLARED HIGH 11 SUP-97-06334 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK FEMORAL-LM-RL-SZ 6 SUP-97-06335 CDM C1776 HCPCS 0278 RC outpatient 4000 4000 4000 57 2280 percent of total billed charges 4000 93 3240 percent of total billed charges 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 51 2040 percent of total billed charges 4000 4000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK FEMORAL-LM-RL-SZ 7 SUP-97-06336 CDM C1776 HCPCS 0278 RC outpatient 4000 4000 4000 57 2280 percent of total billed charges 4000 93 3240 percent of total billed charges 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 51 2040 percent of total billed charges 4000 4000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK FEMORAL-LM-RL-SZ 8 SUP-97-06337 CDM C1776 HCPCS 0278 RC outpatient 4000 4000 4000 57 2280 percent of total billed charges 4000 93 3240 percent of total billed charges 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 51 2040 percent of total billed charges 4000 4000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK FEMORAL-RM-LL-SZ 1 SUP-97-06338 CDM C1776 HCPCS 0278 RC outpatient 4000 4000 4000 57 2280 percent of total billed charges 4000 93 3240 percent of total billed charges 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 51 2040 percent of total billed charges 4000 4000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK FEMORAL-RM-LL-SZ 2 SUP-97-06339 CDM C1776 HCPCS 0278 RC outpatient 4000 4000 4000 57 2280 percent of total billed charges 4000 93 3240 percent of total billed charges 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 51 2040 percent of total billed charges 4000 4000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK FEMORAL-RM-LL-SZ 6 SUP-97-06340 CDM C1776 HCPCS 0278 RC outpatient 4000 4000 4000 57 2280 percent of total billed charges 4000 93 3240 percent of total billed charges 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 51 2040 percent of total billed charges 4000 4000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK FEMORAL-RM-LL-SZ 7 SUP-97-06341 CDM C1776 HCPCS 0278 RC outpatient 4000 4000 4000 57 2280 percent of total billed charges 4000 93 3240 percent of total billed charges 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 51 2040 percent of total billed charges 4000 4000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK FEMORAL-RM-LL-SZ 8 SUP-97-06342 CDM C1776 HCPCS 0278 RC outpatient 4000 4000 4000 57 2280 percent of total billed charges 4000 93 3240 percent of total billed charges 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 51 2040 percent of total billed charges 4000 4000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 36MM LO PRO CANNULATED BLUNT TIP SUP-97-06343 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 38MM LO PRO CANNULATED BLUNT TIP SUP-97-06344 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 40MM LO PRO CANNULATED BLUNT TIP SUP-97-06345 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 42MM LO PRO CANNULATED BLUNT TIP SUP-97-06346 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 44MM LO PRO CANNULATED BLUNT TIP SUP-97-06347 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 50MM LO PRO CANNULATED BLUNT TIP SUP-97-06348 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 55MM LO PRO CANNULATED BLUNT TIP SUP-97-06349 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 60MM LO PRO CANNULATED BLUNT TIP SUP-97-06350 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 20MM LOCKING T8 SUP-97-06351 CDM C1713 HCPCS 0278 RC outpatient 443.98 443.98 443.98 57 253.07 percent of total billed charges 443.98 93 359.62 percent of total billed charges 443.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 443.98 other OPPS APC 443.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 443.98 other OPPS APC 443.98 51 226.43 percent of total billed charges 443.98 443.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT X3 POLY 25MM TRIATHLON TS PLUS SUP-97-06352 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AUGMENT SIZE 5 10MM TRI POST SUP-97-06353 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACHILLIES TENDON WITH BONE BLOCK SUP-97-06354 CDM C1762 HCPCS 0278 RC outpatient 5486.13 5486.13 5486.13 57 3127.09 percent of total billed charges 5486.13 93 4443.77 percent of total billed charges 5486.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5486.13 other OPPS APC 5486.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5486.13 other OPPS APC 5486.13 51 2797.93 percent of total billed charges 5486.13 5486.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 20MM CORTEX SELF TAPPING SUP-97-06355 CDM C1713 HCPCS 0278 RC outpatient 108.56 108.56 108.56 57 61.88 percent of total billed charges 108.56 93 87.93 percent of total billed charges 108.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 108.56 other OPPS APC 108.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 108.56 other OPPS APC 108.56 51 55.37 percent of total billed charges 108.56 108.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 26MM CORTEX SELF TAPPING SUP-97-06356 CDM C1713 HCPCS 0278 RC outpatient 108.56 108.56 108.56 57 61.88 percent of total billed charges 108.56 93 87.93 percent of total billed charges 108.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 108.56 other OPPS APC 108.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 108.56 other OPPS APC 108.56 51 55.37 percent of total billed charges 108.56 108.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 20MM CORTEX SELF TAPPING SUP-97-06357 CDM C1713 HCPCS 0278 RC outpatient 108.56 108.56 108.56 57 61.88 percent of total billed charges 108.56 93 87.93 percent of total billed charges 108.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 108.56 other OPPS APC 108.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 108.56 other OPPS APC 108.56 51 55.37 percent of total billed charges 108.56 108.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL AUGMENT BLOCK 5MM SIZE 5 NEXGEN SUP-97-06358 CDM C1776 HCPCS 0278 RC outpatient 2289.6 2289.6 2289.6 57 1305.07 percent of total billed charges 2289.6 93 1854.58 percent of total billed charges 2289.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2289.6 other OPPS APC 2289.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2289.6 other OPPS APC 2289.6 51 1167.7 percent of total billed charges 2289.6 2289.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT TAPESTRY W/ INSERTION SLEEVE SUP-97-06359 CDM C1762 HCPCS 0278 RC outpatient 6700 6700 6700 57 3819 percent of total billed charges 6700 93 5427 percent of total billed charges 6700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6700 other OPPS APC 6700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6700 other OPPS APC 6700 51 3417 percent of total billed charges 6700 6700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.5 X 32MM HEADLESS CANNULATED COMPRESSION LT SUP-97-06360 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.5 X 34MM HEADLESS CANNULATED COMPRESSION LT SUP-97-06361 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERTAK W/ NEEDLES KNEE DOUBLE LOADED SUP-97-06362 CDM C1713 HCPCS 0278 RC outpatient 1275 1275 1275 57 726.75 percent of total billed charges 1275 93 1032.75 percent of total billed charges 1275 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1275 other OPPS APC 1275 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1275 other OPPS APC 1275 51 650.25 percent of total billed charges 1275 1275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HAMMERTOE IMPLANT SMALL SUP-97-06363 CDM C1713 HCPCS 0278 RC outpatient 4310.63 4310.63 4310.63 57 2457.06 percent of total billed charges 4310.63 93 3491.61 percent of total billed charges 4310.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4310.63 other OPPS APC 4310.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4310.63 other OPPS APC 4310.63 51 2198.42 percent of total billed charges 4310.63 4310.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMORAL HEAD LFIT V40 SUP-97-06364 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBULAR NAIL 4.5 X 180MM SUP-97-06365 CDM C1713 HCPCS 0278 RC outpatient 7250 7250 7250 57 4132.5 percent of total billed charges 7250 93 5872.5 percent of total billed charges 7250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7250 other OPPS APC 7250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7250 other OPPS APC 7250 51 3697.5 percent of total billed charges 7250 7250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBULAR NAIL 5.5 X 180MM SUP-97-06366 CDM C1713 HCPCS 0278 RC outpatient 7250 7250 7250 57 4132.5 percent of total billed charges 7250 93 5872.5 percent of total billed charges 7250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7250 other OPPS APC 7250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7250 other OPPS APC 7250 51 3697.5 percent of total billed charges 7250 7250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYNDESMOSIS REPAIR KIT SUP-97-06367 CDM C1713 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.7 X 20MM ZERO PROFILE SUP-97-06368 CDM C1713 HCPCS 0278 RC outpatient 200 200 200 57 114 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 51 102 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACCOLADE DISTAL SPACER SUP-97-06369 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4 X 10MM VAL KREULOCK TI SUP-97-06371 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LEFT LONG 7 HOLE SUP-97-06372 CDM C1713 HCPCS 0278 RC outpatient 3187.5 3187.5 3187.5 57 1816.88 percent of total billed charges 3187.5 93 2581.88 percent of total billed charges 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 51 1625.63 percent of total billed charges 3187.5 3187.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATELLA ALL POLY VE 29MM SUP-97-06373 CDM C1776 HCPCS 0278 RC outpatient 2172 2172 2172 57 1238.04 percent of total billed charges 2172 93 1759.32 percent of total billed charges 2172 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2172 other OPPS APC 2172 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2172 other OPPS APC 2172 51 1107.72 percent of total billed charges 2172 2172 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESTORATION MODULAR HIP SYSTEM 17 X 115MM SUP-97-06374 CDM C1776 HCPCS 0278 RC outpatient 7313 7313 7313 57 4168.41 percent of total billed charges 7313 93 5923.53 percent of total billed charges 7313 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7313 other OPPS APC 7313 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7313 other OPPS APC 7313 51 3729.63 percent of total billed charges 7313 7313 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT II CLUSTERHOLE HA 46C SUP-97-06375 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CELLERATE RX ACTIVATED COLLAGEN 5G SUP-97-06376 CDM 0272 RC outpatient 3737.5 3737.5 3737.5 74 2765.75 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 3737.5 other OPPS APC 3737.5 3737.5 other OPPS APC 3737.5 27.63 1032.67 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CELLERATE RX ACTIVATED COLLAGEN 1G SUP-97-06377 CDM 0272 RC outpatient 1485 1485 1485 74 1098.9 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 1485 other OPPS APC 1485 1485 other OPPS APC 1485 27.63 410.31 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5 X 34MM CANNULATED PT ASNIS TI SUP-97-06378 CDM C1713 HCPCS 0278 RC outpatient 435.68 435.68 435.68 57 248.34 percent of total billed charges 435.68 93 352.9 percent of total billed charges 435.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 435.68 other OPPS APC 435.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 435.68 other OPPS APC 435.68 51 222.2 percent of total billed charges 435.68 435.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5 X 55MM CANNULATED PT ASNIS TI SUP-97-06379 CDM C1713 HCPCS 0278 RC outpatient 435.68 435.68 435.68 57 248.34 percent of total billed charges 435.68 93 352.9 percent of total billed charges 435.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 435.68 other OPPS APC 435.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 435.68 other OPPS APC 435.68 51 222.2 percent of total billed charges 435.68 435.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 14HOLE LEFT FEMORAL DISTAL LATERAL SUP-97-06380 CDM C1713 HCPCS 0278 RC outpatient 4080.25 4080.25 4080.25 57 2325.74 percent of total billed charges 4080.25 93 3305 percent of total billed charges 4080.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4080.25 other OPPS APC 4080.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4080.25 other OPPS APC 4080.25 51 2080.93 percent of total billed charges 4080.25 4080.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE OLECRANON RIGHT 2 HOLE SUP-97-06381 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 70MM METAPHYSEAL SUP-97-06382 CDM C1713 HCPCS 0278 RC outpatient 195.88 195.88 195.88 57 111.65 percent of total billed charges 195.88 93 158.66 percent of total billed charges 195.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 195.88 other OPPS APC 195.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 195.88 other OPPS APC 195.88 51 99.9 percent of total billed charges 195.88 195.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 6 HOLE PROXIMAL LATERAL TIBIA LEFT SUP-97-06383 CDM C1713 HCPCS 0278 RC outpatient 3116.95 3116.95 3116.95 57 1776.66 percent of total billed charges 3116.95 93 2524.73 percent of total billed charges 3116.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3116.95 other OPPS APC 3116.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3116.95 other OPPS APC 3116.95 51 1589.64 percent of total billed charges 3116.95 3116.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PINNACLE SECTOR II CUP 52MM SUP-97-06384 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE SCREW 6.5 X 15MM SUP-97-06385 CDM C1776 HCPCS 0278 RC outpatient 238 238 238 57 135.66 percent of total billed charges 238 93 192.78 percent of total billed charges 238 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238 other OPPS APC 238 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 238 other OPPS APC 238 51 121.38 percent of total billed charges 238 238 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALTRX NEW 36ID X 52OD SUP-97-06386 CDM C1776 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DELTA CER HEAD 12/14 36MM +5 SUP-97-06387 CDM C1776 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX NON LOCKING 3.5MM X 85MM SUP-97-06388 CDM C1713 HCPCS 0278 RC outpatient 97.28 97.28 97.28 57 55.45 percent of total billed charges 97.28 93 78.8 percent of total billed charges 97.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.28 other OPPS APC 97.28 97.28 other OPPS APC 97.28 51 49.61 percent of total billed charges 97.28 97.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW T8 FULL THREAD 2.4 X 46MM SUP-97-06389 CDM C1713 HCPCS 0278 RC outpatient 362.6 362.6 362.6 57 206.68 percent of total billed charges 362.6 93 293.71 percent of total billed charges 362.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 362.6 other OPPS APC 362.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 362.6 other OPPS APC 362.6 51 184.93 percent of total billed charges 362.6 362.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU225 17.5D SUP-97-0639 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2.7 X 108MM 12 HOLES BROAD LOCK SUP-97-06390 CDM C1713 HCPCS 0278 RC outpatient 2714.4 2714.4 2714.4 57 1547.21 percent of total billed charges 2714.4 93 2198.66 percent of total billed charges 2714.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2714.4 other OPPS APC 2714.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2714.4 other OPPS APC 2714.4 51 1384.34 percent of total billed charges 2714.4 2714.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 2.4 X 69MM 10 HOLES NARROW LOCK SUP-97-06391 CDM C1713 HCPCS 0278 RC outpatient 2150.4 2150.4 2150.4 57 1225.73 percent of total billed charges 2150.4 93 1741.82 percent of total billed charges 2150.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2150.4 other OPPS APC 2150.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2150.4 other OPPS APC 2150.4 51 1096.7 percent of total billed charges 2150.4 2150.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREWDRIVER BLADE T8 AO SELF RETAINING SUP-97-06392 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 32MM CANNULATED SHORT THREAD LOW PROFILE SS SUP-97-06393 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. END CAP 10MM THREADED FLEX THREAD SUP-97-06394 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACCOLADE C CS 127 NK SUP-97-06395 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL COMPONENT SIZE 3 9MM PS ALL POLY TRIATHLON SUP-97-06396 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE RIGHT 4 HOLE LOCKING DISTAL FIBULA TI SUP-97-06397 CDM C1713 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE CLAVICLE 5H RIGHT SUP ANT W/ LAT EXTN SUP-97-06398 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL T2 ANKLE ATHRODESIS RIGHT 12 X 150MM SUP-97-06399 CDM C1713 HCPCS 0278 RC outpatient 3615.75 3615.75 3615.75 57 2060.98 percent of total billed charges 3615.75 93 2928.76 percent of total billed charges 3615.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3615.75 other OPPS APC 3615.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3615.75 other OPPS APC 3615.75 51 1844.03 percent of total billed charges 3615.75 3615.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT X3 POLY 31MM TRIATHLON TS SUP-97-06400 CDM outpatient 5612.5 5612.5 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VAL KREULOCK TI 3.0 X 10 SUP-97-06401 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VAL KREULOCK TI 3.0 X 22 SUP-97-06402 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VAL KREULOCK TI 3.0 X 24 SUP-97-06403 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VAL KREULOCK TI 3.0 X 26 SUP-97-06404 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VAL KREULOCK TI 3.0 X 28 SUP-97-06405 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VAL KREULOCK TI 3.0 X 30 SUP-97-06406 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VAL KREULOCK TI 3.0 X 32 SUP-97-06407 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VAL KREULOCK TI 3.0 X 34 SUP-97-06408 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VAL KREULOCK TI 3.0 X 36 SUP-97-06409 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VAL KREULOCK TI 3.0 X 38 SUP-97-06410 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW VAL KREULOCK TI 3.0 X 40 SUP-97-06411 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 FULLY THREADED LAPIPLASTY SUP-97-06412 CDM C1713 HCPCS 0278 RC outpatient 1725 1725 1725 57 983.25 percent of total billed charges 1725 93 1397.25 percent of total billed charges 1725 1725 other OPPS APC 1725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1725 other OPPS APC 1725 51 879.75 percent of total billed charges 1725 1725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 4 HOLE 55MM VARIAX COMPRESSION STRAIGHT BROAD SUP-97-06413 CDM C1713 HCPCS 0278 RC outpatient 995.28 995.28 995.28 57 567.31 percent of total billed charges 995.28 93 806.18 percent of total billed charges 995.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 995.28 other OPPS APC 995.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 995.28 other OPPS APC 995.28 51 507.59 percent of total billed charges 995.28 995.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 5 HOLE 67MM VARIAX COMPRESSION STRAIGHT BROAD SUP-97-06414 CDM C1713 HCPCS 0278 RC outpatient 1321.32 1321.32 1321.32 57 753.15 percent of total billed charges 1321.32 93 1070.27 percent of total billed charges 1321.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1321.32 other OPPS APC 1321.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1321.32 other OPPS APC 1321.32 51 673.87 percent of total billed charges 1321.32 1321.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 7 HOLE 91MM WITH 2 LOCKING HOLES VARIAX COMPRESSION STRAIGHT BROAD SUP-97-06415 CDM C1713 HCPCS 0278 RC outpatient 1321.32 1321.32 1321.32 57 753.15 percent of total billed charges 1321.32 93 1070.27 percent of total billed charges 1321.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1321.32 other OPPS APC 1321.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1321.32 other OPPS APC 1321.32 51 673.87 percent of total billed charges 1321.32 1321.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 10 HOLE 127MM VARIAX COMPRESSION BROAD SUP-97-06416 CDM C1713 HCPCS 0278 RC outpatient 1939.08 1939.08 1939.08 57 1105.28 percent of total billed charges 1939.08 93 1570.65 percent of total billed charges 1939.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1939.08 other OPPS APC 1939.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1939.08 other OPPS APC 1939.08 51 988.93 percent of total billed charges 1939.08 1939.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 11 HOLE 139MM VARIAX COMPRESSION CURVED BROAD SUP-97-06417 CDM C1713 HCPCS 0278 RC outpatient 2305.68 2305.68 2305.68 57 1314.24 percent of total billed charges 2305.68 93 1867.6 percent of total billed charges 2305.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2305.68 other OPPS APC 2305.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2305.68 other OPPS APC 2305.68 51 1175.9 percent of total billed charges 2305.68 2305.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 14 HOLE 175MM VARIAX COMPRESSION CURVED BROAD SUP-97-06418 CDM C1713 HCPCS 0278 RC outpatient 2305.68 2305.68 2305.68 57 1314.24 percent of total billed charges 2305.68 93 1867.6 percent of total billed charges 2305.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2305.68 other OPPS APC 2305.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2305.68 other OPPS APC 2305.68 51 1175.9 percent of total billed charges 2305.68 2305.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 12 HOLE 151MM VARIAX COMPRESSION CURVED BROAD SUP-97-06419 CDM C1713 HCPCS 0278 RC outpatient 2305.68 2305.68 2305.68 57 1314.24 percent of total billed charges 2305.68 93 1867.6 percent of total billed charges 2305.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2305.68 other OPPS APC 2305.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2305.68 other OPPS APC 2305.68 51 1175.9 percent of total billed charges 2305.68 2305.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 16 HOLE VARIAX STRAIGHT SUP-97-06420 CDM C1713 HCPCS 0278 RC outpatient 1726.92 1726.92 1726.92 57 984.34 percent of total billed charges 1726.92 93 1398.81 percent of total billed charges 1726.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1726.92 other OPPS APC 1726.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1726.92 other OPPS APC 1726.92 51 880.73 percent of total billed charges 1726.92 1726.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT X3 TRIATHLON PS #5 12MM SUP-97-06421 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 7 X 90MM HEADLESS COMPRESSION SHORT THREAD SUP-97-06422 CDM C1713 HCPCS 0278 RC outpatient 1970.64 1970.64 1970.64 57 1123.26 percent of total billed charges 1970.64 93 1596.22 percent of total billed charges 1970.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1970.64 other OPPS APC 1970.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1970.64 other OPPS APC 1970.64 51 1005.03 percent of total billed charges 1970.64 1970.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSN ASF PS 10MM VE L 10-12-GH SUP-97-06423 CDM C1776 HCPCS 0278 RC outpatient 3670 3670 3670 57 2091.9 percent of total billed charges 3670 93 2972.7 percent of total billed charges 3670 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3670 other OPPS APC 3670 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3670 other OPPS APC 3670 51 1871.7 percent of total billed charges 3670 3670 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT HIATAL HERNIA GORE BIO-A SUP-97-06424 CDM C1781 HCPCS 0278 RC outpatient 1530 1530 1530 57 872.1 percent of total billed charges 1530 93 1239.3 percent of total billed charges 1530 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1530 other OPPS APC 1530 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1530 other OPPS APC 1530 51 780.3 percent of total billed charges 1530 1530 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE 15 X 12 EASYFUSE SUP-97-06425 CDM C1713 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4 X 18MM VAL KREULOCK TI SUP-97-06426 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4 X 20MM VAL KREULOCK TI SUP-97-06427 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4 X 22MM VAL KREULOCK TI SUP-97-06428 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE 9 X 30MM BC VENTED SUP-97-06429 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 14MM LOW PROFILE LOCKING SUP-97-06430 CDM C1713 HCPCS 0278 RC outpatient 297.5 297.5 297.5 57 169.58 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 51 151.73 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 20MM LOW PROFILE LOCKING SUP-97-06431 CDM C1713 HCPCS 0278 RC outpatient 297.5 297.5 297.5 57 169.58 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 51 151.73 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE NARROW RIGHT 3 HOLE VOLAR DISTAL RADIUS TI SUP-97-06432 CDM C1713 HCPCS 0278 RC outpatient 2385 2385 2385 57 1359.45 percent of total billed charges 2385 93 1931.85 percent of total billed charges 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 51 1216.35 percent of total billed charges 2385 2385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIGHTROPE II BTB WITH DEPLOYING SUTURE SUP-97-06433 CDM C1713 HCPCS 0278 RC outpatient 1635 1635 1635 57 931.95 percent of total billed charges 1635 93 1324.35 percent of total billed charges 1635 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1635 other OPPS APC 1635 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1635 other OPPS APC 1635 51 833.85 percent of total billed charges 1635 1635 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU450 19.0D SUP-97-06434 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 6 X 95MM CANCELLOUS FULL THREAD SUP-97-06435 CDM C1713 HCPCS 0278 RC outpatient 124.64 124.64 124.64 57 71.04 percent of total billed charges 124.64 93 100.96 percent of total billed charges 124.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 124.64 other OPPS APC 124.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 124.64 other OPPS APC 124.64 51 63.57 percent of total billed charges 124.64 124.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5 X 55MM CORTEX SUP-97-06436 CDM C1713 HCPCS 0278 RC outpatient 110.96 110.96 110.96 57 63.25 percent of total billed charges 110.96 93 89.88 percent of total billed charges 110.96 110.96 other OPPS APC 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 51 56.59 percent of total billed charges 110.96 110.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5 X 70MM CORTEX SUP-97-06437 CDM C1713 HCPCS 0278 RC outpatient 110.96 110.96 110.96 57 63.25 percent of total billed charges 110.96 93 89.88 percent of total billed charges 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 51 56.59 percent of total billed charges 110.96 110.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 5.0 X 65MM SUP-97-06438 CDM C1713 HCPCS 0278 RC outpatient 434.91 434.91 434.91 57 247.9 percent of total billed charges 434.91 93 352.28 percent of total billed charges 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 51 221.8 percent of total billed charges 434.91 434.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HD SCORPION LNT SYSTEM 4.75 BC SWIVELOCK SUP-97-06439 CDM C1713 HCPCS 0278 RC outpatient 2265 2265 2265 57 1291.05 percent of total billed charges 2265 93 1834.65 percent of total billed charges 2265 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2265 other OPPS APC 2265 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2265 other OPPS APC 2265 51 1155.15 percent of total billed charges 2265 2265 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK PATELLOFEMORAL R SZ2 SUP-97-06440 CDM C1766 CPT 0278 RC outpatient 5250 5250 5250 57 2992.5 percent of total billed charges 5250 93 4252.5 percent of total billed charges 5250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5250 other OPPS APC 5250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5250 other OPPS APC 5250 51 2677.5 percent of total billed charges 5250 5250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT MCK TIBIAL ONLAY SZ 7-8MM SUP-97-06441 CDM C1776 HCPCS 0278 RC outpatient 1920 1920 1920 57 1094.4 percent of total billed charges 1920 93 1555.2 percent of total billed charges 1920 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1920 other OPPS APC 1920 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1920 other OPPS APC 1920 51 979.2 percent of total billed charges 1920 1920 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASEPLATE MCK TIBIAL RM/LL SZ 7 SUP-97-06442 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE MTP 0 DEGREE SHORT LEFT SUP-97-06443 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT 32MM 0 DEGREE TRIDENT X3 SUP-97-06444 CDM C1776 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LONG NAIL KIT 11 X 340MM GAMMA 3 SUP-97-06445 CDM C1713 HCPCS 0278 RC outpatient 3477 3477 3477 57 1981.89 percent of total billed charges 3477 93 2816.37 percent of total billed charges 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477 other OPPS APC 3477 51 1773.27 percent of total billed charges 3477 3477 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.4 X 24MM VAL KREULOCK TI SUP-97-06465 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 18MM KREULOCK TI SUP-97-06466 CDM C1713 HCPCS 0278 RC outpatient 885 885 885 57 504.45 percent of total billed charges 885 93 716.85 percent of total billed charges 885 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 51 451.35 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE COTTON 7MM SUP-97-06467 CDM C1762 HCPCS 0278 RC outpatient 3403.13 3403.13 3403.13 57 1939.78 percent of total billed charges 3403.13 93 2756.54 percent of total billed charges 3403.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3403.13 other OPPS APC 3403.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3403.13 other OPPS APC 3403.13 51 1735.6 percent of total billed charges 3403.13 3403.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE EVANS 10MM 25DEGREE SUP-97-06468 CDM C1713 HCPCS 0278 RC outpatient 4056.25 4056.25 4056.25 57 2312.06 percent of total billed charges 4056.25 93 3285.56 percent of total billed charges 4056.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4056.25 other OPPS APC 4056.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4056.25 other OPPS APC 4056.25 51 2068.69 percent of total billed charges 4056.25 4056.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5.5 X 50MM HEADLESS CANNULATED SHORT THREAD MONSTER SUP-97-06469 CDM C1713 HCPCS 0278 RC outpatient 940.95 940.95 940.95 57 536.34 percent of total billed charges 940.95 93 762.17 percent of total billed charges 940.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 940.95 other OPPS APC 940.95 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 940.95 other OPPS APC 940.95 51 479.88 percent of total billed charges 940.95 940.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD 28MM/0 C-TAPER BIOLOX DELTA SUP-97-06470 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 32MM HEADLESS CANNULATED SHORT THREAD MINI MONSTER SUP-97-06471 CDM C1713 HCPCS 0278 RC outpatient 668.15 668.15 668.15 57 380.85 percent of total billed charges 668.15 93 541.2 percent of total billed charges 668.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 668.15 other OPPS APC 668.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 668.15 other OPPS APC 668.15 51 340.76 percent of total billed charges 668.15 668.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 10MM LOCKING PLATE R3CON SUP-97-06472 CDM C1713 HCPCS 0278 RC outpatient 531.3 531.3 531.3 57 302.84 percent of total billed charges 531.3 93 430.35 percent of total billed charges 531.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 531.3 other OPPS APC 531.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 531.3 other OPPS APC 531.3 51 270.96 percent of total billed charges 531.3 531.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 42MM HEADLESS SHORT THREAD SUP-97-06473 CDM C1713 HCPCS 0278 RC outpatient 668.15 668.15 668.15 57 380.85 percent of total billed charges 668.15 93 541.2 percent of total billed charges 668.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 668.15 other OPPS APC 668.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 668.15 other OPPS APC 668.15 51 340.76 percent of total billed charges 668.15 668.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.2 X 24MM LOCKING PLATE R3CON SUP-97-06474 CDM C1713 HCPCS 0278 RC outpatient 386.4 386.4 386.4 57 220.25 percent of total billed charges 386.4 93 312.98 percent of total billed charges 386.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 386.4 other OPPS APC 386.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 386.4 other OPPS APC 386.4 51 197.06 percent of total billed charges 386.4 386.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBIAL BASEPLATE-RM/LL-SZ 2 SUP-97-06475 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBIAL ONLY INSERT SZ 2-8MM SUP-97-06476 CDM C1776 HCPCS 0278 RC outpatient 1920 1920 1920 57 1094.4 percent of total billed charges 1920 93 1555.2 percent of total billed charges 1920 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1920 other OPPS APC 1920 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1920 other OPPS APC 1920 51 979.2 percent of total billed charges 1920 1920 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT II CLUSTERHOLE HA 50D SUP-97-06477 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE FIBERTAPE 2MM 17IN BLUE SUP-97-06478 CDM C1713 HCPCS 0278 RC outpatient 266 266 266 57 151.62 percent of total billed charges 266 93 215.46 percent of total billed charges 266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 266 other OPPS APC 266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 266 other OPPS APC 266 51 135.66 percent of total billed charges 266 266 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.5 X 20MM CORTEX SUP-97-06479 CDM C1713 HCPCS 0278 RC outpatient 110.96 110.96 110.96 57 63.25 percent of total billed charges 110.96 93 89.88 percent of total billed charges 110.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 110.96 other OPPS APC 110.96 110.96 other OPPS APC 110.96 51 56.59 percent of total billed charges 110.96 110.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5 X 44MM LOCKING AXSOS SUP-97-06480 CDM C1713 HCPCS 0278 RC outpatient 434.91 434.91 434.91 57 247.9 percent of total billed charges 434.91 93 352.28 percent of total billed charges 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434.91 other OPPS APC 434.91 51 221.8 percent of total billed charges 434.91 434.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU150 13.0D SUP-97-06481 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.7 X 28MM METAPHYSEAL SUP-97-06482 CDM C1713 HCPCS 0278 RC outpatient 195.88 195.88 195.88 57 111.65 percent of total billed charges 195.88 93 158.66 percent of total billed charges 195.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 195.88 other OPPS APC 195.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 195.88 other OPPS APC 195.88 51 99.9 percent of total billed charges 195.88 195.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 5 X 50MM HEADLESS COMPRESSION SUP-97-06483 CDM C1713 HCPCS 0278 RC outpatient 1221.36 1221.36 1221.36 57 696.18 percent of total billed charges 1221.36 93 989.3 percent of total billed charges 1221.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1221.36 other OPPS APC 1221.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1221.36 other OPPS APC 1221.36 51 622.89 percent of total billed charges 1221.36 1221.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.5 X 50MM HEADLESS CANNULATES SHORT THREAD MINI MONSTER SUP-97-06484 CDM C1713 HCPCS 0278 RC outpatient 668.15 668.15 668.15 57 380.85 percent of total billed charges 668.15 93 541.2 percent of total billed charges 668.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 668.15 other OPPS APC 668.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 668.15 other OPPS APC 668.15 51 340.76 percent of total billed charges 668.15 668.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 0 DEGREE LONG LEFT MTP SUP-97-06485 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 12MM LOCKING LOW PROFILE SUP-97-06486 CDM C1713 HCPCS 0278 RC outpatient 297.5 297.5 297.5 57 169.58 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 51 151.73 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE MEDIAL DISTAL TIBIAL 6 HOLE LEFT 2.7/3.5MM SUP-97-06487 CDM C1713 HCPCS 0278 RC outpatient 4660.5 4660.5 4660.5 57 2656.49 percent of total billed charges 4660.5 93 3775.01 percent of total billed charges 4660.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4660.5 other OPPS APC 4660.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4660.5 other OPPS APC 4660.5 51 2376.86 percent of total billed charges 4660.5 4660.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 20MM LOCKING VA SUP-97-06488 CDM C1713 HCPCS 0278 RC outpatient 623.35 623.35 623.35 57 355.31 percent of total billed charges 623.35 93 504.91 percent of total billed charges 623.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 623.35 other OPPS APC 623.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 623.35 other OPPS APC 623.35 51 317.91 percent of total billed charges 623.35 623.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 22MM LOCKING VA SUP-97-06489 CDM C1713 HCPCS 0278 RC outpatient 623.35 623.35 623.35 57 355.31 percent of total billed charges 623.35 93 504.91 percent of total billed charges 623.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 623.35 other OPPS APC 623.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 623.35 other OPPS APC 623.35 51 317.91 percent of total billed charges 623.35 623.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 22MM CORTEX HD LOW PROFILE SELF TAPPING STARDRIVE SUP-97-06490 CDM C1713 HCPCS 0278 RC outpatient 169 169 169 57 96.33 percent of total billed charges 169 93 136.89 percent of total billed charges 169 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 169 other OPPS APC 169 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 169 other OPPS APC 169 51 86.19 percent of total billed charges 169 169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.5 X 38MM CORTEX HD LOW PROFILE SELF TAPPING STARDRIVE SUP-97-06491 CDM C1713 HCPCS 0278 RC outpatient 169 169 169 57 96.33 percent of total billed charges 169 93 136.89 percent of total billed charges 169 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 169 other OPPS APC 169 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 169 other OPPS APC 169 51 86.19 percent of total billed charges 169 169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CANN COMP HEADLESS 3.0MM X 10MM SUP-97-06492 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXIGRAFT CANNULATED REVISION DOWEL 10MM DIAMETER SUP-97-06493 CDM C1762 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXIGRAFT CANNULATED REVISION DOWEL 11MM DIAMETER SUP-97-06494 CDM C1762 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXIGRAFT CANNULATED REVISION DOWEL 12MM DIAMETER SUP-97-06495 CDM C1762 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG THREADED LOCKING 2.7 X 24MM SUP-97-06496 CDM C1713 HCPCS 0278 RC outpatient 252 252 252 57 143.64 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 51 128.52 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TENDON GRAFTLINK XL SUP-97-06497 CDM C1762 HCPCS 0278 RC outpatient 6450 6450 6450 57 3676.5 percent of total billed charges 6450 93 5224.5 percent of total billed charges 6450 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6450 other OPPS APC 6450 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6450 other OPPS APC 6450 51 3289.5 percent of total billed charges 6450 6450 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI POST AUGMENT SIZE 2 5MM SUP-97-06498 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI TS FEMUR SIZE 2 RIGHT SUP-97-06499 CDM C1776 HCPCS 0278 RC outpatient 12280.8 12280.8 12280.8 57 7000.06 percent of total billed charges 12280.8 93 9947.45 percent of total billed charges 12280.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.8 other OPPS APC 12280.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.8 other OPPS APC 12280.8 51 6263.21 percent of total billed charges 12280.8 12280.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON FEMORAL DISTAL AUGMENT 5MM SUP-97-06500 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT X3 POLY 13MM SUP-97-06501 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUPLING PIN TO ROD APEX PINS 4/5/6MM AND RODS 5/8/11MM SUP-97-06502 CDM C1713 HCPCS 0278 RC outpatient 2217.6 2217.6 2217.6 57 1264.03 percent of total billed charges 2217.6 93 1796.26 percent of total billed charges 2217.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2217.6 other OPPS APC 2217.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2217.6 other OPPS APC 2217.6 51 1130.98 percent of total billed charges 2217.6 2217.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON FEMORAL DISTAL AUGMENT 5MM SIZE 1 RIGHT SUP-97-06503 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 25MM SUP-97-06504 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIALTHLON TS FEMUR SIZE 1 RIGHT SUP-97-06505 CDM C1776 HCPCS 0278 RC outpatient 12280.2 12280.2 12280.2 57 6999.71 percent of total billed charges 12280.2 93 9946.96 percent of total billed charges 12280.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.2 other OPPS APC 12280.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12280.2 other OPPS APC 12280.2 51 6262.9 percent of total billed charges 12280.2 12280.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 INSERT FOR MDM LINER SUP-97-06506 CDM C1776 HCPCS 0278 RC outpatient 2325 2325 2325 57 1325.25 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 51 1185.75 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU150 16.0D SUP-97-06507 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU300 33.5D SUP-97-06508 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU150 15.0D SUP-97-06509 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR KNOTLESS SWIVELOCK 4.75 X 19.1MM W/ TIGERTAPE SUP-97-06510 CDM C1713 HCPCS 0278 RC outpatient 1050 1050 1050 57 598.5 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 51 535.5 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 52MM CANNULATED COMPRESSION HEADLESS LONG THREAD SUP-97-06511 CDM C1713 HCPCS 0278 RC outpatient 1423.5 1423.5 1423.5 57 811.4 percent of total billed charges 1423.5 93 1153.04 percent of total billed charges 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1423.5 other OPPS APC 1423.5 51 725.99 percent of total billed charges 1423.5 1423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 16MM TI CANNULATED PARTIALLY THREADED SUP-97-06512 CDM C1713 HCPCS 0278 RC outpatient 396.48 396.48 396.48 57 225.99 percent of total billed charges 396.48 93 321.15 percent of total billed charges 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 396.48 other OPPS APC 396.48 51 202.2 percent of total billed charges 396.48 396.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU150 14.5D SUP-97-06513 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS CLAREON IOL 18.5D SUP-97-06514 CDM C1780 HCPCS 0278 RC outpatient 525 525 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYHANCE TORIC II DIU150 23.0D SUP-97-06515 CDM V2787 CPT 0278 RC outpatient 1785 1785 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0 X 18MM CAN COMP SCREW SUP-97-23601 CDM C1713 HCPCS 0278 RC outpatient 1007.64 1007.64 1007.64 57 574.35 percent of total billed charges 1007.64 93 816.19 percent of total billed charges 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1007.64 other OPPS APC 1007.64 51 513.9 percent of total billed charges 1007.64 1007.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 30MM COMPRESSION CANNULATED SUP-97-23602 CDM C1713 HCPCS 0278 RC outpatient 1165.92 1165.92 1165.92 57 664.57 percent of total billed charges 1165.92 93 944.4 percent of total billed charges 1165.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1165.92 other OPPS APC 1165.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1165.92 other OPPS APC 1165.92 51 594.62 percent of total billed charges 1165.92 1165.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4 X 32MM COMPRESSION CANNULATED SUP-97-23603 CDM C1713 HCPCS 0278 RC outpatient 1165.92 1165.92 1165.92 57 664.57 percent of total billed charges 1165.92 93 944.4 percent of total billed charges 1165.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1165.92 other OPPS APC 1165.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1165.92 other OPPS APC 1165.92 51 594.62 percent of total billed charges 1165.92 1165.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSS POLY LOCK PIN SUP-97-23619 CDM C1776 HCPCS 0278 RC outpatient 877.5 877.5 877.5 57 500.18 percent of total billed charges 877.5 93 710.78 percent of total billed charges 877.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 877.5 other OPPS APC 877.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 877.5 other OPPS APC 877.5 51 447.53 percent of total billed charges 877.5 877.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSS POLY FEMORAL BUSHING 2PK SUP-97-23620 CDM C1776 HCPCS 0278 RC outpatient 1665 1665 1665 57 949.05 percent of total billed charges 1665 93 1348.65 percent of total billed charges 1665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1665 other OPPS APC 1665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1665 other OPPS APC 1665 51 849.15 percent of total billed charges 1665 1665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSS AXLE SUP-97-23621 CDM C1776 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSS POLY TIBAL BUSHING SUP-97-23622 CDM C1776 HCPCS 0278 RC outpatient 1192.5 1192.5 1192.5 57 679.73 percent of total billed charges 1192.5 93 965.93 percent of total billed charges 1192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1192.5 other OPPS APC 1192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1192.5 other OPPS APC 1192.5 51 608.18 percent of total billed charges 1192.5 1192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSS CEMENTED IM STEM 12 X 150 SUP-97-23623 CDM C1776 HCPCS 0278 RC outpatient 5962.5 5962.5 5962.5 57 3398.63 percent of total billed charges 5962.5 93 4829.63 percent of total billed charges 5962.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5962.5 other OPPS APC 5962.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5962.5 other OPPS APC 5962.5 51 3040.88 percent of total billed charges 5962.5 5962.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSS 3CM RESURFACING RT SUP-97-23624 CDM C1776 HCPCS 0278 RC outpatient 19650 19650 19650 57 11200.5 percent of total billed charges 19650 93 15916.5 percent of total billed charges 19650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19650 other OPPS APC 19650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19650 other OPPS APC 19650 51 10021.5 percent of total billed charges 19650 19650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSS TIBIAL POLY BEARING 22 MM SUP-97-23625 CDM C1776 HCPCS 0278 RC outpatient 3731.25 3731.25 3731.25 57 2126.81 percent of total billed charges 3731.25 93 3022.31 percent of total billed charges 3731.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3731.25 other OPPS APC 3731.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3731.25 other OPPS APC 3731.25 51 1902.94 percent of total billed charges 3731.25 3731.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSS REINFORCED YOKE SUP-97-23626 CDM C1776 HCPCS 0278 RC outpatient 3487.5 3487.5 3487.5 57 1987.88 percent of total billed charges 3487.5 93 2824.88 percent of total billed charges 3487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3487.5 other OPPS APC 3487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3487.5 other OPPS APC 3487.5 51 1778.63 percent of total billed charges 3487.5 3487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSS NON-MOD TIB PLATE LONG 67 SUP-97-23627 CDM C1776 HCPCS 0278 RC outpatient 9165 9165 9165 57 5224.05 percent of total billed charges 9165 93 7423.65 percent of total billed charges 9165 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9165 other OPPS APC 9165 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9165 other OPPS APC 9165 51 4674.15 percent of total billed charges 9165 9165 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT II PSL CLUSTERHOLE HA 50D SUP-97-23628 CDM C1776 HCPCS 0278 RC outpatient 2160 2160 2160 57 1231.2 percent of total billed charges 2160 93 1749.6 percent of total billed charges 2160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2160 other OPPS APC 2160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2160 other OPPS APC 2160 51 1101.6 percent of total billed charges 2160 2160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK FEMORAL-RM-LL-SZ 3 SUP-97-23629 CDM C1776 HCPCS 0278 RC outpatient 3562.5 3562.5 3562.5 57 2030.63 percent of total billed charges 3562.5 93 2885.63 percent of total billed charges 3562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3562.5 other OPPS APC 3562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3562.5 other OPPS APC 3562.5 51 1816.88 percent of total billed charges 3562.5 3562.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBIAL BASEPLATE-RM/LL-SZ 3 SUP-97-23630 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.5MM LOW PROFILE HEX SCREW 55MM SUP-97-23631 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. V40 COCR LFIT HEAD 28MM/+12 SUP-97-23632 CDM C1776 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.0 X 19MM CAN. SCREW SUP-97-23633 CDM C1776 HCPCS 0278 RC outpatient 599.76 599.76 599.76 57 341.86 percent of total billed charges 599.76 93 485.81 percent of total billed charges 599.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 599.76 other OPPS APC 599.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 599.76 other OPPS APC 599.76 51 305.88 percent of total billed charges 599.76 599.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REST MOD PROX CONE BODY 19MM +10 SUP-97-23634 CDM C1776 HCPCS 0278 RC outpatient 8284 8284 8284 57 4721.88 percent of total billed charges 8284 93 6710.04 percent of total billed charges 8284 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8284 other OPPS APC 8284 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8284 other OPPS APC 8284 51 4224.84 percent of total billed charges 8284 8284 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REST MOD CONICAL DISTAL STEM 20MM X 155M SUP-97-23635 CDM C1776 HCPCS 0278 RC outpatient 5935 5935 5935 57 3382.95 percent of total billed charges 5935 93 4807.35 percent of total billed charges 5935 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5935 other OPPS APC 5935 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5935 other OPPS APC 5935 51 3026.85 percent of total billed charges 5935 5935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW GAP PLATE SUP-97-23636 CDM C1776 HCPCS 0278 RC outpatient 429.8 429.8 429.8 57 244.99 percent of total billed charges 429.8 93 348.14 percent of total billed charges 429.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 429.8 other OPPS APC 429.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 429.8 other OPPS APC 429.8 51 219.2 percent of total billed charges 429.8 429.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOOT ARCH 155 MM SUP-97-23637 CDM C1713 HCPCS 0278 RC outpatient 3530.8 3530.8 3530.8 57 2012.56 percent of total billed charges 3530.8 93 2859.95 percent of total billed charges 3530.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3530.8 other OPPS APC 3530.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3530.8 other OPPS APC 3530.8 51 1800.71 percent of total billed charges 3530.8 3530.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOOT RING LONG 155MM SUP-97-23638 CDM C1713 HCPCS 0278 RC outpatient 4060 4060 4060 57 2314.2 percent of total billed charges 4060 93 3288.6 percent of total billed charges 4060 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4060 other OPPS APC 4060 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4060 other OPPS APC 4060 51 2070.6 percent of total billed charges 4060 4060 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS X3 TIBAL INSERT SUP-97-23639 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS FEM COMPONENT BEADED W/PA SUP-97-23640 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NARROW HEADS 4 HOLE SHAFT RIGHT SUP-97-23641 CDM C1776 HCPCS 0278 RC outpatient 1881 1881 1881 57 1072.17 percent of total billed charges 1881 93 1523.61 percent of total billed charges 1881 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1881 other OPPS APC 1881 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1881 other OPPS APC 1881 51 959.31 percent of total billed charges 1881 1881 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK FEMORAL-RM-LL-SZ 5 SUP-97-23642 CDM C1776 HCPCS 0278 RC outpatient 3562.5 3562.5 3562.5 57 2030.63 percent of total billed charges 3562.5 93 2885.63 percent of total billed charges 3562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3562.5 other OPPS APC 3562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3562.5 other OPPS APC 3562.5 51 1816.88 percent of total billed charges 3562.5 3562.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBAL BASEPLATE-RM/LL-SZ 6 SUP-97-23643 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBAL ONLAY INSERT-SZ 6-9MM SUP-97-23644 CDM C1776 HCPCS 0278 RC outpatient 2280 2280 2280 57 1299.6 percent of total billed charges 2280 93 1846.8 percent of total billed charges 2280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2280 other OPPS APC 2280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2280 other OPPS APC 2280 51 1162.8 percent of total billed charges 2280 2280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMPONENT-BEADED W/PA SUP-97-23645 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE SCREW 3.5MM X 34MM SUP-97-23646 CDM C1776 HCPCS 0278 RC outpatient 210 210 210 57 119.7 percent of total billed charges 210 93 170.1 percent of total billed charges 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 210 other OPPS APC 210 51 107.1 percent of total billed charges 210 210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE LOCKING SCREW 3.5MM X 26MM SUP-97-23647 CDM C1713 HCPCS 0278 RC outpatient 525 525 525 57 299.25 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 51 267.75 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LISFRANC PLATE LARGE LEFT TI SUP-97-23648 CDM C1713 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM BEADED W/PA SUP-97-23650 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON CS INS SIZE5 9MM SUP-97-23651 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMPONENT CEMENTED SUP-97-23652 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACTIVAPIN 1.5 X 70MM SUP-97-23653 CDM C1713 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX M STEM NO.5 SUP-97-23654 CDM C1776 HCPCS 0278 RC outpatient 5000 5000 5000 57 2850 percent of total billed charges 5000 93 4050 percent of total billed charges 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 51 2550 percent of total billed charges 5000 5000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON X3 TIBAL BEARING PS SZ2 11MM SUP-97-23655 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT PSL HA CLUSTER 46MM SUP-97-23656 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIZE 1 ACCOLADE III 132 DEG SUP-97-23657 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.0 X 24MM CAN.SCREW TITAN. SUP-97-23658 CDM C1713 HCPCS 0278 RC outpatient 599.76 599.76 599.76 57 341.86 percent of total billed charges 599.76 93 485.81 percent of total billed charges 599.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 599.76 other OPPS APC 599.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 599.76 other OPPS APC 599.76 51 305.88 percent of total billed charges 599.76 599.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.0 X 30MM CAN. SCREW TITAN. SUP-97-23659 CDM C1713 HCPCS 0278 RC outpatient 599.76 599.76 599.76 57 341.86 percent of total billed charges 599.76 93 485.81 percent of total billed charges 599.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 599.76 other OPPS APC 599.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 599.76 other OPPS APC 599.76 51 305.88 percent of total billed charges 599.76 599.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAP AO 3.5MM SUP-97-23660 CDM 0272 RC outpatient 924 924 924 74 683.76 percent of total billed charges 924 93 748.44 percent of total billed charges 924 924 other OPPS APC 924 924 other OPPS APC 924 27.63 255.3 percent of total billed charges 924 924 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON CS INS SIZE5 11MM SUP-97-23661 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON CS INS SIZE5 9MM SUP-97-23662 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMPONENT BEADED W/PA SUP-97-23663 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMPONENT BEADED W/PA SUP-97-23664 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON CS INS SIZE4 11MM SUP-97-23665 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON TRTANIUM BASEPLATE SIZE 1 SUP-97-23666 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIRTHLON CR FEM COMPONENT BEADED W/PA SUP-97-23667 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIRTHLON CS INSERT #1 9MM SUP-97-23668 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7MM DRILL SUP-97-23669 CDM 0272 RC outpatient 542.5 542.5 542.5 74 401.45 percent of total billed charges 542.5 93 439.43 percent of total billed charges 542.5 542.5 other OPPS APC 542.5 542.5 other OPPS APC 542.5 27.63 149.89 percent of total billed charges 542.5 542.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MONSTER BITES BREAKOFF SCREW 3/4 THD2.7X SUP-97-23670 CDM C1713 HCPCS 0278 RC outpatient 816.9 816.9 816.9 57 465.63 percent of total billed charges 816.9 93 661.69 percent of total billed charges 816.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 816.9 other OPPS APC 816.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 816.9 other OPPS APC 816.9 51 416.62 percent of total billed charges 816.9 816.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JMF HOOKPLATE COMP 5 HOLE LEFT SUP-97-23671 CDM C1713 HCPCS 0278 RC outpatient 3990 3990 3990 57 2274.3 percent of total billed charges 3990 93 3231.9 percent of total billed charges 3990 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3990 other OPPS APC 3990 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3990 other OPPS APC 3990 51 2034.9 percent of total billed charges 3990 3990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BG LOCKING SCREW 2.5 X 14MM SUP-97-23672 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BG NON-LOCKING SCREW 2.5 X 30MM SUP-97-23673 CDM C1713 HCPCS 0278 RC outpatient 588 588 588 57 335.16 percent of total billed charges 588 93 476.28 percent of total billed charges 588 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 588 other OPPS APC 588 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 588 other OPPS APC 588 51 299.88 percent of total billed charges 588 588 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BG NON-LOCKING SCREW 2.5 X 34MM SUP-97-23674 CDM C1713 HCPCS 0278 RC outpatient 588 588 588 57 335.16 percent of total billed charges 588 93 476.28 percent of total billed charges 588 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 588 other OPPS APC 588 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 588 other OPPS APC 588 51 299.88 percent of total billed charges 588 588 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BG LOVKING SCREW 2.5 X 10MM SUP-97-23675 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BG LOCKING SCREW 2.5 X 08MM SUP-97-23676 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM 9MM X 2MM SUP-97-23677 CDM C1713 HCPCS 0278 RC outpatient 4025 4025 4025 57 2294.25 percent of total billed charges 4025 93 3260.25 percent of total billed charges 4025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4025 other OPPS APC 4025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4025 other OPPS APC 4025 51 2052.75 percent of total billed charges 4025 4025 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRIVER UNIVERSAL QC T-20 SUP-97-23678 CDM 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.5MM LOW PROFILE HEX SCREW 35MM SUP-97-23679 CDM C1776 HCPCS 0278 RC outpatient 0.01 0.01 0.01 57 0.01 percent of total billed charges 0.01 93 0.01 percent of total billed charges 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 0.01 other OPPS APC 0.01 51 0.01 percent of total billed charges 0.01 0.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK FEMORAL-LM-RL-SZ 4 SUP-97-23680 CDM C1776 HCPCS 0278 RC outpatient 3562.5 3562.5 3562.5 57 2030.63 percent of total billed charges 3562.5 93 2885.63 percent of total billed charges 3562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3562.5 other OPPS APC 3562.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3562.5 other OPPS APC 3562.5 51 1816.88 percent of total billed charges 3562.5 3562.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBIAL ONLAY INSERT-SZ 3-9MM SUP-97-23681 CDM C1776 HCPCS 0278 RC outpatient 2280 2280 2280 57 1299.6 percent of total billed charges 2280 93 1846.8 percent of total billed charges 2280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2280 other OPPS APC 2280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2280 other OPPS APC 2280 51 1162.8 percent of total billed charges 2280 2280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEUROMEND 6MM ID X 5.0CM LENGTH SUP-97-23682 CDM C1776 HCPCS 0278 RC outpatient 2118.75 2118.75 2118.75 57 1207.69 percent of total billed charges 2118.75 93 1716.19 percent of total billed charges 2118.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2118.75 other OPPS APC 2118.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2118.75 other OPPS APC 2118.75 51 1080.56 percent of total billed charges 2118.75 2118.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HAMMER TUBE IMPLANT 3.50MM 0CANNULATED SUP-97-23683 CDM C1776 HCPCS 0278 RC outpatient 2849.85 2849.85 2849.85 57 1624.41 percent of total billed charges 2849.85 93 2308.38 percent of total billed charges 2849.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2849.85 other OPPS APC 2849.85 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2849.85 other OPPS APC 2849.85 51 1453.42 percent of total billed charges 2849.85 2849.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THREADED ROD LENGTH: 120MM SUP-97-23684 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THREADED ROD-LENGTH: 80MM SUP-97-23685 CDM C1713 HCPCS 0278 RC outpatient 183.68 183.68 183.68 57 104.7 percent of total billed charges 183.68 93 148.78 percent of total billed charges 183.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 183.68 other OPPS APC 183.68 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 183.68 other OPPS APC 183.68 51 93.68 percent of total billed charges 183.68 183.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE W/OLIVE-DIA 2.0 X 450MM SUP-97-23686 CDM C1713 HCPCS 0278 RC outpatient 288.12 288.12 288.12 57 164.23 percent of total billed charges 288.12 93 233.38 percent of total billed charges 288.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 288.12 other OPPS APC 288.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 288.12 other OPPS APC 288.12 51 146.94 percent of total billed charges 288.12 288.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE 2MM X 450MM SUP-97-23687 CDM C1713 HCPCS 0278 RC outpatient 204.96 204.96 204.96 57 116.83 percent of total billed charges 204.96 93 166.02 percent of total billed charges 204.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 204.96 other OPPS APC 204.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 204.96 other OPPS APC 204.96 51 104.53 percent of total billed charges 204.96 204.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMP.CEMENTED SUP-97-23688 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON CS INS SIZE 4 11MM SUP-97-23689 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON CS INS SIZE 4 9MM SUP-97-23690 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMP. BEADED W/PA SUP-97-23691 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON CS INS SIZE 6 9MM SUP-97-23692 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0 X 26MM PART THD CAN. SUP-97-23693 CDM C1713 HCPCS 0278 RC outpatient 542.64 542.64 542.64 57 309.3 percent of total billed charges 542.64 93 439.54 percent of total billed charges 542.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.64 other OPPS APC 542.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.64 other OPPS APC 542.64 51 276.75 percent of total billed charges 542.64 542.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.8 COUNTERSINK SUP-97-23694 CDM 0272 RC outpatient 711.36 711.36 711.36 74 526.41 percent of total billed charges 711.36 93 576.2 percent of total billed charges 711.36 711.36 other OPPS APC 711.36 711.36 other OPPS APC 711.36 27.63 196.55 percent of total billed charges 711.36 711.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.1MM DRILL SUP-97-23695 CDM 0272 RC outpatient 243.6 243.6 243.6 74 180.26 percent of total billed charges 243.6 93 197.32 percent of total billed charges 243.6 243.6 other OPPS APC 243.6 243.6 other OPPS APC 243.6 27.63 67.31 percent of total billed charges 243.6 243.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONCIN EXT. SCREW SUP-97-23696 CDM C1713 HCPCS 0278 RC outpatient 239.4 239.4 239.4 57 136.46 percent of total billed charges 239.4 93 193.91 percent of total billed charges 239.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 239.4 other OPPS APC 239.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 239.4 other OPPS APC 239.4 51 122.09 percent of total billed charges 239.4 239.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACE REAMER TUBE SUP-97-23697 CDM 0272 RC outpatient 696.26 696.26 696.26 74 515.23 percent of total billed charges 696.26 93 563.97 percent of total billed charges 696.26 696.26 other OPPS APC 696.26 696.26 other OPPS APC 696.26 27.63 192.38 percent of total billed charges 696.26 696.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 04.034.455S SUP-97-23698 CDM C1713 HCPCS 0278 RC outpatient 3621.75 3621.75 3621.75 57 2064.4 percent of total billed charges 3621.75 93 2933.62 percent of total billed charges 3621.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3621.75 other OPPS APC 3621.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3621.75 other OPPS APC 3621.75 51 1847.09 percent of total billed charges 3621.75 3621.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 04.038.415S SUP-97-23699 CDM C1713 HCPCS 0278 RC outpatient 2304 2304 2304 57 1313.28 percent of total billed charges 2304 93 1866.24 percent of total billed charges 2304 2304 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HELICAL BLADE 115MM TFNA SUP-97-23699 CDM C1713 HCPCS 0278 RC outpatient 2304 2304 2304 2304 other OPPS APC 2304 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2304 other OPPS APC 2304 51 1175.04 percent of total billed charges 2304 2304 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.0 X 65MM PT.THD.CAN.SCREW SUP-97-23700 CDM C1713 HCPCS 0278 RC outpatient 542.64 542.64 542.64 57 309.3 percent of total billed charges 542.64 93 439.54 percent of total billed charges 542.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.64 other OPPS APC 542.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.64 other OPPS APC 542.64 51 276.75 percent of total billed charges 542.64 542.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW HEADLESS COMPRESSION CANNULATED 4.0 X 50MM SUP-97-23701 CDM C1713 HCPCS 0278 RC outpatient 1165.92 1165.92 1165.92 57 664.57 percent of total billed charges 1165.92 93 944.4 percent of total billed charges 1165.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1165.92 other OPPS APC 1165.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1165.92 other OPPS APC 1165.92 51 594.62 percent of total billed charges 1165.92 1165.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT II TRITANIUM CLUSTERHOLE 62G SUP-97-23702 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMPONENT BEADED W/PA SUP-97-23703 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON PS FEM COMPONENT BEADED W/PA SUP-97-23704 CDM C1776 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NO.8 TRIATHLON TS PLUS TIB.INSERT X3 9MM SUP-97-23705 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSN ASF CPS 18MM VE R 3-5CD SUP-97-23706 CDM C1776 HCPCS 0278 RC outpatient 4370 4370 4370 57 2490.9 percent of total billed charges 4370 93 3539.7 percent of total billed charges 4370 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4370 other OPPS APC 4370 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4370 other OPPS APC 4370 51 2228.7 percent of total billed charges 4370 4370 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3MM BLUNT K WIRE SUP-97-23707 CDM 0272 RC outpatient 450.24 450.24 450.24 74 333.18 percent of total billed charges 450.24 93 364.69 percent of total billed charges 450.24 450.24 other OPPS APC 450.24 450.24 other OPPS APC 450.24 27.63 124.4 percent of total billed charges 450.24 450.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PSN TIB STM 5 DEG SZ F L SUP-97-23708 CDM C1776 HCPCS 0278 RC outpatient 3730 3730 3730 57 2126.1 percent of total billed charges 3730 93 3021.3 percent of total billed charges 3730 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3730 other OPPS APC 3730 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3730 other OPPS APC 3730 51 1902.3 percent of total billed charges 3730 3730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXGEN STR.STEM EXT 14MM DIA X145MM SUP-97-23709 CDM C1776 HCPCS 0278 RC outpatient 2570.4 2570.4 2570.4 57 1465.13 percent of total billed charges 2570.4 93 2082.02 percent of total billed charges 2570.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2570.4 other OPPS APC 2570.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2570.4 other OPPS APC 2570.4 51 1310.9 percent of total billed charges 2570.4 2570.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 36MM COCR MOD HD +3MM SUP-97-23710 CDM C1776 HCPCS 0278 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPOLY 36MM RLC LNR MROM SZ24 SUP-97-23711 CDM C1776 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXIS SCREW PECA 4MM LENGTH 46 SUP-97-23714 CDM C1713 HCPCS 0278 RC outpatient 1674.75 1674.75 1674.75 57 954.61 percent of total billed charges 1674.75 93 1356.55 percent of total billed charges 1674.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1674.75 other OPPS APC 1674.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1674.75 other OPPS APC 1674.75 51 854.12 percent of total billed charges 1674.75 1674.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REST MON CONICAL DISTAL STEM 16MM X 155M SUP-97-23715 CDM C1776 HCPCS 0278 RC outpatient 5935 5935 5935 57 3382.95 percent of total billed charges 5935 93 4807.35 percent of total billed charges 5935 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5935 other OPPS APC 5935 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5935 other OPPS APC 5935 51 3026.85 percent of total billed charges 5935 5935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 1.4X150MM K-WIRE SINGLE TROCAR TIP SMOOT SUP-97-23716 CDM C1713 HCPCS 0278 RC outpatient 84 84 84 57 47.88 percent of total billed charges 84 93 68.04 percent of total billed charges 84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84 other OPPS APC 84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84 other OPPS APC 84 51 42.84 percent of total billed charges 84 84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SINUS TARSI PLATE LEFT MEDIUM SUP-97-23717 CDM C1713 HCPCS 0278 RC outpatient 3806.25 3806.25 3806.25 57 2169.56 percent of total billed charges 3806.25 93 3083.06 percent of total billed charges 3806.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3806.25 other OPPS APC 3806.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3806.25 other OPPS APC 3806.25 51 1941.19 percent of total billed charges 3806.25 3806.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. R3CON NON-LOCKING PLATE SCREW 3.5X34MM SUP-97-23718 CDM C1713 HCPCS 0278 RC outpatient 420 420 420 57 239.4 percent of total billed charges 420 93 340.2 percent of total billed charges 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 51 214.2 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. R3CON LOCKING PLATE SCREW 4.2 X 20MM SUP-97-23719 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RCON LOCKING PLATE SCREW 3.5 X 30MM SUP-97-23720 CDM C1713 HCPCS 0278 RC outpatient 531.3 531.3 531.3 57 302.84 percent of total billed charges 531.3 93 430.35 percent of total billed charges 531.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 531.3 other OPPS APC 531.3 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 531.3 other OPPS APC 531.3 51 270.96 percent of total billed charges 531.3 531.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXIS SCREW PECA 3MM X 34 SUP-97-23721 CDM C1713 HCPCS 0278 RC outpatient 1506.6 1506.6 1506.6 57 858.76 percent of total billed charges 1506.6 93 1220.35 percent of total billed charges 1506.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1506.6 other OPPS APC 1506.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1506.6 other OPPS APC 1506.6 51 768.37 percent of total billed charges 1506.6 1506.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI PRESS-FIT STEM 13MM X 100MM SUP-97-23722 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OVER DRILL 2.1 X 90MM SOLID AO SUP-97-23723 CDM 0272 RC outpatient 542.5 542.5 542.5 74 401.45 percent of total billed charges 542.5 93 439.43 percent of total billed charges 542.5 542.5 other OPPS APC 542.5 542.5 other OPPS APC 542.5 27.63 149.89 percent of total billed charges 542.5 542.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BG NON-LOCKING SCREW 2.5 X 10MM SUP-97-23724 CDM C1713 HCPCS 0278 RC outpatient 588 588 588 57 335.16 percent of total billed charges 588 93 476.28 percent of total billed charges 588 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 588 other OPPS APC 588 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 588 other OPPS APC 588 51 299.88 percent of total billed charges 588 588 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI MONSTER HDED SHRT THRED 2X13M SUP-97-23725 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI MONSTER HD SHRT THRED 2X11MM SUP-97-23726 CDM C1713 HCPCS 0278 RC outpatient 507.5 507.5 507.5 57 289.28 percent of total billed charges 507.5 93 411.08 percent of total billed charges 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 507.5 other OPPS APC 507.5 51 258.83 percent of total billed charges 507.5 507.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BG LOCKING SCREW 2.0 X 08MM SUP-97-23727 CDM C1713 HCPCS 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JMF HOOK PLATE COMP. 6 HOLE LEFT SUP-97-23728 CDM C1713 HCPCS 0278 RC outpatient 3990 3990 3990 57 2274.3 percent of total billed charges 3990 93 3231.9 percent of total billed charges 3990 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3990 other OPPS APC 3990 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3990 other OPPS APC 3990 51 2034.9 percent of total billed charges 3990 3990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BG NON-LOCKING SCREW 2.5X32MM SUP-97-23729 CDM C1713 HCPCS 0278 RC outpatient 588 588 588 57 335.16 percent of total billed charges 588 93 476.28 percent of total billed charges 588 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 588 other OPPS APC 588 588 other OPPS APC 588 51 299.88 percent of total billed charges 588 588 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NO.7 TRIATHLON TS PLUS TIBIAL INSERT X3 9M SUP-97-23730 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NO.6 TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 31M SUP-97-23731 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL 1.7 X 120MM SOLID TROCAR TIP AO SUP-97-23732 CDM 0272 RC outpatient 542.5 542.5 542.5 74 401.45 percent of total billed charges 542.5 93 439.43 percent of total billed charges 542.5 542.5 other OPPS APC 542.5 542.5 other OPPS APC 542.5 27.63 149.89 percent of total billed charges 542.5 542.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. R3CON NON-LOCKING PLATE SCREW 3.5X36MM SUP-97-23733 CDM C1713 HCPCS 0278 RC outpatient 420 420 420 57 239.4 percent of total billed charges 420 93 340.2 percent of total billed charges 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 51 214.2 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON CS INS SIZE 4 13MM SUP-97-23734 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXIS SCREW PECA 04 LENGTH 42 SUP-97-23735 CDM C1713 HCPCS 0278 RC outpatient 1674.75 1674.75 1674.75 57 954.61 percent of total billed charges 1674.75 93 1356.55 percent of total billed charges 1674.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1674.75 other OPPS APC 1674.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1674.75 other OPPS APC 1674.75 51 854.12 percent of total billed charges 1674.75 1674.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXIS SCREW PECA 04 LENGTH 40 SUP-97-23736 CDM C1713 HCPCS 0278 RC outpatient 1674.75 1674.75 1674.75 57 954.61 percent of total billed charges 1674.75 93 1356.55 percent of total billed charges 1674.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1674.75 other OPPS APC 1674.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1674.75 other OPPS APC 1674.75 51 854.12 percent of total billed charges 1674.75 1674.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FDL IMPLANT SYSTEM 4.75MM SUP-97-23738 CDM C1713 HCPCS 0278 RC outpatient 3737.5 3737.5 3737.5 57 2130.38 percent of total billed charges 3737.5 93 3027.38 percent of total billed charges 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3737.5 other OPPS APC 3737.5 51 1906.13 percent of total billed charges 3737.5 3737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL CANNULATED 3.5 MM SUP-97-23739 CDM 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 612.5 other OPPS APC 612.5 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE SCREW TI 4.5MM X 55MM SUP-97-23740 CDM C1776 HCPCS 0278 RC outpatient 2385 2385 2385 57 1359.45 percent of total billed charges 2385 93 1931.85 percent of total billed charges 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 2385 other OPPS APC 2385 51 1216.35 percent of total billed charges 2385 2385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBAL TKA TIB STEM CM 12MMDX 100MM L SUP-97-23741 CDM C1776 HCPCS 0278 RC outpatient 1725 1725 1725 57 983.25 percent of total billed charges 1725 93 1397.25 percent of total billed charges 1725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1725 other OPPS APC 1725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1725 other OPPS APC 1725 51 879.75 percent of total billed charges 1725 1725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBAL TKA BEARING IMP PS SZ4 16MM SUP-97-23742 CDM C1776 HCPCS 0278 RC outpatient 2250 2250 2250 57 1282.5 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 51 1147.5 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBAL TKA TIB AUG-MENT SZE4 10MMRL/LM SUP-97-23743 CDM C1776 HCPCS 0278 RC outpatient 1575 1575 1575 57 897.75 percent of total billed charges 1575 93 1275.75 percent of total billed charges 1575 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1575 other OPPS APC 1575 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1575 other OPPS APC 1575 51 803.25 percent of total billed charges 1575 1575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBAL TKA TIB AUG-MENT SZE 4 10MMRM/LL SUP-97-23744 CDM C1776 HCPCS 0278 RC outpatient 1575 1575 1575 57 897.75 percent of total billed charges 1575 93 1275.75 percent of total billed charges 1575 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1575 other OPPS APC 1575 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1575 other OPPS APC 1575 51 803.25 percent of total billed charges 1575 1575 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IBALANCE TKA MODULAR TIBIAL TRAY SZ4 SUP-97-23745 CDM C1776 HCPCS 0278 RC outpatient 3087.5 3087.5 3087.5 57 1759.88 percent of total billed charges 3087.5 93 2500.88 percent of total billed charges 3087.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3087.5 other OPPS APC 3087.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3087.5 other OPPS APC 3087.5 51 1574.63 percent of total billed charges 3087.5 3087.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBIAL ONLAY INSERT-SZ6-8MM SUP-97-23746 CDM C1776 HCPCS 0278 RC outpatient 2280 2280 2280 57 1299.6 percent of total billed charges 2280 93 1846.8 percent of total billed charges 2280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2280 other OPPS APC 2280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2280 other OPPS APC 2280 51 1162.8 percent of total billed charges 2280 2280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON CS INS SZ 6 13MM SUP-97-23747 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS COMPRES SCREW 6.5X40MM SHT THD SUP-97-23748 CDM C1713 HCPCS 0278 RC outpatient 1725 1725 1725 57 983.25 percent of total billed charges 1725 93 1397.25 percent of total billed charges 1725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1725 other OPPS APC 1725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1725 other OPPS APC 1725 51 879.75 percent of total billed charges 1725 1725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEADLESS COMPRES SCREW 6.5X50MM SHT THD SUP-97-23749 CDM C1713 HCPCS 0278 RC outpatient 1725 1725 1725 57 983.25 percent of total billed charges 1725 93 1397.25 percent of total billed charges 1725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1725 other OPPS APC 1725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1725 other OPPS APC 1725 51 879.75 percent of total billed charges 1725 1725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOSYNC EVANS WEDGE 18MM X 18MM X10MM SUP-97-23750 CDM C1713 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE SCREW 2.4X22MM CORTEX SUP-97-23751 CDM C1713 HCPCS 0278 RC outpatient 385 385 385 57 219.45 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 51 196.35 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE VA LKG SCREW 2.4X12.0MM TI SUP-97-23752 CDM C1713 HCPCS 0278 RC outpatient 490 490 490 57 279.3 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 51 249.9 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE VA LKG SCREW 2.4X14.0MM TI SUP-97-23753 CDM C1713 HCPCS 0278 RC outpatient 490 490 490 57 279.3 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 490 other OPPS APC 490 51 249.9 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE VA LKG SCREW 2.4X18.0MM TI SUP-97-23754 CDM C1713 HCPCS 0278 RC outpatient 490 490 490 57 279.3 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 51 249.9 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.0MM DRILL BIT CMP FT CALIBRATED SUP-97-23755 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON CS INS SZ3 13MM SUP-97-23756 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LEFT 2MM LAPIDUS SUP-97-23757 CDM C1713 HCPCS 0278 RC outpatient 3178.75 3178.75 3178.75 57 1811.89 percent of total billed charges 3178.75 93 2574.79 percent of total billed charges 3178.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3178.75 other OPPS APC 3178.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3178.75 other OPPS APC 3178.75 51 1621.16 percent of total billed charges 3178.75 3178.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBIAL ONLAY INSERT-SZ 5-8MM SUP-97-23758 CDM C1776 HCPCS 0278 RC outpatient 2280 2280 2280 57 1299.6 percent of total billed charges 2280 93 1846.8 percent of total billed charges 2280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2280 other OPPS APC 2280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2280 other OPPS APC 2280 51 1162.8 percent of total billed charges 2280 2280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBIAL BASEPLATE-RM/LL-SZ 5 SUP-97-23759 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REVERSE/INVERSE SHOULDER SUP-97-23761 CDM C1776 HCPCS 0278 RC outpatient 16400 16400 16400 57 9348 percent of total billed charges 16400 93 13284 percent of total billed charges 16400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16400 other OPPS APC 16400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16400 other OPPS APC 16400 51 8364 percent of total billed charges 16400 16400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT II TRITANIUM CLUSTERHOLE 64H SUP-97-23763 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT 0 X3 INSERT 36MM ID SUP-97-23764 CDM C1776 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PINN M/H W/GRIPTION 58MM SUP-97-23765 CDM C1776 HCPCS 0278 RC outpatient 6766 6766 6766 57 3856.62 percent of total billed charges 6766 93 5480.46 percent of total billed charges 6766 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6766 other OPPS APC 6766 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6766 other OPPS APC 6766 51 3450.66 percent of total billed charges 6766 6766 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PINN CAN BONE SCREW 6.5MM X 35MM SUP-97-23766 CDM C1776 HCPCS 0278 RC outpatient 407.4 407.4 407.4 57 232.22 percent of total billed charges 407.4 93 329.99 percent of total billed charges 407.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 407.4 other OPPS APC 407.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 407.4 other OPPS APC 407.4 51 207.77 percent of total billed charges 407.4 407.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALTRX +4 10D 40IDX58OD SUP-97-23767 CDM C1776 HCPCS 0278 RC outpatient 4122 4122 4122 57 2349.54 percent of total billed charges 4122 93 3338.82 percent of total billed charges 4122 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4122 other OPPS APC 4122 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4122 other OPPS APC 4122 51 2102.22 percent of total billed charges 4122 4122 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DLT TS CER HD 12/14 40MM +8.5 SUP-97-23768 CDM C1776 HCPCS 0278 RC outpatient 4480 4480 4480 57 2553.6 percent of total billed charges 4480 93 3628.8 percent of total billed charges 4480 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4480 other OPPS APC 4480 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4480 other OPPS APC 4480 51 2284.8 percent of total billed charges 4480 4480 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DLT TS CER HD 12/14 40MM +12 SUP-97-23769 CDM C1776 HCPCS 0278 RC outpatient 4480 4480 4480 57 2553.6 percent of total billed charges 4480 93 3628.8 percent of total billed charges 4480 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4480 other OPPS APC 4480 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4480 other OPPS APC 4480 51 2284.8 percent of total billed charges 4480 4480 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.0 L31MM AO DRILL BIT CAUN.SINK SUP-97-23770 CDM 0272 RC outpatient 638.4 638.4 638.4 74 472.42 percent of total billed charges 638.4 93 517.1 percent of total billed charges 638.4 638.4 other OPPS APC 638.4 638.4 other OPPS APC 638.4 27.63 176.39 percent of total billed charges 638.4 638.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.0 X 14 MM CAN. SCREW SUP-97-23771 CDM C1716 HCPCS 0278 RC outpatient 599.76 599.76 599.76 57 341.86 percent of total billed charges 599.76 93 485.81 percent of total billed charges 599.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 270.91 other OPPS APC 599.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 270.91 other OPPS APC 599.76 51 305.88 percent of total billed charges 599.76 599.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5 X 30MM CORTEX SCREW SUP-97-23772 CDM C1713 HCPCS 0278 RC outpatient 84.16 84.16 84.16 57 47.97 percent of total billed charges 84.16 93 68.17 percent of total billed charges 84.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84.16 other OPPS APC 84.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84.16 other OPPS APC 84.16 51 42.92 percent of total billed charges 84.16 84.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5 X 32MM CORTEX SCREW SUP-97-23773 CDM C1713 HCPCS 0278 RC outpatient 84.16 84.16 84.16 57 47.97 percent of total billed charges 84.16 93 68.17 percent of total billed charges 84.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84.16 other OPPS APC 84.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84.16 other OPPS APC 84.16 51 42.92 percent of total billed charges 84.16 84.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5 X 34MM CORTEX SCREW SUP-97-23774 CDM C1713 HCPCS 0278 RC outpatient 84.16 84.16 84.16 57 47.97 percent of total billed charges 84.16 93 68.17 percent of total billed charges 84.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84.16 other OPPS APC 84.16 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84.16 other OPPS APC 84.16 51 42.92 percent of total billed charges 84.16 84.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8 HOLE NARROW 4.5 X 152 PLATE SUP-97-23775 CDM C1713 HCPCS 0278 RC outpatient 1391.94 1391.94 1391.94 57 793.41 percent of total billed charges 1391.94 93 1127.47 percent of total billed charges 1391.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1391.94 other OPPS APC 1391.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1391.94 other OPPS APC 1391.94 51 709.89 percent of total billed charges 1391.94 1391.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SWANSON FLEXIIBLE HINGE TOE IMPLANT 2S SUP-97-23776 CDM C1776 HCPCS 0278 RC outpatient 3800 3800 3800 57 2166 percent of total billed charges 3800 93 3078 percent of total billed charges 3800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3800 other OPPS APC 3800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3800 other OPPS APC 3800 51 1938 percent of total billed charges 3800 3800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANCELLOUS CHIP SUP-97-23777 CDM C1762 HCPCS 0278 RC outpatient 1022.4 1022.4 1022.4 57 582.77 percent of total billed charges 1022.4 93 828.14 percent of total billed charges 1022.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1022.4 other OPPS APC 1022.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1022.4 other OPPS APC 1022.4 51 521.42 percent of total billed charges 1022.4 1022.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7 X 14 MM SCREW SUP-97-23778 CDM C1713 HCPCS 0278 RC outpatient 490.7 490.7 490.7 57 279.7 percent of total billed charges 490.7 93 397.47 percent of total billed charges 490.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490.7 other OPPS APC 490.7 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490.7 other OPPS APC 490.7 51 250.26 percent of total billed charges 490.7 490.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IS AUGMENT 3CC SUP-97-23779 CDM C1776 HCPCS 0278 RC outpatient 8125 8125 8125 57 4631.25 percent of total billed charges 8125 93 6581.25 percent of total billed charges 8125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8125 other OPPS APC 8125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8125 other OPPS APC 8125 51 4143.75 percent of total billed charges 8125 8125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.5MM CENTER SCREW 36MM SUP-97-23784 CDM C1776 HCPCS 0278 RC outpatient 100 100 100 57 57 percent of total billed charges 100 93 81 percent of total billed charges 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 51 51 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5MM PERIPHERAL SCREW 44MM SUP-97-23785 CDM C1776 HCPCS 0278 RC outpatient 100 100 100 57 57 percent of total billed charges 100 93 81 percent of total billed charges 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 51 51 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HUMERAL CUP 36MM DIA X 4MM THK SUP-97-23786 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 HUMERAL INSERT 36MM X 4MM STANDARD SUP-97-23787 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIBIAL INSERT SIZE 4 9MM TOTAL STABILIZER X3 SUP-97-23788 CDM C1776 HCPCS 0278 RC outpatient 5612.5 5612.5 5612.5 57 3199.13 percent of total billed charges 5612.5 93 4546.13 percent of total billed charges 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5612.5 other OPPS APC 5612.5 51 2862.38 percent of total billed charges 5612.5 5612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.5MM CENTER SCREW 44MM SUP-97-23789 CDM C1776 HCPCS 0278 RC outpatient 100 100 100 57 57 percent of total billed charges 100 93 81 percent of total billed charges 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 100 other OPPS APC 100 51 51 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REUNION TSA HUMERAL STEM 11MM SUP-97-23790 CDM C1776 HCPCS 0278 RC outpatient 7500 7500 7500 57 4275 percent of total billed charges 7500 93 6075 percent of total billed charges 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7500 other OPPS APC 7500 51 3825 percent of total billed charges 7500 7500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 HUMERAL INSERT 36MM X 10MM STANDARD SUP-97-23791 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON CS INS SIZE 5 11MM SUP-97-23792 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK FEMORAL LM-RL-SZ 1 SUP-97-23793 CDM C1776 HCPCS 0278 RC outpatient 4000 4000 4000 57 2280 percent of total billed charges 4000 93 3240 percent of total billed charges 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 51 2040 percent of total billed charges 4000 4000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBIAL BASEPLATE LM/RL- SZ1 SUP-97-23794 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBIAL ONLAY ONSRT SZ 1-10MM SUP-97-23795 CDM C1776 HCPCS 0278 RC outpatient 2280 2280 2280 57 1299.6 percent of total billed charges 2280 93 1846.8 percent of total billed charges 2280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2280 other OPPS APC 2280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2280 other OPPS APC 2280 51 1162.8 percent of total billed charges 2280 2280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON CR FEM COMP.CEMENTED SUP-97-23796 CDM C1776 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON CS INS SZ 4 9MM SUP-97-23797 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIDENT II TRITANIUM CLUSTERHOLE 46C SUP-97-23798 CDM C1776 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 0.8MM 1.7MM DRILL GUIDE DBL. SUP-97-23800 CDM 0272 RC outpatient 1064.16 1064.16 1064.16 74 787.48 percent of total billed charges 1064.16 93 861.97 percent of total billed charges 1064.16 1064.16 other OPPS APC 1064.16 1064.16 other OPPS APC 1064.16 27.63 294.03 percent of total billed charges 1064.16 1064.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.0 X 4MM CAN.SCREW SUP-97-23801 CDM C1716 HCPCS 0278 RC outpatient 599.76 599.76 599.76 57 341.86 percent of total billed charges 599.76 93 485.81 percent of total billed charges 599.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 270.91 other OPPS APC 599.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 270.91 other OPPS APC 599.76 51 305.88 percent of total billed charges 599.76 599.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE VA LKG SCREW 2.4X26.0MM TI SUP-97-23802 CDM C1713 HCPCS 0278 RC outpatient 490 490 490 57 279.3 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 51 249.9 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOW PROFILE VA LKG SCREW 2.4X20.0 MM TI SUP-97-23803 CDM C1713 HCPCS 0278 RC outpatient 490 490 490 57 279.3 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 51 249.9 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIRABO PE LINER 36MM HEAD SUP-97-23804 CDM C1776 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE 3.5 X 111MM 8 HOLE SUP-97-23806 CDM C1713 HCPCS 0278 RC outpatient 1093.86 1093.86 1093.86 57 623.5 percent of total billed charges 1093.86 93 886.03 percent of total billed charges 1093.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1093.86 other OPPS APC 1093.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1093.86 other OPPS APC 1093.86 51 557.87 percent of total billed charges 1093.86 1093.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX SELF TAP 3.5MM X 22MM SUP-97-23807 CDM C1713 HCPCS 0278 RC outpatient 83.4 83.4 83.4 57 47.54 percent of total billed charges 83.4 93 67.55 percent of total billed charges 83.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 83.4 other OPPS APC 83.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 83.4 other OPPS APC 83.4 51 42.53 percent of total billed charges 83.4 83.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTEX NON LOCKING 3.5MM X 42MM SUP-97-23808 CDM C1713 HCPCS 0278 RC outpatient 97.28 97.28 97.28 57 55.45 percent of total billed charges 97.28 93 78.8 percent of total billed charges 97.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.28 other OPPS APC 97.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 97.28 other OPPS APC 97.28 51 49.61 percent of total billed charges 97.28 97.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE PROX LAT TIB 4 HOLE LFT SUP-97-23809 CDM C1713 HCPCS 0278 RC outpatient 3054.25 3054.25 3054.25 57 1740.92 percent of total billed charges 3054.25 93 2473.94 percent of total billed charges 3054.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3054.25 other OPPS APC 3054.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3054.25 other OPPS APC 3054.25 51 1557.67 percent of total billed charges 3054.25 3054.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIATHLON ASYMMETRIC X3 PATELLA SUP-97-23811 CDM C1776 HCPCS 0278 RC outpatient 810 810 810 57 461.7 percent of total billed charges 810 93 656.1 percent of total billed charges 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 51 413.1 percent of total billed charges 810 810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.0 X 15MM TWIST OFF SCREW SUP-97-23812 CDM C1713 HCPCS 0278 RC outpatient 1524 1524 1524 57 868.68 percent of total billed charges 1524 93 1234.44 percent of total billed charges 1524 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1524 other OPPS APC 1524 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1524 other OPPS APC 1524 51 777.24 percent of total billed charges 1524 1524 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.0 X 13MM TWIST OFF SCREW SUP-97-23813 CDM C1713 HCPCS 0278 RC outpatient 1066.8 1066.8 1066.8 57 608.08 percent of total billed charges 1066.8 93 864.11 percent of total billed charges 1066.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1066.8 other OPPS APC 1066.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1066.8 other OPPS APC 1066.8 51 544.07 percent of total billed charges 1066.8 1066.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APEX PIN 4X90MM SUP-97-23816 CDM C1713 HCPCS 0278 RC outpatient 434 434 434 57 247.38 percent of total billed charges 434 93 351.54 percent of total billed charges 434 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434 other OPPS APC 434 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434 other OPPS APC 434 51 221.34 percent of total billed charges 434 434 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE LCP 7 HOLES 3.5MM SUP-97-23818 CDM C1713 HCPCS 0278 RC outpatient 1042.53 1042.53 1042.53 57 594.24 percent of total billed charges 1042.53 93 844.45 percent of total billed charges 1042.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1042.53 other OPPS APC 1042.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1042.53 other OPPS APC 1042.53 51 531.69 percent of total billed charges 1042.53 1042.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.5 IMPLANT STRAIGHT SUP-97-23819 CDM C1713 HCPCS 0278 RC outpatient 6228.13 6228.13 6228.13 57 3550.03 percent of total billed charges 6228.13 93 5044.79 percent of total billed charges 6228.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6228.13 other OPPS APC 6228.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6228.13 other OPPS APC 6228.13 51 3176.35 percent of total billed charges 6228.13 6228.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. K-WIRE SUP-97-23820 CDM C1713 HCPCS 0278 RC outpatient 151.2 151.2 151.2 57 86.18 percent of total billed charges 151.2 93 122.47 percent of total billed charges 151.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 151.2 other OPPS APC 151.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 151.2 other OPPS APC 151.2 51 77.11 percent of total billed charges 151.2 151.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.0 DRILL SUP-97-23821 CDM 0272 RC outpatient 2079 2079 2079 74 1538.46 percent of total billed charges 2079 93 1683.99 percent of total billed charges 2079 2079 other OPPS APC 2079 2079 other OPPS APC 2079 27.63 574.43 percent of total billed charges 2079 2079 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BROACH SUP-97-23822 CDM 0272 RC outpatient 2325 2325 2325 74 1720.5 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 2325 other OPPS APC 2325 2325 other OPPS APC 2325 27.63 642.4 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.0 DRILL WIRE SUP-97-23823 CDM C1713 HCPCS 0278 RC outpatient 301.35 301.35 301.35 57 171.77 percent of total billed charges 301.35 93 244.09 percent of total billed charges 301.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301.35 other OPPS APC 301.35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301.35 other OPPS APC 301.35 51 153.69 percent of total billed charges 301.35 301.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.5 DRILL SUP-97-23824 CDM 0272 RC outpatient 1752 1752 1752 74 1296.48 percent of total billed charges 1752 93 1419.12 percent of total billed charges 1752 1752 other OPPS APC 1752 1752 other OPPS APC 1752 27.63 484.08 percent of total billed charges 1752 1752 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK 8.0 SUP-97-23825 CDM 0272 RC outpatient 1785 1785 1785 74 1320.9 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 27.63 493.2 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8.0 X 105 HEADLESS SCREW SUP-97-23826 CDM C1713 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK 6.5 SUP-97-23827 CDM 0272 RC outpatient 1785 1785 1785 74 1320.9 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 27.63 493.2 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.5 X 70 HEADLESS SCREW SUP-97-23828 CDM C1713 HCPCS 0278 RC outpatient 1817.55 1817.55 1817.55 57 1036 percent of total billed charges 1817.55 93 1472.22 percent of total billed charges 1817.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1817.55 other OPPS APC 1817.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1817.55 other OPPS APC 1817.55 51 926.95 percent of total billed charges 1817.55 1817.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.5 X 80 HEADLESS SCREW SUP-97-23829 CDM C1713 HCPCS 0278 RC outpatient 1817.55 1817.55 1817.55 57 1036 percent of total billed charges 1817.55 93 1472.22 percent of total billed charges 1817.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1817.55 other OPPS APC 1817.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1817.55 other OPPS APC 1817.55 51 926.95 percent of total billed charges 1817.55 1817.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.5 X 85 HEADLESS SCREW SUP-97-23830 CDM C1713 HCPCS 0278 RC outpatient 1817.55 1817.55 1817.55 57 1036 percent of total billed charges 1817.55 93 1472.22 percent of total billed charges 1817.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1817.55 other OPPS APC 1817.55 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1817.55 other OPPS APC 1817.55 51 926.95 percent of total billed charges 1817.55 1817.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5.0 X 90 HEADLESS SCREW SUP-97-23831 CDM C1713 HCPCS 0278 RC outpatient 1498.5 1498.5 1498.5 57 854.15 percent of total billed charges 1498.5 93 1213.79 percent of total billed charges 1498.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1498.5 other OPPS APC 1498.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1498.5 other OPPS APC 1498.5 51 764.24 percent of total billed charges 1498.5 1498.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6.5 X 95 HEADLESS SCREW SUP-97-23832 CDM C1713 HCPCS 0278 RC outpatient 1816.65 1816.65 1816.65 57 1035.49 percent of total billed charges 1816.65 93 1471.49 percent of total billed charges 1816.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1816.65 other OPPS APC 1816.65 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1816.65 other OPPS APC 1816.65 51 926.49 percent of total billed charges 1816.65 1816.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTER SINK SUP-97-23833 CDM 0272 RC outpatient 1785 1785 1785 74 1320.9 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 1785 other OPPS APC 1785 1785 other OPPS APC 1785 27.63 493.2 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.2 DRILL SUP-97-23834 CDM 0272 RC outpatient 1752 1752 1752 74 1296.48 percent of total billed charges 1752 93 1419.12 percent of total billed charges 1752 1752 other OPPS APC 1752 1752 other OPPS APC 1752 27.63 484.08 percent of total billed charges 1752 1752 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.0 K-WIRE SUP-97-23835 CDM C1713 HCPCS 0278 RC outpatient 262.5 262.5 262.5 57 149.63 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 51 133.88 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. X3 TRIATHLON CS INS SIZE 7 3MM SUP-97-23836 CDM C1776 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX M STEM NO.6 SUP-97-23837 CDM C1776 HCPCS 0278 RC outpatient 5000 5000 5000 57 2850 percent of total billed charges 5000 93 4050 percent of total billed charges 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 51 2550 percent of total billed charges 5000 5000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BENCOX M STEM 7 SUP-97-23838 CDM C1776 HCPCS 0278 RC outpatient 5000 5000 5000 57 2850 percent of total billed charges 5000 93 4050 percent of total billed charges 5000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5000 other OPPS APC 5000 5000 other OPPS APC 5000 51 2550 percent of total billed charges 5000 5000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO-PRO SCRW CANN BLUNT 4 X 46 MM TIP SUP-97-23839 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LO-PRO SCRW CANN BLUNT 4 X 48MM TIP SUP-97-23840 CDM C1713 HCPCS 0278 RC outpatient 577.5 577.5 577.5 57 329.18 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 51 294.53 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER 7.0 MM STAINLESS STEEL SUP-97-23841 CDM C1713 HCPCS 0278 RC outpatient 128.4 128.4 128.4 57 73.19 percent of total billed charges 128.4 93 104 percent of total billed charges 128.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 128.4 other OPPS APC 128.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 128.4 other OPPS APC 128.4 51 65.48 percent of total billed charges 128.4 128.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBIAL BASEPLATE LM/RL SZ2 SUP-97-23842 CDM C1776 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK FEMORAL LM-RL SZ2 SUP-97-23843 CDM C1776 HCPCS 0278 RC outpatient 4000 4000 4000 57 2280 percent of total billed charges 4000 93 3240 percent of total billed charges 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 51 2040 percent of total billed charges 4000 4000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MCK TIBIAL ONLAY INSERT SZ2-8MM SUP-97-23844 CDM C1776 HCPCS 0278 RC outpatient 2280 2280 2280 57 1299.6 percent of total billed charges 2280 93 1846.8 percent of total billed charges 2280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2280 other OPPS APC 2280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2280 other OPPS APC 2280 51 1162.8 percent of total billed charges 2280 2280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.7 X 22 MM NON-LKNG SCREW SUP-97-23845 CDM C1713 HCPCS 0278 RC outpatient 349.44 349.44 349.44 57 199.18 percent of total billed charges 349.44 93 283.05 percent of total billed charges 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.44 other OPPS APC 349.44 51 178.21 percent of total billed charges 349.44 349.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 2.2 IMPLANT STRAIGHT SUP-97-23848 CDM C1713 HCPCS 0278 RC outpatient 6228.13 6228.13 6228.13 57 3550.03 percent of total billed charges 6228.13 93 5044.79 percent of total billed charges 6228.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6228.13 other OPPS APC 6228.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6228.13 other OPPS APC 6228.13 51 3176.35 percent of total billed charges 6228.13 6228.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4.75MM BC KNOTLESS SWIVELOCK W/TAPE SUP-97-23849 CDM C1713 HCPCS 0278 RC outpatient 1590 1590 1590 57 906.3 percent of total billed charges 1590 93 1287.9 percent of total billed charges 1590 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1590 other OPPS APC 1590 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1590 other OPPS APC 1590 51 810.9 percent of total billed charges 1590 1590 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIZE 9 ACCOLADE II 132DEG SUP-97-23850 CDM C1776 HCPCS 0278 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIGHT ROPE II BTB RECON IB SUP-97-23888 CDM C1713 HCPCS 0278 RC outpatient 1935 1935 1935 57 1102.95 percent of total billed charges 1935 93 1567.35 percent of total billed charges 1935 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1935 other OPPS APC 1935 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1935 other OPPS APC 1935 51 986.85 percent of total billed charges 1935 1935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER CATHETER PERCUTANEOUS PASSIVE STERILE DISPOSABLE SUP-9731115 CDM 0270 RC outpatient 1307.07 1307.07 1307.07 74 967.23 percent of total billed charges 1307.07 93 1058.73 percent of total billed charges 1307.07 1307.07 other OPPS APC 1307.07 1307.07 other OPPS APC 1307.07 27.63 361.14 percent of total billed charges 1307.07 1307.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT STEREOTACTIC NAVIGUS BRAIN EXTERNAL TRAJECTORY SUP-9733065 CDM 0270 RC outpatient 3082.56 3082.56 3082.56 74 2281.09 percent of total billed charges 3082.56 93 2496.87 percent of total billed charges 3082.56 3082.56 other OPPS APC 3082.56 3082.56 other OPPS APC 3082.56 27.63 851.71 percent of total billed charges 3082.56 3082.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY NEEDLE PASSIVE SUP-9733068_71351 CDM 0270 RC outpatient 1472.25 1472.25 1472.25 74 1089.47 percent of total billed charges 1472.25 93 1192.52 percent of total billed charges 1472.25 1472.25 other OPPS APC 1472.25 1472.25 other OPPS APC 1472.25 27.63 406.78 percent of total billed charges 1472.25 1472.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACKER NAVIGATION FUSION AXIEM ENT INSTRUMENT STERILE LATEX FREE DISPOSABLE SUP-9733533XOM CDM 0270 RC outpatient 535.6 535.6 535.6 74 396.34 percent of total billed charges 535.6 93 433.84 percent of total billed charges 535.6 535.6 other OPPS APC 535.6 535.6 other OPPS APC 535.6 27.63 147.99 percent of total billed charges 535.6 535.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACKER NAVIGATION NONINVASIVE STERILE LATEX FREE DISPOSABLE SUP-9734887_71842 CDM 0270 RC outpatient 564.2 564.2 564.2 74 417.51 percent of total billed charges 564.2 93 457 percent of total billed charges 564.2 564.2 other OPPS APC 564.2 564.2 other OPPS APC 564.2 27.63 155.89 percent of total billed charges 564.2 564.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACKER NAVIGATION FUSION AXIEM NONINVASIVE STERILE LATEX FREE DISPOSABLE SUP-9734887XOM CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRACKER NAVIGATION AXIEM TRACER STERILE LATEX FREE DISPOSABLE SUP-9735317 CDM 0270 RC outpatient 1565.2 1565.2 1565.2 74 1158.25 percent of total billed charges 1565.2 93 1267.81 percent of total billed charges 1565.2 1565.2 other OPPS APC 1565.2 1565.2 other OPPS APC 1565.2 27.63 432.46 percent of total billed charges 1565.2 1565.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STYLET NAVIGATION 2 COIL STERILE LATEX FREE DISPOSABLE SUP-9735428 CDM 0270 RC outpatient 1292.93 1292.93 1292.93 74 956.77 percent of total billed charges 1292.93 93 1047.27 percent of total billed charges 1292.93 1292.93 other OPPS APC 1292.93 1292.93 other OPPS APC 1292.93 27.63 357.24 percent of total billed charges 1292.93 1292.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM DELIVERY SAPIEN 3 OD20 MM COMMANDER DELIVERY SYSTEM STERILE LATEX FREE SUP-9750CM20A CDM 0270 RC outpatient 51300 51300 51300 74 37962 percent of total billed charges 51300 93 41553 percent of total billed charges 51300 51300 other OPPS APC 51300 51300 other OPPS APC 51300 27.63 14174.2 percent of total billed charges 51300 51300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM DELIVERY SAPIEN 3 OD23 MM COMMANDER DELIVERY SYSTEM STERILE LATEX FREE SUP-9750CM23A CDM 0270 RC outpatient 51300 51300 51300 74 37962 percent of total billed charges 51300 93 41553 percent of total billed charges 51300 51300 other OPPS APC 51300 51300 other OPPS APC 51300 27.63 14174.2 percent of total billed charges 51300 51300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM DELIVERY SAPIEN 3 OD26 MM COMMANDER DELIVERY SYSTEM STERILE LATEX FREE SUP-9750CM26A CDM 0270 RC outpatient 51300 51300 51300 74 37962 percent of total billed charges 51300 93 41553 percent of total billed charges 51300 51300 other OPPS APC 51300 51300 other OPPS APC 51300 27.63 14174.2 percent of total billed charges 51300 51300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ATLANTIS VISION TITANIUM L21 MM SPINE CERVICAL ANTERIOR LOCK STERILE SUP-976-121 CDM 270010020 LOCAL 0270 RC outpatient 2663.13 2663.13 2663.13 74 1970.72 percent of total billed charges 2663.13 93 2157.14 percent of total billed charges 2663.13 2663.13 other OPPS APC 2663.13 2663.13 other OPPS APC 2663.13 27.63 735.82 percent of total billed charges 2663.13 2663.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EXTERNAL INVIEW MALE SMALL L25 MM EXTRA ADHESIVE LATEX FREE SUP-97625 CDM outpatient 2.85 2.85 2.85 2.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EXTERNAL INVIEW SILICONE MALE INTERMEDIATE SHORT LENGTH OD32 MM SHEATH SELF ADHESIVE LATEX FREE DISPOSABLE SUP-97632 CDM outpatient 2.85 2.85 2.85 2.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EXTERNAL INVIEW MALE LARGE L36 MM EXTRA ADHESIVE LATEX FREE SUP-97636 CDM outpatient 2.85 2.85 2.85 2.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE COMPRESSION KENDALL SCD EXPRESS LG THIGH LENGTH NYLON DISPOSABLE NS LF ADJUSTABLE CIRCUMFERENTIAL BLADDER SUP-9780 CDM outpatient 47.27 47.27 47.27 47.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEUROSTIMULATOR IMPLANTABLE INTERSTIM MICRO SURESCAN RECHARGABLE SUP-97810 CDM 0270 RC outpatient 30368 30368 30368 74 22472.3 percent of total billed charges 30368 93 24598.1 percent of total billed charges 30368 30368 other OPPS APC 30368 30368 other OPPS APC 30368 27.63 8390.68 percent of total billed charges 30368 30368 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE COMPRESSION KENDALL SCD EXPRESS LG KNEE LENGTH NYLON DISPOSABLE NS LF ADJUSTABLE CIRCUMFERENTIAL BLADDER SUP-9789 CDM 0270 RC outpatient 57.77 57.77 57.77 74 42.75 percent of total billed charges 57.77 93 46.79 percent of total billed charges 57.77 57.77 other OPPS APC 57.77 57.77 other OPPS APC 57.77 27.63 15.96 percent of total billed charges 57.77 57.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE COMPRESSION KENDALL SCD EXPRESS LG KNEE LENGTH NYLON DISPOSABLE NS LF ADJUSTABLE CIRCUMFERENTIAL BLADDER SUP-9789B CDM 0270 RC outpatient 33.86 33.86 33.86 74 25.06 percent of total billed charges 33.86 93 27.43 percent of total billed charges 33.86 33.86 other OPPS APC 33.86 33.86 other OPPS APC 33.86 27.63 9.36 percent of total billed charges 33.86 33.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT NEUROSTIMULATOR INTERSTIM SURESCAN L28 CM 2.16 MM SPACING MRI LEAD KIT SUP-978A128 CDM 0270 RC outpatient 10075 10075 10075 74 7455.5 percent of total billed charges 10075 93 8160.75 percent of total billed charges 10075 10075 other OPPS APC 10075 10075 other OPPS APC 10075 27.63 2783.72 percent of total billed charges 10075 10075 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD NEUROSTIMULATOR INTERSTIM L28 CM QUADRIPOLAR MRI CAPABILITY SUP-978B128 CDM 0270 RC outpatient 10578.8 10578.8 10578.8 74 7828.28 percent of total billed charges 10578.8 93 8568.79 percent of total billed charges 10578.8 10578.8 other OPPS APC 10578.8 10578.8 other OPPS APC 10578.8 27.63 2922.91 percent of total billed charges 10578.8 10578.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE COMPRESSION KENDALL SCD EXPRESS XL KNEE LENGTH DISPOSABLE SUP-9790B CDM 0270 RC outpatient 24.7 24.7 24.7 74 18.28 percent of total billed charges 24.7 93 20.01 percent of total billed charges 24.7 24.7 other OPPS APC 24.7 24.7 other OPPS APC 24.7 27.63 6.82 percent of total billed charges 24.7 24.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT TIBIAL PFC 2 CURVE H17.5 MM KNEE CRUCIATE RETAINING SUP-98-4146 CDM 270010025 LOCAL 0270 RC outpatient 2901.6 2901.6 2901.6 74 2147.18 percent of total billed charges 2901.6 93 2350.3 percent of total billed charges 2901.6 2901.6 other OPPS APC 2901.6 2901.6 other OPPS APC 2901.6 27.63 801.71 percent of total billed charges 2901.6 2901.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR CERVICAL ASPEN FLEXTABS PD4 2-5 YRS FOAM COTTON PEDIATRIC CHIN DOT HOOK LOOP STRAP SUP-983102 CDM 0270 RC outpatient 653.28 653.28 653.28 74 483.43 percent of total billed charges 653.28 93 529.16 percent of total billed charges 653.28 653.28 other OPPS APC 653.28 653.28 other OPPS APC 653.28 27.63 180.5 percent of total billed charges 653.28 653.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR CERVICAL ASPEN FLEXTABS VELCRO POLYETHYLENE FOAM COTTON 3-6 YR REGULAR L37-48 IN CHIN DOT TRACHEOSTOMY OPEN ADJUSTABLE STRAP CONTACT CLOSURE LATEX FREE SUP-983104 CDM 0270 RC outpatient 49.19 49.19 49.19 74 36.4 percent of total billed charges 49.19 93 39.84 percent of total billed charges 49.19 49.19 other OPPS APC 49.19 49.19 other OPPS APC 49.19 27.63 13.59 percent of total billed charges 49.19 49.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR CERVICAL BACK PAD ADULT SHORT SUP-983128 CDM 0270 RC outpatient 71.63 71.63 71.63 74 53.01 percent of total billed charges 71.63 93 58.02 percent of total billed charges 71.63 71.63 other OPPS APC 71.63 71.63 other OPPS APC 71.63 27.63 19.79 percent of total billed charges 71.63 71.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR CERVICAL BACK PAD ADULT TALL SUP-983132 CDM 0270 RC outpatient 71.63 71.63 71.63 74 53.01 percent of total billed charges 71.63 93 58.02 percent of total billed charges 71.63 71.63 other OPPS APC 71.63 71.63 other OPPS APC 71.63 27.63 19.79 percent of total billed charges 71.63 71.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR CERVICAL ASPEN POLYETHYLENE PEDIATRIC SHORT CHIN REST TRACHEOSTOMY OPENING ADJUSTABLE STRAP CONTACT CLOSURE LATEX FREE SUP-983190 CDM 270009188 LOCAL 0270 RC outpatient 22.8 22.8 22.8 74 16.87 percent of total billed charges 22.8 93 18.47 percent of total billed charges 22.8 22.8 other OPPS APC 22.8 22.8 other OPPS APC 22.8 27.63 6.3 percent of total billed charges 22.8 22.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR CERVICAL ASPEN FLEX TABS PD2 9-24MO FOAM COTTON INFANT CHIN DOT HOOK LOOP STRAP SUP-983195 CDM 270009188 LOCAL 0270 RC outpatient 22.8 22.8 22.8 74 16.87 percent of total billed charges 22.8 93 18.47 percent of total billed charges 22.8 22.8 other OPPS APC 22.8 22.8 other OPPS APC 22.8 27.63 6.3 percent of total billed charges 22.8 22.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COLLAR CERVICAL VISTA ADULT UNIVERSAL SET REPLACEMENT PAD LATEX FREE SUP-984002 CDM 270009108 LOCAL 0270 RC outpatient 54 54 54 74 39.96 percent of total billed charges 54 93 43.74 percent of total billed charges 54 54 other OPPS APC 54 54 other OPPS APC 54 27.63 14.92 percent of total billed charges 54 54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAD COLLAR VISTA POLYURETHANE FOAM COTTON UNIVERSAL CERVICAL REPLACEMENT WICK MOISTURE DIAL HEIGHT ADJUSTMENT SUP-984020 CDM 270009108 LOCAL 0270 RC outpatient 54 54 54 74 39.96 percent of total billed charges 54 93 43.74 percent of total billed charges 54 54 other OPPS APC 54 54 other OPPS APC 54 27.63 14.92 percent of total billed charges 54 54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR SHEATH HALYARD PEEL-AWAY OD18 FR ENTERAL ACCESS SYSTEM SERIAL TELESCOPE ACCEPTS 14 FR FEEDING TUBE SUP-98703 CDM 0270 RC outpatient 250.12 250.12 250.12 74 185.09 percent of total billed charges 250.12 93 202.6 percent of total billed charges 250.12 250.12 other OPPS APC 250.12 250.12 other OPPS APC 250.12 27.63 69.11 percent of total billed charges 250.12 250.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR SHEATH HALYARD PEEL-AWAY OD20 FR ENTERAL ACCESS SYSTEM SERIAL TELESCOPE ACCEPTS 16 FR FEEDING TUBE SUP-98704 CDM 0270 RC outpatient 250.12 250.12 250.12 74 185.09 percent of total billed charges 250.12 93 202.6 percent of total billed charges 250.12 250.12 other OPPS APC 250.12 250.12 other OPPS APC 250.12 27.63 69.11 percent of total billed charges 250.12 250.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR SHEATH PEEL-AWAY OD22 FR BUILT IN STERILE LATEX FREE DISPOSABLE MIC MIC-KEY 18 FR FEEDING TUBE SUP-98705 CDM 0270 RC outpatient 250.12 250.12 250.12 74 185.09 percent of total billed charges 250.12 93 202.6 percent of total billed charges 250.12 250.12 other OPPS APC 250.12 250.12 other OPPS APC 250.12 27.63 69.11 percent of total billed charges 250.12 250.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE CUTTING KNEE SUP-98850000000 CDM 270010025 LOCAL 0270 RC outpatient 1820 1820 1820 74 1346.8 percent of total billed charges 1820 93 1474.2 percent of total billed charges 1820 1820 other OPPS APC 1820 1820 other OPPS APC 1820 27.63 502.87 percent of total billed charges 1820 1820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAPER RECORDING .25 IN L100 FT X W50 MM EKG THERMAL 1 CHANNEL GRAY GRID 78560A M1722A/B M1723A/B DEFIBRILLATOR SUP-989803101501 CDM outpatient 7.37 7.37 7.37 7.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER TRANSDUCER PVC PLASTIC NONSTERILE DISPOSABLE OMNIPLANE TEE 21363A BI-PLANE SUP-989803106111 CDM outpatient 3.25 3.25 3.25 3.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - GENERATOR ADDR01 SUP-99-00001 CDM C1785 HCPCS 0275 RC outpatient 9450 9450 9450 57 5386.5 percent of total billed charges 9450 93 7654.5 percent of total billed charges 9450 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9450 other OPPS APC 9450 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9450 other OPPS APC 9450 51 4819.5 percent of total billed charges 9450 9450 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - GENERATOR ADSR01 SUP-99-00002 CDM C1786 HCPCS 0275 RC outpatient 7875 7875 7875 57 4488.75 percent of total billed charges 7875 93 6378.75 percent of total billed charges 7875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7875 other OPPS APC 7875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7875 other OPPS APC 7875 51 4016.25 percent of total billed charges 7875 7875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - LEAD 5076-45 SUP-99-00019 CDM C1898 HCPCS 0275 RC outpatient 1185 1185 1185 57 675.45 percent of total billed charges 1185 93 959.85 percent of total billed charges 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 51 604.35 percent of total billed charges 1185 1185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - LEAD 5076-52 SUP-99-00020 CDM C1898 HCPCS 0275 RC outpatient 1185 1185 1185 57 675.45 percent of total billed charges 1185 93 959.85 percent of total billed charges 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 51 604.35 percent of total billed charges 1185 1185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - LEAD 5076-58 SUP-99-00021 CDM C1898 HCPCS 0275 RC outpatient 1185 1185 1185 57 675.45 percent of total billed charges 1185 93 959.85 percent of total billed charges 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 51 604.35 percent of total billed charges 1185 1185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - STYLET STRAIGHT SUP-99-00024 CDM 0272 RC outpatient 128 128 128 74 94.72 percent of total billed charges 128 93 103.68 percent of total billed charges 128 128 other OPPS APC 128 128 other OPPS APC 128 27.63 35.37 percent of total billed charges 128 128 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - STYLET J SUP-99-00025 CDM 0272 RC outpatient 128 128 128 74 94.72 percent of total billed charges 128 93 103.68 percent of total billed charges 128 128 other OPPS APC 128 128 other OPPS APC 128 27.63 35.37 percent of total billed charges 128 128 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - STYLET STIFF SUP-99-00026 CDM 0272 RC outpatient 128 128 128 74 94.72 percent of total billed charges 128 93 103.68 percent of total billed charges 128 128 other OPPS APC 128 128 other OPPS APC 128 27.63 35.37 percent of total billed charges 128 128 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON PUMP - CATHETER 30CC SUP-99-00029 CDM 0272 RC outpatient 1740 1740 1740 74 1287.6 percent of total billed charges 1740 93 1409.4 percent of total billed charges 1740 1740 other OPPS APC 1740 1740 other OPPS APC 1740 27.63 480.76 percent of total billed charges 1740 1740 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INVRAD HICKMAN 6F SUP-99-00032 CDM C1751 HCPCS 0272 RC outpatient 1554.96 1554.96 1554.96 74 1150.67 percent of total billed charges 1554.96 93 1259.52 percent of total billed charges 1554.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1554.96 other OPPS APC 1554.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1554.96 other OPPS APC 1554.96 27.63 429.64 percent of total billed charges 1554.96 1554.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 3X40X135 SUP-99-00037 CDM C1725 HCPCS 0272 RC outpatient 840 840 840 74 621.6 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 27.63 232.09 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 4X150X135 SUP-99-00040 CDM C1725 HCPCS 0272 RC outpatient 810 810 810 74 599.4 percent of total billed charges 810 93 656.1 percent of total billed charges 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 27.63 223.8 percent of total billed charges 810 810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 4X40X135 SUP-99-00041 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 5X100X135 SUP-99-00044 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 5X100X80 SUP-99-00045 CDM C1725 HCPCS 0272 RC outpatient 840 840 840 74 621.6 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 27.63 232.09 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 5X150X135 SUP-99-00046 CDM C1725 HCPCS 0272 RC outpatient 975 975 975 74 721.5 percent of total billed charges 975 93 789.75 percent of total billed charges 975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 975 other OPPS APC 975 975 other OPPS APC 975 27.63 269.39 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 5X4X135 SUP-99-00048 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 5X6X135 SUP-99-00050 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 5X6X80 SUP-99-00051 CDM C1725 HCPCS 0272 RC outpatient 840 840 840 74 621.6 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 27.63 232.09 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 5X8X80 SUP-99-00052 CDM C1725 HCPCS 0272 RC outpatient 840 840 840 74 621.6 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 27.63 232.09 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 6X10X120 SUP-99-00053 CDM C1725 HCPCS 0272 RC outpatient 840 840 840 74 621.6 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 27.63 232.09 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 6X10X135 SUP-99-00054 CDM C1725 HCPCS 0272 RC outpatient 840 840 840 74 621.6 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 27.63 232.09 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 6X10X80 SUP-99-00055 CDM C1725 HCPCS 0272 RC outpatient 840 840 840 74 621.6 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 27.63 232.09 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 6X15X135 SUP-99-00056 CDM C1725 HCPCS 0272 RC outpatient 810 810 810 74 599.4 percent of total billed charges 810 93 656.1 percent of total billed charges 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 810 other OPPS APC 810 27.63 223.8 percent of total billed charges 810 810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 6X2X80 SUP-99-00057 CDM C1725 HCPCS 0272 RC outpatient 840 840 840 74 621.6 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 27.63 232.09 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 6X4X135 SUP-99-00058 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 6X6X135 SUP-99-00060 CDM C1725 HCPCS 0272 RC outpatient 840 840 840 74 621.6 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 27.63 232.09 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 6X8X135 SUP-99-00062 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 7X4X135 SUP-99-00066 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 8X6X135 SUP-99-00075 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 9X4X80 SUP-99-00080 CDM C1725 HCPCS 0272 RC outpatient 840 840 840 74 621.6 percent of total billed charges 840 93 680.4 percent of total billed charges 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 27.63 232.09 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - WILLIAMS 4 6F SUP-99-00126 CDM 0272 RC outpatient 35 35 35 74 25.9 percent of total billed charges 35 93 28.35 percent of total billed charges 35 35 other OPPS APC 35 35 other OPPS APC 35 27.63 9.67 percent of total billed charges 35 35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - 3MM J FLOPPY SUP-99-00130 CDM C1769 HCPCS 0272 RC outpatient 449.54 449.54 449.54 74 332.66 percent of total billed charges 449.54 93 364.13 percent of total billed charges 449.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 449.54 other OPPS APC 449.54 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 449.54 other OPPS APC 449.54 27.63 124.21 percent of total billed charges 449.54 449.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - KUMPE SUP-99-00134 CDM 0272 RC outpatient 100 100 100 74 74 percent of total billed charges 100 93 81 percent of total billed charges 100 100 other OPPS APC 100 100 other OPPS APC 100 27.63 27.63 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - VTK 125CM SUP-99-00135 CDM 0272 RC outpatient 65 65 65 74 48.1 percent of total billed charges 65 93 52.65 percent of total billed charges 65 65 other OPPS APC 65 65 other OPPS APC 65 27.63 17.96 percent of total billed charges 65 65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - 3MM J .021 SUP-99-00137 CDM C1769 HCPCS 0272 RC outpatient 77.28 77.28 77.28 74 57.19 percent of total billed charges 77.28 93 62.6 percent of total billed charges 77.28 77.28 other OPPS APC 77.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 77.28 other OPPS APC 77.28 27.63 21.35 percent of total billed charges 77.28 77.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - AMPLATZ XSTIFF 260CM SUP-99-00138 CDM C1769 HCPCS 0272 RC outpatient 115.96 115.96 115.96 74 85.81 percent of total billed charges 115.96 93 93.93 percent of total billed charges 115.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 115.96 other OPPS APC 115.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 115.96 other OPPS APC 115.96 27.63 32.04 percent of total billed charges 115.96 115.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - LUNDERQUIST SUP-99-00139 CDM C1769 HCPCS 0272 RC outpatient 339.5 339.5 339.5 74 251.23 percent of total billed charges 339.5 93 275 percent of total billed charges 339.5 339.5 other OPPS APC 339.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 339.5 other OPPS APC 339.5 27.63 93.8 percent of total billed charges 339.5 339.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PNEUMOTHORAX SET CTSUP SUP-99-00140 CDM C1729 HCPCS 0272 RC outpatient 604.49 604.49 604.49 74 447.32 percent of total billed charges 604.49 93 489.64 percent of total billed charges 604.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.49 other OPPS APC 604.49 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 604.49 other OPPS APC 604.49 27.63 167.02 percent of total billed charges 604.49 604.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - RIM 5F SUP-99-00141 CDM 0272 RC outpatient 54 54 54 74 39.96 percent of total billed charges 54 93 43.74 percent of total billed charges 54 54 other OPPS APC 54 54 other OPPS APC 54 27.63 14.92 percent of total billed charges 54 54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - SWAN GANZ MONITORING SUP-99-00149 CDM 0272 RC outpatient 507.4 507.4 507.4 74 375.48 percent of total billed charges 507.4 93 410.99 percent of total billed charges 507.4 507.4 other OPPS APC 507.4 507.4 other OPPS APC 507.4 27.63 140.19 percent of total billed charges 507.4 507.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - SWAN GANZ S TIP MONITORING SUP-99-00150 CDM 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 188 other OPPS APC 188 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - PRELUDE SNAP 7F 13CM SUP-99-00161 CDM C1894 HCPCS 0272 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130 other OPPS APC 130 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - SAFESHEATH 9F 13CM SUP-99-00163 CDM C1894 HCPCS 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - SAFESHEATH 9F 25CM SUP-99-00164 CDM C1894 HCPCS 0272 RC outpatient 1080 1080 1080 74 799.2 percent of total billed charges 1080 93 874.8 percent of total billed charges 1080 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1080 other OPPS APC 1080 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1080 other OPPS APC 1080 27.63 298.4 percent of total billed charges 1080 1080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- MODIFIED HOOK 1 5F SUP-99-00170 CDM 0272 RC outpatient 48 48 48 74 35.52 percent of total billed charges 48 93 38.88 percent of total billed charges 48 48 other OPPS APC 48 48 other OPPS APC 48 27.63 13.26 percent of total billed charges 48 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - BERENSTEIN 5F X 100 SUP-99-00171 CDM 0272 RC outpatient 46 46 46 74 34.04 percent of total billed charges 46 93 37.26 percent of total billed charges 46 46 other OPPS APC 46 46 other OPPS APC 46 27.63 12.71 percent of total billed charges 46 46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - MARKER PIGTAIL 5F X 100 SUP-99-00172 CDM 0272 RC outpatient 315 315 315 74 233.1 percent of total billed charges 315 93 255.15 percent of total billed charges 315 315 other OPPS APC 315 315 other OPPS APC 315 27.63 87.03 percent of total billed charges 315 315 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - BERENSTEIN 5F X 65 SUP-99-00173 CDM 0272 RC outpatient 44 44 44 74 32.56 percent of total billed charges 44 93 35.64 percent of total billed charges 44 44 other OPPS APC 44 44 other OPPS APC 44 27.63 12.16 percent of total billed charges 44 44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - MARKER PIG (20) 5F X 65 SUP-99-00174 CDM 0272 RC outpatient 292.95 292.95 292.95 74 216.78 percent of total billed charges 292.95 93 237.29 percent of total billed charges 292.95 292.95 other OPPS APC 292.95 292.95 other OPPS APC 292.95 27.63 80.94 percent of total billed charges 292.95 292.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - STRAIGHT FLUSH 5F X 65 SUP-99-00175 CDM 0272 RC outpatient 420 420 420 74 310.8 percent of total billed charges 420 93 340.2 percent of total billed charges 420 420 other OPPS APC 420 420 other OPPS APC 420 27.63 116.05 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - STRAIGHT FLUSH 5F X 90 SUP-99-00176 CDM 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - AL 1 6F SUP-99-00177 CDM 0272 RC outpatient 191.8 191.8 191.8 74 141.93 percent of total billed charges 191.8 93 155.36 percent of total billed charges 191.8 191.8 other OPPS APC 191.8 191.8 other OPPS APC 191.8 27.63 52.99 percent of total billed charges 191.8 191.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - AL 2 6F SUP-99-00178 CDM 0272 RC outpatient 153.4 153.4 153.4 74 113.52 percent of total billed charges 153.4 93 124.25 percent of total billed charges 153.4 153.4 other OPPS APC 153.4 153.4 other OPPS APC 153.4 27.63 42.38 percent of total billed charges 153.4 153.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - AR 1 6F SUP-99-00180 CDM 0272 RC outpatient 191.8 191.8 191.8 74 141.93 percent of total billed charges 191.8 93 155.36 percent of total billed charges 191.8 191.8 other OPPS APC 191.8 191.8 other OPPS APC 191.8 27.63 52.99 percent of total billed charges 191.8 191.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - INTERNAL MAMMARY 6F SUP-99-00181 CDM 0272 RC outpatient 38.36 38.36 38.36 74 28.39 percent of total billed charges 38.36 93 31.07 percent of total billed charges 38.36 38.36 other OPPS APC 38.36 38.36 other OPPS APC 38.36 27.63 10.6 percent of total billed charges 38.36 38.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JL 4.0 6F SUP-99-00182 CDM 0272 RC outpatient 36.2 36.2 36.2 74 26.79 percent of total billed charges 36.2 93 29.32 percent of total billed charges 36.2 36.2 other OPPS APC 36.2 36.2 other OPPS APC 36.2 27.63 10 percent of total billed charges 36.2 36.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JL 4.5 6F SUP-99-00183 CDM 0272 RC outpatient 276.85 276.85 276.85 74 204.87 percent of total billed charges 276.85 93 224.25 percent of total billed charges 276.85 276.85 other OPPS APC 276.85 276.85 other OPPS APC 276.85 27.63 76.49 percent of total billed charges 276.85 276.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JL 5.0 6F SUP-99-00184 CDM 0272 RC outpatient 170 170 170 74 125.8 percent of total billed charges 170 93 137.7 percent of total billed charges 170 170 other OPPS APC 170 170 other OPPS APC 170 27.63 46.97 percent of total billed charges 170 170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JL 6.0 6F SUP-99-00185 CDM 0272 RC outpatient 31.64 31.64 31.64 74 23.41 percent of total billed charges 31.64 93 25.63 percent of total billed charges 31.64 31.64 other OPPS APC 31.64 31.64 other OPPS APC 31.64 27.63 8.74 percent of total billed charges 31.64 31.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JR 3.5 6F SUP-99-00186 CDM 0272 RC outpatient 30.68 30.68 30.68 74 22.7 percent of total billed charges 30.68 93 24.85 percent of total billed charges 30.68 30.68 other OPPS APC 30.68 30.68 other OPPS APC 30.68 27.63 8.48 percent of total billed charges 30.68 30.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JR 4.0 6F SUP-99-00187 CDM 0272 RC outpatient 30.68 30.68 30.68 74 22.7 percent of total billed charges 30.68 93 24.85 percent of total billed charges 30.68 30.68 other OPPS APC 30.68 30.68 other OPPS APC 30.68 27.63 8.48 percent of total billed charges 30.68 30.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JR 5.0 6F SUP-99-00188 CDM 0272 RC outpatient 36.2 36.2 36.2 74 26.79 percent of total billed charges 36.2 93 29.32 percent of total billed charges 36.2 36.2 other OPPS APC 36.2 36.2 other OPPS APC 36.2 27.63 10 percent of total billed charges 36.2 36.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JR 6.0 6F SUP-99-00189 CDM 0272 RC outpatient 34 34 34 74 25.16 percent of total billed charges 34 93 27.54 percent of total billed charges 34 34 other OPPS APC 34 34 other OPPS APC 34 27.63 9.39 percent of total billed charges 34 34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - LCB 6F SUP-99-00190 CDM 0272 RC outpatient 38.36 38.36 38.36 74 28.39 percent of total billed charges 38.36 93 31.07 percent of total billed charges 38.36 38.36 other OPPS APC 38.36 38.36 other OPPS APC 38.36 27.63 10.6 percent of total billed charges 38.36 38.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - MULTIPURPOSE A-2 6F SUP-99-00191 CDM 0272 RC outpatient 170 170 170 74 125.8 percent of total billed charges 170 93 137.7 percent of total billed charges 170 170 other OPPS APC 170 170 other OPPS APC 170 27.63 46.97 percent of total billed charges 170 170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - MULTIPURPOSE B-2 6F SUP-99-00192 CDM 0272 RC outpatient 170 170 170 74 125.8 percent of total billed charges 170 93 137.7 percent of total billed charges 170 170 other OPPS APC 170 170 other OPPS APC 170 27.63 46.97 percent of total billed charges 170 170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - PIGTAIL 6F SUP-99-00193 CDM 0272 RC outpatient 30.68 30.68 30.68 74 22.7 percent of total billed charges 30.68 93 24.85 percent of total billed charges 30.68 30.68 other OPPS APC 30.68 30.68 other OPPS APC 30.68 27.63 8.48 percent of total billed charges 30.68 30.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - RCB 6F SUP-99-00194 CDM 0272 RC outpatient 153.4 153.4 153.4 74 113.52 percent of total billed charges 153.4 93 124.25 percent of total billed charges 153.4 153.4 other OPPS APC 153.4 153.4 other OPPS APC 153.4 27.63 42.38 percent of total billed charges 153.4 153.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - .035X50CM SUP-99-00198 CDM C1769 HCPCS 0272 RC outpatient 28.64 28.64 28.64 74 21.19 percent of total billed charges 28.64 93 23.2 percent of total billed charges 28.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28.64 other OPPS APC 28.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 28.64 other OPPS APC 28.64 27.63 7.91 percent of total billed charges 28.64 28.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - 3MM J 150CM SUP-99-00199 CDM C1769 HCPCS 0272 RC outpatient 25.96 25.96 25.96 74 19.21 percent of total billed charges 25.96 93 21.03 percent of total billed charges 25.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 25.96 other OPPS APC 25.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 25.96 other OPPS APC 25.96 27.63 7.17 percent of total billed charges 25.96 25.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - BENSTON ST EXCHANGE SUP-99-00200 CDM C1769 HCPCS 0272 RC outpatient 411.25 411.25 411.25 74 304.33 percent of total billed charges 411.25 93 333.11 percent of total billed charges 411.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 411.25 other OPPS APC 411.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 411.25 other OPPS APC 411.25 27.63 113.63 percent of total billed charges 411.25 411.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - 3MM J EXCHANGE SUP-99-00201 CDM C1769 HCPCS 0272 RC outpatient 40.88 40.88 40.88 74 30.25 percent of total billed charges 40.88 93 33.11 percent of total billed charges 40.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40.88 other OPPS APC 40.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40.88 other OPPS APC 40.88 27.63 11.3 percent of total billed charges 40.88 40.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE-GLIDE SPLASH .018X150 ANGLED SUP-99-00202 CDM C1769 HCPCS 0272 RC outpatient 155.84 155.84 155.84 74 115.32 percent of total billed charges 155.84 93 126.23 percent of total billed charges 155.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 155.84 other OPPS APC 155.84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 155.84 other OPPS APC 155.84 27.63 43.06 percent of total billed charges 155.84 155.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE-GLIDE SPLASH .035X150 ANGLED SUP-99-00204 CDM C1769 HCPCS 0272 RC outpatient 112.56 112.56 112.56 74 83.29 percent of total billed charges 112.56 93 91.17 percent of total billed charges 112.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.56 other OPPS APC 112.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 112.56 other OPPS APC 112.56 27.63 31.1 percent of total billed charges 112.56 112.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE- GLIDE SPLASH .035 STRAIGHT SUP-99-00206 CDM C1769 HCPCS 0272 RC outpatient 128 128 128 74 94.72 percent of total billed charges 128 93 103.68 percent of total billed charges 128 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 128 other OPPS APC 128 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 128 other OPPS APC 128 27.63 35.37 percent of total billed charges 128 128 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE-GLIDE SPLASH 035X180 ANG STIFF SUP-99-00207 CDM C1769 HCPCS 0272 RC outpatient 665 665 665 74 492.1 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 27.63 183.74 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE-GLIDE SPLASH .035X260 STRAIGHT SUP-99-00208 CDM C1769 HCPCS 0272 RC outpatient 124.52 124.52 124.52 74 92.14 percent of total billed charges 124.52 93 100.86 percent of total billed charges 124.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 124.52 other OPPS APC 124.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 124.52 other OPPS APC 124.52 27.63 34.4 percent of total billed charges 124.52 124.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE-GLIDE SPLASH .035X260 ANGLED STANDARD SUP-99-00209 CDM C1769 HCPCS 0272 RC outpatient 145.2 145.2 145.2 74 107.45 percent of total billed charges 145.2 93 117.61 percent of total billed charges 145.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.2 other OPPS APC 145.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.2 other OPPS APC 145.2 27.63 40.12 percent of total billed charges 145.2 145.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - STRAIGHT SUP-99-00210 CDM C1769 HCPCS 0272 RC outpatient 227.15 227.15 227.15 74 168.09 percent of total billed charges 227.15 93 183.99 percent of total billed charges 227.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 227.15 other OPPS APC 227.15 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 227.15 other OPPS APC 227.15 27.63 62.76 percent of total billed charges 227.15 227.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - MAK-NV 6F SUP-99-00217 CDM C1894 HCPCS 0272 RC outpatient 231 231 231 74 170.94 percent of total billed charges 231 93 187.11 percent of total billed charges 231 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 231 other OPPS APC 231 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 231 other OPPS APC 231 27.63 63.83 percent of total billed charges 231 231 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - MICROPUNTURE INTRODUCER 5F SUP-99-00219 CDM C1894 HCPCS 0272 RC outpatient 83.52 83.52 83.52 74 61.8 percent of total billed charges 83.52 93 67.65 percent of total billed charges 83.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 83.52 other OPPS APC 83.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 83.52 other OPPS APC 83.52 27.63 23.08 percent of total billed charges 83.52 83.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 5F SUP-99-00223 CDM C1894 HCPCS 0272 RC outpatient 191.6 191.6 191.6 74 141.78 percent of total billed charges 191.6 93 155.2 percent of total billed charges 191.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 191.6 other OPPS APC 191.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 191.6 other OPPS APC 191.6 27.63 52.94 percent of total billed charges 191.6 191.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 6F SUP-99-00224 CDM C1894 HCPCS 0272 RC outpatient 36.24 36.24 36.24 74 26.82 percent of total billed charges 36.24 93 29.35 percent of total billed charges 36.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36.24 other OPPS APC 36.24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36.24 other OPPS APC 36.24 27.63 10.01 percent of total billed charges 36.24 36.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 6FX11 MARKER TIP SUP-99-00225 CDM C1894 HCPCS 0272 RC outpatient 103.8 103.8 103.8 74 76.81 percent of total billed charges 103.8 93 84.08 percent of total billed charges 103.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 103.8 other OPPS APC 103.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 103.8 other OPPS APC 103.8 27.63 28.68 percent of total billed charges 103.8 103.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 6F X 23CM MARKER TIP SUP-99-00226 CDM C1894 HCPCS 0272 RC outpatient 92.8 92.8 92.8 74 68.67 percent of total billed charges 92.8 93 75.17 percent of total billed charges 92.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.8 other OPPS APC 92.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92.8 other OPPS APC 92.8 27.63 25.64 percent of total billed charges 92.8 92.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 7FX11CM SUP-99-00227 CDM C1894 HCPCS 0272 RC outpatient 38.32 38.32 38.32 74 28.36 percent of total billed charges 38.32 93 31.04 percent of total billed charges 38.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.32 other OPPS APC 38.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.32 other OPPS APC 38.32 27.63 10.59 percent of total billed charges 38.32 38.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 8FX11CM SUP-99-00228 CDM C1894 HCPCS 0272 RC outpatient 38.32 38.32 38.32 74 28.36 percent of total billed charges 38.32 93 31.04 percent of total billed charges 38.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.32 other OPPS APC 38.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.32 other OPPS APC 38.32 27.63 10.59 percent of total billed charges 38.32 38.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOSURE DEVICE - ANGIOSEALVIP - 6F SUP-99-00241 CDM C1762 HCPCS 0272 RC outpatient 735 735 735 74 543.9 percent of total billed charges 735 93 595.35 percent of total billed charges 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 27.63 203.08 percent of total billed charges 735 735 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GLIDEWIRE .018X260 ANGLED SUP-99-00242 CDM C1769 HCPCS 0272 RC outpatient 269.5 269.5 269.5 74 199.43 percent of total billed charges 269.5 93 218.3 percent of total billed charges 269.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 269.5 other OPPS APC 269.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 269.5 other OPPS APC 269.5 27.63 74.46 percent of total billed charges 269.5 269.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GLIDEWIRE .035X260 ANG STIFF SUP-99-00243 CDM C1769 HCPCS 0272 RC outpatient 199.4 199.4 199.4 74 147.56 percent of total billed charges 199.4 93 161.51 percent of total billed charges 199.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 199.4 other OPPS APC 199.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 199.4 other OPPS APC 199.4 27.63 55.09 percent of total billed charges 199.4 199.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - PINNACLE DESTINATION 6FX45CM STRAIGHT TIP SUP-99-00245 CDM C1894 HCPCS 0272 RC outpatient 287 287 287 74 212.38 percent of total billed charges 287 93 232.47 percent of total billed charges 287 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 287 other OPPS APC 287 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 287 other OPPS APC 287 27.63 79.3 percent of total billed charges 287 287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - PINNACLE DESTINATION 7FX45CM STRAIGHT TIP SUP-99-00246 CDM C1894 HCPCS 0272 RC outpatient 287 287 287 74 212.38 percent of total billed charges 287 93 232.47 percent of total billed charges 287 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 287 other OPPS APC 287 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 287 other OPPS APC 287 27.63 79.3 percent of total billed charges 287 287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - AL 3 6F SUP-99-00415 CDM 0272 RC outpatient 170 170 170 74 125.8 percent of total billed charges 170 93 137.7 percent of total billed charges 170 170 other OPPS APC 170 170 other OPPS APC 170 27.63 46.97 percent of total billed charges 170 170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOSURE DEVICE - MYNX CONTROL SUP-99-00416 CDM C1762 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - IM (CORDIS) SUP-99-00435 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XB 3.5 SUP-99-00440 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - EBU3.75 SUP-99-00445 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XB 3 SUP-99-00451 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JR4 SUP-99-00452 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - EBU3.5 SUP-99-00458 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - PROWATER - 180CM SUP-99-00460 CDM C1769 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - DOC EXTENSION SUP-99-00461 CDM 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 297.5 other OPPS APC 297.5 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JCL 4 SUP-99-00477 CDM C1887 HCPCS 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - MIRACLEBROS 3 - 180CM SUP-99-00482 CDM C1769 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JCL 3.5 SH SUP-99-00487 CDM C1887 HCPCS 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - PRONTO LP EXTRACTION SUP-99-00490 CDM C1757 HCPCS 0272 RC outpatient 930 930 930 74 688.2 percent of total billed charges 930 93 753.3 percent of total billed charges 930 930 other OPPS APC 930 930 other OPPS APC 930 27.63 256.96 percent of total billed charges 930 930 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - BMW 190CM SUP-99-00494 CDM C1769 HCPCS 0272 RC outpatient 290.5 290.5 290.5 74 214.97 percent of total billed charges 290.5 93 235.31 percent of total billed charges 290.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 290.5 other OPPS APC 290.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 290.5 other OPPS APC 290.5 27.63 80.27 percent of total billed charges 290.5 290.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - IM SH SUP-99-00499 CDM C1887 HCPCS 0272 RC outpatient 174 174 174 74 128.76 percent of total billed charges 174 93 140.94 percent of total billed charges 174 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174 other OPPS APC 174 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174 other OPPS APC 174 27.63 48.08 percent of total billed charges 174 174 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JR4 SH SUP-99-00508 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - MPA 1 SUP-99-00509 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - FILTERWIRE EZ 2.25-3.5 SUP-99-00514 CDM C1884 HCPCS 0272 RC outpatient 3237.5 3237.5 3237.5 74 2395.75 percent of total billed charges 3237.5 93 2622.38 percent of total billed charges 3237.5 3237.5 other OPPS APC 3237.5 3237.5 other OPPS APC 3237.5 27.63 894.52 percent of total billed charges 3237.5 3237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - TRANSIT 135 CCM SUP-99-00517 CDM C1887 HCPCS 0272 RC outpatient 1650 1650 1650 74 1221 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 27.63 455.9 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - FLEXTOME CUTTING 2.5X10 SUP-99-00521 CDM C1725 HCPCS 0272 RC outpatient 2325 2325 2325 74 1720.5 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 27.63 642.4 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - IM (BS) SUP-99-00522 CDM C1887 HCPCS 0272 RC outpatient 192.5 192.5 192.5 74 142.45 percent of total billed charges 192.5 93 155.93 percent of total billed charges 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 4.0X15 SUP-99-00525 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - AL 1 SH SUP-99-00528 CDM C1887 HCPCS 0272 RC outpatient 193.6 193.6 193.6 74 143.26 percent of total billed charges 193.6 93 156.82 percent of total billed charges 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 27.63 53.49 percent of total billed charges 193.6 193.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - EBU3.5 SH SUP-99-00539 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - SWAN GANZ THERMO SUP-99-00543 CDM 0272 RC outpatient 493.5 493.5 493.5 74 365.19 percent of total billed charges 493.5 93 399.74 percent of total billed charges 493.5 493.5 other OPPS APC 493.5 493.5 other OPPS APC 493.5 27.63 136.35 percent of total billed charges 493.5 493.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERCARDIOCENTESIS TRAY SUP-99-00548 CDM C1729 HCPCS 0272 RC outpatient 280 280 280 74 207.2 percent of total billed charges 280 93 226.8 percent of total billed charges 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 27.63 77.36 percent of total billed charges 280 280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - LCB SH SUP-99-00566 CDM C1887 HCPCS 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - AR 1 SUP-99-00575 CDM C1887 HCPCS 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - BMW 300CM SUP-99-00577 CDM C1769 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JR4 (BS) SUP-99-00579 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 3.5X23 SUP-99-00584 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 4.0X23 SUP-99-00585 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 8F JR4 SH SUP-99-00586 CDM C1887 HCPCS 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - FLEXTOME CUTTING 2.5X15 SUP-99-00587 CDM C1725 HCPCS 0272 RC outpatient 2325 2325 2325 74 1720.5 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 27.63 642.4 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JR3.5 SUP-99-00593 CDM C1887 HCPCS 0272 RC outpatient 174 174 174 74 128.76 percent of total billed charges 174 93 140.94 percent of total billed charges 174 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174 other OPPS APC 174 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174 other OPPS APC 174 27.63 48.08 percent of total billed charges 174 174 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 5X100 SUP-99-00594 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - FLEXTOME CUTTING 2.0 X 15 SUP-99-00595 CDM C1725 HCPCS 0272 RC outpatient 2325 2325 2325 74 1720.5 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 27.63 642.4 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - IM 8F SUP-99-00598 CDM C1887 HCPCS 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 8F IM SH SUP-99-00599 CDM C1887 HCPCS 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - FIELDER FC - 180CM SUP-99-00600 CDM C1769 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 8F EBU3.5 SH SUP-99-00607 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - PINNACLE DESTINATION 6FX60CM STRAIGHT TIP SUP-99-00608 CDM C1894 HCPCS 0272 RC outpatient 315 315 315 74 233.1 percent of total billed charges 315 93 255.15 percent of total billed charges 315 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 315 other OPPS APC 315 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 315 other OPPS APC 315 27.63 87.03 percent of total billed charges 315 315 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 8F EBU3.5 SUP-99-00609 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XB 3.5 SH SUP-99-00612 CDM C1887 HCPCS 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 8F 23CM SUP-99-00613 CDM C1894 HCPCS 0272 RC outpatient 48.36 48.36 48.36 74 35.79 percent of total billed charges 48.36 93 39.17 percent of total billed charges 48.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.36 other OPPS APC 48.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 48.36 other OPPS APC 48.36 27.63 13.36 percent of total billed charges 48.36 48.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - EBU3.75 SH SUP-99-00617 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - VASCUTRACK CUTTING 2.5X60 SUP-99-00620 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - VASCUTRACK CUTTING 2.5X80 SUP-99-00621 CDM C1725 HCPCS 0272 RC outpatient 2250 2250 2250 74 1665 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 27.63 621.68 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - VASCUTRACK CUTTING 3.0X60 SUP-99-00622 CDM C1725 HCPCS 0272 RC outpatient 2250 2250 2250 74 1665 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 27.63 621.68 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - VASCUTRACK CUTTING 3.0X80 SUP-99-00623 CDM C1725 HCPCS 0272 RC outpatient 2250 2250 2250 74 1665 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 27.63 621.68 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - VASCUTRACK CUTTING 4.0X60 SUP-99-00624 CDM C1725 HCPCS 0272 RC outpatient 2250 2250 2250 74 1665 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 27.63 621.68 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - VASCUTRACK CUTTING 4.0X80 SUP-99-00625 CDM C1725 HCPCS 0272 RC outpatient 2250 2250 2250 74 1665 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 27.63 621.68 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - VASCUTRACK CUTTING 5.0X60 SUP-99-00626 CDM C1725 HCPCS 0272 RC outpatient 2250 2250 2250 74 1665 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 27.63 621.68 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - VASCUTRACK CUTTING 5.0X80 SUP-99-00627 CDM C1725 HCPCS 0272 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTABLATOR - 1.50MM ROTAPRO BURR SUP-99-00632 CDM C1724 HCPCS 0272 RC outpatient 4812.5 4812.5 4812.5 74 3561.25 percent of total billed charges 4812.5 93 3898.13 percent of total billed charges 4812.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4812.5 other OPPS APC 4812.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4812.5 other OPPS APC 4812.5 27.63 1329.69 percent of total billed charges 4812.5 4812.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - HERCULINK ELITE 6.0X15 SUP-99-00637 CDM C1876 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - AL 1 SUP-99-00640 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - TWIN-PASS SUP-99-00643 CDM C1887 HCPCS 0272 RC outpatient 885 885 885 74 654.9 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 27.63 244.53 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MINI VISION 2.5X28 SUP-99-00645 CDM C1876 HCPCS 0278 RC outpatient 2325 2325 2325 57 1325.25 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 51 1185.75 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - PROWATER - 300CM SUP-99-00648 CDM C1769 HCPCS 0272 RC outpatient 332.5 332.5 332.5 74 246.05 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 27.63 91.87 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - FIELDER FC - 300CM SUP-99-00649 CDM C1769 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 8F EBU3.75 SUP-99-00651 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JL 3.5 6F SUP-99-00652 CDM 0272 RC outpatient 191.8 191.8 191.8 74 141.93 percent of total billed charges 191.8 93 155.36 percent of total billed charges 191.8 191.8 other OPPS APC 191.8 191.8 other OPPS APC 191.8 27.63 52.99 percent of total billed charges 191.8 191.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VERIFLEX 4.5X20 SUP-99-00653 CDM C1876 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 8F EBU3.75 SH SUP-99-00656 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JR3.5 SH SUP-99-00657 CDM C1887 HCPCS 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - MP1 SUP-99-00660 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MINI VISION 2.5X23 SUP-99-00662 CDM C1876 HCPCS 0278 RC outpatient 2250 2250 2250 57 1282.5 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 51 1147.5 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MINI VISION 2.5X15 SUP-99-00663 CDM C1876 HCPCS 0278 RC outpatient 2325 2325 2325 57 1325.25 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 51 1185.75 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 3.5X28 SUP-99-00665 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JCL 3.5 SUP-99-00678 CDM C1887 HCPCS 0272 RC outpatient 168.6 168.6 168.6 74 124.76 percent of total billed charges 168.6 93 136.57 percent of total billed charges 168.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168.6 other OPPS APC 168.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168.6 other OPPS APC 168.6 27.63 46.58 percent of total billed charges 168.6 168.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 3.0X28 SUP-99-00679 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - EBU4.0 SUP-99-00680 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - FLEXTOME CUTTING 2.0X10 SUP-99-00683 CDM C1725 HCPCS 0272 RC outpatient 2325 2325 2325 74 1720.5 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 27.63 642.4 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - AMPLATZ STIFF STRAIGHT SUP-99-00685 CDM C1769 HCPCS 0272 RC outpatient 96.6 96.6 96.6 74 71.48 percent of total billed charges 96.6 93 78.25 percent of total billed charges 96.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 96.6 other OPPS APC 96.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 96.6 other OPPS APC 96.6 27.63 26.69 percent of total billed charges 96.6 96.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - .018X40CM SUP-99-00686 CDM C1769 HCPCS 0272 RC outpatient 78.4 78.4 78.4 74 58.02 percent of total billed charges 78.4 93 63.5 percent of total billed charges 78.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 78.4 other OPPS APC 78.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 78.4 other OPPS APC 78.4 27.63 21.66 percent of total billed charges 78.4 78.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - MICRO GUIDE 140CM SUP-99-00687 CDM C1887 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 7.0X20 SUP-99-00700 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - MIRACLEBROS 3 - 300CM SUP-99-00702 CDM C1769 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - MIRACLEBROS 6 - 300CM SUP-99-00703 CDM C1769 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 6.0X20 SUP-99-00709 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 5.0X80 SUP-99-00712 CDM C1876 HCPCS 0278 RC outpatient 3125 3125 3125 57 1781.25 percent of total billed charges 3125 93 2531.25 percent of total billed charges 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 51 1593.75 percent of total billed charges 3125 3125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 4.0X18 SUP-99-00713 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - CROSS-OVER SUP-99-00717 CDM 0272 RC outpatient 92.48 92.48 92.48 74 68.44 percent of total billed charges 92.48 93 74.91 percent of total billed charges 92.48 92.48 other OPPS APC 92.48 92.48 other OPPS APC 92.48 27.63 25.55 percent of total billed charges 92.48 92.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - MPA 1 SH SUP-99-00737 CDM C1887 HCPCS 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - PIGTAIL 5F SUP-99-00743 CDM 0272 RC outpatient 38.36 38.36 38.36 74 28.39 percent of total billed charges 38.36 93 31.07 percent of total billed charges 38.36 38.36 other OPPS APC 38.36 38.36 other OPPS APC 38.36 27.63 10.6 percent of total billed charges 38.36 38.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - PIGTAIL ANGLED 5F SUP-99-00744 CDM 0272 RC outpatient 30.68 30.68 30.68 74 22.7 percent of total billed charges 30.68 93 24.85 percent of total billed charges 30.68 30.68 other OPPS APC 30.68 30.68 other OPPS APC 30.68 27.63 8.48 percent of total billed charges 30.68 30.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - QUICK CROSS SELECT 135CM SUP-99-00745 CDM C1887 HCPCS 0272 RC outpatient 2955 2955 2955 74 2186.7 percent of total billed charges 2955 93 2393.55 percent of total billed charges 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 27.63 816.47 percent of total billed charges 2955 2955 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - QUICK CROSS SELECT 65CM SUP-99-00746 CDM C1887 HCPCS 0272 RC outpatient 2955 2955 2955 74 2186.7 percent of total billed charges 2955 93 2393.55 percent of total billed charges 2955 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2955 other OPPS APC 2955 2955 other OPPS APC 2955 27.63 816.47 percent of total billed charges 2955 2955 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - QUICK CROSS 135CM SUP-99-00747 CDM C1887 HCPCS 0272 RC outpatient 2505 2505 2505 74 1853.7 percent of total billed charges 2505 93 2029.05 percent of total billed charges 2505 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2505 other OPPS APC 2505 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2505 other OPPS APC 2505 27.63 692.13 percent of total billed charges 2505 2505 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - QUICK CROSS 65CM SUP-99-00748 CDM C1887 HCPCS 0272 RC outpatient 2505 2505 2505 74 1853.7 percent of total billed charges 2505 93 2029.05 percent of total billed charges 2505 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2505 other OPPS APC 2505 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2505 other OPPS APC 2505 27.63 692.13 percent of total billed charges 2505 2505 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - GLIDESHEATH 6F SUP-99-00754 CDM C1894 HCPCS 0272 RC outpatient 144 144 144 74 106.56 percent of total billed charges 144 93 116.64 percent of total billed charges 144 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 144 other OPPS APC 144 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 144 other OPPS APC 144 27.63 39.79 percent of total billed charges 144 144 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JR3.5 SH (BS) SUP-99-00757 CDM C1887 HCPCS 0272 RC outpatient 192.5 192.5 192.5 74 142.45 percent of total billed charges 192.5 93 155.93 percent of total billed charges 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - LCB SUP-99-00758 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ULTRA 5.0X28 SUP-99-00760 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - PRC 6F SUP-99-00761 CDM 0272 RC outpatient 170 170 170 74 125.8 percent of total billed charges 170 93 137.7 percent of total billed charges 170 170 other OPPS APC 170 170 other OPPS APC 170 27.63 46.97 percent of total billed charges 170 170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VERIFLEX 3.0X32 SUP-99-00770 CDM C1876 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON PUMP - CATHETER 40CC SUP-99-00771 CDM 0272 RC outpatient 2775 2775 2775 74 2053.5 percent of total billed charges 2775 93 2247.75 percent of total billed charges 2775 2775 other OPPS APC 2775 2775 other OPPS APC 2775 27.63 766.73 percent of total billed charges 2775 2775 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - FRONTRUNNER 90CM SUP-99-00775 CDM C1887 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - MICRO GUIDE 90CM SUP-99-00776 CDM C1887 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 5.0X20 SUP-99-00781 CDM C1876 HCPCS 0278 RC outpatient 3125 3125 3125 57 1781.25 percent of total billed charges 3125 93 2531.25 percent of total billed charges 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 51 1593.75 percent of total billed charges 3125 3125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - WHISPER EXTRA .014X300 SUP-99-00784 CDM C1769 HCPCS 0272 RC outpatient 266 266 266 74 196.84 percent of total billed charges 266 93 215.46 percent of total billed charges 266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 266 other OPPS APC 266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 266 other OPPS APC 266 27.63 73.5 percent of total billed charges 266 266 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 6.0X80 SUP-99-00785 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GRAND SLAM 300CM SUP-99-00786 CDM C1769 HCPCS 0272 RC outpatient 339.5 339.5 339.5 74 251.23 percent of total billed charges 339.5 93 275 percent of total billed charges 339.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 339.5 other OPPS APC 339.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 339.5 other OPPS APC 339.5 27.63 93.8 percent of total billed charges 339.5 339.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - HI-TORQUE STEELCORE 18 300CM SUP-99-00787 CDM C1769 HCPCS 0272 RC outpatient 290.5 290.5 290.5 74 214.97 percent of total billed charges 290.5 93 235.31 percent of total billed charges 290.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 290.5 other OPPS APC 290.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 290.5 other OPPS APC 290.5 27.63 80.27 percent of total billed charges 290.5 290.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - SPARTACOR 14 300CM SUP-99-00788 CDM C1769 HCPCS 0272 RC outpatient 290.5 290.5 290.5 74 214.97 percent of total billed charges 290.5 93 235.31 percent of total billed charges 290.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 290.5 other OPPS APC 290.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 290.5 other OPPS APC 290.5 27.63 80.27 percent of total billed charges 290.5 290.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 7FX11 MARKER TIP SUP-99-00789 CDM C1894 HCPCS 0272 RC outpatient 349.13 349.13 349.13 74 258.36 percent of total billed charges 349.13 93 282.8 percent of total billed charges 349.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.13 other OPPS APC 349.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.13 other OPPS APC 349.13 27.63 96.46 percent of total billed charges 349.13 349.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - THROMBECTOMY OMNI SUP-99-00794 CDM C1757 HCPCS 0272 RC outpatient 5421.03 5421.03 5421.03 74 4011.56 percent of total billed charges 5421.03 93 4391.03 percent of total billed charges 5421.03 5421.03 other OPPS APC 5421.03 5421.03 other OPPS APC 5421.03 27.63 1497.83 percent of total billed charges 5421.03 5421.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - VERTEBRAL 4F SUP-99-00811 CDM C1887 HCPCS 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTABLATOR- 1.25MM ROTAPRO BURR SUP-99-00813 CDM C1724 HCPCS 0272 RC outpatient 4812.5 4812.5 4812.5 74 3561.25 percent of total billed charges 4812.5 93 3898.13 percent of total billed charges 4812.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4812.5 other OPPS APC 4812.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4812.5 other OPPS APC 4812.5 27.63 1329.69 percent of total billed charges 4812.5 4812.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 5.0X40 SUP-99-00815 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ULTRA 5.0X18 SUP-99-00816 CDM C1876 HCPCS 0278 RC outpatient 2625 2625 2625 57 1496.25 percent of total billed charges 2625 93 2126.25 percent of total billed charges 2625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2625 other OPPS APC 2625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2625 other OPPS APC 2625 51 1338.75 percent of total billed charges 2625 2625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - WHISPER EXTRA .014X190 SUP-99-00823 CDM C1769 HCPCS 0272 RC outpatient 266 266 266 74 196.84 percent of total billed charges 266 93 215.46 percent of total billed charges 266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 266 other OPPS APC 266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 266 other OPPS APC 266 27.63 73.5 percent of total billed charges 266 266 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 8F JR3.5 SUP-99-00827 CDM C1887 HCPCS 0272 RC outpatient 160 160 160 74 118.4 percent of total billed charges 160 93 129.6 percent of total billed charges 160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160 other OPPS APC 160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160 other OPPS APC 160 27.63 44.21 percent of total billed charges 160 160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 8F AL 1 SH SUP-99-00828 CDM C1887 HCPCS 0272 RC outpatient 198 198 198 74 146.52 percent of total billed charges 198 93 160.38 percent of total billed charges 198 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 198 other OPPS APC 198 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 198 other OPPS APC 198 27.63 54.71 percent of total billed charges 198 198 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 8F AR 1 SH SUP-99-00829 CDM C1887 HCPCS 0272 RC outpatient 198 198 198 74 146.52 percent of total billed charges 198 93 160.38 percent of total billed charges 198 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 198 other OPPS APC 198 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 198 other OPPS APC 198 27.63 54.71 percent of total billed charges 198 198 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MINI VISION 2.5X18 SUP-99-00832 CDM C1876 HCPCS 0278 RC outpatient 2475 2475 2475 57 1410.75 percent of total billed charges 2475 93 2004.75 percent of total billed charges 2475 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2475 other OPPS APC 2475 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2475 other OPPS APC 2475 51 1262.25 percent of total billed charges 2475 2475 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - FILTERWIRE SPIDER 3MM SUP-99-00840 CDM C1884 HCPCS 0272 RC outpatient 5737.5 5737.5 5737.5 74 4245.75 percent of total billed charges 5737.5 93 4647.38 percent of total billed charges 5737.5 5737.5 other OPPS APC 5737.5 5737.5 other OPPS APC 5737.5 27.63 1585.27 percent of total billed charges 5737.5 5737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - FILTERWIRE SPIDER 6MM SUP-99-00841 CDM C1884 HCPCS 0272 RC outpatient 4987.5 4987.5 4987.5 74 3690.75 percent of total billed charges 4987.5 93 4039.88 percent of total billed charges 4987.5 4987.5 other OPPS APC 4987.5 4987.5 other OPPS APC 4987.5 27.63 1378.05 percent of total billed charges 4987.5 4987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - KENETIX 185CM SUP-99-00842 CDM C1769 HCPCS 0272 RC outpatient 1425 1425 1425 74 1054.5 percent of total billed charges 1425 93 1154.25 percent of total billed charges 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 27.63 393.73 percent of total billed charges 1425 1425 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - FRONTRUNNER 140CM SUP-99-00847 CDM C1887 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT RX 2.5X15 SUP-99-00851 CDM C1725 HCPCS 0272 RC outpatient 2400 2400 2400 74 1776 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 27.63 663.12 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - CONFIANZA PRO 12 300CM SUP-99-00853 CDM C1769 HCPCS 0272 RC outpatient 465.5 465.5 465.5 74 344.47 percent of total billed charges 465.5 93 377.06 percent of total billed charges 465.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 465.5 other OPPS APC 465.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 465.5 other OPPS APC 465.5 27.63 128.62 percent of total billed charges 465.5 465.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - MIRACLEBROS 12 300CM SUP-99-00855 CDM C1769 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ICAST COVERED 8X38 SUP-99-00856 CDM C1874 HCPCS 0278 RC outpatient 6437.5 6437.5 6437.5 57 3669.38 percent of total billed charges 6437.5 93 5214.38 percent of total billed charges 6437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6437.5 other OPPS APC 6437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6437.5 other OPPS APC 6437.5 51 3283.13 percent of total billed charges 6437.5 6437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOSURE DEVICE - FEMOSTOP SUP-99-00857 CDM 0272 RC outpatient 318.5 318.5 318.5 74 235.69 percent of total billed charges 318.5 93 257.99 percent of total billed charges 318.5 318.5 other OPPS APC 318.5 318.5 other OPPS APC 318.5 27.63 88 percent of total billed charges 318.5 318.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - THROMBECTOMY PROXI SUP-99-00869 CDM C1757 HCPCS 0272 RC outpatient 4075 4075 4075 74 3015.5 percent of total billed charges 4075 93 3300.75 percent of total billed charges 4075 4075 other OPPS APC 4075 4075 other OPPS APC 4075 27.63 1125.92 percent of total billed charges 4075 4075 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - GLIDECATH 5F 65CM STRAIGHT SUP-99-00870 CDM C1887 HCPCS 0272 RC outpatient 771 771 771 74 570.54 percent of total billed charges 771 93 624.51 percent of total billed charges 771 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 771 other OPPS APC 771 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 771 other OPPS APC 771 27.63 213.03 percent of total billed charges 771 771 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - GLIDECATH 4F 65CM STRAIGHT SUP-99-00871 CDM C1887 HCPCS 0272 RC outpatient 728.25 728.25 728.25 74 538.91 percent of total billed charges 728.25 93 589.88 percent of total billed charges 728.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 728.25 other OPPS APC 728.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 728.25 other OPPS APC 728.25 27.63 201.22 percent of total billed charges 728.25 728.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - GLIDECATH 4F 100CM STRAIGHT SUP-99-00873 CDM C1887 HCPCS 0272 RC outpatient 771 771 771 74 570.54 percent of total billed charges 771 93 624.51 percent of total billed charges 771 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 771 other OPPS APC 771 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 771 other OPPS APC 771 27.63 213.03 percent of total billed charges 771 771 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - GLIDECATH 5F 65CM ANGLED SUP-99-00874 CDM C1887 HCPCS 0272 RC outpatient 771 771 771 74 570.54 percent of total billed charges 771 93 624.51 percent of total billed charges 771 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 771 other OPPS APC 771 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 771 other OPPS APC 771 27.63 213.03 percent of total billed charges 771 771 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - GLIDECATH 4F 65CM ANGLED SUP-99-00875 CDM C1887 HCPCS 0272 RC outpatient 194.2 194.2 194.2 74 143.71 percent of total billed charges 194.2 93 157.3 percent of total billed charges 194.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 194.2 other OPPS APC 194.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 194.2 other OPPS APC 194.2 27.63 53.66 percent of total billed charges 194.2 194.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - GLIDECATH 4F 100CM ANGLED SUP-99-00876 CDM C1887 HCPCS 0272 RC outpatient 771 771 771 74 570.54 percent of total billed charges 771 93 624.51 percent of total billed charges 771 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 771 other OPPS APC 771 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 771 other OPPS APC 771 27.63 213.03 percent of total billed charges 771 771 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - GLIDECATH 5F 100CM ANGLED SUP-99-00877 CDM 0270 RC outpatient 771 771 771 74 570.54 percent of total billed charges 771 93 624.51 percent of total billed charges 771 771 other OPPS APC 771 771 other OPPS APC 771 27.63 213.03 percent of total billed charges 771 771 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT RX EVO 2.5X10 SUP-99-00881 CDM C1725 HCPCS 0272 RC outpatient 2400 2400 2400 74 1776 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 27.63 663.12 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - MIRACLEBROS 6 180CM SUP-99-00884 CDM C1769 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE -BENTSTON 150CM STRAIGHT CTSUP SUP-99-00885 CDM C1769 HCPCS 0272 RC outpatient 38.92 38.92 38.92 74 28.8 percent of total billed charges 38.92 93 31.53 percent of total billed charges 38.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.92 other OPPS APC 38.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.92 other OPPS APC 38.92 27.63 10.75 percent of total billed charges 38.92 38.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 6X20X135 SUP-99-00888 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - GENERATOR ADDRL1 SUP-99-00895 CDM C1785 HCPCS 0275 RC outpatient 9922.5 9922.5 9922.5 57 5655.83 percent of total billed charges 9922.5 93 8037.23 percent of total billed charges 9922.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9922.5 other OPPS APC 9922.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9922.5 other OPPS APC 9922.5 51 5060.48 percent of total billed charges 9922.5 9922.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - GENERATOR ADDSR1 SUP-99-00896 CDM C1786 HCPCS 0275 RC outpatient 9922.5 9922.5 9922.5 57 5655.83 percent of total billed charges 9922.5 93 8037.23 percent of total billed charges 9922.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9922.5 other OPPS APC 9922.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9922.5 other OPPS APC 9922.5 51 5060.48 percent of total billed charges 9922.5 9922.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 5.0X40 SUP-99-00901 CDM C1725 HCPCS 0272 RC outpatient 2925 2925 2925 74 2164.5 percent of total billed charges 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 27.63 808.18 percent of total billed charges 2925 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XBC 3.5 SH SUP-99-00906 CDM C1887 HCPCS 0272 RC outpatient 193.6 193.6 193.6 74 143.26 percent of total billed charges 193.6 93 156.82 percent of total billed charges 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 27.63 53.49 percent of total billed charges 193.6 193.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 6X100 SUP-99-00907 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SNARE - ENSNARE 9-15 SUP-99-00912 CDM C1773 HCPCS 0272 RC outpatient 920.13 920.13 920.13 74 680.9 percent of total billed charges 920.13 93 745.31 percent of total billed charges 920.13 920.13 other OPPS APC 920.13 920.13 other OPPS APC 920.13 27.63 254.23 percent of total billed charges 920.13 920.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SNARE - ENSNARE 6-10 SUP-99-00913 CDM C1773 HCPCS 0272 RC outpatient 933.93 933.93 933.93 74 691.11 percent of total billed charges 933.93 93 756.48 percent of total billed charges 933.93 933.93 other OPPS APC 933.93 933.93 other OPPS APC 933.93 27.63 258.04 percent of total billed charges 933.93 933.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 7.0X80 SUP-99-00914 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 3.0X23 SUP-99-00915 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XBC 3 SH SUP-99-00916 CDM C1887 HCPCS 0272 RC outpatient 193.6 193.6 193.6 74 143.26 percent of total billed charges 193.6 93 156.82 percent of total billed charges 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 27.63 53.49 percent of total billed charges 193.6 193.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - EBU4.5 SUP-99-00917 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 6.0X60 SUP-99-00918 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 3.0X40 SUP-99-00919 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - AMPHIRION 2.5/3.0X210 SUP-99-00920 CDM C1725 HCPCS 0272 RC outpatient 1035 1035 1035 74 765.9 percent of total billed charges 1035 93 838.35 percent of total billed charges 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 27.63 285.97 percent of total billed charges 1035 1035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - RCB SH SUP-99-00923 CDM C1887 HCPCS 0272 RC outpatient 193.6 193.6 193.6 74 143.26 percent of total billed charges 193.6 93 156.82 percent of total billed charges 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 27.63 53.49 percent of total billed charges 193.6 193.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 8F JR3.5 SH SUP-99-00928 CDM C1887 HCPCS 0272 RC outpatient 193.6 193.6 193.6 74 143.26 percent of total billed charges 193.6 93 156.82 percent of total billed charges 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 27.63 53.49 percent of total billed charges 193.6 193.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - THROMBECTOMY SPIROFLEX SUP-99-00929 CDM C1757 HCPCS 0272 RC outpatient 5375 5375 5375 74 3977.5 percent of total billed charges 5375 93 4353.75 percent of total billed charges 5375 5375 other OPPS APC 5375 5375 other OPPS APC 5375 27.63 1485.11 percent of total billed charges 5375 5375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - AMPLATZ ULTRASTIFF 180CM SUP-99-00930 CDM C1769 HCPCS 0272 RC outpatient 116 116 116 74 85.84 percent of total billed charges 116 93 93.96 percent of total billed charges 116 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 116 other OPPS APC 116 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 116 other OPPS APC 116 27.63 32.05 percent of total billed charges 116 116 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - PINNACLE DESTINATION 8F SUP-99-00935 CDM C1894 HCPCS 0272 RC outpatient 371.88 371.88 371.88 74 275.19 percent of total billed charges 371.88 93 301.22 percent of total billed charges 371.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 371.88 other OPPS APC 371.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 371.88 other OPPS APC 371.88 27.63 102.75 percent of total billed charges 371.88 371.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - SAFE 10.5F SUP-99-00939 CDM C1894 HCPCS 0272 RC outpatient 926.25 926.25 926.25 74 685.43 percent of total billed charges 926.25 93 750.26 percent of total billed charges 926.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 926.25 other OPPS APC 926.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 926.25 other OPPS APC 926.25 27.63 255.92 percent of total billed charges 926.25 926.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - AMPHIRION 3.0/3.5X210 SUP-99-00941 CDM C1725 HCPCS 0272 RC outpatient 1185 1185 1185 74 876.9 percent of total billed charges 1185 93 959.85 percent of total billed charges 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 27.63 327.42 percent of total billed charges 1185 1185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 12F SUP-99-00942 CDM C1894 HCPCS 0272 RC outpatient 236.25 236.25 236.25 74 174.83 percent of total billed charges 236.25 93 191.36 percent of total billed charges 236.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.25 other OPPS APC 236.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.25 other OPPS APC 236.25 27.63 65.28 percent of total billed charges 236.25 236.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 14F SUP-99-00943 CDM C1894 HCPCS 0272 RC outpatient 236.25 236.25 236.25 74 174.83 percent of total billed charges 236.25 93 191.36 percent of total billed charges 236.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.25 other OPPS APC 236.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 236.25 other OPPS APC 236.25 27.63 65.28 percent of total billed charges 236.25 236.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 16F SUP-99-00944 CDM C1894 HCPCS 0272 RC outpatient 420 420 420 74 310.8 percent of total billed charges 420 93 340.2 percent of total billed charges 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 27.63 116.05 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 18F SUP-99-00945 CDM C1894 HCPCS 0272 RC outpatient 420 420 420 74 310.8 percent of total billed charges 420 93 340.2 percent of total billed charges 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 420 other OPPS APC 420 27.63 116.05 percent of total billed charges 420 420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - EBU4.0 SH SUP-99-00948 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 8X2X135 SUP-99-00949 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 6.0X40 SUP-99-00950 CDM C1725 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 3.0X15 SUP-99-00951 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 3.0X12 SUP-99-00952 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - WITTOCH STONE BASKET SUP-99-00953 CDM C1773 HCPCS 0272 RC outpatient 1773 1773 1773 74 1312.02 percent of total billed charges 1773 93 1436.13 percent of total billed charges 1773 1773 other OPPS APC 1773 1773 other OPPS APC 1773 27.63 489.88 percent of total billed charges 1773 1773 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 11F X 11CM SUP-99-00954 CDM C1894 HCPCS 0272 RC outpatient 227.5 227.5 227.5 74 168.35 percent of total billed charges 227.5 93 184.28 percent of total billed charges 227.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 227.5 other OPPS APC 227.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 227.5 other OPPS APC 227.5 27.63 62.86 percent of total billed charges 227.5 227.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 5.0X60 SUP-99-00955 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 5.0X20 SUP-99-00956 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EXPRESS LD 8.0X27X75 SUP-99-00957 CDM C1874 HCPCS 0278 RC outpatient 3107.38 3107.38 3107.38 57 1771.21 percent of total billed charges 3107.38 93 2516.98 percent of total billed charges 3107.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3107.38 other OPPS APC 3107.38 3107.38 other OPPS APC 3107.38 51 1584.76 percent of total billed charges 3107.38 3107.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 6.0X100 SUP-99-00959 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 5.0X80 SUP-99-00960 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 4F X 4CM SUP-99-00962 CDM C1894 HCPCS 0272 RC outpatient 306.25 306.25 306.25 74 226.63 percent of total billed charges 306.25 93 248.06 percent of total billed charges 306.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 306.25 other OPPS APC 306.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 306.25 other OPPS APC 306.25 27.63 84.62 percent of total billed charges 306.25 306.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 6.0X80 SUP-99-00963 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EXPRESS LD 7.0X57X75 SUP-99-00964 CDM C1876 HCPCS 0278 RC outpatient 2850 2850 2850 57 1624.5 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 51 1453.5 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JL3.5SH (BS) SUP-99-00966 CDM C1887 HCPCS 0272 RC outpatient 192.5 192.5 192.5 74 142.45 percent of total billed charges 192.5 93 155.93 percent of total billed charges 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JL3.5 (BS) SUP-99-00967 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JL4 (BS) SUP-99-00968 CDM C1887 HCPCS 0272 RC outpatient 188.12 188.12 188.12 74 139.21 percent of total billed charges 188.12 93 152.38 percent of total billed charges 188.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188.12 other OPPS APC 188.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188.12 other OPPS APC 188.12 27.63 51.98 percent of total billed charges 188.12 188.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE ES OTW 3.0X40X145 SUP-99-00972 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 4.0X100 SUP-99-00973 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - PINNACLE DESTINATION 6FX90CM STRAIGHT TIP SUP-99-00974 CDM C1894 HCPCS 0272 RC outpatient 322 322 322 74 238.28 percent of total billed charges 322 93 260.82 percent of total billed charges 322 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 322 other OPPS APC 322 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 322 other OPPS APC 322 27.63 88.97 percent of total billed charges 322 322 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 4.0X60 SUP-99-00977 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 4.0X200 SUP-99-00978 CDM C1725 HCPCS 0272 RC outpatient 1050 1050 1050 74 777 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 27.63 290.12 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - AR 1 SH (MEDTRONIC) SUP-99-00979 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 3.0X120 SUP-99-00980 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - VERSACORE MOD J 260CM SUP-99-00981 CDM C1769 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - PINACLE DESTINATION 8F 90CM SUP-99-00983 CDM C1894 HCPCS 0272 RC outpatient 446.25 446.25 446.25 74 330.23 percent of total billed charges 446.25 93 361.46 percent of total billed charges 446.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 446.25 other OPPS APC 446.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 446.25 other OPPS APC 446.25 27.63 123.3 percent of total billed charges 446.25 446.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 4.0X150 SUP-99-00985 CDM C1725 HCPCS 0272 RC outpatient 731.25 731.25 731.25 74 541.13 percent of total billed charges 731.25 93 592.31 percent of total billed charges 731.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 731.25 other OPPS APC 731.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 731.25 other OPPS APC 731.25 27.63 202.04 percent of total billed charges 731.25 731.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 2.75X18 SUP-99-00986 CDM C1876 HCPCS 0278 RC outpatient 1995 1995 1995 57 1137.15 percent of total billed charges 1995 93 1615.95 percent of total billed charges 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 51 1017.45 percent of total billed charges 1995 1995 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 2.5X18 SUP-99-00987 CDM C1876 HCPCS 0278 RC outpatient 1995 1995 1995 57 1137.15 percent of total billed charges 1995 93 1615.95 percent of total billed charges 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 51 1017.45 percent of total billed charges 1995 1995 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 5.0X80 SUP-99-00988 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - SHUTTLE 6F SUP-99-00989 CDM C1894 HCPCS 0272 RC outpatient 325.5 325.5 325.5 74 240.87 percent of total billed charges 325.5 93 263.66 percent of total billed charges 325.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 325.5 other OPPS APC 325.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 325.5 other OPPS APC 325.5 27.63 89.94 percent of total billed charges 325.5 325.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - FLEXOR 7FRX90CM SUP-99-00990 CDM C1894 HCPCS 0272 RC outpatient 366.73 366.73 366.73 74 271.38 percent of total billed charges 366.73 93 297.05 percent of total billed charges 366.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 366.73 other OPPS APC 366.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 366.73 other OPPS APC 366.73 27.63 101.33 percent of total billed charges 366.73 366.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EMBOLIZATION - COIL MREYE 15MM SUP-99-00991 CDM 0272 RC outpatient 350 350 350 74 259 percent of total billed charges 350 93 283.5 percent of total billed charges 350 350 other OPPS APC 350 350 other OPPS APC 350 27.63 96.71 percent of total billed charges 350 350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EBOLIZATION - COIL NESTER 12MM SUP-99-00992 CDM 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EBOLIZATION - COIL NESTER 10MM SUP-99-00993 CDM 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JL4 SH (CORDIS) SUP-99-00995 CDM C1887 HCPCS 0272 RC outpatient 160 160 160 74 118.4 percent of total billed charges 160 93 129.6 percent of total billed charges 160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160 other OPPS APC 160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160 other OPPS APC 160 27.63 44.21 percent of total billed charges 160 160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - SUPRA CORE 35 SUP-99-00996 CDM C1769 HCPCS 0272 RC outpatient 290.5 290.5 290.5 74 214.97 percent of total billed charges 290.5 93 235.31 percent of total billed charges 290.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 290.5 other OPPS APC 290.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 290.5 other OPPS APC 290.5 27.63 80.27 percent of total billed charges 290.5 290.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - MICROPUNCTURE 4F SUP-99-00999 CDM C1894 HCPCS 0272 RC outpatient 128 128 128 74 94.72 percent of total billed charges 128 93 103.68 percent of total billed charges 128 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 128 other OPPS APC 128 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 128 other OPPS APC 128 27.63 35.37 percent of total billed charges 128 128 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - MICROPUNCTURE 5F SUP-99-01000 CDM C1894 HCPCS 0272 RC outpatient 128 128 128 74 94.72 percent of total billed charges 128 93 103.68 percent of total billed charges 128 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 128 other OPPS APC 128 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 128 other OPPS APC 128 27.63 35.37 percent of total billed charges 128 128 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 5.0X300 SUP-99-01001 CDM C1725 HCPCS 0272 RC outpatient 975 975 975 74 721.5 percent of total billed charges 975 93 789.75 percent of total billed charges 975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 975 other OPPS APC 975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 975 other OPPS APC 975 27.63 269.39 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - FILTERWIRE EZ 3.5-5.5 SUP-99-01002 CDM C1884 HCPCS 0272 RC outpatient 3205.13 3205.13 3205.13 74 2371.8 percent of total billed charges 3205.13 93 2596.16 percent of total billed charges 3205.13 3205.13 other OPPS APC 3205.13 3205.13 other OPPS APC 3205.13 27.63 885.58 percent of total billed charges 3205.13 3205.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING RX 5.0X20 SUP-99-01003 CDM C1725 HCPCS 0272 RC outpatient 870 870 870 74 643.8 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 27.63 240.38 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING RX 4.0X20 SUP-99-01004 CDM C1725 HCPCS 0272 RC outpatient 870 870 870 74 643.8 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 27.63 240.38 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - AL 2 SUP-99-01006 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JR5 SUP-99-01007 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - FLEXOR 45CM 5F SUP-99-01008 CDM C1894 HCPCS 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - FLEXOR 45CM 6F SUP-99-01009 CDM C1894 HCPCS 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 3DRC SUP-99-01015 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - RCB (CORDIS) SUP-99-01016 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EXPRESS LD 8.0X37X75 SUP-99-01019 CDM C1876 HCPCS 0278 RC outpatient 2918.58 2918.58 2918.58 57 1663.59 percent of total billed charges 2918.58 93 2364.05 percent of total billed charges 2918.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2918.58 other OPPS APC 2918.58 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2918.58 other OPPS APC 2918.58 51 1488.48 percent of total billed charges 2918.58 2918.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 7.0X40 SUP-99-01020 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XB 3 SH SUP-99-01021 CDM C1887 HCPCS 0272 RC outpatient 168.6 168.6 168.6 74 124.76 percent of total billed charges 168.6 93 136.57 percent of total billed charges 168.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168.6 other OPPS APC 168.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168.6 other OPPS APC 168.6 27.63 46.58 percent of total billed charges 168.6 168.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 5.0X100 SUP-99-01022 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - JOURNEY ANGLED SUP-99-01023 CDM C1769 HCPCS 0272 RC outpatient 406.88 406.88 406.88 74 301.09 percent of total billed charges 406.88 93 329.57 percent of total billed charges 406.88 406.88 other OPPS APC 406.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 406.88 other OPPS APC 406.88 27.63 112.42 percent of total billed charges 406.88 406.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING SL OTW 3.0X100 SUP-99-01024 CDM C1725 HCPCS 0272 RC outpatient 915 915 915 74 677.1 percent of total billed charges 915 93 741.15 percent of total billed charges 915 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 915 other OPPS APC 915 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 915 other OPPS APC 915 27.63 252.81 percent of total billed charges 915 915 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - TREK 3.0X20 SUP-99-01027 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - FILTERWIRE EMBOSHIELD 5MM SUP-99-01042 CDM C1884 HCPCS 0272 RC outpatient 3687.5 3687.5 3687.5 74 2728.75 percent of total billed charges 3687.5 93 2986.88 percent of total billed charges 3687.5 3687.5 other OPPS APC 3687.5 3687.5 other OPPS APC 3687.5 27.63 1018.86 percent of total billed charges 3687.5 3687.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - FILTERWIRE EMBOSHIELD 7.2MM SUP-99-01043 CDM C1884 HCPCS 0272 RC outpatient 3687.5 3687.5 3687.5 74 2728.75 percent of total billed charges 3687.5 93 2986.88 percent of total billed charges 3687.5 3687.5 other OPPS APC 3687.5 3687.5 other OPPS APC 3687.5 27.63 1018.86 percent of total billed charges 3687.5 3687.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 4.0X40 SUP-99-01049 CDM C1725 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - WRP SUP-99-01052 CDM C1887 HCPCS 0272 RC outpatient 192.5 192.5 192.5 74 142.45 percent of total billed charges 192.5 93 155.93 percent of total billed charges 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - AL 1 SH (MEDTRONIC) SUP-99-01053 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - TREK 2.5X20 SUP-99-01054 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MINI TREK 2.0X20 SUP-99-01055 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 3.5X20 SUP-99-01058 CDM C1725 HCPCS 0272 RC outpatient 2550 2550 2550 74 1887 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 27.63 704.57 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 7.0X80 SUP-99-01059 CDM C1725 HCPCS 0272 RC outpatient 465.5 465.5 465.5 74 344.47 percent of total billed charges 465.5 93 377.06 percent of total billed charges 465.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 465.5 other OPPS APC 465.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 465.5 other OPPS APC 465.5 27.63 128.62 percent of total billed charges 465.5 465.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - AMPHIRION 2.5X80 SUP-99-01060 CDM C1725 HCPCS 0272 RC outpatient 960 960 960 74 710.4 percent of total billed charges 960 93 777.6 percent of total billed charges 960 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 960 other OPPS APC 960 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 960 other OPPS APC 960 27.63 265.25 percent of total billed charges 960 960 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTRAST - ISOVUE 370 200CC SUP-99-01067 CDM Q9967 CPT 0255 RC outpatient 102.08 102.08 0.15 0.15 fee schedule 102.08 93 82.68 percent of total billed charges 102.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 102.08 other OPPS APC 102.08 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 102.08 other OPPS APC 102.08 24.86 25.38 percent of total billed charges 0.15 102.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - LATEX FREE SWAN KIT SUP-99-01068 CDM 0272 RC outpatient 2062.8 2062.8 2062.8 74 1526.47 percent of total billed charges 2062.8 93 1670.87 percent of total billed charges 2062.8 2062.8 other OPPS APC 2062.8 2062.8 other OPPS APC 2062.8 27.63 569.95 percent of total billed charges 2062.8 2062.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT RX 2.0X15 SUP-99-01069 CDM C1725 HCPCS 0272 RC outpatient 2400 2400 2400 74 1776 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 27.63 663.12 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - TREK 2.5X12 SUP-99-01070 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MINI TREK 1.5X12 SUP-99-01071 CDM C1725 HCPCS 0272 RC outpatient 280 280 280 74 207.2 percent of total billed charges 280 93 226.8 percent of total billed charges 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 27.63 77.36 percent of total billed charges 280 280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MINI TREK 2.0X12 SUP-99-01072 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 10X40 SUP-99-01075 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - AL 1 (BS) SUP-99-01077 CDM C1887 HCPCS 0272 RC outpatient 188.12 188.12 188.12 74 139.21 percent of total billed charges 188.12 93 152.38 percent of total billed charges 188.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188.12 other OPPS APC 188.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188.12 other OPPS APC 188.12 27.63 51.98 percent of total billed charges 188.12 188.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 5X20X135 SUP-99-01079 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 6F GUIDELINER SUP-99-01080 CDM C1887 HCPCS 0272 RC outpatient 1230 1230 1230 74 910.2 percent of total billed charges 1230 93 996.3 percent of total billed charges 1230 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1230 other OPPS APC 1230 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1230 other OPPS APC 1230 27.63 339.85 percent of total billed charges 1230 1230 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - TREK 3.0X12 SUP-99-01081 CDM C1725 HCPCS 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XB 4 SUP-99-01082 CDM C1887 HCPCS 0272 RC outpatient 174 174 174 74 128.76 percent of total billed charges 174 93 140.94 percent of total billed charges 174 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174 other OPPS APC 174 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174 other OPPS APC 174 27.63 48.08 percent of total billed charges 174 174 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MINI TREK 2.0X15 SUP-99-01083 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT RX 3.0X15 SUP-99-01084 CDM C1725 HCPCS 0272 RC outpatient 2400 2400 2400 74 1776 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 27.63 663.12 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - TREK 2.5X15 SUP-99-01085 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MINITREK 1.50 X 20 SUP-99-01086 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 5.0X250 SUP-99-01089 CDM C1725 HCPCS 0272 RC outpatient 975 975 975 74 721.5 percent of total billed charges 975 93 789.75 percent of total billed charges 975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 975 other OPPS APC 975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 975 other OPPS APC 975 27.63 269.39 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 4.0X250 SUP-99-01090 CDM C1725 HCPCS 0272 RC outpatient 975 975 975 74 721.5 percent of total billed charges 975 93 789.75 percent of total billed charges 975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 975 other OPPS APC 975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 975 other OPPS APC 975 27.63 269.39 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 2.0X120 SUP-99-01093 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 4.0X40 SUP-99-01098 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - FILTERWIRE RETREIVAL SHEATH SUP-99-01100 CDM C1884 HCPCS 0272 RC outpatient 225.12 225.12 225.12 74 166.59 percent of total billed charges 225.12 93 182.35 percent of total billed charges 225.12 225.12 other OPPS APC 225.12 225.12 other OPPS APC 225.12 27.63 62.2 percent of total billed charges 225.12 225.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 2.0X200 SUP-99-01103 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 2.5X120 SUP-99-01104 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 4.0X18 SUP-99-01107 CDM C1876 HCPCS 0278 RC outpatient 1995 1995 1995 57 1137.15 percent of total billed charges 1995 93 1615.95 percent of total billed charges 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 51 1017.45 percent of total billed charges 1995 1995 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - RCB SH (BS) SUP-99-01108 CDM C1887 HCPCS 0272 RC outpatient 192.5 192.5 192.5 74 142.45 percent of total billed charges 192.5 93 155.93 percent of total billed charges 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - CROSSER 14S SUP-99-01111 CDM C1714 HCPCS 0272 RC outpatient 4937.5 4937.5 4937.5 74 3653.75 percent of total billed charges 4937.5 93 3999.38 percent of total billed charges 4937.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4937.5 other OPPS APC 4937.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4937.5 other OPPS APC 4937.5 27.63 1364.23 percent of total billed charges 4937.5 4937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - MICROSHEATH XL 110 ST SUP-99-01112 CDM C1887 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - SIDEKICK SUPPORT - ANGLED SUP-99-01113 CDM C1887 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 4.0X120 SUP-99-01114 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT RX 3.0X10 SUP-99-01117 CDM C1725 HCPCS 0272 RC outpatient 2400 2400 2400 74 1776 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 27.63 663.12 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EXPRESS SD 6.0X14 SUP-99-01119 CDM C1876 HCPCS 0278 RC outpatient 3313.13 3313.13 3313.13 57 1888.48 percent of total billed charges 3313.13 93 2683.64 percent of total billed charges 3313.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3313.13 other OPPS APC 3313.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3313.13 other OPPS APC 3313.13 51 1689.7 percent of total billed charges 3313.13 3313.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING RX 4.0X15X80 SUP-99-01121 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - RENAL MACH 1 C1 SUP-99-01122 CDM C1887 HCPCS 0272 RC outpatient 322.53 322.53 322.53 74 238.67 percent of total billed charges 322.53 93 261.25 percent of total billed charges 322.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 322.53 other OPPS APC 322.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 322.53 other OPPS APC 322.53 27.63 89.12 percent of total billed charges 322.53 322.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - HERCULINK 5.0X18 SUP-99-01123 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 6.0X40 SUP-99-01124 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 3.0X60 SUP-99-01125 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MINI VISION 2.25X28 SUP-99-01130 CDM C1876 HCPCS 0278 RC outpatient 2250 2250 2250 57 1282.5 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 51 1147.5 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MINI TREK 1.5X6 SUP-99-01131 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 4.0X80 SUP-99-01132 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON- STERLING SL OTW 3.0 X 150 SUP-99-01135 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 3.0X20 SUP-99-01140 CDM C1725 HCPCS 0272 RC outpatient 2550 2550 2550 74 1887 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 27.63 704.57 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 2.5X40 SUP-99-01141 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XB 3.5 SH 8F SUP-99-01155 CDM C1887 HCPCS 0272 RC outpatient 193.6 193.6 193.6 74 143.26 percent of total billed charges 193.6 93 156.82 percent of total billed charges 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 27.63 53.49 percent of total billed charges 193.6 193.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 3.0X80 SUP-99-01157 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JCL 4 SH SUP-99-01158 CDM C1887 HCPCS 0272 RC outpatient 193.6 193.6 193.6 74 143.26 percent of total billed charges 193.6 93 156.82 percent of total billed charges 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 27.63 53.49 percent of total billed charges 193.6 193.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EXPRESS LD 7.0X27X75 SUP-99-01160 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JL4.5 (MEDTRONIC) SUP-99-01162 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - TREK 3.5X12 SUP-99-01163 CDM C1725 HCPCS 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - TREK 3.0X15 SUP-99-01170 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - ROTAWIRE FLOPPY SUP-99-01171 CDM C1769 HCPCS 0272 RC outpatient 446.74 446.74 446.74 74 330.59 percent of total billed charges 446.74 93 361.86 percent of total billed charges 446.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 446.74 other OPPS APC 446.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 446.74 other OPPS APC 446.74 27.63 123.43 percent of total billed charges 446.74 446.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - ROTAWIRE EXTRA SUPPORT SUP-99-01172 CDM C1769 HCPCS 0272 RC outpatient 446.74 446.74 446.74 74 330.59 percent of total billed charges 446.74 93 361.86 percent of total billed charges 446.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 446.74 other OPPS APC 446.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 446.74 other OPPS APC 446.74 27.63 123.43 percent of total billed charges 446.74 446.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 8.0X100 SUP-99-01175 CDM C1876 HCPCS 0278 RC outpatient 2925 2925 2925 57 1667.25 percent of total billed charges 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 51 1491.75 percent of total billed charges 2925 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 4.0X200 SUP-99-01177 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - IM SH (BS) SUP-99-01178 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ICAST COVERED 6X22 SUP-99-01181 CDM C1874 HCPCS 0278 RC outpatient 6287.5 6287.5 6287.5 57 3583.88 percent of total billed charges 6287.5 93 5092.88 percent of total billed charges 6287.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6287.5 other OPPS APC 6287.5 6287.5 other OPPS APC 6287.5 51 3206.63 percent of total billed charges 6287.5 6287.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 6.0X20 SUP-99-01183 CDM C1725 HCPCS 0272 RC outpatient 2850 2850 2850 74 2109 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 27.63 787.46 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 3.0X40 SUP-99-01187 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CLEARWAY RX 2.0X50 SUP-99-01188 CDM C1725 HCPCS 0272 RC outpatient 3125 3125 3125 74 2312.5 percent of total billed charges 3125 93 2531.25 percent of total billed charges 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 27.63 863.44 percent of total billed charges 3125 3125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING SL OTW 2.5X100 SUP-99-01190 CDM C1725 HCPCS 0272 RC outpatient 915 915 915 74 677.1 percent of total billed charges 915 93 741.15 percent of total billed charges 915 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 915 other OPPS APC 915 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 915 other OPPS APC 915 27.63 252.81 percent of total billed charges 915 915 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 4.0X80 SUP-99-01192 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 1.5X40 SUP-99-01194 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MINI TREK 1.5X15 SUP-99-01197 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 7X2X135 SUP-99-01198 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 3.0X15 SUP-99-01200 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 6.0X20 SUP-99-01201 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 3.0X18 SUP-99-01202 CDM C1876 HCPCS 0278 RC outpatient 1995 1995 1995 57 1137.15 percent of total billed charges 1995 93 1615.95 percent of total billed charges 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 51 1017.45 percent of total billed charges 1995 1995 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - AR 2 6F SUP-99-01203 CDM 0272 RC outpatient 191.8 191.8 191.8 74 141.93 percent of total billed charges 191.8 93 155.36 percent of total billed charges 191.8 191.8 other OPPS APC 191.8 191.8 other OPPS APC 191.8 27.63 52.99 percent of total billed charges 191.8 191.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 5.0X120 SUP-99-01204 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - SUPERCROSS 90 DEG. 130CM SUP-99-01205 CDM C1887 HCPCS 0272 RC outpatient 1830 1830 1830 74 1354.2 percent of total billed charges 1830 93 1482.3 percent of total billed charges 1830 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1830 other OPPS APC 1830 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1830 other OPPS APC 1830 27.63 505.63 percent of total billed charges 1830 1830 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EXPRESS LD 6.0X37X75 SUP-99-01206 CDM C1876 HCPCS 0278 RC outpatient 3107.38 3107.38 3107.38 57 1771.21 percent of total billed charges 3107.38 93 2516.98 percent of total billed charges 3107.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3107.38 other OPPS APC 3107.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3107.38 other OPPS APC 3107.38 51 1584.76 percent of total billed charges 3107.38 3107.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EXPRESS LD 6.0X27X75 SUP-99-01207 CDM C1876 HCPCS 0278 RC outpatient 3107.38 3107.38 3107.38 57 1771.21 percent of total billed charges 3107.38 93 2516.98 percent of total billed charges 3107.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3107.38 other OPPS APC 3107.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3107.38 other OPPS APC 3107.38 51 1584.76 percent of total billed charges 3107.38 3107.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - AMPHIRION 2.0X40 SUP-99-01209 CDM C1725 HCPCS 0272 RC outpatient 1035 1035 1035 74 765.9 percent of total billed charges 1035 93 838.35 percent of total billed charges 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 27.63 285.97 percent of total billed charges 1035 1035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - AMPHIRION 1.5X20 SUP-99-01210 CDM C1725 HCPCS 0272 RC outpatient 1035 1035 1035 74 765.9 percent of total billed charges 1035 93 838.35 percent of total billed charges 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 27.63 285.97 percent of total billed charges 1035 1035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 3.0X200 SUP-99-01213 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 2.5X20 SUP-99-01215 CDM C1725 HCPCS 0272 RC outpatient 2550 2550 2550 74 1887 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 27.63 704.57 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JETSTREAM 2.1/3.0 SUP-99-01216 CDM C1714 HCPCS 0272 RC outpatient 8000 8000 8000 74 5920 percent of total billed charges 8000 93 6480 percent of total billed charges 8000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8000 other OPPS APC 8000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8000 other OPPS APC 8000 27.63 2210.4 percent of total billed charges 8000 8000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 3.5X18 SUP-99-01218 CDM C1876 HCPCS 0278 RC outpatient 1995 1995 1995 57 1137.15 percent of total billed charges 1995 93 1615.95 percent of total billed charges 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 51 1017.45 percent of total billed charges 1995 1995 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 2.75X15 SUP-99-01219 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 3.25X20 SUP-99-01220 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 2.5X200 SUP-99-01221 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 3.0X80 SUP-99-01222 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 3.25X15 SUP-99-01223 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 018 6.0X150X130 SUP-99-01224 CDM C1725 HCPCS 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 018 5.0X150X130 SUP-99-01225 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 018 5.0X40X130 SUP-99-01226 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 018 4.0X40X130 SUP-99-01227 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 018 4.0X220X130 SUP-99-01228 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EXPRESS LD 7.0X37X75 SUP-99-01231 CDM C1876 HCPCS 0278 RC outpatient 2775 2775 2775 57 1581.75 percent of total billed charges 2775 93 2247.75 percent of total billed charges 2775 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2775 other OPPS APC 2775 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2775 other OPPS APC 2775 51 1415.25 percent of total billed charges 2775 2775 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 3.75X12 SUP-99-01234 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 3.0X15 SUP-99-01235 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 2.75X12 SUP-99-01236 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 1.5X80 SUP-99-01237 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 3.25X8 SUP-99-01238 CDM C1725 HCPCS 0272 RC outpatient 280 280 280 74 207.2 percent of total billed charges 280 93 226.8 percent of total billed charges 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 280 other OPPS APC 280 27.63 77.36 percent of total billed charges 280 280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 2.75X8 SUP-99-01241 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 3.25X12 SUP-99-01242 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - VERSACORE FLOPPY SUP-99-01243 CDM C1769 HCPCS 0272 RC outpatient 301 301 301 74 222.74 percent of total billed charges 301 93 243.81 percent of total billed charges 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 301 other OPPS APC 301 27.63 83.17 percent of total billed charges 301 301 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 2.25X18 SUP-99-01244 CDM C1876 HCPCS 0278 RC outpatient 1995 1995 1995 57 1137.15 percent of total billed charges 1995 93 1615.95 percent of total billed charges 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 51 1017.45 percent of total billed charges 1995 1995 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 2.5X12 SUP-99-01245 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 4.0X12 SUP-99-01246 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 3.0X20 SUP-99-01247 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 3.0X22 SUP-99-01249 CDM C1876 HCPCS 0278 RC outpatient 1830 1830 1830 57 1043.1 percent of total billed charges 1830 93 1482.3 percent of total billed charges 1830 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1830 other OPPS APC 1830 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1830 other OPPS APC 1830 51 933.3 percent of total billed charges 1830 1830 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 3.0X26 SUP-99-01250 CDM C1876 HCPCS 0278 RC outpatient 1995 1995 1995 57 1137.15 percent of total billed charges 1995 93 1615.95 percent of total billed charges 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 51 1017.45 percent of total billed charges 1995 1995 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 3.0X30 SUP-99-01251 CDM C1876 HCPCS 0278 RC outpatient 1995 1995 1995 57 1137.15 percent of total billed charges 1995 93 1615.95 percent of total billed charges 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 51 1017.45 percent of total billed charges 1995 1995 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING SL OTW 2.0X100 SUP-99-01252 CDM C1725 HCPCS 0272 RC outpatient 795 795 795 74 588.3 percent of total billed charges 795 93 643.95 percent of total billed charges 795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 795 other OPPS APC 795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 795 other OPPS APC 795 27.63 219.66 percent of total billed charges 795 795 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JL3.5 SH (MEDTRONIC) SUP-99-01254 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 3.5X12 SUP-99-01260 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 6X20X75 SUP-99-01264 CDM C1725 HCPCS 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 6X40X75 SUP-99-01265 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 5X40X75 SUP-99-01266 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 7X40X75 SUP-99-01267 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 8X20X75 SUP-99-01268 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 4.0X100 SUP-99-01269 CDM C1725 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 5.0X100 SUP-99-01270 CDM C1725 HCPCS 0272 RC outpatient 3187.5 3187.5 3187.5 74 2358.75 percent of total billed charges 3187.5 93 2581.88 percent of total billed charges 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 27.63 880.71 percent of total billed charges 3187.5 3187.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 6.0X100 SUP-99-01271 CDM C1725 HCPCS 0272 RC outpatient 3187.5 3187.5 3187.5 74 2358.75 percent of total billed charges 3187.5 93 2581.88 percent of total billed charges 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3187.5 other OPPS APC 3187.5 27.63 880.71 percent of total billed charges 3187.5 3187.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 3.0X12 SUP-99-01272 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 4.0X80 SUP-99-01273 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING SL OTW 2.5X150 SUP-99-01275 CDM C1725 HCPCS 0272 RC outpatient 915 915 915 74 677.1 percent of total billed charges 915 93 741.15 percent of total billed charges 915 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 915 other OPPS APC 915 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 915 other OPPS APC 915 27.63 252.81 percent of total billed charges 915 915 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 5X20X135 SUP-99-01276 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 5X200X135 SUP-99-01277 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 4X200X135 SUP-99-01278 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 6X150X135 SUP-99-01279 CDM C1725 HCPCS 0272 RC outpatient 665 665 665 74 492.1 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 27.63 183.74 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - MAGIC TORQUE 260CM SUP-99-01280 CDM C1769 HCPCS 0272 RC outpatient 166.67 166.67 166.67 74 123.34 percent of total billed charges 166.67 93 135 percent of total billed charges 166.67 166.67 other OPPS APC 166.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 166.67 other OPPS APC 166.67 27.63 46.05 percent of total billed charges 166.67 166.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - CROSSER 14P SUP-99-01281 CDM C1714 HCPCS 0272 RC outpatient 4387.5 4387.5 4387.5 74 3246.75 percent of total billed charges 4387.5 93 3553.88 percent of total billed charges 4387.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4387.5 other OPPS APC 4387.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4387.5 other OPPS APC 4387.5 27.63 1212.27 percent of total billed charges 4387.5 4387.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - CROSSER S6 SUP-99-01282 CDM C1714 HCPCS 0272 RC outpatient 4387.5 4387.5 4387.5 74 3246.75 percent of total billed charges 4387.5 93 3553.88 percent of total billed charges 4387.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4387.5 other OPPS APC 4387.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4387.5 other OPPS APC 4387.5 27.63 1212.27 percent of total billed charges 4387.5 4387.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - USHER STRAIGHT (CROSSER) SUP-99-01283 CDM C1887 HCPCS 0272 RC outpatient 885 885 885 74 654.9 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 27.63 244.53 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 018 2.0X80X130 SUP-99-01284 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 5X100X135 SUP-99-01285 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JR4 (MEDTRONIC) SUP-99-01286 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - AMPHIRION 2.5X40 SUP-99-01288 CDM C1725 HCPCS 0272 RC outpatient 930 930 930 74 688.2 percent of total billed charges 930 93 753.3 percent of total billed charges 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 27.63 256.96 percent of total billed charges 930 930 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - AMPHIRION 2.5X120 SUP-99-01289 CDM C1725 HCPCS 0272 RC outpatient 1185 1185 1185 74 876.9 percent of total billed charges 1185 93 959.85 percent of total billed charges 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 27.63 327.42 percent of total billed charges 1185 1185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JETSTREAM 1.6 SUP-99-01291 CDM C1714 HCPCS 0272 RC outpatient 8000 8000 8000 74 5920 percent of total billed charges 8000 93 6480 percent of total billed charges 8000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8000 other OPPS APC 8000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8000 other OPPS APC 8000 27.63 2210.4 percent of total billed charges 8000 8000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - FLEXOR 45CM 7F SUP-99-01292 CDM C1894 HCPCS 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 2.0X150X150 SUP-99-01294 CDM C1725 HCPCS 0272 RC outpatient 1215 1215 1215 74 899.1 percent of total billed charges 1215 93 984.15 percent of total billed charges 1215 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1215 other OPPS APC 1215 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1215 other OPPS APC 1215 27.63 335.7 percent of total billed charges 1215 1215 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 2.0X220X150 SUP-99-01295 CDM C1725 HCPCS 0272 RC outpatient 1185 1185 1185 74 876.9 percent of total billed charges 1185 93 959.85 percent of total billed charges 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 27.63 327.42 percent of total billed charges 1185 1185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 2.5X150X150 SUP-99-01296 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 2.5X220X150 SUP-99-01297 CDM C1725 HCPCS 0272 RC outpatient 1185 1185 1185 74 876.9 percent of total billed charges 1185 93 959.85 percent of total billed charges 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 27.63 327.42 percent of total billed charges 1185 1185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 3.0X150X150 SUP-99-01298 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 3.0X220X150 SUP-99-01299 CDM C1725 HCPCS 0272 RC outpatient 1185 1185 1185 74 876.9 percent of total billed charges 1185 93 959.85 percent of total billed charges 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 27.63 327.42 percent of total billed charges 1185 1185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 4.0X150X150 SUP-99-01300 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 4.0X220X150 SUP-99-01301 CDM C1725 HCPCS 0272 RC outpatient 945 945 945 74 699.3 percent of total billed charges 945 93 765.45 percent of total billed charges 945 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 945 other OPPS APC 945 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 945 other OPPS APC 945 27.63 261.1 percent of total billed charges 945 945 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 2.0X220X150 SUP-99-01303 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 1.5X40X150 SUP-99-01304 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 018 2.0X220X130 SUP-99-01305 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 2.5X40 SUP-99-01306 CDM C1725 HCPCS 0272 RC outpatient 2925 2925 2925 74 2164.5 percent of total billed charges 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 27.63 808.18 percent of total billed charges 2925 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON- MUSTANG OTW 5X150X135 SUP-99-01307 CDM C1725 HCPCS 0272 RC outpatient 665 665 665 74 492.1 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 27.63 183.74 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 6X40X135 SUP-99-01308 CDM C1725 HCPCS 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER - JUGULAR DELIVERY SHEATH SUP-99-01309 CDM 0272 RC outpatient 287 287 287 74 212.38 percent of total billed charges 287 93 232.47 percent of total billed charges 287 287 other OPPS APC 287 287 other OPPS APC 287 27.63 79.3 percent of total billed charges 287 287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 2.0X20 SUP-99-01310 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 2.5X20 SUP-99-01312 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 7F X 23CM MARKER TIP SUP-99-01313 CDM C1894 HCPCS 0272 RC outpatient 324.63 324.63 324.63 74 240.23 percent of total billed charges 324.63 93 262.95 percent of total billed charges 324.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 324.63 other OPPS APC 324.63 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 324.63 other OPPS APC 324.63 27.63 89.7 percent of total billed charges 324.63 324.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 9X40X75 SUP-99-01314 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 3.0X20 SUP-99-01315 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ICAST COVERED 8X59 SUP-99-01316 CDM C1874 HCPCS 0278 RC outpatient 6937.5 6937.5 6937.5 57 3954.38 percent of total billed charges 6937.5 93 5619.38 percent of total billed charges 6937.5 6937.5 other OPPS APC 6937.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6937.5 other OPPS APC 6937.5 51 3538.13 percent of total billed charges 6937.5 6937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 018 4.0X150X130 SUP-99-01317 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 5.0X120X150 SUP-99-01318 CDM C1725 HCPCS 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 018 4.0X80X130 SUP-99-01319 CDM C1725 HCPCS 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 018 6.0X40X130 SUP-99-01320 CDM C1725 HCPCS 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 6F X 7CM SUP-99-01321 CDM C1894 HCPCS 0272 RC outpatient 109.88 109.88 109.88 74 81.31 percent of total billed charges 109.88 93 89 percent of total billed charges 109.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 109.88 other OPPS APC 109.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 109.88 other OPPS APC 109.88 27.63 30.36 percent of total billed charges 109.88 109.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - VERSACORE FLOPPY 260CM SUP-99-01324 CDM C1769 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA LL 35 4.0X150 SUP-99-01325 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA LL 35 4.0X200 SUP-99-01326 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA LL 35 4.0X250 SUP-99-01327 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA LL 35 5.0X150 SUP-99-01328 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA LL 35 5.0X200 SUP-99-01329 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA LL 35 5.0X250 SUP-99-01330 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA LL 35 6.0X150 SUP-99-01331 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA LL 35 6.0X200 SUP-99-01332 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA LL 35 6.0X250 SUP-99-01333 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA LL 35 7.0X150 SUP-99-01334 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 LL 7.0X200 SUP-99-01335 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 3.0X6 SUP-99-01337 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 3.0X8 SUP-99-01339 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 3.0X40 SUP-99-01340 CDM C1725 HCPCS 0272 RC outpatient 2925 2925 2925 74 2164.5 percent of total billed charges 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 27.63 808.18 percent of total billed charges 2925 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 2.0X80X150 SUP-99-01341 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 3.0X80X150 SUP-99-01342 CDM C1725 HCPCS 0272 RC outpatient 735 735 735 74 543.9 percent of total billed charges 735 93 595.35 percent of total billed charges 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 27.63 203.08 percent of total billed charges 735 735 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 3.0X40X150 SUP-99-01343 CDM C1725 HCPCS 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 2.0X150X150 SUP-99-01344 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 3.0X220X150 SUP-99-01345 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 018 7.0X40X130 SUP-99-01346 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - MIRACLEBROS 4.5 -180CM SUP-99-01347 CDM C1769 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOSURE DEVICE - TR BAND - REG SUP-99-01350 CDM 0272 RC outpatient 701.25 701.25 701.25 74 518.93 percent of total billed charges 701.25 93 568.01 percent of total billed charges 701.25 701.25 other OPPS APC 701.25 701.25 other OPPS APC 701.25 27.63 193.76 percent of total billed charges 701.25 701.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 6.0X60 SUP-99-01352 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 5.0X40 SUP-99-01353 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 6.0X40X90 SUP-99-01354 CDM C1725 HCPCS 0272 RC outpatient 2925 2925 2925 74 2164.5 percent of total billed charges 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 27.63 808.18 percent of total billed charges 2925 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 7X20X75 SUP-99-01356 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 3.75X15 SUP-99-01358 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 5X20X75 SUP-99-01359 CDM C1725 HCPCS 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 5.0X20 SUP-99-01361 CDM C1725 HCPCS 0272 RC outpatient 2925 2925 2925 74 2164.5 percent of total billed charges 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 27.63 808.18 percent of total billed charges 2925 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 4X100X135 SUP-99-01365 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - AMPLATZ SPR STF STR 180 BS SUP-99-01368 CDM C1769 HCPCS 0272 RC outpatient 665 665 665 74 492.1 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 27.63 183.74 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 8.0X40 SUP-99-01377 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 2.5X22 SUP-99-01378 CDM C1876 HCPCS 0278 RC outpatient 1995 1995 1995 57 1137.15 percent of total billed charges 1995 93 1615.95 percent of total billed charges 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 51 1017.45 percent of total billed charges 1995 1995 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 4X150X135 SUP-99-01380 CDM C1725 HCPCS 0272 RC outpatient 132 132 132 74 97.68 percent of total billed charges 132 93 106.92 percent of total billed charges 132 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 132 other OPPS APC 132 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 132 other OPPS APC 132 27.63 36.47 percent of total billed charges 132 132 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 6X100X135 SUP-99-01381 CDM C1725 HCPCS 0272 RC outpatient 132 132 132 74 97.68 percent of total billed charges 132 93 106.92 percent of total billed charges 132 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 132 other OPPS APC 132 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 132 other OPPS APC 132 27.63 36.47 percent of total billed charges 132 132 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT RX 2.0X10 SUP-99-01382 CDM C1725 HCPCS 0272 RC outpatient 2550 2550 2550 74 1887 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 27.63 704.57 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 6X60X75 SUP-99-01385 CDM C1725 HCPCS 0272 RC outpatient 665 665 665 74 492.1 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 27.63 183.74 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - V-14 STRAIGHT 300CM SUP-99-01387 CDM C1769 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - V-14 ANGLED 300CM SUP-99-01388 CDM C1769 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - RUBICON 14 150CM SUP-99-01389 CDM C1887 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 3.5X8 SUP-99-01392 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 6.0X100 SUP-99-01393 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 5.0X100 SUP-99-01394 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 2.75X20 SUP-99-01396 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 8X40X75 SUP-99-01397 CDM C1725 HCPCS 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 8X60X75 SUP-99-01399 CDM C1725 HCPCS 0272 RC outpatient 665 665 665 74 492.1 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 27.63 183.74 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 3.0X9 SUP-99-01400 CDM C1876 HCPCS 0278 RC outpatient 1995 1995 1995 57 1137.15 percent of total billed charges 1995 93 1615.95 percent of total billed charges 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 51 1017.45 percent of total billed charges 1995 1995 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 7.0X20 SUP-99-01402 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE ES OTW 2.5X40X150 SUP-99-01403 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 1.5X120 SUP-99-01404 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 2.5X100X150 SUP-99-01405 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 3.0X100X150 SUP-99-01406 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - RBU3.5 SUP-99-01407 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 8.0X40 SUP-99-01408 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - TEARAWAY - 12F SUP-99-01409 CDM C1894 HCPCS 0272 RC outpatient 64 64 64 74 47.36 percent of total billed charges 64 93 51.84 percent of total billed charges 64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 64 other OPPS APC 64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 64 other OPPS APC 64 27.63 17.68 percent of total billed charges 64 64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - TEARAWAY - 14F SUP-99-01410 CDM C1894 HCPCS 0272 RC outpatient 64 64 64 74 47.36 percent of total billed charges 64 93 51.84 percent of total billed charges 64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 64 other OPPS APC 64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 64 other OPPS APC 64 27.63 17.68 percent of total billed charges 64 64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 2.5X26 SUP-99-01411 CDM C1876 HCPCS 0278 RC outpatient 1995 1995 1995 57 1137.15 percent of total billed charges 1995 93 1615.95 percent of total billed charges 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 51 1017.45 percent of total billed charges 1995 1995 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - TRUEPATH CTO SUP-99-01414 CDM C1769 HCPCS 0272 RC outpatient 4762.5 4762.5 4762.5 74 3524.25 percent of total billed charges 4762.5 93 3857.63 percent of total billed charges 4762.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4762.5 other OPPS APC 4762.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4762.5 other OPPS APC 4762.5 27.63 1315.88 percent of total billed charges 4762.5 4762.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - TRUEPATH EXTENSION SUP-99-01415 CDM 0272 RC outpatient 294 294 294 74 217.56 percent of total billed charges 294 93 238.14 percent of total billed charges 294 294 other OPPS APC 294 294 other OPPS APC 294 27.63 81.23 percent of total billed charges 294 294 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 5X40X135 SUP-99-01417 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 2.5X20 SUP-99-01418 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CROSSTELLA 6 X 200 SUP-99-014187 CDM C1725 HCPCS 0272 RC outpatient 1080 1080 1080 74 799.2 percent of total billed charges 1080 93 874.8 percent of total billed charges 1080 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1080 other OPPS APC 1080 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1080 other OPPS APC 1080 27.63 298.4 percent of total billed charges 1080 1080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 6.0X20 SUP-99-01419 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 4.0X100X150 SUP-99-01421 CDM C1725 HCPCS 0272 RC outpatient 930 930 930 74 688.2 percent of total billed charges 930 93 753.3 percent of total billed charges 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 27.63 256.96 percent of total billed charges 930 930 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 6X60X135 SUP-99-01422 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 018 5.0X80X130 SUP-99-01426 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 5.0X40 SUP-99-01427 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 5.0X80X150 SUP-99-01432 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 10X40X75 SUP-99-01433 CDM C1725 HCPCS 0272 RC outpatient 665 665 665 74 492.1 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 27.63 183.74 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - AR 1 (MEDTRONIC) SUP-99-01434 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 2.0X40X150 SUP-99-01438 CDM C1725 HCPCS 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 7X60X75 SUP-99-01439 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE 3.5X40 SUP-99-01440 CDM C1725 HCPCS 0272 RC outpatient 2385 2385 2385 74 1764.9 percent of total billed charges 2385 93 1931.85 percent of total billed charges 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 27.63 658.98 percent of total billed charges 2385 2385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 3.5X20 SUP-99-01441 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 4.0X40 SUP-99-01442 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - VASCUTRACK CUTTING 2.5X60 SUP-99-01443 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 018 6.0X80X130 SUP-99-01444 CDM C1725 HCPCS 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - LIFESTENT 6X60X130 SUP-99-01445 CDM C1874 HCPCS 0278 RC outpatient 3375 3375 3375 57 1923.75 percent of total billed charges 3375 93 2733.75 percent of total billed charges 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 3375 other OPPS APC 3375 51 1721.25 percent of total billed charges 3375 3375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 2.5X8 SUP-99-01446 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 5.0X80 SUP-99-01447 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 4X40X135 SUP-99-01451 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - TREK 2.5X8 SUP-99-01455 CDM C1725 HCPCS 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE 3.5X80 SUP-99-01458 CDM C1725 HCPCS 0272 RC outpatient 2685 2685 2685 74 1986.9 percent of total billed charges 2685 93 2174.85 percent of total billed charges 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 27.63 741.87 percent of total billed charges 2685 2685 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 2.0X20 SUP-99-01461 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 3DRC SH SUP-99-01465 CDM C1887 HCPCS 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MINI TREK II 2.0X20 OTW SUP-99-01466 CDM C1725 HCPCS 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 5X60X135 SUP-99-01467 CDM C1725 HCPCS 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 4X60X135 SUP-99-01468 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 3.0X120 SUP-99-01469 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 2.5X14 SUP-99-01470 CDM C1876 HCPCS 0278 RC outpatient 1995 1995 1995 57 1137.15 percent of total billed charges 1995 93 1615.95 percent of total billed charges 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 51 1017.45 percent of total billed charges 1995 1995 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - LEFTBU3.5 (BS) SUP-99-01471 CDM C1887 HCPCS 0272 RC outpatient 192.5 192.5 192.5 74 142.45 percent of total billed charges 192.5 93 155.93 percent of total billed charges 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EXPRESS LD 8.0X37X135 SUP-99-01473 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 2.5X80X150 SUP-99-01474 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 5.0X120 SUP-99-01475 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EPIC 8X60X75 SUP-99-01476 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - GLIDECATH 4F 120CM ANGLED SUP-99-01477 CDM C1887 HCPCS 0272 RC outpatient 771 771 771 74 570.54 percent of total billed charges 771 93 624.51 percent of total billed charges 771 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 771 other OPPS APC 771 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 771 other OPPS APC 771 27.63 213.03 percent of total billed charges 771 771 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - GLIDECATH 4F 120CM STRAIGHT SUP-99-01478 CDM C1887 HCPCS 0272 RC outpatient 771 771 771 74 570.54 percent of total billed charges 771 93 624.51 percent of total billed charges 771 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 771 other OPPS APC 771 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 771 other OPPS APC 771 27.63 213.03 percent of total billed charges 771 771 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 5X60X75 SUP-99-01479 CDM C1725 HCPCS 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 7X100X135 SUP-99-01482 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - GLIDER RX 2.5X12 SUP-99-01487 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT RX 3.5X10 SUP-99-01493 CDM C1725 HCPCS 0272 RC outpatient 2400 2400 2400 74 1776 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 27.63 663.12 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - HERCULINK 5.0X15 SUP-99-01494 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - RENAL MACH 1 LIMA SUP-99-01495 CDM C1887 HCPCS 0272 RC outpatient 322.53 322.53 322.53 74 238.67 percent of total billed charges 322.53 93 261.25 percent of total billed charges 322.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 322.53 other OPPS APC 322.53 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 322.53 other OPPS APC 322.53 27.63 89.12 percent of total billed charges 322.53 322.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 6.0X80 SUP-99-01496 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 7.0X40 SUP-99-01497 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 7X20X135 SUP-99-01499 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - VASCUTRACK CUTTING 3.0X40 SUP-99-01500 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 2.0X12 SUP-99-01502 CDM C1725 HCPCS 0272 RC outpatient 280 280 280 74 207.2 percent of total billed charges 280 93 226.8 percent of total billed charges 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 27.63 77.36 percent of total billed charges 280 280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE 4.0X80 SUP-99-01503 CDM C1725 HCPCS 0272 RC outpatient 2385 2385 2385 74 1764.9 percent of total billed charges 2385 93 1931.85 percent of total billed charges 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 27.63 658.98 percent of total billed charges 2385 2385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 2.0X15 SUP-99-01505 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - COVERED - VIABAHN 6 X 150 SUP-99-01506 CDM C1874 HCPCS 0278 RC outpatient 9737.5 9737.5 9737.5 57 5550.38 percent of total billed charges 9737.5 93 7887.38 percent of total billed charges 9737.5 9737.5 other OPPS APC 9737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9737.5 other OPPS APC 9737.5 51 4966.13 percent of total billed charges 9737.5 9737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MINI TREK II 2.0X15 OTW SUP-99-01507 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 4.0X20 SUP-99-01509 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 4.5X20 SUP-99-01510 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 4.0X22 SUP-99-01511 CDM C1876 HCPCS 0278 RC outpatient 1995 1995 1995 57 1137.15 percent of total billed charges 1995 93 1615.95 percent of total billed charges 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 51 1017.45 percent of total billed charges 1995 1995 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 4.0X30 SUP-99-01512 CDM C1876 HCPCS 0278 RC outpatient 1995 1995 1995 57 1137.15 percent of total billed charges 1995 93 1615.95 percent of total billed charges 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 51 1017.45 percent of total billed charges 1995 1995 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ULTRA 5.0X13 SUP-99-01514 CDM C1876 HCPCS 0278 RC outpatient 2064 2064 2064 57 1176.48 percent of total billed charges 2064 93 1671.84 percent of total billed charges 2064 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2064 other OPPS APC 2064 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2064 other OPPS APC 2064 51 1052.64 percent of total billed charges 2064 2064 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - OPTISEAL 7F 13CM SUP-99-01515 CDM C1894 HCPCS 0272 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130 other OPPS APC 130 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - OPTISEAL 8F 13CM SUP-99-01516 CDM C1894 HCPCS 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - OPTISEAL 9F 13CM SUP-99-01517 CDM C1894 HCPCS 0272 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130 other OPPS APC 130 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 8.0X20 SUP-99-01518 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 6X20X135 SUP-99-01519 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 8F JCL 3.5 SUP-99-01522 CDM C1887 HCPCS 0272 RC outpatient 193.6 193.6 193.6 74 143.26 percent of total billed charges 193.6 93 156.82 percent of total billed charges 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 27.63 53.49 percent of total billed charges 193.6 193.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 8F JCL 3.5 SH SUP-99-01523 CDM C1887 HCPCS 0272 RC outpatient 193.6 193.6 193.6 74 143.26 percent of total billed charges 193.6 93 156.82 percent of total billed charges 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 27.63 53.49 percent of total billed charges 193.6 193.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 8F JCL 4.0 SH SUP-99-01524 CDM C1887 HCPCS 0272 RC outpatient 193.6 193.6 193.6 74 143.26 percent of total billed charges 193.6 93 156.82 percent of total billed charges 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 27.63 53.49 percent of total billed charges 193.6 193.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 8F JCL 4.0 SUP-99-01525 CDM C1887 HCPCS 0272 RC outpatient 193.6 193.6 193.6 74 143.26 percent of total billed charges 193.6 93 156.82 percent of total billed charges 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 193.6 other OPPS APC 193.6 27.63 53.49 percent of total billed charges 193.6 193.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 2.0X40 SUP-99-01528 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - COVERED - VIABAHN 6 X 50 SUP-99-01530 CDM C1874 HCPCS 0278 RC outpatient 9392.5 9392.5 9392.5 57 5353.73 percent of total billed charges 9392.5 93 7607.93 percent of total billed charges 9392.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9392.5 other OPPS APC 9392.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9392.5 other OPPS APC 9392.5 51 4790.18 percent of total billed charges 9392.5 9392.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - VICTORY 14 - 300CM 12G LOAD SUP-99-01531 CDM C1769 HCPCS 0272 RC outpatient 551.25 551.25 551.25 74 407.93 percent of total billed charges 551.25 93 446.51 percent of total billed charges 551.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.25 other OPPS APC 551.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.25 other OPPS APC 551.25 27.63 152.31 percent of total billed charges 551.25 551.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - VICTORY 14 - 300CM 18G LOAD SUP-99-01532 CDM C1769 HCPCS 0272 RC outpatient 551.25 551.25 551.25 74 407.93 percent of total billed charges 551.25 93 446.51 percent of total billed charges 551.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.25 other OPPS APC 551.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 551.25 other OPPS APC 551.25 27.63 152.31 percent of total billed charges 551.25 551.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON- NC TREK NEO 3.75 X 20 SUP-99-01533 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 018 3.0X220X130 SUP-99-01534 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - HOCKEY STICK SUP-99-01535 CDM C1887 HCPCS 0272 RC outpatient 174 174 174 74 128.76 percent of total billed charges 174 93 140.94 percent of total billed charges 174 174 other OPPS APC 174 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174 other OPPS APC 174 27.63 48.08 percent of total billed charges 174 174 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - HOCKEY STICK SH SUP-99-01536 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EPIC 12X60X75 SUP-99-01538 CDM C1876 HCPCS 0278 RC outpatient 2925 2925 2925 57 1667.25 percent of total billed charges 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 51 1491.75 percent of total billed charges 2925 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - OMNILINK ELITE .035 7.0X29 SUP-99-01540 CDM C1876 HCPCS 0278 RC outpatient 2625 2625 2625 57 1496.25 percent of total billed charges 2625 93 2126.25 percent of total billed charges 2625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2625 other OPPS APC 2625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2625 other OPPS APC 2625 51 1338.75 percent of total billed charges 2625 2625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 6X200X135 SUP-99-01541 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - CONFIANZA 300CM SUP-99-01542 CDM C1769 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 018 3.0X150X130 SUP-99-01545 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EPIC 6X100X120 SUP-99-01546 CDM C1876 HCPCS 0278 RC outpatient 2925 2925 2925 57 1667.25 percent of total billed charges 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 51 1491.75 percent of total billed charges 2925 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EPIC 6X120X120 SUP-99-01547 CDM C1876 HCPCS 0278 RC outpatient 3022.5 3022.5 3022.5 57 1722.83 percent of total billed charges 3022.5 93 2448.23 percent of total billed charges 3022.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3022.5 other OPPS APC 3022.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3022.5 other OPPS APC 3022.5 51 1541.48 percent of total billed charges 3022.5 3022.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 7X60X135 SUP-99-01548 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EPIC 7X60X120 SUP-99-01551 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - OMNILINK ELITE .035 7.0X59 SUP-99-01552 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 2.75X22 SUP-99-01553 CDM C1876 HCPCS 0278 RC outpatient 1995 1995 1995 57 1137.15 percent of total billed charges 1995 93 1615.95 percent of total billed charges 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 51 1017.45 percent of total billed charges 1995 1995 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EPIC 7X120X120 SUP-99-01554 CDM C1876 HCPCS 0278 RC outpatient 3022.5 3022.5 3022.5 57 1722.83 percent of total billed charges 3022.5 93 2448.23 percent of total billed charges 3022.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3022.5 other OPPS APC 3022.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3022.5 other OPPS APC 3022.5 51 1541.48 percent of total billed charges 3022.5 3022.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - OMNILINK ELITE .035 6.0X59 SUP-99-01556 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - OMNILINK ELITE .035 8.0X39 SUP-99-01557 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - OMNILINK ELITE .035 8.0X29 SUP-99-01558 CDM C1876 HCPCS 0278 RC outpatient 2775 2775 2775 57 1581.75 percent of total billed charges 2775 93 2247.75 percent of total billed charges 2775 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2775 other OPPS APC 2775 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2775 other OPPS APC 2775 51 1415.25 percent of total billed charges 2775 2775 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JL 3.5 5F SUP-99-01560 CDM 0272 RC outpatient 38.36 38.36 38.36 74 28.39 percent of total billed charges 38.36 93 31.07 percent of total billed charges 38.36 38.36 other OPPS APC 38.36 38.36 other OPPS APC 38.36 27.63 10.6 percent of total billed charges 38.36 38.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JL 4.0 5F SUP-99-01561 CDM 0272 RC outpatient 34.88 34.88 34.88 74 25.81 percent of total billed charges 34.88 93 28.25 percent of total billed charges 34.88 34.88 other OPPS APC 34.88 34.88 other OPPS APC 34.88 27.63 9.64 percent of total billed charges 34.88 34.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JL 4.5 5F SUP-99-01562 CDM 0272 RC outpatient 68 68 68 74 50.32 percent of total billed charges 68 93 55.08 percent of total billed charges 68 68 other OPPS APC 68 68 other OPPS APC 68 27.63 18.79 percent of total billed charges 68 68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JR 3.5 5F SUP-99-01563 CDM 0272 RC outpatient 30.68 30.68 30.68 74 22.7 percent of total billed charges 30.68 93 24.85 percent of total billed charges 30.68 30.68 other OPPS APC 30.68 30.68 other OPPS APC 30.68 27.63 8.48 percent of total billed charges 30.68 30.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JR 4.0 5F SUP-99-01564 CDM 0272 RC outpatient 335.65 335.65 335.65 74 248.38 percent of total billed charges 335.65 93 271.88 percent of total billed charges 335.65 335.65 other OPPS APC 335.65 335.65 other OPPS APC 335.65 27.63 92.74 percent of total billed charges 335.65 335.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JR 5.0 5F SUP-99-01565 CDM 0272 RC outpatient 30.68 30.68 30.68 74 22.7 percent of total billed charges 30.68 93 24.85 percent of total billed charges 30.68 30.68 other OPPS APC 30.68 30.68 other OPPS APC 30.68 27.63 8.48 percent of total billed charges 30.68 30.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - IMA 5F SUP-99-01566 CDM 0272 RC outpatient 38.36 38.36 38.36 74 28.39 percent of total billed charges 38.36 93 31.07 percent of total billed charges 38.36 38.36 other OPPS APC 38.36 38.36 other OPPS APC 38.36 27.63 10.6 percent of total billed charges 38.36 38.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - AL1 5F SUP-99-01567 CDM 0272 RC outpatient 161.4 161.4 161.4 74 119.44 percent of total billed charges 161.4 93 130.73 percent of total billed charges 161.4 161.4 other OPPS APC 161.4 161.4 other OPPS APC 161.4 27.63 44.59 percent of total billed charges 161.4 161.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - AL2 5F SUP-99-01568 CDM 0272 RC outpatient 34 34 34 74 25.16 percent of total billed charges 34 93 27.54 percent of total billed charges 34 34 other OPPS APC 34 34 other OPPS APC 34 27.63 9.39 percent of total billed charges 34 34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - AR1 5F SUP-99-01569 CDM 0272 RC outpatient 30.68 30.68 30.68 74 22.7 percent of total billed charges 30.68 93 24.85 percent of total billed charges 30.68 30.68 other OPPS APC 30.68 30.68 other OPPS APC 30.68 27.63 8.48 percent of total billed charges 30.68 30.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - MPA2 5F SUP-99-01570 CDM 0272 RC outpatient 31.64 31.64 31.64 74 23.41 percent of total billed charges 31.64 93 25.63 percent of total billed charges 31.64 31.64 other OPPS APC 31.64 31.64 other OPPS APC 31.64 27.63 8.74 percent of total billed charges 31.64 31.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - WILLIAMS RIGHT 5F SUP-99-01571 CDM 0272 RC outpatient 36 36 36 74 26.64 percent of total billed charges 36 93 29.16 percent of total billed charges 36 36 other OPPS APC 36 36 other OPPS APC 36 27.63 9.95 percent of total billed charges 36 36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 10X20X75 SUP-99-01572 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 5F CHECK-FLO MICROPUNCTURE SUP-99-01573 CDM C1894 HCPCS 0272 RC outpatient 114.32 114.32 114.32 74 84.6 percent of total billed charges 114.32 93 92.6 percent of total billed charges 114.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 114.32 other OPPS APC 114.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 114.32 other OPPS APC 114.32 27.63 31.59 percent of total billed charges 114.32 114.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 2.5X15 SUP-99-01574 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 5F JL3.5 (BS) SUP-99-01578 CDM C1887 HCPCS 0272 RC outpatient 188.12 188.12 188.12 74 139.21 percent of total billed charges 188.12 93 152.38 percent of total billed charges 188.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188.12 other OPPS APC 188.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188.12 other OPPS APC 188.12 27.63 51.98 percent of total billed charges 188.12 188.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - LIFESTENT 6X100X130 SUP-99-01579 CDM C1874 HCPCS 0278 RC outpatient 4375 4375 4375 57 2493.75 percent of total billed charges 4375 93 3543.75 percent of total billed charges 4375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4375 other OPPS APC 4375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4375 other OPPS APC 4375 51 2231.25 percent of total billed charges 4375 4375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 5F JL4 (BS) SUP-99-01580 CDM C1887 HCPCS 0272 RC outpatient 188.12 188.12 188.12 74 139.21 percent of total billed charges 188.12 93 152.38 percent of total billed charges 188.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188.12 other OPPS APC 188.12 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188.12 other OPPS APC 188.12 27.63 51.98 percent of total billed charges 188.12 188.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MINI TREK II 1.5X15 OTW SUP-99-01584 CDM C1725 HCPCS 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 5F CLS3.75 (BS) SUP-99-01587 CDM C1887 HCPCS 0272 RC outpatient 192.5 192.5 192.5 74 142.45 percent of total billed charges 192.5 93 155.93 percent of total billed charges 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - CROSSER 14SA 106CM SUP-99-01588 CDM C1714 HCPCS 0272 RC outpatient 4387.5 4387.5 4387.5 74 3246.75 percent of total billed charges 4387.5 93 3553.88 percent of total billed charges 4387.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4387.5 other OPPS APC 4387.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4387.5 other OPPS APC 4387.5 27.63 1212.27 percent of total billed charges 4387.5 4387.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - MICROSHEATH XL 70 ST SUP-99-01589 CDM C1887 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - MICROSHEATH XL 70 VERT SUP-99-01590 CDM C1887 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EPIC 7X100X120 SUP-99-01594 CDM C1876 HCPCS 0278 RC outpatient 2925 2925 2925 57 1667.25 percent of total billed charges 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 51 1491.75 percent of total billed charges 2925 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 4.5X8 SUP-99-01598 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE 2.5X40 SUP-99-01601 CDM C1725 HCPCS 0272 RC outpatient 2385 2385 2385 74 1764.9 percent of total billed charges 2385 93 1931.85 percent of total billed charges 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 27.63 658.98 percent of total billed charges 2385 2385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 018 2.0X150X130 SUP-99-01603 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 8X40X135 SUP-99-01604 CDM C1725 HCPCS 0272 RC outpatient 665 665 665 74 492.1 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 27.63 183.74 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE 2.5X80 SUP-99-01605 CDM C1725 HCPCS 0272 RC outpatient 2385 2385 2385 74 1764.9 percent of total billed charges 2385 93 1931.85 percent of total billed charges 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 27.63 658.98 percent of total billed charges 2385 2385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 3.5X15 SUP-99-01606 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - WIGGLE 190CM SUP-99-01607 CDM C1769 HCPCS 0272 RC outpatient 266 266 266 74 196.84 percent of total billed charges 266 93 215.46 percent of total billed charges 266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 266 other OPPS APC 266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 266 other OPPS APC 266 27.63 73.5 percent of total billed charges 266 266 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - WIGGLE 300CM SUP-99-01608 CDM C1769 HCPCS 0272 RC outpatient 266 266 266 74 196.84 percent of total billed charges 266 93 215.46 percent of total billed charges 266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 266 other OPPS APC 266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 266 other OPPS APC 266 27.63 73.5 percent of total billed charges 266 266 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - OMNILINK ELITE .035 6.0X29 SUP-99-01610 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - OMNILINK ELITE .035 7.0X39 SUP-99-01611 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - RUBICON 35 135CM SUP-99-01612 CDM C1887 HCPCS 0272 RC outpatient 528.5 528.5 528.5 74 391.09 percent of total billed charges 528.5 93 428.09 percent of total billed charges 528.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 528.5 other OPPS APC 528.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 528.5 other OPPS APC 528.5 27.63 146.02 percent of total billed charges 528.5 528.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - RUBICON 18 135CM SUP-99-01613 CDM C1887 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - OMNILINK ELITE .035 9.0X39 SUP-99-01614 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 4.0X15 SUP-99-01616 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MINI TREK 2.0X8 SUP-99-01621 CDM C1725 HCPCS 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MINI TREK II 1.5X20 OTW SUP-99-01622 CDM C1725 HCPCS 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - OPTISEAL 7F 13CM (VS) SUP-99-01624 CDM C1894 HCPCS 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 2.75X18 SUP-99-01625 CDM C1876 HCPCS 0278 RC outpatient 2325 2325 2325 57 1325.25 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 51 1185.75 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - OMNILINK ELITE .035 10.0X29 SUP-99-01627 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - SL 3.0 SUP-99-01630 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - SL 3.0 SH SUP-99-01631 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - SL 3.5 SUP-99-01632 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - SL 3.5 SH SUP-99-01633 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - SL 4.0 SUP-99-01634 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - SL 4.0 SH SUP-99-01635 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 4.0X20 SUP-99-01640 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 2.25X8 SUP-99-01641 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - OPTISEAL 8F 13CM (VS) SUP-99-01642 CDM C1894 HCPCS 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EPIC 6X80X120 SUP-99-01643 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EPIC 6X60X120 SUP-99-01644 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - OMNILINK ELITE .035 8.0X59 SUP-99-01645 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - LIFESTENT 6X80X130 SUP-99-01647 CDM C1874 HCPCS 0278 RC outpatient 3250 3250 3250 57 1852.5 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 51 1657.5 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JL4.5 SH (MEDTRONIC) SUP-99-01648 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JL5.SH (MEDTRONIC) SUP-99-01649 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JL5 6F (CORDIS) SUP-99-01650 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JL6 SH (MEDTRONIC) SUP-99-01651 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - COMMAND ES 0.14 X 300CM SUP-99-01652 CDM C1769 HCPCS 0272 RC outpatient 1815 1815 1815 74 1343.1 percent of total billed charges 1815 93 1470.15 percent of total billed charges 1815 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1815 other OPPS APC 1815 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1815 other OPPS APC 1815 27.63 501.48 percent of total billed charges 1815 1815 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 2.25X15 SUP-99-01653 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - GLIDESHEATH 5F SUP-99-01656 CDM C1894 HCPCS 0272 RC outpatient 200.9 200.9 200.9 74 148.67 percent of total billed charges 200.9 93 162.73 percent of total billed charges 200.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200.9 other OPPS APC 200.9 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200.9 other OPPS APC 200.9 27.63 55.51 percent of total billed charges 200.9 200.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATHERECTOMY - 2.0 CLASSIC CROWN 145CM SUP-99-01657 CDM C1724 HCPCS 0272 RC outpatient 8987.5 8987.5 8987.5 74 6650.75 percent of total billed charges 8987.5 93 7279.88 percent of total billed charges 8987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8987.5 other OPPS APC 8987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8987.5 other OPPS APC 8987.5 27.63 2483.25 percent of total billed charges 8987.5 8987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATHERECTOMY - 1.25 SOLID CROWN 145CM SUP-99-01658 CDM C1724 HCPCS 0272 RC outpatient 8487.5 8487.5 8487.5 74 6280.75 percent of total billed charges 8487.5 93 6874.88 percent of total billed charges 8487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8487.5 other OPPS APC 8487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8487.5 other OPPS APC 8487.5 27.63 2345.1 percent of total billed charges 8487.5 8487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATHERECTOMY - 1.50 SOLID CROWN 145CM SUP-99-01659 CDM C1724 HCPCS 0272 RC outpatient 8487.5 8487.5 8487.5 74 6280.75 percent of total billed charges 8487.5 93 6874.88 percent of total billed charges 8487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8487.5 other OPPS APC 8487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8487.5 other OPPS APC 8487.5 27.63 2345.1 percent of total billed charges 8487.5 8487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATHERECTOMY - 2.00 SOLID CROWN 145CM SUP-99-01660 CDM C1724 HCPCS 0272 RC outpatient 8987.5 8987.5 8987.5 74 6650.75 percent of total billed charges 8987.5 93 7279.88 percent of total billed charges 8987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8987.5 other OPPS APC 8987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8987.5 other OPPS APC 8987.5 27.63 2483.25 percent of total billed charges 8987.5 8987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATHERECTOMY - VIPERWIRE ADVANCE 325CM SUP-99-01662 CDM C1769 HCPCS 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - REGALIA SUP-99-01664 CDM C1769 HCPCS 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - ASTATO XS20 SUP-99-01665 CDM C1769 HCPCS 0272 RC outpatient 560 560 560 74 414.4 percent of total billed charges 560 93 453.6 percent of total billed charges 560 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 560 other OPPS APC 560 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 560 other OPPS APC 560 27.63 154.73 percent of total billed charges 560 560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - ASTATO 30 SUP-99-01666 CDM C1769 HCPCS 0272 RC outpatient 560 560 560 74 414.4 percent of total billed charges 560 93 453.6 percent of total billed charges 560 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 560 other OPPS APC 560 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 560 other OPPS APC 560 27.63 154.73 percent of total billed charges 560 560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 7.0X40X135 SUP-99-01668 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - OMNILINK ELITE .035 6.0X39 SUP-99-01669 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - EXPORT AP SUP-99-01673 CDM 0272 RC outpatient 1485 1485 1485 74 1098.9 percent of total billed charges 1485 93 1202.85 percent of total billed charges 1485 1485 other OPPS APC 1485 1485 other OPPS APC 1485 27.63 410.31 percent of total billed charges 1485 1485 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EXPRESS LD 7.0X27X135 SUP-99-01675 CDM C1876 HCPCS 0278 RC outpatient 3107.38 3107.38 3107.38 57 1771.21 percent of total billed charges 3107.38 93 2516.98 percent of total billed charges 3107.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3107.38 other OPPS APC 3107.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3107.38 other OPPS APC 3107.38 51 1584.76 percent of total billed charges 3107.38 3107.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 2.0X100 SUP-99-01676 CDM C1725 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 2.5X100 SUP-99-01677 CDM C1725 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 3.0X100 SUP-99-01678 CDM C1725 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 3.5X100 SUP-99-01679 CDM C1725 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - VASCUTRACK CUTTING 5.0X150 SUP-99-01682 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - LIFESTENT 6X200X135 SUP-99-01684 CDM C1874 HCPCS 0278 RC outpatient 6000 6000 6000 57 3420 percent of total billed charges 6000 93 4860 percent of total billed charges 6000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6000 other OPPS APC 6000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6000 other OPPS APC 6000 51 3060 percent of total billed charges 6000 6000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - RUBICON 18 90CM SUP-99-01685 CDM C1887 HCPCS 0272 RC outpatient 528.5 528.5 528.5 74 391.09 percent of total billed charges 528.5 93 428.09 percent of total billed charges 528.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 528.5 other OPPS APC 528.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 528.5 other OPPS APC 528.5 27.63 146.02 percent of total billed charges 528.5 528.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT RX 2.0X6 SUP-99-01686 CDM C1725 HCPCS 0272 RC outpatient 2550 2550 2550 74 1887 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 27.63 704.57 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT RX 2.5X6 SUP-99-01687 CDM C1725 HCPCS 0272 RC outpatient 2550 2550 2550 74 1887 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 27.63 704.57 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT RX 3.0X6 SUP-99-01688 CDM C1725 HCPCS 0272 RC outpatient 2550 2550 2550 74 1887 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 27.63 704.57 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT RX 3.5X6 SUP-99-01689 CDM C1725 HCPCS 0272 RC outpatient 2550 2550 2550 74 1887 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 27.63 704.57 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE ES OTW 4.0X40X145 SUP-99-01692 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - OMNILINK ELITE .035 7.0X19 SUP-99-01695 CDM C1876 HCPCS 0278 RC outpatient 2625 2625 2625 57 1496.25 percent of total billed charges 2625 93 2126.25 percent of total billed charges 2625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2625 other OPPS APC 2625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2625 other OPPS APC 2625 51 1338.75 percent of total billed charges 2625 2625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - VASCUTRACK CUTTING 5.0X200 SUP-99-01697 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - TREK 3.5X15 SUP-99-01698 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IVUS - EAGLE EYE - PLATINUM SHORT TIP SUP-99-01699 CDM C1753 HCPCS 0272 RC outpatient 2175 2175 2175 74 1609.5 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 27.63 600.95 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 2.0X100X150 SUP-99-01700 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - GENERATOR A2DSR01 SUP-99-01701 CDM C1786 HCPCS 0275 RC outpatient 11025 11025 11025 57 6284.25 percent of total billed charges 11025 93 8930.25 percent of total billed charges 11025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11025 other OPPS APC 11025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 11025 other OPPS APC 11025 51 5622.75 percent of total billed charges 11025 11025 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 3.0X18 SUP-99-01704 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JL4 (MEDTRONIC) SUP-99-01705 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 3.5X18 SUP-99-01708 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - VASCUTRACK CUTTING 2.0X200 SUP-99-01711 CDM C1725 HCPCS 0272 RC outpatient 2175 2175 2175 74 1609.5 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 27.63 600.95 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 2.75X26 SUP-99-01718 CDM C1876 HCPCS 0278 RC outpatient 1995 1995 1995 57 1137.15 percent of total billed charges 1995 93 1615.95 percent of total billed charges 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 51 1017.45 percent of total billed charges 1995 1995 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 7.0X80X135 SUP-99-01719 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 6.0X40X135 SUP-99-01720 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - VASCUTRACK CUTTING 3.0X200 SUP-99-01721 CDM C1725 HCPCS 0272 RC outpatient 2175 2175 2175 74 1609.5 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 27.63 600.95 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 7X40X40 SUP-99-01722 CDM C1725 HCPCS 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 5X40X40 SUP-99-01723 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JR4.5 (MEDTRONIC) SUP-99-01724 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JR4.5 SH (MEDTRONIC) SUP-99-01725 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 8F PEEL-AWAY SUP-99-01726 CDM C1894 HCPCS 0272 RC outpatient 160 160 160 74 118.4 percent of total billed charges 160 93 129.6 percent of total billed charges 160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160 other OPPS APC 160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160 other OPPS APC 160 27.63 44.21 percent of total billed charges 160 160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ICAST COVERED 7X22 SUP-99-01728 CDM C1874 HCPCS 0278 RC outpatient 6287.5 6287.5 6287.5 57 3583.88 percent of total billed charges 6287.5 93 5092.88 percent of total billed charges 6287.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6287.5 other OPPS APC 6287.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6287.5 other OPPS APC 6287.5 51 3206.63 percent of total billed charges 6287.5 6287.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ICAST COVERED 7X38 SUP-99-01729 CDM C1874 HCPCS 0278 RC outpatient 6437.5 6437.5 6437.5 57 3669.38 percent of total billed charges 6437.5 93 5214.38 percent of total billed charges 6437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6437.5 other OPPS APC 6437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6437.5 other OPPS APC 6437.5 51 3283.13 percent of total billed charges 6437.5 6437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - VASCUTRACK CUTTING 5.0X40 SUP-99-01730 CDM C1725 HCPCS 0272 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 8X80X40 SUP-99-01732 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 6X40X40 SUP-99-01733 CDM C1725 HCPCS 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 4.0X20 SUP-99-01736 CDM C1725 HCPCS 0272 RC outpatient 2925 2925 2925 74 2164.5 percent of total billed charges 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 27.63 808.18 percent of total billed charges 2925 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - RUBICON 35 90CM SUP-99-01741 CDM C1887 HCPCS 0272 RC outpatient 448 448 448 74 331.52 percent of total billed charges 448 93 362.88 percent of total billed charges 448 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 448 other OPPS APC 448 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 448 other OPPS APC 448 27.63 123.78 percent of total billed charges 448 448 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 018 8.0X40X130 SUP-99-01742 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 8X40X40 SUP-99-01743 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - SHUTTLE SELECT 6.5F X 125CM SUP-99-01744 CDM 0272 RC outpatient 200.38 200.38 200.38 74 148.28 percent of total billed charges 200.38 93 162.31 percent of total billed charges 200.38 200.38 other OPPS APC 200.38 200.38 other OPPS APC 200.38 27.63 55.36 percent of total billed charges 200.38 200.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - AMPLATZ SUP STIF 260 1CM TIP SUP-99-01745 CDM C1769 HCPCS 0272 RC outpatient 120 120 120 74 88.8 percent of total billed charges 120 93 97.2 percent of total billed charges 120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 120 other OPPS APC 120 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 120 other OPPS APC 120 27.63 33.16 percent of total billed charges 120 120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - AMPLTZ XSTIFF .035X300CM ST SUP-99-01748 CDM C1769 HCPCS 0272 RC outpatient 81 81 81 74 59.94 percent of total billed charges 81 93 65.61 percent of total billed charges 81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 81 other OPPS APC 81 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 81 other OPPS APC 81 27.63 22.38 percent of total billed charges 81 81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE 5.0X80 SUP-99-01749 CDM C1725 HCPCS 0272 RC outpatient 2505 2505 2505 74 1853.7 percent of total billed charges 2505 93 2029.05 percent of total billed charges 2505 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2505 other OPPS APC 2505 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2505 other OPPS APC 2505 27.63 692.13 percent of total billed charges 2505 2505 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE 6.0X80 SUP-99-01750 CDM C1725 HCPCS 0272 RC outpatient 2505 2505 2505 74 1853.7 percent of total billed charges 2505 93 2029.05 percent of total billed charges 2505 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2505 other OPPS APC 2505 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2505 other OPPS APC 2505 27.63 692.13 percent of total billed charges 2505 2505 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - VASCUTRACK CUTTING 6.0X40 SUP-99-01751 CDM C1725 HCPCS 0272 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 018 5.0X220X130 SUP-99-01752 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - NEPHROURETEROSTOMY 8F 22CM SUP-99-01754 CDM C1758 HCPCS 0272 RC outpatient 356.51 356.51 356.51 74 263.82 percent of total billed charges 356.51 93 288.77 percent of total billed charges 356.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 356.51 other OPPS APC 356.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 356.51 other OPPS APC 356.51 27.63 98.5 percent of total billed charges 356.51 356.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - NEPHROURETEROSTOMY 8F 24CM SUP-99-01755 CDM C1758 HCPCS 0272 RC outpatient 356.51 356.51 356.51 74 263.82 percent of total billed charges 356.51 93 288.77 percent of total billed charges 356.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 356.51 other OPPS APC 356.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 356.51 other OPPS APC 356.51 27.63 98.5 percent of total billed charges 356.51 356.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - NEPHROURETEROSTOMY 8F 26CM SUP-99-01756 CDM C1758 HCPCS 0272 RC outpatient 356.51 356.51 356.51 74 263.82 percent of total billed charges 356.51 93 288.77 percent of total billed charges 356.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 356.51 other OPPS APC 356.51 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 356.51 other OPPS APC 356.51 27.63 98.5 percent of total billed charges 356.51 356.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - RUBICON 35 150CM SUP-99-01757 CDM C1887 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 2.0X100X200 SUP-99-01758 CDM C1725 HCPCS 0272 RC outpatient 735 735 735 74 543.9 percent of total billed charges 735 93 595.35 percent of total billed charges 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 27.63 203.08 percent of total billed charges 735 735 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 2.0X200X200 SUP-99-01759 CDM C1725 HCPCS 0272 RC outpatient 735 735 735 74 543.9 percent of total billed charges 735 93 595.35 percent of total billed charges 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 27.63 203.08 percent of total billed charges 735 735 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 3.0X200X200 SUP-99-01760 CDM C1725 HCPCS 0272 RC outpatient 735 735 735 74 543.9 percent of total billed charges 735 93 595.35 percent of total billed charges 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 27.63 203.08 percent of total billed charges 735 735 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 3.0X100X200 SUP-99-01761 CDM C1725 HCPCS 0272 RC outpatient 735 735 735 74 543.9 percent of total billed charges 735 93 595.35 percent of total billed charges 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 27.63 203.08 percent of total billed charges 735 735 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 4.0X100X200 SUP-99-01762 CDM C1725 HCPCS 0272 RC outpatient 735 735 735 74 543.9 percent of total billed charges 735 93 595.35 percent of total billed charges 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 27.63 203.08 percent of total billed charges 735 735 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 4.0X200X200 SUP-99-01763 CDM C1725 HCPCS 0272 RC outpatient 735 735 735 74 543.9 percent of total billed charges 735 93 595.35 percent of total billed charges 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 27.63 203.08 percent of total billed charges 735 735 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 2.0X120X150 SUP-99-01764 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - VASCUTRACK CUTTING 4.0X40 SUP-99-01765 CDM C1725 HCPCS 0272 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 8.0X40X135 SUP-99-01766 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RIVAL 6X15X135 SUP-99-01768 CDM C1725 HCPCS 0272 RC outpatient 542.5 542.5 542.5 74 401.45 percent of total billed charges 542.5 93 439.43 percent of total billed charges 542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.5 other OPPS APC 542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.5 other OPPS APC 542.5 27.63 149.89 percent of total billed charges 542.5 542.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE 6.0 X 4.0 SUP-99-01770 CDM C1725 HCPCS 0272 RC outpatient 2385 2385 2385 74 1764.9 percent of total billed charges 2385 93 1931.85 percent of total billed charges 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 27.63 658.98 percent of total billed charges 2385 2385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 7X80X40 SUP-99-01771 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 6X80X40 SUP-99-01780 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 5F JR4 (BS) SUP-99-01781 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING RX 5.0X15X80 SUP-99-01783 CDM C1725 HCPCS 0272 RC outpatient 870 870 870 74 643.8 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 27.63 240.38 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EXPRESS SD 5.0X15 SUP-99-01784 CDM C1876 HCPCS 0278 RC outpatient 3313.13 3313.13 3313.13 57 1888.48 percent of total billed charges 3313.13 93 2683.64 percent of total billed charges 3313.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3313.13 other OPPS APC 3313.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3313.13 other OPPS APC 3313.13 51 1689.7 percent of total billed charges 3313.13 3313.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE 4 X 40 SUP-99-01786 CDM C1725 HCPCS 0272 RC outpatient 2385 2385 2385 74 1764.9 percent of total billed charges 2385 93 1931.85 percent of total billed charges 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 27.63 658.98 percent of total billed charges 2385 2385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 6.0X40 SUP-99-01787 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE 3.0X80 SUP-99-01788 CDM C1725 HCPCS 0272 RC outpatient 2385 2385 2385 74 1764.9 percent of total billed charges 2385 93 1931.85 percent of total billed charges 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 27.63 658.98 percent of total billed charges 2385 2385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 3.5X40 SUP-99-01789 CDM C1725 HCPCS 0272 RC outpatient 2925 2925 2925 74 2164.5 percent of total billed charges 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 27.63 808.18 percent of total billed charges 2925 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - MICROPUNCTURE 6F SUP-99-01792 CDM C1894 HCPCS 0272 RC outpatient 115.48 115.48 115.48 74 85.46 percent of total billed charges 115.48 93 93.54 percent of total billed charges 115.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 115.48 other OPPS APC 115.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 115.48 other OPPS APC 115.48 27.63 31.91 percent of total billed charges 115.48 115.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GLIDEWIRE .035X250 STRAIGHT SUP-99-01793 CDM C1769 HCPCS 0272 RC outpatient 144 144 144 74 106.56 percent of total billed charges 144 93 116.64 percent of total billed charges 144 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 144 other OPPS APC 144 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 144 other OPPS APC 144 27.63 39.79 percent of total billed charges 144 144 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT RX 3.5X15 SUP-99-01795 CDM C1725 HCPCS 0272 RC outpatient 2625 2625 2625 74 1942.5 percent of total billed charges 2625 93 2126.25 percent of total billed charges 2625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2625 other OPPS APC 2625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2625 other OPPS APC 2625 27.63 725.29 percent of total billed charges 2625 2625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - LANGSTON DUAL LUMEN PIGTAIL SUP-99-01796 CDM 0272 RC outpatient 2475 2475 2475 74 1831.5 percent of total billed charges 2475 93 2004.75 percent of total billed charges 2475 2475 other OPPS APC 2475 2475 other OPPS APC 2475 27.63 683.84 percent of total billed charges 2475 2475 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - OMNILINK ELITE .035 9.0X59 SUP-99-01798 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 7.0X120 SUP-99-01800 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 10X40 SUP-99-01801 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 12.0X40 SUP-99-01802 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ICAST COVERED 9X59 SUP-99-01804 CDM C1874 HCPCS 0278 RC outpatient 6937.5 6937.5 6937.5 57 3954.38 percent of total billed charges 6937.5 93 5619.38 percent of total billed charges 6937.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6937.5 other OPPS APC 6937.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6937.5 other OPPS APC 6937.5 51 3538.13 percent of total billed charges 6937.5 6937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - TREK 2.75X15 SUP-99-01805 CDM C1725 HCPCS 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EPIC 7X80X120 SUP-99-01807 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ULTRA 4.5X28 SUP-99-01808 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 7.0X100 SUP-99-01809 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE 6.0X120 SUP-99-01810 CDM C1725 HCPCS 0272 RC outpatient 2385 2385 2385 74 1764.9 percent of total billed charges 2385 93 1931.85 percent of total billed charges 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 27.63 658.98 percent of total billed charges 2385 2385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE 5.0X120 SUP-99-01811 CDM C1725 HCPCS 0272 RC outpatient 2685 2685 2685 74 1986.9 percent of total billed charges 2685 93 2174.85 percent of total billed charges 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 27.63 741.87 percent of total billed charges 2685 2685 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE 2.5X120 SUP-99-01812 CDM C1725 HCPCS 0272 RC outpatient 2385 2385 2385 74 1764.9 percent of total billed charges 2385 93 1931.85 percent of total billed charges 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 27.63 658.98 percent of total billed charges 2385 2385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ICAST COVERED 6X59 SUP-99-01816 CDM C1874 HCPCS 0278 RC outpatient 6937.5 6937.5 6937.5 57 3954.38 percent of total billed charges 6937.5 93 5619.38 percent of total billed charges 6937.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6937.5 other OPPS APC 6937.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6937.5 other OPPS APC 6937.5 51 3538.13 percent of total billed charges 6937.5 6937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ICAST COVERED 9X38 SUP-99-01817 CDM C1874 HCPCS 0278 RC outpatient 6437.5 6437.5 6437.5 57 3669.38 percent of total billed charges 6437.5 93 5214.38 percent of total billed charges 6437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6437.5 other OPPS APC 6437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6437.5 other OPPS APC 6437.5 51 3283.13 percent of total billed charges 6437.5 6437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ICAST COVERED 6X38 SUP-99-01818 CDM C1874 HCPCS 0278 RC outpatient 6437.5 6437.5 6437.5 57 3669.38 percent of total billed charges 6437.5 93 5214.38 percent of total billed charges 6437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6437.5 other OPPS APC 6437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6437.5 other OPPS APC 6437.5 51 3283.13 percent of total billed charges 6437.5 6437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ICAST COVERED 7X59 SUP-99-01819 CDM C1874 HCPCS 0278 RC outpatient 6937.5 6937.5 6937.5 57 3954.38 percent of total billed charges 6937.5 93 5619.38 percent of total billed charges 6937.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6937.5 other OPPS APC 6937.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6937.5 other OPPS APC 6937.5 51 3538.13 percent of total billed charges 6937.5 6937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 9.0X40 SUP-99-01820 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 3.5X12 SUP-99-01821 CDM C1876 HCPCS 0278 RC outpatient 1995 1995 1995 57 1137.15 percent of total billed charges 1995 93 1615.95 percent of total billed charges 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 51 1017.45 percent of total billed charges 1995 1995 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 8F AR 2 SH SUP-99-01822 CDM C1887 HCPCS 0272 RC outpatient 198 198 198 74 146.52 percent of total billed charges 198 93 160.38 percent of total billed charges 198 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 198 other OPPS APC 198 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 198 other OPPS APC 198 27.63 54.71 percent of total billed charges 198 198 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EMBOLIZATION - CUBE 10MMX25CM SUP-99-01823 CDM 0272 RC outpatient 2646 2646 2646 74 1958.04 percent of total billed charges 2646 93 2143.26 percent of total billed charges 2646 2646 other OPPS APC 2646 2646 other OPPS APC 2646 27.63 731.09 percent of total billed charges 2646 2646 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EMBOLIZATION - CUBE 15MMX25CM SUP-99-01824 CDM 0272 RC outpatient 2646 2646 2646 74 1958.04 percent of total billed charges 2646 93 2143.26 percent of total billed charges 2646 2646 other OPPS APC 2646 2646 other OPPS APC 2646 27.63 731.09 percent of total billed charges 2646 2646 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - MAGIC TORQUE 180CM SUP-99-01825 CDM C1769 HCPCS 0272 RC outpatient 166.67 166.67 166.67 74 123.34 percent of total billed charges 166.67 93 135 percent of total billed charges 166.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 166.67 other OPPS APC 166.67 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 166.67 other OPPS APC 166.67 27.63 46.05 percent of total billed charges 166.67 166.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - XXL 14X40 SUP-99-01827 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - XXL 16X40 SUP-99-01828 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - XXL 18X40 SUP-99-01829 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 4.5X15 SUP-99-01831 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - GRAFTMASTER (JOSTENT) 2.8X16 SUP-99-01832 CDM C1874 HCPCS 0278 RC outpatient 5987.5 5987.5 5987.5 57 3412.88 percent of total billed charges 5987.5 93 4849.88 percent of total billed charges 5987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5987.5 other OPPS APC 5987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5987.5 other OPPS APC 5987.5 51 3053.63 percent of total billed charges 5987.5 5987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - GRAFTMASTER (JOSTENT) 2.8X26 SUP-99-01833 CDM C1874 HCPCS 0278 RC outpatient 5987.5 5987.5 5987.5 57 3412.88 percent of total billed charges 5987.5 93 4849.88 percent of total billed charges 5987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5987.5 other OPPS APC 5987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5987.5 other OPPS APC 5987.5 51 3053.63 percent of total billed charges 5987.5 5987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - GRAFTMASTER (JOSTENT) 3.5X19 SUP-99-01834 CDM C1874 HCPCS 0278 RC outpatient 5987.5 5987.5 5987.5 57 3412.88 percent of total billed charges 5987.5 93 4849.88 percent of total billed charges 5987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5987.5 other OPPS APC 5987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5987.5 other OPPS APC 5987.5 51 3053.63 percent of total billed charges 5987.5 5987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 9.0X20 SUP-99-01836 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE ES OTW 3.0X20X145 SUP-99-01837 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 6.0X220X150 SUP-99-01838 CDM C1725 HCPCS 0272 RC outpatient 996 996 996 74 737.04 percent of total billed charges 996 93 806.76 percent of total billed charges 996 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 996 other OPPS APC 996 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 996 other OPPS APC 996 27.63 275.19 percent of total billed charges 996 996 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 4X20X135 SUP-99-01842 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 4.0X20 SUP-99-01843 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EMBOLIZATION - 2D 8MMX20CM SUP-99-01844 CDM 0272 RC outpatient 2646 2646 2646 74 1958.04 percent of total billed charges 2646 93 2143.26 percent of total billed charges 2646 2646 other OPPS APC 2646 2646 other OPPS APC 2646 27.63 731.09 percent of total billed charges 2646 2646 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EMBOLIZATION - 2D 12MMX40CM SUP-99-01845 CDM 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 4.0X120 SUP-99-01846 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE 4.5X80 SUP-99-01850 CDM C1725 HCPCS 0272 RC outpatient 2685 2685 2685 74 1986.9 percent of total billed charges 2685 93 2174.85 percent of total billed charges 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2685 other OPPS APC 2685 27.63 741.87 percent of total billed charges 2685 2685 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON-COYOTE OTW 3.0 X 8.0 X 150 SUP-99-01854 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - NAVICROSS 90CM ANGLED SUP-99-01855 CDM C1887 HCPCS 0272 RC outpatient 598.5 598.5 598.5 74 442.89 percent of total billed charges 598.5 93 484.79 percent of total billed charges 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 27.63 165.37 percent of total billed charges 598.5 598.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - NAVICROSS 135CM ANGLED SUP-99-01856 CDM C1887 HCPCS 0272 RC outpatient 598.5 598.5 598.5 74 442.89 percent of total billed charges 598.5 93 484.79 percent of total billed charges 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 27.63 165.37 percent of total billed charges 598.5 598.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - NAVICROSS 150CM ANGLED SUP-99-01857 CDM C1887 HCPCS 0272 RC outpatient 598.5 598.5 598.5 74 442.89 percent of total billed charges 598.5 93 484.79 percent of total billed charges 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 27.63 165.37 percent of total billed charges 598.5 598.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EXPRESS SD 6.0X18 SUP-99-01858 CDM C1876 HCPCS 0278 RC outpatient 3313.13 3313.13 3313.13 57 1888.48 percent of total billed charges 3313.13 93 2683.64 percent of total billed charges 3313.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3313.13 other OPPS APC 3313.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3313.13 other OPPS APC 3313.13 51 1689.7 percent of total billed charges 3313.13 3313.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - AR 2 SUP-99-01859 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 2.0X60X150 SUP-99-01860 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING RX 7.0X20 SUP-99-01862 CDM C1725 HCPCS 0272 RC outpatient 870 870 870 74 643.8 percent of total billed charges 870 93 704.7 percent of total billed charges 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 870 other OPPS APC 870 27.63 240.38 percent of total billed charges 870 870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 2.25X20 SUP-99-01863 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - VASCUTRACK CUTTING 3.5X60 SUP-99-01864 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - VASCUTRACK CUTTING 3.0X150 SUP-99-01865 CDM C1725 HCPCS 0272 RC outpatient 2175 2175 2175 74 1609.5 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 27.63 600.95 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 3.0X120X150 SUP-99-01866 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 2.5X150X150 SUP-99-01867 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 018 6.0X220X130 SUP-99-01868 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE 3.5X120 SUP-99-01869 CDM C1725 HCPCS 0272 RC outpatient 2385 2385 2385 74 1764.9 percent of total billed charges 2385 93 1931.85 percent of total billed charges 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 27.63 658.98 percent of total billed charges 2385 2385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 6.0X80 SUP-99-01870 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 5.0X220 SUP-99-01871 CDM C1725 HCPCS 0272 RC outpatient 996 996 996 74 737.04 percent of total billed charges 996 93 806.76 percent of total billed charges 996 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 996 other OPPS APC 996 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 996 other OPPS APC 996 27.63 275.19 percent of total billed charges 996 996 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE ES OTW 2.0X40X150 SUP-99-01872 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE 3.0X120 SUP-99-01873 CDM C1725 HCPCS 0272 RC outpatient 2385 2385 2385 74 1764.9 percent of total billed charges 2385 93 1931.85 percent of total billed charges 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 27.63 658.98 percent of total billed charges 2385 2385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - OMNILINK ELITE .035 6.0X19 SUP-99-01874 CDM C1876 HCPCS 0278 RC outpatient 2775 2775 2775 57 1581.75 percent of total billed charges 2775 93 2247.75 percent of total billed charges 2775 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2775 other OPPS APC 2775 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2775 other OPPS APC 2775 51 1415.25 percent of total billed charges 2775 2775 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - LIFESTENT 6X120X130 SUP-99-01875 CDM C1874 HCPCS 0278 RC outpatient 4125 4125 4125 57 2351.25 percent of total billed charges 4125 93 3341.25 percent of total billed charges 4125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4125 other OPPS APC 4125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4125 other OPPS APC 4125 51 2103.75 percent of total billed charges 4125 4125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE- 5F CLS3.5 (BS) SUP-99-01876 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 2.5X6 SUP-99-01878 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EXPRESS LD 7.0X57X135 SUP-99-01881 CDM C1876 HCPCS 0278 RC outpatient 3313.13 3313.13 3313.13 57 1888.48 percent of total billed charges 3313.13 93 2683.64 percent of total billed charges 3313.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3313.13 other OPPS APC 3313.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3313.13 other OPPS APC 3313.13 51 1689.7 percent of total billed charges 3313.13 3313.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - NITINOL .018 40CM SUP-99-01882 CDM C1769 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EPIC 6X40X120 SUP-99-01883 CDM C1876 HCPCS 0278 RC outpatient 2925 2925 2925 57 1667.25 percent of total billed charges 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 51 1491.75 percent of total billed charges 2925 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - OMNILINK ELITE .035 9.0X29 SUP-99-01895 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOSURE - VASCBAND -SHORT SUP-99-01899 CDM 0272 RC outpatient 83.2 83.2 83.2 74 61.57 percent of total billed charges 83.2 93 67.39 percent of total billed charges 83.2 83.2 other OPPS APC 83.2 83.2 other OPPS APC 83.2 27.63 22.99 percent of total billed charges 83.2 83.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOSURE - VASCBAND - REGULAR SUP-99-01900 CDM 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOSURE - VASCBAND - LONG SUP-99-01901 CDM 0272 RC outpatient 85.2 85.2 85.2 74 63.05 percent of total billed charges 85.2 93 69.01 percent of total billed charges 85.2 85.2 other OPPS APC 85.2 85.2 other OPPS APC 85.2 27.63 23.54 percent of total billed charges 85.2 85.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOSURE - VASCBAND - EXTRA LONG SUP-99-01902 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CTO - OFFROAD 100CM SUP-99-01903 CDM 0272 RC outpatient 4875 4875 4875 74 3607.5 percent of total billed charges 4875 93 3948.75 percent of total billed charges 4875 4875 other OPPS APC 4875 4875 other OPPS APC 4875 27.63 1346.96 percent of total billed charges 4875 4875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - REVEAL LINQ RECORDER SUP-99-01906 CDM C1764 HCPCS 0278 RC outpatient 9290 9290 9290 57 5295.3 percent of total billed charges 9290 93 7524.9 percent of total billed charges 9290 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9290 other OPPS APC 9290 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9290 other OPPS APC 9290 51 4737.9 percent of total billed charges 9290 9290 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MINI TREK 2.0X6 SUP-99-01911 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATHERECTOMY - 1.25 PEDAL CROWN 145CM SUP-99-01912 CDM C1724 HCPCS 0272 RC outpatient 8487.5 8487.5 8487.5 74 6280.75 percent of total billed charges 8487.5 93 6874.88 percent of total billed charges 8487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8487.5 other OPPS APC 8487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8487.5 other OPPS APC 8487.5 27.63 2345.1 percent of total billed charges 8487.5 8487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 8.0X40 SUP-99-01914 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 2.0X80 SUP-99-01919 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATHERECTOMY - 1.25 CORONARY SUP-99-01921 CDM C1724 HCPCS 0272 RC outpatient 9987.5 9987.5 9987.5 74 7390.75 percent of total billed charges 9987.5 93 8089.88 percent of total billed charges 9987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9987.5 other OPPS APC 9987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9987.5 other OPPS APC 9987.5 27.63 2759.55 percent of total billed charges 9987.5 9987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATHERECTOMY - VIPERWIRE CORONARY SUP-99-01922 CDM C1769 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - USHER ANGLED (CROSSER) SUP-99-01924 CDM C1887 HCPCS 0272 RC outpatient 885 885 885 74 654.9 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 27.63 244.53 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - WALLSTENT 18X60 SUP-99-01931 CDM C1876 HCPCS 0278 RC outpatient 3312.5 3312.5 3312.5 57 1888.13 percent of total billed charges 3312.5 93 2683.13 percent of total billed charges 3312.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3312.5 other OPPS APC 3312.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3312.5 other OPPS APC 3312.5 51 1689.38 percent of total billed charges 3312.5 3312.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - WALLSTENT 20X55 SUP-99-01932 CDM C1876 HCPCS 0278 RC outpatient 2985 2985 2985 57 1701.45 percent of total billed charges 2985 93 2417.85 percent of total billed charges 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 51 1522.35 percent of total billed charges 2985 2985 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - WALLSTENT 22X45 SUP-99-01933 CDM C1876 HCPCS 0278 RC outpatient 2985 2985 2985 57 1701.45 percent of total billed charges 2985 93 2417.85 percent of total billed charges 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 51 1522.35 percent of total billed charges 2985 2985 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - WALLSTENT 24X45 SUP-99-01934 CDM C1876 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 11F SUP-99-01935 CDM C1894 HCPCS 0272 RC outpatient 76 76 76 74 56.24 percent of total billed charges 76 93 61.56 percent of total billed charges 76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 76 other OPPS APC 76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 76 other OPPS APC 76 27.63 21 percent of total billed charges 76 76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 10F SUP-99-01940 CDM C1894 HCPCS 0272 RC outpatient 40 40 40 74 29.6 percent of total billed charges 40 93 32.4 percent of total billed charges 40 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40 other OPPS APC 40 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 40 other OPPS APC 40 27.63 11.05 percent of total billed charges 40 40 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 4.0X40X150 SUP-99-01941 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 2.25X12 SUP-99-01942 CDM C1876 HCPCS 0278 RC outpatient 1995 1995 1995 57 1137.15 percent of total billed charges 1995 93 1615.95 percent of total billed charges 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 51 1017.45 percent of total billed charges 1995 1995 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE 3.0X40 SUP-99-01944 CDM C1725 HCPCS 0272 RC outpatient 2385 2385 2385 74 1764.9 percent of total billed charges 2385 93 1931.85 percent of total billed charges 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 27.63 658.98 percent of total billed charges 2385 2385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 4.5X12 SUP-99-01945 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 4.0X80 SUP-99-01950 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EPIC 7X40X120 SUP-99-01951 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 5.0X200 SUP-99-01952 CDM C1725 HCPCS 0272 RC outpatient 996 996 996 74 737.04 percent of total billed charges 996 93 806.76 percent of total billed charges 996 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 996 other OPPS APC 996 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 996 other OPPS APC 996 27.63 275.19 percent of total billed charges 996 996 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 5.0X150 SUP-99-01953 CDM C1725 HCPCS 0272 RC outpatient 795 795 795 74 588.3 percent of total billed charges 795 93 643.95 percent of total billed charges 795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 795 other OPPS APC 795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 795 other OPPS APC 795 27.63 219.66 percent of total billed charges 795 795 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FFR - VERRATA SUP-99-01955 CDM C1769 HCPCS 0272 RC outpatient 1980 1980 1980 74 1465.2 percent of total billed charges 1980 93 1603.8 percent of total billed charges 1980 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1980 other OPPS APC 1980 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1980 other OPPS APC 1980 27.63 547.07 percent of total billed charges 1980 1980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE 5.0X40 SUP-99-01956 CDM C1725 HCPCS 0272 RC outpatient 2385 2385 2385 74 1764.9 percent of total billed charges 2385 93 1931.85 percent of total billed charges 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 27.63 658.98 percent of total billed charges 2385 2385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - FLEXOR 55CM 6F RAABE SUP-99-01957 CDM C1894 HCPCS 0272 RC outpatient 182 182 182 74 134.68 percent of total billed charges 182 93 147.42 percent of total billed charges 182 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182 other OPPS APC 182 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182 other OPPS APC 182 27.63 50.29 percent of total billed charges 182 182 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 2.5X60X150 SUP-99-01958 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IVUS - VISIONS PV .035 SUP-99-01963 CDM C1753 HCPCS 0272 RC outpatient 2850 2850 2850 74 2109 percent of total billed charges 2850 93 2308.5 percent of total billed charges 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2850 other OPPS APC 2850 27.63 787.46 percent of total billed charges 2850 2850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 6.0X150 SUP-99-01964 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EPIC 8X80X120 SUP-99-01965 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE ES OTW 4.0X20X145 SUP-99-01966 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - TREK 2.75X12 SUP-99-01967 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 4.0X200 SUP-99-01968 CDM C1725 HCPCS 0272 RC outpatient 3687.5 3687.5 3687.5 74 2728.75 percent of total billed charges 3687.5 93 2986.88 percent of total billed charges 3687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3687.5 other OPPS APC 3687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3687.5 other OPPS APC 3687.5 27.63 1018.86 percent of total billed charges 3687.5 3687.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 5.0X200 SUP-99-01969 CDM C1725 HCPCS 0272 RC outpatient 3687.5 3687.5 3687.5 74 2728.75 percent of total billed charges 3687.5 93 2986.88 percent of total billed charges 3687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3687.5 other OPPS APC 3687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3687.5 other OPPS APC 3687.5 27.63 1018.86 percent of total billed charges 3687.5 3687.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 6.0X200 SUP-99-01970 CDM C1725 HCPCS 0272 RC outpatient 3687.5 3687.5 3687.5 74 2728.75 percent of total billed charges 3687.5 93 2986.88 percent of total billed charges 3687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3687.5 other OPPS APC 3687.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3687.5 other OPPS APC 3687.5 27.63 1018.86 percent of total billed charges 3687.5 3687.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 6X80X75 SUP-99-01972 CDM C1725 HCPCS 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATHERECTOMY - 1.25 MICRO CROWN 60CM SUP-99-01974 CDM C1724 HCPCS 0272 RC outpatient 8487.5 8487.5 8487.5 74 6280.75 percent of total billed charges 8487.5 93 6874.88 percent of total billed charges 8487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8487.5 other OPPS APC 8487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8487.5 other OPPS APC 8487.5 27.63 2345.1 percent of total billed charges 8487.5 8487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATHERECTOMY - 1.25 SOLID CROWN 60CM SUP-99-01975 CDM C1714 HCPCS 0272 RC outpatient 9487.5 9487.5 9487.5 74 7020.75 percent of total billed charges 9487.5 93 7684.88 percent of total billed charges 9487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9487.5 other OPPS APC 9487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9487.5 other OPPS APC 9487.5 27.63 2621.4 percent of total billed charges 9487.5 9487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - FIELDER XT - 300CM SUP-99-01978 CDM C1769 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 12X40X75 SUP-99-01979 CDM C1725 HCPCS 0272 RC outpatient 665 665 665 74 492.1 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 27.63 183.74 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - PEDAL MICROPUNCTURE 4F SUP-99-01981 CDM C1894 HCPCS 0272 RC outpatient 201.6 201.6 201.6 74 149.18 percent of total billed charges 201.6 93 163.3 percent of total billed charges 201.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 201.6 other OPPS APC 201.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 201.6 other OPPS APC 201.6 27.63 55.7 percent of total billed charges 201.6 201.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EXPRESS LD 8.0X27X135 SUP-99-01984 CDM C1876 HCPCS 0278 RC outpatient 3107.38 3107.38 3107.38 57 1771.21 percent of total billed charges 3107.38 93 2516.98 percent of total billed charges 3107.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3107.38 other OPPS APC 3107.38 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3107.38 other OPPS APC 3107.38 51 1584.76 percent of total billed charges 3107.38 3107.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 5.0X60 SUP-99-01985 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - TIGER 4.0 5FR 110CM SUP-99-01991 CDM 0272 RC outpatient 140 140 140 74 103.6 percent of total billed charges 140 93 113.4 percent of total billed charges 140 140 other OPPS APC 140 140 other OPPS APC 140 27.63 38.68 percent of total billed charges 140 140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - TIGER 4.5 6FR 110CM SUP-99-01992 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - TIGER 4.5 5FR 110CM SUP-99-01993 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - TIGER 4.0 6FR 110CM SUP-99-01994 CDM 0272 RC outpatient 140 140 140 74 103.6 percent of total billed charges 140 93 113.4 percent of total billed charges 140 140 other OPPS APC 140 140 other OPPS APC 140 27.63 38.68 percent of total billed charges 140 140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 6.0X200X150 SUP-99-01995 CDM C1725 HCPCS 0272 RC outpatient 993 993 993 74 734.82 percent of total billed charges 993 93 804.33 percent of total billed charges 993 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 993 other OPPS APC 993 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 993 other OPPS APC 993 27.63 274.37 percent of total billed charges 993 993 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SUPERA 5.5X80 SUP-99-02000 CDM C1876 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 7.0X60 SUP-99-02001 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - WALLSTENT 20X80 SUP-99-02004 CDM C1876 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - WALLSTENT 22X70 SUP-99-02005 CDM C1876 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - WALLSTENT 24X70 SUP-99-02006 CDM C1876 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JL3.5 (MEDTRONIC) SUP-99-02007 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SUPERA 5.5X150 SUP-99-02009 CDM C1876 HCPCS 0278 RC outpatient 4237.5 4237.5 4237.5 57 2415.38 percent of total billed charges 4237.5 93 3432.38 percent of total billed charges 4237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4237.5 other OPPS APC 4237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4237.5 other OPPS APC 4237.5 51 2161.13 percent of total billed charges 4237.5 4237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 018 3.0X80X130 SUP-99-02010 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - AMPHIRION 3.5/4.0X210 SUP-99-02012 CDM C1725 HCPCS 0272 RC outpatient 1035 1035 1035 74 765.9 percent of total billed charges 1035 93 838.35 percent of total billed charges 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 27.63 285.97 percent of total billed charges 1035 1035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - AMPHIRION 2.0X120 SUP-99-02013 CDM C1725 HCPCS 0272 RC outpatient 930 930 930 74 688.2 percent of total billed charges 930 93 753.3 percent of total billed charges 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 27.63 256.96 percent of total billed charges 930 930 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - AMPHIRION 4.0X80 SUP-99-02014 CDM C1725 HCPCS 0272 RC outpatient 930 930 930 74 688.2 percent of total billed charges 930 93 753.3 percent of total billed charges 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 27.63 256.96 percent of total billed charges 930 930 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EPIC 12X40X75 SUP-99-02016 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - AMPHIRION 4.0X40 SUP-99-02017 CDM C1725 HCPCS 0272 RC outpatient 930 930 930 74 688.2 percent of total billed charges 930 93 753.3 percent of total billed charges 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 27.63 256.96 percent of total billed charges 930 930 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 8.0X40 SUP-99-02018 CDM C1725 HCPCS 0272 RC outpatient 465.5 465.5 465.5 74 344.47 percent of total billed charges 465.5 93 377.06 percent of total billed charges 465.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 465.5 other OPPS APC 465.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 465.5 other OPPS APC 465.5 27.63 128.62 percent of total billed charges 465.5 465.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PACIFIC PLUS 6X80 SUP-99-02019 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PACIFIC PLUS 6X120 SUP-99-02020 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PACIFIC PLUS 6X40 SUP-99-02021 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PACIFIC PLUS 5X120 SUP-99-02022 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ASSURANT COBALT 9X30 SUP-99-02023 CDM C1876 HCPCS 0278 RC outpatient 2595 2595 2595 57 1479.15 percent of total billed charges 2595 93 2101.95 percent of total billed charges 2595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2595 other OPPS APC 2595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2595 other OPPS APC 2595 51 1323.45 percent of total billed charges 2595 2595 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 6.0X200 SUP-99-02024 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SUPERA 4.5X120 SUP-99-02028 CDM C1876 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SUPERA 5.5X120 SUP-99-02029 CDM C1876 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SUPERA 6.5X120 SUP-99-02030 CDM C1876 HCPCS 0278 RC outpatient 4237.5 4237.5 4237.5 57 2415.38 percent of total billed charges 4237.5 93 3432.38 percent of total billed charges 4237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4237.5 other OPPS APC 4237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4237.5 other OPPS APC 4237.5 51 2161.13 percent of total billed charges 4237.5 4237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SUPERA 6.5X150 SUP-99-02031 CDM C1876 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 6.0X120 SUP-99-02033 CDM C1725 HCPCS 0272 RC outpatient 795 795 795 74 588.3 percent of total billed charges 795 93 643.95 percent of total billed charges 795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 795 other OPPS APC 795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 795 other OPPS APC 795 27.63 219.66 percent of total billed charges 795 795 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PERIPHERAL CUTTING 7.0X20X90 SUP-99-02034 CDM C1725 HCPCS 0272 RC outpatient 2325 2325 2325 74 1720.5 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 27.63 642.4 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PERIPHERAL CUTTING 8.0X20X90 SUP-99-02035 CDM C1725 HCPCS 0272 RC outpatient 2325 2325 2325 74 1720.5 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 27.63 642.4 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PERIPHERAL CUTTING 5.0X20X135 SUP-99-02036 CDM C1725 HCPCS 0272 RC outpatient 2250 2250 2250 74 1665 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 27.63 621.68 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PERIPHERAL CUTTING 6.0X20X135 SUP-99-02037 CDM C1725 HCPCS 0272 RC outpatient 2250 2250 2250 74 1665 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 27.63 621.68 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PERIPHERAL CUTTING 3.0X15X140 SUP-99-02038 CDM C1725 HCPCS 0272 RC outpatient 2325 2325 2325 74 1720.5 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 27.63 642.4 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PERIPHERAL CUTTING 4.0X15X140 SUP-99-02039 CDM C1725 HCPCS 0272 RC outpatient 2325 2325 2325 74 1720.5 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 27.63 642.4 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 2.0X80X150 SUP-99-02041 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 2.0X40 SUP-99-02042 CDM C1725 HCPCS 0272 RC outpatient 2925 2925 2925 74 2164.5 percent of total billed charges 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 27.63 808.18 percent of total billed charges 2925 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ASSURANT COBALT 7X40 SUP-99-02043 CDM C1876 HCPCS 0278 RC outpatient 2985 2985 2985 57 1701.45 percent of total billed charges 2985 93 2417.85 percent of total billed charges 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 51 1522.35 percent of total billed charges 2985 2985 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ASSURANT COBALT 7X60 SUP-99-02044 CDM C1876 HCPCS 0278 RC outpatient 2595 2595 2595 57 1479.15 percent of total billed charges 2595 93 2101.95 percent of total billed charges 2595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2595 other OPPS APC 2595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2595 other OPPS APC 2595 51 1323.45 percent of total billed charges 2595 2595 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 7.0X40 SUP-99-02045 CDM C1725 HCPCS 0272 RC outpatient 465.5 465.5 465.5 74 344.47 percent of total billed charges 465.5 93 377.06 percent of total billed charges 465.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 465.5 other OPPS APC 465.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 465.5 other OPPS APC 465.5 27.63 128.62 percent of total billed charges 465.5 465.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - AMPHIRION 3.0X150 SUP-99-02046 CDM C1725 HCPCS 0272 RC outpatient 1035 1035 1035 74 765.9 percent of total billed charges 1035 93 838.35 percent of total billed charges 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 27.63 285.97 percent of total billed charges 1035 1035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - AMPHIRION 4.0X120 SUP-99-02047 CDM C1725 HCPCS 0272 RC outpatient 930 930 930 74 688.2 percent of total billed charges 930 93 753.3 percent of total billed charges 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 27.63 256.96 percent of total billed charges 930 930 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - AMPHIRION 3.0X80 SUP-99-02048 CDM C1725 HCPCS 0272 RC outpatient 930 930 930 74 688.2 percent of total billed charges 930 93 753.3 percent of total billed charges 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 27.63 256.96 percent of total billed charges 930 930 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - AMPHIRION 2.0/2.5X210 SUP-99-02049 CDM C1725 HCPCS 0272 RC outpatient 1035 1035 1035 74 765.9 percent of total billed charges 1035 93 838.35 percent of total billed charges 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 27.63 285.97 percent of total billed charges 1035 1035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - WALLSTENT 18X90 SUP-99-02050 CDM C1876 HCPCS 0278 RC outpatient 3375 3375 3375 57 1923.75 percent of total billed charges 3375 93 2733.75 percent of total billed charges 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 51 1721.25 percent of total billed charges 3375 3375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE RX 2.0X10 SUP-99-02051 CDM C1725 HCPCS 0272 RC outpatient 2250 2250 2250 74 1665 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 27.63 621.68 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE RX 2.5X10 SUP-99-02052 CDM C1725 HCPCS 0272 RC outpatient 2250 2250 2250 74 1665 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 27.63 621.68 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE RX 3.0X20 SUP-99-02053 CDM C1725 HCPCS 0272 RC outpatient 2250 2250 2250 74 1665 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 27.63 621.68 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - FIELDER XT - 190CM SUP-99-02054 CDM C1769 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 7.0X60X135 SUP-99-02055 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 5.0X120 SUP-99-02056 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MINI VISION 2.5X8 SUP-99-02057 CDM C1876 HCPCS 0278 RC outpatient 2475 2475 2475 57 1410.75 percent of total billed charges 2475 93 2004.75 percent of total billed charges 2475 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2475 other OPPS APC 2475 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2475 other OPPS APC 2475 51 1262.25 percent of total billed charges 2475 2475 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 6.0X120 SUP-99-02058 CDM C1725 HCPCS 0272 RC outpatient 465.5 465.5 465.5 74 344.47 percent of total billed charges 465.5 93 377.06 percent of total billed charges 465.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 465.5 other OPPS APC 465.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 465.5 other OPPS APC 465.5 27.63 128.62 percent of total billed charges 465.5 465.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EXPRESS SD 5.0X19 SUP-99-02059 CDM C1876 HCPCS 0278 RC outpatient 3313.13 3313.13 3313.13 57 1888.48 percent of total billed charges 3313.13 93 2683.64 percent of total billed charges 3313.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3313.13 other OPPS APC 3313.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3313.13 other OPPS APC 3313.13 51 1689.7 percent of total billed charges 3313.13 3313.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 4.0X80X150 SUP-99-02060 CDM C1725 HCPCS 0272 RC outpatient 930 930 930 74 688.2 percent of total billed charges 930 93 753.3 percent of total billed charges 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 930 other OPPS APC 930 27.63 256.96 percent of total billed charges 930 930 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - GLIDER RX 1.5X12 SUP-99-02061 CDM C1725 HCPCS 0272 RC outpatient 1050 1050 1050 74 777 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 27.63 290.12 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - GLIDER RX 1.5X8 SUP-99-02062 CDM C1725 HCPCS 0272 RC outpatient 945 945 945 74 699.3 percent of total billed charges 945 93 765.45 percent of total billed charges 945 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 945 other OPPS APC 945 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 945 other OPPS APC 945 27.63 261.1 percent of total billed charges 945 945 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - GLIDER RX 2.0X8 SUP-99-02063 CDM C1725 HCPCS 0272 RC outpatient 885 885 885 74 654.9 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 27.63 244.53 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - GLIDER RX 2.5X8 SUP-99-02064 CDM C1725 HCPCS 0272 RC outpatient 1050 1050 1050 74 777 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 27.63 290.12 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - GLIDER RX 2.0X12 SUP-99-02065 CDM C1725 HCPCS 0272 RC outpatient 1050 1050 1050 74 777 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 27.63 290.12 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PACIFIC EXTREME 5X200 SUP-99-02066 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CLEARWAY RX 5.0X50 SUP-99-02068 CDM C1725 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE 4.0X120 SUP-99-02069 CDM C1725 HCPCS 0272 RC outpatient 2385 2385 2385 74 1764.9 percent of total billed charges 2385 93 1931.85 percent of total billed charges 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2385 other OPPS APC 2385 27.63 658.98 percent of total billed charges 2385 2385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PACIFIC EXTREME 5X250 SUP-99-02072 CDM C1725 HCPCS 0272 RC outpatient 900 900 900 74 666 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 27.63 248.67 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 3.5X26 SUP-99-02074 CDM C1876 HCPCS 0278 RC outpatient 1995 1995 1995 57 1137.15 percent of total billed charges 1995 93 1615.95 percent of total billed charges 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 51 1017.45 percent of total billed charges 1995 1995 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - AMPHIRION 2.0X80 SUP-99-02075 CDM C1725 HCPCS 0272 RC outpatient 1035 1035 1035 74 765.9 percent of total billed charges 1035 93 838.35 percent of total billed charges 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 27.63 285.97 percent of total billed charges 1035 1035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 5.0X40 SUP-99-02076 CDM C1725 HCPCS 0272 RC outpatient 465.5 465.5 465.5 74 344.47 percent of total billed charges 465.5 93 377.06 percent of total billed charges 465.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 465.5 other OPPS APC 465.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 465.5 other OPPS APC 465.5 27.63 128.62 percent of total billed charges 465.5 465.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 6.0X300 SUP-99-02079 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - MODIFIED HOOK SUP-99-02080 CDM 0272 RC outpatient 368.9 368.9 368.9 74 272.99 percent of total billed charges 368.9 93 298.81 percent of total billed charges 368.9 368.9 other OPPS APC 368.9 368.9 other OPPS APC 368.9 27.63 101.93 percent of total billed charges 368.9 368.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.0X15 SUP-99-02081 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ASSURANT COBALT 8X40 SUP-99-02088 CDM C1876 HCPCS 0278 RC outpatient 2985 2985 2985 57 1701.45 percent of total billed charges 2985 93 2417.85 percent of total billed charges 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 51 1522.35 percent of total billed charges 2985 2985 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PACIFIC PLUS 6X60 SUP-99-02089 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PACIFIC PLUS 7X40 SUP-99-02090 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.25X12 SUP-99-02091 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.0X27 SUP-99-02092 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTABLATOR - ROTAGLIDE LUBRICANT 20ML SUP-99-02093 CDM C1724 HCPCS 0272 RC outpatient 310.92 310.92 310.92 74 230.08 percent of total billed charges 310.92 93 251.85 percent of total billed charges 310.92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 310.92 other OPPS APC 310.92 310.92 other OPPS APC 310.92 27.63 85.91 percent of total billed charges 310.92 310.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 5X80X75 SUP-99-02094 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - AMPHIRION 3.0X120 SUP-99-02095 CDM C1725 HCPCS 0272 RC outpatient 930 930 930 74 688.2 percent of total billed charges 930 93 753.3 percent of total billed charges 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 27.63 256.96 percent of total billed charges 930 930 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER - FEMORAL DELIVERY SHEATH SUP-99-02096 CDM 0272 RC outpatient 287 287 287 74 212.38 percent of total billed charges 287 93 232.47 percent of total billed charges 287 287 other OPPS APC 287 287 other OPPS APC 287 27.63 79.3 percent of total billed charges 287 287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING RX 6.0X20 SUP-99-02097 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 2.5X80X150 SUP-99-02098 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 5X60 SUP-99-02100 CDM C2623 HCPCS 0272 RC outpatient 4125 4125 4125 74 3052.5 percent of total billed charges 4125 93 3341.25 percent of total billed charges 4125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4125 other OPPS APC 4125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4125 other OPPS APC 4125 27.63 1139.74 percent of total billed charges 4125 4125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 5X80 SUP-99-02101 CDM C2623 HCPCS 0272 RC outpatient 4125 4125 4125 74 3052.5 percent of total billed charges 4125 93 3341.25 percent of total billed charges 4125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4125 other OPPS APC 4125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4125 other OPPS APC 4125 27.63 1139.74 percent of total billed charges 4125 4125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 5X100 SUP-99-02102 CDM C2623 HCPCS 0272 RC outpatient 3875 3875 3875 74 2867.5 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 27.63 1070.66 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 6X80 SUP-99-02103 CDM C2623 HCPCS 0272 RC outpatient 3875 3875 3875 74 2867.5 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 27.63 1070.66 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 6X60 SUP-99-02104 CDM C2623 HCPCS 0272 RC outpatient 4125 4125 4125 74 3052.5 percent of total billed charges 4125 93 3341.25 percent of total billed charges 4125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4125 other OPPS APC 4125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4125 other OPPS APC 4125 27.63 1139.74 percent of total billed charges 4125 4125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 6X100 SUP-99-02105 CDM C2623 HCPCS 0272 RC outpatient 3250 3250 3250 74 2405 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 27.63 897.98 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PACIFIC EXTREME 6X250 SUP-99-02108 CDM C1725 HCPCS 0272 RC outpatient 900 900 900 74 666 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 27.63 248.67 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 6.0X150 SUP-99-02109 CDM C1725 HCPCS 0272 RC outpatient 465.5 465.5 465.5 74 344.47 percent of total billed charges 465.5 93 377.06 percent of total billed charges 465.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 465.5 other OPPS APC 465.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 465.5 other OPPS APC 465.5 27.63 128.62 percent of total billed charges 465.5 465.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JL4 (CORDIS) SUP-99-02110 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTABLATOR - PERI 1.5MM ROTALINK PLUS SUP-99-02111 CDM C1724 HCPCS 0272 RC outpatient 2994.93 2994.93 2994.93 74 2216.25 percent of total billed charges 2994.93 93 2425.89 percent of total billed charges 2994.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2994.93 other OPPS APC 2994.93 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2994.93 other OPPS APC 2994.93 27.63 827.5 percent of total billed charges 2994.93 2994.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTABLATOR - 2.00MM ROTAPRO BURR SUP-99-02112 CDM C1724 HCPCS 0272 RC outpatient 4812.5 4812.5 4812.5 74 3561.25 percent of total billed charges 4812.5 93 3898.13 percent of total billed charges 4812.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4812.5 other OPPS APC 4812.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4812.5 other OPPS APC 4812.5 27.63 1329.69 percent of total billed charges 4812.5 4812.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTABLATOR - 2.50MM ROTAPRO BURR SUP-99-02113 CDM C1724 HCPCS 0272 RC outpatient 4812.5 4812.5 4812.5 74 3561.25 percent of total billed charges 4812.5 93 3898.13 percent of total billed charges 4812.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4812.5 other OPPS APC 4812.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4812.5 other OPPS APC 4812.5 27.63 1329.69 percent of total billed charges 4812.5 4812.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - ROTAWIRE - PERIPHERAL SUP-99-02114 CDM C1769 HCPCS 0272 RC outpatient 446.74 446.74 446.74 74 330.59 percent of total billed charges 446.74 93 361.86 percent of total billed charges 446.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 446.74 other OPPS APC 446.74 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 446.74 other OPPS APC 446.74 27.63 123.43 percent of total billed charges 446.74 446.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SUPERA 6.5X100 SUP-99-02117 CDM C1876 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ASSURANT COBALT 10X60 SUP-99-02121 CDM C1876 HCPCS 0278 RC outpatient 2985 2985 2985 57 1701.45 percent of total billed charges 2985 93 2417.85 percent of total billed charges 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 51 1522.35 percent of total billed charges 2985 2985 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 6.0X250 SUP-99-02122 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTRAST - ISOVUE 300 150CC SUP-99-02123 CDM Q9967 CPT 0255 RC outpatient 66.64 66.64 0.15 0.15 fee schedule 66.64 93 53.98 percent of total billed charges 66.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 66.64 other OPPS APC 66.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 66.64 other OPPS APC 66.64 24.86 16.57 percent of total billed charges 0.15 66.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTRAST - ISOVUE 300 200CC SUP-99-02124 CDM Q9967 CPT 0255 RC outpatient 66.64 66.64 0.15 0.15 fee schedule 66.64 93 53.98 percent of total billed charges 66.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 66.64 other OPPS APC 66.64 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 66.64 other OPPS APC 66.64 24.86 16.57 percent of total billed charges 0.15 66.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - AMPHIRION 3.0X40 SUP-99-02126 CDM C1725 HCPCS 0272 RC outpatient 930 930 930 74 688.2 percent of total billed charges 930 93 753.3 percent of total billed charges 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 27.63 256.96 percent of total billed charges 930 930 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 5X80X40 SUP-99-02131 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JETSTREAM 2.4/3.4 SUP-99-02135 CDM C1714 HCPCS 0272 RC outpatient 8000 8000 8000 74 5920 percent of total billed charges 8000 93 6480 percent of total billed charges 8000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8000 other OPPS APC 8000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8000 other OPPS APC 8000 27.63 2210.4 percent of total billed charges 8000 8000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 3.5X15 SUP-99-02136 CDM C1876 HCPCS 0278 RC outpatient 1995 1995 1995 57 1137.15 percent of total billed charges 1995 93 1615.95 percent of total billed charges 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 51 1017.45 percent of total billed charges 1995 1995 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PACIFIC EXTREME 6X300 SUP-99-02145 CDM C1725 HCPCS 0272 RC outpatient 900 900 900 74 666 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 27.63 248.67 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SUPERA 5.5X100 SUP-99-02146 CDM C1876 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.75X15 SUP-99-02150 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER - DENALI FEMORAL SUP-99-02151 CDM C1880 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER - DENALI JUGULAR SUP-99-02152 CDM C1880 HCPCS 0278 RC outpatient 3500 3500 3500 57 1995 percent of total billed charges 3500 93 2835 percent of total billed charges 3500 3500 other OPPS APC 3500 3500 other OPPS APC 3500 51 1785 percent of total billed charges 3500 3500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 7.0 X 100 X 135 SUP-99-02153 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.5X15 SUP-99-02154 CDM C1725 HCPCS 0272 RC outpatient 665 665 665 74 492.1 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 27.63 183.74 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PACIFIC PLUS 5X80 SUP-99-02155 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - THRU WAY .014 X 300CM S.T. SUP-99-02156 CDM C1769 HCPCS 0272 RC outpatient 339.71 339.71 339.71 74 251.39 percent of total billed charges 339.71 93 275.17 percent of total billed charges 339.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 339.71 other OPPS APC 339.71 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 339.71 other OPPS APC 339.71 27.63 93.86 percent of total billed charges 339.71 339.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - THROMBECTOMY DISTA SUP-99-02157 CDM C1757 HCPCS 0272 RC outpatient 4887.5 4887.5 4887.5 74 3616.75 percent of total billed charges 4887.5 93 3958.88 percent of total billed charges 4887.5 4887.5 other OPPS APC 4887.5 4887.5 other OPPS APC 4887.5 27.63 1350.42 percent of total billed charges 4887.5 4887.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PACIFIC PLUS 5X60 SUP-99-02158 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ADMIRAL 7.0X150 SUP-99-02161 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ASSURANT COBALT 9X40 SUP-99-02163 CDM C1876 HCPCS 0278 RC outpatient 2595 2595 2595 57 1479.15 percent of total billed charges 2595 93 2101.95 percent of total billed charges 2595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2595 other OPPS APC 2595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2595 other OPPS APC 2595 51 1323.45 percent of total billed charges 2595 2595 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PACIFIC PLUS 5X40 SUP-99-02164 CDM C1725 HCPCS 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON PUMP - CATHETER 40CC NARROWFLEX SUP-99-02165 CDM 0272 RC outpatient 1875 1875 1875 74 1387.5 percent of total billed charges 1875 93 1518.75 percent of total billed charges 1875 1875 other OPPS APC 1875 1875 other OPPS APC 1875 27.63 518.06 percent of total billed charges 1875 1875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - COVERED - VIABAHN 7 X 50 SUP-99-02166 CDM C1874 HCPCS 0278 RC outpatient 7987.5 7987.5 7987.5 57 4552.88 percent of total billed charges 7987.5 93 6469.88 percent of total billed charges 7987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7987.5 other OPPS APC 7987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7987.5 other OPPS APC 7987.5 51 4073.63 percent of total billed charges 7987.5 7987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 5F CLS4 (BS) SUP-99-02171 CDM C1887 HCPCS 0272 RC outpatient 192.5 192.5 192.5 74 142.45 percent of total billed charges 192.5 93 155.93 percent of total billed charges 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SUPERA 4.5X80 SUP-99-02172 CDM C1876 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING SL OTW 3.0X80 SUP-99-02174 CDM C1725 HCPCS 0272 RC outpatient 795 795 795 74 588.3 percent of total billed charges 795 93 643.95 percent of total billed charges 795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 795 other OPPS APC 795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 795 other OPPS APC 795 27.63 219.66 percent of total billed charges 795 795 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 7X40X135 SUP-99-02176 CDM C1725 HCPCS 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.25X20 SUP-99-02178 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCT - DRAGONFLY OPTIS KITS SUP-99-02179 CDM C1753 HCPCS 0272 RC outpatient 2550 2550 2550 74 1887 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 27.63 704.57 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 4.5X15 SUP-99-02180 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EPIC 9X40X75 SUP-99-02181 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MINI TREK II 2.0X12 OTW SUP-99-02183 CDM C1725 HCPCS 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON-MINI TREK II 2.0 X 8 OTW SUP-99-02184 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 5F HYDROPHYPHILIC SUP-99-02185 CDM C1894 HCPCS 0272 RC outpatient 156.56 156.56 156.56 74 115.85 percent of total billed charges 156.56 93 126.81 percent of total billed charges 156.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 156.56 other OPPS APC 156.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 156.56 other OPPS APC 156.56 27.63 43.26 percent of total billed charges 156.56 156.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 6F HYDROPHYPHILIC SUP-99-02186 CDM C1894 HCPCS 0272 RC outpatient 152 152 152 74 112.48 percent of total billed charges 152 93 123.12 percent of total billed charges 152 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152 other OPPS APC 152 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152 other OPPS APC 152 27.63 42 percent of total billed charges 152 152 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SUPERA 4.5X60 SUP-99-02187 CDM C1876 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - IN.PACT ADMIRAL 7X40 SUP-99-02188 CDM C2623 HCPCS 0272 RC outpatient 3725 3725 3725 74 2756.5 percent of total billed charges 3725 93 3017.25 percent of total billed charges 3725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3725 other OPPS APC 3725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3725 other OPPS APC 3725 27.63 1029.22 percent of total billed charges 3725 3725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - IN.PACT ADMIRAL 7X60 SUP-99-02189 CDM C2623 HCPCS 0272 RC outpatient 3725 3725 3725 74 2756.5 percent of total billed charges 3725 93 3017.25 percent of total billed charges 3725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3725 other OPPS APC 3725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3725 other OPPS APC 3725 27.63 1029.22 percent of total billed charges 3725 3725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - IN.PACT ADMIRAL 7X80 SUP-99-02190 CDM C2623 HCPCS 0272 RC outpatient 3725 3725 3725 74 2756.5 percent of total billed charges 3725 93 3017.25 percent of total billed charges 3725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3725 other OPPS APC 3725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3725 other OPPS APC 3725 27.63 1029.22 percent of total billed charges 3725 3725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - IN.PACT ADMIRAL 4X120 SUP-99-02191 CDM C2623 HCPCS 0272 RC outpatient 4100 4100 4100 74 3034 percent of total billed charges 4100 93 3321 percent of total billed charges 4100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4100 other OPPS APC 4100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4100 other OPPS APC 4100 27.63 1132.83 percent of total billed charges 4100 4100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - IN.PACT ADMIRAL 5X120 SUP-99-02192 CDM C2623 HCPCS 0272 RC outpatient 4100 4100 4100 74 3034 percent of total billed charges 4100 93 3321 percent of total billed charges 4100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4100 other OPPS APC 4100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4100 other OPPS APC 4100 27.63 1132.83 percent of total billed charges 4100 4100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - IN.PACT ADMIRAL 6X120 SUP-99-02193 CDM C2623 HCPCS 0272 RC outpatient 4100 4100 4100 74 3034 percent of total billed charges 4100 93 3321 percent of total billed charges 4100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4100 other OPPS APC 4100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4100 other OPPS APC 4100 27.63 1132.83 percent of total billed charges 4100 4100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 3.0X60X150 SUP-99-02194 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ASSURANT COBALT 7X30 SUP-99-02195 CDM C1876 HCPCS 0278 RC outpatient 2595 2595 2595 57 1479.15 percent of total billed charges 2595 93 2101.95 percent of total billed charges 2595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2595 other OPPS APC 2595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2595 other OPPS APC 2595 51 1323.45 percent of total billed charges 2595 2595 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 4.0X60X150 SUP-99-02196 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 4 X 60 X 135 SUP-99-02197 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTABLATOR - 1.75MM ROTAPRO BURR SUP-99-02198 CDM C1724 HCPCS 0272 RC outpatient 4812.5 4812.5 4812.5 74 3561.25 percent of total billed charges 4812.5 93 3898.13 percent of total billed charges 4812.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4812.5 other OPPS APC 4812.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4812.5 other OPPS APC 4812.5 27.63 1329.69 percent of total billed charges 4812.5 4812.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SUPERA 4.5X100 SUP-99-02200 CDM C1876 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SUPERA 4.5X40 SUP-99-02202 CDM C1876 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GLIDEWIRE ADVANTAGE .014X300 ANGLED SUP-99-02204 CDM C1769 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GLIDEWIRE .014X180 ANGLED SUP-99-02205 CDM C1769 HCPCS 0272 RC outpatient 844.77 844.77 844.77 74 625.13 percent of total billed charges 844.77 93 684.26 percent of total billed charges 844.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 844.77 other OPPS APC 844.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 844.77 other OPPS APC 844.77 27.63 233.41 percent of total billed charges 844.77 844.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 4F PEDAL ACCESS KIT SUP-99-02206 CDM C1894 HCPCS 0272 RC outpatient 227.5 227.5 227.5 74 168.35 percent of total billed charges 227.5 93 184.28 percent of total billed charges 227.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 227.5 other OPPS APC 227.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 227.5 other OPPS APC 227.5 27.63 62.86 percent of total billed charges 227.5 227.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 5.0X20 SUP-99-02207 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.5X8 SUP-99-02208 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.75X20 SUP-99-02209 CDM C1725 HCPCS 0272 RC outpatient 665 665 665 74 492.1 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 27.63 183.74 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 4.0X15 SUP-99-02210 CDM C1725 HCPCS 0272 RC outpatient 665 665 665 74 492.1 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 27.63 183.74 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GLIDEWIRE ADVANTAGE .035X260 ANGLED SUP-99-02211 CDM C1769 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GLIDEWIRE ADVANTAGE .035X180 ANGLED SUP-99-02212 CDM C1769 HCPCS 0272 RC outpatient 560 560 560 74 414.4 percent of total billed charges 560 93 453.6 percent of total billed charges 560 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 560 other OPPS APC 560 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 560 other OPPS APC 560 27.63 154.73 percent of total billed charges 560 560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 2.0X12 SUP-99-02214 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SUPERA 5.5X60 SUP-99-02217 CDM C1876 HCPCS 0278 RC outpatient 4237.5 4237.5 4237.5 57 2415.38 percent of total billed charges 4237.5 93 3432.38 percent of total billed charges 4237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4237.5 other OPPS APC 4237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4237.5 other OPPS APC 4237.5 51 2161.13 percent of total billed charges 4237.5 4237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ASSURANT COBALT 8X30 SUP-99-02218 CDM C1876 HCPCS 0278 RC outpatient 2595 2595 2595 57 1479.15 percent of total billed charges 2595 93 2101.95 percent of total billed charges 2595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2595 other OPPS APC 2595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2595 other OPPS APC 2595 51 1323.45 percent of total billed charges 2595 2595 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - THROMBECTOMY AVX SUP-99-02219 CDM C1757 HCPCS 0272 RC outpatient 2010 2010 2010 74 1487.4 percent of total billed charges 2010 93 1628.1 percent of total billed charges 2010 2010 other OPPS APC 2010 2010 other OPPS APC 2010 27.63 555.36 percent of total billed charges 2010 2010 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 2.5 X 12 SUP-99-02221 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 3.0X12 SUP-99-02222 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SABER 6.0X100 SUP-99-02223 CDM C1725 HCPCS 0272 RC outpatient 885 885 885 74 654.9 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 27.63 244.53 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SABER 7.0X80 SUP-99-02225 CDM C1725 HCPCS 0272 RC outpatient 885 885 885 74 654.9 percent of total billed charges 885 93 716.85 percent of total billed charges 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 885 other OPPS APC 885 27.63 244.53 percent of total billed charges 885 885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PACIFIC EXTREME 5X300 SUP-99-02226 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 7.0X40 SUP-99-02227 CDM C1725 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ANGIOSCULPT 8.0X40 SUP-99-02228 CDM C1725 HCPCS 0272 RC outpatient 3487.5 3487.5 3487.5 74 2580.75 percent of total billed charges 3487.5 93 2824.88 percent of total billed charges 3487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3487.5 other OPPS APC 3487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3487.5 other OPPS APC 3487.5 27.63 963.6 percent of total billed charges 3487.5 3487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 1.5X40150 SUP-99-02230 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.0X20 SUP-99-02236 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.25X27 SUP-99-02237 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - SWAN GANZ MONITORING 5F SUP-99-02238 CDM 0272 RC outpatient 450.63 450.63 450.63 74 333.47 percent of total billed charges 450.63 93 365.01 percent of total billed charges 450.63 450.63 other OPPS APC 450.63 450.63 other OPPS APC 450.63 27.63 124.51 percent of total billed charges 450.63 450.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 4.0X40 SUP-99-02239 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 2.75X20 SUP-99-02241 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 2.5 X 10 SUP-99-02242 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - MEMORY BASKET SUP-99-02256 CDM C1773 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - MINI BASKET SUP-99-02257 CDM C1773 HCPCS 0272 RC outpatient 647.5 647.5 647.5 74 479.15 percent of total billed charges 647.5 93 524.48 percent of total billed charges 647.5 647.5 other OPPS APC 647.5 647.5 other OPPS APC 647.5 27.63 178.9 percent of total billed charges 647.5 647.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAINAGE CATHETER - 8F BILIARY CTSUP SUP-99-02258 CDM C1729 HCPCS 0272 RC outpatient 272.69 272.69 272.69 74 201.79 percent of total billed charges 272.69 93 220.88 percent of total billed charges 272.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 272.69 other OPPS APC 272.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 272.69 other OPPS APC 272.69 27.63 75.34 percent of total billed charges 272.69 272.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAINAGE CATHETER - 12F BILIARY CTSUP SUP-99-02259 CDM C1729 HCPCS 0272 RC outpatient 272.69 272.69 272.69 74 201.79 percent of total billed charges 272.69 93 220.88 percent of total billed charges 272.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 272.69 other OPPS APC 272.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 272.69 other OPPS APC 272.69 27.63 75.34 percent of total billed charges 272.69 272.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAINAGE CATHETER - 14F BILIARY CTSUP SUP-99-02260 CDM C1729 HCPCS 0272 RC outpatient 272.69 272.69 272.69 74 201.79 percent of total billed charges 272.69 93 220.88 percent of total billed charges 272.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 272.69 other OPPS APC 272.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 272.69 other OPPS APC 272.69 27.63 75.34 percent of total billed charges 272.69 272.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JL 5.0 5F SUP-99-02261 CDM 0272 RC outpatient 30.68 30.68 30.68 74 22.7 percent of total billed charges 30.68 93 24.85 percent of total billed charges 30.68 30.68 other OPPS APC 30.68 30.68 other OPPS APC 30.68 27.63 8.48 percent of total billed charges 30.68 30.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - V-18 SUP-99-02262 CDM C1769 HCPCS 0272 RC outpatient 276.5 276.5 276.5 74 204.61 percent of total billed charges 276.5 93 223.97 percent of total billed charges 276.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 276.5 other OPPS APC 276.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 276.5 other OPPS APC 276.5 27.63 76.4 percent of total billed charges 276.5 276.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EPIC 10X60X75 SUP-99-02263 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SUPERA 6.5X60 SUP-99-02264 CDM C1876 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ULTRA 4.5X38 SUP-99-02270 CDM C1876 HCPCS 0278 RC outpatient 2325 2325 2325 57 1325.25 percent of total billed charges 2325 93 1883.25 percent of total billed charges 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2325 other OPPS APC 2325 51 1185.75 percent of total billed charges 2325 2325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MISAGO - 7 X 120 SUP-99-02273 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SUPERA 6.5X40 SUP-99-02274 CDM C1876 HCPCS 0278 RC outpatient 4237.5 4237.5 4237.5 57 2415.38 percent of total billed charges 4237.5 93 3432.38 percent of total billed charges 4237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4237.5 other OPPS APC 4237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4237.5 other OPPS APC 4237.5 51 2161.13 percent of total billed charges 4237.5 4237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SUPERA 6.5X30 SUP-99-02275 CDM C1876 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 4X120 SUP-99-02276 CDM C2623 HCPCS 0272 RC outpatient 3250 3250 3250 74 2405 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 27.63 897.98 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 4X150 SUP-99-02277 CDM C2623 HCPCS 0272 RC outpatient 4000 4000 4000 74 2960 percent of total billed charges 4000 93 3240 percent of total billed charges 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4000 other OPPS APC 4000 27.63 1105.2 percent of total billed charges 4000 4000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 5X120 SUP-99-02278 CDM C2623 HCPCS 0272 RC outpatient 3250 3250 3250 74 2405 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 27.63 897.98 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 5X150 SUP-99-02279 CDM C2623 HCPCS 0272 RC outpatient 3937.5 3937.5 3937.5 74 2913.75 percent of total billed charges 3937.5 93 3189.38 percent of total billed charges 3937.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3937.5 other OPPS APC 3937.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3937.5 other OPPS APC 3937.5 27.63 1087.93 percent of total billed charges 3937.5 3937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 6X120 SUP-99-02280 CDM C2623 HCPCS 0272 RC outpatient 3250 3250 3250 74 2405 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 27.63 897.98 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 6X150 SUP-99-02281 CDM C2623 HCPCS 0272 RC outpatient 3937.5 3937.5 3937.5 74 2913.75 percent of total billed charges 3937.5 93 3189.38 percent of total billed charges 3937.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3937.5 other OPPS APC 3937.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3937.5 other OPPS APC 3937.5 27.63 1087.93 percent of total billed charges 3937.5 3937.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ASSURANT COBALT 9X60 SUP-99-02282 CDM C1876 HCPCS 0278 RC outpatient 2595 2595 2595 57 1479.15 percent of total billed charges 2595 93 2101.95 percent of total billed charges 2595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2595 other OPPS APC 2595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2595 other OPPS APC 2595 51 1323.45 percent of total billed charges 2595 2595 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - XXL 18X60 SUP-99-02283 CDM C1725 HCPCS 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 2.75X15 SUP-99-02284 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INNOVA 6X150 SUP-99-02286 CDM C1876 HCPCS 0278 RC outpatient 2706 2706 2706 57 1542.42 percent of total billed charges 2706 93 2191.86 percent of total billed charges 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 51 1380.06 percent of total billed charges 2706 2706 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INNOVA 7X150 SUP-99-02287 CDM C1876 HCPCS 0278 RC outpatient 2706 2706 2706 57 1542.42 percent of total billed charges 2706 93 2191.86 percent of total billed charges 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 51 1380.06 percent of total billed charges 2706 2706 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INNOVA 7X200 SUP-99-02288 CDM C1876 HCPCS 0278 RC outpatient 6125 6125 6125 57 3491.25 percent of total billed charges 6125 93 4961.25 percent of total billed charges 6125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6125 other OPPS APC 6125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6125 other OPPS APC 6125 51 3123.75 percent of total billed charges 6125 6125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INNOVA 6X200 SUP-99-02289 CDM C1876 HCPCS 0278 RC outpatient 6125 6125 6125 57 3491.25 percent of total billed charges 6125 93 4961.25 percent of total billed charges 6125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6125 other OPPS APC 6125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6125 other OPPS APC 6125 51 3123.75 percent of total billed charges 6125 6125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 9.0X100 SUP-99-02291 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 2.0X10 SUP-99-02294 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - AMPHIRION 2.5X150 SUP-99-02295 CDM C1725 HCPCS 0272 RC outpatient 1035 1035 1035 74 765.9 percent of total billed charges 1035 93 838.35 percent of total billed charges 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 27.63 285.97 percent of total billed charges 1035 1035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 XT 2.0X20 SUP-99-02296 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EPIC 8X40X120 SUP-99-03001 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 2.75X12 SUP-99-03002 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 2.5 X 15 SUP-99-03004 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.5X12 SUP-99-03005 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - PINNACLE DEST 6FX45 TUOUY SUP-99-03006 CDM C1894 HCPCS 0272 RC outpatient 322 322 322 74 238.28 percent of total billed charges 322 93 260.82 percent of total billed charges 322 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 322 other OPPS APC 322 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 322 other OPPS APC 322 27.63 88.97 percent of total billed charges 322 322 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - PINNACLE DEST 8FX45 TUOUY SUP-99-03007 CDM C1894 HCPCS 0272 RC outpatient 322 322 322 74 238.28 percent of total billed charges 322 93 260.82 percent of total billed charges 322 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 322 other OPPS APC 322 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 322 other OPPS APC 322 27.63 88.97 percent of total billed charges 322 322 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JL6 (CORDIS) SUP-99-03008 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 1.5 X 15 SUP-99-03009 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.25X15 SUP-99-03013 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 2.5X20 SUP-99-03014 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 XT 1.2X20 SUP-99-03015 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 12X60X75 SUP-99-03118 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 2.0X15 SUP-99-03119 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - WALLSTENT 16X60 SUP-99-03126 CDM C1876 HCPCS 0278 RC outpatient 3312.5 3312.5 3312.5 57 1888.13 percent of total billed charges 3312.5 93 2683.13 percent of total billed charges 3312.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3312.5 other OPPS APC 3312.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3312.5 other OPPS APC 3312.5 51 1689.38 percent of total billed charges 3312.5 3312.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INNOVA 7X120 SUP-99-03128 CDM C1876 HCPCS 0278 RC outpatient 2706 2706 2706 57 1542.42 percent of total billed charges 2706 93 2191.86 percent of total billed charges 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 51 1380.06 percent of total billed charges 2706 2706 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 4.0X8 SUP-99-03129 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 2.0X8 SUP-99-03130 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - GLIDESHEATH SLENDER 6F SUP-99-03132 CDM C1894 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - GLIDESHEATH SLENDER 5F SUP-99-03133 CDM C1894 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 2.0X20 SUP-99-03134 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.5X20 SUP-99-03137 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MISAGO - 7 X 150 SUP-99-03139 CDM C1876 HCPCS 0278 RC outpatient 2475 2475 2475 57 1410.75 percent of total billed charges 2475 93 2004.75 percent of total billed charges 2475 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2475 other OPPS APC 2475 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2475 other OPPS APC 2475 51 1262.25 percent of total billed charges 2475 2475 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MISAGO - 6 X 150 SUP-99-03140 CDM C1876 HCPCS 0278 RC outpatient 2355 2355 2355 57 1342.35 percent of total billed charges 2355 93 1907.55 percent of total billed charges 2355 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2355 other OPPS APC 2355 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2355 other OPPS APC 2355 51 1201.05 percent of total billed charges 2355 2355 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 6.0X120 SUP-99-03141 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INNOVA 7X60 SUP-99-03142 CDM C1876 HCPCS 0278 RC outpatient 2706 2706 2706 57 1542.42 percent of total billed charges 2706 93 2191.86 percent of total billed charges 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 51 1380.06 percent of total billed charges 2706 2706 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INNOVA 7X80 SUP-99-03143 CDM C1876 HCPCS 0278 RC outpatient 2706 2706 2706 57 1542.42 percent of total billed charges 2706 93 2191.86 percent of total billed charges 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 51 1380.06 percent of total billed charges 2706 2706 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 3.5X12 SUP-99-03144 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 4.0X12 SUP-99-03146 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F THERMODILUTION SWAN GANZ SUP-99-03148 CDM 0272 RC outpatient 402.5 402.5 402.5 74 297.85 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 402.5 other OPPS APC 402.5 402.5 other OPPS APC 402.5 27.63 111.21 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - TEMPORARY PACEMAKER SUP-99-03149 CDM C1779 HCPCS 0272 RC outpatient 540 540 540 74 399.6 percent of total billed charges 540 93 437.4 percent of total billed charges 540 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 540 other OPPS APC 540 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 540 other OPPS APC 540 27.63 149.2 percent of total billed charges 540 540 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 3.0X15 SUP-99-03150 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INNOVA 6X80 SUP-99-03151 CDM C1876 HCPCS 0278 RC outpatient 2706 2706 2706 57 1542.42 percent of total billed charges 2706 93 2191.86 percent of total billed charges 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 51 1380.06 percent of total billed charges 2706 2706 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 2.5X8 SUP-99-03152 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 4.0X40 SUP-99-03154 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 10X80X75 SUP-99-03155 CDM C1725 HCPCS 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 10X80X135 SUP-99-03156 CDM C1725 HCPCS 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 2.5X20 SUP-99-03158 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 2.5X12 SUP-99-03159 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.0X8 SUP-99-03160 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.25X8 SUP-99-03161 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - THROMBECTOMY ZELANTE DVT SUP-99-03162 CDM C1757 HCPCS 0272 RC outpatient 9630.5 9630.5 9630.5 74 7126.57 percent of total billed charges 9630.5 93 7800.71 percent of total billed charges 9630.5 9630.5 other OPPS APC 9630.5 9630.5 other OPPS APC 9630.5 27.63 2660.91 percent of total billed charges 9630.5 9630.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING SL OTW 2.0X80 SUP-99-03163 CDM C1725 HCPCS 0272 RC outpatient 795 795 795 74 588.3 percent of total billed charges 795 93 643.95 percent of total billed charges 795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 795 other OPPS APC 795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 795 other OPPS APC 795 27.63 219.66 percent of total billed charges 795 795 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 4.0X26 SUP-99-03165 CDM C1876 HCPCS 0278 RC outpatient 1995 1995 1995 57 1137.15 percent of total billed charges 1995 93 1615.95 percent of total billed charges 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1995 other OPPS APC 1995 51 1017.45 percent of total billed charges 1995 1995 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 6.0X80 SUP-99-03166 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - GLIDESHEATH SLENDER 7F SUP-99-03167 CDM C1894 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GLIDEWIRE .035X180 1.5MM J SUP-99-03168 CDM C1769 HCPCS 0272 RC outpatient 155.4 155.4 155.4 74 115 percent of total billed charges 155.4 93 125.87 percent of total billed charges 155.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 155.4 other OPPS APC 155.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 155.4 other OPPS APC 155.4 27.63 42.94 percent of total billed charges 155.4 155.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GLIDEWIRE .035X260 1.5MM J SUP-99-03169 CDM C1769 HCPCS 0272 RC outpatient 177.6 177.6 177.6 74 131.42 percent of total billed charges 177.6 93 143.86 percent of total billed charges 177.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 177.6 other OPPS APC 177.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 177.6 other OPPS APC 177.6 27.63 49.07 percent of total billed charges 177.6 177.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 4.5X12 SUP-99-03170 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - ULTIMATE 3 5F SUP-99-03171 CDM C1887 HCPCS 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - ULTIMATE 3 6F SUP-99-03172 CDM C1887 HCPCS 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - ULTIMATE 4-T40 5F SUP-99-03173 CDM C1887 HCPCS 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - ULTIMATE 4-T40 6F SUP-99-03174 CDM C1887 HCPCS 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - ULTIMATE 4-T45 5F SUP-99-03175 CDM C1887 HCPCS 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - ULTIMATE 4-T45 6F SUP-99-03176 CDM C1887 HCPCS 0272 RC outpatient 192 192 192 74 142.08 percent of total billed charges 192 93 155.52 percent of total billed charges 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192 other OPPS APC 192 27.63 53.05 percent of total billed charges 192 192 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - METACROSS RX 6.0X100 SUP-99-03178 CDM C1725 HCPCS 0272 RC outpatient 399 399 399 74 295.26 percent of total billed charges 399 93 323.19 percent of total billed charges 399 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 399 other OPPS APC 399 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 399 other OPPS APC 399 27.63 110.24 percent of total billed charges 399 399 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - METACROSS RX 6.0X40 SUP-99-03179 CDM C1725 HCPCS 0272 RC outpatient 402.5 402.5 402.5 74 297.85 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 27.63 111.21 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - RUNTHROUGH 180CM SUP-99-03180 CDM C1769 HCPCS 0272 RC outpatient 280 280 280 74 207.2 percent of total billed charges 280 93 226.8 percent of total billed charges 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 27.63 77.36 percent of total billed charges 280 280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - RUNTHROUGH 300CM SUP-99-03181 CDM C1769 HCPCS 0272 RC outpatient 280 280 280 74 207.2 percent of total billed charges 280 93 226.8 percent of total billed charges 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 27.63 77.36 percent of total billed charges 280 280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 12X60X135 SUP-99-03182 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 4.0X28 SUP-99-03183 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 8f x 11cm SUP-99-03184 CDM C1894 HCPCS 0272 RC outpatient 39.2 39.2 39.2 74 29.01 percent of total billed charges 39.2 93 31.75 percent of total billed charges 39.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.2 other OPPS APC 39.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 39.2 other OPPS APC 39.2 27.63 10.83 percent of total billed charges 39.2 39.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - PINNACLE 9 F SUP-99-03185 CDM C1894 HCPCS 0272 RC outpatient 34 34 34 74 25.16 percent of total billed charges 34 93 27.54 percent of total billed charges 34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34 other OPPS APC 34 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34 other OPPS APC 34 27.63 9.39 percent of total billed charges 34 34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - IKARI LEFT IL3.5SH SUP-99-03186 CDM C1887 HCPCS 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - IKARI LEFT IL3.75 SUP-99-03187 CDM C1887 HCPCS 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - IKARI LEFT IL3.75SH SUP-99-03188 CDM C1887 HCPCS 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - IKARI LEFT IL4.0 SUP-99-03189 CDM C1887 HCPCS 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - IKARI LEFT IL4.0SH SUP-99-03190 CDM C1887 HCPCS 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - IKARI LEFT IL4.5 SUP-99-03191 CDM C1887 HCPCS 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - IKARI LEFT IL4.5SH SUP-99-03192 CDM C1887 HCPCS 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - IKARI RIGHT IR1.0 SUP-99-03193 CDM C1887 HCPCS 0272 RC outpatient 245 245 245 74 181.3 percent of total billed charges 245 93 198.45 percent of total billed charges 245 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 245 other OPPS APC 245 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 245 other OPPS APC 245 27.63 67.69 percent of total billed charges 245 245 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - IKARI RIGHT IR1.0SH SUP-99-03194 CDM C1887 HCPCS 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - IKARI RIGHT IR1.5 SUP-99-03195 CDM C1887 HCPCS 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - IKARI RIGHT IR1.5SH SUP-99-03196 CDM C1887 HCPCS 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - IKARI RIGHT IR2.0 SUP-99-03197 CDM C1887 HCPCS 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - IKARI RIGHT IR2.0SH SUP-99-03198 CDM C1887 HCPCS 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - IKARI LEFT IL3.5 SUP-99-03199 CDM C1887 HCPCS 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - RBU3.5SH SUP-99-03200 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PACIFIC EXTREME 4X300 SUP-99-03202 CDM C1725 HCPCS 0272 RC outpatient 900 900 900 74 666 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 27.63 248.67 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PACIFIC PLUS 4X80 SUP-99-03203 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.0X12 SUP-99-03204 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER-JACKY 5F SUP-99-03205 CDM 0272 RC outpatient 140 140 140 74 103.6 percent of total billed charges 140 93 113.4 percent of total billed charges 140 140 other OPPS APC 140 140 other OPPS APC 140 27.63 38.68 percent of total billed charges 140 140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JACKY 6F SUP-99-03206 CDM 0272 RC outpatient 673.75 673.75 673.75 74 498.58 percent of total billed charges 673.75 93 545.74 percent of total billed charges 673.75 673.75 other OPPS APC 673.75 673.75 other OPPS APC 673.75 27.63 186.16 percent of total billed charges 673.75 673.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - SARAH 6F SUP-99-03207 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - SARAH 5F SUP-99-03208 CDM 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 682.5 other OPPS APC 682.5 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT-INNOVA 6X100 SUP-99-03209 CDM C1876 HCPCS 0278 RC outpatient 2706 2706 2706 57 1542.42 percent of total billed charges 2706 93 2191.86 percent of total billed charges 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 51 1380.06 percent of total billed charges 2706 2706 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - GLIDER RX 2.0X20 SUP-99-03214 CDM C1725 HCPCS 0272 RC outpatient 1050 1050 1050 74 777 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 27.63 290.12 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - GLIDER RX 2.5X20 SUP-99-03215 CDM C1725 HCPCS 0272 RC outpatient 1050 1050 1050 74 777 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 27.63 290.12 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - GLIDER RX 3.0X20 SUP-99-03216 CDM C1725 HCPCS 0272 RC outpatient 1050 1050 1050 74 777 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 27.63 290.12 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - GLIDER RX 3.0X12 SUP-99-03217 CDM C1725 HCPCS 0272 RC outpatient 1050 1050 1050 74 777 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 27.63 290.12 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - METACROSS RX 6.0X150 SUP-99-03219 CDM C1725 HCPCS 0272 RC outpatient 434 434 434 74 321.16 percent of total billed charges 434 93 351.54 percent of total billed charges 434 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434 other OPPS APC 434 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 434 other OPPS APC 434 27.63 119.91 percent of total billed charges 434 434 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE RX 2.0X20 SUP-99-03220 CDM C1725 HCPCS 0272 RC outpatient 2250 2250 2250 74 1665 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 27.63 621.68 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE RX 2.5X20 SUP-99-03221 CDM C1725 HCPCS 0272 RC outpatient 2250 2250 2250 74 1665 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 27.63 621.68 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE RX 3.0X10 SUP-99-03222 CDM C1725 HCPCS 0272 RC outpatient 2250 2250 2250 74 1665 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 27.63 621.68 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CHOCOLATE RX 3.5X20 SUP-99-03223 CDM C1725 HCPCS 0272 RC outpatient 2250 2250 2250 74 1665 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 27.63 621.68 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.75X27 SUP-99-03224 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.75X8 SUP-99-03226 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - IN.PACT ADMIRAL 5X40 SUP-99-03233 CDM C2623 HCPCS 0272 RC outpatient 4100 4100 4100 74 3034 percent of total billed charges 4100 93 3321 percent of total billed charges 4100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4100 other OPPS APC 4100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4100 other OPPS APC 4100 27.63 1132.83 percent of total billed charges 4100 4100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INNOVA 7X100 SUP-99-03234 CDM C1876 HCPCS 0278 RC outpatient 2706 2706 2706 57 1542.42 percent of total billed charges 2706 93 2191.86 percent of total billed charges 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 51 1380.06 percent of total billed charges 2706 2706 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 6.0X150 SUP-99-03235 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INNOVA 7X40 SUP-99-03236 CDM C1876 HCPCS 0278 RC outpatient 2706 2706 2706 57 1542.42 percent of total billed charges 2706 93 2191.86 percent of total billed charges 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 51 1380.06 percent of total billed charges 2706 2706 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - METACROSS RX 5.0X40 SUP-99-03237 CDM C1725 HCPCS 0272 RC outpatient 402.5 402.5 402.5 74 297.85 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 27.63 111.21 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - METACROSS RX 8.0X40 SUP-99-03238 CDM C1725 HCPCS 0272 RC outpatient 402.5 402.5 402.5 74 297.85 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 27.63 111.21 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MISAGO 6 X 40 SUP-99-03239 CDM C1876 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MISAGO - 8 X 40 SUP-99-03240 CDM C1876 HCPCS 0278 RC outpatient 2250 2250 2250 57 1282.5 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 51 1147.5 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 6X40 SUP-99-03241 CDM C2623 HCPCS 0272 RC outpatient 4125 4125 4125 74 3052.5 percent of total billed charges 4125 93 3341.25 percent of total billed charges 4125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4125 other OPPS APC 4125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4125 other OPPS APC 4125 27.63 1139.74 percent of total billed charges 4125 4125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INNOVA 5X80 SUP-99-03243 CDM C1876 HCPCS 0278 RC outpatient 2706 2706 2706 57 1542.42 percent of total billed charges 2706 93 2191.86 percent of total billed charges 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 51 1380.06 percent of total billed charges 2706 2706 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - AMPHIRION 2.0X150 SUP-99-03244 CDM C1725 HCPCS 0272 RC outpatient 1035 1035 1035 74 765.9 percent of total billed charges 1035 93 838.35 percent of total billed charges 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 27.63 285.97 percent of total billed charges 1035 1035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ASSURANT COBALT 6X20 SUP-99-03245 CDM C1876 HCPCS 0278 RC outpatient 2595 2595 2595 57 1479.15 percent of total billed charges 2595 93 2101.95 percent of total billed charges 2595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2595 other OPPS APC 2595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2595 other OPPS APC 2595 51 1323.45 percent of total billed charges 2595 2595 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING SL OTW 3.0X120 SUP-99-03250 CDM C1725 HCPCS 0272 RC outpatient 795 795 795 74 588.3 percent of total billed charges 795 93 643.95 percent of total billed charges 795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 795 other OPPS APC 795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 795 other OPPS APC 795 27.63 219.66 percent of total billed charges 795 795 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 4.0X120X150 SUP-99-03251 CDM C1725 HCPCS 0272 RC outpatient 1215 1215 1215 74 899.1 percent of total billed charges 1215 93 984.15 percent of total billed charges 1215 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1215 other OPPS APC 1215 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1215 other OPPS APC 1215 27.63 335.7 percent of total billed charges 1215 1215 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GLIDEWIRE ADVANTAGE .018X300 ANGLED SUP-99-03252 CDM C1769 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER - RETRIEVAL KIT 20MM SUP-99-03255 CDM C1773 HCPCS 0272 RC outpatient 975 975 975 74 721.5 percent of total billed charges 975 93 789.75 percent of total billed charges 975 975 other OPPS APC 975 975 other OPPS APC 975 27.63 269.39 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CONQUEST 8X40 SUP-99-03256 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - GLIDESHEATH SLENDER 6F DOUBLE W SUP-99-03262 CDM C1894 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 3.0X10 SUP-99-03266 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 1.5 X 10 SUP-99-03267 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - MP B2 SUP-99-03268 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - MPB2 5F SUP-99-03269 CDM 0272 RC outpatient 34 34 34 74 25.16 percent of total billed charges 34 93 27.54 percent of total billed charges 34 34 other OPPS APC 34 34 other OPPS APC 34 27.63 9.39 percent of total billed charges 34 34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FFR - COMET SUP-99-03270 CDM C1769 HCPCS 0272 RC outpatient 2025 2025 2025 74 1498.5 percent of total billed charges 2025 93 1640.25 percent of total billed charges 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 27.63 559.51 percent of total billed charges 2025 2025 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FFR - PRESSUREWIRE X - 175CM SUP-99-03271 CDM C1769 HCPCS 0272 RC outpatient 2025 2025 2025 74 1498.5 percent of total billed charges 2025 93 1640.25 percent of total billed charges 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 27.63 559.51 percent of total billed charges 2025 2025 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - NAVICROSS 150CM STRAIGHT SUP-99-03273 CDM C1887 HCPCS 0272 RC outpatient 172.8 172.8 172.8 74 127.87 percent of total billed charges 172.8 93 139.97 percent of total billed charges 172.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 172.8 other OPPS APC 172.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 172.8 other OPPS APC 172.8 27.63 47.74 percent of total billed charges 172.8 172.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INNOVA 6X40 SUP-99-03274 CDM C1876 HCPCS 0278 RC outpatient 2706 2706 2706 57 1542.42 percent of total billed charges 2706 93 2191.86 percent of total billed charges 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 51 1380.06 percent of total billed charges 2706 2706 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ASSURANT COBALT 8X20 SUP-99-03275 CDM C1876 HCPCS 0278 RC outpatient 2595 2595 2595 57 1479.15 percent of total billed charges 2595 93 2101.95 percent of total billed charges 2595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2595 other OPPS APC 2595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2595 other OPPS APC 2595 51 1323.45 percent of total billed charges 2595 2595 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - FR4 MOD SUP-99-03277 CDM 0272 RC outpatient 38 38 38 74 28.12 percent of total billed charges 38 93 30.78 percent of total billed charges 38 38 other OPPS APC 38 38 other OPPS APC 38 27.63 10.5 percent of total billed charges 38 38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - SOFT - 180CM SUP-99-03278 CDM C1769 HCPCS 0272 RC outpatient 266 266 266 74 196.84 percent of total billed charges 266 93 215.46 percent of total billed charges 266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 266 other OPPS APC 266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 266 other OPPS APC 266 27.63 73.5 percent of total billed charges 266 266 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 2.0X8 SUP-99-03280 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOSURE DEVICE - PERCLOSE PROGLIDE SUP-99-03282 CDM C1762 HCPCS 0272 RC outpatient 753 753 753 74 557.22 percent of total billed charges 753 93 609.93 percent of total billed charges 753 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 753 other OPPS APC 753 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 753 other OPPS APC 753 27.63 208.05 percent of total billed charges 753 753 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATHERECTOMY - 1.50 CLASSIC CROWN 145CM SUP-99-03283 CDM C1724 HCPCS 0272 RC outpatient 8987.5 8987.5 8987.5 74 6650.75 percent of total billed charges 8987.5 93 7279.88 percent of total billed charges 8987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8987.5 other OPPS APC 8987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8987.5 other OPPS APC 8987.5 27.63 2483.25 percent of total billed charges 8987.5 8987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - GLIDESHEATH SLENDER 6F - 25G SUP-99-03284 CDM C1894 HCPCS 0272 RC outpatient 371.88 371.88 371.88 74 275.19 percent of total billed charges 371.88 93 301.22 percent of total billed charges 371.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 371.88 other OPPS APC 371.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 371.88 other OPPS APC 371.88 27.63 102.75 percent of total billed charges 371.88 371.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IABP - 40CC CATHETER SUP-99-03285 CDM 0272 RC outpatient 2289 2289 2289 74 1693.86 percent of total billed charges 2289 93 1854.09 percent of total billed charges 2289 2289 other OPPS APC 2289 2289 other OPPS APC 2289 27.63 632.45 percent of total billed charges 2289 2289 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 3.0X40X145 SUP-99-03286 CDM C1725 HCPCS 0272 RC outpatient 930 930 930 74 688.2 percent of total billed charges 930 93 753.3 percent of total billed charges 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 930 other OPPS APC 930 27.63 256.96 percent of total billed charges 930 930 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 10.0X20 SUP-99-03288 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - AR 2 SH SUP-99-03289 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOSURE DEVICE - ANGIOSEAL PLUS-8F SUP-99-03290 CDM C1762 HCPCS 0272 RC outpatient 735 735 735 74 543.9 percent of total billed charges 735 93 595.35 percent of total billed charges 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 27.63 203.08 percent of total billed charges 735 735 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - CHOICE PT - STRAIGHT - 182CM SUP-99-03291 CDM C1769 HCPCS 0272 RC outpatient 268.73 268.73 268.73 74 198.86 percent of total billed charges 268.73 93 217.67 percent of total billed charges 268.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 268.73 other OPPS APC 268.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 268.73 other OPPS APC 268.73 27.63 74.25 percent of total billed charges 268.73 268.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - CHOICE PT - STRAIGHT - 300CM SUP-99-03292 CDM C1769 HCPCS 0272 RC outpatient 268.72 268.72 268.72 74 198.85 percent of total billed charges 268.72 93 217.66 percent of total billed charges 268.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 268.72 other OPPS APC 268.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 268.72 other OPPS APC 268.72 27.63 74.25 percent of total billed charges 268.72 268.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - RUBICON 18 150CM SUP-99-03293 CDM C1887 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - PIGTAIL ANGLED 6F SUP-99-03294 CDM 0272 RC outpatient 38.36 38.36 38.36 74 28.39 percent of total billed charges 38.36 93 31.07 percent of total billed charges 38.36 38.36 other OPPS APC 38.36 38.36 other OPPS APC 38.36 27.63 10.6 percent of total billed charges 38.36 38.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GLADIUS .014X300 SUP-99-03295 CDM C1769 HCPCS 0272 RC outpatient 560 560 560 74 414.4 percent of total billed charges 560 93 453.6 percent of total billed charges 560 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 560 other OPPS APC 560 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 560 other OPPS APC 560 27.63 154.73 percent of total billed charges 560 560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GLADIUS .018X300 SUP-99-03296 CDM C1769 HCPCS 0272 RC outpatient 560 560 560 74 414.4 percent of total billed charges 560 93 453.6 percent of total billed charges 560 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 560 other OPPS APC 560 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 560 other OPPS APC 560 27.63 154.73 percent of total billed charges 560 560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GOLD .018X300 SUP-99-03297 CDM C1769 HCPCS 0272 RC outpatient 294.88 294.88 294.88 74 218.21 percent of total billed charges 294.88 93 238.85 percent of total billed charges 294.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 294.88 other OPPS APC 294.88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 294.88 other OPPS APC 294.88 27.63 81.48 percent of total billed charges 294.88 294.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 2.0X12 SUP-99-03299 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IABP - 30CC CATHETER SUP-99-03300 CDM 0272 RC outpatient 2359.8 2359.8 2359.8 74 1746.25 percent of total billed charges 2359.8 93 1911.44 percent of total billed charges 2359.8 2359.8 other OPPS APC 2359.8 2359.8 other OPPS APC 2359.8 27.63 652.01 percent of total billed charges 2359.8 2359.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - SION BLUE SUP-99-03301 CDM C1769 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - MULTIPURPOSE A-1 6F SUP-99-03303 CDM 0272 RC outpatient 191.8 191.8 191.8 74 141.93 percent of total billed charges 191.8 93 155.36 percent of total billed charges 191.8 191.8 other OPPS APC 191.8 191.8 other OPPS APC 191.8 27.63 52.99 percent of total billed charges 191.8 191.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 4.0X27 SUP-99-03309 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IVUS - OPTICROSS 18 PERIPHERAL SUP-99-03310 CDM C1753 HCPCS 0272 RC outpatient 3437.5 3437.5 3437.5 74 2543.75 percent of total billed charges 3437.5 93 2784.38 percent of total billed charges 3437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3437.5 other OPPS APC 3437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3437.5 other OPPS APC 3437.5 27.63 949.78 percent of total billed charges 3437.5 3437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 3.5X6 SUP-99-03313 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE- RUNTHROUGH EXTENSION SUP-99-03314 CDM C1769 HCPCS 0272 RC outpatient 280 280 280 74 207.2 percent of total billed charges 280 93 226.8 percent of total billed charges 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 280 other OPPS APC 280 27.63 77.36 percent of total billed charges 280 280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 2.25X12 SUP-99-03315 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 2.75X6 SUP-99-03316 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 1.5X20 SUP-99-03317 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 XT 1.5X12 SUP-99-03318 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - LIFESTREAM COVERED 6X58 SUP-99-03319 CDM C1874 HCPCS 0278 RC outpatient 6250 6250 6250 57 3562.5 percent of total billed charges 6250 93 5062.5 percent of total billed charges 6250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6250 other OPPS APC 6250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6250 other OPPS APC 6250 51 3187.5 percent of total billed charges 6250 6250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - LIFESTREAM COVERED 8X58 SUP-99-03320 CDM C1874 HCPCS 0278 RC outpatient 6250 6250 6250 57 3562.5 percent of total billed charges 6250 93 5062.5 percent of total billed charges 6250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6250 other OPPS APC 6250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6250 other OPPS APC 6250 51 3187.5 percent of total billed charges 6250 6250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 2.5X100X150 SUP-99-03321 CDM C1725 HCPCS 0272 RC outpatient 705 705 705 74 521.7 percent of total billed charges 705 93 571.05 percent of total billed charges 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 705 other OPPS APC 705 27.63 194.79 percent of total billed charges 705 705 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 4.0 X 20 SUP-99-03322 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - LIFESTREAM COVERED 6X37 SUP-99-03323 CDM C1874 HCPCS 0278 RC outpatient 6250 6250 6250 57 3562.5 percent of total billed charges 6250 93 5062.5 percent of total billed charges 6250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6250 other OPPS APC 6250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6250 other OPPS APC 6250 51 3187.5 percent of total billed charges 6250 6250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - LIFESTREAM COVERED 8X37 SUP-99-03324 CDM C1874 HCPCS 0278 RC outpatient 6250 6250 6250 57 3562.5 percent of total billed charges 6250 93 5062.5 percent of total billed charges 6250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6250 other OPPS APC 6250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6250 other OPPS APC 6250 51 3187.5 percent of total billed charges 6250 6250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 5.0X20 SUP-99-03325 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INNOVA 5X40 SUP-99-03326 CDM C1876 HCPCS 0278 RC outpatient 2706 2706 2706 57 1542.42 percent of total billed charges 2706 93 2191.86 percent of total billed charges 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 51 1380.06 percent of total billed charges 2706 2706 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 6.0X40 SUP-99-03327 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - CHOICE PT - J-TIP - 300CM SUP-99-03329 CDM C1769 HCPCS 0272 RC outpatient 268.72 268.72 268.72 74 198.85 percent of total billed charges 268.72 93 217.66 percent of total billed charges 268.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 268.72 other OPPS APC 268.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 268.72 other OPPS APC 268.72 27.63 74.25 percent of total billed charges 268.72 268.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - COVERED - VIABAHN 5 X 50 SUP-99-03330 CDM C1874 HCPCS 0278 RC outpatient 7987.5 7987.5 7987.5 57 4552.88 percent of total billed charges 7987.5 93 6469.88 percent of total billed charges 7987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7987.5 other OPPS APC 7987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7987.5 other OPPS APC 7987.5 51 4073.63 percent of total billed charges 7987.5 7987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - PHOENIX ATHERECTOMY 2.2MM SUP-99-03331 CDM C1724 HCPCS 0272 RC outpatient 7000 7000 7000 74 5180 percent of total billed charges 7000 93 5670 percent of total billed charges 7000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7000 other OPPS APC 7000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7000 other OPPS APC 7000 27.63 1934.1 percent of total billed charges 7000 7000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 4.0X6 SUP-99-03332 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 4.0X8 SUP-99-03333 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 3.0X100X150 SUP-99-03336 CDM C1725 HCPCS 0272 RC outpatient 735 735 735 74 543.9 percent of total billed charges 735 93 595.35 percent of total billed charges 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 27.63 203.08 percent of total billed charges 735 735 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 4.0X20 SUP-99-03339 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 3.0X210 SUP-99-03340 CDM C1725 HCPCS 0272 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 2.75X8 SUP-99-03342 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - LIFESTREAM COVERED 10X38 SUP-99-03344 CDM C1874 HCPCS 0278 RC outpatient 7000 7000 7000 57 3990 percent of total billed charges 7000 93 5670 percent of total billed charges 7000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7000 other OPPS APC 7000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7000 other OPPS APC 7000 51 3570 percent of total billed charges 7000 7000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IVUS - VISIONS PV .014P SUP-99-03345 CDM C1753 HCPCS 0272 RC outpatient 2175 2175 2175 74 1609.5 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 27.63 600.95 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INNOVA 5X100 SUP-99-03347 CDM C1876 HCPCS 0278 RC outpatient 2706 2706 2706 57 1542.42 percent of total billed charges 2706 93 2191.86 percent of total billed charges 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 51 1380.06 percent of total billed charges 2706 2706 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INNOVA 5X150 SUP-99-03348 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - MICROPUNTURE INTRODUCER 4F SUP-99-03350 CDM C1894 HCPCS 0272 RC outpatient 79.56 79.56 79.56 74 58.87 percent of total billed charges 79.56 93 64.44 percent of total billed charges 79.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 79.56 other OPPS APC 79.56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 79.56 other OPPS APC 79.56 27.63 21.98 percent of total billed charges 79.56 79.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 3.0X150 SUP-99-03351 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - CHECK-FLO ADAPTER SUP-99-03352 CDM C1894 HCPCS 0272 RC outpatient 56 56 56 74 41.44 percent of total billed charges 56 93 45.36 percent of total billed charges 56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56 other OPPS APC 56 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 56 other OPPS APC 56 27.63 15.47 percent of total billed charges 56 56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 3.5X40 SUP-99-03353 CDM C1725 HCPCS 0272 RC outpatient 978 978 978 74 723.72 percent of total billed charges 978 93 792.18 percent of total billed charges 978 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 978 other OPPS APC 978 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 978 other OPPS APC 978 27.63 270.22 percent of total billed charges 978 978 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - EBU3.0 SUP-99-03355 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JL3.0 (MEDTRONIC) SUP-99-03356 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 5F EBU3.5 SUP-99-03357 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 5F EBU3.0 SUP-99-03358 CDM C1887 HCPCS 0272 RC outpatient 172.8 172.8 172.8 74 127.87 percent of total billed charges 172.8 93 139.97 percent of total billed charges 172.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 172.8 other OPPS APC 172.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 172.8 other OPPS APC 172.8 27.63 47.74 percent of total billed charges 172.8 172.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 5F JL3 (MEDTRONIC) SUP-99-03359 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F FL3 SUP-99-03360 CDM 0272 RC outpatient 38 38 38 74 28.12 percent of total billed charges 38 93 30.78 percent of total billed charges 38 38 other OPPS APC 38 38 other OPPS APC 38 27.63 10.5 percent of total billed charges 38 38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - FL3 SUP-99-03361 CDM 0272 RC outpatient 38 38 38 74 28.12 percent of total billed charges 38 93 30.78 percent of total billed charges 38 38 other OPPS APC 38 38 other OPPS APC 38 27.63 10.5 percent of total billed charges 38 38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 5 F AR1 (MEDTRONIC) SUP-99-03362 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 5.0X20 SUP-99-03364 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INNOVA 6X60 SUP-99-03365 CDM C1876 HCPCS 0278 RC outpatient 2706 2706 2706 57 1542.42 percent of total billed charges 2706 93 2191.86 percent of total billed charges 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 51 1380.06 percent of total billed charges 2706 2706 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 5.0X12 SUP-99-03366 CDM C1725 HCPCS 0272 RC outpatient 630 630 630 74 466.2 percent of total billed charges 630 93 510.3 percent of total billed charges 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 630 other OPPS APC 630 27.63 174.07 percent of total billed charges 630 630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - COYOTE OTW 3.0X120X150 SUP-99-03367 CDM C1725 HCPCS 0272 RC outpatient 1215 1215 1215 74 899.1 percent of total billed charges 1215 93 984.15 percent of total billed charges 1215 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1215 other OPPS APC 1215 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1215 other OPPS APC 1215 27.63 335.7 percent of total billed charges 1215 1215 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - WALLSTENT 16X90 SUP-99-03368 CDM C1876 HCPCS 0278 RC outpatient 5062.5 5062.5 5062.5 57 2885.63 percent of total billed charges 5062.5 93 4100.63 percent of total billed charges 5062.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5062.5 other OPPS APC 5062.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5062.5 other OPPS APC 5062.5 51 2581.88 percent of total billed charges 5062.5 5062.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - WALLSTENT 14X90 SUP-99-03369 CDM C1876 HCPCS 0278 RC outpatient 3125 3125 3125 57 1781.25 percent of total billed charges 3125 93 2531.25 percent of total billed charges 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 51 1593.75 percent of total billed charges 3125 3125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - WALLSTENT 14X60 SUP-99-03370 CDM C1876 HCPCS 0278 RC outpatient 2985 2985 2985 57 1701.45 percent of total billed charges 2985 93 2417.85 percent of total billed charges 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 51 1522.35 percent of total billed charges 2985 2985 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ATLAS 20X40 SUP-99-03371 CDM C1725 HCPCS 0272 RC outpatient 735 735 735 74 543.9 percent of total billed charges 735 93 595.35 percent of total billed charges 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 27.63 203.08 percent of total billed charges 735 735 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ATLAS 22X40 SUP-99-03372 CDM C1725 HCPCS 0272 RC outpatient 735 735 735 74 543.9 percent of total billed charges 735 93 595.35 percent of total billed charges 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 27.63 203.08 percent of total billed charges 735 735 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ATLAS 14X40 SUP-99-03373 CDM C1725 HCPCS 0272 RC outpatient 1020 1020 1020 74 754.8 percent of total billed charges 1020 93 826.2 percent of total billed charges 1020 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1020 other OPPS APC 1020 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1020 other OPPS APC 1020 27.63 281.83 percent of total billed charges 1020 1020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 10.0X40 SUP-99-03374 CDM C1876 HCPCS 0278 RC outpatient 2250 2250 2250 57 1282.5 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 51 1147.5 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - PROWATERFLEX - 180CM SUP-99-03375 CDM C1769 HCPCS 0272 RC outpatient 266 266 266 74 196.84 percent of total billed charges 266 93 215.46 percent of total billed charges 266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 266 other OPPS APC 266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 266 other OPPS APC 266 27.63 73.5 percent of total billed charges 266 266 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - AR 3 6F SUP-99-03377 CDM 0272 RC outpatient 158.2 158.2 158.2 74 117.07 percent of total billed charges 158.2 93 128.14 percent of total billed charges 158.2 158.2 other OPPS APC 158.2 158.2 other OPPS APC 158.2 27.63 43.71 percent of total billed charges 158.2 158.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - AR 3 5F SUP-99-03378 CDM 0272 RC outpatient 158.2 158.2 158.2 74 117.07 percent of total billed charges 158.2 93 128.14 percent of total billed charges 158.2 158.2 other OPPS APC 158.2 158.2 other OPPS APC 158.2 27.63 43.71 percent of total billed charges 158.2 158.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - AR 2 5F SUP-99-03379 CDM 0272 RC outpatient 191.8 191.8 191.8 74 141.93 percent of total billed charges 191.8 93 155.36 percent of total billed charges 191.8 191.8 other OPPS APC 191.8 191.8 other OPPS APC 191.8 27.63 52.99 percent of total billed charges 191.8 191.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - RBU4.0 5F SUP-99-03380 CDM C1887 HCPCS 0272 RC outpatient 172.8 172.8 172.8 74 127.87 percent of total billed charges 172.8 93 139.97 percent of total billed charges 172.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 172.8 other OPPS APC 172.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 172.8 other OPPS APC 172.8 27.63 47.74 percent of total billed charges 172.8 172.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - RBU4.0 SUP-99-03381 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE- RBU4.5 SUP-99-03382 CDM C1887 HCPCS 0272 RC outpatient 174 174 174 74 128.76 percent of total billed charges 174 93 140.94 percent of total billed charges 174 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174 other OPPS APC 174 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 174 other OPPS APC 174 27.63 48.08 percent of total billed charges 174 174 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 5.5X40 SUP-99-03383 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - AL 0.75 (MEDTRONIC) SUP-99-03385 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 10X60X75 SUP-99-03386 CDM C1725 HCPCS 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - FOUNTAIN INFUSION 10CM SUP-99-03387 CDM 0272 RC outpatient 441.35 441.35 441.35 74 326.6 percent of total billed charges 441.35 93 357.49 percent of total billed charges 441.35 441.35 other OPPS APC 441.35 441.35 other OPPS APC 441.35 27.63 121.95 percent of total billed charges 441.35 441.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - FOUNTAIN INFUSION 30CM SUP-99-03388 CDM 0272 RC outpatient 441.35 441.35 441.35 74 326.6 percent of total billed charges 441.35 93 357.49 percent of total billed charges 441.35 441.35 other OPPS APC 441.35 441.35 other OPPS APC 441.35 27.63 121.95 percent of total billed charges 441.35 441.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - FOUNTAIN INFUSION 20CM SUP-99-03389 CDM 0272 RC outpatient 441.35 441.35 441.35 74 326.6 percent of total billed charges 441.35 93 357.49 percent of total billed charges 441.35 441.35 other OPPS APC 441.35 441.35 other OPPS APC 441.35 27.63 121.95 percent of total billed charges 441.35 441.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 5.5X200 SUP-99-03391 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 035 5.0X40X130 SUP-99-03392 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 035 6.0X150X130 SUP-99-03393 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CONQUEST 12X40 SUP-99-03395 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ULTRA 4.5X18 SUP-99-03396 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTRAST - VISIPAQUE 320 150CC SUP-99-03397 CDM Q9967 CPT 0255 RC outpatient 316.86 316.86 0.15 0.15 fee schedule 316.86 93 256.66 percent of total billed charges 316.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 316.86 other OPPS APC 316.86 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 316.86 other OPPS APC 316.86 24.86 78.77 percent of total billed charges 0.15 316.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTRAST - VISIPAQUE 320 100CC SUP-99-03398 CDM Q9967 CPT 0255 RC outpatient 147.36 147.36 0.15 0.15 fee schedule 147.36 93 119.36 percent of total billed charges 147.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 147.36 other OPPS APC 147.36 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 147.36 other OPPS APC 147.36 24.86 36.63 percent of total billed charges 0.15 147.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTRAST - VISIPAQUE 320 200CC SUP-99-03399 CDM Q9967 CPT 0255 RC outpatient 390.32 390.32 0.15 0.15 fee schedule 390.32 93 316.16 percent of total billed charges 390.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.32 other OPPS APC 390.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 390.32 other OPPS APC 390.32 24.86 97.03 percent of total billed charges 0.15 390.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTRAST - OMNIPAQUE 350 200CC SUP-99-03400 CDM Q9967 CPT 0255 RC outpatient 86.1 86.1 0.15 0.15 fee schedule 86.1 93 69.74 percent of total billed charges 86.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 86.1 other OPPS APC 86.1 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 86.1 other OPPS APC 86.1 24.86 21.4 percent of total billed charges 0.15 86.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTRAST - OMNIPAQUE 350 NOVAPLUS 10 X 100CC Y542 SUP-99-03401 CDM Q9967 CPT 0255 RC outpatient 66.77 66.77 0.15 0.15 fee schedule 66.77 93 54.08 percent of total billed charges 66.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 66.77 other OPPS APC 66.77 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 66.77 other OPPS APC 66.77 24.86 16.6 percent of total billed charges 0.15 66.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - GENERATOR AZURE DUAL W1DR01 SUP-99-03402 CDM C1785 HCPCS 0275 RC outpatient 6243.75 6243.75 6243.75 57 3558.94 percent of total billed charges 6243.75 93 5057.44 percent of total billed charges 6243.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6243.75 other OPPS APC 6243.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6243.75 other OPPS APC 6243.75 51 3184.31 percent of total billed charges 6243.75 6243.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - GENERATOR AZURE SINGL W1SR01 SUP-99-03403 CDM C1786 HCPCS 0275 RC outpatient 4172.94 4172.94 4172.94 57 2378.58 percent of total billed charges 4172.94 93 3380.08 percent of total billed charges 4172.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4172.94 other OPPS APC 4172.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4172.94 other OPPS APC 4172.94 51 2128.2 percent of total billed charges 4172.94 4172.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 12.0X20 SUP-99-03404 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 035 6.0X40X130 SUP-99-03405 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.5X27 SUP-99-03407 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 5.5X150 SUP-99-03408 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLASMA BLADE X 4.0 SUP-99-03409 CDM 0272 RC outpatient 992.25 992.25 992.25 74 734.27 percent of total billed charges 992.25 93 803.72 percent of total billed charges 992.25 992.25 other OPPS APC 992.25 992.25 other OPPS APC 992.25 27.63 274.16 percent of total billed charges 992.25 992.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 6.0X100 SUP-99-03410 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 035 7.0X80X130 SUP-99-03411 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - WALLSTENT 12X90 SUP-99-03412 CDM C1876 HCPCS 0278 RC outpatient 2985 2985 2985 57 1701.45 percent of total billed charges 2985 93 2417.85 percent of total billed charges 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 51 1522.35 percent of total billed charges 2985 2985 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - WALLSTENT 12X60 SUP-99-03413 CDM C1876 HCPCS 0278 RC outpatient 2985 2985 2985 57 1701.45 percent of total billed charges 2985 93 2417.85 percent of total billed charges 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 51 1522.35 percent of total billed charges 2985 2985 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 3.5X120 SUP-99-03414 CDM C1725 HCPCS 0272 RC outpatient 978 978 978 74 723.72 percent of total billed charges 978 93 792.18 percent of total billed charges 978 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 978 other OPPS APC 978 978 other OPPS APC 978 27.63 270.22 percent of total billed charges 978 978 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - PHOENIX ATHERECTOMY 1.8MM SUP-99-03415 CDM C1724 HCPCS 0272 RC outpatient 7000 7000 7000 74 5180 percent of total billed charges 7000 93 5670 percent of total billed charges 7000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7000 other OPPS APC 7000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7000 other OPPS APC 7000 27.63 1934.1 percent of total billed charges 7000 7000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 3.0X120 SUP-99-03416 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 2.0X120 SUP-99-03417 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 6.0X200 SUP-99-03418 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - MULTIPURPOSE A-1 5F SUP-99-03419 CDM 0272 RC outpatient 191.8 191.8 191.8 74 141.93 percent of total billed charges 191.8 93 155.36 percent of total billed charges 191.8 191.8 other OPPS APC 191.8 191.8 other OPPS APC 191.8 27.63 52.99 percent of total billed charges 191.8 191.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 6.0X20 SUP-99-03420 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 6.0X60 SUP-99-03421 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 6.0X180 SUP-99-03422 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - WALLSTENT 12X40 SUP-99-03423 CDM C1876 HCPCS 0278 RC outpatient 2985 2985 2985 57 1701.45 percent of total billed charges 2985 93 2417.85 percent of total billed charges 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 51 1522.35 percent of total billed charges 2985 2985 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - WALLSTENT 14X40 SUP-99-03424 CDM C1876 HCPCS 0278 RC outpatient 2985 2985 2985 57 1701.45 percent of total billed charges 2985 93 2417.85 percent of total billed charges 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 51 1522.35 percent of total billed charges 2985 2985 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - WALLSTENT 16X40 SUP-99-03425 CDM C1876 HCPCS 0278 RC outpatient 2985 2985 2985 57 1701.45 percent of total billed charges 2985 93 2417.85 percent of total billed charges 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 51 1522.35 percent of total billed charges 2985 2985 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - WALLSTENT 18X40 SUP-99-03426 CDM C1876 HCPCS 0278 RC outpatient 2985 2985 2985 57 1701.45 percent of total billed charges 2985 93 2417.85 percent of total billed charges 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2985 other OPPS APC 2985 51 1522.35 percent of total billed charges 2985 2985 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 5.0X40X150 SUP-99-03427 CDM C1725 HCPCS 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 5.0X180 SUP-99-03428 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 5.0X20 SUP-99-03429 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 3.0X18 SUP-99-03430 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 3.0X22 SUP-99-03431 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 5.0X100 SUP-99-03432 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 4.5X22 SUP-99-03433 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 5.0X22 SUP-99-03434 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 3.5X18 SUP-99-03435 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 5.0X15 SUP-99-03436 CDM C1725 HCPCS 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 5.0X40 SUP-99-03437 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 4.0X60 SUP-99-03438 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.5X15 SUP-99-03439 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.5X8 SUP-99-03440 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.5X18 SUP-99-03441 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - METACROSS 6.0X40 OTW SUP-99-03442 CDM C1725 HCPCS 0272 RC outpatient 542.5 542.5 542.5 74 401.45 percent of total billed charges 542.5 93 439.43 percent of total billed charges 542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.5 other OPPS APC 542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.5 other OPPS APC 542.5 27.63 149.89 percent of total billed charges 542.5 542.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - METACROSS 6.0X80 OTW SUP-99-03443 CDM C1725 HCPCS 0272 RC outpatient 542.5 542.5 542.5 74 401.45 percent of total billed charges 542.5 93 439.43 percent of total billed charges 542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.5 other OPPS APC 542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.5 other OPPS APC 542.5 27.63 149.89 percent of total billed charges 542.5 542.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CROSSTELLA 2.0X20 OTW SUP-99-03444 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CROSSTELLA 2.0X20 OTW 90CM SUP-99-03445 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 5.0X200 SUP-99-03446 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 5.0X80 SUP-99-03447 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 3.5X26 SUP-99-03448 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.75X22 SUP-99-03449 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 3.5X30 SUP-99-03450 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 6.0X120 SUP-99-03451 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 6F - PRELUDE IDEAL - SLENDER SUP-99-03452 CDM C1894 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 6X200 SUP-99-03453 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 5X100 SUP-99-03454 CDM C1725 HCPCS 0272 RC outpatient 570.5 570.5 570.5 74 422.17 percent of total billed charges 570.5 93 462.11 percent of total billed charges 570.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 570.5 other OPPS APC 570.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 570.5 other OPPS APC 570.5 27.63 157.63 percent of total billed charges 570.5 570.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 3.5X15 SUP-99-03456 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 6.0X200 SUP-99-03457 CDM C1725 HCPCS 0272 RC outpatient 1266 1266 1266 74 936.84 percent of total billed charges 1266 93 1025.46 percent of total billed charges 1266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1266 other OPPS APC 1266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1266 other OPPS APC 1266 27.63 349.8 percent of total billed charges 1266 1266 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 6X200 SUP-99-03458 CDM C1876 HCPCS 0278 RC outpatient 3750 3750 3750 57 2137.5 percent of total billed charges 3750 93 3037.5 percent of total billed charges 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3750 other OPPS APC 3750 51 1912.5 percent of total billed charges 3750 3750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 3.0X40 SUP-99-03459 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JL 3.5 6F 125CM SUP-99-03460 CDM 0272 RC outpatient 38.36 38.36 38.36 74 28.39 percent of total billed charges 38.36 93 31.07 percent of total billed charges 38.36 38.36 other OPPS APC 38.36 38.36 other OPPS APC 38.36 27.63 10.6 percent of total billed charges 38.36 38.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JR 4.0 6F 125CM SUP-99-03461 CDM 0272 RC outpatient 38.36 38.36 38.36 74 28.39 percent of total billed charges 38.36 93 31.07 percent of total billed charges 38.36 38.36 other OPPS APC 38.36 38.36 other OPPS APC 38.36 27.63 10.6 percent of total billed charges 38.36 38.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 3.5X8 SUP-99-03462 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.75X26 SUP-99-03463 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 5.0X150 SUP-99-03466 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 14.0X40 SUP-99-03467 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 3.0X15 SUP-99-03468 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 3.0X12 SUP-99-03469 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 3.0X12 SUP-99-03470 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 5.0X120 SUP-99-03471 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 3.5X22 SUP-99-03472 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 4.0X22 SUP-99-03473 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 1.5X120X150 SUP-99-03474 CDM C1725 HCPCS 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 4X100 SUP-99-03475 CDM C1725 HCPCS 0272 RC outpatient 570.5 570.5 570.5 74 422.17 percent of total billed charges 570.5 93 462.11 percent of total billed charges 570.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 570.5 other OPPS APC 570.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 570.5 other OPPS APC 570.5 27.63 157.63 percent of total billed charges 570.5 570.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.75X8 SUP-99-03476 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.75X18 SUP-99-03477 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 4.0X26 SUP-99-03478 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 4.0X12 SUP-99-03479 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 3.0X26 SUP-99-03480 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 5.0X60 SUP-99-03481 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - TREK OTW 2.5X12 SUP-99-03482 CDM C1725 HCPCS 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - TREK OTW 2.5X15 SUP-99-03483 CDM C1725 HCPCS 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - TREK OTW 2.5X20 SUP-99-03484 CDM C1725 HCPCS 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 6X60X75 SUP-99-03485 CDM C2623 HCPCS 0272 RC outpatient 4125 4125 4125 74 3052.5 percent of total billed charges 4125 93 3341.25 percent of total billed charges 4125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4125 other OPPS APC 4125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4125 other OPPS APC 4125 27.63 1139.74 percent of total billed charges 4125 4125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 5.5X180 SUP-99-03486 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 3.0X34 SUP-99-03487 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 3.0X38 SUP-99-03488 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 1.5X6 SUP-99-03489 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.75X30 SUP-99-03490 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 3.5X12 SUP-99-03491 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 5X100 SUP-99-03492 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 5X120 SUP-99-03493 CDM C1876 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 4.0X210 SUP-99-03494 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS 2.5X40 SUP-99-03496 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PACIFIC EXTREME 4X200 SUP-99-03497 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 5X200 SUP-99-03498 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 6X150 SUP-99-03499 CDM C1876 HCPCS 0278 RC outpatient 5762.5 5762.5 5762.5 57 3284.63 percent of total billed charges 5762.5 93 4667.63 percent of total billed charges 5762.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5762.5 other OPPS APC 5762.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5762.5 other OPPS APC 5762.5 51 2938.88 percent of total billed charges 5762.5 5762.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - METACROSS 6.0X150 OTW SUP-99-03500 CDM C1725 HCPCS 0272 RC outpatient 542.5 542.5 542.5 74 401.45 percent of total billed charges 542.5 93 439.43 percent of total billed charges 542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.5 other OPPS APC 542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.5 other OPPS APC 542.5 27.63 149.89 percent of total billed charges 542.5 542.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.0X6 SUP-99-03501 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 4.0X18 SUP-99-03502 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 2.0X150 SUP-99-03503 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 1.5X40 SUP-99-03504 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 1.5X20 SUP-99-03505 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 4.0X20 SUP-99-03506 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 XT 1.2X12 SUP-99-03507 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - IN.PACT ADMIRAL 4X150 SUP-99-03508 CDM C2623 HCPCS 0272 RC outpatient 4100 4100 4100 74 3034 percent of total billed charges 4100 93 3321 percent of total billed charges 4100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4100 other OPPS APC 4100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4100 other OPPS APC 4100 27.63 1132.83 percent of total billed charges 4100 4100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - IN.PACT ADMIRAL 5X150 SUP-99-03509 CDM C2623 HCPCS 0272 RC outpatient 4100 4100 4100 74 3034 percent of total billed charges 4100 93 3321 percent of total billed charges 4100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4100 other OPPS APC 4100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4100 other OPPS APC 4100 27.63 1132.83 percent of total billed charges 4100 4100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 5.0X200 SUP-99-03510 CDM C1725 HCPCS 0272 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RE-ENTRY - PIONEER PLUS SUP-99-03511 CDM C1887 HCPCS 0272 RC outpatient 7200 7200 7200 74 5328 percent of total billed charges 7200 93 5832 percent of total billed charges 7200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7200 other OPPS APC 7200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7200 other OPPS APC 7200 27.63 1989.36 percent of total billed charges 7200 7200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 3X20 SUP-99-03512 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 6X40 SUP-99-03513 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 6X120 SUP-99-03514 CDM C1876 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.25X6 SUP-99-03515 CDM C1725 HCPCS 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 5.0X26 SUP-99-03517 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 4.0X15 SUP-99-03519 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 4.0X150 SUP-99-03520 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 6.0X40 SUP-99-03521 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 7X40 SUP-99-03522 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 7X20 SUP-99-03523 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 5.5X60 SUP-99-03524 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 2.0X60 SUP-99-03525 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 2.0X210 SUP-99-03526 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 2.5X20 SUP-99-03527 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 6X100 SUP-99-03528 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 3.0X30 SUP-99-03529 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.75X15 SUP-99-03530 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 2.5X40 SUP-99-03531 CDM C1725 HCPCS 0272 RC outpatient 1158 1158 1158 74 856.92 percent of total billed charges 1158 93 937.98 percent of total billed charges 1158 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1158 other OPPS APC 1158 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1158 other OPPS APC 1158 27.63 319.96 percent of total billed charges 1158 1158 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 XT 1.5X20 SUP-99-03532 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 XT 2.0X12 SUP-99-03533 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 5.0X150 SUP-99-03534 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.5X38 SUP-99-03537 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - AMPLATZ XSTIFF 145CM SUP-99-03538 CDM C1769 HCPCS 0272 RC outpatient 109.96 109.96 109.96 74 81.37 percent of total billed charges 109.96 93 89.07 percent of total billed charges 109.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 109.96 other OPPS APC 109.96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 109.96 other OPPS APC 109.96 27.63 30.38 percent of total billed charges 109.96 109.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - AMPLATZ XSTIFF 3MMJ 145CM SUP-99-03539 CDM C1769 HCPCS 0272 RC outpatient 73.72 73.72 73.72 74 54.55 percent of total billed charges 73.72 93 59.71 percent of total billed charges 73.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 73.72 other OPPS APC 73.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 73.72 other OPPS APC 73.72 27.63 20.37 percent of total billed charges 73.72 73.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - ROADRUNNER 0.035X260 SUP-99-03540 CDM C1769 HCPCS 0272 RC outpatient 152 152 152 74 112.48 percent of total billed charges 152 93 123.12 percent of total billed charges 152 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152 other OPPS APC 152 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 152 other OPPS APC 152 27.63 42 percent of total billed charges 152 152 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 6X37 SUP-99-03541 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.5X12 SUP-99-03543 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 5.5X80 SUP-99-03544 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.5X22 SUP-99-03545 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 3.0X8 SUP-99-03546 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 8X80 SUP-99-03547 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE-GLIDE SPLASH.035X260 ANGLED STIFF SUP-99-03548 CDM C1769 HCPCS 0272 RC outpatient 595 595 595 74 440.3 percent of total billed charges 595 93 481.95 percent of total billed charges 595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 595 other OPPS APC 595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 595 other OPPS APC 595 27.63 164.4 percent of total billed charges 595 595 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 5.0X20 SUP-99-03549 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.75X12 SUP-99-03550 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GLIDEWIRE .035X400 STD STR SUP-99-03551 CDM C1769 HCPCS 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GLIDEWIRE .035X400 STD ANG SUP-99-03552 CDM C1769 HCPCS 0272 RC outpatient 297.5 297.5 297.5 74 220.15 percent of total billed charges 297.5 93 240.98 percent of total billed charges 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 297.5 other OPPS APC 297.5 27.63 82.2 percent of total billed charges 297.5 297.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GLIDEWIRE .035X400 STF ANG SUP-99-03553 CDM C1769 HCPCS 0272 RC outpatient 333.2 333.2 333.2 74 246.57 percent of total billed charges 333.2 93 269.89 percent of total billed charges 333.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 333.2 other OPPS APC 333.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 333.2 other OPPS APC 333.2 27.63 92.06 percent of total billed charges 333.2 333.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GLIDEWIRE .035X400 STF STR SUP-99-03554 CDM C1769 HCPCS 0272 RC outpatient 333.2 333.2 333.2 74 246.57 percent of total billed charges 333.2 93 269.89 percent of total billed charges 333.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 333.2 other OPPS APC 333.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 333.2 other OPPS APC 333.2 27.63 92.06 percent of total billed charges 333.2 333.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - DESTINATION SLENDER 119CM SUP-99-03555 CDM C1894 HCPCS 0272 RC outpatient 852 852 852 74 630.48 percent of total billed charges 852 93 690.12 percent of total billed charges 852 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 852 other OPPS APC 852 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 852 other OPPS APC 852 27.63 235.41 percent of total billed charges 852 852 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - IN.PACT ADMIRAL 6X150 SUP-99-03556 CDM C2623 HCPCS 0272 RC outpatient 4475 4475 4475 74 3311.5 percent of total billed charges 4475 93 3624.75 percent of total billed charges 4475 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4475 other OPPS APC 4475 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4475 other OPPS APC 4475 27.63 1236.44 percent of total billed charges 4475 4475 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 5.0X60 SUP-99-03557 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - IN.PACT ADMIRAL 6X60 SUP-99-03558 CDM C2623 HCPCS 0272 RC outpatient 3725 3725 3725 74 2756.5 percent of total billed charges 3725 93 3017.25 percent of total billed charges 3725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3725 other OPPS APC 3725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3725 other OPPS APC 3725 27.63 1029.22 percent of total billed charges 3725 3725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 7X30 SUP-99-03559 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - BERENSTEIN 5F X 125 SUP-99-03560 CDM 0272 RC outpatient 48 48 48 74 35.52 percent of total billed charges 48 93 38.88 percent of total billed charges 48 48 other OPPS APC 48 48 other OPPS APC 48 27.63 13.26 percent of total billed charges 48 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - BERENSTEIN 4F X 125 SUP-99-03561 CDM 0272 RC outpatient 48 48 48 74 35.52 percent of total billed charges 48 93 38.88 percent of total billed charges 48 48 other OPPS APC 48 48 other OPPS APC 48 27.63 13.26 percent of total billed charges 48 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 6F X 23CM SUP-99-03562 CDM C1894 HCPCS 0272 RC outpatient 52.52 52.52 52.52 74 38.86 percent of total billed charges 52.52 93 42.54 percent of total billed charges 52.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52.52 other OPPS APC 52.52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52.52 other OPPS APC 52.52 27.63 14.51 percent of total billed charges 52.52 52.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - MULTIPURPOSE A-2 6F X 125CM SUP-99-03563 CDM 0272 RC outpatient 166 166 166 74 122.84 percent of total billed charges 166 93 134.46 percent of total billed charges 166 166 other OPPS APC 166 166 other OPPS APC 166 27.63 45.87 percent of total billed charges 166 166 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - MULTIPURPOSE B-2 6F X 125CM SUP-99-03564 CDM 0272 RC outpatient 166 166 166 74 122.84 percent of total billed charges 166 93 134.46 percent of total billed charges 166 166 other OPPS APC 166 166 other OPPS APC 166 27.63 45.87 percent of total billed charges 166 166 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 6X100 SUP-99-03565 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 2.0X100 SUP-99-03566 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 14 3.0X20 SUP-99-03567 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CROSSTELLA 4.0X40 OTW SUP-99-03568 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 3.0X60 SUP-99-03569 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 6X80 SUP-99-03570 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 7X40 150CM SUP-99-03571 CDM C1876 HCPCS 0278 RC outpatient 2235 2235 2235 57 1273.95 percent of total billed charges 2235 93 1810.35 percent of total billed charges 2235 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2235 other OPPS APC 2235 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2235 other OPPS APC 2235 51 1139.85 percent of total billed charges 2235 2235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 7X20 150CM SUP-99-03572 CDM C1876 HCPCS 0278 RC outpatient 2235 2235 2235 57 1273.95 percent of total billed charges 2235 93 1810.35 percent of total billed charges 2235 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2235 other OPPS APC 2235 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2235 other OPPS APC 2235 51 1139.85 percent of total billed charges 2235 2235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 6X60 150CM SUP-99-03573 CDM C1876 HCPCS 0278 RC outpatient 2235 2235 2235 57 1273.95 percent of total billed charges 2235 93 1810.35 percent of total billed charges 2235 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2235 other OPPS APC 2235 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2235 other OPPS APC 2235 51 1139.85 percent of total billed charges 2235 2235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 4X120 SUP-99-03574 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - IN.PACT ADMIRAL 6X80 SUP-99-03575 CDM C2623 HCPCS 0272 RC outpatient 3725 3725 3725 74 2756.5 percent of total billed charges 3725 93 3017.25 percent of total billed charges 3725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3725 other OPPS APC 3725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3725 other OPPS APC 3725 27.63 1029.22 percent of total billed charges 3725 3725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ELUVIA DES 6X40 SUP-99-03576 CDM C1874 HCPCS 0278 RC outpatient 4987.5 4987.5 4987.5 57 2842.88 percent of total billed charges 4987.5 93 4039.88 percent of total billed charges 4987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4987.5 other OPPS APC 4987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4987.5 other OPPS APC 4987.5 51 2543.63 percent of total billed charges 4987.5 4987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ELUVIA DES 6X60 SUP-99-03577 CDM C1874 HCPCS 0278 RC outpatient 5737.5 5737.5 5737.5 57 3270.38 percent of total billed charges 5737.5 93 4647.38 percent of total billed charges 5737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5737.5 other OPPS APC 5737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5737.5 other OPPS APC 5737.5 51 2926.13 percent of total billed charges 5737.5 5737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ELUVIA DES 6X80 SUP-99-03578 CDM C1874 HCPCS 0278 RC outpatient 5737.5 5737.5 5737.5 57 3270.38 percent of total billed charges 5737.5 93 4647.38 percent of total billed charges 5737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5737.5 other OPPS APC 5737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5737.5 other OPPS APC 5737.5 51 2926.13 percent of total billed charges 5737.5 5737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ELUVIA DES 6X100 SUP-99-03579 CDM C1874 HCPCS 0278 RC outpatient 6487.5 6487.5 6487.5 57 3697.88 percent of total billed charges 6487.5 93 5254.88 percent of total billed charges 6487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6487.5 other OPPS APC 6487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6487.5 other OPPS APC 6487.5 51 3308.63 percent of total billed charges 6487.5 6487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ELUVIA DES 6X120 SUP-99-03580 CDM C1874 HCPCS 0278 RC outpatient 7237.5 7237.5 7237.5 57 4125.38 percent of total billed charges 7237.5 93 5862.38 percent of total billed charges 7237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7237.5 other OPPS APC 7237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7237.5 other OPPS APC 7237.5 51 3691.13 percent of total billed charges 7237.5 7237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ELUVIA DES 7X40 SUP-99-03581 CDM C1874 HCPCS 0278 RC outpatient 4987.5 4987.5 4987.5 57 2842.88 percent of total billed charges 4987.5 93 4039.88 percent of total billed charges 4987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4987.5 other OPPS APC 4987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4987.5 other OPPS APC 4987.5 51 2543.63 percent of total billed charges 4987.5 4987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ELUVIA DES 7X60 SUP-99-03582 CDM C1874 HCPCS 0278 RC outpatient 5737.5 5737.5 5737.5 57 3270.38 percent of total billed charges 5737.5 93 4647.38 percent of total billed charges 5737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5737.5 other OPPS APC 5737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5737.5 other OPPS APC 5737.5 51 2926.13 percent of total billed charges 5737.5 5737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ELUVIA DES 7 X 80 SUP-99-03583 CDM C1874 HCPCS 0278 RC outpatient 6487.5 6487.5 6487.5 57 3697.88 percent of total billed charges 6487.5 93 5254.88 percent of total billed charges 6487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6487.5 other OPPS APC 6487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6487.5 other OPPS APC 6487.5 51 3308.63 percent of total billed charges 6487.5 6487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ELUVIA DES 7X100 SUP-99-03584 CDM C1874 HCPCS 0278 RC outpatient 6487.5 6487.5 6487.5 57 3697.88 percent of total billed charges 6487.5 93 5254.88 percent of total billed charges 6487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6487.5 other OPPS APC 6487.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6487.5 other OPPS APC 6487.5 51 3308.63 percent of total billed charges 6487.5 6487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ELUVIA DES 7X120 SUP-99-03585 CDM C1874 HCPCS 0278 RC outpatient 7237.5 7237.5 7237.5 57 4125.38 percent of total billed charges 7237.5 93 5862.38 percent of total billed charges 7237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7237.5 other OPPS APC 7237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7237.5 other OPPS APC 7237.5 51 3691.13 percent of total billed charges 7237.5 7237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 5.0X15 SUP-99-03586 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 8.0X80 SUP-99-03587 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 4.0X150X150 SUP-99-03588 CDM C1725 HCPCS 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 5.0X150X150 SUP-99-03589 CDM C1725 HCPCS 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 035 6.0X200X130 SUP-99-03590 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 5X120 SUP-99-03591 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 4.0X38 SUP-99-03592 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 6X150X150 SUP-99-03593 CDM C1876 HCPCS 0278 RC outpatient 2535 2535 2535 57 1444.95 percent of total billed charges 2535 93 2053.35 percent of total billed charges 2535 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2535 other OPPS APC 2535 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2535 other OPPS APC 2535 51 1292.85 percent of total billed charges 2535 2535 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 5.0X120 SUP-99-03594 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 8X20 SUP-99-03595 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ATLAS 18X40 SUP-99-03596 CDM C1725 HCPCS 0272 RC outpatient 735 735 735 74 543.9 percent of total billed charges 735 93 595.35 percent of total billed charges 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 27.63 203.08 percent of total billed charges 735 735 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 6X27 SUP-99-03597 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 8X37X80 SUP-99-03598 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 035 7.0X40X130 SUP-99-03599 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 4.0X220X150 SUP-99-03600 CDM C1725 HCPCS 0272 RC outpatient 682.5 682.5 682.5 74 505.05 percent of total billed charges 682.5 93 552.83 percent of total billed charges 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 682.5 other OPPS APC 682.5 27.63 188.57 percent of total billed charges 682.5 682.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 5.0X8 SUP-99-03603 CDM C1725 HCPCS 0272 RC outpatient 245 245 245 74 181.3 percent of total billed charges 245 93 198.45 percent of total billed charges 245 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 245 other OPPS APC 245 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 245 other OPPS APC 245 27.63 67.69 percent of total billed charges 245 245 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 2.0X20 SUP-99-03606 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - METACROSS R2P 3.0X60 OTW SUP-99-03607 CDM C1725 HCPCS 0272 RC outpatient 542.5 542.5 542.5 74 401.45 percent of total billed charges 542.5 93 439.43 percent of total billed charges 542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.5 other OPPS APC 542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 542.5 other OPPS APC 542.5 27.63 149.89 percent of total billed charges 542.5 542.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 4.0X100 SUP-99-03608 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 3.0X20 SUP-99-03609 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 5.0X100 SUP-99-03610 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.5X26 SUP-99-03611 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ATLAS 24X40 SUP-99-03612 CDM C1725 HCPCS 0272 RC outpatient 1800 1800 1800 74 1332 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 27.63 497.34 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 6X80 SUP-99-03613 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 5X80 SUP-99-03614 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - TRAILBLAZER - 035X135 ANGLED SUP-99-03615 CDM C1887 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - TRAILBLAZER .035 X 150 ANGLED SUP-99-03616 CDM C1887 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - TRAILBLAZER - 014X150 ANGLED SUP-99-03617 CDM C1887 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRASCORE 6X100 SUP-99-03618 CDM C1725 HCPCS 0272 RC outpatient 2025 2025 2025 74 1498.5 percent of total billed charges 2025 93 1640.25 percent of total billed charges 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 27.63 559.51 percent of total billed charges 2025 2025 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRASCORE 5X100 SUP-99-03619 CDM C1725 HCPCS 0272 RC outpatient 2025 2025 2025 74 1498.5 percent of total billed charges 2025 93 1640.25 percent of total billed charges 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 27.63 559.51 percent of total billed charges 2025 2025 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SUPERA 6.5X80 SUP-99-03620 CDM C1876 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 8.0X60 SUP-99-03621 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 9.0X60 SUP-99-03622 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 6.0X60 SUP-99-03623 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 035 8.0X80X75 SUP-99-03625 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - OMNILINK ELITE .035 10.0X59 SUP-99-03626 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - METACROSS R2P 6.0X200 OTW SUP-99-03627 CDM C1725 HCPCS 0272 RC outpatient 1083.75 1083.75 1083.75 74 801.98 percent of total billed charges 1083.75 93 877.84 percent of total billed charges 1083.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1083.75 other OPPS APC 1083.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1083.75 other OPPS APC 1083.75 27.63 299.44 percent of total billed charges 1083.75 1083.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 6X20 SUP-99-03628 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRASCORE 6X150 SUP-99-03629 CDM C1725 HCPCS 0272 RC outpatient 2025 2025 2025 74 1498.5 percent of total billed charges 2025 93 1640.25 percent of total billed charges 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 27.63 559.51 percent of total billed charges 2025 2025 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 4.0X8 SUP-99-03630 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 3.5X20 SUP-99-03631 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - IN.PACT ADMIRAL 4X60 SUP-99-03632 CDM C2623 HCPCS 0272 RC outpatient 3725 3725 3725 74 2756.5 percent of total billed charges 3725 93 3017.25 percent of total billed charges 3725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3725 other OPPS APC 3725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3725 other OPPS APC 3725 27.63 1029.22 percent of total billed charges 3725 3725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 3.5X60 SUP-99-03633 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ATLAS 12X40 SUP-99-03634 CDM C1725 HCPCS 0272 RC outpatient 735 735 735 74 543.9 percent of total billed charges 735 93 595.35 percent of total billed charges 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 735 other OPPS APC 735 27.63 203.08 percent of total billed charges 735 735 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 5.0X40 SUP-99-03635 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.25X8 SUP-99-03636 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - PINNACLE DESTINATION 7F 90CM SUP-99-03637 CDM C1894 HCPCS 0272 RC outpatient 392 392 392 74 290.08 percent of total billed charges 392 93 317.52 percent of total billed charges 392 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392 other OPPS APC 392 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 392 other OPPS APC 392 27.63 108.31 percent of total billed charges 392 392 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 035 5.0X200X130 SUP-99-03638 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRASCORE 6X200 SUP-99-03639 CDM C1725 HCPCS 0272 RC outpatient 2025 2025 2025 74 1498.5 percent of total billed charges 2025 93 1640.25 percent of total billed charges 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 27.63 559.51 percent of total billed charges 2025 2025 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 3.0X150X150 SUP-99-03640 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - OMNILINK ELITE .035 10.0X39 SUP-99-03641 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - IN.PACT ADMIRAL 4X40 SUP-99-03642 CDM C2623 HCPCS 0272 RC outpatient 3125 3125 3125 74 2312.5 percent of total billed charges 3125 93 2531.25 percent of total billed charges 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 27.63 863.44 percent of total billed charges 3125 3125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - IN.PACT ADMIRAL 6X40 SUP-99-03643 CDM C2623 HCPCS 0272 RC outpatient 3125 3125 3125 74 2312.5 percent of total billed charges 3125 93 2531.25 percent of total billed charges 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3125 other OPPS APC 3125 27.63 863.44 percent of total billed charges 3125 3125 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 6X60 SUP-99-03644 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 4.0X40 SUP-99-03645 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 5X220 SUP-99-03646 CDM C2623 HCPCS 0272 RC outpatient 4500 4500 4500 74 3330 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 27.63 1243.35 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 6X60 SUP-99-03647 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 8F JR4 SUP-99-03648 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 8F MP1 SUP-99-03649 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE-8F MPST SUP-99-03650 CDM C1887 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 8F MB1 SUP-99-03651 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 8X40 SUP-99-03652 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 3.5X210 SUP-99-03653 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 7X150 SUP-99-03654 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 7X120 SUP-99-03655 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 4.0X120 SUP-99-03656 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 5.5X100 SUP-99-03657 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.75X38 SUP-99-03658 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 3.5X34 SUP-99-03663 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 4.5X12 SUP-99-03665 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 6.0X120 SUP-99-03669 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS 2.5X210 SUP-99-03674 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 4.0X80 SUP-99-03675 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 8X60 SUP-99-03677 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 7X200 SUP-99-03678 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 5.0X220X150 SUP-99-03679 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 9X40 SUP-99-03680 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 035 7.0X150X130 SUP-99-03682 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER - CELECT PLATINUM - FEMORAL SUP-99-03683 CDM C1880 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 4X220 SUP-99-03684 CDM C2623 HCPCS 0272 RC outpatient 4500 4500 4500 74 3330 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4500 other OPPS APC 4500 27.63 1243.35 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 8X150X150 SUP-99-03685 CDM C1876 HCPCS 0278 RC outpatient 2535 2535 2535 57 1444.95 percent of total billed charges 2535 93 2053.35 percent of total billed charges 2535 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2535 other OPPS APC 2535 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2535 other OPPS APC 2535 51 1292.85 percent of total billed charges 2535 2535 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 4.5X18 SUP-99-03686 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - RIM 5F (MERIT) SUP-99-03687 CDM 0272 RC outpatient 48 48 48 74 35.52 percent of total billed charges 48 93 38.88 percent of total billed charges 48 48 other OPPS APC 48 48 other OPPS APC 48 27.63 13.26 percent of total billed charges 48 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 7X20 SUP-99-03689 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRASCORE 6X20 SUP-99-03690 CDM C1725 HCPCS 0272 RC outpatient 2025 2025 2025 74 1498.5 percent of total billed charges 2025 93 1640.25 percent of total billed charges 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 27.63 559.51 percent of total billed charges 2025 2025 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 9X30 SUP-99-03691 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 9X30 SUP-99-03692 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 10X20 SUP-99-03693 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 10X30 SUP-99-03694 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 10X37 SUP-99-03695 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 035 12X40X75 SUP-99-03696 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 3.5X22 SUP-99-03697 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 4.0X15 SUP-99-03698 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 3.0X80 SUP-99-03699 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRASCORE 5X150 SUP-99-03700 CDM C1725 HCPCS 0272 RC outpatient 2250 2250 2250 74 1665 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 27.63 621.68 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 2.25X15 SUP-99-03702 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 2.5X15 SUP-99-03703 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 6.0X20 SUP-99-03706 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INNOVA 6X120 SUP-99-03709 CDM C1876 HCPCS 0278 RC outpatient 2706 2706 2706 57 1542.42 percent of total billed charges 2706 93 2191.86 percent of total billed charges 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 51 1380.06 percent of total billed charges 2706 2706 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 3X200 SUP-99-03711 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 7X37 SUP-99-03712 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 10X27 SUP-99-03713 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 7X60 SUP-99-03714 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 7X30 SUP-99-03715 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INNOVA 5X60 SUP-99-03716 CDM C1876 HCPCS 0278 RC outpatient 2706 2706 2706 57 1542.42 percent of total billed charges 2706 93 2191.86 percent of total billed charges 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2706 other OPPS APC 2706 51 1380.06 percent of total billed charges 2706 2706 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRASCORE 4X20 SUP-99-03717 CDM C1725 HCPCS 0272 RC outpatient 2025 2025 2025 74 1498.5 percent of total billed charges 2025 93 1640.25 percent of total billed charges 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 27.63 559.51 percent of total billed charges 2025 2025 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 2.5X100 SUP-99-03718 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - METACROSS R2P 4.0X100 RX SUP-99-03719 CDM C1725 HCPCS 0272 RC outpatient 1083.75 1083.75 1083.75 74 801.98 percent of total billed charges 1083.75 93 877.84 percent of total billed charges 1083.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1083.75 other OPPS APC 1083.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1083.75 other OPPS APC 1083.75 27.63 299.44 percent of total billed charges 1083.75 1083.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATHERECTOMY - 1.25 SOLID CROWN 200CM SUP-99-03722 CDM C1724 HCPCS 0272 RC outpatient 8987.5 8987.5 8987.5 74 6650.75 percent of total billed charges 8987.5 93 7279.88 percent of total billed charges 8987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8987.5 other OPPS APC 8987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8987.5 other OPPS APC 8987.5 27.63 2483.25 percent of total billed charges 8987.5 8987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATHERECTOMY - 1.50 SOLID CROWN 200CM SUP-99-03723 CDM C1724 HCPCS 0272 RC outpatient 8987.5 8987.5 8987.5 74 6650.75 percent of total billed charges 8987.5 93 7279.88 percent of total billed charges 8987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8987.5 other OPPS APC 8987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8987.5 other OPPS APC 8987.5 27.63 2483.25 percent of total billed charges 8987.5 8987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATHERECTOMY - 1.75 SOLID CROWN 180CM SUP-99-03724 CDM C1724 HCPCS 0272 RC outpatient 8987.5 8987.5 8987.5 74 6650.75 percent of total billed charges 8987.5 93 7279.88 percent of total billed charges 8987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8987.5 other OPPS APC 8987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8987.5 other OPPS APC 8987.5 27.63 2483.25 percent of total billed charges 8987.5 8987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATHERECTOMY - VIPERWIRE ADVANCE 475CM SUP-99-03725 CDM C1769 HCPCS 0272 RC outpatient 665 665 665 74 492.1 percent of total billed charges 665 93 538.65 percent of total billed charges 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 665 other OPPS APC 665 27.63 183.74 percent of total billed charges 665 665 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - VIPERCATH XC STRAIGHT SUP-99-03726 CDM C1887 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - VIPERCATH XC ANGLED SUP-99-03727 CDM C1887 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 1.5X8 SUP-99-03736 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SUPERA 6.0X100 SUP-99-03737 CDM C1876 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 2.0 X 6 SUP-99-03739 CDM C1725 HCPCS 0272 RC outpatient 393.75 393.75 393.75 74 291.38 percent of total billed charges 393.75 93 318.94 percent of total billed charges 393.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 393.75 other OPPS APC 393.75 393.75 other OPPS APC 393.75 27.63 108.79 percent of total billed charges 393.75 393.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 4.0X34 SUP-99-03740 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRASCORE 4X100 SUP-99-03741 CDM C1725 HCPCS 0272 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.5X34 SUP-99-03742 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.5X30 SUP-99-03743 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.25X12 SUP-99-03744 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.25X15 SUP-99-03745 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 3.5X38 SUP-99-03746 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 5.0X80 SUP-99-03747 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRASCORE 4X40 SUP-99-03749 CDM C1725 HCPCS 0272 RC outpatient 2025 2025 2025 74 1498.5 percent of total billed charges 2025 93 1640.25 percent of total billed charges 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 27.63 559.51 percent of total billed charges 2025 2025 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 4.5X20 SUP-99-03750 CDM C1725 HCPCS 0272 RC outpatient 332.5 332.5 332.5 74 246.05 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 27.63 91.87 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 5X20 SUP-99-03751 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOSURE DEVICE - MYNX 5F GRIP SUP-99-03754 CDM C1762 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOSURE DEVICE - MYNX 6/7 GRIP SUP-99-03755 CDM C1762 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRASCORE 6X40 SUP-99-03756 CDM C1725 HCPCS 0272 RC outpatient 2025 2025 2025 74 1498.5 percent of total billed charges 2025 93 1640.25 percent of total billed charges 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 27.63 559.51 percent of total billed charges 2025 2025 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.25X18 SUP-99-03758 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - GLIDECATH 4F 150CM MULTICURVE SUP-99-03761 CDM C1887 HCPCS 0272 RC outpatient 717 717 717 74 530.58 percent of total billed charges 717 93 580.77 percent of total billed charges 717 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 717 other OPPS APC 717 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 717 other OPPS APC 717 27.63 198.11 percent of total billed charges 717 717 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 4.5X26 SUP-99-03762 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER - CELECT PLATINUM - JUGULAR SUP-99-03766 CDM C1880 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MUSTANG OTW 9X20X75 SUP-99-03769 CDM C1725 HCPCS 0272 RC outpatient 577.5 577.5 577.5 74 427.35 percent of total billed charges 577.5 93 467.78 percent of total billed charges 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 577.5 other OPPS APC 577.5 27.63 159.56 percent of total billed charges 577.5 577.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IVUS - OPTICROSS 35 PERIPHERAL SUP-99-03770 CDM C1753 HCPCS 0272 RC outpatient 2550 2550 2550 74 1887 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 27.63 704.57 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER - RETREIVAL - CLOVERSNARE SUP-99-03771 CDM C1773 HCPCS 0272 RC outpatient 1905 1905 1905 74 1409.7 percent of total billed charges 1905 93 1543.05 percent of total billed charges 1905 1905 other OPPS APC 1905 1905 other OPPS APC 1905 27.63 526.35 percent of total billed charges 1905 1905 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 4.5 X 8 SUP-99-03774 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 4.0X30 SUP-99-03776 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.75X34 SUP-99-03778 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - SAFESHEATH 10.5 F 25CM SUP-99-03779 CDM C1894 HCPCS 0272 RC outpatient 146 146 146 74 108.04 percent of total billed charges 146 93 118.26 percent of total billed charges 146 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 146 other OPPS APC 146 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 146 other OPPS APC 146 27.63 40.34 percent of total billed charges 146 146 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - SAFESHEATH 10.5 F 13CM SUP-99-03780 CDM C1894 HCPCS 0272 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130 other OPPS APC 130 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 2.5 X 6 SUP-99-03781 CDM C1725 HCPCS 0272 RC outpatient 332.5 332.5 332.5 74 246.05 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 27.63 91.87 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 3.0 X 6 SUP-99-03782 CDM C1725 HCPCS 0272 RC outpatient 332.5 332.5 332.5 74 246.05 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 27.63 91.87 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RANGER DCB 6X40 SUP-99-03783 CDM C2623 HCPCS 0272 RC outpatient 3375 3375 3375 74 2497.5 percent of total billed charges 3375 93 2733.75 percent of total billed charges 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 27.63 932.51 percent of total billed charges 3375 3375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FFR - COMET II SUP-99-03784 CDM C1769 HCPCS 0272 RC outpatient 2175 2175 2175 74 1609.5 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 27.63 600.95 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TYRX -MEDIUM SUP-99-03785 CDM 0272 RC outpatient 2685 2685 2685 74 1986.9 percent of total billed charges 2685 93 2174.85 percent of total billed charges 2685 2685 other OPPS APC 2685 2685 other OPPS APC 2685 27.63 741.87 percent of total billed charges 2685 2685 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TYRX -LARGE SUP-99-03786 CDM 0272 RC outpatient 2685 2685 2685 74 1986.9 percent of total billed charges 2685 93 2174.85 percent of total billed charges 2685 2685 other OPPS APC 2685 2685 other OPPS APC 2685 27.63 741.87 percent of total billed charges 2685 2685 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INNOVA 8 X 40 SUP-99-03787 CDM C1876 HCPCS 0278 RC outpatient 2925 2925 2925 57 1667.25 percent of total billed charges 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 51 1491.75 percent of total billed charges 2925 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 9X17X80 SUP-99-03788 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OPSENS PRESSURE WIRE SUP-99-03789 CDM C1769 HCPCS 0272 RC outpatient 1815 1815 1815 74 1343.1 percent of total billed charges 1815 93 1470.15 percent of total billed charges 1815 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1815 other OPPS APC 1815 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1815 other OPPS APC 1815 27.63 501.48 percent of total billed charges 1815 1815 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.25X22 SUP-99-03790 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 5.5X120 SUP-99-03791 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 18 5.5X20 SUP-99-03792 CDM C1725 HCPCS 0272 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 10.0X60 SUP-99-03793 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 10.0X80 SUP-99-03794 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 14.0X20 SUP-99-03795 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 4.0X100 SUP-99-03796 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 7.0X80 SUP-99-03797 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 8.0X60 SUP-99-03798 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 8.0X80 SUP-99-03799 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 9.0X60 SUP-99-03800 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ARMADA 35 9.0X80 SUP-99-03801 CDM C1725 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CONQUEST 6X40 SUP-99-03802 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CONQUEST 7X40 SUP-99-03803 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - METACROSS R2P 4.0X100 RX SUP-99-03804 CDM C1725 HCPCS 0272 RC outpatient 1083.75 1083.75 1083.75 74 801.98 percent of total billed charges 1083.75 93 877.84 percent of total billed charges 1083.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1083.75 other OPPS APC 1083.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1083.75 other OPPS APC 1083.75 27.63 299.44 percent of total billed charges 1083.75 1083.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - METACROSS R2P 4.0X60 RX SUP-99-03805 CDM C1725 HCPCS 0272 RC outpatient 1083.75 1083.75 1083.75 74 801.98 percent of total billed charges 1083.75 93 877.84 percent of total billed charges 1083.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1083.75 other OPPS APC 1083.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1083.75 other OPPS APC 1083.75 27.63 299.44 percent of total billed charges 1083.75 1083.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - DORADO 8X4X80 SUP-99-03806 CDM C1725 HCPCS 0272 RC outpatient 840 840 840 74 621.6 percent of total billed charges 840 93 680.4 percent of total billed charges 840 840 other OPPS APC 840 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 840 other OPPS APC 840 27.63 232.09 percent of total billed charges 840 840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 10X40 SUP-99-03807 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 10X60 SUP-99-03808 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 3X100 SUP-99-03809 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 3X120 SUP-99-03810 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 3X150 SUP-99-03811 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 3X40 SUP-99-03812 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 3X60 SUP-99-03813 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 3X80 SUP-99-03814 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 4X150 SUP-99-03815 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 4X200 SUP-99-03816 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 4X20 SUP-99-03817 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 4X40 SUP-99-03818 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 4X60 SUP-99-03819 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 4X80 SUP-99-03820 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 5X150 SUP-99-03821 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 5X20 SUP-99-03822 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 5X30 SUP-99-03823 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 5X40 SUP-99-03824 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 5X60 SUP-99-03825 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 6X120 SUP-99-03826 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 6X150 SUP-99-03827 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 6X30 SUP-99-03828 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 6X40 SUP-99-03829 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 7X100 SUP-99-03830 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 7X120 SUP-99-03831 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 7X40 SUP-99-03832 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 7X60 SUP-99-03833 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 7X80 SUP-99-03834 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 8X30 SUP-99-03835 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 9X60 SUP-99-03836 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EVERCROSS 9X80 SUP-99-03837 CDM C1725 HCPCS 0272 RC outpatient 367.5 367.5 367.5 74 271.95 percent of total billed charges 367.5 93 297.68 percent of total billed charges 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 367.5 other OPPS APC 367.5 27.63 101.54 percent of total billed charges 367.5 367.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - METACROSS RX 7.0X200 SUP-99-03838 CDM C1725 HCPCS 0272 RC outpatient 402.5 402.5 402.5 74 297.85 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 27.63 111.21 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - METACROSS RX 7.0X40 SUP-99-03839 CDM C1725 HCPCS 0272 RC outpatient 402.5 402.5 402.5 74 297.85 percent of total billed charges 402.5 93 326.03 percent of total billed charges 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 402.5 other OPPS APC 402.5 27.63 111.21 percent of total billed charges 402.5 402.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - MINI TREK II 1.5X12 OTW SUP-99-03840 CDM C1725 HCPCS 0272 RC outpatient 245 245 245 74 181.3 percent of total billed charges 245 93 198.45 percent of total billed charges 245 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 245 other OPPS APC 245 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 245 other OPPS APC 245 27.63 67.69 percent of total billed charges 245 245 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 2.0X40 SUP-99-03841 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 2.0X80 SUP-99-03842 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 2.5X120 SUP-99-03843 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 2.5X250 SUP-99-03844 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 2.5X60 SUP-99-03845 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS 2.5X80 SUP-99-03846 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 3.0X100 SUP-99-03847 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 3.5X100 SUP-99-03848 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 3.5X150 SUP-99-03849 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 3.5X80 SUP-99-03850 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 6.0X100 SUP-99-03851 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NANOCROSS ELITE 6.0X150 SUP-99-03852 CDM C1725 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 2.0X20 SUP-99-03854 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 2.0X6 SUP-99-03855 CDM C1725 HCPCS 0272 RC outpatient 332.5 332.5 332.5 74 246.05 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 27.63 91.87 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 2.25X20 SUP-99-03856 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 2.25X6 SUP-99-03857 CDM C1725 HCPCS 0272 RC outpatient 332.5 332.5 332.5 74 246.05 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 27.63 91.87 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 2.5X6 SUP-99-03858 CDM C1725 HCPCS 0272 RC outpatient 332.5 332.5 332.5 74 246.05 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 27.63 91.87 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 2.75X27 SUP-99-03859 CDM C1725 HCPCS 0272 RC outpatient 332.5 332.5 332.5 74 246.05 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 332.5 other OPPS APC 332.5 27.63 91.87 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.5X6 SUP-99-03860 CDM C1725 HCPCS 0272 RC outpatient 332.5 332.5 332.5 74 246.05 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 27.63 91.87 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.75X12 SUP-99-03861 CDM C1725 HCPCS 0272 RC outpatient 332.5 332.5 332.5 74 246.05 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 27.63 91.87 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.75X6 SUP-99-03862 CDM C1725 HCPCS 0272 RC outpatient 332.5 332.5 332.5 74 246.05 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 27.63 91.87 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 1.5X6 SUP-99-03863 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 5.0X8 SUP-99-03864 CDM C1725 HCPCS 0272 RC outpatient 332.5 332.5 332.5 74 246.05 percent of total billed charges 332.5 93 269.33 percent of total billed charges 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 332.5 other OPPS APC 332.5 27.63 91.87 percent of total billed charges 332.5 332.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 5.0X12 SUP-99-03865 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PACIFIC EXTREME 7X250 SUP-99-03866 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PACIFIC PLUS 4X120 SUP-99-03867 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PACIFIC PLUS 4X040 SUP-99-03868 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 9.0X40 SUP-99-03869 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING SL OTW 2.0X120 SUP-99-03870 CDM C1725 HCPCS 0272 RC outpatient 795 795 795 74 588.3 percent of total billed charges 795 93 643.95 percent of total billed charges 795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 795 other OPPS APC 795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 795 other OPPS APC 795 27.63 219.66 percent of total billed charges 795 795 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING SL OTW 2.0X150 SUP-99-03871 CDM C1725 HCPCS 0272 RC outpatient 795 795 795 74 588.3 percent of total billed charges 795 93 643.95 percent of total billed charges 795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 795 other OPPS APC 795 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 795 other OPPS APC 795 27.63 219.66 percent of total billed charges 795 795 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING SL OTW 4.0X150 SUP-99-03872 CDM C1725 HCPCS 0272 RC outpatient 750 750 750 74 555 percent of total billed charges 750 93 607.5 percent of total billed charges 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 750 other OPPS APC 750 27.63 207.23 percent of total billed charges 750 750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - TREK 2.5X6 SUP-99-03873 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - TREK 2.75X20 SUP-99-03874 CDM C1725 HCPCS 0272 RC outpatient 245 245 245 74 181.3 percent of total billed charges 245 93 198.45 percent of total billed charges 245 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 245 other OPPS APC 245 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 245 other OPPS APC 245 27.63 67.69 percent of total billed charges 245 245 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - TREK 2.75X8 SUP-99-03875 CDM C1725 HCPCS 0272 RC outpatient 245 245 245 74 181.3 percent of total billed charges 245 93 198.45 percent of total billed charges 245 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 245 other OPPS APC 245 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 245 other OPPS APC 245 27.63 67.69 percent of total billed charges 245 245 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRASCORE 5X200 SUP-99-03876 CDM C1725 HCPCS 0272 RC outpatient 2025 2025 2025 74 1498.5 percent of total billed charges 2025 93 1640.25 percent of total billed charges 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 27.63 559.51 percent of total billed charges 2025 2025 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRASCORE 5X20 SUP-99-03877 CDM C1725 HCPCS 0272 RC outpatient 2025 2025 2025 74 1498.5 percent of total billed charges 2025 93 1640.25 percent of total billed charges 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 27.63 559.51 percent of total billed charges 2025 2025 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRASCORE 5X40 SUP-99-03878 CDM C1725 HCPCS 0272 RC outpatient 2025 2025 2025 74 1498.5 percent of total billed charges 2025 93 1640.25 percent of total billed charges 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 27.63 559.51 percent of total billed charges 2025 2025 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRASCORE 7X40 SUP-99-03879 CDM C1725 HCPCS 0272 RC outpatient 2025 2025 2025 74 1498.5 percent of total billed charges 2025 93 1640.25 percent of total billed charges 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2025 other OPPS APC 2025 27.63 559.51 percent of total billed charges 2025 2025 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 2.5X220X150 SUP-99-03880 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 2.5X80X150 SUP-99-03881 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 4.0X120X150 SUP-99-03882 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 014 4.0X80X150 SUP-99-03883 CDM C1725 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 035 10X80X75 SUP-99-03884 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 035 4.0X150X130 SUP-99-03885 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 035 4.0X200X130 SUP-99-03886 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 035 4.0X40X130 SUP-99-03887 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 035 4.0X80X130 SUP-99-03888 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 035 5.0X80X130 SUP-99-03889 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 035 6.0X80X130 SUP-99-03890 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 035 8.0X40X75 SUP-99-03891 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - ULTRAVERSE 035 9.0X40X75 SUP-99-03892 CDM C1725 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ICAST COVERED 10X38 SUP-99-03893 CDM C1874 HCPCS 0278 RC outpatient 6437.5 6437.5 6437.5 57 3669.38 percent of total billed charges 6437.5 93 5214.38 percent of total billed charges 6437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6437.5 other OPPS APC 6437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6437.5 other OPPS APC 6437.5 51 3283.13 percent of total billed charges 6437.5 6437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.25X30 SUP-99-03894 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.25X26 SUP-99-03895 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 2.25X34 SUP-99-03896 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - RESOLUTE ONYX 4.5X15 SUP-99-03897 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 4.5X30 SUP-99-03898 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 5.0X12 SUP-99-03899 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 5.0X15 SUP-99-03900 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 5.0X18 SUP-99-03901 CDM C1874 HCPCS 0278 RC outpatient 2175 2175 2175 57 1239.75 percent of total billed charges 2175 93 1761.75 percent of total billed charges 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2175 other OPPS APC 2175 51 1109.25 percent of total billed charges 2175 2175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 6X20 150CM SUP-99-0391 CDM C1876 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 10.0X100 SUP-99-03919 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 10.0X60 SUP-99-03920 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 10.0X80 SUP-99-03921 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 6.0X60 SUP-99-03922 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 7.0X100 SUP-99-03923 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 7.0X30 SUP-99-03924 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 7.0X60 SUP-99-03925 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 8.0X20 SUP-99-03926 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 9.0X40 SUP-99-03927 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ABSOLUTE PRO 9.0X80 SUP-99-03928 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 6X100 150CM SUP-99-03929 CDM C1876 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 6X120 150CM SUP-99-03930 CDM C1876 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 6X20 150CM SUP-99-03931 CDM C1876 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 6X40 150CM SUP-99-03932 CDM C1876 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 6X80 150CM SUP-99-03933 CDM C1876 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 7X100 150CM SUP-99-03934 CDM C1876 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 7X120 150CM SUP-99-03935 CDM C1876 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 7X150 150CM SUP-99-03936 CDM C1876 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 7X60 150CM SUP-99-03937 CDM C1876 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 7X80 150CM SUP-99-03938 CDM C1876 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 8X100 150CM SUP-99-03939 CDM C1876 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 8X120 150CM SUP-99-03940 CDM C1876 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 8X20 150CM SUP-99-03941 CDM C1876 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 8X40 150CM SUP-99-03942 CDM C1876 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 8X60 150CM SUP-99-03943 CDM C1876 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 8X80 150CM SUP-99-03944 CDM C1876 HCPCS 0278 RC outpatient 2085 2085 2085 57 1188.45 percent of total billed charges 2085 93 1688.85 percent of total billed charges 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2085 other OPPS APC 2085 51 1063.35 percent of total billed charges 2085 2085 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 2.25X14 SUP-99-03945 CDM C1876 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 2.25X8 SUP-99-03946 CDM C1876 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 2.5X12 SUP-99-03947 CDM C1876 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 2.5X8 SUP-99-03948 CDM C1876 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 2.75X12 SUP-99-03949 CDM C1876 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 2.75X14 SUP-99-03950 CDM C1876 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 3.5X30 SUP-99-03951 CDM C1876 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 3.5X9 SUP-99-03952 CDM C1876 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 4.0X12 SUP-99-03953 CDM C1876 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INTEGRITY 4.0X9 SUP-99-03954 CDM C1876 HCPCS 0278 RC outpatient 1500 1500 1500 57 855 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 51 765 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MINI VISION 2.0X12 SUP-99-03955 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MINI VISION 2.0X15 SUP-99-03956 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MINI VISION 2.0X18 SUP-99-03957 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MINI VISION 2.0X23 SUP-99-03958 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MINI VISION 2.0X28 SUP-99-03959 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MINI VISION 2.0X8 SUP-99-03960 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MINI VISION 2.25X12 SUP-99-03961 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MINI VISION 2.25X15 SUP-99-03962 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MINI VISION 2.25X18 SUP-99-03963 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MINI VISION 2.25X23 SUP-99-03964 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MINI VISION 2.25X8 SUP-99-03965 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MINI VISION 2.5X12 SUP-99-03966 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ULTRA 4.5X13 SUP-99-03967 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ULTRA 5.0X38 SUP-99-03968 CDM C1876 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 5X30 SUP-99-03969 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 5X40 SUP-99-03970 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 5X60 SUP-99-03971 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 5X80 SUP-99-03972 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 6X20 SUP-99-03973 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 6X30 SUP-99-03974 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 6X40 SUP-99-03975 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 7X100 SUP-99-03976 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 7X150 SUP-99-03977 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 7X200 SUP-99-03978 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 7X80 SUP-99-03979 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 8X100 SUP-99-03980 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 8X120 SUP-99-03981 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 8X150 SUP-99-03982 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 8X200 SUP-99-03983 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 8X20 SUP-99-03984 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 8X30 SUP-99-03985 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 8X40 SUP-99-03986 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 8X60 SUP-99-03987 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - EVERFLEX 8X80 SUP-99-03988 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SUPERA 5.5X30 SUP-99-03989 CDM C1876 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SUPERA 5.5X40 SUP-99-03990 CDM C1876 HCPCS 0278 RC outpatient 3875 3875 3875 57 2208.75 percent of total billed charges 3875 93 3138.75 percent of total billed charges 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3875 other OPPS APC 3875 51 1976.25 percent of total billed charges 3875 3875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 2.75X12 SUP-99-03991 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 2.75X15 SUP-99-03992 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 2.75X23 SUP-99-03993 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 2.75X28 SUP-99-03994 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 2.75X8 SUP-99-03995 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 3.0X8 SUP-99-03996 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 3.5X8 SUP-99-03997 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 4.0X12 SUP-99-03998 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISION 4.0X8 SUP-99-03999 CDM C1876 HCPCS 0278 RC outpatient 900 900 900 57 513 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 51 459 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 10X17X80 SUP-99-04000 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 10X57X80 SUP-99-04001 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 6X17X135 SUP-99-04002 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 6X57X135 SUP-99-04003 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 7X17X135 SUP-99-04004 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 7X27X135 SUP-99-04005 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 7X57X135 SUP-99-04006 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 8X17X135 SUP-99-04007 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 8X27X135 SUP-99-04008 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 8X37X135 SUP-99-04009 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 8X57X135 SUP-99-04010 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 8X57X80 SUP-99-04011 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 9X27X80 SUP-99-04012 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 9X37X80 SUP-99-04013 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - VISI-PRO 9X57X80 SUP-99-04014 CDM C1876 HCPCS 0278 RC outpatient 1785 1785 1785 57 1017.45 percent of total billed charges 1785 93 1445.85 percent of total billed charges 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1785 other OPPS APC 1785 51 910.35 percent of total billed charges 1785 1785 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - CLS 3.5SH (BS) SUP-99-04015 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - CLS 3.5 (BS) SUP-99-04016 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - FL4 (BS) SUP-99-04017 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JR3.5 (BS) SUP-99-04018 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JR4.0 SH (BS) SUP-99-04019 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - LEFT BU3.5 SH (BS) SUP-99-04020 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - LEFT BU4.0 (BS) SUP-99-04021 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - LEFT BU4.0 SH (BS) SUP-99-04022 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - AL 2 SH SUP-99-04023 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - AL 3 SUP-99-04024 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JCR4 SUP-99-04025 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JCR4 SH SUP-99-04026 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JL3.0 (CORDIS) SUP-99-04027 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JL3.5 (CORDIS) SUP-99-04028 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JL3.5 SH SUP-99-04029 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JL4.0ST SUP-99-04030 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JL4.5 SUP-99-04031 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XB4.5 SUP-99-04033 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XB4.5 SH SUP-99-04034 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XBC3 SUP-99-04035 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XBC3.5 SUP-99-04036 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XBC4 SUP-99-04037 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XBC4 SH SUP-99-04038 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XBC4.5 SUP-99-04039 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XBC4.5 SH SUP-99-04040 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - RBU4.0 SH SUP-99-04041 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - AL1 SUP-99-04042 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - AR2 SUP-99-04043 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - AR2 SH SUP-99-04044 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - EBU4.5 SH SUP-99-04045 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JR3.5 SUP-99-04046 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JR3.5 SH SUP-99-04047 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JR4 SH SUP-99-04048 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 10X40X75 SUP-99-04049 CDM C2623 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 10X60X75 SUP-99-04050 CDM C2623 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 12X40X75 SUP-99-04051 CDM C2623 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 4X100 SUP-99-04052 CDM C2623 HCPCS 0272 RC outpatient 3250 3250 3250 74 2405 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 27.63 897.98 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 4X40 SUP-99-04053 CDM C2623 HCPCS 0272 RC outpatient 3250 3250 3250 74 2405 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 27.63 897.98 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 4X40X75 SUP-99-04054 CDM C2623 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 4X60 SUP-99-04055 CDM C2623 HCPCS 0272 RC outpatient 3250 3250 3250 74 2405 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 27.63 897.98 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 4X60X75 SUP-99-04056 CDM C2623 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 4X80 SUP-99-04057 CDM C2623 HCPCS 0272 RC outpatient 3250 3250 3250 74 2405 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 27.63 897.98 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 5X40 SUP-99-04058 CDM C2623 HCPCS 0272 RC outpatient 3250 3250 3250 74 2405 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 27.63 897.98 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 5X40X75 SUP-99-04059 CDM C2623 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 5X60X75 SUP-99-04060 CDM C2623 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 6X220 SUP-99-04061 CDM C2623 HCPCS 0272 RC outpatient 3250 3250 3250 74 2405 percent of total billed charges 3250 93 2632.5 percent of total billed charges 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3250 other OPPS APC 3250 27.63 897.98 percent of total billed charges 3250 3250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 6X40X75 SUP-99-04062 CDM C2623 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 7X40X75 SUP-99-04063 CDM C2623 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 7X60X75 SUP-99-04064 CDM C2623 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 8X40X75 SUP-99-04065 CDM C2623 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 8X60X75 SUP-99-04066 CDM C2623 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 9X40X75 SUP-99-04067 CDM C2623 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - LUTONIX 035 9X60X75 SUP-99-04068 CDM C2623 HCPCS 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON- RANGER DCB 5 X 200 SUP-99-04069 CDM C2623 HCPCS 0272 RC outpatient 4987.5 4987.5 4987.5 74 3690.75 percent of total billed charges 4987.5 93 4039.88 percent of total billed charges 4987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4987.5 other OPPS APC 4987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4987.5 other OPPS APC 4987.5 27.63 1378.05 percent of total billed charges 4987.5 4987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RANGER DCB 6X100 SUP-99-04070 CDM C2623 HCPCS 0272 RC outpatient 3375 3375 3375 74 2497.5 percent of total billed charges 3375 93 2733.75 percent of total billed charges 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 27.63 932.51 percent of total billed charges 3375 3375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RANGER DCB 4X200 SUP-99-04071 CDM C2623 HCPCS 0272 RC outpatient 3375 3375 3375 74 2497.5 percent of total billed charges 3375 93 2733.75 percent of total billed charges 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 27.63 932.51 percent of total billed charges 3375 3375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RANGER DCB 4X200 SUP-99-04072 CDM C2623 HCPCS 0272 RC outpatient 3375 3375 3375 74 2497.5 percent of total billed charges 3375 93 2733.75 percent of total billed charges 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 27.63 932.51 percent of total billed charges 3375 3375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON- RANGER DCB 4 X 60 X 135 SUP-99-04074 CDM C2623 HCPCS 0272 RC outpatient 3375 3375 3375 74 2497.5 percent of total billed charges 3375 93 2733.75 percent of total billed charges 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 27.63 932.51 percent of total billed charges 3375 3375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RANGER DCB 5 X 100 SUP-99-04075 CDM C2623 HCPCS 0272 RC outpatient 3375 3375 3375 74 2497.5 percent of total billed charges 3375 93 2733.75 percent of total billed charges 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 27.63 932.51 percent of total billed charges 3375 3375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RANGER DCB 5X150 SUP-99-04076 CDM C2623 HCPCS 0272 RC outpatient 4237.5 4237.5 4237.5 74 3135.75 percent of total billed charges 4237.5 93 3432.38 percent of total billed charges 4237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4237.5 other OPPS APC 4237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4237.5 other OPPS APC 4237.5 27.63 1170.82 percent of total billed charges 4237.5 4237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RANGER DCB 5 X 40 SUP-99-04077 CDM C2623 HCPCS 0272 RC outpatient 3375 3375 3375 74 2497.5 percent of total billed charges 3375 93 2733.75 percent of total billed charges 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 27.63 932.51 percent of total billed charges 3375 3375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RANGER DCB 5X60 SUP-99-04078 CDM C2623 HCPCS 0272 RC outpatient 3375 3375 3375 74 2497.5 percent of total billed charges 3375 93 2733.75 percent of total billed charges 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 27.63 932.51 percent of total billed charges 3375 3375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RANGER DCB 6X150 SUP-99-04079 CDM C2623 HCPCS 0272 RC outpatient 4237.5 4237.5 4237.5 74 3135.75 percent of total billed charges 4237.5 93 3432.38 percent of total billed charges 4237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4237.5 other OPPS APC 4237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4237.5 other OPPS APC 4237.5 27.63 1170.82 percent of total billed charges 4237.5 4237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RANGER DCB 6X200 SUP-99-04080 CDM C2623 HCPCS 0272 RC outpatient 4987.5 4987.5 4987.5 74 3690.75 percent of total billed charges 4987.5 93 4039.88 percent of total billed charges 4987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4987.5 other OPPS APC 4987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4987.5 other OPPS APC 4987.5 27.63 1378.05 percent of total billed charges 4987.5 4987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RANGER DCB 6X60 SUP-99-04081 CDM C2623 HCPCS 0272 RC outpatient 3375 3375 3375 74 2497.5 percent of total billed charges 3375 93 2733.75 percent of total billed charges 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 27.63 932.51 percent of total billed charges 3375 3375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RANGER DCB 7X100 SUP-99-04082 CDM C2623 HCPCS 0272 RC outpatient 3375 3375 3375 74 2497.5 percent of total billed charges 3375 93 2733.75 percent of total billed charges 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 27.63 932.51 percent of total billed charges 3375 3375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RANGER DCB 7X200 SUP-99-04083 CDM C2623 HCPCS 0272 RC outpatient 3375 3375 3375 74 2497.5 percent of total billed charges 3375 93 2733.75 percent of total billed charges 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 27.63 932.51 percent of total billed charges 3375 3375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RANGER DCB 7X150 SUP-99-04084 CDM C2623 HCPCS 0272 RC outpatient 3987.5 3987.5 3987.5 74 2950.75 percent of total billed charges 3987.5 93 3229.88 percent of total billed charges 3987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3987.5 other OPPS APC 3987.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3987.5 other OPPS APC 3987.5 27.63 1101.75 percent of total billed charges 3987.5 3987.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 5F MICROPUNCTURE 11CM SUP-99-04085 CDM C1894 HCPCS 0272 RC outpatient 153.4 153.4 153.4 74 113.52 percent of total billed charges 153.4 93 124.25 percent of total billed charges 153.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 153.4 other OPPS APC 153.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 153.4 other OPPS APC 153.4 27.63 42.38 percent of total billed charges 153.4 153.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 6F MICROPUNCTURE 11CM SUP-99-04086 CDM C1894 HCPCS 0272 RC outpatient 145.6 145.6 145.6 74 107.74 percent of total billed charges 145.6 93 117.94 percent of total billed charges 145.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.6 other OPPS APC 145.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 145.6 other OPPS APC 145.6 27.63 40.23 percent of total billed charges 145.6 145.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - TRAILBLAZER - 018X150 ANGLED SUP-99-04087 CDM C1887 HCPCS 0272 RC outpatient 612.5 612.5 612.5 74 453.25 percent of total billed charges 612.5 93 496.13 percent of total billed charges 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 612.5 other OPPS APC 612.5 27.63 169.23 percent of total billed charges 612.5 612.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTRAST - OMNIPAQUE 300 100CC SUP-99-04088 CDM Q9967 CPT 0255 RC outpatient 356.69 356.69 0.15 0.15 fee schedule 356.69 93 288.92 percent of total billed charges 356.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 356.69 other OPPS APC 356.69 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 356.69 other OPPS APC 356.69 24.86 88.67 percent of total billed charges 0.15 356.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTRAST - OMNIPAQUE 350 10 X 50ML Y540 SUP-99-04089 CDM Q9967 CPT 0255 RC outpatient 298.13 298.13 0.15 0.15 fee schedule 298.13 93 241.49 percent of total billed charges 298.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 298.13 other OPPS APC 298.13 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 298.13 other OPPS APC 298.13 24.86 74.12 percent of total billed charges 0.15 298.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - DESTINATION SLENDER 105CM SUP-99-04090 CDM C1894 HCPCS 0272 RC outpatient 905.25 905.25 905.25 74 669.89 percent of total billed charges 905.25 93 733.25 percent of total billed charges 905.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 905.25 other OPPS APC 905.25 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 905.25 other OPPS APC 905.25 27.63 250.12 percent of total billed charges 905.25 905.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 2.25X8 SUP-99-04091 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 2.25X15 SUP-99-04093 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 2.25X18 SUP-99-04094 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 2.25X28 SUP-99-04096 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 2.25X38 SUP-99-04098 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 2.5X8 SUP-99-04099 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 2.5X12 SUP-99-04100 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 2.5X15 SUP-99-04101 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 2.5X18 SUP-99-04102 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 2.5X23 SUP-99-04103 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 2.5X28 SUP-99-04104 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 2.5X38 SUP-99-04106 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 2.75X8 SUP-99-04107 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 2.75X12 SUP-99-04108 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 2.75X15 SUP-99-04109 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 2.75X18 SUP-99-04110 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 2.75X23 SUP-99-04111 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 2.75X28 SUP-99-04112 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT- XIENCE SKYPOINT 2.75 X 33 SUP-99-04113 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INNOVA 8 X 120 X 130 SUP-99-04115 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.0X12 SUP-99-04116 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.0X15 SUP-99-04117 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.0X18 SUP-99-04118 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.0X23 SUP-99-04119 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.0X28 SUP-99-04120 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.0 X 33 SUP-99-04121 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.0X38 SUP-99-04122 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.25X8 SUP-99-04123 CDM C1874 HCPCS 0272 RC outpatient 1800 1800 1800 74 1332 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 27.63 497.34 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.25X12 SUP-99-04124 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.25X15 SUP-99-04125 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.25X18 SUP-99-04126 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.25X28 SUP-99-04128 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.25X33 SUP-99-04129 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.25X38 SUP-99-04130 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.5X8 SUP-99-04131 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.5X12 SUP-99-04132 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.5X15 SUP-99-04133 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.5X18 SUP-99-04134 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.5X23 SUP-99-04135 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.5X28 SUP-99-04136 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT-XIENCE SKYPOINT 3.5 X 33 SUP-99-04137 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.5X38 SUP-99-04138 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 4.0X8 SUP-99-04139 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 4.0X12 SUP-99-04140 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 4.0X15 SUP-99-04141 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 4.0X18 SUP-99-04142 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 4.0X23 SUP-99-04143 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 4.0X28 SUP-99-04144 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 4.0X33 SUP-99-04145 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 4.0X38 SUP-99-04146 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.0X8 SUP-99-04147 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD - COBALT - DVPA2D1 SUP-99-04148 CDM C1721 HCPCS 0275 RC outpatient 18067 18067 18067 57 10298.2 percent of total billed charges 18067 93 14634.3 percent of total billed charges 18067 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18067 other OPPS APC 18067 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18067 other OPPS APC 18067 51 9214.17 percent of total billed charges 18067 18067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD - COBALT - DVPA2D4 SUP-99-04149 CDM C1721 HCPCS 0275 RC outpatient 16978 16978 16978 57 9677.46 percent of total billed charges 16978 93 13752.2 percent of total billed charges 16978 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16978 other OPPS APC 16978 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 16978 other OPPS APC 16978 51 8658.78 percent of total billed charges 16978 16978 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD - COBALT - DDPA2D4 SUP-99-04150 CDM C1882 HCPCS 0275 RC outpatient 17572 17572 17572 57 10016 percent of total billed charges 17572 93 14233.3 percent of total billed charges 17572 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17572 other OPPS APC 17572 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 17572 other OPPS APC 17572 51 8961.72 percent of total billed charges 17572 17572 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD - COBALT - DTPA2D1 SUP-99-04151 CDM C1882 HCPCS 0275 RC outpatient 37197 37197 37197 57 21202.3 percent of total billed charges 37197 93 30129.6 percent of total billed charges 37197 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 37197 other OPPS APC 37197 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 37197 other OPPS APC 37197 51 18970.5 percent of total billed charges 37197 37197 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD - COBALT - DTPA2D4 SUP-99-04152 CDM C1882 HCPCS 0275 RC outpatient 37197 37197 37197 57 21202.3 percent of total billed charges 37197 93 30129.6 percent of total billed charges 37197 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 37197 other OPPS APC 37197 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 37197 other OPPS APC 37197 51 18970.5 percent of total billed charges 37197 37197 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD - COBALT - DTPA2Q1 SUP-99-04154 CDM C1882 HCPCS 0275 RC outpatient 37197 37197 37197 57 21202.3 percent of total billed charges 37197 93 30129.6 percent of total billed charges 37197 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 37197 other OPPS APC 37197 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 37197 other OPPS APC 37197 51 18970.5 percent of total billed charges 37197 37197 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD - COBALT - DTPA2QQ SUP-99-04155 CDM C1882 HCPCS 0275 RC outpatient 33206 33206 33206 57 18927.4 percent of total billed charges 33206 93 26896.9 percent of total billed charges 33206 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 33206 other OPPS APC 33206 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 33206 other OPPS APC 33206 51 16935.1 percent of total billed charges 33206 33206 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - BIVENT - PRECEPTA - W4TR01 SUP-99-04156 CDM C1721 HCPCS 0275 RC outpatient 12274 12274 12274 57 6996.18 percent of total billed charges 12274 93 9941.94 percent of total billed charges 12274 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12274 other OPPS APC 12274 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 12274 other OPPS APC 12274 51 6259.74 percent of total billed charges 12274 12274 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - BIVENT - PRECEPTA - W1TR01 SUP-99-04157 CDM outpatient 22000 22000 22000 22000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - ATTAIN - VENOGRAM BALLOON SUP-99-04164 CDM C1725 HCPCS 0272 RC outpatient 900 900 900 74 666 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 27.63 248.67 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - ATTAIN SELECT II - 6248V-90 SUP-99-04165 CDM C1887 HCPCS 0272 RC outpatient 900 900 900 74 666 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 27.63 248.67 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - ATTAIN SELECT II - 6248V-130 SUP-99-04166 CDM C1887 HCPCS 0272 RC outpatient 900 900 900 74 666 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 27.63 248.67 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - ATTAIN COMMAND - 6250V-MPR SUP-99-04167 CDM C1887 HCPCS 0272 RC outpatient 900 900 900 74 666 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 27.63 248.67 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - ATTAIN COMMAND - 6250V-MB2 SUP-99-04168 CDM C1887 HCPCS 0272 RC outpatient 900 900 900 74 666 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 27.63 248.67 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - ATTAIN COMMAND - 6250V-MP SUP-99-04169 CDM C1887 HCPCS 0272 RC outpatient 900 900 900 74 666 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 27.63 248.67 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - ATTAIN - 6227DEF SUP-99-04170 CDM C1887 HCPCS 0272 RC outpatient 900 900 900 74 666 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 27.63 248.67 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD - VISIA - DVFB1D4 SUP-99-04171 CDM C1721 HCPCS 0275 RC outpatient 18067 18067 18067 57 10298.2 percent of total billed charges 18067 93 14634.3 percent of total billed charges 18067 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18067 other OPPS APC 18067 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18067 other OPPS APC 18067 51 9214.17 percent of total billed charges 18067 18067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD - VISIA - DVFB1D1 SUP-99-04172 CDM C1721 HCPCS 0275 RC outpatient 18067 18067 18067 57 10298.2 percent of total billed charges 18067 93 14634.3 percent of total billed charges 18067 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18067 other OPPS APC 18067 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18067 other OPPS APC 18067 51 9214.17 percent of total billed charges 18067 18067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD - EVERA - DDMB1D1 SUP-99-04173 CDM C1721 HCPCS 0275 RC outpatient 18725 18725 18725 57 10673.3 percent of total billed charges 18725 93 15167.3 percent of total billed charges 18725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18725 other OPPS APC 18725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18725 other OPPS APC 18725 51 9549.75 percent of total billed charges 18725 18725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD - EVERA - DDMB1D4 SUP-99-04174 CDM C1721 HCPCS 0275 RC outpatient 18067 18067 18067 57 10298.2 percent of total billed charges 18067 93 14634.3 percent of total billed charges 18067 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18067 other OPPS APC 18067 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 18067 other OPPS APC 18067 51 9214.17 percent of total billed charges 18067 18067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - LEAD - SPRINT 6935M-55 SUP-99-04175 CDM C1777 HCPCS 0275 RC outpatient 7767.5 7767.5 7767.5 57 4427.48 percent of total billed charges 7767.5 93 6291.68 percent of total billed charges 7767.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7767.5 other OPPS APC 7767.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7767.5 other OPPS APC 7767.5 51 3961.43 percent of total billed charges 7767.5 7767.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - LEAD - SPRINT 6935M-62 SUP-99-04176 CDM C1777 HCPCS 0275 RC outpatient 2400 2400 2400 57 1368 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 51 1224 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - LEAD - PERFORMA 4298-88 SUP-99-04177 CDM C1900 HCPCS 0275 RC outpatient 4250 4250 4250 57 2422.5 percent of total billed charges 4250 93 3442.5 percent of total billed charges 4250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4250 other OPPS APC 4250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4250 other OPPS APC 4250 51 2167.5 percent of total billed charges 4250 4250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - LEAD ATTAIN 4798-88 SUP-99-04178 CDM C1900 HCPCS 0275 RC outpatient 5050 5050 5050 57 2878.5 percent of total billed charges 5050 93 4090.5 percent of total billed charges 5050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5050 other OPPS APC 5050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5050 other OPPS APC 5050 51 2575.5 percent of total billed charges 5050 5050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CROSSTELLA 5 X 40 SUP-99-04180 CDM C1725 HCPCS 0272 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 780 other OPPS APC 780 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CROSSTELLA 5 X 100 SUP-99-04181 CDM C1725 HCPCS 0272 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 780 other OPPS APC 780 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CROSSTELLA 5 X 150 SUP-99-04182 CDM C1725 HCPCS 0272 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 780 other OPPS APC 780 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CROSSTELLA 5 X 200 SUP-99-04183 CDM C1725 HCPCS 0272 RC outpatient 1080 1080 1080 74 799.2 percent of total billed charges 1080 93 874.8 percent of total billed charges 1080 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1080 other OPPS APC 1080 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1080 other OPPS APC 1080 27.63 298.4 percent of total billed charges 1080 1080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CROSSTELLA 6 X 40 SUP-99-04184 CDM C1725 HCPCS 0272 RC outpatient 1080 1080 1080 74 799.2 percent of total billed charges 1080 93 874.8 percent of total billed charges 1080 1080 other OPPS APC 1080 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1080 other OPPS APC 1080 27.63 298.4 percent of total billed charges 1080 1080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CROSSTELLA 6 X 100 SUP-99-04185 CDM C1725 HCPCS 0272 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CROSSTELLA 6 X 150 SUP-99-04186 CDM C1725 HCPCS 0272 RC outpatient 1080 1080 1080 74 799.2 percent of total billed charges 1080 93 874.8 percent of total billed charges 1080 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1080 other OPPS APC 1080 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1080 other OPPS APC 1080 27.63 298.4 percent of total billed charges 1080 1080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - CROSSTELLA 6 X 200 SUP-99-04187 CDM C1725 HCPCS 0272 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 780 other OPPS APC 780 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - METACROSS RX 8X60 SUP-99-04189 CDM C1725 HCPCS 0272 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 780 other OPPS APC 780 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MISAGO - 6 X 80 SUP-99-04190 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MISAGO - 6 X 100 SUP-99-04191 CDM C1876 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MISAGO - 7X60 SUP-99-04192 CDM C1876 HCPCS 0278 RC outpatient 2700 2700 2700 57 1539 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 51 1377 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - MISAGO - 8 X 80 SUP-99-04193 CDM C1876 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - ATTAIN HYBRID SUP-99-04194 CDM C1769 HCPCS 0272 RC outpatient 900 900 900 74 666 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 27.63 248.67 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - REVEAL LINQ II RECORDER SUP-99-04196 CDM C1764 HCPCS 0278 RC outpatient 9290 9290 9290 57 5295.3 percent of total billed charges 9290 93 7524.9 percent of total billed charges 9290 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9290 other OPPS APC 9290 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9290 other OPPS APC 9290 51 4737.9 percent of total billed charges 9290 9290 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON PUMP - CATHETER 40CC ULTRA SUP-99-04197 CDM 0272 RC outpatient 2400 2400 2400 74 1776 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 2400 other OPPS APC 2400 2400 other OPPS APC 2400 27.63 663.12 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - MONGO GLADIUS 190CM SUP-99-04198 CDM C1769 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - TWIN-PASS TORQUE SUP-99-04199 CDM C1877 HCPCS 0272 RC outpatient 1365 1365 1365 74 1010.1 percent of total billed charges 1365 93 1105.65 percent of total billed charges 1365 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1365 other OPPS APC 1365 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1365 other OPPS APC 1365 27.63 377.15 percent of total billed charges 1365 1365 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - TURNPIKE LP 135CM SUP-99-04200 CDM C1887 HCPCS 0272 RC outpatient 2490 2490 2490 74 1842.6 percent of total billed charges 2490 93 2016.9 percent of total billed charges 2490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2490 other OPPS APC 2490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2490 other OPPS APC 2490 27.63 687.99 percent of total billed charges 2490 2490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FFR - OMNIWIRE SUP-99-04201 CDM C1769 HCPCS 0272 RC outpatient 1980 1980 1980 74 1465.2 percent of total billed charges 1980 93 1603.8 percent of total billed charges 1980 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1980 other OPPS APC 1980 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1980 other OPPS APC 1980 27.63 547.07 percent of total billed charges 1980 1980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - TURNPIKE LP 150CM SUP-99-04202 CDM C1887 HCPCS 0272 RC outpatient 2250 2250 2250 74 1665 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2250 other OPPS APC 2250 27.63 621.68 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - MONGO GLADIUS 300CM SUP-99-04203 CDM C1769 HCPCS 0272 RC outpatient 490 490 490 74 362.6 percent of total billed charges 490 93 396.9 percent of total billed charges 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 490 other OPPS APC 490 27.63 135.39 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE-3MM J .021 X 180 SUP-99-04204 CDM C1769 HCPCS 0272 RC outpatient 77.28 77.28 77.28 74 57.19 percent of total billed charges 77.28 93 62.6 percent of total billed charges 77.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 77.28 other OPPS APC 77.28 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 77.28 other OPPS APC 77.28 27.63 21.35 percent of total billed charges 77.28 77.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - PILOT 200 190CM SUP-99-04205 CDM C1769 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - PILOT 200 300CM SUP-99-04206 CDM C1769 HCPCS 0272 RC outpatient 259 259 259 74 191.66 percent of total billed charges 259 93 209.79 percent of total billed charges 259 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 259 other OPPS APC 259 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 259 other OPPS APC 259 27.63 71.56 percent of total billed charges 259 259 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX 5.0X30 SUP-99-04207 CDM C1874 HCPCS 0278 RC outpatient 1755 1755 1755 57 1000.35 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 2.5X25 SUP-99-04209 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - REVEAL LINQ II SYSTEM SUP-99-04210 CDM C1764 HCPCS 0278 RC outpatient 9000 9000 9000 57 5130 percent of total billed charges 9000 93 7290 percent of total billed charges 9000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9000 other OPPS APC 9000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9000 other OPPS APC 9000 51 4590 percent of total billed charges 9000 9000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - GENERATOR AZURE SINGL W3SR01 SUP-99-04215 CDM C1786 HCPCS 0275 RC outpatient 4172.94 4172.94 4172.94 57 2378.58 percent of total billed charges 4172.94 93 3380.08 percent of total billed charges 4172.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4172.94 other OPPS APC 4172.94 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4172.94 other OPPS APC 4172.94 51 2128.2 percent of total billed charges 4172.94 4172.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - BIVENT - SERENA W1TR02 SUP-99-04216 CDM outpatient 11552 11552 11552 11552 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD - CLARIA DTMA1D1 SUP-99-04217 CDM C1882 HCPCS 0275 RC outpatient 33997 33997 33997 57 19378.3 percent of total billed charges 33997 93 27537.6 percent of total billed charges 33997 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 33997 other OPPS APC 33997 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 33997 other OPPS APC 33997 51 17338.5 percent of total billed charges 33997 33997 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD - CLARIA DTMA1D4 SUP-99-04218 CDM 0275 RC outpatient 36198 36198 36198 57 20632.9 percent of total billed charges 36198 93 29320.4 percent of total billed charges 36198 36198 other OPPS APC 36198 36198 other OPPS APC 36198 51 18461 percent of total billed charges 36198 36198 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD - CLARIA DTMA1Q1 SUP-99-04219 CDM C1725 HCPCS 0272 RC outpatient 36198 36198 36198 74 26786.5 percent of total billed charges 36198 93 29320.4 percent of total billed charges 36198 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36198 other OPPS APC 36198 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 36198 other OPPS APC 36198 27.63 10001.5 percent of total billed charges 36198 36198 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD - CLARIA DTMA1Q1 SUP-99-04220 CDM C1882 HCPCS 0275 RC outpatient 34032 34032 34032 57 19398.2 percent of total billed charges 34032 93 27565.9 percent of total billed charges 34032 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34032 other OPPS APC 34032 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 34032 other OPPS APC 34032 51 17356.3 percent of total billed charges 34032 34032 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - BIVENT - SERENA W4TR02 SUP-99-04221 CDM outpatient 12000 12000 12000 12000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 3.0X30 SUP-99-04223 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - COVERED - VIABAHN 6MM X 7.5CM SUP-99-04225 CDM C1874 HCPCS 0278 RC outpatient 8220 8220 8220 57 4685.4 percent of total billed charges 8220 93 6658.2 percent of total billed charges 8220 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8220 other OPPS APC 8220 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8220 other OPPS APC 8220 51 4192.2 percent of total billed charges 8220 8220 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - COVERED - VIABAHN 7MM X 7.5CM 7F SUP-99-04226 CDM C1874 HCPCS 0278 RC outpatient 8220 8220 8220 57 4685.4 percent of total billed charges 8220 93 6658.2 percent of total billed charges 8220 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8220 other OPPS APC 8220 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8220 other OPPS APC 8220 51 4192.2 percent of total billed charges 8220 8220 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - COVERED - VIABAHN 7MM X 10CM 7F SUP-99-04227 CDM C1874 HCPCS 0278 RC outpatient 8220 8220 8220 57 4685.4 percent of total billed charges 8220 93 6658.2 percent of total billed charges 8220 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8220 other OPPS APC 8220 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8220 other OPPS APC 8220 51 4192.2 percent of total billed charges 8220 8220 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - COVERED - VIABAHN 6MM X 10CM SUP-99-04228 CDM C1874 HCPCS 0278 RC outpatient 8220 8220 8220 57 4685.4 percent of total billed charges 8220 93 6658.2 percent of total billed charges 8220 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8220 other OPPS APC 8220 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8220 other OPPS APC 8220 51 4192.2 percent of total billed charges 8220 8220 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - INNOVA 8X100 SUP-99-04229 CDM C1876 HCPCS 0278 RC outpatient 2925 2925 2925 57 1667.25 percent of total billed charges 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 51 1491.75 percent of total billed charges 2925 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD - MOMENTUM D121 SUP-99-04231 CDM C1721 HCPCS 0275 RC outpatient 19848 19848 19848 57 11313.4 percent of total billed charges 19848 93 16076.9 percent of total billed charges 19848 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19848 other OPPS APC 19848 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 19848 other OPPS APC 19848 51 10122.5 percent of total billed charges 19848 19848 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH- RAINSHEATH 6F 21G BARE NEEDLE SUP-99-04233 CDM C1894 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - RAINSHEATH 6F - 20G ANGIOCATH NEEDLE SUP-99-04234 CDM C1894 HCPCS 0272 RC outpatient 203 203 203 74 150.22 percent of total billed charges 203 93 164.43 percent of total billed charges 203 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 203 other OPPS APC 203 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 203 other OPPS APC 203 27.63 56.09 percent of total billed charges 203 203 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 2.0 X 10 SUP-99-04235 CDM C1769 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SAPPHIRE II PRO 1MM X 8MM SUP-99-04236 CDM C1769 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE .035 6.0X150 SUP-99-04237 CDM C1769 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE .035 4.0X150 SUP-99-04238 CDM C1769 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - HI TORGUE BALANCE J TIP .014 X 190 SUP-99-04239 CDM C1769 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - HI TORQUE PILOT 150 .014 X 190 SUP-99-04240 CDM C1769 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON-ANGIOSCULPT EVO RX 2.0 X 10 SUP-99-04241 CDM C1725 HCPCS 0272 RC outpatient 2400 2400 2400 74 1776 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 27.63 663.12 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON-ANGIOSCULPT EVO RX 2.0 X 15 SUP-99-04242 CDM C1725 HCPCS 0272 RC outpatient 2400 2400 2400 74 1776 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 27.63 663.12 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON-ANGIOSCULPT EVO RX 2.5 X 10 SUP-99-04243 CDM C1725 HCPCS 0272 RC outpatient 2400 2400 2400 74 1776 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 27.63 663.12 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON-ANGIOSCULPT EVO RX 2.5 X 15 SUP-99-04244 CDM C1725 HCPCS 0272 RC outpatient 2400 2400 2400 74 1776 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 27.63 663.12 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON-ANGIOSCULPT EVO RX 3.0 X 10 SUP-99-04245 CDM C1725 HCPCS 0272 RC outpatient 2400 2400 2400 74 1776 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 27.63 663.12 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON-ANGIOSCULPT EVO RX 3.0 X 15 SUP-99-04246 CDM C1725 HCPCS 0272 RC outpatient 2400 2400 2400 74 1776 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 27.63 663.12 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON-ANGIOSCULPT EVO RX 3.5 X 15 SUP-99-04247 CDM C1725 HCPCS 0272 RC outpatient 2400 2400 2400 74 1776 percent of total billed charges 2400 93 1944 percent of total billed charges 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2400 other OPPS APC 2400 27.63 663.12 percent of total billed charges 2400 2400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - VENCLOSE RF 60CM SUP-99-04248 CDM C1725 HCPCS 0272 RC outpatient 900 900 900 74 666 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 27.63 248.67 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - VENCLOSE RF 100CM SUP-99-04249 CDM C1725 HCPCS 0272 RC outpatient 900 900 900 74 666 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 27.63 248.67 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- VENCLOSE MAVEN RF 40CM SUP-99-04250 CDM C1725 HCPCS 0272 RC outpatient 1050 1050 1050 74 777 percent of total billed charges 1050 93 850.5 percent of total billed charges 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1050 other OPPS APC 1050 27.63 290.12 percent of total billed charges 1050 1050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLOSURE - SAFEGUARD FOCUS SUP-99-04251 CDM C1725 HCPCS 0272 RC outpatient 315 315 315 74 233.1 percent of total billed charges 315 93 255.15 percent of total billed charges 315 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 315 other OPPS APC 315 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 315 other OPPS APC 315 27.63 87.03 percent of total billed charges 315 315 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - ACCOLADE MRI EL DR IS-1 SUP-99-04252 CDM C1785 HCPCS 0275 RC outpatient 8581.5 8581.5 8581.5 57 4891.46 percent of total billed charges 8581.5 93 6951.02 percent of total billed charges 8581.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8581.5 other OPPS APC 8581.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8581.5 other OPPS APC 8581.5 51 4376.57 percent of total billed charges 8581.5 8581.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - SASUKE 145CM SUP-99-04253 CDM C1887 HCPCS 0272 RC outpatient 1275 1275 1275 74 943.5 percent of total billed charges 1275 93 1032.75 percent of total billed charges 1275 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1275 other OPPS APC 1275 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1275 other OPPS APC 1275 27.63 352.28 percent of total billed charges 1275 1275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE- GLADIUS .014X200 SUP-99-04254 CDM C1769 HCPCS 0272 RC outpatient 595 595 595 74 440.3 percent of total billed charges 595 93 481.95 percent of total billed charges 595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 595 other OPPS APC 595 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 595 other OPPS APC 595 27.63 164.4 percent of total billed charges 595 595 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE- RG3 330CM SUP-99-04255 CDM C1769 HCPCS 0272 RC outpatient 266 266 266 74 196.84 percent of total billed charges 266 93 215.46 percent of total billed charges 266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 266 other OPPS APC 266 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 266 other OPPS APC 266 27.63 73.5 percent of total billed charges 266 266 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - SUOH 03 190CM SUP-99-04256 CDM C1769 HCPCS 0272 RC outpatient 465.5 465.5 465.5 74 344.47 percent of total billed charges 465.5 93 377.06 percent of total billed charges 465.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 465.5 other OPPS APC 465.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 465.5 other OPPS APC 465.5 27.63 128.62 percent of total billed charges 465.5 465.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE- 7F JR4 (MEDTRONIC) SUP-99-04257 CDM C1887 HCPCS 0272 RC outpatient 180 180 180 74 133.2 percent of total billed charges 180 93 145.8 percent of total billed charges 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 27.63 49.73 percent of total billed charges 180 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE- 7F AL.75 SUP-99-04258 CDM C1887 HCPCS 0272 RC outpatient 180 180 180 74 133.2 percent of total billed charges 180 93 145.8 percent of total billed charges 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 27.63 49.73 percent of total billed charges 180 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE- 7F AL1.0 SUP-99-04259 CDM C1887 HCPCS 0272 RC outpatient 180 180 180 74 133.2 percent of total billed charges 180 93 145.8 percent of total billed charges 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 180 other OPPS APC 180 27.63 49.73 percent of total billed charges 180 180 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.00X8 SUP-99-04260 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.00X12 SUP-99-04261 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.00X15 SUP-99-04262 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.00X18 SUP-99-04263 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.00X22 SUP-99-04264 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.00X26 SUP-99-04265 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.00X30 SUP-99-04266 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.25X8 SUP-99-04267 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.25X12 SUP-99-04268 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.25X15 SUP-99-04269 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.25X18 SUP-99-04270 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.25X22 SUP-99-04271 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.25X26 SUP-99-04272 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.25X30 SUP-99-04273 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.25X34 SUP-99-04274 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.25X38 SUP-99-04275 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.5X8 SUP-99-04276 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.5X12 SUP-99-04277 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.5X15 SUP-99-04278 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.5X18 SUP-99-04279 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.5X22 SUP-99-04280 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.5X26 SUP-99-04281 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.5X30 SUP-99-04282 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.5X34 SUP-99-04283 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.5X38 SUP-99-04284 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.75X8 SUP-99-04285 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.75X12 SUP-99-04286 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.75X15 SUP-99-04287 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.75X18 SUP-99-04288 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.75X22 SUP-99-04289 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.75X26 SUP-99-04290 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.75X30 SUP-99-04291 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.75X34 SUP-99-04292 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 2.75X38 SUP-99-04293 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 3.00X8 SUP-99-04294 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 3.00X12 SUP-99-04295 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 3.00X15 SUP-99-04296 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 3.00X18 SUP-99-04297 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 3.00X22 SUP-99-04298 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 3.00X26 SUP-99-04299 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 3.00X30 SUP-99-04300 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 3.00X34 SUP-99-04301 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 3.00X38 SUP-99-04302 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 3.50X8 SUP-99-04303 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 3.50X12 SUP-99-04304 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 3.50X15 SUP-99-04305 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 3.50X18 SUP-99-04306 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 3.50X22 SUP-99-04307 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 3.50X26 SUP-99-04308 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 3.50X30 SUP-99-04309 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 3.50X34 SUP-99-04310 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 3.5X38 SUP-99-04311 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 4.00X8 SUP-99-04312 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 4.00X12 SUP-99-04313 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 4.00X15 SUP-99-04314 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 4.00X18 SUP-99-04315 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 4.00X22 SUP-99-04316 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 4.00X26 SUP-99-04317 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 4.00X30 SUP-99-04318 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 4.00X34 SUP-99-04319 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JL4.5ST SUP-99-0432 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 4.00X38 SUP-99-04320 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 4.50X12 SUP-99-04321 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 4.50X15 SUP-99-04322 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 4.50X18 SUP-99-04323 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 4.50X22 SUP-99-04324 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 4.50X26 SUP-99-04325 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 4.50X30 SUP-99-04326 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 5.00X12 SUP-99-04327 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 5.00X15 SUP-99-04328 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 5.00X18 SUP-99-04329 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 5.00X22 SUP-99-04330 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 5.00X26 SUP-99-04331 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ONYX FRONTIER 5.00X30 SUP-99-04332 CDM C1874 HCPCS 0278 RC outpatient 1350 1350 1350 57 769.5 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 51 688.5 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ELUVIA 6MM X 150 X 130 SUP-99-04333 CDM C1874 HCPCS 0278 RC outpatient 9237.5 9237.5 9237.5 57 5265.38 percent of total billed charges 9237.5 93 7482.38 percent of total billed charges 9237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9237.5 other OPPS APC 9237.5 9237.5 other OPPS APC 9237.5 51 4711.13 percent of total billed charges 9237.5 9237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ELUVIA 7MM X 150 X 130 SUP-99-04334 CDM C1874 HCPCS 0278 RC outpatient 9237.5 9237.5 9237.5 57 5265.38 percent of total billed charges 9237.5 93 7482.38 percent of total billed charges 9237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9237.5 other OPPS APC 9237.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9237.5 other OPPS APC 9237.5 51 4711.13 percent of total billed charges 9237.5 9237.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.25X8 SUP-99-04335 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - RAINSHEATH 7F SUP-99-04336 CDM C1725 HCPCS 0272 RC outpatient 176 176 176 74 130.24 percent of total billed charges 176 93 142.56 percent of total billed charges 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 176 other OPPS APC 176 27.63 48.63 percent of total billed charges 176 176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - XIENCE SKYPOINT 3.5X28 SUP-99-04338 CDM C1874 HCPCS 0278 RC outpatient 1800 1800 1800 57 1026 percent of total billed charges 1800 93 1458 percent of total billed charges 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1800 other OPPS APC 1800 51 918 percent of total billed charges 1800 1800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 6F JL 4.5 100CM SUP-99-04339 CDM 0272 RC outpatient 32.28 32.28 32.28 74 23.89 percent of total billed charges 32.28 93 26.15 percent of total billed charges 32.28 32.28 other OPPS APC 32.28 32.28 other OPPS APC 32.28 27.63 8.92 percent of total billed charges 32.28 32.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - PILOT 50 HI-TORQUE 190CM SUP-99-04340 CDM C1769 HCPCS 0272 RC outpatient 259 259 259 74 191.66 percent of total billed charges 259 93 209.79 percent of total billed charges 259 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 259 other OPPS APC 259 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 259 other OPPS APC 259 27.63 71.56 percent of total billed charges 259 259 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 2.0FX135CM TELEPORT MICROCATHETER SUP-99-04341 CDM C1769 HCPCS 0272 RC outpatient 1350 1350 1350 74 999 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 27.63 373.01 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - .018X40CM NITINOL SUP-99-04342 CDM C1769 HCPCS 0272 RC outpatient 88 88 88 74 65.12 percent of total billed charges 88 93 71.28 percent of total billed charges 88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 88 other OPPS APC 88 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 88 other OPPS APC 88 27.63 24.31 percent of total billed charges 88 88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RANGER DCB 4X100 SUP-99-04343 CDM C2623 HCPCS 0272 RC outpatient 3375 3375 3375 74 2497.5 percent of total billed charges 3375 93 2733.75 percent of total billed charges 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3375 other OPPS APC 3375 27.63 932.51 percent of total billed charges 3375 3375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - STERLING OTW 2.5X150 SUP-99-04344 CDM C1725 HCPCS 0272 RC outpatient 825 825 825 74 610.5 percent of total billed charges 825 93 668.25 percent of total billed charges 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 825 other OPPS APC 825 27.63 227.95 percent of total billed charges 825 825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 2.5X10 SUP-99-04345 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - CROSSBOSS SUP-99-04346 CDM C1769 HCPCS 0272 RC outpatient 4542.5 4542.5 4542.5 74 3361.45 percent of total billed charges 4542.5 93 3679.43 percent of total billed charges 4542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4542.5 other OPPS APC 4542.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4542.5 other OPPS APC 4542.5 27.63 1255.09 percent of total billed charges 4542.5 4542.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 2.5 X 20 SUP-99-04347 CDM C1876 HCPCS 0278 RC outpatient 2100 2100 2100 57 1197 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 51 1071 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - SOLIA PRO MRI LEAD SUP-99-04348 CDM C1898 HCPCS 0275 RC outpatient 975 975 975 57 555.75 percent of total billed charges 975 93 789.75 percent of total billed charges 975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 975 other OPPS APC 975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 975 other OPPS APC 975 51 497.25 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - DUAL ICD RIVACOR DR-T SUP-99-04349 CDM outpatient 16100 16100 16100 16100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER- DX ICD ACTICOR DX SUP-99-04350 CDM C1882 HCPCS 0275 RC outpatient 15400 15400 15400 57 8778 percent of total billed charges 15400 93 12474 percent of total billed charges 15400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15400 other OPPS APC 15400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 15400 other OPPS APC 15400 51 7854 percent of total billed charges 15400 15400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER- SINGLE ICD RIVACOR VR-T SUP-99-04351 CDM outpatient 14900 14900 14900 14900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER- BI-V ICD RIVACOR CRT-D SUP-99-04352 CDM outpatient 20400 20400 20400 20400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER- SHOCKING LEAD PLEXA PRO MRI LEAD SUP-99-04353 CDM C1898 HCPCS 0275 RC outpatient 5062.5 5062.5 5062.5 57 2885.63 percent of total billed charges 5062.5 93 4100.63 percent of total billed charges 5062.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5062.5 other OPPS APC 5062.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5062.5 other OPPS APC 5062.5 51 2581.88 percent of total billed charges 5062.5 5062.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER- LV LEAD SENTUS QP PRO MRI LEAD SUP-99-04354 CDM C1898 HCPCS 0275 RC outpatient 2913.75 2913.75 2913.75 57 1660.84 percent of total billed charges 2913.75 93 2360.14 percent of total billed charges 2913.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2913.75 other OPPS APC 2913.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2913.75 other OPPS APC 2913.75 51 1486.01 percent of total billed charges 2913.75 2913.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - BI V- EDORA CR-T SUP-99-04355 CDM outpatient 12037.5 12037.5 12037.5 12037.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 1.75X10 SUP-99-04356 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 1.75X15 SUP-99-04357 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 1.75X20 SUP-99-04358 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 2.0X15 SUP-99-04359 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 2.0X20 SUP-99-04360 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 2.25X10 SUP-99-04361 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 2.25X15 SUP-99-04362 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 2.25X20 SUP-99-04363 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 2.5X15 SUP-99-04364 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 2.75X10 SUP-99-04365 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 2.75X15 SUP-99-04366 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 2.75X20 SUP-99-04367 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 3.0X10 SUP-99-04368 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 3.0X15 SUP-99-04369 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 3.0X20 SUP-99-04370 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 3.5X10 SUP-99-04371 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 3.5X15 SUP-99-04372 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 3.5X20 SUP-99-04373 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 4.0X10 SUP-99-04374 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 4.0X15 SUP-99-04375 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SCOREFLEX NC 4.0X20 SUP-99-04376 CDM C1725 HCPCS 0272 RC outpatient 2100 2100 2100 74 1554 percent of total billed charges 2100 93 1701 percent of total billed charges 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2100 other OPPS APC 2100 27.63 580.23 percent of total billed charges 2100 2100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 1.5X20 SUP-99-04377 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 1.5X40 SUP-99-04378 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 1.5X80 SUP-99-04379 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 1.5X120 SUP-99-04380 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 2.0X20 SUP-99-04381 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 2.0X40 SUP-99-04382 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 2.0X80 SUP-99-04383 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 2.0X100 SUP-99-04384 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 2.0X120 SUP-99-04385 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 2.0X150 SUP-99-04386 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 2.0X240 SUP-99-04387 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 2.5X20 SUP-99-04388 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 2.5X40 SUP-99-04389 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 2.5X80 SUP-99-04390 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 2.5X120 SUP-99-04391 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 2.5X240 SUP-99-04392 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 3.0X20 SUP-99-04393 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 3.0X40 SUP-99-04394 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 3.0X80 SUP-99-04395 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 3.0X100 SUP-99-04396 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 3.0X240 SUP-99-04397 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 2.5X150 SUP-99-04398 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 3.5X20 SUP-99-04399 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 3.5X40 SUP-99-04400 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 3.5X60 SUP-99-04401 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 3.5X150 SUP-99-04402 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 3.5X240 SUP-99-04403 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 4.0X20 SUP-99-04404 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 4.0X40 SUP-99-04405 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 4.0X60 SUP-99-04406 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 4.0X80 SUP-99-04407 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 4.0X100 SUP-99-04408 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 4.0X120 SUP-99-04409 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 4.0X240 SUP-99-04410 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 5.0X40 SUP-99-04412 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 5.0X60 SUP-99-04413 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 5.0X80 SUP-99-04414 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 5.0X100 SUP-99-04415 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 5.0X240 SUP-99-04416 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 6.0X80 SUP-99-04417 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 6.0X240 SUP-99-04418 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 5.0X150 SUP-99-04419 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.18 3.0X240 SUP-99-04420 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.18 5.0X40 SUP-99-04421 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.18 5.0X60 SUP-99-04422 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.18 5.0X240 SUP-99-04423 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.18 6.0X80 SUP-99-04424 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.18 6.0X150 SUP-99-04425 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.18 6.0X20 SUP-99-04426 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.18 6.0X40 SUP-99-04427 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.18 6.0X100 SUP-99-04428 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.18 6.0X240 SUP-99-04429 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.35 4.0X40 SUP-99-04430 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.35 4.0X80 SUP-99-04431 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.35 4.0X240 SUP-99-04432 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.35 5.0X20 SUP-99-04433 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.35 5.0X40 SUP-99-04434 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.35 5.0X80 SUP-99-04435 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.35 5.0X150 SUP-99-04436 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.35 6.0X40 SUP-99-04437 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.35 6.0X80 SUP-99-04438 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.35 6.0X100 SUP-99-04439 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.35 6.0X240 SUP-99-04440 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.35 7.0X20 SUP-99-04441 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.35 7.0X40 SUP-99-04442 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.35 7.0X60 SUP-99-04443 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.35 7.0X80 SUP-99-04444 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.35 7.0X100 SUP-99-04445 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.35 7.0X150 SUP-99-04446 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER LITHOTRIPSY SHOCKWAVE M5 L60 MM L110 CM OD4.0 MM OD7 MM CROSSING RANGE .054 IN SHEATH 6F PULSES MAX 300 SUP-99-04448 CDM C1724 HCPCS 0272 RC outpatient 8625 8625 8625 74 6382.5 percent of total billed charges 8625 93 6986.25 percent of total billed charges 8625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8625 other OPPS APC 8625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8625 other OPPS APC 8625 27.63 2383.09 percent of total billed charges 8625 8625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER LITHOTRIPSY SHOCKWAVE M5 L60 MM L110 CM OD5.0 MM OD7 MM CROSSING RANGE .054 IN SHEATH 6F PULSES 300 MAX SUP-99-04449 CDM C1724 HCPCS 0272 RC outpatient 8625 8625 8625 74 6382.5 percent of total billed charges 8625 93 6986.25 percent of total billed charges 8625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8625 other OPPS APC 8625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8625 other OPPS APC 8625 27.63 2383.09 percent of total billed charges 8625 8625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER LITHOTRIPSY SHOCKWAVE M5 L60 MM L110 CM OD6.0 MM OD7 MM CROSSING RANGE .054 IN SHEATH 6F PULSES 300 MAX SUP-99-04450 CDM C1724 HCPCS 0272 RC outpatient 8625 8625 8625 74 6382.5 percent of total billed charges 8625 93 6986.25 percent of total billed charges 8625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8625 other OPPS APC 8625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8625 other OPPS APC 8625 27.63 2383.09 percent of total billed charges 8625 8625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER LITHOTRIPSY SHOCKWAVE M5 L60 MM L110 CM OD7.0 MM OD7 MM CROSSING RANGE .054 IN SHEATH 6F PULSES 300 MAX SUP-99-04451 CDM C1724 HCPCS 0272 RC outpatient 8625 8625 8625 74 6382.5 percent of total billed charges 8625 93 6986.25 percent of total billed charges 8625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8625 other OPPS APC 8625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8625 other OPPS APC 8625 27.63 2383.09 percent of total billed charges 8625 8625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.18 2.0X240 SUP-99-04454 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.18 3.5X40 SUP-99-04455 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.18 3.5X80 SUP-99-04456 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.18 3.5X120 SUP-99-04457 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.18 3.5X150 SUP-99-04458 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.18 4.0X40 SUP-99-04459 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.18 4.0X80 SUP-99-04460 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 437.5 other OPPS APC 437.5 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.18 4.0X120 SUP-99-04461 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.18 4.0X240 SUP-99-04462 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.18 5.0X100 SUP-99-04463 CDM C1725 HCPCS 0272 RC outpatient 437.5 437.5 437.5 74 323.75 percent of total billed charges 437.5 93 354.38 percent of total billed charges 437.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 437.5 other OPPS APC 437.5 437.5 other OPPS APC 437.5 27.63 120.88 percent of total billed charges 437.5 437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.35 5.0X240 SUP-99-04464 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.35 5.0X100 SUP-99-04465 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.35 5.0X60 SUP-99-04466 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.35 6.0X60 SUP-99-04467 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 1.5X240 SUP-99-04468 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 2.5X100 SUP-99-04469 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 3.0X120 SUP-99-04470 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 3.0X150 SUP-99-04471 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 3.5X80 SUP-99-04472 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 3.5X100 SUP-99-04473 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - JADE 0.14 5.0X120 SUP-99-04474 CDM C1725 HCPCS 0272 RC outpatient 472.5 472.5 472.5 74 349.65 percent of total billed charges 472.5 93 382.73 percent of total billed charges 472.5 472.5 other OPPS APC 472.5 472.5 other OPPS APC 472.5 27.63 130.55 percent of total billed charges 472.5 472.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - SION BLUE 190CM SUP-99-04475 CDM C1769 HCPCS 0272 RC outpatient 1425 1425 1425 74 1054.5 percent of total billed charges 1425 93 1154.25 percent of total billed charges 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 27.63 393.73 percent of total billed charges 1425 1425 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - SILVERWAY 1.5J 260CM SUP-99-04476 CDM C1769 HCPCS 0272 RC outpatient 160 160 160 74 118.4 percent of total billed charges 160 93 129.6 percent of total billed charges 160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160 other OPPS APC 160 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 160 other OPPS APC 160 27.63 44.21 percent of total billed charges 160 160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTABLATOR - 2.15MM ROTAPRO BURR SUP-99-04477 CDM C1724 HCPCS 0272 RC outpatient 4812.5 4812.5 4812.5 74 3561.25 percent of total billed charges 4812.5 93 3898.13 percent of total billed charges 4812.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4812.5 other OPPS APC 4812.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4812.5 other OPPS APC 4812.5 27.63 1329.69 percent of total billed charges 4812.5 4812.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTABLATOR - 2.25MM ROTAPRO BURR SUP-99-04478 CDM C1724 HCPCS 0272 RC outpatient 4812.5 4812.5 4812.5 74 3561.25 percent of total billed charges 4812.5 93 3898.13 percent of total billed charges 4812.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4812.5 other OPPS APC 4812.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4812.5 other OPPS APC 4812.5 27.63 1329.69 percent of total billed charges 4812.5 4812.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTABLATOR - 2.38MM ROTAPRO BURR SUP-99-04479 CDM C1724 HCPCS 0272 RC outpatient 4812.5 4812.5 4812.5 74 3561.25 percent of total billed charges 4812.5 93 3898.13 percent of total billed charges 4812.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4812.5 other OPPS APC 4812.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4812.5 other OPPS APC 4812.5 27.63 1329.69 percent of total billed charges 4812.5 4812.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTABLATOR - ROTAWIRE DRIVE FLOPPY SUP-99-04485 CDM C1724 HCPCS 0272 RC outpatient 748.5 748.5 748.5 74 553.89 percent of total billed charges 748.5 93 606.29 percent of total billed charges 748.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.5 other OPPS APC 748.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.5 other OPPS APC 748.5 27.63 206.81 percent of total billed charges 748.5 748.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTABLATOR - ROTAWIRE DRIVE EXTRA SUPPORT SUP-99-04486 CDM C1724 HCPCS 0272 RC outpatient 748.5 748.5 748.5 74 553.89 percent of total billed charges 748.5 93 606.29 percent of total billed charges 748.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.5 other OPPS APC 748.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 748.5 other OPPS APC 748.5 27.63 206.81 percent of total billed charges 748.5 748.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - PILOT 200 J TIP 300CM SUP-99-04487 CDM C1769 HCPCS 0272 RC outpatient 259 259 259 74 191.66 percent of total billed charges 259 93 209.79 percent of total billed charges 259 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 259 other OPPS APC 259 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 259 other OPPS APC 259 27.63 71.56 percent of total billed charges 259 259 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE- HI-TORQUE SUPRA CORE .035 X 190 SUP-99-04488 CDM C1769 HCPCS 0272 RC outpatient 192.5 192.5 192.5 74 142.45 percent of total billed charges 192.5 93 155.93 percent of total billed charges 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 192.5 other OPPS APC 192.5 27.63 53.19 percent of total billed charges 192.5 192.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE- HI-TORQUE SUPRA CORE .035 X 300 SUP-99-04489 CDM C1769 HCPCS 0272 RC outpatient 213.5 213.5 213.5 74 157.99 percent of total billed charges 213.5 93 172.94 percent of total billed charges 213.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 213.5 other OPPS APC 213.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 213.5 other OPPS APC 213.5 27.63 58.99 percent of total billed charges 213.5 213.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - ASTATO 40 .014 X 300 SUP-99-04490 CDM C1769 HCPCS 0272 RC outpatient 525 525 525 74 388.5 percent of total billed charges 525 93 425.25 percent of total billed charges 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 525 other OPPS APC 525 27.63 145.06 percent of total billed charges 525 525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVES- BIOGEL 7 1/2 LATEX UNDERGLOVE SUP-99-04491 CDM outpatient 157.84 157.84 157.84 157.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - EBU3.5 7F 100CM SUP-99-04492 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - EBU3.0 7F 100CM SUP-99-04493 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - EBU4.0 7F 100CM SUP-99-04494 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - AR2 7F 100CM SUP-99-04495 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - AL1 7F 100CM SUP-99-04496 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - AL2 7F 100CM SUP-99-04497 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - JR4 7F 100CM SUP-99-04498 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - FLEXOR 45CM 6F MP TIP SUP-99-04499 CDM C1894 HCPCS 0272 RC outpatient 202.44 202.44 202.44 74 149.81 percent of total billed charges 202.44 93 163.98 percent of total billed charges 202.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 202.44 other OPPS APC 202.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 202.44 other OPPS APC 202.44 27.63 55.93 percent of total billed charges 202.44 202.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - FLEXOR 45CM 6F DOUBLE TIP SUP-99-04500 CDM C1894 HCPCS 0272 RC outpatient 202.44 202.44 202.44 74 149.81 percent of total billed charges 202.44 93 163.98 percent of total billed charges 202.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 202.44 other OPPS APC 202.44 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 202.44 other OPPS APC 202.44 27.63 55.93 percent of total billed charges 202.44 202.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RAPID EXCHANGE ADVANCE PTA 3MMX12CM SUP-99-04501 CDM C1725 HCPCS 0272 RC outpatient 1231.47 1231.47 1231.47 74 911.29 percent of total billed charges 1231.47 93 997.49 percent of total billed charges 1231.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1231.47 other OPPS APC 1231.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1231.47 other OPPS APC 1231.47 27.63 340.26 percent of total billed charges 1231.47 1231.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - FLEXOR 90CM 6F MP TIP SUP-99-04502 CDM C1894 HCPCS 0272 RC outpatient 395.75 395.75 395.75 74 292.86 percent of total billed charges 395.75 93 320.56 percent of total billed charges 395.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 395.75 other OPPS APC 395.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 395.75 other OPPS APC 395.75 27.63 109.35 percent of total billed charges 395.75 395.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 5X100 6F SUP-99-04503 CDM C1874 HCPCS 0278 RC outpatient 4424.98 4424.98 4424.98 57 2522.24 percent of total billed charges 4424.98 93 3584.23 percent of total billed charges 4424.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4424.98 other OPPS APC 4424.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4424.98 other OPPS APC 4424.98 51 2256.74 percent of total billed charges 4424.98 4424.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 5X120 6F SUP-99-04504 CDM C1874 HCPCS 0278 RC outpatient 4924.98 4924.98 4924.98 57 2807.24 percent of total billed charges 4924.98 93 3989.23 percent of total billed charges 4924.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4924.98 other OPPS APC 4924.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4924.98 other OPPS APC 4924.98 51 2511.74 percent of total billed charges 4924.98 4924.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 5X140 6F SUP-99-04505 CDM C1874 HCPCS 0278 RC outpatient 6587.48 6587.48 6587.48 57 3754.86 percent of total billed charges 6587.48 93 5335.86 percent of total billed charges 6587.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6587.48 other OPPS APC 6587.48 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6587.48 other OPPS APC 6587.48 51 3359.61 percent of total billed charges 6587.48 6587.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 5X40 6F SUP-99-04506 CDM C1874 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 5X60 6F SUP-99-04507 CDM C1874 HCPCS 0278 RC outpatient 3674.98 3674.98 3674.98 57 2094.74 percent of total billed charges 3674.98 93 2976.73 percent of total billed charges 3674.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3674.98 other OPPS APC 3674.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3674.98 other OPPS APC 3674.98 51 1874.24 percent of total billed charges 3674.98 3674.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 5X80 6F SUP-99-04508 CDM C1874 HCPCS 0278 RC outpatient 4424.98 4424.98 4424.98 57 2522.24 percent of total billed charges 4424.98 93 3584.23 percent of total billed charges 4424.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4424.98 other OPPS APC 4424.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4424.98 other OPPS APC 4424.98 51 2256.74 percent of total billed charges 4424.98 4424.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 6X100 6F SUP-99-04509 CDM C1874 HCPCS 0278 RC outpatient 4424.98 4424.98 4424.98 57 2522.24 percent of total billed charges 4424.98 93 3584.23 percent of total billed charges 4424.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4424.98 other OPPS APC 4424.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4424.98 other OPPS APC 4424.98 51 2256.74 percent of total billed charges 4424.98 4424.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 6X120 6F SUP-99-04510 CDM C1874 HCPCS 0278 RC outpatient 4924.98 4924.98 4924.98 57 2807.24 percent of total billed charges 4924.98 93 3989.23 percent of total billed charges 4924.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4924.98 other OPPS APC 4924.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4924.98 other OPPS APC 4924.98 51 2511.74 percent of total billed charges 4924.98 4924.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 6X140 6F SUP-99-04511 CDM C1874 HCPCS 0278 RC outpatient 5924.98 5924.98 5924.98 57 3377.24 percent of total billed charges 5924.98 93 4799.23 percent of total billed charges 5924.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5924.98 other OPPS APC 5924.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5924.98 other OPPS APC 5924.98 51 3021.74 percent of total billed charges 5924.98 5924.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 6X40 6F SUP-99-04512 CDM C1874 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 6X60 6F SUP-99-04513 CDM C1874 HCPCS 0278 RC outpatient 3674.98 3674.98 3674.98 57 2094.74 percent of total billed charges 3674.98 93 2976.73 percent of total billed charges 3674.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3674.98 other OPPS APC 3674.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3674.98 other OPPS APC 3674.98 51 1874.24 percent of total billed charges 3674.98 3674.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 6X80 6F SUP-99-04514 CDM C1874 HCPCS 0278 RC outpatient 4424.98 4424.98 4424.98 57 2522.24 percent of total billed charges 4424.98 93 3584.23 percent of total billed charges 4424.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4424.98 other OPPS APC 4424.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4424.98 other OPPS APC 4424.98 51 2256.74 percent of total billed charges 4424.98 4424.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 7X100 6F SUP-99-04515 CDM C1874 HCPCS 0278 RC outpatient 4424.98 4424.98 4424.98 57 2522.24 percent of total billed charges 4424.98 93 3584.23 percent of total billed charges 4424.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4424.98 other OPPS APC 4424.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4424.98 other OPPS APC 4424.98 51 2256.74 percent of total billed charges 4424.98 4424.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 7X120 6F SUP-99-04516 CDM C1874 HCPCS 0278 RC outpatient 4924.98 4924.98 4924.98 57 2807.24 percent of total billed charges 4924.98 93 3989.23 percent of total billed charges 4924.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4924.98 other OPPS APC 4924.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4924.98 other OPPS APC 4924.98 51 2511.74 percent of total billed charges 4924.98 4924.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 7X140 6F SUP-99-04517 CDM C1874 HCPCS 0278 RC outpatient 5924.98 5924.98 5924.98 57 3377.24 percent of total billed charges 5924.98 93 4799.23 percent of total billed charges 5924.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5924.98 other OPPS APC 5924.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5924.98 other OPPS APC 5924.98 51 3021.74 percent of total billed charges 5924.98 5924.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 7X40 6F SUP-99-04518 CDM C1874 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 7X60 6F SUP-99-04519 CDM C1874 HCPCS 0278 RC outpatient 3674.98 3674.98 3674.98 57 2094.74 percent of total billed charges 3674.98 93 2976.73 percent of total billed charges 3674.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3674.98 other OPPS APC 3674.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3674.98 other OPPS APC 3674.98 51 1874.24 percent of total billed charges 3674.98 3674.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 7X80 6F SUP-99-04520 CDM C1874 HCPCS 0278 RC outpatient 4424.98 4424.98 4424.98 57 2522.24 percent of total billed charges 4424.98 93 3584.23 percent of total billed charges 4424.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4424.98 other OPPS APC 4424.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4424.98 other OPPS APC 4424.98 51 2256.74 percent of total billed charges 4424.98 4424.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 8X100 6F SUP-99-04521 CDM C1874 HCPCS 0278 RC outpatient 4424.98 4424.98 4424.98 57 2522.24 percent of total billed charges 4424.98 93 3584.23 percent of total billed charges 4424.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4424.98 other OPPS APC 4424.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4424.98 other OPPS APC 4424.98 51 2256.74 percent of total billed charges 4424.98 4424.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 8X120 6F SUP-99-04522 CDM C1874 HCPCS 0278 RC outpatient 4924.98 4924.98 4924.98 57 2807.24 percent of total billed charges 4924.98 93 3989.23 percent of total billed charges 4924.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4924.98 other OPPS APC 4924.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4924.98 other OPPS APC 4924.98 51 2511.74 percent of total billed charges 4924.98 4924.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 8X40 6F SUP-99-04523 CDM C1874 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 8X60 6F SUP-99-04524 CDM C1874 HCPCS 0278 RC outpatient 3674.98 3674.98 3674.98 57 2094.74 percent of total billed charges 3674.98 93 2976.73 percent of total billed charges 3674.98 3674.98 other OPPS APC 3674.98 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3674.98 other OPPS APC 3674.98 51 1874.24 percent of total billed charges 3674.98 3674.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - ZILVER PTX 8X80 6F SUP-99-04525 CDM C1874 HCPCS 0278 RC outpatient 4424.98 4424.98 4424.98 57 2522.24 percent of total billed charges 4424.98 93 3584.23 percent of total billed charges 4424.98 4424.98 other OPPS APC 4424.98 4424.98 other OPPS APC 4424.98 51 2256.74 percent of total billed charges 4424.98 4424.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XBLAD 3.5 7F SUP-99-04527 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XBLAD 4.0 7F SUP-99-04528 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XBLAD 4.5 7F SUP-99-04529 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XBLAD 3.0 6F SUP-99-04530 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XBLAD 3.5 6F SUP-99-04531 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XBLAD 4.0 6F SUP-99-04532 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XBLAD 4.5 6F SUP-99-04533 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT- COVERED PAPYRUS 2.5 X 20 SUP-99-04535 CDM C1887 HCPCS 0272 RC outpatient 9075 9075 9075 74 6715.5 percent of total billed charges 9075 93 7350.75 percent of total billed charges 9075 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9075 other OPPS APC 9075 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9075 other OPPS APC 9075 27.63 2507.42 percent of total billed charges 9075 9075 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT- COVERED PAPYRUS 3.5 X 20 SUP-99-04536 CDM C1887 HCPCS 0272 RC outpatient 9075 9075 9075 74 6715.5 percent of total billed charges 9075 93 7350.75 percent of total billed charges 9075 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9075 other OPPS APC 9075 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9075 other OPPS APC 9075 27.63 2507.42 percent of total billed charges 9075 9075 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - COVERED PAPYRUS 4.5 X 20 SUP-99-04537 CDM outpatient 9075 9075 9075 9075 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT- COVERED PAPYRUS 3X20 SUP-99-04538 CDM C1887 HCPCS 0272 RC outpatient 9075 9075 9075 74 6715.5 percent of total billed charges 9075 93 7350.75 percent of total billed charges 9075 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9075 other OPPS APC 9075 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9075 other OPPS APC 9075 27.63 2507.42 percent of total billed charges 9075 9075 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - COVERED PAPYRUS 5 X 20 SUP-99-04539 CDM C1887 HCPCS 0272 RC outpatient 9075 9075 9075 74 6715.5 percent of total billed charges 9075 93 7350.75 percent of total billed charges 9075 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9075 other OPPS APC 9075 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9075 other OPPS APC 9075 27.63 2507.42 percent of total billed charges 9075 9075 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT- COVERED PAPYRUS 4.5 X 15 SUP-99-04540 CDM C1887 HCPCS 0272 RC outpatient 9075 9075 9075 74 6715.5 percent of total billed charges 9075 93 7350.75 percent of total billed charges 9075 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9075 other OPPS APC 9075 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9075 other OPPS APC 9075 27.63 2507.42 percent of total billed charges 9075 9075 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - COVERED PAPYRUS 5 X 15 SUP-99-04541 CDM C1887 HCPCS 0272 RC outpatient 9075 9075 9075 74 6715.5 percent of total billed charges 9075 93 7350.75 percent of total billed charges 9075 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9075 other OPPS APC 9075 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9075 other OPPS APC 9075 27.63 2507.42 percent of total billed charges 9075 9075 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - COVERED PAPYRUS 4 X 20 SUP-99-04542 CDM C1887 HCPCS 0272 RC outpatient 9075 9075 9075 74 6715.5 percent of total billed charges 9075 93 7350.75 percent of total billed charges 9075 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9075 other OPPS APC 9075 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9075 other OPPS APC 9075 27.63 2507.42 percent of total billed charges 9075 9075 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC EUPHORA 3.5X20 SUP-99-04543 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GLADIUS .018 X 200 SUP-99-04545 CDM C1769 HCPCS 0272 RC outpatient 2550 2550 2550 74 1887 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 27.63 704.57 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GLADIUS .018 X 300 SUP-99-04546 CDM C1769 HCPCS 0272 RC outpatient 2550 2550 2550 74 1887 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 27.63 704.57 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE- TORQUE DEVICE .014-.038 SUP-99-04547 CDM C1769 HCPCS 0272 RC outpatient 23.76 23.76 23.76 74 17.58 percent of total billed charges 23.76 93 19.25 percent of total billed charges 23.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 23.76 other OPPS APC 23.76 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 23.76 other OPPS APC 23.76 27.63 6.56 percent of total billed charges 23.76 23.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - SION BLUE 190 J TIP SUP-99-04548 CDM C1769 HCPCS 0272 RC outpatient 1425 1425 1425 74 1054.5 percent of total billed charges 1425 93 1154.25 percent of total billed charges 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 27.63 393.73 percent of total billed charges 1425 1425 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - SION BLUE 300 J TIP SUP-99-04549 CDM C1769 HCPCS 0272 RC outpatient 1425 1425 1425 74 1054.5 percent of total billed charges 1425 93 1154.25 percent of total billed charges 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1425 other OPPS APC 1425 27.63 393.73 percent of total billed charges 1425 1425 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STATLOCK - BALLOON PUMP SUP-99-04550 CDM outpatient 80.6 80.6 80.6 80.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD- DUAL EVERA XT GENERATOR SUP-99-04551 CDM outpatient 16691 16691 16691 16691 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD - SPRINT QUATTRO RV LEAD 62CM SUP-99-04552 CDM C1777 HCPCS 0275 RC outpatient 7767.5 7767.5 7767.5 57 4427.48 percent of total billed charges 7767.5 93 6291.68 percent of total billed charges 7767.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7767.5 other OPPS APC 7767.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 7767.5 other OPPS APC 7767.5 51 3961.43 percent of total billed charges 7767.5 7767.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD - SINGLE ELLIPSE ICD GENERATOR SUP-99-04553 CDM outpatient 14850 14850 14850 14850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD - DURATA RV LEAD SUP-99-04554 CDM outpatient 6750 6750 6750 6750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RAPID EXCHANGE ADVANCE PTA 2MMX2CM SUP-99-04555 CDM C1725 HCPCS 0272 RC outpatient 1231.47 1231.47 1231.47 74 911.29 percent of total billed charges 1231.47 93 997.49 percent of total billed charges 1231.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1231.47 other OPPS APC 1231.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1231.47 other OPPS APC 1231.47 27.63 340.26 percent of total billed charges 1231.47 1231.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RAPID EXCHANGE ADVANCE PTA 2MMX12CM SUP-99-04556 CDM C1725 HCPCS 0272 RC outpatient 1231.47 1231.47 1231.47 74 911.29 percent of total billed charges 1231.47 93 997.49 percent of total billed charges 1231.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1231.47 other OPPS APC 1231.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1231.47 other OPPS APC 1231.47 27.63 340.26 percent of total billed charges 1231.47 1231.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RAPID EXCHANGE ADVANCE PTA 2.5MMX2CM SUP-99-04557 CDM C1725 HCPCS 0272 RC outpatient 1231.47 1231.47 1231.47 74 911.29 percent of total billed charges 1231.47 93 997.49 percent of total billed charges 1231.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1231.47 other OPPS APC 1231.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1231.47 other OPPS APC 1231.47 27.63 340.26 percent of total billed charges 1231.47 1231.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RAPID EXCHANGE ADVANCE PTA 2.5MMX12CM SUP-99-04558 CDM C1725 HCPCS 0272 RC outpatient 1231.47 1231.47 1231.47 74 911.29 percent of total billed charges 1231.47 93 997.49 percent of total billed charges 1231.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1231.47 other OPPS APC 1231.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1231.47 other OPPS APC 1231.47 27.63 340.26 percent of total billed charges 1231.47 1231.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - RAPID EXCHANGE ADVANCE PTA 3MMX2CM SUP-99-04559 CDM C1725 HCPCS 0272 RC outpatient 1231.47 1231.47 1231.47 74 911.29 percent of total billed charges 1231.47 93 997.49 percent of total billed charges 1231.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1231.47 other OPPS APC 1231.47 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1231.47 other OPPS APC 1231.47 27.63 340.26 percent of total billed charges 1231.47 1231.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - VERSACROSS TRANS-SEPTAL SHEATH W/230CM WIRE SUP-99-04561 CDM C1893 LOCAL 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE- BMW 190J HYDROPHILLIC SUP-99-04562 CDM C1769 HCPCS 0272 RC outpatient 259 259 259 74 191.66 percent of total billed charges 259 93 209.79 percent of total billed charges 259 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 259 other OPPS APC 259 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 259 other OPPS APC 259 27.63 71.56 percent of total billed charges 259 259 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 6FRX23CM BRITE TIP SUP-99-04563 CDM C1894 HCPCS 0272 RC outpatient 84 84 84 74 62.16 percent of total billed charges 84 93 68.04 percent of total billed charges 84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84 other OPPS APC 84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84 other OPPS APC 84 27.63 23.21 percent of total billed charges 84 84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 7FRX23CM BRITE TIP SUP-99-04564 CDM C1894 HCPCS 0272 RC outpatient 92 92 92 74 68.08 percent of total billed charges 92 93 74.52 percent of total billed charges 92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92 other OPPS APC 92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92 other OPPS APC 92 27.63 25.42 percent of total billed charges 92 92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 6FRX55CM BRITE-TIP SUP-99-04565 CDM C1894 HCPCS 0272 RC outpatient 84 84 84 74 62.16 percent of total billed charges 84 93 68.04 percent of total billed charges 84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84 other OPPS APC 84 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 84 other OPPS APC 84 27.63 23.21 percent of total billed charges 84 84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 3 X 20 SUP-99-04566 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 1.5X20 SUP-99-04567 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - OUTBACK ELITE 6FX120CM RE-ENTRY SUP-99-04568 CDM C1887 HCPCS 0272 RC outpatient 4725 4725 4725 74 3496.5 percent of total billed charges 4725 93 3827.25 percent of total billed charges 4725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4725 other OPPS APC 4725 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 4725 other OPPS APC 4725 27.63 1305.52 percent of total billed charges 4725 4725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART CONTROL 7X40 SUP-99-04569 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART CONTROL 7X60 SUP-99-04570 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART CONTROL 7X80 SUP-99-04571 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART CONTROL 7X100 SUP-99-04572 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART CONTROL 8X40 SUP-99-04573 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART CONTROL 8X60 SUP-99-04574 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART CONTROL 8X80 SUP-99-04575 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART CONTROL 8X100 SUP-99-04576 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART CONTROL 9X40 SUP-99-04577 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART CONTROL 9X60 SUP-99-04578 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART CONTROL 9X80 SUP-99-04579 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART CONTROL 10X40 SUP-99-04580 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART CONTROL 10X60 SUP-99-04581 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART CONTROL 10X80 SUP-99-04582 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART CONTROL 12X30 SUP-99-04583 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART CONTROL 12X40 SUP-99-04584 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART CONTROL 12X60 SUP-99-04585 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART CONTROL 14X30 SUP-99-04586 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART CONTROL 14X40 SUP-99-04587 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART CONTROL 14X60 SUP-99-04588 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART FLEX 5X40 SUP-99-04589 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART FLEX 5X60 SUP-99-04590 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART FLEX 5X80 SUP-99-04591 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART FLEX 5X120 SUP-99-04592 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART FLEX 6X40 SUP-99-04593 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART FLEX 6X60 SUP-99-04594 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART FLEX 6X80 SUP-99-04595 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART FLEX 6X100 SUP-99-04596 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART FLEX 6X120 SUP-99-04597 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART FLEX 6X150 SUP-99-04598 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART FLEX 7X40 SUP-99-04599 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART FLEX 7X60 SUP-99-04600 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART FLEX 7X80 SUP-99-04601 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART FLEX 7X100 SUP-99-04602 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART FLEX 7X120 SUP-99-04603 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART FLEX 7X150 SUP-99-04604 CDM outpatient 2677.5 2677.5 2677.5 2677.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - CORSAIR PRO XS 135CM SUP-99-04605 CDM C1887 HCPCS 0272 RC outpatient 2550 2550 2550 74 1887 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 27.63 704.57 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - CORSAIR PRO XS 150CM SUP-99-04606 CDM C1887 HCPCS 0272 RC outpatient 2550 2550 2550 74 1887 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 27.63 704.57 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 7F GUIDELINER SUP-99-04607 CDM C1887 HCPCS 0272 RC outpatient 1230 1230 1230 74 910.2 percent of total billed charges 1230 93 996.3 percent of total billed charges 1230 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1230 other OPPS APC 1230 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1230 other OPPS APC 1230 27.63 339.85 percent of total billed charges 1230 1230 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - PINNACLE DESTINATION 7FX60CM STRAIGHT TIP SUP-99-04608 CDM C1894 HCPCS 0272 RC outpatient 315 315 315 74 233.1 percent of total billed charges 315 93 255.15 percent of total billed charges 315 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 315 other OPPS APC 315 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 315 other OPPS APC 315 27.63 87.03 percent of total billed charges 315 315 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - PINNACLE DESTINATION 7FX90CM STRAIGHT TIP SUP-99-04609 CDM C1894 HCPCS 0272 RC outpatient 322 322 322 74 238.28 percent of total billed charges 322 93 260.82 percent of total billed charges 322 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 322 other OPPS APC 322 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 322 other OPPS APC 322 27.63 88.97 percent of total billed charges 322 322 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - INFINITI RADIAL 5F RBL-TG 100CM SUP-99-04610 CDM C1874 HCPCS 0272 RC outpatient 96 96 96 74 71.04 percent of total billed charges 96 93 77.76 percent of total billed charges 96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 96 other OPPS APC 96 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 96 other OPPS APC 96 27.63 26.52 percent of total billed charges 96 96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - EDORA DR-T DUAL SUP-99-04611 CDM outpatient 6300 6300 6300 6300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER- EDORA SR-T SINGLE SUP-99-04612 CDM outpatient 5850 5850 5850 5850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.25X12 SUP-99-04613 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.5X12 SUP-99-04614 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.75X12 SUP-99-04615 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 3.0X12 SUP-99-04616 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 3.5X12 SUP-99-04617 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 4.0X12 SUP-99-04618 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 4.5X12 SUP-99-04619 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 5.0X12 SUP-99-04620 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.25X16 SUP-99-04621 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.5X16 SUP-99-04622 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.75X16 SUP-99-04623 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 3.0X16 SUP-99-04624 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 3.5X16 SUP-99-04625 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 4.0X16 SUP-99-04626 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 4.5X16 SUP-99-04627 CDM outpatient 1650 1650 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 5.0X16 SUP-99-04628 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.25X20 SUP-99-04629 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.5X20 SUP-99-04630 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.75X20 SUP-99-04631 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 3.0X20 SUP-99-04632 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 3.5X20 SUP-99-04633 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 4.0X20 SUP-99-04634 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 4.5X20 SUP-99-04635 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 5.0X20 SUP-99-04636 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.25X24 SUP-99-04637 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.5X24 SUP-99-04638 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.75X24 SUP-99-04639 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 3.0X24 SUP-99-04640 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 3.5X24 SUP-99-04641 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 4.0X24 SUP-99-04642 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 4.5X24 SUP-99-04643 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 5.0X24 SUP-99-04644 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.25X28 SUP-99-04645 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.5X28 SUP-99-04646 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.75X28 SUP-99-04647 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 3.0X28 SUP-99-04648 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 3.5X28 SUP-99-04649 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 4.0X28 SUP-99-04650 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 4.5X28 SUP-99-04651 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 5.0X28 SUP-99-04652 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.25X32 SUP-99-04653 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.5X32 SUP-99-04654 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.75X32 SUP-99-04655 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 3.0X32 SUP-99-04656 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 3.5X32 SUP-99-04657 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 4.0X32 SUP-99-04658 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 4.5X32 SUP-99-04659 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 5.0X32 SUP-99-04660 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.25X38 SUP-99-04661 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.5X38 SUP-99-04662 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.75X38 SUP-99-04663 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 3.0X38 SUP-99-04664 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 3.5X38 SUP-99-04665 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 4.0X38 SUP-99-04666 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.5X48 SUP-99-04667 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 2.75X48 SUP-99-04668 CDM C1874 HCPCS 0278 RC outpatient 1650 1650 1650 57 940.5 percent of total billed charges 1650 93 1336.5 percent of total billed charges 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1650 other OPPS APC 1650 51 841.5 percent of total billed charges 1650 1650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 3.0X48 SUP-99-04669 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 3.5X48 SUP-99-04670 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY XD 4.0X48 SUP-99-04671 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 3.5X12 SUP-99-04672 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 4.0X12 SUP-99-04673 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 4.5X12 SUP-99-04674 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 5.0X12 SUP-99-04675 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 3.5X16 SUP-99-04676 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 4.0X16 SUP-99-04677 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 4.5X16 SUP-99-04678 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 5.0X16 SUP-99-04679 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 3.5X20 SUP-99-04680 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 4.0X20 SUP-99-04681 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 4.5X20 SUP-99-04682 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 5.0X20 SUP-99-04683 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 3.5X24 SUP-99-04684 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 4.0X24 SUP-99-04685 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 4.5X24 SUP-99-04686 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 5.0X24 SUP-99-04687 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 3.5X28 SUP-99-04688 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 4.0X28 SUP-99-04689 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 4.5X28 SUP-99-04690 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 5.0X28 SUP-99-04691 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 3.5X32 SUP-99-04692 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 4.0X32 SUP-99-04693 CDM C1874 HCPCS 0278 RC outpatient 2550 2550 2550 57 1453.5 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 51 1300.5 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 4.5X32 SUP-99-04694 CDM C1874 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 5.0X32 SUP-99-04695 CDM C1874 HCPCS 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IVUS - VISIONS PV 0.018 SUP-99-04697 CDM C1753 HCPCS 0272 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - SUPERCROSS 120 DEG. 130CM SUP-99-04698 CDM C1887 HCPCS 0272 RC outpatient 1830 1830 1830 74 1354.2 percent of total billed charges 1830 93 1482.3 percent of total billed charges 1830 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1830 other OPPS APC 1830 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1830 other OPPS APC 1830 27.63 505.63 percent of total billed charges 1830 1830 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - EBU5.0 6F LAUNCHER SUP-99-04699 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - EBU5.0 7F LAUNCHER SUP-99-04700 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT- COVERED VIABAHN 8 X 50 SUP-99-04701 CDM C1874 HCPCS 0278 RC outpatient 9392.5 9392.5 9392.5 57 5353.73 percent of total billed charges 9392.5 93 7607.93 percent of total billed charges 9392.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9392.5 other OPPS APC 9392.5 9392.5 other OPPS APC 9392.5 51 4790.18 percent of total billed charges 9392.5 9392.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - COVERED - VIABAHN 8 X 10 SUP-99-04702 CDM C1874 HCPCS 0278 RC outpatient 8220 8220 8220 57 4685.4 percent of total billed charges 8220 93 6658.2 percent of total billed charges 8220 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8220 other OPPS APC 8220 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8220 other OPPS APC 8220 51 4192.2 percent of total billed charges 8220 8220 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD - DUAL ELLIPSE ICD GENERATOR SUP-99-04703 CDM outpatient 15240 15240 15240 15240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - NAVICROSS 0.018 STRAIGHT 90CM SUP-99-04704 CDM C1887 HCPCS 0272 RC outpatient 598.5 598.5 598.5 74 442.89 percent of total billed charges 598.5 93 484.79 percent of total billed charges 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 27.63 165.37 percent of total billed charges 598.5 598.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - NAVICROSS 0.018 STRAIGHT 135CM SUP-99-04705 CDM C1887 HCPCS 0272 RC outpatient 598.5 598.5 598.5 74 442.89 percent of total billed charges 598.5 93 484.79 percent of total billed charges 598.5 598.5 other OPPS APC 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 27.63 165.37 percent of total billed charges 598.5 598.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - NAVICROSS 0.018 STRAIGHT 150CM SUP-99-04706 CDM C1887 HCPCS 0272 RC outpatient 598.5 598.5 598.5 74 442.89 percent of total billed charges 598.5 93 484.79 percent of total billed charges 598.5 598.5 other OPPS APC 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 27.63 165.37 percent of total billed charges 598.5 598.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - NAVICROSS 0.018 ANGLED 90CM SUP-99-04707 CDM C1887 HCPCS 0272 RC outpatient 598.5 598.5 598.5 74 442.89 percent of total billed charges 598.5 93 484.79 percent of total billed charges 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 27.63 165.37 percent of total billed charges 598.5 598.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - NAVICROSS 0.018 ANGLED 135CM SUP-99-04708 CDM C1887 HCPCS 0272 RC outpatient 598.5 598.5 598.5 74 442.89 percent of total billed charges 598.5 93 484.79 percent of total billed charges 598.5 598.5 other OPPS APC 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 27.63 165.37 percent of total billed charges 598.5 598.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - NAVICROSS 0.018 ANGLED 150CM SUP-99-04709 CDM C1887 HCPCS 0272 RC outpatient 598.5 598.5 598.5 74 442.89 percent of total billed charges 598.5 93 484.79 percent of total billed charges 598.5 598.5 other OPPS APC 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 27.63 165.37 percent of total billed charges 598.5 598.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - NAVICROSS 0.035 STRAIGHT 90CM SUP-99-04710 CDM C1887 HCPCS 0272 RC outpatient 598.5 598.5 598.5 74 442.89 percent of total billed charges 598.5 93 484.79 percent of total billed charges 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 27.63 165.37 percent of total billed charges 598.5 598.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - NAVICROSS 0.035 STRAIGHT 135CM SUP-99-04711 CDM C1887 HCPCS 0272 RC outpatient 598.5 598.5 598.5 74 442.89 percent of total billed charges 598.5 93 484.79 percent of total billed charges 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 27.63 165.37 percent of total billed charges 598.5 598.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - NAVICROSS 0.035 STRAIGHT 150CM SUP-99-04712 CDM C1887 HCPCS 0272 RC outpatient 598.5 598.5 598.5 74 442.89 percent of total billed charges 598.5 93 484.79 percent of total billed charges 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 598.5 other OPPS APC 598.5 27.63 165.37 percent of total billed charges 598.5 598.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - ACUITY PRO CS-IC 7FX60CM CORONARY SINUS SUP-99-04713 CDM C1887 HCPCS 0272 RC outpatient 900 900 900 74 666 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 27.63 248.67 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - ACUITY PRO CS INNER CATHETER 7FX60CM SUP-99-04714 CDM C1887 HCPCS 0272 RC outpatient 900 900 900 74 666 percent of total billed charges 900 93 729 percent of total billed charges 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 900 other OPPS APC 900 27.63 248.67 percent of total billed charges 900 900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - ACUITY PRO CS-EH 9FX45CM EXTENDED HOOK SUP-99-04715 CDM C1887 HCPCS 0272 RC outpatient 1500 1500 1500 74 1110 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 27.63 414.45 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - ACUITY PRO CS 9FX45CM EXTENDED HOOK RIGHT SUP-99-04716 CDM C1887 HCPCS 0272 RC outpatient 1500 1500 1500 74 1110 percent of total billed charges 1500 93 1215 percent of total billed charges 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1500 other OPPS APC 1500 27.63 414.45 percent of total billed charges 1500 1500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER - ACUITY UNIVERSAL CUTTER SUP-99-04717 CDM C1887 HCPCS 0272 RC outpatient 200 200 200 74 148 percent of total billed charges 200 93 162 percent of total billed charges 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 200 other OPPS APC 200 27.63 55.26 percent of total billed charges 200 200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - ANGLED TAPER GLIDECATH 5FX65CM SUP-99-04718 CDM C1887 HCPCS 0272 RC outpatient 194.2 194.2 194.2 74 143.71 percent of total billed charges 194.2 93 157.3 percent of total billed charges 194.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 194.2 other OPPS APC 194.2 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 194.2 other OPPS APC 194.2 27.63 53.66 percent of total billed charges 194.2 194.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - JR4.0 5F (MEDTRONIC) SUP-99-04720 CDM 0272 RC outpatient 36 36 36 74 26.64 percent of total billed charges 36 93 29.16 percent of total billed charges 36 36 other OPPS APC 36 36 other OPPS APC 36 27.63 9.95 percent of total billed charges 36 36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER- QUADRA ASSURA BI-V ICD SUP-99-04721 CDM C1882 HCPCS 0275 RC outpatient 20900 20900 20900 57 11913 percent of total billed charges 20900 93 16929 percent of total billed charges 20900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20900 other OPPS APC 20900 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 20900 other OPPS APC 20900 51 10659 percent of total billed charges 20900 20900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 1.5X12 SUP-99-04722 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 1.5X15 SUP-99-04723 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 1.5X20 SUP-99-04724 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 2.0X6 SUP-99-04725 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 2.25X6 SUP-99-04726 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 2.25X12 SUP-99-04727 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 2.5X25 SUP-99-04728 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 2.75X6 SUP-99-04729 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 3.0X25 SUP-99-04730 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 3.25X6 SUP-99-04731 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 3.5X25 SUP-99-04732 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 3.75X8 SUP-99-04733 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 5.5X12 SUP-99-04734 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 5.5X15 SUP-99-04735 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 5.5X20 SUP-99-04736 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 6.0X12 SUP-99-04737 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 6.0X15 SUP-99-04738 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - NC TREK NEO 6.0X20 SUP-99-04739 CDM C1725 HCPCS 0272 RC outpatient 252 252 252 74 186.48 percent of total billed charges 252 93 204.12 percent of total billed charges 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 252 other OPPS APC 252 27.63 69.63 percent of total billed charges 252 252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - WORLEY-STD 9FX40CM SAFE SHEATH CSG BRAIDED CORE SUP-99-04740 CDM C1894 HCPCS 0272 RC outpatient 673.75 673.75 673.75 74 498.58 percent of total billed charges 673.75 93 545.74 percent of total billed charges 673.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 673.75 other OPPS APC 673.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 673.75 other OPPS APC 673.75 27.63 186.16 percent of total billed charges 673.75 673.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - RESPONSE EP CATHETER 6F SUP-99-04741 CDM C1732 CPT 0278 RC outpatient 1446 1446 1446 57 824.22 percent of total billed charges 1446 93 1171.26 percent of total billed charges 1446 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1446 other OPPS APC 1446 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1446 other OPPS APC 1446 51 737.46 percent of total billed charges 1446 1446 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- PENTARAY D CURVE SUP-99-04746 CDM C1732 CPT 0278 RC outpatient 5195 5195 5195 57 2961.15 percent of total billed charges 5195 93 4207.95 percent of total billed charges 5195 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5195 other OPPS APC 5195 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5195 other OPPS APC 5195 51 2649.45 percent of total billed charges 5195 5195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - PENTARAY F CURVE SUP-99-04747 CDM C1732 CPT 0278 RC outpatient 5195 5195 5195 57 2961.15 percent of total billed charges 5195 93 4207.95 percent of total billed charges 5195 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5195 other OPPS APC 5195 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5195 other OPPS APC 5195 51 2649.45 percent of total billed charges 5195 5195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE- CARTO PENTARAY SUP-99-04748 CDM C1732 CPT 0278 RC outpatient 1557 1557 1557 57 887.49 percent of total billed charges 1557 93 1261.17 percent of total billed charges 1557 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1557 other OPPS APC 1557 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1557 other OPPS APC 1557 51 794.07 percent of total billed charges 1557 1557 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH- VIZIGO MEDIUM CURVE SUP-99-04749 CDM C1766 CPT 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- DECANAV 2-8-2 F CURVE SUP-99-04751 CDM C1732 CPT 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE- DECANAV SUP-99-04752 CDM C1732 CPT 0278 RC outpatient 1557 1557 1557 57 887.49 percent of total billed charges 1557 93 1261.17 percent of total billed charges 1557 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1557 other OPPS APC 1557 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1557 other OPPS APC 1557 51 794.07 percent of total billed charges 1557 1557 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE- NON NAV SUP-99-04753 CDM C1732 CPT 0278 RC outpatient 1557 1557 1557 57 887.49 percent of total billed charges 1557 93 1261.17 percent of total billed charges 1557 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1557 other OPPS APC 1557 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1557 other OPPS APC 1557 51 794.07 percent of total billed charges 1557 1557 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- SMARTTOUCH THERMOCOOL STSF D-F (BI) SUP-99-04754 CDM C1732 CPT 0278 RC outpatient 9445 9445 9445 57 5383.65 percent of total billed charges 9445 93 7650.45 percent of total billed charges 9445 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9445 other OPPS APC 9445 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9445 other OPPS APC 9445 51 4816.95 percent of total billed charges 9445 9445 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE- CARTO 34 PIN RED CONNECTOR SUP-99-04755 CDM C1732 CPT 0278 RC outpatient 1557 1557 1557 57 887.49 percent of total billed charges 1557 93 1261.17 percent of total billed charges 1557 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1557 other OPPS APC 1557 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1557 other OPPS APC 1557 51 794.07 percent of total billed charges 1557 1557 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- ABLATION 4MM D-F CURVE (NON-IRRAGATED) SUP-99-04756 CDM C1732 CPT 0278 RC outpatient 6030 6030 6030 57 3437.1 percent of total billed charges 6030 93 4884.3 percent of total billed charges 6030 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6030 other OPPS APC 6030 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6030 other OPPS APC 6030 51 3075.3 percent of total billed charges 6030 6030 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE- CARTO 3 L10 FT RED SUP-99-04757 CDM C1732 CPT 0278 RC outpatient 1557 1557 1557 57 887.49 percent of total billed charges 1557 93 1261.17 percent of total billed charges 1557 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1557 other OPPS APC 1557 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1557 other OPPS APC 1557 51 794.07 percent of total billed charges 1557 1557 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- SMARTTOUCH THERMOCOOL STSF F CURVE (UNI) SUP-99-04758 CDM C1732 CPT 0278 RC outpatient 8950 8950 8950 57 5101.5 percent of total billed charges 8950 93 7249.5 percent of total billed charges 8950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8950 other OPPS APC 8950 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8950 other OPPS APC 8950 51 4564.5 percent of total billed charges 8950 8950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- U.S. SOUNDSTAR 8F SUP-99-04759 CDM C1759 CPT 0278 RC outpatient 6737.5 6737.5 6737.5 57 3840.38 percent of total billed charges 6737.5 93 5457.38 percent of total billed charges 6737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6737.5 other OPPS APC 6737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6737.5 other OPPS APC 6737.5 51 3436.13 percent of total billed charges 6737.5 6737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- U.S. SOUNDSTAR 10F SUP-99-04760 CDM C1759 CPT 0278 RC outpatient 6737.5 6737.5 6737.5 57 3840.38 percent of total billed charges 6737.5 93 5457.38 percent of total billed charges 6737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6737.5 other OPPS APC 6737.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6737.5 other OPPS APC 6737.5 51 3436.13 percent of total billed charges 6737.5 6737.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ULTRASOUND ACUSON ACUNAV PROBE COVERS SUP-99-04761 CDM C1759 CPT 0278 RC outpatient 315 315 315 57 179.55 percent of total billed charges 315 93 255.15 percent of total billed charges 315 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 315 other OPPS APC 315 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 315 other OPPS APC 315 51 160.65 percent of total billed charges 315 315 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- JOSEPHSON SUP-99-04762 CDM C1730 CPT 0278 RC outpatient 430.5 430.5 430.5 57 245.39 percent of total billed charges 430.5 93 348.71 percent of total billed charges 430.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 430.5 other OPPS APC 430.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 430.5 other OPPS APC 430.5 51 219.56 percent of total billed charges 430.5 430.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- QUAD EP SUP-99-04763 CDM C1730 CPT 0278 RC outpatient 1035 1035 1035 57 589.95 percent of total billed charges 1035 93 838.35 percent of total billed charges 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1035 other OPPS APC 1035 51 527.85 percent of total billed charges 1035 1035 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- ESOPHASTAR MAPPING SUP-99-04764 CDM C1732 CPT 0278 RC outpatient 1344 1344 1344 57 766.08 percent of total billed charges 1344 93 1088.64 percent of total billed charges 1344 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1344 other OPPS APC 1344 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1344 other OPPS APC 1344 51 685.44 percent of total billed charges 1344 1344 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE- COUGAR 190CM SUP-99-04765 CDM C1732 CPT 0278 RC outpatient 224 224 224 57 127.68 percent of total billed charges 224 93 181.44 percent of total billed charges 224 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 224 other OPPS APC 224 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 224 other OPPS APC 224 51 114.24 percent of total billed charges 224 224 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH- AGILIS STEERABLE- SMALL SUP-99-04766 CDM C1766 CPT 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH- AGILIS STEERABLE-MEDIUM SUP-99-04767 CDM C1766 CPT 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH- AGILIS STEERABLE- LARGE SUP-99-04768 CDM C1766 CPT 0278 RC outpatient 3000 3000 3000 57 1710 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3000 other OPPS APC 3000 51 1530 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH- 8.5F SRO FAST-CATH SUP-99-04769 CDM C1893 LOCAL 0278 RC outpatient 490 490 490 57 279.3 percent of total billed charges 490 93 396.9 percent of total billed charges 490 490 other OPPS APC 490 490 other OPPS APC 490 51 249.9 percent of total billed charges 490 490 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH- 8F X 60 RAMP SUP-99-04770 CDM C1893 LOCAL 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- NON NAV P CURVE SUP-99-04771 CDM C1732 CPT 0278 RC outpatient 897 897 897 57 511.29 percent of total billed charges 897 93 726.57 percent of total billed charges 897 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 897 other OPPS APC 897 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 897 other OPPS APC 897 51 457.47 percent of total billed charges 897 897 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER- CLARIA AICD MRI SUP-99-04775 CDM outpatient 33997 33997 33997 33997 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER- LEAD 3830-69 SUP-99-04776 CDM C1882 HCPCS 0275 RC outpatient 1185 1185 1185 57 675.45 percent of total billed charges 1185 93 959.85 percent of total billed charges 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 51 604.35 percent of total billed charges 1185 1185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER- BI-V ICD PERCEPTA SUP-99-04777 CDM outpatient 13037 13037 13037 13037 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- LEAD DELIVERY CATHETER SUP-99-04778 CDM C1732 CPT 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- SELECTSITE DEFLECTABLE SUP-99-04779 CDM C1732 CPT 0278 RC outpatient 1200 1200 1200 57 684 percent of total billed charges 1200 93 972 percent of total billed charges 1200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1200 other OPPS APC 1200 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1200 other OPPS APC 1200 51 612 percent of total billed charges 1200 1200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE- RUNTHROUGH NS HYPERCOAT .014 190CM SUP-99-04780 CDM C1769 HCPCS 0272 RC outpatient 385 385 385 74 284.9 percent of total billed charges 385 93 311.85 percent of total billed charges 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 385 other OPPS APC 385 27.63 106.38 percent of total billed charges 385 385 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- 5F MOD AR1 100CM SUP-99-04781 CDM 0272 RC outpatient 36.2 36.2 36.2 74 26.79 percent of total billed charges 36.2 93 29.32 percent of total billed charges 36.2 36.2 other OPPS APC 36.2 36.2 other OPPS APC 36.2 27.63 10 percent of total billed charges 36.2 36.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "NEEDLE- 1"" 21G" SUP-99-04782 CDM 0272 RC outpatient 1.89 1.89 1.89 74 1.4 percent of total billed charges 1.89 93 1.53 percent of total billed charges 1.89 1.89 other OPPS APC 1.89 1.89 other OPPS APC 1.89 27.63 0.52 percent of total billed charges 1.89 1.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER- TEMPORARY SINGLE CHAMBER SUP-99-04783 CDM 0272 RC outpatient 8618.51 8618.51 8618.51 74 6377.7 percent of total billed charges 8618.51 93 6980.99 percent of total billed charges 8618.51 8618.51 other OPPS APC 8618.51 8618.51 other OPPS APC 8618.51 27.63 2381.29 percent of total billed charges 8618.51 8618.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - SION GW 190CM STRAIGHT SUP-99-04784 CDM C1887 HCPCS 0272 RC outpatient 465.5 465.5 465.5 74 344.47 percent of total billed charges 465.5 93 377.06 percent of total billed charges 465.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 465.5 other OPPS APC 465.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 465.5 other OPPS APC 465.5 27.63 128.62 percent of total billed charges 465.5 465.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - SION BLACK 190CM STRAIGHT SUP-99-04785 CDM C1887 HCPCS 0272 RC outpatient 339.5 339.5 339.5 74 251.23 percent of total billed charges 339.5 93 275 percent of total billed charges 339.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 339.5 other OPPS APC 339.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 339.5 other OPPS APC 339.5 27.63 93.8 percent of total billed charges 339.5 339.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - ALR1-2 6F SUP-99-04786 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 8.5F SR1 FAST-CATH SUP-99-04787 CDM C1893 LOCAL 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 700 other OPPS APC 700 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - OCTARAY 3-3-3-3 D CURVE SUP-99-04788 CDM C1732 CPT 0278 RC outpatient 6375 6375 6375 57 3633.75 percent of total billed charges 6375 93 5163.75 percent of total billed charges 6375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6375 other OPPS APC 6375 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 6375 other OPPS APC 6375 51 3251.25 percent of total billed charges 6375 6375 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE - OCTARAY CABLE SUP-99-04789 CDM C1732 CPT 0278 RC outpatient 3477.5 3477.5 3477.5 57 1982.18 percent of total billed charges 3477.5 93 2816.78 percent of total billed charges 3477.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477.5 other OPPS APC 3477.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3477.5 other OPPS APC 3477.5 51 1773.53 percent of total billed charges 3477.5 3477.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE - REVERSE PIN CABLE (FOR EP STUDY) SUP-99-04790 CDM C1732 CPT 0278 RC outpatient 1557 1557 1557 57 887.49 percent of total billed charges 1557 93 1261.17 percent of total billed charges 1557 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1557 other OPPS APC 1557 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1557 other OPPS APC 1557 51 794.07 percent of total billed charges 1557 1557 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE - REVERSE PIN CABLE (FOR EP STUDY/DECANAV) SUP-99-04791 CDM C1732 CPT 0278 RC outpatient 1557 1557 1557 57 887.49 percent of total billed charges 1557 93 1261.17 percent of total billed charges 1557 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1557 other OPPS APC 1557 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1557 other OPPS APC 1557 51 794.07 percent of total billed charges 1557 1557 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 7F JR4 SH SUP-99-04793 CDM outpatient 182.72 182.72 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F JL3.5 INFINITI DX SUP-99-04794 CDM 0272 RC outpatient 175.4 175.4 175.4 74 129.8 percent of total billed charges 175.4 93 142.07 percent of total billed charges 175.4 175.4 other OPPS APC 175.4 175.4 other OPPS APC 175.4 27.63 48.46 percent of total billed charges 175.4 175.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F JR3.5 INFINITI DX SUP-99-04795 CDM 0272 RC outpatient 175.4 175.4 175.4 74 129.8 percent of total billed charges 175.4 93 142.07 percent of total billed charges 175.4 175.4 other OPPS APC 175.4 175.4 other OPPS APC 175.4 27.63 48.46 percent of total billed charges 175.4 175.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F JL4 INFINITI DX SUP-99-04796 CDM 0272 RC outpatient 175.4 175.4 175.4 74 129.8 percent of total billed charges 175.4 93 142.07 percent of total billed charges 175.4 175.4 other OPPS APC 175.4 175.4 other OPPS APC 175.4 27.63 48.46 percent of total billed charges 175.4 175.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F JR4 INFINITI DX SUP-99-04797 CDM 0272 RC outpatient 175.4 175.4 175.4 74 129.8 percent of total billed charges 175.4 93 142.07 percent of total billed charges 175.4 175.4 other OPPS APC 175.4 175.4 other OPPS APC 175.4 27.63 48.46 percent of total billed charges 175.4 175.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F JL5 INFINITI DX SUP-99-04798 CDM 0272 RC outpatient 175.4 175.4 175.4 74 129.8 percent of total billed charges 175.4 93 142.07 percent of total billed charges 175.4 175.4 other OPPS APC 175.4 175.4 other OPPS APC 175.4 27.63 48.46 percent of total billed charges 175.4 175.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F JR5 INFINITI DX SUP-99-04799 CDM 0272 RC outpatient 175.4 175.4 175.4 74 129.8 percent of total billed charges 175.4 93 142.07 percent of total billed charges 175.4 175.4 other OPPS APC 175.4 175.4 other OPPS APC 175.4 27.63 48.46 percent of total billed charges 175.4 175.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F JL6 INFINITI DX SUP-99-04800 CDM 0272 RC outpatient 175.4 175.4 175.4 74 129.8 percent of total billed charges 175.4 93 142.07 percent of total billed charges 175.4 175.4 other OPPS APC 175.4 175.4 other OPPS APC 175.4 27.63 48.46 percent of total billed charges 175.4 175.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F JR6 INFINITI DX SUP-99-04801 CDM 0272 RC outpatient 175.4 175.4 175.4 74 129.8 percent of total billed charges 175.4 93 142.07 percent of total billed charges 175.4 175.4 other OPPS APC 175.4 175.4 other OPPS APC 175.4 27.63 48.46 percent of total billed charges 175.4 175.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F JR4 SHORT TIP INFINITI DX SUP-99-04802 CDM 0272 RC outpatient 175.4 175.4 175.4 74 129.8 percent of total billed charges 175.4 93 142.07 percent of total billed charges 175.4 175.4 other OPPS APC 175.4 175.4 other OPPS APC 175.4 27.63 48.46 percent of total billed charges 175.4 175.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F IM INFINITI DX SUP-99-04803 CDM 0272 RC outpatient 175.4 175.4 175.4 74 129.8 percent of total billed charges 175.4 93 142.07 percent of total billed charges 175.4 175.4 other OPPS APC 175.4 175.4 other OPPS APC 175.4 27.63 48.46 percent of total billed charges 175.4 175.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 6F AL1 INFINITI DX SUP-99-04804 CDM 0272 RC outpatient 175.4 175.4 175.4 74 129.8 percent of total billed charges 175.4 93 142.07 percent of total billed charges 175.4 175.4 other OPPS APC 175.4 175.4 other OPPS APC 175.4 27.63 48.46 percent of total billed charges 175.4 175.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 6F AL2 INFINITI DX SUP-99-04805 CDM 0272 RC outpatient 175.4 175.4 175.4 74 129.8 percent of total billed charges 175.4 93 142.07 percent of total billed charges 175.4 175.4 other OPPS APC 175.4 175.4 other OPPS APC 175.4 27.63 48.46 percent of total billed charges 175.4 175.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 6F IM INFINITI DX SUP-99-04806 CDM 0272 RC outpatient 175.4 175.4 175.4 74 129.8 percent of total billed charges 175.4 93 142.07 percent of total billed charges 175.4 175.4 other OPPS APC 175.4 175.4 other OPPS APC 175.4 27.63 48.46 percent of total billed charges 175.4 175.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - LEAD-PACE CATH DELIV 4FR 38 SUP-99-04807 CDM C1898 HCPCS 0275 RC outpatient 1185 1185 1185 57 675.45 percent of total billed charges 1185 93 959.85 percent of total billed charges 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1185 other OPPS APC 1185 51 604.35 percent of total billed charges 1185 1185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT- INNOVA 8 X 60 X 130 SUP-99-04810 CDM C1876 HCPCS 0278 RC outpatient 2925 2925 2925 57 1667.25 percent of total billed charges 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 51 1491.75 percent of total billed charges 2925 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT- INNOVA 8 X 80 X 130 SUP-99-04811 CDM C1876 HCPCS 0278 RC outpatient 2925 2925 2925 57 1667.25 percent of total billed charges 2925 93 2369.25 percent of total billed charges 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2925 other OPPS APC 2925 51 1491.75 percent of total billed charges 2925 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - RBL-TG 5F INFINITI TIGER SUP-99-04812 CDM 0272 RC outpatient 108 108 108 74 79.92 percent of total billed charges 108 93 87.48 percent of total billed charges 108 108 other OPPS APC 108 108 other OPPS APC 108 27.63 29.84 percent of total billed charges 108 108 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - 2.00X10 WOLVERINE CUTTING SUP-99-04813 CDM C1725 HCPCS 0272 RC outpatient 2102.4 2102.4 2102.4 74 1555.78 percent of total billed charges 2102.4 93 1702.94 percent of total billed charges 2102.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2102.4 other OPPS APC 2102.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2102.4 other OPPS APC 2102.4 27.63 580.89 percent of total billed charges 2102.4 2102.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - 3.00X10 WOLVERINE CUTTING SUP-99-04814 CDM C1725 HCPCS 0272 RC outpatient 2102.4 2102.4 2102.4 74 1555.78 percent of total billed charges 2102.4 93 1702.94 percent of total billed charges 2102.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2102.4 other OPPS APC 2102.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2102.4 other OPPS APC 2102.4 27.63 580.89 percent of total billed charges 2102.4 2102.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 2.5X12 SHOCKWAVE C2P IVL SUP-99-04815 CDM C1761 CPT 0278 RC outpatient 9400 9400 9400 57 5358 percent of total billed charges 9400 93 7614 percent of total billed charges 9400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9400 other OPPS APC 9400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9400 other OPPS APC 9400 51 4794 percent of total billed charges 9400 9400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 3.0X12 SHOCKWAVE C2P IVL SUP-99-04816 CDM C1761 CPT 0278 RC outpatient 9400 9400 9400 57 5358 percent of total billed charges 9400 93 7614 percent of total billed charges 9400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9400 other OPPS APC 9400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9400 other OPPS APC 9400 51 4794 percent of total billed charges 9400 9400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 3.5X12 SHOCKWAVE C2P IVL SUP-99-04817 CDM C1761 CPT 0278 RC outpatient 9400 9400 9400 57 5358 percent of total billed charges 9400 93 7614 percent of total billed charges 9400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9400 other OPPS APC 9400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9400 other OPPS APC 9400 51 4794 percent of total billed charges 9400 9400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 4.0X12 SHOCKWAVE C2P IVL SUP-99-04818 CDM C1761 CPT 0278 RC outpatient 9400 9400 9400 57 5358 percent of total billed charges 9400 93 7614 percent of total billed charges 9400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9400 other OPPS APC 9400 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 9400 other OPPS APC 9400 51 4794 percent of total billed charges 9400 9400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOCKWAVE IVL CABLE SLEEVES SUP-99-04819 CDM C1724 HCPCS 0272 RC outpatient 24 24 24 74 17.76 percent of total billed charges 24 93 19.44 percent of total billed charges 24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24 other OPPS APC 24 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 24 other OPPS APC 24 27.63 6.63 percent of total billed charges 24 24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 4F JL3.5 INFINITI SUP-99-04820 CDM 0272 RC outpatient 35.08 35.08 35.08 74 25.96 percent of total billed charges 35.08 93 28.41 percent of total billed charges 35.08 35.08 other OPPS APC 35.08 35.08 other OPPS APC 35.08 27.63 9.69 percent of total billed charges 35.08 35.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 4F JR4 INFINITI SUP-99-04821 CDM 0272 RC outpatient 35.08 35.08 35.08 74 25.96 percent of total billed charges 35.08 93 28.41 percent of total billed charges 35.08 35.08 other OPPS APC 35.08 35.08 other OPPS APC 35.08 27.63 9.69 percent of total billed charges 35.08 35.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 6FX11CM W/0.38X50CM WIRE SUP-99-04822 CDM C1894 HCPCS 0272 RC outpatient 38.32 38.32 38.32 74 28.36 percent of total billed charges 38.32 93 31.04 percent of total billed charges 38.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.32 other OPPS APC 38.32 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 38.32 other OPPS APC 38.32 27.63 10.59 percent of total billed charges 38.32 38.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 3DRC 4F SUP-99-04823 CDM 0272 RC outpatient 35.08 35.08 35.08 74 25.96 percent of total billed charges 35.08 93 28.41 percent of total billed charges 35.08 35.08 other OPPS APC 35.08 35.08 other OPPS APC 35.08 27.63 9.69 percent of total billed charges 35.08 35.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - LEAD 479888 ATTAIN MRI SUP-99-04824 CDM C1898 HCPCS 0275 RC outpatient 5050 5050 5050 57 2878.5 percent of total billed charges 5050 93 4090.5 percent of total billed charges 5050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5050 other OPPS APC 5050 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 5050 other OPPS APC 5050 51 2575.5 percent of total billed charges 5050 5050 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - 2.0X6.0 WOLVERINE CUTTING SUP-99-04825 CDM C1725 HCPCS 0272 RC outpatient 2102.4 2102.4 2102.4 74 1555.78 percent of total billed charges 2102.4 93 1702.94 percent of total billed charges 2102.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2102.4 other OPPS APC 2102.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2102.4 other OPPS APC 2102.4 27.63 580.89 percent of total billed charges 2102.4 2102.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - 3.0X6.0 WOLVERINE CUTTING SUP-99-04826 CDM C1725 HCPCS 0272 RC outpatient 2102.4 2102.4 2102.4 74 1555.78 percent of total billed charges 2102.4 93 1702.94 percent of total billed charges 2102.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2102.4 other OPPS APC 2102.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2102.4 other OPPS APC 2102.4 27.63 580.89 percent of total billed charges 2102.4 2102.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F JL3.5 INFINITI DX SUP-99-04827 CDM 0272 RC outpatient 175.4 175.4 175.4 74 129.8 percent of total billed charges 175.4 93 142.07 percent of total billed charges 175.4 175.4 other OPPS APC 175.4 175.4 other OPPS APC 175.4 27.63 48.46 percent of total billed charges 175.4 175.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 6FX45CM STRAIGHT CATAPULT SUP-99-04830 CDM C1894 HCPCS 0272 RC outpatient 381.5 381.5 381.5 74 282.31 percent of total billed charges 381.5 93 309.02 percent of total billed charges 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 381.5 other OPPS APC 381.5 27.63 105.41 percent of total billed charges 381.5 381.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - COMMAND LT 0.18X300CM SUP-99-04832 CDM C1769 HCPCS 0272 RC outpatient 423.5 423.5 423.5 74 313.39 percent of total billed charges 423.5 93 343.04 percent of total billed charges 423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 423.5 other OPPS APC 423.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 423.5 other OPPS APC 423.5 27.63 117.01 percent of total billed charges 423.5 423.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER- ELLIPSE DR SUP-99-04833 CDM outpatient 15240 15240 15240 15240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 4F RAINSHEATH TIBIAL PEDAL SUP-99-04835 CDM C1894 HCPCS 0272 RC outpatient 188 188 188 74 139.12 percent of total billed charges 188 93 152.28 percent of total billed charges 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 188 other OPPS APC 188 27.63 51.94 percent of total billed charges 188 188 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SYNERGY MEGATRON 3.5X8 SUP-99-04837 CDM C1874 HCPCS 0272 RC outpatient 2550 2550 2550 74 1887 percent of total billed charges 2550 93 2065.5 percent of total billed charges 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2550 other OPPS APC 2550 27.63 704.57 percent of total billed charges 2550 2550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - WHISPER LS 190CM STRAIGHT TIP SUP-99-04839 CDM C1769 HCPCS 0272 RC outpatient 290.5 290.5 290.5 74 214.97 percent of total billed charges 290.5 93 235.31 percent of total billed charges 290.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 290.5 other OPPS APC 290.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 290.5 other OPPS APC 290.5 27.63 80.27 percent of total billed charges 290.5 290.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - WHISPER LS 300CM STRAIGHT TIP SUP-99-04840 CDM C1769 HCPCS 0272 RC outpatient 290.5 290.5 290.5 74 214.97 percent of total billed charges 290.5 93 235.31 percent of total billed charges 290.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 290.5 other OPPS APC 290.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 290.5 other OPPS APC 290.5 27.63 80.27 percent of total billed charges 290.5 290.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - WHISPER MS 190CM STRAIGHT TIP SUP-99-04841 CDM C1769 HCPCS 0272 RC outpatient 290.5 290.5 290.5 74 214.97 percent of total billed charges 290.5 93 235.31 percent of total billed charges 290.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 290.5 other OPPS APC 290.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 290.5 other OPPS APC 290.5 27.63 80.27 percent of total billed charges 290.5 290.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - WHISPER MS 300CM STRAIGHT TIP SUP-99-04842 CDM C1769 HCPCS 0272 RC outpatient 290.5 290.5 290.5 74 214.97 percent of total billed charges 290.5 93 235.31 percent of total billed charges 290.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 290.5 other OPPS APC 290.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 290.5 other OPPS APC 290.5 27.63 80.27 percent of total billed charges 290.5 290.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GLIDEWIRE STIFF SHAFT STRAIGHT FLEXIBLE TIP 260CM SUP-99-04844 CDM C1769 HCPCS 0272 RC outpatient 199.4 199.4 199.4 74 147.56 percent of total billed charges 199.4 93 161.51 percent of total billed charges 199.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 199.4 other OPPS APC 199.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 199.4 other OPPS APC 199.4 27.63 55.09 percent of total billed charges 199.4 199.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IABP- SENSATION PLUS 40CC SUP-99-04846 CDM 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IABP- SENSATION PLUS 50CC SUP-99-04847 CDM 0272 RC outpatient 3000 3000 3000 74 2220 percent of total billed charges 3000 93 2430 percent of total billed charges 3000 3000 other OPPS APC 3000 3000 other OPPS APC 3000 27.63 828.9 percent of total billed charges 3000 3000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 5F X 23CM BRITE TIP SUP-99-04848 CDM C1894 HCPCS 0272 RC outpatient 92 92 92 74 68.08 percent of total billed charges 92 93 74.52 percent of total billed charges 92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92 other OPPS APC 92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92 other OPPS APC 92 27.63 25.42 percent of total billed charges 92 92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH- 8F X 10CM ( TERUMO) SUP-99-04849 CDM C1894 HCPCS 0272 RC outpatient 35 35 35 74 25.9 percent of total billed charges 35 93 28.35 percent of total billed charges 35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35 other OPPS APC 35 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 35 other OPPS APC 35 27.63 9.67 percent of total billed charges 35 35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - FIELDER PTCA GW 180CM SUP-99-04850 CDM C1769 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - XB 2.5 SUP-99-04852 CDM C1887 HCPCS 0272 RC outpatient 182.72 182.72 182.72 74 135.21 percent of total billed charges 182.72 93 148 percent of total billed charges 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 182.72 other OPPS APC 182.72 27.63 50.49 percent of total billed charges 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- WEBSTER HIS EP SUP-99-04854 CDM C1732 CPT 0278 RC outpatient 700 700 700 57 399 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 51 357 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- 6F P-CURVE SUPRA CS SUP-99-04855 CDM C1732 CPT 0278 RC outpatient 897 897 897 57 511.29 percent of total billed charges 897 93 726.57 percent of total billed charges 897 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 897 other OPPS APC 897 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 897 other OPPS APC 897 51 457.47 percent of total billed charges 897 897 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- 6F F-CURVE FIXED QUAD SUP-99-04856 CDM C1732 CPT 0278 RC outpatient 430.5 430.5 430.5 57 245.39 percent of total billed charges 430.5 93 348.71 percent of total billed charges 430.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 430.5 other OPPS APC 430.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 430.5 other OPPS APC 430.5 51 219.56 percent of total billed charges 430.5 430.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F JR4 125CM SUP-99-04858 CDM 0272 RC outpatient 135 135 135 74 99.9 percent of total billed charges 135 93 109.35 percent of total billed charges 135 135 other OPPS APC 135 135 other OPPS APC 135 27.63 37.3 percent of total billed charges 135 135 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F JL4 125CM SUP-99-04859 CDM 0272 RC outpatient 135 135 135 74 99.9 percent of total billed charges 135 93 109.35 percent of total billed charges 135 135 other OPPS APC 135 135 other OPPS APC 135 27.63 37.3 percent of total billed charges 135 135 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F STR 110CM TEMPO SUP-99-04860 CDM 0272 RC outpatient 56.7 56.7 56.7 74 41.96 percent of total billed charges 56.7 93 45.93 percent of total billed charges 56.7 56.7 other OPPS APC 56.7 56.7 other OPPS APC 56.7 27.63 15.67 percent of total billed charges 56.7 56.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - 2.5X6.0 WOLVERINE CUTTING SUP-99-04861 CDM C1725 HCPCS 0272 RC outpatient 2102.4 2102.4 2102.4 74 1555.78 percent of total billed charges 2102.4 93 1702.94 percent of total billed charges 2102.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2102.4 other OPPS APC 2102.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2102.4 other OPPS APC 2102.4 27.63 580.89 percent of total billed charges 2102.4 2102.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - 3.5X6.0 WOLVERINE CUTTING SUP-99-04862 CDM C1725 HCPCS 0272 RC outpatient 2102.4 2102.4 2102.4 74 1555.78 percent of total billed charges 2102.4 93 1702.94 percent of total billed charges 2102.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2102.4 other OPPS APC 2102.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2102.4 other OPPS APC 2102.4 27.63 580.89 percent of total billed charges 2102.4 2102.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 4F JL4 INFINITI DX SUP-99-04863 CDM 0272 RC outpatient 175.4 175.4 175.4 74 129.8 percent of total billed charges 175.4 93 142.07 percent of total billed charges 175.4 175.4 other OPPS APC 175.4 175.4 other OPPS APC 175.4 27.63 48.46 percent of total billed charges 175.4 175.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH- SAFESHEATH 11F X 13 SUP-99-04864 CDM C1894 HCPCS 0272 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130 other OPPS APC 130 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - PRONTO V4 6F SUP-99-04865 CDM C1757 HCPCS 0272 RC outpatient 996 996 996 74 737.04 percent of total billed charges 996 93 806.76 percent of total billed charges 996 996 other OPPS APC 996 996 other OPPS APC 996 27.63 275.19 percent of total billed charges 996 996 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - WORLEY 9FX50CM SAFESHEATH JUMBO CURVE SUP-99-04866 CDM C1894 HCPCS 0272 RC outpatient 673.75 673.75 673.75 74 498.58 percent of total billed charges 673.75 93 545.74 percent of total billed charges 673.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 673.75 other OPPS APC 673.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 673.75 other OPPS APC 673.75 27.63 186.16 percent of total billed charges 673.75 673.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 9.5FR SAFESHEATH SUP-99-04867 CDM C1894 HCPCS 0272 RC outpatient 568.75 568.75 568.75 74 420.88 percent of total billed charges 568.75 93 460.69 percent of total billed charges 568.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 568.75 other OPPS APC 568.75 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 568.75 other OPPS APC 568.75 27.63 157.15 percent of total billed charges 568.75 568.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - PERIPHERAL CUTTING BALLOON 7X2.0X135 SUP-99-04868 CDM outpatient 2250 2250 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - UNIFUSE 4F X 135CM X 20CM INFUSION PATTERN SUP-99-04869 CDM 0272 RC outpatient 996 996 996 74 737.04 percent of total billed charges 996 93 806.76 percent of total billed charges 996 996 other OPPS APC 996 996 other OPPS APC 996 27.63 275.19 percent of total billed charges 996 996 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - UNIFUSE 4F X 135CM X 30CM INFUSION PATTERN SUP-99-04870 CDM 0272 RC outpatient 996 996 996 74 737.04 percent of total billed charges 996 93 806.76 percent of total billed charges 996 996 other OPPS APC 996 996 other OPPS APC 996 27.63 275.19 percent of total billed charges 996 996 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - UNIFUSE 4F X 135CM X 50CM INFUSION PATTERN SUP-99-04871 CDM 0272 RC outpatient 996 996 996 74 737.04 percent of total billed charges 996 93 806.76 percent of total billed charges 996 996 other OPPS APC 996 996 other OPPS APC 996 27.63 275.19 percent of total billed charges 996 996 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 6F TELESCOPE GUIDE EXTENSION SUP-99-04872 CDM C1887 HCPCS 0272 RC outpatient 975 975 975 74 721.5 percent of total billed charges 975 93 789.75 percent of total billed charges 975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 975 other OPPS APC 975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 975 other OPPS APC 975 27.63 269.39 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F STRAIGHT PIGTAIL SUP-99-04873 CDM 0481 RC outpatient 114.01 114.01 114.01 74 84.37 percent of total billed charges 114.01 93 92.35 percent of total billed charges 114.01 114.01 other OPPS APC 114.01 114.01 other OPPS APC 114.01 51 58.15 percent of total billed charges 114.01 114.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F LCB (CORDIS) SUP-99-04874 CDM 0272 RC outpatient 175.4 175.4 175.4 74 129.8 percent of total billed charges 175.4 93 142.07 percent of total billed charges 175.4 175.4 other OPPS APC 175.4 175.4 other OPPS APC 175.4 27.63 48.46 percent of total billed charges 175.4 175.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F RCB (CORDIS) SUP-99-04875 CDM 0272 RC outpatient 175.4 175.4 175.4 74 129.8 percent of total billed charges 175.4 93 142.07 percent of total billed charges 175.4 175.4 other OPPS APC 175.4 175.4 other OPPS APC 175.4 27.63 48.46 percent of total billed charges 175.4 175.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F TG 4.0 100CM INFINITI AMBI SUP-99-04876 CDM 0272 RC outpatient 144 144 144 74 106.56 percent of total billed charges 144 93 116.64 percent of total billed charges 144 144 other OPPS APC 144 144 other OPPS APC 144 27.63 39.79 percent of total billed charges 144 144 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5.5F GUIDELINER SUP-99-04877 CDM C1887 HCPCS 0272 RC outpatient 1230 1230 1230 74 910.2 percent of total billed charges 1230 93 996.3 percent of total billed charges 1230 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1230 other OPPS APC 1230 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1230 other OPPS APC 1230 27.63 339.85 percent of total billed charges 1230 1230 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - WHOLEY WIRE 0.35X175CM FLOPPY TIP STRAIGHT SUP-99-04878 CDM C1769 HCPCS 0272 RC outpatient 349.79 349.79 349.79 74 258.84 percent of total billed charges 349.79 93 283.33 percent of total billed charges 349.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.79 other OPPS APC 349.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.79 other OPPS APC 349.79 27.63 96.65 percent of total billed charges 349.79 349.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - WHOLEY WIRE 0.35X175CM MOD. J-TIP/SHAPEABLE SUP-99-04879 CDM C1769 HCPCS 0272 RC outpatient 349.79 349.79 349.79 74 258.84 percent of total billed charges 349.79 93 283.33 percent of total billed charges 349.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.79 other OPPS APC 349.79 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 349.79 other OPPS APC 349.79 27.63 96.65 percent of total billed charges 349.79 349.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- CXI SUPPORT CATHETER 2.3F X 135CM SUP-99-04880 CDM C1887 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F TG 4.0 125CM INFINITI AMBI SUP-99-04881 CDM 0272 RC outpatient 155 155 155 74 114.7 percent of total billed charges 155 93 125.55 percent of total billed charges 155 155 other OPPS APC 155 155 other OPPS APC 155 27.63 42.83 percent of total billed charges 155 155 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE- GAIA PV .018 X 300CM SUP-99-04882 CDM C1769 HCPCS 0272 RC outpatient 2700 2700 2700 74 1998 percent of total billed charges 2700 93 2187 percent of total billed charges 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 2700 other OPPS APC 2700 27.63 746.01 percent of total billed charges 2700 2700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - TEMPO 4F UF 90CM 5SH SUP-99-04883 CDM 0272 RC outpatient 56.72 56.72 56.72 74 41.97 percent of total billed charges 56.72 93 45.94 percent of total billed charges 56.72 56.72 other OPPS APC 56.72 56.72 other OPPS APC 56.72 27.63 15.67 percent of total billed charges 56.72 56.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - SAPPHIRE II PRO 1MM X 5MM SUP-99-04884 CDM C1769 HCPCS 0272 RC outpatient 700 700 700 74 518 percent of total billed charges 700 93 567 percent of total billed charges 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 700 other OPPS APC 700 27.63 193.41 percent of total billed charges 700 700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 4FX11CM BRITE TIP SUP-99-04885 CDM C1894 HCPCS 0272 RC outpatient 52 52 52 74 38.48 percent of total billed charges 52 93 42.12 percent of total billed charges 52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52 other OPPS APC 52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52 other OPPS APC 52 27.63 14.37 percent of total billed charges 52 52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 4FX23CM BRITE TIP SUP-99-04886 CDM C1894 HCPCS 0272 RC outpatient 92 92 92 74 68.08 percent of total billed charges 92 93 74.52 percent of total billed charges 92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92 other OPPS APC 92 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 92 other OPPS APC 92 27.63 25.42 percent of total billed charges 92 92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 5FX11CM BRITE TIP SUP-99-04887 CDM C1894 HCPCS 0272 RC outpatient 52 52 52 74 38.48 percent of total billed charges 52 93 42.12 percent of total billed charges 52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52 other OPPS APC 52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52 other OPPS APC 52 27.63 14.37 percent of total billed charges 52 52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 6FX11CM BRITE TIP SUP-99-04888 CDM C1894 HCPCS 0272 RC outpatient 52 52 52 74 38.48 percent of total billed charges 52 93 42.12 percent of total billed charges 52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52 other OPPS APC 52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52 other OPPS APC 52 27.63 14.37 percent of total billed charges 52 52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 7FX11CM BRITE TIP SUP-99-04889 CDM C1894 HCPCS 0272 RC outpatient 52 52 52 74 38.48 percent of total billed charges 52 93 42.12 percent of total billed charges 52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52 other OPPS APC 52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52 other OPPS APC 52 27.63 14.37 percent of total billed charges 52 52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - AICD COBALT XT HF QUAD SUP-99-04890 CDM outpatient 35403 35403 35403 35403 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - FINECROSS MICRO CATHETER 130CM SUP-99-04891 CDM C1887 HCPCS 0272 RC outpatient 1350 1350 1350 74 999 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 27.63 373.01 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - FINECROSS MICRO CATHETER 150CM SUP-99-04892 CDM C1887 HCPCS 0272 RC outpatient 1350 1350 1350 74 999 percent of total billed charges 1350 93 1093.5 percent of total billed charges 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1350 other OPPS APC 1350 27.63 373.01 percent of total billed charges 1350 1350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GLIDEWIRE 180CM BABY-J 1.5MMJ SUP-99-04893 CDM C1769 HCPCS 0272 RC outpatient 158.8 158.8 158.8 74 117.51 percent of total billed charges 158.8 93 128.63 percent of total billed charges 158.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 158.8 other OPPS APC 158.8 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 158.8 other OPPS APC 158.8 27.63 43.88 percent of total billed charges 158.8 158.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT - SMART CONTROL 9X80 SUP-99-04894 CDM C1725 HCPCS outpatient 2205 2205 2205 2205 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 5F JL4 (CORDIS) SUP-99-04895 CDM outpatient 182.72 182.72 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 5F JR4 (CORDIS) SUP-99-04896 CDM outpatient 182.72 182.72 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 5F JL3.5 (CORDIS) SUP-99-04897 CDM outpatient 182.72 182.72 182.72 182.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F 3DRC (CORDIS) SUP-99-04898 CDM 0272 RC outpatient 45 45 45 74 33.3 percent of total billed charges 45 93 36.45 percent of total billed charges 45 45 other OPPS APC 45 45 other OPPS APC 45 27.63 12.43 percent of total billed charges 45 45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F AR1 MOD (CORDIS) SUP-99-04899 CDM 0272 RC outpatient 35.08 35.08 35.08 74 25.96 percent of total billed charges 35.08 93 28.41 percent of total billed charges 35.08 35.08 other OPPS APC 35.08 35.08 other OPPS APC 35.08 27.63 9.69 percent of total billed charges 35.08 35.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE - 6F JR4 (MEDTRONIC) SUP-99-04900 CDM C1887 HCPCS 0272 RC outpatient 168 168 168 74 124.32 percent of total billed charges 168 93 136.08 percent of total billed charges 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 168 other OPPS APC 168 27.63 46.42 percent of total billed charges 168 168 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- RUBICON CONTROL .018 X 135CM SUP-99-04901 CDM C1887 HCPCS 0272 RC outpatient 3062.5 3062.5 3062.5 74 2266.25 percent of total billed charges 3062.5 93 2480.63 percent of total billed charges 3062.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3062.5 other OPPS APC 3062.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3062.5 other OPPS APC 3062.5 27.63 846.17 percent of total billed charges 3062.5 3062.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- RUBICON CONTROL .035 X 135CM ANGLE2 SUP-99-04902 CDM C1887 HCPCS 0272 RC outpatient 3062.5 3062.5 3062.5 74 2266.25 percent of total billed charges 3062.5 93 2480.63 percent of total billed charges 3062.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3062.5 other OPPS APC 3062.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 3062.5 other OPPS APC 3062.5 27.63 846.17 percent of total billed charges 3062.5 3062.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 8FRX11CM BRITE-TIP SUP-99-04903 CDM C1894 HCPCS 0272 RC outpatient 52 52 52 74 38.48 percent of total billed charges 52 93 42.12 percent of total billed charges 52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52 other OPPS APC 52 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 52 other OPPS APC 52 27.63 14.37 percent of total billed charges 52 52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - CS DECA NON STEERABLE 120CM SUP-99-04904 CDM C1730 CPT 0278 RC outpatient 975 975 975 57 555.75 percent of total billed charges 975 93 789.75 percent of total billed charges 975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 975 other OPPS APC 975 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 975 other OPPS APC 975 51 497.25 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER-ATTAIN STRAIGHT LEAD 4398-88 SUP-99-04905 CDM outpatient 4250 4250 4250 4250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE- IRONMAN .014 X 190CM STRAIGHT SUP-99-04906 CDM outpatient 290.5 290.5 290.5 290.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE- IRONMAN .014 X 190CM JTIP SUP-99-04907 CDM outpatient 290.5 290.5 290.5 290.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - GRAND SLAM PTCA 180CM SUP-99-04908 CDM outpatient 339.5 339.5 339.5 339.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 5F JL3 CORDIS INFINITI 100CM SUP-99-04909 CDM 0272 RC outpatient 135 135 135 74 99.9 percent of total billed charges 135 93 109.35 percent of total billed charges 135 135 other OPPS APC 135 135 other OPPS APC 135 27.63 37.3 percent of total billed charges 135 135 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - 6F JR4 INFINITI (CORDIS) SUP-99-04913 CDM 0272 RC outpatient 35.08 35.08 35.08 74 25.96 percent of total billed charges 35.08 93 28.41 percent of total billed charges 35.08 35.08 other OPPS APC 35.08 35.08 other OPPS APC 35.08 27.63 9.69 percent of total billed charges 35.08 35.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - OCTAPOLAR - STEERABLE 6F X 92CM SUP-99-04914 CDM C1730 CPT 0278 RC outpatient 1482 1482 1482 57 844.74 percent of total billed charges 1482 93 1200.42 percent of total billed charges 1482 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1482 other OPPS APC 1482 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1482 other OPPS APC 1482 51 755.82 percent of total billed charges 1482 1482 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON - EUPHORA 2.0 X 6MM SUP-99-04916 CDM C1725 HCPCS 0272 RC outpatient 262.5 262.5 262.5 74 194.25 percent of total billed charges 262.5 93 212.63 percent of total billed charges 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 262.5 other OPPS APC 262.5 27.63 72.53 percent of total billed charges 262.5 262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER LITHOTRIPSY SHOCKWAVE M5 L6.5 MM L135 CM OD7.0 MM OD7 MM CROSSING RANGE .054 IN SHEATH 6F PULSES 300 MAX SUP-99-04917 CDM C1724 HCPCS 0272 RC outpatient 8625 8625 8625 74 6382.5 percent of total billed charges 8625 93 6986.25 percent of total billed charges 8625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8625 other OPPS APC 8625 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 8625 other OPPS APC 8625 27.63 2383.09 percent of total billed charges 8625 8625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER- BI/DIRECTIONAL CS SUP-99-04918 CDM C1730 CPT 0278 RC outpatient 1947 1947 1947 57 1109.79 percent of total billed charges 1947 93 1577.07 percent of total billed charges 1947 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1947 other OPPS APC 1947 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 1947 other OPPS APC 1947 51 992.97 percent of total billed charges 1947 1947 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH- 11F X 25CM SUP-99-04919 CDM C1894 HCPCS 0272 RC outpatient 68.6 68.6 68.6 74 50.76 percent of total billed charges 68.6 93 55.57 percent of total billed charges 68.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 68.6 other OPPS APC 68.6 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 68.6 other OPPS APC 68.6 27.63 18.95 percent of total billed charges 68.6 68.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SNARE- 2MM MICROSNARE SUP-99-04920 CDM C1773 HCPCS 0272 RC outpatient 1748.79 1748.79 1748.79 1748.79 other OPPS APC 1748.79 1748.79 other OPPS APC 1748.79 27.63 483.19 percent of total billed charges 1748.79 1748.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SNARE- 4MM MICROSNARE SUP-99-04921 CDM C1773 HCPCS 0272 RC outpatient 1748.79 1748.79 1748.79 1748.79 other OPPS APC 1748.79 1748.79 other OPPS APC 1748.79 27.63 483.19 percent of total billed charges 1748.79 1748.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SNARE- 7MM MICROSNARE (MICRA) SUP-99-04922 CDM C1773 HCPCS 0272 RC outpatient 1748.79 1748.79 1748.79 1748.79 other OPPS APC 1748.79 1748.79 other OPPS APC 1748.79 27.63 483.19 percent of total billed charges 1748.79 1748.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR- 20F COONS SUP-99-04923 CDM C1773 HCPCS 0272 RC outpatient 103.96 103.96 103.96 103.96 other OPPS APC 103.96 103.96 other OPPS APC 103.96 27.63 28.72 percent of total billed charges 103.96 103.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - MICRA AV2 SYSTEM SUP-99-04924 CDM outpatient 19100 19100 19100 19100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - MICRA AVR2 SYSTEM SUP-99-04925 CDM outpatient 16310 16310 16310 16310 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH - 14F X 30CM SUP-99-04926 CDM outpatient 251.79 251.79 251.79 251.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET ANGIOGRAPHY STANDARD BORE L135 IN MALE LUER LOCK FILTER MICRO DRIP CHAMBER STERILE LATEX FREE DISPOSABLE CLEAR SUP-99000069 CDM 0270 RC outpatient 32.24 32.24 32.24 74 23.86 percent of total billed charges 32.24 93 26.11 percent of total billed charges 32.24 32.24 other OPPS APC 32.24 32.24 other OPPS APC 32.24 27.63 8.91 percent of total billed charges 32.24 32.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY ACHIEVE 3D L20 MM MAPPING LOOP SUP-990063-020 CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAP POSITIONING DIGIT TRAP SMALL FINGER ATRAUMATIC HOOK GRASP STERILE DISPOSABLE TRACTION TOWER SUP-9906 CDM 0270 RC outpatient 33.1 33.1 33.1 74 24.49 percent of total billed charges 33.1 93 26.81 percent of total billed charges 33.1 33.1 other OPPS APC 33.1 33.1 other OPPS APC 33.1 27.63 9.15 percent of total billed charges 33.1 33.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BATTERY SUP-99702 CDM 0270 RC outpatient 39624 39624 39624 74 29321.8 percent of total billed charges 39624 93 32095.4 percent of total billed charges 39624 39624 other OPPS APC 39624 39624 other OPPS APC 39624 27.63 10948.1 percent of total billed charges 39624 39624 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOCKINETTE ORTHOPEDIC COTTON L54 IN X W16 IN IMPERVIOUS STERILE LATEX FREE SUP-9978-16 CDM 0270 RC outpatient 16.74 16.74 16.74 74 12.39 percent of total billed charges 16.74 93 13.56 percent of total billed charges 16.74 16.74 other OPPS APC 16.74 16.74 other OPPS APC 16.74 27.63 4.63 percent of total billed charges 16.74 16.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR DENTAL CARBIDE 703 TAPER FLAT CROSS CUT L65 MM L4.8 MM OD2.1 MM ODSEC1.6 MM HANDPIECE SHANK SUP-9993605 CDM 0270 RC outpatient 22.62 22.62 22.62 74 16.74 percent of total billed charges 22.62 93 18.32 percent of total billed charges 22.62 22.62 other OPPS APC 22.62 22.62 other OPPS APC 22.62 27.63 6.25 percent of total billed charges 22.62 22.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR DENTAL CARBIDE 703 TAPER FLAT CROSS CUT L44.5 MM L4.8 MM OD2.1 MM ODSEC1.6 MM HANDPIECE SHANK SUP-9997496 CDM 0270 RC outpatient 21.32 21.32 21.32 74 15.78 percent of total billed charges 21.32 93 17.27 percent of total billed charges 21.32 21.32 other OPPS APC 21.32 21.32 other OPPS APC 21.32 27.63 5.89 percent of total billed charges 21.32 21.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR SQ EMBLEM A219 S-ICD PULSE GENERATOR SYSTEM INCLUDES ELECTRODE SUP-9B11 CDM 0275 RC outpatient 43740 43740 43740 57 24931.8 percent of total billed charges 43740 93 35429.4 percent of total billed charges 43740 43740 other OPPS APC 43740 43740 other OPPS APC 43740 51 22307.4 percent of total billed charges 43740 43740 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MIDAS REX LEGEND BALL FLUTE L9 CM OD5 MM BURR SUP-9BA50 CDM 270010028 LOCAL 0270 RC outpatient 497.64 497.64 497.64 74 368.25 percent of total billed charges 497.64 93 403.09 percent of total billed charges 497.64 497.64 other OPPS APC 497.64 497.64 other OPPS APC 497.64 27.63 137.5 percent of total billed charges 497.64 497.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MIDAS REX LEGEND BALL FLUTE L9 CM OD7.5 MM BURR SUP-9BA75 CDM 270010028 LOCAL 0270 RC outpatient 497.64 497.64 497.64 74 368.25 percent of total billed charges 497.64 93 403.09 percent of total billed charges 497.64 497.64 other OPPS APC 497.64 497.64 other OPPS APC 497.64 27.63 137.5 percent of total billed charges 497.64 497.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER ACCOLADE DR MRI SYSTEM DUAL CHAMBER 2 LEADS SUP-9H32 CDM 0270 RC outpatient 10613.3 10613.3 10613.3 74 7853.81 percent of total billed charges 10613.3 93 8596.73 percent of total billed charges 10613.3 10613.3 other OPPS APC 10613.3 10613.3 other OPPS APC 10613.3 27.63 2932.44 percent of total billed charges 10613.3 10613.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER ACCOLADE SR MRI SYSTEM SINGLE CHAMBER 1 LEAD SUP-9H42 CDM 0275 RC outpatient 10012.5 10012.5 10012.5 57 5707.13 percent of total billed charges 10012.5 93 8110.13 percent of total billed charges 10012.5 10012.5 other OPPS APC 10012.5 10012.5 other OPPS APC 10012.5 51 5106.38 percent of total billed charges 10012.5 10012.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER ACCOLADE DR EL MRI SYSTEM _44046_ SUP-9H52 CDM 0275 RC outpatient 10613.3 10613.3 10613.3 57 6049.55 percent of total billed charges 10613.3 93 8596.73 percent of total billed charges 10613.3 10613.3 other OPPS APC 10613.3 10613.3 other OPPS APC 10613.3 51 5412.76 percent of total billed charges 10613.3 10613.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MIDAS REX LEGEND MATCH HEAD FLUTE L9 CM OD3 MM BURR SUP-9MH30 CDM 270010028 LOCAL 0270 RC outpatient 479.54 479.54 479.54 74 354.86 percent of total billed charges 479.54 93 388.43 percent of total billed charges 479.54 479.54 other OPPS APC 479.54 479.54 other OPPS APC 479.54 27.63 132.5 percent of total billed charges 479.54 479.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MIDAS REX LEGEND DIAMOND MATCH HEAD L9 CM OD3 MM BURR SUP-9MH30D CDM 270010028 LOCAL 0270 RC outpatient 538.36 538.36 538.36 74 398.39 percent of total billed charges 538.36 93 436.07 percent of total billed charges 538.36 538.36 other OPPS APC 538.36 538.36 other OPPS APC 538.36 27.63 148.75 percent of total billed charges 538.36 538.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT-P SYSTEM CARDIAC VISIONIST X4 SUP-9V6G/J/H CDM 0481 RC outpatient 23569 23569 23569 74 17441.1 percent of total billed charges 23569 93 19090.9 percent of total billed charges 23569 23569 other OPPS APC 23569 23569 other OPPS APC 23569 51 12020.2 percent of total billed charges 23569 23569 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIT DRAINAGE PLEUR-EVAC 2350 CC BALANCE LARGE CAPACITY COLLECTION CHAMBER ACCURATE PRESSURE CONTROL STERILE LATEX FREE BLUE RED WHITE PNEUMONECTOMY SUP-A-4301-08LF CDM 270009126 LOCAL 0270 RC outpatient 133.63 133.63 133.63 74 98.89 percent of total billed charges 133.63 93 108.24 percent of total billed charges 133.63 133.63 other OPPS APC 133.63 133.63 other OPPS APC 133.63 27.63 36.92 percent of total billed charges 133.63 133.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM DRAINAGE PLEUR-EVAC 2500 CC COLLECTION CHAMBER SELF SEAL SAMPLE PORT CONNECTOR STERILE LATEX FREE DISPOSABLE A-6000 CACTUS SUP-A-6000-08LF CDM 270009127 LOCAL 0270 RC outpatient 105.92 105.92 105.92 74 78.38 percent of total billed charges 105.92 93 85.8 percent of total billed charges 105.92 105.92 other OPPS APC 105.92 105.92 other OPPS APC 105.92 27.63 29.27 percent of total billed charges 105.92 105.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER OR TABLE COMFORT 4 W20-24 IN X H25-38 IN RADIOLUCENT EXTENSION SAVE SPACE RAIL FRAME LATEX FREE DISPOSABLE SPINE SYSTEM SUP-A-70260 CDM 0270 RC outpatient 39 39 39 74 28.86 percent of total billed charges 39 93 31.59 percent of total billed charges 39 39 other OPPS APC 39 39 other OPPS APC 39 27.63 10.78 percent of total billed charges 39 39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVERS ALLEN COMFORT COVERS - SEE PMM# 54030 SUP-A-70260-A5 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK POSITIONING FOAM PRONE DISPOSABLE C PRONE C FLEX HEAD POSITIONING SYSTEM SUP-A-70310 CDM 0270 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 27.63 21.55 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK ALLEN COMFORT MASK - SEE PMM# 54031 SUP-A-70310-A6 CDM 0270 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 27.63 21.55 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAPE EXAM C-FLEX HEAD CE MARKED CLEAN CAPE PROTECT FROM FLUIDS AND OTHER CONTAMINANTS DURING SURGERY DISPOSABLE SUP-A-70702 CDM 0270 RC outpatient 19.76 19.76 19.76 74 14.62 percent of total billed charges 19.76 93 16.01 percent of total billed charges 19.76 19.76 other OPPS APC 19.76 19.76 other OPPS APC 19.76 27.63 5.46 percent of total billed charges 19.76 19.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER POSITIONING BOW FRAME SKIN CARE STANDARD SUP-A-70810 CDM 0270 RC outpatient 211.07 211.07 211.07 74 156.19 percent of total billed charges 211.07 93 170.97 percent of total billed charges 211.07 211.07 other OPPS APC 211.07 211.07 other OPPS APC 211.07 27.63 58.32 percent of total billed charges 211.07 211.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER POSITIONING BOW FRAME SKIN CARE STANDARD SUP-A-70810C CDM 0270 RC outpatient 128.44 128.44 128.44 74 95.05 percent of total billed charges 128.44 93 104.04 percent of total billed charges 128.44 128.44 other OPPS APC 128.44 128.44 other OPPS APC 128.44 27.63 35.49 percent of total billed charges 128.44 128.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM DRAINAGE PLEUR-EVAC PLASTIC SMALL STATURE 2500 ML 16 LPM CONTINUOUS REINFUSION DRY SUCTION LATEX FREE SUP-A-9250LF CDM 270009032 LOCAL 0270 RC outpatient 150.8 150.8 150.8 74 111.59 percent of total billed charges 150.8 93 122.15 percent of total billed charges 150.8 150.8 other OPPS APC 150.8 150.8 other OPPS APC 150.8 27.63 41.67 percent of total billed charges 150.8 150.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CONNECTING FLEXABILITY SUP-A-FASE-CBL4 CDM 0270 RC outpatient 868.4 868.4 868.4 74 642.62 percent of total billed charges 868.4 93 703.4 percent of total billed charges 868.4 868.4 other OPPS APC 868.4 868.4 other OPPS APC 868.4 27.63 239.94 percent of total billed charges 868.4 868.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION FLEXABILITY SENSOR ENABLED ENSITE PRECISION MEDIGUIDE 1-4-1 SPACE D-F CURVE L 115CM L 4MM OD 8FR BI-DIRECTIONAL HANDLE IRRIGATE SUP-A-FASE-DF CDM 0481 RC outpatient 4810 4810 4810 74 3559.4 percent of total billed charges 4810 93 3896.1 percent of total billed charges 4810 4810 other OPPS APC 4810 4810 other OPPS APC 4810 51 2453.1 percent of total billed charges 4810 4810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION FLEXABILITY SENSOR ENABLED ENSITE PRECISION MEDIGUIDE 1-4-1 SPACE F-J CURVE L 115CM L 4MM OD 8FR BI-DIRECTIONAL HANDLE IRRIGATE SUP-A-FASE-FJ CDM 0481 RC outpatient 4810 4810 4810 74 3559.4 percent of total billed charges 4810 93 3896.1 percent of total billed charges 4810 4810 other OPPS APC 4810 4810 other OPPS APC 4810 51 2453.1 percent of total billed charges 4810 4810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION TACTICATH 2-2-2MM SPACEDAMATO TYPE FIX CURVE L115CM L3.5MM OD8 FR BIDIRECTIONAL IRRIGATE CONTACT FORCE FIBER OPTIC SUP-A-TCSE-DF CDM 0270 RC outpatient 7020 7020 7020 74 5194.8 percent of total billed charges 7020 93 5686.2 percent of total billed charges 7020 7020 other OPPS APC 7020 7020 other OPPS APC 7020 27.63 1939.63 percent of total billed charges 7020 7020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION TACTICATH SENSOR ENABLED 2-2-2MM SPACE F-J CURVE L115CM L 3.5MM OD 8 FR IRRIGATE BIDIRECTIONAL SUP-A-TCSE-FJ CDM 0270 RC outpatient 7020 7020 7020 74 5194.8 percent of total billed charges 7020 93 5686.2 percent of total billed charges 7020 7020 other OPPS APC 7020 7020 other OPPS APC 7020 27.63 1939.63 percent of total billed charges 7020 7020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION TACTIFLEX SE UNIDIRECTIONAL CURVE D SENSOR ENABLED SUP-A-TFSE-D CDM 0481 RC outpatient 9880 9880 9880 74 7311.2 percent of total billed charges 9880 93 8002.8 percent of total billed charges 9880 9880 other OPPS APC 9880 9880 other OPPS APC 9880 51 5038.8 percent of total billed charges 9880 9880 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION TACTIFLEX SE BIDIRECTIONAL CURVE D-F SENSOR ENABLED SUP-A-TFSE-DF CDM 0481 RC outpatient 10140 10140 10140 74 7503.6 percent of total billed charges 10140 93 8213.4 percent of total billed charges 10140 10140 other OPPS APC 10140 10140 other OPPS APC 10140 51 5171.4 percent of total billed charges 10140 10140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION TACTIFLEX SE UNIDIRECTIONAL CURVE F SENSOR ENABLED SUP-A-TFSE-F CDM 0481 RC outpatient 9880 9880 9880 74 7311.2 percent of total billed charges 9880 93 8002.8 percent of total billed charges 9880 9880 other OPPS APC 9880 9880 other OPPS APC 9880 51 5038.8 percent of total billed charges 9880 9880 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION TACTIFLEX SE BIDIRECTIONAL CURVE F-J SENSOR ENABLED SUP-A-TFSE-FJ CDM 0481 RC outpatient 10140 10140 10140 74 7503.6 percent of total billed charges 10140 93 8213.4 percent of total billed charges 10140 10140 other OPPS APC 10140 10140 other OPPS APC 10140 51 5171.4 percent of total billed charges 10140 10140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL ADJUSTMENT HELIX LOCKING TOOL SUP-A001HELX CDM 0270 RC outpatient 65 65 65 74 48.1 percent of total billed charges 65 93 52.65 percent of total billed charges 65 65 other OPPS APC 65 65 other OPPS APC 65 27.63 17.96 percent of total billed charges 65 65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ABLATION 15 SAFIRE BLU DUO 4 MM MEDIUM CURL BIDIRECTIONALIRRIGATE TIP SUP-A088107 CDM 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ABLATION 15 SAFIRE BLU DUO COMFORTGRIP 2-5-2 MM SPACE 2 MM LARGE CURL4 MM BIDIRECTIONAL IRRIGATE TIP SUP-A088109 CDM 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT GPS KNEE SUP-A10007 CDM 270010025 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT NAVIGATION EXACTECHGPS STERILE ROBOTIC V2 KNEE IMPLANT SUP-A10012 CDM 270010025 LOCAL 0270 RC outpatient 1300 1300 1300 74 962 percent of total billed charges 1300 93 1053 percent of total billed charges 1300 1300 other OPPS APC 1300 1300 other OPPS APC 1300 27.63 359.19 percent of total billed charges 1300 1300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN SKULL MAYFIELD PLASTIC ADULT CRANIUM WING GROOVE STERILE DISPOSABLE SUP-A1072 CDM 0270 RC outpatient 49.62 49.62 49.62 74 36.72 percent of total billed charges 49.62 93 40.19 percent of total billed charges 49.62 49.62 other OPPS APC 49.62 49.62 other OPPS APC 49.62 27.63 13.71 percent of total billed charges 49.62 49.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. A11B-5 8MM CURRETTE BX/5 SUP-A11B-5 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACHIEVE 18G X 15 CM SUP-A1815 CDM outpatient 78.96 78.96 78.96 78.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND 4-0 18IN BLACK SILK BRAID TIES 12 STRAND PRECUT SUP-A183H CDM 0270 RC outpatient 4.94 4.94 4.94 74 3.66 percent of total billed charges 4.94 93 4 percent of total billed charges 4.94 4.94 other OPPS APC 4.94 4.94 other OPPS APC 4.94 27.63 1.36 percent of total billed charges 4.94 4.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND 3-0 18IN BLACK SILK BRAID TIES 12 STRAND PRECUT SUP-A184H CDM 0270 RC outpatient 4.21 4.21 4.21 74 3.12 percent of total billed charges 4.21 93 3.41 percent of total billed charges 4.21 4.21 other OPPS APC 4.21 4.21 other OPPS APC 4.21 27.63 1.16 percent of total billed charges 4.21 4.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND 2-0 18IN BLACK SILK BRAID TIES 12 STRAND PRECUT SUP-A185H CDM 0270 RC outpatient 3.54 3.54 3.54 74 2.62 percent of total billed charges 3.54 93 2.87 percent of total billed charges 3.54 3.54 other OPPS APC 3.54 3.54 other OPPS APC 3.54 27.63 0.98 percent of total billed charges 3.54 3.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND 0 18IN BLACK SILK BRAID TIE 6 STRAND PRECUT SUP-A186H CDM 0270 RC outpatient 80.68 80.68 80.68 74 59.7 percent of total billed charges 80.68 93 65.35 percent of total billed charges 80.68 80.68 other OPPS APC 80.68 80.68 other OPPS APC 80.68 27.63 22.29 percent of total billed charges 80.68 80.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND SUTUPAK SILK 1 L18 IN BRAID TIES 6 STRAND PRECUT BLACK SUP-A187H CDM 0270 RC outpatient 2.04 2.04 2.04 74 1.51 percent of total billed charges 2.04 93 1.65 percent of total billed charges 2.04 2.04 other OPPS APC 2.04 2.04 other OPPS APC 2.04 27.63 0.56 percent of total billed charges 2.04 2.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SQ ICD A219 Emblem Device _41836_ SUP-A219 CDM 0275 RC outpatient 39440 39440 39440 57 22480.8 percent of total billed charges 39440 93 31946.4 percent of total billed charges 39440 39440 other OPPS APC 39440 39440 other OPPS APC 39440 51 20114.4 percent of total billed charges 39440 39440 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE CUTTING LOOP RESECTOSCOPE ROLLER BALL 24 TO 28FR SUP-A22255C CDM 0270 RC outpatient 166.3 166.3 166.3 74 123.06 percent of total billed charges 166.3 93 134.7 percent of total billed charges 166.3 166.3 other OPPS APC 166.3 166.3 other OPPS APC 166.3 27.63 45.95 percent of total billed charges 166.3 166.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR ARISTOTLE NITINOL HYDROPHILIC L46 CM L35 CM L200 CM L10 CM OD.024 IN SOFT PROFILE RADIOPAQUE FLATTEN CORE TUBE SUP-A24-200-001 CDM 0270 RC outpatient 1924 1924 1924 74 1423.76 percent of total billed charges 1924 93 1558.44 percent of total billed charges 1924 1924 other OPPS APC 1924 1924 other OPPS APC 1924 27.63 531.6 percent of total billed charges 1924 1924 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR ARISTOTLE NITINOL HYDROPHILIC L46 CM L35 CM L200 CM L10 CM OD.024 IN STANDARD PROFILE RADIOPAQUE FLATTEN CORE TUBE SUP-A24-200-002 CDM 0270 RC outpatient 1924 1924 1924 74 1423.76 percent of total billed charges 1924 93 1558.44 percent of total billed charges 1924 1924 other OPPS APC 1924 1924 other OPPS APC 1924 27.63 531.6 percent of total billed charges 1924 1924 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR ARISTOTLE L200CM L10 CM RADIOPAQUE OD 0.024 IN 24 GUIDEWIRE SUPPORT PROFILE WIRE HYCROPHILIC COATING L46CM SUP-A24-200-003 CDM 0270 RC outpatient 1924 1924 1924 74 1423.76 percent of total billed charges 1924 93 1558.44 percent of total billed charges 1924 1924 other OPPS APC 1924 1924 other OPPS APC 1924 27.63 531.6 percent of total billed charges 1924 1924 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT AFX ACTIVESEAL STRATA STRAIGHT 55MM 25MM 17FR EPTFE ENDOVASCULAR ABDOMEN SUP-A25-25/C55 CDM 270010015 LOCAL 0270 RC outpatient 14297.4 14297.4 14297.4 74 10580.1 percent of total billed charges 14297.4 93 11580.9 percent of total billed charges 14297.4 14297.4 other OPPS APC 14297.4 14297.4 other OPPS APC 14297.4 27.63 3950.37 percent of total billed charges 14297.4 14297.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT AFX VELA 75MM 25MM STRATA STERILE LF AORTIC EXTENSION AAA SUP-A25-25/C75V CDM 270010015 LOCAL 0270 RC outpatient 14297.4 14297.4 14297.4 74 10580.1 percent of total billed charges 14297.4 93 11580.9 percent of total billed charges 14297.4 14297.4 other OPPS APC 14297.4 14297.4 other OPPS APC 14297.4 27.63 3950.37 percent of total billed charges 14297.4 14297.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT AFX VELA 75MM 20MM 28MM STRATA STERILE LF SUPRARENAL AORTIC EXTENSION AAA SUP-A28-28/C75-O20V CDM 270010015 LOCAL 0270 RC outpatient 14297.4 14297.4 14297.4 74 10580.1 percent of total billed charges 14297.4 93 11580.9 percent of total billed charges 14297.4 14297.4 other OPPS APC 14297.4 14297.4 other OPPS APC 14297.4 27.63 3950.37 percent of total billed charges 14297.4 14297.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT AFX VELA 75MM 28MM STRATA STERILE LF AORTIC EXTENSION AAA SUP-A28-28/C75V CDM 270010015 LOCAL 0270 RC outpatient 14297.4 14297.4 14297.4 74 10580.1 percent of total billed charges 14297.4 93 11580.9 percent of total billed charges 14297.4 14297.4 other OPPS APC 14297.4 14297.4 other OPPS APC 14297.4 27.63 3950.37 percent of total billed charges 14297.4 14297.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT AFX VELA 95MM 20MM 28MM STRATA STERILE LF ENDOVASCULAR AORTIC EXTENSION AAA SUP-A28-28/C95-O20V CDM 270010015 LOCAL 0270 RC outpatient 14297.4 14297.4 14297.4 74 10580.1 percent of total billed charges 14297.4 93 11580.9 percent of total billed charges 14297.4 14297.4 other OPPS APC 14297.4 14297.4 other OPPS APC 14297.4 27.63 3950.37 percent of total billed charges 14297.4 14297.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ENDOLOGIC VELA INFRARENAL EXTENSION SUP-A28-28/C95V CDM 270010015 LOCAL 0270 RC outpatient 14297.4 14297.4 14297.4 74 10580.1 percent of total billed charges 14297.4 93 11580.9 percent of total billed charges 14297.4 14297.4 other OPPS APC 14297.4 14297.4 other OPPS APC 14297.4 27.63 3950.37 percent of total billed charges 14297.4 14297.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC ADVISA DR MRI SURESCAN 2 CHAMBER DIGITAL ATRIAL TACHYARRHYTHMIA THERAPY SUP-A2DR01 CDM 0275 RC outpatient 6291 6291 6291 57 3585.87 percent of total billed charges 6291 93 5095.71 percent of total billed charges 6291 6291 other OPPS APC 6291 6291 other OPPS APC 6291 51 3208.41 percent of total billed charges 6291 6291 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND 3-0 30IN BLACK SILK BRAID TIE 12 STRAND PRECUT SUP-A304H CDM 0270 RC outpatient 7.07 7.07 7.07 74 5.23 percent of total billed charges 7.07 93 5.73 percent of total billed charges 7.07 7.07 other OPPS APC 7.07 7.07 other OPPS APC 7.07 27.63 1.95 percent of total billed charges 7.07 7.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND 2-0 30IN BLACK SILK BRAID TIE 12 STRAND PRECUT SUP-A305H CDM 0270 RC outpatient 5.83 5.83 5.83 74 4.31 percent of total billed charges 5.83 93 4.72 percent of total billed charges 5.83 5.83 other OPPS APC 5.83 5.83 other OPPS APC 5.83 27.63 1.61 percent of total billed charges 5.83 5.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND 0 30IN BLACK SILK BRAID TIE 6 STRAND PRECUT SUP-A306H CDM 0270 RC outpatient 3.36 3.36 3.36 74 2.49 percent of total billed charges 3.36 93 2.72 percent of total billed charges 3.36 3.36 other OPPS APC 3.36 3.36 other OPPS APC 3.36 27.63 0.93 percent of total billed charges 3.36 3.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND 1 30IN BLACK SILK BRAID TIE 6 STRAND PRECUT SUP-A307H CDM 0270 RC outpatient 3.34 3.34 3.34 74 2.47 percent of total billed charges 3.34 93 2.71 percent of total billed charges 3.34 3.34 other OPPS APC 3.34 3.34 other OPPS APC 3.34 27.63 0.92 percent of total billed charges 3.34 3.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY CATHETERIZATION BARD OD16 FR 350ML URINE METER SUP-A319416A CDM 270009006 LOCAL 0270 RC outpatient 86.84 86.84 86.84 74 64.26 percent of total billed charges 86.84 93 70.34 percent of total billed charges 86.84 86.84 other OPPS APC 86.84 86.84 other OPPS APC 86.84 27.63 23.99 percent of total billed charges 86.84 86.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY CATHETER SURESTEP LUBRI-SIL IC COMPLETE CARE OD 16 FRENCH 350ML FOLEY URINE METER TEMPERATURE SENSING STERILE LATEX FREE DISPOSABLE SUP-A319516A CDM 0270 RC outpatient 103.48 103.48 103.48 74 76.58 percent of total billed charges 103.48 93 83.82 percent of total billed charges 103.48 103.48 other OPPS APC 103.48 103.48 other OPPS APC 103.48 27.63 28.59 percent of total billed charges 103.48 103.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT AFX VELA 100MM 20MM 34MM STRATA STERILE LF ENDOVASCULAR AORTIC EXTENSION AAA SUP-A34-34/C100-O20V CDM 270010015 LOCAL 0270 RC outpatient 14297.4 14297.4 14297.4 74 10580.1 percent of total billed charges 14297.4 93 11580.9 percent of total billed charges 14297.4 14297.4 other OPPS APC 14297.4 14297.4 other OPPS APC 14297.4 27.63 3950.37 percent of total billed charges 14297.4 14297.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT AFX VELA 80MM 20MM 34MM STRATA STERILE LF ENDOVASCULAR AORTIC EXTENSION AAA SUP-A34-34/C80-O20V CDM 270010015 LOCAL 0270 RC outpatient 14297.4 14297.4 14297.4 74 10580.1 percent of total billed charges 14297.4 93 11580.9 percent of total billed charges 14297.4 14297.4 other OPPS APC 14297.4 14297.4 other OPPS APC 14297.4 27.63 3950.37 percent of total billed charges 14297.4 14297.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT AFX VELA 80MM 34MM STRATA STERILE LF AORTIC EXTENSION AAA SUP-A34-34/C80V CDM 270010015 LOCAL 0270 RC outpatient 14297.4 14297.4 14297.4 74 10580.1 percent of total billed charges 14297.4 93 11580.9 percent of total billed charges 14297.4 14297.4 other OPPS APC 14297.4 14297.4 other OPPS APC 14297.4 27.63 3950.37 percent of total billed charges 14297.4 14297.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC ADVISA SR MR SURESCAN 12.7 ML 22 GM 1 CHAMBER UNIPOLAR BIPOLAR IS-1 SUP-A3SR01 CDM 0275 RC outpatient 4104 4104 4104 57 2339.28 percent of total billed charges 4104 93 3324.24 percent of total billed charges 4104 4104 other OPPS APC 4104 4104 other OPPS APC 4104 51 2093.04 percent of total billed charges 4104 4104 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EXTERNAL FIXATION DFS TAPER L120 MM L40 MM OD4.5-3.5 MM ODSEC6 MM CORTICAL SHANK NONSTERILE PIN TO BAR SYSTEM 3.2 MM DRILL SUP-A45-12040 CDM 0270 RC outpatient 437.58 437.58 437.58 74 323.81 percent of total billed charges 437.58 93 354.44 percent of total billed charges 437.58 437.58 other OPPS APC 437.58 437.58 other OPPS APC 437.58 27.63 120.9 percent of total billed charges 437.58 437.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISP KIT RESECTOSCOPE SUP-A4525LINS CDM 0270 RC outpatient 74.75 74.75 74.75 74 55.32 percent of total billed charges 74.75 93 60.55 percent of total billed charges 74.75 74.75 other OPPS APC 74.75 74.75 other OPPS APC 74.75 27.63 20.65 percent of total billed charges 74.75 74.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EMBOLECTOMY SYNTEL 80CM 3FR LF VASCULAR CYLINDRICAL SYMMETRICAL BALLOON NONFRAGMENT FLEXIBLE SPRING TIP SUP-A4F03 CDM 270009142 LOCAL 0270 RC outpatient 45.85 45.85 45.85 74 33.93 percent of total billed charges 45.85 93 37.14 percent of total billed charges 45.85 45.85 other OPPS APC 45.85 45.85 other OPPS APC 45.85 27.63 12.67 percent of total billed charges 45.85 45.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EMBOLECTOMY SYNTEL L80 CM OD4 FR VASCULAR NONFRAGMENT CYLINDRICAL SYMMETRICAL BALLOON FLEXIBLE SPRING TIP LATEX FREE SUP-A4F05 CDM 270009142 LOCAL 0270 RC outpatient 45.85 45.85 45.85 74 33.93 percent of total billed charges 45.85 93 37.14 percent of total billed charges 45.85 45.85 other OPPS APC 45.85 45.85 other OPPS APC 45.85 27.63 12.67 percent of total billed charges 45.85 45.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW EXTERNAL FIXATION DFS TAPER L130 MM L40 MM OD6-5 MM ODSEC6 MM CORTICAL NONSTERILE 4.8 MM DRILL SUP-A60-13040 CDM 0270 RC outpatient 437.58 437.58 437.58 74 323.81 percent of total billed charges 437.58 93 354.44 percent of total billed charges 437.58 437.58 other OPPS APC 437.58 437.58 other OPPS APC 437.58 27.63 120.9 percent of total billed charges 437.58 437.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION FLEXABILITY 1-4-1 MM SPACE D-F CURVE L115 CM L4 MM OD8 FR 4 HOLE IRRIGATE BIDIRECTIONAL HANDLE SUP-A701125 CDM 0270 RC outpatient 5236.4 5236.4 5236.4 74 3874.94 percent of total billed charges 5236.4 93 4241.48 percent of total billed charges 5236.4 5236.4 other OPPS APC 5236.4 5236.4 other OPPS APC 5236.4 27.63 1446.82 percent of total billed charges 5236.4 5236.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION FLEXABILITY 1-4-1 MM SPACE F-J CURVE L115 CM L4 MM OD8 FR 4 HOLE IRRIGATE BIDIRECTIONAL HANDLE SUP-A701128 CDM 0270 RC outpatient 52036.4 52036.4 52036.4 74 38506.9 percent of total billed charges 52036.4 93 42149.5 percent of total billed charges 52036.4 52036.4 other OPPS APC 52036.4 52036.4 other OPPS APC 52036.4 27.63 14377.7 percent of total billed charges 52036.4 52036.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PORT IMPLANTABLE INFUSION POWERFLOW AIRGUARD CHRONOFLEX TITANIUM SILICONE OD 9.6 FR HIGH FLOW POWER INJECTABLE FUNNEL LIGHTWEIGHT SUP-A710962 CDM 0270 RC outpatient 1821.74 1821.74 1821.74 74 1348.09 percent of total billed charges 1821.74 93 1475.61 percent of total billed charges 1821.74 1821.74 other OPPS APC 1821.74 1821.74 other OPPS APC 1821.74 27.63 503.35 percent of total billed charges 1821.74 1821.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAUTERY OPHTHALMIC DIAGNOSTICK 1300 F FINE BATTERY LOW TEMPERATURE STERILE LATEX DISPOSABLE SUP-AA00 CDM outpatient 11.9 11.9 11.9 11.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAUTERY BATTERY DIAGNOSTICK L2 IN OPHTHALMIC PENCIL CORDLESS HIGH TEMPERATURE LOOP STERILE LATEX FREE DISPOSABLE SUP-AA05 CDM 0270 RC outpatient 27.28 27.28 27.28 74 20.19 percent of total billed charges 27.28 93 22.1 percent of total billed charges 27.28 27.28 other OPPS APC 27.28 27.28 other OPPS APC 27.28 27.63 7.54 percent of total billed charges 27.28 27.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE AMNIOFIX PURION 6X4CM AMNIOTIC MEMBRANE SHEET SUP-AAS-5460 CDM 0270 RC outpatient 4681.3 4681.3 4681.3 74 3464.16 percent of total billed charges 4681.3 93 3791.85 percent of total billed charges 4681.3 4681.3 other OPPS APC 4681.3 4681.3 other OPPS APC 4681.3 27.63 1293.44 percent of total billed charges 4681.3 4681.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ORBITAL RETISERT .59 MG INTRAVITREAL EYE SUP-AB41601 CDM 0270 RC outpatient 47450 47450 47450 74 35113 percent of total billed charges 47450 93 38434.5 percent of total billed charges 47450 47450 other OPPS APC 47450 47450 other OPPS APC 47450 27.63 13110.4 percent of total billed charges 47450 47450 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM BONE CEMENT ABS 3 ML DELIVERY MIX SUP-ABS-1000L CDM 0270 RC outpatient 637 637 637 74 471.38 percent of total billed charges 637 93 515.97 percent of total billed charges 637 637 other OPPS APC 637 637 other OPPS APC 637 27.63 176 percent of total billed charges 637 637 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE BLOOD COLLECTION ACP 2 CAP STERILE SUP-ABS-10010S CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM BONE CEMENT FUNNEL SUP-ABS-1003 CDM 0270 RC outpatient 72.8 72.8 72.8 74 53.87 percent of total billed charges 72.8 93 58.97 percent of total billed charges 72.8 72.8 other OPPS APC 72.8 72.8 other OPPS APC 72.8 27.63 20.11 percent of total billed charges 72.8 72.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID BIOCARTILAGE 1 CC SUP-ABS-1010-BC CDM 0270 RC outpatient 2548 2548 2548 74 1885.52 percent of total billed charges 2548 93 2063.88 percent of total billed charges 2548 2548 other OPPS APC 2548 2548 other OPPS APC 2548 27.63 704.01 percent of total billed charges 2548 2548 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT NET SUP-ABS-1050 CDM 0270 RC outpatient 1001 1001 1001 74 740.74 percent of total billed charges 1001 93 810.81 percent of total billed charges 1001 1001 other OPPS APC 1001 1001 other OPPS APC 1001 27.63 276.58 percent of total billed charges 1001 1001 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CARTIFORM OSTEOCHONDRAL DISK OD20 MM ALLOGRAFT CRYOPRESERVE FLEXIBE TRIMMABLE SUP-ABS-1101 CDM 270010031 LOCAL 0270 RC outpatient 22100 22100 22100 74 16354 percent of total billed charges 22100 93 17901 percent of total billed charges 22100 22100 other OPPS APC 22100 22100 other OPPS APC 22100 27.63 6106.23 percent of total billed charges 22100 22100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOGRAFT OATS SET 16MM SUP-ABS-1981-16S CDM 0270 RC outpatient 2015 2015 2015 74 1491.1 percent of total billed charges 2015 93 1632.15 percent of total billed charges 2015 2015 other OPPS APC 2015 2015 other OPPS APC 2015 27.63 556.74 percent of total billed charges 2015 2015 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE STIMUBLAST 10 CC PUTTY SUP-ABS-2001-10 CDM 270010031 LOCAL 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOSYNC PURE 1CC SUP-ABS-2010-01 CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOSYNC PURE 2.5CC SUP-ABS-2010-02 CDM 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOSYNC PURE 5CC SUP-ABS-2010-05 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOSYNC PURE 10CC SUP-ABS-2010-10 CDM 0270 RC outpatient 4420 4420 4420 74 3270.8 percent of total billed charges 4420 93 3580.2 percent of total billed charges 4420 4420 other OPPS APC 4420 4420 other OPPS APC 4420 27.63 1221.25 percent of total billed charges 4420 4420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PUTTY ALLOSYNC DBM 1.0CC SUP-ABS-2012-01 CDM 270010031 LOCAL 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PUTTY ALLOSYNC DBM 2.5CC SUP-ABS-2012-02 CDM 270010031 LOCAL 0270 RC outpatient 1144 1144 1144 74 846.56 percent of total billed charges 1144 93 926.64 percent of total billed charges 1144 1144 other OPPS APC 1144 1144 other OPPS APC 1144 27.63 316.09 percent of total billed charges 1144 1144 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PUTTY ALLOSYNC DBM 5.0CC SUP-ABS-2012-05 CDM 270010031 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID ALLOSYNC DEMINERALIZED BONE MATRIX 1 CC GEL SUP-ABS-2013-01 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID ALLOSYNC DEMINERALIZED BONE MATRIX 5 CC GEL SUP-ABS-2013-05 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID ALLOSYNC DEMINERALIZED BONE MATRIX 10 CC GEL SUP-ABS-2013-10 CDM 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOSYNC EXPAND 1CC SUP-ABS-2017-01 CDM 0270 RC outpatient 479.36 479.36 479.36 74 354.73 percent of total billed charges 479.36 93 388.28 percent of total billed charges 479.36 479.36 other OPPS APC 479.36 479.36 other OPPS APC 479.36 27.63 132.45 percent of total billed charges 479.36 479.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOSYNC EXPAND 2.5CC SUP-ABS-2017-02 CDM 0270 RC outpatient 957.27 957.27 957.27 74 708.38 percent of total billed charges 957.27 93 775.39 percent of total billed charges 957.27 957.27 other OPPS APC 957.27 957.27 other OPPS APC 957.27 27.63 264.49 percent of total billed charges 957.27 957.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOSYNC EXPAND 5CC SUP-ABS-2017-05 CDM 0270 RC outpatient 1794 1794 1794 74 1327.56 percent of total billed charges 1794 93 1453.14 percent of total billed charges 1794 1794 other OPPS APC 1794 1794 other OPPS APC 1794 27.63 495.68 percent of total billed charges 1794 1794 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOSYNC EXPAND 10CC SUP-ABS-2017-10 CDM 0270 RC outpatient 3109.6 3109.6 3109.6 74 2301.1 percent of total billed charges 3109.6 93 2518.78 percent of total billed charges 3109.6 3109.6 other OPPS APC 3109.6 3109.6 other OPPS APC 3109.6 27.63 859.18 percent of total billed charges 3109.6 3109.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT QUICKSET 5CC SUP-ABS-3005 CDM 0270 RC outpatient 4004 4004 4004 74 2962.96 percent of total billed charges 4004 93 3243.24 percent of total billed charges 4004 4004 other OPPS APC 4004 4004 other OPPS APC 4004 27.63 1106.31 percent of total billed charges 4004 4004 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENT BONE QUICKSET MACROPOROUS 8 ML CLOSED MIX SYSTEM INJECTABLE RESORBABLE SUP-ABS-3008 CDM 0270 RC outpatient 5187 5187 5187 74 3838.38 percent of total billed charges 5187 93 4201.47 percent of total billed charges 5187 5187 other OPPS APC 5187 5187 other OPPS APC 5187 27.63 1433.17 percent of total billed charges 5187 5187 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING WOUND JUMPSTART L8 IN OD1.5 IN ANTIMICROBIAL SUP-ABS-4005 CDM 0270 RC outpatient 49.4 49.4 49.4 74 36.56 percent of total billed charges 49.4 93 40.01 percent of total billed charges 49.4 49.4 other OPPS APC 49.4 49.4 other OPPS APC 49.4 27.63 13.65 percent of total billed charges 49.4 49.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE FIXATION ABSORBATACK POLYESTER SPIRAL L5.1 MM L4.1 MM OD5 MM 30 TACK ABSORBABLE PISTOL GRIP HANDLE DISPOSABLE BLACK VIOLET LAPAROSCOPIC HERNIA REPAIR SUP-ABSTACK30 CDM 0270 RC outpatient 1554.38 1554.38 1554.38 74 1150.24 percent of total billed charges 1554.38 93 1259.05 percent of total billed charges 1554.38 1554.38 other OPPS APC 1554.38 1554.38 other OPPS APC 1554.38 27.63 429.48 percent of total billed charges 1554.38 1554.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLUG DEFIBRILLATOR PHOTON RECEPTACLE DF-1 ATLAS EPIC ICD PORT SUP-AC-DP-3 CDM 0481 RC outpatient 61.75 61.75 61.75 74 45.7 percent of total billed charges 61.75 93 50.02 percent of total billed charges 61.75 61.75 other OPPS APC 61.75 61.75 other OPPS APC 61.75 51 31.49 percent of total billed charges 61.75 61.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLUG DEFIBRILLATOR PHOTON MICRO IS-1 PORT SUP-AC-IP-2 CDM 0481 RC outpatient 86.45 86.45 86.45 74 63.97 percent of total billed charges 86.45 93 70.02 percent of total billed charges 86.45 86.45 other OPPS APC 86.45 86.45 other OPPS APC 86.45 51 44.09 percent of total billed charges 86.45 86.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CAPTURE TRANSFORMING EXTREMITIES TITANIUM LOW PROFILE L12 MM OD2 MM FOREFOOT MIDFOOT SELF DRILL SELF TAP CANNULATED HYBRID THREAD SUP-AC2012 CDM 0270 RC outpatient 466.31 466.31 466.31 74 345.07 percent of total billed charges 466.31 93 377.71 percent of total billed charges 466.31 466.31 other OPPS APC 466.31 466.31 other OPPS APC 466.31 27.63 128.84 percent of total billed charges 466.31 466.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CAPTURE TRANSFORMING EXTREMITIES TITANIUM L30 MM OD3 MM FOREFOOT MIDFOOT LOW PROFILE CANNULATED HYBRID THREADS SELF DRILLING SELF TAPPING DISPOSABLE SUP-AC3030 CDM 0270 RC outpatient 625.43 625.43 625.43 74 462.82 percent of total billed charges 625.43 93 506.6 percent of total billed charges 625.43 625.43 other OPPS APC 625.43 625.43 other OPPS APC 625.43 27.63 172.81 percent of total billed charges 625.43 625.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL 14MM X 13MM X 5MM 3D 7DEG SUP-AC4-243057 CDM 270010020 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL 14MM X 13MM X 6MM 3D 7DEG SUP-AC4-243067 CDM 270010020 LOCAL 0270 RC outpatient 3380 3380 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL 14MM X 13MM X 7MM 3D 7DEG SUP-AC4-243077 CDM 270010020 LOCAL 0270 RC outpatient 3380 3380 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SPACER SPINAL INTERBODY 14X13X7MM, 7 DEGREE, 3D" SUP-AC4-243077 CDM 270010020 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SPACER SPINAL INTERBODY 14X13X8MM, 7 DEGREE, 3D" SUP-AC4-243087 CDM 270010020 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL 16MM X 14MM X 7MM 3D 7DEG SUP-AC4-264077 CDM 270010020 LOCAL 0270 RC outpatient 3380 3380 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SPACER SPINAL INTERBODY 16X14X7MM, 7 DEGREE, 3D" SUP-AC4-264077 CDM 270010020 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER CATHETER PITON STERILE LATEX FREE DISPOSABLE SUP-AC4003M_66562 CDM 0481 RC outpatient 70.2 70.2 70.2 74 51.95 percent of total billed charges 70.2 93 56.86 percent of total billed charges 70.2 70.2 other OPPS APC 70.2 70.2 other OPPS APC 70.2 51 35.8 percent of total billed charges 70.2 70.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SUPRAPUBIC SUPRAFOLEY PLASTIC OD16 FR SHARP TIP BEVELLED TROCAR STERILE LATEX FREE DISPOSABLE SUP-AC851 CDM 270009027 LOCAL 0270 RC outpatient 17.28 17.28 17.28 74 12.79 percent of total billed charges 17.28 93 14 percent of total billed charges 17.28 17.28 other OPPS APC 17.28 17.28 other OPPS APC 17.28 27.63 4.77 percent of total billed charges 17.28 17.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEARS ELECTROSURGICAL HARMONIC ACE CURVE 36CM 5MM TITANIUM DISPOSABLE STERILE LF SHAFT PISTOL HANDLE HANDCONTROL SUP-ACE36P CDM 0270 RC outpatient 1083.54 1083.54 1083.54 74 801.82 percent of total billed charges 1083.54 93 877.67 percent of total billed charges 1083.54 1083.54 other OPPS APC 1083.54 1083.54 other OPPS APC 1083.54 27.63 299.38 percent of total billed charges 1083.54 1083.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE ATRICLIP 45D 35MM 6CM NITINOL POLYESTER FLEXIBLE SHAFT PLUNGER GRIP LEFT ATRIAL APPENDAGE EXCLUSION SUP-ACH 235 CDM 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE ATRICLIP 45D 40MM 6CM NITINOL POLYESTER FLEXIBLE SHAFT PLUNGER GRIP LEFT ATRIAL APPENDAGE EXCLUSION SUP-ACH 240 CDM 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE ATRICLIP 45D 45MM 6CM NITINOL TITANIUM POLYESTER FLEXIBLE SHAFT PLUNGER GRIP LEFT ATRIAL APPENDAGE SUP-ACH 245 CDM 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE ATRICLIP 45D 50MM 6CM NITINOL TITANIUM POLYESTER FLEXIBLE SHAFT PLUNGER GRIP LEFT ATRIAL APPENDAGE SUP-ACH 250 CDM 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE ATRICLIP FLEXV L35 MM 1 HAND SMALL FOOTPRINT SUTURE LESS CLIP DEPLOYMENT STERILE LATEX FREE DISPOSABLE LEFT ATRIAL APPENDAGE EXCLUSION SYSTEM SUP-ACHV35 CDM 0270 RC outpatient 4810 4810 4810 74 3559.4 percent of total billed charges 4810 93 3896.1 percent of total billed charges 4810 4810 other OPPS APC 4810 4810 other OPPS APC 4810 27.63 1329 percent of total billed charges 4810 4810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE ATRICLIP FLEXV L40 MM 1 HAND SMALL FOOTPRINT SUTURE LESS CLIP DEPLOYMENT STERILE LATEX FREE DISPOSABLE LEFT ATRIAL APPENDAGE EXCLUSION SYSTEM SUP-ACHV40 CDM 0270 RC outpatient 4810 4810 4810 74 3559.4 percent of total billed charges 4810 93 3896.1 percent of total billed charges 4810 4810 other OPPS APC 4810 4810 other OPPS APC 4810 27.63 1329 percent of total billed charges 4810 4810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE ATRICLIP FLEXV L45 MM 1 HAND SMALL FOOTPRINT SUTURE LESS CLIP DEPLOYMENT STERILE LATEX FREE DISPOSABLE LEFT ATRIAL APPENDAGE EXCLUSION SYSTEM SUP-ACHV45 CDM 0270 RC outpatient 4810 4810 4810 74 3559.4 percent of total billed charges 4810 93 3896.1 percent of total billed charges 4810 4810 other OPPS APC 4810 4810 other OPPS APC 4810 27.63 1329 percent of total billed charges 4810 4810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE ATRICLIP FLEXV L50 MM 1 HAND SMALL FOOTPRINT SUTURE LESS CLIP DEPLOYMENT STERILE LATEX FREE DISPOSABLE LEFT ATRIAL APPENDAGE EXCLUSION SYSTEM SUP-ACHV50 CDM 0270 RC outpatient 4810 4810 4810 74 3559.4 percent of total billed charges 4810 93 3896.1 percent of total billed charges 4810 4810 other OPPS APC 4810 4810 other OPPS APC 4810 27.63 1329 percent of total billed charges 4810 4810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET VENTILATOR HUMIDIFIER LATEX FREE MONSOON III STERILE WATER SUP-ACU-7718-PK5 CDM 0270 RC outpatient 26.52 26.52 26.52 74 19.62 percent of total billed charges 26.52 93 21.48 percent of total billed charges 26.52 26.52 other OPPS APC 26.52 26.52 other OPPS APC 26.52 27.63 7.33 percent of total billed charges 26.52 26.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE CONNECTING L13 FT CUFF LATEX FREE DISPOSABLE BLUE ACUTRONIC MONSOON III JET VENTILATOR SUP-ACU-7720T-PK5 CDM 0270 RC outpatient 161.2 161.2 161.2 74 119.29 percent of total billed charges 161.2 93 130.57 percent of total billed charges 161.2 161.2 other OPPS APC 161.2 161.2 other OPPS APC 161.2 27.63 44.54 percent of total billed charges 161.2 161.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICE 10F ACUNAV ULTRASOUND reprocessed SUP-ACU10043342 CDM 0270 RC outpatient 2542.8 2542.8 2542.8 74 1881.67 percent of total billed charges 2542.8 93 2059.67 percent of total billed charges 2542.8 2542.8 other OPPS APC 2542.8 2542.8 other OPPS APC 2542.8 27.63 702.58 percent of total billed charges 2542.8 2542.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACUNAV 8FR ICE reprocessed SUP-ACU10135910 CDM 0270 RC outpatient 2542.8 2542.8 2542.8 74 1881.67 percent of total billed charges 2542.8 93 2059.67 percent of total billed charges 2542.8 2542.8 other OPPS APC 2542.8 2542.8 other OPPS APC 2542.8 27.63 702.58 percent of total billed charges 2542.8 2542.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AGENT BULKING MACROPLASTIQUE SYNTHETIC ADMINISTRATION DEVICE ONLY ADAPTER REUSABLE STRESS URINARY INCONTINENCE SUP-AD-US CDM 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM PACEMAKER CARDIAC ADAPTA DR THK7.5 MM W47.9 MM X H44.7 MM 12.1 ML 27.1 GM ATRIUM VENTRICLE IMPLANTABLE 2 CHAMBER RATE RESPONSIVE UNIPOLAR BIPOLAR SUP-ADAPTADRK2 CDM 0275 RC outpatient 7875 7875 7875 57 4488.75 percent of total billed charges 7875 93 6378.75 percent of total billed charges 7875 7875 other OPPS APC 7875 7875 other OPPS APC 7875 51 4016.25 percent of total billed charges 7875 7875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM PACEMAKER ADAPTA DR LONGEVITY DUAL CHAMBER SYSTEM SUP-ADAPTALGDRK2 CDM 0275 RC outpatient 7875 7875 7875 57 4488.75 percent of total billed charges 7875 93 6378.75 percent of total billed charges 7875 7875 other OPPS APC 7875 7875 other OPPS APC 7875 51 4016.25 percent of total billed charges 7875 7875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM PACEMAKER CARDIAC ADAPTA DR THK7.5 MM SMALL W47.9 MM X H44.7 MM 12.1 ML 27.1 GM ATRIUM VENTRICLE 2 CHAMBER IMPLANTABLE RATE RESPONSIVE UNIPOLAR BIPOLAR SUP-ADAPTASMDRK2 CDM 0275 RC outpatient 7875 7875 7875 57 4488.75 percent of total billed charges 7875 93 6378.75 percent of total billed charges 7875 7875 other OPPS APC 7875 7875 other OPPS APC 7875 51 4016.25 percent of total billed charges 7875 7875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM PACEMAKER CARDIAC ADAPTA SR ATRIUM VENTRICLE IMPLANTABLE 1 CHAMBER RATE RESPONSIVE UNIPOLAR BIPOLAR SUP-ADAPTASRK2 CDM 0275 RC outpatient 5625 5625 5625 57 3206.25 percent of total billed charges 5625 93 4556.25 percent of total billed charges 5625 5625 other OPPS APC 5625 5625 other OPPS APC 5625 51 2868.75 percent of total billed charges 5625 5625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PPM ADDR01 ADAPTA DR DEVICE _1999654_ SUP-ADDR01 CDM 0275 RC outpatient 4725 4725 4725 57 2693.25 percent of total billed charges 4725 93 3827.25 percent of total billed charges 4725 4725 other OPPS APC 4725 4725 other OPPS APC 4725 51 2409.75 percent of total billed charges 4725 4725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC ADAPTA DR 2 CHAMBER SUP-ADDR03 CDM 0275 RC outpatient 6097.5 6097.5 6097.5 57 3475.58 percent of total billed charges 6097.5 93 4938.98 percent of total billed charges 6097.5 6097.5 other OPPS APC 6097.5 6097.5 other OPPS APC 6097.5 51 3109.73 percent of total billed charges 6097.5 6097.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC ADAPTA DR 2 CHAMBER SUP-ADDR06 CDM 0275 RC outpatient 6097.5 6097.5 6097.5 57 3475.58 percent of total billed charges 6097.5 93 4938.98 percent of total billed charges 6097.5 6097.5 other OPPS APC 6097.5 6097.5 other OPPS APC 6097.5 51 3109.73 percent of total billed charges 6097.5 6097.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PPM ADDRL1 ADAPTA DR DEVICE _45786_ SUP-ADDRL1 CDM 0275 RC outpatient 4725 4725 4725 57 2693.25 percent of total billed charges 4725 93 3827.25 percent of total billed charges 4725 4725 other OPPS APC 4725 4725 other OPPS APC 4725 51 2409.75 percent of total billed charges 4725 4725 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER ADAPTA DR LONGEVITY DEVICE SUP-ADDRS1 CDM 0275 RC outpatient 6097.5 6097.5 6097.5 57 3475.58 percent of total billed charges 6097.5 93 4938.98 percent of total billed charges 6097.5 6097.5 other OPPS APC 6097.5 6097.5 other OPPS APC 6097.5 51 3109.73 percent of total billed charges 6097.5 6097.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER ADAPTA DUAL CHAMBER SYSTEM SUP-ADDRSERIES S CDM 0270 RC outpatient 12757 12757 12757 74 9440.18 percent of total billed charges 12757 93 10333.2 percent of total billed charges 12757 12757 other OPPS APC 12757 12757 other OPPS APC 12757 27.63 3524.76 percent of total billed charges 12757 12757 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PPM ADSR01 ADAPTA SR DEVICE _1999967_ SUP-ADSR01 CDM 0275 RC outpatient 3600 3600 3600 57 2052 percent of total billed charges 3600 93 2916 percent of total billed charges 3600 3600 other OPPS APC 3600 3600 other OPPS APC 3600 51 1836 percent of total billed charges 3600 3600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER ADAPTA SINGLE CHAMBER DEVICE SUP-ADSR03 CDM 0275 RC outpatient 4736.25 4736.25 4736.25 57 2699.66 percent of total billed charges 4736.25 93 3836.36 percent of total billed charges 4736.25 4736.25 other OPPS APC 4736.25 4736.25 other OPPS APC 4736.25 51 2415.49 percent of total billed charges 4736.25 4736.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER ADAPTA SINGLE CHAMBER DEVICE SUP-ADSR06 CDM 0275 RC outpatient 4736.25 4736.25 4736.25 57 2699.66 percent of total billed charges 4736.25 93 3836.36 percent of total billed charges 4736.25 4736.25 other OPPS APC 4736.25 4736.25 other OPPS APC 4736.25 51 2415.49 percent of total billed charges 4736.25 4736.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM PACEMAKER ADVISA DR MRI SUP-ADVISAMRIPEEM CDM 0275 RC outpatient 7875 7875 7875 57 4488.75 percent of total billed charges 7875 93 6378.75 percent of total billed charges 7875 7875 other OPPS APC 7875 7875 other OPPS APC 7875 51 4016.25 percent of total billed charges 7875 7875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER ADVISA MRI DUAL CHAMBER SYSTEM SUP-ADVISAMRIPEEM-SYS CDM 0275 RC outpatient 11925 11925 11925 57 6797.25 percent of total billed charges 11925 93 9659.25 percent of total billed charges 11925 11925 other OPPS APC 11925 11925 other OPPS APC 11925 51 6081.75 percent of total billed charges 11925 11925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM ADVISA SR MRI SUP-ADVISASRMRIPEEM CDM 0275 RC outpatient 6979.5 6979.5 6979.5 57 3978.32 percent of total billed charges 6979.5 93 5653.4 percent of total billed charges 6979.5 6979.5 other OPPS APC 6979.5 6979.5 other OPPS APC 6979.5 51 3559.55 percent of total billed charges 6979.5 6979.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER INTERNAL CLIP WECK HEM-O-LOK AUTO ENDO5 POLYMER 5 MM BOW STRAIGHT L33 CM AUTOMATIC CLOSURE MEDIUM LARGE CLIP LOCK NONABSORBABLE STERILE LATEX FREE DISPOSABLE ENDO SURGERY SUP-AE05ML CDM 0270 RC outpatient 290.16 290.16 290.16 74 214.72 percent of total billed charges 290.16 93 235.03 percent of total billed charges 290.16 290.16 other OPPS APC 290.16 290.16 other OPPS APC 290.16 27.63 80.17 percent of total billed charges 290.16 290.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ANEURX AAADVANTAGE XCELERANT NITINOL STRAIGHT L4 CM OD24 MM ODSEC21 FR ENDOVASCULAR ABDOMEN AORTA ILIUM INFRARENAL SYSTEM SELF EXPANDING WOVEN EXTENDER CUFF HYDRO DELIVERY AAA SUP-AEXCH242440 CDM 270010015 LOCAL 0270 RC outpatient 6890 6890 6890 74 5098.6 percent of total billed charges 6890 93 5580.9 percent of total billed charges 6890 6890 other OPPS APC 6890 6890 other OPPS APC 6890 27.63 1903.71 percent of total billed charges 6890 6890 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ANEURX AAADVANTAGE XCELERANT NITINOL STRAIGHT L4 CM OD28 MM ODSEC21 FR ENDOVASCULAR ABDOMEN AORTA ILIUM INFRARENAL SYSTEM SELF EXPANDING WOVEN EXTENDER CUFF HYDRO DELIVERY AAA SUP-AEXCH282840 CDM 270010015 LOCAL 0270 RC outpatient 6890 6890 6890 74 5098.6 percent of total billed charges 6890 93 5580.9 percent of total billed charges 6890 6890 other OPPS APC 6890 6890 other OPPS APC 6890 27.63 1903.71 percent of total billed charges 6890 6890 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VEST HALO AIRFLOW SMALL 28-38 SUP-AF101 CDM 0270 RC outpatient 4875 4875 4875 74 3607.5 percent of total billed charges 4875 93 3948.75 percent of total billed charges 4875 4875 other OPPS APC 4875 4875 other OPPS APC 4875 27.63 1346.96 percent of total billed charges 4875 4875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VEST HALO AIRFLOW TALL 30 TO 44IN SUP-AF102 CDM 0270 RC outpatient 4875 4875 4875 74 3607.5 percent of total billed charges 4875 93 3948.75 percent of total billed charges 4875 4875 other OPPS APC 4875 4875 other OPPS APC 4875 27.63 1346.96 percent of total billed charges 4875 4875 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER CRYOABLATION ARTIC FRONT ADVANCE PRO L23CM SUP-AFAPRO23 CDM 0270 RC outpatient 11570 11570 11570 74 8561.8 percent of total billed charges 11570 93 9371.7 percent of total billed charges 11570 11570 other OPPS APC 11570 11570 other OPPS APC 11570 27.63 3196.79 percent of total billed charges 11570 11570 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER CRYOABLATION ARTIC FRONT ADVANCE PRO L28CM SUP-AFAPRO28 CDM 0270 RC outpatient 11570 11570 11570 74 8561.8 percent of total billed charges 11570 93 9371.7 percent of total billed charges 11570 11570 other OPPS APC 11570 11570 other OPPS APC 11570 27.63 3196.79 percent of total billed charges 11570 11570 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE ARTHROFLEX MATRACELL THK1.5MM 40X70MM ACELLULAR DERMAL MATRIX STERILE ALLOGRAFT SUP-AFLEX101 CDM 270010031 LOCAL 0270 RC outpatient 7045.56 7045.56 7045.56 74 5213.71 percent of total billed charges 7045.56 93 5706.9 percent of total billed charges 7045.56 7045.56 other OPPS APC 7045.56 7045.56 other OPPS APC 7045.56 27.63 1946.69 percent of total billed charges 7045.56 7045.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE DERMIS L70 MM X W40 MM X H2 MM DECELLULARIZED LATEX FREE SUP-AFLEX201 CDM 270010031 LOCAL 0270 RC outpatient 8405.23 8405.23 8405.23 74 6219.87 percent of total billed charges 8405.23 93 6808.24 percent of total billed charges 8405.23 8405.23 other OPPS APC 8405.23 8405.23 other OPPS APC 8405.23 27.63 2322.37 percent of total billed charges 8405.23 8405.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE ARTHROFLEX THK2.5-3.5MM 70X40MM DECELLULARIZED DERMIS ALLOGRAFT SUP-AFLEX301 CDM 0270 RC outpatient 10304.4 10304.4 10304.4 74 7625.22 percent of total billed charges 10304.4 93 8346.52 percent of total billed charges 10304.4 10304.4 other OPPS APC 10304.4 10304.4 other OPPS APC 10304.4 27.63 2847.09 percent of total billed charges 10304.4 10304.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ARTHROFLEX 20 X 25 X 1.0 MM SUP-AFLEX402 CDM 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE ARTHROFLEX FLEXIGRAFT DERMIS THK.3-.7 MM L40 MM X W30 MM PATCH MATRACELL TECHNOLOGY DECELLULARIZED STERILE SUP-AFLEX500 CDM 270010031 LOCAL 0270 RC outpatient 2593.6 2593.6 2593.6 74 1919.26 percent of total billed charges 2593.6 93 2100.82 percent of total billed charges 2593.6 2593.6 other OPPS APC 2593.6 2593.6 other OPPS APC 2593.6 27.63 716.61 percent of total billed charges 2593.6 2593.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE ARTHROFLEX DECELLULARIZED DERMIS THK1.76-2.25 MM L14 MM X W10 MM ALLOGRAFT PATCH SUP-AFLEX822 CDM 0270 RC outpatient 1530.18 1530.18 1530.18 74 1132.33 percent of total billed charges 1530.18 93 1239.45 percent of total billed charges 1530.18 1530.18 other OPPS APC 1530.18 1530.18 other OPPS APC 1530.18 27.63 422.79 percent of total billed charges 1530.18 1530.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE HELI-FX 22MM SUP-AG-64 CDM 0270 RC outpatient 4578.6 4578.6 4578.6 74 3388.16 percent of total billed charges 4578.6 93 3708.67 percent of total billed charges 4578.6 4578.6 other OPPS APC 4578.6 4578.6 other OPPS APC 4578.6 27.63 1265.07 percent of total billed charges 4578.6 4578.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR ARTEGRAFT 6MM 40CM WOVEN BOVINE COLLAGEN CAROTID ARTERY F/LOWER EXTREMITY BYPASS SUP-AG740 CDM 0270 RC outpatient 5535.4 5535.4 5535.4 74 4096.2 percent of total billed charges 5535.4 93 4483.67 percent of total billed charges 5535.4 5535.4 other OPPS APC 5535.4 5535.4 other OPPS APC 5535.4 27.63 1529.43 percent of total billed charges 5535.4 5535.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC SOFT-VU KUMPE CURVE ANGLE L40 CM OD4 FR NONBRAIDED SOFT RADIOPAQUE TIP HIGH TORQUE SHAFT SELECTIVE STERILE DISPOSABLE .035 IN GUIDEWIRE SUP-AGDSCH343015 CDM 0270 RC outpatient 89.44 89.44 89.44 74 66.19 percent of total billed charges 89.44 93 72.45 percent of total billed charges 89.44 89.44 other OPPS APC 89.44 89.44 other OPPS APC 89.44 27.63 24.71 percent of total billed charges 89.44 89.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Fix This SUP-AGH146000 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER FIXOS L150 MM OD1.4 MM FOOT ANKLE SMOOTH TROCAR TIP SUP-AGK0214150 CDM 0270 RC outpatient 166.4 166.4 166.4 74 123.14 percent of total billed charges 166.4 93 134.78 percent of total billed charges 166.4 166.4 other OPPS APC 166.4 166.4 other OPPS APC 166.4 27.63 45.98 percent of total billed charges 166.4 166.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER L100 MM OD1.6 MM FOOT ANKLE SMOOTH TROCAR SUP-AGK16100 CDM 0270 RC outpatient 110.24 110.24 110.24 74 81.58 percent of total billed charges 110.24 93 89.29 percent of total billed charges 110.24 110.24 other OPPS APC 110.24 110.24 other OPPS APC 110.24 27.63 30.46 percent of total billed charges 110.24 110.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIELDER XT STRAIGHT TIP GUIDEWIRE 190CM SUP-AGP140002 CDM 0481 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 51 172.38 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ASAHI SION BLUE STRAIGHT TIP GUIDEWIRE 180CM SUP-AHW14R004S CDM 0481 RC outpatient 351 351 351 74 259.74 percent of total billed charges 351 93 284.31 percent of total billed charges 351 351 other OPPS APC 351 351 other OPPS APC 351 51 179.01 percent of total billed charges 351 351 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC ARROW L60 CM OD5 FR ODSEC7 MM .75 CC 1 LUMEN BALLOON WEDGE PRESSURE TAPER TIP ACCEPTS .025 IN GUIDEWIRE 5 FR INTRODUCER SUP-AI-07123 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC ARROW L110 CM OD5 FR ODSEC8 MM .75 CC 1 LUMEN BALLOON WEDGE PRESSURE TAPER TIP STERILE ACCEPTS .025 IN GUIDEWIRE 5 FR INTRODUCER SUP-AI-07124 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROWATER STRAIGHT TIP GUIDEWIRE 180CM SUP-AJH146000 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT THORACENTESIS ARROW-CLARKE PLEURA-SEAL SHARPSAWAY II CHLORAPREP HI-LITE ORANGE POLYURETHANE L7 1/2 IN L1 1/2 IN OD8 FR ODSEC18 GA 5 ML 3 WAY STOPCOCK NEEDLE CATHETER SELF SEAL VALVE LUER LOCK SYRINGE STERILE LATEX SUP-AK-01000 CDM 270009223 LOCAL 0270 RC outpatient 129.2 129.2 129.2 74 95.61 percent of total billed charges 129.2 93 104.65 percent of total billed charges 129.2 129.2 other OPPS APC 129.2 129.2 other OPPS APC 129.2 27.63 35.7 percent of total billed charges 129.2 129.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DRAINAGE L6.44 IN OD8 FR ODSEC22 GA 10 ML PNEUMOTHORAX CATHETER RADIOPAQUE NEEDLE SHARP SAFETY LATEX FREE SUP-AK-01500 CDM 270009127 LOCAL 0270 RC outpatient 358.8 358.8 358.8 74 265.51 percent of total billed charges 358.8 93 290.63 percent of total billed charges 358.8 358.8 other OPPS APC 358.8 358.8 other OPPS APC 358.8 27.63 99.14 percent of total billed charges 358.8 358.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTRODUCER ARROW-FLEX .035IN 10CM 6.35CM 8.5FR 18GA POLYURETHANE LF PERCUTANEOUS SUP-AK-09803-CDC CDM 270009145 LOCAL 0270 RC outpatient 31.44 31.44 31.44 74 23.27 percent of total billed charges 31.44 93 25.47 percent of total billed charges 31.44 31.44 other OPPS APC 31.44 31.44 other OPPS APC 31.44 27.63 8.69 percent of total billed charges 31.44 31.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETERIZATION ARROW-HOWES BLUE FLEXTIP ARROWG+ARD SHARPSAWAY II POLYURETHANE .035 IN L6 IN L2 1/2 IN OD12 FR ODSEC18 GA CENTRAL VENOUS MULTILUMEN CATHETER GUIDEWIRE NEEDLE SUP-AK-22123-SK CDM 0270 RC outpatient 315.64 315.64 315.64 74 233.57 percent of total billed charges 315.64 93 255.67 percent of total billed charges 315.64 315.64 other OPPS APC 315.64 315.64 other OPPS APC 315.64 27.63 87.21 percent of total billed charges 315.64 315.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER ARROW-HOWES ARROWG+ARD BLUE BLUE FLEXTIP .035IN 20CM 2.5IN 12FR 18GA SUP-AK-25123 CDM 0270 RC outpatient 1227.2 1227.2 1227.2 74 908.13 percent of total billed charges 1227.2 93 994.03 percent of total billed charges 1227.2 1227.2 other OPPS APC 1227.2 1227.2 other OPPS APC 1227.2 27.63 339.08 percent of total billed charges 1227.2 1227.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER ARROWG+ARD BLUE BLUE FLEXTIP POLYURETHANE .038 IN L20 CM L2.5 IN OD14 FR ODSEC18 GA 2 LUMEN GUIDEWIRE NEEDLE SHARP SAFETY LATEX FREE HEMODIALYSIS SUP-AK-25142-CDC CDM 270009216 LOCAL 0270 RC outpatient 135.64 135.64 135.64 74 100.37 percent of total billed charges 135.64 93 109.87 percent of total billed charges 135.64 135.64 other OPPS APC 135.64 135.64 other OPPS APC 135.64 27.63 37.48 percent of total billed charges 135.64 135.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRUSH CYTOLOGY SUPERTRAX INREACH L120 CM L2 MM OD1.7 MM METAL TIPPED SHEATH STERILE DISPOSABLE TOOL SUP-AKI00100-01 CDM 0270 RC outpatient 92.04 92.04 92.04 74 68.11 percent of total billed charges 92.04 93 74.55 percent of total billed charges 92.04 92.04 other OPPS APC 92.04 92.04 other OPPS APC 92.04 27.63 25.43 percent of total billed charges 92.04 92.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ENDOSCOPIC SUERTRAX 130CM 21GA 1.8MM CLEAR ASPIRATE EXTEND WORKING CHANNEL CATHETER SUP-AKI00101-01 CDM 0270 RC outpatient 360.36 360.36 360.36 74 266.67 percent of total billed charges 360.36 93 291.89 percent of total billed charges 360.36 360.36 other OPPS APC 360.36 360.36 other OPPS APC 360.36 27.63 99.57 percent of total billed charges 360.36 360.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS BIOPSY SUPERTRAX L110 CM L2 MM OD1.7 MM SHAFT REINFORCED STACKED COIL DESIGN PROPRIETARY SHEATH SMOOTH BILATERAL CUP STERILE DISPOSABLE SUP-AKI00133-01 CDM 0270 RC outpatient 287.56 287.56 287.56 74 212.79 percent of total billed charges 287.56 93 232.92 percent of total billed charges 287.56 287.56 other OPPS APC 287.56 287.56 other OPPS APC 287.56 27.63 79.45 percent of total billed charges 287.56 287.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPONGE LAPAROTOMY L18 IN X W4 IN STERILE SUP-AL0418 CDM 0270 RC outpatient 0.47 0.47 0.47 74 0.35 percent of total billed charges 0.47 93 0.38 percent of total billed charges 0.47 0.47 other OPPS APC 0.47 0.47 other OPPS APC 0.47 27.63 0.13 percent of total billed charges 0.47 0.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPONGE LAPAROTOMY TYVEK L12 IN X W12 IN PUNCTURE RESISTANT STERILE SUP-AL1212 CDM 0270 RC outpatient 0.63 0.63 0.63 74 0.47 percent of total billed charges 0.63 93 0.51 percent of total billed charges 0.63 0.63 other OPPS APC 0.63 0.63 other OPPS APC 0.63 27.63 0.17 percent of total billed charges 0.63 0.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPONGE LAPAROTOMY L18 IN X W18 IN STERILE SUP-AL1818 CDM 0270 RC outpatient 0.63 0.63 0.63 74 0.47 percent of total billed charges 0.63 93 0.51 percent of total billed charges 0.63 0.63 other OPPS APC 0.63 0.63 other OPPS APC 0.63 27.63 0.17 percent of total billed charges 0.63 0.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPONGE LAPAROTOMY TYVEK L18 IN X W18 IN PUNCTURE RESISTANT NONLOOP RING STERILE SUP-AL1818R CDM outpatient 0.75 0.75 0.75 0.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JACKET STAFF BARRIER UNISOFT COTTON MEDIUM WARMUP SNAP BUTTON BREATHABLE ANTISTATIC TREAT LATEX FREE DISPOSABLE BLUE SUP-ALA28010 CDM outpatient 21.15 21.15 21.15 21.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JACKET STAFF BARRIER UNISOFT COTTON LARGE WARMUP SNAP BUTTON BREATHABLE ANTISTATIC TREAT LATEX FREE DISPOSABLE BLUE SUP-ALA28020 CDM outpatient 22.17 22.17 22.17 22.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JACKET STAFF BARRIER UNISOFT COTTON XL WARMUP SNAP BUTTON BREATHABLE ANTISTATIC TREAT LATEX FREE DISPOSABLE BLUE SUP-ALA28030 CDM outpatient 23.37 23.37 23.37 23.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY ESOPHAGEAL MASK SIZE 3 CHILD 30ML AIR VOLUME FLEXIBLE CUFFED SUP-ALBF030SU CDM outpatient 34.5 34.5 34.5 34.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY ESOPHAGEAL MASK SIZE 4 ADULT 45ML AIR VOLUME FLEXIBLE CUFFED SUP-ALBF040SU CDM outpatient 33.67 33.67 33.67 33.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY ESOPHAGEAL MASK SIZE 5 ADULT 45ML AIR VOLUME FLEXIBLE CUFFED SUP-ALBF050SU CDM outpatient 33.67 33.67 33.67 33.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM LEAD DELIVERY ACUITY BREAKAWAY SUP-ALDS CDM 0275 RC outpatient 1019.2 1019.2 1019.2 57 580.94 percent of total billed charges 1019.2 93 825.55 percent of total billed charges 1019.2 1019.2 other OPPS APC 1019.2 1019.2 other OPPS APC 1019.2 51 519.79 percent of total billed charges 1019.2 1019.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STYLETS ABBOTT/ST JUDE CRM _34810_ SUP-ALL PN# CDM 0270 RC outpatient 22 22 22 74 16.28 percent of total billed charges 22 93 17.82 percent of total billed charges 22 22 other OPPS APC 22 22 other OPPS APC 22 27.63 6.08 percent of total billed charges 22 22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRASPER SURGICAL AHMED MICRO 25 GM DISPOSABLE SUP-AMG-1001 CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK ANESTHESIA PEDIATRIC 2 TRADITIONAL SUP-AMINF2CH CDM 0270 RC outpatient 5.19 5.19 5.19 74 3.84 percent of total billed charges 5.19 93 4.2 percent of total billed charges 5.19 5.19 other OPPS APC 5.19 5.19 other OPPS APC 5.19 27.63 1.43 percent of total billed charges 5.19 5.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT AMPLIA MRI SYSTEM SUP-AMPLIAMRICRTDMMAM CDM outpatient 41300 41300 41300 41300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT AMPLIA MRI QUAD SYSTEM SUP-AMPLIAMRIQDCRTMMQM CDM outpatient 42300 42300 42300 42300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT SEPARATOR BASIC PLATELET MAGELLAN SUP-AMS305 CDM 0270 RC outpatient 442 442 442 74 327.08 percent of total billed charges 442 93 358.02 percent of total billed charges 442 442 other OPPS APC 442 442 other OPPS APC 442 27.63 122.12 percent of total billed charges 442 442 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUMP PUMP SUP-AN-42 CDM 270009037 LOCAL 0270 RC outpatient 77.22 77.22 77.22 74 57.14 percent of total billed charges 77.22 93 62.55 percent of total billed charges 77.22 77.22 other OPPS APC 77.22 77.22 other OPPS APC 77.22 27.63 21.34 percent of total billed charges 77.22 77.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 10.0 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-10.0 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 10.5 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-10.5 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 11.0 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-11.0 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 11.5 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-11.5 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 12.0 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-12.0 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 12.5 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-12.5 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 13.0 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-13.0 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 13.5 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-13.5 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 14.0 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-14.0 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 14.5 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-14.5 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 15.0 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-15.0 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 15.5 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-15.5 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 16.0 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-16.0 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 16.5 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-16.5 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 17.0 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-17.0 CDM 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 17.5 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-17.5 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 18.0 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-18.0 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 18.5 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-18.5 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 19.0 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-19.0 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 19.5 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-19.5 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 20.0 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-20.0 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 20.5 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-20.5 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 21.0 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-21.0 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 21.5 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-21.5 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 22.0 DIOIPTER POSTERIOR CHAMBER SUP-AO60P-22.0 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 26% HYDROPHILIC ACRYLIC 0 D +20 DIOPTER BICONVEX L10.7 MM OD6 MM POSTERIOR CHAMBER SUP-AO60P2000 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR AKREOS AO 26% HYDROPHILIC ACRYLIC 0 D +22 DIOPTER BICONVEX L10.7 MM OD6 MM POSTERIOR CHAMBER SUP-AO60P2200 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L2 CM OD1 MM EXTRA SOFT SUP-APB-1-2-3D-ES CDM 0270 RC outpatient 6032 6032 6032 74 4463.68 percent of total billed charges 6032 93 4885.92 percent of total billed charges 6032 6032 other OPPS APC 6032 6032 other OPPS APC 6032 27.63 1666.64 percent of total billed charges 6032 6032 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L3 CM OD1 MM EXTRA SOFT SUP-APB-1-3-3D-ES CDM 0270 RC outpatient 6032 6032 6032 74 4463.68 percent of total billed charges 6032 93 4885.92 percent of total billed charges 6032 6032 other OPPS APC 6032 6032 other OPPS APC 6032 27.63 1666.64 percent of total billed charges 6032 6032 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L3 CM OD1.5 MM EXTRA SOFT SUP-APB-1.5-3-3D-ES CDM 0270 RC outpatient 6032 6032 6032 74 4463.68 percent of total billed charges 6032 93 4885.92 percent of total billed charges 6032 6032 other OPPS APC 6032 6032 other OPPS APC 6032 27.63 1666.64 percent of total billed charges 6032 6032 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L4 CM OD1.5 MM EXTRA SOFT SUP-APB-1.5-4-3D-ES CDM 0270 RC outpatient 6032 6032 6032 74 4463.68 percent of total billed charges 6032 93 4885.92 percent of total billed charges 6032 6032 other OPPS APC 6032 6032 other OPPS APC 6032 27.63 1666.64 percent of total billed charges 6032 6032 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L2 CM OD2 MM EXTRA SOFT SUP-APB-2-2-3D-ES CDM 0270 RC outpatient 6032 6032 6032 74 4463.68 percent of total billed charges 6032 93 4885.92 percent of total billed charges 6032 6032 other OPPS APC 6032 6032 other OPPS APC 6032 27.63 1666.64 percent of total billed charges 6032 6032 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L4 CM OD2 MM EXTRA SOFT SUP-APB-2-4-3D-ES CDM 0270 RC outpatient 6032 6032 6032 74 4463.68 percent of total billed charges 6032 93 4885.92 percent of total billed charges 6032 6032 other OPPS APC 6032 6032 other OPPS APC 6032 27.63 1666.64 percent of total billed charges 6032 6032 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L6 CM OD2.5 MM EXTRA SOFT SUP-APB-2.5-6-3D-ES CDM 0270 RC outpatient 6032 6032 6032 74 4463.68 percent of total billed charges 6032 93 4885.92 percent of total billed charges 6032 6032 other OPPS APC 6032 6032 other OPPS APC 6032 27.63 1666.64 percent of total billed charges 6032 6032 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L4 CM OD3 MM EXTRA SOFT SUP-APB-3-4-3D-ES CDM 0270 RC outpatient 6032 6032 6032 74 4463.68 percent of total billed charges 6032 93 4885.92 percent of total billed charges 6032 6032 other OPPS APC 6032 6032 other OPPS APC 6032 27.63 1666.64 percent of total billed charges 6032 6032 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L6 CM OD3 MM EXTRA SOFT SUP-APB-3-6-3D-ES CDM 0270 RC outpatient 6032 6032 6032 74 4463.68 percent of total billed charges 6032 93 4885.92 percent of total billed charges 6032 6032 other OPPS APC 6032 6032 other OPPS APC 6032 27.63 1666.64 percent of total billed charges 6032 6032 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L8 CM OD3 MM EXTRA SOFT SUP-APB-3-8-3D-ES CDM 0270 RC outpatient 6032 6032 6032 74 4463.68 percent of total billed charges 6032 93 4885.92 percent of total billed charges 6032 6032 other OPPS APC 6032 6032 other OPPS APC 6032 27.63 1666.64 percent of total billed charges 6032 6032 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L10 CM OD3.5 MM EXTRA SOFT SUP-APB-3.5-10-3D-ES CDM 0270 RC outpatient 6032 6032 6032 74 4463.68 percent of total billed charges 6032 93 4885.92 percent of total billed charges 6032 6032 other OPPS APC 6032 6032 other OPPS APC 6032 27.63 1666.64 percent of total billed charges 6032 6032 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L6 CM OD3.5 MM EXTRA SOFT SUP-APB-3.5-6-3D-ES CDM 0270 RC outpatient 6032 6032 6032 74 4463.68 percent of total billed charges 6032 93 4885.92 percent of total billed charges 6032 6032 other OPPS APC 6032 6032 other OPPS APC 6032 27.63 1666.64 percent of total billed charges 6032 6032 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L10 CM OD4 MM ODSEC.0115 IN NEUROVASCULAR SUPER SOFT DETACHABLE SUP-APB-4-10-3D-SS CDM 0270 RC outpatient 4258.8 4258.8 4258.8 74 3151.51 percent of total billed charges 4258.8 93 3449.63 percent of total billed charges 4258.8 4258.8 other OPPS APC 4258.8 4258.8 other OPPS APC 4258.8 27.63 1176.71 percent of total billed charges 4258.8 4258.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L6 CM OD4 MM ODSEC.0115 IN NEUROVASCULAR SUPER SOFT DETACHABLE SUP-APB-4-6-3D-SS CDM 0270 RC outpatient 4258.8 4258.8 4258.8 74 3151.51 percent of total billed charges 4258.8 93 3449.63 percent of total billed charges 4258.8 4258.8 other OPPS APC 4258.8 4258.8 other OPPS APC 4258.8 27.63 1176.71 percent of total billed charges 4258.8 4258.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L8 CM OD4 MM ODSEC.0115 IN NEUROVASCULAR SUPER SOFT DETACHABLE SUP-APB-4-8-3D-SS CDM 0270 RC outpatient 4258.8 4258.8 4258.8 74 3151.51 percent of total billed charges 4258.8 93 3449.63 percent of total billed charges 4258.8 4258.8 other OPPS APC 4258.8 4258.8 other OPPS APC 4258.8 27.63 1176.71 percent of total billed charges 4258.8 4258.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L10 CM OD5 MM ODSEC.0115 IN NEUROVASCULAR SUPER SOFT DETACHABLE SUP-APB-5-10-3D-SS CDM 0270 RC outpatient 4258.8 4258.8 4258.8 74 3151.51 percent of total billed charges 4258.8 93 3449.63 percent of total billed charges 4258.8 4258.8 other OPPS APC 4258.8 4258.8 other OPPS APC 4258.8 27.63 1176.71 percent of total billed charges 4258.8 4258.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L15 CM OD5 MM ODSEC.0115 IN NEUROVASCULAR SUPER SOFT DETACHABLE SUP-APB-5-15-3D-SS CDM 0270 RC outpatient 4258.8 4258.8 4258.8 74 3151.51 percent of total billed charges 4258.8 93 3449.63 percent of total billed charges 4258.8 4258.8 other OPPS APC 4258.8 4258.8 other OPPS APC 4258.8 27.63 1176.71 percent of total billed charges 4258.8 4258.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L8 CM OD5 MM ODSEC.0115 IN NEUROVASCULAR SUPER SOFT DETACHABLE SUP-APB-5-8-3D-SS CDM 0270 RC outpatient 4258.8 4258.8 4258.8 74 3151.51 percent of total billed charges 4258.8 93 3449.63 percent of total billed charges 4258.8 4258.8 other OPPS APC 4258.8 4258.8 other OPPS APC 4258.8 27.63 1176.71 percent of total billed charges 4258.8 4258.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM EMBOLIZATION AXIUM PRIME LATTICEFX 3D L10 CM OD6 MM ODSEC.0115 IN NEUROVASCULAR DETACHABLE COIL SUP-APB-6-10-3D-SS CDM 0270 RC outpatient 4258.8 4258.8 4258.8 74 3151.51 percent of total billed charges 4258.8 93 3449.63 percent of total billed charges 4258.8 4258.8 other OPPS APC 4258.8 4258.8 other OPPS APC 4258.8 27.63 1176.71 percent of total billed charges 4258.8 4258.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L15 CM OD6 MM ODSEC.0115 IN NEUROVASCULAR SUPER SOFT DETACHABLE SUP-APB-6-15-3D-SS CDM 0270 RC outpatient 4258.8 4258.8 4258.8 74 3151.51 percent of total billed charges 4258.8 93 3449.63 percent of total billed charges 4258.8 4258.8 other OPPS APC 4258.8 4258.8 other OPPS APC 4258.8 27.63 1176.71 percent of total billed charges 4258.8 4258.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L20 CM OD6 MM ODSEC.0115 IN NEUROVASCULAR SUPER SOFT DETACHABLE SUP-APB-6-20-3D-SS CDM 0270 RC outpatient 4258.8 4258.8 4258.8 74 3151.51 percent of total billed charges 4258.8 93 3449.63 percent of total billed charges 4258.8 4258.8 other OPPS APC 4258.8 4258.8 other OPPS APC 4258.8 27.63 1176.71 percent of total billed charges 4258.8 4258.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SWABSTICK COMPOUND BENZION TINCTURE SUP-APLS1106 CDM 0270 RC outpatient 2.52 2.52 2.52 74 1.86 percent of total billed charges 2.52 93 2.04 percent of total billed charges 2.52 2.52 other OPPS APC 2.52 2.52 other OPPS APC 2.52 27.63 0.7 percent of total billed charges 2.52 2.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANNULATED 30MM SUP-AR+8840C-30 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 0 FIBERWIRE 38' BLUE SUP-AR--7254 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE BONE 20X6MM COCR STERILE ACL PCL LOW PROFILE SPIKE LIGAMENT SUP-AR-1006 CDM 0270 RC outpatient 205.4 205.4 205.4 74 152 percent of total billed charges 205.4 93 166.37 percent of total billed charges 205.4 205.4 other OPPS APC 205.4 205.4 other OPPS APC 205.4 27.63 56.75 percent of total billed charges 205.4 205.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE BONE COCR SPIKE L20 MM X W8 MM ACL PCL LOW PROFILE LIGAMENT STERILE SUP-AR-1008 CDM 0270 RC outpatient 205.4 205.4 205.4 74 152 percent of total billed charges 205.4 93 166.37 percent of total billed charges 205.4 205.4 other OPPS APC 205.4 205.4 other OPPS APC 205.4 27.63 56.75 percent of total billed charges 205.4 205.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE BONE 20X11MM COCR STERILE ACL PCL LOW PROFILE SPIKE LIGAMENT SUP-AR-1011 CDM 0270 RC outpatient 205.4 205.4 205.4 74 152 percent of total billed charges 205.4 93 166.37 percent of total billed charges 205.4 205.4 other OPPS APC 205.4 205.4 other OPPS APC 205.4 27.63 56.75 percent of total billed charges 205.4 205.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE BONE COCR SPIKE L20 MM X W16 MM ACL PCL STERILE SUP-AR-1016 CDM 0270 RC outpatient 205.4 205.4 205.4 74 152 percent of total billed charges 205.4 93 166.37 percent of total billed charges 205.4 205.4 other OPPS APC 205.4 205.4 other OPPS APC 205.4 27.63 56.75 percent of total billed charges 205.4 205.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ASPIRATION 60 ML BONE MARROW 1 PREP TRAY SYRINGE STERILE DISPOSABLE SUP-AR-1101DS CDM 0270 RC outpatient 377 377 377 74 278.98 percent of total billed charges 377 93 305.37 percent of total billed charges 377 377 other OPPS APC 377 377 other OPPS APC 377 27.63 104.17 percent of total billed charges 377 377 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL OD1.7 MM CANNULATED AO CONNECTION SUP-AR-1201-7DC CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER ARTHROSCOPIC FLIPCUTTER II RETROGRADE LOW PROFILE OD10 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING POSITIONER REAMER STERILE LATEX FREE DISPOSABLE BLUE SUP-AR-1204AF-100 CDM 0270 RC outpatient 845 845 845 74 625.3 percent of total billed charges 845 93 684.45 percent of total billed charges 845 845 other OPPS APC 845 845 other OPPS APC 845 27.63 233.47 percent of total billed charges 845 845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER ARTHROSCOPIC FLIPCUTTER II RETROGRADE LOW PROFILE OD10.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING POSITIONER REAMER STERILE LATEX FREE DISPOSABLE BLUE SUP-AR-1204AF-105 CDM 0270 RC outpatient 845 845 845 74 625.3 percent of total billed charges 845 93 684.45 percent of total billed charges 845 845 other OPPS APC 845 845 other OPPS APC 845 27.63 233.47 percent of total billed charges 845 845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER ARTHROSCOPIC DRILL PIN FEMORAL SOCKET HOUSING POSITIONER REAMER FLIPCUTTER II SUP-AR-1204AF-110 CDM 0270 RC outpatient 845 845 845 74 625.3 percent of total billed charges 845 93 684.45 percent of total billed charges 845 845 other OPPS APC 845 845 other OPPS APC 845 27.63 233.47 percent of total billed charges 845 845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER ARTHROSCOPIC FLIPCUTTER II RETROCONSTRUCTION OD12 MM ACL PCL DRILL PIN REAMER SUP-AR-1204AF-120 CDM 0270 RC outpatient 845 845 845 74 625.3 percent of total billed charges 845 93 684.45 percent of total billed charges 845 845 other OPPS APC 845 845 other OPPS APC 845 27.63 233.47 percent of total billed charges 845 845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER ARTHROSCOPIC FLIPCUTTER II RETROGRADE LOW PROFILE OD13 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING POSITIONER REAMER STERILE LATEX FREE DISPOSABLE BLUE SUP-AR-1204AF-130 CDM 0270 RC outpatient 845 845 845 74 625.3 percent of total billed charges 845 93 684.45 percent of total billed charges 845 845 other OPPS APC 845 845 other OPPS APC 845 27.63 233.47 percent of total billed charges 845 845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER ARTHROSCOPIC FLIPCUTTER II RETROGRADE LOW PROFILE OD7 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING POSITIONER REAMER STERILE LATEX FREE DISPOSABLE BLUE SUP-AR-1204AF-70 CDM 0270 RC outpatient 845 845 845 74 625.3 percent of total billed charges 845 93 684.45 percent of total billed charges 845 845 other OPPS APC 845 845 other OPPS APC 845 27.63 233.47 percent of total billed charges 845 845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER ARTHROSCOPIC FLIPCUTTER II RETROGRADE OD7.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING REAMER STERILE LATEX FREE DISPOSABLE BLUE SUP-AR-1204AF-75 CDM 0270 RC outpatient 845 845 845 74 625.3 percent of total billed charges 845 93 684.45 percent of total billed charges 845 845 other OPPS APC 845 845 other OPPS APC 845 27.63 233.47 percent of total billed charges 845 845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER ARTHROSCOPIC FLIPCUTTER II RETROGRADE LOW PROFILE OD8 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING POSITIONER REAMER STERILE LATEX FREE DISPOSABLE BLUE SUP-AR-1204AF-80 CDM 0270 RC outpatient 845 845 845 74 625.3 percent of total billed charges 845 93 684.45 percent of total billed charges 845 845 other OPPS APC 845 845 other OPPS APC 845 27.63 233.47 percent of total billed charges 845 845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER ARTHROSCOPIC FLIPCUTTER II RETROGRADE LOW PROFILE OD8.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING POSITIONER REAMER STERILE LATEX FREE DISPOSABLE BLUE SUP-AR-1204AF-85 CDM 0270 RC outpatient 845 845 845 74 625.3 percent of total billed charges 845 93 684.45 percent of total billed charges 845 845 other OPPS APC 845 845 other OPPS APC 845 27.63 233.47 percent of total billed charges 845 845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER ARTHROSCOPIC FLIPCUTTER II RETROGRADE OD9 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING REAMER STERILE LATEX FREE DISPOSABLE BLUE SUP-AR-1204AF-90 CDM 0270 RC outpatient 845 845 845 74 625.3 percent of total billed charges 845 93 684.45 percent of total billed charges 845 845 other OPPS APC 845 845 other OPPS APC 845 27.63 233.47 percent of total billed charges 845 845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER ARTHROSCOPIC FLIPCUTTER II RETROGRADE LOW PROFILE OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING POSITIONER REAMER STERILE LATEX FREE DISPOSABLE BLUE SUP-AR-1204AF-95 CDM 0270 RC outpatient 845 845 845 74 625.3 percent of total billed charges 845 93 684.45 percent of total billed charges 845 845 other OPPS APC 845 845 other OPPS APC 845 27.63 233.47 percent of total billed charges 845 845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT NON CANNULATED SUP-AR-1204D CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER SURGICAL OD9 MM CANNULATED COLLAR PIN SET CORING STERILE DISPOSABLE SUP-AR-1223S CDM 0270 RC outpatient 479.7 479.7 479.7 74 354.98 percent of total billed charges 479.7 93 388.56 percent of total billed charges 479.7 479.7 other OPPS APC 479.7 479.7 other OPPS APC 479.7 27.63 132.54 percent of total billed charges 479.7 479.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER SURGICAL OD10 MM CANNULATED COLLAR PIN SET CORING STERILE DISPOSABLE SUP-AR-1224S CDM 0270 RC outpatient 479.7 479.7 479.7 74 354.98 percent of total billed charges 479.7 93 388.56 percent of total billed charges 479.7 479.7 other OPPS APC 479.7 479.7 other OPPS APC 479.7 27.63 132.54 percent of total billed charges 479.7 479.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER SURGICAL OD11 MM CANNULATED COLLAR PIN SET CORING STERILE DISPOSABLE SUP-AR-1226S CDM 0270 RC outpatient 533 533 533 74 394.42 percent of total billed charges 533 93 431.73 percent of total billed charges 533 533 other OPPS APC 533 533 other OPPS APC 533 27.63 147.27 percent of total billed charges 533 533 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL OD2.4 MM STEP 3 MM SUTURETAK SUP-AR-1250LT CDM 0270 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 27.63 57.47 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PASSER SUTURE FIBERWIRE NITINOL OD18 GA STERILE DISPOSABLE ARTHROSCOPY SUP-AR-1255-18 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SUTURE SCORPION KNEE SUP-AR-12990N CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM L7.5 MM KNEE FEMUR STERILE 6.5 MM CANCELLOUS 4.5 MM CORTICAL SCREW OPENING WEDGE OSTEOTOMY SUP-AR-13100T-07.5 CDM 0270 RC outpatient 2327 2327 2327 74 1721.98 percent of total billed charges 2327 93 1884.87 percent of total billed charges 2327 2327 other OPPS APC 2327 2327 other OPPS APC 2327 27.63 642.95 percent of total billed charges 2327 2327 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE CONTOURLOCK FEMORAL OSTEOTOMY RIGHT S/M SUP-AR-13110R-01 CDM 0270 RC outpatient 2925 2925 2925 74 2164.5 percent of total billed charges 2925 93 2369.25 percent of total billed charges 2925 2925 other OPPS APC 2925 2925 other OPPS APC 2925 27.63 808.18 percent of total billed charges 2925 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS 1.5MM FULL THREAD HEXAGON 12MM 2.3MM TITANIUM STERILE FOREFOOT CORTICAL SELF DRILL SELF SUP-AR-13120T-12 CDM 0270 RC outpatient 169 169 169 74 125.06 percent of total billed charges 169 93 136.89 percent of total billed charges 169 169 other OPPS APC 169 169 other OPPS APC 169 27.63 46.69 percent of total billed charges 169 169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM 1.5 MM FULL THREAD HEXAGON L14 MM OD2.3 MM FOREFOOT CORTICAL SELF DRILL SELF TAP SOLID STERILE PROXIMAL OPENING WEDGE OSTEOTOMY SUP-AR-13120T-14 CDM 0270 RC outpatient 169 169 169 74 125.06 percent of total billed charges 169 93 136.89 percent of total billed charges 169 169 other OPPS APC 169 169 other OPPS APC 169 27.63 46.69 percent of total billed charges 169 169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM 1.5 MM FULL THREAD HEXAGON L16 MM OD2.3 MM FOREFOOT CORTICAL SELF DRILL SELF TAP SOLID STERILE PROXIMAL OPENING WEDGE OSTEOTOMY SUP-AR-13120T-16 CDM 0270 RC outpatient 169 169 169 74 125.06 percent of total billed charges 169 93 136.89 percent of total billed charges 169 169 other OPPS APC 169 169 other OPPS APC 169 27.63 46.69 percent of total billed charges 169 169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LAG CANNULATED 2.3 X 16MM SUP-AR-13120T-16C CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM 1.5 MM FULL THREAD HEXAGON L18 MM OD2.3 MM FOREFOOT CORTICAL SELF DRILL SELF TAP SOLID STERILE PROXIMAL OPENING WEDGE OSTEOTOMY SUP-AR-13120T-18 CDM 0270 RC outpatient 169 169 169 74 125.06 percent of total billed charges 169 93 136.89 percent of total billed charges 169 169 other OPPS APC 169 169 other OPPS APC 169 27.63 46.69 percent of total billed charges 169 169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS 1.5MM PARTIAL THREAD HEXAGON 18MM 2.3MM TITANIUM STERILE FOREFOOT CANCELLOUS LAG SUP-AR-13120T-18C CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM 1.5 MM FULL THREAD HEXAGON L20 MM OD2.3 MM FOREFOOT CORTICAL SELF DRILL SELF TAP SOLID STERILE PROXIMAL OPENING WEDGE OSTEOTOMY SUP-AR-13120T-20 CDM 0270 RC outpatient 169 169 169 74 125.06 percent of total billed charges 169 93 136.89 percent of total billed charges 169 169 other OPPS APC 169 169 other OPPS APC 169 27.63 46.69 percent of total billed charges 169 169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHRES LAG CANNULATED 2.S X 20MM SUP-AR-13120T-20C CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM 1.5 MM FULL THREAD HEXAGON L22 MM OD2.3 MM FOREFOOT CORTICAL SELF DRILL SELF TAP SOLID STERILE PROXIMAL OPENING WEDGE OSTEOTOMY SUP-AR-13120T-22 CDM 0270 RC outpatient 169 169 169 74 125.06 percent of total billed charges 169 93 136.89 percent of total billed charges 169 169 other OPPS APC 169 169 other OPPS APC 169 27.63 46.69 percent of total billed charges 169 169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS 1.5MM FULL THREAD HEXAGON 24MM 2.3MM TITANIUM STERILE FOREFOOT CORTICAL SELF DRILL SELF SUP-AR-13120T-24 CDM 0270 RC outpatient 169 169 169 74 125.06 percent of total billed charges 169 93 136.89 percent of total billed charges 169 169 other OPPS APC 169 169 other OPPS APC 169 27.63 46.69 percent of total billed charges 169 169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM 1.5 MM FULL THREAD HEXAGON L26 MM OD2.3 MM FOREFOOT CORTICAL SELF DRILL SELF TAP SOLID STERILE PROXIMAL OPENING WEDGE OSTEOTOMY SUP-AR-13120T-26 CDM 0270 RC outpatient 169 169 169 74 125.06 percent of total billed charges 169 93 136.89 percent of total billed charges 169 169 other OPPS APC 169 169 other OPPS APC 169 27.63 46.69 percent of total billed charges 169 169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM 1.5 MM FULL THREAD HEXAGON L28 MM OD2.3 MM FOREFOOT CORTICAL SELF DRILL SELF TAP SOLID STERILE PROXIMAL OPENING WEDGE OSTEOTOMY SUP-AR-13120T-28 CDM 0270 RC outpatient 169 169 169 74 125.06 percent of total billed charges 169 93 136.89 percent of total billed charges 169 169 other OPPS APC 169 169 other OPPS APC 169 27.63 46.69 percent of total billed charges 169 169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 12MM 2.3MM SS STERILE CORTICAL SUP-AR-13123-12 CDM 0270 RC outpatient 193.7 193.7 193.7 74 143.34 percent of total billed charges 193.7 93 156.9 percent of total billed charges 193.7 193.7 other OPPS APC 193.7 193.7 other OPPS APC 193.7 27.63 53.52 percent of total billed charges 193.7 193.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 14MM 2.3MM SS STERILE CORTICAL SUP-AR-13123-14 CDM 0270 RC outpatient 169 169 169 74 125.06 percent of total billed charges 169 93 136.89 percent of total billed charges 169 169 other OPPS APC 169 169 other OPPS APC 169 27.63 46.69 percent of total billed charges 169 169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX CORTICAL 2.3MM SUP-AR-13123-16 CDM 0270 RC outpatient 169 169 169 74 125.06 percent of total billed charges 169 93 136.89 percent of total billed charges 169 169 other OPPS APC 169 169 other OPPS APC 169 27.63 46.69 percent of total billed charges 169 169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LOW PROFILE 7MM SS STERILE TIBIA DISTAL 5MM SCREW OPENING WEDGE SUP-AR-13200D-05 CDM 0270 RC outpatient 1352 1352 1352 74 1000.48 percent of total billed charges 1352 93 1095.12 percent of total billed charges 1352 1352 other OPPS APC 1352 1352 other OPPS APC 1352 27.63 373.56 percent of total billed charges 1352 1352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL LOW PROFILE L7 MM TIBIA DISTAL STERILE 3.5-4 MM SCREW OPENING WEDGE OSTEOTOMY SUP-AR-13200D-07 CDM 0270 RC outpatient 1352 1352 1352 74 1000.48 percent of total billed charges 1352 93 1095.12 percent of total billed charges 1352 1352 other OPPS APC 1352 1352 other OPPS APC 1352 27.63 373.56 percent of total billed charges 1352 1352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM L FLAT LOW PROFILE METATARSUS 2.4 MM SCREW SUP-AR-13200M CDM 0270 RC outpatient 2067 2067 2067 74 1529.58 percent of total billed charges 2067 93 1674.27 percent of total billed charges 2067 2067 other OPPS APC 2067 2067 other OPPS APC 2067 27.63 571.11 percent of total billed charges 2067 2067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM LOW PROFILE L9 MM TIBIA ANTEROPOSTERIOR SLOPE 6.5 MM CANCELLOUS 4.5 MM CORTICAL SCREW OSTEOTOMY SUP-AR-13200ST-09.0 CDM 0270 RC outpatient 1898 1898 1898 74 1404.52 percent of total billed charges 1898 93 1537.38 percent of total billed charges 1898 1898 other OPPS APC 1898 1898 other OPPS APC 1898 27.63 524.42 percent of total billed charges 1898 1898 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE L30 MM KNEE 2 HOLE SUPPORT STERILE OSTEOTOMY SUP-AR-13215 CDM 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE FASTAK II FIBERWIRE 2-0 SM 7.5MM 2.4MM TITANIUM STERILE BIOABSORBABLE HANDLE INSERTER SUP-AR-1322-752SF CDM 0270 RC outpatient 481 481 481 74 355.94 percent of total billed charges 481 93 389.61 percent of total billed charges 481 481 other OPPS APC 481 481 other OPPS APC 481 27.63 132.9 percent of total billed charges 481 481 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOLDER PLATE BB TAK DISPOSABLE SUP-AR-13226 CDM 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOLDER PLATE BB-TAK THREAD DISPOSABLE SUP-AR-13226T CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE BIO-SUTURETAK FIBERWIRE RAYON 2-0 MICRO STRAIGHT FORWARD TAPER L8.5 MM OD2.4 MM SMALL BONE 2 NEEDLE BIOABSORBABLE INSERTION LATEX FREE DISPOSABLE SUP-AR-1322BCNF CDM 0270 RC outpatient 845 845 845 74 625.3 percent of total billed charges 845 93 684.45 percent of total billed charges 845 845 other OPPS APC 845 845 other OPPS APC 845 27.63 233.47 percent of total billed charges 845 845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT SUTURE DISPOSABLE MINI SUTURETAK SUP-AR-1322DSC CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC OD.034 IN TROCAR DISPOSABLE SUP-AR-13240K CDM 0270 RC outpatient 39 39 39 74 28.86 percent of total billed charges 39 93 31.59 percent of total billed charges 39 39 other OPPS APC 39 39 other OPPS APC 39 27.63 10.78 percent of total billed charges 39 39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE BIO-FASTAK FIBERWIRE POLY L LACTIDE CO D L LACTIDE ACID 2 L14 MM OD3 MM SHOULDER BRAID EYELET HANDLE INSERTER THREAD STERILE SUP-AR-1324BF CDM 0270 RC outpatient 3185 3185 3185 74 2356.9 percent of total billed charges 3185 93 2579.85 percent of total billed charges 3185 3185 other OPPS APC 3185 3185 other OPPS APC 3185 27.63 880.02 percent of total billed charges 3185 3185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L35 MM OD6.5 MM TIBIA CANCELLOUS OPENING WEDGE OSTEOTOMY SUP-AR-13280-35 CDM 270010020 LOCAL 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.5MM 40MM TITANIUM TIBIA CANCELLOUS OPENING WEDGE OSTEOTOMY SUP-AR-13280-40 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L45 MM OD6.5 MM TIBIA CANCELLOUS OPENING WEDGE OSTEOTOMY SUP-AR-13280-45 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L50 MM OD6.5 MM TIBIA CANCELLOUS OPENING WEDGE OSTEOTOMY SUP-AR-13280-50 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L55 MM OD6.5 MM TIBIA CANCELLOUS OPENING WEDGE OSTEOTOMY SUP-AR-13280-55 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L60 MM OD6.5 MM TIBIA CANCELLOUS OPENING WEDGE OSTEOTOMY SUP-AR-13280-60 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L65 MM OD6.5 MM TIBIA CANCELLOUS OPENING WEDGE OSTEOTOMY SUP-AR-13280-65 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L70 MM OD6.5 MM TIBIA CANCELLOUS OPENING WEDGE OSTEOTOMY SUP-AR-13280-70 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE PIN ORTHOPEDIC OD2.4 MM FEMUR BREAK AWAY OSTEOTOMY SUP-AR-13303-2.4 CDM 0270 RC outpatient 96.2 96.2 96.2 74 71.19 percent of total billed charges 96.2 93 77.92 percent of total billed charges 96.2 96.2 other OPPS APC 96.2 96.2 other OPPS APC 96.2 27.63 26.58 percent of total billed charges 96.2 96.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE PIN ORTHOPEDIC OD3 MM FEMUR BREAK AWAY OSTEOTOMY SUP-AR-13303-3.0 CDM 0270 RC outpatient 83.2 83.2 83.2 74 61.57 percent of total billed charges 83.2 93 67.39 percent of total billed charges 83.2 83.2 other OPPS APC 83.2 83.2 other OPPS APC 83.2 27.63 22.99 percent of total billed charges 83.2 83.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL HIGH TIBIAL OSTEOTOMY TITANIUM SCREW SUP-AR-13319 CDM 0270 RC outpatient 187.2 187.2 187.2 74 138.53 percent of total billed charges 187.2 93 151.63 percent of total billed charges 187.2 187.2 other OPPS APC 187.2 187.2 other OPPS APC 187.2 27.63 51.72 percent of total billed charges 187.2 187.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L52 MM OD4.5 MM TIBIA CORTICAL OPENING WEDGE OSTEOTOMY SUP-AR-133380-52 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE OSFERION OSTEO 10MM X 30MM SUP-AR-13370-2 CDM 270010031 LOCAL 0270 RC outpatient 1287 1287 1287 74 952.38 percent of total billed charges 1287 93 1042.47 percent of total billed charges 1287 1287 other OPPS APC 1287 1287 other OPPS APC 1287 27.63 355.6 percent of total billed charges 1287 1287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE OSFERION OSTEO 12MM X 35MM SUP-AR-13370-3 CDM 270010031 LOCAL 0270 RC outpatient 1287 1287 1287 74 952.38 percent of total billed charges 1287 93 1042.47 percent of total billed charges 1287 1287 other OPPS APC 1287 1287 other OPPS APC 1287 27.63 355.6 percent of total billed charges 1287 1287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID OSFERION 75 D THK7 MM TRAPEZOID L25 MM X W9 MM SUP-AR-13372-2 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L34 MM OD4.5 MM TIBIA CORTICAL OPENING WEDGE OSTEOTOMY SUP-AR-13380-34 CDM 270010031 LOCAL 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L36 MM OD4.5 MM TIBIA CORTICAL OPENING WEDGE OSTEOTOMY SUP-AR-13380-36 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L38 MM OD4.5 MM TIBIA CORTICAL OPENING WEDGE OSTEOTOMY SUP-AR-13380-38 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L40 MM OD4.5 MM TIBIA CORTICAL OPENING WEDGE OSTEOTOMY SUP-AR-13380-40 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L42 MM OD4.5 MM TIBIA CORTICAL OPENING WEDGE OSTEOTOMY SUP-AR-13380-42 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L44 MM OD4.5 MM TIBIA CORTICAL OPENING WEDGE OSTEOTOMY SUP-AR-13380-44 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L46 MM OD4.5 MM TIBIA CORTICAL OPENING WEDGE OSTEOTOMY SUP-AR-13380-46 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L48 MM OD4.5 MM TIBIA CORTICAL OPENING WEDGE OSTEOTOMY SUP-AR-13380-48 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L50 MM OD4.5 MM TIBIA CORTICAL OPENING WEDGE OSTEOTOMY SUP-AR-13380-50 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L52 MM OD4.5 MM TIBIA CORTICAL OPENING WEDGE OSTEOTOMY SUP-AR-13380-52 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE TIBIAL IBALANCE 6 D 7 D LARGE XL HIGH TIBIAL OSTEOTOMY SUP-AR-13400L-06 CDM 0270 RC outpatient 4940 4940 4940 74 3655.6 percent of total billed charges 4940 93 4001.4 percent of total billed charges 4940 4940 other OPPS APC 4940 4940 other OPPS APC 4940 27.63 1364.92 percent of total billed charges 4940 4940 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE TIBIAL IBALANCE 7 D 8 D LARGE XL KNEE HIGH TIBIAL OSTEOTOMY SUP-AR-13400L-08 CDM 0270 RC outpatient 4940 4940 4940 74 3655.6 percent of total billed charges 4940 93 4001.4 percent of total billed charges 4940 4940 other OPPS APC 4940 4940 other OPPS APC 4940 27.63 1364.92 percent of total billed charges 4940 4940 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE TIBIAL IBALANCE PEEK 9 D 10 D LARGE XL KNEE HIGH OSTEOTOMY PLATE SUP-AR-13400L-10 CDM 0270 RC outpatient 4940 4940 4940 74 3655.6 percent of total billed charges 4940 93 4001.4 percent of total billed charges 4940 4940 other OPPS APC 4940 4940 other OPPS APC 4940 27.63 1364.92 percent of total billed charges 4940 4940 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE TIBIAL IBALANCE 5 D 6 D SMALL MEDIUM HIGH TIBIAL OSTEOTOMY SUP-AR-13400M-05 CDM 0270 RC outpatient 4940 4940 4940 74 3655.6 percent of total billed charges 4940 93 4001.4 percent of total billed charges 4940 4940 other OPPS APC 4940 4940 other OPPS APC 4940 27.63 1364.92 percent of total billed charges 4940 4940 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT HTO SM 11 DEG/MED 10DEG SUP-AR-13400M-10 CDM 0270 RC outpatient 4940 4940 4940 74 3655.6 percent of total billed charges 4940 93 4001.4 percent of total billed charges 4940 4940 other OPPS APC 4940 4940 other OPPS APC 4940 27.63 1364.92 percent of total billed charges 4940 4940 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE IBALANCE L22 MM OD6.5 MM CANCELLOUS HIGH TIBIAL OSTEOTOMY SUP-AR-13401-22 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE IBALANCE L24 MM OD6.5 MM CANCELLOUS HIGH TIBIAL OSTEOTOMY SUP-AR-13401-24 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE IBALANCE L30 MM OD6.5 MM CORTICAL HIGH TIBIAL OSTEOTOMY SUP-AR-13401-30 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE IBALANCE L32 MM OD6.5 MM CANCELLOUS HIGH TIBIAL OSTEOTOMY SUP-AR-13401-32 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE IBALANCE L32 MM OD4.5 MM CORTICAL HIGH TIBIAL OSTEOTOMY SUP-AR-13402-32 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW HTO ANCHOR IBALANCE CORTICAL 32MM SUP-AR-13402-32 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE IBALANCE L36 MM OD4.5 MM CORTICAL HIGH TIBIAL OSTEOTOMY SUP-AR-13402-36 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE IBALANCE L38 MM OD4.5 MM CORTICAL HIGH TIBIAL OSTEOTOMY SUP-AR-13402-38 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE IBALANCE L40 MM OD4.5 MM CORTICAL HIGH TIBIAL OSTEOTOMY SUP-AR-13402-40 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE IBALANCE L42 MM OD4.5 MM CORTICAL HIGH TIBIAL OSTEOTOMY SUP-AR-13402-42 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE IBALANCE L44 MM OD4.5 MM CORTICAL HIGH TIBIAL OSTEOTOMY SUP-AR-13402-44 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE IBALANCE L46 MM OD4.5 MM CORTICAL HIGH TIBIAL OSTEOTOMY SUP-AR-13402-46 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE IBALANCE L48 MM OD4.5 MM CORTICAL HIGH TIBIAL OSTEOTOMY SUP-AR-13402-48 CDM 0270 RC outpatient 748.8 748.8 748.8 74 554.11 percent of total billed charges 748.8 93 606.53 percent of total billed charges 748.8 748.8 other OPPS APC 748.8 748.8 other OPPS APC 748.8 27.63 206.89 percent of total billed charges 748.8 748.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC 14MM TITANIUM STERILE LOW PROFILE SPIKE CANCELLOUS SCREW SUP-AR-1349 CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC TITANIUM SPIKE LOW PROFILE OD14 MM ACL PCL CANCELLOUS SCREW SUP-AR-1349NS CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE BIOCOMPOSITE L23 MM OD7 MM ACL PCL CANNULATED REDUCE HEAD STERILE SUP-AR-1370C CDM 0270 RC outpatient 611 611 611 74 452.14 percent of total billed charges 611 93 494.91 percent of total billed charges 611 611 other OPPS APC 611 611 other OPPS APC 611 27.63 168.82 percent of total billed charges 611 611 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE TITANIUM L20 MM OD7 MM ACL PCL CANNULATED SHEATH STERILE ACCEPTS 2 MM NITINOL GUIDEPIN SUP-AR-1370E CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE BIOCOMPOSITE BLUNT FULL THREAD STEP TAPER L28 MM OD7 MM ACL PCL CANNULATED FULL SEAT REDUCE HEAD STERILE SUP-AR-1370TC CDM 0270 RC outpatient 611 611 611 74 452.14 percent of total billed charges 611 93 494.91 percent of total billed charges 611 611 other OPPS APC 611 611 other OPPS APC 611 27.63 168.82 percent of total billed charges 611 611 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CONTOURLOCK HTO PLATE L7.5 MM TIBIA LEFT ANTEROPOSTERIOR SLOPE STERILE OPENING WEDGE OSTEOTOMY SUP-AR-13720-07.5 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CONTOURLOCK HTO PLATE L9 MM TIBIA LEFT ANTEROPOSTERIOR SLOPE STERILE OPENING WEDGE OSTEOTOMY SUP-AR-13720-09.0 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CONTOURLOCK HTO PLATE L12.5 MM TIBIA LEFT ANTEROPOSTERIOR SLOPE STERILE OPENING WEDGE OSTEOTOMY SUP-AR-13720-12.5 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CONTOURLOCK HTO PLATE L5 MM TIBIA RIGHT ANTEROPOSTERIOR SLOPE STERILE OPENING WEDGE OSTEOTOMY SUP-AR-13725-05.0 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CONTOURLOCK HTO PLATE L7.5 MM TIBIA RIGHT ANTEROPOSTERIOR SLOPE STERILE OPENING WEDGE OSTEOTOMY SUP-AR-13725-07.5 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CONTOURLOCK HTO PLATE L9 MM TIBIA RIGHT ANTEROPOSTERIOR SLOPE STERILE OPENING WEDGE OSTEOTOMY SUP-AR-13725-09.0 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE ARTHREX CONTOURLOCK HTO SLOPED W SD-R SUP-AR-13725-12.5 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE CONTOURLOCK HTO PLATE L15 MM TIBIA RIGHT ANTEROPOSTERIOR SLOPE STERILE OPENING WEDGE OSTEOTOMY SUP-AR-13725-15.0 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE BIO-INTERFERENCE 23MM 8MM POLY-L-LACTIC ACID STERILE ACL PCL CANNULATED SHEATH SUP-AR-1380B CDM 0270 RC outpatient 369.2 369.2 369.2 74 273.21 percent of total billed charges 369.2 93 299.05 percent of total billed charges 369.2 369.2 other OPPS APC 369.2 369.2 other OPPS APC 369.2 27.63 102.01 percent of total billed charges 369.2 369.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE BIOCOMPOSITE STEP TAPER L23 MM OD8 MM ACL PCL CANNULATED REDUCE HEAD STERILE SUP-AR-1380C CDM 0270 RC outpatient 611 611 611 74 452.14 percent of total billed charges 611 93 494.91 percent of total billed charges 611 611 other OPPS APC 611 611 other OPPS APC 611 27.63 168.82 percent of total billed charges 611 611 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE TITANIUM L20 MM OD8 MM ACL PCL CANNULATED SHEATH STERILE ACCEPTS 2 MM NITINOL GUIDEPIN SUP-AR-1380E CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE BIOCOMPOSITE BLUNT FULL THREAD STEP TAPER L28 MM OD8 MM ACL PCL CANNULATED FULL SEAT REDUCE HEAD STERILE SUP-AR-1380TC CDM 0270 RC outpatient 611 611 611 74 452.14 percent of total billed charges 611 93 494.91 percent of total billed charges 611 611 other OPPS APC 611 611 other OPPS APC 611 27.63 168.82 percent of total billed charges 611 611 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE BIOCOMPOSITE STEP TAPER L23 MM OD9 MM ACL PCL CANNULATED REDUCE HEAD STERILE SUP-AR-1390C CDM 0270 RC outpatient 611 611 611 74 452.14 percent of total billed charges 611 93 494.91 percent of total billed charges 611 611 other OPPS APC 611 611 other OPPS APC 611 27.63 168.82 percent of total billed charges 611 611 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE TITANIUM L20 MM OD9 MM ACL PCL CANNULATED SHEATH STERILE ACCEPTS 2 MM NITINOL GUIDEPIN SUP-AR-1390E CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE BIOCOMPOSITE 28MM 9MM BLUNT FULL THREAD STEP TAPER ACL PCL SUP-AR-1390TC CDM 0270 RC outpatient 611 611 611 74 452.14 percent of total billed charges 611 93 494.91 percent of total billed charges 611 611 other OPPS APC 611 611 other OPPS APC 611 27.63 168.82 percent of total billed charges 611 611 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SUTURE SCORPION SUREFIRE ROTATOR CUFF SUP-AR-13991N CDM 0270 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SUTURE MULTIFIRE SCORPION SUP-AR-13995N CDM 0270 RC outpatient 442 442 442 74 327.08 percent of total billed charges 442 93 358.02 percent of total billed charges 442 442 other OPPS APC 442 442 other OPPS APC 442 27.63 122.12 percent of total billed charges 442 442 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SUTURE MULTIFIRE SCORPION SUP-AR-13999HDN CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE BIO-INTERFERENCE POLY L LACTIC ACID L23 MM OD10 MM ACL PCL CANNULATED SHEATH STERILE SUP-AR-1400B CDM 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE BIOCOMPOSITE 23MM 10MM STEP TAPER ACL PCL CANNULATED REDUCE HEAD SUP-AR-1400C CDM 0270 RC outpatient 611 611 611 74 452.14 percent of total billed charges 611 93 494.91 percent of total billed charges 611 611 other OPPS APC 611 611 other OPPS APC 611 27.63 168.82 percent of total billed charges 611 611 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE BIO-INTERFERENCE POLY L LACTIC ACID FULL THREAD L28 MM OD10 MM ACL PCL CANNULATED STERILE SUP-AR-1400TB CDM 0270 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE BIOCOMPOSITE BLUNT FULL THREAD STEP TAPER L28 MM OD10 MM ACL PCL CANNULATED FULL SEAT REDUCE HEAD STERILE SUP-AR-1400TC CDM 0270 RC outpatient 611 611 611 74 452.14 percent of total billed charges 611 93 494.91 percent of total billed charges 611 611 other OPPS APC 611 611 other OPPS APC 611 27.63 168.82 percent of total billed charges 611 611 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE BIOCOMPOSITE BLUNT FULL THREAD STEP TAPER L28 MM OD11 MM ACL PCL CANNULATED FULL SEAT REDUCE HEAD STERILE SUP-AR-1403TC CDM 0270 RC outpatient 585 585 585 74 432.9 percent of total billed charges 585 93 473.85 percent of total billed charges 585 585 other OPPS APC 585 585 other OPPS APC 585 27.63 161.64 percent of total billed charges 585 585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE BIOCOMPOSITE BLUNT FULL THREAD STEP TAPER L28 MM OD12 MM ACL PCL CANNULATED FULL SEAT REDUCE HEAD STERILE SUP-AR-1404TC CDM 0270 RC outpatient 611 611 611 74 452.14 percent of total billed charges 611 93 494.91 percent of total billed charges 611 611 other OPPS APC 611 611 other OPPS APC 611 27.63 168.82 percent of total billed charges 611 611 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE TENODESIS BIOCOMPOSITE L8 MM OD3 MM SOFT TISSUE HANDLE INSERTER STERILE SUP-AR-1530BC CDM 0270 RC outpatient 975 975 975 74 721.5 percent of total billed charges 975 93 789.75 percent of total billed charges 975 975 other OPPS APC 975 975 other OPPS APC 975 27.63 269.39 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE TENODESIS PEEK-OPTIMA L8 MM OD3 MM FOOT ANKLE HANDLE INSERTER VENT STERILE SUP-AR-1530PS CDM 0270 RC outpatient 1001 1001 1001 74 740.74 percent of total billed charges 1001 93 810.81 percent of total billed charges 1001 1001 other OPPS APC 1001 1001 other OPPS APC 1001 27.63 276.58 percent of total billed charges 1001 1001 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE BIO-TENODESIS POLY L LACTIC ACID L10 MM OD4 MM ACL PCL RECONSTRUCTION STERILE SUP-AR-1540BC CDM 0270 RC outpatient 897 897 897 74 663.78 percent of total billed charges 897 93 726.57 percent of total billed charges 897 897 other OPPS APC 897 897 other OPPS APC 897 27.63 247.84 percent of total billed charges 897 897 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE TENODESIS BIOCOMPOSITE L15 MM OD4.75 MM ACL STERILE SUP-AR-1547BC CDM 0270 RC outpatient 897 897 897 74 663.78 percent of total billed charges 897 93 726.57 percent of total billed charges 897 897 other OPPS APC 897 897 other OPPS APC 897 27.63 247.84 percent of total billed charges 897 897 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE TENODESIS BIOCOMPOSITE L15 MM OD5.5 MM ACL STERILE SUP-AR-1555BC CDM 0270 RC outpatient 897 897 897 74 663.78 percent of total billed charges 897 93 726.57 percent of total billed charges 897 897 other OPPS APC 897 897 other OPPS APC 897 27.63 247.84 percent of total billed charges 897 897 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE TENODESIS BIOCOMPOSITE L15 MM OD6.25 MM ACL STERILE SUP-AR-1562BC CDM 0270 RC outpatient 897 897 897 74 663.78 percent of total billed charges 897 93 726.57 percent of total billed charges 897 897 other OPPS APC 897 897 other OPPS APC 897 27.63 247.84 percent of total billed charges 897 897 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE BIO-TENODESIS POLY L LACTIC ACID L23 MM OD7 MM ACL PCL RECONSTRUCTION STERILE SUP-AR-1570B CDM 0270 RC outpatient 741 741 741 74 548.34 percent of total billed charges 741 93 600.21 percent of total billed charges 741 741 other OPPS APC 741 741 other OPPS APC 741 27.63 204.74 percent of total billed charges 741 741 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE TENODESIS BIOCOMPOSITE L23 MM OD8 MM ACL STERILE SUP-AR-1580BC CDM 0270 RC outpatient 819 819 819 74 606.06 percent of total billed charges 819 93 663.39 percent of total billed charges 819 819 other OPPS APC 819 819 other OPPS APC 819 27.63 226.29 percent of total billed charges 819 819 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIGHTROPE ARTHREX BTB SUP-AR-15888BTB CDM 0270 RC outpatient 1105 1105 1105 74 817.7 percent of total billed charges 1105 93 895.05 percent of total billed charges 1105 1105 other OPPS APC 1105 1105 other OPPS APC 1105 27.63 305.31 percent of total billed charges 1105 1105 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE FIXATION TIGHTROPE SM 10MM BONE TENDON BONE ACL 4 POINT LOCK ADJUSTABLE LOOP SUP-AR-1588BTB CDM 0270 RC outpatient 1105 1105 1105 74 817.7 percent of total billed charges 1105 93 895.05 percent of total billed charges 1105 1105 other OPPS APC 1105 1105 other OPPS APC 1105 27.63 305.31 percent of total billed charges 1105 1105 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE FIXATION TIGHTROPE SM 10MM BONE TENDON BONE ACL 4 POINT LOCK ADJUSTABLE LOOP SUP-AR-1588BTB-1B CDM 0270 RC outpatient 1677 1677 1677 74 1240.98 percent of total billed charges 1677 93 1358.37 percent of total billed charges 1677 1677 other OPPS APC 1677 1677 other OPPS APC 1677 27.63 463.36 percent of total billed charges 1677 1677 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE FIXATION TIGHTROPE TITANIUM UHMWPE DISPOSABLE STERILE LF ACL RIGHT SUP-AR-1588RT CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE FIXATION TIGHTROPE FIBERTAG ACL SUP-AR-1588RTT CDM 0270 RC outpatient 1365 1365 1365 74 1010.1 percent of total billed charges 1365 93 1105.65 percent of total billed charges 1365 1365 other OPPS APC 1365 1365 other OPPS APC 1365 27.63 377.15 percent of total billed charges 1365 1365 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE FIXATION TIGHTROPE FIBERTAG ACL SUP-AR-1588RTT2 CDM 0270 RC outpatient 1547 1547 1547 1547 other OPPS APC 1547 1547 other OPPS APC 1547 27.63 427.44 percent of total billed charges 1547 1547 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUTTON FIXATION TIGHTROPE 12MM 8MM ACL ATTACHABLE SLOT SUP-AR-1588TB CDM 0270 RC outpatient 371.8 371.8 371.8 74 275.13 percent of total billed charges 371.8 93 301.16 percent of total billed charges 371.8 371.8 other OPPS APC 371.8 371.8 other OPPS APC 371.8 27.63 102.73 percent of total billed charges 371.8 371.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUTTON FIXATION TIGHTROPE ROUND OD14 MM ACL ATTACHABLE SUP-AR-1588TB-1 CDM 0270 RC outpatient 556.4 556.4 556.4 74 411.74 percent of total billed charges 556.4 93 450.68 percent of total billed charges 556.4 556.4 other OPPS APC 556.4 556.4 other OPPS APC 556.4 27.63 153.73 percent of total billed charges 556.4 556.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUTTON FIXATION TIGHTROPE ROUND CONCAVE OD11 MM ATTACHABLE SUP-AR-1588TB-3 CDM 0270 RC outpatient 582.4 582.4 582.4 74 430.98 percent of total billed charges 582.4 93 471.74 percent of total billed charges 582.4 582.4 other OPPS APC 582.4 582.4 other OPPS APC 582.4 27.63 160.92 percent of total billed charges 582.4 582.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUTTON FIXATION TIGHTROPE ROUND CONCAVE OD11 MM ATTACHABLE SUP-AR-1588TB-3IB CDM 0270 RC outpatient 715 715 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUTTON FIXATION TIGHTROPE OD14 MM ODSEC8 MM ACL ATTACHABLE SLOT SUP-AR-1588TB-4 CDM 0270 RC outpatient 582.4 582.4 582.4 74 430.98 percent of total billed charges 582.4 93 471.74 percent of total billed charges 582.4 582.4 other OPPS APC 582.4 582.4 other OPPS APC 582.4 27.63 160.92 percent of total billed charges 582.4 582.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE FIXATION TIGHTROPE UHMWPE ACL ATTACHABLE SUP-AR-1588TN CDM 0270 RC outpatient 478.4 478.4 478.4 74 354.02 percent of total billed charges 478.4 93 387.5 percent of total billed charges 478.4 478.4 other OPPS APC 478.4 478.4 other OPPS APC 478.4 27.63 132.18 percent of total billed charges 478.4 478.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE FIXATION TIGHTROPE UHMWPE ACL ATTACHABLE OPEN SUP-AR-1588TN-1 CDM 0270 RC outpatient 504.4 504.4 504.4 74 373.26 percent of total billed charges 504.4 93 408.56 percent of total billed charges 504.4 504.4 other OPPS APC 504.4 504.4 other OPPS APC 504.4 27.63 139.37 percent of total billed charges 504.4 504.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE FIXATION TIGHTROPE UHMWPE ACL ATTACHABLE OPEN SUP-AR-1588TN-21 CDM 0270 RC outpatient 767 767 767 74 567.58 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 27.63 211.92 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE FIXATION TIGHTROPE FIBERTAG ACL ABS SUP-AR-1588TNT CDM 0270 RC outpatient 871 871 871 74 644.54 percent of total billed charges 871 93 705.51 percent of total billed charges 871 871 other OPPS APC 871 871 other OPPS APC 871 27.63 240.66 percent of total billed charges 871 871 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE FIXATION TIGHTROPE FIBERTAG ACL ABS SUP-AR-1588TNT2 CDM 0270 RC outpatient 1053 1053 1053 1053 other OPPS APC 1053 1053 other OPPS APC 1053 27.63 290.94 percent of total billed charges 1053 1053 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUTTON PCL SUP-AR-1588TP CDM 0270 RC outpatient 907.4 907.4 907.4 74 671.48 percent of total billed charges 907.4 93 734.99 percent of total billed charges 907.4 907.4 other OPPS APC 907.4 907.4 other OPPS APC 907.4 27.63 250.71 percent of total billed charges 907.4 907.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE TENODESIS BIOCOMPOSITE L23 MM OD9 MM ACL STERILE SUP-AR-1590BC CDM 0270 RC outpatient 819 819 819 74 606.06 percent of total billed charges 819 93 663.39 percent of total billed charges 819 819 other OPPS APC 819 819 other OPPS APC 819 27.63 226.29 percent of total billed charges 819 819 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE POSITIONING STAR SLEEVE VELCRO FOAM ARM FOREARM WRIST TRACTION SLING STERILE DISPOSABLE SUP-AR-1606V CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT POSITIONING UNIVERSAL HEAD STERILE DISPOSABLE SUP-AR-1627-06 CDM 0270 RC outpatient 51.97 51.97 51.97 74 38.46 percent of total billed charges 51.97 93 42.1 percent of total billed charges 51.97 51.97 other OPPS APC 51.97 51.97 other OPPS APC 51.97 27.63 14.36 percent of total billed charges 51.97 51.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT POSITIONING TRIMANO BEACH CHAIR ARM HOLDER DRAPE LIGHTWEIGHT DISPOSABLE SUP-AR-1644 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE BIO-TENODESIS PEEK-OPTIMA L8 MM OD5.5 MM ACL RECONSTRUCTION STERILE SUP-AR-1655PS CDM 0270 RC outpatient 741 741 741 74 548.34 percent of total billed charges 741 93 600.21 percent of total billed charges 741 741 other OPPS APC 741 741 other OPPS APC 741 27.63 204.74 percent of total billed charges 741 741 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE BIO-TENODESIS PEEK-OPTIMA L10 MM OD5.5 MM ACL RECONSTRUCTION STERILE SUP-AR-1655PS-10 CDM 0270 RC outpatient 741 741 741 74 548.34 percent of total billed charges 741 93 600.21 percent of total billed charges 741 741 other OPPS APC 741 741 other OPPS APC 741 27.63 204.74 percent of total billed charges 741 741 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE SWIVELOCK TENODESIS BIOCOMPOSITE L19.5 MM OD7 MM SHOULDER BICEPS FORK EYELET STERILE SUP-AR-1662BC-7 CDM 0270 RC outpatient 1131 1131 1131 74 836.94 percent of total billed charges 1131 93 916.11 percent of total billed charges 1131 1131 other OPPS APC 1131 1131 other OPPS APC 1131 27.63 312.5 percent of total billed charges 1131 1131 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE SWIVELOCK TENODESIS BIOCOMPOSITE L19.5 MM OD8 MM SHOULDER BICEPS FORK EYELET STERILE SUP-AR-1662BC-8 CDM 0270 RC outpatient 1131 1131 1131 74 836.94 percent of total billed charges 1131 93 916.11 percent of total billed charges 1131 1131 other OPPS APC 1131 1131 other OPPS APC 1131 27.63 312.5 percent of total billed charges 1131 1131 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE SWIVELOCK TENODESIS BIOCOMPOSITE L19.5 MM OD9 MM SHOULDER BICEPS FORK EYELET STERILE SUP-AR-1662BC-9 CDM 0270 RC outpatient 1131 1131 1131 74 836.94 percent of total billed charges 1131 93 916.11 percent of total billed charges 1131 1131 other OPPS APC 1131 1131 other OPPS APC 1131 27.63 312.5 percent of total billed charges 1131 1131 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INSTRUMENT BIO-TENODESIS BIOABSORBABLE STERILE DISPOSABLE SUP-AR-1676DS CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE TENODESIS BIOCOMPOSITE L12 MM OD8 MM ACL STERILE SUP-AR-1680BC CDM 0270 RC outpatient 897 897 897 74 663.78 percent of total billed charges 897 93 726.57 percent of total billed charges 897 897 other OPPS APC 897 897 other OPPS APC 897 27.63 247.84 percent of total billed charges 897 897 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ARTHROSCOPIC FIXATION INTERNALBRACE SWIVELOCK BIOCOMPOSITE STANDARD OD4.75 MM ODSEC3.5 MM RADIOPAQUE SUP-AR-1788J-CP CDM 0270 RC outpatient 3887 3887 3887 74 2876.38 percent of total billed charges 3887 93 3148.47 percent of total billed charges 3887 3887 other OPPS APC 3887 3887 other OPPS APC 3887 27.63 1073.98 percent of total billed charges 3887 3887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POWER PICK 45 DEG SUP-AR-1850PP-45 CDM 0270 RC outpatient 262.6 262.6 262.6 74 194.32 percent of total billed charges 262.6 93 212.71 percent of total billed charges 262.6 262.6 other OPPS APC 262.6 262.6 other OPPS APC 262.6 27.63 72.56 percent of total billed charges 262.6 262.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INSTRUMENT ACL TRANSTIBIAL DISPOSABLE SUP-AR-1898S CDM 0270 RC outpatient 306.8 306.8 306.8 74 227.03 percent of total billed charges 306.8 93 248.51 percent of total billed charges 306.8 306.8 other OPPS APC 306.8 306.8 other OPPS APC 306.8 27.63 84.77 percent of total billed charges 306.8 306.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SPREADER SUP-AR-19007GS CDM 0270 RC outpatient 975 975 975 74 721.5 percent of total billed charges 975 93 789.75 percent of total billed charges 975 975 other OPPS APC 975 975 other OPPS APC 975 27.63 269.39 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "FIBERSTITCH IMPLANT, CURVED RC" SUP-AR-19032C CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "FIBERSTITCH IMPLANT, STRAIGHT RC" SUP-AR-19032S CDM 0270 RC outpatient 1501.5 1501.5 1501.5 74 1111.11 percent of total billed charges 1501.5 93 1216.22 percent of total billed charges 1501.5 1501.5 other OPPS APC 1501.5 1501.5 other OPPS APC 1501.5 27.63 414.86 percent of total billed charges 1501.5 1501.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE CORKSCREW FIBERWIRE TITANIUM 0 2.3 MM 1/2 CIRCLE 2 DIAMOND POINT FULL THREAD L26.5 MM L10 MM OD3.5 MM ID2.5 MM FOOT ELBOW KIT PRELOAD SELF DRILL SELF TAP STERILE DISPOSABLE SUP-AR-1915FT CDM 0270 RC outpatient 741 741 741 74 548.34 percent of total billed charges 741 93 600.21 percent of total billed charges 741 741 other OPPS APC 741 741 other OPPS APC 741 27.63 204.74 percent of total billed charges 741 741 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE CORKSCREW FIBERWIRE 2 12MM 3.5MM TITANIUM DISPOSABLE STERILE ROTATOR CUFF SELF TAP EYELET HANDLE INSERTER SUP-AR-1915SF CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE CORKSCREW FIBERWIRE 2 15.5MM 5MM TITANIUM DISPOSABLE STERILE ROTATOR CUFF SELF TAP EYELET HANDLE INSERTER SUP-AR-1920SF CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE PUSHLOCK BIOCOMPOSITE L24 MM OD4.5 MM STERILE DISPOSABLE SUP-AR-1922BC CDM 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INSTRUMENT OD2.9 MM DISPOSABLE 2.9 MM PUSHLOCK SUP-AR-1923DHS CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ENDOSCOPIC INSTRUMENT PUSHLOCK 1.1MM 17GA 2.9MM METAL NITINOL DISPOSABLE CANNULA SUP-AR-1923PK CDM 0270 RC outpatient 572 572 572 74 423.28 percent of total billed charges 572 93 463.32 percent of total billed charges 572 572 other OPPS APC 572 572 other OPPS APC 572 27.63 158.04 percent of total billed charges 572 572 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE BIO-CORKSCREW POLY L LACTIDE CO D L LACTIDE ACID 2 FULL THREAD L17.9 MM OD6.5 MM ROTATOR CUFF 2 BIOABSORBABLE STERILE DISPOSABLE SUP-AR-1925BF CDM 0270 RC outpatient 676 676 676 74 500.24 percent of total billed charges 676 93 547.56 percent of total billed charges 676 676 other OPPS APC 676 676 other OPPS APC 676 27.63 186.78 percent of total billed charges 676 676 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE CORKSCREW FIBERWIRE TITANIUM 2 L15.5 MM OD6.5 MM ROTATOR CUFF 2 BIOABSORBABLE HANDLE INSERTER STERILE DISPOSABLE SUP-AR-1925SF CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE BIO-PUSHLOCK L19.5 MM OD3.5 MM STERILE DISPOSABLE SUP-AR-1926B CDM 0270 RC outpatient 676 676 676 74 500.24 percent of total billed charges 676 93 547.56 percent of total billed charges 676 676 other OPPS APC 676 676 other OPPS APC 676 27.63 186.78 percent of total billed charges 676 676 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PUNCH SUTURE PUSHLOCK 3.5MM SUP-AR-1926P CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE BIO-CORKSCREW FIBERWIRE 2 FULL THREAD 14.7MM 5.5MM POLY-L-LACTIC ACID DISPOSABLE STERILE SUP-AR-1927BF CDM 0270 RC outpatient 308.75 308.75 308.75 74 228.48 percent of total billed charges 308.75 93 250.09 percent of total billed charges 308.75 308.75 other OPPS APC 308.75 308.75 other OPPS APC 308.75 27.63 85.31 percent of total billed charges 308.75 308.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE TAK-ANCHOR SUP-AR-1934BCF-2 CDM 0270 RC outpatient 832 832 832 74 615.68 percent of total billed charges 832 93 673.92 percent of total billed charges 832 832 other OPPS APC 832 832 other OPPS APC 832 27.63 229.88 percent of total billed charges 832 832 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE SUTURETAK FIBERWIRE BIOCOMPOSITE 2 L12 MM OD2.4 MM STERILE DISPOSABLE SUP-AR-1934BCF-24 CDM 0270 RC outpatient 793 793 793 74 586.82 percent of total billed charges 793 93 642.33 percent of total billed charges 793 793 other OPPS APC 793 793 other OPPS APC 793 27.63 219.11 percent of total billed charges 793 793 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE BIO-SUTURETAK FIBERWIRE POLY L LACTIDE CO D L LACTIDE ACID 2 L14.5 MM OD3 MM ROTATOR CUFF BIOABSORBABLE PUSH IN STERILE DISPOSABLE SUP-AR-1934BF CDM 0270 RC outpatient 637 637 637 74 471.38 percent of total billed charges 637 93 515.97 percent of total billed charges 637 637 other OPPS APC 637 637 other OPPS APC 637 27.63 176 percent of total billed charges 637 637 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ARTHROSCOPIC FIXATION DISPOSABLE 3MM SUTURETAK SUP-AR-1934DS-2 CDM 0270 RC outpatient 416 416 416 74 307.84 percent of total billed charges 416 93 336.96 percent of total billed charges 416 416 other OPPS APC 416 416 other OPPS APC 416 27.63 114.94 percent of total billed charges 416 416 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INSERTION BIO-SUTURETAK NITINOL 1.1 MM OD17 GA ODSEC2.4 MM SPINE DRILL NEEDLE PERCUTANEOUS INSERTION PORTAL DILATOR WIRE DISPOSABLE SUP-AR-1934PI CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT 3MM PERCUTANEOUS INSERTION SUP-AR-1934PI-30 CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE BIO-SUTURETAK FIBERWIRE PEEK 2 L12.4MM OD 3MM SUP-AR-1934PS CDM 0270 RC outpatient 624 624 624 74 461.76 percent of total billed charges 624 93 505.44 percent of total billed charges 624 624 other OPPS APC 624 624 other OPPS APC 624 27.63 172.41 percent of total billed charges 624 624 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE BIOCOMPOSITE SUTURETAK KNOTLESS 3X12.7MM SUP-AR-1938BC CDM 0270 RC outpatient 1105 1105 1105 74 817.7 percent of total billed charges 1105 93 895.05 percent of total billed charges 1105 1105 other OPPS APC 1105 1105 other OPPS APC 1105 27.63 305.31 percent of total billed charges 1105 1105 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE KNOTLESS SUTURETAK FIBERWIRE PEEK 2 L 12.7 MM OD 3 MM SUP-AR-1938PS CDM 0270 RC outpatient 1001 1001 1001 74 740.74 percent of total billed charges 1001 93 810.81 percent of total billed charges 1001 1001 other OPPS APC 1001 1001 other OPPS APC 1001 27.63 276.58 percent of total billed charges 1001 1001 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE CORKSCREW PEEK 2 L10.2 MM OD3.9 MM KNOTLESS SUP-AR-1941PS CDM 0270 RC outpatient 1001 1001 1001 74 740.74 percent of total billed charges 1001 93 810.81 percent of total billed charges 1001 1001 other OPPS APC 1001 1001 other OPPS APC 1001 27.63 276.58 percent of total billed charges 1001 1001 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET GRAFT HARVEST OATS OD7 MM ODSEC6 MM ACL ALIGNMENT ROD CORE EXTRUDER DELIVERY TUBE TAMP GUIDE PIN STERILE DISPOSABLE SUP-AR-1981-06S CDM 0270 RC outpatient 1352 1352 1352 74 1000.48 percent of total billed charges 1352 93 1095.12 percent of total billed charges 1352 1352 other OPPS APC 1352 1352 other OPPS APC 1352 27.63 373.56 percent of total billed charges 1352 1352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET GRAFT HARVEST OATS OD9 MM ODSEC8 MM ACL ALIGNMENT ROD CORE EXTRUDER DELIVERY TUBE TAMP STERILE DISPOSABLE SUP-AR-1981-08S CDM 0270 RC outpatient 1352 1352 1352 74 1000.48 percent of total billed charges 1352 93 1095.12 percent of total billed charges 1352 1352 other OPPS APC 1352 1352 other OPPS APC 1352 27.63 373.56 percent of total billed charges 1352 1352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET GRAFT HARVEST OATS OD11 MM ODSEC10 MM ACL ALIGNMENT ROD CORE EXTRUDER DELIVERY TUBE TAMP STERILE DISPOSABLE SUP-AR-1981-10S CDM 0270 RC outpatient 1352 1352 1352 74 1000.48 percent of total billed charges 1352 93 1095.12 percent of total billed charges 1352 1352 other OPPS APC 1352 1352 other OPPS APC 1352 27.63 373.56 percent of total billed charges 1352 1352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE FIXATION AC GRAFTROPE STERILE SHOULDER ARTHROSCOPY SUP-AR-2258 CDM 270010031 LOCAL 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE FIXATION BIOCOMPOSITE DISTAL BICEPS REPAIR SUP-AR-2260BC CDM 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUTTON SUTURE L12 MM BICEPS STERILE SUP-AR-2261 CDM 0270 RC outpatient 767 767 767 74 567.58 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 27.63 211.92 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ARTHROSCOPIC FIXATION TIGERTAPE SUTURELASSO 2 MM OD3 MM 2 DOG BONE BUTTON CANNULATED DRILL LOOP SD WIRE SUP-AR-2271 CDM 0270 RC outpatient 2925 2925 2925 74 2164.5 percent of total billed charges 2925 93 2369.25 percent of total billed charges 2925 2925 other OPPS APC 2925 2925 other OPPS APC 2925 27.63 808.18 percent of total billed charges 2925 2925 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OBTURATOR ARTHROSCOPIC FLEXIBLE SUP-AR-2275 CDM 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE SWIVELOCK C 19.1MM 5.5MM BIOCOMPOSITE PEEK DISPOSABLE STERILE CLOSED EYELET VENT SUP-AR-2323BCC CDM 0270 RC outpatient 988 988 988 74 731.12 percent of total billed charges 988 93 800.28 percent of total billed charges 988 988 other OPPS APC 988 988 other OPPS APC 988 27.63 272.98 percent of total billed charges 988 988 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE BIO-SWIVELOCK C L19.1 MM OD5.5 MM CLOSED EYELET VENT STERILE DISPOSABLE SUP-AR-2323BSLC CDM 0270 RC outpatient 1060.8 1060.8 1060.8 74 784.99 percent of total billed charges 1060.8 93 859.25 percent of total billed charges 1060.8 1060.8 other OPPS APC 1060.8 1060.8 other OPPS APC 1060.8 27.63 293.1 percent of total billed charges 1060.8 1060.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE SWIVELOCK C BIOCOMPOSITE PEEK L19.1 MM OD4.75 MM CLOSED EYELET VENT STERILE DISPOSABLE SUP-AR-2324BCC CDM 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE ANCHPEEK SWIVLOCK SUP-AR-2324PSLC CDM 0270 RC outpatient 975 975 975 74 721.5 percent of total billed charges 975 93 789.75 percent of total billed charges 975 975 other OPPS APC 975 975 other OPPS APC 975 27.63 269.39 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE SWIVELOCK BIOCOMPOSITE L15.8 MM OD3.5 MM SHOULDER SUP-AR-2325BCC CDM 0270 RC outpatient 988 988 988 74 731.12 percent of total billed charges 988 93 800.28 percent of total billed charges 988 988 other OPPS APC 988 988 other OPPS APC 988 27.63 272.98 percent of total billed charges 988 988 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 3.9MM SWIVELOCK ANCHOR SUP-AR-2326PSLC CDM 0270 RC outpatient 975 975 975 74 721.5 percent of total billed charges 975 93 789.75 percent of total billed charges 975 975 other OPPS APC 975 975 other OPPS APC 975 27.63 269.39 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ARTHROSCOPIC FIXATION ARTHREX KNOTLESS STERILE LATEX FREE DISPOSABLE REPAIR SYSTEM SUP-AR-2371 CDM 0270 RC outpatient 4448.6 4448.6 4448.6 74 3291.96 percent of total billed charges 4448.6 93 3603.37 percent of total billed charges 4448.6 4448.6 other OPPS APC 4448.6 4448.6 other OPPS APC 4448.6 27.63 1229.15 percent of total billed charges 4448.6 4448.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE STRIPPER TENDON 9 MM SUP-AR-2385-09 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE STRIPPER W10 MM QUADRICEPS TENDON DISPOSABLE SUP-AR-2385-10 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUADPRO HARVESTOR 9MM SUP-AR-2386-09 CDM 27000000 LOCAL 0270 RC outpatient 1105 1105 1105 74 817.7 percent of total billed charges 1105 93 895.05 percent of total billed charges 1105 1105 other OPPS APC 1105 1105 other OPPS APC 1105 27.63 305.31 percent of total billed charges 1105 1105 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUADPRO HARVESTOR 10MM SUP-AR-2386-10 CDM 27000000 LOCAL 0270 RC outpatient 1105 1105 1105 74 817.7 percent of total billed charges 1105 93 895.05 percent of total billed charges 1105 1105 other OPPS APC 1105 1105 other OPPS APC 1105 27.63 305.31 percent of total billed charges 1105 1105 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM FIXATION SPEEDBRIDGE FIBERTAPE SWIVELOCK BIOCOMPOSITE L24 MM OD5.5 MM KIT BIOABSORBABLE HANDLE INSERTER PRELOAD SELF PUNCH STERILE DISPOSABLE ARTHROSCOPY SUP-AR-2600SBS-5 CDM 0270 RC outpatient 4420 4420 4420 74 3270.8 percent of total billed charges 4420 93 3580.2 percent of total billed charges 4420 4420 other OPPS APC 4420 4420 other OPPS APC 4420 27.63 1221.25 percent of total billed charges 4420 4420 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM FIXATION SPEEDBRIDGE SWIVELOCK FIBERTAPE PEEK OD4.75 MM 2 PRELOAD LOOP DISPOSABLE PUNCH BLACK BLUE WHITE SUP-AR-2600SBS-6 CDM 0270 RC outpatient 4160 4160 4160 74 3078.4 percent of total billed charges 4160 93 3369.6 percent of total billed charges 4160 4160 other OPPS APC 4160 4160 other OPPS APC 4160 27.63 1149.41 percent of total billed charges 4160 4160 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE PUSHLOCK BIOCOMPOSITE SHORT L12.5 MM OD2.9 MM CANNULATED EYELET HANDLE INSERTER STERILE DISPOSABLE SUP-AR-2923BC CDM 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE PUSHLOCK BIOCOMPOSITE HIP SUP-AR-2923BCH CDM 0270 RC outpatient 1092 1092 1092 74 808.08 percent of total billed charges 1092 93 884.52 percent of total billed charges 1092 1092 other OPPS APC 1092 1092 other OPPS APC 1092 27.63 301.72 percent of total billed charges 1092 1092 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH ARTHROSCOPIC DART STRAIGHT MENISCUS CANNULA STERILE DISPOSABLE SUP-AR-3007 CDM 0270 RC outpatient 46.28 46.28 46.28 74 34.25 percent of total billed charges 46.28 93 37.49 percent of total billed charges 46.28 46.28 other OPPS APC 46.28 46.28 other OPPS APC 46.28 27.63 12.79 percent of total billed charges 46.28 46.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH ARTHROSCOPIC DART 15 D UP MENISCUS CANNULA STERILE DISPOSABLE SUP-AR-3007-15 CDM 0270 RC outpatient 231.4 231.4 231.4 74 171.24 percent of total billed charges 231.4 93 187.43 percent of total billed charges 231.4 231.4 other OPPS APC 231.4 231.4 other OPPS APC 231.4 27.63 63.94 percent of total billed charges 231.4 231.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DART FIXATION DARTSTICK POLY L LACTIDE CO D L LACTIDE ACID L12 MM OD1.3 MM MENISCUS REVERSE BARB STERILE SUP-AR-3007-B12 CDM 0270 RC outpatient 113.52 113.52 113.52 74 84 percent of total billed charges 113.52 93 91.95 percent of total billed charges 113.52 113.52 other OPPS APC 113.52 113.52 other OPPS APC 113.52 27.63 31.37 percent of total billed charges 113.52 113.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT QUICKSET 8CC SUP-AR-3008 CDM 0270 RC outpatient 5187 5187 5187 74 3838.38 percent of total billed charges 5187 93 4201.47 percent of total billed charges 5187 5187 other OPPS APC 5187 5187 other OPPS APC 5187 27.63 1433.17 percent of total billed charges 5187 5187 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 1.8 MM HIP FLEXIBLE STERILE REUSABLE FIBERTAK SUP-AR-3600ND-2 CDM 0270 RC outpatient 273 273 273 74 202.02 percent of total billed charges 273 93 221.13 percent of total billed charges 273 273 other OPPS APC 273 273 other OPPS APC 273 27.63 75.43 percent of total billed charges 273 273 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIPLE LOADED BIFERTAK ANCHOR SUP-AR-3631-1 CDM 0270 RC outpatient 1001 1001 1001 74 740.74 percent of total billed charges 1001 93 810.81 percent of total billed charges 1001 1001 other OPPS APC 1001 1001 other OPPS APC 1001 27.63 276.58 percent of total billed charges 1001 1001 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRIPLE LOADED BIFERTAK ANCHOR SUP-AR-3633 CDM 0270 RC outpatient 1001 1001 1001 74 740.74 percent of total billed charges 1001 93 810.81 percent of total billed charges 1001 1001 other OPPS APC 1001 1001 other OPPS APC 1001 27.63 276.58 percent of total billed charges 1001 1001 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE ARTHREX FIBERTAK STERILE LATEX FREE DISPOSABLE SUP-AR-3638 CDM 0270 RC outpatient 1144 1144 1144 74 846.56 percent of total billed charges 1144 93 926.64 percent of total billed charges 1144 1144 other OPPS APC 1144 1144 other OPPS APC 1144 27.63 316.09 percent of total billed charges 1144 1144 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ARTHROSCOPIC FIXATION CURVE SPEAR DISPOSABLE SUP-AR-3638DC CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE FIBERTAK TIGERTAIL LABRALTAPE 2 2 ROW KNOTLESS BLACK GREEN WHITE ROTATOR CUFF REPAIR SUP-AR-3651T CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE FIBERTAK FIBERTAPE SUTURETAPE L1.3 MM OD2.6 MM ODSEC1.7 MM SELF PUNCH BLACK WHITE SUP-AR-3652TSP CDM 0270 RC outpatient 1222 1222 1222 74 904.28 percent of total billed charges 1222 93 989.82 percent of total billed charges 1222 1222 other OPPS APC 1222 1222 other OPPS APC 1222 27.63 337.64 percent of total billed charges 1222 1222 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET IMPLANT ARTHREX FIBERTAK BICEPS STERILE LATEX FREE SUP-AR-3670 CDM 0270 RC outpatient 1625 1625 1625 74 1202.5 percent of total billed charges 1625 93 1316.25 percent of total billed charges 1625 1625 other OPPS APC 1625 1625 other OPPS APC 1625 27.63 448.99 percent of total billed charges 1625 1625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DART FIXATION CHONDRAL DART POLY L LACTIC ACID L18 MM OD1.3 MM STERILE SUP-AR-4005B-18 CDM 0270 RC outpatient 314.6 314.6 314.6 74 232.8 percent of total billed charges 314.6 93 254.83 percent of total billed charges 314.6 314.6 other OPPS APC 314.6 314.6 other OPPS APC 314.6 27.63 86.92 percent of total billed charges 314.6 314.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET ENDOSCOPIC INSTRUMENT CHONDRAL DART L9 MM 1 SHOT SHEATH CANNULA DRILL FLAP REPAIR INSERTER STERILE DISPOSABLE SUP-AR-4009S CDM 0270 RC outpatient 533 533 533 74 394.42 percent of total billed charges 533 93 431.73 percent of total billed charges 533 533 other OPPS APC 533 533 other OPPS APC 533 27.63 147.27 percent of total billed charges 533 533 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE FASTTHREAD PEEK L20 MM OD7 MM SUP-AR-4020P-07 CDM 0270 RC outpatient 767 767 767 74 567.58 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 27.63 211.92 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE ARTHREX PEEK L20 MM OD8 MM SUP-AR-4020P-08 CDM 0270 RC outpatient 767 767 767 74 567.58 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 27.63 211.92 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE ARTHREX PEEK L20 MM OD9 MM SUP-AR-4020P-09 CDM 0270 RC outpatient 767 767 767 74 567.58 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 27.63 211.92 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET SUTURING CURVE PROTECTOR NITINOL CANNULA MALLEABLE NEEDLE HOLDER WIRE LOOP SUP-AR-4060S CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PASSER SUTURE SUTURELASSO NITINOL 90 D OD2.3 MM ELBOW SHOULDER STERILE DISPOSABLE ARTHROSCOPY SUP-AR-4065-90S CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PASSER SUTURE SUTURELASSO SD NITINOL 90 D LEFT CURVE OD1.8 MM ODSEC3.8 MM THUMB PAD STERILE DISPOSABLE LABRAL ARTHROSCOPY ROTATOR CUFF REPAIR SUP-AR-4068-90L CDM 0270 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PASSER SUTURE SUTURELASSO SD NITINOL 90 D RIGHT CURVE OD1.8 MM ODSEC3.8 MM THUMB PAD STERILE DISPOSABLE LABRAL ARTHROSCOPY ROTATOR CUFF REPAIR SUP-AR-4068-90R CDM 0270 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PASSER SUTURE SUTURELASSO CRESCENT STERILE DISPOSABLE HIP ARTHROSCOPY SUP-AR-4068CH CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET ENDOSCOPIC INSTRUMENT CHONDRAL DART MULTISHOT STERILE DISPOSABLE OSTEOCHONDRAL FLAP REPAIR SUP-AR-4095S CDM 0270 RC outpatient 1352 1352 1352 74 1000.48 percent of total billed charges 1352 93 1095.12 percent of total billed charges 1352 1352 other OPPS APC 1352 1352 other OPPS APC 1352 27.63 373.56 percent of total billed charges 1352 1352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INSTRUMENT TRIM-IT DRILL PIN KIRSCHNER L100 MM OD1.5 MM BONE TAMP GUIDE SLEEVE RADIOLUCENCY SUPERIOR SHEAR STRENGTH STERILE DISPOSABLE SUP-AR-4151DS CDM outpatient 910 910 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INSTRUMENT TRIM-IT DRILL PIN KIRSCHNER 100MM 2MM DISPOSABLE STERILE BONE TAMP SUP-AR-4152DS CDM 0270 RC outpatient 546 546 546 74 404.04 percent of total billed charges 546 93 442.26 percent of total billed charges 546 546 other OPPS APC 546 546 other OPPS APC 546 27.63 150.86 percent of total billed charges 546 546 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT TRAUMA FIXATION PIP DART PEEK 10 D L30 MM OD2.5 MM RADIOLUCENT INSERTER DRILL GUIDEWIRE STERILE SUP-AR-4154P-3010 CDM 270010020 LOCAL 0270 RC outpatient 1547 1547 1547 74 1144.78 percent of total billed charges 1547 93 1253.07 percent of total billed charges 1547 1547 other OPPS APC 1547 1547 other OPPS APC 1547 27.63 427.44 percent of total billed charges 1547 1547 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL TRIM-IT OD3.5 MM SUP-AR-4160-35 CDM 0270 RC outpatient 205.4 205.4 205.4 74 152 percent of total billed charges 205.4 93 166.37 percent of total billed charges 205.4 205.4 other OPPS APC 205.4 205.4 other OPPS APC 205.4 27.63 56.75 percent of total billed charges 205.4 205.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL TRIM-IT OD4 MM SUP-AR-4160-40 CDM 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SUTURING MENISCAL CINCH CURVE STERILE DISPOSABLE SUP-AR-4500 CDM 0270 RC outpatient 741 741 741 74 548.34 percent of total billed charges 741 93 600.21 percent of total billed charges 741 741 other OPPS APC 741 741 other OPPS APC 741 27.63 204.74 percent of total billed charges 741 741 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MENISCAL CINCH SUP-AR-4501 CDM 0270 RC outpatient 1027 1027 1027 74 759.98 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 27.63 283.76 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SUTURE SPEEDCINCH FIBERWIRE PEEK 2-0 CURVE SUP-AR-4502 CDM 0270 RC outpatient 1027 1027 1027 74 759.98 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 27.63 283.76 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE FIBERSTITCH FIBER WIRE POLYESTER 2-0 CURVE SUP-AR-4570 CDM 0270 RC outpatient 1287 1287 1287 74 952.38 percent of total billed charges 1287 93 1042.47 percent of total billed charges 1287 1287 other OPPS APC 1287 1287 other OPPS APC 1287 27.63 355.6 percent of total billed charges 1287 1287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERSTITCH IMPLANT STRAIGHT SUP-AR-4570S CDM 0270 RC outpatient 1287 1287 1287 74 952.38 percent of total billed charges 1287 93 1042.47 percent of total billed charges 1287 1287 other OPPS APC 1287 1287 other OPPS APC 1287 27.63 355.6 percent of total billed charges 1287 1287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE FIBERSTITCH FIBER WIRE POLYESTER 2-0 CURVE SUP-AR-4580 CDM 0270 RC outpatient 1430 1430 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERSTITCH IMPLANT STRAIGHT SUP-AR-4580S CDM 0270 RC outpatient 1430 1430 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTHREX IBALANCE UKA TIBIAL BEARING SIZE 2 10MM SUP-AR-501-TBB0 CDM 270010025 LOCAL 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEARING TIBIAL IBALANCE POLYETHYLENE 2 H8 MM KNEE UNICONDYLAR ANATOMIC DESIGN RESURFACE SUP-AR-501-TBB8 CDM 270010025 LOCAL 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEARING TIBIAL IBALANCE POLYETHYLENE 3 H8 MM KNEE UNICONDYLAR ANATOMIC DESIGN RESURFACE SUP-AR-501-TBC8 CDM 270010025 LOCAL 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEARING TIBIAL IBALANCE POLYETHYLENE 3 H9 MM KNEE UNICONDYLAR ANATOMIC DESIGN RESURFACE SUP-AR-501-TBC9 CDM 270010025 LOCAL 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEARING TIBIAL IBALANCE POLYETHYLENE 4 H8 MM KNEE UNICONDYLAR ANATOMIC DESIGN RESURFACE SUP-AR-501-TBD8 CDM 270010025 LOCAL 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTHREX IBALANCE UKA TIBIAL BEARING SIZE 4 9MM SUP-AR-501-TBD9 CDM 270010025 LOCAL 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTHREX IBALANCE UKA TIBIAL BEARING SIZE 5 8MM SUP-AR-501-TBE8 CDM 270010025 LOCAL 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTHREX IBALANCE UKA TIBIAL BEARING SIZE 5 9MM SUP-AR-501-TBE9 CDM 270010025 LOCAL 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTHREX IBALANCE UKA TIBIAL BEARING SIZE 5 10MM SUP-AR-501-TBEO CDM 270010025 LOCAL 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTHREX IBALANCE UKA TIBIAL BEARING SIZE 6 8MM SUP-AR-501-TBF8 CDM 270010025 LOCAL 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL IBALANCE 2 KNEE UNICONDYLAR LEFT MEDIAL ANATOMIC DESIGN CEMENTED RESURFACE SUP-AR-501-TTLB CDM 270010025 LOCAL 0270 RC outpatient 2392 2392 2392 74 1770.08 percent of total billed charges 2392 93 1937.52 percent of total billed charges 2392 2392 other OPPS APC 2392 2392 other OPPS APC 2392 27.63 660.91 percent of total billed charges 2392 2392 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL IBALANCE 3 KNEE UNICONDYLAR LEFT MEDIAL ANATOMIC DESIGN CEMENTED RESURFACE SUP-AR-501-TTLC CDM 270010025 LOCAL 0270 RC outpatient 2392 2392 2392 74 1770.08 percent of total billed charges 2392 93 1937.52 percent of total billed charges 2392 2392 other OPPS APC 2392 2392 other OPPS APC 2392 27.63 660.91 percent of total billed charges 2392 2392 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL IBALANCE 4 KNEE UNICONDYLAR LEFT MEDIAL ANATOMIC CEMENT RESURFACE SUP-AR-501-TTLD CDM 270010025 LOCAL 0270 RC outpatient 2392 2392 2392 74 1770.08 percent of total billed charges 2392 93 1937.52 percent of total billed charges 2392 2392 other OPPS APC 2392 2392 other OPPS APC 2392 27.63 660.91 percent of total billed charges 2392 2392 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY IBALANCE TIBIAL SIZ 5 LEFT MEDIAL RL SUP-AR-501-TTLE CDM 270010025 LOCAL 0270 RC outpatient 2392 2392 2392 74 1770.08 percent of total billed charges 2392 93 1937.52 percent of total billed charges 2392 2392 other OPPS APC 2392 2392 other OPPS APC 2392 27.63 660.91 percent of total billed charges 2392 2392 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL IBALANCE 1 KNEE UNICONDYLAR RIGHT MEDIAL ANATOMIC DESIGN CEMENTED RESURFACE SUP-AR-501-TTRA CDM 270010025 LOCAL 0270 RC outpatient 4368 4368 4368 74 3232.32 percent of total billed charges 4368 93 3538.08 percent of total billed charges 4368 4368 other OPPS APC 4368 4368 other OPPS APC 4368 27.63 1206.88 percent of total billed charges 4368 4368 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL IBALANCE 2 KNEE UNICONDYLAR RIGHT MEDIAL ANATOMIC DESIGN CEMENTED RESURFACE SUP-AR-501-TTRB CDM 270010025 LOCAL 0270 RC outpatient 2392 2392 2392 74 1770.08 percent of total billed charges 2392 93 1937.52 percent of total billed charges 2392 2392 other OPPS APC 2392 2392 other OPPS APC 2392 27.63 660.91 percent of total billed charges 2392 2392 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL IBALANCE 3 KNEE UNICONDYLAR RIGHT MEDIAL ANATOMIC DESIGN CEMENTED RESURFACE SUP-AR-501-TTRC CDM 270010025 LOCAL 0270 RC outpatient 2392 2392 2392 74 1770.08 percent of total billed charges 2392 93 1937.52 percent of total billed charges 2392 2392 other OPPS APC 2392 2392 other OPPS APC 2392 27.63 660.91 percent of total billed charges 2392 2392 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL ARTHREX IBALANCE UKA SIZE 4 RIGHT MEDIAL SUP-AR-501-TTRD CDM 270010025 LOCAL 0270 RC outpatient 2392 2392 2392 74 1770.08 percent of total billed charges 2392 93 1937.52 percent of total billed charges 2392 2392 other OPPS APC 2392 2392 other OPPS APC 2392 27.63 660.91 percent of total billed charges 2392 2392 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL ARTHREX IBALANCE UKA SIZE 5 RIGHT MEDIAL SUP-AR-501-TTRE CDM 270010025 LOCAL 0270 RC outpatient 2392 2392 2392 74 1770.08 percent of total billed charges 2392 93 1937.52 percent of total billed charges 2392 2392 other OPPS APC 2392 2392 other OPPS APC 2392 27.63 660.91 percent of total billed charges 2392 2392 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY TIBIAL ARTHREX IBALANCE UKA SIZE 6 RIGHT MEDIAL SUP-AR-501-TTRF CDM 270010025 LOCAL 0270 RC outpatient 2392 2392 2392 74 1770.08 percent of total billed charges 2392 93 1937.52 percent of total billed charges 2392 2392 other OPPS APC 2392 2392 other OPPS APC 2392 27.63 660.91 percent of total billed charges 2392 2392 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL IBALANCE 2 KNEE UNICONDYLAR LEFT MEDIAL ANATOMIC DESIGN CEMENTED RESURFACE SUP-AR-501-UFLB CDM 270010025 LOCAL 0270 RC outpatient 4238 4238 4238 74 3136.12 percent of total billed charges 4238 93 3432.78 percent of total billed charges 4238 4238 other OPPS APC 4238 4238 other OPPS APC 4238 27.63 1170.96 percent of total billed charges 4238 4238 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL IBALANCE 4 KNEE UNICONDYLAR LEFT MEDIAL ANATOMIC DESIGN CEMENTED RESURFACE SUP-AR-501-UFLD CDM 0270 RC outpatient 4238 4238 4238 74 3136.12 percent of total billed charges 4238 93 3432.78 percent of total billed charges 4238 4238 other OPPS APC 4238 4238 other OPPS APC 4238 27.63 1170.96 percent of total billed charges 4238 4238 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL IBALANCE 5 KNEE UNICONDYLAR LEFT MEDIAL ANATOMIC CEMENT RESURFACE SUP-AR-501-UFLE CDM 270010025 LOCAL 0270 RC outpatient 4238 4238 4238 74 3136.12 percent of total billed charges 4238 93 3432.78 percent of total billed charges 4238 4238 other OPPS APC 4238 4238 other OPPS APC 4238 27.63 1170.96 percent of total billed charges 4238 4238 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL IBALANCE 6 KNEE UNICONDYLAR LEFT MEDIAL ANATOMIC DESIGN CEMENTED RESURFACE SUP-AR-501-UFLF CDM 0270 RC outpatient 4238 4238 4238 74 3136.12 percent of total billed charges 4238 93 3432.78 percent of total billed charges 4238 4238 other OPPS APC 4238 4238 other OPPS APC 4238 27.63 1170.96 percent of total billed charges 4238 4238 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL IBALANCE 2 KNEE UNICONDYLAR RIGHT MEDIAL ANATOMIC DESIGN CEMENTED RESURFACE SUP-AR-501-UFRB CDM 270010025 LOCAL 0270 RC outpatient 4368 4368 4368 74 3232.32 percent of total billed charges 4368 93 3538.08 percent of total billed charges 4368 4368 other OPPS APC 4368 4368 other OPPS APC 4368 27.63 1206.88 percent of total billed charges 4368 4368 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL IBALANCE 3 KNEE UNICONDYLAR RIGHT MEDIAL ANATOMIC DESIGN CEMENTED RESURFACE SUP-AR-501-UFRC CDM 270010025 LOCAL 0270 RC outpatient 4238 4238 4238 74 3136.12 percent of total billed charges 4238 93 3432.78 percent of total billed charges 4238 4238 other OPPS APC 4238 4238 other OPPS APC 4238 27.63 1170.96 percent of total billed charges 4238 4238 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL IBALANCE 4 KNEE UNICONDYLAR RIGHT MEDIAL ANATOMIC DESIGN CEMENTED RESURFACE SUP-AR-501-UFRD CDM 270010025 LOCAL 0270 RC outpatient 4238 4238 4238 74 3136.12 percent of total billed charges 4238 93 3432.78 percent of total billed charges 4238 4238 other OPPS APC 4238 4238 other OPPS APC 4238 27.63 1170.96 percent of total billed charges 4238 4238 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR ARTHREX IBALANCE UKA CEMENTED SIZE 5 RIGHT MEDIAL SUP-AR-501-UFRE CDM 270010025 LOCAL 0270 RC outpatient 4238 4238 4238 74 3136.12 percent of total billed charges 4238 93 3432.78 percent of total billed charges 4238 4238 other OPPS APC 4238 4238 other OPPS APC 4238 27.63 1170.96 percent of total billed charges 4238 4238 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR ARTHREX IBALANCE UKA CEMENTED SIZE 6 RIGHT MEDIAL SUP-AR-501-UFRF CDM 270010025 LOCAL 0270 RC outpatient 4238 4238 4238 74 3136.12 percent of total billed charges 4238 93 3432.78 percent of total billed charges 4238 4238 other OPPS APC 4238 4238 other OPPS APC 4238 27.63 1170.96 percent of total billed charges 4238 4238 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT FEMORAL IBALANCE 2 PATELLOFEMORAL LEFT SUP-AR-502-2L CDM 0270 RC outpatient 6090.55 6090.55 6090.55 74 4507.01 percent of total billed charges 6090.55 93 4933.35 percent of total billed charges 6090.55 6090.55 other OPPS APC 6090.55 6090.55 other OPPS APC 6090.55 27.63 1682.82 percent of total billed charges 6090.55 6090.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE BIO-COMPRESSION SCREW POLY L LACTIC ACID TAPER L18 MM OD3-3.7 MM SMALL BONE CANNULATED SELF COMPRESS THREAD PITCH STERILE SUP-AR-5025B-18 CDM 0270 RC outpatient 1027 1027 1027 74 759.98 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 27.63 283.76 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE BIO-COMPRESSION SCREW POLY L LACTIC ACID TAPER L20 MM OD2.7-3.7 MM SMALL BONE CANNULATED SELF COMPRESS THREAD PITCH STERILE SUP-AR-5025B-20 CDM 0270 RC outpatient 1027 1027 1027 74 759.98 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 27.63 283.76 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE BIO-COMPRESSION SCREW POLY L LACTIC ACID TAPER L22 MM OD3-3.7 MM SMALL BONE CANNULATED SELF COMPRESS THREAD PITCH STERILE SUP-AR-5025B-22 CDM 0270 RC outpatient 1027 1027 1027 74 759.98 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 27.63 283.76 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAP SURGICAL L20 MM CANNULATED DILATOR 3 MM BIO-COMPRESSION SCREW SUP-AR-5025TBC CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL CANNULATED BIO-COMPRESSION SCREW SUP-AR-5025TDC CDM 0270 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW INTERFERENCE BIOCOMPOSITE DELTA L35 MM OD9 MM ACL CANNULATED STERILE SUP-AR-5035TC-09 CDM 0270 RC outpatient 611 611 611 74 452.14 percent of total billed charges 611 93 494.91 percent of total billed charges 611 611 other OPPS APC 611 611 other OPPS APC 611 27.63 168.82 percent of total billed charges 611 611 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ARTHREX IBALANCE PATELLA DOME 30X8MM SUP-AR-504-PSB6 CDM 0270 RC outpatient 1518.79 1518.79 1518.79 74 1123.9 percent of total billed charges 1518.79 93 1230.22 percent of total billed charges 1518.79 1518.79 other OPPS APC 1518.79 1518.79 other OPPS APC 1518.79 27.63 419.64 percent of total billed charges 1518.79 1518.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEARING TIBIAL IBALANCE POLYETHYLENE VITAMIN E 1 H8 MM UNICOMPARTMENTAL KNEE ARTHROPLASTY SUP-AR-521-TBA8 CDM 270010025 LOCAL 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEARING TIBIAL IBALANCE POLYETHYLENE VITAMIN E 1 H9 MM UNICOMPARTMENTAL KNEE ARTHROPLASTYL SUP-AR-521-TBA9 CDM 270010025 LOCAL 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEARING TIBIAL IBALANCE POLYETHYLENE VITAMIN E 2 H8 MM KNEE BICOMPARTMENT ARTHROPLASTY SUP-AR-521-TBB8 CDM 270010025 LOCAL 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEARING TIBIAL IBALANCE POLYETHYLENE VITAMIN E 2 H9 MM UNICOMPARTMENTAL KNEE ARTHROPLASTY SUP-AR-521-TBB9 CDM 270010025 LOCAL 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEARING TIBIAL IBALANCE POLYETHYLENE VITAMIN E 3 H8 MM UNICOMPARTMENTAL KNEE ARTHROPLASTY SUP-AR-521-TBC8 CDM 270010025 LOCAL 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEARING TIBIAL IBALANCE POLYETHYLENE VITAMIN E 4 H8 MM UNICOMPARTMENTAL KNEE ARTHROPLASTY SUP-AR-521-TBD8 CDM 270010025 LOCAL 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEARING TIBIAL IBALANCE POLYETHYLENE VITAMIN E 4 H9 MM UNICOMPARTMENTAL KNEE ARTHROPLASTY SUP-AR-521-TBD9 CDM 270010025 LOCAL 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEARING TIBIAL IBALANCE POLYETHYLENE VITAMIN E 5 H8 MM UNICOMPARTMENTAL KNEE ARTHROPLASTY SUP-AR-521-TBE8 CDM 270010025 LOCAL 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT UKA TIBIAL BEARING SIZE 6 8MM SUP-AR-521-TBF8 CDM 270010025 LOCAL 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT BLADE IBALANCE 2 FINISH PATELLOFEMORAL JOINT ARTHROPLASTY SUP-AR-602-27 CDM 0270 RC outpatient 190.66 190.66 190.66 74 141.09 percent of total billed charges 190.66 93 154.43 percent of total billed charges 190.66 190.66 other OPPS APC 190.66 190.66 other OPPS APC 190.66 27.63 52.68 percent of total billed charges 190.66 190.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PASSER SUTURE SUTURELASSO SD NITINOL 25 D TIGHT LEFT CURVE OD1.8 MM ODSEC3.8 MM STERILE DISPOSABLE LABRAL ARTHROSCOPY ROTATOR CUFF REPAIR SUP-AR-6068-25TL CDM 0270 RC outpatient 416 416 416 74 307.84 percent of total billed charges 416 93 336.96 percent of total billed charges 416 416 other OPPS APC 416 416 other OPPS APC 416 27.63 114.94 percent of total billed charges 416 416 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PASSER SUTURE SUTURELASSO SD NITINOL 25 D TIGHT RIGHT CURVE OD1.8 MM ODSEC3.8 MM THUMB PAD STERILE DISPOSABLE LABRAL ARTHROSCOPY ROTATOR CUFF REPAIR SUP-AR-6068-25TR CDM 0270 RC outpatient 416 416 416 74 307.84 percent of total billed charges 416 93 336.96 percent of total billed charges 416 416 other OPPS APC 416 416 other OPPS APC 416 27.63 114.94 percent of total billed charges 416 416 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SHAVER SABRETOOTH COOLCUT CURVE HIP LENGTH L19 CM OD4.2 MM STERILE DISPOSABLE SUP-AR-6420CST CDM 0270 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 27.63 30.17 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SHAVER EXCALIBUR COOLCUT HIP LENGTH L19 CM OD4.2 MM STERILE DISPOSABLE SUP-AR-6420EX CDM 0270 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 27.63 30.17 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "TORPEDO HL 4,2MM X 19CM" SUP-AR-6420TD CDM 0270 RC outpatient 236.6 236.6 236.6 74 175.08 percent of total billed charges 236.6 93 191.65 percent of total billed charges 236.6 236.6 other OPPS APC 236.6 236.6 other OPPS APC 236.6 27.63 65.37 percent of total billed charges 236.6 236.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET TUBING DUALWAVE CASSETTE OUTFLOW STERILE DISPOSABLE ARTHROSCOPY PUMP SUP-AR-6430 CDM 0270 RC outpatient 85.28 85.28 85.28 74 63.11 percent of total billed charges 85.28 93 69.08 percent of total billed charges 85.28 85.28 other OPPS APC 85.28 85.28 other OPPS APC 85.28 27.63 23.56 percent of total billed charges 85.28 85.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR ROUND CONCAVE HL SUP-AR-6500VBE CDM 0270 RC outpatient 262.6 262.6 262.6 74 194.32 percent of total billed charges 262.6 93 212.71 percent of total billed charges 262.6 262.6 other OPPS APC 262.6 262.6 other OPPS APC 262.6 27.63 72.56 percent of total billed charges 262.6 262.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ENDOSCOPIC INSTRUMENT MASTER L1.5 MM OD14 GA HIP GUIDEWIRE KNIFE BLADE SPINAL NEEDLE DISPOSABLE ARTHROSCOPY SUP-AR-6526S CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA GEMINI SUP-AR-6572 CDM 0270 RC outpatient 83.2 83.2 83.2 74 61.57 percent of total billed charges 83.2 93 67.39 percent of total billed charges 83.2 83.2 other OPPS APC 83.2 83.2 other OPPS APC 83.2 27.63 22.99 percent of total billed charges 83.2 83.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA BUTTON PASSPORT SILICONE CURVE LOW PROFILE L3 CM ID8 MM HIP 1 PIECE MOLD 2 DAM DESIGN 2 FLANGE FLEXIBLE SOFT STERILE LATEX FREE DISPOSABLE SUP-AR-6592-08-30 CDM 0270 RC outpatient 83.2 83.2 83.2 74 61.57 percent of total billed charges 83.2 93 67.39 percent of total billed charges 83.2 83.2 other OPPS APC 83.2 83.2 other OPPS APC 83.2 27.63 22.99 percent of total billed charges 83.2 83.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA BUTTON PASSPORT SILICONE CURVE LOW PROFILE L4 CM ID8 MM HIP 1 PIECE MOLD 2 DAM DESIGN 2 FLANGE FLEXIBLE SOFT STERILE LATEX FREE DISPOSABLE SUP-AR-6592-08-40 CDM 0270 RC outpatient 83.2 83.2 83.2 74 61.57 percent of total billed charges 83.2 93 67.39 percent of total billed charges 83.2 83.2 other OPPS APC 83.2 83.2 other OPPS APC 83.2 27.63 22.99 percent of total billed charges 83.2 83.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA BUTTON PASSPORT SILICONE CURVE LOW PROFILE L5 CM ID8 MM HIP 1 PIECE MOLD 2 DAM DESIGN 2 FLANGE FLEXIBLE SOFT STERILE LATEX FREE DISPOSABLE SUP-AR-6592-08-50 CDM 0270 RC outpatient 83.2 83.2 83.2 74 61.57 percent of total billed charges 83.2 93 67.39 percent of total billed charges 83.2 83.2 other OPPS APC 83.2 83.2 other OPPS APC 83.2 27.63 22.99 percent of total billed charges 83.2 83.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA BUTTON PASSPORT SILICONE CURVE LOW PROFILE L2 CM ID10 MM HIP 1 PIECE MOLD 2 DAM DESIGN 2 FLANGE FLEXIBLE SOFT STERILE LATEX FREE DISPOSABLE SUP-AR-6592-10-20 CDM 0270 RC outpatient 83.2 83.2 83.2 74 61.57 percent of total billed charges 83.2 93 67.39 percent of total billed charges 83.2 83.2 other OPPS APC 83.2 83.2 other OPPS APC 83.2 27.63 22.99 percent of total billed charges 83.2 83.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA BUTTON PASSPORT SILICONE CURVE LOW PROFILE L3 CM ID10 MM HIP 1 PIECE MOLD 2 DAM DESIGN 2 FLANGE FLEXIBLE SOFT STERILE LATEX FREE DISPOSABLE SUP-AR-6592-10-30 CDM 0270 RC outpatient 83.2 83.2 83.2 74 61.57 percent of total billed charges 83.2 93 67.39 percent of total billed charges 83.2 83.2 other OPPS APC 83.2 83.2 other OPPS APC 83.2 27.63 22.99 percent of total billed charges 83.2 83.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA BUTTON PASSPORT CURVE LOW PROFILE 5CM 10MM SILICONE DISPOSABLE STERILE LF HIP SUP-AR-6592-10-40 CDM 0270 RC outpatient 83.2 83.2 83.2 74 61.57 percent of total billed charges 83.2 93 67.39 percent of total billed charges 83.2 83.2 other OPPS APC 83.2 83.2 other OPPS APC 83.2 27.63 22.99 percent of total billed charges 83.2 83.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA BUTTON PASSPORT SILICONE CURVE LOW PROFILE L5 CM ID10 MM HIP 1 PIECE MOLD 2 DAM DESIGN 2 FLANGE FLEXIBLE SOFT STERILE LATEX FREE DISPOSABLE SUP-AR-6592-10-50 CDM 0270 RC outpatient 83.2 83.2 83.2 74 61.57 percent of total billed charges 83.2 93 67.39 percent of total billed charges 83.2 83.2 other OPPS APC 83.2 83.2 other OPPS APC 83.2 27.63 22.99 percent of total billed charges 83.2 83.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA BUTTON PASSPORT SUP-AR-6592-12-30 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA PASSPORT SUP-AR-6592-12-40 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL MINI L2.75 MM OD.066 IN CANNULATED OPEN REPAIR SUP-AR-7000-14 CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHER ORTHOPEDIC TITANIUM 3.75 MM SCREW SUP-AR-7000-15 CDM 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L34 MM OD3.75 MM SHOULDER GLENOID SELF DRILL SELF TAP CANNULATED SUP-AR-7000-34FT CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L36 MM OD3.75 MM SHOULDER GLENOID SELF DRILL SELF TAP CANNULATED SUP-AR-7000-36FT CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM PARTIAL THREAD L42 MM OD3.75 MM SHOULDER GLENOID SELF DRILL SELF TAP CANNULATED SUP-AR-7000-42 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE FIBERWIRE 2 T-5 L38 IN BRAID TIES MULTISTRAND LOWER KNOT PROFILE BLUE SUP-AR-7200 CDM 0270 RC outpatient 57.2 57.2 57.2 74 42.33 percent of total billed charges 57.2 93 46.33 percent of total billed charges 57.2 57.2 other OPPS APC 57.2 57.2 other OPPS APC 57.2 27.63 15.8 percent of total billed charges 57.2 57.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE FIBERWIRE 2 1/2 CIRCLE STRAIGHT DIAMOND POINT REVERSE CUT L38 IN L36.6 MM BRAID TIES MULTISTRAND 2 STRAND LOWER KNOT PROFILE BLACK BLUE WHITE SUP-AR-7201 CDM 0270 RC outpatient 67.6 67.6 67.6 74 50.02 percent of total billed charges 67.6 93 54.76 percent of total billed charges 67.6 67.6 other OPPS APC 67.6 67.6 other OPPS APC 67.6 27.63 18.68 percent of total billed charges 67.6 67.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE FIBERWIRE 2 T-8 L38 IN 2 ARM BRAID MULTISTRAND LOWER KNOT PROFILE BARB BLUE SUP-AR-7206 CDM 0270 RC outpatient 57.2 57.2 57.2 74 42.33 percent of total billed charges 57.2 93 46.33 percent of total billed charges 57.2 57.2 other OPPS APC 57.2 57.2 other OPPS APC 57.2 27.63 15.8 percent of total billed charges 57.2 57.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE FIBERWIRE 2 T-5 L38 IN BRAID TIES MULTISTRAND LOWER KNOT PROFILE BLACK BLUE WHITE SUP-AR-7208 CDM 0270 RC outpatient 124.8 124.8 124.8 74 92.35 percent of total billed charges 124.8 93 101.09 percent of total billed charges 124.8 124.8 other OPPS APC 124.8 124.8 other OPPS APC 124.8 27.63 34.48 percent of total billed charges 124.8 124.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE FIBERSTICK TIGERSTICK 2 L50 IN L12 IN 1 END STIFFEN BRAID MONOFILAMENT TIES BLUE SUP-AR-7209 CDM 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE TIGERSTICK TIGERWIRE 2 50IN 12IN BLACK WHITE 1 END STIFFEN SUP-AR-7209T CDM 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE FIBERWIRE 5 CCS-1 L38 IN BRAID TIES MULTISTRAND LOWER KNOT PROFILE BLUE SUP-AR-7211 CDM 0270 RC outpatient 104 104 104 74 76.96 percent of total billed charges 104 93 84.24 percent of total billed charges 104 104 other OPPS APC 104 104 other OPPS APC 104 27.63 28.74 percent of total billed charges 104 104 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE FIBERWIRE 2-0 3/8 CIRCLE TAPER 38IN 18IN BLUE BRAID TIES MULTISTRAND LOWER KNOT PROFILE SUP-AR-7221 CDM 0275 RC outpatient 54.6 54.6 54.6 57 31.12 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 51 27.85 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE FIBERWIRE 3-0 T-43 L18 IN BRAID TIES MULTISTRAND LOWER KNOT PROFILE BLUE SUP-AR-7227-01 CDM 0270 RC outpatient 57.2 57.2 57.2 74 42.33 percent of total billed charges 57.2 93 46.33 percent of total billed charges 57.2 57.2 other OPPS APC 57.2 57.2 other OPPS APC 57.2 27.63 15.8 percent of total billed charges 57.2 57.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE FIBERLOOP 4-0 SUP-AR-7229-20 CDM 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE FIBERLOOP 2-0 SD-2 L13 IN 2 ARM MULTISTRAND BLUE SUP-AR-7232-03 CDM 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE FIBERLOOP 2 L7 MM STRAIGHT L20 IN L76 MM BRAID MULTISTRAND NEEDLE BLUE SUP-AR-7234 CDM 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE FIBERLINK FIBERWIRE 2 L26 IN L1.5 IN BRAID TIES MULTISTRAND CLOSE LOOP BLUE SUP-AR-7235 CDM 0270 RC outpatient 143 143 143 74 105.82 percent of total billed charges 143 93 115.83 percent of total billed charges 143 143 other OPPS APC 143 143 other OPPS APC 143 27.63 39.51 percent of total billed charges 143 143 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE TIGERLINK FIBERWIRE 2 L26 IN CLOSED LOOP BLACK WHITE SUP-AR-7235T CDM 0270 RC outpatient 143 143 143 74 105.82 percent of total billed charges 143 93 115.83 percent of total billed charges 143 143 other OPPS APC 143 143 other OPPS APC 143 27.63 39.51 percent of total billed charges 143 143 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE FIBERTAPE FIBERWIRE 2 TAPER L54 IN L36 IN X W2 MM BRAID BLUE SUP-AR-7237 CDM 0270 RC outpatient 136.5 136.5 136.5 74 101.01 percent of total billed charges 136.5 93 110.57 percent of total billed charges 136.5 136.5 other OPPS APC 136.5 136.5 other OPPS APC 136.5 27.63 37.71 percent of total billed charges 136.5 136.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE FIBERLOOP FIBERTAG SWAGE STRAIGHT NEEDLE SUP-AR-7266 CDM 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE FIBERTAPE CERCLAGE SUP-AR-7267 CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE TIGERTAPE CERCLAGE SUP-AR-7267T CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE FIBERTAPE CERCLAGE SUP-AR-7268 CDM 0270 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 27.63 341.23 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE TIGERTAPE CERCLAGE SUP-AR-7268T CDM 0270 RC outpatient 1235 1235 1235 74 913.9 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 27.63 341.23 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SHAVER COOLCUT L7 CM OD3 MM SMALL JOINT ARTHROSCOPIC DISSECTOR STERILE DISPOSABLE SUP-AR-7300DS CDM 0270 RC outpatient 96.2 96.2 96.2 74 71.19 percent of total billed charges 96.2 93 77.92 percent of total billed charges 96.2 96.2 other OPPS APC 96.2 96.2 other OPPS APC 96.2 27.63 26.58 percent of total billed charges 96.2 96.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SHAVER OVAL OD3 MM 10 FLUTE SUP-AR-7300OBT CDM 0270 RC outpatient 96.2 96.2 96.2 74 71.19 percent of total billed charges 96.2 93 77.92 percent of total billed charges 96.2 96.2 other OPPS APC 96.2 96.2 other OPPS APC 96.2 27.63 26.58 percent of total billed charges 96.2 96.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE LABRALTAPE 1.5 MM L36 IN WHITE SUP-AR-7500 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE SUTURETAPE L40 IN OD1.3 MM X 2 STRAND BLACK BLUE WHITE SUP-AR-7501 CDM 0270 RC outpatient 169 169 169 74 125.06 percent of total billed charges 169 93 136.89 percent of total billed charges 169 169 other OPPS APC 169 169 other OPPS APC 169 27.63 46.69 percent of total billed charges 169 169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SUTURE 2-0 MINI MENISCUS TAPE REPAIR SUP-AR-7523 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE SUTURETAPE FIBERLINK ENDOSCOPIC TAPE 1.3MM FLAT CLOSED LOOP WHITE BLUE BRAIDED SUP-AR-7535 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE SUTURETAPE TIGERLINK 1.3MM FLAT CLOSED LOOP WHITE BLACK ENDOSCOPIC TAPE BRAIDED NONABSORBABLE SUP-AR-7535T CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBERLINK SUTURETAPE 0.9MM WH/BL SUP-AR-7559 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIGERLINK SUTURETAPE 0.9MM WH/BLK SUP-AR-7559T CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SUTURE PASSING MEDIUM SUP-AR-7816 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC L100 MM OD1.2 MM FOOT ANKLE THREAD STERILE DISPOSABLE COMPRESSION STAPLE INSTRUMENT SET SUP-AR-8005K CDM 0270 RC outpatient 57.2 57.2 57.2 74 42.33 percent of total billed charges 57.2 93 46.33 percent of total billed charges 57.2 57.2 other OPPS APC 57.2 57.2 other OPPS APC 57.2 27.63 15.8 percent of total billed charges 57.2 57.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L25 MM FOOT ANKLE 2 COMPRESSION 2 HOLE SUP-AR-8006-25 CDM 0270 RC outpatient 2327 2327 2327 74 1721.98 percent of total billed charges 2327 93 1884.87 percent of total billed charges 2327 2327 other OPPS APC 2327 2327 other OPPS APC 2327 27.63 642.95 percent of total billed charges 2327 2327 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L30 MM FOOT ANKLE 2 COMPRESSION 2 HOLE SUP-AR-8006-30 CDM 0270 RC outpatient 2327 2327 2327 74 1721.98 percent of total billed charges 2327 93 1884.87 percent of total billed charges 2327 2327 other OPPS APC 2327 2327 other OPPS APC 2327 27.63 642.95 percent of total billed charges 2327 2327 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L25 MM FOOT ANKLE 2 COMPRESSION 3 HOLE SUP-AR-8007-25 CDM 0270 RC outpatient 2587 2587 2587 74 1914.38 percent of total billed charges 2587 93 2095.47 percent of total billed charges 2587 2587 other OPPS APC 2587 2587 other OPPS APC 2587 27.63 714.79 percent of total billed charges 2587 2587 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE ARTHREX 4 HOLE DBL COMPRESSION 25MM SUP-AR-8008-25 CDM 0270 RC outpatient 3107 3107 3107 74 2299.18 percent of total billed charges 3107 93 2516.67 percent of total billed charges 3107 3107 other OPPS APC 3107 3107 other OPPS APC 3107 27.63 858.46 percent of total billed charges 3107 3107 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL STRAIGHT L30 MM FOOT ANKLE 2 COMPRESSION 4 HOLE SUP-AR-8008-30 CDM 0270 RC outpatient 3107 3107 3107 74 2299.18 percent of total billed charges 3107 93 2516.67 percent of total billed charges 3107 3107 other OPPS APC 3107 3107 other OPPS APC 3107 27.63 858.46 percent of total billed charges 3107 3107 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL SQUARE L20 MM FOOT ANKLE 2 COMPRESSION 4 HOLE SUP-AR-8009-20 CDM 0270 RC outpatient 3107 3107 3107 74 2299.18 percent of total billed charges 3107 93 2516.67 percent of total billed charges 3107 3107 other OPPS APC 3107 3107 other OPPS APC 3107 27.63 858.46 percent of total billed charges 3107 3107 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE ARTHREX 4 HOLE DBL COMPRESSION SQUARE 20MM SUP-AR-8009-25 CDM 0270 RC outpatient 3107 3107 3107 74 2299.18 percent of total billed charges 3107 93 2516.67 percent of total billed charges 3107 3107 other OPPS APC 3107 3107 other OPPS APC 3107 27.63 858.46 percent of total billed charges 3107 3107 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POWER PICK 30DEG SUP-AR-8150PP-30 CDM 0270 RC outpatient 262.6 262.6 262.6 74 194.32 percent of total billed charges 262.6 93 212.71 percent of total billed charges 262.6 262.6 other OPPS APC 262.6 262.6 other OPPS APC 262.6 27.63 72.56 percent of total billed charges 262.6 262.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POWERPICK 1.5MM SUP-AR-8150PP-45 CDM 0270 RC outpatient 377 377 377 74 278.98 percent of total billed charges 377 93 305.37 percent of total billed charges 377 377 other OPPS APC 377 377 other OPPS APC 377 27.63 104.17 percent of total billed charges 377 377 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 91MM SS FIBULA RIGHT DISTAL 5 HOLE LOCK MODULAR LOW PROFILE SUP-AR-8343BR-05 CDM 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISSECTOR ENDOSCOPIC COOLCUT L13 CM OD3.5 MM ARTHROSCOPY SUP-AR-8350DS CDM 0270 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 27.63 30.17 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER BONE CUTTING COOLCUT L13 CM OD3.8 MM SUP-AR-8380BC CDM 0270 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 27.63 30.17 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SHAVER COOLCUT L13 CM OD3.8 MM SLOT WHISKER STERILE DISPOSABLE SUP-AR-8380SW CDM 0270 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 27.63 30.17 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER ARTHROSCOPIC COOLCUT CURVE L13 CM OD4 MM BONE STERILE SUP-AR-8400BC CDM 0270 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 27.63 30.17 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISSECTOR ENDOSCOPIC COOLCUT CURVE L13 CM OD4 MM SERRATE TOOTH STERILE DISPOSABLE ARTHROSCOPY SUP-AR-8400CDS CDM 0270 RC outpatient 96.2 96.2 96.2 74 71.19 percent of total billed charges 96.2 93 77.92 percent of total billed charges 96.2 96.2 other OPPS APC 96.2 96.2 other OPPS APC 96.2 27.63 26.58 percent of total billed charges 96.2 96.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SHAVER CLEARCUT COOLCUT 8 FLUTE ROUND L13 CM OD4 MM STERILE SUP-AR-8400CRE CDM 0270 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 27.63 30.17 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SHAVER CLEARCUT COOLCUT 6 FLUTE L13 CM OD4 MM SLAP STERILE SUP-AR-8400CSS CDM 0270 RC outpatient 96.2 96.2 96.2 74 71.19 percent of total billed charges 96.2 93 77.92 percent of total billed charges 96.2 96.2 other OPPS APC 96.2 96.2 other OPPS APC 96.2 27.63 26.58 percent of total billed charges 96.2 96.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SHAVER SABRETOOTH COOLCUT STAINLESS STEEL CURVE L13 CM OD4 MM RESECTION STERILE DISPOSABLE SUP-AR-8400CST CDM 0270 RC outpatient 96.2 96.2 96.2 74 71.19 percent of total billed charges 96.2 93 77.92 percent of total billed charges 96.2 96.2 other OPPS APC 96.2 96.2 other OPPS APC 96.2 27.63 26.58 percent of total billed charges 96.2 96.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SHAVER TORPEDO CURVE 13CM 4MM SUP-AR-8400CTD CDM 0270 RC outpatient 262.6 262.6 262.6 74 194.32 percent of total billed charges 262.6 93 212.71 percent of total billed charges 262.6 262.6 other OPPS APC 262.6 262.6 other OPPS APC 262.6 27.63 72.56 percent of total billed charges 262.6 262.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SHAVER COOLCUT L13 CM OD4 MM STERILE DISPOSABLE SUP-AR-8400DS CDM 0270 RC outpatient 96.2 96.2 96.2 74 71.19 percent of total billed charges 96.2 93 77.92 percent of total billed charges 96.2 96.2 other OPPS APC 96.2 96.2 other OPPS APC 96.2 27.63 26.58 percent of total billed charges 96.2 96.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RASP SURGICAL POWERASP COOLCUT FLAT L13 CM X W4 MM SMOOTH SUP-AR-8400PR CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SHAVER SABRETOOTH COOLCUT L12.5 MM OD4 MM STERILE DISPOSABLE SUP-AR-8400ST CDM 0270 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 27.63 30.17 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SHAVER CLEARCUT OVAL L13 CM OD5 MM 12 FLUTE SUP-AR-8500COT CDM 0270 RC outpatient 96.2 96.2 96.2 74 71.19 percent of total billed charges 96.2 93 77.92 percent of total billed charges 96.2 96.2 other OPPS APC 96.2 96.2 other OPPS APC 96.2 27.63 26.58 percent of total billed charges 96.2 96.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHAVER BURR OVAL CLEARCUT 5.0MM SUP-AR-8500COY CDM 0270 RC outpatient 110.24 110.24 110.24 74 81.58 percent of total billed charges 110.24 93 89.29 percent of total billed charges 110.24 110.24 other OPPS APC 110.24 110.24 other OPPS APC 110.24 27.63 30.46 percent of total billed charges 110.24 110.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SHAVER COOLCUT FLUSHCUT 12 FLUTE OVAL L13 CM OD5 MM SUP-AR-8500FOT CDM 0270 RC outpatient 96.2 96.2 96.2 74 71.19 percent of total billed charges 96.2 93 77.92 percent of total billed charges 96.2 96.2 other OPPS APC 96.2 96.2 other OPPS APC 96.2 27.63 26.58 percent of total billed charges 96.2 96.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM L26 MM OD4.5 MM ANKLE SUP-AR-8545-26 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM L28 MM OD4.5 MM ANKLE FUSION PLATE SYSTEM SUP-AR-8545-28 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM L30 MM OD4.5 MM ANKLE SUP-AR-8545-30 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE L32 MM OD4.5 MM ANKLE SUP-AR-8545-32 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS 36MM 4.5MM TITANIUM ANKLE SUP-AR-8545-36 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE L38 MM OD4.5 MM ANKLE SUP-AR-8545-38 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS 40MM 4.5MM TITANIUM ANKLE SUP-AR-8545-40 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX LOW PROFILE TI 4.5MM X 44MM SUP-AR-8545-44 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM L50 MM OD4.5 MM ANKLE FUSION PLATE SYSTEM SUP-AR-8545-50 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM L20 MM OD4.5 MM ANKLE LOCK SUP-AR-8545L-20 CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS L24 MM OD4.5 MM ANKLE LOCK LOW PROFILE SUP-AR-8545L-24 CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE L26 MM OD4.5 MM ANKLE LOCK SUP-AR-8545L-26 CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE L32 MM OD4.5 MM ANKLE LOCK SUP-AR-8545L-32 CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE L34 MM OD4.5 MM ANKLE LOCK SUP-AR-8545L-34 CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE L38 MM OD4.5 MM ANKLE LOCK SUP-AR-8545L-38 CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ARTHREX LOW PROFILE SCREWS TITANIUM L42 MM OD4.5 MM LOCK STERILE SUP-AR-8545L-42 CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ARTHREX TITANIUM L44 MM OD4.5 MM LOCK LOW PROFILE NONSTERILE SUP-AR-8545L-44 CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOW PROFILE LOCKING 4.5MM X 55MM STERILE SUP-AR-8545L-55S CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR SHAVER CLEARCUT COOLCUT 8 FLUTE ROUND L13 CM OD5.5 MM STERILE DISPOSABLE SUP-AR-8550CRE CDM 0270 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 27.63 30.17 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SHAVER EXCALIBUR COOLCUT L13 CM OD5.5 MM STERILE DISPOSABLE SUP-AR-8550EX CDM 0270 RC outpatient 96.2 96.2 96.2 74 71.19 percent of total billed charges 96.2 93 77.92 percent of total billed charges 96.2 96.2 other OPPS APC 96.2 96.2 other OPPS APC 96.2 27.63 26.58 percent of total billed charges 96.2 96.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SHAVER POWERASP COOLCUT PARTIAL THREAD LOW PROFILE L13 CM X W5.5 MM STERILE SUP-AR-8550PR CDM 0270 RC outpatient 377 377 377 74 278.98 percent of total billed charges 377 93 305.37 percent of total billed charges 377 377 other OPPS APC 377 377 other OPPS APC 377 27.63 104.17 percent of total billed charges 377 377 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM L25 MM OD5.5 MM CANCELLOUS ANKLE FUSION PLATE SYSTEM SUP-AR-8555-25 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM L40 MM OD5.5 MM ANKLE CANCELLOUS SUP-AR-8555-40 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL OD 3 MM CANNULATED DISPOSABLE 4.3 MM HEADLESS COMPRESSION SCREW SUP-AR-8610DB-43C CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION ARTHREX KIRSCHNER L 170 MM OD 1.35 MM NONSTERILE SUP-AR-8610K-43 CDM 0270 RC outpatient 52 52 52 74 38.48 percent of total billed charges 52 93 42.12 percent of total billed charges 52 52 other OPPS APC 52 52 other OPPS APC 52 27.63 14.37 percent of total billed charges 52 52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T15 PARTIAL THREAD L 40 MM OD 4.3MM COMPRESSION CANNUALTED SELF TAP HEADLESS SUP-AR-8643-40 CDM 0270 RC outpatient 975 975 975 74 721.5 percent of total billed charges 975 93 789.75 percent of total billed charges 975 975 other OPPS APC 975 975 other OPPS APC 975 27.63 269.39 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T 15 PARTIAL THREAD L 46 MM OD 4.3 MM COMPRESSION CANNUALTED SELF TAP HEADLESS SUP-AR-8643-46 CDM 0270 RC outpatient 975 975 975 74 721.5 percent of total billed charges 975 93 789.75 percent of total billed charges 975 975 other OPPS APC 975 975 other OPPS APC 975 27.63 269.39 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM FIXATION CPR MINI SCORPION DX SUP-AR-8690DS CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE BONE STAINLESS STEEL SMALL L8 MM SUTURE SUP-AR-8708 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PLAPLE 12MM SS DIAPHYSIS LOW PROFILE SUP-AR-8714 CDM 0270 RC outpatient 1001 1001 1001 74 740.74 percent of total billed charges 1001 93 810.81 percent of total billed charges 1001 1001 other OPPS APC 1001 1001 other OPPS APC 1001 27.63 276.58 percent of total billed charges 1001 1001 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE PLAPLE STAINLESS STEEL LOW PROFILE L15 MM SMALL BONE 2.3 MM CORTICAL SCREW SUP-AR-8715 CDM 0270 RC outpatient 1001 1001 1001 74 740.74 percent of total billed charges 1001 93 810.81 percent of total billed charges 1001 1001 other OPPS APC 1001 1001 other OPPS APC 1001 27.63 276.58 percent of total billed charges 1001 1001 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE QUICKFIX TITANIUM T8 PARTIAL THREAD HEXALOBE LOW PROFILE L14 MM OD2.4 MM SMALL BONE CORTICAL SELF DRILL SELF TAP CANNULATED SNAP OFF ACCEPTS .034 IN GUIDEWIRE SUP-AR-8724-14 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T8 FULL THREAD 16MM 2.4MM TITANIUM CORTICAL SELF DRILL SELF TAP CANNULATED HEXALOBE SUP-AR-8724-16 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T8 FULL THREAD 18MM 2.4MM TITANIUM CORTICAL SELF DRILL SELF TAP CANNULATED HEXALOBE SUP-AR-8724-18 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T8 FULL THREAD 20MM 2.4MM TITANIUM CORTICAL SELF DRILL SELF TAP CANNULATED HEXALOBE SUP-AR-8724-20 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T8 FULL THREAD 22MM 2.4MM TITANIUM CORTICAL SELF DRILL SELF TAP CANNULATED HEXALOBE SUP-AR-8724-22 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T8 FULL THREAD 24MM 2.4MM TITANIUM CORTICAL SELF DRILL SELF TAP CANNULATED HEXALOBE SUP-AR-8724-24 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T8 FULL THREAD 26MM 2.4MM TITANIUM CORTICAL SELF DRILL SELF TAP CANNULATED HEXALOBE SUP-AR-8724-26 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T8 FULL THREAD 28MM 2.4MM TITANIUM CORTICAL SELF DRILL SELF TAP CANNULATED HEXALOBE SUP-AR-8724-28 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T8 FULL THREAD 30MM 2.4MM TITANIUM CORTICAL SELF DRILL SELF TAP CANNULATED HEXALOBE SUP-AR-8724-30 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE COMPRESSION FT TITANIUM 1.5 MM MICRO FULL THREAD L26 MM OD2.5 MM COMPRESSION SELF TAP CANNULATED HEX SUP-AR-8725-26H CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CREW BONE COMPRESSION FT TITANIUM 1.5 MM MICRO FULL THREAD L30 MM OD2.5 MM COMPRESSION SELF TAP CANNULATED HEX SUP-AR-8725-30H CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE QUICKFIX TITANIUM T10 PARTIAL THREAD HEXALOBE LOW PROFILE L14 MM OD3 MM SMALL BONE CANCELLOUS SELF DRILL SELF TAP CANNULATED ACCEPTS .045 IN GUIDEWIRE SUP-AR-8730-14PT CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE QUICKFIX TITANIUM T10 PARTIAL THREAD HEXALOBE LOW PROFILE L16 MM OD3 MM SMALL BONE CANCELLOUS SELF DRILL SELF TAP CANNULATED ACCEPTS .045 IN GUIDEWIRE SUP-AR-8730-16PT CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE QUICKFIX TITANIUM T10 PARTIAL THREAD HEXALOBE LOW PROFILE L18 MM OD3 MM SMALL BONE CANCELLOUS SELF DRILL SELF TAP CANNULATED ACCEPTS .045 IN GUIDEWIRE SUP-AR-8730-18PT CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE QUICKFIX T10 PARTIAL THREAD 26MM 3MM TITANIUM CANCELLOUS CANNULATED SELF TAP SELF DRILL HEXALOBE ACCEPTS .045 SUP-AR-8730-26PT CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE COMPRESSION FT MINI FULL THREAD L34 MM OD3.5 MM SUP-AR-8730-34H CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC QUICKFIX OD1.35 MM CANNULATED TROCAR TIP SUP-AR-8737-01 CDM 0270 RC outpatient 39 39 39 74 28.86 percent of total billed charges 39 93 31.59 percent of total billed charges 39 39 other OPPS APC 39 39 other OPPS APC 39 27.63 10.78 percent of total billed charges 39 39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC QUICKFIX OD.045 IN CANNULATED LASER LINE TROCAR SUP-AR-8737-04 CDM 0270 RC outpatient 39 39 39 74 28.86 percent of total billed charges 39 93 31.59 percent of total billed charges 39 39 other OPPS APC 39 39 other OPPS APC 39 27.63 10.78 percent of total billed charges 39 39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL QUICKFIX OD2.5 MM CANNULATED SUP-AR-8737-09 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE MEASURING QUICKFIX TRIPLEPLAY CANNULATED 3 MM SCREW SUP-AR-8737-13 CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL STRAIGHT OD2 MM CANNULATED DISPOSABLE MICRO COMPRESSION FULL THREAD SCREW SUP-AR-8737-34 CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC OD.045 IN 2 TROCAR TIP LASER MARK SUP-AR-8737-41KD CDM 0270 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 27.63 21.55 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL STRAIGHT OD2.7 MM CALIBRATE CANNULATED STANDARD COMPRESSION FT 4 MM SCREW SUP-AR-8737-50 CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE QUICKFIX TITANIUM SHORT PARTIAL THREAD T15 HEXALOBE LOW PROFILE L20 MM OD4 MM SMALL BONE CANCELLOUS BIOCOMPATIBLE SELF DRILL SELF TAP CANNULATED ACCEPTS .053 IN GUIDEWIRE SUP-AR-8740-20PTS CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE QUICKFIX TITANIUM T15 SHORT THREAD L24 MM OD4 MM CANCELLOUS CANNULATED SELF TAP SELF DRILL HEXALOBE ACCEPTS .053 IN GUIDEWIRE SUP-AR-8740-24PTS CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW QUICKFIX CANNULATED 4.0MM X 28 SUP-AR-8740-28-PTS CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE QUICKFIX T15 SHORT THREAD 32MM 4MM TITANIUM CANCELLOUS CANNULATED SELF TAP SELF DRILL HEXALOBE ACCEPTS .053IN SUP-AR-8740-32PTS CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIAM 4.0X34MM SUP-AR-8740-34PTS CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW QUICKFIX CANNULATED 4.0MM X 39 SUP-AR-8740-38-PTS CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE COMPRESSION FT TITANIUM STANDARD FULL THREAD L40 MM OD4 MM COMPRESSION SELF TAP CANNULATED HEX SUP-AR-8740-40H CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TITANIUM CANNULATED QUICKFIX 4.0X40MM SUP-AR-8740-40PTS CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE COMPRESSION FT TITANIUM STANDARD FULL THREAD L42 MM OD4 MM COMPRESSION SELF TAP CANNULATED HEX SUP-AR-8740-42H CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX QUICKFIX TI CAN 4.0 X 42MM SUP-AR-8740-42PTS CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE QUICKFIX T15 SHORT THREAD 46MM 4MM TITANIUM CANCELLOUS CANNULATED SELF TAP SELF DRILL HEXALOBE ACCEPTS .053IN SUP-AR-8740-46PTS CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX QUICKFIX TI CAN 4.0 X 50MM SUP-AR-8740-50PTS CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL XL PROFILE DISPOSABLE 7 MM SCREW SUP-AR-8770-03 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE SUP-AR-8770-50H CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L80 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE SUP-AR-8770-80H CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L90 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE SUP-AR-8770-90H CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L95 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE SUP-AR-8770-95H CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC ARTHREX OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW SUP-AR-8770K CDM 0270 RC outpatient 39 39 39 74 28.86 percent of total billed charges 39 93 31.59 percent of total billed charges 39 39 other OPPS APC 39 39 other OPPS APC 39 27.63 10.78 percent of total billed charges 39 39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL L14 MM OD2.7 MM CORTICAL NONLOCK STERILE ANKLE FRACTURE MANAGEMENT SYSTEM SUP-AR-8827-14 CDM 0270 RC outpatient 117 117 117 74 86.58 percent of total billed charges 117 93 94.77 percent of total billed charges 117 117 other OPPS APC 117 117 other OPPS APC 117 27.63 32.33 percent of total billed charges 117 117 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE STAINLESS STEEL T10 FULL THREAD L18 MM OD2.7 MM CORTEX SELF TAP ANKLE FRACTURE MANAGEMENT SUP-AR-8827-18 CDM 0270 RC outpatient 117 117 117 74 86.58 percent of total billed charges 117 93 94.77 percent of total billed charges 117 117 other OPPS APC 117 117 other OPPS APC 117 27.63 32.33 percent of total billed charges 117 117 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL L34 MM OD2.7 MM FOOT ANKLE CORTICAL SOLID SHAFT KNOTLESS TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8827-34 CDM 0270 RC outpatient 117 117 117 74 86.58 percent of total billed charges 117 93 94.77 percent of total billed charges 117 117 other OPPS APC 117 117 other OPPS APC 117 27.63 32.33 percent of total billed charges 117 117 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL L36 MM OD2.7 MM FOOT ANKLE CORTICAL SOLID SHAFT KNOTLESS TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8827-36 CDM 0270 RC outpatient 117 117 117 74 86.58 percent of total billed charges 117 93 94.77 percent of total billed charges 117 117 other OPPS APC 117 117 other OPPS APC 117 27.63 32.33 percent of total billed charges 117 117 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL L44 MM OD2.7 MM FOOT ANKLE CORTICAL SOLID SHAFT KNOTLESS TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8827-44 CDM 0270 RC outpatient 117 117 117 74 86.58 percent of total billed charges 117 93 94.77 percent of total billed charges 117 117 other OPPS APC 117 117 other OPPS APC 117 27.63 32.33 percent of total billed charges 117 117 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL L46 MM OD2.7 MM FOOT ANKLE CORTICAL SOLID SHAFT KNOTLESS TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8827-46 CDM 0270 RC outpatient 117 117 117 74 86.58 percent of total billed charges 117 93 94.77 percent of total billed charges 117 117 other OPPS APC 117 117 other OPPS APC 117 27.63 32.33 percent of total billed charges 117 117 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL OD2.7 MM 2.7/3 MM SCREW ANKLE FRACTURE MANAGEMENT SYSTEM SUP-AR-8827D-01 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX 2.7MM LP LOCKING 10MM SUP-AR-8827L-10 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX 2.7MM LP LOCKING 12MM SUP-AR-8827L-12 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX 2.7MM LP LOCKING 14MM SUP-AR-8827L-14 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX 2.7MM LP LOCKING 16MM SUP-AR-8827L-16 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX 2.7MM LP LOCKING 18MM SUP-AR-8827L-18 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX 2.7MM LP LOCKING 20MM SUP-AR-8827L-20 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX 2.7MM LP LOCKING 22MM SUP-AR-8827L-22 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX 2.7MM LP LOCKING 24MM SUP-AR-8827L-24 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX 2.7MM LP LOCKING 26MM SUP-AR-8827L-26 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 CANCELLOUS NON LOCKING LP 10MM SUP-AR-8830-10 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 CANCELLOUS NON LOCKING LP 12MM SUP-AR-8830-12 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 CANCELLOUS NON LOCKING LP 14MM SUP-AR-8830-14 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 CANCELLOUS NON LOCKING LP 16MM SUP-AR-8830-16 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 CANCELLOUS NON LOCKING LP 18MM SUP-AR-8830-18 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 CANCELLOUS NON LOCKING LP 20MM SUP-AR-8830-20 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 CANCELLOUS NON LOCKING LP 22MM SUP-AR-8830-22 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 CANCELLOUS NON LOCKING LP 24MM SUP-AR-8830-24 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 CANCELLOUS NON LOCKING LP 26MM SUP-AR-8830-26 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 CANCELLOUS NON LOCKING LP 28MM SUP-AR-8830-28 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 3.0 CANCELLOUS NON LOCKING LP 30MM SUP-AR-8830-30 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 10MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE SELF TAP TIGHTROPE SUP-AR-8835-10 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 12MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE SELF TAP TIGHTROPE SUP-AR-8835-12 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 14MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE SELF TAP TIGHTROPE SUP-AR-8835-14 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 16MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE SELF TAP TIGHTROPE SUP-AR-8835-16 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 18MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE SELF TAP TIGHTROPE SUP-AR-8835-18 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 20MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE SELF TAP TIGHTROPE SUP-AR-8835-20 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 22MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE SELF TAP TIGHTROPE SUP-AR-8835-22 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 24MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE SELF TAP TIGHTROPE SUP-AR-8835-24 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 26MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE SELF TAP TIGHTROPE SUP-AR-8835-26 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 28MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE SELF TAP TIGHTROPE SUP-AR-8835-28 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL T15 HEXALOBE FULL THREAD L30 MM OD3.5 MM ANKLE CORTICAL MODULAR SELF DRILL SOLID TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8835-30 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL T15 HEXALOBE FULL THREAD L30 MM OD3.5 MM ANKLE CORTICAL MODULAR SELF DRILL SOLID TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8835-32 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 34MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE SELF TAP TIGHTROPE SUP-AR-8835-34 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL T15 FULL THREAD HEXALOBE L35 MM OD3.5 MM ANKLE CORTICAL SELF DRILL SOLID MODULAR TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8835-35 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 36MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE SELF TAP TIGHTROPE SUP-AR-8835-36 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL T15 HEXALOBE FULL THREAD L38 MM OD3.5 MM ANKLE CORTICAL MODULAR SELF DRILL SOLID TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8835-38 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 40MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE SELF TAP TIGHTROPE SUP-AR-8835-40 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 42MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE SELF TAP TIGHTROPE SUP-AR-8835-42 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL T15 FULL THREAD HEXALOBE L44 MM OD3.5 MM ANKLE CORTICAL SELF DRILL SOLID MODULAR TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8835-44 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL T15 FULL THREAD HEXALOBE L45 MM OD3.5 MM ANKLE CORTICAL SELF DRILL SOLID MODULAR TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8835-45 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL T15 HEXALOBE FULL THREAD L46 MM OD3.5 MM ANKLE CORTICAL MODULAR SELF DRILL SOLID TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8835-46 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL T15 FULL THREAD HEXALOBE L50 MM OD3.5 MM ANKLE CORTICAL SELF DRILL SOLID MODULAR TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8835-50 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL T15 FULL THREAD HEXALOBE L55 MM OD3.5 MM ANKLE CORTICAL SELF DRILL SOLID MODULAR TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8835-55 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL T15 FULL THREAD HEXALOBE L60 MM OD3.5 MM ANKLE CORTICAL SELF DRILL SOLID MODULAR TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8835-60 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL T15 FULL THREAD HEXALOBE L10 MM OD3.5 MM ANKLE CORTICAL SELF DRILL SOLID LOCK MODULAR TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8835L-10 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 12MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE LOCK TIGHTROPE SUP-AR-8835L-12 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 14MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE LOCK TIGHTROPE SUP-AR-8835L-14 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 16MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE LOCK TIGHTROPE SUP-AR-8835L-16 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL T15 FULL THREAD HEXALOBE L18 MM OD3.5 MM ANKLE CORTICAL SELF DRILL SOLID LOCK MODULAR TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8835L-18 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 20MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE LOCK TIGHTROPE SUP-AR-8835L-20 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 22MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE LOCK TIGHTROPE SUP-AR-8835L-22 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL T15 HEXALOBE FULL THREAD L24 MM OD3.5 MM ANKLE CORTICAL LOCK MODULAR SELF DRILL SOLID TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8835L-24 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL T15 HEXALOBE FULL THREAD L26 MM OD3.5 MM ANKLE CORTICAL LOCK MODULAR SELF DRILL SOLID TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8835L-26 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL T15 HEXALOBE FULL THREAD L28 MM OD3.5 MM ANKLE CORTICAL LOCK MODULAR SELF DRILL SOLID TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8835L-28 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL T15 FULL THREAD HEXALOBE L30 MM OD3.5 MM ANKLE CORTICAL SELF DRILL SOLID LOCK MODULAR TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8835L-30 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 32MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE LOCK TIGHTROPE SUP-AR-8835L-32 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL T15 HEXALOBE FULL THREAD L34 MM OD3.5 MM ANKLE CORTICAL LOCK MODULAR SELF DRILL SOLID TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8835L-34 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 36MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE LOCK TIGHTROPE SUP-AR-8835L-36 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 38MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE LOCK TIGHTROPE SUP-AR-8835L-38 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 40MM 3.5MM SS ANKLE CORTICAL MODULAR SOLID HEXALOBE LOCK TIGHTROPE SUP-AR-8835L-40 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL T15 FULL THREAD HEXALOBE L45 MM OD3.5 MM ANKLE CORTICAL SELF DRILL SOLID LOCK MODULAR TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8835L-45 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS STAINLESS STEEL T15 HEXALOBE FULL THREAD L50 MM OD3.5 MM ANKLE CORTICAL LOCK MODULAR SELF DRILL SOLID TIGHTROPE SYNDESMOSIS FIXATION SUP-AR-8835L-50 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 10MM SUP-AR-8840-10 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 12MM SUP-AR-8840-12 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 14MM SUP-AR-8840-14 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 16MM SUP-AR-8840-16 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 18MM SUP-AR-8840-18 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 20MM SUP-AR-8840-20 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 22MM SUP-AR-8840-22 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 24MM SUP-AR-8840-24 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 26MM SUP-AR-8840-26 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 28MM SUP-AR-8840-28 CDM 0270 RC outpatient 88.4 88.4 88.4 74 65.42 percent of total billed charges 88.4 93 71.6 percent of total billed charges 88.4 88.4 other OPPS APC 88.4 88.4 other OPPS APC 88.4 27.63 24.42 percent of total billed charges 88.4 88.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 30MM SUP-AR-8840-30 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 32MM SUP-AR-8840-32 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 34MM SUP-AR-8840-34 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 36MM SUP-AR-8840-36 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 38MM SUP-AR-8840-38 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 40MM SUP-AR-8840-40 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 42MM SUP-AR-8840-42 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 44MM SUP-AR-8840-44 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 45MM SUP-AR-8840-45 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 46MM SUP-AR-8840-46 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 48MM SUP-AR-8840-48 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 50MM SUP-AR-8840-50 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 55MM SUP-AR-8840-55 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP NONLOCKING CANCELLOUS 60MM SUP-AR-8840-60 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANNULATED 30MM SUP-AR-8840C-30 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANNULATED 32MM SUP-AR-8840C-32 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANNULATED 34MM SUP-AR-8840C-34 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANNULATED 35MM SUP-AR-8840C-35 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANNULATED 36MM SUP-AR-8840C-36 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANNULATED 38MM SUP-AR-8840C-38 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANNULATED 40MM SUP-AR-8840C-40 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANNULATED 42MM SUP-AR-8840C-42 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANNULATED 44MM SUP-AR-8840C-44 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANNULATED 45MM SUP-AR-8840C-45 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANNULATED 46MM SUP-AR-8840C-46 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANNULATED 48MM SUP-AR-8840C-48 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANNULATED 50MM SUP-AR-8840C-50 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANNULATED 55MM SUP-AR-8840C-55 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANNULATED 60MM SUP-AR-8840C-60 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4MM LOW PROFILE LONG THREAD CANNULTED 30MM SUP-AR-8840CL-30 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4MM LOW PROFILE LONG THREAD CANNULTED 32MM SUP-AR-8840CL-32 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4MM LOW PROFILE LONG THREAD CANNULTED 34MM SUP-AR-8840CL-34 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4MM LOW PROFILE LONG THREAD CANNULTED 35MM SUP-AR-8840CL-35 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4MM LOW PROFILE LONG THREAD CANNULTED 36MM SUP-AR-8840CL-36 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4MM LOW PROFILE LONG THREAD CANNULTED 38MM SUP-AR-8840CL-38 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4MM LOW PROFILE LONG THREAD CANNULTED 40MM SUP-AR-8840CL-40 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4MM LOW PROFILE LONG THREAD CANNULTED 42MM SUP-AR-8840CL-42 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4MM LOW PROFILE LONG THREAD CANNULTED 44MM SUP-AR-8840CL-44 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4MM LOW PROFILE LONG THREAD CANNULTED 45MM SUP-AR-8840CL-45 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4MM LOW PROFILE LONG THREAD CANNULTED 46MM SUP-AR-8840CL-46 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4MM LOW PROFILE LONG THREAD CANNULTED 48MM SUP-AR-8840CL-48 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4MM LOW PROFILE LONG THREAD CANNULTED 50MM SUP-AR-8840CL-50 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4MM LOW PROFILE LONG THREAD CANNULTED 55MM SUP-AR-8840CL-55 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4MM LOW PROFILE LONG THREAD CANNULTED 60MM SUP-AR-8840CL-60 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANCELLOUS 30MM SUP-AR-8840P-30 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANCELLOUS 32MM SUP-AR-8840P-32 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANCELLOUS 34MM SUP-AR-8840P-34 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANCELLOUS 36MM SUP-AR-8840P-36 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANCELLOUS 38MM SUP-AR-8840P-39 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANCELLOUS 40MM SUP-AR-8840P-40 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANCELLOUS 42MM SUP-AR-8840P-42 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANCELLOUS 44MM SUP-AR-8840P-44 CDM 0270 RC outpatient 351 351 351 74 259.74 percent of total billed charges 351 93 284.31 percent of total billed charges 351 351 other OPPS APC 351 351 other OPPS APC 351 27.63 96.98 percent of total billed charges 351 351 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANCELLOUS 46MM SUP-AR-8840P-46 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANCELLOUS 48MM SUP-AR-8840P-48 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANCELLOUS 50MM SUP-AR-8840P-50 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANCELLOUS 55MM SUP-AR-8840P-55 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP SHORT THREAD CANCELLOUS 60MM SUP-AR-8840P-60 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP LONG THREAD CANCELLOUS 30MM SUP-AR-8840PL-30 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP LONG THREAD CANCELLOUS 32MM SUP-AR-8840PL-32 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP LONG THREAD CANCELLOUS 34MM SUP-AR-8840PL-34 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP LONG THREAD CANCELLOUS 36MM SUP-AR-8840PL-36 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP LONG THREAD CANCELLOUS 38MM SUP-AR-8840PL-38 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP LONG THREAD CANCELLOUS 40MM SUP-AR-8840PL-40 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP LONG THREAD CANCELLOUS 42MM SUP-AR-8840PL-42 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP LONG THREAD CANCELLOUS 44MM SUP-AR-8840PL-44 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP LONG THREAD CANCELLOUS 46MM SUP-AR-8840PL-46 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP LONG THREAD CANCELLOUS 48MM SUP-AR-8840PL-48 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP LONG THREAD CANCELLOUS 50MM SUP-AR-8840PL-50 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP LONG THREAD CANCELLOUS 55MM SUP-AR-8840PL-55 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 4.0MM LP LONG THREAD CANCELLOUS 60MM SUP-AR-8840PL-60 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SUTURE STERILE PERCUTANEOUS ACHILLES REPAIR SYSTEM SUP-AR-8860DS CDM 0270 RC outpatient 3887 3887 3887 74 2876.38 percent of total billed charges 3887 93 3148.47 percent of total billed charges 3887 3887 other OPPS APC 3887 3887 other OPPS APC 3887 27.63 1073.98 percent of total billed charges 3887 3887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SUTURE STERILE PERCUTANEOUS ACHILLES REPAIR SYSTEM SUP-AR-8862DS CDM 0270 RC outpatient 3887 3887 3887 74 2876.38 percent of total billed charges 3887 93 3148.47 percent of total billed charges 3887 3887 other OPPS APC 3887 3887 other OPPS APC 3887 27.63 1073.98 percent of total billed charges 3887 3887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 1.7MM SUP-AR-8916-14 CDM 0270 RC outpatient 205.4 205.4 205.4 74 152 percent of total billed charges 205.4 93 166.37 percent of total billed charges 205.4 205.4 other OPPS APC 205.4 205.4 other OPPS APC 205.4 27.63 56.75 percent of total billed charges 205.4 205.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUTTON SUTURE OD12 MM STERILE SUP-AR-8922 CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE QUICKFIX T8 PARTIAL THREAD HEXALOBE LOW PROFILE 12MM 2.4MM TITANIUM SM SUP-AR-8924-12 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX LOW PROFILE 2.4MM X 28 SUP-AR-8924-28 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX LOW PROFILE 2.4MM X 30 SUP-AR-8924-30 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM FIXATION TIGHTROPE XP STAINLESS STEEL SYNDESMOSIS REPAIR SUP-AR-8925SS CDM 0270 RC outpatient 3887 3887 3887 74 2876.38 percent of total billed charges 3887 93 3148.47 percent of total billed charges 3887 3887 other OPPS APC 3887 3887 other OPPS APC 3887 27.63 1073.98 percent of total billed charges 3887 3887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTUREBRIDGE BIOCOMPOSITE ACHILLES SUP-AR-8927BCNF-CP CDM 0270 RC outpatient 4147 4147 4147 74 3068.78 percent of total billed charges 4147 93 3359.07 percent of total billed charges 4147 4147 other OPPS APC 4147 4147 other OPPS APC 4147 27.63 1145.82 percent of total billed charges 4147 4147 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE BIO-CORKSCREW FIBERWIRE POLY L LACTIDE CO D L LACTIDE ACID 1 LARGE FULL THREAD TAPER L15 MM OD5.5 MM BRAID NEEDLE SUP-AR-8927BNF CDM 0270 RC outpatient 767 767 767 74 567.58 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 27.63 211.92 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET IMPLANT SUTUREBRIDGE LARGE TAPER ANCHOR DRILL GUIDE NEEDLE PUNCH TAP ACHILLES PACK SUP-AR-8927BNF-CP CDM 0270 RC outpatient 4147 4147 4147 74 3068.78 percent of total billed charges 4147 93 3359.07 percent of total billed charges 4147 4147 other OPPS APC 4147 4147 other OPPS APC 4147 27.63 1145.82 percent of total billed charges 4147 4147 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET IMPLANT SUTUREBRIDGE ANCHOR DRILL GUIDE PUNCH TAP ACHILLES PACK SUP-AR-8928BC-CP CDM 0270 RC outpatient 4524 4524 4524 74 3347.76 percent of total billed charges 4524 93 3664.44 percent of total billed charges 4524 4524 other OPPS APC 4524 4524 other OPPS APC 4524 27.63 1249.98 percent of total billed charges 4524 4524 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ACHILLES SPEEDB WITH JUMP SUP-AR-8928BCJ-CP CDM 0270 RC outpatient 5187 5187 5187 74 3838.38 percent of total billed charges 5187 93 4201.47 percent of total billed charges 5187 5187 other OPPS APC 5187 5187 other OPPS APC 5187 27.63 1433.17 percent of total billed charges 5187 5187 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM FIXATION SPEEDBRIDGE ACHILLES MIDSUBSTANCE SUP-AR-8929BC-CP CDM 0270 RC outpatient 2535 2535 2535 74 1875.9 percent of total billed charges 2535 93 2053.35 percent of total billed charges 2535 2535 other OPPS APC 2535 2535 other OPPS APC 2535 27.63 700.42 percent of total billed charges 2535 2535 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 2MM 11MM QUICKFIX TITANIUM FULL THREAD FOOT HAND ANKLE WRIST 3 PRONG SELF SUP-AR-8930-11 CDM 0270 RC outpatient 624 624 624 74 461.76 percent of total billed charges 624 93 505.44 percent of total billed charges 624 624 other OPPS APC 624 624 other OPPS APC 624 27.63 172.41 percent of total billed charges 624 624 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE QUICKFIX FULL THREAD 12MM 2MM BLUE TITANIUM 3 PRONG SELF DRILL SELF TAP SNAP OFF SUP-AR-8930-12 CDM 0270 RC outpatient 624 624 624 74 461.76 percent of total billed charges 624 93 505.44 percent of total billed charges 624 624 other OPPS APC 624 624 other OPPS APC 624 27.63 172.41 percent of total billed charges 624 624 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE QUICKFIX FULL THREAD 13MM 2MM GREEN TITANIUM 3 PRONG SELF DRILL SELF TAP SNAP OFF SUP-AR-8930-13 CDM 0270 RC outpatient 624 624 624 74 461.76 percent of total billed charges 624 93 505.44 percent of total billed charges 624 624 other OPPS APC 624 624 other OPPS APC 624 27.63 172.41 percent of total billed charges 624 624 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE QUICKFIX TITANIUM FULL THREAD L14 MM OD2 MM FOOT HAND ANKLE WRIST 3 PRONG SELF DRILL SELF TAP SNAP OFF SOLID PURPLE SUP-AR-8930-14 CDM 0270 RC outpatient 624 624 624 74 461.76 percent of total billed charges 624 93 505.44 percent of total billed charges 624 624 other OPPS APC 624 624 other OPPS APC 624 27.63 172.41 percent of total billed charges 624 624 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX QUICKFIX 3 X 13MM SUP-AR-8931-13 CDM 0270 RC outpatient 624 624 624 74 461.76 percent of total billed charges 624 93 505.44 percent of total billed charges 624 624 other OPPS APC 624 624 other OPPS APC 624 27.63 172.41 percent of total billed charges 624 624 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTERSINK SUP-AR-8932-23 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS FULL THREAD 12MM 3MM TITANIUM FOREFOOT SUP-AR-8933-12 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T10 FULL THREAD 14MM 3MM TITANIUM FOREFOOT CORTICAL SELF TAP SOLID HEXALOBE COMPREHENSIVE SUP-AR-8933-14 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX LOW PROFILE TI 3 X 14MM CANNULATED SUP-AR-8933-14PT CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T10 FULL THREAD 16MM 3MM TITANIUM FOREFOOT CORTICAL SELF TAP SOLID HEXALOBE COMPREHENSIVE SUP-AR-8933-16 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM 2.5 MM PARTIAL THREAD HEXAGON L16 MM OD3 MM FOREFOOT CANCELLOUS SELF DRILL SELF TAP CANNULATED ACCEPTS .045 IN GUIDEWIRE SUP-AR-8933-16PT CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T10 FULL THREAD 18MM 3MM TITANIUM FOREFOOT CORTICAL SELF TAP SOLID HEXALOBE COMPREHENSIVE SUP-AR-8933-18 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM 2.5 MM PARTIAL THREAD HEXAGON L18 MM OD3 MM FOREFOOT CANCELLOUS SELF DRILL SELF TAP CANNULATED ACCEPTS .045 IN GUIDEWIRE SUP-AR-8933-18PT CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LO-PRO 3.0MMX20 SUP-AR-8933-20 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL OD2 MM CANNULATED AO SUP-AR-8933-20C CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM 2.5 MM PARTIAL THREAD HEXAGON L20 MM OD3 MM FOREFOOT CANCELLOUS SELF DRILL SELF TAP CANNULATED ACCEPTS .045 IN GUIDEWIRE SUP-AR-8933-20PT CDM 0270 RC outpatient 273 273 273 74 202.02 percent of total billed charges 273 93 221.13 percent of total billed charges 273 273 other OPPS APC 273 273 other OPPS APC 273 27.63 75.43 percent of total billed charges 273 273 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LO-PRO TITANIUM 3.0X22 SUP-AR-8933-22 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX LOW PROFILE TI 3 X 22MM CANNULATED SUP-AR-8933-22PT CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM FULL THREAD T10 HEXALOBE L24 MM OD3 MM FOREFOOT CORTICAL SELF DRILL SOLID SUP-AR-8933-24 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM 2.5 MM PARTIAL THREAD HEXAGON L24 MM OD3 MM FOREFOOT CANCELLOUS SELF DRILL SELF TAP CANNULATED ACCEPTS .045 IN GUIDEWIRE SUP-AR-8933-24PT CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX LOW PROFILE TI 3MM X 26MM SUP-AR-8933-26 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM 2.5 MM PARTIAL THREAD HEXAGON L26 MM OD3 MM FOREFOOT CANCELLOUS SELF DRILL SELF TAP CANNULATED ACCEPTS .045 IN GUIDEWIRE SUP-AR-8933-26PT CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX LOW PROFILE TI 3MM X 28MM SUP-AR-8933-28 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS 2.5MM PARTIAL THREAD 28MM 3MM TITANIUM FOREFOOT CANCELLOUS SELF DRILL SELF TAP CANNULATED SUP-AR-8933-28PT CDM 0270 RC outpatient 358.8 358.8 358.8 74 265.51 percent of total billed charges 358.8 93 290.63 percent of total billed charges 358.8 358.8 other OPPS APC 358.8 358.8 other OPPS APC 358.8 27.63 99.14 percent of total billed charges 358.8 358.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM 2.5 MM PARTIAL THREAD HEXAGON L30 MM OD3 MM FOREFOOT CANCELLOUS SELF DRILL SELF TAP CANNULATED ACCEPTS .045 IN GUIDEWIRE SUP-AR-8933-30PT CDM 0270 RC outpatient 273 273 273 74 202.02 percent of total billed charges 273 93 221.13 percent of total billed charges 273 273 other OPPS APC 273 273 other OPPS APC 273 27.63 75.43 percent of total billed charges 273 273 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS 2.5MM PARTIAL THREAD 32MM 3MM TITANIUM FOREFOOT CANCELLOUS SELF DRILL SELF TAP CANNULATED SUP-AR-8933-32PT CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE KREULOCK TITANIUM L 12 MM OD 3 MM HYBRID VARIABLE ANGLE NONSTERILE LATEX FREE SUP-AR-8933HVCL-12 CDM 0270 RC outpatient 767 767 767 74 567.58 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 27.63 211.92 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE KREULOCK TITANIUM L 14 MM OD 3 MM HYBRID VARIABLE ANGLE NONSTERILE LATEX FREE SUP-AR-8933HVCL-14 CDM 0270 RC outpatient 767 767 767 74 567.58 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 27.63 211.92 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC L5.91 IN OD.045 IN TROCAR TIP SUP-AR-8933K CDM 0270 RC outpatient 18.2 18.2 18.2 74 13.47 percent of total billed charges 18.2 93 14.74 percent of total billed charges 18.2 18.2 other OPPS APC 18.2 18.2 other OPPS APC 18.2 27.63 5.03 percent of total billed charges 18.2 18.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER L5.91 IN OD.045 IN 2 TROCAR TIP SUP-AR-8933KD CDM 0270 RC outpatient 20.8 20.8 20.8 74 15.39 percent of total billed charges 20.8 93 16.85 percent of total billed charges 20.8 20.8 other OPPS APC 20.8 20.8 other OPPS APC 20.8 27.63 5.75 percent of total billed charges 20.8 20.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T10 FULL THREAD 12MM 3MM TITANIUM FOREFOOT CORTICAL SELF TAP SOLID LOCK HEXALOBE SUP-AR-8933L-12 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T10 FULL THREAD 14MM 3MM TITANIUM FOREFOOT CORTICAL SELF TAP SOLID LOCK HEXALOBE SUP-AR-8933L-14 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T10 FULL THREAD 16MM 3MM TITANIUM FOREFOOT CORTICAL SELF TAP SOLID LOCK HEXALOBE SUP-AR-8933L-16 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T10 FULL THREAD 18MM 3MM TITANIUM FOREFOOT CORTICAL SELF TAP SOLID LOCK HEXALOBE SUP-AR-8933L-18 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE TITANIUM T 15 FULL THREAD L 14 MM OD 3.5 MM MIDFOOT CORTICAL SELF DRILL SOLID HEXALOBE SUP-AR-8935-14 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD HEXALOBE L16 MM OD3.5 MM MIDFOOT CORTICAL SELF DRILL SOLID SUP-AR-8935-16 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD HEXALOBE L18 MM OD3.5 MM MIDFOOT CORTICAL SELF DRILL SOLID SUP-AR-8935-18 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD HEXALOBE L20 MM OD3.5 MM MIDFOOT CORTICAL SELF DRILL SOLID SUP-AR-8935-20 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD HEXALOBE L26 MM OD3.5 MM MIDFOOT CORTICAL SELF DRILL SOLID SUP-AR-8935-26 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD HEXALOBE L28 MM OD3.5 MM MIDFOOT CORTICAL SELF DRILL SOLID SUP-AR-8935-28 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX LOW PROFILE TI 3.5MM X 30MM SUP-AR-8935-30 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 32MM 3.5MM TITANIUM MIDFOOT CORTICAL SELF TAP SOLID HEXALOBE COMPREHENSIVE SUP-AR-8935-32 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 34MM 3.5MM TITANIUM MIDFOOT CORTICAL SELF TAP SOLID HEXALOBE COMPREHENSIVE SUP-AR-8935-34 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 36MM 3.5MM TITANIUM MIDFOOT CORTICAL SELF TAP SOLID HEXALOBE COMPREHENSIVE SUP-AR-8935-36 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 38MM 3.5MM TITANIUM MIDFOOT CORTICAL SELF TAP SOLID HEXALOBE COMPREHENSIVE SUP-AR-8935-38 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 40MM 3.5MM TITANIUM MIDFOOT CORTICAL SELF TAP SOLID HEXALOBE COMPREHENSIVE SUP-AR-8935-40 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD HEXALOBE L42 MM OD3.5 MM MIDFOOT CORTICAL SELF DRILL SOLID SUP-AR-8935-42 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX LOW PROFILE TI 3.5MM X 44MM SUP-AR-8935-44 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX LOW PROFILE TI 3.5MM X 46MM SUP-AR-8935-46 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE KREULOCK TITANIUM L 14 MM OD 3.5 MM NONSTERILE LATEX FREE SUP-AR-8935CL-14 CDM 0270 RC outpatient 767 767 767 74 567.58 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 27.63 211.92 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE KREULOCK TITANIUM L 16 MM OD 3.5 MM NONSTERILE LATEX FREE SUP-AR-8935CL-16 CDM 0270 RC outpatient 767 767 767 74 567.58 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 27.63 211.92 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD L14 MM OD3.5 MM MIDFOOT CORTICAL SELF TAP SOLID HEXALOBE LOCK COMPREHENSIVE FOOT SYSTEM SUP-AR-8935L-14 CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD L16 MM OD3.5 MM MIDFOOT CORTICAL SELF TAP SOLID HEXALOBE LOCK COMPREHENSIVE FOOT SYSTEM SUP-AR-8935L-16 CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD L20 MM OD3.5 MM MIDFOOT CORTICAL SELF TAP SOLID HEXALOBE LOCK COMPREHENSIVE FOOT SYSTEM SUP-AR-8935L-20 CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T15 FULL THREAD HEXALOBE L28 MM OD3.5 MM MIDFOOT CORTICAL SELF DRILL SOLID LOCK SUP-AR-8935L-28 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 30MM 3.5MM TITANIUM MIDFOOT CORTICAL SELF TAP SOLID HEXALOBE LOCK SUP-AR-8935L-30 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T15 FULL THREAD HEXALOBE L32 MM OD3.5 MM MIDFOOT CORTICAL SELF DRILL SOLID LOCK SUP-AR-8935L-32 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 34MM 3.5MM TITANIUM MIDFOOT CORTICAL SELF TAP SOLID HEXALOBE LOCK SUP-AR-8935L-34 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 36MM 3.5MM TITANIUM MIDFOOT CORTICAL SELF TAP SOLID HEXALOBE LOCK SUP-AR-8935L-36 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 38MM 3.5MM TITANIUM MIDFOOT CORTICAL SELF TAP SOLID HEXALOBE LOCK SUP-AR-8935L-38 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX LOCKING TI 3.5MM X 40MM SUP-AR-8935L-40 CDM 0270 RC outpatient 223.6 223.6 223.6 74 165.46 percent of total billed charges 223.6 93 181.12 percent of total billed charges 223.6 223.6 other OPPS APC 223.6 223.6 other OPPS APC 223.6 27.63 61.78 percent of total billed charges 223.6 223.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM T15 FULL THREAD HEXALOBE L42 MM OD3.5 MM MIDFOOT CORTICAL SELF DRILL SOLID LOCK SUP-AR-8935L-42 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD HEXALOBE L18 MM OD4 MM MIDFOOT CANCELLOUS SELF DRILL SOLID SUP-AR-8940-18 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD L28 MM OD4 MM MIDFOOT CANCELLOUS SELF TAP SOLID HEXALOBE COMPREHENSIVE FOOT SYSTEM SUP-AR-8940-28 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD L30 MM OD4 MM MIDFOOT CANCELLOUS SELF TAP SOLID HEXALOBE COMPREHENSIVE FOOT SYSTEM SUP-AR-8940-30 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD L34 MM OD4 MM MIDFOOT CANCELLOUS SELF TAP SOLID HEXALOBE COMPREHENSIVE FOOT SYSTEM SUP-AR-8940-34 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS T15 FULL THREAD 36MM 4MM TITANIUM MIDFOOT CANCELLOUS SELF TAP SOLID HEXALOBE COMPREHENSIVE SUP-AR-8940-36 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD HEXALOBE L38 MM OD4 MM MIDFOOT CANCELLOUS SELF DRILL SOLID SUP-AR-8940-38 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM LOW PROFILE NONSTERILE LAPIDUS SUP-AR-8941 CDM 0270 RC outpatient 2327 2327 2327 74 1721.98 percent of total billed charges 2327 93 1884.87 percent of total billed charges 2327 2327 other OPPS APC 2327 2327 other OPPS APC 2327 27.63 642.95 percent of total billed charges 2327 2327 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC 6IN .062IN SUP-AR-8941-6 CDM 0270 RC outpatient 104 104 104 74 76.96 percent of total billed charges 104 93 84.24 percent of total billed charges 104 104 other OPPS APC 104 104 other OPPS APC 104 27.63 28.74 percent of total billed charges 104 104 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC OD.062 IN TROCAR TIP DISPOSABLE SUP-AR-8941K CDM 0270 RC outpatient 39 39 39 74 28.86 percent of total billed charges 39 93 31.59 percent of total billed charges 39 39 other OPPS APC 39 39 other OPPS APC 39 27.63 10.78 percent of total billed charges 39 39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM LEFT LOW PROFILE NONSTERILE PLANTAR LAPIDUS SUP-AR-8941PL CDM 0270 RC outpatient 3887 3887 3887 74 2876.38 percent of total billed charges 3887 93 3148.47 percent of total billed charges 3887 3887 other OPPS APC 3887 3887 other OPPS APC 3887 27.63 1073.98 percent of total billed charges 3887 3887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE RIGHT PLANTAR NONSTERILE LAPIDUS SUP-AR-8941PR CDM 0270 RC outpatient 3887 3887 3887 74 2876.38 percent of total billed charges 3887 93 3148.47 percent of total billed charges 3887 3887 other OPPS APC 3887 3887 other OPPS APC 3887 27.63 1073.98 percent of total billed charges 3887 3887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 2.6MM CANNULATED SUP-AR-8943-02 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 2.5MM CALIBRATE SUP-AR-8943-13 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 2MM SUP-AR-8943-16 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 2.5MM SUP-AR-8943-30 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 3MM SUP-AR-8943-36 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC L150 MM OD.053 IN ANKLE THREAD TROCAR DISPOSABLE 4 MM CANNULATED SCREW SUP-AR-8943-38 CDM 0270 RC outpatient 52 52 52 74 38.48 percent of total billed charges 52 93 42.12 percent of total billed charges 52 52 other OPPS APC 52 52 other OPPS APC 52 27.63 14.37 percent of total billed charges 52 52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 2.5MM SUP-AR-8943-42 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL LOW PROFILE FIBULA LEFT DISTAL 4 HOLE LOCK MODULAR SUP-AR-8943BL-04 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 91MM SS FIBULA LEFT DISTAL 5 HOLE LOCK MODULAR LOW PROFILE SUP-AR-8943BL-05 CDM 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE ARTHREX LOCKING DISTAL FIBULA LEFT 6 HOLE SUP-AR-8943BL-06 CDM 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 130MM SS FIBULA LEFT DISTAL 8 HOLE LOCK MODULAR LOW PROFILE SUP-AR-8943BL-08 CDM 0270 RC outpatient 2067 2067 2067 74 1529.58 percent of total billed charges 2067 93 1674.27 percent of total billed charges 2067 2067 other OPPS APC 2067 2067 other OPPS APC 2067 27.63 571.11 percent of total billed charges 2067 2067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE ARTHREX LOCKING DISTAL FIBULA LEFT 10 HOLE SUP-AR-8943BL-10 CDM 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE ARTHREX LOCKING DISTAL FIBULA LEFT 12 HOLE SUP-AR-8943BL-12 CDM 0270 RC outpatient 2236 2236 2236 74 1654.64 percent of total billed charges 2236 93 1811.16 percent of total billed charges 2236 2236 other OPPS APC 2236 2236 other OPPS APC 2236 27.63 617.81 percent of total billed charges 2236 2236 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE ARTHREX LOCKING DISTAL FIBULA LEFT 14 HOLE SUP-AR-8943BL-14 CDM 0270 RC outpatient 2262 2262 2262 74 1673.88 percent of total billed charges 2262 93 1832.22 percent of total billed charges 2262 2262 other OPPS APC 2262 2262 other OPPS APC 2262 27.63 624.99 percent of total billed charges 2262 2262 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 79MM SS FIBULA RIGHT DISTAL 4 HOLE LOCK MODULAR LOW PROFILE SUP-AR-8943BR-04 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE ARTHREX LOCKING DISTAL FIBULA RIGHT 5 HOLE SUP-AR-8943BR-05 CDM 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 104MM SS FIBULA RIGHT DISTAL 6 HOLE LOCK MODULAR LOW PROFILE SUP-AR-8943BR-06 CDM 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL LOW PROFILE ANKLE RIGHT FIBULA 8 HOLE LOCK MODULAR SUP-AR-8943BR-08 CDM 0270 RC outpatient 2067 2067 2067 74 1529.58 percent of total billed charges 2067 93 1674.27 percent of total billed charges 2067 2067 other OPPS APC 2067 2067 other OPPS APC 2067 27.63 571.11 percent of total billed charges 2067 2067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE ARTHREX LOCKING DISTAL FIBULA RIGHT 10 HOLE SUP-AR-8943BR-10 CDM 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE ARTHREX LOCKING DISTAL FIBULA RIGHT 12 HOLE SUP-AR-8943BR-12 CDM 0270 RC outpatient 2236 2236 2236 74 1654.64 percent of total billed charges 2236 93 1811.16 percent of total billed charges 2236 2236 other OPPS APC 2236 2236 other OPPS APC 2236 27.63 617.81 percent of total billed charges 2236 2236 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL STRAIGHT L55 MM ANKLE 4 HOLE LOCK SUP-AR-8943C-04 CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL STRAIGHT L93 MM ANKLE 7 HOLE LOCK SUP-AR-8943C-07 CDM 0270 RC outpatient 1365 1365 1365 74 1010.1 percent of total billed charges 1365 93 1105.65 percent of total billed charges 1365 1365 other OPPS APC 1365 1365 other OPPS APC 1365 27.63 377.15 percent of total billed charges 1365 1365 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL STRAIGHT L106 MM ANKLE 8 HOLE LOCK SUP-AR-8943C-08 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL STRAIGHT L131 MM ANKLE 10 HOLE LOCK SUP-AR-8943C-10 CDM 0270 RC outpatient 1547 1547 1547 74 1144.78 percent of total billed charges 1547 93 1253.07 percent of total billed charges 1547 1547 other OPPS APC 1547 1547 other OPPS APC 1547 27.63 427.44 percent of total billed charges 1547 1547 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL STRAIGHT L156 MM ANKLE 12 HOLE LOCK SUP-AR-8943C-12 CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L79 MM FOOT ANKLE MEDIAL 5 HOLE HOOK LOCK SUP-AR-8943H-05 CDM 0270 RC outpatient 2145 2145 2145 74 1587.3 percent of total billed charges 2145 93 1737.45 percent of total billed charges 2145 2145 other OPPS APC 2145 2145 other OPPS APC 2145 27.63 592.66 percent of total billed charges 2145 2145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L97 MM FOOT ANKLE MEDIAL 7 HOLE HOOK LOCK SUP-AR-8943H-07 CDM 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL 1/3 TUBE L47 MM ANKLE 4 HOLE LOCK SUP-AR-8943T-04 CDM 0270 RC outpatient 585 585 585 74 432.9 percent of total billed charges 585 93 473.85 percent of total billed charges 585 585 other OPPS APC 585 585 other OPPS APC 585 27.63 161.64 percent of total billed charges 585 585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL 1/3 TUBE L59 MM ANKLE 5 HOLE LOCK SUP-AR-8943T-05 CDM 0270 RC outpatient 611 611 611 74 452.14 percent of total billed charges 611 93 494.91 percent of total billed charges 611 611 other OPPS APC 611 611 other OPPS APC 611 27.63 168.82 percent of total billed charges 611 611 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL 1/3 TUBE L72 MM ANKLE 6 HOLE LOCK SUP-AR-8943T-06 CDM 0270 RC outpatient 624 624 624 74 461.76 percent of total billed charges 624 93 505.44 percent of total billed charges 624 624 other OPPS APC 624 624 other OPPS APC 624 27.63 172.41 percent of total billed charges 624 624 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL 1/3 TUBE L85 MM ANKLE 7 HOLE LOCK SUP-AR-8943T-07 CDM 0270 RC outpatient 663 663 663 74 490.62 percent of total billed charges 663 93 537.03 percent of total billed charges 663 663 other OPPS APC 663 663 other OPPS APC 663 27.63 183.19 percent of total billed charges 663 663 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL 1/3 TUBE L98 MM ANKLE 8 HOLE LOCK SUP-AR-8943T-08 CDM 0270 RC outpatient 689 689 689 74 509.86 percent of total billed charges 689 93 558.09 percent of total billed charges 689 689 other OPPS APC 689 689 other OPPS APC 689 27.63 190.37 percent of total billed charges 689 689 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL 1/3 TUBE L123 MM ANKLE 10 HOLE LOCK SUP-AR-8943T-10 CDM 0270 RC outpatient 728 728 728 74 538.72 percent of total billed charges 728 93 589.68 percent of total billed charges 728 728 other OPPS APC 728 728 other OPPS APC 728 27.63 201.15 percent of total billed charges 728 728 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL 1/3 TUBE L148 MM ANKLE 12 HOLE LOCK SUP-AR-8943T-12 CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L72 MM ANKLE LATERAL 3 HOLE AVULSION HOOK LOCK SUP-AR-8943TH-03 CDM 0270 RC outpatient 1820 1820 1820 74 1346.8 percent of total billed charges 1820 93 1474.2 percent of total billed charges 1820 1820 other OPPS APC 1820 1820 other OPPS APC 1820 27.63 502.87 percent of total billed charges 1820 1820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L98 MM ANKLE LATERAL 5 HOLE AVULSION HOOK LOCK SUP-AR-8943TH-05 CDM 0270 RC outpatient 1820 1820 1820 74 1346.8 percent of total billed charges 1820 93 1474.2 percent of total billed charges 1820 1820 other OPPS APC 1820 1820 other OPPS APC 1820 27.63 502.87 percent of total billed charges 1820 1820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STAINLESS STEEL L97 MM FOOT ANKLE MEDIAL 7 HOLE HOOK LOCK SUP-AR-8943TH-07 CDM 0270 RC outpatient 1820 1820 1820 74 1346.8 percent of total billed charges 1820 93 1474.2 percent of total billed charges 1820 1820 other OPPS APC 1820 1820 other OPPS APC 1820 27.63 502.87 percent of total billed charges 1820 1820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE ARTHREX NON- LOCKING THIRD TUBULAR 5HOLE SUP-AR-8943TNL-05 CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE ARTHREX NON- LOCKING THIRD TUBULAR 6HOLE SUP-AR-8943TNL-06 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE ARTHREX NON- LOCKING THIRD TUBULAR 7HOLE SUP-AR-8943TNL-07 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE ARTHREX NON- LOCKING THIRD TUBULAR 8HOLE SUP-AR-8943TNL-08 CDM 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL 2MM AO SUP-AR-8944-22 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LOW PROFILE MTP PLATE TITANIUM SHORT STRAIGHT FOREFOOT FUSION MODULE SUP-AR-8944-SP CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE ARTHREX LO PRO MTP PLT CONTRD LNG LTI SUP-AR-8944CL-L CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LOW PROFILE MTP PLATE TITANIUM LONG CONTOUR METATARSOPHALANGEAL LEFT FUSION MODULE SUP-AR-8944CL-P CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE ARTHREX LO PRO MTP PLT CONTRD LNG RTI SUP-AR-8944CR-L CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAMER METATARSAL 22MM SUP-AR-8944MR-22 CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS PARTIAL THREAD 60MM 4.5MM TITANIUM MALLEOLAR CORTICAL SELF DRILL SELF TAP CANNULATED HEX SUP-AR-8945-60PT CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM COTTON LOW PROFILE L2 MM FOOT ANKLE 2.4 MM SCREW SUP-AR-8948-02 CDM 0270 RC outpatient 2067 2067 2067 74 1529.58 percent of total billed charges 2067 93 1674.27 percent of total billed charges 2067 2067 other OPPS APC 2067 2067 other OPPS APC 2067 27.63 571.11 percent of total billed charges 2067 2067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM COTTON LOW PROFILE L4 MM FOOT ANKLE 2.4 MM SCREW SUP-AR-8948-04 CDM 0270 RC outpatient 2067 2067 2067 74 1529.58 percent of total billed charges 2067 93 1674.27 percent of total billed charges 2067 2067 other OPPS APC 2067 2067 other OPPS APC 2067 27.63 571.11 percent of total billed charges 2067 2067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM COTTON LOW PROFILE L6 MM FOOT ANKLE 2.4 MM SCREW SUP-AR-8948-06 CDM 0270 RC outpatient 2067 2067 2067 74 1529.58 percent of total billed charges 2067 93 1674.27 percent of total billed charges 2067 2067 other OPPS APC 2067 2067 other OPPS APC 2067 27.63 571.11 percent of total billed charges 2067 2067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM COTTON LOW PROFILE L8 MM FOOT ANKLE 2.4 MM SCREW SUP-AR-8948-08 CDM 0270 RC outpatient 2067 2067 2067 74 1529.58 percent of total billed charges 2067 93 1674.27 percent of total billed charges 2067 2067 other OPPS APC 2067 2067 other OPPS APC 2067 27.63 571.11 percent of total billed charges 2067 2067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE 104MM SS FIBULA LEFT DISTAL 6 HOLE LOCK MODULAR LOW PROFILE SUP-AR-894BL-06 CDM 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC .045 IN OD3 MM 2 TROCAR TIP GRADUATE DISPOSABLE SUP-AR-8950-06 CDM outpatient 52 52 52 52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE T LOW PROFILE 2.4MM FOOT 7 HOLE SUP-AR-8952MS-07 CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE T TITANIUM FOOT METATARSAL 5 HOLE LOW PROFILE 2.4MM SCREW SUP-AR-8952MT-05 CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STRAIGHT TITANIUM FOOT TARSOMETATARSAL 4 HOLE LOW PROFILE 3MM SCREW SUP-AR-8952TS-04 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM STRAIGHT 5 HOLE LOW PROFILE 3 MM SCREW SUP-AR-8952TS-05 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM T LOW PROFILE L3 MM FOOT 3 HOLE SUP-AR-8952TT-03 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE T TITANIUM FOOT TARSOMETATARSAL 4 HOLE LOW PROFILE 3MM SCREW SUP-AR-8952TT-04 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN FIXATION SCHANZ L150 MM OD5 MM SELF DRILL CALCANEAL FRACTURE SUP-AR-8954-01 CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE ARTHREX CALC FX PERC NR PROC/POST TUBER LEFT SUP-AR-8954YL-L CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LONG LOW PROFILE TAPER CALCANEUS LEFT ANTERIOR POSTERIOR LOCK ATTACHABLE GUIDE PERCUTANEOUS SUP-AR-8954YL-S CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LONG LOW PROFILE TAPER CALCANEUS RIGHT ANTERIOR POSTERIOR LOCK ATTACHABLE GUIDE PERCUTANEOUS SUP-AR-8954YR-L CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STANDARD LOW PROFILE TAPER CALCANEUS RIGHT ANTERIOR POSTERIOR LOCK ATTACHABLE GUIDE PERCUTANEOUS SUP-AR-8954YR-S CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL OD3.5 MM CANNULATED FIFTH METATARSAL FRACTURE SYSTEM SUP-AR-8956C-35PD CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ARTHROSCOPIC L203.2 MM OD.078 IN TROCAR TIP DISPOSABLE SUP-AR-8956K-01 CDM 0270 RC outpatient 65 65 65 74 48.1 percent of total billed charges 65 93 52.65 percent of total billed charges 65 65 other OPPS APC 65 65 other OPPS APC 65 27.63 17.96 percent of total billed charges 65 65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE L278 MM TIBIA RIGHT DISTAL MEDIAL 16 HOLE TAPER TIP OBLONG HOLE LOW PROFILE SUP-AR-8963MR-16 CDM 0270 RC outpatient 4784 4784 4784 74 3540.16 percent of total billed charges 4784 93 3875.04 percent of total billed charges 4784 4784 other OPPS APC 4784 4784 other OPPS APC 4784 27.63 1321.82 percent of total billed charges 4784 4784 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS TITANIUM 3.5 MM L40 MM L18 MM OD6.7 MM CANCELLOUS SELF DRILL SELF TAP CANNULATED HEX ACCEPTS .096 IN GUIDEWIRE SUP-AR-8967-1840 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS 3.5MM 85MM 18MM 6.7MM TITANIUM CANCELLOUS SELF DRILL SELF TAP CANNULATED HEX ACCEPTS .096 SUP-AR-8967-1885 CDM 0270 RC outpatient 572 572 572 74 423.28 percent of total billed charges 572 93 463.32 percent of total billed charges 572 572 other OPPS APC 572 572 other OPPS APC 572 27.63 158.04 percent of total billed charges 572 572 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS 3.5MM 90MM 18MM 6.7MM TITANIUM CANCELLOUS SELF DRILL SELF TAP CANNULATED HEX ACCEPTS .096 SUP-AR-8967-1890 CDM 0270 RC outpatient 572 572 572 74 423.28 percent of total billed charges 572 93 463.32 percent of total billed charges 572 572 other OPPS APC 572 572 other OPPS APC 572 27.63 158.04 percent of total billed charges 572 572 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ARTHROSCOPIC L8 IN OD.092 IN TROCAR DISPOSABLE SUP-AR-8967K CDM 0270 RC outpatient 39 39 39 74 28.86 percent of total billed charges 39 93 31.59 percent of total billed charges 39 39 other OPPS APC 39 39 other OPPS APC 39 27.63 10.78 percent of total billed charges 39 39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ARTHROSCOPIC L12 IN OD.094 IN TROCAR DISPOSABLE SUP-AR-8967K-12 CDM 0270 RC outpatient 57.2 57.2 57.2 74 42.33 percent of total billed charges 57.2 93 46.33 percent of total billed charges 57.2 57.2 other OPPS APC 57.2 57.2 other OPPS APC 57.2 27.63 15.8 percent of total billed charges 57.2 57.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL OD3 MM CALIBRATE SUP-AR-8970-30 CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL OD3 MM CANNULATED SUP-AR-8970-30C CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL ARTHREX LONG OD3 MM CALIBRATE NONSTERILE DISPOSABLE SUP-AR-8970-30L CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL OD4 MM CANNULATED SUP-AR-8970-40C CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM ANKLE LEFT ANTERIOR FUSION SUP-AR-8970AL CDM 0270 RC outpatient 5395 5395 5395 74 3992.3 percent of total billed charges 5395 93 4369.95 percent of total billed charges 5395 5395 other OPPS APC 5395 5395 other OPPS APC 5395 27.63 1490.64 percent of total billed charges 5395 5395 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ANKLE TIBIOTALAR LATERAL FUSION SUP-AR-8970TT CDM 0270 RC outpatient 5395 5395 5395 74 3992.3 percent of total billed charges 5395 93 4369.95 percent of total billed charges 5395 5395 other OPPS APC 5395 5395 other OPPS APC 5395 27.63 1490.64 percent of total billed charges 5395 5395 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL L2.5 MM SYNDESMOSIS SUP-AR-8973-25 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INSTRUMENT FIBULOCK STERILE DISPOSABLE SUP-AR-8973DS CDM 0270 RC outpatient 1820 1820 1820 74 1346.8 percent of total billed charges 1820 93 1474.2 percent of total billed charges 1820 1820 other OPPS APC 1820 1820 other OPPS APC 1820 27.63 502.87 percent of total billed charges 1820 1820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAIL INTRAMEDULLARY FIBULOCK L130 MM OD3 MM FIBULAR LEFT SUP-AR-8973L-30-130 CDM 0270 RC outpatient 7787 7787 7787 74 5762.38 percent of total billed charges 7787 93 6307.47 percent of total billed charges 7787 7787 other OPPS APC 7787 7787 other OPPS APC 7787 27.63 2151.55 percent of total billed charges 7787 7787 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ENDOSCOPIC INSTRUMENT DISPOSABLE DX SWIVELOCK SUP-AR-8979DS CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE DX SWIVELOCK PEEK MEDIUM L13.5 MM OD3.5 MM FOOT ELBOW SCAPHOLUNATE LIGAMENT REPAIR SUP-AR-8979P CDM 0270 RC outpatient 1105 1105 1105 74 817.7 percent of total billed charges 1105 93 895.05 percent of total billed charges 1105 1105 other OPPS APC 1105 1105 other OPPS APC 1105 27.63 305.31 percent of total billed charges 1105 1105 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LO-PRO 5MM X 45MM SUP-AR-9045-45PT CDM 0270 RC outpatient 2067 2067 2067 74 1529.58 percent of total billed charges 2067 93 1674.27 percent of total billed charges 2067 2067 other OPPS APC 2067 2067 other OPPS APC 2067 27.63 571.11 percent of total billed charges 2067 2067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE LOW PROFILE SCREWS PARTIAL THREAD 50MM 4.5MM TITANIUM METATARSUS SOLID SELF TAP JONES FRACTURE SUP-AR-9045-50PT CDM 0270 RC outpatient 2067 2067 2067 74 1529.58 percent of total billed charges 2067 93 1674.27 percent of total billed charges 2067 2067 other OPPS APC 2067 2067 other OPPS APC 2067 27.63 571.11 percent of total billed charges 2067 2067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM PARTIAL THREAD LOW PROFILE L50 MM OD5.5 MM METATARSUS SOLID JONES FRACTURE SUP-AR-9055-50PT CDM 0270 RC outpatient 2067 2067 2067 74 1529.58 percent of total billed charges 2067 93 1674.27 percent of total billed charges 2067 2067 other OPPS APC 2067 2067 other OPPS APC 2067 27.63 571.11 percent of total billed charges 2067 2067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL L132 MM OD5 MM SUP-AR-9100-05P CDM 270010030 LOCAL 0270 RC outpatient 5512.62 5512.62 5512.62 74 4079.34 percent of total billed charges 5512.62 93 4465.22 percent of total billed charges 5512.62 5512.62 other OPPS APC 5512.62 5512.62 other OPPS APC 5512.62 27.63 1523.14 percent of total billed charges 5512.62 5512.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS APEX 132.5 D L60 MM OD5 MM SUP-AR-9100-05S CDM 270010030 LOCAL 0270 RC outpatient 5512.62 5512.62 5512.62 74 4079.34 percent of total billed charges 5512.62 93 4465.22 percent of total billed charges 5512.62 5512.62 other OPPS APC 5512.62 5512.62 other OPPS APC 5512.62 27.63 1523.14 percent of total billed charges 5512.62 5512.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS II L115 MM OD6 MM SHOULDER STERILE SUP-AR-9100-06P CDM 270010030 LOCAL 0270 RC outpatient 5512.62 5512.62 5512.62 74 4079.34 percent of total billed charges 5512.62 93 4465.22 percent of total billed charges 5512.62 5512.62 other OPPS APC 5512.62 5512.62 other OPPS APC 5512.62 27.63 1523.14 percent of total billed charges 5512.62 5512.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS APEX RECTANGLE L60 MM OD6 MM SHOULDER PRESS FIT REMOVABLE TRUNION SUTURE HOLE ARTHROPLASTY SUP-AR-9100-06S CDM 270010030 LOCAL 0270 RC outpatient 5512.62 5512.62 5512.62 74 4079.34 percent of total billed charges 5512.62 93 4465.22 percent of total billed charges 5512.62 5512.62 other OPPS APC 5512.62 5512.62 other OPPS APC 5512.62 27.63 1523.14 percent of total billed charges 5512.62 5512.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS II L140 MM OD7 MM SHOULDER STERILE SUP-AR-9100-07P CDM 270010030 LOCAL 0270 RC outpatient 5512.62 5512.62 5512.62 74 4079.34 percent of total billed charges 5512.62 93 4465.22 percent of total billed charges 5512.62 5512.62 other OPPS APC 5512.62 5512.62 other OPPS APC 5512.62 27.63 1523.14 percent of total billed charges 5512.62 5512.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS APEX RECTANGLE L60 MM OD7 MM SHOULDER PRESS FIT REMOVABLE TRUNION SUTURE HOLE ARTHROPLASTY SUP-AR-9100-07S CDM 270010030 LOCAL 0270 RC outpatient 5512.62 5512.62 5512.62 74 4079.34 percent of total billed charges 5512.62 93 4465.22 percent of total billed charges 5512.62 5512.62 other OPPS APC 5512.62 5512.62 other OPPS APC 5512.62 27.63 1523.14 percent of total billed charges 5512.62 5512.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS II L143 MM OD8 MM SHOULDER STERILE SUP-AR-9100-08P CDM 270010030 LOCAL 0270 RC outpatient 5512.62 5512.62 5512.62 74 4079.34 percent of total billed charges 5512.62 93 4465.22 percent of total billed charges 5512.62 5512.62 other OPPS APC 5512.62 5512.62 other OPPS APC 5512.62 27.63 1523.14 percent of total billed charges 5512.62 5512.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS APEX RECTANGLE L60 MM OD8 MM SHOULDER PRESS FIT REMOVABLE TRUNION SUTURE HOLE ARTHROPLASTY SUP-AR-9100-08S CDM 270010030 LOCAL 0270 RC outpatient 5512.62 5512.62 5512.62 74 4079.34 percent of total billed charges 5512.62 93 4465.22 percent of total billed charges 5512.62 5512.62 other OPPS APC 5512.62 5512.62 other OPPS APC 5512.62 27.63 1523.14 percent of total billed charges 5512.62 5512.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS II L146 MM OD9 MM SHOULDER STERILE SUP-AR-9100-09P CDM 270010030 LOCAL 0270 RC outpatient 5512.65 5512.65 5512.65 74 4079.36 percent of total billed charges 5512.65 93 4465.25 percent of total billed charges 5512.65 5512.65 other OPPS APC 5512.65 5512.65 other OPPS APC 5512.65 27.63 1523.15 percent of total billed charges 5512.65 5512.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS APEX RECTANGLE L60 MM OD9 MM SHOULDER PRESS FIT REMOVABLE TRUNION SUTURE HOLE ARTHROPLASTY SUP-AR-9100-09S CDM 270010030 LOCAL 0270 RC outpatient 5512.62 5512.62 5512.62 74 4079.34 percent of total billed charges 5512.62 93 4465.22 percent of total billed charges 5512.62 5512.62 other OPPS APC 5512.62 5512.62 other OPPS APC 5512.62 27.63 1523.14 percent of total billed charges 5512.62 5512.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS II L148 MM OD10 MM SHOULDER STERILE SUP-AR-9100-10P CDM 270010030 LOCAL 0270 RC outpatient 5512.62 5512.62 5512.62 74 4079.34 percent of total billed charges 5512.62 93 4465.22 percent of total billed charges 5512.62 5512.62 other OPPS APC 5512.62 5512.62 other OPPS APC 5512.62 27.63 1523.14 percent of total billed charges 5512.62 5512.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS APEX RECTANGLE L60 MM OD10 MM SHOULDER PRESS FIT REMOVABLE TRUNION SUTURE HOLE ARTHROPLASTY SUP-AR-9100-10S CDM 270010030 LOCAL 0270 RC outpatient 5512.62 5512.62 5512.62 74 4079.34 percent of total billed charges 5512.62 93 4465.22 percent of total billed charges 5512.62 5512.62 other OPPS APC 5512.62 5512.62 other OPPS APC 5512.62 27.63 1523.14 percent of total billed charges 5512.62 5512.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS II L151 MM OD11 MM SHOULDER STERILE SUP-AR-9100-11P CDM 270010030 LOCAL 0270 RC outpatient 5512.65 5512.65 5512.65 74 4079.36 percent of total billed charges 5512.65 93 4465.25 percent of total billed charges 5512.65 5512.65 other OPPS APC 5512.65 5512.65 other OPPS APC 5512.65 27.63 1523.15 percent of total billed charges 5512.65 5512.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS APEX RECTANGLE L60 MM OD11 MM SHOULDER PRESS FIT REMOVABLE TRUNION SUTURE HOLE ARTHROPLASTY SUP-AR-9100-11S CDM 270010030 LOCAL 0270 RC outpatient 5512.62 5512.62 5512.62 74 4079.34 percent of total billed charges 5512.62 93 4465.22 percent of total billed charges 5512.62 5512.62 other OPPS APC 5512.62 5512.62 other OPPS APC 5512.62 27.63 1523.14 percent of total billed charges 5512.62 5512.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS II L151 MM OD12 MM SHOULDER STERILE SUP-AR-9100-12P CDM 270010030 LOCAL 0270 RC outpatient 5512.62 5512.62 5512.62 74 4079.34 percent of total billed charges 5512.62 93 4465.22 percent of total billed charges 5512.62 5512.62 other OPPS APC 5512.62 5512.62 other OPPS APC 5512.62 27.63 1523.14 percent of total billed charges 5512.62 5512.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS APEX RECTANGLE L60 MM OD12 MM SHOULDER PRESS FIT REMOVABLE TRUNION SUTURE HOLE ARTHROPLASTY SUP-AR-9100-12S CDM 270010030 LOCAL 0270 RC outpatient 5512.62 5512.62 5512.62 74 4079.34 percent of total billed charges 5512.62 93 4465.22 percent of total billed charges 5512.62 5512.62 other OPPS APC 5512.62 5512.62 other OPPS APC 5512.62 27.63 1523.14 percent of total billed charges 5512.62 5512.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS OD13 MM SHOULDER SUP-AR-9100-13P CDM 270010030 LOCAL 0270 RC outpatient 5512.62 5512.62 5512.62 74 4079.34 percent of total billed charges 5512.62 93 4465.22 percent of total billed charges 5512.62 5512.62 other OPPS APC 5512.62 5512.62 other OPPS APC 5512.62 27.63 1523.14 percent of total billed charges 5512.62 5512.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS APEX RECTANGLE L65 MM OD13 MM SHOULDER PRESS FIT REMOVABLE TRUNION SUTURE HOLE ARTHROPLASTY SUP-AR-9100-13S CDM 270010030 LOCAL 0270 RC outpatient 5512.62 5512.62 5512.62 74 4079.34 percent of total billed charges 5512.62 93 4465.22 percent of total billed charges 5512.62 5512.62 other OPPS APC 5512.62 5512.62 other OPPS APC 5512.62 27.63 1523.14 percent of total billed charges 5512.62 5512.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT GLENOID UNIVERS II POLYETHYLENE SMALL SHOULDER CEMENTED PEG STERILE SUP-AR-9105-01 CDM 270010030 LOCAL 0270 RC outpatient 2703.79 2703.79 2703.79 74 2000.8 percent of total billed charges 2703.79 93 2190.07 percent of total billed charges 2703.79 2703.79 other OPPS APC 2703.79 2703.79 other OPPS APC 2703.79 27.63 747.06 percent of total billed charges 2703.79 2703.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT GLENOID UNIVERS II POLYETHYLENE MEDIUM SHOULDER CEMENTED PEG STERILE SUP-AR-9105-02 CDM 270010030 LOCAL 0270 RC outpatient 2703.82 2703.82 2703.82 74 2000.83 percent of total billed charges 2703.82 93 2190.09 percent of total billed charges 2703.82 2703.82 other OPPS APC 2703.82 2703.82 other OPPS APC 2703.82 27.63 747.07 percent of total billed charges 2703.82 2703.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT GLENOID UNIVERS II POLYETHYLENE LARGE SHOULDER CEMENTED PEG STERILE SUP-AR-9105-03 CDM 270010030 LOCAL 0270 RC outpatient 2703.79 2703.79 2703.79 74 2000.8 percent of total billed charges 2703.79 93 2190.07 percent of total billed charges 2703.79 2703.79 other OPPS APC 2703.79 2703.79 other OPPS APC 2703.79 27.63 747.06 percent of total billed charges 2703.79 2703.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT GLENOID UNIVERS II POLYETHYLENE XL SHOULDER CEMENTED PEG STERILE SUP-AR-9105-04 CDM 270010030 LOCAL 0270 RC outpatient 2703.79 2703.79 2703.79 74 2000.8 percent of total billed charges 2703.79 93 2190.07 percent of total billed charges 2703.79 2703.79 other OPPS APC 2703.79 2703.79 other OPPS APC 2703.79 27.63 747.06 percent of total billed charges 2703.79 2703.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT GLENOID UNIVERS VAULTLOCK SMALL STERILE LATEX FREE DISPOSABLE SUP-AR-9106-01 CDM 270010030 LOCAL 0270 RC outpatient 2703.79 2703.79 2703.79 74 2000.8 percent of total billed charges 2703.79 93 2190.07 percent of total billed charges 2703.79 2703.79 other OPPS APC 2703.79 2703.79 other OPPS APC 2703.79 27.63 747.06 percent of total billed charges 2703.79 2703.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT GLENOID ARTHREX UNIVERS MEDIUM VAULTLOCK STERILE SUP-AR-9106-02 CDM 270010030 LOCAL 0270 RC outpatient 2703.82 2703.82 2703.82 74 2000.83 percent of total billed charges 2703.82 93 2190.09 percent of total billed charges 2703.82 2703.82 other OPPS APC 2703.82 2703.82 other OPPS APC 2703.82 27.63 747.07 percent of total billed charges 2703.82 2703.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLENOID WITH CLEAT LARGE SUP-AR-9106-03 CDM 270010030 LOCAL 0270 RC outpatient 2703.79 2703.79 2703.79 74 2000.8 percent of total billed charges 2703.79 93 2190.07 percent of total billed charges 2703.79 2703.79 other OPPS APC 2703.79 2703.79 other OPPS APC 2703.79 27.63 747.06 percent of total billed charges 2703.79 2703.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASEPLATE GLENOID SMALL UNIVERSAL SHOULDER SUP-AR-9120-01 CDM 270010030 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASEPLATE GLENOID MEDIUM UNIVERSAL SHOULDER SUP-AR-9120-02 CDM 270010030 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASEPLATE GLENOID LARGE UNIVERSAL SHOULDER SUP-AR-9120-03 CDM 270010030 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD HUMERAL UNIVERS II H17 MM OD40 MM SHOULDER ANATOMIC RESTORATION VARIABLE ADJUSTMENT STERILE SUP-AR-9140-17P CDM 270010030 LOCAL 0270 RC outpatient 2599.38 2599.38 2599.38 74 1923.54 percent of total billed charges 2599.38 93 2105.5 percent of total billed charges 2599.38 2599.38 other OPPS APC 2599.38 2599.38 other OPPS APC 2599.38 27.63 718.21 percent of total billed charges 2599.38 2599.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD HUMERAL UNIVERS II H17 MM OD42 MM SHOULDER ANATOMIC RESTORATION VARIABLE ADJUSTMENT STERILE SUP-AR-9142-17P CDM 270010030 LOCAL 0270 RC outpatient 2599.38 2599.38 2599.38 74 1923.54 percent of total billed charges 2599.38 93 2105.5 percent of total billed charges 2599.38 2599.38 other OPPS APC 2599.38 2599.38 other OPPS APC 2599.38 27.63 718.21 percent of total billed charges 2599.38 2599.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD HUMERAL UNIVERS II H17 MM OD44 MM SHOULDER ANATOMIC RESTORATION VARIABLE ADJUSTMENT STERILE SUP-AR-9144-17P CDM 270010030 LOCAL 0270 RC outpatient 2599.38 2599.38 2599.38 74 1923.54 percent of total billed charges 2599.38 93 2105.5 percent of total billed charges 2599.38 2599.38 other OPPS APC 2599.38 2599.38 other OPPS APC 2599.38 27.63 718.21 percent of total billed charges 2599.38 2599.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD HUMERAL UNIVERS II H19 MM OD44 MM SHOULDER ANATOMIC RESTORATION VARIABLE ADJUSTMENT STERILE SUP-AR-9144-19P CDM 270010030 LOCAL 0270 RC outpatient 2599.38 2599.38 2599.38 74 1923.54 percent of total billed charges 2599.38 93 2105.5 percent of total billed charges 2599.38 2599.38 other OPPS APC 2599.38 2599.38 other OPPS APC 2599.38 27.63 718.21 percent of total billed charges 2599.38 2599.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX CENTRAL NL UNI REV 6.5MM X 20MM SUP-AR-9145-20NL CDM 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERS REVERS 18 D L24 MM OD4.5 MM SHOULDER GLENOID PERIPHERAL LOCK VARIABLE ANGLE SUP-AR-9145-24 CDM 270010030 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERS REVERS L24 MM OD4.5 MM PERIPHERAL NONLOCK SUP-AR-9145-24NL CDM 270010030 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERS REVERS 18 D L30 MM OD4.5 MM SHOULDER GLENOID PERIPHERAL LOCK VARIABLE ANGLE SUP-AR-9145-30 CDM 270010030 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX PERIPHERAL NL UNI REV 4.5MM X 30MM SUP-AR-9145-30NL CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERS REVERS 18 D L36 MM OD4.5 MM SHOULDER GLENOID PERIPHERAL LOCK VARIABLE ANGLE SUP-AR-9145-36 CDM 270010030 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERS REVERS L36 MM OD4.5 MM PERIPHERAL NONLOCK SUP-AR-9145-36NL CDM 270010030 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERS REVERS 18 D L42 MM OD4.5 MM SHOULDER GLENOID PERIPHERAL LOCK VARIABLE ANGLE SUP-AR-9145-42 CDM 270010030 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW UNI GLENOID PERIPHERAL 4.5MM SUP-AR-9145-42NL CDM 270010030 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD HUMERAL UNIVERS II H18 MM OD46 MM SHOULDER ANATOMIC RESTORATION VARIABLE ADJUSTMENT STERILE SUP-AR-9146-18P CDM 270010030 LOCAL 0270 RC outpatient 2599.38 2599.38 2599.38 74 1923.54 percent of total billed charges 2599.38 93 2105.5 percent of total billed charges 2599.38 2599.38 other OPPS APC 2599.38 2599.38 other OPPS APC 2599.38 27.63 718.21 percent of total billed charges 2599.38 2599.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD HUMERAL UNIVERSAL CA 48/19 SUP-AR-9148-19CA CDM 270010030 LOCAL 0270 RC outpatient 2599.38 2599.38 2599.38 74 1923.54 percent of total billed charges 2599.38 93 2105.5 percent of total billed charges 2599.38 2599.38 other OPPS APC 2599.38 2599.38 other OPPS APC 2599.38 27.63 718.21 percent of total billed charges 2599.38 2599.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD HUMERAL UNIVERS II H19 MM OD48 MM SHOULDER ANATOMIC RESTORATION VARIABLE ADJUSTMENT STERILE SUP-AR-9148-19P CDM 270010030 LOCAL 0270 RC outpatient 2599.38 2599.38 2599.38 74 1923.54 percent of total billed charges 2599.38 93 2105.5 percent of total billed charges 2599.38 2599.38 other OPPS APC 2599.38 2599.38 other OPPS APC 2599.38 27.63 718.21 percent of total billed charges 2599.38 2599.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD HUMERAL UNIVERS II H21 MM OD48 MM SHOULDER ANATOMIC RESTORATION VARIABLE ADJUSTMENT STERILE SUP-AR-9148-21P CDM 270010030 LOCAL 0270 RC outpatient 2599.38 2599.38 2599.38 74 1923.54 percent of total billed charges 2599.38 93 2105.5 percent of total billed charges 2599.38 2599.38 other OPPS APC 2599.38 2599.38 other OPPS APC 2599.38 27.63 718.21 percent of total billed charges 2599.38 2599.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD HUMERAL UNIVERS II H19 MM OD50 MM SHOULDER ANATOMIC RESTORATION VARIABLE ADJUSTMENT STERILE SUP-AR-9150-19P CDM 270010030 LOCAL 0270 RC outpatient 2599.38 2599.38 2599.38 74 1923.54 percent of total billed charges 2599.38 93 2105.5 percent of total billed charges 2599.38 2599.38 other OPPS APC 2599.38 2599.38 other OPPS APC 2599.38 27.63 718.21 percent of total billed charges 2599.38 2599.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD HUMERAL UNIVERS II H21 MM OD50 MM SHOULDER ANATOMIC RESTORATION VARIABLE ADJUSTMENT STERILE SUP-AR-9150-21P CDM 270010030 LOCAL 0270 RC outpatient 2599.38 2599.38 2599.38 74 1923.54 percent of total billed charges 2599.38 93 2105.5 percent of total billed charges 2599.38 2599.38 other OPPS APC 2599.38 2599.38 other OPPS APC 2599.38 27.63 718.21 percent of total billed charges 2599.38 2599.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD HUMERAL UNIVERS II H20 MM OD52 MM SHOULDER ANATOMIC RESTORATION VARIABLE ADJUSTMENT STERILE SUP-AR-9152-20P CDM 270010030 LOCAL 0270 RC outpatient 2599.38 2599.38 2599.38 74 1923.54 percent of total billed charges 2599.38 93 2105.5 percent of total billed charges 2599.38 2599.38 other OPPS APC 2599.38 2599.38 other OPPS APC 2599.38 27.63 718.21 percent of total billed charges 2599.38 2599.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD HUMERAL UNIVERS II H22 MM OD52 MM SHOULDER ANATOMIC RESTORATION VARIABLE ADJUSTMENT STERILE SUP-AR-9152-22P CDM 270010030 LOCAL 0270 RC outpatient 2599.38 2599.38 2599.38 74 1923.54 percent of total billed charges 2599.38 93 2105.5 percent of total billed charges 2599.38 2599.38 other OPPS APC 2599.38 2599.38 other OPPS APC 2599.38 27.63 718.21 percent of total billed charges 2599.38 2599.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD HUMERAL UNIVERS II H21 MM OD54 MM SHOULDER ANATOMIC RESTORATION VARIABLE ADJUSTMENT STERILE SUP-AR-9154-21P CDM 270010030 LOCAL 0270 RC outpatient 2599.38 2599.38 2599.38 74 1923.54 percent of total billed charges 2599.38 93 2105.5 percent of total billed charges 2599.38 2599.38 other OPPS APC 2599.38 2599.38 other OPPS APC 2599.38 27.63 718.21 percent of total billed charges 2599.38 2599.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD HUMERAL UNIVERS II H23 MM OD54 MM SHOULDER ANATOMIC RESTORATION VARIABLE ADJUSTMENT STERILE SUP-AR-9154-23P CDM 270010030 LOCAL 0270 RC outpatient 2599.38 2599.38 2599.38 74 1923.54 percent of total billed charges 2599.38 93 2105.5 percent of total billed charges 2599.38 2599.38 other OPPS APC 2599.38 2599.38 other OPPS APC 2599.38 27.63 718.21 percent of total billed charges 2599.38 2599.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD HUMERAL UNIVERS II H22 MM OD56 MM SHOULDER ANATOMIC RESTORATION VARIABLE ADJUSTMENT STERILE SUP-AR-9156-22P CDM 270010030 LOCAL 0270 RC outpatient 2599.38 2599.38 2599.38 74 1923.54 percent of total billed charges 2599.38 93 2105.5 percent of total billed charges 2599.38 2599.38 other OPPS APC 2599.38 2599.38 other OPPS APC 2599.38 27.63 718.21 percent of total billed charges 2599.38 2599.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERS REVERS L15 MM OD6.5 MM SHOULDER GLENOID CENTRAL VARIABLE ANGLE SUP-AR-9165-15 CDM 270010030 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX CENTRAL NL UNI REV 6.5 X 15MM SUP-AR-9165-15NL CDM 270010030 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERS REVERS L20 MM OD6.5 MM SHOULDER GLENOID CENTRAL VARIABLE ANGLE SUP-AR-9165-20 CDM 270010030 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX PERIPHERAL NL UNI REV 6.5MM X 20MM SUP-AR-9165-20NL CDM 270010030 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX CENTRAL GLENOID 25MM SUP-AR-9165-25 CDM 270010030 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX CENTRAL NL UNI REV 6.5 X 25MM SUP-AR-9165-25NL CDM 270010030 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CENTRAL NL 6 .5MM SUP-AR-9165-35NL CDM 270010030 LOCAL 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC L150 MM OD2.8 MM SUP-AR-9165K CDM 270010030 LOCAL 0270 RC outpatient 858 858 858 74 634.92 percent of total billed charges 858 93 694.98 percent of total billed charges 858 858 other OPPS APC 858 858 other OPPS APC 858 27.63 237.07 percent of total billed charges 858 858 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT GLENOID ARTHREX ECLIPSE OD47 MM SHOULDER TRUNION SUP-AR-9301-47CPC CDM 270010030 LOCAL 0270 RC outpatient 10530 10530 10530 74 7792.2 percent of total billed charges 10530 93 8529.3 percent of total billed charges 10530 10530 other OPPS APC 10530 10530 other OPPS APC 10530 27.63 2909.44 percent of total billed charges 10530 10530 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD HUMERAL ECLIPSE H18 MM OD47 MM SHOULDER STERILE ARTHROPLASTY SUP-AR-9347-18 CDM 270010030 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JOINT TOE ANATOEMIC COCR L17 MM PHALANX PILOT PUNCH STERILE SUP-AR-9500-170 CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JOINT TOE ANATOEMIC COCR L20 MM PHALANX PILOT PUNCH STERILE SUP-AR-9500-200 CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JOINT TOE ANATOEMIC COCR L21.5 MM PHALANX PILOT PUNCH STERILE SUP-AR-9500-215 CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JOINT TOE ANATOEMIC COCR L23 MM PHALANX PILOT PUNCH STERILE SUP-AR-9500-230 CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS REVERS CALCIUM PHOSPHATE 135 D 5 L95 MM SHOULDER SET SUPPLEMENTARY MONOBLOCK PROXIMAL FILL STERILE ARTHROPLASTY SUP-AR-9501-05-135CPC CDM 270010030 LOCAL 0270 RC outpatient 6955 6955 6955 74 5146.7 percent of total billed charges 6955 93 5633.55 percent of total billed charges 6955 6955 other OPPS APC 6955 6955 other OPPS APC 6955 27.63 1921.67 percent of total billed charges 6955 6955 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERSAL REVERSE 5MM SUP-AR-9501-05P CDM 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS REVERS CALCIUM PHOSPHATE 6 L111 MM SHOULDER CORE SET PROXIMAL FILL STERILE ARTHROPLASTY SUP-AR-9501-06CPC CDM 270010030 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERSAL REVERSE 6MM SUP-AR-9501-06P CDM 270010030 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS REVERS CALCIUM PHOSPHATE 7 L115 MM SHOULDER CORE SET PROXIMAL FILL STERILE ARTHROPLASTY SUP-AR-9501-07CPC CDM 270010030 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL ARTHREX UNIVERS REVERS 7 SHOULDER STERILE SUP-AR-9501-07P CDM 270010030 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS REVERS CALCIUM PHOSPHATE 8 L119 MM SHOULDER CORE SET PROXIMAL FILL STERILE ARTHROPLASTY SUP-AR-9501-08CPC CDM 270010030 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT REVERSE APEX STEM SIZE 8 SUP-AR-9501-08S CDM 270010030 LOCAL 0270 RC outpatient 6984.9 6984.9 6984.9 74 5168.83 percent of total billed charges 6984.9 93 5657.77 percent of total billed charges 6984.9 6984.9 other OPPS APC 6984.9 6984.9 other OPPS APC 6984.9 27.63 1929.93 percent of total billed charges 6984.9 6984.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS REVERS CALCIUM PHOSPHATE 9 L123 MM SHOULDER CORE SET PROXIMAL FILL STERILE ARTHROPLASTY SUP-AR-9501-09CPC CDM 270010030 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL ARTHREX UNIVERS REVERS 9 SHOULDER STERILE SUP-AR-9501-09P CDM 270010030 LOCAL 0270 RC outpatient 4280.17 4280.17 4280.17 74 3167.33 percent of total billed charges 4280.17 93 3466.94 percent of total billed charges 4280.17 4280.17 other OPPS APC 4280.17 4280.17 other OPPS APC 4280.17 27.63 1182.61 percent of total billed charges 4280.17 4280.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS REVERS CALCIUM PHOSPHATE 10 L127 MM SHOULDER CORE SET PROXIMAL FILL STERILE ARTHROPLASTY SUP-AR-9501-10CPC CDM 270010030 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL ARTHREX UNIVERS REVERS 10 SHOULDER STERILE SUP-AR-9501-10P CDM 270010030 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL UNIVERS REVERS CALCIUM PHOSPHATE 11 L131 MM SHOULDER CORE SET PROXIMAL FILL STERILE ARTHROPLASTY SUP-AR-9501-11CPC CDM 270010030 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL ARTHREX UNIVERS REVERS 11 SHOULDER STERILE SUP-AR-9501-11P CDM 270010030 LOCAL 0270 RC outpatient 4755.4 4755.4 4755.4 74 3519 percent of total billed charges 4755.4 93 3851.87 percent of total billed charges 4755.4 4755.4 other OPPS APC 4755.4 4755.4 other OPPS APC 4755.4 27.63 1313.92 percent of total billed charges 4755.4 4755.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT UNIVERSAL REVERSE APEX STEM SIZE 11 SUP-AR-9501-11S CDM 270010030 LOCAL 0270 RC outpatient 6984.9 6984.9 6984.9 74 5168.83 percent of total billed charges 6984.9 93 5657.77 percent of total billed charges 6984.9 6984.9 other OPPS APC 6984.9 6984.9 other OPPS APC 6984.9 27.63 1929.93 percent of total billed charges 6984.9 6984.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER HEAD ARTHREX OD36 MM REVERSE STERILE CUFF ARTHROPATHY SUP-AR-9502-36ARCA CDM 270010030 LOCAL 0270 RC outpatient 4615 4615 4615 74 3415.1 percent of total billed charges 4615 93 3738.15 percent of total billed charges 4615 4615 other OPPS APC 4615 4615 other OPPS APC 4615 27.63 1275.12 percent of total billed charges 4615 4615 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP HUMERAL UNIVERS REVERS CALCIUM PHOSPHATE NEUTRAL OD36 MM SHOULDER STERILE ARTHROPLASTY SUP-AR-9502-36CPC CDM 270010030 LOCAL 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP HUMERAL UNIVERS REVERS CALCIUM PHOSPHATE +2 MM OFFSET OD36 MM SHOULDER RIGHT STERILE ARTHROPLASTY SUP-AR-9502-36RCPC CDM 270010030 LOCAL 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP HUMERAL UNIVERS REVERS CALCIUM PHOSPHATE NEUTRAL OD39 MM SHOULDER STERILE ARTHROPLASTY SUP-AR-9502-39CPC CDM 270010030 LOCAL 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP ARTHREX UNIV REVERSE 39MM +2MM LEFT OFFSET SUP-AR-9502-39LCPC CDM 270010030 LOCAL 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP HUMERAL UNIVERS REVERS CALCIUM PHOSPHATE +2 MM OFFSET OD39 MM SHOULDER RIGHT STERILE ARTHROPLASTY SUP-AR-9502-39RCPC CDM 270010030 LOCAL 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP HUMERAL UNIVERS REVERS CALCIUM PHOSPHATE NEUTRAL OD42 MM SHOULDER STERILE ARTHROPLASTY SUP-AR-9502-42CPC CDM 270010030 LOCAL 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC QUANTUM APEX BALLOON 2.5 X 30 SUP-AR-9502-42LCPC CDM 0481 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 51 1160.25 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP UNIVERSAL REVERSE SUTURE 36 NEUTRAL SUP-AR-9502F-36CPC CDM 270010030 LOCAL 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP UNIVERSAL REVERSE SUTURE 36 SUP-AR-9502F-36LCPC CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP HUMERAL UNIVERS REVERS NEUTRAL OD39 MM SHOULDER SUTURE STERILE SUP-AR-9502F-39CPC CDM 270010030 LOCAL 0270 RC outpatient 3074.47 3074.47 3074.47 74 2275.11 percent of total billed charges 3074.47 93 2490.32 percent of total billed charges 3074.47 3074.47 other OPPS APC 3074.47 3074.47 other OPPS APC 3074.47 27.63 849.48 percent of total billed charges 3074.47 3074.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP HUMERAL UNIVERS REVERS +2 OD39 MM SHOULDER LEFT SUTURE SUP-AR-9502F-39LCPC CDM 270010030 LOCAL 0270 RC outpatient 3074.47 3074.47 3074.47 74 2275.11 percent of total billed charges 3074.47 93 2490.32 percent of total billed charges 3074.47 3074.47 other OPPS APC 3074.47 3074.47 other OPPS APC 3074.47 27.63 849.48 percent of total billed charges 3074.47 3074.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP ARTHREX UNIVERSAL REVERSE SUTURE 39 +2 RIGHT SUP-AR-9502F-39RCPC CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIVERS REVERS SUTURE CUP 42 (NEUTRAL) SUP-AR-9502F-42CPC CDM 270010030 LOCAL 0270 RC outpatient 3074.47 3074.47 3074.47 74 2275.11 percent of total billed charges 3074.47 93 2490.32 percent of total billed charges 3074.47 3074.47 other OPPS APC 3074.47 3074.47 other OPPS APC 3074.47 27.63 849.48 percent of total billed charges 3074.47 3074.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP HUMERAL UNIVERS REVERS 2 OD42 MM SHOULDER LEFT SUTURE SUP-AR-9502F-42LCPC CDM 270010030 LOCAL 0270 RC outpatient 3074.47 3074.47 3074.47 74 2275.11 percent of total billed charges 3074.47 93 2490.32 percent of total billed charges 3074.47 3074.47 other OPPS APC 3074.47 3074.47 other OPPS APC 3074.47 27.63 849.48 percent of total billed charges 3074.47 3074.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP UNIVERSAL REVERSE NEUTRAL 36MM SUP-AR-9503-3633-3 CDM 270010030 LOCAL 0270 RC outpatient 3416.09 3416.09 3416.09 74 2527.91 percent of total billed charges 3416.09 93 2767.03 percent of total billed charges 3416.09 3416.09 other OPPS APC 3416.09 3416.09 other OPPS APC 3416.09 27.63 943.87 percent of total billed charges 3416.09 3416.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT HUMERAL H+6 MM OD36 MM ODSEC42 MM SHOULDER CONSTRAIN COMBINATION SUP-AR-9503-3942-6 CDM 270010030 LOCAL 0270 RC outpatient 2375.1 2375.1 2375.1 74 1757.57 percent of total billed charges 2375.1 93 1923.83 percent of total billed charges 2375.1 2375.1 other OPPS APC 2375.1 2375.1 other OPPS APC 2375.1 27.63 656.24 percent of total billed charges 2375.1 2375.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT HUMERAL UNIVERS REVERS +3 MM LARGE OD42 MM SHOULDER CONSTRAIN STERILE ARTHROPLASTY SUP-AR-9503L-03C CDM 270010030 LOCAL 0270 RC outpatient 1748.21 1748.21 1748.21 74 1293.68 percent of total billed charges 1748.21 93 1416.05 percent of total billed charges 1748.21 1748.21 other OPPS APC 1748.21 1748.21 other OPPS APC 1748.21 27.63 483.03 percent of total billed charges 1748.21 1748.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT HUMERAL UNIVERS REVERS +6 MM LARGE OD42 MM SHOULDER STERILE ARTHROPLASTY SUP-AR-9503L-06C CDM 270010030 LOCAL 0270 RC outpatient 1748.21 1748.21 1748.21 74 1293.68 percent of total billed charges 1748.21 93 1416.05 percent of total billed charges 1748.21 1748.21 other OPPS APC 1748.21 1748.21 other OPPS APC 1748.21 27.63 483.03 percent of total billed charges 1748.21 1748.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT HUMERAL UNIVERS REVERS +3 MM MEDIUM OD39 MM SHOULDER STERILE ARTHROPLASTY SUP-AR-9503M-03 CDM 270010030 LOCAL 0270 RC outpatient 1942.46 1942.46 1942.46 74 1437.42 percent of total billed charges 1942.46 93 1573.39 percent of total billed charges 1942.46 1942.46 other OPPS APC 1942.46 1942.46 other OPPS APC 1942.46 27.63 536.7 percent of total billed charges 1942.46 1942.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT HUMERAL UNIVERS REVERS +3 MM MEDIUM OD39 MM SHOULDER CONSTRAIN STERILE ARTHROPLASTY SUP-AR-9503M-03C CDM 270010030 LOCAL 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT HUMERAL M/39 +6 TO FIT IN 39 CUP SUP-AR-9503M-06 CDM 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT ARTHREX HUMERAL M/39 +6 SUP-AR-9503M-06C CDM 270010030 LOCAL 0270 RC outpatient 1748.21 1748.21 1748.21 74 1293.68 percent of total billed charges 1748.21 93 1416.05 percent of total billed charges 1748.21 1748.21 other OPPS APC 1748.21 1748.21 other OPPS APC 1748.21 27.63 483.03 percent of total billed charges 1748.21 1748.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT HUMERAL UNIVERS REVERS +3 MM SMALL OD36 MM SHOULDER CONSTRAIN STERILE ARTHROPLASTY SUP-AR-9503S-03 CDM 270010030 LOCAL 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT HUMERAL UNIVERS REVERS +3 MM SMALL OD36 MM SHOULDER CONSTRAIN STERILE ARTHROPLASTY SUP-AR-9503S-03C CDM 270010030 LOCAL 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 1748.21 1748.21 other OPPS APC 3640 3640 other OPPS APC 1748.21 27.63 483.03 percent of total billed charges 1748.21 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT HUMERAL UNIVERS REVERS +3 MM SMALL OD36 MM SHOULDER CONSTRAIN STERILE ARTHROPLASTY SUP-AR-9503S-03C CDM 270010030 LOCAL 0270 RC outpatient 3640 3640 1748.21 74 1293.68 percent of total billed charges 1748.21 93 1416.05 percent of total billed charges 3640 3640 other OPPS APC 1748.21 1748.21 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 1748.21 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT HUMERAL UNIVERS REVERS +6 MM SMALL OD36 MM SHOULDER STERILE ARTHROPLASTY SUP-AR-9503S-06 CDM 270010030 LOCAL 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT HUMERAL UNIVERS REVERS +6 MM SMALL OD36 MM SHOULDER CONSTRAIN STERILE ARTHROPLASTY SUP-AR-9503S-06C CDM 270010030 LOCAL 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD GLENOID UNIVERS REVERS CALCIUM PHOSPHATE +4 MM LARGE UNIVERSAL LATERAL OFFSET OD42 MM SHOULDER GLENOSPHERE VARIABLE ANGLE STERILE ARTHROPLASTY SUP-AR-9504L-04 CDM 270010030 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD GLENOID UNIVERS REVERS CALCIUM PHOSPHATE MEDIUM UNIVERSAL OD39 MM SHOULDER GLENOSPHERE VARIABLE ANGLE STERILE ARTHROPLASTY SUP-AR-9504M CDM 270010030 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD GLENOID UNIVERS REVERS CALCIUM PHOSPHATE +2.5 MM MEDIUM UNIVERSAL INFERIOR OFFSET OD42 MM SHOULDER GLENOSPHERE VARIABLE ANGLE STERILE ARTHROPLASTY SUP-AR-9504M-02 CDM 270010030 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD GLENOID UNIVERS REVERS CALCIUM PHOSPHATE +4 MM MEDIUM UNIVERSAL LATERAL OFFSET OD39 MM SHOULDER GLENOSPHERE VARIABLE ANGLE STERILE ARTHROPLASTY SUP-AR-9504M-04 CDM 270010030 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD GLENOID UNIVERS REVERS CALCIUM PHOSPHATE SMALL UNIVERSAL OD36 MM SHOULDER GLENOSPHERE VARIABLE ANGLE STERILE ARTHROPLASTY SUP-AR-9504S CDM 270010030 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD GLENOID UNIVERS REVERS CALCIUM PHOSPHATE +2.5 MM SMALL UNIVERSAL INFERIOR OFFSET OD39 MM SHOULDER GLENOSPHERE VARIABLE ANGLE STERILE ARTHROPLASTY SUP-AR-9504S-02 CDM 270010030 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD GLENOID UNIVERS REVERS CALCIUM PHOSPHATE +4 MM SMALL UNIVERSAL LATERAL OFFSET OD36 MM SHOULDER GLENOSPHERE VARIABLE ANGLE STERILE ARTHROPLASTY SUP-AR-9504S-04 CDM 270010030 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD GLENOID UNIVERS REVERS CALCIUM PHOSPHATE +2.5 MM INFERIOR OFFSET OD36 MM SHOULDER GLENOSPHERE VARIABLE ANGLE STERILE ARTHROPLASTY SUP-AR-9504S-INF CDM 270010030 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD HUMERAL ARTHREX H17 MM OD44 MM REVERSE STERILE CUFF ARTHROPATHY SUP-AR-9544-17RCA CDM 270010030 LOCAL 0270 RC outpatient 4365.4 4365.4 4365.4 74 3230.4 percent of total billed charges 4365.4 93 3535.97 percent of total billed charges 4365.4 4365.4 other OPPS APC 4365.4 4365.4 other OPPS APC 4365.4 27.63 1206.16 percent of total billed charges 4365.4 4365.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLENOSPHERE LATERAL 33MM +4 SUP-AR-95564-2433-LAT CDM 270010030 LOCAL 0270 RC outpatient 4319.35 4319.35 4319.35 74 3196.32 percent of total billed charges 4319.35 93 3498.67 percent of total billed charges 4319.35 4319.35 other OPPS APC 4319.35 4319.35 other OPPS APC 4319.35 27.63 1193.44 percent of total billed charges 4319.35 4319.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASEPLATE GLENOID ARTHREX L24 MM SHOULDER MODULAR STERILE LATEX FREE SUP-AR-9560-24 CDM 0270 RC outpatient 4131.56 4131.56 4131.56 74 3057.35 percent of total billed charges 4131.56 93 3346.56 percent of total billed charges 4131.56 4131.56 other OPPS APC 4131.56 4131.56 other OPPS APC 4131.56 27.63 1141.55 percent of total billed charges 4131.56 4131.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASEPLATE MODULAR 24MM +2 LATRAL SUP-AR-9560-24-2 CDM 270010030 LOCAL 0270 RC outpatient 4169.46 4169.46 4169.46 74 3085.4 percent of total billed charges 4169.46 93 3377.26 percent of total billed charges 4169.46 4169.46 other OPPS APC 4169.46 4169.46 other OPPS APC 4169.46 27.63 1152.02 percent of total billed charges 4169.46 4169.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASEPLATE MODULAR 24MM +4 SUP-AR-9560-24-4 CDM 270010030 LOCAL 0270 RC outpatient 4131.56 4131.56 4131.56 74 3057.35 percent of total billed charges 4131.56 93 3346.56 percent of total billed charges 4131.56 4131.56 other OPPS APC 4131.56 4131.56 other OPPS APC 4131.56 27.63 1141.55 percent of total billed charges 4131.56 4131.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASEPLATE 24MM MONOBLOCK SCREW SUP-AR-9560-24S CDM 0270 RC outpatient 5969.91 5969.91 5969.91 74 4417.73 percent of total billed charges 5969.91 93 4835.63 percent of total billed charges 5969.91 5969.91 other OPPS APC 5969.91 5969.91 other OPPS APC 5969.91 27.63 1649.49 percent of total billed charges 5969.91 5969.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CENTRAL MODULAR 20MM SUP-AR-9561-20S CDM 270010030 LOCAL 0270 RC outpatient 1800.47 1800.47 1800.47 74 1332.35 percent of total billed charges 1800.47 93 1458.38 percent of total billed charges 1800.47 1800.47 other OPPS APC 1800.47 1800.47 other OPPS APC 1800.47 27.63 497.47 percent of total billed charges 1800.47 1800.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CENTRAL MODULAR 25MM SUP-AR-9561-25S CDM 270010030 LOCAL 0270 RC outpatient 1784.07 1784.07 1784.07 74 1320.21 percent of total billed charges 1784.07 93 1445.1 percent of total billed charges 1784.07 1784.07 other OPPS APC 1784.07 1784.07 other OPPS APC 1784.07 27.63 492.94 percent of total billed charges 1784.07 1784.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L28 MM OD4.5 MM PERIPHERAL STERILE SUP-AR-9561-30S CDM 0270 RC outpatient 1784.02 1784.02 1784.02 74 1320.17 percent of total billed charges 1784.02 93 1445.06 percent of total billed charges 1784.02 1784.02 other OPPS APC 1784.02 1784.02 other OPPS APC 1784.02 27.63 492.92 percent of total billed charges 1784.02 1784.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PERIPHERAL NON-LOCKING 4.5MM X 20MM SUP-AR-9562-20NL CDM 0270 RC outpatient 227.42 227.42 227.42 74 168.29 percent of total billed charges 227.42 93 184.21 percent of total billed charges 227.42 227.42 other OPPS APC 227.42 227.42 other OPPS APC 227.42 27.63 62.84 percent of total billed charges 227.42 227.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PERIPHERAL NON-LOCKING 4.5MM X 24MM SUP-AR-9562-24NL CDM 0270 RC outpatient 227.42 227.42 227.42 74 168.29 percent of total billed charges 227.42 93 184.21 percent of total billed charges 227.42 227.42 other OPPS APC 227.42 227.42 other OPPS APC 227.42 27.63 62.84 percent of total billed charges 227.42 227.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L28 MM OD4.5 MM PERIPHERAL STERILE SUP-AR-9562-28NL CDM 0270 RC outpatient 225.37 225.37 225.37 74 166.77 percent of total billed charges 225.37 93 182.55 percent of total billed charges 225.37 225.37 other OPPS APC 225.37 225.37 other OPPS APC 225.37 27.63 62.27 percent of total billed charges 225.37 225.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PERIPHERAL NON LOCKING 4.5MM X 32MM SUP-AR-9562-32NL CDM 270010030 LOCAL 0270 RC outpatient 227.42 227.42 227.42 74 168.29 percent of total billed charges 227.42 93 184.21 percent of total billed charges 227.42 227.42 other OPPS APC 227.42 227.42 other OPPS APC 227.42 27.63 62.84 percent of total billed charges 227.42 227.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PERIPHERAL NON LOCKING 4.5MM X 40MM SUP-AR-9562-40NL CDM 270010030 LOCAL 0270 RC outpatient 227.42 227.42 227.42 74 168.29 percent of total billed charges 227.42 93 184.21 percent of total billed charges 227.42 227.42 other OPPS APC 227.42 227.42 other OPPS APC 227.42 27.63 62.84 percent of total billed charges 227.42 227.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L44 MM OD4.5 MM PERIPHERAL STERILE SUP-AR-9562-44NL CDM 270010030 LOCAL 0270 RC outpatient 225.37 225.37 225.37 74 166.77 percent of total billed charges 225.37 93 182.55 percent of total billed charges 225.37 225.37 other OPPS APC 225.37 225.37 other OPPS APC 225.37 27.63 62.27 percent of total billed charges 225.37 225.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PERIPHERAL LOCKING 5.5MM X 16MM SUP-AR-9563-16 CDM 270010030 LOCAL 0270 RC outpatient 227.42 227.42 227.42 74 168.29 percent of total billed charges 227.42 93 184.21 percent of total billed charges 227.42 227.42 other OPPS APC 227.42 227.42 other OPPS APC 227.42 27.63 62.84 percent of total billed charges 227.42 227.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L20 MM OD5.5 MM LOCK PERIPHERAL STERILE SUP-AR-9563-20 CDM 270010030 LOCAL 0270 RC outpatient 225.37 225.37 225.37 74 166.77 percent of total billed charges 225.37 93 182.55 percent of total billed charges 225.37 225.37 other OPPS APC 225.37 225.37 other OPPS APC 225.37 27.63 62.27 percent of total billed charges 225.37 225.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PERIPHERAL LOCKING 5.5MM X 24MM SUP-AR-9563-24 CDM 270010030 LOCAL 0270 RC outpatient 227.42 227.42 227.42 74 168.29 percent of total billed charges 227.42 93 184.21 percent of total billed charges 227.42 227.42 other OPPS APC 227.42 227.42 other OPPS APC 227.42 27.63 62.84 percent of total billed charges 227.42 227.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE UNIVERS REVERS L44 MM OD5.5 MM GLENOID PERIPHERAL LOCK MODULAR SUP-AR-9563-44 CDM 270010030 LOCAL 0270 RC outpatient 202.83 202.83 202.83 74 150.09 percent of total billed charges 202.83 93 164.29 percent of total billed charges 202.83 202.83 other OPPS APC 202.83 202.83 other OPPS APC 202.83 27.63 56.04 percent of total billed charges 202.83 202.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLENOSPHERE 36/24 SUP-AR-9564-2436 CDM 270010030 LOCAL 0270 RC outpatient 4359 4359 4359 74 3225.66 percent of total billed charges 4359 93 3530.79 percent of total billed charges 4359 4359 other OPPS APC 4359 4359 other OPPS APC 4359 27.63 1204.39 percent of total billed charges 4359 4359 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLENOSPHERE 36MM +2.5 INF SUP-AR-9564-2436-INF CDM 270010030 LOCAL 0270 RC outpatient 4359 4359 4359 74 3225.66 percent of total billed charges 4359 93 3530.79 percent of total billed charges 4359 4359 other OPPS APC 4359 4359 other OPPS APC 4359 27.63 1204.39 percent of total billed charges 4359 4359 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPHERE GLENOID +4 MM OD36 MM ODSEC24 MM SHOULDER LATERALIZE GLENOSPHERE STERILE LATEX FREE DISPOSABLE SUP-AR-9564-2436-LAT CDM 0270 RC outpatient 4319.35 4319.35 4319.35 74 3196.32 percent of total billed charges 4319.35 93 3498.67 percent of total billed charges 4319.35 4319.35 other OPPS APC 4319.35 4319.35 other OPPS APC 4319.35 27.63 1193.44 percent of total billed charges 4319.35 4319.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT GLENOID UNIVERS REVERS BIOSYNC POROUS OD39 MM ODSEC24 MM SHOULDER GLENOSPHERE TAPER BASEPLATE MODULAR SUP-AR-9564-2439 CDM 270010030 LOCAL 0270 RC outpatient 4319.35 4319.35 4319.35 74 3196.32 percent of total billed charges 4319.35 93 3498.67 percent of total billed charges 4319.35 4319.35 other OPPS APC 4319.35 4319.35 other OPPS APC 4319.35 27.63 1193.44 percent of total billed charges 4319.35 4319.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLENOSPHERE 39MM +2.5INF/24 SUP-AR-9564-2439-INF CDM 270010030 LOCAL 0270 RC outpatient 4319.35 4319.35 4319.35 74 3196.32 percent of total billed charges 4319.35 93 3498.67 percent of total billed charges 4319.35 4319.35 other OPPS APC 4319.35 4319.35 other OPPS APC 4319.35 27.63 1193.44 percent of total billed charges 4319.35 4319.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLENOSPHERE 39 +4 LATERAL/24 SUP-AR-9564-2439-LAT CDM 0270 RC outpatient 4359 4359 4359 74 3225.66 percent of total billed charges 4359 93 3530.79 percent of total billed charges 4359 4359 other OPPS APC 4359 4359 other OPPS APC 4359 27.63 1204.39 percent of total billed charges 4359 4359 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 24MM BASEPLATE 20 ° FULL AUGMENT +2 LAT SUP-AR-9580-2420-2 CDM 270010030 LOCAL 0270 RC outpatient 7488 7488 7488 74 5541.12 percent of total billed charges 7488 93 6065.28 percent of total billed charges 7488 7488 other OPPS APC 7488 7488 other OPPS APC 7488 27.63 2068.93 percent of total billed charges 7488 7488 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPONENT GLENOID UNIVERS REVERS POROUS OD30 MM MODULAR POST SUP-AR-9582-30 CDM 270010030 LOCAL 0270 RC outpatient 3393 3393 3393 74 2510.82 percent of total billed charges 3393 93 2748.33 percent of total billed charges 3393 3393 other OPPS APC 3393 3393 other OPPS APC 3393 27.63 937.49 percent of total billed charges 3393 3393 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE ELECTROSURGICAL COOLCUT 50 D OD3 MM ASPIRATE ABLATION RADIOFREQUENCY WAND STERILE SUP-AR-9803A-50 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE ELECTROSURGICAL COOLCUT 90 D OD3 MM ASPIRATE ABLATION RADIOFREQUENCY WAND STERILE SUP-AR-9803A-90 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL COOLCUT 45 D BALL ARTHROSCOPY SUP-AR-9808-45 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE ELECTROSURGICAL ARTHREX APOLLORF 90 D 1 PIECE HAND CONTROL MULTIPLE PORT PLASMA BASE BIPOLAR RF TECHNOLOGY SUP-AR-9821 CDM 0270 RC outpatient 395.2 395.2 395.2 74 292.45 percent of total billed charges 395.2 93 320.11 percent of total billed charges 395.2 395.2 other OPPS APC 395.2 395.2 other OPPS APC 395.2 27.63 109.19 percent of total billed charges 395.2 395.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE ARTHROSCOPIC APOLLORF 90 D HOOK L2 MM OD.75 MM TISSUE 1 PIECE ACTIVE ELECTRODE HANDCONTROL NONASPIRATE STERILE LATEX FREE DISPOSABLE SYNERGYRF SUP-AR-9825 CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE TITANIUM L 100MM FIBULA RIGHT DISTAL POSTEROLATERAL 6 HOLE SUP-AR-9963APLR-06 CDM 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOW PROFILE 3.5MM X 14MM SUP-AR8935-14 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP ARTHREX REVERSE SUTURE CUP SIZE 39 SUP-AR9502F-39LCPC CDM 270010030 LOCAL 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE MEDRAD MARK 7 ARTERION DISPOSABLE SUP-ART700SYR CDM 0270 RC outpatient 24.36 24.36 24.36 74 18.03 percent of total billed charges 24.36 93 19.73 percent of total billed charges 24.36 24.36 other OPPS APC 24.36 24.36 other OPPS APC 24.36 27.63 6.73 percent of total billed charges 24.36 24.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH GYNECARE Y SUP-ARTY CDM 0270 RC outpatient 2313.4 2313.4 2313.4 74 1711.92 percent of total billed charges 2313.4 93 1873.85 percent of total billed charges 2313.4 2313.4 other OPPS APC 2313.4 2313.4 other OPPS APC 2313.4 27.63 639.19 percent of total billed charges 2313.4 2313.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC ARROW-BERMAN 6FR 110CM TAPERED PULMONARY ARTERY 2-LUMEN WEDGE PRESSURE 0.035IN GW 1EA SUP-ARWAI07126 CDM 0270 RC outpatient 760.99 760.99 760.99 74 563.13 percent of total billed charges 760.99 93 616.4 percent of total billed charges 760.99 760.99 other OPPS APC 760.99 760.99 other OPPS APC 760.99 27.63 210.26 percent of total billed charges 760.99 760.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOANCHOR HELI-FX SUP-AS-85 CDM 0270 RC outpatient 12350 12350 12350 74 9139 percent of total billed charges 12350 93 10003.5 percent of total billed charges 12350 12350 other OPPS APC 12350 12350 other OPPS APC 12350 27.63 3412.31 percent of total billed charges 12350 12350 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK VITRECTOMY 20G SUP-AS1212101 CDM 270009169 LOCAL 0270 RC outpatient 49.56 49.56 49.56 74 36.67 percent of total billed charges 49.56 93 40.14 percent of total billed charges 49.56 49.56 other OPPS APC 49.56 49.56 other OPPS APC 49.56 27.63 13.69 percent of total billed charges 49.56 49.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK TOTAL 23G SUP-AS1212201 CDM 0270 RC outpatient 1226.47 1226.47 1226.47 74 907.59 percent of total billed charges 1226.47 93 993.44 percent of total billed charges 1226.47 1226.47 other OPPS APC 1226.47 1226.47 other OPPS APC 1226.47 27.63 338.87 percent of total billed charges 1226.47 1226.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION GLUTARALDEHYDE CIDEX 1GL 0.55% ORTHO-PHTHALALDEHYDE REUSABLE LF HIGH LEVEL DISINFECTANT CONTAINER SUP-AS20390 CDM outpatient 48.93 48.93 48.93 48.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK PHACO W. LEGACY CASSETTE SUP-AS4212-34 CDM 270009168 LOCAL 0270 RC outpatient 519.56 519.56 519.56 74 384.47 percent of total billed charges 519.56 93 420.84 percent of total billed charges 519.56 519.56 other OPPS APC 519.56 519.56 other OPPS APC 519.56 27.63 143.55 percent of total billed charges 519.56 519.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK PHACO W. LEGACY CASSETTE SUP-AS4212-35 CDM 270009168 LOCAL 0270 RC outpatient 572.81 572.81 572.81 74 423.88 percent of total billed charges 572.81 93 463.98 percent of total billed charges 572.81 572.81 other OPPS APC 572.81 572.81 other OPPS APC 572.81 27.63 158.27 percent of total billed charges 572.81 572.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WAND ELECTROSURGICAL MULTIVAC PLATINUM 50 D XL L195 MM OD3 MM HIP INTEGRATED CABLE LONG SHAFT LENGTH BIPOLAR SUP-ASC4730-01 CDM 0270 RC outpatient 907.4 907.4 907.4 74 671.48 percent of total billed charges 907.4 93 734.99 percent of total billed charges 907.4 907.4 other OPPS APC 907.4 907.4 other OPPS APC 907.4 27.63 250.71 percent of total billed charges 907.4 907.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER ADELANTE SIGMA PLUS 8F SUP-ASGP08010 CDM 0481 RC outpatient 41.6 41.6 41.6 74 30.78 percent of total billed charges 41.6 93 33.7 percent of total billed charges 41.6 41.6 other OPPS APC 41.6 41.6 other OPPS APC 41.6 51 21.22 percent of total billed charges 41.6 41.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER L4.5 IN OD9 FR CENTRAL VENOUS 2 LUMEN SUP-ASK-21242-PR CDM 0270 RC outpatient 466.38 466.38 466.38 74 345.12 percent of total billed charges 466.38 93 377.77 percent of total billed charges 466.38 466.38 other OPPS APC 466.38 466.38 other OPPS APC 466.38 27.63 128.86 percent of total billed charges 466.38 466.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET TUBING AIRSEAL ACTIVATE CHARCOAL 3 LUMEN FILTER STERILE LATEX FREE DISPOSABLE SUP-ASM-EVAC1 CDM 0270 RC outpatient 250.61 250.61 250.61 74 185.45 percent of total billed charges 250.61 93 202.99 percent of total billed charges 250.61 250.61 other OPPS APC 250.61 250.61 other OPPS APC 250.61 27.63 69.24 percent of total billed charges 250.61 250.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP SPRAY APPLICATOR MAGELLAN SUP-ASM700 CDM 0270 RC outpatient 46.8 46.8 46.8 74 34.63 percent of total billed charges 46.8 93 37.91 percent of total billed charges 46.8 46.8 other OPPS APC 46.8 46.8 other OPPS APC 46.8 27.63 12.93 percent of total billed charges 46.8 46.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAD POSITIONING UNIVERSAL PERINEAL POST SUP-AT092000 CDM 0270 RC outpatient 169 169 169 74 125.06 percent of total billed charges 169 93 136.89 percent of total billed charges 169 169 other OPPS APC 169 169 other OPPS APC 169 27.63 46.69 percent of total billed charges 169 169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRACE HIP POST OPERATIVE BLEDSOE PHILIPPON WITH POSITIONING KIT AND POST PAD RIGHT LEG REGULAR 163CM SUP-AT093205 CDM 0270 RC outpatient 754 754 754 74 557.96 percent of total billed charges 754 93 610.74 percent of total billed charges 754 754 other OPPS APC 754 754 other OPPS APC 754 27.63 208.33 percent of total billed charges 754 754 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACUTRAK 2 MINI DRILL SUP-AT2-1509 CDM 0270 RC outpatient 777.4 777.4 777.4 74 575.28 percent of total billed charges 777.4 93 629.69 percent of total billed charges 777.4 777.4 other OPPS APC 777.4 777.4 other OPPS APC 777.4 27.63 214.8 percent of total billed charges 777.4 777.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACUTRAK 2 DRILL SUP-AT2-2515 CDM 0270 RC outpatient 777.4 777.4 777.4 74 575.28 percent of total billed charges 777.4 93 629.69 percent of total billed charges 777.4 777.4 other OPPS APC 777.4 777.4 other OPPS APC 777.4 27.63 214.8 percent of total billed charges 777.4 777.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MICRO 8.0MM SUP-AT2-C08 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MICRO 9.0MM SUP-AT2-C09 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MICRO 11.0MM SUP-AT2-C11 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MICRO 12.0MM SUP-AT2-C12 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MICRO 13.0MM SUP-AT2-C13 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MICRO 14.0MM SUP-AT2-C14 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MICRO 16.0MM SUP-AT2-C16 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MICRO 18.0MM SUP-AT2-C18 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MICRO 20.0MM SUP-AT2-C20 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ACUTRAK 2 TITANIUM MICRO FULL THREAD L24 MM OD2.5-2.8 MM SELF CUT CANNULATED VARIABLE PITCH HEADLESS STERILE SUP-AT2-C24 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ACUTRAK 2 TITANIUM MICRO FULL THREAD L26 MM OD2.5-2.8 MM COMPRESSION CANNULATED SELF TAP HEADLESS NONSTERILE ACCEPTS .035 IN GUIDEWIRE SUP-AT2-C26 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE ACUTRAK 2 TITANIUM MICRO FULL THREAD TAPER L30 MM OD2.5-2.8 MM SELF TAP SELF CUT CANNULATED VARIABLE PITCH NONSTERILE SUP-AT2-C30 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACUTRAK 2 DRILL LONG SUP-AT2-L2515 CDM 0270 RC outpatient 863.2 863.2 863.2 74 638.77 percent of total billed charges 863.2 93 699.19 percent of total billed charges 863.2 863.2 other OPPS APC 863.2 863.2 other OPPS APC 863.2 27.63 238.5 percent of total billed charges 863.2 863.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI 16.0MM SUP-AT2-M16 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI 18.0MM SUP-AT2-M18 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACUTRAK 2 MINI DRILL SUP-AT2-M1813 CDM 0270 RC outpatient 777.4 777.4 777.4 74 575.28 percent of total billed charges 777.4 93 629.69 percent of total billed charges 777.4 777.4 other OPPS APC 777.4 777.4 other OPPS APC 777.4 27.63 214.8 percent of total billed charges 777.4 777.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI 20.0MM SUP-AT2-M20 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI 22.0MM SUP-AT2-M22 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI 24.0MM SUP-AT2-M24 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI 26.0MM SUP-AT2-M26 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI 28.0MM SUP-AT2-M28 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW MINI 30.0MM SUP-AT2-M30 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STANDARD 16.0 MM SUP-AT2-S16 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STANDARD 18.0 MM SUP-AT2-S18 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STANDARD 20.0 MM SUP-AT2-S20 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STANDARD 22.0 MM SUP-AT2-S22 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STANDARD 24.0 MM SUP-AT2-S24 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STANDARD 26.0 MM SUP-AT2-S26 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STANDARD 28.0 MM SUP-AT2-S28 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STANDARD 30.0 MM SUP-AT2-S30 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STANDARD 32.0 MM SUP-AT2-S32 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW STANDARD 34.0 MM SUP-AT2-S34 CDM 27000000 LOCAL 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACUTRAK 2 MINI DRILL LONG SUP-AT2M-L1813 CDM 0270 RC outpatient 863.2 863.2 863.2 74 638.77 percent of total billed charges 863.2 93 699.19 percent of total billed charges 863.2 863.2 other OPPS APC 863.2 863.2 other OPPS APC 863.2 27.63 238.5 percent of total billed charges 863.2 863.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GORE EXCLUDER THORACOABDOMINAL BRANCH ENDOPROSTHESIS, 31 MM" SUP-ATAA43120160A CDM 0270 RC outpatient 75400 75400 75400 74 55796 percent of total billed charges 75400 93 61074 percent of total billed charges 75400 75400 other OPPS APC 75400 75400 other OPPS APC 75400 27.63 20833 percent of total billed charges 75400 75400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GORE EXCLUDER THORACOABDOMINAL BRANCH ENDOPROSTHESIS, 37 MM" SUP-ATAA43720160A CDM 0270 RC outpatient 75400 75400 75400 74 55796 percent of total billed charges 75400 93 61074 percent of total billed charges 75400 75400 other OPPS APC 75400 75400 other OPPS APC 75400 27.63 20833 percent of total billed charges 75400 75400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER RELOAD LINEAR CUTTER ENDOPATH BLUE 45MM SUP-ATB45 CDM 0270 RC outpatient 198.63 198.63 198.63 74 146.99 percent of total billed charges 198.63 93 160.89 percent of total billed charges 198.63 198.63 other OPPS APC 198.63 198.63 other OPPS APC 198.63 27.63 54.88 percent of total billed charges 198.63 198.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ENDOPATH ETS FLEX L45 MM REGULAR TISSUE LINEAR CUTTER ARTICULATE RELOAD STERILE LATEX FREE DISPOSABLE ENDOSCOPIC SUP-ATS45NK CDM 0270 RC outpatient 570.57 570.57 570.57 74 422.22 percent of total billed charges 570.57 93 462.16 percent of total billed charges 570.57 570.57 other OPPS APC 570.57 570.57 other OPPS APC 570.57 27.63 157.65 percent of total billed charges 570.57 570.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISCONTINUED AS OF 10/1/16 - STAPLER INTERNAL ENDOPATH ETS FLEX 35MM 340MM WHITE DISPOSABLE STERILE LF VASCULAR 6 SUP-ATW35 CDM 0270 RC outpatient 661.91 661.91 661.91 74 489.81 percent of total billed charges 661.91 93 536.15 percent of total billed charges 661.91 661.91 other OPPS APC 661.91 661.91 other OPPS APC 661.91 27.63 182.89 percent of total billed charges 661.91 661.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP INTERNAL FILSHIE SILASTIC TITANIUM SMALL FALLOPIAN TUBE SOFT LINE UPPER JAW STERILE LATEX FREE TUBAL LIGATION SYSTEM SUP-AVM-851J CDM 0270 RC outpatient 314.6 314.6 314.6 74 232.8 percent of total billed charges 314.6 93 254.83 percent of total billed charges 314.6 314.6 other OPPS APC 314.6 314.6 other OPPS APC 314.6 27.63 86.92 percent of total billed charges 314.6 314.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT LAPAROSCOPIC FILSHIE STERISHOT II STANDARD APPLICATOR 1 PAIR CLIP SUP-AVM-951 CDM 0270 RC outpatient 804.44 804.44 804.44 74 595.29 percent of total billed charges 804.44 93 651.6 percent of total billed charges 804.44 804.44 other OPPS APC 804.44 804.44 other OPPS APC 804.44 27.63 222.27 percent of total billed charges 804.44 804.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH RENU L108 MM OD26 MM ABDOMINAL AORTIC ANEURYSM CONVERTER ONE-SHOT SYSTEM SUP-AX1-1-26-108 CDM 270010015 LOCAL 0270 RC outpatient 17966 17966 17966 74 13294.8 percent of total billed charges 17966 93 14552.5 percent of total billed charges 17966 17966 other OPPS APC 17966 17966 other OPPS APC 17966 27.63 4964.01 percent of total billed charges 17966 17966 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH RENU L108 MM OD30 MM ABDOMINAL AORTIC ANEURYSM CONVERTER ONE-SHOT SYSTEM SUP-AX1-1-30-108 CDM 270010015 LOCAL 0270 RC outpatient 17966 17966 17966 74 13294.8 percent of total billed charges 17966 93 14552.5 percent of total billed charges 17966 17966 other OPPS APC 17966 17966 other OPPS APC 17966 27.63 4964.01 percent of total billed charges 17966 17966 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH RENU L108 MM OD32 MM ABDOMINAL AORTIC ANEURYSM CONVERTER ONE-SHOT SYSTEM SUP-AX1-1-32-108 CDM 270010015 LOCAL 0270 RC outpatient 17966 17966 17966 74 13294.8 percent of total billed charges 17966 93 14552.5 percent of total billed charges 17966 17966 other OPPS APC 17966 17966 other OPPS APC 17966 27.63 4964.01 percent of total billed charges 17966 17966 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR RENU ZENITH L108 MM L37-71 MM OD32-12 MM ODSEC7.7 MM ID20 FR ABDOMINAL AORTIC ANEURYSM Z-TRAK INTRODUCTION SYSTEM ANCILLARY CONVERTER SUP-AX1-1-32-108ZT CDM 270010015 LOCAL 0270 RC outpatient 17966 17966 17966 74 13294.8 percent of total billed charges 17966 93 14552.5 percent of total billed charges 17966 17966 other OPPS APC 17966 17966 other OPPS APC 17966 27.63 4964.01 percent of total billed charges 17966 17966 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ZENITH RENU AAA ANCILLARY GRAFT CONVERTER SUP-AX1-1-36-108 CDM 270010015 LOCAL 0270 RC outpatient 17966 17966 17966 74 13294.8 percent of total billed charges 17966 93 14552.5 percent of total billed charges 17966 17966 other OPPS APC 17966 17966 other OPPS APC 17966 27.63 4964.01 percent of total billed charges 17966 17966 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH RENU L113 MM OD26 MM ABDOMINAL AORTIC ANEURYSM CONVERTER ONE-SHOT SYSTEM SUP-AX1-2-26-113 CDM 270010015 LOCAL 0270 RC outpatient 17966 17966 17966 74 13294.8 percent of total billed charges 17966 93 14552.5 percent of total billed charges 17966 17966 other OPPS APC 17966 17966 other OPPS APC 17966 27.63 4964.01 percent of total billed charges 17966 17966 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH RENU AAA L127 MM OD36 MM OD22 FR ABDOMINAL AORTIC ANEURYSM SUP-AX1-2-36-127 CDM 270010015 LOCAL 0270 RC outpatient 17966 17966 17966 74 13294.8 percent of total billed charges 17966 93 14552.5 percent of total billed charges 17966 17966 other OPPS APC 17966 17966 other OPPS APC 17966 27.63 4964.01 percent of total billed charges 17966 17966 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH RENU L127 MM OD36-12 MM ABDOMINAL AORTIC ANEURYSM ANCILLARY CONVERTER SUP-AX1-2-36-127-ZT CDM 270010015 LOCAL 0270 RC outpatient 17966 17966 17966 74 13294.8 percent of total billed charges 17966 93 14552.5 percent of total billed charges 17966 17966 other OPPS APC 17966 17966 other OPPS APC 17966 27.63 4964.01 percent of total billed charges 17966 17966 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL PROXIMATE ACCESS STANDARD 55MMX3.5MM 1.5MM BLUE TITANIUM DISPOSABLE STERILE LF REGULAR TISSUE 2 ROW SUP-AX55B CDM 270009089 LOCAL 0270 RC outpatient 299.84 299.84 299.84 74 221.88 percent of total billed charges 299.84 93 242.87 percent of total billed charges 299.84 299.84 other OPPS APC 299.84 299.84 other OPPS APC 299.84 27.63 82.85 percent of total billed charges 299.84 299.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR TALENT XCELERANT POLYESTER NITINOL BIFURCATED L60 MM L28 MM OD32 MM ODSEC22 FR DESCENDING ABDOMEN AORTA SELF EXPANDING EXTENSION STENT RADIOPAQUE HYDRO DELIVERY SYSTEM AAA SUP-AXF3232W28XH CDM 270010015 LOCAL 0270 RC outpatient 8775 8775 8775 74 6493.5 percent of total billed charges 8775 93 7107.75 percent of total billed charges 8775 8775 other OPPS APC 8775 8775 other OPPS APC 8775 27.63 2424.53 percent of total billed charges 8775 8775 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR TALENT XCELERANT POLYESTER NITINOL BIFURCATED L60 MM L26 MM OD36 MM ODSEC22 FR DESCENDING ABDOMEN AORTA SELF EXPANDING EXTENSION STENT RADIOPAQUE HYDRO DELIVERY SYSTEM AAA SUP-AXF3636W26XH CDM 270010015 LOCAL 0270 RC outpatient 9555 9555 9555 74 7070.7 percent of total billed charges 9555 93 7739.55 percent of total billed charges 9555 9555 other OPPS APC 9555 9555 other OPPS APC 9555 27.63 2640.05 percent of total billed charges 9555 9555 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER AZURE S XT SR W1SR01 MRI SYSTEM SYSTEMSYSTEM SUP-AZURESXTMRIMEEM CDM 0275 RC outpatient 7436.25 7436.25 7436.25 57 4238.66 percent of total billed charges 7436.25 93 6023.36 percent of total billed charges 7436.25 7436.25 other OPPS APC 7436.25 7436.25 other OPPS APC 7436.25 51 3792.49 percent of total billed charges 7436.25 7436.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER AZURE MRI XT DR DUAL CHAMBER SYSTEM SUP-AZUREXTDRMRIMEEM CDM 0275 RC outpatient 10462.5 10462.5 10462.5 57 5963.63 percent of total billed charges 10462.5 93 8474.63 percent of total billed charges 10462.5 10462.5 other OPPS APC 10462.5 10462.5 other OPPS APC 10462.5 51 5335.88 percent of total billed charges 10462.5 10462.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE CALIBRATION LAP-BAND AP SILICONE L157 CM OD13 MM 15-25 CC 2 LUMEN TRANSLUCENT BALLOON SENSOR TIP NONSTERILE LATEX FREE SUP-B-2017 CDM 0270 RC outpatient 488.8 488.8 488.8 74 361.71 percent of total billed charges 488.8 93 395.93 percent of total billed charges 488.8 488.8 other OPPS APC 488.8 488.8 other OPPS APC 488.8 27.63 135.06 percent of total billed charges 488.8 488.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE GASTRIC BAND LAP-BAND 89MM 20GA SS PLASTIC DISPOSABLE STERILE ACCESS PORT NONCORE DEFLECT TIP HUB SUP-B-20301-10 CDM 0270 RC outpatient 14.04 14.04 14.04 74 10.39 percent of total billed charges 14.04 93 11.37 percent of total billed charges 14.04 14.04 other OPPS APC 14.04 14.04 other OPPS APC 14.04 27.63 3.88 percent of total billed charges 14.04 14.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACCESS PORT GASTRIC BAND LAP-BAND TITANIUM KIT HIGH COMPRESSION SEPTUM RESERVOIR RADIOPAQUE STERILE LATEX FREE VG AP STANDARD BAND SUP-B-2104 CDM 0270 RC outpatient 2314 2314 2314 74 1712.36 percent of total billed charges 2314 93 1874.34 percent of total billed charges 2314 2314 other OPPS APC 2314 2314 other OPPS APC 2314 27.63 639.36 percent of total billed charges 2314 2314 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM GASTRIC BAND LAP-BAND AP OMNIFORM STAINLESS STEEL SILICONE ELASTOMER STANDARD L50 CM 10 CC ACCESS PORT I ADJUSTABLE CONNECTOR RADIOPAQUE STERILE LATEX FREE SUP-B-2240 CDM 0270 RC outpatient 8203 8203 8203 74 6070.22 percent of total billed charges 8203 93 6644.43 percent of total billed charges 8203 8203 other OPPS APC 8203 8203 other OPPS APC 8203 27.63 2266.49 percent of total billed charges 8203 8203 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM GASTRIC BAND LAP-BAND AP OMNIFORM STAINLESS STEEL SILICONE ELASTOMER LARGE L50 CM 14 CC ACCESS PORT I ADJUSTABLE CONNECTOR RADIOPAQUE STERILE LATEX FREE SUP-B-2245 CDM 0270 RC outpatient 8203 8203 8203 74 6070.22 percent of total billed charges 8203 93 6644.43 percent of total billed charges 8203 8203 other OPPS APC 8203 8203 other OPPS APC 8203 27.63 2266.49 percent of total billed charges 8203 8203 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HYPODERMIC BD POLYPROPYLENE REGULAR WALL L1 1/2 IN OD21 GA REGULAR BEVEL LUER HUB DEHP FREE STERILE LATEX FREE DISPOSABLE GREEN SUP-B-D305167Z CDM 0270 RC outpatient 0.19 0.19 0.19 74 0.14 percent of total billed charges 0.19 93 0.15 percent of total billed charges 0.19 0.19 other OPPS APC 0.19 0.19 other OPPS APC 0.19 27.63 0.05 percent of total billed charges 0.19 0.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR LAPAROSCOPIC ENDOPATH XCEL 100MM 11MM DISPOSABLE STERILE LF STABILITY SLEEVE BLADELESS OBTURATOR OPTIONAL PISTOL SUP-B11LT CDM 0270 RC outpatient 63.72 63.72 63.72 74 47.15 percent of total billed charges 63.72 93 51.61 percent of total billed charges 63.72 63.72 other OPPS APC 63.72 63.72 other OPPS APC 63.72 27.63 17.61 percent of total billed charges 63.72 63.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR LAPAROSCOPIC ENDOPATH XCEL L100 MM OD12 MM BLADELESS OPTICAL TIP OBTURATOR RADIOLUCENT SLEEVE STERILE DISPOSABLE SUP-B12LT CDM 0270 RC outpatient 63.72 63.72 63.72 74 47.15 percent of total billed charges 63.72 93 51.61 percent of total billed charges 63.72 63.72 other OPPS APC 63.72 63.72 other OPPS APC 63.72 27.63 17.61 percent of total billed charges 63.72 63.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR LAPAROSCOPIC ENDOPATH XCEL L150 MM OD12 MM STABILITY SLEEVE BLADELESS LOW SYSTEM DRAG FORCE OPTIONAL PISTOL HANDLE STERILE DISPOSABLE SUP-B12XT CDM 0270 RC outpatient 80.34 80.34 80.34 74 59.45 percent of total billed charges 80.34 93 65.08 percent of total billed charges 80.34 80.34 other OPPS APC 80.34 80.34 other OPPS APC 80.34 27.63 22.2 percent of total billed charges 80.34 80.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR LAPAROSCOPIC ENDOPATH XCEL L100 MM OD15 MM BLADELESS OPTICAL TIP OBTURATOR RADIOLUCENT SLEEVE STERILE DISPOSABLE SUP-B15LT CDM 0270 RC outpatient 110.82 110.82 110.82 74 82.01 percent of total billed charges 110.82 93 89.76 percent of total billed charges 110.82 110.82 other OPPS APC 110.82 110.82 other OPPS APC 110.82 27.63 30.62 percent of total billed charges 110.82 110.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK O2/CO2 CAPNOMASK ADULT TRANSPARENT GAS SAMPLING LINE DEHP PVC FREE LATEX FREE SUP-B180155 CDM 0270 RC outpatient 11.44 11.44 11.44 74 8.47 percent of total billed charges 11.44 93 9.27 percent of total billed charges 11.44 11.44 other OPPS APC 11.44 11.44 other OPPS APC 11.44 27.63 3.16 percent of total billed charges 11.44 11.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POM With Microstream Philips SUP-B180159 CDM 0270 RC outpatient 20.02 20.02 20.02 74 14.81 percent of total billed charges 20.02 93 16.22 percent of total billed charges 20.02 20.02 other OPPS APC 20.02 20.02 other OPPS APC 20.02 27.63 5.53 percent of total billed charges 20.02 20.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK OXYGEN POM ELITE PVC ADULT L10 FT OD5.8 IN ID3.5 IN HIGH CONCENTRATION CO2 MONITOR MALE TO MALE MALE SAMPLE LINE LATEX FREE SUP-B180160 CDM 0270 RC outpatient 19.07 19.07 19.07 74 14.11 percent of total billed charges 19.07 93 15.45 percent of total billed charges 19.07 19.07 other OPPS APC 19.07 19.07 other OPPS APC 19.07 27.63 5.27 percent of total billed charges 19.07 19.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK OXYGEN POM ELITE MSA ADULT HIGH CONCENTRATION CO2 MONITOR LATEX FREE MICROSTREAM SUP-B180163 CDM 0270 RC outpatient 35.19 35.19 35.19 74 26.04 percent of total billed charges 35.19 93 28.5 percent of total billed charges 35.19 35.19 other OPPS APC 35.19 35.19 other OPPS APC 35.19 27.63 9.72 percent of total billed charges 35.19 35.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON PRESTERILIZED LATEX SUP-B20BU CDM 0270 RC outpatient 70.2 70.2 70.2 74 51.95 percent of total billed charges 70.2 93 56.86 percent of total billed charges 70.2 70.2 other OPPS APC 70.2 70.2 other OPPS APC 70.2 27.63 19.4 percent of total billed charges 70.2 70.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISPOSABLE BALLOON CATHETER 5FR 11MM 1050MM KINK RESISTANT EXCELLENT XRAY VISIBILITY DILATATION SUP-B5-2C CDM 0270 RC outpatient 291.51 291.51 291.51 74 215.72 percent of total billed charges 291.51 93 236.12 percent of total billed charges 291.51 291.51 other OPPS APC 291.51 291.51 other OPPS APC 291.51 27.63 80.54 percent of total billed charges 291.51 291.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR LAPAROSCOPIC ENDOPATH XCEL 150MM 5MM DISPOSABLE STERILE STABILITY SLEEVE SUP-B5XT CDM 0270 RC outpatient 63.72 63.72 63.72 74 47.15 percent of total billed charges 63.72 93 51.61 percent of total billed charges 63.72 63.72 other OPPS APC 63.72 63.72 other OPPS APC 63.72 27.63 17.61 percent of total billed charges 63.72 63.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE SILICONE L110 CM OD2.5 MM ID1.1 MM OPEN END MULTIPERFORATE DISTAL TIP RADIOPAQUE CSF SUP-B905S_72548 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOLOGIX AFX MAIN ENDO AAA SUP-BA-25-80/113-40 CDM 270010015 LOCAL 0270 RC outpatient 29146 29146 29146 74 21568 percent of total billed charges 29146 93 23608.3 percent of total billed charges 29146 29146 other OPPS APC 29146 29146 other OPPS APC 29146 27.63 8053.04 percent of total billed charges 29146 29146 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.7MM TORNIER SUP-BA0010349 CDM 0270 RC outpatient 234 234 234 74 173.16 percent of total billed charges 234 93 189.54 percent of total billed charges 234 234 other OPPS APC 234 234 other OPPS APC 234 27.63 64.65 percent of total billed charges 234 234 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOLOGIX AFX BIFURCATED ENDOVASCULAR SUP-BA22-60/113-40 CDM 270010015 LOCAL 0270 RC outpatient 29146 29146 29146 74 21568 percent of total billed charges 29146 93 23608.3 percent of total billed charges 29146 29146 other OPPS APC 29146 29146 other OPPS APC 29146 27.63 8053.04 percent of total billed charges 29146 29146 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOLOGIX AFX BIFURCATED ENDOVASCULAR SUP-BA22-70/116-30 CDM 270010015 LOCAL 0270 RC outpatient 29146 29146 29146 74 21568 percent of total billed charges 29146 93 23608.3 percent of total billed charges 29146 29146 other OPPS APC 29146 29146 other OPPS APC 29146 27.63 8053.04 percent of total billed charges 29146 29146 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT AFX ACTIVESEAL STRATA 2 BRANCH 80MM 40MM 22-16MM 17FR EPTFE ENDOVASCULAR SUP-BA22-80/116-40 CDM 270010015 LOCAL 0270 RC outpatient 29146 29146 29146 74 21568 percent of total billed charges 29146 93 23608.3 percent of total billed charges 29146 29146 other OPPS APC 29146 29146 other OPPS APC 29146 27.63 8053.04 percent of total billed charges 29146 29146 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT AFX 2 BRANCH 90MM 30MM 22MM 16MM STRATA STERILE LF MAIN BODY ILIAC LIMB AAA SUP-BA22-90/116-30 CDM 270010015 LOCAL 0270 RC outpatient 29146 29146 29146 74 21568 percent of total billed charges 29146 93 23608.3 percent of total billed charges 29146 29146 other OPPS APC 29146 29146 other OPPS APC 29146 27.63 8053.04 percent of total billed charges 29146 29146 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOLOGIX BIFURCATED ENDO AAA SUP-BA25-70/116-30 CDM 270010015 LOCAL 0270 RC outpatient 29146 29146 29146 74 21568 percent of total billed charges 29146 93 23608.3 percent of total billed charges 29146 29146 other OPPS APC 29146 29146 other OPPS APC 29146 27.63 8053.04 percent of total billed charges 29146 29146 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT AFX ACTIVESEAL STRATA EPTFE 2 BRANCH L90 MM L30 MM OD25-16 MM ID17 FR ENDOVASCULAR SELF EXPAND MAIN BODY AAA SUP-BA25-90/116-30 CDM 270010015 LOCAL 0270 RC outpatient 29146 29146 29146 74 21568 percent of total billed charges 29146 93 23608.3 percent of total billed charges 29146 29146 other OPPS APC 29146 29146 other OPPS APC 29146 27.63 8053.04 percent of total billed charges 29146 29146 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOLOGIX AFX BIFURCATED ENDOVASCULAR SUP-BA26-60/116-40 CDM 270010015 LOCAL 0270 RC outpatient 29146 29146 29146 74 21568 percent of total billed charges 29146 93 23608.3 percent of total billed charges 29146 29146 other OPPS APC 29146 29146 other OPPS APC 29146 27.63 8053.04 percent of total billed charges 29146 29146 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOLOGIX BIFURCATED ENDO AAA SUP-BA28-70/116-30 CDM 270010015 LOCAL 0270 RC outpatient 29146 29146 29146 74 21568 percent of total billed charges 29146 93 23608.3 percent of total billed charges 29146 29146 other OPPS APC 29146 29146 other OPPS APC 29146 27.63 8053.04 percent of total billed charges 29146 29146 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT AFX ACTIVESEAL STRATA 2 BRANCH 80MM 40MM 28-16MM 17FR EPTFE SELF EXPAND SUP-BA28-80/116-40 CDM 270010015 LOCAL 0270 RC outpatient 29146 29146 29146 74 21568 percent of total billed charges 29146 93 23608.3 percent of total billed charges 29146 29146 other OPPS APC 29146 29146 other OPPS APC 29146 27.63 8053.04 percent of total billed charges 29146 29146 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT AFX 2 BRANCH 80MM 40MM 28MM 20MM STRATA STERILE LF MAIN BODY ILIAC LIMB AAA SUP-BA28-80/120-40 CDM 270010015 LOCAL 0270 RC outpatient 29146 29146 29146 74 21568 percent of total billed charges 29146 93 23608.3 percent of total billed charges 29146 29146 other OPPS APC 29146 29146 other OPPS APC 29146 27.63 8053.04 percent of total billed charges 29146 29146 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOLOGIX BIFURCATED ENDO AAA SUP-BA28-90/116-30 CDM 270010015 LOCAL 0270 RC outpatient 29146 29146 29146 74 21568 percent of total billed charges 29146 93 23608.3 percent of total billed charges 29146 29146 other OPPS APC 29146 29146 other OPPS APC 29146 27.63 8053.04 percent of total billed charges 29146 29146 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOLOGIX MAIN BODY ENDO AAA SUP-BA28-90/120-30 CDM 270010015 LOCAL 0270 RC outpatient 29146 29146 29146 74 21568 percent of total billed charges 29146 93 23608.3 percent of total billed charges 29146 29146 other OPPS APC 29146 29146 other OPPS APC 29146 27.63 8053.04 percent of total billed charges 29146 29146 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY BIOPSY JAMSHIDI ILLINOIS STANDARD 4IN 11GA 15GA DISPOSABLE STERILE NEEDLE SUP-BAK4511 CDM 270009052 LOCAL 0270 RC outpatient 36 36 36 74 26.64 percent of total billed charges 36 93 29.16 percent of total billed charges 36 36 other OPPS APC 36 36 other OPPS APC 36 27.63 9.95 percent of total billed charges 36 36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER BALLAST HYDROPHILIC LONG L90 CM OD.1-.106 IN ID.088 IN SOFT COIL DISTAL TIP BRAID REINFORCE PROXIMAL SEGMENT SUP-BALLAST90 CDM 0270 RC outpatient 1495 1495 1495 74 1106.3 percent of total billed charges 1495 93 1210.95 percent of total billed charges 1495 1495 other OPPS APC 1495 1495 other OPPS APC 1495 27.63 413.07 percent of total billed charges 1495 1495 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EP DYNAMIC DECA XT LARGE Reproc SUP-BAR201102 CDM 0270 RC outpatient 296.4 296.4 296.4 74 219.34 percent of total billed charges 296.4 93 240.08 percent of total billed charges 296.4 296.4 other OPPS APC 296.4 296.4 other OPPS APC 296.4 27.63 81.9 percent of total billed charges 296.4 296.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VIABAHN BX BALLOON ENDO SUP-BAXL085902A CDM 0270 RC outpatient 9292.4 9292.4 9292.4 74 6876.38 percent of total billed charges 9292.4 93 7526.84 percent of total billed charges 9292.4 9292.4 other OPPS APC 9292.4 9292.4 other OPPS APC 9292.4 27.63 2567.49 percent of total billed charges 9292.4 9292.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VIABAHN BX BALLOON ENDO SUP-BAXL087902A CDM 0270 RC outpatient 10194.6 10194.6 10194.6 74 7544 percent of total billed charges 10194.6 93 8257.63 percent of total billed charges 10194.6 10194.6 other OPPS APC 10194.6 10194.6 other OPPS APC 10194.6 27.63 2816.77 percent of total billed charges 10194.6 10194.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMALL BRONCH CYTOLOGY BRUSH SUP-BC-203D-2006 CDM 0270 RC outpatient 391.33 391.33 391.33 74 289.58 percent of total billed charges 391.33 93 316.98 percent of total billed charges 391.33 391.33 other OPPS APC 391.33 391.33 other OPPS APC 391.33 27.63 108.12 percent of total billed charges 391.33 391.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON OCCLUSION SCEPTER MINI L9 MM OD2.2 MM STERILE LATEX FREE DISPOSABLE SUP-BC0210M CDM 0270 RC outpatient 8827 8827 8827 74 6531.98 percent of total billed charges 8827 93 7149.87 percent of total billed charges 8827 8827 other OPPS APC 8827 8827 other OPPS APC 8827 27.63 2438.9 percent of total billed charges 8827 8827 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON OCCLUSION SCEPTER XC HYDROPHILIC L5 MM L150 CM L11 MM OD2.1-2.8 FR ODSEC4 MM 3 TIP MARKER EXTRA COMPLIANT FLEXIBLE COAXIAL LUMEN SOFT STERILE LATEX FREE DISPOSABLE ACCEPTS .014 IN GUIDEWIRE SUP-BC0411XC CDM 0270 RC outpatient 5083 5083 5083 74 3761.42 percent of total billed charges 5083 93 4117.23 percent of total billed charges 5083 5083 other OPPS APC 5083 5083 other OPPS APC 5083 27.63 1404.43 percent of total billed charges 5083 5083 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR DRAINAGE BLAKE 1:1 3/8.5MMX3/16IN WHITE SILICONE DISPOSABLE STERILE LF CARDIAC 4 CHANNEL RADIOPAQUE SOLID CORE SUP-BCC1 CDM 0270 RC outpatient 41.6 41.6 41.6 74 30.78 percent of total billed charges 41.6 93 33.7 percent of total billed charges 41.6 41.6 other OPPS APC 41.6 41.6 other OPPS APC 41.6 27.63 11.49 percent of total billed charges 41.6 41.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR DRAINAGE BLAKE 2:1 3/8.5MMX3/16IN WHITE SILICONE DISPOSABLE STERILE LF CARDIAC 4 CHANNEL RADIOPAQUE SOLID CORE SUP-BCC2 CDM 0270 RC outpatient 43.49 43.49 43.49 74 32.18 percent of total billed charges 43.49 93 35.23 percent of total billed charges 43.49 43.49 other OPPS APC 43.49 43.49 other OPPS APC 43.49 27.63 12.02 percent of total billed charges 43.49 43.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR DRAINAGE BLAKE 3:1 3/8.5MMX3/16IN WHITE SILICONE DISPOSABLE STERILE LF CARDIAC 4 CHANNEL RADIOPAQUE SOLID CORE SUP-BCC3 CDM 0270 RC outpatient 43.49 43.49 43.49 74 32.18 percent of total billed charges 43.49 93 35.23 percent of total billed charges 43.49 43.49 other OPPS APC 43.49 43.49 other OPPS APC 43.49 27.63 12.02 percent of total billed charges 43.49 43.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON TRILOBE SIZE LARGE SUP-BCL2645 CDM 270010019 LOCAL 0270 RC outpatient 1851.2 1851.2 1851.2 74 1369.89 percent of total billed charges 1851.2 93 1499.47 percent of total billed charges 1851.2 1851.2 other OPPS APC 1851.2 1851.2 other OPPS APC 1851.2 27.63 511.49 percent of total billed charges 1851.2 1851.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOOD GORE TRI-LOBE SUP-BCM1634 CDM 270010015 LOCAL 0270 RC outpatient 1851.2 1851.2 1851.2 74 1369.89 percent of total billed charges 1851.2 93 1499.47 percent of total billed charges 1851.2 1851.2 other OPPS APC 1851.2 1851.2 other OPPS APC 1851.2 27.63 511.49 percent of total billed charges 1851.2 1851.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY EZ STEER 2-8-2 MM SPACING D-F CURVE OD7 FR CORONARY SINUS BIDIRECTIONAL 12 PIN AUTO ID DEFLECTABLE TIP SUP-BD710DF282CT CDM 0270 RC outpatient 1687.4 1687.4 1687.4 74 1248.68 percent of total billed charges 1687.4 93 1366.79 percent of total billed charges 1687.4 1687.4 other OPPS APC 1687.4 1687.4 other OPPS APC 1687.4 27.63 466.23 percent of total billed charges 1687.4 1687.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CATHETER ABLATION THERMOCOOLSF 2-5-2 SPACE 3.5MM D-F CURVE, L 115 CMOD 8 FR 6 ELECTRODE TIP BI-DIRECTIONAL NON-NAVIGATIONAL" SUP-BDI35DFRT CDM 0481 RC outpatient 4989.4 4989.4 4989.4 74 3692.16 percent of total billed charges 4989.4 93 4041.41 percent of total billed charges 4989.4 4989.4 other OPPS APC 4989.4 4989.4 other OPPS APC 4989.4 51 2544.59 percent of total billed charges 4989.4 4989.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION THERMOCOOL SF 2-5-2 SPACE 3.5MM F-J CURVE L115 CM OD 8 FR 6 ELECTRODE TIP BI-DIRECTIONAL NON-NAVIGATIONAL SUP-BDI35FJRT CDM 0481 RC outpatient 4989.4 4989.4 4989.4 74 3692.16 percent of total billed charges 4989.4 93 4041.41 percent of total billed charges 4989.4 4989.4 other OPPS APC 4989.4 4989.4 other OPPS APC 4989.4 51 2544.59 percent of total billed charges 4989.4 4989.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT AFX2 2 BRANCH L70 MM L30 MM OD22 MM ODSEC16 MM MAIN BODY ILIAC LIMB STERILE LATEX FREE AAA SUP-BEA22-70/I16-30 CDM 0270 RC outpatient 37697.4 37697.4 37697.4 74 27896.1 percent of total billed charges 37697.4 93 30534.9 percent of total billed charges 37697.4 37697.4 other OPPS APC 37697.4 37697.4 other OPPS APC 37697.4 27.63 10415.8 percent of total billed charges 37697.4 37697.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT AFX2 2 BRANCH L80 MM L40 MM OD22 MM ODSEC16 MM MAIN BODY ILIAC LIMB STERILE LATEX FREE AAA SUP-BEA22-80/I16-40 CDM 270010015 LOCAL 0270 RC outpatient 37697.4 37697.4 37697.4 74 27896.1 percent of total billed charges 37697.4 93 30534.9 percent of total billed charges 37697.4 37697.4 other OPPS APC 37697.4 37697.4 other OPPS APC 37697.4 27.63 10415.8 percent of total billed charges 37697.4 37697.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOLOGIX AFX MAIN BODY SUP-BEA25-60/116-40 CDM 0270 RC outpatient 37697.4 37697.4 37697.4 74 27896.1 percent of total billed charges 37697.4 93 30534.9 percent of total billed charges 37697.4 37697.4 other OPPS APC 37697.4 37697.4 other OPPS APC 37697.4 27.63 10415.8 percent of total billed charges 37697.4 37697.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOLOBIX AAA AFX2 MAIN BODY SUP-BEA25-90/116-30 CDM 270010015 LOCAL 0270 RC outpatient 37697.4 37697.4 37697.4 74 27896.1 percent of total billed charges 37697.4 93 30534.9 percent of total billed charges 37697.4 37697.4 other OPPS APC 37697.4 37697.4 other OPPS APC 37697.4 27.63 10415.8 percent of total billed charges 37697.4 37697.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE OPHTHALMIC BEAVER MINI-BLADE STRAIGHT BLUE GRINDLESS SHARP ALL AROUND PREASSEMBLE 2 BEVEL SUP-BEAVER6900 CDM outpatient 16.53 16.53 16.53 16.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTAINER HISTOLOGY SURE-LOK 10% NEUTRAL BUFFER FORMALIN 95 KPA C1.25 GL .6 GL PREFILL SUP-BF125GAZER CDM 0270 RC outpatient 103.06 103.06 103.06 74 76.26 percent of total billed charges 103.06 93 83.48 percent of total billed charges 103.06 103.06 other OPPS APC 103.06 103.06 other OPPS APC 103.06 27.63 28.48 percent of total billed charges 103.06 103.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE HYPODERMIC BD REGULAR WALL 5/8IN 25GA BLUE POLYPROPYLENE DISPOSABLE STERILE LF REGULAR BEVEL LUER HUB DEHP FREE SUP-BF305122 CDM 0270 RC outpatient 8.88 8.88 8.88 74 6.57 percent of total billed charges 8.88 93 7.19 percent of total billed charges 8.88 8.88 other OPPS APC 8.88 8.88 other OPPS APC 8.88 27.63 2.45 percent of total billed charges 8.88 8.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEP GRASPING BACKHAUS TOWEL PIERCING RATCHET HANDLE NON STERILE 3.5IN SUP-BF431R CDM 0270 RC outpatient 25.09 25.09 25.09 74 18.57 percent of total billed charges 25.09 93 20.32 percent of total billed charges 25.09 25.09 other OPPS APC 25.09 25.09 other OPPS APC 25.09 27.63 6.93 percent of total billed charges 25.09 25.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ANEURX AAADVANTAGE XCELERANT NITINOL BIFURCATED L13.5 CM OD20-12 MM ODSEC21 FR ENDOVASCULAR ABDOMEN AORTA ILIUM INFRARENAL SYSTEM SELF EXPANDING WOVEN STENT HYDRO DELIVERY AAA SUP-BFXCH2012135 CDM 270010015 LOCAL 0270 RC outpatient 21060 21060 21060 74 15584.4 percent of total billed charges 21060 93 17058.6 percent of total billed charges 21060 21060 other OPPS APC 21060 21060 other OPPS APC 21060 27.63 5818.88 percent of total billed charges 21060 21060 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ANEURX AAADVANTAGE XCELERANT NITINOL BIFURCATED L13.5 CM OD24-14 MM ODSEC21 FR ENDOVASCULAR ABDOMEN AORTA ILIUM INFRARENAL SYSTEM SELF EXPANDING WOVEN STENT HYDRO DELIVERY AAA SUP-BFXCH2414135 CDM 270010015 LOCAL 0270 RC outpatient 21060 21060 21060 74 15584.4 percent of total billed charges 21060 93 17058.6 percent of total billed charges 21060 21060 other OPPS APC 21060 21060 other OPPS APC 21060 27.63 5818.88 percent of total billed charges 21060 21060 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ANEURX AAADVANTAGE XCELERANT NITINOL BIFURCATED L16.5 CM OD24-14 MM ODSEC21 FR ENDOVASCULAR ABDOMEN AORTA ILIUM INFRARENAL SYSTEM SELF EXPANDING WOVEN STENT HYDRO DELIVERY AAA SUP-BFXCH2414165 CDM 270010015 LOCAL 0270 RC outpatient 21580 21580 21580 74 15969.2 percent of total billed charges 21580 93 17479.8 percent of total billed charges 21580 21580 other OPPS APC 21580 21580 other OPPS APC 21580 27.63 5962.55 percent of total billed charges 21580 21580 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ANEURX AAADVANTAGE XCELERANT NITINOL BIFURCATED L13.5 CM OD28-16 MM ODSEC21 FR ENDOVASCULAR ABDOMEN AORTA ILIUM INFRARENAL SYSTEM SELF EXPANDING WOVEN STENT HYDRO DELIVERY AAA SUP-BFXCH2816135 CDM 270010015 LOCAL 0270 RC outpatient 21060 21060 21060 74 15584.4 percent of total billed charges 21060 93 17058.6 percent of total billed charges 21060 21060 other OPPS APC 21060 21060 other OPPS APC 21060 27.63 5818.88 percent of total billed charges 21060 21060 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ANEURX AAADVANTAGE XCELERANT NITINOL BIFURCATED L16.5 CM OD28-16 MM ODSEC21 FR ENDOVASCULAR ABDOMEN AORTA ILIUM INFRARENAL SYSTEM SELF EXPANDING WOVEN STENT HYDRO DELIVERY AAA SUP-BFXCH2816165 CDM 270010015 LOCAL 0270 RC outpatient 21580 21580 21580 74 15969.2 percent of total billed charges 21580 93 17479.8 percent of total billed charges 21580 21580 other OPPS APC 21580 21580 other OPPS APC 21580 27.63 5962.55 percent of total billed charges 21580 21580 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADHESIVE SKIN CLOSURE BIOGLUE BSA GLUTARALDEHYDE 5 ML CARTRIDGE SYRINGE STERILE LATEX FREE DISPOSABLE HAZARDOUS SUP-BG-3005-5-US CDM 0270 RC outpatient 1349.4 1349.4 1349.4 74 998.56 percent of total billed charges 1349.4 93 1093.01 percent of total billed charges 1349.4 1349.4 other OPPS APC 1349.4 1349.4 other OPPS APC 1349.4 27.63 372.84 percent of total billed charges 1349.4 1349.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT OPHTHALMIC BAERVELDT SILICONE 350 SQ MM ANTERIOR CHAMBER 1 QUADRANT INSERTION FIXATION SUTURE HOLE RECESS KNOT CAPABILITY GLAUCOMA SUP-BG101-350 CDM 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT OPHTHALMIC BAERVELDT 350SQ MM SILICONE ANTERIOR CHAMBER QUADRANT INSERTION FIXATION SUTURE HOLE RECESS KNOT SUP-BG102-350 CDM 0270 RC outpatient 1820 1820 1820 74 1346.8 percent of total billed charges 1820 93 1474.2 percent of total billed charges 1820 1820 other OPPS APC 1820 1820 other OPPS APC 1820 27.63 502.87 percent of total billed charges 1820 1820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADHESIVE SKIN CLOSURE BIOGLUE 5 ML CARTRIDGES TWIST RING TOOLS STERILE LATEX FREE DISPOSABLE SUP-BG3010-5-G CDM 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADHESIVE SURGICAL BIOGLUE BOVINE SERUM ALBUMIN GLUTARALDEHYDE L12 MM 10 ML SOFT TISSUE PREFILL SYRINGE PLUNGER 3 SPREADER 4 STANDARD TIP STERILE LATEX FREE DISPOSABLE SUP-BG3510-5-US CDM 0270 RC outpatient 3484 3484 3484 74 2578.16 percent of total billed charges 3484 93 2822.04 percent of total billed charges 3484 3484 other OPPS APC 3484 3484 other OPPS APC 3484 27.63 962.63 percent of total billed charges 3484 3484 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON OCCLUSION EMBOGUARD L85 CM SUP-BG8785U CDM 0270 RC outpatient 6659.41 6659.41 6659.41 74 4927.96 percent of total billed charges 6659.41 93 5394.12 percent of total billed charges 6659.41 6659.41 other OPPS APC 6659.41 6659.41 other OPPS APC 6659.41 27.63 1839.99 percent of total billed charges 6659.41 6659.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON OCCLUSION EMBOGUARD L95 CM SUP-BG8795U CDM 0270 RC outpatient 6659.41 6659.41 6659.41 74 4927.96 percent of total billed charges 6659.41 93 5394.12 percent of total billed charges 6659.41 6659.41 other OPPS APC 6659.41 6659.41 other OPPS APC 6659.41 27.63 1839.99 percent of total billed charges 6659.41 6659.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIOGLUE APPLICATOR BGAT-US SUP-BGAT-US CDM 0270 RC outpatient 97.5 97.5 97.5 74 72.15 percent of total billed charges 97.5 93 78.98 percent of total billed charges 97.5 97.5 other OPPS APC 97.5 97.5 other OPPS APC 97.5 27.63 26.94 percent of total billed charges 97.5 97.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADHESIVE SURGICAL BIOGLUE L 12 MM SYRINGE SPREADER TIP SUP-BGST-12 CDM 0270 RC outpatient 1352 1352 1352 74 1000.48 percent of total billed charges 1352 93 1095.12 percent of total billed charges 1352 1352 other OPPS APC 1352 1352 other OPPS APC 1352 27.63 373.56 percent of total billed charges 1352 1352 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER GUIDEWIRE L7 CM OD18 GA TAPERED LUER HUB WINGED BASE PLATE SUP-BGWI1802 CDM 0270 RC outpatient 14.35 14.35 14.35 74 10.62 percent of total billed charges 14.35 93 11.62 percent of total billed charges 14.35 14.35 other OPPS APC 14.35 14.35 other OPPS APC 14.35 27.63 3.96 percent of total billed charges 14.35 14.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HARVESTER BONE AVITUS SUP-BH8 CDM 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SINUS BALLOON CATHETER SUP-BID30Z CDM outpatient 232.6 232.6 232.6 232.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BILATERAL TOTAL KNEE CAP PRICING-DEPUY SUP-BILATERALKNEE-DEPUY CDM 270010025 LOCAL 0270 RC outpatient 20800 20800 20800 74 15392 percent of total billed charges 20800 93 16848 percent of total billed charges 20800 20800 other OPPS APC 20800 20800 other OPPS APC 20800 27.63 5747.04 percent of total billed charges 20800 20800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICE 10F SOUNDSTAR ULTRASOUND reprocessed SUP-BIO10439072 CDM 0270 RC outpatient 3754.4 3754.4 3754.4 74 2778.26 percent of total billed charges 3754.4 93 3041.06 percent of total billed charges 3754.4 3754.4 other OPPS APC 3754.4 3754.4 other OPPS APC 3754.4 27.63 1037.34 percent of total billed charges 3754.4 3754.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CATHETER CARTO 3 L3 MR 12 34 PIN DARK BLUE LIGHT BLUE DECAPOLAR WEBSTER CS BIDIRECTIONAL AUTO ID REPROCESSED SUP-BIOCB3412CT CDM 0270 RC outpatient 85.8 85.8 85.8 74 63.49 percent of total billed charges 85.8 93 69.5 percent of total billed charges 85.8 85.8 other OPPS APC 85.8 85.8 other OPPS APC 85.8 27.63 23.71 percent of total billed charges 85.8 85.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CATHETER CARTO 3 L 10FT 20 POLE 34 PIN STERILE LATEX FREE DISPOSABLE DARK BLUE LIGHT BLUE REPROCESSED SUP-BIOCB3434CT CDM 0270 RC outpatient 85.8 85.8 85.8 74 63.49 percent of total billed charges 85.8 93 69.5 percent of total billed charges 85.8 85.8 other OPPS APC 85.8 85.8 other OPPS APC 85.8 27.63 23.71 percent of total billed charges 85.8 85.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CATHETER 3 INTERFACE SPLIT HANDLE STERILE LATEX FREE DISPOSABLE REPROCESSED SUP-BIOD134401 CDM 0270 RC outpatient 85.8 85.8 85.8 74 63.49 percent of total billed charges 85.8 93 69.5 percent of total billed charges 85.8 85.8 other OPPS APC 85.8 85.8 other OPPS APC 85.8 27.63 23.71 percent of total billed charges 85.8 85.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER LEAD L10 CM EXTENSION PACING SUP-BLV-BIS-10 CDM 0275 RC outpatient 650 650 650 57 370.5 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 51 331.5 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MILL BONE LEGEND PNEUMATIC DISPOSABLE SUP-BM200 CDM 270010028 LOCAL 0270 RC outpatient 980.98 980.98 980.98 74 725.93 percent of total billed charges 980.98 93 794.59 percent of total billed charges 980.98 980.98 other OPPS APC 980.98 980.98 other OPPS APC 980.98 27.63 271.04 percent of total billed charges 980.98 980.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE INJECTION 10ML FLUID DISPENSING SYSTEM SUP-BMG513540 CDM 0270 RC outpatient 38.43 38.43 38.43 74 28.44 percent of total billed charges 38.43 93 31.13 percent of total billed charges 38.43 38.43 other OPPS APC 38.43 38.43 other OPPS APC 38.43 27.63 10.62 percent of total billed charges 38.43 38.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DELIVERY SYSTEM BENCHMARK STRAIGHT L105 CM ID.07 IN LATEX FREE SUP-BMK6F105 CDM 0270 RC outpatient 2561 2561 2561 74 1895.14 percent of total billed charges 2561 93 2074.41 percent of total billed charges 2561 2561 other OPPS APC 2561 2561 other OPPS APC 2561 27.63 707.6 percent of total billed charges 2561 2561 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DELIVERY SYSTEM BENCHMARK STRAIGHT L95 CM ID.07 IN LATEX FREE SUP-BMK6F95 CDM 0270 RC outpatient 2561 2561 2561 74 1895.14 percent of total billed charges 2561 93 2074.41 percent of total billed charges 2561 2561 other OPPS APC 2561 2561 other OPPS APC 2561 27.63 707.6 percent of total billed charges 2561 2561 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION NAVIGATIONAL BIDIRECTIONAL 4 MM SPACE D-F CURVE L115 CM L4 MM OD7 FR SUP-BN7TCDF4L CDM 0270 RC outpatient 6271.2 6271.2 6271.2 74 4640.69 percent of total billed charges 6271.2 93 5079.67 percent of total billed charges 6271.2 6271.2 other OPPS APC 6271.2 6271.2 other OPPS APC 6271.2 27.63 1732.73 percent of total billed charges 6271.2 6271.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION NAVIGATIONAL BIDIRECTIONAL 4 MM SPACE F-J CURVE L115 CM L4 MM OD7 FR SUP-BN7TCFJ4L CDM 0270 RC outpatient 6271.2 6271.2 6271.2 74 4640.69 percent of total billed charges 6271.2 93 5079.67 percent of total billed charges 6271.2 6271.2 other OPPS APC 6271.2 6271.2 other OPPS APC 6271.2 27.63 1732.73 percent of total billed charges 6271.2 6271.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY CARTO 3 THERMOCOOL SF D-F CURVE OD 7.5 FR BIDRIECTIONAL DEFLECTABLE TIP STEERABLE MULTIELECTRODE STERILE DISPOSABLE SUP-BNI35DFCT CDM 0270 RC outpatient 8619 8619 8619 74 6378.06 percent of total billed charges 8619 93 6981.39 percent of total billed charges 8619 8619 other OPPS APC 8619 8619 other OPPS APC 8619 27.63 2381.43 percent of total billed charges 8619 8619 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY CARTO 3 THERMOCOOL SF F-J CURVE OD7.5 FR BIDIRECTIONAL STEERABLE MULTIELECTRODE DEFLECTABLE TIP STERILE SUP-BNI35FJCT CDM 0270 RC outpatient 8686.6 8686.6 8686.6 74 6428.08 percent of total billed charges 8686.6 93 7036.15 percent of total billed charges 8686.6 8686.6 other OPPS APC 8686.6 8686.6 other OPPS APC 8686.6 27.63 2400.11 percent of total billed charges 8686.6 8686.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BREAST LOCALIZATION SUP-BNL2007 CDM 0270 RC outpatient 42.64 42.64 42.64 74 31.55 percent of total billed charges 42.64 93 34.54 percent of total billed charges 42.64 42.64 other OPPS APC 42.64 42.64 other OPPS APC 42.64 27.63 11.78 percent of total billed charges 42.64 42.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BREAST LOCALIZATION WIRE 20 X 10 CM SUP-BNL2010 CDM 0270 RC outpatient 42.64 42.64 42.64 74 31.55 percent of total billed charges 42.64 93 34.54 percent of total billed charges 42.64 42.64 other OPPS APC 42.64 42.64 other OPPS APC 42.64 27.63 11.78 percent of total billed charges 42.64 42.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE TANTALUM SILICONE STANDARD STRAIGHT OD2.5 MM ID1.3 MM RIGHT ANGLE ADAPTER RADIOPAQUE DEPTH MARK INTRODUCE STYLET CSF SUP-BO1910_72547 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE CATHETER BOBBY L95 CM 8 F BALLOON GUIDE SUP-BOB-895 CDM 0270 RC outpatient 6240 6240 6240 74 4617.6 percent of total billed charges 6240 93 5054.4 percent of total billed charges 6240 6240 other OPPS APC 6240 6240 other OPPS APC 6240 27.63 1724.11 percent of total billed charges 6240 6240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC LOTUS EDGE OD 23MM TRANSCATHETER 15 FRENCH ISLEEVE EXPANDABLE INTRODUCER SET SUP-BOM23EDGE15ISLEEVE CDM 0270 RC outpatient 51300 51300 51300 74 37962 percent of total billed charges 51300 93 41553 percent of total billed charges 51300 51300 other OPPS APC 51300 51300 other OPPS APC 51300 27.63 14174.2 percent of total billed charges 51300 51300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC LOTUS EDGE OD 25MM TRANSCATHETER 15 FRENCH ISLEEVE EXPANDABLE INTRODUCER SET SUP-BOM25EDGE15ISLEEVE CDM 0270 RC outpatient 51300 51300 51300 74 37962 percent of total billed charges 51300 93 41553 percent of total billed charges 51300 51300 other OPPS APC 51300 51300 other OPPS APC 51300 27.63 14174.2 percent of total billed charges 51300 51300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC LOTUS EDGE OD 27MM TRANSCATHETER 15 FRENCH ISLEEVE EXPANDABLE INTRODUCER SET SUP-BOM27EDGE15ISLEEVE CDM 0270 RC outpatient 51300 51300 51300 74 37962 percent of total billed charges 51300 93 41553 percent of total billed charges 51300 51300 other OPPS APC 51300 51300 other OPPS APC 51300 27.63 14174.2 percent of total billed charges 51300 51300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET FOLLOWER HEYMAN PLASTIC L13.35 IN OD10-24 FR URETHRAL STRAIGHT TIP STERILE LATEX FREE DISPOSABLE SUP-BRD021100PK CDM 0270 RC outpatient 83.99 83.99 83.99 74 62.15 percent of total billed charges 83.99 93 68.03 percent of total billed charges 83.99 83.99 other OPPS APC 83.99 83.99 other OPPS APC 83.99 27.63 23.21 percent of total billed charges 83.99 83.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILIFORM URETHRAL L12.5 IN OD3 FR DILATION CATHETER WOVEN SPIRAL TIP STERILE LATEX FREE REUSABLE SUP-BRD022103 CDM 0270 RC outpatient 188.19 188.19 188.19 74 139.26 percent of total billed charges 188.19 93 152.43 percent of total billed charges 188.19 188.19 other OPPS APC 188.19 188.19 other OPPS APC 188.19 27.63 52 percent of total billed charges 188.19 188.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILIFORM URETHRAL L12.5 IN OD4 FR DILATION CATHETER WOVEN SPIRAL TIP STERILE LATEX FREE REUSABLE SUP-BRD022104 CDM 0270 RC outpatient 188.19 188.19 188.19 74 139.26 percent of total billed charges 188.19 93 152.43 percent of total billed charges 188.19 188.19 other OPPS APC 188.19 188.19 other OPPS APC 188.19 27.63 52 percent of total billed charges 188.19 188.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILIFORM URETHRAL L12.5 IN OD5 FR DILATION CATHETER WOVEN SPIRAL TIP STERILE LATEX FREE REUSABLE SUP-BRD022105 CDM 0270 RC outpatient 188.19 188.19 188.19 74 139.26 percent of total billed charges 188.19 93 152.43 percent of total billed charges 188.19 188.19 other OPPS APC 188.19 188.19 other OPPS APC 188.19 27.63 52 percent of total billed charges 188.19 188.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILIFORM URETHRAL L12.5 IN OD6 FR DILATION CATHETER WOVEN SPIRAL TIP STERILE LATEX FREE REUSABLE SUP-BRD022106 CDM 0270 RC outpatient 188.19 188.19 188.19 74 139.26 percent of total billed charges 188.19 93 152.43 percent of total billed charges 188.19 188.19 other OPPS APC 188.19 188.19 other OPPS APC 188.19 27.63 52 percent of total billed charges 188.19 188.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM DISTENTION VEIN BONCHECK SUP-BSVD200 CDM 270009148 LOCAL 0270 RC outpatient 47.84 47.84 47.84 74 35.4 percent of total billed charges 47.84 93 38.75 percent of total billed charges 47.84 47.84 other OPPS APC 47.84 47.84 other OPPS APC 47.84 27.63 13.22 percent of total billed charges 47.84 47.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL BONASTENT L30 MM L900 MM OD10 MM ODSEC8 FR DELIVERY DEVICE SUP-BTB-100309 CDM 0270 RC outpatient 6487 6487 6487 74 4800.38 percent of total billed charges 6487 93 5254.47 percent of total billed charges 6487 6487 other OPPS APC 6487 6487 other OPPS APC 6487 27.63 1792.36 percent of total billed charges 6487 6487 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL BONASTENT L30 MM L900 MM OD12 MM ODSEC9 FR DELIVERY DEVICE SUP-BTB-120309 CDM 0270 RC outpatient 6487 6487 6487 74 4800.38 percent of total billed charges 6487 93 5254.47 percent of total billed charges 6487 6487 other OPPS APC 6487 6487 other OPPS APC 6487 27.63 1792.36 percent of total billed charges 6487 6487 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL BONASTENT L70 MM L900 MM OD16 MM ODSEC12 FR DELIVERY DEVICE SUP-BTB-160609 CDM 0270 RC outpatient 6487 6487 6487 74 4800.38 percent of total billed charges 6487 93 5254.47 percent of total billed charges 6487 6487 other OPPS APC 6487 6487 other OPPS APC 6487 27.63 1792.36 percent of total billed charges 6487 6487 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL BONASTENT L80 MM L900 MM OD16 MM ODSEC12 FR DELIVERY DEVICE SUP-BTB-160809 CDM 0270 RC outpatient 6487 6487 6487 74 4800.38 percent of total billed charges 6487 93 5254.47 percent of total billed charges 6487 6487 other OPPS APC 6487 6487 other OPPS APC 6487 27.63 1792.36 percent of total billed charges 6487 6487 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL BONASTENT L60 MM L900 MM OD18 MM ODSEC16 FR DELIVERY DEVICE SUP-BTB-180609 CDM 0270 RC outpatient 6487 6487 6487 74 4800.38 percent of total billed charges 6487 93 5254.47 percent of total billed charges 6487 6487 other OPPS APC 6487 6487 other OPPS APC 6487 27.63 1792.36 percent of total billed charges 6487 6487 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISSECTOR ENDOSCOPIC ENDOPATH BLUNT 5MM DISPOSABLE STERILE SUP-BTD05 CDM 270009084 LOCAL 0270 RC outpatient 10.54 10.54 10.54 74 7.8 percent of total billed charges 10.54 93 8.54 percent of total billed charges 10.54 10.54 other OPPS APC 10.54 10.54 other OPPS APC 10.54 27.63 2.91 percent of total billed charges 10.54 10.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATH BALLOON SUP-BVCS6180 CDM 0270 RC outpatient 234 234 234 74 173.16 percent of total billed charges 234 93 189.54 percent of total billed charges 234 234 other OPPS APC 234 234 other OPPS APC 234 27.63 64.65 percent of total billed charges 234 234 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OVERTUBE ENDOSCOPIC GUARDUS STANDARD TAPER L25 CM OD19.5 MM ODSEC8.6-10 MM ID16.7 MM ESOPHAGUS INSUFFLATION CAP NONSTERILE LATEX FREE DISPOSABLE SUP-BX00711146 CDM 0270 RC outpatient 481.44 481.44 481.44 74 356.27 percent of total billed charges 481.44 93 389.97 percent of total billed charges 481.44 481.44 other OPPS APC 481.44 481.44 other OPPS APC 481.44 27.63 133.02 percent of total billed charges 481.44 481.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OVERTUBE ENDOSCOPIC GUARDUS STANDARD TAPER L50 CM OD19.5 MM ODSEC8.6-10 MM ID16.7 MM ESOPHAGUS INSUFFLATION CAP PROTECTION SAFETY REINFORCE STERILE DISPOSABLE SUP-BX00711148 CDM 0270 RC outpatient 525.96 525.96 525.96 74 389.21 percent of total billed charges 525.96 93 426.03 percent of total billed charges 525.96 525.96 other OPPS APC 525.96 525.96 other OPPS APC 525.96 27.63 145.32 percent of total billed charges 525.96 525.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SPECIMEN RETRIEVAL TALON STAINLESS STEEL L160CM OD2.5MM 4 PRONG GRASP INWARD FACE ATRAUMATIC HOOK SHEATH LATEX FREE DISPOSABLE SUP-BX00711175 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SPECIMEN RETRIEVAL RAPTOR L230 CM OD2.4 MM HYBRID JAW CONFIGURATION FLEXIBLE DISTAL WIRE GRASP STERILE DISPOSABLE SUP-BX00711177 CDM 0270 RC outpatient 343.2 343.2 343.2 74 253.97 percent of total billed charges 343.2 93 277.99 percent of total billed charges 343.2 343.2 other OPPS APC 343.2 343.2 other OPPS APC 343.2 27.63 94.83 percent of total billed charges 343.2 343.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE IRRIGATION MIO OVERSIZE L86 CM X W76 CM L28 CM X W25 CM ORGANIZER MEDICAL STERILE SUP-BX00711750 CDM 0270 RC outpatient 29.64 29.64 29.64 74 21.93 percent of total billed charges 29.64 93 24.01 percent of total billed charges 29.64 29.64 other OPPS APC 29.64 29.64 other OPPS APC 29.64 27.63 8.19 percent of total billed charges 29.64 29.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NET SPECIMEN RETRIEVAL ROTH NET PLATINUM UNIVERSAL L230 CM L5.5 CM X W4 CM OD2.5 MM NONSTERILE LATEX FREE DISPOSABLE SUP-BX00715050 CDM 0270 RC outpatient 273 273 273 74 202.02 percent of total billed charges 273 93 221.13 percent of total billed charges 273 273 other OPPS APC 273 273 other OPPS APC 273 27.63 75.43 percent of total billed charges 273 273 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN VBX GRAFT SEMI-COMPLIANT 6MM 8MM POSTDILATED 39MM 135CM ILIAC ARTERY RX BALLOON-EXPANDING COVERED PRE-MOUNTED STAINLESS STEEL MRI-CONDITIONAL NON-RADIOLUCENT 0.035IN GW 7 FR SHEATH f/5-13MM VESSEL SUP-BXA063902A CDM 0270 RC outpatient 10332.4 10332.4 10332.4 74 7645.98 percent of total billed charges 10332.4 93 8369.24 percent of total billed charges 10332.4 10332.4 other OPPS APC 10332.4 10332.4 other OPPS APC 10332.4 27.63 2854.84 percent of total billed charges 10332.4 10332.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN VBX GRAFT SEMI-COMPLIANT 6MM 8MM POSTDILATED 59MM 135CM ILIAC ARTERY RX BALLOON-EXPANDING COVERED PRE-MOUNTED STAINLESS STEEL MRI-CONDITIONAL NON-RADIOLUCENT 0.035IN GW 7 FR SHEATH f/5-13MM VESSEL SUP-BXA065902A CDM 0270 RC outpatient 10332.4 10332.4 10332.4 74 7645.98 percent of total billed charges 10332.4 93 8369.24 percent of total billed charges 10332.4 10332.4 other OPPS APC 10332.4 10332.4 other OPPS APC 10332.4 27.63 2854.84 percent of total billed charges 10332.4 10332.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN VBX GRAFT SEMI-COMPLIANT 7MM 11MM POSTDILATED 39MM 135CM ILIAC ARTERY RX BALLOON-EXPANDING COVERED PRE-MOUNTED STAINLESS STEEL MRI-CONDITIONAL NON-RADIOLUCENT 0.035IN GW 7 FR SHEATH f/5-13MM VESSEL SUP-BXA073902A CDM 0270 RC outpatient 10332.4 10332.4 10332.4 74 7645.98 percent of total billed charges 10332.4 93 8369.24 percent of total billed charges 10332.4 10332.4 other OPPS APC 10332.4 10332.4 other OPPS APC 10332.4 27.63 2854.84 percent of total billed charges 10332.4 10332.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN VBX GRAFT SEMI-COMPLIANT 7MM 11MM POSTDILATED 59MM 135CM ILIAC ARTERY RX BALLOON-EXPANDING COVERED PRE-MOUNTED STAINLESS STEEL MRI-CONDITIONAL NON-RADIOLUCENT 0.035IN GW 7 FR SHEATH f/5-13MM VESSEL SUP-BXA075902A CDM 0270 RC outpatient 10332.4 10332.4 10332.4 74 7645.98 percent of total billed charges 10332.4 93 8369.24 percent of total billed charges 10332.4 10332.4 other OPPS APC 10332.4 10332.4 other OPPS APC 10332.4 27.63 2854.84 percent of total billed charges 10332.4 10332.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN VBX GRAFT SEMI-COMPLIANT 8MM 11MM POSTDILATED 39MM 135CM ILIAC ARTERY RX BALLOON-EXPANDING COVERED PRE-MOUNTED STAINLESS STEEL MRI-CONDITIONAL NON-RADIOLUCENT 0.035IN GW 7 FR SHEATH f/5-13MM VESSEL SUP-BXA083902A CDM 0270 RC outpatient 10332.4 10332.4 10332.4 74 7645.98 percent of total billed charges 10332.4 93 8369.24 percent of total billed charges 10332.4 10332.4 other OPPS APC 10332.4 10332.4 other OPPS APC 10332.4 27.63 2854.84 percent of total billed charges 10332.4 10332.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN VBX GRAFT SEMI-COMPLIANT 8MM 11MM POSTDILATED 59MM 135CM ILIAC ARTERY RX BALLOON-EXPANDING COVERED PRE-MOUNTED STAINLESS STEEL MRI-CONDITIONAL NON-RADIOLUCENT 0.035IN GW 7 FR SHEATH f/5-13MM VESSEL SUP-BXA085902A CDM 0270 RC outpatient 10332.4 10332.4 10332.4 74 7645.98 percent of total billed charges 10332.4 93 8369.24 percent of total billed charges 10332.4 10332.4 other OPPS APC 10332.4 10332.4 other OPPS APC 10332.4 27.63 2854.84 percent of total billed charges 10332.4 10332.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN VBX GRAFT SEMI-COMPLIANT 10MM 13MM POSTDILATED 39MM 135CM ILIAC ARTERY RX BALLOON-EXPANDING COVERED PRE-MOUNTED STAINLESS STEEL MRI-CONDITIONAL NON-RADIOLUCENT 0.035IN GW 8 FR SHEATH f/5-13MM VESSEL SUP-BXA103902A CDM 0270 RC outpatient 10332.4 10332.4 10332.4 74 7645.98 percent of total billed charges 10332.4 93 8369.24 percent of total billed charges 10332.4 10332.4 other OPPS APC 10332.4 10332.4 other OPPS APC 10332.4 27.63 2854.84 percent of total billed charges 10332.4 10332.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN VBX GRAFT SEMI-COMPLIANT 10MM 13MM POSTDILATED 59MM 135CM ILIAC ARTERY RX BALLOON-EXPANDING COVERED PRE-MOUNTED STAINLESS STEEL MRI-CONDITIONAL NON-RADIOLUCENT 0.035IN GW 8 FR SHEATH f/5-13MM VESSEL SUP-BXA105902A CDM 0270 RC outpatient 10332.4 10332.4 10332.4 74 7645.98 percent of total billed charges 10332.4 93 8369.24 percent of total billed charges 10332.4 10332.4 other OPPS APC 10332.4 10332.4 other OPPS APC 10332.4 27.63 2854.84 percent of total billed charges 10332.4 10332.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN VBX GRAFT SEMI-COMPLIANT 11MM 16MMSQ POSTDILATED 39MM 135CM ILIAC ARTERY RX BALLOON-EXPANDING COVERED PRE-MOUNTED STAINLESS STEEL MRI-CONDITIONAL NON-RADIOLUCENT 0.035IN GW 8 FR SHEATH f/5-13MM VESSEL SUP-BXA113902A CDM 0270 RC outpatient 10332.4 10332.4 10332.4 74 7645.98 percent of total billed charges 10332.4 93 8369.24 percent of total billed charges 10332.4 10332.4 other OPPS APC 10332.4 10332.4 other OPPS APC 10332.4 27.63 2854.84 percent of total billed charges 10332.4 10332.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN VBX GRAFT SEMI-COMPLIANT 11MM 16MMSQ POSTDILATED 59MM 135CM ILIAC ARTERY RX BALLOON-EXPANDING COVERED PRE-MOUNTED STAINLESS STEEL MRI-CONDITIONAL NON-RADIOLUCENT 0.035IN GW 8 FR SHEATH f/5-13MM VESSEL SUP-BXA115902A CDM 0270 RC outpatient 10332.4 10332.4 10332.4 74 7645.98 percent of total billed charges 10332.4 93 8369.24 percent of total billed charges 10332.4 10332.4 other OPPS APC 10332.4 10332.4 other OPPS APC 10332.4 27.63 2854.84 percent of total billed charges 10332.4 10332.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIABAHN BALLOON ENDO SUP-BXAL085901A CDM 0270 RC outpatient 9110.4 9110.4 9110.4 74 6741.7 percent of total billed charges 9110.4 93 7379.42 percent of total billed charges 9110.4 9110.4 other OPPS APC 9110.4 9110.4 other OPPS APC 9110.4 27.63 2517.2 percent of total billed charges 9110.4 9110.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VIABAHN BX BALLOON 8MMX59MM SUP-BXAL085902A CDM 0270 RC outpatient 9292.4 9292.4 9292.4 74 6876.38 percent of total billed charges 9292.4 93 7526.84 percent of total billed charges 9292.4 9292.4 other OPPS APC 9292.4 9292.4 other OPPS APC 9292.4 27.63 2567.49 percent of total billed charges 9292.4 9292.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VIABAHN BX BALLOON 8MMX79MM SUP-BXAL087902A CDM 0270 RC outpatient 10202.4 10202.4 10202.4 74 7549.78 percent of total billed charges 10202.4 93 8263.94 percent of total billed charges 10202.4 10202.4 other OPPS APC 10202.4 10202.4 other OPPS APC 10202.4 27.63 2818.92 percent of total billed charges 10202.4 10202.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM GASTRIC BAND LAP-BAND AP RAPIDPORT EZ OMNIFORM STAINLESS STEEL SILICONE ELASTOMER LARGE L50 CM 14 CC ADJUSTABLE CONNECTOR RADIOPAQUE END PLUG STERILE LATEX FREE SUP-C-2365 CDM 0270 RC outpatient 11934 11934 11934 74 8831.16 percent of total billed charges 11934 93 9666.54 percent of total billed charges 11934 11934 other OPPS APC 11934 11934 other OPPS APC 11934 27.63 3297.36 percent of total billed charges 11934 11934 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE SURGISIS BIODESIGN PORCINE ACELLULAR COLLAGEN MATRIX L20 CM X W7 CM 4 LAYER SUP-C-SLH-4S-7X20 CDM 0270 RC outpatient 3082.56 3082.56 3082.56 74 2281.09 percent of total billed charges 3082.56 93 2496.87 percent of total billed charges 3082.56 3082.56 other OPPS APC 3082.56 3082.56 other OPPS APC 3082.56 27.63 851.71 percent of total billed charges 3082.56 3082.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND SILK 2-0 SH L18 IN CONTROL RELEASE BRAID 8 STRAND BLACK SUP-C012D CDM 0270 RC outpatient 20.72 20.72 20.72 74 15.33 percent of total billed charges 20.72 93 16.78 percent of total billed charges 20.72 20.72 other OPPS APC 20.72 20.72 other OPPS APC 20.72 27.63 5.72 percent of total billed charges 20.72 20.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND SILK 3-0 SH L18 IN CONTROL RELEASE BRAID 8 STRAND BLACK SUP-C013D CDM 0270 RC outpatient 20.79 20.79 20.79 74 15.38 percent of total billed charges 20.79 93 16.84 percent of total billed charges 20.79 20.79 other OPPS APC 20.79 20.79 other OPPS APC 20.79 27.63 5.74 percent of total billed charges 20.79 20.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND SILK 4-0 SH L18 IN CONTROL RELEASE BRAID 8 STRAND BLACK SUP-C014D CDM 0270 RC outpatient 21.14 21.14 21.14 74 15.64 percent of total billed charges 21.14 93 17.12 percent of total billed charges 21.14 21.14 other OPPS APC 21.14 21.14 other OPPS APC 21.14 27.63 5.84 percent of total billed charges 21.14 21.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND SILK 4-0 SH L30 IN CONTROL RELEASE BRAID 8 STRAND BLACK SUP-C018D CDM 0270 RC outpatient 26.76 26.76 26.76 74 19.8 percent of total billed charges 26.76 93 21.68 percent of total billed charges 26.76 26.76 other OPPS APC 26.76 26.76 other OPPS APC 26.76 27.63 7.39 percent of total billed charges 26.76 26.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CEMENT BONE HV-R KYPHX MIXER GRADUATE MARK DISPENSE PLUNGER LUER FIT STIR PADDLE SUP-C01B CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "ADULT CAPNOXYGEN CO2 MONITORING FACE MASK, CO2-01" SUP-C02-01 CDM 0270 RC outpatient 11.44 11.44 11.44 74 8.47 percent of total billed charges 11.44 93 9.27 percent of total billed charges 11.44 11.44 other OPPS APC 11.44 11.44 other OPPS APC 11.44 27.63 3.16 percent of total billed charges 11.44 11.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPECULUM VAGINAL ER-SPEC OFFICE SPEC MEDIUM LED LIGHT BATTERY LOCK HINGE NONSTERILE LATEX FREE DISPOSABLE CLEAR SUP-C020110-1 CDM outpatient 12.37 12.37 7.75 74 5.74 percent of total billed charges 7.75 7.75 other OPPS APC 7.75 27.63 2.14 percent of total billed charges 7.75 12.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPECULUM VAGINAL ER-SPEC OFFICE SPEC MEDIUM LED LIGHT BATTERY LOCK HINGE NONSTERILE LATEX FREE DISPOSABLE CLEAR SUP-C020110-1 CDM 0270 RC outpatient 7.75 7.75 7.75 74 5.74 percent of total billed charges 7.75 7.75 other OPPS APC 7.75 27.63 2.14 percent of total billed charges 7.75 7.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPECULUM VAGINAL ER-SPEC OFFICE SPEC MEDIUM LED LIGHT BATTERY LOCK HINGE NONSTERILE LATEX FREE DISPOSABLE CLEAR SUP-C020110-1 CDM outpatient 12.37 12.37 7.75 93 6.28 percent of total billed charges 7.75 7.75 other OPPS APC 7.75 12.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPECULUM VAGINAL ER-SPEC OFFICE SPEC MEDIUM LED LIGHT BATTERY LOCK HINGE NONSTERILE LATEX FREE DISPOSABLE CLEAR SUP-C020110-1 CDM 0270 RC outpatient 7.75 7.75 7.75 93 6.28 percent of total billed charges 7.75 7.75 other OPPS APC 7.75 7.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND SILK 0 CT-1 L18 IN CONTROL RELEASE BRAID 8 STRAND BLACK SUP-C021D CDM 0270 RC outpatient 21.48 21.48 21.48 74 15.9 percent of total billed charges 21.48 93 17.4 percent of total billed charges 21.48 21.48 other OPPS APC 21.48 21.48 other OPPS APC 21.48 27.63 5.93 percent of total billed charges 21.48 21.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR SMART CONTROL MICROMARKER NITINOL L40 MM L120 CM OD6 MM ILIAC SELF EXPAND MICROMESH SEGMENT DELIVERY HANDLE STERILE LATEX FREE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE 6 FR SHEATH 8 FR GUIDE CATHETER 4-5 MM VESSEL SUP-C06040ML CDM 0270 RC outpatient 1664 1664 1664 74 1231.36 percent of total billed charges 1664 93 1347.84 percent of total billed charges 1664 1664 other OPPS APC 1664 1664 other OPPS APC 1664 27.63 459.76 percent of total billed charges 1664 1664 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR SMART CONTROL MICROMARKER NITINOL L40 MM L80 CM OD6 MM ILIAC SELF EXPAND MICROMESH SEGMENT DELIVERY HANDLE ACCEPTS .035 IN GUIDEWIRE 6 FR SHEATH 8 FR GUIDE CATHETER 4-5 MM VESSEL SUP-C06040SL CDM 0270 RC outpatient 1664 1664 1664 74 1231.36 percent of total billed charges 1664 93 1347.84 percent of total billed charges 1664 1664 other OPPS APC 1664 1664 other OPPS APC 1664 27.63 459.76 percent of total billed charges 1664 1664 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR CORDIS SMART CONTROL 80MM 120CM 6MM NITINOL LF ILIAC SUPERFICIAL FEMORAL ARTERY DELIVERY HANDLE SELF SUP-C06080ML CDM 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR SMART CONTROL MICROMARKER NITINOL L80 MM L80 CM OD6 MM ILIAC SELF EXPAND MICROMESH SEGMENT DELIVERY HANDLE LATEX FREE ACCEPTS .035 IN GUIDEWIRE 6 FR SHEATH 8 FR GUIDE CATHETER SUP-C06080SL CDM 0270 RC outpatient 1664 1664 1664 74 1231.36 percent of total billed charges 1664 93 1347.84 percent of total billed charges 1664 1664 other OPPS APC 1664 1664 other OPPS APC 1664 27.63 459.76 percent of total billed charges 1664 1664 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR SMART CONTROL MICROMARKER NITINOL L100 MM L120 CM OD6 MM ILIAC SELF EXPAND MICROMESH SEGMENT DELIVERY HANDLE STERILE LATEX FREE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE 6 FR SHEATH 8 FR GUIDE CATHETER 4-5 MM VESSEL SUP-C06100ML CDM 0270 RC outpatient 3247.4 3247.4 3247.4 74 2403.08 percent of total billed charges 3247.4 93 2630.39 percent of total billed charges 3247.4 3247.4 other OPPS APC 3247.4 3247.4 other OPPS APC 3247.4 27.63 897.26 percent of total billed charges 3247.4 3247.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR SMART CONTROL MICROMARKER NITINOL L100 MM L80 CM OD6 MM ILIAC SELF EXPAND MICROMESH SEGMENT DELIVERY HANDLE LATEX FREE ACCEPTS .035 IN GUIDEWIRE 6 FR SHEATH 8 FR GUIDE CATHETER SUP-C06100SL CDM 0270 RC outpatient 1664 1664 1664 74 1231.36 percent of total billed charges 1664 93 1347.84 percent of total billed charges 1664 1664 other OPPS APC 1664 1664 other OPPS APC 1664 27.63 459.76 percent of total billed charges 1664 1664 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMART BILLARY STENT 6X150 SUP-C06150MB CDM 0270 RC outpatient 3770 3770 3770 74 2789.8 percent of total billed charges 3770 93 3053.7 percent of total billed charges 3770 3770 other OPPS APC 3770 3770 other OPPS APC 3770 27.63 1041.65 percent of total billed charges 3770 3770 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR SMART MICROMARKER NITINOL L150 MM L120 CM OD6 MM ILIAC SELF EXPAND MICROMESH SEGMENT DELIVERY HANDLE ACCEPTS .035 IN GUIDEWIRE 6 FR SHEATH 8 FR GUIDE CATHETER SUP-C06150ML CDM 0270 RC outpatient 2522 2522 2522 74 1866.28 percent of total billed charges 2522 93 2042.82 percent of total billed charges 2522 2522 other OPPS APC 2522 2522 other OPPS APC 2522 27.63 696.83 percent of total billed charges 2522 2522 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR SMART CONTROL MICROMARKER NITINOL L20 MM L120 CM OD7 MM ILIAC SELF EXPAND MICROMESH SEGMENT DELIVERY HANDLE ACCEPTS .035 IN GUIDEWIRE 6 FR SHEATH 8 FR GUIDE CATHETER 5-6 MM VESSEL SUP-C07020ML CDM 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR SMART CONTROL MICROMARKER NITINOL L60 MM L120 CM OD7 MM ILIAC SELF EXPAND SUP-C07060ML CDM 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR SMART CONTROL MICROMARKER NITINOL L80 MM L120 CM OD7 MM ILIAC SELF EXPAND MICROMESH SEGMENT DELIVERY HANDLE STERILE LATEX FREE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE 6 FR SHEATH 8 FR GUIDE CATHETER 5-6 MM VESSEL SUP-C07080ML CDM 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR SMART CONTROL MICROMARKER NITINOL L80 MM L80 CM OD7 MM ILIAC SELF EXPAND MICROMESH SEGMENT DELIVERY HANDLE LATEX FREE ACCEPTS .035 IN GUIDEWIRE 6 FR SHEATH 8 FR GUIDE CATHETER SUP-C07080SL CDM 0270 RC outpatient 1664 1664 1664 74 1231.36 percent of total billed charges 1664 93 1347.84 percent of total billed charges 1664 1664 other OPPS APC 1664 1664 other OPPS APC 1664 27.63 459.76 percent of total billed charges 1664 1664 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR CORDIS SMART CONTROL 100MM 120CM 7MM NITINOL LF ILIAC SUPERFICIAL FEMORAL ARTERY DELIVERY HANDLE SELF SUP-C07100ML CDM 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY 7MM 120MM 120CM .035IN SELF EXPANDABLE MICROMESH SEGMENT GUIDEWIRE SUP-C07120MB CDM 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR SMART CONTROL MICROMARKER NITINOL L150 MM L120 CM OD7 MM ILIAC SELF EXPANDABLE MICROMESH SEGMENT DELIVERY HANDLE LATEX FREE ACCEPTS .035 IN GUIDEWIRE 6 FR SHEATH SUP-C07150ML CDM 0270 RC outpatient 2522 2522 2522 74 1866.28 percent of total billed charges 2522 93 2042.82 percent of total billed charges 2522 2522 other OPPS APC 2522 2522 other OPPS APC 2522 27.63 696.83 percent of total billed charges 2522 2522 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR CORDIS SMART CONTROL 30MM 80CM 8MM NITINOL LF ILIAC SUPERFICIAL FEMORAL ARTERY DELIVERY HANDLE SELF SUP-C08030SL_40472 CDM 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR SMART CONTROL MICROMARKER NITINOL L40 MM L80 CM OD8 MM ILIAC SELF EXPAND MICROMESH SEGMENT DELIVERY HANDLE STERILE LATEX FREE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE 6 FR SHEATH 8 FR GUIDE CATHETER 6-7 MM VESSEL SUP-C08040SL CDM 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR SMART CONTROL MICROMARKER NITINOL L60 MM L120 CM OD8 MM ILIAC SELF EXPAND SUP-C08060ML CDM 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR CORDIS SMART CONTROL 60MM 80CM 8MM NITINOL LF ILIAC SUPERFICIAL FEMORAL ARTERY DELIVERY HANDLE SELF SUP-C08060SL_28331 CDM 0270 RC outpatient 1664 1664 1664 74 1231.36 percent of total billed charges 1664 93 1347.84 percent of total billed charges 1664 1664 other OPPS APC 1664 1664 other OPPS APC 1664 27.63 459.76 percent of total billed charges 1664 1664 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR SMART CONTROL MICROMARKER NITINOL L80 MM L120 CM OD8 MM ILIAC SELF EXPAND MICROMESH SEGMENT DELIVERY HANDLE STERILE LATEX FREE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE 6 FR SHEATH 8 FR GUIDE CATHETER 6-7 MM VESSEL SUP-C08080ML CDM 0270 RC outpatient 3185 3185 3185 74 2356.9 percent of total billed charges 3185 93 2579.85 percent of total billed charges 3185 3185 other OPPS APC 3185 3185 other OPPS APC 3185 27.63 880.02 percent of total billed charges 3185 3185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR SMART CONTROL MICROMARKER NITINOL L100 MM L80 CM OD8 MM ILIAC SELF EXPAND MICROMESH SEGMENT DELIVERY HANDLE LATEX FREE ACCEPTS .035 IN GUIDEWIRE 6 FR SHEATH 8 FR GUIDE CATHETER SUP-C08100SL CDM 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR ZTHREAD 15MM X 100MM SUP-C0R37 CDM 0270 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR HASSON 12MM SUP-C0R47 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR HASSON 12MMX130 BLUNT TIP SUP-C0R50 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR DISPOSABLE LIGHTED 135MM X 30MM SUP-C100110 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR SMART CONTROL MICROMARKER NITINOL L40 MM L80 CM OD10 MM ILIAC SELF EXPAND MICROMESH SEGMENT DELIVERY HANDLE ACCEPTS .035 IN GUIDEWIRE 6 FR SHEATH 8 FR GUIDE CATHETER 8-9 MM VESSEL SUP-C10040SL CDM 0270 RC outpatient 1664 1664 1664 74 1231.36 percent of total billed charges 1664 93 1347.84 percent of total billed charges 1664 1664 other OPPS APC 1664 1664 other OPPS APC 1664 27.63 459.76 percent of total billed charges 1664 1664 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR PRESSUREWIRE X 0.014IN 175CM STRAIGHT TIP RX F/FFR TESTING SUP-C12059 CDM 0481 RC outpatient 1625 1625 1625 74 1202.5 percent of total billed charges 1625 93 1316.25 percent of total billed charges 1625 1625 other OPPS APC 1625 1625 other OPPS APC 1625 51 828.75 percent of total billed charges 1625 1625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY SMART 60MM 80CM 12MM 7FR SHEATH SUP-C12060SB CDM 0270 RC outpatient 2158 2158 2158 74 1596.92 percent of total billed charges 2158 93 1747.98 percent of total billed charges 2158 2158 other OPPS APC 2158 2158 other OPPS APC 2158 27.63 596.26 percent of total billed charges 2158 2158 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY SMART CONTROL NITINOL L60 MM L120 CM OD14 MM SELF EXPAND MICROMESH GEOMETRY DELIVERY HANDLE SEGMENT ACCEPTS .035 IN GUIDEWIRE 7 FR SHEATH 12-13 MM DUCT TRANSHEPATIC SUP-C14060MB CDM 0270 RC outpatient 2119 2119 2119 74 1568.06 percent of total billed charges 2119 93 1716.39 percent of total billed charges 2119 2119 other OPPS APC 2119 2119 other OPPS APC 2119 27.63 585.48 percent of total billed charges 2119 2119 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY SMART CONTROL MICROMARKER NITINOL L80 MM L80 CM OD14 MM SELF EXPAND MICROMESH SEGMENT DELIVERY HANDLE LATEX FREE ACCEPTS .035 IN GUIDEWIRE 6 FR SHEATH 8 FR GUIDE CATHETER TRANSHEPATIC SUP-C14080SB CDM 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM GASTRIC BAND LAP-BAND AP RAPIDPORT EZ OMNIFORM STAINLESS STEEL SILICONE ELASTOMER STANDARD L50 CM 10 CC ADJUSTABLE CONNECTOR RADIOPAQUE END PLUG STERILE LATEX FREE SUP-C2360 CDM 0270 RC outpatient 11934 11934 11934 74 8831.16 percent of total billed charges 11934 93 9666.54 percent of total billed charges 11934 11934 other OPPS APC 11934 11934 other OPPS APC 11934 27.63 3297.36 percent of total billed charges 11934 11934 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ATHERECTOMY SHOCKWAVE C2 IVL 2.5 X 12 MM SUP-C2IVL2512 CDM 0270 RC outpatient 12220 12220 12220 74 9042.8 percent of total billed charges 12220 93 9898.2 percent of total billed charges 12220 12220 other OPPS APC 12220 12220 other OPPS APC 12220 27.63 3376.39 percent of total billed charges 12220 12220 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ATHERECTOMY SHOCKWAVE C2 IVL 3.0 X 12 MM SUP-C2IVL3012 CDM 0270 RC outpatient 12220 12220 12220 74 9042.8 percent of total billed charges 12220 93 9898.2 percent of total billed charges 12220 12220 other OPPS APC 12220 12220 other OPPS APC 12220 27.63 3376.39 percent of total billed charges 12220 12220 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ATHERECTOMY SHOCKWAVE C2 IVL 3.5 X 12 MM SUP-C2IVL3512 CDM 0270 RC outpatient 12220 12220 12220 74 9042.8 percent of total billed charges 12220 93 9898.2 percent of total billed charges 12220 12220 other OPPS APC 12220 12220 other OPPS APC 12220 27.63 3376.39 percent of total billed charges 12220 12220 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ATHERECTOMY SHOCKWAVE C2 IVL 4.0 X 12 MM SUP-C2IVL4012 CDM 0270 RC outpatient 12220 12220 12220 74 9042.8 percent of total billed charges 12220 93 9898.2 percent of total billed charges 12220 12220 other OPPS APC 12220 12220 other OPPS APC 12220 27.63 3376.39 percent of total billed charges 12220 12220 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ULTRASOUND SHOCKWAVE C2+ HYDROPHILIC L 138CM L 12 MM OD 2.5MM OD SEC .044 IN CORONARY ARTERIAL CONNECTOR CABLE GENERATOR SHAFT DEPTH MARKER INTEGRATE EMITTER STERILE LATEX FREE DISPOSABLE ACCEPTS 5 FR GUIDE SUP-C2PIVL2512 CDM 0270 RC outpatient 12220 12220 12220 74 9042.8 percent of total billed charges 12220 93 9898.2 percent of total billed charges 12220 12220 other OPPS APC 12220 12220 other OPPS APC 12220 27.63 3376.39 percent of total billed charges 12220 12220 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ULTRASOUND SHOCKWAVE C2+ HYDROPHILIC L 138CM L 12 MM OD 3MM OD SEC .045 IN CORONARY ARTERIAL CONNECTOR CABLE GENERATOR SHAFT DEPTH MARKER INTEGRATE EMITTER STERILE LATEX FREE DISPOSABLE ACCEPTS 5 FR GUIDE SUP-C2PIVL3012 CDM 0270 RC outpatient 12220 12220 12220 74 9042.8 percent of total billed charges 12220 93 9898.2 percent of total billed charges 12220 12220 other OPPS APC 12220 12220 other OPPS APC 12220 27.63 3376.39 percent of total billed charges 12220 12220 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ULTRASOUND SHOCKWAVE C2+ HYDROPHILIC L 138CM L 12 MM OD 3.5MM OD SEC .045 IN CORONARY ARTERIAL CONNECTOR CABLE GENERATOR SHAFT DEPTH MARKER INTEGRATE EMITTER STERILE LATEX FREE DISPOSABLE ACCEPTS 5 FR GUIDE SUP-C2PIVL3512 CDM 0270 RC outpatient 12220 12220 12220 74 9042.8 percent of total billed charges 12220 93 9898.2 percent of total billed charges 12220 12220 other OPPS APC 12220 12220 other OPPS APC 12220 27.63 3376.39 percent of total billed charges 12220 12220 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ULTRASOUND SHOCKWAVE C2+ HYDROPHILIC L 138CM L 12 MM OD 4MM OD SEC .047 IN CORONARY ARTERIAL CONNECTOR CABLE GENERATOR SHAFT DEPTH MARKER INTEGRATE EMITTER STERILE LATEX FREE DISPOSABLE ACCEPTS 5 FR GUIDE SUP-C2PIVL4012 CDM 0270 RC outpatient 12220 12220 12220 74 9042.8 percent of total billed charges 12220 93 9898.2 percent of total billed charges 12220 12220 other OPPS APC 12220 12220 other OPPS APC 12220 27.63 3376.39 percent of total billed charges 12220 12220 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC SYNCRA THK6 MM W57 MM X H59 MM 15 ML 26 GM ATRIUM VENTRICLE 2 CHAMBER RATE RESPONSIVE UNIPOLAR IS 1 CRT SUP-C2TR01 CDM 0275 RC outpatient 13800 13800 13800 57 7866 percent of total billed charges 13800 93 11178 percent of total billed charges 13800 13800 other OPPS APC 13800 13800 other OPPS APC 13800 51 7038 percent of total billed charges 13800 13800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING SELECTSITE L45 CM DEFLECTABLE L 30 CM L40 CM OD 8.4 FR ODSEC 9 FR ID 5.7 FR BRAID SUP-C304-HIS CDM 0275 RC outpatient 1040 1040 1040 57 592.8 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING SELECTSITE L40 CM OD2.8 MM ID1.9 MM STERILE LATEX FREE DISPOSABLE SUP-C304L6906 CDM 0275 RC outpatient 1040 1040 1040 57 592.8 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING SELECTSITE LATEX FREE GLOBAL SUP-C304S5906 CDM 0275 RC outpatient 1040 1040 1040 57 592.8 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING SELECTSITE L74 CM CORONARY SINUS DEFLECTABLE LEAD DELIVERY STEERABLE LATEX FREE SUP-C304XL7405 CDM 0275 RC outpatient 1040 1040 1040 57 592.8 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR CORDIS AQUATRACK ANGLE SHORT TAPER 150CM 8IN .035IN NITINOL POLYMER HYDROPHILIC DISPOSABLE STERILE LF SUP-C3515RSA CDM 0270 RC outpatient 104 104 104 74 76.96 percent of total billed charges 104 93 84.24 percent of total billed charges 104 104 other OPPS APC 104 104 other OPPS APC 104 27.63 28.74 percent of total billed charges 104 104 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR CORDIS AQUATRACK ANGLE SHORT TAPER 150CM 5IN .035IN NITINOL POLYMER HYDROPHILIC DISPOSABLE STERILE LF SUP-C3515SSA_41397 CDM 0270 RC outpatient 135.2 135.2 135.2 74 100.05 percent of total billed charges 135.2 93 109.51 percent of total billed charges 135.2 135.2 other OPPS APC 135.2 135.2 other OPPS APC 135.2 27.63 37.36 percent of total billed charges 135.2 135.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR CORDIS AQUATRACK ANGLE SHORT TAPER 260CM 8IN .035IN NITINOL POLYMER HYDROPHILIC DISPOSABLE STERILE LF SUP-C3526RSA CDM 0270 RC outpatient 135.2 135.2 135.2 74 100.05 percent of total billed charges 135.2 93 109.51 percent of total billed charges 135.2 135.2 other OPPS APC 135.2 135.2 other OPPS APC 135.2 27.63 37.36 percent of total billed charges 135.2 135.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR CORDIS AQUATRACK ANGLE SHORT TAPER 260CM 5IN .035IN NITINOL POLYMER HYDROPHILIC DISPOSABLE STERILE LF SUP-C3526SSA CDM 0270 RC outpatient 135.2 135.2 135.2 74 100.05 percent of total billed charges 135.2 93 109.51 percent of total billed charges 135.2 135.2 other OPPS APC 135.2 135.2 other OPPS APC 135.2 27.63 37.36 percent of total billed charges 135.2 135.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIGER WIRE 260CM ANGLED FLOPPY SUP-C405085 CDM 0481 RC outpatient 254.8 254.8 254.8 74 188.55 percent of total billed charges 254.8 93 206.39 percent of total billed charges 254.8 254.8 other OPPS APC 254.8 254.8 other OPPS APC 254.8 51 129.95 percent of total billed charges 254.8 254.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR ANGLE L180 CM L12 CM OD.035 IN STEERABLE SHAFT FLOPPY TIP SUP-C405086 CDM 0481 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 51 159.12 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARTRIDGE GRASPER DIRECT DRIVE L38 CM L20 MM OD5 MM ATRAUMATIC STERILE DISPOSABLE SUP-C4120 CDM 0270 RC outpatient 182 182 182 74 134.68 percent of total billed charges 182 93 147.42 percent of total billed charges 182 182 other OPPS APC 182 182 other OPPS APC 182 27.63 50.29 percent of total billed charges 182 182 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRASPER LAPAROSCOPIC DIRECT DRIVE EPIX LATIS L35 CM L20 MM OD5 MM AUTOMATIC HANDLE PAD STERILE LATEX FREE DISPOSABLE SUP-C4130 CDM 0270 RC outpatient 117 117 117 74 86.58 percent of total billed charges 117 93 94.77 percent of total billed charges 117 117 other OPPS APC 117 117 other OPPS APC 117 27.63 32.33 percent of total billed charges 117 117 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REAGENT CHEMISTRY 10% NEUTRAL BUFFERED FORMALIN 60 ML HAZARDOUS SUP-C4320-30H CDM 0270 RC outpatient 0.99 0.99 0.99 74 0.73 percent of total billed charges 0.99 93 0.8 percent of total billed charges 0.99 0.99 other OPPS APC 0.99 0.99 other OPPS APC 0.99 27.63 0.27 percent of total billed charges 0.99 0.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTAINER HISTOLOGY SP 10% NEUTRAL BUFFER FORMALIN POLYPROPYLENE C180 ML WIDE MOUTH 90 ML AUTOCLAVABLE CRACK RESISTANT FLEXIBLE INNER SEAL PREFILL SUP-C4320-90B CDM 0270 RC outpatient 2.95 2.95 2.95 74 2.18 percent of total billed charges 2.95 93 2.39 percent of total billed charges 2.95 2.95 other OPPS APC 2.95 2.95 other OPPS APC 2.95 27.63 0.82 percent of total billed charges 2.95 2.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CIRCUIT ANESTHESIA ADULT SUP-C45101722D-NL CDM 0270 RC outpatient 20.8 20.8 20.8 74 15.39 percent of total billed charges 20.8 93 16.85 percent of total billed charges 20.8 20.8 other OPPS APC 20.8 20.8 other OPPS APC 20.8 27.63 5.75 percent of total billed charges 20.8 20.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRTP C4TR01 CONSULTA DEVICE SUP-C4TR01 CDM 0275 RC outpatient 13800 13800 13800 57 7866 percent of total billed charges 13800 93 11178 percent of total billed charges 13800 13800 other OPPS APC 13800 13800 other OPPS APC 13800 51 7038 percent of total billed charges 13800 13800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRTP C4TR01CARDIAC CONSULTA CRT-P SUP-C4TR01-SYS CDM 0270 RC outpatient 22100 22100 22100 74 16354 percent of total billed charges 22100 93 17901 percent of total billed charges 22100 22100 other OPPS APC 22100 22100 other OPPS APC 22100 27.63 6106.23 percent of total billed charges 22100 22100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE NUROLON 2-0 SH 18IN BLACK NYLON 6 6 CONTROL RELEASE BRAID 8 STRAND SUP-C512D CDM 0270 RC outpatient 25.03 25.03 25.03 74 18.52 percent of total billed charges 25.03 93 20.27 percent of total billed charges 25.03 25.03 other OPPS APC 25.03 25.03 other OPPS APC 25.03 27.63 6.92 percent of total billed charges 25.03 25.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE NUROLON 0 CT-2 18IN BLACK NYLON 6 6 CONTROL RELEASE BRAID 8 STRAND SUP-C527D CDM 0270 RC outpatient 27.57 27.57 27.57 74 20.4 percent of total billed charges 27.57 93 22.33 percent of total billed charges 27.57 27.57 other OPPS APC 27.57 27.57 other OPPS APC 27.57 27.63 7.62 percent of total billed charges 27.57 27.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE NUROLON 4-0 RB-1 18IN BLACK NYLON 6 6 CONTROL RELEASE BRAID 8 STRAND SUP-C554D CDM 0270 RC outpatient 33.97 33.97 33.97 74 25.14 percent of total billed charges 33.97 93 27.52 percent of total billed charges 33.97 33.97 other OPPS APC 33.97 33.97 other OPPS APC 33.97 27.63 9.39 percent of total billed charges 33.97 33.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE NUROLON 4-0 TF 18IN BLACK NYLON 6 6 CONTROL RELEASE BRAID 8 STRAND SUP-C584D CDM 0270 RC outpatient 35.98 35.98 35.98 74 26.63 percent of total billed charges 35.98 93 29.14 percent of total billed charges 35.98 35.98 other OPPS APC 35.98 35.98 other OPPS APC 35.98 27.63 9.94 percent of total billed charges 35.98 35.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER VIVA C6TR01 DEVICE SUP-C6TR01 CDM 0275 RC outpatient 12834 12834 12834 57 7315.38 percent of total billed charges 12834 93 10395.5 percent of total billed charges 12834 12834 other OPPS APC 12834 12834 other OPPS APC 12834 51 6545.34 percent of total billed charges 12834 12834 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE LAPAROSCOPIC HAND ACCESS GELPORT XE ALEXIS WOUND RETRACTOR 100MM SUP-C8106 CDM 0270 RC outpatient 1181.05 1181.05 1181.05 74 873.98 percent of total billed charges 1181.05 93 956.65 percent of total billed charges 1181.05 1181.05 other OPPS APC 1181.05 1181.05 other OPPS APC 1181.05 27.63 326.32 percent of total billed charges 1181.05 1181.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL ALEXIS 360D SM ATRAUMATIC SELF RETAIN FLEXIBLE RING WOUND PROTECTOR 2.5-6CM INCISION SUP-C8301 CDM 0270 RC outpatient 93.6 93.6 93.6 74 69.26 percent of total billed charges 93.6 93 75.82 percent of total billed charges 93.6 93.6 other OPPS APC 93.6 93.6 other OPPS APC 93.6 27.63 25.86 percent of total billed charges 93.6 93.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL ALEXIS 360 D MEDIUM FLEXIBLE RING ATRAUMATIC SELF RETAINING WOUND PROTECTOR 5-9 CM INCISION SUP-C8302 CDM 0270 RC outpatient 93.6 93.6 93.6 74 69.26 percent of total billed charges 93.6 93 75.82 percent of total billed charges 93.6 93.6 other OPPS APC 93.6 93.6 other OPPS APC 93.6 27.63 25.86 percent of total billed charges 93.6 93.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROTECTOR TISSUE ALEXIS LARGE FLEXIBLE RETRACTION RING ATRAUMATIC 360 DEGREE PROTECTION LATEX FREE 9-14 CM INCISION SUP-C8303 CDM 0270 RC outpatient 143 143 143 74 105.82 percent of total billed charges 143 93 115.83 percent of total billed charges 143 143 other OPPS APC 143 143 other OPPS APC 143 27.63 39.51 percent of total billed charges 143 143 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL ALEXIS 360 D XL FLEXIBLE RING ATRAUMATIC SELF RETAINING WOUND PROTECTOR 11-17 CM INCISION SUP-C8304 CDM 0270 RC outpatient 179.4 179.4 179.4 74 132.76 percent of total billed charges 179.4 93 145.31 percent of total billed charges 179.4 179.4 other OPPS APC 179.4 179.4 other OPPS APC 179.4 27.63 49.57 percent of total billed charges 179.4 179.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SWAB CULTURE BD CULTURESWAB LIQUID STUART MED STERILE SUP-C8552-11S CDM 0270 RC outpatient 1.3 1.3 1.3 74 0.96 percent of total billed charges 1.3 93 1.05 percent of total billed charges 1.3 1.3 other OPPS APC 1.3 1.3 other OPPS APC 1.3 27.63 0.36 percent of total billed charges 1.3 1.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PORT HAND ACCESS ALEXIS GELPORT L120 MM ABDOMEN WOUND RETRACTOR LAPAROSCOPIC MARK PEN INCISION TEMPLATE GELSEAL TECHNOLOGY LATEX FREE SUP-C8XX2 CDM 0270 RC outpatient 1859 1859 1859 74 1375.66 percent of total billed charges 1859 93 1505.79 percent of total billed charges 1859 1859 other OPPS APC 1859 1859 other OPPS APC 1859 27.63 513.64 percent of total billed charges 1859 1859 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP PADLOCK DEFECT CLOSURE SYSTEM SUP-C910001 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRUTCH WALKING ALUMINUM C300 LB ADULT L62-70 IN AXILLARY STYLE PUSH BUTTON SUP-CA901AD CDM 270009111 LOCAL 0270 RC outpatient 12.97 12.97 12.97 74 9.6 percent of total billed charges 12.97 93 10.51 percent of total billed charges 12.97 12.97 other OPPS APC 12.97 12.97 other OPPS APC 12.97 27.63 3.58 percent of total billed charges 12.97 12.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE ADHESIVE L5 YD X W4 IN SELF ADHERENT NONSTERILE LATEX FREE SUP-CAH45LF CDM 0270 RC outpatient 4.63 4.63 4.63 74 3.43 percent of total billed charges 4.63 93 3.75 percent of total billed charges 4.63 4.63 other OPPS APC 4.63 4.63 other OPPS APC 4.63 27.63 1.28 percent of total billed charges 4.63 4.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE SELF ADHESIVE 4IN X 5YD LATEX FREE STERILE SUP-CAH45LFS CDM 270009185 LOCAL 0270 RC outpatient 3.4 3.4 3.4 74 2.52 percent of total billed charges 3.4 93 2.75 percent of total billed charges 3.4 3.4 other OPPS APC 3.4 3.4 other OPPS APC 3.4 27.63 0.94 percent of total billed charges 3.4 3.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE SELF ADHESIVE 6IN X 5YD LATEX FREE STERILE SUP-CAH65LFS CDM 270009185 LOCAL 0270 RC outpatient 3.4 3.4 3.4 74 2.52 percent of total billed charges 3.4 93 2.75 percent of total billed charges 3.4 3.4 other OPPS APC 3.4 3.4 other OPPS APC 3.4 27.63 0.94 percent of total billed charges 3.4 3.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CANCELLOUS H1-4 MM 15 ML FREEZE DRIED CHIPS SUP-CAN15 CDM 270010031 LOCAL 0270 RC outpatient 721.66 721.66 721.66 74 534.03 percent of total billed charges 721.66 93 584.54 percent of total billed charges 721.66 721.66 other OPPS APC 721.66 721.66 other OPPS APC 721.66 27.63 199.39 percent of total billed charges 721.66 721.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE CANCELLOUS H1-4 MM 30 ML FREEZE DRIED CHIPS SUP-CAN30 CDM 270010031 LOCAL 0270 RC outpatient 1245.84 1245.84 1245.84 74 921.92 percent of total billed charges 1245.84 93 1009.13 percent of total billed charges 1245.84 1245.84 other OPPS APC 1245.84 1245.84 other OPPS APC 1245.84 27.63 344.23 percent of total billed charges 1245.84 1245.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOTAL KNEE 3 PIECE CAP PRICE SUP-CAPKNEE3 CDM 270010025 LOCAL 0270 RC outpatient 9100 9100 9100 74 6734 percent of total billed charges 9100 93 7371 percent of total billed charges 9100 9100 other OPPS APC 9100 9100 other OPPS APC 9100 27.63 2514.33 percent of total billed charges 9100 9100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOTAL KNEE 4 PIECE CAP PRICE SUP-CAPKNEE4 CDM 270010025 LOCAL 0270 RC outpatient 9620 9620 9620 74 7118.8 percent of total billed charges 9620 93 7792.2 percent of total billed charges 9620 9620 other OPPS APC 9620 9620 other OPPS APC 9620 27.63 2658.01 percent of total billed charges 9620 9620 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT CARTIVA 10MM SUP-CAR-10-US CDM 0270 RC outpatient 10140 10140 10140 74 7503.6 percent of total billed charges 10140 93 8213.4 percent of total billed charges 10140 10140 other OPPS APC 10140 10140 other OPPS APC 10140 27.63 2801.68 percent of total billed charges 10140 10140 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA TRANSPORT 8MM SUP-CAT00222 CDM 0270 RC outpatient 187.2 187.2 187.2 74 138.53 percent of total billed charges 187.2 93 151.63 percent of total billed charges 187.2 187.2 other OPPS APC 187.2 187.2 other OPPS APC 187.2 27.63 51.72 percent of total billed charges 187.2 187.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA ARTHROSCOPIC TRANSPORT 4 8MM POLYMER PROXIMAL SECUREMENT THREAD SUP-CAT00223 CDM 0270 RC outpatient 187.2 187.2 187.2 74 138.53 percent of total billed charges 187.2 93 151.63 percent of total billed charges 187.2 187.2 other OPPS APC 187.2 187.2 other OPPS APC 187.2 27.63 51.72 percent of total billed charges 187.2 187.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA ARTHROSCOPIC TRANSPORT 7 8MM POLYMER PROXIMAL SECUREMENT THREAD SUP-CAT00224 CDM 0270 RC outpatient 238.68 238.68 238.68 74 176.62 percent of total billed charges 238.68 93 193.33 percent of total billed charges 238.68 238.68 other OPPS APC 238.68 238.68 other OPPS APC 238.68 27.63 65.95 percent of total billed charges 238.68 238.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE ARTHROSCOPIC SAMURAI FULL RADIUS CAPSULAR TISSUE SUP-CAT00227 CDM 0270 RC outpatient 649.74 649.74 649.74 74 480.81 percent of total billed charges 649.74 93 526.29 percent of total billed charges 649.74 649.74 other OPPS APC 649.74 649.74 other OPPS APC 649.74 27.63 179.52 percent of total billed charges 649.74 649.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NANOPASS 45DEG LEFT SUP-CAT01355 CDM 0270 RC outpatient 676 676 676 74 500.24 percent of total billed charges 676 93 547.56 percent of total billed charges 676 676 other OPPS APC 676 676 other OPPS APC 676 27.63 186.78 percent of total billed charges 676 676 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NANOPASS 45DEG RIGHT SUP-CAT01356 CDM 0270 RC outpatient 676 676 676 74 500.24 percent of total billed charges 676 93 547.56 percent of total billed charges 676 676 other OPPS APC 676 676 other OPPS APC 676 27.63 186.78 percent of total billed charges 676 676 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARTRIDGE ENDOSCOPIC INJECTOR II NEEDLE SUP-CAT01857 CDM 0270 RC outpatient 782.63 782.63 782.63 74 579.15 percent of total billed charges 782.63 93 633.93 percent of total billed charges 782.63 782.63 other OPPS APC 782.63 782.63 other OPPS APC 782.63 27.63 216.24 percent of total billed charges 782.63 782.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE NANOTACK 25 D OD1.4 MM FLEX INSERTER 2 STAGE FIXATION PILOT HOLE ANATOMIC LABRUM RESTORATION SYSTEM SUP-CAT01858 CDM 0270 RC outpatient 758.55 758.55 758.55 74 561.33 percent of total billed charges 758.55 93 614.43 percent of total billed charges 758.55 758.55 other OPPS APC 758.55 758.55 other OPPS APC 758.55 27.63 209.59 percent of total billed charges 758.55 758.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL NANOTACK FLEX ANATOMIC LABRUM RESTORATION SYSTEM SUP-CAT01859 CDM 0270 RC outpatient 407.55 407.55 407.55 74 301.59 percent of total billed charges 407.55 93 330.12 percent of total billed charges 407.55 407.55 other OPPS APC 407.55 407.55 other OPPS APC 407.55 27.63 112.61 percent of total billed charges 407.55 407.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PASS CAPSULE SUP-CAT02122 CDM 0270 RC outpatient 725.4 725.4 725.4 74 536.8 percent of total billed charges 725.4 93 587.57 percent of total billed charges 725.4 725.4 other OPPS APC 725.4 725.4 other OPPS APC 725.4 27.63 200.43 percent of total billed charges 725.4 725.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SUTURING NANOPASS CRESCENT OD1.5 MM ACETABULAR LABRUM MANAGER REACH SMALL FOOTPRINT SUP-CAT02298 CDM 0270 RC outpatient 807.04 807.04 807.04 74 597.21 percent of total billed charges 807.04 93 653.7 percent of total billed charges 807.04 807.04 other OPPS APC 807.04 807.04 other OPPS APC 807.04 27.63 222.99 percent of total billed charges 807.04 807.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR SUTURE CINCHLOCK SS KNOTLESS INSERTER LOCK ANATOMIC LABRUM RESTORATION SYSTEM SUP-CAT02462 CDM 0270 RC outpatient 947.7 947.7 947.7 74 701.3 percent of total billed charges 947.7 93 767.64 percent of total billed charges 947.7 947.7 other OPPS APC 947.7 947.7 other OPPS APC 947.7 27.63 261.85 percent of total billed charges 947.7 947.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLINGSHOT SUP-CAT02589 CDM 0270 RC outpatient 925.55 925.55 925.55 74 684.91 percent of total billed charges 925.55 93 749.7 percent of total billed charges 925.55 925.55 other OPPS APC 925.55 925.55 other OPPS APC 925.55 27.63 255.73 percent of total billed charges 925.55 925.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR CINCHLOCK FLEX KNOTLESS SUP-CAT02643 CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT CINCHLOCK FLEX SUP-CAT02644 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR CINCHLOCK FLEX KNOTLESS SUP-CAT05643 CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY INDIGO L100 CM OD8 FR ASPIRATION EXTRA TORQUE TIP SUP-CAT8XTORQ115 CDM 0270 RC outpatient 7670 7670 7670 74 5675.8 percent of total billed charges 7670 93 6212.7 percent of total billed charges 7670 7670 other OPPS APC 7670 7670 other OPPS APC 7670 27.63 2119.22 percent of total billed charges 7670 7670 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE LAPAROSCOPIC ENDOPATH XCEL OPTIVIEW UNIVERSAL L100 MM OD11 MM BLUNT TIP RADIOPAQUE TROCAR CANNULA STERILE LATEX FREE DISPOSABLE SUP-CB11LT CDM 0270 RC outpatient 44.33 44.33 44.33 74 32.8 percent of total billed charges 44.33 93 35.91 percent of total billed charges 44.33 44.33 other OPPS APC 44.33 44.33 other OPPS APC 44.33 27.63 12.25 percent of total billed charges 44.33 44.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE LAPAROSCOPIC ENDOPATH XCEL UNIVERSAL 100MM 12MM DISPOSABLE STERILE STABILITY BLADELESS OBTURATOR OPTIONAL PISTOL SUP-CB12LT CDM 0270 RC outpatient 44.33 44.33 44.33 74 32.8 percent of total billed charges 44.33 93 35.91 percent of total billed charges 44.33 44.33 other OPPS APC 44.33 44.33 other OPPS APC 44.33 27.63 12.25 percent of total billed charges 44.33 44.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CATHETER CARTO 3 L3 MR 12 34 PIN DARK BLUE LIGHT BLUE WEBSTER DECAPOLAR WEBSTER CS BIDIRECTIONAL AUTO ID SUP-CB3412CT CDM 0270 RC outpatient 1349.4 1349.4 1349.4 74 998.56 percent of total billed charges 1349.4 93 1093.01 percent of total billed charges 1349.4 1349.4 other OPPS APC 1349.4 1349.4 other OPPS APC 1349.4 27.63 372.84 percent of total billed charges 1349.4 1349.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CATHETER CARTO 3 L10 FT BLUE SUP-CB3434CT CDM 0270 RC outpatient 1349.4 1349.4 1349.4 74 998.56 percent of total billed charges 1349.4 93 1093.01 percent of total billed charges 1349.4 1349.4 other OPPS APC 1349.4 1349.4 other OPPS APC 1349.4 27.63 372.84 percent of total billed charges 1349.4 1349.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE LAPAROSCOPIC ENDOPATH XCEL UNIVERSAL 100MM 5MM DISPOSABLE STERILE STABILITY BLADELESS OBTURATOR OPTIONAL PISTOL SUP-CB5LT CDM 0270 RC outpatient 44.33 44.33 44.33 74 32.8 percent of total billed charges 44.33 93 35.91 percent of total billed charges 44.33 44.33 other OPPS APC 44.33 44.33 other OPPS APC 44.33 27.63 12.25 percent of total billed charges 44.33 44.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE COMPRESSION L5 YD X W3 IN LIGHTWEIGHT SELF ADHERENT BREATHABLE NONSTERILE LATEX FREE SUP-CBN1003 CDM 270009185 LOCAL 0270 RC outpatient 3.4 3.4 3.4 74 2.52 percent of total billed charges 3.4 93 2.75 percent of total billed charges 3.4 3.4 other OPPS APC 3.4 3.4 other OPPS APC 3.4 27.63 0.94 percent of total billed charges 3.4 3.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC FORTIFY VR TITANIUM THK14 MM 40 J W40 MM X H71 MM 35 ML 75 GM 1 CHAMBER DF-4 RF TELEMETRY SUP-CD1231-40-S CDM 0275 RC outpatient 35175 35175 35175 57 20049.8 percent of total billed charges 35175 93 28491.8 percent of total billed charges 35175 35175 other OPPS APC 35175 35175 other OPPS APC 35175 51 17939.3 percent of total billed charges 35175 35175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORTIFY VR ICD SUP-CD1231-40Q-D CDM 0275 RC outpatient 20525 20525 20525 57 11699.3 percent of total billed charges 20525 93 16625.3 percent of total billed charges 20525 20525 other OPPS APC 20525 20525 other OPPS APC 20525 51 10467.8 percent of total billed charges 20525 20525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD 1257-40 ASSURE VR SUP-CD1257-40 CDM 0275 RC outpatient 20525 20525 20525 57 11699.3 percent of total billed charges 20525 93 16625.3 percent of total billed charges 20525 20525 other OPPS APC 20525 20525 other OPPS APC 20525 51 10467.8 percent of total billed charges 20525 20525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD CD1257-40Q ASSURE VR SUP-CD1257-40Q CDM 0275 RC outpatient 20525 20525 20525 57 11699.3 percent of total billed charges 20525 93 16625.3 percent of total billed charges 20525 20525 other OPPS APC 20525 20525 other OPPS APC 20525 51 10467.8 percent of total billed charges 20525 20525 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD FORTIFY ASSURA VR40 DR4 CONNECTOR SINGLE CHAMBER SYSTEM SUP-CD1257-40QS CDM 0275 RC outpatient 35175 35175 35175 57 20049.8 percent of total billed charges 35175 93 28491.8 percent of total billed charges 35175 35175 other OPPS APC 35175 35175 other OPPS APC 35175 51 17939.3 percent of total billed charges 35175 35175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD FORTIFY ASSURA VR 40 SINGLE CHAMBER SYSTEM SUP-CD1257-40S CDM 0275 RC outpatient 35175 35175 35175 57 20049.8 percent of total billed charges 35175 93 28491.8 percent of total billed charges 35175 35175 other OPPS APC 35175 35175 other OPPS APC 35175 51 17939.3 percent of total billed charges 35175 35175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC ELLIPSE VR TITANIUM THK12 MM 36 J W51 MM X H68 MM 31 ML 66 GM VENTRICLE 1 CHAMBER 1 IS-1 1 DF-1 HIGH VOLTAGE SUP-CD1311-36 CDM 0275 RC outpatient 20100 20100 20100 57 11457 percent of total billed charges 20100 93 16281 percent of total billed charges 20100 20100 other OPPS APC 20100 20100 other OPPS APC 20100 51 10251 percent of total billed charges 20100 20100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC MRI ELLIPSE VR TITANIUM THK12 MM 36 J W66 MM X H51 MM 31 ML 66 GM VENTRICLE 2 CHAMBER 2 DF-4 HIGH VOLTAGE SUP-CD1311-36Q CDM 0275 RC outpatient 34214 34214 34214 57 19502 percent of total billed charges 34214 93 27713.3 percent of total billed charges 34214 34214 other OPPS APC 34214 34214 other OPPS APC 34214 51 17449.1 percent of total billed charges 34214 34214 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD ELLIPSE MRI VR 36 DF4 CONNECTOR SYSTEM SUP-CD1311-36QS CDM 0275 RC outpatient 37800 37800 37800 57 21546 percent of total billed charges 37800 93 30618 percent of total billed charges 37800 37800 other OPPS APC 37800 37800 other OPPS APC 37800 51 19278 percent of total billed charges 37800 37800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD ELLIPSE VR 36 SYSTEM SUP-CD1311-36S CDM 0275 RC outpatient 35175 35175 35175 57 20049.8 percent of total billed charges 35175 93 28491.8 percent of total billed charges 35175 35175 other OPPS APC 35175 35175 other OPPS APC 35175 51 17939.3 percent of total billed charges 35175 35175 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD NG ASSURA VR SUP-CD1357-40C CDM 0275 RC outpatient 15070 15070 15070 57 8589.9 percent of total billed charges 15070 93 12206.7 percent of total billed charges 15070 15070 other OPPS APC 15070 15070 other OPPS APC 15070 51 7685.7 percent of total billed charges 15070 15070 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD NG ASSURA VR SYSTEM SUP-CD1357-40C SYS CDM 0275 RC outpatient 20144 20144 20144 57 11482.1 percent of total billed charges 20144 93 16316.6 percent of total billed charges 20144 20144 other OPPS APC 20144 20144 other OPPS APC 20144 51 10273.4 percent of total billed charges 20144 20144 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC FORTIFY ASSURA VR THK14 MM 40 J L71 MM X W40 MM 35 CC 75 GM VENTRICLE 1 CHAMBER 2 DF-4 CARDIOVERTER SUP-CD1357-40Q CDM 0275 RC outpatient 14850 14850 14850 57 8464.5 percent of total billed charges 14850 93 12028.5 percent of total billed charges 14850 14850 other OPPS APC 14850 14850 other OPPS APC 14850 51 7573.5 percent of total billed charges 14850 14850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC ELLIPSE VR DYNAMICTX SHOCKGUARD SENSEABILITY PARYLENE THK12 MM 36 J ANGLE W51 MM X H68 MM 31 ML 66 GM 1 CHAMBER IS-1 DF-4 CONNECTOR VECTOR SWITCH ALGORITHM IMPLANTABLE CARDIOVERTER DEFIBRILLATOR SUP-CD1411-36C CDM 0275 RC outpatient 15070 15070 15070 57 8589.9 percent of total billed charges 15070 93 12206.7 percent of total billed charges 15070 15070 other OPPS APC 15070 15070 other OPPS APC 15070 51 7685.7 percent of total billed charges 15070 15070 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC MRI ELLIPSE VR DYNAMICTX SHOCKGUARD SENSEABILITY QHR ANGLE THK12 MM 36 J W51 MM X H66 MM 31 ML 67 GM 1 CHAMBER DF-4 CONNECTOR VECTOR SWITCH ALGORITHM HEADER SUP-CD1411-36Q CDM 0275 RC outpatient 14850 14850 14850 57 8464.5 percent of total billed charges 14850 93 12028.5 percent of total billed charges 14850 14850 other OPPS APC 14850 14850 other OPPS APC 14850 51 7573.5 percent of total billed charges 14850 14850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD NG MRI ELLIPSE VR SYSTEM SUP-CD1411-36Q SYS CDM 0275 RC outpatient 21520 21520 21520 57 12266.4 percent of total billed charges 21520 93 17431.2 percent of total billed charges 21520 21520 other OPPS APC 21520 21520 other OPPS APC 21520 51 10975.2 percent of total billed charges 21520 21520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORTIFY DR ICD SUP-CD2231-40Q-D CDM 0275 RC outpatient 35895 35895 35895 57 20460.2 percent of total billed charges 35895 93 29075 percent of total billed charges 35895 35895 other OPPS APC 35895 35895 other OPPS APC 35895 51 18306.5 percent of total billed charges 35895 35895 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM ICD DR FORTIFY SUP-CD2231-40Q-S CDM 0275 RC outpatient 39000 39000 39000 57 22230 percent of total billed charges 39000 93 31590 percent of total billed charges 39000 39000 other OPPS APC 39000 39000 other OPPS APC 39000 51 19890 percent of total billed charges 39000 39000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD CD2257-40 ASSURA _35376_ SUP-CD2257-40 CDM 0275 RC outpatient 35895 35895 35895 57 20460.2 percent of total billed charges 35895 93 29075 percent of total billed charges 35895 35895 other OPPS APC 35895 35895 other OPPS APC 35895 51 18306.5 percent of total billed charges 35895 35895 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD CD 2257-40Q FORTIFY ASSURA DR SUP-CD2257-40Q CDM 0275 RC outpatient 35895 35895 35895 57 20460.2 percent of total billed charges 35895 93 29075 percent of total billed charges 35895 35895 other OPPS APC 35895 35895 other OPPS APC 35895 51 18306.5 percent of total billed charges 35895 35895 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD FORTIFY ASSURA DR40 DF4 DUAL CHAMBER SYSTEM SUP-CD2257-40QS CDM 0275 RC outpatient 39000 39000 39000 57 22230 percent of total billed charges 39000 93 31590 percent of total billed charges 39000 39000 other OPPS APC 39000 39000 other OPPS APC 39000 51 19890 percent of total billed charges 39000 39000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD FORTIFY DR 40 DUAL CHAMBER SYSTEM SUP-CD2257-40S CDM 0275 RC outpatient 39000 39000 39000 57 22230 percent of total billed charges 39000 93 31590 percent of total billed charges 39000 39000 other OPPS APC 39000 39000 other OPPS APC 39000 51 19890 percent of total billed charges 39000 39000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC MRI ELLIPSE DR TITANIUM THK12 MM 36 J W51 MM X H70 MM 31 ML 68 GM VENTRICLE 1 CHAMBER 1 IS-1 2 DF-4 HIGH VOLTAGE SUP-CD2311-36Q CDM 0275 RC outpatient 21900 21900 21900 57 12483 percent of total billed charges 21900 93 17739 percent of total billed charges 21900 21900 other OPPS APC 21900 21900 other OPPS APC 21900 51 11169 percent of total billed charges 21900 21900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD ELLIPSE DR 36 SYSTEM SUP-CD2311-36S CDM 0275 RC outpatient 35304 35304 35304 57 20123.3 percent of total billed charges 35304 93 28596.2 percent of total billed charges 35304 35304 other OPPS APC 35304 35304 other OPPS APC 35304 51 18005 percent of total billed charges 35304 35304 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC FORTIFY ASSURA DR 2 CHAMBER CARDIOVERTER SUP-CD2357-40C CDM 0275 RC outpatient 15240 15240 15240 57 8686.8 percent of total billed charges 15240 93 12344.4 percent of total billed charges 15240 15240 other OPPS APC 15240 15240 other OPPS APC 15240 51 7772.4 percent of total billed charges 15240 15240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD NG ASSURA DR DUAL CHAMBER SYSTEM SUP-CD2357-40C SYS CDM 0275 RC outpatient 21093 21093 21093 57 12023 percent of total billed charges 21093 93 17085.3 percent of total billed charges 21093 21093 other OPPS APC 21093 21093 other OPPS APC 21093 51 10757.4 percent of total billed charges 21093 21093 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC FORTIFY ASSURA DR 40 J 2 CHAMBER CARDIOVERTER SSJ4 CONNECTOR SUP-CD2357-40Q CDM 0275 RC outpatient 15240 15240 15240 57 8686.8 percent of total billed charges 15240 93 12344.4 percent of total billed charges 15240 15240 other OPPS APC 15240 15240 other OPPS APC 15240 51 7772.4 percent of total billed charges 15240 15240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD NG ELLIPSE DR SUP-CD2411-36C CDM 0275 RC outpatient 15240 15240 15240 57 8686.8 percent of total billed charges 15240 93 12344.4 percent of total billed charges 15240 15240 other OPPS APC 15240 15240 other OPPS APC 15240 51 7772.4 percent of total billed charges 15240 15240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC MRI ELLIPSE DR DF-4 CONNECTOR DUAL CHAMBER SUP-CD2411-36Q CDM 0275 RC outpatient 15240 15240 15240 57 8686.8 percent of total billed charges 15240 93 12344.4 percent of total billed charges 15240 15240 other OPPS APC 15240 15240 other OPPS APC 15240 51 7772.4 percent of total billed charges 15240 15240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIFY HF CRT-D SUP-CD3231-40Q-D CDM 0275 RC outpatient 37555 37555 37555 57 21406.3 percent of total billed charges 37555 93 30419.5 percent of total billed charges 37555 37555 other OPPS APC 37555 37555 other OPPS APC 37555 51 19153 percent of total billed charges 37555 37555 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUADRA HF CRT-D SUP-CD3249-40/40Q CDM 0275 RC outpatient 39425 39425 39425 57 22472.3 percent of total billed charges 39425 93 31934.3 percent of total billed charges 39425 39425 other OPPS APC 39425 39425 other OPPS APC 39425 51 20106.8 percent of total billed charges 39425 39425 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD QUADRA HF CRT-D SYSTEM SUP-CD3249-40/40QS CDM 0275 RC outpatient 69355 69355 69355 57 39532.3 percent of total billed charges 69355 93 56177.6 percent of total billed charges 69355 69355 other OPPS APC 69355 69355 other OPPS APC 69355 51 35371.1 percent of total billed charges 69355 69355 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRTD CD3257-40Q ASSURA _35390_ SUP-CD3257-40Q CDM 0275 RC outpatient 37555 37555 37555 57 21406.3 percent of total billed charges 37555 93 30419.5 percent of total billed charges 37555 37555 other OPPS APC 37555 37555 other OPPS APC 37555 51 19153 percent of total billed charges 37555 37555 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. QUADRA ASSURA CRT-D SUP-CD3265-40 CDM 0275 RC outpatient 41974.5 41974.5 41974.5 57 23925.5 percent of total billed charges 41974.5 93 33999.3 percent of total billed charges 41974.5 41974.5 other OPPS APC 41974.5 41974.5 other OPPS APC 41974.5 51 21407 percent of total billed charges 41974.5 41974.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC QUADRA ASSURA TAILOREDTHERAPY SHOCKGUARD DECISIONTX THK14MM 41X76MM 38CC 81GM IS-1 IS4 DF4 SUP-CD3265-40Q CDM 0275 RC outpatient 41974.5 41974.5 41974.5 57 23925.5 percent of total billed charges 41974.5 93 33999.3 percent of total billed charges 41974.5 41974.5 other OPPS APC 41974.5 41974.5 other OPPS APC 41974.5 51 21407 percent of total billed charges 41974.5 41974.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD BIV QUADRA ASSURA CRT-D DF4 CONNECTOR SYSTEM SUP-CD3265-40QS CDM 0275 RC outpatient 48774 48774 48774 57 27801.2 percent of total billed charges 48774 93 39506.9 percent of total billed charges 48774 48774 other OPPS APC 48774 48774 other OPPS APC 48774 51 24874.7 percent of total billed charges 48774 48774 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC QUADRA ASSURA CRT-D TITANIUM THK14 MM 40 J W41 MM X H83 MM 40 ML 83 GM VENTRICLE 2 CHAMBER 1 IS-1 1 DF-1 1 IS-4 HIGH VOLTAGE SUP-CD3265-40S CDM 0275 RC outpatient 48774 48774 48774 57 27801.2 percent of total billed charges 48774 93 39506.9 percent of total billed charges 48774 48774 other OPPS APC 48774 48774 other OPPS APC 48774 51 24874.7 percent of total billed charges 48774 48774 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC UNIFY ASSURA CRT 40 J CARDIOVERTER SUP-CD3357-40C CDM 0275 RC outpatient 20900 20900 20900 57 11913 percent of total billed charges 20900 93 16929 percent of total billed charges 20900 20900 other OPPS APC 20900 20900 other OPPS APC 20900 51 10659 percent of total billed charges 20900 20900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC UNIFY ASSURA CRT CARDIOVERTER NEXT GENERATION SUP-CD3357-40Q CDM 0275 RC outpatient 20900 20900 20900 57 11913 percent of total billed charges 20900 93 16929 percent of total billed charges 20900 20900 other OPPS APC 20900 20900 other OPPS APC 20900 51 10659 percent of total billed charges 20900 20900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC QUADRA ASSURA CRT CARDIOVERTER NEXT GENERATION AICD SUP-CD3365-40C CDM 0275 RC outpatient 21690 21690 21690 57 12363.3 percent of total billed charges 21690 93 17568.9 percent of total billed charges 21690 21690 other OPPS APC 21690 21690 other OPPS APC 21690 51 11061.9 percent of total billed charges 21690 21690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC QUADRA ASSURA CRT-D THK14 MM 40 J W41 MM X H76 MM 38 ML 81 GM 2 CHAMBER RESYNCHRONIZATION THERAPY SUP-CD3365-40Q CDM 0275 RC outpatient 21690 21690 21690 57 12363.3 percent of total billed charges 21690 93 17568.9 percent of total billed charges 21690 21690 other OPPS APC 21690 21690 other OPPS APC 21690 51 11061.9 percent of total billed charges 21690 21690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD QUADRA ASSURA MP CRT-D SUP-CD3369-40C CDM 0275 RC outpatient 20900 20900 20900 57 11913 percent of total billed charges 20900 93 16929 percent of total billed charges 20900 20900 other OPPS APC 20900 20900 other OPPS APC 20900 51 10659 percent of total billed charges 20900 20900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD QUADRA ASSURA MP CRT-D MERLIN PKG SUP-CD3369-40C CELL CDM 0275 RC outpatient 20900 20900 20900 57 11913 percent of total billed charges 20900 93 16929 percent of total billed charges 20900 20900 other OPPS APC 20900 20900 other OPPS APC 20900 51 10659 percent of total billed charges 20900 20900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD QUADRA ASSURA MP CRT-D SYSTEM SUP-CD3369-40C SYSTEM CDM 0275 RC outpatient 37515 37515 37515 57 21383.5 percent of total billed charges 37515 93 30387.2 percent of total billed charges 37515 37515 other OPPS APC 37515 37515 other OPPS APC 37515 51 19132.7 percent of total billed charges 37515 37515 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD QUADRA ASSURA MP CRT-D DR4 CONNECTOR SUP-CD3369-40Q CDM 0275 RC outpatient 20900 20900 20900 57 11913 percent of total billed charges 20900 93 16929 percent of total billed charges 20900 20900 other OPPS APC 20900 20900 other OPPS APC 20900 51 10659 percent of total billed charges 20900 20900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD QUADRA ASSURA MP CRT-D DF MERLIN PKG SUP-CD3369-40Q CELL CDM 0275 RC outpatient 36400 36400 36400 57 20748 percent of total billed charges 36400 93 29484 percent of total billed charges 36400 36400 other OPPS APC 36400 36400 other OPPS APC 36400 51 18564 percent of total billed charges 36400 36400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD QUADRA ASSURA MP CRT-D DF4 CONNECTOR SYSTEM SUP-CD3369-40Q SYSTEM CDM 0275 RC outpatient 37515 37515 37515 57 21383.5 percent of total billed charges 37515 93 30387.2 percent of total billed charges 37515 37515 other OPPS APC 37515 37515 other OPPS APC 37515 51 19132.7 percent of total billed charges 37515 37515 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC ENTRANT 2 CHAMBER IS-1 DF4 CONNECTOR SUP-CDDRA300Q CDM 0275 RC outpatient 15500 15500 15500 57 8835 percent of total billed charges 15500 93 12555 percent of total billed charges 15500 15500 other OPPS APC 15500 15500 other OPPS APC 15500 51 7905 percent of total billed charges 15500 15500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC GALLANT 2 CHAMBER IS-1 DF4 CONNECTOR SUP-CDDRA500Q CDM 0275 RC outpatient 16218 16218 16218 57 9244.26 percent of total billed charges 16218 93 13136.6 percent of total billed charges 16218 16218 other OPPS APC 16218 16218 other OPPS APC 16218 51 8271.18 percent of total billed charges 16218 16218 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL PROXIMATE TITANIUM CURVE CIRCLE L18 CM L5.5 MM X H1-2.5 MM OD21 MM INTRALUMINAL STERILE LATEX FREE DISPOSABLE 12.4 MM LUMEN SUP-CDH21A CDM 270009089 LOCAL 0270 RC outpatient 299.84 299.84 299.84 74 221.88 percent of total billed charges 299.84 93 242.87 percent of total billed charges 299.84 299.84 other OPPS APC 299.84 299.84 other OPPS APC 299.84 27.63 82.85 percent of total billed charges 299.84 299.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL PROXIMATE TITANIUM CURVE CIRCLE H5.5 MM L18 CM X H1-2.5 MM OD25 MM INTRALUMINAL LINEAR CUTTER ADJUSTABLE FLEXIBLE STERILE LATEX FREE DISPOSABLE 16.4 MM LUMEN ENDOSCOPIC SUP-CDH25A CDM 270009089 LOCAL 0270 RC outpatient 299.84 299.84 299.84 74 221.88 percent of total billed charges 299.84 93 242.87 percent of total billed charges 299.84 299.84 other OPPS APC 299.84 299.84 other OPPS APC 299.84 27.63 82.85 percent of total billed charges 299.84 299.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ECHELON CIRCULAR 22 MM 25 L5.2 MM X H1.5-2.2 MM 3D GRIP SURFACE POWER ADJUSTABLE STAPLE STERILE SUP-CDH25P CDM 0270 RC outpatient 1087.29 1087.29 1087.29 74 804.59 percent of total billed charges 1087.29 93 880.7 percent of total billed charges 1087.29 1087.29 other OPPS APC 1087.29 1087.29 other OPPS APC 1087.29 27.63 300.42 percent of total billed charges 1087.29 1087.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL PROXIMATE TITANIUM CURVE CIRCLE H5.5 MM L18 CM X H1-2.5 MM OD29 MM INTRALUMINAL LINEAR CUTTER ADJUSTABLE FLEXIBLE STERILE LATEX FREE DISPOSABLE 20.4 MM LUMEN ENDOSCOPIC SUP-CDH29A CDM 270009089 LOCAL 0270 RC outpatient 299.84 299.84 299.84 74 221.88 percent of total billed charges 299.84 93 242.87 percent of total billed charges 299.84 299.84 other OPPS APC 299.84 299.84 other OPPS APC 299.84 27.63 82.85 percent of total billed charges 299.84 299.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ECHELON CIRCULAR 29 MM 26 L5.2 MM X H1.5-2.2 MM 3D GRIP SURFACE POWER ADJUSTABLE STAPLE SUP-CDH29P CDM 0270 RC outpatient 1087.29 1087.29 1087.29 74 804.59 percent of total billed charges 1087.29 93 880.7 percent of total billed charges 1087.29 1087.29 other OPPS APC 1087.29 1087.29 other OPPS APC 1087.29 27.63 300.42 percent of total billed charges 1087.29 1087.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL PROXIMATE TITANIUM CURVE CIRCLE H5.5 MM L18 CM X H1-2.5 MM OD33 MM INTRALUMINAL LINEAR CUTTER ADJUSTABLE FLEXIBLE STERILE LATEX FREE DISPOSABLE 24.4 MM LUMEN ENDOSCOPIC SUP-CDH33A CDM 270009089 LOCAL 0270 RC outpatient 299.84 299.84 299.84 74 221.88 percent of total billed charges 299.84 93 242.87 percent of total billed charges 299.84 299.84 other OPPS APC 299.84 299.84 other OPPS APC 299.84 27.63 82.85 percent of total billed charges 299.84 299.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC ENTRANT IS-4 DF4 IS-1 CONNECOR RESYNCHRONIZATION SUP-CDHFA300Q CDM 0275 RC outpatient 21200 21200 21200 57 12084 percent of total billed charges 21200 93 17172 percent of total billed charges 21200 21200 other OPPS APC 21200 21200 other OPPS APC 21200 51 10812 percent of total billed charges 21200 21200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC GALLANT IS-4 DF4 IS-1 CONNECTOR RESYNCHRONIZATION SUP-CDHFA500Q CDM 0275 RC outpatient 33852 33852 33852 57 19295.6 percent of total billed charges 33852 93 27420.1 percent of total billed charges 33852 33852 other OPPS APC 33852 33852 other OPPS APC 33852 51 17264.5 percent of total billed charges 33852 33852 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EPI SENSE CATHETER SUP-CDK-1413 CDM 0270 RC outpatient 9965.8 9965.8 9965.8 74 7374.69 percent of total billed charges 9965.8 93 8072.3 percent of total billed charges 9965.8 9965.8 other OPPS APC 9965.8 9965.8 other OPPS APC 9965.8 27.63 2753.55 percent of total billed charges 9965.8 9965.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE COAGULATION EPI-SENSE L3 CM GUIDE ELECTRODE IRRIGATION PERFUSION LUMEN SUCTION 6130 SUP-CDP-4330 CDM 0270 RC outpatient 29900 29900 29900 74 22126 percent of total billed charges 29900 93 24219 percent of total billed charges 29900 29900 other OPPS APC 29900 29900 other OPPS APC 29900 27.63 8261.37 percent of total billed charges 29900 29900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DECOMPRESSION MARCON .035 IN L350 CM OD10 FR COLON DISPOSABLE SUP-CDSM-10 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC ENTRANT 1 CHAMBER DF4 CONNECTOR SUP-CDVRA300Q CDM 0275 RC outpatient 15300 15300 15300 57 8721 percent of total billed charges 15300 93 12393 percent of total billed charges 15300 15300 other OPPS APC 15300 15300 other OPPS APC 15300 51 7803 percent of total billed charges 15300 15300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC GALLANT 1 CHAMBER DF4 CONNECTOR SUP-CDVRA500Q CDM 0275 RC outpatient 16031 16031 16031 57 9137.67 percent of total billed charges 16031 93 12985.1 percent of total billed charges 16031 16031 other OPPS APC 16031 16031 other OPPS APC 16031 51 8175.81 percent of total billed charges 16031 16031 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR GORE EXCLUDER L10 CM OD10 MM ILIAC BRANCH COMPONENT AAA SUP-CEB231010A CDM 0270 RC outpatient 30849 30849 30849 74 22828.3 percent of total billed charges 30849 93 24987.7 percent of total billed charges 30849 30849 other OPPS APC 30849 30849 other OPPS APC 30849 27.63 8523.58 percent of total billed charges 30849 30849 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOPROSTHESIS GORE ILIAC BRANCH SUP-CEB231210A CDM 270010015 LOCAL 0270 RC outpatient 30849 30849 30849 74 22828.3 percent of total billed charges 30849 93 24987.7 percent of total billed charges 30849 30849 other OPPS APC 30849 30849 other OPPS APC 30849 27.63 8523.58 percent of total billed charges 30849 30849 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR GORE EXCLUDER L10 CM OD14.5 MM ILIAC BRANCH COMPONENT AAA SUP-CEB231410A CDM 270010015 LOCAL 0270 RC outpatient 30849 30849 30849 74 22828.3 percent of total billed charges 30849 93 24987.7 percent of total billed charges 30849 30849 other OPPS APC 30849 30849 other OPPS APC 30849 27.63 8523.58 percent of total billed charges 30849 30849 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUSTOM GI KIT SUP-CEK-746-20 CDM 0270 RC outpatient 12.65 12.65 12.65 74 9.36 percent of total billed charges 12.65 93 10.25 percent of total billed charges 12.65 12.65 other OPPS APC 12.65 12.65 other OPPS APC 12.65 27.63 3.5 percent of total billed charges 12.65 12.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CELLSAVER CHARGE SUP-CELLSAVER CDM 270010026 LOCAL 0270 RC outpatient 429.75 429.75 429.75 74 318.02 percent of total billed charges 429.75 93 348.1 percent of total billed charges 429.75 429.75 other OPPS APC 429.75 429.75 other OPPS APC 429.75 27.63 118.74 percent of total billed charges 429.75 429.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP STAND ALONE CERVICAL PLATING-LDR SUP-CERV-ST ALONE PLATE CDM 270010020 LOCAL 0270 RC outpatient 7280 7280 7280 74 5387.2 percent of total billed charges 7280 93 5896.8 percent of total billed charges 7280 7280 other OPPS APC 7280 7280 other OPPS APC 7280 27.63 2011.46 percent of total billed charges 7280 7280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUSION CERVICAL LEVEL 1-BIOMET SUP-CERVICALL1-BIOMET CDM 270010020 LOCAL 0270 RC outpatient 2990 2990 2990 74 2212.6 percent of total billed charges 2990 93 2421.9 percent of total billed charges 2990 2990 other OPPS APC 2990 2990 other OPPS APC 2990 27.63 826.14 percent of total billed charges 2990 2990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUSION CERVICAL LEVEL 1 SUP-CERVICALL1-SYNTHES CDM 270010008 LOCAL 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUSION CERVICAL LEVEL 2 SUP-CERVICALL2 CDM 270010009 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUSION CERVICAL LEVEL 2-BIOMET SUP-CERVICALL2-BIOMET CDM 270010020 LOCAL 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUSION CERVICAL LEVEL 3 SUP-CERVICALL3 CDM 270010010 LOCAL 0270 RC outpatient 7020 7020 7020 74 5194.8 percent of total billed charges 7020 93 5686.2 percent of total billed charges 7020 7020 other OPPS APC 7020 7020 other OPPS APC 7020 27.63 1939.63 percent of total billed charges 7020 7020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR W/BALLOON BLADED 11MMX100MM SUP-CFB33 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR SHEILD/BLADED W/BALLOON 12MM X 100MM SUP-CFB73 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER PAPER STERRAD NONCELLULOSE 9 X 6IN SUP-CFDST-2 CDM outpatient 0.33 0.33 0.33 0.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR DENTAL CARBIDE 7902 12 BLADE TRIMMING FINISHING FRICTION GRIP SUP-CFNNEE010FZ CDM outpatient 19.13 19.13 19.13 19.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR W BALLOON 5MM X 100MM SUP-CFR03 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR W/BALLOON 11MM X 100MM SUP-CFR33 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR BLADLESS W/BALLOOON 12MM X 150MM SUP-CFR71 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR BLADELESS W/BALLOON 12MMX100MM SUP-CFR73 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR SLEEVE W/BALLOON 5MM X 100MM SUP-CFS02 CDM 0270 RC outpatient 143 143 143 74 105.82 percent of total billed charges 143 93 115.83 percent of total billed charges 143 143 other OPPS APC 143 143 other OPPS APC 143 27.63 39.51 percent of total billed charges 143 143 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE BALLOON 11MM X 100MM SUP-CFS12 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE W/BALLOON 12MM X 100MM SUP-CFS22 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP ASPIRATION SONASTAR MONOPOLAR RF CABLE HANDPIECE SUP-CFSM6-D050 CDM 0270 RC outpatient 205.4 205.4 205.4 74 152 percent of total billed charges 205.4 93 166.37 percent of total billed charges 205.4 205.4 other OPPS APC 205.4 205.4 other OPPS APC 205.4 27.63 56.75 percent of total billed charges 205.4 205.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH LAPAROSCOPIC SONASTAR PLASTIC OD10 MM RIGID REUSABLE SUP-CFSM6-H190 CDM 0270 RC outpatient 1825.2 1825.2 1825.2 74 1350.65 percent of total billed charges 1825.2 93 1478.41 percent of total billed charges 1825.2 1825.2 other OPPS APC 1825.2 1825.2 other OPPS APC 1825.2 27.63 504.3 percent of total billed charges 1825.2 1825.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC GLIDECATH HYDROPHILIC NYLON SIM2 CURVE L100 CM L15 CM OD4 FR 2 STAINLESS STEEL BRAIDED POLYURETHANE JACKET ACCEPTS .038 IN GUIDEWIRE SUP-CG402 CDM 0270 RC outpatient 126.23 126.23 126.23 74 93.41 percent of total billed charges 126.23 93 102.25 percent of total billed charges 126.23 126.23 other OPPS APC 126.23 126.23 other OPPS APC 126.23 27.63 34.88 percent of total billed charges 126.23 126.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC GLIDECATH GLIDE TECHNOLOGY STAINLESS STEEL HYDROPHILIC COBRA 2 CURVE L65 CM OD4 FR ID.041 IN 2 BRAID ACCEPTS .038 IN GUIDEWIRE SUP-CG409 CDM 0270 RC outpatient 126.23 126.23 126.23 74 93.41 percent of total billed charges 126.23 93 102.25 percent of total billed charges 126.23 126.23 other OPPS APC 126.23 126.23 other OPPS APC 126.23 27.63 34.88 percent of total billed charges 126.23 126.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC GLIDECATH GLIDE TECHNOLOGY STAINLESS STEEL HYDROPHILIC STRAIGHT CURVE L65 CM OD4 FR ID.041 IN 2 BRAID ACCEPTS .038 IN GUIDEWIRE SUP-CG412 CDM 0270 RC outpatient 126.23 126.23 126.23 74 93.41 percent of total billed charges 126.23 93 102.25 percent of total billed charges 126.23 126.23 other OPPS APC 126.23 126.23 other OPPS APC 126.23 27.63 34.88 percent of total billed charges 126.23 126.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER - GLIDECATH 4F 65CM ANGLED SUP-CG415 CDM 0270 RC outpatient 126.23 126.23 126.23 74 93.41 percent of total billed charges 126.23 93 102.25 percent of total billed charges 126.23 126.23 other OPPS APC 126.23 126.23 other OPPS APC 126.23 27.63 34.88 percent of total billed charges 126.23 126.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC GLIDECATH GLIDE TECHNOLOGY STAINLESS STEEL HYDROPHILIC ANGLE L65 CM L15 CM OD4 FR ID.041 IN 2 BRAID SUP-CG415 CDM 0270 RC outpatient 126.23 126.23 126.23 74 93.41 percent of total billed charges 126.23 93 102.25 percent of total billed charges 126.23 126.23 other OPPS APC 126.23 126.23 other OPPS APC 126.23 27.63 34.88 percent of total billed charges 126.23 126.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC GLIDECATH STAINLESS STEEL HYDROPHILIC L100 CM L15 CM OD4 FR ID.041 IN 2 BRAID ANGLE TIP STERILE LATEX FREE ACCEPTS .038 IN GUIDEWIRE SUP-CG416 CDM 0270 RC outpatient 126.23 126.23 126.23 74 93.41 percent of total billed charges 126.23 93 102.25 percent of total billed charges 126.23 126.23 other OPPS APC 126.23 126.23 other OPPS APC 126.23 27.63 34.88 percent of total billed charges 126.23 126.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC GLIDECATH GLIDE TECHNOLOGY STAINLESS STEEL HYDROPHILIC ANGLE L120 CM OD4 FR ID.041 IN 2 BRAID ACCEPTS .038 IN GUIDEWIRE SUP-CG417 CDM 0270 RC outpatient 126.23 126.23 126.23 74 93.41 percent of total billed charges 126.23 93 102.25 percent of total billed charges 126.23 126.23 other OPPS APC 126.23 126.23 other OPPS APC 126.23 27.63 34.88 percent of total billed charges 126.23 126.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC GLIDECATH GLIDE TECHNOLOGY STAINLESS STEEL HYDROPHILIC COBRA 2 CURVE L65 CM L25 CM OD5 FR ID.047 IN 1 BRAID SUP-CG502 CDM 0270 RC outpatient 126.23 126.23 126.23 74 93.41 percent of total billed charges 126.23 93 102.25 percent of total billed charges 126.23 126.23 other OPPS APC 126.23 126.23 other OPPS APC 126.23 27.63 34.88 percent of total billed charges 126.23 126.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC GLIDECATH GLIDE TECHNOLOGY STAINLESS STEEL HYDROPHILIC STRAIGHT CURVE L65 CM OD5 FR ID.047 IN 1 BRAID ACCEPTS .038 IN GUIDEWIRE SUP-CG505 CDM 0270 RC outpatient 126.23 126.23 126.23 74 93.41 percent of total billed charges 126.23 93 102.25 percent of total billed charges 126.23 126.23 other OPPS APC 126.23 126.23 other OPPS APC 126.23 27.63 34.88 percent of total billed charges 126.23 126.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC GLIDECATH GLIDE TECHNOLOGY STAINLESS STEEL HYDROPHILIC ANGLE L65 CM L25 CM OD5 FR ID.047 IN 1 BRAID SUP-CG507 CDM 0270 RC outpatient 126.23 126.23 126.23 74 93.41 percent of total billed charges 126.23 93 102.25 percent of total billed charges 126.23 126.23 other OPPS APC 126.23 126.23 other OPPS APC 126.23 27.63 34.88 percent of total billed charges 126.23 126.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC GLIDECATH GLIDE TECHNOLOGY STAINLESS STEEL HYDROPHILIC ANGLE L100 CM L25 CM OD5 FR ID.047 IN 1 BRAID SUP-CG508 CDM 0270 RC outpatient 126.23 126.23 126.23 74 93.41 percent of total billed charges 126.23 93 102.25 percent of total billed charges 126.23 126.23 other OPPS APC 126.23 126.23 other OPPS APC 126.23 27.63 34.88 percent of total billed charges 126.23 126.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC GLIDECATH RADIFOCUS STAINLESS STEEL HYDROPHILIC SIM1 CURVE L100 CM OD5 FR PERIPHERAL BRAID STERILE LATEX FREE ACCEPTS .038 IN GUIDEWIRE SUP-CG510 CDM 0270 RC outpatient 126.23 126.23 126.23 74 93.41 percent of total billed charges 126.23 93 102.25 percent of total billed charges 126.23 126.23 other OPPS APC 126.23 126.23 other OPPS APC 126.23 27.63 34.88 percent of total billed charges 126.23 126.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC GLIDECATH GLIDE TECHNOLOGY STAINLESS STEEL HYDROPHILIC SIMMONS 2 CURVE L100 CM OD5 FR ID.047 IN 1 BRAID ACCEPTS .038 IN GUIDEWIRE SUP-CG511 CDM 0270 RC outpatient 126.23 126.23 126.23 74 93.41 percent of total billed charges 126.23 93 102.25 percent of total billed charges 126.23 126.23 other OPPS APC 126.23 126.23 other OPPS APC 126.23 27.63 34.88 percent of total billed charges 126.23 126.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC GLIDECATH RADIFOCUS STAINLESS STEEL HYDROPHILIC SIM3 CURVE L100 CM OD5 FR CEREBRAL BRAID STERILE LATEX FREE ACCEPTS .038 IN GUIDEWIRE SUP-CG512 CDM 0270 RC outpatient 126.23 126.23 126.23 74 93.41 percent of total billed charges 126.23 93 102.25 percent of total billed charges 126.23 126.23 other OPPS APC 126.23 126.23 other OPPS APC 126.23 27.63 34.88 percent of total billed charges 126.23 126.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUARD CONTAMINATION CATHETER SUP-CG8580 CDM 0481 RC outpatient 51.35 51.35 51.35 74 38 percent of total billed charges 51.35 93 41.59 percent of total billed charges 51.35 51.35 other OPPS APC 51.35 51.35 other OPPS APC 51.35 51 26.19 percent of total billed charges 51.35 51.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR COUGAR XT HYDRO-TRACK J L190 CM OD.014 IN EXTRA SUPPORT SUP-CGRXT190HJ CDM 0481 RC outpatient 166.4 166.4 166.4 74 123.14 percent of total billed charges 166.4 93 134.78 percent of total billed charges 166.4 166.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR COUGAR XT HYDRO-TRACK STRAIGHT L190 CM OD.014 IN EXTRA SUPPORT SUP-CGRXT190HS CDM 0481 RC outpatient 166.4 166.4 166.4 74 123.14 percent of total billed charges 166.4 93 134.78 percent of total billed charges 166.4 166.4 other OPPS APC 166.4 166.4 other OPPS APC 166.4 51 84.86 percent of total billed charges 166.4 166.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT AXILLARY CANNULA SUP-CGS2008S CDM 0270 RC outpatient 2028 2028 2028 74 1500.72 percent of total billed charges 2028 93 1642.68 percent of total billed charges 2028 2028 other OPPS APC 2028 2028 other OPPS APC 2028 27.63 560.34 percent of total billed charges 2028 2028 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADHESIVE SKIN CLOSURE OCTYL DOME .8 ML STERILE TINT SUP-CHLOT01-08 CDM 0270 RC outpatient 33.49 33.49 33.49 74 24.78 percent of total billed charges 33.49 93 27.13 percent of total billed charges 33.49 33.49 other OPPS APC 33.49 33.49 other OPPS APC 33.49 27.63 9.25 percent of total billed charges 33.49 33.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHARTIS CATHETER SUP-CHR-CA-12.0 CDM 0270 RC outpatient 2652 2652 2652 74 1962.48 percent of total billed charges 2652 93 2148.12 percent of total billed charges 2652 2652 other OPPS APC 2652 2652 other OPPS APC 2652 27.63 732.75 percent of total billed charges 2652 2652 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE VERTIGRAFT CORTICAL OD10 MM FREEZE DRIED DOWEL SUP-CL10 CDM 270010012 LOCAL 0270 RC outpatient 1336.4 1336.4 1336.4 74 988.94 percent of total billed charges 1336.4 93 1082.48 percent of total billed charges 1336.4 1336.4 other OPPS APC 1336.4 1336.4 other OPPS APC 1336.4 27.63 369.25 percent of total billed charges 1336.4 1336.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE VERTIGRAFT CANCELLOUS CORTICAL L15 MM OD12 MM DOWEL ANTERIOR CERVICAL FUSION CYLINDRICAL FREEZE DRIED SUP-CL12 CDM 270010031 LOCAL 0270 RC outpatient 1336.4 1336.4 1336.4 74 988.94 percent of total billed charges 1336.4 93 1082.48 percent of total billed charges 1336.4 1336.4 other OPPS APC 1336.4 1336.4 other OPPS APC 1336.4 27.63 369.25 percent of total billed charges 1336.4 1336.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRTD CLARIA MRI QUAD SYSTEM SUP-CLARIAMRIQDCRTMMQM CDM 0275 RC outpatient 61360 61360 61360 57 34975.2 percent of total billed charges 61360 93 49701.6 percent of total billed charges 61360 61360 other OPPS APC 61360 61360 other OPPS APC 61360 51 31293.6 percent of total billed charges 61360 61360 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM LEAD DELIVERY ACUITY CUTAWAY SUP-CLDS CDM 0275 RC outpatient 1170 1170 1170 57 666.9 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUSP LOCK II SUP-CLII CDM 0270 RC outpatient 65 65 65 74 48.1 percent of total billed charges 65 93 52.65 percent of total billed charges 65 65 other OPPS APC 65 65 other OPPS APC 65 27.63 17.96 percent of total billed charges 65 65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUSP LOK II LOW PROFILE SUP-CLIILP CDM 0270 RC outpatient 75.4 75.4 75.4 74 55.8 percent of total billed charges 75.4 93 61.07 percent of total billed charges 75.4 75.4 other OPPS APC 75.4 75.4 other OPPS APC 75.4 27.63 20.83 percent of total billed charges 75.4 75.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUSP-LOK MINI FLAT SUP-CLIIM CDM 0270 RC outpatient 70.2 70.2 70.2 74 51.95 percent of total billed charges 70.2 93 56.86 percent of total billed charges 70.2 70.2 other OPPS APC 70.2 70.2 other OPPS APC 70.2 27.63 19.4 percent of total billed charges 70.2 70.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUSP LOCK MINI CURVED SUP-CLIIMC CDM 0270 RC outpatient 70.2 70.2 70.2 74 51.95 percent of total billed charges 70.2 93 56.86 percent of total billed charges 70.2 70.2 other OPPS APC 70.2 70.2 other OPPS APC 70.2 27.63 19.4 percent of total billed charges 70.2 70.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUSP LOK 11 MINI LOW PROFILE CURVED SUP-CLIIMCLP CDM 0270 RC outpatient 85.8 85.8 85.8 74 63.49 percent of total billed charges 85.8 93 69.5 percent of total billed charges 85.8 85.8 other OPPS APC 85.8 85.8 other OPPS APC 85.8 27.63 23.71 percent of total billed charges 85.8 85.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUSP LOCK INSTRUMENT 4IN SUP-CLPI1 CDM 0270 RC outpatient 143 143 143 74 105.82 percent of total billed charges 143 93 115.83 percent of total billed charges 143 143 other OPPS APC 143 143 other OPPS APC 143 27.63 39.51 percent of total billed charges 143 143 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADHESIVE SKIN CLOSURE DERMABOND PRINEO 2 OCTYL CYANOACRYLATE L22 CM 3.8 ML TOPICAL MESH APPLICATOR LIQUID DISPENSER STERILE DISPOSABLE SUP-CLR222US-15 CDM 0270 RC outpatient 218.23 218.23 218.23 74 161.49 percent of total billed charges 218.23 93 176.77 percent of total billed charges 218.23 218.23 other OPPS APC 218.23 218.23 other OPPS APC 218.23 27.63 60.3 percent of total billed charges 218.23 218.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADHESIVE SKIN CLOSURE DERMABOND PRINEO 2 OCTYL CYANOACRYLATE L60 CM 3.8 ML TOPICAL MESH APPLICATOR LIQUID DISPENSER STERILE DISPOSABLE SUP-CLR602US CDM 0270 RC outpatient 336.01 336.01 336.01 74 248.65 percent of total billed charges 336.01 93 272.17 percent of total billed charges 336.01 336.01 other OPPS APC 336.01 336.01 other OPPS APC 336.01 27.63 92.84 percent of total billed charges 336.01 336.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DELIVERY SYSTEM L112.5 CM L6.9 CM OD18 FR ACCEPTS .035 IN GUIDEWIRE SUP-CLS-3000-18F-US CDM 0270 RC outpatient 1014 1014 1014 74 750.36 percent of total billed charges 1014 93 821.34 percent of total billed charges 1014 1014 other OPPS APC 1014 1014 other OPPS APC 1014 27.63 280.17 percent of total billed charges 1014 1014 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MATRIX TISSUE ALLODERM SELECT THK.4-1.6 MM MEDIUM CONTOUR L19.3 CM X W9.6 CM ALLOGRAFT REGENERATIVE PERFORATE SUP-CM1518P CDM 0270 RC outpatient 12875.2 12875.2 12875.2 74 9527.65 percent of total billed charges 12875.2 93 10428.9 percent of total billed charges 12875.2 12875.2 other OPPS APC 12875.2 12875.2 other OPPS APC 12875.2 27.63 3557.42 percent of total billed charges 12875.2 12875.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH CARDIOVASCULAR ECM PORCINE SMALL INTESTINE SUBMUCOSA L10 CM X W7 CM PERICARDIUM EXTRACELLULAR MATRIX 4 PLY CLOSURE STERILE SUP-CMCV-003-401 CDM 0270 RC outpatient 2535 2535 2535 74 1875.9 percent of total billed charges 2535 93 2053.35 percent of total billed charges 2535 2535 other OPPS APC 2535 2535 other OPPS APC 2535 27.63 700.42 percent of total billed charges 2535 2535 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH CARDIOVASCULAR ECM PORCINE SMALL INTESTINE SUBMUCOSA L15 CM X W7 CM PERICARDIUM 1 PIECE CLOSURE SUP-CMCV-003-402 CDM 0270 RC outpatient 3887 3887 3887 74 2876.38 percent of total billed charges 3887 93 3148.47 percent of total billed charges 3887 3887 other OPPS APC 3887 3887 other OPPS APC 3887 27.63 1073.98 percent of total billed charges 3887 3887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CORMATRIX ECM 4X7 SUP-CMCV-004-404 CDM 0270 RC outpatient 2446.6 2446.6 2446.6 74 1810.48 percent of total billed charges 2446.6 93 1981.75 percent of total billed charges 2446.6 2446.6 other OPPS APC 2446.6 2446.6 other OPPS APC 2446.6 27.63 676 percent of total billed charges 2446.6 2446.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH CARDIOVASCULAR ECM PORCINE SMALL INTESTINE SUBMUCOSA L15 CM X W7 CM PERICARDIUM 1 PIECE CLOSURE SUP-CMCV-060-402 CDM 0270 RC outpatient 3518.32 3518.32 3518.32 74 2603.56 percent of total billed charges 3518.32 93 2849.84 percent of total billed charges 3518.32 3518.32 other OPPS APC 3518.32 3518.32 other OPPS APC 3518.32 27.63 972.11 percent of total billed charges 3518.32 3518.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CORMATRIX ECM 4X7 SUP-CMCV-067-404 CDM 0270 RC outpatient 2160.08 2160.08 2160.08 74 1598.46 percent of total billed charges 2160.08 93 1749.66 percent of total billed charges 2160.08 2160.08 other OPPS APC 2160.08 2160.08 other OPPS APC 2160.08 27.63 596.83 percent of total billed charges 2160.08 2160.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENVELOPE DEFIBRILLATOR AIGISRX R MINOCYCLINE RIFAMPIN POLYMER MEDIUM L2.5 IN X W2.7 IN ANTIBACTERIAL PACEMAKER FULLY RESORBABLE MULTIFILAMENT KNITTED STERILE DISPOSABLE SUP-CMRM-6122-B CDM 0270 RC outpatient 2509 2509 2509 74 1856.66 percent of total billed charges 2509 93 2032.29 percent of total billed charges 2509 2509 other OPPS APC 2509 2509 other OPPS APC 2509 27.63 693.24 percent of total billed charges 2509 2509 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENVELOPE ABSORBABLE TYRX LG 3.3X2.9IN POLYARYLATE MINOCYCLINE RIFAMPIN STERILE ICD SUP-CMRM6133 CDM 0270 RC outpatient 2327 2327 2327 74 1721.98 percent of total billed charges 2327 93 1884.87 percent of total billed charges 2327 2327 other OPPS APC 2327 2327 other OPPS APC 2327 27.63 642.95 percent of total billed charges 2327 2327 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG DRAINAGE FLO-CHECK L6 FT IMPRINT SCREEN MESH NONSTERILE LATEX FREE DISPOSABLE UROLOGY SUP-CMS-950P CDM 0270 RC outpatient 24.44 24.44 24.44 74 18.09 percent of total billed charges 24.44 93 19.8 percent of total billed charges 24.44 24.44 other OPPS APC 24.44 24.44 other OPPS APC 24.44 27.63 6.75 percent of total billed charges 24.44 24.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG DRAINAGE UROLOGY SEIMENS NONSTERILE W/ REDUCER SUP-CMS-955V-8 CDM 0270 RC outpatient 30.86 30.86 30.86 74 22.84 percent of total billed charges 30.86 93 25 percent of total billed charges 30.86 30.86 other OPPS APC 30.86 30.86 other OPPS APC 30.86 27.63 8.53 percent of total billed charges 30.86 30.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CEREBRAL PROTECTION SENTINEL SUP-CMS15-10C-US CDM 0481 RC outpatient 10400 10400 10400 74 7696 percent of total billed charges 10400 93 8424 percent of total billed charges 10400 10400 other OPPS APC 10400 10400 other OPPS APC 10400 51 5304 percent of total billed charges 10400 10400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR APPROACH STAINLESS STEEL TAPER L300 CM OD.014 IN 25 GM TIP LOAD SUP-CMW-14-300-25G CDM 0270 RC outpatient 417.3 417.3 417.3 74 308.8 percent of total billed charges 417.3 93 338.01 percent of total billed charges 417.3 417.3 other OPPS APC 417.3 417.3 other OPPS APC 417.3 27.63 115.3 percent of total billed charges 417.3 417.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATFORM ACCESS GELPOINT PATH TRANSANAL L5.5 CM X W4 CM OD10 MM GELSEAL CAP 4 SELF RETAIN SLEEVE OBTURATOR INTRODUCER SUP-CNB11 CDM outpatient 2275 2275 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATFORM ACCESS GELPOINT GELSEAL ALEXIS MINI OD10 MM ODSEC12 MM CAP PROTECTOR 4 SLEEVE INTRODUCER SUP-CNGL3 CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION ACU-LOC 2 TITANIUM L12 MM OD2.3 MM CORTICAL LOCK STERILE SUP-CO-S2312 CDM 0270 RC outpatient 254.8 254.8 254.8 74 188.55 percent of total billed charges 254.8 93 206.39 percent of total billed charges 254.8 254.8 other OPPS APC 254.8 254.8 other OPPS APC 254.8 27.63 70.4 percent of total billed charges 254.8 254.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION ACU-LOC TITANIUM L14 MM OD2.3 MM CORTICAL SMOOTH LOCK NONSTERILE BRONZE SUP-CO-S2314 CDM 0270 RC outpatient 254.8 254.8 254.8 74 188.55 percent of total billed charges 254.8 93 206.39 percent of total billed charges 254.8 254.8 other OPPS APC 254.8 254.8 other OPPS APC 254.8 27.63 70.4 percent of total billed charges 254.8 254.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION ACU-LOC TITANIUM L16 MM OD2.3 MM CORTICAL SMOOTH LOCK NONSTERILE BRONZE SUP-CO-S2316 CDM 0270 RC outpatient 254.8 254.8 254.8 74 188.55 percent of total billed charges 254.8 93 206.39 percent of total billed charges 254.8 254.8 other OPPS APC 254.8 254.8 other OPPS APC 254.8 27.63 70.4 percent of total billed charges 254.8 254.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION ACU-LOC TITANIUM L18 MM OD2.3 MM CORTICAL SMOOTH LOCK NONSTERILE BRONZE SUP-CO-S2318 CDM 0270 RC outpatient 254.8 254.8 254.8 74 188.55 percent of total billed charges 254.8 93 206.39 percent of total billed charges 254.8 254.8 other OPPS APC 254.8 254.8 other OPPS APC 254.8 27.63 70.4 percent of total billed charges 254.8 254.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.3MM X 18MM SUP-CO-T02318 CDM 0270 RC outpatient 254.8 254.8 254.8 74 188.55 percent of total billed charges 254.8 93 206.39 percent of total billed charges 254.8 254.8 other OPPS APC 254.8 254.8 other OPPS APC 254.8 27.63 70.4 percent of total billed charges 254.8 254.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L12 MM OD2.3 MM CORTEX LOCK HEXAGONAL NONSTERILE GOLD WRIST PLATE SYSTEM SUP-CO-T2312 CDM 0270 RC outpatient 254.8 254.8 254.8 74 188.55 percent of total billed charges 254.8 93 206.39 percent of total billed charges 254.8 254.8 other OPPS APC 254.8 254.8 other OPPS APC 254.8 27.63 70.4 percent of total billed charges 254.8 254.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L14 MM OD2.3 MM CORTEX LOCK HEXAGONAL NONSTERILE GOLD WRIST PLATE SYSTEM SUP-CO-T2314 CDM 0270 RC outpatient 254.8 254.8 254.8 74 188.55 percent of total billed charges 254.8 93 206.39 percent of total billed charges 254.8 254.8 other OPPS APC 254.8 254.8 other OPPS APC 254.8 27.63 70.4 percent of total billed charges 254.8 254.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW LOCKING 2.3MM X 16MM SUP-CO-T2316 CDM 0270 RC outpatient 254.8 254.8 254.8 74 188.55 percent of total billed charges 254.8 93 206.39 percent of total billed charges 254.8 254.8 other OPPS APC 254.8 254.8 other OPPS APC 254.8 27.63 70.4 percent of total billed charges 254.8 254.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L18 MM OD2.3 MM CORTEX LOCK HEXAGONAL NONSTERILE GOLD WRIST PLATE SYSTEM SUP-CO-T2318 CDM 0270 RC outpatient 254.8 254.8 254.8 74 188.55 percent of total billed charges 254.8 93 206.39 percent of total billed charges 254.8 254.8 other OPPS APC 254.8 254.8 other OPPS APC 254.8 27.63 70.4 percent of total billed charges 254.8 254.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L20 MM OD2.3 MM CORTEX LOCK HEXAGONAL NONSTERILE GOLD WRIST PLATE SYSTEM SUP-CO-T2320 CDM 0270 RC outpatient 254.8 254.8 254.8 74 188.55 percent of total billed charges 254.8 93 206.39 percent of total billed charges 254.8 254.8 other OPPS APC 254.8 254.8 other OPPS APC 254.8 27.63 70.4 percent of total billed charges 254.8 254.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM FULL THREAD L22 MM OD2.3 MM CORTEX LOCK HEXAGONAL NONSTERILE GOLD WRIST PLATE SYSTEM SUP-CO-T2322 CDM 0270 RC outpatient 254.8 254.8 254.8 74 188.55 percent of total billed charges 254.8 93 206.39 percent of total billed charges 254.8 254.8 other OPPS APC 254.8 254.8 other OPPS APC 254.8 27.63 70.4 percent of total billed charges 254.8 254.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERFORATOR CRANIAL STAINLESS STEEL 14 MM 11 MM OD14 MM SHARP HUDSON END STERILE DISPOSABLE SUP-CO261221 CDM 0270 RC outpatient 959.4 959.4 959.4 74 709.96 percent of total billed charges 959.4 93 777.11 percent of total billed charges 959.4 959.4 other OPPS APC 959.4 959.4 other OPPS APC 959.4 27.63 265.08 percent of total billed charges 959.4 959.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP SYRINGE COLEMAN LUER LOCK STERILE SUP-COL-LLCAP CDM 0270 RC outpatient 2.86 2.86 2.86 74 2.12 percent of total billed charges 2.86 93 2.32 percent of total billed charges 2.86 2.86 other OPPS APC 2.86 2.86 other OPPS APC 2.86 27.63 0.79 percent of total billed charges 2.86 2.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER COMPIA DTMC1D1 MRI SYSTEM SUP-COMPIAMRICRTDMMAM CDM 0275 RC outpatient 42120 42120 42120 57 24008.4 percent of total billed charges 42120 93 34117.2 percent of total billed charges 42120 42120 other OPPS APC 42120 42120 other OPPS APC 42120 51 21481.2 percent of total billed charges 42120 42120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRTD COMPIA MRI QUAD SYSTEM SUP-COMPIAMRIQDCRTMMQM CDM outpatient 35000 35000 35000 35000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRATTICE BPS CONTOUR 2 SUP-CON2006 CDM 0270 RC outpatient 5777.2 5777.2 5777.2 74 4275.13 percent of total billed charges 5777.2 93 4679.53 percent of total billed charges 5777.2 5777.2 other OPPS APC 5777.2 5777.2 other OPPS APC 5777.2 27.63 1596.24 percent of total billed charges 5777.2 5777.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT-P C4TR01 CONSULTA SYSTEM WITH ATTAIN LV LEAD SUP-CONSULTACRTPMEAM CDM 0275 RC outpatient 15400 15400 15400 57 8778 percent of total billed charges 15400 93 12474 percent of total billed charges 15400 15400 other OPPS APC 15400 15400 other OPPS APC 15400 51 7854 percent of total billed charges 15400 15400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT-P C4TR01 CONSULTA SYSTEM W/ STARFIX SUP-CONSULTACRTPMEPM CDM 0275 RC outpatient 15400 15400 15400 57 8778 percent of total billed charges 15400 93 12474 percent of total billed charges 15400 15400 other OPPS APC 15400 15400 other OPPS APC 15400 51 7854 percent of total billed charges 15400 15400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR ZTHREAD 8MM X 100MM SUP-COQ19 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR ZTHREAD 15MM X 100MM SUP-COR37 CDM 0270 RC outpatient 127.4 127.4 127.4 74 94.28 percent of total billed charges 127.4 93 103.19 percent of total billed charges 127.4 127.4 other OPPS APC 127.4 127.4 other OPPS APC 127.4 27.63 35.2 percent of total billed charges 127.4 127.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR HASSON 12MM SUP-COR47 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR HASSON 12MMX130 BLUNT TIP SUP-COR50 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER TRI-STAPLE ENDO GIA 2 MM L45 MM MEDIUM THICK TISSUE REINFORCE SUP-COVTRSB45AMT CDM 0270 RC outpatient 1013.53 1013.53 1013.53 74 750.01 percent of total billed charges 1013.53 93 820.96 percent of total billed charges 1013.53 1013.53 other OPPS APC 1013.53 1013.53 other OPPS APC 1013.53 27.63 280.04 percent of total billed charges 1013.53 1013.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARRX CLEANING CAP SMALL SUP-CP-001A CDM 0270 RC outpatient 97.24 97.24 97.24 74 71.96 percent of total billed charges 97.24 93 78.76 percent of total billed charges 97.24 97.24 other OPPS APC 97.24 97.24 other OPPS APC 97.24 27.63 26.87 percent of total billed charges 97.24 97.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARRZ CLEANING CAP MEDIUM SUP-CP-002A CDM 0270 RC outpatient 97.24 97.24 97.24 74 71.96 percent of total billed charges 97.24 93 78.76 percent of total billed charges 97.24 97.24 other OPPS APC 97.24 97.24 other OPPS APC 97.24 27.63 26.87 percent of total billed charges 97.24 97.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC CARBO-SEAL GELWEAVE VALSALVA OD21 MM ID24 MM MECHANICAL ROTATABLE CONDUIT LOW PROFILE HOLDER SUP-CP-021 CDM 0270 RC outpatient 17410.6 17410.6 17410.6 74 12883.9 percent of total billed charges 17410.6 93 14102.6 percent of total billed charges 17410.6 17410.6 other OPPS APC 17410.6 17410.6 other OPPS APC 17410.6 27.63 4810.56 percent of total billed charges 17410.6 17410.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC CARBO-SEAL GELWEAVE VALSALVA OD23 MM ID26 MM MECHANICAL ROTATABLE CONDUIT LOW PROFILE HOLDER SUP-CP-023 CDM 0270 RC outpatient 17410.6 17410.6 17410.6 74 12883.9 percent of total billed charges 17410.6 93 14102.6 percent of total billed charges 17410.6 17410.6 other OPPS APC 17410.6 17410.6 other OPPS APC 17410.6 27.63 4810.56 percent of total billed charges 17410.6 17410.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC CARBO-SEAL GELWEAVE VALSALVA OD25 MM ID28 MM MECHANICAL ROTATABLE CONDUIT LOW PROFILE HOLDER SUP-CP-025 CDM 0270 RC outpatient 16902.6 16902.6 16902.6 74 12507.9 percent of total billed charges 16902.6 93 13691.1 percent of total billed charges 16902.6 16902.6 other OPPS APC 16902.6 16902.6 other OPPS APC 16902.6 27.63 4670.19 percent of total billed charges 16902.6 16902.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC CARBO-SEAL GELWEAVE VALSALVA OD27 MM ID28 MM MECHANICAL ROTATABLE CONDUIT LOW PROFILE HOLDER SUP-CP-027 CDM 0270 RC outpatient 17410.6 17410.6 17410.6 74 12883.9 percent of total billed charges 17410.6 93 14102.6 percent of total billed charges 17410.6 17410.6 other OPPS APC 17410.6 17410.6 other OPPS APC 17410.6 27.63 4810.56 percent of total billed charges 17410.6 17410.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC CARBO-SEAL GELWEAVE VALSALVA OD29 MM ID32 MM MECHANICAL ROTATABLE CONDUIT LOW PROFILE HOLDER SUP-CP-029 CDM 0270 RC outpatient 16902.6 16902.6 16902.6 74 12507.9 percent of total billed charges 16902.6 93 13691.1 percent of total billed charges 16902.6 16902.6 other OPPS APC 16902.6 16902.6 other OPPS APC 16902.6 27.63 4670.19 percent of total billed charges 16902.6 16902.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PATCH VASCULAR CAROTID KNITTED 6 X 75MM SUP-CP0675 CDM 0270 RC outpatient 351 351 351 74 259.74 percent of total billed charges 351 93 284.31 percent of total billed charges 351 351 other OPPS APC 351 351 other OPPS APC 351 27.63 96.98 percent of total billed charges 351 351 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH CARDIOVASCULAR COLLAGEN L75 CM X W8 MM CAROTID SUP-CP0875 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER LEAD CPS STANDARD CORONARY SINUS PLACEMENT KIT SUP-CPS STD PKG 01 CDM 0275 RC outpatient 945.25 945.25 945.25 57 538.79 percent of total billed charges 945.25 93 765.65 percent of total billed charges 945.25 945.25 other OPPS APC 945.25 945.25 other OPPS APC 945.25 51 482.08 percent of total billed charges 945.25 945.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CATHETER CARTO 3 L10 FT RED SUP-CR3425CT CDM 0270 RC outpatient 1349.4 1349.4 1349.4 74 998.56 percent of total billed charges 1349.4 93 1093.01 percent of total billed charges 1349.4 1349.4 other OPPS APC 1349.4 1349.4 other OPPS APC 1349.4 27.63 372.84 percent of total billed charges 1349.4 1349.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CATHETER CARTO 3 L10 FT HYPERTONICS 34 PIN TO LEMO 34 PIN CONNECTOR RED SUP-CR3434CT CDM 0270 RC outpatient 1349.4 1349.4 1349.4 74 998.56 percent of total billed charges 1349.4 93 1093.01 percent of total billed charges 1349.4 1349.4 other OPPS APC 1349.4 1349.4 other OPPS APC 1349.4 27.63 372.84 percent of total billed charges 1349.4 1349.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER CONTOUR 40MMX3.5MM 1.5MM BLUE TITANIUM DISPOSABLE STERILE LF REGULAR TISSUE 4 ROW CARTRIDGE SUP-CR40B CDM 0270 RC outpatient 658.07 658.07 658.07 74 486.97 percent of total billed charges 658.07 93 533.04 percent of total billed charges 658.07 658.07 other OPPS APC 658.07 658.07 other OPPS APC 658.07 27.63 181.82 percent of total billed charges 658.07 658.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP SURGICAL DLP L3 MM CORONARY ARTERY RETRACTION SUP-CRC-3 CDM 0270 RC outpatient 122.33 122.33 122.33 74 90.52 percent of total billed charges 122.33 93 99.09 percent of total billed charges 122.33 122.33 other OPPS APC 122.33 122.33 other OPPS APC 122.33 27.63 33.8 percent of total billed charges 122.33 122.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH REFERENCE CARTO 3 EXTERNAL SUP-CREFP6 CDM 0270 RC outpatient 1261 1261 1261 74 933.14 percent of total billed charges 1261 93 1021.41 percent of total billed charges 1261 1261 other OPPS APC 1261 1261 other OPPS APC 1261 27.63 348.41 percent of total billed charges 1261 1261 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP BOUFFANT MEDWEIGHT SPUNBOND BLUE 24 SUP-CRI1202 CDM 0270 RC outpatient 0.17 0.17 0.17 74 0.13 percent of total billed charges 0.17 93 0.14 percent of total billed charges 0.17 0.17 other OPPS APC 0.17 0.17 other OPPS APC 0.17 27.63 0.05 percent of total billed charges 0.17 0.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRYOICE CRYOABLATION PROBE 10CM MALLEABLE SUP-CRY03 CDM 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM COMPRESSION THERAPY COLD MACHINE SUP-CRYO CDM 270010004 LOCAL 0270 RC outpatient 13754 13754 13754 74 10178 percent of total billed charges 13754 93 11140.7 percent of total billed charges 13754 13754 other OPPS APC 13754 13754 other OPPS APC 13754 27.63 3800.23 percent of total billed charges 13754 13754 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRYOTHERAPY RENAL SUP-CRYO2 CDM 270010004 LOCAL 0270 RC outpatient 13754 13754 13754 74 10178 percent of total billed charges 13754 93 11140.7 percent of total billed charges 13754 13754 other OPPS APC 13754 13754 other OPPS APC 13754 27.63 3800.23 percent of total billed charges 13754 13754 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHONDROCYTES AUTOLOGOUS SUP-CS-1000 CDM 0270 RC outpatient 119118 119118 119118 74 88147.7 percent of total billed charges 119118 93 96486 percent of total billed charges 119118 119118 other OPPS APC 119118 119118 other OPPS APC 119118 27.63 32912.4 percent of total billed charges 119118 119118 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEAL ENDOSCOPIC INSTRUMENT SILICONE LARGE OD6-12 FR NONSTERILE DISPOSABLE BLUE CYSTOSCOPE SUP-CS-B612 CDM 0270 RC outpatient 24.4 24.4 24.4 74 18.06 percent of total billed charges 24.4 93 19.76 percent of total billed charges 24.4 24.4 other OPPS APC 24.4 24.4 other OPPS APC 24.4 27.63 6.74 percent of total billed charges 24.4 24.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR CATHETER 1MM ID 2.1MM OD 12.7MM STRAIGHT SYMMETRICAL 2-WAY 316L STEEL SUP-CS1_72550 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DVR TITANIUM L10 MM OD3.5 MM RADIUS CORTICAL DISTAL NONSTERILE ANATOMIC VOLAR PLATE SYSTEM SUP-CS10000 CDM 0270 RC outpatient 143.91 143.91 143.91 74 106.49 percent of total billed charges 143.91 93 116.57 percent of total billed charges 143.91 143.91 other OPPS APC 143.91 143.91 other OPPS APC 143.91 27.63 39.76 percent of total billed charges 143.91 143.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL TITANIUM 3.5 X 12MM SUP-CS12 CDM 0270 RC outpatient 224.64 224.64 224.64 74 166.23 percent of total billed charges 224.64 93 181.96 percent of total billed charges 224.64 224.64 other OPPS APC 224.64 224.64 other OPPS APC 224.64 27.63 62.07 percent of total billed charges 224.64 224.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DVR TITANIUM L12 MM OD3.5 MM RADIUS CORTICAL DISTAL NONSTERILE ANATOMIC VOLAR PLATE SYSTEM SUP-CS12000 CDM 0270 RC outpatient 143.91 143.91 143.91 74 106.49 percent of total billed charges 143.91 93 116.57 percent of total billed charges 143.91 143.91 other OPPS APC 143.91 143.91 other OPPS APC 143.91 27.63 39.76 percent of total billed charges 143.91 143.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 14MM 3.5MM TITANIUM NS CORTICAL DVR ANATOMIC VOLAR PLATE SYSTEM SUP-CS14000 CDM 0270 RC outpatient 143.91 143.91 143.91 74 106.49 percent of total billed charges 143.91 93 116.57 percent of total billed charges 143.91 143.91 other OPPS APC 143.91 143.91 other OPPS APC 143.91 27.63 39.76 percent of total billed charges 143.91 143.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL TITANIUM 3.5 X 16MM SUP-CS16 CDM 0270 RC outpatient 224.64 224.64 224.64 74 166.23 percent of total billed charges 224.64 93 181.96 percent of total billed charges 224.64 224.64 other OPPS APC 224.64 224.64 other OPPS APC 224.64 27.63 62.07 percent of total billed charges 224.64 224.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE L18 MM OD3.5 MM CORTICAL DISTAL VOLAR RADIAL SUP-CS18 CDM 0270 RC outpatient 224.64 224.64 224.64 74 166.23 percent of total billed charges 224.64 93 181.96 percent of total billed charges 224.64 224.64 other OPPS APC 224.64 224.64 other OPPS APC 224.64 27.63 62.07 percent of total billed charges 224.64 224.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DVR TITANIUM L18 MM OD3.5 MM RADIUS CORTICAL DISTAL ANATOMIC VOLAR PLATE SYSTEM SUP-CS18000 CDM 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE ULRICH 12-17 EXPANDABLE TITAMIUM SUP-CS2250-16-12 CDM 270010020 LOCAL 0270 RC outpatient 15600 15600 15600 74 11544 percent of total billed charges 15600 93 12636 percent of total billed charges 15600 15600 other OPPS APC 15600 15600 other OPPS APC 15600 27.63 4310.28 percent of total billed charges 15600 15600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL CONTOUR CURVE 40MMX3.5MM 1.5MM BLUE TITANIUM DISPOSABLE STERILE LF REGULAR TISSUE 4 ROW LINEAR CUTTER SUP-CS40B CDM 0270 RC outpatient 1169.61 1169.61 1169.61 74 865.51 percent of total billed charges 1169.61 93 947.38 percent of total billed charges 1169.61 1169.61 other OPPS APC 1169.61 1169.61 other OPPS APC 1169.61 27.63 323.16 percent of total billed charges 1169.61 1169.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL CONTOUR CURVE 40MMX4.7MM 2MM GREEN TITANIUM DISPOSABLE STERILE LF THICK TISSUE 4 ROW LINEAR CUTTER SUP-CS40G CDM 0270 RC outpatient 1169.61 1169.61 1169.61 74 865.51 percent of total billed charges 1169.61 93 947.38 percent of total billed charges 1169.61 1169.61 other OPPS APC 1169.61 1169.61 other OPPS APC 1169.61 27.63 323.16 percent of total billed charges 1169.61 1169.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CERVICAL SPINE TRUSS SYSTEM L14 MM OD3.5 MM SPINE VARIABLE ANGLE SELF DRILL STERILE LATEX FREE SUP-CSCR-3514-SD-SP CDM 270010020 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRACE WALKING PACESETTER II 3-6.5IN 4-7.5IN STANDARD SM BLACK FOAM NS LF FOOT ANKLE 2 LAMINATE WRAP ROCKER SOLE CLOSED SUP-CSG53550-A CDM 0270 RC outpatient 66.61 66.61 66.61 74 49.29 percent of total billed charges 66.61 93 53.95 percent of total billed charges 66.61 66.61 other OPPS APC 66.61 66.61 other OPPS APC 66.61 27.63 18.4 percent of total billed charges 66.61 66.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRACE WALKING PACESETTER II FOAM 7-8.5 8-10 MEDIUM STANDARD FOOT ANKLE 2 LAMINATE WRAP ROCKER SOLE CLOSED HEEL NONSTERILE LATEX FREE BLACK SUP-CSG53550-B CDM 0270 RC outpatient 66.61 66.61 66.61 74 49.29 percent of total billed charges 66.61 93 53.95 percent of total billed charges 66.61 66.61 other OPPS APC 66.61 66.61 other OPPS APC 66.61 27.63 18.4 percent of total billed charges 66.61 66.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRACE WALKING PACESETTER II 11-16 13+ STANDARD XL BLACK FOAM NS LF FOOT ANKLE WRAP LAMINATE ROCKER SOLE CLOSED HEEL SUP-CSG53550-C CDM 0270 RC outpatient 66.61 66.61 66.61 74 49.29 percent of total billed charges 66.61 93 53.95 percent of total billed charges 66.61 66.61 other OPPS APC 66.61 66.61 other OPPS APC 66.61 27.63 18.4 percent of total billed charges 66.61 66.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRACE WALKING PACESETTER II FOAM 9-10.5 10.5-12.5 LARGE STANDARD FOOT ANKLE 2 LAMINATE WRAP ROCKER SOLE CLOSED HEEL NONSTERILE LATEX FREE BLACK SUP-CSG53550-D CDM 0270 RC outpatient 66.61 66.61 66.61 74 49.29 percent of total billed charges 66.61 93 53.95 percent of total billed charges 66.61 66.61 other OPPS APC 66.61 66.61 other OPPS APC 66.61 27.63 18.4 percent of total billed charges 66.61 66.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER LEAD WORLEY TEAR-AWAY STANDARD L40 CM BRAID CORE CATHETER SUP-CSGWORBC19M_72371 CDM 0270 RC outpatient 500.5 500.5 500.5 74 370.37 percent of total billed charges 500.5 93 405.41 percent of total billed charges 500.5 500.5 other OPPS APC 500.5 500.5 other OPPS APC 500.5 27.63 138.29 percent of total billed charges 500.5 500.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER LEAD SAFESHEATH CSG WORLEY JUMBO CURVE L50 CM OD9 FR CORONARY SINUS HEMOSTATIC VALVE SPLITTABLE KINK RESISTANT BRAID CORE SUP-CSGWORBC29M_72372 CDM 0270 RC outpatient 500.5 500.5 500.5 74 370.37 percent of total billed charges 500.5 93 405.41 percent of total billed charges 500.5 500.5 other OPPS APC 500.5 500.5 other OPPS APC 500.5 27.63 138.29 percent of total billed charges 500.5 500.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER LEAD WORLEY TEAR-AWAY STANDARD L40 CM BRAID CORE CATHETER SUP-CSGWORLBC19M CDM 0270 RC outpatient 500.5 500.5 500.5 74 370.37 percent of total billed charges 500.5 93 405.41 percent of total billed charges 500.5 500.5 other OPPS APC 500.5 500.5 other OPPS APC 500.5 27.63 138.29 percent of total billed charges 500.5 500.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE ELECTROSURGICAL COAGULATING CATHETER RF SUP-CSK-2000 CDM 0270 RC outpatient 9965.8 9965.8 9965.8 74 7374.69 percent of total billed charges 9965.8 93 8072.3 percent of total billed charges 9965.8 9965.8 other OPPS APC 9965.8 9965.8 other OPPS APC 9965.8 27.63 2753.55 percent of total billed charges 9965.8 9965.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CANNULA WITH GUIDE KIT, 30CM" SUP-CSK-6131 CDM 0270 RC outpatient 9968.4 9968.4 9968.4 74 7376.62 percent of total billed charges 9968.4 93 8074.4 percent of total billed charges 9968.4 9968.4 other OPPS APC 9968.4 9968.4 other OPPS APC 9968.4 27.63 2754.27 percent of total billed charges 9968.4 9968.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL CERVICAL SPINE TRUSS SYSTEM-STAND ALONE STERILE LATEX FREE SUP-CSTS-SA-SM0706-SP CDM 270010020 LOCAL 0270 RC outpatient 6240 6240 6240 74 4617.6 percent of total billed charges 6240 93 5054.4 percent of total billed charges 6240 6240 other OPPS APC 6240 6240 other OPPS APC 6240 27.63 1724.11 percent of total billed charges 6240 6240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 10.0 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 10.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 10.5 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 10.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 11.0 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 11.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 11.5 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 11.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 12.0 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 12.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 12.5 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 12.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 13.0 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 13.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 13.5 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 13.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 14.0 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 14.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 14.5 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 14.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL CT LUCIA 602 3-PIECE 15.0 DIOPTER 6MM 13MM POSTERIOR CHAMBER MONOFOCAL ASPHERIC ACRYLIC PVDF MONOFILAMENT UV ABS MOD-C 5DEG SUP-CT LUCIA 602 15.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 15.5 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 15.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 16.0 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 16.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL CT LUCIA 602 3-PIECE 16.5 DIOPTER 6MM 13MM POSTERIOR CHAMBER MONOFOCAL ASPHERIC ACRYLIC PVDF MONOFILAMENT UV ABS MOD-C 5DEG SUP-CT LUCIA 602 16.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL CT LUCIA 602 3-PIECE 17.0 DIOPTER 6MM 13MM POSTERIOR CHAMBER MONOFOCAL ASPHERIC ACRYLIC PVDF MONOFILAMENT UV ABS MOD-C 5DEG SUP-CT LUCIA 602 17.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL CT LUCIA 602 3-PIECE 17.5 DIOPTER 6MM 13MM POSTERIOR CHAMBER MONOFOCAL ASPHERIC ACRYLIC PVDF MONOFILAMENT UV ABS MOD-C 5DEG SUP-CT LUCIA 602 17.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL CT LUCIA 602 3-PIECE 18.0 DIOPTER 6MM 13MM POSTERIOR CHAMBER MONOFOCAL ASPHERIC ACRYLIC PVDF MONOFILAMENT UV ABS MOD-C 5DEG SUP-CT LUCIA 602 18.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL CT LUCIA 602 3-PIECE 18.5 DIOPTER 6MM 13MM POSTERIOR CHAMBER MONOFOCAL ASPHERIC ACRYLIC PVDF MONOFILAMENT UV ABS MOD-C 5DEG SUP-CT LUCIA 602 18.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL CT LUCIA 602 3-PIECE 19.0 DIOPTER 6MM 13MM POSTERIOR CHAMBER MONOFOCAL ASPHERIC ACRYLIC PVDF MONOFILAMENT UV ABS MOD-C 5DEG SUP-CT LUCIA 602 19.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL CT LUCIA 602 3-PIECE 19.5 DIOPTER 6MM 13MM POSTERIOR CHAMBER MONOFOCAL ASPHERIC ACRYLIC PVDF MONOFILAMENT UV ABS MOD-C 5DEG SUP-CT LUCIA 602 19.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL CT LUCIA 602 3-PIECE 20.0 DIOPTER 6MM 13MM POSTERIOR CHAMBER MONOFOCAL ASPHERIC ACRYLIC PVDF MONOFILAMENT UV ABS MOD-C 5DEG SUP-CT LUCIA 602 20.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL CT LUCIA 602 3-PIECE 20.5 DIOPTER 6MM 13MM POSTERIOR CHAMBER MONOFOCAL ASPHERIC ACRYLIC PVDF MONOFILAMENT UV ABS MOD-C 5DEG SUP-CT LUCIA 602 20.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL CT LUCIA 602 3-PIECE 21.0 DIOPTER 6MM 13MM POSTERIOR CHAMBER MONOFOCAL ASPHERIC ACRYLIC PVDF MONOFILAMENT UV ABS MOD-C 5DEG SUP-CT LUCIA 602 21.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL CT LUCIA 602 3-PIECE 21.5 DIOPTER 6MM 13MM POSTERIOR CHAMBER MONOFOCAL ASPHERIC ACRYLIC PVDF MONOFILAMENT UV ABS MOD-C 5DEG SUP-CT LUCIA 602 21.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL CT LUCIA 602 3-PIECE 22.0 DIOPTER 6MM 13MM POSTERIOR CHAMBER MONOFOCAL ASPHERIC ACRYLIC PVDF MONOFILAMENT UV ABS MOD-C 5DEG SUP-CT LUCIA 602 22.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 22.5 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 22.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL CT LUCIA 602 3-PIECE 23.0 DIOPTER 6MM 13MM POSTERIOR CHAMBER MONOFOCAL ASPHERIC ACRYLIC PVDF MONOFILAMENT UV ABS MOD-C 5DEG SUP-CT LUCIA 602 23.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL CT LUCIA 602 3-PIECE 23.5 DIOPTER 6MM 13MM POSTERIOR CHAMBER MONOFOCAL ASPHERIC ACRYLIC PVDF MONOFILAMENT UV ABS MOD-C 5DEG SUP-CT LUCIA 602 23.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 24.0 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 24.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL CT LUCIA 602 3-PIECE 24.5 DIOPTER 6MM 13MM POSTERIOR CHAMBER MONOFOCAL ASPHERIC ACRYLIC PVDF MONOFILAMENT UV ABS MOD-C 5DEG SUP-CT LUCIA 602 24.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL CT LUCIA 602 3-PIECE 25.0 DIOPTER 6MM 13MM POSTERIOR CHAMBER MONOFOCAL ASPHERIC ACRYLIC PVDF MONOFILAMENT UV ABS MOD-C 5DEG SUP-CT LUCIA 602 25.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL CT LUCIA 602 3-PIECE 25.5 DIOPTER 6MM 13MM POSTERIOR CHAMBER MONOFOCAL ASPHERIC ACRYLIC PVDF MONOFILAMENT UV ABS MOD-C 5DEG SUP-CT LUCIA 602 25.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL CT LUCIA 602 3-PIECE 26.0 DIOPTER 6MM 13MM POSTERIOR CHAMBER MONOFOCAL ASPHERIC ACRYLIC PVDF MONOFILAMENT UV ABS MOD-C 5DEG SUP-CT LUCIA 602 26.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 26.5 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 26.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 27.0 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 27.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 27.5 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 27.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 28.0 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 28.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 28.5 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 28.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL CT LUCIA 602 3-PIECE 29.0 DIOPTER 6MM 13MM POSTERIOR CHAMBER MONOFOCAL ASPHERIC ACRYLIC PVDF MONOFILAMENT UV ABS MOD-C 5DEG SUP-CT LUCIA 602 29.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 29.5 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 29.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 30.0 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 30.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR 31.0D 3-PIECE MONOFOCAL HYDROPHOBIC SUP-CT LUCIA 602 31.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 33.0 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 33.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 34.0 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUCIA 602 34.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR 4.0D 3-PIECE MONOFOCAL HYDROPHOBIC SUP-CT LUCIA 602 4.00 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR 7.5D 3-PIECE MONOFOCAL HYDROPHOBIC SUP-CT LUCIA 602 7.50 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR 8.0 D 3-PIECE MONOFOCAL HYDROPHOBIC SUP-CT LUCIA 602 8.00 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR 8.5 D 3-PIECE MONOFOCAL HYDROPHOBIC SUP-CT LUCIA 602 8.50 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR 9.0D 3-PIECE MONOFOCAL HYDROPHOBIC SUP-CT LUCIA 602 9.00 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR 4.5D 3-PIECE MONOFOCAL HYDROPHOBIC SUP-CT LUCIA 602.US/+4.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 3-PIECE 6.0 DIOPTER 6MM 13MM ACRYLIC POSTERIOR CHAMBER MONOFOCAL ASPHERIC CT LUCIA 602 5DEG SUP-CT LUICA 602 06.0 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHICAGO TIP 12FR SELFCLEANING DISP SUCTION SUP-CT212 CDM 0270 RC outpatient 83.2 83.2 83.2 74 61.57 percent of total billed charges 83.2 93 67.39 percent of total billed charges 83.2 83.2 other OPPS APC 83.2 83.2 other OPPS APC 83.2 27.63 22.99 percent of total billed charges 83.2 83.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR BLADED Z THREAD 11MM X 100MM SUP-CTB33 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR BLADED Z THREAD/SHIELDED SUP-CTBO3 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CORETEMP FLUID WARMING DRAPE 56""X56""" SUP-CTD100 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR 31.5D 3-PIECE MONOFOCAL HYDROPHOBIC SUP-CTLUCIA 602 31.5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR 7.00 DIOPTER 3-PIECE MONOFOCAL HYDROPHOBIC SUP-CTLUCIA602 7.00 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR ZTHREAD 5MM X 150MM SUP-CTR01 CDM outpatient 286 286 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR ZTHREAD 5MM X 100MM SUP-CTR03 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR ZTHREAD 11MM X 100 SUP-CTR33 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR Z THREAD 12MM X 150MM SUP-CTR71 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR OPTICAL ZTHREAD 12MM X 10MM SUP-CTR73 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR SLEEVE ZTHREAD 5MM X 100MM SUP-CTS02 CDM 0270 RC outpatient 143 143 143 74 105.82 percent of total billed charges 143 93 115.83 percent of total billed charges 143 143 other OPPS APC 143 143 other OPPS APC 143 27.63 39.51 percent of total billed charges 143 143 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE ZTHREAD 11MM X 100MM SUP-CTS12 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE ZTHREAD 12MM X 100MM SUP-CTS22 CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JELLY PETROLEUM VASELINE CURAD LF 5GM OINTMENT MOISTURIZER FOIL PACK SUP-CUR005345 CDM 0270 RC outpatient 0.15 0.15 0.15 74 0.11 percent of total billed charges 0.15 93 0.12 percent of total billed charges 0.15 0.15 other OPPS APC 0.15 0.15 other OPPS APC 0.15 27.63 0.04 percent of total billed charges 0.15 0.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE ANGIOGRAFT SAPHENOUS VEIN L21-30 CM OD3 MM CRYOPRESERVED SUP-CV21-30 CDM 0270 RC outpatient 14077.6 14077.6 14077.6 74 10417.4 percent of total billed charges 14077.6 93 11402.8 percent of total billed charges 14077.6 14077.6 other OPPS APC 14077.6 14077.6 other OPPS APC 14077.6 27.63 3889.63 percent of total billed charges 14077.6 14077.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE ANGIOGRAFT SAPHENOUS VEIN L31-45 CM OD3 MM ALLOGRAFT SUP-CV31-45 CDM 0270 RC outpatient 15506.5 15506.5 15506.5 74 11474.8 percent of total billed charges 15506.5 93 12560.2 percent of total billed charges 15506.5 15506.5 other OPPS APC 15506.5 15506.5 other OPPS APC 15506.5 27.63 4284.43 percent of total billed charges 15506.5 15506.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SAPHENOUS VEIN GRAFT 45-60CM SUP-CV45-60 CDM 0270 RC outpatient 16856.1 16856.1 16856.1 74 12473.5 percent of total billed charges 16856.1 93 13653.5 percent of total billed charges 16856.1 16856.1 other OPPS APC 16856.1 16856.1 other OPPS APC 16856.1 27.63 4657.34 percent of total billed charges 16856.1 16856.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE ANGIOGRAFT SAPHENOUS VEIN L61-70 CM OD3 MM CRYOPRESERVED SUP-CV61-70 CDM 0270 RC outpatient 18285 18285 18285 74 13530.9 percent of total billed charges 18285 93 14810.8 percent of total billed charges 18285 18285 other OPPS APC 18285 18285 other OPPS APC 18285 27.63 5052.14 percent of total billed charges 18285 18285 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE ANGIOGRAFT SAPHENOUS VEIN L71-80 CM OD3 MM CRYOPRESERVE SUP-CV71-80 CDM 0270 RC outpatient 19478.5 19478.5 19478.5 74 14414.1 percent of total billed charges 19478.5 93 15777.6 percent of total billed charges 19478.5 19478.5 other OPPS APC 19478.5 19478.5 other OPPS APC 19478.5 27.63 5381.92 percent of total billed charges 19478.5 19478.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND 0 CT-1 18IN GREEN POLYESTER CONTROL RELEASE BRAID 8 STRAND SUP-CX21D CDM 0270 RC outpatient 27.09 27.09 27.09 74 20.05 percent of total billed charges 27.09 93 21.94 percent of total billed charges 27.09 27.09 other OPPS APC 27.09 27.09 other OPPS APC 27.09 27.63 7.48 percent of total billed charges 27.09 27.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND 2-0 CT-2 18IN GREEN POLYESTER CONTROL RELEASE BRAID 8 STRAND SUP-CX26D CDM 0270 RC outpatient 306.96 306.96 306.96 74 227.15 percent of total billed charges 306.96 93 248.64 percent of total billed charges 306.96 306.96 other OPPS APC 306.96 306.96 other OPPS APC 306.96 27.63 84.81 percent of total billed charges 306.96 306.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND 0 CT-2 18IN GREEN POLYESTER CONTROL RELEASE BRAID 8 STRAND SUP-CX27D CDM 0270 RC outpatient 26.69 26.69 26.69 74 19.75 percent of total billed charges 26.69 93 21.62 percent of total billed charges 26.69 26.69 other OPPS APC 26.69 26.69 other OPPS APC 26.69 27.63 7.37 percent of total billed charges 26.69 26.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND 0 CTX 18IN GREEN POLYESTER CONTROL RELEASE BRAID 8 STRAND SUP-CX31D CDM 0270 RC outpatient 320.42 320.42 320.42 74 237.11 percent of total billed charges 320.42 93 259.54 percent of total billed charges 320.42 320.42 other OPPS APC 320.42 320.42 other OPPS APC 320.42 27.63 88.53 percent of total billed charges 320.42 320.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXCLUDER CONFORM EXTENDER AAA SUP-CXA2000005 CDM 0270 RC outpatient 12750.4 12750.4 12750.4 74 9435.3 percent of total billed charges 12750.4 93 10327.8 percent of total billed charges 12750.4 12750.4 other OPPS APC 12750.4 12750.4 other OPPS APC 12750.4 27.63 3522.94 percent of total billed charges 12750.4 12750.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER L12 CM L5.5 CM OD14.5 MM ODSEC23 MM TRUNK IPSILATERAL LEG ACTIVE CONTROL ACCEPTS 15 FR INTRODUCER SHEATH ENDOPROSTHESIS AAA SUP-CXT231412 CDM 0270 RC outpatient 36335 36335 36335 74 26887.9 percent of total billed charges 36335 93 29431.3 percent of total billed charges 36335 36335 other OPPS APC 36335 36335 other OPPS APC 36335 27.63 10039.4 percent of total billed charges 36335 36335 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CATHETER CARTO 3 L10 FT HYPERTONICS 12 PIN TO REDEL 12 PIN CONNECTOR YELLOW SUP-CY1212CT CDM 0270 RC outpatient 1349.4 1349.4 1349.4 74 998.56 percent of total billed charges 1349.4 93 1093.01 percent of total billed charges 1349.4 1349.4 other OPPS APC 1349.4 1349.4 other OPPS APC 1349.4 27.63 372.84 percent of total billed charges 1349.4 1349.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANNUS RETENTION SYSTEM 4 PAD 2 STRAP STERILE SUP-CZ-PRS-04 CDM 0270 RC outpatient 188.5 188.5 188.5 74 139.49 percent of total billed charges 188.5 93 152.69 percent of total billed charges 188.5 188.5 other OPPS APC 188.5 188.5 other OPPS APC 188.5 27.63 52.08 percent of total billed charges 188.5 188.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS EYE SUP-CZ70BD CDM V2631 CPT 0276 RC outpatient 325 325 325 57 185.25 percent of total billed charges 325 93 263.25 percent of total billed charges 325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 325 other OPPS APC 325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 325 other OPPS APC 325 51 165.75 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET ADMINISTRATION LEVEL 1 950 ML/MIN INTRAVENOUS NORMOTHERMIC STERILE LATEX FREE DISPOSABLE FAST FLOW FLUID WARMER SUP-D-100 CDM 270009203 LOCAL 0270 RC outpatient 77.7 77.7 77.7 74 57.5 percent of total billed charges 77.7 93 62.94 percent of total billed charges 77.7 77.7 other OPPS APC 77.7 77.7 other OPPS APC 77.7 27.63 21.47 percent of total billed charges 77.7 77.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP RADIOLOGY X-DRAPE COMFORTFIT ADJUSTABLE FIT 0.125MM LE LIGHTWEIGHT F/X-RAY FLUOROSCOPIC PROCEDURE HEAD NON-STERILE DISPOSABLE 88/CA SUP-D-125N CDM 0270 RC outpatient 9.15 9.15 9.15 74 6.77 percent of total billed charges 9.15 93 7.41 percent of total billed charges 9.15 9.15 other OPPS APC 9.15 9.15 other OPPS APC 9.15 27.63 2.53 percent of total billed charges 9.15 9.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER MAPPING ADVISOR HD GRID SENSOR ENABLED BI-D SUP-D-AVHD-DF16 CDM 0270 RC outpatient 5070 5070 5070 74 3751.8 percent of total billed charges 5070 93 4106.7 percent of total billed charges 5070 5070 other OPPS APC 5070 5070 other OPPS APC 5070 27.63 1400.84 percent of total billed charges 5070 5070 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CATHETER SENSOR ENABLED L1.5 MR 12 PIN SUP-D-AVSE-CBL12 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE ADVISOR HD CATHETER SUP-D-AVSE-CBL22 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BI-DIRECTIONAL CIRCULAR MAPPING 15MM CURVE DF ADVISOR FL SENSOR ENABLED SUP-D-AVSE-DF10-F15 CDM 0481 RC outpatient 3952 3952 3952 74 2924.48 percent of total billed charges 3952 93 3201.12 percent of total billed charges 3952 3952 other OPPS APC 3952 3952 other OPPS APC 3952 51 2015.52 percent of total billed charges 3952 3952 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BI-DIRECTIONAL CIRCULAR MAPPING 20MM CURVE DF ADVISOR FL SENSOR ENABLED SUP-D-AVSE-DF10-F20 CDM 0481 RC outpatient 3952 3952 3952 74 2924.48 percent of total billed charges 3952 93 3201.12 percent of total billed charges 3952 3952 other OPPS APC 3952 3952 other OPPS APC 3952 51 2015.52 percent of total billed charges 3952 3952 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CATHETER SENSOR ENABLED SUP-D-ENS-AVSE-6-CBL CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CATHETER INQUIRY ENSITE 10 PIN SUP-D-ENS-INQ-OD-CBL CDM 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CATHETER SURELINK L 120CM 4 PIN BLUE SUP-D-ENS-INQ-Q-CBL CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CATHETER LIVEWIRE RESPONSE 4 PIN SUP-D-ENS-L/R-BQ-CBL CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVOLUT FX DELIVERY SYSTEM 23-29MM SUP-D-EVOLUTFX-2329 CDM 0270 RC outpatient 5486 5486 5486 74 4059.64 percent of total billed charges 5486 93 4443.66 percent of total billed charges 5486 5486 other OPPS APC 5486 5486 other OPPS APC 5486 27.63 1515.78 percent of total billed charges 5486 5486 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVOLUT FX DELIVERY SYSTEM 34MM SUP-D-EVOLUTFX-34 CDM 0270 RC outpatient 5486 5486 5486 74 4059.64 percent of total billed charges 5486 93 4443.66 percent of total billed charges 5486 5486 other OPPS APC 5486 5486 other OPPS APC 5486 27.63 1515.78 percent of total billed charges 5486 5486 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 23-29 EVOLUTE PRO DELIVERY SYSTEM SUP-D-EVPROP2329US CDM 0270 RC outpatient 6786 6786 6786 74 5021.64 percent of total billed charges 6786 93 5496.66 percent of total billed charges 6786 6786 other OPPS APC 6786 6786 other OPPS APC 6786 27.63 1874.97 percent of total billed charges 6786 6786 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVOLUT PRO+ DELIVERY SYSTEM 34MM SUP-D-EVPROP34US CDM 0270 RC outpatient 6786 6786 6786 74 5021.64 percent of total billed charges 6786 93 5496.66 percent of total billed charges 6786 6786 other OPPS APC 6786 6786 other OPPS APC 6786 27.63 1874.97 percent of total billed charges 6786 6786 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD D020 DYNAGEN MINI VR DF4 DEVICE SUP-D020 CDM 0275 RC outpatient 20100 20100 20100 57 11457 percent of total billed charges 20100 93 16281 percent of total billed charges 20100 20100 other OPPS APC 20100 20100 other OPPS APC 20100 51 10251 percent of total billed charges 20100 20100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD D021 DYNAGEN MINI DR DEVICE SUP-D021 CDM 0275 RC outpatient 20100 20100 20100 57 11457 percent of total billed charges 20100 93 16281 percent of total billed charges 20100 20100 other OPPS APC 20100 20100 other OPPS APC 20100 51 10251 percent of total billed charges 20100 20100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD D022 DYNAGEN MINI DR DF4 DEVICE SUP-D022 CDM 0275 RC outpatient 20793 20793 20793 57 11852 percent of total billed charges 20793 93 16842.3 percent of total billed charges 20793 20793 other OPPS APC 20793 20793 other OPPS APC 20793 51 10604.4 percent of total billed charges 20793 20793 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD D023 DYNAGEN MINI DR DEVICE SUP-D023 CDM 0275 RC outpatient 20793 20793 20793 57 11852 percent of total billed charges 20793 93 16842.3 percent of total billed charges 20793 20793 other OPPS APC 20793 20793 other OPPS APC 20793 51 10604.4 percent of total billed charges 20793 20793 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ICE WITH 4 WAY STEERING SUP-D087031 CDM 0270 RC outpatient 5460 5460 5460 74 4040.4 percent of total billed charges 5460 93 4422.6 percent of total billed charges 5460 5460 other OPPS APC 5460 5460 other OPPS APC 5460 27.63 1508.6 percent of total billed charges 5460 5460 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR LAPAROSCOPIC ENDOPATH XCEL 100MM 11MM DISPOSABLE STERILE STABILITY SLEEVE DILATE SUP-D11LT CDM 0270 RC outpatient 63.72 63.72 63.72 74 47.15 percent of total billed charges 63.72 93 51.61 percent of total billed charges 63.72 63.72 other OPPS APC 63.72 63.72 other OPPS APC 63.72 27.63 17.61 percent of total billed charges 63.72 63.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE ICD MONENTUM EL VR DF1 SUP-D120 CDM 0275 RC outpatient 19252 19252 19252 57 10973.6 percent of total billed charges 19252 93 15594.1 percent of total billed charges 19252 19252 other OPPS APC 19252 19252 other OPPS APC 19252 51 9818.52 percent of total billed charges 19252 19252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD D121 MOMENTUM EL DR DF1 DEVICE ONLY SUP-D121 CDM 0275 RC outpatient 19848 19848 19848 57 11313.4 percent of total billed charges 19848 93 16076.9 percent of total billed charges 19848 19848 other OPPS APC 19848 19848 other OPPS APC 19848 51 10122.5 percent of total billed charges 19848 19848 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY PENTARRAY 2-6-2 MM SPACE F CURVE L115CM OD 7 FR NAVIGATION 20 ELECTRODE SUP-D128208 CDM 0270 RC outpatient 5402.8 5402.8 5402.8 74 3998.07 percent of total billed charges 5402.8 93 4376.27 percent of total billed charges 5402.8 5402.8 other OPPS APC 5402.8 5402.8 other OPPS APC 5402.8 27.63 1492.79 percent of total billed charges 5402.8 5402.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY PENTARRAY 2-6-2 MM D CURVE OD 7 FR NAVIGATION ELECTRODE SUP-D128211 CDM 0270 RC outpatient 5402.8 5402.8 5402.8 74 3998.07 percent of total billed charges 5402.8 93 4376.27 percent of total billed charges 5402.8 5402.8 other OPPS APC 5402.8 5402.8 other OPPS APC 5402.8 27.63 1492.79 percent of total billed charges 5402.8 5402.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR LAPAROSCOPIC ENDOPATH XCEL 100MM 12MM DISPOSABLE STERILE STABILITY SLEEVE DILATE SUP-D12LT CDM 0270 RC outpatient 63.72 63.72 63.72 74 47.15 percent of total billed charges 63.72 93 51.61 percent of total billed charges 63.72 63.72 other OPPS APC 63.72 63.72 other OPPS APC 63.72 27.63 17.61 percent of total billed charges 63.72 63.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY LASSO 2515 NAVISTAR 2-6-2 MM SPACE D CURVE L115 CM OD7 FR 22 ELECTRODE VARIABLE SUP-D134301 CDM 0270 RC outpatient 6123 6123 6123 74 4531.02 percent of total billed charges 6123 93 4959.63 percent of total billed charges 6123 6123 other OPPS APC 6123 6123 other OPPS APC 6123 27.63 1691.78 percent of total billed charges 6123 6123 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CATHETER CARTO 3 L3 MR INTERFACE SUP-D134401 CDM 0270 RC outpatient 1349.4 1349.4 1349.4 74 998.56 percent of total billed charges 1349.4 93 1093.01 percent of total billed charges 1349.4 1349.4 other OPPS APC 1349.4 1349.4 other OPPS APC 1349.4 27.63 372.84 percent of total billed charges 1349.4 1349.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CATHETER CARTO3 L 9 FT 20 ELECTRODES SPLIT HANDLES EXTEND STERILE LATEX FREE DISPOSABLE SUP-D134402 CDM 0270 RC outpatient 3616.6 3616.6 3616.6 74 2676.28 percent of total billed charges 3616.6 93 2929.45 percent of total billed charges 3616.6 3616.6 other OPPS APC 3616.6 3616.6 other OPPS APC 3616.6 27.63 999.27 percent of total billed charges 3616.6 3616.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION SMARTTOUCH THERMOCOOL SF F CURVE UNIDIRECTIONAL THERMOCOUPLE SUP-D134702 CDM 0270 RC outpatient 9308 9308 9308 74 6887.92 percent of total billed charges 9308 93 7539.48 percent of total billed charges 9308 9308 other OPPS APC 9308 9308 other OPPS APC 9308 27.63 2571.8 percent of total billed charges 9308 9308 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION SMARTTOUCH THERMOCOOL SF F-J CURVE OD 8 FR BIDRECTIONAL THERMOCOUPLE SUP-D134804 CDM 0270 RC outpatient 9822.8 9822.8 9822.8 74 7268.87 percent of total billed charges 9822.8 93 7956.47 percent of total billed charges 9822.8 9822.8 other OPPS APC 9822.8 9822.8 other OPPS APC 9822.8 27.63 2714.04 percent of total billed charges 9822.8 9822.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION SMARTTOUCH THERMOCOOL SF D-F CURVE OD 8 FR BIODIRECTIONAL THERMOCOUPLE SUP-D134805 CDM 0270 RC outpatient 9822.8 9822.8 9822.8 74 7268.87 percent of total billed charges 9822.8 93 7956.47 percent of total billed charges 9822.8 9822.8 other OPPS APC 9822.8 9822.8 other OPPS APC 9822.8 27.63 2714.04 percent of total billed charges 9822.8 9822.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY OD6 FR CSF10 PIN AUTO ID DODECAPOLAR SUP-D135304 CDM 0270 RC outpatient 1362.4 1362.4 1362.4 74 1008.18 percent of total billed charges 1362.4 93 1103.54 percent of total billed charges 1362.4 1362.4 other OPPS APC 1362.4 1362.4 other OPPS APC 1362.4 27.63 376.43 percent of total billed charges 1362.4 1362.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER VIZIGO CURVE ID8.5 FR SMC SUP-D138501 CDM 0270 RC outpatient 2701.4 2701.4 2701.4 74 1999.04 percent of total billed charges 2701.4 93 2188.13 percent of total billed charges 2701.4 2701.4 other OPPS APC 2701.4 2701.4 other OPPS APC 2701.4 27.63 746.4 percent of total billed charges 2701.4 2701.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER VIZIGO CURVE ID8.5 FR MDC SUP-D138502 CDM 0270 RC outpatient 2701.4 2701.4 2701.4 74 1999.04 percent of total billed charges 2701.4 93 2188.13 percent of total billed charges 2701.4 2701.4 other OPPS APC 2701.4 2701.4 other OPPS APC 2701.4 27.63 746.4 percent of total billed charges 2701.4 2701.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER VIZIGO CURVE ID8.5 FR LGC SUP-D138503 CDM 0270 RC outpatient 2701.4 2701.4 2701.4 74 1999.04 percent of total billed charges 2701.4 93 2188.13 percent of total billed charges 2701.4 2701.4 other OPPS APC 2701.4 2701.4 other OPPS APC 2701.4 27.63 746.4 percent of total billed charges 2701.4 2701.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAPPING CATHETER WITH TRUEREF TECHNOLOGY D-F SUP-D140901 CDM 0270 RC outpatient 6630 6630 6630 74 4906.2 percent of total billed charges 6630 93 5370.3 percent of total billed charges 6630 6630 other OPPS APC 6630 6630 other OPPS APC 6630 27.63 1831.87 percent of total billed charges 6630 6630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MAPPING CATHETER WITH TRUEREF TECHNOLOGY F-J SUP-D140902 CDM 0270 RC outpatient 6630 6630 6630 74 4906.2 percent of total billed charges 6630 93 5370.3 percent of total billed charges 6630 6630 other OPPS APC 6630 6630 other OPPS APC 6630 27.63 1831.87 percent of total billed charges 6630 6630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER MAPPING OPTRELL DF CURVE 36 ELECTRODE SUP-D142901 CDM 0270 RC outpatient 6630 6630 6630 74 4906.2 percent of total billed charges 6630 93 5370.3 percent of total billed charges 6630 6630 other OPPS APC 6630 6630 other OPPS APC 6630 27.63 1831.87 percent of total billed charges 6630 6630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER MAPPING OPTRELL FJ CURVE 36 ELECTRODE SUP-D142902 CDM 0270 RC outpatient 6630 6630 6630 74 4906.2 percent of total billed charges 6630 93 5370.3 percent of total billed charges 6630 6630 other OPPS APC 6630 6630 other OPPS APC 6630 27.63 1831.87 percent of total billed charges 6630 6630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC DYNAGEN ENDURALIFE EASYVIEW HF PERSPECTIV D.99 CM W5.37 CM X H7.36 CM 29.5 CC 68.9 GM VENTRICULAR 1 CHAMBER EXTEND LONGEVITY DF4 CONNECTOR SUP-D150 CDM 0275 RC outpatient 19800 19800 19800 57 11286 percent of total billed charges 19800 93 16038 percent of total billed charges 19800 19800 other OPPS APC 19800 19800 other OPPS APC 19800 51 10098 percent of total billed charges 19800 19800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC DYNAGEN ENDURALIFE EASYVIEW D.99 CM W5.37 CM X H7.79 CM 31.5 ML RIGHT VENTRICLE 1 CHAMBER IS-1 DF-4 CONNECTOR EXTEND LONGEVITY SUP-D151 CDM 0275 RC outpatient 18252 18252 18252 57 10403.6 percent of total billed charges 18252 93 14784.1 percent of total billed charges 18252 18252 other OPPS APC 18252 18252 other OPPS APC 18252 51 9308.52 percent of total billed charges 18252 18252 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC DYNAGEN ENDURALIFE EASYVIEW HF PERSPECTIV D.99 CM W5.37 CM X H7.68 CM 31 CC 71.4 GM VENTRICULAR 2 CHAMBER EXTEND LONGEVITY IS-1 DF4 CONNECTOR SUP-D152 CDM 0275 RC outpatient 20156 20156 20156 57 11488.9 percent of total billed charges 20156 93 16326.4 percent of total billed charges 20156 20156 other OPPS APC 20156 20156 other OPPS APC 20156 51 10279.6 percent of total billed charges 20156 20156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC DYNAGEN ENDURALIFE EASYVIEW HF PERSPECTIV D.99 CM W5.37 CM X H7.79 CM 31.5 CC 71 GM VENTRICULAR 2 CHAMBER EXTEND LONGEVITY IS-1 DF-1 CONNECTOR SUP-D153 CDM 0275 RC outpatient 18848 18848 18848 57 10743.4 percent of total billed charges 18848 93 15266.9 percent of total billed charges 18848 18848 other OPPS APC 18848 18848 other OPPS APC 18848 51 9612.48 percent of total billed charges 18848 18848 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY OCTARAY 2-2-2-2-2 MM SPACE D CURVE STERILE LATEX FREE DISPOSABLE SUP-D160901 CDM 0270 RC outpatient 6630 6630 6630 74 4906.2 percent of total billed charges 6630 93 5370.3 percent of total billed charges 6630 6630 other OPPS APC 6630 6630 other OPPS APC 6630 27.63 1831.87 percent of total billed charges 6630 6630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY OCTARAY 2-3-2-3-2 MM SPACE D CURVE STERILE LATEX FREE DISPOSABLE SUP-D160902 CDM 0270 RC outpatient 6630 6630 6630 74 4906.2 percent of total billed charges 6630 93 5370.3 percent of total billed charges 6630 6630 other OPPS APC 6630 6630 other OPPS APC 6630 27.63 1831.87 percent of total billed charges 6630 6630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY OCTARAY 3-3-3-3-3 MM SPCAE D CURVE STERILE LATEX FREE DISPOSABLE SUP-D160903 CDM 0270 RC outpatient 6630 6630 6630 74 4906.2 percent of total billed charges 6630 93 5370.3 percent of total billed charges 6630 6630 other OPPS APC 6630 6630 other OPPS APC 6630 27.63 1831.87 percent of total billed charges 6630 6630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY OCTARAY 2-2-2-2-2 MM SPACE F CURVE STERILE LATEX FREE DISPOSABLE SUP-D160904 CDM 0270 RC outpatient 6630 6630 6630 74 4906.2 percent of total billed charges 6630 93 5370.3 percent of total billed charges 6630 6630 other OPPS APC 6630 6630 other OPPS APC 6630 27.63 1831.87 percent of total billed charges 6630 6630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY OCTARAY 2-5-2-5-2 MM SPACE F CURVE STERILE LATEX FREE DISPOSABLE SUP-D160905 CDM 0270 RC outpatient 6630 6630 6630 74 4906.2 percent of total billed charges 6630 93 5370.3 percent of total billed charges 6630 6630 other OPPS APC 6630 6630 other OPPS APC 6630 27.63 1831.87 percent of total billed charges 6630 6630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY OCTARAY 3-3-3-3-3 MM SPCAE F CURVE STERILE LATEX FREE DISPOSABLE SUP-D160906 CDM 0270 RC outpatient 6630 6630 6630 74 4906.2 percent of total billed charges 6630 93 5370.3 percent of total billed charges 6630 6630 other OPPS APC 6630 6630 other OPPS APC 6630 27.63 1831.87 percent of total billed charges 6630 6630 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PULMONARY ARTERY SWAN-GANZ L110 CM OD7 FR ATRIUM VENTRICLE 4 LUMEN THERMODILUTION PACING LATEX SUP-D200F7 CDM 0481 RC outpatient 1281.8 1281.8 1281.8 74 948.53 percent of total billed charges 1281.8 93 1038.26 percent of total billed charges 1281.8 1281.8 other OPPS APC 1281.8 1281.8 other OPPS APC 1281.8 51 653.72 percent of total billed charges 1281.8 1281.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PULMONARY ARTERY SWAN-GANZ AMC THROMBOSHIELD L110 CM OD7 FR ATRIUM VENTRICLE 4 LUMEN THERMODILUTION PACING LATEX SUP-D200HF7 CDM 0270 RC outpatient 615 615 615 74 455.1 percent of total billed charges 615 93 498.15 percent of total billed charges 615 615 other OPPS APC 615 615 other OPPS APC 615 27.63 169.92 percent of total billed charges 615 615 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC SECURA DR THK15 MM W51 MM X H64 MM 37 ML 68 GM ATRIUM VENTRICLE 2 CHAMBER 2 IS-1 2 DF-1 IMPLANTABLE SUP-D224DRG CDM 0275 RC outpatient 36608 36608 36608 57 20866.6 percent of total billed charges 36608 93 29652.5 percent of total billed charges 36608 36608 other OPPS APC 36608 36608 other OPPS APC 36608 51 18670.1 percent of total billed charges 36608 36608 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR MAXIMO II CRTD SUP-D224TRKD CDM 0275 RC outpatient 44631.6 44631.6 44631.6 57 25440 percent of total billed charges 44631.6 93 36151.6 percent of total billed charges 44631.6 44631.6 other OPPS APC 44631.6 44631.6 other OPPS APC 44631.6 51 22762.1 percent of total billed charges 44631.6 44631.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD D224VRC SECURA DEVICE _19261_ SUP-D224VRC CDM 0275 RC outpatient 20712 20712 20712 57 11805.8 percent of total billed charges 20712 93 16776.7 percent of total billed charges 20712 20712 other OPPS APC 20712 20712 other OPPS APC 20712 51 10563.1 percent of total billed charges 20712 20712 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC SECURA VR SUP-D224VRC S CDM 0275 RC outpatient 46225.4 46225.4 46225.4 57 26348.5 percent of total billed charges 46225.4 93 37442.6 percent of total billed charges 46225.4 46225.4 other OPPS APC 46225.4 46225.4 other OPPS APC 46225.4 51 23575 percent of total billed charges 46225.4 46225.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR VIGILANT EL VR DF4 SINGLE CHAMBER SUP-D232 CDM 0275 RC outpatient 20800 20800 20800 57 11856 percent of total billed charges 20800 93 16848 percent of total billed charges 20800 20800 other OPPS APC 20800 20800 other OPPS APC 20800 51 10608 percent of total billed charges 20800 20800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR VIGILANT EL DR DF4 DUAL CHAMBER SUP-D233 CDM 0275 RC outpatient 21156 21156 21156 57 12058.9 percent of total billed charges 21156 93 17136.4 percent of total billed charges 21156 21156 other OPPS APC 21156 21156 other OPPS APC 21156 51 10789.6 percent of total billed charges 21156 21156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL LULU L4.5 IN X W3.5 IN X W2.5 IN RADIUS FEMUR ANGIOGRAPHY SHEET APERATURE STERILE SUP-D2366 CDM 270009119 LOCAL 0270 RC outpatient 52.68 52.68 52.68 74 38.98 percent of total billed charges 52.68 93 42.67 percent of total billed charges 52.68 52.68 other OPPS APC 52.68 52.68 other OPPS APC 52.68 27.63 14.56 percent of total billed charges 52.68 52.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC MAXIMO II DR ICD THK15 MM W51 MM X H68 MM 37 ML 68 GM ATRIUM VENTRICLE 2 CHAMBER 2 IS-1 2 DF-1 IMPLANTABLE SUP-D284DRG CDM 0275 RC outpatient 40370.2 40370.2 40370.2 57 23011 percent of total billed charges 40370.2 93 32699.9 percent of total billed charges 40370.2 40370.2 other OPPS APC 40370.2 40370.2 other OPPS APC 40370.2 51 20588.8 percent of total billed charges 40370.2 40370.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUSHION POSITIONING PRONEVIEW INSITE FOAM ADULT LARGE INSERT LATEX FREE OR SUP-D28503CE CDM 0270 RC outpatient 65 65 65 74 48.1 percent of total billed charges 65 93 52.65 percent of total billed charges 65 65 other OPPS APC 65 65 other OPPS APC 65 27.63 17.96 percent of total billed charges 65 65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC PROTECTA XT CRT-D SUP-D314TRG CDM 0275 RC outpatient 33993 33993 33993 57 19376 percent of total billed charges 33993 93 27534.3 percent of total billed charges 33993 33993 other OPPS APC 33993 33993 other OPPS APC 33993 51 17336.4 percent of total billed charges 33993 33993 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR D314DRG CARDIAC PROTECTA XT VR IMPLANTABLE SUP-D314VRG CDM 275001002 LOCAL 0275 RC outpatient 20712 20712 20712 57 11805.8 percent of total billed charges 20712 93 16776.7 percent of total billed charges 20712 20712 other OPPS APC 20712 20712 other OPPS APC 20712 51 10563.1 percent of total billed charges 20712 20712 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD PROTECTA DR DEVICE SUP-D334DRGD334DRM CDM 0275 RC outpatient 41607.8 41607.8 41607.8 57 23716.5 percent of total billed charges 41607.8 93 33702.3 percent of total billed charges 41607.8 41607.8 other OPPS APC 41607.8 41607.8 other OPPS APC 41607.8 51 21220 percent of total billed charges 41607.8 41607.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC PROTECTA XT CRT-D THK15 MM W51 MM X H69 MM 38 ML 68 GM VENTRICLE 2 CHAMBER 2 IS-1 2 DF-1 IMPLANTABLE SUP-D334TRG CDM 0275 RC outpatient 36966 36966 36966 57 21070.6 percent of total billed charges 36966 93 29942.5 percent of total billed charges 36966 36966 other OPPS APC 36966 36966 other OPPS APC 36966 51 18852.7 percent of total billed charges 36966 36966 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC PROTECTA 35J W51 MM X H64 MM 37 ML 68 GM VENTRICLE IMPLANTABLE CARDIOVERTER BIPHASIC WAVEFORM SUP-D334VRG CDM 0275 RC outpatient 21589 21589 21589 57 12305.7 percent of total billed charges 21589 93 17487.1 percent of total billed charges 21589 21589 other OPPS APC 21589 21589 other OPPS APC 21589 51 11010.4 percent of total billed charges 21589 21589 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REFLEXION SPIRAL BIDIRECTIONAL EP CATHETER SUP-D402865 CDM 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SENSATION 40CC IAB W KIT SUP-D684-00-0470-01U CDM 0270 RC outpatient 2799.32 2799.32 2799.32 74 2071.5 percent of total billed charges 2799.32 93 2267.45 percent of total billed charges 2799.32 2799.32 other OPPS APC 2799.32 2799.32 other OPPS APC 2799.32 27.63 773.45 percent of total billed charges 2799.32 2799.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY REDEL WEBSTER 10MM SPACE REGULAR D CURVE L 92CM L 1MM OD 6FR DEFLECTABLE QUADRAPOLAR AUTO ID SUP-D6DR252CT CDM 0270 RC outpatient 897 897 897 74 663.78 percent of total billed charges 897 93 726.57 percent of total billed charges 897 897 other OPPS APC 897 897 other OPPS APC 897 27.63 247.84 percent of total billed charges 897 897 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 6-0 P-1 18IN VIOLET BRAID COATED D SPECIAL SUP-D8097 CDM 0270 RC outpatient 123.61 123.61 123.61 74 91.47 percent of total billed charges 123.61 93 100.12 percent of total billed charges 123.61 123.61 other OPPS APC 123.61 123.61 other OPPS APC 123.61 27.63 34.15 percent of total billed charges 123.61 123.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND EXCEL 2 30IN GREEN LIGHT GREEN WHITE TIES BRAID D SUP-D8811 CDM 0270 RC outpatient 54.44 54.44 54.44 74 40.29 percent of total billed charges 54.44 93 44.1 percent of total billed charges 54.44 54.44 other OPPS APC 54.44 54.44 other OPPS APC 54.44 27.63 15.04 percent of total billed charges 54.44 54.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING SOFIA STRAIGHT L115 CM OD6 FR DISTAL ACCESS SHAPE MANDREL INTRODUCER SHEATH SOFT TORQUEABLE STERILE LATEX FREE SUP-DA6115ST CDM 0270 RC outpatient 6825 6825 6825 74 5050.5 percent of total billed charges 6825 93 5528.25 percent of total billed charges 6825 6825 other OPPS APC 6825 6825 other OPPS APC 6825 27.63 1885.75 percent of total billed charges 6825 6825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EP JOSEPHSON 5 MM Reproc SUP-DAI401227 CDM 0270 RC outpatient 98.8 98.8 98.8 74 73.11 percent of total billed charges 98.8 93 80.03 percent of total billed charges 98.8 98.8 other OPPS APC 98.8 98.8 other OPPS APC 98.8 27.63 27.3 percent of total billed charges 98.8 98.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY RESPONSE 1MM 2-8-2 MM SPACE CORONARY SINUS LEFT CURVE L65CM OD 6 FR ODSEC 2MM DECAPOLAR TORQUE CONTROL BAND ELECTRODE REPROCESSED SUP-DAI401353 CDM 0270 RC outpatient 98.8 98.8 98.8 74 73.11 percent of total billed charges 98.8 93 80.03 percent of total billed charges 98.8 98.8 other OPPS APC 98.8 98.8 other OPPS APC 98.8 27.63 27.3 percent of total billed charges 98.8 98.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "BAG 24"" DOME LARGE" SUP-DB-0024 CDM 0270 RC outpatient 7.41 7.41 7.41 74 5.48 percent of total billed charges 7.41 93 6 percent of total billed charges 7.41 7.41 other OPPS APC 7.41 7.41 other OPPS APC 7.41 27.63 2.05 percent of total billed charges 7.41 7.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 3.3MM SUP-DB-3.3 CDM 0270 RC outpatient 304.2 304.2 304.2 74 225.11 percent of total billed charges 304.2 93 246.4 percent of total billed charges 304.2 304.2 other OPPS APC 304.2 304.2 other OPPS APC 304.2 27.63 84.05 percent of total billed charges 304.2 304.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND BAG SUP-DB-6550 CDM 0270 RC outpatient 31.85 31.85 31.85 74 23.57 percent of total billed charges 31.85 93 25.8 percent of total billed charges 31.85 31.85 other OPPS APC 31.85 31.85 other OPPS APC 31.85 27.63 8.8 percent of total billed charges 31.85 31.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL DVR STAINLESS STEEL OD2.5 MM STERILE DISPOSABLE ANATOMIC VOLAR PLATING SYSTEM SUP-DB25 CDM 0270 RC outpatient 164.97 164.97 164.97 74 122.08 percent of total billed charges 164.97 93 133.63 percent of total billed charges 164.97 164.97 other OPPS APC 164.97 164.97 other OPPS APC 164.97 27.63 45.58 percent of total billed charges 164.97 164.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL BONE 3.2 X 130MM SUP-DB32 CDM 0270 RC outpatient 226.98 226.98 226.98 74 167.97 percent of total billed charges 226.98 93 183.85 percent of total billed charges 226.98 226.98 other OPPS APC 226.98 226.98 other OPPS APC 226.98 27.63 62.71 percent of total billed charges 226.98 226.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT DUAL BALLOON LOOP WITH DOPPLER SUP-DBD1009P CDM 0270 RC outpatient 845 845 845 74 625.3 percent of total billed charges 845 93 684.45 percent of total billed charges 845 845 other OPPS APC 845 845 other OPPS APC 845 27.63 233.47 percent of total billed charges 845 845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ATHERECTOMY DIAMONDBACK 360 L135CM OD 1.25 MM CORONARY CLASSIC CROWN STERILE LATEX FREE DISPOSABLE SUP-DBEC-125 CDM 0270 RC outpatient 10387 10387 10387 74 7686.38 percent of total billed charges 10387 93 8413.47 percent of total billed charges 10387 10387 other OPPS APC 10387 10387 other OPPS APC 10387 27.63 2869.93 percent of total billed charges 10387 10387 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL UTAHBALL L11 CM OD3 MM BALL SHAFT DISPOSABLE BLACK SUP-DBL-311 CDM 0270 RC outpatient 40.56 40.56 40.56 74 30.01 percent of total billed charges 40.56 93 32.85 percent of total billed charges 40.56 40.56 other OPPS APC 40.56 40.56 other OPPS APC 40.56 27.63 11.21 percent of total billed charges 40.56 40.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL UTAHBALL STAINLESS STEEL BALL L11 CM OD5 MM ODSEC3/32 IN Y SHAFT STERILE DISPOSABLE RED LEEP SUP-DBL-511 CDM 0270 RC outpatient 41.86 41.86 41.86 74 30.98 percent of total billed charges 41.86 93 33.91 percent of total billed charges 41.86 41.86 other OPPS APC 41.86 41.86 other OPPS APC 41.86 27.63 11.57 percent of total billed charges 41.86 41.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION TAKERU L6MM OD SEC 1.5MM RAPID EXCHANGE LOW ENTRY PROFILE SUP-DC-RY1506UA1 CDM 0481 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 51 152.49 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION TAKERU L12MMOD SEC 1.5MM RAPID EXCHANGE LOW ENTRY PROFILE PTCA SUP-DC-RY1512UA1 CDM 0481 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 51 152.49 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION TAKERU L 15MM OD SEC 1.5 MM RAPID EXCHANGE LOW ENTRY PROFILE PTCA SUP-DC-RY1515UA1 CDM 0481 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 51 152.49 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION TAKERU L12 MM OD2 MM RX LOW ENTRY PROFILE PTCA SUP-DC-RY2012UA2 CDM 0481 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 51 152.49 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION TAKERU 1.5 MM 1.2 MM L12 MM ODSEC3 MM RAPID EXCHANGE LOW ENTRY PROFILE SEMICOMPLAINT TIGHT REWRAP PTCA SUP-DC-RY3012UA2 CDM 0481 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 51 152.49 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP INTERNAL DURACLIP SMALL L165 CM X W11 MM L10 MM OD2.8 MM REPOSITIONABLE GASTROSCOPE HEMOSTASIS SUP-DC0165 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP INTERNAL DURACLIP SMALL L235 CM X W11 MM L10 MM OD2.8 MM REPOSITIONABLE COLONOSCOPE HEMOSTASIS SUP-DC0235 CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP HEMOSTATIC DURACLIP L235 CM L16 MM OD2.8 MM REPOSITIONABLE COLONOSCOPE SUP-DC0235W CDM 0270 RC outpatient 338 338 338 74 250.12 percent of total billed charges 338 93 273.78 percent of total billed charges 338 338 other OPPS APC 338 338 other OPPS APC 338 27.63 93.39 percent of total billed charges 338 338 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION ORTHOLOC 1.1MM FOREFOOT TEMPORARY SUP-DC4212 CDM 0270 RC outpatient 319.8 319.8 319.8 74 236.65 percent of total billed charges 319.8 93 259.04 percent of total billed charges 319.8 319.8 other OPPS APC 319.8 319.8 other OPPS APC 319.8 27.63 88.36 percent of total billed charges 319.8 319.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT 2.0MM SUP-DC6106 CDM 0270 RC outpatient 689 689 689 74 509.86 percent of total billed charges 689 93 558.09 percent of total billed charges 689 689 other OPPS APC 689 689 other OPPS APC 689 27.63 190.37 percent of total billed charges 689 689 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP DRINKING STYROFOAM 10 OZ HOT COLD INSULATED DISPOSABLE WHITE SUP-DCC 10J10 CDM 0270 RC outpatient 0.1 0.1 0.1 74 0.07 percent of total billed charges 0.1 93 0.08 percent of total billed charges 0.1 0.1 other OPPS APC 0.1 0.1 other OPPS APC 0.1 27.63 0.03 percent of total billed charges 0.1 0.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP DRINKING 10OZ STYROFOAM HOT COLD INSULATED WHITE DISPOSABLE SUP-DCC10J10 CDM 0270 RC outpatient 0.09 0.09 0.09 74 0.07 percent of total billed charges 0.09 93 0.07 percent of total billed charges 0.09 0.09 other OPPS APC 0.09 0.09 other OPPS APC 0.09 27.63 0.02 percent of total billed charges 0.09 0.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE DERMACELL DERMIS L7 CM X W6 CM X H.2-.75 MM DECELLULARIZED MESHED SUP-DCELL153 CDM 0270 RC outpatient 3341 3341 3341 74 2472.34 percent of total billed charges 3341 93 2706.21 percent of total billed charges 3341 3341 other OPPS APC 3341 3341 other OPPS APC 3341 27.63 923.12 percent of total billed charges 3341 3341 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY EP STAR 2FR 5-5-5MM SPACING 130CM 1.5MM TIP CORONARY SINUS OCTAPOLAR FIXED MAPPING W/1.3MM ELECTRODE 10-PIN CABLE SUP-DCF-2-8-55-130 CDM 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DELIVERY SYSTEM COREVALVE OD18 FR ACCEPTS 7.3 CM SUP-DCS-C4-18F-US CDM 0270 RC outpatient 5486 5486 5486 74 4059.64 percent of total billed charges 5486 93 4443.66 percent of total billed charges 5486 5486 other OPPS APC 5486 5486 other OPPS APC 5486 27.63 1515.78 percent of total billed charges 5486 5486 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD DDB1D4 Evera XT DF$ SUP-DDB1D4 CDM 0275 RC outpatient 23400 23400 23400 57 13338 percent of total billed charges 23400 93 18954 percent of total billed charges 23400 23400 other OPPS APC 23400 23400 other OPPS APC 23400 51 11934 percent of total billed charges 23400 23400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD DDBB1D1 Evera XT MRI Device _39246_ SUP-DDBB1D1 CDM 0275 RC outpatient 15900 15900 15900 57 9063 percent of total billed charges 15900 93 12879 percent of total billed charges 15900 15900 other OPPS APC 15900 15900 other OPPS APC 15900 51 8109 percent of total billed charges 15900 15900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVERA XT DR DUAL CHAMBER ICD SYSTEM SUP-DDBB1D1 S CDM 0275 RC outpatient 21680 21680 21680 57 12357.6 percent of total billed charges 21680 93 17560.8 percent of total billed charges 21680 21680 other OPPS APC 21680 21680 other OPPS APC 21680 51 11056.8 percent of total billed charges 21680 21680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC EVERA XT 1 CHAMBER ICD DF-4 SMARTSHOCK TECHNOLOGY PHYSIOCURVE DESIGN SUP-DDBB1D4 CDM 0275 RC outpatient 15900 15900 15900 57 9063 percent of total billed charges 15900 93 12879 percent of total billed charges 15900 15900 other OPPS APC 15900 15900 other OPPS APC 15900 51 8109 percent of total billed charges 15900 15900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVERA XT DR DUAL CHAMBER ICD SYSTEM SUP-DDBB1D4 S CDM 0275 RC outpatient 21680 21680 21680 57 12357.6 percent of total billed charges 21680 93 17560.8 percent of total billed charges 21680 21680 other OPPS APC 21680 21680 other OPPS APC 21680 51 11056.8 percent of total billed charges 21680 21680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD EVERA MRI XT DR DEVICE SUP-DDMB1D1 CDM 0270 RC outpatient 16691 16691 16691 74 12351.3 percent of total billed charges 16691 93 13519.7 percent of total billed charges 16691 16691 other OPPS APC 16691 16691 other OPPS APC 16691 27.63 4611.72 percent of total billed charges 16691 16691 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD EVERA MRI XT DR DEVICE SUP-DDMB1D4 CDM 0275 RC outpatient 16691 16691 16691 57 9513.87 percent of total billed charges 16691 93 13519.7 percent of total billed charges 16691 16691 other OPPS APC 16691 16691 other OPPS APC 16691 51 8512.41 percent of total billed charges 16691 16691 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD COBALT XT MRI DR DEVICE SUP-DDPA2D1 CDM 0275 RC outpatient 17572 17572 17572 57 10016 percent of total billed charges 17572 93 14233.3 percent of total billed charges 17572 17572 other OPPS APC 17572 17572 other OPPS APC 17572 51 8961.72 percent of total billed charges 17572 17572 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD COBALT XT MRI DR SURESCAN DEVICE SUP-DDPA2D4 CDM 0275 RC outpatient 17572 17572 17572 57 10016 percent of total billed charges 17572 93 14233.3 percent of total billed charges 17572 17572 other OPPS APC 17572 17572 other OPPS APC 17572 51 8961.72 percent of total billed charges 17572 17572 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE ELECTROPHYSIOLOGY EPSTAR SUP-DEX-10 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR DISTAFLO 80CM 7MM STERILE DISTAL PERIPHERAL PERIPHERAL BYPASS SUP-DF8007SC CDM 0270 RC outpatient 5521.07 5521.07 5521.07 74 4085.59 percent of total billed charges 5521.07 93 4472.07 percent of total billed charges 5521.07 5521.07 other OPPS APC 5521.07 5521.07 other OPPS APC 5521.07 27.63 1525.47 percent of total billed charges 5521.07 5521.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR DISTAFLO 80CM 8MM STERILE ARTERIAL BYPASS CUFF HYPERPLASIA HIGH SUP-DF8008SC CDM 0270 RC outpatient 13218.4 13218.4 13218.4 74 9781.62 percent of total billed charges 13218.4 93 10706.9 percent of total billed charges 13218.4 13218.4 other OPPS APC 13218.4 13218.4 other OPPS APC 13218.4 27.63 3652.24 percent of total billed charges 13218.4 13218.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR DISTAFLO 2 BRANCH SM 80CM 6MM FLEX SUP-DFM8006SC CDM 0270 RC outpatient 11125.4 11125.4 11125.4 74 8232.8 percent of total billed charges 11125.4 93 9011.57 percent of total billed charges 11125.4 11125.4 other OPPS APC 11125.4 11125.4 other OPPS APC 11125.4 27.63 3073.95 percent of total billed charges 11125.4 11125.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT DISTOFLO 7X80 SUP-DFM8007SC CDM 0270 RC outpatient 5007.78 5007.78 5007.78 74 3705.76 percent of total billed charges 5007.78 93 4056.3 percent of total billed charges 5007.78 5007.78 other OPPS APC 5007.78 5007.78 other OPPS APC 5007.78 27.63 1383.65 percent of total billed charges 5007.78 5007.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR DISTAFLO SM BEAD MINI CUFF 80MM 6MM PTFE PERIPHERAL FLEX SUP-DFX8006SC CDM 0270 RC outpatient 7159.07 7159.07 7159.07 74 5297.71 percent of total billed charges 7159.07 93 5798.85 percent of total billed charges 7159.07 7159.07 other OPPS APC 7159.07 7159.07 other OPPS APC 7159.07 27.63 1978.05 percent of total billed charges 7159.07 7159.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH DURAL DURA-GUARD BOVINE PERICARDIAL L4 CM X W4 CM RESORBABLE STERILE DURAPLASTY SUP-DG0404SN CDM 0270 RC outpatient 956.9 956.9 956.9 74 708.11 percent of total billed charges 956.9 93 775.09 percent of total billed charges 956.9 956.9 other OPPS APC 956.9 956.9 other OPPS APC 956.9 27.63 264.39 percent of total billed charges 956.9 956.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH DURAL DURA-GUARD BOVINE PERICARDIAL L8 CM X W6 CM STERILE SUP-DG0608SN CDM 0270 RC outpatient 1469.49 1469.49 1469.49 74 1087.42 percent of total billed charges 1469.49 93 1190.29 percent of total billed charges 1469.49 1469.49 other OPPS APC 1469.49 1469.49 other OPPS APC 1469.49 27.63 406.02 percent of total billed charges 1469.49 1469.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE DRILL STANDARD 2.0MM SUP-DG20 CDM 0270 RC outpatient 187.2 187.2 187.2 74 138.53 percent of total billed charges 187.2 93 151.63 percent of total billed charges 187.2 187.2 other OPPS APC 187.2 187.2 other OPPS APC 187.2 27.63 51.72 percent of total billed charges 187.2 187.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRIEVER ENDOSCOPIC RESCUENET PROMESH OMNILOOP L5.5 CM X W3CM L230CM OD2.5MM RETRIEVAL NET FOREIGN BODY REMOVAL GREATER VISIBILITY ULTRA STRONG BLUE SUP-DGN-538-5 CDM 0270 RC outpatient 238.71 238.71 238.71 74 176.65 percent of total billed charges 238.71 93 193.36 percent of total billed charges 238.71 238.71 other OPPS APC 238.71 238.71 other OPPS APC 238.71 27.63 65.96 percent of total billed charges 238.71 238.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL HARMONIC SCALPEL ULTRACISION TITANIUM HOOK L14 CM OD5 MM DISSECT STERILE LATEX FREE DISPOSABLE SUP-DH145 CDM 0270 RC outpatient 409.34 409.34 409.34 74 302.91 percent of total billed charges 409.34 93 331.57 percent of total billed charges 409.34 409.34 other OPPS APC 409.34 409.34 other OPPS APC 409.34 27.63 113.1 percent of total billed charges 409.34 409.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE INJECTION INJETAK ANGLE L 35 CM OD 4.8 FR 3 BEVEL INDICATOR TIP CANNULA BLACK CYSTOSCOPY SUP-DIS199 CDM 0270 RC outpatient 180.7 180.7 180.7 74 133.72 percent of total billed charges 180.7 93 146.37 percent of total billed charges 180.7 180.7 other OPPS APC 180.7 180.7 other OPPS APC 180.7 27.63 49.93 percent of total billed charges 180.7 180.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY JAMSHIDI 4IN 11GA DISPOSABLE STERILE LF BONE MARROW TAPER DISTAL ADAPTER SHARP BEVEL TIP SUP-DJ4011X CDM 0270 RC outpatient 39.03 39.03 39.03 74 28.88 percent of total billed charges 39.03 93 31.61 percent of total billed charges 39.03 39.03 other OPPS APC 39.03 39.03 other OPPS APC 39.03 27.63 10.78 percent of total billed charges 39.03 39.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY JAMSHIDI L6 IN OD11 GA BONE MARROW ILIAC STERNUM ASPIRATION ADJUSTABLE DEPTH GUARD TWISTOFF CAP STERILE LATEX FREE DISPOSABLE SUP-DJ6011X CDM outpatient 41.55 41.55 41.55 41.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC MITROFLOW OD19 MM PRT DURABILITY SYNCHRONOUS LEAFLET ACTION MAXIMIZED FLOW AREA STREAMLINED SEWING RING SUP-DLA 19 CDM 0270 RC outpatient 13644.8 13644.8 13644.8 74 10097.2 percent of total billed charges 13644.8 93 11052.3 percent of total billed charges 13644.8 13644.8 other OPPS APC 13644.8 13644.8 other OPPS APC 13644.8 27.63 3770.06 percent of total billed charges 13644.8 13644.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC MITROFLOW OD21 MM PRT DURABILITY SYNCHRONOUS LEAFLET ACTION MAXIMIZED FLOW AREA STREAMLINED SEWING RING SUP-DLA21 CDM 0270 RC outpatient 13644.8 13644.8 13644.8 74 10097.2 percent of total billed charges 13644.8 93 11052.3 percent of total billed charges 13644.8 13644.8 other OPPS APC 13644.8 13644.8 other OPPS APC 13644.8 27.63 3770.06 percent of total billed charges 13644.8 13644.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC MITROFLOW OD23 MM PRT DURABILITY SYNCHRONOUS LEAFLET ACTION MAXIMIZED FLOW AREA STREAMLINED SEWING RING SUP-DLA23 CDM 0270 RC outpatient 13644.8 13644.8 13644.8 74 10097.2 percent of total billed charges 13644.8 93 11052.3 percent of total billed charges 13644.8 13644.8 other OPPS APC 13644.8 13644.8 other OPPS APC 13644.8 27.63 3770.06 percent of total billed charges 13644.8 13644.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC MITROFLOW OD25 MM PRT DURABILITY SYNCHRONOUS LEAFLET ACTION MAXIMIZED FLOW AREA STREAMLINED SEWING RING SUP-DLA25 CDM 0270 RC outpatient 13644.8 13644.8 13644.8 74 10097.2 percent of total billed charges 13644.8 93 11052.3 percent of total billed charges 13644.8 13644.8 other OPPS APC 13644.8 13644.8 other OPPS APC 13644.8 27.63 3770.06 percent of total billed charges 13644.8 13644.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC MITROFLOW H16 MM W13 MM OD27.3 MM ID22.9 MM PERICARDIUM PHOSPHOLIPID REDUCTION TREATMENT OPTIMIZED HEMODYNAMIC PERFORMANCE UNIFORM MECHANICAL BEHAVIOUR UNIQUE DESIGN SUP-DLA27 CDM 0270 RC outpatient 14053 14053 14053 74 10399.2 percent of total billed charges 14053 93 11382.9 percent of total billed charges 14053 14053 other OPPS APC 14053 14053 other OPPS APC 14053 27.63 3882.84 percent of total billed charges 14053 14053 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL UTAHLOOP SAFE-T-GAUGE LETZ TUNGSTEN L15 MM X W20 MM L11 CM OD3/32 IN WIRE ROUND LOOP Y SHAFT DISPOSABLE BLUE SUP-DLP-L11 CDM 0270 RC outpatient 41.86 41.86 41.86 74 30.98 percent of total billed charges 41.86 93 33.91 percent of total billed charges 41.86 41.86 other OPPS APC 41.86 41.86 other OPPS APC 41.86 27.63 11.57 percent of total billed charges 41.86 41.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL LETZ UTAHLOOP SAFE-T-GAUGE STAINLESS STEEL TUNGSTEN ROUND LOOP L12 MM X W15 MM L11 CM OD3/32 IN Y SHAFT WIRE DISPOSABLE GREEN SUP-DLP-M11 CDM 0270 RC outpatient 40.56 40.56 40.56 74 30.01 percent of total billed charges 40.56 93 32.85 percent of total billed charges 40.56 40.56 other OPPS APC 40.56 40.56 other OPPS APC 40.56 27.63 11.21 percent of total billed charges 40.56 40.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL LETZ UTAHLOOP SAFE-T-GAUGE STAINLESS STEEL TUNGSTEN ROUND LOOP L10 MM X W10 MM L11 CM OD3/32 IN Y SHAFT WIRE DISPOSABLE YELLOW SUP-DLP-S11 CDM 0270 RC outpatient 41.86 41.86 41.86 74 30.98 percent of total billed charges 41.86 93 33.91 percent of total billed charges 41.86 41.86 other OPPS APC 41.86 41.86 other OPPS APC 41.86 27.63 11.57 percent of total billed charges 41.86 41.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL UTAHLOOP LETZ SAFE-T-GAUGE STAINLESS STEEL TUNGSTEN PLASTIC ROUND LOOP L12 MM X W20 MM L11 CM OD3/32 IN SHAFT WIRE STERILE DISPOSABLE WHITE SUP-DLP-W11 CDM 0270 RC outpatient 40.56 40.56 40.56 74 30.01 percent of total billed charges 40.56 93 32.85 percent of total billed charges 40.56 40.56 other OPPS APC 40.56 40.56 other OPPS APC 40.56 27.63 11.21 percent of total billed charges 40.56 40.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET DRAINAGE L25 CM L26.5 CM OD5 FR RING CATHETER TROCAR NEEDLE STERILE DISPOSABLE SUP-DLPN-40-25-RING CDM 0270 RC outpatient 158.57 158.57 158.57 74 117.34 percent of total billed charges 158.57 93 128.44 percent of total billed charges 158.57 158.57 other OPPS APC 158.57 158.57 other OPPS APC 158.57 27.63 43.81 percent of total billed charges 158.57 158.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BONE CEMENT L7.5 CM OD12 GA DELIVERY STERILE SUP-DLS-7122-01S CDM 0270 RC outpatient 155.87 155.87 155.87 74 115.34 percent of total billed charges 155.87 93 126.25 percent of total billed charges 155.87 155.87 other OPPS APC 155.87 155.87 other OPPS APC 155.87 27.63 43.07 percent of total billed charges 155.87 155.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RECORDER CARDIAC CONFIRM SENSABILITY 39 MM SPACING L56.3 MM X W18.5 MM X H8 MM 6.5 ML 12 GM ACTIVATED MONITORING IMPLANTABLE SUP-DM2100 CDM 0270 RC outpatient 10342.8 10342.8 10342.8 74 7653.67 percent of total billed charges 10342.8 93 8377.67 percent of total billed charges 10342.8 10342.8 other OPPS APC 10342.8 10342.8 other OPPS APC 10342.8 27.63 2857.72 percent of total billed charges 10342.8 10342.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOOP DM 3500 CONFIRM RX SUP-DM3500 CDM 0275 RC outpatient 10374 10374 10374 57 5913.18 percent of total billed charges 10374 93 8402.94 percent of total billed charges 10374 10374 other OPPS APC 10374 10374 other OPPS APC 10374 51 5290.74 percent of total billed charges 10374 10374 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CARDIAC ASSERT-IQ THK 3.1MM 3+ L9.4 MM X H 46.5MM ICM SUP-DM5300 CDM 0270 RC outpatient 12428 12428 12428 74 9196.72 percent of total billed charges 12428 93 10066.7 percent of total billed charges 12428 12428 other OPPS APC 12428 12428 other OPPS APC 12428 27.63 3433.86 percent of total billed charges 12428 12428 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CARDIAC ASSERT-IQ THK 4.4MM EL + L 9.4MM X H 49MM ICM SUP-DM5500 CDM 0270 RC outpatient 12948 12948 12948 74 9581.52 percent of total billed charges 12948 93 10487.9 percent of total billed charges 12948 12948 other OPPS APC 12948 12948 other OPPS APC 12948 27.63 3577.53 percent of total billed charges 12948 12948 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH DURAL DURAMATRIX-ONLAY PLUS COLLAGEN L3 IN X W1 IN REGENERATION MEMBRANE STERILE SUP-DMOP13 CDM 0270 RC outpatient 1137.47 1137.47 1137.47 74 841.73 percent of total billed charges 1137.47 93 921.35 percent of total billed charges 1137.47 1137.47 other OPPS APC 1137.47 1137.47 other OPPS APC 1137.47 27.63 314.28 percent of total billed charges 1137.47 1137.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH DURAL DURAMATRIX-ONLAY PLUS COLLAGEN L5 IN X W4 IN REGENERATION MEMBRANE STERILE SUP-DMOP45 CDM 0270 RC outpatient 3204.71 3204.71 3204.71 74 2371.49 percent of total billed charges 3204.71 93 2595.82 percent of total billed charges 3204.71 3204.71 other OPPS APC 3204.71 3204.71 other OPPS APC 3204.71 27.63 885.46 percent of total billed charges 3204.71 3204.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE DURAMATRIX L3 IN X W1 IN SUTURABLE SUP-DMS13 CDM 0270 RC outpatient 1170.52 1170.52 1170.52 74 866.18 percent of total billed charges 1170.52 93 948.12 percent of total billed charges 1170.52 1170.52 other OPPS APC 1170.52 1170.52 other OPPS APC 1170.52 27.63 323.41 percent of total billed charges 1170.52 1170.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE DURAMATRIX L5 IN X W4 IN SUTURABLE SUP-DMS45 CDM 0270 RC outpatient 3199.27 3199.27 3199.27 74 2367.46 percent of total billed charges 3199.27 93 2591.41 percent of total billed charges 3199.27 3199.27 other OPPS APC 3199.27 3199.27 other OPPS APC 3199.27 27.63 883.96 percent of total billed charges 3199.27 3199.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADHESIVE SKIN CLOSURE DERMABOND ADVANCED .7ML 2 OCTYL CYANOACRYLATE MICROBIAL BARRIER APPLICATOR FLEXIBLE LIQUID SUP-DNX12 CDM 0270 RC outpatient 49.41 49.41 49.41 74 36.56 percent of total billed charges 49.41 93 40.02 percent of total billed charges 49.41 49.41 other OPPS APC 49.41 49.41 other OPPS APC 49.41 27.63 13.65 percent of total billed charges 49.41 49.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRIP RETINAL SILICONE 4 MM STYLE 42 STERILE SUP-DORC 92-10 CDM 0270 RC outpatient 47.32 47.32 47.32 74 35.02 percent of total billed charges 47.32 93 38.33 percent of total billed charges 47.32 47.32 other OPPS APC 47.32 47.32 other OPPS APC 47.32 27.63 13.07 percent of total billed charges 47.32 47.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE SCLERAL SILICONE ROUND STYLE 72 BUCKLING SUP-DORC 92-30 CDM 0270 RC outpatient 24.96 24.96 24.96 74 18.47 percent of total billed charges 24.96 93 20.22 percent of total billed charges 24.96 24.96 other OPPS APC 24.96 24.96 other OPPS APC 24.96 27.63 6.9 percent of total billed charges 24.96 24.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN DISTRACTION TITANIUM UNIVERSAL 3 FLUTE L12 MM SAFER SHARPER STRONGER STERILE DISPOSABLE BLUE ANTERIOR CERVICAL FUSION SUP-DP-12-TB CDM 0270 RC outpatient 58.5 58.5 58.5 74 43.29 percent of total billed charges 58.5 93 47.39 percent of total billed charges 58.5 58.5 other OPPS APC 58.5 58.5 other OPPS APC 58.5 27.63 16.16 percent of total billed charges 58.5 58.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN DISTRACTION TITANIUM L14 MM SHARP STERILE DISPOSABLE YELLOW ANTERIOR CERVICAL FUSION SUP-DP-14-TY CDM 0270 RC outpatient 58.5 58.5 58.5 74 43.29 percent of total billed charges 58.5 93 47.39 percent of total billed charges 58.5 58.5 other OPPS APC 58.5 58.5 other OPPS APC 58.5 27.63 16.16 percent of total billed charges 58.5 58.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN DISTRACTION TITANIUM L16 MM DISPOSABLE GREEN SUP-DP-16-TG CDM 0270 RC outpatient 58.5 58.5 58.5 74 43.29 percent of total billed charges 58.5 93 47.39 percent of total billed charges 58.5 58.5 other OPPS APC 58.5 58.5 other OPPS APC 58.5 27.63 16.16 percent of total billed charges 58.5 58.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PUNCH AORTIC TELEFLEX STANDARD LENGTH L7 3/4 IN OD4 MM VASCULAR 2 CUT ACTION DIAMOND EDGE STERILE LATEX FREE DISPOSABLE SUP-DP-40K CDM 0270 RC outpatient 43.33 43.33 43.33 74 32.06 percent of total billed charges 43.33 93 35.1 percent of total billed charges 43.33 43.33 other OPPS APC 43.33 43.33 other OPPS APC 43.33 27.63 11.97 percent of total billed charges 43.33 43.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADHESIVE SKIN CLOSURE DERMABOND PROPEN 2 OCTYL CYANOACRYLATE XL .75 ML HIGH VISCOSITY LIQUID STRONG FLEXIBLE STERILE LATEX FREE DISPOSABLE SUP-DPPXL6 CDM 0270 RC outpatient 190.37 190.37 190.37 74 140.87 percent of total billed charges 190.37 93 154.2 percent of total billed charges 190.37 190.37 other OPPS APC 190.37 190.37 other OPPS APC 190.37 27.63 52.6 percent of total billed charges 190.37 190.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY DRIVER COBALT L18 MM ID3 MM RAPID EXCHANGE BALLOON EXPANDABLE SUP-DRV30018UX CDM 0270 RC outpatient 1365 1365 1365 74 1010.1 percent of total billed charges 1365 93 1105.65 percent of total billed charges 1365 1365 other OPPS APC 1365 1365 other OPPS APC 1365 27.63 377.15 percent of total billed charges 1365 1365 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW DISTRACTION QUICK START L14 MM STERILE SPRING SUP-DS-0024 CDM 0270 RC outpatient 631.8 631.8 631.8 74 467.53 percent of total billed charges 631.8 93 511.76 percent of total billed charges 631.8 631.8 other OPPS APC 631.8 631.8 other OPPS APC 631.8 27.63 174.57 percent of total billed charges 631.8 631.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PINS DISTRACTION 16MM SUP-DS-0026 CDM 0270 RC outpatient 631.8 631.8 631.8 74 467.53 percent of total billed charges 631.8 93 511.76 percent of total billed charges 631.8 631.8 other OPPS APC 631.8 631.8 other OPPS APC 631.8 27.63 174.57 percent of total billed charges 631.8 631.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER SKIN 3M PRECISE 15 COUNT ARCUATE STYLE MULTISHOT STERILE LATEX FREE DISPOSABLE SUP-DS-15 CDM outpatient 14.12 14.12 14.12 14.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT STYLET J L46 CM OD.014 IN ATRIAL SUP-DS06001/46 CDM 0275 RC outpatient 185.25 185.25 185.25 57 105.59 percent of total billed charges 185.25 93 150.05 percent of total billed charges 185.25 185.25 other OPPS APC 185.25 185.25 other OPPS APC 185.25 51 94.48 percent of total billed charges 185.25 185.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHI-PACK STAINLESS STEEL 4 L18 IN MONOFILAMENT 12 STRAND PRECUT TIES NONSTERILE SILVER SUP-DS22 CDM 0270 RC outpatient 17.34 17.34 17.34 74 12.83 percent of total billed charges 17.34 93 14.05 percent of total billed charges 17.34 17.34 other OPPS APC 17.34 17.34 other OPPS APC 17.34 27.63 4.79 percent of total billed charges 17.34 17.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE 2 18IN SILVER SS NS MONOFILAMENT TIE 12 STRAND SUP-DS24 CDM 0270 RC outpatient 16.51 16.51 16.51 74 12.22 percent of total billed charges 16.51 93 13.37 percent of total billed charges 16.51 16.51 other OPPS APC 16.51 16.51 other OPPS APC 16.51 27.63 4.56 percent of total billed charges 16.51 16.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING CPS AIM CARDIAC VALVE BYPASS TOOL SUP-DS2A002 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLITTER CATHETER CPS UNIVERSAL ERGONOMIC DESIGN ACCEPTS 4-6 FR LEAD SUP-DS2A003 CDM 0270 RC outpatient 123.5 123.5 123.5 74 91.39 percent of total billed charges 123.5 93 100.04 percent of total billed charges 123.5 123.5 other OPPS APC 123.5 123.5 other OPPS APC 123.5 27.63 34.12 percent of total billed charges 123.5 123.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DIRECT SL II -300004_ SUP-DS2C00-SERIES CDM 0275 RC outpatient 910 910 910 57 518.7 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 51 464.1 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING CPS DIRECT 115 D OD10.06 FR STERILE LATEX FREE DISPOSABLE SUP-DS2C019 CDM 0275 RC outpatient 1430 1430 1430 57 815.1 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 51 729.3 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH CPS DIRECT 135 D UNIVERSAL OD10.06 FR STERILE LATEX FREE DISPOSABLE SUP-DS2C020 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER CARDIAC CPS LOCATOR SMALL PERCUTANEOUS 3D STERILE SUP-DS2C100 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER CARDIAC CPS LOCATOR MEDIUM PERCUTANEOUS 3D STERILE SUP-DS2C200-42 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER CARDIAC CPS LOCATOR LARGE PERCUTANEOUS 3D STERILE SUP-DS2C300-42 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR CPS COURIER MEDIUM L195 CM STERILE LATEX FREE DISPOSABLE SUP-DS2G002 CDM 0270 RC outpatient 210.6 210.6 210.6 74 155.84 percent of total billed charges 210.6 93 170.59 percent of total billed charges 210.6 210.6 other OPPS APC 210.6 210.6 other OPPS APC 210.6 27.63 58.19 percent of total billed charges 210.6 210.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR CPS COURIER STAINLESS STEEL OD.014 IN FIRM TIP SUP-DS2G003 CDM 0270 RC outpatient 210.6 210.6 210.6 74 155.84 percent of total billed charges 210.6 93 170.59 percent of total billed charges 210.6 210.6 other OPPS APC 210.6 210.6 other OPPS APC 210.6 27.63 58.19 percent of total billed charges 210.6 210.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIM SL SUP-DS2N021-SERIES CDM 0275 RC outpatient 533 533 533 57 303.81 percent of total billed charges 533 93 431.73 percent of total billed charges 533 533 other OPPS APC 533 533 other OPPS APC 533 51 271.83 percent of total billed charges 533 533 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING CPS AIM SL DIRECT-TO-TARGET PEBAX 90 D L59 CM OD7.62 FR CORONARY SINUS SLITTABLE INTEGRATE VALVE INNER KINK RESISTANCE SUP-DS2N027-59 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL PACEMAKER AGILIGS HISPRO SLITTER SUP-DS3A001 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER GORE DRYSEAL L33 CM OD12 FR ODSEC4.7 MM ID4 MM DILATOR VALVE INFLATION SYRINGE SUP-DSF1233 CDM 0270 RC outpatient 1684.8 1684.8 1684.8 74 1246.75 percent of total billed charges 1684.8 93 1364.69 percent of total billed charges 1684.8 1684.8 other OPPS APC 1684.8 1684.8 other OPPS APC 1684.8 27.63 465.51 percent of total billed charges 1684.8 1684.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER GORE DRYSEAL L45 CM OD12 FR ODSEC4 MM ID4.7 MM DILATOR VALVE INFLATION SYRINGE SUP-DSF1245 CDM 0270 RC outpatient 2519.4 2519.4 2519.4 74 1864.36 percent of total billed charges 2519.4 93 2040.71 percent of total billed charges 2519.4 2519.4 other OPPS APC 2519.4 2519.4 other OPPS APC 2519.4 27.63 696.11 percent of total billed charges 2519.4 2519.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER GORE DRYSEAL L33 CM OD14 FR ODSEC5.3 MM ID4.7 MM DILATOR VALVE INFLATION SYRINGE SUP-DSF1433 CDM 0481 RC outpatient 1684.8 1684.8 1684.8 74 1246.75 percent of total billed charges 1684.8 93 1364.69 percent of total billed charges 1684.8 1684.8 other OPPS APC 1684.8 1684.8 other OPPS APC 1684.8 51 859.25 percent of total billed charges 1684.8 1684.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER GORE DRYSEAL FLEX HYDROPHILIC L33 CM OD5.6 MM ID15 FR SUP-DSF1533 CDM 0270 RC outpatient 1684.8 1684.8 1684.8 74 1246.75 percent of total billed charges 1684.8 93 1364.69 percent of total billed charges 1684.8 1684.8 other OPPS APC 1684.8 1684.8 other OPPS APC 1684.8 27.63 465.51 percent of total billed charges 1684.8 1684.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER GORE DRYSEAL L33 CM OD16 FR ODSEC6.1 MM ID5.3 MM DILATOR VALVE INFLATION SYRINGE SUP-DSF1633 CDM 0270 RC outpatient 1684.8 1684.8 1684.8 74 1246.75 percent of total billed charges 1684.8 93 1364.69 percent of total billed charges 1684.8 1684.8 other OPPS APC 1684.8 1684.8 other OPPS APC 1684.8 27.63 465.51 percent of total billed charges 1684.8 1684.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER GORE DRYSEAL L33 CM OD18 FR ODSEC6.7 MM ID6 MM DILATOR VALVE INFLATION SYRINGE SUP-DSF1833 CDM 270010015 LOCAL 0270 RC outpatient 2230.8 2230.8 2230.8 74 1650.79 percent of total billed charges 2230.8 93 1806.95 percent of total billed charges 2230.8 2230.8 other OPPS APC 2230.8 2230.8 other OPPS APC 2230.8 27.63 616.37 percent of total billed charges 2230.8 2230.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER GORE DRYSEAL L33 CM OD20 FR ODSEC7.5 MM ID6.7 MM DILATOR VALVE INFLATION SYRINGE SUP-DSF2033 CDM 0481 RC outpatient 2230.8 2230.8 2230.8 74 1650.79 percent of total billed charges 2230.8 93 1806.95 percent of total billed charges 2230.8 2230.8 other OPPS APC 2230.8 2230.8 other OPPS APC 2230.8 51 1137.71 percent of total billed charges 2230.8 2230.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH GORE DRYSEAL 22FR SUP-DSF2233 CDM 270010015 LOCAL 0270 RC outpatient 2230.8 2230.8 2230.8 74 1650.79 percent of total billed charges 2230.8 93 1806.95 percent of total billed charges 2230.8 2230.8 other OPPS APC 2230.8 2230.8 other OPPS APC 2230.8 27.63 616.37 percent of total billed charges 2230.8 2230.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH GORE DRYSEAL 12FR X 28 SUP-DSL1228 CDM 270010015 LOCAL 0270 RC outpatient 733.2 733.2 733.2 74 542.57 percent of total billed charges 733.2 93 593.89 percent of total billed charges 733.2 733.2 other OPPS APC 733.2 733.2 other OPPS APC 733.2 27.63 202.58 percent of total billed charges 733.2 733.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH DRYSEAL SUP-DSL1245 CDM 270010015 LOCAL 0270 RC outpatient 1666.6 1666.6 1666.6 74 1233.28 percent of total billed charges 1666.6 93 1349.95 percent of total billed charges 1666.6 1666.6 other OPPS APC 1666.6 1666.6 other OPPS APC 1666.6 27.63 460.48 percent of total billed charges 1666.6 1666.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH DRYSEAL SUP-DSL1628 CDM 270010015 LOCAL 0270 RC outpatient 733.2 733.2 733.2 74 542.57 percent of total billed charges 733.2 93 593.89 percent of total billed charges 733.2 733.2 other OPPS APC 733.2 733.2 other OPPS APC 733.2 27.63 202.58 percent of total billed charges 733.2 733.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER STERILIZATION CONTAINER GENESIS L9.5 IN X W9.5 IN STEAM EO STERILIZATION STERRAD SUP-DST-3 CDM outpatient 0.25 0.25 0.25 0.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OSCOR DESTINO TWIST UNIDIRECTIONAL GUIDING SHEATH SUP-DST0857322 CDM 0481 RC outpatient 1495 1495 1495 74 1106.3 percent of total billed charges 1495 93 1210.95 percent of total billed charges 1495 1495 other OPPS APC 1495 1495 other OPPS APC 1495 51 762.45 percent of total billed charges 1495 1495 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING KIT CENTRAL LINE WITH BIOPATCH AND SORBAVIEW DRESSING - CUSTOM KIT SUP-DT17925 CDM 0270 RC outpatient 55.94 55.94 55.94 74 41.4 percent of total billed charges 55.94 93 45.31 percent of total billed charges 55.94 55.94 other OPPS APC 55.94 55.94 other OPPS APC 55.94 27.63 15.46 percent of total billed charges 55.94 55.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC VIVA XT CRT-D 35 ML 80 GM ICD DF-1 BIPHASIC WAVEFORM RESYNCHRONIZATION THERAPY SUP-DTBA1D1 CDM 0275 RC outpatient 19400 19400 19400 57 11058 percent of total billed charges 19400 93 15714 percent of total billed charges 19400 19400 other OPPS APC 19400 19400 other OPPS APC 19400 51 9894 percent of total billed charges 19400 19400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC VIVA XT CRT-D 35 ML 80 GM ICD DF-4 BIPHASIC WAVEFORM RESYNCHRONIZATION THERAPY SUP-DTBA1D4 CDM 0275 RC outpatient 19400 19400 19400 57 11058 percent of total billed charges 19400 93 15714 percent of total billed charges 19400 19400 other OPPS APC 19400 19400 other OPPS APC 19400 51 9894 percent of total billed charges 19400 19400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRTD DTBA1Q1 VIVA QUAD DF1 DEVICE _40073_ SUP-DTBA1Q1 CDM 0275 RC outpatient 34400 34400 34400 57 19608 percent of total billed charges 34400 93 27864 percent of total billed charges 34400 34400 other OPPS APC 34400 34400 other OPPS APC 34400 51 17544 percent of total billed charges 34400 34400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC VIVA QUAD XT RESYNCHRONIZATION THERAPY SUP-DTBA1QQ CDM 0275 RC outpatient 19400 19400 19400 57 11058 percent of total billed charges 19400 93 15714 percent of total billed charges 19400 19400 other OPPS APC 19400 19400 other OPPS APC 19400 51 9894 percent of total billed charges 19400 19400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRTD CLARIA MRI DEVICE SUP-DTMA1D1 CDM 0275 RC outpatient 33997 33997 33997 57 19378.3 percent of total billed charges 33997 93 27537.6 percent of total billed charges 33997 33997 other OPPS APC 33997 33997 other OPPS APC 33997 51 17338.5 percent of total billed charges 33997 33997 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRTD CLARIA MRI DEVICE SUP-DTMA1D4 CDM 0275 RC outpatient 33997 33997 33997 57 19378.3 percent of total billed charges 33997 93 27537.6 percent of total billed charges 33997 33997 other OPPS APC 33997 33997 other OPPS APC 33997 51 17338.5 percent of total billed charges 33997 33997 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRTD CLARIA MRI QUAD DEVICE SUP-DTMA1Q1 CDM 0275 RC outpatient 34032 34032 34032 57 19398.2 percent of total billed charges 34032 93 27565.9 percent of total billed charges 34032 34032 other OPPS APC 34032 34032 other OPPS APC 34032 51 17356.3 percent of total billed charges 34032 34032 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRTD CALRIA MRI QUAD DEVICE SUP-DTMA1QQ CDM 0275 RC outpatient 34032 34032 34032 57 19398.2 percent of total billed charges 34032 93 27565.9 percent of total billed charges 34032 34032 other OPPS APC 34032 34032 other OPPS APC 34032 51 17356.3 percent of total billed charges 34032 34032 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT AMPLIA MRI DEVICE SUP-DTMB1D1 CDM 0275 RC outpatient 33873 33873 33873 57 19307.6 percent of total billed charges 33873 93 27437.1 percent of total billed charges 33873 33873 other OPPS APC 33873 33873 other OPPS APC 33873 51 17275.2 percent of total billed charges 33873 33873 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT AMPLIA MRI DEVICE SUP-DTMB1D4 CDM 0275 RC outpatient 33873 33873 33873 57 19307.6 percent of total billed charges 33873 93 27437.1 percent of total billed charges 33873 33873 other OPPS APC 33873 33873 other OPPS APC 33873 51 17275.2 percent of total billed charges 33873 33873 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE AMPLIA MRI QUAD DF1 SUP-DTMB1Q1 CDM 0275 RC outpatient 33873 33873 33873 57 19307.6 percent of total billed charges 33873 93 27437.1 percent of total billed charges 33873 33873 other OPPS APC 33873 33873 other OPPS APC 33873 51 17275.2 percent of total billed charges 33873 33873 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT AMPLIA MRI QUAD DEVICE SUP-DTMB1QQ CDM 0275 RC outpatient 33873 33873 33873 57 19307.6 percent of total billed charges 33873 93 27437.1 percent of total billed charges 33873 33873 other OPPS APC 33873 33873 other OPPS APC 33873 51 17275.2 percent of total billed charges 33873 33873 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER COMPIA DTMC1D1 MRI DEVICE SUP-DTMC1D1 CDM 0275 RC outpatient 20868 20868 20868 57 11894.8 percent of total billed charges 20868 93 16903.1 percent of total billed charges 20868 20868 other OPPS APC 20868 20868 other OPPS APC 20868 51 10642.7 percent of total billed charges 20868 20868 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRTD COMPIA MRI QUAD DEVICE SUP-DTMC1QQ CDM 0275 RC outpatient 20437.5 20437.5 20437.5 57 11649.4 percent of total billed charges 20437.5 93 16554.4 percent of total billed charges 20437.5 20437.5 other OPPS APC 20437.5 20437.5 other OPPS APC 20437.5 51 10423.1 percent of total billed charges 20437.5 20437.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEBRILLATOR CARDIAC COBALT XT CRT-D DF-1 PIN PLUG RADIOPAQUE STERILE RESYNCHRONIZATION SUP-DTPA2D1 CDM 0275 RC outpatient 35365 35365 35365 57 20158 percent of total billed charges 35365 93 28645.7 percent of total billed charges 35365 35365 other OPPS APC 35365 35365 other OPPS APC 35365 51 18036.2 percent of total billed charges 35365 35365 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC COBALT XT CRT-D DF4 CONNECTOR RADIOPAQUE STERILE RESYNCHRONIZATION SUP-DTPA2D4 CDM 0275 RC outpatient 35365 35365 35365 57 20158 percent of total billed charges 35365 93 28645.7 percent of total billed charges 35365 35365 other OPPS APC 35365 35365 other OPPS APC 35365 51 18036.2 percent of total billed charges 35365 35365 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC COBALT XT CRT-D QUAD 2 DF1 CONNECTOR RADIOPAQUE STERILE RESYNCHRONIZATION SUP-DTPA2Q1 CDM 0275 RC outpatient 35403 35403 35403 57 20179.7 percent of total billed charges 35403 93 28676.4 percent of total billed charges 35403 35403 other OPPS APC 35403 35403 other OPPS APC 35403 51 18055.5 percent of total billed charges 35403 35403 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC COBALT XT CRT-D QUAD DF4 CONNECTOR RADIOPAQUE STERILE RESYNCHRONIZATION SUP-DTPA2QQ CDM 0275 RC outpatient 35403 35403 35403 57 20179.7 percent of total billed charges 35403 93 28676.4 percent of total billed charges 35403 35403 other OPPS APC 35403 35403 other OPPS APC 35403 51 18055.5 percent of total billed charges 35403 35403 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC COBALT HF 2 CHAMBER DF-1 PIN PLUG RADIOPAQUE STERILE VENTRICULAR TACHYARRHYTHMIAS SUP-DTPB2D1 CDM 0275 RC outpatient 33997 33997 33997 57 19378.3 percent of total billed charges 33997 93 27537.6 percent of total billed charges 33997 33997 other OPPS APC 33997 33997 other OPPS APC 33997 51 17338.5 percent of total billed charges 33997 33997 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC COBALT HF 2 CHAMBER DF4 INLINE CONNECTOR RADIOPAQUE STERILE VENTRICULAR TACHYARRHYTHMIAS SUP-DTPB2D4 CDM 0275 RC outpatient 33997 33997 33997 57 19378.3 percent of total billed charges 33997 93 27537.6 percent of total billed charges 33997 33997 other OPPS APC 33997 33997 other OPPS APC 33997 51 17338.5 percent of total billed charges 33997 33997 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC COBALT HF 2 CHAMBER DF-1 PIN PLUG IS4 INLINE CONNECTOR RADIOPAQUE STERILE VENTRICULAR TACHYARRHYTHMIAS SUP-DTPB2Q1 CDM 0275 RC outpatient 34032 34032 34032 57 19398.2 percent of total billed charges 34032 93 27565.9 percent of total billed charges 34032 34032 other OPPS APC 34032 34032 other OPPS APC 34032 51 17356.3 percent of total billed charges 34032 34032 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC COBALT HF 2 CHAMBER DF4 INLINE CONNECTOR IS4 INLINE CONNECTOR RADIOPAQUE STERILE VENTRICULAR TACHYARRHYTHMIAS SUP-DTPB2QQ CDM 0275 RC outpatient 34032 34032 34032 57 19398.2 percent of total billed charges 34032 93 27565.9 percent of total billed charges 34032 34032 other OPPS APC 34032 34032 other OPPS APC 34032 51 17356.3 percent of total billed charges 34032 34032 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD DVAB1D1 VISIA AF VR DEVICE _44981_ SUP-DVAB1D1 CDM 0275 RC outpatient 15605 15605 15605 57 8894.85 percent of total billed charges 15605 93 12640 percent of total billed charges 15605 15605 other OPPS APC 15605 15605 other OPPS APC 15605 51 7958.55 percent of total billed charges 15605 15605 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD VISIA AF VR DEVICE SUP-DVAB1D4 CDM 0275 RC outpatient 17145 17145 17145 57 9772.65 percent of total billed charges 17145 93 13887.5 percent of total billed charges 17145 17145 other OPPS APC 17145 17145 other OPPS APC 17145 51 8743.95 percent of total billed charges 17145 17145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC PHYSIOCURVE EVERA XT VR SMARTSHOCK 1 CHAMBER DF-1 ICD SUP-DVBB1D1 CDM 0275 RC outpatient 14400 14400 14400 57 8208 percent of total billed charges 14400 93 11664 percent of total billed charges 14400 14400 other OPPS APC 14400 14400 other OPPS APC 14400 51 7344 percent of total billed charges 14400 14400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD DVBB1D1 EVERA XT VR SINGLE CHAMBER ICD SYSTEM SUP-DVBB1D1 S CDM 0275 RC outpatient 35600 35600 35600 57 20292 percent of total billed charges 35600 93 28836 percent of total billed charges 35600 35600 other OPPS APC 35600 35600 other OPPS APC 35600 51 18156 percent of total billed charges 35600 35600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC EVERA XT 1 CHAMBER ICD DF-4 SMARTSHOCK TECHNOLOGY PHYSIOCURVE DESIGN SUP-DVBB1D4 CDM 0275 RC outpatient 14400 14400 14400 57 8208 percent of total billed charges 14400 93 11664 percent of total billed charges 14400 14400 other OPPS APC 14400 14400 other OPPS APC 14400 51 7344 percent of total billed charges 14400 14400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD-VR DVEA3E4 EV ICD EV4 SUP-DVEA3E4 CDM 0481 RC outpatient 52000 52000 52000 74 38480 percent of total billed charges 52000 93 42120 percent of total billed charges 52000 52000 other OPPS APC 52000 52000 other OPPS APC 52000 51 26520 percent of total billed charges 52000 52000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD VISIA AF MRI VR DEVICE SUP-DVFB1D1 CDM 0275 RC outpatient 16146 16146 16146 57 9203.22 percent of total billed charges 16146 93 13078.3 percent of total billed charges 16146 16146 other OPPS APC 16146 16146 other OPPS APC 16146 51 8234.46 percent of total billed charges 16146 16146 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD VISIA AF MRI SURESCAN VR DEVICE SUP-DVFB1D4 CDM 0275 RC outpatient 16146 16146 16146 57 9203.22 percent of total billed charges 16146 93 13078.3 percent of total billed charges 16146 16146 other OPPS APC 16146 16146 other OPPS APC 16146 51 8234.46 percent of total billed charges 16146 16146 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD EVERA MRI XT VR DEVICE SUP-DVMB1D4 CDM 0275 RC outpatient 14400 14400 14400 57 8208 percent of total billed charges 14400 93 11664 percent of total billed charges 14400 14400 other OPPS APC 14400 14400 other OPPS APC 14400 51 7344 percent of total billed charges 14400 14400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD COBALT XT MRI VR DEVICE SUP-DVPA2D1 CDM 0275 RC outpatient 16978 16978 16978 57 9677.46 percent of total billed charges 16978 93 13752.2 percent of total billed charges 16978 16978 other OPPS APC 16978 16978 other OPPS APC 16978 51 8658.78 percent of total billed charges 16978 16978 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD COBALT XT MRI DR SURESCAN DEVICE SUP-DVPA2D4 CDM 0275 RC outpatient 16978 16978 16978 57 9677.46 percent of total billed charges 16978 93 13752.2 percent of total billed charges 16978 16978 other OPPS APC 16978 16978 other OPPS APC 16978 51 8658.78 percent of total billed charges 16978 16978 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DVR ANATOMIC STD HEAD LEFT SUP-DVRAL CDM 0270 RC outpatient 2210.03 2210.03 2210.03 74 1635.42 percent of total billed charges 2210.03 93 1790.12 percent of total billed charges 2210.03 2210.03 other OPPS APC 2210.03 2210.03 other OPPS APC 2210.03 27.63 610.63 percent of total billed charges 2210.03 2210.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DVR FAST GUIDE TITANIUM L59.5 MM X W24.4 MM RADIUS LEFT DISTAL VOLAR 4 HOLE STANDARD HEAD NONSTERILE SUP-DVRAL CDM 0270 RC outpatient 1325.61 1325.61 1325.61 74 980.95 percent of total billed charges 1325.61 93 1073.74 percent of total billed charges 1325.61 1325.61 other OPPS APC 1325.61 1325.61 other OPPS APC 1325.61 27.63 366.27 percent of total billed charges 1325.61 1325.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DVR FAST GUIDE TITANIUM NARROW L57.2 MM X W21.6 MM RADIUS RIGHT DISTAL VOLAR 4 HOLE SUP-DVRAN-R CDM 0270 RC outpatient 2210.03 2210.03 2210.03 74 1635.42 percent of total billed charges 2210.03 93 1790.12 percent of total billed charges 2210.03 2210.03 other OPPS APC 2210.03 2210.03 other OPPS APC 2210.03 27.63 610.63 percent of total billed charges 2210.03 2210.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DVR FAST GUIDE KIRSCHNER TITANIUM NARROW STANDARD L57.2 MM X W21.6 MM RADIUS LEFT DISTAL VOLAR 4 HOLE LOW PROFILE FIX ANGLE WIRE SUP-DVRANL CDM 0270 RC outpatient 2210.03 2210.03 2210.03 74 1635.42 percent of total billed charges 2210.03 93 1790.12 percent of total billed charges 2210.03 2210.03 other OPPS APC 2210.03 2210.03 other OPPS APC 2210.03 27.63 610.63 percent of total billed charges 2210.03 2210.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DVR FAST GUIDE TITANIUM SHORT NARROW L48.9 MM X W21.6 MM RADIUS LEFT DISTAL VOLAR 3 HOLE LOW PROFILE SUP-DVRANS-L CDM 0270 RC outpatient 2210.03 2210.03 2210.03 74 1635.42 percent of total billed charges 2210.03 93 1790.12 percent of total billed charges 2210.03 2210.03 other OPPS APC 2210.03 2210.03 other OPPS APC 2210.03 27.63 610.63 percent of total billed charges 2210.03 2210.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DVR FAST GUIDE TITANIUM SHORT NARROW L48.9 MM X W21.6 MM RADIUS RIGHT DISTAL VOLAR 3 HOLE LOW PROFILE SUP-DVRANS-R CDM 0270 RC outpatient 2210.03 2210.03 2210.03 74 1635.42 percent of total billed charges 2210.03 93 1790.12 percent of total billed charges 2210.03 2210.03 other OPPS APC 2210.03 2210.03 other OPPS APC 2210.03 27.63 610.63 percent of total billed charges 2210.03 2210.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DVR ANATOMIC STD HEAD RIGHT SUP-DVRAR CDM 0270 RC outpatient 1325.61 1325.61 1325.61 74 980.95 percent of total billed charges 1325.61 93 1073.74 percent of total billed charges 1325.61 1325.61 other OPPS APC 1325.61 1325.61 other OPPS APC 1325.61 27.63 366.27 percent of total billed charges 1325.61 1325.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DVR FAST GUIDE TITANIUM L59.5 MM X W24.4 MM RADIUS RIGHT DISTAL VOLAR 4 HOLE STANDARD HEAD NONSTERILE SUP-DVRAR CDM 0270 RC outpatient 1325.61 1325.61 1325.61 74 980.95 percent of total billed charges 1325.61 93 1073.74 percent of total billed charges 1325.61 1325.61 other OPPS APC 1325.61 1325.61 other OPPS APC 1325.61 27.63 366.27 percent of total billed charges 1325.61 1325.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DVR FAST GUIDE TITANIUM SHORT L51.3 MM X W24.4 MM RADIUS LEFT DISTAL VOLAR 3 HOLE 2 TIER NONSTERILE SUP-DVRASL CDM 0270 RC outpatient 1325.61 1325.61 1325.61 74 980.95 percent of total billed charges 1325.61 93 1073.74 percent of total billed charges 1325.61 1325.61 other OPPS APC 1325.61 1325.61 other OPPS APC 1325.61 27.63 366.27 percent of total billed charges 1325.61 1325.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DVR FAST GUIDE TITANIUM SHORT L51.3 MM X W24.4 MM RADIUS RIGHT DISTAL VOLAR 3 HOLE 2 TIER NONSTERILE SUP-DVRASR CDM 0270 RC outpatient 1325.61 1325.61 1325.61 74 980.95 percent of total billed charges 1325.61 93 1073.74 percent of total billed charges 1325.61 1325.61 other OPPS APC 1325.61 1325.61 other OPPS APC 1325.61 27.63 366.27 percent of total billed charges 1325.61 1325.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DVR FAST GUIDE TITANIUM L62.6 MM X W28.2 MM RADIUS RIGHT DISTAL VOLAR 4 HOLE 2 TIER WIDE HEAD NONSTERILE SUP-DVRAW-R CDM 0270 RC outpatient 1325.61 1325.61 1325.61 74 980.95 percent of total billed charges 1325.61 93 1073.74 percent of total billed charges 1325.61 1325.61 other OPPS APC 1325.61 1325.61 other OPPS APC 1325.61 27.63 366.27 percent of total billed charges 1325.61 1325.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DVR FAST GUIDE TITANIUM L62.6 MM X W28.2 MM RADIUS LEFT DISTAL VOLAR 4 HOLE 2 TIER WIDE HEAD NONSTERILE SUP-DVRAWL CDM 0270 RC outpatient 2210.03 2210.03 2210.03 74 1635.42 percent of total billed charges 2210.03 93 1790.12 percent of total billed charges 2210.03 2210.03 other OPPS APC 2210.03 2210.03 other OPPS APC 2210.03 27.63 610.63 percent of total billed charges 2210.03 2210.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DVR TITANIUM STANDARD L89.5 MM X W24.4 MM RADIUS LEFT VOLAR 7 HOLE EXTEND FAST GUIDE ANATOMIC SUP-DVRAX-L CDM 0270 RC outpatient 2084.94 2084.94 2084.94 74 1542.86 percent of total billed charges 2084.94 93 1688.8 percent of total billed charges 2084.94 2084.94 other OPPS APC 2084.94 2084.94 other OPPS APC 2084.94 27.63 576.07 percent of total billed charges 2084.94 2084.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DVR TITANIUM STANDARD L89.5 MM X W24.4 MM RIGHT DISTAL VOLAR RADIUS 7 HOLE EXTENDED FAST GUIDE ANATOMIC SUP-DVRAX-R CDM 0270 RC outpatient 2084.94 2084.94 2084.94 74 1542.86 percent of total billed charges 2084.94 93 1688.8 percent of total billed charges 2084.94 2084.94 other OPPS APC 2084.94 2084.94 other OPPS APC 2084.94 27.63 576.07 percent of total billed charges 2084.94 2084.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW PERIPHERAL REVERSED 5.0MM X 26MM SUP-DWJ334 CDM 270010030 LOCAL 0270 RC outpatient 2.6 2.6 2.6 74 1.92 percent of total billed charges 2.6 93 2.11 percent of total billed charges 2.6 2.6 other OPPS APC 2.6 2.6 other OPPS APC 2.6 27.63 0.72 percent of total billed charges 2.6 2.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT HUMERAL PERFORM THK+0 MM 1/2 OD36 MM SHOULDER STERILE LATEX FREE SUP-DWP1360 CDM 270010030 LOCAL 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM HUMERAL PERFORM 2+ SHOULDER STERILE LATEX FREE SUP-DWX2PS CDM 270010030 LOCAL 0270 RC outpatient 10823.8 10823.8 10823.8 74 8009.61 percent of total billed charges 10823.8 93 8767.28 percent of total billed charges 10823.8 10823.8 other OPPS APC 10823.8 10823.8 other OPPS APC 10823.8 27.63 2990.62 percent of total billed charges 10823.8 10823.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5F DXTERITY JL 3.5 DIAGNOSTIC CATHETER SUP-DXT5JL35_70553 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5F DXTERITY JL 4.0 DIAGNOSTIC CATHETER SUP-DXT5JL40_70557 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5F DXTERITY JL 4.5 DIAGNOSTIC CATHETER SUP-DXT5JL45_70554 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5F DXTERITY JL 5.0 DIAGNOSTIC CATHETER SUP-DXT5JL50_70555 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5F DXTERITY JR 4.0 DIAGNOSTIC CATHETER SUP-DXT5JR40_70558 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5F DXTERITY PIG STR DIAGNOSTIC CATHETER SUP-DXT5PIGSTA_70556 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F DXTERITY 3DRC DIAGNOSTIC CATHETER SUP-DXT63DRC_70269 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DIAGNOSTIC DXTERITY INSLIDE AMPLATZ LEFT 1 CURVE L100 CM OD 6 FR ID .056 IN LARGE LUMEN RADIOPAQUE 2 BRAID WIRE COLOR CODED HUB STERILE ACCEPTS .038 IN GUIDEWIRE SUP-DXT6AL10_70270 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F DXTERITY AL 2.0 DIAGNOSTIC CATHETER SUP-DXT6AL20_70271 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DIAGNOSTIC DXTERITY INSLIDE AMPLATZ LEFT 3 CURVE L100 CM OD 6 FR ID .056 IN LARGE LUMEN RADIOPAQUE 2 BRAID WIRE COLOR CODED HUB STERILE ACCEPTS .038 IN GUIDEWIRE SUP-DXT6AL30_70272 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F DXTERITY AR MOD DIAGNOSTIC CATHETER SUP-DXT6ARM_70273 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F DXTERITY IMA DIAGNOSTIC CATHETER SUP-DXT6IMA_70274 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F DXTERITY JL 3.5 DIAGNOSTIC CATHETER SUP-DXT6JL35_70275 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F DXTERITY JL 4.0 DIAGNOSTIC CATHETER SUP-DXT6JL40_70276 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DIAGNOSTIC DXTERITY INSLIDE JUDKINS LEFT 4 CURVE L125CM OD 6FR ID .056 IN LARGE LUMEN RADIOPAQUE 2 BRAID WIRE COLOR CODED HUB STERILE ACCEPTS .038 IN GUIDEWIRE SUP-DXT6JL40X_70443 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F DXTERITY JL 4.5 DIAGNOSTIC CATHETER SUP-DXT6JL45_70277 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DIAGNOSTIC DXTERITY INSLIDE JUDKINS LEFT 5 CURVE L100 CM OD 6 FR ID .056 IN LARGE LUMEN RADIOPAQUE 2 BRAID WIRE COLOR CODED HUB STERILE ACCEPTS .038 IN GUIDEWIRE SUP-DXT6JL50_70278 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DIAGNOSTIC DXTERITY INSLIDE JUDKINS LEFT 5 CURVE L125CM OD 6FR ID .056 IN LARGE LUMEN RADIOPAQUE 2 BRAID WIRE COLOR CODED HUB STERILE ACCEPTS .038 IN GUIDEWIRE SUP-DXT6JL50X_70444 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F DXTERITY JL 6.0 DIAGNOSTIC CATHETER SUP-DXT6JL60_70279 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F DXTERITY JR 3.5 DIAGNOSTIC CATHETER SUP-DXT6JR35 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F DXTERITY JR 4.0 DIAGNOSTIC CATHETER SUP-DXT6JR40_70281 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DIAGNOSTIC DXTERITY INSLIDE JUDKINS RIGHT 4 CURVE L125CM OD 6FR ID .056 IN LARGE LUMEN RADIOPAQUE 2 BRAID WIRE COLOR CODED HUB STERILE ACCEPTS .038 IN GUIDEWIRE SUP-DXT6JR40X_70445 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DIAGNOSTIC DXTERITY INSLIDE JUDKINS RIGHT 5 CURVE L100 CM OD 6 FR ID .056 IN LARGE LUMEN RADIOPAQUE 2 BRAID WIRE COLOR CODED HUB STERILE ACCEPTS .038 IN GUIDEWIRE SUP-DXT6JR50_70282 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DIAGNOSTIC DXTERITY INSLIDE JUDKINS RIGHT 5 CURVE L125CM OD 6FR ID .056 IN LARGE LUMEN RADIOPAQUE 2 BRAID WIRE COLOR CODED HUB STERILE ACCEPTS .038 IN GUIDEWIRE SUP-DXT6JR50X_70446 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DIAGNOSTIC DXTERITY INSLIDE JUDKINS RIGHT 6 CURVE L100 CM OD 6 FR ID .056 IN LARGE LUMEN RADIOPAQUE 2 BRAID WIRE COLOR CODED HUB STERILE ACCEPTS .038 IN GUIDEWIRE SUP-DXT6JR60_70283 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DIAGNOSTIC DXTERITY INSLIDE LEFT CORONARY BYPASS CURVE L100 CM OD 6 FR ID .056 IN LARGE LUMEN RADIOPAQUE 2 BRAID WIRE COLOR CODED HUB STERILE ACCEPTS .038 IN GUIDEWIRE SUP-DXT6LCB_70284 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DIAGNOSTIC DXTERITY INSLIDE MULTIPURPOSE A CURVE L100 CM OD 6 FR ID .056 IN LARGE LUMEN RADIOPAQUE 2 BRAID WIRE COLOR CODED HUB STERILE ACCEPTS .038 IN GUIDEWIRE SUP-DXT6MPA_70285 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DIAGNOSTIC DXTERITY INSLIDE MULTIPURPOSE A CURVE L110CM OD 6FR ID .056 IN LARGE LUMEN RADIOPAQUE 2 BRAID WIRE COLOR CODED HUB STERILE ACCEPTS .038 IN GUIDEWIRE SUP-DXT6MPAA_70447 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DIAGNOSTIC DXTERITY INSLIDE MULTIPURPOSE A CURVE L100 CM OD6 FR ID.056 IN LARGE LUMEN 2 SIDEHOLE RADIOPAQUE 2 BRAID WIRE STERILE ACCEPTS .038 IN GUIDEWIRE SUP-DXT6MPASH_70559 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DIAGNOSTIC DXTERITY INSLIDE MULTIPURPOSE B CURVE L100 CM OD 6 FR ID .056 IN LARGE LUMEN RADIOPAQUE 2 BRAID WIRE COLOR CODED HUB STERILE ACCEPTS .038 IN GUIDEWIRE SUP-DXT6MPB_70286 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F DXTERITY 145 PIGTAIL DIAGNOSTIC CATHETER SUP-DXT6PIG45A_70287 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F DXTERITY PIG STR DIAGNOSTIC CATHETER SUP-DXT6PIGSTA_70288 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DIAGNOSTIC DXTERITY INSLIDE PIGTAIL STRAIGHT CURVE L125 CM OD 6 FR ID .056 IN LARGE LUMEN 6 SIDEHOLE RADIOPAQUE 2 BRAID WIRE STERILE ACCEPTS .038 IN GUIDEWIRE SUP-DXT6PIGSTX_70289 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F DXTERITY RCB DIAGNOSTIC CATHETER SUP-DXT6RCB_70290 CDM 0481 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 51 11.93 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISH PETRI STERILE SUP-DYND04138H CDM 0270 RC outpatient 3.35 3.35 3.35 74 2.48 percent of total billed charges 3.35 93 2.71 percent of total billed charges 3.35 3.35 other OPPS APC 3.35 3.35 other OPPS APC 3.35 27.63 0.93 percent of total billed charges 3.35 3.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY CATHETERIZATION VINYL RUBBER OD15 FR PRECONNECT URETHRAL STERILE LATEX RED SUP-DYND10407 CDM 270009005 LOCAL 0270 RC outpatient 6.62 6.62 6.62 74 4.9 percent of total billed charges 6.62 93 5.36 percent of total billed charges 6.62 6.62 other OPPS APC 6.62 6.62 other OPPS APC 6.62 27.63 1.83 percent of total billed charges 6.62 6.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETHRAL SELECTSILICONE FOLEY 12FR 10ML BALLOON BULLET TIP 2-WAY LARGE LUMEN SYMMETRIC BALLOON SILICONE LATEX-FREE NON-RADIOLUCENT SUP-DYND11500 CDM 0270 RC outpatient 7.7 7.7 7.7 7.7 other OPPS APC 7.7 7.7 other OPPS APC 7.7 27.63 2.13 percent of total billed charges 7.7 7.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLUG CATHETER PROTECTOR CAP DRAIN TUBE COVER SET STERILE LATEX FREE SUP-DYND12200 CDM 0270 RC outpatient 0.61 0.61 0.61 74 0.45 percent of total billed charges 0.61 93 0.49 percent of total billed charges 0.61 0.61 other OPPS APC 0.61 0.61 other OPPS APC 0.61 27.63 0.17 percent of total billed charges 0.61 0.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG DRAINAGE MED 600ML STERILE LF LEG TWIST VALVE STRAP SUP-DYND12574_701450 CDM 270009001 LOCAL 0270 RC outpatient 3.34 3.34 3.34 74 2.47 percent of total billed charges 3.34 93 2.71 percent of total billed charges 3.34 3.34 other OPPS APC 3.34 3.34 other OPPS APC 3.34 27.63 0.92 percent of total billed charges 3.34 3.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE IRRIGATION TYVEK 60 ML THUMB RING PISTON RIGID BASE ELONGATE TIP STERILE LATEX FREE DISPOSABLE SUP-DYND20302 CDM 0270 RC outpatient 2.59 2.59 2.59 74 1.92 percent of total billed charges 2.59 93 2.1 percent of total billed charges 2.59 2.59 other OPPS APC 2.59 2.59 other OPPS APC 2.59 27.63 0.72 percent of total billed charges 2.59 2.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE IRRIGATION TOOMEY CONTRO-PISTON TYVEK 70CC GRADUATE ELONGATE TIP EXTRA LONG ORIFICE LUER ADAPTER STERILE LATEX FREE DISPOSABLE SUP-DYND20323 CDM 0270 RC outpatient 2.7 2.7 2.7 74 2 percent of total billed charges 2.7 93 2.19 percent of total billed charges 2.7 2.7 other OPPS APC 2.7 2.7 other OPPS APC 2.7 27.63 0.75 percent of total billed charges 2.7 2.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTAINER SPECIMEN 4OZ POLYPROPYLENE STERILE LF LEAK RESISTANT SCREW ON LID GRADUATED SUP-DYND30351 CDM 0270 RC outpatient 1.22 1.22 1.22 74 0.9 percent of total billed charges 1.22 93 0.99 percent of total billed charges 1.22 1.22 other OPPS APC 1.22 1.22 other OPPS APC 1.22 27.63 0.34 percent of total billed charges 1.22 1.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTAINER SPECIMEN 4OZ OR STRL SUP-DYND30389 CDM outpatient 1.56 1.56 1.56 1.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTAINER PATHOLOGY 16OZ POLYPROPYLENE NS LF LEAK RESISTANT LID FREEZABLE SUP-DYND34260_701263 CDM 0270 RC outpatient 0.75 0.75 0.75 74 0.56 percent of total billed charges 0.75 93 0.61 percent of total billed charges 0.75 0.75 other OPPS APC 0.75 0.75 other OPPS APC 0.75 27.63 0.21 percent of total billed charges 0.75 0.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP SUCTION YANKAUER PLASTIC STANDARD TUBE RIGID TRANSPARENT SLIP RESISTANT HANDLE STERILE LATEX FREE CLEAR SUP-DYND50130 CDM 0270 RC outpatient 1.43 1.43 1.43 74 1.06 percent of total billed charges 1.43 93 1.16 percent of total billed charges 1.43 1.43 other OPPS APC 1.43 1.43 other OPPS APC 1.43 27.63 0.4 percent of total billed charges 1.43 1.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOWL SOLUTION LG 32OZ LIGHT BLUE PLASTIC STERILE LF GRADUATED NO AUTOCLAVABLE SUP-DYND50320 CDM 0270 RC outpatient 2.43 2.43 2.43 74 1.8 percent of total billed charges 2.43 93 1.97 percent of total billed charges 2.43 2.43 other OPPS APC 2.43 2.43 other OPPS APC 2.43 27.63 0.67 percent of total billed charges 2.43 2.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR TUBING STRAIGHT STERILE LF 5IN 1 MALE END LIGHTWEIGHT SUP-DYND50510 CDM 0270 RC outpatient 0.63 0.63 0.63 74 0.47 percent of total billed charges 0.63 93 0.51 percent of total billed charges 0.63 0.63 other OPPS APC 0.63 0.63 other OPPS APC 0.63 27.63 0.17 percent of total billed charges 0.63 0.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR MEDICATED 8IN PVP IODINE STERILE LF SWABSTICK PRESATURATE SUP-DYND70288 CDM 0270 RC outpatient 8.32 8.32 8.32 74 6.16 percent of total billed charges 8.32 93 6.74 percent of total billed charges 8.32 8.32 other OPPS APC 8.32 8.32 other OPPS APC 8.32 27.63 2.3 percent of total billed charges 8.32 8.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR MEDICATED 8IN PVP IODINE STERILE LF SWABSTICK PRESATURATE SUP-DYND70288S CDM 0270 RC outpatient 21.13 21.13 21.13 74 15.64 percent of total billed charges 21.13 93 17.12 percent of total billed charges 21.13 21.13 other OPPS APC 21.13 21.13 other OPPS APC 21.13 27.63 5.84 percent of total billed charges 21.13 21.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE GASTROSTOMY KANGAROO 16FR 20ML SILICONE Y PORT GRADUATE SHAFT ROUND TIP OPEN DISTAL END SUP-DYND70316 CDM 0270 RC outpatient 18.75 18.75 18.75 74 13.88 percent of total billed charges 18.75 93 15.19 percent of total billed charges 18.75 18.75 other OPPS APC 18.75 18.75 other OPPS APC 18.75 27.63 5.18 percent of total billed charges 18.75 18.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE GASTROSTOMY KANGAROO 18FR 20ML SILICONE Y PORT GRADUATE SHAFT ROUND TIP OPEN DISTAL END SUP-DYND70318 CDM 0270 RC outpatient 65.65 65.65 65.65 74 48.58 percent of total billed charges 65.65 93 53.18 percent of total billed charges 65.65 65.65 other OPPS APC 65.65 65.65 other OPPS APC 65.65 27.63 18.14 percent of total billed charges 65.65 65.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE GASTROSTOMY SILICONE L9.5 IN OD20 FR 15 CC 3 PORT GASTRIC BALLOON ROUND TIP LATEX FREE WHITE SUP-DYND70320 CDM 270009103 LOCAL 0270 RC outpatient 93.76 93.76 93.76 74 69.38 percent of total billed charges 93.76 93 75.95 percent of total billed charges 93.76 93.76 other OPPS APC 93.76 93.76 other OPPS APC 93.76 27.63 25.91 percent of total billed charges 93.76 93.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY SKIN SCRUB 4OZ CHG VINYL COTTON STERILE LF WET SUP-DYND70663 CDM 0270 RC outpatient 15.34 15.34 15.34 74 11.35 percent of total billed charges 15.34 93 12.43 percent of total billed charges 15.34 15.34 other OPPS APC 15.34 15.34 other OPPS APC 15.34 27.63 4.24 percent of total billed charges 15.34 15.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY SKIN SCRUB VINYL WET SMALL WING SPONGE STICK COTTON TIP APPLICATOR LATEX FREE SUP-DYND70668 CDM 270009183 LOCAL 0270 RC outpatient 15.32 15.32 15.32 74 11.34 percent of total billed charges 15.32 93 12.41 percent of total billed charges 15.32 15.32 other OPPS APC 15.32 15.32 other OPPS APC 15.32 27.63 4.23 percent of total billed charges 15.32 15.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT IV CHLORAPREP TEGADERM L2 IN X W2 IN .67 ML IV START STERILE LATEX FREE SUP-DYND74268 CDM 0270 RC outpatient 2.96 2.96 2.96 74 2.19 percent of total billed charges 2.96 93 2.4 percent of total billed charges 2.96 2.96 other OPPS APC 2.96 2.96 other OPPS APC 2.96 27.63 0.82 percent of total billed charges 2.96 2.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION PREP 10% PVP IODINE 3/4 OZ POUCH PACKET CONTAINER STERILE LATEX FREE SUP-DYNDA2232A CDM 0270 RC outpatient 7.06 7.06 7.06 74 5.22 percent of total billed charges 7.06 93 5.72 percent of total billed charges 7.06 7.06 other OPPS APC 7.06 7.06 other OPPS APC 7.06 27.63 1.95 percent of total billed charges 7.06 7.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL BREAST BIOPSY SUP-DYNDA2378A CDM 0270 RC outpatient 10.41 10.41 10.41 74 7.7 percent of total billed charges 10.41 93 8.43 percent of total billed charges 10.41 10.41 other OPPS APC 10.41 10.41 other OPPS APC 10.41 27.63 2.88 percent of total billed charges 10.41 10.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK REVEAL LINQ SUP-DYNDA2379 CDM 0481 RC outpatient 32.19 32.19 32.19 74 23.82 percent of total billed charges 32.19 93 26.07 percent of total billed charges 32.19 32.19 other OPPS APC 32.19 32.19 other OPPS APC 32.19 51 16.42 percent of total billed charges 32.19 32.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLIDIFIER FLUID LIQUI-LOC HOT DOG LATEX FREE RED SOLIDIFIES UPTO 1500 ML SUP-DYNDS1500HP CDM 0270 RC outpatient 3.09 3.09 3.09 74 2.29 percent of total billed charges 3.09 93 2.5 percent of total billed charges 3.09 3.09 other OPPS APC 3.09 3.09 other OPPS APC 3.09 27.63 0.85 percent of total billed charges 3.09 3.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE ELASTIC SOFTWRAP STERILE 2X5YD SUP-DYNJ05125 CDM 0270 RC outpatient 4.3 4.3 4.3 74 3.18 percent of total billed charges 4.3 93 3.48 percent of total billed charges 4.3 4.3 other OPPS APC 4.3 4.3 other OPPS APC 4.3 27.63 1.19 percent of total billed charges 4.3 4.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE COMPRESSION SOFT WRAP COTTON POLYESTER L5 YD X W3 IN ELASTIC KNITTED BREATHABLE CLIP STERILE LATEX FREE BEIGE SUP-DYNJ05126 CDM 0270 RC outpatient 6.48 6.48 6.48 74 4.8 percent of total billed charges 6.48 93 5.25 percent of total billed charges 6.48 6.48 other OPPS APC 6.48 6.48 other OPPS APC 6.48 27.63 1.79 percent of total billed charges 6.48 6.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE COMPRESSION SOFT-WRAP 5YDX4IN BEIGE POLYESTER COTTON STERILE LF ELASTIC CLIP CLOSURE STRETCH BREATHABLE SUP-DYNJ05131 CDM 0270 RC outpatient 4.56 4.56 4.56 74 3.37 percent of total billed charges 4.56 93 3.69 percent of total billed charges 4.56 4.56 other OPPS APC 4.56 4.56 other OPPS APC 4.56 27.63 1.26 percent of total billed charges 4.56 4.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BANDAGE ELASTIC ESMARK STERILE 4X12 LF SUP-DYNJ05917 CDM 0270 RC outpatient 7.37 7.37 7.37 74 5.45 percent of total billed charges 7.37 93 5.97 percent of total billed charges 7.37 7.37 other OPPS APC 7.37 7.37 other OPPS APC 7.37 27.63 2.04 percent of total billed charges 7.37 7.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY SURGICAL 54X54IN STERILE LF 2 BASIN GRADUATED SUP-DYNJ06600 CDM 0270 RC outpatient 15.76 15.76 15.76 74 11.66 percent of total billed charges 15.76 93 12.77 percent of total billed charges 15.76 15.76 other OPPS APC 15.76 15.76 other OPPS APC 15.76 27.63 4.35 percent of total billed charges 15.76 15.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING INSUFFLATION DYOPNEUMATIC .1UM 10FT STERILE LF ABDOMINAL BACTERIAL VIRAL FILTER 1 LUER LOCK CPC CONNECTOR SUP-DYNJ06933 CDM 0270 RC outpatient 31.52 31.52 31.52 74 23.32 percent of total billed charges 31.52 93 25.53 percent of total billed charges 31.52 31.52 other OPPS APC 31.52 31.52 other OPPS APC 31.52 27.63 8.71 percent of total billed charges 31.52 31.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY SUTURE REMOVAL E KITS ADSON IRIS 3X3IN ALCOHOL GAUZE DISPOSABLE STERILE LF FORCEPS SCISSORS PREP PAD SUP-DYNJ07254A CDM 270009021 LOCAL 0270 RC outpatient 1.8 1.8 1.8 74 1.33 percent of total billed charges 1.8 93 1.46 percent of total billed charges 1.8 1.8 other OPPS APC 1.8 1.8 other OPPS APC 1.8 27.63 0.5 percent of total billed charges 1.8 1.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM AAA SUP-DYNJ59257 CDM 270009162 LOCAL 0270 RC outpatient 694.2 694.2 694.2 74 513.71 percent of total billed charges 694.2 93 562.3 percent of total billed charges 694.2 694.2 other OPPS APC 694.2 694.2 other OPPS APC 694.2 27.63 191.81 percent of total billed charges 694.2 694.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK ANKLE SUP-DYNJ59259A CDM 0270 RC outpatient 186.97 186.97 186.97 74 138.36 percent of total billed charges 186.97 93 151.45 percent of total billed charges 186.97 186.97 other OPPS APC 186.97 186.97 other OPPS APC 186.97 27.63 51.66 percent of total billed charges 186.97 186.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK ARTERIOGRAM CUSTOM SUP-DYNJ59260 CDM 0270 RC outpatient 115.77 115.77 115.77 74 85.67 percent of total billed charges 115.77 93 93.77 percent of total billed charges 115.77 115.77 other OPPS APC 115.77 115.77 other OPPS APC 115.77 27.63 31.99 percent of total billed charges 115.77 115.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL ARTHROSCOPY SUP-DYNJ59261A CDM 270009167 LOCAL 0270 RC outpatient 174.3 174.3 174.3 74 128.98 percent of total billed charges 174.3 93 141.18 percent of total billed charges 174.3 174.3 other OPPS APC 174.3 174.3 other OPPS APC 174.3 27.63 48.16 percent of total billed charges 174.3 174.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM AV FISTULA SUP-DYNJ59262 CDM 0270 RC outpatient 192.67 192.67 192.67 74 142.58 percent of total billed charges 192.67 93 156.06 percent of total billed charges 192.67 192.67 other OPPS APC 192.67 192.67 other OPPS APC 192.67 27.63 53.23 percent of total billed charges 192.67 192.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK BASIC NEURO SUP-DYNJ59263A CDM 270009164 LOCAL 0270 RC outpatient 291.85 291.85 291.85 74 215.97 percent of total billed charges 291.85 93 236.4 percent of total billed charges 291.85 291.85 other OPPS APC 291.85 291.85 other OPPS APC 291.85 27.63 80.64 percent of total billed charges 291.85 291.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK BIOPSY BASIN CUSTOM SUP-DYNJ59264 CDM 0270 RC outpatient 24.67 24.67 24.67 74 18.26 percent of total billed charges 24.67 93 19.98 percent of total billed charges 24.67 24.67 other OPPS APC 24.67 24.67 other OPPS APC 24.67 27.63 6.82 percent of total billed charges 24.67 24.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK BIOPSY BASIN CUSTOM SUP-DYNJ59264A CDM 0270 RC outpatient 29.85 29.85 29.85 74 22.09 percent of total billed charges 29.85 93 24.18 percent of total billed charges 29.85 29.85 other OPPS APC 29.85 29.85 other OPPS APC 29.85 27.63 8.25 percent of total billed charges 29.85 29.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK HEART CABG ACCESSORY SUP-DYNJ59265 CDM 0270 RC outpatient 365.09 365.09 365.09 74 270.17 percent of total billed charges 365.09 93 295.72 percent of total billed charges 365.09 365.09 other OPPS APC 365.09 365.09 other OPPS APC 365.09 27.63 100.87 percent of total billed charges 365.09 365.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK CARDIAC CATHETER SUP-DYNJ59266A CDM 0481 RC outpatient 85.81 85.81 85.81 74 63.5 percent of total billed charges 85.81 93 69.51 percent of total billed charges 85.81 85.81 other OPPS APC 85.81 85.81 other OPPS APC 85.81 51 43.76 percent of total billed charges 85.81 85.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM CAROTID SUP-DYNJ59267 CDM 270009166 LOCAL 0270 RC outpatient 326.41 326.41 326.41 74 241.54 percent of total billed charges 326.41 93 264.39 percent of total billed charges 326.41 326.41 other OPPS APC 326.41 326.41 other OPPS APC 326.41 27.63 90.19 percent of total billed charges 326.41 326.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK CERVICAL ACCESSORY SUP-DYNJ59268 CDM 0270 RC outpatient 89.62 89.62 89.62 74 66.32 percent of total billed charges 89.62 93 72.59 percent of total billed charges 89.62 89.62 other OPPS APC 89.62 89.62 other OPPS APC 89.62 27.63 24.76 percent of total billed charges 89.62 89.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM CHEST SUP-DYNJ59269A CDM 0270 RC outpatient 312.26 312.26 312.26 74 231.07 percent of total billed charges 312.26 93 252.93 percent of total billed charges 312.26 312.26 other OPPS APC 312.26 312.26 other OPPS APC 312.26 27.63 86.28 percent of total billed charges 312.26 312.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM CRANI ACCESSORY SUP-DYNJ59270 CDM 270009165 LOCAL 0270 RC outpatient 540.74 540.74 540.74 74 400.15 percent of total billed charges 540.74 93 438 percent of total billed charges 540.74 540.74 other OPPS APC 540.74 540.74 other OPPS APC 540.74 27.63 149.41 percent of total billed charges 540.74 540.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM C SECTION SUP-DYNJ59271 CDM 270009192 LOCAL 0270 RC outpatient 195.24 195.24 195.24 74 144.48 percent of total billed charges 195.24 93 158.14 percent of total billed charges 195.24 195.24 other OPPS APC 195.24 195.24 other OPPS APC 195.24 27.63 53.94 percent of total billed charges 195.24 195.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM C SECTION SUP-DYNJ59271A CDM 270009192 LOCAL 0270 RC outpatient 227.92 227.92 227.92 74 168.66 percent of total billed charges 227.92 93 184.62 percent of total billed charges 227.92 227.92 other OPPS APC 227.92 227.92 other OPPS APC 227.92 27.63 62.97 percent of total billed charges 227.92 227.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL BASIN CUSTOM CV DRAPE SUP-DYNJ59272 CDM 0270 RC outpatient 270.93 270.93 270.93 74 200.49 percent of total billed charges 270.93 93 219.45 percent of total billed charges 270.93 270.93 other OPPS APC 270.93 270.93 other OPPS APC 270.93 27.63 74.86 percent of total billed charges 270.93 270.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL HYSTEROSCOPY D C SUP-DYNJ59273 CDM 0270 RC outpatient 53.44 53.44 53.44 74 39.55 percent of total billed charges 53.44 93 43.29 percent of total billed charges 53.44 53.44 other OPPS APC 53.44 53.44 other OPPS APC 53.44 27.63 14.77 percent of total billed charges 53.44 53.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK DAVINCI UROLOGY SUP-DYNJ59274 CDM 0270 RC outpatient 587.04 587.04 587.04 74 434.41 percent of total billed charges 587.04 93 475.5 percent of total billed charges 587.04 587.04 other OPPS APC 587.04 587.04 other OPPS APC 587.04 27.63 162.2 percent of total billed charges 587.04 587.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM DENTAL SUP-DYNJ59275A CDM 0270 RC outpatient 67.02 67.02 67.02 74 49.59 percent of total billed charges 67.02 93 54.29 percent of total billed charges 67.02 67.02 other OPPS APC 67.02 67.02 other OPPS APC 67.02 27.63 18.52 percent of total billed charges 67.02 67.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK DAVINCI DR IM SUP-DYNJ59276 CDM 0270 RC outpatient 627.43 627.43 627.43 74 464.3 percent of total billed charges 627.43 93 508.22 percent of total billed charges 627.43 627.43 other OPPS APC 627.43 627.43 other OPPS APC 627.43 27.63 173.36 percent of total billed charges 627.43 627.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL EP SUP-DYNJ59277 CDM 0270 RC outpatient 107.78 107.78 107.78 74 79.76 percent of total billed charges 107.78 93 87.3 percent of total billed charges 107.78 107.78 other OPPS APC 107.78 107.78 other OPPS APC 107.78 27.63 29.78 percent of total billed charges 107.78 107.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK FEMPOP BYPASS SUP-DYNJ59278 CDM 270009163 LOCAL 0270 RC outpatient 497.69 497.69 497.69 74 368.29 percent of total billed charges 497.69 93 403.13 percent of total billed charges 497.69 497.69 other OPPS APC 497.69 497.69 other OPPS APC 497.69 27.63 137.51 percent of total billed charges 497.69 497.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM GYN LAPAROSCOPY SUP-DYNJ59279 CDM 270009174 LOCAL 0270 RC outpatient 180.22 180.22 180.22 74 133.36 percent of total billed charges 180.22 93 145.98 percent of total billed charges 180.22 180.22 other OPPS APC 180.22 180.22 other OPPS APC 180.22 27.63 49.79 percent of total billed charges 180.22 180.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK HEART SUP-DYNJ59280A CDM 270009194 LOCAL 0270 RC outpatient 489.81 489.81 489.81 74 362.46 percent of total billed charges 489.81 93 396.75 percent of total billed charges 489.81 489.81 other OPPS APC 489.81 489.81 other OPPS APC 489.81 27.63 135.33 percent of total billed charges 489.81 489.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK LAPAROSCOPIC SUP-DYNJ59282 CDM 0270 RC outpatient 219.22 219.22 219.22 74 162.22 percent of total billed charges 219.22 93 177.57 percent of total billed charges 219.22 219.22 other OPPS APC 219.22 219.22 other OPPS APC 219.22 27.63 60.57 percent of total billed charges 219.22 219.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK MAJOR ABDOMINAL SUP-DYNJ59283 CDM 270009161 LOCAL 0270 RC outpatient 93.55 93.55 93.55 74 69.23 percent of total billed charges 93.55 93 75.78 percent of total billed charges 93.55 93.55 other OPPS APC 93.55 93.55 other OPPS APC 93.55 27.63 25.85 percent of total billed charges 93.55 93.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM MAJOR ORTHO HAND SUP-DYNJ59284 CDM 0270 RC outpatient 119.59 119.59 119.59 74 88.5 percent of total billed charges 119.59 93 96.87 percent of total billed charges 119.59 119.59 other OPPS APC 119.59 119.59 other OPPS APC 119.59 27.63 33.04 percent of total billed charges 119.59 119.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK MINOR SUP-DYNJ59286 CDM 0270 RC outpatient 70.1 70.1 70.1 74 51.87 percent of total billed charges 70.1 93 56.78 percent of total billed charges 70.1 70.1 other OPPS APC 70.1 70.1 other OPPS APC 70.1 27.63 19.37 percent of total billed charges 70.1 70.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM PACEMAKER DYNJ59287 SUP-DYNJ59287 CDM 0270 RC outpatient 72.12 72.12 72.12 74 53.37 percent of total billed charges 72.12 93 58.42 percent of total billed charges 72.12 72.12 other OPPS APC 72.12 72.12 other OPPS APC 72.12 27.63 19.93 percent of total billed charges 72.12 72.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM PACEMAKER SUP-DYNJ59287A CDM 0270 RC outpatient 114.85 114.85 114.85 74 84.99 percent of total billed charges 114.85 93 93.03 percent of total billed charges 114.85 114.85 other OPPS APC 114.85 114.85 other OPPS APC 114.85 27.63 31.73 percent of total billed charges 114.85 114.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK PLIF ACCESSORY SUP-DYNJ59288 CDM 0270 RC outpatient 142.73 142.73 142.73 74 105.62 percent of total billed charges 142.73 93 115.61 percent of total billed charges 142.73 142.73 other OPPS APC 142.73 142.73 other OPPS APC 142.73 27.63 39.44 percent of total billed charges 142.73 142.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SHOULDER ARTHROSCOPY SUP-DYNJ59289A CDM 270009121 LOCAL 0270 RC outpatient 218.95 218.95 218.95 74 162.02 percent of total billed charges 218.95 93 177.35 percent of total billed charges 218.95 218.95 other OPPS APC 218.95 218.95 other OPPS APC 218.95 27.63 60.5 percent of total billed charges 218.95 218.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM TAVR SUP-DYNJ59291 CDM 270009161 LOCAL 0270 RC outpatient 218.79 218.79 218.79 74 161.9 percent of total billed charges 218.79 93 177.22 percent of total billed charges 218.79 218.79 other OPPS APC 218.79 218.79 other OPPS APC 218.79 27.63 60.45 percent of total billed charges 218.79 218.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM TOTAL HIP ACCESSORY SUP-DYNJ59292 CDM 270009120 LOCAL 0270 RC outpatient 102.61 102.61 102.61 74 75.93 percent of total billed charges 102.61 93 83.11 percent of total billed charges 102.61 102.61 other OPPS APC 102.61 102.61 other OPPS APC 102.61 27.63 28.35 percent of total billed charges 102.61 102.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL TOTAL JOINT SUP-DYNJ59293 CDM 0270 RC outpatient 630.86 630.86 630.86 74 466.84 percent of total billed charges 630.86 93 511 percent of total billed charges 630.86 630.86 other OPPS APC 630.86 630.86 other OPPS APC 630.86 27.63 174.31 percent of total billed charges 630.86 630.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL TOTAL JOINT SUP-DYNJ59293A CDM 0270 RC outpatient 997.05 997.05 997.05 74 737.82 percent of total billed charges 997.05 93 807.61 percent of total billed charges 997.05 997.05 other OPPS APC 997.05 997.05 other OPPS APC 997.05 27.63 275.48 percent of total billed charges 997.05 997.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL TOTAL KNEE ACCESSORY SUP-DYNJ59294 CDM 270009119 LOCAL 0270 RC outpatient 67.16 67.16 67.16 74 49.7 percent of total billed charges 67.16 93 54.4 percent of total billed charges 67.16 67.16 other OPPS APC 67.16 67.16 other OPPS APC 67.16 27.63 18.56 percent of total billed charges 67.16 67.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM TOTAL SHOULDER ACCESSORY SUP-DYNJ59295A CDM 0270 RC outpatient 202.53 202.53 202.53 74 149.87 percent of total billed charges 202.53 93 164.05 percent of total billed charges 202.53 202.53 other OPPS APC 202.53 202.53 other OPPS APC 202.53 27.63 55.96 percent of total billed charges 202.53 202.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK TROCH NAIL SUP-DYNJ59296 CDM 0270 RC outpatient 165.77 165.77 165.77 74 122.67 percent of total billed charges 165.77 93 134.27 percent of total billed charges 165.77 165.77 other OPPS APC 165.77 165.77 other OPPS APC 165.77 27.63 45.8 percent of total billed charges 165.77 165.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK VITRECTOMY II SUP-DYNJ59297A CDM 0270 RC outpatient 146.14 146.14 146.14 74 108.14 percent of total billed charges 146.14 93 118.37 percent of total billed charges 146.14 146.14 other OPPS APC 146.14 146.14 other OPPS APC 146.14 27.63 40.38 percent of total billed charges 146.14 146.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK CUSTOM SHAKUR SUP-DYNJ62390 CDM 0270 RC outpatient 421.03 421.03 421.03 74 311.56 percent of total billed charges 421.03 93 341.03 percent of total billed charges 421.03 421.03 other OPPS APC 421.03 421.03 other OPPS APC 421.03 27.63 116.33 percent of total billed charges 421.03 421.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK ANESTHESIA STANDARD SIZE 2 INFANT FACE DOME ROUND BRIDGE FLEXIBLE TOP VALVE INFLATION PORT LATEX-FREE SUP-DYNJAAMASK32 CDM 0270 RC outpatient 3.58 3.58 3.58 3.58 other OPPS APC 3.58 3.58 other OPPS APC 3.58 27.63 0.99 percent of total billed charges 3.58 3.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTOR M/M WITH ROTATOR SUP-DYNJADAPMM CDM 0270 RC outpatient 2.8 2.8 2.8 74 2.07 percent of total billed charges 2.8 93 2.27 percent of total billed charges 2.8 2.8 other OPPS APC 2.8 2.8 other OPPS APC 2.8 27.63 0.77 percent of total billed charges 2.8 2.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CIRCUIT BREATHING PEDIATRIC L90 IN 1 L 2 LIMB EXPAND TUBE GAS SAMPLE PORT FLEXIBLE LIGHTWEIGHT LATEX FREE TRANSPARENT SUP-DYNJAP9810_160766 CDM 0270 RC outpatient 15.89 15.89 15.89 74 11.76 percent of total billed charges 15.89 93 12.87 percent of total billed charges 15.89 15.89 other OPPS APC 15.89 15.89 other OPPS APC 15.89 27.63 4.39 percent of total billed charges 15.89 15.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DECANTER BAG 6 INCH VIAL SUP-DYNJDEC06 CDM 0270 RC outpatient 2.55 2.55 2.55 74 1.89 percent of total billed charges 2.55 93 2.07 percent of total billed charges 2.55 2.55 other OPPS APC 2.55 2.55 other OPPS APC 2.55 27.63 0.7 percent of total billed charges 2.55 2.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COUNTER SPONGE BAG LATEX FREE BLUE IV POLE SUP-DYNJE1001 CDM 0270 RC outpatient 0.65 0.65 0.65 74 0.48 percent of total billed charges 0.65 93 0.53 percent of total billed charges 0.65 0.65 other OPPS APC 0.65 0.65 other OPPS APC 0.65 27.63 0.18 percent of total billed charges 0.65 0.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOWL GUIDEWIRE 5 TAB BASIN RING GRASPABLE STERILE LATEX SUP-DYNJGUIDEB2 CDM 0481 RC outpatient 19.03 19.03 19.03 74 14.08 percent of total billed charges 19.03 93 15.41 percent of total billed charges 19.03 19.03 other OPPS APC 19.03 19.03 other OPPS APC 19.03 51 9.71 percent of total billed charges 19.03 19.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. *ORDER WITH SUB AS #58154. GUIDEWIRE VASCULAR FIXED CORE PRECOATED 0.035IN 180CM 3MM TIP STAINLESS STEEL PTFE COATED J-TIP STRAIGHT TAPER LATEX-FREE STERILE SUP-DYNJGWIRE02H CDM 0481 RC outpatient 23.77 23.77 23.77 23.77 other OPPS APC 23.77 23.77 other OPPS APC 23.77 51 12.12 percent of total billed charges 23.77 23.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE INFLATION L10 IN 20 ML STERILE LATEX FREE DISPOSABLE ROYAL BLUE ANGIO SUP-DYNJINFLATE CDM 0270 RC outpatient 80.79 80.79 80.79 74 59.78 percent of total billed charges 80.79 93 65.44 percent of total billed charges 80.79 80.79 other OPPS APC 80.79 80.79 other OPPS APC 80.79 27.63 22.32 percent of total billed charges 80.79 80.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL PROXIMA SMS T L135 IN X W74 IN L24 IN X W20 IN ABSORBENT REINFORCE HOOK LOOP LINE HOLDER POUCH STERILE LATEX FREE DISPOSABLE CRANIOTOMY SUP-DYNJP10040 CDM outpatient 35.26 35.26 35.26 35.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE SURGICAL ECLIPSE L23 IN CSR WRAP GOWN STERILE LATEX FREE BLUE SUP-DYNJP2000 CDM 0270 RC outpatient 1.6 1.6 1.6 74 1.18 percent of total billed charges 1.6 93 1.3 percent of total billed charges 1.6 1.6 other OPPS APC 1.6 1.6 other OPPS APC 1.6 27.63 0.44 percent of total billed charges 1.6 1.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GOWN SURGICAL SIRUS SMS POLYETHYLENE LARGE L43 IN AAMI LEVEL 4 IMPERVIOUS SLEEVE REINFORCE HOOK LOOP CLOSURE STERILE LATEX FREE DISPOSABLE BLUE SUP-DYNJP2207S CDM 0270 RC outpatient 7.76 7.76 7.76 74 5.74 percent of total billed charges 7.76 93 6.29 percent of total billed charges 7.76 7.76 other OPPS APC 7.76 7.76 other OPPS APC 7.76 27.63 2.14 percent of total billed charges 7.76 7.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GOWN SURGICAL SIRUS SMS POLYETHYLENE XL L47 IN AAMI LEVEL 4 IMPERVIOUS SLEEVE REINFORCE HOOK LOOP CLOSURE STERILE LATEX FREE DISPOSABLE BLUE SUP-DYNJP2208S CDM 0270 RC outpatient 8.49 8.49 8.49 74 6.28 percent of total billed charges 8.49 93 6.88 percent of total billed charges 8.49 8.49 other OPPS APC 8.49 8.49 other OPPS APC 8.49 27.63 2.35 percent of total billed charges 8.49 8.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GOWN SURGICAL SIRUS SMS POLYETHYLENE 2XL L49 IN AAMI LEVEL 4 IMPERVIOUS SLEEVE REINFORCE HOOK LOOP CLOSURE STERILE LATEX FREE DISPOSABLE BLUE SUP-DYNJP2209S CDM 0270 RC outpatient 11.2 11.2 11.2 74 8.29 percent of total billed charges 11.2 93 9.07 percent of total billed charges 11.2 11.2 other OPPS APC 11.2 11.2 other OPPS APC 11.2 27.63 3.09 percent of total billed charges 11.2 11.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GOWN SURGICAL SIRUS SMS POLYETHYLENE XL XLONG L56 IN AAMI LEVEL 4 IMPERVIOUS REINFORCE HOOK LOOP CLOSURE STERILE LATEX FREE DISPOSABLE BLUE SUP-DYNJP2228S CDM 0270 RC outpatient 9.75 9.75 9.75 74 7.22 percent of total billed charges 9.75 93 7.9 percent of total billed charges 9.75 9.75 other OPPS APC 9.75 9.75 other OPPS APC 9.75 27.63 2.69 percent of total billed charges 9.75 9.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GOWN SURGICAL 2XL XLONG 56IN BLUE PREVENTION PLUS DISPOSABLE STERILE LF AAMI LEVEL 4 IMPERVIOUS HOOK LOOP CLOSURE SUP-DYNJP2303P CDM 0270 RC outpatient 12.96 12.96 12.96 74 9.59 percent of total billed charges 12.96 93 10.5 percent of total billed charges 12.96 12.96 other OPPS APC 12.96 12.96 other OPPS APC 12.96 27.63 3.58 percent of total billed charges 12.96 12.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GOWN SURGICAL LARGE L43 IN LEVEL 4 REINFORCE HOOK LOOP CLOSURE BREATHABLE FILM SLEEVE STERILE LATEX FREE DISPOSABLE BLUE SUP-DYNJP2306P CDM 0270 RC outpatient 9.79 9.79 9.79 74 7.24 percent of total billed charges 9.79 93 7.93 percent of total billed charges 9.79 9.79 other OPPS APC 9.79 9.79 other OPPS APC 9.79 27.63 2.7 percent of total billed charges 9.79 9.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GOWN SURGICAL PREVENTION PLUS 4XL AAMI LEVEL 4 IMPERVIOUS HOOK LOOP CLOSURE BREATHABLE STERILE LATEX FREE DISPOSABLE BLUE SUP-DYNJP2309P CDM 0270 RC outpatient 17.79 17.79 17.79 74 13.16 percent of total billed charges 17.79 93 14.41 percent of total billed charges 17.79 17.79 other OPPS APC 17.79 17.79 other OPPS APC 17.79 27.63 4.92 percent of total billed charges 17.79 17.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER TABLE SMS STANDARD L90 IN X W60 IN REINFORCE HEAVY DUTY STERILE LATEX FREE DISPOSABLE SUP-DYNJP2314 CDM 0270 RC outpatient 8.41 8.41 8.41 74 6.22 percent of total billed charges 8.41 93 6.81 percent of total billed charges 8.41 8.41 other OPPS APC 8.41 8.41 other OPPS APC 8.41 27.63 2.32 percent of total billed charges 8.41 8.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GOWN SURGICAL ORBIS 4XL LEVEL 3 FULL REINFORCE SET IN SLEEVE STERILE LATEX FREE BLUE SUP-DYNJP2369P CDM 0270 RC outpatient 17.79 17.79 17.79 74 13.16 percent of total billed charges 17.79 93 14.41 percent of total billed charges 17.79 17.79 other OPPS APC 17.79 17.79 other OPPS APC 17.79 27.63 4.92 percent of total billed charges 17.79 17.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GOWN SURGICAL ORBIS 2XL L 56.5 IN AAMI LEVEL 4 HOOK LOOP CLOSURE LOW LINT STERILE LATEX FREE DARK BLUE SUP-DYNJP2373P_440916 CDM 0270 RC outpatient 12.89 12.89 12.89 74 9.54 percent of total billed charges 12.89 93 10.44 percent of total billed charges 12.89 12.89 other OPPS APC 12.89 12.89 other OPPS APC 12.89 27.63 3.56 percent of total billed charges 12.89 12.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL SMS L26 IN X W15 IN UTILITY TAPE STERILE LATEX FREE DISPOSABLE SUP-DYNJP2405 CDM 0270 RC outpatient 0.62 0.62 0.62 74 0.46 percent of total billed charges 0.62 93 0.5 percent of total billed charges 0.62 0.62 other OPPS APC 0.62 0.62 other OPPS APC 0.62 27.63 0.17 percent of total billed charges 0.62 0.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL PROXIMA SMS 3/4 L77 IN X W53 IN SHEET STERILE LATEX FREE DISPOSABLE BLUE SUP-DYNJP2414 CDM 0270 RC outpatient 3.77 3.77 3.77 74 2.79 percent of total billed charges 3.77 93 3.05 percent of total billed charges 3.77 3.77 other OPPS APC 3.77 3.77 other OPPS APC 3.77 27.63 1.04 percent of total billed charges 3.77 3.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEGGINGS SURGICAL PROXIMA SMS L48 IN X W31 IN L6 IN CUFF STERILE LATEX FREE DISPOSABLE SUP-DYNJP2460A CDM 0270 RC outpatient 5.67 5.67 5.67 74 4.2 percent of total billed charges 5.67 93 4.59 percent of total billed charges 5.67 5.67 other OPPS APC 5.67 5.67 other OPPS APC 5.67 27.63 1.57 percent of total billed charges 5.67 5.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL PROXIMA SMS L76 IN X W54 IN L24 IN X W6 IN U DRAPE IMPERVIOUS SPLIT ADHESIVE STERILE LATEX FREE DISPOSABLE SUP-DYNJP2499 CDM 0270 RC outpatient 5.9 5.9 5.9 74 4.37 percent of total billed charges 5.9 93 4.78 percent of total billed charges 5.9 5.9 other OPPS APC 5.9 5.9 other OPPS APC 5.9 27.63 1.63 percent of total billed charges 5.9 5.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE EQUIPMENT PROXIMA SMS L53 IN X W24 IN MAYOSTAND COVER STERILE LATEX FREE DISPOSABLE SUP-DYNJP2500 CDM 0270 RC outpatient 2.01 2.01 2.01 74 1.49 percent of total billed charges 2.01 93 1.63 percent of total billed charges 2.01 2.01 other OPPS APC 2.01 2.01 other OPPS APC 2.01 27.63 0.56 percent of total billed charges 2.01 2.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL SMS T L121 IN X W102 IN X H78 IN L12 IN X W4 IN FENESTRATE ABSORBENT REINFORCE ARMBOARD COVER INSTRUMENT PAD STERILE LATEX FREE DISPOSABLE LAPAROTOMY T DRAPELAPAROTOMY T DRAPE SUP-DYNJP3003 CDM 0270 RC outpatient 12.68 12.68 12.68 74 9.38 percent of total billed charges 12.68 93 10.27 percent of total billed charges 12.68 12.68 other OPPS APC 12.68 12.68 other OPPS APC 12.68 27.63 3.5 percent of total billed charges 12.68 12.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL PROXIMA SMS L14 IN W4 IN CONTOUR L121 IN X W102 IN X H78 IN L29 IN X W29 IN FENESTRATE ABSORBENT REINFORCE HOOK LOOP CLOSURE STERILE LATEX FREE DISPOSABLE TRANSVERSE LAPAROTOMY SUP-DYNJP3005 CDM 0270 RC outpatient 12.65 12.65 12.65 74 9.36 percent of total billed charges 12.65 93 10.25 percent of total billed charges 12.65 12.65 other OPPS APC 12.65 12.65 other OPPS APC 12.65 27.63 3.5 percent of total billed charges 12.65 12.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL PROXIMA SMS PEDIATRIC L6 IN W6 IN L121 IN X W102 IN X H78 IN L20 IN X W18 IN FENESTRATE ABSORBENT REINFORCE T DRAPE ARMBOARD COVER STERILE LATEX FREE DISPOSABLE LAPAROTOMY SUP-DYNJP3009 CDM 0270 RC outpatient 14.24 14.24 14.24 74 10.54 percent of total billed charges 14.24 93 11.53 percent of total billed charges 14.24 14.24 other OPPS APC 14.24 14.24 other OPPS APC 14.24 27.63 3.93 percent of total billed charges 14.24 14.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL PROXIMA SMS L122 IN X W102 IN X H78 IN ABDOMINAL ABSORBENT REINFORCE FENESTRATE MAJOR STERILE LATEX FREE DISPOSABLE SUP-DYNJP3103 CDM 0270 RC outpatient 27.25 27.25 27.25 74 20.17 percent of total billed charges 27.25 93 22.07 percent of total billed charges 27.25 27.25 other OPPS APC 27.25 27.25 other OPPS APC 27.25 27.63 7.53 percent of total billed charges 27.25 27.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL PROXIMA SMS L80 IN X W75 IN PERIGROIN PACK BILATERAL SPLIT STERILE LATEX FREE DISPOSABLE SUP-DYNJP4007 CDM 0270 RC outpatient 12.71 12.71 12.71 74 9.41 percent of total billed charges 12.71 93 10.3 percent of total billed charges 12.71 12.71 other OPPS APC 12.71 12.71 other OPPS APC 12.71 27.63 3.51 percent of total billed charges 12.71 12.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL PROXIMA SMS L159 IN X W 84 IN X L 30 IN X W 9 IN 2 FENESTRATE ABSORBANT REINFORCE PANEL POUCH STERILE LATEX FREE DISPOSABLE FEMORAL ANGIOGRAPHY SUP-DYNJP4119 CDM outpatient 23.99 23.99 23.99 23.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL XL L159 IN X W80 IN OD5 1/2 IN POUCH 2 FLUID CONTROL HDA REINFORCEMENT 2 SIDE PANEL FEMORAL ANGIOGRAPHY SUP-DYNJP4119HDA CDM 0270 RC outpatient 41.65 41.65 41.65 74 30.82 percent of total billed charges 41.65 93 33.74 percent of total billed charges 41.65 41.65 other OPPS APC 41.65 41.65 other OPPS APC 41.65 27.63 11.51 percent of total billed charges 41.65 41.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL ECLIPSE T L76 IN X W44 IN L23 IN X W16 IN CYSTOSCOPY VI DRAPE ABSORBENT REINFORCEMENT MESH SCREEN STERILE LATEX FREE SUP-DYNJP5050 CDM 270009170 LOCAL 0270 RC outpatient 18.83 18.83 18.83 74 13.93 percent of total billed charges 18.83 93 15.25 percent of total billed charges 18.83 18.83 other OPPS APC 18.83 18.83 other OPPS APC 18.83 27.63 5.2 percent of total billed charges 18.83 18.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL SMS L44.5 IN X W40 IN L32 IN X W29 IN UNDER BUTTOCK POUCH BACK STERILE LATEX FREE SUP-DYNJP6004 CDM 0270 RC outpatient 5.47 5.47 5.47 74 4.05 percent of total billed charges 5.47 93 4.43 percent of total billed charges 5.47 5.47 other OPPS APC 5.47 5.47 other OPPS APC 5.47 27.63 1.51 percent of total billed charges 5.47 5.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL SMS L44.5 IN X W40 IN L32 IN X W29 IN UNDER BUTTOCK POUCH BACK STERILE LATEX FREE SUP-DYNJP6006 CDM 0270 RC outpatient 8.34 8.34 8.34 74 6.17 percent of total billed charges 8.34 93 6.76 percent of total billed charges 8.34 8.34 other OPPS APC 8.34 8.34 other OPPS APC 8.34 27.63 2.3 percent of total billed charges 8.34 8.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL PROXIMA SMS L5 IN W5 IN L121 IN X W78 IN L28 IN X W20 IN THYROID DIAMOND FENESTRATE ABSORBENT REINFORCE ADHESIVE CONTACT CLOSURE STERILE LATEX FREE DISPOSABLE SUP-DYNJP7002 CDM 0270 RC outpatient 10.9 10.9 10.9 74 8.07 percent of total billed charges 10.9 93 8.83 percent of total billed charges 10.9 10.9 other OPPS APC 10.9 10.9 other OPPS APC 10.9 27.63 3.01 percent of total billed charges 10.9 10.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL SMS L128 IN X W121 IN X H90 IN EXTREMITY ABSORBENT REINFORCE CIRCULAR FENESTRATE ARMBOARD COVER HOOK LOOP LINE HOLDER STERILE LATEX FREE DISPOSABLE SUP-DYNJP8003 CDM 0270 RC outpatient 17.9 17.9 17.9 74 13.25 percent of total billed charges 17.9 93 14.5 percent of total billed charges 17.9 17.9 other OPPS APC 17.9 17.9 other OPPS APC 17.9 27.63 4.95 percent of total billed charges 17.9 17.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL PROXIMA L121 IN X W74 IN BILATERAL EXTREMITY REINFORCED FENESTRATED STERILE LATEX FREE SUP-DYNJP8006 CDM outpatient 13.94 13.94 13.94 13.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL SMS L108 IN X W77 IN L37 IN X W2.5 IN ADHESIVE IMPERVIOUS ULTRA LOW LINT PUNCTURE RESISTANT STERILE LATEX FREE DISPOSABLE SUP-DYNJP8304UG CDM 0270 RC outpatient 17.13 17.13 17.13 74 12.68 percent of total billed charges 17.13 93 13.88 percent of total billed charges 17.13 17.13 other OPPS APC 17.13 17.13 other OPPS APC 17.13 27.63 4.73 percent of total billed charges 17.13 17.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL ECLIPSE LITHOTOMY IV GYN T SHEET NO GOWN STERILE LATEX FREE SUP-DYNJP9010S CDM 270009174 LOCAL 0270 RC outpatient 14.01 14.01 14.01 74 10.37 percent of total billed charges 14.01 93 11.35 percent of total billed charges 14.01 14.01 other OPPS APC 14.01 14.01 other OPPS APC 14.01 27.63 3.87 percent of total billed charges 14.01 14.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL ECLIPSE LITHOTOMY IV GYN T SHEET NO GOWN STERILE LATEX FREE SUP-DYNJP9030 CDM 270009174 LOCAL 0270 RC outpatient 14.01 14.01 14.01 74 10.37 percent of total billed charges 14.01 93 11.35 percent of total billed charges 14.01 14.01 other OPPS APC 14.01 14.01 other OPPS APC 14.01 27.63 3.87 percent of total billed charges 14.01 14.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL ECLIPSE LITHOTOMY IV GYN T SHEET NO GOWN STERILE LATEX FREE SUP-DYNJP9030A CDM 270009174 LOCAL 0270 RC outpatient 14.01 14.01 14.01 74 10.37 percent of total billed charges 14.01 93 11.35 percent of total billed charges 14.01 14.01 other OPPS APC 14.01 14.01 other OPPS APC 14.01 27.63 3.87 percent of total billed charges 14.01 14.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE HIGH PRESSURE POLYCARBONATE 10ML WHITE SUP-DYNJSYRPC10W CDM 0481 RC outpatient 5.01 5.01 5.01 74 3.71 percent of total billed charges 5.01 93 4.06 percent of total billed charges 5.01 5.01 other OPPS APC 5.01 5.01 other OPPS APC 5.01 51 2.56 percent of total billed charges 5.01 5.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING HIGH PRESS 10 M/F ROT CLR SUP-DYNJTBGHP10R CDM 0270 RC outpatient 8.83 8.83 8.83 74 6.53 percent of total billed charges 8.83 93 7.15 percent of total billed charges 8.83 8.83 other OPPS APC 8.83 8.83 other OPPS APC 8.83 27.63 2.44 percent of total billed charges 8.83 8.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY SURGICAL INFANT L2.5 IN OD21 GA LUMBAR PUNCTURE NEEDLE MANOMETER LATEX SUP-DYNJTS07025_705216 CDM 270009046 LOCAL 0270 RC outpatient 90.38 90.38 90.38 74 66.88 percent of total billed charges 90.38 93 73.21 percent of total billed charges 90.38 90.38 other OPPS APC 90.38 90.38 other OPPS APC 90.38 27.63 24.97 percent of total billed charges 90.38 90.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY SPINAL ADULT L 3.5IN OD 20GA NEEDLE SYRINGE LIDOCAINE ABSORBANT TOWEL LATEX FREE LUMBAR PUNCTURE SUP-DYNJTS4301 CDM 270009046 LOCAL 0270 RC outpatient 49.3 49.3 49.3 74 36.48 percent of total billed charges 49.3 93 39.93 percent of total billed charges 49.3 49.3 other OPPS APC 49.3 49.3 other OPPS APC 49.3 27.63 13.62 percent of total billed charges 49.3 49.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. *ORDER WITH SUB AS #58154. SPIKE TUBING SHORT 2IN STANDARD BORE FIXED MALE LL 1-WAY STOPCOCK CLEAR LATEX-FREE STERILE 25/CA SUP-DYNJVSPIKE1 CDM 0481 RC outpatient 7.56 7.56 7.56 7.56 other OPPS APC 7.56 7.56 other OPPS APC 7.56 51 3.86 percent of total billed charges 7.56 7.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN WOUND CHANNEL 24FR DIA ROUND FULL FLUTED W/O TROCAR LATEX-FREE NON-RADIOLUCENT SILICONE SUP-DYNJWE2234 CDM 0270 RC outpatient 44.63 44.63 44.63 74 33.03 percent of total billed charges 44.63 93 36.15 percent of total billed charges 44.63 44.63 other OPPS APC 44.63 44.63 other OPPS APC 44.63 27.63 12.33 percent of total billed charges 44.63 44.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 7 CUSPID SECOND PRIMARY MOLAR UPPER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-E-UR-7 CDM 0270 RC outpatient 17.05 17.05 17.05 74 12.62 percent of total billed charges 17.05 93 13.81 percent of total billed charges 17.05 17.05 other OPPS APC 17.05 17.05 other OPPS APC 17.05 27.63 4.71 percent of total billed charges 17.05 17.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH VASCULAR XENOSURE BOVINE PERICARDIUM THK.45 MM TAPER L8 CM X W.8 CM BIOLOGIC STERILE DISPOSABLE SUP-E0.8P8 CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL EPIC FLEXFIT PORCINE PERICARDIAL LOW PROFILE H16 MM OD25 MM ID23 MM BIOPROSTHESIS STENT HOLDER SUP-E100-25M-00 CDM 0270 RC outpatient 11908 11908 11908 74 8811.92 percent of total billed charges 11908 93 9645.48 percent of total billed charges 11908 11908 other OPPS APC 11908 11908 other OPPS APC 11908 27.63 3290.18 percent of total billed charges 11908 11908 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL EPIC FLEXFIT PORCINE PERICARDIAL H17 MM OD35 MM ID27 MM BIOPROSTHESIS STENT HOLDER LOW PROFILE SUP-E100-27M-00 CDM 0270 RC outpatient 11908 11908 11908 74 8811.92 percent of total billed charges 11908 93 9645.48 percent of total billed charges 11908 11908 other OPPS APC 11908 11908 other OPPS APC 11908 27.63 3290.18 percent of total billed charges 11908 11908 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL EPIC FLEXFIT PORCINE PERICARDIAL LOW PROFILE H19 MM OD29 MM ID27 MM BIOPROSTHESIS STENT HOLDER SUP-E100-29M-00 CDM 0270 RC outpatient 11908 11908 11908 74 8811.92 percent of total billed charges 11908 93 9645.48 percent of total billed charges 11908 11908 other OPPS APC 11908 11908 other OPPS APC 11908 27.63 3290.18 percent of total billed charges 11908 11908 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL EPIC FLEXFIT PORCINE PERICARDIAL LOW PROFILE H20 MM OD31 MM ID29 MM BIOPROSTHESIS STENT HOLDER SUP-E100-31M-00 CDM 0270 RC outpatient 11908 11908 11908 74 8811.92 percent of total billed charges 11908 93 9645.48 percent of total billed charges 11908 11908 other OPPS APC 11908 11908 other OPPS APC 11908 27.63 3290.18 percent of total billed charges 11908 11908 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL EPIC FLEXFIT PORCINE PERICARDIAL LOW PROFILE H20 MM OD33 MM ID31 MM BIOPROSTHESIS STENT HOLDER SUP-E100-33M-00 CDM 0270 RC outpatient 11908 11908 11908 74 8811.92 percent of total billed charges 11908 93 9645.48 percent of total billed charges 11908 11908 other OPPS APC 11908 11908 other OPPS APC 11908 27.63 3290.18 percent of total billed charges 11908 11908 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EMBOLECTOMY L60 CM OD2 FR ODSEC4.5 MM .5 ML 1 LUMEN BALLOON LATEX SUP-E1601-26 CDM 0270 RC outpatient 179.4 179.4 179.4 74 132.76 percent of total billed charges 179.4 93 145.31 percent of total billed charges 179.4 179.4 other OPPS APC 179.4 179.4 other OPPS APC 179.4 27.63 49.57 percent of total billed charges 179.4 179.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EMBOLECTOMY LEMAITRE L80 CM OD3 FR ODSEC8 MM .20 ML STERILE LATEX DISPOSABLE SUP-E1601-38 CDM 0270 RC outpatient 179.4 179.4 179.4 74 132.76 percent of total billed charges 179.4 93 145.31 percent of total billed charges 179.4 179.4 other OPPS APC 179.4 179.4 other OPPS APC 179.4 27.63 49.57 percent of total billed charges 179.4 179.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EMBOLECTOMY LEMAITRE L80 CM OD4 FR ODSEC10.5 MM 75 ML STERILE LATEX DISPOSABLE SUP-E1601-48 CDM 0270 RC outpatient 179.4 179.4 179.4 74 132.76 percent of total billed charges 179.4 93 145.31 percent of total billed charges 179.4 179.4 other OPPS APC 179.4 179.4 other OPPS APC 179.4 27.63 49.57 percent of total billed charges 179.4 179.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EMBOLECTOMY LEMAITRE L80 CM OD5 FR ODSEC13 MM 15 ML STERILE LATEX DISPOSABLE SUP-E1601-58 CDM 270009142 LOCAL 0270 RC outpatient 179.4 179.4 179.4 74 132.76 percent of total billed charges 179.4 93 145.31 percent of total billed charges 179.4 179.4 other OPPS APC 179.4 179.4 other OPPS APC 179.4 27.63 49.57 percent of total billed charges 179.4 179.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EMBOLECTOMY LEMAITRE L80 CM OD6 FR ODSEC13.5 MM 16 ML STERILE LATEX DISPOSABLE SUP-E1601-68 CDM 270009142 LOCAL 0270 RC outpatient 179.4 179.4 179.4 74 132.76 percent of total billed charges 179.4 93 145.31 percent of total billed charges 179.4 179.4 other OPPS APC 179.4 179.4 other OPPS APC 179.4 27.63 49.57 percent of total billed charges 179.4 179.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EMBOLECTOMY FOGARTY THRULUMEN 40CM 3FR 5MM SS SILICONE NATURAL RUBBER STERILE LATEX ARTERY OTW RADIOPAQUE SUP-E1651-34 CDM 0270 RC outpatient 309.4 309.4 309.4 74 228.96 percent of total billed charges 309.4 93 250.61 percent of total billed charges 309.4 309.4 other OPPS APC 309.4 309.4 other OPPS APC 309.4 27.63 85.49 percent of total billed charges 309.4 309.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EMBOLECTOMY FOGARTY THRULUMEN 80CM 3FR 5MM SS SILICONE NATURAL RUBBER STERILE LATEX ARTERY OTW RADIOPAQUE SUP-E1651-38 CDM 0270 RC outpatient 309.4 309.4 309.4 74 228.96 percent of total billed charges 309.4 93 250.61 percent of total billed charges 309.4 309.4 other OPPS APC 309.4 309.4 other OPPS APC 309.4 27.63 85.49 percent of total billed charges 309.4 309.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EMBOLECTOMY FOGARTY THRULUMEN 40CM 4FR 9MM SS SILICONE NATURAL RUBBER STERILE LATEX ARTERY OTW RADIOPAQUE SUP-E1651-44 CDM 0270 RC outpatient 309.4 309.4 309.4 74 228.96 percent of total billed charges 309.4 93 250.61 percent of total billed charges 309.4 309.4 other OPPS APC 309.4 309.4 other OPPS APC 309.4 27.63 85.49 percent of total billed charges 309.4 309.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EMBOLECTOMY LEMAITRE L80 CM OD5 FR ODSEC11 MM 1.5 ML DISTAL 1 LUMEN BALLOON OTW SYRINGE STERILE LATEX DISPOSABLE WHITE SUP-E1651-58 CDM 0270 RC outpatient 215.8 215.8 215.8 74 159.69 percent of total billed charges 215.8 93 174.8 percent of total billed charges 215.8 215.8 other OPPS APC 215.8 215.8 other OPPS APC 215.8 27.63 59.63 percent of total billed charges 215.8 215.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EMBOLECTOMY LEMAITRE .035 IN C1.6 ML L40 CM OD7 FR ODSEC13 MM 2 LUMEN OTW IRRIGATION RAPID EXCHANGE GUIDEWIRE LATEX BLUE SUP-E1651-64 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EMBOLECTOMY FOGARTY THRULUMEN 40CM 5.5FR 11MM SS SILICONE NATURAL RUBBER LATEX ARTERIAL OTW RADIOPAQUE ACCEPTS SUP-E1651-84 CDM 0270 RC outpatient 309.4 309.4 309.4 74 228.96 percent of total billed charges 309.4 93 250.61 percent of total billed charges 309.4 309.4 other OPPS APC 309.4 309.4 other OPPS APC 309.4 27.63 85.49 percent of total billed charges 309.4 309.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL EPIC PLUS TISSUE 25MM 16MM 22.6MM STENT 9MM PROTRUSION FLEXIBLE STENT PORCINE AORTIC VALVE CUSPS INTRA ANNULAR SUPRA CUFF LINX MRI-CONDITIONAL SUP-E200-25M CDM 0270 RC outpatient 13015.4 13015.4 13015.4 13015.4 other OPPS APC 13015.4 13015.4 other OPPS APC 13015.4 27.63 3596.17 percent of total billed charges 13015.4 13015.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL EPIC PLUS TISSUE 27MM 17MM 24.5MM STENT 9MM PROTRUSION FLEXIBLE STENT PORCINE AORTIC VALVE CUSPS INTRA ANNULAR SUPRA CUFF LINX MRI-CONDITIONAL SUP-E200-27M CDM 0270 RC outpatient 13015.4 13015.4 13015.4 13015.4 other OPPS APC 13015.4 13015.4 other OPPS APC 13015.4 27.63 3596.17 percent of total billed charges 13015.4 13015.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL EPIC PLUS TISSUE 29MM 19MM 26.3MM STENT 10MM PROTRUSION FLEXIBLE STENT PORCINE AORTIC VALVE CUSPS INTRA ANNULAR SUPRA CUFF LINX MRI-CONDITIONAL SUP-E200-29M CDM 0270 RC outpatient 13015.4 13015.4 13015.4 13015.4 other OPPS APC 13015.4 13015.4 other OPPS APC 13015.4 27.63 3596.17 percent of total billed charges 13015.4 13015.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL EPIC PLUS TISSUE 31MM 20MM 28.4MM STENT 10MM PROTRUSION FLEXIBLE STENT PORCINE AORTIC VALVE CUSPS INTRA ANNULAR SUPRA CUFF LINX MRI-CONDITIONAL SUP-E200-31M CDM 0270 RC outpatient 13015.4 13015.4 13015.4 13015.4 other OPPS APC 13015.4 13015.4 other OPPS APC 13015.4 27.63 3596.17 percent of total billed charges 13015.4 13015.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL EPIC PLUS TISSUE 33MM 20MM 30.3MM STENT 11MM PROTRUSION FLEXIBLE STENT PORCINE AORTIC VALVE CUSPS INTRA ANNULAR SUPRA CUFF LINX MRI-CONDITIONAL SUP-E200-33M CDM 0270 RC outpatient 13015.4 13015.4 13015.4 13015.4 other OPPS APC 13015.4 13015.4 other OPPS APC 13015.4 27.63 3596.17 percent of total billed charges 13015.4 13015.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER OCCLUSION PRUITT L24 CM OD12 FR AORTA STERILE LATEX FREE DISPOSABLE SUP-E2100-12 CDM 0270 RC outpatient 1323.4 1323.4 1323.4 74 979.32 percent of total billed charges 1323.4 93 1071.95 percent of total billed charges 1323.4 1323.4 other OPPS APC 1323.4 1323.4 other OPPS APC 1323.4 27.63 365.66 percent of total billed charges 1323.4 1323.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL ARGON PLUS VALLEYLAB 10FT 1IN DISPOSABLE STERILE LF HANDSET RETRACTABLE BLADE HOLSTER SUP-E2520H CDM 0270 RC outpatient 213.83 213.83 213.83 74 158.23 percent of total billed charges 213.83 93 173.2 percent of total billed charges 213.83 213.83 other OPPS APC 213.83 213.83 other OPPS APC 213.83 27.63 59.08 percent of total billed charges 213.83 213.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL ARGONPLUS L11 IN FLEXIBLE LAPAROSCOPIC STERILE DISPOSABLE SUP-E2530-28 CDM 0270 RC outpatient 179.66 179.66 179.66 74 132.95 percent of total billed charges 179.66 93 145.52 percent of total billed charges 179.66 179.66 other OPPS APC 179.66 179.66 other OPPS APC 179.66 27.63 49.64 percent of total billed charges 179.66 179.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL ARGONPLUS L6 IN HANDSET COAGULATION FLEXIBLE STERILE DISPOSABLE SUP-E2530-6 CDM 0270 RC outpatient 150.9 150.9 150.9 74 111.67 percent of total billed charges 150.9 93 122.23 percent of total billed charges 150.9 150.9 other OPPS APC 150.9 150.9 other OPPS APC 150.9 27.63 41.69 percent of total billed charges 150.9 150.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER ENPULSE E2DR01 SUP-E2DR01 CDM 0270 RC outpatient 16900 16900 16900 74 12506 percent of total billed charges 16900 93 13689 percent of total billed charges 16900 16900 other OPPS APC 16900 16900 other OPPS APC 16900 27.63 4669.47 percent of total billed charges 16900 16900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT XENOSURE BIOLOGIC VASCULAR PATCH 2 CM X 9CM SUP-E2P9 CDM 0270 RC outpatient 933.4 933.4 933.4 74 690.72 percent of total billed charges 933.4 93 756.05 percent of total billed charges 933.4 933.4 other OPPS APC 933.4 933.4 other OPPS APC 933.4 27.63 257.9 percent of total billed charges 933.4 933.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL ARGON PLUS VALLEYLAB 10FT 1IN DISPOSABLE STERILE LF HANDSET RETRACTABLE BLADE HOLSTER SUP-E3520H_105966 CDM 0270 RC outpatient 226.65 226.65 226.65 74 167.72 percent of total billed charges 226.65 93 183.59 percent of total billed charges 226.65 226.65 other OPPS APC 226.65 226.65 other OPPS APC 226.65 27.63 62.62 percent of total billed charges 226.65 226.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ATTACHMENT SMOKE EVACUATOR ACCUVAC FLEXIBLE CAUTERY HANDSWITCH STERILE DISPOSABLE TRIVERSE DEVICE STANDARD VALLEYLAB SEA3710 RAPIDVAC SUP-E3590 CDM 0270 RC outpatient 18.88 18.88 18.88 74 13.97 percent of total billed charges 18.88 93 15.29 percent of total billed charges 18.88 18.88 other OPPS APC 18.88 18.88 other OPPS APC 18.88 27.63 5.22 percent of total billed charges 18.88 18.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER SMOKE EVACUATOR OPTIMUMM ULTRA LOW PENETRATION AIR STERILE SUP-E3625 CDM 0270 RC outpatient 983.98 983.98 983.98 74 728.15 percent of total billed charges 983.98 93 797.02 percent of total billed charges 983.98 983.98 other OPPS APC 983.98 983.98 other OPPS APC 983.98 27.63 271.87 percent of total billed charges 983.98 983.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PREFILTER SMOKE EVACUATOR OPTIMUMM OD1 1/3 IN SUP-E3630 CDM 0270 RC outpatient 15.84 15.84 15.84 74 11.72 percent of total billed charges 15.84 93 12.83 percent of total billed charges 15.84 15.84 other OPPS APC 15.84 15.84 other OPPS APC 15.84 27.63 4.38 percent of total billed charges 15.84 15.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER SMOKE EVACUATOR OPTIMUMM OD1 1/3-3/8 IN PREFILTER NONSTERILE DISPOSABLE SUP-E3660 CDM 0270 RC outpatient 4.47 4.47 4.47 74 3.31 percent of total billed charges 4.47 93 3.62 percent of total billed charges 4.47 4.47 other OPPS APC 4.47 4.47 other OPPS APC 4.47 27.63 1.24 percent of total billed charges 4.47 4.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA IRRIGATION BISHOP-HARMON STAINLESS STEEL 30 D L25 MM OD19 GA POLISH FINISH FLATTEN BLUNT TIP STERILE SUP-E4922 CDM outpatient 47.47 47.47 47.47 47.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALLEYLAB GROUNDING PAD UNIPOLAR-GREY SUP-E7506 CDM 0275 RC outpatient 14.84 14.84 14.84 57 8.46 percent of total billed charges 14.84 93 12.02 percent of total billed charges 14.84 14.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE PATIENT RETURN VALLEYLAB 9FT PVC DISPOSABLE NS LF ADULT CORD NONIRRITATE NONSENSITIZE ADHESIVE STRIP RECQM SUP-E7507 CDM 0270 RC outpatient 14 14 14 74 10.36 percent of total billed charges 14 93 11.34 percent of total billed charges 14 14 other OPPS APC 14 14 other OPPS APC 14 27.63 3.87 percent of total billed charges 14 14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BINDER BREAST LINED 3XL SUP-EAB3XLFLLAVDR CDM 0270 RC outpatient 79.69 79.69 79.69 74 58.97 percent of total billed charges 79.69 93 64.55 percent of total billed charges 79.69 79.69 other OPPS APC 79.69 79.69 other OPPS APC 79.69 27.63 22.02 percent of total billed charges 79.69 79.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BINDER BREAST LINED LARGE SUP-EABLLSDRBGE CDM 0270 RC outpatient 122.12 122.12 122.12 74 90.37 percent of total billed charges 122.12 93 98.92 percent of total billed charges 122.12 122.12 other OPPS APC 122.12 122.12 other OPPS APC 122.12 27.63 33.74 percent of total billed charges 122.12 122.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE FIXATION ENDOANCHOR 20IN 5MM NITINOL STERILE HERNIA REPAIR SUP-EANCHR5 CDM 0270 RC outpatient 316.05 316.05 316.05 74 233.88 percent of total billed charges 316.05 93 256 percent of total billed charges 316.05 316.05 other OPPS APC 316.05 316.05 other OPPS APC 316.05 27.63 87.32 percent of total billed charges 316.05 316.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL LEAD DELIVERY TUNNELING SUBSTERNAL F/IMPLANTABLE DEFIBRILLATOR ICD SYSTEM SUP-EAZ101 CDM 0481 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 51 795.6 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL LEAD DELIVERY TUNNELING TRANSVERSE F/IMPLANTABLE DEFIBRILLATOR ICD SYSTEM SUP-EAZ201 CDM 0481 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 51 795.6 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZEPHYR 4.0 ENDOBRONCHIAL SUP-EBV-TS-4.0 CDM 0270 RC outpatient 6136 6136 6136 74 4540.64 percent of total billed charges 6136 93 4970.16 percent of total billed charges 6136 6136 other OPPS APC 6136 6136 other OPPS APC 6136 27.63 1695.38 percent of total billed charges 6136 6136 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZEPHYR 4.0-LP ENDOBRONCHIAL VALVE SUP-EBV-TS-4.0-LP CDM 0270 RC outpatient 6136 6136 6136 74 4540.64 percent of total billed charges 6136 93 4970.16 percent of total billed charges 6136 6136 other OPPS APC 6136 6136 other OPPS APC 6136 27.63 1695.38 percent of total billed charges 6136 6136 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZEPHYR 5.5 ENDOBRONCHIAL VALVE SUP-EBV-TS-5.5 CDM 0270 RC outpatient 6136 6136 6136 74 4540.64 percent of total billed charges 6136 93 4970.16 percent of total billed charges 6136 6136 other OPPS APC 6136 6136 other OPPS APC 6136 27.63 1695.38 percent of total billed charges 6136 6136 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZEPHYR 5.5-LP ENDOBRONCHIAL VALVE SUP-EBV-TS-5.5-LP CDM 0270 RC outpatient 6136 6136 6136 74 4540.64 percent of total billed charges 6136 93 4970.16 percent of total billed charges 6136 6136 other OPPS APC 6136 6136 other OPPS APC 6136 27.63 1695.38 percent of total billed charges 6136 6136 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ARRAY BALLOON SUP-EC1000-204 CDM 0270 RC outpatient 9100 9100 9100 74 6734 percent of total billed charges 9100 93 7371 percent of total billed charges 9100 9100 other OPPS APC 9100 9100 other OPPS APC 9100 27.63 2514.33 percent of total billed charges 9100 9100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ECHELON FLEX ENDOPATH L45 MM L340 MM 6 ROW 12 FIRING ARTICULATION ROTATE KNOB STERILE LATEX FREE DISPOSABLE SUP-EC45A CDM 0270 RC outpatient 797.29 797.29 797.29 74 589.99 percent of total billed charges 797.29 93 645.8 percent of total billed charges 797.29 797.29 other OPPS APC 797.29 797.29 other OPPS APC 797.29 27.63 220.29 percent of total billed charges 797.29 797.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ECHELON FLEX ENDOPATH 12 MM L60 MM L340 MM 6 ROW 12 FIRING LINEAR CUTTER TROCAR ARTICULATE STERILE LATEX FREE DISPOSABLE ENDOSCOPIC SUP-EC60A CDM 0270 RC outpatient 900.16 900.16 900.16 74 666.12 percent of total billed charges 900.16 93 729.13 percent of total billed charges 900.16 900.16 other OPPS APC 900.16 900.16 other OPPS APC 900.16 27.63 248.71 percent of total billed charges 900.16 900.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CONTROL POWER SUP-ECB00018200 CDM 0270 RC outpatient 572 572 572 74 423.28 percent of total billed charges 572 93 463.32 percent of total billed charges 572 572 other OPPS APC 572 572 other OPPS APC 572 27.63 158.04 percent of total billed charges 572 572 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR ACUSEAL PTFE L40 CM OD6 CM 3 LAYER SUP-ECH060040A CDM 0270 RC outpatient 3494.4 3494.4 3494.4 74 2585.86 percent of total billed charges 3494.4 93 2830.46 percent of total billed charges 3494.4 3494.4 other OPPS APC 3494.4 3494.4 other OPPS APC 3494.4 27.63 965.5 percent of total billed charges 3494.4 3494.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR ACUSEAL L50 CM OD6 CM SUP-ECH060050A CDM 0270 RC outpatient 4105.4 4105.4 4105.4 74 3038 percent of total billed charges 4105.4 93 3325.37 percent of total billed charges 4105.4 4105.4 other OPPS APC 4105.4 4105.4 other OPPS APC 4105.4 27.63 1134.32 percent of total billed charges 4105.4 4105.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ENDOSCOPIC ECHOTIP ULTRA 8- CM 20GA 6FR DISPOSABLE STERILE CELIAC PLEXUS ULTRASOUND CONE TIP SIDEHOLE NEUROLYSIS SUP-ECHO-20-CPN CDM 0270 RC outpatient 714.69 714.69 714.69 74 528.87 percent of total billed charges 714.69 93 578.9 percent of total billed charges 714.69 714.69 other OPPS APC 714.69 714.69 other OPPS APC 714.69 27.63 197.47 percent of total billed charges 714.69 714.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ECHELON FLEX ENDOPATH STAINLESS STEEL H3.5 MM L45 MM H1.5 MM REGULAR TISSUE 6 ROW STERILE LATEX FREE DISPOSABLE BLUE SUP-ECR45B CDM 0270 RC outpatient 385.01 385.01 385.01 74 284.91 percent of total billed charges 385.01 93 311.86 percent of total billed charges 385.01 385.01 other OPPS APC 385.01 385.01 other OPPS APC 385.01 27.63 106.38 percent of total billed charges 385.01 385.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ECHELON FLEX ENDOPATH 4.1MM 45MM 2MM GREEN SS DISPOSABLE STERILE LF THICK TISSUE 6 ROW SUP-ECR45G CDM 0270 RC outpatient 356.13 356.13 356.13 74 263.54 percent of total billed charges 356.13 93 288.47 percent of total billed charges 356.13 356.13 other OPPS APC 356.13 356.13 other OPPS APC 356.13 27.63 98.4 percent of total billed charges 356.13 356.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ECHELON FLEX ENDOPATH STAINLESS STEEL H2.5 MM L45 MM H1 MM THIN VASCULAR TISSUE 6 ROW STERILE LATEX FREE DISPOSABLE WHITE SUP-ECR45W CDM 0270 RC outpatient 416.16 416.16 416.16 74 307.96 percent of total billed charges 416.16 93 337.09 percent of total billed charges 416.16 416.16 other OPPS APC 416.16 416.16 other OPPS APC 416.16 27.63 114.99 percent of total billed charges 416.16 416.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ECHELON FLEX ENDOPATH 3.5MM 60MM 1.5MM BLUE SS DISPOSABLE STERILE LF REGULAR TISSUE 6 ROW SUP-ECR60B CDM 0270 RC outpatient 420.15 420.15 420.15 74 310.91 percent of total billed charges 420.15 93 340.32 percent of total billed charges 420.15 420.15 other OPPS APC 420.15 420.15 other OPPS APC 420.15 27.63 116.09 percent of total billed charges 420.15 420.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ECHELON FLEX ENDOPATH 4.1MM 60MM 2MM GREEN SS DISPOSABLE STERILE LF THICK TISSUE 6 ROW SUP-ECR60G CDM 0270 RC outpatient 446.32 446.32 446.32 74 330.28 percent of total billed charges 446.32 93 361.52 percent of total billed charges 446.32 446.32 other OPPS APC 446.32 446.32 other OPPS APC 446.32 27.63 123.32 percent of total billed charges 446.32 446.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER 60MMX2MM ECHELON FLEX ENDOPATH SS MESENTERY STERILE .75MM LF SUP-ECR60M CDM 0270 RC outpatient 381.44 381.44 381.44 74 282.27 percent of total billed charges 381.44 93 308.97 percent of total billed charges 381.44 381.44 other OPPS APC 381.44 381.44 other OPPS APC 381.44 27.63 105.39 percent of total billed charges 381.44 381.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL PROXIMATE TITANIUM CURVE CIRCLE L18 CM L5.5 MM X H1-2.5 MM OD21 MM INTRALUMINAL STERILE LATEX FREE DISPOSABLE 12.4 MM LUMEN SUP-ECS21B CDM 270009089 LOCAL 0270 RC outpatient 61.87 61.87 61.87 74 45.78 percent of total billed charges 61.87 93 50.11 percent of total billed charges 61.87 61.87 other OPPS APC 61.87 61.87 other OPPS APC 61.87 27.63 17.09 percent of total billed charges 61.87 61.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ENDOPATH CURVE CIRCLE H5.5 MM L28 CM X H1-2.5 MM OD25 MM INTRALUMINAL LINEAR CUTTER ADJUSTABLE FLEXIBLE STERILE LATEX FREE DISPOSABLE 16.4 MM LUMEN ENDOSCOPIC SUP-ECS25 CDM 270009090 LOCAL 0270 RC outpatient 36 36 36 74 26.64 percent of total billed charges 36 93 29.16 percent of total billed charges 36 36 other OPPS APC 36 36 other OPPS APC 36 27.63 9.95 percent of total billed charges 36 36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ENDOPATH CURVE CIRCLE H5.5 MM L28 CM X H1-2.5 MM OD25 MM INTRALUMINAL LINEAR CUTTER ADJUSTABLE FLEXIBLE STERILE LATEX FREE DISPOSABLE 16.4 MM LUMEN ENDOSCOPIC SUP-ECS25A CDM 0270 RC outpatient 682.87 682.87 682.87 74 505.32 percent of total billed charges 682.87 93 553.12 percent of total billed charges 682.87 682.87 other OPPS APC 682.87 682.87 other OPPS APC 682.87 27.63 188.68 percent of total billed charges 682.87 682.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ENDOPATH CURVE CIRCLE H5.5 MM L28 CM X H1-2.5 MM OD25 MM INTRALUMINAL LINEAR CUTTER ADJUSTABLE FLEXIBLE STERILE LATEX FREE DISPOSABLE 16.4 MM LUMEN ENDOSCOPIC SUP-ECS25B CDM 0270 RC outpatient 720.54 720.54 720.54 74 533.2 percent of total billed charges 720.54 93 583.64 percent of total billed charges 720.54 720.54 other OPPS APC 720.54 720.54 other OPPS APC 720.54 27.63 199.09 percent of total billed charges 720.54 720.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL PROXIMATE TITANIUM CURVE CIRCLE H5.5 MM L18 CM X H1-2.5 MM OD25 MM INTRALUMINAL LINEAR CUTTER ADJUSTABLE FLEXIBLE STERILE LATEX FREE DISPOSABLE 16.4 MM LUMEN ENDOSCOPIC SUP-ECS25B CDM 270009089 LOCAL 0270 RC outpatient 614 614 614 74 454.36 percent of total billed charges 614 93 497.34 percent of total billed charges 614 614 other OPPS APC 614 614 other OPPS APC 614 27.63 169.65 percent of total billed charges 614 614 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL PROXIMATE TITANIUM CURVE CIRCLE H5.5 MM L18 CM X H1-2.5 MM OD33 MM INTRALUMINAL LINEAR CUTTER ADJUSTABLE FLEXIBLE STERILE LATEX FREE DISPOSABLE 24.4 MM LUMEN ENDOSCOPIC SUP-ECS33B CDM 270009089 LOCAL 0270 RC outpatient 607.92 607.92 607.92 74 449.86 percent of total billed charges 607.92 93 492.42 percent of total billed charges 607.92 607.92 other OPPS APC 607.92 607.92 other OPPS APC 607.92 27.63 167.97 percent of total billed charges 607.92 607.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZEPHYR 4.0 DELIVERY CATHETER SUP-EDC-TS-4.0 CDM 0270 RC outpatient 1391 1391 1391 74 1029.34 percent of total billed charges 1391 93 1126.71 percent of total billed charges 1391 1391 other OPPS APC 1391 1391 other OPPS APC 1391 27.63 384.33 percent of total billed charges 1391 1391 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZEPHYR 4.0-J DELIVERY CATHETER SUP-EDC-TS-4.0-J CDM 0270 RC outpatient 1391 1391 1391 74 1029.34 percent of total billed charges 1391 93 1126.71 percent of total billed charges 1391 1391 other OPPS APC 1391 1391 other OPPS APC 1391 27.63 384.33 percent of total billed charges 1391 1391 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZEPHYR 5.5 DUAL MARK DELIVERY CATHETER SUP-EDC-TS-5.5-DM CDM 0270 RC outpatient 1391 1391 1391 74 1029.34 percent of total billed charges 1391 93 1126.71 percent of total billed charges 1391 1391 other OPPS APC 1391 1391 other OPPS APC 1391 27.63 384.33 percent of total billed charges 1391 1391 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ENDO GIA TRI-STAPLE TITANIUM 3 MM 3.5 MM 4 MM L45 MM MEDIUM THICK TISSUE ARTICULATE KNIFE BLADE FIX ANVIL LARGE BUCKET STERILE LATEX FREE DISPOSABLE PURPLE SUP-EGIA45AMT CDM 0270 RC outpatient 538.59 538.59 538.59 74 398.56 percent of total billed charges 538.59 93 436.26 percent of total billed charges 538.59 538.59 other OPPS APC 538.59 538.59 other OPPS APC 538.59 27.63 148.81 percent of total billed charges 538.59 538.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ENDO GIA TRI-STAPLE TITANIUM 2 MM 2.5 MM 3 MM L45 MM MEDIUM VASCULAR TISSUE ARTICULATE KNIFE BLADE FIX ANVIL LARGE BUCKET STERILE LATEX FREE DISPOSABLE TAN SUP-EGIA45AVM CDM 0270 RC outpatient 518.76 518.76 518.76 74 383.88 percent of total billed charges 518.76 93 420.2 percent of total billed charges 518.76 518.76 other OPPS APC 518.76 518.76 other OPPS APC 518.76 27.63 143.33 percent of total billed charges 518.76 518.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ENDO GIA TRI-STAPLE 3MM 3.5MM 4MM 60MM PURPLE TITANIUM DISPOSABLE STERILE LF MED THICK TISSUE ARTICULATE SUP-EGIA60AMT CDM 0270 RC outpatient 750.85 750.85 750.85 74 555.63 percent of total billed charges 750.85 93 608.19 percent of total billed charges 750.85 750.85 other OPPS APC 750.85 750.85 other OPPS APC 750.85 27.63 207.46 percent of total billed charges 750.85 750.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ENDO GIA TRI-STAPLE 2MM 2.5MM 3MM 60MM TAN TITANIUM DISPOSABLE STERILE LF MED VASCULAR TISSUE ARTICULATE SUP-EGIA60AVM CDM 0270 RC outpatient 729.58 729.58 729.58 74 539.89 percent of total billed charges 729.58 93 590.96 percent of total billed charges 729.58 729.58 other OPPS APC 729.58 729.58 other OPPS APC 729.58 27.63 201.58 percent of total billed charges 729.58 729.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ENDO GIA ULTRA TRI-STAPLE SHORT UNIVERSAL 6CM 12MM TITANIUM DISPOSABLE STERILE LF THIN VASCULAR TISSUE SUP-EGIAUSHORT CDM 0270 RC outpatient 291.88 291.88 291.88 74 215.99 percent of total billed charges 291.88 93 236.42 percent of total billed charges 291.88 291.88 other OPPS APC 291.88 291.88 other OPPS APC 291.88 27.63 80.65 percent of total billed charges 291.88 291.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ENDO GIA ULTRA TRI-STAPLE UNIVERSAL STANDARD 16CMX4MM PVC DISPOSABLE STERILE LF EXTRA THICK TISSUE SUP-EGIAUSTND CDM 0270 RC outpatient 324.26 324.26 324.26 74 239.95 percent of total billed charges 324.26 93 262.65 percent of total billed charges 324.26 324.26 other OPPS APC 324.26 324.26 other OPPS APC 324.26 27.63 89.59 percent of total billed charges 324.26 324.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ENDO GIA ULTRA TRI-STAPLE XL UNIVERSAL 26CMX4MM BLACK TITANIUM EXTRA THICK TISSUE ARTICULATE HAND GRASP SUP-EGIAUXL CDM 0270 RC outpatient 518.76 518.76 518.76 74 383.88 percent of total billed charges 518.76 93 420.2 percent of total billed charges 518.76 518.76 other OPPS APC 518.76 518.76 other OPPS APC 518.76 27.63 143.33 percent of total billed charges 518.76 518.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WAND ELECTROSURGICAL REFLEX ULTRA 45 COBLATION SILICONE LONG 3 DEPTH MARK INSULATE SHAFT SPACER TURBINATE REDUCTION BLACK SUP-EICA4845-01 CDM 0270 RC outpatient 731.09 731.09 731.09 74 541.01 percent of total billed charges 731.09 93 592.18 percent of total billed charges 731.09 731.09 other OPPS APC 731.09 731.09 other OPPS APC 731.09 27.63 202 percent of total billed charges 731.09 731.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WAND ELECTROSURGICAL EVAC 70 XTRA L6 IN INTEGRATE SALINE SUCTION PORT 3 WIRE ACTIVE ELECTRODE MALLEABLE SHAFT ADENOTONSILLECTOMY SUP-EICA5872-01 CDM 0270 RC outpatient 766.22 766.22 766.22 74 567 percent of total billed charges 766.22 93 620.64 percent of total billed charges 766.22 766.22 other OPPS APC 766.22 766.22 other OPPS APC 766.22 27.63 211.71 percent of total billed charges 766.22 766.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIGATOR ENDOSCOPIC ENDOLOOP VICRYL 12 L18 IN ABSORBABLE SUTURE BRAID SUP-EJ10G CDM 0270 RC outpatient 102.18 102.18 102.18 74 75.61 percent of total billed charges 102.18 93 82.77 percent of total billed charges 102.18 102.18 other OPPS APC 102.18 102.18 other OPPS APC 102.18 27.63 28.23 percent of total billed charges 102.18 102.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLEANER ELECTRO LUBE ROBOTIC SUP-EL101 CDM 0270 RC outpatient 76.57 76.57 76.57 74 56.66 percent of total billed charges 76.57 93 62.02 percent of total billed charges 76.57 76.57 other OPPS APC 76.57 76.57 other OPPS APC 76.57 27.63 21.16 percent of total billed charges 76.57 76.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER INTERNAL CLIP LIGAMAX MED LG 5MM TITANIUM DISPOSABLE STERILE ANGLE JAW DISTAL TIP CLOSE ANTIBACKUP LAST LOCKOUT SUP-EL5ML CDM 0270 RC outpatient 349.34 349.34 349.34 74 258.51 percent of total billed charges 349.34 93 282.97 percent of total billed charges 349.34 349.34 other OPPS APC 349.34 349.34 other OPPS APC 349.34 27.63 96.52 percent of total billed charges 349.34 349.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER CABLE SOUNDSTAR L 5FT SUP-EM5050040 CDM 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CATHETER CARTO 3 L6 MR 20 POLE NONSTERILE REUSABLE PENTARRAY ECO LASSO CATHETER SUP-EM5050060 CDM 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ELECTRODE ENSITE PRECISION SURFACE SUP-EN0020-P CDM 0481 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 51 1591.2 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SNARE VASCULAR EN SNARE STANDARD L47 IN L100 CM OD.47-.79 IN ODSEC6 FR 3 LOOP NITINOL WIRE CATHETER SUP-EN2006020 CDM 0270 RC outpatient 809.82 809.82 809.82 74 599.27 percent of total billed charges 809.82 93 655.95 percent of total billed charges 809.82 809.82 other OPPS APC 809.82 809.82 other OPPS APC 809.82 27.63 223.75 percent of total billed charges 809.82 809.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENCLOSE II WITH 4.0MM PUNCH SUP-EN240 CDM 0270 RC outpatient 1476.8 1476.8 1476.8 74 1092.83 percent of total billed charges 1476.8 93 1196.21 percent of total billed charges 1476.8 1476.8 other OPPS APC 1476.8 1476.8 other OPPS APC 1476.8 27.63 408.04 percent of total billed charges 1476.8 1476.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT POLYESTER NITINOL BIFURCATED L124 MM OD25-16 MM ID18 FR ENDOVASCULAR ABDOMEN AORTA SYSTEM SELF EXPANDING C DESIGN RADIOPAQUE AAA SUP-ENBF2516C124E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT POLYESTER NITINOL BIFURCATED L124 MM OD28-16 MM ID20 FR ENDOVASCULAR ABDOMEN AORTA SYSTEM SELF EXPANDING C DESIGN RADIOPAQUE AAA SUP-ENBF2816C124E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT POLYESTER NITINOL BIFURCATED L145 MM OD32-20 MM ID20 FR ENDOVASCULAR ABDOMEN AORTA SYSTEM SELF EXPANDING C DESIGN RADIOPAQUE AAA SUP-ENBF3220C145E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT 49MM 28MM 20FR ENDURANT ENDOVASCULAR ABDOMEN AORTA POLYESTER NITINOL SUP-ENCF2828C49E CDM 270010015 LOCAL 0270 RC outpatient 11115 11115 11115 74 8225.1 percent of total billed charges 11115 93 9003.15 percent of total billed charges 11115 11115 other OPPS APC 11115 11115 other OPPS APC 11115 27.63 3071.07 percent of total billed charges 11115 11115 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT POLYESTER NITINOL L82 MM OD10 MM ID14 FR ENDOVASCULAR ABDOMEN AORTA ILIUM SYSTEM SELF EXPANDING EXTENSION C DESIGN RADIOPAQUE AAA SUP-ENEW1010C82E CDM 270010015 LOCAL 0270 RC outpatient 12090 12090 12090 74 8946.6 percent of total billed charges 12090 93 9792.9 percent of total billed charges 12090 12090 other OPPS APC 12090 12090 other OPPS APC 12090 27.63 3340.47 percent of total billed charges 12090 12090 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT POLYESTER NITINOL L82 MM OD13 MM ID14 FR ENDOVASCULAR SELF EXPAND EXTENSION C DESIGN RADIOPAQUE AAA SUP-ENEW1313C82E CDM 270010015 LOCAL 0270 RC outpatient 12090 12090 12090 74 8946.6 percent of total billed charges 12090 93 9792.9 percent of total billed charges 12090 12090 other OPPS APC 12090 12090 other OPPS APC 12090 27.63 3340.47 percent of total billed charges 12090 12090 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT POLYESTER NITINOL L174 MM L124 MM OD16-10 MM ODSEC14 FR ENDOVASCULAR ABDOMEN AORTA ILIUM SYSTEM SELF EXPANDING CONTRALATERAL LIMB RADIOPAQUE AAA SUP-ENLW1610C124E CDM 270010015 LOCAL 0270 RC outpatient 12935 12935 12935 74 9571.9 percent of total billed charges 12935 93 10477.4 percent of total billed charges 12935 12935 other OPPS APC 12935 12935 other OPPS APC 12935 27.63 3573.94 percent of total billed charges 12935 12935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDURANT LIMB SHORT SUP-ENLW1612C82E CDM 270010015 LOCAL 0270 RC outpatient 12610 12610 12610 74 9331.4 percent of total billed charges 12610 93 10214.1 percent of total billed charges 12610 12610 other OPPS APC 12610 12610 other OPPS APC 12610 27.63 3484.14 percent of total billed charges 12610 12610 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT POLYESTER NITINOL L132 MM L82 MM OD16/13 MM ODSEC14 FR ENDOVASCULAR SELF EXPAND CONTRALATERAL LIMB RADIOPAQUE AAA SUP-ENLW1613C82E CDM 270010015 LOCAL 0270 RC outpatient 12610 12610 12610 74 9331.4 percent of total billed charges 12610 93 10214.1 percent of total billed charges 12610 12610 other OPPS APC 12610 12610 other OPPS APC 12610 27.63 3484.14 percent of total billed charges 12610 12610 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT POLYESTER NITINOL L132 MM L82 MM OD20-16 MM ODSEC16 FR ENDOVASCULAR ABDOMEN AORTA ILIUM SYSTEM SELF EXPANDING CONTRALATERAL LIMB RADIOPAQUE AAA SUP-ENLW1620C82E CDM 270010015 LOCAL 0270 RC outpatient 11635 11635 11635 74 8609.9 percent of total billed charges 11635 93 9424.35 percent of total billed charges 11635 11635 other OPPS APC 11635 11635 other OPPS APC 11635 27.63 3214.75 percent of total billed charges 11635 11635 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT POLYESTER NITINOL L132 MM L82 MM OD28-16 MM ODSEC16 FR ENDOVASCULAR ABDOMEN AORTA ILIUM SYSTEM SELF EXPANDING CONTRALATERAL LIMB RADIOPAQUE AAA SUP-ENLW1628C82E CDM 270010015 LOCAL 0270 RC outpatient 12610 12610 12610 74 9331.4 percent of total billed charges 12610 93 10214.1 percent of total billed charges 12610 12610 other OPPS APC 12610 12610 other OPPS APC 12610 27.63 3484.14 percent of total billed charges 12610 12610 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER ENRHYTHM DR DUAL CHANBER SYSTEM SUP-ENRHYTHMDRK2 CDM 0270 RC outpatient 13969.8 13969.8 13969.8 74 10337.7 percent of total billed charges 13969.8 93 11315.5 percent of total billed charges 13969.8 13969.8 other OPPS APC 13969.8 13969.8 other OPPS APC 13969.8 27.63 3859.86 percent of total billed charges 13969.8 13969.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ELECTRODE SURFACE ENSITE X SUP-ENSITE-SEK-5-01 CDM 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM DELIVERY CATHETER ENVEO R WITH INLINE SHEATH SUP-ENVEOR-N-US CDM 0270 RC outpatient 5486 5486 5486 74 4059.64 percent of total billed charges 5486 93 4443.66 percent of total billed charges 5486 5486 other OPPS APC 5486 5486 other OPPS APC 5486 27.63 1515.78 percent of total billed charges 5486 5486 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM DELIVERY CATHETER ENVEO R INFLOW OUTFLOW CONE BACKPLATE CAPSULE GUIDE TUBE STERILE DISPOSABLE SUP-ENVEOR-US CDM 0270 RC outpatient 5486 5486 5486 74 4059.64 percent of total billed charges 5486 93 4443.66 percent of total billed charges 5486 5486 other OPPS APC 5486 5486 other OPPS APC 5486 27.63 1515.78 percent of total billed charges 5486 5486 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EnVEO PRO DELIVERY SYSTEM OD18 FR SUP-ENVPRO-14-US CDM 0270 RC outpatient 5486 5486 5486 74 4059.64 percent of total billed charges 5486 93 4443.66 percent of total billed charges 5486 5486 other OPPS APC 5486 5486 other OPPS APC 5486 27.63 1515.78 percent of total billed charges 5486 5486 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DELIVERY SYSTEM OD20 FR SUP-ENVPRO-16-US CDM 0270 RC outpatient 5486 5486 5486 74 4059.64 percent of total billed charges 5486 93 4443.66 percent of total billed charges 5486 5486 other OPPS APC 5486 5486 other OPPS APC 5486 27.63 1515.78 percent of total billed charges 5486 5486 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE 7-0 BV175-8 L30 IN 2 ARM MONOFILAMENT BLUE SUP-EP8755H CDM 0270 RC outpatient 66.91 66.91 66.91 74 49.51 percent of total billed charges 66.91 93 54.2 percent of total billed charges 66.91 66.91 other OPPS APC 66.91 66.91 other OPPS APC 66.91 27.63 18.49 percent of total billed charges 66.91 66.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER INTERNAL CLIP LIGAMAX LIGACLIP MED LG 8.8MM 10MM TITANIUM DISPOSABLE STERILE LF VASCULAR ANGLE JAW DISTAL TIP SUP-ER320 CDM 270009088 LOCAL 0270 RC outpatient 132.68 132.68 132.68 74 98.18 percent of total billed charges 132.68 93 107.47 percent of total billed charges 132.68 132.68 other OPPS APC 132.68 132.68 other OPPS APC 132.68 27.63 36.66 percent of total billed charges 132.68 132.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER INTERNAL CLIP LIGAMAX LIGACLIP LG 12MM TITANIUM DISPOSABLE STERILE LF VASCULAR ANGLE JAW DISTAL TIP CLOSE SUP-ER420 CDM 0270 RC outpatient 223.53 223.53 223.53 74 165.41 percent of total billed charges 223.53 93 181.06 percent of total billed charges 223.53 223.53 other OPPS APC 223.53 223.53 other OPPS APC 223.53 27.63 61.76 percent of total billed charges 223.53 223.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS BIPOLAR ENDOPATH BABCOCK 360D 33CM 5MM DISPOSABLE STERILE LF RATCHET HANDLE ROTATION KNOB SUP-ES5BB CDM 0270 RC outpatient 177.8 177.8 177.8 74 131.57 percent of total billed charges 177.8 93 144.02 percent of total billed charges 177.8 177.8 other OPPS APC 177.8 177.8 other OPPS APC 177.8 27.63 49.13 percent of total billed charges 177.8 177.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR LAPAROSCOPIC ENDOPATH XCEL L100 MM OD8 MM STABILITY SLEEVE BLADELESS OPTICAL TIP OBTURATOR STERILE DISPOSABLE SUP-ESB8LT CDM 0270 RC outpatient 63.72 63.72 63.72 74 47.15 percent of total billed charges 63.72 93 51.61 percent of total billed charges 63.72 63.72 other OPPS APC 63.72 63.72 other OPPS APC 63.72 27.63 17.61 percent of total billed charges 63.72 63.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX H&L-B ONE-SHOT POLYESTER STAINLESS STEEL BIFURCATED L39 MM OD22 MM ODSEC6.9 MM ID18 FR ABDOMEN AORTA AORTOILIAC SELF EXPANDING ANCILLARY WOVEN LEG EXTENSION INTRODUCTION SYSTEM AAA SUP-ESBE-22-39 CDM 270010015 LOCAL 0270 RC outpatient 5358.6 5358.6 5358.6 74 3965.36 percent of total billed charges 5358.6 93 4340.47 percent of total billed charges 5358.6 5358.6 other OPPS APC 5358.6 5358.6 other OPPS APC 5358.6 27.63 1480.58 percent of total billed charges 5358.6 5358.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX H&L-B ONE-SHOT POLYESTER STAINLESS STEEL BIFURCATED L39 MM OD24 MM ODSEC6.9 MM ID18 FR ABDOMEN AORTA AORTOILIAC SELF EXPANDING ANCILLARY WOVEN LEG EXTENSION INTRODUCTION SYSTEM AAA SUP-ESBE-24-39 CDM 270010015 LOCAL 0270 RC outpatient 5358.6 5358.6 5358.6 74 3965.36 percent of total billed charges 5358.6 93 4340.47 percent of total billed charges 5358.6 5358.6 other OPPS APC 5358.6 5358.6 other OPPS APC 5358.6 27.63 1480.58 percent of total billed charges 5358.6 5358.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX H&L-B ONE-SHOT POLYESTER STAINLESS STEEL BIFURCATED L39 MM OD26 MM ODSEC6.9 MM ID18 FR ABDOMEN AORTA AORTOILIAC SELF EXPANDING ANCILLARY WOVEN LEG EXTENSION INTRODUCTION SYSTEM AAA SUP-ESBE-26-39 CDM 270010015 LOCAL 0270 RC outpatient 5358.6 5358.6 5358.6 74 3965.36 percent of total billed charges 5358.6 93 4340.47 percent of total billed charges 5358.6 5358.6 other OPPS APC 5358.6 5358.6 other OPPS APC 5358.6 27.63 1480.58 percent of total billed charges 5358.6 5358.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX H&L-B ONE-SHOT POLYESTER STAINLESS STEEL BIFURCATED L39 MM OD28 MM ODSEC7.7 MM ID20 FR ABDOMEN AORTA AORTOILIAC SELF EXPANDING ANCILLARY WOVEN LEG EXTENSION INTRODUCTION SYSTEM AAA SUP-ESBE-28-39 CDM 270010015 LOCAL 0270 RC outpatient 2.6 2.6 2.6 74 1.92 percent of total billed charges 2.6 93 2.11 percent of total billed charges 2.6 2.6 other OPPS APC 2.6 2.6 other OPPS APC 2.6 27.63 0.72 percent of total billed charges 2.6 2.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX H&L-B ONE-SHOT POLYESTER STAINLESS STEEL BIFURCATED L39 MM OD30 MM ODSEC7.7 MM ID20 FR ABDOMEN AORTA AORTOILIAC SELF EXPANDING ANCILLARY WOVEN LEG EXTENSION INTRODUCTION SYSTEM AAA SUP-ESBE-30-39 CDM 270010015 LOCAL 0270 RC outpatient 5358.6 5358.6 5358.6 74 3965.36 percent of total billed charges 5358.6 93 4340.47 percent of total billed charges 5358.6 5358.6 other OPPS APC 5358.6 5358.6 other OPPS APC 5358.6 27.63 1480.58 percent of total billed charges 5358.6 5358.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX H&L-B ONE-SHOT POLYESTER STAINLESS STEEL BIFURCATED L39 MM OD32 MM ODSEC7.7 MM ID20 FR ABDOMEN AORTA AORTOILIAC SELF EXPANDING ANCILLARY WOVEN LEG EXTENSION INTRODUCTION SYSTEM AAA SUP-ESBE-32-39 CDM 270010015 LOCAL 0270 RC outpatient 5051.8 5051.8 5051.8 74 3738.33 percent of total billed charges 5051.8 93 4091.96 percent of total billed charges 5051.8 5051.8 other OPPS APC 5051.8 5051.8 other OPPS APC 5051.8 27.63 1395.81 percent of total billed charges 5051.8 5051.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR RENU H&L-B ONE-SHOT ZENITH STAINLESS STEELL POLYESTER WOVEN 2 BRANCH L50 MM OD36 MM ODSEC7.7 MM ID20 FR ANCILLARY CONVERTER LIGHTWEIGHT AAA SUP-ESBE-36-50 CDM 270010015 LOCAL 0270 RC outpatient 5051.8 5051.8 5051.8 74 3738.33 percent of total billed charges 5051.8 93 4091.96 percent of total billed charges 5051.8 5051.8 other OPPS APC 5051.8 5051.8 other OPPS APC 5051.8 27.63 1395.81 percent of total billed charges 5051.8 5051.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT IIS NITINOL PLATINUM POLYESTER L103 MM OD14-28 MM ODSEC18 FR INFRARENAL CATHETER RADIOPAQUE SELF EXPAND FLEXIBLE STERILE LATEX FREE ACCEPTS .035 IN GUIDEWIRE AAA SUP-ESBF2814C103E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT IIS NITINOL PLATINUM POLYESTER 2 BRANCH L103 MM OD14-32 MM ODSEC20 FR INFRARENAL CATHETER RADIOPAQUE C DESIGN SELF EXPAND FLEXIBLE STERILE LATEX FREE ACCEPTS .035 IN GUIDEWIRE AAA SUP-ESBF3214C103E CDM 270010015 LOCAL 0270 RC outpatient 26972.4 26972.4 26972.4 74 19959.6 percent of total billed charges 26972.4 93 21847.6 percent of total billed charges 26972.4 26972.4 other OPPS APC 26972.4 26972.4 other OPPS APC 26972.4 27.63 7452.47 percent of total billed charges 26972.4 26972.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX H&L-B ONE-SHOT POLYESTER STAINLESS STEEL BIFURCATED L80 MM OD24-12 MM ODSEC6.9 MM ID18 FR ABDOMINAL AORTIC ANEURYSM SELF EXPANDING ANCILLARY WOVEN LEG EXTENSION INTRODUCTION SYSTEM AAA SUP-ESC-24-12-80 CDM 270010015 LOCAL 0270 RC outpatient 6307.6 6307.6 6307.6 74 4667.62 percent of total billed charges 6307.6 93 5109.16 percent of total billed charges 6307.6 6307.6 other OPPS APC 6307.6 6307.6 other OPPS APC 6307.6 27.63 1742.79 percent of total billed charges 6307.6 6307.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ECHELON FLEX ENDOPATH 2MM 60MM .75MM GRAY SS DISPOSABLE STERILE LF MESENTERY THIN TISSUE 6 ROW SUP-ESECR60M CDM 0270 RC outpatient 524.92 524.92 524.92 74 388.44 percent of total billed charges 524.92 93 425.19 percent of total billed charges 524.92 524.92 other OPPS APC 524.92 524.92 other OPPS APC 524.92 27.63 145.04 percent of total billed charges 524.92 524.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER INTERNAL CLIP LIGAMAX LIGACLIP MED LG 8.8MM 10MM TITANIUM DISPOSABLE STERILE LF VASCULAR ANGLE JAW DISTAL TIP SUP-ESER320 CDM 270009088 LOCAL 0270 RC outpatient 132.68 132.68 132.68 74 98.18 percent of total billed charges 132.68 93 107.47 percent of total billed charges 132.68 132.68 other OPPS APC 132.68 132.68 other OPPS APC 132.68 27.63 36.66 percent of total billed charges 132.68 132.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIGATOR ENDOSCOPIC ENDOLOOP 12 18IN VIOLET PDS II LF MONOFILAMENT TIE LOOP SUTURE SUP-ESEZ10G CDM 270009006 LOCAL 0270 RC outpatient 12.49 12.49 12.49 74 9.24 percent of total billed charges 12.49 93 10.12 percent of total billed charges 12.49 12.49 other OPPS APC 12.49 12.49 other OPPS APC 12.49 27.63 3.45 percent of total billed charges 12.49 12.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER INTERNAL CLIP LIGACLIP 30D LG 13IN TITANIUM DISPOSABLE STERILE LF LIGATE MULTIPLE OPEN SUP-ESMCL20 CDM 270009085 LOCAL 0270 RC outpatient 68.68 68.68 68.68 74 50.82 percent of total billed charges 68.68 93 55.63 percent of total billed charges 68.68 68.68 other OPPS APC 68.68 68.68 other OPPS APC 68.68 27.63 18.98 percent of total billed charges 68.68 68.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER INTERNAL CLIP LIGACLIP 30D MED 11.5IN TITANIUM DISPOSABLE STERILE LF LIGATE MULTIPLE OPEN 20 CLIP SUP-ESMCM20 CDM 270009085 LOCAL 0270 RC outpatient 68.68 68.68 68.68 74 50.82 percent of total billed charges 68.68 93 55.63 percent of total billed charges 68.68 68.68 other OPPS APC 68.68 68.68 other OPPS APC 68.68 27.63 18.98 percent of total billed charges 68.68 68.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE INSUFFLATION ENDOPATH ULTRA VERESS STAINLESS STEEL PLASTIC L120 MM OD14 GA STOPCOCK LUER LOCK BLUNT STYLET HANDLE STERILE DISPOSABLE PNEUMOPERITONEUM SUP-ESPN120 CDM 270009197 LOCAL 0270 RC outpatient 43.52 43.52 43.52 74 32.2 percent of total billed charges 43.52 93 35.25 percent of total billed charges 43.52 43.52 other OPPS APC 43.52 43.52 other OPPS APC 43.52 27.63 12.02 percent of total billed charges 43.52 43.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE INSUFFLATION ENDOPATH 150MM 14GA SS DISPOSABLE STERILE SPRING LOAD BLUNT STYLET STOPCOCK LUER LOCK CONNECTOR SUP-ESPN150 CDM 270009197 LOCAL 0270 RC outpatient 43.52 43.52 43.52 74 32.2 percent of total billed charges 43.52 93 35.25 percent of total billed charges 43.52 43.52 other OPPS APC 43.52 43.52 other OPPS APC 43.52 27.63 12.02 percent of total billed charges 43.52 43.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER SURGICAL ENDOPATH INTERNAL LINEAR CUTTER DISPOSABLE REGULAR 35MM SUP-ESTSB35 CDM 0270 RC outpatient 506.84 506.84 506.84 74 375.06 percent of total billed charges 506.84 93 410.54 percent of total billed charges 506.84 506.84 other OPPS APC 506.84 506.84 other OPPS APC 506.84 27.63 140.04 percent of total billed charges 506.84 506.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE THROMBECTOMY EMBOTRAP OD 5MM X L 21MM RADIOPAQUE SUP-ET-009-521 CDM 0270 RC outpatient 18720 18720 18720 74 13852.8 percent of total billed charges 18720 93 15163.2 percent of total billed charges 18720 18720 other OPPS APC 18720 18720 other OPPS APC 18720 27.63 5172.34 percent of total billed charges 18720 18720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE THROMBECTOMY EMBOTRAP OD5MM X L 33MM RADIOPAQUE SUP-ET009533 CDM 0270 RC outpatient 18720 18720 18720 74 13852.8 percent of total billed charges 18720 93 15163.2 percent of total billed charges 18720 18720 other OPPS APC 18720 18720 other OPPS APC 18720 27.63 5172.34 percent of total billed charges 18720 18720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE THROMBECTOMY EMBOTRAP OD 5MM X L 21MM RADIOPAQUE SUP-ET309522 CDM 0270 RC outpatient 23599.8 23599.8 23599.8 74 17463.9 percent of total billed charges 23599.8 93 19115.8 percent of total billed charges 23599.8 23599.8 other OPPS APC 23599.8 23599.8 other OPPS APC 23599.8 27.63 6520.63 percent of total billed charges 23599.8 23599.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE THROMBECTOMY EMBOTRAP OD5MM X L 33MM RADIOPAQUE SUP-ET309537 CDM 0270 RC outpatient 17940 17940 17940 74 13275.6 percent of total billed charges 17940 93 14531.4 percent of total billed charges 17940 17940 other OPPS APC 17940 17940 other OPPS APC 17940 27.63 4956.82 percent of total billed charges 17940 17940 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC 2 BRANCH L145 MM OD23-13 MM ODSEC18 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL 1 PIECE KINK RESISTANT AAA SUP-ETBF2313C145E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC 2 BRANCH L166 MM OD23-13 MM ODSEC18 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL 1 PIECE KINK RESISTANT AAA SUP-ETBF2313C166E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC 2 BRANCH L124 MM OD23-16 MM ODSEC18 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL 1 PIECE KINK RESISTANT AAA SUP-ETBF2316C124E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC 2 BRANCH L166 MM OD25-13 MM ODSEC18 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL 1 PIECE KINK RESISTANT AAA SUP-ETBF2513C166E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC 2 BRANCH L124 MM OD25-16 MM ODSEC18 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL 1 PIECE KINK RESISTANT AAA SUP-ETBF2516C124E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC 2 BRANCH L145 MM OD25-16 MM ODSEC18 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL 1 PIECE KINK RESISTANT AAA SUP-ETBF2516C145E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC 2 BRANCH L166 MM OD25-16 MM ODSEC18 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL 1 PIECE KINK RESISTANT AAA SUP-ETBF2516C166E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT L124 MM OD28-13 MM ODSEC18 FR ENDOVASCULAR PROXIMAL DISTAL SYSTEM BIFURCATED C DESIGN AAA SUP-ETBF2813C124E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC 2 BRANCH L145 MM OD28-13 MM ODSEC18 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL 1 PIECE KINK RESISTANT AAA SUP-ETBF2813C145E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC 2 BRANCH L166 MM OD28-13 MM ODSEC18 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL 1 PIECE KINK RESISTANT AAA SUP-ETBF2813C166E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC 2 BRANCH L124 MM OD28-16 MM ODSEC18 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL 1 PIECE KINK RESISTANT AAA SUP-ETBF2816C124E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC 2 BRANCH L145 MM OD28-16 MM ODSEC18 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL 1 PIECE KINK RESISTANT AAA SUP-ETBF2816C145E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER BIFURCATE L166 MM OD28-16 MM ODSEC18 FR ENDOVASCULAR ABDOMEN AORTA ILIUM C AAA SUP-ETBF2816C166E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC 2 BRANCH L124 MM OD32-16 MM ODSEC20 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL 1 PIECE KINK RESISTANT AAA SUP-ETBF3216C124E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC 2 BRANCH L166 MM OD32-16 MM ODSEC20 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL 1 PIECE KINK RESISTANT AAA SUP-ETBF3216C166E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II 2 BRANCH L145 MM OD32/20 MM ODSEC20 FR ENDOVASCULAR ABDOMINAL AORTIC ANEURYSM C DESIGN SUP-ETBF3220C145E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC 2 BRANCH L166 MM OD32-20 MM ODSEC20 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL 1 PIECE KINK RESISTANT AAA SUP-ETBF3220C166E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC 2 BRANCH L166 MM OD36-16 MM ODSEC20 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL 1 PIECE KINK RESISTANT AAA SUP-ETBF3616C166E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II 2 BRANCH AAA SUP-ETBF3620C166E CDM 270010015 LOCAL 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II POLYESTER NITINOL L49 MM OD28 MM ODSEC18 FR ENDOVASCULAR AORTIC EXTENSION STERILE AAA SUP-ETCF2828C49E CDM 270010015 LOCAL 0270 RC outpatient 11115 11115 11115 74 8225.1 percent of total billed charges 11115 93 9003.15 percent of total billed charges 11115 11115 other OPPS APC 11115 11115 other OPPS APC 11115 27.63 3071.07 percent of total billed charges 11115 11115 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II POLYESTER NITINOL L49 MM OD32 MM ODSEC20 FR ENDOVASCULAR AORTIC EXTENSION STERILE AAA SUP-ETCF3232C49E CDM 270010015 LOCAL 0270 RC outpatient 11895 11895 11895 74 8802.3 percent of total billed charges 11895 93 9634.95 percent of total billed charges 11895 11895 other OPPS APC 11895 11895 other OPPS APC 11895 27.63 3286.59 percent of total billed charges 11895 11895 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II POLYESTER NITINOL L49 MM OD36 MM ODSEC20 FR ENDOVASCULAR AORTIC EXTENSION STERILE AAA SUP-ETCF3636C49E CDM 270010015 LOCAL 0270 RC outpatient 12155 12155 12155 74 8994.7 percent of total billed charges 12155 93 9845.55 percent of total billed charges 12155 12155 other OPPS APC 12155 12155 other OPPS APC 12155 27.63 3358.43 percent of total billed charges 12155 12155 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II POLYESTER NITINOL L82 MM OD13 MM ODSEC14 FR ENDOVASCULAR ILIAC EXTENSION STERILE AAA SUP-ETEW1313C82E CDM 270010015 LOCAL 0270 RC outpatient 12090 12090 12090 74 8946.6 percent of total billed charges 12090 93 9792.9 percent of total billed charges 12090 12090 other OPPS APC 12090 12090 other OPPS APC 12090 27.63 3340.47 percent of total billed charges 12090 12090 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHILON MULTIPASS 4-0 PC-1 L18 IN MONOFILAMENT PLIABILIZE BLACK SUP-ETH1854G CDM 0270 RC outpatient 9.78 9.78 9.78 74 7.24 percent of total billed charges 9.78 93 7.92 percent of total billed charges 9.78 9.78 other OPPS APC 9.78 9.78 other OPPS APC 9.78 27.63 2.7 percent of total billed charges 9.78 9.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADHESIVE SKIN CLOSURE DERMABOND MINI .36 ML 2-OCTYL CYANOACRYLATE HIGH VISCOSITY LIQUID APPLICATOR MICROBIAL BARRIER STERILE SUP-ETHDHVM12 CDM 0270 RC outpatient 28.3 28.3 28.3 74 20.94 percent of total billed charges 28.3 93 22.92 percent of total billed charges 28.3 28.3 other OPPS APC 28.3 28.3 other OPPS APC 28.3 27.63 7.82 percent of total billed charges 28.3 28.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 2-0 CT-1 L27 IN BRAID COATED UNDYED SUP-ETHJ259H CDM 0270 RC outpatient 3.55 3.55 3.55 74 2.63 percent of total billed charges 3.55 93 2.88 percent of total billed charges 3.55 3.55 other OPPS APC 3.55 3.55 other OPPS APC 3.55 27.63 0.98 percent of total billed charges 3.55 3.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND EXCEL 2-0 CT-2 L30 IN BRAID GREEN SUP-ETHX411H CDM 0270 RC outpatient 3.7 3.7 3.7 74 2.74 percent of total billed charges 3.7 93 3 percent of total billed charges 3.7 3.7 other OPPS APC 3.7 3.7 other OPPS APC 3.7 27.63 1.02 percent of total billed charges 3.7 3.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC L124 MM OD16-10 MM ODSEC14 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL CONTRALATERAL ILIAC LIMB 1 PIECE AAA SUP-ETLW1610C124E CDM 270010015 LOCAL 0270 RC outpatient 12935 12935 12935 74 9571.9 percent of total billed charges 12935 93 10477.4 percent of total billed charges 12935 12935 other OPPS APC 12935 12935 other OPPS APC 12935 27.63 3573.94 percent of total billed charges 12935 12935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC L156 MM OD16-10 MM ODSEC16 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL CONTRALATERAL ILIAC LIMB 1 PIECE AAA SUP-ETLW1610C156E CDM 270010015 LOCAL 0270 RC outpatient 16640 16640 16640 74 12313.6 percent of total billed charges 16640 93 13478.4 percent of total billed charges 16640 16640 other OPPS APC 16640 16640 other OPPS APC 16640 27.63 4597.63 percent of total billed charges 16640 16640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC L82 MM OD16-10 MM ODSEC14 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL CONTRALATERAL ILIAC LIMB 1 PIECE AAA SUP-ETLW1610C82E CDM 270010015 LOCAL 0270 RC outpatient 12610 12610 12610 74 9331.4 percent of total billed charges 12610 93 10214.1 percent of total billed charges 12610 12610 other OPPS APC 12610 12610 other OPPS APC 12610 27.63 3484.14 percent of total billed charges 12610 12610 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC L93 MM OD16-10 MM ODSEC14 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL CONTRALATERAL ILIAC LIMB 1 PIECE AAA SUP-ETLW1610C93E CDM 270010015 LOCAL 0270 RC outpatient 12805 12805 12805 74 9475.7 percent of total billed charges 12805 93 10372 percent of total billed charges 12805 12805 other OPPS APC 12805 12805 other OPPS APC 12805 27.63 3538.02 percent of total billed charges 12805 12805 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC L124 MM OD16-13 MM ODSEC14 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL CONTRALATERAL ILIAC LIMB 1 PIECE AAA SUP-ETLW1613C124E CDM 270010015 LOCAL 0270 RC outpatient 13452.4 13452.4 13452.4 74 9954.78 percent of total billed charges 13452.4 93 10896.4 percent of total billed charges 13452.4 13452.4 other OPPS APC 13452.4 13452.4 other OPPS APC 13452.4 27.63 3716.9 percent of total billed charges 13452.4 13452.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC L156 MM OD16-13 MM ODSEC16 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL CONTRALATERAL ILIAC LIMB 1 PIECE AAA SUP-ETLW1613C156E CDM 270010015 LOCAL 0270 RC outpatient 16640 16640 16640 74 12313.6 percent of total billed charges 16640 93 13478.4 percent of total billed charges 16640 16640 other OPPS APC 16640 16640 other OPPS APC 16640 27.63 4597.63 percent of total billed charges 16640 16640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC L82 MM OD16-13 MM ODSEC14 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL CONTRALATERAL ILIAC LIMB 1 PIECE AAA SUP-ETLW1613C82E CDM 270010015 LOCAL 0270 RC outpatient 12610 12610 12610 74 9331.4 percent of total billed charges 12610 93 10214.1 percent of total billed charges 12610 12610 other OPPS APC 12610 12610 other OPPS APC 12610 27.63 3484.14 percent of total billed charges 12610 12610 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II 2 BRANCH 93MM 143MM 16-13MM 14FR NITINOL POLYESTER HYDROPHILIC ENDOVASCULAR ILIAC RADIOPAQUE SUP-ETLW1613C93E CDM 270010015 LOCAL 0270 RC outpatient 12805 12805 12805 74 9475.7 percent of total billed charges 12805 93 10372 percent of total billed charges 12805 12805 other OPPS APC 12805 12805 other OPPS APC 12805 27.63 3538.02 percent of total billed charges 12805 12805 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC L124 MM OD16-16 MM ODSEC14 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL CONTRALATERAL ILIAC LIMB 1 PIECE AAA SUP-ETLW1616C124E CDM 270010015 LOCAL 0270 RC outpatient 12805 12805 12805 74 9475.7 percent of total billed charges 12805 93 10372 percent of total billed charges 12805 12805 other OPPS APC 12805 12805 other OPPS APC 12805 27.63 3538.02 percent of total billed charges 12805 12805 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDURANT 11 STENT GRAFT LIMB SUP-ETLW1616C146E CDM 0270 RC outpatient 16640 16640 16640 74 12313.6 percent of total billed charges 16640 93 13478.4 percent of total billed charges 16640 16640 other OPPS APC 16640 16640 other OPPS APC 16640 27.63 4597.63 percent of total billed charges 16640 16640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC L156 MM OD16-16 MM ODSEC16 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL CONTRALATERAL ILIAC LIMB 1 PIECE AAA SUP-ETLW1616C156E CDM 270010015 LOCAL 0270 RC outpatient 16640 16640 16640 74 12313.6 percent of total billed charges 16640 93 13478.4 percent of total billed charges 16640 16640 other OPPS APC 16640 16640 other OPPS APC 16640 27.63 4597.63 percent of total billed charges 16640 16640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC L82 MM OD16-16 MM ODSEC14 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL CONTRALATERAL ILIAC LIMB 1 PIECE AAA SUP-ETLW1616C82E CDM 270010015 LOCAL 0270 RC outpatient 11635 11635 11635 74 8609.9 percent of total billed charges 11635 93 9424.35 percent of total billed charges 11635 11635 other OPPS APC 11635 11635 other OPPS APC 11635 27.63 3214.75 percent of total billed charges 11635 11635 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II 2 BRANCH 93MM 143MM 16MM 14FR NITINOL POLYESTER HYDROPHILIC ENDOVASCULAR ILIAC RADIOPAQUE SUP-ETLW1616C93E CDM 270010015 LOCAL 0270 RC outpatient 12090 12090 12090 74 8946.6 percent of total billed charges 12090 93 9792.9 percent of total billed charges 12090 12090 other OPPS APC 12090 12090 other OPPS APC 12090 27.63 3340.47 percent of total billed charges 12090 12090 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC L124 MM OD16-20 MM ODSEC16 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL CONTRALATERAL ILIAC LIMB 1 PIECE AAA SUP-ETLW1620C124E CDM 270010015 LOCAL 0270 RC outpatient 12935 12935 12935 74 9571.9 percent of total billed charges 12935 93 10477.4 percent of total billed charges 12935 12935 other OPPS APC 12935 12935 other OPPS APC 12935 27.63 3573.94 percent of total billed charges 12935 12935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC L156 MM OD16-20 MM ODSEC16 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL CONTRALATERAL ILIAC LIMB 1 PIECE AAA SUP-ETLW1620C156E CDM 270010015 LOCAL 0270 RC outpatient 16640 16640 16640 74 12313.6 percent of total billed charges 16640 93 13478.4 percent of total billed charges 16640 16640 other OPPS APC 16640 16640 other OPPS APC 16640 27.63 4597.63 percent of total billed charges 16640 16640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC L82 MM OD16-20 MM ODSEC16 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL CONTRALATERAL ILIAC LIMB 1 PIECE AAA SUP-ETLW1620C82E CDM 270010015 LOCAL 0270 RC outpatient 11635 11635 11635 74 8609.9 percent of total billed charges 11635 93 9424.35 percent of total billed charges 11635 11635 other OPPS APC 11635 11635 other OPPS APC 11635 27.63 3214.75 percent of total billed charges 11635 11635 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC L93 MM OD16-20 MM ODSEC16 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL CONTRALATERAL ILIAC LIMB 1 PIECE AAA SUP-ETLW1620C93E CDM 270010015 LOCAL 0270 RC outpatient 12805 12805 12805 74 9475.7 percent of total billed charges 12805 93 10372 percent of total billed charges 12805 12805 other OPPS APC 12805 12805 other OPPS APC 12805 27.63 3538.02 percent of total billed charges 12805 12805 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC L124 MM OD16-24 MM ODSEC16 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL CONTRALATERAL ILIAC LIMB 1 PIECE AAA SUP-ETLW1624C124E CDM 270010015 LOCAL 0270 RC outpatient 12935 12935 12935 74 9571.9 percent of total billed charges 12935 93 10477.4 percent of total billed charges 12935 12935 other OPPS APC 12935 12935 other OPPS APC 12935 27.63 3573.94 percent of total billed charges 12935 12935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC L156 MM OD16-24 MM ODSEC16 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL CONTRALATERAL ILIAC LIMB 1 PIECE AAA SUP-ETLW1624C156E CDM 270010015 LOCAL 0270 RC outpatient 16640 16640 16640 74 12313.6 percent of total billed charges 16640 93 13478.4 percent of total billed charges 16640 16640 other OPPS APC 16640 16640 other OPPS APC 16640 27.63 4597.63 percent of total billed charges 16640 16640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II NITINOL POLYESTER HYDROPHILIC L93 MM OD16-24 MM ODSEC16 FR ENDOVASCULAR DELIVERY SYSTEM C DISTAL CONTRALATERAL ILIAC LIMB 1 PIECE AAA SUP-ETLW1624C93E CDM 270010015 LOCAL 0270 RC outpatient 12805 12805 12805 74 9475.7 percent of total billed charges 12805 93 10372 percent of total billed charges 12805 12805 other OPPS APC 12805 12805 other OPPS APC 12805 27.63 3538.02 percent of total billed charges 12805 12805 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PROLENE ETHIGUARD 0 CTX-B L30 IN MONOFILAMENT BLUE SUP-ETPB31H CDM 0270 RC outpatient 6.43 6.43 6.43 74 4.76 percent of total billed charges 6.43 93 5.21 percent of total billed charges 6.43 6.43 other OPPS APC 6.43 6.43 other OPPS APC 6.43 27.63 1.78 percent of total billed charges 6.43 6.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROTECTOR ENDO TUBE ADULT WITH TRIPLE RING FITS TUBE SIZES 6.5-9.5 MM SUP-ETPSR300A50 CDM 0270 RC outpatient 11.5 11.5 11.5 74 8.51 percent of total billed charges 11.5 93 9.32 percent of total billed charges 11.5 11.5 other OPPS APC 11.5 11.5 other OPPS APC 11.5 27.63 3.18 percent of total billed charges 11.5 11.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II POLYESTER NITINOL L70 MM OD28 MM ODSEC18 FR ENDOVASCULAR AORTIC EXTENSION STERILE AAA SUP-ETTF2828C70E CDM 270010015 LOCAL 0270 RC outpatient 2.6 2.6 2.6 74 1.92 percent of total billed charges 2.6 93 2.11 percent of total billed charges 2.6 2.6 other OPPS APC 2.6 2.6 other OPPS APC 2.6 27.63 0.72 percent of total billed charges 2.6 2.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ENDURANT II POLYESTER NITINOL L70 MM OD32 MM ODSEC20 FR ENDOVASCULAR AORTIC EXTENSION STERILE AAA SUP-ETTF3232C70E CDM 270010015 LOCAL 0270 RC outpatient 19695 19695 19695 74 14574.3 percent of total billed charges 19695 93 15953 percent of total billed charges 19695 19695 other OPPS APC 19695 19695 other OPPS APC 19695 27.63 5441.73 percent of total billed charges 19695 19695 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM INFLATION ACCLARENT AERA BALLOON DILATION STERILE LATEX FREE DISPOSABLE EUSTACHIAN TUBE SUP-EU061655Z CDM 270010000 LOCAL 0270 RC outpatient 5226 5226 5226 74 3867.24 percent of total billed charges 5226 93 4233.06 percent of total billed charges 5226 5226 other OPPS APC 5226 5226 other OPPS APC 5226 27.63 1443.94 percent of total billed charges 5226 5226 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA 142CM 6MM 1.5MM ULTRA-SLIM DURA-TRAC STERILE LF RAPID EXCHANGE RADIOPAQUE FEMALE SUP-EUP1506X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA 142CM 10MM 1.5MM ULTRA-SLIM DURA-TRAC STERILE LF RAPID EXCHANGE RADIOPAQUE FEMALE SUP-EUP1510X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L12 MM OD2.1-2.5 FR ODSEC1.5 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA SUP-EUP1512X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L15 MM OD2.1-2.5 FR ODSEC1.5 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA SUP-EUP1515X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 20 MM ODSEC 1.5 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP1520X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA 142CM 6MM 2MM ULTRA-SLIM DURA-TRAC STERILE LF RAPID EXCHANGE RADIOPAQUE FEMALE LUER SUP-EUP2006X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L10 MM OD2.1-2.5 FR ODSEC2 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA SUP-EUP2010X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L12 MM OD2.1-2.5 FR ODSEC2 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA SUP-EUP2012X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L15 MM OD2.1-2.5 FR ODSEC2 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA SUP-EUP2015X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L20 MM OD2.1-2.5 FR ODSEC2 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA SUP-EUP2020X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 25 MM ODSEC 2.0 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP2025X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 30 MM ODSEC 2.0 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP2030X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA-SLIM DURA-TRAC L142 CM L10 MM ODSEC2.25 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP22510X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 12 MM ODSEC 2.25 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP22512X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 15 MM ODSEC 2.25 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP22515X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L6 MM OD2.1-2.5 FR ODSEC2.5 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA SUP-EUP2506X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L10 MM OD2.1-2.5 FR ODSEC2.5 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA SUP-EUP2510X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L12 MM OD2.1-2.5 FR ODSEC2.5 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA SUP-EUP2512X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L15 MM OD2.1-2.5 FR ODSEC2.5 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA SUP-EUP2515X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L20 MM OD2.1-2.5 FR ODSEC2.5 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA SUP-EUP2520X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 25 MM ODSEC 2.5 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP2525X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 30 MM ODSEC 2.5 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP2530X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 15 MM ODSEC 2.75 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP27515X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA 142CM 6MM 3MM ULTRA-SLIM DURA-TRAC STERILE LF RAPID EXCHANGE RADIOPAQUE FEMALE LUER SUP-EUP3006X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA 142CM 10MM 3MM ULTRA-SLIM DURA-TRAC STERILE LF RAPID EXCHANGE RADIOPAQUE FEMALE LUER SUP-EUP3010X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA 142CM 12MM 3MM ULTRA-SLIM DURA-TRAC STERILE LF RAPID EXCHANGE RADIOPAQUE FEMALE LUER SUP-EUP3012X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA POWERTRAC ULTRA-SLIM DURA-TRAC L142 CM L15 MM OD2.1-2.5 FR ODSEC3 MM RAPID EXCHANGE TAPER SHAFT RADIOPAQUE FEMALE LUER PTCA SUP-EUP3015X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 20 MM ODSEC 3.0 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP3020X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 25 MM ODSEC 3.0 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP3025X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 30 MM ODSEC 3.0 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP3030X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA-SLIM DURA-TRAC L142 CM L6 MM ODSEC3.5 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP3506X_65940 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA-SLIM DURA-TRAC L142CM L 10MM ODSEC 3.5 MM RAPID EXCHANGE TAPER SHIFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP3510X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 12 MM ODSEC 3.5 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP3512X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 15 MM ODSEC 3.5 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP3515X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 20 MM ODSEC 3.5 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP3520X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 25 MM ODSEC 3.5 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP3525X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 30 MM ODSEC 3.5 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP3530X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA-SLIM DURA-TRAC L142 CM L6 MM ODSEC4 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP4006X_65941 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 10 MM ODSEC 4.0 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP4010X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 12 MM ODSEC 4.0 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP4012X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 15 MM ODSEC 4.0 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP4015X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 20 MM ODSEC 4.0 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP4020X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 25 MM ODSEC 4.0 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP4025X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EUPHORA ULTRA SLIM DURA TRAC 142CM L 30 MM ODSEC 4.0 MM RAPID EXCHANGE TAPER SHAFT LOW PROFILE RADIOPAQUE LATEX FREE PTCA SUP-EUP4030X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PULMONARY ARTERY ENDOVENT OD8.3 FR FLOW DIRECT PLACEMENT SUP-EV CDM 0270 RC outpatient 4095 4095 4095 74 3030.3 percent of total billed charges 4095 93 3316.95 percent of total billed charges 4095 4095 other OPPS APC 4095 4095 other OPPS APC 4095 27.63 1131.45 percent of total billed charges 4095 4095 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD EV240152 SUBSTERNAL LEAD 52CM SUP-EV240152 CDM 0481 RC outpatient 14014 14014 14014 74 10370.4 percent of total billed charges 14014 93 11351.3 percent of total billed charges 14014 14014 other OPPS APC 14014 14014 other OPPS APC 14014 51 7147.14 percent of total billed charges 14014 14014 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD EV240163 SUBSTERNAL LEAD 63CM SUP-EV240163 CDM 0481 RC outpatient 14014 14014 14014 74 10370.4 percent of total billed charges 14014 93 11351.3 percent of total billed charges 14014 14014 other OPPS APC 14014 14014 other OPPS APC 14014 51 7147.14 percent of total billed charges 14014 14014 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC EVERA MRI XT DR SURESCAN 2 CHAMBER ANTITACHYCARDIA SUP-EVERAMRIXTDRMMEM CDM 0275 RC outpatient 35398 35398 35398 57 20176.9 percent of total billed charges 35398 93 28672.4 percent of total billed charges 35398 35398 other OPPS APC 35398 35398 other OPPS APC 35398 51 18053 percent of total billed charges 35398 35398 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD DVBM1D4 EVERA XT MRI VR SYSTEM SUP-EVERAMRIXTVREMEM CDM 0275 RC outpatient 35800 35800 35800 57 20406 percent of total billed charges 35800 93 28998 percent of total billed charges 35800 35800 other OPPS APC 35800 35800 other OPPS APC 35800 51 18258 percent of total billed charges 35800 35800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD DVBB1D1 EVERA XT VR DF4 SYSTEM SUP-EVERAXTVREMEM-SYS CDM 0275 RC outpatient 34200 34200 34200 57 19494 percent of total billed charges 34200 93 27702 percent of total billed charges 34200 34200 other OPPS APC 34200 34200 other OPPS APC 34200 51 17442 percent of total billed charges 34200 34200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT CLAMP EVERCLIP FOGARTY HYDRAGRIP L33 MM ATRAUMATIC OCCLUSION SOFT COMPLIANT TRACTION GENTLE SURROUND VESSEL SET STERILE LATEX FREE DISPOSABLE SUP-EVERGRIP33 CDM 0270 RC outpatient 57.36 57.36 57.36 74 42.45 percent of total billed charges 57.36 93 46.46 percent of total billed charges 57.36 57.36 other OPPS APC 57.36 57.36 other OPPS APC 57.36 27.63 15.85 percent of total billed charges 57.36 57.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT CLAMP EVERCLIP FOGARTY HYDRAGRIP L61 MM ATRAUMATIC OCCLUSION SOFT COMPLIANT TRACTION GENTLE SURROUND VESSEL RUBBER PYRAMID SET STERILE LATEX FREE DISPOSABLE SUP-EVERGRIP61 CDM 0270 RC outpatient 51.14 51.14 51.14 74 37.84 percent of total billed charges 51.14 93 41.42 percent of total billed charges 51.14 51.14 other OPPS APC 51.14 51.14 other OPPS APC 51.14 27.63 14.13 percent of total billed charges 51.14 51.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVOLUT FX+ 23MM VALVE SUP-EVFXPLUS-23 CDM 0481 RC outpatient 83200 83200 83200 74 61568 percent of total billed charges 83200 93 67392 percent of total billed charges 83200 83200 other OPPS APC 83200 83200 other OPPS APC 83200 51 42432 percent of total billed charges 83200 83200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVOLUT FX+ 26MM VALVE SUP-EVFXPLUS-26 CDM 0481 RC outpatient 83200 83200 83200 74 61568 percent of total billed charges 83200 93 67392 percent of total billed charges 83200 83200 other OPPS APC 83200 83200 other OPPS APC 83200 51 42432 percent of total billed charges 83200 83200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVOLUT FX+ 29MM VALVE SUP-EVFXPLUS-29 CDM 0481 RC outpatient 83200 83200 83200 74 61568 percent of total billed charges 83200 93 67392 percent of total billed charges 83200 83200 other OPPS APC 83200 83200 other OPPS APC 83200 51 42432 percent of total billed charges 83200 83200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVOLUT FX+ 34MM VALVE SUP-EVFXPLUS-34 CDM 0481 RC outpatient 83200 83200 83200 74 61568 percent of total billed charges 83200 93 67392 percent of total billed charges 83200 83200 other OPPS APC 83200 83200 other OPPS APC 83200 51 42432 percent of total billed charges 83200 83200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC EVOLUT FX 23 MM SUP-EVOLUTFX-23 CDM 0270 RC outpatient 78000 78000 78000 74 57720 percent of total billed charges 78000 93 63180 percent of total billed charges 78000 78000 other OPPS APC 78000 78000 other OPPS APC 78000 27.63 21551.4 percent of total billed charges 78000 78000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC EVOLUT FX 26 MM SUP-EVOLUTFX-26 CDM 0270 RC outpatient 78000 78000 78000 74 57720 percent of total billed charges 78000 93 63180 percent of total billed charges 78000 78000 other OPPS APC 78000 78000 other OPPS APC 78000 27.63 21551.4 percent of total billed charges 78000 78000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC EVOLUT FX 29 MM SUP-EVOLUTFX-29 CDM 0270 RC outpatient 78000 78000 78000 74 57720 percent of total billed charges 78000 93 63180 percent of total billed charges 78000 78000 other OPPS APC 78000 78000 other OPPS APC 78000 27.63 21551.4 percent of total billed charges 78000 78000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC EVOLUT FX 34 MM SUP-EVOLUTFX-34 CDM 0270 RC outpatient 78000 78000 78000 74 57720 percent of total billed charges 78000 93 63180 percent of total billed charges 78000 78000 other OPPS APC 78000 78000 other OPPS APC 78000 27.63 21551.4 percent of total billed charges 78000 78000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE TRANSCATHETER AORTIC 23 SUP-EVOLUTPRO-23-US CDM 27000000 LOCAL 0270 RC outpatient 78000 78000 78000 74 57720 percent of total billed charges 78000 93 63180 percent of total billed charges 78000 78000 other OPPS APC 78000 78000 other OPPS APC 78000 27.63 21551.4 percent of total billed charges 78000 78000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE TRANSCATHER AORTIC 26 SUP-EVOLUTPRO-26-US CDM 27000000 LOCAL 0270 RC outpatient 48800 48800 48800 74 36112 percent of total billed charges 48800 93 39528 percent of total billed charges 48800 48800 other OPPS APC 48800 48800 other OPPS APC 48800 27.63 13483.4 percent of total billed charges 48800 48800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE TRANSCATHETER AORTIC 29 SUP-EVOLUTPRO-29-US CDM 0270 RC outpatient 78000 78000 78000 74 57720 percent of total billed charges 78000 93 63180 percent of total billed charges 78000 78000 other OPPS APC 78000 78000 other OPPS APC 78000 27.63 21551.4 percent of total billed charges 78000 78000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC TRANSCATHETER EVOLUTR 23MM SUP-EVOLUTR-23-US CDM 0270 RC outpatient 48800 48800 48800 74 36112 percent of total billed charges 48800 93 39528 percent of total billed charges 48800 48800 other OPPS APC 48800 48800 other OPPS APC 48800 27.63 13483.4 percent of total billed charges 48800 48800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC TRANSCATHETER EVOLUTR 26MM SUP-EVOLUTR-26-US CDM 0270 RC outpatient 48800 48800 48800 74 36112 percent of total billed charges 48800 93 39528 percent of total billed charges 48800 48800 other OPPS APC 48800 48800 other OPPS APC 48800 27.63 13483.4 percent of total billed charges 48800 48800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC COREVALVE EVOLUT R PORCINE PERICARDIUM 29 MM OD23-26 MM 1 LAYER SELF EXPAND MULTILEVEL TRANSCATHETER STERILE SUP-EVOLUTR-29-US CDM 0270 RC outpatient 48800 48800 48800 74 36112 percent of total billed charges 48800 93 39528 percent of total billed charges 48800 48800 other OPPS APC 48800 48800 other OPPS APC 48800 27.63 13483.4 percent of total billed charges 48800 48800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC TRANSCATHETER EVOLUTR 34MM SUP-EVOLUTR-34-US CDM 0270 RC outpatient 48800 48800 48800 74 36112 percent of total billed charges 48800 93 39528 percent of total billed charges 48800 48800 other OPPS APC 48800 48800 other OPPS APC 48800 27.63 13483.4 percent of total billed charges 48800 48800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC TRANSCATHETER EVOLUTR 23MM SUP-EVPROPLUS-23US CDM 0270 RC outpatient 78000 78000 78000 74 57720 percent of total billed charges 78000 93 63180 percent of total billed charges 78000 78000 other OPPS APC 78000 78000 other OPPS APC 78000 27.63 21551.4 percent of total billed charges 78000 78000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 26MM EVOLUT PRO+ TAVR VALVE SUP-EVPROPLUS-26US CDM 0270 RC outpatient 48800 48800 48800 74 36112 percent of total billed charges 48800 93 39528 percent of total billed charges 48800 48800 other OPPS APC 48800 48800 other OPPS APC 48800 27.63 13483.4 percent of total billed charges 48800 48800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVOLUT PRO+ TAVR VALVE 29MM SUP-EVPROPLUS-29US CDM 0270 RC outpatient 48800 48800 48800 74 36112 percent of total billed charges 48800 93 39528 percent of total billed charges 48800 48800 other OPPS APC 48800 48800 other OPPS APC 48800 27.63 13483.4 percent of total billed charges 48800 48800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVOLUT PRO+ TAVR VALVE 34MM SUP-EVPROPLUS-34US CDM 0270 RC outpatient 48800 48800 48800 74 36112 percent of total billed charges 48800 93 39528 percent of total billed charges 48800 48800 other OPPS APC 48800 48800 other OPPS APC 48800 27.63 13483.4 percent of total billed charges 48800 48800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER USB L65 MM X W25 MM X H13.5 MM 19.5 ML 30 GM WIRELESS MODEM SUPERIOR PERFORMANCE DIGITAL SIMPLE SUP-EX1151 CDM 0275 RC outpatient 1235 1235 1235 57 703.95 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT TRANSMITTER BROADBAND SUP-EX1170 CDM 0275 RC outpatient 1235 1235 1235 57 703.95 percent of total billed charges 1235 93 1000.35 percent of total billed charges 1235 1235 other OPPS APC 1235 1235 other OPPS APC 1235 51 629.85 percent of total billed charges 1235 1235 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACTIVATOR PATIENT FOR MRI SUP-EX4000 CDM 0275 RC outpatient 741 741 741 57 422.37 percent of total billed charges 741 93 600.21 percent of total billed charges 741 741 other OPPS APC 741 741 other OPPS APC 741 51 377.91 percent of total billed charges 741 741 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE EXOSEAL OD5 FR FEMORAL ARTERY ABSORBABLE PLUG APPLIER HANDLE DELIVERY SHAFT STERILE LATEX FREE SUP-EX500_49624 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE EXOSEAL OD6 FR FEMORAL ARTERY ABSORBABLE PLUG APPLIER HANDLE DELIVERY SHAFT STERILE LATEX FREE SUP-EX600 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F EXPORT ASPIRATION CATHETER SUP-EXPORTAP CDM 0270 RC outpatient 1105 1105 1105 74 817.7 percent of total billed charges 1105 93 895.05 percent of total billed charges 1105 1105 other OPPS APC 1105 1105 other OPPS APC 1105 27.63 305.31 percent of total billed charges 1105 1105 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6FR OPTISEAL 13CM SUP-EXT-1000093-001 CDM 0275 RC outpatient 185.95 185.95 185.95 57 105.99 percent of total billed charges 185.95 93 150.62 percent of total billed charges 185.95 185.95 other OPPS APC 185.95 185.95 other OPPS APC 185.95 51 94.83 percent of total billed charges 185.95 185.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 7FR OPTISEAL 13CM SUP-EXT-1000093-002 CDM 0275 RC outpatient 185.95 185.95 185.95 57 105.99 percent of total billed charges 185.95 93 150.62 percent of total billed charges 185.95 185.95 other OPPS APC 185.95 185.95 other OPPS APC 185.95 51 94.83 percent of total billed charges 185.95 185.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 8FR OPTISEAL 13CM SUP-EXT-1000093-003 CDM 0275 RC outpatient 215.8 215.8 215.8 57 123.01 percent of total billed charges 215.8 93 174.8 percent of total billed charges 215.8 215.8 other OPPS APC 215.8 215.8 other OPPS APC 215.8 51 110.06 percent of total billed charges 215.8 215.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPREADER ENDOSCOPIC AMPLIFEYE SMALL OD11-12.5 MM FLEXIBLE DETECTION ARM 1 ROW SECURE FIT STERILE DISPOSABLE SUP-EYE-101 CDM 0270 RC outpatient 65 65 65 74 48.1 percent of total billed charges 65 93 52.65 percent of total billed charges 65 65 other OPPS APC 65 65 other OPPS APC 65 27.63 17.96 percent of total billed charges 65 65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE COMPRESSION PRELUDESYNC EZ SLIP-N-LOCK L29 CM RADIAL CINCH BAND CAP LARGE CLEAR WINDOW AREA 2 HAND PLACEMENT LATEX FREE SUP-EZ-REG CDM 0270 RC outpatient 70.2 70.2 70.2 74 51.95 percent of total billed charges 70.2 93 56.86 percent of total billed charges 70.2 70.2 other OPPS APC 70.2 70.2 other OPPS APC 70.2 27.63 19.4 percent of total billed charges 70.2 70.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE COMPRESSION PRELUDESYNC EZ SLIP-N-LOCK L23 CM RADIAL CINCH BAND CAP LARGE CLEAR WINDOW AREA 2 HAND PLACEMENT LATEX FREE SUP-EZ-SML CDM 0270 RC outpatient 70.2 70.2 70.2 74 51.95 percent of total billed charges 70.2 93 56.86 percent of total billed charges 70.2 70.2 other OPPS APC 70.2 70.2 other OPPS APC 70.2 27.63 19.4 percent of total billed charges 70.2 70.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIGATOR 18IN ENDOLOOP MONOFILAMENT TIES LOOP SUTURE ENDOSCOPIC PDS II 12 LF VIOLET SUP-EZ10G CDM 0270 RC outpatient 107.87 107.87 107.87 74 79.82 percent of total billed charges 107.87 93 87.37 percent of total billed charges 107.87 107.87 other OPPS APC 107.87 107.87 other OPPS APC 107.87 27.63 29.8 percent of total billed charges 107.87 107.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ENDOPATH 45MM 300MM BLUE DISPOSABLE STERILE LF 8 FIRING LINEAR CUTTER RELOAD NO ARTICULATION SUP-EZ45B CDM 270009088 LOCAL 0270 RC outpatient 132.68 132.68 132.68 74 98.18 percent of total billed charges 132.68 93 107.47 percent of total billed charges 132.68 132.68 other OPPS APC 132.68 132.68 other OPPS APC 132.68 27.63 36.66 percent of total billed charges 132.68 132.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ENDOPATH L45 MM L300 MM THICK TISSUE 8 FIRING LINEAR CUTTER RELOAD NO ARTICULATION STERILE LATEX FREE DISPOSABLE GREEN ENDOSCOPIC SUP-EZ45G CDM 270009089 LOCAL 0270 RC outpatient 299.84 299.84 299.84 74 221.88 percent of total billed charges 299.84 93 242.87 percent of total billed charges 299.84 299.84 other OPPS APC 299.84 299.84 other OPPS APC 299.84 27.63 82.85 percent of total billed charges 299.84 299.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. F05A BIOPSY DEVICE SUP-F05A CDM 0270 RC outpatient 353.6 353.6 353.6 74 261.66 percent of total billed charges 353.6 93 286.42 percent of total billed charges 353.6 353.6 other OPPS APC 353.6 353.6 other OPPS APC 353.6 27.63 97.7 percent of total billed charges 353.6 353.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL VOITEX LPR 15 X 20 CM ELLIPSE SUP-F10244-1520L CDM 0270 RC outpatient 10475.3 10475.3 10475.3 74 7751.7 percent of total billed charges 10475.3 93 8484.97 percent of total billed charges 10475.3 10475.3 other OPPS APC 10475.3 10475.3 other OPPS APC 10475.3 27.63 2894.32 percent of total billed charges 10475.3 10475.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL OVITEX 1S 20CM X 20CM PERMANENT POLYPROPYLENE POLYMER 6-LAYER TRIMMABLE REINFORCED BIOSCAFFOLD INTRAPERITONEAL FLAT SHEET F/HERNIA REPAIR SUP-F10246-2020P CDM 0270 RC outpatient 16848 16848 16848 74 12467.5 percent of total billed charges 16848 93 13646.9 percent of total billed charges 16848 16848 other OPPS APC 16848 16848 other OPPS APC 16848 27.63 4655.1 percent of total billed charges 16848 16848 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH OVITEX 1S SIX LAYER 25 X 30 CM PERMANENT SUP-F10246-2530P CDM 0270 RC outpatient 25935 25935 25935 74 19191.9 percent of total billed charges 25935 93 21007.3 percent of total billed charges 25935 25935 other OPPS APC 25935 25935 other OPPS APC 25935 27.63 7165.84 percent of total billed charges 25935 25935 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH HERNIA OVITEX POLYGLYCOLIC ACID THK 1.1MM 6MM L 10CM X W 6CM RESORBABLE GRID 1 SMOOTH SIDE VISCERA CONTACT SUP-F10256-0610G CDM 0270 RC outpatient 2527.2 2527.2 2527.2 74 1870.13 percent of total billed charges 2527.2 93 2047.03 percent of total billed charges 2527.2 2527.2 other OPPS APC 2527.2 2527.2 other OPPS APC 2527.2 27.63 698.27 percent of total billed charges 2527.2 2527.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE OPTOWIRE III L180 CM STRIAGHT TIP WITHOUT GAUGE CONNECTOR MODERN PRESSURE SUP-F1032 CDM 0481 RC outpatient 1534 1534 1534 74 1135.16 percent of total billed charges 1534 93 1242.54 percent of total billed charges 1534 1534 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MIDAS REX LEGEND TAPER L8 CM L15.9 MM OD2.3 MM BURR FOOT ATTACHMENT SUP-F2/8TA23 CDM 270010028 LOCAL 0270 RC outpatient 398.11 398.11 398.11 74 294.6 percent of total billed charges 398.11 93 322.47 percent of total billed charges 398.11 398.11 other OPPS APC 398.11 398.11 other OPPS APC 398.11 27.63 110 percent of total billed charges 398.11 398.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIDAS REX DRILL BIT S-1 SUP-F39TA30_62653 CDM 0270 RC outpatient 477.28 477.28 477.28 74 353.19 percent of total billed charges 477.28 93 386.6 percent of total billed charges 477.28 477.28 other OPPS APC 477.28 477.28 other OPPS APC 477.28 27.63 131.87 percent of total billed charges 477.28 477.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY 2-8-2 MM SPACE P CURVE L 60CM L 1MM OD 5 FR DECAPOLAR FIX AUTO ID SUP-F5ADP282CT CDM 0270 RC outpatient 777.4 777.4 777.4 74 575.28 percent of total billed charges 777.4 93 629.69 percent of total billed charges 777.4 777.4 other OPPS APC 777.4 777.4 other OPPS APC 777.4 27.63 214.8 percent of total billed charges 777.4 777.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY 5MM SPACE A CURVE L 115CM L 1MM OD 6FR QUADRAPOLAR AUTO ID SUP-F6QA005CT CDM 0270 RC outpatient 319.8 319.8 319.8 74 236.65 percent of total billed charges 319.8 93 259.04 percent of total billed charges 319.8 319.8 other OPPS APC 319.8 319.8 other OPPS APC 319.8 27.63 88.36 percent of total billed charges 319.8 319.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL OPTIFORM SIZE 21MM SUP-F7-021 CDM 0270 RC outpatient 11562.2 11562.2 11562.2 74 8556.03 percent of total billed charges 11562.2 93 9365.38 percent of total billed charges 11562.2 11562.2 other OPPS APC 11562.2 11562.2 other OPPS APC 11562.2 27.63 3194.64 percent of total billed charges 11562.2 11562.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL OPTIFORM TITANIUM OD23 MM MECHANICAL ROTATABLE FLEXIBLE SYMMETRICAL SEW CUFF STIFFENING RING SUP-F7-023 CDM 0270 RC outpatient 11562.2 11562.2 11562.2 74 8556.03 percent of total billed charges 11562.2 93 9365.38 percent of total billed charges 11562.2 11562.2 other OPPS APC 11562.2 11562.2 other OPPS APC 11562.2 27.63 3194.64 percent of total billed charges 11562.2 11562.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL OPTIFORM TITANIUM OD25 MM MECHANICAL ROTATABLE FLEXIBLE SYMMETRICAL SEW CUFF STIFFENING RING SUP-F7-025 CDM 0270 RC outpatient 11562.2 11562.2 11562.2 74 8556.03 percent of total billed charges 11562.2 93 9365.38 percent of total billed charges 11562.2 11562.2 other OPPS APC 11562.2 11562.2 other OPPS APC 11562.2 27.63 3194.64 percent of total billed charges 11562.2 11562.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL OPTIFORM TITANIUM OD27 MM MECHANICAL ROTATABLE FLEXIBLE SYMMETRICAL SEW CUFF STIFFENING RING SUP-F7-027 CDM 0270 RC outpatient 11562.2 11562.2 11562.2 74 8556.03 percent of total billed charges 11562.2 93 9365.38 percent of total billed charges 11562.2 11562.2 other OPPS APC 11562.2 11562.2 other OPPS APC 11562.2 27.63 3194.64 percent of total billed charges 11562.2 11562.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL OPTIFORM TITANIUM OD29 MM MECHANICAL ROTATABLE FLEXIBLE SYMMETRICAL SEW CUFF STIFFENING RING SUP-F7-029 CDM 0270 RC outpatient 11562.2 11562.2 11562.2 74 8556.03 percent of total billed charges 11562.2 93 9365.38 percent of total billed charges 11562.2 11562.2 other OPPS APC 11562.2 11562.2 other OPPS APC 11562.2 27.63 3194.64 percent of total billed charges 11562.2 11562.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL OPTIFORM TITANIUM OD31 MM MECHANICAL ROTATABLE FLEXIBLE SYMMETRICAL SEW CUFF STIFFENING RING SUP-F7-031 CDM 0270 RC outpatient 11562.2 11562.2 11562.2 74 8556.03 percent of total billed charges 11562.2 93 9365.38 percent of total billed charges 11562.2 11562.2 other OPPS APC 11562.2 11562.2 other OPPS APC 11562.2 27.63 3194.64 percent of total billed charges 11562.2 11562.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL OPTIFORM TITANIUM OD33 MM MECHANICAL ROTATABLE FLEXIBLE SYMMETRICAL SEW CUFF STIFFENING RING SUP-F7-033 CDM 0270 RC outpatient 11562.2 11562.2 11562.2 74 8556.03 percent of total billed charges 11562.2 93 9365.38 percent of total billed charges 11562.2 11562.2 other OPPS APC 11562.2 11562.2 other OPPS APC 11562.2 27.63 3194.64 percent of total billed charges 11562.2 11562.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET CATHETERIZATION .025 IN L4 1/4 IN OD18 GA ODSEC20 GA ARTERIAL RADIOPAQUE SPRING GUIDEWIRE INTRODUCER NEEDLE WING CLIP SUTURE LATEX FREE SUP-FA-04018 CDM 270009180 LOCAL 0270 RC outpatient 13.32 13.32 13.32 74 9.86 percent of total billed charges 13.32 93 10.79 percent of total billed charges 13.32 13.32 other OPPS APC 13.32 13.32 other OPPS APC 13.32 27.63 3.68 percent of total billed charges 13.32 13.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET CATHETERIZATION POLYURETHANE .018 IN L10.8 CM L13.3 CM OD20 GA ODSEC22 GA ARTERY RADIOPAQUE GUIDEWIRE INTRODUCER NEEDLE WING CLIP LATEX FREE SUP-FA-04020 CDM 270009180 LOCAL 0270 RC outpatient 13.32 13.32 13.32 74 9.86 percent of total billed charges 13.32 93 10.79 percent of total billed charges 13.32 13.32 other OPPS APC 13.32 13.32 other OPPS APC 13.32 27.63 3.68 percent of total billed charges 13.32 13.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION MARKSMAN STAINLESS STEEL MICRO L105 CM L10 CM OD2.8-3.2 FR ID.027 IN PERIPHERAL CORONARY COIL KINK RESISTANT PIPELINE EMBOLISATION DEVICE SUP-FA-55105-1015 CDM 0270 RC outpatient 3346.2 3346.2 3346.2 74 2476.19 percent of total billed charges 3346.2 93 2710.42 percent of total billed charges 3346.2 3346.2 other OPPS APC 3346.2 3346.2 other OPPS APC 3346.2 27.63 924.56 percent of total billed charges 3346.2 3346.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION MARKSMAN STAINLESS STEEL HYDROPHILIC MICRO L135 CM L10 CM OD2.8-3.2 FR ID.027 IN PERIPHERAL CORONARY 1 LUMEN RADIOPAQUE MARKER COIL BRAID PIPELINE EMBOLISATION DEVICE SUP-FA-55135-1030 CDM 0270 RC outpatient 3346.2 3346.2 3346.2 74 2476.19 percent of total billed charges 3346.2 93 2710.42 percent of total billed charges 3346.2 3346.2 other OPPS APC 3346.2 3346.2 other OPPS APC 3346.2 27.63 924.56 percent of total billed charges 3346.2 3346.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCATHETER INFUSION MARKSMAN STAINLESS STEE L150 CM L10 CM OD2.8-3.2 FR ID.027 IN PERIPHERAL ACCEPTS .021 IN GUIDEWIRE SUP-FA-55150-1030 CDM 0270 RC outpatient 3346.2 3346.2 3346.2 74 2476.19 percent of total billed charges 3346.2 93 2710.42 percent of total billed charges 3346.2 3346.2 other OPPS APC 3346.2 3346.2 other OPPS APC 3346.2 27.63 924.56 percent of total billed charges 3346.2 3346.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION MARKSMAN L160 CM SUP-FA-55160-1030 CDM 0270 RC outpatient 3809 3809 3809 74 2818.66 percent of total billed charges 3809 93 3085.29 percent of total billed charges 3809 3809 other OPPS APC 3809 3809 other OPPS APC 3809 27.63 1052.43 percent of total billed charges 3809 3809 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION MARKSMAN MICRO L160 CM L10 CM OD2.8-3.2 FR ID.027 IN ACCEPTS .021 IN GUIDEWIRE SUP-FA-55160-1030 CDM 0270 RC outpatient 3346.2 3346.2 3346.2 74 2476.19 percent of total billed charges 3346.2 93 2710.42 percent of total billed charges 3346.2 3346.2 other OPPS APC 3346.2 3346.2 other OPPS APC 3346.2 27.63 924.56 percent of total billed charges 3346.2 3346.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION MARKSMAN STAINLESS STEEL HYDROPHILIC MICRO L150 CM L10 CM OD2.8-3.2 FR ID.027 IN PERIPHERAL CORONARY 1 LUMEN RADIOPAQUE MARKER COIL BRAID PIPELINE EMBOLISATION DEVICE SUP-FA551501030_41413 CDM 0270 RC outpatient 3549 3549 3549 74 2626.26 percent of total billed charges 3549 93 2874.69 percent of total billed charges 3549 3549 other OPPS APC 3549 3549 other OPPS APC 3549 27.63 980.59 percent of total billed charges 3549 3549 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR FLAIR FLARE 50MM 80CM 7MM EPTFE STERILE ARTERIOVENOUS 2 LAYER ENCAPSULATION STENT SELF EXPAND ACCEPTS SUP-FAF07050 CDM 0270 RC outpatient 6344 6344 6344 74 4694.56 percent of total billed charges 6344 93 5138.64 percent of total billed charges 6344 6344 other OPPS APC 6344 6344 other OPPS APC 6344 27.63 1752.85 percent of total billed charges 6344 6344 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET ADMINISTRATION L48 IN FLUID NONVENTED SPIKE PINCH CLAMP LARGE BORE TUBING SUP-FAS5248 CDM 0270 RC outpatient 6.76 6.76 6.76 74 5 percent of total billed charges 6.76 93 5.48 percent of total billed charges 6.76 6.76 other OPPS APC 6.76 6.76 other OPPS APC 6.76 27.63 1.87 percent of total billed charges 6.76 6.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC CORDIS FRONTRUNNER XP CTO 140CM 2.3MM 4.5FR PERIPHERAL BRAID LOW PROFILE ACCEPTS 6FR SHEATH SUP-FBP39140 CDM 0270 RC outpatient 2444 2444 2444 74 1808.56 percent of total billed charges 2444 93 1979.64 percent of total billed charges 2444 2444 other OPPS APC 2444 2444 other OPPS APC 2444 27.63 675.28 percent of total billed charges 2444 2444 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC FRONTRUNNER XP HYDROPHILIC L90 CM L2.3 MM PERIPHERAL LOW PROFILE ACCEPTS 6 FR SHEATH CHRONIC TOTAL OCCLUSION SUP-FBS3990 CDM 0270 RC outpatient 2659.8 2659.8 2659.8 74 1968.25 percent of total billed charges 2659.8 93 2154.44 percent of total billed charges 2659.8 2659.8 other OPPS APC 2659.8 2659.8 other OPPS APC 2659.8 27.63 734.9 percent of total billed charges 2659.8 2659.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L30 CM OD10 MM FRAME V01 SUP-FC-10-30-3D CDM 0270 RC outpatient 7007 7007 7007 74 5185.18 percent of total billed charges 7007 93 5675.67 percent of total billed charges 7007 7007 other OPPS APC 7007 7007 other OPPS APC 7007 27.63 1936.03 percent of total billed charges 7007 7007 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L40 CM OD10 MM NEUROVASCULAR FRAME V01 SUP-FC-10-40-3D CDM 0270 RC outpatient 7007 7007 7007 74 5185.18 percent of total billed charges 7007 93 5675.67 percent of total billed charges 7007 7007 other OPPS APC 7007 7007 other OPPS APC 7007 27.63 1936.03 percent of total billed charges 7007 7007 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L40 CM OD12 MM FRAME V01 SUP-FC-12-40-3D CDM 0270 RC outpatient 7007 7007 7007 74 5185.18 percent of total billed charges 7007 93 5675.67 percent of total billed charges 7007 7007 other OPPS APC 7007 7007 other OPPS APC 7007 27.63 1936.03 percent of total billed charges 7007 7007 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L50 CM OD14 MM NEUROVASCULAR FRAME V01 SUP-FC-14-50-3D CDM 0270 RC outpatient 7007 7007 7007 74 5185.18 percent of total billed charges 7007 93 5675.67 percent of total billed charges 7007 7007 other OPPS APC 7007 7007 other OPPS APC 7007 27.63 1936.03 percent of total billed charges 7007 7007 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L50 CM OD16 MM NEUROVASCULAR FRAME V01 SUP-FC-16-50-3D CDM 0270 RC outpatient 7007 7007 7007 74 5185.18 percent of total billed charges 7007 93 5675.67 percent of total billed charges 7007 7007 other OPPS APC 7007 7007 other OPPS APC 7007 27.63 1936.03 percent of total billed charges 7007 7007 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L50 CM OD18 MM NEUROVASCULAR FRAME V01 SUP-FC-18-50-3D CDM 0270 RC outpatient 7007 7007 7007 74 5185.18 percent of total billed charges 7007 93 5675.67 percent of total billed charges 7007 7007 other OPPS APC 7007 7007 other OPPS APC 7007 27.63 1936.03 percent of total billed charges 7007 7007 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L50 CM OD20 MM FRAME V01 SUP-FC-20-50-3D CDM 0270 RC outpatient 7007 7007 7007 74 5185.18 percent of total billed charges 7007 93 5675.67 percent of total billed charges 7007 7007 other OPPS APC 7007 7007 other OPPS APC 7007 27.63 1936.03 percent of total billed charges 7007 7007 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L50 CM OD22 MM FRAME V01 SUP-FC-22-50-3D CDM 0270 RC outpatient 7007 7007 7007 74 5185.18 percent of total billed charges 7007 93 5675.67 percent of total billed charges 7007 7007 other OPPS APC 7007 7007 other OPPS APC 7007 27.63 1936.03 percent of total billed charges 7007 7007 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L50 CM OD25 MM FRAME V01 SUP-FC-25-50-3D CDM 0270 RC outpatient 7007 7007 7007 74 5185.18 percent of total billed charges 7007 93 5675.67 percent of total billed charges 7007 7007 other OPPS APC 7007 7007 other OPPS APC 7007 27.63 1936.03 percent of total billed charges 7007 7007 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L6 CM OD3 MM FRAME V01 SUP-FC-3-6-3D CDM 0270 RC outpatient 6227 6227 6227 74 4607.98 percent of total billed charges 6227 93 5043.87 percent of total billed charges 6227 6227 other OPPS APC 6227 6227 other OPPS APC 6227 27.63 1720.52 percent of total billed charges 6227 6227 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L8 CM OD3 MM FRAME V01 SUP-FC-3-8-3D CDM 0270 RC outpatient 6227 6227 6227 74 4607.98 percent of total billed charges 6227 93 5043.87 percent of total billed charges 6227 6227 other OPPS APC 6227 6227 other OPPS APC 6227 27.63 1720.52 percent of total billed charges 6227 6227 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L6 CM OD3.5 MM FRAME V01 SUP-FC-3.5-6-3D CDM 0270 RC outpatient 6227 6227 6227 74 4607.98 percent of total billed charges 6227 93 5043.87 percent of total billed charges 6227 6227 other OPPS APC 6227 6227 other OPPS APC 6227 27.63 1720.52 percent of total billed charges 6227 6227 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L10 CM OD4 MM FRAME V01 SUP-FC-4-10-3D CDM 0270 RC outpatient 6227 6227 6227 74 4607.98 percent of total billed charges 6227 93 5043.87 percent of total billed charges 6227 6227 other OPPS APC 6227 6227 other OPPS APC 6227 27.63 1720.52 percent of total billed charges 6227 6227 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L12 CM OD4 MM FRAME V01 SUP-FC-4-12-3D CDM 0270 RC outpatient 6227 6227 6227 74 4607.98 percent of total billed charges 6227 93 5043.87 percent of total billed charges 6227 6227 other OPPS APC 6227 6227 other OPPS APC 6227 27.63 1720.52 percent of total billed charges 6227 6227 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L6 CM OD4 MM FRAME V01 SUP-FC-4-6-3D CDM 0270 RC outpatient 6227 6227 6227 74 4607.98 percent of total billed charges 6227 93 5043.87 percent of total billed charges 6227 6227 other OPPS APC 6227 6227 other OPPS APC 6227 27.63 1720.52 percent of total billed charges 6227 6227 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L10 CM OD5 MM FRAME V01 SUP-FC-5-10-3D CDM 0270 RC outpatient 6227 6227 6227 74 4607.98 percent of total billed charges 6227 93 5043.87 percent of total billed charges 6227 6227 other OPPS APC 6227 6227 other OPPS APC 6227 27.63 1720.52 percent of total billed charges 6227 6227 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L15 CM OD5 MM FRAME V01 SUP-FC-5-15-3D CDM 0270 RC outpatient 6227 6227 6227 74 4607.98 percent of total billed charges 6227 93 5043.87 percent of total billed charges 6227 6227 other OPPS APC 6227 6227 other OPPS APC 6227 27.63 1720.52 percent of total billed charges 6227 6227 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L10 CM OD6 MM FRAME V01 SUP-FC-6-10-3D CDM 0270 RC outpatient 6227 6227 6227 74 4607.98 percent of total billed charges 6227 93 5043.87 percent of total billed charges 6227 6227 other OPPS APC 6227 6227 other OPPS APC 6227 27.63 1720.52 percent of total billed charges 6227 6227 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L15 CM OD6 MM FRAME V01 SUP-FC-6-15-3D CDM 0270 RC outpatient 6227 6227 6227 74 4607.98 percent of total billed charges 6227 93 5043.87 percent of total billed charges 6227 6227 other OPPS APC 6227 6227 other OPPS APC 6227 27.63 1720.52 percent of total billed charges 6227 6227 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L20 CM OD6 MM FRAME V01 SUP-FC-6-20-3D CDM 0270 RC outpatient 6227 6227 6227 74 4607.98 percent of total billed charges 6227 93 5043.87 percent of total billed charges 6227 6227 other OPPS APC 6227 6227 other OPPS APC 6227 27.63 1720.52 percent of total billed charges 6227 6227 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L15 CM OD7 MM FRAME V01 SUP-FC-7-15-3D CDM 0270 RC outpatient 6227 6227 6227 74 4607.98 percent of total billed charges 6227 93 5043.87 percent of total billed charges 6227 6227 other OPPS APC 6227 6227 other OPPS APC 6227 27.63 1720.52 percent of total billed charges 6227 6227 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L20 CM OD7 MM FRAME V01 SUP-FC-7-20-3D CDM 0270 RC outpatient 6227 6227 6227 74 4607.98 percent of total billed charges 6227 93 5043.87 percent of total billed charges 6227 6227 other OPPS APC 6227 6227 other OPPS APC 6227 27.63 1720.52 percent of total billed charges 6227 6227 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L30 CM OD7 MM FRAME V01 SUP-FC-7-30-3D CDM 0270 RC outpatient 6227 6227 6227 74 4607.98 percent of total billed charges 6227 93 5043.87 percent of total billed charges 6227 6227 other OPPS APC 6227 6227 other OPPS APC 6227 27.63 1720.52 percent of total billed charges 6227 6227 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L20 CM OD8 MM FRAME V01 SUP-FC-8-20-3D CDM 0270 RC outpatient 7007 7007 7007 74 5185.18 percent of total billed charges 7007 93 5675.67 percent of total billed charges 7007 7007 other OPPS APC 7007 7007 other OPPS APC 7007 27.63 1936.03 percent of total billed charges 7007 7007 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L30 CM OD8 MM FRAME V01 SUP-FC-8-30-3D CDM 0270 RC outpatient 7007 7007 7007 74 5185.18 percent of total billed charges 7007 93 5675.67 percent of total billed charges 7007 7007 other OPPS APC 7007 7007 other OPPS APC 7007 27.63 1936.03 percent of total billed charges 7007 7007 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM 3D L20 CM OD9 MM FRAME V01 SUP-FC-9-20-3D CDM 0270 RC outpatient 7007 7007 7007 74 5185.18 percent of total billed charges 7007 93 5675.67 percent of total billed charges 7007 7007 other OPPS APC 7007 7007 other OPPS APC 7007 27.63 1936.03 percent of total billed charges 7007 7007 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION AXIUM PRIME 3D L30 CM OD9 MM FRAME V01 SUP-FC-9-30-3D CDM 0270 RC outpatient 7007 7007 7007 74 5185.18 percent of total billed charges 7007 93 5675.67 percent of total billed charges 7007 7007 other OPPS APC 7007 7007 other OPPS APC 7007 27.63 1936.03 percent of total billed charges 7007 7007 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEARS ELECTROSURGICAL HARMONIC FOCUS CURVE 17CM 16MM 5MM DISPOSABLE STERILE 2 HANDCONTROL ACTIVE BLADE SOFT GRIP SUP-FCS17 CDM 0270 RC outpatient 1426.98 1426.98 1426.98 74 1055.97 percent of total billed charges 1426.98 93 1155.85 percent of total billed charges 1426.98 1426.98 other OPPS APC 1426.98 1426.98 other OPPS APC 1426.98 27.63 394.27 percent of total billed charges 1426.98 1426.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BIT DRILL FAST OD2 MM ULNA ANATOMIC STERILE DISPOSABLE ANATOMIC VOLAR PLATING SYSTEM SUP-FDB20 CDM 0270 RC outpatient 263.95 263.95 263.95 74 195.32 percent of total billed charges 263.95 93 213.8 percent of total billed charges 263.95 263.95 other OPPS APC 263.95 263.95 other OPPS APC 263.95 27.63 72.93 percent of total billed charges 263.95 263.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER BOOT JACKSON TRAUMA SMALL SUP-FE00384 CDM outpatient 247.1 247.1 247.1 247.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER BOOT LG SET SUP-FE00386 CDM outpatient 123.55 123.55 123.55 123.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM YASARGIL PHYNOX STANDARD 6.2 MM OPENING L9.1 MM SYSTEM TEMPORARY SUP-FE756K CDM outpatient 1075.05 1075.05 1075.05 1075.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM YASARGIL TITANIUM STANDARD 8 MM OPENING L11 MM CEREBRAL ANGLED RIGHT BAYONET PERMANENT SUP-FE769K CDM outpatient 1075.05 1075.05 1075.05 1075.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM YASARGIL TITANIUM STANDARD 7.4 MM OPENING CURVED L10.4 MM CEREBRUM TEMPORARY SUP-FE785K CDM outpatient 1075.05 1075.05 1075.05 1075.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT FLUENCY PLUS EPTFE CARBON L60 MM L80 CM OD8 MM ODSEC9 FR ENDOVASCULAR 2 LAYER KINK RESISTANCE INNER CATHETER MULTIBRAID DELIVERY SYSTEM RADIOPAQUE ACCEPTS .035 IN GUIDEWIRE SUP-FEM08060 CDM 0270 RC outpatient 12467 12467 12467 74 9225.58 percent of total billed charges 12467 93 10098.3 percent of total billed charges 12467 12467 other OPPS APC 12467 12467 other OPPS APC 12467 27.63 3444.63 percent of total billed charges 12467 12467 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ALLERGAN MODERATE HEIGHT FULL PROJECTION SILICONE 425CC SUP-FF-410425 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE MATRIX P5.8 CM FULL HEIGHT FULL PROJECTION W14.5 CM X H15 CM 595 ML STYLE FF HIGHLY COHESIVE GEL STERILE LATEX FREE SUP-FF-410595 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP EXTERNAL DISPOSABLE STERILE SCALP 10 CLIP 20 CARTRIDGE SUP-FF013P CDM 0270 RC outpatient 67.72 67.72 67.72 74 50.11 percent of total billed charges 67.72 93 54.85 percent of total billed charges 67.72 67.72 other OPPS APC 67.72 67.72 other OPPS APC 67.72 27.63 18.71 percent of total billed charges 67.72 67.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN BONE DISTRACTION NEURO STERILE CASPAR 14MM SUP-FF904SB CDM 0270 RC outpatient 251.46 251.46 251.46 74 186.08 percent of total billed charges 251.46 93 203.68 percent of total billed charges 251.46 251.46 other OPPS APC 251.46 251.46 other OPPS APC 251.46 27.63 69.48 percent of total billed charges 251.46 251.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN BONE DISTRACTION NEURO STERILE CASPAR 16MM SUP-FF905SB CDM 0270 RC outpatient 251.46 251.46 251.46 74 186.08 percent of total billed charges 251.46 93 203.68 percent of total billed charges 251.46 251.46 other OPPS APC 251.46 251.46 other OPPS APC 251.46 27.63 69.48 percent of total billed charges 251.46 251.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ULTRASOUND NUVISION ICE OD10 FR SUP-FG10593 CDM 0270 RC outpatient 9620 9620 9620 74 7118.8 percent of total billed charges 9620 93 7792.2 percent of total billed charges 9620 9620 other OPPS APC 9620 9620 other OPPS APC 9620 27.63 2658.01 percent of total billed charges 9620 9620 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MIDWEST CARBIDE BURR SUP-FG1170L CDM 0270 RC outpatient 8.32 8.32 8.32 74 6.16 percent of total billed charges 8.32 93 6.74 percent of total billed charges 8.32 8.32 other OPPS APC 8.32 8.32 other OPPS APC 8.32 27.63 2.3 percent of total billed charges 8.32 8.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION PHENOM MICRO ID.027 IN SUP-FG15150-0615-1S CDM 0270 RC outpatient 3549 3549 3549 74 2626.26 percent of total billed charges 3549 93 2874.69 percent of total billed charges 3549 3549 other OPPS APC 3549 3549 other OPPS APC 3549 27.63 980.59 percent of total billed charges 3549 3549 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION PHENOM L120 CM OD.061 IN ODSEC.055 IN ID.044 IN ROUND DISTAL TIP SUP-FG19120-1030-1S CDM 0270 RC outpatient 5330 5330 5330 74 3944.2 percent of total billed charges 5330 93 4317.3 percent of total billed charges 5330 5330 other OPPS APC 5330 5330 other OPPS APC 5330 27.63 1472.68 percent of total billed charges 5330 5330 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE EXAM NITRL PF TXT FNGR S SUP-FG2501 CDM 0270 RC outpatient 0.12 0.12 0.12 74 0.09 percent of total billed charges 0.12 93 0.1 percent of total billed charges 0.12 0.12 other OPPS APC 0.12 0.12 other OPPS APC 0.12 27.63 0.03 percent of total billed charges 0.12 0.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE EXAM NITRILE PF TXT FNGR XL SUP-FG2504 CDM 0270 RC outpatient 0.13 0.13 0.13 74 0.1 percent of total billed charges 0.13 93 0.11 percent of total billed charges 0.13 0.13 other OPPS APC 0.13 0.13 other OPPS APC 0.13 27.63 0.04 percent of total billed charges 0.13 0.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE FLEXIGRAFT GRAFTLINK L60-80 MM OD7.5-10.5 MM FROZEN ALLOGRAFT PRESUTURE PRESIZE STERILE ALL-INSIDE ACL RECONSTRUCTION SUP-FGL CDM 270010031 LOCAL 0270 RC outpatient 5649.8 5649.8 5649.8 74 4180.85 percent of total billed charges 5649.8 93 4576.34 percent of total billed charges 5649.8 5649.8 other OPPS APC 5649.8 5649.8 other OPPS APC 5649.8 27.63 1561.04 percent of total billed charges 5649.8 5649.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE FLEXIGRAFT 230MM 4+ MM GRACILIS TENDON ALLOGRAFT FROZEN SUP-FGRACILIS CDM 270010031 LOCAL 0270 RC outpatient 3133.18 3133.18 3133.18 74 2318.55 percent of total billed charges 3133.18 93 2537.88 percent of total billed charges 3133.18 3133.18 other OPPS APC 3133.18 3133.18 other OPPS APC 3133.18 27.63 865.7 percent of total billed charges 3133.18 3133.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAPSULE VIDEO PILLCAM SB 3 156D 434.1MHZ 26.2MM 11.4MM WHITE PLASTIC 3GM 4 LIGHT EMIT DIODE BATTERY SUP-FGS-0500 CDM 0270 RC outpatient 1365.78 1365.78 1365.78 74 1010.68 percent of total billed charges 1365.78 93 1106.28 percent of total billed charges 1365.78 1365.78 other OPPS APC 1365.78 1365.78 other OPPS APC 1365.78 27.63 377.37 percent of total billed charges 1365.78 1365.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PILLCAM SENSOR BELT 2 DISPOSABLE SUP-FGS-0510 CDM 0270 RC outpatient 80.6 80.6 80.6 74 59.64 percent of total billed charges 80.6 93 65.29 percent of total billed charges 80.6 80.6 other OPPS APC 80.6 80.6 other OPPS APC 80.6 27.63 22.27 percent of total billed charges 80.6 80.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CF DELIVERY DEVICE CAPSULE BRAVO X 5 SUP-FGS-0635 CDM 0270 RC outpatient 832 832 832 74 615.68 percent of total billed charges 832 93 673.92 percent of total billed charges 832 832 other OPPS APC 832 832 other OPPS APC 832 27.63 229.88 percent of total billed charges 832 832 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAMERA ENDOSCOPIC PILLCAM ESO CAPSULE SUP-FGS-0668 CDM 0270 RC outpatient 83.2 83.2 83.2 74 61.57 percent of total billed charges 83.2 93 67.39 percent of total billed charges 83.2 83.2 other OPPS APC 83.2 83.2 other OPPS APC 83.2 27.63 22.99 percent of total billed charges 83.2 83.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE VERTIGRAFT 42MM HUMERUS HEAD FROZEN SUP-FHH CDM 270010031 LOCAL 0270 RC outpatient 2442.47 2442.47 2442.47 74 1807.43 percent of total billed charges 2442.47 93 1978.4 percent of total billed charges 2442.47 2442.47 other OPPS APC 2442.47 2442.47 other OPPS APC 2442.47 27.63 674.85 percent of total billed charges 2442.47 2442.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL BIT ODONTOID SUP-FJ966R CDM 270010020 LOCAL 0270 RC outpatient 1606.05 1606.05 1606.05 74 1188.48 percent of total billed charges 1606.05 93 1300.9 percent of total billed charges 1606.05 1606.05 other OPPS APC 1606.05 1606.05 other OPPS APC 1606.05 27.63 443.75 percent of total billed charges 1606.05 1606.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RONGEUR SURGICAL KERRISON 130D 9INX2MM UPWARD CUTTING DETACHABLE THIN FOOTPLATE SUP-FK925B CDM 0270 RC outpatient 2092.43 2092.43 2092.43 74 1548.4 percent of total billed charges 2092.43 93 1694.87 percent of total billed charges 2092.43 2092.43 other OPPS APC 2092.43 2092.43 other OPPS APC 2092.43 27.63 578.14 percent of total billed charges 2092.43 2092.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RONGEUR DET 9 THP 40 DEGREE UP 5MM SUP-FK928R CDM outpatient 1818.47 1818.47 1818.47 1818.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM ABLATION CARDIO FLEXVIEW WITH FLEX10 PROBE SUP-FLEX 10 XE CDM 0270 RC outpatient 10010 10010 10010 74 7407.4 percent of total billed charges 10010 93 8108.1 percent of total billed charges 10010 10010 other OPPS APC 10010 10010 other OPPS APC 10010 27.63 2765.76 percent of total billed charges 10010 10010 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR LAPAROSCOPIC DEXTRUS SMALL LOW PROFILE FIX LENGTH ADJUSTABLE VALVE REMOVABLE SEAL CAP STERILE DISPOSABLE HAND ASSISTED LAPAROSCOPY SUP-FLR01 CDM 0270 RC outpatient 160.67 160.67 160.67 74 118.9 percent of total billed charges 160.67 93 130.14 percent of total billed charges 160.67 160.67 other OPPS APC 160.67 160.67 other OPPS APC 160.67 27.63 44.39 percent of total billed charges 160.67 160.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR LAPAROSCOPIC DEXTRUS MEDIUM LOW PROFILE FIX LENGTH ADJUSTABLE VALVE REMOVABLE SEAL CAP STERILE DISPOSABLE HAND ASSISTED LAPAROSCOPY SUP-FLR02 CDM 0270 RC outpatient 167.09 167.09 167.09 74 123.65 percent of total billed charges 167.09 93 135.34 percent of total billed charges 167.09 167.09 other OPPS APC 167.09 167.09 other OPPS APC 167.09 27.63 46.17 percent of total billed charges 167.09 167.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE MATRIX P5 CM FULL HEIGHT MODERATE PROJECTION W13.5 CM X H14 CM 440 ML STYLE FM HIGHLY COHESIVE GEL STERILE LATEX FREE SUP-FM410-440 CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE FLEXIGRAFT MENISCUS TIBIAL LIGAMENT FEMUR LEFT MEDIAL SPACER STABILIZING FUNCTION SUP-FMN-LM CDM 270010031 LOCAL 0270 RC outpatient 9977.66 9977.66 9977.66 74 7383.47 percent of total billed charges 9977.66 93 8081.9 percent of total billed charges 9977.66 9977.66 other OPPS APC 9977.66 9977.66 other OPPS APC 9977.66 27.63 2756.83 percent of total billed charges 9977.66 9977.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SECUREMENT STATLOCK TRICOT ADULT FOLEY ANCHOR PAD STABILIZATION STERILE LATEX FREE DISPOSABLE SILICONE CATHETER SUP-FOL0102 CDM outpatient 7.85 7.85 7.85 7.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SECUREMENT STATLOCK TRICOT ADULT FOLEY ANCHOR PAD STABILIZATION LATEX FREE 3 WAY CATHETER SUP-FOL0105 CDM outpatient 7.96 7.96 7.96 7.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM STENT VASCULAR FORMULA 418 5MM 16MM 135CM RENAL ARTERY OTW BALLOON-EXPANDING PRE-MOUNTED STAINLESS STEEL MRI-CONDITIONAL NON-RADIOLUCENT 0.018IN GW 5FR SHEATH 6FR GUIDE CATH SUP-FOR418-18-135-5-16 CDM 0270 RC outpatient 2730 2730 2730 74 2020.2 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 2730 other OPPS APC 2730 2730 other OPPS APC 2730 27.63 754.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM STENT VASCULAR FORMULA 418 5MM 20MM 135CM RENAL ARTERY OTW BALLOON-EXPANDING PRE-MOUNTED STAINLESS STEEL MRI-CONDITIONAL NON-RADIOLUCENT 0.018IN GW 5FR SHEATH 6FR GUIDE CATH SUP-FOR418-18-135-5-20 CDM 0270 RC outpatient 2730 2730 2730 74 2020.2 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 2730 other OPPS APC 2730 2730 other OPPS APC 2730 27.63 754.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM STENT VASCULAR FORMULA 418 6MM 16MM 135CM RENAL ARTERY OTW BALLOON-EXPANDING PRE-MOUNTED STAINLESS STEEL MRI-CONDITIONAL NON-RADIOLUCENT 0.018IN GW 5FR SHEATH 6FR GUIDE CATH SUP-FOR418-18-135-6-16 CDM 0270 RC outpatient 2730 2730 2730 74 2020.2 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 2730 other OPPS APC 2730 2730 other OPPS APC 2730 27.63 754.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROLL POSITIONING DEVON FOAM L17 IN OD5 IN CHEST RELIABLE EXCEPTIONAL STABILITY CUSHIONING LATEX FREE DISPOSABLE SUP-FP-CHEST CDM outpatient 11.2 11.2 11.2 11.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SYNTHETIC TISSUE BIO-A L9 CM OD16 MM FISTULA PLUG DISK BIOABSORBABLE REINFORCEMENT SCAFFOLD SUP-FP0616 CDM 0270 RC outpatient 2189.2 2189.2 2189.2 74 1620.01 percent of total billed charges 2189.2 93 1773.25 percent of total billed charges 2189.2 2189.2 other OPPS APC 2189.2 2189.2 other OPPS APC 2189.2 27.63 604.88 percent of total billed charges 2189.2 2189.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION F3 FULL THREAD L10 MM OD2.5 MM FOOT LOCKING SCREW FRAGMENT ANATOMIC LOCKED PLATING SYSTEM SUP-FP10 CDM 0270 RC outpatient 143.91 143.91 143.91 74 106.49 percent of total billed charges 143.91 93 116.57 percent of total billed charges 143.91 143.91 other OPPS APC 143.91 143.91 other OPPS APC 143.91 27.63 39.76 percent of total billed charges 143.91 143.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION F3 FULL THREAD 12MM 2.5MM FOOT LOCKING SCREW FRAGMENT ANATOMIC LOCKED SUP-FP12 CDM 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION F3 FULL THREAD L14 MM OD2.5 MM FOOT LOCKING SCREW FRAGMENT PLATE SYSTEM SUP-FP14 CDM 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION F3 TIMAX FULL THREAD L16 MM OD2.5 MM FOOT LOCKING SCREW FRAGMENT ANATOMIC LOCKED PLATING SYSTEM SUP-FP16 CDM 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION F3 TITANIUM FULL THREAD L18 MM OD2.5 MM FOOT LOCKING SCREW NONSTERILE FRAGMENT ANATOMIC LOCKED PLATING SYSTEM SUP-FP18 CDM 0270 RC outpatient 143.91 143.91 143.91 74 106.49 percent of total billed charges 143.91 93 116.57 percent of total billed charges 143.91 143.91 other OPPS APC 143.91 143.91 other OPPS APC 143.91 27.63 39.76 percent of total billed charges 143.91 143.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION F3 FULL THREAD L20 MM OD2.5 MM FOOT LOCKING SCREW FRAGMENT PLATE SYSTEM SUP-FP20 CDM 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION F3 FULL THREAD L22 MM OD2.5 MM HAND LOCK SCREW NONSTERILE ANATOMIC PLATING SYSTEM SUP-FP22 CDM 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION F3 FULL THREAD L26 MM OD2.5 MM FOOT LOCKING SCREW FRAGMENT ANATOMIC LOCKED PLATING SYSTEM SUP-FP26 CDM 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BELT SUPPORT MEDTRONIC MEDIUM SUP-FP9000M CDM 0270 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 27.63 31.61 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ETCHING 1.2 ML SYRINGE 40% GEL SUP-FPSCHEIN095 CDM 0270 RC outpatient 132.57 132.57 132.57 74 98.1 percent of total billed charges 132.57 93 107.38 percent of total billed charges 132.57 132.57 other OPPS APC 132.57 132.57 other OPPS APC 132.57 27.63 36.63 percent of total billed charges 132.57 132.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC FREESTYLE PORCINE H30 MM OD19 MM ROOT BIOPROSTHESIS STENTLESS SUP-FR995-19 CDM 0270 RC outpatient 14820 14820 14820 74 10966.8 percent of total billed charges 14820 93 12004.2 percent of total billed charges 14820 14820 other OPPS APC 14820 14820 other OPPS APC 14820 27.63 4094.77 percent of total billed charges 14820 14820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC FREESTYLE PORCINE H32 MM H3 MM OD21 MM ROOT PHYSIOLOGIC FIXATION LOW GRADIENT HEMODYNAMICS STERILE SUP-FR995-21 CDM 0270 RC outpatient 14820 14820 14820 74 10966.8 percent of total billed charges 14820 93 12004.2 percent of total billed charges 14820 14820 other OPPS APC 14820 14820 other OPPS APC 14820 27.63 4094.77 percent of total billed charges 14820 14820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC FREESTYLE PORCINE H34 MM H3 MM OD23 MM ROOT BIOPROSTHESIS STERILE SUP-FR995-23 CDM 0270 RC outpatient 14820 14820 14820 74 10966.8 percent of total billed charges 14820 93 12004.2 percent of total billed charges 14820 14820 other OPPS APC 14820 14820 other OPPS APC 14820 27.63 4094.77 percent of total billed charges 14820 14820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC FREESTYLE PORCINE H34 MM H3 MM OD25 MM ROOT BIOPROSTHESIS STERILE SUP-FR995-25 CDM 0270 RC outpatient 14820 14820 14820 74 10966.8 percent of total billed charges 14820 93 12004.2 percent of total billed charges 14820 14820 other OPPS APC 14820 14820 other OPPS APC 14820 27.63 4094.77 percent of total billed charges 14820 14820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC FREESTYLE PORCINE H34 MM H3 MM OD27 MM ROOT BIOPROSTHESIS STERILE SUP-FR995-27 CDM 0270 RC outpatient 14820 14820 14820 74 10966.8 percent of total billed charges 14820 93 12004.2 percent of total billed charges 14820 14820 other OPPS APC 14820 14820 other OPPS APC 14820 27.63 4094.77 percent of total billed charges 14820 14820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC FREESTYLE PORCINE H3 MM OD29 MM ROOT PHYSIOLOGIC FIXATION LOW GRADIENT HEMODYNAMICS STERILE SUP-FR995-29 CDM 0270 RC outpatient 14820 14820 14820 74 10966.8 percent of total billed charges 14820 93 12004.2 percent of total billed charges 14820 14820 other OPPS APC 14820 14820 other OPPS APC 14820 27.63 4094.77 percent of total billed charges 14820 14820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT LAPAROSCOPIC LIGATOR FALOPE-RING 2 RING 2 INCISION APPLICATOR RADIOPAQUE STERILE REUSABLE 30 PROCEDURE SUP-FRB-30 CDM 0270 RC outpatient 236.56 236.56 236.56 74 175.05 percent of total billed charges 236.56 93 191.61 percent of total billed charges 236.56 236.56 other OPPS APC 236.56 236.56 other OPPS APC 236.56 27.63 65.36 percent of total billed charges 236.56 236.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT TENDON ROPE SUP-FROPE CDM 270010031 LOCAL 0270 RC outpatient 1966.74 1966.74 1966.74 74 1455.39 percent of total billed charges 1966.74 93 1593.06 percent of total billed charges 1966.74 1966.74 other OPPS APC 1966.74 1966.74 other OPPS APC 1966.74 27.63 543.41 percent of total billed charges 1966.74 1966.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR FALLER TUNNELER SUP-FS-401 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SYNTHETIC TISSUE BIO-A L8 CM X W8 CM TISSUE BIOABSORBABLE REINFORCEMENT SCAFFOLD SUP-FS0808 CDM 0270 RC outpatient 1060.8 1060.8 1060.8 74 784.99 percent of total billed charges 1060.8 93 859.25 percent of total billed charges 1060.8 1060.8 other OPPS APC 1060.8 1060.8 other OPPS APC 1060.8 27.63 293.1 percent of total billed charges 1060.8 1060.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL BIO-A SYNTHETIC L30 CM X W10 CM TISSUE BIOABSORBABLE REINFORCEMENT SCAFFOLD TRIMMABLE SUP-FS1030 CDM 0270 RC outpatient 5122 5122 5122 74 3790.28 percent of total billed charges 5122 93 4148.82 percent of total billed charges 5122 5122 other OPPS APC 5122 5122 other OPPS APC 5122 27.63 1415.21 percent of total billed charges 5122 5122 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SYNTHETIC TISSUE BIO-A L20 CM X W20 CM TISSUE BIOABSORBABLE REINFORCEMENT SCAFFOLD SUP-FS2020 CDM 0270 RC outpatient 6838 6838 6838 74 5060.12 percent of total billed charges 6838 93 5538.78 percent of total billed charges 6838 6838 other OPPS APC 6838 6838 other OPPS APC 6838 27.63 1889.34 percent of total billed charges 6838 6838 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GARTER EYE WITH SHIELDS SUP-FSCLF-50AC CDM outpatient 5.41 5.41 5.41 5.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM YASARGIL TITANIUM STANDARD 6.2 MM OPENING L8 MM CEREBRAL ANGLED FORWARD TEMPORARY STERILE LATEX FREE DISPOSABLE SUP-FT113T CDM outpatient 1347.5 1347.5 1347.5 1347.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHUNT CARDIOVASCULAR FLO-THRU SILICONE BULB TAPER L18 MM OD1.25 MM INTRALUMINAL RADIOPAQUE FLEXIBLE ATRAUMATIC EASY INSERTION STERILE DISPOSABLE SUP-FT12125 CDM 0270 RC outpatient 629.2 629.2 629.2 74 465.61 percent of total billed charges 629.2 93 509.65 percent of total billed charges 629.2 629.2 other OPPS APC 629.2 629.2 other OPPS APC 629.2 27.63 173.85 percent of total billed charges 629.2 629.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHUNT CARDIOVASCULAR FLO-THRU SILICONE TAPER L18 MM OD1.5 MM INTRALUMINAL 1 PIECE RADIOPAQUE TUBE FLEXIBLE ATRAUMATIC BULB EASY INSERTION STERILE DISPOSABLE SUP-FT12150 CDM 0270 RC outpatient 186.39 186.39 186.39 74 137.93 percent of total billed charges 186.39 93 150.98 percent of total billed charges 186.39 186.39 other OPPS APC 186.39 186.39 other OPPS APC 186.39 27.63 51.5 percent of total billed charges 186.39 186.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHUNT CARDIOVASCULAR FLO-THRU SILICONE TAPER L18 MM OD1.75 MM INTRALUMINAL 1 PIECE RADIOPAQUE TUBE FLEXIBLE ATRAUMATIC BULB EASY INSERTION STERILE DISPOSABLE SUP-FT12175 CDM 0270 RC outpatient 186.39 186.39 186.39 74 137.93 percent of total billed charges 186.39 93 150.98 percent of total billed charges 186.39 186.39 other OPPS APC 186.39 186.39 other OPPS APC 186.39 27.63 51.5 percent of total billed charges 186.39 186.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHUNT CARDIOVASCULAR FLO-THRU SILICONE TAPER L18 MM OD2 MM INTRALUMINAL 1 PIECE RADIOPAQUE TUBE FLEXIBLE ATRAUMATIC BULB EASY INSERTION STERILE DISPOSABLE SUP-FT12200 CDM 0270 RC outpatient 186.39 186.39 186.39 74 137.93 percent of total billed charges 186.39 93 150.98 percent of total billed charges 186.39 186.39 other OPPS APC 186.39 186.39 other OPPS APC 186.39 27.63 51.5 percent of total billed charges 186.39 186.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHUNT CARDIOVASCULAR FLO-THRU SILICONE TAPER L18 MM OD2.25 MM INTRALUMINAL 1 PIECE RADIOPAQUE TUBE FLEXIBLE ATRAUMATIC BULB EASY INSERTION STERILE DISPOSABLE SUP-FT12225 CDM 0270 RC outpatient 186.39 186.39 186.39 74 137.93 percent of total billed charges 186.39 93 150.98 percent of total billed charges 186.39 186.39 other OPPS APC 186.39 186.39 other OPPS APC 186.39 27.63 51.5 percent of total billed charges 186.39 186.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHUNT CARDIOVASCULAR FLO-THRU L18 MM OD2.5 MM INTRALUMINAL SUP-FT12250 CDM 0270 RC outpatient 465.97 465.97 465.97 74 344.82 percent of total billed charges 465.97 93 377.44 percent of total billed charges 465.97 465.97 other OPPS APC 465.97 465.97 other OPPS APC 465.97 27.63 128.75 percent of total billed charges 465.97 465.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHUNT CARDIOVASCULAR FLO-THRU L18 MM OD2.75 MM INTRALUMINAL GLOBAL SUP-FT12275 CDM 0270 RC outpatient 186.39 186.39 186.39 74 137.93 percent of total billed charges 186.39 93 150.98 percent of total billed charges 186.39 186.39 other OPPS APC 186.39 186.39 other OPPS APC 186.39 27.63 51.5 percent of total billed charges 186.39 186.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM YASARGIL TITANIUM 6.2 MM OPENING STANDARD L7 MM CEREBRUM TEMPORARY MRI SAFETY NONFERROMAGNETIC BLUE SPRING GOLDEN BLADE STERILE LATEX FREE DISPOSABLE SUP-FT240T CDM 0270 RC outpatient 1137.63 1137.63 1137.63 74 841.85 percent of total billed charges 1137.63 93 921.48 percent of total billed charges 1137.63 1137.63 other OPPS APC 1137.63 1137.63 other OPPS APC 1137.63 27.63 314.33 percent of total billed charges 1137.63 1137.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM YASARGIL TITANIUM STANDARD 7 MM OPEN L8.6 MM CEREBRAL CURVE LATERAL TEMPORARY STERILE LATEX FREE DISPOSABLE SUP-FT247T CDM outpatient 1137.63 1137.63 1137.63 1137.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM YASARGIL TITANIUM STANDARD 6.5 MM OPENING L6.1 MM OD3.5 MM CEREBRAL ANGLED FORWARD FENESTRATED PERMANENT STERILE LATEX FREE DISPOSABLE SUP-FT603T CDM 0270 RC outpatient 919.36 919.36 919.36 74 680.33 percent of total billed charges 919.36 93 744.68 percent of total billed charges 919.36 919.36 other OPPS APC 919.36 919.36 other OPPS APC 919.36 27.63 254.02 percent of total billed charges 919.36 919.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM YASARGIL TITANIUM MINI 4.6 MM OPENING L7 MM CEREBRAL STRAIGHT PERMANENT STERILE LATEX FREE DISPOSABLE SUP-FT720T CDM 0270 RC outpatient 919.36 919.36 919.36 74 680.33 percent of total billed charges 919.36 93 744.68 percent of total billed charges 919.36 919.36 other OPPS APC 919.36 919.36 other OPPS APC 919.36 27.63 254.02 percent of total billed charges 919.36 919.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM YASARGIL TITANIUM 4.4 MM OPEN MINI L6.6 MM CEREBRAL PERMANENT MR CONDITIONAL SPRING BLADE STERILE SILVER VIOLET SUP-FT722T CDM 0270 RC outpatient 919.36 919.36 919.36 74 680.33 percent of total billed charges 919.36 93 744.68 percent of total billed charges 919.36 919.36 other OPPS APC 919.36 919.36 other OPPS APC 919.36 27.63 254.02 percent of total billed charges 919.36 919.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM YASARGIL TITANIUM 6.2 MM OPEN STANDARD L7 MM CEREBRAL PERMANENT MR CONDITIONAL SPRING BLADE STERILE BLUE SILVER SUP-FT740T CDM 0270 RC outpatient 919.36 919.36 919.36 74 680.33 percent of total billed charges 919.36 93 744.68 percent of total billed charges 919.36 919.36 other OPPS APC 919.36 919.36 other OPPS APC 919.36 27.63 254.02 percent of total billed charges 919.36 919.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM YASARGIL TITANIUM STANDARD 6 MM OPENING L6.5 MM CEREBRAL SLIGHTLY CURVED PERMANENT STERILE LATEX FREE DISPOSABLE SUP-FT742T CDM 0270 RC outpatient 919.36 919.36 919.36 74 680.33 percent of total billed charges 919.36 93 744.68 percent of total billed charges 919.36 919.36 other OPPS APC 919.36 919.36 other OPPS APC 919.36 27.63 254.02 percent of total billed charges 919.36 919.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM YASARGIL TITANIUM 7 MM OPENING STANDARD L8.6 MM CEREBRUM PERMANENT MRI SAFETY NONFERROMAGNETIC BLUE SPRING SILVER BLADE STERILE SUP-FT747T CDM 0270 RC outpatient 919.36 919.36 919.36 74 680.33 percent of total billed charges 919.36 93 744.68 percent of total billed charges 919.36 919.36 other OPPS APC 919.36 919.36 other OPPS APC 919.36 27.63 254.02 percent of total billed charges 919.36 919.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ANEURYSM YASARGIL TITANIUM STANDARD 7 MM OPENING L9 MM CEREBRAL STRAIGHT PERMANENT STERILE LATEX FREE DISPOSABLE SUP-FT750T CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL FLUENCY PLUS PUZZLE 40MM 80CM 8MM 9FR NITINOL EPTFE STERILE GRAFT RADIOPAQUE SELF EXPAND CATHETER SUP-FTM08040 CDM 0270 RC outpatient 12256.4 12256.4 12256.4 74 9069.74 percent of total billed charges 12256.4 93 9927.68 percent of total billed charges 12256.4 12256.4 other OPPS APC 12256.4 12256.4 other OPPS APC 12256.4 27.63 3386.44 percent of total billed charges 12256.4 12256.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH UROLOGICAL FLEXOR PARALLEL RAPID RELEASE ACCESS 10.7FR 35CM URETERAL TAPERED TIP W/DILAT AQ HYDROPHILIC STERILE SINGLE-USE SUP-FUS-107035-P CDM 0270 RC outpatient 486.88 486.88 486.88 486.88 other OPPS APC 486.88 486.88 other OPPS APC 486.88 27.63 134.52 percent of total billed charges 486.88 486.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH UROLOGICAL FLEXOR PARALLEL RAPID RELEASE ACCESS 12FR 35CM URETERAL TAPERED TIP W/DILAT AQ HYDROPHILIC STERILE SINGLE-USE SUP-FUS-120035-P CDM 0270 RC outpatient 499.41 499.41 499.41 499.41 other OPPS APC 499.41 499.41 other OPPS APC 499.41 27.63 137.99 percent of total billed charges 499.41 499.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P6.1 CM FULL HEIGHT EXTRA FULL PROJECTION W13 CM X H13.5 CM 450 GM STYLE 410 STERILE SUP-FX-410-450 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP SURGICAL STEALTH 6MM STERILE ATRAUMATIC OCCLUSION FIBRA SPRING SUP-G-6050 CDM 0270 RC outpatient 57.2 57.2 57.2 74 42.33 percent of total billed charges 57.2 93 46.33 percent of total billed charges 57.2 57.2 other OPPS APC 57.2 57.2 other OPPS APC 57.2 27.63 15.8 percent of total billed charges 57.2 57.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY CHIBA 15CM 22GA DISPOSABLE STERILE SOFT TISSUE ASPIRATION SUP-G00012 CDM 0270 RC outpatient 26.99 26.99 26.99 74 19.97 percent of total billed charges 26.99 93 21.86 percent of total billed charges 26.99 26.99 other OPPS APC 26.99 26.99 other OPPS APC 26.99 27.63 7.46 percent of total billed charges 26.99 26.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY CHIBA L 15CM OD 22GA ASPIRATION STERILE DISPOSABLE SUP-G00012 CDM 0270 RC outpatient 29.87 29.87 29.87 74 22.1 percent of total billed charges 29.87 93 24.19 percent of total billed charges 29.87 29.87 other OPPS APC 29.87 29.87 other OPPS APC 29.87 27.63 8.25 percent of total billed charges 29.87 29.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOPCOCK INTRAVENOUS PLASTIC ID .95IN PERIPHERAL 2 FEMALE TO MALE LUER LOCK 1 WAY LOW PRESSURE ROTATE ADAPTER STERILE DISPOSABLE SUP-G00164 CDM 0270 RC outpatient 17.55 17.55 17.55 74 12.99 percent of total billed charges 17.55 93 14.22 percent of total billed charges 17.55 17.55 other OPPS APC 17.55 17.55 other OPPS APC 17.55 27.63 4.85 percent of total billed charges 17.55 17.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOPCOCK INTRAVENOUS PLASTIC ID .07IN PERIPHERAL 1 WAY FEMALE TO MALE LUER LOCK STERILE DISPOSABLE SUP-G00213 CDM 0270 RC outpatient 14.82 14.82 14.82 74 10.97 percent of total billed charges 14.82 93 12 percent of total billed charges 14.82 14.82 other OPPS APC 14.82 14.82 other OPPS APC 14.82 27.63 4.09 percent of total billed charges 14.82 14.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE WIRE VASCULAR 1.5MM J TIP .035IN DIA 145CM LONG FIXED CORE SUP-G00507 CDM 0270 RC outpatient 29.46 29.46 29.46 74 21.8 percent of total billed charges 29.46 93 23.86 percent of total billed charges 29.46 29.46 other OPPS APC 29.46 29.46 other OPPS APC 29.46 27.63 8.14 percent of total billed charges 29.46 29.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR SAFE-T-J STANDARD CURVE TAPER 145CM 1.5CM .035IN SS PTFE DISPOSABLE STERILE FIX CORE FLEXIBLE TIP SUP-G00511 CDM 0270 RC outpatient 33.77 33.77 33.77 74 24.99 percent of total billed charges 33.77 93 27.35 percent of total billed charges 33.77 33.77 other OPPS APC 33.77 33.77 other OPPS APC 33.77 27.63 9.33 percent of total billed charges 33.77 33.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR BENTSON STANDARD 145CM 6CM .035IN SS PTFE DISPOSABLE STERILE FIX CORE ATRAUMATIC TIP EXTRA FLOPPY SUP-G00691 CDM 0270 RC outpatient 42.87 42.87 42.87 74 31.72 percent of total billed charges 42.87 93 34.72 percent of total billed charges 42.87 42.87 other OPPS APC 42.87 42.87 other OPPS APC 42.87 27.63 11.84 percent of total billed charges 42.87 42.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR BENTSON STANDARD 145CM 6CM .035IN SS HEPARIN PTFE DISPOSABLE STERILE FIX CORE ATRAUMATIC TIP EXTRA SUP-G00692 CDM 0270 RC outpatient 41.73 41.73 41.73 74 30.88 percent of total billed charges 41.73 93 33.8 percent of total billed charges 41.73 41.73 other OPPS APC 41.73 41.73 other OPPS APC 41.73 27.63 11.53 percent of total billed charges 41.73 41.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR HIWIRE PTFE STAINLESS STEEL STRAIGHT TAPER L145 CM L10 CM OD.035 IN NEWTON LT ATRAUMATIC FLEXIBLE TIP FIXED CORE SUP-G00701 CDM 0270 RC outpatient 27.74 27.74 27.74 74 20.53 percent of total billed charges 27.74 93 22.47 percent of total billed charges 27.74 27.74 other OPPS APC 27.74 27.74 other OPPS APC 27.74 27.63 7.66 percent of total billed charges 27.74 27.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY CHIBA L15CM OD 20GA ASPIRATION STERILE DISPOSABLE SUP-G00777 CDM outpatient 29.87 29.87 29.87 29.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY CHIBA L15 CM OD 18GA ASPIRATION STERILE DISPOSABLE SUP-G00850 CDM 0270 RC outpatient 29.87 29.87 29.87 74 22.1 percent of total billed charges 29.87 93 24.19 percent of total billed charges 29.87 29.87 other OPPS APC 29.87 29.87 other OPPS APC 29.87 27.63 8.25 percent of total billed charges 29.87 29.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR VASCULAR STANDARD JCD CURVE 20CM 6FR DISPOSABLE STERILE VESSEL RADIOPAQUE ACCEPTS .038IN GUIDEWIRE SUP-G00937 CDM 0270 RC outpatient 23.37 23.37 23.37 74 17.29 percent of total billed charges 23.37 93 18.93 percent of total billed charges 23.37 23.37 other OPPS APC 23.37 23.37 other OPPS APC 23.37 27.63 6.46 percent of total billed charges 23.37 23.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR VASCULAR STANDARD JCD CURVE 20CM 5FR DISPOSABLE STERILE RADIOPAQUE ACCEPTS .035IN GUIDEWIRE SUP-G00972 CDM 0270 RC outpatient 23.37 23.37 23.37 74 17.29 percent of total billed charges 23.37 93 18.93 percent of total billed charges 23.37 23.37 other OPPS APC 23.37 23.37 other OPPS APC 23.37 27.63 6.46 percent of total billed charges 23.37 23.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR VASCULAR STANDARD JCD CURVE 20CM 7FR DISPOSABLE STERILE VESSEL RADIOPAQUE ACCEPTS .038IN GUIDEWIRE SUP-G00973 CDM 0270 RC outpatient 23.37 23.37 23.37 74 17.29 percent of total billed charges 23.37 93 18.93 percent of total billed charges 23.37 23.37 other OPPS APC 23.37 23.37 other OPPS APC 23.37 27.63 6.46 percent of total billed charges 23.37 23.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR VASCULAR STANDARD JCD CURVE 20CM 15.5CM 8FR DISPOSABLE STERILE VESSEL RADIOPAQUE ACCEPTS .038IN GUIDEWIRE SUP-G00980 CDM 0270 RC outpatient 23.37 23.37 23.37 74 17.29 percent of total billed charges 23.37 93 18.93 percent of total billed charges 23.37 23.37 other OPPS APC 23.37 23.37 other OPPS APC 23.37 27.63 6.46 percent of total billed charges 23.37 23.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR VASCULAR STANDARD JCD CURVE 20CM 9FR DISPOSABLE STERILE VESSEL RADIOPAQUE ACCEPTS .038IN GUIDEWIRE SUP-G00992 CDM 0270 RC outpatient 23.37 23.37 23.37 74 17.29 percent of total billed charges 23.37 93 18.93 percent of total billed charges 23.37 23.37 other OPPS APC 23.37 23.37 other OPPS APC 23.37 27.63 6.46 percent of total billed charges 23.37 23.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR VASCULAR STANDARD JCD CURVE 20CM 10FR DISPOSABLE STERILE VESSEL RADIOPAQUE ACCEPTS .038IN GUIDEWIRE SUP-G00993 CDM 0270 RC outpatient 23.37 23.37 23.37 74 17.29 percent of total billed charges 23.37 93 18.93 percent of total billed charges 23.37 23.37 other OPPS APC 23.37 23.37 other OPPS APC 23.37 27.63 6.46 percent of total billed charges 23.37 23.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR VASCULAR STANDARD JCD CURVE 20CM 11FR DISPOSABLE STERILE VESSEL RADIOPAQUE ACCEPTS .038IN GUIDEWIRE SUP-G00994 CDM 0270 RC outpatient 21.66 21.66 21.66 74 16.03 percent of total billed charges 21.66 93 17.54 percent of total billed charges 21.66 21.66 other OPPS APC 21.66 21.66 other OPPS APC 21.66 27.63 5.98 percent of total billed charges 21.66 21.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR VASCULAR STANDARD JCD CURVE 20CM 12FR DISPOSABLE STERILE VESSEL RADIOPAQUE ACCEPTS .038IN GUIDEWIRE SUP-G00995 CDM 0270 RC outpatient 23.37 23.37 23.37 74 17.29 percent of total billed charges 23.37 93 18.93 percent of total billed charges 23.37 23.37 other OPPS APC 23.37 23.37 other OPPS APC 23.37 27.63 6.46 percent of total billed charges 23.37 23.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR VASCULAR STANDARD JCD CURVE 20CM 14FR DISPOSABLE STERILE VESSEL RADIOPAQUE ACCEPTS .038IN GUIDEWIRE SUP-G00996 CDM 0270 RC outpatient 23.37 23.37 23.37 74 17.29 percent of total billed charges 23.37 93 18.93 percent of total billed charges 23.37 23.37 other OPPS APC 23.37 23.37 other OPPS APC 23.37 27.63 6.46 percent of total billed charges 23.37 23.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY CHIBA L 20CM OD 18GA ASPIRATION STERILE DISPOSABLE SUP-G01047 CDM outpatient 29.87 29.87 29.87 29.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY CHIBA L10CM OD 20GA ASPIRATION STERILE DISPOSABLE SUP-G01112 CDM outpatient 29.87 29.87 29.87 29.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR VASCULAR STANDARD JCD CURVE 20CM 16FR DISPOSABLE STERILE VESSEL RADIOPAQUE ACCEPTS .038IN GUIDEWIRE SUP-G01212 CDM 0270 RC outpatient 21.66 21.66 21.66 74 16.03 percent of total billed charges 21.66 93 17.54 percent of total billed charges 21.66 21.66 other OPPS APC 21.66 21.66 other OPPS APC 21.66 27.63 5.98 percent of total billed charges 21.66 21.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR 1.5MM ROSEN CURVE J 260CM .035IN SS HEPARIN PTFE HEAVY DUTY MANDRIL FIX CORE EXCHANGE FLEXIBLE TIP SUP-G01253 CDM 0270 RC outpatient 46.8 46.8 46.8 74 34.63 percent of total billed charges 46.8 93 37.91 percent of total billed charges 46.8 46.8 other OPPS APC 46.8 46.8 other OPPS APC 46.8 27.63 12.93 percent of total billed charges 46.8 46.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR ROSEN J CURVE 180CM 1.5MM .035IN SS PTFE DISPOSABLE STERILE FIX CORE HEAVY DUTY EXCHANGE SUP-G01264 CDM 0270 RC outpatient 33.8 33.8 33.8 74 25.01 percent of total billed charges 33.8 93 27.38 percent of total billed charges 33.8 33.8 other OPPS APC 33.8 33.8 other OPPS APC 33.8 27.63 9.34 percent of total billed charges 33.8 33.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RADIAL COOK BENTSON GUIDEWIRE 180CM SUP-G01290 CDM 0481 RC outpatient 42.15 42.15 42.15 74 31.19 percent of total billed charges 42.15 93 34.14 percent of total billed charges 42.15 42.15 other OPPS APC 42.15 42.15 other OPPS APC 42.15 51 21.5 percent of total billed charges 42.15 42.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY CHIBA L10 CM OD 18GA ASPIRATION STERILE DISPSABLE SUP-G01559 CDM outpatient 29.87 29.87 29.87 29.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PEEL-AWAY L15.5 CM OD9 FR PERCUTANEOUS STERILE DISPOSABLE SUP-G01697 CDM 0270 RC outpatient 125.92 125.92 125.92 74 93.18 percent of total billed charges 125.92 93 102 percent of total billed charges 125.92 125.92 other OPPS APC 125.92 125.92 other OPPS APC 125.92 27.63 34.79 percent of total billed charges 125.92 125.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR COONS STAINLESS STEEL PTFE 3.5 CM STRAIGHT TAPER FLOPPY L180 CM L15 CM OD.035 IN HEAVY DUTY FLEXIBLE TIP INTERVENTIONAL ATRAUMATIC SUP-G02621 CDM 0270 RC outpatient 80.57 80.57 80.57 74 59.62 percent of total billed charges 80.57 93 65.26 percent of total billed charges 80.57 80.57 other OPPS APC 80.57 80.57 other OPPS APC 80.57 27.63 22.26 percent of total billed charges 80.57 80.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR COONS STAINLESS STEEL PTFE 3.5 CM STRAIGHT TAPER FLOPPY L260 CM L15 CM OD.035 IN HEAVY DUTY FLEXIBLE TIP INTERVENTIONAL ATRAUMATIC SUP-G02622 CDM 0270 RC outpatient 93.57 93.57 93.57 74 69.24 percent of total billed charges 93.57 93 75.79 percent of total billed charges 93.57 93.57 other OPPS APC 93.57 93.57 other OPPS APC 93.57 27.63 25.85 percent of total billed charges 93.57 93.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET INTRODUCER PEEL-AWAY DISPOSABLE STERILE PERCUTANEOUS SHEATH SUP-G02997 CDM 0270 RC outpatient 125.92 125.92 125.92 74 93.18 percent of total billed charges 125.92 93 102 percent of total billed charges 125.92 125.92 other OPPS APC 125.92 125.92 other OPPS APC 125.92 27.63 34.79 percent of total billed charges 125.92 125.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET DRAINAGE STANDARD 29CM 20CM 9FR 18GA SS VINYL PTFE DISPOSABLE STERILE LF THORACIC 1 WAY STOPCOCK CATHETER NEEDLE SUP-G03301 CDM 0270 RC outpatient 449.05 449.05 449.05 74 332.3 percent of total billed charges 449.05 93 363.73 percent of total billed charges 449.05 449.05 other OPPS APC 449.05 449.05 other OPPS APC 449.05 27.63 124.07 percent of total billed charges 449.05 449.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR AMPLATZ STAINLESS STEEL PTFE 3 MM RADIUS L3 CM CURVE TAPER L180 CM L7 CM OD.035 IN FLOPPY TIP EXTRA STIFF SUPPORT SUP-G03565 CDM 0270 RC outpatient 54.44 54.44 54.44 74 40.29 percent of total billed charges 54.44 93 44.1 percent of total billed charges 54.44 54.44 other OPPS APC 54.44 54.44 other OPPS APC 54.44 27.63 15.04 percent of total billed charges 54.44 54.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION CODA 120CM 9FR 32MM POLYURETHANE 2 LUMEN RADIOPAQUE ACCEPTS .035IN GUIDEWIRE 12FR INTRODUCER SUP-G03831 CDM 0270 RC outpatient 1244.1 1244.1 1244.1 74 920.63 percent of total billed charges 1244.1 93 1007.72 percent of total billed charges 1244.1 1244.1 other OPPS APC 1244.1 1244.1 other OPPS APC 1244.1 27.63 343.74 percent of total billed charges 1244.1 1244.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR VASCULAR MAC-LOC COONS ULTRATHANE HYDROPHILIC TAPER L20CM OD 16FR PERCUTANEOUS LOCK LOOP STERILE DISPOSABLE ACCEPTS .038IN GUIDEWIRE CECOSTOMY SUP-G03947 CDM 0270 RC outpatient 45.03 45.03 45.03 74 33.32 percent of total billed charges 45.03 93 36.47 percent of total billed charges 45.03 45.03 other OPPS APC 45.03 45.03 other OPPS APC 45.03 27.63 12.44 percent of total billed charges 45.03 45.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COONS DILATOR 18 FR SUP-G04051 CDM 0270 RC outpatient 45.03 45.03 45.03 74 33.32 percent of total billed charges 45.03 93 36.47 percent of total billed charges 45.03 45.03 other OPPS APC 45.03 45.03 other OPPS APC 45.03 27.63 12.44 percent of total billed charges 45.03 45.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PEEL-AWAY LG 13CM 20CM 22FR DISPOSABLE STERILE PERCUTANEOUS DILATOR ACCEPTS .038IN GUIDEWIRE SUP-G04096 CDM 0270 RC outpatient 129.38 129.38 129.38 74 95.74 percent of total billed charges 129.38 93 104.8 percent of total billed charges 129.38 129.38 other OPPS APC 129.38 129.38 other OPPS APC 129.38 27.63 35.75 percent of total billed charges 129.38 129.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PEEL-AWAY LG 13CM 20CM 24FR DISPOSABLE STERILE PERCUTANEOUS ACCEPTS .038IN GUIDEWIRE SUP-G0446 CDM 0270 RC outpatient 123.81 123.81 123.81 74 91.62 percent of total billed charges 123.81 93 100.29 percent of total billed charges 123.81 123.81 other OPPS APC 123.81 123.81 other OPPS APC 123.81 27.63 34.21 percent of total billed charges 123.81 123.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY PERICARDIOCENTESIS PIGTAIL CURVE L40 CM L15 CM OD8.3 FR ODSEC18 GA PERICARDIAL SAC 6 SIDEPORT LOCK CATHETER ALLIGATOR CLIP CABLE STERILE DISPOSABLE ACCEPTS .038 IN GUIDEWIRE SUP-G04507 CDM 0270 RC outpatient 485.68 485.68 485.68 74 359.4 percent of total billed charges 485.68 93 393.4 percent of total billed charges 485.68 485.68 other OPPS APC 485.68 485.68 other OPPS APC 485.68 27.63 134.19 percent of total billed charges 485.68 485.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC ROYAL FLUSH PLUS NYLON .035 IN STANDARD PIGTAIL CURVE L90 CM OD5 FR 10 SIDEPORT HIGH FLOW ACCEPTS .035 SUP-G04721 CDM 0270 RC outpatient 39.35 39.35 39.35 74 29.12 percent of total billed charges 39.35 93 31.87 percent of total billed charges 39.35 39.35 other OPPS APC 39.35 39.35 other OPPS APC 39.35 27.63 10.87 percent of total billed charges 39.35 39.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. .018 COPE MANDRIL WIRE SUP-G05183 CDM 0481 RC outpatient 85.7 85.7 85.7 74 63.42 percent of total billed charges 85.7 93 69.42 percent of total billed charges 85.7 85.7 other OPPS APC 85.7 85.7 other OPPS APC 85.7 51 43.71 percent of total billed charges 85.7 85.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER DRAINAGE OD20-40 FR TUBING MULTIPURPOSE SUP-G05302 CDM 0270 RC outpatient 34.06 34.06 34.06 74 25.2 percent of total billed charges 34.06 93 27.59 percent of total billed charges 34.06 34.06 other OPPS APC 34.06 34.06 other OPPS APC 34.06 27.63 9.41 percent of total billed charges 34.06 34.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR MICROPUNCTURE NITINOL STRAIGHT L80 CM OD.018 IN SUP-G05822 CDM 0270 RC outpatient 96.17 96.17 96.17 74 71.17 percent of total billed charges 96.17 93 77.9 percent of total billed charges 96.17 96.17 other OPPS APC 96.17 96.17 other OPPS APC 96.17 27.63 26.57 percent of total billed charges 96.17 96.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGE NYLON STAINLESS STEEL .038 IN SIM2 CURVE L 100 CM OD 5 FR CEREBRAL FLEXIBLE ATRAUMATIC TIP SUP-G05976 CDM 0270 RC outpatient 67.59 67.59 67.59 74 50.02 percent of total billed charges 67.59 93 54.75 percent of total billed charges 67.59 67.59 other OPPS APC 67.59 67.59 other OPPS APC 67.59 27.63 18.68 percent of total billed charges 67.59 67.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COOK 6F FA DIAGNOSTIC CATHETER SUP-G05988 CDM 0481 RC outpatient 39.34 39.34 39.34 74 29.11 percent of total billed charges 39.34 93 31.87 percent of total billed charges 39.34 39.34 other OPPS APC 39.34 39.34 other OPPS APC 39.34 51 20.06 percent of total billed charges 39.34 39.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COOK 6F FA1 DIAGNOSTIC CATHETER SUP-G05989 CDM 0481 RC outpatient 39.34 39.34 39.34 74 29.11 percent of total billed charges 39.34 93 31.87 percent of total billed charges 39.34 39.34 other OPPS APC 39.34 39.34 other OPPS APC 39.34 51 20.06 percent of total billed charges 39.34 39.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COOK 6F FA2 DIAGNOSTIC CATHETER SUP-G05990 CDM 0481 RC outpatient 107.12 107.12 107.12 74 79.27 percent of total billed charges 107.12 93 86.77 percent of total billed charges 107.12 107.12 other OPPS APC 107.12 107.12 other OPPS APC 107.12 51 54.63 percent of total billed charges 107.12 107.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGE NYLON STAINLESS STEEL .038 IN H1 CURVE L 100CM OD 5FR CEREBRAL FLEXIBLE ATRAUMATIC TIP SUP-G06005 CDM 0270 RC outpatient 62.4 62.4 62.4 74 46.18 percent of total billed charges 62.4 93 50.54 percent of total billed charges 62.4 62.4 other OPPS APC 62.4 62.4 other OPPS APC 62.4 27.63 17.24 percent of total billed charges 62.4 62.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET CATHETER MELKER STANDARD 3.8CM 15MM 3.5MM DISPOSABLE STERILE EMERGENCY CRICOTHYROTOMY SUP-G06245 CDM outpatient 616.2 616.2 616.2 616.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET INTERVENTIONAL RB FLEXOR CHECK-FLO TORCON NB DISPOSABLE STERILE LIVER TRANSJUGULAR ACCESS SUP-G06541 CDM 0270 RC outpatient 1632.77 1632.77 1632.77 74 1208.25 percent of total billed charges 1632.77 93 1322.54 percent of total billed charges 1632.77 1632.77 other OPPS APC 1632.77 1632.77 other OPPS APC 1632.77 27.63 451.13 percent of total billed charges 1632.77 1632.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGEBEACON TIP STAINLESS STEEL NYLON WEINBERG CEREBRAL CURVE LOW PROFILE TAPER L100CM OD 5FR RADIOPAQUE ACCEPTS .038 IN GUIDEWIRE SUP-G07099 CDM 0270 RC outpatient 67.59 67.59 67.59 74 50.02 percent of total billed charges 67.59 93 54.75 percent of total billed charges 67.59 67.59 other OPPS APC 67.59 67.59 other OPPS APC 67.59 27.63 18.68 percent of total billed charges 67.59 67.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEP RETRIEVAL VASCULAR SUP-G07187 CDM 0270 RC outpatient 1269.55 1269.55 1269.55 74 939.47 percent of total billed charges 1269.55 93 1028.34 percent of total billed charges 1269.55 1269.55 other OPPS APC 1269.55 1269.55 other OPPS APC 1269.55 27.63 350.78 percent of total billed charges 1269.55 1269.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH FLEXOR CHECK-FLO L30 CM OD 8 FR ID 2.9MM RADIOPAQUE SMALL VALVE STERILE DISPOSABLE ACCEPTS .038 IN GUIDEWIRE SUP-G07878 CDM 0270 RC outpatient 124.96 124.96 124.96 74 92.47 percent of total billed charges 124.96 93 101.22 percent of total billed charges 124.96 124.96 other OPPS APC 124.96 124.96 other OPPS APC 124.96 27.63 34.53 percent of total billed charges 124.96 124.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGE BEACON TIP STAINLESS STEEL NYLON C1 CURVE ANGLE L65 CM OD5 FR MULTIPURPOSE ACCEPTS .035 IN GUIDEWIRE SUP-G08441 CDM 0270 RC outpatient 39.36 39.36 39.36 74 29.13 percent of total billed charges 39.36 93 31.88 percent of total billed charges 39.36 39.36 other OPPS APC 39.36 39.36 other OPPS APC 39.36 27.63 10.88 percent of total billed charges 39.36 39.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGE BEACON TIP NYLON STAINLESS STEEL .035 IN C1 CURVE L100 CM OD5 FR CEREBRAL ANGLED MULTIPURPOSE SUP-G08623 CDM 0270 RC outpatient 39.36 39.36 39.36 74 29.13 percent of total billed charges 39.36 93 31.88 percent of total billed charges 39.36 39.36 other OPPS APC 39.36 39.36 other OPPS APC 39.36 27.63 10.88 percent of total billed charges 39.36 39.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR ROADRUNNER TAPER FLOPPY ANGLE SPRING COIL 300CM 8.5CM .014IN PLATINUM NITINOL PTFE DISPOSABLE STERILE SUP-G08801 CDM 0270 RC outpatient 331.47 331.47 331.47 74 245.29 percent of total billed charges 331.47 93 268.49 percent of total billed charges 331.47 331.47 other OPPS APC 331.47 331.47 other OPPS APC 331.47 27.63 91.59 percent of total billed charges 331.47 331.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET INTRODUCER CHECK-FLO 30CM 41CM 12FR 4MM DISPOSABLE STERILE ACCEPTS .038IN GUIDEWIRE SUP-G08956 CDM 0270 RC outpatient 162.24 162.24 162.24 74 120.06 percent of total billed charges 162.24 93 131.41 percent of total billed charges 162.24 162.24 other OPPS APC 162.24 162.24 other OPPS APC 162.24 27.63 44.83 percent of total billed charges 162.24 162.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER CATHETER CHECK-FLO PERFORMER .038IN 30CM 14FR 4.6MM RADIOPAQUE BAND SUP-G08957 CDM 0481 RC outpatient 187.04 187.04 187.04 74 138.41 percent of total billed charges 187.04 93 151.5 percent of total billed charges 187.04 187.04 other OPPS APC 187.04 187.04 other OPPS APC 187.04 51 95.39 percent of total billed charges 187.04 187.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR ROADRUNNER PC HYDROPHILIC NITINOL PLATINUM ANGLE TAPER STANDARD L260 CM OD.035 IN RADIOPAQUE STIFF SHAFT SUP-G09105 CDM 0270 RC outpatient 103.27 103.27 103.27 74 76.42 percent of total billed charges 103.27 93 83.65 percent of total billed charges 103.27 103.27 other OPPS APC 103.27 103.27 other OPPS APC 103.27 27.63 28.53 percent of total billed charges 103.27 103.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE BILIARY L40 CM OD16 FR .038 IN ULTRATHANE HYDROPHILIC SUP-G09205 CDM 0270 RC outpatient 240.97 240.97 240.97 74 178.32 percent of total billed charges 240.97 93 195.19 percent of total billed charges 240.97 240.97 other OPPS APC 240.97 240.97 other OPPS APC 240.97 27.63 66.58 percent of total billed charges 240.97 240.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH FLEXOR CHECK-FLO L90 CM OD8 FR ID2.9 MM RADIOPAQUE SMALL VALVE STERILE DISPOSABLE ACCEPTS .038 IN GUIDEWIRE SUP-G09602 CDM 0270 RC outpatient 189.8 189.8 189.8 74 140.45 percent of total billed charges 189.8 93 153.74 percent of total billed charges 189.8 189.8 other OPPS APC 189.8 189.8 other OPPS APC 189.8 27.63 52.44 percent of total billed charges 189.8 189.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR ROADRUNNER PC NIMBLE NITINOL PLATINUM HYDROPHILIC L145 CM OD.035 IN ANGLE SHORT TAPER FLEXIBLE SHAFT SUP-G09607 CDM 0270 RC outpatient 100.07 100.07 100.07 74 74.05 percent of total billed charges 100.07 93 81.06 percent of total billed charges 100.07 100.07 other OPPS APC 100.07 100.07 other OPPS APC 100.07 27.63 27.65 percent of total billed charges 100.07 100.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER CATHETER CHECK-FLO PERFORMER .038IN 30CM 16FR 5.3MM RADIOPAQUE BAND SUP-G09691 CDM 0270 RC outpatient 267.3 267.3 267.3 74 197.8 percent of total billed charges 267.3 93 216.51 percent of total billed charges 267.3 267.3 other OPPS APC 267.3 267.3 other OPPS APC 267.3 27.63 73.85 percent of total billed charges 267.3 267.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE MAC-LOC ULTRATHANE AQ L45 CM OD8.5 FR 6 SIDEPORT TROCAR MULTIPURPOSE RADIOPAQUE STERILE LATEX FREE DISPOSABLE ACCEPTS .038 IN GUIDEWIRE SUP-G09765 CDM 0270 RC outpatient 302.98 302.98 302.98 74 224.21 percent of total billed charges 302.98 93 245.41 percent of total billed charges 302.98 302.98 other OPPS APC 302.98 302.98 other OPPS APC 302.98 27.63 83.71 percent of total billed charges 302.98 302.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COOK PERICARDIOCENTESIS TRAY SUP-G10210 CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET INTRODUCER PEEL-AWAY MICROPUNCTURE ECHOTIP TORQ-FLEX STAINLESS STEEL .018 IN T L65 CM L9 CM OD5.5 FR LUER LOCK SHEATH ENTRY NEEDLE GUIDEWIRE PICC DENNY MODIFICATION STERILE DISPOSABLE SUP-G11567 CDM 0270 RC outpatient 209.33 209.33 209.33 74 154.9 percent of total billed charges 209.33 93 169.56 percent of total billed charges 209.33 209.33 other OPPS APC 209.33 209.33 other OPPS APC 209.33 27.63 57.84 percent of total billed charges 209.33 209.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER CATHETER CHECK-FLO FLEXOR HYDROPHILIC NITINOL PLATINUM .038 IN L70 CM L38 CM OD7 FR RAABE SET STERILE DISPOSABLE SUP-G11635 CDM 0270 RC outpatient 124.96 124.96 124.96 74 92.47 percent of total billed charges 124.96 93 101.22 percent of total billed charges 124.96 124.96 other OPPS APC 124.96 124.96 other OPPS APC 124.96 27.63 34.53 percent of total billed charges 124.96 124.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH GUIDING FLEXOR CHECK-FLO 70CM 6FR 2.2MM RAABE MODIFICATION ACCEPTS .038IN GUIDEWIRE SUP-G11636 CDM 0270 RC outpatient 123.63 123.63 123.63 74 91.49 percent of total billed charges 123.63 93 100.14 percent of total billed charges 123.63 123.63 other OPPS APC 123.63 123.63 other OPPS APC 123.63 27.63 34.16 percent of total billed charges 123.63 123.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH GUIDING FLEXOR CHECK-FLO 55CM 6FR 2.2MM RAABE MODIFICATION ACCEPTS .038IN GUIDEWIRE SUP-G11638 CDM 0270 RC outpatient 123.63 123.63 123.63 74 91.49 percent of total billed charges 123.63 93 100.14 percent of total billed charges 123.63 123.63 other OPPS APC 123.63 123.63 other OPPS APC 123.63 27.63 34.16 percent of total billed charges 123.63 123.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGE BEACON STAINLESS STEEL NYLON VTK CURVE L125 CM OD5 FR RADIOPAQUE BRAID TAPER TIP STERILE LATEX FREE ACCEPTS .038 IN GUIDEWIRE SUP-G11642 CDM 0270 RC outpatient 67.59 67.59 67.59 74 50.02 percent of total billed charges 67.59 93 54.75 percent of total billed charges 67.59 67.59 other OPPS APC 67.59 67.59 other OPPS APC 67.59 27.63 18.68 percent of total billed charges 67.59 67.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH CHECK-FLO PERFORMER LG 30CM 42CM 18FR 5.9MM AQ DISPOSABLE STERILE RADIOPAQUE DILATOR NONTAPER END SUP-G11672 CDM 0481 RC outpatient 253.33 253.33 253.33 74 187.46 percent of total billed charges 253.33 93 205.2 percent of total billed charges 253.33 253.33 other OPPS APC 253.33 253.33 other OPPS APC 253.33 51 129.2 percent of total billed charges 253.33 253.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COOK 5F PIGTAIL SIZING CATHETER SUP-G11916 CDM 0270 RC outpatient 204.22 204.22 204.22 74 151.12 percent of total billed charges 204.22 93 165.42 percent of total billed charges 204.22 204.22 other OPPS APC 204.22 204.22 other OPPS APC 204.22 27.63 56.43 percent of total billed charges 204.22 204.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE AMPLATZ ULTRATHANE UNIVERSAL L50 CM OD10.2 FR 6 SIDEPORT STERILE DISPOSABLE ACCEPTS .038 IN GUIDEWIRE SUP-G11974 CDM 0270 RC outpatient 298.97 298.97 298.97 74 221.24 percent of total billed charges 298.97 93 242.17 percent of total billed charges 298.97 298.97 other OPPS APC 298.97 298.97 other OPPS APC 298.97 27.63 82.61 percent of total billed charges 298.97 298.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC SLIP-CATH BEACON TIP STAINLESS STEEL NYLON HYDROPHILIC VTK CURVE L125 CM OD5 FR CEREBRAL RADIOPAQUE BRAID KINK RESISTANCE STERILE LATEX FREE ACCEPTS .038 IN GUIDEWIRE SUP-G12082 CDM 0270 RC outpatient 168.99 168.99 168.99 74 125.05 percent of total billed charges 168.99 93 136.88 percent of total billed charges 168.99 168.99 other OPPS APC 168.99 168.99 other OPPS APC 168.99 27.63 46.69 percent of total billed charges 168.99 168.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE CHROMIC 4-0 SH L27 IN MONOFILAMENT BROWN SUP-G121H CDM 0270 RC outpatient 8.4 8.4 8.4 74 6.22 percent of total billed charges 8.4 93 6.8 percent of total billed charges 8.4 8.4 other OPPS APC 8.4 8.4 other OPPS APC 8.4 27.63 2.32 percent of total billed charges 8.4 8.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH GUIDING FLEXOR RAABE AQ L90 CM OD6 FR ID2.2 MM CHECK-FLO VALVE SOFT TIP RADIOPAQUE BAND STIFF SHAFT STERILE DISPOSABLE ACCEPTS .038 IN GUIDEWIRE SUP-G12266 CDM 0270 RC outpatient 160.94 160.94 160.94 74 119.1 percent of total billed charges 160.94 93 130.36 percent of total billed charges 160.94 160.94 other OPPS APC 160.94 160.94 other OPPS APC 160.94 27.63 44.47 percent of total billed charges 160.94 160.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE CHROMIC 3-0 SH L27 IN MONOFILAMENT BROWN SUP-G122H CDM 0270 RC outpatient 7.11 7.11 7.11 74 5.26 percent of total billed charges 7.11 93 5.76 percent of total billed charges 7.11 7.11 other OPPS APC 7.11 7.11 other OPPS APC 7.11 27.63 1.96 percent of total billed charges 7.11 7.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE CHROMIC 2-0 SH L27 IN MONOFILAMENT BROWN SUP-G123H CDM 0270 RC outpatient 6.57 6.57 6.57 74 4.86 percent of total billed charges 6.57 93 5.32 percent of total billed charges 6.57 6.57 other OPPS APC 6.57 6.57 other OPPS APC 6.57 27.63 1.82 percent of total billed charges 6.57 6.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOMENTUM CRT-D SUP-G124 CDM 0275 RC outpatient 35560 35560 35560 57 20269.2 percent of total billed charges 35560 93 28803.6 percent of total billed charges 35560 35560 other OPPS APC 35560 35560 other OPPS APC 35560 51 18135.6 percent of total billed charges 35560 35560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX L71 MM OD12 MM ODSEC14 FR CONTRALATERAL/IPSILATERAL ILIAC LEGS AAA SUP-G12447 CDM 270010015 LOCAL 0270 RC outpatient 7230.6 7230.6 7230.6 74 5350.64 percent of total billed charges 7230.6 93 5856.79 percent of total billed charges 7230.6 7230.6 other OPPS APC 7230.6 7230.6 other OPPS APC 7230.6 27.63 1997.81 percent of total billed charges 7230.6 7230.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX L88 MM OD12 MM ODSEC14 FR CONTRALATERAL IPSILATERAL ILIAC LEG AAA SUP-G12448 CDM 270010015 LOCAL 0270 RC outpatient 7446.4 7446.4 7446.4 74 5510.34 percent of total billed charges 7446.4 93 6031.58 percent of total billed charges 7446.4 7446.4 other OPPS APC 7446.4 7446.4 other OPPS APC 7446.4 27.63 2057.44 percent of total billed charges 7446.4 7446.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX L71 MM OD18 MM OD14 FR ABDOMINAL AORTIC ANEURYSM CONTRALATERAL/IPSILATERAL ILIAC LEGS SUP-G12461 CDM 270010015 LOCAL 0270 RC outpatient 7020 7020 7020 74 5194.8 percent of total billed charges 7020 93 5686.2 percent of total billed charges 7020 7020 other OPPS APC 7020 7020 other OPPS APC 7020 27.63 1939.63 percent of total billed charges 7020 7020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX L88 MM OD18 MM ODSEC16 FR CONTRALATERAL IPSILATERAL ILIAC LEG ABDOMINAL AORTIC ANEURYSM SUP-G12462 CDM 270010015 LOCAL 0270 RC outpatient 7446.4 7446.4 7446.4 74 5510.34 percent of total billed charges 7446.4 93 6031.58 percent of total billed charges 7446.4 7446.4 other OPPS APC 7446.4 7446.4 other OPPS APC 7446.4 27.63 2057.44 percent of total billed charges 7446.4 7446.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX L71 MM OD20 MM ODSEC16 FR CONTRALATERAL IPSILATERAL ILIAC LEG AAA SUP-G12465 CDM 270010015 LOCAL 0270 RC outpatient 7230.6 7230.6 7230.6 74 5350.64 percent of total billed charges 7230.6 93 5856.79 percent of total billed charges 7230.6 7230.6 other OPPS APC 7230.6 7230.6 other OPPS APC 7230.6 27.63 1997.81 percent of total billed charges 7230.6 7230.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CRTD MOMENTUM IS1 DF1 DEVICE SUP-G125 CDM 0275 RC outpatient 35560 35560 35560 57 20269.2 percent of total billed charges 35560 93 28803.6 percent of total billed charges 35560 35560 other OPPS APC 35560 35560 other OPPS APC 35560 51 18135.6 percent of total billed charges 35560 35560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY RHINO TRACH NBR 8 BLUE SUP-G12565 CDM 270009013 LOCAL 0270 RC outpatient 352.2 352.2 352.2 74 260.63 percent of total billed charges 352.2 93 285.28 percent of total billed charges 352.2 352.2 other OPPS APC 352.2 352.2 other OPPS APC 352.2 27.63 97.31 percent of total billed charges 352.2 352.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CHAIT PERC CATHETER SUP-G12571 CDM 0270 RC outpatient 1199.69 1199.69 1199.69 74 887.77 percent of total billed charges 1199.69 93 971.75 percent of total billed charges 1199.69 1199.69 other OPPS APC 1199.69 1199.69 other OPPS APC 1199.69 27.63 331.47 percent of total billed charges 1199.69 1199.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE SURGISIS BIODESIGN 10X7CM PORCINE ACELLULAR COLLAGEN MATRIX LF 4 LAYER MESH HIATAL HERNIA REPAIR SUP-G12580 CDM 0270 RC outpatient 2704.78 2704.78 2704.78 74 2001.54 percent of total billed charges 2704.78 93 2190.87 percent of total billed charges 2704.78 2704.78 other OPPS APC 2704.78 2704.78 other OPPS APC 2704.78 27.63 747.33 percent of total billed charges 2704.78 2704.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CRTD MOMENTUM LV1 DF1 SUP-G126 CDM 0275 RC outpatient 35560 35560 35560 57 20269.2 percent of total billed charges 35560 93 28803.6 percent of total billed charges 35560 35560 other OPPS APC 35560 35560 other OPPS APC 35560 51 18135.6 percent of total billed charges 35560 35560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH GUIDING FLEXOR CHECK-FLO L70 CM OD9 FR ID3.2 MM RAABE MODIFICATION RADIOPAQUE STERILE DISPOSABLE ACCEPTS .038 IN GUIDEWIRE SUP-G12606 CDM 0270 RC outpatient 160.94 160.94 160.94 74 119.1 percent of total billed charges 160.94 93 130.36 percent of total billed charges 160.94 160.94 other OPPS APC 160.94 160.94 other OPPS APC 160.94 27.63 44.47 percent of total billed charges 160.94 160.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH CHECK-FLO XL 40CM 20FR AQ DISPOSABLE STERILE DILATOR NONTAPER SUP-G12830 CDM 0270 RC outpatient 873 873 873 74 646.02 percent of total billed charges 873 93 707.13 percent of total billed charges 873 873 other OPPS APC 873 873 other OPPS APC 873 27.63 241.21 percent of total billed charges 873 873 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH CHECK-FLO XL 25CM 41CM 22FR AQ DISPOSABLE STERILE DILATOR NONTAPER SUP-G12831 CDM 0270 RC outpatient 1008.8 1008.8 1008.8 74 746.51 percent of total billed charges 1008.8 93 817.13 percent of total billed charges 1008.8 1008.8 other OPPS APC 1008.8 1008.8 other OPPS APC 1008.8 27.63 278.73 percent of total billed charges 1008.8 1008.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER CATHETER FLEXOR SHUTTLE 90CM 7FR 2.5MM AQ DISPOSABLE STERILE TUOHY BORST SIDEARM DILATOR RADIOPAQUE ACCEPTS SUP-G12835 CDM 0270 RC outpatient 254.8 254.8 254.8 74 188.55 percent of total billed charges 254.8 93 206.39 percent of total billed charges 254.8 254.8 other OPPS APC 254.8 254.8 other OPPS APC 254.8 27.63 70.4 percent of total billed charges 254.8 254.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE 0 MH 27IN CHROMIC MONOFILAMENT SUP-G128H CDM 0270 RC outpatient 8.35 8.35 8.35 74 6.18 percent of total billed charges 8.35 93 6.76 percent of total billed charges 8.35 8.35 other OPPS APC 8.35 8.35 other OPPS APC 8.35 27.63 2.31 percent of total billed charges 8.35 8.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER CATHETER CHECK-FLO FLEXOR HYDROPHILIC .038 IN L55 CM OD5 FR RAABE MODIFICATION SHORT DILATOR TIP FABRICATED SHEATH RADIOPAQUE BAND HEMOSTASIS VALVE STERILE DISPOSABLE SUP-G13009 CDM 0270 RC outpatient 119.6 119.6 119.6 74 88.5 percent of total billed charges 119.6 93 96.88 percent of total billed charges 119.6 119.6 other OPPS APC 119.6 119.6 other OPPS APC 119.6 27.63 33.05 percent of total billed charges 119.6 119.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER CATHETER CHECK-FLO FLEXOR 38.5CM 10FR DISPOSABLE STERILE TRANSJUGULAR INTRAHEPATIC RING GUIDE SHEATH SUP-G13081 CDM 0270 RC outpatient 310.67 310.67 310.67 74 229.9 percent of total billed charges 310.67 93 251.64 percent of total billed charges 310.67 310.67 other OPPS APC 310.67 310.67 other OPPS APC 310.67 27.63 85.84 percent of total billed charges 310.67 310.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH GUIDING FLEXOR RAABE AQ L70 CM OD5 FR ID1.9 MM CHECK-FLO VALVE SOFT TIP RADIOPAQUE BAND STIFF SHAFT STERILE DISPOSABLE ACCEPTS .038 IN GUIDEWIRE SUP-G13091 CDM 0270 RC outpatient 119.6 119.6 119.6 74 88.5 percent of total billed charges 119.6 93 96.88 percent of total billed charges 119.6 119.6 other OPPS APC 119.6 119.6 other OPPS APC 119.6 27.63 33.05 percent of total billed charges 119.6 119.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANSEL SHEATH 7F 55 CM .035 SUP-G13132 CDM 0270 RC outpatient 278.2 278.2 278.2 74 205.87 percent of total billed charges 278.2 93 225.34 percent of total billed charges 278.2 278.2 other OPPS APC 278.2 278.2 other OPPS APC 278.2 27.63 76.87 percent of total billed charges 278.2 278.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH GUIDING FLEXOR SHUTTLE AQ L80 CM OD6 FR ID2.2 MM SOFT TIP RADIOPAQUE BAND STIFF SHAFT STERILE DISPOSABLE ACCEPTS .038 IN GUIDEWIRE SUP-G13539 CDM 0270 RC outpatient 272.43 272.43 272.43 74 201.6 percent of total billed charges 272.43 93 220.67 percent of total billed charges 272.43 272.43 other OPPS APC 272.43 272.43 other OPPS APC 272.43 27.63 75.27 percent of total billed charges 272.43 272.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC BEACON TIP .035 IN VANSCHIE4 CURVE L65 CM OD5 FR BIFURCATED STERILE SUP-G13792 CDM 0270 RC outpatient 403 403 403 74 298.22 percent of total billed charges 403 93 326.43 percent of total billed charges 403 403 other OPPS APC 403 403 other OPPS APC 403 27.63 111.35 percent of total billed charges 403 403 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CRTD MOMENTUM X4 DF1 SUP-G138 CDM 0275 RC outpatient 36764 36764 36764 57 20955.5 percent of total billed charges 36764 93 29778.8 percent of total billed charges 36764 36764 other OPPS APC 36764 36764 other OPPS APC 36764 51 18749.6 percent of total billed charges 36764 36764 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE TORQUE OLCOTT HYDROPHILIC .014-.045 IN 1 HAND GUIDEWIRE STERILE DISPOSABLE SUP-G13811 CDM 0270 RC outpatient 25.97 25.97 25.97 74 19.22 percent of total billed charges 25.97 93 21.04 percent of total billed charges 25.97 25.97 other OPPS APC 25.97 25.97 other OPPS APC 25.97 27.63 7.18 percent of total billed charges 25.97 25.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET DILATOR STAINLESS STEEL POLYETHYLENE STRAIGHT L37 CM L80 CM OD8-24 FR ODSEC.038 IN URETHRAL RADIOPAQUE GUIDEWIRE SAFETY INDEX MARK SUP-G14185 CDM 0270 RC outpatient 831.01 831.01 831.01 74 614.95 percent of total billed charges 831.01 93 673.12 percent of total billed charges 831.01 831.01 other OPPS APC 831.01 831.01 other OPPS APC 831.01 27.63 229.61 percent of total billed charges 831.01 831.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PUNCH SURGICAL 3MM 14FR REUSABLE NS FOLEY CATHETER TIP SUP-G14241 CDM 0270 RC outpatient 177.84 177.84 177.84 74 131.6 percent of total billed charges 177.84 93 144.05 percent of total billed charges 177.84 177.84 other OPPS APC 177.84 177.84 other OPPS APC 177.84 27.63 49.14 percent of total billed charges 177.84 177.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET DILATOR AMPLATZ 84CM 30CM 16CM 6-30FR 8FR PTFE RENAL RADIOPAQUE SHEATH SUP-G14292 CDM 0270 RC outpatient 684.45 684.45 684.45 74 506.49 percent of total billed charges 684.45 93 554.4 percent of total billed charges 684.45 684.45 other OPPS APC 684.45 684.45 other OPPS APC 684.45 27.63 189.11 percent of total billed charges 684.45 684.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER RENAL TORCON STAINLESS STEEL COBRA CURVE L65 CM OD6 FR INNER BRAID ACCEPTS .038 IN GUIDEWIRE SUP-G14408 CDM 270009106 LOCAL 0270 RC outpatient 17.27 17.27 17.27 74 12.78 percent of total billed charges 17.27 93 13.99 percent of total billed charges 17.27 17.27 other OPPS APC 17.27 17.27 other OPPS APC 17.27 27.63 4.77 percent of total billed charges 17.27 17.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET NEPHROSTOMY KAYE POLYETHELENE POLYURETHANE PVC L25 CM L15 CM OD17 FR ODSEC12 MM 10 ML PERCUTANEOUS TAMPONADE BALLOON CATHETER STENT Y CONNECT TUBE SYRINGE STERILE LATEX FREE DISPOSABLE SUP-G14423 CDM 0270 RC outpatient 611.65 611.65 611.65 74 452.62 percent of total billed charges 611.65 93 495.44 percent of total billed charges 611.65 611.65 other OPPS APC 611.65 611.65 other OPPS APC 611.65 27.63 169 percent of total billed charges 611.65 611.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET DILATOR AMPLATZ STANDARD L30 CM L20 CM OD6-30 FR RENAL TFE CATHETER RADIOPAQUE SHEATH MODIFIED SUP-G14485 CDM 0270 RC outpatient 699.66 699.66 699.66 74 517.75 percent of total billed charges 699.66 93 566.72 percent of total billed charges 699.66 699.66 other OPPS APC 699.66 699.66 other OPPS APC 699.66 27.63 193.32 percent of total billed charges 699.66 699.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETERAL FLEXI-TIP STANDARD L70 CM OD5 FR OPEN END LATEX FREE ACCEPTS .038 IN GUIDEWIRE RETROGRADE PYELOGRAM SUP-G14521 CDM 0270 RC outpatient 45.88 45.88 45.88 74 33.95 percent of total billed charges 45.88 93 37.16 percent of total billed charges 45.88 45.88 other OPPS APC 45.88 45.88 other OPPS APC 45.88 27.63 12.68 percent of total billed charges 45.88 45.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRUSH CYTOLOGY L115 CM OD3.2 FR URETERAL BIOPSY SET STRAIGHT TIP OCCLUSIVE SUP-G14919 CDM 270009191 LOCAL 0270 RC outpatient 261.92 261.92 261.92 74 193.82 percent of total billed charges 261.92 93 212.16 percent of total billed charges 261.92 261.92 other OPPS APC 261.92 261.92 other OPPS APC 261.92 27.63 72.37 percent of total billed charges 261.92 261.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC DYNAGEN ACUSHOCK EASYVIEW SAFETYCORE D.99 CM W5.37 CM X H8.18 CM 32.5 CC 73.6 GM RIGHT ATRIUM RIGHT VENTRICLE LEFT VENTRICLE IS-1 DF4 CONNECTOR HIGH ENERGY TAPER LEAD TIP STERILE SUP-G150 CDM 0275 RC outpatient 34560 34560 34560 57 19699.2 percent of total billed charges 34560 93 27993.6 percent of total billed charges 34560 34560 other OPPS APC 34560 34560 other OPPS APC 34560 51 17625.6 percent of total billed charges 34560 34560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS ENDOSCOPIC L115 CM OD3.3 FR TISSUE FLEXIBLE OVAL BIOPSY CUP SUP-G15054 CDM 0270 RC outpatient 1180.95 1180.95 1180.95 74 873.9 percent of total billed charges 1180.95 93 956.57 percent of total billed charges 1180.95 1180.95 other OPPS APC 1180.95 1180.95 other OPPS APC 1180.95 27.63 326.3 percent of total billed charges 1180.95 1180.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC DYNAGEN ACUSHOCK EASYVIEW SAFETYCORE D.99 CM W5.37 CM X H8.08 CM 32 CC 72.8 GM RIGHT ATRIUM RIGHT VENTRICLE LEFT VENTRICLE IS-1 DF-1 CONNECTOR HIGH ENERGY TAPER LEAD TIP STERILE SUP-G151 CDM 0275 RC outpatient 34560 34560 34560 57 19699.2 percent of total billed charges 34560 93 27993.6 percent of total billed charges 34560 34560 other OPPS APC 34560 34560 other OPPS APC 34560 51 17625.6 percent of total billed charges 34560 34560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC DYNAGEN ACUSHOCK EASYVIEW SAFETYCORE D.99 CM W5.37 CM X H8.08 CM 32 CC 72.9 GM RIGHT ATRIUM RIGHT VENTRICLE LEFT VENTRICLE IS-1 DF-1 LV-1 CONNECTOR TAPER LEAD TIP STERILE SUP-G154 CDM 0275 RC outpatient 34560 34560 34560 57 19699.2 percent of total billed charges 34560 93 27993.6 percent of total billed charges 34560 34560 other OPPS APC 34560 34560 other OPPS APC 34560 51 17625.6 percent of total billed charges 34560 34560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC DYNAGEN X4 D.99 IN MINI W5.37 CM X H8.08 CM 32 CC 73.4 GM IS-1 DF-1 IS-4 CONNECTOR STERILE SUP-G156 CDM 0275 RC outpatient 35764 35764 35764 57 20385.5 percent of total billed charges 35764 93 28968.8 percent of total billed charges 35764 35764 other OPPS APC 35764 35764 other OPPS APC 35764 51 18239.6 percent of total billed charges 35764 35764 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC DYNAGEN X4 D.99 IN MINI W5.37 CM X H8.18 CM 32.5 CC 73.8 GM IS-1 DF-4 IS-4 CONNECTOR STERILE SUP-G158 CDM 0275 RC outpatient 37312 37312 37312 57 21267.8 percent of total billed charges 37312 93 30222.7 percent of total billed charges 37312 37312 other OPPS APC 37312 37312 other OPPS APC 37312 51 19029.1 percent of total billed charges 37312 37312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URODYNAMIC L38 CM OD7 FR 2 LUMEN SUP-G15899 CDM outpatient 63.39 63.39 63.39 63.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET CATHETER TROCAR L54 CM OD8 FR SUPRAPUBIC DRAINAGE ADAPTER STERILE CYSTOSTOMY SUP-G16696 CDM outpatient 218.66 218.66 218.66 218.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETERAL FLEXI-TIP AQ OD.05 IN L50 CM OD6/10 FR ODSEC.04 IN 2 LUMEN STERILE LATEX FREE SUP-G17323 CDM 0270 RC outpatient 164.84 164.84 164.84 74 121.98 percent of total billed charges 164.84 93 133.52 percent of total billed charges 164.84 164.84 other OPPS APC 164.84 164.84 other OPPS APC 164.84 27.63 45.55 percent of total billed charges 164.84 164.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIPS INSTINCT HEMOSTATIC SUP-G18344 CDM 0270 RC outpatient 606.32 606.32 606.32 74 448.68 percent of total billed charges 606.32 93 491.12 percent of total billed charges 606.32 606.32 other OPPS APC 606.32 606.32 other OPPS APC 606.32 27.63 167.53 percent of total billed charges 606.32 606.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING CXI STAINLESS STEEL HYDROPHILIC STRAIGHT L65 CM OD2.3 FR MARKER BAND RADIOPAQUE BRAID KINK RESISTANT .018 IN ACCEPTS GUIDEWIRE SUP-G18367 CDM 0270 RC outpatient 528.92 528.92 528.92 74 391.4 percent of total billed charges 528.92 93 428.43 percent of total billed charges 528.92 528.92 other OPPS APC 528.92 528.92 other OPPS APC 528.92 27.63 146.14 percent of total billed charges 528.92 528.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SUPPORT CXI STAINLESS STEEL HYDROPHILIC L150 CM OD2.3 FR STRAIGHT TIP BRAID KINK RESISTANT RADIOPAQUE ACCEPTS .014 IN GUIDEWIRE SUP-G18373 CDM 0270 RC outpatient 545.97 545.97 545.97 74 404.02 percent of total billed charges 545.97 93 442.24 percent of total billed charges 545.97 545.97 other OPPS APC 545.97 545.97 other OPPS APC 545.97 27.63 150.85 percent of total billed charges 545.97 545.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SUPPORT CXI STRAIGHT L65 CM OD2.6 FR ACCEPTS .018 IN GUIDEWIRE SUP-G18377 CDM 0270 RC outpatient 571.97 571.97 571.97 74 423.26 percent of total billed charges 571.97 93 463.3 percent of total billed charges 571.97 571.97 other OPPS APC 571.97 571.97 other OPPS APC 571.97 27.63 158.04 percent of total billed charges 571.97 571.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX 30MM 14MM ANCILLARY ILIAC PLUG AAA SUP-G18505 CDM 270010015 LOCAL 0270 RC outpatient 5202.6 5202.6 5202.6 74 3849.92 percent of total billed charges 5202.6 93 4214.11 percent of total billed charges 5202.6 5202.6 other OPPS APC 5202.6 5202.6 other OPPS APC 5202.6 27.63 1437.48 percent of total billed charges 5202.6 5202.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX Z-TRAK L30 MM OD16 MM ODSEC5.4 MM ID14 FR ANCILLARY ILIAC PLUG INTRODUCER SHEATH ABDOMINAL AORTIC ANEURYSM SUP-G18506 CDM 270010015 LOCAL 0270 RC outpatient 5202.6 5202.6 5202.6 74 3849.92 percent of total billed charges 5202.6 93 4214.11 percent of total billed charges 5202.6 5202.6 other OPPS APC 5202.6 5202.6 other OPPS APC 5202.6 27.63 1437.48 percent of total billed charges 5202.6 5202.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR 30MM 24MM 6MM 16FR ZENITH FLEX Z-TRAK ANCILLARY ILIAC PLUG SUP-G18508 CDM 270010015 LOCAL 0270 RC outpatient 5202.6 5202.6 5202.6 74 3849.92 percent of total billed charges 5202.6 93 4214.11 percent of total billed charges 5202.6 5202.6 other OPPS APC 5202.6 5202.6 other OPPS APC 5202.6 27.63 1437.48 percent of total billed charges 5202.6 5202.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH ACCESS FLEXOR 55CM 12FR AQ DISPOSABLE STERILE LATEX URETERAL DILATION CONTINUOUS WORK CHANNEL FLEXIBLE SCOPE SUP-G19169 CDM 0270 RC outpatient 475.96 475.96 475.96 74 352.21 percent of total billed charges 475.96 93 385.53 percent of total billed charges 475.96 475.96 other OPPS APC 475.96 475.96 other OPPS APC 475.96 27.63 131.51 percent of total billed charges 475.96 475.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION MREYE PLATINUM L 5CM OD 10MM 1.6 LOOP ACCEPTS .035 IN CATHETER SUP-G19908 CDM 0270 RC outpatient 280.77 280.77 280.77 74 207.77 percent of total billed charges 280.77 93 227.42 percent of total billed charges 280.77 280.77 other OPPS APC 280.77 280.77 other OPPS APC 280.77 27.63 77.58 percent of total billed charges 280.77 280.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION MREYE PLATINUM L5 CM OD10 MM 1.6 LOOP ACCEPTS .035 IN CATHETER SUP-G19908 CDM 0270 RC outpatient 280.77 280.77 280.77 74 207.77 percent of total billed charges 280.77 93 227.42 percent of total billed charges 280.77 280.77 other OPPS APC 280.77 280.77 other OPPS APC 280.77 27.63 77.58 percent of total billed charges 280.77 280.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION MREYE .PLATINUM .035IN L15CM OD15MM 3.2 LOOP STERILE SUP-G20055 CDM 0270 RC outpatient 179.14 179.14 179.14 74 132.56 percent of total billed charges 179.14 93 145.1 percent of total billed charges 179.14 179.14 other OPPS APC 179.14 179.14 other OPPS APC 179.14 27.63 49.5 percent of total billed charges 179.14 179.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION MREYE 15MM 5CM HIGH RADIAL FORCE PUSHABLE 1-LOOP INCONEL SYNTHETIC FIBER MRI-CONDITIONAL RADIOPAQUE 0.035IN CATH SUP-G20149 CDM 0270 RC outpatient 431.16 431.16 431.16 74 319.06 percent of total billed charges 431.16 93 349.24 percent of total billed charges 431.16 431.16 other OPPS APC 431.16 431.16 other OPPS APC 431.16 27.63 119.13 percent of total billed charges 431.16 431.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION MREYE PLATINUM L5 CM OD6 MM 2.7 LOOP END HOLE STERILE ACCEPTS .035 IN GUIDEWIRE SUP-G20291 CDM 0270 RC outpatient 280.77 280.77 280.77 74 207.77 percent of total billed charges 280.77 93 227.42 percent of total billed charges 280.77 280.77 other OPPS APC 280.77 280.77 other OPPS APC 280.77 27.63 77.58 percent of total billed charges 280.77 280.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION MREYE 12MM 10CM HIGH RADIAL FORCE PUSHABLE 2.65-LOOP INCONEL SYNTHETIC FIBER MRI-CONDITIONAL RADIOPAQUE 0.035IN CATH SUP-G20825 CDM 0270 RC outpatient 280.77 280.77 280.77 74 207.77 percent of total billed charges 280.77 93 227.42 percent of total billed charges 280.77 280.77 other OPPS APC 280.77 280.77 other OPPS APC 280.77 27.63 77.58 percent of total billed charges 280.77 280.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET STENT ZIMMON POLYETHYLENE 2 PIGTAIL CURVE L5 CM OD10 FR BILIARY PUSH CATHETER SMOOTH CANNULATION TAPER TIP STERILE PURPLE ACCEPTS .035 IN GUIDEWIRE SUP-G21783 CDM 0270 RC outpatient 387.4 387.4 387.4 74 286.68 percent of total billed charges 387.4 93 313.79 percent of total billed charges 387.4 387.4 other OPPS APC 387.4 387.4 other OPPS APC 387.4 27.63 107.04 percent of total billed charges 387.4 387.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPHINCTEROTOME ENDOSCOPIC HUIBREGTSE L200 CM L4 MM OD5 FR 1 LUMEN NEEDLE KNIFE PAPILLOTOME EXPOSED CUTTING WIRE PURPLE ACCEPTS .035 IN GUIDEWIRE SUP-G22037 CDM 0270 RC outpatient 543.4 543.4 543.4 74 402.12 percent of total billed charges 543.4 93 440.15 percent of total billed charges 543.4 543.4 other OPPS APC 543.4 543.4 other OPPS APC 543.4 27.63 150.14 percent of total billed charges 543.4 543.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT PANCREATIC ZIMMON POLYETHYLENE PIGTAIL CURVE TAPER L7 CM OD7 FR STERILE DISPOSABLE PURPLE SUP-G22353 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT PANCREATIC ZIMMON POLYETHYLENE PIGTAIL CURVE TAPER SPIRAL L7 CM OD5 FR RADIOPAQUE MARKER SIDEHOLE STERILE DISPOSABLE BLUE ACCEPTS .025 IN GUIDEWIRE SUP-G22360 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SPECIMEN RETRIEVAL TRI-EX .035IN 200CM 7-5FR 8.5MM 1.5ML PURPLE DISPOSABLE STERILE LATEX BILE DUCT 3 LUMEN SUP-G22530 CDM 0270 RC outpatient 418.6 418.6 418.6 74 309.76 percent of total billed charges 418.6 93 339.07 percent of total billed charges 418.6 418.6 other OPPS APC 418.6 418.6 other OPPS APC 418.6 27.63 115.66 percent of total billed charges 418.6 418.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET GASTROSTOMY PEG24 .035IN 66CM 200CM 12FR DISPOSABLE STERILE JEJUNUM FEEDING TUBE GUIDEWIRE GASTRIC LUMEN SUP-G22639 CDM 0270 RC outpatient 540.64 540.64 540.64 74 400.07 percent of total billed charges 540.64 93 437.92 percent of total billed charges 540.64 540.64 other OPPS APC 540.64 540.64 other OPPS APC 540.64 27.63 149.38 percent of total billed charges 540.64 540.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SNARE ENDOSCOPIC ACUSNARE TEFLON NITINOL STAINLESS STEEL DUCKBILL L25 MM L240 CM OD7 FR ESOPHAGEAL COLON 1 PIECE GRADUATED MARK HANDLE ACCESSORY CHANNEL STERILE DISPOSABLE SUP-G22649 CDM 0270 RC outpatient 104 104 104 74 76.96 percent of total billed charges 104 93 84.24 percent of total billed charges 104 104 other OPPS APC 104 104 other OPPS APC 104 27.63 28.74 percent of total billed charges 104 104 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL UNIVERSA AQ 2 PIGTAIL CURVE L20 CM OD5 FR RADIOPAQUE POSITIONER MONOFILAMENT TETHER STRAIGHTENER STERILE SUP-G23365 CDM 0270 RC outpatient 350.45 350.45 350.45 74 259.33 percent of total billed charges 350.45 93 283.86 percent of total billed charges 350.45 350.45 other OPPS APC 350.45 350.45 other OPPS APC 350.45 27.63 96.83 percent of total billed charges 350.45 350.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL UNIVERSA AQ 2 PIGTAIL CURVE L22 CM OD5 FR RADIOPAQUE POSITIONER MONOFILAMENT TETHER STRAIGHTENER STERILE SUP-G23366 CDM 0270 RC outpatient 350.45 350.45 350.45 74 259.33 percent of total billed charges 350.45 93 283.86 percent of total billed charges 350.45 350.45 other OPPS APC 350.45 350.45 other OPPS APC 350.45 27.63 96.83 percent of total billed charges 350.45 350.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL UNIVERSA AQ 2 PIGTAIL CURVE L24 CM OD5 FR RADIOPAQUE POSITIONER MONOFILAMENT TETHER STRAIGHTENER STERILE SUP-G23367 CDM 0270 RC outpatient 350.45 350.45 350.45 74 259.33 percent of total billed charges 350.45 93 283.86 percent of total billed charges 350.45 350.45 other OPPS APC 350.45 350.45 other OPPS APC 350.45 27.63 96.83 percent of total billed charges 350.45 350.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL UNIVERSA AQ 2 PIGTAIL CURVE L26 CM OD5 FR RADIOPAQUE POSITIONER MONOFILAMENT TETHER STRAIGHTENER STERILE SUP-G23368 CDM 0270 RC outpatient 350.45 350.45 350.45 74 259.33 percent of total billed charges 350.45 93 283.86 percent of total billed charges 350.45 350.45 other OPPS APC 350.45 350.45 other OPPS APC 350.45 27.63 96.83 percent of total billed charges 350.45 350.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL UNIVERSA AQ 2 PIGTAIL CURVE L28 CM OD5 FR RADIOPAQUE POSITIONER MONOFILAMENT TETHER STRAIGHTENER STERILE SUP-G23369 CDM 0270 RC outpatient 350.45 350.45 350.45 74 259.33 percent of total billed charges 350.45 93 283.86 percent of total billed charges 350.45 350.45 other OPPS APC 350.45 350.45 other OPPS APC 350.45 27.63 96.83 percent of total billed charges 350.45 350.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL UNIVERSA AQ 2 PIGTAIL CURVE L30 CM OD5 FR RADIOPAQUE POSITIONER MONOFILAMENT TETHER STRAIGHTENER STERILE SUP-G23370 CDM 0270 RC outpatient 350.45 350.45 350.45 74 259.33 percent of total billed charges 350.45 93 283.86 percent of total billed charges 350.45 350.45 other OPPS APC 350.45 350.45 other OPPS APC 350.45 27.63 96.83 percent of total billed charges 350.45 350.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL UNIVERSA AQ 2 PIGTAIL CURVE L22-32 CM L145 CM OD5 FR RADIOPAQUE MULTILENGTH GRADUATE MARK POSITIONER STERILE ACCEPTS .038 IN GUIDEWIRE SUP-G23511 CDM 0270 RC outpatient 350.45 350.45 350.45 74 259.33 percent of total billed charges 350.45 93 283.86 percent of total billed charges 350.45 350.45 other OPPS APC 350.45 350.45 other OPPS APC 350.45 27.63 96.83 percent of total billed charges 350.45 350.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION CODA .035 IN L120 CM OD10 FR ODSEC40 MM 46 ML SUP-G23773 CDM 0270 RC outpatient 1244.1 1244.1 1244.1 74 920.63 percent of total billed charges 1244.1 93 1007.72 percent of total billed charges 1244.1 1244.1 other OPPS APC 1244.1 1244.1 other OPPS APC 1244.1 27.63 343.74 percent of total billed charges 1244.1 1244.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT PANCREATIC ZIMMON POLYETHYLENE TAPER PIGTAIL CURVE SPIRAL L5 CM OD5 FR STERILE DISPOSABLE BLUE SUP-G24574 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRTD G247 VIGILANT MRI X4 DF4 _51712_ SUP-G247 CDM 0275 RC outpatient 38312 38312 38312 57 21837.8 percent of total billed charges 38312 93 31032.7 percent of total billed charges 38312 38312 other OPPS APC 38312 38312 other OPPS APC 38312 51 19539.1 percent of total billed charges 38312 38312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY SOLUS .035 IN 2 PIGTAIL CURVE L5 CM L210 CM OD10 FR ODSEC5 FR INTRODUCER GUIDING CATHETER TRACER METRO DIRECT GUIDEWIRE STERILE DISPOSABLE PURPLE SUP-G25672 CDM 0270 RC outpatient 358.8 358.8 358.8 74 265.51 percent of total billed charges 358.8 93 290.63 percent of total billed charges 358.8 358.8 other OPPS APC 358.8 358.8 other OPPS APC 358.8 27.63 99.14 percent of total billed charges 358.8 358.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SNARE VASCULAR NEEDLES EYE CHECK-FLO OD12 FR L94 CM L145 CM OD20 MM ODSEC16 FR SUP-G26515 CDM 0481 RC outpatient 3616.57 3616.57 3616.57 74 2676.26 percent of total billed charges 3616.57 93 2929.42 percent of total billed charges 3616.57 3616.57 other OPPS APC 3616.57 3616.57 other OPPS APC 3616.57 51 1844.45 percent of total billed charges 3616.57 3616.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER CATHETER CHECK-FLO PERFORMER L35 CM OD16 FR ID5.3 MM RADIOPAQUE BAND SET LARGE VALVE SHEATH STERILE DISPOSABLE ACCEPTS .038 IN GUIDEWIRE RCFW SUP-G27023 CDM 0270 RC outpatient 308.88 308.88 308.88 74 228.57 percent of total billed charges 308.88 93 250.19 percent of total billed charges 308.88 308.88 other OPPS APC 308.88 308.88 other OPPS APC 308.88 27.63 85.34 percent of total billed charges 308.88 308.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT EXTENDER SQUARE COUPLING ZENITH AAA MAIN BODY 30 X 88MM SUP-G279465 CDM 270010015 LOCAL 0270 RC outpatient 19240 19240 19240 74 14237.6 percent of total billed charges 19240 93 15584.4 percent of total billed charges 19240 19240 other OPPS APC 19240 19240 other OPPS APC 19240 27.63 5316.01 percent of total billed charges 19240 19240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXTENDER SQUARE COUPLING ZENITH AAA MAIN BODY 32 X 103MM SUP-G279481 CDM 270010015 LOCAL 0270 RC outpatient 2.6 2.6 2.6 74 1.92 percent of total billed charges 2.6 93 2.11 percent of total billed charges 2.6 2.6 other OPPS APC 2.6 2.6 other OPPS APC 2.6 27.63 0.72 percent of total billed charges 2.6 2.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET INTRODUCER PERFORMER L13 CM OD16 FR ACCEPTS .038 IN GUIDEWIRE SUP-G28322 CDM 0272 RC outpatient 308.88 308.88 308.88 74 228.57 percent of total billed charges 308.88 93 250.19 percent of total billed charges 308.88 308.88 other OPPS APC 308.88 308.88 other OPPS APC 308.88 27.63 85.34 percent of total billed charges 308.88 308.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER CATHETER CHECK-FLO PERFORMER .038IN 45CM 12FR 4MM RADIOPAQUE BAND SUP-G28433 CDM 0270 RC outpatient 403 403 403 74 298.22 percent of total billed charges 403 93 326.43 percent of total billed charges 403 403 other OPPS APC 403 403 other OPPS APC 403 27.63 111.35 percent of total billed charges 403 403 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP SURGICAL PEERS STAINLESS STEEL L5 3/4 IN NONPERFORATE TOWEL CURVE JAW NONSTERILE REUSABLE SUP-G2869-11 CDM 0270 RC outpatient 100.59 100.59 100.59 74 74.44 percent of total billed charges 100.59 93 81.48 percent of total billed charges 100.59 100.59 other OPPS APC 100.59 100.59 other OPPS APC 100.59 27.63 27.79 percent of total billed charges 100.59 100.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH GUIDING CHECK-FLO FLEXOR AQ HYDROPHILIC ANL1 CURVE L45 CM OD7 FR SUP-G29985 CDM 0270 RC outpatient 139.05 139.05 139.05 74 102.9 percent of total billed charges 139.05 93 112.63 percent of total billed charges 139.05 139.05 other OPPS APC 139.05 139.05 other OPPS APC 139.05 27.63 38.42 percent of total billed charges 139.05 139.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON ADVANCE 18LP LOW PROFILE SUP-G30946 CDM 0270 RC outpatient 624 624 624 74 461.76 percent of total billed charges 624 93 505.44 percent of total billed charges 624 624 other OPPS APC 624 624 other OPPS APC 624 27.63 172.41 percent of total billed charges 624 624 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON ADVANCE 18LP LOW PROFILE SUP-G30955 CDM 0270 RC outpatient 624 624 624 74 461.76 percent of total billed charges 624 93 505.44 percent of total billed charges 624 624 other OPPS APC 624 624 other OPPS APC 624 27.63 172.41 percent of total billed charges 624 624 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON ADVANCE 18LP LOW PROFILE SUP-G30958 CDM 0270 RC outpatient 624 624 624 74 461.76 percent of total billed charges 624 93 505.44 percent of total billed charges 624 624 other OPPS APC 624 624 other OPPS APC 624 27.63 172.41 percent of total billed charges 624 624 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC SLIP-CATH HYDROPHILIC BEACON C2 CURVE L100 CM OD4 FR VISCERA ACCEPTS .038 IN GUIDEWIRE SUP-G31022 CDM 0270 RC outpatient 107.96 107.96 107.96 74 79.89 percent of total billed charges 107.96 93 87.45 percent of total billed charges 107.96 107.96 other OPPS APC 107.96 107.96 other OPPS APC 107.96 27.63 29.83 percent of total billed charges 107.96 107.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC SLIP-CATH BEACON TIP HYDROPHILIC .038 IN MPA CURVE L100 CM OD4 FR ANGLED MULTIPURPOSE SUP-G31023 CDM 0270 RC outpatient 107.96 107.96 107.96 74 79.89 percent of total billed charges 107.96 93 87.45 percent of total billed charges 107.96 107.96 other OPPS APC 107.96 107.96 other OPPS APC 107.96 27.63 29.83 percent of total billed charges 107.96 107.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH GUIDING FLEXOR SHUTTLE-SL 90CM 6FR .087IN HYDROPHILIC DISPOSABLE STERILE TUOHY BORST SIDEARM RADIOPAQUE STIFFEN SUP-G31138 CDM 0270 RC outpatient 283.35 283.35 283.35 74 209.68 percent of total billed charges 283.35 93 229.51 percent of total billed charges 283.35 283.35 other OPPS APC 283.35 283.35 other OPPS APC 283.35 27.63 78.29 percent of total billed charges 283.35 283.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX 2 BRANCH L96 MM OD32 MM ODSEC20 FR MAIN BODY INTRODUCER SHEATH AAA SUP-G31184 CDM 270010015 LOCAL 0270 RC outpatient 21351.2 21351.2 21351.2 74 15799.9 percent of total billed charges 21351.2 93 17294.5 percent of total billed charges 21351.2 21351.2 other OPPS APC 21351.2 21351.2 other OPPS APC 21351.2 27.63 5899.34 percent of total billed charges 21351.2 21351.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR LUNDERQUIST STRAIGHT 260CM 15CM .035IN SS PTFE LF EXTRA STIFF FLEXIBLE TIP EXCHANGE SUP-G31453 CDM 0270 RC outpatient 325.26 325.26 325.26 74 240.69 percent of total billed charges 325.26 93 263.46 percent of total billed charges 325.26 325.26 other OPPS APC 325.26 325.26 other OPPS APC 325.26 27.63 89.87 percent of total billed charges 325.26 325.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH CHECK-FLO FLEXOR 40CM 10FR 3.4MM DISPOSABLE STERILE PERIPHERAL LG VALVE RADIOPAQUE NONTAPER END SUP-G32233 CDM 0270 RC outpatient 167.91 167.91 167.91 74 124.25 percent of total billed charges 167.91 93 136.01 percent of total billed charges 167.91 167.91 other OPPS APC 167.91 167.91 other OPPS APC 167.91 27.63 46.39 percent of total billed charges 167.91 167.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET STENT RESONANCE 24CM 6FR METAL DISPOSABLE STERILE ADULT URETER RADIOPAQUE POSITIONER EXTRINSIC OBSTRUCTION SUP-G34110 CDM outpatient 2902.59 2902.59 2902.59 2902.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET URETERAL RESONANCE 26CM 6FR METAL DISPOSABLE STERILE ADULT URETER RADIOPAQUE POSITIONER EXTRINSIC OBSTRUCTION SUP-G34111 CDM 0270 RC outpatient 3094 3094 3094 74 2289.56 percent of total billed charges 3094 93 2506.14 percent of total billed charges 3094 3094 other OPPS APC 3094 3094 other OPPS APC 3094 27.63 854.87 percent of total billed charges 3094 3094 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER EMBOLIZATION CELECT NAVALIGN 65CM 49MM 71CM 30MM 7FR PLATINUM HYDROPHILIC DISPOSABLE STERILE VENA CAVA JUGULAR SUP-G34309 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER EMBOLIZATION CELECT NAVALIGN 65CM 49MM 79CM 30MM 7FR PLATINUM HYDROPHILIC DISPOSABLE STERILE VENA CAVA RADIOPAQUE SUP-G34502 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER MICRO STIFFEN 4FR SUP-G35550 CDM 0270 RC outpatient 58.4 58.4 58.4 74 43.22 percent of total billed charges 58.4 93 47.3 percent of total billed charges 58.4 58.4 other OPPS APC 58.4 58.4 other OPPS APC 58.4 27.63 16.14 percent of total billed charges 58.4 58.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER MICRO STIFFEN 5FR SUP-G35551 CDM 0270 RC outpatient 58.4 58.4 58.4 74 43.22 percent of total billed charges 58.4 93 47.3 percent of total billed charges 58.4 58.4 other OPPS APC 58.4 58.4 other OPPS APC 58.4 27.63 16.14 percent of total billed charges 58.4 58.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR RENU H&L-B ONE-SHOT ZENITH STAINLESS STEEL POLYESTER WOVEN 2 BRANCH L108 MM L71-37 MM OD12-24 MM ID18 FR ILIUM INFRARENAL ANCILLARY CONVERTER INTRODUCTION SYSTEM AAA SUP-G36153 CDM 270010015 LOCAL 0270 RC outpatient 16445 16445 16445 74 12169.3 percent of total billed charges 16445 93 13320.5 percent of total billed charges 16445 16445 other OPPS APC 16445 16445 other OPPS APC 16445 27.63 4543.75 percent of total billed charges 16445 16445 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ZILVER PTX 100MM 125CM 6MM 6FR PACLITAXEL ELUTING NITINOL STERILE PERIPHERAL OTW DELIVERY SYSTEM ACCEPTS SUP-G38481 CDM 0270 RC outpatient 4901 4901 4901 74 3626.74 percent of total billed charges 4901 93 3969.81 percent of total billed charges 4901 4901 other OPPS APC 4901 4901 other OPPS APC 4901 27.63 1354.15 percent of total billed charges 4901 4901 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER CATHETER RESPONSE AGILIS NXT L 40 CM L 11.4 CM OD 8.5 FR ODSEC 17 GA EPICARDIUM STEERABLE ATRAUMATIC TIP INTEGRATE HEMOSTASIS VALVE ACCEPTS .032 IN GUIDEWIRE SUP-G402047 CDM 0270 RC outpatient 2743 2743 2743 74 2029.82 percent of total billed charges 2743 93 2221.83 percent of total billed charges 2743 2743 other OPPS APC 2743 2743 other OPPS APC 2743 27.63 757.89 percent of total billed charges 2743 2743 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE PROCEDURE BRK-1 ADULT L71 CM OD18 GA TRANSSEPTAL CURVE SUP-G407209 CDM 0270 RC outpatient 585 585 585 74 432.9 percent of total billed charges 585 93 473.85 percent of total billed charges 585 585 other OPPS APC 585 585 other OPPS APC 585 27.63 161.64 percent of total billed charges 585 585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH AGILIS NXT DUAL REACH .032 IN LARGE CURL CURVE L50 MM L71 CM OD8.5 FR STEERABLE ERGONOMIC HANDLE ATRAUMATIC TIP INTEGRATE HEMOSTASIS VALVE RADIOPAQUE TIP MARKER SUP-G408324 CDM 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION MREYE 3MM 2CM HIGH RADIAL FORCE PUSHABLE 2.1-LOOP INCONEL SYNTHETIC FIBER MRI-CONDITIONAL RADIOPAQUE 0.035IN CATH SUP-G42406 CDM 0270 RC outpatient 280.77 280.77 280.77 74 207.77 percent of total billed charges 280.77 93 227.42 percent of total billed charges 280.77 280.77 other OPPS APC 280.77 280.77 other OPPS APC 280.77 27.63 77.58 percent of total billed charges 280.77 280.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION MREYE 5MM 3CM HIGH RADIAL FORCE PUSHABLE 1.9-LOOP INCONEL SYNTHETIC FIBER MRI-CONDITIONAL RADIOPAQUE 0.035IN CATH SUP-G42410 CDM 0270 RC outpatient 280.77 280.77 280.77 74 207.77 percent of total billed charges 280.77 93 227.42 percent of total billed charges 280.77 280.77 other OPPS APC 280.77 280.77 other OPPS APC 280.77 27.63 77.58 percent of total billed charges 280.77 280.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION MREYE 3MM 5CM HIGH RADIAL FORCE PUSHABLE 5.3-LOOP INCONEL SYNTHETIC FIBER MRI-CONDITIONAL RADIOPAQUE 0.035IN CATH SUP-G42419 CDM 0270 RC outpatient 280.77 280.77 280.77 74 207.77 percent of total billed charges 280.77 93 227.42 percent of total billed charges 280.77 280.77 other OPPS APC 280.77 280.77 other OPPS APC 280.77 27.63 77.58 percent of total billed charges 280.77 280.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION MREYE 5CM 8MM PLATINUM STERILE ARTERIAL VENOUS 2 LOOP ACCEPTS .038IN GUIDEWIRE SUP-G42463 CDM 0270 RC outpatient 280.77 280.77 280.77 74 207.77 percent of total billed charges 280.77 93 227.42 percent of total billed charges 280.77 280.77 other OPPS APC 280.77 280.77 other OPPS APC 280.77 27.63 77.58 percent of total billed charges 280.77 280.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH RENU H&L-B ONE-SHOT 2 BRANCH CYLINDER 116MM 64-52MM 12-36MM 22FR SS POLYESTER INFRARENAL SUP-G43370 CDM 270010015 LOCAL 0270 RC outpatient 16936.4 16936.4 16936.4 74 12532.9 percent of total billed charges 16936.4 93 13718.5 percent of total billed charges 16936.4 16936.4 other OPPS APC 16936.4 16936.4 other OPPS APC 16936.4 27.63 4679.53 percent of total billed charges 16936.4 16936.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ZILVER 518 NITINOL .018 IN L40 MM L125 CM OD6 MM ODSEC5 FR ILIAC ARTERY SELF EXPANDABLE SUP-G43771 CDM 0270 RC outpatient 2535 2535 2535 74 1875.9 percent of total billed charges 2535 93 2053.35 percent of total billed charges 2535 2535 other OPPS APC 2535 2535 other OPPS APC 2535 27.63 700.42 percent of total billed charges 2535 2535 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ZILVER 635 NITINOL .035 IN L60 MM L125 CM SUP-G43832 CDM 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ZILVER 8MM X 40MM SUP-G43856 CDM 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ZILVER 635 FLEXOR 40MM 80CM 10MM 6FR NITINOL STERILE ILIAC ARTERY SELF EXPAND SLOT TUBE DELIVERY SYSTEM SUP-G43866 CDM 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ZILVER 635 NITINOL .035 IN L80 MM L80 CM OD10 MM ODSEC6 FR ILIAC ARTERY SELF EXPANDING FLEXIBLE SLOTTED TUBE FLEXOR INTRODUCER GUIDEWIRE STERILE SUP-G43868 CDM 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET INTRODUCER MICROPUNCTURE SILHOUETTE STAINLESS STEEL L40 CM L10 CM OD5 FR OD.018 IN WIRE GUIDE PLATINUM TIP TRANSITIONLESS COAXIAL CATHETER DILATOR STERILE DISPOSABLE SUP-G43872 CDM 0270 RC outpatient 72.64 72.64 72.64 74 53.75 percent of total billed charges 72.64 93 58.84 percent of total billed charges 72.64 72.64 other OPPS APC 72.64 72.64 other OPPS APC 72.64 27.63 20.07 percent of total billed charges 72.64 72.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR LUNDERQUIST .035IN CURVE 260CM 4CM SS PTFE 2 END FLOPPY TIP SUP-G45208 CDM 0481 RC outpatient 315 315 315 74 233.1 percent of total billed charges 315 93 255.15 percent of total billed charges 315 315 other OPPS APC 315 315 other OPPS APC 315 51 160.65 percent of total billed charges 315 315 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR LUNDERQUIST TAPER 260CM 11CM .035IN SS PTFE DISPOSABLE STERILE EXTRA STIFF FLOPPY CURVE TIP EXCHANGE SUP-G45353 CDM 0270 RC outpatient 329.16 329.16 329.16 74 243.58 percent of total billed charges 329.16 93 266.62 percent of total billed charges 329.16 329.16 other OPPS APC 329.16 329.16 other OPPS APC 329.16 27.63 90.95 percent of total billed charges 329.16 329.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTRACTOR STONE RETRIEVAL NCOMPASS 1.7FR 1CM BASKET 115CM URINARY TRACT 4/16-WIRE TIPLESS REMOVABLE UNIDEX HANDLE NITINOL STERILE SINGLE-USE SUP-G46027 CDM 0270 RC outpatient 827.81 827.81 827.81 74 612.58 percent of total billed charges 827.81 93 670.53 percent of total billed charges 827.81 827.81 other OPPS APC 827.81 827.81 other OPPS APC 827.81 27.63 228.72 percent of total billed charges 827.81 827.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JOINT FINGER SWANSON 3 MCP FLEXIBLE GROMMET STERILE SUP-G4700003 CDM 0270 RC outpatient 4035.2 4035.2 4035.2 74 2986.05 percent of total billed charges 4035.2 93 3268.51 percent of total billed charges 4035.2 4035.2 other OPPS APC 4035.2 4035.2 other OPPS APC 4035.2 27.63 1114.93 percent of total billed charges 4035.2 4035.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JOINT FINGER SWANSON 4 MCP FLEXIBLE GROMMET STERILE SUP-G4700004 CDM 0270 RC outpatient 4035.2 4035.2 4035.2 74 2986.05 percent of total billed charges 4035.2 93 3268.51 percent of total billed charges 4035.2 4035.2 other OPPS APC 4035.2 4035.2 other OPPS APC 4035.2 27.63 1114.93 percent of total billed charges 4035.2 4035.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JOINT FINGER SWANSON 5 MCP FLEXIBLE GROMMET STERILE SUP-G4700005 CDM 0270 RC outpatient 4035.2 4035.2 4035.2 74 2986.05 percent of total billed charges 4035.2 93 3268.51 percent of total billed charges 4035.2 4035.2 other OPPS APC 4035.2 4035.2 other OPPS APC 4035.2 27.63 1114.93 percent of total billed charges 4035.2 4035.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCOIL EMBOLIZATION NESTER 12MM 14CM PUSHABLE 3.7-LOOP SYNTHETIC FIBER PLATINUM MRI-CONDITIONAL RADIOPAQUE 0.035IN CATH SUP-G47346 CDM 0270 RC outpatient 337.97 337.97 337.97 74 250.1 percent of total billed charges 337.97 93 273.76 percent of total billed charges 337.97 337.97 other OPPS APC 337.97 337.97 other OPPS APC 337.97 27.63 93.38 percent of total billed charges 337.97 337.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCOIL EMBOLIZATION NESTER 16MM 7CM PUSHABLE 1.4-LOOP SYNTHETIC FIBER PLATINUM MRI-CONDITIONAL RADIOPAQUE 0.035IN CATH SUP-G47348 CDM 0270 RC outpatient 337.97 337.97 337.97 74 250.1 percent of total billed charges 337.97 93 273.76 percent of total billed charges 337.97 337.97 other OPPS APC 337.97 337.97 other OPPS APC 337.97 27.63 93.38 percent of total billed charges 337.97 337.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCOIL EMBOLIZATION NESTER 20MM 20CM PUSHABLE 3.2-LOOP SYNTHETIC FIBER PLATINUM MRI-CONDITIONAL RADIOPAQUE 0.035IN CATH SUP-G47361 CDM 0270 RC outpatient 408.17 408.17 408.17 74 302.05 percent of total billed charges 408.17 93 330.62 percent of total billed charges 408.17 408.17 other OPPS APC 408.17 408.17 other OPPS APC 408.17 27.63 112.78 percent of total billed charges 408.17 408.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCOIL EMBOLIZATION NESTER 10MM 7CM PUSHABLE 2.2-LOOP SYNTHETIC FIBER PLATINUM MRI-CONDITIONAL RADIOPAQUE 0.035IN CATH SUP-G47365 CDM 0270 RC outpatient 309.37 309.37 309.37 74 228.93 percent of total billed charges 309.37 93 250.59 percent of total billed charges 309.37 309.37 other OPPS APC 309.37 309.37 other OPPS APC 309.37 27.63 85.48 percent of total billed charges 309.37 309.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCOIL EMBOLIZATION NESTER 3MM 7CM PUSHABLE 7.4-LOOP SYNTHETIC FIBER PLATINUM MRI-CONDITIONAL RADIOPAQUE 0.035IN CATH SUP-G47371 CDM 0270 RC outpatient 309.37 309.37 309.37 74 228.93 percent of total billed charges 309.37 93 250.59 percent of total billed charges 309.37 309.37 other OPPS APC 309.37 309.37 other OPPS APC 309.37 27.63 85.48 percent of total billed charges 309.37 309.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCOIL EMBOLIZATION NESTER 4MM 7CM PUSHABLE 5.6-LOOP SYNTHETIC FIBER PLATINUM MRI-CONDITIONAL RADIOPAQUE 0.035IN CATH SUP-G47372 CDM 0270 RC outpatient 309.37 309.37 309.37 74 228.93 percent of total billed charges 309.37 93 250.59 percent of total billed charges 309.37 309.37 other OPPS APC 309.37 309.37 other OPPS APC 309.37 27.63 85.48 percent of total billed charges 309.37 309.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCOIL EMBOLIZATION NESTER 6MM 7CM PUSHABLE 3.7-LOOP SYNTHETIC FIBER PLATINUM MRI-CONDITIONAL RADIOPAQUE 0.035IN CATH SUP-G47374 CDM 0270 RC outpatient 309.37 309.37 309.37 74 228.93 percent of total billed charges 309.37 93 250.59 percent of total billed charges 309.37 309.37 other OPPS APC 309.37 309.37 other OPPS APC 309.37 27.63 85.48 percent of total billed charges 309.37 309.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCOIL EMBOLIZATION NESTER 8MM 7CM PUSHABLE 2.8-LOOP SYNTHETIC FIBER PLATINUM MRI-CONDITIONAL RADIOPAQUE 0.035IN CATH SUP-G47375 CDM 0270 RC outpatient 309.37 309.37 309.37 74 228.93 percent of total billed charges 309.37 93 250.59 percent of total billed charges 309.37 309.37 other OPPS APC 309.37 309.37 other OPPS APC 309.37 27.63 85.48 percent of total billed charges 309.37 309.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ENDOSCOPIC ACROBAT 2 HYDROPHILIC L5.8 CM STRAIGHT L450 CM L4 CM OD.035 IN RADIOPAQUE CALIBRATED TIP SUP-G47616 CDM 0270 RC outpatient 590.2 590.2 590.2 74 436.75 percent of total billed charges 590.2 93 478.06 percent of total billed charges 590.2 590.2 other OPPS APC 590.2 590.2 other OPPS APC 590.2 27.63 163.07 percent of total billed charges 590.2 590.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION MREYE PLATINUM .035 IN L3 CM OD2 MM 4.8 LOOP STERILE SUP-G47900 CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4F MICROPUNCTURE INTRODUCER SET 10CM SUP-G47940 CDM 0481 RC outpatient 70.8 70.8 70.8 74 52.39 percent of total billed charges 70.8 93 57.35 percent of total billed charges 70.8 70.8 other OPPS APC 70.8 70.8 other OPPS APC 70.8 51 36.11 percent of total billed charges 70.8 70.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4F MICROPUNTURE SHEATH 7CM SUP-G47945 CDM 0270 RC outpatient 71.99 71.99 71.99 74 53.27 percent of total billed charges 71.99 93 58.31 percent of total billed charges 71.99 71.99 other OPPS APC 71.99 71.99 other OPPS APC 71.99 27.63 19.89 percent of total billed charges 71.99 71.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET ACCESS MICROPUNCTURE STAINLESS STEEL PLATINUM .018 IN L40 CM L10 CM L7 CM OD4 FR ODSEC21 GA GUIDEWIRE PART NEEDLE TRANSITIONLESS TIP COAXIAL CATHETER STERILE DISPOSABLE SUP-G47950 CDM 0270 RC outpatient 72.64 72.64 72.64 74 53.75 percent of total billed charges 72.64 93 58.84 percent of total billed charges 72.64 72.64 other OPPS APC 72.64 72.64 other OPPS APC 72.64 27.63 20.07 percent of total billed charges 72.64 72.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER MICRO STIFFEN 4FR SUP-G48004 CDM 0270 RC outpatient 133.12 133.12 133.12 74 98.51 percent of total billed charges 133.12 93 107.83 percent of total billed charges 133.12 133.12 other OPPS APC 133.12 133.12 other OPPS APC 133.12 27.63 36.78 percent of total billed charges 133.12 133.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER MICRO STIFFEN 5FR SUP-G48008 CDM 0270 RC outpatient 133.12 133.12 133.12 74 98.51 percent of total billed charges 133.12 93 107.83 percent of total billed charges 133.12 133.12 other OPPS APC 133.12 133.12 other OPPS APC 133.12 27.63 36.78 percent of total billed charges 133.12 133.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH GUIDING CHECK-FLO FLEXOR HYDROPHILIC .018/.035 IN ANL0 CURVE L90 CM OD4 FR ID.059 IN RADIOPAQUE BAND HEMOSTASIS VALVE SHORT DILATOR TIP GUIDING SHEATH ANSEL MODIFICATION STERILE DISPOSABLE SUP-G48188 CDM 0270 RC outpatient 276.38 276.38 276.38 74 204.52 percent of total billed charges 276.38 93 223.87 percent of total billed charges 276.38 276.38 other OPPS APC 276.38 276.38 other OPPS APC 276.38 27.63 76.36 percent of total billed charges 276.38 276.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH GUIDING CHECK-FLO HYDROPHILIC ANL0 CURVE STRAIGHT L90 CM OD5 FR ID.074 IN CHECK-FLO VALVE GUIDING SHEATH STIFF SHAFT SOFT TIP RADIOPAQUE BAND .018/.035 IN GUIDEWIRE SUP-G48189 CDM 0270 RC outpatient 283.35 283.35 283.35 74 209.68 percent of total billed charges 283.35 93 229.51 percent of total billed charges 283.35 283.35 other OPPS APC 283.35 283.35 other OPPS APC 283.35 27.63 78.29 percent of total billed charges 283.35 283.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH GUIDING FLEXOR AQ ANL0 CURVE L110 CM OD4 FR ID.059 IN RADIOPAQUE BAND KINK RESISTANT LOW FRICTION CHECK-FLO VALVE STERILE DISPOSABLE ACCEPTS .035/.018 IN GUIDEWIRE SUP-G48191 CDM 0270 RC outpatient 283.35 283.35 283.35 74 209.68 percent of total billed charges 283.35 93 229.51 percent of total billed charges 283.35 283.35 other OPPS APC 283.35 283.35 other OPPS APC 283.35 27.63 78.29 percent of total billed charges 283.35 283.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTRACTOR STONE NGAGE NITINOL L115 CM OD1.7 FR ODSEC11 MM KIDNEY URETER SUP-G48295 CDM 0270 RC outpatient 777.24 777.24 777.24 74 575.16 percent of total billed charges 777.24 93 629.56 percent of total billed charges 777.24 777.24 other OPPS APC 777.24 777.24 other OPPS APC 777.24 27.63 214.75 percent of total billed charges 777.24 777.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX Z-TRAK BIFURCATED 82MM 24MM 7.1MM 18FR POLYESTER SS SELF EXPANDING ANCILLARY WOVEN LEG SUP-G48407 CDM 270010015 LOCAL 0270 RC outpatient 18980 18980 18980 74 14045.2 percent of total billed charges 18980 93 15373.8 percent of total billed charges 18980 18980 other OPPS APC 18980 18980 other OPPS APC 18980 27.63 5244.17 percent of total billed charges 18980 18980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH SPIRAL-Z Z-TRAK 2 BRANCH 56MM 13MM 5.4MM 14FR NITINOL SS POLYESTER STERILE ILIAC LEG TRANSCEND SUP-G48410 CDM 270010015 LOCAL 0270 RC outpatient 22651.2 22651.2 22651.2 74 16761.9 percent of total billed charges 22651.2 93 18347.5 percent of total billed charges 22651.2 22651.2 other OPPS APC 22651.2 22651.2 other OPPS APC 22651.2 27.63 6258.53 percent of total billed charges 22651.2 22651.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR BIFURCATED MAIN BODY ZENITH AAA TFFB-26-82-ZT SUP-G48412 CDM 270010015 LOCAL 0270 RC outpatient 18980 18980 18980 74 14045.2 percent of total billed charges 18980 93 15373.8 percent of total billed charges 18980 18980 other OPPS APC 18980 18980 other OPPS APC 18980 27.63 5244.17 percent of total billed charges 18980 18980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX 2 BRANCH L96 MM OD26 MM ODSEC7.1 MM ID18 FR ABDOMINAL AORTIC ANEURYSM Z-TRAK INTRODUCTION SYSTEM ANCILLARY COMPONENT SUP-G48413 CDM 270010015 LOCAL 0270 RC outpatient 18980 18980 18980 74 14045.2 percent of total billed charges 18980 93 15373.8 percent of total billed charges 18980 18980 other OPPS APC 18980 18980 other OPPS APC 18980 27.63 5244.17 percent of total billed charges 18980 18980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX Z-TRAK POLYESTER STAINLESS STEEL BIFURCATED L111 MM OD26 MM ODSEC7.1 MM ID18 FR ABDOMINAL AORTIC ANEURYSM SELF EXPANDING ANCILLARY WOVEN LEG EXTENSION INTRODUCTION SYSTEM AAA SUP-G48414 CDM 270010015 LOCAL 0270 RC outpatient 18980 18980 18980 74 14045.2 percent of total billed charges 18980 93 15373.8 percent of total billed charges 18980 18980 other OPPS APC 18980 18980 other OPPS APC 18980 27.63 5244.17 percent of total billed charges 18980 18980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX Z-TRAK 2 BRANCH 82MM 28MM 7.7MM 20FR SS POLYESTER SELF EXPAND ANCILLARY WOVEN SUP-G48417 CDM 270010015 LOCAL 0270 RC outpatient 18980 18980 18980 74 14045.2 percent of total billed charges 18980 93 15373.8 percent of total billed charges 18980 18980 other OPPS APC 18980 18980 other OPPS APC 18980 27.63 5244.17 percent of total billed charges 18980 18980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX Z-TRAK 2 BRANCH 96MM 28MM 7.7MM 20FR SS POLYESTER SELF EXPAND ANCILLARY WOVEN SUP-G48418 CDM 270010015 LOCAL 0270 RC outpatient 18980 18980 18980 74 14045.2 percent of total billed charges 18980 93 15373.8 percent of total billed charges 18980 18980 other OPPS APC 18980 18980 other OPPS APC 18980 27.63 5244.17 percent of total billed charges 18980 18980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX Z-TRAK 2 BRANCH 111MM 28MM 7.7MM 20FR SS POLYESTER SELF EXPAND ANCILLARY WOVEN SUP-G48419 CDM 270010015 LOCAL 0270 RC outpatient 18980 18980 18980 74 14045.2 percent of total billed charges 18980 93 15373.8 percent of total billed charges 18980 18980 other OPPS APC 18980 18980 other OPPS APC 18980 27.63 5244.17 percent of total billed charges 18980 18980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX Z-TRAK POLYESTER STAINLESS STEEL BIFURCATED L96 MM OD30 MM ODSEC7.7 MM ID20 FR ABDOMINAL AORTIC ANEURYSM SELF EXPANDING ANCILLARY WOVEN LEG EXTENSION INTRODUCTION SYSTEM SUP-G48423 CDM 270010015 LOCAL 0270 RC outpatient 18980 18980 18980 74 14045.2 percent of total billed charges 18980 93 15373.8 percent of total billed charges 18980 18980 other OPPS APC 18980 18980 other OPPS APC 18980 27.63 5244.17 percent of total billed charges 18980 18980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX 2 BRANCH L96 MM OD32 MM ODSEC7.7 MM ID20 FR ABDOMINAL AORTIC ANEURYSM Z-TRAK INTRODUCTION SYSTEM ANCILLARY COMPONENT SUP-G48428 CDM 270010015 LOCAL 0270 RC outpatient 18980 18980 18980 74 14045.2 percent of total billed charges 18980 93 15373.8 percent of total billed charges 18980 18980 other OPPS APC 18980 18980 other OPPS APC 18980 27.63 5244.17 percent of total billed charges 18980 18980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX Z-TRAK POLYESTER STAINLESS STEEL WOVEN 2 BRANCH L111 MM OD32 MM ODSEC20 FR SELF EXPANDABLE ANCILLARY EG EXTENSION INTRODUCTION SYSTEM AAA SUP-G48429 CDM 270010015 LOCAL 0270 RC outpatient 18980 18980 18980 74 14045.2 percent of total billed charges 18980 93 15373.8 percent of total billed charges 18980 18980 other OPPS APC 18980 18980 other OPPS APC 18980 27.63 5244.17 percent of total billed charges 18980 18980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX Z-TRAK POLYESTER STAINLESS STEEL 2 BRANCH L95 MM OD36 MM ODSEC8.5 MM ID22 FR ABDOMINAL AORTIC ANEURYSM SELF EXPANDING MAIN BODY INTRODUCTION SYSTEM TRIGGER WIRE RELEASE RADIOPAQUE BAND STERILE SUP-G48432 CDM 270010015 LOCAL 0270 RC outpatient 18980 18980 18980 74 14045.2 percent of total billed charges 18980 93 15373.8 percent of total billed charges 18980 18980 other OPPS APC 18980 18980 other OPPS APC 18980 27.63 5244.17 percent of total billed charges 18980 18980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVACULAR ZENITH FLEX Z TRAK BIFURCATED MAIN BODY TFFB-36-131ZT SUP-G48434 CDM 270010015 LOCAL 0270 RC outpatient 18980 18980 18980 74 14045.2 percent of total billed charges 18980 93 15373.8 percent of total billed charges 18980 18980 other OPPS APC 18980 18980 other OPPS APC 18980 27.63 5244.17 percent of total billed charges 18980 18980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH GUIDING FLEXOR CHECK-FLO MULTIPURPOSE CURVE 55CM 7FR 2.5MM HIGH FLEX DILATOR ACCEPTS .035IN GUIDEWIRE SUP-G49043 CDM 0270 RC outpatient 169.47 169.47 169.47 74 125.41 percent of total billed charges 169.47 93 137.27 percent of total billed charges 169.47 169.47 other OPPS APC 169.47 169.47 other OPPS APC 169.47 27.63 46.82 percent of total billed charges 169.47 169.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING CXI 90CM 2.6FR SS HYDROPHILIC POLYMER DISPOSABLE STERILE LOW PROFILE ANGLE TIP BRAID RADIOPAQUE ACCEPTS SUP-G50002 CDM 0270 RC outpatient 528.92 528.92 528.92 74 391.4 percent of total billed charges 528.92 93 428.43 percent of total billed charges 528.92 528.92 other OPPS APC 528.92 528.92 other OPPS APC 528.92 27.63 146.14 percent of total billed charges 528.92 528.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SUPPORT CXI 150CM 2.6FR SS POLYMER HYDROPHILIC DISPOSABLE STERILE LOW PROFILE ANGLE TIP BRAID RADIOPAQUE SUP-G50003 CDM 0270 RC outpatient 571.97 571.97 571.97 74 423.26 percent of total billed charges 571.97 93 463.3 percent of total billed charges 571.97 571.97 other OPPS APC 571.97 571.97 other OPPS APC 571.97 27.63 158.04 percent of total billed charges 571.97 571.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING CXI 90CM 2.6FR SS POLYMER HYDROPHILIC DISPOSABLE STERILE LOW PROFILE STRAIGHT TIP BRAID RADIOPAQUE SUP-G50004 CDM 0270 RC outpatient 489.89 489.89 489.89 74 362.52 percent of total billed charges 489.89 93 396.81 percent of total billed charges 489.89 489.89 other OPPS APC 489.89 489.89 other OPPS APC 489.89 27.63 135.36 percent of total billed charges 489.89 489.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER BIOHAZARD RED 37X50 3.0 MIL SUP-G5000XR CDM 0270 RC outpatient 1.4 1.4 1.4 74 1.04 percent of total billed charges 1.4 93 1.13 percent of total billed charges 1.4 1.4 other OPPS APC 1.4 1.4 other OPPS APC 1.4 27.63 0.39 percent of total billed charges 1.4 1.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR APPROACH STAINLESS STEEL TAPER L300 CM OD.014 IN 12 GM TIP LOAD SUP-G50791 CDM 0270 RC outpatient 417.3 417.3 417.3 74 308.8 percent of total billed charges 417.3 93 338.01 percent of total billed charges 417.3 417.3 other OPPS APC 417.3 417.3 other OPPS APC 417.3 27.63 115.3 percent of total billed charges 417.3 417.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGE BEACON NYLON C2 CURVE LOW PROFILE TAPER L65 CM OD4 FR HUB TO TIP OPTIMAL STEERABILITY ACCEPTS .035 IN GUIDEWIRE SUP-G51313 CDM 0270 RC outpatient 39.36 39.36 39.36 74 29.13 percent of total billed charges 39.36 93 31.88 percent of total billed charges 39.36 39.36 other OPPS APC 39.36 39.36 other OPPS APC 39.36 27.63 10.88 percent of total billed charges 39.36 39.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGE BEACON TIP NYLON .035 IN RIM CURVE L65 CM OD4 FR LOW PROFILE HUB TO TIP TAPERED TIP OPTIMAL STEERABILITY SUP-G51315 CDM 0270 RC outpatient 39.36 39.36 39.36 74 29.13 percent of total billed charges 39.36 93 31.88 percent of total billed charges 39.36 39.36 other OPPS APC 39.36 39.36 other OPPS APC 39.36 27.63 10.88 percent of total billed charges 39.36 39.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SUPPORT CROSSCATH .035 IN L135 CM OD4.8-3.7 FR SUP-G51581 CDM 0270 RC outpatient 395.17 395.17 395.17 74 292.43 percent of total billed charges 395.17 93 320.09 percent of total billed charges 395.17 395.17 other OPPS APC 395.17 395.17 other OPPS APC 395.17 27.63 109.19 percent of total billed charges 395.17 395.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING CXI SUPPORT 4FR 135CM STRAIGHT NSP PERIPHERAL BRAIDED COAXIAL STAINLESS STEEL HYDROPHILIC TUNGSTEN MARKER RADIOPAQUE MARKER 0.035IN GW SUP-G52542 CDM 0270 RC outpatient 545.97 545.97 545.97 74 404.02 percent of total billed charges 545.97 93 442.24 percent of total billed charges 545.97 545.97 other OPPS APC 545.97 545.97 other OPPS APC 545.97 27.63 150.85 percent of total billed charges 545.97 545.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET DILATOR HYDROPHILIC .035 IN L45 CM OD14 FR ENDOVASCULAR LONG TAPERED SUP-G52833 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET DILATOR HYDROPHILIC LONG TAPER L45 CM OD16 FR ODSEC18 FR ENDOVASCULAR ACCEPTS .035 IN GUIDEWIRE SUP-G52834 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET DILATOR ZENITH HYDROPHILIC LONG TAPER L45 CM OD20 FR ODSEC22 FR ENDOVASCULAR OTW ACCEPTS .035 IN GUIDEWIRE SUP-G52835 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET DILATOR HYDROPHILIC LONG TAPER L45 CM OD24 FR ODSEC26 FR ENDOVASCULAR TRACKABLE ACCEPTS .035 IN GUIDEWIRE SUP-G52836 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH TX2 L77 MM OD38 MM ODSEC22 FR THORACIC AORTIC ANEURYSM PROXIMAL EXTENSION PROFORM Z TRAK PLUS INTRODUCTION SYSTEM SUP-G53459 CDM 270010015 LOCAL 0270 RC outpatient 14339 14339 14339 74 10610.9 percent of total billed charges 14339 93 11614.6 percent of total billed charges 14339 14339 other OPPS APC 14339 14339 other OPPS APC 14339 27.63 3961.87 percent of total billed charges 14339 14339 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY ECHOTIP PROCORE 8- CM 19GA 4.8FR DISPOSABLE STERILE HIGH DEFINITION ULTRASOUND RECESSED BALL TIP SHEATH 2 SUP-G53585 CDM 0270 RC outpatient 949 949 949 74 702.26 percent of total billed charges 949 93 768.69 percent of total billed charges 949 949 other OPPS APC 949 949 other OPPS APC 949 27.63 262.21 percent of total billed charges 949 949 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGE BEACON TIP NYLON SIM1 CURVE L65 CM OD4 FR LOW PROFILE OPTIMAL STEERABILITY RADIOPAQUE ACCEPTS .035 IN GUIDEWIRE SUP-G53763 CDM 0270 RC outpatient 39.36 39.36 39.36 74 29.13 percent of total billed charges 39.36 93 31.88 percent of total billed charges 39.36 39.36 other OPPS APC 39.36 39.36 other OPPS APC 39.36 27.63 10.88 percent of total billed charges 39.36 39.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX OD7.7 MM L80 MM OD28 MM ODSEC12 MM ID20 FR CONVERTER ANCILLARY COMPONENT INTRODUCER SHEATH Z-TRAK AAA SUP-G55192 CDM 270010015 LOCAL 0270 RC outpatient 6632.6 6632.6 6632.6 74 4908.12 percent of total billed charges 6632.6 93 5372.41 percent of total billed charges 6632.6 6632.6 other OPPS APC 6632.6 6632.6 other OPPS APC 6632.6 27.63 1832.59 percent of total billed charges 6632.6 6632.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX OD7.7 MM L80 MM OD32 MM ODSEC12 MM ID20 FR CONVERTER ANCILLARY COMPONENT INTRODUCER SHEATH Z-TRAK AAA SUP-G55193 CDM 270010015 LOCAL 0270 RC outpatient 6632.6 6632.6 6632.6 74 4908.12 percent of total billed charges 6632.6 93 5372.41 percent of total billed charges 6632.6 6632.6 other OPPS APC 6632.6 6632.6 other OPPS APC 6632.6 27.63 1832.59 percent of total billed charges 6632.6 6632.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX OD7.7 MM L82 MM OD36 MM ODSEC12 MM ID20 FR CONVERTER ANCILLARY COMPONENT INTRODUCER SHEATH Z-TRAK AAA SUP-G55194 CDM 270010015 LOCAL 0270 RC outpatient 6632.6 6632.6 6632.6 74 4908.12 percent of total billed charges 6632.6 93 5372.41 percent of total billed charges 6632.6 6632.6 other OPPS APC 6632.6 6632.6 other OPPS APC 6632.6 27.63 1832.59 percent of total billed charges 6632.6 6632.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX 50MM 36MM Z-TRAK MAIN BODY EXTENSION AAA SUP-G55210 CDM 270010015 LOCAL 0270 RC outpatient 5353.4 5353.4 5353.4 74 3961.52 percent of total billed charges 5353.4 93 4336.25 percent of total billed charges 5353.4 5353.4 other OPPS APC 5353.4 5353.4 other OPPS APC 5353.4 27.63 1479.14 percent of total billed charges 5353.4 5353.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX 58MM 28MM Z-TRAK MAIN BODY EXTENSION AAA SUP-G55214 CDM 270010015 LOCAL 0270 RC outpatient 5353.4 5353.4 5353.4 74 3961.52 percent of total billed charges 5353.4 93 4336.25 percent of total billed charges 5353.4 5353.4 other OPPS APC 5353.4 5353.4 other OPPS APC 5353.4 27.63 1479.14 percent of total billed charges 5353.4 5353.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX 58MM 32MM Z-TRAK MAIN BODY EXTENSION AAA SUP-G55216 CDM 270010015 LOCAL 0270 RC outpatient 5353.4 5353.4 5353.4 74 3961.52 percent of total billed charges 5353.4 93 4336.25 percent of total billed charges 5353.4 5353.4 other OPPS APC 5353.4 5353.4 other OPPS APC 5353.4 27.63 1479.14 percent of total billed charges 5353.4 5353.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH SPIRAL-Z NITINOL L74 MM OD9 MM ODSEC5.4 MM ID4.7 MM ABDOMINAL AORTIC ANEURYSM ILIAC LEG TRANSCEND PRECISION FLEXIBILITY KINK RESISTANT DELIVERABILITY SUP-G55220 CDM 270010015 LOCAL 0270 RC outpatient 8738.6 8738.6 8738.6 74 6466.56 percent of total billed charges 8738.6 93 7078.27 percent of total billed charges 8738.6 8738.6 other OPPS APC 8738.6 8738.6 other OPPS APC 8738.6 27.63 2414.48 percent of total billed charges 8738.6 8738.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH SPIRAL-Z NITINOL L74 MM OD11 MM ODSEC5.4 MM ID4.7 MM ABDOMINAL AORTIC ANEURYSM ILIAC LEG TRANSCEND PRECISION FLEXIBILITY SUP-G55226 CDM 270010015 LOCAL 0270 RC outpatient 8738.6 8738.6 8738.6 74 6466.56 percent of total billed charges 8738.6 93 7078.27 percent of total billed charges 8738.6 8738.6 other OPPS APC 8738.6 8738.6 other OPPS APC 8738.6 27.63 2414.48 percent of total billed charges 8738.6 8738.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH SPIRAL-Z Z-TRAK POLYESTER STAINLESS STEEL NITINOL BIFURCATED L90 MM OD11 MM ID14 FR ABDOMEN AORTA AORTOILIAC SELF EXPANDING WOVEN LEG EXTENSION INTRODUCTION SYSTEM AAA SUP-G55227 CDM 270010015 LOCAL 0270 RC outpatient 8738.6 8738.6 8738.6 74 6466.56 percent of total billed charges 8738.6 93 7078.27 percent of total billed charges 8738.6 8738.6 other OPPS APC 8738.6 8738.6 other OPPS APC 8738.6 27.63 2414.48 percent of total billed charges 8738.6 8738.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH SPIRAL-Z Z-TRAK 2 BRANCH 56MM 13MM 5.4MM 14FR NITINOL SS POLYESTER STERILE ILIAC LEG TRANSCEND SUP-G55231 CDM 270010015 LOCAL 0270 RC outpatient 8738.6 8738.6 8738.6 74 6466.56 percent of total billed charges 8738.6 93 7078.27 percent of total billed charges 8738.6 8738.6 other OPPS APC 8738.6 8738.6 other OPPS APC 8738.6 27.63 2414.48 percent of total billed charges 8738.6 8738.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH SPIRAL-Z Z-TRAK 2 BRANCH 74MM 13MM 5.4MM 14FR NITINOL SS POLYESTER STERILE ILIAC LEG TRANSCEND SUP-G55232 CDM 270010015 LOCAL 0270 RC outpatient 8738.6 8738.6 8738.6 74 6466.56 percent of total billed charges 8738.6 93 7078.27 percent of total billed charges 8738.6 8738.6 other OPPS APC 8738.6 8738.6 other OPPS APC 8738.6 27.63 2414.48 percent of total billed charges 8738.6 8738.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH SPIRAL-Z POLYESTER STAINLESS STEEL NITINOL BIFURCATED L90 MM OD13 MM ODSEC5.4 MM ID14 FR ABDOMINAL AORTIC ANEURYSM ANCILLARY CONTRALATERAL/IPSILATERAL ILIAC LEG AAA SUP-G55233 CDM 270010015 LOCAL 0270 RC outpatient 8738.6 8738.6 8738.6 74 6466.56 percent of total billed charges 8738.6 93 7078.27 percent of total billed charges 8738.6 8738.6 other OPPS APC 8738.6 8738.6 other OPPS APC 8738.6 27.63 2414.48 percent of total billed charges 8738.6 8738.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCUALAR AAA VASCULAR ILIAC LEG ZSLE-13-107-ZT SUP-G55234 CDM 270010015 LOCAL 0270 RC outpatient 8738.6 8738.6 8738.6 74 6466.56 percent of total billed charges 8738.6 93 7078.27 percent of total billed charges 8738.6 8738.6 other OPPS APC 8738.6 8738.6 other OPPS APC 8738.6 27.63 2414.48 percent of total billed charges 8738.6 8738.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR AAA ZENITH # ZSLE-13-122-ZT SUP-G55235 CDM 270010015 LOCAL 0270 RC outpatient 8738.6 8738.6 8738.6 74 6466.56 percent of total billed charges 8738.6 93 7078.27 percent of total billed charges 8738.6 8738.6 other OPPS APC 8738.6 8738.6 other OPPS APC 8738.6 27.63 2414.48 percent of total billed charges 8738.6 8738.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR SPIRAL-Z ZENITH L122 MM OD13 MM ODSEC5.4 MM ID14 FR ABDOMINAL AORTIC ANEURYSM ILIUM STERILE SUP-G55235 CDM 270010015 LOCAL 0270 RC outpatient 8738.6 8738.6 8738.6 74 6466.56 percent of total billed charges 8738.6 93 7078.27 percent of total billed charges 8738.6 8738.6 other OPPS APC 8738.6 8738.6 other OPPS APC 8738.6 27.63 2414.48 percent of total billed charges 8738.6 8738.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH SPIRAL-Z POLYESTER STAINLESS STEEL NITINOL BIFURCATED L56 MM OD16 MM ODSEC5.4 MM ID14 FR ABDOMINAL AORTIC ANEURYSM ANCILLARY CONTRALATERAL/IPSILATERAL ILIAC LEG AAA SUP-G55237 CDM 270010015 LOCAL 0270 RC outpatient 8738.6 8738.6 8738.6 74 6466.56 percent of total billed charges 8738.6 93 7078.27 percent of total billed charges 8738.6 8738.6 other OPPS APC 8738.6 8738.6 other OPPS APC 8738.6 27.63 2414.48 percent of total billed charges 8738.6 8738.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH SPIRAL-Z Z-TRAK 2 BRANCH 74MM 16MM 5.4MM 14FR NITINOL SS POLYESTER STERILE ILIAC LEG TRANSCEND SUP-G55238 CDM 270010015 LOCAL 0270 RC outpatient 8738.6 8738.6 8738.6 74 6466.56 percent of total billed charges 8738.6 93 7078.27 percent of total billed charges 8738.6 8738.6 other OPPS APC 8738.6 8738.6 other OPPS APC 8738.6 27.63 2414.48 percent of total billed charges 8738.6 8738.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH SPIRAL-Z Z-TRAK 2 BRANCH 90MM 16MM 5.4MM 14FR NITINOL SS POLYESTER STERILE ILIAC LEG TRANSCEND SUP-G55239 CDM 270010015 LOCAL 0270 RC outpatient 8738.6 8738.6 8738.6 74 6466.56 percent of total billed charges 8738.6 93 7078.27 percent of total billed charges 8738.6 8738.6 other OPPS APC 8738.6 8738.6 other OPPS APC 8738.6 27.63 2414.48 percent of total billed charges 8738.6 8738.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH SPIRAL-Z 2 BRANCH 56MM 20MM 6MM 16FR NITINOL SS POLYESTER ILIAC LEG TRANSCEND PRECISION KINK SUP-G55241 CDM 270010015 LOCAL 0270 RC outpatient 8738.6 8738.6 8738.6 74 6466.56 percent of total billed charges 8738.6 93 7078.27 percent of total billed charges 8738.6 8738.6 other OPPS APC 8738.6 8738.6 other OPPS APC 8738.6 27.63 2414.48 percent of total billed charges 8738.6 8738.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH SPIRAL-Z 2 BRANCH 74MM 20MM 6MM 16FR NITINOL SS POLYESTER ILIAC LEG TRANSCEND PRECISION KINK SUP-G55242 CDM 270010015 LOCAL 0270 RC outpatient 8738.6 8738.6 8738.6 74 6466.56 percent of total billed charges 8738.6 93 7078.27 percent of total billed charges 8738.6 8738.6 other OPPS APC 8738.6 8738.6 other OPPS APC 8738.6 27.63 2414.48 percent of total billed charges 8738.6 8738.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR SPIRAL-Z ZENITH Z-TRAK POLYESTER STAINLESS STEEL NITINOL 2 BRANCH L90 MM OD20 MM ID16 FR ABDOMINAL AORTIC ANEURYSM SELF EXPANDING LEG EXTENSION INTRODUCTION SYSTEM SUP-G55243 CDM 270010015 LOCAL 0270 RC outpatient 8738.6 8738.6 8738.6 74 6466.56 percent of total billed charges 8738.6 93 7078.27 percent of total billed charges 8738.6 8738.6 other OPPS APC 8738.6 8738.6 other OPPS APC 8738.6 27.63 2414.48 percent of total billed charges 8738.6 8738.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH SPIRAL-Z AQ L56 MM L71 CM OD24 MM ODSEC6 MM ID5.3 MM ABDOMINAL AORTIC ANEURYSM ILIAC LEG CAPTOR HEMOSTATIC VALVE FLEXOR INTRODUCER SHEATH RADIOPAQUE BAND PRECISION DESIGN SUP-G55245 CDM 270010015 LOCAL 0270 RC outpatient 8738.6 8738.6 8738.6 74 6466.56 percent of total billed charges 8738.6 93 7078.27 percent of total billed charges 8738.6 8738.6 other OPPS APC 8738.6 8738.6 other OPPS APC 8738.6 27.63 2414.48 percent of total billed charges 8738.6 8738.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH SPIRAL-Z Z-TRAK POLYESTER STAINLESS STEEL NITINOL BIFURCATED L74 MM OD24 MM ID16 FR ABDOMEN AORTA AORTOILIAC SELF EXPANDING WOVEN LEG EXTENSION INTRODUCTION SYSTEM AAA SUP-G55246 CDM 270010015 LOCAL 0270 RC outpatient 8738.6 8738.6 8738.6 74 6466.56 percent of total billed charges 8738.6 93 7078.27 percent of total billed charges 8738.6 8738.6 other OPPS APC 8738.6 8738.6 other OPPS APC 8738.6 27.63 2414.48 percent of total billed charges 8738.6 8738.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH SPIRAL-Z POLYESTER STAINLESS STEEL NITINOL L90 MM OD24 MM ODSEC6 MM ID16 FR ABDOMINAL AORTIC ANEURYSM ANCILLARY CONTRALATERAL/IPSILATERAL ILIAC LEG SUP-G55247 CDM 270010015 LOCAL 0270 RC outpatient 8738.6 8738.6 8738.6 74 6466.56 percent of total billed charges 8738.6 93 7078.27 percent of total billed charges 8738.6 8738.6 other OPPS APC 8738.6 8738.6 other OPPS APC 8738.6 27.63 2414.48 percent of total billed charges 8738.6 8738.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR RENU ZENITH L108 MM OD24 MM ABDOMINAL AORTIC ANEURYSM ANCILLARY CONVERTER SUP-G55361 CDM 270010015 LOCAL 0270 RC outpatient 17966 17966 17966 74 13294.8 percent of total billed charges 17966 93 14552.5 percent of total billed charges 17966 17966 other OPPS APC 17966 17966 other OPPS APC 17966 27.63 4964.01 percent of total billed charges 17966 17966 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR RENU ZENITH L108 MM OD28 MM ABDOMINAL AORTIC ANEURYSM ANCILLARY CONVERTER SUP-G55374 CDM 270010015 LOCAL 0270 RC outpatient 17966 17966 17966 74 13294.8 percent of total billed charges 17966 93 14552.5 percent of total billed charges 17966 17966 other OPPS APC 17966 17966 other OPPS APC 17966 27.63 4964.01 percent of total billed charges 17966 17966 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH RENU H&L-B ONE-SHOT POLYESTER STAINLESS STEEL BIFURCATED L108 MM L71-37 MM OD28-12 MM ID20 FR ABDOMINAL AORTIC ANEURYSM CONVERTER H&L-B ONE-SHOT INTRODUCTION SYSTEM ANCILLARY AAA SUP-G55374 CDM 270010015 LOCAL 0270 RC outpatient 16936.4 16936.4 16936.4 74 12532.9 percent of total billed charges 16936.4 93 13718.5 percent of total billed charges 16936.4 16936.4 other OPPS APC 16936.4 16936.4 other OPPS APC 16936.4 27.63 4679.53 percent of total billed charges 16936.4 16936.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ZENITH RENU AAA ANCILLARY GRAFT CONVERTER #AX1-2-28-113 SUP-G55376 CDM 270010015 LOCAL 0270 RC outpatient 18506.8 18506.8 18506.8 74 13695 percent of total billed charges 18506.8 93 14990.5 percent of total billed charges 18506.8 18506.8 other OPPS APC 18506.8 18506.8 other OPPS APC 18506.8 27.63 5113.43 percent of total billed charges 18506.8 18506.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH RENU Z-TRAK L113 MM L59-54 MM OD30-12 MM ODSEC7.7 MM ID20 FR ANCILLARY CONVERTER INTRODUCTION SYSTEM INTRODUCER SHEATH STERILE AAA SUP-G55382 CDM 270010015 LOCAL 0270 RC outpatient 17966 17966 17966 74 13294.8 percent of total billed charges 17966 93 14552.5 percent of total billed charges 17966 17966 other OPPS APC 17966 17966 other OPPS APC 17966 27.63 4964.01 percent of total billed charges 17966 17966 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH RENU L113 MM OD32-12 MM ABDOMINAL AORTIC ANEURYSM ANCILLARY CONVERTER #AX1-2-32-113ZT SUP-G55388 CDM 270010015 LOCAL 0270 RC outpatient 17966 17966 17966 74 13294.8 percent of total billed charges 17966 93 14552.5 percent of total billed charges 17966 17966 other OPPS APC 17966 17966 other OPPS APC 17966 27.63 4964.01 percent of total billed charges 17966 17966 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR Z-TRAK ZENITH RENU POLYESTER WOVEN L113 MM L54-59 MM OD12-28 MM ANCILLARY CONVERTER STERILE ACCEPTS 20 FR INTRODUCER SHEATH AAA SUP-G55394 CDM 270010015 LOCAL 0270 RC outpatient 17966 17966 17966 74 13294.8 percent of total billed charges 17966 93 14552.5 percent of total billed charges 17966 17966 other OPPS APC 17966 17966 other OPPS APC 17966 27.63 4964.01 percent of total billed charges 17966 17966 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR MICROPUNCTURE NITINOL ANGLE L60 CM OD.018 IN SUP-G55560 CDM 0270 RC outpatient 42.56 42.56 42.56 74 31.49 percent of total billed charges 42.56 93 34.47 percent of total billed charges 42.56 42.56 other OPPS APC 42.56 42.56 other OPPS APC 42.56 27.63 11.76 percent of total billed charges 42.56 42.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY ECHOTIP PROCORE 8- CM 22GA 5.2FR DISPOSABLE STERILE HIGH DEFINITION ULTRASOUND RECESSED BALL TIP SHEATH 2 SUP-G55736 CDM 0270 RC outpatient 949 949 949 74 702.26 percent of total billed charges 949 93 768.69 percent of total billed charges 949 949 other OPPS APC 949 949 other OPPS APC 949 27.63 262.21 percent of total billed charges 949 949 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY ECHOTIP PROCORE 0-8CM 25GA 5.2FR DISPOSABLE STERILE CONTOUR HANDLE BEVEL STYLET TIP HD ULTRASOUND SUP-G55738 CDM 0270 RC outpatient 1063.4 1063.4 1063.4 74 786.92 percent of total billed charges 1063.4 93 861.35 percent of total billed charges 1063.4 1063.4 other OPPS APC 1063.4 1063.4 other OPPS APC 1063.4 27.63 293.82 percent of total billed charges 1063.4 1063.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET SUPRAPUBIC STAMEY MALECOT STAINLESS STEEL POLYETHYLENE PVC L30 CM OD14 FR PERCUTANEOUS NEEDLE OBTURATOR CONNECT TUBE 1 WAY STOPCOCK STERILE DISPOSABLE SUP-G55824 CDM 0270 RC outpatient 184.57 184.57 184.57 74 136.58 percent of total billed charges 184.57 93 149.5 percent of total billed charges 184.57 184.57 other OPPS APC 184.57 184.57 other OPPS APC 184.57 27.63 51 percent of total billed charges 184.57 184.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT MICROINTRODUCER STAINLESS STEEL SILICONE NITINOL .018 IN REGULAR TAPER L40 CM L7 CM OD5 FR ODSEC21 GA DILATOR SMOOTH NEEDLE SOFT TIP WIRE MANDREL SUP-G56202 CDM 0481 RC outpatient 93.44 93.44 93.44 74 69.15 percent of total billed charges 93.44 93 75.69 percent of total billed charges 93.44 93.44 other OPPS APC 93.44 93.44 other OPPS APC 93.44 51 47.65 percent of total billed charges 93.44 93.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH CHECK-FLO FLEXOR .035 IN L70 CM OD4 FR ID.059 IN ANL0 CURVE STRAIGHT TIP ANSEL MODIFICATION HIGH FLEX DILATOR GUIDEWIRE SUP-G56219 CDM 0270 RC outpatient 201.6 201.6 201.6 74 149.18 percent of total billed charges 201.6 93 163.3 percent of total billed charges 201.6 201.6 other OPPS APC 201.6 201.6 other OPPS APC 201.6 27.63 55.7 percent of total billed charges 201.6 201.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH CHECK-FLO FLEXOR .035 IN L70 CM OD7 FR ID.1 IN ANL0 CURVE STRAIGHT TIP ANSEL MODIFICATION HIGH FLEX DILATOR GUIDEWIRE SUP-G56222 CDM 0270 RC outpatient 201.6 201.6 201.6 74 149.18 percent of total billed charges 201.6 93 163.3 percent of total billed charges 201.6 201.6 other OPPS APC 201.6 201.6 other OPPS APC 201.6 27.63 55.7 percent of total billed charges 201.6 201.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH GUIDING FLEXOR CHECK-FLO HYDROPHILIC ANL0 CURVE L70 CM OD8 FR ID2.9 MM RADIOPAQUE HIGH FLEX DILATOR STERILE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-G56223 CDM 0270 RC outpatient 201.6 201.6 201.6 74 149.18 percent of total billed charges 201.6 93 163.3 percent of total billed charges 201.6 201.6 other OPPS APC 201.6 201.6 other OPPS APC 201.6 27.63 55.7 percent of total billed charges 201.6 201.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH GUIDING FLEXOR 5FR 55CM SUP-G56230 CDM 0270 RC outpatient 169.47 169.47 169.47 74 125.41 percent of total billed charges 169.47 93 137.27 percent of total billed charges 169.47 169.47 other OPPS APC 169.47 169.47 other OPPS APC 169.47 27.63 46.82 percent of total billed charges 169.47 169.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH CHECK-FLO FLEXOR 6 FR 1 CURVE MULTIPURPOSE TIP ANSEL MODIFICATION HIGH FLEX DILATOR GUIDEWIRE SUP-G56236 CDM 0270 RC outpatient 168.48 168.48 168.48 74 124.68 percent of total billed charges 168.48 93 136.47 percent of total billed charges 168.48 168.48 other OPPS APC 168.48 168.48 other OPPS APC 168.48 27.63 46.55 percent of total billed charges 168.48 168.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH CHECK-FLO FLEXOR .035 IN L45 CM OD10 FR ID.134 IN ANL0 CURVE STRAIGHT TIP ANSEL MODIFICATION HIGH FLEX DILATOR GUIDEWIRE SUP-G56278 CDM 0270 RC outpatient 174.38 174.38 174.38 74 129.04 percent of total billed charges 174.38 93 141.25 percent of total billed charges 174.38 174.38 other OPPS APC 174.38 174.38 other OPPS APC 174.38 27.63 48.18 percent of total billed charges 174.38 174.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC BEACON TORCON NB ADVANTAGE MULTIPURPOSE A CURVE L125 CM OD4 FR LATEX FREE ACCEPTS .035 IN GUIDEWIRE SUP-G56360 CDM 0270 RC outpatient 39.36 39.36 39.36 74 29.13 percent of total billed charges 39.36 93 31.88 percent of total billed charges 39.36 39.36 other OPPS APC 39.36 39.36 other OPPS APC 39.36 27.63 10.88 percent of total billed charges 39.36 39.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY SURGICAL WAYNE CHLORAPREP L29 CM L5 CM OD14 FR ODSEC18 GA PERCUTANEOUS 19 SIDEPORT CATHETER ECHOGENIC ENTRY NEEDLE GUIDEWIRE DILATOR STERILE DISPOSABLE PNEUMOTHORAX SUP-G56537 CDM 0270 RC outpatient 918.89 918.89 918.89 74 679.98 percent of total billed charges 918.89 93 744.3 percent of total billed charges 918.89 918.89 other OPPS APC 918.89 918.89 other OPPS APC 918.89 27.63 253.89 percent of total billed charges 918.89 918.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEMOSPRAY 7 SUP-G56572 CDM 0270 RC outpatient 6500 6500 6500 74 4810 percent of total billed charges 6500 93 5265 percent of total billed charges 6500 6500 other OPPS APC 6500 6500 other OPPS APC 6500 27.63 1795.95 percent of total billed charges 6500 6500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM STENT VASCULAR FORMULA 418 5MM 16MM 135CM RENAL ARTERY OTW BALLOON-EXPANDING PRE-MOUNTED STAINLESS STEEL MRI-CONDITIONAL NON-RADIOLUCENT 0.018IN GW 5FR SHEATH 6FR GUIDE CATH SUP-G56623 CDM 0270 RC outpatient 2320.47 2320.47 2320.47 74 1717.15 percent of total billed charges 2320.47 93 1879.58 percent of total billed charges 2320.47 2320.47 other OPPS APC 2320.47 2320.47 other OPPS APC 2320.47 27.63 641.15 percent of total billed charges 2320.47 2320.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM STENT VASCULAR FORMULA 418 5MM 20MM 135CM RENAL ARTERY OTW BALLOON-EXPANDING PRE-MOUNTED STAINLESS STEEL MRI-CONDITIONAL NON-RADIOLUCENT 0.018IN GW 5FR SHEATH 6FR GUIDE CATH SUP-G56624 CDM 0270 RC outpatient 2320.47 2320.47 2320.47 74 1717.15 percent of total billed charges 2320.47 93 1879.58 percent of total billed charges 2320.47 2320.47 other OPPS APC 2320.47 2320.47 other OPPS APC 2320.47 27.63 641.15 percent of total billed charges 2320.47 2320.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM STENT VASCULAR FORMULA 418 6MM 16MM 135CM RENAL ARTERY OTW BALLOON-EXPANDING PRE-MOUNTED STAINLESS STEEL MRI-CONDITIONAL NON-RADIOLUCENT 0.018IN GW 5FR SHEATH 6FR GUIDE CATH SUP-G56626 CDM 0270 RC outpatient 2320.47 2320.47 2320.47 74 1717.15 percent of total billed charges 2320.47 93 1879.58 percent of total billed charges 2320.47 2320.47 other OPPS APC 2320.47 2320.47 other OPPS APC 2320.47 27.63 641.15 percent of total billed charges 2320.47 2320.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY FORMULA 414 STAINLESS STEEL .014 IN L16 MM L135 CM OD5 MM ODSEC6 FR RENAL RAPID EXCHANGE BALLOON EXPANDABLE SLOTTED TUBE CONFIGURATION GUIDEWIRE STERILE DISPOSABLE SUP-G56968 CDM 0270 RC outpatient 2502.45 2502.45 2502.45 74 1851.81 percent of total billed charges 2502.45 93 2026.98 percent of total billed charges 2502.45 2502.45 other OPPS APC 2502.45 2502.45 other OPPS APC 2502.45 27.63 691.43 percent of total billed charges 2502.45 2502.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY FORMULA 414 STAINLESS STEEL .014 IN L20 MM L135 CM OD5 MM ODSEC6 FR RENAL RAPID EXCHANGE BALLOON EXPANDABLE SLOTTED TUBE CONFIGURATION GUIDEWIRE STERILE DISPOSABLE SUP-G56969 CDM 0270 RC outpatient 2730 2730 2730 74 2020.2 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 2730 other OPPS APC 2730 2730 other OPPS APC 2730 27.63 754.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY FORMULA 414 STAINLESS STEEL .014 IN L16 MM L135 CM OD6 MM ODSEC6 FR RENAL RAPID EXCHANGE BALLOON EXPANDABLE SLOTTED TUBE CONFIGURATION GUIDEWIRE STERILE DISPOSABLE SUP-G56971 CDM 0270 RC outpatient 2730 2730 2730 74 2020.2 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 2730 other OPPS APC 2730 2730 other OPPS APC 2730 27.63 754.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ESOPHAGEAL TAEWOONG NITI-S L10 CM L180 CM OD20 MM ODSEC10.5 MM DELIVERY SYSTEM TTS SUP-G57347 CDM 0270 RC outpatient 7111 7111 7111 74 5262.14 percent of total billed charges 7111 93 5759.91 percent of total billed charges 7111 7111 other OPPS APC 7111 7111 other OPPS APC 7111 27.63 1964.77 percent of total billed charges 7111 7111 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ESOPHAGEAL TAEWOONG NITI-S L15 CM L180 CM OD20 MM ODSEC10.5 MM DELIVERY SYSTEM THROUGH THE SCOPE SUP-G57357 CDM 0270 RC outpatient 7111 7111 7111 74 5262.14 percent of total billed charges 7111 93 5759.91 percent of total billed charges 7111 7111 other OPPS APC 7111 7111 other OPPS APC 7111 27.63 1964.77 percent of total billed charges 7111 7111 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZILVER VENA 14MMX100MM SUP-G57445 CDM 0270 RC outpatient 4911.37 4911.37 4911.37 74 3634.41 percent of total billed charges 4911.37 93 3978.21 percent of total billed charges 4911.37 4911.37 other OPPS APC 4911.37 4911.37 other OPPS APC 4911.37 27.63 1357.01 percent of total billed charges 4911.37 4911.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY ZILVER VENA L140 MM L80 CM OD14 MM VENOUS DELIVERY SYSTEM SELF EXPAND OTW OPEN CELL ACCEPTS .035 IN GUIDEWIRE SUP-G57446 CDM 0270 RC outpatient 4911.37 4911.37 4911.37 74 3634.41 percent of total billed charges 4911.37 93 3978.21 percent of total billed charges 4911.37 4911.37 other OPPS APC 4911.37 4911.37 other OPPS APC 4911.37 27.63 1357.01 percent of total billed charges 4911.37 4911.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZILVER VENA 16MMX100MM SUP-G57448 CDM 0270 RC outpatient 4911.37 4911.37 4911.37 74 3634.41 percent of total billed charges 4911.37 93 3978.21 percent of total billed charges 4911.37 4911.37 other OPPS APC 4911.37 4911.37 other OPPS APC 4911.37 27.63 1357.01 percent of total billed charges 4911.37 4911.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY ZILVER VENA L140 MM L80 CM OD16 MM VENOUS DELIVERY SYSTEM SELF EXPAND OTW OPEN CELL ACCEPTS .035 IN GUIDEWIRE SUP-G57449 CDM 0270 RC outpatient 4911.37 4911.37 4911.37 74 3634.41 percent of total billed charges 4911.37 93 3978.21 percent of total billed charges 4911.37 4911.37 other OPPS APC 4911.37 4911.37 other OPPS APC 4911.37 27.63 1357.01 percent of total billed charges 4911.37 4911.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET DILATOR AMPLATZ 84CM 30CM 16CM 6-30FR 8FR PTFE RENAL RADIOPAQUE SHEATH SUP-G57459 CDM 0270 RC outpatient 800.38 800.38 800.38 74 592.28 percent of total billed charges 800.38 93 648.31 percent of total billed charges 800.38 800.38 other OPPS APC 800.38 800.38 other OPPS APC 800.38 27.63 221.14 percent of total billed charges 800.38 800.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET DILATOR AMPLATZ STANDARD L30 CM L20 CM OD6-30 FR RENAL TFE CATHETER RADIOPAQUE SHEATH MODIFIED SUP-G57460 CDM 0270 RC outpatient 699.66 699.66 699.66 74 517.75 percent of total billed charges 699.66 93 566.72 percent of total billed charges 699.66 699.66 other OPPS APC 699.66 699.66 other OPPS APC 699.66 27.63 193.32 percent of total billed charges 699.66 699.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION AMPLATZ L84 CM OD8 FR RENAL GUIDE STERILE SUP-G57462 CDM outpatient 84.76 84.76 84.76 84.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL ALEXIS O 360 D LARGE RIGID RING ATRAUMATIC UNIQUE C SECTION 9-14 CM INCISION SUP-G6313 CDM 0270 RC outpatient 143 143 143 74 105.82 percent of total billed charges 143 93 115.83 percent of total billed charges 143 143 other OPPS APC 143 143 other OPPS APC 143 27.63 39.51 percent of total billed charges 143 143 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE G650DL SUP-G650DL CDM 0270 RC outpatient 65 65 65 74 48.1 percent of total billed charges 65 93 52.65 percent of total billed charges 65 65 other OPPS APC 65 65 other OPPS APC 65 27.63 17.96 percent of total billed charges 65 65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR GLIDEWIRE ADVANTAGE PTFE NITINOL HYDROPHILIC ANGLE L180 CM L25 CM OD.035 IN SUP-GA3501 CDM 0481 RC outpatient 416 416 416 74 307.84 percent of total billed charges 416 93 336.96 percent of total billed charges 416 416 other OPPS APC 416 416 other OPPS APC 416 51 212.16 percent of total billed charges 416 416 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR GLIDEWIRE ADVANTAGE PTFE NITINOL HYDROPHILIC ANGLED L260 CM L25 CM OD.035 IN SUP-GA3502 CDM 0481 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 51 238.68 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PROCEDURE SUPPLIES GALAXY SYSTEM DISPOSABLE SUP-GALK-001 CDM 0270 RC outpatient 5720 5720 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL GORE ENFORM POROUS L10 CM X W10 CM PREPERITONEAL 2 SIDE TEXTURE SMOOTH SUP-GBWR1010 CDM 0270 RC outpatient 3458 3458 3458 74 2558.92 percent of total billed charges 3458 93 2800.98 percent of total billed charges 3458 3458 other OPPS APC 3458 3458 other OPPS APC 3458 27.63 955.45 percent of total billed charges 3458 3458 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER CONTOUR 40MMX3.5MM 1.5MM BLUE TITANIUM DISPOSABLE STERILE LF REGULAR TISSUE 4 ROW CARTRIDGE SUP-GCR40B CDM 0270 RC outpatient 737.04 737.04 737.04 737.04 other OPPS APC 737.04 737.04 other OPPS APC 737.04 27.63 203.64 percent of total billed charges 737.04 737.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL CONTOUR CURVE 40MMX3.5MM 1.5MM BLUE TITANIUM DISPOSABLE STERILE LF REGULAR TISSUE 4 ROW LINEAR CUTTER SUP-GCS40B CDM 0270 RC outpatient 1309.97 1309.97 1309.97 74 969.38 percent of total billed charges 1309.97 93 1061.08 percent of total billed charges 1309.97 1309.97 other OPPS APC 1309.97 1309.97 other OPPS APC 1309.97 27.63 361.94 percent of total billed charges 1309.97 1309.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AXS INFINITY SHEATH 90CM SUP-GEN-10476 CDM 0270 RC outpatient 1365 1365 1365 74 1010.1 percent of total billed charges 1365 93 1105.65 percent of total billed charges 1365 1365 other OPPS APC 1365 1365 other OPPS APC 1365 27.63 377.15 percent of total billed charges 1365 1365 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH AXS INFINITY LS LONG 80 CM SUP-GEN-10800-80 CDM 0270 RC outpatient 1378 1378 1378 74 1019.72 percent of total billed charges 1378 93 1116.18 percent of total billed charges 1378 1378 other OPPS APC 1378 1378 other OPPS APC 1378 27.63 380.74 percent of total billed charges 1378 1378 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH AXS INFINITY LS LONG 90 CM SUP-GEN-10800-90 CDM 0270 RC outpatient 1541.8 1541.8 1541.8 74 1140.93 percent of total billed charges 1541.8 93 1248.86 percent of total billed charges 1541.8 1541.8 other OPPS APC 1541.8 1541.8 other OPPS APC 1541.8 27.63 426 percent of total billed charges 1541.8 1541.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY EXPORTAP L145 CM OD7 FR ID.08 IN ASPIRATION FULL-WALL VARIABLE BRAIDED SOFT FORWARD FACING ACCEPTS .014 IN GUIDEWIRE SUP-GEZ6200US7B CDM 0270 RC outpatient 1105 1105 1105 74 817.7 percent of total billed charges 1105 93 895.05 percent of total billed charges 1105 1105 other OPPS APC 1105 1105 other OPPS APC 1105 27.63 305.31 percent of total billed charges 1105 1105 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PASSER SUTURE GABBAY-FRATER GUIDE ORGANIZER STERILE LATEX FREE VALVE IMPLANTATION SUP-GFS-10A CDM 0270 RC outpatient 44.63 44.63 44.63 74 33.03 percent of total billed charges 44.63 93 36.15 percent of total billed charges 44.63 44.63 other OPPS APC 44.63 44.63 other OPPS APC 44.63 27.63 12.33 percent of total billed charges 44.63 44.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PASSER SUTURE GABBAY-FRATER GUIDE ORGANIZER LATEX FREE VALVE SUP-GFS-1A CDM 0270 RC outpatient 66.3 66.3 66.3 74 49.06 percent of total billed charges 66.3 93 53.7 percent of total billed charges 66.3 66.3 other OPPS APC 66.3 66.3 other OPPS APC 66.3 27.63 18.32 percent of total billed charges 66.3 66.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MARKER ENDOSCOPIC SPOT STERILE 5 ML GI TRACT SYRINGE PREFILL SUP-GIS-45 CDM 0270 RC outpatient 98.8 98.8 98.8 74 73.11 percent of total billed charges 98.8 93 80.03 percent of total billed charges 98.8 98.8 other OPPS APC 98.8 98.8 other OPPS APC 98.8 27.63 27.3 percent of total billed charges 98.8 98.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AGENT LIFTING SUBMUCOSAL EVERLIFT 5ML SUP-GIS-55 CDM 0270 RC outpatient 104 104 104 74 76.96 percent of total billed charges 104 93 84.24 percent of total billed charges 104 104 other OPPS APC 104 104 other OPPS APC 104 27.63 28.74 percent of total billed charges 104 104 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AGENT LIFTING SUBMUCOSAL EVERLIFT 10 ML SUP-GIS-59 CDM 0270 RC outpatient 182 182 182 74 134.68 percent of total billed charges 182 93 147.42 percent of total billed charges 182 182 other OPPS APC 182 182 other OPPS APC 182 27.63 50.29 percent of total billed charges 182 182 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE MONOPOLAR SPATULA TIP MODULAR DURABILITY ENHANCED SAFETY SUP-GK386R CDM 270010015 LOCAL 0270 RC outpatient 186.52 186.52 186.52 74 138.02 percent of total billed charges 186.52 93 151.08 percent of total billed charges 186.52 186.52 other OPPS APC 186.52 186.52 other OPPS APC 186.52 27.63 51.54 percent of total billed charges 186.52 186.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL 20 x 25 CM 0.5 CM THICK SYNECOR SUP-GKFR2025 CDM 0270 RC outpatient 7865 7865 7865 74 5820.1 percent of total billed charges 7865 93 6370.65 percent of total billed charges 7865 7865 other OPPS APC 7865 7865 other OPPS APC 7865 27.63 2173.1 percent of total billed charges 7865 7865 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL GORE SYNECOR RECTANGLE L25 CM X W20 CM PREPERITONEAL KNIT WEB SUP-GKWR2025 CDM 0270 RC outpatient 8262.8 8262.8 8262.8 74 6114.47 percent of total billed charges 8262.8 93 6692.87 percent of total billed charges 8262.8 8262.8 other OPPS APC 8262.8 8262.8 other OPPS APC 8262.8 27.63 2283.01 percent of total billed charges 8262.8 8262.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL GORE SYNECOR RECTANGLE L30 CM X W20 CM PREPERITONEAL KNIT WEB SUP-GKWR2030 CDM 0270 RC outpatient 11663.6 11663.6 11663.6 74 8631.06 percent of total billed charges 11663.6 93 9447.52 percent of total billed charges 11663.6 11663.6 other OPPS APC 11663.6 11663.6 other OPPS APC 11663.6 27.63 3222.65 percent of total billed charges 11663.6 11663.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE POLYSORB 2-0 V-20 L30 IN BRAID COATED VIOLET SUP-GL-123 CDM 0270 RC outpatient 9.13 9.13 9.13 74 6.76 percent of total billed charges 9.13 93 7.4 percent of total billed charges 9.13 9.13 other OPPS APC 9.13 9.13 other OPPS APC 9.13 27.63 2.52 percent of total billed charges 9.13 9.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETAINER DRESSING SURGITUBE 2P TUBULAR 7/8IN WHITE COTTON LF LG FINGER TOE ELASTIC NET SUP-GL242 CDM 0270 RC outpatient 36.43 36.43 36.43 74 26.96 percent of total billed charges 36.43 93 29.51 percent of total billed charges 36.43 36.43 other OPPS APC 36.43 36.43 other OPPS APC 36.43 27.63 10.07 percent of total billed charges 36.43 36.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL 1 X 1 MINI G3 SUP-GLM910010 CDM 0270 RC outpatient 5415.8 5415.8 5415.8 74 4007.69 percent of total billed charges 5415.8 93 4386.8 percent of total billed charges 5415.8 5415.8 other OPPS APC 5415.8 5415.8 other OPPS APC 5415.8 27.63 1496.39 percent of total billed charges 5415.8 5415.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL 1 X 1.5 MINI G3 SUP-GLM910015 CDM 0270 RC outpatient 5415.8 5415.8 5415.8 74 4007.69 percent of total billed charges 5415.8 93 4386.8 percent of total billed charges 5415.8 5415.8 other OPPS APC 5415.8 5415.8 other OPPS APC 5415.8 27.63 1496.39 percent of total billed charges 5415.8 5415.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL 1 X 2 MINI G3 SUP-GLM910020 CDM 0270 RC outpatient 5415.8 5415.8 5415.8 74 4007.69 percent of total billed charges 5415.8 93 4386.8 percent of total billed charges 5415.8 5415.8 other OPPS APC 5415.8 5415.8 other OPPS APC 5415.8 27.63 1496.39 percent of total billed charges 5415.8 5415.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL 1 X 2.5 MINI G3 SUP-GLM910025 CDM 0270 RC outpatient 5415.8 5415.8 5415.8 74 4007.69 percent of total billed charges 5415.8 93 4386.8 percent of total billed charges 5415.8 5415.8 other OPPS APC 5415.8 5415.8 other OPPS APC 5415.8 27.63 1496.39 percent of total billed charges 5415.8 5415.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL 1 X 3 MINI G3 SUP-GLM910030 CDM 0270 RC outpatient 4928.38 4928.38 4928.38 74 3647 percent of total billed charges 4928.38 93 3991.99 percent of total billed charges 4928.38 4928.38 other OPPS APC 4928.38 4928.38 other OPPS APC 4928.38 27.63 1361.71 percent of total billed charges 4928.38 4928.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL 1 X 4 MINI G3 SUP-GLM910040 CDM 0270 RC outpatient 5415.8 5415.8 5415.8 74 4007.69 percent of total billed charges 5415.8 93 4386.8 percent of total billed charges 5415.8 5415.8 other OPPS APC 5415.8 5415.8 other OPPS APC 5415.8 27.63 1496.39 percent of total billed charges 5415.8 5415.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL 1.5 X 2 MINI G3 SUP-GLM915020 CDM 0270 RC outpatient 4928.38 4928.38 4928.38 74 3647 percent of total billed charges 4928.38 93 3991.99 percent of total billed charges 4928.38 4928.38 other OPPS APC 4928.38 4928.38 other OPPS APC 4928.38 27.63 1361.71 percent of total billed charges 4928.38 4928.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL 1.5 X 2.5 MINI G3 SUP-GLM915025 CDM 0270 RC outpatient 5415.8 5415.8 5415.8 74 4007.69 percent of total billed charges 5415.8 93 4386.8 percent of total billed charges 5415.8 5415.8 other OPPS APC 5415.8 5415.8 other OPPS APC 5415.8 27.63 1496.39 percent of total billed charges 5415.8 5415.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL 1.5 X 3 MINI G3 SUP-GLM915030 CDM 0270 RC outpatient 5415.8 5415.8 5415.8 74 4007.69 percent of total billed charges 5415.8 93 4386.8 percent of total billed charges 5415.8 5415.8 other OPPS APC 5415.8 5415.8 other OPPS APC 5415.8 27.63 1496.39 percent of total billed charges 5415.8 5415.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL 1.5 X 4 MINI G3 SUP-GLM915040 CDM 0270 RC outpatient 5415.8 5415.8 5415.8 74 4007.69 percent of total billed charges 5415.8 93 4386.8 percent of total billed charges 5415.8 5415.8 other OPPS APC 5415.8 5415.8 other OPPS APC 5415.8 27.63 1496.39 percent of total billed charges 5415.8 5415.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL 2 X 3 MINI G3 SUP-GLM920030 CDM 0270 RC outpatient 5415.8 5415.8 5415.8 74 4007.69 percent of total billed charges 5415.8 93 4386.8 percent of total billed charges 5415.8 5415.8 other OPPS APC 5415.8 5415.8 other OPPS APC 5415.8 27.63 1496.39 percent of total billed charges 5415.8 5415.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL 2 X 4 MINI G3 SUP-GLM920040 CDM 0270 RC outpatient 4928.38 4928.38 4928.38 74 3647 percent of total billed charges 4928.38 93 3991.99 percent of total billed charges 4928.38 4928.38 other OPPS APC 4928.38 4928.38 other OPPS APC 4928.38 27.63 1361.71 percent of total billed charges 4928.38 4928.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL 2 X 6 MINI G3 SUP-GLM920060 CDM 0270 RC outpatient 4928.38 4928.38 4928.38 74 3647 percent of total billed charges 4928.38 93 3991.99 percent of total billed charges 4928.38 4928.38 other OPPS APC 4928.38 4928.38 other OPPS APC 4928.38 27.63 1361.71 percent of total billed charges 4928.38 4928.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL 2.5 X 3.5 MINI G3 SUP-GLM925035 CDM 0270 RC outpatient 5415.8 5415.8 5415.8 74 4007.69 percent of total billed charges 5415.8 93 4386.8 percent of total billed charges 5415.8 5415.8 other OPPS APC 5415.8 5415.8 other OPPS APC 5415.8 27.63 1496.39 percent of total billed charges 5415.8 5415.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL 2.5 X 4.5 MINI G3 SUP-GLM925045 CDM 0270 RC outpatient 5415.8 5415.8 5415.8 74 4007.69 percent of total billed charges 5415.8 93 4386.8 percent of total billed charges 5415.8 5415.8 other OPPS APC 5415.8 5415.8 other OPPS APC 5415.8 27.63 1496.39 percent of total billed charges 5415.8 5415.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL 2.5 X 5.5 MINI G3 SUP-GLM925055 CDM 0270 RC outpatient 5415.8 5415.8 5415.8 74 4007.69 percent of total billed charges 5415.8 93 4386.8 percent of total billed charges 5415.8 5415.8 other OPPS APC 5415.8 5415.8 other OPPS APC 5415.8 27.63 1496.39 percent of total billed charges 5415.8 5415.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL 3 X 4 MINI G3 SUP-GLM930040 CDM 0270 RC outpatient 5415.8 5415.8 5415.8 74 4007.69 percent of total billed charges 5415.8 93 4386.8 percent of total billed charges 5415.8 5415.8 other OPPS APC 5415.8 5415.8 other OPPS APC 5415.8 27.63 1496.39 percent of total billed charges 5415.8 5415.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL 3 X 6 MINI G3 SUP-GLM930060 CDM 0270 RC outpatient 5415.8 5415.8 5415.8 74 4007.69 percent of total billed charges 5415.8 93 4386.8 percent of total billed charges 5415.8 5415.8 other OPPS APC 5415.8 5415.8 other OPPS APC 5415.8 27.63 1496.39 percent of total billed charges 5415.8 5415.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL 3 X 8 MINI G3 SUP-GLM930080 CDM 0270 RC outpatient 5415.8 5415.8 5415.8 74 4007.69 percent of total billed charges 5415.8 93 4386.8 percent of total billed charges 5415.8 5415.8 other OPPS APC 5415.8 5415.8 other OPPS APC 5415.8 27.63 1496.39 percent of total billed charges 5415.8 5415.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROPHILIC NITINOL GUIDEWIRE 45 DEGREE ANGLE SUP-GM1221 CDM 0270 RC outpatient 845 845 845 74 625.3 percent of total billed charges 845 93 684.45 percent of total billed charges 845 845 other OPPS APC 845 845 other OPPS APC 845 27.63 233.47 percent of total billed charges 845 845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROPHILIC NITINOL GUIDEWIRE 90 DEGREE ANGLE SUP-GM1222 CDM 0270 RC outpatient 754 754 754 74 557.96 percent of total billed charges 754 93 610.74 percent of total billed charges 754 754 other OPPS APC 754 754 other OPPS APC 754 27.63 208.33 percent of total billed charges 754 754 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR HEADLINER NITINOL GOLD HYDROPHILIC L20 CM TAPER L200 CM L1.5 MM OD .012 IN J STANDARD TIP COIL TORQUE DEVICE STERILE LATEX FREE DISPSABLE SUP-GM1223 CDM 0270 RC outpatient 754 754 754 74 557.96 percent of total billed charges 754 93 610.74 percent of total billed charges 754 754 other OPPS APC 754 754 other OPPS APC 754 27.63 208.33 percent of total billed charges 754 754 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROPHILIC NITINOL GUIDEWIRE 90/150 ANGLE SUP-GM1224 CDM 0270 RC outpatient 754 754 754 74 557.96 percent of total billed charges 754 93 610.74 percent of total billed charges 754 754 other OPPS APC 754 754 other OPPS APC 754 27.63 208.33 percent of total billed charges 754 754 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROPHILIC NITINOL GUIDEWIRE STR SHAPEABLE SUP-GM1421 CDM 0270 RC outpatient 754 754 754 74 557.96 percent of total billed charges 754 93 610.74 percent of total billed charges 754 754 other OPPS APC 754 754 other OPPS APC 754 27.63 208.33 percent of total billed charges 754 754 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROPHILIC NITINOL GUIDEWIRE 45 DEGREE SHAPEABLE SUP-GM1422 CDM 0270 RC outpatient 754 754 754 74 557.96 percent of total billed charges 754 93 610.74 percent of total billed charges 754 754 other OPPS APC 754 754 other OPPS APC 754 27.63 208.33 percent of total billed charges 754 754 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROPHILIC NITINOL GUIDEWIRE 70 DEGREE SHAPEABLE SUP-GM1423 CDM 0270 RC outpatient 754 754 754 74 557.96 percent of total billed charges 754 93 610.74 percent of total billed charges 754 754 other OPPS APC 754 754 other OPPS APC 754 27.63 208.33 percent of total billed charges 754 754 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROPHILIC NITINOL GUIDEWIRE 45 DEGREE ANGLE SUP-GM1621 CDM 0270 RC outpatient 754 754 754 74 557.96 percent of total billed charges 754 93 610.74 percent of total billed charges 754 754 other OPPS APC 754 754 other OPPS APC 754 27.63 208.33 percent of total billed charges 754 754 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROPHILIC NITINOL GUIDEWIRE 90 DEGREE ANGLE SUP-GM1622 CDM 0270 RC outpatient 754 754 754 74 557.96 percent of total billed charges 754 93 610.74 percent of total billed charges 754 754 other OPPS APC 754 754 other OPPS APC 754 27.63 208.33 percent of total billed charges 754 754 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR HEADLINER HYDROPHILIC NITINOL J L200 CM L35 CM OD .016 IN FLOPPY TIP SUP-GM1623 CDM 0270 RC outpatient 754 754 754 74 557.96 percent of total billed charges 754 93 610.74 percent of total billed charges 754 754 other OPPS APC 754 754 other OPPS APC 754 27.63 208.33 percent of total billed charges 754 754 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR HEADLINER HYDROPHILIC NITINOL DOUBLE ANGLE L200 CM L35 CM OD .016 IN FLOPPY TIP SUP-GM1624 CDM 0270 RC outpatient 754 754 754 74 557.96 percent of total billed charges 754 93 610.74 percent of total billed charges 754 754 other OPPS APC 754 754 other OPPS APC 754 27.63 208.33 percent of total billed charges 754 754 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROPHILIC NITINOL GUIDEWIRE 90/150 ANGLE SUP-GM1624 CDM 0270 RC outpatient 754 754 754 74 557.96 percent of total billed charges 754 93 610.74 percent of total billed charges 754 754 other OPPS APC 754 754 other OPPS APC 754 27.63 208.33 percent of total billed charges 754 754 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING SUCTION/IRRIGATION SET STERILE DISPOSABLE JET UNIT SUP-GN094 CDM 0270 RC outpatient 132.62 132.62 132.62 74 98.14 percent of total billed charges 132.62 93 107.42 percent of total billed charges 132.62 132.62 other OPPS APC 132.62 132.62 other OPPS APC 132.62 27.63 36.64 percent of total billed charges 132.62 132.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROVENA SNARE 10.0MM SUP-GN1000 CDM 0270 RC outpatient 702 702 702 74 519.48 percent of total billed charges 702 93 568.62 percent of total billed charges 702 702 other OPPS APC 702 702 other OPPS APC 702 27.63 193.96 percent of total billed charges 702 702 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT SNARE AMPLATZ GOOSENECK 120CM 102CM 15MM 6FR NITINOL CATHETER PREFORM LOOP RADIOPAQUE SUP-GN1500 CDM 0481 RC outpatient 807.2 807.2 807.2 74 597.33 percent of total billed charges 807.2 93 653.83 percent of total billed charges 807.2 807.2 other OPPS APC 807.2 807.2 other OPPS APC 807.2 51 411.67 percent of total billed charges 807.2 807.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EV3 AMPLATZ GOOSE NECK SNARE KIT 25MM SUP-GN2500 CDM 0481 RC outpatient 807.2 807.2 807.2 74 597.33 percent of total billed charges 807.2 93 653.83 percent of total billed charges 807.2 807.2 other OPPS APC 807.2 807.2 other OPPS APC 807.2 51 411.67 percent of total billed charges 807.2 807.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT SNARE AMPLATZ GOOSENECK NITINOL L120 CM L102 CM OD35 MM ODSEC6 FR CATHETER INTRODUCER TORQUE DEVICE RADIOPAQUE SUP-GN3500 CDM 0481 RC outpatient 807.2 807.2 807.2 74 597.33 percent of total billed charges 807.2 93 653.83 percent of total billed charges 807.2 807.2 other OPPS APC 807.2 807.2 other OPPS APC 807.2 51 411.67 percent of total billed charges 807.2 807.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR GLIDEWIRE TERUMO GLIDE TECHNOLOGY STANDARD ANGLE 180CM 3CM .018IN NITINOL HYDROPHILIC CORE TO TIP SUP-GR1806 CDM 0270 RC outpatient 139.75 139.75 139.75 74 103.42 percent of total billed charges 139.75 93 113.2 percent of total billed charges 139.75 139.75 other OPPS APC 139.75 139.75 other OPPS APC 139.75 27.63 38.61 percent of total billed charges 139.75 139.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR GLIDEWIRE ANGLE STANDARD 150CM 3CM .035IN HYDROPHILIC JACKET CORE TO TIP ATRAUMATIC SUP-GR3506 CDM 0270 RC outpatient 75.4 75.4 75.4 74 55.8 percent of total billed charges 75.4 93 61.07 percent of total billed charges 75.4 75.4 other OPPS APC 75.4 75.4 other OPPS APC 75.4 27.63 20.83 percent of total billed charges 75.4 75.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR GLIDEWIRE TUNGSTEN NITINOL POLYURETHANE HYDROPHILIC ANGLE STANDARD L180 CM L3 CM OD.035 IN PERIPHERAL JACKET CORE TO TIP ATRAUMATIC SUP-GR3508 CDM 0481 RC outpatient 103.22 103.22 103.22 74 76.38 percent of total billed charges 103.22 93 83.61 percent of total billed charges 103.22 103.22 other OPPS APC 103.22 103.22 other OPPS APC 103.22 51 52.64 percent of total billed charges 103.22 103.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR GLIDEWIRE TUNGSTEN NITINOL POLYURETHANE HYDROPHILIC ANGLE STANDARD L260 CM L3 CM OD.035 IN PERIPHERAL JACKET CORE TO TIP ATRAUMATIC SUP-GR3509 CDM 0481 RC outpatient 115.44 115.44 115.44 74 85.43 percent of total billed charges 115.44 93 93.51 percent of total billed charges 115.44 115.44 other OPPS APC 115.44 115.44 other OPPS APC 115.44 51 58.87 percent of total billed charges 115.44 115.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR GLIDEWIRE NITINOL TUNGSTEN POLYURETHANE HYDROPHILIC 1.5 MM J CURVE STANDARD L180 CM L3 CM OD.035 IN FLEXIBLE ATRAUMATIC TIP RADIOPAQUE KINK RESISTANCE SUP-GR3525 CDM 0270 RC outpatient 103.22 103.22 103.22 74 76.38 percent of total billed charges 103.22 93 83.61 percent of total billed charges 103.22 103.22 other OPPS APC 103.22 103.22 other OPPS APC 103.22 27.63 28.52 percent of total billed charges 103.22 103.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR GLIDEWIRE NITINOL TUNGSTEN POLYURETHANE HYDROPHILIC 1.5 MM J CURVE STANDARD TAPER L260 CM L3 CM OD.035 IN FLEXIBLE ATRAUMATIC TIP RADIOPAQUE KINK RESISTANCE SUP-GR3526 CDM 0270 RC outpatient 115.44 115.44 115.44 74 85.43 percent of total billed charges 115.44 93 93.51 percent of total billed charges 115.44 115.44 other OPPS APC 115.44 115.44 other OPPS APC 115.44 27.63 31.9 percent of total billed charges 115.44 115.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR GLIDEWIRE NITINOL TUNGSTEN POLYURETHANE HYDROPHILIC STANDARD STRAIGHT L150 CM L3 CM OD.038 IN RADIOPAQUE FLEXIBLE SHAPEABLE KINK RESISTANCE SUP-GR3801 CDM 0270 RC outpatient 75.4 75.4 75.4 74 55.8 percent of total billed charges 75.4 93 61.07 percent of total billed charges 75.4 75.4 other OPPS APC 75.4 75.4 other OPPS APC 75.4 27.63 20.83 percent of total billed charges 75.4 75.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIDEWIRE.038 X 150CM SUP-GR3806 CDM 0270 RC outpatient 75.4 75.4 75.4 74 55.8 percent of total billed charges 75.4 93 61.07 percent of total billed charges 75.4 75.4 other OPPS APC 75.4 75.4 other OPPS APC 75.4 27.63 20.83 percent of total billed charges 75.4 75.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING BLACKMAX L22 MM OD2.15 MM SPIRAL ROUTER STERILE GREEN BURR SUP-GRE-1S CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SUTURE 30 INCHES, BLACK 3-0, COVIDIEN SOFSILK" SUP-GS-832 CDM 0270 RC outpatient 7.64 7.64 7.64 74 5.65 percent of total billed charges 7.64 93 6.19 percent of total billed charges 7.64 7.64 other OPPS APC 7.64 7.64 other OPPS APC 7.64 27.63 2.11 percent of total billed charges 7.64 7.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR GLIDEWIRE NITINOL HYDROPHILIC STRAIGHT L260 CM L3 CM OD.035 IN STIFF SHAFT FLEXIBLE SUP-GS3504 CDM 0270 RC outpatient 129.61 129.61 129.61 74 95.91 percent of total billed charges 129.61 93 104.98 percent of total billed charges 129.61 129.61 other OPPS APC 129.61 129.61 other OPPS APC 129.61 27.63 35.81 percent of total billed charges 129.61 129.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR GLIDEWIRE HYDROPHILIC ANGLE L150 CM L3 CM OD.035 IN FLEXIBLE TIP STIFF SHAFT SUP-GS3506 CDM 0270 RC outpatient 117.39 117.39 117.39 74 86.87 percent of total billed charges 117.39 93 95.09 percent of total billed charges 117.39 117.39 other OPPS APC 117.39 117.39 other OPPS APC 117.39 27.63 32.43 percent of total billed charges 117.39 117.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR GLIDEWIRE HYDROPHILIC ANGLE L260 CM L3 CM OD.035 IN STIFF SHAFT SUP-GS3509 CDM outpatient 129.61 129.61 129.61 129.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER VASCULAR CEREBASE DA GUIDING SHEATH 0.09IN 8FR 90CM DISTAL STRAIGHT EA SUP-GS9090SD CDM 0270 RC outpatient 1548.74 1548.74 1548.74 1548.74 other OPPS APC 1548.74 1548.74 other OPPS APC 1548.74 27.63 427.92 percent of total billed charges 1548.74 1548.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER VASCULAR CEREBASE DA GUIDING SHEATH 0.09IN 8FR 95CM DISTAL STRAIGHT EA SUP-GS9095SD CDM 0270 RC outpatient 1548.74 1548.74 1548.74 74 1146.07 percent of total billed charges 1548.74 93 1254.48 percent of total billed charges 1548.74 1548.74 other OPPS APC 1548.74 1548.74 other OPPS APC 1548.74 27.63 427.92 percent of total billed charges 1548.74 1548.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROGEL SUP-GSP002 CDM 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ECHELON ENDOPATH L45 MM X H3.6 MM H1.5 MM REGULAR TISSUE BLUE SUP-GST45B CDM 0270 RC outpatient 445.42 445.42 445.42 74 329.61 percent of total billed charges 445.42 93 360.79 percent of total billed charges 445.42 445.42 other OPPS APC 445.42 445.42 other OPPS APC 445.42 27.63 123.07 percent of total billed charges 445.42 445.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ECHELON ENDOPATH H4.1 MM THICK TISSUE GREEN SUP-GST45G CDM 0270 RC outpatient 422.13 422.13 422.13 74 312.38 percent of total billed charges 422.13 93 341.93 percent of total billed charges 422.13 422.13 other OPPS APC 422.13 422.13 other OPPS APC 422.13 27.63 116.63 percent of total billed charges 422.13 422.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ECHELON ENDOPATH H2.6 MM VASCULAR THIN TISSUE WHITE SUP-GST45W CDM 0270 RC outpatient 445.42 445.42 445.42 74 329.61 percent of total billed charges 445.42 93 360.79 percent of total billed charges 445.42 445.42 other OPPS APC 445.42 445.42 other OPPS APC 445.42 27.63 123.07 percent of total billed charges 445.42 445.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ECHELON ENDOPATH L60 MM X H3.6 MM H1.5 MM REGULAR TISSUE BLUE SUP-GST60B CDM 0270 RC outpatient 481.63 481.63 481.63 74 356.41 percent of total billed charges 481.63 93 390.12 percent of total billed charges 481.63 481.63 other OPPS APC 481.63 481.63 other OPPS APC 481.63 27.63 133.07 percent of total billed charges 481.63 481.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ECHELON ENDOPATH L60 MM X H3.8 MM H1.8 MM REGULAR THICK TISSUE GOLD SUP-GST60D CDM 0270 RC outpatient 481.63 481.63 481.63 74 356.41 percent of total billed charges 481.63 93 390.12 percent of total billed charges 481.63 481.63 other OPPS APC 481.63 481.63 other OPPS APC 481.63 27.63 133.07 percent of total billed charges 481.63 481.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ECHELON ENDOPATH H4.1 MM THICK TISSUE GREEN SUP-GST60G CDM 0270 RC outpatient 481.63 481.63 481.63 74 356.41 percent of total billed charges 481.63 93 390.12 percent of total billed charges 481.63 481.63 other OPPS APC 481.63 481.63 other OPPS APC 481.63 27.63 133.07 percent of total billed charges 481.63 481.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ECHELON ENDOPATH 4.2MM BLACK VERY THICK TISSUE SUP-GST60T CDM 0270 RC outpatient 456.46 456.46 456.46 74 337.78 percent of total billed charges 456.46 93 369.73 percent of total billed charges 456.46 456.46 other OPPS APC 456.46 456.46 other OPPS APC 456.46 27.63 126.12 percent of total billed charges 456.46 456.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ECHELON ENDOPATH 2.6MM WHITE VASCULAR THIN TISSUE SUP-GST60W CDM 0270 RC outpatient 481.63 481.63 481.63 74 356.41 percent of total billed charges 481.63 93 390.12 percent of total billed charges 481.63 481.63 other OPPS APC 481.63 481.63 other OPPS APC 481.63 27.63 133.07 percent of total billed charges 481.63 481.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCCLUDER CARDIOVASCULAR GORE EPTFE OD 20MM SEPTAL SOFT WIRE FRAME FLUOROSCOPIC IMAGE SUP-GSX0020A CDM 0275 RC outpatient 15950 15950 15950 57 9091.5 percent of total billed charges 15950 93 12919.5 percent of total billed charges 15950 15950 other OPPS APC 15950 15950 other OPPS APC 15950 51 8134.5 percent of total billed charges 15950 15950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCCLUDER CARDIOVASCULAR GORE EPTFE OD 25MM SEPTAL SOFT WIRE FRAME FLUOROSCOPIC IMAGE SUP-GSX0025A CDM 0275 RC outpatient 16312 16312 16312 57 9297.84 percent of total billed charges 16312 93 13212.7 percent of total billed charges 16312 16312 other OPPS APC 16312 16312 other OPPS APC 16312 51 8319.12 percent of total billed charges 16312 16312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCCLUDER CARDIOVASCULAR GORE EPTFE OD 30MM SEPTAL SOFT WIRE FRAME FLUOROSCOPIC IMAGE SUP-GSX0030A CDM 0275 RC outpatient 16312 16312 16312 57 9297.84 percent of total billed charges 16312 93 13212.7 percent of total billed charges 16312 16312 other OPPS APC 16312 16312 other OPPS APC 16312 51 8319.12 percent of total billed charges 16312 16312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA ERCP TAPER TIP COOK SUP-GT-1-T CDM 0270 RC outpatient 169 169 169 74 125.06 percent of total billed charges 169 93 136.89 percent of total billed charges 169 169 other OPPS APC 169 169 other OPPS APC 169 27.63 46.69 percent of total billed charges 169 169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BARRX RFA ENDOSCOPIC GUIDEWIRE COATED 0.038IN X 260CM SUP-GW-002B CDM 0270 RC outpatient 499.2 499.2 499.2 74 369.41 percent of total billed charges 499.2 93 404.35 percent of total billed charges 499.2 499.2 other OPPS APC 499.2 499.2 other OPPS APC 499.2 27.63 137.93 percent of total billed charges 499.2 499.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR TRAXCESS NITINOL STAINLESS STEEL HYDROPHILIC L115 CM OD.014 IN ATRAUMATIC TIP KINK RESISTANT PUSH PULL CONTROL DOCK SUP-GW14100EX CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR TRAXCESS 14 NITINOL STAINLESS STEEL HYDROPHILIC L3 CM L200 CM L40 CM OD.012-.014 IN RADIOPAQUE SOFT ATRAUMATIC TIP HYBRID SUP-GW1420040 CDM 0270 RC outpatient 1118 1118 1118 74 827.32 percent of total billed charges 1118 93 905.58 percent of total billed charges 1118 1118 other OPPS APC 1118 1118 other OPPS APC 1118 27.63 308.9 percent of total billed charges 1118 1118 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR TRAXCESS 14 SELECT STAINLESS STEEL NITINOL HYDROPHILIC L98 CM L200 CM L3 CM OD.014 IN ODSEC.012 IN RADIOPAQUE SOFT ATRAUMATIC TIP KINK RESISTANT SUP-GW1420040S CDM 0270 RC outpatient 1417 1417 1417 74 1048.58 percent of total billed charges 1417 93 1147.77 percent of total billed charges 1417 1417 other OPPS APC 1417 1417 other OPPS APC 1417 27.63 391.52 percent of total billed charges 1417 1417 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR TRAXCESS 14 EX HYDROPHILIC STAINLESS STEEL 6 CM L200 CM L40 CM OD.012 IN ODSEC.014 IN RADIOPAQUE SUP-GW1420040X CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR CENTURION DISPOSABLE STERILE LF SUP-GW3245I CDM 0270 RC outpatient 25.48 25.48 25.48 74 18.86 percent of total billed charges 25.48 93 20.64 percent of total billed charges 25.48 25.48 other OPPS APC 25.48 25.48 other OPPS APC 25.48 27.63 7.04 percent of total billed charges 25.48 25.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAVR CONFIDA BRECKER GUIDEWIRE 260CM SUP-GWBC30 CDM 0481 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 51 258.57 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR DIAMONDBACK 360 VIPERWIRE ADVANCE L325 CM OD .014 IN CORONARY FLEXIBLE TIP STERILE LATEX FREE DISPOSABLE SUP-GWC-12325LG-FT CDM 0270 RC outpatient 546 546 546 74 404.04 percent of total billed charges 546 93 442.26 percent of total billed charges 546 546 other OPPS APC 546 546 other OPPS APC 546 27.63 150.86 percent of total billed charges 546 546 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR ATTAIN HYBRID STRAIGHT L78 CM OD.014 IN STABILITY SUP-GWR419478 CDM 0275 RC outpatient 260 260 260 57 148.2 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 51 132.6 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR ATTAIN HYBRID STRAIGHT 108CM 88CM .014IN TACHYARRHYTHMIA DEVICE SUP-GWR419488 CDM 0275 RC outpatient 260 260 260 57 148.2 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 51 132.6 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR ATTAIN HYBRID STRAIGHT L88 CM OD.018 IN STABILITY SUP-GWR419588 CDM 0275 RC outpatient 260 260 260 57 148.2 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 51 132.6 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR ATTAIN HYBRID STRAIGHT L98 CM OD.018 IN STABILITY SUP-GWR419678 CDM 0275 RC outpatient 100 100 100 57 57 percent of total billed charges 100 93 81 percent of total billed charges 100 100 other OPPS APC 100 100 other OPPS APC 100 51 51 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR ATTAIN HYBRID STRAIGHT L108 CM OD.018 IN STABILITY SUP-GWR419688 CDM 0275 RC outpatient 100 100 100 57 57 percent of total billed charges 100 93 81 percent of total billed charges 100 100 other OPPS APC 100 100 other OPPS APC 100 51 51 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR ROUND SUP-H1.018SHP11 CDM 0270 RC outpatient 2.31 2.31 2.31 74 1.71 percent of total billed charges 2.31 93 1.87 percent of total billed charges 2.31 2.31 other OPPS APC 2.31 2.31 other OPPS APC 2.31 27.63 0.64 percent of total billed charges 2.31 2.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR ROUND SUP-H1.023SHP11 CDM 0270 RC outpatient 3.25 3.25 3.25 74 2.41 percent of total billed charges 3.25 93 2.63 percent of total billed charges 3.25 3.25 other OPPS APC 3.25 3.25 other OPPS APC 3.25 27.63 0.9 percent of total billed charges 3.25 3.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP FEMORAL 3 HOLE 52MM SUP-H1.A11.1052 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHELL 3HOLE 54MM SUP-H1.A11.1054 CDM 270010024 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP MIRABO 3 HOLE 58MM SUP-H1.A11.1058 CDM 270010024 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP ACETABULAR BENCOX MIRABO TITANIUM DOME OD64 MM HIP SUP-H1.A11.1064 CDM 270010025 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP ACETABULAR BENCOX MIRABO OD56 MM HIP STERILE SUP-H1.A11.2056 CDM 270010024 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP MIRABO 3 HOLE 56MM SUP-H1.A11.2058 CDM 270010024 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.4MM X 15MM SUP-H1.B11.0015 CDM 270010024 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.4MM X 20MM SUP-H1.B11.0020 CDM 270010024 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.4MM X 25MM SUP-H1.B11.0025 CDM 270010024 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 6.4MM X 30MM SUP-H1.B11.0030 CDM 270010024 LOCAL 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BENCOX BONE 6.4 X 35MM SUP-H1.B11.0035 CDM 270010024 LOCAL 0270 RC outpatient 176.8 176.8 176.8 74 130.83 percent of total billed charges 176.8 93 143.21 percent of total billed charges 176.8 176.8 other OPPS APC 176.8 176.8 other OPPS APC 176.8 27.63 48.85 percent of total billed charges 176.8 176.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER BENCOX STANDARD 36MM HEAD SUP-H1.L51.3644 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER STANDARD 36MM SUP-H1.L61.3644 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER MIRABO STANDARD 36MM HEAD SUP-H1.L61.3648 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER BENCOX MIRABO STANDARD 36MM SUP-H1.L61.3652 CDM 270010025 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR LAPAROSCOPIC ENDOPATH XCEL OPTIVIEW 100MM 12MM DISPOSABLE STERILE SMOOTH SLEEVE OBTURATOR BLUNT TIP PISTOL HANDLE SUP-H12LP CDM 0270 RC outpatient 63.72 63.72 63.72 74 47.15 percent of total billed charges 63.72 93 51.61 percent of total billed charges 63.72 63.72 other OPPS APC 63.72 63.72 other OPPS APC 63.72 27.63 17.61 percent of total billed charges 63.72 63.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEDPAN PATIENT PLASTIC CONTOUR CONVENTIONAL DUSTY ROSE SUP-H131-10 CDM 0270 RC outpatient 8.38 8.38 8.38 74 6.2 percent of total billed charges 8.38 93 6.79 percent of total billed charges 8.38 8.38 other OPPS APC 8.38 8.38 other OPPS APC 8.38 27.63 2.32 percent of total billed charges 8.38 8.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. URINAL PATIENT MEDICHOICE POLYPROPYLENE MALE 1 OZ HANG LID TRANSLUCENT GRADUATED NOTCH HANDLE DISPOSABLE SUP-H140-01 CDM 0270 RC outpatient 0.91 0.91 0.91 74 0.67 percent of total billed charges 0.91 93 0.74 percent of total billed charges 0.91 0.91 other OPPS APC 0.91 0.91 other OPPS APC 0.91 27.63 0.25 percent of total billed charges 0.91 0.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR SURGICAL HANCOCK 18 MM SUP-H1701A18 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR PERFUSION HANCOCK OD18 MM APICAL LEFT VENTRICLE SUP-H174A-18 CDM 0270 RC outpatient 11700 11700 11700 74 8658 percent of total billed charges 11700 93 9477 percent of total billed charges 11700 11700 other OPPS APC 11700 11700 other OPPS APC 11700 27.63 3232.71 percent of total billed charges 11700 11700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOPCOCK ANGIOGRAPHY MARQUIS POLYCARBONATE DELRIN 1050 PSI 1 WAY FIXED MALE LUER DARK BLUE SUP-H1FLC CDM outpatient 4.42 4.42 4.42 4.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR CUTTER . SUP-H251E.11.040 CDM 0270 RC outpatient 42.9 42.9 42.9 74 31.75 percent of total billed charges 42.9 93 34.75 percent of total billed charges 42.9 42.9 other OPPS APC 42.9 42.9 other OPPS APC 42.9 27.63 11.85 percent of total billed charges 42.9 42.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR CUTTER . SUP-H251E104.040 CDM 0270 RC outpatient 37.47 37.47 37.47 74 27.73 percent of total billed charges 37.47 93 30.35 percent of total billed charges 37.47 37.47 other OPPS APC 37.47 37.47 other OPPS APC 37.47 27.63 10.35 percent of total billed charges 37.47 37.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASIN EMESIS POLYPROPYLENE KIDNEY L9 IN X W3.8 IN X H2 IN 16 OZ GRADUATED FLEXIBLE LATEX FREE DISPOSABLE DUSTY ROSE SUP-H300-10 CDM outpatient 0.33 0.33 0.33 0.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR ST. LONG SUP-H33L.11.016 CDM 0270 RC outpatient 2.6 2.6 2.6 74 1.92 percent of total billed charges 2.6 93 2.11 percent of total billed charges 2.6 2.6 other OPPS APC 2.6 2.6 other OPPS APC 2.6 27.63 0.72 percent of total billed charges 2.6 2.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOPCOCK ANGIOGRAPHY MARQUIS POLYCARBONATE DELRIN 1050 PSI 3 WAY FIXED MALE LUER DARK BLUE SUP-H3FLC CDM 0270 RC outpatient 49.4 49.4 49.4 74 36.56 percent of total billed charges 49.4 93 40.01 percent of total billed charges 49.4 49.4 other OPPS APC 49.4 49.4 other OPPS APC 49.4 27.63 13.65 percent of total billed charges 49.4 49.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR CUTTER . SUP-H71E104050 CDM 0270 RC outpatient 42.9 42.9 42.9 74 31.75 percent of total billed charges 42.9 93 34.75 percent of total billed charges 42.9 42.9 other OPPS APC 42.9 42.9 other OPPS APC 42.9 27.63 11.85 percent of total billed charges 42.9 42.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR CUTTER SUP-H73E.11.040E CDM 0270 RC outpatient 42.9 42.9 42.9 74 31.75 percent of total billed charges 42.9 93 34.75 percent of total billed charges 42.9 42.9 other OPPS APC 42.9 42.9 other OPPS APC 42.9 27.63 11.85 percent of total billed charges 42.9 42.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR CARBIDE CUTTER SUP-H73E.11.060 CDM 0270 RC outpatient 42.9 42.9 42.9 74 31.75 percent of total billed charges 42.9 93 34.75 percent of total billed charges 42.9 42.9 other OPPS APC 42.9 42.9 other OPPS APC 42.9 27.63 11.85 percent of total billed charges 42.9 42.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L12 MM ODSEC4.5 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7439912412450 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE INFLATION GATEWAY ENCORE 26 ADVANTAGE Y 20 ML KIT ADAPTER TORQUE GUIDEWIRE INTRODUCER SUP-H74904527052 CDM 0270 RC outpatient 82.37 82.37 82.37 74 60.95 percent of total billed charges 82.37 93 66.72 percent of total billed charges 82.37 82.37 other OPPS APC 82.37 82.37 other OPPS APC 82.37 27.63 22.76 percent of total billed charges 82.37 82.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON FEMORAL RIGHT 3.5 CURVE L100 CM OD5 FR ID.045 IN ROBUST SHAFT FULL LENGTH WIRE BRAID SUPER SOFT TIP VASCULAR ACCESS SUP-H74908526012 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON FEMORAL RIGHT 4 CURVE L100 CM OD5 FR ID.045 IN ROBUST SHAFT FULL LENGTH WIRE BRAID SUPER SOFT TIP VASCULAR ACCESS SUP-H74908526022 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5F FL3.5 DIAGNOSTIC CATHETER SUP-H7490852621 CDM 0481 RC outpatient 20.15 20.15 20.15 74 14.91 percent of total billed charges 20.15 93 16.32 percent of total billed charges 20.15 20.15 other OPPS APC 20.15 20.15 other OPPS APC 20.15 51 10.28 percent of total billed charges 20.15 20.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO FEMORAL LEFT 3.5 CURVE 100CM 5FR .045IN TRILON VENTRICLE ROBUST SHAFT FULL LENGTH WIRE BRAID SUP-H7490852621 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO FEMORAL LEFT 4 CURVE OD5 FR SUP-H74908526222 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON FULL LENGTH FEMORAL LEFT 4.5 CURVE L100 CM OD5 FR ID.045 IN ROBUST SHAFT WIRE BRAID SUP-H74908526232 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON FEMORAL LEFT 5 CURVE L100 CM OD5 FR ID.045 IN ROBUST SHAFT FULL LENGTH WIRE BRAID SUPER SOFT TIP VASCULAR ACCESS SUP-H74908526242 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON PIGTAIL CURVE FULL LENGTH L110 CM OD5 FR ID.041 IN VENTRICLE WIRE BRAIDING SUP-H74908526402 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON FULL LENGTH AMPLATZ LEFT 2 CURVE L100 CM OD5 FR ID.045 IN ROBUST SHAFT WIRE BRAID SUP-H74908526981 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F FR3.5 DIAGNOSTIC CATHETER 100CM SUP-H74908641012 CDM 0481 RC outpatient 20.15 20.15 20.15 74 14.91 percent of total billed charges 20.15 93 16.32 percent of total billed charges 20.15 20.15 other OPPS APC 20.15 20.15 other OPPS APC 20.15 51 10.28 percent of total billed charges 20.15 20.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F FR4 DIAGNOSTIC CATHETER 100CM SUP-H74908641022 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F FR5 DIAGNOSTIC CATHETER 100CM SUP-H74908641031 CDM 0481 RC outpatient 25.87 25.87 25.87 74 19.14 percent of total billed charges 25.87 93 20.95 percent of total billed charges 25.87 25.87 other OPPS APC 25.87 25.87 other OPPS APC 25.87 51 13.19 percent of total billed charges 25.87 25.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON FEMORAL RIGHT 6 CURVE L100 CM OD6 FR ID.056 IN ROBUST SHAFT FULL LENGTH WIRE BRAID VASCULAR ACCESS SUP-H74908641041 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON FULL LENGTH MUTLIPURPOSE A 1 CURVE L100 CM OD6 FR ID.052 IN ROBUST SHAFT WIRE BRAID SUP-H749086411172 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON MUTLIPURPOSE A 2 CURVE L100 CM OD6 FR ID.052 IN ROBUST SHAFT FULL LENGTH WIRE BRAID SIDEHOLE VASCULAR ACCESS SUP-H749086411211 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON MULTIPURPOSE A 2 CURVE L125 CM OD6 FR ID.052 IN ROBUST SHAFT FULL LENGTH WIRE BRAID SUPER SOFT TIP SIDEHOLE SUP-H749086411222 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON MULTIPURPOSE B 2 CURVE L100 CM OD6 FR ID.052 IN ROBUST SHAFT FULL LENGTH WIRE BRAID SUPER SOFT TIP SIDEHOLE SUP-H749086411461 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON RIGHT CORONARY BYPASS CURVE L100 CM OD6 FR ID.056 IN ROBUST SHAFT FULL LENGTH WIRE BRAID VASCULAR ACCESS SUP-H749086411901 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO LEFT CORONARY BYPASS CURVE OD6 FR SUP-H74908641195 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F IM DIAGNOSTIC CATHETER 100CM SUP-H749086412012 CDM 0481 RC outpatient 20.15 20.15 20.15 74 14.91 percent of total billed charges 20.15 93 16.32 percent of total billed charges 20.15 20.15 other OPPS APC 20.15 20.15 other OPPS APC 20.15 51 10.28 percent of total billed charges 20.15 20.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F FL3.5 DIAGNOSTIC CATHETER 100CM SUP-H74908641212 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON PIGTAIL CURVE L125 CM OD6 FR ID.052 IN ROBUST SHAFT FULL LENGTH WIRE BRAID SOFT TIP SUP-H749086412152 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON FEMORAL LEFT 4 CURVE L125 CM OD6 FR ID.056 IN ROBUST SHAFT FULL LENGTH WIRE BRAID SUPER SOFT TIP SUP-H749086412202 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F FL4 DIAGNOSTIC CATHETER 100CM SUP-H74908641222 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON FEMORAL RIGHT 4 CURVE L125 CM OD6 FR ID.056 IN ROBUST SHAFT FULL LENGTH WIRE BRAID SUPER SOFT TIP SUP-H749086412252 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC FR5 CURVE 6FR .056IN 125CM EXPO SUP-H749086412302 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO FEMORAL LEFT 4.5 CURVE OD6 FR SUP-H74908641232 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON FULL LENGTH FEMORAL LEFT 5 CURVE L100 CM OD6 FR ID.056 IN ROBUST SHAFT WIRE BRAID SUP-H749086412352 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO FEMORAL LEFT 5 CURVE OD6 FR SUP-H74908641242 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F FL6 DIAGNOSTIC CATHETER 100CM SUP-H74908641252 CDM 0481 RC outpatient 20.15 20.15 20.15 74 14.91 percent of total billed charges 20.15 93 16.32 percent of total billed charges 20.15 20.15 other OPPS APC 20.15 20.15 other OPPS APC 20.15 51 10.28 percent of total billed charges 20.15 20.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F PIGTAIL CATHETER 110CM SUP-H74908641402 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F 145 PIGTAIL CATHETER 110CM SUP-H74908641412 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO WILLIAMS RIGHT CURVE 100CM 6FR .056IN SUP-H74908641502 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON FULL LENGTH AMPLATZ RIGHT MODIFIED CURVE L100 CM OD6 FR ID.056 IN ROBUST SHAFT WIRE BRAID SUP-H74908641892 CDM 0481 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 51 9.98 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F AL1 DIAGNOSTIC CATHETER 100CM SUP-H7490864196 CDM 0481 RC outpatient 20.15 20.15 20.15 74 14.91 percent of total billed charges 20.15 93 16.32 percent of total billed charges 20.15 20.15 other OPPS APC 20.15 20.15 other OPPS APC 20.15 51 10.28 percent of total billed charges 20.15 20.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON AMPLATZ LEFT 2 CURVE L100 CM OD6 FR ID.056 IN ROBUST SHAFT FULL LENGTH WIRE BRAID VASCULAR ACCESS SUP-H74908641981 CDM outpatient 20.75 20.75 20.75 20.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC EXPO TRILON AMPLATZ LEFT 2 CURVE L100 CM OD6 FR ID.056 IN ROBUST SHAFT FULL LENGTH WIRE BRAID VASCULAR ACCESS SUP-H74908641982 CDM 0270 RC outpatient 19.57 19.57 19.57 74 14.48 percent of total billed charges 19.57 93 15.85 percent of total billed charges 19.57 19.57 other OPPS APC 19.57 19.57 other OPPS APC 19.57 27.63 5.41 percent of total billed charges 19.57 19.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR CHOICE PT SECONDLINE 0.014IN 300CM 35CM TIP 2.1GM STRAIGHT TIP FLOPPY LIGHT SUPPORT SS POLYMER HYDROPHILIC 1EA SUP-H74912154011 CDM 0270 RC outpatient 234 234 234 74 173.16 percent of total billed charges 234 93 189.54 percent of total billed charges 234 234 other OPPS APC 234 234 other OPPS APC 234 27.63 64.65 percent of total billed charges 234 234 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR CHOICE PT SECONDLINE 0.014IN 300CM 35CM TIP 2.1GM STRAIGHT TIP FLOPPY LIGHT SUPPORT SS POLYMER HYDROPHILIC 5/BX SUP-H74912154012 CDM 0270 RC outpatient 200.2 200.2 200.2 74 148.15 percent of total billed charges 200.2 93 162.16 percent of total billed charges 200.2 200.2 other OPPS APC 200.2 200.2 other OPPS APC 200.2 27.63 55.32 percent of total billed charges 200.2 200.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR CHOICE PT SECONDLINE 0.014IN 185CM 35CM TIP 2.1GM STRAIGHT TIP FLOPPY LIGHT SUPPORT SS POLYMER HYDROPHILIC 1EA SUP-H74912160011 CDM 0270 RC outpatient 234 234 234 74 173.16 percent of total billed charges 234 93 189.54 percent of total billed charges 234 234 other OPPS APC 234 234 other OPPS APC 234 27.63 64.65 percent of total billed charges 234 234 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR CHOICE PT STRAIGHT L185 CM L35 CM OD.014 IN FLOPPY RADIOPAQUE LIGHT RAIL SUPPORT SUP-H74912160012 CDM 0270 RC outpatient 200.2 200.2 200.2 74 148.15 percent of total billed charges 200.2 93 162.16 percent of total billed charges 200.2 200.2 other OPPS APC 200.2 200.2 other OPPS APC 200.2 27.63 55.32 percent of total billed charges 200.2 200.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - CHOICE FLOPPY - 182CM SUP-H7491216001J1 CDM C1769 HCPCS 0272 RC outpatient 288.4 288.4 288.4 74 213.42 percent of total billed charges 288.4 93 233.6 percent of total billed charges 288.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 288.4 other OPPS APC 288.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 288.4 other OPPS APC 288.4 27.63 79.68 percent of total billed charges 288.4 288.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE - CHOICE PT - J-TIP - 182CM SUP-H7491216001J1 CDM C1769 HCPCS 0272 RC outpatient 268.73 268.73 268.73 74 198.86 percent of total billed charges 268.73 93 217.67 percent of total billed charges 268.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 268.73 other OPPS APC 268.73 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 268.73 other OPPS APC 268.73 27.63 74.25 percent of total billed charges 268.73 268.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR CHOICE PT SECONDLINE 0.014IN 185CM 35CM TIP 2.1GM J-TIP FLOPPY LIGHT SUPPORT SS POLYMER HYDROPHILIC 5/BX SUP-H7491216001J2 CDM 0270 RC outpatient 200.2 200.2 200.2 74 148.15 percent of total billed charges 200.2 93 162.16 percent of total billed charges 200.2 200.2 other OPPS APC 200.2 200.2 other OPPS APC 200.2 27.63 55.32 percent of total billed charges 200.2 200.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR CHOICE PT SECONDLINE 0.014IN 182CM 35CM TIP 2GM STRAIGHT TIP EXTRA SUPPORT SS POLYMER HYDROPHILIC 5/BX SUP-H74912161012 CDM 0270 RC outpatient 200.2 200.2 200.2 74 148.15 percent of total billed charges 200.2 93 162.16 percent of total billed charges 200.2 200.2 other OPPS APC 200.2 200.2 other OPPS APC 200.2 27.63 55.32 percent of total billed charges 200.2 200.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTERWIRE EZ LARGE VESSEL 3.5MM - 5.5MM SUP-H749201001900 CDM 0481 RC outpatient 4338.36 4338.36 4338.36 74 3210.39 percent of total billed charges 4338.36 93 3514.07 percent of total billed charges 4338.36 4338.36 other OPPS APC 4338.36 4338.36 other OPPS APC 4338.36 51 2212.56 percent of total billed charges 4338.36 4338.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LUBRICANT INSTRUMENT ROTAGLIDE 20 CC PERIPHERAL VIAL ROTABLATOR SUP-H7492354800162 CDM 0270 RC outpatient 230.97 230.97 230.97 74 170.92 percent of total billed charges 230.97 93 187.09 percent of total billed charges 230.97 230.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTABLATOR BURR CATHETER 1.25MM SUP-H749236310020 CDM 0270 RC outpatient 4147 4147 4147 74 3068.78 percent of total billed charges 4147 93 3359.07 percent of total billed charges 4147 4147 other OPPS APC 4147 4147 other OPPS APC 4147 27.63 1145.82 percent of total billed charges 4147 4147 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTABLATOR BURR CATHETER 1.5MM SUP-H749236310030 CDM 0270 RC outpatient 4147 4147 4147 74 3068.78 percent of total billed charges 4147 93 3359.07 percent of total billed charges 4147 4147 other OPPS APC 4147 4147 other OPPS APC 4147 27.63 1145.82 percent of total billed charges 4147 4147 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTABLATOR BURR CATHETER 1.75MM SUP-H749236310040 CDM 0270 RC outpatient 4147 4147 4147 74 3068.78 percent of total billed charges 4147 93 3359.07 percent of total billed charges 4147 4147 other OPPS APC 4147 4147 other OPPS APC 4147 27.63 1145.82 percent of total billed charges 4147 4147 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTABLATOR BURR CATHETER 2.0MM SUP-H749236310050 CDM 0270 RC outpatient 4147 4147 4147 74 3068.78 percent of total billed charges 4147 93 3359.07 percent of total billed charges 4147 4147 other OPPS APC 4147 4147 other OPPS APC 4147 27.63 1145.82 percent of total billed charges 4147 4147 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTA BURR 2.25 SUP-H749236310060 CDM 0270 RC outpatient 4147 4147 4147 74 3068.78 percent of total billed charges 4147 93 3359.07 percent of total billed charges 4147 4147 other OPPS APC 4147 4147 other OPPS APC 4147 27.63 1145.82 percent of total billed charges 4147 4147 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTA BURR 2.5 SUP-H749236310070 CDM 0270 RC outpatient 4147 4147 4147 74 3068.78 percent of total billed charges 4147 93 3359.07 percent of total billed charges 4147 4147 other OPPS APC 4147 4147 other OPPS APC 4147 27.63 1145.82 percent of total billed charges 4147 4147 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTA BURR 2.15 SUP-H749236310150 CDM 0270 RC outpatient 4147 4147 4147 74 3068.78 percent of total billed charges 4147 93 3359.07 percent of total billed charges 4147 4147 other OPPS APC 4147 4147 other OPPS APC 4147 27.63 1145.82 percent of total billed charges 4147 4147 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS SD MONORAIL STAINLESS STEEL L15 MM L90 CM OD4 MM RENAL PREMOUNT BALLOON EXPAND CATHETER RADIOPAQUE STERILE DISPOSABLE ACCEPTS 5 FR SHEATH 6 FR GUIDE PTRA FG SUP-H74937911415900 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS SD MONORAIL STAINLESS STEEL L15 MM L90 CM OD5 MM RENAL PREMOUNT BALLOON EXPAND CATHETER RADIOPAQUE STERILE DISPOSABLE ACCEPTS 5 FR SHEATH 6 FR GUIDE PTRA FG SUP-H74937911515900 CDM 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS SD MONORAIL STAINLESS STEEL L14 MM L150 CM OD6 MM RENAL PREMOUNT BALLOON EXPAND CATHETER RADIOPAQUE STERILE DISPOSABLE ACCEPTS 5 FR SHEATH 6 FR GUIDE PTRA SUP-H74937911614150 CDM 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS SD MONORAIL STAINLESS STEEL L14 MM L90 CM OD6 MM RENAL PREMOUNT BALLOON EXPAND CATHETER RADIOPAQUE STERILE DISPOSABLE ACCEPTS 5 FR SHEATH 6 FR GUIDE PTRA SUP-H74937911614900 CDM 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS SD MONORAIL STAINLESS STEEL L19 MM L150 CM OD5 MM RENAL PREMOUNT BALLOON EXPAND CATHETER RADIOPAQUE STERILE DISPOSABLE ACCEPTS 5 FR SHEATH 6 FR GUIDE PTRA SUP-H74937912519150 CDM 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS SD MONORAIL STAINLESS STEEL L19 MM L90 CM OD5 MM RENAL PREMOUNT BALLOON EXPAND CATHETER RADIOPAQUE STERILE DISPOSABLE ACCEPTS 5 FR SHEATH 6 FR GUIDE PTRA FG SUP-H74937912519900 CDM 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY 6MM 18MM 150CM PREMOUNT BALLOON EXPAND CATHETER RADIOPAQUE RENAL SUP-H74937912618150 CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS SD MONORAIL METAL SMALL L18 MM L90 CM OD6 MM RENAL PREMOUNT BALLOON EXPAND SUP-H74937912618900 CDM 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS LD TANDEM ARCHITECTURE STAINLESS STEEL L30 MM L25 MM L75 CM OD10 MM ILIAC OTW PREMOUNT NONCOMPLIANT BALLOON RADIOPAQUE STERILE DISPOSABLE SUP-H74938046102070 CDM 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS LD L40 MM L37 MM L75 CM OD10 MM ILIAC OTW PREMOUNT CATHETER ACCEPTS 7 FR SHEATH SUP-H74938046104070 CDM 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY 6MM 27MM 75CM 30MM OTW PREMOUNT NONCOMPLIANT BALLOON RADIOPAQUE ILIAC SUP-H74938046630750 CDM 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS LD TANDEM ARCHITECTURE METAL L40 MM L37 MM L75 CM OD6 MM OTW PREMOUNT BALLOON EXPAND STERILE DISPOSABLE ACCEPTS 6 FR INTRODUCER SHEATH SUP-H74938046640750 CDM 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS LD TANDEM ARCHITECTURE METAL L30 MM L27 MM L75 CM OD7 MM OTW PREMOUNT BALLOON EXPAND STERILE DISPOSABLE ACCEPTS 6 FR INTRODUCER SHEATH SUP-H74938046730750 CDM 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS LD TANDEM ARCHITECTURE METAL L40 MM L37 MM L75 CM OD7 MM OTW PREMOUNT BALLOON EXPAND STERILE DISPOSABLE ACCEPTS 6 FR INTRODUCER SHEATH SUP-H74938046740750 CDM 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS LD TANDEM ARCHITECTURE STAINLESS STEEL L60 MM L57 MM L75 CM OD7 MM ILIAC OTW PREMOUNT BALLOON EXPAND RADIOPAQUE STERILE DISPOSABLE ACCEPTS 6 FR SHEATH SUP-H74938046760750 CDM 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS LD TANDEM ARCHITECTURE STAINLESS STEEL L30 MM L27 MM L75 CM OD8 MM ILIAC OTW PREMOUNT NONCOMPLIANT BALLOON RADIOPAQUE STERILE DISPOSABLE SUP-H74938046830750 CDM 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS LD TANDEM ARCHITECTURE METAL L40 MM L37 MM L75 CM OD8 MM OTW PREMOUNT BALLOON EXPAND STERILE DISPOSABLE ACCEPTS 6 FR INTRODUCER SHEATH SUP-H74938046840750 CDM 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS LD TANDEM ARCHITECTURE METAL L30 MM L27 MM L135 CM OD6 MM ILIAC OTW PREMOUNT BALLOON EXPAND CATHETER STERILE DISPOSABLE ACCEPTS 6 FR INTRODUCER SHEATH SUP-H74938047630130 CDM 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS LD TANDEM ARCHITECTURE METAL L30 MM L27 MM L135 CM OD7 MM OTW PREMOUNT BALLOON EXPAND STERILE DISPOSABLE ACCEPTS 6 FR INTRODUCER SHEATH SUP-H74938047730130 CDM 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS LD TANDEM ARCHITECTURE METAL L30 MM L27 MM L135 CM OD8 MM ILIAC OTW PREMOUNT BALLOON EXPAND CATHETER STERILE DISPOSABLE ACCEPTS 6 FR INTRODUCER SHEATH SUP-H74938047830130 CDM 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR PT2 STAINLESS STEEL NITINOL POLYMER HYDROPHILIC STRAIGHT L185 CM OD.014 IN MODERATE SUPPORT INTERMEDIATE TIP SUP-H74938931032 CDM 0481 RC outpatient 173.67 173.67 173.67 74 128.52 percent of total billed charges 173.67 93 140.67 percent of total billed charges 173.67 173.67 other OPPS APC 173.67 173.67 other OPPS APC 173.67 51 88.57 percent of total billed charges 173.67 173.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR PT2 POLYMER HYDROPHILIC L185 CM OD.014 IN MODERATE RAIL SUPPORT INTERMEDIATE J TIP SUP-H7493893103J2 CDM 0481 RC outpatient 173.67 173.67 173.67 74 128.52 percent of total billed charges 173.67 93 140.67 percent of total billed charges 173.67 173.67 other OPPS APC 173.67 173.67 other OPPS APC 173.67 51 88.57 percent of total billed charges 173.67 173.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY 10MM 79MM 135CM SELF EXPAND SENTINOL NITINOL ACCEPTS 6FR SHEATH SUP-H7493894818010 CDM 0275 RC outpatient 9305.4 9305.4 9305.4 57 5304.08 percent of total billed charges 9305.4 93 7537.37 percent of total billed charges 9305.4 9305.4 other OPPS APC 9305.4 9305.4 other OPPS APC 9305.4 51 4745.75 percent of total billed charges 9305.4 9305.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IQ MARKER WIRE 185 STRAIGHT SUP-H74938950012 CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IQ MARKER WIRE 185 J SUP-H7493895001J2 CDM 0481 RC outpatient 208 208 208 74 153.92 percent of total billed charges 208 93 168.48 percent of total billed charges 208 208 other OPPS APC 208 208 other OPPS APC 208 51 106.08 percent of total billed charges 208 208 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING MONORAIL LOW PROFILE TAPER L135 CM L20 MM OD3.8-3.4 FR ODSEC3 MM RAPID EXCHANGE INFLATION PORT ACCEPTS .018 IN GUIDEWIRE PTA SUP-H74939031302010 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING MONORAIL LOW PROFILE HELIX L135 CM L20 MM OD3.8-3.4 FR ODSEC4 MM RAPID EXCHANGE ACCEPTS .018 IN GUIDEWIRE TRANSLUMINAL ANGIOPLASTY SUP-H74939031402010 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING MONORAIL PEBAX BIOSLIDE TAPER L135 CM L20 MM OD3.8-3.4 FR ODSEC5 MM RAPID EXCHANGE INFLATION PORT LOW PROFILE ACCEPTS .018 IN GUIDEWIRE 4 FR SHEATH PTA SUP-H74939031502010 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE SAVION FIX.014/300 CM ANGLED TIP SUP-H74939031502010 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING MONORAIL PEBAX BIOSLIDE L80 CM L40 MM ODSEC5 MM PERIPHERAL TAPER TIP LOW PROFILE INFLATE PORT ACCEPTS .018 IN GUIDEWIRE 4 FR SHEATH 6 FR GUIDE CATHETER PTA SUP-H74939031504080 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING MONORAIL PEBAX BIOSLIDE TAPER L135 CM L20 MM OD3.8-3.4 FR ODSEC6 MM RAPID EXCHANGE INFLATION PORT LOW PROFILE ACCEPTS .018 IN GUIDEWIRE 4 FR SHEATH PTA SUP-H74939031602010 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON ANGIOPLASTY DILATATION WORKHORSE STERLING MONORAIL 6MM X 20MM 80CM RX SEMI-COMPLIANT COAXIAL F/PTA LOW-PROFILE PEBAX BIOSLIDE PERIPHERAL RADIOPAQUE MARKER 0.018IN GW 4FR SHEATH SUP-H74939031602080 CDM 0270 RC outpatient 715 715 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING PEBAX BIOSLIDE L135 CM L40 MM OD7 FR ODSEC10 MM ID5 FR OTW INFLATION PORT LOW PROFILE TAPER TIP ACCEPTS .018 IN GUIDEWIRE PTA SUP-H74939032104010 CDM 0270 RC outpatient 702 702 702 74 519.48 percent of total billed charges 702 93 568.62 percent of total billed charges 702 702 other OPPS APC 702 702 other OPPS APC 702 27.63 193.96 percent of total billed charges 702 702 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION LOW PROFILE TAPER 4FR 3MM 150CM 40MM OTW INFLATION WIRE SUP-H74939032300410 CDM 0270 RC outpatient 702 702 702 74 519.48 percent of total billed charges 702 93 568.62 percent of total billed charges 702 702 other OPPS APC 702 702 other OPPS APC 702 27.63 193.96 percent of total billed charges 702 702 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING PEBAX BIOSLIDE LOW PROFILE TAPER L150 CM L60 MM OD4 FR ODSEC3 MM OTW INFLATION WIRE PORT ACCEPTS .018 IN GUIDEWIRE PTA SUP-H74939032300610 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING LOW PROFILE TAPER L40 CM L20 MM OD3.8 FR ODSEC4 MM OTW RAPID EXCHANGE INFLATION WIRE PORT ACCEPTS .014/.018 IN GUIDEWIRE 4 FR INTRODUCER SHEATH PTA SUP-H74939032402040 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING .018 IN L135 CM L40 MM OD6 FR ODSEC4 MM OTW LOW PROFILE INFLATION PORT GUIDEWIRE ANGIOPLASTY ACCEPTS 4 FR INTRODUCER SHEATH SUP-H74939032404010 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING PEBAX BIOSLIDE L40 CM L40 MM OD6 FR ODSEC4 MM ID4 FR OTW INFLATION PORT LOW PROFILE TAPER TIP ACCEPTS .018 IN GUIDEWIRE PTA SUP-H74939032404040 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING PEBAX BIOSLIDE L135 CM L60 MM OD6 FR ODSEC4 MM OTW LOW PROFILE INFLATION WIRE PORT ACCEPTS .018 IN GUIDEWIRE 4 FR INTRODUCER SHEATH PTA SUP-H74939032406010 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING .018 IN L135 MM L100 MM OD6 FR ODSEC5 MM OTW LOW PROFILE INFLATION PORT GUIDEWIRE ANGIOPLASTY ACCEPTS 4 FR INTRODUCER SHEATH SUP-H74939032501010 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON ANGIOPLASTY DILATATION WORKHORSE HYBRID STERLING 5MM X 150MM 150CM OTW SEMI-COMPLIANT COAXIAL F/PTA LOW-PROFILE PEBAX BIOSLIDE PERIPHERAL RADIOPAQUE MARKER 0.018IN GW 5FR SHEATH SUP-H74939032501510 CDM 0270 RC outpatient 702 702 702 702 other OPPS APC 702 702 other OPPS APC 702 27.63 193.96 percent of total billed charges 702 702 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION 7FR 5MM 5FR 150CM 150MM OTW INFLATION PORT LOW PROFILE SUP-H74939032501510 CDM 0270 RC outpatient 702 702 702 74 519.48 percent of total billed charges 702 93 568.62 percent of total billed charges 702 702 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING .018 L135 CM L20 MM OD6 FR ODSEC5 MM OTW LOW PROFILE INFLATION PORT GUIDEWIRE PTA ACCEPTS 4 FR INTRODUCER SHEATH SUP-H74939032502010 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING L40 CM L20 MM OD3.8 FR ODSEC5 MM OTW RAPID EXCHANGE INFLATION WIRE PORT ACCEPTS .018 GUIDEWIRE 4 FR INTRODUCER SHEATH ANGIOPLASTY SUP-H74939032502040 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON ANGIOPLASTY DILATATION WORKHORSE HYBRID STERLING 5MM X 200MM 150CM OTW SEMI-COMPLIANT COAXIAL F/PTA LOW-PROFILE PEBAX BIOSLIDE PERIPHERAL RADIOPAQUE MARKER 0.018IN GW 5FR SHEATH SUP-H74939032502110 CDM 0270 RC outpatient 863.2 863.2 863.2 863.2 other OPPS APC 863.2 863.2 other OPPS APC 863.2 27.63 238.5 percent of total billed charges 863.2 863.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION 7FR 5MM 5FR 150CM 220MM OTW INFLATION PORT LOW PROFILE SUP-H74939032502210 CDM 0270 RC outpatient 767 767 767 74 567.58 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 27.63 211.92 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING .018 IN L135 MM L40 MM OD6 FR ODSEC5 MM OTW LOW PROFILE INFLATION PORT GUIDEWIRE ANGIOPLASTY ACCEPTS 4 FR INTRODUCER SHEATH SUP-H74939032504010 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING L40 CM L40 MM OD3.8 FR ODSEC5 MM OTW ACCEPTS .018 IN GUIDEWIRE 4 FR INTRODUCER SHEATH ANGIOPLASTY SUP-H74939032504040 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING .018 IN L135 MM L60 MM OD6 FR ODSEC5 MM OTW LOW PROFILE INFLATION PORT GUIDEWIRE ANGIOPLASTY ACCEPTS 4 FR INTRODUCER SHEATH SUP-H74939032506010 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING .018 IN L135 MM L100 MM OD7 FR ODSEC6 MM OTW LOW PROFILE INFLATION PORT GUIDEWIRE ANGIOPLASTY ACCEPTS 5 FR INTRODUCER SHEATH SUP-H74939032601010 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON ANGIOPLASTY DILATATION WORKHORSE HYBRID STERLING 6MM X 150MM 150CM OTW SEMI-COMPLIANT COAXIAL F/PTA LOW-PROFILE PEBAX BIOSLIDE PERIPHERAL RADIOPAQUE MARKER 0.018IN GW 5FR SHEATH SUP-H74939032601510 CDM 0270 RC outpatient 702 702 702 702 other OPPS APC 702 702 other OPPS APC 702 27.63 193.96 percent of total billed charges 702 702 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION 7FR 6MM 5FR 150CM 150MM OTW INFLATION PORT LOW PROFILE SUP-H74939032601510 CDM 0270 RC outpatient 702 702 702 74 519.48 percent of total billed charges 702 93 568.62 percent of total billed charges 702 702 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING L135 CM L20 MM OD6 FR ODSEC6 MM OTW INFLATION PORT TAPER TIP ACCEPTS .018 IN GUIDEWIRE 5 FR SHEATH PTA SUP-H74939032602010 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON ANGIOPLASTY DILATATION WORKHORSE HYBRID STERLING 6MM X 200MM 150CM OTW SEMI-COMPLIANT COAXIAL F/PTA LOW-PROFILE PEBAX BIOSLIDE PERIPHERAL RADIOPAQUE MARKER 0.018IN GW 5FR SHEATH SUP-H74939032602110 CDM 0270 RC outpatient 863.2 863.2 863.2 863.2 other OPPS APC 863.2 863.2 other OPPS APC 863.2 27.63 238.5 percent of total billed charges 863.2 863.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION 7FR 6MM 5FR 150CM 220MM OTW INFLATION PORT LOW PROFILE SUP-H74939032602210 CDM 0270 RC outpatient 767 767 767 74 567.58 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 27.63 211.92 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING PEBAX BIOSLIDE L135 CM L40 MM OD6 FR ODSEC6 MM ID4 FR OTW LOW PROFILE INFLATION WIRE PORT ACCEPTS .018 IN GUIDEWIRE PTA SUP-H74939032604010 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING L40 CM L40 MM OD3.8 FR ODSEC6 MM OTW ACCEPTS .018 GUIDEWIRE 4 FR INTRODUCER SHEATH ANGIOPLASTY SUP-H74939032604040 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING .018 IN L135 MM L60 MM OD6 FR ODSEC6 MM OTW LOW PROFILE INFLATION PORT GUIDEWIRE ANGIOPLASTY ACCEPTS 4 FR INTRODUCER SHEATH SUP-H74939032606010 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON ANGIOPLASTY DILATATION WORKHORSE STERLING 7MM X 40MM 135CM OTW SEMI-COMPLIANT COAXIAL F/PTA LOW-PROFILE PEBAX BIOSLIDE PERIPHERAL RADIOPAQUE MARKER 0.018IN GW 4FR SHEATH SUP-H74939032704010 CDM 0270 RC outpatient 650 650 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING PEBAX BIOSLIDE LOW PROFILE TAPER L135 CM L40 MM OD3.8 FR ODSEC7 MM OTW INFLATION PORT ACCEPTS .018 IN GUIDEWIRE 4 FR SHEATH PTA SUP-H74939032704010 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING L40 CM L40 MM OD3.8 FR ODSEC7 MM OTW ACCEPTS .018 IN GUIDEWIRE 4 FR INTRODUCER SHEATH ANGIOPLASTY SUP-H74939032704040 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING PEBAX BIOSLIDE LOW PROFILE TAPER L135 CM L60 MM OD4.8 FR ODSEC7 MM OTW INFLATION PORT ACCEPTS .018 IN GUIDEWIRE 5 FR SHEATH PTA SUP-H74939032706010 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING PEBAX BIOSLIDE L135 CM L20 MM OD6 FR ODSEC8 MM ID4 FR OTW INFLATION PORT LOW PROFILE TAPER TIP ACCEPTS .018 IN GUIDEWIRE PTA SUP-H74939032802010 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING PEBAX BIOSLIDE L135 CM L40 MM OD6 FR ODSEC8 MM ID4 FR OTW INFLATION PORT LOW PROFILE TAPER TIP ACCEPTS .018 IN GUIDEWIRE PTA SUP-H74939032804010 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION 7FR 9MM 5FR 135CM 40MM OTW INFLATION PORT LOW PROFILE SUP-H74939032904010 CDM 0270 RC outpatient 702 702 702 74 519.48 percent of total billed charges 702 93 568.62 percent of total billed charges 702 702 other OPPS APC 702 702 other OPPS APC 702 27.63 193.96 percent of total billed charges 702 702 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON ANGIOPLASTY DILATATION WORKHORSE STERLING 3MM X 40MM 150CM OTW SEMI-COMPLIANT COAXIAL F/PTA LOW-PROFILE PEBAX BIOSLIDE PERIPHERAL RADIOPAQUE MARKER 0.018IN GW 4FR SHEATH SUP-H749390332300410 CDM 0270 RC outpatient 715 715 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTERWIRE EZ SMALL VESSEL 2.25MM - 3.5MM SUP-H749390711900 CDM 0481 RC outpatient 4338.36 4338.36 4338.36 74 3210.39 percent of total billed charges 4338.36 93 3514.07 percent of total billed charges 4338.36 4338.36 other OPPS APC 4338.36 4338.36 other OPPS APC 4338.36 51 2212.56 percent of total billed charges 4338.36 4338.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR 185CM .014IN SLEEVE MODERATE RAIL SUPPORT HYBRID J MICRO CUT SUP-H7493912201J0 CDM 0481 RC outpatient 182 182 182 74 134.68 percent of total billed charges 182 93 147.42 percent of total billed charges 182 182 other OPPS APC 182 182 other OPPS APC 182 51 92.82 percent of total billed charges 182 182 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L6 MM ODSEC2.25 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912406220 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L6 MM ODSEC2.5 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912406250 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L6 MM ODSEC2.75 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912406270 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L6 MM ODSEC3 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912406300 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L6 MM ODSEC3.25 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912406320 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L6 MM ODSEC3.5 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912406350 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L6 MM ODSEC3.75 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912406370 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L8 MM ODSEC2.25 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912408220 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX MONORAIL 143CM 8MM 2.5MM PLATINUM IRIDIUM RAPID EXCHANGE ACCEPTS .014IN SUP-H7493912408250 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX MONORAIL 143CM 8MM 2.75MM PLATINUM IRIDIUM RAPID EXCHANGE ACCEPTS .014IN SUP-H7493912408270 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L8 MM ODSEC3 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912408300 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L8 MM ODSEC3.25 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912408320 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX MONORAIL 143CM 8MM 3.5MM PLATINUM IRIDIUM RAPID EXCHANGE ACCEPTS .014IN SUP-H7493912408350 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX MONORAIL 143CM 8MM 3.75MM PLATINUM IRIDIUM RAPID EXCHANGE ACCEPTS .014IN SUP-H7493912408370 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX MONORAIL 143CM 8MM 4MM PLATINUM IRIDIUM RAPID EXCHANGE ACCEPTS .014IN SUP-H7493912408400 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L8 MM ODSEC4.5 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912408450 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L8 MM ODSEC5 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912408500 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L12 MM ODSEC2.25 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912412220 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L12 MM ODSEC2.5 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912412250 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L12 MM ODSEC2.75 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912412270 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L12 MM ODSEC3 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912412300 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L12 MM ODSEC3.25 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912412320 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L12 MM ODSEC3.5 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912412350 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L12 MM ODSEC3.75 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912412370 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L12 MM ODSEC4 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912412400 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NC QUANTUM APEX BALLOON 4.5 X 12 SUP-H7493912412450 CDM 0481 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 51 152.49 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L12 MM ODSEC5 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912412500 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L15 MM ODSEC2 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912415200 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L15 MM ODSEC2.25 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912415220 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX MONORAIL 143CM 15MM 2.5MM PLATINUM IRIDIUM RAPID EXCHANGE ACCEPTS .014IN SUP-H7493912415250 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX MONORAIL 143CM 15MM 2.75MM PLATINUM IRIDIUM RAPID EXCHANGE ACCEPTS .014IN SUP-H7493912415270 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX MONORAIL 143CM 15MM 3MM PLATINUM IRIDIUM RAPID EXCHANGE ACCEPTS .014IN SUP-H7493912415300 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L15 MM ODSEC3.25 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912415320 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L15 MM ODSEC3.5 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912415350 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L15 MM ODSEC3.75 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912415370 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX MONORAIL 143CM 15MM 4MM PLATINUM IRIDIUM RAPID EXCHANGE ACCEPTS .014IN SUP-H7493912415400 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L15 MM ODSEC4.5 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912415450 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L15 MM ODSEC5 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912415500 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L20 MM ODSEC2.25 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912420220 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L20 MM ODSEC2.5 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912420250 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L20 MM ODSEC2.75 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912420270 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX MONORAIL 143CM 20MM 3MM PLATINUM IRIDIUM RAPID EXCHANGE ACCEPTS .014IN SUP-H7493912420300 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX MONORAIL 143CM 20MM 3.25MM PLATINUM IRIDIUM RAPID EXCHANGE ACCEPTS .014IN SUP-H7493912420320 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L20 MM ODSEC3.5 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912420350 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L20 MM ODSEC3.75 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912420370 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX MONORAIL 143CM 20MM 4MM PLATINUM IRIDIUM RAPID EXCHANGE ACCEPTS .014IN SUP-H7493912420400 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L20 MM ODSEC4.5 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912420450 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L20 MM ODSEC5 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912420500 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L30 MM ODSEC2.75 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912430270 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX MONORAIL 143CM 30MM 3MM PLATINUM IRIDIUM RAPID EXCHANGE ACCEPTS .014IN SUP-H7493912430300 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L30 MM ODSEC3.25 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912430320 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC QUANTUM APEX PLATINUM IRIDIUM L143 CM L30 MM ODSEC3.5 MM MONORAIL RAPID EXCHANGE ACCEPTS .014 IN GUIDEWIRE PTCA SUP-H7493912430350 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE ES 142CM 20MM 6FR 2MM OTW LOW PROFILE ACCEPTS .014IN GUIDEWIRE 4FR INTRODUCER SHEATH SUP-H74939134202010 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE ES 144CM 40MM 6FR 2MM OTW LOW PROFILE ACCEPTS .014IN GUIDEWIRE 4FR INTRODUCER SHEATH SUP-H74939134204010 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE ES 143CM 20MM 6FR 2.5MM OTW LOW PROFILE ACCEPTS .014IN GUIDEWIRE 4FR INTRODUCER SUP-H74939134252010 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE ES 145CM 40MM 6FR 2.5MM OTW LOW PROFILE ACCEPTS .014IN GUIDEWIRE 4FR INTRODUCER SUP-H74939134254010 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE ES 143CM 20MM 6FR 3MM OTW LOW PROFILE ACCEPTS .014IN GUIDEWIRE 4FR INTRODUCER SHEATH SUP-H74939134302010 CDM 0270 RC outpatient 767 767 767 74 567.58 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 27.63 211.92 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE ES .014 IN L145 CM L40 MM ODSEC3 MM OTW ULTRA LOW PROFILE GUIDEWIRE SUP-H74939134304010 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE ES 143CM 20MM 6FR 4MM OTW LOW PROFILE ACCEPTS .014IN GUIDEWIRE 4FR INTRODUCER SHEATH SUP-H74939134402010 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE ES 145CM 40MM 6FR 4MM OTW LOW PROFILE ACCEPTS .014IN GUIDEWIRE 4FR INTRODUCER SHEATH SUP-H74939134404010 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING SL L150 CM L100 MM OD3.8 FR ODSEC3 MM OTW LOW PROFILE ACCEPTS .018 IN GUIDEWIRE 4 FR SHEATH PTA SUP-H74939148301010 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION STERLING SL L150 CM L100 MM OD3.8 FR ODSEC4 MM OTW LOW PROFILE ACCEPTS .018 IN GUIDEWIRE 4 FR SHEATH PTA SUP-H74939148401010 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L135 CM L20 MM ODSEC3 MM HIGH PRESSURE SUP-H74939171030210 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX L135 CM L40 MM ODSEC3 MM HIGH PRESSURE ACCEPTS .035 IN GUIDEWIRE 5 FR INTRODUCER SHEATH SUP-H74939171030410 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION .035IN 4MM 135CM 20MM HIGH PRESSURE LOW PROFILE GUIDEWIRE SUP-H74939171040210 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG 135CM 20MM 4MM NYBAX HIGH PRESSURE ACCEPTS .035IN GUIDEWIRE 5FR INTRODUCER SHEATH SUP-H74939171040210 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG 75CM 20MM 4MM NYBAX HIGH PRESSURE ACCEPTS .035IN GUIDEWIRE 5FR INTRODUCER SHEATH SUP-H74939171040270 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L135 CM L40 MM ODSEC4 MM HIGH PRESSURE SUP-H74939171040410 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L75 CM L40 MM ODSEC4 MM HIGH PRESSURE SUP-H74939171040470 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L135 CM L100 MM ODSEC4 MM HIGH PRESSURE SUP-H74939171041010 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON ANGIOPLASTY DILATATION WORKHORSE MUSTANG 4MM X 150MM 135CM OTW NON-COMPLIANT 2-LUMEN F/PTA LOW-PROFILE HIGH PRESSURE NYBAX LUBRICIOUS MEDIGLIDE PERIPHERAL RADIOPAQUE MARKER 0.035IN GW 5FR SHEATH SUP-H74939171041510 CDM 0270 RC outpatient 494 494 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L135 CM L150 MM ODSEC4 MM HIGH PRESSURE SUP-H74939171041510 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L135 CM L20 MM ODSEC5 MM HIGH PRESSURE SUP-H74939171050210 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L40 CM L20 MM ODSEC5 MM HIGH PRESSURE SUP-H74939171050240 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L75 CM L20 MM ODSEC5 MM HIGH PRESSURE SUP-H74939171050270 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L135 CM L40 MM ODSEC5 MM HIGH PRESSURE SUP-H74939171050410 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L75 CM L40 MM ODSEC5 MM HIGH PRESSURE SUP-H74939171050470 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L135 CM L100 MM ODSEC5 MM HIGH PRESSURE SUP-H74939171051010 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON- MUSTANG OTW 5X150X135 SUP-H74939171051510 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L135 CM L150 MM ODSEC5 MM HIGH PRESSURE SUP-H74939171051510 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L135 CM L20 MM ODSEC6 MM HIGH PRESSURE SUP-H74939171060210 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L75 CM L20 MM ODSEC6 MM HIGH PRESSURE SUP-H74939171060270 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ULTRA-THIN/SDS HYDROPHILIC .035 IN STANDARD L135 CM L40 MM OD5.3 FR ODSEC6 MM PERIPHERAL OTW GUIDEWIRE ACCEPTS 5 FR INTRODUCER SHEATH PTA SUP-H74939171060410 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG 75CM 40MM 6MM NYBAX HIGH PRESSURE ACCEPTS .035IN GUIDEWIRE 5FR INTRODUCER SHEATH SUP-H74939171060470 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L135 CM L60 MM ODSEC6 MM HIGH PRESSURE SUP-H74939171060610 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG 75CM 60MM 6MM NYBAX HIGH PRESSURE ACCEPTS .035IN GUIDEWIRE 5FR INTRODUCER SHEATH SUP-H74939171060670 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L135 CM L100 MM ODSEC6 MM HIGH PRESSURE SUP-H74939171061010 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L135 CM L150 MM ODSEC6 MM HIGH PRESSURE SUP-H74939171061510 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L75 CM L20 MM ODSEC7 MM HIGH PRESSURE SUP-H74939171070270 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L135 CM L40 MM ODSEC7 MM HIGH PRESSURE SUP-H74939171070410 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L40 CM L40 MM ODSEC7 MM HIGH PRESSURE SUP-H74939171070440 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG 75CM 40MM 7MM NYBAX HIGH PRESSURE ACCEPTS .035IN GUIDEWIRE 5FR INTRODUCER SHEATH SUP-H74939171070470 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L75 CM L60 MM ODSEC7 MM HIGH PRESSURE SUP-H74939171070670 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L75 CM L80 MM ODSEC7 MM HIGH PRESSURE SUP-H74939171070870 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L135 CM L20 MM ODSEC8 MM HIGH PRESSURE SUP-H74939171080210 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L75 CM L20 MM ODSEC8 MM HIGH PRESSURE SUP-H74939171080270 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L135 CM L40 MM ODSEC8 MM HIGH PRESSURE SUP-H74939171080410 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG 75CM 40MM 8MM NYBAX HIGH PRESSURE ACCEPTS .035IN GUIDEWIRE 6FR INTRODUCER SHEATH SUP-H74939171080470 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L75 CM L60 MM ODSEC8 MM HIGH PRESSURE SUP-H74939171080670 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG 75CM 80MM 8MM NYBAX HIGH PRESSURE ACCEPTS .035IN GUIDEWIRE 6FR INTRODUCER SHEATH SUP-H74939171080870 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L75 CM L20 MM ODSEC9 MM HIGH PRESSURE SUP-H74939171090270 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L135 CM L40 MM ODSEC9 MM HIGH PRESSURE SUP-H74939171090410 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG 75CM 40MM 9MM NYBAX HIGH PRESSURE ACCEPTS .035IN GUIDEWIRE SUP-H74939171090470 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L75 CM L20 MM ODSEC10 MM HIGH PRESSURE SUP-H74939171100270 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L135 CM L40 MM ODSEC10 MM HIGH PRESSURE SUP-H74939171100410 CDM 0270 RC outpatient 494 494 494 74 365.56 percent of total billed charges 494 93 400.14 percent of total billed charges 494 494 other OPPS APC 494 494 other OPPS APC 494 27.63 136.49 percent of total billed charges 494 494 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L75 CM L40 MM ODSEC10 MM HIGH PRESSURE SUP-H74939171100470 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L135 CM L40 MM ODSEC12 MM HIGH PRESSURE SUP-H74939171120410 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION MUSTANG NYBAX .035 IN L75 CM L40 MM ODSEC12 MM HIGH PRESSURE SUP-H74939171120470 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE NYBAX LUBRICIOUS BIOSLIDE .014 IN L150 CM L80 MM ODSEC2 MM OTW ULTRA LOW PROFILE SUP-H74939186200810 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE NYBAX LUBRICIOUS BIOSLIDE .014 IN L150 CM L220 MM ODSEC2 MM OTW ULTRA LOW PROFILE SUP-H74939186202210 CDM 0270 RC outpatient 1027 1027 1027 74 759.98 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 27.63 283.76 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE NYBAX LUBRICIOUS BIOSLIDE .014 IN L150 CM L60 MM ODSEC2.5 MM OTW ULTRA LOW PROFILE SUP-H74939186250610 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE NYBAX LUBRICIOUS BIOSLIDE .014 IN L150 CM L80 MM ODSEC2.5 MM OTW ULTRA LOW PROFILE SUP-H74939186250810 CDM 0270 RC outpatient 767 767 767 74 567.58 percent of total billed charges 767 93 621.27 percent of total billed charges 767 767 other OPPS APC 767 767 other OPPS APC 767 27.63 211.92 percent of total billed charges 767 767 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE NYBAX LUBRICIOUS BIOSLIDE .014 IN L150 CM L100 MM ODSEC2.5 MM OTW ULTRA LOW PROFILE SUP-H74939186251010 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE NYBAX LUBRICIOUS BIOSLIDE .014 IN L150 CM L150 MM ODSEC2.5 MM OTW ULTRA LOW PROFILE SUP-H74939186251510 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE NYBAX LUBRICIOUS BIOSLIDE .014 IN L150 CM L220 MM ODSEC2.5 MM OTW ULTRA LOW PROFILE SUP-H74939186252210 CDM 0270 RC outpatient 1027 1027 1027 74 759.98 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 27.63 283.76 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE NYBAX LUBRICIOUS BIOSLIDE .014 IN L150 CM L60 MM ODSEC3 MM OTW ULTRA LOW PROFILE SUP-H74939186300610 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE NYBAX LUBRICIOUS BIOSLIDE .014 IN L150 CM L80 MM ODSEC3 MM OTW ULTRA LOW PROFILE SUP-H74939186300810 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE NYBAX LUBRICIOUS BIOSLIDE .014 IN L150 CM L100 MM ODSEC3 MM OTW ULTRA LOW PROFILE SUP-H74939186301010 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE 150CM 150MM 3MM NYBAX LUBRICIOUS BIOSLIDE OTW ULTRA LOW PROFILE ACCEPTS .014IN SUP-H74939186301510 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE 150CM 220MM 3MM NYBAX LUBRICIOUS BIOSLIDE OTW ULTRA LOW PROFILE ACCEPTS .014IN SUP-H74939186302210 CDM 0270 RC outpatient 1027 1027 1027 74 759.98 percent of total billed charges 1027 93 831.87 percent of total billed charges 1027 1027 other OPPS APC 1027 1027 other OPPS APC 1027 27.63 283.76 percent of total billed charges 1027 1027 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE NYBAX LUBRICIOUS BIOSLIDE .014 IN L150 CM L60 MM ODSEC4 MM OTW ULTRA LOW PROFILE SUP-H74939186400610 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE .014IN 150CM 80MM 4MM NYBAX LUBRICIOUS BIOSLIDE SUP-H74939186400810 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE NYBAX LUBRICIOUS BIOSLIDE .014 IN L150 CM L100 MM ODSEC4 MM OTW ULTRA LOW PROFILE SUP-H74939186401010 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE NYBAX LUBRICIOUS BIOSLIDE .014 IN L150 CM L150 MM ODSEC4 MM OTW ULTRA LOW PROFILE SUP-H74939186401510 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON ANGIOPLASTY DILATATION WORKHORSE COYOTE 4MM X 220MM 150CM OTW F/PTA ULTRA LOW-PROFILE NYBAX LUBRICIOUS BIOSLIDE PERIPHERAL BTK 0.014IN GW 4FR SHEATH SUP-H74939186402210 CDM 0270 RC outpatient 819 819 819 819 other OPPS APC 819 819 other OPPS APC 819 27.63 226.29 percent of total billed charges 819 819 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION COYOTE NYBAX LUBRICIOUS BIOSLIDE .014 IN L150 CM L220 MM ODSEC4 MM OTW ULTRA LOW PROFILE SUP-H74939186402210 CDM 0270 RC outpatient 819 819 819 74 606.06 percent of total billed charges 819 93 663.39 percent of total billed charges 819 819 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EMERGE MONORAIL OPTILEAP XTRA ZGLIDE L144 CM L8 MM ODSEC1.2 MM 2 LUMEN ULTRA LOW PROFILE WORKHORSE RADIOPAQUE ACCEPTS 6 FR GUIDE CATHETER PTCA SUP-H7493918908120 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EMERGE MONORAIL 144CM 8MM 6FR 1.5MM .07IN OPTILEAP ZGLIDE XTRA PLATINUM 2 SHAFT RAPID SUP-H7493918908150 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EMERGE MONORAIL OPTILEAP ZGLIDE XTRA PLATINUM L144 CM L8 MM OD6 FR ODSEC2 MM ID.07 IN 2 SHAFT RAPID EXCHANGE RADIOPAQUE ULTRA LOW PROFILE PTCA SUP-H7493918908200 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EMERGE MONORAIL OPTILEAP XTRA L144 CM L8 MM ODSEC2.25 MM 2 LUMEN ULTRA LOW PROFILE WORKHORSE RADIOPAQUE ACCEPTS 6 FR GUIDE CATHETER PTCA SUP-H7493918908220 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EMERGE MONORIAL OPTILEAP XTRA L144CM L8MM ODSEC 2.5MM 2LUMEN ULTRA LOW PROFILE WORKHORSE RADIOPAQUE ACCEPTS 6 FR GUIDE CATHETER PTCA SUP-H7493918908250 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EMERGE MONORAIL OPTILEAP XTRA L144 CM L8 MM ODSEC2.75 MM 2 LUMEN ULTRA LOW PROFILE WORKHORSE RADIOPAQUE ACCEPTS 6 FR GUIDE CATHETER PTCA SUP-H7493918908270 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EMERGE MONORAIL OPTILEAP ZGLIDE XTRA L144 CM L8 MM OD6 FR ODSEC3 MM ID.07 IN 2 SHAFT RAPID EXCHANGE RADIOPAQUE ULTRA LOW PROFILE PTCA FG SUP-H7493918908300 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EMERGE MONORAIL OPTILEAP ZGLIDE XTRA L144 CM L8 MM OD6 FR ODSEC3.5 MM ID.07 IN 2 SHAFT RAPID EXCHANGE RADIOPAQUE ULTRA LOW PROFILE PTCA FG SUP-H7493918908350 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EMERGE MONORAIL OPTILEAP XTRA L144CM L8MM ODSEC 4MM 2 LUMEN ULTRA LOW PROFILE WORKHORSE RADIOPAQUE ACCEPTS 6 FR GUIDE CATHETER PTCA SUP-H7493918908400 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 1.20 X 12MM SUP-H7493918912120 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 1.50 X 12MM SUP-H7493918912150 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 2.00 X 12MM SUP-H7493918912200 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EMERGE MONORAIL 144CM 12MM 6FR 2.25MM .07IN OPTILEAP ZGLIDE XTRA PLATINUM 2 SHAFT RAPID SUP-H7493918912220 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 2.50 X 12MM SUP-H7493918912250 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EMERGE MONORAIL OPTILEAP ZGLIDE XTRA L144 CM L12 MM OD6 FR ODSEC2.75 MM ID.07 IN 2 SHAFT RAPID EXCHANGE RADIOPAQUE ULTRA LOW PROFILE PTCA FG SUP-H7493918912270 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 3.00 X 12MM SUP-H7493918912300 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 3.50 X 12MM SUP-H7493918912350 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EMERGE MONORAIL OPTILEAP ZGLIDE XTRA L144 CM L12 MM OD6 FR ODSEC3.75 MM ID.07 IN 2 SHAFT RAPID EXCHANGE RADIOPAQUE ULTRA LOW PROFILE PTCA FG SUP-H7493918912370 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 4.00 X 12MM SUP-H7493918912400 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 1.20 X 15MM SUP-H7493918915120 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 1.50 X 15MM SUP-H7493918915150 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 2.00 X 15MM SUP-H7493918915200 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EMERGE MONORAIL OPTILEAP ZGLIDE XTRA L144 CM L15 MM OD6 FR ODSEC2.25 MM ID.07 IN 2 SHAFT RAPID EXCHANGE RADIOPAQUE ULTRA LOW PROFILE PTCA FG SUP-H7493918915220 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 2.50 X 15MM SUP-H7493918915250 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EMERGE MONORAIL OPTILEAP ZGLIDE XTRA L144 CM L15 MM OD6 FR ODSEC2.75 MM ID.07 IN 2 SHAFT RAPID EXCHANGE RADIOPAQUE ULTRA LOW PROFILE PTCA FG SUP-H7493918915270 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 3.00 X 15MM SUP-H7493918915300 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 3.50 X 15MM SUP-H7493918915350 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 4.00 X 15MM SUP-H7493918915400 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 1.20 X 20MM SUP-H7493918920120 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 1.50 X 20MM SUP-H7493918920150 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 2.00 X 20MM SUP-H7493918920200 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EMERGE MONORAIL OPTILEAP XTRA ZGLIDE L144 CM L20 MM ODSEC2.25 MM 2 LUMEN ULTRA LOW PROFILE WORKHORSE RADIOPAQUE ACCEPTS 6 FR GUIDE CATHETER PTCA SUP-H7493918920220 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 2.50 X 20MM SUP-H7493918920250 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EMERGE MONORAIL OPTILEAP XTRA ZGLIDE L144 CM L20 MM ODSEC2.75 MM 2 LUMEN ULTRA LOW PROFILE WORKHORSE RADIOPAQUE ACCEPTS 6 FR GUIDE CATHETER PTCA SUP-H7493918920270 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 3.00 X 20MM SUP-H7493918920300 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 3.50 X 20MM SUP-H7493918920350 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 4.00 X 20MM SUP-H7493918920400 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 2.00 X 30MM SUP-H7493918930200 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 2.50 X 30MM SUP-H7493918930250 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 3.00 X 30MM SUP-H7493918930300 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 3.50 X 30MM SUP-H7493918930350 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC EMERGE BALLOON 4.00 X 30MM SUP-H7493918930400 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EMERGE MONORAIL OPTILEAP ZGLIDE XTRA L144 CM L8 MM OD6 FR ODSEC1.5 MM ID.07 IN RAPID EXCHANGE PUSH MARKER BAND ULTRA LOW PROFILE PTCA FG SUP-H7493919008150 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EMERGE MR PUSH 12X1.5 SUP-H7493919012150 CDM 0481 RC outpatient 314.6 314.6 314.6 74 232.8 percent of total billed charges 314.6 93 254.83 percent of total billed charges 314.6 314.6 other OPPS APC 314.6 314.6 other OPPS APC 314.6 51 160.45 percent of total billed charges 314.6 314.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EMERGE MONORAIL OPTILEAP ZGLIDE XTRA L144 CM L15 MM OD6 FR ODSEC1.5 MM ID.07 IN RAPID EXCHANGE PUSH MARKER BAND ULTRA LOW PROFILE PTCA FG SUP-H7493919015150 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION EMERGE MONORAIL OPTILEAP ZGLIDE XTRA L144 CM L20 MM OD6 FR ODSEC1.5 MM ID.07 IN RAPID EXCHANGE PUSH MARKER BAND ULTRA LOW PROFILE PTCA FG SUP-H7493919020150 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL .035 IN L100 MM L120 CM OD6 MM ILIAC ARTERY SELF EXPAND OTW GUIDEWIRE RADIOPAQUE ACCEPTS 6 FR SHEATH SUP-H74939200061020 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L120 CM L120 MM L163 CM OD6 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200061220 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L120 CM L20 MM L154 CM OD6 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200062020 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L120 CM L30 MM L154 CM OD6 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200063020 CDM 0270 RC outpatient 2457 2457 2457 74 1818.18 percent of total billed charges 2457 93 1990.17 percent of total billed charges 2457 2457 other OPPS APC 2457 2457 other OPPS APC 2457 27.63 678.87 percent of total billed charges 2457 2457 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L120 CM L40 MM L155 CM OD6 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200064020 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL .035 IN L40 MM L75 CM OD6 MM ILIAC ARTERY SELF EXPAND OTW GUIDEWIRE RADIOPAQUE MARKER ACCEPTS 6 FR SHEATH SUP-H74939200064070 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL .035 IN L60 MM L120 CM OD6 MM ILIAC ARTERY SELF EXPAND OTW GUIDEWIRE RADIOPAQUE MARKER ACCEPTS 6 FR SHEATH SUP-H74939200066020 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L70 MM L120 CM OD6 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200067020 CDM 0270 RC outpatient 2457 2457 2457 74 1818.18 percent of total billed charges 2457 93 1990.17 percent of total billed charges 2457 2457 other OPPS APC 2457 2457 other OPPS APC 2457 27.63 678.87 percent of total billed charges 2457 2457 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L120 CM L80 MM L159 CM OD6 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200068020 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR 6MM 80MM 114CM 75CM SELF EXPAND ILIAC ARTERY EPIC NITINOL ACCEPTS 6FR SUP-H74939200068070 CDM 0270 RC outpatient 2457 2457 2457 74 1818.18 percent of total billed charges 2457 93 1990.17 percent of total billed charges 2457 2457 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM STENT VASCULAR EPIC 6MM 80MM 75CM ILIAC ARTERY OTW SELF-EXPANDING NITINOL MRI-CONDITIONAL NON-RADIOLUCENT 0.035IN GW 6FR SHEATH SUP-H74939200068070 CDM 0270 RC outpatient 2457 2457 2457 2457 other OPPS APC 2457 2457 other OPPS APC 2457 27.63 678.87 percent of total billed charges 2457 2457 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL .035 IN L100 MM L120 CM OD7 MM ILIAC ARTERY SELF EXPAND OTW GUIDEWIRE RADIOPAQUE ACCEPTS 6 FR SHEATH SUP-H74939200071020 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L120 CM L120 MM L163 CM OD7 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200071220 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L20 MM L120 CM OD7 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200072020 CDM 0270 RC outpatient 2457 2457 2457 74 1818.18 percent of total billed charges 2457 93 1990.17 percent of total billed charges 2457 2457 other OPPS APC 2457 2457 other OPPS APC 2457 27.63 678.87 percent of total billed charges 2457 2457 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L120 CM L30 MM L154 CM OD7 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200073020 CDM 0270 RC outpatient 2457 2457 2457 74 1818.18 percent of total billed charges 2457 93 1990.17 percent of total billed charges 2457 2457 other OPPS APC 2457 2457 other OPPS APC 2457 27.63 678.87 percent of total billed charges 2457 2457 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL .035 IN L40 MM L75 CM OD7 MM ILIAC ARTERY SELF EXPAND OTW GUIDEWIRE RADIOPAQUE MARKER ACCEPTS 6 FR SHEATH SUP-H74939200074070 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L120 CM L60 MM L157 CM OD7 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200076020 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L75 CM L60 MM L112 CM OD7 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200076070 CDM 0270 RC outpatient 2457 2457 2457 74 1818.18 percent of total billed charges 2457 93 1990.17 percent of total billed charges 2457 2457 other OPPS APC 2457 2457 other OPPS APC 2457 27.63 678.87 percent of total billed charges 2457 2457 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L120 CM L80 MM L159 CM OD7 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200078020 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L75 CM L80 MM L114 CM OD7 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200078070 CDM 0270 RC outpatient 2457 2457 2457 74 1818.18 percent of total billed charges 2457 93 1990.17 percent of total billed charges 2457 2457 other OPPS APC 2457 2457 other OPPS APC 2457 27.63 678.87 percent of total billed charges 2457 2457 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L100 MM L75 CM OD8 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200081070 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL .035 IN L120 MM L120 CM OD8 MM ILIAC ARTERY SELF EXPAND OTW GUIDEWIRE RADIOPAQUE ACCEPTS 6 FR SHEATH SUP-H74939200081220 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L20 MM L75 CM OD8 MM ILIUM SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200082070 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L120 CM L40 MM L155 CM OD8 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200084020 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL .035 IN L40 MM L75 CM OD8 MM ILIAC ARTERY SELF EXPAND OTW GUIDEWIRE RADIOPAQUE MARKER ACCEPTS 6 FR SHEATH SUP-H74939200084070 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L120 CM L60 MM L157 CM OD8 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200086020 CDM 0270 RC outpatient 2457 2457 2457 74 1818.18 percent of total billed charges 2457 93 1990.17 percent of total billed charges 2457 2457 other OPPS APC 2457 2457 other OPPS APC 2457 27.63 678.87 percent of total billed charges 2457 2457 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC METALLIC L60 MM L75 CM OD8 MM ODSEC6 FR ILIAC ARTERY SELF EXPAND SHEATH SUP-H74939200086070 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L120 CM L80 MM L159 CM OD8 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200088020 CDM 0270 RC outpatient 2457 2457 2457 74 1818.18 percent of total billed charges 2457 93 1990.17 percent of total billed charges 2457 2457 other OPPS APC 2457 2457 other OPPS APC 2457 27.63 678.87 percent of total billed charges 2457 2457 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L75 CM L80 MM L114 CM OD8 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200088070 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L75 CM L60 MM L112 CM OD9 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200096070 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L75 CM L20 MM L109 CM OD10 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200102070 CDM 0270 RC outpatient 2457 2457 2457 74 1818.18 percent of total billed charges 2457 93 1990.17 percent of total billed charges 2457 2457 other OPPS APC 2457 2457 other OPPS APC 2457 27.63 678.87 percent of total billed charges 2457 2457 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC 110CM 40MM 75CM 10MM NITINOL ILIAC ARTERY OTW RADIOPAQUE SELF EXPAND ACCEPTS .035IN GUIDEWIRE 6FR SUP-H74939200104070 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC 75CM 60MM 112CM 10MM NITINOL ILIAC ARTERY OTW RADIOPAQUE SELF EXPAND ACCEPTS .035IN GUIDEWIRE 6FR SUP-H74939200106070 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L75 CM L80 MM L114 CM OD10 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200108070 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L110 CM L40 MM L75 CM OD12 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200124070 CDM 0270 RC outpatient 2457 2457 2457 74 1818.18 percent of total billed charges 2457 93 1990.17 percent of total billed charges 2457 2457 other OPPS APC 2457 2457 other OPPS APC 2457 27.63 678.87 percent of total billed charges 2457 2457 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR EPIC NITINOL L75 CM L60 MM L112 CM OD12 MM ILIAC ARTERY SELF EXPAND ACCEPTS 6 FR SHEATH SUP-H74939200126070 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER VASCULAR OFFROAD PLATINUM IRIDIUM OD2.4 FR MICRO LONG L100 CM L109 CM OD5 FR ODSEC5.4 MM POSITION BALLOON LANCET TIP FLEXIBLE NECK RO MARKER ACCEPTS .035 IN GUIDEWIRE 6 FR SHEATH SUP-H74939202100540 CDM 0270 RC outpatient 5590 5590 5590 74 4136.6 percent of total billed charges 5590 93 4527.9 percent of total billed charges 5590 5590 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE CATHETER TRUEPATH EXTENSION CHRONIC TOTAL OCCLUSION DEVICE SUP-H74939208001601 CDM 0270 RC outpatient 265.2 265.2 265.2 74 196.25 percent of total billed charges 265.2 93 214.81 percent of total billed charges 265.2 265.2 other OPPS APC 265.2 265.2 other OPPS APC 265.2 27.63 73.27 percent of total billed charges 265.2 265.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE ATHERECTOMY TRUEPATH .017IN 165CM .018IN DIAMOND PERIPHERAL ROTATIONAL DISTAL TIP MOTOR HOUSING CONTROL UNIT SUP-H74939208181650 CDM 0270 RC outpatient 5304 5304 5304 74 3924.96 percent of total billed charges 5304 93 4296.24 percent of total billed charges 5304 5304 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SUPPORT RUBICON 150CM STRAIGHT TIP ACCEPTS .014IN GUIDEWIRE 4FR SHEATH SUP-H74939212014151 CDM 0270 RC outpatient 351 351 351 74 259.74 percent of total billed charges 351 93 284.31 percent of total billed charges 351 351 other OPPS APC 351 351 other OPPS APC 351 27.63 96.98 percent of total billed charges 351 351 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR V-14 CONTROLWIRE FRONTLINE SPECIALTY 0.014IN 300CM 8CM SHORT TAPER 6GM SHAPEABLE STRAIGHT TIP STIFF RAIL SUPPORT ROBUST PERIPHERAL SCITANIUM ICE POLYMER SLEEVE RADIOPAQUE TIP SUP-H74939216730010 CDM 0270 RC outpatient 546 546 546 546 other OPPS APC 546 546 other OPPS APC 546 27.63 150.86 percent of total billed charges 546 546 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR V-14 CONTROLWIRE SCITANIUM ICE POLYMER SHORT TAPER L300 CM L8 CM OD.014 IN PERIPHERAL STRAIGHT TIP RADIOPAQUE TORQUE CONTROL RAIL SUPPORT SUP-H74939216730010 CDM 0270 RC outpatient 546 546 546 74 404.04 percent of total billed charges 546 93 442.26 percent of total billed charges 546 546 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR V-14 CONTROLWIRE FRONTLINE SPECIALTY 0.014IN 300CM 8CM SHORT TAPER 6GM SHAPEABLE ANGLED TIP STIFF RAIL SUPPORT ROBUST PERIPHERAL SCITANIUM ICE POLYMER SLEEVE RADIOPAQUE TIP SUP-H74939216730020 CDM 0270 RC outpatient 546 546 546 546 other OPPS APC 546 546 other OPPS APC 546 27.63 150.86 percent of total billed charges 546 546 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR V-14 CONTROLWIRE SHORT TAPER STRAIGHT 300CM 8CM .014IN SCITANIUM ICE POLYMER PERIPHERAL RADIOPAQUE SUP-H74939216730020 CDM 0270 RC outpatient 546 546 546 74 404.04 percent of total billed charges 546 93 442.26 percent of total billed charges 546 546 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT REBEL MR PLATINUM CHROMIUM 3.5MM X 32 MM SUP-H74939227432350 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR 300CM .014IN 12GA BROAD MATRIX PUSHABILITY EXCELLENT CROSS ENHANCE SUP-H74939230300120 CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR VICTORY 14 SPECIALTY CROSSING 0.014IN 300CM 14CM TIP 12GM SHAPEABLE STRAIGHT TIP PERIPHERAL STAINLESS STEEL HYDROPHILIC POLYMER SLEEVE RADIOPAQUE TIP SUP-H74939230300120 CDM 0270 RC outpatient 390 390 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR 300CM .014IN 18GA BROAD MATRIX EXCELLENT CROSS ENHANCE TORQUE SUP-H74939230300180 CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR VICTORY STAINLESS STEEL PTFE HYDROPHILIC STRAIGHT L300 CM OD.014 IN ODSEC25 GA BROAD MATRIX PUSHABILITY EXCELLENT CROSS ENHANCE TORQUE RADIOPAQUE DISPOSABLE BLUE SUP-H74939231300250 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING 15MM SPACE 4FR 1.7FR 135CM RADIOPAQUE STRAIGHT TIP HUB SHAFT NYLON SUP-H74939239018131 CDM 0270 RC outpatient 408.15 408.15 408.15 74 302.03 percent of total billed charges 408.15 93 330.6 percent of total billed charges 408.15 408.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING RUBICON CROSSING SUPPORT 4FR 135CM STRAIGHT PERIPHERAL ULTRA LOW-PROFILE PURPLE TIP CLEAR SHAFT BIOSLIDE NYLON HYDROPHILIC RADIOPAQUE MARKER 0.018IN GW SUP-H74939239018131 CDM 0270 RC outpatient 408.15 408.15 408.15 408.15 other OPPS APC 408.15 408.15 other OPPS APC 408.15 27.63 112.77 percent of total billed charges 408.15 408.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING RUBICON BIOSLIDE ULTRA LOW PROFILE TAPER L65 CM OD5 FR 3 RADIOPAQUE SUPPORT PURPLE ACCPTS .035 IN GUIDEWIRE SUP-H74939240035061 CDM 0270 RC outpatient 351 351 351 74 259.74 percent of total billed charges 351 93 284.31 percent of total billed charges 351 351 other OPPS APC 351 351 other OPPS APC 351 27.63 96.98 percent of total billed charges 351 351 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING RUBICON 50MM SPACE 90CM 5.1FR 2.84FR CLEAR PURPLE NYLON HYDROPHILIC RADIOPAQUE STRAIGHT TIP HUB SHAFT SUP-H74939240035091 CDM 0270 RC outpatient 387.4 387.4 387.4 74 286.68 percent of total billed charges 387.4 93 313.79 percent of total billed charges 387.4 387.4 other OPPS APC 387.4 387.4 other OPPS APC 387.4 27.63 107.04 percent of total billed charges 387.4 387.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING RUBICON NYLON HYDROPHILIC 50 MM SPACE L135 CM OD5.1 FR ODSEC2.84 FR RADIOPAQUE STRAIGHT TIP HUB SHAFT CLEAR PURPLE ACCEPTS .035 IN GUIDEWIRE 5 FR SHEATH SUP-H74939240035131 CDM 0270 RC outpatient 351 351 351 74 259.74 percent of total billed charges 351 93 284.31 percent of total billed charges 351 351 other OPPS APC 351 351 other OPPS APC 351 27.63 96.98 percent of total billed charges 351 351 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 8MM 144CM 2.25MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926008220 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 8MM 144CM 2.5MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926008250 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 8MM 144CM 2.75MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926008270 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 8MM 144CM 3MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926008300 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 8MM 144CM 3.5MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926008350 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 8MM 144CM 4MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926008400 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 12MM 144CM 2.25MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926012220 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 12MM 144CM 2.5MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926012250 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 12MM 144CM 2.75MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926012270 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 12MM 144CM 3MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926012300 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 12MM 144CM 3.5MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926012350 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 12MM 144CM 4MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926012400 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYNERGY II US MR 4.50X12MM SUP-H7493926012450 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYNERGY II US MR 5.00X12MM SUP-H7493926012500 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 16MM 144CM 2.25MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926016220 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 16MM 144CM 2.5MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926016250 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 16MM 144CM 2.75MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926016270 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 16MM 144CM 3MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926016300 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 16MM 144CM 3.5MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926016350 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 16MM 144CM 4MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926016400 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYNERGY II US MR 4.50X16MM SUP-H7493926016450 CDM 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYNERGY II US MR 5.00X16MM SUP-H7493926016500 CDM 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 20MM 144CM 2.25MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926020220 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 20MM 144CM 2.5MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926020250 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 20MM 144CM 2.75MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926020270 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 20MM 144CM 3MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926020300 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 20MM 144CM 3.5MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926020350 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 20MM 144CM 4MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926020400 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYNERGY II US MR 4.50X20MM SUP-H7493926020450 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYNERGY II US MR 5.00X20MM SUP-H749392602050 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 24MM 144CM 2.25MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926024220 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 24MM 144CM 2.5MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926024250 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 24MM 144CM 2.75MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926024270 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 24MM 144CM 3MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926024300 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 24MM 144CM 3.5MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926024350 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY MONORAIL 24MM 144CM 4MM 2.7-2.1FR SYNCHRONY EVEROLIMUS PLATINUM CHROMIUM RADIOPAQUE 1 SUP-H7493926024400 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYNERGY II US MR 4.50X24MM SUP-H7493926024450 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYNERGY II US MR 5.00X24MM SUP-H7493926024500 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 28MM 144CM 2.25MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926028220 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 28MM 144CM 2.5MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926028250 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 28MM 144CM 2.75MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926028270 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 28MM 144CM 3MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926028300 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 28MM 144CM 3.5MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926028350 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY MONORAIL 28MM 144CM 4MM 2.7-2.1FR SYNCHRONY EVEROLIMUS PLATINUM CHROMIUM RADIOPAQUE 1 SUP-H7493926028400 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYNERGY II US MR 4.50X28MM SUP-H7493926028450 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYNERGY II US MR 5.00X28MM SUP-H7493926028500 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 32MM 144CM 2.25MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926032220 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 32MM 144CM 2.5MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926032250 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 32MM 144CM 2.75MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926032270 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 32MM 144CM 3MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926032300 CDM 0481 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 51 729.3 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 32MM 144CM 3.5MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926032350 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 32MM 144CM 4MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926032400 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYNERGY II US MR 4.50X32MM SUP-H7493926032450 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYNERGY II US MR 5.00X32MM SUP-H7493926032500 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 38MM 144CM 2.25MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926038220 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 38MM 144CM 2.5MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926038250 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 38MM 144CM 2.75MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926038270 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 38MM 144CM 3MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926038300 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY 38MM 144CM 3.5MM PEBAX EVEROLIMUS ELUTING PLATINUM CHROMIUM PLGA RADIOPAQUE 1 ACCESS PORT SUP-H7493926038350 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 2.00 X 8MM SUP-H7493926708200 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 2.25 X 8MM SUP-H7493926708220 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 2.50 X 8MM SUP-H7493926708250 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 2.75 X 8MM SUP-H7493926708270 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 3.00 X 8MM SUP-H7493926708300 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 3.25 X 8MM SUP-H7493926708320 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 3.50 X 8MM SUP-H7493926708350 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 3.75 X 8MM SUP-H7493926708370 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 4.00 X 8MM SUP-H7493926708400 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 4.50 X 8MM SUP-H7493926708450 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 5.00 X 8MM SUP-H7493926708500 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 2.00 X 12MM SUP-H7493926712200 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 2.25 X 12MM SUP-H7493926712220 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 2.50 X 12MM SUP-H7493926712250 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 2.75 X 12MM SUP-H7493926712270 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 3.00 X 12MM SUP-H7493926712300 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 3.25 X 12MM SUP-H7493926712320 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 3.50 X 12MM SUP-H7493926712350 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 3.75 X 12MM SUP-H7493926712370 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 4.00 X 12MM SUP-H7493926712400 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 4.50 X 12MM SUP-H7493926712450 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 5.00 X 12MM SUP-H7493926712500 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 2.00 X 15MM SUP-H7493926715200 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 2.25 X 15MM SUP-H7493926715220 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 2.50 X 15MM SUP-H7493926715250 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 2.75 X 15MM SUP-H7493926715270 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 3.00 X 15MM SUP-H7493926715300 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 3.25 X 15MM SUP-H7493926715320 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 3.50 X 15MM SUP-H7493926715350 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 3.75 X 15MM SUP-H7493926715370 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 4.00 X 15MM SUP-H7493926715400 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 4.50 X 15MM SUP-H7493926715450 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 5.00 X 15MM SUP-H7493926715500 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 2.00 X 20MM SUP-H7493926720200 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 2.25 X 20MM SUP-H7493926720220 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 2.50 X 20MM SUP-H7493926720250 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 2.75 X 20MM SUP-H7493926720270 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 3.00 X 20MM SUP-H7493926720300 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 3.25 X 20MM SUP-H7493926720320 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 3.50 X 20MM SUP-H7493926720350 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 3.75 X 20MM SUP-H7493926720370 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 4.00 X 20MM SUP-H7493926720400 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 4.50 X 20MM SUP-H7493926720450 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 5.00 X 20MM SUP-H7493926720500 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 2.00 X 30MM SUP-H7493926730200 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 2.25 X 30MM SUP-H7493926730220 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 2.50 X 30MM SUP-H7493926730250 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 2.75 X 30MM SUP-H7493926730270 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 3.00 X 30MM SUP-H7493926730300 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 3.25 X 30MM SUP-H7493926730320 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 3.50 X 30MM SUP-H7493926730350 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 3.75 X 30MM SUP-H7493926730370 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOSTON SCIENTIFIC NC EMERGE 4.00 X 30MM SUP-H7493926730400 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 8MM 140CM 2.75MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927408270 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 8MM 140CM 3MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927408300 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 8MM 140CM 3.5MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927408350 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 8MM 140CM 4MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927408400 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL MONORAIL PLATINUM CHROMIUM L140 CM L12 MM L144 CM OD2.5 MM ODSEC2.7-2.1 FR CATHETER SUP-H7493927412250 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 12MM 140CM 2.75MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927412270 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL MONORAIL PLATINUM CHROMIUM L140 CM L12 MM L144 CM OD3 MM ODSEC2.7-2.1 FR CATHETER SUP-H7493927412300 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 12MM 140CM 3.5MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927412350 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL MONORAIL PLATINUM CHROMIUM L140 CM L12 MM L144 CM OD4 MM ODSEC2.7-2.1 FR CATHETER SUP-H7493927412400 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 12MM 140CM 4.5MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927412450 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 16MM 140CM 2.5MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927416250 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 16MM 140CM 2.75MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927416270 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 16MM 140CM 3MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927416300 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 16MM 140CM 3.5MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927416350 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 16MM 140CM 4MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927416400 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL MONORAIL PLATINUM CHROMIUM L140 CM L16 MM L144 CM OD4.5 MM ODSEC2.7-2.1 FR CATHETER SUP-H7493927416450 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM STENT CORONARY REBEL2.5MM X 20MM SUP-H7493927420250 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL MONORAIL BARE METAL PLATINUM CHROMIUM L20 MM L144 CM OD2.75 MM ODSEC2.7-2.1 FR STERILE SUP-H7493927420270 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 20MM 140CM 3MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927420300 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 20MM 140CM 3.5MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927420350 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 20MM 140CM 4MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927420400 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 20MM 140CM 4.5MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927420450 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM STENT CORONARY REBEL 2.5MM X 24MM SUP-H7493927424250 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 24MM 140CM 2.75MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927424270 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 24MM 140CM 3MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927424300 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL MONORAIL PLATINUM CHROMIUM L140 CM L24 MM L144 CM OD3.5 MM ODSEC2.7-2.1 FR CATHETER SUP-H7493927424350 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 24MM 140CM 4MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927424400 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 24MM 140CM 4.5MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927424450 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM STENT CORONARY REBEL 2.50 X 28 SUP-H7493927428250 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 28MM 140CM 2.75MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927428270 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL MONORAIL PLATINUM CHROMIUM L140 CM L28 MM L144 CM OD3 MM ODSEC2.7-2.1 FR CATHETER SUP-H7493927428300 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL MONORAIL PLATINUM CHROMIUM L140 CM L28 MM L144 CM OD3.5 MM ODSEC2.7-2.1 FR CATHETER SUP-H7493927428350 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 28MM 140CM 4MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927428400 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 28MM 140CM 4.5MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927428450 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 32MM 140CM 3MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927432300 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 32MM 140CM 4MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927432400 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT REBEL 32MM 140CM 4.5MM PLATINUM CHROMIUM RADIOPAQUE BALLOON EXPANDABLE ACCEPTS .014- IN GUIDEWIRE SUP-H7493927432450 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCATHETER CEREBROVASCULAR MAMBA FLEX L 135CM STERILE LATEX FREE DISPOSABLE SUP-H7493928713540 CDM 0481 RC outpatient 1417 1417 1417 74 1048.58 percent of total billed charges 1417 93 1147.77 percent of total billed charges 1417 1417 other OPPS APC 1417 1417 other OPPS APC 1417 51 722.67 percent of total billed charges 1417 1417 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR SAMURAI SENTAI STRAIGHT L190 CM WORKHORS SUP-H749393021902 CDM 0481 RC outpatient 204.67 204.67 204.67 74 151.46 percent of total billed charges 204.67 93 165.78 percent of total billed charges 204.67 204.67 other OPPS APC 204.67 204.67 other OPPS APC 204.67 51 104.38 percent of total billed charges 204.67 204.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR SAMURAI SENTAI J CURVE L190 CM WORKHORSE SUP-H74939302190J2 CDM 0481 RC outpatient 204.67 204.67 204.67 74 151.46 percent of total billed charges 204.67 93 165.78 percent of total billed charges 204.67 204.67 other OPPS APC 204.67 204.67 other OPPS APC 204.67 51 104.38 percent of total billed charges 204.67 204.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6FR GUIDEZILLA II EXTENSION CATHETER SUP-H7493933515060 CDM 0270 RC outpatient 1144 1144 1144 74 846.56 percent of total billed charges 1144 93 926.64 percent of total billed charges 1144 1144 other OPPS APC 1144 1144 other OPPS APC 1144 27.63 316.09 percent of total billed charges 1144 1144 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6FR RADIAL GUIDEZILLA II EXTENSION CATHETER SUP-H74939335150610 CDM 0270 RC outpatient 1144 1144 1144 74 846.56 percent of total billed charges 1144 93 926.64 percent of total billed charges 1144 1144 other OPPS APC 1144 1144 other OPPS APC 1144 27.63 316.09 percent of total billed charges 1144 1144 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION WOLVERINE CUTTING BALLOON MONORAIL Z-GLIDE L 6CM OD 2 MM BUMPER TIP ATHEROTOME RADIOPAQUE MIDSHAFT SUP-H74939401062000 CDM 0270 RC outpatient 1822.08 1822.08 1822.08 74 1348.34 percent of total billed charges 1822.08 93 1475.88 percent of total billed charges 1822.08 1822.08 other OPPS APC 1822.08 1822.08 other OPPS APC 1822.08 27.63 503.44 percent of total billed charges 1822.08 1822.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION WOLVERINE CUTTING BALLOON MONORAIL Z-GLIDE L 6CM OD 2.25 MM BUMPER TIP ATHEROTOME RADIOPAQUE MIDSHAFT SUP-H74939401062250 CDM 0270 RC outpatient 1822.08 1822.08 1822.08 74 1348.34 percent of total billed charges 1822.08 93 1475.88 percent of total billed charges 1822.08 1822.08 other OPPS APC 1822.08 1822.08 other OPPS APC 1822.08 27.63 503.44 percent of total billed charges 1822.08 1822.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION WOLVERINE CUTTING BALLOON MONORAIL Z-GLIDE L 6CM OD 2.5 MM BUMPER TIP ATHEROTOME RADIOPAQUE MIDSHAFT SUP-H74939401062500 CDM 0270 RC outpatient 1822.08 1822.08 1822.08 74 1348.34 percent of total billed charges 1822.08 93 1475.88 percent of total billed charges 1822.08 1822.08 other OPPS APC 1822.08 1822.08 other OPPS APC 1822.08 27.63 503.44 percent of total billed charges 1822.08 1822.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION WOLVERINE CUTTING BALLOON MONORAIL Z-GLIDE L 6CM OD 2.75 MM BUMPER TIP ATHEROTOME RADIOPAQUE MIDSHAFT SUP-H74939401062750 CDM 0270 RC outpatient 1822.08 1822.08 1822.08 74 1348.34 percent of total billed charges 1822.08 93 1475.88 percent of total billed charges 1822.08 1822.08 other OPPS APC 1822.08 1822.08 other OPPS APC 1822.08 27.63 503.44 percent of total billed charges 1822.08 1822.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION WOLVERINE CUTTING BALLOON MONORAIL Z-GLIDE L 6CM OD 3 MM BUMPER TIP ATHEROTOME RADIOPAQUE MIDSHAFT SUP-H74939401063000 CDM 0270 RC outpatient 1822.08 1822.08 1822.08 74 1348.34 percent of total billed charges 1822.08 93 1475.88 percent of total billed charges 1822.08 1822.08 other OPPS APC 1822.08 1822.08 other OPPS APC 1822.08 27.63 503.44 percent of total billed charges 1822.08 1822.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION WOLVERINE CUTTING BALLOON MONORAIL Z-GLIDE L 6CM OD 3.25 MM BUMPER TIP ATHEROTOME RADIOPAQUE MIDSHAFT SUP-H74939401063250 CDM 0270 RC outpatient 1822.08 1822.08 1822.08 74 1348.34 percent of total billed charges 1822.08 93 1475.88 percent of total billed charges 1822.08 1822.08 other OPPS APC 1822.08 1822.08 other OPPS APC 1822.08 27.63 503.44 percent of total billed charges 1822.08 1822.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION WOLVERINE CUTTING BALLOON MONORAIL Z-GLIDE L 6CM OD 3.5 MM BUMPER TIP ATHEROTOME RADIOPAQUE MIDSHAFT SUP-H74939401063500 CDM 0270 RC outpatient 1822.08 1822.08 1822.08 74 1348.34 percent of total billed charges 1822.08 93 1475.88 percent of total billed charges 1822.08 1822.08 other OPPS APC 1822.08 1822.08 other OPPS APC 1822.08 27.63 503.44 percent of total billed charges 1822.08 1822.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION WOLVERINE CUTTING BALLOON MONORAIL Z-GLIDE L 6CM OD 3.75 MM BUMPER TIP ATHEROTOME RADIOPAQUE MIDSHAFT SUP-H74939401063750 CDM 0270 RC outpatient 1822.08 1822.08 1822.08 74 1348.34 percent of total billed charges 1822.08 93 1475.88 percent of total billed charges 1822.08 1822.08 other OPPS APC 1822.08 1822.08 other OPPS APC 1822.08 27.63 503.44 percent of total billed charges 1822.08 1822.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION WOLVERINE CUTTING BALLOON MONORAIL Z-GLIDE L 10CM OD 2 MM BUMPER TIP ATHEROTOME RADIOPAQUE MIDSHAFT SUP-H74939401102000 CDM 0270 RC outpatient 1822.08 1822.08 1822.08 74 1348.34 percent of total billed charges 1822.08 93 1475.88 percent of total billed charges 1822.08 1822.08 other OPPS APC 1822.08 1822.08 other OPPS APC 1822.08 27.63 503.44 percent of total billed charges 1822.08 1822.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION WOLVERINE CUTTING BALLOON MONORAIL Z-GLIDE L 10CM OD 2.5 MM BUMPER TIP ATHEROTOME RADIOPAQUE MIDSHAFT SUP-H74939401102500 CDM 0270 RC outpatient 1822.08 1822.08 1822.08 74 1348.34 percent of total billed charges 1822.08 93 1475.88 percent of total billed charges 1822.08 1822.08 other OPPS APC 1822.08 1822.08 other OPPS APC 1822.08 27.63 503.44 percent of total billed charges 1822.08 1822.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION WOLVERINE CUTTING BALLOON MONORAIL Z-GLIDE L 10CM OD 2.75 MM BUMPER TIP ATHEROTOME RADIOPAQUE MIDSHAFT SUP-H74939401102750 CDM 0270 RC outpatient 1822.08 1822.08 1822.08 74 1348.34 percent of total billed charges 1822.08 93 1475.88 percent of total billed charges 1822.08 1822.08 other OPPS APC 1822.08 1822.08 other OPPS APC 1822.08 27.63 503.44 percent of total billed charges 1822.08 1822.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION WOLVERINE CUTTING BALLOON MONORAIL Z-GLIDE L 10CM OD 3 MM BUMPER TIP ATHEROTOME RADIOPAQUE MIDSHAFT SUP-H74939401103000 CDM 0270 RC outpatient 1822.08 1822.08 1822.08 74 1348.34 percent of total billed charges 1822.08 93 1475.88 percent of total billed charges 1822.08 1822.08 other OPPS APC 1822.08 1822.08 other OPPS APC 1822.08 27.63 503.44 percent of total billed charges 1822.08 1822.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION WOLVERINE CUTTING BALLOON MONORAIL Z-GLIDE L 10CM OD 3.5 MM BUMPER TIP ATHEROTOME RADIOPAQUE MIDSHAFT SUP-H74939401103500 CDM 0270 RC outpatient 1822.08 1822.08 1822.08 74 1348.34 percent of total billed charges 1822.08 93 1475.88 percent of total billed charges 1822.08 1822.08 other OPPS APC 1822.08 1822.08 other OPPS APC 1822.08 27.63 503.44 percent of total billed charges 1822.08 1822.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION WOLVERINE CUTTING BALLOON MONORAIL Z-GLIDE L 10CM OD 4 MM BUMPER TIP ATHEROTOME RADIOPAQUE MIDSHAFT SUP-H74939401104000 CDM 0270 RC outpatient 1822.08 1822.08 1822.08 74 1348.34 percent of total billed charges 1822.08 93 1475.88 percent of total billed charges 1822.08 1822.08 other OPPS APC 1822.08 1822.08 other OPPS APC 1822.08 27.63 503.44 percent of total billed charges 1822.08 1822.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION WOLVERINE CUTTING BALLOON MONORAIL Z-GLIDE L 15CM OD 2 MM BUMPER TIP ATHEROTOME RADIOPAQUE MIDSHAFT SUP-H74939401152000 CDM 0270 RC outpatient 1822.08 1822.08 1822.08 74 1348.34 percent of total billed charges 1822.08 93 1475.88 percent of total billed charges 1822.08 1822.08 other OPPS APC 1822.08 1822.08 other OPPS APC 1822.08 27.63 503.44 percent of total billed charges 1822.08 1822.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION WOLVERINE CUTTING BALLOON MONORAIL Z-GLIDE L 15CM OD 2.75 MM BUMPER TIP ATHEROTOME RADIOPAQUE MIDSHAFT SUP-H74939401152750 CDM 0270 RC outpatient 1822.08 1822.08 1822.08 74 1348.34 percent of total billed charges 1822.08 93 1475.88 percent of total billed charges 1822.08 1822.08 other OPPS APC 1822.08 1822.08 other OPPS APC 1822.08 27.63 503.44 percent of total billed charges 1822.08 1822.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION WOLVERINE CUTTING BALLOON MONORAIL Z-GLIDE L 15CM OD 3 MM BUMPER TIP ATHEROTOME RADIOPAQUE MIDSHAFT SUP-H74939401153000 CDM 0270 RC outpatient 1822.08 1822.08 1822.08 74 1348.34 percent of total billed charges 1822.08 93 1475.88 percent of total billed charges 1822.08 1822.08 other OPPS APC 1822.08 1822.08 other OPPS APC 1822.08 27.63 503.44 percent of total billed charges 1822.08 1822.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION WOLVERINE CUTTING BALLOON MONORAIL Z-GLIDE L 15CM OD 3.25 MM BUMPER TIP ATHEROTOME RADIOPAQUE MIDSHAFT SUP-H74939401153250 CDM 0270 RC outpatient 1822.08 1822.08 1822.08 74 1348.34 percent of total billed charges 1822.08 93 1475.88 percent of total billed charges 1822.08 1822.08 other OPPS APC 1822.08 1822.08 other OPPS APC 1822.08 27.63 503.44 percent of total billed charges 1822.08 1822.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION WOLVERINE CUTTING BALLOON MONORAIL Z-GLIDE L 15CM OD 3.75 MM BUMPER TIP ATHEROTOME RADIOPAQUE MIDSHAFT SUP-H74939401153750 CDM 0270 RC outpatient 1822.08 1822.08 1822.08 74 1348.34 percent of total billed charges 1822.08 93 1475.88 percent of total billed charges 1822.08 1822.08 other OPPS APC 1822.08 1822.08 other OPPS APC 1822.08 27.63 503.44 percent of total billed charges 1822.08 1822.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.25 X 8MM SUP-H7493941208220 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.5 X 8MM SUP-H7493941208250 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.75 X 8MM SUP-H7493941208270 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 3.0 X 8MM SUP-H7493941208300 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 3.5 X 8MM SUP-H7493941208350 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 4.0 X 8MM SUP-H7493941208400 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.25 X 12MM SUP-H7493941212220 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.5 X 12MM SUP-H7493941212250 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.75 X 12MM SUP-H7493941212270 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 3.0 X 12MM SUP-H7493941212300 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 3.5 X 12MM SUP-H7493941212350 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 4.0 X 12MM SUP-H7493941212400 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.25 X 16MM SUP-H7493941216220 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.5 X 16MM SUP-H7493941216250 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.75 X 16MM SUP-H7493941216270 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 3.0 X 16MM SUP-H7493941216300 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 3.5 X 16MM SUP-H7493941216350 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 4.0 X 16MM SUP-H7493941216400 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.25 X 20MM SUP-H7493941220220 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.5 X 20MM SUP-H7493941220250 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.75 X 20MM SUP-H7493941220270 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 3.0 X 20MM SUP-H7493941220300 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 3.5 X 20MM SUP-H7493941220350 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 4.0 X 20MM SUP-H7493941220400 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.25 X 24MM SUP-H7493941224220 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.5 X 24MM SUP-H7493941224250 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.75 X 24MM SUP-H7493941224270 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 3.0 X 24MM SUP-H7493941224300 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 3.5 X 24MM SUP-H7493941224350 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 4.0 X 24MM SUP-H7493941224400 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.25 X 28MM SUP-H7493941228220 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.5 X 28MM SUP-H7493941228250 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.75 X 28MM SUP-H7493941228270 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 3.0 X 28MM SUP-H7493941228300 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 3.5 X 28MM SUP-H7493941228350 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 4.0 X 28MM SUP-H7493941228400 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.25 X 32MM SUP-H7493941232220 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.5 X 32MM SUP-H7493941232250 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.75 X 32MM SUP-H7493941232270 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 3.0 X 32MM SUP-H7493941232300 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 3.5 X 32MM SUP-H7493941232350 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 4.0 X 32MM SUP-H7493941232400 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.5 X 38MM SUP-H7493941238250 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 2.75 X 38MM SUP-H7493941238270 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 3.0 X 38MM SUP-H7493941238300 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 3.5 X 38MM SUP-H7493941238350 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROMUS ELITE STENT 4.0 X 38MM SUP-H7493941238400 CDM 0270 RC outpatient 2275 2275 2275 74 1683.5 percent of total billed charges 2275 93 1842.75 percent of total billed charges 2275 2275 other OPPS APC 2275 2275 other OPPS APC 2275 27.63 628.58 percent of total billed charges 2275 2275 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.25 X 8MM SUP-H7493941808220 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.50 X 8MM SUP-H7493941808250 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.75 X 8MM SUP-H7493941808270 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 3.00 X 8MM SUP-H7493941808300 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 3.50 X 8MM SUP-H7493941808350 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 4.00 X 8MM SUP-H7493941808400 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.25 X 12MM SUP-H7493941812220 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.50 X 12MM SUP-H7493941812250 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.75 X 12MM SUP-H7493941812270 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 3.00 X 12MM SUP-H7493941812300 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 3.50 X 12MM SUP-H7493941812350 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 4.00 X 12MM SUP-H7493941812400 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 4.50 X 12MM SUP-H7493941812450 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 5.00 X 12MM SUP-H7493941812500 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.25 X 16MM SUP-H7493941816220 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.50 X 16MM SUP-H7493941816250 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.75 X 16MM SUP-H7493941816270 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 3.00 X 16MM SUP-H7493941816300 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 3.50 X 16MM SUP-H7493941816350 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 4.00 X 16MM SUP-H7493941816400 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 4.50 X 16MM SUP-H7493941816450 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 5.00 X 16MM SUP-H7493941816500 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.25 X 20MM SUP-H7493941820220 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.50 X 20MM SUP-H7493941820250 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.75 X 20MM SUP-H7493941820270 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 3.00 X 20MM SUP-H7493941820300 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 3.50 X 20MM SUP-H7493941820350 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 4.00 X 20MM SUP-H7493941820400 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 4.50 X 20MM SUP-H7493941820450 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 5.00 X 20MM SUP-H7493941820500 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.50 X 24MM SUP-H74939418224250 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.25 X 24MM SUP-H7493941824220 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.75 X 24MM SUP-H7493941824270 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 3.00 X 24MM SUP-H7493941824300 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 3.50 X 24MM SUP-H7493941824350 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 4.00 X 24MM SUP-H7493941824400 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 4.50 X 24MM SUP-H7493941824450 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 5.00 X 24MM SUP-H7493941824500 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.25 X 28MM SUP-H7493941828220 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.50 X 28MM SUP-H7493941828250 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.75 X 28MM SUP-H7493941828270 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 3.00 x 28MM SUP-H7493941828300 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 3.50 X 28MM SUP-H7493941828350 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 4.00 X 28MM SUP-H7493941828400 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 4.50 X 28MM SUP-H7493941828450 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 5.00 X 28MM SUP-H7493941828500 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.25 X 32MM SUP-H7493941832220 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.50 X 32MM SUP-H7493941832250 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.75 X 32MM SUP-H7493941832270 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 3.00 X 32MM SUP-H7493941832300 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 3.50 x 32MM SUP-H7493941832350 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 4.00 X 32MM SUP-H7493941832400 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 4.50 X 32MM SUP-H7493941832450 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 5.00 X 32MM SUP-H7493941832500 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.25 X 38MM SUP-H7493941838220 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.50 X 38MM SUP-H7493941838250 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.75 X 38MM SUP-H7493941838270 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 3.00 X 38MM SUP-H7493941838300 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 3.50 X 38MM SUP-H7493941838350 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 4.00 X 38MM SUP-H7493941838400 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.50 X 48MM SUP-H7493941848250 CDM 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 2.75 X 48MM SUP-H7493941848270 CDM 0270 RC outpatient 1430 1430 1430 74 1058.2 percent of total billed charges 1430 93 1158.3 percent of total billed charges 1430 1430 other OPPS APC 1430 1430 other OPPS APC 1430 27.63 395.11 percent of total billed charges 1430 1430 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 3.00 X 48MM SUP-H7493941848300 CDM 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 3.50 X 48MM SUP-H7493941848350 CDM 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT SYNERGY XD MR 4.00 X 48MM SUP-H7493941848400 CDM 0270 RC outpatient 2210 2210 2210 74 1635.4 percent of total billed charges 2210 93 1790.1 percent of total billed charges 2210 2210 other OPPS APC 2210 2210 other OPPS APC 2210 27.63 610.62 percent of total billed charges 2210 2210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR ROTAWIRE 0.014IN 330CM 2.2CM TIP DRIVE FLOPPY FLEXIBLE WIRECLIP TORQUER 5/BX SUP-H74939462005 CDM 0270 RC outpatient 648.7 648.7 648.7 74 480.04 percent of total billed charges 648.7 93 525.45 percent of total billed charges 648.7 648.7 other OPPS APC 648.7 648.7 other OPPS APC 648.7 27.63 179.24 percent of total billed charges 648.7 648.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTAPRO 1.25MM BURR SUP-H749394671250 CDM 0270 RC outpatient 5005 5005 5005 74 3703.7 percent of total billed charges 5005 93 4054.05 percent of total billed charges 5005 5005 other OPPS APC 5005 5005 other OPPS APC 5005 27.63 1382.88 percent of total billed charges 5005 5005 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTAPRO 1.50MM BURR SUP-H749394671500 CDM 0270 RC outpatient 5005 5005 5005 74 3703.7 percent of total billed charges 5005 93 4054.05 percent of total billed charges 5005 5005 other OPPS APC 5005 5005 other OPPS APC 5005 27.63 1382.88 percent of total billed charges 5005 5005 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTAPRO 1.75MM BURR SUP-H749394671750 CDM 0270 RC outpatient 5005 5005 5005 74 3703.7 percent of total billed charges 5005 93 4054.05 percent of total billed charges 5005 5005 other OPPS APC 5005 5005 other OPPS APC 5005 27.63 1382.88 percent of total billed charges 5005 5005 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTAPRO 2.00MM BURR SUP-H749394672000 CDM 0270 RC outpatient 5447 5447 5447 74 4030.78 percent of total billed charges 5447 93 4412.07 percent of total billed charges 5447 5447 other OPPS APC 5447 5447 other OPPS APC 5447 27.63 1505.01 percent of total billed charges 5447 5447 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTERWIRE EZ BENT TIP RETRIEVAL SHEATH 1.40MM X 150CM SUP-H749501001500 CDM 0481 RC outpatient 214.5 214.5 214.5 74 158.73 percent of total billed charges 214.5 93 173.75 percent of total billed charges 214.5 214.5 other OPPS APC 214.5 214.5 other OPPS APC 214.5 51 109.4 percent of total billed charges 214.5 214.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OPTICROSS 6 CORONARY IMAGING CATHETER SUP-H7495181160 CDM 0481 RC outpatient 1901.9 1901.9 1901.9 74 1407.41 percent of total billed charges 1901.9 93 1540.54 percent of total billed charges 1901.9 1901.9 other OPPS APC 1901.9 1901.9 other OPPS APC 1901.9 51 969.97 percent of total billed charges 1901.9 1901.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMET PRESSURE GUIDEWIRE SUP-H7495551110 CDM 0481 RC outpatient 1901.9 1901.9 1901.9 74 1407.41 percent of total billed charges 1901.9 93 1540.54 percent of total billed charges 1901.9 1901.9 other OPPS APC 1901.9 1901.9 other OPPS APC 1901.9 51 969.97 percent of total billed charges 1901.9 1901.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATH LAB ELECTROPHYSIOLOGY RS PENINSULA REGIONAL SUP-H749601604241 CDM 0481 RC outpatient 24.71 24.71 24.71 74 18.29 percent of total billed charges 24.71 93 20.02 percent of total billed charges 24.71 24.71 other OPPS APC 24.71 24.71 other OPPS APC 24.71 51 12.6 percent of total billed charges 24.71 24.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY EXPRESS SD MONORAIL STAINLESS STEEL L18 MM L150 CM OD6 MM RENAL PREMOUNT BALLOON EXPAND CATHETER RADIOPAQUE STERILE DISPOSABLE ACCEPTS 5 FR SHEATH 6 FR GUIDE PTRA SUP-H7497912618150 CDM 0270 RC outpatient 2405 2405 2405 74 1779.7 percent of total billed charges 2405 93 1948.05 percent of total billed charges 2405 2405 other OPPS APC 2405 2405 other OPPS APC 2405 27.63 664.5 percent of total billed charges 2405 2405 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXTOME CUTTING BALLOON 2.0 X 6 SUP-H749CBM3200060 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXTOME CUTTING BALLOON 2.0 X 10 SUP-H749CBM3200100 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXTOME CUTTING BALLOON 2.0 X 15 SUP-H749CBM3200150 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXTOME CUTTING BALLOON 2.25 X 6 SUP-H749CBM3225060 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION FLEXTOME NYLON L142 CM L10 MM ODSEC2.25 MM MONORAIL CUTTING BALLOON SUP-H749CBM3225100 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION FLEXTOME NYLON L142 CM L15 MM ODSEC2.25 MM MONORAIL CUTTING BALLOON SUP-H749CBM3225150 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXTOME CUTTING BALLOON 2.5 X 6 SUP-H749CBM3250060 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXTOME CUTTING BALLOON 2.5 X 10 SUP-H749CBM3250100 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION FLEXTOME NYLON L142 CM L15 MM ODSEC2.5 MM MONORAIL CUTTING BALLOON SUP-H749CBM3250150 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXTOME CUTTING BALLOON 2.75 X 6 SUP-H749CBM3275060 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXTOME CUTTING BALLOON 2.75 X 10 SUP-H749CBM3275100 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXTOME CUTTING BALLOON 2.75 X 15 SUP-H749CBM3275150 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXTOME CUTTING BALLOON 3.0 X 6 SUP-H749CBM3300060 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXTOME CUTTING BALLOON 3.0 X 10 SUP-H749CBM3300100 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXTOME CUTTING BALLOON 3.0 X 15 SUP-H749CBM3300150 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXTOME CUTTING BALLOON 3.25 X 6 SUP-H749CBM3325060 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION FLEXTOME NYLON L142 CM L10 MM ODSEC3.25 MM MONORAIL CUTTING BALLOON SUP-H749CBM3325100 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXTOME CUTTING BALLOON 3.25 X 15 SUP-H749CBM3325150 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXTOME CUTTING BALLOON 3.5 X 6 SUP-H749CBM3350060 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXTOME CUTTING BALLOON 3.5 X 10 SUP-H749CBM3350100 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXTOME CUTTING BALLOON 3.5 X 15 SUP-H749CBM3350150 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXTOME CUTTING BALLOON 3.75 X 6 SUP-H749CBM3375060 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON FLEXTOME CUTTING 3.75 X 10 MM SUP-H749CBM3375100 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXTOME CUTTING BALLOON 3.75 X 15 SUP-H749CBM3375150 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION FLEXTOME NYLON L142 CM L6 MM ODSEC4 MM MONORAIL CUTTING BALLOON SUP-H749CBM3400060 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLEXTOME CUTTING BALLOON 4.0 X 10 SUP-H749CBM3400100 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION FLEXTOME NYLON L142 CM L15 MM ODSEC4 MM MONORAIL CUTTING BALLOON SUP-H749CBM3400150 CDM 0481 RC outpatient 2216.5 2216.5 2216.5 74 1640.21 percent of total billed charges 2216.5 93 1795.37 percent of total billed charges 2216.5 2216.5 other OPPS APC 2216.5 2216.5 other OPPS APC 2216.5 51 1130.42 percent of total billed charges 2216.5 2216.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC LOTUS EDGE OD 23MM TRANSCATHETER PREMOUNT STERILE LATEX FREE SUP-H749LVSUS230 CDM 0270 RC outpatient 51300 51300 51300 74 37962 percent of total billed charges 51300 93 41553 percent of total billed charges 51300 51300 other OPPS APC 51300 51300 other OPPS APC 51300 27.63 14174.2 percent of total billed charges 51300 51300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC LOTUS EDGE OD 25MM TRANSCATHETER PREMOUNT STERILE LATEX FREE SUP-H749LVSUS250 CDM 0270 RC outpatient 51300 51300 51300 74 37962 percent of total billed charges 51300 93 41553 percent of total billed charges 51300 51300 other OPPS APC 51300 51300 other OPPS APC 51300 27.63 14174.2 percent of total billed charges 51300 51300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC LOTUS EDGE OD 27MM TRANSCATHETER PREMOUNT STERILE LATEX FREE SUP-H749LVSUS270 CDM 0270 RC outpatient 51300 51300 51300 74 37962 percent of total billed charges 51300 93 41553 percent of total billed charges 51300 51300 other OPPS APC 51300 51300 other OPPS APC 51300 27.63 14174.2 percent of total billed charges 51300 51300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC SOFT-VU SOS OMNI 0 CURVE L80 CM OD4 FR VISCERAL BRAID ULTRA TORQUE SHAFT SOFT RADIOPAQUE TIP SELECTIVE ACCEPTS .035 IN GUIDEWIRE SUP-H787107114045 CDM 0270 RC outpatient 57.04 57.04 57.04 74 42.21 percent of total billed charges 57.04 93 46.2 percent of total billed charges 57.04 57.04 other OPPS APC 57.04 57.04 other OPPS APC 57.04 27.63 15.76 percent of total billed charges 57.04 57.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC SOFT-VU SOS OMNI2 CURVE 80CM 5FR DISPOSABLE STERILE VISCERA BRAID ULTRA TORQUE SHAFT RADIOPAQUE SUP-H787107120025 CDM 0270 RC outpatient 59.9 59.9 59.9 74 44.33 percent of total billed charges 59.9 93 48.52 percent of total billed charges 59.9 59.9 other OPPS APC 59.9 59.9 other OPPS APC 59.9 27.63 16.55 percent of total billed charges 59.9 59.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC SOFT-VU OMNI FLUSH 0 CURVE L90 CM OD5 FR HIGH TORQUE SHAFT SOFT RADIOPAQUE TIP ACCEPTS .035 IN GUIDEWIRE SUP-H787107322025 CDM 0270 RC outpatient 27.82 27.82 27.82 74 20.59 percent of total billed charges 27.82 93 22.53 percent of total billed charges 27.82 27.82 other OPPS APC 27.82 27.82 other OPPS APC 27.82 27.63 7.69 percent of total billed charges 27.82 27.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC SOFT-VU OMNI FLUSH 0 CURVE L65 CM OD4 FR HIGH TORQUE SHAFT SOFT RADIOPAQUE TIP ACCEPTS .035 IN GUIDEWIRE SUP-H787107323015 CDM 0270 RC outpatient 173.16 173.16 173.16 74 128.14 percent of total billed charges 173.16 93 140.26 percent of total billed charges 173.16 173.16 other OPPS APC 173.16 173.16 other OPPS APC 173.16 27.63 47.84 percent of total billed charges 173.16 173.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC SOFT-VU OMNI FLUSH 0 CURVE L90 CM OD4 FR VISCERAL SOFT RADIOPAQUE TIP HIGH TORQUE SHAFT ACCEPTS .035 IN GUIDEWIRE SUP-H787107323025 CDM 0270 RC outpatient 49.01 49.01 49.01 74 36.27 percent of total billed charges 49.01 93 39.7 percent of total billed charges 49.01 49.01 other OPPS APC 49.01 49.01 other OPPS APC 49.01 27.63 13.54 percent of total billed charges 49.01 49.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER KUMPE 5FR 65CM SUP-H787107327015-US CDM 0270 RC outpatient 90.09 90.09 90.09 74 66.67 percent of total billed charges 90.09 93 72.97 percent of total billed charges 90.09 90.09 other OPPS APC 90.09 90.09 other OPPS APC 90.09 27.63 24.89 percent of total billed charges 90.09 90.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC SOFT-VU KUMPE CURVE ANGLE L40 CM OD4 FR NONBRAIDED SOFT RADIOPAQUE TIP HIGH TORQUE SHAFT SELECTIVE STERILE DISPOSABLE .035 IN GUIDEWIRE SUP-H787107343015 CDM 0270 RC outpatient 116.84 116.84 116.84 74 86.46 percent of total billed charges 116.84 93 94.64 percent of total billed charges 116.84 116.84 other OPPS APC 116.84 116.84 other OPPS APC 116.84 27.63 32.28 percent of total billed charges 116.84 116.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL C0-90D TROCAR BEVEL 15CM 6.4FR STARBURST XL 3.5CM SUP-H7877001039021 CDM 0270 RC outpatient 5530.2 5530.2 5530.2 74 4092.35 percent of total billed charges 5530.2 93 4479.46 percent of total billed charges 5530.2 5530.2 other OPPS APC 5530.2 5530.2 other OPPS APC 5530.2 27.63 1527.99 percent of total billed charges 5530.2 5530.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL STARBURST XL TROCAR L10 CM L3-5 CM OD14 GA 9 ARRAY SLIM HANDLE DESIGN EXPANDABLE RADIOFREQUENCY ABLATION ATTACHED CABLE STERILE DISPOSABLE SUP-H7877001039031 CDM 0270 RC outpatient 5530.2 5530.2 5530.2 74 4092.35 percent of total billed charges 5530.2 93 4479.46 percent of total billed charges 5530.2 5530.2 other OPPS APC 5530.2 5530.2 other OPPS APC 5530.2 27.63 1527.99 percent of total billed charges 5530.2 5530.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR SOLERO MICROWAVE 14 CM SUP-H787700106001US0 CDM 0270 RC outpatient 7800 7800 7800 74 5772 percent of total billed charges 7800 93 6318 percent of total billed charges 7800 7800 other OPPS APC 7800 7800 other OPPS APC 7800 27.63 2155.14 percent of total billed charges 7800 7800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLERO APPLICATOR 19 CM SUP-H787700106001US0 CDM 0270 RC outpatient 7800 7800 7800 74 5772 percent of total billed charges 7800 93 6318 percent of total billed charges 7800 7800 other OPPS APC 7800 7800 other OPPS APC 7800 27.63 2155.14 percent of total billed charges 7800 7800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLERO APPLICATOR 19 CM SUP-H787700106002US0 CDM 0270 RC outpatient 7800 7800 7800 74 5772 percent of total billed charges 7800 93 6318 percent of total billed charges 7800 7800 other OPPS APC 7800 7800 other OPPS APC 7800 27.63 2155.14 percent of total billed charges 7800 7800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLERO APPLICATOR 19 CM SUP-H787700106002US1 CDM 0270 RC outpatient 7800 7800 7800 74 5772 percent of total billed charges 7800 93 6318 percent of total billed charges 7800 7800 other OPPS APC 7800 7800 other OPPS APC 7800 27.63 2155.14 percent of total billed charges 7800 7800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLERO APPLICATOR 29CM SUP-H787700106003US0 CDM 0270 RC outpatient 8600.8 8600.8 8600.8 74 6364.59 percent of total billed charges 8600.8 93 6966.65 percent of total billed charges 8600.8 8600.8 other OPPS APC 8600.8 8600.8 other OPPS APC 8600.8 27.63 2376.4 percent of total billed charges 8600.8 8600.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLERO APPLICATOR 29CM SUP-H787700106003US2 CDM 0270 RC outpatient 7800 7800 7800 74 5772 percent of total billed charges 7800 93 6318 percent of total billed charges 7800 7800 other OPPS APC 7800 7800 other OPPS APC 7800 27.63 2155.14 percent of total billed charges 7800 7800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GUIDEWIRE, PTFE 035 X 260CM FC ST" SUP-H7878101352601 CDM 0481 RC outpatient 30.11 30.11 30.11 74 22.28 percent of total billed charges 30.11 93 24.39 percent of total billed charges 30.11 30.11 other OPPS APC 30.11 30.11 other OPPS APC 30.11 51 15.36 percent of total billed charges 30.11 30.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GUIDEWIRE, PTFE 035 X 180CM FC 3MM J" SUP-H7878105351801 CDM 0481 RC outpatient 28 28 28 74 20.72 percent of total billed charges 28 93 22.68 percent of total billed charges 28 28 other OPPS APC 28 28 other OPPS APC 28 51 14.28 percent of total billed charges 28 28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GUIDEWIRE, PTFE 035 X 260CM FC 3MM J" SUP-H7878105352601 CDM 0481 RC outpatient 39.81 39.81 39.81 74 29.46 percent of total billed charges 39.81 93 32.25 percent of total billed charges 39.81 39.81 other OPPS APC 39.81 39.81 other OPPS APC 39.81 51 20.3 percent of total billed charges 39.81 39.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PORT IMPLANTABLE INFUSION VORTEX LP PEELPRO TITANIUM SILICONE PTFE OD 11.4 FR OD SEC 12 FR 2 DETACH CATHETER INTRODUCER BAYONET LOCK STERILE SUP-H787LVTX52130 CDM 0270 RC outpatient 741 741 741 74 548.34 percent of total billed charges 741 93 600.21 percent of total billed charges 741 741 other OPPS APC 741 741 other OPPS APC 741 27.63 204.74 percent of total billed charges 741 741 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTAINER HISTOLOGY HISTOPLEX 10% NEUTRAL BUFFER FORMALIN POLYETHYLENE 8 L CAP STURDY TAMPER EVIDENT BUCKET NONSTERILE WHITE SUP-H80002 CDM outpatient 48.43 48.43 48.43 48.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROTAWIRE AND WIRECLIP TORQUER 330CM SUP-H802228240022 CDM 0270 RC outpatient 557.7 557.7 557.7 74 412.7 percent of total billed charges 557.7 93 451.74 percent of total billed charges 557.7 557.7 other OPPS APC 557.7 557.7 other OPPS APC 557.7 27.63 154.09 percent of total billed charges 557.7 557.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PLAIN 3-0 FS-2 L27 IN MONOFILAMENT YELLOWISH TAN SUP-H822H CDM 0270 RC outpatient 7.31 7.31 7.31 74 5.41 percent of total billed charges 7.31 93 5.92 percent of total billed charges 7.31 7.31 other OPPS APC 7.31 7.31 other OPPS APC 7.31 27.63 2.02 percent of total billed charges 7.31 7.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ENDOSCOPIC WALLSTENT TAPER 500CM .035IN DISPOSABLE SUPER STIFF SUP-H965180011 CDM 0270 RC outpatient 293.28 293.28 293.28 74 217.03 percent of total billed charges 293.28 93 237.56 percent of total billed charges 293.28 293.28 other OPPS APC 293.28 293.28 other OPPS APC 293.28 27.63 81.03 percent of total billed charges 293.28 293.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS WALLSTENT UNISTEP PLUS 75CM 40MM 100CM 16MM METAL TRACHEOBRONCHIAL CATHETER UNCONSTRAIN FLEXIBLE SUP-H965403310 CDM 0270 RC outpatient 2587.65 2587.65 2587.65 74 1914.86 percent of total billed charges 2587.65 93 2096 percent of total billed charges 2587.65 2587.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS WALLSTENT UNISTEP PLUS METAL L100 CM L60 MM L75 CM OD16 MM ODSEC9 FR TRACHEOBRONCHIAL CATHETER UNCONSTRAIN FLEXIBLE ACCEPTS 10 FR SHEATH SUP-H965403320 CDM 0270 RC outpatient 2587.65 2587.65 2587.65 74 1914.86 percent of total billed charges 2587.65 93 2096 percent of total billed charges 2587.65 2587.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT WALL 18X60 SUP-H965404120 CDM 0270 RC outpatient 3365.6 3365.6 3365.6 74 2490.54 percent of total billed charges 3365.6 93 2726.14 percent of total billed charges 3365.6 3365.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS TRACHEOBRONCHIAL 55MM 20MM METAL WALLSTENT UNISTEP PLUS 75CM SUP-H965404310 CDM 0270 RC outpatient 2876.59 2876.59 2876.59 74 2128.68 percent of total billed charges 2876.59 93 2330.04 percent of total billed charges 2876.59 2876.59 other OPPS APC 2876.59 2876.59 other OPPS APC 2876.59 27.63 794.8 percent of total billed charges 2876.59 2876.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS WALLSTENT UNISTEP PLUS METAL L100 CM L80 MM L75 CM OD20 MM TRACHEOBRONCHIAL FLEXIBLE DELIVERY SYSTEM ACCEPTS 11 FR SHEATH SUP-H965404320 CDM 0270 RC outpatient 4391.95 4391.95 4391.95 74 3250.04 percent of total billed charges 4391.95 93 3557.48 percent of total billed charges 4391.95 4391.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS WALLSTENT UNISTEP PLUS METAL L100 CM L70 MM L75 CM OD22 MM TRACHEOBRONCHIAL FLEXIBLE DELIVERY SYSTEM ACCEPTS 11 FR SHEATH SUP-H965404520 CDM 0270 RC outpatient 4391.95 4391.95 4391.95 74 3250.04 percent of total billed charges 4391.95 93 3557.48 percent of total billed charges 4391.95 4391.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MANIFOLD RIGHT SUP-H965700383011 CDM 0481 RC outpatient 14.12 14.12 14.12 74 10.45 percent of total billed charges 14.12 93 11.44 percent of total billed charges 14.12 14.12 other OPPS APC 14.12 14.12 other OPPS APC 14.12 51 7.2 percent of total billed charges 14.12 14.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STOPCOCK ANGIOGRAPHY NAMIC 1050 PSI 3 WAY ROTATE ADAPTER RIGHT PORT SUP-H965700550091 CDM 0270 RC outpatient 5.2 5.2 5.2 74 3.85 percent of total billed charges 5.2 93 4.21 percent of total billed charges 5.2 5.2 other OPPS APC 5.2 5.2 other OPPS APC 5.2 27.63 1.44 percent of total billed charges 5.2 5.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. .035 NAVILYST GUIDEWIRE 175J SUP-H965970002101 CDM 0481 RC outpatient 24.18 24.18 24.18 74 17.89 percent of total billed charges 24.18 93 19.59 percent of total billed charges 24.18 24.18 other OPPS APC 24.18 24.18 other OPPS APC 24.18 51 12.33 percent of total billed charges 24.18 24.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. .035 X 145 15MM J WIRE SUP-H965970002171 CDM 0481 RC outpatient 21.31 21.31 21.31 74 15.77 percent of total billed charges 21.31 93 17.26 percent of total billed charges 21.31 21.31 other OPPS APC 21.31 21.31 other OPPS APC 21.31 51 10.87 percent of total billed charges 21.31 21.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAVILYST .035 STRAIGHT TIP GUIDEWIRE 260CM SUP-H965970004011 CDM 0481 RC outpatient 30.11 30.11 30.11 74 22.28 percent of total billed charges 30.11 93 24.39 percent of total billed charges 30.11 30.11 other OPPS APC 30.11 30.11 other OPPS APC 30.11 51 15.36 percent of total billed charges 30.11 30.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NAVILYST .035 J-TIP GUIDEWIRE 260CM SUP-H965970004051 CDM 0481 RC outpatient 34.4 34.4 34.4 74 25.46 percent of total billed charges 34.4 93 27.86 percent of total billed charges 34.4 34.4 other OPPS APC 34.4 34.4 other OPPS APC 34.4 51 17.54 percent of total billed charges 34.4 34.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUP BENCOX 3HOLE 56MM SUP-HA.A11.2056 CDM 270010024 LOCAL 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL BENCOX 2 STANDARD OFFSET HIP MODULAR STERILE SUP-HA.F22.1002 CDM 270010024 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL STANDARD SIZE 3 SUP-HA.F22.1003 CDM 270010024 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL BENCOX 4 STANDARD OFFSET HIP MODULAR STERILE SUP-HA.F22.1004 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM BENCOX STANDARD SIZE 5 FEMORAL STEM SUP-HA.F22.1005 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL BENCOX 6 STANDARD OFFSET HIP MODULAR STERILE SUP-HA.F22.1006 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL BENCOX 7 STANDARD OFFSET HIP MODULAR STERILE SUP-HA.F22.1007 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL BENCOX 8 STANDARD OFFSET HIP MODULAR STERILE SUP-HA.F22.1008 CDM 270010024 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL BENCOX 132 D 9 STANDARD OFFSET HIP SUP-HA.F22.1009 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL BENCOX 132 D 10 STANDARD OFFSET HIP SUP-HA.F22.1010 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL BENCOX M LATERALIZED SIZE 1 SUP-HA.F24.1001 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL BENCOX 132 D 2 LATERALIZE OFFSET HIP SUP-HA.F24.1002 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL LATERALIZED SIZE 3 SUP-HA.F24.1003 CDM 270010024 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL BENCOX LATERALIZE OFFSET HIP MODULAR STERILE SUP-HA.F24.1004 CDM 270010024 LOCAL 0270 RC outpatient 5200 5200 5200 74 3848 percent of total billed charges 5200 93 4212 percent of total billed charges 5200 5200 other OPPS APC 5200 5200 other OPPS APC 5200 27.63 1436.76 percent of total billed charges 5200 5200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL BENCOX LATERALIZED SIZE 5 SUP-HA.F24.1005 CDM 270010024 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR BENCOX LATERALIZED SIZE 6 SUP-HA.F24.1006 CDM 270010024 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL LATERALIZED SIZE 7 SUP-HA.F24.1007 CDM 270010024 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL LATERALIZED SIZE 8 SUP-HA.F24.1008 CDM 270010024 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM LATERALIZED SIZE 9 SUP-HA.F24.1009 CDM 270010024 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR BENCOX LATERALIZED SIZE 10 SUP-HA.F24.1010 CDM 270010024 LOCAL 0270 RC outpatient 5980 5980 5980 74 4425.2 percent of total billed charges 5980 93 4843.8 percent of total billed charges 5980 5980 other OPPS APC 5980 5980 other OPPS APC 5980 27.63 1652.27 percent of total billed charges 5980 5980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP ENDOSCOPE SEALING DEXTRUS VALUELINK SUP-HAP02 CDM 0270 RC outpatient 1578.99 1578.99 1578.99 74 1168.45 percent of total billed charges 1578.99 93 1278.98 percent of total billed charges 1578.99 1578.99 other OPPS APC 1578.99 1578.99 other OPPS APC 1578.99 27.63 436.27 percent of total billed charges 1578.99 1578.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEARS ELECTROSURGICAL HARMONIC ACE+ CURVE 36CM 5MM TITANIUM DISPOSABLE STERILE 2 HAND CONTROL BUTTON TAPER TIP SUP-HAR36 CDM 0270 RC outpatient 1255.01 1255.01 1255.01 74 928.71 percent of total billed charges 1255.01 93 1016.56 percent of total billed charges 1255.01 1255.01 other OPPS APC 1255.01 1255.01 other OPPS APC 1255.01 27.63 346.76 percent of total billed charges 1255.01 1255.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEARS LAPAROSCOPIC HARMONIC ACE +7 L45 CM OD5 MM CURVE TIP ADVANCE HEMOSTASIS ULTRASONIC SUP-HAR745 CDM 0270 RC outpatient 1483.6 1483.6 1483.6 74 1097.86 percent of total billed charges 1483.6 93 1201.72 percent of total billed charges 1483.6 1483.6 other OPPS APC 1483.6 1483.6 other OPPS APC 1483.6 27.63 409.92 percent of total billed charges 1483.6 1483.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEARS ELECTROSURGICAL HARMONIC FOCUS+ CURVE TAPER 9CM DISPOSABLE STERILE 2 HAND CONTROL ADAPTIVE TISSUE TECHNOLOGY SOFT SUP-HAR9F CDM 0270 RC outpatient 1176.42 1176.42 1176.42 74 870.55 percent of total billed charges 1176.42 93 952.9 percent of total billed charges 1176.42 1176.42 other OPPS APC 1176.42 1176.42 other OPPS APC 1176.42 27.63 325.04 percent of total billed charges 1176.42 1176.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEARS LAPAROSCOPIC HARMONIC ACE +7 L45 CM OD5 MM CURVE TIP ADVANCE HEMOSTASIS ULTRASONIC SUP-HARH45 CDM 0270 RC outpatient 1483.6 1483.6 1483.6 74 1097.86 percent of total billed charges 1483.6 93 1201.72 percent of total billed charges 1483.6 1483.6 other OPPS APC 1483.6 1483.6 other OPPS APC 1483.6 27.63 409.92 percent of total billed charges 1483.6 1483.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE PROPATEN CBAS STANDARD WALL L70 CM L40 CM ID8 MM AXILLOBIFEMORAL REMOVABLE RING SUP-HAX01A CDM 0270 RC outpatient 9963.2 9963.2 9963.2 74 7372.77 percent of total billed charges 9963.2 93 8070.19 percent of total billed charges 9963.2 9963.2 other OPPS APC 9963.2 9963.2 other OPPS APC 9963.2 27.63 2752.83 percent of total billed charges 9963.2 9963.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOLDER TUBE FOAM ADULT SOFT STRAP ADJUSTABLE HOOK LOOP CLOSURE SNUG FIT LAMINATE LATEX FREETRACHEOSTOMY SUP-HCS540 CDM outpatient 4.55 4.55 4.55 4.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT SUTURE HEART IN-HOUSE CUSTOM SUP-HEART CUSTOM CDM 0270 RC outpatient 334.05 334.05 334.05 74 247.2 percent of total billed charges 334.05 93 270.58 percent of total billed charges 334.05 334.05 other OPPS APC 334.05 334.05 other OPPS APC 334.05 27.63 92.3 percent of total billed charges 334.05 334.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAROTID PATCH KNITTED HEK06/75CPUT EA SUP-HEK06/75CUT CDM 0270 RC outpatient 278.2 278.2 278.2 74 205.87 percent of total billed charges 278.2 93 225.34 percent of total billed charges 278.2 278.2 other OPPS APC 278.2 278.2 other OPPS APC 278.2 27.63 76.87 percent of total billed charges 278.2 278.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH CARDIOVASCULAR HEMACAROTID COLLAGEN POLYESTER THK.41 MM ULTRA THIN WALL L75 MM X W8 MM KNITTED COATED REVERSE LOCKNIT SUP-HEK08/75CPUT CDM 0270 RC outpatient 278.2 278.2 278.2 74 205.87 percent of total billed charges 278.2 93 225.34 percent of total billed charges 278.2 278.2 other OPPS APC 278.2 278.2 other OPPS APC 278.2 27.63 76.87 percent of total billed charges 278.2 278.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH CARDIOVASCULAR HEMACAROTID PATCH ULTRATHIN INTERVASCULAR POLYESTER COLLAGEN THK.65 MM L75 MM X W8 MM KNIT REVERSE LOCKNIT SUP-HEK08/75CPUT1 CDM 0270 RC outpatient 278.2 278.2 278.2 74 205.87 percent of total billed charges 278.2 93 225.34 percent of total billed charges 278.2 278.2 other OPPS APC 278.2 278.2 other OPPS APC 278.2 27.63 76.87 percent of total billed charges 278.2 278.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR HEMABRIDGE INTERVASCULAR INTERGARD COLLAGEN POLYESTER THK.38 MM OD10/8/8 MM L50 CM L30 CM OD28 MM ODSEC10 MM AORTIC ARCH 4 BRANCH WOVEN SUP-HEWAA2810080810/1 CDM 0270 RC outpatient 5544.63 5544.63 5544.63 74 4103.03 percent of total billed charges 5544.63 93 4491.15 percent of total billed charges 5544.63 5544.63 other OPPS APC 5544.63 5544.63 other OPPS APC 5544.63 27.63 1531.98 percent of total billed charges 5544.63 5544.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR HEMABRIDGE INTERVASCULAR INTERGARD THK.38MM 4 BRANCH 10X8X8MM 50 SUP-HEWAA3010080810/1 CDM 0270 RC outpatient 5544.63 5544.63 5544.63 74 4103.03 percent of total billed charges 5544.63 93 4491.15 percent of total billed charges 5544.63 5544.63 other OPPS APC 5544.63 5544.63 other OPPS APC 5544.63 27.63 1531.98 percent of total billed charges 5544.63 5544.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE SURGICAL HELI-FX L62 CM L28 MM OD16 FR AAA DEFLECT TIP SUP-HG-16-62-28 CDM 270010015 LOCAL 0270 RC outpatient 4854.2 4854.2 4854.2 74 3592.11 percent of total billed charges 4854.2 93 3931.9 percent of total billed charges 4854.2 4854.2 other OPPS APC 4854.2 4854.2 other OPPS APC 4854.2 27.63 1341.22 percent of total billed charges 4854.2 4854.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOPROSTHESIS GORE INTERNAL ILIAC ILIAC COMPONENT SUP-HGB161007A CDM 270010015 LOCAL 0270 RC outpatient 8611.2 8611.2 8611.2 74 6372.29 percent of total billed charges 8611.2 93 6975.07 percent of total billed charges 8611.2 8611.2 other OPPS APC 8611.2 8611.2 other OPPS APC 8611.2 27.63 2379.27 percent of total billed charges 8611.2 8611.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR GORE EXCLUDER L7 CM OD14.5 MM ILIAC INTERNAL COMPONENT AAA SUP-HGB161407A CDM 270010015 LOCAL 0270 RC outpatient 8611.2 8611.2 8611.2 74 6372.29 percent of total billed charges 8611.2 93 6975.07 percent of total billed charges 8611.2 8611.2 other OPPS APC 8611.2 8611.2 other OPPS APC 8611.2 27.63 2379.27 percent of total billed charges 8611.2 8611.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR HEMAGARD COLLAGEN POLYESTER STRAIGHT L20 CM X H.49 MM OD6 MM KNIT REVERSE LOCKNIT CROSS LINK EXCELLENT HEAL SUP-HGK0006-40 CDM 0270 RC outpatient 969.93 969.93 969.93 74 717.75 percent of total billed charges 969.93 93 785.64 percent of total billed charges 969.93 969.93 other OPPS APC 969.93 969.93 other OPPS APC 969.93 27.63 267.99 percent of total billed charges 969.93 969.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR HEMAGARD COLLAGEN POLYESTER STRAIGHT L40 CM X H.49 MM OD7 MM KNIT REVERSE LOCKNIT CROSS LINK EXCELLENT HEAL SUP-HGK0007-40 CDM 0270 RC outpatient 941.67 941.67 941.67 74 696.84 percent of total billed charges 941.67 93 762.75 percent of total billed charges 941.67 941.67 other OPPS APC 941.67 941.67 other OPPS APC 941.67 27.63 260.18 percent of total billed charges 941.67 941.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR HEMAGARD COLLAGEN POLYESTER STRAIGHT L70 CM X H.49 MM OD7 MM KNIT REVERSE LOCKNIT CROSS LINK EXCELLENT HEAL SUP-HGK0007-70 CDM 0270 RC outpatient 1005.89 1005.89 1005.89 74 744.36 percent of total billed charges 1005.89 93 814.77 percent of total billed charges 1005.89 1005.89 other OPPS APC 1005.89 1005.89 other OPPS APC 1005.89 27.63 277.93 percent of total billed charges 1005.89 1005.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR HEMAGARD COLLAGEN POLYESTER STRAIGHT L40 CM X H.49 MM OD8 MM KNIT REVERSE LOCKNIT CROSS LINK EXCELLENT HEAL SUP-HGK0008-40 CDM 0270 RC outpatient 969.93 969.93 969.93 74 717.75 percent of total billed charges 969.93 93 785.64 percent of total billed charges 969.93 969.93 other OPPS APC 969.93 969.93 other OPPS APC 969.93 27.63 267.99 percent of total billed charges 969.93 969.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR HEMAGARD COLLAGEN POLYESTER STRAIGHT L70 CM X H.49 MM OD8 MM KNIT REVERSE LOCKNIT CROSS LINK EXCELLENT HEAL SUP-HGK0008-70 CDM 0270 RC outpatient 1005.89 1005.89 1005.89 74 744.36 percent of total billed charges 1005.89 93 814.77 percent of total billed charges 1005.89 1005.89 other OPPS APC 1005.89 1005.89 other OPPS APC 1005.89 27.63 277.93 percent of total billed charges 1005.89 1005.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR HEMAGARD COLLAGEN POLYESTER STRAIGHT L40 CM X H.49 MM OD10 MM KNIT REVERSE LOCKNIT CROSS LINK EXCELLENT HEAL SUP-HGK0010-40 CDM 0270 RC outpatient 941.67 941.67 941.67 74 696.84 percent of total billed charges 941.67 93 762.75 percent of total billed charges 941.67 941.67 other OPPS APC 941.67 941.67 other OPPS APC 941.67 27.63 260.18 percent of total billed charges 941.67 941.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR 40CM 12MM KNIT REVERSE LOCKNIT SUTURABILITY INTERVASCULAR SUP-HGK0012-40 CDM 0270 RC outpatient 969.93 969.93 969.93 74 717.75 percent of total billed charges 969.93 93 785.64 percent of total billed charges 969.93 969.93 other OPPS APC 969.93 969.93 other OPPS APC 969.93 27.63 267.99 percent of total billed charges 969.93 969.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD STRAIGHT 40CM 14MM VELOUR COLLAGEN SUP-HGK0014-40 CDM 0270 RC outpatient 941.67 941.67 941.67 74 696.84 percent of total billed charges 941.67 93 762.75 percent of total billed charges 941.67 941.67 other OPPS APC 941.67 941.67 other OPPS APC 941.67 27.63 260.18 percent of total billed charges 941.67 941.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR HEMAGARD BOVINE TYPE I COLLAGEN POLYESTER FABRIC STRAIGHT L40 CM X H.49 MM OD16 MM KNITTED REVERSE LOCKNIT CROSS LINKED RADIAL TENSILE STRENGTH EXCELLENT HEALING SUP-HGK0016-40 CDM 0270 RC outpatient 969.93 969.93 969.93 74 717.75 percent of total billed charges 969.93 93 785.64 percent of total billed charges 969.93 969.93 other OPPS APC 969.93 969.93 other OPPS APC 969.93 27.63 267.99 percent of total billed charges 969.93 969.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER STRAIGHT L20 CM OD18 MM KNIT REVERSE LOCKNIT SUTURABILITY SUP-HGK0018-20 CDM 0270 RC outpatient 699.66 699.66 699.66 74 517.75 percent of total billed charges 699.66 93 566.72 percent of total billed charges 699.66 699.66 other OPPS APC 699.66 699.66 other OPPS APC 699.66 27.63 193.32 percent of total billed charges 699.66 699.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER STRAIGHT L40 CM OD20 MM KNIT REVERSE LOCKNIT SUTURABILITY SUP-HGK0020-40 CDM 0270 RC outpatient 941.67 941.67 941.67 74 696.84 percent of total billed charges 941.67 93 762.75 percent of total billed charges 941.67 941.67 other OPPS APC 941.67 941.67 other OPPS APC 941.67 27.63 260.18 percent of total billed charges 941.67 941.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR HEMAGARD COLLAGEN POLYESTER STRAIGHT L40 CM X H.49 MM OD22 MM KNIT REVERSE LOCKNIT CROSS LINK EXCELLENT HEAL SUP-HGK0022-40 CDM 0270 RC outpatient 969.93 969.93 969.93 74 717.75 percent of total billed charges 969.93 93 785.64 percent of total billed charges 969.93 969.93 other OPPS APC 969.93 969.93 other OPPS APC 969.93 27.63 267.99 percent of total billed charges 969.93 969.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR HEMASHIELD PLATINUM 2 VELOUR COLLAGEN STRAIGHT L15 CM OD38 MM THORACIC 2 PASS SEWING WOVEN STERILE SUP-HGK0024-40 CDM 0270 RC outpatient 941.67 941.67 941.67 74 696.84 percent of total billed charges 941.67 93 762.75 percent of total billed charges 941.67 941.67 other OPPS APC 941.67 941.67 other OPPS APC 941.67 27.63 260.18 percent of total billed charges 941.67 941.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER 2 BRANCH L50 CM OD12 MM ODSEC6 MM KNIT REVERSE LOCKNIT SUTURABILITY SUP-HGK1206 CDM 0270 RC outpatient 1805.8 1805.8 1805.8 74 1336.29 percent of total billed charges 1805.8 93 1462.7 percent of total billed charges 1805.8 1805.8 other OPPS APC 1805.8 1805.8 other OPPS APC 1805.8 27.63 498.94 percent of total billed charges 1805.8 1805.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE HEMAGARD BOVINE TYPE I COLLAGEN POLYESTER FABRIC L50 CM X H.49 MM OD14/7 MM VASCULAR BIFURCATED KNITTED CROSS LINKED TENSILE STRENGTH EXCELLENT HANDLING SUP-HGK1407 CDM 0270 RC outpatient 1373.74 1373.74 1373.74 74 1016.57 percent of total billed charges 1373.74 93 1112.73 percent of total billed charges 1373.74 1373.74 other OPPS APC 1373.74 1373.74 other OPPS APC 1373.74 27.63 379.56 percent of total billed charges 1373.74 1373.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE HEMAGARD BOVINE TYPE I COLLAGEN POLYESTER FABRIC L50 CM X H.49 MM OD16/8 MM VASCULAR BIFURCATED KNITTED CROSS LINKED TENSILE STRENGTH EXCELLENT HANDLING SUP-HGK1608 CDM 0270 RC outpatient 1414.95 1414.95 1414.95 74 1047.06 percent of total billed charges 1414.95 93 1146.11 percent of total billed charges 1414.95 1414.95 other OPPS APC 1414.95 1414.95 other OPPS APC 1414.95 27.63 390.95 percent of total billed charges 1414.95 1414.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER 2 BRANCH L50 CM OD18 MM ODSEC9 MM KNIT REVERSE LOCKNIT SUTURABILITY SUP-HGK1809 CDM 0270 RC outpatient 1373.74 1373.74 1373.74 74 1016.57 percent of total billed charges 1373.74 93 1112.73 percent of total billed charges 1373.74 1373.74 other OPPS APC 1373.74 1373.74 other OPPS APC 1373.74 27.63 379.56 percent of total billed charges 1373.74 1373.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE HEMAGARD BOVINE TYPE I COLLAGEN POLYESTER FABRIC L50 CM X H.49 MM OD20/10 MM VASCULAR BIFURCATED KNITTED CROSS LINKED TENSILE STRENGTH EXCELLENT HANDLING SUP-HGK2010 CDM 0270 RC outpatient 1373.74 1373.74 1373.74 74 1016.57 percent of total billed charges 1373.74 93 1112.73 percent of total billed charges 1373.74 1373.74 other OPPS APC 1373.74 1373.74 other OPPS APC 1373.74 27.63 379.56 percent of total billed charges 1373.74 1373.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE HEMAGARD BOVINE TYPE I COLLAGEN POLYESTER FABRIC 2 BRANCH L50 CM X H.49 MM OD22/11 MM VASCULAR BIFURCATED KNITTED CROSS LINKED TENSILE STRENGTH EXCELLENT HANDLING SUP-HGK2211 CDM 0270 RC outpatient 1805.8 1805.8 1805.8 74 1336.29 percent of total billed charges 1805.8 93 1462.7 percent of total billed charges 1805.8 1805.8 other OPPS APC 1805.8 1805.8 other OPPS APC 1805.8 27.63 498.94 percent of total billed charges 1805.8 1805.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR HEMAGARD COLLAGEN POLYESTER 2 BRANCH L50 CM X H.49 MM OD22/12 MM KNIT REVERSE LOCKNIT CROSS LINK EXCELLENT HEAL SUP-HGK2412 CDM 0270 RC outpatient 1805.8 1805.8 1805.8 74 1336.29 percent of total billed charges 1805.8 93 1462.7 percent of total billed charges 1805.8 1805.8 other OPPS APC 1805.8 1805.8 other OPPS APC 1805.8 27.63 498.94 percent of total billed charges 1805.8 1805.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR 100/55CMX.49MM 8MM 60/30CM AXILLOBIFEMORAL KNIT CROSS LINK SUP-HGKAX0808RS60/30 CDM 0270 RC outpatient 3279.93 3279.93 3279.93 74 2427.15 percent of total billed charges 3279.93 93 2656.74 percent of total billed charges 3279.93 3279.93 other OPPS APC 3279.93 3279.93 other OPPS APC 3279.93 27.63 906.24 percent of total billed charges 3279.93 3279.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL GORE BIO-A SYNTHETIC L10 CM X W7 CM TISSUE REINFORCEMENT HIATAL HERNIA REPAIR SUP-HH0710 CDM 0270 RC outpatient 1326 1326 1326 74 981.24 percent of total billed charges 1326 93 1074.06 percent of total billed charges 1326 1326 other OPPS APC 1326 1326 other OPPS APC 1326 27.63 366.37 percent of total billed charges 1326 1326 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DRAPE SPY-PHI DRUG SUP-HH9006 CDM 0270 RC outpatient 1629.64 1629.64 1629.64 74 1205.93 percent of total billed charges 1629.64 93 1320.01 percent of total billed charges 1629.64 1629.64 other OPPS APC 1629.64 1629.64 other OPPS APC 1629.64 27.63 450.27 percent of total billed charges 1629.64 1629.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EXTERNAL INVIEW MALE MEDIUM L29 MM EXTRA ADHESIVE LATEX FREE SUP-HL97629A CDM outpatient 2.85 2.85 2.85 2.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MATTRESS TRANSFER HOVERMATT W34 IN BREATHABLE NONSTERILE LATEX FREE DISPOSABLE SUP-HM34SPU-B CDM 0270 RC outpatient 193.18 193.18 193.18 74 142.95 percent of total billed charges 193.18 93 156.48 percent of total billed charges 193.18 193.18 other OPPS APC 193.18 193.18 other OPPS APC 193.18 27.63 53.38 percent of total billed charges 193.18 193.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MATTRESS TRANSFER HOVERMATT 120 D W39 IN BREATHABLE NONSTERILE LATEX FREE DISPOSABLE SUP-HM39SPU-B CDM 0270 RC outpatient 218.66 218.66 218.66 74 161.81 percent of total billed charges 218.66 93 177.11 percent of total billed charges 218.66 218.66 other OPPS APC 218.66 218.66 other OPPS APC 218.66 27.63 60.42 percent of total billed charges 218.66 218.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROYAL FLUSH HIGH FLOW CATHETER 6F SUP-HN6.038110P105PIG CDM 0270 RC outpatient 38.64 38.64 38.64 74 28.59 percent of total billed charges 38.64 93 31.3 percent of total billed charges 38.64 38.64 other OPPS APC 38.64 38.64 other OPPS APC 38.64 27.63 10.68 percent of total billed charges 38.64 38.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGE STAINLESS STEEL NYLON GPC CURVE L100 CM OD7 FR PULMONARY 4 SIDEPORT STERILE DISPOSABLE ACCEPTS .038 IN GUIDEWIRE SUP-HNB7.038100P4SGPC CDM 0270 RC outpatient 38.64 38.64 38.64 74 28.59 percent of total billed charges 38.64 93 31.3 percent of total billed charges 38.64 38.64 other OPPS APC 38.64 38.64 other OPPS APC 38.64 27.63 10.68 percent of total billed charges 38.64 38.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGE BEACON TIP VANSCHIE 4 CURVE ANGLE L65 CM OD5 FR MULTIPURPOSE ACCEPTS .035 IN GUIDEWIRE SUP-HNBR5.0-35-65-P-NS CDM 0270 RC outpatient 67.6 67.6 67.6 74 50.02 percent of total billed charges 67.6 93 54.76 percent of total billed charges 67.6 67.6 other OPPS APC 67.6 67.6 other OPPS APC 67.6 27.63 18.68 percent of total billed charges 67.6 67.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGE BEACON TIP ANGLE SIMMONS 2 CURVE 100CM 5FR SS NYLON CEREBRAL MULTIPURPOSE SUP-HNBR5.035100PNSSIM2 CDM 0270 RC outpatient 39.36 39.36 39.36 74 29.13 percent of total billed charges 39.36 93 31.88 percent of total billed charges 39.36 39.36 other OPPS APC 39.36 39.36 other OPPS APC 39.36 27.63 10.88 percent of total billed charges 39.36 39.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGE STAINLESS STEEL NYLON COBRA 3 CURVE BEACON TIP L65 CM OD5 FR VISCERA ACCEPTS .035 IN GUIDEWIRE SUP-HNBR5.03565PNSC3 CDM 0270 RC outpatient 101.4 101.4 101.4 74 75.04 percent of total billed charges 101.4 93 82.13 percent of total billed charges 101.4 101.4 other OPPS APC 101.4 101.4 other OPPS APC 101.4 27.63 28.02 percent of total billed charges 101.4 101.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGE BEACON TIP ANGLE ROSCH INFERIOR MESENTRIC CURVE 65CM 5FR SS NYLON VISCERAL SUP-HNBR5.03565PNSRIM CDM 0270 RC outpatient 39.36 39.36 39.36 74 29.13 percent of total billed charges 39.36 93 31.88 percent of total billed charges 39.36 39.36 other OPPS APC 39.36 39.36 other OPPS APC 39.36 27.63 10.88 percent of total billed charges 39.36 39.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC TORCON NB ADVANTAGE BEACON TIP STAINLESS STEEL NYLON ANGLE KMP CURVE TAPER L65 CM OD5 FR LOW PROFILE OPTIMAL STEERABILITY ACCEPTS .035 IN GUIDEWIRE SUP-HNBR5.03865PNSKMP CDM 0270 RC outpatient 39.36 39.36 39.36 74 29.13 percent of total billed charges 39.36 93 31.88 percent of total billed charges 39.36 39.36 other OPPS APC 39.36 39.36 other OPPS APC 39.36 27.63 10.88 percent of total billed charges 39.36 39.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETERAL ROYAL FLUSH PLUS NYLON BEACON TIP VCF CURVE SPIRAL L65 CM OD4 FR 8 SIDEPORT HIGH FLOW RADIOPAQUE ACCEPTS .035 IN GUIDEWIRE SUP-HNR4.03565P8SVCF CDM 0270 RC outpatient 38.64 38.64 38.64 74 28.59 percent of total billed charges 38.64 93 31.3 percent of total billed charges 38.64 38.64 other OPPS APC 38.64 38.64 other OPPS APC 38.64 27.63 10.68 percent of total billed charges 38.64 38.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC ROYAL FLUSH PLUS BEACON TIP NYLON PLASTIC VERRILL CONTRALATERAL FLUSH CURVE L65 CM OD5 FR 8 SPIRAL SIDEPORT HIGH FLOW ACCEPTS .035 IN GUIDEWIRE SUP-HNR5.03565P8SVCF CDM 0270 RC outpatient 193.18 193.18 193.18 74 142.95 percent of total billed charges 193.18 93 156.48 percent of total billed charges 193.18 193.18 other OPPS APC 193.18 193.18 other OPPS APC 193.18 27.63 53.38 percent of total billed charges 193.18 193.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC ROYAL FLUSH PLUS BEACON TIP PIGTAIL CURVE L70 CM OD5 FR AORTIC 10 SIDEPORT HIGH FLOW ACCEPTS .035 IN GUIDEWIRE VENTRICULOGRAPHY SUP-HNR5.03570P10SPIG CDM 0270 RC outpatient 38.64 38.64 38.64 74 28.59 percent of total billed charges 38.64 93 31.3 percent of total billed charges 38.64 38.64 other OPPS APC 38.64 38.64 other OPPS APC 38.64 27.63 10.68 percent of total billed charges 38.64 38.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HANDPIECE ENDOSCOPIC SOLOGRIP III DELIVERY SYSTEM SUP-HP-SG3 CDM 0270 RC outpatient 15483 15483 15483 74 11457.4 percent of total billed charges 15483 93 12541.2 percent of total billed charges 15483 15483 other OPPS APC 15483 15483 other OPPS APC 15483 27.63 4277.95 percent of total billed charges 15483 15483 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSITIONER SURGICAL STARFISH HEART NON STERNOTOMY DISPOSABLE SUP-HP102 CDM 0270 RC outpatient 3107 3107 3107 74 2299.18 percent of total billed charges 3107 93 2516.67 percent of total billed charges 3107 3107 other OPPS APC 3107 3107 other OPPS APC 3107 27.63 858.46 percent of total billed charges 3107 3107 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSITIONER SURGICAL STARFISH EVO HEART MULTIAPPENDAGE SILICONE SUCTION CUP LOW PROFILE SUP-HP3000 CDM 0270 RC outpatient 2067 2067 2067 74 1529.58 percent of total billed charges 2067 93 1674.27 percent of total billed charges 2067 2067 other OPPS APC 2067 2067 other OPPS APC 2067 27.63 571.11 percent of total billed charges 2067 2067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING ANGIOGRAPHY PVC 900 PSI L48 IN OD.158 IN ID.071 IN RIGID CONTRAST INJECTION FIXED MALE CONNECTOR CLEAR SUP-HP9481E CDM 0270 RC outpatient 7.15 7.15 7.15 74 5.29 percent of total billed charges 7.15 93 5.79 percent of total billed charges 7.15 7.15 other OPPS APC 7.15 7.15 other OPPS APC 7.15 27.63 1.98 percent of total billed charges 7.15 7.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE OPTIMA CORONARY 2MM SUP-HQF2FMC CDM 0270 RC outpatient 6487 6487 6487 74 4800.38 percent of total billed charges 6487 93 5254.47 percent of total billed charges 6487 6487 other OPPS APC 6487 6487 other OPPS APC 6487 27.63 1792.36 percent of total billed charges 6487 6487 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE OPTIMA CORONARY 3MM SUP-HQF3FMC CDM 0270 RC outpatient 6489.6 6489.6 6489.6 74 4802.3 percent of total billed charges 6489.6 93 5256.58 percent of total billed charges 6489.6 6489.6 other OPPS APC 6489.6 6489.6 other OPPS APC 6489.6 27.63 1793.08 percent of total billed charges 6489.6 6489.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE OPTIMA CORONARY 4MM SUP-HQF4FMC CDM 0270 RC outpatient 5720 5720 5720 74 4232.8 percent of total billed charges 5720 93 4633.2 percent of total billed charges 5720 5720 other OPPS APC 5720 5720 other OPPS APC 5720 27.63 1580.44 percent of total billed charges 5720 5720 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE OPTIMA NEURO 1.5MM SUP-HQG1.5MB CDM 0270 RC outpatient 3081 3081 3081 74 2279.94 percent of total billed charges 3081 93 2495.61 percent of total billed charges 3081 3081 other OPPS APC 3081 3081 other OPPS APC 3081 27.63 851.28 percent of total billed charges 3081 3081 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE OPTIMA NEURO 2.0MM SUP-HQG2MB CDM 0270 RC outpatient 2704 2704 2704 74 2000.96 percent of total billed charges 2704 93 2190.24 percent of total billed charges 2704 2704 other OPPS APC 2704 2704 other OPPS APC 2704 27.63 747.12 percent of total billed charges 2704 2704 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FLOWPROBE OPTIMA 3.0MM SUP-HQG3MB CDM 0270 RC outpatient 2717 2717 2717 74 2010.58 percent of total billed charges 2717 93 2200.77 percent of total billed charges 2717 2717 other OPPS APC 2717 2717 other OPPS APC 2717 27.63 750.71 percent of total billed charges 2717 2717 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAYONET OPTIMA 3.0MM SHORT SUP-HQG3MB-S CDM 0270 RC outpatient 2717 2717 2717 74 2010.58 percent of total billed charges 2717 93 2200.77 percent of total billed charges 2717 2717 other OPPS APC 2717 2717 other OPPS APC 2717 27.63 750.71 percent of total billed charges 2717 2717 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAYONET OPTIMA 4.0MM SHORT SUP-HQG4MB-S CDM 0270 RC outpatient 2717 2717 2717 74 2010.58 percent of total billed charges 2717 93 2200.77 percent of total billed charges 2717 2717 other OPPS APC 2717 2717 other OPPS APC 2717 27.63 750.71 percent of total billed charges 2717 2717 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAYONET OPTIMA 6.0MM SHORT SUP-HQG6MB-S CDM 0270 RC outpatient 2717 2717 2717 74 2010.58 percent of total billed charges 2717 93 2200.77 percent of total billed charges 2717 2717 other OPPS APC 2717 2717 other OPPS APC 2717 27.63 750.71 percent of total billed charges 2717 2717 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE POSTOPERATIVE DARCO ORTHOWEDGE 15 D 6-8 7 1/2-10 SMALL CONTACT CLOSURE DORSIFLEXION REMOVABLE INSOLE SQUARE TOE NONSTERILE LATEX FREE SUP-HS1005-10 CDM 0270 RC outpatient 31.62 31.62 31.62 74 23.4 percent of total billed charges 31.62 93 25.61 percent of total billed charges 31.62 31.62 other OPPS APC 31.62 31.62 other OPPS APC 31.62 27.63 8.74 percent of total billed charges 31.62 31.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE POSTOPERATIVE DARCO ORTHOWEDGE 15 D 8 1/2-10 10 1/2-13 MEDIUM CONTACT CLOSURE DORSIFLEXION REMOVABLE INSOLE SQUARE TOE NONSTERILE LATEX FREE SUP-HS1005-12 CDM 0270 RC outpatient 34.09 34.09 34.09 74 25.23 percent of total billed charges 34.09 93 27.61 percent of total billed charges 34.09 34.09 other OPPS APC 34.09 34.09 other OPPS APC 34.09 27.63 9.42 percent of total billed charges 34.09 34.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOE POSTOPERATIVE DARCO ORTHOWEDGE 15 D 10 1/2-12 13 1/2+ LARGE CONTACT CLOSURE DORSIFLEXION REMOVABLE INSOLE SQUARE TOE NONSTERILE LATEX FREE SUP-HS1005-14 CDM 0270 RC outpatient 34.09 34.09 34.09 74 25.23 percent of total billed charges 34.09 93 27.61 percent of total billed charges 34.09 34.09 other OPPS APC 34.09 34.09 other OPPS APC 34.09 27.63 9.42 percent of total billed charges 34.09 34.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SEALING HEARTSTRING III OD3.8 MM PROXIMAL DELIVERY LOADER AORTIC CUTTER SUP-HSK-3038 CDM 0270 RC outpatient 1542.63 1542.63 1542.63 74 1141.55 percent of total billed charges 1542.63 93 1249.53 percent of total billed charges 1542.63 1542.63 other OPPS APC 1542.63 1542.63 other OPPS APC 1542.63 27.63 426.23 percent of total billed charges 1542.63 1542.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HALO BREMER CROWN SMALL SUP-HT035 CDM 0270 RC outpatient 2106 2106 2106 74 1558.44 percent of total billed charges 2106 93 1705.86 percent of total billed charges 2106 2106 other OPPS APC 2106 2106 other OPPS APC 2106 27.63 581.89 percent of total billed charges 2106 2106 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN HALO LARGE 23 TO 26 SUP-HT036 CDM 0270 RC outpatient 2106 2106 2106 74 1558.44 percent of total billed charges 2106 93 1705.86 percent of total billed charges 2106 2106 other OPPS APC 2106 2106 other OPPS APC 2106 27.63 581.89 percent of total billed charges 2106 2106 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE PROPATEN HEPARIN PROPATEN PTFE THIN WALL L50 CM L40 CM ID6 MM REMOVABLE RING STRETCH SUP-HT064050A CDM 0270 RC outpatient 4836 4836 4836 74 3578.64 percent of total billed charges 4836 93 3917.16 percent of total billed charges 4836 4836 other OPPS APC 4836 4836 other OPPS APC 4836 27.63 1336.19 percent of total billed charges 4836 4836 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE HEPARIN PROPATEN PTFE THIN WALL L70 CM L60 CM ID6 MM REMOVABLE RING STRETCH SUP-HT066070A CDM 0270 RC outpatient 6601.4 6601.4 6601.4 74 4885.04 percent of total billed charges 6601.4 93 5347.13 percent of total billed charges 6601.4 6601.4 other OPPS APC 6601.4 6601.4 other OPPS APC 6601.4 27.63 1823.97 percent of total billed charges 6601.4 6601.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE HEPARIN PROPATEN PTFE THIN WALL L80 CM L60 CM ID6 MM REMOVABLE RING STRETCH SUP-HT066080A CDM 0270 RC outpatient 7436 7436 7436 74 5502.64 percent of total billed charges 7436 93 6023.16 percent of total billed charges 7436 7436 other OPPS APC 7436 7436 other OPPS APC 7436 27.63 2054.57 percent of total billed charges 7436 7436 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE HEPARIN PROPATEN PTFE THIN WALL L80 CM L60 CM ID7 MM REMOVABLE RING STRETCH SUP-HT076080A CDM 0270 RC outpatient 7436 7436 7436 74 5502.64 percent of total billed charges 7436 93 6023.16 percent of total billed charges 7436 7436 other OPPS APC 7436 7436 other OPPS APC 7436 27.63 2054.57 percent of total billed charges 7436 7436 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE HEPARIN PROPATEN PTFE THIN WALL L80 CM L70 CM ID8 MM REMOVABLE RING STRETCH SUP-HT087080A CDM 0270 RC outpatient 7662.2 7662.2 7662.2 74 5670.03 percent of total billed charges 7662.2 93 6206.38 percent of total billed charges 7662.2 7662.2 other OPPS APC 7662.2 7662.2 other OPPS APC 7662.2 27.63 2117.07 percent of total billed charges 7662.2 7662.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SKIN MEMODERM ACELLULAR DERMAL MATRIX L4 CM X W2 CM X H.33-.61 MM NONMESHED ROOM TEMPERATURE STORAGE STERILE SUP-HTM0330204 CDM 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SKIN MEMODERM DERMIS ACELLULAR L4 CM X W4 CM X H.4-.8 MM MESHED STERILE SUP-HTM0400404M CDM 0270 RC outpatient 2615.6 2615.6 2615.6 74 1935.54 percent of total billed charges 2615.6 93 2118.64 percent of total billed charges 2615.6 2615.6 other OPPS APC 2615.6 2615.6 other OPPS APC 2615.6 27.63 722.69 percent of total billed charges 2615.6 2615.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER CATHETER 8IN 8FR BLUE POLYURETHANE HEMOSTASIS VALVE STOPCOCK SIDE ARM TUBE SUP-HVA-100 CDM 270010015 LOCAL 0270 RC outpatient 65 65 65 74 48.1 percent of total billed charges 65 93 52.65 percent of total billed charges 65 65 other OPPS APC 65 65 other OPPS APC 65 27.63 17.96 percent of total billed charges 65 65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIGATOR ENDOSCOPIC POLYLOOP NYLON L230 CM OD30 MM PREASSEMBLE PRELOAD DEVICE DISPOSABLE POLYPECTOMY SUP-HX-400U-30 CDM 0270 RC outpatient 240.37 240.37 240.37 74 177.87 percent of total billed charges 240.37 93 194.7 percent of total billed charges 240.37 240.37 other OPPS APC 240.37 240.37 other OPPS APC 240.37 27.63 66.41 percent of total billed charges 240.37 240.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT AFX 70MM 20-13MM STRATA STERILE LF ILIAC LIMB AAA SUP-I20-13/C70F-SA CDM 270010015 LOCAL 0270 RC outpatient 10397.4 10397.4 10397.4 74 7694.08 percent of total billed charges 10397.4 93 8421.89 percent of total billed charges 10397.4 10397.4 other OPPS APC 10397.4 10397.4 other OPPS APC 10397.4 27.63 2872.8 percent of total billed charges 10397.4 10397.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PORT ACCESS AIRSEAL L100 MM OD12 MM OBTURATOR BLADELESS OPTICAL TIP STERILE LATEX FREE DISPOSABLE SUP-IAS12-100LPI CDM 0270 RC outpatient 243 243 243 74 179.82 percent of total billed charges 243 93 196.83 percent of total billed charges 243 243 other OPPS APC 243 243 other OPPS APC 243 27.63 67.14 percent of total billed charges 243 243 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PORT ACCESS AIRSEAL L120 MM OD12 MM 2 WALL CANNULA PALM GRIP OBTURATOR BLADELESS OPTICAL TIP VALVELESS TROCAR SUP-IAS12-120LPI CDM 0270 RC outpatient 250.61 250.61 250.61 74 185.45 percent of total billed charges 250.61 93 202.99 percent of total billed charges 250.61 250.61 other OPPS APC 250.61 250.61 other OPPS APC 250.61 27.63 69.24 percent of total billed charges 250.61 250.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PORT AIRSEAL 5MM ACCESS PORT AND OBTURATOR SUP-IAS5-120LP CDM 0270 RC outpatient 238.81 238.81 238.81 74 176.72 percent of total billed charges 238.81 93 193.44 percent of total billed charges 238.81 238.81 other OPPS APC 238.81 238.81 other OPPS APC 238.81 27.63 65.98 percent of total billed charges 238.81 238.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRSEAL 8MM ACCESS PORT AND OBTURATOR SUP-IAS8-100LP CDM 0270 RC outpatient 239.55 239.55 239.55 74 177.27 percent of total billed charges 239.55 93 194.04 percent of total billed charges 239.55 239.55 other OPPS APC 239.55 239.55 other OPPS APC 239.55 27.63 66.19 percent of total billed charges 239.55 239.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY 2-5-2 MM SPACING LARGE L110 CM OD6 FR DECAPOLAR STEERABLE SUP-IBI-81104 CDM 0270 RC outpatient 884 884 884 74 654.16 percent of total billed charges 884 93 716.04 percent of total billed charges 884 884 other OPPS APC 884 884 other OPPS APC 884 27.63 244.25 percent of total billed charges 884 884 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY INQUIRY 2-5-2 MM SPACING LARGE CURVE L110 CM L2 MM OD6 FR MAPPING QUADRIPOLAR STEERABLE SUP-IBI-81404 CDM 0270 RC outpatient 754 754 754 74 557.96 percent of total billed charges 754 93 610.74 percent of total billed charges 754 754 other OPPS APC 754 754 other OPPS APC 754 27.63 208.33 percent of total billed charges 754 754 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY INQUIRY 2-5-2 MM SPACING L1 CURVE L110 CM OD6 FR OCTAPOLAR STEERABLE BIDIRECTIONAL DIAGNOSTIC SUP-IBI-81516 CDM 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CATHETER INQUIRY L1.5 MR 4 PIN CONNECTING DIAGNOSTIC SUP-IBI-85953 CDM 0270 RC outpatient 291.2 291.2 291.2 74 215.49 percent of total billed charges 291.2 93 235.87 percent of total billed charges 291.2 291.2 other OPPS APC 291.2 291.2 other OPPS APC 291.2 27.63 80.46 percent of total billed charges 291.2 291.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CATHETER INQUIRY L1.5 MR 10 PIN CONNECTING DIAGNOSTIC SUP-IBI-85954 CDM 0270 RC outpatient 351 351 351 74 259.74 percent of total billed charges 351 93 284.31 percent of total billed charges 351 351 other OPPS APC 351 351 other OPPS APC 351 27.63 96.98 percent of total billed charges 351 351 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AXS CATALYST 7 132CM SUP-IC068132 CDM 0270 RC outpatient 7441.2 7441.2 7441.2 74 5506.49 percent of total billed charges 7441.2 93 6027.37 percent of total billed charges 7441.2 7441.2 other OPPS APC 7441.2 7441.2 other OPPS APC 7441.2 27.63 2056 percent of total billed charges 7441.2 7441.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SUCTION 71 L132 CM LARGE BORE SUP-IC71132UG CDM 0270 RC outpatient 6500 6500 6500 74 4810 percent of total billed charges 6500 93 5265 percent of total billed charges 6500 6500 other OPPS APC 6500 6500 other OPPS APC 6500 27.63 1795.95 percent of total billed charges 6500 6500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER VASCULAR ZOOM L100 CM OD6 FR ODSEC.108 IN ID.088 IN LARGE DISTAL PLATFORM STERILE LATEX FREE SUP-ICTC088110 CDM 0270 RC outpatient 8307 8307 8307 74 6147.18 percent of total billed charges 8307 93 6728.67 percent of total billed charges 8307 8307 other OPPS APC 8307 8307 other OPPS APC 8307 27.63 2295.22 percent of total billed charges 8307 8307 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE VERTIGRAFT ILIAC CREST H18 MM FREEZE DRIED WEDGE SUP-ICW8 CDM 270010031 LOCAL 0270 RC outpatient 2025.71 2025.71 2025.71 74 1499.03 percent of total billed charges 2025.71 93 1640.83 percent of total billed charges 2025.71 2025.71 other OPPS APC 2025.71 2025.71 other OPPS APC 2025.71 27.63 559.7 percent of total billed charges 2025.71 2025.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE DURAGEN BOVINE COLLAGEN MATRIX L3 IN X W1 IN CRANIAL DURA PATCH RESORBABLE SUTURABLE STERILE DURAPLASTY SUP-ID1301 CDM 270010012 LOCAL 0270 RC outpatient 1335.23 1335.23 1335.23 74 988.07 percent of total billed charges 1335.23 93 1081.54 percent of total billed charges 1335.23 1335.23 other OPPS APC 1335.23 1335.23 other OPPS APC 1335.23 27.63 368.92 percent of total billed charges 1335.23 1335.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE DURAGEN BOVINE COLLAGEN MATRIX L5 IN X W4 IN CRANIUM RESORBABLE SUTURABLE STERILE DURAPLASTY SUP-ID4501 CDM 270010012 LOCAL 0270 RC outpatient 4190.71 4190.71 4190.71 74 3101.13 percent of total billed charges 4190.71 93 3394.48 percent of total billed charges 4190.71 4190.71 other OPPS APC 4190.71 4190.71 other OPPS APC 4190.71 27.63 1157.89 percent of total billed charges 4190.71 4190.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRUNION ARTHREX ECLIPSE TPS CAP COATED 41MM SUP-IDE-AR-9300-41CPC CDM 270010030 LOCAL 0270 RC outpatient 2756.31 2756.31 2756.31 74 2039.67 percent of total billed charges 2756.31 93 2232.61 percent of total billed charges 2756.31 2756.31 other OPPS APC 2756.31 2756.31 other OPPS APC 2756.31 27.63 761.57 percent of total billed charges 2756.31 2756.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRUNION ARTHREX ECLIPSE TPS CAP COATED 43MM SUP-IDE-AR-9300-43CPC CDM 270010030 LOCAL 0270 RC outpatient 2756.31 2756.31 2756.31 74 2039.67 percent of total billed charges 2756.31 93 2232.61 percent of total billed charges 2756.31 2756.31 other OPPS APC 2756.31 2756.31 other OPPS APC 2756.31 27.63 761.57 percent of total billed charges 2756.31 2756.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRUNION ARTHREX ECLIPSE TPS CAP COATED 45MM SUP-IDE-AR-9300-45CPC CDM 270010030 LOCAL 0270 RC outpatient 2756.31 2756.31 2756.31 74 2039.67 percent of total billed charges 2756.31 93 2232.61 percent of total billed charges 2756.31 2756.31 other OPPS APC 2756.31 2756.31 other OPPS APC 2756.31 27.63 761.57 percent of total billed charges 2756.31 2756.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRUNION ARTHREX ECLIPSE TPS CAP COATED 47MM SUP-IDE-AR-9300-47CPC CDM 270010030 LOCAL 0270 RC outpatient 2756.31 2756.31 2756.31 74 2039.67 percent of total billed charges 2756.31 93 2232.61 percent of total billed charges 2756.31 2756.31 other OPPS APC 2756.31 2756.31 other OPPS APC 2756.31 27.63 761.57 percent of total billed charges 2756.31 2756.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRUNION ARTHREX ECLIPSE TPS CAP COATED 49MM SUP-IDE-AR-9300-49CPC CDM 270010030 LOCAL 0270 RC outpatient 2756.31 2756.31 2756.31 74 2039.67 percent of total billed charges 2756.31 93 2232.61 percent of total billed charges 2756.31 2756.31 other OPPS APC 2756.31 2756.31 other OPPS APC 2756.31 27.63 761.57 percent of total billed charges 2756.31 2756.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRUNION ARTHREX ECLIPSE TPS CAP COATED 53MM SUP-IDE-AR-9300-53CPC CDM 270010030 LOCAL 0270 RC outpatient 2756.31 2756.31 2756.31 74 2039.67 percent of total billed charges 2756.31 93 2232.61 percent of total billed charges 2756.31 2756.31 other OPPS APC 2756.31 2756.31 other OPPS APC 2756.31 27.63 761.57 percent of total billed charges 2756.31 2756.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX ECLIPLSE HOLLOW 30MM SM SUP-IDE-AR-9301-01 CDM 270010030 LOCAL 0270 RC outpatient 2756.31 2756.31 2756.31 74 2039.67 percent of total billed charges 2756.31 93 2232.61 percent of total billed charges 2756.31 2756.31 other OPPS APC 2756.31 2756.31 other OPPS APC 2756.31 27.63 761.57 percent of total billed charges 2756.31 2756.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX ECLIPLSE HOLLOW 35MM MED SUP-IDE-AR-9301-02 CDM 270010030 LOCAL 0270 RC outpatient 2756.31 2756.31 2756.31 74 2039.67 percent of total billed charges 2756.31 93 2232.61 percent of total billed charges 2756.31 2756.31 other OPPS APC 2756.31 2756.31 other OPPS APC 2756.31 27.63 761.57 percent of total billed charges 2756.31 2756.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW ARTHREX ECLIPLSE HOLLOW 40MM LG SUP-IDE-AR-9301-03 CDM 270010030 LOCAL 0270 RC outpatient 2756.31 2756.31 2756.31 74 2039.67 percent of total billed charges 2756.31 93 2232.61 percent of total billed charges 2756.31 2756.31 other OPPS APC 2756.31 2756.31 other OPPS APC 2756.31 27.63 761.57 percent of total billed charges 2756.31 2756.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HUMERAL HEAD ARTHREX ECLIPSE 41/16 SUP-IDE-AR-9341-16 CDM 270010030 LOCAL 0270 RC outpatient 2703.79 2703.79 2703.79 74 2000.8 percent of total billed charges 2703.79 93 2190.07 percent of total billed charges 2703.79 2703.79 other OPPS APC 2703.79 2703.79 other OPPS APC 2703.79 27.63 747.06 percent of total billed charges 2703.79 2703.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HUMERAL HEAD ARTHREX ECLIPSE 43/16 SUP-IDE-AR-9343-16 CDM 270010030 LOCAL 0270 RC outpatient 2599.38 2599.38 2599.38 74 1923.54 percent of total billed charges 2599.38 93 2105.5 percent of total billed charges 2599.38 2599.38 other OPPS APC 2599.38 2599.38 other OPPS APC 2599.38 27.63 718.21 percent of total billed charges 2599.38 2599.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HUMERAL HEAD ARTHREX ECLIPSE 43/18 SUP-IDE-AR-9343-18 CDM 270010030 LOCAL 0270 RC outpatient 2599.38 2599.38 2599.38 74 1923.54 percent of total billed charges 2599.38 93 2105.5 percent of total billed charges 2599.38 2599.38 other OPPS APC 2599.38 2599.38 other OPPS APC 2599.38 27.63 718.21 percent of total billed charges 2599.38 2599.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HUMERAL HEAD ARTHREX ECLIPSE 45/17 SUP-IDE-AR-9345-17 CDM 270010030 LOCAL 0270 RC outpatient 2599.38 2599.38 2599.38 74 1923.54 percent of total billed charges 2599.38 93 2105.5 percent of total billed charges 2599.38 2599.38 other OPPS APC 2599.38 2599.38 other OPPS APC 2599.38 27.63 718.21 percent of total billed charges 2599.38 2599.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HUMERAL HEAD ARTHREX ECLIPSE 47/18 SUP-IDE-AR-9347-18 CDM 270010030 LOCAL 0270 RC outpatient 2599.38 2599.38 2599.38 74 1923.54 percent of total billed charges 2599.38 93 2105.5 percent of total billed charges 2599.38 2599.38 other OPPS APC 2599.38 2599.38 other OPPS APC 2599.38 27.63 718.21 percent of total billed charges 2599.38 2599.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HUMERAL HEAD ARTHREX ECLIPSE 47/20 SUP-IDE-AR-9347-20 CDM 270010030 LOCAL 0270 RC outpatient 2703.79 2703.79 2703.79 74 2000.8 percent of total billed charges 2703.79 93 2190.07 percent of total billed charges 2703.79 2703.79 other OPPS APC 2703.79 2703.79 other OPPS APC 2703.79 27.63 747.06 percent of total billed charges 2703.79 2703.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HUMERAL HEAD ARTHREX ECLIPSE 49/18 SUP-IDE-AR-9349-18 CDM 270010030 LOCAL 0270 RC outpatient 2599.38 2599.38 2599.38 74 1923.54 percent of total billed charges 2599.38 93 2105.5 percent of total billed charges 2599.38 2599.38 other OPPS APC 2599.38 2599.38 other OPPS APC 2599.38 27.63 718.21 percent of total billed charges 2599.38 2599.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HUMERAL HEAD ARTHREX ECLIPSE 53/22 SUP-IDE-AR-9353-22 CDM 270010030 LOCAL 0270 RC outpatient 2703.79 2703.79 2703.79 74 2000.8 percent of total billed charges 2703.79 93 2190.07 percent of total billed charges 2703.79 2703.79 other OPPS APC 2703.79 2703.79 other OPPS APC 2703.79 27.63 747.06 percent of total billed charges 2703.79 2703.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ANEURX AAADVANTAGE XCELERANT NITINOL STRAIGHT L5.5 CM OD14 MM ODSEC16 FR ENDOVASCULAR ABDOMEN AORTA ILIUM INFRARENAL SYSTEM SELF EXPANDING WOVEN EXTENDER CUFF HYDRO DELIVERY AAA SUP-IEXCH141455 CDM 270010015 LOCAL 0270 RC outpatient 6890 6890 6890 74 5098.6 percent of total billed charges 6890 93 5580.9 percent of total billed charges 6890 6890 other OPPS APC 6890 6890 other OPPS APC 6890 27.63 1903.71 percent of total billed charges 6890 6890 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ANEURX ILIAC EXTENDER CUFF HYDRO DELIVERY AAA SUP-IEXCH161655 CDM 270010015 LOCAL 0270 RC outpatient 6890 6890 6890 74 5098.6 percent of total billed charges 6890 93 5580.9 percent of total billed charges 6890 6890 other OPPS APC 6890 6890 other OPPS APC 6890 27.63 1903.71 percent of total billed charges 6890 6890 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ANEURX AAADVANTAGE XCELERANT NITINOL FLARED L8.5 CM OD20-16 MM ODSEC19 FR ENDOVASCULAR ABDOMEN AORTA ILIUM INFRARENAL SYSTEM SELF EXPANDING WOVEN EXTENDER CUFF HYDRO DELIVERY AAA SUP-IEXCH162085 CDM 270010015 LOCAL 0270 RC outpatient 9750 9750 9750 74 7215 percent of total billed charges 9750 93 7897.5 percent of total billed charges 9750 9750 other OPPS APC 9750 9750 other OPPS APC 9750 27.63 2693.93 percent of total billed charges 9750 9750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ANEURX AAADVANTAGE XCELERANT NITINOL FLARED L8.5 CM OD24-18 MM ODSEC19 FR ENDOVASCULAR ABDOMEN AORTA ILIUM INFRARENAL SYSTEM SELF EXPANDING WOVEN EXTENDER CUFF HYDRO DELIVERY AAA SUP-IEXCH182485 CDM 270010015 LOCAL 0270 RC outpatient 9750 9750 9750 74 7215 percent of total billed charges 9750 93 7897.5 percent of total billed charges 9750 9750 other OPPS APC 9750 9750 other OPPS APC 9750 27.63 2693.93 percent of total billed charges 9750 9750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERGARD COLLAGEN POLYESTER VELOUR STRAIGHT L40 CM ID6 MM KNIT REVERSE LOCKNIT SUP-IGK0006-40 CDM 0270 RC outpatient 969.93 969.93 969.93 74 717.75 percent of total billed charges 969.93 93 785.64 percent of total billed charges 969.93 969.93 other OPPS APC 969.93 969.93 other OPPS APC 969.93 27.63 267.99 percent of total billed charges 969.93 969.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD HEPARIN VELOUR COLLAGEN POLYESTER STRAIGHT L70 CM L20 CM OD6 MM KNIT REVERSE LOCKNIT RADIAL SUPPORT SUP-IGK0006RS20H CDM 0270 RC outpatient 2057.12 2057.12 2057.12 74 1522.27 percent of total billed charges 2057.12 93 1666.27 percent of total billed charges 2057.12 2057.12 other OPPS APC 2057.12 2057.12 other OPPS APC 2057.12 27.63 568.38 percent of total billed charges 2057.12 2057.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER STRAIGHT L40 CM OD7 MM KNIT REVERSE LOCKNIT SUTURABILITY SUP-IGK0007-40 CDM 0270 RC outpatient 969.93 969.93 969.93 74 717.75 percent of total billed charges 969.93 93 785.64 percent of total billed charges 969.93 969.93 other OPPS APC 969.93 969.93 other OPPS APC 969.93 27.63 267.99 percent of total billed charges 969.93 969.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER STRAIGHT L70 CM OD7 MM KNIT REVERSE LOCKNIT SUTURABILITY SUP-IGK0007-70 CDM 0270 RC outpatient 1005.89 1005.89 1005.89 74 744.36 percent of total billed charges 1005.89 93 814.77 percent of total billed charges 1005.89 1005.89 other OPPS APC 1005.89 1005.89 other OPPS APC 1005.89 27.63 277.93 percent of total billed charges 1005.89 1005.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER STRAIGHT L40 CM OD8 MM KNIT REVERSE LOCKNIT SUTURABILITY SUP-IGK0008-40 CDM 0270 RC outpatient 1004.85 1004.85 1004.85 74 743.59 percent of total billed charges 1004.85 93 813.93 percent of total billed charges 1004.85 1004.85 other OPPS APC 1004.85 1004.85 other OPPS APC 1004.85 27.63 277.64 percent of total billed charges 1004.85 1004.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER STRAIGHT L70 CM OD8 MM KNIT REVERSE LOCKNIT WATER PERMEABLE SUP-IGK0008-70 CDM 0270 RC outpatient 1073.38 1073.38 1073.38 74 794.3 percent of total billed charges 1073.38 93 869.44 percent of total billed charges 1073.38 1073.38 other OPPS APC 1073.38 1073.38 other OPPS APC 1073.38 27.63 296.57 percent of total billed charges 1073.38 1073.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER STRAIGHT L40 CM OD10 MM KNIT SUP-IGK0010-40 CDM 0270 RC outpatient 1004.85 1004.85 1004.85 74 743.59 percent of total billed charges 1004.85 93 813.93 percent of total billed charges 1004.85 1004.85 other OPPS APC 1004.85 1004.85 other OPPS APC 1004.85 27.63 277.64 percent of total billed charges 1004.85 1004.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER STRAIGHT L40 CM OD12 MM KNIT SUP-IGK0012-40 CDM 0270 RC outpatient 969.93 969.93 969.93 74 717.75 percent of total billed charges 969.93 93 785.64 percent of total billed charges 969.93 969.93 other OPPS APC 969.93 969.93 other OPPS APC 969.93 27.63 267.99 percent of total billed charges 969.93 969.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER STRAIGHT L40 CM OD14 MM KNIT REVERSE LOCKNIT SUTURABILITY SUP-IGK0014-40 CDM 0270 RC outpatient 1004.85 1004.85 1004.85 74 743.59 percent of total billed charges 1004.85 93 813.93 percent of total billed charges 1004.85 1004.85 other OPPS APC 1004.85 1004.85 other OPPS APC 1004.85 27.63 277.64 percent of total billed charges 1004.85 1004.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER STRAIGHT L40 CM OD16 MM KNIT SUP-IGK0016-40 CDM 0270 RC outpatient 969.93 969.93 969.93 74 717.75 percent of total billed charges 969.93 93 785.64 percent of total billed charges 969.93 969.93 other OPPS APC 969.93 969.93 other OPPS APC 969.93 27.63 267.99 percent of total billed charges 969.93 969.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER STRAIGHT L20 CM OD18 MM KNIT REVERSE LOCKNIT SUTURABILITY SUP-IGK0018-20 CDM 0270 RC outpatient 720.64 720.64 720.64 74 533.27 percent of total billed charges 720.64 93 583.72 percent of total billed charges 720.64 720.64 other OPPS APC 720.64 720.64 other OPPS APC 720.64 27.63 199.11 percent of total billed charges 720.64 720.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER STRAIGHT L40 CM OD20 MM KNIT SUP-IGK0020-40 CDM 0270 RC outpatient 941.67 941.67 941.67 74 696.84 percent of total billed charges 941.67 93 762.75 percent of total billed charges 941.67 941.67 other OPPS APC 941.67 941.67 other OPPS APC 941.67 27.63 260.18 percent of total billed charges 941.67 941.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER STRAIGHT L40 CM OD22 MM KNIT SUP-IGK0022-40 CDM 0270 RC outpatient 1004.85 1004.85 1004.85 74 743.59 percent of total billed charges 1004.85 93 813.93 percent of total billed charges 1004.85 1004.85 other OPPS APC 1004.85 1004.85 other OPPS APC 1004.85 27.63 277.64 percent of total billed charges 1004.85 1004.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER STRAIGHT L40 CM OD24 MM KNIT SUP-IGK0024-40 CDM 0270 RC outpatient 1004.85 1004.85 1004.85 74 743.59 percent of total billed charges 1004.85 93 813.93 percent of total billed charges 1004.85 1004.85 other OPPS APC 1004.85 1004.85 other OPPS APC 1004.85 27.63 277.64 percent of total billed charges 1004.85 1004.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER 2 BRANCH L50 CM OD12 MM ODSEC6 MM KNIT REVERSE LOCKNIT SUTURABILITY SUP-IGK1206 CDM 0270 RC outpatient 1805.8 1805.8 1805.8 74 1336.29 percent of total billed charges 1805.8 93 1462.7 percent of total billed charges 1805.8 1805.8 other OPPS APC 1805.8 1805.8 other OPPS APC 1805.8 27.63 498.94 percent of total billed charges 1805.8 1805.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERGARD COLLAGEN POLYESTER ID7 MM BIFURCATED L50 CM ID14 MM IDSEC7 MM KNITTED REVERSE LOCKNIT SUP-IGK1407 CDM 0270 RC outpatient 1465.88 1465.88 1465.88 74 1084.75 percent of total billed charges 1465.88 93 1187.36 percent of total billed charges 1465.88 1465.88 other OPPS APC 1465.88 1465.88 other OPPS APC 1465.88 27.63 405.02 percent of total billed charges 1465.88 1465.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERGARD POLYESTER VELOUR COLLAGEN 2 BRANCH L50 CM ID16 MM IDSEC8 MM THORAX ABDOMEN KNIT REVERSE LOCKNIT SUP-IGK1608 CDM 0270 RC outpatient 1465.88 1465.88 1465.88 74 1084.75 percent of total billed charges 1465.88 93 1187.36 percent of total billed charges 1465.88 1465.88 other OPPS APC 1465.88 1465.88 other OPPS APC 1465.88 27.63 405.02 percent of total billed charges 1465.88 1465.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER 2 BRANCH L50 CM OD18 MM ODSEC9 MM KNIT SUP-IGK1809 CDM 0270 RC outpatient 1373.74 1373.74 1373.74 74 1016.57 percent of total billed charges 1373.74 93 1112.73 percent of total billed charges 1373.74 1373.74 other OPPS APC 1373.74 1373.74 other OPPS APC 1373.74 27.63 379.56 percent of total billed charges 1373.74 1373.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER 2 BRANCH L50 CM OD20 MM ODSEC10 MM KNIT SUP-IGK2010 CDM 0270 RC outpatient 1373.74 1373.74 1373.74 74 1016.57 percent of total billed charges 1373.74 93 1112.73 percent of total billed charges 1373.74 1373.74 other OPPS APC 1373.74 1373.74 other OPPS APC 1373.74 27.63 379.56 percent of total billed charges 1373.74 1373.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERGARD COLLAGEN POLYESTER SMALL DIAMETER L50 CM OD22/11 MM KNITTED BIFURCATED SUP-IGK2211 CDM 0270 RC outpatient 1465.88 1465.88 1465.88 74 1084.75 percent of total billed charges 1465.88 93 1187.36 percent of total billed charges 1465.88 1465.88 other OPPS APC 1465.88 1465.88 other OPPS APC 1465.88 27.63 405.02 percent of total billed charges 1465.88 1465.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER 2 BRANCH L50 CM OD24 MM ODSEC12 MM KNIT SUP-IGK2412 CDM 0270 RC outpatient 1465.88 1465.88 1465.88 74 1084.75 percent of total billed charges 1465.88 93 1187.36 percent of total billed charges 1465.88 1465.88 other OPPS APC 1465.88 1465.88 other OPPS APC 1465.88 27.63 405.02 percent of total billed charges 1465.88 1465.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER L60 CM L30 MM OD8 MM AXILLO BIFEMORAL KNIT RADIAL SUPPORT SUP-IGKAX0808RS60/30 CDM 0270 RC outpatient 3279.93 3279.93 3279.93 74 2427.15 percent of total billed charges 3279.93 93 2656.74 percent of total billed charges 3279.93 3279.93 other OPPS APC 3279.93 3279.93 other OPPS APC 3279.93 27.63 906.24 percent of total billed charges 3279.93 3279.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERGARD STRAIGHT 30CM 26MM VELOUR COLLAGEN POLYESTER THORACIC AORTA WOVEN EXCLUSIVE WEAVE SUP-IGW0026-30 CDM 0270 RC outpatient 1267.89 1267.89 1267.89 74 938.24 percent of total billed charges 1267.89 93 1026.99 percent of total billed charges 1267.89 1267.89 other OPPS APC 1267.89 1267.89 other OPPS APC 1267.89 27.63 350.32 percent of total billed charges 1267.89 1267.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER STRAIGHT L15 CM OD28 MM THORACIC AORTA WOVEN EXCLUSIVE WEAVE SUP-IGW0028-15 CDM 0270 RC outpatient 1036.91 1036.91 1036.91 74 767.31 percent of total billed charges 1036.91 93 839.9 percent of total billed charges 1036.91 1036.91 other OPPS APC 1036.91 1036.91 other OPPS APC 1036.91 27.63 286.5 percent of total billed charges 1036.91 1036.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER STRAIGHT L15 CM OD30 MM THORACIC AORTA WOVEN EXCLUSIVE WEAVE SUP-IGW0030-15 CDM 0270 RC outpatient 1036.91 1036.91 1036.91 74 767.31 percent of total billed charges 1036.91 93 839.9 percent of total billed charges 1036.91 1036.91 other OPPS APC 1036.91 1036.91 other OPPS APC 1036.91 27.63 286.5 percent of total billed charges 1036.91 1036.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERGARD VELOUR COLLAGEN POLYESTER STRAIGHT L30 CM OD30 MM THORACIC AORTA WOVEN EXCLUSIVE WEAVE SUP-IGW0030-30 CDM 0270 RC outpatient 1267.89 1267.89 1267.89 74 938.24 percent of total billed charges 1267.89 93 1026.99 percent of total billed charges 1267.89 1267.89 other OPPS APC 1267.89 1267.89 other OPPS APC 1267.89 27.63 350.32 percent of total billed charges 1267.89 1267.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR INTERGARD COLLAGEN POLYESTER VELOUR STRAIGHT L30 CM ID32 MM WOVEN SUP-IGW0032-30 CDM 0270 RC outpatient 1000.87 1000.87 1000.87 74 740.64 percent of total billed charges 1000.87 93 810.7 percent of total billed charges 1000.87 1000.87 other OPPS APC 1000.87 1000.87 other OPPS APC 1000.87 27.63 276.54 percent of total billed charges 1000.87 1000.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH SENSOR ILLUMISITE NONSTERILE LATEX FREE DISPOSABLE SUP-ILS-1000-SP CDM 0270 RC outpatient 735.8 735.8 735.8 74 544.49 percent of total billed charges 735.8 93 596 percent of total billed charges 735.8 735.8 other OPPS APC 735.8 735.8 other OPPS APC 735.8 27.63 203.3 percent of total billed charges 735.8 735.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ENDOSCOPIC 180 D L1070 MM OD2.7 MM ENDOBRONCHIAL CATHETER STERILE LATEX FREE REUSABLE SUP-ILS-1800-KT CDM 0270 RC outpatient 4310.8 4310.8 4310.8 74 3189.99 percent of total billed charges 4310.8 93 3491.75 percent of total billed charges 4310.8 4310.8 other OPPS APC 4310.8 4310.8 other OPPS APC 4310.8 27.63 1191.07 percent of total billed charges 4310.8 4310.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER BRONCHOSCOPE ILLUMISITE STERILE LATEX FREE REUSABLE OLYMPUS BRONCHOSCOPE SUP-ILS-2000-PK CDM 0270 RC outpatient 232.44 232.44 232.44 74 172.01 percent of total billed charges 232.44 93 188.28 percent of total billed charges 232.44 232.44 other OPPS APC 232.44 232.44 other OPPS APC 232.44 27.63 64.22 percent of total billed charges 232.44 232.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ASPIRATION ARCPOINT METAL L137 MM OD21 GA ODSEC1.9 MM PULMONARY BRAID TAPER SHEATH SHORT RIGID LENGTH 2 MM CHANNEL SUP-ILS-2100-PN CDM 0270 RC outpatient 594.88 594.88 594.88 74 440.21 percent of total billed charges 594.88 93 481.85 percent of total billed charges 594.88 594.88 other OPPS APC 594.88 594.88 other OPPS APC 594.88 27.63 164.37 percent of total billed charges 594.88 594.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ANEURX AAADVANTAGE XCELERANT NITINOL STRAIGHT L11.5 CM OD12 MM ODSEC16 FR ENDOVASCULAR ABDOMEN AORTA ILIUM INFRARENAL SYSTEM SELF EXPANDING WOVEN LIMB HYDRO DELIVERY AAA SUP-ILXCH1212115 CDM 270010015 LOCAL 0270 RC outpatient 8580 8580 8580 74 6349.2 percent of total billed charges 8580 93 6949.8 percent of total billed charges 8580 8580 other OPPS APC 8580 8580 other OPPS APC 8580 27.63 2370.65 percent of total billed charges 8580 8580 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ANEURX AAADVANTAGE XCELERANT NITINOL STRAIGHT L13.5 CM OD12 MM ODSEC16 FR ENDOVASCULAR ABDOMEN AORTA ILIUM INFRARENAL SYSTEM SELF EXPANDING WOVEN LIMB HYDRO DELIVERY AAA SUP-ILXCH1212135 CDM 270010015 LOCAL 0270 RC outpatient 9360 9360 9360 74 6926.4 percent of total billed charges 9360 93 7581.6 percent of total billed charges 9360 9360 other OPPS APC 9360 9360 other OPPS APC 9360 27.63 2586.17 percent of total billed charges 9360 9360 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ANEURX AAADVANTAGE XCELERANT NITINOL STRAIGHT L8.5 CM OD12 MM ODSEC16 FR ENDOVASCULAR ABDOMEN AORTA ILIUM INFRARENAL SYSTEM SELF EXPANDING WOVEN LIMB HYDRO DELIVERY AAA SUP-ILXCH121285 CDM 270010015 LOCAL 0270 RC outpatient 8190 8190 8190 74 6060.6 percent of total billed charges 8190 93 6633.9 percent of total billed charges 8190 8190 other OPPS APC 8190 8190 other OPPS APC 8190 27.63 2262.9 percent of total billed charges 8190 8190 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ANEURX AAADVANTAGE XCELERANT NITINOL STRAIGHT L11.5 CM OD14 MM ODSEC16 FR ENDOVASCULAR ABDOMEN AORTA ILIUM INFRARENAL SYSTEM SELF EXPANDING WOVEN LIMB HYDRO DELIVERY AAA SUP-ILXCH1414115 CDM 270010015 LOCAL 0270 RC outpatient 8580 8580 8580 74 6349.2 percent of total billed charges 8580 93 6949.8 percent of total billed charges 8580 8580 other OPPS APC 8580 8580 other OPPS APC 8580 27.63 2370.65 percent of total billed charges 8580 8580 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ANEURX AAADVANTAGE XCELERANT NITINOL STRAIGHT L13.5 CM OD14 MM ODSEC16 FR ENDOVASCULAR ABDOMEN AORTA ILIUM INFRARENAL SYSTEM SELF EXPANDING WOVEN LIMB HYDRO DELIVERY AAA SUP-ILXCH1414135 CDM 270010015 LOCAL 0270 RC outpatient 9360 9360 9360 74 6926.4 percent of total billed charges 9360 93 7581.6 percent of total billed charges 9360 9360 other OPPS APC 9360 9360 other OPPS APC 9360 27.63 2586.17 percent of total billed charges 9360 9360 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT LEG MEDRONIC ILXCH1414185 SUP-ILXCH1414185 CDM 270010015 LOCAL 0270 RC outpatient 8190 8190 8190 74 6060.6 percent of total billed charges 8190 93 6633.9 percent of total billed charges 8190 8190 other OPPS APC 8190 8190 other OPPS APC 8190 27.63 2262.9 percent of total billed charges 8190 8190 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT ANEURX AAADVANTAGE XCELERANT NITINOL STRAIGHT L13.5 CM OD16 MM ODSEC16 FR ENDOVASCULAR ABDOMEN AORTA ILIUM INFRARENAL SYSTEM SELF EXPANDING WOVEN LIMB HYDRO DELIVERY AAA SUP-ILXCH1616135 CDM 270010015 LOCAL 0270 RC outpatient 9360 9360 9360 74 6926.4 percent of total billed charges 9360 93 7581.6 percent of total billed charges 9360 9360 other OPPS APC 9360 9360 other OPPS APC 9360 27.63 2586.17 percent of total billed charges 9360 9360 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY STERILIZATION DAVINCI XI ONE INST SUP-IN-8931-01-R CDM 0270 RC outpatient 1146.6 1146.6 1146.6 74 848.48 percent of total billed charges 1146.6 93 928.75 percent of total billed charges 1146.6 1146.6 other OPPS APC 1146.6 1146.6 other OPPS APC 1146.6 27.63 316.81 percent of total billed charges 1146.6 1146.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ASPIRATION AXS VECTA 71 L115 CM OD.082-.085 IN ID.071 IN SCOUT INTRODUCER STERILE LATEX FREE DISPOSABLE SUP-INC-11129-115 CDM 0270 RC outpatient 6580.6 6580.6 6580.6 74 4869.64 percent of total billed charges 6580.6 93 5330.29 percent of total billed charges 6580.6 6580.6 other OPPS APC 6580.6 6580.6 other OPPS APC 6580.6 27.63 1818.22 percent of total billed charges 6580.6 6580.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ASPIRATION AXS VECTA 71 L125 CM OD.082-.085 IN ID.071 IN SCOUT INTRODUCER STERILE LATEX FREE DISPOSABLE SUP-INC-11129-125 CDM 0270 RC outpatient 7511.4 7511.4 7511.4 74 5558.44 percent of total billed charges 7511.4 93 6084.23 percent of total billed charges 7511.4 7511.4 other OPPS APC 7511.4 7511.4 other OPPS APC 7511.4 27.63 2075.4 percent of total billed charges 7511.4 7511.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CATHETER THROMBECTOMY AXS VECTA 71 ASPIRATION INTERMEDIATE 0.085/0.082IN P/D 0.071IN ID 132CM LARGE BORE CROSS COIL W/2-PEEL-AWAY/SCOUT INTRODUCER SHORT TUOHY BORST HEMOSTATIC VALVE SS NITINOL NON-RADIOLUCENT SUP-INC-11129-132 CDM 0270 RC outpatient 7511.4 7511.4 7511.4 7511.4 other OPPS APC 7511.4 7511.4 other OPPS APC 7511.4 27.63 2075.4 percent of total billed charges 7511.4 7511.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AXS INFINITY SHEATH PLUS SHEATH SUP-INC-11196-90 CDM 0270 RC outpatient 1599 1599 1599 74 1183.26 percent of total billed charges 1599 93 1295.19 percent of total billed charges 1599 1599 other OPPS APC 1599 1599 other OPPS APC 1599 27.63 441.8 percent of total billed charges 1599 1599 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AXS VECTA 046 CATH 125CM - US SUP-INC-11814-125 CDM 0270 RC outpatient 4724.2 4724.2 4724.2 74 3495.91 percent of total billed charges 4724.2 93 3826.6 percent of total billed charges 4724.2 4724.2 other OPPS APC 4724.2 4724.2 other OPPS APC 4724.2 27.63 1305.3 percent of total billed charges 4724.2 4724.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AXS VECTA 046 CATH 146CM - US SUP-INC-11814-146 CDM 0270 RC outpatient 4724.2 4724.2 4724.2 74 3495.91 percent of total billed charges 4724.2 93 3826.6 percent of total billed charges 4724.2 4724.2 other OPPS APC 4724.2 4724.2 other OPPS APC 4724.2 27.63 1305.3 percent of total billed charges 4724.2 4724.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY AXS VECTA 46 INTERMEDIATE 0.046IN ID 0.056IN OD DISTAL 0.058IN OD PROXIMAL 160CM LOW-PROFILE SOFT ATRAUMATIC TIP PTFE LINER HYDROPHILIC NITINOL SUP-INC-11814-160 CDM 0270 RC outpatient 4724.2 4724.2 4724.2 4724.2 other OPPS APC 4724.2 4724.2 other OPPS APC 4724.2 27.63 1305.3 percent of total billed charges 4724.2 4724.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CONNECTOR IG4 IR 2 VPAD DISPOSABLE SUP-INS-0048 CDM 0270 RC outpatient 676 676 676 74 500.24 percent of total billed charges 676 93 547.56 percent of total billed charges 676 676 other OPPS APC 676 676 other OPPS APC 676 27.63 186.78 percent of total billed charges 676 676 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAD INSTRUMENT ALWAYS-ON TIP TRACKED SPIN DRIVE UPAD 2 PATIENT TRACKER LUNG DISEASE MANAGEMENT SUP-INS-0050 CDM 0270 RC outpatient 982.8 982.8 982.8 74 727.27 percent of total billed charges 982.8 93 796.07 percent of total billed charges 982.8 982.8 other OPPS APC 982.8 982.8 other OPPS APC 982.8 27.63 271.55 percent of total billed charges 982.8 982.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS BIOPSY ALWAYS-ON TIP TRACKED SPIN DRIVE L900-1100 MM SERRATE LUNG DISEASE MANAGEMENT SUP-INS-0372 CDM 0270 RC outpatient 1474.2 1474.2 1474.2 74 1090.91 percent of total billed charges 1474.2 93 1194.1 percent of total billed charges 1474.2 1474.2 other OPPS APC 1474.2 1474.2 other OPPS APC 1474.2 27.63 407.32 percent of total billed charges 1474.2 1474.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERAN SPIN FLEX NEEDLE 22G SUP-INS-5410 CDM 0270 RC outpatient 2211.3 2211.3 2211.3 74 1636.36 percent of total billed charges 2211.3 93 1791.15 percent of total billed charges 2211.3 2211.3 other OPPS APC 2211.3 2211.3 other OPPS APC 2211.3 27.63 610.98 percent of total billed charges 2211.3 2211.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERAN SPIN XTEND NEEDLE 21G SUP-INS-5450 CDM 0270 RC outpatient 2211.3 2211.3 2211.3 74 1636.36 percent of total billed charges 2211.3 93 1791.15 percent of total billed charges 2211.3 2211.3 other OPPS APC 2211.3 2211.3 other OPPS APC 2211.3 27.63 610.98 percent of total billed charges 2211.3 2211.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERAN SPINPREC KIT BIOPSY NITINOL 5 GUN 5 NEEDLE FLEXIBLE SUP-INS-5600 CDM 0270 RC outpatient 982.8 982.8 982.8 74 727.27 percent of total billed charges 982.8 93 796.07 percent of total billed charges 982.8 982.8 other OPPS APC 982.8 982.8 other OPPS APC 982.8 27.63 271.55 percent of total billed charges 982.8 982.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERAN SPIN PERC LOCALIZATION NEEDLE 19 GA 1CM MARKING ZONE SUP-INS-5610 CDM 0270 RC outpatient 1953.12 1953.12 1953.12 74 1445.31 percent of total billed charges 1953.12 93 1582.03 percent of total billed charges 1953.12 1953.12 other OPPS APC 1953.12 1953.12 other OPPS APC 1953.12 27.63 539.65 percent of total billed charges 1953.12 1953.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHANNEL WORKING SPIN ACCESS CATHETER 180 D OLYMPUS SCOPE SUP-INS-5905 CDM 0270 RC outpatient 2808 2808 2808 74 2077.92 percent of total billed charges 2808 93 2274.48 percent of total billed charges 2808 2808 other OPPS APC 2808 2808 other OPPS APC 2808 27.63 775.85 percent of total billed charges 2808 2808 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT EXTERNAL DRAINAGE ACCUDRAIN SPECIAL LATEX FREE INS8400 SUP-INS8400 CDM 270009150 LOCAL 0270 RC outpatient 641.78 641.78 641.78 74 474.92 percent of total billed charges 641.78 93 519.84 percent of total billed charges 641.78 641.78 other OPPS APC 641.78 641.78 other OPPS APC 641.78 27.63 177.32 percent of total billed charges 641.78 641.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET VENTRICULAR DRAINAGE TRAUMACATH L35 CM OD10 FR ODSEC3.3 MM ID1.9 MM CONNECTOR TROCAR SUTURE COLLAR STYLET STERILE LATEX FREE SUP-INS8420 CDM 270009149 LOCAL 0270 RC outpatient 96 96 96 74 71.04 percent of total billed charges 96 93 77.76 percent of total billed charges 96 96 other OPPS APC 96 96 other OPPS APC 96 27.63 26.52 percent of total billed charges 96 96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM DRAINAGE LIMITORR VOLUME LIMITING CSF SUP-INS9020 CDM 0270 RC outpatient 855.87 855.87 855.87 74 633.34 percent of total billed charges 855.87 93 693.25 percent of total billed charges 855.87 855.87 other OPPS APC 855.87 855.87 other OPPS APC 855.87 27.63 236.48 percent of total billed charges 855.87 855.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CRANIOTOMY BETADINE L5/8 IN OD25 GA 12 ML STERILE SUP-INSHITH CDM 0270 RC outpatient 937.3 937.3 937.3 74 693.6 percent of total billed charges 937.3 93 759.21 percent of total billed charges 937.3 937.3 other OPPS APC 937.3 937.3 other OPPS APC 937.3 27.63 258.98 percent of total billed charges 937.3 937.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L8 MM OD2.25 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT22508UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L12 MM OD2.25 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT22512UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L14 MM OD2.25 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT22514UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L22 MM OD2.25 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT22522UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L26 MM OD2.25 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT22526UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L8 MM OD2.5 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT25008UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L12 MM OD2.5 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT25012UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L18 MM OD2.5 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT25018UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L22 MM OD2.5 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT25022UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L26 MM OD2.5 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT25026UX CDM 0270 RC outpatient 1885 1885 1885 74 1394.9 percent of total billed charges 1885 93 1526.85 percent of total billed charges 1885 1885 other OPPS APC 1885 1885 other OPPS APC 1885 27.63 520.83 percent of total billed charges 1885 1885 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L12 MM OD2.75 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT27512UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L18 MM OD2.75 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT27518UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L9 MM OD3 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT30009UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L12 MM OD3 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT30012UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L15 MM OD3 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT30015UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L18 MM OD3 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT30018UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L30 MM OD3 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT30030UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L12 MM OD3.5 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT35012UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L15 MM OD3.5 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT35015UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L26 MM OD3.5 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT35026UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L12 MM OD4 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT40012UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L18 MM OD4 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT40018UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L22 MM OD4 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT40022UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L26 MM OD4 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT40026UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY INTEGRITY MICROTRAC SOFTER FULCRUM COCR L30 MM OD4 MM RAPID EXCHANGE 1 CONTINUOUS SINUSOID STRAND INTEGRATE TIP RADIOPAQUE STERILE SUP-INT40030UX CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSTRUMENT BIOPSY BARD MAX-CORE L16 CM OD14 GA 2 TRIGGER ULTRA SHARP TIP BEVEL TROCAR ANGLE NOTCH STERILE LATEX FREE DISPOSABLE SUP-IPRMC1416 CDM 0270 RC outpatient 142.68 142.68 142.68 74 105.58 percent of total billed charges 142.68 93 115.57 percent of total billed charges 142.68 142.68 other OPPS APC 142.68 142.68 other OPPS APC 142.68 27.63 39.42 percent of total billed charges 142.68 142.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. .035 180CM INQWIRE WIRE J TIP SUP-IQ35F180J3F CDM 0481 RC outpatient 16.07 16.07 16.07 74 11.89 percent of total billed charges 16.07 93 13.02 percent of total billed charges 16.07 16.07 other OPPS APC 16.07 16.07 other OPPS APC 16.07 51 8.2 percent of total billed charges 16.07 16.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RADIAL .035 INQWIRE J-TIP WIRE 210CM SUP-IQ35F210J3 CDM 0481 RC outpatient 26.52 26.52 26.52 74 19.62 percent of total billed charges 26.52 93 21.48 percent of total billed charges 26.52 26.52 other OPPS APC 26.52 26.52 other OPPS APC 26.52 51 13.53 percent of total billed charges 26.52 26.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GW DIAGNOSTIC AMPLATZ INQWIRE .0035 IN 145 CM L 3MM J-TIP _62241_ SUP-IQA505 CDM 0481 RC outpatient 111.8 111.8 111.8 74 82.73 percent of total billed charges 111.8 93 90.56 percent of total billed charges 111.8 111.8 other OPPS APC 111.8 111.8 other OPPS APC 111.8 51 57.02 percent of total billed charges 111.8 111.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GW DIAGNOSTIC AMPLATZ INQWIRE .0035 IN 180 CM L 3MM J-TIP _62243_ SUP-IQA506 CDM 0481 RC outpatient 169 169 169 74 125.06 percent of total billed charges 169 93 136.89 percent of total billed charges 169 169 other OPPS APC 169 169 other OPPS APC 169 51 86.19 percent of total billed charges 169 169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET IRRIGATION LEVEL 1 NORMOFLO 300 MMHG GAS VENT SURGE CHAMBER 2 SPIKE POSTOPERATIVE CBI SETUP STERILE LATEX FREE DISPOSABLE SUP-IR-600 CDM 0270 RC outpatient 97.68 97.68 97.68 74 72.28 percent of total billed charges 97.68 93 79.12 percent of total billed charges 97.68 97.68 other OPPS APC 97.68 97.68 other OPPS APC 97.68 27.63 26.99 percent of total billed charges 97.68 97.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM WOUND IRRIGATION IRRISEPT 0.05% CHLORHEXIDINE GLUCONATE 99.95% WATER 450ML BOTTLE STERILE SUP-IRCEPT450USA CDM 0270 RC outpatient 170.69 170.69 170.69 74 126.31 percent of total billed charges 170.69 93 138.26 percent of total billed charges 170.69 170.69 other OPPS APC 170.69 170.69 other OPPS APC 170.69 27.63 47.16 percent of total billed charges 170.69 170.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM WOUND IRRIGATION IRRIMAX 0.9% SODIUM CHLORIDE 450ML SPLASH GUARD NONSTERILE SUP-IRCMAX101 CDM 0270 RC outpatient 39.26 39.26 39.26 74 29.05 percent of total billed charges 39.26 93 31.8 percent of total billed charges 39.26 39.26 other OPPS APC 39.26 39.26 other OPPS APC 39.26 27.63 10.85 percent of total billed charges 39.26 39.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE INTERING PTFE THIN WALL L40 CM L40 CM ID6 MM RADIAL SUPPORT STRETCH LINE SUP-IRST06040040L CDM 0270 RC outpatient 2106 2106 2106 74 1558.44 percent of total billed charges 2106 93 1705.86 percent of total billed charges 2106 2106 other OPPS APC 2106 2106 other OPPS APC 2106 27.63 581.89 percent of total billed charges 2106 2106 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE INTERING PTFE THIN WALL L60 CM L60 CM ID6 MM RADIAL SUPPORT STRETCH LINE SUP-IRST06060060L CDM 0270 RC outpatient 3452.8 3452.8 3452.8 74 2555.07 percent of total billed charges 3452.8 93 2796.77 percent of total billed charges 3452.8 3452.8 other OPPS APC 3452.8 3452.8 other OPPS APC 3452.8 27.63 954.01 percent of total billed charges 3452.8 3452.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE INTERING PTFE THIN WALL L80 CM L80 CM ID6 MM RADIAL SUPPORT STRETCH LINE SUP-IRST06080080L CDM 0270 RC outpatient 3853.2 3853.2 3853.2 74 2851.37 percent of total billed charges 3853.2 93 3121.09 percent of total billed charges 3853.2 3853.2 other OPPS APC 3853.2 3853.2 other OPPS APC 3853.2 27.63 1064.64 percent of total billed charges 3853.2 3853.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE INTERING PTFE THIN WALL L40 CM L40 CM ID8 MM RADIAL SUPPORT STRETCH LINE SUP-IRST08040040L CDM 0270 RC outpatient 2353 2353 2353 74 1741.22 percent of total billed charges 2353 93 1905.93 percent of total billed charges 2353 2353 other OPPS APC 2353 2353 other OPPS APC 2353 27.63 650.13 percent of total billed charges 2353 2353 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE INTERING PTFE THIN WALL L60 CM L60 CM ID8 MM RADIAL SUPPORT STRETCH LINE SUP-IRST08060060L CDM 0270 RC outpatient 3096.6 3096.6 3096.6 74 2291.48 percent of total billed charges 3096.6 93 2508.25 percent of total billed charges 3096.6 3096.6 other OPPS APC 3096.6 3096.6 other OPPS APC 3096.6 27.63 855.59 percent of total billed charges 3096.6 3096.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE INTERING PTFE THIN WALL L80 CM L80 CM ID8 MM RADIAL SUPPORT STRETCH LINE SUP-IRST08080080L CDM 0270 RC outpatient 3853.2 3853.2 3853.2 74 2851.37 percent of total billed charges 3853.2 93 3121.09 percent of total billed charges 3853.2 3853.2 other OPPS APC 3853.2 3853.2 other OPPS APC 3853.2 27.63 1064.64 percent of total billed charges 3853.2 3853.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EP Decapolar STEERABLE DECAPOLAR LARGE CURVE reproc SUP-IRV81104 CDM 0270 RC outpatient 296.4 296.4 296.4 74 219.34 percent of total billed charges 296.4 93 240.08 percent of total billed charges 296.4 296.4 other OPPS APC 296.4 296.4 other OPPS APC 296.4 27.63 81.9 percent of total billed charges 296.4 296.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EP STEERABLE QUAD LARGE CURVE reproc SUP-IRV81404 CDM 0270 RC outpatient 296.4 296.4 296.4 74 219.34 percent of total billed charges 296.4 93 240.08 percent of total billed charges 296.4 296.4 other OPPS APC 296.4 296.4 other OPPS APC 296.4 27.63 81.9 percent of total billed charges 296.4 296.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EP STEERABLE OCTAPOLAR LARGE CURVE reproc SUP-IRV81809 CDM 0270 RC outpatient 296.4 296.4 296.4 74 219.34 percent of total billed charges 296.4 93 240.08 percent of total billed charges 296.4 296.4 other OPPS APC 296.4 296.4 other OPPS APC 296.4 27.63 81.9 percent of total billed charges 296.4 296.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM WOUND IRRIGATION IRRISEPT 0.05% CHLORHEXIDINE GLUCONATE 99.95% WATER 450ML BOTTLE STERILE SUP-ISEPT-450-USA CDM 0270 RC outpatient 170.69 170.69 170.69 74 126.31 percent of total billed charges 170.69 93 138.26 percent of total billed charges 170.69 170.69 other OPPS APC 170.69 170.69 other OPPS APC 170.69 27.63 47.16 percent of total billed charges 170.69 170.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROSTATE SEEDS ISOAID SUP-ISOTOPE I-125 CDM Q3001 CPT 0270 RC outpatient 70 70 70 74 51.8 percent of total billed charges 70 93 56.7 percent of total billed charges 70 70 other OPPS APC 70 70 other OPPS APC 70 27.63 19.34 percent of total billed charges 70 70 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROSTATE SEEDS THERAGENICS SUP-ISOTOPE PD-103 CDM Q3001 CPT 0270 RC outpatient 100 100 100 74 74 percent of total billed charges 100 93 81 percent of total billed charges 100 100 other OPPS APC 100 100 other OPPS APC 100 27.63 27.63 percent of total billed charges 100 100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING ASPIRATION INDIGO L110 IN LATEX FREE SUP-IST3 CDM 0270 RC outpatient 1157 1157 1157 74 856.18 percent of total billed charges 1157 93 937.17 percent of total billed charges 1157 1157 other OPPS APC 1157 1157 other OPPS APC 1157 27.63 319.68 percent of total billed charges 1157 1157 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR TALENT XCELERANT POLYESTER NITINOL L90 MM L75 MM OD14-10 MM ODSEC18 FR DESCENDING ABDOMEN AORTA ILIUM SELF EXPANDING EXTENSION STENT RADIOPAQUE HYDRO DELIVERY SYSTEM AAA SUP-IXW1410C75XH CDM 270010015 LOCAL 0270 RC outpatient 11635 11635 11635 74 8609.9 percent of total billed charges 11635 93 9424.35 percent of total billed charges 11635 11635 other OPPS APC 11635 11635 other OPPS APC 11635 27.63 3214.75 percent of total billed charges 11635 11635 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 2 CP L27 IN BRAID COATED UNDYED SUP-J195H CDM 0270 RC outpatient 4.33 4.33 4.33 74 3.2 percent of total billed charges 4.33 93 3.51 percent of total billed charges 4.33 4.33 other OPPS APC 4.33 4.33 other OPPS APC 4.33 27.63 1.2 percent of total billed charges 4.33 4.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 1 CP L27 IN BRAID COATED UNDYED SUP-J196H CDM 0270 RC outpatient 3.9 3.9 3.9 74 2.89 percent of total billed charges 3.9 93 3.16 percent of total billed charges 3.9 3.9 other OPPS APC 3.9 3.9 other OPPS APC 3.9 27.63 1.08 percent of total billed charges 3.9 3.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL LIGAPAK 4-0 L54 IN BRAID REEL COATED VIOLET SUP-J204G CDM 0270 RC outpatient 0.42 0.42 0.42 74 0.31 percent of total billed charges 0.42 93 0.34 percent of total billed charges 0.42 0.42 other OPPS APC 0.42 0.42 other OPPS APC 0.42 27.63 0.12 percent of total billed charges 0.42 0.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL LIGAPAK 3-0 L54 IN BRAID REEL COATED VIOLET SUP-J205G CDM 0270 RC outpatient 5.04 5.04 5.04 74 3.73 percent of total billed charges 5.04 93 4.08 percent of total billed charges 5.04 5.04 other OPPS APC 5.04 5.04 other OPPS APC 5.04 27.63 1.39 percent of total billed charges 5.04 5.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL LIGAPAK 2-0 L54 IN BRAID REEL COATED VIOLET SUP-J206G CDM 0270 RC outpatient 5.08 5.08 5.08 74 3.76 percent of total billed charges 5.08 93 4.11 percent of total billed charges 5.08 5.08 other OPPS APC 5.08 5.08 other OPPS APC 5.08 27.63 1.4 percent of total billed charges 5.08 5.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POLYPROPYLENE 9-0 SUP-J2558N CDM 0270 RC outpatient 624 624 624 74 461.76 percent of total billed charges 624 93 505.44 percent of total billed charges 624 624 other OPPS APC 624 624 other OPPS APC 624 27.63 172.41 percent of total billed charges 624 624 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 0 CT-1 L27 IN BRAID COATED UNDYED SUP-J260H CDM 0270 RC outpatient 3.56 3.56 3.56 74 2.63 percent of total billed charges 3.56 93 2.88 percent of total billed charges 3.56 3.56 other OPPS APC 3.56 3.56 other OPPS APC 3.56 27.63 0.98 percent of total billed charges 3.56 3.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 2-0 CP-1 L27 IN BRAID COATED UNDYED SUP-J266H CDM 0270 RC outpatient 3.85 3.85 3.85 74 2.85 percent of total billed charges 3.85 93 3.12 percent of total billed charges 3.85 3.85 other OPPS APC 3.85 3.85 other OPPS APC 3.85 27.63 1.06 percent of total billed charges 3.85 3.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 2-0 CT-2 L27 IN BRAID COATED UNDYED SUP-J269H CDM 0270 RC outpatient 4.08 4.08 4.08 74 3.02 percent of total billed charges 4.08 93 3.3 percent of total billed charges 4.08 4.08 other OPPS APC 4.08 4.08 other OPPS APC 4.08 27.63 1.13 percent of total billed charges 4.08 4.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL LIGAPAK 3-0 L54 IN BRAID REEL COATED UNDYED SUP-J285G CDM 0270 RC outpatient 68.2 68.2 68.2 74 50.47 percent of total billed charges 68.2 93 55.24 percent of total billed charges 68.2 68.2 other OPPS APC 68.2 68.2 other OPPS APC 68.2 27.63 18.84 percent of total billed charges 68.2 68.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 5-0 RB-1 L27 IN BRAID COATED VIOLET SUP-J303H CDM 0270 RC outpatient 3.45 3.45 3.45 74 2.55 percent of total billed charges 3.45 93 2.79 percent of total billed charges 3.45 3.45 other OPPS APC 3.45 3.45 other OPPS APC 3.45 27.63 0.95 percent of total billed charges 3.45 3.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 4-0 SH-1 L27 IN BRAID COATED VIOLET SUP-J310H CDM 0270 RC outpatient 3.69 3.69 3.69 74 2.73 percent of total billed charges 3.69 93 2.99 percent of total billed charges 3.69 3.69 other OPPS APC 3.69 3.69 other OPPS APC 3.69 27.63 1.02 percent of total billed charges 3.69 3.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 3-0 SH-1 L27 IN BRAID COATED VIOLET SUP-J311H CDM 0270 RC outpatient 3.93 3.93 3.93 74 2.91 percent of total billed charges 3.93 93 3.18 percent of total billed charges 3.93 3.93 other OPPS APC 3.93 3.93 other OPPS APC 3.93 27.63 1.09 percent of total billed charges 3.93 3.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 3-0 SH L27 IN BRAID COATED VIOLET SUP-J316H CDM 0270 RC outpatient 3.56 3.56 3.56 74 2.63 percent of total billed charges 3.56 93 2.88 percent of total billed charges 3.56 3.56 other OPPS APC 3.56 3.56 other OPPS APC 3.56 27.63 0.98 percent of total billed charges 3.56 3.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 2-0 SH L27 IN BRAID COATED VIOLET SUP-J317H CDM 0270 RC outpatient 3.55 3.55 3.55 74 2.63 percent of total billed charges 3.55 93 2.88 percent of total billed charges 3.55 3.55 other OPPS APC 3.55 3.55 other OPPS APC 3.55 27.63 0.98 percent of total billed charges 3.55 3.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 2-0 CT-2 L27 IN BRAID COATED VIOLET SUP-J333H CDM 0270 RC outpatient 3.63 3.63 3.63 74 2.69 percent of total billed charges 3.63 93 2.94 percent of total billed charges 3.63 3.63 other OPPS APC 3.63 3.63 other OPPS APC 3.63 27.63 1 percent of total billed charges 3.63 3.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 1 CT-2 L27 IN BRAID COATED VIOLET SUP-J335H CDM 0270 RC outpatient 3.99 3.99 3.99 74 2.95 percent of total billed charges 3.99 93 3.23 percent of total billed charges 3.99 3.99 other OPPS APC 3.99 3.99 other OPPS APC 3.99 27.63 1.1 percent of total billed charges 3.99 3.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 3-0 CT-1 L27 IN BRAID COATED VIOLET SUP-J338H CDM 0270 RC outpatient 3.57 3.57 3.57 74 2.64 percent of total billed charges 3.57 93 2.89 percent of total billed charges 3.57 3.57 other OPPS APC 3.57 3.57 other OPPS APC 3.57 27.63 0.99 percent of total billed charges 3.57 3.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 2-0 CT-1 L27 IN BRAID COATED VIOLET SUP-J339H CDM 0270 RC outpatient 3.55 3.55 3.55 74 2.63 percent of total billed charges 3.55 93 2.88 percent of total billed charges 3.55 3.55 other OPPS APC 3.55 3.55 other OPPS APC 3.55 27.63 0.98 percent of total billed charges 3.55 3.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 0 CT-1 L27 IN BRAID COATED VIOLET SUP-J340H CDM 0270 RC outpatient 3.6 3.6 3.6 74 2.66 percent of total billed charges 3.6 93 2.92 percent of total billed charges 3.6 3.6 other OPPS APC 3.6 3.6 other OPPS APC 3.6 27.63 0.99 percent of total billed charges 3.6 3.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 0 CT-1 L36 IN BRAID COATED VIOLET SUP-J346H CDM 0270 RC outpatient 3.79 3.79 3.79 74 2.8 percent of total billed charges 3.79 93 3.07 percent of total billed charges 3.79 3.79 other OPPS APC 3.79 3.79 other OPPS APC 3.79 27.63 1.05 percent of total billed charges 3.79 3.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 2-0 CT L36 IN BRAID COATED VIOLET SUP-J357H CDM 0270 RC outpatient 4.12 4.12 4.12 74 3.05 percent of total billed charges 4.12 93 3.34 percent of total billed charges 4.12 4.12 other OPPS APC 4.12 4.12 other OPPS APC 4.12 27.63 1.14 percent of total billed charges 4.12 4.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 1 CT L36 IN BRAID COATED VIOLET SUP-J359H CDM 0270 RC outpatient 3.92 3.92 3.92 74 2.9 percent of total billed charges 3.92 93 3.18 percent of total billed charges 3.92 3.92 other OPPS APC 3.92 3.92 other OPPS APC 3.92 27.63 1.08 percent of total billed charges 3.92 3.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 0 CTX L36 IN BRAID COATED VIOLET SUP-J370H CDM 0270 RC outpatient 3.93 3.93 3.93 74 2.91 percent of total billed charges 3.93 93 3.18 percent of total billed charges 3.93 3.93 other OPPS APC 3.93 3.93 other OPPS APC 3.93 27.63 1.09 percent of total billed charges 3.93 3.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 0 UR-5 L27 IN BRAID COATED VIOLET SUP-J376H CDM 0270 RC outpatient 4.24 4.24 4.24 74 3.14 percent of total billed charges 4.24 93 3.43 percent of total billed charges 4.24 4.24 other OPPS APC 4.24 4.24 other OPPS APC 4.24 27.63 1.17 percent of total billed charges 4.24 4.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL MULTIPASS 8-0 BV130-5 5IN VIOLET BRAID COATED SUP-J401G CDM 0270 RC outpatient 38.3 38.3 38.3 74 28.34 percent of total billed charges 38.3 93 31.02 percent of total billed charges 38.3 38.3 other OPPS APC 38.3 38.3 other OPPS APC 38.3 27.63 10.58 percent of total billed charges 38.3 38.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 4-0 SH L27 IN BRAID COATED UNDYED SUP-J415H CDM 0270 RC outpatient 3.38 3.38 3.38 74 2.5 percent of total billed charges 3.38 93 2.74 percent of total billed charges 3.38 3.38 other OPPS APC 3.38 3.38 other OPPS APC 3.38 27.63 0.93 percent of total billed charges 3.38 3.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 3-0 SH L27 IN BRAID COATED UNDYED SUP-J416H CDM 0270 RC outpatient 3.38 3.38 3.38 74 2.5 percent of total billed charges 3.38 93 2.74 percent of total billed charges 3.38 3.38 other OPPS APC 3.38 3.38 other OPPS APC 3.38 27.63 0.93 percent of total billed charges 3.38 3.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 4-0 FS-2 L27 IN BRAID COATED UNDYED SUP-J422H CDM 0270 RC outpatient 15 15 15 74 11.1 percent of total billed charges 15 93 12.15 percent of total billed charges 15 15 other OPPS APC 15 15 other OPPS APC 15 27.63 4.14 percent of total billed charges 15 15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL MULTIPASS 4-0 PS-2 27IN UNDYED BRAID COATED SUP-J426H CDM 0270 RC outpatient 9.06 9.06 9.06 74 6.7 percent of total billed charges 9.06 93 7.34 percent of total billed charges 9.06 9.06 other OPPS APC 9.06 9.06 other OPPS APC 9.06 27.63 2.5 percent of total billed charges 9.06 9.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 2-0 CP-1 L27 IN BRAID COATED VIOLET SUP-J466H CDM 0270 RC outpatient 4.46 4.46 4.46 74 3.3 percent of total billed charges 4.46 93 3.61 percent of total billed charges 4.46 4.46 other OPPS APC 4.46 4.46 other OPPS APC 4.46 27.63 1.23 percent of total billed charges 4.46 4.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 0 CP-1 L27 IN BRAID COATED VIOLET SUP-J467H CDM 0270 RC outpatient 4.15 4.15 4.15 74 3.07 percent of total billed charges 4.15 93 3.36 percent of total billed charges 4.15 4.15 other OPPS APC 4.15 4.15 other OPPS APC 4.15 27.63 1.15 percent of total billed charges 4.15 4.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 1 CP-1 L27 IN BRAIDED COATED VIOLET SUP-J468H CDM 0270 RC outpatient 4.29 4.29 4.29 74 3.17 percent of total billed charges 4.29 93 3.47 percent of total billed charges 4.29 4.29 other OPPS APC 4.29 4.29 other OPPS APC 4.29 27.63 1.19 percent of total billed charges 4.29 4.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 6-0 P-1 L18 IN BRAID COATED UNDYED SUP-J489G CDM 0270 RC outpatient 11.99 11.99 11.99 74 8.87 percent of total billed charges 11.99 93 9.71 percent of total billed charges 11.99 11.99 other OPPS APC 11.99 11.99 other OPPS APC 11.99 27.63 3.31 percent of total billed charges 11.99 11.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 5-0 P-1 L18 IN BRAID COATED UNDYED SUP-J490G CDM 0270 RC outpatient 10.4 10.4 10.4 74 7.7 percent of total billed charges 10.4 93 8.42 percent of total billed charges 10.4 10.4 other OPPS APC 10.4 10.4 other OPPS APC 10.4 27.63 2.87 percent of total billed charges 10.4 10.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL MULTIPASS 5-0 P-3 18IN UNDYED BRAID COATED SUP-J493G CDM 0270 RC outpatient 11.86 11.86 11.86 74 8.78 percent of total billed charges 11.86 93 9.61 percent of total billed charges 11.86 11.86 other OPPS APC 11.86 11.86 other OPPS APC 11.86 27.63 3.28 percent of total billed charges 11.86 11.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL MULTIPASS 3-0 PS-2 18IN UNDYED BRAID COATED SUP-J497G CDM 0270 RC outpatient 9.33 9.33 9.33 74 6.9 percent of total billed charges 9.33 93 7.56 percent of total billed charges 9.33 9.33 other OPPS APC 9.33 9.33 other OPPS APC 9.33 27.63 2.58 percent of total billed charges 9.33 9.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL MULTIPASS 6-0 PS-3 L18 IN BRAID COATED UNDYED SUP-J499G CDM outpatient 10.38 10.38 10.38 10.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL MULTIPASS 5-0 PS-3 L18 IN BRAID COATED UNDYED SUP-J500G CDM 0270 RC outpatient 10.8 10.8 10.8 74 7.99 percent of total billed charges 10.8 93 8.75 percent of total billed charges 10.8 10.8 other OPPS APC 10.8 10.8 other OPPS APC 10.8 27.63 2.98 percent of total billed charges 10.8 10.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 5-0 P-2 L18 IN BRAID COATED UNDYED SUP-J503G CDM 0270 RC outpatient 12.45 12.45 12.45 74 9.21 percent of total billed charges 12.45 93 10.08 percent of total billed charges 12.45 12.45 other OPPS APC 12.45 12.45 other OPPS APC 12.45 27.63 3.44 percent of total billed charges 12.45 12.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 4-0 P-2 L18 IN BRAID COATED UNDYED SUP-J504G CDM 0270 RC outpatient 13.12 13.12 13.12 74 9.71 percent of total billed charges 13.12 93 10.63 percent of total billed charges 13.12 13.12 other OPPS APC 13.12 13.12 other OPPS APC 13.12 27.63 3.63 percent of total billed charges 13.12 13.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL MULTIPASS 5-0 PS-4 18IN UNDYED BRAID COATED SUP-J506G CDM 0270 RC outpatient 9.49 9.49 9.49 74 7.02 percent of total billed charges 9.49 93 7.69 percent of total billed charges 9.49 9.49 other OPPS APC 9.49 9.49 other OPPS APC 9.49 27.63 2.62 percent of total billed charges 9.49 9.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 6-0 PS-6 18IN UNDYED BRAID COATED SUP-J510G CDM 0270 RC outpatient 13.06 13.06 13.06 74 9.66 percent of total billed charges 13.06 93 10.58 percent of total billed charges 13.06 13.06 other OPPS APC 13.06 13.06 other OPPS APC 13.06 27.63 3.61 percent of total billed charges 13.06 13.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL MICROPOINT 7-0 TG140-8 18IN VIOLET 2 ARM BRAID COATED SUP-J546G CDM 0270 RC outpatient 32.1 32.1 32.1 74 23.75 percent of total billed charges 32.1 93 26 percent of total billed charges 32.1 32.1 other OPPS APC 32.1 32.1 other OPPS APC 32.1 27.63 8.87 percent of total billed charges 32.1 32.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL MICROPOINT 6-0 S-14 12IN VIOLET 2 ARM BRAID COATED SUP-J552G CDM 0270 RC outpatient 33.45 33.45 33.45 74 24.75 percent of total billed charges 33.45 93 27.09 percent of total billed charges 33.45 33.45 other OPPS APC 33.45 33.45 other OPPS APC 33.45 27.63 9.24 percent of total billed charges 33.45 33.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 2-0 UR-6 L27 IN BRAID COATED VIOLET SUP-J602H CDM 0270 RC outpatient 4.21 4.21 4.21 74 3.12 percent of total billed charges 4.21 93 3.41 percent of total billed charges 4.21 4.21 other OPPS APC 4.21 4.21 other OPPS APC 4.21 27.63 1.16 percent of total billed charges 4.21 4.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 0 UR-6 L27 IN BRAID COATED VIOLET SUP-J603H CDM 0270 RC outpatient 4.73 4.73 4.73 74 3.5 percent of total billed charges 4.73 93 3.83 percent of total billed charges 4.73 4.73 other OPPS APC 4.73 4.73 other OPPS APC 4.73 27.63 1.31 percent of total billed charges 4.73 4.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 0 STANDARD SHORT L18 IN BRAID TIES 3 STRAND COATED VIOLET SUP-J636H CDM 0270 RC outpatient 5.78 5.78 5.78 74 4.28 percent of total billed charges 5.78 93 4.68 percent of total billed charges 5.78 5.78 other OPPS APC 5.78 5.78 other OPPS APC 5.78 27.63 1.6 percent of total billed charges 5.78 5.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 2-0 18IN UNDYED BRAID TIE 3 STRAND COATED SUP-J645H CDM 0270 RC outpatient 5.59 5.59 5.59 74 4.14 percent of total billed charges 5.59 93 4.53 percent of total billed charges 5.59 5.59 other OPPS APC 5.59 5.59 other OPPS APC 5.59 27.63 1.54 percent of total billed charges 5.59 5.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 3-0 KS L27 IN BRAID COATED UNDYED SUP-J663H CDM 0270 RC outpatient 4.88 4.88 4.88 74 3.61 percent of total billed charges 4.88 93 3.95 percent of total billed charges 4.88 4.88 other OPPS APC 4.88 4.88 other OPPS APC 4.88 27.63 1.35 percent of total billed charges 4.88 4.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 18IN UNDYED 2 ARM BRAID COATED SUP-J670G CDM 0270 RC outpatient 33.5 33.5 33.5 74 24.79 percent of total billed charges 33.5 93 27.14 percent of total billed charges 33.5 33.5 other OPPS APC 33.5 33.5 other OPPS APC 33.5 27.63 9.26 percent of total billed charges 33.5 33.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 2-0 CT-2 L18 IN CONTROL RELEASE BRAID 8 STRAND COATED VIOLET SUP-J726D CDM 0270 RC outpatient 314.86 314.86 314.86 74 233 percent of total billed charges 314.86 93 255.04 percent of total billed charges 314.86 314.86 other OPPS APC 314.86 314.86 other OPPS APC 314.86 27.63 87 percent of total billed charges 314.86 314.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 2-0 CT-1 L18 IN CONTROL RELEASE BRAID 8 STRAND COATED VIOLET SUP-J739D CDM 0270 RC outpatient 26.95 26.95 26.95 74 19.94 percent of total billed charges 26.95 93 21.83 percent of total billed charges 26.95 26.95 other OPPS APC 26.95 26.95 other OPPS APC 26.95 27.63 7.45 percent of total billed charges 26.95 26.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 0 CT-1 L18 IN CONTROL RELEASE BRAID 8 STRAND COATED VIOLET SUP-J740D CDM 0270 RC outpatient 27.05 27.05 27.05 74 20.02 percent of total billed charges 27.05 93 21.91 percent of total billed charges 27.05 27.05 other OPPS APC 27.05 27.05 other OPPS APC 27.05 27.63 7.47 percent of total billed charges 27.05 27.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 4-0 TF L18 IN CONTROL RELEASE BRAID 8 STRAND COATED VIOLET SUP-J743D CDM 0270 RC outpatient 34.91 34.91 34.91 74 25.83 percent of total billed charges 34.91 93 28.28 percent of total billed charges 34.91 34.91 other OPPS APC 34.91 34.91 other OPPS APC 34.91 27.63 9.65 percent of total billed charges 34.91 34.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 2-0 CP-2 L18 IN CONTROL RELEASE BRAID 8 STRAND COATED UNDYED SUP-J762D CDM 0270 RC outpatient 32.89 32.89 32.89 74 24.34 percent of total billed charges 32.89 93 26.64 percent of total billed charges 32.89 32.89 other OPPS APC 32.89 32.89 other OPPS APC 32.89 27.63 9.09 percent of total billed charges 32.89 32.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 3-0 SH L18 IN CONTROL RELEASE BRAID 8 STRAND COATED VIOLET SUP-J774D CDM 0270 RC outpatient 26.58 26.58 26.58 74 19.67 percent of total billed charges 26.58 93 21.53 percent of total billed charges 26.58 26.58 other OPPS APC 26.58 26.58 other OPPS APC 26.58 27.63 7.34 percent of total billed charges 26.58 26.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 3-0 X-1 L18 IN CONTROL RELEASE BRAID 8 STRAND COATED VIOLET SUP-J790D CDM 0270 RC outpatient 37.38 37.38 37.38 74 27.66 percent of total billed charges 37.38 93 30.28 percent of total billed charges 37.38 37.38 other OPPS APC 37.38 37.38 other OPPS APC 37.38 27.63 10.33 percent of total billed charges 37.38 37.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 5-0 PC-12 18IN UNDYED CONTROL RELEASE BRAID 8 STRAND COATED SUP-J813G CDM 0270 RC outpatient 11.34 11.34 11.34 74 8.39 percent of total billed charges 11.34 93 9.19 percent of total billed charges 11.34 11.34 other OPPS APC 11.34 11.34 other OPPS APC 11.34 27.63 3.13 percent of total billed charges 11.34 11.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 4-0 PC-1 18IN UNDYED BRAID COATED SUP-J835G CDM 0270 RC outpatient 11.13 11.13 11.13 74 8.24 percent of total billed charges 11.13 93 9.02 percent of total billed charges 11.13 11.13 other OPPS APC 11.13 11.13 other OPPS APC 11.13 27.63 3.08 percent of total billed charges 11.13 11.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 0 CT-1 L18 IN CONTROL RELEASE BRAID 8 STRAND COATED UNDYED SUP-J840D CDM 0270 RC outpatient 27.1 27.1 27.1 74 20.05 percent of total billed charges 27.1 93 21.95 percent of total billed charges 27.1 27.1 other OPPS APC 27.1 27.1 other OPPS APC 27.1 27.63 7.49 percent of total billed charges 27.1 27.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 3-0 SH L18 IN CONTROL RELEASE BRAID 8 STRAND COATED UNDYED SUP-J864D CDM 0270 RC outpatient 26.89 26.89 26.89 74 19.9 percent of total billed charges 26.89 93 21.78 percent of total billed charges 26.89 26.89 other OPPS APC 26.89 26.89 other OPPS APC 26.89 27.63 7.43 percent of total billed charges 26.89 26.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL MULTIPASS 4-0 PS-1 27IN UNDYED BRAID COATED SUP-J935H CDM 0270 RC outpatient 11.32 11.32 11.32 74 8.38 percent of total billed charges 11.32 93 9.17 percent of total billed charges 11.32 11.32 other OPPS APC 11.32 11.32 other OPPS APC 11.32 27.63 3.13 percent of total billed charges 11.32 11.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL MULTIPASS 3-0 PS-1 27IN UNDYED BRAID COATED SUP-J936H CDM 0270 RC outpatient 10.42 10.42 10.42 74 7.71 percent of total billed charges 10.42 93 8.44 percent of total billed charges 10.42 10.42 other OPPS APC 10.42 10.42 other OPPS APC 10.42 27.63 2.88 percent of total billed charges 10.42 10.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL 3-0 CT L36 IN BRAID COATED UNDYED SUP-J956H CDM 0270 RC outpatient 3.63 3.63 3.63 74 2.69 percent of total billed charges 3.63 93 2.94 percent of total billed charges 3.63 3.63 other OPPS APC 3.63 3.63 other OPPS APC 3.63 27.63 1 percent of total billed charges 3.63 3.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAVR COOK 10F DILATOR 20CM SUP-JCD10.0-38-20 CDM 0270 RC outpatient 21.03 21.03 21.03 74 15.56 percent of total billed charges 21.03 93 17.03 percent of total billed charges 21.03 21.03 other OPPS APC 21.03 21.03 other OPPS APC 21.03 27.63 5.81 percent of total billed charges 21.03 21.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAVR COOK 12F DILATOR 20CM SUP-JCD12.0-38-20 CDM 0270 RC outpatient 21.03 21.03 21.03 74 15.56 percent of total billed charges 21.03 93 17.03 percent of total billed charges 21.03 21.03 other OPPS APC 21.03 21.03 other OPPS APC 21.03 27.63 5.81 percent of total billed charges 21.03 21.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAVR COOK 14F DILATOR 20CM SUP-JCD14.0-38-20 CDM 0270 RC outpatient 21.03 21.03 21.03 74 15.56 percent of total billed charges 21.03 93 17.03 percent of total billed charges 21.03 21.03 other OPPS APC 21.03 21.03 other OPPS APC 21.03 27.63 5.81 percent of total billed charges 21.03 21.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAVR COOK 16F DILATOR 20CM SUP-JCD16.0-38-20 CDM 0270 RC outpatient 21.03 21.03 21.03 74 15.56 percent of total billed charges 21.03 93 17.03 percent of total billed charges 21.03 21.03 other OPPS APC 21.03 21.03 other OPPS APC 21.03 27.63 5.81 percent of total billed charges 21.03 21.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COOK 8F DILATOR 20CM SUP-JCD8.0-38-20 CDM 0270 RC outpatient 21.03 21.03 21.03 74 15.56 percent of total billed charges 21.03 93 17.03 percent of total billed charges 21.03 21.03 other OPPS APC 21.03 21.03 other OPPS APC 21.03 27.63 5.81 percent of total billed charges 21.03 21.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WARMER SCOPE SUP-JNM-200016 CDM 0270 RC outpatient 14.3 14.3 14.3 74 10.58 percent of total billed charges 14.3 93 11.58 percent of total billed charges 14.3 14.3 other OPPS APC 14.3 14.3 other OPPS APC 14.3 27.63 3.95 percent of total billed charges 14.3 14.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN WOUND JACKSON-PRATT SILICONE 3/4 FLUTE OD10 FR ODSEC19 FR ROUND HUBLESS CHANNEL TROCAR SUP-JP-2226 CDM 270009031 LOCAL 0270 RC outpatient 9.91 9.91 9.91 74 7.33 percent of total billed charges 9.91 93 8.03 percent of total billed charges 9.91 9.91 other OPPS APC 9.91 9.91 other OPPS APC 9.91 27.63 2.74 percent of total billed charges 9.91 9.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN INCISION JACKSON-PRATT SILICONE OD15 FR ROUND HUBLESS CHANNEL STERILE LATEX FREE DISPOSABLE WHITE SUP-JP-2228 CDM 270009031 LOCAL 0270 RC outpatient 9.91 9.91 9.91 74 7.33 percent of total billed charges 9.91 93 8.03 percent of total billed charges 9.91 9.91 other OPPS APC 9.91 9.91 other OPPS APC 9.91 27.63 2.74 percent of total billed charges 9.91 9.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN INCISION JACKSON-PRATT SILICONE ROUND OD19 FR ROUND HUBLESS CHANNEL STERILE LATEX FREE DISPOSABLE SUP-JP-2230 CDM 0270 RC outpatient 24.25 24.25 24.25 74 17.95 percent of total billed charges 24.25 93 19.64 percent of total billed charges 24.25 24.25 other OPPS APC 24.25 24.25 other OPPS APC 24.25 27.63 6.7 percent of total billed charges 24.25 24.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTRODUCER SILICONE L115 CM OD2 MM GUIDE SHEATH BIOPSY FORCEPS STOPPER DISPOSABLE CYTOLOGY BRUSH SUP-K-201 CDM 0270 RC outpatient 372.01 372.01 372.01 74 275.29 percent of total billed charges 372.01 93 301.33 percent of total billed charges 372.01 372.01 other OPPS APC 372.01 372.01 other OPPS APC 372.01 27.63 102.79 percent of total billed charges 372.01 372.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTRODUCER SILICONE L115 CM OD2.6 MM GUIDE SHEATH BIOPSY FORCEPS STOPPER DISPOSABLE CYTOLOGY BRUSH SUP-K-204 CDM 0270 RC outpatient 332.15 332.15 332.15 74 245.79 percent of total billed charges 332.15 93 269.04 percent of total billed charges 332.15 332.15 other OPPS APC 332.15 332.15 other OPPS APC 332.15 27.63 91.77 percent of total billed charges 332.15 332.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE MEDICAL 0.25 CC HIGH RESOLUTION SUP-K01-07892 CDM 0270 RC outpatient 23.4 23.4 23.4 74 17.32 percent of total billed charges 23.4 93 18.95 percent of total billed charges 23.4 23.4 other OPPS APC 23.4 23.4 other OPPS APC 23.4 27.63 6.47 percent of total billed charges 23.4 23.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPIKE ANGIOGRAPHY L6.5 IN 3 WAY STOPCOCK MANAGEMENT SUP-K08-00417B CDM 0270 RC outpatient 6.58 6.58 6.58 74 4.87 percent of total billed charges 6.58 93 5.33 percent of total billed charges 6.58 6.58 other OPPS APC 6.58 6.58 other OPPS APC 6.58 27.63 1.82 percent of total billed charges 6.58 6.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET ADMINISTRATION L72 IN FLUID LARGE BORE TUBING VENTED MACRO DRIP CHAMBER BALL DISPOSABLE SUP-K08-02385 CDM outpatient 13 13 13 13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT IV ADMINISTRATION CUSTOM K08-03200 FLUID STERILE SINGLE USE SUP-K08-03200 CDM 0270 RC outpatient 37.7 37.7 37.7 74 27.9 percent of total billed charges 37.7 93 30.54 percent of total billed charges 37.7 37.7 other OPPS APC 37.7 37.7 other OPPS APC 37.7 27.63 10.42 percent of total billed charges 37.7 37.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAMP BONE INFLATABLE KYPHX ELEVATE 15 X 3.0MM SUP-K16A CDM 0270 RC outpatient 3000.4 3000.4 3000.4 74 2220.3 percent of total billed charges 3000.4 93 2430.32 percent of total billed charges 3000.4 3000.4 other OPPS APC 3000.4 3000.4 other OPPS APC 3000.4 27.63 829.01 percent of total billed charges 3000.4 3000.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC INGENIO RYTHMIQ D7.5 MM MODIFIED ELLIPSE W44.5 MM X H45.7 MM 11.5 ML 23.5 GM ATRIUM VENTRICLE 1 CHAMBER IS-1 CONNECTOR RATE RESPONSIVE UNIPOLAR BIPOLAR SR SUP-K172 CDM 0270 RC outpatient 11060.4 11060.4 11060.4 74 8184.7 percent of total billed charges 11060.4 93 8958.92 percent of total billed charges 11060.4 11060.4 other OPPS APC 11060.4 11060.4 other OPPS APC 11060.4 27.63 3055.99 percent of total billed charges 11060.4 11060.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER INGENIO SR SINGLE CBR SYSTEM SUP-K172S CDM 0270 RC outpatient 12053.6 12053.6 12053.6 74 8919.66 percent of total billed charges 12053.6 93 9763.42 percent of total billed charges 12053.6 12053.6 other OPPS APC 12053.6 12053.6 other OPPS APC 12053.6 27.63 3330.41 percent of total billed charges 12053.6 12053.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC INGENIO RYTHMIQ D7.5 MM MODIFIED ELLIPSE W44.5 MM X H47 MM 12 ML 24.5 GM ATRIUM VENTRICLE 2 CHAMBER IS-1 CONNECTOR RATE RESPONSIVE UNIPOLAR BIPOLAR DR SUP-K173 CDM 0270 RC outpatient 13374.4 13374.4 13374.4 74 9897.06 percent of total billed charges 13374.4 93 10833.3 percent of total billed charges 13374.4 13374.4 other OPPS APC 13374.4 13374.4 other OPPS APC 13374.4 27.63 3695.35 percent of total billed charges 13374.4 13374.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER INGENIO DR DUAL CHAMBER SYSTEM SUP-K173S CDM 0270 RC outpatient 15197 15197 15197 74 11245.8 percent of total billed charges 15197 93 12309.6 percent of total billed charges 15197 15197 other OPPS APC 15197 15197 other OPPS APC 15197 27.63 4198.93 percent of total billed charges 15197 15197 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAMP SURGICAL EXACT L15 MM OD3 MM INFLATABLE BONE SUP-K17B CDM 0270 RC outpatient 3042 3042 3042 74 2251.08 percent of total billed charges 3042 93 2464.02 percent of total billed charges 3042 3042 other OPPS APC 3042 3042 other OPPS APC 3042 27.63 840.5 percent of total billed charges 3042 3042 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP SUCTION ARGYLE YANKAUER VINYL PEDIATRIC L25 CM OD12 FR FINE FLEXIBLE NONBREAKABLE SMOOTH INNER LUMEN STERILE LATEX FREE DISPOSABLE SUP-K60 CDM 0270 RC outpatient 1.12 1.12 1.12 74 0.83 percent of total billed charges 1.12 93 0.91 percent of total billed charges 1.12 1.12 other OPPS APC 1.12 1.12 other OPPS APC 1.12 27.63 0.31 percent of total billed charges 1.12 1.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND 4-0 SH 30IN BLACK SILK BRAID SUP-K831H CDM 0270 RC outpatient 110.14 110.14 110.14 74 81.5 percent of total billed charges 110.14 93 89.21 percent of total billed charges 110.14 110.14 other OPPS APC 110.14 110.14 other OPPS APC 110.14 27.63 30.43 percent of total billed charges 110.14 110.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND SILK 3-0 SH L30 IN BRAID BLACK SUP-K832H CDM 0270 RC outpatient 2.97 2.97 2.97 74 2.2 percent of total billed charges 2.97 93 2.41 percent of total billed charges 2.97 2.97 other OPPS APC 2.97 2.97 other OPPS APC 2.97 27.63 0.82 percent of total billed charges 2.97 2.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND SILK 2-0 SH L30 IN BRAID BLACK SUP-K833H CDM 0270 RC outpatient 3 3 3 74 2.22 percent of total billed charges 3 93 2.43 percent of total billed charges 3 3 other OPPS APC 3 3 other OPPS APC 3 27.63 0.83 percent of total billed charges 3 3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND SILK 2-0 MH L30 IN BRAID BLACK SUP-K843H CDM 0270 RC outpatient 3.38 3.38 3.38 74 2.5 percent of total billed charges 3.38 93 2.74 percent of total billed charges 3.38 3.38 other OPPS APC 3.38 3.38 other OPPS APC 3.38 27.63 0.93 percent of total billed charges 3.38 3.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND SILK 0 MH L30 IN BRAID BLACK SUP-K844H CDM 0270 RC outpatient 3.04 3.04 3.04 74 2.25 percent of total billed charges 3.04 93 2.46 percent of total billed charges 3.04 3.04 other OPPS APC 3.04 3.04 other OPPS APC 3.04 27.63 0.84 percent of total billed charges 3.04 3.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND SILK 1 MH L30 IN BRAID BLACK SUP-K845H CDM 0270 RC outpatient 4.28 4.28 4.28 74 3.17 percent of total billed charges 4.28 93 3.47 percent of total billed charges 4.28 4.28 other OPPS APC 4.28 4.28 other OPPS APC 4.28 27.63 1.18 percent of total billed charges 4.28 4.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP SUCTION MEDI-VAC YANKAUER BULBOUS WITHOUT CONTROL VENT HANDLE STERILE LATEX FREE CLEAR SUP-K86 CDM 0270 RC outpatient 1.07 1.07 1.07 74 0.79 percent of total billed charges 1.07 93 0.87 percent of total billed charges 1.07 1.07 other OPPS APC 1.07 1.07 other OPPS APC 1.07 27.63 0.3 percent of total billed charges 1.07 1.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND SILK 5-0 RB-1 L30 IN BRAID BLACK SUP-K870H CDM 0270 RC outpatient 4.47 4.47 4.47 74 3.31 percent of total billed charges 4.47 93 3.62 percent of total billed charges 4.47 4.47 other OPPS APC 4.47 4.47 other OPPS APC 4.47 27.63 1.24 percent of total billed charges 4.47 4.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND SILK 4-0 RB-1 L30 IN BRAID BLACK SUP-K871H CDM 0270 RC outpatient 3.67 3.67 3.67 74 2.72 percent of total billed charges 3.67 93 2.97 percent of total billed charges 3.67 3.67 other OPPS APC 3.67 3.67 other OPPS APC 3.67 27.63 1.01 percent of total billed charges 3.67 3.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND SILK 3-0 RB-1 L30 IN BRAID BLACK SUP-K872H CDM 0270 RC outpatient 3.62 3.62 3.62 74 2.68 percent of total billed charges 3.62 93 2.93 percent of total billed charges 3.62 3.62 other OPPS APC 3.62 3.62 other OPPS APC 3.62 27.63 1 percent of total billed charges 3.62 3.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENSARE ENDOLOGIX 18-30 SUP-K881530 CDM 270010015 LOCAL 0270 RC outpatient 1053 1053 1053 74 779.22 percent of total billed charges 1053 93 852.93 percent of total billed charges 1053 1053 other OPPS APC 1053 1053 other OPPS APC 1053 27.63 290.94 percent of total billed charges 1053 1053 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE SILK 2-0 BLK BR BB 30IN SUP-K883H CDM 0270 RC outpatient 4.81 4.81 4.81 74 3.56 percent of total billed charges 4.81 93 3.9 percent of total billed charges 4.81 4.81 other OPPS APC 4.81 4.81 other OPPS APC 4.81 27.63 1.33 percent of total billed charges 4.81 4.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SWEAT BANDS SUP-KC-16750 CDM 0270 RC outpatient 2.51 2.51 2.51 74 1.86 percent of total billed charges 2.51 93 2.03 percent of total billed charges 2.51 2.51 other OPPS APC 2.51 2.51 other OPPS APC 2.51 27.63 0.69 percent of total billed charges 2.51 2.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING WOUND TELFA MYLAR L6 IN X W4 IN ABSORBENT ADHESIVE STRIP BACK SHEET FILM NONWOVEN STERILE LATEX FREE DISPOSABLE SUP-KC2562 CDM 0270 RC outpatient 2.67 2.67 2.67 74 1.98 percent of total billed charges 2.67 93 2.16 percent of total billed charges 2.67 2.67 other OPPS APC 2.67 2.67 other OPPS APC 2.67 27.63 0.74 percent of total billed charges 2.67 2.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH GUIDING FLEXOR CHECK-FLO MULTIPURPOSE CURVE 90CM 6FR 2.2MM ACCEPTS .018/.038IN GUIDEWIRE SUP-KCFW6.0183890RBANL1H CDM 0270 RC outpatient 239.72 239.72 239.72 74 177.39 percent of total billed charges 239.72 93 194.17 percent of total billed charges 239.72 239.72 other OPPS APC 239.72 239.72 other OPPS APC 239.72 27.63 66.23 percent of total billed charges 239.72 239.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH RAABE 5 F 55 CM SUP-KCFW7.0183845RBANL2H CDM 0270 RC outpatient 124.8 124.8 124.8 74 92.35 percent of total billed charges 124.8 93 101.09 percent of total billed charges 124.8 124.8 other OPPS APC 124.8 124.8 other OPPS APC 124.8 27.63 34.48 percent of total billed charges 124.8 124.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT LEAD DELIVERY SUP-KIT CDM 0275 RC outpatient 1300 1300 1300 57 741 percent of total billed charges 1300 93 1053 percent of total billed charges 1300 1300 other OPPS APC 1300 1300 other OPPS APC 1300 51 663 percent of total billed charges 1300 1300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK BATTERY STERILE DISPOSABLE KLS-SD-1000 SUP-KLS-BP-001 CDM 0270 RC outpatient 562.43 562.43 562.43 74 416.2 percent of total billed charges 562.43 93 455.57 percent of total billed charges 562.43 562.43 other OPPS APC 562.43 562.43 other OPPS APC 562.43 27.63 155.4 percent of total billed charges 562.43 562.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SAW THK.64 MM D33 MM THIN W9.4 MM STERNUM STERILE SUP-KM-32 CDM 0270 RC outpatient 16.22 16.22 16.22 74 12 percent of total billed charges 16.22 93 13.14 percent of total billed charges 16.22 16.22 other OPPS APC 16.22 16.22 other OPPS APC 16.22 27.63 4.48 percent of total billed charges 16.22 16.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL SMS L124 IN X W90 IN OD2.5 IN KNEE CIRCULAR FENESTRATION FLUID COLLECTION POUCH SUCTION PORT TUBE HOLDER STERILE ARTHROSCOPY SUP-KM89265 CDM 0270 RC outpatient 47.91 47.91 47.91 74 35.45 percent of total billed charges 47.91 93 38.81 percent of total billed charges 47.91 47.91 other OPPS APC 47.91 47.91 other OPPS APC 47.91 27.63 13.24 percent of total billed charges 47.91 47.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PUSHER KNOT MINIMAL INCISION VALVE SURGERY SUP-KP1 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY SURGICAL BONE FIRST FRACTURE KYPHOPAK EXPRESS OSTEO INTRODUCER 15 X 2.0MM SUP-KPE1003 CDM 0270 RC outpatient 9347 9347 9347 74 6916.78 percent of total billed charges 9347 93 7571.07 percent of total billed charges 9347 9347 other OPPS APC 9347 9347 other OPPS APC 9347 27.63 2582.58 percent of total billed charges 9347 9347 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY INTRODUCER KYPHOPAK XPANDER 20/3 SPINE FIRST FRACTURE KYPHX ONE STEP OSTEO SUP-KPT2005 CDM 0270 RC outpatient 9237.8 9237.8 9237.8 74 6835.97 percent of total billed charges 9237.8 93 7482.62 percent of total billed charges 9237.8 9237.8 other OPPS APC 9237.8 9237.8 other OPPS APC 9237.8 27.63 2552.4 percent of total billed charges 9237.8 9237.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC KAPPA L48 MM X H45 MM 9.7 CC 25.5 GM PULSE GENERATOR IMPLANTABLE 700 SERIES SUP-KSR700SERIES CDM 0270 RC outpatient 11960 11960 11960 74 8850.4 percent of total billed charges 11960 93 9687.6 percent of total billed charges 11960 11960 other OPPS APC 11960 11960 other OPPS APC 11960 27.63 3304.55 percent of total billed charges 11960 11960 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE FIXATION KIRSCHNER STAINLESS STEEL OD1.6 MM NONSTERILE SUP-KW062SS CDM 0270 RC outpatient 36.27 36.27 36.27 74 26.84 percent of total billed charges 36.27 93 29.38 percent of total billed charges 36.27 36.27 other OPPS APC 36.27 36.27 other OPPS APC 36.27 27.63 10.02 percent of total billed charges 36.27 36.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OINTMENT SKIN 10% PVP IODINE STERILE 1GM SUP-L-2001 CDM 0270 RC outpatient 0.45 0.45 0.45 74 0.33 percent of total billed charges 0.45 93 0.36 percent of total billed charges 0.45 0.45 other OPPS APC 0.45 0.45 other OPPS APC 0.45 27.63 0.12 percent of total billed charges 0.45 0.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION PREP POVIDONE IODINE .75 OZ LIQUID POUCH NONSTERILE LATEX FREE SUP-L-3011-5S CDM 0270 RC outpatient 1.1 1.1 1.1 74 0.81 percent of total billed charges 1.1 93 0.89 percent of total billed charges 1.1 1.1 other OPPS APC 1.1 1.1 other OPPS APC 1.1 27.63 0.3 percent of total billed charges 1.1 1.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLEDGET CARDIOVASCULAR TEFLON THK1/16 IN LARGE L3/8 IN X W3/16 IN SOFT SUTURE STERILE LATEX FREE SUP-L-705 CDM 0270 RC outpatient 12.15 12.15 12.15 74 8.99 percent of total billed charges 12.15 93 9.84 percent of total billed charges 12.15 12.15 other OPPS APC 12.15 12.15 other OPPS APC 12.15 27.63 3.36 percent of total billed charges 12.15 12.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Enveo PRO OD14 FR LOAD SUP-L-ENVPRO-14-US CDM 0270 RC outpatient 1014 1014 1014 74 750.36 percent of total billed charges 1014 93 821.34 percent of total billed charges 1014 1014 other OPPS APC 1014 1014 other OPPS APC 1014 27.63 280.17 percent of total billed charges 1014 1014 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM DELIVERY OD16 FR LOAD SUP-L-ENVPRO-16-US CDM 0270 RC outpatient 1014 1014 1014 74 750.36 percent of total billed charges 1014 93 821.34 percent of total billed charges 1014 1014 other OPPS APC 1014 1014 other OPPS APC 1014 27.63 280.17 percent of total billed charges 1014 1014 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVOLUT FX LOADING SYSTEM 23-29MM SUP-L-EVOLUTFX-2329 CDM 0270 RC outpatient 1014 1014 1014 74 750.36 percent of total billed charges 1014 93 821.34 percent of total billed charges 1014 1014 other OPPS APC 1014 1014 other OPPS APC 1014 27.63 280.17 percent of total billed charges 1014 1014 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVOLUT FX LOADING SYSTEM 34MM SUP-L-EVOLUTFX-34 CDM 0270 RC outpatient 1014 1014 1014 74 750.36 percent of total billed charges 1014 93 821.34 percent of total billed charges 1014 1014 other OPPS APC 1014 1014 other OPPS APC 1014 27.63 280.17 percent of total billed charges 1014 1014 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVOLUT PRO+ LOADING SYSTEM 23-29MM SUP-L-EVPROP2329US CDM 0270 RC outpatient 1014 1014 1014 74 750.36 percent of total billed charges 1014 93 821.34 percent of total billed charges 1014 1014 other OPPS APC 1014 1014 other OPPS APC 1014 27.63 280.17 percent of total billed charges 1014 1014 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVOLUT PRO+ LOADING SYSTEM 34MM SUP-L-EVPROP34US CDM 0270 RC outpatient 1014 1014 1014 74 750.36 percent of total billed charges 1014 93 821.34 percent of total billed charges 1014 1014 other OPPS APC 1014 1014 other OPPS APC 1014 27.63 280.17 percent of total billed charges 1014 1014 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE LIGAPAK 2-0 54IN YELLOWISH TAN PLAIN MONOFILAMENT REEL SUP-L103G CDM 0270 RC outpatient 9.57 9.57 9.57 74 7.08 percent of total billed charges 9.57 93 7.75 percent of total billed charges 9.57 9.57 other OPPS APC 9.57 9.57 other OPPS APC 9.57 27.63 2.64 percent of total billed charges 9.57 9.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE LIGAPAK 3-0 54IN BROWN CHROMIC MONOFILAMENT REEL SUP-L112G CDM 0270 RC outpatient 8.72 8.72 8.72 74 6.45 percent of total billed charges 8.72 93 7.06 percent of total billed charges 8.72 8.72 other OPPS APC 8.72 8.72 other OPPS APC 8.72 27.63 2.41 percent of total billed charges 8.72 8.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PPM L300 ACCOLADE SR DEVICE _41833_ SUP-L300 CDM 0275 RC outpatient 7112.25 7112.25 7112.25 57 4053.98 percent of total billed charges 7112.25 93 5760.92 percent of total billed charges 7112.25 7112.25 other OPPS APC 7112.25 7112.25 other OPPS APC 7112.25 51 3627.25 percent of total billed charges 7112.25 7112.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC ACCOLADE LATITUDE NXT PACESAFE EASYVIEW D.75 CM W4.45 CM X H5.02 CM 13.7 CC 24.8 GM RIGHT ATRIUM RIGHT VENTRICLE 2 CHAMBER IS1 CONNECTOR SUP-L301 CDM 0275 RC outpatient 7701.75 7701.75 7701.75 57 4390 percent of total billed charges 7701.75 93 6238.42 percent of total billed charges 7701.75 7701.75 other OPPS APC 7701.75 7701.75 other OPPS APC 7701.75 51 3927.89 percent of total billed charges 7701.75 7701.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER ACCOLADE DR MRI SINGLE CHAMBER SUP-L310 CDM 0275 RC outpatient 8010 8010 8010 57 4565.7 percent of total billed charges 8010 93 6488.1 percent of total billed charges 8010 8010 other OPPS APC 8010 8010 other OPPS APC 8010 51 4085.1 percent of total billed charges 8010 8010 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER - ACCOLADE DR MRI DUAL CHAMBER SUP-L311 CDM 0270 RC outpatient 9916.4 9916.4 9916.4 74 7338.14 percent of total billed charges 9916.4 93 8032.28 percent of total billed charges 9916.4 9916.4 other OPPS APC 9916.4 9916.4 other OPPS APC 9916.4 27.63 2739.9 percent of total billed charges 9916.4 9916.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER ACCOLADE DR MRI DUAL CHAMBER SUP-L311 CDM 0270 RC outpatient 8581.5 8581.5 8581.5 74 6350.31 percent of total billed charges 8581.5 93 6951.02 percent of total billed charges 8581.5 8581.5 other OPPS APC 8581.5 8581.5 other OPPS APC 8581.5 27.63 2371.07 percent of total billed charges 8581.5 8581.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER L321 ACCOLADE EL DEVICE _42916_ SUP-L321 CDM 0275 RC outpatient 7701.75 7701.75 7701.75 57 4390 percent of total billed charges 7701.75 93 6238.42 percent of total billed charges 7701.75 7701.75 other OPPS APC 7701.75 7701.75 other OPPS APC 7701.75 51 3927.89 percent of total billed charges 7701.75 7701.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER ACCOLADE DR EL MRI DUAL CHAMBER SUP-L331 CDM 0275 RC outpatient 8581.5 8581.5 8581.5 57 4891.46 percent of total billed charges 8581.5 93 6951.02 percent of total billed charges 8581.5 8581.5 other OPPS APC 8581.5 8581.5 other OPPS APC 8581.5 51 4376.57 percent of total billed charges 8581.5 8581.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SHOCKWAVE L6 IVL CATHETER, 8.0X30 MM" SUP-L6IVL080030 CDM 0270 RC outpatient 8970 8970 8970 74 6637.8 percent of total billed charges 8970 93 7265.7 percent of total billed charges 8970 8970 other OPPS APC 8970 8970 other OPPS APC 8970 27.63 2478.41 percent of total billed charges 8970 8970 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SHOCKWAVE L6 IVL CATHETER, 9.0X30 MM" SUP-L6IVL090030 CDM 0270 RC outpatient 8970 8970 8970 74 6637.8 percent of total billed charges 8970 93 7265.7 percent of total billed charges 8970 8970 other OPPS APC 8970 8970 other OPPS APC 8970 27.63 2478.41 percent of total billed charges 8970 8970 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SHOCKWAVE L6 IVL CATHETER, 10.0X30 MM" SUP-L6IVL100030 CDM 0270 RC outpatient 8970 8970 8970 74 6637.8 percent of total billed charges 8970 93 7265.7 percent of total billed charges 8970 8970 other OPPS APC 8970 8970 other OPPS APC 8970 27.63 2478.41 percent of total billed charges 8970 8970 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SHOCKWAVE L6 IVL CATHETER, 12.0X30 MM" SUP-L6IVL120030 CDM 0270 RC outpatient 8970 8970 8970 74 6637.8 percent of total billed charges 8970 93 7265.7 percent of total billed charges 8970 8970 other OPPS APC 8970 8970 other OPPS APC 8970 27.63 2478.41 percent of total billed charges 8970 8970 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND 4-0 144IN BLACK SILK BRAID REEL SUP-LA53G CDM 0270 RC outpatient 48 48 48 74 35.52 percent of total billed charges 48 93 38.88 percent of total billed charges 48 48 other OPPS APC 48 48 other OPPS APC 48 27.63 13.26 percent of total billed charges 48 48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON 3 DIMENSIONAL RIGHT CORONARY CURVE L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA63DRC CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER DRC CURVE L100 CM OD6 FR CORONARY SIDEHOLE SUP-LA63DRCSH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON AMPLATZ 1 LEFT CORONARY CURVE L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6AL10 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON AMPLATZ 1 LEFT CORONARY CURVE L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL SIDEHOLE STERILE DISPOSABLE SUP-LA6AL10SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON AMPLATZ 2 LEFT CORONARY CURVE L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6AL20 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON AMPLATZ 2 LEFT CORONARY CURVE L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL SIDEHOLE STERILE DISPOSABLE SUP-LA6AL20SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON AMPLATZ .75 LEFT CORONARY CURVE L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6AL75 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON AMPLATZ 1 RIGHT CORONARY CURVE L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6AR10 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER AR1 CURVE L100 CM OD6 FR CORONARY SIDEHOLE SUP-LA6AR10SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON AMPLATZ 2 RIGHT CORONARY CURVE L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6AR20 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER AR2 CURVE L100 CM OD6 FR CORONARY SIDEHOLE SUP-LA6AR20SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON EXTRA BACKUP 3 LEFT CURVE L100 CM OD6 FR ID.071 IN CORONARY LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6EBU30 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON EXTRA BACKUP 3.5 LEFT CURVE L100 CM OD6 FR ID.071 IN CORONARY LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6EBU35 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON EXTRA BACKUP 3.5 LEFT CURVE L100 CM OD6 FR ID.071 IN CORONARY LARGE LUMEN RADIOPAQUE FULL WALL SIDEHOLE STERILE DISPOSABLE SUP-LA6EBU35SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON EXTRA BACKUP 3.75 LEFT CURVE L100 CM OD6 FR ID.071 IN CORONARY LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6EBU375 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER EBU3.75 LEFT CURVE L100 CM OD6 FR CORONARY SIDEHOLE SUP-LA6EBU375SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON EXTRA BACKUP 4 LEFT CURVE L100 CM OD6 FR ID.071 IN CORONARY LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6EBU40 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON EXTRA BACKUP 4 LEFT CURVE L100 CM OD6 FR ID.071 IN CORONARY LARGE LUMEN RADIOPAQUE FULL WALL SIDEHOLE STERILE DISPOSABLE SUP-LA6EBU40SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON EXTRA BACKUP 4.5 LEFT CURVE L100 CM OD6 FR ID.071 IN CORONARY LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6EBU45 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON EXTRA BACKUP 5 LEFT CURVE L100 CM OD6 FR ID.071 IN CORONARY LARGE LUMEN FLEXIBLE DISTAL SEGMENT FULL WALL TECHNOLOGY RADIOPAQUE MARKER BAND SUP-LA6EBU50 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON STANDARD FR4 CURVE L100CM OD 6 FR CORONARY LARGE LUMEN RADIOPAQUE FLEXIBLE DISTAL SEGMENT STERILE LATEX FREE SUP-LA6FR40_66268 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER HS1 CURVE L100 CM OD6 FR CORONARY SUP-LA6HSI CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON HS2 CURVE OD6 FR ID.071 IN CORONARY MULTIPURPOSE LARGE LUMEN FLEXIBLE DISTAL SEGMENT FULL WALL TECHNOLOGY RADIOPAQUE MARKER BAND STERILE DISPOSABLE SUP-LA6HSII CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER HS1 CURVE OD6 FR SIDEHOLE SUP-LA6HSISH CDM 0270 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 27.63 30.17 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON INTERNAL MAMMARY ARTERY CURVE L100 CM OD6 FR ID.071 IN CORONARY LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6IMA CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON IMA CURVE L90 CM OD6 FR PERIPHERAL LARGE LUMEN RADIOPAQUE FLEXIBLE DISTAL SEGMENT STERILE LATEX FREE SUP-LA6IMAD CDM outpatient 109.2 109.2 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON INTERNAL MAMMARY ARTERY CURVE L100 CM OD6 FR ID.071 IN CORONARY LARGE LUMEN RADIOPAQUE FULL WALL SIDEHOLE STERILE DISPOSABLE SUP-LA6IMASH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON STANDARD JCL4 CURVE L100CM OD 6 FR CORONARY PERIPHERAL LARGE LUMEN RADIOPAQUE FLEXIBLE DISTALSEGMENT STERILE LATEX FREE SUP-LA6JCL40_66622 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON JUDKINS CORONARY 3 LEFT CURVE STANDARD L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6JL30 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON JUDKINS CORONARY 3.5 LEFT CURVE STANDARD L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6JL35 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON JUDKINS CORONARY 3.5 LEFT CURVE STANDARD L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL SIDEHOLE STERILE DISPOSABLE SUP-LA6JL35SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON JUDKINS CORONARY 4 LEFT CURVE STANDARD L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6JL40 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON JUDKINS CORONARY 4 LEFT CURVE STANDARD L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL SIDEHOLE STERILE DISPOSABLE SUP-LA6JL40SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON JUDKINS CORONARY 4.5 LEFT CURVE STANDARD L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6JL45 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER JL4.5 CURVE L100 CM OD6 FR CORONARY SIDEHOLE SUP-LA6JL45SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON JUDKINS CORONARY 5 LEFT CURVE STANDARD L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6JL50 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER JL5 CURVE SIDEHOLE L100 CM OD6 FR CORONARY SIDEHOLE SUP-LA6JL50SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F LAUNCHER GUIDE JL 6.0 SUP-LA6JL60 CDM 0481 RC outpatient 128.7 128.7 128.7 74 95.24 percent of total billed charges 128.7 93 104.25 percent of total billed charges 128.7 128.7 other OPPS APC 128.7 128.7 other OPPS APC 128.7 51 65.64 percent of total billed charges 128.7 128.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING JL6 CURVE 6FR 100CM CORONARY LAUNCHER SUP-LA6JL60 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON JUDKINS CORONARY 3 RIGHT CURVE STANDARD L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6JR30 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON JUDKINS CORONARY 3.5 RIGHT CURVE STANDARD L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6JR35 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON JUDKINS CORONARY 3.5 RIGHT CURVE STANDARD L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL SIDEHOLE STERILE DISPOSABLE SUP-LA6JR35SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON JUDKINS CORONARY 4 RIGHT CURVE STANDARD L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6JR40 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON JUDKINS CORONARY 4 RIGHT CURVE STANDARD L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL SIDEHOLE STERILE DISPOSABLE SUP-LA6JR40SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON LEFT CORONARY BYPASS CURVE L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6LCB CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON MULTIPURPOSE 1 CURVE L100 CM OD6 FR ID.071 IN CORONARY LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6MP1 CDM 0270 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 27.63 30.17 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON MUTLIPURPOSE 1 CURVE OD6 FR LARGE LUMEN RADIOPAQUE FLEXIBLE DISTAL SEGMENT SIDEHOLE SUP-LA6MP1SH CDM 0270 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 27.63 30.17 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER RESS CURVE L100 CM OD6 FR CORONARY SUP-LA6MRESS CDM 0481 RC outpatient 110.5 110.5 110.5 74 81.77 percent of total billed charges 110.5 93 89.51 percent of total billed charges 110.5 110.5 other OPPS APC 110.5 110.5 other OPPS APC 110.5 51 56.36 percent of total billed charges 110.5 110.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON RIGHT CORONARY BYPASS CURVE L100 CM OD6 FR ID.071 IN LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA6RCB CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 7F LAUNCHER GUIDE AL .75 SUP-LA7AL75 CDM 0481 RC outpatient 110.5 110.5 110.5 74 81.77 percent of total billed charges 110.5 93 89.51 percent of total billed charges 110.5 110.5 other OPPS APC 110.5 110.5 other OPPS APC 110.5 51 56.36 percent of total billed charges 110.5 110.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER 3DRC CURVE OD8 FR CORONARY SUP-LA83DRC CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER 3DRC CURVE OD8 FR CORONARY SIDEHOLE SUP-LA83DRCSH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER AL10 CURVE L100 CM OD8 FR CORONARY LATEX FREE SUP-LA8AL10 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER AL10 CURVE L100 CM OD8 FR CORONARY SIDEHOLE LATEX FREE SUP-LA8AL10SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON AL2 CURVE L90 CM L55 CM OD8 FR ID.09 IN CORONARY LARGE LUMEN FLEXIBLE DISTAL SEGMENT FULL WALL TECHNOLOGY RADIOPAQUE MARKER BAND ROBUST SUP-LA8AL20 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER AL20 CURVE L100 CM OD8 FR CORONARY SIDEHOLE LATEX FREE SUP-LA8AL20SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER AL2.5 CURVE L100 CM OD8 FR CORONARY SUP-LA8AL25 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER AL2.5 CURVE L100 CM OD8 FR CORONARY SIDEHOLE SUP-LA8AL25SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER AL3 CURVE L100 CM OD8 FR CORONARY SUP-LA8AL30 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER AL3 CURVE L100 CM OD8 FR CORONARY SIDEHOLE SUP-LA8AL30SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER AL.75 CURVE L100 CM OD8 FR CORONARY SUP-LA8AL75 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER AL.75 CURVE L100 CM OD8 FR CORONARY SIDEHOLE SUP-LA8AL75SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER AMPLATZ RIGHT 1 CURVE L100 CM OD8 FR ID.09 IN CORONARY RADIOPAQUE LARGE LUMEN FLEXIBLE DISTAL SEGMENT WITHOUT SIDEHOLE BLUE SUP-LA8AR10 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER AMPLATZ RIGHT 1 CURVE L100 CM OD8 FR ID.09 IN CORONARY RADIOPAQUE LARGE LUMEN FLEXIBLE DISTAL SEGMENT SIDEHOLE ORANGE SUP-LA8AR10SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER AR2 CURVE L100 CM OD8 FR ID.09 IN CORONARY LARGE LUMEN FLEXIBLE DISTAL SEGMENT FULL WALL TECHNOLOGY RADIOPAQUE MARKER BAND NYLON SHAFT STERILE DISPOSABLE SUP-LA8AR20 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER AR2 CURVE L100 CM OD8 FR CORONARY SIDEHOLE SUP-LA8AR20SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON EBU3 CURVE L 100CM OD 8FR CORONARY LARGE LUMEN RADIOPAQUE FLEXIBLE DISTAL SEGMENT STERILE LATEX FREE SUP-LA8EBU30_66347 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON EXTRA BACKUP 3.5 LEFT CURVE L100 CM OD8 FR ID.09 IN CORONARY LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA8EBU35 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER EBU3.5 CURVE SIDEHOLE L100 CM OD8 FR LEFT CORONARY SIDEHOLE SUP-LA8EBU35SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON EXTRA BACKUP 3.75 LEFT CURVE L90 CM OD8 FR ID.09 IN CORONARY LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA8EBU375 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER EBU3.75 CURVE L100 CM OD8 FR CORONARY SIDEHOLE LATEX FREE SUP-LA8EBU375SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON EXTRA BACKUP 4 LEFT CURVE L100 CM OD8 FR ID.09 IN CORONARY LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA8EBU40 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER EBU4 CURVE SIDEHOLE L100 CM OD8 FR LEFT CORONARY SIDEHOLE SUP-LA8EBU40SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON EXTRA BACKUP 4.5 LEFT CURVE L100 CM OD8 FR ID.09 IN CORONARY LARGE LUMEN RADIOPAQUE FULL WALL FLEXIBLE DISTAL SEGMENT STERILE DISPOSABLE SUP-LA8EBU45 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER EBU4.5 CURVE OD8 FR CORONARY SIDEHOLE SUP-LA8EBU45SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER EBU5 CURVE L100 CM OD8 FR LEFT CORONARY SUP-LA8EBU50 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING XB5 CURVE 8FR 100CM CORONARY SIDEHOLE LAUNCHER SUP-LA8EBU50SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER FR4 CURVE OD8 FR CORONARY SUP-LA8FR40 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER FR4 CURVE OD8 FR CORONARY SIDEHOLE SUP-LA8FR40SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER HS2 CURVE OD8 FR MULTIPURPOSE SUP-LA8HS2 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER HS1 CURVE L100 CM OD8 FR ID.09 IN CORONARY LARGE LUMEN FULL WALL TECHNOLOGY RADIOPAQUE MARKER BAND FLEXIBLE DISTAL SEGMENT MULTIPURPOSE STERILE DISPOSABLE SUP-LA8HSI CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER HSI CURVE OD8 FR CORONARY SIDEHOLE LATEX FREE SUP-LA8HSIISH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER HS1 CURVE OD8 FR CORONARY SIDEHOLE SUP-LA8HSISH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER IM CURVE L100 CM OD8 FR CORONARY SUP-LA8IMA CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER IM CURVE L100 CM OD8 FR CORONARY SIDEHOLE SUP-LA8IMASH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER JL3 CURVE L100 CM OD8 FR CORONARY SUP-LA8JL30 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER JL3 CURVE L100 CM OD8 FR CORONARY SIDEHOLE SUP-LA8JL30SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER JL3.5 CURVE STANDARD L100 CM OD8 FR ID.09 IN CORONARY LARGE LUMEN FLEXIBLE DISTAL SEGMENT FULL WALL TECHNOLOGY RADIOPAQUE MARKER BAND NYLON SHAFT STERILE DISPOSABLE SUP-LA8JL35 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER JL3.5 CURVE L100 CM OD8 FR CORONARY FLEXIBLE SUP-LA8JL35SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER NYLON JUDKINS LEFT 4 CURVE L100 CM OD8 FR ID.09 IN CORONARY LARGE LUMEN RADIOPAQUE MARKER BAND FULL WALL ROBUST STERILE DISPOSABLE SUP-LA8JL40 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER JL4 CURVE L100 CM OD8 FR CORONARY SIDEHOLE LATEX FREE SUP-LA8JL40SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER JL4.5 CURVE L100 CM OD8 FR CORONARY SUP-LA8JL45 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER JL4.5 CURVE L100 CM OD8 FR ID.09 IN CORONARY SIDEHOLE SUP-LA8JL45SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER JL5 CURVE L100 CM OD8 FR CORONARY SUP-LA8JL50 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER JL5 CURVE L100 CM OD8 FR ID.09 IN CORONARY SIDEHOLE SUP-LA8JL50SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING JL6 CURVE 8FR 100CM CORONARY LAUNCHER SUP-LA8JL60 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER JL6 CURVE L100 CM OD8 FR CORONARY SIDEHOLE SUP-LA8JL60SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER JR3.5 CURVE L100 CM OD8 FR CORONARY SUP-LA8JR35 CDM 0270 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 27.63 30.17 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER JR3.5 CURVE SIDEHOLE L100 CM OD8 FR CORONARY SIDEHOLE SUP-LA8JR35SH CDM 0272 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 27.63 30.17 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER LARGE JR4 CURVE L100 CM OD8 FR ID.09 IN CORONARY RADIOPAQUE MARKER FLEXIBLE LUMEN FULL WALL TECHNOLOGY STERILE DISPOSABLE SUP-LA8JR40 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER JR4 CURVE L100 CM OD8 FR CORONARY SIDEHOLE LATEX FREE SUP-LA8JR40SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER JR4.5 CURVE L100 CM OD8 FR CORONARY SUP-LA8JR45 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER JR4.5 CURVE L100 CM OD8 FR CORONARY SIDEHOLE SUP-LA8JR45SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER JR5 CURVE L100 CM OD8 FR CORONARY SUP-LA8JR50 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER JR5 CURVE L100 CM OD8 FR CORONARY SIDEHOLE SUP-LA8JR50SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER LCB CURVE L100 CM OD8 FR CORONARY SUP-LA8LCB CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER LCB CURVE SIDEHOLE L100 CM OD8 FR CORONARY SIDEHOLE SUP-LA8LCBSH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER MB1 CURVE L100 CM OD8 FR CORONARY SUP-LA8MB1 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER MB1 CURVE L100 CM OD8 FR CORONARY SIDEHOLE SUP-LA8MB1SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER MP2 CURVE L100 CM OD8 FR CORONARY SUP-LA8MB2 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER MB2 CURVE L100 CM OD8 FR CORONARY SIDEHOLE SUP-LA8MB2SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER RCB CURVE L100 CM OD8 FR ID.09 IN CORONARY LARGE LUMEN FLEXIBLE DISTAL SEGMENT FULL WALL TECHNOLOGY RADIOPAQUE MARKER BAND NYLON SHAFT STERILE DISPOSABLE SUP-LA8RCB CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER RCB CURVE L100 CM OD8 FR CORONARY SIDEHOLE SUP-LA8RCBSH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER SFR4 CURVE OD8 FR CORONARY SUP-LA8SFR40 CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER SFR4 CURVE OD8 FR CORONARY SIDEHOLE SUP-LA8SFR40SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING LAUNCHER SR4 CURVE SIDEHOLE L100 CM OD8 FR CORONARY SIDEHOLE SUP-LA8SR40SH CDM 0481 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 51 55.69 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOFTWARE MEDICAL FFRANGIO NONINVASIVE FRACTIONAL FLOW RESERVE ACTIVATION KEY DISPOSABLE SUP-LAB0000379-BX CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE TITANIUM PARTIAL THREAD L36 MM OD4 MM SPINE ODONTOID CORTICAL SUP-LB516T CDM 0270 RC outpatient 6545.14 6545.14 6545.14 74 4843.4 percent of total billed charges 6545.14 93 5301.56 percent of total billed charges 6545.14 6545.14 other OPPS APC 6545.14 6545.14 other OPPS APC 6545.14 27.63 1808.42 percent of total billed charges 6545.14 6545.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LABEL MEDICAL 2 TIP SKIN UTILITY MARKER BLANK STOP SLEEVE GOLD STANDARD STERILE SUP-LBLBLANKGSM CDM 0270 RC outpatient 4.6 4.6 4.6 74 3.4 percent of total billed charges 4.6 93 3.73 percent of total billed charges 4.6 4.6 other OPPS APC 4.6 4.6 other OPPS APC 4.6 27.63 1.27 percent of total billed charges 4.6 4.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG TRASH LINEAR LOW DENSITY 1.50 MIL CLEAR 55 GA 36X58 100 PER CASE SUP-LBR3658X3C CDM 0270 RC outpatient 0.81 0.81 0.81 74 0.6 percent of total billed charges 0.81 93 0.66 percent of total billed charges 0.81 0.81 other OPPS APC 0.81 0.81 other OPPS APC 0.81 27.63 0.22 percent of total billed charges 0.81 0.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER INTERNAL CLIP LIGACLIP TITANIUM LARGE TUBE L27 CM ENDOSCOPIC LIGATE STERILE LATEX FREE REUSABLE SUP-LC410 CDM outpatient 207.14 207.14 207.14 207.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SUPRAMID 4-0 EXTRA WHITE CABLE NYLON 20"" LOOPED" SUP-LCW-40 CDM 0270 RC outpatient 487.5 487.5 487.5 74 360.75 percent of total billed charges 487.5 93 394.88 percent of total billed charges 487.5 487.5 other OPPS APC 487.5 487.5 other OPPS APC 487.5 27.63 134.7 percent of total billed charges 487.5 487.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD OPTISURE DF4 SUP-LDA SERIES CDM 0275 RC outpatient 9305.4 9305.4 9305.4 57 5304.08 percent of total billed charges 9305.4 93 7537.37 percent of total billed charges 9305.4 9305.4 other OPPS APC 9305.4 9305.4 other OPPS APC 9305.4 51 4745.75 percent of total billed charges 9305.4 9305.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD DEFIBRILLATOR OPTISURE L65 CM OD8 FR ENDOCARDIUM 1 COIL DF1 SUP-LDA210/65 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD DEFIBRILLATOR OPTISURE L52 CM OD8 FR ENDOCARDIUM 1 COIL DF4 SUP-LDA210Q/52 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD DEFIBRILLATOR OPTISURE L58 CM OD8 FR ENDOCARDIUM 1 COIL DF4 SUP-LDA210Q/58 CDM 0275 RC outpatient 7020 7020 7020 57 4001.4 percent of total billed charges 7020 93 5686.2 percent of total billed charges 7020 7020 other OPPS APC 7020 7020 other OPPS APC 7020 51 3580.2 percent of total billed charges 7020 7020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD DEFIBRILLATOR OPTISURE L65 CM OD8 FR ENDOCARDIUM 1 COIL DF4 SUP-LDA210Q/65 CDM 0275 RC outpatient 7020 7020 7020 57 4001.4 percent of total billed charges 7020 93 5686.2 percent of total billed charges 7020 7020 other OPPS APC 7020 7020 other OPPS APC 7020 51 3580.2 percent of total billed charges 7020 7020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD DEFIBRILLATOR OPTISURE L65 CM L17 CM OD8 FR ENDOCARDIUM 2 COIL DF1 SUP-LDA220/65 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD DEFIBRILLATOR OPTISURE L52 CM L17 CM OD8 FR ENDOCARDIUM 2 COIL DF4 SUP-LDA220Q/52 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD DEFIBRILLATOR OPTISURE L58 CM L17 CM OD8 FR ENDOCARDIUM 2 COIL DF4 SUP-LDA220Q/58 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD DEFIBRILLATOR OPTISURE L65 CM L17 CM OD8 FR ENDOCARDIUM 2 COIL DF4 SUP-LDA220Q/65 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD DEFIBRILLATOR OPTISURE L65 CM L21 CM OD8 FR ENDOCARDIUM 2 COIL DF4 SUP-LDA230Q/65 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD OPTISURE DF4 PASSIVE DUAL SHOCK L52 X 17 SUP-LDP220Q/65 CDM 0275 RC outpatient 7176 7176 7176 57 4090.32 percent of total billed charges 7176 93 5812.56 percent of total billed charges 7176 7176 other OPPS APC 7176 7176 other OPPS APC 7176 51 3659.76 percent of total billed charges 7176 7176 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST TRUFORM 2 NATRELLE BIOCELL MATRIX SILICONE P4.4 CM LOW HEIGHT FULL PROJECTION W11 CM X H9.1 CM 205 SUP-LF-410205 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P5.3 CM LOW HEIGHT FULL PROJECTION W13.5 CM X H11.4 CM 390 ML 390 GM STYLE 410 GEL TEXTURED SUP-LF-410390 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSTRUMENT ELECTROSURGICAL LIGASURE FORCETRIAD TISSUEFECT 28D 3.4V 14.7MM CURVE 18.8CM 16.5X1-4MM DISPOSABLE STERILE LF SUP-LF1212A CDM 0270 RC outpatient 1927.54 1927.54 1927.54 74 1426.38 percent of total billed charges 1927.54 93 1561.31 percent of total billed charges 1927.54 1927.54 other OPPS APC 1927.54 1927.54 other OPPS APC 1927.54 27.63 532.58 percent of total billed charges 1927.54 1927.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALER/DIVIDER BIPOLAR LIGASURE 180D STRAIGHT 37CM 19.5MM 5MM DISPOSABLE STERILE LF HANDSWITCH 2 ACTION CONTOUR BLUNT SUP-LF1837 CDM 0270 RC outpatient 2076.69 2076.69 2076.69 74 1536.75 percent of total billed charges 2076.69 93 1682.12 percent of total billed charges 2076.69 2076.69 other OPPS APC 2076.69 2076.69 other OPPS APC 2076.69 27.63 573.79 percent of total billed charges 2076.69 2076.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE ELECTROSURGICAL LIGASURE MARYLAND 350 D L23 CM OPEN SEALER DIVIDER 1 STEP SEAL FORCETRIAD SUP-LF1923 CDM 0270 RC outpatient 2179.55 2179.55 2179.55 74 1612.87 percent of total billed charges 2179.55 93 1765.44 percent of total billed charges 2179.55 2179.55 other OPPS APC 2179.55 2179.55 other OPPS APC 2179.55 27.63 602.21 percent of total billed charges 2179.55 2179.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALER/DIVIDER LAPAROSCOPIC LIGASURE 350 D L18.5 MM L44 CM L20.3 MM MARYLAND CURVE JAW NANO COAT VALLEYLAB FT10 LS10 FORCETRIAD ENERGY PLATFORM SUP-LF1944 CDM 0270 RC outpatient 2447.54 2447.54 2447.54 74 1811.18 percent of total billed charges 2447.54 93 1982.51 percent of total billed charges 2447.54 2447.54 other OPPS APC 2447.54 2447.54 other OPPS APC 2447.54 27.63 676.26 percent of total billed charges 2447.54 2447.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALER/DIVIDER BIPOLAR LIGASURE IMPACT 180 D L34 MM LARGE L7.1 IN L36 MM OD13.5 MM HAND ACTIVATION CURVE JAW THERMAL SPREAD LIGHTWEIGHT STERILE DISPOSABLE FORCETRIAD SUP-LF4418 CDM 0270 RC outpatient 2981.45 2981.45 2981.45 74 2206.27 percent of total billed charges 2981.45 93 2414.97 percent of total billed charges 2981.45 2981.45 other OPPS APC 2981.45 2981.45 other OPPS APC 2981.45 27.63 823.77 percent of total billed charges 2981.45 2981.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALER/DIVIDER MONOPOLAR LIGASURE ADVANCE VALLEYLAB L17.3 IN OD5 MM CURVE BILATERAL JAW ELECTRODE TIP HAND SWITCH DISPOSABLE FORCETRIAD ENERGY PLATFORM LAPAROSCOPIC SUP-LF5544 CDM 0270 RC outpatient 1781 1781 1781 74 1317.94 percent of total billed charges 1781 93 1442.61 percent of total billed charges 1781 1781 other OPPS APC 1781 1781 other OPPS APC 1781 27.63 492.09 percent of total billed charges 1781 1781 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADHESIVE SKIN CLOSURE LIQUIBAND BUTYL .5 ML TOPICAL FLOW CONTROL MICROBIAL BARRIER PROTECTION UNIQUE WING APPLICATOR STERILE CLEAR SUP-LFC004T CDM 0270 RC outpatient 33.49 33.49 33.49 74 24.78 percent of total billed charges 33.49 93 27.13 percent of total billed charges 33.49 33.49 other OPPS APC 33.49 33.49 other OPPS APC 33.49 27.63 9.25 percent of total billed charges 33.49 33.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOAP LIQUID PALMOLIVE 3 OZ- 72 PER CASE SUP-LGSCPC01417 CDM 0270 RC outpatient 3.86 3.86 3.86 74 2.86 percent of total billed charges 3.86 93 3.13 percent of total billed charges 3.86 3.86 other OPPS APC 3.86 3.86 other OPPS APC 3.86 27.63 1.07 percent of total billed charges 3.86 3.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE HOCKEY STICK LEFT SMALL SUP-LHS CDM 0270 RC outpatient 2.6 2.6 2.6 74 1.92 percent of total billed charges 2.6 93 2.11 percent of total billed charges 2.6 2.6 other OPPS APC 2.6 2.6 other OPPS APC 2.6 27.63 0.72 percent of total billed charges 2.6 2.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CARDIAC MONITOR REVEAL LINQ MYCARELINK LOOP RECORDER MONITOR SUP-LINQ II LNQ22 CDM 0270 RC outpatient 11700 11700 11700 74 8658 percent of total billed charges 11700 93 9477 percent of total billed charges 11700 11700 other OPPS APC 11700 11700 other OPPS APC 11700 27.63 3232.71 percent of total billed charges 11700 11700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY INDIGO 7FR 130CM TORQ TIP W/LIGHTNING BOLT ASPIRATION TUBING SUP-LITNGBT7TQ130 CDM 0270 RC outpatient 20852 20852 20852 74 15430.5 percent of total billed charges 20852 93 16890.1 percent of total billed charges 20852 20852 other OPPS APC 20852 20852 other OPPS APC 20852 27.63 5761.41 percent of total billed charges 20852 20852 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY INDIGO LIGHTNING FLASH SELECT 135 6FR 100CM HTORQ BER TIP W/ASPIRATION TUBING SUP-LITNGFHT100BER CDM 0270 RC outpatient 25402 25402 25402 74 18797.5 percent of total billed charges 25402 93 20575.6 percent of total billed charges 25402 25402 other OPPS APC 25402 25402 other OPPS APC 25402 27.63 7018.57 percent of total billed charges 25402 25402 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT PENILE SCROTAL INFLATABLE WITH INHIBIZONE TACTILE PUMP 700CX SUP-LK10110 CDM 270010002 LOCAL 0270 RC outpatient 2.6 2.6 2.6 74 1.92 percent of total billed charges 2.6 93 2.11 percent of total billed charges 2.6 2.6 other OPPS APC 2.6 2.6 other OPPS APC 2.6 27.63 0.72 percent of total billed charges 2.6 2.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEIGHT EYELID THINPROFILE GOLD H.6 MM 1.4 GM SPHERICAL CURVATURE TAPERED LOWER EDGE ROUND CORNER SMOOTH SUP-LL4014 CDM 0270 RC outpatient 845 845 845 74 625.3 percent of total billed charges 845 93 684.45 percent of total billed charges 845 845 other OPPS APC 845 845 other OPPS APC 845 27.63 233.47 percent of total billed charges 845 845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MONITOR CARDIAC REVEAL LINQ II IMPLANTABLE 8.0MM X 45.1MM X 4.2MM 1.4CM3 3.4GM INSERTABLE AF DETECTION SUP-LNQ22 CDM 0270 RC outpatient 11700 11700 11700 11700 other OPPS APC 11700 11700 other OPPS APC 11700 27.63 3232.71 percent of total billed charges 11700 11700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CARDIAC MONITOR LINQ II RECORDER SUP-LNQ22SYS CDM 0270 RC outpatient 11700 11700 11700 74 8658 percent of total billed charges 11700 93 9477 percent of total billed charges 11700 11700 other OPPS APC 11700 11700 other OPPS APC 11700 27.63 3232.71 percent of total billed charges 11700 11700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ECHELON FLEX ENDOPATH 12 MM LONG L60 MM L440 MM 6 ROW 12 FIRING LINEAR CUTTER TROCAR FLEXIBLE STERILE LATEX FREE DISPOSABLE SUP-LONG60A CDM 0270 RC outpatient 845 845 845 74 625.3 percent of total billed charges 845 93 684.45 percent of total billed charges 845 845 other OPPS APC 845 845 other OPPS APC 845 27.63 233.47 percent of total billed charges 845 845 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD TENDRIL MRI 46CM SUP-LPA1200M/46 CDM 0275 RC outpatient 780 780 780 57 444.6 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 51 397.8 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD TENDRIL MRI 52CM SUP-LPA1200M/52 CDM 0275 RC outpatient 780 780 780 57 444.6 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 51 397.8 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD PACING TENDRIL MRI L58 CM SUP-LPA1200M/58 CDM 0275 RC outpatient 780 780 780 57 444.6 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 51 397.8 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH LAPAROSCOPIC PROGRIP ANATOMIC 10X15CM LT SUP-LPG1510AL CDM 0270 RC outpatient 1028.87 1028.87 1028.87 74 761.36 percent of total billed charges 1028.87 93 833.38 percent of total billed charges 1028.87 1028.87 other OPPS APC 1028.87 1028.87 other OPPS APC 1028.87 27.63 284.28 percent of total billed charges 1028.87 1028.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH LAPAROSCOPIC PROGRIP ANATOMIC 10X15CM RT SUP-LPG1510AR CDM 0270 RC outpatient 1028.87 1028.87 1028.87 74 761.36 percent of total billed charges 1028.87 93 833.38 percent of total billed charges 1028.87 1028.87 other OPPS APC 1028.87 1028.87 other OPPS APC 1028.87 27.63 284.28 percent of total billed charges 1028.87 1028.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH ANATOMICAL LEFT 16X12 SUP-LPG1612AL CDM 0270 RC outpatient 1152.35 1152.35 1152.35 74 852.74 percent of total billed charges 1152.35 93 933.4 percent of total billed charges 1152.35 1152.35 other OPPS APC 1152.35 1152.35 other OPPS APC 1152.35 27.63 318.39 percent of total billed charges 1152.35 1152.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH ANATOMICAL RIGHT 16X13 SUP-LPG1612AR CDM 0270 RC outpatient 1152.35 1152.35 1152.35 74 852.74 percent of total billed charges 1152.35 93 933.4 percent of total billed charges 1152.35 1152.35 other OPPS APC 1152.35 1152.35 other OPPS APC 1152.35 27.63 318.39 percent of total billed charges 1152.35 1152.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PORT IMPLANTABLE INFUSION LIFEPORT POLYURETHANE BAYONET OD6.6 FR ODSEC7 FR 2 LUMEN DETACHABLE CATHETER INTRODUCER PATENT LOCK MECHANISM MRI SAFE STERILE LATEX FREE DISPOSABLE SUP-LPS7255 CDM 0270 RC outpatient 1001 1001 1001 74 740.74 percent of total billed charges 1001 93 810.81 percent of total billed charges 1001 1001 other OPPS APC 1001 1001 other OPPS APC 1001 27.63 276.58 percent of total billed charges 1001 1001 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP APPLICATOR LIQUIBAND ADHESIVE TISSUE DOME STERILE SUP-LQB003T CDM 0270 RC outpatient 31.2 31.2 31.2 74 23.09 percent of total billed charges 31.2 93 25.27 percent of total billed charges 31.2 31.2 other OPPS APC 31.2 31.2 other OPPS APC 31.2 27.63 8.62 percent of total billed charges 31.2 31.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM LOADING ENVEOR 34 TRANSCATHER AORTIC VALVE SUP-LS-ENVEOR-34-US CDM 0270 RC outpatient 1014 1014 1014 74 750.36 percent of total billed charges 1014 93 821.34 percent of total billed charges 1014 1014 other OPPS APC 1014 1014 other OPPS APC 1014 27.63 280.17 percent of total billed charges 1014 1014 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM INTRODUCER 23 MM LOAD SUP-LS-ENVEOR23US CDM 0270 RC outpatient 1014 1014 1014 74 750.36 percent of total billed charges 1014 93 821.34 percent of total billed charges 1014 1014 other OPPS APC 1014 1014 other OPPS APC 1014 27.63 280.17 percent of total billed charges 1014 1014 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM LOADING ENVEOR 26 & 29 TRANSCATHER AORTIC VALVE SUP-LS-ENVEOR2629US CDM 0270 RC outpatient 1014 1014 1014 74 750.36 percent of total billed charges 1014 93 821.34 percent of total billed charges 1014 1014 other OPPS APC 1014 1014 other OPPS APC 1014 27.63 280.17 percent of total billed charges 1014 1014 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SYSTEM LOADING ENVEO R 26,29MM" SUP-LS-MDT2-2629-US CDM 0270 RC outpatient 1014 1014 1014 74 750.36 percent of total billed charges 1014 93 821.34 percent of total billed charges 1014 1014 other OPPS APC 1014 1014 other OPPS APC 1014 27.63 280.17 percent of total billed charges 1014 1014 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALER/DIVIDER LAPAROSCOPIC LIGASURE 179D 12MM 37CM 18X2.6MM 5MM DISPOSABLE STERILE DOLPHIN NOSE TIP FORCETRIAD PLATFORM SUP-LS1500 CDM 0270 RC outpatient 1369.99 1369.99 1369.99 74 1013.79 percent of total billed charges 1369.99 93 1109.69 percent of total billed charges 1369.99 1369.99 other OPPS APC 1369.99 1369.99 other OPPS APC 1369.99 27.63 378.53 percent of total billed charges 1369.99 1369.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AVEIR LEADLESS VR DEL CATH LSCD111 SUP-LSCD111 CDM 0270 RC outpatient 4550 4550 4550 74 3367 percent of total billed charges 4550 93 3685.5 percent of total billed charges 4550 4550 other OPPS APC 4550 4550 other OPPS APC 4550 27.63 1257.17 percent of total billed charges 4550 4550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AVEIR LEADLESS DR DEL CATH SUP-LSCD201 CDM 0481 RC outpatient 4550 4550 4550 74 3367 percent of total billed charges 4550 93 3685.5 percent of total billed charges 4550 4550 other OPPS APC 4550 4550 other OPPS APC 4550 51 2320.5 percent of total billed charges 4550 4550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM PACEMAKER AVEIR LEADLESS VR RET CATH TRI LOOP SUP-LSCR111 CDM 0270 RC outpatient 7800 7800 7800 74 5772 percent of total billed charges 7800 93 6318 percent of total billed charges 7800 7800 other OPPS APC 7800 7800 other OPPS APC 7800 27.63 2155.14 percent of total billed charges 7800 7800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTRODUCER AVEIR HYDROPHILIC COATED L 30 CM OD 8.9 MM 25 FR INTRODUCER STERILE DISPOSABLE SUP-LSN25301 CDM 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTRODUCER AVEIR HYDROPHILIC COATED L 50 CM OD 8.9 MM 25 FR INTRODUCER STERILE DISPOSABLE SUP-LSN25501 CDM 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM PACEMAKER AVEIR 19.5 F LEADLESS PACEMAKER 38.5 MM RV SUP-LSP112V CDM 0270 RC outpatient 15300 15300 15300 74 11322 percent of total billed charges 15300 93 12393 percent of total billed charges 15300 15300 other OPPS APC 15300 15300 other OPPS APC 15300 27.63 4227.39 percent of total billed charges 15300 15300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEADLESS DR PM 19.5F 32.2MM RA SUP-LSP201A_76117 CDM 0481 RC outpatient 32890 32890 32890 74 24338.6 percent of total billed charges 32890 93 26640.9 percent of total billed charges 32890 32890 other OPPS APC 32890 32890 other OPPS APC 32890 51 16773.9 percent of total billed charges 32890 32890 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEADLESS DR PM 19.5F 38.0MM RV SUP-LSP202V CDM 0481 RC outpatient 21840 21840 21840 74 16161.6 percent of total billed charges 21840 93 17690.4 percent of total billed charges 21840 21840 other OPPS APC 21840 21840 other OPPS APC 21840 51 11138.4 percent of total billed charges 21840 21840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER INLINE CAMERA SUP-LT-CO2 CDM 0270 RC outpatient 327.86 327.86 327.86 74 242.62 percent of total billed charges 327.86 93 265.57 percent of total billed charges 327.86 327.86 other OPPS APC 327.86 327.86 other OPPS APC 327.86 27.63 90.59 percent of total billed charges 327.86 327.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP INTERNAL LIGACLIP EXTRA SM 2.6MM BLUE TITANIUM DISPOSABLE STERILE LF LIGATE OPEN ENDOSCOPIC SUP-LT100 CDM 0270 RC outpatient 5.65 5.65 5.65 74 4.18 percent of total billed charges 5.65 93 4.58 percent of total billed charges 5.65 5.65 other OPPS APC 5.65 5.65 other OPPS APC 5.65 27.63 1.56 percent of total billed charges 5.65 5.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP INTERNAL LIGACLIP EXTRA SM BLUE TITANIUM DISPOSABLE STERILE LF LIGATE OPEN ENDOSCOPIC SUP-LT102 CDM 0270 RC outpatient 15.66 15.66 15.66 74 11.59 percent of total billed charges 15.66 93 12.68 percent of total billed charges 15.66 15.66 other OPPS APC 15.66 15.66 other OPPS APC 15.66 27.63 4.33 percent of total billed charges 15.66 15.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP INTERNAL LIGACLIP EXTRA TITANIUM MEDIUM LIGATE OPEN SILVER SUP-LT200 CDM 0270 RC outpatient 6.81 6.81 6.81 74 5.04 percent of total billed charges 6.81 93 5.52 percent of total billed charges 6.81 6.81 other OPPS APC 6.81 6.81 other OPPS APC 6.81 27.63 1.88 percent of total billed charges 6.81 6.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP INTERNAL LIGACLIP EXTRA MED SILVER TITANIUM DISPOSABLE STERILE LF LIGATE OPEN ENDOSCOPIC SUP-LT202 CDM 0270 RC outpatient 18.56 18.56 18.56 74 13.73 percent of total billed charges 18.56 93 15.03 percent of total billed charges 18.56 18.56 other OPPS APC 18.56 18.56 other OPPS APC 18.56 27.63 5.13 percent of total billed charges 18.56 18.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP INTERNAL LIGACLIP EXTRA LG 6.2MM YELLOW TITANIUM DISPOSABLE STERILE LF LIGATE OPEN SUP-LT400 CDM 0270 RC outpatient 11.68 11.68 11.68 74 8.64 percent of total billed charges 11.68 93 9.46 percent of total billed charges 11.68 11.68 other OPPS APC 11.68 11.68 other OPPS APC 11.68 27.63 3.23 percent of total billed charges 11.68 11.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MANIPULATOR ENDOSCOPIC HUMI UTERINE ADJUSTABLE SUP-LTL-6003 CDM 0270 RC outpatient 75.62 75.62 75.62 74 55.96 percent of total billed charges 75.62 93 61.25 percent of total billed charges 75.62 75.62 other OPPS APC 75.62 75.62 other OPPS APC 75.62 27.63 20.89 percent of total billed charges 75.62 75.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POUCH STERILIZATION STERIKING TYVEK POLYPROPYLENE L270 MM X W130 MM SELF SEAL ADHESIVE COATED TAPE SUP-LTSS4NI CDM 0270 RC outpatient 0.69 0.69 0.69 74 0.51 percent of total billed charges 0.69 93 0.56 percent of total billed charges 0.69 0.69 other OPPS APC 0.69 0.69 other OPPS APC 0.69 27.63 0.19 percent of total billed charges 0.69 0.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POUCH STERILIZATION STERIKING TYVEK L13 IN X W7.5 IN GAS SELF SEAL HIGH RESISTANT LATEX SUP-LTSS5A CDM 0270 RC outpatient 1 1 1 74 0.74 percent of total billed charges 1 93 0.81 percent of total billed charges 1 1 other OPPS APC 1 1 other OPPS APC 1 27.63 0.28 percent of total billed charges 1 1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUSION LUMBAR LEVEL 1 NUVASIVE SUP-LUMBAR1NUVASIVE CDM 270010020 LOCAL 0270 RC outpatient 11440 11440 11440 74 8465.6 percent of total billed charges 11440 93 9266.4 percent of total billed charges 11440 11440 other OPPS APC 11440 11440 other OPPS APC 11440 27.63 3160.87 percent of total billed charges 11440 11440 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUSION LUMBAR LEVEL 1-SEA SPINE SUP-LUMBAR1SEASPINE CDM 270010020 LOCAL 0270 RC outpatient 10400 10400 10400 74 7696 percent of total billed charges 10400 93 8424 percent of total billed charges 10400 10400 other OPPS APC 10400 10400 other OPPS APC 10400 27.63 2873.52 percent of total billed charges 10400 10400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUSION LUMBAR LEVEL 1-STRYKER SUP-LUMBAR1STRYKER CDM 270010005 LOCAL 0270 RC outpatient 10400 10400 10400 74 7696 percent of total billed charges 10400 93 8424 percent of total billed charges 10400 10400 other OPPS APC 10400 10400 other OPPS APC 10400 27.63 2873.52 percent of total billed charges 10400 10400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUSION LUMBAR LEVEL 2 NUVASIVE SUP-LUMBAR2NUVASIVE CDM 270010020 LOCAL 0270 RC outpatient 15080 15080 15080 74 11159.2 percent of total billed charges 15080 93 12214.8 percent of total billed charges 15080 15080 other OPPS APC 15080 15080 other OPPS APC 15080 27.63 4166.6 percent of total billed charges 15080 15080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUSION LUMBAR LEVEL 3-STRYKER SUP-LUMBAR3STRYKER CDM 270010020 LOCAL 0270 RC outpatient 20800 20800 20800 74 15392 percent of total billed charges 20800 93 16848 percent of total billed charges 20800 20800 other OPPS APC 20800 20800 other OPPS APC 20800 27.63 5747.04 percent of total billed charges 20800 20800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUSION LUMBAR LEVEL 4 NUVASIVE SUP-LUMBAR4NUVASIVE CDM 270010020 LOCAL 0270 RC outpatient 32240 32240 32240 74 23857.6 percent of total billed charges 32240 93 26114.4 percent of total billed charges 32240 32240 other OPPS APC 32240 32240 other OPPS APC 32240 27.63 8907.91 percent of total billed charges 32240 32240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUSION LUMBAR LEVEL 4-STRYKER SUP-LUMBAR4STRYKER CDM 270010020 LOCAL 0270 RC outpatient 26000 26000 26000 74 19240 percent of total billed charges 26000 93 21060 percent of total billed charges 26000 26000 other OPPS APC 26000 26000 other OPPS APC 26000 27.63 7183.8 percent of total billed charges 26000 26000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUSION LUMBAR LEVEL 1 SUP-LUMBARL1 CDM 270010005 LOCAL 0270 RC outpatient 11440 11440 11440 74 8465.6 percent of total billed charges 11440 93 9266.4 percent of total billed charges 11440 11440 other OPPS APC 11440 11440 other OPPS APC 11440 27.63 3160.87 percent of total billed charges 11440 11440 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUSION LUMBAR LEVEL 2 SUP-LUMBARL2 CDM 270010006 LOCAL 0270 RC outpatient 16640 16640 16640 74 12313.6 percent of total billed charges 16640 93 13478.4 percent of total billed charges 16640 16640 other OPPS APC 16640 16640 other OPPS APC 16640 27.63 4597.63 percent of total billed charges 16640 16640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUSION LUMBAR LEVEL 3 SUP-LUMBARL3 CDM 270010007 LOCAL 0270 RC outpatient 20280 20280 20280 74 15007.2 percent of total billed charges 20280 93 16426.8 percent of total billed charges 20280 20280 other OPPS APC 20280 20280 other OPPS APC 20280 27.63 5603.36 percent of total billed charges 20280 20280 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FUSION LUMBAR LEVEL 4 SUP-LUMBARL4 CDM 270010020 LOCAL 0270 RC outpatient 32240 32240 32240 74 23857.6 percent of total billed charges 32240 93 26114.4 percent of total billed charges 32240 32240 other OPPS APC 32240 32240 other OPPS APC 32240 27.63 8907.91 percent of total billed charges 32240 32240 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LUMBAR FUSION CAP LEVEL 5 SUP-LUMBSTRY5 CDM 270010020 LOCAL 0270 RC outpatient 29640 29640 29640 74 21933.6 percent of total billed charges 29640 93 24008.4 percent of total billed charges 29640 29640 other OPPS APC 29640 29640 other OPPS APC 29640 27.63 8189.53 percent of total billed charges 29640 29640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 2.5X8 SUP-LUN250R08US_51176 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 2.5X12 SUP-LUN250R12US_51180 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 2.5X15 SUP-LUN250R15US_51181 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 2.5X17 SUP-LUN250R17US_51182 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 2.5X20 SUP-LUN250R20US_51183 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 2.5X24 SUP-LUN250R24US_51184 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 2.5X28 SUP-LUN250R28US_51185 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 2.5X33 SUP-LUN250R33US_51186 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 2.75X8 SUP-LUN275R08US_51187 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 2.75X12 SUP-LUN275R12US_51188 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 2.75X15 SUP-LUN275R15US_51189 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 2.75X17 SUP-LUN275R17US_51190 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 2.75X20 SUP-LUN275R20US_51191 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 2.75X24 SUP-LUN275R24US_51192 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 2.75X28 SUP-LUN275R28US_51193 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 2.75X33 SUP-LUN275R33US_51194 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 3.0X8 SUP-LUN300R08US_51195 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 3.0X12 SUP-LUN300R12US_51196 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 3.0X15 SUP-LUN300R15US_51197 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 3.0X17 SUP-LUN300R17US_51198 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 3.0X20 SUP-LUN300R20US_51199 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 3.0X24 SUP-LUN300R24US_51200 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 3.0X28 SUP-LUN300R28US_51201 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 3.0X33 SUP-LUN300R33US_51202 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 3.5X8 SUP-LUN350R08US_51203 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 3.5X12 SUP-LUN350R12US_51204 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 3.5X15 SUP-LUN350R15US_51205 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 3.5X17 SUP-LUN350R17US_51206 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 3.5X20 SUP-LUN350R20US_51207 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 3.5X24 SUP-LUN350R24US_51208 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 3.5X28 SUP-LUN350R28US_51209 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 3.5X33 SUP-LUN350R33US_51210 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 4.0X8 SUP-LUN400R08US_51211 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 4.0X12 SUP-LUN400R12US_51212 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 4.0X15 SUP-LUN400R15US_51213 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 4.0X17 SUP-LUN400R17US_51214 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 4.0X20 SUP-LUN400R20US_51215 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 4.0X24 SUP-LUN400R24US_51216 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 4.0X28 SUP-LUN400R28US_51217 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ELUNIR 4.0X33 SUP-LUN400R33US_51223 CDM 0481 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 51 861.9 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE LOCALIZATION DUALOCK L10.7 CM OD 20 GA BREAST LESION MARK SUP-LW0107 CDM 0270 RC outpatient 85.8 85.8 85.8 74 63.49 percent of total billed charges 85.8 93 69.5 percent of total billed charges 85.8 85.8 other OPPS APC 85.8 85.8 other OPPS APC 85.8 27.63 23.71 percent of total billed charges 85.8 85.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "IMPLANT STYKE 410 LX LOW HEIGHT, EXTRA FULL PROJECTION 570CC" SUP-LX-410570 CDM 270010025 LOCAL 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "IMPLANT STYKE 410 LX LOW HEIGHT, EXTRA FULL PROJECTION 625CC" SUP-LX-410625 CDM 270010025 LOCAL 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MICROMAX STANDARD LENGTH DIAMOND BALL L8 CM OD2 MM NONSTERILE MEDIUM QD11 SUP-M-2SD-G1 CDM 0270 RC outpatient 434.2 434.2 434.2 74 321.31 percent of total billed charges 434.2 93 351.7 percent of total billed charges 434.2 434.2 other OPPS APC 434.2 434.2 other OPPS APC 434.2 27.63 119.97 percent of total billed charges 434.2 434.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING FLUTE DRUM L8.9 MM OD4 MM SIDE CUT BURR QD11 MEDIUM SUP-M-4DRM-G1 CDM 0270 RC outpatient 595.4 595.4 595.4 74 440.6 percent of total billed charges 595.4 93 482.27 percent of total billed charges 595.4 595.4 other OPPS APC 595.4 595.4 other OPPS APC 595.4 27.63 164.51 percent of total billed charges 595.4 595.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING BALL FLUTE OD5 MM BURR MEDIUM STRAIGHT ATTACHMENT SUP-M-5B-G1 CDM 0270 RC outpatient 184.6 184.6 184.6 74 136.6 percent of total billed charges 184.6 93 149.53 percent of total billed charges 184.6 184.6 other OPPS APC 184.6 184.6 other OPPS APC 184.6 27.63 51 percent of total billed charges 184.6 184.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR 330CM .009IN TORQUER XSUPPORT SPRING TIP .014IN ROTAWIRE WIRECLIP SUP-M0011373321 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR CATHETER ROTABLATOR ROTALINK PLUS 135CM 1.5MM DIAMOND PERIPHERAL OTW PROTECTIVE SHEATH ROTATIONAL SUP-M0011401500 CDM 0270 RC outpatient 3770 3770 3770 74 2789.8 percent of total billed charges 3770 93 3053.7 percent of total billed charges 3770 3770 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BURR CATHETER ROTABLATOR ROTALINK PLUS 135CM 2MM DIAMOND PERIPHERAL OTW PROTECTIVE SHEATH ROTATIONAL SUP-M0011402000 CDM 0270 RC outpatient 3770 3770 3770 74 2789.8 percent of total billed charges 3770 93 3053.7 percent of total billed charges 3770 3770 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM ATHERECTOMY ROTALINK PLUS 2.5MM PERIPHERAL INTERVENTION SUP-M0011402500 CDM 0270 RC outpatient 3770 3770 3770 74 2789.8 percent of total billed charges 3770 93 3053.7 percent of total billed charges 3770 3770 other OPPS APC 3770 3770 other OPPS APC 3770 27.63 1041.65 percent of total billed charges 3770 3770 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LUBRICANT ATHERECTOMY CATHETER ROTAGLIDE PERIPHERAL 6/BX SUP-M00114100062 CDM 0270 RC outpatient 322.4 322.4 322.4 74 238.58 percent of total billed charges 322.4 93 261.14 percent of total billed charges 322.4 322.4 other OPPS APC 322.4 322.4 other OPPS APC 322.4 27.63 89.08 percent of total billed charges 322.4 322.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION XXL .035 IN L75 CM L40 MM OD5.8 FR ODSEC14 MM PERIPHERAL LARGE VESSEL GUIDEWIRE ACCEPTS 7 FR INTRODUCER SHEATH PTA SUP-M001145140 CDM 0270 RC outpatient 585 585 585 74 432.9 percent of total billed charges 585 93 473.85 percent of total billed charges 585 585 other OPPS APC 585 585 other OPPS APC 585 27.63 161.64 percent of total billed charges 585 585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION XXL .035 IN L75 CM L40 MM OD5.8 FR ODSEC16 MM PERIPHERAL LARGE VESSEL PTA SUP-M001145520 CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION XXL L75 CM L40 MM OD5.8 FR ODSEC18 MM PERIPHERAL LARGE VESSEL SCRATCH RESISTANT QUADRA FOLD TECHNOLOGY HIGH STRENGTH SHAFT ACCEPTS .035 IN GUIDEWIRE PTA SUP-M001145570 CDM 0270 RC outpatient 585 585 585 74 432.9 percent of total billed charges 585 93 473.85 percent of total billed charges 585 585 other OPPS APC 585 585 other OPPS APC 585 27.63 161.64 percent of total billed charges 585 585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION 5.8FR 18MM 120CM 40MM LG VESSEL SCRATCH RESISTANT QUADRA SUP-M001145580 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE INFLATION ENCORE 26 L3 IN OD12 FR 20 ML PRESSURE GAUGE LATEX FREE SUP-M001151050 CDM 0270 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 27.63 21.55 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER CATHETER GATEWAY PLUS Y SUP-M001153223 CDM 0270 RC outpatient 55.43 55.43 55.43 74 41.02 percent of total billed charges 55.43 93 44.9 percent of total billed charges 55.43 55.43 other OPPS APC 55.43 55.43 other OPPS APC 55.43 27.63 15.32 percent of total billed charges 55.43 55.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION .035IN STANDARD 5.3FR 6MM 135CM 40MM PERIPHERAL OTW SUP-M001176280 CDM 0270 RC outpatient 429 429 429 74 317.46 percent of total billed charges 429 93 347.49 percent of total billed charges 429 429 other OPPS APC 429 429 other OPPS APC 429 27.63 118.53 percent of total billed charges 429 429 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING RENEGADE STC-18 90 D MICRO L130 CM L20 CM OD3-2.4 FR ID.021 IN RADIOPAQUE SUP-M001181330 CDM 0270 RC outpatient 1278.26 1278.26 1278.26 74 945.91 percent of total billed charges 1278.26 93 1035.39 percent of total billed charges 1278.26 1278.26 other OPPS APC 1278.26 1278.26 other OPPS APC 1278.26 27.63 353.18 percent of total billed charges 1278.26 1278.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING RENEGADE STC-18 MICRO 150CM 20CM 3-2.4FR .021IN RADIOPAQUE STRAIGHT TIP SUP-M001181370 CDM 0270 RC outpatient 1225.22 1225.22 1225.22 74 906.66 percent of total billed charges 1225.22 93 992.43 percent of total billed charges 1225.22 1225.22 other OPPS APC 1225.22 1225.22 other OPPS APC 1225.22 27.63 338.53 percent of total billed charges 1225.22 1225.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION .027IN MICRO BERN 2.8FR 155CM 1 RADIOPAQUE TORQUEABLE FLEXIBLE SUP-M001195450 CDM 0270 RC outpatient 1509.3 1509.3 1509.3 74 1116.88 percent of total billed charges 1509.3 93 1222.53 percent of total billed charges 1509.3 1509.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCATHETER VASCULAR DIREXION HI-FLO 0.027IN ID 3/2.8FR P/D 155CM BERN PERIPHERAL BRAIDED TORQUEABLE SLOTTED NITINOL 1-RADIOPAQUE MARKER SUP-M001195450 CDM 0270 RC outpatient 1509.3 1509.3 1509.3 1509.3 other OPPS APC 1509.3 1509.3 other OPPS APC 1509.3 27.63 417.02 percent of total billed charges 1509.3 1509.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION .016IN MICRO BERN 2.4FR 130CM 180CM TORQUEABLE FLEXIBLE GUIDEWIRE SUP-M001195640 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM MICROCATHETER VASCULAR DIREXION 0.021IN ID 2.7/2.4FR P/D 130CM PERIPHERAL BERN BRAIDED PRE-LOADED TORQUEABLE SLOTTED W/180CM FATHOM-16 GW NITINOL 1-RADIOPAQUE MARKER SUP-M001195640 CDM 0270 RC outpatient 2080 2080 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION MICRO STRAIGHT 2.8-3FR .027IN 130CM 180CM PRELOAD TORQUEABLE SUP-M001195710 CDM 0270 RC outpatient 1989 1989 1989 74 1471.86 percent of total billed charges 1989 93 1611.09 percent of total billed charges 1989 1989 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM MICROCATHETER VASCULAR DIREXION HI-FLO 0.027IN ID 3/2.8FR P/D 130CM PERIPHERAL STRAIGHT BRAIDED PRE-LOADED TORQUEABLE SLOTTED W/180CM FATHOM-16 GW NITINOL 1-RADIOPAQUE MARKER SUP-M001195710 CDM 0270 RC outpatient 1989 1989 1989 1989 other OPPS APC 1989 1989 other OPPS APC 1989 27.63 549.56 percent of total billed charges 1989 1989 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER INFUSION .027IN MICRO BERN 2.4FR 130CM 180CM TORQUEABLE FLEXIBLE GUIDEWIRE SUP-M001195740 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM MICROCATHETER VASCULAR DIREXION HI-FLO 0.027IN ID 3/2.8FR P/D 130CM PERIPHERAL BERN BRAIDED PRE-LOADED TORQUEABLE SLOTTED W/180CM FATHOM-16 GW NITINOL 1-RADIOPAQUE MARKER SUP-M001195740 CDM 0270 RC outpatient 2080 2080 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING MACH1 PTFE LIMA CURVE L55 CM OD6 FR ID.07 IN PERIPHERAL SUP-M001196620 CDM 0270 RC outpatient 199.65 199.65 199.65 74 147.74 percent of total billed charges 199.65 93 161.72 percent of total billed charges 199.65 199.65 other OPPS APC 199.65 199.65 other OPPS APC 199.65 27.63 55.16 percent of total billed charges 199.65 199.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER GUIDING MACH1 PTFE MULTIPURPOSE CURVE L90 CM OD8 FR ID.091 IN PERIPHERAL FLEXIBLE DISTAL SHAFT SMOOTH INNER LINER LARGE LUMEN ATRAUMATIC RADIOPAQUE TIP SUP-M001198260 CDM 0270 RC outpatient 199.65 199.65 199.65 74 147.74 percent of total billed charges 199.65 93 161.72 percent of total billed charges 199.65 199.65 other OPPS APC 199.65 199.65 other OPPS APC 199.65 27.63 55.16 percent of total billed charges 199.65 199.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM INTRODUCER ACCUSTICK II L15 CM OD21 GA NEEDLE STYLET RADIOPAQUE SUP-M001206041 CDM 0270 RC outpatient 54.6 54.6 54.6 74 40.4 percent of total billed charges 54.6 93 44.23 percent of total billed charges 54.6 54.6 other OPPS APC 54.6 54.6 other OPPS APC 54.6 27.63 15.09 percent of total billed charges 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM INTRODUCER ACCUSTICK II OD6 FR STERILE DISPOSABLE SUP-M001207050 CDM 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NEPHROURETERAL PIGTAIL 22CM 8FR PERCUFLEX METAL STIFFEN CANNULA NONCOATED INTERNAL EXTERNAL DRAINAGE SUP-M001221360 CDM 0270 RC outpatient 265.2 265.2 265.2 74 196.25 percent of total billed charges 265.2 93 214.81 percent of total billed charges 265.2 265.2 other OPPS APC 265.2 265.2 other OPPS APC 265.2 27.63 73.27 percent of total billed charges 265.2 265.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NEPHROURETERAL PERCUFLEX METAL PIGTAIL L24 CM OD8 FR STIFFEN CANNULA NONCOATED INTERNAL EXTERNAL DRAINAGE SUP-M001221370 CDM 0270 RC outpatient 265.2 265.2 265.2 74 196.25 percent of total billed charges 265.2 93 214.81 percent of total billed charges 265.2 265.2 other OPPS APC 265.2 265.2 other OPPS APC 265.2 27.63 73.27 percent of total billed charges 265.2 265.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NEPHROURETERAL PIGTAIL 26CM 8FR PERCUFLEX METAL STIFFEN CANNULA NONCOATED INTERNAL EXTERNAL DRAINAGE SUP-M001221380 CDM 0270 RC outpatient 265.2 265.2 265.2 74 196.25 percent of total billed charges 265.2 93 214.81 percent of total billed charges 265.2 265.2 other OPPS APC 265.2 265.2 other OPPS APC 265.2 27.63 73.27 percent of total billed charges 265.2 265.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE CONNECTING DRAINAGE BAG SUP-M001229101 CDM 0270 RC outpatient 28.6 28.6 28.6 74 21.16 percent of total billed charges 28.6 93 23.17 percent of total billed charges 28.6 28.6 other OPPS APC 28.6 28.6 other OPPS APC 28.6 27.63 7.9 percent of total billed charges 28.6 28.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE APD FLEXIMA METAL HYDROPHILIC LOOP L25 CM OD6 FR REGULAR DUROMETER FLEXIBLE STIFF CANNULA LARGE LUMEN STERILE DISPOSABLE SUP-M001271330 CDM 0270 RC outpatient 205.4 205.4 205.4 74 152 percent of total billed charges 205.4 93 166.37 percent of total billed charges 205.4 205.4 other OPPS APC 205.4 205.4 other OPPS APC 205.4 27.63 56.75 percent of total billed charges 205.4 205.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE APD FLEXIMA LOOP 25CM 8FR METAL HYDROPHILIC DISPOSABLE STERILE REGULAR DUROMETER STIFF CANNULA LG SUP-M001271340 CDM 0270 RC outpatient 205.4 205.4 205.4 74 152 percent of total billed charges 205.4 93 166.37 percent of total billed charges 205.4 205.4 other OPPS APC 205.4 205.4 other OPPS APC 205.4 27.63 56.75 percent of total billed charges 205.4 205.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE APD FLEXIMA METAL HYDROPHILIC LOOP L25 CM OD10 FR REGULAR DUROMETER FLEXIBLE STIFF CANNULA LARGE LUMEN STERILE DISPOSABLE SUP-M001271350 CDM 0270 RC outpatient 205.4 205.4 205.4 74 152 percent of total billed charges 205.4 93 166.37 percent of total billed charges 205.4 205.4 other OPPS APC 205.4 205.4 other OPPS APC 205.4 27.63 56.75 percent of total billed charges 205.4 205.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE APD FLEXIMA METAL HYDROPHILIC LOOP L25 CM OD12 FR REGULAR DUROMETER FLEXIBLE STIFF CANNULA LARGE LUMEN STERILE DISPOSABLE SUP-M001271380 CDM 0270 RC outpatient 205.4 205.4 205.4 74 152 percent of total billed charges 205.4 93 166.37 percent of total billed charges 205.4 205.4 other OPPS APC 205.4 205.4 other OPPS APC 205.4 27.63 56.75 percent of total billed charges 205.4 205.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE APD FLEXIMA METAL HYDROPHILIC LOOP L25 CM OD14 FR REGULAR DUROMETER FLEXIBLE STIFF CANNULA LARGE LUMEN ABSCESS STERILE DISPOSABLE SUP-M001271390 CDM 0270 RC outpatient 208.65 208.65 208.65 74 154.4 percent of total billed charges 208.65 93 169.01 percent of total billed charges 208.65 208.65 other OPPS APC 208.65 208.65 other OPPS APC 208.65 27.63 57.65 percent of total billed charges 208.65 208.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE FLEXIMA PIGTAIL CURVE L35 CM OD8 FR BILIARY FLEXIBLE STIFF CANNULA LOCK DUROMETER LARGE HOLE SUP-M001271540 CDM 0270 RC outpatient 208.65 208.65 208.65 74 154.4 percent of total billed charges 208.65 93 169.01 percent of total billed charges 208.65 208.65 other OPPS APC 208.65 208.65 other OPPS APC 208.65 27.63 57.65 percent of total billed charges 208.65 208.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE FLEXIMA PIGTAIL CURVE L35 CM OD10 FR BILIARY FLEXIBLE STIFF CANNULA LOCK DUROMETER LARGE HOLE SUP-M001271550 CDM 0270 RC outpatient 205.4 205.4 205.4 74 152 percent of total billed charges 205.4 93 166.37 percent of total billed charges 205.4 205.4 other OPPS APC 205.4 205.4 other OPPS APC 205.4 27.63 56.75 percent of total billed charges 205.4 205.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE FLEXIMA PIGTAIL CURVE L35 CM OD8 FR BILIARY REGULAR DUROMETER FLEXIBLE STIFF CANNULA LOCK LARGE HOLE SUP-M001271560 CDM 0270 RC outpatient 205.4 205.4 205.4 74 152 percent of total billed charges 205.4 93 166.37 percent of total billed charges 205.4 205.4 other OPPS APC 205.4 205.4 other OPPS APC 205.4 27.63 56.75 percent of total billed charges 205.4 205.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE FLEXIMA PIGTAIL CURVE L35 CM OD10 FR BILIARY REGULAR DUROMETER FLEXIBLE STIFF CANNULA LOCK LARGE HOLE SUP-M001271570 CDM 0270 RC outpatient 205.4 205.4 205.4 74 152 percent of total billed charges 205.4 93 166.37 percent of total billed charges 205.4 205.4 other OPPS APC 205.4 205.4 other OPPS APC 205.4 27.63 56.75 percent of total billed charges 205.4 205.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE FLEXIMA PIGTAIL CURVE L35 CM OD12 FR BILIARY FLEXIBLE STIFF CANNULA LOCK REGULAR DUROMETER LARGE HOLE SUP-M001271580 CDM 0270 RC outpatient 205.4 205.4 205.4 74 152 percent of total billed charges 205.4 93 166.37 percent of total billed charges 205.4 205.4 other OPPS APC 205.4 205.4 other OPPS APC 205.4 27.63 56.75 percent of total billed charges 205.4 205.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE FLEXIMA PIGTAIL CURVE L35 CM OD14 FR BILIARY REGULAR DUROMETER FLEXIBLE STIFF CANNULA LOCK LARGE HOLE SUP-M001271590 CDM 0270 RC outpatient 190.61 190.61 190.61 74 141.05 percent of total billed charges 190.61 93 154.39 percent of total billed charges 190.61 190.61 other OPPS APC 190.61 190.61 other OPPS APC 190.61 27.63 52.67 percent of total billed charges 190.61 190.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL FLEXIMA GLIDEX LARGE REGULAR PIGTAIL CURVE L22 CM OD8 FR NEPHROURETERAL DUROMETER DRAINAGE HOLE CATHETER FLEXIBLE STIFFEN CANNULA SUP-M001274010 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL FLEXIMA .038 IN LARGE REGULAR PIGTAIL CURVE L24 CM OD8 FR NEPHROURETERAL DUROMETER GUIDEWIRE STABILIZER FLEXIBLE STIFF CANNULA SUP-M001274020 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL FLEXIMA .038 IN LARGE REGULAR PIGTAIL CURVE L26 CM OD8 FR NEPHROURETERAL DUROMETER GUIDEWIRE STABILIZER FLEXIBLE STIFF CANNULA SUP-M001274030 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 100CM CEREBRAL BRAID TORQUE SELECTIVE SUP-M001314051 CDM 0270 RC outpatient 25.95 25.95 25.95 74 19.2 percent of total billed charges 25.95 93 21.02 percent of total billed charges 25.95 25.95 other OPPS APC 25.95 25.95 other OPPS APC 25.95 27.63 7.17 percent of total billed charges 25.95 25.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 65CM CEREBRAL BRAID TORQUE SELECTIVE SUP-M001314101 CDM 0270 RC outpatient 129.77 129.77 129.77 74 96.03 percent of total billed charges 129.77 93 105.11 percent of total billed charges 129.77 129.77 other OPPS APC 129.77 129.77 other OPPS APC 129.77 27.63 35.86 percent of total billed charges 129.77 129.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC PIGTAIL CURVE 4FR 65CM BRAID TORQUE SELECTIVE RADIOPAQUE SOFT SUP-M001315091 CDM 0270 RC outpatient 25.95 25.95 25.95 74 19.2 percent of total billed charges 25.95 93 21.02 percent of total billed charges 25.95 25.95 other OPPS APC 25.95 25.95 other OPPS APC 25.95 27.63 7.17 percent of total billed charges 25.95 25.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 4FR 65CM BRAID TORQUE SELECTIVE RADIOPAQUE SUP-M001315251 CDM 0270 RC outpatient 25.95 25.95 25.95 74 19.2 percent of total billed charges 25.95 93 21.02 percent of total billed charges 25.95 25.95 other OPPS APC 25.95 25.95 other OPPS APC 25.95 27.63 7.17 percent of total billed charges 25.95 25.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION INTERLOCK FIBERED IDC STANDARD LENGTH 2D 4CM 2MM DACRON PLATINUM OCCLUSION SYSTEM SUP-M001361480 CDM 0270 RC outpatient 936 936 936 74 692.64 percent of total billed charges 936 93 758.16 percent of total billed charges 936 936 other OPPS APC 936 936 other OPPS APC 936 27.63 258.62 percent of total billed charges 936 936 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION INTERLOCK IDC PLATINUM FIBER .018 IN STANDARD LENGTH 2D L6 CM OD2 MM OCCLUSION SYSTEM SUP-M001361490 CDM 0270 RC outpatient 1286.22 1286.22 1286.22 74 951.8 percent of total billed charges 1286.22 93 1041.84 percent of total billed charges 1286.22 1286.22 other OPPS APC 1286.22 1286.22 other OPPS APC 1286.22 27.63 355.38 percent of total billed charges 1286.22 1286.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION INTERLOCK FIBERED IDC STANDARD LENGTH 2D 6CM 3MM DACRON PLATINUM 18 COIL DETACHABLE OCCLUSION SUP-M001361500 CDM 0270 RC outpatient 936 936 936 74 692.64 percent of total billed charges 936 93 758.16 percent of total billed charges 936 936 other OPPS APC 936 936 other OPPS APC 936 27.63 258.62 percent of total billed charges 936 936 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION INTERLOCK FIBERED IDC 2D L8 CM OD4 MM 18 COIL DETACHABLE OCCLUSION SUP-M001361520 CDM 0270 RC outpatient 936 936 936 74 692.64 percent of total billed charges 936 93 758.16 percent of total billed charges 936 936 other OPPS APC 936 936 other OPPS APC 936 27.63 258.62 percent of total billed charges 936 936 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION INTERLOCK FIBERED IDC STANDARD LENGTH 2D 15CM 5MM CLEAR DACRON PLATINUM 18 COIL OCCLUSION SYSTEM SUP-M001361550 CDM 0270 RC outpatient 936 936 936 74 692.64 percent of total billed charges 936 93 758.16 percent of total billed charges 936 936 other OPPS APC 936 936 other OPPS APC 936 27.63 258.62 percent of total billed charges 936 936 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION INTERLOCK FIBERED IDC STANDARD LENGTH 2D 10CM 6MM CLEAR DACRON PLATINUM 18 COIL OCCLUSION SYSTEM SUP-M001361560 CDM 0270 RC outpatient 936 936 936 74 692.64 percent of total billed charges 936 93 758.16 percent of total billed charges 936 936 other OPPS APC 936 936 other OPPS APC 936 27.63 258.62 percent of total billed charges 936 936 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION INTERLOCK FIBERED IDC .018 IN 2D L20 CM OD8 MM DETACHABLE OCCLUSION SUP-M001361580 CDM 0270 RC outpatient 936 936 936 74 692.64 percent of total billed charges 936 93 758.16 percent of total billed charges 936 936 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION INTERLOCK-18 IDC OCCLUSION 0.018IN 8MM 20CM PERIPHERAL 2D HELICAL DETACHABLE FIBER DACRON PLATINUM NON-RADIOLUCENT MARKER 0.021IN CATH SUP-M001361580 CDM 0270 RC outpatient 936 936 936 936 other OPPS APC 936 936 other OPPS APC 936 27.63 258.62 percent of total billed charges 936 936 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION INTERLOCK FIBERED IDC DIAMOND 2.3CM 3MM 2MM CLEAR DACRON PLATINUM 18 COIL OCCLUSION SYSTEM BUNDLE SUP-M001361740 CDM 0270 RC outpatient 936 936 936 74 692.64 percent of total billed charges 936 93 758.16 percent of total billed charges 936 936 other OPPS APC 936 936 other OPPS APC 936 27.63 258.62 percent of total billed charges 936 936 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION INTERLOCK FIBERED IDC STANDARD LENGTH 2D 40CM 12MM DACRON PLATINUM 35 COIL DETACHABLE DELIVERY WIRE SM SUP-M001363630 CDM 0270 RC outpatient 2392 2392 2392 74 1770.08 percent of total billed charges 2392 93 1937.52 percent of total billed charges 2392 2392 other OPPS APC 2392 2392 other OPPS APC 2392 27.63 660.91 percent of total billed charges 2392 2392 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION INTERLOCK FIBER .035 IN CUBE L20 CM OD8 MM OCCLUSION SYSTEM DETACHABLE SUP-M001363760 CDM 0270 RC outpatient 1872 1872 1872 74 1385.28 percent of total billed charges 1872 93 1516.32 percent of total billed charges 1872 1872 other OPPS APC 1872 1872 other OPPS APC 1872 27.63 517.23 percent of total billed charges 1872 1872 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION INTERLOCK FIBERED IDC CUBE 25CM 10MM DACRON PLATINUM 35 COIL DETACHABLE DELIVERY WIRE SM ARM ACCEPTS 5 SUP-M001363790 CDM 0270 RC outpatient 1872 1872 1872 74 1385.28 percent of total billed charges 1872 93 1516.32 percent of total billed charges 1872 1872 other OPPS APC 1872 1872 other OPPS APC 1872 27.63 517.23 percent of total billed charges 1872 1872 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION INTERLOCK FIBERED IDC CUBE L40 CM OD10 MM 35 COIL DETACHABLE OCCLUSION SUP-M001363800 CDM 0270 RC outpatient 2392 2392 2392 74 1770.08 percent of total billed charges 2392 93 1937.52 percent of total billed charges 2392 2392 other OPPS APC 2392 2392 other OPPS APC 2392 27.63 660.91 percent of total billed charges 2392 2392 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION INTERLOCK FIBERED IDC CUBE 25CM 15MM DACRON PLATINUM 35 COIL DETACHABLE DELIVERY WIRE SM ARM ACCEPTS 5 SUP-M001363810 CDM 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION INTERLOCK FIBERED IDC CUBE L40 CM OD15 MM 35 COIL DETACHABLE OCCLUSION SUP-M001363820 CDM 0270 RC outpatient 2392 2392 2392 74 1770.08 percent of total billed charges 2392 93 1937.52 percent of total billed charges 2392 2392 other OPPS APC 2392 2392 other OPPS APC 2392 27.63 660.91 percent of total billed charges 2392 2392 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION INTERLOCK FIBERED IDC CUBE 40CM 20MM DACRON PLATINUM 35 COIL DETACHABLE DELIVERY WIRE SM ARM ACCEPTS 5 SUP-M001363830 CDM 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR JOURNEY NITINOL HYDROPHILIC L300 CM L2 CM OD.014 IN PERIPHERAL FLEXIBLE CONVENTION STRAIGHT TIP SUP-M001391280 CDM 0270 RC outpatient 313.64 313.64 313.64 74 232.09 percent of total billed charges 313.64 93 254.05 percent of total billed charges 313.64 313.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE FLOW CONTROL 1050 PSI 1 WAY HIGH PRESSURE FLOSWITCH SUP-M001442001 CDM 0270 RC outpatient 11.16 11.16 11.16 74 8.26 percent of total billed charges 11.16 93 9.04 percent of total billed charges 11.16 11.16 other OPPS APC 11.16 11.16 other OPPS APC 11.16 27.63 3.08 percent of total billed charges 11.16 11.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR ZIPWIRE HYDROPHILIC L150 CM L3 CM OD.035 IN STANDARD SHAFT TAPER ANGLE TIP SUP-M00146151B1 CDM 0270 RC outpatient 104 104 104 74 76.96 percent of total billed charges 104 93 84.24 percent of total billed charges 104 104 other OPPS APC 104 104 other OPPS APC 104 27.63 28.74 percent of total billed charges 104 104 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR ZIPWIRE NITINOL POLYMER HYDROPHILIC STANDARD STRAIGHT L150 CM L3 CM OD.035 IN SUPER ELASTIC CORE PRECISE TORQUE CONTROL SUPERIOR VISIBILITY SUP-M00146155B1 CDM 0270 RC outpatient 104 104 104 74 76.96 percent of total billed charges 104 93 84.24 percent of total billed charges 104 104 other OPPS APC 104 104 other OPPS APC 104 27.63 28.74 percent of total billed charges 104 104 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR AMPLATZ SUPER STIFF STAINLESS STEEL PTFE L3 MM SHORT FLAT TAPER L180 CM L7 CM OD.035 IN STRAIGHT TIP SUP-M001465011 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR AMPLATZ SUPER STIFF STAINLESS STEEL PTFE 3 MM J L260 CM L7 CM OD.035 IN FLEXIBLE TIP SUP-M001465021 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR AMPLATZ SUPER STIFF STAINLESS STEEL PTFE SHORT TAPER L260 CM L1 CM OD.035 IN STRAIGHT TIP SUP-M001465090 CDM 0270 RC outpatient 78.75 78.75 78.75 74 58.28 percent of total billed charges 78.75 93 63.79 percent of total billed charges 78.75 78.75 other OPPS APC 78.75 78.75 other OPPS APC 78.75 27.63 21.76 percent of total billed charges 78.75 78.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR AMPLATZ SUPER STIFF STAINLESS STEEL PTFE TAPER L180 CM L7 CM OD.035 IN PERIPHERAL STRAIGHT TIP SUP-M001465251 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR AMPLATZ SUPER STIFF STAINLESS STEEL PTFE STRAIGHT L260 CM L7 CM OD.035 IN FLEXIBLE TIP SUP-M001465261 CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR MAGIC TORQUE GLIDEX PLATINUM SHAPEABLE CURVE L180 CM L5 CM OD.035 IN STRAIGHT TIP RADIOPAQUE DISTAL MARKER SUP-M001465911 CDM 0270 RC outpatient 108.33 108.33 108.33 74 80.16 percent of total billed charges 108.33 93 87.75 percent of total billed charges 108.33 108.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR MAGIC TORQUE GLIDEX PLATINUM SHAPEABLE CURVE L260 CM L5 CM OD.035 IN STRAIGHT TIP RADIOPAQUE DISTAL MARKER SUP-M001465921 CDM 0270 RC outpatient 108.33 108.33 108.33 74 80.16 percent of total billed charges 108.33 93 87.75 percent of total billed charges 108.33 108.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR TRANSEND SCITANIUM ICE TUNGSTEN POLYETHYLENE L190 CM L2 CM OD.014 IN PERIPHERAL STEERABLE STRAIGHT TIP SUP-M001468010 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR V-18 CONTROLWIRE SCITANIUM ICE STRAIGHT L110 CM L8 CM OD.018 IN RADIOPAQUE SUP-M001468480 CDM 0270 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR V-18 CONTROLWIRE SCITANIUM ICE TAPER L300 CM L8 CM OD.018 IN PERIPHERAL RADIOPAQUE STRAIGHT TIP SUP-M001468540 CDM 0270 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR FATHOM-14 0.014IN 300CM 10CM PERIPHERAL STRAIGHT STEERABLE SS NITINOL PLATINUM TUNGSTEN PTFE HYDROPHILIC SUP-M001508140 CDM 0270 RC outpatient 624 624 624 624 other OPPS APC 624 624 other OPPS APC 624 27.63 172.41 percent of total billed charges 624 624 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR FATHOM-14 0.014IN 300CM 10CM PERIPHERAL ANGLED STEERABLE SS NITINOL PLATINUM TUNGSTEN PTFE HYDROPHILIC SUP-M001508150 CDM 0270 RC outpatient 624 624 624 624 other OPPS APC 624 624 other OPPS APC 624 27.63 172.41 percent of total billed charges 624 624 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR FATHOM STAINLESS STEEL NITINOL PTFE HYDROPHILIC L180 CM L25 CM OD.016 IN PERIPHERAL STEERABLE STRAIGHT TIP HYPOTUBE MICROSCOPIC CHANNEL SUP-M001509100 CDM 0270 RC outpatient 901.68 901.68 901.68 74 667.24 percent of total billed charges 901.68 93 730.36 percent of total billed charges 901.68 901.68 other OPPS APC 901.68 901.68 other OPPS APC 901.68 27.63 249.13 percent of total billed charges 901.68 901.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR FATHOM NITINOL STRAIGHT L200 CM L25 CM OD.016 IN STEERABLE SUP-M001509200 CDM 27000000 LOCAL 0270 RC outpatient 624 624 624 74 461.76 percent of total billed charges 624 93 505.44 percent of total billed charges 624 624 other OPPS APC 624 624 other OPPS APC 624 27.63 172.41 percent of total billed charges 624 624 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR FATHOM NITINOL ANGLE L200 CM L25 CM OD.016 IN STEERABLE SUP-M001509210 CDM 27000000 LOCAL 0270 RC outpatient 901.68 901.68 901.68 74 667.24 percent of total billed charges 901.68 93 730.36 percent of total billed charges 901.68 901.68 other OPPS APC 901.68 901.68 other OPPS APC 901.68 27.63 249.13 percent of total billed charges 901.68 901.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS WALLGRAFT UNISTEP PLUS METAL L90 CM L50 MM L116 CM OD14 MM ODSEC12 FR PERIPHERAL CATHETER SUP-M001705450 CDM 0270 RC outpatient 5226 5226 5226 74 3867.24 percent of total billed charges 5226 93 4233.06 percent of total billed charges 5226 5226 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS UNISTEP PLUS WALLGRAFT METAL L116 CM L70 MM L90 CM OD14 MM ODSEC12 FR COVER COATED DELIVERY SYSTEM SUP-M001705470 CDM 0270 RC outpatient 5226 5226 5226 74 3867.24 percent of total billed charges 5226 93 4233.06 percent of total billed charges 5226 5226 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS UNISTEP PLUS WALLGRAFT METAL L116 CM L70 MM L90 CM OD8 MM ODSEC9 FR COVER COATED DELIVERY SYSTEM SUP-M001705870 CDM 0270 RC outpatient 5850 5850 5850 74 4329 percent of total billed charges 5850 93 4738.5 percent of total billed charges 5850 5850 other OPPS APC 5850 5850 other OPPS APC 5850 27.63 1616.36 percent of total billed charges 5850 5850 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS WALLSTENT RP METAL L75 CM L68 MM L100 CM OD10 MM BILIARY TRACHEOBRONCHIAL VENOUS CATHETER ACCEPTS 7 FR SHEATH TIPS TRANSHEPATIC SUP-M001711360 CDM 0270 RC outpatient 3052.4 3052.4 3052.4 74 2258.78 percent of total billed charges 3052.4 93 2472.44 percent of total billed charges 3052.4 3052.4 other OPPS APC 3052.4 3052.4 other OPPS APC 3052.4 27.63 843.38 percent of total billed charges 3052.4 3052.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS WALLSTENT MONORAIL METAL L22 MM L135 CM OD6 MM CAROTID CLOSED CELL RECONSTRAINABLE FLEXIBLE RADIOPAQUE ACCEPTS 5 FR SHEATH 7 FR GUIDE CATHETER SUP-M001719000 CDM 0270 RC outpatient 6413.81 6413.81 6413.81 74 4746.22 percent of total billed charges 6413.81 93 5195.19 percent of total billed charges 6413.81 6413.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS WALLSTENT MONORAIL METAL L21 MM L135 CM OD8 MM CAROTID CLOSED CELL RECONSTRAINABLE FLEXIBLE RADIOPAQUE ACCEPTS 5 FR SHEATH 7 FR GUIDE CATHETER SUP-M001719010 CDM 0270 RC outpatient 5707 5707 5707 74 4223.18 percent of total billed charges 5707 93 4622.67 percent of total billed charges 5707 5707 other OPPS APC 5707 5707 other OPPS APC 5707 27.63 1576.84 percent of total billed charges 5707 5707 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS WALLSTENT MONORAIL METAL L29 MM L135 CM OD8 MM CAROTID CLOSED CELL RECONSTRAINABLE FLEXIBLE RADIOPAQUE ACCEPTS 5 FR SHEATH 7 FR GUIDE CATHETER SUP-M001719020 CDM 0270 RC outpatient 6413.81 6413.81 6413.81 74 4746.22 percent of total billed charges 6413.81 93 5195.19 percent of total billed charges 6413.81 6413.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS WALLSTENT MONORAIL METAL L24 MM L135 CM OD10 MM CAROTID CLOSED CELL RECONSTRAINABLE FLEXIBLE RADIOPAQUE ACCEPTS 6 FR SHEATH 8 FR GUIDE CATHETER SUP-M001719040 CDM 0270 RC outpatient 5707 5707 5707 74 4223.18 percent of total billed charges 5707 93 4622.67 percent of total billed charges 5707 5707 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PARTICLES EMBOLIZATION CONTOUR PVA 355-500 UM SUP-M0017600421 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION 5MM 135CM 20MM OTW INFLATION PORT TAPER TIP PLAQUE SUP-M001PCB50201350 CDM 0270 RC outpatient 2015 2015 2015 74 1491.1 percent of total billed charges 2015 93 1632.15 percent of total billed charges 2015 2015 other OPPS APC 2015 2015 other OPPS APC 2015 27.63 556.74 percent of total billed charges 2015 2015 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION 7MM 135CM 20MM OTW INFLATION PORT TAPER TIP PLAQUE SUP-M001PCB70201350 CDM 0270 RC outpatient 2015 2015 2015 74 1491.1 percent of total billed charges 2015 93 1632.15 percent of total billed charges 2015 2015 other OPPS APC 2015 2015 other OPPS APC 2015 27.63 556.74 percent of total billed charges 2015 2015 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SM 3MM 140CM 1.5CM OTW PLAQUE MODIFICATION PERIPHERAL SUP-M001PCBO3015140F0 CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION 4MM 140CM 1.5CM OTW PLAQUE MODIFICATION PERIPHERAL SUP-M001PCBO4015140F0 CDM 0270 RC outpatient 2015 2015 2015 74 1491.1 percent of total billed charges 2015 93 1632.15 percent of total billed charges 2015 2015 other OPPS APC 2015 2015 other OPPS APC 2015 27.63 556.74 percent of total billed charges 2015 2015 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FABRIC CARDIOVASCULAR 3X1IN HEMASHIELD THK.76MM 2 VELOUR KNITTED ULTRATHIN WOVEN SUP-M002000195140 CDM 0270 RC outpatient 319.02 319.02 319.02 74 236.07 percent of total billed charges 319.02 93 258.41 percent of total billed charges 319.02 319.02 other OPPS APC 319.02 319.02 other OPPS APC 319.02 27.63 88.15 percent of total billed charges 319.02 319.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FABRIC CARDIOVASCULAR HEMASHIELD 2 VELOUR COLLAGEN THK.76 MM L6 IN X W1 IN KNIT IMPREGNATE STERILE SUP-M002000195170 CDM 0270 RC outpatient 385.53 385.53 385.53 74 285.29 percent of total billed charges 385.53 93 312.28 percent of total billed charges 385.53 385.53 other OPPS APC 385.53 385.53 other OPPS APC 385.53 27.63 106.52 percent of total billed charges 385.53 385.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FABRIC CARDIOVASCULAR HEMASHIELD 2 VELOUR COLLAGEN POLYESTER THK.46 MM L6 IN X W1 IN WOVEN IMPREGNATE BLOOD TIGHT SEAL KNIT STERILE SUP-M002000196170 CDM 0270 RC outpatient 399.41 399.41 399.41 74 295.56 percent of total billed charges 399.41 93 323.52 percent of total billed charges 399.41 399.41 other OPPS APC 399.41 399.41 other OPPS APC 399.41 27.63 110.36 percent of total billed charges 399.41 399.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FABRIC CARDIOVASCULAR HEMASHIELD 2 VELOUR COLLAGEN POLYESTER THK.46 IN L3 IN X W2 IN WOVEN IMPREGNATE SUP-M002000196240 CDM 0270 RC outpatient 385.53 385.53 385.53 74 285.29 percent of total billed charges 385.53 93 312.28 percent of total billed charges 385.53 385.53 other OPPS APC 385.53 385.53 other OPPS APC 385.53 27.63 106.52 percent of total billed charges 385.53 385.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR HEMASHIELD PLATINUM 2 VELOUR COLLAGEN STRAIGHT L15 CM OD34 MM THORACIC 2 PASS SEWING WOVEN STERILE SUP-M00202175134P0 CDM 0270 RC outpatient 806 806 806 74 596.44 percent of total billed charges 806 93 652.86 percent of total billed charges 806 806 other OPPS APC 806 806 other OPPS APC 806 27.63 222.7 percent of total billed charges 806 806 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT HEMASHIELD PLATINUM 34MMX30CM SUP-M00202175434P0 CDM 0270 RC outpatient 1468.38 1468.38 1468.38 74 1086.6 percent of total billed charges 1468.38 93 1189.39 percent of total billed charges 1468.38 1468.38 other OPPS APC 1468.38 1468.38 other OPPS APC 1468.38 27.63 405.71 percent of total billed charges 1468.38 1468.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT HEMASHIELD PLATINUM 38MMX30CM SUP-M00202175438P0 CDM 0270 RC outpatient 1468.38 1468.38 1468.38 74 1086.6 percent of total billed charges 1468.38 93 1189.39 percent of total billed charges 1468.38 1468.38 other OPPS APC 1468.38 1468.38 other OPPS APC 1468.38 27.63 405.71 percent of total billed charges 1468.38 1468.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT CARDIOVASCULAR HEMASHIELD PLATINUM 2 VELOUR COLLAGEN POLYESTER ANGLE 4 BRANCH L50 CM OD28 MM ODSEC12/10/8/8 MM THORAX WOVEN SOFT FLEXIBLE STERILE SUP-M00202175728AP0 CDM 0270 RC outpatient 4471.56 4471.56 4471.56 74 3308.95 percent of total billed charges 4471.56 93 3621.96 percent of total billed charges 4471.56 4471.56 other OPPS APC 4471.56 4471.56 other OPPS APC 4471.56 27.63 1235.49 percent of total billed charges 4471.56 4471.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR HEMASHIELD PLATINUM 2 VELOUR COLLAGEN POLYESTER 60 D 4 BRANCH L50 CM OD30 MM ODSEC12/10/8/8 MM THORAX 2 PASS SEWING WOVEN STERILE SUP-M00202175730AP0 CDM 0270 RC outpatient 4856.02 4856.02 4856.02 74 3593.45 percent of total billed charges 4856.02 93 3933.38 percent of total billed charges 4856.02 4856.02 other OPPS APC 4856.02 4856.02 other OPPS APC 4856.02 27.63 1341.72 percent of total billed charges 4856.02 4856.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SIZER LARGE 24-38 SUP-M002363200211 CDM 0270 RC outpatient 9.92 9.92 9.92 74 7.34 percent of total billed charges 9.92 93 8.04 percent of total billed charges 9.92 9.92 other OPPS APC 9.92 9.92 other OPPS APC 9.92 27.63 2.74 percent of total billed charges 9.92 9.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYNCHRO 010 WIRE SUP-M00316310 CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCATHETER CEREBROVASCULAR EXCELSIOR SL-10 HYDROPHILIC .014 IN 45 D C CURVE L150CM L6CM OD2.4-1.7 FR 2 TIP MARKER PRESHAPED PEEL AWAY INTRODUCER STERILE DISPOSABLE SUP-M0031681930 CDM 0270 RC outpatient 3268.2 3268.2 3268.2 74 2418.47 percent of total billed charges 3268.2 93 2647.24 percent of total billed charges 3268.2 3268.2 other OPPS APC 3268.2 3268.2 other OPPS APC 3268.2 27.63 903 percent of total billed charges 3268.2 3268.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCATHETER CEREBROVASCULAR EXCELSIOR SL-10 HYDROPHILIC .014 IN 45 D S CURVE L150CM L6CM OD2.4-1.7 FR 2 TIP MARKER PRESHAPED PEEL AWAY INTRODUCER STERILE DISPOSABLE SUP-M0031691940 CDM 0270 RC outpatient 2795 2795 2795 74 2068.3 percent of total billed charges 2795 93 2263.95 percent of total billed charges 2795 2795 other OPPS APC 2795 2795 other OPPS APC 2795 27.63 772.26 percent of total billed charges 2795 2795 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR SYNCHRO2 HYDROPHILIC NITINOL STANDARD L200CM L35 CM OD .014 IN DURABLE ATRAUMATIC RIBBON TIP MICROFABRICATED ACCESS LENGTH STERILE DISPOSABLE SUP-M00326410 CDM 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYNCHRO2 STANDARD PRESHAPE WIRE SUP-M00326420 CDM 0270 RC outpatient 1729 1729 1729 74 1279.46 percent of total billed charges 1729 93 1400.49 percent of total billed charges 1729 1729 other OPPS APC 1729 1729 other OPPS APC 1729 27.63 477.72 percent of total billed charges 1729 1729 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR SYNCHRO2 NITINOL STAINLESS STEEL HYDROPHILIC L300 CM L35 CM OD.014 IN STANDARD TIP RADIOPAQUE EXCHANGE LENGTH STERILE LATEX FREE DISPOSABLE SUP-M00326510 CDM 0270 RC outpatient 2145 2145 2145 74 1587.3 percent of total billed charges 2145 93 1737.45 percent of total billed charges 2145 2145 other OPPS APC 2145 2145 other OPPS APC 2145 27.63 592.66 percent of total billed charges 2145 2145 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 ULTRA 2.5MM X 4CM SUP-M0035422540 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TARGET 360 ULTRA 4.5MM X 10MM SUP-M0035424510 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TARGET 360 ULTRA 5MM X 15MM SUP-M0035425150 CDM 0270 RC outpatient 6882.2 6882.2 6882.2 74 5092.83 percent of total billed charges 6882.2 93 5574.58 percent of total billed charges 6882.2 6882.2 other OPPS APC 6882.2 6882.2 other OPPS APC 6882.2 27.63 1901.55 percent of total billed charges 6882.2 6882.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 NANO 2MM X 3CM SUP-M0035442030 CDM 0270 RC outpatient 6019 6019 6019 74 4454.06 percent of total billed charges 6019 93 4875.39 percent of total billed charges 6019 6019 other OPPS APC 6019 6019 other OPPS APC 6019 27.63 1663.05 percent of total billed charges 6019 6019 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TARGET 360 NANO 3MM X 6MM SUP-M0035443060 CDM 0270 RC outpatient 6882.2 6882.2 6882.2 74 5092.83 percent of total billed charges 6882.2 93 5574.58 percent of total billed charges 6882.2 6882.2 other OPPS APC 6882.2 6882.2 other OPPS APC 6882.2 27.63 1901.55 percent of total billed charges 6882.2 6882.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TARGET 360 NANO 3.5MM X 6MM SUP-M0035443560 CDM 0270 RC outpatient 6214 6214 6214 74 4598.36 percent of total billed charges 6214 93 5033.34 percent of total billed charges 6214 6214 other OPPS APC 6214 6214 other OPPS APC 6214 27.63 1716.93 percent of total billed charges 6214 6214 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 360 SOFT XL 7MM X 20CM SUP-M0036127200 CDM 0270 RC outpatient 8255 8255 8255 74 6108.7 percent of total billed charges 8255 93 6686.55 percent of total billed charges 8255 8255 other OPPS APC 8255 8255 other OPPS APC 8255 27.63 2280.86 percent of total billed charges 8255 8255 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 3D 4 X 8CM SUP-M0036154080 CDM 0270 RC outpatient 6019 6019 6019 74 4454.06 percent of total billed charges 6019 93 4875.39 percent of total billed charges 6019 6019 other OPPS APC 6019 6019 other OPPS APC 6019 27.63 1663.05 percent of total billed charges 6019 6019 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 3D 7 X 15CM SUP-M0036157150 CDM 0270 RC outpatient 6214 6214 6214 74 4598.36 percent of total billed charges 6214 93 5033.34 percent of total billed charges 6214 6214 other OPPS APC 6214 6214 other OPPS APC 6214 27.63 1716.93 percent of total billed charges 6214 6214 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL TARGET DETACHABLE 3D 8 X 25CM SUP-M0036158250 CDM 0270 RC outpatient 6019 6019 6019 74 4454.06 percent of total billed charges 6019 93 4875.39 percent of total billed charges 6019 6019 other OPPS APC 6019 6019 other OPPS APC 6019 27.63 1663.05 percent of total billed charges 6019 6019 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DELIVERY AXS OFFSET ASSIST .050 IN X 150CM L SUP-M003DC050150A0Q CDM 0270 RC outpatient 2990 2990 2990 74 2212.6 percent of total billed charges 2990 93 2421.9 percent of total billed charges 2990 2990 other OPPS APC 2990 2990 other OPPS APC 2990 27.63 826.14 percent of total billed charges 2990 2990 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ACCESS AXS CATALYST 5 DISTAL 115 CM SUP-M003IC0581150 CDM 0270 RC outpatient 5257.2 5257.2 5257.2 74 3890.33 percent of total billed charges 5257.2 93 4258.33 percent of total billed charges 5257.2 5257.2 other OPPS APC 5257.2 5257.2 other OPPS APC 5257.2 27.63 1452.56 percent of total billed charges 5257.2 5257.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON OCCLUSION TRANSFORM L5 MM OD3 MM 1 LUMEN SUPER COMPLIANT STERILE LATEX FREE DISPOSABLE ACCEPTS .014 IN GUIDEWIRE SUP-M003SSC03050 CDM 0270 RC outpatient 4511 4511 4511 74 3338.14 percent of total billed charges 4511 93 3653.91 percent of total billed charges 4511 4511 other OPPS APC 4511 4511 other OPPS APC 4511 27.63 1246.39 percent of total billed charges 4511 4511 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON OCCLUSION TRANSFORM L150CM L7MM OD 2.8 FR ODSEC 4MM 1 LUMEN SUPER COMPLIANT ACCEPTS .014 IN GUIDEWIRE SUP-M003SSC04070 CDM 0270 RC outpatient 5155.8 5155.8 5155.8 74 3815.29 percent of total billed charges 5155.8 93 4176.2 percent of total billed charges 5155.8 5155.8 other OPPS APC 5155.8 5155.8 other OPPS APC 5155.8 27.63 1424.55 percent of total billed charges 5155.8 5155.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON OCCLUSION TRANSFORM L7 MM OD7 MM 1 LUMEN SUPER COMPLIANT STERILE LATEX FREE DISPOSABLE ACCEPTS .014 IN GUIDEWIRE SUP-M003SSC07070 CDM 0270 RC outpatient 4511 4511 4511 74 3338.14 percent of total billed charges 4511 93 3653.91 percent of total billed charges 4511 4511 other OPPS APC 4511 4511 other OPPS APC 4511 27.63 1246.39 percent of total billed charges 4511 4511 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRANSFORM 7X10 SUP-M003SSC07100 CDM 0270 RC outpatient 4979 4979 4979 74 3684.46 percent of total billed charges 4979 93 4032.99 percent of total billed charges 4979 4979 other OPPS APC 4979 4979 other OPPS APC 4979 27.63 1375.7 percent of total billed charges 4979 4979 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY DYNAMIC XT 2-5-2 MM SPACE LARGE 4 CURVE L110CM OD 6 FR DECAPOLAR UNIDIRECTIONAL STEERABLE 10 ELECTRODE LATEX FREE SUP-M0042011010 CDM 0270 RC outpatient 1222 1222 1222 74 904.28 percent of total billed charges 1222 93 989.82 percent of total billed charges 1222 1222 other OPPS APC 1222 1222 other OPPS APC 1222 27.63 337.64 percent of total billed charges 1222 1222 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE DECA BARD SURELINK SUP-M004560004AO CDM 0270 RC outpatient 403 403 403 74 298.22 percent of total billed charges 403 93 326.43 percent of total billed charges 403 403 other OPPS APC 403 403 other OPPS APC 403 27.63 111.35 percent of total billed charges 403 403 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOCLAMP AORTIC CATHETER 100CM SUP-M004EC10010 CDM 0270 RC outpatient 6791.2 6791.2 6791.2 74 5025.49 percent of total billed charges 6791.2 93 5500.87 percent of total billed charges 6791.2 6791.2 other OPPS APC 6791.2 6791.2 other OPPS APC 6791.2 27.63 1876.41 percent of total billed charges 6791.2 6791.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT TUBE PEG ENDOVIVE SAFETY 20FR PUSH W/ENFIT SUP-M00509011 CDM 0270 RC outpatient 301.28 301.28 301.28 74 222.95 percent of total billed charges 301.28 93 244.04 percent of total billed charges 301.28 301.28 other OPPS APC 301.28 301.28 other OPPS APC 301.28 27.63 83.24 percent of total billed charges 301.28 301.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT TUBE PEG ENDOVIVE 20FR STANDARD PULL W/ENFIT SUP-M00509041 CDM 0270 RC outpatient 194.14 194.14 194.14 74 143.66 percent of total billed charges 194.14 93 157.25 percent of total billed charges 194.14 194.14 other OPPS APC 194.14 194.14 other OPPS APC 194.14 27.63 53.64 percent of total billed charges 194.14 194.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR FEEDING SET ENFIT PORT TRANSITION SINGLE-USE 10/BX SUP-M00509241 CDM 0270 RC outpatient 12.17 12.17 12.17 74 9.01 percent of total billed charges 12.17 93 9.86 percent of total billed charges 12.17 12.17 other OPPS APC 12.17 12.17 other OPPS APC 12.17 27.63 3.36 percent of total billed charges 12.17 12.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE GASTROSTOMY ENDOVIVE REPLACEMENT 14FR STRAIGHT 3-PORT SUP-M00509891 CDM 0270 RC outpatient 94.81 94.81 94.81 74 70.16 percent of total billed charges 94.81 93 76.8 percent of total billed charges 94.81 94.81 other OPPS APC 94.81 94.81 other OPPS APC 94.81 27.63 26.2 percent of total billed charges 94.81 94.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE GASTROSTOMY ENDOVIVE REPLACEMENT 16FR STRAIGHT 3-PORT SUP-M00509901 CDM 0270 RC outpatient 94.81 94.81 94.81 74 70.16 percent of total billed charges 94.81 93 76.8 percent of total billed charges 94.81 94.81 other OPPS APC 94.81 94.81 other OPPS APC 94.81 27.63 26.2 percent of total billed charges 94.81 94.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE GASTROSTOMY ENDOVIVE REPLACEMENT 18FR STRAIGHT 3-PORT SUP-M00509911 CDM 0270 RC outpatient 94.81 94.81 94.81 74 70.16 percent of total billed charges 94.81 93 76.8 percent of total billed charges 94.81 94.81 other OPPS APC 94.81 94.81 other OPPS APC 94.81 27.63 26.2 percent of total billed charges 94.81 94.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE GASTROSTOMY ENDOVIVE REPLACEMENT 20FR STRAIGHT 3-PORT SUP-M00509921 CDM 0270 RC outpatient 94.81 94.81 94.81 74 70.16 percent of total billed charges 94.81 93 76.8 percent of total billed charges 94.81 94.81 other OPPS APC 94.81 94.81 other OPPS APC 94.81 27.63 26.2 percent of total billed charges 94.81 94.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE GASTROSTOMY ENDOVIVE REPLACEMENT 22FR STRAIGHT 3-PORT SUP-M00509931 CDM 0270 RC outpatient 94.81 94.81 94.81 74 70.16 percent of total billed charges 94.81 93 76.8 percent of total billed charges 94.81 94.81 other OPPS APC 94.81 94.81 other OPPS APC 94.81 27.63 26.2 percent of total billed charges 94.81 94.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE GASTROSTOMY ENDOVIVE REPLACEMENT 20FR RIGHT ANGLED 3-PORT SUP-M00510001 CDM 0270 RC outpatient 94.81 94.81 94.81 74 70.16 percent of total billed charges 94.81 93 76.8 percent of total billed charges 94.81 94.81 other OPPS APC 94.81 94.81 other OPPS APC 94.81 27.63 26.2 percent of total billed charges 94.81 94.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASKET SPECIMEN RETRIEVAL TRAPEZOID 3.2 MM L180 CM L5 CM OD2.5 CM BILIARY RAPID EXCHANGE LITHOTRIPTER STERILE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00510880 CDM 0270 RC outpatient 775.22 775.22 775.22 74 573.66 percent of total billed charges 775.22 93 627.93 percent of total billed charges 775.22 775.22 other OPPS APC 775.22 775.22 other OPPS APC 775.22 27.63 214.19 percent of total billed charges 775.22 775.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS BIOPSY RADIAL JAW 4 2.8 MM LARGE CAPACITY L240 CM OD2.4 MM NEEDLE DISPOSABLE ORANGE SUP-M00513331 CDM 0270 RC outpatient 50.21 50.21 50.21 74 37.16 percent of total billed charges 50.21 93 40.67 percent of total billed charges 50.21 50.21 other OPPS APC 50.21 50.21 other OPPS APC 50.21 27.63 13.87 percent of total billed charges 50.21 50.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS ENDOSCOPIC RADIAL JAW 4 JUMBO L240 CM OD2.8 MM NEEDLE STERILE DISPOSABLE ORANGE SUP-M00513373 CDM 0270 RC outpatient 136.58 136.58 136.58 74 101.07 percent of total billed charges 136.58 93 110.63 percent of total billed charges 136.58 136.58 other OPPS APC 136.58 136.58 other OPPS APC 136.58 27.63 37.74 percent of total billed charges 136.58 136.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS BIOPSY RADIAL JAW 4 PEDIATRIC L160 CM OD1.8 MM ODSEC2 MM NEEDLE CHANNEL DISPOSABLE GASTROSCOPIC SUP-M00513453 CDM 0270 RC outpatient 104.44 104.44 104.44 74 77.29 percent of total billed charges 104.44 93 84.6 percent of total billed charges 104.44 104.44 other OPPS APC 104.44 104.44 other OPPS APC 104.44 27.63 28.86 percent of total billed charges 104.44 104.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS RADIAL JAW 4 HOT BIOPSY FORCEPS SUP-M00515031 CDM 0270 RC outpatient 130.19 130.19 130.19 74 96.34 percent of total billed charges 130.19 93 105.45 percent of total billed charges 130.19 130.19 other OPPS APC 130.19 130.19 other OPPS APC 130.19 27.63 35.97 percent of total billed charges 130.19 130.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ENDOSCOPIC JAGWIRE L180 CM OD.035 IN PULMONARY DISPOSABLE SUP-M00515171 CDM 0270 RC outpatient 355.24 355.24 355.24 74 262.88 percent of total billed charges 355.24 93 287.74 percent of total billed charges 355.24 355.24 other OPPS APC 355.24 355.24 other OPPS APC 355.24 27.63 98.15 percent of total billed charges 355.24 355.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS BIOPSY RADIAL JAW 4 STAINLESS STEEL STANDARD CAPACITY L100 CM OD1.8 MM PULMONARY PRECISE BITE CONSISTENT SAMPLE RETENTION STREAMLINE CATHETER POSITION MARKER DISPOSABLE SUP-M00515181 CDM 0270 RC outpatient 87.76 87.76 87.76 74 64.94 percent of total billed charges 87.76 93 71.09 percent of total billed charges 87.76 87.76 other OPPS APC 87.76 87.76 other OPPS APC 87.76 27.63 24.25 percent of total billed charges 87.76 87.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS BIOPSY RADIAL JAW 4 LARGE CAPACITY L100 CM OD2.4 MM PULMONARY PRECISE BITE CONSISTENT SAMPLE RETENTION STREAMLINE CATHETER POSITION MARKER DISPOSABLE SUP-M00515201 CDM 0270 RC outpatient 82.05 82.05 82.05 74 60.72 percent of total billed charges 82.05 93 66.46 percent of total billed charges 82.05 82.05 other OPPS APC 82.05 82.05 other OPPS APC 82.05 27.63 22.67 percent of total billed charges 82.05 82.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS BIOPSY NEEDLE 160CM 1.8MM RADIAL JAW 3 PEDIATRIC GASTROINTESTINE STERILE SUP-M00515791 CDM 0275 RC outpatient 9305.4 9305.4 9305.4 57 5304.08 percent of total billed charges 9305.4 93 7537.37 percent of total billed charges 9305.4 9305.4 other OPPS APC 9305.4 9305.4 other OPPS APC 9305.4 51 4745.75 percent of total billed charges 9305.4 9305.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ESOPHAGEAL WALLFLEX PERMALUME NITINOL FLARE L10.3 CM L120 CM OD18 MM ODSEC18.5 FR SELF EXPAND WIRE REMOVAL SUTURE FLEXIBLE DELIVERY CATHETER DISPOSABLE SUP-M00516700 CDM 0270 RC outpatient 6799.31 6799.31 6799.31 74 5031.49 percent of total billed charges 6799.31 93 5507.44 percent of total billed charges 6799.31 6799.31 other OPPS APC 6799.31 6799.31 other OPPS APC 6799.31 27.63 1878.65 percent of total billed charges 6799.31 6799.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ESOPHAGEAL WALLFLEX PERMALUME NITINOL FLARE LOW PROFILE L12 CM L120 CM OD18 MM ODSEC18.5 FR SELF EXPAND WIRE REMOVAL SUTURE FLEXIBLE DELIVERY CATHETER COAXIAL DISPOSABLE SUP-M00516710 CDM 0270 RC outpatient 6420.86 6420.86 6420.86 74 4751.44 percent of total billed charges 6420.86 93 5200.9 percent of total billed charges 6420.86 6420.86 other OPPS APC 6420.86 6420.86 other OPPS APC 6420.86 27.63 1774.08 percent of total billed charges 6420.86 6420.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ESOPHAGEAL WALLFLEX PERMALUME NITINOL FLARE LOW PROFILE L15 CM L120 CM OD18 MM ODSEC18.5 FR SELF EXPAND WIRE REMOVAL SUTURE FLEXIBLE DELIVERY CATHETER COAXIAL DISPOSABLE SUP-M00516720 CDM 0270 RC outpatient 6356.64 6356.64 6356.64 74 4703.91 percent of total billed charges 6356.64 93 5148.88 percent of total billed charges 6356.64 6356.64 other OPPS APC 6356.64 6356.64 other OPPS APC 6356.64 27.63 1756.34 percent of total billed charges 6356.64 6356.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ESOPHAGEAL WALLFLEX PERMALUME NITINOL FLARE LOW PROFILE L10 CM L120 CM OD23 MM ODSEC18.5 FR SELF EXPAND WIRE REMOVAL SUTURE FLEXIBLE DELIVERY CATHETER COAXIAL DISPOSABLE SUP-M00516730 CDM 0270 RC outpatient 6356.64 6356.64 6356.64 74 4703.91 percent of total billed charges 6356.64 93 5148.88 percent of total billed charges 6356.64 6356.64 other OPPS APC 6356.64 6356.64 other OPPS APC 6356.64 27.63 1756.34 percent of total billed charges 6356.64 6356.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ESOPHAGEAL WALLFLEX PERMALUME TEFLON NITINOL OD28 MM FLARE L12.5 CM L78 CM OD23 MM ODSEC18.5 FR REMOVAL SUTURE FLEXIBLE DELIVERY CATHETER LOW PROFILE COAXIAL DISPOSABLE JAGWIRE ACCEPTS .038 IN GUIDEWIRE SUP-M00516740 CDM 0270 RC outpatient 6799.31 6799.31 6799.31 74 5031.49 percent of total billed charges 6799.31 93 5507.44 percent of total billed charges 6799.31 6799.31 other OPPS APC 6799.31 6799.31 other OPPS APC 6799.31 27.63 1878.65 percent of total billed charges 6799.31 6799.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ESOPHAGEAL WALLFLEX PERMALUME TEFLON NITINOL OD28 MM FLARE L15.5 CM L78 CM OD23 MM ODSEC18.5 FR REMOVAL SUTURE FLEXIBLE DELIVERY CATHETER LOW PROFILE COAXIAL DISPOSABLE JAGWIRE ACCEPTS .038 IN GUIDEWIRE SUP-M00516750 CDM 0270 RC outpatient 6799.31 6799.31 6799.31 74 5031.49 percent of total billed charges 6799.31 93 5507.44 percent of total billed charges 6799.31 6799.31 other OPPS APC 6799.31 6799.31 other OPPS APC 6799.31 27.63 1878.65 percent of total billed charges 6799.31 6799.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ESOPHAGEAL WALLFLEX PERMALUME L12 CM L9 CM OD23 MM ODSEC18.5 FR BRAID LOW PROFILE DISPOSABLE SUP-M00516940 CDM 0270 RC outpatient 6627.89 6627.89 6627.89 74 4904.64 percent of total billed charges 6627.89 93 5368.59 percent of total billed charges 6627.89 6627.89 other OPPS APC 6627.89 6627.89 other OPPS APC 6627.89 27.63 1831.29 percent of total billed charges 6627.89 6627.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SCLEROTHERAPY INTERJECT L4 MM L240 CM OD23 GA ODSEC2.3 MM ID.32 MM INNER CATHETER SHEATH STERILE DISPOSABLE CLEAR SUP-M00518301 CDM 0270 RC outpatient 97.47 97.47 97.47 74 72.13 percent of total billed charges 97.47 93 78.95 percent of total billed charges 97.47 97.47 other OPPS APC 97.47 97.47 other OPPS APC 97.47 27.63 26.93 percent of total billed charges 97.47 97.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIFTER SURGICAL ORISE INTERJECT GEL 23 G 10 ML SYRINGE KIT TWIN PACK DISPOSABLE CLEAR SUP-M00519210 CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT SYRINGE ORISE INTERJECT OD23 GA 10 ML 1 PACK GEL PREFILL PREDYE CLEAR SUP-M00519231 CDM 0270 RC outpatient 330.72 330.72 330.72 74 244.73 percent of total billed charges 330.72 93 267.88 percent of total billed charges 330.72 330.72 other OPPS APC 330.72 330.72 other OPPS APC 330.72 27.63 91.38 percent of total billed charges 330.72 330.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP HEMOSTATIC RESOLUTION 360 L235 CM BRAID TACTILE FEEDBACK SUP-M00521232 CDM 0270 RC outpatient 575.43 575.43 575.43 74 425.82 percent of total billed charges 575.43 93 466.1 percent of total billed charges 575.43 575.43 other OPPS APC 575.43 575.43 other OPPS APC 575.43 27.63 158.99 percent of total billed charges 575.43 575.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP LIGATION RESOLUTION 360 ULTRA 17 MM OPEN L235 CM BRAID ROTATION CONTROL KNOB SUP-M00521402 CDM 0270 RC outpatient 625.36 625.36 625.36 74 462.77 percent of total billed charges 625.36 93 506.54 percent of total billed charges 625.36 625.36 other OPPS APC 625.36 625.36 other OPPS APC 625.36 27.63 172.79 percent of total billed charges 625.36 625.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP ENDOSCOPIC MANTIS TRUGRIP L235 CM L2.8 MM 3 STEP ANCHOR PRONG CLOSURE MINIMAL SLIPPAG SUP-M00521421 CDM 0270 RC outpatient 1024.4 1024.4 1024.4 74 758.06 percent of total billed charges 1024.4 93 829.76 percent of total billed charges 1024.4 1024.4 other OPPS APC 1024.4 1024.4 other OPPS APC 1024.4 27.63 283.04 percent of total billed charges 1024.4 1024.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIP HEMOSTATIC RESOLUTION 2.8MM 11MM OPEN 235CM DISPOSABLE STERILE RADIOPAQUE PRELOAD SUP-M00522611 CDM 0270 RC outpatient 450.65 450.65 450.65 74 333.48 percent of total billed charges 450.65 93 365.03 percent of total billed charges 450.65 450.65 other OPPS APC 450.65 450.65 other OPPS APC 450.65 27.63 124.51 percent of total billed charges 450.65 450.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA ERCP CONTOUR TAPER L210 CM OD5 FR BILIARY DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00530860 CDM 0270 RC outpatient 153.71 153.71 153.71 74 113.75 percent of total billed charges 153.71 93 124.51 percent of total billed charges 153.71 153.71 other OPPS APC 153.71 153.71 other OPPS APC 153.71 27.63 42.47 percent of total billed charges 153.71 153.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROKNIFE XL TRIPLE-LUMEN NEEDLE KNIFE SUP-M00532810 CDM 0270 RC outpatient 407.89 407.89 407.89 74 301.84 percent of total billed charges 407.89 93 330.39 percent of total billed charges 407.89 407.89 other OPPS APC 407.89 407.89 other OPPS APC 407.89 27.63 112.7 percent of total billed charges 407.89 407.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY ADVANIX PLASTIC DUODENAL BEND L7 CM OD7 FR DELIVERY SYSTEM RAPID EXCHANGE BARB TO BARB PRELOAD 3.2 MM WORK CHANNEL SUP-M00534210 CDM 0270 RC outpatient 396.24 396.24 396.24 74 293.22 percent of total billed charges 396.24 93 320.95 percent of total billed charges 396.24 396.24 other OPPS APC 396.24 396.24 other OPPS APC 396.24 27.63 109.48 percent of total billed charges 396.24 396.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY ADVANIX PLASTIC DUODENAL BEND L9 CM OD7 FR DELIVERY SYSTEM RAPID EXCHANGE BARB TO BARB PRELOAD 3.2 MM WORK CHANNEL SUP-M00534220 CDM 0270 RC outpatient 396.24 396.24 396.24 74 293.22 percent of total billed charges 396.24 93 320.95 percent of total billed charges 396.24 396.24 other OPPS APC 396.24 396.24 other OPPS APC 396.24 27.63 109.48 percent of total billed charges 396.24 396.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY ADVANIX NAVIFLEX PLASTIC DUODENAL BEND L10 CM OD5 FR PRELOAD TEMPORARY RAPID EXCHANGE ACCEPTS .035 IN GUIDEWIRE SUP-M00534320 CDM 0270 RC outpatient 396.24 396.24 396.24 74 293.22 percent of total billed charges 396.24 93 320.95 percent of total billed charges 396.24 396.24 other OPPS APC 396.24 396.24 other OPPS APC 396.24 27.63 109.48 percent of total billed charges 396.24 396.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY ADVANIX PLASTIC DUODENAL BEND L7 CM OD10 FR DELIVERY SYSTEM RADIOPAQUE PRELOAD RAPID EXCHANGE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00534330 CDM 0270 RC outpatient 396.24 396.24 396.24 74 293.22 percent of total billed charges 396.24 93 320.95 percent of total billed charges 396.24 396.24 other OPPS APC 396.24 396.24 other OPPS APC 396.24 27.63 109.48 percent of total billed charges 396.24 396.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY ADVANIX PLASTIC DUODENAL BEND L9 CM OD10 FR DELIVERY SYSTEM RAPID EXCHANGE BARB TO BARB PRELOAD 4.2 MM WORK CHANNEL SUP-M00534340 CDM 0270 RC outpatient 396.24 396.24 396.24 74 293.22 percent of total billed charges 396.24 93 320.95 percent of total billed charges 396.24 396.24 other OPPS APC 396.24 396.24 other OPPS APC 396.24 27.63 109.48 percent of total billed charges 396.24 396.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY ADVANIX PLASTIC DUODENAL BEND L12 CM OD10 FR DELIVERY SYSTEM RAPID EXCHANGE BARB TO BARB PRELOAD 4.2 MM WORK CHANNEL SUP-M00534350 CDM 0270 RC outpatient 396.24 396.24 396.24 74 293.22 percent of total billed charges 396.24 93 320.95 percent of total billed charges 396.24 396.24 other OPPS APC 396.24 396.24 other OPPS APC 396.24 27.63 109.48 percent of total billed charges 396.24 396.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT PANCREATIC ADVANIX NAVIFLEX POLYMER PIGTAIL CURVE L5 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED NO LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE SUP-M00537410 CDM 0270 RC outpatient 546.52 546.52 546.52 74 404.42 percent of total billed charges 546.52 93 442.68 percent of total billed charges 546.52 546.52 other OPPS APC 546.52 546.52 other OPPS APC 546.52 27.63 151 percent of total billed charges 546.52 546.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT PANCREATIC ADVANIX NAVIFLEX DREAMWIRE SUP-M00537470 CDM 0270 RC outpatient 546.52 546.52 546.52 74 404.42 percent of total billed charges 546.52 93 442.68 percent of total billed charges 546.52 546.52 other OPPS APC 546.52 546.52 other OPPS APC 546.52 27.63 151 percent of total billed charges 546.52 546.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS GRASPING RESCUE L230CM W8MM OD2.4MM RAT TOOTH ALLIGATOR JAW CATHETER COMBO 2.8CM MINIMUM WORKING CHANNEL SUP-M00538351 CDM 0270 RC outpatient 238.71 238.71 238.71 74 176.65 percent of total billed charges 238.71 93 193.36 percent of total billed charges 238.71 238.71 other OPPS APC 238.71 238.71 other OPPS APC 238.71 27.63 65.96 percent of total billed charges 238.71 238.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY FLEXIMA PLASTIC DUODENAL BEND L5 CM OD7 FR TEMPORARY DELIVERY SYSTEM DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00539200 CDM 270009083 LOCAL 0270 RC outpatient 114 114 114 74 84.36 percent of total billed charges 114 93 92.34 percent of total billed charges 114 114 other OPPS APC 114 114 other OPPS APC 114 27.63 31.5 percent of total billed charges 114 114 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY FLEXIMA PLASTIC DUODENAL BEND L7 CM OD7 FR TEMPORARY DELIVERY SYSTEM DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00539210 CDM 0270 RC outpatient 313.33 313.33 313.33 74 231.86 percent of total billed charges 313.33 93 253.8 percent of total billed charges 313.33 313.33 other OPPS APC 313.33 313.33 other OPPS APC 313.33 27.63 86.57 percent of total billed charges 313.33 313.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY FLEXIMA PLASTIC DUODENAL BEND L10 CM OD7 FR TEMPORARY DELIVERY SYSTEM DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00539220 CDM 0270 RC outpatient 310.49 310.49 310.49 74 229.76 percent of total billed charges 310.49 93 251.5 percent of total billed charges 310.49 310.49 other OPPS APC 310.49 310.49 other OPPS APC 310.49 27.63 85.79 percent of total billed charges 310.49 310.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY FLEXIMA PLASTIC L12 CM OD7 FR TEMPORARY DELIVERY SYSTEM DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00539230_158914 CDM 0270 RC outpatient 313.33 313.33 313.33 74 231.86 percent of total billed charges 313.33 93 253.8 percent of total billed charges 313.33 313.33 other OPPS APC 313.33 313.33 other OPPS APC 313.33 27.63 86.57 percent of total billed charges 313.33 313.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY FLEXIMA PLASTIC L15 CM OD7 FR TEMPORARY DELIVERY SYSTEM DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00539240 CDM 0270 RC outpatient 292.92 292.92 292.92 74 216.76 percent of total billed charges 292.92 93 237.27 percent of total billed charges 292.92 292.92 other OPPS APC 292.92 292.92 other OPPS APC 292.92 27.63 80.93 percent of total billed charges 292.92 292.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY FLEXIMA PLASTIC DUODENAL BEND L5 CM OD10 FR TEMPORARY DELIVERY SYSTEM DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00539300 CDM 0270 RC outpatient 310.49 310.49 310.49 74 229.76 percent of total billed charges 310.49 93 251.5 percent of total billed charges 310.49 310.49 other OPPS APC 310.49 310.49 other OPPS APC 310.49 27.63 85.79 percent of total billed charges 310.49 310.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY FLEXIMA PLASTIC DUODENAL BEND L7 CM OD10 FR TEMPORARY DELIVERY SYSTEM DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00539310 CDM 0270 RC outpatient 292.92 292.92 292.92 74 216.76 percent of total billed charges 292.92 93 237.27 percent of total billed charges 292.92 292.92 other OPPS APC 292.92 292.92 other OPPS APC 292.92 27.63 80.93 percent of total billed charges 292.92 292.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY FLEXIMA PLASTIC DUODENAL BEND L10 CM OD10 FR TEMPORARY DELIVERY SYSTEM DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00539320 CDM 0270 RC outpatient 313.33 313.33 313.33 74 231.86 percent of total billed charges 313.33 93 253.8 percent of total billed charges 313.33 313.33 other OPPS APC 313.33 313.33 other OPPS APC 313.33 27.63 86.57 percent of total billed charges 313.33 313.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY FLEXIMA PLASTIC L12 CM OD10 FR TEMPORARY DELIVERY SYSTEM DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00539330 CDM 0270 RC outpatient 313.33 313.33 313.33 74 231.86 percent of total billed charges 313.33 93 253.8 percent of total billed charges 313.33 313.33 other OPPS APC 313.33 313.33 other OPPS APC 313.33 27.63 86.57 percent of total billed charges 313.33 313.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY FLEXIMA PLASTIC L15 CM OD10 FR TEMPORARY DELIVERY SYSTEM DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00539340 CDM 0270 RC outpatient 310.49 310.49 310.49 74 229.76 percent of total billed charges 310.49 93 251.5 percent of total billed charges 310.49 310.49 other OPPS APC 310.49 310.49 other OPPS APC 310.49 27.63 85.79 percent of total billed charges 310.49 310.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIGATOR ENDOSCOPIC SPEEDBAND SUPERVIEW SUPER 7 2.8 MM L2.8 MM OD8.6-11.5 MM ESOPHAGEAL 1 STRING MULTIPLE BAND ERGONOMIC HANDLE AUDIBLE CLICK STERILE LATEX FREE DISPOSABLE HEMOSTASIS SUP-M00542253 CDM 0270 RC outpatient 416.1 416.1 416.1 74 307.91 percent of total billed charges 416.1 93 337.04 percent of total billed charges 416.1 416.1 other OPPS APC 416.1 416.1 other OPPS APC 416.1 27.63 114.97 percent of total billed charges 416.1 416.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DUODENOSCOPE FLEXIBLE EXHALT L1240MM OD 15.1MM ODSEC 11.3MM ID 4.2MM STERILE DISPOSABLE MODEL D SUP-M00542421 CDM 0270 RC outpatient 7618 7618 7618 74 5637.32 percent of total billed charges 7618 93 6170.58 percent of total billed charges 7618 7618 other OPPS APC 7618 7618 other OPPS APC 7618 27.63 2104.85 percent of total billed charges 7618 7618 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTROLLER ENDOSCOPIC CAMERA EXALT SUP-M00542430 CDM 0270 RC outpatient 7618 7618 7618 74 5637.32 percent of total billed charges 7618 93 6170.58 percent of total billed charges 7618 7618 other OPPS APC 7618 7618 other OPPS APC 7618 27.63 2104.85 percent of total billed charges 7618 7618 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRUSH CYTOLOGY COMBO CATH L200 CM X W2.1 MM OD8 FR BILIARY RAPID EXCHANGE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00545000 CDM 0270 RC outpatient 286.55 286.55 286.55 74 212.05 percent of total billed charges 286.55 93 232.11 percent of total billed charges 286.55 286.55 other OPPS APC 286.55 286.55 other OPPS APC 286.55 27.63 79.17 percent of total billed charges 286.55 286.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE LOCKING AUTOCAP RX GUIDEWIRES 0.025 IN AND 0.035 IN OLYMPUS COMPAT FOR ERCP STERILE SUP-M00545101 CDM 0270 RC outpatient 44.07 44.07 44.07 74 32.61 percent of total billed charges 44.07 93 35.7 percent of total billed charges 44.07 44.07 other OPPS APC 44.07 44.07 other OPPS APC 44.07 27.63 12.18 percent of total billed charges 44.07 44.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RX LOCKING DEVICE BX PORT CAP PROTECTOR/SYSTEM SUP-M00545261 CDM 0270 RC outpatient 295.41 295.41 295.41 74 218.6 percent of total billed charges 295.41 93 239.28 percent of total billed charges 295.41 295.41 other OPPS APC 295.41 295.41 other OPPS APC 295.41 27.63 81.62 percent of total billed charges 295.41 295.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CATHETER BALLOON DILATATION HURRICANE 4, 2CM" SUP-M00545890 CDM 0270 RC outpatient 661.1 661.1 661.1 74 489.21 percent of total billed charges 661.1 93 535.49 percent of total billed charges 661.1 661.1 other OPPS APC 661.1 661.1 other OPPS APC 661.1 27.63 182.66 percent of total billed charges 661.1 661.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CATHETER BALLOON DILATATION HURRICANE 10, 2CM" SUP-M00545950 CDM 0270 RC outpatient 667.78 667.78 667.78 74 494.16 percent of total billed charges 667.78 93 540.9 percent of total billed charges 667.78 667.78 other OPPS APC 667.78 667.78 other OPPS APC 667.78 27.63 184.51 percent of total billed charges 667.78 667.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER CHOLANGIOGRAM SPYSCOPE OD10 FR ACCESS DELIVERY DISPOSABLE SUP-M00546230 CDM 0270 RC outpatient 2156.7 2156.7 2156.7 74 1595.96 percent of total billed charges 2156.7 93 1746.93 percent of total billed charges 2156.7 2156.7 other OPPS APC 2156.7 2156.7 other OPPS APC 2156.7 27.63 595.9 percent of total billed charges 2156.7 2156.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS BIOPSY SPYBITE MAX L286 CM OD1.2 MM STERILE LATEX FREE DISPOSABLE SUP-M00546470 CDM 0270 RC outpatient 1592.06 1592.06 1592.06 74 1178.12 percent of total billed charges 1592.06 93 1289.57 percent of total billed charges 1592.06 1592.06 other OPPS APC 1592.06 1592.06 other OPPS APC 1592.06 27.63 439.89 percent of total billed charges 1592.06 1592.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASKET SPECIMEN RETRIEVAL SPYGLASS L286 CM X W15 MM STERILE LATEX FREE DISPOSABLE SUP-M00546550 CDM 0270 RC outpatient 1486.78 1486.78 1486.78 74 1100.22 percent of total billed charges 1486.78 93 1204.29 percent of total billed charges 1486.78 1486.78 other OPPS APC 1486.78 1486.78 other OPPS APC 1486.78 27.63 410.8 percent of total billed charges 1486.78 1486.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SNARE ENDOSCOPIC SPYGLASS L286 CM X W9 MM STERILE LATEX FREE DISPOSABLE SUP-M00546560 CDM 0270 RC outpatient 1575.99 1575.99 1575.99 74 1166.23 percent of total billed charges 1575.99 93 1276.55 percent of total billed charges 1575.99 1575.99 other OPPS APC 1575.99 1575.99 other OPPS APC 1575.99 27.63 435.45 percent of total billed charges 1575.99 1575.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPYSCOPE DS II SUP-M00546610 CDM 0270 RC outpatient 7078.5 7078.5 7078.5 74 5238.09 percent of total billed charges 7078.5 93 5733.59 percent of total billed charges 7078.5 7078.5 other OPPS APC 7078.5 7078.5 other OPPS APC 7078.5 27.63 1955.79 percent of total billed charges 7078.5 7078.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE SPYSCOPE LITHOTRIPTER AUTOLITH L375 CM OD1.9 FR BIPOLAR ELECTROHYDRAULIC STERILE DISPOSABLE BILIARY STONE TREATMENT SUP-M00546620 CDM 0270 RC outpatient 1115.4 1115.4 1115.4 74 825.4 percent of total billed charges 1115.4 93 903.47 percent of total billed charges 1115.4 1115.4 other OPPS APC 1115.4 1115.4 other OPPS APC 1115.4 27.63 308.19 percent of total billed charges 1115.4 1115.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON RETRIEVAL EXTRACTOR PRO RX L200 CM OD6-7 FR ODSEC9-12 MM BILIARY 3 LUMEN ABOVE INJECTION SQUARE SHOULDER STERILE LATEX DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00547000 CDM 0270 RC outpatient 423.2 423.2 423.2 74 313.17 percent of total billed charges 423.2 93 342.79 percent of total billed charges 423.2 423.2 other OPPS APC 423.2 423.2 other OPPS APC 423.2 27.63 116.93 percent of total billed charges 423.2 423.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON RETRIEVAL EXTRACTOR PRO RX L200 CM OD6-7 FR ODSEC12-15 MM BILIARY 3 LUMEN ABOVE INJECTION SQUARE SHOULDER STERILE LATEX DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00547010 CDM 0270 RC outpatient 423.2 423.2 423.2 74 313.17 percent of total billed charges 423.2 93 342.79 percent of total billed charges 423.2 423.2 other OPPS APC 423.2 423.2 other OPPS APC 423.2 27.63 116.93 percent of total billed charges 423.2 423.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON RETRIEVAL EXTRACTOR PRO RX L200 CM OD6-7 FR ODSEC15-18 MM BILIARY 3 LUMEN ABOVE INJECTION SQUARE SHOULDER STERILE LATEX DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00547020 CDM 0270 RC outpatient 423.2 423.2 423.2 74 313.17 percent of total billed charges 423.2 93 342.79 percent of total billed charges 423.2 423.2 other OPPS APC 423.2 423.2 other OPPS APC 423.2 27.63 116.93 percent of total billed charges 423.2 423.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON RETRIEVAL EXTRACTOR PRO XL 200CM 6-7FR 9-12MM DISPOSABLE STERILE LATEX BILIARY 3 LUMEN ABOVE INJECTION SQUARE SUP-M00547100 CDM 0270 RC outpatient 271.28 271.28 271.28 74 200.75 percent of total billed charges 271.28 93 219.74 percent of total billed charges 271.28 271.28 other OPPS APC 271.28 271.28 other OPPS APC 271.28 27.63 74.95 percent of total billed charges 271.28 271.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON RETRIEVAL EXTRACTOR PRO XL 12-15MM SUP-M00547110 CDM 0270 RC outpatient 271.28 271.28 271.28 74 200.75 percent of total billed charges 271.28 93 219.74 percent of total billed charges 271.28 271.28 other OPPS APC 271.28 271.28 other OPPS APC 271.28 27.63 74.95 percent of total billed charges 271.28 271.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SPECIMEN RETRIEVAL EXTRACTOR PRO XL 7-6FR 12-15MM 200CM BILIARY 3 LUMEN RAPID SUP-M00547110 CDM 0275 RC outpatient 2600 2600 2600 57 1482 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON RETRIEVAL EXTRACTOR PRO XL 200CM 6-7FR 9-12MM DISPOSABLE STERILE LATEX BILIARY 3 LUMEN BELOW INJECTION SQUARE SUP-M00547130 CDM 0270 RC outpatient 268.94 268.94 268.94 74 199.02 percent of total billed charges 268.94 93 217.84 percent of total billed charges 268.94 268.94 other OPPS APC 268.94 268.94 other OPPS APC 268.94 27.63 74.31 percent of total billed charges 268.94 268.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON RETRIEVAL EXTRACTOR PRO XL 200CM 6-7FR 12-15MM DISPOSABLE STERILE LATEX BILIARY 3 LUMEN BELOW INJECTION SQUARE SUP-M00547140 CDM 0270 RC outpatient 268.94 268.94 268.94 74 199.02 percent of total billed charges 268.94 93 217.84 percent of total billed charges 268.94 268.94 other OPPS APC 268.94 268.94 other OPPS APC 268.94 27.63 74.31 percent of total billed charges 268.94 268.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON CRE PULMONARY SUP-M00550310 CDM 0270 RC outpatient 923.86 923.86 923.86 74 683.66 percent of total billed charges 923.86 93 748.33 percent of total billed charges 923.86 923.86 other OPPS APC 923.86 923.86 other OPPS APC 923.86 27.63 255.26 percent of total billed charges 923.86 923.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR ENDOSCOPIC CRE L3 CM L75 CM OD8-9-10 MM PULMONARY BALLOON RADIOPAQUE RECTILINEAR SHOULDER STERILE DISPOSABLE ACCEPTS .035 IN JAGWIRE SUP-M00550330 CDM 0270 RC outpatient 863.72 863.72 863.72 74 639.15 percent of total billed charges 863.72 93 699.61 percent of total billed charges 863.72 863.72 other OPPS APC 863.72 863.72 other OPPS APC 863.72 27.63 238.65 percent of total billed charges 863.72 863.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR ENDOSCOPIC CRE L3 CM L75 CM OD10-11-12 MM PULMONARY BALLOON RADIOPAQUE RECTILINEAR SHOULDER STERILE DISPOSABLE ACCEPTS .035 IN JAGWIRE SUP-M00550340 CDM 0270 RC outpatient 923.86 923.86 923.86 74 683.66 percent of total billed charges 923.86 93 748.33 percent of total billed charges 923.86 923.86 other OPPS APC 923.86 923.86 other OPPS APC 923.86 27.63 255.26 percent of total billed charges 923.86 923.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR ENDOSCOPIC CRE L75 CM L3 CM OD12-15 MM PULMONARY BALLOON RADIOPAQUE STERILE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00550350 CDM 0270 RC outpatient 923.86 923.86 923.86 74 683.66 percent of total billed charges 923.86 93 748.33 percent of total billed charges 923.86 923.86 other OPPS APC 923.86 923.86 other OPPS APC 923.86 27.63 255.26 percent of total billed charges 923.86 923.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ERCP BALLOON RETRIEVAL EXTRACTOR XL 11.5 MM SUP-M00550460 CDM 0270 RC outpatient 299 299 299 74 221.26 percent of total billed charges 299 93 242.19 percent of total billed charges 299 299 other OPPS APC 299 299 other OPPS APC 299 27.63 82.61 percent of total billed charges 299 299 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE INFLATION CRE STERI-FLATE DISPOSABLE SUP-M00550630 CDM outpatient 119.78 119.78 119.78 74 88.64 percent of total billed charges 119.78 27.63 33.1 percent of total billed charges 119.78 119.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE INFLATION CRE STERI-FLATE DISPOSABLE SUP-M00550630 CDM 0270 RC outpatient 119.78 119.78 119.78 74 88.64 percent of total billed charges 119.78 27.63 33.1 percent of total billed charges 119.78 119.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE INFLATION CRE STERI-FLATE DISPOSABLE SUP-M00550630 CDM outpatient 119.78 119.78 119.78 93 97.02 percent of total billed charges 119.78 119.78 other OPPS APC 119.78 119.78 other OPPS APC 119.78 119.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE INFLATION CRE STERI-FLATE DISPOSABLE SUP-M00550630 CDM 0270 RC outpatient 119.78 119.78 119.78 93 97.02 percent of total billed charges 119.78 119.78 other OPPS APC 119.78 119.78 other OPPS APC 119.78 119.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION RIGIFLEX II L90 CM L10 CM OD14 FR ODSEC30 MM RADIOPAQUE STERILE LATEX FREE DISPOSABLE ACCEPTS .038 IN GUIDEWIRE SUP-M00554500 CDM 0270 RC outpatient 2051.4 2051.4 2051.4 74 1518.04 percent of total billed charges 2051.4 93 1661.63 percent of total billed charges 2051.4 2051.4 other OPPS APC 2051.4 2051.4 other OPPS APC 2051.4 27.63 566.8 percent of total billed charges 2051.4 2051.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION RIGIFLEX II L90 CM L10 CM OD14 FR ODSEC35 MM RADIOPAQUE STERILE LATEX FREE DISPOSABLE ACCEPTS .038 IN GUIDEWIRE ACHALASIA SUP-M00554510 CDM 0270 RC outpatient 2051.4 2051.4 2051.4 74 1518.04 percent of total billed charges 2051.4 93 1661.63 percent of total billed charges 2051.4 2051.4 other OPPS APC 2051.4 2051.4 other OPPS APC 2051.4 27.63 566.8 percent of total billed charges 2051.4 2051.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION RIGIFLEX II L90 CM L10 CM OD14 FR ODSEC40 MM RADIOPAQUE STERILE LATEX FREE DISPOSABLE ACCEPTS .038 IN GUIDEWIRE ACHALASIA SUP-M00554520 CDM 0270 RC outpatient 2051.4 2051.4 2051.4 74 1518.04 percent of total billed charges 2051.4 93 1661.63 percent of total billed charges 2051.4 2051.4 other OPPS APC 2051.4 2051.4 other OPPS APC 2051.4 27.63 566.8 percent of total billed charges 2051.4 2051.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ASPIRATION EXPECT SLIMLINE 8- CM 137.5-141.5CM 22GA 1.83MM 20CC COCR ECHOGENIC PATTERN ULTRASOUND STYLET CAP 2.4 SUP-M00555510 CDM 0270 RC outpatient 643.24 643.24 643.24 74 476 percent of total billed charges 643.24 93 521.02 percent of total billed charges 643.24 643.24 other OPPS APC 643.24 643.24 other OPPS APC 643.24 27.63 177.73 percent of total billed charges 643.24 643.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ENDOSCOPIC EXPECT SLIMLINE NITINOL L8- CM L2.8 MM OD25 GA ODSEC1.83 MM 20 ML BEVEL 1 WAY STOPCOCK ASPIRATION SLIMLINE HANDLE SUP-M00555520 CDM 0270 RC outpatient 643.24 643.24 643.24 74 476 percent of total billed charges 643.24 93 521.02 percent of total billed charges 643.24 643.24 other OPPS APC 643.24 643.24 other OPPS APC 643.24 27.63 177.73 percent of total billed charges 643.24 643.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ASPIRATION EXPECT SLIMLINE 8- CM 137.5-141.5CM 19GA 1.73MM 20CC COCR ECHOGENIC PATTERN ULTRASOUND STYLET CAP 2.8 SUP-M00555530 CDM 0270 RC outpatient 1207.83 1207.83 1207.83 74 893.79 percent of total billed charges 1207.83 93 978.34 percent of total billed charges 1207.83 1207.83 other OPPS APC 1207.83 1207.83 other OPPS APC 1207.83 27.63 333.72 percent of total billed charges 1207.83 1207.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ASPIRATION 22GA 0-8CML F/ENDOSCOPIC ULTRASOUND ACQUIRE LATEX-FREE NON-RADIOLUCENT SUP-M00555540 CDM 0270 RC outpatient 1115.09 1115.09 1115.09 74 825.17 percent of total billed charges 1115.09 93 903.22 percent of total billed charges 1115.09 1115.09 other OPPS APC 1115.09 1115.09 other OPPS APC 1115.09 27.63 308.1 percent of total billed charges 1115.09 1115.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE BIOPSY ACQUIRE OD25 GA ENDOSCOPIC ULTRASOUND FINE NEEDLE STERILE DISPOSABLE SUP-M00555560 CDM 0270 RC outpatient 1105.03 1105.03 1105.03 74 817.72 percent of total billed charges 1105.03 93 895.07 percent of total billed charges 1105.03 1105.03 other OPPS APC 1105.03 1105.03 other OPPS APC 1105.03 27.63 305.32 percent of total billed charges 1105.03 1105.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 19GA ACQUIRE NEEDLE SUP-M00555580 CDM 0270 RC outpatient 1515.8 1515.8 1515.8 74 1121.69 percent of total billed charges 1515.8 93 1227.8 percent of total billed charges 1515.8 1515.8 other OPPS APC 1515.8 1515.8 other OPPS APC 1515.8 27.63 418.82 percent of total billed charges 1515.8 1515.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ENDOSCOPIC HYDRA JAGWIRE PTFE HYDROPHILIC STRAIGHT L450 CM OD.035 IN BILIARY HIGH PERFORMANCE RAPID EXCHANGE RADIOPAQUE DISTAL STERILE DISPOSABLE SUP-M00556041 CDM 0270 RC outpatient 512.82 512.82 512.82 74 379.49 percent of total billed charges 512.82 93 415.38 percent of total billed charges 512.82 512.82 other OPPS APC 512.82 512.82 other OPPS APC 512.82 27.63 141.69 percent of total billed charges 512.82 512.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ENDOSCOPIC JAGWIRE REVOLUTION 0.025IN 260CM BILIARY ANGLED ROUND TIP F/CANNULATION DUCT NITINOL TUNGSTEN HYDROPHILIC EA SUP-M00557010 CDM 0270 RC outpatient 512.82 512.82 512.82 74 379.49 percent of total billed charges 512.82 93 415.38 percent of total billed charges 512.82 512.82 other OPPS APC 512.82 512.82 other OPPS APC 512.82 27.63 141.69 percent of total billed charges 512.82 512.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ENDOSCOPIC JAGWIRE REVOLUTION 0.025IN 260CM BILIARY ANGLED ROUND TIP F/CANNULATION DUCT NITINOL TUNGSTEN HYDROPHILIC 2/BX SUP-M00557011 CDM 0270 RC outpatient 512.82 512.82 512.82 74 379.49 percent of total billed charges 512.82 93 415.38 percent of total billed charges 512.82 512.82 other OPPS APC 512.82 512.82 other OPPS APC 512.82 27.63 141.69 percent of total billed charges 512.82 512.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR ENDOSCOPIC CRE PEBAX 2.8 MM L180 CM L8 CM OD6-7-8 MM ODSEC6 FR ESOPHAGEAL BALLOON LOW PROFILE FIX WIRE STERILE LATEX FREE DISPOSABLE SUP-M00558330 CDM outpatient 419.8 419.8 419.8 419.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR ENDOSCOPIC CRE PEBAX 2.8 MM L180 CM L8 CM OD8-9-10 MM ODSEC6 FR ESOPHAGEAL BALLOON LOW PROFILE FIX WIRE STERILE LATEX FREE DISPOSABLE SUP-M00558340 CDM outpatient 419.8 419.8 419.8 419.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR ENDOSCOPIC CRE PEBAX 2.8 MM L180 CM L8 CM OD10-11-12 MM ODSEC6 FR ESOPHAGEAL BALLOON LOW PROFILE FIX WIRE STERILE LATEX FREE DISPOSABLE SUP-M00558350 CDM outpatient 419.8 419.8 419.8 419.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR ENDOSCOPIC CRE PEBAX L180 CM L8 CM OD6 FR ODSEC12-13.5-15 MM ESOPHAGEAL FIX WIRE BALLOON ROUND SHOULDER STERILE LATEX FREE DISPOSABLE SUP-M00558360 CDM outpatient 427.6 427.6 427.6 427.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR ENDOSCOPIC CRE PEBAX 2.8 MM L180 CM L8 CM OD18-19-20 MM ODSEC6 FR ESOPHAGEAL BALLOON LOW PROFILE FIX WIRE STERILE LATEX FREE DISPOSABLE SUP-M00558380 CDM outpatient 427.6 427.6 427.6 427.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRE PRO CATHETER BALLOON DILATATION CRE PEBAX 2.8 MM 3.2 MM L240 CM L5.5 CM OD6-7-8 MM ESOPHAGEAL PYLORIC BILIARY LOW PROFILE RADIOPACQUE GUIDEWIRE SUP-M00558660 CDM 0270 RC outpatient 622.73 622.73 622.73 74 460.82 percent of total billed charges 622.73 93 504.41 percent of total billed charges 622.73 622.73 other OPPS APC 622.73 622.73 other OPPS APC 622.73 27.63 172.06 percent of total billed charges 622.73 622.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRE PRO DILATOR ENDOSCOPIC CRE PEBAX 2.8 MM 3.2 MM L240 CM L5.5 CM OD8-9-10 MM ODSEC7.5 FR ESOPHAGEAL PYLORIC BILIARY BALLOON LOW PROFILE GUIDEWIRE STERILE LATEX FREE DISPOSABLE SUP-M00558670 CDM 0270 RC outpatient 622.73 622.73 622.73 74 460.82 percent of total billed charges 622.73 93 504.41 percent of total billed charges 622.73 622.73 other OPPS APC 622.73 622.73 other OPPS APC 622.73 27.63 172.06 percent of total billed charges 622.73 622.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRE PRO CATHETER BALLOON DILATATION CRE PEBAX 2.8 MM 3.2 MM L240 CM L5.5 CM OD10-11-12 MM ODSEC7.5 FR ESOPHAGEAL PYLORIC BILIARY LOW PROFILE GUIDEWIRE STERILE LATEX FREE DISPOSABLE SUP-M00558680 CDM 0270 RC outpatient 622.73 622.73 622.73 74 460.82 percent of total billed charges 622.73 93 504.41 percent of total billed charges 622.73 622.73 other OPPS APC 622.73 622.73 other OPPS APC 622.73 27.63 172.06 percent of total billed charges 622.73 622.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRE PRO CATHETER BALLOON DILATATION CRE PEBAX 2.8 MM 3.2 MM L240 CM L5.5 CM OD11-13.5-15 MM ODSEC7.5 FR ESOPHAGEAL PYLORIC BILIARY BALLOON LOW PROFILE GUIDEWIRE STERILE LATEX FREE DISPOSABLE SUP-M00558690 CDM 0270 RC outpatient 622.73 622.73 622.73 74 460.82 percent of total billed charges 622.73 93 504.41 percent of total billed charges 622.73 622.73 other OPPS APC 622.73 622.73 other OPPS APC 622.73 27.63 172.06 percent of total billed charges 622.73 622.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRE PRO CATHETER BALLOON DILATION CRE PEBAX L240 CM L5.5 CM OD15-16.5-18 MM ODSEC7.5 FR ESOPHAGEAL PYLORIC BILIARY BALLOON LOW PROFILE GUIDEWIRE STERILE LATEX FREE DISPOSABLE SUP-M00558700 CDM outpatient 889.41 889.41 622.73 74 460.82 percent of total billed charges 622.73 93 504.41 percent of total billed charges 622.73 889.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRE PRO CATHETER BALLOON DILATION CRE PEBAX L240 CM L5.5 CM OD15-16.5-18 MM ODSEC7.5 FR ESOPHAGEAL PYLORIC BILIARY BALLOON LOW PROFILE GUIDEWIRE STERILE LATEX FREE DISPOSABLE SUP-M00558700 CDM 0270 RC outpatient 622.73 622.73 622.73 74 460.82 percent of total billed charges 622.73 93 504.41 percent of total billed charges 622.73 622.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRE PRO CATHETER BALLOON DILATION CRE PEBAX L240 CM L5.5 CM OD15-16.5-18 MM ODSEC7.5 FR ESOPHAGEAL PYLORIC BILIARY BALLOON LOW PROFILE GUIDEWIRE STERILE LATEX FREE DISPOSABLE SUP-M00558700 CDM outpatient 622.73 622.73 622.73 74 460.82 percent of total billed charges 622.73 93 504.41 percent of total billed charges 622.73 622.73 other OPPS APC 622.73 622.73 other OPPS APC 622.73 27.63 172.06 percent of total billed charges 622.73 622.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRE PRO CATHETER BALLOON DILATION CRE PEBAX L240 CM L5.5 CM OD15-16.5-18 MM ODSEC7.5 FR ESOPHAGEAL PYLORIC BILIARY BALLOON LOW PROFILE GUIDEWIRE STERILE LATEX FREE DISPOSABLE SUP-M00558700 CDM 0270 RC outpatient 622.73 622.73 622.73 74 460.82 percent of total billed charges 622.73 93 504.41 percent of total billed charges 622.73 622.73 other OPPS APC 622.73 622.73 other OPPS APC 622.73 27.63 172.06 percent of total billed charges 622.73 622.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRE PRO DILATOR ENDOSCOPIC CRE PEBAX 2.8 MM 3.2 MM 3.7 MM 4.2 MM L240 CM L5.5 CM OD18-19-20 MM ODSEC7.5 FR ESOPHAGEAL PYLORIC BILIARY BALLOON LOW PROFILE GUIDEWIRE STERILE LATEX FREE DISPOSABLE SUP-M00558710 CDM 0270 RC outpatient 622.73 622.73 622.73 74 460.82 percent of total billed charges 622.73 93 504.41 percent of total billed charges 622.73 622.73 other OPPS APC 622.73 622.73 other OPPS APC 622.73 27.63 172.06 percent of total billed charges 622.73 622.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION CRE L5.5 CM L6-7-8 MM ODSEC18-21-24 FR BILIARY MULTILUMEN RADIOPAQUE STERILE ACCEPTS .035 IN GUIDEWIRE SUP-M00558860 CDM 0270 RC outpatient 813.02 813.02 813.02 74 601.63 percent of total billed charges 813.02 93 658.55 percent of total billed charges 813.02 813.02 other OPPS APC 813.02 813.02 other OPPS APC 813.02 27.63 224.64 percent of total billed charges 813.02 813.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION CRE PEBAX ADULT L5.5 CM OD8-9-10 MM RAPID EXCHANGE RADIOPAGUE SUP-M00558870 CDM 0270 RC outpatient 813.02 813.02 813.02 74 601.63 percent of total billed charges 813.02 93 658.55 percent of total billed charges 813.02 813.02 other OPPS APC 813.02 813.02 other OPPS APC 813.02 27.63 224.64 percent of total billed charges 813.02 813.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION CRE RX L5.5 CM ODSEC10-11-12 MM BILIARY MULTILUMEN RADIOPAQUE STERILE ACCEPTS .035 IN GUIDEWIRE SUP-M00558880 CDM 0270 RC outpatient 813.02 813.02 813.02 74 601.63 percent of total billed charges 813.02 93 658.55 percent of total billed charges 813.02 813.02 other OPPS APC 813.02 813.02 other OPPS APC 813.02 27.63 224.64 percent of total billed charges 813.02 813.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION CRE RX L5.5 CM ODSEC12-13.5-15 MM BILIARY MULTILUMEN RADIOPAQUE STERILE ACCEPTS .035 IN GUIDEWIRE SUP-M00558890 CDM 0270 RC outpatient 813.02 813.02 813.02 74 601.63 percent of total billed charges 813.02 93 658.55 percent of total billed charges 813.02 813.02 other OPPS APC 813.02 813.02 other OPPS APC 813.02 27.63 224.64 percent of total billed charges 813.02 813.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION CRE PEBAX ADULT 3.7 MM L180 CM L5.5 CM ODSEC15/16.5/18 MM BILIARY RAPID EXCHANGE RADIOPAQUE ROUND BALLOON SHOULDER SUP-M00558900 CDM 0270 RC outpatient 813.02 813.02 813.02 74 601.63 percent of total billed charges 813.02 93 658.55 percent of total billed charges 813.02 813.02 other OPPS APC 813.02 813.02 other OPPS APC 813.02 27.63 224.64 percent of total billed charges 813.02 813.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION CRE PEBAX ADULT 3.7 MM L180 CM L5.5 CM ODSEC18/19/20 MM BILIARY RAPID EXCHANGE RADIOPAQUE ROUND BALLOON SHOULDER SUP-M00558910 CDM 0270 RC outpatient 813.02 813.02 813.02 74 601.63 percent of total billed charges 813.02 93 658.55 percent of total billed charges 813.02 813.02 other OPPS APC 813.02 813.02 other OPPS APC 813.02 27.63 224.64 percent of total billed charges 813.02 813.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROHEMOSTASIS GOLD PROBE HEMOGLIDE L300 CM OD10 FR BIPOLAR STANDARD PLUG CONNECTOR STERILE DISPOSABLE SUP-M00560101 CDM 0270 RC outpatient 350.51 350.51 350.51 74 259.38 percent of total billed charges 350.51 93 283.91 percent of total billed charges 350.51 350.51 other OPPS APC 350.51 350.51 other OPPS APC 350.51 27.63 96.85 percent of total billed charges 350.51 350.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SNARE SURGICAL ROUND OD20 MM COLD SUP-M00561102 CDM 0270 RC outpatient 48.23 48.23 48.23 74 35.69 percent of total billed charges 48.23 93 39.07 percent of total billed charges 48.23 48.23 other OPPS APC 48.23 48.23 other OPPS APC 48.23 27.63 13.33 percent of total billed charges 48.23 48.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SNARE ENDOSCOPIC JUMBO LARGE OVAL MEDIUM STIFF DISPOSABLE OLYMPUS SUP-M00561311 CDM 0270 RC outpatient 47.67 47.67 47.67 74 35.28 percent of total billed charges 47.67 93 38.61 percent of total billed charges 47.67 47.67 other OPPS APC 47.67 47.67 other OPPS APC 47.67 27.63 13.17 percent of total billed charges 47.67 47.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SNARE ENDOSCOPIC CAPTIFLEX MICRO OVAL L240 CM OD2.4 MM ODSEC13 MM FLEXIBLE STERILE DISPOSABLE POLYPECTOMY SUP-M00562422 CDM 0270 RC outpatient 26.24 26.24 26.24 74 19.42 percent of total billed charges 26.24 93 21.25 percent of total billed charges 26.24 26.24 other OPPS APC 26.24 26.24 other OPPS APC 26.24 27.63 7.25 percent of total billed charges 26.24 26.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SNARE ENDOSCOPIC CAPTIFLEX XS OVAL L240 CM W11 MM OD2.4 MM LOOP FLEXIBLE BRAID WIRE HOT COLD INDICATION STERILE DISPOSABLE POLYPECTOMY SUP-M00562471 CDM 0270 RC outpatient 36.41 36.41 36.41 74 26.94 percent of total billed charges 36.41 93 29.49 percent of total billed charges 36.41 36.41 other OPPS APC 36.41 36.41 other OPPS APC 36.41 27.63 10.06 percent of total billed charges 36.41 36.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ASPIRATION EXCELON L15 MM L130 CM OD19 GA ODSEC1.8 MM TRANSBRONCHIAL 1 HAND LOCK ERGONOMIC HANDLE STERILE DISPOSABLE SUP-M00564101 CDM 0270 RC outpatient 229.25 229.25 229.25 74 169.65 percent of total billed charges 229.25 93 185.69 percent of total billed charges 229.25 229.25 other OPPS APC 229.25 229.25 other OPPS APC 229.25 27.63 63.34 percent of total billed charges 229.25 229.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ASPIRATION EXCELON 15MM 130CM 21GA 1.8MM 20ML DISPOSABLE TRANSBRONCHIAL SYRINGE LOCK ERGONOMIC HANDLE CATHETER SUP-M00564121 CDM 0270 RC outpatient 245.21 245.21 245.21 74 181.46 percent of total billed charges 245.21 93 198.62 percent of total billed charges 245.21 245.21 other OPPS APC 245.21 245.21 other OPPS APC 245.21 27.63 67.75 percent of total billed charges 245.21 245.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT DUODENAL WALLFLEX NITINOL L270 CM L6 CM L230 CM OD22-27 MM ODSEC10 FR DELIVERY SYSTEM CATHETER FLEXIBLE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00565010 CDM 0270 RC outpatient 7118.38 7118.38 7118.38 74 5267.6 percent of total billed charges 7118.38 93 5765.89 percent of total billed charges 7118.38 7118.38 other OPPS APC 7118.38 7118.38 other OPPS APC 7118.38 27.63 1966.81 percent of total billed charges 7118.38 7118.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT DUODENAL WALLFLEX NITINOL L9 CM L230 CM OD22-27 MM ODSEC10 FR DELIVERY SYSTEM CATHETER FLEXIBLE STERILE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00565020 CDM 0270 RC outpatient 6654.99 6654.99 6654.99 74 4924.69 percent of total billed charges 6654.99 93 5390.54 percent of total billed charges 6654.99 6654.99 other OPPS APC 6654.99 6654.99 other OPPS APC 6654.99 27.63 1838.77 percent of total billed charges 6654.99 6654.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT COLONIC WALLFLEX NITINOL L230 CM L90 CM L270 CM OD25-30 MM ODSEC10 FR DELIVERY SYSTEM STERILE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00565050 CDM 0270 RC outpatient 6654.99 6654.99 6654.99 74 4924.69 percent of total billed charges 6654.99 93 5390.54 percent of total billed charges 6654.99 6654.99 other OPPS APC 6654.99 6654.99 other OPPS APC 6654.99 27.63 1838.77 percent of total billed charges 6654.99 6654.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT COLONIC WALLFLEX NITINOL L270 CM L12 CM L230 CM OD25-30 MM ODSEC10 FR DELIVERY SYSTEM STERILE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00565060 CDM 0270 RC outpatient 6654.99 6654.99 6654.99 74 4924.69 percent of total billed charges 6654.99 93 5390.54 percent of total billed charges 6654.99 6654.99 other OPPS APC 6654.99 6654.99 other OPPS APC 6654.99 27.63 1838.77 percent of total billed charges 6654.99 6654.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PEG ENDOVIVE SAFETYGLIDE CHLORAPREP XYLOCAINE SILICONE 11 L1 1/2 IN OD20 FR ODSEC22 GA PUSH METHOD AMPULE 2 EXTERNAL BOLSTER SPRING LOAD BLADE STERILE LATEX FREE DISPOSABLE SUP-M00566471 CDM 0270 RC outpatient 281.66 281.66 281.66 74 208.43 percent of total billed charges 281.66 93 228.14 percent of total billed charges 281.66 281.66 other OPPS APC 281.66 281.66 other OPPS APC 281.66 27.63 77.82 percent of total billed charges 281.66 281.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PEG ENDOVIVE SILICONE STANDARD UNIVERSAL OD20 FR 5 ML PULL FENESTRATE DRAPE CLAMP STERILE DISPOSABLE ENTERAL ACCESS DEVICE SUP-M00568201 CDM 0270 RC outpatient 194.14 194.14 194.14 74 143.66 percent of total billed charges 194.14 93 157.25 percent of total billed charges 194.14 194.14 other OPPS APC 194.14 194.14 other OPPS APC 194.14 27.63 53.64 percent of total billed charges 194.14 194.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY WALLFLEX PERMALUME L194 CM L40 MM OD10 MM ODSEC8.5 FR RAPID EXCHANGE FULL COVER ACCEPTS .035 IN GUIDEWIRE SUP-M00570360 CDM 0270 RC outpatient 7591.95 7591.95 7591.95 74 5618.04 percent of total billed charges 7591.95 93 6149.48 percent of total billed charges 7591.95 7591.95 other OPPS APC 7591.95 7591.95 other OPPS APC 7591.95 27.63 2097.66 percent of total billed charges 7591.95 7591.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY WALLFLEX PERMALUME L60 MM OD10 MM ODSEC8.5 FR RAPID EXCHANGE SELF EXPAND ACCEPTS .035 IN GUIDEWIRE SUP-M00570370 CDM 0270 RC outpatient 7523.57 7523.57 7523.57 74 5567.44 percent of total billed charges 7523.57 93 6094.09 percent of total billed charges 7523.57 7523.57 other OPPS APC 7523.57 7523.57 other OPPS APC 7523.57 27.63 2078.76 percent of total billed charges 7523.57 7523.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY WALLFLEX PERMALUME METAL .035 IN L80 MM L94 CM OD10 MM ODSEC8.5 FR GUIDEWIRE CATHETER FULL COVER TRANSHEPATIC ACCEPTS 9 FR SHEATH SUP-M00570380 CDM 0270 RC outpatient 7097.71 7097.71 7097.71 74 5252.31 percent of total billed charges 7097.71 93 5749.15 percent of total billed charges 7097.71 7097.71 other OPPS APC 7097.71 7097.71 other OPPS APC 7097.71 27.63 1961.1 percent of total billed charges 7097.71 7097.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY WALLFLEX METAL L60 MM OD10 MM ODSEC8 FR UNCOVER RAPID EXCHANGE DELIVERY SYSTEM SELF EXPAND ACCEPTS .035 IN GUIDEWIRE SUP-M00570640 CDM 0270 RC outpatient 4503.98 4503.98 4503.98 74 3332.95 percent of total billed charges 4503.98 93 3648.22 percent of total billed charges 4503.98 4503.98 other OPPS APC 4503.98 4503.98 other OPPS APC 4503.98 27.63 1244.45 percent of total billed charges 4503.98 4503.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY WALLFLEX L80 MM OD10 MM ODSEC8 FR RAPID EXCHANGE DELIVERY SYSTEM ACCEPTS .035 IN GUIDEWIRE SUP-M00570650 CDM 0270 RC outpatient 4817.62 4817.62 4817.62 74 3565.04 percent of total billed charges 4817.62 93 3902.27 percent of total billed charges 4817.62 4817.62 other OPPS APC 4817.62 4817.62 other OPPS APC 4817.62 27.63 1331.11 percent of total billed charges 4817.62 4817.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY WALLFLEX PERMALUME .035 IN L60 MM L3.2 MM OD10 MM ODSEC8.5 FR FLUOROSCOPY MARKER RAPID EXCHANGE PARTIAL COVER CATHETER SUP-M00570730 CDM 0270 RC outpatient 7123.32 7123.32 7123.32 74 5271.26 percent of total billed charges 7123.32 93 5769.89 percent of total billed charges 7123.32 7123.32 other OPPS APC 7123.32 7123.32 other OPPS APC 7123.32 27.63 1968.17 percent of total billed charges 7123.32 7123.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY WALLFLEX PERMALUME PLATINOL METAL L80 MM L68 MM OD10 MM ODSEC8.5 FR RAPID EXCHANGE PARTIAL COVER DELIVERY SYSTEM ACCEPTS .035 IN DREAMWIRE SUP-M00570740 CDM 0270 RC outpatient 7123.32 7123.32 7123.32 74 5271.26 percent of total billed charges 7123.32 93 5769.89 percent of total billed charges 7123.32 7123.32 other OPPS APC 7123.32 7123.32 other OPPS APC 7123.32 27.63 1968.17 percent of total billed charges 7123.32 7123.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY WALLFLEX .035 IN L40 MM OD10 MM ODSEC8.5 FR RAPID EXCHANGE SUP-M00570890 CDM 0270 RC outpatient 4817.62 4817.62 4817.62 74 3565.04 percent of total billed charges 4817.62 93 3902.27 percent of total billed charges 4817.62 4817.62 other OPPS APC 4817.62 4817.62 other OPPS APC 4817.62 27.63 1331.11 percent of total billed charges 4817.62 4817.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL ULTRAFLEX OD4.1 MM L40 MM OD10 MM ODSEC15 FR PROXIMAL RELEASE AIRWAY STERILE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00576440 CDM 0270 RC outpatient 6206.43 6206.43 6206.43 74 4592.76 percent of total billed charges 6206.43 93 5027.21 percent of total billed charges 6206.43 6206.43 other OPPS APC 6206.43 6206.43 other OPPS APC 6206.43 27.63 1714.84 percent of total billed charges 6206.43 6206.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL ULTRAFLEX OD4.1 MM L40 MM OD12 MM ODSEC17 FR PROXIMAL RELEASE AIRWAY STERILE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00576460 CDM 0270 RC outpatient 6206.43 6206.43 6206.43 74 4592.76 percent of total billed charges 6206.43 93 5027.21 percent of total billed charges 6206.43 6206.43 other OPPS APC 6206.43 6206.43 other OPPS APC 6206.43 27.63 1714.84 percent of total billed charges 6206.43 6206.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL ULTRAFLEX OD4.1 MM L40 MM L180 MM OD14 MM ODSEC18 FR UNCOVER PROXIMAL RELEASE AIRWAY STERILE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE SUP-M00576480 CDM 0270 RC outpatient 6206.43 6206.43 6206.43 74 4592.76 percent of total billed charges 6206.43 93 5027.21 percent of total billed charges 6206.43 6206.43 other OPPS APC 6206.43 6206.43 other OPPS APC 6206.43 27.63 1714.84 percent of total billed charges 6206.43 6206.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL ULTRAFLEX NITINOL SILICONE OD4 MM L30 MM L15 MM OD10 MM ODSEC18 FR FLEXIBLE OPEN LOOP RADIOPAQUE LOW PROFILE KNIT STERILE DISPOSABLE ACCEPTS .035 IN PULMONARY JAGWIRE SUP-M00576530 CDM 0270 RC outpatient 7915.05 7915.05 7915.05 74 5857.14 percent of total billed charges 7915.05 93 6411.19 percent of total billed charges 7915.05 7915.05 other OPPS APC 7915.05 7915.05 other OPPS APC 7915.05 27.63 2186.93 percent of total billed charges 7915.05 7915.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL ULTRAFLEX NITINOL SILICONE L95 CM OD4 MM L40 MM L25 MM OD10 MM ODSEC18 FR FLEXIBLE OPEN LOOP RADIOPAQUE LOW PROFILE KNIT STERILE DISPOSABLE ACCEPTS .035 IN PULMONARY JAGWIRE SUP-M00576540 CDM 0270 RC outpatient 7915.05 7915.05 7915.05 74 5857.14 percent of total billed charges 7915.05 93 6411.19 percent of total billed charges 7915.05 7915.05 other OPPS APC 7915.05 7915.05 other OPPS APC 7915.05 27.63 2186.93 percent of total billed charges 7915.05 7915.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL ULTRAFLEX NITINOL SILICONE L95 CM OD4 MM L30 MM L15 MM OD12 MM ODSEC20 FR FLEXIBLE OPEN LOOP RADIOPAQUE LOW PROFILE KNIT STERILE DISPOSABLE ACCEPTS .035 IN PULMONARY JAGWIRE SUP-M00576550 CDM 0270 RC outpatient 7915.05 7915.05 7915.05 74 5857.14 percent of total billed charges 7915.05 93 6411.19 percent of total billed charges 7915.05 7915.05 other OPPS APC 7915.05 7915.05 other OPPS APC 7915.05 27.63 2186.93 percent of total billed charges 7915.05 7915.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL ULTRAFLEX NITINOL SILICONE L95 CM OD4 MM L40 MM L25 MM OD12 MM ODSEC20 FR FLEXIBLE OPEN LOOP RADIOPAQUE LOW PROFILE KNIT STERILE DISPOSABLE ACCEPTS .035 IN PULMONARY JAGWIRE SUP-M00576560 CDM 0270 RC outpatient 7915.05 7915.05 7915.05 74 5857.14 percent of total billed charges 7915.05 93 6411.19 percent of total billed charges 7915.05 7915.05 other OPPS APC 7915.05 7915.05 other OPPS APC 7915.05 27.63 2186.93 percent of total billed charges 7915.05 7915.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TRACHEOBRONCHIAL ULTRAFLEX NITINOL SILICONE L95 CM OD4 MM L40 MM L25 MM OD14 MM ODSEC24 FR FLEXIBLE OPEN LOOP RADIOPAQUE LOW PROFILE KNIT STERILE DISPOSABLE ACCEPTS .035 IN PULMONARY JAGWIRE SUP-M00576580 CDM 0270 RC outpatient 7915.05 7915.05 7915.05 74 5857.14 percent of total billed charges 7915.05 93 6411.19 percent of total billed charges 7915.05 7915.05 other OPPS APC 7915.05 7915.05 other OPPS APC 7915.05 27.63 2186.93 percent of total billed charges 7915.05 7915.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE GASTROSTOMY ENDOVIVE STANDARD STRAIGHT 14FR BALLOON REPLACEMENT BOLSTER SUP-M00582050 CDM 0270 RC outpatient 94.8 94.8 94.8 74 70.15 percent of total billed charges 94.8 93 76.79 percent of total billed charges 94.8 94.8 other OPPS APC 94.8 94.8 other OPPS APC 94.8 27.63 26.19 percent of total billed charges 94.8 94.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE GASTROSTOMY ENDOVIVE STANDARD STRAIGHT 16FR BALLOON REPLACEMENT BOLSTER SUP-M00582060 CDM 0270 RC outpatient 94.8 94.8 94.8 74 70.15 percent of total billed charges 94.8 93 76.79 percent of total billed charges 94.8 94.8 other OPPS APC 94.8 94.8 other OPPS APC 94.8 27.63 26.19 percent of total billed charges 94.8 94.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE GASTROSTOMY ENDOVIVE STANDARD STRAIGHT 18FR BALLOON REPLACEMENT BOLSTER SUP-M00582070 CDM 0270 RC outpatient 94.8 94.8 94.8 74 70.15 percent of total billed charges 94.8 93 76.79 percent of total billed charges 94.8 94.8 other OPPS APC 94.8 94.8 other OPPS APC 94.8 27.63 26.19 percent of total billed charges 94.8 94.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE GASTROSTOMY ENDOVIVE STRAIGHT OD20 FR STANDARD PROFILE REPLACEMENT BALLOON BOLSTER SUP-M00582080 CDM 0270 RC outpatient 94.8 94.8 94.8 74 70.15 percent of total billed charges 94.8 93 76.79 percent of total billed charges 94.8 94.8 other OPPS APC 94.8 94.8 other OPPS APC 94.8 27.63 26.19 percent of total billed charges 94.8 94.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE GASTROSTOMY ENDOVIVE RIGHT ANGLE OD20 FR BALLOON REPLACEMENT BOLSTER STANDARD PROFILE SUP-M00582150 CDM 0270 RC outpatient 94.8 94.8 94.8 74 70.15 percent of total billed charges 94.8 93 76.79 percent of total billed charges 94.8 94.8 other OPPS APC 94.8 94.8 other OPPS APC 94.8 27.63 26.19 percent of total billed charges 94.8 94.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE GASTROSTOMY ENDOVIVE STANDARD STRAIGHT 22FR BALLOON REPLACEMENT BOLSTER SUP-M00582860 CDM 0270 RC outpatient 94.8 94.8 94.8 74 70.15 percent of total billed charges 94.8 93 76.79 percent of total billed charges 94.8 94.8 other OPPS APC 94.8 94.8 other OPPS APC 94.8 27.63 26.19 percent of total billed charges 94.8 94.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPHINCTEROTOME ENDOSCOPIC DREAMTOME DREAMWIRE L5 MM .035 IN STRAIGHT L260 CM L20 MM OD4.4 FR BILIARY RAPID EXCHANGE CANNULATED CHANNEL C CUT WIRE SUP-M00584040 CDM 0270 RC outpatient 1238.69 1238.69 1238.69 74 916.63 percent of total billed charges 1238.69 93 1003.34 percent of total billed charges 1238.69 1238.69 other OPPS APC 1238.69 1238.69 other OPPS APC 1238.69 27.63 342.25 percent of total billed charges 1238.69 1238.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ENDOSCOPIC ALAIR L5 MM OD1.5 MM BRONCHUS THERMOPLASTY STERILE DISPOSABLE SUP-M005ATS25010 CDM 0270 RC outpatient 6500 6500 6500 74 4810 percent of total billed charges 6500 93 5265 percent of total billed charges 6500 6500 other OPPS APC 6500 6500 other OPPS APC 6500 27.63 1795.95 percent of total billed charges 6500 6500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL PERCUFLEX PLUS HYDROPLUS PIGTAIL CURVE L22 CM OD4.8 FR TAPER TIP BLADDER MARK LOW PROFILE LARGE INNER LUMEN LATEX FREE DISPOSABLE SUP-M0061752510 CDM 0270 RC outpatient 290.39 290.39 290.39 74 214.89 percent of total billed charges 290.39 93 235.22 percent of total billed charges 290.39 290.39 other OPPS APC 290.39 290.39 other OPPS APC 290.39 27.63 80.23 percent of total billed charges 290.39 290.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL PERCUFLEX PLUS HYDROPLUS PIGTAIL CURVE L24 CM OD4.8 FR TAPER TIP BLADDER MARK LOW PROFILE LARGE INNER LUMEN LATEX FREE DISPOSABLE SUP-M0061752520 CDM 0270 RC outpatient 290.39 290.39 290.39 74 214.89 percent of total billed charges 290.39 93 235.22 percent of total billed charges 290.39 290.39 other OPPS APC 290.39 290.39 other OPPS APC 290.39 27.63 80.23 percent of total billed charges 290.39 290.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL PERCUFLEX PLUS HYDROPLUS PIGTAIL CURVE L26 CM OD4.8 FR TAPER TIP BLADDER MARK LOW PROFILE LARGE INNER LUMEN LATEX FREE DISPOSABLE SUP-M0061752530 CDM 0270 RC outpatient 290.39 290.39 290.39 74 214.89 percent of total billed charges 290.39 93 235.22 percent of total billed charges 290.39 290.39 other OPPS APC 290.39 290.39 other OPPS APC 290.39 27.63 80.23 percent of total billed charges 290.39 290.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL PERCUFLEX PLUS HYDROPLUS PIGTAIL CURVE L28 CM OD4.8 FR TAPER TIP BLADDER MARK LOW PROFILE LARGE INNER LUMEN LATEX FREE DISPOSABLE SUP-M0061752540 CDM 0270 RC outpatient 290.39 290.39 290.39 74 214.89 percent of total billed charges 290.39 93 235.22 percent of total billed charges 290.39 290.39 other OPPS APC 290.39 290.39 other OPPS APC 290.39 27.63 80.23 percent of total billed charges 290.39 290.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL CONTOUR PERCUFLEX HYDROPLUS PIGTAIL CURVE L 22 CM OD 6 FR TAPER TIP BLADDER MARK LOW PROFILE LARGE INNER LUMEN SUP-M0061752610 CDM 0270 RC outpatient 290.39 290.39 290.39 74 214.89 percent of total billed charges 290.39 93 235.22 percent of total billed charges 290.39 290.39 other OPPS APC 290.39 290.39 other OPPS APC 290.39 27.63 80.23 percent of total billed charges 290.39 290.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL PERCUFLEX 8X24CM SUP-M0061752820 CDM 0270 RC outpatient 290.39 290.39 290.39 74 214.89 percent of total billed charges 290.39 93 235.22 percent of total billed charges 290.39 290.39 other OPPS APC 290.39 290.39 other OPPS APC 290.39 27.63 80.23 percent of total billed charges 290.39 290.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL PERCUFLEX PLUS HYDROPLUS PIGTAIL CURVE L26 CM OD8 FR TAPER TIP BLADDER MARK LOW PROFILE LARGE INNER LUMEN LATEX FREE SUP-M0061752830 CDM 0270 RC outpatient 290.39 290.39 290.39 74 214.89 percent of total billed charges 290.39 93 235.22 percent of total billed charges 290.39 290.39 other OPPS APC 290.39 290.39 other OPPS APC 290.39 27.63 80.23 percent of total billed charges 290.39 290.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL PERCUFLEX 8X24CM SUP-M0061752920 CDM 0270 RC outpatient 287.51 287.51 287.51 74 212.76 percent of total billed charges 287.51 93 232.88 percent of total billed charges 287.51 287.51 other OPPS APC 287.51 287.51 other OPPS APC 287.51 27.63 79.44 percent of total billed charges 287.51 287.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL CONTOUR PERCUFLEX HYDROPLUS PIGTAIL CURVE L24 CM OD6 FR TAPER TIP BLADDER MARK LOW PROFILE LARGE INNER LUMEN LATEX FREE SUP-M0061802220 CDM 0270 RC outpatient 290.39 290.39 290.39 74 214.89 percent of total billed charges 290.39 93 235.22 percent of total billed charges 290.39 290.39 other OPPS APC 290.39 290.39 other OPPS APC 290.39 27.63 80.23 percent of total billed charges 290.39 290.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL CONTOUR PERCUFLEX HYDROPLUS PIGTAIL CURVE L26 CM OD6 FR TAPER TIP BLADDER MARK LOW PROFILE LARGE INNER LUMEN LATEX FREE SUP-M0061802230 CDM 0270 RC outpatient 290.39 290.39 290.39 74 214.89 percent of total billed charges 290.39 93 235.22 percent of total billed charges 290.39 290.39 other OPPS APC 290.39 290.39 other OPPS APC 290.39 27.63 80.23 percent of total billed charges 290.39 290.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL CONTOUR PERCUFLEX HYDROPLUS PIGTAIL CURVE L28 CM OD6 FR TAPER TIP BLADDER MARK LOW PROFILE LARGE INNER LUMEN LATEX FREE SUP-M0061802240 CDM 0270 RC outpatient 290.39 290.39 290.39 74 214.89 percent of total billed charges 290.39 93 235.22 percent of total billed charges 290.39 290.39 other OPPS APC 290.39 290.39 other OPPS APC 290.39 27.63 80.23 percent of total billed charges 290.39 290.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL CONTOUR PERCUFLEX HYDROPLUS PIGTAIL CURVE L30 CM OD6 FR TAPER TIP BLADDER MARK LOW PROFILE LARGE INNER LUMEN LATEX FREE SUP-M0061802250 CDM 0270 RC outpatient 290.39 290.39 290.39 74 214.89 percent of total billed charges 290.39 93 235.22 percent of total billed charges 290.39 290.39 other OPPS APC 290.39 290.39 other OPPS APC 290.39 27.63 80.23 percent of total billed charges 290.39 290.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL CONTOUR PERCUFLEX HYDROPLUS PIGTAIL CURVE L24 CM OD7 FR TAPER TIP BLADDER MARK LOW PROFILE LARGE INNER LUMEN LATEX FREE SUP-M0061802320 CDM 0270 RC outpatient 290.39 290.39 290.39 74 214.89 percent of total billed charges 290.39 93 235.22 percent of total billed charges 290.39 290.39 other OPPS APC 290.39 290.39 other OPPS APC 290.39 27.63 80.23 percent of total billed charges 290.39 290.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL CONTOUR PERCUFLEX HYDROPLUS PIGTAIL CURVE L26 CM OD7 FR TAPER TIP BLADDER MARK LOW PROFILE LARGE INNER LUMEN LATEX FREE SUP-M0061802330 CDM 0270 RC outpatient 290.39 290.39 290.39 74 214.89 percent of total billed charges 290.39 93 235.22 percent of total billed charges 290.39 290.39 other OPPS APC 290.39 290.39 other OPPS APC 290.39 27.63 80.23 percent of total billed charges 290.39 290.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL CONTOUR PERCUFLEX PLUS HYDROPLUS PIGTAIL CURVE L24 CM OD8 FR LARGE INNER LUMEN LOW PROFILE BLADDER MARK TAPER TIP LATEX FREE SUP-M0061802420 CDM 0270 RC outpatient 290.39 290.39 290.39 74 214.89 percent of total billed charges 290.39 93 235.22 percent of total billed charges 290.39 290.39 other OPPS APC 290.39 290.39 other OPPS APC 290.39 27.63 80.23 percent of total billed charges 290.39 290.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL CONTOUR PERCUFLEX PLUS HYDROPLUS PIGTAIL CURVE L26 CM OD8 FR LARGE INNER LUMEN LOW PROFILE BLADDER MARK TAPER TIP LATEX FREE SUP-M0061802430 CDM 0270 RC outpatient 290.39 290.39 290.39 74 214.89 percent of total billed charges 290.39 93 235.22 percent of total billed charges 290.39 290.39 other OPPS APC 290.39 290.39 other OPPS APC 290.39 27.63 80.23 percent of total billed charges 290.39 290.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT NEPHROSTOMY NEPHROMAX AMPLATZ ENCORE PTFE SILICONE L17 CM L55 CM L12 CM OD7 FR ODSEC30 FR HIGH PRESSURE BALLOON CATHETER FIRM RENAL SHEATH RADIOPAQUE LOW PROFILE LATEX FREE RADIAL DILATATION SUP-M0062101180 CDM 0270 RC outpatient 678.31 678.31 678.31 74 501.95 percent of total billed charges 678.31 93 549.43 percent of total billed charges 678.31 678.31 other OPPS APC 678.31 678.31 other OPPS APC 678.31 27.63 187.42 percent of total billed charges 678.31 678.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER UROMAX ULTRA QUADRA-FOLD ENCORE HYDROPLUS POLYMER L75 CM L4 CM OD5.8 FR ODSEC15 FR URINARY TRACT HIGH PRESSURE KINK RESISTANT SHAFT RADIOPAQUE TAPER DISTAL END LATEX FREE ACCEPTS .038 IN GUIDEWIRE RADIAL DILATATION SUP-M0062251210 CDM 270009094 LOCAL 0270 RC outpatient 199.49 199.49 199.49 74 147.62 percent of total billed charges 199.49 93 161.59 percent of total billed charges 199.49 199.49 other OPPS APC 199.49 199.49 other OPPS APC 199.49 27.63 55.12 percent of total billed charges 199.49 199.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER UROMAX ULTRA QUADRA-FOLD ENCORE HYDROPLUS POLYMER L75 CM L4 CM OD5.8 FR ODSEC18 FR URINARY TRACT HIGH PRESSURE KINK RESISTANT SHAFT RADIOPAQUE TAPER DISTAL END LATEX FREE ACCEPTS .038 IN GUIDEWIRE RADIAL DILATATION SUP-M0062251220 CDM 0270 RC outpatient 696.93 696.93 696.93 74 515.73 percent of total billed charges 696.93 93 564.51 percent of total billed charges 696.93 696.93 other OPPS APC 696.93 696.93 other OPPS APC 696.93 27.63 192.56 percent of total billed charges 696.93 696.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH ACCESS NAVIGATOR HD STAINLESS STEEL HYDROPHILIC L28 CM OD11-13 FR URETERAL 2 DUROMETER DILATOR RADIOPAQUE INNOVATIVE HUB LATEX FREE URETEROSCOPIC SUP-M0062502210 CDM 0270 RC outpatient 331.27 331.27 331.27 74 245.14 percent of total billed charges 331.27 93 268.33 percent of total billed charges 331.27 331.27 other OPPS APC 331.27 331.27 other OPPS APC 331.27 27.63 91.53 percent of total billed charges 331.27 331.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH ACCESS NAVIGATOR HD STAINLESS STEEL HYDROPHILIC L36 CM OD11-13 FR URETERAL 2 DUROMETER DILATOR RADIOPAQUE INNOVATIVE HUB LATEX FREE URETEROSCOPIC SUP-M0062502220 CDM 0270 RC outpatient 331.27 331.27 331.27 74 245.14 percent of total billed charges 331.27 93 268.33 percent of total billed charges 331.27 331.27 other OPPS APC 331.27 331.27 other OPPS APC 331.27 27.63 91.53 percent of total billed charges 331.27 331.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH ACCESS NAVIGATOR HD STAINLESS STEEL HYDROPHILIC L46 CM OD11-13 FR URETERAL 2 DUROMETER DILATOR RADIOPAQUE INNOVATIVE HUB LATEX FREE URETEROSCOPIC SUP-M0062502230 CDM 0270 RC outpatient 331.27 331.27 331.27 74 245.14 percent of total billed charges 331.27 93 268.33 percent of total billed charges 331.27 331.27 other OPPS APC 331.27 331.27 other OPPS APC 331.27 27.63 91.53 percent of total billed charges 331.27 331.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS SPECIMEN RETRIEVAL TRICEP POLYAMIDE L90 CM OD3 FR HOOK PRONG GRASP EXTRA STRENGTH STERILE LATEX FREE DISPOSABLE SUP-M0063701220 CDM 0270 RC outpatient 464.78 464.78 464.78 74 343.94 percent of total billed charges 464.78 93 376.47 percent of total billed charges 464.78 464.78 other OPPS APC 464.78 464.78 other OPPS APC 464.78 27.63 128.42 percent of total billed charges 464.78 464.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASKET STONE RETRIEVAL ZEROTIP NITINOL L120 CM OD16 MM ODSEC3 FR URETERAL 4 WIRE FLAT DISTAL SURFACE KNOT TIPLESS STERILE LATEX FREE DISPOSABLE SUP-M0063901030 CDM 0270 RC outpatient 501.62 501.62 501.62 74 371.2 percent of total billed charges 501.62 93 406.31 percent of total billed charges 501.62 501.62 other OPPS APC 501.62 501.62 other OPPS APC 501.62 27.63 138.6 percent of total billed charges 501.62 501.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BASKET ZERO TIP 1.9 FR SUP-M0063901050 CDM 0270 RC outpatient 569.95 569.95 569.95 74 421.76 percent of total billed charges 569.95 93 461.66 percent of total billed charges 569.95 569.95 other OPPS APC 569.95 569.95 other OPPS APC 569.95 27.63 157.48 percent of total billed charges 569.95 569.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE STONE RETRIEVAL DAKOTA OPENSURE NITINOL L120 CM OD1.9 FR ODSEC8 MM 3 ARM FLEXIBLE BASKET SUP-M0063905000 CDM 0270 RC outpatient 561.39 561.39 561.39 74 415.43 percent of total billed charges 561.39 93 454.73 percent of total billed charges 561.39 561.39 other OPPS APC 561.39 561.39 other OPPS APC 561.39 27.63 155.11 percent of total billed charges 561.39 561.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SPECIMEN RETRIEVAL BACKSTOP OD3 FR URETERAL DISPOSABLE CLEAR STONE ANTIRETROPULSION SUP-M0063909000 CDM 0270 RC outpatient 982.8 982.8 982.8 74 727.27 percent of total billed charges 982.8 93 796.07 percent of total billed charges 982.8 982.8 other OPPS APC 982.8 982.8 other OPPS APC 982.8 27.63 271.55 percent of total billed charges 982.8 982.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SPECIMEN RETRIEVAL BACKSTOP OD5 FR URETERAL STONE ANTIRETROPULSION DEVICE GEL DISPOSABLE CLEAR SUP-M0063909010 CDM 0270 RC outpatient 982.8 982.8 982.8 74 727.27 percent of total billed charges 982.8 93 796.07 percent of total billed charges 982.8 982.8 other OPPS APC 982.8 982.8 other OPPS APC 982.8 27.63 271.55 percent of total billed charges 982.8 982.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETERAL AXXCESS PERCUFLEX L70 CM OD6 FR TAPER TIP 1 LUMEN RADIOPAQUE OPEN END STERILE LATEX FREE DISPOSABLE SUP-M0064001161 CDM outpatient 28.48 28.48 28.48 28.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER URETERAL FLEXIMA L70 CM OD5 FR 1 LUMEN OPEN END INJECTION HUB LATEX FREE SUP-M0064002011 CDM outpatient 24.4 24.4 24.4 24.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER NEPHROSTOMY MALECOT L35 CM OD14 FR DRAINAGE STERILE LATEX FREE DISPOSABLE SUP-M0064101000 CDM 0270 RC outpatient 200.2 200.2 200.2 74 148.15 percent of total billed charges 200.2 93 162.16 percent of total billed charges 200.2 200.2 other OPPS APC 200.2 200.2 other OPPS APC 200.2 27.63 55.32 percent of total billed charges 200.2 200.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY TOPNOTCH L21 CM OD18 G AUTOMATE SUP-M0065101101 CDM 0270 RC outpatient 98.8 98.8 98.8 74 73.11 percent of total billed charges 98.8 93 80.03 percent of total billed charges 98.8 98.8 other OPPS APC 98.8 98.8 other OPPS APC 98.8 27.63 27.3 percent of total billed charges 98.8 98.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNIT ELECTROSURGICAL GENESYS HTA PROCEDURE SET SUP-M006580211 CDM 0270 RC outpatient 4654 4654 4654 74 3443.96 percent of total billed charges 4654 93 3769.74 percent of total billed charges 4654 4654 other OPPS APC 4654 4654 other OPPS APC 4654 27.63 1285.9 percent of total billed charges 4654 4654 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE UROLOGICAL AMPLATZ SUPER STIFF PTFE STRAIGHT L145 CM L3.5 CM OD.035 IN FLEXIBLE TIP FLAT WIRE OUTER COIL LATEX FREE SUP-M0066401081 CDM 0270 RC outpatient 66.84 66.84 66.84 74 49.46 percent of total billed charges 66.84 93 54.14 percent of total billed charges 66.84 66.84 other OPPS APC 66.84 66.84 other OPPS APC 66.84 27.63 18.47 percent of total billed charges 66.84 66.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE UROLOGICAL SENSOR NITINOL STAINLESS STEEL HYDROPHILIC PTFE STRAIGHT L150 CM L3 CM OD.035 IN URETERAL FLEXIBLE TIP RADIOPAQUE LATEX FREE SUP-M0066703081 CDM 0270 RC outpatient 110.7 110.7 110.7 74 81.92 percent of total billed charges 110.7 93 89.67 percent of total billed charges 110.7 110.7 other OPPS APC 110.7 110.7 other OPPS APC 110.7 27.63 30.59 percent of total billed charges 110.7 110.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE UROLOGICAL ZIPWIRE NITINOL POLYURETHANE HYDROPHILIC STRAIGHT L150 CM L3 CM OD.038 IN URETERAL RADIOPAQUE STANDARD SHAFT STEERABLE KINK RESISTANT SUP-M0066802001 CDM 0270 RC outpatient 141.95 141.95 141.95 74 105.04 percent of total billed charges 141.95 93 114.98 percent of total billed charges 141.95 141.95 other OPPS APC 141.95 141.95 other OPPS APC 141.95 27.63 39.22 percent of total billed charges 141.95 141.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM IRRIGATION PUMP SAPS 10 CC 1 ACTION 1 WAY VALVE VACUUM SYRINGE LATEX FREE URETEROSCOPY LASER LITHOTRIPSY SUP-M0067201001 CDM 0270 RC outpatient 122.85 122.85 122.85 74 90.91 percent of total billed charges 122.85 93 99.51 percent of total billed charges 122.85 122.85 other OPPS APC 122.85 122.85 other OPPS APC 122.85 27.63 33.94 percent of total billed charges 122.85 122.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EVACUATOR UROLOGY UROVAC BLADDER ADAPTER IRRIGATION LATEX DISPOSABLE SUP-M0067301251 CDM 0270 RC outpatient 63.28 63.28 63.28 74 46.83 percent of total billed charges 63.28 93 51.26 percent of total billed charges 63.28 63.28 other OPPS APC 63.28 63.28 other OPPS APC 63.28 27.63 17.48 percent of total billed charges 63.28 63.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HANDLE ENDOSCOPIC GUIDEWIRE TORQUE VISE STEERABLE SUP-M0067301301 CDM 0270 RC outpatient 23.99 23.99 23.99 74 17.75 percent of total billed charges 23.99 93 19.43 percent of total billed charges 23.99 23.99 other OPPS APC 23.99 23.99 other OPPS APC 23.99 27.63 6.63 percent of total billed charges 23.99 23.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON ABS COATED BRAIDED POLYESTER DOUBLE ARMED WITH TC NEEDLE 36IN SUTURE SUP-M0068221141 CDM 0270 RC outpatient 108.11 108.11 108.11 74 80 percent of total billed charges 108.11 93 87.57 percent of total billed charges 108.11 108.11 other OPPS APC 108.11 108.11 other OPPS APC 108.11 27.63 29.87 percent of total billed charges 108.11 108.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SUTURING CAPIO SLIM FUNNEL TRANSVAGINAL ERGONOMIC HANDLE REDUCE PROFILE OPEN ACCESS CAPTURE STERILE DISPOSABLE SUP-M0068318250 CDM 0270 RC outpatient 1444.77 1444.77 1444.77 74 1069.13 percent of total billed charges 1444.77 93 1170.26 percent of total billed charges 1444.77 1444.77 other OPPS APC 1444.77 1444.77 other OPPS APC 1444.77 27.63 399.19 percent of total billed charges 1444.77 1444.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SUTURING CAPIO SLIM FUNNEL TRANSVAGINAL ERGONOMIC HANDLE REDUCE PROFILE OPEN ACCESS CAPTURE STERILE DISPOSABLE SUP-M0068318261 CDM 0270 RC outpatient 1338.48 1338.48 1338.48 74 990.48 percent of total billed charges 1338.48 93 1084.17 percent of total billed charges 1338.48 1338.48 other OPPS APC 1338.48 1338.48 other OPPS APC 1338.48 27.63 369.82 percent of total billed charges 1338.48 1338.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON ABS COATED BRAIDED POLYESTER DOUBLE ARMED WITH TC NEEDLE 36IN SUTURE SUP-M0068331141 CDM 0270 RC outpatient 108.11 108.11 108.11 74 80 percent of total billed charges 108.11 93 87.57 percent of total billed charges 108.11 108.11 other OPPS APC 108.11 108.11 other OPPS APC 108.11 27.63 29.87 percent of total billed charges 108.11 108.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NON ABS COATED BRAIDED POLYESTER DOUBLE ARMED WITH TC NEEDLE 36IN SUTURE SUP-M0068332241 CDM 0270 RC outpatient 154.85 154.85 154.85 74 114.59 percent of total billed charges 154.85 93 125.43 percent of total billed charges 154.85 154.85 other OPPS APC 154.85 154.85 other OPPS APC 154.85 27.63 42.79 percent of total billed charges 154.85 154.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PROBE SWISS LITHOCLAST TRILOGY L350 MM X W3.9 MM DISPOSABLE BLUE SUP-M0068403540 CDM 0270 RC outpatient 2636.71 2636.71 2636.71 74 1951.17 percent of total billed charges 2636.71 93 2135.74 percent of total billed charges 2636.71 2636.71 other OPPS APC 2636.71 2636.71 other OPPS APC 2636.71 27.63 728.52 percent of total billed charges 2636.71 2636.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PROBE SWISS LITHOCLAST TRILOGY L440 MM X W3.9 MM DISPOSABLE BLUE SUP-M0068403550 CDM 0270 RC outpatient 2636.71 2636.71 2636.71 74 1951.17 percent of total billed charges 2636.71 93 2135.74 percent of total billed charges 2636.71 2636.71 other OPPS APC 2636.71 2636.71 other OPPS APC 2636.71 27.63 728.52 percent of total billed charges 2636.71 2636.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBER LASER FLEXIVA FLEXSHIELD 200 UM HIGH POWER POLISH OUTPUT TIP NONTAPER GUIDE CONNECTOR LATEX FREE DISPOSABLE SUP-M0068403911 CDM 0270 RC outpatient 992.16 992.16 992.16 74 734.2 percent of total billed charges 992.16 93 803.65 percent of total billed charges 992.16 992.16 other OPPS APC 992.16 992.16 other OPPS APC 992.16 27.63 274.13 percent of total billed charges 992.16 992.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBER LASER FLEXIVA FLEXSHIELD 365 UM HIGH POWER POLISH OUTPUT TIP NONTAPER GUIDE CONNECTOR LATEX FREE DISPOSABLE SUP-M0068403920 CDM 0270 RC outpatient 830.93 830.93 830.93 74 614.89 percent of total billed charges 830.93 93 673.05 percent of total billed charges 830.93 830.93 other OPPS APC 830.93 830.93 other OPPS APC 830.93 27.63 229.59 percent of total billed charges 830.93 830.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBER LASER FLEXIVA FLEXSHIELD 550 UM HIGH POWER POLISH OUTPUT TIP NONTAPER GUIDE CONNECTOR LATEX FREE DISPOSABLE SUP-M0068403931 CDM 0270 RC outpatient 1095.31 1095.31 1095.31 74 810.53 percent of total billed charges 1095.31 93 887.2 percent of total billed charges 1095.31 1095.31 other OPPS APC 1095.31 1095.31 other OPPS APC 1095.31 27.63 302.63 percent of total billed charges 1095.31 1095.31 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBER LASER FLEXIVA TRAC TIP FLEXSHIELD HOLMIUM 200 UM FLEXIBLE CUSTOM GUIDE CONNECTOR LATEX FREE DISPOSABLE SUP-M0068403960 CDM 0270 RC outpatient 1233.41 1233.41 1233.41 74 912.72 percent of total billed charges 1233.41 93 999.06 percent of total billed charges 1233.41 1233.41 other OPPS APC 1233.41 1233.41 other OPPS APC 1233.41 27.63 340.79 percent of total billed charges 1233.41 1233.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE LITHOTRIPTER SWISS LITHOCLAST L330 MM OD3.3 MM ULTRASOUND FLEXIBLE LATEX FREE DISPOSABLE SUP-M0068407140 CDM 0270 RC outpatient 1334.68 1334.68 1334.68 74 987.66 percent of total billed charges 1334.68 93 1081.09 percent of total billed charges 1334.68 1334.68 other OPPS APC 1334.68 1334.68 other OPPS APC 1334.68 27.63 368.77 percent of total billed charges 1334.68 1334.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE LITHOTRIPTER 330MM 3.8MM ULTRASOUND FLEXIBLE SWISS LITHOCLAST LF DISPOSABLE SUP-M0068407150 CDM 0270 RC outpatient 1375.97 1375.97 1375.97 74 1018.22 percent of total billed charges 1375.97 93 1114.54 percent of total billed charges 1375.97 1375.97 other OPPS APC 1375.97 1375.97 other OPPS APC 1375.97 27.63 380.18 percent of total billed charges 1375.97 1375.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE LITHOTRIPTER SWISS LITHOCLAST L403 MM OD3.8 MM ULTRASOUND FLEXIBLE LATEX FREE DISPOSABLE SUP-M0068407170 CDM 0270 RC outpatient 1334.68 1334.68 1334.68 74 987.66 percent of total billed charges 1334.68 93 1081.09 percent of total billed charges 1334.68 1334.68 other OPPS APC 1334.68 1334.68 other OPPS APC 1334.68 27.63 368.77 percent of total billed charges 1334.68 1334.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE LITHOTRIPTER SWISS LITHOCLAST L497 MM OD1 MM PNEUMATIC LATEX FREE DISPOSABLE SUP-M0068407320 CDM 0270 RC outpatient 578.45 578.45 578.45 74 428.05 percent of total billed charges 578.45 93 468.54 percent of total billed charges 578.45 578.45 other OPPS APC 578.45 578.45 other OPPS APC 578.45 27.63 159.83 percent of total billed charges 578.45 578.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE PNEUMATIC 1.0MM X 570MM SUP-M0068407330 CDM 0270 RC outpatient 578.45 578.45 578.45 74 428.05 percent of total billed charges 578.45 93 468.54 percent of total billed charges 578.45 578.45 other OPPS APC 578.45 578.45 other OPPS APC 578.45 27.63 159.83 percent of total billed charges 578.45 578.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE LITHOTRIPTER SWISS LITHOCLAST L425 MM OD2 MM PNEUMATIC LATEX FREE DISPOSABLE SUP-M0068407370 CDM 0270 RC outpatient 578.45 578.45 578.45 74 428.05 percent of total billed charges 578.45 93 468.54 percent of total billed charges 578.45 578.45 other OPPS APC 578.45 578.45 other OPPS APC 578.45 27.63 159.83 percent of total billed charges 578.45 578.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LITHOTRIPTER SURGICAL SWISS LITHOCLAST 1 PIECE STONE CATCHER STERILE SUP-M0068407501 CDM 0270 RC outpatient 184.49 184.49 184.49 74 136.52 percent of total billed charges 184.49 93 149.44 percent of total billed charges 184.49 184.49 other OPPS APC 184.49 184.49 other OPPS APC 184.49 27.63 50.97 percent of total billed charges 184.49 184.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBER LASER SLIMLINE EZ DUOTOME SIDELITE HOLMIUM 100W 550 UM OD7.2 FR SIDE FIRING COHERENT DISPOSABLE CONTINUOUS FLOW CYSTOSCOPE SUP-M0068408460 CDM 0270 RC outpatient 2000.7 2000.7 2000.7 74 1480.52 percent of total billed charges 2000.7 93 1620.57 percent of total billed charges 2000.7 2000.7 other OPPS APC 2000.7 2000.7 other OPPS APC 2000.7 27.63 552.79 percent of total billed charges 2000.7 2000.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM URETHRAL SUPPORT OBTRYX FEMALE MIDURETHRAL TRANSOBTURATOR SLING HALO NEEDLE STRESS URINARY INCONTINENCE SUP-M0068505000 CDM 0270 RC outpatient 2514.41 2514.41 2514.41 74 1860.66 percent of total billed charges 2514.41 93 2036.67 percent of total billed charges 2514.41 2514.41 other OPPS APC 2514.41 2514.41 other OPPS APC 2514.41 27.63 694.73 percent of total billed charges 2514.41 2514.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT INJECTABLE COAPTITE 1 ML SYRINGE BULK AGENT SUP-M0068903000 CDM 0270 RC outpatient 624 624 624 74 461.76 percent of total billed charges 624 93 505.44 percent of total billed charges 624 624 other OPPS APC 624 624 other OPPS APC 624 27.63 172.41 percent of total billed charges 624 624 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT INJECTABLE SIDEKICK COAPTITE L14.6 IN OD21 GA SUP-M0068903020 CDM 0270 RC outpatient 70.2 70.2 70.2 74 51.95 percent of total billed charges 70.2 93 56.86 percent of total billed charges 70.2 70.2 other OPPS APC 70.2 70.2 other OPPS APC 70.2 27.63 19.4 percent of total billed charges 70.2 70.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBER LASER FLEXIVA FLEXSHIELD 365 UM HIGH POWER POLISH OUTPUT TIP NONTAPER GUIDE CONNECTOR LATEX FREE DISPOSABLE SUP-M006L8405921 CDM 0270 RC outpatient 847.55 847.55 847.55 74 627.19 percent of total billed charges 847.55 93 686.52 percent of total billed charges 847.55 847.55 other OPPS APC 847.55 847.55 other OPPS APC 847.55 27.63 234.18 percent of total billed charges 847.55 847.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBER ENDOSCOPIC LASER FLEXIVA PULSE 550UM HIGH POWER EA SUP-M006L8405930 CDM 0270 RC outpatient 1085.84 1085.84 1085.84 74 803.52 percent of total billed charges 1085.84 93 879.53 percent of total billed charges 1085.84 1085.84 other OPPS APC 1085.84 1085.84 other OPPS APC 1085.84 27.63 300.02 percent of total billed charges 1085.84 1085.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIBER LASER FLEXIVA TRAC TIP FLEXSHIELD HOLMIUM 200 UM FLEXIBLE CUSTOM GUIDE CONNECTOR LATEX FREE DISPOSABLE SUP-M006L8405960 CDM 0270 RC outpatient 1258.09 1258.09 1258.09 74 930.99 percent of total billed charges 1258.09 93 1019.05 percent of total billed charges 1258.09 1258.09 other OPPS APC 1258.09 1258.09 other OPPS APC 1258.09 27.63 347.61 percent of total billed charges 1258.09 1258.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE MICRO SUP-M1071 CDM 0270 RC outpatient 84.45 84.45 84.45 74 62.49 percent of total billed charges 84.45 93 68.4 percent of total billed charges 84.45 84.45 other OPPS APC 84.45 84.45 other OPPS APC 84.45 27.63 23.33 percent of total billed charges 84.45 84.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRAP CATHETER VELCRO FOAM UNIVERSAL L22 IN X W2 IN ELASTIC SKIN IRRITATE TAPE HOOK LOOP FASTENER SOFT NONSTERILE LATEX FREE SUP-M1133 CDM 0270 RC outpatient 4.64 4.64 4.64 74 3.43 percent of total billed charges 4.64 93 3.76 percent of total billed charges 4.64 4.64 other OPPS APC 4.64 4.64 other OPPS APC 4.64 27.63 1.28 percent of total billed charges 4.64 4.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH EXTRA MICRA INTRODUCER NOT IN SYSTEM SUP-M12355A CDM 0275 RC outpatient 1560 1560 1560 57 889.2 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 51 795.6 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE INDICATOR 3M COMPLY 55MRX24MM BLUE LF LEAD FREE INK STRETCHABLE BACK STEAM STERILIZATION DISPOSABLE WRAP SUP-M1355-24MA CDM 0270 RC outpatient 196.43 196.43 196.43 74 145.36 percent of total billed charges 196.43 93 159.11 percent of total billed charges 196.43 196.43 other OPPS APC 196.43 196.43 other OPPS APC 196.43 27.63 54.27 percent of total billed charges 196.43 196.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HOLDER LIMB QUICK RELEASE 60 INCH STRAP SUP-M2028 CDM 270009040 LOCAL 0270 RC outpatient 3.42 3.42 3.42 74 2.53 percent of total billed charges 3.42 93 2.77 percent of total billed charges 3.42 3.42 other OPPS APC 3.42 3.42 other OPPS APC 3.42 27.63 0.94 percent of total billed charges 3.42 3.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MITTEN RESTRAINT COTTON UNIVERSAL WRIST 2 PAD CONTACT CLOSURE INSPECTION FLAP HANDCONTROL NONSTERILE LATEX FREE SUP-M2042 CDM 270009157 LOCAL 0270 RC outpatient 19.7 19.7 19.7 74 14.58 percent of total billed charges 19.7 93 15.96 percent of total billed charges 19.7 19.7 other OPPS APC 19.7 19.7 other OPPS APC 19.7 27.63 5.44 percent of total billed charges 19.7 19.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROTECTOR EXTREMITY KODEL UNIVERSAL HEEL ELBOW DELUXE FULL FOOT DESIGN VENTILATION HOLE STRAP HOOK LOOP CLOSURE NONSTERILE LATEX FREE SUP-M3014D-6 CDM 0270 RC outpatient 3.35 3.35 3.35 74 2.48 percent of total billed charges 3.35 93 2.71 percent of total billed charges 3.35 3.35 other OPPS APC 3.35 3.35 other OPPS APC 3.35 27.63 0.93 percent of total billed charges 3.35 3.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD NEUROSTIMULATOR PRECISION ARTISAN PLATNALOCK L70 CM X W8 CM X H2 CM PADDLE LIM SPINAL CORD STIMULATOR SYSTEM SUP-M365SC8216700 CDM 0270 RC outpatient 8827 8827 8827 74 6531.98 percent of total billed charges 8827 93 7149.87 percent of total billed charges 8827 8827 other OPPS APC 8827 8827 other OPPS APC 8827 27.63 2438.9 percent of total billed charges 8827 8827 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER AVA 3XI STANDARD OD8.5 FR 3 L STERILE LATEX FREE DISPOSABLE SUP-M3L85FKIC CDM 270009030 LOCAL 0270 RC outpatient 303.21 303.21 303.21 74 224.38 percent of total billed charges 303.21 93 245.6 percent of total billed charges 303.21 303.21 other OPPS APC 303.21 303.21 other OPPS APC 303.21 27.63 83.78 percent of total billed charges 303.21 303.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT COCHLEAR PONTO 9 MM WIDE W4 MM OD4.5 MM 1 STAGE PREMOUNT ABUTMENT CONNECTION SCREW STERILE SUP-M51137 CDM 0270 RC outpatient 8840 8840 8840 74 6541.6 percent of total billed charges 8840 93 7160.4 percent of total billed charges 8840 8840 other OPPS APC 8840 8840 other OPPS APC 8840 27.63 2442.49 percent of total billed charges 8840 8840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT COCHLEAR PONTO 12 MM WIDE W4 MM OD4.5 MM 1 STAGE PREMOUNT ABUTMENT CONNECTION SCREW STERILE SUP-M51138 CDM 0270 RC outpatient 8840 8840 8840 74 6541.6 percent of total billed charges 8840 93 7160.4 percent of total billed charges 8840 8840 other OPPS APC 8840 8840 other OPPS APC 8840 27.63 2442.49 percent of total billed charges 8840 8840 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROCESSOR SOUND PONTO PLUS LEFT DIAMOND BLACK SUP-M51700 CDM 0270 RC outpatient 12155 12155 12155 74 8994.7 percent of total billed charges 12155 93 9845.55 percent of total billed charges 12155 12155 other OPPS APC 12155 12155 other OPPS APC 12155 27.63 3358.43 percent of total billed charges 12155 12155 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROCESSOR SOUND PONTO PRO RIGHT EAR POWER STERILE CHROMA BEIGE BONE ANCHORED HEARING SYSTEM SUP-M51735 CDM 0270 RC outpatient 8720.84 8720.84 8720.84 74 6453.42 percent of total billed charges 8720.84 93 7063.88 percent of total billed charges 8720.84 8720.84 other OPPS APC 8720.84 8720.84 other OPPS APC 8720.84 27.63 2409.57 percent of total billed charges 8720.84 8720.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PROCESSOR SOUND, PONTO PLUS POWER, RIGHT, WHITE SILVER" SUP-M51737 CDM 0270 RC outpatient 12155 12155 12155 74 8994.7 percent of total billed charges 12155 93 9845.55 percent of total billed charges 12155 12155 other OPPS APC 12155 12155 other OPPS APC 12155 27.63 3358.43 percent of total billed charges 12155 12155 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SHOCKWAVE M5+ IVL CATHETER, 3.5X60MM" SUP-M5PIVL3560 CDM 0270 RC outpatient 8970 8970 8970 74 6637.8 percent of total billed charges 8970 93 7265.7 percent of total billed charges 8970 8970 other OPPS APC 8970 8970 other OPPS APC 8970 27.63 2478.41 percent of total billed charges 8970 8970 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SHOCKWAVE M5+ IVL CATHETER, 4.0X60MM" SUP-M5PIVL4060 CDM 0270 RC outpatient 8970 8970 8970 74 6637.8 percent of total billed charges 8970 93 7265.7 percent of total billed charges 8970 8970 other OPPS APC 8970 8970 other OPPS APC 8970 27.63 2478.41 percent of total billed charges 8970 8970 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SHOCKWAVE M5+ IVL CATHETER, 4.5X60MM" SUP-M5PIVL4560 CDM 0270 RC outpatient 8970 8970 8970 74 6637.8 percent of total billed charges 8970 93 7265.7 percent of total billed charges 8970 8970 other OPPS APC 8970 8970 other OPPS APC 8970 27.63 2478.41 percent of total billed charges 8970 8970 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SHOCKWAVE M5+ IVL CATHETER, 5.0X60MM" SUP-M5PIVL5060 CDM 0270 RC outpatient 8970 8970 8970 74 6637.8 percent of total billed charges 8970 93 7265.7 percent of total billed charges 8970 8970 other OPPS APC 8970 8970 other OPPS APC 8970 27.63 2478.41 percent of total billed charges 8970 8970 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SHOCKWAVE M5+ IVL CATHETER, 5.5X60MM" SUP-M5PIVL5560 CDM 0270 RC outpatient 8970 8970 8970 74 6637.8 percent of total billed charges 8970 93 7265.7 percent of total billed charges 8970 8970 other OPPS APC 8970 8970 other OPPS APC 8970 27.63 2478.41 percent of total billed charges 8970 8970 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SHOCKWAVE M5+ IVL CATHETER, 6.0X60MM" SUP-M5PIVL6060 CDM 0270 RC outpatient 8970 8970 8970 74 6637.8 percent of total billed charges 8970 93 7265.7 percent of total billed charges 8970 8970 other OPPS APC 8970 8970 other OPPS APC 8970 27.63 2478.41 percent of total billed charges 8970 8970 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SHOCKWAVE M5+ IVL CATHETER, 6.5X60MM" SUP-M5PIVL6560 CDM 0270 RC outpatient 8970 8970 8970 74 6637.8 percent of total billed charges 8970 93 7265.7 percent of total billed charges 8970 8970 other OPPS APC 8970 8970 other OPPS APC 8970 27.63 2478.41 percent of total billed charges 8970 8970 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SHOCKWAVE M5+ IVL CATHETER, 7.0X60MM" SUP-M5PIVL7060 CDM 0270 RC outpatient 8970 8970 8970 74 6637.8 percent of total billed charges 8970 93 7265.7 percent of total billed charges 8970 8970 other OPPS APC 8970 8970 other OPPS APC 8970 27.63 2478.41 percent of total billed charges 8970 8970 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SHOCKWAVE M5+ IVL CATHETER, 8.0X60MM" SUP-M5PIVL8060 CDM 0270 RC outpatient 8970 8970 8970 74 6637.8 percent of total billed charges 8970 93 7265.7 percent of total billed charges 8970 8970 other OPPS APC 8970 8970 other OPPS APC 8970 27.63 2478.41 percent of total billed charges 8970 8970 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING WOUND WHITEFOAM VAC POLYVINYL ALCOHOL THK1 CM SMALL L10 CM X W7.5 CM HIGHER TENSILE STRENGTH INCREASE DENSITY DISPOSABLE WHITE SUP-M6275033/10 CDM 0270 RC outpatient 24.54 24.54 24.54 74 18.16 percent of total billed charges 24.54 93 19.88 percent of total billed charges 24.54 24.54 other OPPS APC 24.54 24.54 other OPPS APC 24.54 27.63 6.78 percent of total billed charges 24.54 24.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANISTER WOUND DRAIN VAC ATS 500 ML TUBING CLAMP CONNECTOR GEL STERILE LATEX FREE DISPOSABLE SUP-M6275063 CDM 0270 RC outpatient 181.87 181.87 181.87 74 134.58 percent of total billed charges 181.87 93 147.31 percent of total billed charges 181.87 181.87 other OPPS APC 181.87 181.87 other OPPS APC 181.87 27.63 50.25 percent of total billed charges 181.87 181.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR WOUND DRAIN TRAC Y DRESSING SYSTEM STERILE LATEX FREE SUP-M6275066/10 CDM 0270 RC outpatient 4.4 4.4 4.4 74 3.26 percent of total billed charges 4.4 93 3.56 percent of total billed charges 4.4 4.4 other OPPS APC 4.4 4.4 other OPPS APC 4.4 27.63 1.22 percent of total billed charges 4.4 4.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING WOUND VACUUM CLOSURE GRANUFOAM SILVER LARGE SUP-M6275099-10 CDM 0270 RC outpatient 181.34 181.34 181.34 74 134.19 percent of total billed charges 181.34 93 146.89 percent of total billed charges 181.34 181.34 other OPPS APC 181.34 181.34 other OPPS APC 181.34 27.63 50.1 percent of total billed charges 181.34 181.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WATCHMAN TRUSEAL SHEATH SINGLE CURVE _62669_ SUP-M635TU70010 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WATCHMAN TRUSEAL SHEATH DOUBLE CURVE_62670_ SUP-M635TU70020 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WATCHMAN TRUSEAL SHEATH ANTERIOR CURVE _62671_ SUP-M635TU70040 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE WATCHMAN FXD CURVE OD 15 FR 2 CURVE ACCESS SYSTEM LEFT ARTRIAL APPENDAGE SUP-M635TU80010 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE WATCHMAN FXD CURVE OD 15 FR ID 12 FR 2 CURVE ACCESS SYSTEM LEFT ATRIAL APPENDAGE SUP-M635TU80020 CDM 0481 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 51 1326 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH DEVICE WATCHMAN STEERABLE ACCESS LEFT ARTRIAL APPENDAGE SUP-M635TU90050 CDM 0481 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 51 1989 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Watchman FLX 20MM _62663_ SUP-M635WU50200 CDM 0481 RC outpatient 35800 35800 35800 74 26492 percent of total billed charges 35800 93 28998 percent of total billed charges 35800 35800 other OPPS APC 35800 35800 other OPPS APC 35800 51 18258 percent of total billed charges 35800 35800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Watchman FLX 24mm _62665_ SUP-M635WU50240 CDM 0481 RC outpatient 35800 35800 35800 74 26492 percent of total billed charges 35800 93 28998 percent of total billed charges 35800 35800 other OPPS APC 35800 35800 other OPPS APC 35800 51 18258 percent of total billed charges 35800 35800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Watchman FLX 27mm _62666_ SUP-M635WU50270 CDM 0481 RC outpatient 35800 35800 35800 74 26492 percent of total billed charges 35800 93 28998 percent of total billed charges 35800 35800 other OPPS APC 35800 35800 other OPPS APC 35800 51 18258 percent of total billed charges 35800 35800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Watchman FLX 31 mm _62667_ SUP-M635WU50310 CDM 0481 RC outpatient 35800 35800 35800 74 26492 percent of total billed charges 35800 93 28998 percent of total billed charges 35800 35800 other OPPS APC 35800 35800 other OPPS APC 35800 51 18258 percent of total billed charges 35800 35800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Watchman FLX 35 _62668_ SUP-M635WU50350 CDM 0481 RC outpatient 35800 35800 35800 74 26492 percent of total billed charges 35800 93 28998 percent of total billed charges 35800 35800 other OPPS APC 35800 35800 other OPPS APC 35800 51 18258 percent of total billed charges 35800 35800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE WATCHMAN FLX PRO L 20 MM LEFT ATRIAL APPENDAGE STERILE LATEX FREE DISPOSABLE DELIVERY SYSTEM SUP-M635WU60200 CDM 0481 RC outpatient 44200 44200 44200 74 32708 percent of total billed charges 44200 93 35802 percent of total billed charges 44200 44200 other OPPS APC 44200 44200 other OPPS APC 44200 51 22542 percent of total billed charges 44200 44200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE WATCHMAN FLX PRO L 24 MM LEFT ATRIAL APPENDAGE STERILE LATEX FREE DISPOSABLE DELIVERY SYSTEM SUP-M635WU60240 CDM 0481 RC outpatient 44200 44200 44200 74 32708 percent of total billed charges 44200 93 35802 percent of total billed charges 44200 44200 other OPPS APC 44200 44200 other OPPS APC 44200 51 22542 percent of total billed charges 44200 44200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE WATCHMAN FLX PRO L 27MM LEFT ATRIAL APPENDAGE STERILE LATEX FREE DISPOSABLE DELIVERY SYSTEM SUP-M635WU60270 CDM 0481 RC outpatient 44200 44200 44200 74 32708 percent of total billed charges 44200 93 35802 percent of total billed charges 44200 44200 other OPPS APC 44200 44200 other OPPS APC 44200 51 22542 percent of total billed charges 44200 44200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE WATCHMAN FLX PRO L 31 MM LEFT ATRIAL APPENDAGE STERILE LATEX FREE DISPOSABLE DELIVERY SYSTEM SUP-M635WU60310 CDM 0481 RC outpatient 44200 44200 44200 74 32708 percent of total billed charges 44200 93 35802 percent of total billed charges 44200 44200 other OPPS APC 44200 44200 other OPPS APC 44200 51 22542 percent of total billed charges 44200 44200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE WATCHMAN FLX PRO L 35MM LEFT ATRIAL APPENDAGE STERILE LATEX FREE DISPOSABLE DELIVERY SYSTEM SUP-M635WU60350 CDM 0481 RC outpatient 44200 44200 44200 74 32708 percent of total billed charges 44200 93 35802 percent of total billed charges 44200 44200 other OPPS APC 44200 44200 other OPPS APC 44200 51 22542 percent of total billed charges 44200 44200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE WATCHMAN FLX PRO L 40 MM LEFT ATRIAL APPENDAGE STERILE LATEX FREE DISPOSABLE DELIVERY SYSTEM SUP-M635WU60400 CDM 0481 RC outpatient 44200 44200 44200 74 32708 percent of total billed charges 44200 93 35802 percent of total billed charges 44200 44200 other OPPS APC 44200 44200 other OPPS APC 44200 51 22542 percent of total billed charges 44200 44200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE TAPERCUT STAINLESS STEEL 6 V-40 L18 IN MONOFILAMENT 4 STRAND SUP-M649G CDM 0270 RC outpatient 31.01 31.01 31.01 74 22.95 percent of total billed charges 31.01 93 25.12 percent of total billed charges 31.01 31.01 other OPPS APC 31.01 31.01 other OPPS APC 31.01 27.63 8.57 percent of total billed charges 31.01 31.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING WOUND ABTHERA FOAM OPEN ABDOMEN PAD STERILE LATEX FREE DISPOSABLE SUP-M8275026/5.S CDM 0270 RC outpatient 1255.77 1255.77 1255.77 74 929.27 percent of total billed charges 1255.77 93 1017.17 percent of total billed charges 1255.77 1255.77 other OPPS APC 1255.77 1255.77 other OPPS APC 1255.77 27.63 346.97 percent of total billed charges 1255.77 1255.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DRESSING GRANUFOAM SENSAT.R.A.C. V.A.C. POLYURETHANE FOAM THK3.3 CM SMALL STANDARD L10 CM X W7.5 CM 1 ADHESIVE DRAPE PAD HYDROPHOBIC FLEXIBLE DISPOSABLE SUP-M8275051/10 CDM 270009205 LOCAL 0270 RC outpatient 27.53 27.53 27.53 74 20.37 percent of total billed charges 27.53 93 22.3 percent of total billed charges 27.53 27.53 other OPPS APC 27.53 27.53 other OPPS APC 27.53 27.63 7.61 percent of total billed charges 27.53 27.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DRESSING GRANUFOAM SENSATRAC VAC POLYURETHANE FOAM THK3.3 CM MEDIUM STANDARD L18 CM X W12.5 CM 2 ADHESIVE DRAPE PAD HARD TO REACH FLEXIBLE HYDROPHOBIC SUP-M8275052/10 CDM 270009207 LOCAL 0270 RC outpatient 34.72 34.72 34.72 74 25.69 percent of total billed charges 34.72 93 28.12 percent of total billed charges 34.72 34.72 other OPPS APC 34.72 34.72 other OPPS APC 34.72 27.63 9.59 percent of total billed charges 34.72 34.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DRESSING GRANUFOAM VAC POLYURETHANE FOAM HYDROPHOBIC THK3.3 CM LARGE STANDARD L26 CM X W15 CM 2 ADHESIVE DRAPE SENSATRAC PAD HARD TO REACH FLEXIBLE BLACK SUP-M8275053/10 CDM 270009208 LOCAL 0270 RC outpatient 47.89 47.89 47.89 74 35.44 percent of total billed charges 47.89 93 38.79 percent of total billed charges 47.89 47.89 other OPPS APC 47.89 47.89 other OPPS APC 47.89 27.63 13.23 percent of total billed charges 47.89 47.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAD WOUND DRAIN SENSATRAC VAC TUBE CLAMP CONNECTOR STERILE DISPOSABLE SUP-M8275057/10 CDM 0270 RC outpatient 44.04 44.04 44.04 74 32.59 percent of total billed charges 44.04 93 35.67 percent of total billed charges 44.04 44.04 other OPPS APC 44.04 44.04 other OPPS APC 44.04 27.63 12.17 percent of total billed charges 44.04 44.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANISTER WOUND DRAIN INFOVAC C500 ML GEL TUBE CLAMP CONNECTOR CHARCOAL FILTER STERILE DISPOSABLE SUP-M8275063/10 CDM 270009209 LOCAL 0270 RC outpatient 35.92 35.92 35.92 74 26.58 percent of total billed charges 35.92 93 29.1 percent of total billed charges 35.92 35.92 other OPPS APC 35.92 35.92 other OPPS APC 35.92 27.63 9.92 percent of total billed charges 35.92 35.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DRESSING GRANUFOAM SILVER SENSATRAC VAC POLYURETHANE FOAM THK3.3 CM MEDIUM L18 CM X W12.5 CM ADHESIVE DRAPE PAD WASHABLE STERILE BLACK SUP-M8275096/10 CDM 0270 RC outpatient 143.24 143.24 143.24 74 106 percent of total billed charges 143.24 93 116.02 percent of total billed charges 143.24 143.24 other OPPS APC 143.24 143.24 other OPPS APC 143.24 27.63 39.58 percent of total billed charges 143.24 143.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE PERMA-HAND SILK 0 SH L30 IN BRAID 4 STRAND BLACK SUP-M834G CDM 0270 RC outpatient 18.34 18.34 18.34 74 13.57 percent of total billed charges 18.34 93 14.86 percent of total billed charges 18.34 18.34 other OPPS APC 18.34 18.34 other OPPS APC 18.34 27.63 5.07 percent of total billed charges 18.34 18.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE FEEDING TUBE LOPEZ VALVE UNIVERSAL DISPOSABLE NS LF ENTERAL 4 WAY 2 LUER LOCK MEDICATION PORT ROTATE SUP-M9000 CDM 0270 RC outpatient 4.96 4.96 4.96 74 3.67 percent of total billed charges 4.96 93 4.02 percent of total billed charges 4.96 4.96 other OPPS APC 4.96 4.96 other OPPS APC 4.96 27.63 1.37 percent of total billed charges 4.96 4.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SAGITTAL SAW BLADE LARGE SUP-MA-2108-109 CDM 0270 RC outpatient 127.4 127.4 127.4 74 94.28 percent of total billed charges 127.4 93 103.19 percent of total billed charges 127.4 127.4 other OPPS APC 127.4 127.4 other OPPS APC 127.4 27.63 35.2 percent of total billed charges 127.4 127.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL ACRYSOF 10D MODIFIED C BICONVEX 13MM 6MM BLUE MONOFLEX STERILE POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR SUP-MA60AC CDM V2631 CPT 0276 RC outpatient 348.4 348.4 348.4 57 198.59 percent of total billed charges 348.4 93 282.2 percent of total billed charges 348.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 348.4 other OPPS APC 348.4 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 348.4 other OPPS APC 348.4 51 177.68 percent of total billed charges 348.4 348.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR ACRYSOF EXPAND MONOFLEX 5 D +2.5 DIOPTER MODIFIED C MENISCUS L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE UV ABSORBENT STERILE BLUE APHAKIA 118.9 A-CONSTANT SUP-MA60MA.025 CDM V2631 CPT 0276 RC outpatient 325 325 325 57 185.25 percent of total billed charges 325 93 263.25 percent of total billed charges 325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 325 other OPPS APC 325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 325 other OPPS APC 325 51 165.75 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCATHETER 165 CM L .008 IN GUIDEWIRE 1.2 FR .009 IN FLOW-DEPENDENT MAGIC SUP-MAGIC1.2F CDM 0270 RC outpatient 3367 3367 3367 74 2491.58 percent of total billed charges 3367 93 2727.27 percent of total billed charges 3367 3367 other OPPS APC 3367 3367 other OPPS APC 3367 27.63 930.3 percent of total billed charges 3367 3367 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCATHETER 165 CM L 1.2 FR .009 IN .03 IN OLIVE TIP FLOW-DEPENDENT MAGIC SUP-MAGIC1.2OLIVE CDM 0270 RC outpatient 2587 2587 2587 74 1914.38 percent of total billed charges 2587 93 2095.47 percent of total billed charges 2587 2587 other OPPS APC 2587 2587 other OPPS APC 2587 27.63 714.79 percent of total billed charges 2587 2587 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR ENDOSCOPIC ID8 MM FLEXIBLE STERILE DISPOSABLE LTF-160/240 PLEURAVIDEOSCOPE SUP-MAJ-1058 CDM 0270 RC outpatient 144.26 144.26 144.26 74 106.75 percent of total billed charges 144.26 93 116.85 percent of total billed charges 144.26 144.26 other OPPS APC 144.26 144.26 other OPPS APC 144.26 27.63 39.86 percent of total billed charges 144.26 144.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON ENDOSCOPIC STERILE LATEX BFUC160F SUP-MAJ-1351 CDM 0270 RC outpatient 1434.84 1434.84 1434.84 74 1061.78 percent of total billed charges 1434.84 93 1162.22 percent of total billed charges 1434.84 1434.84 other OPPS APC 1434.84 1434.84 other OPPS APC 1434.84 27.63 396.45 percent of total billed charges 1434.84 1434.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AIR/WATER PROVENTIL ATTACH ULTRASOUND SCOPE SUP-MAJ-1444 CDM 0270 RC outpatient 825.6 825.6 825.6 74 610.94 percent of total billed charges 825.6 93 668.74 percent of total billed charges 825.6 825.6 other OPPS APC 825.6 825.6 other OPPS APC 825.6 27.63 228.11 percent of total billed charges 825.6 825.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE SUCTION VISERA FLEXIBLE ATTACHMENT STERILE DISPOSABLE BRONCHOSCOPE SUP-MAJ-209 CDM 0270 RC outpatient 36.76 36.76 36.76 74 27.2 percent of total billed charges 36.76 93 29.78 percent of total billed charges 36.76 36.76 other OPPS APC 36.76 36.76 other OPPS APC 36.76 27.63 10.16 percent of total billed charges 36.76 36.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE BIOPSY BRONCHUS VENTRICLE STERILE DISPOSABLE BRONCHOSCOPE SUP-MAJ-210 CDM outpatient 16.65 16.65 16.65 16.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER ENDOSCOPE DISTAL STERILE LATEX FREE DISPOSABLE SUP-MAJ-2315 CDM 0270 RC outpatient 278.46 278.46 278.46 74 206.06 percent of total billed charges 278.46 93 225.55 percent of total billed charges 278.46 278.46 other OPPS APC 278.46 278.46 other OPPS APC 278.46 27.63 76.94 percent of total billed charges 278.46 278.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ENDOSCOPIC ULTRASOUND BALLOON CUFF LATEX SUP-MAJ-233 CDM 0270 RC outpatient 90.61 90.61 90.61 74 67.05 percent of total billed charges 90.61 93 73.39 percent of total billed charges 90.61 90.61 other OPPS APC 90.61 90.61 other OPPS APC 90.61 27.63 25.04 percent of total billed charges 90.61 90.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH ENDOSCOPIC OD2.6 MM ULTRASOUND CUFF STERILE LATEX DISPOSABLE SUP-MAJ-643R CDM 0270 RC outpatient 456.25 456.25 456.25 74 337.63 percent of total billed charges 456.25 93 369.56 percent of total billed charges 456.25 456.25 other OPPS APC 456.25 456.25 other OPPS APC 456.25 27.63 126.06 percent of total billed charges 456.25 456.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK PHACOEMULSIFICATION RING INJECTOR SUP-MAL-0001-1 CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE HEMOSTASIS ACCESS PLUS VALUELINK LARGE BORE SUP-MAP150 CDM 0270 RC outpatient 30.37 30.37 30.37 74 22.47 percent of total billed charges 30.37 93 24.6 percent of total billed charges 30.37 30.37 other OPPS APC 30.37 30.37 other OPPS APC 30.37 27.63 8.39 percent of total billed charges 30.37 30.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE HEMOSTASIS DOUBLEPLAY POLYCARBONATE SILICONE ID9 FR 2 LARGE BORE SUP-MAP220 CDM 0270 RC outpatient 33.75 33.75 33.75 74 24.98 percent of total billed charges 33.75 93 27.34 percent of total billed charges 33.75 33.75 other OPPS APC 33.75 33.75 other OPPS APC 33.75 27.63 9.33 percent of total billed charges 33.75 33.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE HEMOSTASIS PHD METAL POLYCARBONATE SILICONE ID 7.3 FR INSERTION TOOL TORQUE DEVICE COMPRESSION SEAL PUSH RELEASE MECHANISM CLEAR SUP-MAP802 CDM 0481 RC outpatient 57.2 57.2 57.2 74 42.33 percent of total billed charges 57.2 93 46.33 percent of total billed charges 57.2 57.2 other OPPS APC 57.2 57.2 other OPPS APC 57.2 51 29.17 percent of total billed charges 57.2 57.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ELECTRODE ELECTROSURGICAL ISOLATOR TRANSPOLAR PEN L19 CM MULTIFUNCTIONAL LINEAR ABLATION SUP-MAX1 CDM 0270 RC outpatient 4940 4940 4940 74 3655.6 percent of total billed charges 4940 93 4001.4 percent of total billed charges 4940 4940 other OPPS APC 4940 4940 other OPPS APC 4940 27.63 1364.92 percent of total billed charges 4940 4940 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SENSOR PULSE OXIMETER FINGER DISPOSABLE ADULT 18IN SUP-MAXA CDM 270009154 LOCAL 0270 RC outpatient 10.8 10.8 10.8 74 7.99 percent of total billed charges 10.8 93 8.75 percent of total billed charges 10.8 10.8 other OPPS APC 10.8 10.8 other OPPS APC 10.8 27.63 2.98 percent of total billed charges 10.8 10.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SENSOR PULSE OXIMETRY DISPOSABLE INFANT ADHESIVE SUP-MAXI CDM outpatient 28.68 28.68 28.68 28.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC MAXIMO II CRT SUP-MAXIICRTDMMMM CDM 0275 RC outpatient 58931.6 58931.6 58931.6 57 33591 percent of total billed charges 58931.6 93 47734.6 percent of total billed charges 58931.6 58931.6 other OPPS APC 58931.6 58931.6 other OPPS APC 58931.6 51 30055.1 percent of total billed charges 58931.6 58931.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC MAXIMO II VR SYSTEM ICD SUP-MAXIIDRMMEM CDM 0275 RC outpatient 48404.2 48404.2 48404.2 57 27590.4 percent of total billed charges 48404.2 93 39207.4 percent of total billed charges 48404.2 48404.2 other OPPS APC 48404.2 48404.2 other OPPS APC 48404.2 51 24686.1 percent of total billed charges 48404.2 48404.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEFIBRILLATOR CARDIAC MAXIMO II VR SYSTEM ICD SUP-MAXIIVREMEM CDM 0275 RC outpatient 41342.6 41342.6 41342.6 57 23565.3 percent of total billed charges 41342.6 93 33487.5 percent of total billed charges 41342.6 41342.6 other OPPS APC 41342.6 41342.6 other OPPS APC 41342.6 51 21084.7 percent of total billed charges 41342.6 41342.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SENSOR PULSE OXIMETRY DISPOSABLE PEDIATRIC ADHESIVE STRAP 18IN CABLE F/OXISENSOR II SUP-MAXP CDM 0270 RC outpatient 22.06 22.06 22.06 74 16.32 percent of total billed charges 22.06 93 17.87 percent of total billed charges 22.06 22.06 other OPPS APC 22.06 22.06 other OPPS APC 22.06 27.63 6.1 percent of total billed charges 22.06 22.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MOBI-C 13X15 SUP-MB3355 CDM 0270 RC outpatient 14040 14040 14040 74 10389.6 percent of total billed charges 14040 93 11372.4 percent of total billed charges 14040 14040 other OPPS APC 14040 14040 other OPPS APC 14040 27.63 3879.25 percent of total billed charges 14040 14040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MOBI-C CERVICAL DISC 15X15X5 SUP-MB3555 CDM 270010000 LOCAL 0270 RC outpatient 14040 14040 14040 74 10389.6 percent of total billed charges 14040 93 11372.4 percent of total billed charges 14040 14040 other OPPS APC 14040 14040 other OPPS APC 14040 27.63 3879.25 percent of total billed charges 14040 14040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MOBI-C CERVICAL DISC 15X17X5 SUP-MB3575 CDM 270010000 LOCAL 0270 RC outpatient 14040 14040 14040 74 10389.6 percent of total billed charges 14040 93 11372.4 percent of total billed charges 14040 14040 other OPPS APC 14040 14040 other OPPS APC 14040 27.63 3879.25 percent of total billed charges 14040 14040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND 5 V-37 L30 IN BRAID 4 STRAND GREEN SUP-MB66G CDM 0270 RC outpatient 37.13 37.13 37.13 74 27.48 percent of total billed charges 37.13 93 30.08 percent of total billed charges 37.13 37.13 other OPPS APC 37.13 37.13 other OPPS APC 37.13 27.63 10.26 percent of total billed charges 37.13 37.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PANTS INCONTINENCE PROTECTION PLUS MESH 2XL OD38-58 IN LATEX FREE DISPOSABLE MATERNITY SUP-MBP3704 CDM 0270 RC outpatient 1.05 1.05 1.05 74 0.78 percent of total billed charges 1.05 93 0.85 percent of total billed charges 1.05 1.05 other OPPS APC 1.05 1.05 other OPPS APC 1.05 27.63 0.29 percent of total billed charges 1.05 1.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL SHANK CANNULATED 5.5MM X 35MM SUP-MC1-155035 CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW CORTICAL SHANK CANNULATED 5.5MM X 40MM SUP-MC1-155040 CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD MARINER CORTICAL CONTOURED 35MM PRECONTOURED SUP-MC1-200035 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROD MARINER CORTICAL CONTOURED 40MM PRECONTOURED SUP-MC1-200040 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ROI-C STANDARD H5-7 MM SPINE LEVEL 2 LOCK SUP-MC1005T CDM 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE ROI-C LONG H8-10 MM SPINE LEVEL 2 LOCK SUP-MC1006T CDM 270010020 LOCAL 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL MC+ L15.5 MM X W14 MM X H5 MM SUP-MC1321P CDM 270010020 LOCAL 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL ROI-C L15.5 MM X W14 MM X H6 MM SUP-MC1322P CDM 270010020 LOCAL 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL ROI-C L15.5 MM X W14 MM X H7 MM SUP-MC1323P CDM 270010020 LOCAL 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL MC+ L17 MM X W14 MM X H6 MM SUP-MC1332P CDM 270010020 LOCAL 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL ROI-C L17 MM X W14 MM X H7 MM SUP-MC1333P CDM 270010020 LOCAL 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL ROI-C L14 MM X W12 MM X H5 MM SUP-MC1341P CDM 270010020 LOCAL 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL ROI-C L14 MM X W12 MM X H6 MM SUP-MC1342P CDM 270010020 LOCAL 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL ROI-C L15.5 MM X W12 MM X H5 MM SUP-MC1351P CDM 270010020 LOCAL 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSTRUMENT BIOPSY BARD MAX-CORE ANGLE 22MM 10CM 7.8CM 14GA PINK DISPOSABLE STERILE LF PROSTATIC 2 TRIGGER ULTRA SHARP SUP-MC1410 CDM 0270 RC outpatient 121.08 121.08 121.08 74 89.6 percent of total billed charges 121.08 93 98.07 percent of total billed charges 121.08 121.08 other OPPS APC 121.08 121.08 other OPPS APC 121.08 27.63 33.45 percent of total billed charges 121.08 121.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSTRUMENT BIOPSY BARD MAX-CORE L16 CM OD14 GA 2 TRIGGER ULTRA SHARP TIP BEVEL TROCAR ANGLE NOTCH STERILE LATEX FREE DISPOSABLE SUP-MC1416 CDM 0270 RC outpatient 141.26 141.26 141.26 74 104.53 percent of total billed charges 141.26 93 114.42 percent of total billed charges 141.26 141.26 other OPPS APC 141.26 141.26 other OPPS APC 141.26 27.63 39.03 percent of total billed charges 141.26 141.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ROI-C LORDOTIC 6MM 14X15.5MM SUP-MC1422P CDM 270010020 LOCAL 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ROI-C LORDOTIC 7MM 14X15.5MM SUP-MC1423P CDM 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ROI-C LORDOTIC 6MM 12X14MM SUP-MC1442P CDM 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAGE SPINAL ROI-C D12 MM LORDOTIC W14 MM X H7-4.1 MM .38 ML CERVICAL SUP-MC1443P CDM 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSTRUMENT BIOPSY BARD MAX-CORE ANGLE 22MM 20CM 13.8CM 18GA PINK DISPOSABLE STERILE LF PROSTATIC 2 TRIGGER ULTRA SHARP SUP-MC1820 CDM 0270 RC outpatient 120.99 120.99 120.99 74 89.53 percent of total billed charges 120.99 93 98 percent of total billed charges 120.99 120.99 other OPPS APC 120.99 120.99 other OPPS APC 120.99 27.63 33.43 percent of total billed charges 120.99 120.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROWLER EX MICROCATHETER .021 160CM SUP-MC2165S2U CDM 0270 RC outpatient 3244.98 3244.98 3244.98 74 2401.29 percent of total billed charges 3244.98 93 2628.43 percent of total billed charges 3244.98 3244.98 other OPPS APC 3244.98 3244.98 other OPPS APC 3244.98 27.63 896.59 percent of total billed charges 3244.98 3244.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER SURGICAL MIDAS REX LEGEND DIAMOND METAL L.8 MM OD25.4 MM WHEEL SUP-MC254 CDM 0270 RC outpatient 574.55 574.55 574.55 74 425.17 percent of total billed charges 574.55 93 465.39 percent of total billed charges 574.55 574.55 other OPPS APC 574.55 574.55 other OPPS APC 574.55 27.63 158.75 percent of total billed charges 574.55 574.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTER SURGICAL MIDAS REX LEGEND CARBIDE METAL L18.3 MM OD3 MM SUP-MC30 CDM 270010028 LOCAL 0270 RC outpatient 694.43 694.43 694.43 74 513.88 percent of total billed charges 694.43 93 562.49 percent of total billed charges 694.43 694.43 other OPPS APC 694.43 694.43 other OPPS APC 694.43 27.63 191.87 percent of total billed charges 694.43 694.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER INTERNAL CLIP 30D LG 13IN LIGATE MULTIPLE OPEN STERILE LIGACLIP LF DISPOSABLE SUP-MCL20 CDM 270009085 LOCAL 0270 RC outpatient 68.68 68.68 68.68 74 50.82 percent of total billed charges 68.68 93 55.63 percent of total billed charges 68.68 68.68 other OPPS APC 68.68 68.68 other OPPS APC 68.68 27.63 18.98 percent of total billed charges 68.68 68.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER INTERNAL CLIP 30D MED 11.5IN TITANIUM MULTIPLE LIGATE LIGACLIP STERILE LF SUP-MCM20 CDM 270009085 LOCAL 0270 RC outpatient 68.68 68.68 68.68 74 50.82 percent of total billed charges 68.68 93 55.63 percent of total billed charges 68.68 68.68 other OPPS APC 68.68 68.68 other OPPS APC 68.68 27.63 18.98 percent of total billed charges 68.68 68.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MONOCRYL PLUS 3-0 SH L27 IN MONOFILAMENT ANTIBACTERIAL SUP-MCP316H CDM 0270 RC outpatient 5.8 5.8 5.8 74 4.29 percent of total billed charges 5.8 93 4.7 percent of total billed charges 5.8 5.8 other OPPS APC 5.8 5.8 other OPPS APC 5.8 27.63 1.6 percent of total billed charges 5.8 5.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MONOCRYL MULTIPASS 4-0 PS-2 L18 IN MONOFILAMENT UNDYED SUP-MCP496G CDM 0270 RC outpatient 13.49 13.49 13.49 74 9.98 percent of total billed charges 13.49 93 10.93 percent of total billed charges 13.49 13.49 other OPPS APC 13.49 13.49 other OPPS APC 13.49 27.63 3.73 percent of total billed charges 13.49 13.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC 20-23MM 0-40MM COREVALVE 26MM HEART PORCINE PERICARDIUM NITINOL FRAME SUP-MCS-P3-26-AOA-US CDM 0270 RC outpatient 78000 78000 78000 74 57720 percent of total billed charges 78000 93 63180 percent of total billed charges 78000 78000 other OPPS APC 78000 78000 other OPPS APC 78000 27.63 21551.4 percent of total billed charges 78000 78000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC COREVALVE PORCINE PERICARDIUM 29 MM OD23-26 MM ODSEC0-43 MM HEART NITINOL FRAME BIOPROSTHESIS SUP-MCS-P3-29-AOA-US CDM 0270 RC outpatient 78000 78000 78000 74 57720 percent of total billed charges 78000 93 63180 percent of total billed charges 78000 78000 other OPPS APC 78000 78000 other OPPS APC 78000 27.63 21551.4 percent of total billed charges 78000 78000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC COREVALVE PORCINE PERICARDIUM 31 MM OD26-29 MM ODSEC0-43 MM HEART NITINOL FRAME BIOPROSTHESIS SUP-MCS-P3-31-AOA-US CDM 0270 RC outpatient 78000 78000 78000 74 57720 percent of total billed charges 78000 93 63180 percent of total billed charges 78000 78000 other OPPS APC 78000 78000 other OPPS APC 78000 27.63 21551.4 percent of total billed charges 78000 78000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC COREVALVE PORCINE PERICARDIUM 26 MM OD20-23 MM ODSEC0-40 MM HEART NITINOL FRAME BIOPROSTHESIS SUP-MCS-PC-26-AOA-US CDM 0270 RC outpatient 78000 78000 78000 74 57720 percent of total billed charges 78000 93 63180 percent of total billed charges 78000 78000 other OPPS APC 78000 78000 other OPPS APC 78000 27.63 21551.4 percent of total billed charges 78000 78000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER INTERNAL CLIP LIGACLIP SM 23.8CM TITANIUM DISPOSABLE STERILE LF LIGATE MULTIPLE OPEN SUP-MCS20 CDM 270009085 LOCAL 0270 RC outpatient 68.68 68.68 68.68 74 50.82 percent of total billed charges 68.68 93 55.63 percent of total billed charges 68.68 68.68 other OPPS APC 68.68 68.68 other OPPS APC 68.68 27.63 18.98 percent of total billed charges 68.68 68.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARD INDICATOR STERILCONTAINER STERILE STEAM ETO STERILIZATION AESCULAP GENERATION 3 CONTAINER SUP-MD347 CDM 0270 RC outpatient 0.29 0.29 0.29 74 0.21 percent of total billed charges 0.29 93 0.23 percent of total billed charges 0.29 0.29 other OPPS APC 0.29 0.29 other OPPS APC 0.29 27.63 0.08 percent of total billed charges 0.29 0.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MECHANICAL DETACHMENT HANDLE SUP-MDH1 CDM 0270 RC outpatient 711.93 711.93 711.93 74 526.83 percent of total billed charges 711.93 93 576.66 percent of total billed charges 711.93 711.93 other OPPS APC 711.93 711.93 other OPPS APC 711.93 27.63 196.71 percent of total billed charges 711.93 711.93 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JELLY LUBRICANT E-Z 2 OZ WATER SOLUBLE FLIP TOP TUBE GREASELESS STERILE LATEX FREE SUP-MDS032285 CDM 0270 RC outpatient 5.38 5.38 5.38 74 3.98 percent of total billed charges 5.38 93 4.36 percent of total billed charges 5.38 5.38 other OPPS APC 5.38 5.38 other OPPS APC 5.38 27.63 1.49 percent of total billed charges 5.38 5.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REMOVER NAIL POLISH PDI 2.6X1.2IN LF PAD NONFLAMMABLE ACETONE FREE SUP-MDS090780 CDM outpatient 0.03 0.03 0.03 0.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALCOHOL 70% ISOPROPYL 16OZ SUP-MDS098003Z CDM 0270 RC outpatient 4.43 4.43 4.43 74 3.28 percent of total billed charges 4.43 93 3.59 percent of total billed charges 4.43 4.43 other OPPS APC 4.43 4.43 other OPPS APC 4.43 27.63 1.22 percent of total billed charges 4.43 4.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION ANTISEPTIC 70% ISOPROPYL ALCOHOL 16 OZ BOTTLE LATEX FREE SUP-MDS098003Z CDM 0270 RC outpatient 4.58 4.58 4.58 74 3.39 percent of total billed charges 4.58 93 3.71 percent of total billed charges 4.58 4.58 other OPPS APC 4.58 4.58 other OPPS APC 4.58 27.63 1.27 percent of total billed charges 4.58 4.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION ANTISEPTIC 70% ISOPROPYL ALCOHOL 4 OZ BOTTLE LATEX FREE SUP-MDS098011 CDM 0270 RC outpatient 3.21 3.21 3.21 74 2.38 percent of total billed charges 3.21 93 2.6 percent of total billed charges 3.21 3.21 other OPPS APC 3.21 3.21 other OPPS APC 3.21 27.63 0.89 percent of total billed charges 3.21 3.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HYDROGEN PEROXIDE 4OZ SUP-MDS098014 CDM 0270 RC outpatient 1.53 1.53 1.53 74 1.13 percent of total billed charges 1.53 93 1.24 percent of total billed charges 1.53 1.53 other OPPS APC 1.53 1.53 other OPPS APC 1.53 27.63 0.42 percent of total billed charges 1.53 1.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION ANTISEPTIC 3% HYDROGEN PEROXIDE 8 OZ FIRST AID ORAL DEBRIDE AGENT LATEX FREE SUP-MDS098015 CDM 0270 RC outpatient 2.7 2.7 2.7 74 2 percent of total billed charges 2.7 93 2.19 percent of total billed charges 2.7 2.7 other OPPS APC 2.7 2.7 other OPPS APC 2.7 27.63 0.75 percent of total billed charges 2.7 2.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION SCRUB DYNA-HEX 4 4% CHG 32 OZ FLIP TOP BOTTLE ANTISEPTIC LIQUID LATEX FREE SUP-MDS098725 CDM outpatient 18.41 18.41 18.41 18.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOTHBRUSH ORAL NYLON ADULT 30 TUFT BRISTLE EXTRA SOFT LATEX FREE DISPOSABLE SUP-MDS136000 CDM outpatient 0.09 0.09 0.09 0.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR COTTON TIP WOOD 6 STERILE SUP-MDS202000 CDM 0270 RC outpatient 0.04 0.04 0.04 74 0.03 percent of total billed charges 0.04 93 0.03 percent of total billed charges 0.04 0.04 other OPPS APC 0.04 0.04 other OPPS APC 0.04 27.63 0.01 percent of total billed charges 0.04 0.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR FIBER TIPPED PREMIERPRO 6IN COTTON DISPOSABLE NS LF SOFT ABSORBENT STURDY SUP-MDS202055ZZ CDM 0270 RC outpatient 0.02 0.02 0.02 74 0.01 percent of total billed charges 0.02 93 0.02 percent of total billed charges 0.02 0.02 other OPPS APC 0.02 0.02 other OPPS APC 0.02 27.63 0.01 percent of total billed charges 0.02 0.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISINFECTANT INSTRUMENT ORTHOPHTHALDEHYDE 1 GL HIGH LEVEL LATEX FREE SUP-MDS88OPA28 CDM outpatient 101.19 101.19 101.19 101.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW DISTRACTION STAINLESS STEEL L12 MM SPINE CERVICAL ANTERIOR SHARP TIP SELF TAP THREAD PIN UNIVERSAL BULLET HEAD STERILE LATEX FREE DISPOSABLE SUP-MDS9091212 CDM 0270 RC outpatient 85.07 85.07 85.07 74 62.95 percent of total billed charges 85.07 93 68.91 percent of total billed charges 85.07 85.07 other OPPS APC 85.07 85.07 other OPPS APC 85.07 27.63 23.5 percent of total billed charges 85.07 85.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW DISTRACTION 14MM SS DISPOSABLE STERILE LF SPINE CERVICAL ANTERIOR SHARP TIP SELF TAP THREAD PIN UNIVERSAL BULLET SUP-MDS9091414 CDM 0270 RC outpatient 73.11 73.11 73.11 74 54.1 percent of total billed charges 73.11 93 59.22 percent of total billed charges 73.11 73.11 other OPPS APC 73.11 73.11 other OPPS APC 73.11 27.63 20.2 percent of total billed charges 73.11 73.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRUTCH WALKING ALUMINUM C300 LB ADULT L62-70 IN AXILLARY STYLE PUSH BUTTON SUP-MDSV80535 CDM 270009111 LOCAL 0270 RC outpatient 21.08 21.08 21.08 74 15.6 percent of total billed charges 21.08 93 17.07 percent of total billed charges 21.08 21.08 other OPPS APC 21.08 21.08 other OPPS APC 21.08 27.63 5.82 percent of total billed charges 21.08 21.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLIPPERS PATIENT TERRYCLOTH ADULT LARGE 2 TREAD SLIP ON OFF LATEX FREE BLUE SUP-MDTDBLTREADL CDM 270009080 LOCAL 0270 RC outpatient 0.91 0.91 0.91 74 0.67 percent of total billed charges 0.91 93 0.74 percent of total billed charges 0.91 0.91 other OPPS APC 0.91 0.91 other OPPS APC 0.91 27.63 0.25 percent of total billed charges 0.91 0.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLIPPERS PATIENT TERRYCLOTH PEDIATRIC TODDLER 2 TREAD SLIP ON OFF LATEX FREE TEAL SUP-MDTDBLTREADT CDM 270009080 LOCAL 0270 RC outpatient 1.03 1.03 1.03 74 0.76 percent of total billed charges 1.03 93 0.83 percent of total billed charges 1.03 1.03 other OPPS APC 1.03 1.03 other OPPS APC 1.03 27.63 0.28 percent of total billed charges 1.03 1.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLIPPERS PATIENT TERRYCLOTH ADULT 2XL 2 TREAD SLIP ON OFF LATEX FREE GRAY SUP-MDTDBLTREDXXL CDM 270009080 LOCAL 0270 RC outpatient 1.05 1.05 1.05 74 0.78 percent of total billed charges 1.05 93 0.85 percent of total billed charges 1.05 1.05 other OPPS APC 1.05 1.05 other OPPS APC 1.05 27.63 0.29 percent of total billed charges 1.05 1.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLIPPERS PATIENT BARIATRIC 2 TREAD GRAY SUP-MDTDBLTRXXXL CDM 270009080 LOCAL 0270 RC outpatient 1.23 1.23 1.23 74 0.91 percent of total billed charges 1.23 93 1 percent of total billed charges 1.23 1.23 other OPPS APC 1.23 1.23 other OPPS APC 1.23 27.63 0.34 percent of total billed charges 1.23 1.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FOOTWEAR PATIENT PEDIATRIC TERRY IN YELLOW SUP-MDTPS4B01FPY CDM 270009080 LOCAL 0270 RC outpatient 0.78 0.78 0.78 74 0.58 percent of total billed charges 0.78 93 0.63 percent of total billed charges 0.78 0.78 other OPPS APC 0.78 0.78 other OPPS APC 0.78 27.63 0.22 percent of total billed charges 0.78 0.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLIPPERS FALL PREVENTION DOUBLE TREAD RED L SUP-MDTPS4B04FPR CDM 270009080 LOCAL 0270 RC outpatient 1.02 1.02 1.02 74 0.75 percent of total billed charges 1.02 93 0.83 percent of total billed charges 1.02 1.02 other OPPS APC 1.02 1.02 other OPPS APC 1.02 27.63 0.28 percent of total billed charges 1.02 1.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLIPPERS FALL PREVENTION DOUBLE TREAD RED XL SUP-MDTPS4B05FPR CDM 270009080 LOCAL 0270 RC outpatient 1.13 1.13 1.13 74 0.84 percent of total billed charges 1.13 93 0.92 percent of total billed charges 1.13 1.13 other OPPS APC 1.13 1.13 other OPPS APC 1.13 27.63 0.31 percent of total billed charges 1.13 1.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLIPPERS FALL PREVENTION DOUBLE TREAD RED XXL SUP-MDTPS4B06FPR CDM 270009080 LOCAL 0270 RC outpatient 1.11 1.11 1.11 74 0.82 percent of total billed charges 1.11 93 0.9 percent of total billed charges 1.11 1.11 other OPPS APC 1.11 1.11 other OPPS APC 1.11 27.63 0.31 percent of total billed charges 1.11 1.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLIPPERS FALL PREVENTION BARIATRIC DOUBLE TREAD RED SUP-MDTPS4B07FPR CDM 270009080 LOCAL 0270 RC outpatient 1.21 1.21 1.21 74 0.9 percent of total billed charges 1.21 93 0.98 percent of total billed charges 1.21 1.21 other OPPS APC 1.21 1.21 other OPPS APC 1.21 27.63 0.33 percent of total billed charges 1.21 1.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRIPPER MEDENVISION SUP-ME-GR1000 CDM 0270 RC outpatient 357.5 357.5 357.5 74 264.55 percent of total billed charges 357.5 93 289.58 percent of total billed charges 357.5 357.5 other OPPS APC 357.5 357.5 other OPPS APC 357.5 27.63 98.78 percent of total billed charges 357.5 357.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAD POSITIONING SHEEPSKIN KNEE REPLACEMENT NONSTERILE SUP-ME3333 CDM 0270 RC outpatient 59.67 59.67 59.67 74 44.16 percent of total billed charges 59.67 93 48.33 percent of total billed charges 59.67 59.67 other OPPS APC 59.67 59.67 other OPPS APC 59.67 27.63 16.49 percent of total billed charges 59.67 59.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST TRUFORM 2 NATRELLE BIOCELL MATRIX SILICONE P4.2 CM MODERATE HEIGHT FULL PROJECTION W10.5 CM X H9.6 CM 195 SUP-MF-410195 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST TRUFORM 2 NATRELLE BIOCELL MATRIX SILICONE P4.4 CM MODERATE HEIGHT FULL PROJECTION W11 CM X H10.1 CM 225 SUP-MF-410225 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST TRUFORM 2 NATRELLE BIOCELL MATRIX SILICONE P4.8 CM MODERATE HEIGHT FULL PROJECTION W12 CM X H11.1 CM 295 GM STYLE 410MF GEL TEXTURE HIGHLY COHESIVE STERILE LATEX FREE SUP-MF-410295 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MODERATE HEIGHT FULL PROJECTION 470CC SUP-MF-410470 CDM 270010032 LOCAL 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE MATRIX P6.2 CM MODERATE HEIGHT FULL PROJECTION W15.5 CM X H13.9 CM 640 ML STYLE MF HIGHLY COHESIVE GEL STERILE LATEX FREE SUP-MF-410640 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RONGEUR SURGICAL DECKER 2 MM X 6 MM L152 MM STRAIGHT SUP-MF055R CDM outpatient 1253.98 1253.98 1253.98 1253.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC FRONTRUNNER XP CTO L82 CM L76 CM OD4.5 FR MICROGUIDE STERILE LATEX FREE ACCEPTS 6 FR SHEATH SUP-MGC3990 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC FRONTRUNNER XP CTO L132 CM L126 CM OD4.5 FR MICROGUIDE STERILE LATEX FREE ACCEPTS 6 FR SHEATH SUP-MGX39140 CDM 0270 RC outpatient 566.8 566.8 566.8 74 419.43 percent of total billed charges 566.8 93 459.11 percent of total billed charges 566.8 566.8 other OPPS APC 566.8 566.8 other OPPS APC 566.8 27.63 156.61 percent of total billed charges 566.8 566.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL BIOGEL ORTHOPRO 7 298X91MM BROWN POLYISOPRENE STERILE LF POWDER FREE BEAD CUFF MICRO ROUGHENED NON SUP-MHC47670 CDM 0270 RC outpatient 170.16 170.16 170.16 74 125.92 percent of total billed charges 170.16 93 137.83 percent of total billed charges 170.16 170.16 other OPPS APC 170.16 170.16 other OPPS APC 170.16 27.63 47.02 percent of total billed charges 170.16 170.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM RETRACTOR JOSEPH LAMELAS ATRIAL LIFT SYSTEM 2 BLADE STABILIZATION POST INSERTION TIP SUP-MI-ALS-001 CDM 0270 RC outpatient 996.67 996.67 996.67 74 737.54 percent of total billed charges 996.67 93 807.3 percent of total billed charges 996.67 996.67 other OPPS APC 996.67 996.67 other OPPS APC 996.67 27.63 275.38 percent of total billed charges 996.67 996.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH MICRA INTRODUCER SUP-MI2355A CDM 0275 RC outpatient 1560 1560 1560 57 889.2 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 51 795.6 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC MICRA AV2 LEADLESS BUNDLE SUP-MICRAAV2SYSTEM CDM 0275 RC outpatient 31772 31772 31772 57 18110 percent of total billed charges 31772 93 25735.3 percent of total billed charges 31772 31772 other OPPS APC 31772 31772 other OPPS APC 31772 51 16203.7 percent of total billed charges 31772 31772 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM PACING MICRA AV SUP-MICRAAVTCPSYSTEM CDM 0275 RC outpatient 18150 18150 18150 57 10345.5 percent of total billed charges 18150 93 14701.5 percent of total billed charges 18150 18150 other OPPS APC 18150 18150 other OPPS APC 18150 51 9256.5 percent of total billed charges 18150 18150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM PACING MICRA TRANSCATHETER SUP-MICRATCPSYSTEM CDM 0275 RC outpatient 15650 15650 15650 57 8920.5 percent of total billed charges 15650 93 12676.5 percent of total billed charges 15650 15650 other OPPS APC 15650 15650 other OPPS APC 15650 51 7981.5 percent of total billed charges 15650 15650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC MICRA VR2 LEADLESS BUNDLE SUP-MICRAVR2SYSTEM CDM 0275 RC outpatient 24466 24466 24466 57 13945.6 percent of total billed charges 24466 93 19817.5 percent of total billed charges 24466 24466 other OPPS APC 24466 24466 other OPPS APC 24466 51 12477.7 percent of total billed charges 24466 24466 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE BIOCELL SILICONE MATRIX P4.8 CM MODERATE HEIGHT MODERATE PROJECTION W13 CM X H12.1 CM 360 ML STYLE 410MM HIGHLY COHESIVE GEL STERILE LATEX FREE SUP-MM-410360 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER PHLEBOTOMY VENOJECT II MULTISAMPLE EVACUATE MALE LUER SUP-MN2000T CDM 0270 RC outpatient 0.64 0.64 0.64 74 0.47 percent of total billed charges 0.64 93 0.52 percent of total billed charges 0.64 0.64 other OPPS APC 0.64 0.64 other OPPS APC 0.64 27.63 0.18 percent of total billed charges 0.64 0.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 2.25 X 8 SUP-MNC22508_52226 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 2.25 X 10 SUP-MNC22510_52227 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 2.25 X 13 SUP-MNC22513_52228 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 2.25 X 15 SUP-MNC22515_52229 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 2.5 X 8 SUP-MNC25008_52230 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 2.5 X 10 SUP-MNC25010_52231 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 2.5 X 13 SUP-MNC25013_52232 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 2.5 X 15 SUP-MNC25015_52233 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 2.75 X 8 SUP-MNC27508_52234 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 2.75 X 10 SUP-MNC27510_52235 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 2.75 X 13 SUP-MNC27513_52236 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 2.75 X 15 SUP-MNC27515_52237 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 3.0 X 8 SUP-MNC30008_52238 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 3.0 X 10 SUP-MNC30010_52239 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 3.0 X 13 SUP-MNC30013_52240 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 3.0 X 15 SUP-MNC30015_52241 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 3.0 X 18 SUP-MNC30018_52242 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 3.5 X 8 SUP-MNC35008_52243 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 3.5 X 10 SUP-MNC35010_52244 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 3.5 X 13 SUP-MNC35013_52245 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 3.5 X 15 SUP-MNC35015_52246 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 4.0 X 8 SUP-MNC40008_52247 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 4.0 X 10 SUP-MNC40010_52248 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 4.0 X 13 SUP-MNC40013_52249 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 4.0 X 15 SUP-MNC40015_52250 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 4.5 X 8 SUP-MNC45008_52251 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 4.5 X 10 SUP-MNC45010_52252 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 4.5 X 13 SUP-MNC45013_52253 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC NC BALLOON 4.5 X 15 SUP-MNC45015_52254 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON OCCLUSION GORE 10-37 MM L90 CM L4 CM MOLD STENT GRAFT OPTIMIZE SEAL ACCEPTS .035 IN GUIDEWIRE SUP-MOB37 CDM 0270 RC outpatient 1391 1391 1391 74 1029.34 percent of total billed charges 1391 93 1126.71 percent of total billed charges 1391 1391 other OPPS APC 1391 1391 other OPPS APC 1391 27.63 384.33 percent of total billed charges 1391 1391 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 1.50 X 9 SUP-MOZ15009_52193 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 1.50 X 12 SUP-MOZ15012_52194 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 1.50 X 15 SUP-MOZ15015_52195 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 2.0 X 9 SUP-MOZ20009_52196 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 2.0 X 12 SUP-MOZ20012_52197 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 2.0 X 15 SUP-MOZ20015_52198 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 2.5 X 9 SUP-MOZ25009_52199 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 2.5 X 14 SUP-MOZ25014_52200 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 2.5 X 17 SUP-MOZ25017_52201 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 2.5 X 20 SUP-MOZ25020_52202 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 3.0 X 9 SUP-MOZ30009_52212 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 3.0 X 14 SUP-MOZ30014_52213 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 3.0 X 17 SUP-MOZ30017_52214 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 3.0 X 20 SUP-MOZ30020_52215 CDM 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 3.0 X 25 SUP-MOZ30025_52216 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 3.0 X 30 SUP-MOZ30030_52217 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 3.0 X 38 SUP-MOZ30038_52218 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 3.0 X 41 SUP-MOZ30041_52219 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 3.5 X 9 SUP-MOZ35009_52220 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 3.5 X 14 SUP-MOZ35014_52221 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 3.5 X 17 SUP-MOZ35017_52222 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MOZEC BALLOON 3.5 X 20 SUP-MOZ35020_52223 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON MOZEC 3.5X25 RAPID EXCHANGE ELONGATE TIP PTCA SUP-MOZ35025_52224 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON MOZEC 3.5X30 RAPID EXCHANGE ELONGATE TIP PTCA SUP-MOZ35030_52225 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POTTS NEEDLE SUP-MPCN1802 CDM 0481 RC outpatient 21.45 21.45 21.45 74 15.87 percent of total billed charges 21.45 93 17.37 percent of total billed charges 21.45 21.45 other OPPS APC 21.45 21.45 other OPPS APC 21.45 51 10.94 percent of total billed charges 21.45 21.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 4F MICROPUNTURE SHEATH 4CM PEDS SUP-MPIS-401-PED-U-SST CDM 0270 RC outpatient 92.56 92.56 92.56 74 68.49 percent of total billed charges 92.56 93 74.97 percent of total billed charges 92.56 92.56 other OPPS APC 92.56 92.56 other OPPS APC 92.56 27.63 25.57 percent of total billed charges 92.56 92.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR PUSH-PLUS MICROPUNCTURE 40CM 10CM .018IN 5FR SS 1 PART NEEDLE STIFFENED CANNULA COAXIAL CATHETER SUP-MPIS-501-10.0-SC-SST CDM 0270 RC outpatient 113.59 113.59 113.59 74 84.06 percent of total billed charges 113.59 93 92.01 percent of total billed charges 113.59 113.59 other OPPS APC 113.59 113.59 other OPPS APC 113.59 27.63 31.38 percent of total billed charges 113.59 113.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET INTRODUCER MICROPUNCTURE PUSH-PLUS NITINOL .018 IN L40 CM L10 CM OD4 FR TRANSITIONLESS STIFFENED CANNULA PLATINUM TIP NITINOL WIREGUIDE COAXIAL CATHETER STERILE DISPOSABLE SUP-MPIS401-10.0SCNTSST CDM 0270 RC outpatient 127.84 127.84 127.84 74 94.6 percent of total billed charges 127.84 93 103.55 percent of total billed charges 127.84 127.84 other OPPS APC 127.84 127.84 other OPPS APC 127.84 27.63 35.32 percent of total billed charges 127.84 127.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER MICRO STIFFEN 4FR SUP-MPIS402-10.0SCNTUSST CDM 0270 RC outpatient 57.2 57.2 57.2 74 42.33 percent of total billed charges 57.2 93 46.33 percent of total billed charges 57.2 57.2 other OPPS APC 57.2 57.2 other OPPS APC 57.2 27.63 15.8 percent of total billed charges 57.2 57.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE MACROPLASTIQUE 2.5CC SUP-MPQ-2.5 CDM 0270 RC outpatient 2207.4 2207.4 2207.4 74 1633.48 percent of total billed charges 2207.4 93 1787.99 percent of total billed charges 2207.4 2207.4 other OPPS APC 2207.4 2207.4 other OPPS APC 2207.4 27.63 609.9 percent of total billed charges 2207.4 2207.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE BIOCELL SILICONE MATRIX P6.1 CM MODERATE HEIGHT FULL PROJECTION W15 CM X H13.6 CM 580 ML STYLE 410MF HIGHLY COHESIVE GEL STERILE LATEX FREE SUP-MR-410580 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MR8 ACORN L10 CM OD6 MM SUP-MR8-10AC60 CDM 0270 RC outpatient 463.71 463.71 463.71 74 343.15 percent of total billed charges 463.71 93 375.61 percent of total billed charges 463.71 463.71 other OPPS APC 463.71 463.71 other OPPS APC 463.71 27.63 128.12 percent of total billed charges 463.71 463.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MR8 DIAMOND BALL L10 CM OD3 MM SUP-MR8-10BA30D CDM 0270 RC outpatient 468.23 468.23 468.23 74 346.49 percent of total billed charges 468.23 93 379.27 percent of total billed charges 468.23 468.23 other OPPS APC 468.23 468.23 other OPPS APC 468.23 27.63 129.37 percent of total billed charges 468.23 468.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MR8 DIAMOND BALL L10 CM OD4 MM SUP-MR8-10BA40D CDM 0270 RC outpatient 497.64 497.64 497.64 74 368.25 percent of total billed charges 497.64 93 403.09 percent of total billed charges 497.64 497.64 other OPPS APC 497.64 497.64 other OPPS APC 497.64 27.63 137.5 percent of total billed charges 497.64 497.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MR8 BALL L10 CM OD5 MM SUP-MR8-10BA50 CDM 0270 RC outpatient 472.76 472.76 472.76 74 349.84 percent of total billed charges 472.76 93 382.94 percent of total billed charges 472.76 472.76 other OPPS APC 472.76 472.76 other OPPS APC 472.76 27.63 130.62 percent of total billed charges 472.76 472.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MR8 DIAMOND BALL L10 CM OD5 MM SUP-MR8-10BA50D CDM 0270 RC outpatient 481.81 481.81 481.81 74 356.54 percent of total billed charges 481.81 93 390.27 percent of total billed charges 481.81 481.81 other OPPS APC 481.81 481.81 other OPPS APC 481.81 27.63 133.12 percent of total billed charges 481.81 481.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MR8 CYLINDER L10 CM OD5 MM SUP-MR8-10CY50 CDM 0270 RC outpatient 454.66 454.66 454.66 74 336.45 percent of total billed charges 454.66 93 368.27 percent of total billed charges 454.66 454.66 other OPPS APC 454.66 454.66 other OPPS APC 454.66 27.63 125.62 percent of total billed charges 454.66 454.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MR8 MATCH HEAD L10 CM OD2.2 MM STERILE DISPOSABLE SUP-MR8-10MH22 CDM 0270 RC outpatient 407.16 407.16 407.16 74 301.3 percent of total billed charges 407.16 93 329.8 percent of total billed charges 407.16 407.16 other OPPS APC 407.16 407.16 other OPPS APC 407.16 27.63 112.5 percent of total billed charges 407.16 407.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MR8 MATCH HEAD L10 CM OD3 MM STERILE DISPOSABLE SUP-MR8-10MH30 CDM 0270 RC outpatient 425.26 425.26 425.26 74 314.69 percent of total billed charges 425.26 93 344.46 percent of total billed charges 425.26 425.26 other OPPS APC 425.26 425.26 other OPPS APC 425.26 27.63 117.5 percent of total billed charges 425.26 425.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MR8 TAPER L7 CM OD1.1 MM SUP-MR8-7TA11 CDM 0270 RC outpatient 359.66 359.66 359.66 74 266.15 percent of total billed charges 359.66 93 291.32 percent of total billed charges 359.66 359.66 other OPPS APC 359.66 359.66 other OPPS APC 359.66 27.63 99.37 percent of total billed charges 359.66 359.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MR8 L7 CM L4 MM OD1 MM TWIST DRILL SUP-MR8-7TD104 CDM 0270 RC outpatient 359.66 359.66 359.66 74 266.15 percent of total billed charges 359.66 93 291.32 percent of total billed charges 359.66 359.66 other OPPS APC 359.66 359.66 other OPPS APC 359.66 27.63 99.37 percent of total billed charges 359.66 359.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MR8 BALL L9 CM OD5 MM SUP-MR8-9BA50 CDM 0270 RC outpatient 497.64 497.64 497.64 74 368.25 percent of total billed charges 497.64 93 403.09 percent of total billed charges 497.64 497.64 other OPPS APC 497.64 497.64 other OPPS APC 497.64 27.63 137.5 percent of total billed charges 497.64 497.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MIDAS REX MR8 BALL L9 CM OD5 MM SYMMETRICAL STERILE LATEX FREE DISPOSABLE SUP-MR8-9BA50T CDM 0270 RC outpatient 610.74 610.74 610.74 74 451.95 percent of total billed charges 610.74 93 494.7 percent of total billed charges 610.74 610.74 other OPPS APC 610.74 610.74 other OPPS APC 610.74 27.63 168.75 percent of total billed charges 610.74 610.74 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MR8 BALL L9 CM OD7.5 MM SUP-MR8-9BA75 CDM 0270 RC outpatient 497.64 497.64 497.64 74 368.25 percent of total billed charges 497.64 93 403.09 percent of total billed charges 497.64 497.64 other OPPS APC 497.64 497.64 other OPPS APC 497.64 27.63 137.5 percent of total billed charges 497.64 497.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MR8 L9 CM OD25.4 MM WHEEL SUP-MR8-9MC254 CDM 0270 RC outpatient 574.55 574.55 574.55 74 425.17 percent of total billed charges 574.55 93 465.39 percent of total billed charges 574.55 574.55 other OPPS APC 574.55 574.55 other OPPS APC 574.55 27.63 158.75 percent of total billed charges 574.55 574.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MR8 L9 CM OD3 MM METAL CUTTER STERILE DISPOSABLE METAL CUT SUP-MR8-9MC30 CDM 0270 RC outpatient 694.43 694.43 694.43 74 513.88 percent of total billed charges 694.43 93 562.49 percent of total billed charges 694.43 694.43 other OPPS APC 694.43 694.43 other OPPS APC 694.43 27.63 191.87 percent of total billed charges 694.43 694.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MR8 DIAMOND MATCH HEAD L9 CM OD3 MM SUP-MR8-9MH30D CDM 0270 RC outpatient 538.36 538.36 538.36 74 398.39 percent of total billed charges 538.36 93 436.07 percent of total billed charges 538.36 538.36 other OPPS APC 538.36 538.36 other OPPS APC 538.36 27.63 148.75 percent of total billed charges 538.36 538.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MIDAS REX MR8 7 CM TAPER OD2.3 MM STERILE LATEX FREE DISPOSABLE SUP-MR8-F2/7TA23 CDM 0270 RC outpatient 398.11 398.11 398.11 74 294.6 percent of total billed charges 398.11 93 322.47 percent of total billed charges 398.11 398.11 other OPPS APC 398.11 398.11 other OPPS APC 398.11 27.63 110 percent of total billed charges 398.11 398.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MIDAS REX MR8 F3 TAPER L9 CM OD3 MM STERILE LATEX FREE DISPOSABLE SUP-MR8-F3/9TA30 CDM 0270 RC outpatient 477.28 477.28 477.28 74 353.19 percent of total billed charges 477.28 93 386.6 percent of total billed charges 477.28 477.28 other OPPS APC 477.28 477.28 other OPPS APC 477.28 27.63 131.87 percent of total billed charges 477.28 477.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MR8 BALL L10 CM OD2 MM SUP-MR810BA20_71344 CDM 0270 RC outpatient 441.09 441.09 441.09 74 326.41 percent of total billed charges 441.09 93 357.28 percent of total billed charges 441.09 441.09 other OPPS APC 441.09 441.09 other OPPS APC 441.09 27.63 121.87 percent of total billed charges 441.09 441.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MR8 BALL L10 CM OD3 MM SUP-MR810BA30_71345 CDM 0270 RC outpatient 441.09 441.09 441.09 74 326.41 percent of total billed charges 441.09 93 357.28 percent of total billed charges 441.09 441.09 other OPPS APC 441.09 441.09 other OPPS APC 441.09 27.63 121.87 percent of total billed charges 441.09 441.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MR8 CYLINDER L10 CM OD4 MM SUP-MR810CY40_71346 CDM 0270 RC outpatient 454.66 454.66 454.66 74 336.45 percent of total billed charges 454.66 93 368.27 percent of total billed charges 454.66 454.66 other OPPS APC 454.66 454.66 other OPPS APC 454.66 27.63 125.62 percent of total billed charges 454.66 454.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MR8 OVAL L10 CM OD4 MM SUP-MR810OV40_71347 CDM 0270 RC outpatient 475.02 475.02 475.02 74 351.51 percent of total billed charges 475.02 93 384.77 percent of total billed charges 475.02 475.02 other OPPS APC 475.02 475.02 other OPPS APC 475.02 27.63 131.25 percent of total billed charges 475.02 475.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MR8 MATCH HEAD L14 CM OD3 MM STERILE DISPOSABLE SUP-MR814MH30_71348 CDM 0270 RC outpatient 481.81 481.81 481.81 74 356.54 percent of total billed charges 481.81 93 390.27 percent of total billed charges 481.81 481.81 other OPPS APC 481.81 481.81 other OPPS APC 481.81 27.63 133.12 percent of total billed charges 481.81 481.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING MIDAS REX MR8 MATCH HEAD L9 CM OD3 MM STERILE LATEX FREE DISPOSABLE SUP-MR89MH30_71343 CDM 0270 RC outpatient 479.54 479.54 479.54 74 354.86 percent of total billed charges 479.54 93 388.43 percent of total billed charges 479.54 479.54 other OPPS APC 479.54 479.54 other OPPS APC 479.54 27.63 132.5 percent of total billed charges 479.54 479.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ENDOSCOPIC MACROPLASTIQUE UROPLASTY L14.5 IN L.54 IN OD3.8 FR ODSEC20 GA URETHRAL INJECTABLE HUB WING SHAFT DISPOSABLE SUP-MRN-420 CDM 0270 RC outpatient 106.6 106.6 106.6 74 78.88 percent of total billed charges 106.6 93 86.35 percent of total billed charges 106.6 106.6 other OPPS APC 106.6 106.6 other OPPS APC 106.6 27.63 29.45 percent of total billed charges 106.6 106.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR ENDOSCOPIC SURGIFLO 34CM DISPOSABLE STERILE LF SUP-MS1995 CDM 0270 RC outpatient 131.21 131.21 131.21 74 97.1 percent of total billed charges 131.21 93 106.28 percent of total billed charges 131.21 131.21 other OPPS APC 131.21 131.21 other OPPS APC 131.21 27.63 36.25 percent of total billed charges 131.21 131.21 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHCLOTH REMEDY PHYTOPLEX DIMETHICONE 3 PACK SUP-MSC092503 CDM 0270 RC outpatient 2.62 2.62 2.62 74 1.94 percent of total billed charges 2.62 93 2.12 percent of total billed charges 2.62 2.62 other OPPS APC 2.62 2.62 other OPPS APC 2.62 27.63 0.72 percent of total billed charges 2.62 2.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WASHCLOTH CLEANSING ALOETOUCH 8X8IN 3.2% DIMETHICONE DISPOSABLE LF NONANTIBACTERIAL NEEDLE PUNCH MED WEIGHT ALCOHOL FREE SUP-MSC095223 CDM 0270 RC outpatient 1.54 1.54 1.54 74 1.14 percent of total billed charges 1.54 93 1.25 percent of total billed charges 1.54 1.54 other OPPS APC 1.54 1.54 other OPPS APC 1.54 27.63 0.43 percent of total billed charges 1.54 1.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCRUB SURGICAL CLOTH CHG L10.5 IN X W9 IN RINSE FREE NONSTERILE LATEX FREE FRAGRANCE FREE SUP-MSC096CHG CDM 0270 RC outpatient 4.98 4.98 4.98 74 3.69 percent of total billed charges 4.98 93 4.03 percent of total billed charges 4.98 4.98 other OPPS APC 4.98 4.98 other OPPS APC 4.98 27.63 1.38 percent of total billed charges 4.98 4.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCRUB SURGICAL HAND STERILLIUM 33.8 OZ SCENT FREE FRAGRANCE FREE NONSTICKY WATERLESS BRUSHLESS LATEX FREE CLEAR SUP-MSC097058_14124 CDM outpatient 133.95 133.95 133.95 133.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIPES FLUSHABLE SUP-MSC263810 CDM 0270 RC outpatient 4.27 4.27 4.27 74 3.16 percent of total billed charges 4.27 93 3.46 percent of total billed charges 4.27 4.27 other OPPS APC 4.27 4.27 other OPPS APC 4.27 27.63 1.18 percent of total billed charges 4.27 4.27 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UNDERPAD FLUFF STD 23X24 SUP-MSC281241LB CDM 0270 RC outpatient 0.4 0.4 0.4 74 0.3 percent of total billed charges 0.4 93 0.32 percent of total billed charges 0.4 0.4 other OPPS APC 0.4 0.4 other OPPS APC 0.4 27.63 0.11 percent of total billed charges 0.4 0.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING GEL SILVASORB .25 OZ SUP-MSC93025EP_17380 CDM 0270 RC outpatient 15.39 15.39 15.39 74 11.39 percent of total billed charges 15.39 93 12.47 percent of total billed charges 15.39 15.39 other OPPS APC 15.39 15.39 other OPPS APC 15.39 27.63 4.25 percent of total billed charges 15.39 15.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLOVE SURGICAL SENSICARE ISOLEX POLYISOPRENE PLOYMER 5.5 L 12 IN POWDER FREE SMOOTH TEXTURE BEAD CUFF STERILE LATEX FREE CREAM 9.1MIL THICKNESS SUP-MSG9055 CDM 0270 RC outpatient 2.05 2.05 2.05 74 1.52 percent of total billed charges 2.05 93 1.66 percent of total billed charges 2.05 2.05 other OPPS APC 2.05 2.05 other OPPS APC 2.05 27.63 0.57 percent of total billed charges 2.05 2.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE ANGIOGRAPHY MEDALLION 1 ML CLEAR POLYCARBONATE BARREL FIXED MALE LUER PLUNGER YELLOW SUP-MSS011-Y CDM 0270 RC outpatient 5.07 5.07 5.07 74 3.75 percent of total billed charges 5.07 93 4.11 percent of total billed charges 5.07 5.07 other OPPS APC 5.07 5.07 other OPPS APC 5.07 27.63 1.4 percent of total billed charges 5.07 5.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIZER IMPLANT NATRELLE INSPIRA SILICONE P6.7 CM EXTRA FULL PROFILE ROUND OD14.5 CM 750 CC BREAST GEL SMOOTH RESTERILIZABLE SUP-MSZ-X750 CDM 0270 RC outpatient 546 546 546 74 404.04 percent of total billed charges 546 93 442.26 percent of total billed charges 546 546 other OPPS APC 546 546 other OPPS APC 546 27.63 150.86 percent of total billed charges 546 546 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIZER IMPLANT NATRELLE BIOCELL SILICONE P3.2 CM MODERATE PROFILE ROUND OD11.7 CM 240 ML BREAST STYLE MSZ10 SMOOTH TEXTURE RESTERILIZABLE STERILE LATEX FREE SUP-MSZ10240 CDM 0270 RC outpatient 572 572 572 74 423.28 percent of total billed charges 572 93 463.32 percent of total billed charges 572 572 other OPPS APC 572 572 other OPPS APC 572 27.63 158.04 percent of total billed charges 572 572 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIZER IMPLANT NATRELLE BIOCELL SILICONE P4.1 CM MODERATE PLUS PROFILE ROUND OD12.9 CM 371 ML BREAST STYLE MSZ15 GEL SMOOTH TEXTURE RESTERILIZABLE STERILE LATEX FREE SUP-MSZ15371 CDM 0270 RC outpatient 572 572 572 74 423.28 percent of total billed charges 572 93 463.32 percent of total billed charges 572 572 other OPPS APC 572 572 other OPPS APC 572 27.63 158.04 percent of total billed charges 572 572 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIZER IMPLANT NATRELLE BIOCELL SILICONE P5 CM HIGH PROFILE ROUND OD11.9 CM 400 ML BREAST STYLE MSZ20 GEL SMOOTH TEXTURE RESTERILIZABLE STERILE LATEX FREE SUP-MSZ20400 CDM 0270 RC outpatient 546 546 546 74 404.04 percent of total billed charges 546 93 442.26 percent of total billed charges 546 546 other OPPS APC 546 546 other OPPS APC 546 27.63 150.86 percent of total billed charges 546 546 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIZER IMPLANT NATRELLE BIOCELL SILICONE P5.2 CM HIGH PROFILE ROUND OD12.4 CM 450 ML BREAST STYLE MSZ20 GEL SMOOTH TEXTURE RESTERILIZABLE STERILE LATEX FREE SUP-MSZ20450 CDM 0270 RC outpatient 546 546 546 74 404.04 percent of total billed charges 546 93 442.26 percent of total billed charges 546 546 other OPPS APC 546 546 other OPPS APC 546 27.63 150.86 percent of total billed charges 546 546 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIZER IMPLANT NATRELLE SILICONE P3.6 CM XHIGH PROFILE ROUND OD7.4 CM 120 ML BREAST STYLE 45 SMOOTH STERILE SUP-MSZ20500 CDM 0270 RC outpatient 546 546 546 74 404.04 percent of total billed charges 546 93 442.26 percent of total billed charges 546 546 other OPPS APC 546 546 other OPPS APC 546 27.63 150.86 percent of total billed charges 546 546 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIZER IMPLANT NATRELLE BIOCELL SILICONE P5.7 CM HIGH PROFILE ROUND OD13.8 CM 600 ML BREAST STYLE MSZ20 GEL SMOOTH TEXTURE RESTERILIZABLE STERILE LATEX FREE SUP-MSZ20600 CDM 0270 RC outpatient 546 546 546 74 404.04 percent of total billed charges 546 93 442.26 percent of total billed charges 546 546 other OPPS APC 546 546 other OPPS APC 546 27.63 150.86 percent of total billed charges 546 546 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIZER IMPLANT NATRELLE BIOCELL SILICONE P6.2 CM HIGH PROFILE ROUND OD14.5 CM 700 ML BREAST STYLE MSZ20 GEL SMOOTH TEXTURE RESTERILIZABLE STERILE LATEX FREE SUP-MSZ20700 CDM 0270 RC outpatient 546 546 546 74 404.04 percent of total billed charges 546 93 442.26 percent of total billed charges 546 546 other OPPS APC 546 546 other OPPS APC 546 27.63 150.86 percent of total billed charges 546 546 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIZER IMPLANT NATRELLE BIOCELL SILICONE P6 CM HIGH PROFILE ROUND OD15 CM 750 ML BREAST STYLE MSZ20 GEL SMOOTH TEXTURE RESTERILIZABLE STERILE LATEX FREE SUP-MSZ20750 CDM 0270 RC outpatient 572 572 572 74 423.28 percent of total billed charges 572 93 463.32 percent of total billed charges 572 572 other OPPS APC 572 572 other OPPS APC 572 27.63 158.04 percent of total billed charges 572 572 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIZER IMPLANT NATRELLE BIOCELL SILICONE P6.1 CM HIGH PROFILE ROUND OD15.3 CM 800 ML BREAST STYLE MSZ20 GEL SMOOTH TEXTURE RESTERILIZABLE STERILE LATEX FREE SUP-MSZ20800 CDM 0270 RC outpatient 572 572 572 74 423.28 percent of total billed charges 572 93 463.32 percent of total billed charges 572 572 other OPPS APC 572 572 other OPPS APC 572 27.63 158.04 percent of total billed charges 572 572 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIZER IMPLANT NATRELLE SILICONE P4.4 CM LOW HEIGHT FULL PROJECTION W11 CM X H9.1 CM 205 SUP-MSZLF205 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIZER IMPLANT NATRELLE SILICONE P4.2 CM FULL PROJECTION MODERATE HEIGHT W10.5 CM X H9.6 CM 195 ML SUP-MSZMF195 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIZER IMPLANT NATRELLE SILICONE P4.4 CM FULL PROJECTION MODERATE HEIGHT W11 CM X H10.1 CM 225 ML SUP-MSZMF225 CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR KELMAN MULTIFLEX III PMMA SUP-MTA3U0 CDM V2631 CPT 0276 RC outpatient 325 325 325 57 185.25 percent of total billed charges 325 93 263.25 percent of total billed charges 325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 325 other OPPS APC 325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 325 other OPPS APC 325 51 165.75 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR KELMAN MULTIFLEX III PMMA +21 DIOPTER CONVEXOPLANO L12.5 MM OD5.5 MM ANTERIOR CHAMBER 1 PIECE UV ABSORBENT STERILE CLEAR APHAKIA 115.3 A-CONSTANT SUP-MTA3U0.210 CDM V2631 CPT 0276 RC outpatient 325 325 325 57 185.25 percent of total billed charges 325 93 263.25 percent of total billed charges 325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 325 other OPPS APC 325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 325 other OPPS APC 325 51 165.75 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR KELMAN MULTIFLEX III PMMA CONVEXOPLANO L13 MM ANTERIOR CHAMBER 1 PIECE UV ABSORBENT STERILE CLEAR APHAKIA 115.3 A-CONSTANT SUP-MTA4U0 CDM V2631 CPT 0276 RC outpatient 325 325 325 57 185.25 percent of total billed charges 325 93 263.25 percent of total billed charges 325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 325 other OPPS APC 325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 325 other OPPS APC 325 51 165.75 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR KELMAN MULTIFLEX III PMMA +6.5 DIOPTER CONVEXOPLANO L13 MM OD5.5 MM ANTERIOR CHAMBER 1 PIECE UV ABSORBENT STERILE CLEAR APHAKIA 115.3 A-CONSTANT SUP-MTA4U0.065 CDM V2631 CPT 0276 RC outpatient 325 325 325 57 185.25 percent of total billed charges 325 93 263.25 percent of total billed charges 325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 325 other OPPS APC 325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 325 other OPPS APC 325 51 165.75 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR KELMAN MULTIFLEX III PMMA +13.5 DIOPTER CONVEXOPLANO L13.5 MM OD5.5 MM ANTERIOR CHAMBER 1 PIECE UV ABSORBENT STERILE CLEAR APHAKIA 115.3 A-CONSTANT SUP-MTA5U0.135 CDM V2631 CPT 0276 RC outpatient 325 325 325 57 185.25 percent of total billed charges 325 93 263.25 percent of total billed charges 325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 325 other OPPS APC 325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 325 other OPPS APC 325 51 165.75 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR KELMAN MULTIFLEX III PMMA CONVEXOPLANO L13.5 MM OD5.5 MM ANTERIOR CHAMBER 1 PIECE UV ABSORBENT STERILE CLEAR APHAKIA 115.3 A-CONSTANT SUP-MTA5UO CDM V2631 CPT 0276 RC outpatient 325 325 325 57 185.25 percent of total billed charges 325 93 263.25 percent of total billed charges 325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 325 other OPPS APC 325 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 325 other OPPS APC 325 51 165.75 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VIP BONE MODEL SUP-MWJ004 CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MODERATE HIEGHT EXTRA FILL SHAPED GEL 225CC SUP-MX-410255 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P6.2 CM MODERATE HEIGHT EXTRA FULL PROJECTION W13.5 CM X H12.5 CM 445 ML 445 GM STYLE 410 GEL TEXTURED SUP-MX-410445 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P6.5 CM MODERATE HEIGHT EXTRA FULL PROJECTION W14 CM X H12.9 CM 520 ML 520 GM STYLE 410 SUP-MX-410520 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST MODERATE HEIGHT EXTRA FILL PROJECTION 620CC SUP-MX-410620 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE SILICONE P7.1 CM H13.9 CM OD15.5 CM 685 GM MODERATE HEIGHT EXTRA FULL PROJECTION STYLE 410MX SUP-MX-410685 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET EXTENSION L35 IN 3.9 ML INTRAVENOUS 3 WAY STOPCOCK MALE LUER LOCK CAP INJECTION SITE STANDARD BORE STERILE LATEX FREE DISPOSABLE WHITE SUP-MX253L CDM 0270 RC outpatient 2.56 2.56 2.56 74 1.89 percent of total billed charges 2.56 93 2.07 percent of total billed charges 2.56 2.56 other OPPS APC 2.56 2.56 other OPPS APC 2.56 27.63 0.71 percent of total billed charges 2.56 2.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET EXTENSION STANDARD BORE 34 INCHES 3.8ML PRIMING VOLUME 4 WAYSTOPCOCK MALE LUER LOCK SUP-MX423L CDM outpatient 2.6 2.6 2.6 2.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG PRESSURE INFUSION MEDEX C-FUSOR CRYSTAL LARGE 1000 ML INTRAVENOUS 3 WAY STOPCOCK EXTENSION SQUEEZE BULB SECURE FASTEN NONSTERILE LATEX FREE CLEAR SUP-MX4810 CDM 0270 RC outpatient 154.67 154.67 154.67 74 114.46 percent of total billed charges 154.67 93 125.28 percent of total billed charges 154.67 154.67 other OPPS APC 154.67 154.67 other OPPS APC 154.67 27.63 42.74 percent of total billed charges 154.67 154.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP INTRAVENOUS MEDEX 2 FUNCTION LUER LOCK NONDEHP NONPVC STERILE LATEX FREE DISPOSABLE WHITE MALE FEMALE PORT SUP-MX491 CDM 0270 RC outpatient 0.39 0.39 0.39 74 0.29 percent of total billed charges 0.39 93 0.32 percent of total billed charges 0.39 0.39 other OPPS APC 0.39 0.39 other OPPS APC 0.39 27.63 0.11 percent of total billed charges 0.39 0.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE MYNXGRIP OD5 FR VASCULAR SUP-MX5021 CDM 0270 RC outpatient 585 585 585 74 432.9 percent of total billed charges 585 93 473.85 percent of total billed charges 585 585 other OPPS APC 585 585 other OPPS APC 585 27.63 161.64 percent of total billed charges 585 585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE MYNX CONTROL VCD 5 FRENCH SUP-MX5060 CDM 0270 RC outpatient 559 559 559 74 413.66 percent of total billed charges 559 93 452.79 percent of total billed charges 559 559 other OPPS APC 559 559 other OPPS APC 559 27.63 154.45 percent of total billed charges 559 559 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENVISTA IOL SUP-MX60E CDM V2631 CPT 0276 RC outpatient 377 377 377 57 214.89 percent of total billed charges 377 93 305.37 percent of total billed charges 377 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 377 other OPPS APC 377 Paid using APC or APG reimbursement logic. Includes reimbursement for any outliers. 377 other OPPS APC 377 51 192.27 percent of total billed charges 377 377 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE MYNX 6FR7FR SUP-MX6721 CDM 0270 RC outpatient 585 585 585 74 432.9 percent of total billed charges 585 93 473.85 percent of total billed charges 585 585 other OPPS APC 585 585 other OPPS APC 585 27.63 161.64 percent of total billed charges 585 585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE MYNX CONTROL VCD 6/7 FRENCH SUP-MX6760 CDM 0270 RC outpatient 611 611 611 74 452.14 percent of total billed charges 611 93 494.91 percent of total billed charges 611 611 other OPPS APC 611 611 other OPPS APC 611 27.63 168.82 percent of total billed charges 611 611 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND 2 V-37 L30 IN BRAID 4 STRAND GREEN SUP-MX69G CDM 0270 RC outpatient 36.78 36.78 36.78 74 27.22 percent of total billed charges 36.78 93 29.79 percent of total billed charges 36.78 36.78 other OPPS APC 36.78 36.78 other OPPS APC 36.78 27.63 10.16 percent of total billed charges 36.78 36.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHORT MICRO PROCEDURE TRAY SUP-MXA-D214 CDM 0270 RC outpatient 1565.2 1565.2 1565.2 74 1158.25 percent of total billed charges 1565.2 93 1267.81 percent of total billed charges 1565.2 1565.2 other OPPS APC 1565.2 1565.2 other OPPS APC 1565.2 27.63 432.46 percent of total billed charges 1565.2 1565.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING HIGH FLOW SONASTAR AND IRRIGATION SUP-MXA-HF CDM 0270 RC outpatient 449.28 449.28 449.28 74 332.47 percent of total billed charges 449.28 93 363.92 percent of total billed charges 449.28 449.28 other OPPS APC 449.28 449.28 other OPPS APC 449.28 27.63 124.14 percent of total billed charges 449.28 449.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE LAPAROSCOPIC SONASTAR PLASTIC SILICONE RUBBER 23KHZ STANDARD L30 CM ID1.9 MM RIGID SHEATH STRAIGHT ASPIRATION TIP REPOSABLE SUP-MXA-L002 CDM 0270 RC outpatient 444.6 444.6 444.6 74 329 percent of total billed charges 444.6 93 360.13 percent of total billed charges 444.6 444.6 other OPPS APC 444.6 444.6 other OPPS APC 444.6 27.63 122.84 percent of total billed charges 444.6 444.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET TUBING ULTRASONIC ASPIRATOR SONASTAR SUP-MXA-PA CDM 0270 RC outpatient 449.28 449.28 449.28 74 332.47 percent of total billed charges 449.28 93 363.92 percent of total billed charges 449.28 449.28 other OPPS APC 449.28 449.28 other OPPS APC 449.28 27.63 124.14 percent of total billed charges 449.28 449.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE SCALPEL MISONIZ 10MM BLUNT SUP-MXB-10 CDM 0270 RC outpatient 981.76 981.76 981.76 74 726.5 percent of total billed charges 981.76 93 795.23 percent of total billed charges 981.76 981.76 other OPPS APC 981.76 981.76 other OPPS APC 981.76 27.63 271.26 percent of total billed charges 981.76 981.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE SCALPEL MISONIX 20MM BLUNT SUP-MXB-20 CDM 0270 RC outpatient 981.76 981.76 981.76 74 726.5 percent of total billed charges 981.76 93 795.23 percent of total billed charges 981.76 981.76 other OPPS APC 981.76 981.76 other OPPS APC 981.76 27.63 271.26 percent of total billed charges 981.76 981.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE SCALPEL MISONIX UNILATERAL SERRATIONS SUP-MXB-B1 CDM 0270 RC outpatient 981.76 981.76 981.76 74 726.5 percent of total billed charges 981.76 93 795.23 percent of total billed charges 981.76 981.76 other OPPS APC 981.76 981.76 other OPPS APC 981.76 27.63 271.26 percent of total billed charges 981.76 981.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BONE SHAVER MISONIX MICRO HOOK SUP-MXB-S1 CDM 0270 RC outpatient 983.45 983.45 983.45 74 727.75 percent of total billed charges 983.45 93 796.59 percent of total billed charges 983.45 983.45 other OPPS APC 983.45 983.45 other OPPS APC 983.45 27.63 271.73 percent of total billed charges 983.45 983.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHAVER SURGICAL BONESCALPEL DIAMOND OD4.4 MM SHORT EXTENSION SILICONE SLEEVE STERILE DISPOSABLE SUP-MXB-S3 CDM 0270 RC outpatient 981.76 981.76 981.76 74 726.5 percent of total billed charges 981.76 93 795.23 percent of total billed charges 981.76 981.76 other OPPS APC 981.76 981.76 other OPPS APC 981.76 27.63 271.26 percent of total billed charges 981.76 981.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IRRIGATION TUBE SET SUP-MXB-T CDM 0270 RC outpatient 110.24 110.24 110.24 74 81.58 percent of total billed charges 110.24 93 89.29 percent of total billed charges 110.24 110.24 other OPPS APC 110.24 110.24 other OPPS APC 110.24 27.63 30.46 percent of total billed charges 110.24 110.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOOP SURGICAL BILLEAU MEDIUM L6.4 IN OD5 MM ODSEC3 MM EAR FLEXIBLE SHAFT ROUND HANDLE SUP-N0410 2 CDM outpatient 105.3 105.3 105.3 105.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERTS 66MM SUP-N10126 CDM 0270 RC outpatient 133.9 133.9 133.9 74 99.09 percent of total billed charges 133.9 93 108.46 percent of total billed charges 133.9 133.9 other OPPS APC 133.9 133.9 other OPPS APC 133.9 27.63 37 percent of total billed charges 133.9 133.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR NITREX NITINOL 0 D STRAIGHT L60 CM L5 CM OD.018 IN PERIPHERAL CORONARY ATRAUMATIC RADIOPAQUE INTERMEDIATE TIP KINK RESISTANT SUP-N180601_72902 CDM 0270 RC outpatient 155.43 155.43 155.43 74 115.02 percent of total billed charges 155.43 93 125.9 percent of total billed charges 155.43 155.43 other OPPS APC 155.43 155.43 other OPPS APC 155.43 27.63 42.95 percent of total billed charges 155.43 155.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR NITREX NITINOL TUNGSTEN SILICONE GOLD 15 D L260 CM L8 CM OD.025 IN INTERMEDIATE ANGLE TIP SUP-N252601_40175 CDM 0270 RC outpatient 670.8 670.8 670.8 74 496.39 percent of total billed charges 670.8 93 543.35 percent of total billed charges 670.8 670.8 other OPPS APC 670.8 670.8 other OPPS APC 670.8 27.63 185.34 percent of total billed charges 670.8 670.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR NITREX NITINOL TUNGSTEN SILICONE GOLD 45 D L180 CM L4 CM OD.035 IN STANDARD TIP STIFF SHAFT KINK RESISTANT STEERABLE SUP-N351805 CDM 0270 RC outpatient 155.43 155.43 155.43 74 115.02 percent of total billed charges 155.43 93 125.9 percent of total billed charges 155.43 155.43 other OPPS APC 155.43 155.43 other OPPS APC 155.43 27.63 42.95 percent of total billed charges 155.43 155.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING SUCTION MEDI-VAC L12 FT ID1/4 IN NONCONDUCTIVE MALE TO MALE CONNECTOR STERILE LATEX FREE CLEAR SUP-N612 CDM 0270 RC outpatient 2.46 2.46 2.46 74 1.82 percent of total billed charges 2.46 93 1.99 percent of total billed charges 2.46 2.46 other OPPS APC 2.46 2.46 other OPPS APC 2.46 27.63 0.68 percent of total billed charges 2.46 2.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING SUCTION MEDI-VAC MAXI-GRIP L6 FT ID1/4 IN NONCONDUCTIVE MALE TO MALE STERILE CLEAR SUP-N66A CDM 0270 RC outpatient 1.52 1.52 1.52 74 1.12 percent of total billed charges 1.52 93 1.23 percent of total billed charges 1.52 1.52 other OPPS APC 1.52 1.52 other OPPS APC 1.52 27.63 0.42 percent of total billed charges 1.52 1.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEUROMONITORING CHARGES SUP-NA CDM 0270 RC outpatient 416 416 416 74 307.84 percent of total billed charges 416 93 336.96 percent of total billed charges 416 416 other OPPS APC 416 416 other OPPS APC 416 27.63 114.94 percent of total billed charges 416 416 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ASPIRATION L40 MM L700 MM OD22 GA ODSEC1.8 MM ECHOGENIC DIMPLE FLEXIBLE PRESTERILIZE SAFE RELIABLE STERILE DISPOSABLE SUP-NA-201SX-4022-A CDM 0270 RC outpatient 237.56 237.56 237.56 74 175.79 percent of total billed charges 237.56 93 192.42 percent of total billed charges 237.56 237.56 other OPPS APC 237.56 237.56 other OPPS APC 237.56 27.63 65.64 percent of total billed charges 237.56 237.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE ASPIRATION VIZISHOT L70 CM L40 MM OD21 GA ID1.9 MM ECHOGENIC DIMPLED TIP DESIGN MAXIMUM EXTRUDING STROKE STERILE DISPOSABLE SUP-NA-210SX-4021 CDM 0270 RC outpatient 291.8 291.8 291.8 74 215.93 percent of total billed charges 291.8 93 236.36 percent of total billed charges 291.8 291.8 other OPPS APC 291.8 291.8 other OPPS APC 291.8 27.63 80.62 percent of total billed charges 291.8 291.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEUROMONITORING CHARGES SUP-NA2 CDM 0270 RC outpatient 416 416 416 74 307.84 percent of total billed charges 416 93 336.96 percent of total billed charges 416 416 other OPPS APC 416 416 other OPPS APC 416 27.63 114.94 percent of total billed charges 416 416 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRUSH CYTOLOGY L11 MM L140 CM OD1.7 MM ODSEC1.9 MM NEEDLE TIP STERILE DISPOSABLE SUP-NB-120 CDM 0270 RC outpatient 136.45 136.45 136.45 74 100.97 percent of total billed charges 136.45 93 110.52 percent of total billed charges 136.45 136.45 other OPPS APC 136.45 136.45 other OPPS APC 136.45 27.63 37.7 percent of total billed charges 136.45 136.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SUPPORT NAVICROSS STAINLESS STEEL HYDROPHILIC 12 MM L65 CM L40 CM PERIPHERAL 2 BRAID RADIOPAQUE STRAIGHT TAPER TIP STERILE LATEX FREE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE 4 FR INTRODUCER SHEATH SUP-NC35650 CDM 0270 RC outpatient 444.6 444.6 444.6 74 329 percent of total billed charges 444.6 93 360.13 percent of total billed charges 444.6 444.6 other OPPS APC 444.6 444.6 other OPPS APC 444.6 27.63 122.84 percent of total billed charges 444.6 444.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 6MM 2MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP2006X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 8MM 2MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP2008X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 12MM 2MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP2012X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 15MM 2MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP2015X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 20MM 2MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP2020X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 6MM 2.25MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP22506X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 8MM 2.25MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP22508X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 12MM 2.25MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP22512X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 15MM 2.25MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP22515X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 20MM 2.25MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP22520X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 6MM 2.5MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP2506X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 8MM 2.5MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP2508X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 12MM 2.5MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP2512X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 15MM 2.5MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP2515X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 20MM 2.5MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP2520X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 27MM 2.5MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP2527X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 6MM 2.75MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP27506X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 8MM 2.75MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP27508X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 12MM 2.75MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP27512X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 15MM 2.75MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP27515X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 20MM 2.75MM DURA-TRAC NYLON STERILE LF RAPID EXCHANGE RADIOPAQUE FEMALE SUP-NCEUP27520X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 27MM 2.75MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP27527X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 6MM 3MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP3006X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 8MM 3MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP3008X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 12MM 3MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP3012X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 15MM 3MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP3015X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 20MM 3MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP3020X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 27MM 3MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP3027X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 6MM 3.25MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP32506X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 8MM 3.25MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP32508X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 12MM 3.25MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP32512X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 15MM 3.25MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP32515X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 20MM 3.25MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP32520X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 27MM 3.25MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP32527X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 6MM 3.5MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP3506X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 8MM 3.5MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP3508X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 12MM 3.5MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP3512X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 15MM 3.5MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP3515X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 20MM 3.5MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP3520X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 27MM 3.5MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP3527X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 6MM 3.75MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP37506X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 8MM 3.75MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP37508X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 12MM 3.75MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP37512X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 15MM 3.75MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP37515X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 20MM 3.75MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP37520X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 27MM 3.75MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP37527X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 6MM 4MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP4006X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 8MM 4MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP4008X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 12MM 4MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP4012X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 15MM 4MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP4015X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 20MM 4MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP4020X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 27MM 4MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP4027X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 8MM 4.5MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP4508X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 12MM 4.5MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP4512X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON NCEUPHORA SUP-NCEUP4515X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 20MM 4.5MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP4520X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 8MM 5MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP5008X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 12MM 5MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP5012X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION NC EUPHORA 142CM 15MM 5MM DURATRAC NYLON PLATINUM IRIDIUM STERILE LF RAPID EXCHANGE SUP-NCEUP5015X CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXTRACTOR STONE RETRIEVAL NCOMPASS 1.7FR 1CM BASKET 115CM URINARY TRACT 4/16-WIRE TIPLESS REMOVABLE UNIDEX HANDLE NITINOL STERILE SINGLE-USE SUP-NCT4-017115 CDM 0270 RC outpatient 730.08 730.08 730.08 74 540.26 percent of total billed charges 730.08 93 591.36 percent of total billed charges 730.08 730.08 other OPPS APC 730.08 730.08 other OPPS APC 730.08 27.63 201.72 percent of total billed charges 730.08 730.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CYLINDER MEDICAL GAS 200 51IN 9IN NITROGEN HIGH PRESSURE SUP-NI NF200 CDM 0270 RC outpatient 15.13 15.13 15.13 74 11.2 percent of total billed charges 15.13 93 12.26 percent of total billed charges 15.13 15.13 other OPPS APC 15.13 15.13 other OPPS APC 15.13 27.63 4.18 percent of total billed charges 15.13 15.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 115CM CEREGLIDE 71 CATHETER SUP-NIC71115U CDM 0270 RC outpatient 7553.39 7553.39 7553.39 74 5589.51 percent of total billed charges 7553.39 93 6118.25 percent of total billed charges 7553.39 7553.39 other OPPS APC 7553.39 7553.39 other OPPS APC 7553.39 27.63 2087 percent of total billed charges 7553.39 7553.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 125CM CEREGLIDE 71 CATHETER SUP-NIC71125U CDM 0270 RC outpatient 7553.39 7553.39 7553.39 74 5589.51 percent of total billed charges 7553.39 93 6118.25 percent of total billed charges 7553.39 7553.39 other OPPS APC 7553.39 7553.39 other OPPS APC 7553.39 27.63 2087 percent of total billed charges 7553.39 7553.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 132CM CEREGLIDE 71 CATHETER SUP-NIC71132U CDM 0270 RC outpatient 7553.39 7553.39 7553.39 74 5589.51 percent of total billed charges 7553.39 93 6118.25 percent of total billed charges 7553.39 7553.39 other OPPS APC 7553.39 7553.39 other OPPS APC 7553.39 27.63 2087 percent of total billed charges 7553.39 7553.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 137CM CEREGLIDE 71 CATHETER SUP-NIC71137U CDM 0270 RC outpatient 7553.39 7553.39 7553.39 74 5589.51 percent of total billed charges 7553.39 93 6118.25 percent of total billed charges 7553.39 7553.39 other OPPS APC 7553.39 7553.39 other OPPS APC 7553.39 27.63 2087 percent of total billed charges 7553.39 7553.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE SUCTION FRAZIER VMUELLER STAINLESS STEEL ANGLE L3 7/8 IN L3.88 IN OD12 FR FINGER VALVE OBTURATOR NONSTERILE SUP-NL1903 CDM 0270 RC outpatient 87.2 87.2 87.2 74 64.53 percent of total billed charges 87.2 93 70.63 percent of total billed charges 87.2 87.2 other OPPS APC 87.2 87.2 other OPPS APC 87.2 27.63 24.09 percent of total billed charges 87.2 87.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EMBOLECTOMY STAINLESS STEEL SILICONE L80 CM OD3 FR ODSEC5 MM .1 ML SMOOTH BALLOON ATTACHMENT SYRINGE FLAT PACK LATEX FREE SUP-NL3EMB80 CDM 0270 RC outpatient 162.37 162.37 162.37 74 120.15 percent of total billed charges 162.37 93 131.52 percent of total billed charges 162.37 162.37 other OPPS APC 162.37 162.37 other OPPS APC 162.37 27.63 44.86 percent of total billed charges 162.37 162.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK EMBOLECTOMY FOGARTY SILICONE STAINLESS STEEL L80 CM OD4 FR SYRINGE FLAT LATEX FREE SUP-NL4EMB80 CDM 0270 RC outpatient 170.48 170.48 170.48 74 126.16 percent of total billed charges 170.48 93 138.09 percent of total billed charges 170.48 170.48 other OPPS APC 170.48 170.48 other OPPS APC 170.48 27.63 47.1 percent of total billed charges 170.48 170.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EMBOLECTOMY STAINLESS STEEL SILICONE L80 CM OD5 FR ODSEC11 MM .75 ML SMOOTH BALLOON ATTACHMENT SYRINGE FLAT PACK LATEX FREE SUP-NL5EMB80 CDM 0270 RC outpatient 170.48 170.48 170.48 74 126.16 percent of total billed charges 170.48 93 138.09 percent of total billed charges 170.48 170.48 other OPPS APC 170.48 170.48 other OPPS APC 170.48 27.63 47.1 percent of total billed charges 170.48 170.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK EMBOLECTOMY FOGARTY SILICONE STAINLESS STEEL L80 CM OD6 FR SYRINGE FLAT LATEX FREE SUP-NL6EMB80 CDM 0270 RC outpatient 154.65 154.65 154.65 74 114.44 percent of total billed charges 154.65 93 125.27 percent of total billed charges 154.65 154.65 other OPPS APC 154.65 154.65 other OPPS APC 154.65 27.63 42.73 percent of total billed charges 154.65 154.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESERVOIR SHUNT OMMAYA STANDARD L2.5 CM OD2.5 CM 1.26 ML CSF VENTRICULAR CATHETER FLAT BOTTOM STERILE SUP-NL8501211 CDM 0270 RC outpatient 1112.72 1112.72 1112.72 74 823.41 percent of total billed charges 1112.72 93 901.3 percent of total billed charges 1112.72 1112.72 other OPPS APC 1112.72 1112.72 other OPPS APC 1112.72 27.63 307.44 percent of total billed charges 1112.72 1112.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESERVOIR SHUNT OMMAYA L2.5 CM 1.14 ML CSF FLAT BOTTOM SIDE INLET STERILE SUP-NL8501212 CDM 0270 RC outpatient 1112.72 1112.72 1112.72 74 823.41 percent of total billed charges 1112.72 93 901.3 percent of total billed charges 1112.72 1112.72 other OPPS APC 1112.72 1112.72 other OPPS APC 1112.72 27.63 307.44 percent of total billed charges 1112.72 1112.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHUNT CAROTID SUNDT SILICONE L30 CM OD3-4 MM TEMPORARY EXTERNAL LOOP SOFT CONICAL BULB SPRING REINFORCED STERILE DISPOSABLE ENDARTERECTOMY SUP-NL8505070 CDM 0270 RC outpatient 1142.88 1142.88 1142.88 74 845.73 percent of total billed charges 1142.88 93 925.73 percent of total billed charges 1142.88 1142.88 other OPPS APC 1142.88 1142.88 other OPPS APC 1142.88 27.63 315.78 percent of total billed charges 1142.88 1142.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHUNT CAROTID SUNDT SILICONE L30 CM OD3.5-5 MM TEMPORARY EXTERNAL LOOP SOFT CONICAL BULB SPRING REINFORCED STERILE DISPOSABLE ENDARTERECTOMY SUP-NL8505071 CDM 0270 RC outpatient 782.6 782.6 782.6 74 579.12 percent of total billed charges 782.6 93 633.91 percent of total billed charges 782.6 782.6 other OPPS APC 782.6 782.6 other OPPS APC 782.6 27.63 216.23 percent of total billed charges 782.6 782.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUNDT EXTERNAL SHUNT 4MMX5MM SUP-NL8505072 CDM 0270 RC outpatient 1348.59 1348.59 1348.59 74 997.96 percent of total billed charges 1348.59 93 1092.36 percent of total billed charges 1348.59 1348.59 other OPPS APC 1348.59 1348.59 other OPPS APC 1348.59 27.63 372.62 percent of total billed charges 1348.59 1348.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG EXTERNAL DRAINAGE HERMETIC PLUS 700 ML CSF REPLACEMENT STERILE LATEX FREE DISPOSABLE SUP-NL8508305N CDM 270009182 LOCAL 0270 RC outpatient 12 12 12 74 8.88 percent of total billed charges 12 93 9.72 percent of total billed charges 12 12 other OPPS APC 12 12 other OPPS APC 12 27.63 3.32 percent of total billed charges 12 12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 2.75X8 BARE METAL SUP-NLX27508US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHARGE NEUROMONITORING PROCEDURE-NEURO SUP-NMPROCCHG CDM 270010017 LOCAL 0270 RC outpatient 416 416 416 74 307.84 percent of total billed charges 416 93 336.96 percent of total billed charges 416 416 other OPPS APC 416 416 other OPPS APC 416 27.63 114.94 percent of total billed charges 416 416 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHARGE NEUROMONITORING PROCEDURE-ALL SERVICES EXCEPT NEURO SUP-NMPROCCHG-ALL CDM 270010017 LOCAL 0270 RC outpatient 416 416 416 74 307.84 percent of total billed charges 416 93 336.96 percent of total billed charges 416 416 other OPPS APC 416 416 other OPPS APC 416 27.63 114.94 percent of total billed charges 416 416 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CHARGE NEUROMONITORING SET UP SUP-NMSETUP CDM 270010017 LOCAL 0270 RC outpatient 113.75 113.75 113.75 74 84.18 percent of total billed charges 113.75 93 92.14 percent of total billed charges 113.75 113.75 other OPPS APC 113.75 113.75 other OPPS APC 113.75 27.63 31.43 percent of total billed charges 113.75 113.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. POSITIONER OR FOAM H2 IN OD9 IN ID4 IN HEAD HIGH RESILIENT RING CUSHION LATEX FREE RASPBERRY SUP-NON081141 CDM 0270 RC outpatient 3.47 3.47 3.47 74 2.57 percent of total billed charges 3.47 93 2.81 percent of total billed charges 3.47 3.47 other OPPS APC 3.47 3.47 other OPPS APC 3.47 27.63 0.96 percent of total billed charges 3.47 3.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WEDGE POSITIONING DEVON FOAM L17 IN X W7.5 IN X H7.5 IN OR TABLE LATEX FREE SUP-NON081244 CDM 0270 RC outpatient 21.91 21.91 21.91 74 16.21 percent of total billed charges 21.91 93 17.75 percent of total billed charges 21.91 21.91 other OPPS APC 21.91 21.91 other OPPS APC 21.91 27.63 6.05 percent of total billed charges 21.91 21.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRADLE POSITIONING FOAM L24IN X W5 IN XH3 IN ARM CONVOLUTE LATEX FREE LAMINECTOMY SUP-NON081344 CDM 0270 RC outpatient 7.86 7.86 7.86 74 5.82 percent of total billed charges 7.86 93 6.37 percent of total billed charges 7.86 7.86 other OPPS APC 7.86 7.86 other OPPS APC 7.86 27.63 2.17 percent of total billed charges 7.86 7.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOWEL SURGICAL 26X18IN WHITE POLY TISSUE STERILE LF DRAPE SUP-NON21001 CDM 0270 RC outpatient 0.55 0.55 0.55 74 0.41 percent of total billed charges 0.55 93 0.45 percent of total billed charges 0.55 0.55 other OPPS APC 0.55 0.55 other OPPS APC 0.55 27.63 0.15 percent of total billed charges 0.55 0.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL TISSUE POLY PAPER L18 IN X W26 IN ABSORBENT REPELLENT INNER LAYER IMPERVIOUS FENESTRATE STERILE LATEX FREE DISPOSABLE SUP-NON21003 CDM 0270 RC outpatient 0.54 0.54 0.54 74 0.4 percent of total billed charges 0.54 93 0.44 percent of total billed charges 0.54 0.54 other OPPS APC 0.54 0.54 other OPPS APC 0.54 27.63 0.15 percent of total billed charges 0.54 0.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAD ABDOMINAL L30 IN X W10 IN ABSORBENT NONWOVEN STERILE LATEX FREE SUP-NON21459 CDM 0270 RC outpatient 3.67 3.67 3.67 74 2.72 percent of total billed charges 3.67 93 2.97 percent of total billed charges 3.67 3.67 other OPPS APC 3.67 3.67 other OPPS APC 3.67 27.63 1.01 percent of total billed charges 3.67 3.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAD EYE CURITY COTTON OVAL L2 5/8 IN X W1 5/8 IN ABSORBENT NONWOVEN STERILE LATEX FREE DISPOSABLE SUP-NON21600 CDM outpatient 0.37 0.37 0.37 0.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAD SANITARY MAXI 11IN HEAVY ABSORBENT FLUFF POLYMER LATEX-FREE ADHESIVE STRIP NON-STERILE 12/BG INDIVIDUALLY WRAPPED SUP-NON241286 CDM 0270 RC outpatient 0.16 0.16 0.16 74 0.12 percent of total billed charges 0.16 93 0.13 percent of total billed charges 0.16 0.16 other OPPS APC 0.16 0.16 other OPPS APC 0.16 27.63 0.04 percent of total billed charges 0.16 0.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TISSUE FACIAL PAPER STANDARD L7 IN X W5.7 IN 2 PLY RECYCLED LATEX FREE SUP-NON243275 CDM 270009084 LOCAL 0270 RC outpatient 10.54 10.54 10.54 74 7.8 percent of total billed charges 10.54 93 8.54 percent of total billed charges 10.54 10.54 other OPPS APC 10.54 10.54 other OPPS APC 10.54 27.63 2.91 percent of total billed charges 10.54 10.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PILLOWCASE TISSUE POLY 21X30 WHITE SUP-NON24345 CDM 0270 RC outpatient 0.72 0.72 0.72 74 0.53 percent of total billed charges 0.72 93 0.58 percent of total billed charges 0.72 0.72 other OPPS APC 0.72 0.72 other OPPS APC 0.72 27.63 0.2 percent of total billed charges 0.72 0.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK SURGICAL COMFORT-CONE POLY ELASTIC HEADBAND TIE BLUE SUP-NON27381 CDM 0270 RC outpatient 0.44 0.44 0.44 74 0.33 percent of total billed charges 0.44 93 0.36 percent of total billed charges 0.44 0.44 other OPPS APC 0.44 0.44 other OPPS APC 0.44 27.63 0.12 percent of total billed charges 0.44 0.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COVER SHOE 3-LAYER NONSKID BLUE XLG SUP-NON28859 CDM 0270 RC outpatient 0.13 0.13 0.13 74 0.1 percent of total billed charges 0.13 93 0.11 percent of total billed charges 0.13 0.13 other OPPS APC 0.13 0.13 other OPPS APC 0.13 27.63 0.04 percent of total billed charges 0.13 0.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ROLL COTTON LG 8.5X1FT STERILE LF 1LB HIGH ABSORBENT SUP-NON6028 CDM 0270 RC outpatient 9.55 9.55 9.55 74 7.07 percent of total billed charges 9.55 93 7.74 percent of total billed charges 9.55 9.55 other OPPS APC 9.55 9.55 other OPPS APC 9.55 27.63 2.64 percent of total billed charges 9.55 9.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC AUROUS BEACON TIP PIGTAIL 70CM 5FR NYLON 10 SIDEPORT RADIOPAQUE GOLD BAND ACCEPTS .035IN GUIDEWIRE SUP-NR5.03570P105PIGCSC2 CDM 0270 RC outpatient 220.57 220.57 220.57 74 163.22 percent of total billed charges 220.57 93 178.66 percent of total billed charges 220.57 220.57 other OPPS APC 220.57 220.57 other OPPS APC 220.57 27.63 60.94 percent of total billed charges 220.57 220.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "71CM HIGH FLOW RADIOFREQUENCY TRANSSEPTAL NEEDLE, CURVE 1 EEPROM" SUP-NRG-E-HF-71-C1 CDM 0481 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 51 636.48 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE TRANSSEPTAL NRG SAVE TIME CURVE C1 L98 CM OD19-22 GA RADIOFREQUENCY ACCEPTS 8.5 FR STEERABLE SHEATH .032 IN DILATOR SYSTEM SUP-NRG-E-HF-98-C1 CDM 0270 RC outpatient 1248 1248 1248 74 923.52 percent of total billed charges 1248 93 1010.88 percent of total billed charges 1248 1248 other OPPS APC 1248 1248 other OPPS APC 1248 27.63 344.82 percent of total billed charges 1248 1248 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALER TISSUE ENSEAL G2 STRAIGHT L45 CM OD5 MM ARTICULATE SUP-NSLG2S45A CDM 0270 RC outpatient 1473.97 1473.97 1473.97 74 1090.74 percent of total billed charges 1473.97 93 1193.92 percent of total billed charges 1473.97 1473.97 other OPPS APC 1473.97 1473.97 other OPPS APC 1473.97 27.63 407.26 percent of total billed charges 1473.97 1473.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENSEALX1 LARGE JAW TISSUE SUP-NSLX120L CDM 0270 RC outpatient 1394.67 1394.67 1394.67 74 1032.06 percent of total billed charges 1394.67 93 1129.68 percent of total billed charges 1394.67 1394.67 other OPPS APC 1394.67 1394.67 other OPPS APC 1394.67 27.63 385.35 percent of total billed charges 1394.67 1394.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALER TISSUE ENSEAL X1 L25 CM TAPER TIP CURVE JAW STERILE LATEX FREE DISPOSABLE SUP-NSLX125C CDM 0270 RC outpatient 1189.39 1189.39 1189.39 74 880.15 percent of total billed charges 1189.39 93 963.41 percent of total billed charges 1189.39 1189.39 other OPPS APC 1189.39 1189.39 other OPPS APC 1189.39 27.63 328.63 percent of total billed charges 1189.39 1189.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENSEAL X1 CURVED JAW LAPRASCOPIC SUP-NSLX137C CDM 0270 RC outpatient 1365.01 1365.01 1365.01 74 1010.11 percent of total billed charges 1365.01 93 1105.66 percent of total billed charges 1365.01 1365.01 other OPPS APC 1365.01 1365.01 other OPPS APC 1365.01 27.63 377.15 percent of total billed charges 1365.01 1365.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALER TISSUE ENSEAL STRAIGHT L37 CM OD5 MM TISSUE SEAL JAW SUP-NSLX137S CDM 0270 RC outpatient 1129.69 1129.69 1129.69 74 835.97 percent of total billed charges 1129.69 93 915.05 percent of total billed charges 1129.69 1129.69 other OPPS APC 1129.69 1129.69 other OPPS APC 1129.69 27.63 312.13 percent of total billed charges 1129.69 1129.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEALER TISSUE ENSEAL X1 L45 CM TAPER TIP CURVE JAW STERILE LATEX FREE DISPOSABLE SUP-NSLX145C CDM 0270 RC outpatient 1467.85 1467.85 1467.85 74 1086.21 percent of total billed charges 1467.85 93 1188.96 percent of total billed charges 1467.85 1467.85 other OPPS APC 1467.85 1467.85 other OPPS APC 1467.85 27.63 405.57 percent of total billed charges 1467.85 1467.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT TRANSSEPTAL NRG RADIOFREQUENCY PTW-25-230 SUP-NTK-711-8545 CDM 0481 RC outpatient 2262 2262 2262 74 1673.88 percent of total billed charges 2262 93 1832.22 percent of total billed charges 2262 2262 other OPPS APC 2262 2262 other OPPS APC 2262 51 1153.62 percent of total billed charges 2262 2262 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT TRANSSEPTAL NRG RADIOFREQUENCY SUP-NTK-711-8545N CDM 0481 RC outpatient 1703 1703 1703 74 1260.22 percent of total billed charges 1703 93 1379.43 percent of total billed charges 1703 1703 other OPPS APC 1703 1703 other OPPS APC 1703 51 868.53 percent of total billed charges 1703 1703 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEXTRA HAMMER TOE SUP-NX-3532K CDM 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PROCEDURE NEXTRA STEP DRILL PROXIMAL IMPLANT BONE HOLDER IMPLANT DRIVER IMPLANT HANDLE STERILE HAMMERTOE CORRECTION SYSTEM SUP-NX-4532K CDM 0270 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 27.63 862.06 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 2.5X8 BARE METAL SUP-NXL25008US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 2.75X17 BARE METAL SUP-NXL27517US CDM 0481 RC outpatient 104 104 104 74 76.96 percent of total billed charges 104 93 84.24 percent of total billed charges 104 104 other OPPS APC 104 104 other OPPS APC 104 51 53.04 percent of total billed charges 104 104 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 2.75X28 BARE METAL SUP-NXL27528US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 2.75X33 BARE METAL SUP-NXL27533US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 3.0X8 BARE METAL SUP-NXL30008US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 3.0X12 BARE METAL SUP-NXL30012US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 3.0X17 BARE METAL SUP-NXL30017US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 3.0X20 BARE METAL SUP-NXL30020US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 3.0X24 BARE METAL SUP-NXL30024US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 3.0X28 BARE METAL SUP-NXL30028US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 3.0X33 BARE METAL SUP-NXL30033US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 3.5X8 BARE METAL SUP-NXL35008US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 3.5X12 BARE METAL SUP-NXL35012US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 3.5X17 BARE METAL SUP-NXL35017US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 3.5X20 BARE METAL SUP-NXL35020US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 3.5X24 BARE METAL SUP-NXL35024US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 3.5X28 BARE METAL SUP-NXL35028US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 3.5X33 BARE METAL SUP-NXL35033US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 4.0X12 BARE METAL SUP-NXL40012US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 4.0X17 BARE METAL SUP-NXL40017US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 4.0X20 BARE METAL SUP-NXL40020US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 4.0X24 BARE METAL SUP-NXL40024US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 4.0X28 BARE METAL SUP-NXL40028US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT NIRXCELL 4.0X33 BARE METAL SUP-NXL40033US CDM 0481 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 51 530.4 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MEDTRONIC TALENT OCCLUDER SUP-OCL08US CDM 270010015 LOCAL 0270 RC outpatient 6695 6695 6695 74 4954.3 percent of total billed charges 6695 93 5422.95 percent of total billed charges 6695 6695 other OPPS APC 6695 6695 other OPPS APC 6695 27.63 1849.83 percent of total billed charges 6695 6695 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCCLUDER CARDIOVASCULAR TALENT L31 MM OD17.5 FR DELIVERY SYSTEM STENT GARFT CATHETER AAA SUP-OCL10US CDM 270010015 LOCAL 0270 RC outpatient 6695 6695 6695 74 4954.3 percent of total billed charges 6695 93 5422.95 percent of total billed charges 6695 6695 other OPPS APC 6695 6695 other OPPS APC 6695 27.63 1849.83 percent of total billed charges 6695 6695 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MEDTRONIC TALENT OCCLUDER SUP-OCL12US CDM 270010015 LOCAL 0270 RC outpatient 6695 6695 6695 74 4954.3 percent of total billed charges 6695 93 5422.95 percent of total billed charges 6695 6695 other OPPS APC 6695 6695 other OPPS APC 6695 27.63 1849.83 percent of total billed charges 6695 6695 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MEDTRONIC TALENT OCCLUDER SUP-OCL16US CDM 270010015 LOCAL 0270 RC outpatient 6695 6695 6695 74 4954.3 percent of total billed charges 6695 93 5422.95 percent of total billed charges 6695 6695 other OPPS APC 6695 6695 other OPPS APC 6695 27.63 1849.83 percent of total billed charges 6695 6695 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCCLUDER CARDIOVASCULAR TALENT L35 MM OD20 MM OD17.5 FR DELIVERY SYSTEM STENT GRAFT CATHETER SUP-OCL20US CDM 270010015 LOCAL 0270 RC outpatient 6695 6695 6695 74 4954.3 percent of total billed charges 6695 93 5422.95 percent of total billed charges 6695 6695 other OPPS APC 6695 6695 other OPPS APC 6695 27.63 1849.83 percent of total billed charges 6695 6695 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT MEDTRONIC TALENT OCCLUDER SUP-OCL24US CDM 270010015 LOCAL 0270 RC outpatient 6695 6695 6695 74 4954.3 percent of total billed charges 6695 93 5422.95 percent of total billed charges 6695 6695 other OPPS APC 6695 6695 other OPPS APC 6695 27.63 1849.83 percent of total billed charges 6695 6695 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS VITRECTOMY 30 DEG SUP-ODV3P CDM 0270 RC outpatient 68.9 68.9 68.9 74 50.99 percent of total billed charges 68.9 93 55.81 percent of total billed charges 68.9 68.9 other OPPS APC 68.9 68.9 other OPPS APC 68.9 27.63 19.04 percent of total billed charges 68.9 68.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS VITRECTOMY BICONCAVE SUP-ODVB CDM 0270 RC outpatient 68.9 68.9 68.9 74 50.99 percent of total billed charges 68.9 93 55.81 percent of total billed charges 68.9 68.9 other OPPS APC 68.9 68.9 other OPPS APC 68.9 27.63 19.04 percent of total billed charges 68.9 68.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS VITRECTOMY FLAT SUP-ODVF CDM 0270 RC outpatient 68.9 68.9 68.9 74 50.99 percent of total billed charges 68.9 93 55.81 percent of total billed charges 68.9 68.9 other OPPS APC 68.9 68.9 other OPPS APC 68.9 27.63 19.04 percent of total billed charges 68.9 68.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCCLUDER SHUNT AXIUS L16.25 MM OD1.5 MM CORONARY TEMPORARY SUP-OF-1500 CDM 0270 RC outpatient 267.13 267.13 267.13 74 197.68 percent of total billed charges 267.13 93 216.38 percent of total billed charges 267.13 267.13 other OPPS APC 267.13 267.13 other OPPS APC 267.13 27.63 73.81 percent of total billed charges 267.13 267.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHUNT CARDIOVASCULAR AXIUS STANDARD TAPER L17.5 MM OD1.75 MM CORONARY ARTERY INTERNAL COIL OFFSET THREADED TAB VISUALIZATION OF ANASTOMOTIC SITE SUP-OF-1750 CDM 0270 RC outpatient 267.13 267.13 267.13 74 197.68 percent of total billed charges 267.13 93 216.38 percent of total billed charges 267.13 267.13 other OPPS APC 267.13 267.13 other OPPS APC 267.13 27.63 73.81 percent of total billed charges 267.13 267.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCCLUDER SHUNT AXIUS L18 MM OD2 MM CORONARY TEMPORARY SUP-OF-2000 CDM 0270 RC outpatient 248.65 248.65 248.65 74 184 percent of total billed charges 248.65 93 201.41 percent of total billed charges 248.65 248.65 other OPPS APC 248.65 248.65 other OPPS APC 248.65 27.63 68.7 percent of total billed charges 248.65 248.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCCLUDER SHUNT AXIUS L19 MM OD2.5 MM CORONARY TEMPORARY SUP-OF-2500 CDM 0270 RC outpatient 267.13 267.13 267.13 74 197.68 percent of total billed charges 267.13 93 216.38 percent of total billed charges 267.13 267.13 other OPPS APC 267.13 267.13 other OPPS APC 267.13 27.63 73.81 percent of total billed charges 267.13 267.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT ORTHOPEDIC ORTHO-GLASS FIBERGLASS L15 FT X W3 IN WRIST IMMOBILIZER WRINKLE FREE STRETCH PAD COVER INTERLOCK PERFORMANCE TECHNOLOGY LATEX FREE SUP-OG-3L2 CDM 0270 RC outpatient 125.58 125.58 125.58 74 92.93 percent of total billed charges 125.58 93 101.72 percent of total billed charges 125.58 125.58 other OPPS APC 125.58 125.58 other OPPS APC 125.58 27.63 34.7 percent of total billed charges 125.58 125.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT ORTHOPEDIC ORTHO-GLASS FIBERGLASS L15 FT X W4 IN WRIST IMMOBILIZER WRINKLE FREE STRETCH PAD COVER INTERLOCK PERFORMANCE TECHNOLOGY LATEX FREE SUP-OG-4L2 CDM 0270 RC outpatient 150.7 150.7 150.7 74 111.52 percent of total billed charges 150.7 93 122.07 percent of total billed charges 150.7 150.7 other OPPS APC 150.7 150.7 other OPPS APC 150.7 27.63 41.64 percent of total billed charges 150.7 150.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPLINT ORTHOPEDIC ORTHO-GLASS 15FTX5IN FIBERGLASS LF WRIST WRINKLE FREE STRETCH PAD COVER ROLL SUP-OG-5L2 CDM 0270 RC outpatient 188.37 188.37 188.37 74 139.39 percent of total billed charges 188.37 93 152.58 percent of total billed charges 188.37 188.37 other OPPS APC 188.37 188.37 other OPPS APC 188.37 27.63 52.05 percent of total billed charges 188.37 188.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LUBRICANT INSTRUMENT 1 REPLACEMENT FILTER OIL NONSTERILE AUTOLUBE II AND III SUP-OIL-II CDM outpatient 70.2 70.2 70.2 70.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLAMP ELECTROSURGICAL ISOLATOR TRANSPOLAR L6.3 MM ELECTRODE SUP-OLL2 CDM 0270 RC outpatient 7020 7020 7020 74 5194.8 percent of total billed charges 7020 93 5686.2 percent of total billed charges 7020 7020 other OPPS APC 7020 7020 other OPPS APC 7020 27.63 1939.63 percent of total billed charges 7020 7020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON DISSECTOR LAPAROSCOPIC PDB SPACEMAKER EXTRA VIEW LG KIDNEY PVC DISPOSABLE STERILE LF PREPERITONEAL DISTENTION SUP-OMS-PDBS2 CDM 270009200 LOCAL 0270 RC outpatient 162 162 162 74 119.88 percent of total billed charges 162 93 131.22 percent of total billed charges 162 162 other OPPS APC 162 162 other OPPS APC 162 27.63 44.76 percent of total billed charges 162 162 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE FIXATION TACKER TITANIUM OD5 MM 5 FULL HELICAL TACK REPOSABLE SYSTEM DISPOSABLE LAPAROSCOPIC HERNIA REPAIR SUP-OMS-TTSD CDM 270009199 LOCAL 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISSECTOR BALLOON PREPERITONEAL KIDNEY SUP-OMSPDBS2 CDM 0270 RC outpatient 4916.73 4916.73 4916.73 74 3638.38 percent of total billed charges 4916.73 93 3982.55 percent of total billed charges 4916.73 4916.73 other OPPS APC 4916.73 4916.73 other OPPS APC 4916.73 27.63 1358.49 percent of total billed charges 4916.73 4916.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TROCAR LAPAROSCOPIC SPACEMAKER 5MM 7/8 MM LARGE TRIANGLE OD10 MM PREPERITONEUM BALLOON BUILT IN CONVERTER DISTAL END SYRINGE STERILE DISPOSABLE HERNIA SUP-OMST10SB CDM 270009200 LOCAL 0270 RC outpatient 162 162 162 74 119.88 percent of total billed charges 162 93 131.22 percent of total billed charges 162 162 other OPPS APC 162 162 other OPPS APC 162 27.63 44.76 percent of total billed charges 162 162 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SNARE ENDOSCOPIC ONE SNARE NITINOL TUNGSTEN GOLD L47 IN OD.39 IN VASCULAR 1 LOOP SUPERELASTIC FLEXIBLE KINK RESISTANCE SUP-ONE1000 CDM 0270 RC outpatient 691.73 691.73 691.73 74 511.88 percent of total billed charges 691.73 93 560.3 percent of total billed charges 691.73 691.73 other OPPS APC 691.73 691.73 other OPPS APC 691.73 27.63 191.12 percent of total billed charges 691.73 691.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE CRYOLIFE ONX MITRAL STANDARD 31/33 SUP-ONXM-31/33 CDM 0270 RC outpatient 10387 10387 10387 74 7686.38 percent of total billed charges 10387 93 8413.47 percent of total billed charges 10387 10387 other OPPS APC 10387 10387 other OPPS APC 10387 27.63 2869.93 percent of total billed charges 10387 10387 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.0 X 8MM SUP-ONYXNG20008UX_69302 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.0 X 12MM SUP-ONYXNG20012UX_69311 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.0 X 15MM SUP-ONYXNG20015UX_69320 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.0 X 18MM SUP-ONYXNG20018UX_69333 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.0 X 22MM SUP-ONYXNG20022UX_69343 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.0 X 26MM SUP-ONYXNG20026UX_69355 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.0 X 30MM SUP-ONYXNG20030UX_69364 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.25 X 8MM SUP-ONYXNG22508UX_69305 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.25 X 12MM SUP-ONYXNG22512UX_69312 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.25 X 15MM SUP-ONYXNG22515UX_69321 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.25 X 18MM SUP-ONYXNG22518UX_69334 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.25 X 22MM SUP-ONYXNG22522UX_69344 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.25 X 26MM SUP-ONYXNG22526UX_69356 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.25 X 30MM SUP-ONYXNG22530UX_69365 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.25 X 34MM SUP-ONYXNG22534UX_69391 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.25 X 38MM SUP-ONYXNG22538UX_69398 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.5 X 8MM SUP-ONYXNG25008UX_69306 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.5 X 12MM SUP-ONYXNG25012UX_69313 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.5 X 15MM SUP-ONYXNG25015UX_69322 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.5 X 18MM SUP-ONYXNG25018UX_69335 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.5 X 22MM SUP-ONYXNG25022UX_69345 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.5 X 26MM SUP-ONYXNG25026UX_69357 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.5 X 30MM SUP-ONYXNG25030UX_69384 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.5 X 34MM SUP-ONYXNG25034UX_69392 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.5 X 38MM SUP-ONYXNG25038UX_69399 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.75 X 8MM SUP-ONYXNG27508UX_69307 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.75 X 12MM SUP-ONYXNG27512UX_69314 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.75 X 15MM SUP-ONYXNG27515UX_69323 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.75 X 18MM SUP-ONYXNG27518UX_69336 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.75 X 22MM SUP-ONYXNG27522UX_69346 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.75 X 26MM SUP-ONYXNG27526UX_69358 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.75 X 30MM SUP-ONYXNG27530UX_69385 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.75 X 34MM SUP-ONYXNG27534UX_69393 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 2.75 X 38MM SUP-ONYXNG27538UX_69400 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 3.0 X 8MM SUP-ONYXNG30008UX_69308 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 3.0 X 12MM SUP-ONYXNG30012UX_69315 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 3.0 X 15MM SUP-ONYXNG30015UX_69324 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 3.0 X 18MM SUP-ONYXNG30018UX_69338 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 3.0 X 22MM SUP-ONYXNG30022UX_69347 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 3.0 X 26MM SUP-ONYXNG30026UX_69359 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 3.0 X 30MM SUP-ONYXNG30030UX_69386 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 3.0 X 34MM SUP-ONYXNG30034UX_69394 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 3.0 X 38MM SUP-ONYXNG30038UX_69401 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 3.5 X 8MM SUP-ONYXNG35008UX_69309 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 3.5 X 12MM SUP-ONYXNG35012UX_69316 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 3.5 X 15MM SUP-ONYXNG35015UX_69325 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 3.5 X 18MM SUP-ONYXNG35018UX_69339 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 3.5 X 22MM SUP-ONYXNG35022UX_69348 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 3.5 X 26MM SUP-ONYXNG35026UX_69360 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 3.5 X 30MM SUP-ONYXNG35030UX_69388 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 3.5 X 34MM SUP-ONYXNG35034UX_69395 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 3.5 X 38MM SUP-ONYXNG35038UX_69406 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 4.0 X 8MM SUP-ONYXNG40008UX_69310 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 4.0 X 12MM SUP-ONYXNG40012UX_69317 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 4.0 X 15MM SUP-ONYXNG40015UX_69326 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 4.0 X 18MM SUP-ONYXNG40018UX_69340 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 4.0 X 22MM SUP-ONYXNG40022UX_69349 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 4.0 X 26MM SUP-ONYXNG40026UX_69361 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 4.0 X 30MM SUP-ONYXNG40030UX_69389 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 4.0 X 34MM SUP-ONYXNG40034UX_69396 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 4.0 X 38MM SUP-ONYXNG40038UX_69407 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 4.5 X 12MM SUP-ONYXNG45012UX_69318 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 4.5 X 15MM SUP-ONYXNG45015UX_69327 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 4.5 X 18MM SUP-ONYXNG45018UX_69341 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 4.5 X 22MM SUP-ONYXNG45022UX_69350 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 4.5 X 26MM SUP-ONYXNG45026UX_69362 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 4.5 X 30MM SUP-ONYXNG45030UX_69390 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 5.0 X 12MM SUP-ONYXNG50012UX_69319 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 5.0 X 15MM SUP-ONYXNG50015UX_69328 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 5.0 X 18MM SUP-ONYXNG50018UX_69342 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 5.0 X 22MM SUP-ONYXNG50022UX_69351 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ONYX FRONTIER RX CORONARY STENT 5.0 X 26MM SUP-ONYXNG50026UX_69363 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE WARMING STERILE 44 X 44 SUP-ORS-100 CDM 0270 RC outpatient 65 65 65 74 48.1 percent of total billed charges 65 93 52.65 percent of total billed charges 65 65 other OPPS APC 65 65 other OPPS APC 65 27.63 17.96 percent of total billed charges 65 65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SLUSH STERILE 44 X 66 SUP-ORS-320 CDM 0270 RC outpatient 106.17 106.17 106.17 74 78.57 percent of total billed charges 106.17 93 86 percent of total billed charges 106.17 106.17 other OPPS APC 106.17 106.17 other OPPS APC 106.17 27.63 29.33 percent of total billed charges 106.17 106.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAPE SURGICAL BASIN DOUBLE DISC SLUSH WARMER MACHINE 44 X 66IN SUP-ORS320 CDM 0270 RC outpatient 105.63 105.63 105.63 74 78.17 percent of total billed charges 105.63 93 85.56 percent of total billed charges 105.63 105.63 other OPPS APC 105.63 105.63 other OPPS APC 105.63 27.63 29.19 percent of total billed charges 105.63 105.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMOBILIZER ORTHOPEDIC ALUMINUM FOAM 24 IN OD 17.5 IN OD SEC 16 IN KNEE 3 PANEL LOOP LOCK CLOSURE POSTERIOR STAY ADJUSTABLE LATEX FREE SUP-ORT2410016_57632 CDM 270009016 LOCAL 0270 RC outpatient 20.8 20.8 20.8 74 15.39 percent of total billed charges 20.8 93 16.85 percent of total billed charges 20.8 20.8 other OPPS APC 20.8 20.8 other OPPS APC 20.8 27.63 5.75 percent of total billed charges 20.8 20.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Fix This SUP-ORT2410020 CDM 270009016 LOCAL 0270 RC outpatient 24.3 24.3 24.3 74 17.98 percent of total billed charges 24.3 93 19.68 percent of total billed charges 24.3 24.3 other OPPS APC 24.3 24.3 other OPPS APC 24.3 27.63 6.71 percent of total billed charges 24.3 24.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMOBILIZER ORTHOPEDIC ALUMINUM TRICOT UNIVERSAL L12 IN KNEE POSTERIOR STAY HOOK LOOP CLOSURE 3 PANEL LATEX FREE SUP-ORT2411012 CDM 270009016 LOCAL 0270 RC outpatient 35.28 35.28 35.28 74 26.11 percent of total billed charges 35.28 93 28.58 percent of total billed charges 35.28 35.28 other OPPS APC 35.28 35.28 other OPPS APC 35.28 27.63 9.75 percent of total billed charges 35.28 35.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMOBILIZER ORTHOPEDIC ALUMINUM FOAM 24 IN OD 17.5 IN OD SEC 16 IN KNEE 3 PANEL LOOP LOCK CLOSURE POSTERIOR STAY ADJUSTABLE LATEX FREE SUP-ORT2411016_57632 CDM 270009016 LOCAL 0270 RC outpatient 36.61 36.61 36.61 74 27.09 percent of total billed charges 36.61 93 29.65 percent of total billed charges 36.61 36.61 other OPPS APC 36.61 36.61 other OPPS APC 36.61 27.63 10.12 percent of total billed charges 36.61 36.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMOBILIZER ORTHOPEDIC ALUMINUM FOAM 26 IN OD 20.5 IN ODSEC 22 IN L KNEE 3 PANEL LOOP LOCK CLOSURE POSTERIOR STAY ADJUSTABLE LATEX FREE SUP-ORT2411022 CDM 270009016 LOCAL 0270 RC outpatient 37.96 37.96 37.96 74 28.09 percent of total billed charges 37.96 93 30.75 percent of total billed charges 37.96 37.96 other OPPS APC 37.96 37.96 other OPPS APC 37.96 27.63 10.49 percent of total billed charges 37.96 37.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WAX BONE MONTAGE STERILE SUP-OS-MON-1001 CDM 0270 RC outpatient 4677.4 4677.4 4677.4 74 3461.28 percent of total billed charges 4677.4 93 3788.69 percent of total billed charges 4677.4 4677.4 other OPPS APC 4677.4 4677.4 other OPPS APC 4677.4 27.63 1292.37 percent of total billed charges 4677.4 4677.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE ONE-STEP TEFLON L10 CM OD5 FR PERCUTANEOUS 4 SIDEHOLE LUER LOCK INTRODUCER NEEDLE SWIVEL NUT CENTESIS SUP-OSC-5F-10 CDM 0270 RC outpatient 44.88 44.88 44.88 74 33.21 percent of total billed charges 44.88 93 36.35 percent of total billed charges 44.88 44.88 other OPPS APC 44.88 44.88 other OPPS APC 44.88 27.63 12.4 percent of total billed charges 44.88 44.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE ONE-STEP TEFLON L10 CM OD5 FR PERCUTANEOUS 4 SIDEHOLE LUER LOCK INTRODUCER NEEDLE SWIVEL NUT CENTESIS SUP-OSC-5F-10L CDM 0270 RC outpatient 44.88 44.88 44.88 74 33.21 percent of total billed charges 44.88 93 36.35 percent of total billed charges 44.88 44.88 other OPPS APC 44.88 44.88 other OPPS APC 44.88 27.63 12.4 percent of total billed charges 44.88 44.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE 5FR 7CM ONE STEP 4 SIDEHOLE LUER LOCK INTRODUCER NEEDLE SWIVEL NUT SUP-OSC-5F-7 CDM 0270 RC outpatient 44.88 44.88 44.88 74 33.21 percent of total billed charges 44.88 93 36.35 percent of total billed charges 44.88 44.88 other OPPS APC 44.88 44.88 other OPPS APC 44.88 27.63 12.4 percent of total billed charges 44.88 44.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE 5FR 7CM ONE STEP 4 SIDEHOLE LUER LOCK INTRODUCER NEEDLE SWIVEL NUT SUP-OSC-5F-7L CDM 0270 RC outpatient 44.88 44.88 44.88 74 33.21 percent of total billed charges 44.88 93 36.35 percent of total billed charges 44.88 44.88 other OPPS APC 44.88 44.88 other OPPS APC 44.88 27.63 12.4 percent of total billed charges 44.88 44.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DRAINAGE ONE STEP L7 CM OD5 FR PERCUTANEOUS 4 HOLE SELF CLOSING INTRODUCER NEEDLE VALVED TAPERED TIP FIXED LUER SUP-OSC-5F-7LT CDM 0270 RC outpatient 40.43 40.43 40.43 74 29.92 percent of total billed charges 40.43 93 32.75 percent of total billed charges 40.43 40.43 other OPPS APC 40.43 40.43 other OPPS APC 40.43 27.63 11.17 percent of total billed charges 40.43 40.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HANDPIECE BIPOLAR ISOLATOR SYNERGY L5.4 CM OD5 MM CURVE SUP-OSL2 CDM 0270 RC outpatient 6760 6760 6760 74 5002.4 percent of total billed charges 6760 93 5475.6 percent of total billed charges 6760 6760 other OPPS APC 6760 6760 other OPPS APC 6760 27.63 1867.79 percent of total billed charges 6760 6760 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT NEEDLE GUIDE CIV FLEX SONOSITE OD21 GA COVER BAND GEL STERILE TEAL L25 SUP-P09073-01 CDM 0270 RC outpatient 59.8 59.8 59.8 74 44.25 percent of total billed charges 59.8 93 48.44 percent of total billed charges 59.8 59.8 other OPPS APC 59.8 59.8 other OPPS APC 59.8 27.63 16.52 percent of total billed charges 59.8 59.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SMOOTH PEG SUP-P1000 CDM 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAIN PUMP DELIVER DIRECTLY TO AMERI-DOSE 205 FLANDERS ROAD WESTBOROUGH MA 01581 SUP-P100X2 CDM 0270 RC outpatient 234 234 234 74 173.16 percent of total billed charges 234 93 189.54 percent of total billed charges 234 234 other OPPS APC 234 234 other OPPS APC 234 27.63 64.65 percent of total billed charges 234 234 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG SMOOTH 2.0MM 12MM LONG SUP-P12 CDM 0270 RC outpatient 187.2 187.2 187.2 74 138.53 percent of total billed charges 187.2 93 151.63 percent of total billed charges 187.2 187.2 other OPPS APC 187.2 187.2 other OPPS APC 187.2 27.63 51.72 percent of total billed charges 187.2 187.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION DVR L12 MM OD2 MM SMOOTH LOCKING ANATOMIC VOLAR PLATING SYSTEM SUP-P12000 CDM 0270 RC outpatient 143.91 143.91 143.91 74 106.49 percent of total billed charges 143.91 93 116.57 percent of total billed charges 143.91 143.91 other OPPS APC 143.91 143.91 other OPPS APC 143.91 27.63 39.76 percent of total billed charges 143.91 143.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAPER RECORDING I PLY RECORD PRINTER SUP-P129359008 CDM 0270 RC outpatient 20.82 20.82 20.82 74 15.41 percent of total billed charges 20.82 93 16.86 percent of total billed charges 20.82 20.82 other OPPS APC 20.82 20.82 other OPPS APC 20.82 27.63 5.75 percent of total billed charges 20.82 20.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION DVR L14 MM OD2 MM SMOOTH LOCKING ANATOMIC VOLAR PLATING SYSTEM SUP-P14000 CDM 0270 RC outpatient 143.91 143.91 143.91 74 106.49 percent of total billed charges 143.91 93 116.57 percent of total billed charges 143.91 143.91 other OPPS APC 143.91 143.91 other OPPS APC 143.91 27.63 39.76 percent of total billed charges 143.91 143.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION DVR L16 MM OD2 MM SMOOTH LOCKING NONSTERILE ANATOMIC VOLAR PLATING SYSTEM SUP-P16000 CDM 0270 RC outpatient 143.91 143.91 143.91 74 106.49 percent of total billed charges 143.91 93 116.57 percent of total billed charges 143.91 143.91 other OPPS APC 143.91 143.91 other OPPS APC 143.91 27.63 39.76 percent of total billed charges 143.91 143.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION DVR L18 MM OD2 MM SMOOTH LOCKING NONSTERILE ANATOMIC VOLAR PLATING SYSTEM SUP-P18000 CDM 0270 RC outpatient 143.91 143.91 143.91 74 106.49 percent of total billed charges 143.91 93 116.57 percent of total billed charges 143.91 143.91 other OPPS APC 143.91 143.91 other OPPS APC 143.91 27.63 39.76 percent of total billed charges 143.91 143.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM ATHERECTOMY PHOENIX L149 CM OD1.8 MM CATHETER HANDLE WIRE CLIP OTW STERILE DISPOSABLE ACCEPTS .014 IN GUIDEWIRE 5 FR SHEATH 2.5 MM VESSEL SUP-P18149K CDM 0270 RC outpatient 7020 7020 7020 74 5194.8 percent of total billed charges 7020 93 5686.2 percent of total billed charges 7020 7020 other OPPS APC 7020 7020 other OPPS APC 7020 27.63 1939.63 percent of total billed charges 7020 7020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION DVR BLUNT L20 MM OD2 MM SMOOTH LOCK NONSTERILE ANATOMIC VOLAR PLATING SYSTEM SUP-P20000 CDM 0270 RC outpatient 143.91 143.91 143.91 74 106.49 percent of total billed charges 143.91 93 116.57 percent of total billed charges 143.91 143.91 other OPPS APC 143.91 143.91 other OPPS APC 143.91 27.63 39.76 percent of total billed charges 143.91 143.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION DVR L22 MM OD2 MM SMOOTH LOCKING NONSTERILE ANATOMIC VOLAR PLATING SYSTEM SUP-P22000 CDM 0270 RC outpatient 143.91 143.91 143.91 74 106.49 percent of total billed charges 143.91 93 116.57 percent of total billed charges 143.91 143.91 other OPPS APC 143.91 143.91 other OPPS APC 143.91 27.63 39.76 percent of total billed charges 143.91 143.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM ATHERECTOMY PHOENIX L130 CM OD2.2 MM ROTATIONAL OTW FRONT CUT LOW PROFILE STERILE DISPOSABLE ACCEPTS .014 IN GUIDEWIRE 5 FR SHEATH 3 MM VESSEL SUP-P22130K CDM 0270 RC outpatient 7020 7020 7020 74 5194.8 percent of total billed charges 7020 93 5686.2 percent of total billed charges 7020 7020 other OPPS APC 7020 7020 other OPPS APC 7020 27.63 1939.63 percent of total billed charges 7020 7020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM ATHERECTOMY PHOENIX L149 CM OD2.2 MM ROTATIONAL OTW FRONT CUT LOW PROFILE STERILE DISPOSABLE ACCEPTS .014 IN GUIDEWIRE 5 FR SHEATH 3 MM VESSEL SUP-P22149K CDM 0270 RC outpatient 7020 7020 7020 74 5194.8 percent of total billed charges 7020 93 5686.2 percent of total billed charges 7020 7020 other OPPS APC 7020 7020 other OPPS APC 7020 27.63 1939.63 percent of total billed charges 7020 7020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION DVR FULL THREAD L24 MM OD2 MM FOOT SMOOTH LOCKING NONSTERILE ANATOMIC VOLAR PLATING SYSTEM SUP-P24000 CDM 0270 RC outpatient 143.91 143.91 143.91 74 106.49 percent of total billed charges 143.91 93 116.57 percent of total billed charges 143.91 143.91 other OPPS APC 143.91 143.91 other OPPS APC 143.91 27.63 39.76 percent of total billed charges 143.91 143.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM 7F ATHERECTOMY 2.4 SUP-P24130 CDM 0270 RC outpatient 7020 7020 7020 74 5194.8 percent of total billed charges 7020 93 5686.2 percent of total billed charges 7020 7020 other OPPS APC 7020 7020 other OPPS APC 7020 27.63 1939.63 percent of total billed charges 7020 7020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION DVR L26 MM OD2 MM SMOOTH NONLOCKING SCREW NONSTERILE ANATOMIC VOLAR PLATING SYSTEM SUP-P26000 CDM 0270 RC outpatient 143.91 143.91 143.91 74 106.49 percent of total billed charges 143.91 93 116.57 percent of total billed charges 143.91 143.91 other OPPS APC 143.91 143.91 other OPPS APC 143.91 27.63 39.76 percent of total billed charges 143.91 143.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION L28 MM OD2 MM ORTHOPEDIC SMOOTH SUP-P28 CDM 0270 RC outpatient 187.2 187.2 187.2 74 138.53 percent of total billed charges 187.2 93 151.63 percent of total billed charges 187.2 187.2 other OPPS APC 187.2 187.2 other OPPS APC 187.2 27.63 51.72 percent of total billed charges 187.2 187.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION DVR L28 MM OD2 MM SMOOTH NONLOCKING SCREW NONSTERILE ANATOMIC VOLAR PLATING SYSTEM SUP-P28000 CDM 0270 RC outpatient 143.91 143.91 143.91 74 106.49 percent of total billed charges 143.91 93 116.57 percent of total billed charges 143.91 143.91 other OPPS APC 143.91 143.91 other OPPS APC 143.91 27.63 39.76 percent of total billed charges 143.91 143.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION DVR L30 MM OD2 MM SMOOTH NONLOCKING SCREW NONSTERILE ANATOMIC VOLAR PLATING SYSTEM SUP-P30000 CDM 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER CAN 24 INCH LOW DENSITY 0.7 MIL STAR BOTTOM SUP-P3320ZC CDM 0270 RC outpatient 0.14 0.14 0.14 74 0.1 percent of total billed charges 0.14 93 0.11 percent of total billed charges 0.14 0.14 other OPPS APC 0.14 0.14 other OPPS APC 0.14 27.63 0.04 percent of total billed charges 0.14 0.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ON Q PAINBUSTER 400ML SUP-P400X5 CDM 0270 RC outpatient 507 507 507 74 375.18 percent of total billed charges 507 93 410.67 percent of total billed charges 507 507 other OPPS APC 507 507 other OPPS APC 507 27.63 140.08 percent of total billed charges 507 507 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY PALMAZ STAINLESS STEEL XL L40 MM OD10 MM BALLOON EXPANDABLE CLOSED CELL UNMOUNT SHEATH INTRODUCER STERILE LATEX FREE DISPOSABLE POWERFLEX PLUS CATHETER TRANSHEPATIC SUP-P4010 CDM 0270 RC outpatient 2470 2470 2470 74 1827.8 percent of total billed charges 2470 93 2000.7 percent of total billed charges 2470 2470 other OPPS APC 2470 2470 other OPPS APC 2470 27.63 682.46 percent of total billed charges 2470 2470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC POLYETHYLENE NEWTON 4 CURVE L100 CM OD5 FR CEREBRAL ACCEPTS .035 IN GUIDEWIRE SUP-P5.0-35-100-P-NS-HN4 CDM 0270 RC outpatient 39.4 39.4 39.4 74 29.16 percent of total billed charges 39.4 93 31.91 percent of total billed charges 39.4 39.4 other OPPS APC 39.4 39.4 other OPPS APC 39.4 27.63 10.89 percent of total billed charges 39.4 39.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR ENDOSCOPIC 2CM L OD 6-7-8 MM PULMONARY BALLOON SUP-P6L20 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRACKET ARMBOARD REPAIR KIT SUP-P764316574 CDM 0270 RC outpatient 659.59 659.59 659.59 74 488.1 percent of total billed charges 659.59 93 534.27 percent of total billed charges 659.59 659.59 other OPPS APC 659.59 659.59 other OPPS APC 659.59 27.63 182.24 percent of total billed charges 659.59 659.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROBE DOPPLER SMARTDOP 8MHZ VASCULAR PENCIL STERILE ES-100X ES-1000SPM PRINTER SMARTDOP SUP-P8M05S8A CDM outpatient 972.4 972.4 972.4 972.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LUBRICANT INSTRUMENT LEGEND OILER DIFFUSER PACK ROUND CARTRIDGE LATEX FREE SUP-PA100-A CDM 0270 RC outpatient 90.45 90.45 90.45 74 66.93 percent of total billed charges 90.45 93 73.26 percent of total billed charges 90.45 90.45 other OPPS APC 90.45 90.45 other OPPS APC 90.45 27.63 24.99 percent of total billed charges 90.45 90.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IRRIGATOR ENDOSCOPIC PATHFINDER PLUS BULB L10 IN UROLOGICAL TUBE LUER LOCK STERILE DISPOSABLE SUP-PA701 CDM 0270 RC outpatient 103.09 103.09 103.09 74 76.29 percent of total billed charges 103.09 93 83.5 percent of total billed charges 103.09 103.09 other OPPS APC 103.09 103.09 other OPPS APC 103.09 27.63 28.48 percent of total billed charges 103.09 103.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAIN CUSTOM PACK SUP-PAIN1158B CDM 0270 RC outpatient 29.61 29.61 29.61 74 21.91 percent of total billed charges 29.61 93 23.98 percent of total billed charges 29.61 29.61 other OPPS APC 29.61 29.61 other OPPS APC 29.61 27.63 8.18 percent of total billed charges 29.61 29.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VIAL SPECIMEN 10ML 1 HAND HINGE CAP STERILE SUP-PAINVIAL1 CDM 0270 RC outpatient 7.37 7.37 7.37 74 5.45 percent of total billed charges 7.37 93 5.97 percent of total billed charges 7.37 7.37 other OPPS APC 7.37 7.37 other OPPS APC 7.37 27.63 2.04 percent of total billed charges 7.37 7.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANISTER SUCTION MAX NONSTERILE SUP-PAPS2 CDM 0270 RC outpatient 949 949 949 74 702.26 percent of total billed charges 949 93 768.69 percent of total billed charges 949 949 other OPPS APC 949 949 other OPPS APC 949 27.63 262.21 percent of total billed charges 949 949 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANISTER SUCTION PENUMBRA ENGINE NONSTERILE SUP-PAPS3 CDM 0270 RC outpatient 949 949 949 74 702.26 percent of total billed charges 949 93 768.69 percent of total billed charges 949 949 other OPPS APC 949 949 other OPPS APC 949 27.63 262.21 percent of total billed charges 949 949 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY PALMAZ BLUE SLALOM FLEXSEGMENT COCR L17 MM L14 MM L80 CM OD5 MM OTW BALLOON EXPANDABLE CLOSED CELL SHEATH INTRODUCER STERILE LATEX FREE DISPOSABLE ACCEPTS .018 IN GUIDEWIRE 5 FR INTRODUCER SHEATH 6 FR GUIDE CATHETER TRANSHEPATIC SUP-PB1550BSS CDM 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY PALMAZ BLUE SLALOM FLEXSEGMENT COCR L17 MM L14 MM L80 CM OD6 MM OTW BALLOON EXPANDABLE CLOSED CELL ACCEPTS .018 IN GUIDEWIRE 5 FR INTRODUCER SHEATH 6 FR GUIDE CATHETER TRANSHEPATIC SUP-PB1560BSS CDM 0270 RC outpatient 2930.46 2930.46 2930.46 74 2168.54 percent of total billed charges 2930.46 93 2373.67 percent of total billed charges 2930.46 2930.46 other OPPS APC 2930.46 2930.46 other OPPS APC 2930.46 27.63 809.69 percent of total billed charges 2930.46 2930.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY 18MM 5MM 5FR FLEXSEGMENT PALMAZ BLUE SLALOM .018IN COCR OTW BALLOON SUP-PB1850BSS CDM 0270 RC outpatient 2930.46 2930.46 2930.46 74 2168.54 percent of total billed charges 2930.46 93 2373.67 percent of total billed charges 2930.46 2930.46 other OPPS APC 2930.46 2930.46 other OPPS APC 2930.46 27.63 809.69 percent of total billed charges 2930.46 2930.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY PALMAZ BLUE SLALOM FLEXSEGMENT COCR L20 MM L17 MM L80 CM OD6 MM OTW BALLOON EXPANDABLE CLOSED CELL STERILE LATEX FREE DISPOSABLE ACCEPTS .018 IN GUIDEWIRE 5 FR INTRODUCER SHEATH 6 FR GUIDE CATHETER TRANSHEPATIC SUP-PB1860BSS CDM 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRI-POUR BEAKERS 1000ML SUP-PB5935-1KO CDM 0270 RC outpatient 2.16 2.16 2.16 74 1.6 percent of total billed charges 2.16 93 1.75 percent of total billed charges 2.16 2.16 other OPPS APC 2.16 2.16 other OPPS APC 2.16 27.63 0.6 percent of total billed charges 2.16 2.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLEARGUIDE BIPOLAR DEVICE PBD02 SUP-PBD02 CDM 0270 RC outpatient 994.5 994.5 994.5 74 735.93 percent of total billed charges 994.5 93 805.55 percent of total billed charges 994.5 994.5 other OPPS APC 994.5 994.5 other OPPS APC 994.5 27.63 274.78 percent of total billed charges 994.5 994.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR PRECISE PRO RX NITINOL L20 MM L135 CM OD5 MM CAROTID ARTERY RAPID EXCHANGE SELF EXPAND MICROMESH SEGMENT ACCEPTS .014 IN GUIDEWIRE 5 FR SHEATH 7 FR GUIDE CATHETER 4-5 MM VESSEL SUP-PC0520RXC_75066 CDM 0270 RC outpatient 4095 4095 4095 74 3030.3 percent of total billed charges 4095 93 3316.95 percent of total billed charges 4095 4095 other OPPS APC 4095 4095 other OPPS APC 4095 27.63 1131.45 percent of total billed charges 4095 4095 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR PRECISE PRO RX NITINOL L30 MM L135 CM OD5 MM CAROTID ARTERY RAPID EXCHANGE SELF EXPAND MICROMESH SEGMENT ACCEPTS .014 IN GUIDEWIRE 5 FR SHEATH 7 FR GUIDE CATHETER 4-5 MM VESSEL SUP-PC0530RXC_75067 CDM 0270 RC outpatient 4095 4095 4095 74 3030.3 percent of total billed charges 4095 93 3316.95 percent of total billed charges 4095 4095 other OPPS APC 4095 4095 other OPPS APC 4095 27.63 1131.45 percent of total billed charges 4095 4095 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR PRECISE PRO RX NITINOL L40 MM L135 CM OD5 MM CAROTID ARTERY RAPID EXCHANGE SELF EXPAND MICROMESH SEGMENT ACCEPTS .014 IN GUIDEWIRE 5 FR SHEATH 7 FR GUIDE CATHETER 4-5 MM VESSEL SUP-PC0540RXC_75068 CDM 0270 RC outpatient 4095 4095 4095 74 3030.3 percent of total billed charges 4095 93 3316.95 percent of total billed charges 4095 4095 other OPPS APC 4095 4095 other OPPS APC 4095 27.63 1131.45 percent of total billed charges 4095 4095 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR PRECISE PRO RX NITINOL L20 MM L135 CM OD6 MM CAROTID ARTERY RAPID EXCHANGE SELF EXPAND MICROMESH SEGMENT ACCEPTS .014 IN GUIDEWIRE 5 FR SHEATH 7 FR GUIDE CATHETER 4-5 MM VESSEL SUP-PC0620RXC_75069 CDM 0270 RC outpatient 4095 4095 4095 74 3030.3 percent of total billed charges 4095 93 3316.95 percent of total billed charges 4095 4095 other OPPS APC 4095 4095 other OPPS APC 4095 27.63 1131.45 percent of total billed charges 4095 4095 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR PRECISE PRO RX NITINOL L30 MM L135 CM OD6 MM CAROTID ARTERY RAPID EXCHANGE SELF EXPAND MICROMESH SEGMENT ACCEPTS .014 IN GUIDEWIRE 5 FR SHEATH 7 FR GUIDE CATHETER 4-5 MM VESSEL SUP-PC0630RXC_75070 CDM 0270 RC outpatient 4095 4095 4095 74 3030.3 percent of total billed charges 4095 93 3316.95 percent of total billed charges 4095 4095 other OPPS APC 4095 4095 other OPPS APC 4095 27.63 1131.45 percent of total billed charges 4095 4095 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR PRECISE PRO RX NITINOL L40 MM L135 CM OD6 MM CAROTID ARTERY RAPID EXCHANGE SELF EXPAND MICROMESH SEGMENT ACCEPTS .014 IN GUIDEWIRE 5 FR SHEATH 7 FR GUIDE CATHETER 4-5 MM VESSEL SUP-PC0640RXC_75071 CDM 0270 RC outpatient 4095 4095 4095 74 3030.3 percent of total billed charges 4095 93 3316.95 percent of total billed charges 4095 4095 other OPPS APC 4095 4095 other OPPS APC 4095 27.63 1131.45 percent of total billed charges 4095 4095 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR PRECISE PRO RX NITINOL L20 MM L135 CM OD7 MM CAROTID ARTERY RAPID EXCHANGE SELF EXPAND MICROMESH SEGMENT ACCEPTS .014 IN GUIDEWIRE 5 FR SHEATH 7 FR GUIDE CATHETER 5-6 MM VESSEL SUP-PC0720RXC_75072 CDM 0270 RC outpatient 4095 4095 4095 74 3030.3 percent of total billed charges 4095 93 3316.95 percent of total billed charges 4095 4095 other OPPS APC 4095 4095 other OPPS APC 4095 27.63 1131.45 percent of total billed charges 4095 4095 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR PRECISE PRO RX NITINOL L30 MM L135 CM OD7 MM CAROTID ARTERY RAPID EXCHANGE SELF EXPAND MICROMESH SEGMENT ACCEPTS .014 IN GUIDEWIRE 5 FR SHEATH 7 FR GUIDE CATHETER 5-6 MM VESSEL SUP-PC0730RXC_75073 CDM 0270 RC outpatient 4095 4095 4095 74 3030.3 percent of total billed charges 4095 93 3316.95 percent of total billed charges 4095 4095 other OPPS APC 4095 4095 other OPPS APC 4095 27.63 1131.45 percent of total billed charges 4095 4095 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR PRECISE PRO RX NITINOL L40 MM L135 CM OD7 MM CAROTID ARTERY RAPID EXCHANGE SELF EXPAND MICROMESH SEGMENT ACCEPTS .014 IN GUIDEWIRE 5 FR SHEATH 7 FR GUIDE CATHETER 5-6 MM VESSEL SUP-PC0740RXC_75074 CDM 0270 RC outpatient 4095 4095 4095 74 3030.3 percent of total billed charges 4095 93 3316.95 percent of total billed charges 4095 4095 other OPPS APC 4095 4095 other OPPS APC 4095 27.63 1131.45 percent of total billed charges 4095 4095 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR PRECISE PRO RX NITINOL L20 MM L135 CM OD8 MM CAROTID ARTERY RAPID EXCHANGE SELF EXPAND MICROMESH SEGMENT ACCEPTS .014 IN GUIDEWIRE 5 FR SHEATH 7 FR GUIDE CATHETER 6-7 MM VESSEL SUP-PC0820RXC_75076 CDM 0270 RC outpatient 4095 4095 4095 74 3030.3 percent of total billed charges 4095 93 3316.95 percent of total billed charges 4095 4095 other OPPS APC 4095 4095 other OPPS APC 4095 27.63 1131.45 percent of total billed charges 4095 4095 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR PRECISE PRO RX NITINOL L30 MM L135 CM OD8 MM CAROTID ARTERY RAPID EXCHANGE SELF EXPAND MICROMESH SEGMENT ACCEPTS .014 IN GUIDEWIRE 5 FR SHEATH 7 FR GUIDE CATHETER 6-7 MM VESSEL SUP-PC0830RXC_75077 CDM 0270 RC outpatient 4095 4095 4095 74 3030.3 percent of total billed charges 4095 93 3316.95 percent of total billed charges 4095 4095 other OPPS APC 4095 4095 other OPPS APC 4095 27.63 1131.45 percent of total billed charges 4095 4095 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR PRECISE PRO RX NITINOL L40 MM L135 CM OD8 MM CAROTID ARTERY RAPID EXCHANGE SELF EXPAND MICROMESH SEGMENT ACCEPTS .014 IN GUIDEWIRE 5 FR SHEATH 7 FR GUIDE CATHETER 6-7 MM VESSEL SUP-PC0840RXC_75078 CDM 0270 RC outpatient 4095 4095 4095 74 3030.3 percent of total billed charges 4095 93 3316.95 percent of total billed charges 4095 4095 other OPPS APC 4095 4095 other OPPS APC 4095 27.63 1131.45 percent of total billed charges 4095 4095 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR PRECISE PRO RX NITINOL L20 MM L135 CM OD9 MM CAROTID ARTERY RAPID EXCHANGE SELF EXPAND MICROMESH SEGMENT ACCEPTS .014 IN GUIDEWIRE 6 FR SHEATH 8 FR GUIDE CATHETER 7-8 MM VESSEL SUP-PC0920RXC_75079 CDM 0270 RC outpatient 4095 4095 4095 74 3030.3 percent of total billed charges 4095 93 3316.95 percent of total billed charges 4095 4095 other OPPS APC 4095 4095 other OPPS APC 4095 27.63 1131.45 percent of total billed charges 4095 4095 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR PRECISE PRO RX NITINOL L30 MM L135 CM OD9 MM CAROTID ARTERY RAPID EXCHANGE SELF EXPAND MICROMESH SEGMENT ACCEPTS .014 IN GUIDEWIRE 6 FR SHEATH 8 FR GUIDE CATHETER 7-8 MM VESSEL SUP-PC0930RXC_75080 CDM 0270 RC outpatient 4095 4095 4095 74 3030.3 percent of total billed charges 4095 93 3316.95 percent of total billed charges 4095 4095 other OPPS APC 4095 4095 other OPPS APC 4095 27.63 1131.45 percent of total billed charges 4095 4095 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR PRECISE PRO RX NITINOL L40 MM L135 CM OD9 MM CAROTID ARTERY RAPID EXCHANGE SELF EXPAND MICROMESH SEGMENT ACCEPTS .014 IN GUIDEWIRE 6 FR SHEATH 8 FR GUIDE CATHETER 7-8 MM VESSEL SUP-PC0940RXC_75081 CDM 0270 RC outpatient 4095 4095 4095 74 3030.3 percent of total billed charges 4095 93 3316.95 percent of total billed charges 4095 4095 other OPPS APC 4095 4095 other OPPS APC 4095 27.63 1131.45 percent of total billed charges 4095 4095 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH CARDIOVASCULAR SUPPLE PERI-GUARD APEX PROCESSING BOVINE PERICARDIAL L16 CM X W10 CM NONPYROGENIC STERILE SUP-PC1016NBIO CDM 0270 RC outpatient 2171.86 2171.86 2171.86 74 1607.18 percent of total billed charges 2171.86 93 1759.21 percent of total billed charges 2171.86 2171.86 other OPPS APC 2171.86 2171.86 other OPPS APC 2171.86 27.63 600.08 percent of total billed charges 2171.86 2171.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR PRECISE PRO RX NITINOL L20 MM L135 CM OD10 MM CAROTID ARTERY RAPID EXCHANGE SELF EXPAND MICROMESH SEGMENT ACCEPTS .014 IN GUIDEWIRE 6 FR SHEATH 8 FR GUIDE CATHETER 8-9 MM VESSEL SUP-PC1020RXC_75082 CDM 0270 RC outpatient 4095 4095 4095 74 3030.3 percent of total billed charges 4095 93 3316.95 percent of total billed charges 4095 4095 other OPPS APC 4095 4095 other OPPS APC 4095 27.63 1131.45 percent of total billed charges 4095 4095 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR PRECISE PRO RX NITINOL L30 MM L135 CM OD10 MM CAROTID ARTERY RAPID EXCHANGE SELF EXPAND MICROMESH SEGMENT ACCEPTS .014 IN GUIDEWIRE 6 FR SHEATH 8 FR GUIDE CATHETER 8-9 MM VESSEL SUP-PC1030RXC_75083 CDM 0270 RC outpatient 4095 4095 4095 74 3030.3 percent of total billed charges 4095 93 3316.95 percent of total billed charges 4095 4095 other OPPS APC 4095 4095 other OPPS APC 4095 27.63 1131.45 percent of total billed charges 4095 4095 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR PRECISE PRO RX NITINOL L40 MM L135 CM OD10 MM CAROTID ARTERY RAPID EXCHANGE SELF EXPAND MICROMESH SEGMENT ACCEPTS .014 IN GUIDEWIRE 6 FR SHEATH 8 FR GUIDE CATHETER 8-9 MM VESSEL SUP-PC1040RXC_75084 CDM 0270 RC outpatient 4095 4095 4095 74 3030.3 percent of total billed charges 4095 93 3316.95 percent of total billed charges 4095 4095 other OPPS APC 4095 4095 other OPPS APC 4095 27.63 1131.45 percent of total billed charges 4095 4095 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PERICARDIOCENTESIS PIGTAIL CURVE L40 CM OD8 FR CATHETER SUP-PC801 CDM 0481 RC outpatient 301.6 301.6 301.6 74 223.18 percent of total billed charges 301.6 93 244.3 percent of total billed charges 301.6 301.6 other OPPS APC 301.6 301.6 other OPPS APC 301.6 51 153.82 percent of total billed charges 301.6 301.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE 1-8MM 5CC CANCELLOUS ALLOGRAFT CHIP CRUSHED PRESERVON SUP-PCAN5 CDM 270010031 LOCAL 0270 RC outpatient 423.12 423.12 423.12 74 313.11 percent of total billed charges 423.12 93 342.73 percent of total billed charges 423.12 423.12 other OPPS APC 423.12 423.12 other OPPS APC 423.12 27.63 116.91 percent of total billed charges 423.12 423.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION PERIPHERAL CUTTING BALLOON 135CM 20MM 5MM OTW TAPER TIP INFLATE PORT PLAQUE MODIFICATION SUP-PCB5020135 CDM 0270 RC outpatient 2015 2015 2015 74 1491.1 percent of total billed charges 2015 93 1632.15 percent of total billed charges 2015 2015 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON CUTTING 6 X 2 X 135 SUP-PCB6020135 CDM 0270 RC outpatient 1755 1755 1755 74 1298.7 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION PERIPHERAL CUTTING BALLOON L135 CM L20 MM ODSEC7 MM OTW INFLATION PORT TAPER TIP PLAQUE MODIFICATION ACCEPTS .018 IN GUIDEWIRE 7 FR SHEATH ANGIOPLASTY ATHERECTOMY SUP-PCB7020135 CDM 0270 RC outpatient 1755 1755 1755 74 1298.7 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION SMALL PERIPHERAL CUTTING BALLOON L142 CM L1.5 CM ODSEC4 MM OTW ATHEROTOME TAPER TIP ACCEPTS .014 IN GUIDEWIRE SUP-PCBO4015140F CDM 0270 RC outpatient 2015 2015 2015 74 1491.1 percent of total billed charges 2015 93 1632.15 percent of total billed charges 2015 2015 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL PROCEED PROLENE OXIDIZED CELLULOSE L8 IN X W6 IN FASCIA FLEXIBLE TISSUE SEPARATE BIORESORBABLE STERILE HERNIA REPAIR SUP-PCDG1 CDM 0270 RC outpatient 2134.81 2134.81 2134.81 74 1579.76 percent of total billed charges 2134.81 93 1729.2 percent of total billed charges 2134.81 2134.81 other OPPS APC 2134.81 2134.81 other OPPS APC 2134.81 27.63 589.85 percent of total billed charges 2134.81 2134.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL PROCEED OVAL 10X8IN PROLENE OXIDIZED CELLULOSE STERILE FASCIAL LAPAROSCOPIC VENTRAL HERNIA REPAIR SUP-PCDH1 CDM 0270 RC outpatient 3932.71 3932.71 3932.71 74 2910.21 percent of total billed charges 3932.71 93 3185.5 percent of total billed charges 3932.71 3932.71 other OPPS APC 3932.71 3932.71 other OPPS APC 3932.71 27.63 1086.61 percent of total billed charges 3932.71 3932.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL PROCEED OVAL 15X10CM HERNIA REPAIR SUP-PCDN1 CDM 0270 RC outpatient 1279.36 1279.36 1279.36 74 946.73 percent of total billed charges 1279.36 93 1036.28 percent of total billed charges 1279.36 1279.36 other OPPS APC 1279.36 1279.36 other OPPS APC 1279.36 27.63 353.49 percent of total billed charges 1279.36 1279.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM ATHERECTOMY PHOENIX L127 CM OD2.4 MM OTW FRONT CUT LOW PROFILE NONDEFLECT ACCEPTS .014 IN GUIDEWIRE SUP-PD24127K CDM 0270 RC outpatient 7020 7020 7020 74 5194.8 percent of total billed charges 7020 93 5686.2 percent of total billed charges 7020 7020 other OPPS APC 7020 7020 other OPPS APC 7020 27.63 1939.63 percent of total billed charges 7020 7020 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCRAPER MEBRANE 23 G SUP-PD800.23 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PDS PLUS 6-0 P-1 L18 IN MONOFILAMENT ANTIBACTERIAL UNDYED SUP-PDP489G CDM 0270 RC outpatient 16.53 16.53 16.53 74 12.23 percent of total billed charges 16.53 93 13.39 percent of total billed charges 16.53 16.53 other OPPS APC 16.53 16.53 other OPPS APC 16.53 27.63 4.57 percent of total billed charges 16.53 16.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PDS PLUS MULTIPASS 5-0 P-3 18IN UNDYED MONOFILAMENT SUP-PDP493G CDM 0270 RC outpatient 17.32 17.32 17.32 74 12.82 percent of total billed charges 17.32 93 14.03 percent of total billed charges 17.32 17.32 other OPPS APC 17.32 17.32 other OPPS APC 17.32 27.63 4.79 percent of total billed charges 17.32 17.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE #5-0 PDS SUP-PDP844G CDM outpatient 16.51 16.51 16.51 16.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 3 CUSPID FIRST PRIMARY MOLAR LOWER LEFT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-DLL3 CDM 0270 RC outpatient 27.97 27.97 27.97 74 20.7 percent of total billed charges 27.97 93 22.66 percent of total billed charges 27.97 27.97 other OPPS APC 27.97 27.97 other OPPS APC 27.97 27.63 7.73 percent of total billed charges 27.97 27.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 4 CUSPID FIRST PRIMARY MOLAR LOWER LEFT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-DLL4 CDM 0270 RC outpatient 26.77 26.77 26.77 74 19.81 percent of total billed charges 26.77 93 21.68 percent of total billed charges 26.77 26.77 other OPPS APC 26.77 26.77 other OPPS APC 26.77 27.63 7.4 percent of total billed charges 26.77 26.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 5 CUSPID FIRST PRIMARY MOLAR LOWER LEFT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-DLL5 CDM 0270 RC outpatient 27.97 27.97 27.97 74 20.7 percent of total billed charges 27.97 93 22.66 percent of total billed charges 27.97 27.97 other OPPS APC 27.97 27.97 other OPPS APC 27.97 27.63 7.73 percent of total billed charges 27.97 27.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 6 CUSPID FIRST PRIMARY MOLAR LOWER LEFT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-DLL6 CDM 0270 RC outpatient 23.39 23.39 23.39 74 17.31 percent of total billed charges 23.39 93 18.95 percent of total billed charges 23.39 23.39 other OPPS APC 23.39 23.39 other OPPS APC 23.39 27.63 6.46 percent of total billed charges 23.39 23.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 7 CUSPID FIRST PRIMARY MOLAR LOWER LEFT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-DLL7 CDM 0270 RC outpatient 17.67 17.67 17.67 74 13.08 percent of total billed charges 17.67 93 14.31 percent of total billed charges 17.67 17.67 other OPPS APC 17.67 17.67 other OPPS APC 17.67 27.63 4.88 percent of total billed charges 17.67 17.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 4 CUSPID FIRST PRIMARY MOLAR LOWER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-DLR4 CDM 0270 RC outpatient 26.77 26.77 26.77 74 19.81 percent of total billed charges 26.77 93 21.68 percent of total billed charges 26.77 26.77 other OPPS APC 26.77 26.77 other OPPS APC 26.77 27.63 7.4 percent of total billed charges 26.77 26.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 5 CUSPID FIRST PRIMARY MOLAR LOWER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-DLR5 CDM 0270 RC outpatient 26.77 26.77 26.77 74 19.81 percent of total billed charges 26.77 93 21.68 percent of total billed charges 26.77 26.77 other OPPS APC 26.77 26.77 other OPPS APC 26.77 27.63 7.4 percent of total billed charges 26.77 26.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 6 CUSPID FIRST PRIMARY MOLAR LOWER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-DLR6 CDM 0270 RC outpatient 17.05 17.05 17.05 74 12.62 percent of total billed charges 17.05 93 13.81 percent of total billed charges 17.05 17.05 other OPPS APC 17.05 17.05 other OPPS APC 17.05 27.63 4.71 percent of total billed charges 17.05 17.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 7 CUSPID FIRST PRIMARY MOLAR LOWER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-DLR7 CDM 0270 RC outpatient 17.05 17.05 17.05 74 12.62 percent of total billed charges 17.05 93 13.81 percent of total billed charges 17.05 17.05 other OPPS APC 17.05 17.05 other OPPS APC 17.05 27.63 4.71 percent of total billed charges 17.05 17.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 4 CUSPID FIRST PRIMARY MOLAR UPPER LEFT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-DUL4 CDM 0270 RC outpatient 26.77 26.77 26.77 74 19.81 percent of total billed charges 26.77 93 21.68 percent of total billed charges 26.77 26.77 other OPPS APC 26.77 26.77 other OPPS APC 26.77 27.63 7.4 percent of total billed charges 26.77 26.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 5 CUSPID FIRST PRIMARY MOLAR UPPER LEFT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-DUL5 CDM 0270 RC outpatient 27.97 27.97 27.97 74 20.7 percent of total billed charges 27.97 93 22.66 percent of total billed charges 27.97 27.97 other OPPS APC 27.97 27.97 other OPPS APC 27.97 27.63 7.73 percent of total billed charges 27.97 27.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 6 CUSPID FIRST PRIMARY MOLAR UPPER LEFT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-DUL6 CDM 0270 RC outpatient 23.39 23.39 23.39 74 17.31 percent of total billed charges 23.39 93 18.95 percent of total billed charges 23.39 23.39 other OPPS APC 23.39 23.39 other OPPS APC 23.39 27.63 6.46 percent of total billed charges 23.39 23.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 7 CUSPID FIRST PRIMARY MOLAR UPPER LEFT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-DUL7 CDM 0270 RC outpatient 17.05 17.05 17.05 74 12.62 percent of total billed charges 17.05 93 13.81 percent of total billed charges 17.05 17.05 other OPPS APC 17.05 17.05 other OPPS APC 17.05 27.63 4.71 percent of total billed charges 17.05 17.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 3 CUSPID FIRST PRIMARY MOLAR UPPER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-DUR3 CDM 0270 RC outpatient 26.77 26.77 26.77 74 19.81 percent of total billed charges 26.77 93 21.68 percent of total billed charges 26.77 26.77 other OPPS APC 26.77 26.77 other OPPS APC 26.77 27.63 7.4 percent of total billed charges 26.77 26.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 4 CUSPID FIRST PRIMARY MOLAR UPPER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-DUR4 CDM 0270 RC outpatient 26.77 26.77 26.77 74 19.81 percent of total billed charges 26.77 93 21.68 percent of total billed charges 26.77 26.77 other OPPS APC 26.77 26.77 other OPPS APC 26.77 27.63 7.4 percent of total billed charges 26.77 26.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 5 CUSPID FIRST PRIMARY MOLAR UPPER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-DUR5 CDM 0270 RC outpatient 26.77 26.77 26.77 74 19.81 percent of total billed charges 26.77 93 21.68 percent of total billed charges 26.77 26.77 other OPPS APC 26.77 26.77 other OPPS APC 26.77 27.63 7.4 percent of total billed charges 26.77 26.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 6 CUSPID FIRST PRIMARY MOLAR UPPER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-DUR6 CDM 0270 RC outpatient 26.77 26.77 26.77 74 19.81 percent of total billed charges 26.77 93 21.68 percent of total billed charges 26.77 26.77 other OPPS APC 26.77 26.77 other OPPS APC 26.77 27.63 7.4 percent of total billed charges 26.77 26.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 7 CUSPID FIRST PRIMARY MOLAR UPPER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-DUR7 CDM 0270 RC outpatient 23.39 23.39 23.39 74 17.31 percent of total billed charges 23.39 93 18.95 percent of total billed charges 23.39 23.39 other OPPS APC 23.39 23.39 other OPPS APC 23.39 27.63 6.46 percent of total billed charges 23.39 23.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC E-LL-3 CUSPID SECOND PRIMARY MOLAR LOWER LEFT PREFABRICATE PRETRIM BELL CRIMP REPLACEMENT SUP-PDRP-ELL3 CDM 0270 RC outpatient 27.97 27.97 27.97 74 20.7 percent of total billed charges 27.97 93 22.66 percent of total billed charges 27.97 27.97 other OPPS APC 27.97 27.97 other OPPS APC 27.97 27.63 7.73 percent of total billed charges 27.97 27.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC E-LL-4 CUSPID SECOND PRIMARY MOLAR LOWER LEFT PREFABRICATE PRETRIM BELL CRIMP REPLACEMENT SUP-PDRP-ELL4 CDM 0270 RC outpatient 23.39 23.39 23.39 74 17.31 percent of total billed charges 23.39 93 18.95 percent of total billed charges 23.39 23.39 other OPPS APC 23.39 23.39 other OPPS APC 23.39 27.63 6.46 percent of total billed charges 23.39 23.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 5 CUSPID SECOND PRIMARY MOLAR LOWER LEFT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-ELL5 CDM 0270 RC outpatient 17.36 17.36 17.36 74 12.85 percent of total billed charges 17.36 93 14.06 percent of total billed charges 17.36 17.36 other OPPS APC 17.36 17.36 other OPPS APC 17.36 27.63 4.8 percent of total billed charges 17.36 17.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 6 CUSPID SECOND PRIMARY MOLAR LOWER LEFT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-ELL6 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 3 CUSPID SECOND PRIMARY MOLAR LOWER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-ELR3 CDM 0270 RC outpatient 26.77 26.77 26.77 74 19.81 percent of total billed charges 26.77 93 21.68 percent of total billed charges 26.77 26.77 other OPPS APC 26.77 26.77 other OPPS APC 26.77 27.63 7.4 percent of total billed charges 26.77 26.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 4 CUSPID SECOND PRIMARY MOLAR LOWER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-ELR4 CDM 0270 RC outpatient 27.97 27.97 27.97 74 20.7 percent of total billed charges 27.97 93 22.66 percent of total billed charges 27.97 27.97 other OPPS APC 27.97 27.97 other OPPS APC 27.97 27.63 7.73 percent of total billed charges 27.97 27.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 5 CUSPID SECOND PRIMARY MOLAR LOWER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-ELR5 CDM 0270 RC outpatient 23.39 23.39 23.39 74 17.31 percent of total billed charges 23.39 93 18.95 percent of total billed charges 23.39 23.39 other OPPS APC 23.39 23.39 other OPPS APC 23.39 27.63 6.46 percent of total billed charges 23.39 23.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 6 CUSPID SECOND PRIMARY MOLAR LOWER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-ELR6 CDM 0270 RC outpatient 23.39 23.39 23.39 74 17.31 percent of total billed charges 23.39 93 18.95 percent of total billed charges 23.39 23.39 other OPPS APC 23.39 23.39 other OPPS APC 23.39 27.63 6.46 percent of total billed charges 23.39 23.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 2 CUSPID SECOND PRIMARY MOLAR UPPER LEFT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-EUL2 CDM 0270 RC outpatient 27.97 27.97 27.97 74 20.7 percent of total billed charges 27.97 93 22.66 percent of total billed charges 27.97 27.97 other OPPS APC 27.97 27.97 other OPPS APC 27.97 27.63 7.73 percent of total billed charges 27.97 27.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 3 CUSPID SECOND PRIMARY MOLAR UPPER LEFT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-EUL3 CDM 0270 RC outpatient 26.77 26.77 26.77 74 19.81 percent of total billed charges 26.77 93 21.68 percent of total billed charges 26.77 26.77 other OPPS APC 26.77 26.77 other OPPS APC 26.77 27.63 7.4 percent of total billed charges 26.77 26.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 4 CUSPID SECOND PRIMARY MOLAR UPPER LEFT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-EUL4 CDM 0270 RC outpatient 26.77 26.77 26.77 74 19.81 percent of total billed charges 26.77 93 21.68 percent of total billed charges 26.77 26.77 other OPPS APC 26.77 26.77 other OPPS APC 26.77 27.63 7.4 percent of total billed charges 26.77 26.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 5 CUSPID SECOND PRIMARY MOLAR UPPER LEFT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-EUL5 CDM 0270 RC outpatient 23.39 23.39 23.39 74 17.31 percent of total billed charges 23.39 93 18.95 percent of total billed charges 23.39 23.39 other OPPS APC 23.39 23.39 other OPPS APC 23.39 27.63 6.46 percent of total billed charges 23.39 23.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN 6 CUSPID SECOND PRIMARY MOLAR UPPER LEFT SS 3M ESPE PREFABRICATE PRETRIM BELL SUP-PDRP-EUL6 CDM 0270 RC outpatient 21.14 21.14 21.14 74 15.64 percent of total billed charges 21.14 93 17.12 percent of total billed charges 21.14 21.14 other OPPS APC 21.14 21.14 other OPPS APC 21.14 27.63 5.84 percent of total billed charges 21.14 21.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 7 CUSPID SECOND PRIMARY MOLAR UPPER LEFT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-EUL7 CDM 0270 RC outpatient 16.37 16.37 16.37 74 12.11 percent of total billed charges 16.37 93 13.26 percent of total billed charges 16.37 16.37 other OPPS APC 16.37 16.37 other OPPS APC 16.37 27.63 4.52 percent of total billed charges 16.37 16.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 3 CUSPID SECOND PRIMARY MOLAR UPPER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-EUR3 CDM 0270 RC outpatient 26.77 26.77 26.77 74 19.81 percent of total billed charges 26.77 93 21.68 percent of total billed charges 26.77 26.77 other OPPS APC 26.77 26.77 other OPPS APC 26.77 27.63 7.4 percent of total billed charges 26.77 26.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC E-UR-4 CUSPID SECOND PRIMARY MOLAR UPPER RIGHT PREFABRICATE PRETRIM BELL CRIMP REPLACEMENT SUP-PDRP-EUR4 CDM 0270 RC outpatient 26.77 26.77 26.77 74 19.81 percent of total billed charges 26.77 93 21.68 percent of total billed charges 26.77 26.77 other OPPS APC 26.77 26.77 other OPPS APC 26.77 27.63 7.4 percent of total billed charges 26.77 26.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 5 CUSPID SECOND PRIMARY MOLAR UPPER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-EUR5 CDM 0270 RC outpatient 23.39 23.39 23.39 74 17.31 percent of total billed charges 23.39 93 18.95 percent of total billed charges 23.39 23.39 other OPPS APC 23.39 23.39 other OPPS APC 23.39 27.63 6.46 percent of total billed charges 23.39 23.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CROWN DENTAL 3M ESPE STAINLESS STEEL PEDIATRIC 6 CUSPID SECOND PRIMARY MOLAR UPPER RIGHT PREFABRICATE PRETRIM BELL CRIMP SUP-PDRP-EUR6 CDM 0270 RC outpatient 23.39 23.39 23.39 74 17.31 percent of total billed charges 23.39 93 18.95 percent of total billed charges 23.39 23.39 other OPPS APC 23.39 23.39 other OPPS APC 23.39 27.63 6.46 percent of total billed charges 23.39 23.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION PIPELINE FLEX L14MM OD 4.5MM NEUROVASCULAR 48 STRAND BRAID MESH UNIFORM RADIOPACITY LOW PROFILE DISTAL TIP STERILE LATEX FREE SUP-PED-450-14 CDM 0270 RC outpatient 40118 40118 40118 74 29687.3 percent of total billed charges 40118 93 32495.6 percent of total billed charges 40118 40118 other OPPS APC 40118 40118 other OPPS APC 40118 27.63 11084.6 percent of total billed charges 40118 40118 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION PIPELINE FLEX L16 MM OD 4.75 MM NEUROVASCULAR 48 STRAND BRAID MESH UNIFORM RADIOPACITY LOW PROFILE DISTAL TIP STERILE LATEX FREE SUP-PED-475-16 CDM 0270 RC outpatient 40118 40118 40118 74 29687.3 percent of total billed charges 40118 93 32495.6 percent of total billed charges 40118 40118 other OPPS APC 40118 40118 other OPPS APC 40118 27.63 11084.6 percent of total billed charges 40118 40118 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT-P PERCEPTA MRI SYSTEM SUP-PERCEPTAMRIMMAM CDM 0275 RC outpatient 16965 16965 16965 57 9670.05 percent of total billed charges 16965 93 13741.7 percent of total billed charges 16965 16965 other OPPS APC 16965 16965 other OPPS APC 16965 51 8652.15 percent of total billed charges 16965 16965 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERCEPTA MRI QUAD CRT-P SYSTEM MMQE SUP-PERCEPTAMRIQDMMQE CDM 0275 RC outpatient 22100 22100 22100 57 12597 percent of total billed charges 22100 93 17901 percent of total billed charges 22100 22100 other OPPS APC 22100 22100 other OPPS APC 22100 51 11271 percent of total billed charges 22100 22100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT-P PERCEPTA MRI QUAD SYSTEM SUP-PERCEPTAMRIQDMMQM CDM 0275 RC outpatient 15400 15400 15400 57 8778 percent of total billed charges 15400 93 12474 percent of total billed charges 15400 15400 other OPPS APC 15400 15400 other OPPS APC 15400 51 7854 percent of total billed charges 15400 15400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PERFUSION OPEN HEART SUPPLIES SUP-PERFSUPP CDM 270010026 LOCAL 0270 RC outpatient 2250 2250 2250 74 1665 percent of total billed charges 2250 93 1822.5 percent of total billed charges 2250 2250 other OPPS APC 2250 2250 other OPPS APC 2250 27.63 621.68 percent of total billed charges 2250 2250 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONTAINER HISTOLOGY SURE-LOK 10% NEUTRAL BUFFER FORMALIN 95 KPA .6 GL PREFILL SUP-PFNBF-0.6G CDM 0270 RC outpatient 117.23 117.23 117.23 74 86.75 percent of total billed charges 117.23 93 94.96 percent of total billed charges 117.23 117.23 other OPPS APC 117.23 117.23 other OPPS APC 117.23 27.63 32.39 percent of total billed charges 117.23 117.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PATCH, PHOTOFIX CAROTID 0.8X8" SUP-PFP0.8X8 CDM 0270 RC outpatient 483.6 483.6 483.6 74 357.86 percent of total billed charges 483.6 93 391.72 percent of total billed charges 483.6 483.6 other OPPS APC 483.6 483.6 other OPPS APC 483.6 27.63 133.62 percent of total billed charges 483.6 483.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "PATCH, PHOTOFIX CAROTID 2X9" SUP-PFP2X9 CDM 0270 RC outpatient 611 611 611 74 452.14 percent of total billed charges 611 93 494.91 percent of total billed charges 611 611 other OPPS APC 611 611 other OPPS APC 611 27.63 168.82 percent of total billed charges 611 611 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE FEEDING NEOCONNECT ENFIT POLYURETHANE L60 CM OD 5 FR ENTERAL RADIOPAQUE BOTTOMLESS HUB CLOSURE PLUG WAVE PATTERN DEHP FREE PURPLE SUP-PFTM5.0P-NC CDM 0270 RC outpatient 21.63 21.63 21.63 74 16.01 percent of total billed charges 21.63 93 17.52 percent of total billed charges 21.63 21.63 other OPPS APC 21.63 21.63 other OPPS APC 21.63 27.63 5.98 percent of total billed charges 21.63 21.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE FEEDING NEOCONNECT ENFIT PVC L40CM OD 5 FR ENTERAL RADIOPAQUE BOTTOMLESS HUB CLOSURE PLUG WAVE PATTERN DEHP FREE PURPLE SUP-PFTS5.0V-NC CDM 0270 RC outpatient 11.11 11.11 11.11 74 8.22 percent of total billed charges 11.11 93 9 percent of total billed charges 11.11 11.11 other OPPS APC 11.11 11.11 other OPPS APC 11.11 27.63 3.07 percent of total billed charges 11.11 11.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE CARTER-THOMASON XL PILOT GUIDES 5MM 10-12 MM SUP-PG-5/10 CDM 0270 RC outpatient 336.02 336.02 336.02 74 248.65 percent of total billed charges 336.02 93 272.18 percent of total billed charges 336.02 336.02 other OPPS APC 336.02 336.02 other OPPS APC 336.02 27.63 92.84 percent of total billed charges 336.02 336.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH CARDIOVASCULAR SUPPLE PERI-GUARD APEX PROCESSING BOVINE PERICARDIAL L16 CM X W10 CM NONPYROGENIC STERILE SUP-PG1016 CDM 0270 RC outpatient 2348.87 2348.87 2348.87 74 1738.16 percent of total billed charges 2348.87 93 1902.58 percent of total billed charges 2348.87 2348.87 other OPPS APC 2348.87 2348.87 other OPPS APC 2348.87 27.63 648.99 percent of total billed charges 2348.87 2348.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER PG123000 SUP-PG123000 CDM 270010015 LOCAL 0270 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 27.63 61.06 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE LIGHT SUPPORT PHOENIX .014 IN 300 CM 5.5 CM FLOPPY TIP SUP-PG14300LF CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE LIGHT SUPPORT PHOENIX .014 IN 300 CM 5.5 CM FLOPPY TIP SUP-PG14300XF CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY PALMAZ GENESIS OPTA PRO FLEXSEGMENT STAINLESS STEEL L30 MM LARGE L26 MM L80 CM OD7 MM ID6-7 FR BALLOON EXPANDABLE DILATATION CATHETER CLOSED CELL STERILE LATEX FREE DISPOSABLE ACCEPTS .035 IN GUIDEWIRE 8-9 FR GUIDE CATHETER PTA TRANSHE* SUP-PG2970BPS CDM 0270 RC outpatient 2727.66 2727.66 2727.66 74 2018.47 percent of total billed charges 2727.66 93 2209.4 percent of total billed charges 2727.66 2727.66 other OPPS APC 2727.66 2727.66 other OPPS APC 2727.66 27.63 753.65 percent of total billed charges 2727.66 2727.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR EXTENDED SPRAY TIP FOR PROGEL 16CM SUP-PGEN005-06 CDM 0270 RC outpatient 433.68 433.68 433.68 74 320.92 percent of total billed charges 433.68 93 351.28 percent of total billed charges 433.68 433.68 other OPPS APC 433.68 433.68 other OPPS APC 433.68 27.63 119.83 percent of total billed charges 433.68 433.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP APPLICATOR PROGEL L29 CM SPRAYER EXTENDED SUP-PGEN00511 CDM 0270 RC outpatient 433.68 433.68 433.68 74 320.92 percent of total billed charges 433.68 93 351.28 percent of total billed charges 433.68 433.68 other OPPS APC 433.68 433.68 other OPPS APC 433.68 27.63 119.83 percent of total billed charges 433.68 433.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROGEL AIR SEALANT SUP-PGPS002 CDM 0270 RC outpatient 3059.42 3059.42 3059.42 74 2263.97 percent of total billed charges 3059.42 93 2478.13 percent of total billed charges 3059.42 3059.42 other OPPS APC 3059.42 3059.42 other OPPS APC 3059.42 27.63 845.32 percent of total billed charges 3059.42 3059.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TIGRIS 5MM X 60MM 120 CM CATHETER SUP-PHA050602A CDM 0270 RC outpatient 3983.2 3983.2 3983.2 74 2947.57 percent of total billed charges 3983.2 93 3226.39 percent of total billed charges 3983.2 3983.2 other OPPS APC 3983.2 3983.2 other OPPS APC 3983.2 27.63 1100.56 percent of total billed charges 3983.2 3983.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TIGRIS 5MM X 100MM 120 CM CATHETER SUP-PHA051002A CDM 0270 RC outpatient 3983.2 3983.2 3983.2 74 2947.57 percent of total billed charges 3983.2 93 3226.39 percent of total billed charges 3983.2 3983.2 other OPPS APC 3983.2 3983.2 other OPPS APC 3983.2 27.63 1100.56 percent of total billed charges 3983.2 3983.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TIGRIS 6MM X 40MM 120 CM CATHETER SUP-PHA060402A CDM 0270 RC outpatient 3983.2 3983.2 3983.2 74 2947.57 percent of total billed charges 3983.2 93 3226.39 percent of total billed charges 3983.2 3983.2 other OPPS APC 3983.2 3983.2 other OPPS APC 3983.2 27.63 1100.56 percent of total billed charges 3983.2 3983.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TIGRIS 6MM X 60MM 120 CM CATHETER SUP-PHA060602A CDM 0270 RC outpatient 3983.2 3983.2 3983.2 74 2947.57 percent of total billed charges 3983.2 93 3226.39 percent of total billed charges 3983.2 3983.2 other OPPS APC 3983.2 3983.2 other OPPS APC 3983.2 27.63 1100.56 percent of total billed charges 3983.2 3983.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TIGRIS 6MM X 80 MM 120 CM CATHETER SUP-PHA060802A CDM 0270 RC outpatient 3983.2 3983.2 3983.2 74 2947.57 percent of total billed charges 3983.2 93 3226.39 percent of total billed charges 3983.2 3983.2 other OPPS APC 3983.2 3983.2 other OPPS APC 3983.2 27.63 1100.56 percent of total billed charges 3983.2 3983.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TIGRIS 6MM X 100MM 120 CM CATHETER SUP-PHA061002A CDM 0270 RC outpatient 3983.2 3983.2 3983.2 74 2947.57 percent of total billed charges 3983.2 93 3226.39 percent of total billed charges 3983.2 3983.2 other OPPS APC 3983.2 3983.2 other OPPS APC 3983.2 27.63 1100.56 percent of total billed charges 3983.2 3983.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TIGRIS 7MM X 40MM 120 CM CATHETER SUP-PHA070402A CDM 0270 RC outpatient 3983.2 3983.2 3983.2 74 2947.57 percent of total billed charges 3983.2 93 3226.39 percent of total billed charges 3983.2 3983.2 other OPPS APC 3983.2 3983.2 other OPPS APC 3983.2 27.63 1100.56 percent of total billed charges 3983.2 3983.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TIGRIS 7MM X 60MM 120 CM CATHETER SUP-PHA070602A CDM 0270 RC outpatient 3983.2 3983.2 3983.2 74 2947.57 percent of total billed charges 3983.2 93 3226.39 percent of total billed charges 3983.2 3983.2 other OPPS APC 3983.2 3983.2 other OPPS APC 3983.2 27.63 1100.56 percent of total billed charges 3983.2 3983.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TIGRIS 7MM X 80MM 120 CM CATHETER SUP-PHA070802A CDM 0270 RC outpatient 3983.2 3983.2 3983.2 74 2947.57 percent of total billed charges 3983.2 93 3226.39 percent of total billed charges 3983.2 3983.2 other OPPS APC 3983.2 3983.2 other OPPS APC 3983.2 27.63 1100.56 percent of total billed charges 3983.2 3983.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT TIGRIS 7MM X 100MM 120 CM CATHETER SUP-PHA071002A CDM 0270 RC outpatient 3983.2 3983.2 3983.2 74 2947.57 percent of total billed charges 3983.2 93 3226.39 percent of total billed charges 3983.2 3983.2 other OPPS APC 3983.2 3983.2 other OPPS APC 3983.2 27.63 1100.56 percent of total billed charges 3983.2 3983.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT GORE EXCLUDER 23MM X 3.3CM SUP-PLA230300 CDM 270010015 LOCAL 0270 RC outpatient 9107.8 9107.8 9107.8 74 6739.77 percent of total billed charges 9107.8 93 7377.32 percent of total billed charges 9107.8 9107.8 other OPPS APC 9107.8 9107.8 other OPPS APC 9107.8 27.63 2516.49 percent of total billed charges 9107.8 9107.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT GORE EXCLUDER 26MM X 3.3CM SUP-PLA260300 CDM 270010015 LOCAL 0270 RC outpatient 9107.8 9107.8 9107.8 74 6739.77 percent of total billed charges 9107.8 93 7377.32 percent of total billed charges 9107.8 9107.8 other OPPS APC 9107.8 9107.8 other OPPS APC 9107.8 27.63 2516.49 percent of total billed charges 9107.8 9107.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT GORE EXCLUDER 28.5MM X 3.3CM SUP-PLA280300 CDM 270010015 LOCAL 0270 RC outpatient 9107.8 9107.8 9107.8 74 6739.77 percent of total billed charges 9107.8 93 7377.32 percent of total billed charges 9107.8 9107.8 other OPPS APC 9107.8 9107.8 other OPPS APC 9107.8 27.63 2516.49 percent of total billed charges 9107.8 9107.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT GORE AORTIC EXTENDER SUP-PLA320400 CDM 270010015 LOCAL 0270 RC outpatient 9107.8 9107.8 9107.8 74 6739.77 percent of total billed charges 9107.8 93 7377.32 percent of total billed charges 9107.8 9107.8 other OPPS APC 9107.8 9107.8 other OPPS APC 9107.8 27.63 2516.49 percent of total billed charges 9107.8 9107.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT GORE EXCLUDER 36MM X4.5CM SUP-PLA360400 CDM 270010015 LOCAL 0270 RC outpatient 9107.8 9107.8 9107.8 74 6739.77 percent of total billed charges 9107.8 93 7377.32 percent of total billed charges 9107.8 9107.8 other OPPS APC 9107.8 9107.8 other OPPS APC 9107.8 27.63 2516.49 percent of total billed charges 9107.8 9107.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR 10CM 12MM EXCLUDER CONTRALATERAL LEG STENT EXTENDER DELIVERY SUP-PLC121000 CDM 270010015 LOCAL 0270 RC outpatient 12942.8 12942.8 12942.8 74 9577.67 percent of total billed charges 12942.8 93 10483.7 percent of total billed charges 12942.8 12942.8 other OPPS APC 12942.8 12942.8 other OPPS APC 12942.8 27.63 3576.1 percent of total billed charges 12942.8 12942.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FEP L12 CM OD12 MM CONTRALATERAL LEG STENT EXTENDER DELIVERY SYSTEM AAA ACCEPTS ID10-11 MM ACCEPTS 12FR SHEATH SUP-PLC121200 CDM 270010015 LOCAL 0270 RC outpatient 12942.8 12942.8 12942.8 74 9577.67 percent of total billed charges 12942.8 93 10483.7 percent of total billed charges 12942.8 12942.8 other OPPS APC 12942.8 12942.8 other OPPS APC 12942.8 27.63 3576.1 percent of total billed charges 12942.8 12942.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ENDOPROSTHESIS AAA SUP-PLC121400 CDM 0270 RC outpatient 12942.8 12942.8 12942.8 74 9577.67 percent of total billed charges 12942.8 93 10483.7 percent of total billed charges 12942.8 12942.8 other OPPS APC 12942.8 12942.8 other OPPS APC 12942.8 27.63 3576.1 percent of total billed charges 12942.8 12942.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FEP L10 CM OD14.5 MM CONTRALATERAL LEG STENT EXTENDER DELIVERY SYSTEM AAA ACCEPTS ID12-13.5 MM ACCEPTS 12FR SHEATH SUP-PLC14100 CDM 270010015 LOCAL 0270 RC outpatient 12942.8 12942.8 12942.8 74 9577.67 percent of total billed charges 12942.8 93 10483.7 percent of total billed charges 12942.8 12942.8 other OPPS APC 12942.8 12942.8 other OPPS APC 12942.8 27.63 3576.1 percent of total billed charges 12942.8 12942.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER 14.5MMX10CM SUP-PLC141000 CDM 270010015 LOCAL 0270 RC outpatient 12942.8 12942.8 12942.8 74 9577.67 percent of total billed charges 12942.8 93 10483.7 percent of total billed charges 12942.8 12942.8 other OPPS APC 12942.8 12942.8 other OPPS APC 12942.8 27.63 3576.1 percent of total billed charges 12942.8 12942.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FEP L12 CM OD14.5 MM CONTRALATERAL LEG STENT EXTENDER DELIVERY SYSTEM AAA ACCEPTS ID12-13.5 MM ACCEPTS 12FR SHEATH SUP-PLC141200 CDM 270010015 LOCAL 0270 RC outpatient 12942.8 12942.8 12942.8 74 9577.67 percent of total billed charges 12942.8 93 10483.7 percent of total billed charges 12942.8 12942.8 other OPPS APC 12942.8 12942.8 other OPPS APC 12942.8 27.63 3576.1 percent of total billed charges 12942.8 12942.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR GORE EXCLUDER L14 CM OD14.5 MM ID12-13.5 MM CONTRALATERAL LEG AAA ACCEPTS 12 FR SHEATH SUP-PLC141400 CDM 0270 RC outpatient 12942.8 12942.8 12942.8 74 9577.67 percent of total billed charges 12942.8 93 10483.7 percent of total billed charges 12942.8 12942.8 other OPPS APC 12942.8 12942.8 other OPPS APC 12942.8 27.63 3576.1 percent of total billed charges 12942.8 12942.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT GORE EXCLUDER 16MM X 9.5 CM SUP-PLC161000 CDM 270010015 LOCAL 0270 RC outpatient 12942.8 12942.8 12942.8 74 9577.67 percent of total billed charges 12942.8 93 10483.7 percent of total billed charges 12942.8 12942.8 other OPPS APC 12942.8 12942.8 other OPPS APC 12942.8 27.63 3576.1 percent of total billed charges 12942.8 12942.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT GORE EXCLUDER 16MM X 11.5 CM SUP-PLC161200 CDM 270010015 LOCAL 0270 RC outpatient 12942.8 12942.8 12942.8 74 9577.67 percent of total billed charges 12942.8 93 10483.7 percent of total billed charges 12942.8 12942.8 other OPPS APC 12942.8 12942.8 other OPPS APC 12942.8 27.63 3576.1 percent of total billed charges 12942.8 12942.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP L13.5 CM OD16 MM ID13.5-14.5 MM CONTRALATERAL LEG STENT ABRASION RESISTANT SINUSOIDAL DESIGN SEAL CUFF AAA SUP-PLC161400 CDM 270010015 LOCAL 0270 RC outpatient 12942.8 12942.8 12942.8 74 9577.67 percent of total billed charges 12942.8 93 10483.7 percent of total billed charges 12942.8 12942.8 other OPPS APC 12942.8 12942.8 other OPPS APC 12942.8 27.63 3576.1 percent of total billed charges 12942.8 12942.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT GORE EXCLUDER AAA ENDOPROSTHESIS-CONTRALATERAL LEG SUP-PLC181000 CDM 270010015 LOCAL 0270 RC outpatient 12942.8 12942.8 12942.8 74 9577.67 percent of total billed charges 12942.8 93 10483.7 percent of total billed charges 12942.8 12942.8 other OPPS APC 12942.8 12942.8 other OPPS APC 12942.8 27.63 3576.1 percent of total billed charges 12942.8 12942.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT GORE EXCLUDER AAA ENDOPROSTHESIS-CONTRALATERAL LEG SUP-PLC181200 CDM 270010015 LOCAL 0270 RC outpatient 12942.8 12942.8 12942.8 74 9577.67 percent of total billed charges 12942.8 93 10483.7 percent of total billed charges 12942.8 12942.8 other OPPS APC 12942.8 12942.8 other OPPS APC 12942.8 27.63 3576.1 percent of total billed charges 12942.8 12942.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT GORE EXCLUDER AAA ENDOPROSTHESIS-CONTRALATERAL LEG SUP-PLC181400 CDM 270010015 LOCAL 0270 RC outpatient 12942.8 12942.8 12942.8 74 9577.67 percent of total billed charges 12942.8 93 10483.7 percent of total billed charges 12942.8 12942.8 other OPPS APC 12942.8 12942.8 other OPPS APC 12942.8 27.63 3576.1 percent of total billed charges 12942.8 12942.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT GORE EXCLUDER 20MM X 9.5 CM SUP-PLC201000 CDM 270010015 LOCAL 0270 RC outpatient 12942.8 12942.8 12942.8 74 9577.67 percent of total billed charges 12942.8 93 10483.7 percent of total billed charges 12942.8 12942.8 other OPPS APC 12942.8 12942.8 other OPPS APC 12942.8 27.63 3576.1 percent of total billed charges 12942.8 12942.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP L11.5 CM OD20 MM ID16.5-18.5 MM CONTRALATERAL LEG STENT ABRASION RESISTANT SINUSOIDAL DESIGN SEAL CUFF AAA SUP-PLC201200 CDM 270010015 LOCAL 0270 RC outpatient 12942.8 12942.8 12942.8 74 9577.67 percent of total billed charges 12942.8 93 10483.7 percent of total billed charges 12942.8 12942.8 other OPPS APC 12942.8 12942.8 other OPPS APC 12942.8 27.63 3576.1 percent of total billed charges 12942.8 12942.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR GORE-TEX EXCLUDER NITINOL FEP L13.5 CM OD20 MM ID16.5-18.5 MM CONTRALATERAL LEG SINUSOIDAL STENT SEAL CUFF ABRASION RESISTANT AAA SUP-PLC201400 CDM 270010015 LOCAL 0270 RC outpatient 12942.8 12942.8 12942.8 74 9577.67 percent of total billed charges 12942.8 93 10483.7 percent of total billed charges 12942.8 12942.8 other OPPS APC 12942.8 12942.8 other OPPS APC 12942.8 27.63 3576.1 percent of total billed charges 12942.8 12942.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT GORE EXCLUDER AAA ENDOPROSTHESIS-CONTRALATERAL LEG PROSTHESIS SUP-PLC231000 CDM 270010015 LOCAL 0270 RC outpatient 12942.8 12942.8 12942.8 74 9577.67 percent of total billed charges 12942.8 93 10483.7 percent of total billed charges 12942.8 12942.8 other OPPS APC 12942.8 12942.8 other OPPS APC 12942.8 27.63 3576.1 percent of total billed charges 12942.8 12942.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT GORE EXCLUDER 27MM X 10 CM SUP-PLC271000 CDM 270010015 LOCAL 0270 RC outpatient 12942.8 12942.8 12942.8 74 9577.67 percent of total billed charges 12942.8 93 10483.7 percent of total billed charges 12942.8 12942.8 other OPPS APC 12942.8 12942.8 other OPPS APC 12942.8 27.63 3576.1 percent of total billed charges 12942.8 12942.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP L12 CM OD27 MM SUP-PLC271200 CDM 0270 RC outpatient 12942.8 12942.8 12942.8 74 9577.67 percent of total billed charges 12942.8 93 10483.7 percent of total billed charges 12942.8 12942.8 other OPPS APC 12942.8 12942.8 other OPPS APC 12942.8 27.63 3576.1 percent of total billed charges 12942.8 12942.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT GORE EXCLUDER AAA ENDOPROSTHESIS SUP-PLC271400 CDM 270010015 LOCAL 0270 RC outpatient 12942.8 12942.8 12942.8 74 9577.67 percent of total billed charges 12942.8 93 10483.7 percent of total billed charges 12942.8 12942.8 other OPPS APC 12942.8 12942.8 other OPPS APC 12942.8 27.63 3576.1 percent of total billed charges 12942.8 12942.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM LEAD DELIVERY ACUITY PRO SUP-PLDS CDM 0275 RC outpatient 392 392 392 57 223.44 percent of total billed charges 392 93 317.52 percent of total billed charges 392 392 other OPPS APC 392 392 other OPPS APC 392 51 199.92 percent of total billed charges 392 392 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ECHELON FLEX ENDOPATH L45 MM L440 MM LINEAR CUTTER ARTICULATE POWER KNIFE REVERSE SWITCH TRIGGER LOCK STERILE DISPOSABLE ENDOSCOPIC SUP-PLEE45A CDM 0270 RC outpatient 798.8 798.8 798.8 74 591.11 percent of total billed charges 798.8 93 647.03 percent of total billed charges 798.8 798.8 other OPPS APC 798.8 798.8 other OPPS APC 798.8 27.63 220.71 percent of total billed charges 798.8 798.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ECHELON FLEX POWERED PLUS LONG 440MM 60MM LINEAR CUTTER ENDOSCOPIC SUP-PLEE60A CDM 0270 RC outpatient 1021.55 1021.55 1021.55 74 755.95 percent of total billed charges 1021.55 93 827.46 percent of total billed charges 1021.55 1021.55 other OPPS APC 1021.55 1021.55 other OPPS APC 1021.55 27.63 282.25 percent of total billed charges 1021.55 1021.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT GORE EXCLUDER 16MM X 10MMX 7CM SUP-PLL161007 CDM 270010015 LOCAL 0270 RC outpatient 9107.8 9107.8 9107.8 74 6739.77 percent of total billed charges 9107.8 93 7377.32 percent of total billed charges 9107.8 9107.8 other OPPS APC 9107.8 9107.8 other OPPS APC 9107.8 27.63 2516.49 percent of total billed charges 9107.8 9107.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FEP L7 CM OD12 MM ILIAC ARTERY STENT EXTENDER DELIVERY SYSTEM AAA ACCEPTS ID10-11 MM ACCEPTS 12FR SHEATH SUP-PLL161207 CDM 0270 RC outpatient 9107.8 9107.8 9107.8 74 6739.77 percent of total billed charges 9107.8 93 7377.32 percent of total billed charges 9107.8 9107.8 other OPPS APC 9107.8 9107.8 other OPPS APC 9107.8 27.63 2516.49 percent of total billed charges 9107.8 9107.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR GORE EXCLUDER EPTFE NITINOL L7 CM OD14.5 MM ID12-13.5 MM ILIAC SINUSOIDAL STENT SEAL CUFF BOND FILM ACCEPTS 15 FR SHEATH AAA SUP-PLL161407 CDM 0270 RC outpatient 9107.8 9107.8 9107.8 74 6739.77 percent of total billed charges 9107.8 93 7377.32 percent of total billed charges 9107.8 9107.8 other OPPS APC 9107.8 9107.8 other OPPS APC 9107.8 27.63 2516.49 percent of total billed charges 9107.8 9107.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLUMEPEN ULTRA SURGICAL SMOKE EVAC PENCIL SUP-PLPUL2020 CDM 0270 RC outpatient 62.57 62.57 62.57 74 46.3 percent of total billed charges 62.57 93 50.68 percent of total billed charges 62.57 62.57 other OPPS APC 62.57 62.57 other OPPS APC 62.57 27.63 17.29 percent of total billed charges 62.57 62.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH SAFE 6 FRENCH SUP-PLS-1006 CDM 0275 RC outpatient 221 221 221 57 125.97 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 51 112.71 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH SAFE 7 FRENCH SUP-PLS-1007 CDM 0275 RC outpatient 221 221 221 57 125.97 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 51 112.71 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PRELUDE SNAP L13 CM OD8 FR ROBUST VALVE SPLITTABLE SIDEPORT HUB BLUE SUP-PLS-1008 CDM 0275 RC outpatient 221 221 221 57 125.97 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 51 112.71 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PRELUDE SNAP L13 CM OD9 FR ID.118 IN ROBUST VALVE SPLITTABLE SIDEPORT HUB BLACK SUP-PLS-1009 CDM 0275 RC outpatient 221 221 221 57 125.97 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 51 112.71 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH SAFE 10 FRENCH SUP-PLS-1010 CDM 0275 RC outpatient 221 221 221 57 125.97 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 51 112.71 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM DRUG DELIVERY SILVERSOAKER ON-Q PAINBUSTER T-PEEL L3.5 IN L2.5 IN CATHETER ANTIMICROBIAL NEEDLE POSTOPERATIVE EXPANSION SUP-PM010-A CDM 0270 RC outpatient 119.6 119.6 119.6 74 88.5 percent of total billed charges 119.6 93 96.88 percent of total billed charges 119.6 119.6 other OPPS APC 119.6 119.6 other OPPS APC 119.6 27.63 33.05 percent of total billed charges 119.6 119.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PUMP PAIN SUP-PM012 CDM 0270 RC outpatient 304.72 304.72 304.72 74 225.49 percent of total billed charges 304.72 93 246.82 percent of total billed charges 304.72 304.72 other OPPS APC 304.72 304.72 other OPPS APC 304.72 27.63 84.19 percent of total billed charges 304.72 304.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PUMP PAIN BX/5 SUP-PM028 CDM 0270 RC outpatient 790.92 790.92 790.92 74 585.28 percent of total billed charges 790.92 93 640.65 percent of total billed charges 790.92 790.92 other OPPS APC 790.92 790.92 other OPPS APC 790.92 27.63 218.53 percent of total billed charges 790.92 790.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC ENDURITY THK6 MM W50 MM X H41 MM 9.7 ML 19 GM 1 CHAMBER UNIPOLAR BIPOLAR EGM IS-1 SUP-PM1160 CDM 0275 RC outpatient 4681.13 4681.13 4681.13 57 2668.24 percent of total billed charges 4681.13 93 3791.72 percent of total billed charges 4681.13 4681.13 other OPPS APC 4681.13 4681.13 other OPPS APC 4681.13 51 2387.38 percent of total billed charges 4681.13 4681.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER SINGLE CHAMBER ACCENT FR SR SYSTEM SUP-PM1210S CDM 0270 RC outpatient 12275.6 12275.6 12275.6 74 9083.97 percent of total billed charges 12275.6 93 9943.27 percent of total billed charges 12275.6 12275.6 other OPPS APC 12275.6 12275.6 other OPPS APC 12275.6 27.63 3391.76 percent of total billed charges 12275.6 12275.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER ASSURITY SR DEVICE SUP-PM1240 CDM 0275 RC outpatient 7112.25 7112.25 7112.25 57 4053.98 percent of total billed charges 7112.25 93 5760.92 percent of total billed charges 7112.25 7112.25 other OPPS APC 7112.25 7112.25 other OPPS APC 7112.25 51 3627.25 percent of total billed charges 7112.25 7112.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER ASSURITY MR SR-RF SUP-PM1272 CDM 0275 RC outpatient 4500 4500 4500 57 2565 percent of total billed charges 4500 93 3645 percent of total billed charges 4500 4500 other OPPS APC 4500 4500 other OPPS APC 4500 51 2295 percent of total billed charges 4500 4500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER ASSURITY MRI SR-RF MERILN PKG SUP-PM1272CELL CDM 0275 RC outpatient 4681.13 4681.13 4681.13 57 2668.24 percent of total billed charges 4681.13 93 3791.72 percent of total billed charges 4681.13 4681.13 other OPPS APC 4681.13 4681.13 other OPPS APC 4681.13 51 2387.38 percent of total billed charges 4681.13 4681.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC ENDURITY THK6 MM W50 MM X H46 MM 10.4 ML 19 GM 2 CHAMBER UNIPOLAR BIPOLAR EGM IS-1 SUP-PM2160 CDM 0275 RC outpatient 6156 6156 6156 57 3508.92 percent of total billed charges 6156 93 4986.36 percent of total billed charges 6156 6156 other OPPS APC 6156 6156 other OPPS APC 6156 51 3139.56 percent of total billed charges 6156 6156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC ASSURITY AUTOCAPTURE INVISILINK SENSEABILITY THK6 MM SMALL W50 MM X H47 MM 10.4 CC 20 GM 2 CHAMBER IS-1 CONNECTOR REAL TIME ELECTROGRAM WIRELESS TELEMETRY SUP-PM2240 CDM 0275 RC outpatient 5625 5625 5625 57 3206.25 percent of total billed charges 5625 93 4556.25 percent of total billed charges 5625 5625 other OPPS APC 5625 5625 other OPPS APC 5625 51 2868.75 percent of total billed charges 5625 5625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM IS-1 CONNECTOR SUP-PM2272 CDM 0275 RC outpatient 6760 6760 6760 57 3853.2 percent of total billed charges 6760 93 5475.6 percent of total billed charges 6760 6760 other OPPS APC 6760 6760 other OPPS APC 6760 51 3447.6 percent of total billed charges 6760 6760 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC ALLURE RF INVISILINK THK6 MM W59 MM X H55 MM 14 ML 24 GM VENTRICLE IS-1 SUP-PM3222 CDM 0275 RC outpatient 12475 12475 12475 57 7110.75 percent of total billed charges 12475 93 10104.8 percent of total billed charges 12475 12475 other OPPS APC 12475 12475 other OPPS APC 12475 51 6362.25 percent of total billed charges 12475 12475 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC ALLURE RF INVISILINK THK6 MM W59 MM X H55 MM 14 ML 24 GM VENTRICLE IS-1 SUP-PM3222-SYS CDM 0275 RC outpatient 14210 14210 14210 57 8099.7 percent of total billed charges 14210 93 11510.1 percent of total billed charges 14210 14210 other OPPS APC 14210 14210 other OPPS APC 14210 51 7247.1 percent of total billed charges 14210 14210 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC ALLURE QUADRA RF INVISILINK THK6 MM W59 MM X H56 MM 15 ML 27 GM VENTRICLE IS4-LLLL IS-1 SUP-PM3242 CDM 0275 RC outpatient 12771 12771 12771 57 7279.47 percent of total billed charges 12771 93 10344.5 percent of total billed charges 12771 12771 other OPPS APC 12771 12771 other OPPS APC 12771 51 6513.21 percent of total billed charges 12771 12771 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER ALLURE QUAD BIV SYSTEM SUP-PM3242-SYS CDM 0275 RC outpatient 14710 14710 14710 57 8384.7 percent of total billed charges 14710 93 11915.1 percent of total billed charges 14710 14710 other OPPS APC 14710 14710 other OPPS APC 14710 51 7502.1 percent of total billed charges 14710 14710 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER QUADRA ALLURE MP RF CRT-P SUP-PM3262 CDM 0275 RC outpatient 12262.5 12262.5 12262.5 57 6989.63 percent of total billed charges 12262.5 93 9932.63 percent of total billed charges 12262.5 12262.5 other OPPS APC 12262.5 12262.5 other OPPS APC 12262.5 51 6253.88 percent of total billed charges 12262.5 12262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER QUADRA ALLURE MPFR CRT-O MERLIN PKG SUP-PM3262CELL CDM 0275 RC outpatient 12262.5 12262.5 12262.5 57 6989.63 percent of total billed charges 12262.5 93 9932.63 percent of total billed charges 12262.5 12262.5 other OPPS APC 12262.5 12262.5 other OPPS APC 12262.5 51 6253.88 percent of total billed charges 12262.5 12262.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER QUADRA ALLURE MP RF CRT-P SYSTEM SUP-PM3262SYSTEM CDM 0275 RC outpatient 14710 14710 14710 57 8384.7 percent of total billed charges 14710 93 11915.1 percent of total billed charges 14710 14710 other OPPS APC 14710 14710 other OPPS APC 14710 51 7502.1 percent of total billed charges 14710 14710 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER QUADRA ALLURE MP CRT-P BIV SUP-PM3562 CDM 0275 RC outpatient 12521 12521 12521 57 7136.97 percent of total billed charges 12521 93 10142 percent of total billed charges 12521 12521 other OPPS APC 12521 12521 other OPPS APC 12521 51 6385.71 percent of total billed charges 12521 12521 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER QUADRA ALLURE MP CRT-P BIV SYSTEM SUP-PM3562SYSTEM CDM 0275 RC outpatient 19760 19760 19760 57 11263.2 percent of total billed charges 19760 93 16005.6 percent of total billed charges 19760 19760 other OPPS APC 19760 19760 other OPPS APC 19760 51 10077.6 percent of total billed charges 19760 19760 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ON Q PAIN BUSTER 400ML SUP-PM400XD CDM 0270 RC outpatient 416 416 416 74 307.84 percent of total billed charges 416 93 336.96 percent of total billed charges 416 416 other OPPS APC 416 416 other OPPS APC 416 27.63 114.94 percent of total billed charges 416 416 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCISSORS MONOPOLAR METZENBAUM L310 MM OD5 MM INSERT SUP-PM697R CDM 0270 RC outpatient 2132.18 2132.18 2132.18 74 1577.81 percent of total billed charges 2132.18 93 1727.07 percent of total billed charges 2132.18 2132.18 other OPPS APC 2132.18 2132.18 other OPPS APC 2132.18 27.63 589.12 percent of total billed charges 2132.18 2132.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PPM PM2272 ASSURITY MRI DR-RF DEVICE _45055_ SUP-PMM2272 CDM 0275 RC outpatient 4950 4950 4950 57 2821.5 percent of total billed charges 4950 93 4009.5 percent of total billed charges 4950 4950 other OPPS APC 4950 4950 other OPPS APC 4950 51 2524.5 percent of total billed charges 4950 4950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT NITINOL NYLON RECTANGLE HELIX TAPER L137 CM L6 MM ODSEC2 MM RADIOPAQUE RAPID EXCHANGE FLEXIBLE ELECTROPOLISH ACCEPTS .014 IN GUIDEWIRE 6 FR GUIDE CATHETER PTCA SUP-PN-2200-2006-B CDM outpatient 2080 2080 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT NITINOL NYLON RECTANGLE HELIX TAPER L137 CM L6 MM ODSEC2.5 MM RADIOPAQUE RAPID EXCHANGE FLEXIBLE ELECTROPOLISH ACCEPTS .014 IN GUIDEWIRE 6 FR GUIDE CATHETER PTCA SUP-PN-2200-2506-B CDM outpatient 2080 2080 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT NITINOL NYLON RECTANGLE HELIX TAPER L137 CM L10 MM ODSEC2.5 MM RADIOPAQUE RAPID EXCHANGE FLEXIBLE ELECTROPOLISH ACCEPTS .014 IN GUIDEWIRE 6 FR GUIDE CATHETER PTCA SUP-PN-2200-2510-B CDM outpatient 2080 2080 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT NITINOL NYLON RECTANGLE HELIX TAPER L137 CM L6 MM ODSEC3 MM RADIOPAQUE RAPID EXCHANGE FLEXIBLE ELECTROPOLISH ACCEPTS .014 IN GUIDEWIRE 6 FR GUIDE CATHETER PTCA SUP-PN-2200-3006-B CDM outpatient 2080 2080 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION ANGIOSCULPT NITINOL NYLON RECTANGLE HELIX TAPER L137 CM L6 MM ODSEC3.5 MM RADIOPAQUE RAPID EXCHANGE FLEXIBLE ELECTROPOLISH ACCEPTS .014 IN GUIDEWIRE 6 FR GUIDE CATHETER PTCA SUP-PN-2200-3506-B CDM outpatient 2080 2080 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION RECTANGLE HELIX TAPER 3.5MM 137CM 10MM RADIOPAQUE RAPID SUP-PN-2200-3510-B CDM outpatient 2080 2080 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE INSUFFLATION 120MM 14GA ENDOPATH ULTRA VERESS STOPCOCK LUER LOCK BLUNT STYLET SUP-PN120 CDM 0270 RC outpatient 31.57 31.57 31.57 74 23.36 percent of total billed charges 31.57 93 25.57 percent of total billed charges 31.57 31.57 other OPPS APC 31.57 31.57 other OPPS APC 31.57 27.63 8.72 percent of total billed charges 31.57 31.57 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE INSUFFLATION 150MM 14GA ENDOPATH SPRING LOAD BLUNT HANDLE STOPCOCK STERILE SUP-PN150 CDM 0270 RC outpatient 32.68 32.68 32.68 74 24.18 percent of total billed charges 32.68 93 26.47 percent of total billed charges 32.68 32.68 other OPPS APC 32.68 32.68 other OPPS APC 32.68 27.63 9.03 percent of total billed charges 32.68 32.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPERBAG 1O MED NYLON SPECIMEN RETRIEVAL BAG SUP-PNI0240 CDM 0270 RC outpatient 81.65 81.65 81.65 74 60.42 percent of total billed charges 81.65 93 66.14 percent of total billed charges 81.65 81.65 other OPPS APC 81.65 81.65 other OPPS APC 81.65 27.63 22.56 percent of total billed charges 81.65 81.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG SPECIMEN RETRIEVAL SUPERBAG NYLON LARGE L12 MM 750 ML REDEPLOYABLE INTRODUCER WIDE MOUTH OPEN SUP-PNI0750 CDM 0270 RC outpatient 127.18 127.18 127.18 74 94.11 percent of total billed charges 127.18 93 103.02 percent of total billed charges 127.18 127.18 other OPPS APC 127.18 127.18 other OPPS APC 127.18 27.63 35.14 percent of total billed charges 127.18 127.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUPERBAG 15 2XL NYLON SPECIMEN RETRIEVAL BAG SUP-PNI2000 CDM 0270 RC outpatient 175.38 175.38 175.38 74 129.78 percent of total billed charges 175.38 93 142.06 percent of total billed charges 175.38 175.38 other OPPS APC 175.38 175.38 other OPPS APC 175.38 27.63 48.46 percent of total billed charges 175.38 175.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER NEURON MAX STAINLESS STEEL HYDROPHILIC LONG STRAIGHT L80 CM L4 CM OD6 FR ODSEC8 FR ID.088 IN SOFT TIP CROSSCUT ROTATE HEMOSTATIC VALVE DILATOR ACCEPTS .035/.038 IN GUIDEWIRE SUP-PNML6F088804 CDM 0270 RC outpatient 1274 1274 1274 74 942.76 percent of total billed charges 1274 93 1031.94 percent of total billed charges 1274 1274 other OPPS APC 1274 1274 other OPPS APC 1274 27.63 352.01 percent of total billed charges 1274 1274 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY NEURON L120 CM SUP-PNS5F120BER CDM 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DELIVERY SYSTEM NEURON SELECT STAINLESS STEEL POLYMER BERENSTEIN CURVE L130 CM L9 CM OD5 FR ID.04 IN LUMEN SOFT SHAFT RADIOPAQUE ACCEPTS .035/.038 IN GUIDEWIRE SUP-PNS5F130BER CDM 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DELIVERY SYSTEM NEURON STAINLESS STEEL .038 IN SIMS CURVE L130 CM L9 CM OD5 FR ID.04 IN PROXIMAL DISTAL INTRACRANIAL LUMEN FULL LENGTHRADIOPAQUE MARKER SUP-PNS5F130SIM CDM 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DELIVERY SYSTEM NEURON STAINLESS STEEL BERENSTEIN CURVE L125 CM L9 CM OD6 FR ODSEC5.6 FR ID.04 IN SELECT LATEX FREE ACCEPTS .035-.038 IN GUIDEWIRE SUP-PNS6F125BER CDM 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DELIVERY SYSTEM NEURON SELECT STAINLESS STEEL H1 CURVE L125 CM L9 CM OD6 FR ODSEC5-5.6 FR ID.04 IN ACCEPTS .035/.038 IN GUIDEWIRE SUP-PNS6F125H1 CDM 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER DELIVERY SYSTEM NEURON SELECT STAINLESS STEEL POLYMER SIMMONS CURVE L125 CM L9 CM OD6 FR ODSEC5-5.6 FR ID.04 IN BRAID SOFT DISTAL SHAFT LATEX FREE ACCEPTS .035/.038 IN GUIDEWIRE SUP-PNS6F125SIM CDM 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT JAW FORCEP DISSECTING MARYLAND 5MM X 31CM SUP-PO608R CDM outpatient 981.45 981.45 981.45 981.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG SPECIMEN RETRIEVAL ENDOPOUCH PLASTIC LARGE L6 IN X W4 IN OD10 MM 224 ML INTRODUCER TUBE FLEXIBLE THUMB RING HANDLE SYRINGE MOTION DEPLOYMENT STERILE LATEX FREE DISPOSABLE SUP-POUCH CDM 0270 RC outpatient 131.3 131.3 131.3 74 97.16 percent of total billed charges 131.3 93 106.35 percent of total billed charges 131.3 131.3 other OPPS APC 131.3 131.3 other OPPS APC 131.3 27.63 36.28 percent of total billed charges 131.3 131.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL VITAMESH POLYPROPYLENE MACROPOROUS RECTANGLE FLAT L6 IN X W3 IN SUP-PPBF0715 CDM 0270 RC outpatient 117.26 117.26 117.26 74 86.77 percent of total billed charges 117.26 93 94.98 percent of total billed charges 117.26 117.26 other OPPS APC 117.26 117.26 other OPPS APC 117.26 27.63 32.4 percent of total billed charges 117.26 117.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL VITAMESH POLYPROPYLENE MACROPOROUS SQUARE FLAT L6 IN X W6 IN SUP-PPBF1515 CDM 0270 RC outpatient 159.9 159.9 159.9 74 118.33 percent of total billed charges 159.9 93 129.52 percent of total billed charges 159.9 159.9 other OPPS APC 159.9 159.9 other OPPS APC 159.9 27.63 44.18 percent of total billed charges 159.9 159.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL VITAMESH POLYPROPYLENE MACROPOROUS FLAT L12 IN X W12 IN SUP-PPBF3030 CDM 0270 RC outpatient 414.96 414.96 414.96 74 307.07 percent of total billed charges 414.96 93 336.12 percent of total billed charges 414.96 414.96 other OPPS APC 414.96 414.96 other OPPS APC 414.96 27.63 114.65 percent of total billed charges 414.96 414.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL PROXIMATE PPH 33MM DISPOSABLE STERILE LF SET PROLAPSE HEMORRHOID SUP-PPH03 CDM 0270 RC outpatient 1033.5 1033.5 1033.5 74 764.79 percent of total billed charges 1033.5 93 837.14 percent of total billed charges 1033.5 1033.5 other OPPS APC 1033.5 1033.5 other OPPS APC 1033.5 27.63 285.56 percent of total billed charges 1033.5 1033.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PDS PLUS 2-0 CT L 27 IN ANTIBACTERIAL VIOLET SUP-PPP333H CDM 0270 RC outpatient 7.5 7.5 7.5 74 5.55 percent of total billed charges 7.5 93 6.08 percent of total billed charges 7.5 7.5 other OPPS APC 7.5 7.5 other OPPS APC 7.5 27.63 2.07 percent of total billed charges 7.5 7.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DRESSING NEGATIVE PRESSURE VACUUM PEEL AND PLACE PREVENA 20CM SUP-PRE1001US CDM 0270 RC outpatient 1325.61 1325.61 1325.61 74 980.95 percent of total billed charges 1325.61 93 1073.74 percent of total billed charges 1325.61 1325.61 other OPPS APC 1325.61 1325.61 other OPPS APC 1325.61 27.63 366.27 percent of total billed charges 1325.61 1325.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING PEEL AND PLACE PREVENA 20CM SUP-PRE1055US CDM 0270 RC outpatient 774.52 774.52 774.52 74 573.14 percent of total billed charges 774.52 93 627.36 percent of total billed charges 774.52 774.52 other OPPS APC 774.52 774.52 other OPPS APC 774.52 27.63 214 percent of total billed charges 774.52 774.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNISTER NEGATIVE PRESSURE 45ML PREVENA SUP-PRE1095 CDM 0270 RC outpatient 63.3 63.3 63.3 74 46.84 percent of total billed charges 63.3 93 51.27 percent of total billed charges 63.3 63.3 other OPPS APC 63.3 63.3 other OPPS APC 63.3 27.63 17.49 percent of total billed charges 63.3 63.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DRESSING WITH VACUUM PEEL AND PLACE PREVENA 13CM SUP-PRE1101US CDM 0270 RC outpatient 1325.61 1325.61 1325.61 74 980.95 percent of total billed charges 1325.61 93 1073.74 percent of total billed charges 1325.61 1325.61 other OPPS APC 1325.61 1325.61 other OPPS APC 1325.61 27.63 366.27 percent of total billed charges 1325.61 1325.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PREVENA 13CM DUAL KIT SUP-PRE1121US CDM 0270 RC outpatient 1824.71 1824.71 1824.71 74 1350.29 percent of total billed charges 1824.71 93 1478.02 percent of total billed charges 1824.71 1824.71 other OPPS APC 1824.71 1824.71 other OPPS APC 1824.71 27.63 504.17 percent of total billed charges 1824.71 1824.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING PEEL AND PLACE PREVENA 13CM SUP-PRE1155US CDM 0270 RC outpatient 774.52 774.52 774.52 74 573.14 percent of total billed charges 774.52 93 627.36 percent of total billed charges 774.52 774.52 other OPPS APC 774.52 774.52 other OPPS APC 774.52 27.63 214 percent of total billed charges 774.52 774.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING CUSTOMIZABLE PREVENA PLUS SUP-PRE4001US CDM 0270 RC outpatient 1706.56 1706.56 1706.56 74 1262.85 percent of total billed charges 1706.56 93 1382.31 percent of total billed charges 1706.56 1706.56 other OPPS APC 1706.56 1706.56 other OPPS APC 1706.56 27.63 471.52 percent of total billed charges 1706.56 1706.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNISTER 150ML REPLACEMENT SUP-PRE4095 CDM 0270 RC outpatient 67.6 67.6 67.6 74 50.02 percent of total billed charges 67.6 93 54.76 percent of total billed charges 67.6 67.6 other OPPS APC 67.6 67.6 other OPPS APC 67.6 27.63 18.68 percent of total billed charges 67.6 67.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR PREVENA VAC SUP-PRE9090 CDM 0270 RC outpatient 9.1 9.1 9.1 74 6.73 percent of total billed charges 9.1 93 7.37 percent of total billed charges 9.1 9.1 other OPPS APC 9.1 9.1 other OPPS APC 9.1 27.63 2.51 percent of total billed charges 9.1 9.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP PRICING TOTAL JOINT DEPUY PRESSFIT HIP-4 PIECE SUP-PRESSFIT HIP-DEPUY CDM 270010024 LOCAL 0270 RC outpatient 11960 11960 11960 74 8850.4 percent of total billed charges 11960 93 9687.6 percent of total billed charges 11960 11960 other OPPS APC 11960 11960 other OPPS APC 11960 27.63 3304.55 percent of total billed charges 11960 11960 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PRIMARY TOTAL KNEE 2 PIECE SYSTEM - CAPITATED PRICING SUP-PRIMARYKNEEZIM2PC CDM 270010025 LOCAL 0270 RC outpatient 10400 10400 10400 74 7696 percent of total billed charges 10400 93 8424 percent of total billed charges 10400 10400 other OPPS APC 10400 10400 other OPPS APC 10400 27.63 2873.52 percent of total billed charges 10400 10400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE ATRICLIP PRO2 GILLINOV-COSGROVE L35 MM STERILE LATEX FREE DISPOSABLE LEFT ATRIAL APPENDAGE EXCLUSION SYSTEM SUP-PRO235 CDM 0270 RC outpatient 9880 9880 9880 74 7311.2 percent of total billed charges 9880 93 8002.8 percent of total billed charges 9880 9880 other OPPS APC 9880 9880 other OPPS APC 9880 27.63 2729.84 percent of total billed charges 9880 9880 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER INTERNAL CLIP ATRICLIP PRO2 GILLINOV-COSGROVE L40 MM PRELOAD STERILE LATEX FREE DISPOSABLE LEFT ATRIAL APPENDAGE EXCLUSION SYSTEM SUP-PRO240 CDM 0270 RC outpatient 9880 9880 9880 74 7311.2 percent of total billed charges 9880 93 8002.8 percent of total billed charges 9880 9880 other OPPS APC 9880 9880 other OPPS APC 9880 27.63 2729.84 percent of total billed charges 9880 9880 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE ATRICLIP PRO2 GILLINOV-COSGROVE L45 MM STERILE LATEX FREE DISPOSABLE LEFT ATRIAL APPENDAGE EXCLUSION SYSTEM SUP-PRO245 CDM 0270 RC outpatient 9880 9880 9880 74 7311.2 percent of total billed charges 9880 93 8002.8 percent of total billed charges 9880 9880 other OPPS APC 9880 9880 other OPPS APC 9880 27.63 2729.84 percent of total billed charges 9880 9880 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE ATRICLIP PRO2 GILLINOV-COSGROVE L50 MM STERILE LATEX FREE DISPOSABLE LEFT ATRIAL APPENDAGE EXCLUSION SYSTEM SUP-PRO250 CDM 0270 RC outpatient 9880 9880 9880 74 7311.2 percent of total billed charges 9880 93 8002.8 percent of total billed charges 9880 9880 other OPPS APC 9880 9880 other OPPS APC 9880 27.63 2729.84 percent of total billed charges 9880 9880 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT PROTECTA CRT-D SYSTEM SUP-PROECTACRTDMMM CDM 0275 RC outpatient 42466 42466 42466 57 24205.6 percent of total billed charges 42466 93 34397.5 percent of total billed charges 42466 42466 other OPPS APC 42466 42466 other OPPS APC 42466 51 21657.7 percent of total billed charges 42466 42466 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD PROTECTA DR SYSTEM SUP-PROTECTADRMMEM CDM 0270 RC outpatient 49641.8 49641.8 49641.8 74 36734.9 percent of total billed charges 49641.8 93 40209.9 percent of total billed charges 49641.8 49641.8 other OPPS APC 49641.8 49641.8 other OPPS APC 49641.8 27.63 13716 percent of total billed charges 49641.8 49641.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD PROTECTA VR SYSTEM SUP-PROTECTAVREMEM CDM 0275 RC outpatient 46225.4 46225.4 46225.4 57 26348.5 percent of total billed charges 46225.4 93 37442.6 percent of total billed charges 46225.4 46225.4 other OPPS APC 46225.4 46225.4 other OPPS APC 46225.4 51 23575 percent of total billed charges 46225.4 46225.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE ATRICLIP PROV L50 MM TIP FIRST OPEN END CLIP LEFT ATRIAL APPENDAGE EXCLUSION SYSTEM 12 MM PORT SUP-PROV50` CDM 0270 RC outpatient 14300 14300 14300 74 10582 percent of total billed charges 14300 93 11583 percent of total billed charges 14300 14300 other OPPS APC 14300 14300 other OPPS APC 14300 27.63 3951.09 percent of total billed charges 14300 14300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER SKIN PROXIMATE RH STAINLESS STEEL 360 D WIDE RECTANGULAR L3.9 MM X W6.9 MM OD.58 MM 35 COUNT ROTATE HEAD ERGONOMIC PISTOL GRIP HANDLE RATCHET MECHANISM STERILE LATEX FREE DISPOSABLE SUP-PRW35 CDM 0270 RC outpatient 45.96 45.96 45.96 74 34.01 percent of total billed charges 45.96 93 37.23 percent of total billed charges 45.96 45.96 other OPPS APC 45.96 45.96 other OPPS APC 45.96 27.63 12.7 percent of total billed charges 45.96 45.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SKIN CLOSURE ZIP NON INVASIVE FLEXIBLE 16 CM SUP-PS1160 CDM 0481 RC outpatient 221 221 221 74 163.54 percent of total billed charges 221 93 179.01 percent of total billed charges 221 221 other OPPS APC 221 221 other OPPS APC 221 51 112.71 percent of total billed charges 221 221 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SURGICAL PLASMABLADE PEAK W4 MM CAUTERY SPATULA TIP HIGHLY INSULATED BENDABLE SHAFT ERGONOMIC HANDPIECE DISPOSABLE SUP-PS200-040 CDM 0270 RC outpatient 859.95 859.95 859.95 74 636.36 percent of total billed charges 859.95 93 696.56 percent of total billed charges 859.95 859.95 other OPPS APC 859.95 859.95 other OPPS APC 859.95 27.63 237.6 percent of total billed charges 859.95 859.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZIPLINE ZIP 8I SURGICAL CLOSURE DEVICE SUP-PS2080 CDM 0481 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 51 99.45 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE ELECTROSURGICAL PLASMABLADE X STERILE LATEX FREE DISPOSABLE PINK 3.0S LIGHT SUP-PS210030SLIGHT_72344 CDM 0270 RC outpatient 1144 1144 1144 74 846.56 percent of total billed charges 1144 93 926.64 percent of total billed charges 1144 1144 other OPPS APC 1144 1144 other OPPS APC 1144 27.63 316.09 percent of total billed charges 1144 1144 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOGRAFT HUMAN TISSUE STRAVIX 18SQCM 3CM X 6CM CRYOPRESERVED PLACENTAL MATRIX UMBILICAL CORD >2YR SHELFLIFE SUP-PS60008 CDM 0270 RC outpatient 6942 6942 6942 74 5137.08 percent of total billed charges 6942 93 5623.02 percent of total billed charges 6942 6942 other OPPS APC 6942 6942 other OPPS APC 6942 27.63 1918.07 percent of total billed charges 6942 6942 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALLOGRAFT HUMAN TISSUE STRAVIX 18SQCM 3CM X 6 CM MESHED CRYOPRESERVED PLACENTAL MATRIX UMBILICAL CORD >2YR SHELFLIFE SUP-PS60036 CDM 0270 RC outpatient 6904.3 6904.3 6904.3 74 5109.18 percent of total billed charges 6904.3 93 5592.48 percent of total billed charges 6904.3 6904.3 other OPPS APC 6904.3 6904.3 other OPPS APC 6904.3 27.63 1907.66 percent of total billed charges 6904.3 6904.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE STRAVIX PLACENTAL TISSUE L6 CM X W3 CM ALLOGRAFT SUP-PS61036 CDM outpatient 6949.8 6949.8 6949.8 6949.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY PENUMBRA SYSTEM MAX SEPERATOR FLEX NITINOL L132 CM L136 CM OD6.0-5.0 FR ID.054 IN REPERFUSION MAX TRACKING TECHNOLOGY ACCEPTS .014 IN GUIDEWIRE SUP-PSC054 CDM 0270 RC outpatient 4342 4342 4342 74 3213.08 percent of total billed charges 4342 93 3517.02 percent of total billed charges 4342 4342 other OPPS APC 4342 4342 other OPPS APC 4342 27.63 1199.69 percent of total billed charges 4342 4342 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REINFORCEMENT STAPLE LINE PERI-STRIPS DRY VERITAS 6 FIRING GEL TUBE LINEAR STERILE LATEX FREE DISPOSABLE ECHELON 45 SUP-PSD4506ECHV CDM 0270 RC outpatient 556.36 556.36 556.36 74 411.71 percent of total billed charges 556.36 93 450.65 percent of total billed charges 556.36 556.36 other OPPS APC 556.36 556.36 other OPPS APC 556.36 27.63 153.72 percent of total billed charges 556.36 556.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REINFORCEMENT STAPLE LINE PERI-STRIPS DRY VERITAS 6 FIRING 3 GEL TUBE STERILE LATEX FREE DISPOSABLE EZ 45 SUP-PSD4506EV CDM 0270 RC outpatient 9.01 9.01 9.01 74 6.67 percent of total billed charges 9.01 93 7.3 percent of total billed charges 9.01 9.01 other OPPS APC 9.01 9.01 other OPPS APC 9.01 27.63 2.49 percent of total billed charges 9.01 9.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL PERI-STRIPS DRY L60 MM 6 LOAD UNIT 3 TUBE STERILE GEL STERILE DISPOSABLE ETHICON ECHELON SUP-PSD6006ECHV CDM 0270 RC outpatient 540.15 540.15 540.15 74 399.71 percent of total billed charges 540.15 93 437.52 percent of total billed charges 540.15 540.15 other OPPS APC 540.15 540.15 other OPPS APC 540.15 27.63 149.24 percent of total billed charges 540.15 540.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REINFORCEMENT STAPLE LINE PERI-STRIPS DRY VERITAS 6 FIRING 3 GEL TUBE STERILE LATEX FREE DISPOSABLE ENDO GIA 60 SUP-PSD6006UV CDM 0270 RC outpatient 540.15 540.15 540.15 74 399.71 percent of total billed charges 540.15 93 437.52 percent of total billed charges 540.15 540.15 other OPPS APC 540.15 540.15 other OPPS APC 540.15 27.63 149.24 percent of total billed charges 540.15 540.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ECHELON FLEX POWERED PLUS STANDARD 340MM 60MM LF LINEAR CUT ENDOSCOPIC SUP-PSEE60A CDM 0270 RC outpatient 1021.55 1021.55 1021.55 74 755.95 percent of total billed charges 1021.55 93 827.46 percent of total billed charges 1021.55 1021.55 other OPPS APC 1021.55 1021.55 other OPPS APC 1021.55 27.63 282.25 percent of total billed charges 1021.55 1021.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEPARATOR 054 SUP-PSF054 CDM 0270 RC outpatient 7748 7748 7748 74 5733.52 percent of total billed charges 7748 93 6275.88 percent of total billed charges 7748 7748 other OPPS APC 7748 7748 other OPPS APC 7748 27.63 2140.77 percent of total billed charges 7748 7748 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PRELUDE .038 IN L11 CM L50 CM OD8 FR GUIDEWIRE KINK RESISTANT FLEXIBLE RADIOPAQUE LATEX FREE BLUE SUP-PSI-8F-11-038 CDM 0270 RC outpatient 24.91 24.91 24.91 74 18.43 percent of total billed charges 24.91 93 20.18 percent of total billed charges 24.91 24.91 other OPPS APC 24.91 24.91 other OPPS APC 24.91 27.63 6.88 percent of total billed charges 24.91 24.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PERITONEAL DIALYSIS EXTENDED TWO-PIECE FELANGE WITH EXTENDER FOR OPEN DISSECTION SUP-PSNA-100 CDM 0270 RC outpatient 1105 1105 1105 74 817.7 percent of total billed charges 1105 93 895.05 percent of total billed charges 1105 1105 other OPPS APC 1105 1105 other OPPS APC 1105 27.63 305.31 percent of total billed charges 1105 1105 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS GORE VIATORR NITINOL STAINLESS STEEL PLASTIC EPTFE L7 CM L2 CM OD10 MM SELF EXPAND RADIOPAQUE 2 LUMEN CATHETER ACCESS SLEEVE STERILE ACCEPTS .038- IN GUIDEWIRE 10 FR INTRODUCER SHEATH TIPS SUP-PTB107275 CDM 0270 RC outpatient 11193 11193 11193 74 8282.82 percent of total billed charges 11193 93 9066.33 percent of total billed charges 11193 11193 other OPPS APC 11193 11193 other OPPS APC 11193 27.63 3092.63 percent of total billed charges 11193 11193 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS GORE VIATORR NITINOL STAINLESS STEEL PLASTIC EPTFE L5 CM L2 CM OD10 MM SELF EXPAND RADIOPAQUE 2 LUMEN CATHETER ACCESS SLEEVE STERILE ACCEPTS .038- IN GUIDEWIRE 10 FR INTRODUCER SHEATH TIPS SUP-PTB8105275 CDM 0270 RC outpatient 12360.4 12360.4 12360.4 74 9146.7 percent of total billed charges 12360.4 93 10011.9 percent of total billed charges 12360.4 12360.4 other OPPS APC 12360.4 12360.4 other OPPS APC 12360.4 27.63 3415.18 percent of total billed charges 12360.4 12360.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS GORE VIATORR NITINOL STAINLESS STEEL PLASTIC EPTFE L6 CM L2 CM OD10 MM SELF EXPAND RADIOPAQUE 2 LUMEN CATHETER ACCESS SLEEVE STERILE ACCEPTS .038- IN GUIDEWIRE 10 FR INTRODUCER SHEATH TIPS SUP-PTB8107275 CDM 0270 RC outpatient 14734.2 14734.2 14734.2 74 10903.3 percent of total billed charges 14734.2 93 11934.7 percent of total billed charges 14734.2 14734.2 other OPPS APC 14734.2 14734.2 other OPPS APC 14734.2 27.63 4071.06 percent of total billed charges 14734.2 14734.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE PROTRACK PIGTAIL 0.025 IN DIAMETER 175 CM OVERALL LENGTH SUP-PTW-25-175 CDM 0481 RC outpatient 559 559 559 74 413.66 percent of total billed charges 559 93 452.79 percent of total billed charges 559 559 other OPPS APC 559 559 other OPPS APC 559 51 285.09 percent of total billed charges 559 559 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE PROTRACK PIGTAIL 0.025 IN DIAMETER 230 CM OVERALL LENGTH SUP-PTW-25-230 CDM 0481 RC outpatient 611 611 611 74 452.14 percent of total billed charges 611 93 494.91 percent of total billed charges 611 611 other OPPS APC 611 611 other OPPS APC 611 51 311.61 percent of total billed charges 611 611 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ECHELON FLEX STANDARD L32 CM L35 MM VASCULAR TISSUE POWER ADVANCE PLACEMENT TIP ARTICULATE SUP-PVE35A CDM 0270 RC outpatient 842.86 842.86 842.86 74 623.72 percent of total billed charges 842.86 93 682.72 percent of total billed charges 842.86 842.86 other OPPS APC 842.86 842.86 other OPPS APC 842.86 27.63 232.88 percent of total billed charges 842.86 842.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EXTERNAL FEMALE PUREWICK SUP-PWF030 CDM outpatient 20.15 20.15 20.15 20.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER EXTERNAL FEMALE PUREWICK SUP-PWF030F CDM outpatient 20.35 20.35 20.35 20.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PRESSURE MONITOR TRUWAVE L60 IN L12 IN 3 WAY STOPCOCK TRANSDUCER FLUSH DEVICE MACRODRIP TUBE STERILE DISPOSABLE MODEL PX600F SUP-PX272 CDM 270009140 LOCAL 0270 RC outpatient 13.5 13.5 13.5 74 9.99 percent of total billed charges 13.5 93 10.94 percent of total billed charges 13.5 13.5 other OPPS APC 13.5 13.5 other OPPS APC 13.5 27.63 3.73 percent of total billed charges 13.5 13.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRANSDUCER PRESSURE TRUWAVE 1 BOND 1 WAY SHUTOFF STOPCOCK STERILE LATEX FREE DISPOSABLE SUP-PX600 CDM outpatient 43.26 43.26 43.26 43.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FEP L3.3 CM OD23 MM AORTA STENT EXTENDER DELIVERY SYSTEM AAA ACCEPTS ID 19-21 MM ACCEPTS 18FR SHEATH SUP-PXA230300 CDM 270010015 LOCAL 0270 RC outpatient 6544.2 6544.2 6544.2 74 4842.71 percent of total billed charges 6544.2 93 5300.8 percent of total billed charges 6544.2 6544.2 other OPPS APC 6544.2 6544.2 other OPPS APC 6544.2 27.63 1808.16 percent of total billed charges 6544.2 6544.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP LOW PROFILE L3.3 CM OD26 MM ODSEC18 FR ID22-23 MM AORTA STENT EXTENDER DELIVERY SYSTEM SEAL CUFF FLEXIBLE AAA SUP-PXA260300 CDM 270010015 LOCAL 0270 RC outpatient 6141.2 6141.2 6141.2 74 4544.49 percent of total billed charges 6141.2 93 4974.37 percent of total billed charges 6141.2 6141.2 other OPPS APC 6141.2 6141.2 other OPPS APC 6141.2 27.63 1696.81 percent of total billed charges 6141.2 6141.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FEP L3.3 CM OD28.5 MM AORTA STENT EXTENDER DELIVERY SYSTEM AAA ACCEPTS ID 24-26 MM ACCEPTS 18FR SHEATH SUP-PXA280300 CDM 270010015 LOCAL 0270 RC outpatient 6141.2 6141.2 6141.2 74 4544.49 percent of total billed charges 6141.2 93 4974.37 percent of total billed charges 6141.2 6141.2 other OPPS APC 6141.2 6141.2 other OPPS APC 6141.2 27.63 1696.81 percent of total billed charges 6141.2 6141.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR 10CM 12MM EXCLUDER CONTRALATERAL LEG STENT EXTENDER DELIVERY SUP-PXC121000 CDM 270010015 LOCAL 0270 RC outpatient 12019.8 12019.8 12019.8 74 8894.65 percent of total billed charges 12019.8 93 9736.04 percent of total billed charges 12019.8 12019.8 other OPPS APC 12019.8 12019.8 other OPPS APC 12019.8 27.63 3321.07 percent of total billed charges 12019.8 12019.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FEP L12 CM OD12 MM CONTRALATERAL LEG STENT EXTENDER DELIVERY SYSTEM AAA ACCEPTS ID10-11 MM ACCEPTS 12FR SHEATH SUP-PXC121200 CDM 270010015 LOCAL 0270 RC outpatient 12019.8 12019.8 12019.8 74 8894.65 percent of total billed charges 12019.8 93 9736.04 percent of total billed charges 12019.8 12019.8 other OPPS APC 12019.8 12019.8 other OPPS APC 12019.8 27.63 3321.07 percent of total billed charges 12019.8 12019.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FEP L14 CM OD12 MM CONTRALATERAL LEG STENT EXTENDER DELIVERY SYSTEM AAA ACCEPTS ID10-11 MM ACCEPTS 12FR SHEATH SUP-PXC121400 CDM 270010015 LOCAL 0270 RC outpatient 12019.8 12019.8 12019.8 74 8894.65 percent of total billed charges 12019.8 93 9736.04 percent of total billed charges 12019.8 12019.8 other OPPS APC 12019.8 12019.8 other OPPS APC 12019.8 27.63 3321.07 percent of total billed charges 12019.8 12019.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FEP L10 CM OD14.5 MM CONTRALATERAL LEG STENT EXTENDER DELIVERY SYSTEM AAA ACCEPTS ID12-13.5 MM ACCEPTS 12FR SHEATH SUP-PXC141000 CDM 270010015 LOCAL 0270 RC outpatient 12019.8 12019.8 12019.8 74 8894.65 percent of total billed charges 12019.8 93 9736.04 percent of total billed charges 12019.8 12019.8 other OPPS APC 12019.8 12019.8 other OPPS APC 12019.8 27.63 3321.07 percent of total billed charges 12019.8 12019.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FEP L12 CM OD14.5 MM CONTRALATERAL LEG STENT EXTENDER DELIVERY SYSTEM AAA ACCEPTS ID12-13.5 MM ACCEPTS 12FR SHEATH SUP-PXC141200 CDM 270010015 LOCAL 0270 RC outpatient 12019.8 12019.8 12019.8 74 8894.65 percent of total billed charges 12019.8 93 9736.04 percent of total billed charges 12019.8 12019.8 other OPPS APC 12019.8 12019.8 other OPPS APC 12019.8 27.63 3321.07 percent of total billed charges 12019.8 12019.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP LOW PROFILE L14 CM OD14.5 MM CONTRALATERAL LEG STENT EXTENDER DELIVERY SYSTEM SEAL CUFF FLEXIBLE AAA SUP-PXC141400 CDM 270010015 LOCAL 0270 RC outpatient 12019.8 12019.8 12019.8 74 8894.65 percent of total billed charges 12019.8 93 9736.04 percent of total billed charges 12019.8 12019.8 other OPPS APC 12019.8 12019.8 other OPPS APC 12019.8 27.63 3321.07 percent of total billed charges 12019.8 12019.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FEP L11.5 CM OD16 MM CONTRALATERAL LEG STENT EXTENDER DELIVERY SYSTEM AAA ACCEPTS ID13.5-14.5 MM ACCEPTS 18FR SHEATH SUP-PXC161200 CDM 270010015 LOCAL 0270 RC outpatient 12019.8 12019.8 12019.8 74 8894.65 percent of total billed charges 12019.8 93 9736.04 percent of total billed charges 12019.8 12019.8 other OPPS APC 12019.8 12019.8 other OPPS APC 12019.8 27.63 3321.07 percent of total billed charges 12019.8 12019.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FEP L13.5 CM OD16 MM CONTRALATERAL LEG STENT EXTENDER DELIVERY SYSTEM AAA ACCEPTS ID13.5-14.5 MM ACCEPTS 18FR SHEATH SUP-PXC161400 CDM 270010015 LOCAL 0270 RC outpatient 12019.8 12019.8 12019.8 74 8894.65 percent of total billed charges 12019.8 93 9736.04 percent of total billed charges 12019.8 12019.8 other OPPS APC 12019.8 12019.8 other OPPS APC 12019.8 27.63 3321.07 percent of total billed charges 12019.8 12019.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FEP L9.5 CM OD18 MM CONTRALATERAL LEG STENT EXTENDER DELIVERY SYSTEM AAA ACCEPTS ID14.5-16.5 MM ACCEPTS 18FR SHEATH SUP-PXC181000 CDM 270010015 LOCAL 0270 RC outpatient 12019.8 12019.8 12019.8 74 8894.65 percent of total billed charges 12019.8 93 9736.04 percent of total billed charges 12019.8 12019.8 other OPPS APC 12019.8 12019.8 other OPPS APC 12019.8 27.63 3321.07 percent of total billed charges 12019.8 12019.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FEP L11.5 CM OD18 MM CONTRALATERAL LEG STENT EXTENDER DELIVERY SYSTEM AAA ACCEPTS ID14.5-16.5 MM ACCEPTS 18FR SHEATH SUP-PXC181200 CDM 270010015 LOCAL 0270 RC outpatient 12019.8 12019.8 12019.8 74 8894.65 percent of total billed charges 12019.8 93 9736.04 percent of total billed charges 12019.8 12019.8 other OPPS APC 12019.8 12019.8 other OPPS APC 12019.8 27.63 3321.07 percent of total billed charges 12019.8 12019.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP LOW PROFILE L13.5 CM OD18 MM ODSEC18 FR ID14.5-16.5 MM CONTRALATERAL LEG STENT EXTENDER DELIVERY SYSTEM SEAL CUFF FLEXIBLE AAA SUP-PXC181400 CDM 270010015 LOCAL 0270 RC outpatient 12019.8 12019.8 12019.8 74 8894.65 percent of total billed charges 12019.8 93 9736.04 percent of total billed charges 12019.8 12019.8 other OPPS APC 12019.8 12019.8 other OPPS APC 12019.8 27.63 3321.07 percent of total billed charges 12019.8 12019.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FEP L9.5 CM OD20 MM CONTRALATERAL LEG STENT EXTENDER DELIVERY SYSTEM AAA ACCEPTS ID16.5-18.5 MM ACCEPTS 18FR SHEATH SUP-PXC201000 CDM 270010015 LOCAL 0270 RC outpatient 12019.8 12019.8 12019.8 74 8894.65 percent of total billed charges 12019.8 93 9736.04 percent of total billed charges 12019.8 12019.8 other OPPS APC 12019.8 12019.8 other OPPS APC 12019.8 27.63 3321.07 percent of total billed charges 12019.8 12019.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FEP L11.5 CM OD20 MM CONTRALATERAL LEG STENT EXTENDER DELIVERY SYSTEM AAA ACCEPTS ID16.5-18.5 MM ACCEPTS 18FR SHEATH SUP-PXC201200 CDM 270010015 LOCAL 0270 RC outpatient 12019.8 12019.8 12019.8 74 8894.65 percent of total billed charges 12019.8 93 9736.04 percent of total billed charges 12019.8 12019.8 other OPPS APC 12019.8 12019.8 other OPPS APC 12019.8 27.63 3321.07 percent of total billed charges 12019.8 12019.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT GORE EXCLUDER 16MM X 10MMX 7CM SUP-PXL161007 CDM 270010015 LOCAL 0270 RC outpatient 8460.4 8460.4 8460.4 74 6260.7 percent of total billed charges 8460.4 93 6852.92 percent of total billed charges 8460.4 8460.4 other OPPS APC 8460.4 8460.4 other OPPS APC 8460.4 27.63 2337.61 percent of total billed charges 8460.4 8460.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FEP L7 CM OD12 MM ILIAC ARTERY STENT EXTENDER DELIVERY SYSTEM AAA ACCEPTS ID10-11 MM ACCEPTS 12FR SHEATH SUP-PXL161207 CDM 270010015 LOCAL 0270 RC outpatient 8460.4 8460.4 8460.4 74 6260.7 percent of total billed charges 8460.4 93 6852.92 percent of total billed charges 8460.4 8460.4 other OPPS APC 8460.4 8460.4 other OPPS APC 8460.4 27.63 2337.61 percent of total billed charges 8460.4 8460.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP LOW PROFILE L7 CM OD14.5 MM ODSEC12 FR ID12-13.5 MM ILIUM STENT EXTENDER DELIVERY SYSTEM SEAL CUFF FLEXIBLE AAA SUP-PXL161407 CDM 270010015 LOCAL 0270 RC outpatient 8460.4 8460.4 8460.4 74 6260.7 percent of total billed charges 8460.4 93 6852.92 percent of total billed charges 8460.4 8460.4 other OPPS APC 8460.4 8460.4 other OPPS APC 8460.4 27.63 2337.61 percent of total billed charges 8460.4 8460.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP L14 CM OD23 MM ODSEC12 MM TRUNK IPSILATERAL LEG STENT DELIVERY SYSTEM AAA ACCEPTS 18FR SHEATH SUP-PXT231214 CDM 270010015 LOCAL 0270 RC outpatient 20225.4 20225.4 20225.4 74 14966.8 percent of total billed charges 20225.4 93 16382.6 percent of total billed charges 20225.4 20225.4 other OPPS APC 20225.4 20225.4 other OPPS APC 20225.4 27.63 5588.28 percent of total billed charges 20225.4 20225.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP L16 CM OD23 MM ODSEC12 MM TRUNK IPSILATERAL LEG STENT DELIVERY SYSTEM AAA ACCEPTS 18FR SHEATH SUP-PXT231216 CDM 270010015 LOCAL 0270 RC outpatient 18512 18512 18512 74 13698.9 percent of total billed charges 18512 93 14994.7 percent of total billed charges 18512 18512 other OPPS APC 18512 18512 other OPPS APC 18512 27.63 5114.87 percent of total billed charges 18512 18512 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP LOW PROFILE L14 CM OD23 MM ODSEC14.5 MM TRUNK IPSILATERAL LEG STENT DELIVERY SYSTEM AAA ACCEPTS 18FR SHEATH SUP-PXT231414 CDM 270010015 LOCAL 0270 RC outpatient 20225.4 20225.4 20225.4 74 14966.8 percent of total billed charges 20225.4 93 16382.6 percent of total billed charges 20225.4 20225.4 other OPPS APC 20225.4 20225.4 other OPPS APC 20225.4 27.63 5588.28 percent of total billed charges 20225.4 20225.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP L14 CM OD26 MM ODSEC12 MM TRUNK IPSILATERAL LEG STENT DELIVERY SYSTEM AAA ACCEPTS 18FR SHEATH SUP-PXT261214 CDM 270010015 LOCAL 0270 RC outpatient 19827.6 19827.6 19827.6 74 14672.4 percent of total billed charges 19827.6 93 16060.4 percent of total billed charges 19827.6 19827.6 other OPPS APC 19827.6 19827.6 other OPPS APC 19827.6 27.63 5478.37 percent of total billed charges 19827.6 19827.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP L16 CM OD26 MM ODSEC12 MM TRUNK IPSILATERAL LEG STENT DELIVERY SYSTEM AAA ACCEPTS 18FR SHEATH SUP-PXT261216 CDM 270010015 LOCAL 0270 RC outpatient 18974.8 18974.8 18974.8 74 14041.4 percent of total billed charges 18974.8 93 15369.6 percent of total billed charges 18974.8 18974.8 other OPPS APC 18974.8 18974.8 other OPPS APC 18974.8 27.63 5242.74 percent of total billed charges 18974.8 18974.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP L18 CM OD26 MM ODSEC12 MM TRUNK IPSILATERAL LEG STENT ACCEPTS 18 FR SHEATH AAA SUP-PXT261218 CDM 270010015 LOCAL 0270 RC outpatient 19827.6 19827.6 19827.6 74 14672.4 percent of total billed charges 19827.6 93 16060.4 percent of total billed charges 19827.6 19827.6 other OPPS APC 19827.6 19827.6 other OPPS APC 19827.6 27.63 5478.37 percent of total billed charges 19827.6 19827.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP L12 CM OD26 MM ODSEC14.5 MM TRUNK IPSILATERAL LEG STENT DELIVERY SYSTEM AAA ACCEPTS 18FR SHEATH SUP-PXT261412 CDM 270010015 LOCAL 0270 RC outpatient 19827.6 19827.6 19827.6 74 14672.4 percent of total billed charges 19827.6 93 16060.4 percent of total billed charges 19827.6 19827.6 other OPPS APC 19827.6 19827.6 other OPPS APC 19827.6 27.63 5478.37 percent of total billed charges 19827.6 19827.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP L14 CM OD26 MM ODSEC14.5 MM TRUNK IPSILATERAL LEG STENT DELIVERY SYSTEM AAA ACCEPTS 18FR SHEATH SUP-PXT261414 CDM 270010015 LOCAL 0270 RC outpatient 18974.8 18974.8 18974.8 74 14041.4 percent of total billed charges 18974.8 93 15369.6 percent of total billed charges 18974.8 18974.8 other OPPS APC 18974.8 18974.8 other OPPS APC 18974.8 27.63 5242.74 percent of total billed charges 18974.8 18974.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP LOW PROFILE L16 CM OD26 MM ODSEC14.5 MM ID22-23 MM TRUNK IPSILATERAL LEG STENT EXTENDER DELIVERY SYSTEM SEAL CUFF FLEXIBLE AAA SUP-PXT261416 CDM 270010015 LOCAL 0270 RC outpatient 20225.4 20225.4 20225.4 74 14966.8 percent of total billed charges 20225.4 93 16382.6 percent of total billed charges 20225.4 20225.4 other OPPS APC 20225.4 20225.4 other OPPS APC 20225.4 27.63 5588.28 percent of total billed charges 20225.4 20225.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP L18 CM OD26 MM ODSEC14.5 MM TRUNK IPSILATERAL LEG STENT DELIVERY SYSTEM AAA ACCEPTS 18FR SHEATH SUP-PXT261418 CDM 270010015 LOCAL 0270 RC outpatient 20225.4 20225.4 20225.4 74 14966.8 percent of total billed charges 20225.4 93 16382.6 percent of total billed charges 20225.4 20225.4 other OPPS APC 20225.4 20225.4 other OPPS APC 20225.4 27.63 5588.28 percent of total billed charges 20225.4 20225.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP L14 CM OD28.5 MM ODSEC12 MM TRUNK IPSILATERAL LEG STENT DELIVERY SYSTEM AAA ACCEPTS 18FR SHEATH SUP-PXT281214 CDM 270010015 LOCAL 0270 RC outpatient 20225.4 20225.4 20225.4 74 14966.8 percent of total billed charges 20225.4 93 16382.6 percent of total billed charges 20225.4 20225.4 other OPPS APC 20225.4 20225.4 other OPPS APC 20225.4 27.63 5588.28 percent of total billed charges 20225.4 20225.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP L16 CM OD28.5 MM ODSEC12 MM TRUNK IPSILATERAL LEG STENT DELIVERY SYSTEM ACCEPTS 18 FR SHEATH AAA SUP-PXT281216 CDM 270010015 LOCAL 0270 RC outpatient 18974.8 18974.8 18974.8 74 14041.4 percent of total billed charges 18974.8 93 15369.6 percent of total billed charges 18974.8 18974.8 other OPPS APC 18974.8 18974.8 other OPPS APC 18974.8 27.63 5242.74 percent of total billed charges 18974.8 18974.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP L12 CM OD28.5 MM ODSEC14.5 MM TRUNK IPSILATERAL LEG STENT DELIVERY SYSTEM AAA ACCEPTS 18FR SHEATH SUP-PXT281412 CDM 270010015 LOCAL 0270 RC outpatient 18512 18512 18512 74 13698.9 percent of total billed charges 18512 93 14994.7 percent of total billed charges 18512 18512 other OPPS APC 18512 18512 other OPPS APC 18512 27.63 5114.87 percent of total billed charges 18512 18512 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP L14 CM OD28.5 MM ODSEC14.5 MM TRUNK IPSILATERAL LEG STENT DELIVERY SYSTEM AAA ACCEPTS 18FR SHEATH SUP-PXT281414 CDM 270010015 LOCAL 0270 RC outpatient 20225.4 20225.4 20225.4 74 14966.8 percent of total billed charges 20225.4 93 16382.6 percent of total billed charges 20225.4 20225.4 other OPPS APC 20225.4 20225.4 other OPPS APC 20225.4 27.63 5588.28 percent of total billed charges 20225.4 20225.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER GORE-TEX NITINOL FEP L18 CM OD28.5 MM ODSEC14.5 MM TRUNK IPSILATERAL LEG STENT DELIVERY SYSTEM AAA ACCEPTS 18FR SHEATH SUP-PXT281418 CDM 270010015 LOCAL 0270 RC outpatient 18512 18512 18512 74 13698.9 percent of total billed charges 18512 93 14994.7 percent of total billed charges 18512 18512 other OPPS APC 18512 18512 other OPPS APC 18512 27.63 5114.87 percent of total billed charges 18512 18512 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER SKIN PROXIMATE PX STAINLESS STEEL WIDE RECTANGULAR L3.9 MM X W6.9 MM OD.58 MM 35 COUNT MULTIDIRECTIONAL RELEASE FIX HEAD ERGONOMIC PISTOL GRIP HANDLE STERILE LATEX FREE DISPOSABLE SUP-PXW35 CDM 0270 RC outpatient 19.96 19.96 19.96 74 14.77 percent of total billed charges 19.96 93 16.17 percent of total billed charges 19.96 19.96 other OPPS APC 19.96 19.96 other OPPS APC 19.96 27.63 5.51 percent of total billed charges 19.96 19.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND EXCEL TAPERCUT THK1.5 MM 2-0 V-4 L30 IN L7 MM X W3 MM 2 ARM BRAID 10 STRAND FIRM PLEDGET GREEN WHITE SUP-PXX22 CDM 0270 RC outpatient 1997.01 1997.01 1997.01 74 1477.79 percent of total billed charges 1997.01 93 1617.58 percent of total billed charges 1997.01 1997.01 other OPPS APC 1997.01 1997.01 other OPPS APC 1997.01 27.63 551.77 percent of total billed charges 1997.01 1997.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND EXCEL TAPERCUT THK1.5 MM 2-0 V-4 L30 IN L7 MM X W3 MM 2 ARM BRAID 10 STRAND FIRM PLEDGET GREEN WHITE SUP-PXX22N CDM 0270 RC outpatient 1043.07 1043.07 1043.07 74 771.87 percent of total billed charges 1043.07 93 844.89 percent of total billed charges 1043.07 1043.07 other OPPS APC 1043.07 1043.07 other OPPS APC 1043.07 27.63 288.2 percent of total billed charges 1043.07 1043.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND EXCEL THK1.5 MM 0 SH L30 IN L7 MM X W3 MM 2 ARM BRAID 10 STRAND FIRM PLEDGET GREEN WHITE SUP-PXX87 CDM 0270 RC outpatient 131.22 131.22 131.22 74 97.1 percent of total billed charges 131.22 93 106.29 percent of total billed charges 131.22 131.22 other OPPS APC 131.22 131.22 other OPPS APC 131.22 27.63 36.26 percent of total billed charges 131.22 131.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND EXCEL THK1.5 MM 0 SH L30 IN L7 MM X W3 MM 2 ARM BRAID 10 STRAND FIRM PLEDGET GREEN WHITE SUP-PXX87N CDM 0270 RC outpatient 131.22 131.22 131.22 74 97.1 percent of total billed charges 131.22 93 106.29 percent of total billed charges 131.22 131.22 other OPPS APC 131.22 131.22 other OPPS APC 131.22 27.63 36.26 percent of total billed charges 131.22 131.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIPE CLEANING SUPER SANI-CLOTH (FOR DAVINCI ONLY) SUP-Q86984A CDM 0270 RC outpatient 13.47 13.47 13.47 74 9.97 percent of total billed charges 13.47 93 10.91 percent of total billed charges 13.47 13.47 other OPPS APC 13.47 13.47 other OPPS APC 13.47 27.63 3.72 percent of total billed charges 13.47 13.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICE SOUNDSTAR 8Fr REPROC _61682_ SUP-R10439236 CDM 0270 RC outpatient 3915.6 3915.6 3915.6 74 2897.54 percent of total billed charges 3915.6 93 3171.64 percent of total billed charges 3915.6 3915.6 other OPPS APC 3915.6 3915.6 other OPPS APC 3915.6 27.63 1081.88 percent of total billed charges 3915.6 3915.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STRIP SKIN CLOSURE 3M STERI-STRIP POLYESTER POROUS L3 IN X W1/4 IN REINFORCE HYPOALLERGENIC NONINVASIVE BREATHABLE STERILE LATEX FREE WHITE SUP-R1541 CDM 0270 RC outpatient 1.28 1.28 1.28 74 0.95 percent of total billed charges 1.28 93 1.04 percent of total billed charges 1.28 1.28 other OPPS APC 1.28 1.28 other OPPS APC 1.28 27.63 0.35 percent of total billed charges 1.28 1.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CARD HOLDER 3 X 5 SUP-R15588T2 CDM outpatient 31.54 31.54 31.54 31.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE 5-0 MERSELINE SUP-R690G CDM 0270 RC outpatient 9.11 9.11 9.11 74 6.74 percent of total billed charges 9.11 93 7.38 percent of total billed charges 9.11 9.11 other OPPS APC 9.11 9.11 other OPPS APC 9.11 27.63 2.52 percent of total billed charges 9.11 9.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE MERSILENE MULTIPASS 4-0 P-3 L18 IN BRAID WHITE SUP-R691G CDM 0270 RC outpatient 10.03 10.03 10.03 74 7.42 percent of total billed charges 10.03 93 8.12 percent of total billed charges 10.03 10.03 other OPPS APC 10.03 10.03 other OPPS APC 10.03 27.63 2.77 percent of total billed charges 10.03 10.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION DECANAV CARTO 3 2 MM 2-8-2 MM D CURVE L115CM OD 7 FR 10 PLE SUP-R7D282CT CDM 0270 RC outpatient 2964 2964 2964 74 2193.36 percent of total billed charges 2964 93 2400.84 percent of total billed charges 2964 2964 other OPPS APC 2964 2964 other OPPS APC 2964 27.63 818.95 percent of total billed charges 2964 2964 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ABLATION DECANAV 2MM 2-8-2 MM F CURVE L115CM OD 7 FR 10 POLE TIP SUP-R7F282CT CDM 0270 RC outpatient 2964 2964 2964 74 2193.36 percent of total billed charges 2964 93 2400.84 percent of total billed charges 2964 2964 other OPPS APC 2964 2964 other OPPS APC 2964 27.63 818.95 percent of total billed charges 2964 2964 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET CATHETERIZATION POLYURETHANE OD.018 IN L1 3/4 IN OD20 GA ODSEC22 GA RADIAL ARTERY CATHETER RADIOPAQUE SPRING GUIDEWIRE INTRODUCER NEEDLE SUP-RA-04020 CDM outpatient 24.02 24.02 24.02 24.02 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT ARTERIAL LINE QUICKFLASH POLYURETHANE L1 1/2 IN OD20 GA ODSEC.018 IN RADIAL ARTERY CATHETER RADIOPAQUE SPRING GUIDEWIRE NEEDLE LATEX FREE SUP-RA-04220 CDM 0270 RC outpatient 31.41 31.41 31.41 74 23.24 percent of total billed charges 31.41 93 25.44 percent of total billed charges 31.41 31.41 other OPPS APC 31.41 31.41 other OPPS APC 31.41 27.63 8.68 percent of total billed charges 31.41 31.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE QUILL PDO 2 1/2 CIRCLE L36 CM L48 MM 2 ARM MONOFILAMENT BARB TAPER POINT VIOLET SUP-RA-1065Q CDM 0270 RC outpatient 52.12 52.12 52.12 74 38.57 percent of total billed charges 52.12 93 42.22 percent of total billed charges 52.12 52.12 other OPPS APC 52.12 52.12 other OPPS APC 52.12 27.63 14.4 percent of total billed charges 52.12 52.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BONE MARROW ASPIRATE 11GUAGE SUP-RAN-1115H5T-BNT CDM 0270 RC outpatient 169 169 169 74 125.06 percent of total billed charges 169 93 136.89 percent of total billed charges 169 169 other OPPS APC 169 169 other OPPS APC 169 27.63 46.69 percent of total billed charges 169 169 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE DELIVERY 8X11 SUP-RAN-811-CT CDM 0270 RC outpatient 585 585 585 74 432.9 percent of total billed charges 585 93 473.85 percent of total billed charges 585 585 other OPPS APC 585 585 other OPPS APC 585 27.63 161.64 percent of total billed charges 585 585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COOK 18F CHECK-FLO SHEATH 13CM SUP-RCF-18.0P-38-J CDM 0481 RC outpatient 315.2 315.2 315.2 74 233.25 percent of total billed charges 315.2 93 255.31 percent of total billed charges 315.2 315.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER CATHETER 65CM 12FR CHECK-FLO SHEATH SUP-RCFW-12.0-38-65-RB CDM 0270 RC outpatient 345.8 345.8 345.8 74 255.89 percent of total billed charges 345.8 93 280.1 percent of total billed charges 345.8 345.8 other OPPS APC 345.8 345.8 other OPPS APC 345.8 27.63 95.54 percent of total billed charges 345.8 345.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COOK 16F CHECK-FLO PERFORMER SHEATH 30CM SUP-RCFW-16.0P-38-30-RB CDM 0270 RC outpatient 315.2 315.2 315.2 74 233.25 percent of total billed charges 315.2 93 255.31 percent of total billed charges 315.2 315.2 other OPPS APC 315.2 315.2 other OPPS APC 315.2 27.63 87.09 percent of total billed charges 315.2 315.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Sheath16 Fr x 45CM CHECK-FLO SUP-RCFW-16.0P-38-45-RB CDM 0481 RC outpatient 324.66 324.66 324.66 74 240.25 percent of total billed charges 324.66 93 262.97 percent of total billed charges 324.66 324.66 other OPPS APC 324.66 324.66 other OPPS APC 324.66 51 165.58 percent of total billed charges 324.66 324.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER CATHETER CHECK-FLO FLEXOR 40CM 6FR BALKIN UP AND OVER CONTRALATERAL DESIGN WITHOUT GUIDEWIRE RADIOPAQUE BAND SUP-RCFW-6.0-38-40-BLKN CDM 0270 RC outpatient 351 351 351 74 259.74 percent of total billed charges 351 93 284.31 percent of total billed charges 351 351 other OPPS APC 351 351 other OPPS APC 351 27.63 96.98 percent of total billed charges 351 351 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE-TEX STANDARD WALL L45 CM L5 CM ID6 MM RING LINE HEMODIALYSIS SUP-RD06005045L CDM 0270 RC outpatient 1183 1183 1183 74 875.42 percent of total billed charges 1183 93 958.23 percent of total billed charges 1183 1183 other OPPS APC 1183 1183 other OPPS APC 1183 27.63 326.86 percent of total billed charges 1183 1183 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LASSO ECO CATHETER 2515 D CURVE reproc SUP-RD134301 CDM 0270 RC outpatient 2334.8 2334.8 2334.8 74 1727.75 percent of total billed charges 2334.8 93 1891.19 percent of total billed charges 2334.8 2334.8 other OPPS APC 2334.8 2334.8 other OPPS APC 2334.8 27.63 645.11 percent of total billed charges 2334.8 2334.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG PLASTIC THK2 MIL L10 IN X W8 IN ZIPLOCK CLEAR SUP-RDPA29 CDM 0270 RC outpatient 0.07 0.07 0.07 74 0.05 percent of total billed charges 0.07 93 0.06 percent of total billed charges 0.07 0.07 other OPPS APC 0.07 0.07 other OPPS APC 0.07 27.63 0.02 percent of total billed charges 0.07 0.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER REPERFUSION RED 43 .043 IN L160 CM OD1.52 MM SUP-RED43160 CDM 0270 RC outpatient 6422 6422 6422 74 4752.28 percent of total billed charges 6422 93 5201.82 percent of total billed charges 6422 6422 other OPPS APC 6422 6422 other OPPS APC 6422 27.63 1774.4 percent of total billed charges 6422 6422 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER THROMBECTOMY RED 62 REPERFUSION 0.076IN 0.062IN LUMEN 138CM LOW-PROFILE W/PENUMBRA ASPIRATION TUBING SUP-RED62SKIT CDM 0270 RC outpatient 7371 7371 7371 74 5454.54 percent of total billed charges 7371 93 5970.51 percent of total billed charges 7371 7371 other OPPS APC 7371 7371 other OPPS APC 7371 27.63 2036.61 percent of total billed charges 7371 7371 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY RED 68 L132 CM REPERFUSION CATHETER PENUMBRA ASPIRATION TUBING NO CE STERILE SUP-RED68KIT CDM 0270 RC outpatient 7371 7371 7371 74 5454.54 percent of total billed charges 7371 93 5970.51 percent of total billed charges 7371 7371 other OPPS APC 7371 7371 other OPPS APC 7371 27.63 2036.61 percent of total billed charges 7371 7371 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY RED 72 L132 CM REPERFUSION CATHETER PENUMBRA ASPIRATION TUBING NO CE STERILE SUP-RED72KIT CDM 0270 RC outpatient 7371 7371 7371 74 5454.54 percent of total billed charges 7371 93 5970.51 percent of total billed charges 7371 7371 other OPPS APC 7371 7371 other OPPS APC 7371 27.63 2036.61 percent of total billed charges 7371 7371 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEPLOYMENT CATHETER AND LOADER HUD SUP-REF-HUS-C26N CDM 0270 RC outpatient 2600 2600 2600 74 1924 percent of total billed charges 2600 93 2106 percent of total billed charges 2600 2600 other OPPS APC 2600 2600 other OPPS APC 2600 27.63 718.38 percent of total billed charges 2600 2600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AIRWAY IBV NITINOL UMBRELLA OD5 MM CARTRIDGE FRAME HUMANITARIAN DEVICE SUP-REF-HUS-V5 CDM 0270 RC outpatient 6890 6890 6890 74 5098.6 percent of total billed charges 6890 93 5580.9 percent of total billed charges 6890 6890 other OPPS APC 6890 6890 other OPPS APC 6890 27.63 1903.71 percent of total billed charges 6890 6890 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AIRWAY IBV NITINOL UMBRELLA OD6 MM CARTRIDGE FRAME HUMANITARIAN DEVICE SUP-REF-HUS-V6 CDM 0270 RC outpatient 6890 6890 6890 74 5098.6 percent of total billed charges 6890 93 5580.9 percent of total billed charges 6890 6890 other OPPS APC 6890 6890 other OPPS APC 6890 27.63 1903.71 percent of total billed charges 6890 6890 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AIRWAY IBV NITINOL UMBRELLA OD7 MM CARTRIDGE FRAME HUMANITARIAN DEVICE SUP-REF-HUS-V7 CDM 0270 RC outpatient 6890 6890 6890 74 5098.6 percent of total billed charges 6890 93 5580.9 percent of total billed charges 6890 6890 other OPPS APC 6890 6890 other OPPS APC 6890 27.63 1903.71 percent of total billed charges 6890 6890 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AIRWAY IBV NITINOL UMBRELLA OD9 MM CARTRIDGE FRAME HUMANITARIAN DEVICE SUP-REF-HUS-V9 CDM 0270 RC outpatient 8970 8970 8970 74 6637.8 percent of total billed charges 8970 93 7265.7 percent of total billed charges 8970 8970 other OPPS APC 8970 8970 other OPPS APC 8970 27.63 2478.41 percent of total billed charges 8970 8970 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AIRWAY SIZING KIT HUD SUP-REF-HUS-VSK CDM 0270 RC outpatient 780 780 780 74 577.2 percent of total billed charges 780 93 631.8 percent of total billed charges 780 780 other OPPS APC 780 780 other OPPS APC 780 27.63 215.51 percent of total billed charges 780 780 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER BALLOON DILATATION RELIANT POLYURETHANE L100 CM OD8 FR ODSEC10-46 MM DELIVERY ENDOLEAK SEAL ACCEPTS .038 IN GUIDEWIRE AAA STENT GRAFT SYSTEM SUP-REL46 CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP PRICING EXACTECH TOTAL SHOULDER WTIH REV STEM AT 40% SUP-REVSHOULD-EXACT CDM 270010030 LOCAL 0270 RC outpatient 12438.4 12438.4 12438.4 74 9204.42 percent of total billed charges 12438.4 93 10075.1 percent of total billed charges 12438.4 12438.4 other OPPS APC 12438.4 12438.4 other OPPS APC 12438.4 27.63 3436.73 percent of total billed charges 12438.4 12438.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP PRICING REVERSE SHOULDER EXACTECH SUP-REVSHOULDER-EXACTECH CDM 270010030 LOCAL 0270 RC outpatient 18200 18200 18200 74 13468 percent of total billed charges 18200 93 14742 percent of total billed charges 18200 18200 other OPPS APC 18200 18200 other OPPS APC 18200 27.63 5028.66 percent of total billed charges 18200 18200 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAD ELECTROSURGICAL GROUNDING PODIATHERM GENERATOR PAIN MANAGEMENT CABLE DISPOSABLE SUP-RF-DGP-S CDM 0270 RC outpatient 31.2 31.2 31.2 74 23.09 percent of total billed charges 31.2 93 25.27 percent of total billed charges 31.2 31.2 other OPPS APC 31.2 31.2 other OPPS APC 31.2 27.63 8.62 percent of total billed charges 31.2 31.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT BONE OSTEOCHONDRAL L16 MM ALLOGRAFT FRESH SUP-RFP16 CDM 0270 RC outpatient 11960 11960 11960 74 8850.4 percent of total billed charges 11960 93 9687.6 percent of total billed charges 11960 11960 other OPPS APC 11960 11960 other OPPS APC 11960 27.63 3304.55 percent of total billed charges 11960 11960 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR ROADRUNNER HYDROPHILIC NITINOL PLATINUM TAPER L260 CM OD.035 IN RADIOPAQUE FLEXIBLE TIP SUP-RFSPC-35-260 CDM 0270 RC outpatient 114.4 114.4 114.4 74 84.66 percent of total billed charges 114.4 93 92.66 percent of total billed charges 114.4 114.4 other OPPS APC 114.4 114.4 other OPPS APC 114.4 27.63 31.61 percent of total billed charges 114.4 114.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE CONNECTOR RFP-100A SUP-RFX-BAY-TS CDM 0481 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 51 198.9 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SUPPORT NAVIEN NITINOL STRAIGHT L115 CM L8 CM OD5 FR ID.058 IN INTRACRANIAL SUP-RFX058-115-08 CDM 0270 RC outpatient 5083 5083 5083 74 3761.42 percent of total billed charges 5083 93 4117.23 percent of total billed charges 5083 5083 other OPPS APC 5083 5083 other OPPS APC 5083 27.63 1404.43 percent of total billed charges 5083 5083 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SUPPORT NAVIEN NITINOL STRAIGHT L115 CM L8 CM OD6 FR ID.072 IN INTRACRANIAL STERILE SUP-RFX072-115-08 CDM 0270 RC outpatient 3185 3185 3185 74 2356.9 percent of total billed charges 3185 93 2579.85 percent of total billed charges 3185 3185 other OPPS APC 3185 3185 other OPPS APC 3185 27.63 880.02 percent of total billed charges 3185 3185 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISSECTOR ENDOSCOPIC REALIZE SUP-RGBRS1 CDM 0270 RC outpatient 580.01 580.01 580.01 74 429.21 percent of total billed charges 580.01 93 469.81 percent of total billed charges 580.01 580.01 other OPPS APC 580.01 580.01 other OPPS APC 580.01 27.63 160.26 percent of total billed charges 580.01 580.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIGATOR ENDOSCOPIC REALIZE GASTRIC SUP-RGCT360 CDM 0270 RC outpatient 379.76 379.76 379.76 74 281.02 percent of total billed charges 379.76 93 307.61 percent of total billed charges 379.76 379.76 other OPPS APC 379.76 379.76 other OPPS APC 379.76 27.63 104.93 percent of total billed charges 379.76 379.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SINUS KENNEDY SUP-RH-7532-10 CDM 0270 RC outpatient 48.1 48.1 48.1 74 35.59 percent of total billed charges 48.1 93 38.96 percent of total billed charges 48.1 48.1 other OPPS APC 48.1 48.1 other OPPS APC 48.1 27.63 13.29 percent of total billed charges 48.1 48.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE DVR HOCKEY STICK RIGHT WRIST FRAGMENT STERILE SUP-RHS CDM 0270 RC outpatient 1365 1365 1365 74 1010.1 percent of total billed charges 1365 93 1105.65 percent of total billed charges 1365 1365 other OPPS APC 1365 1365 other OPPS APC 1365 27.63 377.15 percent of total billed charges 1365 1365 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LABEL ORANGE MEDICATION ADDED 2 1/2 X 1 3/4 LATEX FREE NON-STERILE SUP-RL2404K CDM outpatient 0.06 0.06 0.06 0.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT GORE EXCLUDER AAA ENDOPROSTHESIS TRUNK-IPSILATERAL LEG SUP-RLT231412 CDM 270010015 LOCAL 0270 RC outpatient 31569.2 31569.2 31569.2 74 23361.2 percent of total billed charges 31569.2 93 25571 percent of total billed charges 31569.2 31569.2 other OPPS APC 31569.2 31569.2 other OPPS APC 31569.2 27.63 8722.57 percent of total billed charges 31569.2 31569.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. EXCLUDER AAA ENDO GRAFT 23MMX14.5MMX14CM SUP-RLT231414 CDM 0270 RC outpatient 31569.2 31569.2 31569.2 74 23361.2 percent of total billed charges 31569.2 93 25571 percent of total billed charges 31569.2 31569.2 other OPPS APC 31569.2 31569.2 other OPPS APC 31569.2 27.63 8722.57 percent of total billed charges 31569.2 31569.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT GORE EXCLUDER AAA PROSTHESIS 26MM IPSILATERAL LET SUP-RLT261216 CDM 270010015 LOCAL 0270 RC outpatient 31569.2 31569.2 31569.2 74 23361.2 percent of total billed charges 31569.2 93 25571 percent of total billed charges 31569.2 31569.2 other OPPS APC 31569.2 31569.2 other OPPS APC 31569.2 27.63 8722.57 percent of total billed charges 31569.2 31569.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT GORE EXCLUDER AAA ENDOPROSTHESIS SUP-RLT261218 CDM 270010015 LOCAL 0270 RC outpatient 31569.2 31569.2 31569.2 74 23361.2 percent of total billed charges 31569.2 93 25571 percent of total billed charges 31569.2 31569.2 other OPPS APC 31569.2 31569.2 other OPPS APC 31569.2 27.63 8722.57 percent of total billed charges 31569.2 31569.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT GORE EXCLUDER 26MM X 14.5MM X 12CM SUP-RLT261412 CDM 270010015 LOCAL 0270 RC outpatient 31569.2 31569.2 31569.2 74 23361.2 percent of total billed charges 31569.2 93 25571 percent of total billed charges 31569.2 31569.2 other OPPS APC 31569.2 31569.2 other OPPS APC 31569.2 27.63 8722.57 percent of total billed charges 31569.2 31569.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER AAA TRUNK IPSILATERAL LEG STENT DELIVERY SYSTEM SUP-RLT261414 CDM 270010015 LOCAL 0270 RC outpatient 31569.2 31569.2 31569.2 74 23361.2 percent of total billed charges 31569.2 93 25571 percent of total billed charges 31569.2 31569.2 other OPPS APC 31569.2 31569.2 other OPPS APC 31569.2 27.63 8722.57 percent of total billed charges 31569.2 31569.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR GORE EXCLUDER C3 NITINOL EPTFE L18 CM OD26 MM ODSEC14.5 MM ID22-23 MM IDSEC12-13.5 MM TRUNK IPSILATERAL LEG BOND FILM SEAL CUFF LOW PROFILE SINUSOIDAL STENT ACCEPTS 16 FR SHEATH AAA SUP-RLT261418 CDM 270010015 LOCAL 0270 RC outpatient 31569.2 31569.2 31569.2 74 23361.2 percent of total billed charges 31569.2 93 25571 percent of total billed charges 31569.2 31569.2 other OPPS APC 31569.2 31569.2 other OPPS APC 31569.2 27.63 8722.57 percent of total billed charges 31569.2 31569.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR GORE EXCLUDER C3 NITINOL EPTFE L14 CM OD28.5 MM ODSEC12 MM ID24-26 MM IDSEC10-11 MM TRUNK IPSILATERAL LEG BOND FILM SEAL CUFF LOW PROFILE SINUSOIDAL STENT ACCEPTS 16 FR SHEATH AAA SUP-RLT281214 CDM 0270 RC outpatient 31569.2 31569.2 31569.2 74 23361.2 percent of total billed charges 31569.2 93 25571 percent of total billed charges 31569.2 31569.2 other OPPS APC 31569.2 31569.2 other OPPS APC 31569.2 27.63 8722.57 percent of total billed charges 31569.2 31569.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR GORE EXCLUDER C3 NITINOL EPTFE L16 CM OD28.5 MM ODSEC12 MM ID24-26 MM IDSEC10-11 MM TRUNK IPSILATERAL LEG BOND FILM SEAL CUFF LOW PROFILE SINUSOIDAL STENT ACCEPTS 16 FR SHEATH AAA SUP-RLT281216 CDM 0270 RC outpatient 31569.2 31569.2 31569.2 74 23361.2 percent of total billed charges 31569.2 93 25571 percent of total billed charges 31569.2 31569.2 other OPPS APC 31569.2 31569.2 other OPPS APC 31569.2 27.63 8722.57 percent of total billed charges 31569.2 31569.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT GORE EXCLUDER 28MM X 14.5MM X 12CM SUP-RLT281412 CDM 270010015 LOCAL 0270 RC outpatient 31569.2 31569.2 31569.2 74 23361.2 percent of total billed charges 31569.2 93 25571 percent of total billed charges 31569.2 31569.2 other OPPS APC 31569.2 31569.2 other OPPS APC 31569.2 27.63 8722.57 percent of total billed charges 31569.2 31569.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR GORE EXCLUDER C3 NITINOL EPTFE L14 CM OD28.5 MM ODSEC14.5 MM ID24-26 MM IDSEC12-13.5 MM TRUNK IPSILATERAL LEG BOND FILM SEAL CUFF LOW PROFILE SINUSOIDAL STENT ACCEPTS 16 FR SHEATH AAA SUP-RLT281414 CDM 270010015 LOCAL 0270 RC outpatient 31569.2 31569.2 31569.2 74 23361.2 percent of total billed charges 31569.2 93 25571 percent of total billed charges 31569.2 31569.2 other OPPS APC 31569.2 31569.2 other OPPS APC 31569.2 27.63 8722.57 percent of total billed charges 31569.2 31569.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR GORE EXCLUDER C3 NITINOL EPTFE L16 CM OD28.5 MM ODSEC14.5 MM ID24-26 MM IDSEC12-13.5 MM TRUNK IPSILATERAL LEG BOND FILM SEAL CUFF LOW PROFILE SINUSOIDAL STENT ACCEPTS 16 FR SHEATH AAA SUP-RLT281416 CDM 270010015 LOCAL 0270 RC outpatient 31569.2 31569.2 31569.2 74 23361.2 percent of total billed charges 31569.2 93 25571 percent of total billed charges 31569.2 31569.2 other OPPS APC 31569.2 31569.2 other OPPS APC 31569.2 27.63 8722.57 percent of total billed charges 31569.2 31569.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR GORE EXCLUDER C3 NITINOL EPTFE L18 CM OD28.5 MM ODSEC14.5 MM ID24-26 MM IDSEC12-13.5 MM TRUNK IPSILATERAL LEG BOND FILM SEAL CUFF LOW PROFILE SINUSOIDAL STENT ACCEPTS 16 FR SHEATH AAA SUP-RLT281418 CDM 0270 RC outpatient 31569.2 31569.2 31569.2 74 23361.2 percent of total billed charges 31569.2 93 25571 percent of total billed charges 31569.2 31569.2 other OPPS APC 31569.2 31569.2 other OPPS APC 31569.2 27.63 8722.57 percent of total billed charges 31569.2 31569.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT GORE EXCLUDER 31MM X 14.5MM X 13CM SUP-RLT311413 CDM 270010015 LOCAL 0270 RC outpatient 31569.2 31569.2 31569.2 74 23361.2 percent of total billed charges 31569.2 93 25571 percent of total billed charges 31569.2 31569.2 other OPPS APC 31569.2 31569.2 other OPPS APC 31569.2 27.63 8722.57 percent of total billed charges 31569.2 31569.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT GORE EXCLUDER AAA ENDOPROSTHESIS TRUNK-IPSILATERAL LEG SUP-RLT311415 CDM 270010015 LOCAL 0270 RC outpatient 31569.2 31569.2 31569.2 74 23361.2 percent of total billed charges 31569.2 93 25571 percent of total billed charges 31569.2 31569.2 other OPPS APC 31569.2 31569.2 other OPPS APC 31569.2 27.63 8722.57 percent of total billed charges 31569.2 31569.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT GORE EXCLUDER AAA ENDOPROSTHESIS TRUNK-IPSILATERAL LEG SUP-RLT311417 CDM 270010015 LOCAL 0270 RC outpatient 31569.2 31569.2 31569.2 74 23361.2 percent of total billed charges 31569.2 93 25571 percent of total billed charges 31569.2 31569.2 other OPPS APC 31569.2 31569.2 other OPPS APC 31569.2 27.63 8722.57 percent of total billed charges 31569.2 31569.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT GORE EXCLUDER 35MM X 14.5MM X 14CM SUP-RLT351414 CDM 270010015 LOCAL 0270 RC outpatient 31569.2 31569.2 31569.2 74 23361.2 percent of total billed charges 31569.2 93 25571 percent of total billed charges 31569.2 31569.2 other OPPS APC 31569.2 31569.2 other OPPS APC 31569.2 27.63 8722.57 percent of total billed charges 31569.2 31569.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR EXCLUDER C3 GORE-TEX NITINOL FEP L16 CM OD35 MM ODSEC14.5 MM TRUNK IPSILATERAL LEG STENT DELIVERY SYSTEM AAA SUP-RLT351416 CDM 270010015 LOCAL 0270 RC outpatient 31569.2 31569.2 31569.2 74 23361.2 percent of total billed charges 31569.2 93 25571 percent of total billed charges 31569.2 31569.2 other OPPS APC 31569.2 31569.2 other OPPS APC 31569.2 27.63 8722.57 percent of total billed charges 31569.2 31569.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR GORE EXCLUDER C3 GORE-TEX NITINOL FEP L18 CM OD35 MM ODSEC14.5 MM ID30-32 MM IDSEC12-13.5 MM TRUNK IPSILATERAL LEG DELIVERY SYSTEM LOW PROFILE AAA ACCEPTS 18 FR SHEATH SUP-RLT351418 CDM 0270 RC outpatient 31569.2 31569.2 31569.2 74 23361.2 percent of total billed charges 31569.2 93 25571 percent of total billed charges 31569.2 31569.2 other OPPS APC 31569.2 31569.2 other OPPS APC 31569.2 27.63 8722.57 percent of total billed charges 31569.2 31569.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND SURGICAL LIGATION REALIZE GASTRIC DISSECTOR ADJUSTABLE SUP-RLZB22D1 CDM 0270 RC outpatient 7344.48 7344.48 7344.48 74 5434.92 percent of total billed charges 7344.48 93 5949.03 percent of total billed charges 7344.48 7344.48 other OPPS APC 7344.48 7344.48 other OPPS APC 7344.48 27.63 2029.28 percent of total billed charges 7344.48 7344.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND SURGICAL LIGATION REALIZE GASTRIC ENDOSCOPIC DISSECTOR CALIBRATION TUBE SUP-RLZB22DG1 CDM 0270 RC outpatient 7436 7436 7436 74 5502.64 percent of total billed charges 7436 93 6023.16 percent of total billed charges 7436 7436 other OPPS APC 7436 7436 other OPPS APC 7436 27.63 2054.57 percent of total billed charges 7436 7436 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER BAND REALIZE GASTRIC C ADJUSTABLE ENDOSCOPIC DISSECTOR KIT LAP SUP-RLZB32 CDM 0270 RC outpatient 6988.8 6988.8 6988.8 74 5171.71 percent of total billed charges 6988.8 93 5660.93 percent of total billed charges 6988.8 6988.8 other OPPS APC 6988.8 6988.8 other OPPS APC 6988.8 27.63 1931.01 percent of total billed charges 6988.8 6988.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND SURGICAL LIGATION REALIZE C DISSECTOR SUP-RLZB32D1 CDM 0270 RC outpatient 7010.64 7010.64 7010.64 74 5187.87 percent of total billed charges 7010.64 93 5678.62 percent of total billed charges 7010.64 7010.64 other OPPS APC 7010.64 7010.64 other OPPS APC 7010.64 27.63 1937.04 percent of total billed charges 7010.64 7010.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACCESS PORT GASTRIC BAND REALIZE SUTURELESS APPLIER SUP-RLZPT2 CDM 0270 RC outpatient 2899.94 2899.94 2899.94 74 2145.96 percent of total billed charges 2899.94 93 2348.95 percent of total billed charges 2899.94 2899.94 other OPPS APC 2899.94 2899.94 other OPPS APC 2899.94 27.63 801.25 percent of total billed charges 2899.94 2899.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F GLIDESHEATH W/ NEEDLE SUP-RM RF6F10PA CDM 0270 RC outpatient 156 156 156 74 115.44 percent of total billed charges 156 93 126.36 percent of total billed charges 156 156 other OPPS APC 156 156 other OPPS APC 156 27.63 43.1 percent of total billed charges 156 156 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIDESHEATH SLENDER 6FR 10CM SUP-RM*ES6F10HAU CDM 0270 RC outpatient 260 260 260 74 192.4 percent of total billed charges 260 93 210.6 percent of total billed charges 260 260 other OPPS APC 260 260 other OPPS APC 260 27.63 71.84 percent of total billed charges 260 260 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GLIDESHEATH 5FR SUP-RMBF5F10PA CDM 0481 RC outpatient 109.98 109.98 109.98 74 81.39 percent of total billed charges 109.98 93 89.08 percent of total billed charges 109.98 109.98 other OPPS APC 109.98 109.98 other OPPS APC 109.98 51 56.09 percent of total billed charges 109.98 109.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F GLIDESHEATH W/O NEEDLE SUP-RMBF6M10MA CDM 0270 RC outpatient 109.98 109.98 109.98 74 81.39 percent of total billed charges 109.98 93 89.08 percent of total billed charges 109.98 109.98 other OPPS APC 109.98 109.98 other OPPS APC 109.98 27.63 30.39 percent of total billed charges 109.98 109.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L26 MM L140 CM ID2 MM EXTRA SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RNYX20026UX_53330 CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L8 MM L140 CM ID2 MM EXTRA SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX20008UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L12 MM L140 CM ID2 MM EXTRA SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX20012UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L15 MM L140 CM ID2 MM EXTRA SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX20015UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L18 MM L140 CM ID2 MM EXTRA SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX20018UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L22 MM L140 CM ID2 MM EXTRA SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX20022UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESOLUTE ONYX STENT 2.0 X 26 MM SUP-RONYX20026UX CDM 0481 RC outpatient 1755 1755 1755 74 1298.7 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 1755 other OPPS APC 1755 1755 other OPPS APC 1755 51 895.05 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L30 MM L140 CM ID2 MM EXTRA SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX20030UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L8 MM L140 CM ID2.25 MM SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX22508UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L12 MM L140 CM ID2.25 MM SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX22512UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L15 MM L140 CM ID2.25 MM SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX22515UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L18 MM L140 CM ID2.25 MM SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX22518UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L22 MM L140 CM ID2.25 MM SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX22522UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L26 MM L140 CM ID2.25 MM SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX22526UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L30 MM L140 CM ID2.25 MM SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX22530UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L34 MM L140 CM ID2.25 MM SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX22534UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L38 MM L140 CM ID2.25 MM SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX22538UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L8 MM L140 CM ID2.5 MM SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX25008UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L12 MM L140 CM ID2.5 MM SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX25012UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L15 MM L140 CM ID2.5 MM SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX25015UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L18 MM L140 CM ID2.5 MM SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX25018UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L22 MM L140 CM ID2.5 MM SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX25022UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L26 MM L140 CM ID2.5 MM SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX25026UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L30 MM L140 CM ID2.5 MM SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX25030UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L34 MM L140 CM ID2.5 MM SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX25034UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L38 MM L140 CM ID2.5 MM SMALL VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX25038UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L8 MM L140 CM ID2.75 MM MEDIUM VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX27508UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L12 MM L140 CM ID2.75 MM MEDIUM VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX27512UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L15 MM L140 CM ID2.75 MM MEDIUM VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX27515UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L18 MM L140 CM ID2.75 MM MEDIUM VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX27518UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L22 MM L140 CM ID2.75 MM MEDIUM VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX27522UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L26 MM L140 CM ID2.75 MM MEDIUM VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX27526UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L30 MM L140 CM ID2.75 MM MEDIUM VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX27530UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L34 MM L140 CM ID2.75 MM MEDIUM VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX27534UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L38 MM L140 CM ID2.75 MM MEDIUM VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX27538UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L8 MM L140 CM ID3 MM MEDIUM VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX30008UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L12 MM L140 CM ID3 MM MEDIUM VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX30012UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L15 MM L140 CM ID3 MM MEDIUM VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX30015UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L18 MM L140 CM ID3 MM MEDIUM VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX30018UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L22 MM L140 CM ID3 MM MEDIUM VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX30022UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L26 MM L140 CM ID3 MM MEDIUM VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX30026UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L30 MM L140 CM ID3 MM MEDIUM VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX30030UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L34 MM L140 CM ID3 MM MEDIUM VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX30034UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L38 MM L140 CM ID3 MM MEDIUM VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX30038UXE CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L8 MM L140 CM ID3.5 MM LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX35008UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L12 MM L140 CM ID3.5 MM LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX35012UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L15 MM L140 CM ID3.5 MM LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX35015UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L18 MM L140 CM ID3.5 MM LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX35018UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L22 MM L140 CM ID3.5 MM LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX35022UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L26 MM L140 CM ID3.5 MM LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX35026UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L30 MM L140 CM ID3.5 MM LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX35030UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L34 MM L140 CM ID3.5 MM LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX35034UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L38 MM L140 CM ID3.5 MM LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX35038UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L8 MM L140 CM ID4 MM LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX40008UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L12 MM L140 CM ID4 MM LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX40012UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L15 MM L140 CM ID4 MM LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX40015UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L18 MM L140 CM ID4 MM LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX40018UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L22 MM L140 CM ID4 MM LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX40022UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L26 MM L140 CM ID4 MM LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX40026UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L30 MM L140 CM ID4 MM LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX40030UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L34 MM L140 CM ID4 MM LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX40034UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L38 MM L140 CM ID4 MM LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX40038UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L12 MM L140 CM ID4.5 MM EXTRA LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX45012UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L15 MM L140 CM ID4.5 MM EXTRA LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX45015UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L18 MM L140 CM ID4.5 MM EXTRA LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX45018UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L22 MM L140 CM ID4.5 MM EXTRA LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX45022UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L26 MM L140 CM ID4.5 MM EXTRA LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX45026UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L30 MM L140 CM ID4.5 MM EXTRA LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX45030UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L12 MM L140 CM ID5 MM EXTRA LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX50012UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L15 MM L140 CM ID5 MM EXTRA LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX50015UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L18 MM L140 CM ID5 MM EXTRA LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX50018UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L22 MM L140 CM ID5 MM EXTRA LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX50022UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L26 MM L140 CM ID5 MM EXTRA LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX50026UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE ONYX BIOLINX ZOTAROLIMUS COCR L30 MM L140 CM ID5 MM EXTRA LARGE VESSEL RAPID EXCHANGE DELIVERY SYSTEM RADIOPAQUE 1 ACCESS PORT ACCEPTS .014 IN GUIDEWIRE 5 FR GUIDE CATHETER SUP-RONYX50030UX CDM 0481 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE-TEX STANDARD WALL L80 CM L70 CM ID6 MM REMOVABLE RING LINE STERILE SUP-RR06070080L CDM 0270 RC outpatient 4776.2 4776.2 4776.2 74 3534.39 percent of total billed charges 4776.2 93 3868.72 percent of total billed charges 4776.2 4776.2 other OPPS APC 4776.2 4776.2 other OPPS APC 4776.2 27.63 1319.66 percent of total billed charges 4776.2 4776.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE-TEX STANDARD WALL L80 CM L70 CM ID8 MM REMOVABLE RING LINE STERILE SUP-RR08070080L CDM 0270 RC outpatient 2966.6 2966.6 2966.6 74 2195.28 percent of total billed charges 2966.6 93 2402.95 percent of total billed charges 2966.6 2966.6 other OPPS APC 2966.6 2966.6 other OPPS APC 2966.6 27.63 819.67 percent of total billed charges 2966.6 2966.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINED GRAFT 6X70X80 EA SUP-RR6070080L CDM 0270 RC outpatient 2506.4 2506.4 2506.4 74 1854.74 percent of total billed charges 2506.4 93 2030.18 percent of total billed charges 2506.4 2506.4 other OPPS APC 2506.4 2506.4 other OPPS APC 2506.4 27.63 692.52 percent of total billed charges 2506.4 2506.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE-TEX THIN WALL RING L40 CM L30 CM ID6 MM SUP-RRT06030040L CDM 0270 RC outpatient 1866.8 1866.8 1866.8 74 1381.43 percent of total billed charges 1866.8 93 1512.11 percent of total billed charges 1866.8 1866.8 other OPPS APC 1866.8 1866.8 other OPPS APC 1866.8 27.63 515.8 percent of total billed charges 1866.8 1866.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE-TEX THIN WALL L70 CM L60 CM ID6 MM REMOVABLE RING LINE STERILE SUP-RRT06060070L CDM 0270 RC outpatient 4851.6 4851.6 4851.6 74 3590.18 percent of total billed charges 4851.6 93 3929.8 percent of total billed charges 4851.6 4851.6 other OPPS APC 4851.6 4851.6 other OPPS APC 4851.6 27.63 1340.5 percent of total billed charges 4851.6 4851.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE-TEX THIN WALL RING L70 CM L70 CM ID8 MM SUP-RRT08070070L CDM 0270 RC outpatient 3065.4 3065.4 3065.4 74 2268.4 percent of total billed charges 3065.4 93 2482.97 percent of total billed charges 3065.4 3065.4 other OPPS APC 3065.4 3065.4 other OPPS APC 3065.4 27.63 846.97 percent of total billed charges 3065.4 3065.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SYSTEM BALLOON SINUPLASTY, MAXILLARY, FRONTAL AND SPHENOID" SUP-RS0606MFSZ CDM outpatient 6081.4 6081.4 6081.4 6081.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM DIAGNOSTIC CATHETER RELIEVA SPIN RELIEVA VORTEX 2 F-70 L16 MM OD6 MM FRONTAL BALLOON SLIDER SUCTION CONTROL WIRE SPINNER SINUPLASTY SUP-RS0616F CDM outpatient 4355 4355 4355 4355 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE MERSILENE 5 MM CTX L12 IN 2 ARM WOVEN WHITE SUP-RS22 CDM 0270 RC outpatient 77.96 77.96 77.96 74 57.69 percent of total billed charges 77.96 93 63.15 percent of total billed charges 77.96 77.96 other OPPS APC 77.96 77.96 other OPPS APC 77.96 27.63 21.54 percent of total billed charges 77.96 77.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE MERSILENE 5 MM MO-4 L12 IN WOVEN WHITE SUP-RS23 CDM 0270 RC outpatient 80.83 80.83 80.83 74 59.81 percent of total billed charges 80.83 93 65.47 percent of total billed charges 80.83 80.83 other OPPS APC 80.83 80.83 other OPPS APC 80.83 27.63 22.33 percent of total billed charges 80.83 80.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE SHARPSHOOTER SUP-RS2535 CDM 0270 RC outpatient 139 139 139 74 102.86 percent of total billed charges 139 93 112.59 percent of total billed charges 139 139 other OPPS APC 139 139 other OPPS APC 139 27.63 38.41 percent of total billed charges 139 139 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RECHARGER NEUROSTIMULATOR MEDTRONIC RECHARGER SUP-RS5200 CDM 0270 RC outpatient 3510 3510 3510 74 2597.4 percent of total billed charges 3510 93 2843.1 percent of total billed charges 3510 3510 other OPPS APC 3510 3510 other OPPS APC 3510 27.63 969.81 percent of total billed charges 3510 3510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY TITANIUM OD24 MM RIGID SADDLE SUTURE CUFF SUP-RSAR-24 CDM 0270 RC outpatient 6895.2 6895.2 6895.2 74 5102.45 percent of total billed charges 6895.2 93 5585.11 percent of total billed charges 6895.2 6895.2 other OPPS APC 6895.2 6895.2 other OPPS APC 6895.2 27.63 1905.14 percent of total billed charges 6895.2 6895.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY TITANIUM OD26 MM RIGID SADDLE SUTURE CUFF SUP-RSAR-26 CDM 0270 RC outpatient 6760 6760 6760 74 5002.4 percent of total billed charges 6760 93 5475.6 percent of total billed charges 6760 6760 other OPPS APC 6760 6760 other OPPS APC 6760 27.63 1867.79 percent of total billed charges 6760 6760 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY TITANIUM OD28 MM RIGID SADDLE SUTURE CUFF SUP-RSAR-28 CDM 0270 RC outpatient 6895.2 6895.2 6895.2 74 5102.45 percent of total billed charges 6895.2 93 5585.11 percent of total billed charges 6895.2 6895.2 other OPPS APC 6895.2 6895.2 other OPPS APC 6895.2 27.63 1905.14 percent of total billed charges 6895.2 6895.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY TITANIUM OD30 MM RIGID SADDLE SUTURE CUFF SUP-RSAR-30 CDM 0270 RC outpatient 6895.2 6895.2 6895.2 74 5102.45 percent of total billed charges 6895.2 93 5585.11 percent of total billed charges 6895.2 6895.2 other OPPS APC 6895.2 6895.2 other OPPS APC 6895.2 27.63 1905.14 percent of total billed charges 6895.2 6895.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY TITANIUM OD32 MM RIGID SADDLE SUTURE CUFF SUP-RSAR-32 CDM 0270 RC outpatient 6895.2 6895.2 6895.2 74 5102.45 percent of total billed charges 6895.2 93 5585.11 percent of total billed charges 6895.2 6895.2 other OPPS APC 6895.2 6895.2 other OPPS APC 6895.2 27.63 1905.14 percent of total billed charges 6895.2 6895.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RING ANNULOPLASTY TITANIUM OD34 MM RIGID SADDLE SUTURE CUFF SUP-RSAR-34 CDM 0270 RC outpatient 6895.2 6895.2 6895.2 74 5102.45 percent of total billed charges 6895.2 93 5585.11 percent of total billed charges 6895.2 6895.2 other OPPS APC 6895.2 6895.2 other OPPS APC 6895.2 27.63 1905.14 percent of total billed charges 6895.2 6895.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PINNACLE R/O II L6 CM L2.5 CM ID4 FR DILATOR RADIOPAQUE MARKER SUP-RSB401 CDM 0270 RC outpatient 48.75 48.75 48.75 74 36.08 percent of total billed charges 48.75 93 39.49 percent of total billed charges 48.75 48.75 other OPPS APC 48.75 48.75 other OPPS APC 48.75 27.63 13.47 percent of total billed charges 48.75 48.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PINNACLE R/O II L6 CM L2.5 CM ID5 FR DILATOR RADIOPAQUE MARKER SUP-RSB501 CDM 0270 RC outpatient 48.75 48.75 48.75 74 36.08 percent of total billed charges 48.75 93 39.49 percent of total billed charges 48.75 48.75 other OPPS APC 48.75 48.75 other OPPS APC 48.75 27.63 13.47 percent of total billed charges 48.75 48.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PINNACLE R/O II L6 CM L2.5 CM ID6 FR DILATOR RADIOPAQUE MARKER SUP-RSB601 CDM 0270 RC outpatient 48.75 48.75 48.75 74 36.08 percent of total billed charges 48.75 93 39.49 percent of total billed charges 48.75 48.75 other OPPS APC 48.75 48.75 other OPPS APC 48.75 27.63 13.47 percent of total billed charges 48.75 48.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH GUIDING PINNACLE DESTINATION TUOHY-BORST STAINLESS STEEL HYDROPHILIC STRAIGHT L90 CM L15 CM OD7 FR ODSEC.122 IN ID.101 IN RADIOPAQUE CROSS CUT VALVE SUP-RSC06 CDM 0270 RC outpatient 239.2 239.2 239.2 74 177.01 percent of total billed charges 239.2 93 193.75 percent of total billed charges 239.2 239.2 other OPPS APC 239.2 239.2 other OPPS APC 239.2 27.63 66.09 percent of total billed charges 239.2 239.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SUCTION PVC PEDIATRIC STRAIGHT CONTROL VENT DELEE TIP GRADUATED STERILE LATEX FREE SUP-RSC08D CDM 0270 RC outpatient 0.96 0.96 0.96 74 0.71 percent of total billed charges 0.96 93 0.78 percent of total billed charges 0.96 0.96 other OPPS APC 0.96 0.96 other OPPS APC 0.96 27.63 0.27 percent of total billed charges 0.96 0.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L8 MM L140 CM OD2.7-2.1 FR ID2.25 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT22508UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L12 MM L140 CM OD2.7-2.1 FR ID2.25 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT22512UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L14 MM L140 CM OD2.7-2.1 FR ID2.25 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT22514UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L18 MM L140 CM OD2.7-2.1 FR ID2.25 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT22518UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L22 MM L140 CM OD2.7-2.1 FR ID2.25 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT22522UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L26 MM L140 CM OD2.7-2.1 FR ID2.25 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT22526UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L30 MM L140 CM OD2.7-2.1 FR ID2.25 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT22530UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L8 MM L140 CM OD2.7-2.1 FR ID2.5 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT25008UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L12 MM L140 CM OD2.7-2.1 FR ID2.5 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT25012UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L14 MM L140 CM OD2.7-2.1 FR ID2.5 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT25014UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L18 MM L140 CM OD2.7-2.1 FR ID2.5 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT25018UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L22 MM L140 CM OD2.7-2.1 FR ID2.5 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT25022UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L26 MM L140 CM OD2.7-2.1 FR ID2.5 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT25026UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L30 MM L140 CM OD2.7-2.1 FR ID2.5 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT25030UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L8 MM L140 CM OD2.7-2.1 FR ID2.75 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT27508UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L12 MM L140 CM OD2.7-2.1 FR ID2.75 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT27512UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L14 MM L140 CM OD2.7-2.1 FR ID2.75 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT27514UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L18 MM L140 CM OD2.7-2.1 FR ID2.75 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT27518UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L22 MM L140 CM OD2.7-2.1 FR ID2.75 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT27522UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L26 MM L140 CM OD2.7-2.1 FR ID2.75 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT27526UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L30 MM L140 CM OD2.7-2.1 FR ID2.75 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT27530UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L9 MM L140 CM OD2.7-2.1 FR ID3 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT30009UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L12 MM L140 CM OD2.7-2.1 FR ID3 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT30012UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L15 MM L140 CM OD2.7-2.1 FR ID3 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT30015UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L18 MM L140 CM OD2.7-2.1 FR ID3 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT30018UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L22 MM L140 CM OD2.7-2.1 FR ID3 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT30022UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L26 MM L140 CM OD2.7-2.1 FR ID3 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT30026UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L30 MM L140 CM OD2.7-2.1 FR ID3 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT30030UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L9 MM L140 CM OD2.7-2.1 FR ID3.5 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT35009UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L12 MM L140 CM OD2.7-2.1 FR ID3.5 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT35012UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L15 MM L140 CM OD2.7-2.1 FR ID3.5 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT35015UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L18 MM L140 CM OD2.7-2.1 FR ID3.5 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT35018UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L22 MM L140 CM OD2.7-2.1 FR ID3.5 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT35022UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L26 MM L140 CM OD2.7-2.1 FR ID3.5 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT35026UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L30 MM L140 CM OD2.7-2.1 FR ID3.5 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT35030UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L9 MM L140 CM OD2.7-2.1 FR ID4 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT40009UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L12 MM L140 CM OD2.7-2.1 FR ID4 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT40012UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L15 MM L140 CM OD2.7-2.1 FR ID4 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT40015UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L18 MM L140 CM OD2.7-2.1 FR ID4 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT40018UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L22 MM L140 CM OD2.7-2.1 FR ID4 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT40022UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L26 MM L140 CM OD2.7-2.1 FR ID4 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT40026UX CDM 0270 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 27.63 933.89 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CORONARY STENT RESOLUTE INTEGRITY MICROTRAC ZOTAROLIMUS ELUTING COCR L30 MM L140 CM OD2.7-2.1 FR ID4 MM 1 STRAND RAPID EXCHANGE INTEGRATE TIP LOW PROFILE ACCEPTS .014 IN GUIDEWIRE SUP-RSINT40030UX CDM 0270 RC outpatient 1170 1170 1170 74 865.8 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 27.63 323.27 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM BALLOON DILATATION RELIEVA SPINPLUS L16 MM OD6 MM 3 GUIDE KIT STERILE LATEX FREE SUP-RSP0616MFSZ CDM 270010000 LOCAL 0270 RC outpatient 6263.84 6263.84 6263.84 74 4635.24 percent of total billed charges 6263.84 93 5073.71 percent of total billed charges 6263.84 6263.84 other OPPS APC 6263.84 6263.84 other OPPS APC 6263.84 27.63 1730.7 percent of total billed charges 6263.84 6263.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH GUIDING PINNACLE DESTINATION PTFE NYLON HYDROPHILIC STRAIGHT CURVE L45 CM L5 CM OD7 FR 3 RADIOPAQUE CROSSCUT VALVE SMOOTH DILATOR ACCEPTS .038 IN GUIDEWIRE SUP-RSR04 CDM 0270 RC outpatient 213.2 213.2 213.2 74 157.77 percent of total billed charges 213.2 93 172.69 percent of total billed charges 213.2 213.2 other OPPS APC 213.2 213.2 other OPPS APC 213.2 27.63 58.91 percent of total billed charges 213.2 213.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE .038 IN L10 CM L2.5 CM ID10 FR PERIPHERAL GUIDEWIRE DILATOR KINK RESISTANT SUP-RSS002 CDM 0481 RC outpatient 22.1 22.1 22.1 74 16.35 percent of total billed charges 22.1 93 17.9 percent of total billed charges 22.1 22.1 other OPPS APC 22.1 22.1 other OPPS APC 22.1 51 11.27 percent of total billed charges 22.1 22.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE L25 CM L2.5 CM ID10 FR PERIPHERAL DILATOR KINK RESISTANT SUP-RSS006 CDM 0270 RC outpatient 44.59 44.59 44.59 74 33 percent of total billed charges 44.59 93 36.12 percent of total billed charges 44.59 44.59 other OPPS APC 44.59 44.59 other OPPS APC 44.59 27.63 12.32 percent of total billed charges 44.59 44.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER PINNACLE STAINLESS STEEL .035IN L10 CM L2.5 CM ID11 FR PERIPHERAL SNAP ON DILATOR LOCK KINK RESISTANT SMOOTH TRANSITION SPRING COIL GUIDEWIRE SUP-RSS101 CDM 0272 RC outpatient 22.75 22.75 22.75 74 16.84 percent of total billed charges 22.75 93 18.43 percent of total billed charges 22.75 22.75 other OPPS APC 22.75 22.75 other OPPS APC 22.75 27.63 6.29 percent of total billed charges 22.75 22.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER PINNACLE HYDROPHILIC PTFE .038 IN L10 CM L2.5 CM OD11 FR PERIPHERAL GUIDEWIRE DILATOR KINK RESISTANT SUP-RSS103 CDM 0270 RC outpatient 22.75 22.75 22.75 74 16.84 percent of total billed charges 22.75 93 18.43 percent of total billed charges 22.75 22.75 other OPPS APC 22.75 22.75 other OPPS APC 22.75 27.63 6.29 percent of total billed charges 22.75 22.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER CATHETER PINNACLE 11FR STANDARD 25CM CROSS-CUT VALVE SNAP-ON LOCK PERIPHERAL W/2.5CM DIL W/O GW HYDROPHILIC 0.038IN GW SUP-RSS105 CDM 0270 RC outpatient 51.87 51.87 51.87 other OPPS APC 51.87 51.87 other OPPS APC 51.87 27.63 14.33 percent of total billed charges 51.87 51.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PINNACLE HYDROPHILIC L10 CM L2.5 CM OD4 FR PERIPHERAL KINK RESISTANT DESIGN CROSS CUT VALVE SMOOTH TRANSITION DILATOR SUP-RSS403 CDM 0270 RC outpatient 22.75 22.75 22.75 74 16.84 percent of total billed charges 22.75 93 18.43 percent of total billed charges 22.75 22.75 other OPPS APC 22.75 22.75 other OPPS APC 22.75 27.63 6.29 percent of total billed charges 22.75 22.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER PINNACLE STAINLESS STEEL .035 IN L10 CM L2.5 CM ID5 FR PERIPHERAL SNAP ON DILATOR LOCK KINK RESISTANT SMOOTH TRANSITION SPRING COIL GUIDEWIRE SUP-RSS501 CDM 0270 RC outpatient 22.75 22.75 22.75 74 16.84 percent of total billed charges 22.75 93 18.43 percent of total billed charges 22.75 22.75 other OPPS APC 22.75 22.75 other OPPS APC 22.75 27.63 6.29 percent of total billed charges 22.75 22.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PINNACLE STAINLESS STEEL HYDROPHILIC PTFE L10 CM L2.5 CM ID5 FR CORONARY DILATOR KINK RESISTANT SMOOTH TRANSITION SNAP ON ACCEPTS .038 IN GUIDEWIRE SUP-RSS502 CDM 0481 RC outpatient 22.1 22.1 22.1 74 16.35 percent of total billed charges 22.1 93 17.9 percent of total billed charges 22.1 22.1 other OPPS APC 22.1 22.1 other OPPS APC 22.1 51 11.27 percent of total billed charges 22.1 22.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER PINNACLE .038IN 10CM 2.5CM 5FR HYDROPHILIC PTFE KINK RESISTANT DILATOR GUIDEWIRE SUP-RSS503 CDM 0270 RC outpatient 22.75 22.75 22.75 74 16.84 percent of total billed charges 22.75 93 18.43 percent of total billed charges 22.75 22.75 other OPPS APC 22.75 22.75 other OPPS APC 22.75 27.63 6.29 percent of total billed charges 22.75 22.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER PINNACLE HYDROPHILIC PTFE .038 IN L25 CM L2.5 CM OD5 FR GUIDEWIRE DILATOR KINK RESISTANT SUP-RSS505 CDM 0270 RC outpatient 51.87 51.87 51.87 74 38.38 percent of total billed charges 51.87 93 42.01 percent of total billed charges 51.87 51.87 other OPPS APC 51.87 51.87 other OPPS APC 51.87 27.63 14.33 percent of total billed charges 51.87 51.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE STANDARD L25 CM L2.5 CM ID5 FR CORONARY DILATOR KINK RESISTANT SMOOTH TRANSITION SNAP ON GUIDEWIRE SUP-RSS506 CDM 0270 RC outpatient 44.59 44.59 44.59 74 33 percent of total billed charges 44.59 93 36.12 percent of total billed charges 44.59 44.59 other OPPS APC 44.59 44.59 other OPPS APC 44.59 27.63 12.32 percent of total billed charges 44.59 44.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER PINNACLE STAINLESS STEEL .035 IN L10 CM L2.5 CM ID6 FR PERIPHERAL SNAP ON DILATOR LOCK KINK RESISTANT SMOOTH TRANSITION SPRING COIL GUIDEWIRE SUP-RSS601 CDM 0270 RC outpatient 22.75 22.75 22.75 74 16.84 percent of total billed charges 22.75 93 18.43 percent of total billed charges 22.75 22.75 other OPPS APC 22.75 22.75 other OPPS APC 22.75 27.63 6.29 percent of total billed charges 22.75 22.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE .038 IN L10 CM L2.5 CM ID6 FR CORONARY GUIDEWIRE DILATOR KINK RESISTANT SUP-RSS602 CDM 270009215 LOCAL 0270 RC outpatient 22.1 22.1 22.1 74 16.35 percent of total billed charges 22.1 93 17.9 percent of total billed charges 22.1 22.1 other OPPS APC 22.1 22.1 other OPPS APC 22.1 27.63 6.11 percent of total billed charges 22.1 22.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE .035 IN L10 CM L2.5 CM OD6 FR MINI GUIDEWIRE DILATOR SUP-RSS603 CDM 0270 RC outpatient 22.75 22.75 22.75 74 16.84 percent of total billed charges 22.75 93 18.43 percent of total billed charges 22.75 22.75 other OPPS APC 22.75 22.75 other OPPS APC 22.75 27.63 6.29 percent of total billed charges 22.75 22.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE .035 IN L25 CM L2.5 CM OD6 FR PERIPHERAL GUIDEWIRE DILATOR KINK RESISTANT SUP-RSS605 CDM 0270 RC outpatient 51.87 51.87 51.87 74 38.38 percent of total billed charges 51.87 93 42.01 percent of total billed charges 51.87 51.87 other OPPS APC 51.87 51.87 other OPPS APC 51.87 27.63 14.33 percent of total billed charges 51.87 51.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE L25 CM L2.5 CM ID6 FR CORONARY DILATOR KINK RESISTANT SUP-RSS606 CDM 0270 RC outpatient 44.59 44.59 44.59 74 33 percent of total billed charges 44.59 93 36.12 percent of total billed charges 44.59 44.59 other OPPS APC 44.59 44.59 other OPPS APC 44.59 27.63 12.32 percent of total billed charges 44.59 44.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE .038 IN L10 CM L2.5 CM ID7 FR CORONARY GUIDEWIRE DILATOR KINK RESISTANT SUP-RSS702 CDM 0481 RC outpatient 22.1 22.1 22.1 74 16.35 percent of total billed charges 22.1 93 17.9 percent of total billed charges 22.1 22.1 other OPPS APC 22.1 22.1 other OPPS APC 22.1 51 11.27 percent of total billed charges 22.1 22.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER PINNACLE DESTINATION PTFE HYDROPHILIC L10 CM L2.5 CM OD7 FR PERIPHERAL KINK RESISTANT DESIGN CROSS CUT VALVE SMOOTH TRANSITION DILATOR SUP-RSS703 CDM 0270 RC outpatient 22.75 22.75 22.75 74 16.84 percent of total billed charges 22.75 93 18.43 percent of total billed charges 22.75 22.75 other OPPS APC 22.75 22.75 other OPPS APC 22.75 27.63 6.29 percent of total billed charges 22.75 22.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER PINNACLE DESTINATION PTFE HYDROPHILIC L25 CM L2.5 CM OD7 FR PERIPHERAL KINK RESISTANT DESIGN CROSS CUT VALVE SMOOTH TRANSITION DILATOR SUP-RSS705 CDM 0270 RC outpatient 51.87 51.87 51.87 74 38.38 percent of total billed charges 51.87 93 42.01 percent of total billed charges 51.87 51.87 other OPPS APC 51.87 51.87 other OPPS APC 51.87 27.63 14.33 percent of total billed charges 51.87 51.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE .038 IN L10 CM L2.5 CM ID8 FR CORONARY GUIDEWIRE DILATOR KINK RESISTANT SUP-RSS802 CDM 270009215 LOCAL 0270 RC outpatient 22.1 22.1 22.1 74 16.35 percent of total billed charges 22.1 93 17.9 percent of total billed charges 22.1 22.1 other OPPS APC 22.1 22.1 other OPPS APC 22.1 27.63 6.11 percent of total billed charges 22.1 22.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE .035 IN L10 CM L2.5 CM ID8 FR PERIPHERAL DILATOR KINK RESISTANT SUP-RSS803 CDM 0270 RC outpatient 22.75 22.75 22.75 74 16.84 percent of total billed charges 22.75 93 18.43 percent of total billed charges 22.75 22.75 other OPPS APC 22.75 22.75 other OPPS APC 22.75 27.63 6.29 percent of total billed charges 22.75 22.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE L25 CM L2.5 CM ID8 FR CORONARY DILATOR KINK RESISTANT SMOOTH TRANSITION SNAP ON SUP-RSS806 CDM 270009215 LOCAL 0270 RC outpatient 44.59 44.59 44.59 74 33 percent of total billed charges 44.59 93 36.12 percent of total billed charges 44.59 44.59 other OPPS APC 44.59 44.59 other OPPS APC 44.59 27.63 12.32 percent of total billed charges 44.59 44.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE .038 IN L10 CM L2.5 CM ID9 FR CORONARY GUIDEWIRE DILATOR KINK RESISTANT SUP-RSS902 CDM 0481 RC outpatient 22.1 22.1 22.1 74 16.35 percent of total billed charges 22.1 93 17.9 percent of total billed charges 22.1 22.1 other OPPS APC 22.1 22.1 other OPPS APC 22.1 51 11.27 percent of total billed charges 22.1 22.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH INTRODUCER PINNACLE HYDROPHILIC PTFE .038 IN L10 CM L2.5 CM OD9 FR GUIDEWIRE DILATOR KINK RESISTANT SUP-RSS903 CDM 0270 RC outpatient 22.75 22.75 22.75 74 16.84 percent of total billed charges 22.75 93 18.43 percent of total billed charges 22.75 22.75 other OPPS APC 22.75 22.75 other OPPS APC 22.75 27.63 6.29 percent of total billed charges 22.75 22.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH PINNACLE HYDROPHILIC PTFE L25 CM L2.5 CM ID9 FR CORONARY DILATOR KINK RESISTANT SUP-RSS906 CDM 0270 RC outpatient 44.59 44.59 44.59 74 33 percent of total billed charges 44.59 93 36.12 percent of total billed charges 44.59 44.59 other OPPS APC 44.59 44.59 other OPPS APC 44.59 27.63 12.32 percent of total billed charges 44.59 44.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MASK CPAP ROLLFIT TUBEFIT ERGOSOFT LARGE FULL FACE NON VENT ANTIASPHYXIATION VALVE 2 SIDE CUP DISPOSABLE SUP-RT045L CDM outpatient 65.78 65.78 65.78 65.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CIRCUIT BREATHING ADULT 2 HEAT VENT LIGHTWEIGHT FLEXIBLE LATEX FREE RT SERIES SUP-RT110 CDM outpatient 44.5 44.5 44.5 44.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM SUCTION REVOLVE STERILE DISPOSABLE ADVANCE ADIPOSE SYSTEM SUP-RV0001 CDM 0270 RC outpatient 1518.4 1518.4 1518.4 74 1123.62 percent of total billed charges 1518.4 93 1229.9 percent of total billed charges 1518.4 1518.4 other OPPS APC 1518.4 1518.4 other OPPS APC 1518.4 27.63 419.53 percent of total billed charges 1518.4 1518.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE QUILL 2 .5 CIRCLE 36CM 36MM VIOLET POLYDIOXANONE 2 ARM MONOFILAMENT TAPER POINT REINFORCE NEEDLE SUP-RX-1062Q CDM 0270 RC outpatient 49.95 49.95 49.95 74 36.96 percent of total billed charges 49.95 93 40.46 percent of total billed charges 49.95 49.95 other OPPS APC 49.95 49.95 other OPPS APC 49.95 27.63 13.8 percent of total billed charges 49.95 49.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE QUILL 0 .5 CIRCLE 14CM 36MM VIOLET POLYDIOXANONE 2 ARM MONOFILAMENT TAPER POINT REINFORCE NEEDLE SUP-RX-1069Q CDM 0270 RC outpatient 49.29 49.29 49.29 74 36.47 percent of total billed charges 49.29 93 39.92 percent of total billed charges 49.29 49.29 other OPPS APC 49.29 49.29 other OPPS APC 49.29 27.63 13.62 percent of total billed charges 49.29 49.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH RENU Z-TRAK L54 MM OD36 MM ODSEC8.5 MM ID22 FR INTRODUCTION SYSTEM ANCILLARY MAIN BODY EXTENSION INTRODUCER SHEATH AAA SUP-RX1-36-54-ZT CDM 270010015 LOCAL 0270 RC outpatient 14814.8 14814.8 14814.8 74 10963 percent of total billed charges 14814.8 93 12000 percent of total billed charges 14814.8 14814.8 other OPPS APC 14814.8 14814.8 other OPPS APC 14814.8 27.63 4093.33 percent of total billed charges 14814.8 14814.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG TRASH LINEAR LOW DENSITY 1.50 MIL CLEAR 55 GA 36X58 100 PER CASE SUP-RXS9926XC CDM outpatient 0.89 0.89 0.89 0.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT TRIDENT COCR +2.5 MM OFFSET C TAPER OD28 MM HIP SUP-S-1400-HH82 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL LFIT COCR C TAPER HIP INTERLOCK SUP-S-1400-HH84 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 7 -5 MM STRAIGHT L155 MM OD11 MM HIP REDUCE SUP-S-2651-0711 CDM 270010024 LOCAL 0270 RC outpatient 12862.2 12862.2 12862.2 74 9518.03 percent of total billed charges 12862.2 93 10418.4 percent of total billed charges 12862.2 12862.2 other OPPS APC 12862.2 12862.2 other OPPS APC 12862.2 27.63 3553.83 percent of total billed charges 12862.2 12862.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 7 -5 MM STRAIGHT L155 MM OD13 MM HIP REDUCE SUP-S-2651-0713 CDM 270010024 LOCAL 0270 RC outpatient 12862.2 12862.2 12862.2 74 9518.03 percent of total billed charges 12862.2 93 10418.4 percent of total billed charges 12862.2 12862.2 other OPPS APC 12862.2 12862.2 other OPPS APC 12862.2 27.63 3553.83 percent of total billed charges 12862.2 12862.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 8 -5 MM STRAIGHT L155 MM OD12 MM HIP REDUCE SUP-S-2651-0812 CDM 270010024 LOCAL 0270 RC outpatient 12862.2 12862.2 12862.2 74 9518.03 percent of total billed charges 12862.2 93 10418.4 percent of total billed charges 12862.2 12862.2 other OPPS APC 12862.2 12862.2 other OPPS APC 12862.2 27.63 3553.83 percent of total billed charges 12862.2 12862.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 8 -5 MM STRAIGHT L155 MM OD14 MM HIP REDUCE SUP-S-2651-0814 CDM 270010024 LOCAL 0270 RC outpatient 12862.2 12862.2 12862.2 74 9518.03 percent of total billed charges 12862.2 93 10418.4 percent of total billed charges 12862.2 12862.2 other OPPS APC 12862.2 12862.2 other OPPS APC 12862.2 27.63 3553.83 percent of total billed charges 12862.2 12862.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 9 -5 MM STRAIGHT L155 MM OD13 MM HIP REDUCE SUP-S-2651-0913 CDM 270010024 LOCAL 0270 RC outpatient 12862.2 12862.2 12862.2 74 9518.03 percent of total billed charges 12862.2 93 10418.4 percent of total billed charges 12862.2 12862.2 other OPPS APC 12862.2 12862.2 other OPPS APC 12862.2 27.63 3553.83 percent of total billed charges 12862.2 12862.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION HA TITANIUM 9 -5 MM STRAIGHT L155 MM OD15 MM HIP REDUCE NECK SUP-S-2651-0915 CDM 270010024 LOCAL 0270 RC outpatient 12862.2 12862.2 12862.2 74 9518.03 percent of total billed charges 12862.2 93 10418.4 percent of total billed charges 12862.2 12862.2 other OPPS APC 12862.2 12862.2 other OPPS APC 12862.2 27.63 3553.83 percent of total billed charges 12862.2 12862.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 10 -5 MM STRAIGHT L155 MM OD14 MM HIP REDUCE SUP-S-2651-1014 CDM 270010024 LOCAL 0270 RC outpatient 12862.2 12862.2 12862.2 74 9518.03 percent of total billed charges 12862.2 93 10418.4 percent of total billed charges 12862.2 12862.2 other OPPS APC 12862.2 12862.2 other OPPS APC 12862.2 27.63 3553.83 percent of total billed charges 12862.2 12862.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 10 -5 MM STRAIGHT L155 MM OD16 MM HIP REDUCE SUP-S-2651-1016 CDM 270010024 LOCAL 0270 RC outpatient 12862.2 12862.2 12862.2 74 9518.03 percent of total billed charges 12862.2 93 10418.4 percent of total billed charges 12862.2 12862.2 other OPPS APC 12862.2 12862.2 other OPPS APC 12862.2 27.63 3553.83 percent of total billed charges 12862.2 12862.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 11 -5 MM STRAIGHT L155 MM OD15 MM HIP REDUCE SUP-S-2651-1115 CDM 270010024 LOCAL 0270 RC outpatient 12862.2 12862.2 12862.2 74 9518.03 percent of total billed charges 12862.2 93 10418.4 percent of total billed charges 12862.2 12862.2 other OPPS APC 12862.2 12862.2 other OPPS APC 12862.2 27.63 3553.83 percent of total billed charges 12862.2 12862.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 11 -5 MM STRAIGHT L155 MM OD17 MM HIP REDUCE SUP-S-2651-1117 CDM 270010024 LOCAL 0270 RC outpatient 12862.2 12862.2 12862.2 74 9518.03 percent of total billed charges 12862.2 93 10418.4 percent of total billed charges 12862.2 12862.2 other OPPS APC 12862.2 12862.2 other OPPS APC 12862.2 27.63 3553.83 percent of total billed charges 12862.2 12862.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 12 -5 MM STRAIGHT L155 MM OD16 MM HIP REDUCE SUP-S-2651-1216 CDM 270010024 LOCAL 0270 RC outpatient 12862.2 12862.2 12862.2 74 9518.03 percent of total billed charges 12862.2 93 10418.4 percent of total billed charges 12862.2 12862.2 other OPPS APC 12862.2 12862.2 other OPPS APC 12862.2 27.63 3553.83 percent of total billed charges 12862.2 12862.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 12 -5 MM STRAIGHT L155 MM OD18 MM HIP REDUCE SUP-S-2651-1218 CDM 270010024 LOCAL 0270 RC outpatient 12862.2 12862.2 12862.2 74 9518.03 percent of total billed charges 12862.2 93 10418.4 percent of total billed charges 12862.2 12862.2 other OPPS APC 12862.2 12862.2 other OPPS APC 12862.2 27.63 3553.83 percent of total billed charges 12862.2 12862.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 8 -5 MM STRAIGHT L205 MM OD12 MM HIP REDUCE SUP-S-2652-0812 CDM 270010024 LOCAL 0270 RC outpatient 13622.7 13622.7 13622.7 74 10080.8 percent of total billed charges 13622.7 93 11034.4 percent of total billed charges 13622.7 13622.7 other OPPS APC 13622.7 13622.7 other OPPS APC 13622.7 27.63 3763.95 percent of total billed charges 13622.7 13622.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 8 -5 MM STRAIGHT L205 MM OD14 MM HIP REDUCE SUP-S-2652-0814 CDM 270010024 LOCAL 0270 RC outpatient 13622.7 13622.7 13622.7 74 10080.8 percent of total billed charges 13622.7 93 11034.4 percent of total billed charges 13622.7 13622.7 other OPPS APC 13622.7 13622.7 other OPPS APC 13622.7 27.63 3763.95 percent of total billed charges 13622.7 13622.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 9 -5 MM STRAIGHT L205 MM OD13 MM HIP REDUCE SUP-S-2652-0913 CDM 270010024 LOCAL 0270 RC outpatient 13622.7 13622.7 13622.7 74 10080.8 percent of total billed charges 13622.7 93 11034.4 percent of total billed charges 13622.7 13622.7 other OPPS APC 13622.7 13622.7 other OPPS APC 13622.7 27.63 3763.95 percent of total billed charges 13622.7 13622.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 9 -5 MM STRAIGHT L205 MM OD15 MM HIP REDUCE SUP-S-2652-0915 CDM 270010024 LOCAL 0270 RC outpatient 13622.7 13622.7 13622.7 74 10080.8 percent of total billed charges 13622.7 93 11034.4 percent of total billed charges 13622.7 13622.7 other OPPS APC 13622.7 13622.7 other OPPS APC 13622.7 27.63 3763.95 percent of total billed charges 13622.7 13622.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 10 -5 MM STRAIGHT L205 MM OD14 MM HIP REDUCE SUP-S-2652-1014 CDM 270010024 LOCAL 0270 RC outpatient 13622.7 13622.7 13622.7 74 10080.8 percent of total billed charges 13622.7 93 11034.4 percent of total billed charges 13622.7 13622.7 other OPPS APC 13622.7 13622.7 other OPPS APC 13622.7 27.63 3763.95 percent of total billed charges 13622.7 13622.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 10 -5 MM STRAIGHT L205 MM OD16 MM HIP REDUCE SUP-S-2652-1016 CDM 270010024 LOCAL 0270 RC outpatient 13622.7 13622.7 13622.7 74 10080.8 percent of total billed charges 13622.7 93 11034.4 percent of total billed charges 13622.7 13622.7 other OPPS APC 13622.7 13622.7 other OPPS APC 13622.7 27.63 3763.95 percent of total billed charges 13622.7 13622.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 11 -5 MM STRAIGHT L205 MM OD15 MM HIP REDUCE SUP-S-2652-1115 CDM 270010024 LOCAL 0270 RC outpatient 13622.7 13622.7 13622.7 74 10080.8 percent of total billed charges 13622.7 93 11034.4 percent of total billed charges 13622.7 13622.7 other OPPS APC 13622.7 13622.7 other OPPS APC 13622.7 27.63 3763.95 percent of total billed charges 13622.7 13622.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION HA TITANIUM 11 -5 MM STRAIGHT L205 MM OD17 MM HIP DISTAL REVISION REDUCE NECK CEMENT SUP-S-2652-1117 CDM 270010024 LOCAL 0270 RC outpatient 13622.7 13622.7 13622.7 74 10080.8 percent of total billed charges 13622.7 93 11034.4 percent of total billed charges 13622.7 13622.7 other OPPS APC 13622.7 13622.7 other OPPS APC 13622.7 27.63 3763.95 percent of total billed charges 13622.7 13622.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 12 -5 MM STRAIGHT L205 MM OD16 MM HIP REDUCE SUP-S-2652-1216 CDM 270010024 LOCAL 0270 RC outpatient 13622.7 13622.7 13622.7 74 10080.8 percent of total billed charges 13622.7 93 11034.4 percent of total billed charges 13622.7 13622.7 other OPPS APC 13622.7 13622.7 other OPPS APC 13622.7 27.63 3763.95 percent of total billed charges 13622.7 13622.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL RESTORATION HA TITANIUM 12 STRAIGHT L205 MM OD18 MM HIP DISTAL REVISION REDUCE NECK CEMENT SUP-S-2652-1218 CDM 270010024 LOCAL 0270 RC outpatient 13622.7 13622.7 13622.7 74 10080.8 percent of total billed charges 13622.7 93 11034.4 percent of total billed charges 13622.7 13622.7 other OPPS APC 13622.7 13622.7 other OPPS APC 13622.7 27.63 3763.95 percent of total billed charges 13622.7 13622.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 17 -5 MM STRAIGHT L205 MM OD13 MM HIP REDUCE SUP-S-2652-1317 CDM 270010024 LOCAL 0270 RC outpatient 13622.7 13622.7 13622.7 74 10080.8 percent of total billed charges 13622.7 93 11034.4 percent of total billed charges 13622.7 13622.7 other OPPS APC 13622.7 13622.7 other OPPS APC 13622.7 27.63 3763.95 percent of total billed charges 13622.7 13622.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 13 -5 MM STRAIGHT L205 MM OD19 MM HIP REDUCE SUP-S-2652-1319 CDM 270010024 LOCAL 0270 RC outpatient 13622.7 13622.7 13622.7 74 10080.8 percent of total billed charges 13622.7 93 11034.4 percent of total billed charges 13622.7 13622.7 other OPPS APC 13622.7 13622.7 other OPPS APC 13622.7 27.63 3763.95 percent of total billed charges 13622.7 13622.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 14 -5 MM STRAIGHT L205 MM OD18 MM HIP REDUCE SUP-S-2652-1418 CDM 270010024 LOCAL 0270 RC outpatient 13622.7 13622.7 13622.7 74 10080.8 percent of total billed charges 13622.7 93 11034.4 percent of total billed charges 13622.7 13622.7 other OPPS APC 13622.7 13622.7 other OPPS APC 13622.7 27.63 3763.95 percent of total billed charges 13622.7 13622.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 14 -5 MM STRAIGHT L205 MM OD20 MM HIP REDUCE SUP-S-2652-1420 CDM 270010024 LOCAL 0270 RC outpatient 13622.7 13622.7 13622.7 74 10080.8 percent of total billed charges 13622.7 93 11034.4 percent of total billed charges 13622.7 13622.7 other OPPS APC 13622.7 13622.7 other OPPS APC 13622.7 27.63 3763.95 percent of total billed charges 13622.7 13622.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NECK FEMORAL RESTORATION TITANIUM HA PLASMA SPRAY 14 -5 MM STRAIGHT L205 MM OD22 MM HIP REDUCE SUP-S-2652-1422 CDM 270010024 LOCAL 0270 RC outpatient 13622.7 13622.7 13622.7 74 10080.8 percent of total billed charges 13622.7 93 11034.4 percent of total billed charges 13622.7 13622.7 other OPPS APC 13622.7 13622.7 other OPPS APC 13622.7 27.63 3763.95 percent of total billed charges 13622.7 13622.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTRODUCER CATHETER S-MAK MINI ACCESS 5FR 15CM COAXIAL W/0.018IN 60CM NT/PT CORE/TIP BOWTIE GW STIFF DIL 21GA 7CM ECHO-ENHANCED NDL SUP-S-MAK501N15BT CDM 0270 RC outpatient 122.07 122.07 122.07 other OPPS APC 122.07 122.07 other OPPS APC 122.07 27.63 33.73 percent of total billed charges 122.07 122.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT PATCH SCLERAL 7X7 SUP-S0500S1-77 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE-TEX STANDARD WALL L40 CM ID6 MM PERIPHERAL STRETCH STERILE SUP-S0604 CDM 0270 RC outpatient 1461.2 1461.2 1461.2 74 1081.29 percent of total billed charges 1461.2 93 1183.57 percent of total billed charges 1461.2 1461.2 other OPPS APC 1461.2 1461.2 other OPPS APC 1461.2 27.63 403.73 percent of total billed charges 1461.2 1461.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETAINER DRESSING SPANDAGE FABRIC ADULT 7 AVERAGE L25 YD CRANIUM EAR FACE HEAD NECK ELASTIC CUT TO FIT NET PRECISE STRETCH LATEX FREE SUP-S07 CDM 0270 RC outpatient 26 26 26 74 19.24 percent of total billed charges 26 93 21.06 percent of total billed charges 26 26 other OPPS APC 26 26 other OPPS APC 26 27.63 7.18 percent of total billed charges 26 26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETAINER DRESSING SPANDAGE FABRIC ADULT 8 LARGE TUBULAR L25 YD EAR FACE LEG NECK ELASTIC CUT TO FIT NET PRECISE LATEX FREE SUP-S08 CDM 0270 RC outpatient 27.23 27.23 27.23 74 20.15 percent of total billed charges 27.23 93 22.06 percent of total billed charges 27.23 27.23 other OPPS APC 27.23 27.23 other OPPS APC 27.23 27.63 7.52 percent of total billed charges 27.23 27.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DILATOR LACRIMAL POLYPROPYLENE STAINLESS STEEL PUNCTUM PLUG INSERTER STERILE DISPOSABLE SUP-S1.3090U CDM 0270 RC outpatient 30.33 30.33 30.33 74 22.44 percent of total billed charges 30.33 93 24.57 percent of total billed charges 30.33 30.33 other OPPS APC 30.33 30.33 other OPPS APC 30.33 27.63 8.38 percent of total billed charges 30.33 30.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETAINER DRESSING CUT-TO-FIT SPANDAGE FABRIC 10 XL L25 YD ABDOMEN BREAST CHEST SHOULDER ELASTIC NET PRECISE STRETCH LATEX FREE SUP-S10 CDM outpatient 85.15 85.15 85.15 85.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PLAIN 0 L54 IN MONOFILAMENT TIES YELLOWISH TAN SUP-S104H CDM 0270 RC outpatient 6.92 6.92 6.92 74 5.12 percent of total billed charges 6.92 93 5.61 percent of total billed charges 6.92 6.92 other OPPS APC 6.92 6.92 other OPPS APC 6.92 27.63 1.91 percent of total billed charges 6.92 6.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 7 FR SWAN S-TIP MONITORING CATHETER SUP-S111F7 CDM 0481 RC outpatient 234 234 234 74 173.16 percent of total billed charges 234 93 189.54 percent of total billed charges 234 234 other OPPS APC 234 234 other OPPS APC 234 51 119.34 percent of total billed charges 234 234 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MONOKA MINI SUP-S11500 CDM 0270 RC outpatient 119.16 119.16 119.16 74 88.18 percent of total billed charges 119.16 93 96.52 percent of total billed charges 119.16 119.16 other OPPS APC 119.16 119.16 other OPPS APC 119.16 27.63 32.92 percent of total billed charges 119.16 119.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE #2 CHROMIC SUP-S116H CDM 0270 RC outpatient 6.83 6.83 6.83 74 5.05 percent of total billed charges 6.83 93 5.53 percent of total billed charges 6.83 6.83 other OPPS APC 6.83 6.83 other OPPS APC 6.83 27.63 1.89 percent of total billed charges 6.83 6.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 7 FR SWAN S-TIP THERMODILUTION CATHETER SUP-S144F7 CDM 0481 RC outpatient 257.4 257.4 257.4 74 190.48 percent of total billed charges 257.4 93 208.49 percent of total billed charges 257.4 257.4 other OPPS APC 257.4 257.4 other OPPS APC 257.4 51 131.27 percent of total billed charges 257.4 257.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE HEMOSTASIS STERILE LF AORTIC EXTENSION AFX INTRODUCER SYSTEM SUP-S17-45 CDM 270010015 LOCAL 0270 RC outpatient 1297.4 1297.4 1297.4 74 960.08 percent of total billed charges 1297.4 93 1050.89 percent of total billed charges 1297.4 1297.4 other OPPS APC 1297.4 1297.4 other OPPS APC 1297.4 27.63 358.47 percent of total billed charges 1297.4 1297.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE HEMOSTASIS STERILE LF AORTIC EXTENSION AFX INTRODUCER SYSTEM SUP-S17-45AFX CDM 270010015 LOCAL 0270 RC outpatient 871 871 871 74 644.54 percent of total billed charges 871 93 705.51 percent of total billed charges 871 871 other OPPS APC 871 871 other OPPS APC 871 27.63 240.66 percent of total billed charges 871 871 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE SCLERAL SILICONE L30 MM OD1.65 MM ID.76 MM ROUND STERILE SUP-S3019 CDM 0270 RC outpatient 21.32 21.32 21.32 74 15.78 percent of total billed charges 21.32 93 17.27 percent of total billed charges 21.32 21.32 other OPPS APC 21.32 21.32 other OPPS APC 21.32 27.63 5.89 percent of total billed charges 21.32 21.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD FEMORAL SELEX M2A-MAGNUM COCR +3 MM OD40 MM HIP SOLID MODULAR SUP-S331140 CDM 270010024 LOCAL 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC SAPIEN 3 COMMANDER EDWARDS OD 20 MM TRANSCATHETER ULTRA LOW PROFILE SUP-S3UCM220A CDM 0270 RC outpatient 51300 51300 51300 74 37962 percent of total billed charges 51300 93 41553 percent of total billed charges 51300 51300 other OPPS APC 51300 51300 other OPPS APC 51300 27.63 14174.2 percent of total billed charges 51300 51300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC SAPIEN 3 COMMANDER EDWARDS OD 23 MM TRANSCATHETER ULTRA LOW PROFILE SUP-S3UCM223A CDM 0270 RC outpatient 51300 51300 51300 74 37962 percent of total billed charges 51300 93 41553 percent of total billed charges 51300 51300 other OPPS APC 51300 51300 other OPPS APC 51300 27.63 14174.2 percent of total billed charges 51300 51300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC SAPIEN 3 COMMANDER EDWARDS OD 26 MM TRANSCATHETER ULTRA LOW PROFILE SUP-S3UCM226A CDM 0270 RC outpatient 51300 51300 51300 74 37962 percent of total billed charges 51300 93 41553 percent of total billed charges 51300 51300 other OPPS APC 51300 51300 other OPPS APC 51300 27.63 14174.2 percent of total billed charges 51300 51300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PARTICLES EMBOLIZATION EMBOSPHERE 300-500 UM MICROSPHERE ID.038 IN 2 ML PREFILL SYRINGE BLUE SUP-S420GH CDM 0270 RC outpatient 693.34 693.34 693.34 74 513.07 percent of total billed charges 693.34 93 561.61 percent of total billed charges 693.34 693.34 other OPPS APC 693.34 693.34 other OPPS APC 693.34 27.63 191.57 percent of total billed charges 693.34 693.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE-TEX STANDARD WALL TAPER L45 CM ID4-6 MM PERIPHERAL STRETCH STERILE SUP-S46045 CDM 0270 RC outpatient 1710.8 1710.8 1710.8 74 1265.99 percent of total billed charges 1710.8 93 1385.75 percent of total billed charges 1710.8 1710.8 other OPPS APC 1710.8 1710.8 other OPPS APC 1710.8 27.63 472.69 percent of total billed charges 1710.8 1710.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE-TEX STANDARD WALL TAPER L45 CM ID4-7 MM PERIPHERAL STRETCH STERILE SUP-S47045 CDM 0270 RC outpatient 1710.8 1710.8 1710.8 74 1265.99 percent of total billed charges 1710.8 93 1385.75 percent of total billed charges 1710.8 1710.8 other OPPS APC 1710.8 1710.8 other OPPS APC 1710.8 27.63 472.69 percent of total billed charges 1710.8 1710.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE-TEX STANDARD WALL TAPER L55 CM ID4-7 MM LINE PERIPHERAL STRETCH STERILE SUP-S47055 CDM 0270 RC outpatient 2017.6 2017.6 2017.6 74 1493.02 percent of total billed charges 2017.6 93 1634.26 percent of total billed charges 2017.6 2017.6 other OPPS APC 2017.6 2017.6 other OPPS APC 2017.6 27.63 557.46 percent of total billed charges 2017.6 2017.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER 2.5MM X 40 MM - 135CM SUP-S4IVLK2540 CDM 0270 RC outpatient 7150 7150 7150 74 5291 percent of total billed charges 7150 93 5791.5 percent of total billed charges 7150 7150 other OPPS APC 7150 7150 other OPPS APC 7150 27.63 1975.55 percent of total billed charges 7150 7150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER 3.0MM X 40 MM - 135CM SUP-S4IVLK3040 CDM 0270 RC outpatient 7150 7150 7150 74 5291 percent of total billed charges 7150 93 5791.5 percent of total billed charges 7150 7150 other OPPS APC 7150 7150 other OPPS APC 7150 27.63 1975.55 percent of total billed charges 7150 7150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER 3.5MM X 40 MM - 135CM SUP-S4IVLK3540 CDM 0270 RC outpatient 7150 7150 7150 74 5291 percent of total billed charges 7150 93 5791.5 percent of total billed charges 7150 7150 other OPPS APC 7150 7150 other OPPS APC 7150 27.63 1975.55 percent of total billed charges 7150 7150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER 4.0MM X 40 MM - 135CM SUP-S4IVLK4040 CDM 0270 RC outpatient 7150 7150 7150 74 5291 percent of total billed charges 7150 93 5791.5 percent of total billed charges 7150 7150 other OPPS APC 7150 7150 other OPPS APC 7150 27.63 1975.55 percent of total billed charges 7150 7150 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC TOP HAT OD19 MM SUPRA ANNULAR DESIGN TITANIUM STIFFENING RING EFFORTLESS SUTURING SUP-S5-019 CDM 0270 RC outpatient 11562.2 11562.2 11562.2 74 8556.03 percent of total billed charges 11562.2 93 9365.38 percent of total billed charges 11562.2 11562.2 other OPPS APC 11562.2 11562.2 other OPPS APC 11562.2 27.63 3194.64 percent of total billed charges 11562.2 11562.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC SORIN S5-021 SUP-S5-021 CDM 0270 RC outpatient 11562.2 11562.2 11562.2 74 8556.03 percent of total billed charges 11562.2 93 9365.38 percent of total billed charges 11562.2 11562.2 other OPPS APC 11562.2 11562.2 other OPPS APC 11562.2 27.63 3194.64 percent of total billed charges 11562.2 11562.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC TOP HAT OD23 MM SUPRA ANNULAR DESIGN TITANIUM STIFFENING RING EFFORTLESS SUTURING SUP-S5-023 CDM 0270 RC outpatient 11562.2 11562.2 11562.2 74 8556.03 percent of total billed charges 11562.2 93 9365.38 percent of total billed charges 11562.2 11562.2 other OPPS APC 11562.2 11562.2 other OPPS APC 11562.2 27.63 3194.64 percent of total billed charges 11562.2 11562.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC TOP HAT OD25 MM SUPRA ANNULAR DESIGN TITANIUM STIFFENING RING EFFORTLESS SUTURING SUP-S5-025 CDM 0270 RC outpatient 11562.2 11562.2 11562.2 74 8556.03 percent of total billed charges 11562.2 93 9365.38 percent of total billed charges 11562.2 11562.2 other OPPS APC 11562.2 11562.2 other OPPS APC 11562.2 27.63 3194.64 percent of total billed charges 11562.2 11562.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC TOP HAT OD27 MM SUPRA ANNULAR DESIGN TITANIUM STIFFENING RING EFFORTLESS SUTURING SUP-S5-027 CDM 0270 RC outpatient 11562.2 11562.2 11562.2 74 8556.03 percent of total billed charges 11562.2 93 9365.38 percent of total billed charges 11562.2 11562.2 other OPPS APC 11562.2 11562.2 other OPPS APC 11562.2 27.63 3194.64 percent of total billed charges 11562.2 11562.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND SCLERAL BUCKLING TYPE 41 3.5MM X 100MM 0.75MM THK RETINAL SOFT ELASTIC TAILORED TO SIZE W/FIXATION SLEEVE SILICONE STERILE SINGLE-USE MEDICAL GRADE BIOCOMPATIBLE SUP-S5.1010 CDM 0270 RC outpatient 28.6 28.6 28.6 74 21.16 percent of total billed charges 28.6 93 23.17 percent of total billed charges 28.6 28.6 other OPPS APC 28.6 28.6 other OPPS APC 28.6 27.63 7.9 percent of total billed charges 28.6 28.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND SCLERAL BUCKLING TYPE 42 4MM X 120MM 1.25MM THK RETINAL SOFT ELASTIC TAILORED TO SIZE W/FIXATION SLEEVE SILICONE STERILE SINGLE-USE MEDICAL GRADE BIOCOMPATIBLE SUP-S5.1020 CDM 0270 RC outpatient 28.6 28.6 28.6 74 21.16 percent of total billed charges 28.6 93 23.17 percent of total billed charges 28.6 28.6 other OPPS APC 28.6 28.6 other OPPS APC 28.6 27.63 7.9 percent of total billed charges 28.6 28.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND SCLERAL TYPE 240 2.5X0.6MM SILICONE SUP-S5.2000 CDM 0270 RC outpatient 28.6 28.6 28.6 74 21.16 percent of total billed charges 28.6 93 23.17 percent of total billed charges 28.6 28.6 other OPPS APC 28.6 28.6 other OPPS APC 28.6 27.63 7.9 percent of total billed charges 28.6 28.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLEEVE SCLERAL TYPE 70 FIXATION SILICONE STERILE SUP-S5.3000 CDM 0270 RC outpatient 18.2 18.2 18.2 74 13.47 percent of total billed charges 18.2 93 14.74 percent of total billed charges 18.2 18.2 other OPPS APC 18.2 18.2 other OPPS APC 18.2 27.63 5.03 percent of total billed charges 18.2 18.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FIXATION SLEEVE TYPE 72 SUP-S5.3020 CDM 0270 RC outpatient 18.2 18.2 18.2 74 13.47 percent of total billed charges 18.2 93 14.74 percent of total billed charges 18.2 18.2 other OPPS APC 18.2 18.2 other OPPS APC 18.2 27.63 5.03 percent of total billed charges 18.2 18.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT STERILE ORBITAL 16MM SUP-S6.1016 CDM 0270 RC outpatient 143 143 143 74 105.82 percent of total billed charges 143 93 115.83 percent of total billed charges 143 143 other OPPS APC 143 143 other OPPS APC 143 27.63 39.51 percent of total billed charges 143 143 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONFORMER OPHTHALMIC SMALL OD20 MM PERFORATE SUP-S6.2230 CDM 0270 RC outpatient 109.2 109.2 109.2 74 80.81 percent of total billed charges 109.2 93 88.45 percent of total billed charges 109.2 109.2 other OPPS APC 109.2 109.2 other OPPS APC 109.2 27.63 30.17 percent of total billed charges 109.2 109.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONFORMER OPHTHALMIC SMALL OD20 MM PERFORATE SUP-S6.2230U CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONFORMER OPHTHALMIC MEDIUM OD23 MM PERFORATE SUP-S6.2231 CDM 0270 RC outpatient 96.2 96.2 96.2 74 71.19 percent of total billed charges 96.2 93 77.92 percent of total billed charges 96.2 96.2 other OPPS APC 96.2 96.2 other OPPS APC 96.2 27.63 26.58 percent of total billed charges 96.2 96.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONFORMER OPHTHALMIC MEDIUM OD23 MM PERFORATE SUP-S6.2231U CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONFORMER OPHTHALMIC LARGE OD26 MM PERFORATE SUP-S6.2232 CDM 0270 RC outpatient 96.2 96.2 96.2 74 71.19 percent of total billed charges 96.2 93 77.92 percent of total billed charges 96.2 96.2 other OPPS APC 96.2 96.2 other OPPS APC 96.2 27.63 26.58 percent of total billed charges 96.2 96.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONFORMER OPHTHALMIC LARGE OD26 MM PERFORATE SUP-S6.2232U CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PARTICLES EMBOLIZATION EMBOSPHERE TRISACRYL GELATIN 500-700 UM MICROSPHERE ROUND 20 ML SYRINGE RED SUP-S620GH CDM 0270 RC outpatient 624 624 624 74 461.76 percent of total billed charges 624 93 505.44 percent of total billed charges 624 624 other OPPS APC 624 624 other OPPS APC 624 27.63 172.41 percent of total billed charges 624 624 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PARTICLES EMBOLIZATION EMBOGOLD TRISACRYL GELATIN 700-900 UM MICROSPHERE 2 ML PREFILL SYRINGE GREEN SUP-S820GH CDM 0270 RC outpatient 642.2 642.2 642.2 74 475.23 percent of total billed charges 642.2 93 520.18 percent of total billed charges 642.2 642.2 other OPPS APC 642.2 642.2 other OPPS APC 642.2 27.63 177.44 percent of total billed charges 642.2 642.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TIP 25G GRIESHABER ADVANCED BACKFLUSH TIP SUP-S9.3010.25 CDM 0270 RC outpatient 130 130 130 74 96.2 percent of total billed charges 130 93 105.3 percent of total billed charges 130 130 other OPPS APC 130 130 other OPPS APC 130 27.63 35.92 percent of total billed charges 130 130 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH CONTAMINATION TWISTLOCK CATH-GARD 4-7 FR SUP-SA-09847 CDM 0270 RC outpatient 58.42 58.42 58.42 74 43.23 percent of total billed charges 58.42 93 47.32 percent of total billed charges 58.42 58.42 other OPPS APC 58.42 58.42 other OPPS APC 58.42 27.63 16.14 percent of total billed charges 58.42 58.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LABEL ANESTHESIA 1 IN CORE L500 IN X W1/2 IN HEPARIN UNITS/ML DATE TIME INT BLACK WHITE SUP-SA-320 CDM 0270 RC outpatient 10.11 10.11 10.11 74 7.48 percent of total billed charges 10.11 93 8.19 percent of total billed charges 10.11 10.11 other OPPS APC 10.11 10.11 other OPPS APC 10.11 27.63 2.79 percent of total billed charges 10.11 10.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLIER INTERNAL CLIP APTUS ENDOSYSTEMS ENDOANCHORS HELI-FX L86 CM OD12 FR 10 CASSETTE BATTERY OPERATE VISUAL AUDIO FEEDBACK SUP-SA-85 CDM 0270 RC outpatient 13091 13091 13091 74 9687.34 percent of total billed charges 13091 93 10603.7 percent of total billed charges 13091 13091 other OPPS APC 13091 13091 other OPPS APC 13091 27.63 3617.04 percent of total billed charges 13091 13091 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER SPINAL CORNERSTONE PSR PEEK-OPTIMA D11 MM W14 MM X H11 MM LIF LATERAL PORT SUP-SA-85 CDM 270010020 LOCAL 0270 RC outpatient 2535 2535 2535 74 1875.9 percent of total billed charges 2535 93 2053.35 percent of total billed charges 2535 2535 other OPPS APC 2535 2535 other OPPS APC 2535 27.63 700.42 percent of total billed charges 2535 2535 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT CATHETER VANTEX L20 CM OD7 FR 3 LUMEN STERILE LATEX FREE DISPOSABLE CDP SUP-SA3720KINL CDM 270009030 LOCAL 0270 RC outpatient 172.75 172.75 172.75 74 127.84 percent of total billed charges 172.75 93 139.93 percent of total billed charges 172.75 172.75 other OPPS APC 172.75 172.75 other OPPS APC 172.75 27.63 47.73 percent of total billed charges 172.75 172.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR POSTERIOR OVAL FOLDABLE ACRYSOF SUP-SA60AT CDM outpatient 348.4 348.4 348.4 348.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR ANTERIOR CHAMBER ACRYSOF RESTORE 6.0MM SUP-SA60D3 CDM V2788 CPT 0276 RC outpatient 2327 2327 2327 57 1326.39 percent of total billed charges 2327 93 1884.87 percent of total billed charges 2327 2327 other OPPS APC 2327 2327 other OPPS APC 2327 51 1186.77 percent of total billed charges 2327 2327 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK CHOLANGIOGRAM SUP-SANHDCAPNA CDM 0270 RC outpatient 9 9 9 74 6.66 percent of total billed charges 9 93 7.29 percent of total billed charges 9 9 other OPPS APC 9 9 other OPPS APC 9 27.63 2.49 percent of total billed charges 9 9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBING ABLATION CARTO SMARTABLATE PUMP STERILE SUP-SAT001 CDM 0270 RC outpatient 236.6 236.6 236.6 74 175.08 percent of total billed charges 236.6 93 191.65 percent of total billed charges 236.6 236.6 other OPPS APC 236.6 236.6 other OPPS APC 236.6 27.63 65.37 percent of total billed charges 236.6 236.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE-TEX STANDARD WALL L70 CM L40 CM ID8 MM IDSEC8 MM AXILLOBIFEMORAL STRETCH STERILE LATEX FREE SUP-SAX01D CDM 0270 RC outpatient 6058 6058 6058 74 4482.92 percent of total billed charges 6058 93 4906.98 percent of total billed charges 6058 6058 other OPPS APC 6058 6058 other OPPS APC 6058 27.63 1673.83 percent of total billed charges 6058 6058 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BUTTON SUCTION BRONCHOSCOPE SUP-SB-602 CDM 0270 RC outpatient 24.7 24.7 24.7 74 18.28 percent of total billed charges 24.7 93 20.01 percent of total billed charges 24.7 24.7 other OPPS APC 24.7 24.7 other OPPS APC 24.7 27.63 6.82 percent of total billed charges 24.7 24.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL OD5 MM SUP-SB080050 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEAM FULL 7.0MM X 100 SUP-SB170100 CDM 0270 RC outpatient 3816.8 3816.8 3816.8 74 2824.43 percent of total billed charges 3816.8 93 3091.61 percent of total billed charges 3816.8 3816.8 other OPPS APC 3816.8 3816.8 other OPPS APC 3816.8 27.63 1054.58 percent of total billed charges 3816.8 3816.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BOLT ORTHOPEDIC SALVATION FULL THREAD 125MM 11MM 7MM FOOT ANKLE FUSION BEAM SUP-SB170125 CDM 0270 RC outpatient 3816.8 3816.8 3816.8 74 2824.43 percent of total billed charges 3816.8 93 3091.61 percent of total billed charges 3816.8 3816.8 other OPPS APC 3816.8 3816.8 other OPPS APC 3816.8 27.63 1054.58 percent of total billed charges 3816.8 3816.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG SPECIMEN LAB GUARD POLYETHYLENE THK1.75 MIL L9 IN X W6 IN 4 WALL ZIPLOCK BIOHAZARD LOGO SUP-SBL2R69B CDM 0270 RC outpatient 0.13 0.13 0.13 74 0.1 percent of total billed charges 0.13 93 0.11 percent of total billed charges 0.13 0.13 other OPPS APC 0.13 0.13 other OPPS APC 0.13 27.63 0.04 percent of total billed charges 0.13 0.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE ENDOSCOPIC PLUNGE BOB POLY OD10 MM PORT CLEANER Q TIP ABSORBENT OBTURATOR SUP-SC-01 CDM 0270 RC outpatient 18.13 18.13 18.13 74 13.42 percent of total billed charges 18.13 93 14.69 percent of total billed charges 18.13 18.13 other OPPS APC 18.13 18.13 other OPPS APC 18.13 27.63 5.01 percent of total billed charges 18.13 18.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENERATOR NEUROSTIMULATOR PRECISION SPECTRA TITANIUM EPOXY SILICONE D10.8 MM W46 MM X H50 MM IMPLANTABLE PULSE RECHARGABLE HANDHELD REMOTE CONTROL SUP-SC-1132 CDM 0270 RC outpatient 42627 42627 42627 74 31544 percent of total billed charges 42627 93 34527.9 percent of total billed charges 42627 42627 other OPPS APC 42627 42627 other OPPS APC 42627 27.63 11777.8 percent of total billed charges 42627 42627 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GENERATOR NEUROSTIMULATOR PRECISION MONTAGE 16 CONTACT MRI SUP-SC-1200 CDM 270010020 LOCAL 0270 RC outpatient 46800 46800 46800 74 34632 percent of total billed charges 46800 93 37908 percent of total billed charges 46800 46800 other OPPS APC 46800 46800 other OPPS APC 46800 27.63 12930.8 percent of total billed charges 46800 46800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEUROSTIMULATOR IMPLANTABLE WAVEWRITER ALPHA IMPLANTABLE PULSE 32 CONTACT IMAGEREADY SUP-SC-1232 CDM 0270 RC outpatient 44980 44980 44980 74 33285.2 percent of total billed charges 44980 93 36433.8 percent of total billed charges 44980 44980 other OPPS APC 44980 44980 other OPPS APC 44980 27.63 12428 percent of total billed charges 44980 44980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL TUNNELING VERCISE LONG L35 CM STERILE SUP-SC-4254 CDM 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CLIK ANCHOR HEX WRENCH SUP-SC-4276 CDM 270010020 LOCAL 0270 RC outpatient 65 65 65 74 48.1 percent of total billed charges 65 93 52.65 percent of total billed charges 65 65 other OPPS APC 65 65 other OPPS APC 65 27.63 17.96 percent of total billed charges 65 65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR LEAD CLIKX STERILE DISPOSABLE SUP-SC-4318 CDM 270010020 LOCAL 0270 RC outpatient 975 975 975 74 721.5 percent of total billed charges 975 93 789.75 percent of total billed charges 975 975 other OPPS APC 975 975 other OPPS APC 975 27.63 269.39 percent of total billed charges 975 975 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. REMOTE SPECTRA SPINAL STIM SUP-SC-5532-1 CDM 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT NEUROSTIMULATOR FREELINK REMOTE CONTROL NONSTERILE LATEX FREE SUP-SC-5562-1 CDM 270010020 LOCAL 0270 RC outpatient 3640 3640 3640 74 2693.6 percent of total billed charges 3640 93 2948.4 percent of total billed charges 3640 3640 other OPPS APC 3640 3640 other OPPS APC 3640 27.63 1005.73 percent of total billed charges 3640 3640 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT REMOTE CONTROL NEUROSTIMULATOR FREELINK SUP-SC-5572-1 CDM 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM CHARGING BOSTON SCI SPINAL STIM SUP-SC-6412-3 CDM 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD NEUROSTIMULATOR ARTISAN L50 CM SUP-SC-8216-50 CDM 270010020 LOCAL 0270 RC outpatient 8827 8827 8827 74 6531.98 percent of total billed charges 8827 93 7149.87 percent of total billed charges 8827 8827 other OPPS APC 8827 8827 other OPPS APC 8827 27.63 2438.9 percent of total billed charges 8827 8827 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LEAD ARTISAN SPINAL STIM SUP-SC-8216-70 CDM 0270 RC outpatient 8827 8827 8827 74 6531.98 percent of total billed charges 8827 93 7149.87 percent of total billed charges 8827 8827 other OPPS APC 8827 8827 other OPPS APC 8827 27.63 2438.9 percent of total billed charges 8827 8827 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT LEAD NEUROSTIMULATOR COVEREDGE 50CM 32-CONTACT TIGHT SPACED W/PADDLE SUTURE SLEEVE POSITION LABEL MRI-CONDITIONAL SPINAL CORD SUP-SC-8336-50 CDM 0270 RC outpatient 10400 10400 10400 74 7696 percent of total billed charges 10400 93 8424 percent of total billed charges 10400 10400 other OPPS APC 10400 10400 other OPPS APC 10400 27.63 2873.52 percent of total billed charges 10400 10400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER SUPPORT SURECROSS HYDROPHILIC 15 MM SPACE L90 CM L40 CM OD5 FR ODSEC.039 IN VISIBLE MARKER ACCEPTS .014 IN GUIDEWIRE 4 FR SHEATH SUP-SC1490 CDM 0270 RC outpatient 273.26 273.26 273.26 74 202.21 percent of total billed charges 273.26 93 221.34 percent of total billed charges 273.26 273.26 other OPPS APC 273.26 273.26 other OPPS APC 273.26 27.63 75.5 percent of total billed charges 273.26 273.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT GENFLEX2 THREE PEG PATELLA 35MM SUP-SC1591-35 CDM 270010025 LOCAL 0270 RC outpatient 468 468 468 74 346.32 percent of total billed charges 468 93 379.08 percent of total billed charges 468 468 other OPPS APC 468 468 other OPPS APC 468 27.63 129.31 percent of total billed charges 468 468 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FEMUR GENFLEX2 RIGHT PS SIZE 2.5 SUP-SC3750-2.5 CDM 270010025 LOCAL 0270 RC outpatient 3549 3549 3549 74 2626.26 percent of total billed charges 3549 93 2874.69 percent of total billed charges 3549 3549 other OPPS APC 3549 3549 other OPPS APC 3549 27.63 980.59 percent of total billed charges 3549 3549 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONS STELKAST /GENERAL FEMORLAL TRAY SUP-SC3899 CDM 270010000 LOCAL 0270 RC outpatient 26 26 26 74 19.24 percent of total billed charges 26 93 21.06 percent of total billed charges 26 26 other OPPS APC 26 26 other OPPS APC 26 27.63 7.18 percent of total billed charges 26 26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ECHELON FLEX ENDOPATH L45 MM L280 MM LINEAR CUTTER ARTICULATE COMPACT STERILE LATEX FREE DISPOSABLE SUP-SC45A CDM 0270 RC outpatient 797.29 797.29 797.29 74 589.99 percent of total billed charges 797.29 93 645.8 percent of total billed charges 797.29 797.29 other OPPS APC 797.29 797.29 other OPPS APC 797.29 27.63 220.29 percent of total billed charges 797.29 797.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ECHELON FLEX ENDOPATH L60 MM L280 MM LINEAR CUTTER ARTICULATE COMPACT ENDOSCOPIC SUP-SC60A CDM 0270 RC outpatient 971.36 971.36 971.36 74 718.81 percent of total billed charges 971.36 93 786.8 percent of total billed charges 971.36 971.36 other OPPS APC 971.36 971.36 other OPPS APC 971.36 27.63 268.39 percent of total billed charges 971.36 971.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ANGIOGRAPHIC SLIP-CATH BEACON TIP HYDROPHILIC VITEK CURVE L100 CM OD5 FR CEREBRAL ACCEPTS .038 IN GUIDEWIRE SUP-SCBR5.038100PNSVTK CDM 0270 RC outpatient 107.96 107.96 107.96 74 79.89 percent of total billed charges 107.96 93 87.45 percent of total billed charges 107.96 107.96 other OPPS APC 107.96 107.96 other OPPS APC 107.96 27.63 29.83 percent of total billed charges 107.96 107.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA SILICONE FULL PROFILE 295 CC SMOOTH SHELL SURFACE HIGHLY COHESIVE GEL STERILE SUP-SCF-295 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA SILICONE FULL PROFILE 325 CC SMOOTH SHELL SURFACE HIGHLY COHESIVE GEL STERILE SUP-SCF-325 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA SILICONE FULL PROFILE 365 CC SMOOTH SHELL SURFACE HIGHLY COHESIVE GEL STERILE SUP-SCF-365 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA SILICONE FULL PROFILE 385 CC SMOOTH SHELL SURFACE HIGHLY COHESIVE GEL STERILE SUP-SCF-385 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA SILICONE FULL PROFILE 415 CC SMOOTH SHELL SURFACE HIGHLY COHESIVE GEL STERILE SUP-SCF-415 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA 605 CC COHESIVE STERILE LATEX FREE SUP-SCF-605 CDM 0270 RC outpatient 2932.8 2932.8 2932.8 74 2170.27 percent of total billed charges 2932.8 93 2375.57 percent of total billed charges 2932.8 2932.8 other OPPS APC 2932.8 2932.8 other OPPS APC 2932.8 27.63 810.33 percent of total billed charges 2932.8 2932.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA SILICONE FULL PROFILE 650 CC SMOOTH SHELL SURFACE HIGHLY COHESIVE GEL STERILE LATEX FREE SUP-SCF-650 CDM 0270 RC outpatient 2932.8 2932.8 2932.8 74 2170.27 percent of total billed charges 2932.8 93 2375.57 percent of total billed charges 2932.8 2932.8 other OPPS APC 2932.8 2932.8 other OPPS APC 2932.8 27.63 810.33 percent of total billed charges 2932.8 2932.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA SILICONE LOW PLUS PROFILE 250 CC SMOOTH SHELL SURFACE HIGHLY COHESIVE GEL STERILE SUP-SCLP-250 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA SILICONE LOW PLUS PROFILE 300 CC SMOOTH SHELL SURFACE HIGHLY COHESIVE GEL STERILE SUP-SCLP-300 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA MODERATE PROFILE 310 CC SMOOTH SHELL SURFACE COHESIVE STERILE LATEX FREE SUP-SCM-310 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA MODERATE PROFILE 330 CC SMOOTH SHELL SURFACE COHESIVE STERILE LATEX FREE SUP-SCM-330 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROGRAMMER SPINAL CORD STIMULATOR SUP-SCSCAPP CDM 0270 RC outpatient 1300 1300 1300 74 962 percent of total billed charges 1300 93 1053 percent of total billed charges 1300 1300 other OPPS APC 1300 1300 other OPPS APC 1300 27.63 359.19 percent of total billed charges 1300 1300 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WAND SCS CAP SUP-SCSCAPW CDM 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WAND SPINAL CORD STIMULATOR SUP-SCSCAPW CDM 0270 RC outpatient 2340 2340 2340 74 1731.6 percent of total billed charges 2340 93 1895.4 percent of total billed charges 2340 2340 other OPPS APC 2340 2340 other OPPS APC 2340 27.63 646.54 percent of total billed charges 2340 2340 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PAD HEMOSTATIC CLO-SUR PAD POLYPROLATE HYDROPHILIC L4 CM X W4 CM VASCULAR NONWOVEN ANTIMICROBIAL BARRIER SCION SUP-SCV22P-AB CDM 0270 RC outpatient 67.96 67.96 67.96 74 50.29 percent of total billed charges 67.96 93 55.05 percent of total billed charges 67.96 67.96 other OPPS APC 67.96 67.96 other OPPS APC 67.96 27.63 18.78 percent of total billed charges 67.96 67.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM AV FISTULA LF SUP-SCVHDAFPNA CDM 0270 RC outpatient 178.22 178.22 178.22 74 131.88 percent of total billed charges 178.22 93 144.36 percent of total billed charges 178.22 178.22 other OPPS APC 178.22 178.22 other OPPS APC 178.22 27.63 49.24 percent of total billed charges 178.22 178.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM AV FISTULA LATEX FREE SUP-SCVHDAFPNB CDM 0270 RC outpatient 184.83 184.83 184.83 74 136.77 percent of total billed charges 184.83 93 149.71 percent of total billed charges 184.83 184.83 other OPPS APC 184.83 184.83 other OPPS APC 184.83 27.63 51.07 percent of total billed charges 184.83 184.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM AAA LF SUP-SCVHDAZPNA CDM 270009162 LOCAL 0270 RC outpatient 199.13 199.13 199.13 74 147.36 percent of total billed charges 199.13 93 161.3 percent of total billed charges 199.13 199.13 other OPPS APC 199.13 199.13 other OPPS APC 199.13 27.63 55.02 percent of total billed charges 199.13 199.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM AAA LATEX FREE SUP-SCVHDAZPNC CDM 270009162 LOCAL 0270 RC outpatient 199.13 199.13 199.13 74 147.36 percent of total billed charges 199.13 93 161.3 percent of total billed charges 199.13 199.13 other OPPS APC 199.13 199.13 other OPPS APC 199.13 27.63 55.02 percent of total billed charges 199.13 199.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM CAROTID LATEX FREE SUP-SCVHDCPPNC CDM 270009166 LOCAL 0270 RC outpatient 298.09 298.09 298.09 74 220.59 percent of total billed charges 298.09 93 241.45 percent of total billed charges 298.09 298.09 other OPPS APC 298.09 298.09 other OPPS APC 298.09 27.63 82.36 percent of total billed charges 298.09 298.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SMOOTH ROUND GEL EXTRA FULL 420CC SUP-SCX-420 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SMOOTH ROUND GEL EXTRA FULL 470CC SUP-SCX-470 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SMOOTH ROUND GEL EXTRA FULL 495CC SUP-SCX-495 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA COHESIVE 525 CC STERILE SUP-SCX-525 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SMOOTH ROUND GEL EXTRA FULL 545CC SUP-SCX-545 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT INSPIRA COHESIVE SMOOTH ROUND EXTRA FULL 560CC SUP-SCX-560 CDM 27000000 LOCAL 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA COHESIVE 615 CC STERILE SUP-SCX-615 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA SILICONE EXTRA FULL PROFILE 650 CC SMOOTH SHELL SURFACE HIGHLY COHESIVE GEL STERILE LATEX FREE SUP-SCX-650 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA 700 CC COHESIVE STERILE SUP-SCX-700 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SMALL ROUND GEL 750CC SUP-SCX-750 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST SMALL ROUND GEL 800CC SUP-SCX-800 CDM 0270 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SNARE ENDOSCOPIC SNAREMASTER SPIRAL L230 CM OD2.8 MM ODSEC20 MM RIDGE WIRE DISPOSABLE SUP-SD-230U-20 CDM 0270 RC outpatient 532.17 532.17 532.17 74 393.81 percent of total billed charges 532.17 93 431.06 percent of total billed charges 532.17 532.17 other OPPS APC 532.17 532.17 other OPPS APC 532.17 27.63 147.04 percent of total billed charges 532.17 532.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ELECTROPHYSIOLOGY EDGE 180 D PREFORM CURVE EXTEND WORK CHANNEL RADIOPAQUE TELESCOPE STEERING CONTROL SUP-SD180EWCTE CDM 0270 RC outpatient 1227.46 1227.46 1227.46 74 908.32 percent of total billed charges 1227.46 93 994.24 percent of total billed charges 1227.46 1227.46 other OPPS APC 1227.46 1227.46 other OPPS APC 1227.46 27.63 339.15 percent of total billed charges 1227.46 1227.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER BRONCHOSCOPE EDGE OLYMPUS SUP-SD300BAPK CDM 0270 RC outpatient 223.6 223.6 223.6 74 165.46 percent of total billed charges 223.6 93 181.12 percent of total billed charges 223.6 223.6 other OPPS APC 223.6 223.6 other OPPS APC 223.6 27.63 61.78 percent of total billed charges 223.6 223.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER NAVIGATION EDGE 45 D PREFORM CURVE EXTEND WORK CHANNEL RADIOPAQUE TELESCOPE STEERING CONTROL SUP-SD45EWCTE CDM 0270 RC outpatient 1227.46 1227.46 1227.46 74 908.32 percent of total billed charges 1227.46 93 994.24 percent of total billed charges 1227.46 1227.46 other OPPS APC 1227.46 1227.46 other OPPS APC 1227.46 27.63 339.15 percent of total billed charges 1227.46 1227.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSULFLATION TUBING SUP-SD500.02 CDM outpatient 17.55 17.55 17.55 17.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER NAVIGATION EDGE 90 D EXTEND WORK CHANNEL SUP-SD90EWCTE-FT CDM 0270 RC outpatient 1614.6 1614.6 1614.6 74 1194.8 percent of total billed charges 1614.6 93 1307.83 percent of total billed charges 1614.6 1614.6 other OPPS APC 1614.6 1614.6 other OPPS APC 1614.6 27.63 446.11 percent of total billed charges 1614.6 1614.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY SUPERDIMENSION SHORT L130 MM L2 MM OD21 GA ODSEC1.8 MM PREMARK ASPIRATE CATHETER SUP-SDAN1000 CDM 0270 RC outpatient 399.36 399.36 399.36 74 295.53 percent of total billed charges 399.36 93 323.48 percent of total billed charges 399.36 399.36 other OPPS APC 399.36 399.36 other OPPS APC 399.36 27.63 110.34 percent of total billed charges 399.36 399.36 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEPS BIOPSY SUPERDIMENSION L110 CM OD1.7 MM PREMARK SUP-SDBF1000 CDM 0270 RC outpatient 316.68 316.68 316.68 74 234.34 percent of total billed charges 316.68 93 256.51 percent of total billed charges 316.68 316.68 other OPPS APC 316.68 316.68 other OPPS APC 316.68 27.63 87.5 percent of total billed charges 316.68 316.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM BIOPSY CORE GENCUT SUP-SDCT-01 CDM 0270 RC outpatient 1003.6 1003.6 1003.6 74 742.66 percent of total billed charges 1003.6 93 812.92 percent of total billed charges 1003.6 1003.6 other OPPS APC 1003.6 1003.6 other OPPS APC 1003.6 27.63 277.29 percent of total billed charges 1003.6 1003.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MARKER FIDUCIAL SUPERLOCK NITINOL L7 MM L3.5 MM OD4 MM ODSEC.8 MM COIL SEED GOLD SUP-SDGN447 CDM 0270 RC outpatient 631.28 631.28 631.28 74 467.15 percent of total billed charges 631.28 93 511.34 percent of total billed charges 631.28 631.28 other OPPS APC 631.28 631.28 other OPPS APC 631.28 27.63 174.42 percent of total billed charges 631.28 631.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PROCEDURE EDGE 180 D LOCATABLE GUIDE FIRM TIP EXTEND WORK CHANNEL CATHETER SUP-SDK4000-FT CDM 0270 RC outpatient 4050.8 4050.8 4050.8 74 2997.59 percent of total billed charges 4050.8 93 3281.15 percent of total billed charges 4050.8 4050.8 other OPPS APC 4050.8 4050.8 other OPPS APC 4050.8 27.63 1119.24 percent of total billed charges 4050.8 4050.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PROCEDURE EDGE 190 SUP-SDK4190-FT CDM 0270 RC outpatient 4050.8 4050.8 4050.8 74 2997.59 percent of total billed charges 4050.8 93 3281.15 percent of total billed charges 4050.8 4050.8 other OPPS APC 4050.8 4050.8 other OPPS APC 4050.8 27.63 1119.24 percent of total billed charges 4050.8 4050.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PROCEDURE EDGE 45 SUP-SDK4450-FT CDM 0270 RC outpatient 4050.8 4050.8 4050.8 74 2997.59 percent of total billed charges 4050.8 93 3281.15 percent of total billed charges 4050.8 4050.8 other OPPS APC 4050.8 4050.8 other OPPS APC 4050.8 27.63 1119.24 percent of total billed charges 4050.8 4050.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT PROCEDURE EDGE 90D LOCATABLE GUIDE FIRM TIP EXTEND WORK CHANNEL CATHETER SUP-SDK4900-FT CDM 0270 RC outpatient 4050.8 4050.8 4050.8 74 2997.59 percent of total billed charges 4050.8 93 3281.15 percent of total billed charges 4050.8 4050.8 other OPPS APC 4050.8 4050.8 other OPPS APC 4050.8 27.63 1119.24 percent of total billed charges 4050.8 4050.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MARKER RADIOLOGY SUPERDIMENSION L125 CM OD5 FR ID.04 IN DELIVERY TOOL KIT CATHETER SUP-SDMDK1000 CDM 0270 RC outpatient 319.8 319.8 319.8 74 236.65 percent of total billed charges 319.8 93 259.04 percent of total billed charges 319.8 319.8 other OPPS APC 319.8 319.8 other OPPS APC 319.8 27.63 88.36 percent of total billed charges 319.8 319.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRUSH CYTOLOGY NEEDLE L120 MM L2 MM OD1.7 MM ASPIRATE PORT SUP-SDNB2000 CDM 0270 RC outpatient 261.3 261.3 261.3 74 193.36 percent of total billed charges 261.3 93 211.65 percent of total billed charges 261.3 261.3 other OPPS APC 261.3 261.3 other OPPS APC 261.3 27.63 72.2 percent of total billed charges 261.3 261.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER SIGMA SDR300 SUP-SDR300SERIES CDM 0270 RC outpatient 11440 11440 11440 74 8465.6 percent of total billed charges 11440 93 9266.4 percent of total billed charges 11440 11440 other OPPS APC 11440 11440 other OPPS APC 11440 27.63 3160.87 percent of total billed charges 11440 11440 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE COMPRESSION PRELUDESYNC L24 CM BAND STERILE LATEX FREE DISPOSABLE SUP-SDRB-REG-LT CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE COMPRESSION PRELUDESYNC L24 CM RADIAL DISTAL BAND STERILE LATEX FREE DISPOSABLE SUP-SDRB-REG-RT CDM 0270 RC outpatient 91 91 91 74 67.34 percent of total billed charges 91 93 73.71 percent of total billed charges 91 91 other OPPS APC 91 91 other OPPS APC 91 27.63 25.14 percent of total billed charges 91 91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BRUSH CYTOLOGY SUPERDIMENSION 115MM 10MM 1.9MM 3 NEEDLE SUP-SDTNB1000 CDM 0270 RC outpatient 459.68 459.68 459.68 74 340.16 percent of total billed charges 459.68 93 372.34 percent of total billed charges 459.68 459.68 other OPPS APC 459.68 459.68 other OPPS APC 459.68 27.63 127.01 percent of total billed charges 459.68 459.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRYSEAL SHEATH 26F SUP-SDV2628 CDM 0481 RC outpatient 897 897 897 74 663.78 percent of total billed charges 897 93 726.57 percent of total billed charges 897 897 other OPPS APC 897 897 other OPPS APC 897 51 457.47 percent of total billed charges 897 897 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE ENDOSCOPIC WITH ADAPTER SUP-SEAL005 CDM 0270 RC outpatient 31.2 31.2 31.2 74 23.09 percent of total billed charges 31.2 93 25.27 percent of total billed charges 31.2 31.2 other OPPS APC 31.2 31.2 other OPPS APC 31.2 27.63 8.62 percent of total billed charges 31.2 31.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC SENSIA DR 2.8V 1.2AH D7.5 MM W47.9 MM X H44.7 MM 12.1 ML 27.1 GM ATRIUM VENTRICLE IMPLANTABLE 2 CHAMBER RATE RESPONSIVE UNIPOLAR BIPOLAR IS-1 SUP-SEDR01 CDM 0275 RC outpatient 8653.5 8653.5 8653.5 57 4932.5 percent of total billed charges 8653.5 93 7009.34 percent of total billed charges 8653.5 8653.5 other OPPS APC 8653.5 8653.5 other OPPS APC 8653.5 51 4413.29 percent of total billed charges 8653.5 8653.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE INFLATION ACCLARENT SE TUBE PRESSURE GAUGE VACUUM LINE DISPOSABLE BLUE BALLOON SINUPLASTY SUP-SEID CDM 270010000 LOCAL 0270 RC outpatient 239.56 239.56 239.56 74 177.27 percent of total billed charges 239.56 93 194.04 percent of total billed charges 239.56 239.56 other OPPS APC 239.56 239.56 other OPPS APC 239.56 27.63 66.19 percent of total billed charges 239.56 239.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET AIRSEAL BIFURCATED SMOKE EVAC FILTERED TUBE SET SUP-SEM-EVAC CDM 0270 RC outpatient 195.49 195.49 195.49 74 144.66 percent of total billed charges 195.49 93 158.35 percent of total billed charges 195.49 195.49 other OPPS APC 195.49 195.49 other OPPS APC 195.49 27.63 54.01 percent of total billed charges 195.49 195.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC SENSIA SR THK7.5 MM W42.9 MM X H40.2 MM 9.7 ML 21.5 GM ATRIUM VENTRICLE IMPLANTABLE 1 CHAMBER UNIPOLAR BIPOLAR IS-1 SUP-SENSIASRK2 CDM 0275 RC outpatient 7794 7794 7794 57 4442.58 percent of total billed charges 7794 93 6313.14 percent of total billed charges 7794 7794 other OPPS APC 7794 7794 other OPPS APC 7794 51 3974.94 percent of total billed charges 7794 7794 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SEPARATOR THROMBECTOMY INDIGO 8 SUP-SEP8 CDM 0270 RC outpatient 5083 5083 5083 74 3761.42 percent of total billed charges 5083 93 4117.23 percent of total billed charges 5083 5083 other OPPS APC 5083 5083 other OPPS APC 5083 27.63 1404.43 percent of total billed charges 5083 5083 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PPM SESR01/03 SENSIA DEVICE SUP-SESR D CDM 0275 RC outpatient 8653.5 8653.5 8653.5 57 4932.5 percent of total billed charges 8653.5 93 7009.34 percent of total billed charges 8653.5 8653.5 other OPPS APC 8653.5 8653.5 other OPPS APC 8653.5 51 4413.29 percent of total billed charges 8653.5 8653.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC SENSIA SR 2.8V .97AH D7.5 MM L42.9 MM X H40.2 MM 9.7 ML 21.5 GM ATRIUM VENTRICLE 1 CHAMBER RATE RESPONSIVE IS-1 UNIPOLAR BIPOLAR SUP-SESR01 CDM 0275 RC outpatient 7112.25 7112.25 7112.25 57 4053.98 percent of total billed charges 7112.25 93 5760.92 percent of total billed charges 7112.25 7112.25 other OPPS APC 7112.25 7112.25 other OPPS APC 7112.25 51 3627.25 percent of total billed charges 7112.25 7112.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PPM SEDR01 SENSIA DR DEVICE SUP-SESRSERIES D CDM 0275 RC outpatient 8653.5 8653.5 8653.5 57 4932.5 percent of total billed charges 8653.5 93 7009.34 percent of total billed charges 8653.5 8653.5 other OPPS APC 8653.5 8653.5 other OPPS APC 8653.5 51 4413.29 percent of total billed charges 8653.5 8653.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SUPRAPUBIC LAWRENCE SUPRA-FOLEY STAINLESS STEEL OD16 FR SHARP TIP SHIELD TROCAR HANDLE CANNULA LATEX FREE ORANGE SUP-SF-S16-851 CDM 0270 RC outpatient 53.04 53.04 53.04 74 39.25 percent of total billed charges 53.04 93 42.96 percent of total billed charges 53.04 53.04 other OPPS APC 53.04 53.04 other OPPS APC 53.04 27.63 14.65 percent of total billed charges 53.04 53.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY 31CM 4MM SOLITAIRE 2 20MM MICRO 180CM ACCEPTS .021IN GUIDEWIRE SUP-SFR2-4-20 CDM 0270 RC outpatient 19825 19825 19825 74 14670.5 percent of total billed charges 19825 93 16058.3 percent of total billed charges 19825 19825 other OPPS APC 19825 19825 other OPPS APC 19825 27.63 5477.65 percent of total billed charges 19825 19825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY 31CM 6MM SOLITAIRE 2 20MM MICRO 180CM ACCEPTS .027IN GUIDEWIRE SUP-SFR2620_42566 CDM 0270 RC outpatient 19825 19825 19825 74 14670.5 percent of total billed charges 19825 93 16058.3 percent of total billed charges 19825 19825 other OPPS APC 19825 19825 other OPPS APC 19825 27.63 5477.65 percent of total billed charges 19825 19825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY SOLITAIRE 2 20 MM MICRO L31 CM L180 CM OD4 MM ACCEPTS .021 IN GUIDEWIRE REVASCULARIZATION SUP-SFR342010_42565 CDM 0270 RC outpatient 19825 19825 19825 74 14670.5 percent of total billed charges 19825 93 16058.3 percent of total billed charges 19825 19825 other OPPS APC 19825 19825 other OPPS APC 19825 27.63 5477.65 percent of total billed charges 19825 19825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE THROMBECTOMY SOLITAIRE PARAMETRIC PLATINUM NITINOL L180 CM L40 MM OD4 MM SCAFFOLD RADIOPAQUE ACCEPTS 2-4 MM VESSEL .021 MICRO CATHETER SUP-SFR344010_51767 CDM 0270 RC outpatient 20222.8 20222.8 20222.8 74 14964.9 percent of total billed charges 20222.8 93 16380.5 percent of total billed charges 20222.8 20222.8 other OPPS APC 20222.8 20222.8 other OPPS APC 20222.8 27.63 5587.56 percent of total billed charges 20222.8 20222.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER THROMBECTOMY SOLITAIRE 2 20 MM MICRO L31 CM L180 CM OD6 MM ACCEPTS .027 IN GUIDEWIRE REVASCULARIZATION SUP-SFR362010_42566 CDM 0270 RC outpatient 19825 19825 19825 74 14670.5 percent of total billed charges 19825 93 16058.3 percent of total billed charges 19825 19825 other OPPS APC 19825 19825 other OPPS APC 19825 27.63 5477.65 percent of total billed charges 19825 19825 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE THROMBECTOMY SOLITAIRE PLATINUM L180 CM L40 MM OD6 MM ID.027 MM INTRACRANIAL VESSEL RESTORE BLOOD FLOW REVASCULARIZATION PUSHWIRE RADIOPAQUE 3-5.5 MM VESSEL SUP-SFR364010_51768 CDM 0270 RC outpatient 20222.8 20222.8 20222.8 74 14964.9 percent of total billed charges 20222.8 93 16380.5 percent of total billed charges 20222.8 20222.8 other OPPS APC 20222.8 20222.8 other OPPS APC 20222.8 27.63 5587.56 percent of total billed charges 20222.8 20222.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR SOLITAIRE PARAMETRIC 10 MM SPACE 3-1 L50 MM L40 MM OD4 MM RADIOPAQUE REVASCULARIZATION OVERLAP DIFFERENTIATE RADIAL OUTWARD FORCE 2-4 MM VESSEL .021-.027 IN MICROCATHETER SUP-SFR4-4-40-10 CDM 0270 RC outpatient 17810 17810 17810 74 13179.4 percent of total billed charges 17810 93 14426.1 percent of total billed charges 17810 17810 other OPPS APC 17810 17810 other OPPS APC 17810 27.63 4920.9 percent of total billed charges 17810 17810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE THROMBECTOMY SOLITAIRE X L200 CM L40 CM OD6 MM ID.021-.027 IN REVASCULARIZATION RADIOPAQUE STERILE ACCEPTS 2-5.5 MM VESSEL .021-.027 MM MICROCATHETER SUP-SFR4-6-40-10 CDM 0270 RC outpatient 17810 17810 17810 74 13179.4 percent of total billed charges 17810 93 14426.1 percent of total billed charges 17810 17810 other OPPS APC 17810 17810 other OPPS APC 17810 27.63 4920.9 percent of total billed charges 17810 17810 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE PLAIN ON KEITH NEEDLE SUP-SG-6042 CDM 0270 RC outpatient 19.76 19.76 19.76 74 14.62 percent of total billed charges 19.76 93 16.01 percent of total billed charges 19.76 19.76 other OPPS APC 19.76 19.76 other OPPS APC 19.76 27.63 5.46 percent of total billed charges 19.76 19.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE SUTUPAK CHROMIC 2-0 L18 IN MONOFILAMENT 12 STRAND PRECUT SUP-SG13T CDM 0270 RC outpatient 35.43 35.43 35.43 74 26.22 percent of total billed charges 35.43 93 28.7 percent of total billed charges 35.43 35.43 other OPPS APC 35.43 35.43 other OPPS APC 35.43 27.63 9.79 percent of total billed charges 35.43 35.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP PRICING SHOULDER EXACTECH WITH AUG GLENOID ADJ SUP-SHOULD-REVERSE EXACT CDM 270010030 LOCAL 0270 RC outpatient 23920 23920 23920 74 17700.8 percent of total billed charges 23920 93 19375.2 percent of total billed charges 23920 23920 other OPPS APC 23920 23920 other OPPS APC 23920 27.63 6609.1 percent of total billed charges 23920 23920 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR SILICONE 3PIECE SUP-SI40NB CDM 0270 RC outpatient 325 325 325 74 240.5 percent of total billed charges 325 93 263.25 percent of total billed charges 325 325 other OPPS APC 325 325 other OPPS APC 325 27.63 89.8 percent of total billed charges 325 325 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER TRI-STAPLE 2 MM L30 MM VASCULAR MEDIUM THICK TISSUE ARTICULATE CURVE TIP INTRODUCER SIGNIA SUP-SIG30CTAVM CDM 0270 RC outpatient 519.92 519.92 519.92 74 384.74 percent of total billed charges 519.92 93 421.14 percent of total billed charges 519.92 519.92 other OPPS APC 519.92 519.92 other OPPS APC 519.92 27.63 143.65 percent of total billed charges 519.92 519.92 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER TRI-STAPLE 2MM 45MM DISPOSABLE STERILE LF EXTRA THICK TISSUE ARTICULATE SIGNIA STAPLING SYSTEM SUP-SIG45AXT CDM 0270 RC outpatient 599.35 599.35 599.35 74 443.52 percent of total billed charges 599.35 93 485.47 percent of total billed charges 599.35 599.35 other OPPS APC 599.35 599.35 other OPPS APC 599.35 27.63 165.6 percent of total billed charges 599.35 599.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ENDO GIA TRI-STAPLE TITANIUM 2 MM 2.5 MM 3 MM L45 MM MEDIUM VASCULAR TISSUE ARTICULATE CURVE TIP ANVIL STERILE LATEX FREE DISPOSABLE TAN SUP-SIG45CTAVM CDM 0270 RC outpatient 1598.66 1598.66 1598.66 74 1183.01 percent of total billed charges 1598.66 93 1294.91 percent of total billed charges 1598.66 1598.66 other OPPS APC 1598.66 1598.66 other OPPS APC 1598.66 27.63 441.71 percent of total billed charges 1598.66 1598.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ENDO GIA TRI-STAPLE 4MM 4.5MM 5MM 60MM BLACK PVC DISPOSABLE STERILE LF EXTRA THICK TISSUE ARTICULATE SUP-SIG60AXT CDM 0270 RC outpatient 865.51 865.51 865.51 74 640.48 percent of total billed charges 865.51 93 701.06 percent of total billed charges 865.51 865.51 other OPPS APC 865.51 865.51 other OPPS APC 865.51 27.63 239.14 percent of total billed charges 865.51 865.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ENDO GIA TRI-STAPLE 3MM 3.5MM 4MM PURPLE TITANIUM DISPOSABLE STERILE LF MED THICK TISSUE ARTICULATE KNIFE SUP-SIGRADMT CDM 0270 RC outpatient 1110.51 1110.51 1110.51 74 821.78 percent of total billed charges 1110.51 93 899.51 percent of total billed charges 1110.51 1110.51 other OPPS APC 1110.51 1110.51 other OPPS APC 1110.51 27.63 306.83 percent of total billed charges 1110.51 1110.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ENDO GIA TRI-STAPLE TITANIUM XTHICK TISSUE RADIAL STERILE LATEX FREE DISPOSABLE BLACK SUP-SIGRADXT CDM 0270 RC outpatient 1277.08 1277.08 1277.08 74 945.04 percent of total billed charges 1277.08 93 1034.43 percent of total billed charges 1277.08 1277.08 other OPPS APC 1277.08 1277.08 other OPPS APC 1277.08 27.63 352.86 percent of total billed charges 1277.08 1277.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER SIGNIA SMALL DIAMETER THIN L45 MM OD8 MM VASCULAR CURVE TIP STERILE LATEX FREE DISPOSABLE CANNULA SUP-SIGSDL45CTVT CDM 0270 RC outpatient 1365 1365 1365 74 1010.1 percent of total billed charges 1365 93 1105.65 percent of total billed charges 1365 1365 other OPPS APC 1365 1365 other OPPS APC 1365 27.63 377.15 percent of total billed charges 1365 1365 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ENDO GIA TRI-STAPLE TITANIUM 3 MM 3.5 MM 4 MM L45 MM MEDIUM THICK TISSUE ARTICULATE REINFORCE STERILE LATEX FREE DISPOSABLE PURPLE SUP-SIGTRS45AMT CDM 0270 RC outpatient 965.26 965.26 965.26 74 714.29 percent of total billed charges 965.26 93 781.86 percent of total billed charges 965.26 965.26 other OPPS APC 965.26 965.26 other OPPS APC 965.26 27.63 266.7 percent of total billed charges 965.26 965.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ENDO GIA TRI-STAPLE TITANIUM 4 MM 4.5 MM 5 MM L45 MM EXTRA THICK TISSUE ARTICULATE REINFORCE STERILE LATEX FREE DISPOSABLE BLACK SUP-SIGTRSB45AXT CDM 0270 RC outpatient 1104.3 1104.3 1104.3 74 817.18 percent of total billed charges 1104.3 93 894.48 percent of total billed charges 1104.3 1104.3 other OPPS APC 1104.3 1104.3 other OPPS APC 1104.3 27.63 305.12 percent of total billed charges 1104.3 1104.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER SIGNIA TRI-STAPLE BUTTRESS REINFORCED 60MM MED/THK SUP-SIGTRSB60AMT CDM 0270 RC outpatient 1404.64 1404.64 1404.64 74 1039.43 percent of total billed charges 1404.64 93 1137.76 percent of total billed charges 1404.64 1404.64 other OPPS APC 1404.64 1404.64 other OPPS APC 1404.64 27.63 388.1 percent of total billed charges 1404.64 1404.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ENDO GIA TRI-STAPLE TITANIUM 4 MM 4.5 MM 5 MM L60 MM EXTRA THICK TISSUE ARTICULATE REINFORCE STERILE LATEX FREE DISPOSABLE BLACK SUP-SIGTRSB60AXT CDM 0270 RC outpatient 1335.64 1335.64 1335.64 74 988.37 percent of total billed charges 1335.64 93 1081.87 percent of total billed charges 1335.64 1335.64 other OPPS APC 1335.64 1335.64 other OPPS APC 1335.64 27.63 369.04 percent of total billed charges 1335.64 1335.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING BLACK MAX STANDARD STRAIGHT OD25.4 MM DIAMOND DISK STERILE SILVER BURR SUP-SIL-14 CDM 270010027 LOCAL 0270 RC outpatient 384.8 384.8 384.8 74 284.75 percent of total billed charges 384.8 93 311.69 percent of total billed charges 384.8 384.8 other OPPS APC 384.8 384.8 other OPPS APC 384.8 27.63 106.32 percent of total billed charges 384.8 384.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING DIAMOND BALL OD4 MM NONSTERILE BURR 6.1 CM ATTACHMENT SUP-SIL-17-4 CDM 0270 RC outpatient 366.6 366.6 366.6 74 271.28 percent of total billed charges 366.6 93 296.95 percent of total billed charges 366.6 366.6 other OPPS APC 366.6 366.6 other OPPS APC 366.6 27.63 101.29 percent of total billed charges 366.6 366.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING BLACK MAX FLUTE ACORN OD6 MM NONSTERILE SILVER BURR SUP-SIL-24 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING BLACK MAX STANDARD STRAIGHT FLUTE ACORN L6.1 CM OD7.5 MM ATTACHMENT NONSTERILE SILVER BURR SUP-SIL-32 CDM 0270 RC outpatient 215.8 215.8 215.8 74 159.69 percent of total billed charges 215.8 93 174.8 percent of total billed charges 215.8 215.8 other OPPS APC 215.8 215.8 other OPPS APC 215.8 27.63 59.63 percent of total billed charges 215.8 215.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING BLACK MAX STANDARD STRAIGHT FLUTE BALL L6.1 CM OD4 MM ATTACHMENT NONSTERILE SILVER BURR SUP-SIL-4 CDM 0270 RC outpatient 200.2 200.2 200.2 74 148.15 percent of total billed charges 200.2 93 162.16 percent of total billed charges 200.2 200.2 other OPPS APC 200.2 200.2 other OPPS APC 200.2 27.63 55.32 percent of total billed charges 200.2 200.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING BLACK MAX STRAIGHT COARSE DIAMOND BALL L6.1 CM OD5 MM ATTACHMENT NONSTERILE BURR SUP-SIL-5 CDM 0270 RC outpatient 200.2 200.2 200.2 74 148.15 percent of total billed charges 200.2 93 162.16 percent of total billed charges 200.2 200.2 other OPPS APC 200.2 200.2 other OPPS APC 200.2 27.63 55.32 percent of total billed charges 200.2 200.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CONNECTOR IRRIGATION HYDRA METAL 1 WAY VALVE WATER JET DISPOSABLE OLYMPUS SUP-SIT-361-100 CDM 0270 RC outpatient 4.22 4.22 4.22 74 3.12 percent of total billed charges 4.22 93 3.42 percent of total billed charges 4.22 4.22 other OPPS APC 4.22 4.22 other OPPS APC 4.22 27.63 1.17 percent of total billed charges 4.22 4.22 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROVENA SNARE 4.0MM SUP-SK400 CDM 0270 RC outpatient 1456 1456 1456 74 1077.44 percent of total billed charges 1456 93 1179.36 percent of total billed charges 1456 1456 other OPPS APC 1456 1456 other OPPS APC 1456 27.63 402.29 percent of total billed charges 1456 1456 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT SNARE AMPLATZ GOOSENECK NITINOL 90 D MICRO L175 CM L150 CM OD7 MM ODSEC2.3-3 FR LOOP CATHETER KINK RESISTANCE SUP-SK700 CDM 0270 RC outpatient 1755 1755 1755 74 1298.7 percent of total billed charges 1755 93 1421.55 percent of total billed charges 1755 1755 other OPPS APC 1755 1755 other OPPS APC 1755 27.63 484.91 percent of total billed charges 1755 1755 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA RADIOFREQUENCY SILICONE CURVE L100 MM L10 MM OD18 GA ACTIVE TIP PREMIUM NEEDLE ERGONOMIC HUB STEERABLE SHAFT SUP-SL-C1010-18 CDM 0270 RC outpatient 33.8 33.8 33.8 74 25.01 percent of total billed charges 33.8 93 27.38 percent of total billed charges 33.8 33.8 other OPPS APC 33.8 33.8 other OPPS APC 33.8 27.63 9.34 percent of total billed charges 33.8 33.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE RF 20GA X 10 SUP-SL-C1010-20 CDM 0270 RC outpatient 33.8 33.8 33.8 74 25.01 percent of total billed charges 33.8 93 27.38 percent of total billed charges 33.8 33.8 other OPPS APC 33.8 33.8 other OPPS APC 33.8 27.63 9.34 percent of total billed charges 33.8 33.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA RADIOFREQUENCY SILICONE CURVE L15 CM L10 MM OD18 GA ACTIVE TIP PREMIUM NEEDLE ERGONOMIC HUB STEERABLE SHAFT SUP-SL-C1510-18 CDM 0270 RC outpatient 33.8 33.8 33.8 74 25.01 percent of total billed charges 33.8 93 27.38 percent of total billed charges 33.8 33.8 other OPPS APC 33.8 33.8 other OPPS APC 33.8 27.63 9.34 percent of total billed charges 33.8 33.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA RADIOFREQUENCY SILICONE CURVE L15 CM L10 MM OD20 GA ACTIVE TIP PREMIUM NEEDLE ERGONOMIC HUB STEERABLE SHAFT SUP-SL-C1510-20 CDM 0270 RC outpatient 33.8 33.8 33.8 74 25.01 percent of total billed charges 33.8 93 27.38 percent of total billed charges 33.8 33.8 other OPPS APC 33.8 33.8 other OPPS APC 33.8 27.63 9.34 percent of total billed charges 33.8 33.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER MILLEX-GS MIXED CELLULOSE ESTER .22 UM H26 MM OD33 MM 100 ML FEMALE LUER LOCK MALE LUER SLIP STERILE BLUE SUP-SLGSM33SS CDM 0270 RC outpatient 14.66 14.66 14.66 74 10.85 percent of total billed charges 14.66 93 11.87 percent of total billed charges 14.66 14.66 other OPPS APC 14.66 14.66 other OPPS APC 14.66 27.63 4.05 percent of total billed charges 14.66 14.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER KIT TRIPLE 8.5F SUP-SM3L85FHKI CDM 270009030 LOCAL 0270 RC outpatient 187.46 187.46 187.46 74 138.72 percent of total billed charges 187.46 93 151.84 percent of total billed charges 187.46 187.46 other OPPS APC 187.46 187.46 other OPPS APC 187.46 27.63 51.8 percent of total billed charges 187.46 187.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM GYN LAPAROSCOPY LF HAZARDOUS SUP-SMAHDGYPNA CDM 270009174 LOCAL 0270 RC outpatient 334.07 334.07 334.07 74 247.21 percent of total billed charges 334.07 93 270.6 percent of total billed charges 334.07 334.07 other OPPS APC 334.07 334.07 other OPPS APC 334.07 27.63 92.3 percent of total billed charges 334.07 334.07 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM GYN LASER LATEX FREE PENINSULA REGIONAL MEDICAL CENTER SUP-SMAHDLSPNA CDM 0270 RC outpatient 67.29 67.29 67.29 74 49.79 percent of total billed charges 67.29 93 54.5 percent of total billed charges 67.29 67.29 other OPPS APC 67.29 67.29 other OPPS APC 67.29 27.63 18.59 percent of total billed charges 67.29 67.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MARKER BREAST BIOPSY CELERO SYSTEM SUP-SMARK-CELERO CDM 0270 RC outpatient 214.37 214.37 214.37 74 158.63 percent of total billed charges 214.37 93 173.64 percent of total billed charges 214.37 214.37 other OPPS APC 214.37 214.37 other OPPS APC 214.37 27.63 59.23 percent of total billed charges 214.37 214.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON DISSECTOR LAPAROSCOPIC SPACEMAKER PLUS BTT ENDO LUBE FOAM OVAL PREPERITONEAL 3 VALVE RIGID SPRING GRIP LOCK COLLAR BLUNT TIP TROCAR LATEX DISPOSABLE HERNIA SUP-SMBTTOVL CDM 0270 RC outpatient 1943.82 1943.82 1943.82 74 1438.43 percent of total billed charges 1943.82 93 1574.49 percent of total billed charges 1943.82 1943.82 other OPPS APC 1943.82 1943.82 other OPPS APC 1943.82 27.63 537.08 percent of total billed charges 1943.82 1943.82 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON DISSECTOR LAPAROSCOPIC SPACEMAKER PLUS BTT ENDO LUBE FOAM OVAL PREPERITONEAL 3 VALVE RIGID SPRING GRIP LOCK COLLAR BLUNT TIP TROCAR LATEX DISPOSABLE HERNIA SUP-SMBTTOVLX CDM 0270 RC outpatient 2400.24 2400.24 2400.24 74 1776.18 percent of total billed charges 2400.24 93 1944.19 percent of total billed charges 2400.24 2400.24 other OPPS APC 2400.24 2400.24 other OPPS APC 2400.24 27.63 663.19 percent of total billed charges 2400.24 2400.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE VISICOIL PRELOAD 50MM X 1CM SUP-SN-050-010-PL15 CDM 0270 RC outpatient 572 572 572 74 423.28 percent of total billed charges 572 93 463.32 percent of total billed charges 572 572 other OPPS APC 572 572 other OPPS APC 572 27.63 158.04 percent of total billed charges 572 572 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BIOPSY JAMSHIDI MENGHINI L100 MM OD15 GA SOFT TISSUE HOSPITAL WRAP TOWEL FENESTRATED DRAPE SYRINGE SCALPEL BLADE STERILE LATEX DISPOSABLE SUP-SN1015X CDM 270009055 LOCAL 0270 RC outpatient 18.56 18.56 18.56 74 13.73 percent of total billed charges 18.56 93 15.03 percent of total billed charges 18.56 18.56 other OPPS APC 18.56 18.56 other OPPS APC 18.56 27.63 5.13 percent of total billed charges 18.56 18.56 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR ACRYSOF NATURAL STABLEFORCE ACRYLIC 0 D MODIFIED L BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER 1 PIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE APHAKIA 118.4 A-CONSTANT SUP-SN60AT CDM 0270 RC outpatient 400.4 400.4 400.4 74 296.3 percent of total billed charges 400.4 93 324.32 percent of total billed charges 400.4 400.4 other OPPS APC 400.4 400.4 other OPPS APC 400.4 27.63 110.63 percent of total billed charges 400.4 400.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL 0 D +14 DIOPTER MODIFIED L BICONVEX 13MM 6MM POSTERIOR CHAMBER 1 PIECE SUP-SN60AT.140 CDM 0270 RC outpatient 400.4 400.4 400.4 74 296.3 percent of total billed charges 400.4 93 324.32 percent of total billed charges 400.4 400.4 other OPPS APC 400.4 400.4 other OPPS APC 400.4 27.63 110.63 percent of total billed charges 400.4 400.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL ACRYSOF IQ 0D MODIFIED L BICONVEX 13MM 6MM NATURAL 1 PIECE ANTERIOR ASPHERIC 118.7A-CONSTANT SUP-SN60WF CDM 0270 RC outpatient 390 390 390 74 288.6 percent of total billed charges 390 93 315.9 percent of total billed charges 390 390 other OPPS APC 390 390 other OPPS APC 390 27.63 107.76 percent of total billed charges 390 390 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL ACRYSOF NATURAL IQ RESTOR STABLEFORCE 0 D +3 DIOPTER +3 ADD BICONVEX 13MM 6MM YELLOW HYDROPHOBIC ACRYLIC SUP-SN6AD1 CDM 0270 RC outpatient 2327 2327 2327 74 1721.98 percent of total billed charges 2327 93 1884.87 percent of total billed charges 2327 2327 other OPPS APC 2327 2327 other OPPS APC 2327 27.63 642.95 percent of total billed charges 2327 2327 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR RESTORE ASPHERIC SUP-SN6AD3U CDM V2788 CPT 0276 RC outpatient 2327 2327 2327 57 1326.39 percent of total billed charges 2327 93 1884.87 percent of total billed charges 2327 2327 other OPPS APC 2327 2327 other OPPS APC 2327 51 1186.77 percent of total billed charges 2327 2327 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE ACRYLIC 0 D +19 DIOPTER +1.5 CYLINDER BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER 1 PIECE FOLDABLE ASPHERIC OPTIC UV BLUE LIGHT FILTER STERILE ASTIGMATISM APHAKIA 119 A-CONSTANT SUP-SN6AT3.190 CDM 0270 RC outpatient 1287 1287 1287 74 952.38 percent of total billed charges 1287 93 1042.47 percent of total billed charges 1287 1287 other OPPS APC 1287 1287 other OPPS APC 1287 27.63 355.6 percent of total billed charges 1287 1287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL ACRYSOF IQ 0D +2.25 CYLINDER BICONVEX TORIC 13MM 6MM NATURAL ASPHERIC 119A-CONSTANT SUP-SN6AT4 CDM 0270 RC outpatient 1287 1287 1287 74 952.38 percent of total billed charges 1287 93 1042.47 percent of total billed charges 1287 1287 other OPPS APC 1287 1287 other OPPS APC 1287 27.63 355.6 percent of total billed charges 1287 1287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS IOL ACRYSOF IQ 0D +3 CYLINDER BICONVEX TORIC 13MM 6MM NATURAL ASPHERIC 119A-CONSTANT SUP-SN6AT5 CDM 0270 RC outpatient 1287 1287 1287 74 952.38 percent of total billed charges 1287 93 1042.47 percent of total billed charges 1287 1287 other OPPS APC 1287 1287 other OPPS APC 1287 27.63 355.6 percent of total billed charges 1287 1287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE ACRYLIC 0 D +23.5 DIOPTER +3.75 CYLINDER BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER 1 PIECE FOLDABLE ASPHERIC OPTIC UV BLUE LIGHT FILTER STERILE ASTIGMATISM APHAKIA 119 A-CONSTANT SUP-SN6AT6.235 CDM 0270 RC outpatient 1287 1287 1287 74 952.38 percent of total billed charges 1287 93 1042.47 percent of total billed charges 1287 1287 other OPPS APC 1287 1287 other OPPS APC 1287 27.63 355.6 percent of total billed charges 1287 1287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE ACRYLIC 0 D +27 DIOPTER +4.5 CYLINDER BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER 1 PIECE FOLDABLE ASPHERIC OPTIC UV BLUE LIGHT FILTER STERILE ASTIGMATISM APHAKIA 119 A-CONSTANT SUP-SN6AT7.270 CDM 0270 RC outpatient 1287 1287 1287 74 952.38 percent of total billed charges 1287 93 1042.47 percent of total billed charges 1287 1287 other OPPS APC 1287 1287 other OPPS APC 1287 27.63 355.6 percent of total billed charges 1287 1287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE ACRYLIC 0 D +11.5 DIOPTER +6 CYLINDER BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER 1 PIECE FOLDABLE ASPHERIC OPTIC UV BLUE LIGHT FILTER STERILE ASTIGMATISM APHAKIA 119 A-CONSTANT SUP-SN6AT9.115 CDM 0270 RC outpatient 1287 1287 1287 74 952.38 percent of total billed charges 1287 93 1042.47 percent of total billed charges 1287 1287 other OPPS APC 1287 1287 other OPPS APC 1287 27.63 355.6 percent of total billed charges 1287 1287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM CRANI ACCESSORY LF SUP-SNEHDCSPNA CDM 270009165 LOCAL 0270 RC outpatient 58.63 58.63 58.63 74 43.39 percent of total billed charges 58.63 93 47.49 percent of total billed charges 58.63 58.63 other OPPS APC 58.63 58.63 other OPPS APC 58.63 27.63 16.2 percent of total billed charges 58.63 58.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM CRANI ACCESSORY LATEX FREE SUP-SNEHDCSPNB CDM 270009165 LOCAL 0270 RC outpatient 58.63 58.63 58.63 74 43.39 percent of total billed charges 58.63 93 47.49 percent of total billed charges 58.63 58.63 other OPPS APC 58.63 58.63 other OPPS APC 58.63 27.63 16.2 percent of total billed charges 58.63 58.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE GALUCOMA MODEL S2 SUP-SNG042165 CDM 0270 RC outpatient 1495 1495 1495 74 1106.3 percent of total billed charges 1495 93 1210.95 percent of total billed charges 1495 1495 other OPPS APC 1495 1495 other OPPS APC 1495 27.63 413.07 percent of total billed charges 1495 1495 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLADE SURGICAL HARMONIC SYNERGY CURVE SUP-SNGCB CDM 0270 RC outpatient 639.34 639.34 639.34 74 473.11 percent of total billed charges 639.34 93 517.87 percent of total billed charges 639.34 639.34 other OPPS APC 639.34 639.34 other OPPS APC 639.34 27.63 176.65 percent of total billed charges 639.34 639.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER PERITONEAL DIALYSIS EXTENDED TWO-PIECE WITH EXTENDER FOR LAPROSCOPIC PLACMENT SUP-SNPS-53113 CDM 0270 RC outpatient 1105 1105 1105 74 817.7 percent of total billed charges 1105 93 895.05 percent of total billed charges 1105 1105 other OPPS APC 1105 1105 other OPPS APC 1105 27.63 305.31 percent of total billed charges 1105 1105 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSERT CLAMP FOGARTY HYDRAGRIP L86 MM SOFTJAW SET ATRAUMATIC OCCLUSION HIGH FLOW STERILE LATEX FREE DISPOSABLE SUP-SOFT86 CDM 0270 RC outpatient 4.8 4.8 4.8 74 3.55 percent of total billed charges 4.8 93 3.89 percent of total billed charges 4.8 4.8 other OPPS APC 4.8 4.8 other OPPS APC 4.8 27.63 1.33 percent of total billed charges 4.8 4.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER SOLARA W4TR03 MRI SYSTEM SUP-SOLARAMRIMMAM CDM 0275 RC outpatient 20800 20800 20800 57 11856 percent of total billed charges 20800 93 16848 percent of total billed charges 20800 20800 other OPPS APC 20800 20800 other OPPS APC 20800 51 10608 percent of total billed charges 20800 20800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CPT ARTHROSCOPY SUP-SOPHDATPNC CDM 270009167 LOCAL 0270 RC outpatient 61.49 61.49 61.49 74 45.5 percent of total billed charges 61.49 93 49.81 percent of total billed charges 61.49 61.49 other OPPS APC 61.49 61.49 other OPPS APC 61.49 27.63 16.99 percent of total billed charges 61.49 61.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK TROCH NAIL SUP-SOPHDTNPNC CDM 0270 RC outpatient 151.84 151.84 151.84 74 112.36 percent of total billed charges 151.84 93 122.99 percent of total billed charges 151.84 151.84 other OPPS APC 151.84 151.84 other OPPS APC 151.84 27.63 41.95 percent of total billed charges 151.84 151.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACK SURGICAL CUSTOM TOTAL SHOULDER ACCESSORY LF SUP-SOPHDTSPNA CDM 0270 RC outpatient 64.51 64.51 64.51 74 47.74 percent of total billed charges 64.51 93 52.25 percent of total billed charges 64.51 64.51 other OPPS APC 64.51 64.51 other OPPS APC 64.51 27.63 17.82 percent of total billed charges 64.51 64.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN SKULL TZ MEDICAL STAINLESS STEEL SHARP CLAMP PROTECTIVE CAP STERILE DISPOSABLE SUP-SP-001 CDM 0270 RC outpatient 70.2 70.2 70.2 74 51.95 percent of total billed charges 70.2 93 56.86 percent of total billed charges 70.2 70.2 other OPPS APC 70.2 70.2 other OPPS APC 70.2 27.63 19.4 percent of total billed charges 70.2 70.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BURR HOLE 18.5MM W.SLOT SUP-SP-1863 CDM 0270 RC outpatient 566.8 566.8 566.8 74 419.43 percent of total billed charges 566.8 93 459.11 percent of total billed charges 566.8 566.8 other OPPS APC 566.8 566.8 other OPPS APC 566.8 27.63 156.61 percent of total billed charges 566.8 566.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE L26 MM ORAL CRANIOMAXILLOFACIAL 2 X 4 HOLE MATRIX SUP-SP-1864 CDM 0270 RC outpatient 665.6 665.6 665.6 74 492.54 percent of total billed charges 665.6 93 539.14 percent of total billed charges 665.6 665.6 other OPPS APC 665.6 665.6 other OPPS APC 665.6 27.63 183.91 percent of total billed charges 665.6 665.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SHUNT THINFLAP SMALL SUP-SP-1941 CDM 0270 RC outpatient 566.8 566.8 566.8 74 419.43 percent of total billed charges 566.8 93 459.11 percent of total billed charges 566.8 566.8 other OPPS APC 566.8 566.8 other OPPS APC 566.8 27.63 156.61 percent of total billed charges 566.8 566.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SHUNT X-DRIVE THINFLAP MEDIUM L18.5 MM SPECIALTY SUP-SP-1942 CDM 0270 RC outpatient 566.8 566.8 566.8 74 419.43 percent of total billed charges 566.8 93 459.11 percent of total billed charges 566.8 566.8 other OPPS APC 566.8 566.8 other OPPS APC 566.8 27.63 156.61 percent of total billed charges 566.8 566.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE SHUNT X-DRIVE THINFLAP LARGE L24 MM SPECIALTY SUP-SP-1943 CDM 0270 RC outpatient 566.8 566.8 566.8 74 419.43 percent of total billed charges 566.8 93 459.11 percent of total billed charges 566.8 566.8 other OPPS APC 566.8 566.8 other OPPS APC 566.8 27.63 156.61 percent of total billed charges 566.8 566.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE LACTOSORB L50 MM X W50 MM X H.25 MM ORBITAL FLOOR SUP-SP-1966 CDM 0270 RC outpatient 3939 3939 3939 74 2914.86 percent of total billed charges 3939 93 3190.59 percent of total billed charges 3939 3939 other OPPS APC 3939 3939 other OPPS APC 3939 27.63 1088.35 percent of total billed charges 3939 3939 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE THINFLAP STERILETRAC 2Y L23 MM CRANIOMAXILLOFACIAL ORAL LOW PROFILE X DRIVE SUP-SP-2046 CDM 0270 RC outpatient 587.6 587.6 587.6 74 434.82 percent of total billed charges 587.6 93 475.96 percent of total billed charges 587.6 587.6 other OPPS APC 587.6 587.6 other OPPS APC 587.6 27.63 162.35 percent of total billed charges 587.6 587.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STERNALOCK BLU 70 D L STERNUM 8 HOLE PRIMARY CLOSURE SYSTEM SUP-SP-2913 CDM 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STERNALOCK BLU Y STERNUM 12 HOLE PRIMARY CLOSURE SYSTEM SUP-SP-2914 CDM 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STERNALOCK BLU 60 D JL STERNUM SUP-SP-3142 CDM 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DVR TITANIUM 1.3 MM SQUARE L10 MM OD2.5 MM ELBOW RADIUS CANCELLOUS VOLAR PEG SELF TAP ANATOMIC LOCK PLATE SYSTEM SUP-SP10000 CDM 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1.3MM 16MM 2.5MM TITANIUM NS PEG SELF TAP TIP SQUARE DVR ALPS HAND FRACTURE SYSTEM SUP-SP16000 CDM 0270 RC outpatient 224.64 224.64 224.64 74 166.23 percent of total billed charges 224.64 93 181.96 percent of total billed charges 224.64 224.64 other OPPS APC 224.64 224.64 other OPPS APC 224.64 27.63 62.07 percent of total billed charges 224.64 224.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1.3MM 18MM 2.5MM TITANIUM NS PEG SELF TAP TIP SQUARE DVR ALPS HAND FRACTURE SYSTEM SUP-SP18000 CDM 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1.3MM 20MM 2.5MM TITANIUM NS PEG SELF TAP TIP SQUARE DVR ALPS HAND FRACTURE SYSTEM SUP-SP20000 CDM 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1.3MM 22MM 2.5MM TITANIUM NS PEG SELF TAP TIP SQUARE DVR ALPS HAND FRACTURE SYSTEM SUP-SP22000 CDM 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 1.3MM 24MM 2.5MM TITANIUM NS PEG SELF TAP TIP SQUARE DVR ALPS HAND FRACTURE SYSTEM SUP-SP24000 CDM 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE DVR TITANIUM 1.3 MM SQUARE L26 MM OD2.5 MM ELBOW RADIUS CANCELLOUS VOLAR PEG SELF TAP ANATOMIC LOCK PLATE SYSTEM SUP-SP26000 CDM 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION L30 MM OD2.5 MM SUP-SP30000 CDM 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL INTERSPACE SMALL L150 MM L22 MM OD46 MM HIP SHORT STEM ADVANCE 2 STAGE REVISION ARTHROPLASTY SUP-SPC0023 CDM 0270 RC outpatient 9932 9932 9932 74 7349.68 percent of total billed charges 9932 93 8044.92 percent of total billed charges 9932 9932 other OPPS APC 9932 9932 other OPPS APC 9932 27.63 2744.21 percent of total billed charges 9932 9932 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL INTERSPACE MEDIUM SHORT L156 MM L25 MM OD54 MM HIP ADVANCE 2 STAGE REVISION ARTHROPLASTY SUP-SPC0123 CDM 0270 RC outpatient 9932 9932 9932 74 7349.68 percent of total billed charges 9932 93 8044.92 percent of total billed charges 9932 9932 other OPPS APC 9932 9932 other OPPS APC 9932 27.63 2744.21 percent of total billed charges 9932 9932 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STEM FEMORAL INTERSPACE GENTAMICIN STAINLESS STEEL PMMA SHORT LARGE L171 MM OD60 MM ODSEC33 MM HIP HIGH RELEASE SUP-SPC0223 CDM 0270 RC outpatient 9932 9932 9932 74 7349.68 percent of total billed charges 9932 93 8044.92 percent of total billed charges 9932 9932 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER CEMENT INTERSPACE SM LONG CYLINDRICAL 265MM 46MM 22MM GENTAMICIN SS PMMA STERILE HIP RADIOPAQUE 2 STAGE REVISION SUP-SPC0323 CDM 0270 RC outpatient 9932 9932 9932 74 7349.68 percent of total billed charges 9932 93 8044.92 percent of total billed charges 9932 9932 other OPPS APC 9932 9932 other OPPS APC 9932 27.63 2744.21 percent of total billed charges 9932 9932 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER CEMENT INTERSPACE MED LONG CYLINDRICAL 271MM 54MM 25MM GENTAMICIN SS PMMA STERILE HIP RADIOPAQUE 2 STAGE REVISION SUP-SPC0423 CDM 0270 RC outpatient 9932 9932 9932 74 7349.68 percent of total billed charges 9932 93 8044.92 percent of total billed charges 9932 9932 other OPPS APC 9932 9932 other OPPS APC 9932 27.63 2744.21 percent of total billed charges 9932 9932 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER CEMENT INTERSPACE LG LONG CYLINDRICAL 283.5MM 60MM 33MM GENTAMICIN SS PMMA STERILE HIP RADIOPAQUE 2 STAGE SUP-SPC0523 CDM 0270 RC outpatient 9932 9932 9932 74 7349.68 percent of total billed charges 9932 93 8044.92 percent of total billed charges 9932 9932 other OPPS APC 9932 9932 other OPPS APC 9932 27.63 2744.21 percent of total billed charges 9932 9932 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM EMBOLIC PROTECTION SPIDERFX TUNGSTEN NITINOL L320 CM OD5 MM CAROTID RADIOPAQUE FILTER CAPTURE WIRE GUIDE CATHETER GOLD SUP-SPD2-US-050-320 CDM 0270 RC outpatient 4036.03 4036.03 4036.03 74 2986.66 percent of total billed charges 4036.03 93 3269.18 percent of total billed charges 4036.03 4036.03 other OPPS APC 4036.03 4036.03 other OPPS APC 4036.03 27.63 1115.16 percent of total billed charges 4036.03 4036.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM EMBOLIC PROTECTION SPIDERFX TUNGSTEN NITINOL L320 CM OD6 MM CAROTID RADIOPAQUE FILTER CAPTURE WIRE GUIDE CATHETER GOLD SUP-SPD2-US-060-320 CDM 0270 RC outpatient 4036.03 4036.03 4036.03 74 2986.66 percent of total billed charges 4036.03 93 3269.18 percent of total billed charges 4036.03 4036.03 other OPPS APC 4036.03 4036.03 other OPPS APC 4036.03 27.63 1115.16 percent of total billed charges 4036.03 4036.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM EMBOLIC PROTECTION SPIDERFX NITINOL TUNGSTEN GOLD 7 MM L320 CM OD.014 IN CAROTID RADIOPAQUE FILTER CAPTURE WIRE BRAID ACCEPTS .066 IN GUIDE CATHETER SUP-SPD2-US-070-320 CDM 0270 RC outpatient 4036.03 4036.03 4036.03 74 2986.66 percent of total billed charges 4036.03 93 3269.18 percent of total billed charges 4036.03 4036.03 other OPPS APC 4036.03 4036.03 other OPPS APC 4036.03 27.63 1115.16 percent of total billed charges 4036.03 4036.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPINAL STIMULATOR CAP PRICING SUP-SPINALSTIMCAP CDM 0270 RC outpatient 54600 54600 54600 74 40404 percent of total billed charges 54600 93 44226 percent of total billed charges 54600 54600 other OPPS APC 54600 54600 other OPPS APC 54600 27.63 15086 percent of total billed charges 54600 54600 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL INTERSPACE CEMEX GENTAMICIN SMALL L60 MM X W36 MM X H16 MM OD54 MM ID40 MM .9 GM KNEE HIGH RELEASE SUP-SPK0022 CDM 0270 RC outpatient 9100 9100 9100 74 6734 percent of total billed charges 9100 93 7371 percent of total billed charges 9100 9100 other OPPS APC 9100 9100 other OPPS APC 9100 27.63 2514.33 percent of total billed charges 9100 9100 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL INTERSPACE MEDIUM KNEE SUP-SPK0121 CDM 270010025 LOCAL 0270 RC outpatient 6500 6500 6500 74 4810 percent of total billed charges 6500 93 5265 percent of total billed charges 6500 6500 other OPPS APC 6500 6500 other OPPS APC 6500 27.63 1795.95 percent of total billed charges 6500 6500 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER FEMORAL INTERSPACE CEMEX GENTAMICIN MEDIUM L70 MM X W42 MM X H17 MM OD64 MM ID47 MM 1.3 GM KNEE HIGH RELEASE PREFORM SUP-SPK0122 CDM outpatient 9932 9932 9932 9932 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER CEMENT INTERSPACE LG 80MM 74MM GENTAMICIN PMMA DISPOSABLE STERILE KNEE HIGH RELEASE TEMPORARY 2 STAGE REVISION SUP-SPK0222 CDM 0270 RC outpatient 10374 10374 10374 74 7676.76 percent of total billed charges 10374 93 8402.94 percent of total billed charges 10374 10374 other OPPS APC 10374 10374 other OPPS APC 10374 27.63 2866.34 percent of total billed charges 10374 10374 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER HUMERAL INTERSPACE CEMEX GENTAMICIN STAINLESS STEEL STANDARD L125 MM X H22 MM OD46 MM ODSEC11 MM .8 GM SHOULDER SUP-SPS0021K CDM 270010030 LOCAL 0270 RC outpatient 11570 11570 11570 74 8561.8 percent of total billed charges 11570 93 9371.7 percent of total billed charges 11570 11570 other OPPS APC 11570 11570 other OPPS APC 11570 27.63 3196.79 percent of total billed charges 11570 11570 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOULDER INNERSPACE 41MM SUP-SPS0121 CDM 0270 RC outpatient 11570 11570 11570 74 8561.8 percent of total billed charges 11570 93 9371.7 percent of total billed charges 11570 11570 other OPPS APC 11570 11570 other OPPS APC 11570 27.63 3196.79 percent of total billed charges 11570 11570 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHOULDER INNERSPACE 41MM SUP-SPS0121K CDM 0270 RC outpatient 11570 11570 11570 74 8561.8 percent of total billed charges 11570 93 9371.7 percent of total billed charges 11570 11570 other OPPS APC 11570 11570 other OPPS APC 11570 27.63 3196.79 percent of total billed charges 11570 11570 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SPACER INTERSPACE SHOULDER WITH VANCOMYCIN 46MM XXL SUP-SPSCM4U CDM 0270 RC outpatient 19760 19760 19760 74 14622.4 percent of total billed charges 19760 93 16005.6 percent of total billed charges 19760 19760 other OPPS APC 19760 19760 other OPPS APC 19760 27.63 5459.69 percent of total billed charges 19760 19760 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT PANCREATIC ZIMMON L5 CM X OD 7F SINGLE PIGTAIL SUP-SPSOF-7-5 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE EXTERNAL DRAINAGE POLARIS 80-400 HP L32 MM X W4.6 MM OD16 MM ADJUSTABLE PRESSURE CSF STERILE SUP-SPV400_72545 CDM 0270 RC outpatient 10101 10101 10101 74 7474.74 percent of total billed charges 10101 93 8181.81 percent of total billed charges 10101 10101 other OPPS APC 10101 10101 other OPPS APC 10101 27.63 2790.91 percent of total billed charges 10101 10101 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE EXTERNAL DRAINAGE POLARIS 80-400 HP ADJUSTABLE PRESSURE ANTECHAMBER SUP-SPVA400_72543 CDM 0270 RC outpatient 10959 10959 10959 74 8109.66 percent of total billed charges 10959 93 8876.79 percent of total billed charges 10959 10959 other OPPS APC 10959 10959 other OPPS APC 10959 27.63 3027.97 percent of total billed charges 10959 10959 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR ENROUTE PTFE HYDROPHILIC L5 CM L95 CM L15 CM OD .014 IN RADIOPAQUE SUP-SR-014-GW CDM 0270 RC outpatient 559 559 559 74 413.66 percent of total billed charges 559 93 452.79 percent of total billed charges 559 559 other OPPS APC 559 559 other OPPS APC 559 27.63 154.45 percent of total billed charges 559 559 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ENROUTE UBER FLEX STRAIGHT L20 MM L57 CM OD 6MM DELIVERY SYSTEM ANGLE TIP DYNAMIC FLOW CONTROLLER ACCEPTS .035IN GUIDEWIRE 4-5MM VESSEL TRANSCAROTID ARTERY REVASCULARIZATION SUP-SR-0620-CS CDM 0270 RC outpatient 7410 7410 7410 74 5483.4 percent of total billed charges 7410 93 6002.1 percent of total billed charges 7410 7410 other OPPS APC 7410 7410 other OPPS APC 7410 27.63 2047.38 percent of total billed charges 7410 7410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ENROUTE UBER FLEX STRAIGHT L30 MM L57 CM OD 6MM DELIVERY SYSTEM ANGLE TIP DYNAMIC FLOW CONTROLLER ACCEPTS .014/.038 IN GUIDEWIRE 4-5MM VESSEL TRANSCAROTID ARTERY REVASCULARIZATION SUP-SR-0630-CS CDM 0270 RC outpatient 7410 7410 7410 74 5483.4 percent of total billed charges 7410 93 6002.1 percent of total billed charges 7410 7410 other OPPS APC 7410 7410 other OPPS APC 7410 27.63 2047.38 percent of total billed charges 7410 7410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ENROUTE UBER FLEX STRAIGHT L40 MM L57 CM OD 6MM DELIVERY SYSTEM ANGLE TIP DYNAMIC FLOW CONTROLLER ACCEPTS .035 IN GUIDEWIRE 4-5MM VESSEL TRANSCAROTID ARTERY REVASCULARIZATION SUP-SR-0640-CS CDM 0270 RC outpatient 7410 7410 7410 74 5483.4 percent of total billed charges 7410 93 6002.1 percent of total billed charges 7410 7410 other OPPS APC 7410 7410 other OPPS APC 7410 27.63 2047.38 percent of total billed charges 7410 7410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ENROUTE L30 MM L57 CM OD7 MM ODSEC.065 IN DELIVERY SYSTEM ANGLE TIP DYNAMIC FLOW CONTROLLER MICROMESH GEOMETRY ACCEPTS .014/.038 IN GUIDEWIRE 5-6 MM VESSEL TRANSCAROTID ARTERY REVASCULARIZATION SUP-SR-0730-CS CDM 0270 RC outpatient 7410 7410 7410 74 5483.4 percent of total billed charges 7410 93 6002.1 percent of total billed charges 7410 7410 other OPPS APC 7410 7410 other OPPS APC 7410 27.63 2047.38 percent of total billed charges 7410 7410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ENROUTE UBER FLEX STRAIGHT L40 MM L57 CM OD 7MM DELIVERY SYSTEM ANGLE TIP DYNAMIC FLOW CONTROLLER ACCEPTS .014/.038 IN GUIDEWIRE 5-6 MM VESSEL TRANSCAROTID ARTERY REVASCULARIZATION SUP-SR-0740-CS CDM 0270 RC outpatient 7410 7410 7410 74 5483.4 percent of total billed charges 7410 93 6002.1 percent of total billed charges 7410 7410 other OPPS APC 7410 7410 other OPPS APC 7410 27.63 2047.38 percent of total billed charges 7410 7410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ENROUTE NITINOL TAPER L30 MM L57 CM OD8-6 MM DELIVERY SYSTEM TRANSCAROTID ARTERY REVASCULARIZATION SUP-SR-080630-TCS CDM 0270 RC outpatient 7410 7410 7410 74 5483.4 percent of total billed charges 7410 93 6002.1 percent of total billed charges 7410 7410 other OPPS APC 7410 7410 other OPPS APC 7410 27.63 2047.38 percent of total billed charges 7410 7410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ENROUTE NITINOL TAPER L40 MM L57 CM OD8-6 MM DELIVERY SYSTEM TRANSCAROTID ARTERY REVASCULARIZATION SUP-SR-080640-TCS CDM 0270 RC outpatient 7410 7410 7410 74 5483.4 percent of total billed charges 7410 93 6002.1 percent of total billed charges 7410 7410 other OPPS APC 7410 7410 other OPPS APC 7410 27.63 2047.38 percent of total billed charges 7410 7410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ENROUTE UBER FLEX STRAIGHT L30 MM L57 CM OD 8MM DELIVERY SYSTEM ANGLE TIP DYNAMIC FLOW CONTROLLER ACCEPTS .014/.038 IN GUIDEWIRE 6-7MM VESSEL TRANSCAROTID ARTERY REVASCULARIZATION SUP-SR-0830-CS CDM 0270 RC outpatient 7410 7410 7410 74 5483.4 percent of total billed charges 7410 93 6002.1 percent of total billed charges 7410 7410 other OPPS APC 7410 7410 other OPPS APC 7410 27.63 2047.38 percent of total billed charges 7410 7410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ENROUTE UBER FLEX STRAIGHT L40 MM L57 CM OD 8MM DELIVERY SYSTEM ANGLE TIP DYNAMIC FLOW CONTROLLER ACCEPTS .014/.038 IN GUIDEWIRE 6-7MM VESSEL TRANSCAROTID ARTERY REVASCULARIZATION SUP-SR-0840-CS CDM 0270 RC outpatient 7410 7410 7410 74 5483.4 percent of total billed charges 7410 93 6002.1 percent of total billed charges 7410 7410 other OPPS APC 7410 7410 other OPPS APC 7410 27.63 2047.38 percent of total billed charges 7410 7410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ENROUTE NITINOL TAPER L30 MM L57 CM OD9-7 MM DELIVERY SYSTEM TRANSCAROTID ARTERY REVASCULARIZATION SUP-SR-090730-TCS CDM 0270 RC outpatient 7410 7410 7410 74 5483.4 percent of total billed charges 7410 93 6002.1 percent of total billed charges 7410 7410 other OPPS APC 7410 7410 other OPPS APC 7410 27.63 2047.38 percent of total billed charges 7410 7410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ENROUTE NITINOL TAPER L40 MM L57 CM OD9-7 MM DELIVERY SYSTEM TRANSCAROTID ARTERY REVASCULARIZATION SUP-SR-090740-TCS CDM 0270 RC outpatient 7410 7410 7410 74 5483.4 percent of total billed charges 7410 93 6002.1 percent of total billed charges 7410 7410 other OPPS APC 7410 7410 other OPPS APC 7410 27.63 2047.38 percent of total billed charges 7410 7410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ENROUTE UBER FLEX STRAIGHT L30 MM L57 CM OD 9MM DELIVERY SYSTEM ANGLE TIP DYNAMIC FLOW CONTROLLER ACCEPTS .014/.038 IN GUIDEWIRE 7-8MM VESSEL TRANSCAROTID ARTERY REVASCULARIZATION SUP-SR-0930-CS CDM 0270 RC outpatient 7410 7410 7410 74 5483.4 percent of total billed charges 7410 93 6002.1 percent of total billed charges 7410 7410 other OPPS APC 7410 7410 other OPPS APC 7410 27.63 2047.38 percent of total billed charges 7410 7410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ENROUTE UBER FLEX STRAIGHT L40 MM L57 CM OD 9MM DELIVERY SYSTEM ANGLE TIP DYNAMIC FLOW CONTROLLER ACCEPTS .014/.038 IN GUIDEWIRE 7-8MM VESSEL TRANSCAROTID ARTERY REVASCULARIZATION SUP-SR-0940-CS CDM 0270 RC outpatient 7410 7410 7410 74 5483.4 percent of total billed charges 7410 93 6002.1 percent of total billed charges 7410 7410 other OPPS APC 7410 7410 other OPPS APC 7410 27.63 2047.38 percent of total billed charges 7410 7410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ENROUTE NITINOL TAPER L30 MM L57 CM OD10-8 MM DELIVERY SYSTEM TRANSCAROTID ARTERY REVASCULARIZATION SUP-SR-100830-TCS CDM 0270 RC outpatient 7410 7410 7410 74 5483.4 percent of total billed charges 7410 93 6002.1 percent of total billed charges 7410 7410 other OPPS APC 7410 7410 other OPPS APC 7410 27.63 2047.38 percent of total billed charges 7410 7410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ENROUTE NITINOL TAPER L40 MM L57 CM OD10-8 MM DELIVERY SYSTEM TRANSCAROTID ARTERY REVASCULARIZATION SUP-SR-100840-TCS CDM 0270 RC outpatient 7410 7410 7410 74 5483.4 percent of total billed charges 7410 93 6002.1 percent of total billed charges 7410 7410 other OPPS APC 7410 7410 other OPPS APC 7410 27.63 2047.38 percent of total billed charges 7410 7410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ENROUTE UBER FLEX NITONOL SHORT STRAIGHT L30MM L57CM OD 10 MM OD 6 FR PRELOAD DELIVERY SYSTEM SELFEXPAND CATHETER ACCEPTS .014 IN GUIDEWIRE 8-9MM VESSEL TRANSCAROTID ARTERY REVASCULARIZATION SUP-SR-1030-CS CDM 0270 RC outpatient 7410 7410 7410 74 5483.4 percent of total billed charges 7410 93 6002.1 percent of total billed charges 7410 7410 other OPPS APC 7410 7410 other OPPS APC 7410 27.63 2047.38 percent of total billed charges 7410 7410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ENROUTE UBER FLEX NITINOL L40 MM L57 CM OD 10MM ODSEC .078IN DELIVERY SYSTEM ANGLE TIP DYNAMIC FLOW CONTROLLER ACCEPTS .014/.038 IN GUIDEWIRE 8-9 MM VESSEL TRANSCAROTID ARTERY REVASCULARIZATION SUP-SR-1040-CS CDM 0270 RC outpatient 7410 7410 7410 74 5483.4 percent of total billed charges 7410 93 6002.1 percent of total billed charges 7410 7410 other OPPS APC 7410 7410 other OPPS APC 7410 27.63 2047.38 percent of total billed charges 7410 7410 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BALLOON ONSET SOLOPATH 19F/23F X 35CM ONSET SUP-SR-1935 CDM 0481 RC outpatient 2002 2002 2002 74 1481.48 percent of total billed charges 2002 93 1621.62 percent of total billed charges 2002 2002 other OPPS APC 2002 2002 other OPPS APC 2002 51 1021.02 percent of total billed charges 2002 2002 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTERVENTIONAL ENROUTE TRANSCAROTID NEUROPROTECTION SUP-SR-200-NPS CDM 0270 RC outpatient 9750 9750 9750 74 7215 percent of total billed charges 9750 93 7897.5 percent of total billed charges 9750 9750 other OPPS APC 9750 9750 other OPPS APC 9750 27.63 2693.93 percent of total billed charges 9750 9750 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTRODUCER SILK ROAD .018 IN L50 CM L15 CM OD 4 FR MICROWIRE EXTENSION TUBE NEEDLE STIFF DILATOR SUP-SR-4F21G7D-MP CDM 0270 RC outpatient 520 520 520 74 384.8 percent of total billed charges 520 93 421.2 percent of total billed charges 520 520 other OPPS APC 520 520 other OPPS APC 520 27.63 143.68 percent of total billed charges 520 520 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEURO ACCESS NEEDLE KIT - BEVEL TIP SUP-SR061100 CDM 0270 RC outpatient 954.2 954.2 954.2 74 706.11 percent of total billed charges 954.2 93 772.9 percent of total billed charges 954.2 954.2 other OPPS APC 954.2 954.2 other OPPS APC 954.2 27.63 263.65 percent of total billed charges 954.2 954.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT NEEDLE SPINAL DIAMOND TIP NEURO ACCESS SUP-SR061102 CDM 0270 RC outpatient 954.2 954.2 954.2 74 706.11 percent of total billed charges 954.2 93 772.9 percent of total billed charges 954.2 954.2 other OPPS APC 954.2 954.2 other OPPS APC 954.2 27.63 263.65 percent of total billed charges 954.2 954.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 5F MPA INFINITY SUP-SR4967 CDM 0481 RC outpatient 71.5 71.5 71.5 74 52.91 percent of total billed charges 71.5 93 57.92 percent of total billed charges 71.5 71.5 other OPPS APC 71.5 71.5 other OPPS APC 71.5 51 36.47 percent of total billed charges 71.5 71.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA FULL PROFILE 415CC SUP-SRF-415 CDM 0270 RC outpatient 2067 2067 2067 74 1529.58 percent of total billed charges 2067 93 1674.27 percent of total billed charges 2067 2067 other OPPS APC 2067 2067 other OPPS APC 2067 27.63 571.11 percent of total billed charges 2067 2067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA FULL PROFILE ROUND 450CC SILICONE STERILE SMOOTH SHELL COHESIVE GEL 1 LUMEN PATCH SUP-SRF-450 CDM 0270 RC outpatient 2067 2067 2067 74 1529.58 percent of total billed charges 2067 93 1674.27 percent of total billed charges 2067 2067 other OPPS APC 2067 2067 other OPPS APC 2067 27.63 571.11 percent of total billed charges 2067 2067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA FULL PROFILE 485 CC SMOOTH SHELL SURFACE SUP-SRF-485 CDM 0270 RC outpatient 2067 2067 2067 74 1529.58 percent of total billed charges 2067 93 1674.27 percent of total billed charges 2067 2067 other OPPS APC 2067 2067 other OPPS APC 2067 27.63 571.11 percent of total billed charges 2067 2067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA FULL PROFILE 520CC SMOOTH SHELL SURFACE SUP-SRF-520 CDM 0270 RC outpatient 2129.4 2129.4 2129.4 74 1575.76 percent of total billed charges 2129.4 93 1724.81 percent of total billed charges 2129.4 2129.4 other OPPS APC 2129.4 2129.4 other OPPS APC 2129.4 27.63 588.35 percent of total billed charges 2129.4 2129.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA FULL PROFILE 560CC SMOOTH SHELL SURFACE SUP-SRF-560 CDM 0270 RC outpatient 2067 2067 2067 74 1529.58 percent of total billed charges 2067 93 1674.27 percent of total billed charges 2067 2067 other OPPS APC 2067 2067 other OPPS APC 2067 27.63 571.11 percent of total billed charges 2067 2067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA FULL PROFILE 605CC SMOOTH SHELL SURFACE SUP-SRF-605 CDM 0270 RC outpatient 2129.4 2129.4 2129.4 74 1575.76 percent of total billed charges 2129.4 93 1724.81 percent of total billed charges 2129.4 2129.4 other OPPS APC 2129.4 2129.4 other OPPS APC 2129.4 27.63 588.35 percent of total billed charges 2129.4 2129.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA FULL PROFILE 650CC SMOOTH SHELL SURFACE SUP-SRF-650 CDM 0270 RC outpatient 2067 2067 2067 74 1529.58 percent of total billed charges 2067 93 1674.27 percent of total billed charges 2067 2067 other OPPS APC 2067 2067 other OPPS APC 2067 27.63 571.11 percent of total billed charges 2067 2067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA LOW PLUS PROFILE 250 CC SMOOTH SHELL SURFACE SUP-SRLP-250 CDM 0270 RC outpatient 2067 2067 2067 74 1529.58 percent of total billed charges 2067 93 1674.27 percent of total billed charges 2067 2067 other OPPS APC 2067 2067 other OPPS APC 2067 27.63 571.11 percent of total billed charges 2067 2067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT NATRELE STYLE SRM SMOOTH RESPONSIVE GEL MODERATE PROFILE SUP-SRM-310 CDM 0270 RC outpatient 2067 2067 2067 74 1529.58 percent of total billed charges 2067 93 1674.27 percent of total billed charges 2067 2067 other OPPS APC 2067 2067 other OPPS APC 2067 27.63 571.11 percent of total billed charges 2067 2067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA MODERATE PROFILE 375 CC SMOOTH SHELL SURFACE SUP-SRM-375 CDM 0270 RC outpatient 2158 2158 2158 74 1596.92 percent of total billed charges 2158 93 1747.98 percent of total billed charges 2158 2158 other OPPS APC 2158 2158 other OPPS APC 2158 27.63 596.26 percent of total billed charges 2158 2158 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA MODERATE PROFILE 405 CC SMOOTH SHELL SURFACE SUP-SRM-405 CDM 0270 RC outpatient 2158 2158 2158 74 1596.92 percent of total billed charges 2158 93 1747.98 percent of total billed charges 2158 2158 other OPPS APC 2158 2158 other OPPS APC 2158 27.63 596.26 percent of total billed charges 2158 2158 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILLER BONE VOID NORIAN SRS 3 CC ROTATORY MIX STERILE SUP-SRS-003-RMS CDM 270010031 LOCAL 0270 RC outpatient 2461.68 2461.68 2461.68 74 1821.64 percent of total billed charges 2461.68 93 1993.96 percent of total billed charges 2461.68 2461.68 other OPPS APC 2461.68 2461.68 other OPPS APC 2461.68 27.63 680.16 percent of total billed charges 2461.68 2461.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA XFULL PROFILE 445 CC SMOOTH SHELL SURFACE SUP-SRX-445 CDM 0270 RC outpatient 2067 2067 2067 74 1529.58 percent of total billed charges 2067 93 1674.27 percent of total billed charges 2067 2067 other OPPS APC 2067 2067 other OPPS APC 2067 27.63 571.11 percent of total billed charges 2067 2067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA XFULL PROFILE 495 CC SMOOTH SHELL SURFACE SUP-SRX-495 CDM 0270 RC outpatient 2067 2067 2067 74 1529.58 percent of total billed charges 2067 93 1674.27 percent of total billed charges 2067 2067 other OPPS APC 2067 2067 other OPPS APC 2067 27.63 571.11 percent of total billed charges 2067 2067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT BREAST NATRELLE INSPIRA XFULL PROFILE 650 CC SMOOTH SHELL SURFACE SUP-SRX-650 CDM 0270 RC outpatient 2067 2067 2067 74 1529.58 percent of total billed charges 2067 93 1674.27 percent of total billed charges 2067 2067 other OPPS APC 2067 2067 other OPPS APC 2067 27.63 571.11 percent of total billed charges 2067 2067 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SWEAT BANDS SUP-SS-16750PK CDM 0270 RC outpatient 3.53 3.53 3.53 74 2.61 percent of total billed charges 3.53 93 2.86 percent of total billed charges 3.53 3.53 other OPPS APC 3.53 3.53 other OPPS APC 3.53 27.63 0.98 percent of total billed charges 3.53 3.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADAPTER INTRODUCER SAFESHEATH STANDARD WING SEAL SPLITTABLE HEMOSTATIC VALVE ATTAIN SUP-SS-SA-09MM CDM 0275 RC outpatient 108.68 108.68 108.68 57 61.95 percent of total billed charges 108.68 93 88.03 percent of total billed charges 108.68 108.68 other OPPS APC 108.68 108.68 other OPPS APC 108.68 51 55.43 percent of total billed charges 108.68 108.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTRODUCER SAFESHEATH II L13CM OD 10.5 FR PEEL AWAY SUP-SS105 CDM 0481 RC outpatient 422.5 422.5 422.5 74 312.65 percent of total billed charges 422.5 93 342.23 percent of total billed charges 422.5 422.5 other OPPS APC 422.5 422.5 other OPPS APC 422.5 51 215.48 percent of total billed charges 422.5 422.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH SAFESHEATH II .038 IN L13 CM L19.5 CM OD11 FR VASCULAR 3 WAY STOPCOCK TEAR AWAY HEMOSTATIC VALVE SIDEPORT ELASTOMER SNAP LOCKING DILATOR SUP-SS11_72373 CDM 0270 RC outpatient 94.9 94.9 94.9 74 70.23 percent of total billed charges 94.9 93 76.87 percent of total billed charges 94.9 94.9 other OPPS APC 94.9 94.9 other OPPS APC 94.9 27.63 26.22 percent of total billed charges 94.9 94.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE SUTUPAK 0 18IN SILVER SS MONOFILAMENT TIES 17 STRAND PRECUT SUP-SS26G CDM 0270 RC outpatient 19.55 19.55 19.55 74 14.47 percent of total billed charges 19.55 93 15.84 percent of total billed charges 19.55 19.55 other OPPS APC 19.55 19.55 other OPPS APC 19.55 27.63 5.4 percent of total billed charges 19.55 19.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE SUTUPAK 2-0 18IN SILVER SS MONOFILAMENT TIES 17 STRAND PRECUT SUP-SS28G CDM 0270 RC outpatient 19.55 19.55 19.55 74 14.47 percent of total billed charges 19.55 93 15.84 percent of total billed charges 19.55 19.55 other OPPS APC 19.55 19.55 other OPPS APC 19.55 27.63 5.4 percent of total billed charges 19.55 19.55 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTRODUCER SAFESHEATH II L13CM OD 7 FR PEEL AWAY SUP-SS7 CDM 0481 RC outpatient 84.5 84.5 84.5 74 62.53 percent of total billed charges 84.5 93 68.45 percent of total billed charges 84.5 84.5 other OPPS APC 84.5 84.5 other OPPS APC 84.5 51 43.1 percent of total billed charges 84.5 84.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH SAFESHEATH II L 13 CM OD 8 FR SUP-SS8 CDM 0481 RC outpatient 84.5 84.5 84.5 74 62.53 percent of total billed charges 84.5 93 68.45 percent of total billed charges 84.5 84.5 other OPPS APC 84.5 84.5 other OPPS APC 84.5 51 43.1 percent of total billed charges 84.5 84.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTRODUCER SAFESHEATH II L13CM OD 9 FR PEEL AWAY SUP-SS9 CDM 0481 RC outpatient 84.5 84.5 84.5 74 62.53 percent of total billed charges 84.5 93 68.45 percent of total billed charges 84.5 84.5 other OPPS APC 84.5 84.5 other OPPS APC 84.5 51 43.1 percent of total billed charges 84.5 84.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM INTRODUCER CATHETER 9FR 13CM SAFESHEATH II LATEX-FREE SUP-SSCL9 CDM 0481 RC outpatient 416 416 416 74 307.84 percent of total billed charges 416 93 336.96 percent of total billed charges 416 416 other OPPS APC 416 416 other OPPS APC 416 51 212.16 percent of total billed charges 416 416 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PORT IMPLANTABLE INFUSION VORTEX TR TITANIUM SILICONE LARGE OD10 FR ODSEC9.6 FR 1 STEP LOCK MECHANISM DETACHABLE CATHETER INTRODUCER SEPTUM STERILE LATEX FREE DISPOSABLE SUP-SSDX-16-I CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR NITINOL STAINLESS STEEL L215 CM L45 CM OD.014 IN SOFT ACCESS PRESHAPE SUP-SSFT215PRE CDM 0270 RC outpatient 1934.4 1934.4 1934.4 74 1431.46 percent of total billed charges 1934.4 93 1566.86 percent of total billed charges 1934.4 1934.4 other OPPS APC 1934.4 1934.4 other OPPS APC 1934.4 27.63 534.47 percent of total billed charges 1934.4 1934.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR SYNCHRO SELECT NITINOL STAINLESS STEEL STRAIGHT L215 CM L35 CM OD.014 IN SOFT ACCESS LENGTH SUP-SSFT215STR CDM 0270 RC outpatient 1934.4 1934.4 1934.4 74 1431.46 percent of total billed charges 1934.4 93 1566.86 percent of total billed charges 1934.4 1934.4 other OPPS APC 1934.4 1934.4 other OPPS APC 1934.4 27.63 534.47 percent of total billed charges 1934.4 1934.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR NITINOL STAINLESS STEEL L300 CM L45 CM OD.014 IN SOFT EXCHANGE PRESHAPE SUP-SSFT300PRE CDM 0270 RC outpatient 2493.4 2493.4 2493.4 74 1845.12 percent of total billed charges 2493.4 93 2019.65 percent of total billed charges 2493.4 2493.4 other OPPS APC 2493.4 2493.4 other OPPS APC 2493.4 27.63 688.93 percent of total billed charges 2493.4 2493.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR SYNCHRO SELECT NITINOL STAINLESS STEEL STRAIGHT L300 CM L35 CM OD.014 IN SOFT EXCHANGE LENGTH SUP-SSFT300STR CDM 0270 RC outpatient 2249 2249 2249 74 1664.26 percent of total billed charges 2249 93 1821.69 percent of total billed charges 2249 2249 other OPPS APC 2249 2249 other OPPS APC 2249 27.63 621.4 percent of total billed charges 2249 2249 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHIELD OPHTHALMIC PMMA LARGE L24 MM X W22 MM CORNEA HANDLE STERILE BLACK CLEAR SUP-SSHA-03-10 CDM outpatient 54.6 54.6 54.6 54.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTRODUCER SAFESHEATH II LONG L23CM L 28.5CM OD 10.5 FR VASCULAR SIDEPORT TEAR AWAY DILATOR HEMOSTATIC VALVE ORANGE SUP-SSL105 CDM 0481 RC outpatient 474.5 474.5 474.5 74 351.13 percent of total billed charges 474.5 93 384.35 percent of total billed charges 474.5 474.5 other OPPS APC 474.5 474.5 other OPPS APC 474.5 51 242 percent of total billed charges 474.5 474.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTRODUCER SAFESHEATH II LONG L23CM L 28.5CM OD 7 FR VASCULAR SIDEPORT TEAR AWAY DILATOR HEMOSTATIC VALVE ORANGE SUP-SSL7 CDM 0481 RC outpatient 474.5 474.5 474.5 74 351.13 percent of total billed charges 474.5 93 384.35 percent of total billed charges 474.5 474.5 other OPPS APC 474.5 474.5 other OPPS APC 474.5 51 242 percent of total billed charges 474.5 474.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTRODUCER SAFESHEATH II LONG L23CM L 28.5CM OD 9 FR VASCULAR SIDEPORT TEAR AWAY DILATOR HEMOSTATIC VALVE ORANGE SUP-SSL9 CDM 0275 RC outpatient 94.9 94.9 94.9 57 54.09 percent of total billed charges 94.9 93 76.87 percent of total billed charges 94.9 94.9 other OPPS APC 94.9 94.9 other OPPS APC 94.9 51 48.4 percent of total billed charges 94.9 94.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE SAFESEPT 150CM TRANSSEPTAL SUP-SSNF CDM 0481 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 51 331.5 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER SIGMA SSR300 SUP-SSR300SERIES CDM 0270 RC outpatient 11960 11960 11960 74 8850.4 percent of total billed charges 11960 93 9687.6 percent of total billed charges 11960 11960 other OPPS APC 11960 11960 other OPPS APC 11960 27.63 3304.55 percent of total billed charges 11960 11960 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STYLET STRAIGHTENING SUP-SST-650 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR NITINOL STAINLESS STEEL STANDARD L215 CM L45 CM OD.014 IN PRESHAPE ACCESS SUP-SSTD215PRE CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYNCHRO SELECT STANDARD STRAIGHT 0.014IN X 215CM SUP-SSTD215STR CDM 0270 RC outpatient 1934.4 1934.4 1934.4 74 1431.46 percent of total billed charges 1934.4 93 1566.86 percent of total billed charges 1934.4 1934.4 other OPPS APC 1934.4 1934.4 other OPPS APC 1934.4 27.63 534.47 percent of total billed charges 1934.4 1934.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR SYNCHRO SELECT NITINOL STAINLESS STEEL STANDARD L300 CM L35 CM OD.014 IN EXCHANGE PRESHAPE SUP-SSTD300PRE CDM 0270 RC outpatient 2249 2249 2249 74 1664.26 percent of total billed charges 2249 93 1821.69 percent of total billed charges 2249 2249 other OPPS APC 2249 2249 other OPPS APC 2249 27.63 621.4 percent of total billed charges 2249 2249 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR SYNCHRO SELECT NITINOL STAINLESS STEEL STANDARD L300 CM L35 CM OD.014 IN EXCHANGE SUP-SSTD300STR CDM 0270 RC outpatient 2249 2249 2249 74 1664.26 percent of total billed charges 2249 93 1821.69 percent of total billed charges 2249 2249 other OPPS APC 2249 2249 other OPPS APC 2249 27.63 621.4 percent of total billed charges 2249 2249 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHIELD CONTAMINATION TWISTLOCK CATH-GARD L80 CM PERCUTANEOUS ADAPTER BLUE 7 FR CATHETER SUP-ST-09870 CDM 0270 RC outpatient 27.86 27.86 27.86 74 20.62 percent of total billed charges 27.86 93 22.57 percent of total billed charges 27.86 27.86 other OPPS APC 27.86 27.86 other OPPS APC 27.86 27.63 7.7 percent of total billed charges 27.86 27.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE-TEX THIN WALL L40 CM ID6 MM PERIPHERAL STRETCH STERILE SUP-ST0604 CDM 0270 RC outpatient 1679.6 1679.6 1679.6 74 1242.9 percent of total billed charges 1679.6 93 1360.48 percent of total billed charges 1679.6 1679.6 other OPPS APC 1679.6 1679.6 other OPPS APC 1679.6 27.63 464.07 percent of total billed charges 1679.6 1679.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JOINT TOE SMART TOE TITANIUM ALLOY NITINOL 10 D THK1.2 MM L16 MM X W2-5.5 MM L10 MM X W3-6 MM INTRAMEDULLARY 1 PIECE NONUNION RESISTS ROTATION WITHOUT POSTOPERATIVE NO HEALTHY JOINT DISRUPTION SUP-ST0A-16 CDM 0270 RC outpatient 3104.4 3104.4 3104.4 74 2297.26 percent of total billed charges 3104.4 93 2514.56 percent of total billed charges 3104.4 3104.4 other OPPS APC 3104.4 3104.4 other OPPS APC 3104.4 27.63 857.75 percent of total billed charges 3104.4 3104.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JOINT TOE SMART TOE II NITINOL 10 D L6 MM L19 MM X W2-5.5 MM X H1.2 MM L13 MM X W3-6 MM SMALL BONE 1 PIECE HOLE STERILE SUP-ST0A-19 CDM 0270 RC outpatient 3104.4 3104.4 3104.4 74 2297.26 percent of total billed charges 3104.4 93 2514.56 percent of total billed charges 3104.4 3104.4 other OPPS APC 3104.4 3104.4 other OPPS APC 3104.4 27.63 857.75 percent of total billed charges 3104.4 3104.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. JOINT TOE SMART TOE II NITINOL 10 D FLAT L16 MM FOOT ANKLE INTRAMEDULLARY 1 PIECE HOLE STERILE SUP-STOA-16P CDM 0270 RC outpatient 2327.78 2327.78 2327.78 74 1722.56 percent of total billed charges 2327.78 93 1885.5 percent of total billed charges 2327.78 2327.78 other OPPS APC 2327.78 2327.78 other OPPS APC 2327.78 27.63 643.17 percent of total billed charges 2327.78 2327.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE STRAIGHT DISTAL VOLAR RADIAL FRAGMENT STERILE SUP-STR CDM 0270 RC outpatient 1365 1365 1365 74 1010.1 percent of total billed charges 1365 93 1105.65 percent of total billed charges 1365 1365 other OPPS APC 1365 1365 other OPPS APC 1365 27.63 377.15 percent of total billed charges 1365 1365 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INSTRUMENT SPINESTAR ABLATION SUP-STR-1015L CDM 0270 RC outpatient 7257.25 7257.25 7257.25 74 5370.37 percent of total billed charges 7257.25 93 5878.37 percent of total billed charges 7257.25 7257.25 other OPPS APC 7257.25 7257.25 other OPPS APC 7257.25 27.63 2005.18 percent of total billed charges 7257.25 7257.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE FIXATION SECURESTRAP L5 MM ABSORBABLE STRAP HERNIA REPAIR SUP-STRAP12 CDM 0270 RC outpatient 847.3 847.3 847.3 74 627 percent of total billed charges 847.3 93 686.31 percent of total billed charges 847.3 847.3 other OPPS APC 847.3 847.3 other OPPS APC 847.3 27.63 234.11 percent of total billed charges 847.3 847.3 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE FIXATION SECURESTRAP 5MM DISPOSABLE 25 ABSORBABLE STRAP MESH HERNIA REPAIR SUP-STRAP25 CDM 0270 RC outpatient 1273.58 1273.58 1273.58 74 942.45 percent of total billed charges 1273.58 93 1031.6 percent of total billed charges 1273.58 1273.58 other OPPS APC 1273.58 1273.58 other OPPS APC 1273.58 27.63 351.89 percent of total billed charges 1273.58 1273.58 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUBE DRAIN SILICONE T L30CM OD 10FR SOFT PLIABLE SUP-SU130-1228 CDM 270009031 LOCAL 0270 RC outpatient 611 611 611 74 452.14 percent of total billed charges 611 93 494.91 percent of total billed charges 611 611 other OPPS APC 611 611 other OPPS APC 611 27.63 168.82 percent of total billed charges 611 611 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RESERVOIR DRAINAGE JACKSON-PRATT BULB 100CC SILICONE DISPOSABLE STERILE LF SUP-SU130-1305 CDM 0481 RC outpatient 8.35 8.35 8.35 74 6.18 percent of total billed charges 8.35 93 6.76 percent of total billed charges 8.35 8.35 other OPPS APC 8.35 8.35 other OPPS APC 8.35 51 4.26 percent of total billed charges 8.35 8.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN WOUND JACKSON-PRATT SILICONE FLAT L20 CM X W7 MM FULL PERFORATION WITHOUT TROCAR SUP-SU130-1310 CDM 270009031 LOCAL 0270 RC outpatient 9.91 9.91 9.91 74 7.33 percent of total billed charges 9.91 93 8.03 percent of total billed charges 9.91 9.91 other OPPS APC 9.91 9.91 other OPPS APC 9.91 27.63 2.74 percent of total billed charges 9.91 9.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN INCISION JACKSON-PRATT ROUND 10FR SILICONE DISPOSABLE STERILE LF PERFORATE END WITHOUT TROCAR RADIOPAQUE RESERVOIR SUP-SU130-1321 CDM 270009031 LOCAL 0270 RC outpatient 9.91 9.91 9.91 74 7.33 percent of total billed charges 9.91 93 8.03 percent of total billed charges 9.91 9.91 other OPPS APC 9.91 9.91 other OPPS APC 9.91 27.63 2.74 percent of total billed charges 9.91 9.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN INCISION JACKSON-PRATT SILICONE ROUND L3/16 IN OD15 FR END PERFORATE WITHOUT TROCAR RADIOPAQUE STERILE LATEX FREE DISPOSABLE SUP-SU130-1323 CDM 0481 RC outpatient 9.91 9.91 9.91 74 7.33 percent of total billed charges 9.91 93 8.03 percent of total billed charges 9.91 9.91 other OPPS APC 9.91 9.91 other OPPS APC 9.91 51 5.05 percent of total billed charges 9.91 9.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRAIN INCISION JACKSON-PRATT SILICONE ROUND L1/4 IN OD19 FR END PERFORATE WITHOUT TROCAR RADIOPAQUE STERILE LATEX FREE DISPOSABLE SUP-SU130-1325 CDM 0270 RC outpatient 14.4 14.4 14.4 74 10.66 percent of total billed charges 14.4 93 11.66 percent of total billed charges 14.4 14.4 other OPPS APC 14.4 14.4 other OPPS APC 14.4 27.63 3.98 percent of total billed charges 14.4 14.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT DRAINAGE JACKSON-PRATT PVC 1/8 IN ROUND OD10 FR 400 ML 3 SPRING RESERVOIR TROCAR Y CONNECTOR STERILE LATEX FREE DISPOSABLE SUP-SU130-402D CDM 270009033 LOCAL 0270 RC outpatient 18.83 18.83 18.83 74 13.93 percent of total billed charges 18.83 93 15.25 percent of total billed charges 18.83 18.83 other OPPS APC 18.83 18.83 other OPPS APC 18.83 27.63 5.2 percent of total billed charges 18.83 18.83 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEP ARTERY ROCHESTER OCHSNER 1 X 2 TEETH STRAIGHT 8.0IN SUP-SU2804 CDM 0270 RC outpatient 40.72 40.72 40.72 74 30.13 percent of total billed charges 40.72 93 32.98 percent of total billed charges 40.72 40.72 other OPPS APC 40.72 40.72 other OPPS APC 40.72 27.63 11.25 percent of total billed charges 40.72 40.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER LEAD SAFESHEATH ULTRA SILICONE L13 CM OD9 FR HEMOSTATIC VALVE LOW PROFILE TEAR AWAY SIDEPORT ERGONOMICALLY DESIGNED SUP-SU9 CDM 0270 RC outpatient 247 247 247 74 182.78 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 27.63 68.25 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER LEAD SAFESHEATH ULTRA SILICONE L23 CM OD7 FR HEMOSTATIC VALVE LOW PROFILE TEAR AWAY SIDEPORT ERGONOMICALLY DESIGNED SUP-SUL7 CDM 0275 RC outpatient 247 247 247 57 140.79 percent of total billed charges 247 93 200.07 percent of total billed charges 247 247 other OPPS APC 247 247 other OPPS APC 247 51 125.97 percent of total billed charges 247 247 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROTECTOR TEETH SUP-SUN-9-3041-03 CDM outpatient 7.23 7.23 7.23 7.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE SUCTION ORCA STERILE DISPOSABLE OLYMPUS SUP-SUV-617-50 CDM 0270 RC outpatient 23.43 23.43 23.43 74 17.34 percent of total billed charges 23.43 93 18.98 percent of total billed charges 23.43 23.43 other OPPS APC 23.43 23.43 other OPPS APC 23.43 27.63 6.47 percent of total billed charges 23.43 23.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT RESTORE FLOW SAPHENOUS VEIN CRYO PRESERVED SUP-SV104 CDM 0270 RC outpatient 19890 19890 19890 74 14718.6 percent of total billed charges 19890 93 16110.9 percent of total billed charges 19890 19890 other OPPS APC 19890 19890 other OPPS APC 19890 27.63 5495.61 percent of total billed charges 19890 19890 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. NEEDLE BRONCHOSCOPIC WANG L15 MM OD21 GA TRANSBRONCHIAL LUMEN ASPIRATE BIOPSY STERILE LATEX FREE DISPOSABLE CENTRAL SUP-SW-221 CDM 0270 RC outpatient 137.94 137.94 137.94 74 102.08 percent of total billed charges 137.94 93 111.73 percent of total billed charges 137.94 137.94 other OPPS APC 137.94 137.94 other OPPS APC 137.94 27.63 38.11 percent of total billed charges 137.94 137.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SUTURING ETHIBOND EXCEL 0 EEN L6 IN STERILE DISPOSABLE SUP-SW110 CDM 0270 RC outpatient 53.24 53.24 53.24 74 39.4 percent of total billed charges 53.24 93 43.12 percent of total billed charges 53.24 53.24 other OPPS APC 53.24 53.24 other OPPS APC 53.24 27.63 14.71 percent of total billed charges 53.24 53.24 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD SUTURE ASSISTANT ETHIBOND EXCEL 0 SH 6IN PRETIED KNOT SUP-SW120 CDM 0270 RC outpatient 55.1 55.1 55.1 74 40.77 percent of total billed charges 55.1 93 44.63 percent of total billed charges 55.1 55.1 other OPPS APC 55.1 55.1 other OPPS APC 55.1 27.63 15.22 percent of total billed charges 55.1 55.1 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SUTURE STRATAFIX PDO 1 CTX L36 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM VIOLET BIDIRECTIONAL SUP-SXPD2B405 CDM 0270 RC outpatient 79.8 79.8 79.8 74 59.05 percent of total billed charges 79.8 93 64.64 percent of total billed charges 79.8 79.8 other OPPS APC 79.8 79.8 other OPPS APC 79.8 27.63 22.05 percent of total billed charges 79.8 79.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SUTURE 0 30CM STRATAFIX SPIRAL PDS PLUS VIOLET CT-1 SUP-SXPP1B450 CDM 0270 RC outpatient 102.64 102.64 102.64 74 75.95 percent of total billed charges 102.64 93 83.14 percent of total billed charges 102.64 102.64 other OPPS APC 102.64 102.64 other OPPS APC 102.64 27.63 28.36 percent of total billed charges 102.64 102.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SUTURE 0 23CM STRATAFIX SPIRAL PDS PLUS CT-1 SUP-SXPP1B455 CDM 0270 RC outpatient 105.23 105.23 105.23 74 77.87 percent of total billed charges 105.23 93 85.24 percent of total billed charges 105.23 105.23 other OPPS APC 105.23 105.23 other OPPS APC 105.23 27.63 29.08 percent of total billed charges 105.23 105.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT-P C2TR01 SYNCRA SYSTEM WITH ATTAIN LV LEAD SUP-SYNCRACRIPTMEAM CDM 0275 RC outpatient 15400 15400 15400 57 8778 percent of total billed charges 15400 93 12474 percent of total billed charges 15400 15400 other OPPS APC 15400 15400 other OPPS APC 15400 51 7854 percent of total billed charges 15400 15400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT-P C2TR01 SYNCRA SYSTEM W/STARFIX LV LEAD SUP-SYNCRACRTPMEPM CDM 0275 RC outpatient 15400 15400 15400 57 8778 percent of total billed charges 15400 93 12474 percent of total billed charges 15400 15400 other OPPS APC 15400 15400 other OPPS APC 15400 51 7854 percent of total billed charges 15400 15400 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER SYNCRA SYSTEM CRT-P SUP-SYNCRASYS CDM 0275 RC outpatient 23907 23907 23907 57 13627 percent of total billed charges 23907 93 19364.7 percent of total billed charges 23907 23907 other OPPS APC 23907 23907 other OPPS APC 23907 51 12192.6 percent of total billed charges 23907 23907 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE MEDICAL 60 ML LUER LOCK STERILE LATEX FREE SUP-SYR160010Z CDM 0270 RC outpatient 1.54 1.54 1.54 74 1.14 percent of total billed charges 1.54 93 1.25 percent of total billed charges 1.54 1.54 other OPPS APC 1.54 1.54 other OPPS APC 1.54 27.63 0.43 percent of total billed charges 1.54 1.54 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SIZER GEL 325CC SUP-SZ20325 CDM 0270 RC outpatient 546 546 546 74 404.04 percent of total billed charges 546 93 442.26 percent of total billed charges 546 546 other OPPS APC 546 546 other OPPS APC 546 27.63 150.86 percent of total billed charges 546 546 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GEL SIZER 350CC SUP-SZ20350 CDM 0270 RC outpatient 546 546 546 74 404.04 percent of total billed charges 546 93 442.26 percent of total billed charges 546 546 other OPPS APC 546 546 other OPPS APC 546 27.63 150.86 percent of total billed charges 546 546 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE LABELING TIME 3 IN L2160 IN X W.5 IN ROLL ADHESIVE CORE RED SUP-T-1260-5 CDM 0270 RC outpatient 13.13 13.13 13.13 74 9.72 percent of total billed charges 13.13 93 10.64 percent of total billed charges 13.13 13.13 other OPPS APC 13.13 13.13 other OPPS APC 13.13 27.63 3.63 percent of total billed charges 13.13 13.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUNNELER T17X8 W SHEATH SUP-T11X10 CDM 0270 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 27.63 21.55 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BLANKET WARMING L10.5 IN X W10.5 IN KNEE SHOULDER COLD MOTORIZED PORTABLE NONSTERILE SUP-T5035NS CDM 0270 RC outpatient 54.91 54.91 54.91 74 40.63 percent of total billed charges 54.91 93 44.48 percent of total billed charges 54.91 54.91 other OPPS APC 54.91 54.91 other OPPS APC 54.91 27.63 15.17 percent of total billed charges 54.91 54.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC HANCOCK II ULTRA CINCH PORCINE H15.0 MM OD21 MM BIOPROSTHESIS STENTED HOLDER SEWING RING SUP-T505U221 CDM 0270 RC outpatient 8710 8710 8710 74 6445.4 percent of total billed charges 8710 93 7055.1 percent of total billed charges 8710 8710 other OPPS APC 8710 8710 other OPPS APC 8710 27.63 2406.57 percent of total billed charges 8710 8710 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC HANCOCK II ULTRA CINCH PORCINE H16.0 MM OD23 MM BIOPROSTHESIS STENTED HOLDER SEWING RING SUP-T505U223 CDM 0270 RC outpatient 8710 8710 8710 74 6445.4 percent of total billed charges 8710 93 7055.1 percent of total billed charges 8710 8710 other OPPS APC 8710 8710 other OPPS APC 8710 27.63 2406.57 percent of total billed charges 8710 8710 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC HANCOCK II ULTRA CINCH PORCINE H17.5 MM OD25 MM BIOPROSTHESIS STENTED HOLDER SEWING RING SUP-T505U225 CDM 0270 RC outpatient 8710 8710 8710 74 6445.4 percent of total billed charges 8710 93 7055.1 percent of total billed charges 8710 8710 other OPPS APC 8710 8710 other OPPS APC 8710 27.63 2406.57 percent of total billed charges 8710 8710 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC HANCOCK II ULTRA CINCH PORCINE H18.5 MM OD27 MM BIOPROSTHESIS STENTED HOLDER SEWING RING SUP-T505U227 CDM 0270 RC outpatient 8710 8710 8710 74 6445.4 percent of total billed charges 8710 93 7055.1 percent of total billed charges 8710 8710 other OPPS APC 8710 8710 other OPPS APC 8710 27.63 2406.57 percent of total billed charges 8710 8710 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC HANCOCK II ULTRA CINCH PORCINE H20.0 MM OD29 MM BIOPROSTHESIS STENTED HOLDER SEWING RING SUP-T505U229 CDM 0270 RC outpatient 8710 8710 8710 74 6445.4 percent of total billed charges 8710 93 7055.1 percent of total billed charges 8710 8710 other OPPS APC 8710 8710 other OPPS APC 8710 27.63 2406.57 percent of total billed charges 8710 8710 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL HANCOCK II CINCH PORCINE 18 MM OD25 MM BIOPROSTHESIS STENTED HOLDER SUP-T510C25 CDM 0270 RC outpatient 9880 9880 9880 74 7311.2 percent of total billed charges 9880 93 8002.8 percent of total billed charges 9880 9880 other OPPS APC 9880 9880 other OPPS APC 9880 27.63 2729.84 percent of total billed charges 9880 9880 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL HANCOCK II CINCH PORCINE 19 MM OD27 MM BIOPROSTHESIS STENTED HOLDER SUP-T510C27 CDM 0270 RC outpatient 9880 9880 9880 74 7311.2 percent of total billed charges 9880 93 8002.8 percent of total billed charges 9880 9880 other OPPS APC 9880 9880 other OPPS APC 9880 27.63 2729.84 percent of total billed charges 9880 9880 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL HANCOCK II CINCH PORCINE 20.5 MM OD29 MM BIOPROSTHESIS STENTED HOLDER SUP-T510C29 CDM 0270 RC outpatient 9880 9880 9880 74 7311.2 percent of total billed charges 9880 93 8002.8 percent of total billed charges 9880 9880 other OPPS APC 9880 9880 other OPPS APC 9880 27.63 2729.84 percent of total billed charges 9880 9880 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL HANCOCK II CINCH PORCINE 22 MM OD31 MM BIOPROSTHESIS STENTED HOLDER SUP-T510C31 CDM 0270 RC outpatient 9880 9880 9880 74 7311.2 percent of total billed charges 9880 93 8002.8 percent of total billed charges 9880 9880 other OPPS APC 9880 9880 other OPPS APC 9880 27.63 2729.84 percent of total billed charges 9880 9880 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE MITRAL HANCOCK II CINCH PORCINE 23 MM OD33 MM BIOPROSTHESIS STENTED HOLDER SUP-T510C33 CDM 0270 RC outpatient 9880 9880 9880 74 7311.2 percent of total billed charges 9880 93 8002.8 percent of total billed charges 9880 9880 other OPPS APC 9880 9880 other OPPS APC 9880 27.63 2729.84 percent of total billed charges 9880 9880 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY TRYTON 2.5/2.5 RAPID EXCHANGE RADIOPAQUE SIDE BRANCH CATHETER ACCEPTS .014 IN GUIDEWIRE 5FR GUIDE CATHETER 19MM SUP-T52525191US_52188 CDM 0481 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 51 1723.8 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BMS TRYTON 2.5-3.0 X19 MM SUP-T52530191US_52189 CDM 0481 RC outpatient 5070 5070 5070 74 3751.8 percent of total billed charges 5070 93 4106.7 percent of total billed charges 5070 5070 other OPPS APC 5070 5070 other OPPS APC 5070 51 2585.7 percent of total billed charges 5070 5070 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY TRYTON 2.5/3.5 RAPID EXCHANGE RADIOPAQUE SIDE BRANCH CATHETER ACCEPTS .014 IN GUIDEWIRE 5FR GUIDE CATHETER 19 SUP-T52535191US_52190 CDM 0481 RC outpatient 5070 5070 5070 74 3751.8 percent of total billed charges 5070 93 4106.7 percent of total billed charges 5070 5070 other OPPS APC 5070 5070 other OPPS APC 5070 51 2585.7 percent of total billed charges 5070 5070 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY TRYTON 30/35 RAPID EXCHANGE RADIOPAQUE SIDE BRANCH CATHETER ACCEPTS .014 IN GUIDEWIRE 5FR GUIDE CATHETER 15 SUP-T53035151US_52191 CDM 0481 RC outpatient 5070 5070 5070 74 3751.8 percent of total billed charges 5070 93 4106.7 percent of total billed charges 5070 5070 other OPPS APC 5070 5070 other OPPS APC 5070 51 2585.7 percent of total billed charges 5070 5070 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT CORONARY TRYTON COCR NYLON THK85 UM .02 IN L15MM L140CM OD 3.5-4 MM ODSEC.035IN RAPID EXCHANGE RADIOPAQUE SIDE BRANCH CATHETER ACCEPTS .014 IN GUIDEWIRE 6FR GUIDE CATHETER SUP-T53540151US_52192 CDM 0481 RC outpatient 3380 3380 3380 74 2501.2 percent of total billed charges 3380 93 2737.8 percent of total billed charges 3380 3380 other OPPS APC 3380 3380 other OPPS APC 3380 51 1723.8 percent of total billed charges 3380 3380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TENOLOCK ANCHOR SUP-T60S CDM 0270 RC outpatient 894.71 894.71 894.71 74 662.09 percent of total billed charges 894.71 93 724.72 percent of total billed charges 894.71 894.71 other OPPS APC 894.71 894.71 other OPPS APC 894.71 27.63 247.21 percent of total billed charges 894.71 894.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. THERAPY COLD SUP-T800 CDM 0270 RC outpatient 180.7 180.7 180.7 74 133.72 percent of total billed charges 180.7 93 146.37 percent of total billed charges 180.7 180.7 other OPPS APC 180.7 180.7 other OPPS APC 180.7 27.63 49.93 percent of total billed charges 180.7 180.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ADPATER TITANIUM FOR TRANSFER KIT SUP-TA-200 CDM 0270 RC outpatient 273 273 273 74 202.02 percent of total billed charges 273 93 221.13 percent of total billed charges 273 273 other OPPS APC 273 273 other OPPS APC 273 27.63 75.43 percent of total billed charges 273 273 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAG GENESIS BASKET MID BLUE SUP-TB3-10 CDM outpatient 11.34 11.34 11.34 11.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH TX2 L80 MM OD28 MM ODSEC20 FR THORACIC TBE COMPONENT PROXIMAL EXTENSION PROFORM AA SUP-TBE-28-80-PF-US CDM 270010015 LOCAL 0270 RC outpatient 14339 14339 14339 74 10610.9 percent of total billed charges 14339 93 11614.6 percent of total billed charges 14339 14339 other OPPS APC 14339 14339 other OPPS APC 14339 27.63 3961.87 percent of total billed charges 14339 14339 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH TX2 PRO-FORM Z-TRAK PLUS POLYESTER STAINLESS STEEL BIFURCATED L80 MM OD30 MM ID20 FR THORACIC AORTIC ANEURYSM PROXIMAL EXTENSION PRO-FORM Z-TRAK PLUS INTRODUCTION SYSTEM AAA SUP-TBE-30-80-PF-US CDM 270010015 LOCAL 0270 RC outpatient 14339 14339 14339 74 10610.9 percent of total billed charges 14339 93 11614.6 percent of total billed charges 14339 14339 other OPPS APC 14339 14339 other OPPS APC 14339 27.63 3961.87 percent of total billed charges 14339 14339 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH TX2 PRO-FORM Z-TRAK PLUS POLYESTER STAINLESS STEEL BIFURCATED L80 MM OD32 MM ODSEC20 FR THORAX AORTA SELF EXPANDING WOVEN PROXIMAL INTRODUCTION SYSTEM AAA SUP-TBE-32-80-PF-US CDM 270010015 LOCAL 0270 RC outpatient 14339 14339 14339 74 10610.9 percent of total billed charges 14339 93 11614.6 percent of total billed charges 14339 14339 other OPPS APC 14339 14339 other OPPS APC 14339 27.63 3961.87 percent of total billed charges 14339 14339 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH TX2 L77 MM OD34 MM ODSEC20 FR THORACIC AORTIC ANEURYSM DISTAL EXTENSION TBE COMPONENT PROFORM SUP-TBE-34-77-PF-US CDM 270010015 LOCAL 0270 RC outpatient 14339 14339 14339 74 10610.9 percent of total billed charges 14339 93 11614.6 percent of total billed charges 14339 14339 other OPPS APC 14339 14339 other OPPS APC 14339 27.63 3961.87 percent of total billed charges 14339 14339 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH TX2 L77 MM OD36 MM ODSEC22 FR PROXIMAL EXTENSION Z-TRAK PLUS TAA SUP-TBE-36-77-PF-US CDM 270010015 LOCAL 0270 RC outpatient 14339 14339 14339 74 10610.9 percent of total billed charges 14339 93 11614.6 percent of total billed charges 14339 14339 other OPPS APC 14339 14339 other OPPS APC 14339 27.63 3961.87 percent of total billed charges 14339 14339 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH TX2 L81 MM OD40 MM ODSEC8.5 MM ID22 FR THORACIC AORTIC ANEURYSM PRO-FORM Z-TRAK PLUS INTRODUCTION SYSTEM TBE COMPONENT PROXIMAL EXTENSION SUP-TBE-40-81-PF-US CDM 270010015 LOCAL 0270 RC outpatient 14339 14339 14339 74 10610.9 percent of total billed charges 14339 93 11614.6 percent of total billed charges 14339 14339 other OPPS APC 14339 14339 other OPPS APC 14339 27.63 3961.87 percent of total billed charges 14339 14339 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH TX2 POLYESTER L81 MM OD42 MM ID22 FR THORACIC AORTIC ANEURYSM PROXIMAL EXTENSION PRO-FORM Z-TRAK PLUS INTRODUCTION SYSTEM SUP-TBE-42-81-PF-US CDM 270010015 LOCAL 0270 RC outpatient 14339 14339 14339 74 10610.9 percent of total billed charges 14339 93 11614.6 percent of total billed charges 14339 14339 other OPPS APC 14339 14339 other OPPS APC 14339 27.63 3961.87 percent of total billed charges 14339 14339 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG SPECIMEN RETRIEVAL AMI L5 MM 100 ML ABDOMEN TROCAR STERILE DISPOSABLE SUP-TBI1031 CDM 0270 RC outpatient 188.5 188.5 188.5 74 139.49 percent of total billed charges 188.5 93 152.69 percent of total billed charges 188.5 188.5 other OPPS APC 188.5 188.5 other OPPS APC 188.5 27.63 52.08 percent of total billed charges 188.5 188.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL VIEWSITE 6MM X 7CM X 4MM BRAIN SELF-RETAINING SUP-TC060407 CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL VIEWSITE 12MM X 3CM X 8MM CYLINDRICAL STABLE INTRODUCER CHANNEL CLEAR STERILE SINGLE-USE F/BRAIN ACCESS SYSTEM SUP-TC120803 CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL VIEWSITE 12MM X 5CM X 8MM CYLINDRICAL STABLE INTRODUCER CHANNEL CLEAR STERILE SINGLE-USE F/BRAIN ACCESS SYSTEM SUP-TC120805.AC CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL VIEWSITE OD27 MM L5 CM OD12 MM ODSEC8 MM ALIGNMENT CLIP SELF RETAIN SUP-TC120805AC CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL VIEWSITE 12MM X 7CM X 8MM CYLINDRICAL STABLE INTRODUCER CHANNEL CLEAR STERILE SINGLE-USE F/BRAIN ACCESS SYSTEM SUP-TC120807.AC CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL VIEWSITE OD27 MM L7 CM OD12 MM ODSEC8 MM ALIGNMENT CLIP SELF RETAIN SUP-TC120807AC CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SET RETRACTOR SURGICAL VIEWSITE 3CM 17MM X 11MM W/INTRODUCER WORKING CHANNEL PORT SUP-TC171103 CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL VIEWSITE 17MM X 5CM X 11MM CYLINDRICAL STABLE INTRODUCER CHANNEL CLEAR STERILE SINGLE-USE F/BRAIN ACCESS SYSTEM SUP-TC171105.AC CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL VIEWSITE OD32 MM L5 CM OD17 MM ODSEC11 MM ALIGNMENT CLIP SELF RETAIN SUP-TC171105AC CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL VIEWSITE 17MM X 7CM X 11MM CYLINDRICAL STABLE INTRODUCER CHANNEL CLEAR STERILE SINGLE-USE F/BRAIN ACCESS SYSTEM SUP-TC171107.AC CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL VIEWSITE OD32 MM L7 CM OD17 MM ODSEC11 MM ALIGNMENT CLIP SELF RETAIN SUP-TC171107AC CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL VIEWSITE 21MM X 3CM X 15MM CYLINDRICAL STABLE INTRODUCER CHANNEL CLEAR STERILE SINGLE-USE F/BRAIN ACCESS SYSTEM SUP-TC211503 CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL VIEWSITE 21MM X 5CM X 15MM CYLINDRICAL STABLE INTRODUCER CHANNEL CLEAR STERILE SINGLE-USE F/BRAIN ACCESS SYSTEM SUP-TC211505.AC CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL VIEWSITE 21MM X 7CM X 15MM CYLINDRICAL STABLE INTRODUCER CHANNEL CLEAR STERILE SINGLE-USE F/BRAIN ACCESS SYSTEM SUP-TC211507.AC CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL VIEWSITE 28MM X 3CM X 20MM CYLINDRICAL STABLE INTRODUCER CHANNEL CLEAR STERILE SINGLE-USE F/BRAIN ACCESS SYSTEM SUP-TC282003 CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL VIEWSITE 28MM X 5CM X 20MM CYLINDRICAL STABLE INTRODUCER CHANNEL CLEAR STERILE SINGLE-USE F/BRAIN ACCESS SYSTEM SUP-TC282005.AC CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL VIEWSITE 28MM X 7CM X 20MM CYLINDRICAL STABLE INTRODUCER CHANNEL CLEAR STERILE SINGLE-USE F/BRAIN ACCESS SYSTEM SUP-TC282007.AC CDM 0270 RC outpatient 1807 1807 1807 74 1337.18 percent of total billed charges 1807 93 1463.67 percent of total billed charges 1807 1807 other OPPS APC 1807 1807 other OPPS APC 1807 27.63 499.27 percent of total billed charges 1807 1807 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER PROXIMATE TITANIUM L55 MM X H3.81 MM H3.81 MM REGULAR TISSUE 4 ROW LINEAR CUTTER CARTRIDGE SAFETY LOCK OUT DISPOSABLE BLUE SUP-TCR55 CDM 270009086 LOCAL 0270 RC outpatient 134.98 134.98 134.98 74 99.89 percent of total billed charges 134.98 93 109.33 percent of total billed charges 134.98 134.98 other OPPS APC 134.98 134.98 other OPPS APC 134.98 27.63 37.29 percent of total billed charges 134.98 134.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER PROXIMATE TITANIUM H3.85 MM H1.5 MM REGULAR TISSUE STERILE LATEX FREE DISPOSABLE BLUE ENDOSCOPIC SUP-TCR75 CDM 270009086 LOCAL 0270 RC outpatient 134.98 134.98 134.98 74 99.89 percent of total billed charges 134.98 93 109.33 percent of total billed charges 134.98 134.98 other OPPS APC 134.98 134.98 other OPPS APC 134.98 27.63 37.29 percent of total billed charges 134.98 134.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL PROXIMATE TITANIUM L90 MM X H1.5-2.5 MM H1.5 MM THICK TISSUE 2 ROW LINEAR CUTTER ADJUSTABLE HEAVY WIRE STERILE LATEX FREE DISPOSABLE ENDOSCOPIC SUP-TCT10 CDM 270009088 LOCAL 0270 RC outpatient 542.6 542.6 542.6 74 401.52 percent of total billed charges 542.6 93 439.51 percent of total billed charges 542.6 542.6 other OPPS APC 542.6 542.6 other OPPS APC 542.6 27.63 149.92 percent of total billed charges 542.6 542.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE TORQUE GLIDECATH .010-.038 IN GUIDEWIRE SUP-TD01 CDM 0270 RC outpatient 15.44 15.44 15.44 74 11.43 percent of total billed charges 15.44 93 12.51 percent of total billed charges 15.44 15.44 other OPPS APC 15.44 15.44 other OPPS APC 15.44 27.63 4.27 percent of total billed charges 15.44 15.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PROGRIP MESH 15X9 SUP-TEM1509G CDM 0270 RC outpatient 1004.87 1004.87 1004.87 74 743.6 percent of total billed charges 1004.87 93 813.94 percent of total billed charges 1004.87 1004.87 other OPPS APC 1004.87 1004.87 other OPPS APC 1004.87 27.63 277.65 percent of total billed charges 1004.87 1004.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL PARIETEX PROGRIP RECTANGLE L20 CM X W15 CM SELF FIXATING FLAT SHEET SUP-TEM2015G CDM 0270 RC outpatient 1183.78 1183.78 1183.78 74 876 percent of total billed charges 1183.78 93 958.86 percent of total billed charges 1183.78 1183.78 other OPPS APC 1183.78 1183.78 other OPPS APC 1183.78 27.63 327.08 percent of total billed charges 1183.78 1183.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRUE FLOW VALVULOPLASTY PERFUSION CATHETER 20MM SUP-TF0203511 CDM 0481 RC outpatient 5187 5187 5187 74 3838.38 percent of total billed charges 5187 93 4201.47 percent of total billed charges 5187 5187 other OPPS APC 5187 5187 other OPPS APC 5187 51 2645.37 percent of total billed charges 5187 5187 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRUE FLOW VALVULOPLASTY PERFUSION CATHETER 22MM SUP-TF0223512 CDM 0481 RC outpatient 5187 5187 5187 74 3838.38 percent of total billed charges 5187 93 4201.47 percent of total billed charges 5187 5187 other OPPS APC 5187 5187 other OPPS APC 5187 51 2645.37 percent of total billed charges 5187 5187 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRUE FLOW VALVULOPLASTY PERFUSION CATHETER 24MM SUP-TF0243514 CDM 0481 RC outpatient 5187 5187 5187 74 3838.38 percent of total billed charges 5187 93 4201.47 percent of total billed charges 5187 5187 other OPPS APC 5187 5187 other OPPS APC 5187 51 2645.37 percent of total billed charges 5187 5187 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "8F, 45 DEGREE FIXED-CURVE TRANSSEPTAL GUIDING SHEATH" SUP-TF85-32-63-45 CDM 0481 RC outpatient 416 416 416 74 307.84 percent of total billed charges 416 93 336.96 percent of total billed charges 416 416 other OPPS APC 416 416 other OPPS APC 416 51 212.16 percent of total billed charges 416 416 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT ENDOVASCULAR ZENITH ENDO GRAFT SUP-TFB-30-74 CDM 270010015 LOCAL 0270 RC outpatient 23329.8 23329.8 23329.8 74 17264 percent of total billed charges 23329.8 93 18897.1 percent of total billed charges 23329.8 23329.8 other OPPS APC 23329.8 23329.8 other OPPS APC 23329.8 27.63 6446.02 percent of total billed charges 23329.8 23329.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX Z-TRAK POLYESTER STAINLESS STEEL BIFURCATED L111 MM OD22 MM ID18 FR ABDOMEN AORTA AORTOILIAC SELF EXPANDING WOVEN MAIN BODY INTRODUCTION SYSTEM AAA SUP-TFFB-22-111-ZT CDM 270010015 LOCAL 0270 RC outpatient 23329.8 23329.8 23329.8 74 17264 percent of total billed charges 23329.8 93 18897.1 percent of total billed charges 23329.8 23329.8 other OPPS APC 23329.8 23329.8 other OPPS APC 23329.8 27.63 6446.02 percent of total billed charges 23329.8 23329.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR BIFURCATED MAIN BODY ZENITH AAA SUP-TFFB-22-82-ZT CDM 270010015 LOCAL 0270 RC outpatient 18980 18980 18980 74 14045.2 percent of total billed charges 18980 93 15373.8 percent of total billed charges 18980 18980 other OPPS APC 18980 18980 other OPPS APC 18980 27.63 5244.17 percent of total billed charges 18980 18980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX Z-TRAK BIFURCATED 96MM 24MM 7.1MM 18FR POLYESTER SS SELF EXPANDING ANCILLARY WOVEN LEG SUP-TFFB-24-96-ZT CDM 270010015 LOCAL 0270 RC outpatient 18980 18980 18980 74 14045.2 percent of total billed charges 18980 93 15373.8 percent of total billed charges 18980 18980 other OPPS APC 18980 18980 other OPPS APC 18980 27.63 5244.17 percent of total billed charges 18980 18980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX Z-TRAK 2 BRANCH 82MM 26MM 18FR SS POLYESTER SELF EXPAND WOVEN LEG EXTENSION INTRODUCTION SUP-TFFB-26-82ZT CDM 270010015 LOCAL 0270 RC outpatient 23329.8 23329.8 23329.8 74 17264 percent of total billed charges 23329.8 93 18897.1 percent of total billed charges 23329.8 23329.8 other OPPS APC 23329.8 23329.8 other OPPS APC 23329.8 27.63 6446.02 percent of total billed charges 23329.8 23329.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX Z-TRAK POLYESTER STAINLESS STEEL WOVEN 2 BRANCH L111 MM OD30 MM ODSEC20 FR SELF EXPANDABLE ANCILLARY EG EXTENSION INTRODUCTION SYSTEM AAA SUP-TFFB-30-111ZT CDM 270010015 LOCAL 0270 RC outpatient 18980 18980 18980 74 14045.2 percent of total billed charges 18980 93 15373.8 percent of total billed charges 18980 18980 other OPPS APC 18980 18980 other OPPS APC 18980 27.63 5244.17 percent of total billed charges 18980 18980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX Z-TRAK POLYESTER STAINLESS STEEL BIFURCATED L82 MM OD30 MM ODSEC7.7 MM ID20 FR ABDOMINAL AORTIC ANEURYSM SELF EXPANDING ANCILLARY WOVEN LEG EXTENSION INTRODUCTION SYSTEM SUP-TFFB-30-82-ZT CDM 270010015 LOCAL 0270 RC outpatient 18980 18980 18980 74 14045.2 percent of total billed charges 18980 93 15373.8 percent of total billed charges 18980 18980 other OPPS APC 18980 18980 other OPPS APC 18980 27.63 5244.17 percent of total billed charges 18980 18980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX AAA BIFURCATED MAIN BODY SUP-TFFB-32-82-ZT CDM 270010015 LOCAL 0270 RC outpatient 24029.2 24029.2 24029.2 74 17781.6 percent of total billed charges 24029.2 93 19463.7 percent of total billed charges 24029.2 24029.2 other OPPS APC 24029.2 24029.2 other OPPS APC 24029.2 27.63 6639.27 percent of total billed charges 24029.2 24029.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX 2 BRANCH L113 MM OD36 MM OD22 FR ABDOMINAL AORTIC ANEURYSM ANCILLARY COMPONENT MAIN BODY INTRODUCER SHEATH SUP-TFFB-36-113-ZT CDM 270010015 LOCAL 0270 RC outpatient 18980 18980 18980 74 14045.2 percent of total billed charges 18980 93 15373.8 percent of total billed charges 18980 18980 other OPPS APC 18980 18980 other OPPS APC 18980 27.63 5244.17 percent of total billed charges 18980 18980 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC TRIFECTA GLIDE LINX BOVINE PERICARDIUM POLYESTER H15 MM H12 MM OD24 MM ODSEC19 MM FATIGUE RESISTANT LATEX FREE SUP-TFGT-19A CDM 0270 RC outpatient 12740 12740 12740 74 9427.6 percent of total billed charges 12740 93 10319.4 percent of total billed charges 12740 12740 other OPPS APC 12740 12740 other OPPS APC 12740 27.63 3520.06 percent of total billed charges 12740 12740 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC TRIFECTA GLIDE LINX TITANIUM POLYESTER PORCINE PERICARDIUM 13 MM H16 MM OD26 MM ODSEC21 MM RADIOPAQUE SEWING CUFF LATEX FREE SUP-TFGT-21A CDM 0270 RC outpatient 12740 12740 12740 74 9427.6 percent of total billed charges 12740 93 10319.4 percent of total billed charges 12740 12740 other OPPS APC 12740 12740 other OPPS APC 12740 27.63 3520.06 percent of total billed charges 12740 12740 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC TRIFECTA GLIDE LINX TITANIUM POLYESTER PORCINE PERICARDIUM 13 MM H17 MM OD28 MM ODSEC23 MM RADIOPAQUE SEWING CUFF LATEX FREE SUP-TFGT-23A CDM 0270 RC outpatient 12740 12740 12740 74 9427.6 percent of total billed charges 12740 93 10319.4 percent of total billed charges 12740 12740 other OPPS APC 12740 12740 other OPPS APC 12740 27.63 3520.06 percent of total billed charges 12740 12740 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC TRIFECTA GLIDE LINX TITANIUM POLYESTER PORCINE PERICARDIUM 13 MM H17 MM OD28 MM ODSEC25 MM RADIOPAQUE SEWING CUFF LATEX FREE SUP-TFGT-25A CDM 0270 RC outpatient 12740 12740 12740 74 9427.6 percent of total billed charges 12740 93 10319.4 percent of total billed charges 12740 12740 other OPPS APC 12740 12740 other OPPS APC 12740 27.63 3520.06 percent of total billed charges 12740 12740 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC TRIFECTA GLIDE LINX TITANIUM POLYESTER BOVINE PORCINE PERICARDIUM 15 MM H19 MM OD27 MM ODSEC33 MM FATIGUE RESISTANT SEWING CUFF LATEX FREE SUP-TFGT-27A CDM 0270 RC outpatient 12740 12740 12740 74 9427.6 percent of total billed charges 12740 93 10319.4 percent of total billed charges 12740 12740 other OPPS APC 12740 12740 other OPPS APC 12740 27.63 3520.06 percent of total billed charges 12740 12740 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE AORTIC TRIFECTA GLIDE LINX TITANIUM POLYESTER BOVINE PORCINE PERICARDIUM 16 MM H20 MM OD35 MM ODSEC29 MM FATIGUE RESISTANT SEWING CUFF LATEX FREE SUP-TFGT-29A CDM 0270 RC outpatient 12220 12220 12220 74 9042.8 percent of total billed charges 12220 93 9898.2 percent of total billed charges 12220 12220 other OPPS APC 12220 12220 other OPPS APC 12220 27.63 3376.39 percent of total billed charges 12220 12220 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX Z-TRAK POLYESTER STAINLESS STEEL WOVEN 2 BRANCH L90 MM OD12 MM ODSEC6 MM ID16 FR SELF EXPANDABLE ANCILLARY LEG EXTENSION INTRODUCTION SYSTEM AAA SUP-TFLE-12-90-ZT CDM 270010015 LOCAL 0270 RC outpatient 8021 8021 8021 74 5935.54 percent of total billed charges 8021 93 6497.01 percent of total billed charges 8021 8021 other OPPS APC 8021 8021 other OPPS APC 8021 27.63 2216.2 percent of total billed charges 8021 8021 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX L56 MM OD14 MM ID16 FR ABDOMINAL AORTIC ANEURYSM CONTRALATERAL IPSILATERAL ILIAC LEG SUP-TFLE-14-56-ZT CDM 270010015 LOCAL 0270 RC outpatient 8509.8 8509.8 8509.8 74 6297.25 percent of total billed charges 8509.8 93 6892.94 percent of total billed charges 8509.8 8509.8 other OPPS APC 8509.8 8509.8 other OPPS APC 8509.8 27.63 2351.26 percent of total billed charges 8509.8 8509.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX STAINLESS STEEL POLYESTER L56 MM OD18 MM ID16 FR SELF EXPAND ANCILLARY WOVEN LEG EXTENSION Z-TRAK AAA SUP-TFLE-18-56-ZT CDM 270010015 LOCAL 0270 RC outpatient 8509.8 8509.8 8509.8 74 6297.25 percent of total billed charges 8509.8 93 6892.94 percent of total billed charges 8509.8 8509.8 other OPPS APC 8509.8 8509.8 other OPPS APC 8509.8 27.63 2351.26 percent of total billed charges 8509.8 8509.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX L54 MM OD20 MM ODSEC16 FR CONTRALATERAL/IPSILATERAL ILIAC LEGS AAA SUP-TFLE-20-56-ZT CDM 270010015 LOCAL 0270 RC outpatient 7789.6 7789.6 7789.6 74 5764.3 percent of total billed charges 7789.6 93 6309.58 percent of total billed charges 7789.6 7789.6 other OPPS APC 7789.6 7789.6 other OPPS APC 7789.6 27.63 2152.27 percent of total billed charges 7789.6 7789.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH FLEX Z-TRAK POLYESTER STAINLESS STEEL BIFURCATED L56 MM OD22 MM ODSEC6 MM ID16 FR ABDOMINAL AORTIC ANEURYSM SELF EXPANDING ANCILLARY WOVEN LEG EXTENSION INTRODUCTION SYSTEM AAA SUP-TFLE-22-56-ZT CDM 270010015 LOCAL 0270 RC outpatient 8021 8021 8021 74 5935.54 percent of total billed charges 8021 93 6497.01 percent of total billed charges 8021 8021 other OPPS APC 8021 8021 other OPPS APC 8021 27.63 2216.2 percent of total billed charges 8021 8021 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VALVE HEART SIZE 33MM SUP-TFX730033 CDM 0270 RC outpatient 16380 16380 16380 74 12121.2 percent of total billed charges 16380 93 13267.8 percent of total billed charges 16380 16380 other OPPS APC 16380 16380 other OPPS APC 16380 27.63 4525.79 percent of total billed charges 16380 16380 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH CATHETER TOURGUIDE HYDROPHILIC 180 D L45 CM L9 MM ID6.5 FR STEERABLE SUP-TG0654509 CDM 0270 RC outpatient 1495 1495 1495 74 1106.3 percent of total billed charges 1495 93 1210.95 percent of total billed charges 1495 1495 other OPPS APC 1495 1495 other OPPS APC 1495 27.63 413.07 percent of total billed charges 1495 1495 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH CATHETER TOURGUIDE HYDROPHILIC 180 D L45 CM L17 MM ID6.5 FR STEERABLE SUP-TG0654517 CDM 0270 RC outpatient 1586 1586 1586 74 1173.64 percent of total billed charges 1586 93 1284.66 percent of total billed charges 1586 1586 other OPPS APC 1586 1586 other OPPS APC 1586 27.63 438.21 percent of total billed charges 1586 1586 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER SHEATH STEERABLE 6.5FR ID 55CML 180DEG ANGLED TIP TOURGUIDE SUP-TG0655509 CDM 0270 RC outpatient 1495 1495 1495 74 1106.3 percent of total billed charges 1495 93 1210.95 percent of total billed charges 1495 1495 other OPPS APC 1495 1495 other OPPS APC 1495 27.63 413.07 percent of total billed charges 1495 1495 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH CATHETER TOURGUIDE HYDROPHILIC 180 D L70 CM L55 CM ID6.5 FR STEERABLE SUP-TG0655517_72909 CDM 0270 RC outpatient 1586 1586 1586 74 1173.64 percent of total billed charges 1586 93 1284.66 percent of total billed charges 1586 1586 other OPPS APC 1586 1586 other OPPS APC 1586 27.63 438.21 percent of total billed charges 1586 1586 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH CATHETER TOURGUIDE HYDROPHILIC 180 D L45 CM L9 MM ID7 FR STEERABLE SUP-TG0704509_72906 CDM 0270 RC outpatient 1586 1586 1586 74 1173.64 percent of total billed charges 1586 93 1284.66 percent of total billed charges 1586 1586 other OPPS APC 1586 1586 other OPPS APC 1586 27.63 438.21 percent of total billed charges 1586 1586 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH CATHETER TOURGUIDE HYDROPHOBIC 180 D L45 CM L17 MM ID7 FR STEERABLE RADIOPAQUE TAPER DISTAL TIP BRAID SHAFT SUP-TG0704517_72908 CDM 0270 RC outpatient 1586 1586 1586 74 1173.64 percent of total billed charges 1586 93 1284.66 percent of total billed charges 1586 1586 other OPPS APC 1586 1586 other OPPS APC 1586 27.63 438.21 percent of total billed charges 1586 1586 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. INTRODUCER CATHETER TOURGUIDE 7FR 2.4MM LUMEN 55CM 180DEG TIP STEERABLE W/75CM DIL 0.038IN GW SUP-TG0705509 CDM 0270 RC outpatient 1495 1495 1495 74 1106.3 percent of total billed charges 1495 93 1210.95 percent of total billed charges 1495 1495 other OPPS APC 1495 1495 other OPPS APC 1495 27.63 413.07 percent of total billed charges 1495 1495 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH CATHETER TOURGUIDE HYDROPHILIC 180 D L55 CM L9 MM ID7 FR STEERABLE SUP-TG0705509_72906 CDM 0270 RC outpatient 1586 1586 1586 74 1173.64 percent of total billed charges 1586 93 1284.66 percent of total billed charges 1586 1586 other OPPS APC 1586 1586 other OPPS APC 1586 27.63 438.21 percent of total billed charges 1586 1586 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TARGET TETRA L2 CM OD1.5 MM DETACHABLE STERILE SUP-TG5411520 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TARGET TETRA L3 CM OD1.5 MM DETACHABLE STERILE SUP-TG5411530 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TARGET TETRA L2.5 CM OD2 MM DETACHABLE STERILE SUP-TG5412025 CDM 0270 RC outpatient 6981 6981 6981 74 5165.94 percent of total billed charges 6981 93 5654.61 percent of total billed charges 6981 6981 other OPPS APC 6981 6981 other OPPS APC 6981 27.63 1928.85 percent of total billed charges 6981 6981 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TARGET TETRA L3.5 CM OD2 MM DETACHABLE STERILE SUP-TG5412035 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TARGET TETRA L4.5 CM OD2 MM DETACHABLE STERILE SUP-TG5412045 CDM 0270 RC outpatient 6981 6981 6981 74 5165.94 percent of total billed charges 6981 93 5654.61 percent of total billed charges 6981 6981 other OPPS APC 6981 6981 other OPPS APC 6981 27.63 1928.85 percent of total billed charges 6981 6981 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TARGET TETRA L6 CM OD2 MM DETACHABLE STERILE SUP-TG5412060 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TARGET TETRA L3.5 CM OD2.5 MM DETACHABLE STERILE SUP-TG5412535 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TARGET TETRA L4.5 CM OD2.5 MM DETACHABLE STERILE SUP-TG5412545 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TARGET TETRA L6 CM OD2.5 MM DETACHABLE STERILE SUP-TG5412560 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TARGET TETRA L10 CM OD3 MM DETACHABLE STERILE SUP-TG5413010 CDM 0270 RC outpatient 6981 6981 6981 74 5165.94 percent of total billed charges 6981 93 5654.61 percent of total billed charges 6981 6981 other OPPS APC 6981 6981 other OPPS APC 6981 27.63 1928.85 percent of total billed charges 6981 6981 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TARGET TETRA L4.5 CM OD3 MM DETACHABLE STERILE SUP-TG5413045 CDM 0270 RC outpatient 6981 6981 6981 74 5165.94 percent of total billed charges 6981 93 5654.61 percent of total billed charges 6981 6981 other OPPS APC 6981 6981 other OPPS APC 6981 27.63 1928.85 percent of total billed charges 6981 6981 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TARGET TETRA L6 CM OD3 MM DETACHABLE STERILE SUP-TG5413060 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TARGET TETRA L8 CM OD3 MM DETACHABLE STERILE SUP-TG5413080 CDM 0270 RC outpatient 6981 6981 6981 74 5165.94 percent of total billed charges 6981 93 5654.61 percent of total billed charges 6981 6981 other OPPS APC 6981 6981 other OPPS APC 6981 27.63 1928.85 percent of total billed charges 6981 6981 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TARGET TETRA L10 CM OD3.5 MM DETACHABLE STERILE SUP-TG5413510 CDM 0270 RC outpatient 6981 6981 6981 74 5165.94 percent of total billed charges 6981 93 5654.61 percent of total billed charges 6981 6981 other OPPS APC 6981 6981 other OPPS APC 6981 27.63 1928.85 percent of total billed charges 6981 6981 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TARGET TETRA L6 CM OD3.5 MM DETACHABLE STERILE SUP-TG5413560 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TARGET TETRA L8 CM OD3.5 MM DETACHABLE STERILE SUP-TG5413580 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TARGET TETRA L10 CM OD4 MM DETACHABLE STERILE SUP-TG5414010 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TARGET TETRA L6 CM OD4 MM DETACHABLE STERILE SUP-TG5414060 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TARGET TETRA L8 CM OD4 MM DETACHABLE STERILE SUP-TG5414080 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COIL EMBOLIZATION TARGET TETRA L10 CM OD4.5 MM DETACHABLE STERILE SUP-TG5414510 CDM 0270 RC outpatient 6648.2 6648.2 6648.2 74 4919.67 percent of total billed charges 6648.2 93 5385.04 percent of total billed charges 6648.2 6648.2 other OPPS APC 6648.2 6648.2 other OPPS APC 6648.2 27.63 1836.9 percent of total billed charges 6648.2 6648.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT TAG L10 CM OD21 MM THORACIC ACTIVE CONTROL CONFORMABLE SUP-TGM212110 CDM 270010015 LOCAL 0270 RC outpatient 51329.2 51329.2 51329.2 74 37983.6 percent of total billed charges 51329.2 93 41576.7 percent of total billed charges 51329.2 51329.2 other OPPS APC 51329.2 51329.2 other OPPS APC 51329.2 27.63 14182.3 percent of total billed charges 51329.2 51329.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT TAG L10 CM OD21-26 MM THORACIC ACTIVE CONTROL CONFORMABLE SUP-TGM262110 CDM 270010015 LOCAL 0270 RC outpatient 51329.2 51329.2 51329.2 74 37983.6 percent of total billed charges 51329.2 93 41576.7 percent of total billed charges 51329.2 51329.2 other OPPS APC 51329.2 51329.2 other OPPS APC 51329.2 27.63 14182.3 percent of total billed charges 51329.2 51329.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT TAG L10 CM OD26 MM THORACIC ACTIVE CONTROL CONFORMABLE SUP-TGM262610 CDM 270010015 LOCAL 0270 RC outpatient 51329.2 51329.2 51329.2 74 37983.6 percent of total billed charges 51329.2 93 41576.7 percent of total billed charges 51329.2 51329.2 other OPPS APC 51329.2 51329.2 other OPPS APC 51329.2 27.63 14182.3 percent of total billed charges 51329.2 51329.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT TAG L10 CM OD28 MM THORACIC ACTIVE CONTROL CONFORMABLE SUP-TGM282810 CDM 270010015 LOCAL 0270 RC outpatient 51329.2 51329.2 51329.2 74 37983.6 percent of total billed charges 51329.2 93 41576.7 percent of total billed charges 51329.2 51329.2 other OPPS APC 51329.2 51329.2 other OPPS APC 51329.2 27.63 14182.3 percent of total billed charges 51329.2 51329.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT TAG L10 CM OD26-31 MM THORACIC ACTIVE CONTROL CONFORMABLE SUP-TGMR312610 CDM 270010015 LOCAL 0270 RC outpatient 51329.2 51329.2 51329.2 74 37983.6 percent of total billed charges 51329.2 93 41576.7 percent of total billed charges 51329.2 51329.2 other OPPS APC 51329.2 51329.2 other OPPS APC 51329.2 27.63 14182.3 percent of total billed charges 51329.2 51329.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT TAG L10 CM OD31 MM THORACIC ACTIVE CONTROL CONFORMABLE SUP-TGMR313110 CDM 270010015 LOCAL 0270 RC outpatient 51329.2 51329.2 51329.2 74 37983.6 percent of total billed charges 51329.2 93 41576.7 percent of total billed charges 51329.2 51329.2 other OPPS APC 51329.2 51329.2 other OPPS APC 51329.2 27.63 14182.3 percent of total billed charges 51329.2 51329.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT THORACIC ENDOPROSTHESIS 21X10 SUP-TGU212110 CDM 270010015 LOCAL 0270 RC outpatient 45497.4 45497.4 45497.4 74 33668.1 percent of total billed charges 45497.4 93 36852.9 percent of total billed charges 45497.4 45497.4 other OPPS APC 45497.4 45497.4 other OPPS APC 45497.4 27.63 12570.9 percent of total billed charges 45497.4 45497.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT THORACIC ENDOPROSTHESIS 26X21X10 SUP-TGU262110 CDM 270010015 LOCAL 0270 RC outpatient 45497.4 45497.4 45497.4 74 33668.1 percent of total billed charges 45497.4 93 36852.9 percent of total billed charges 45497.4 45497.4 other OPPS APC 45497.4 45497.4 other OPPS APC 45497.4 27.63 12570.9 percent of total billed charges 45497.4 45497.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT THORACIC ENDOPROSTHESIS 26X26X10 SUP-TGU262610 CDM 270010015 LOCAL 0270 RC outpatient 45497.4 45497.4 45497.4 74 33668.1 percent of total billed charges 45497.4 93 36852.9 percent of total billed charges 45497.4 45497.4 other OPPS APC 45497.4 45497.4 other OPPS APC 45497.4 27.63 12570.9 percent of total billed charges 45497.4 45497.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT THORACIC ENDOPROSTHESIS 28X28X10 SUP-TGU282810 CDM 270010015 LOCAL 0270 RC outpatient 45497.4 45497.4 45497.4 74 33668.1 percent of total billed charges 45497.4 93 36852.9 percent of total billed charges 45497.4 45497.4 other OPPS APC 45497.4 45497.4 other OPPS APC 45497.4 27.63 12570.9 percent of total billed charges 45497.4 45497.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT THORACIC ENDOPROSTHESIS 31X26X10 SUP-TGU312610 CDM 270010015 LOCAL 0270 RC outpatient 45497.4 45497.4 45497.4 74 33668.1 percent of total billed charges 45497.4 93 36852.9 percent of total billed charges 45497.4 45497.4 other OPPS APC 45497.4 45497.4 other OPPS APC 45497.4 27.63 12570.9 percent of total billed charges 45497.4 45497.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT THORACIC ENDOPROSTHESIS 31X31X10 SUP-TGU313110 CDM 270010015 LOCAL 0270 RC outpatient 45497.4 45497.4 45497.4 74 33668.1 percent of total billed charges 45497.4 93 36852.9 percent of total billed charges 45497.4 45497.4 other OPPS APC 45497.4 45497.4 other OPPS APC 45497.4 27.63 12570.9 percent of total billed charges 45497.4 45497.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT THORACIC ENDOPROSTHESIS 34X34X15 SUP-TGU343415 CDM 270010015 LOCAL 0270 RC outpatient 45497.4 45497.4 45497.4 74 33668.1 percent of total billed charges 45497.4 93 36852.9 percent of total billed charges 45497.4 45497.4 other OPPS APC 45497.4 45497.4 other OPPS APC 45497.4 27.63 12570.9 percent of total billed charges 45497.4 45497.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT STIMULATOR PROXIMATE GENITOURINARY HANDSET NONSTERILE LATEX FREE REUSABLE SUP-TH90G01 CDM 0270 RC outpatient 5070 5070 5070 74 3751.8 percent of total billed charges 5070 93 4106.7 percent of total billed charges 5070 5070 other OPPS APC 5070 5070 other OPPS APC 5070 27.63 1400.84 percent of total billed charges 5070 5070 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT NEUROSTIMULATOR COMMUNICATOR HANDSET NONSTERILE LATEX FREE REUSABLE SUP-TH90P01 CDM 0270 RC outpatient 5070 5070 5070 74 3751.8 percent of total billed charges 5070 93 4106.7 percent of total billed charges 5070 5070 other OPPS APC 5070 5070 other OPPS APC 5070 27.63 1400.84 percent of total billed charges 5070 5070 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ATHERECTOMY TURBOHAWK MEC 135CM 5.9CM 2-4MM CALCIUM PERIPHERAL ARTERY SM VESSEL EXTEND TIP HIGH EFFICIENCY CUT SUP-THSSXC_41385 CDM 0270 RC outpatient 8580 8580 8580 74 6349.2 percent of total billed charges 8580 93 6949.8 percent of total billed charges 8580 8580 other OPPS APC 8580 8580 other OPPS APC 8580 27.63 2370.65 percent of total billed charges 8580 8580 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CUTTING HEAD SUP-TIVH40 CDM 0270 RC outpatient 751.4 751.4 751.4 74 556.04 percent of total billed charges 751.4 93 608.63 percent of total billed charges 751.4 751.4 other OPPS APC 751.4 751.4 other OPPS APC 751.4 27.63 207.61 percent of total billed charges 751.4 751.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT LIVER ACCESS BIOPSY SUP-TL-19 CDM 0270 RC outpatient 1942.2 1942.2 1942.2 74 1437.23 percent of total billed charges 1942.2 93 1573.18 percent of total billed charges 1942.2 1942.2 other OPPS APC 1942.2 1942.2 other OPPS APC 1942.2 27.63 536.63 percent of total billed charges 1942.2 1942.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL PROXIMATE PX STAINLESS STEEL TITANIUM WIDE L3.9 MM X W6.9 MM X H1 MM OD.58 MM 35 COUNT FIX HEAD ERGONOMIC PISTOL GRIP HANDLE RELOADABLE STERILE LATEX FREE DISPOSABLE SUP-TL90 CDM 270009225 LOCAL 0270 RC outpatient 208.98 208.98 208.98 74 154.65 percent of total billed charges 208.98 93 169.27 percent of total billed charges 208.98 208.98 other OPPS APC 208.98 208.98 other OPPS APC 208.98 27.63 57.74 percent of total billed charges 208.98 208.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL PROXIMATE TITANIUM L100 MM X H3.85 MM H1.5 MM REGULAR TISSUE 2 ROW LINEAR CUTTER SAFETY LOCKOUT HEAVY WIRE STERILE LATEX FREE DISPOSABLE BLUE ENDOSCOPIC SUP-TLC10 CDM 270009089 LOCAL 0270 RC outpatient 299.84 299.84 299.84 74 221.88 percent of total billed charges 299.84 93 242.87 percent of total billed charges 299.84 299.84 other OPPS APC 299.84 299.84 other OPPS APC 299.84 27.63 82.85 percent of total billed charges 299.84 299.84 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "GORE TRI-LUMEN CATHETER, 140CM" SUP-TLC140 CDM 0270 RC outpatient 2548 2548 2548 74 1885.52 percent of total billed charges 2548 93 2063.88 percent of total billed charges 2548 2548 other OPPS APC 2548 2548 other OPPS APC 2548 27.63 704.01 percent of total billed charges 2548 2548 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL PROXIMATE TITANIUM STANDARD L55 MM X H3.81 MM H1.5 MM REGULAR TISSUE 4 ROW LINEAR CUTTER CARTRIDGE SAFETY LOCK OUT STERILE LATEX FREE DISPOSABLE BLUE ENDOSCOPIC SUP-TLC55 CDM 270009088 LOCAL 0270 RC outpatient 132.68 132.68 132.68 74 98.18 percent of total billed charges 132.68 93 107.47 percent of total billed charges 132.68 132.68 other OPPS APC 132.68 132.68 other OPPS APC 132.68 27.63 36.66 percent of total billed charges 132.68 132.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL PROXIMATE TITANIUM STANDARD H1.5 MM L75 MM X H4.5 MM H2 MM REGULAR TISSUE 4 ROW LINEAR CUTTER SAFETY LOCKOUT HEAVY WIRE STERILE LATEX FREE DISPOSABLE BLUE ENDOSCOPIC SUP-TLC75 CDM 270009226 LOCAL 0270 RC outpatient 198 198 198 74 146.52 percent of total billed charges 198 93 160.38 percent of total billed charges 198 198 other OPPS APC 198 198 other OPPS APC 198 27.63 54.71 percent of total billed charges 198 198 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CAP TOTAL SHOULDER PRICING-DEPUY SUP-TOTALSHOULDER-DEP CDM 270010030 LOCAL 0270 RC outpatient 10816 10816 10816 74 8003.84 percent of total billed charges 10816 93 8760.96 percent of total billed charges 10816 10816 other OPPS APC 10816 10816 other OPPS APC 10816 27.63 2988.46 percent of total billed charges 10816 10816 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.5MM THREADED PEG 20MM SUP-TP-20 CDM 0270 RC outpatient 224.64 224.64 224.64 74 166.23 percent of total billed charges 224.64 93 181.96 percent of total billed charges 224.64 224.64 other OPPS APC 224.64 224.64 other OPPS APC 224.64 27.63 62.07 percent of total billed charges 224.64 224.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.5MM THREADED PEG 24MM SUP-TP-24 CDM 0270 RC outpatient 224.64 224.64 224.64 74 166.23 percent of total billed charges 224.64 93 181.96 percent of total billed charges 224.64 224.64 other OPPS APC 224.64 224.64 other OPPS APC 224.64 27.63 62.07 percent of total billed charges 224.64 224.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.5MM THREADED PEGS 26MM SUP-TP-26 CDM 0270 RC outpatient 210.6 210.6 210.6 74 155.84 percent of total billed charges 210.6 93 170.59 percent of total billed charges 210.6 210.6 other OPPS APC 210.6 210.6 other OPPS APC 210.6 27.63 58.19 percent of total billed charges 210.6 210.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION DVR TITANIUM PARTIAL THREAD L10 MM OD2.5 MM DISTAL VOLAR RADIUS LOCK BLUE ANATOMIC PLATING SYSTEM SUP-TP10000 CDM 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION DVR TITANIUM PARTIAL THREAD L12 MM OD2.5 MM DISTAL VOLAR RADIUS LOCK BLUE ANATOMIC PLATING SYSTEM SUP-TP12000 CDM 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION DVR TITANIUM PARTIAL THREAD L14 MM OD2.5 MM DISTAL VOLAR RADIUS LOCK BLUE ANATOMIC PLATING SYSTEM SUP-TP14000 CDM 0270 RC outpatient 143.91 143.91 143.91 74 106.49 percent of total billed charges 143.91 93 116.57 percent of total billed charges 143.91 143.91 other OPPS APC 143.91 143.91 other OPPS APC 143.91 27.63 39.76 percent of total billed charges 143.91 143.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION DVR TITANIUM PARTIAL THREAD L16 MM OD2.5 MM DISTAL VOLAR RADIUS LOCK BLUE ANATOMIC PLATING SYSTEM SUP-TP16000 CDM 0270 RC outpatient 143.91 143.91 143.91 74 106.49 percent of total billed charges 143.91 93 116.57 percent of total billed charges 143.91 143.91 other OPPS APC 143.91 143.91 other OPPS APC 143.91 27.63 39.76 percent of total billed charges 143.91 143.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION PARTIAL THREAD 18MM 2.5MM NS ANATOMIC PLATE SYSTEM SUP-TP18000 CDM 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION PARTIAL THREAD 20MM 2.5MM NS ANATOMIC PLATE SYSTEM SUP-TP20000 CDM 0270 RC outpatient 143.91 143.91 143.91 74 106.49 percent of total billed charges 143.91 93 116.57 percent of total billed charges 143.91 143.91 other OPPS APC 143.91 143.91 other OPPS APC 143.91 27.63 39.76 percent of total billed charges 143.91 143.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION DVR TITANIUM PARTIAL THREAD L22 MM OD2.5 MM RADIUS DISTAL VOLAR LOCK ANATOMIC PLATING SYSTEM SUP-TP22000 CDM 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION DVR TITANIUM PARTIAL THREAD L24 MM OD2.5 MM RADIUS DISTAL VOLAR LOCK ANATOMIC PLATING SYSTEM SUP-TP24000 CDM 0270 RC outpatient 143.91 143.91 143.91 74 106.49 percent of total billed charges 143.91 93 116.57 percent of total billed charges 143.91 143.91 other OPPS APC 143.91 143.91 other OPPS APC 143.91 27.63 39.76 percent of total billed charges 143.91 143.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW 2.5MM THREADED PEG 26MM SUP-TP26 CDM 0270 RC outpatient 210.6 210.6 210.6 74 155.84 percent of total billed charges 210.6 93 170.59 percent of total billed charges 210.6 210.6 other OPPS APC 210.6 210.6 other OPPS APC 210.6 27.63 58.19 percent of total billed charges 210.6 210.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION DVR TITANIUM PARTIAL THREAD L26 MM OD2.5 MM DISTAL VOLAR RADIUS LOCK BLUE ANATOMIC PLATING SYSTEM SUP-TP26000 CDM 270010022 LOCAL 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION DVR TITANIUM PARTIAL THREAD L28 MM OD2.5 MM VOLAR DISTAL RADIUS LOCK BLUE ANATOMIC PLATING SYSTEM SUP-TP28000 CDM 0270 RC outpatient 224.64 224.64 224.64 74 166.23 percent of total billed charges 224.64 93 181.96 percent of total billed charges 224.64 224.64 other OPPS APC 224.64 224.64 other OPPS APC 224.64 27.63 62.07 percent of total billed charges 224.64 224.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PEG FIXATION DVR TITANIUM PARTIAL THREAD L30 MM OD2.5 MM DISTAL VOLAR RADIAL LOCK BLUE ANATOMIC PLATING SYSTEM SUP-TP30000 CDM 0270 RC outpatient 238.11 238.11 238.11 74 176.2 percent of total billed charges 238.11 93 192.87 percent of total billed charges 238.11 238.11 other OPPS APC 238.11 238.11 other OPPS APC 238.11 27.63 65.79 percent of total billed charges 238.11 238.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE PERICARDIUM THK.5 MM OPHTHALMIC ALLOGRAFT HYDRATED RUBBER-FREE MRI COMPATIBLE LATEX FREE SUP-TPH CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE PERICARDIUM L1 CM X W1 CM PATCH (TSH) SUP-TPH447-13605 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TUTOPLAST PERICARDIUM 1.5CM SUP-TPHPC15 CDM 0270 RC outpatient 715 715 715 74 529.1 percent of total billed charges 715 93 579.15 percent of total billed charges 715 715 other OPPS APC 715 715 other OPPS APC 715 27.63 197.55 percent of total billed charges 715 715 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE STAINLESS STEEL 2-0 SH SKS-3 L24 IN 2 ARM BRAID DARK BLUE LIGHT BLUE SUP-TPW32 CDM 0270 RC outpatient 53.67 53.67 53.67 74 39.72 percent of total billed charges 53.67 93 43.47 percent of total billed charges 53.67 53.67 other OPPS APC 53.67 53.67 other OPPS APC 53.67 27.63 14.83 percent of total billed charges 53.67 53.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER PROXIMATE TL TITANIUM H2.5 MM H1 MM ENDOSCOPIC LINEAR CUTTER STERILE LATEX FREE DISPOSABLE SUP-TR30 CDM 270009085 LOCAL 0270 RC outpatient 68.68 68.68 68.68 74 50.82 percent of total billed charges 68.68 93 55.63 percent of total billed charges 68.68 68.68 other OPPS APC 68.68 68.68 other OPPS APC 68.68 27.63 18.98 percent of total billed charges 68.68 68.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISCONTINUED AS OF 10/1/16 - RELOAD STAPLER ENDOPATH ETS 3.5MM 1.5MM BLUE DISPOSABLE STERILE LF REGULAR TISSUE 6 SUP-TR35B CDM 270009086 LOCAL 0270 RC outpatient 134.98 134.98 134.98 74 99.89 percent of total billed charges 134.98 93 109.33 percent of total billed charges 134.98 134.98 other OPPS APC 134.98 134.98 other OPPS APC 134.98 27.63 37.29 percent of total billed charges 134.98 134.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ENDOPATH ETS 35MMX2.5MM 1MM WHITE DISPOSABLE STERILE LF THIN VASCULAR TISSUE 6 STAPLE LINEAR SUP-TR35W CDM 270009226 LOCAL 0270 RC outpatient 198 198 198 74 146.52 percent of total billed charges 198 93 160.38 percent of total billed charges 198 198 other OPPS APC 198 198 other OPPS APC 198 27.63 54.71 percent of total billed charges 198 198 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ENDOPATH TITANIUM L45 MM X H4.1 MM H2 MM THICK TISSUE 44 COUNT 4 ROW DISPOSABLE GREEN LAPAROSCOPIC SUP-TR45G CDM 270009086 LOCAL 0270 RC outpatient 134.98 134.98 134.98 74 99.89 percent of total billed charges 134.98 93 109.33 percent of total billed charges 134.98 134.98 other OPPS APC 134.98 134.98 other OPPS APC 134.98 27.63 37.29 percent of total billed charges 134.98 134.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DISCONTINUED - RELOAD STAPLER PROXIMATE TITANIUM STANDARD THICK TISSUE SUP-TR90 CDM 270009085 LOCAL 0270 RC outpatient 68.68 68.68 68.68 74 50.82 percent of total billed charges 68.68 93 55.63 percent of total billed charges 68.68 68.68 other OPPS APC 68.68 68.68 other OPPS APC 68.68 27.63 18.98 percent of total billed charges 68.68 68.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND COMPRESSION TRANSRADIAL BAND STD INFLATOR SUP-TRB24-REG CDM 0270 RC outpatient 65 65 65 74 48.1 percent of total billed charges 65 93 52.65 percent of total billed charges 65 65 other OPPS APC 65 65 other OPPS APC 65 27.63 17.96 percent of total billed charges 65 65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAND COMPRESSION TRANSRADIAL BAND LG INFLATOR SUP-TRB29-LRG CDM 0270 RC outpatient 65 65 65 74 48.1 percent of total billed charges 65 93 52.65 percent of total billed charges 65 65 other OPPS APC 65 65 other OPPS APC 65 27.63 17.96 percent of total billed charges 65 65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER PROXIMATE L90 MM SUP-TRH90 CDM 270009085 LOCAL 0270 RC outpatient 68.68 68.68 68.68 74 50.82 percent of total billed charges 68.68 93 55.63 percent of total billed charges 68.68 68.68 other OPPS APC 68.68 68.68 other OPPS APC 68.68 27.63 18.98 percent of total billed charges 68.68 68.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL ENDOPATH CURVE CIRCLE 5.5MM 28CMX1-2.5MM 29MM DISPOSABLE STERILE LF INTRALUMINAL LINEAR CUTTER SUP-TRIEEA28XT CDM 0270 RC outpatient 682.87 682.87 682.87 74 505.32 percent of total billed charges 682.87 93 553.12 percent of total billed charges 682.87 682.87 other OPPS APC 682.87 682.87 other OPPS APC 682.87 27.63 188.68 percent of total billed charges 682.87 682.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL EEA 4 MM 4.5 MM 5 MM XTHICK OD28 MM BLACK SUP-TRIEEA28XT_11858 CDM 0270 RC outpatient 1062.7 1062.7 1062.7 74 786.4 percent of total billed charges 1062.7 93 860.79 percent of total billed charges 1062.7 1062.7 other OPPS APC 1062.7 1062.7 other OPPS APC 1062.7 27.63 293.62 percent of total billed charges 1062.7 1062.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL LARGE RING OD9 CM SOFT TISSUE SOFT COMPLIANT STERILE DISPOSABLE SUP-TRL CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RETRACTOR SURGICAL MEDIUM RING OD7.5 CM SOFT TISSUE SOFT COMPLIANT STERILE DISPOSABLE SUP-TRM CDM 0270 RC outpatient 910 910 910 74 673.4 percent of total billed charges 910 93 737.1 percent of total billed charges 910 910 other OPPS APC 910 910 other OPPS APC 910 27.63 251.43 percent of total billed charges 910 910 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ANCHOR TISSUE RETRIEVAL BAG W/15MM INTRODUCER SUP-TRS-175S-B2 CDM 0270 RC outpatient 355.33 355.33 355.33 74 262.94 percent of total billed charges 355.33 93 287.82 percent of total billed charges 355.33 355.33 other OPPS APC 355.33 355.33 other OPPS APC 355.33 27.63 98.18 percent of total billed charges 355.33 355.33 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG TISSUE RETRIEVAL ANCHOR C4000 ML 25 MM L38.1 CM OD16.5 CM INTRODUCER TROCAR SUP-TRS-TV-25 CDM 0270 RC outpatient 635.7 635.7 635.7 74 470.42 percent of total billed charges 635.7 93 514.92 percent of total billed charges 635.7 635.7 other OPPS APC 635.7 635.7 other OPPS APC 635.7 27.63 175.64 percent of total billed charges 635.7 635.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE ENDOSCOPIC PLUNGE BOB POLY OD5 MM PORT CLEANER Q TIP ABSORBENT OBTURATOR SUP-TS-0005 CDM 0270 RC outpatient 67.34 67.34 67.34 74 49.83 percent of total billed charges 67.34 93 54.55 percent of total billed charges 67.34 67.34 other OPPS APC 67.34 67.34 other OPPS APC 67.34 27.63 18.61 percent of total billed charges 67.34 67.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. OCTOPUS NS TS102 SUP-TS102 CDM 0270 RC outpatient 3627 3627 3627 74 2683.98 percent of total billed charges 3627 93 2937.87 percent of total billed charges 3627 3627 other OPPS APC 3627 3627 other OPPS APC 3627 27.63 1002.14 percent of total billed charges 3627 3627 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ARTERIAL LINE SWAN-GANZ L100 CM L24 CM OD5 FR PULMONARY ARTERY THERMODILUTION PORT SUP-TS105F5 CDM 0481 RC outpatient 603.38 603.38 603.38 74 446.5 percent of total billed charges 603.38 93 488.74 percent of total billed charges 603.38 603.38 other OPPS APC 603.38 603.38 other OPPS APC 603.38 51 307.72 percent of total billed charges 603.38 603.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STABILIZER SURGICAL OCTOPUS TISSUE EVOLUTION SUP-TS2000 CDM 0270 RC outpatient 3107 3107 3107 74 2299.18 percent of total billed charges 3107 93 2516.67 percent of total billed charges 3107 3107 other OPPS APC 3107 3107 other OPPS APC 3107 27.63 858.46 percent of total billed charges 3107 3107 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA TRANSSEPTAL 18G 71 CM 38 DEGREE ANGLE SUP-TSC071 CDM 0481 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 51 39.78 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA 71CM 72 DEGREE ANGLE TRANSSEPTAL SUP-TSC171 CDM 0481 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 51 39.78 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STABILIZER SURGICAL OCTOPUS NUVO SUP-TSMICS1 CDM 0270 RC outpatient 4667 4667 4667 74 3453.58 percent of total billed charges 4667 93 3780.27 percent of total billed charges 4667 4667 other OPPS APC 4667 4667 other OPPS APC 4667 27.63 1289.49 percent of total billed charges 4667 4667 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE ABLATION TACTISYS QUARTZ RF TACTIFLEX SE SUP-TSQ-RF-TFSE-CBL CDM 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHETER ENDOSCOPIC BARRX L135 CM L15.7 MM X W7.5 MM OD2.8 MM ESOPHAGUS CHANNEL RADIOFREQUENCY ABLATION ACTIVE ELECTRODE TORQUE BREAK DISPOSABLE OLYMPUS PENTAX FUJINON SUP-TTS-1100 CDM 0270 RC outpatient 5319.6 5319.6 5319.6 74 3936.5 percent of total billed charges 5319.6 93 4308.88 percent of total billed charges 5319.6 5319.6 other OPPS APC 5319.6 5319.6 other OPPS APC 5319.6 27.63 1469.81 percent of total billed charges 5319.6 5319.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING BLACK MAX STANDARD TAPER STRAIGHT FLUTE BALL L12.6 CM OD5 MM STERILE DISPOSABLE TURQUOISE BURR SUP-TURQ - L5 CDM 0270 RC outpatient 455 455 455 74 336.7 percent of total billed charges 455 93 368.55 percent of total billed charges 455 455 other OPPS APC 455 455 other OPPS APC 455 27.63 125.72 percent of total billed charges 455 455 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING TURQUOISE 12.6CM 5MM BLACK MAX STANDARD TAPER STRAIGHT FLUTE BALL SUP-TURQ-L5 CDM 0270 RC outpatient 200.2 200.2 200.2 74 148.15 percent of total billed charges 200.2 93 162.16 percent of total billed charges 200.2 200.2 other OPPS APC 200.2 200.2 other OPPS APC 200.2 27.63 55.32 percent of total billed charges 200.2 200.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING BLACK MAX STRAIGHT FLUTE BALL TAPER L12.6 CM OD6 MM ATTACHMENT NONSTERILE TURQUOISE BURR SUP-TURQ-L6 CDM 0270 RC outpatient 696.8 696.8 696.8 74 515.63 percent of total billed charges 696.8 93 564.41 percent of total billed charges 696.8 696.8 other OPPS APC 696.8 696.8 other OPPS APC 696.8 27.63 192.53 percent of total billed charges 696.8 696.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL DISSECTING BLACKMAX TAPER FLUTE MATCHSTICK 12.6CM 3MM DISPOSABLE STERILE STRAIGHT ATTACHMENT BURR SUP-TURQ-L8 CDM 0270 RC outpatient 650 650 650 74 481 percent of total billed charges 650 93 526.5 percent of total billed charges 650 650 other OPPS APC 650 650 other OPPS APC 650 27.63 179.6 percent of total billed charges 650 650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOOL TVI SUP-TVI-07 CDM 0275 RC outpatient 86.45 86.45 86.45 57 49.28 percent of total billed charges 86.45 93 70.02 percent of total billed charges 86.45 86.45 other OPPS APC 86.45 86.45 other OPPS APC 86.45 51 44.09 percent of total billed charges 86.45 86.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLING GYNECOLOGICAL GYNECARE TVT EXACT OD3 MM TROCAR SHAFT ERGONOMIC HANDLE STRESS URINARY INCONTINENCE RETROPUBIC SUP-TVTRL CDM 0270 RC outpatient 3388.11 3388.11 3388.11 74 2507.2 percent of total billed charges 3388.11 93 2744.37 percent of total billed charges 3388.11 3388.11 other OPPS APC 3388.11 3388.11 other OPPS APC 3388.11 27.63 936.13 percent of total billed charges 3388.11 3388.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL PROXIMATE TITANIUM L30 MM X H1-2.5 MM H1 MM STANDARD TISSUE 2 ROW LINEAR CUTTER ADJUSTABLE HEAVY WIRE STERILE LATEX FREE DISPOSABLE ENDOSCOPIC SUP-TX30B CDM 270009088 LOCAL 0270 RC outpatient 241.79 241.79 241.79 74 178.92 percent of total billed charges 241.79 93 195.85 percent of total billed charges 241.79 241.79 other OPPS APC 241.79 241.79 other OPPS APC 241.79 27.63 66.81 percent of total billed charges 241.79 241.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL PROXIMATE TX TITANIUM L30 MM X H2.5 MM H1 MM VASCULAR TISSUE 3 ROW LINEAR RELOAD STERILE LATEX FREE DISPOSABLE WHITE SUP-TX30V CDM 270009088 LOCAL 0270 RC outpatient 216.12 216.12 216.12 74 159.93 percent of total billed charges 216.12 93 175.06 percent of total billed charges 216.12 216.12 other OPPS APC 216.12 216.12 other OPPS APC 216.12 27.63 59.71 percent of total billed charges 216.12 216.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLER INTERNAL PROXIMATE TITANIUM STANDARD L60 MM X H3.5 MM H1.5 MM REGULAR TISSUE 2 ROW LINEAR RELOADABLE PARALLEL JAW CLOSURE STERILE LATEX FREE DISPOSABLE BLUE SUP-TX60B CDM 270009088 LOCAL 0270 RC outpatient 132.68 132.68 132.68 74 98.18 percent of total billed charges 132.68 93 107.47 percent of total billed charges 132.68 132.68 other OPPS APC 132.68 132.68 other OPPS APC 132.68 27.63 36.66 percent of total billed charges 132.68 132.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMOBILIZER ORTHOPEDIC TIETEX FOAM MEDIUM UNIVERSAL L16 1/2 IN X W8 IN SHOULDER ADJUSTABLE STRAP O RING HOOK LOOP CLOSURE NONSTERILE LATEX FREE SUP-TX9023-02 CDM 270009116 LOCAL 0270 RC outpatient 3.89 3.89 3.89 74 2.88 percent of total billed charges 3.89 93 3.15 percent of total billed charges 3.89 3.89 other OPPS APC 3.89 3.89 other OPPS APC 3.89 27.63 1.07 percent of total billed charges 3.89 3.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMMOBILIZER ORTHOPEDIC TIETEX FOAM LARGE UNIVERSAL L19 1/2 IN X W9 IN SHOULDER ADJUSTABLE STRAP O RING HOOK LOOP CLOSURE NONSTERILE LATEX FREE SUP-TX9023-03 CDM 270009116 LOCAL 0270 RC outpatient 3.89 3.89 3.89 74 2.88 percent of total billed charges 3.89 93 3.15 percent of total billed charges 3.89 3.89 other OPPS APC 3.89 3.89 other OPPS APC 3.89 27.63 1.07 percent of total billed charges 3.89 3.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLING ORTHOPEDIC TIETEX SMALL ARM ENVELOPE SHOULDER STRAP SLIDE BUCKLE SUP-TX9901-02 CDM 270009116 LOCAL 0270 RC outpatient 4.65 4.65 4.65 74 3.44 percent of total billed charges 4.65 93 3.77 percent of total billed charges 4.65 4.65 other OPPS APC 4.65 4.65 other OPPS APC 4.65 27.63 1.28 percent of total billed charges 4.65 4.65 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLING ORTHOPEDIC TIETEX MEDIUM ARM ENVELOPE SHOULDER STRAP SLIDE BUCKLE SUP-TX9901-03 CDM 270009116 LOCAL 0270 RC outpatient 3.89 3.89 3.89 74 2.88 percent of total billed charges 3.89 93 3.15 percent of total billed charges 3.89 3.89 other OPPS APC 3.89 3.89 other OPPS APC 3.89 27.63 1.07 percent of total billed charges 3.89 3.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SLING ORTHOPEDIC TIETEX LARGE ARM ENVELOPE SHOULDER STRAP SLIDE BUCKLE SUP-TX9901-04 CDM 270009116 LOCAL 0270 RC outpatient 3.89 3.89 3.89 74 2.88 percent of total billed charges 3.89 93 3.15 percent of total billed charges 3.89 3.89 other OPPS APC 3.89 3.89 other OPPS APC 3.89 27.63 1.07 percent of total billed charges 3.89 3.89 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRTP U125 VALITUDE device only SUP-U125 CDM 0275 RC outpatient 12834 12834 12834 57 7315.38 percent of total billed charges 12834 93 10395.5 percent of total billed charges 12834 12834 other OPPS APC 12834 12834 other OPPS APC 12834 51 6545.34 percent of total billed charges 12834 12834 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC VALITUDE X4 D.75 CM W4.45 CM X H6.17 CM 17.6 ML 33 GM RIGHT ATRIUM RIGHT VENTRICLE IS-1 CONNECTOR SUP-U128 CDM 0275 RC outpatient 12834 12834 12834 57 7315.38 percent of total billed charges 12834 93 10395.5 percent of total billed charges 12834 12834 other OPPS APC 12834 12834 other OPPS APC 12834 51 6545.34 percent of total billed charges 12834 12834 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TAPE UMBILICAL 36X1/8IN COTTON STERILE LF TIE WOVEN NONABSORBABLE MULTIPACK SUP-U12T CDM 0270 RC outpatient 4.81 4.81 4.81 74 3.56 percent of total billed charges 4.81 93 3.9 percent of total billed charges 4.81 4.81 other OPPS APC 4.81 4.81 other OPPS APC 4.81 27.63 1.33 percent of total billed charges 4.81 4.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SWITCH FLOW HIGH PRESSURE SUP-U1SHC CDM 0270 RC outpatient 12.35 12.35 12.35 74 9.14 percent of total billed charges 12.35 93 10 percent of total billed charges 12.35 12.35 other OPPS APC 12.35 12.35 other OPPS APC 12.35 27.63 3.41 percent of total billed charges 12.35 12.35 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE CHROMIC 4-0 RB-1 L27 IN MONOFILAMENT BROWN SUP-U203H CDM 0270 RC outpatient 7.47 7.47 7.47 74 5.53 percent of total billed charges 7.47 93 6.05 percent of total billed charges 7.47 7.47 other OPPS APC 7.47 7.47 other OPPS APC 7.47 27.63 2.06 percent of total billed charges 7.47 7.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CRTP VALTITUDE LV-1 SUP-U226 CDM 0275 RC outpatient 12834 12834 12834 57 7315.38 percent of total billed charges 12834 93 10395.5 percent of total billed charges 12834 12834 other OPPS APC 12834 12834 other OPPS APC 12834 51 6545.34 percent of total billed charges 12834 12834 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT-P PACEMAKER CARDIAC VISIONIST X4 DEVICE SUP-U228 CDM 0481 RC outpatient 18629 18629 18629 74 13785.5 percent of total billed charges 18629 93 15089.5 percent of total billed charges 18629 18629 other OPPS APC 18629 18629 other OPPS APC 18629 51 9500.79 percent of total billed charges 18629 18629 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE CHROMIC 2-0 UR-5 L27 IN MONOFILAMENT BROWN SUP-U245H CDM 0270 RC outpatient 9.62 9.62 9.62 74 7.12 percent of total billed charges 9.62 93 7.79 percent of total billed charges 9.62 9.62 other OPPS APC 9.62 9.62 other OPPS APC 9.62 27.63 2.66 percent of total billed charges 9.62 9.62 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE CHROMIC 0 UR-5 L27 IN MONOFILAMENT BROWN SUP-U246H CDM 0270 RC outpatient 8.46 8.46 8.46 74 6.26 percent of total billed charges 8.46 93 6.85 percent of total billed charges 8.46 8.46 other OPPS APC 8.46 8.46 other OPPS APC 8.46 27.63 2.34 percent of total billed charges 8.46 8.46 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN DISTRACTOR L14 MM OD14 MM NONSTERILE ANTERIOR CERVICAL FUSION SUP-U44-640-14 CDM 270010013 LOCAL 0270 RC outpatient 245.7 245.7 245.7 74 181.82 percent of total billed charges 245.7 93 199.02 percent of total billed charges 245.7 245.7 other OPPS APC 245.7 245.7 other OPPS APC 245.7 27.63 67.89 percent of total billed charges 245.7 245.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F DXTERITY ULTRA 3.5 DIAGNOSTIC CATHETER SUP-U6ULTRA35 CDM 0481 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 51 39.78 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. 6F DXTERITY ULTRA 4.0 DIAGNOSTIC CATHETER SUP-U6ULTRA40 CDM 0481 RC outpatient 78 78 78 74 57.72 percent of total billed charges 78 93 63.18 percent of total billed charges 78 78 other OPPS APC 78 78 other OPPS APC 78 51 39.78 percent of total billed charges 78 78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LIGHT MAT SUP-UA2550 CDM 0270 RC outpatient 155.48 155.48 155.48 74 115.06 percent of total billed charges 155.48 93 125.94 percent of total billed charges 155.48 155.48 other OPPS APC 155.48 155.48 other OPPS APC 155.48 27.63 42.96 percent of total billed charges 155.48 155.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE CORTICAL ENDOFIX 3.0 X 7MM SUP-UCS7 CDM 0270 RC outpatient 215.28 215.28 215.28 74 159.31 percent of total billed charges 215.28 93 174.38 percent of total billed charges 215.28 215.28 other OPPS APC 215.28 215.28 other OPPS APC 215.28 27.63 59.48 percent of total billed charges 215.28 215.28 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE SUP-UH1-41-26 CDM 270010023 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD42 MM ID26 MM HIP SUP-UH1-42-26 CDM 270010023 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. UHR BIPOLAR 28 X 42MM SUP-UH1-42-28 CDM 270010023 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD43 MM ID26 MM HIP SUP-UH1-43-26 CDM 270010023 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD44 MM ID28 MM HIP SUP-UH1-44-28 CDM 270010023 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID26 MM HIP SUP-UH1-45-26 CDM 270010023 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP SUP-UH1-45-28 CDM 270010023 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD46 MM ID28 MM HIP SUP-UH1-46-28 CDM 270010023 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP SUP-UH1-47-28 CDM 270010023 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP SUP-UH1-48-28 CDM 270010023 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIPOLAR UHR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP SUP-UH1-49-28 CDM 270010023 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD50 MM ID28 MM HIP SUP-UH1-50-28 CDM 270010023 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP SUP-UH1-51-28 CDM 270010023 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP SUP-UH1-52-28 CDM 270010023 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP SUP-UH1-53-28 CDM 270010023 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD54 MM ID28 MM HIP SUP-UH1-54-28 CDM 270010023 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP SUP-UH1-55-28 CDM 270010023 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD56 MM ID28 MM HIP SUP-UH1-56-28 CDM 270010023 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP SUP-UH1-58-28 CDM 270010023 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD61 MM ID28 MM HIP SUP-UH1-61-28 CDM 270010023 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD64 MM ID28 MM HIP SUP-UH1-64-28 CDM 270010023 LOCAL 0270 RC outpatient 1690 1690 1690 74 1250.6 percent of total billed charges 1690 93 1368.9 percent of total billed charges 1690 1690 other OPPS APC 1690 1690 other OPPS APC 1690 27.63 466.95 percent of total billed charges 1690 1690 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT UROLOGICAL UROLIFT SUP-UL400-4 CDM 0270 RC outpatient 2535 2535 2535 74 1875.9 percent of total billed charges 2535 93 2053.35 percent of total billed charges 2535 2535 other OPPS APC 2535 2535 other OPPS APC 2535 27.63 700.42 percent of total billed charges 2535 2535 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CASSETTE WOUND DRAINAGE VAC VERALINK NON-STERILE DISPOSABLE SUP-ULTLNK0500.S CDM 0270 RC outpatient 135.85 135.85 135.85 74 100.53 percent of total billed charges 135.85 93 110.04 percent of total billed charges 135.85 135.85 other OPPS APC 135.85 135.85 other OPPS APC 135.85 27.63 37.54 percent of total billed charges 135.85 135.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRESSING WOUND VAC VERAFLO CLEANSE CHOICE MEDIUM TUBULAR FLEXIBLE COMPLEX GEOMETRY MOISTURE RESISTANCE LATEX FREE SUP-ULTVCC05MD.S CDM 0270 RC outpatient 340.86 340.86 340.86 74 252.24 percent of total billed charges 340.86 93 276.1 percent of total billed charges 340.86 340.86 other OPPS APC 340.86 340.86 other OPPS APC 340.86 27.63 94.18 percent of total billed charges 340.86 340.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT COFLEX PARADIGM SPINE SIZE 8MM SUP-UQI00008 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SPINAL COFLEX TITANIUM 10 MM 1 PIECE EXCELLENT FATIGUE INTERLAMINAR STABILIZATION XRAY VISIBLE STERILE YELLOW SUP-UQI00010 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT COFLEX PARADIGM SPINE SIZE 12MM SUP-UQI00012 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SPINAL COFLEX TITANIUM 14 MM 1 PIECE EXCELLENT FATIGUE INTERLAMINAR STABILIZATION XRAY VISIBLE STERILE RED SUP-UQI00014 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SPINAL COFLEX TITANIUM 16 MM 1 PIECE EXCELLENT FATIGUE INTERLAMINAR STABILIZATION XRAY VISIBLE STERILE BLUE SUP-UQI00016 CDM 270010020 LOCAL 0270 RC outpatient 13000 13000 13000 74 9620 percent of total billed charges 13000 93 10530 percent of total billed charges 13000 13000 other OPPS APC 13000 13000 other OPPS APC 13000 27.63 3591.9 percent of total billed charges 13000 13000 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL UNIVERSA AQ 2 PIGTAIL CURVE L22-32 CM OD5 FR RADIOPAQUE POSITIONER MONOFILAMENT TETHER STRAIGHTENER STERILE SUP-US-500-RT1 CDM 0270 RC outpatient 371.25 371.25 371.25 74 274.73 percent of total billed charges 371.25 93 300.71 percent of total billed charges 371.25 371.25 other OPPS APC 371.25 371.25 other OPPS APC 371.25 27.63 102.58 percent of total billed charges 371.25 371.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL UNIVERSA AQ 2 PIGTAIL CURVE L22-32 CM OD5 FR RADIOPAQUE POSITIONER MONOFILAMENT TETHER STRAIGHTENER STERILE SUP-US-500-RTI CDM 0270 RC outpatient 371.25 371.25 371.25 74 274.73 percent of total billed charges 371.25 93 300.71 percent of total billed charges 371.25 371.25 other OPPS APC 371.25 371.25 other OPPS APC 371.25 27.63 102.58 percent of total billed charges 371.25 371.25 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRIPPER MEDENVISION SUP-US-ITEM02385 CDM 0270 RC outpatient 255.06 255.06 255.06 74 188.74 percent of total billed charges 255.06 93 206.6 percent of total billed charges 255.06 255.06 other OPPS APC 255.06 255.06 other OPPS APC 255.06 27.63 70.47 percent of total billed charges 255.06 255.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ESYSUIT MEDENVISION SUP-US-ITEM02386 CDM 0270 RC outpatient 241.16 241.16 241.16 74 178.46 percent of total billed charges 241.16 93 195.34 percent of total billed charges 241.16 241.16 other OPPS APC 241.16 241.16 other OPPS APC 241.16 27.63 66.63 percent of total billed charges 241.16 241.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CABLE BIPOLAR 12FT DISPOSABLE BIPOLAR BOVIE CONMED VALLEYLAB SUP-US349SP CDM 0270 RC outpatient 22.18 22.18 22.18 74 16.41 percent of total billed charges 22.18 93 17.97 percent of total billed charges 22.18 22.18 other OPPS APC 22.18 22.18 other OPPS APC 22.18 27.63 6.13 percent of total billed charges 22.18 22.18 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM IRRIGATION LATEX FREE CORD ELECTROSURGICAL BI-POLAR SILICONE FLAT ROUND FOOTSWITCH DUAL PIN PLUG SUP-US352 CDM 0270 RC outpatient 89.29 89.29 89.29 74 66.07 percent of total billed charges 89.29 93 72.32 percent of total billed charges 89.29 89.29 other OPPS APC 89.29 89.29 other OPPS APC 89.29 27.63 24.67 percent of total billed charges 89.29 89.29 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LOCK STERILIZATION CONTAINER STERILCONTAINER TAMPER EVIDENT SEAL STEAM INDICATOR DOT STERILE DISPOSABLE ORANGE SUP-US906 CDM outpatient 0.37 0.37 0.37 0.37 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN BONE INSTRUMENT HOLDING 3.5IN SUP-US930 CDM outpatient 12.77 12.77 12.77 12.77 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL UNIVERSA AQ 2 PIGTAIL CURVE L22-32 CM L145 CM OD5 FR RADIOPAQUE MULTILENGTH GRADUATE MARK POSITIONER STERILE ACCEPTS .038 IN GUIDEWIRE SUP-USH-500-RT1 CDM 0270 RC outpatient 350.45 350.45 350.45 74 259.33 percent of total billed charges 350.45 93 283.86 percent of total billed charges 350.45 350.45 other OPPS APC 350.45 350.45 other OPPS APC 350.45 27.63 96.83 percent of total billed charges 350.45 350.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL UNIVERSA AQ 2 PIGTAIL CURVE L20 CM OD5 FR RADIOPAQUE POSITIONER MONOFILAMENT TETHER STRAIGHTENER STERILE SUP-USH-520-RT1 CDM 0270 RC outpatient 371.44 371.44 371.44 74 274.87 percent of total billed charges 371.44 93 300.87 percent of total billed charges 371.44 371.44 other OPPS APC 371.44 371.44 other OPPS APC 371.44 27.63 102.63 percent of total billed charges 371.44 371.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL UNIVERSA AQ 2 PIGTAIL CURVE L22 CM OD5 FR RADIOPAQUE POSITIONER MONOFILAMENT TETHER STRAIGHTENER STERILE SUP-USH-522-RT1 CDM 0270 RC outpatient 371.44 371.44 371.44 74 274.87 percent of total billed charges 371.44 93 300.87 percent of total billed charges 371.44 371.44 other OPPS APC 371.44 371.44 other OPPS APC 371.44 27.63 102.63 percent of total billed charges 371.44 371.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL UNIVERSA AQ 2 PIGTAIL CURVE L24 CM OD5 FR RADIOPAQUE POSITIONER MONOFILAMENT TETHER STRAIGHTENER STERILE SUP-USH-524-RT1 CDM 0270 RC outpatient 371.44 371.44 371.44 74 274.87 percent of total billed charges 371.44 93 300.87 percent of total billed charges 371.44 371.44 other OPPS APC 371.44 371.44 other OPPS APC 371.44 27.63 102.63 percent of total billed charges 371.44 371.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL UNIVERSA AQ 2 PIGTAIL CURVE L26 CM OD5 FR RADIOPAQUE POSITIONER MONOFILAMENT TETHER STRAIGHTENER STERILE SUP-USH-526-RT1 CDM 0270 RC outpatient 371.44 371.44 371.44 74 274.87 percent of total billed charges 371.44 93 300.87 percent of total billed charges 371.44 371.44 other OPPS APC 371.44 371.44 other OPPS APC 371.44 27.63 102.63 percent of total billed charges 371.44 371.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL UNIVERSA AQ 2 PIGTAIL CURVE L28 CM OD5 FR RADIOPAQUE POSITIONER MONOFILAMENT TETHER STRAIGHTENER STERILE SUP-USH-528-RT1 CDM 0270 RC outpatient 371.44 371.44 371.44 74 274.87 percent of total billed charges 371.44 93 300.87 percent of total billed charges 371.44 371.44 other OPPS APC 371.44 371.44 other OPPS APC 371.44 27.63 102.63 percent of total billed charges 371.44 371.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT URETERAL UNIVERSA AQ 2 PIGTAIL CURVE L30 CM OD5 FR RADIOPAQUE POSITIONER MONOFILAMENT TETHER STRAIGHTENER STERILE SUP-USH-530-RT1 CDM 0270 RC outpatient 371.44 371.44 371.44 74 274.87 percent of total billed charges 371.44 93 300.87 percent of total billed charges 371.44 371.44 other OPPS APC 371.44 371.44 other OPPS APC 371.44 27.63 102.63 percent of total billed charges 371.44 371.44 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH ZURPAZ 8.5FR MED CURL STEERABLE SUP-USMCA8520 CDM 0270 RC outpatient 1950 1950 1950 74 1443 percent of total billed charges 1950 93 1579.5 percent of total billed charges 1950 1950 other OPPS APC 1950 1950 other OPPS APC 1950 27.63 538.79 percent of total billed charges 1950 1950 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SOFT TISSUE CRYOVEIN SAPHENOUS VEIN L20-80+ CM OD3-6 MM EXCELLENT RESISTANCE SUP-V010 CDM 0270 RC outpatient 20800 20800 20800 74 15392 percent of total billed charges 20800 93 16848 percent of total billed charges 20800 20800 other OPPS APC 20800 20800 other OPPS APC 20800 27.63 5747.04 percent of total billed charges 20800 20800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT SAPHENOUS VEING DOUBLE GRAFT SUP-V010-DP CDM 0270 RC outpatient 22386 22386 22386 74 16565.6 percent of total billed charges 22386 93 18132.7 percent of total billed charges 22386 22386 other OPPS APC 22386 22386 other OPPS APC 22386 27.63 6185.25 percent of total billed charges 22386 22386 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE-TEX STANDARD WALL L40 CM ID6 MM LINE STERILE LATEX FREE SUP-V06040L CDM 0270 RC outpatient 1125.8 1125.8 1125.8 74 833.09 percent of total billed charges 1125.8 93 911.9 percent of total billed charges 1125.8 1125.8 other OPPS APC 1125.8 1125.8 other OPPS APC 1125.8 27.63 311.06 percent of total billed charges 1125.8 1125.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE-TEX STANDARD WALL L70 CM ID6 MM LINE STERILE LATEX FREE SUP-V06070L CDM 0270 RC outpatient 1424.8 1424.8 1424.8 74 1054.35 percent of total billed charges 1424.8 93 1154.09 percent of total billed charges 1424.8 1424.8 other OPPS APC 1424.8 1424.8 other OPPS APC 1424.8 27.63 393.67 percent of total billed charges 1424.8 1424.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC INVIVE IS1 LV1 CONNECTOR CARDIAC RESYNCHRONIZATION THERAPY SUP-V172/73 CDM 0270 RC outpatient 17742.4 17742.4 17742.4 74 13129.4 percent of total billed charges 17742.4 93 14371.3 percent of total billed charges 17742.4 17742.4 other OPPS APC 17742.4 17742.4 other OPPS APC 17742.4 27.63 4902.23 percent of total billed charges 17742.4 17742.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER INVIVE CRTP SYSTEM SUP-V172/73S CDM 0270 RC outpatient 22435.4 22435.4 22435.4 74 16602.2 percent of total billed charges 22435.4 93 18172.7 percent of total billed charges 22435.4 22435.4 other OPPS APC 22435.4 22435.4 other OPPS APC 22435.4 27.63 6198.9 percent of total billed charges 22435.4 22435.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE-TEX STANDARD WALL TAPER L40 CM ID4-6 MM LINE STERILE LATEX FREE SUP-V46040L CDM 0270 RC outpatient 1151.8 1151.8 1151.8 74 852.33 percent of total billed charges 1151.8 93 932.96 percent of total billed charges 1151.8 1151.8 other OPPS APC 1151.8 1151.8 other OPPS APC 1151.8 27.63 318.24 percent of total billed charges 1151.8 1151.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE-TEX STANDARD WALL TAPER L50 CM ID4-7 MM LINE STERILE LATEX FREE SUP-V47050L CDM 0270 RC outpatient 1549.6 1549.6 1549.6 74 1146.7 percent of total billed charges 1549.6 93 1255.18 percent of total billed charges 1549.6 1549.6 other OPPS APC 1549.6 1549.6 other OPPS APC 1549.6 27.63 428.15 percent of total billed charges 1549.6 1549.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE VACUUM EXTRACTION PALMPUMP KIWI OMNICUP NEONATE FLEXIBLE STEM LOW PROFILE CUP TRACTION FORCE INDICATOR SUP-VAC-6000MT CDM 0270 RC outpatient 75.71 75.71 75.71 74 56.03 percent of total billed charges 75.71 93 61.33 percent of total billed charges 75.71 75.71 other OPPS APC 75.71 75.71 other OPPS APC 75.71 27.63 20.92 percent of total billed charges 75.71 75.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT SUTURE VALVE IN-HOUSE CUSTOM SUP-VALVE CUSTOM CDM 0270 RC outpatient 240.53 240.53 240.53 74 177.99 percent of total billed charges 240.53 93 194.83 percent of total billed charges 240.53 240.53 other OPPS APC 240.53 240.53 other OPPS APC 240.53 27.63 66.46 percent of total billed charges 240.53 240.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT VALIANT STRAIGHT L100 MM OD32 MM PROXIMAL MAIN SECTION FREE FLOW CAPTIVIA DELIVERY SYSTEM THORACIC AORTIC ANEURYSM REPAIR SUP-VAMC3232C100TU CDM 270010015 LOCAL 0270 RC outpatient 42237 42237 42237 74 31255.4 percent of total billed charges 42237 93 34212 percent of total billed charges 42237 42237 other OPPS APC 42237 42237 other OPPS APC 42237 27.63 11670.1 percent of total billed charges 42237 42237 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR VALIANT STENT 22MM P/D 150MM STRAIGHT PROXIMAL FREEFLO C DISTAL CROSS-PROFILE CAPTIVIA TU THORACIC NITINOL HYDROPHILIC F/TAA MRI-CONDITIONAL NON-RADIOLUCENT 22FR CATH SUP-VAMF2222C150TU CDM 0270 RC outpatient 47510 47510 47510 47510 other OPPS APC 47510 47510 other OPPS APC 47510 27.63 13127 percent of total billed charges 47510 47510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR VALIANT STENT 24MM P/D 150MM STRAIGHT PROXIMAL FREEFLO C DISTAL CROSS-PROFILE CAPTIVIA TU THORACIC NITINOL HYDROPHILIC F/TAA MRI-CONDITIONAL NON-RADIOLUCENT 22FR CATH SUP-VAMF2424C150TU CDM 0270 RC outpatient 47510 47510 47510 47510 other OPPS APC 47510 47510 other OPPS APC 47510 27.63 13127 percent of total billed charges 47510 47510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR VALIANT STENT 26MM P/D 150MM STRAIGHT PROXIMAL FREEFLO C DISTAL CROSS-PROFILE CAPTIVIA TU THORACIC NITINOL HYDROPHILIC F/TAA MRI-CONDITIONAL NON-RADIOLUCENT 22FR CATH SUP-VAMF2626C150TU CDM 0270 RC outpatient 47510 47510 47510 47510 other OPPS APC 47510 47510 other OPPS APC 47510 27.63 13127 percent of total billed charges 47510 47510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR VALIANT STENT 28MM P/D 150MM STRAIGHT PROXIMAL FREEFLO C DISTAL CROSS-PROFILE CAPTIVIA TU THORACIC NITINOL HYDROPHILIC F/TAA MRI-CONDITIONAL NON-RADIOLUCENT 22FR CATH SUP-VAMF2828C150TU CDM 0270 RC outpatient 47510 47510 47510 47510 other OPPS APC 47510 47510 other OPPS APC 47510 27.63 13127 percent of total billed charges 47510 47510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR VALIANT STENT 30MM P/D 150MM STRAIGHT PROXIMAL FREEFLO C DISTAL CROSS-PROFILE CAPTIVIA TU THORACIC NITINOL HYDROPHILIC F/TAA MRI-CONDITIONAL NON-RADIOLUCENT 22FR CATH SUP-VAMF3030C150TU CDM 0270 RC outpatient 47510 47510 47510 47510 other OPPS APC 47510 47510 other OPPS APC 47510 27.63 13127 percent of total billed charges 47510 47510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR VALIANT STENT 32MM P/D 150MM STRAIGHT PROXIMAL FREEFLO C DISTAL CROSS-PROFILE CAPTIVIA TU THORACIC NITINOL HYDROPHILIC F/TAA MRI-CONDITIONAL NON-RADIOLUCENT 22FR CATH SUP-VAMF3232C150TU CDM 0270 RC outpatient 47510 47510 47510 47510 other OPPS APC 47510 47510 other OPPS APC 47510 27.63 13127 percent of total billed charges 47510 47510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR VALIANT STENT 36MM P/D 150MM STRAIGHT PROXIMAL FREEFLO C DISTAL CROSS-PROFILE CAPTIVIA TU THORACIC NITINOL HYDROPHILIC F/TAA MRI-CONDITIONAL NON-RADIOLUCENT 24FR CATH SUP-VAMF3636C150TU CDM 0270 RC outpatient 47510 47510 47510 47510 other OPPS APC 47510 47510 other OPPS APC 47510 27.63 13127 percent of total billed charges 47510 47510 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT THORACIC MEDTRONIC VALIANT SUP-VAMF3838C150TU CDM 270010015 LOCAL 0270 RC outpatient 48087 48087 48087 74 35584.4 percent of total billed charges 48087 93 38950.5 percent of total billed charges 48087 48087 other OPPS APC 48087 48087 other OPPS APC 48087 27.63 13286.4 percent of total billed charges 48087 48087 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT VALIANT CAPTIVIA NITINOL PLATINUM IRIDIUM HYDROPHILIC SINUSOIDAL STRAIGHT L207 MM L200 MM OD38 MM ODSEC24 FR THORACIC PROXIMAL FREEFLO RADIOPAQUE MARKER SUP-VAMF3838C200TU CDM 270010015 LOCAL 0270 RC outpatient 50687 50687 50687 74 37508.4 percent of total billed charges 50687 93 41056.5 percent of total billed charges 50687 50687 other OPPS APC 50687 50687 other OPPS APC 50687 27.63 14004.8 percent of total billed charges 50687 50687 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT VALIANT STRAIGHT SINUSOIDAL 150MM 40MM 40MM ENDOVASCULAR SYSTEM FREEFLO SUP-VAMF4040C150TU CDM 270010015 LOCAL 0270 RC outpatient 48087 48087 48087 74 35584.4 percent of total billed charges 48087 93 38950.5 percent of total billed charges 48087 48087 other OPPS APC 48087 48087 other OPPS APC 48087 27.63 13286.4 percent of total billed charges 48087 48087 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT STENT VALIANT CAPTIVIA NITINOL PLATINUM IRIDIUM HYDROPHILIC SINUSOIDAL TAPER L160 MM L150 MM OD36-40 MM ODSEC24 FR THORACIC CLOSED WEB RADIOPAQUE MARKER SUP-VAMFC4036C150TU CDM 270010015 LOCAL 0270 RC outpatient 46137 46137 46137 74 34141.4 percent of total billed charges 46137 93 37371 percent of total billed charges 46137 46137 other OPPS APC 46137 46137 other OPPS APC 46137 27.63 12747.7 percent of total billed charges 46137 46137 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ENDOPATH ECHELON TITANIUM L35 MM X H2.5 MM H1 MM THIN VASCULAR TISSUE 4 ROW WHITE ADVANCE PLACEMENT TIP SUP-VASECR35 CDM 0270 RC outpatient 439.34 439.34 439.34 74 325.11 percent of total billed charges 439.34 93 355.87 percent of total billed charges 439.34 439.34 other OPPS APC 439.34 439.34 other OPPS APC 439.34 27.63 121.39 percent of total billed charges 439.34 439.34 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN HEPARIN L5 CM L120 CM OD8 MM ODSEC8 FR SUPERFICIAL FEMORAL ARTERY ILIUM DELIVERY SYSTEM 0.014-0.018 IN GUIDEWIRE 0.035 IN GUIDEWIRE SUP-VBH080502 CDM 0270 RC outpatient 7805.2 7805.2 7805.2 74 5775.85 percent of total billed charges 7805.2 93 6322.21 percent of total billed charges 7805.2 7805.2 other OPPS APC 7805.2 7805.2 other OPPS APC 7805.2 27.63 2156.58 percent of total billed charges 7805.2 7805.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN 5CM 120CM 9MM 9FR HEPARIN ILIAC ARTERY DELIVERY SYSTEM TIP TO HUB DEPLOYMENT ACCEPTS SUP-VBH090502A CDM 0270 RC outpatient 8892 8892 8892 74 6580.08 percent of total billed charges 8892 93 7202.52 percent of total billed charges 8892 8892 other OPPS APC 8892 8892 other OPPS APC 8892 27.63 2456.86 percent of total billed charges 8892 8892 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN 10CM 120CM 10MM 11FR HEPARIN ILIAC ARTERY DELIVERY SYSTEM TIP TO HUB DEPLOYMENT ACCEPTS SUP-VBH101002A CDM 0270 RC outpatient 10199.8 10199.8 10199.8 74 7547.85 percent of total billed charges 10199.8 93 8261.84 percent of total billed charges 10199.8 10199.8 other OPPS APC 10199.8 10199.8 other OPPS APC 10199.8 27.63 2818.2 percent of total billed charges 10199.8 10199.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT GORE VIABAHN SUP-VBH101502 CDM 0270 RC outpatient 9570.6 9570.6 9570.6 74 7082.24 percent of total billed charges 9570.6 93 7752.19 percent of total billed charges 9570.6 9570.6 other OPPS APC 9570.6 9570.6 other OPPS APC 9570.6 27.63 2644.36 percent of total billed charges 9570.6 9570.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN 10CM 120CM 10MM 11FR HEPARIN ILIAC ARTERY DELIVERY SYSTEM TIP TO HUB DEPLOYMENT ACCEPTS SUP-VBHR101002A CDM 0270 RC outpatient 11068.2 11068.2 11068.2 74 8190.47 percent of total billed charges 11068.2 93 8965.24 percent of total billed charges 11068.2 11068.2 other OPPS APC 11068.2 11068.2 other OPPS APC 11068.2 27.63 3058.14 percent of total billed charges 11068.2 11068.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN HEPARIN L15 CM L120 CM OD5 MM ODSEC6 FR SUPERFICIAL FEMORAL ARTERY ILIUM DELIVERY SYSTEM ACCEPTS .014/.018 IN GUIDEWIRE SUP-VBJ051502 CDM 0270 RC outpatient 9822.8 9822.8 9822.8 74 7268.87 percent of total billed charges 9822.8 93 7956.47 percent of total billed charges 9822.8 9822.8 other OPPS APC 9822.8 9822.8 other OPPS APC 9822.8 27.63 2714.04 percent of total billed charges 9822.8 9822.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS GORE VIABAHN HEPARIN L15 CM L120 CM OD6 MM ODSEC6 FR SUPERFICIAL FEMORAL ARTERY ILIAC STERILE LATEX FREE ACCEPTS .014/.018 IN GUIDEWIRE 4.8-5.5 MM VESSEL SUP-VBJ061502 CDM 0270 RC outpatient 9822.8 9822.8 9822.8 74 7268.87 percent of total billed charges 9822.8 93 7956.47 percent of total billed charges 9822.8 9822.8 other OPPS APC 9822.8 9822.8 other OPPS APC 9822.8 27.63 2714.04 percent of total billed charges 9822.8 9822.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN HEPARIN L10 CM L120 CM OD7 MM ODSEC7 FR SUPERFICIAL FEMORAL ARTERY ILIUM DELIVERY SYSTEM 0.014-0.018 IN GUIDEWIRE SUP-VBJ071002 CDM 0270 RC outpatient 11369.8 11369.8 11369.8 74 8413.65 percent of total billed charges 11369.8 93 9209.54 percent of total billed charges 11369.8 11369.8 other OPPS APC 11369.8 11369.8 other OPPS APC 11369.8 27.63 3141.48 percent of total billed charges 11369.8 11369.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN HEPARIN L15 CM L120 CM OD7 MM ODSEC7 FR SUPERFICIAL FEMORAL ARTERY ILIAC DELIVERY SYSTEM SUP-VBJ071502 CDM 0270 RC outpatient 9822.8 9822.8 9822.8 74 7268.87 percent of total billed charges 9822.8 93 7956.47 percent of total billed charges 9822.8 9822.8 other OPPS APC 9822.8 9822.8 other OPPS APC 9822.8 27.63 2714.04 percent of total billed charges 9822.8 9822.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN HEPARIN NITINOL EPTFE L2.5 CM L120 CM OD5 MM FLEXIBLE SELF EXPAND RADIOPAQUE STERILE DISPOSABLE ACCEPTS .014/.018 IN GUIDEWIRE 6 FR INTRODUCER SHEATH 4-4.7 MM VESSEL SUP-VBJR050202A CDM 0270 RC outpatient 10394.8 10394.8 10394.8 74 7692.15 percent of total billed charges 10394.8 93 8419.79 percent of total billed charges 10394.8 10394.8 other OPPS APC 10394.8 10394.8 other OPPS APC 10394.8 27.63 2872.08 percent of total billed charges 10394.8 10394.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN HEPARIN NITINOL EPTFE L25 CM L120 CM OD5 MM FLEXIBLE SELF EXPAND RADIOPAQUE STERILE DISPOSABLE ACCEPTS .014/.018 IN GUIDEWIRE 6 FR INTRODUCER SHEATH 4-4.7 MM VESSEL SUP-VBJR052502A CDM 0270 RC outpatient 20160.4 20160.4 20160.4 74 14918.7 percent of total billed charges 20160.4 93 16329.9 percent of total billed charges 20160.4 20160.4 other OPPS APC 20160.4 20160.4 other OPPS APC 20160.4 27.63 5570.32 percent of total billed charges 20160.4 20160.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN HEPARIN NITINOL EPTFE L2.5 CM L120 CM OD6 MM FLEXIBLE SELF EXPAND RADIOPAQUE STERILE DISPOSABLE ACCEPTS .014/.018 IN GUIDEWIRE 6 FR INTRODUCER SHEATH 4.8-5.5 MM VESSEL SUP-VBJR060202A CDM 0270 RC outpatient 10394.8 10394.8 10394.8 74 7692.15 percent of total billed charges 10394.8 93 8419.79 percent of total billed charges 10394.8 10394.8 other OPPS APC 10394.8 10394.8 other OPPS APC 10394.8 27.63 2872.08 percent of total billed charges 10394.8 10394.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS GORE VIABAHN HEPARIN L15 CM L120 CM OD6 MM ODSEC6 FR SUPERFICIAL FEMORAL ARTERY ILIAC STERILE LATEX FREE ACCEPTS .014/.018 IN GUIDEWIRE 4.8-5.5 MM VESSEL SUP-VBJR061502A CDM 0270 RC outpatient 12264.2 12264.2 12264.2 74 9075.51 percent of total billed charges 12264.2 93 9934 percent of total billed charges 12264.2 12264.2 other OPPS APC 12264.2 12264.2 other OPPS APC 12264.2 27.63 3388.6 percent of total billed charges 12264.2 12264.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN HEPARIN NITINOL EPTFE L25 CM L120 CM OD6 MM FLEXIBLE SELF EXPAND RADIOPAQUE STERILE DISPOSABLE ACCEPTS .014/.018 IN GUIDEWIRE 6 FR INTRODUCER SHEATH 4.8-5.5 MM VESSEL SUP-VBJR062502A CDM 0270 RC outpatient 20826 20826 20826 74 15411.2 percent of total billed charges 20826 93 16869.1 percent of total billed charges 20826 20826 other OPPS APC 20826 20826 other OPPS APC 20826 27.63 5754.22 percent of total billed charges 20826 20826 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN HEPARIN L5 CM L120 CM OD7 MM ODSEC7 FR SUPERFICIAL FEMORAL ARTERY ILIUM DELIVERY SYSTEM ACCEPTS .014/.018 IN GUIDEWIRE SUP-VBJR070502A CDM 0270 RC outpatient 10394.8 10394.8 10394.8 74 7692.15 percent of total billed charges 10394.8 93 8419.79 percent of total billed charges 10394.8 10394.8 other OPPS APC 10394.8 10394.8 other OPPS APC 10394.8 27.63 2872.08 percent of total billed charges 10394.8 10394.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN HEPARIN L10 CM L120 CM OD7 MM ODSEC7 FR SUPERFICIAL FEMORAL ARTERY ILIUM DELIVERY SYSTEM 0.014-0.018 IN GUIDEWIRE SUP-VBJR071002A CDM 0270 RC outpatient 11369.8 11369.8 11369.8 74 8413.65 percent of total billed charges 11369.8 93 9209.54 percent of total billed charges 11369.8 11369.8 other OPPS APC 11369.8 11369.8 other OPPS APC 11369.8 27.63 3141.48 percent of total billed charges 11369.8 11369.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN HEPARIN L15 CM L120 CM OD7 MM ODSEC7 FR SUPERFICIAL FEMORAL ARTERY ILIAC DELIVERY SYSTEM SUP-VBJR071502A CDM 0270 RC outpatient 12669.8 12669.8 12669.8 74 9375.65 percent of total billed charges 12669.8 93 10262.5 percent of total billed charges 12669.8 12669.8 other OPPS APC 12669.8 12669.8 other OPPS APC 12669.8 27.63 3500.67 percent of total billed charges 12669.8 12669.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN HEPARIN NITINOL EPTFE L25 CM L120 CM OD7 MM FLEXIBLE SELF EXPAND RADIOPAQUE STERILE DISPOSABLE ACCEPTS .014/.018 IN GUIDEWIRE 7 FR INTRODUCER SHEATH 5.6-6.5 MM VESSEL SUP-VBJR072502A CDM 0270 RC outpatient 18353.4 18353.4 18353.4 74 13581.5 percent of total billed charges 18353.4 93 14866.3 percent of total billed charges 18353.4 18353.4 other OPPS APC 18353.4 18353.4 other OPPS APC 18353.4 27.63 5071.04 percent of total billed charges 18353.4 18353.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN HEPARIN L5 CM L120 CM OD8 MM ODSEC7 FR SUPERFICIAL FEMORAL ARTERY ILIUM DELIVERY SYSTEM ACCEPTS .014/.018 IN GUIDEWIRE SUP-VBJR080502A CDM 0270 RC outpatient 10394.8 10394.8 10394.8 74 7692.15 percent of total billed charges 10394.8 93 8419.79 percent of total billed charges 10394.8 10394.8 other OPPS APC 10394.8 10394.8 other OPPS APC 10394.8 27.63 2872.08 percent of total billed charges 10394.8 10394.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN HEPARIN L10 CM L120 CM OD8 MM SUPERFICIAL FEMORAL ARTERY ILIAC ACCEPTS .014/.018 IN GUIDEWIRE SUP-VBJR081002A CDM 0270 RC outpatient 11369.8 11369.8 11369.8 74 8413.65 percent of total billed charges 11369.8 93 9209.54 percent of total billed charges 11369.8 11369.8 other OPPS APC 11369.8 11369.8 other OPPS APC 11369.8 27.63 3141.48 percent of total billed charges 11369.8 11369.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN HEPARIN L15 CM L120 CM OD8 MM ODSEC7 FR SUPERFICIAL FEMORAL ARTERY ILIUM DELIVERY SYSTEM ACCEPTS .014/.018 IN GUIDEWIRE SUP-VBJR081502A CDM 0270 RC outpatient 11167 11167 11167 74 8263.58 percent of total billed charges 11167 93 9045.27 percent of total billed charges 11167 11167 other OPPS APC 11167 11167 other OPPS APC 11167 27.63 3085.44 percent of total billed charges 11167 11167 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS VIABAHN HEPARIN NITINOL EPTFE L25 CM L120 CM OD8 MM FLEXIBLE SELF EXPAND RADIOPAQUE STERILE DISPOSABLE ACCEPTS .014/.018 IN GUIDEWIRE 6 FR INTRODUCER SHEATH 6.6-7.5 MM VESSEL SUP-VBJR082502 CDM 0270 RC outpatient 17472 17472 17472 74 12929.3 percent of total billed charges 17472 93 14152.3 percent of total billed charges 17472 17472 other OPPS APC 17472 17472 other OPPS APC 17472 27.63 4827.51 percent of total billed charges 17472 17472 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT ENDOPROSTHESIS 25CM 8MM HEPARIN NITINOL EPTFE VIABAHN 120CM FLEXIBLE SELF SUP-VBJR082502A CDM 0270 RC outpatient 10127 10127 10127 74 7493.98 percent of total billed charges 10127 93 8202.87 percent of total billed charges 10127 10127 other OPPS APC 10127 10127 other OPPS APC 10127 27.63 2798.09 percent of total billed charges 10127 10127 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SOLUTION OPHTHALMIC VISIONBLUE .5ML TRYPAN VIAL SUP-VBL-10-S-USA CDM 0270 RC outpatient 129.48 129.48 129.48 74 95.82 percent of total billed charges 129.48 93 104.88 percent of total billed charges 129.48 129.48 other OPPS APC 129.48 129.48 other OPPS APC 129.48 27.63 35.78 percent of total billed charges 129.48 129.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT VESSEL HARVESTING SM #17 ULTRA RETRACTOR OPTICAL DISSECTOR PRECISION BIPOLAR VEIN SUP-VC17 CDM 0270 RC outpatient 1419.6 1419.6 1419.6 74 1050.5 percent of total billed charges 1419.6 93 1149.88 percent of total billed charges 1419.6 1419.6 other OPPS APC 1419.6 1419.6 other OPPS APC 1419.6 27.63 392.24 percent of total billed charges 1419.6 1419.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT VESSEL HARVESTING SM #21 ULTRA RETRACTOR OPTICAL DISSECTOR PRECISION BIPOLAR VEIN SUP-VC21 CDM 0270 RC outpatient 1942.2 1942.2 1942.2 74 1437.23 percent of total billed charges 1942.2 93 1573.18 percent of total billed charges 1942.2 1942.2 other OPPS APC 1942.2 1942.2 other OPPS APC 1942.2 27.63 536.63 percent of total billed charges 1942.2 1942.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT VESSEL HARVESTING SM #23 ULTRA RETRACTOR OPTICAL DISSECTOR PRECISION BIPOLAR VEIN SUP-VC23 CDM 0270 RC outpatient 1326 1326 1326 74 981.24 percent of total billed charges 1326 93 1074.06 percent of total billed charges 1326 1326 other OPPS APC 1326 1326 other OPPS APC 1326 27.63 366.37 percent of total billed charges 1326 1326 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL PLUS LIGAPAK 3-0 L54 IN BRAID REEL ANTIBACTERIAL COATED VIOLET SUP-VCP205G CDM 0270 RC outpatient 5.79 5.79 5.79 74 4.28 percent of total billed charges 5.79 93 4.69 percent of total billed charges 5.79 5.79 other OPPS APC 5.79 5.79 other OPPS APC 5.79 27.63 1.6 percent of total billed charges 5.79 5.79 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL PLUS 5-0 RB-1 L27 IN BRAID ANTIBACTERIAL COATED UNDYED SUP-VCP213H CDM 0270 RC outpatient 5.11 5.11 5.11 74 3.78 percent of total billed charges 5.11 93 4.14 percent of total billed charges 5.11 5.11 other OPPS APC 5.11 5.11 other OPPS APC 5.11 27.63 1.41 percent of total billed charges 5.11 5.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL PLUS 2-0 CP-1 L27 IN BRAID ANTIBACTERIAL COATED UNDYED SUP-VCP266H CDM 0270 RC outpatient 4.43 4.43 4.43 74 3.28 percent of total billed charges 4.43 93 3.59 percent of total billed charges 4.43 4.43 other OPPS APC 4.43 4.43 other OPPS APC 4.43 27.63 1.22 percent of total billed charges 4.43 4.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE 2-0 27IN VICRYL SUP-VCP269H CDM 0270 RC outpatient 4.13 4.13 4.13 74 3.06 percent of total billed charges 4.13 93 3.35 percent of total billed charges 4.13 4.13 other OPPS APC 4.13 4.13 other OPPS APC 4.13 27.63 1.14 percent of total billed charges 4.13 4.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL PLUS LIGAPAK 0 L54 IN BRAID ANTIBACTERIAL COATED DISPOSABLE UNDYED SUP-VCP287G CDM 0481 RC outpatient 5.73 5.73 5.73 74 4.24 percent of total billed charges 5.73 93 4.64 percent of total billed charges 5.73 5.73 other OPPS APC 5.73 5.73 other OPPS APC 5.73 51 2.92 percent of total billed charges 5.73 5.73 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL PLUS 3-0 SH-1 L27 IN BRAID ANTIBACTERIAL COATED VIOLET SUP-VCP311H CDM 0270 RC outpatient 4.78 4.78 4.78 74 3.54 percent of total billed charges 4.78 93 3.87 percent of total billed charges 4.78 4.78 other OPPS APC 4.78 4.78 other OPPS APC 4.78 27.63 1.32 percent of total billed charges 4.78 4.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL PLUS 4-0 SH L27 IN BRAID ANTIBACTERIAL COATED VIOLET SUP-VCP315H CDM 0270 RC outpatient 4.59 4.59 4.59 74 3.4 percent of total billed charges 4.59 93 3.72 percent of total billed charges 4.59 4.59 other OPPS APC 4.59 4.59 other OPPS APC 4.59 27.63 1.27 percent of total billed charges 4.59 4.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL PLUS 2-0 CT L36 IN BRAID ANTIBACTERIAL COATED VIOLET SUP-VCP357H CDM 0270 RC outpatient 4.39 4.39 4.39 74 3.25 percent of total billed charges 4.39 93 3.56 percent of total billed charges 4.39 4.39 other OPPS APC 4.39 4.39 other OPPS APC 4.39 27.63 1.21 percent of total billed charges 4.39 4.39 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE COATED VICRYL PLUS 0 UR-5 L27 IN BRAID ANTIBACTERIAL COATED VIOLET SUP-VCP376H CDM 0270 RC outpatient 5.15 5.15 5.15 74 3.81 percent of total billed charges 5.15 93 4.17 percent of total billed charges 5.15 5.15 other OPPS APC 5.15 5.15 other OPPS APC 5.15 27.63 1.42 percent of total billed charges 5.15 5.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL PLUS 3-0 SH L27 IN BRAID ANTIBACTERIAL COATED UNDYED SUP-VCP416H CDM 0270 RC outpatient 4.09 4.09 4.09 74 3.03 percent of total billed charges 4.09 93 3.31 percent of total billed charges 4.09 4.09 other OPPS APC 4.09 4.09 other OPPS APC 4.09 27.63 1.13 percent of total billed charges 4.09 4.09 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL PLUS 4-0 FS-2 L27 IN BRAID COATED ANTIBACTERIAL SUP-VCP422H CDM 0270 RC outpatient 5.76 5.76 5.76 74 4.26 percent of total billed charges 5.76 93 4.67 percent of total billed charges 5.76 5.76 other OPPS APC 5.76 5.76 other OPPS APC 5.76 27.63 1.59 percent of total billed charges 5.76 5.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL PLUS MULTIPASS 4-0 PS-2 L27 IN BRAID ANTIBACTERIAL COATED UNIDIRECTIONAL UNDYED SUP-VCP426H CDM 0270 RC outpatient 11.01 11.01 11.01 74 8.15 percent of total billed charges 11.01 93 8.92 percent of total billed charges 11.01 11.01 other OPPS APC 11.01 11.01 other OPPS APC 11.01 27.63 3.04 percent of total billed charges 11.01 11.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL PLUS MULTIPASS 2-0 PS-2 L27 IN BRAID COATED UNDYED SUP-VCP428H CDM 0270 RC outpatient 11.66 11.66 11.66 74 8.63 percent of total billed charges 11.66 93 9.44 percent of total billed charges 11.66 11.66 other OPPS APC 11.66 11.66 other OPPS APC 11.66 27.63 3.22 percent of total billed charges 11.66 11.66 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE VICRYL 2-0 SUP-VCP443H CDM 0270 RC outpatient 6.67 6.67 6.67 74 4.94 percent of total billed charges 6.67 93 5.4 percent of total billed charges 6.67 6.67 other OPPS APC 6.67 6.67 other OPPS APC 6.67 27.63 1.84 percent of total billed charges 6.67 6.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL MULTIPASS 4-0 P-3 18IN UNDYED BRAID COATED SUP-VCP494G CDM 0270 RC outpatient 11.75 11.75 11.75 74 8.7 percent of total billed charges 11.75 93 9.52 percent of total billed charges 11.75 11.75 other OPPS APC 11.75 11.75 other OPPS APC 11.75 27.63 3.25 percent of total billed charges 11.75 11.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL PLUS 5-0 P-2 L18 IN BRAID ANTIBACTERIAL COATED UNDYED SUP-VCP503G CDM 0270 RC outpatient 12.45 12.45 12.45 74 9.21 percent of total billed charges 12.45 93 10.08 percent of total billed charges 12.45 12.45 other OPPS APC 12.45 12.45 other OPPS APC 12.45 27.63 3.44 percent of total billed charges 12.45 12.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL PLUS 2-0 UR-6 L27 IN BRAID ANTIBACTERIAL COATED VIOLET SUP-VCP602H CDM 0270 RC outpatient 5.12 5.12 5.12 74 3.79 percent of total billed charges 5.12 93 4.15 percent of total billed charges 5.12 5.12 other OPPS APC 5.12 5.12 other OPPS APC 5.12 27.63 1.41 percent of total billed charges 5.12 5.12 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL PLUS 0 UR-6 L27 IN BRAID ANTIBACTERIAL COATED VIOLET SUP-VCP603H CDM 0270 RC outpatient 5.05 5.05 5.05 74 3.74 percent of total billed charges 5.05 93 4.09 percent of total billed charges 5.05 5.05 other OPPS APC 5.05 5.05 other OPPS APC 5.05 27.63 1.4 percent of total billed charges 5.05 5.05 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VICRYL PLUS COATED SIZE 0 VIOLET CONTROL RELEASE 8PK SUP-VCP727D CDM 0270 RC outpatient 30.75 30.75 30.75 74 22.76 percent of total billed charges 30.75 93 24.91 percent of total billed charges 30.75 30.75 other OPPS APC 30.75 30.75 other OPPS APC 30.75 27.63 8.5 percent of total billed charges 30.75 30.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL PLUS 4-0 TF L18 IN CONTROL RELEASE BRAID 8 STRAND ANTIBACTERIAL VIOLET SUP-VCP743D CDM 0270 RC outpatient 42.4 42.4 42.4 74 31.38 percent of total billed charges 42.4 93 34.34 percent of total billed charges 42.4 42.4 other OPPS APC 42.4 42.4 other OPPS APC 42.4 27.63 11.72 percent of total billed charges 42.4 42.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL PLUS 2-0 CP-2 L18 IN CONTROL RELEASE BRAID 8 STRAND ANTIBACTERIAL UNDYED SUP-VCP762D CDM 0270 RC outpatient 37.86 37.86 37.86 74 28.02 percent of total billed charges 37.86 93 30.67 percent of total billed charges 37.86 37.86 other OPPS APC 37.86 37.86 other OPPS APC 37.86 27.63 10.46 percent of total billed charges 37.86 37.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL PLUS 3-0 X-1 L18 IN CONTROL RELEASE BRAID 8 STRAND ANTIBACTERIAL VIOLET SUP-VCP790D CDM 0270 RC outpatient 45.38 45.38 45.38 74 33.58 percent of total billed charges 45.38 93 36.76 percent of total billed charges 45.38 45.38 other OPPS APC 45.38 45.38 other OPPS APC 45.38 27.63 12.54 percent of total billed charges 45.38 45.38 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL PLUS 0 CT-1 L18 IN CONTROL RELEASE BRAID 8 STRAND ANTIBACTERIAL UNDYED SUP-VCP840D CDM 0270 RC outpatient 31.19 31.19 31.19 74 23.08 percent of total billed charges 31.19 93 25.26 percent of total billed charges 31.19 31.19 other OPPS APC 31.19 31.19 other OPPS APC 31.19 27.63 8.62 percent of total billed charges 31.19 31.19 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL PLUS MULTIPASS 3-0 PS-1 L27 IN BRAID ANTIBACTERIAL COATED UNDYED SUP-VCP936H CDM 0270 RC outpatient 11.99 11.99 11.99 74 8.87 percent of total billed charges 11.99 93 9.71 percent of total billed charges 11.99 11.99 other OPPS APC 11.99 11.99 other OPPS APC 11.99 27.63 3.31 percent of total billed charges 11.99 11.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL PLUS 3-0 CT L36 IN BRAID ANTIBACTERIAL COATED UNDYED SUP-VCP956H CDM 0270 RC outpatient 4.4 4.4 4.4 74 3.26 percent of total billed charges 4.4 93 3.56 percent of total billed charges 4.4 4.4 other OPPS APC 4.4 4.4 other OPPS APC 4.4 27.63 1.22 percent of total billed charges 4.4 4.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHER BALLOON DILATATION VIDA L100 CM L 4 CM ODSEC 12 MM PERIPHERAL LOW PROFILE PREDICTABLE SIZE RUPTURE RESISTANT STERILE LATEX FREE ACCEPTS .035 IN GUIDEWIRE 7 FR SHEATH PERCUTANEOUS TRANSLUMINAL VALVULOPLASTY SUP-VDA100124 CDM 0481 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 51 1591.2 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHER BALLOON DILATATION VIDA L100 CM L 4 CM ODSEC 14 MM PERIPHERAL LOW PROFILE PREDICTABLE SIZE RUPTURE RESISTANT STERILE LATEX FREE ACCEPTS .035 IN GUIDEWIRE 7 FR SHEATH PERCUTANEOUS TRANSLUMINAL VALVULOPLASTY SUP-VDA100144 CDM 0481 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 51 1591.2 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHER BALLOON DILATATION VIDA L100 CM L 4 CM ODSEC 16 MM PERIPHERAL LOW PROFILE PREDICTABLE SIZE RUPTURE RESISTANT STERILE LATEX FREE ACCEPTS .035 IN GUIDEWIRE 8 FR SHEATH PERCUTANEOUS TRANSLUMINAL VALVULOPLASTY SUP-VDA100164 CDM 0481 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 51 1591.2 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHER BALLOON DILATATION VIDA L100 CM L 4 CM ODSEC 18 MM PERIPHERAL LOW PROFILE PREDICTABLE SIZE RUPTURE RESISTANT STERILE LATEX FREE ACCEPTS .035 IN GUIDEWIRE 8 FR SHEATH PERCUTANEOUS TRANSLUMINAL VALVULOPLASTY SUP-VDA100184 CDM 0481 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 51 1591.2 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHER BALLOON DILATATION VIDA L100 CM L 4 CM ODSEC 20 MM PERIPHERAL LOW PROFILE PREDICTABLE SIZE RUPTURE RESISTANT STERILE LATEX FREE ACCEPTS .035 IN GUIDEWIRE 9 FR SHEATH PERCUTANEOUS TRANSLUMINAL VALVULOPLASTY SUP-VDA100204 CDM 0481 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 51 1591.2 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHER BALLOON DILATATION VIDA L100 CM L 4 CM ODSEC 22 MM PERIPHERAL LOW PROFILE PREDICTABLE SIZE RUPTURE RESISTANT STERILE LATEX FREE ACCEPTS .035 IN GUIDEWIRE 10 FR SHEATH PERCUTANEOUS TRANSLUMINAL VALVULOPLASTY SUP-VDA100224 CDM 0481 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 51 1591.2 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHER BALLOON DILATATION VIDA L100 CM L 4 CM ODSEC 24 MM PERIPHERAL LOW PROFILE PREDICTABLE SIZE RUPTURE RESISTANT STERILE LATEX FREE ACCEPTS .035 IN GUIDEWIRE 10 FR SHEATH PERCUTANEOUS TRANSLUMINAL VALVULOPLASTY SUP-VDA100244 CDM 0481 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 51 1591.2 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CATHER BALLOON DILATATION VIDA L100 CM L 4 CM ODSEC 26 MM PERIPHERAL LOW PROFILE PREDICTABLE SIZE RUPTURE RESISTANT STERILE LATEX FREE ACCEPTS .035 IN GUIDEWIRE 12 FR SHEATH PERCUTANEOUS TRANSLUMINAL VALVULOPLASTY SUP-VDA100264 CDM 0481 RC outpatient 3120 3120 3120 74 2308.8 percent of total billed charges 3120 93 2527.2 percent of total billed charges 3120 3120 other OPPS APC 3120 3120 other OPPS APC 3120 51 1591.2 percent of total billed charges 3120 3120 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BEAD PARTICLES EMBOLIZATION LC 70-150UM 2ML VIAL BLACK SUP-VE020GS CDM 0270 RC outpatient 6110 6110 6110 74 4521.4 percent of total billed charges 6110 93 4949.1 percent of total billed charges 6110 6110 other OPPS APC 6110 6110 other OPPS APC 6110 27.63 1688.19 percent of total billed charges 6110 6110 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PARTICLES EMBOLIZATION LC BEAD 100-300UM 2ML YELLOW VIAL SUP-VE220GS CDM 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PARTICLES EMBOLIZATION LC BEAD 300-500UM 2ML BLUE VIAL SUP-VE420GS CDM 0270 RC outpatient 4680 4680 4680 74 3463.2 percent of total billed charges 4680 93 3790.8 percent of total billed charges 4680 4680 other OPPS APC 4680 4680 other OPPS APC 4680 27.63 1293.08 percent of total billed charges 4680 4680 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PPM VEDR01 VERSA DR DEVICE SUP-VEDR01 D CDM 0275 RC outpatient 8653.5 8653.5 8653.5 57 4932.5 percent of total billed charges 8653.5 93 7009.34 percent of total billed charges 8653.5 8653.5 other OPPS APC 8653.5 8653.5 other OPPS APC 8653.5 51 4413.29 percent of total billed charges 8653.5 8653.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER CARDIAC VERSA DR 2.8V 1.3AH D7.5 MM W44.9 MM X H44.7 MM 12.1 CC 27.1 GM ATRIUM VENTRICLE IMPLANTABLE 2 CHAMBER UNIPOLAR BIPOLAR SUP-VEDR01 S CDM 0270 RC outpatient 12038 12038 12038 74 8908.12 percent of total billed charges 12038 93 9750.78 percent of total billed charges 12038 12038 other OPPS APC 12038 12038 other OPPS APC 12038 27.63 3326.1 percent of total billed charges 12038 12038 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH CARDIOVASCULAR VASCU-GUARD BOVINE PERICARDIAL TAPER L8 CM X W.8 CM PERIPHERAL APEX PROCESS SUP-VG0108 CDM 0270 RC outpatient 608.5 608.5 608.5 74 450.29 percent of total billed charges 608.5 93 492.89 percent of total billed charges 608.5 608.5 other OPPS APC 608.5 608.5 other OPPS APC 608.5 27.63 168.13 percent of total billed charges 608.5 608.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH CARDIOVASCULAR VASCU-GUARD BOVINE PERICARDIAL TAPER L8 CM X W.8 CM PERIPHERAL APEX PROCESS SUP-VG0108N CDM 0270 RC outpatient 562.67 562.67 562.67 74 416.38 percent of total billed charges 562.67 93 455.76 percent of total billed charges 562.67 562.67 other OPPS APC 562.67 562.67 other OPPS APC 562.67 27.63 155.47 percent of total billed charges 562.67 562.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT VESSEL HARVESTING VASOVIEW HEMOPRO 2 ENDOSCOPIC SUP-VH-4000 CDM 0270 RC outpatient 2779.14 2779.14 2779.14 74 2056.56 percent of total billed charges 2779.14 93 2251.1 percent of total billed charges 2779.14 2779.14 other OPPS APC 2779.14 2779.14 other OPPS APC 2779.14 27.63 767.88 percent of total billed charges 2779.14 2779.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT VAC VIA 7-DAY THERAPY SYSTEM SUP-VIAKIT077D01 CDM 0270 RC outpatient 1882.4 1882.4 1882.4 74 1392.98 percent of total billed charges 1882.4 93 1524.74 percent of total billed charges 1882.4 1882.4 other OPPS APC 1882.4 1882.4 other OPPS APC 1882.4 27.63 520.11 percent of total billed charges 1882.4 1882.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CANNULA PERFUSION VENOUS IRRIGATION BEVELED TIP SUP-VIC CDM 0270 RC outpatient 27.53 27.53 27.53 74 20.37 percent of total billed charges 27.53 93 22.3 percent of total billed charges 27.53 27.53 other OPPS APC 27.53 27.53 other OPPS APC 27.53 27.63 7.61 percent of total billed charges 27.53 27.53 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MODEL 3D GLENOID SUP-VIP-GM-3D-1 CDM 270010030 LOCAL 0270 RC outpatient 1040 1040 1040 74 769.6 percent of total billed charges 1040 93 842.4 percent of total billed charges 1040 1040 other OPPS APC 1040 1040 other OPPS APC 1040 27.63 287.35 percent of total billed charges 1040 1040 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ICD VISIA AF MRI VR SYSTEM SUP-VISIAAFMRIEMEM CDM 0275 RC outpatient 34650 34650 34650 57 19750.5 percent of total billed charges 34650 93 28066.5 percent of total billed charges 34650 34650 other OPPS APC 34650 34650 other OPPS APC 34650 51 17671.5 percent of total billed charges 34650 34650 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER VIVA C6TR01 SYSTEM SUP-VIVACRTPMEAM CDM 0275 RC outpatient 17560.4 17560.4 17560.4 57 10009.4 percent of total billed charges 17560.4 93 14223.9 percent of total billed charges 17560.4 17560.4 other OPPS APC 17560.4 17560.4 other OPPS APC 17560.4 51 8955.8 percent of total billed charges 17560.4 17560.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER VIVA C6TR01 SYSTEM W STARFIX LEAD SUP-VIVACRTPMEPM CDM 0275 RC outpatient 17560.4 17560.4 17560.4 57 10009.4 percent of total billed charges 17560.4 93 14223.9 percent of total billed charges 17560.4 17560.4 other OPPS APC 17560.4 17560.4 other OPPS APC 17560.4 51 8955.8 percent of total billed charges 17560.4 17560.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT-D VIVA QUAD XT SYSTEM SUP-VIVAQUADXTCRTDMMQM CDM 0275 RC outpatient 36322 36322 36322 57 20703.5 percent of total billed charges 36322 93 29420.8 percent of total billed charges 36322 36322 other OPPS APC 36322 36322 other OPPS APC 36322 51 18524.2 percent of total billed charges 36322 36322 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ALCOHOL 70% ISOPROPYL 16OZ SUP-VJO098003 CDM 0270 RC outpatient 3.98 3.98 3.98 74 2.95 percent of total billed charges 3.98 93 3.22 percent of total billed charges 3.98 3.98 other OPPS APC 3.98 3.98 other OPPS APC 3.98 27.63 1.1 percent of total billed charges 3.98 3.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MESH SURGICAL VICRYL L6 IN X W6 IN KNIT WOVEN SUP-VKMM CDM 270009092 LOCAL 0270 RC outpatient 114.9 114.9 114.9 74 85.03 percent of total billed charges 114.9 93 93.07 percent of total billed charges 114.9 114.9 other OPPS APC 114.9 114.9 other OPPS APC 114.9 27.63 31.75 percent of total billed charges 114.9 114.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VLOC 180 ABSORBABLE RELOAD 10MM SUP-VLOCA008L CDM 0270 RC outpatient 327.94 327.94 327.94 74 242.68 percent of total billed charges 327.94 93 265.63 percent of total billed charges 327.94 327.94 other OPPS APC 327.94 327.94 other OPPS APC 327.94 27.63 90.61 percent of total billed charges 327.94 327.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE V-LOC 180 3-0 P-14 18IN CLEAR ABSORBABLE PREMIUM REVERSE CUT SUP-VLOCL0124 CDM 0270 RC outpatient 57.01 57.01 57.01 74 42.19 percent of total billed charges 57.01 93 46.18 percent of total billed charges 57.01 57.01 other OPPS APC 57.01 57.01 other OPPS APC 57.01 27.63 15.75 percent of total billed charges 57.01 57.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE V-LOC 180 0 GS-21 L15 CM L37 MM ABSORBABLE GREEN SUP-VLOCL0306 CDM 0270 RC outpatient 56.41 56.41 56.41 74 41.74 percent of total billed charges 56.41 93 45.69 percent of total billed charges 56.41 56.41 other OPPS APC 56.41 56.41 other OPPS APC 56.41 27.63 15.59 percent of total billed charges 56.41 56.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE V-LOC 180 2-0 GS-21 12IN GREEN ABSORBABLE TAPER POINT SUP-VLOCL0315 CDM 0270 RC outpatient 56.41 56.41 56.41 74 41.74 percent of total billed charges 56.41 93 45.69 percent of total billed charges 56.41 56.41 other OPPS APC 56.41 56.41 other OPPS APC 56.41 27.63 15.59 percent of total billed charges 56.41 56.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE V-LOC 180 0 GS-21 12IN GREEN ABSORBABLE TAPER POINT SUP-VLOCL0316 CDM 0270 RC outpatient 56.41 56.41 56.41 74 41.74 percent of total billed charges 56.41 93 45.69 percent of total billed charges 56.41 56.41 other OPPS APC 56.41 56.41 other OPPS APC 56.41 27.63 15.59 percent of total billed charges 56.41 56.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SUTURE V-LOC 180 SURGALLOY 3-0 V-20 TAPER POINT L 6IN ABSORBABLE GREEN SUP-VLOCL0604 CDM 0270 RC outpatient 54.04 54.04 54.04 74 39.99 percent of total billed charges 54.04 93 43.77 percent of total billed charges 54.04 54.04 other OPPS APC 54.04 54.04 other OPPS APC 54.04 27.63 14.93 percent of total billed charges 54.04 54.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE V-LOC 180 2-0 V-20 1/2 CIRCLE L18 IN L26 MM TAPER POINT ABSORBABLE GREEN SUP-VLOCL0625 CDM 0270 RC outpatient 53.51 53.51 53.51 74 39.6 percent of total billed charges 53.51 93 43.34 percent of total billed charges 53.51 53.51 other OPPS APC 53.51 53.51 other OPPS APC 53.51 27.63 14.78 percent of total billed charges 53.51 53.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE V-LOC 180 SURGALLOY 3-0 V-20 1/2 CIRCLE L9 IN L26 MM TAPER POINT ABSORBABLE GREEN SUP-VLOCL0644 CDM 0270 RC outpatient 54.04 54.04 54.04 74 39.99 percent of total billed charges 54.04 93 43.77 percent of total billed charges 54.04 54.04 other OPPS APC 54.04 54.04 other OPPS APC 54.04 27.63 14.93 percent of total billed charges 54.04 54.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE V-LOC 180 2-0 GS-22 1/2 CIRCLE L6 IN L27 MM TAPER POINT ABSORBABLE GREEN SUP-VLOCL2105 CDM 0270 RC outpatient 54.04 54.04 54.04 74 39.99 percent of total billed charges 54.04 93 43.77 percent of total billed charges 54.04 54.04 other OPPS APC 54.04 54.04 other OPPS APC 54.04 27.63 14.93 percent of total billed charges 54.04 54.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE V-LOC 90 SURGALLOY 3-0 P-12 3/8 CIRCLE L12IN L19MM REVERSE CUT ABSORBABLE 2 ANGLE CUT BARB PATTERN UNDYED SUP-VLOCM0014 CDM 0270 RC outpatient 57.01 57.01 57.01 74 42.19 percent of total billed charges 57.01 93 46.18 percent of total billed charges 57.01 57.01 other OPPS APC 57.01 57.01 other OPPS APC 57.01 27.63 15.75 percent of total billed charges 57.01 57.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE V-LOC 90 SURGALLOY 2-0 P-12 3/8 CIRCLE L 12IN L19MM REVERSE CUT ABSORBABLE 2 ANGLE CUT BARB PATTERN UNDYED SUP-VLOCM0015 CDM 0270 RC outpatient 57.01 57.01 57.01 74 42.19 percent of total billed charges 57.01 93 46.18 percent of total billed charges 57.01 57.01 other OPPS APC 57.01 57.01 other OPPS APC 57.01 27.63 15.75 percent of total billed charges 57.01 57.01 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE V-LOC 90 4-0 SC-2 STRAIGHT L45 CM L60 MM 2 ANGLE CUT ABSORBABLE BARB UNDYED SUP-VLOCM0223 CDM 0270 RC outpatient 56.45 56.45 56.45 74 41.77 percent of total billed charges 56.45 93 45.72 percent of total billed charges 56.45 56.45 other OPPS APC 56.45 56.45 other OPPS APC 56.45 27.63 15.6 percent of total billed charges 56.45 56.45 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE V-LOC 90 3-0 SC-2 STRAIGHT L45 CM L60 MM 2 ANGLE CUT ABSORBABLE BARB UNDYED SUP-VLOCM0224 CDM 0270 RC outpatient 67.7 67.7 67.7 74 50.1 percent of total billed charges 67.7 93 54.84 percent of total billed charges 67.7 67.7 other OPPS APC 67.7 67.7 other OPPS APC 67.7 27.63 18.71 percent of total billed charges 67.7 67.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SUTURE VLOC NON ABS DVC 1BL 18""L GS-21" SUP-VLOCN0327 CDM 0270 RC outpatient 56.41 56.41 56.41 74 41.74 percent of total billed charges 56.41 93 45.69 percent of total billed charges 56.41 56.41 other OPPS APC 56.41 56.41 other OPPS APC 56.41 27.63 15.59 percent of total billed charges 56.41 56.41 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE SYNETURE V-LOC 1 GS-21 L 9IN ABSORBABLE BLUE SUP-VLOCN0347 CDM 0270 RC outpatient 58.63 58.63 58.63 74 43.39 percent of total billed charges 58.63 93 47.49 percent of total billed charges 58.63 58.63 other OPPS APC 58.63 58.63 other OPPS APC 58.63 27.63 16.2 percent of total billed charges 58.63 58.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE CLOSURE V-LOC 2-0 V-20 L12IIN NONABSORBABLE BLUE SUP-VLOCN0615 CDM 0270 RC outpatient 53.51 53.51 53.51 74 39.6 percent of total billed charges 53.51 93 43.34 percent of total billed charges 53.51 53.51 other OPPS APC 53.51 53.51 other OPPS APC 53.51 27.63 14.78 percent of total billed charges 53.51 53.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE V-LOC 3-0 NON ABSORBABLE WOUND CLOSURE DEVICE SUP-VLOCN0644 CDM 0270 RC outpatient 54.04 54.04 54.04 74 39.99 percent of total billed charges 54.04 93 43.77 percent of total billed charges 54.04 54.04 other OPPS APC 54.04 54.04 other OPPS APC 54.04 27.63 14.93 percent of total billed charges 54.04 54.04 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE QUILL 2-0 MONODERM SUP-VP-1000Q CDM 0270 RC outpatient 59.85 59.85 59.85 74 44.29 percent of total billed charges 59.85 93 48.48 percent of total billed charges 59.85 59.85 other OPPS APC 59.85 59.85 other OPPS APC 59.85 27.63 16.54 percent of total billed charges 59.85 59.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE SECUREMENT STATLOCK PICC PLUS FOAM ADULT CRESCENT STABILIZATION ANCHOR PAD FIX POST GULL WING STERILE LATEX FREE DISPOSABLE SUP-VPPDFP CDM outpatient 10.32 10.32 10.32 10.32 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LUBRICANT INSTRUMENT VIPERSLIDE 100 ML BAG ATHERECTOMY STERILE LATEX FREE DISPOSABLE SUP-VPR-SLD2 CDM 0270 RC outpatient 218.4 218.4 218.4 74 161.62 percent of total billed charges 218.4 93 176.9 percent of total billed charges 218.4 218.4 other OPPS APC 218.4 218.4 other OPPS APC 218.4 27.63 60.34 percent of total billed charges 218.4 218.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL RAPIDE 4-0 RB-1 L27 IN BRAID COATED UNDYED SUP-VR214 CDM 0270 RC outpatient 7.49 7.49 7.49 74 5.54 percent of total billed charges 7.49 93 6.07 percent of total billed charges 7.49 7.49 other OPPS APC 7.49 7.49 other OPPS APC 7.49 27.63 2.07 percent of total billed charges 7.49 7.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYRINGE DENTAL ACTIVA BIOACTIVE-RESTORATIVE 5 ML SUP-VR2A1 CDM 0270 RC outpatient 681.17 681.17 681.17 74 504.07 percent of total billed charges 681.17 93 551.75 percent of total billed charges 681.17 681.17 other OPPS APC 681.17 681.17 other OPPS APC 681.17 27.63 188.21 percent of total billed charges 681.17 681.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. COMPOSITE DENTAL ACTIVA BIOACTIVE-RESTORATIVE METAL OD20 GA 5 ML SYRINGE OPAQUE +40 AUTOMIX TIP CANNULA A2 SUP-VR2A2 CDM 0270 RC outpatient 681.17 681.17 681.17 74 504.07 percent of total billed charges 681.17 93 551.75 percent of total billed charges 681.17 681.17 other OPPS APC 681.17 681.17 other OPPS APC 681.17 27.63 188.21 percent of total billed charges 681.17 681.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE VICRYL RAPIDE 3-0 SH L27 IN BRAID COATED UNDYED SUP-VR416 CDM 0270 RC outpatient 7.15 7.15 7.15 74 5.29 percent of total billed charges 7.15 93 5.79 percent of total billed charges 7.15 7.15 other OPPS APC 7.15 7.15 other OPPS APC 7.15 27.63 1.98 percent of total billed charges 7.15 7.15 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FORCEP RETRIEVAL VASCULAR SUP-VRF-3.0-120 CDM 0270 RC outpatient 871.91 871.91 871.91 74 645.21 percent of total billed charges 871.91 93 706.25 percent of total billed charges 871.91 871.91 other OPPS APC 871.91 871.91 other OPPS APC 871.91 27.63 240.91 percent of total billed charges 871.91 871.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. FILTER SMOKE EVACUATOR NEPTUNE REPLACEMENT SUP-VSNEP04 CDM 0270 RC outpatient 851.48 851.48 851.48 74 630.1 percent of total billed charges 851.48 93 689.7 percent of total billed charges 851.48 851.48 other OPPS APC 851.48 851.48 other OPPS APC 851.48 27.63 235.26 percent of total billed charges 851.48 851.48 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM ENDOSCOPIC VEIN HARVESTING VIRTUOSAPH PLUS WITH RADIAL SUP-VSP550EX CDM 0270 RC outpatient 1820 1820 1820 74 1346.8 percent of total billed charges 1820 93 1474.2 percent of total billed charges 1820 1820 other OPPS APC 1820 1820 other OPPS APC 1820 27.63 502.87 percent of total billed charges 1820 1820 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH VERSA CROSS STEERABLE 8.5F LARGE BIDIRECTIONAL SUP-VST85-35-BD-71L-D1 CDM 0481 RC outpatient 2730 2730 2730 74 2020.2 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 2730 other OPPS APC 2730 2730 other OPPS APC 2730 51 1392.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH VERSA CROSS STEERABLE 8.5F MEDIUM BIDIRECTIONAL SUP-VST85-35-BD-71M-D1 CDM 0481 RC outpatient 2730 2730 2730 74 2020.2 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 2730 other OPPS APC 2730 2730 other OPPS APC 2730 51 1392.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SHEATH VERSA CORSS STEERABLE 8.5F SMALL BIDIRECTIONAL SUP-VST85-35-BD-71S-D1 CDM 0481 RC outpatient 2730 2730 2730 74 2020.2 percent of total billed charges 2730 93 2211.3 percent of total billed charges 2730 2730 other OPPS APC 2730 2730 other OPPS APC 2730 51 1392.3 percent of total billed charges 2730 2730 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERSA CROSS TRANSSEPTAL STEERABLE BIDIRECTIONAL ACCESS 8.5F SYSTEM W/45 SHEATH AND PIGTAIL SUP-VSTK-35P-230-85-BD-7 CDM 0481 RC outpatient 4550 4550 4550 74 3367 percent of total billed charges 4550 93 3685.5 percent of total billed charges 4550 4550 other OPPS APC 4550 4550 other OPPS APC 4550 51 2320.5 percent of total billed charges 4550 4550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE VERSA CROSS STEERABLE BIDIRECTIONAL ACCESS 8.5F SYSTEM W/45 SHEATH AND PIGTAIL SUP-VSTK0022 CDM 0481 RC outpatient 4550 4550 4550 74 3367 percent of total billed charges 4550 93 3685.5 percent of total billed charges 4550 4550 other OPPS APC 4550 4550 other OPPS APC 4550 51 2320.5 percent of total billed charges 4550 4550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACCESS VERSACROSS STEERABLE 0.035IN 230 PIGTAIL CM RF WIRE 71CM BI-DIRECTIONAL STEERABLE SHEATH SMALL D1 CURVE 8.5 FRENCH SUP-VSTK35P2308571SD1 CDM 0481 RC outpatient 4615 4615 4615 74 3415.1 percent of total billed charges 4615 93 3738.15 percent of total billed charges 4615 4615 other OPPS APC 4615 4615 other OPPS APC 4615 51 2353.65 percent of total billed charges 4615 4615 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Fix This SUP-VSTK35P23085B7 CDM 0481 RC outpatient 4550 4550 4550 74 3367 percent of total billed charges 4550 93 3685.5 percent of total billed charges 4550 4550 other OPPS APC 4550 4550 other OPPS APC 4550 51 2320.5 percent of total billed charges 4550 4550 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACCESS VERSACROSS STEERABLE 0.035IN 230 PIGTAIL CM RF WIRE 71CM BI-DIRECTIONAL STEERABLE SHEATH LARGE D1 CURVE 8.5 FRENCH SUP-VSTK35P23085BD71LD1 CDM 0481 RC outpatient 4615 4615 4615 74 3415.1 percent of total billed charges 4615 93 3738.15 percent of total billed charges 4615 4615 other OPPS APC 4615 4615 other OPPS APC 4615 51 2353.65 percent of total billed charges 4615 4615 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ACCESS VERSACROSS STEERABLE 0.035 IN. 230 PIGTAIL CM RF WIRE 71CM BI-DIRECTIONAL STEERABLE SHEATH MEDIUM D1 CURVE 8.5 FRENCH SUP-VSTK35P23085BD71MD1 CDM 0481 RC outpatient 4615 4615 4615 74 3415.1 percent of total billed charges 4615 93 3738.15 percent of total billed charges 4615 4615 other OPPS APC 4615 4615 other OPPS APC 4615 51 2353.65 percent of total billed charges 4615 4615 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR LAPROSCOPIC VISTASEAL L 35CM DUAL SUP-VSTL35 CDM 0270 RC outpatient 168.97 168.97 168.97 74 125.04 percent of total billed charges 168.97 93 136.87 percent of total billed charges 168.97 168.97 other OPPS APC 168.97 168.97 other OPPS APC 168.97 27.63 46.69 percent of total billed charges 168.97 168.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. APPLICATOR LAPAROSCOPIC VISTASEAL L45 CM DUAL APPLICATOR FLEXIBLE SUP-VSTL45 CDM 0270 RC outpatient 168.97 168.97 168.97 74 125.04 percent of total billed charges 168.97 93 136.87 percent of total billed charges 168.97 168.97 other OPPS APC 168.97 168.97 other OPPS APC 168.97 27.63 46.69 percent of total billed charges 168.97 168.97 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE-TEX THIN WALL L40 CM ID6 MM LINE STERILE LATEX FREE SUP-VT06040L CDM 0270 RC outpatient 1175.2 1175.2 1175.2 74 869.65 percent of total billed charges 1175.2 93 951.91 percent of total billed charges 1175.2 1175.2 other OPPS APC 1175.2 1175.2 other OPPS APC 1175.2 27.63 324.71 percent of total billed charges 1175.2 1175.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE-TEX THIN WALL L70 CM ID6 MM LINE STERILE LATEX FREE SUP-VT06070L CDM 0270 RC outpatient 3322.8 3322.8 3322.8 74 2458.87 percent of total billed charges 3322.8 93 2691.47 percent of total billed charges 3322.8 3322.8 other OPPS APC 3322.8 3322.8 other OPPS APC 3322.8 27.63 918.09 percent of total billed charges 3322.8 3322.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT VASCULAR GORE-TEX THIN WALL L70 CM ID7 MM LINE STERILE LATEX FREE SUP-VT07070L CDM 0270 RC outpatient 1648.4 1648.4 1648.4 74 1219.82 percent of total billed charges 1648.4 93 1335.2 percent of total billed charges 1648.4 1648.4 other OPPS APC 1648.4 1648.4 other OPPS APC 1648.4 27.63 455.45 percent of total billed charges 1648.4 1648.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM PERFUSION ANGIOVAC OD22 FR VENOUS DRAINAGE CANNULA BALLOON ACTUATE EXPANDABLE FUNNEL DISTAL TIP CIRCUIT DISPOSABLE SUP-VTX-4000 CDM 0270 RC outpatient 33800 33800 33800 74 25012 percent of total billed charges 33800 93 27378 percent of total billed charges 33800 33800 other OPPS APC 33800 33800 other OPPS APC 33800 27.63 9338.94 percent of total billed charges 33800 33800 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERACROSS ZERO EXCHANGE WATCHMAN SHEATH DELIVERY SUP-VXAK0007 CDM 0272 RC outpatient 2847 2847 2847 74 2106.78 percent of total billed charges 2847 93 2306.07 percent of total billed charges 2847 2847 other OPPS APC 2847 2847 other OPPS APC 2847 27.63 786.63 percent of total billed charges 2847 2847 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WIRE VERSA CROSS ACCESS 8.5F FIXED SYSTEM W/45 SHEATH AND PIGTAIL SUP-VXSK0032 CDM 0481 RC outpatient 2652 2652 2652 74 1962.48 percent of total billed charges 2652 93 2148.12 percent of total billed charges 2652 2652 other OPPS APC 2652 2652 other OPPS APC 2652 51 1352.52 percent of total billed charges 2652 2652 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. KIT INTRODUCER CATHETER VERSACROSS SHEATH 8.5FR 63CM 55DEG CURVED TRANSSEPTAL W/0.035IN 230CM PIGTAIL TIP RF GW D1 CURVE DIL CONNECTOR CABLE SUP-VXSK0034 CDM 0481 RC outpatient 2652 2652 2652 74 1962.48 percent of total billed charges 2652 93 2148.12 percent of total billed charges 2652 2652 other OPPS APC 2652 2652 other OPPS APC 2652 51 1352.52 percent of total billed charges 2652 2652 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. VERSA CROSS TRANSSEPTAL ACCESS 8.5F FIXED SYSTEM W/45 SHEATH AND PIGTAIL_62301_ SUP-VXSK35P2306345D CDM 0481 RC outpatient 2652 2652 2652 74 1962.48 percent of total billed charges 2652 93 2148.12 percent of total billed charges 2652 2652 other OPPS APC 2652 2652 other OPPS APC 2652 51 1352.52 percent of total billed charges 2652 2652 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. Fix This SUP-VXSK35P2306345D1 CDM 0481 RC outpatient 2652 2652 2652 74 1962.48 percent of total billed charges 2652 93 2148.12 percent of total billed charges 2652 2652 other OPPS APC 2652 2652 other OPPS APC 2652 51 1352.52 percent of total billed charges 2652 2652 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE AZURE XT DR MRI SURESCAN SUP-W1DR01 CDM 0275 RC outpatient 6243.75 6243.75 6243.75 57 3558.94 percent of total billed charges 6243.75 93 5057.44 percent of total billed charges 6243.75 6243.75 other OPPS APC 6243.75 6243.75 other OPPS APC 6243.75 51 3184.31 percent of total billed charges 6243.75 6243.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER AZURE S XT SR W1SR01 MRI DEVICE SUP-W1SR01 CDM 0275 RC outpatient 4172.94 4172.94 4172.94 57 2378.58 percent of total billed charges 4172.94 93 3380.08 percent of total billed charges 4172.94 4172.94 other OPPS APC 4172.94 4172.94 other OPPS APC 4172.94 51 2128.2 percent of total billed charges 4172.94 4172.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT-P PERCEPTA MRI SUP-W1TR01 CDM 0275 RC outpatient 13037 13037 13037 57 7431.09 percent of total billed charges 13037 93 10560 percent of total billed charges 13037 13037 other OPPS APC 13037 13037 other OPPS APC 13037 51 6648.87 percent of total billed charges 13037 13037 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER SOLARA W1TR03 MRI DEVICE SUP-W1TR03 CDM 0275 RC outpatient 12700 12700 12700 57 7239 percent of total billed charges 12700 93 10287 percent of total billed charges 12700 12700 other OPPS APC 12700 12700 other OPPS APC 12700 51 6477 percent of total billed charges 12700 12700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H5 MM OD10 MM ID.033 IN LOW PROFILE STERILE LATEX FREE VIA 33 SUP-W2-10-5 CDM 0270 RC outpatient 38870 38870 38870 74 28763.8 percent of total billed charges 38870 93 31484.7 percent of total billed charges 38870 38870 other OPPS APC 38870 38870 other OPPS APC 38870 27.63 10739.8 percent of total billed charges 38870 38870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H6 MM OD10 MM ID.033 IN LOW PROFILE STERILE LATEX FREE VIA 33 SUP-W2-10-6 CDM 0270 RC outpatient 38870 38870 38870 74 28763.8 percent of total billed charges 38870 93 31484.7 percent of total billed charges 38870 38870 other OPPS APC 38870 38870 other OPPS APC 38870 27.63 10739.8 percent of total billed charges 38870 38870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H7 MM OD10 MM ID.033 IN LOW PROFILE STERILE LATEX FREE VIA 33 SUP-W2-10-7 CDM 0270 RC outpatient 38870 38870 38870 74 28763.8 percent of total billed charges 38870 93 31484.7 percent of total billed charges 38870 38870 other OPPS APC 38870 38870 other OPPS APC 38870 27.63 10739.8 percent of total billed charges 38870 38870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H8 MM OD10 MM ID.033 IN LOW PROFILE STERILE LATEX FREE VIA 33 SUP-W2-10-8 CDM 0270 RC outpatient 38870 38870 38870 74 28763.8 percent of total billed charges 38870 93 31484.7 percent of total billed charges 38870 38870 other OPPS APC 38870 38870 other OPPS APC 38870 27.63 10739.8 percent of total billed charges 38870 38870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM EMBOLIZATION WEB SLS H8.6 MM OD10 MM INTRASACCULAR MICROBRAID ACCEPTS .033 IN CATHETER ANEURYSM SUP-W2-10-S CDM 0270 RC outpatient 38870 38870 38870 74 28763.8 percent of total billed charges 38870 93 31484.7 percent of total billed charges 38870 38870 other OPPS APC 38870 38870 other OPPS APC 38870 27.63 10739.8 percent of total billed charges 38870 38870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H6 MM OD11 MM ID.033 IN LOW PROFILE STERILE LATEX FREE VIA 33 SUP-W2-11-6 CDM 0270 RC outpatient 38870 38870 38870 74 28763.8 percent of total billed charges 38870 93 31484.7 percent of total billed charges 38870 38870 other OPPS APC 38870 38870 other OPPS APC 38870 27.63 10739.8 percent of total billed charges 38870 38870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H7 MM OD11 MM ID.033 IN LOW PROFILE STERILE LATEX FREE VIA 33 SUP-W2-11-7 CDM 0270 RC outpatient 38870 38870 38870 74 28763.8 percent of total billed charges 38870 93 31484.7 percent of total billed charges 38870 38870 other OPPS APC 38870 38870 other OPPS APC 38870 27.63 10739.8 percent of total billed charges 38870 38870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H8 MM OD11 MM ID.033 IN LOW PROFILE STERILE LATEX FREE VIA 33 SUP-W2-11-8 CDM 0270 RC outpatient 38870 38870 38870 74 28763.8 percent of total billed charges 38870 93 31484.7 percent of total billed charges 38870 38870 other OPPS APC 38870 38870 other OPPS APC 38870 27.63 10739.8 percent of total billed charges 38870 38870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H9 MM OD11 MM ID.033 IN LOW PROFILE STERILE LATEX FREE VIA 33 SUP-W2-11-9 CDM 0270 RC outpatient 38870 38870 38870 74 28763.8 percent of total billed charges 38870 93 31484.7 percent of total billed charges 38870 38870 other OPPS APC 38870 38870 other OPPS APC 38870 27.63 10739.8 percent of total billed charges 38870 38870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM EMBOLIZATION WEB SLS H9.6 MM OD11 MM INTRASACCULAR MICROBRAID ACCEPTS .033 IN CATHETER ANEURYSM SUP-W2-11-S CDM 0270 RC outpatient 38870 38870 38870 74 28763.8 percent of total billed charges 38870 93 31484.7 percent of total billed charges 38870 38870 other OPPS APC 38870 38870 other OPPS APC 38870 27.63 10739.8 percent of total billed charges 38870 38870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H3 MM OD8 MM ID.027 IN LOW PROFILE STERILE LATEX FREE VIA 27 SUP-W2-8-3 CDM 0270 RC outpatient 38870 38870 38870 74 28763.8 percent of total billed charges 38870 93 31484.7 percent of total billed charges 38870 38870 other OPPS APC 38870 38870 other OPPS APC 38870 27.63 10739.8 percent of total billed charges 38870 38870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H4 MM OD8 MM ID.027 IN LOW PROFILE STERILE LATEX FREE VIA 27 SUP-W2-8-4 CDM 0270 RC outpatient 38870 38870 38870 74 28763.8 percent of total billed charges 38870 93 31484.7 percent of total billed charges 38870 38870 other OPPS APC 38870 38870 other OPPS APC 38870 27.63 10739.8 percent of total billed charges 38870 38870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H5 MM OD8 MM ID.027 IN LOW PROFILE STERILE LATEX FREE VIA 27 SUP-W2-8-5 CDM 0270 RC outpatient 38870 38870 38870 74 28763.8 percent of total billed charges 38870 93 31484.7 percent of total billed charges 38870 38870 other OPPS APC 38870 38870 other OPPS APC 38870 27.63 10739.8 percent of total billed charges 38870 38870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H6 MM OD8 MM ID.027 IN LOW PROFILE STERILE LATEX FREE VIA 27 SUP-W2-8-6 CDM 0270 RC outpatient 38870 38870 38870 74 28763.8 percent of total billed charges 38870 93 31484.7 percent of total billed charges 38870 38870 other OPPS APC 38870 38870 other OPPS APC 38870 27.63 10739.8 percent of total billed charges 38870 38870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM EMBOLIZATION WEB SLS H6.6 MM OD8 MM INTRASACCULAR MICROBRAID ACCEPTS .027 IN CATHETER ANEURYSM SUP-W2-8-S CDM 0270 RC outpatient 38870 38870 38870 74 28763.8 percent of total billed charges 38870 93 31484.7 percent of total billed charges 38870 38870 other OPPS APC 38870 38870 other OPPS APC 38870 27.63 10739.8 percent of total billed charges 38870 38870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H4 MM OD9 MM ID.027 IN LOW PROFILE STERILE LATEX FREE VIA 27 SUP-W2-9-4 CDM 0270 RC outpatient 38870 38870 38870 74 28763.8 percent of total billed charges 38870 93 31484.7 percent of total billed charges 38870 38870 other OPPS APC 38870 38870 other OPPS APC 38870 27.63 10739.8 percent of total billed charges 38870 38870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H5 MM OD9 MM ID.027 IN INTRASACCULAR LOW PROFILE VIA 27 SUP-W2-9-5 CDM 0270 RC outpatient 38870 38870 38870 74 28763.8 percent of total billed charges 38870 93 31484.7 percent of total billed charges 38870 38870 other OPPS APC 38870 38870 other OPPS APC 38870 27.63 10739.8 percent of total billed charges 38870 38870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H6 MM OD9 MM ID.027 IN LOW PROFILE STERILE LATEX FREE VIA 27 SUP-W2-9-6 CDM 0270 RC outpatient 38870 38870 38870 74 28763.8 percent of total billed charges 38870 93 31484.7 percent of total billed charges 38870 38870 other OPPS APC 38870 38870 other OPPS APC 38870 27.63 10739.8 percent of total billed charges 38870 38870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H7 MM OD9 MM ID.027 IN LOW PROFILE STERILE LATEX FREE VIA 27 SUP-W2-9-7 CDM 0270 RC outpatient 38870 38870 38870 74 28763.8 percent of total billed charges 38870 93 31484.7 percent of total billed charges 38870 38870 other OPPS APC 38870 38870 other OPPS APC 38870 27.63 10739.8 percent of total billed charges 38870 38870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM EMBOLIZATION WEB SLS H7.6 MM OD9 MM INTRASACCULAR MICROBRAID ACCEPTS .027 IN CATHETER ANEURYSM SUP-W2-9-S CDM 0270 RC outpatient 38870 38870 38870 74 28763.8 percent of total billed charges 38870 93 31484.7 percent of total billed charges 38870 38870 other OPPS APC 38870 38870 other OPPS APC 38870 27.63 10739.8 percent of total billed charges 38870 38870 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. WAX BONE 2.5 GM ABSORBABLE HEMOSTATIC AGENT SUP-W31G CDM 0270 RC outpatient 12.26 12.26 12.26 74 9.07 percent of total billed charges 12.26 93 9.93 percent of total billed charges 12.26 12.26 other OPPS APC 12.26 12.26 other OPPS APC 12.26 27.63 3.39 percent of total billed charges 12.26 12.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER AZURE S W3DR01 MRI DEVICE SUP-W3DR01 CDM 0275 RC outpatient 6621.75 6621.75 6621.75 57 3774.4 percent of total billed charges 6621.75 93 5363.62 percent of total billed charges 6621.75 6621.75 other OPPS APC 6621.75 6621.75 other OPPS APC 6621.75 51 3377.09 percent of total billed charges 6621.75 6621.75 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER AZURE S W3SR01 MRI DEVICE SUP-W3SR01 CDM 0275 RC outpatient 4172.94 4172.94 4172.94 57 2378.58 percent of total billed charges 4172.94 93 3380.08 percent of total billed charges 4172.94 4172.94 other OPPS APC 4172.94 4172.94 other OPPS APC 4172.94 51 2128.2 percent of total billed charges 4172.94 4172.94 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. CRT-P PERCEPTA MRI QUAD DEVICE SUP-W4TR01 CDM 0275 RC outpatient 13037 13037 13037 57 7431.09 percent of total billed charges 13037 93 10560 percent of total billed charges 13037 13037 other OPPS APC 13037 13037 other OPPS APC 13037 51 6648.87 percent of total billed charges 13037 13037 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PACEMAKER SOLARA W4TR03 MRI QUAD DEVICE SUP-W4TR03 CDM 0275 RC outpatient 12700 12700 12700 57 7239 percent of total billed charges 12700 93 10287 percent of total billed charges 12700 12700 other OPPS APC 12700 12700 other OPPS APC 12700 51 6477 percent of total billed charges 12700 12700 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H2 MM OD4 MM SUP-W5-4-2 CDM 0270 RC outpatient 42887 42887 42887 74 31736.4 percent of total billed charges 42887 93 34738.5 percent of total billed charges 42887 42887 other OPPS APC 42887 42887 other OPPS APC 42887 27.63 11849.7 percent of total billed charges 42887 42887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H3 MM OD4 MM SUP-W5-4-3 CDM 0270 RC outpatient 42887 42887 42887 74 31736.4 percent of total billed charges 42887 93 34738.5 percent of total billed charges 42887 42887 other OPPS APC 42887 42887 other OPPS APC 42887 27.63 11849.7 percent of total billed charges 42887 42887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SPHERE H2.6 MM OD4 MM 1 LAYER VIA 17 CATHETER SUP-W5-4-S CDM 0270 RC outpatient 42887 42887 42887 74 31736.4 percent of total billed charges 42887 93 34738.5 percent of total billed charges 42887 42887 other OPPS APC 42887 42887 other OPPS APC 42887 27.63 11849.7 percent of total billed charges 42887 42887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H2 MM OD5 MM VIA 17 SUP-W5-4.5-2 CDM 0270 RC outpatient 42887 42887 42887 74 31736.4 percent of total billed charges 42887 93 34738.5 percent of total billed charges 42887 42887 other OPPS APC 42887 42887 other OPPS APC 42887 27.63 11849.7 percent of total billed charges 42887 42887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H3 MM OD4.5 MM VIA 17 SUP-W5-4.5-3 CDM 0270 RC outpatient 42887 42887 42887 74 31736.4 percent of total billed charges 42887 93 34738.5 percent of total billed charges 42887 42887 other OPPS APC 42887 42887 other OPPS APC 42887 27.63 11849.7 percent of total billed charges 42887 42887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H2 MM OD5 MM SUP-W5-5-2 CDM 0270 RC outpatient 42887 42887 42887 74 31736.4 percent of total billed charges 42887 93 34738.5 percent of total billed charges 42887 42887 other OPPS APC 42887 42887 other OPPS APC 42887 27.63 11849.7 percent of total billed charges 42887 42887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H3 MM OD5 MM SUP-W5-5-3 CDM 0270 RC outpatient 42887 42887 42887 74 31736.4 percent of total billed charges 42887 93 34738.5 percent of total billed charges 42887 42887 other OPPS APC 42887 42887 other OPPS APC 42887 27.63 11849.7 percent of total billed charges 42887 42887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SPHERE H3.6 MM OD5 MM 1 LAYER VIA 17 CATHETER SUP-W5-5-S CDM 0270 RC outpatient 42887 42887 42887 74 31736.4 percent of total billed charges 42887 93 34738.5 percent of total billed charges 42887 42887 other OPPS APC 42887 42887 other OPPS APC 42887 27.63 11849.7 percent of total billed charges 42887 42887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H3 MM OD6 MM STERILE LATEX FREE DISPOSABLE SUP-W5-6-2 CDM 0270 RC outpatient 42887 42887 42887 74 31736.4 percent of total billed charges 42887 93 34738.5 percent of total billed charges 42887 42887 other OPPS APC 42887 42887 other OPPS APC 42887 27.63 11849.7 percent of total billed charges 42887 42887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H3 MM OD6 MM SUP-W5-6-3 CDM 0270 RC outpatient 42887 42887 42887 74 31736.4 percent of total billed charges 42887 93 34738.5 percent of total billed charges 42887 42887 other OPPS APC 42887 42887 other OPPS APC 42887 27.63 11849.7 percent of total billed charges 42887 42887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H4 MM OD6 MM SUP-W5-6-4 CDM 0270 RC outpatient 42887 42887 42887 74 31736.4 percent of total billed charges 42887 93 34738.5 percent of total billed charges 42887 42887 other OPPS APC 42887 42887 other OPPS APC 42887 27.63 11849.7 percent of total billed charges 42887 42887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SPHERE H4.6 MM OD6 MM 1 LAYER VIA 17 CATHETER SUP-W5-6-S CDM 0270 RC outpatient 42887 42887 42887 74 31736.4 percent of total billed charges 42887 93 34738.5 percent of total billed charges 42887 42887 other OPPS APC 42887 42887 other OPPS APC 42887 27.63 11849.7 percent of total billed charges 42887 42887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SYSTEM EMBOLIZATION WEB 17 SL 7X2 H2 MM OD 7 MM RECOMMENDED VIA 17 STERILE SUP-W5-7-2 CDM 0270 RC outpatient 42887 42887 42887 74 31736.4 percent of total billed charges 42887 93 34738.5 percent of total billed charges 42887 42887 other OPPS APC 42887 42887 other OPPS APC 42887 27.63 11849.7 percent of total billed charges 42887 42887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H3 MM OD7 MM SUP-W5-7-3 CDM 0270 RC outpatient 42887 42887 42887 74 31736.4 percent of total billed charges 42887 93 34738.5 percent of total billed charges 42887 42887 other OPPS APC 42887 42887 other OPPS APC 42887 27.63 11849.7 percent of total billed charges 42887 42887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H4 MM OD7 MM SUP-W5-7-4 CDM 0270 RC outpatient 42887 42887 42887 74 31736.4 percent of total billed charges 42887 93 34738.5 percent of total billed charges 42887 42887 other OPPS APC 42887 42887 other OPPS APC 42887 27.63 11849.7 percent of total billed charges 42887 42887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SL H5 MM OD7 MM SUP-W5-7-5 CDM 0270 RC outpatient 42887 42887 42887 74 31736.4 percent of total billed charges 42887 93 34738.5 percent of total billed charges 42887 42887 other OPPS APC 42887 42887 other OPPS APC 42887 27.63 11849.7 percent of total billed charges 42887 42887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE EMBOLIZATION WEB SPHERE H5.6 MM OD7 MM 1 LAYER VIA 17 CATHETER SUP-W5-7-S CDM 0270 RC outpatient 42887 42887 42887 74 31736.4 percent of total billed charges 42887 93 34738.5 percent of total billed charges 42887 42887 other OPPS APC 42887 42887 other OPPS APC 42887 27.63 11849.7 percent of total billed charges 42887 42887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR ASAHI CHIKAI ACTONE SLIP-COAT STAINLESS STEEL L 200CM L 9CM OD .2MM ODSEC .26MM 2 SPRING COIL RADIOPAQUE OPTIMUM BALANCE STRAIGHT TIP SUP-WAIN-CKI-008-200 CDM 0270 RC outpatient 1625 1625 1625 74 1202.5 percent of total billed charges 1625 93 1316.25 percent of total billed charges 1625 1625 other OPPS APC 1625 1625 other OPPS APC 1625 27.63 448.99 percent of total billed charges 1625 1625 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AGENT HEMOSTATIC CELLERATERX HYDROLYZED BOVINE COLLAGEN POWDER SUP-WCI-01-SACRXP CDM 0270 RC outpatient 1287 1287 1287 74 952.38 percent of total billed charges 1287 93 1042.47 percent of total billed charges 1287 1287 other OPPS APC 1287 1287 other OPPS APC 1287 27.63 355.6 percent of total billed charges 1287 1287 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. AGENT HEMOSTATIC CELLERATERX COLLAGEN 5 GM POWDER BOTTLE SUP-WCI-05-SACRXP CDM 0270 RC outpatient 3887 3887 3887 74 2876.38 percent of total billed charges 3887 93 3148.47 percent of total billed charges 3887 3887 other OPPS APC 3887 3887 other OPPS APC 3887 27.63 1073.98 percent of total billed charges 3887 3887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CAGE MEDTRONIC WAVE OBLIQUE 12 X 24MM, 12DEG" SUP-WO-11.24.12 CDM 270010020 LOCAL 0270 RC outpatient 12166.4 12166.4 12166.4 74 9003.17 percent of total billed charges 12166.4 93 9854.82 percent of total billed charges 12166.4 12166.4 other OPPS APC 12166.4 12166.4 other OPPS APC 12166.4 27.63 3361.59 percent of total billed charges 12166.4 12166.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CAGE MEDTRONIC WAVE OBLIQUE 11 X 24MM, 6DEG" SUP-WO-11.24.6 CDM 270010020 LOCAL 0270 RC outpatient 12166.4 12166.4 12166.4 74 9003.17 percent of total billed charges 12166.4 93 9854.82 percent of total billed charges 12166.4 12166.4 other OPPS APC 12166.4 12166.4 other OPPS APC 12166.4 27.63 3361.59 percent of total billed charges 12166.4 12166.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "CAGE MEDTRONIC WAVE OBLIQUE 12 X 26MM, 12DEG" SUP-WO-12.26.12 CDM 270010020 LOCAL 0270 RC outpatient 12166.4 12166.4 12166.4 74 9003.17 percent of total billed charges 12166.4 93 9854.82 percent of total billed charges 12166.4 12166.4 other OPPS APC 12166.4 12166.4 other OPPS APC 12166.4 27.63 3361.59 percent of total billed charges 12166.4 12166.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LV WORLEY STD CURVE CSG GUIDE KIT _62559_ SUP-WOR-CSG-B1-09 CDM 0275 RC outpatient 1014.23 1014.23 1014.23 57 578.11 percent of total billed charges 1014.23 93 821.53 percent of total billed charges 1014.23 1014.23 other OPPS APC 1014.23 1014.23 other OPPS APC 1014.23 51 517.26 percent of total billed charges 1014.23 1014.23 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LV WORLEY RENAL CURVE INTRODUCER KIT _62560_ SUP-WORLVI-75-5-62-55-RE CDM 0275 RC outpatient 1170 1170 1170 57 666.9 percent of total billed charges 1170 93 947.7 percent of total billed charges 1170 1170 other OPPS APC 1170 1170 other OPPS APC 1170 51 596.7 percent of total billed charges 1170 1170 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PATCH WOUND CLOSURE WITTMANN PATCH 40X20CM 40X10CM STERILE ABDOMINAL HOOK/LOOP SHEET SUP-WP2040 CDM 0270 RC outpatient 4134 4134 4134 74 3059.16 percent of total billed charges 4134 93 3348.54 percent of total billed charges 4134 4134 other OPPS APC 4134 4134 other OPPS APC 4134 27.63 1142.22 percent of total billed charges 4134 4134 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE L14 MM OD4 MM CALCANEUS LOCK SUP-WPLTS14 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TORNIER 4.0MM LOCKING 20MM SUP-WPLTS20 CDM 0270 RC outpatient 288.6 288.6 288.6 74 213.56 percent of total billed charges 288.6 93 233.77 percent of total billed charges 288.6 288.6 other OPPS APC 288.6 288.6 other OPPS APC 288.6 27.63 79.74 percent of total billed charges 288.6 288.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE WAVE LG NS LEFT TENDON SUP-WPTLL CDM 0270 RC outpatient 3112.2 3112.2 3112.2 74 2303.03 percent of total billed charges 3112.2 93 2520.88 percent of total billed charges 3112.2 3112.2 other OPPS APC 3112.2 3112.2 other OPPS APC 3112.2 27.63 859.9 percent of total billed charges 3112.2 3112.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE WAVE LG NS RIGHT SUP-WPTLR CDM 0270 RC outpatient 2964 2964 2964 74 2193.36 percent of total billed charges 2964 93 2400.84 percent of total billed charges 2964 2964 other OPPS APC 2964 2964 other OPPS APC 2964 27.63 818.95 percent of total billed charges 2964 2964 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TORNIER 4.0MM LOCKING 14MM SUP-WPTLS14 CDM 0270 RC outpatient 288.6 288.6 288.6 74 213.56 percent of total billed charges 288.6 93 233.77 percent of total billed charges 288.6 288.6 other OPPS APC 288.6 288.6 other OPPS APC 288.6 27.63 79.74 percent of total billed charges 288.6 288.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TORNIER 4.0MM LOCKING 16MM SUP-WPTLS16 CDM 0270 RC outpatient 288.6 288.6 288.6 74 213.56 percent of total billed charges 288.6 93 233.77 percent of total billed charges 288.6 288.6 other OPPS APC 288.6 288.6 other OPPS APC 288.6 27.63 79.74 percent of total billed charges 288.6 288.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TORNIER 4.0MM LOCKING 18MM SUP-WPTLS18 CDM 0270 RC outpatient 288.6 288.6 288.6 74 213.56 percent of total billed charges 288.6 93 233.77 percent of total billed charges 288.6 288.6 other OPPS APC 288.6 288.6 other OPPS APC 288.6 27.63 79.74 percent of total billed charges 288.6 288.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TORNIER 4.0MM LOCKING 22MM SUP-WPTLS22 CDM 0270 RC outpatient 288.6 288.6 288.6 74 213.56 percent of total billed charges 288.6 93 233.77 percent of total billed charges 288.6 288.6 other OPPS APC 288.6 288.6 other OPPS APC 288.6 27.63 79.74 percent of total billed charges 288.6 288.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TORNIER 4.0MM LOCKING 24MM SUP-WPTLS24 CDM 0270 RC outpatient 205.4 205.4 205.4 74 152 percent of total billed charges 205.4 93 166.37 percent of total billed charges 205.4 205.4 other OPPS APC 205.4 205.4 other OPPS APC 205.4 27.63 56.75 percent of total billed charges 205.4 205.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE 26MM 4MM NS LOWER EXTREMITY LOCK SUP-WPTLS26 CDM 0270 RC outpatient 288.6 288.6 288.6 74 213.56 percent of total billed charges 288.6 93 233.77 percent of total billed charges 288.6 288.6 other OPPS APC 288.6 288.6 other OPPS APC 288.6 27.63 79.74 percent of total billed charges 288.6 288.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE 28MM 4MM NS LOWER EXTREMITY LOCK SUP-WPTLS28 CDM 0270 RC outpatient 288.6 288.6 288.6 74 213.56 percent of total billed charges 288.6 93 233.77 percent of total billed charges 288.6 288.6 other OPPS APC 288.6 288.6 other OPPS APC 288.6 27.63 79.74 percent of total billed charges 288.6 288.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE 30MM 4MM NS LOWER EXTREMITY LOCK SUP-WPTLS30 CDM 0270 RC outpatient 327.6 327.6 327.6 74 242.42 percent of total billed charges 327.6 93 265.36 percent of total billed charges 327.6 327.6 other OPPS APC 327.6 327.6 other OPPS APC 327.6 27.63 90.52 percent of total billed charges 327.6 327.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE 32MM 4MM NS LOWER EXTREMITY LOCK SUP-WPTLS32 CDM 0270 RC outpatient 327.6 327.6 327.6 74 242.42 percent of total billed charges 327.6 93 265.36 percent of total billed charges 327.6 327.6 other OPPS APC 327.6 327.6 other OPPS APC 327.6 27.63 90.52 percent of total billed charges 327.6 327.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE 34MM 4MM NS LOWER EXTREMITY LOCK SUP-WPTLS34 CDM 0270 RC outpatient 327.6 327.6 327.6 74 242.42 percent of total billed charges 327.6 93 265.36 percent of total billed charges 327.6 327.6 other OPPS APC 327.6 327.6 other OPPS APC 327.6 27.63 90.52 percent of total billed charges 327.6 327.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE 36MM 4MM NS LOWER EXTREMITY LOCK SUP-WPTLS36 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE 38MM 4MM NS LOWER EXTREMITY LOCK SUP-WPTLS38 CDM 0270 RC outpatient 288.6 288.6 288.6 74 213.56 percent of total billed charges 288.6 93 233.77 percent of total billed charges 288.6 288.6 other OPPS APC 288.6 288.6 other OPPS APC 288.6 27.63 79.74 percent of total billed charges 288.6 288.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE 40MM 4MM NS LOWER EXTREMITY LOCK SUP-WPTLS40 CDM 0270 RC outpatient 327.6 327.6 327.6 74 242.42 percent of total billed charges 327.6 93 265.36 percent of total billed charges 327.6 327.6 other OPPS APC 327.6 327.6 other OPPS APC 327.6 27.63 90.52 percent of total billed charges 327.6 327.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TORNIER 4.0MM LOCKING 42MM SUP-WPTLS42 CDM 0270 RC outpatient 288.6 288.6 288.6 74 213.56 percent of total billed charges 288.6 93 233.77 percent of total billed charges 288.6 288.6 other OPPS APC 288.6 288.6 other OPPS APC 288.6 27.63 79.74 percent of total billed charges 288.6 288.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TORNIER 4.0MM LOCKING 44MM SUP-WPTLS44 CDM 0270 RC outpatient 312 312 312 74 230.88 percent of total billed charges 312 93 252.72 percent of total billed charges 312 312 other OPPS APC 312 312 other OPPS APC 312 27.63 86.21 percent of total billed charges 312 312 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE TORNIER CALCANEAL MEDIUM LEFT SUP-WPTML CDM 0270 RC outpatient 2787.2 2787.2 2787.2 74 2062.53 percent of total billed charges 2787.2 93 2257.63 percent of total billed charges 2787.2 2787.2 other OPPS APC 2787.2 2787.2 other OPPS APC 2787.2 27.63 770.1 percent of total billed charges 2787.2 2787.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE WAVE MED NS RIGHT SUP-WPTMR CDM 0270 RC outpatient 2787.2 2787.2 2787.2 74 2062.53 percent of total billed charges 2787.2 93 2257.63 percent of total billed charges 2787.2 2787.2 other OPPS APC 2787.2 2787.2 other OPPS APC 2787.2 27.63 770.1 percent of total billed charges 2787.2 2787.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE WAVE SM NS LEFT SUP-WPTSL CDM 0270 RC outpatient 2787.2 2787.2 2787.2 74 2062.53 percent of total billed charges 2787.2 93 2257.63 percent of total billed charges 2787.2 2787.2 other OPPS APC 2787.2 2787.2 other OPPS APC 2787.2 27.63 770.1 percent of total billed charges 2787.2 2787.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PLATE BONE WAVE SM NS RIGHT SUP-WPTSR CDM 0270 RC outpatient 3112.2 3112.2 3112.2 74 2303.03 percent of total billed charges 3112.2 93 2520.88 percent of total billed charges 3112.2 3112.2 other OPPS APC 3112.2 3112.2 other OPPS APC 3112.2 27.63 859.9 percent of total billed charges 3112.2 3112.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE .045 X 6IN STRAIGHT SUP-WS-0906ST CDM 0270 RC outpatient 44.2 44.2 44.2 74 32.71 percent of total billed charges 44.2 93 35.8 percent of total billed charges 44.2 44.2 other OPPS APC 44.2 44.2 other OPPS APC 44.2 27.63 12.21 percent of total billed charges 44.2 44.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE .045 X 6IN STRAIGHT SUP-WS-1106ST CDM 0270 RC outpatient 44.2 44.2 44.2 74 32.71 percent of total billed charges 44.2 93 35.8 percent of total billed charges 44.2 44.2 other OPPS APC 44.2 44.2 other OPPS APC 44.2 27.63 12.21 percent of total billed charges 44.2 44.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC STAINLESS STEEL L6 IN OD.054 IN TROCAR SUP-WS-1406ST CDM 0270 RC outpatient 44.2 44.2 44.2 74 32.71 percent of total billed charges 44.2 93 35.8 percent of total billed charges 44.2 44.2 other OPPS APC 44.2 44.2 other OPPS APC 44.2 27.63 12.21 percent of total billed charges 44.2 44.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE .054 X 7IN STRAIGHT SUP-WS-1407ST CDM 0270 RC outpatient 44.2 44.2 44.2 74 32.71 percent of total billed charges 44.2 93 35.8 percent of total billed charges 44.2 44.2 other OPPS APC 44.2 44.2 other OPPS APC 44.2 27.63 12.21 percent of total billed charges 44.2 44.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE ORTHOPEDIC ACUTRAK 2 STAINLESS STEEL L5 IN OD.059 IN 1 TROCAR NONSTERILE SUP-WS-1505ST CDM 0270 RC outpatient 44.2 44.2 44.2 74 32.71 percent of total billed charges 44.2 93 35.8 percent of total billed charges 44.2 44.2 other OPPS APC 44.2 44.2 other OPPS APC 44.2 27.63 12.21 percent of total billed charges 44.2 44.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RADPAD SHIELD SUP-WT5110AO CDM 0481 RC outpatient 141.7 141.7 141.7 74 104.86 percent of total billed charges 141.7 93 114.78 percent of total billed charges 141.7 141.7 other OPPS APC 141.7 141.7 other OPPS APC 141.7 51 72.27 percent of total billed charges 141.7 141.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TORNIER 4.0MM LOCKING 42MM SUP-WTPLS42 CDM 0270 RC outpatient 205.4 205.4 205.4 74 152 percent of total billed charges 205.4 93 166.37 percent of total billed charges 205.4 205.4 other OPPS APC 205.4 205.4 other OPPS APC 205.4 27.63 56.75 percent of total billed charges 205.4 205.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDEWIRE VASCULAR WHOLEY PLATINUM TUNGSTEN L175 CM OD.035 IN STANDARD STRAIGHT TIP EXTENSION TORQUEABLE LUBRICITY STERILE SUP-WWSS35175 CDM 0481 RC outpatient 267.8 267.8 267.8 74 198.17 percent of total billed charges 267.8 93 216.92 percent of total billed charges 267.8 267.8 other OPPS APC 267.8 267.8 other OPPS APC 267.8 51 136.58 percent of total billed charges 267.8 267.8 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND 2-0 L18 IN BRAID TIES 12 STRAND GREEN SUP-X185H CDM 0270 RC outpatient 5.69 5.69 5.69 74 4.21 percent of total billed charges 5.69 93 4.61 percent of total billed charges 5.69 5.69 other OPPS APC 5.69 5.69 other OPPS APC 5.69 27.63 1.57 percent of total billed charges 5.69 5.69 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND 1 XLH L30 IN 2 ARM BRAID GREEN SUP-X190G CDM 0270 RC outpatient 16.85 16.85 16.85 74 12.47 percent of total billed charges 16.85 93 13.65 percent of total billed charges 16.85 16.85 other OPPS APC 16.85 16.85 other OPPS APC 16.85 27.63 4.66 percent of total billed charges 16.85 16.85 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. "SUTURE, ETHIBOND-EXCEL, GREEN, 0, 30"", CT-2" SUP-X412H CDM 0270 RC outpatient 3.95 3.95 3.95 74 2.92 percent of total billed charges 3.95 93 3.2 percent of total billed charges 3.95 3.95 other OPPS APC 3.95 3.95 other OPPS APC 3.95 27.63 1.09 percent of total billed charges 3.95 3.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND 2-0 CT-1 L30 IN BRAID GREEN SUP-X423H CDM 0270 RC outpatient 4.49 4.49 4.49 74 3.32 percent of total billed charges 4.49 93 3.64 percent of total billed charges 4.49 4.49 other OPPS APC 4.49 4.49 other OPPS APC 4.49 27.63 1.24 percent of total billed charges 4.49 4.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND 0 CT-1 L30 IN BRAID GREEN SUP-X424H CDM 0270 RC outpatient 3.95 3.95 3.95 74 2.92 percent of total billed charges 3.95 93 3.2 percent of total billed charges 3.95 3.95 other OPPS APC 3.95 3.95 other OPPS APC 3.95 27.63 1.09 percent of total billed charges 3.95 3.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND 1 CT-1 L30 IN BRAID GREEN SUP-X425H CDM 0270 RC outpatient 4.49 4.49 4.49 74 3.32 percent of total billed charges 4.49 93 3.64 percent of total billed charges 4.49 4.49 other OPPS APC 4.49 4.49 other OPPS APC 4.49 27.63 1.24 percent of total billed charges 4.49 4.49 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND EXCEL 4-0 SH L36 IN 2 ARM BRAID GREEN SUP-X521H CDM 0270 RC outpatient 9.61 9.61 9.61 74 7.11 percent of total billed charges 9.61 93 7.78 percent of total billed charges 9.61 9.61 other OPPS APC 9.61 9.61 other OPPS APC 9.61 27.63 2.66 percent of total billed charges 9.61 9.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND 2-0 SH L36 IN 2 ARM BRAID GREEN SUP-X523H CDM 0270 RC outpatient 9.71 9.71 9.71 74 7.19 percent of total billed charges 9.71 93 7.87 percent of total billed charges 9.71 9.71 other OPPS APC 9.71 9.71 other OPPS APC 9.71 27.63 2.68 percent of total billed charges 9.71 9.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND 0 SH L36 IN 2 ARM BRAID GREEN SUP-X524H CDM 0270 RC outpatient 9.87 9.87 9.87 74 7.3 percent of total billed charges 9.87 93 7.99 percent of total billed charges 9.87 9.87 other OPPS APC 9.87 9.87 other OPPS APC 9.87 27.63 2.73 percent of total billed charges 9.87 9.87 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND EXCEL 4-0 RB-1 L36 IN 2 ARM BRAID GREEN SUP-X557H CDM 0270 RC outpatient 9.76 9.76 9.76 74 7.22 percent of total billed charges 9.76 93 7.91 percent of total billed charges 9.76 9.76 other OPPS APC 9.76 9.76 other OPPS APC 9.76 27.63 2.7 percent of total billed charges 9.76 9.76 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND EXCEL MULTIPASS 4-0 PS-2 18IN WHITE BRAID SUP-X692G CDM 0270 RC outpatient 10.14 10.14 10.14 74 7.5 percent of total billed charges 10.14 93 8.21 percent of total billed charges 10.14 10.14 other OPPS APC 10.14 10.14 other OPPS APC 10.14 27.63 2.8 percent of total billed charges 10.14 10.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TOWEL OR STERILE 17X24IN BLUE XRAY DETECTABLE SUP-X8312W CDM outpatient 1.42 1.42 1.42 1.42 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE NONABSORBABLE ETHIBOND 3-0 SH L30 IN BRAID GREEN SUP-X832H CDM 0270 RC outpatient 4.61 4.61 4.61 74 3.41 percent of total billed charges 4.61 93 3.73 percent of total billed charges 4.61 4.61 other OPPS APC 4.61 4.61 other OPPS APC 4.61 27.63 1.27 percent of total billed charges 4.61 4.61 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY LAPAROSCOPIC ACCESS SUP-XAB50S CDM 0270 RC outpatient 607.14 607.14 607.14 74 449.28 percent of total billed charges 607.14 93 491.78 percent of total billed charges 607.14 607.14 other OPPS APC 607.14 607.14 other OPPS APC 607.14 27.63 167.75 percent of total billed charges 607.14 607.14 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. TRAY LAPAROSCOPIC BARIATRIC SUP-XBB77S CDM 0270 RC outpatient 433.51 433.51 433.51 74 320.8 percent of total billed charges 433.51 93 351.14 percent of total billed charges 433.51 433.51 other OPPS APC 433.51 433.51 other OPPS APC 433.51 27.63 119.78 percent of total billed charges 433.51 433.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR RINGLOC ARCOMXL 10 D 23 ID32 MM HIP SUP-XL-105833 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR RINGLOC ARCOMXL 10 D 24 ID36 MM HIP SUP-XL-105894 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR RINGLOC MAX-ROM ARCOMXL 25 ID36 MM HIP SUP-XL-105995 CDM 270010024 LOCAL 0270 RC outpatient 2080 2080 2080 74 1539.2 percent of total billed charges 2080 93 1684.8 percent of total billed charges 2080 2080 other OPPS APC 2080 2080 other OPPS APC 2080 27.63 574.7 percent of total billed charges 2080 2080 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LINER ACETABULAR RINGLOC ARCOMXL +3 MM 22 ID32 MM HIP HIGH WALL SUP-XL-108322 CDM 270010024 LOCAL 0270 RC outpatient 1560 1560 1560 74 1154.4 percent of total billed charges 1560 93 1263.6 percent of total billed charges 1560 1560 other OPPS APC 1560 1560 other OPPS APC 1560 27.63 431.03 percent of total billed charges 1560 1560 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BINDER BREAST LINED XL SUP-XLL-BG-DR CDM 0270 RC outpatient 111.98 111.98 111.98 74 82.87 percent of total billed charges 111.98 93 90.7 percent of total billed charges 111.98 111.98 other OPPS APC 111.98 111.98 other OPPS APC 111.98 27.63 30.94 percent of total billed charges 111.98 111.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER PROXIMATE TL TITANIUM H1 MM VASCULAR TISSUE STERILE LATEX FREE DISPOSABLE ENDOSCOPIC SUP-XR30V CDM 270009085 LOCAL 0270 RC outpatient 106.11 106.11 106.11 74 78.52 percent of total billed charges 106.11 93 85.95 percent of total billed charges 106.11 106.11 other OPPS APC 106.11 106.11 other OPPS APC 106.11 27.63 29.32 percent of total billed charges 106.11 106.11 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER PROXIMATE TX TITANIUM L60 MM X H3.5 MM H1.5 MM REGULAR TISSUE 2 ROW STERILE LATEX FREE DISPOSABLE BLUE ENDOSCOPIC SUP-XR60B CDM 270009085 LOCAL 0270 RC outpatient 68.68 68.68 68.68 74 50.82 percent of total billed charges 68.68 93 55.63 percent of total billed charges 68.68 68.68 other OPPS APC 68.68 68.68 other OPPS APC 68.68 27.63 18.98 percent of total billed charges 68.68 68.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. MICROCATHETER XT27 X 150 SUP-XT275081 CDM 0270 RC outpatient 3354 3354 3354 74 2481.96 percent of total billed charges 3354 93 2716.74 percent of total billed charges 3354 3354 other OPPS APC 3354 3354 other OPPS APC 3354 27.63 926.71 percent of total billed charges 3354 3354 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MONOCRYL 5-0 RB-1 L27 IN MONOFILAMENT UNDYED SUP-Y213H CDM 0270 RC outpatient 202.72 202.72 202.72 74 150.01 percent of total billed charges 202.72 93 164.2 percent of total billed charges 202.72 202.72 other OPPS APC 202.72 202.72 other OPPS APC 202.72 27.63 56.01 percent of total billed charges 202.72 202.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MONOCRYL 3-0 RB-1 L27 IN MONOFILAMENT UNDYED SUP-Y215H CDM 0270 RC outpatient 16.81 16.81 16.81 74 12.44 percent of total billed charges 16.81 93 13.62 percent of total billed charges 16.81 16.81 other OPPS APC 16.81 16.81 other OPPS APC 16.81 27.63 4.64 percent of total billed charges 16.81 16.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MONOCRYL 3-0 RB-1 L27 IN MONOFILAMENT VIOLET SUP-Y305H CDM 0270 RC outpatient 5.6 5.6 5.6 74 4.14 percent of total billed charges 5.6 93 4.54 percent of total billed charges 5.6 5.6 other OPPS APC 5.6 5.6 other OPPS APC 5.6 27.63 1.55 percent of total billed charges 5.6 5.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MONOCRYL 3-0 SH L27 IN MONOFILAMENT VIOLET SUP-Y316H CDM 0270 RC outpatient 4.78 4.78 4.78 74 3.54 percent of total billed charges 4.78 93 3.87 percent of total billed charges 4.78 4.78 other OPPS APC 4.78 4.78 other OPPS APC 4.78 27.63 1.32 percent of total billed charges 4.78 4.78 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MONOCRYL 1 CT-1 L36 IN MONOFILAMENT VIOLET SUP-Y347H CDM 0270 RC outpatient 5.67 5.67 5.67 74 4.2 percent of total billed charges 5.67 93 4.59 percent of total billed charges 5.67 5.67 other OPPS APC 5.67 5.67 other OPPS APC 5.67 27.63 1.57 percent of total billed charges 5.67 5.67 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MONOCRYL 0 UR-5 L27 IN MONOFILAMENT VIOLET SUP-Y378H CDM 0270 RC outpatient 6.08 6.08 6.08 74 4.5 percent of total billed charges 6.08 93 4.92 percent of total billed charges 6.08 6.08 other OPPS APC 6.08 6.08 other OPPS APC 6.08 27.63 1.68 percent of total billed charges 6.08 6.08 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MONOCRYL 3-0 SH L27 IN MONOFILAMENT UNDYED SUP-Y416H CDM 0270 RC outpatient 181.51 181.51 181.51 74 134.32 percent of total billed charges 181.51 93 147.02 percent of total billed charges 181.51 181.51 other OPPS APC 181.51 181.51 other OPPS APC 181.51 27.63 50.15 percent of total billed charges 181.51 181.51 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MONOCRYL MULTIPASS 4-0 PS-2 L27 IN MONOFILAMENT UNDYED SUP-Y426H CDM 0270 RC outpatient 13.86 13.86 13.86 74 10.26 percent of total billed charges 13.86 93 11.23 percent of total billed charges 13.86 13.86 other OPPS APC 13.86 13.86 other OPPS APC 13.86 27.63 3.83 percent of total billed charges 13.86 13.86 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MONOCRYL PLUS MULTIPASS 3-0 PS-2 27IN UNDYED MONOFILAMENT SUP-Y427H CDM 0270 RC outpatient 13.71 13.71 13.71 74 10.15 percent of total billed charges 13.71 93 11.11 percent of total billed charges 13.71 13.71 other OPPS APC 13.71 13.71 other OPPS APC 13.71 27.63 3.79 percent of total billed charges 13.71 13.71 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MONOCRYL MULTIPASS 5-0 P-3 L18 IN MONOFILAMENT VIOLET SUP-Y463G CDM 0270 RC outpatient 14.63 14.63 14.63 74 10.83 percent of total billed charges 14.63 93 11.85 percent of total billed charges 14.63 14.63 other OPPS APC 14.63 14.63 other OPPS APC 14.63 27.63 4.04 percent of total billed charges 14.63 14.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MONOCRYL MULTIPASS 6-0 P-3 L18 IN MONOFILAMENT UNDYED SUP-Y492G CDM 0270 RC outpatient 14.81 14.81 14.81 74 10.96 percent of total billed charges 14.81 93 12 percent of total billed charges 14.81 14.81 other OPPS APC 14.81 14.81 other OPPS APC 14.81 27.63 4.09 percent of total billed charges 14.81 14.81 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MONOCRYL MULTIPASS 5-0 P-3 L18 IN MONOFILAMENT UNDYED SUP-Y493G CDM outpatient 14.63 14.63 14.63 14.63 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MONOCRYL 3-0 KS L27 IN MONOFILAMENT UNDYED SUP-Y523H CDM 0270 RC outpatient 8.16 8.16 8.16 74 6.04 percent of total billed charges 8.16 93 6.61 percent of total billed charges 8.16 8.16 other OPPS APC 8.16 8.16 other OPPS APC 8.16 27.63 2.25 percent of total billed charges 8.16 8.16 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MONOCRYL 2-0 UR-6 27IN VIOLET MONOFILAMENT SUP-Y605H CDM 0270 RC outpatient 6.9 6.9 6.9 74 5.11 percent of total billed charges 6.9 93 5.59 percent of total billed charges 6.9 6.9 other OPPS APC 6.9 6.9 other OPPS APC 6.9 27.63 1.91 percent of total billed charges 6.9 6.9 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MONOCRYL 3-0 CT-1 L36 IN MONOFILAMENT UNDYED SUP-Y944H CDM 0270 RC outpatient 5.59 5.59 5.59 74 4.14 percent of total billed charges 5.59 93 4.53 percent of total billed charges 5.59 5.59 other OPPS APC 5.59 5.59 other OPPS APC 5.59 27.63 1.54 percent of total billed charges 5.59 5.59 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MONOCRYL 2-0 CT-1 L36 IN MONOFILAMENT UNDYED SUP-Y945H CDM 0270 RC outpatient 5.64 5.64 5.64 74 4.17 percent of total billed charges 5.64 93 4.57 percent of total billed charges 5.64 5.64 other OPPS APC 5.64 5.64 other OPPS APC 5.64 27.63 1.56 percent of total billed charges 5.64 5.64 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE MONOCRYL 0 CT-1 L36 IN MONOFILAMENT UNDYED SUP-Y946H CDM 0270 RC outpatient 5.52 5.52 5.52 74 4.08 percent of total billed charges 5.52 93 4.47 percent of total billed charges 5.52 5.52 other OPPS APC 5.52 5.52 other OPPS APC 5.52 27.63 1.53 percent of total billed charges 5.52 5.52 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE MONOCRYL 1 CT-1 36IN MONOFILAMENT UNDYED ABSORBABLE SUP-Y947H CDM 0270 RC outpatient 6.88 6.88 6.88 74 5.09 percent of total billed charges 6.88 93 5.57 percent of total billed charges 6.88 6.88 other OPPS APC 6.88 6.88 other OPPS APC 6.88 27.63 1.9 percent of total billed charges 6.88 6.88 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DEVICE CLOSURE QUILL MONODERM 0 1/2 CIRCLE TAPER L36 CM L36 MM 2 ARM MONOFILAMENT ABSORBABLE SUTURE SUP-YA-1029Q CDM 0270 RC outpatient 54.72 54.72 54.72 74 40.49 percent of total billed charges 54.72 93 44.32 percent of total billed charges 54.72 54.72 other OPPS APC 54.72 54.72 other OPPS APC 54.72 27.63 15.12 percent of total billed charges 54.72 54.72 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PDS II 4-0 RB-1 L 27IN MONOFILAMENT VIOLET SUP-Z304H CDM 0270 RC outpatient 6.03 6.03 6.03 74 4.46 percent of total billed charges 6.03 93 4.88 percent of total billed charges 6.03 6.03 other OPPS APC 6.03 6.03 other OPPS APC 6.03 27.63 1.67 percent of total billed charges 6.03 6.03 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PDS II 3-0 SH L27 IN MONOFILAMENT VIOLET SUP-Z316H CDM 0270 RC outpatient 6.26 6.26 6.26 74 4.63 percent of total billed charges 6.26 93 5.07 percent of total billed charges 6.26 6.26 other OPPS APC 6.26 6.26 other OPPS APC 6.26 27.63 1.73 percent of total billed charges 6.26 6.26 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PDS II 2-0 SH L27 IN MONOFILAMENT VIOLET SUP-Z317H CDM 0270 RC outpatient 6.13 6.13 6.13 74 4.54 percent of total billed charges 6.13 93 4.97 percent of total billed charges 6.13 6.13 other OPPS APC 6.13 6.13 other OPPS APC 6.13 27.63 1.69 percent of total billed charges 6.13 6.13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PDS II 0 CT-1 L27 IN MONOFILAMENT VIOLET SUP-Z340H CDM 0270 RC outpatient 6.06 6.06 6.06 74 4.48 percent of total billed charges 6.06 93 4.91 percent of total billed charges 6.06 6.06 other OPPS APC 6.06 6.06 other OPPS APC 6.06 27.63 1.67 percent of total billed charges 6.06 6.06 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PDS II 1 CT-1 L27 IN MONOFILAMENT VIOLET SUP-Z341H CDM 0270 RC outpatient 6.17 6.17 6.17 74 4.57 percent of total billed charges 6.17 93 5 percent of total billed charges 6.17 6.17 other OPPS APC 6.17 6.17 other OPPS APC 6.17 27.63 1.7 percent of total billed charges 6.17 6.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PDS II 1 CTX L36 IN MONOFILAMENT VIOLET SUP-Z371T CDM 0270 RC outpatient 6.98 6.98 6.98 74 5.17 percent of total billed charges 6.98 93 5.65 percent of total billed charges 6.98 6.98 other OPPS APC 6.98 6.98 other OPPS APC 6.98 27.63 1.93 percent of total billed charges 6.98 6.98 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PDS II 4-0 FS-2 L27 IN MONOFILAMENT UNDYED SUP-Z422H CDM 0270 RC outpatient 9.99 9.99 9.99 74 7.39 percent of total billed charges 9.99 93 8.09 percent of total billed charges 9.99 9.99 other OPPS APC 9.99 9.99 other OPPS APC 9.99 27.63 2.76 percent of total billed charges 9.99 9.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PDS II 3-0 FS-2 L27 IN MONOFILAMENT UNDYED SUP-Z423H CDM 0270 RC outpatient 9.43 9.43 9.43 74 6.98 percent of total billed charges 9.43 93 7.64 percent of total billed charges 9.43 9.43 other OPPS APC 9.43 9.43 other OPPS APC 9.43 27.63 2.61 percent of total billed charges 9.43 9.43 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PDS II MULTIPASS 5-0 P-3 L18 IN MONOFILAMENT UNDYED SUP-Z493G CDM 0270 RC outpatient 13.96 13.96 13.96 74 10.33 percent of total billed charges 13.96 93 11.31 percent of total billed charges 13.96 13.96 other OPPS APC 13.96 13.96 other OPPS APC 13.96 27.63 3.86 percent of total billed charges 13.96 13.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PDS II MULTIPASS 4-0 P-3 L18 IN MONOFILAMENT UNDYED SUP-Z494G CDM 0270 RC outpatient 13 13 13 74 9.62 percent of total billed charges 13 93 10.53 percent of total billed charges 13 13 other OPPS APC 13 13 other OPPS APC 13 27.63 3.59 percent of total billed charges 13 13 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PDS II MULTIPASS 4-0 PS-2 18IN UNDYED MONOFILAMENT SUP-Z496G CDM 0270 RC outpatient 13.96 13.96 13.96 74 10.33 percent of total billed charges 13.96 93 11.31 percent of total billed charges 13.96 13.96 other OPPS APC 13.96 13.96 other OPPS APC 13.96 27.63 3.86 percent of total billed charges 13.96 13.96 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PDS II MULTIPASS 4-0 PS-2 L18 IN MONOFILAMENT VIOLET SUP-Z513G CDM 0270 RC outpatient 15.91 15.91 15.91 74 11.77 percent of total billed charges 15.91 93 12.89 percent of total billed charges 15.91 15.91 other OPPS APC 15.91 15.91 other OPPS APC 15.91 27.63 4.4 percent of total billed charges 15.91 15.91 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PDS II MULTIPASS 6-0 PC-1 L18 IN MONOFILAMENT UNDYED SUP-Z833G CDM 0270 RC outpatient 14.5 14.5 14.5 74 10.73 percent of total billed charges 14.5 93 11.75 percent of total billed charges 14.5 14.5 other OPPS APC 14.5 14.5 other OPPS APC 14.5 27.63 4.01 percent of total billed charges 14.5 14.5 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PDS II 1 TP-1 L96 IN MONOFILAMENT LOOP VIOLET SUP-Z880G CDM 0270 RC outpatient 11.99 11.99 11.99 74 8.87 percent of total billed charges 11.99 93 9.71 percent of total billed charges 11.99 11.99 other OPPS APC 11.99 11.99 other OPPS APC 11.99 27.63 3.31 percent of total billed charges 11.99 11.99 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PDS II 0 CTX L60 IN MONOFILAMENT LOOP VIOLET SUP-Z990G CDM 0270 RC outpatient 13.47 13.47 13.47 74 9.97 percent of total billed charges 13.47 93 10.91 percent of total billed charges 13.47 13.47 other OPPS APC 13.47 13.47 other OPPS APC 13.47 27.63 3.72 percent of total billed charges 13.47 13.47 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SUTURE ABSORBABLE PDS II 0 TP-1 L60 IN MONOFILAMENT LOOP VIOLET SUP-Z991G CDM 0270 RC outpatient 12.95 12.95 12.95 74 9.58 percent of total billed charges 12.95 93 10.49 percent of total billed charges 12.95 12.95 other OPPS APC 12.95 12.95 other OPPS APC 12.95 27.63 3.58 percent of total billed charges 12.95 12.95 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS INTRAOCULAR POSTERIOR CHAMBER FOLDABLE BICONVEX MODIFIED PROLATE TECNIS SOFT ACRYLIC SUP-ZA9003 CDM 0270 RC outpatient 403 403 403 74 298.22 percent of total billed charges 403 93 326.43 percent of total billed charges 403 403 other OPPS APC 403 403 other OPPS APC 403 27.63 111.35 percent of total billed charges 403 403 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. LENS TECHNIS IOL SUP-ZCB00 CDM 0270 RC outpatient 387.4 387.4 387.4 74 286.68 percent of total billed charges 387.4 93 313.79 percent of total billed charges 387.4 387.4 other OPPS APC 387.4 387.4 other OPPS APC 387.4 27.63 107.04 percent of total billed charges 387.4 387.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY ZIMMON L4 CM OD7 FR 2 PIGTAIL SUP-ZEBD-7-4 CDM 0270 RC outpatient 364 364 364 74 269.36 percent of total billed charges 364 93 294.84 percent of total billed charges 364 364 other OPPS APC 364 364 other OPPS APC 364 27.63 100.57 percent of total billed charges 364 364 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT BILIARY ZIMMON L5 CM OD7 FR 2 PIGTAIL SUP-ZEBD-7-5 CDM 0270 RC outpatient 387.4 387.4 387.4 74 286.68 percent of total billed charges 387.4 93 313.79 percent of total billed charges 387.4 387.4 other OPPS APC 387.4 387.4 other OPPS APC 387.4 27.63 107.04 percent of total billed charges 387.4 387.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. ZERO PROFILE PLATE SYSTEM SUP-ZERO PROFILE PLATE CDM 0270 RC outpatient 11532 11532 11532 74 8533.71 percent of total billed charges 11532 93 9340.95 percent of total billed charges 11532 11532 other OPPS APC 11532 11532 other OPPS APC 11532 27.63 3186.3 percent of total billed charges 11532 11532 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH L76 MM L62 MM OD16 FR ABDOMINAL AORTIC ANEURYSM VISCERAL FENESTRATION DISTAL BIFURCATED BODY SUP-ZFEN-D-16-62-76-C CDM 270010015 LOCAL 0270 RC outpatient 10189.4 10189.4 10189.4 74 7540.16 percent of total billed charges 10189.4 93 8253.41 percent of total billed charges 10189.4 10189.4 other OPPS APC 10189.4 10189.4 other OPPS APC 10189.4 27.63 2815.33 percent of total billed charges 10189.4 10189.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR H&L-B ONE-SHOT ZENITH POLYESTER WOVEN L109 MM OD28 MM 2 PROXIMAL INTERNAL STENT FENESTRATE STERILE ACCEPTS 20 FR INTRODUCER SHEATH AAA SUP-ZFEN-P-2-28-109R CDM 270010015 LOCAL 0270 RC outpatient 28470 28470 28470 74 21067.8 percent of total billed charges 28470 93 23060.7 percent of total billed charges 28470 28470 other OPPS APC 28470 28470 other OPPS APC 28470 27.63 7866.26 percent of total billed charges 28470 28470 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. BAG PLASTIC DAWNMIST THK2 MIL L15 IN X W12 IN 37.4 LB ZIPLOCK RECLOSABLE LATEX FREE CLEAR SUP-ZIP1215 CDM outpatient 0.17 0.17 0.17 0.17 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ZILVER PTX L60 MM L125 CM OD6 MM ODSEC6 FR PERIPHERAL DRUG ELUTING OTW DELIVERY SYSTEM ACCEPTS .035 IN GUIDEWIRE SUP-ZIV6-35-125-6-60-PTX CDM 0270 RC outpatient 3887 3887 3887 74 2876.38 percent of total billed charges 3887 93 3148.47 percent of total billed charges 3887 3887 other OPPS APC 3887 3887 other OPPS APC 3887 27.63 1073.98 percent of total billed charges 3887 3887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ZILVER 635 FLEXOR 80MM 125CM 7MM 6FR NITINOL STERILE ILIAC ARTERY SELF EXPAND SLOT TUBE DELIVERY SYSTEM SUP-ZIV6-35-125-7-80 CDM 0270 RC outpatient 3900 3900 3900 74 2886 percent of total billed charges 3900 93 3159 percent of total billed charges 3900 3900 other OPPS APC 3900 3900 other OPPS APC 3900 27.63 1077.57 percent of total billed charges 3900 3900 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ZILVER PTX L60 MM L125 CM OD8 MM ODSEC6 FR PERIPHERAL DRUG ELUTING OTW DELIVERY SYSTEM ACCEPTS .035 IN GUIDEWIRE SUP-ZIV6-35-125-8-60-PTX CDM 0270 RC outpatient 3887 3887 3887 74 2876.38 percent of total billed charges 3887 93 3148.47 percent of total billed charges 3887 3887 other OPPS APC 3887 3887 other OPPS APC 3887 27.63 1073.98 percent of total billed charges 3887 3887 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STENT VASCULAR ZILVER 635 FLEXOR 40MM 80CM 7MM 6FR NITINOL STERILE ILIAC ARTERY SELF EXPAND SLOT TUBE DELIVERY SYSTEM SUP-ZIV6-35-80-7-40 CDM 0270 RC outpatient 2860 2860 2860 74 2116.4 percent of total billed charges 2860 93 2316.6 percent of total billed charges 2860 2860 other OPPS APC 2860 2860 other OPPS APC 2860 27.63 790.22 percent of total billed charges 2860 2860 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. DRILL SURGICAL WAVE CANNULATED TOP TRAY SUP-ZPCDR27 CDM 0270 RC outpatient 369.2 369.2 369.2 74 273.21 percent of total billed charges 369.2 93 299.05 percent of total billed charges 369.2 369.2 other OPPS APC 369.2 369.2 other OPPS APC 369.2 27.63 102.01 percent of total billed charges 369.2 369.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. PIN GUIDE 1.6MM TORNIER SUP-ZPCP16 CDM 0270 RC outpatient 41.6 41.6 41.6 74 30.78 percent of total billed charges 41.6 93 33.7 percent of total billed charges 41.6 41.6 other OPPS APC 41.6 41.6 other OPPS APC 41.6 27.63 11.49 percent of total billed charges 41.6 41.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE 26MM 4MM NS LOWER EXTREMITY LAG CANNULATED BOTTOM TRAY SUP-ZPCS26 CDM 0270 RC outpatient 824.2 824.2 824.2 74 609.91 percent of total billed charges 824.2 93 667.6 percent of total billed charges 824.2 824.2 other OPPS APC 824.2 824.2 other OPPS APC 824.2 27.63 227.73 percent of total billed charges 824.2 824.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW TORNIER 4.0MM CANNULATED LAG 28MM SUP-ZPCS28 CDM 0270 RC outpatient 585 585 585 74 432.9 percent of total billed charges 585 93 473.85 percent of total billed charges 585 585 other OPPS APC 585 585 other OPPS APC 585 27.63 161.64 percent of total billed charges 585 585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE 30MM 4MM NS LOWER EXTREMITY LAG CANNULATED BOTTOM TRAY SUP-ZPCS30 CDM 0270 RC outpatient 824.2 824.2 824.2 74 609.91 percent of total billed charges 824.2 93 667.6 percent of total billed charges 824.2 824.2 other OPPS APC 824.2 824.2 other OPPS APC 824.2 27.63 227.73 percent of total billed charges 824.2 824.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE 32MM 4MM NS LOWER EXTREMITY LAG CANNULATED BOTTOM TRAY SUP-ZPCS32 CDM 0270 RC outpatient 824.2 824.2 824.2 74 609.91 percent of total billed charges 824.2 93 667.6 percent of total billed charges 824.2 824.2 other OPPS APC 824.2 824.2 other OPPS APC 824.2 27.63 227.73 percent of total billed charges 824.2 824.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE 34MM 4MM NS LOWER EXTREMITY LAG CANNULATED BOTTOM TRAY SUP-ZPCS34 CDM 0270 RC outpatient 824.2 824.2 824.2 74 609.91 percent of total billed charges 824.2 93 667.6 percent of total billed charges 824.2 824.2 other OPPS APC 824.2 824.2 other OPPS APC 824.2 27.63 227.73 percent of total billed charges 824.2 824.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE 36MM 4MM NS LOWER EXTREMITY LAG CANNULATED BOTTOM TRAY SUP-ZPCS36 CDM 0270 RC outpatient 587.6 587.6 587.6 74 434.82 percent of total billed charges 587.6 93 475.96 percent of total billed charges 587.6 587.6 other OPPS APC 587.6 587.6 other OPPS APC 587.6 27.63 162.35 percent of total billed charges 587.6 587.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW TORNIER 4.0MM CANNULATED LAG 38MM SUP-ZPCS38 CDM 0270 RC outpatient 824.2 824.2 824.2 74 609.91 percent of total billed charges 824.2 93 667.6 percent of total billed charges 824.2 824.2 other OPPS APC 824.2 824.2 other OPPS APC 824.2 27.63 227.73 percent of total billed charges 824.2 824.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE 40MM 4MM NS LOWER EXTREMITY LAG CANNULATED BOTTOM TRAY SUP-ZPCS40 CDM 0270 RC outpatient 587.6 587.6 587.6 74 434.82 percent of total billed charges 587.6 93 475.96 percent of total billed charges 587.6 587.6 other OPPS APC 587.6 587.6 other OPPS APC 587.6 27.63 162.35 percent of total billed charges 587.6 587.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW TORNIER 4.0MM CANNULATED LAG 42MM SUP-ZPCS42 CDM 0270 RC outpatient 585 585 585 74 432.9 percent of total billed charges 585 93 473.85 percent of total billed charges 585 585 other OPPS APC 585 585 other OPPS APC 585 27.63 161.64 percent of total billed charges 585 585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE 44MM 4MM NS LOWER EXTREMITY LAG CANNULATED BOTTOM TRAY SUP-ZPCS44 CDM 0270 RC outpatient 587.6 587.6 587.6 74 434.82 percent of total billed charges 587.6 93 475.96 percent of total billed charges 587.6 587.6 other OPPS APC 587.6 587.6 other OPPS APC 587.6 27.63 162.35 percent of total billed charges 587.6 587.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW TORNIER 4.0MM CANNULATED LAG 46MM SUP-ZPCS46 CDM 0270 RC outpatient 585 585 585 74 432.9 percent of total billed charges 585 93 473.85 percent of total billed charges 585 585 other OPPS APC 585 585 other OPPS APC 585 27.63 161.64 percent of total billed charges 585 585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE 48MM 4MM NS LOWER EXTREMITY LAG CANNULATED BOTTOM TRAY SUP-ZPCS48 CDM 0270 RC outpatient 587.6 587.6 587.6 74 434.82 percent of total billed charges 587.6 93 475.96 percent of total billed charges 587.6 587.6 other OPPS APC 587.6 587.6 other OPPS APC 587.6 27.63 162.35 percent of total billed charges 587.6 587.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW TORNIER 4.0MM CANNULATED LAG 50MM SUP-ZPCS50 CDM 0270 RC outpatient 585 585 585 74 432.9 percent of total billed charges 585 93 473.85 percent of total billed charges 585 585 other OPPS APC 585 585 other OPPS APC 585 27.63 161.64 percent of total billed charges 585 585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE 55MM 4MM NS LOWER EXTREMITY LAG CANNULATED BOTTOM TRAY SUP-ZPCS55 CDM 0270 RC outpatient 824.2 824.2 824.2 74 609.91 percent of total billed charges 824.2 93 667.6 percent of total billed charges 824.2 824.2 other OPPS APC 824.2 824.2 other OPPS APC 824.2 27.63 227.73 percent of total billed charges 824.2 824.2 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW TORNIER 4.0MM CANNULATED LAG 60MM SUP-ZPCS60 CDM 0270 RC outpatient 585 585 585 74 432.9 percent of total billed charges 585 93 473.85 percent of total billed charges 585 585 other OPPS APC 585 585 other OPPS APC 585 27.63 161.64 percent of total billed charges 585 585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW TORNIER 4.0MM CANNULATED LAG 65MM SUP-ZPCS65 CDM 0270 RC outpatient 585 585 585 74 432.9 percent of total billed charges 585 93 473.85 percent of total billed charges 585 585 other OPPS APC 585 585 other OPPS APC 585 27.63 161.64 percent of total billed charges 585 585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW TORNIER 4.0MM CANNULATED LAG 70MM SUP-ZPCS70 CDM 0270 RC outpatient 585 585 585 74 432.9 percent of total billed charges 585 93 473.85 percent of total billed charges 585 585 other OPPS APC 585 585 other OPPS APC 585 27.63 161.64 percent of total billed charges 585 585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW TORNIER 4.0MM CANNULATED LAG 75MM SUP-ZPCS75 CDM 0270 RC outpatient 585 585 585 74 432.9 percent of total billed charges 585 93 473.85 percent of total billed charges 585 585 other OPPS APC 585 585 other OPPS APC 585 27.63 161.64 percent of total billed charges 585 585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE 80MM 4MM NS LOWER EXTREMITY LAG CANNULATED BOTTOM TRAY SUP-ZPCS80 CDM 0270 RC outpatient 884 884 884 74 654.16 percent of total billed charges 884 93 716.04 percent of total billed charges 884 884 other OPPS APC 884 884 other OPPS APC 884 27.63 244.25 percent of total billed charges 884 884 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW TORNIER 4.0MM CANNULATED LAG 85MM SUP-ZPCS85 CDM 0270 RC outpatient 585 585 585 74 432.9 percent of total billed charges 585 93 473.85 percent of total billed charges 585 585 other OPPS APC 585 585 other OPPS APC 585 27.63 161.64 percent of total billed charges 585 585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. IMPLANT SCREW TORNIER 4.0MM CANNULATED LAG 90MM SUP-ZPCS90 CDM 0270 RC outpatient 585 585 585 74 432.9 percent of total billed charges 585 93 473.85 percent of total billed charges 585 585 other OPPS APC 585 585 other OPPS APC 585 27.63 161.64 percent of total billed charges 585 585 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE FULL THREAD 26MM 4MM NS LOWER EXTREMITY NONLOCK SUP-ZPFTS26 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE FULL THREAD 28MM 4MM NS LOWER EXTREMITY NONLOCK SUP-ZPFTS28 CDM 0270 RC outpatient 301.6 301.6 301.6 74 223.18 percent of total billed charges 301.6 93 244.3 percent of total billed charges 301.6 301.6 other OPPS APC 301.6 301.6 other OPPS APC 301.6 27.63 83.33 percent of total billed charges 301.6 301.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE FULL THREAD 30MM 4MM NS LOWER EXTREMITY NONLOCK SUP-ZPFTS30 CDM 0270 RC outpatient 301.6 301.6 301.6 74 223.18 percent of total billed charges 301.6 93 244.3 percent of total billed charges 301.6 301.6 other OPPS APC 301.6 301.6 other OPPS APC 301.6 27.63 83.33 percent of total billed charges 301.6 301.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE FULL THREAD 32MM 4MM NS LOWER EXTREMITY NONLOCK SUP-ZPFTS32 CDM 0270 RC outpatient 301.6 301.6 301.6 74 223.18 percent of total billed charges 301.6 93 244.3 percent of total billed charges 301.6 301.6 other OPPS APC 301.6 301.6 other OPPS APC 301.6 27.63 83.33 percent of total billed charges 301.6 301.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE FULL THREAD 34MM 4MM NS LOWER EXTREMITY NONLOCK SUP-ZPFTS34 CDM 0270 RC outpatient 301.6 301.6 301.6 74 223.18 percent of total billed charges 301.6 93 244.3 percent of total billed charges 301.6 301.6 other OPPS APC 301.6 301.6 other OPPS APC 301.6 27.63 83.33 percent of total billed charges 301.6 301.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE FULL THREAD 36MM 4MM NS LOWER EXTREMITY NONLOCK SUP-ZPFTS36 CDM 0270 RC outpatient 301.6 301.6 301.6 74 223.18 percent of total billed charges 301.6 93 244.3 percent of total billed charges 301.6 301.6 other OPPS APC 301.6 301.6 other OPPS APC 301.6 27.63 83.33 percent of total billed charges 301.6 301.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE FULL THREAD 38MM 4MM NS LOWER EXTREMITY NONLOCK SUP-ZPFTS38 CDM 0270 RC outpatient 301.6 301.6 301.6 74 223.18 percent of total billed charges 301.6 93 244.3 percent of total billed charges 301.6 301.6 other OPPS APC 301.6 301.6 other OPPS APC 301.6 27.63 83.33 percent of total billed charges 301.6 301.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE FULL THREAD 40MM 4MM NS LOWER EXTREMITY NONLOCK SUP-ZPFTS40 CDM 0270 RC outpatient 301.6 301.6 301.6 74 223.18 percent of total billed charges 301.6 93 244.3 percent of total billed charges 301.6 301.6 other OPPS APC 301.6 301.6 other OPPS APC 301.6 27.63 83.33 percent of total billed charges 301.6 301.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE FULL THREAD L42 MM OD4 MM CALCANEAL NONLOCKING SUP-ZPFTS42 CDM 0270 RC outpatient 270.4 270.4 270.4 74 200.1 percent of total billed charges 270.4 93 219.02 percent of total billed charges 270.4 270.4 other OPPS APC 270.4 270.4 other OPPS APC 270.4 27.63 74.71 percent of total billed charges 270.4 270.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE FULL THREAD 44MM 4MM NS LOWER EXTREMITY NONLOCK SUP-ZPFTS44 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TORNIER FULLY THREADED 46MM SUP-ZPFTS46 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE FULL THREAD 48MM 4MM NS LOWER EXTREMITY NONLOCK SUP-ZPFTS48 CDM 0270 RC outpatient 270.4 270.4 270.4 74 200.1 percent of total billed charges 270.4 93 219.02 percent of total billed charges 270.4 270.4 other OPPS APC 270.4 270.4 other OPPS APC 270.4 27.63 74.71 percent of total billed charges 270.4 270.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE FULL THREAD L50 MM OD4 MM CALCANEAL NONLOCKING SUP-ZPFTS50 CDM 0270 RC outpatient 192.4 192.4 192.4 74 142.38 percent of total billed charges 192.4 93 155.84 percent of total billed charges 192.4 192.4 other OPPS APC 192.4 192.4 other OPPS APC 192.4 27.63 53.16 percent of total billed charges 192.4 192.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE FULL THREAD 55MM 4MM NS LOWER EXTREMITY NONLOCK SUP-ZPFTS55 CDM 0270 RC outpatient 192.4 192.4 192.4 74 142.38 percent of total billed charges 192.4 93 155.84 percent of total billed charges 192.4 192.4 other OPPS APC 192.4 192.4 other OPPS APC 192.4 27.63 53.16 percent of total billed charges 192.4 192.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE FULL THREAD 60MM 4MM NS LOWER EXTREMITY NONLOCK SUP-ZPFTS60 CDM 0270 RC outpatient 192.4 192.4 192.4 74 142.38 percent of total billed charges 192.4 93 155.84 percent of total billed charges 192.4 192.4 other OPPS APC 192.4 192.4 other OPPS APC 192.4 27.63 53.16 percent of total billed charges 192.4 192.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE FULL THREAD 65MM 4MM NS LOWER EXTREMITY NONLOCK SUP-ZPFTS65 CDM 0270 RC outpatient 192.4 192.4 192.4 74 142.38 percent of total billed charges 192.4 93 155.84 percent of total billed charges 192.4 192.4 other OPPS APC 192.4 192.4 other OPPS APC 192.4 27.63 53.16 percent of total billed charges 192.4 192.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE FULL THREAD L70 MM OD4 MM CALCANEAL NONLOCKING SUP-ZPFTS70 CDM 0270 RC outpatient 192.4 192.4 192.4 74 142.38 percent of total billed charges 192.4 93 155.84 percent of total billed charges 192.4 192.4 other OPPS APC 192.4 192.4 other OPPS APC 192.4 27.63 53.16 percent of total billed charges 192.4 192.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TORNIER FULLY THREADED 75MM SUP-ZPFTS75 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE FULL THREAD 80MM 4MM NS LOWER EXTREMITY NONLOCK SUP-ZPFTS80 CDM 0270 RC outpatient 270.4 270.4 270.4 74 200.1 percent of total billed charges 270.4 93 219.02 percent of total billed charges 270.4 270.4 other OPPS APC 270.4 270.4 other OPPS APC 270.4 27.63 74.71 percent of total billed charges 270.4 270.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TORNIER FULLY THREADED 85MM SUP-ZPFTS85 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW TORNIER FULLY THREADED 90MM SUP-ZPFTS90 CDM 0270 RC outpatient 286 286 286 74 211.64 percent of total billed charges 286 93 231.66 percent of total billed charges 286 286 other OPPS APC 286 286 other OPPS APC 286 27.63 79.02 percent of total billed charges 286 286 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GUIDE PIN ORTHOPEDIC WAVE L130 MM OD1.6 MM TOP TRAY SUP-ZPGP16 CDM 0270 RC outpatient 93.6 93.6 93.6 74 69.26 percent of total billed charges 93.6 93 75.82 percent of total billed charges 93.6 93.6 other OPPS APC 93.6 93.6 other OPPS APC 93.6 27.63 25.86 percent of total billed charges 93.6 93.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE L32 MM OD4 MM CALCANEAL LOCKING NONCANNULATED SUP-ZPLS32 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE L34 MM OD4 MM CALCANEUS LOCK SUP-ZPLS34 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE L36 MM OD4 MM CALCANEUS LOCK SUP-ZPLS36 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE WAVE L38 MM OD4 MM CALCANEUS LOCK SUP-ZPLS38 CDM 0270 RC outpatient 195 195 195 74 144.3 percent of total billed charges 195 93 157.95 percent of total billed charges 195 195 other OPPS APC 195 195 other OPPS APC 195 27.63 53.88 percent of total billed charges 195 195 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. SCREW BONE 5MM CALCANEUS SUP-ZPSS5 CDM 0270 RC outpatient 231.4 231.4 231.4 74 171.24 percent of total billed charges 231.4 93 187.43 percent of total billed charges 231.4 231.4 other OPPS APC 231.4 231.4 other OPPS APC 231.4 27.63 63.94 percent of total billed charges 231.4 231.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. RELOAD STAPLER ENDOPATH L300 MM X H3.5 MM H1.5 MM REGULAR TISSUE 4 ROW LINEAR CUTTER LOCK OUT STERILE LATEX FREE DISPOSABLE BLUE LAPAROSCOPIC SUP-ZR45B CDM 270009088 LOCAL 0270 RC outpatient 132.68 132.68 132.68 74 98.18 percent of total billed charges 132.68 93 107.47 percent of total billed charges 132.68 132.68 other OPPS APC 132.68 132.68 other OPPS APC 132.68 27.63 36.66 percent of total billed charges 132.68 132.68 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. STAPLE CARTRIDGE RELOAD ENDOPATH LINEAR CUTTER THICK TISSUE GREEN 44 PER PACKAGE 45MM SUP-ZR45G CDM 0270 RC outpatient 344.7 344.7 344.7 74 255.08 percent of total billed charges 344.7 93 279.21 percent of total billed charges 344.7 344.7 other OPPS APC 344.7 344.7 other OPPS APC 344.7 27.63 95.24 percent of total billed charges 344.7 344.7 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR SPIRAL-Z ZENITH POLYESTER STAINLESS STEEL NITINOL 2 BRANCH L107 MM OD13 MM ODSEC5.4 MM ID14 FR ABDOMINAL AORTIC ANEURYSM ANCILLARY CONTRALATERAL IPSILATERAL ILIAC LEG SUP-ZSLE-13-107-ZT CDM 270010015 LOCAL 0270 RC outpatient 8738.6 8738.6 8738.6 74 6466.56 percent of total billed charges 8738.6 93 7078.27 percent of total billed charges 8738.6 8738.6 other OPPS APC 8738.6 8738.6 other OPPS APC 8738.6 27.63 2414.48 percent of total billed charges 8738.6 8738.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH SPIRAL-Z Z-TRAK POLYESTER STAINLESS STEEL NITINOL BIFURCATED L39 MM OD24 MM ID16 FR ABDOMEN AORTA AORTOILIAC SELF EXPANDING WOVEN LEG EXTENSION INTRODUCTION SYSTEM AAA SUP-ZSLE-24-39-ZT CDM 270010015 LOCAL 0270 RC outpatient 8738.6 8738.6 8738.6 74 6466.56 percent of total billed charges 8738.6 93 7078.27 percent of total billed charges 8738.6 8738.6 other OPPS APC 8738.6 8738.6 other OPPS APC 8738.6 27.63 2414.48 percent of total billed charges 8738.6 8738.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH SPIRAL-Z Z-TRAK POLYESTER STAINLESS STEEL NITINOL BIFURCATED L90 MM OD9 MM ODSEC5.4 MM ID14 FR ABDOMEN AORTA AORTOILIAC Z-TRAK INTRODUCTION SYSTEM CONTRALATERAL/IPSILATERAL ILIAC LEG AAA SUP-ZSLE-9-90-ZT CDM 270010015 LOCAL 0270 RC outpatient 8738.6 8738.6 8738.6 74 6466.56 percent of total billed charges 8738.6 93 7078.27 percent of total billed charges 8738.6 8738.6 other OPPS APC 8738.6 8738.6 other OPPS APC 8738.6 27.63 2414.48 percent of total billed charges 8738.6 8738.6 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH ALPHA FLEXOR CAPTOR NITINOL POLYPROPYLENE POLYESTER FABRIC HYDROPHILIC OD6 MM CYLINDRICAL L109 MM OD28 MM ODSEC24-25 MM ID16 FR THORACIC 2 PIECE PROXIMAL COMPONENT SELF EXPAND INTRODUCER SHEATH STERILE ACCEPTS .035 IN GUIDE* SUP-ZTA-P-28-109-W CDM 270010015 LOCAL 0270 RC outpatient 41509 41509 41509 74 30716.7 percent of total billed charges 41509 93 33622.3 percent of total billed charges 41509 41509 other OPPS APC 41509 41509 other OPPS APC 41509 27.63 11468.9 percent of total billed charges 41509 41509 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH TX2 Z-TRAK POLYESTER STAINLESS STEEL BIFURCATED L120 MM OD28 MM ID20 FR THORACIC AORTIC ANEURYSM PROXIMAL PRO-FORM Z-TRAK PLUS INTRODUCTION SYSTEM AAA SUP-ZTEG-2P-28-120-PF-US CDM 270010015 LOCAL 0270 RC outpatient 31444.4 31444.4 31444.4 74 23268.9 percent of total billed charges 31444.4 93 25470 percent of total billed charges 31444.4 31444.4 other OPPS APC 31444.4 31444.4 other OPPS APC 31444.4 27.63 8688.09 percent of total billed charges 31444.4 31444.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH TX2 PRO-FORM Z-TRAK PLUS POLYESTER STAINLESS STEEL BIFURCATED L120 MM OD32 MM ID20 FR THORACIC AORTIC ANEURYSM PROXIMAL PRO-FORM Z-TRAK PLUS INTRODUCTION SYSTEM AAA SUP-ZTEG-2P-32-120-PF-US CDM 270010015 LOCAL 0270 RC outpatient 31444.4 31444.4 31444.4 74 23268.9 percent of total billed charges 31444.4 93 25470 percent of total billed charges 31444.4 31444.4 other OPPS APC 31444.4 31444.4 other OPPS APC 31444.4 27.63 8688.09 percent of total billed charges 31444.4 31444.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR PRO-FORM Z-TRAK PLUS ZENITH TX2 STAINLESS STEEL POLYESTER WOVEN 2 BRANCH CYLINDER L127 MM OD36 MM ODSEC22 FR THORACIC AORTIC ANEURYSM 2 PIECE PROXIMAL COMPONENT SELF EXPANDABLE BARB STENT RADIOPAQUE STERILE SUP-ZTEG-2P-36-127-PF-US CDM 270010015 LOCAL 0270 RC outpatient 31444.4 31444.4 31444.4 74 23268.9 percent of total billed charges 31444.4 93 25470 percent of total billed charges 31444.4 31444.4 other OPPS APC 31444.4 31444.4 other OPPS APC 31444.4 27.63 8688.09 percent of total billed charges 31444.4 31444.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH TX2 PRO-FORM Z-TRAK PLUS POLYESTER STAINLESS STEEL BIFURCATED L152 MM OD36 MM ODSEC22 FR THORAX AORTA SELF EXPANDING WOVEN PROXIMAL INTRODUCTION SYSTEM AAA SUP-ZTEG-2P-36-152-PF-US CDM 270010015 LOCAL 0270 RC outpatient 31444.4 31444.4 31444.4 74 23268.9 percent of total billed charges 31444.4 93 25470 percent of total billed charges 31444.4 31444.4 other OPPS APC 31444.4 31444.4 other OPPS APC 31444.4 27.63 8688.09 percent of total billed charges 31444.4 31444.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH TX2 PRO-FORM Z-TRAK PLUS L108 MM OD40 MM ODSEC22 FR ID22 FR INTRODUCER SHEATH THORACIC AORTIC ANEURYSM SUP-ZTEG-2P-40-108-PF-US CDM 270010015 LOCAL 0270 RC outpatient 31444.4 31444.4 31444.4 74 23268.9 percent of total billed charges 31444.4 93 25470 percent of total billed charges 31444.4 31444.4 other OPPS APC 31444.4 31444.4 other OPPS APC 31444.4 27.63 8688.09 percent of total billed charges 31444.4 31444.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH TX2 PRO-FORM STAINLESS STEEL POLYESTER L135 MM OD42 MM ODSEC8.5 MM ID22 FR 2 BRANCH PROXIMAL COMPONENT Z-TRAK PLUS TAA SUP-ZTEG-2P-42-135-PF-US CDM 270010015 LOCAL 0270 RC outpatient 31444.4 31444.4 31444.4 74 23268.9 percent of total billed charges 31444.4 93 25470 percent of total billed charges 31444.4 31444.4 other OPPS APC 31444.4 31444.4 other OPPS APC 31444.4 27.63 8688.09 percent of total billed charges 31444.4 31444.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule. GRAFT ENDOVASCULAR ZENITH TX2 L158 MM OD42 MM ODSEC22 FR THORACIC PROXIMAL TAPERED COMPONENT PROFORM INTRODUCTION SYSTEM AA SUP-ZTEG-2PT-4-158-PF-US CDM 270010015 LOCAL 0270 RC outpatient 31444.4 31444.4 31444.4 74 23268.9 percent of total billed charges 31444.4 93 25470 percent of total billed charges 31444.4 31444.4 other OPPS APC 31444.4 31444.4 other OPPS APC 31444.4 27.63 8688.09 percent of total billed charges 31444.4 31444.4 Discounted cash amount determined by Nanticoke financial assistance policy and all self pay patients charges are discounted by Medicare fee schedule.